Correlation of measured amnionic fluid volume to sonographic and magnetic resonance predictions

Effects of COVID-19 home quarantine on pregnancy outcomes of patients with gestational diabetes mellitus: a retrospective cohort study

OBJECTIVE

This study aimed to evaluate the effects of the home quarantine on pregnancy outcomes of gestational diabetes mellitus (GDM) patients during the COVID-19 outbreak.

METHODS

The complete electronic medical records of patients with GDM with home quarantine history were collected and classified into the home quarantine group from 24 February 2020 to 24 November 2020. The same period of patients with GDM without home quarantine history were included in the control group from 2018 to 2019. The pregnant outcomes of the home quarantine and control groups were systematically compared, such as neonatal weight, head circumference, body length, one-minute Apgar score, fetal macrosomia, and pre-term delivery.

RESULTS

A total of 1358 patients with GDM were included in the analysis, including 484 in 2018, 468 in 2019, and 406 in 2020. Patients with GDM with home quarantine in 2020 had higher glycemic levels and adverse pregnancy outcomes than in 2018 and 2019, including higher cesarean section rates, lower Apgar scores, and higher incidence of macrosomia and umbilical cord around the neck. More importantly, the second trimester of home quarantine had brought a broader impact on pregnant women and fetuses.

CONCLUSION

Home quarantine has aggravated the condition of GDM pregnant women and brought more adverse pregnancy outcomes during the COVID-19 outbreak. Therefore, we suggested governments and hospitals strengthen lifestyle guidance, glucose management, and antenatal care for patients with GDM with home quarantine during public health emergencies.

Novel Computerized Analytic Technique for Quantification of Amniotic Fluid Volume in Fetal MRI

OBJECTIVE. Fetal MRI is increasingly used in the evaluation of suspected congenital anomalies. Assessment of amniotic fluid volume (AFV) is crucial, but no automated quantitative technique is currently available for MRI. The purpose of this study was to develop and evaluate an analytic technique for quantifying AFV in fetal MRI. MATERIALS AND METHODS. Two MRI phantoms containing known quantities of synthetic amniotic fluid were created. A 3D steady-state free precession sequence was used for 1.5-T MRI of the phantoms and as part of a standard clinical fetal MRI protocol. Software was developed and used to retrospectively calculate AFV for the phantom and 20 clinical MRI examinations. Times to completion were recorded. AFV was also calculated by a manual hand-tracing method. To evaluate performance, paired t tests were used to compare computer-generated measurements with known phantom volumes. Intraclass correlation coefficients were calculated to assess agreement between computer-generated and manual measurements. RESULTS. There was no significant difference between computer-generated measurements of known AFV in the MRI phantoms (p > 0.11). When the software program was applied to the clinical MRI examinations, the mean time to complete AFV measurement was 110 seconds. There was excellent reliability between total AFV calculated by the two software users and by means of manual measurements (intraclass correlation coefficient, 0.995; p < 0.01). CONCLUSION. The computerized analysis evaluated in this study rapidly and accurately quantifies AFV in fetal MRI. The results are concordant with known phantom volumes and manual measurements. The technique is promising for objective MRI evaluation of AFV and has the potential to improve prenatal diagnosis and management.

Fetal Head and Neck Masses: MRI Prediction of Significant Morbidity

OBJECTIVE

The purpose of this study is to determine which MRI parameters of fetal head and neck masses predict high-morbidity neonatal outcomes, including ex utero intrapartum treatment (EXIT) procedure.

MATERIALS AND METHODS

This retrospective study (2004-2016) included parameters of polyhydramnios (based on largest vertical pocket), mass effect on the trachea, mass midline extension, and morphologic grade and size of masses. The morbid cohort included those requiring an EXIT procedure, difficult intubation at delivery, or lethal outcome. Predictive modeling with a multivariable logistic regression and ROC analysis was then performed.

RESULTS

Of 36 fetuses, five were delivered by EXIT procedures, there was one neonatal death within 12 hours after delivery, and another neonate required multiple intubation attempts. The remaining 29 fetuses were delivered at outside institutions with no interventions or neonatal morbidity. The largest vertical pocket and mass effect on the trachea were selected as independent predictors by the logistic regression. The cross-validated ROC AUC was 0.951 (95% CI, 0.8795-1).

CONCLUSION

The largest vertical pocket measurement and mass effect on the trachea were the most contributory MRI parameters that predicted significant morbidity in fetuses with masses of the face and neck, along with other significant parameters. These parameters predict significant morbid neonatal outcomes, including the need for EXIT procedures.

Amniotic fluid as a vital sign for fetal wellbeing

Introduction: Amniotic fluid, once thought to merely provide protection and room for necessary movement and growth for the fetus, is now understood to be a highly complex and dynamic system that is studied as a data point to interpret fetal wellbeing. Methods: Assessment of amniotic fluid volume is now routine when performing a sonographic evaluation of fetal status and is an important consideration in the assessment and management of perinatal morbidity and mortality.1,2 In this review, we will cover the dynamics that affect amniotic fluid volume, review methods for measurement and quantification of volume, review definitions for normative data as related to neonatal outcomes, and provide evidence based guidance on the workup and management options for oligoydramnios and polyhydramnios in singleton and twin pregnancies. Conclusions: When abnormalities of fluid exist, appropriate workup to uncover the underlying etiology should be initiated as adverse fetal outcomes are sometimes associated with these variations from normalcy.

Human birth observed in real-time open magnetic resonance imaging

OBJECTIVE

Knowledge about the mechanism of labor is based on assumptions and radiographic studies performed decades ago. The goal of this study was to describe the relationship between the fetus and the pelvis as the fetus travels through the birth canal, using an open magnetic resonance imaging (MRI) scanner.

STUDY DESIGN

The design of the study used a real-time MRI series during delivery of the fetal head.

RESULTS

Delivery occurred by progressive head extension. However, extension was a very late movement that was observed when the occiput was in close contact with the inferior margin of the symphysis pubis, occurring simultaneously with gliding downward of the fetal head.

CONCLUSION

This observational study shows, for the first time, that birth can be analyzed with real-time MRI. MRI technology allows assessment of maternal and fetal anatomy during labor and delivery.

Management of oligohydramnios in pregnancy

The finding of oligohydramnios in pregnancy is problematic. The various mechanisms that control amniotic fluid, the inability to precisely measure and quantify the amount, and the relevance of a "decreased" amount of fluid make the management of this finding unclear. Given the limited amount of data, the single deepest vertical pocket may be a better method than the amniotic fluid index to define oligohydramnios. A large prospective study is needed to develop the most optimal management recommendations, especially for idiopathic oligohydramnios at or near term.

Investigation of normal organ development with fetal MRI

The understanding of the presentation of normal organ development on fetal MRI forms the basis for recognition of pathological states. During the second and third trimesters, maturational processes include changes in size, shape and signal intensities of organs. Visualization of these developmental processes requires tailored MR protocols. Further prerequisites for recognition of normal maturational states are unequivocal intrauterine orientation with respect to left and right body halves, fetal proportions, and knowledge about the MR presentation of extrafetal/intrauterine organs. Emphasis is laid on the demonstration of normal MR appearance of organs that are frequently involved in malformation syndromes. In addition, examples of time-dependent contrast enhancement of intrauterine structures are given.