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Favaretto M, Rost M. "A Picture Paints a Thousand Words"-A Systematic Review of the Ethical Issues of Prenatal Ultrasound. JOURNAL OF BIOETHICAL INQUIRY 2024:10.1007/s11673-024-10360-0. [PMID: 39158656 DOI: 10.1007/s11673-024-10360-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/18/2024] [Indexed: 08/20/2024]
Abstract
Prenatal ultrasound is a non-invasive diagnostic examination. Despite the recognized diagnostic value, this technology raises complex ethical questions. The aim of this study is to provide a comprehensive analysis that coherently maps the ethical challenges raised by prenatal ultrasound examination, both 2D and 3D. We performed a systematic literature review. Six databases were systematically searched. The results highlight how concerns related to beneficence, informed consent, and autonomy are mainly related to routine use of prenatal ultrasound in the clinical context, while considerations linked to overmedicalization of pregnancy, discrimination, and fetal ontology were often reported in relation to the impact ultrasound is having on medicine and society. Ethical issues in the context of pre-abortion ultrasound, obstetric practices in low-income settings, and keepsake ultrasound imaging were also greatly discussed. Since prenatal ultrasound practices critically impact pregnant people's autonomy and their role within pregnancy, we conclude that information providing strategies should be developed to appropriately inform pregnant people about the nature, purpose, risks, and choices revolving around prenatal ultrasound. In addition, as it is becoming increasingly difficult to separate the social and clinical dimensions of prenatal ultrasound, future research should focus on examining if and how such dimensions should be reconciled.
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Affiliation(s)
- M Favaretto
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - M Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
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Paudel S, Poudel SK, Shah R, Regmi S, Zoowa R. Dandy Walker variant with agenesis of corpus callosum diagnosed late prenatally by foetal ultrasound: a case report. Ann Med Surg (Lond) 2024; 86:2301-2304. [PMID: 38576980 PMCID: PMC10990358 DOI: 10.1097/ms9.0000000000001844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction and importance Dandy Walker variant is an intracranial disorder involving variable hypoplasia of cerebellar vermis without posterior fossa enlargement. An anomaly scan performed at mid second trimester has good sensitivity and specificity for detecting foetal congenital anomalies. Despite that, some cases like the authors' might go undiagnosed due to normal biometric parameters for that gestational age and may be detected later in intrauterine life. Case presentation A primi-gravid mother underwent sonographic evaluation at 20+4 weeks of gestation that revealed all foetal parameters within normal limits. Only at 31+2 weeks of gestation, a posterior fossa cyst communicating with forth ventricle was detected. Foetal MRI done at 8 days of life (DOL), confirmed these findings and diagnosis of Dandy Walker variant with agenesis of corpus callosum was made. Clinical discussion Although the chances of a CNS anomaly is exceedingly low when foetal metrics like head circumference, atrial width and Cisterna Magna are within normal limits, some cases like the authors' may develop anomalies later in the intrauterine life which may lead to delayed diagnosis of the cases. Thorough performance of anomaly scan involving a multiplanar approach may help in prompt diagnosis of foetal anomalies. Conclusion The risks of development of posterior fossa anomalies can exist even after second trimester scan, Clinicians should be aware of this possibility and assess the posterior fossa at repeat scans done later in intrauterine life. Early diagnosis can provide an option to couples of the termination of pregnancy which is complicated when detected later in the intrauterine life.
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Affiliation(s)
| | - Shree Krishna Poudel
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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Wanyonyi S, Nyagaka F, Okiro P, Ogutu L, Nyaichowa A, Oindi F, Sequeira E. Umbilical cord hemangioma and pseudocyst with favorable fetal outcome. Clin Case Rep 2023; 11:e7656. [PMID: 37415590 PMCID: PMC10319952 DOI: 10.1002/ccr3.7656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/19/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Abstract
Key Clinical Message There is a high association between umbilical cord hemangiomas or cysts with fetal mortality. However, favorable outcome is possible with proper prenatal monitoring and care. Abstract Umbilical cord hemangiomas are rare neoplasms of vascular origin, commonly found in the free section of the umbilical cord proximal to placental insertion. They are associated with an increased risk of fetal mortality. We present a rare co-occurrence of an umbilical cord hemangioma and a pseudocyst managed conservatively, with favorable fetal outcome despite the interval increase in size, decreased caliber of the umbilical arteries, and fetal chest compression.
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Affiliation(s)
- Sikolia Wanyonyi
- Department of Obstetrics and GynecologyAga Khan UniversityNairobiKenya
| | - Felix Nyagaka
- Department of Obstetrics and GynecologyAga Khan UniversityNairobiKenya
| | | | - Lilian Ogutu
- Department of PathologyAga Khan UniversityNairobiKenya
| | - Alice Nyaichowa
- Department of Obstetrics and GynecologyAga Khan UniversityNairobiKenya
| | - Felix Oindi
- Department of Obstetrics and GynecologyAga Khan UniversityNairobiKenya
| | - Evan Sequeira
- Department of Obstetrics and GynecologyAga Khan UniversityNairobiKenya
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Dangat K, Gupte S, Wagh G, Lalwani S, Randhir K, Madiwale S, Pisal H, Kadam V, Gundu S, Chandhiok N, Kulkarni B, Joshi S, Fall C, Sachdev HS. Gestational weight gain in the REVAMP pregnancy cohort in Western India: Comparison with international and national references. Front Med (Lausanne) 2022; 9:1022990. [PMID: 36275827 PMCID: PMC9579320 DOI: 10.3389/fmed.2022.1022990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To determine the trimester specific gestational weight gain (GWG) in a population of pregnant women from Western India and compare it with the Intergrowth-21st international and an Indian reference (GARBH-Ini cohort-Group for Advanced Research on BirtH outcomes). Study design A prospective longitudinal observational study was undertaken in Pune, West India and data for gestational weight gain was collected [the REVAMP study (Research Exploring Various Aspects and Mechanisms in Preeclampsia)]. Generalized Additive Models for Location, Scale and Shape method (GAMLSS model) were used to create GWG centile curves according to gestational age, stratified by BMI at recruitment (n = 640) and compared with Intergrowth-21st reference and GARBH-Ini cohort. Multivariable regression analysis was used to evaluate the relationship between GWG and antenatal risk factors. Results The median GWG was 1.68, 5.80, 7.06, and 11.56 kg at gestational ages 18, 26, 30, and 40 weeks, respectively. In our study, pregnant women gained less weight throughout pregnancy compared to Intergrowth-21st study, but more weight compared to the GARBH-Ini cohort centile curves in all the BMI categories. GWG in overweight/obese women (BMI ≥ 25) was significantly lower (<0.001) as compared to underweight (BMI < 18.5), or normal weight women (BMI ≥ 18.5 and <25). The median GWG at 40 weeks in underweight, normal and overweight/obese women was 13.18, 11.74, and 10.48 kg, respectively. Higher maternal BMI, older maternal age, higher parity and higher hemoglobin concentrations were associated with lower GWG, while taller maternal height was associated with greater GWG. Conclusion GWG of Indian women is lower than the prescriptive standards of the Intergrowth charts.
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Affiliation(s)
- Kamini Dangat
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | | | - Girija Wagh
- Department of Obstetrics and Gynecology, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Sanjay Lalwani
- Department of Pediatrics, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Karuna Randhir
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Shweta Madiwale
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Hemlata Pisal
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Vrushali Kadam
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Shridevi Gundu
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Nomita Chandhiok
- Division of Reproductive, Biology, Maternal and Child Health (RBMCH) and Nutrition, Indian Council of Medical Research, New Delhi, India
| | - Bharati Kulkarni
- Division of Reproductive, Biology, Maternal and Child Health (RBMCH) and Nutrition, Indian Council of Medical Research, New Delhi, India
| | - Sadhana Joshi
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Caroline Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
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Liang J, Ma Q, Zhao X, Pan G, Zhang G, Zhu B, Xue Y, Li D, Lu B. Feasibility Analysis of 3D Printing With Prenatal Ultrasound for the Diagnosis of Fetal Abnormalities. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1385-1396. [PMID: 34510491 DOI: 10.1002/jum.15821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/04/2021] [Accepted: 08/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To assess the feasibility and accuracy of 3D printing with prenatal three-dimensional ultrasound (3DUS) in the diagnosis of fetal abnormalities. METHODS Fetuses initially diagnosed with various abnormalities were included in this retrospective study. The fetuses were examined by 3DUS, modeled, and 3D printed, and the dimensional accuracy of the 3D prints was analyzed. The effectiveness, demand, necessity of 3D printing, and the diagnostic accuracy of different methods were analyzed based on questionnaire responses from 40 senior ultrasound doctors and 40 postgraduate students. RESULTS A total of 12 fetuses with cleft lip and palate, spinal, heart, or brain abnormalities were included for detailed assessment. All deviations (mean deviation: 0.1 mm) between the original images and the final 3D prints lay within the consistency boundary (-1.12, 1.31 mm) (P > .05). In the subsequent analyses, 90.8% of the doctors and 94.2% of the students strongly agreed that 3D printing could precisely represent and depict fetal abnormalities. The average misdiagnosis rate of the doctors decreased from 5% to 0.4% after the application of 3D printing combined with 3DUS in comparison with 3DUS alone, and the corresponding value for the students dropped from 17.9% to 5.2%. CONCLUSIONS The errors in modeling and 3D printing based on 3DUS were within acceptable limits, and 3D printing improved the diagnosis of various fetal abnormalities.
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Affiliation(s)
- Jixiang Liang
- The State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Shaanxi, China
- Institute of 3D Printing, Beijing City University, Beijing, China
| | - Qiang Ma
- Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, China
| | - Xin Zhao
- Institute of 3D Printing, Beijing City University, Beijing, China
| | - Guangyu Pan
- Department of Cardiovascular Surgery, Peking University International Hospital, Beijing, China
| | - Gen Zhang
- Department of Cardiovascular Surgery, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Sichuan, China
| | - Bin Zhu
- Department of Anesthesiology, Peking University International Hospital, Beijing, China
| | - Yanfang Xue
- Institute of 3D Printing, Beijing City University, Beijing, China
| | - Dianyuan Li
- Department of Cardiovascular Surgery, Peking University International Hospital, Beijing, China
- Nanjing Medical University Affiliated Suzhou Hospital, Jiangsu, China
| | - Bingheng Lu
- The State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Shaanxi, China
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Hautala J, Gissler M, Ritvanen A, Tekay A, Pitkänen-Argillander O, Stefanovic V, Sarkola T, Helle E, Pihkala J, Pätilä T, Mattila IP, Jokinen E, Räsänen J, Ojala T. The implementation of a nationwide anomaly screening programme improves prenatal detection of major cardiac defects: an 11-year national population-based cohort study. BJOG 2019; 126:864-873. [PMID: 30576052 DOI: 10.1111/1471-0528.15589] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate whether a nationwide prenatal anomaly screening programme improves detection rates of univentricular heart (UVH) and transposition of great arteries (TGA), and whether maternal risk factors for severe fetal heart disease affect prenatal detection. DESIGN Population-based cohort study. SETTING Nationwide data from Finnish registries 2004-14. POPULATION A total of 642 456 parturients and 3449 terminated pregnancies due to severe fetal anomaly. METHODS Prenatal detection rates were calculated in three time periods (prescreening, transition and screening phase). The effect of maternal risk factors (obesity, in vitro fertilisation, pregestational diabetes and smoking) was evaluated. MAIN OUTCOME MEASURES Change in detection rates and impact of maternal risk factors on screening programme efficacy. RESULTS In total, 483 cases of UVH and 184 of TGA were detected. The prenatal detection rate of UVH increased from 50.4% to 82.8% and of TGA from 12.3% to 41.0% (P < 0.0001). Maternal risk factors did not affect prenatal detection rate, but detection rate differed substantially by region. CONCLUSIONS A nationwide screening programme improved overall UVH and TGA detection rates, but regional differences were observed. Obesity or other maternal risk factors did not affect the screening programme efficacy. The establishment of structured guidelines and recommendations is essential when implementing the screening programme. In addition, a prospective screening register is highly recommended to ensure high quality of screening. TWEETABLE ABSTRACT Implementation of a nationwide prenatal anomaly screening improved detection rates of UVH and TGA.
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Affiliation(s)
- J Hautala
- Department of Obstetrics and Gynaecology, Women's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - A Ritvanen
- Register of Congenital Malformations, National Institute for Health and Welfare, Helsinki, Finland
| | - A Tekay
- Department of Obstetrics and Gynaecology, Women's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - O Pitkänen-Argillander
- Department of Paediatric Cardiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - V Stefanovic
- Department of Obstetrics and Gynaecology, Women's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Sarkola
- Department of Paediatric Cardiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - E Helle
- Department of Paediatric Cardiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Pihkala
- Department of Paediatric Cardiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Pätilä
- Division of Paediatric Surgery, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - I P Mattila
- Division of Paediatric Surgery, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - E Jokinen
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - J Räsänen
- Department of Obstetrics and Gynaecology, Women's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - T Ojala
- Department of Paediatric Cardiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Mak ASL, Leung KY. Prenatal ultrasonography of craniofacial abnormalities. Ultrasonography 2018; 38:13-24. [PMID: 30343558 PMCID: PMC6323313 DOI: 10.14366/usg.18031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/03/2018] [Indexed: 01/07/2023] Open
Abstract
Craniofacial abnormalities are common. It is important to examine the fetal face and skull Epub ahead of print during prenatal ultrasound examinations because abnormalities of these structures may indicate the presence of other, more subtle anomalies, syndromes, chromosomal abnormalities, or even rarer conditions, such as infections or metabolic disorders. The prenatal diagnosis of craniofacial abnormalities remains difficult, especially in the first trimester. A systematic approach to the fetal skull and face can increase the detection rate. When an abnormality is found, it is important to perform a detailed scan to determine its severity and search for additional abnormalities. The use of 3-/4-dimensional ultrasound may be useful in the assessment of cleft palate and craniosynostosis. Fetal magnetic resonance imaging can facilitate the evaluation of the palate, micrognathia, cranial sutures, brain, and other fetal structures. Invasive prenatal diagnostic techniques are indicated to exclude chromosomal abnormalities. Molecular analysis for some syndromes is feasible if the family history is suggestive.
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Affiliation(s)
- Annisa Shui Lam Mak
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Kwok Yin Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China
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Kwiatkowski S, Kwiatkowska E, Rzepka R, Torbe A, Dolegowska B. Ischemic placental syndrome--prediction and new disease monitoring. J Matern Fetal Neonatal Med 2015; 29:2033-9. [PMID: 26444581 DOI: 10.3109/14767058.2015.1072165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The last decade has seen an improved understanding of the cause of the development of pathologies such as gestational hypertension, preeclampsia, intrauterine growth restriction, intrauterine fetal death or placental abruption. Nowadays, we know that most conditions within this group share the same pathogenesis, the cause of which is placental ischemia. The following review is an attempt to propose a new method for prediction, diagnosis and--above all--appropriate monitoring of pregnant women and fetuses developing the ischemic placental syndrome with the use of tests that are new but yet widely available in clinical diagnosis. They are closely related to the condition's pathogenesis, therefore their elevated levels may predate clinical symptoms, and--most importantly--they correlate with syndrome aggravation and the occurrence of complications. Perhaps, the new look will allow us to improve perinatal results by reducing mortality and severe complications in pregnant women and fetal deaths resulting from sudden intrauterine fetal death or placental abruption.
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Affiliation(s)
| | - Ewa Kwiatkowska
- b Department of Nephrology , Transplantology and Internal Medicine , and
| | | | | | - Barbara Dolegowska
- c Department of Laboratory Diagnostics , Pomeranian University of Medicine , Szczecin , Poland
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