Journal of Clinical Medicine

Editorial

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6 pages, 182 KiB

Open AccessEditorial

Clinical Ultrasound Applications in Obstetrics and Gynecology in the Year 2024

by Florian Recker, Ulrich Gembruch and Brigitte Strizek

J. Clin. Med. 2024, 13(5), 1244; https://doi.org/10.3390/jcm13051244 - 22 Feb 2024

Cited by 1 | Viewed by 3472

Abstract

Ultrasound imaging stands as a fundamental technology in the realms of obstetrics and gynecology, utilizing high-frequency sound waves to create detailed images of the internal structures of the body [...] Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

Research

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13 pages, 2182 KiB

Open AccessArticle

AI-Enhanced Analysis Reveals Impact of Maternal Diabetes on Subcutaneous Fat Mass in Fetuses without Growth Alterations

by Hector Borboa-Olivares, Johnatan Torres-Torres, Arturo Flores-Pliego, Aurora Espejel-Nuñez, Ignacio Camacho-Arroyo, Mario Guzman-Huerta, Otilia Perichart-Perera, Omar Piña-Ramirez and Guadalupe Estrada-Gutierrez

J. Clin. Med. 2023, 12(20), 6485; https://doi.org/10.3390/jcm12206485 - 12 Oct 2023

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Abstract

Pregnant women with diabetes often present impaired fetal growth, which is less common if maternal diabetes is well-controlled. However, developing strategies to estimate fetal body composition beyond fetal growth that could better predict metabolic complications later in life is essential. This study aimed [...] Read more.

Pregnant women with diabetes often present impaired fetal growth, which is less common if maternal diabetes is well-controlled. However, developing strategies to estimate fetal body composition beyond fetal growth that could better predict metabolic complications later in life is essential. This study aimed to evaluate subcutaneous fat tissue (femur and humerus) in fetuses with normal growth among pregnant women with well-controlled diabetes using a reproducible 3D-ultrasound tool and offline TUI (Tomographic Ultrasound Imaging) analysis. Additionally, three artificial intelligence classifier models were trained and validated to assess the clinical utility of the fetal subcutaneous fat measurement. A significantly larger subcutaneous fat area was found in three-femur and two-humerus selected segments of fetuses from women with diabetes compared to the healthy pregnant control group. The full classifier model that includes subcutaneous fat measure, gestational age, fetal weight, fetal abdominal circumference, maternal body mass index, and fetal weight percentile as variables, showed the best performance, with a detection rate of 70%, considering a false positive rate of 10%, and a positive predictive value of 82%. These findings provide valuable insights into the impact of maternal diabetes on fetal subcutaneous fat tissue as a variable independent of fetal growth. Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

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13 pages, 1308 KiB

Open AccessArticle

Novel Three-Dimensional Body Scan Anthropometry versus MR-Pelvimetry for Vaginal Breech Delivery Assessment

by Anne Dathan-Stumpf, Massimiliano Lia, Christof Meigen, Karoline Bornmann, Mireille Martin, Manuela Aßmann, Wieland Kiess and Holger Stepan

J. Clin. Med. 2023, 12(19), 6181; https://doi.org/10.3390/jcm12196181 - 25 Sep 2023

Cited by 1 | Viewed by 1363

Abstract

In this prospective, monocentric study, we investigated the potency of a novel three-dimensional (3D) body scanner for external pelvic assessment in birth planning for intended vaginal breech delivery. Between April 2021 and June 2022, 73 singleton pregnancies with intended vaginal birth from breech [...] Read more.

In this prospective, monocentric study, we investigated the potency of a novel three-dimensional (3D) body scanner for external pelvic assessment in birth planning for intended vaginal breech delivery. Between April 2021 and June 2022, 73 singleton pregnancies with intended vaginal birth from breech presentation (>36.0 weeks of gestation) were measured using a pelvimeter by Martin, a three-dimensional body scanner, and MR-pelvimetry. Measures were related to vaginal birth and intrapartum cesarean section. A total of 26 outer pelvic dimensions and 7 inner pelvic measurements were determined. The rate of successful vaginal breech delivery was 56.9%. The AUC (area under the curve) of the obstetric conjugate (OC) measured by MRI for predicting the primary outcome was 0.62 (OR 0.63; p = 0.22), adjusted for neonatal birth weight 0.66 (OR 0.60; p = 0.19). Of the 22 measured 3D body scanner values, the ratio of waist girth to maternal height showed the best prediction (AUC = 0.71; OR 1.27; p = 0.015). The best predictive pelvimeter value was the distantia spinarum with an AUC of 0.65 (OR = 0.80). The 3D body scanner technique is at least equal to predict successful vaginal breech delivery compared to MRI diagnostics. Further large-scale, prospective studies are needed to verify these results. Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

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12 pages, 2338 KiB

Open AccessArticle

Spectrum and Outcome of Prenatally Diagnosed Fetal Primary Cardiomyopathies—A Twenty-Year Overview

by Adeline Walter, Elina Calite, Annegret Geipel, Brigitte Strizek, Florian Recker, Ulrike Herberg, Christoph Berg and Ulrich Gembruch

J. Clin. Med. 2023, 12(13), 4366; https://doi.org/10.3390/jcm12134366 - 28 Jun 2023

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Abstract

Objective: to assess the course and outcome of fetuses affected by primary cardiomyopathy (CM). Methods: Retrospective study of 21 cases with prenatal diagnosis of a primary CM in one tertiary center over a period of 20 years. Charts were reviewed for echocardiographic findings, [...] Read more.

Objective: to assess the course and outcome of fetuses affected by primary cardiomyopathy (CM). Methods: Retrospective study of 21 cases with prenatal diagnosis of a primary CM in one tertiary center over a period of 20 years. Charts were reviewed for echocardiographic findings, pregnancy outcome, and postnatal course. The utility of prenatal evaluation was discussed. Results: The mean gestational age (GA) at diagnosis was 26.7 (±5.1) weeks. A total of 33.3% (7/21) had associated anomalies. Genetic etiology was confirmed in 50.0% (10/20, with one case lost to follow up). The overall survival rate of the entire study population was 40% (8/20) including termination of pregnancy in 20% (4/20) and an intrauterine mortality rate of 5% (1/20). Of the initial survivors (n = 15), a neonatal and early infant mortality rate of 46.7% (7/15) was calculated. Prenatal isolated right ventricular involvement was the only identified significant parameter for survival (p = 0.035). Four phenotypical groups were identified: 42.9% (9/21) hypertrophic (HCM), 38.1% (8/21) dilated (DCM), 14.3% (3/21) isolated noncompaction (NCCM), and 4.8% (1/21) restrictive CM (RCM). Fetuses assigned to isolated NCCM revealed a 100% survival rate. Conclusion: Prenatal detection is feasible but needs to a introduce classification method for better consulting and management practices. A poor outcome is still observed in many cases, but an increase in examiners’ awareness may influence optimal multispecialized care. Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

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14 pages, 5663 KiB

Open AccessArticle

Feasibility and Acceptance of Self-Guided Mobile Ultrasound among Pregnant Women in Routine Prenatal Care

by Constanza A. Pontones, Adriana Titzmann, Hanna Huebner, Nina Danzberger, Matthias Ruebner, Lothar Häberle, Bjoern M. Eskofier, Michael Nissen, Sven Kehl, Florian Faschingbauer, Matthias W. Beckmann, Peter A. Fasching and Michael O. Schneider

J. Clin. Med. 2023, 12(13), 4224; https://doi.org/10.3390/jcm12134224 - 22 Jun 2023

Cited by 2 | Viewed by 2129

Abstract

Background and objectives: Mobile and remote ultrasound devices are becoming increasingly available. The benefits and possible risks of self-guided ultrasound examinations conducted by pregnant women at home have not yet been well explored. This study investigated aspects of feasibility and acceptance, as well [...] Read more.

Background and objectives: Mobile and remote ultrasound devices are becoming increasingly available. The benefits and possible risks of self-guided ultrasound examinations conducted by pregnant women at home have not yet been well explored. This study investigated aspects of feasibility and acceptance, as well as the success rates of such examinations. Methods: In this prospective, single-center, interventional study, forty-six women with singleton pregnancies between 17 + 0 and 29 + 6 weeks of gestation were included in two cohorts, using two different mobile ultrasound systems. The participants examined the fetal heartbeat, fetal profile and amniotic fluid. Aspects of feasibility and acceptance were evaluated using a questionnaire. Success rates in relation to image and video quality were evaluated by healthcare professionals. Results: Two thirds of the women were able to imagine performing the self-guided examination at home, but 87.0% would prefer live support by a professional. Concerns about their own safety and that of the child were expressed by 23.9% of the women. Success rates for locating the target structure were 52.2% for videos of the fetal heartbeat, 52.2% for videos of the amniotic fluid in all four quadrants and 17.9% for videos of the fetal profile. Conclusion: These results show wide acceptance of self-examination using mobile systems for fetal ultrasonography during pregnancy. Image quality was adequate for assessing the amniotic fluid and fetal heartbeat in most participants. Further studies are needed to determine whether ultrasound self-examinations can be implemented in prenatal care and how this would affect the fetomaternal outcome Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

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11 pages, 791 KiB

Open AccessArticle

Fetal Cerebellar Area: Ultrasound Reference Ranges at 13–39 Weeks of Gestation

by Luigi Manzo, Giuliana Orlandi, Olimpia Gabrielli, Paolo Toscano, Enrica Di Lella, Antonia Lettieri, Laura Letizia Mazzarelli, Giordana Sica, Letizia Di Meglio, Lavinia Di Meglio, Gabriele Ruffo, Carmine Sica, Ferdinando Antonio Gulino, Giosuè Giordano Incognito, Attilio Tuscano, Alice Giorno and Aniello Di Meglio

J. Clin. Med. 2023, 12(12), 4080; https://doi.org/10.3390/jcm12124080 - 16 Jun 2023

Cited by 1 | Viewed by 4553

Abstract

Background and Objectives: The present study aims to provide prenatal 2-dimensional ultrasonographic (2D-US) nomograms of the normal cerebellar area. Materials and Methods: This is a prospective cross-sectional analysis of 252 normal singleton pregnancies, ranging from 13 to 39 weeks of gestation. The operator [...] Read more.

Background and Objectives: The present study aims to provide prenatal 2-dimensional ultrasonographic (2D-US) nomograms of the normal cerebellar area. Materials and Methods: This is a prospective cross-sectional analysis of 252 normal singleton pregnancies, ranging from 13 to 39 weeks of gestation. The operator performed measurements of the fetal cerebellar area in the transverse plane using 2D-US. The relationship between cerebellar area and gestational age (GA) was determined through regression equations. Results: A significant, strong positive correlation was investigated between the cerebellar area with GA (r-value = 0.89), and a positive correlation indicates that with increasing GA, the cerebellar area increased in all the participants of the study. Several 2D-US nomograms of the normal cerebellar area were provided, and an increase of 0.4% in the cerebellar area each week of GA was reported. Conclusions: We presented information on the typical dimensions of the fetal cerebellar area throughout gestation. In future studies, it could be evaluated how the cerebellar area changes with cerebellar abnormalities. It should be established if calculating the cerebellar area in addition to the routine transverse cerebellar diameter may help in discriminating posterior fossa anomalies or even help to identify anomalies that would otherwise remain undetected. Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

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15 pages, 16833 KiB

Open AccessArticle

Predicting Preterm Birth with Strain Ratio Analysis of the Internal Cervical Os: A Prospective Study

by Alina-Madalina Luca, Raluca Haba, Luiza-Maria Cobzeanu, Dragos Nemescu, Anamaria Harabor, Raluca Mogos, Ana-Maria Adam, Valeriu Harabor, Aurel Nechita, Gigi Adam, Alexandru Carauleanu, Sadiye-Ioana Scripcariu, Ingrid-Andrada Vasilache, Tudor Gisca and Demetra Socolov

J. Clin. Med. 2023, 12(12), 3885; https://doi.org/10.3390/jcm12123885 - 7 Jun 2023

Cited by 1 | Viewed by 1420

Abstract

(1) Background: Cervical elastography is a new concept that could allow clinicians to assess cervical consistency in various clinical scenarios. We aimed to evaluate the predictive performance of the strain ratio (SR) at the level of the internal os, either individually or in [...] Read more.

(1) Background: Cervical elastography is a new concept that could allow clinicians to assess cervical consistency in various clinical scenarios. We aimed to evaluate the predictive performance of the strain ratio (SR) at the level of the internal os, either individually or in combination with other parameters, in the prediction of spontaneous preterm birth (PTB) at various gestational ages. (2) Methods: This prospective study included 114 pregnant patients with a high-risk profile for PTB who underwent cervical elastography during the second trimester. Clinical and paraclinical data were assessed using univariate analysis, logistic regression, and sensitivity analysis. (3) Results: The SR achieved an area under the receiver operating curve (AUROC) value of 0.850, a sensitivity of 85.71%, and a specificity of 84.31% in the prediction of PTB before 37 weeks of gestation. The combined model showed superior results in terms of accuracy (AUROC = 0.938), sensitivity (92.31%), and specificity (95.16%). When considering PTB subtypes, the highest AUROC value (0.80) and accuracy (95.61%) of this marker were achieved in the prediction of extremely preterm birth, before 28 weeks of gestation. (4) Conclusions: The SR achieved an overall good predictive performance in the prediction of PTB and could be further evaluated in various cohorts of patients. Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

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11 pages, 1421 KiB

Open AccessArticle

Prediction of Neonatal Respiratory Morbidity Assessed by Quantitative Ultrasound Lung Texture Analysis in Twin Pregnancies

by Ana L. Moreno-Espinosa, Ameth Hawkins-Villarreal, David Coronado-Gutierrez, Xavier P. Burgos-Artizzu, Raigam J. Martínez-Portilla, Tatiana Peña-Ramirez, Dahiana M. Gallo, Stefan R. Hansson, Eduard Gratacòs and Montse Palacio

J. Clin. Med. 2022, 11(16), 4895; https://doi.org/10.3390/jcm11164895 - 20 Aug 2022

Cited by 1 | Viewed by 2153

Abstract

The objective of this study was to evaluate the performance of quantitative ultrasound of fetal lung texture analysis in predicting neonatal respiratory morbidity (NRM) in twin pregnancies. This was an ambispective study involving consecutive cases. Eligible cases included twin pregnancies between 27.0 and [...] Read more.

The objective of this study was to evaluate the performance of quantitative ultrasound of fetal lung texture analysis in predicting neonatal respiratory morbidity (NRM) in twin pregnancies. This was an ambispective study involving consecutive cases. Eligible cases included twin pregnancies between 27.0 and 38.6 weeks of gestation, for which an ultrasound image of the fetal thorax was obtained within 48 h of delivery. Images were analyzed using quantusFLM^® version 3.0. The primary outcome of this study was neonatal respiratory morbidity, defined as the occurrence of either transient tachypnea of the newborn or respiratory distress syndrome. The performance of quantusFLM^® in predicting NRM was analyzed by matching quantitative ultrasound analysis and clinical outcomes. This study included 166 images. Neonatal respiratory morbidity occurred in 12.7% of cases, and it was predicted by quantusFLM^® analysis with an overall sensitivity of 42.9%, specificity of 95.9%, positive predictive value of 60%, and negative predictive value of 92.1%. The accuracy was 89.2%, with a positive likelihood ratio of 10.4, and a negative likelihood ratio of 0.6. The results of this study demonstrate the good prediction capability of NRM in twin pregnancies using a non-invasive lung texture analysis software. The test showed an overall good performance with high specificity, negative predictive value, and accuracy. Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

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Other

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4 pages, 206 KiB

Open AccessReply

Reply to Rubin, J.M.; Kripfgans, O.D. Comment on “Barbieri et al. Umbilical Vein Blood Flow in Uncomplicated Pregnancies: Systematic Review of Available Reference Charts and Comparison with a New Cohort. J. Clin. Med. 2023, 12, 3132”

by Moira Barbieri, Enrico Mario Ferrazzi and Tamara Stampalija

J. Clin. Med. 2024, 13(9), 2654; https://doi.org/10.3390/jcm13092654 - 30 Apr 2024

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Abstract

We thank the authors for the interest in our paper [...] Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

3 pages, 167 KiB

Open AccessComment

Comment on Barbieri et al. Umbilical Vein Blood Flow in Uncomplicated Pregnancies: Systematic Review of Available Reference Charts and Comparison with a New Cohort. J. Clin. Med. 2023, 12, 3132

by Jonathan M. Rubin and Oliver D. Kripfgans

J. Clin. Med. 2024, 13(8), 2347; https://doi.org/10.3390/jcm13082347 - 18 Apr 2024

Cited by 1 | Viewed by 619

Abstract

We would like to comment on the systemic review article published in the Journal of Clinical Medicine by Barbieri et al [...] Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

31 pages, 3442 KiB

Open AccessSystematic Review

Evolving the Era of 5D Ultrasound? A Systematic Literature Review on the Applications for Artificial Intelligence Ultrasound Imaging in Obstetrics and Gynecology

by Elena Jost, Philipp Kosian, Jorge Jimenez Cruz, Shadi Albarqouni, Ulrich Gembruch, Brigitte Strizek and Florian Recker

J. Clin. Med. 2023, 12(21), 6833; https://doi.org/10.3390/jcm12216833 - 29 Oct 2023

Cited by 15 | Viewed by 3543

Abstract

Artificial intelligence (AI) has gained prominence in medical imaging, particularly in obstetrics and gynecology (OB/GYN), where ultrasound (US) is the preferred method. It is considered cost effective and easily accessible but is time consuming and hindered by the need for specialized training. To [...] Read more.

Artificial intelligence (AI) has gained prominence in medical imaging, particularly in obstetrics and gynecology (OB/GYN), where ultrasound (US) is the preferred method. It is considered cost effective and easily accessible but is time consuming and hindered by the need for specialized training. To overcome these limitations, AI models have been proposed for automated plane acquisition, anatomical measurements, and pathology detection. This study aims to overview recent literature on AI applications in OB/GYN US imaging, highlighting their benefits and limitations. For the methodology, a systematic literature search was performed in the PubMed and Cochrane Library databases. Matching abstracts were screened based on the PICOS (Participants, Intervention or Exposure, Comparison, Outcome, Study type) scheme. Articles with full text copies were distributed to the sections of OB/GYN and their research topics. As a result, this review includes 189 articles published from 1994 to 2023. Among these, 148 focus on obstetrics and 41 on gynecology. AI-assisted US applications span fetal biometry, echocardiography, or neurosonography, as well as the identification of adnexal and breast masses, and assessment of the endometrium and pelvic floor. To conclude, the applications for AI-assisted US in OB/GYN are abundant, especially in the subspecialty of obstetrics. However, while most studies focus on common application fields such as fetal biometry, this review outlines emerging and still experimental fields to promote further research. Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

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9 pages, 1127 KiB

Open AccessProtocol

Study Protocol of a Prospective, Monocentric, Single-Arm Study Investigating the Safety and Efficacy of Local Ablation of Symptomatic Uterine Fibroids with US-Guided High-Intensity Focused Ultrasound (HIFU)

by Dieter M. Matlac, Tolga Tonguc, Nikola Mutschler, Florian Recker, Olga Ramig, Holger M. Strunk, Tatjana Dell, Claus C. Pieper, Martin Coenen, Christine Fuhrmann, Oregan Vautey, Eva-Katharina Egger, Jim Küppers, Rupert Conrad, Markus Essler, Alexander Mustea and Milka Marinova

J. Clin. Med. 2023, 12(18), 5926; https://doi.org/10.3390/jcm12185926 - 12 Sep 2023

Cited by 1 | Viewed by 1515

Abstract

Uterine fibroids are the most common benign tumors of the uterus. Approximately 20–50% of women with myomas experience a variety of symptoms such as vaginal bleeding, abdominal pain, pelvic pain and pressure, and urological problems, possibly interfering with fertility and pregnancy. Although surgery [...] Read more.

Uterine fibroids are the most common benign tumors of the uterus. Approximately 20–50% of women with myomas experience a variety of symptoms such as vaginal bleeding, abdominal pain, pelvic pain and pressure, and urological problems, possibly interfering with fertility and pregnancy. Although surgery remains the standard treatment option for fibroids, non-invasive therapeutic options, such as high-intensity focused ultrasound (HIFU), have emerged over the last dec ade. During HIFU, ultrasound is focused on the target tissue causing coagulation necrosis. HIFU has, meanwhile, become an established method for treating uterine fibroids in many countries. Clinical data have shown that it effectively alleviates fibroid-related symptoms and reduces fibroid size with a very low rate of side effects. However, there is a lack of data on how this treatment affects laboratory parameters and structural features of uterine tissue. As our center is the only one in German-speaking countries where ultrasound-guided HIFU technology is currently established, the aim of this prospective, monocentric, single-arm trial is not only to evaluate the safety and efficacy of local US-guided HIFU in symptomatic uterine fibroid patients according to GCP standards but also to explore its effects on blood parameters and the structural integrity of uterine tissue using elastographic methods. Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

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9 pages, 9704 KiB

Open AccessCase Report

Intraoperative Utilization of Indocyanine Green (ICG) Dye for the Assessment of Ovarian Perfusion—Case Report and Review of the Literature

by Ruben Plöger, Mateja Condic, Damian J. Ralser, Hannah M. Plöger, Eva K. Egger, Lucia A. Otten and Alexander Mustea

J. Clin. Med. 2023, 12(18), 5923; https://doi.org/10.3390/jcm12185923 - 12 Sep 2023

Cited by 2 | Viewed by 1188

Abstract

The assessment of ovarian perfusion after detorsion is crucial in the surgical management of patients with ovarian torsion. In current routine clinical practice, the surgical decision (preservation of the ovary versus oophorectomy) is based on the subjective impression of the surgeon. Intraoperative indocyanine [...] Read more.

The assessment of ovarian perfusion after detorsion is crucial in the surgical management of patients with ovarian torsion. In current routine clinical practice, the surgical decision (preservation of the ovary versus oophorectomy) is based on the subjective impression of the surgeon. Intraoperative indocyanine green (ICG) angiography has been shown to sufficiently reflect tissue perfusion with a potential impact on the surgical procedure. Currently, there are only sparse data available on the utilization of ICG in the surgical treatment of ovarian torsion. Here, we describe the successful intraoperative use of ICG in a 17-year-old female patient with ovarian torsion who underwent ovary-preserving surgery. Further, a systematic literature review was performed. Based on the data available to date, the use of ICG in the surgical treatment of ovarian torsion is feasible and safe. The extent to which this might reduce the necessity for oophorectomy has to be evaluated in further investigations. Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

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12 pages, 5899 KiB

Open AccessSystematic Review

Prenatal Diagnosis of an Intrathoracic Left Kidney Associated with Congenital Diaphragmatic Hernia: Case Report and Systematic Review

by Giuliana Orlandi, Paolo Toscano, Olimpia Gabrielli, Enrica Di Lella, Antonia Lettieri, Luigi Manzo, Laura Letizia Mazzarelli, Carmine Sica, Letizia Di Meglio, Lavinia Di Meglio, Ferdinando Antonio Gulino, Giosuè Giordano Incognito, Attilio Tuscano, Stefano Cianci and Aniello Di Meglio

J. Clin. Med. 2023, 12(11), 3608; https://doi.org/10.3390/jcm12113608 - 23 May 2023

Cited by 6 | Viewed by 1939

Abstract

Introduction: A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration, diaphragmatic hernia, and traumatic diaphragmatic rupture. We report a case of a prenatal-diagnosed ITK related to a congenital [...] Read more.

Introduction: A congenital intrathoracic kidney (ITK) is a rare anomaly that is recognized to have four causes: renal ectopia with an intact diaphragm, diaphragmatic eventration, diaphragmatic hernia, and traumatic diaphragmatic rupture. We report a case of a prenatal-diagnosed ITK related to a congenital diaphragmatic hernia (CDH) and conducted a systematic review of all cases of the prenatal diagnosis of this association. Case presentation: A fetal ultrasound scan at 22 gestational weeks showed left CDH and ITK, hyperechoic left lung parenchyma, and mediastinal shift. The fetal echocardiography and karyotype were normal. Magnetic resonance imaging at 30 gestational weeks confirmed the ultrasound suspicion of left CDH in association with bowel and left kidney herniation. The fetal growth, amniotic fluid, and Doppler indices remained within the normal range over time. The woman delivered the newborn via an at-term spontaneous vaginal delivery. The newborn was stabilized and underwent non-urgent surgical correction; the postoperative course was uneventful. Conclusions: CDH is the rarest cause of ITK; we found only eleven cases describing this association. The mean gestational age at diagnosis was 29 ± 4 weeks and 4 days. There were seven cases of right and four cases of left CDH. There were associated anomalies in only three fetuses. All women delivered live babies, the herniated kidneys showed no functional damage after their surgical correction, and the prognosis was favorable after surgical repair. The prenatal diagnosis and counseling of this condition are important in planning adequate prenatal and postnatal management in order to improve neonatal outcomes. Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

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16 pages, 4184 KiB

Open AccessSystematic Review

Umbilical Vein Blood Flow in Uncomplicated Pregnancies: Systematic Review of Available Reference Charts and Comparison with a New Cohort

by Moira Barbieri, Giulia Zamagni, Ilaria Fantasia, Lorenzo Monasta, Leila Lo Bello, Mariachiara Quadrifoglio, Giuseppe Ricci, Gianpaolo Maso, Monica Piccoli, Daniela Denis Di Martino, Enrico Mario Ferrazzi and Tamara Stampalija

J. Clin. Med. 2023, 12(9), 3132; https://doi.org/10.3390/jcm12093132 - 26 Apr 2023

Cited by 2 | Viewed by 1827

Abstract

The objectives of the study were (1) to perform a systematic review of the available umbilical vein blood flow volume (UV-Q) reference ranges in uncomplicated pregnancies; and (2) to compare the findings of the systematic review with UV-Q values obtained from a local [...] Read more.

The objectives of the study were (1) to perform a systematic review of the available umbilical vein blood flow volume (UV-Q) reference ranges in uncomplicated pregnancies; and (2) to compare the findings of the systematic review with UV-Q values obtained from a local cohort. Available literature in the English language on this topic was identified following the PRISMA guidelines. Selected original articles were further grouped based on the UV sampling sites and the formulae used to compute UV-Q. The 50th percentiles, the means, or the best-fitting curves were derived from the formulae or the reported tables presented by authors. A prospective observational study of uncomplicated singleton pregnancies from 20⁺⁰ to 40⁺⁶ weeks of gestation was conducted to compare UV-Q with the results of this systematic review. Fifteen sets of data (fourteen sets belonging to manuscripts identified by the research strategy and one obtained from our cohort) were compared. Overall, there was a substantial heterogeneity among the reported UV-Q central values, although when using the same sampling methodology and formulae, the values overlap. Our data suggest that when adhering to the same methodology, the UV-Q assessment is accurate and reproducible, thus encouraging further investigation on the possible clinical applications of this measurement in clinical practice. Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

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9 pages, 1877 KiB

Open AccessCase Report

Body Stalk Anomaly Complicated by Ectopia Cordis: First-Trimester Diagnosis of Two Cases Using 2- and 3-Dimensional Sonography

by Elisa Pappalardo, Ferdinando Antonio Gulino, Carla Ettore, Francesco Cannone and Giuseppe Ettore

J. Clin. Med. 2023, 12(5), 1896; https://doi.org/10.3390/jcm12051896 - 27 Feb 2023

Cited by 6 | Viewed by 2422

Abstract

Introduction: Body stalk anomaly is a severe defect of the abdominal wall, characterized by the evisceration of abdominal organs and, in more severe cases, thoracic organs as well. The most serious condition in a body stalk anomaly may be complicated by ectopia cordis, [...] Read more.

Introduction: Body stalk anomaly is a severe defect of the abdominal wall, characterized by the evisceration of abdominal organs and, in more severe cases, thoracic organs as well. The most serious condition in a body stalk anomaly may be complicated by ectopia cordis, an abnormal location of the heart outside the thorax. The aim of this scientific work is to describe our experience with the prenatal diagnosis of ectopia cordis as part of the first-trimester sonographic screening for aneuploidy. Methods: We report two cases of body stalk anomalies complicated by ectopia cordis. The first case was identified during a first ultrasound examination at 9 weeks of gestation. The second was identified during an ultrasound examination at 13 weeks of gestation. Both of these cases were diagnosed using high-quality 2- and 3-dimensional ultrasonographic images obtained by the Realistic Vue and Crystal Vue techniques. The chorionic villus sampling showed that the fetal karyotype and CGH-array were both normal. Results: In our clinical case reports, the patients, immediately after the diagnosis of a body stalk anomaly complicated by ectopia cordis, opted for the termination of pregnancies. Conclusion: Performing an early diagnosis of a body stalk anomaly that is complicated by ectopia cordis is desirable, considering their poor prognoses. Most of the reported cases in the literature suggest that an early diagnosis can be made between 10 and 14 weeks of gestation. A combination of 2- and 3-dimensional sonography could allow an early diagnosis of body stalk anomalies complicated by ectopia cordis, particularly using new ultrasonographic techniques, the Realistic Vue and the Crystal Vue. Full article

(This article belongs to the Special Issue Clinical Imaging Applications in Obstetrics and Gynecology)

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