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The article presents a study which examines the progression angle on transperineal ultrasound imaging between different delivery modes in sustained second stage of labor with occipitoanterior fetal position. It details the results among the cases of women with occipitoanterior fetal position. It notes that this parameter could be used in a predictive model for better decision making relative to operative delivery for obstructed labor.

Objective To describe the course and outcome of fetuses with absent or reversed end-diastolic (ARED) flow in the umbilical artery (UA) and to examine the influence of prematurity according to gestational age at delivery. Methods Sixty pregnancies complicated by ARED flow in the UA were monitored by repeat Doppler measurements of arterial and venous vessels, non-stress tests (cardiotocogram (CTG)) and maternal investigations, and were delivered between 24 and 14 weeks. Fetal outcome was investigated and compared to a control group of appropriate-for-gestational age (AGA) preterm neonates, matched for gestational age. Mortality, birth weight, Apgar scores, postnatal cord arterial pH and need for ventilation were all recorded, as were cases of respiratory distress syndrome, bronchopulmonary dysplasia, persistent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage, periventricular leukomalacia, abnormal neurological findings and those requiring surgical intervention. Additionally, the group of fetuses with ARED flow was divided into three subgroups of different degrees of prematurity (delivery between 24 + 0 and 28 + 6 weeks, delivery between 29 + 0 and 31 + 6 weeks, and delivery after 32 weeks) and compared according to the above parameters. Results Pre- or postnatal death occurred in 16 cases. Comparing the 44 (61%) that were born alive with the AGA neonates, significant differences were found in birth weight (P < 0.001), arterial pH value (P < 0001), bronchopulmonary dysplasia (P = 0.002) and intestinal complications (P < 0.01). Prematurity-related complications were: need for ventilation (P = 0.00 1), respiratory distress syndrome (P < 0.0001), periventricular leukomalacia (P = 0.002) and pathological neurological testing (P = 0.005). Conclusions Neonates displaying ARED flow before birth are growth restricted, acidemic at delivery and are at high risk of developing broncho pulmonary dysplasia and intestinal complications. While perinatal mortality seems to be related to abnormal fetal Doppler velocimetry, age at delivery has a significant impact on short-term morbidity. After 32 weeks, morbidity is low and delivery should be considered. It could be speculated from our data that prolongation of pregnancy with Doppler velocimetry monitoring could help to reduce morbidity, although prolongation remains limited in most cases. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Congenital heart defects (CHD), particularly conotruncal anomalies, may be associated with deletion of chromosome 22q11.2. Thymic aplasia or hypoplasia is known to be a typical feature in this condition. We aimed to establish (i) the prevalence of del22q11.2 in fetal CHD and (ii) whether ultrasound assessment of an absent or hypoplastic fetal thymus helps in preselection of a group who are at high risk for this deletion. Study design In fetuses (> 16 weeks) with CHD, karyotyping and fluorescence in situ hybridization for 22q11.2 were offered and the fetal thymus was evaluated sonographically. Results One hundred and forty-nine fetuses with CHD and normal karyotype were analyzed. Seventy-six fetuses had conotruncal anomalies. 22q11.2 deletion was present in 10 cases (6.7%), all of which had conotruncal anomalies (13.1%). Thymic hypoplasia or absence was suspected in 11 cases with conotruncal anomaly. Nine of these 11 had the deletion; two cases were false positive. One fetus with a normal-sized thymus had deletion of 22q11.2 (sensitivity 90%, specificity 98.5%, positive predictive value 81.8%, and negative predictive value 99.2%). By subtype of cardiac anomaly, there was deletion in four of six fetuses with interruption of the aortic arch, two of four with absent pulmonary valve syndrome, three of nine with truncus arteriosus and one of 11 cases of tetralogy of Fallot. Pulmonary atresia with ventricular septal defect ( n = 7), right-sided aortic arch ( n = 4), transposition of the great arteries ( n = 14), double outlet right ventricle ( n = 13) and other complex malpositions of the great vessels ( n = 8) were not associated with the deletion. Conclusion Thymic hypoplasia or aplasia may reliably be diagnosed during fetal echocardiography. The technique allows identification of a group at high risk for 22q11.2 deletion and is more specific and sensitive than by subtype of cardiac anomaly alone. [ABSTRACT FROM AUTHOR]

Objective The purpose of this investigation was to examine the characteristics of breathing-related fluid flow in the trachea of human fetuses with congenital diaphragmatic hernia in the hopes of developing a standard for the prenatal diagnosis of the degree of severity of the resulting pulmonary hypoplasia. Our ultimate goal is the prediction of postnatal mortality in fetuses with congenital diaphragmatic hernia. Subjects and methods The study comprised six cases of isolated congenital diaphragmatic hernia (one on the right side; five on the left) varying in gestational age from 26 to 36 weeks. Four of the patients survived after surgical repair and two died during the neonatal period owing to lung hypoplasia. Color Doppler was used to visualize the fluid displacement in the trachea generated by fetal breathing movements. Spectral Doppler was then used to analyze the fluid flow velocity waveforms. More than 40 continuous breathing cycles (inspiration + expiration) were recorded for each case. We distinguished between regular and irregular patterns. Results Only the regular breathing phases, defined as five or more consecutive cycles of symmetric appearance, were considered for analysis. The inspiration and expiration times, the peak velocity of inspired and expired fluid and the volume obtained by integration of the tracheal fluid flow displaced during fetal breathing were compared with those of five healthy fetuses for each gestational age. Only the tracheal volume flow was helpful in predicting outcome. In normal pregnancies this parameter increased from 0.21 ± 0.10 ml/breath (mean ± SD) at 26 weeks to 1.37 ± 0.48 ml/breath at 36 weeks of gestation. A significantly low (p < 0.05) volume flow was found only in the fetuses with congenital diaphragmatic hernia with a lethal postnatal outcome, whereas this parameter was normal in all survivors. Conclusions Our preliminary observations suggest that the tracheal volume flow during fetal breathing... [ABSTRACT FROM AUTHOR]

Prenatal suspicion of esophageal atresia is usually based on the finding of a small or absent fetal stomach in association with polyhydramnios. As similar findings may be generated by other abnormalities, confirmation of the diagnosis is generally not possible until birth. We present a case in which the suspicion of esophageal atresia was raised in the 22nd week of pregnancy in the presence of a small stomach bubble associated with a persistent left superior vena cava. The diagnosis was confirmed 4 weeks later by direct visualization of the fluid-filled blind-ending esophagus during fetal swallowing, which we called the upper neck pouch sign. This is the first case in which the onset of this sonographic entity was specifically observed on serially repeated sonograms as early as the 22nd week. The appearance of this direct sign of esophageal atresia is described, and the literature is reviewed. [ABSTRACT FROM AUTHOR]

AbstractThe prenatal sonographic features of a fetus with right-sided congenital diaphragmatic hernia diagnosed at 33 weeks are presented. Color Doppler demonstrated an abnormal course of the right renal artery, arising from the aorta and feeding the intrathoracic right kidney. This case report stresses the role of color Doppler in defining which organs have herniated in fetuses with diaphragmatic hernia. [ABSTRACT FROM AUTHOR]

Investigates fetal heart hemodynamics with the use of spectral and color Doppler ultrasound. Features and advantages of power Doppler ultrasound; Visualization of the crossing of the aorta and pulmonary artery; Three-dimensional power Doppler ultrasound of the crossing of the great vessels; Use of the Philips-ATL Ultrasound machine HDI-500 with integrated Color Power Angio. [ABSTRACT FROM AUTHOR]

Rhabdoid tumors of the kidney are highly lethal malignancies of infancy. We report the prenatal detection of a renal rhabdoid tumor with mesoblastic components in a fetus at 27 weeks of gestation. The tumor presented as a large mass in the left renal area and there was concomitant massive polyhydramnios. Though the sonographic features alone did not allow distinction from a benign lesion, the aggressive tumor growth indicated malignancy. Amniotic fluid cytology was performed but failed to confirm the diagnosis. Corticosteroids were administered for lung maturation. Tocolysis, including betamimetics, magnesium and indomethacin, was performed to prevent premature labor. Additionally, serial amniodrainage was performed. At 30 weeks of gestation fetal hydrops developed and a Cesarean section was performed. After delivery, ventilation of the preterm infant was insufficient due to diaphragm elevation by the huge tumor, requiring immediate tumor surgery. However, though ventilation was improved the infant died of cardiac failure 4 h after surgery. [ABSTRACT FROM AUTHOR]

A response by K.D. Kalache and colleagues to a letter to the editor about their article "Transperineal ultrasound imaging in prolonged second stage of labor with occipitoanterior presenting fetuses: how well does the angle of progression predict the mode of delivery?" in the 2009 issue is presented.

The article presents a three-dimensional power Doppler ultrasound image of right-sided aortic arch with vascular ring and aberrant subclavian artery. Two typical forms of a right aortic arch can be distinguished, which in one condition a vascular ring is found called U-sign prenatally. The prenatal diagnosis showed that the trachea and esophagus are entrapped between the arch and the left ductus arteriosus.

Objectives: Recent ultrasound studies have shown that it is feasible to objectively and reproducibly assess fetal head position and station within the pelvis. We sought to evaluate the impact of this new approach on decision making by physicians in a cohort of women with a prolonged second stage of labor. Methods: This was a retrospective cohort study that included all women with fetuses in cephalic presentation, who were diagnosed with a prolonged second stage of labor, and who delivered in a 1-year period. We compared a group of women ( n == 121) with a prolonged second stage of labor who underwent intrapartal ultrasound prior to obstetrical intervention (Group A, n == 43) with a group of women for whom the delivery modus was decided upon after clinical digital examination alone (Group B, n == 78). Results: There were no significant differences in maternal and neonatal morbidity between both groups. The rate of second-stage cesarean section was significantly higher ( p < 0.50) in Group B without ultrasound compared to Group A with ultrasound prior to operative delivery (20/78 vs. 7/43). Seven patients in Group A delivered spontaneously, but none of the patients in Group B had spontaneous deliveries. Conclusions: Intrapartal ultrasound in patients with a prolonged second stage of labor may change obstetrical practice by reducing the number of second stage cesarean section without increasing maternal and neonatal morbidity. [ABSTRACT FROM AUTHOR]

Objective We investigated the correlation between the angle of progression measured by transperineal ultrasound and fetal head station measured by open magnetic resonance imaging (MRI), the gold standard, in pregnant women at full term. Methods Thirty-one pregnant women at full term with a fetus in the occipitoanterior position were enrolled. First, the distance between the leading part of the skull and the interspinal plane was obtained using an open MRI system with the patient in a supine position. Immediately after MRI, the angle of progression was obtained by transperineal ultrasound without changing the woman's posture. Results There was a significant correlation between the angle of progression determined by transperineal sonography and the distance between the presenting fetal part and the level of the maternal ischial spines (y = -0.51× + 60.8, r2 = 0.38, P < 0.001). None of the fetal heads was engaged at the time of MRI and ultrasound examinations. Conclusions The present study demonstrated a predictable relationship between the angle of progression obtained by transperineal ultrasound and the traditional scale used to quantify fetal head descent. Based on our results, station 0 would correspond to a 120°? angle of progression. However, this correlation is based on statistical assumptions only and has to be proven in future studies. [ABSTRACT FROM AUTHOR]

The article presents a study that aims to find out measurement reliability when images were obtained by some operators with varying ultrasound experience. It cites that intraclass correlation coefficients (ICCs) having 95 percent confidence interval (CI) were used to measure interobserver reliability and Bland-Altman test was used to assess interobserver agreement. It states that transperineal ultrasound imaging's angle of progression measurement is reliable despite ultrasound experience.

Objectives: To assess whether ultrasound experience or fetal head station affects the reliability of measurement of fetal head descent using the angle of progression on intrapartum ultrasound images obtained by a single experienced operator, and to determine reliability of measurements when images were acquired by different operators with variable ultrasound experience. Methods: One experienced obstetrician performed 44 transperineal ultrasound examinations of women at term and in prolonged second stage of labor with the fetus in the occipitoanterior position. Three midwives without ultrasound experience, three obstetricians with < 5 years' experience and three obstetricians with > 10 years' experience measured fetal head descent based on the angle of progression in the images obtained. The angle of progression was measured by two obstetricians in independent ultrasound examinations of 24 laboring women at term with the fetus in the cephalic position to allow assessment of the reliability of image acquisition. Intraclass correlation coefficients (ICCs) with 95% confidence interval (CI) were used to evaluate interobserver reliability and Bland-Altman analysis was used to assess interobserver agreement. Results: In total, 444 measurements were performed and compared. Interobserver reliability with respect to offline image analysis was substantial (overall ICC, 0.72; 95% CI, 0.63-0.81). ICCs were 0.82 (95% CI, 0.70-0.89), 0.81 (95% CI, 0.71-0.88) and 0.61 (95% CI, 0.43-074) for observers with > 10 years', < 5 years' and no ultrasound experience, respectively. There were no significant differences between ICCs among observer groups according to ultrasound experience. Fetal head station did not affect reliability. Bland-Altman analysis indicated reasonable agreement between measurements obtained by two different operators with > 10 years' and < 5 years' ultrasound experience (bias, -1.09 degrees ; 95% limits of agreement, -8.76 to 6.58). The reliability of measurement of the angle of progression following separate image acquisition by two experienced operators was similar to the reliability of offline image analysis (ICC, 0.86; 95% CI, 0.70-0.93). Conclusions: Measurement of the angle of progression on transperineal ultrasound imaging is reliable regardless of fetal head station or the clinician's level of ultrasound experience. [ABSTRACT FROM AUTHOR]

An abstract of the conference paper "Intrapartum assessment of fetal head descent: A feasibility study using three dimensional transperineal ultrasound" by C. E. Macpherson and colleagues is presented.

An abstract of the article "Three-Dimensional Power Doppler Sonography in the diagnosis of Arteriovenous Malformations of the uterus and treated by selective uterine artery embolization," by C. Bamberg and colleagues, is presented.

A letter to the editor is presented in response to article about three-dimensional (3D) ultrasound demonstration of rib abnormalities in a fetus with trisomy 21.