1
|
Plöger R, Behning C, Walter A, Jimenez Cruz J, Gembruch U, Strizek B, Recker F. Next-generation monitoring in obstetrics: Assessing the accuracy of non-piezo portable ultrasound technology. Acta Obstet Gynecol Scand 2024. [PMID: 39032032 DOI: 10.1111/aogs.14922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION The emergence of handheld ultrasound devices capable of connecting to cell phones or tablets heralds a significant advancement in medical technology, particularly within the field of obstetrics. These devices offer the promise of immediate bedside ultrasound examinations, potentially revolutionizing patient care by enabling fetal assessments in diverse settings. MATERIAL AND METHODS This prospective study aimed to validate the reliability of non-piezo, chip-based handheld ultrasound devices in clinical obstetric practice. Conducted in a university hospital obstetric ward, the study included 100 pregnant women between 17 and 41 weeks of gestation. Participants underwent ultrasound examinations using both conventional and portable point-of-care ultrasound (POCUS) devices to compare the accuracy in estimating fetal weight and other parameters, such as cardiac activity, fetal presentation, placental location, and amniotic fluid volume. The reliability and agreement between the devices were assessed using intraclass correlation coefficients, Bland-Altman plots, and Pearson correlation coefficients. RESULTS The results show a near-perfect agreement (0.98) and correlation (r = 0.98, p < 0.001) for estimated fetal weight and most biometry measurements between the two types of ultrasound devices, with slight deviations in head circumference and amniotic fluid index measurements. Subgroup analysis revealed variations in agreement and correlation rates with higher BMI and advanced gestational age, indicating areas for further refinement. CONCLUSIONS These findings affirm the high reliability of handheld ultrasound devices for basic obstetric ultrasound evaluations, supporting their integration into daily clinical practice. This technology improves the flexibility and immediacy of prenatal care, although further research is needed to optimize its application across patient populations and treatment settings.
Collapse
Affiliation(s)
- Ruben Plöger
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Charlotte Behning
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Adeline Walter
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Jorge Jimenez Cruz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
2
|
Luntsi G, Burabe FA, Ogenyi PA, Zira JD, Chigozie NI, Nkubli FB, Dauda M. Sonographic Estimation of Amniotic Fluid Volume Using the Amniotic Fluid Index and the Single Deepest Pocket in a Resource-Limited Setting. J Med Ultrasound 2018; 27:63-68. [PMID: 31316214 PMCID: PMC6607887 DOI: 10.4103/jmu.jmu_26_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/18/2018] [Indexed: 11/04/2022] Open
Abstract
Objective To determine the normal value of amniotic fluid (AF) volume among pregnant women in a Northern Nigerian population and to determine if there is a relationship between AF index (AFI) and single deepest pocket (SDP) with anthropometric variables. Materials and Methods A prospective cross-sectional study was conducted among singleton pregnant women at late second and third trimester attending the antenatal clinic in Abubakar Tafawa Balewa Teaching Hospital, Bauchi, from December 2016 to April 2017. The mean AFI and SDP were measured by sonography. Ethical approval was obtained from the institution and informed consent was sought for from all the participants. Descriptive statistics, i.e. mean, standard deviation, and correlation coefficient, were used for the analysis. Results A total of 206 women, aged between 18 and 40 years, with fetal gestational ages between 22 and 39 weeks were included in the study. The values for AFI in the study ranged from 12 to 28.7 cm, with a mean value of 19.84 ± 3.64 cm, and SDP ranged from 3.7 to 9.1 cm with a mean value of 6.04 ± 1.12 cm. This study found a weak relationship between the anthropometric variables and AFI and SDP and a strong relationship between AFI and SDP with a correlation coefficient of R = 0.901 and P = 0.014. Conclusion This study found the mean values for AF volume using AFI and SDP in the studied population to be 19.84 ± 3.64 cm and 6.04 ± 1.12 cm, respectively; a strong positive relationship between AFI and SDP; and a negative relationship between body mass index with AFI and SDP.
Collapse
Affiliation(s)
- Geofery Luntsi
- Department of Medical Radiography, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Falmata Ali Burabe
- Department of Medical Radiography, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Prince Ame Ogenyi
- Department of Radiology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Joseph Dlama Zira
- Department of Radiology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Nwobi Ivor Chigozie
- Department of Medical Radiography, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Flavious Bobuin Nkubli
- Department of Medical Radiography, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Maikudi Dauda
- Department of Medical Radiography, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| |
Collapse
|
3
|
Mehler K, Gottschalk I, Burgmaier K, Volland R, Büscher AK, Feldkötter M, Keller T, Weber LT, Kribs A, Habbig S. Prenatal parental decision-making and postnatal outcome in renal oligohydramnios. Pediatr Nephrol 2018; 33:651-659. [PMID: 29075889 DOI: 10.1007/s00467-017-3812-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/13/2017] [Accepted: 09/11/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous studies on renal oligohydramnios (ROH) report highly variable outcome and identify early onset of ROH and presence of extrarenal manifestations as predictors of adverse outcome in most cases. Data on termination of pregnancy (TOP) and associated parental decision-making processes are mostly missing, but context-sensitive for the interpretation of these findings. We provide here a comprehensive analysis on the diagnosis, prenatal decision-making and postnatal clinical course in all pregnancies with ROH at our medical centre over an 8-year period. METHODS We report retrospective chart review data on 103 consecutive pregnancies from 2008 to 2015 with a median follow-up of 554 days. RESULTS After ROH diagnosis, 38 families opted for TOP. This decision was associated with onset of ROH (p < 0.001), underlying renal disease (p = 0.001) and presence of extrarenal manifestations (p = 0.02). Eight infants died in utero and 8 cases were lost to follow-up. Of the 49 liveborn children, 11 received palliative and 38 underwent active care. Overall survival of the latter group was 84.2% (n = 32) corresponding to 31% of all pregnancies (32 out of 103) analysed. One third of the surviving infants needed renal replacement therapy during the first 6 weeks of life. CONCLUSIONS Over one third of pregnancies with ROH were terminated and the parental decision was based on risk factors associated with adverse outcome. Neonatal death was rare in the actively treated infants and the overall outcome promising. Our study illustrates that only careful analysis of the whole process, from prenatal diagnosis via parental decision-making to postnatal outcome, allows sensible interpretation of outcome data.
Collapse
Affiliation(s)
- Katrin Mehler
- Neonatology and Pediatric Intensive Care, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
| | - Ingo Gottschalk
- Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Cologne, Cologne, Germany
| | - Kathrin Burgmaier
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
| | - Ruth Volland
- Pediatric Oncology and Hematology, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
| | - Anja K Büscher
- Clinic for Pediatrics II, Pediatric Nephrology, University of Essen, Essen, Germany
| | | | - Titus Keller
- Neonatology and Pediatric Intensive Care, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
| | - Angela Kribs
- Neonatology and Pediatric Intensive Care, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
| | - Sandra Habbig
- Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany.
| |
Collapse
|
4
|
Causes of renal oligohydramnios: impact on prenatal counseling and postnatal outcome. Pediatr Nephrol 2018; 33:541-545. [PMID: 29128922 DOI: 10.1007/s00467-017-3833-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 10/22/2017] [Accepted: 10/24/2017] [Indexed: 01/22/2023]
Abstract
The presence of renal oligohydramnios (ROH) in a fetus has been associated in the past with a poor prognosis for survival, although recent studies have shown that survival has improved considerably due to the advances in neonatology and pediatric nephrology. In an article recently published in Pediatric Nephrology, evaluation of a large series by Mehler and colleagues confirms the improved prognosis, showing a survival rate of 32 of 38 (84%). In addition, only 12 of 35 (34%) neonates required renal replacement therapy. In five of these 12 children the dialysis could be terminated after the neonatal period. This study has important implications on the decision-making process and counseling of families. While 37% of families of the study opted for termination of pregnancies, palliative care was chosen by 8% of the families, representing an important option when a decision cannot be made rapidly by affected families. A multidisciplinary approach is not only necessary in the active treatment of neonates with a history of ROH but also in antenatal counseling. In this regard future efforts should establish consensus on an ethical framework for the decision-making process in ROH.
Collapse
|
5
|
Hughes DS, Magann EF. Antenatal fetal surveillance "Assessment of the AFV". Best Pract Res Clin Obstet Gynaecol 2016; 38:12-23. [PMID: 27756534 DOI: 10.1016/j.bpobgyn.2016.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/10/2016] [Accepted: 08/08/2016] [Indexed: 11/29/2022]
Abstract
The evaluation of amniotic fluid volume (AFV) is an established part of the antenatal surveillance of pregnancies at risk for an adverse pregnancy outcome. The two most commonly used ultrasound techniques to estimate AFV are the amniotic fluid index (AFI) and the single deepest pocket (SDP). Four studies have defined normal AFVs, and although their normal volumes have similarities, there are also differences primarily due to the statistical methodology used in each study. Dye-determined AFV correlates with ultrasound estimates for normal fluid volumes but correlates poorly for oligohydramnios and polyhydramnios. The addition of color Doppler in estimating AFV leads to the overdiagnosis of oligohydramnios. Neither the AFI nor the SDP is superior in identifying oligohydramnios, but the SDP is a better measurement choice as the use of AFI increases the diagnosis rate of oligohydramnios and labor inductions without an improvement in pregnancy outcomes.
Collapse
Affiliation(s)
- Dawn S Hughes
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| |
Collapse
|
6
|
Onwuzu S, Eze C, Ugwu L, Abonyi O, Adejoh T. Ultrasound biometry of normal human amniotic fluid index in a Nigerian population. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2015.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Aulbert W, Kemper MJ. Severe antenatally diagnosed renal disorders: background, prognosis and practical approach. Pediatr Nephrol 2016; 31:563-74. [PMID: 26081158 DOI: 10.1007/s00467-015-3140-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/12/2015] [Accepted: 05/29/2015] [Indexed: 12/20/2022]
Abstract
Nowadays most renal disorders, especially urinary tract malformations and renal cystic disease, are diagnosed antenatally. In cases of severe bilateral disease, intrauterine renal dysfunction may lead to renal oligohydramnios (ROH), resulting in pulmonary hypoplasia which affects perinatal mortality and morbidity as well as the long-term outcome. However, some infants may only have mild pulmonary and renal disease, and advances in postnatal and dialysis treatment have resulted in improved short- and long-term outcome even in those infants with severe ROH. Here, we review the current state of knowledge and clinical experience of patients presenting antenatally with severe bilateral renal disorders and ROH. By addressing underlying mechanisms, intrauterine tools of diagnosis and treatment as well as published outcome data, we hope to improve antenatal counselling and postnatal care. KEY SUMMARY POINTS: 1. Nowadays most renal disorders are diagnosed antenatally, especially urinary tract malformations and renal cystic disease. 2. Severe kidney dysfunction may lead to renal oligohydramnios, which can cause pulmonary hypoplasia and is a risk factor of perinatal mortality and postnatal renal outcome. However, as considerable clinical heterogeneity is present, outcome predictions need to be treated with caution. 3. Advances in postnatal and dialysis treatment have resulted in improved short- and long-term outcomes even in infants with severe renal oligohydramnios. 4. A multidisciplinary approach with specialist input is required when counselling a family with an ROH-affected fetus as the decision-making process is very challenging.
Collapse
Affiliation(s)
- Wiebke Aulbert
- Pediatric Nephrology, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Markus J Kemper
- Pediatric Nephrology, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| |
Collapse
|