RESUMEN

PURPOSE: Complex fetal behavior involving multiple parts of the body, called general movement (GM), has been considered an essential predictor of neurological functional development because it directly reflects the integrity of the brain and central and peripheral nervous systems. We have developed a novel method for quantitative analysis of fetal behavior using four-dimensional ultrasound (4DUS) and conducted a pilot study for quantitative assessment of fetal GM in the early second trimester. METHODS: All subjects underwent 4DUS to depict the whole fetal body, and maximum velocity (MAXV), median velocity (MV), average velocity (AV), and mode velocity (MOV) were calculated by utilizing optical flow analysis. Receiver operating characteristic (ROC) curve analysis was performed to analyze the optimal speed parameters for detecting GM in the fetus. The Mann-Whitney U test was used to validate MAXV, AV, and MV ability to detect fetal GM. RESULTS: The presence of fetal GMs and the absence of fetal GMs were 226 and 107, respectively, based on optical flow analysis. Mann-Whitney U test revealed a significant difference in the presence or absence of fetal GM in MAXV, MV, AV, and MOV. ROC analysis showed that the area under the curve (AUC) of MAXV was 0.959; the threshold was 0.421, the sensitivity was 86%, and the specificity was 93%. In contrast, the AUC/threshold for AV and MV was 0.700/0.110 (sensitivity 71% and specificity 76%) and 0.521/0.119 (sensitivity 21% and specificity 90%), respectively. Spearman's rank correlation analysis also showed a weak negative correlation between GM and MAXV (r = - 0.235, P < 0.01) and AV (r = - 0.28, P < 0.01). CONCLUSION: In this study, we conducted a quantitative analysis of fetal behavior based on optical flow using 4DUS and demonstrated that it was highly accurate for detecting GMs and for evaluating developmental changes in GMs. The implementation of quantitative analysis of fetal GMs in the early second trimester has been very preliminary, and there is much debate on how it will be clinically applied to perinatal assessment.

Asunto(s)

RESUMEN

Low-grade appendiceal mucinous neoplasms are rare and difficult to diagnose preoperatively because of a lack of characteristic symptoms. A 24-year-old female with no symptoms before pregnancy underwent an elective cesarean section at 38 weeks of gestation because of cephalo-pelvic disproportion. Although no abnormalities were detected in the newborn, uterus, or uterine adnexa, a sausage-like, swollen appendix was noted. The patient underwent appendectomy. Pathology showed the tumor was a low-grade appendiceal mucinous neoplasm.

RESUMEN

PURPOSE: Spatiotemporal image correlation (STIC) is an excellent imaging modality for observing the fetal heart. High-quality STIC volume data are needed for an antenatal anatomic survey to diagnose congenital heart disease. We aimed to clarify the causes of unsuccessful STIC volume data acquisition and describe a more accurate, efficient STIC examination. METHODS: This cross-sectional study of 1124 women with fetuses assessed risk factors for unsuccessful acquisition of STIC volume data. Logistic regression analysis quantified the relation between unsuccessful acquisition and clinical variables, including maternal body mass index (BMI), shadowing artifacts due to unexpected fetal limb movement (SAU), estimated fetal weight (EFW), gestational age (GA), use of volume rendering images in four-dimensional ultrasonography (4D-US), fetal heart rate (FHR), maternal age, anterior placenta, and prior lower abdominal surgery. RESULTS: STIC volume data acquisition was unsuccessful in 210 of 1124 (18.6%) cases. SAU, BMI ≥ 28 kg/m2, not using volume rendering images in 4D-US, EFW ≥ 1300 g, and anterior placenta were independent risk factors for unsuccessful STIC data acquisition. CONCLUSIONS: Avoiding SAU was the most important factor for accurate, efficient STIC evaluations for diagnosing congenital heart disease antenatally. The risk was not explained by lack of sonographer proficiency. Volume rendering images in 4D-US is a promising approach to successful acquisition of STIC volume data.

Asunto(s)

Asunto(s)

RESUMEN

AIM: This study was performed to determine the rate of pregnant occupants in motor vehicle accidents (MVA) and the frequency of seatbelt use in pregnancy in Japan. METHODS: A questionnaire survey was conducted at seven centers located in Sapporo, targeting all 3952 women in gestational weeks 35-37 during the study period between June 2013 and January 2014. Information was collected on parity, driver's license, seatbelt use, seat preference, carrying Mother and Child Health Handbook when going out, and experience of occupant MVA during current pregnancy. Women who reported always using a seatbelt were classified as always seatbelt users (ASU). RESULTS: A total of 2420 women who were given questionnaires provided responses (response rate, 61%). Seventy women (2.9%) reported having experienced an occupant MVA during the current pregnancy. MVA rate was significantly lower for ASU than non-ASU (2.6% [55/2097] vs 4.6% [15/323], respectively, P < 0.0001), and for ASU women preferring the rear seat than for other women (1.3% [6/451] vs 3.3% [64/1969], respectively, P = 0.0282). MVA rate tended to be lower for women preferring the rear seat than the front seat (1.7% [10/575] vs 3.3% [60/1845], respectively, P = 0.0637). The number of ASU, 94% (2286/2420) before pregnancy, decreased significantly to 87% (2097/2420) after the current pregnancy (P < 0.0001). CONCLUSION: The careful attitude of pregnant women toward driving safety may be associated with reduced risk of MVA in pregnancy. There is a need for an intensified campaign to promote seatbelt use among pregnant women.

Asunto(s)

RESUMEN

PURPOSE: This study aimed to show reconstruction of the fetal stomach using the HDlive rendering mode in ultrasound. METHODS: Seventeen healthy singleton fetuses at 18-34 weeks' gestational age were observed using the HDlive rendering mode of ultrasound in utero. RESULTS: In all of the fetuses, we identified specific spatial structures, including macroscopic anatomical features (e.g., the pyrous, cardia, fundus, and great curvature) of the fetal stomach, using the HDlive rendering mode. In particular, HDlive rendering images showed remarkably fine details that appeared as if they were being viewed under an endoscope, with visible rugal folds after 27 weeks' gestational age. CONCLUSION: Our study suggests that the HDlive rendering mode can be used as an additional method for evaluating the fetal stomach. The HDlive rendering mode shows detailed 3D structural images and anatomically realistic images of the fetal stomach. This technique may be effective in prenatal diagnosis for examining detailed information of fetal organs.

Asunto(s)

RESUMEN

We present herein our first experience with a case of thanatophoric dysplasia (type I) that was diagnosed during the second trimester using three- and four-dimensional HDlive ultrasonography. The HDlive rendering mode clearly showed the anatomical features of thanatophoric dysplasia: external malformations and skeletal abnormalities, including extremely short limbs, flattened vertebral bodies, and short horizontal ribs, among others. HDlive can provide valuable, highly realistic images for the differential diagnosis of skeletal dysplasia. It may also play an important complementary role when conventional two- and three-dimensional ultrasonography does not provide sufficient definition.

Asunto(s)

Asunto(s)

RESUMEN

Placental lakes are sonolucent areas often found in the normal placenta. Most of them are asymptomatic. They are sometimes related to placenta accreta or intrauterine fetal growth restriction, among other conditions. Although Doppler sonography is useful for evaluating noxious placental lakes, it is not easy to adapt Doppler studies to conventional two-dimensional color Doppler sonography because of the low-velocity blood flow and high vascularity in the placenta. Here, we demonstrate how three-dimensional high-definition imaging of flow provides a novel visual depiction of placental lakes, which helps substantially with the differential diagnosis. As far as we know, there have been no previous reports of observation of placental lakes using three-dimensional high-definition imaging of flow.

Asunto(s)

RESUMEN

BACKGROUND: Various etiologies of myomatous erythrocytosis syndrome (erythrocytosis associated with a uterine leiomyoma), one of which is altered production of erythropoietin, have been proposed. We report a case of erythrocytosis associated with a large uterine leiomyoma in which erythropoietin activity and immunostaining for erythropoietin in the leiomyoma were found. CASE: A 64-year-old woman, gravida 2, para 1, was referred to our department for treatment of a large uterine myoma and erythrocytosis with elevated levels of erythropoietin. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed, and the results of the pathological examination confirmed the diagnosis of leiomyoma of the uterus, which weighed 920 g. The patient's postoperative course was satisfactory, and the levels of hemoglobin and erythropoietin were normalized and remained within normal ranges. The level of erythropoietin in the uterine leiomyoma measured by radioimmunoassay was elevated (372 mU/wet gram), and specific immunostaining for erythropoietin was found in the cytoplasm of leiomyoma cells. The levels of erythropoietin extracted from uterine leiomyomas of other patients who did not have erythrocytosis (control patients, n = 5) were lower (65 +/- 15.3 mU/wet gram), but specific immunostaining for erythropoietin was also found in the cytoplasm of leiomyoma cells from those patients. CONCLUSIONS: Our case was typical of myomatous erythrocytosis syndrome in which uterine leiomyoma was proved to produce erythropoietin. Our results also suggest that erythropoietin is produced in uterine leiomyomas of patients with and without erythrocytosis. Leiomyoma of the uterus may affect the production of erythropoietin and may develop into myomatous erythrocytosis syndrome when the level of erythropoietin exceeds the normal range.

Asunto(s)