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Objectives: To evaluate the ability of sonographers to prospectively identify intracranial translucency and posterior brain structures at 11 to 13 weeks and to evaluate measurement reproducibility of brain stem and brain stem-occipital bone diameters on stored images., Methods: After specific training for intracranial translucency visualization, 10 nonphysician sonographers prospectively identified intracranial translucency at the 11- to 13-week scan, noting whether intracranial translucency was present, absent, or uncertain. If absent/uncertain, they documented the reason as spina bifida or an inadequate image (with reasons for the inadequate image). Measurements of brain stem and brain stem-occipital bone diameters were performed on stored images. Fifty randomly selected cases were reviewed for intraobserver and interobserver variability., Results: In 313 singleton pregnancies, the posterior brain including intracranial translucency was evaluated; 293 (93.6%) had known pregnancy outcomes. None had open spina bifida, but 7 had chromosomal or congenital abnormalities. In the remaining 286 normal fetuses, intracranial translucency was seen in 275 (96%) and uncertain in 11 (4%), due to inadequate images (top 3 reasons were fetal position [n = 8], obesity [n = 5], and retroverted uterus [n = 4]). Fetal position and gestational age were significantly associated with intracranial translucency visualization (P < .05). Intraobserver and interobserver agreement rates were moderate for measurements of brain stem diameter (intraclass correlation coefficients, 0.59 and 0.57) and substantial for brain stem-occipital bone diameter (intraclass correlation coefficients, 0.76 and 0.61). Bland-Altman analysis revealed negligible intraobserver and interobserver differences in brain stem and brain stem-occipital bone diameter measurements., Conclusions: Intracranial translucency can be prospectively identified by trained sonographers in 96% of normal fetuses at 11 to 13 weeks. Measurements of brain stem and brain stem-occipital bone diameters are reproducible., (© 2014 by the American Institute of Ultrasound in Medicine.)

Objective: To determine the visualization rates of fetal anatomic structures by three-dimensional ultrasound (3DUS) at 12-13 weeks of gestation., Study Design: This was a prospective observational study of women presenting for nuchal translucency ultrasound. Five 3D volumes of the fetus were acquired transabdominally. Two investigators independently reviewed the stored volumes offline following a standardized protocol., Results: One hundred singleton fetuses were examined. The mean time for 3D volumes acquisition was 4.8 min; and for 3D review 17 min. Anatomic structures were seen as follows: cranium, lateral cerebral ventricles and abdominal wall 100%; stomach, vertebrae, upper and lower limbs >or= 94%; face 71%, bladder 58%, both kidneys 39%, skin overlying spine 26% and heart 18%. Agreement between two observers ranged from 100% (for head, abdominal wall and lower limbs) to 43% (for visualization of skin overlying spine). A complete basic anatomic survey was achieved in 11.4% of the 12-week fetuses and 33.3% of the 13-week fetuses (p-value = 0.038)., Conclusions: First-trimester transabdominal 3DUS was adequate for assessment of the head, abdominal wall, stomach, limbs and vertebral alignment. It was less effective for evaluating the heart and intactness of the skin over the spine., (Copyright (c) 2010 John Wiley & Sons, Ltd.)

Objective: To assess women's knowledge of and views on the evaluation and reporting of ultrasound soft markers., Methods: A prospective survey of 263 women undergoing 18 to 20 week anatomy ultrasound examination at Mount Sinai Hospital, a level 3 perinatal referral centre for a multi-ethnic population of approximately 2.5 million., Results: Prior to reading an information pamphlet provided in the context of this survey, 30% of women (79/263) reported having heard of the term soft marker and 59% of these women (47/79) had discussed soft markers with their caregiver. When asked their preferences about the reporting of ultrasound soft markers, 53% of women said that soft markers should be reported routinely, 20% said they should be reported when the caregiver thinks it necessary, and 23% preferred they be reported only when they have been discussed prior to the ultrasound examination. A minority of respondents (8%) had not participated in prenatal screening for aneuploidy. All of these women preferred that soft markers be reported only after pre-screening discussion., Conclusion: The study demonstrates that most women have little prior knowledge about routine examination for soft markers during the anatomy ultrasound examination and emphasizes the importance of expanding counselling and informed consent to include this aspect of prenatal screening.

Objectives: (1) To elucidate the views of obstetricians with respect to the use of transvaginal ultrasound in general, and, specifically, for determining cervical length, and the conditions under which obstetricians would employ cervical cerclage based on a sonographically revealed shortened cervix; and (2) to determine the possibility of a randomized controlled trial on the use of cervical cerclage in this situation., Methods: A 7-item questionnaire in French and English was designed and pretested. Questionnaires were mailed to 1421 physicians identified in the Canadian Medical Directory as practising obstetricians/gynaecologists in Canada. Returned questionnaires were scanned into an Access database for simple descriptive analyses., Results: Responses were received from 766 physicians. Of these 766 respondents, 604 physicians indicated they continued to practise obstetrics and supplied information that was usable in the analysis. The majority of the 604 respondents (85.6%) reported that they would recommend transvaginal ultrasound only in pregnant women with 1 or more risk factors for preterm birth. Respondents were most likely to recommend a cerclage, and least unsure of their decision to do so, if the gestational age was less than 23 weeks, the cervical length was less than 1 cm, and additional risk factors for preterm birth were present. As gestational age and cervical length increased, respondents were less likely to recommend cerclage and more unsure of their decision to do so. The pattern of responses was similar for singleton and multiple pregnancies. The McDonald technique was favoured over the Shirodkar technique by 70.4% of the respondents who performed cervical cerclage procedures. Adjunctive antibiotics were used with cerclage by 52.5% and adjunctive tocolytics were employed by 37.4%. The majority (68.8%) of the respondents who performed cervical cerclage procedures stated that they would participate in a randomized controlled trial on the effectiveness of cerclage for a sonographically revealed short cervix., Conclusion: In the case of a short cervix determined by ultrasound, there is significant uncertainty surrounding the decision whether to place a cerclage and considerable variation in the clinical practice on its placement. In the absence of good evidence to guide clinical practice, a randomized controlled trial is being planned.

Objective: The purpose of this study was to determine the effectiveness of cerclage for a shortened cervix on transvaginal ultrasound scanning in terms of the rates of preterm delivery and adverse neonatal and maternal outcomes., Study Design: Pre-MEDLINE and MEDLINE, EMBASE, and the Cochrane Library were searched for human studies that compared cerclage placement to no cerclage on the basis of transvaginal ultrasound findings of a short cervix (< or =2.5 cm). Two authors independently determined eligibility and abstracted data. Meta-analyses were conducted when possible., Results: Thirty-five studies were reviewed; 6 studies were eligible and were included in the analysis. There was no statistically significant effect of cerclage on the rates of preterm delivery (<37, <34, <32, and <28 weeks of gestation), preterm labor, neonatal mortality or morbidity, gestational age at delivery, or time to delivery. Birth weight was significantly higher with than without cerclage (P=.004)., Conclusion: The available evidence does not support cerclage for a sonographically detected short cervix. A randomized controlled trial is needed to determine whether this intervention will reduce adverse neonatal outcomes.

The authors report the prenatal diagnosis by ultrasonography of dicephalus dipus dibrachius conjoined twins (with two heads, one body, two legs and two arms) at 31 weeks' gestation. They discuss the types of conjoined twinning and their frequency of occurrence and the criteria for prenatal diagnosis, and they offer recommendations for management.