Background Congenital Heart Disease represents the most frequent fetal malformation. The lack of prenatal identification of congenital heart defects can have adverse consequences for the neonate, while a correct prenatal diagnosis of specific cardiac anomalies improves neonatal care neurologic and surgery outcomes. Sonographers perform prenatal diagnosis manually during the first or second-trimester scan, but the reported detection rates are low. This project’s primary objective is to develop an Intelligent Decision Support System that uses two-dimensional video files of cardiac sweeps obtained during the standard first-trimester fetal echocardiography (FE) to signal the presence/absence of previously learned key features. Methods The cross-sectional study will be divided into a training part of the machine learning approaches and the testing phase on previously unseen frames and eventually on actual video scans. Pregnant women in their 12–13 + 6 weeks of gestation admitted for routine first-trimester anomaly scan will be consecutively included in a two-year study, depending on the availability of the experienced sonographers in early fetal cardiac imaging involved in this research. The Data Science / IT department (DSIT) will process the key planes identified by the sonographers in the two- dimensional heart cine loop sweeps: four-chamber view, left and right ventricular outflow tracts, three vessels, and trachea view. The frames will be grouped into the classes representing the plane views, and then different state-of-the- art deep-learning (DL) pre-trained algorithms will be tested on the data set. The sonographers will validate all the intermediary findings at the frame level and the meaningfulness of the video labeling. Discussion FE is feasible and efficient during the first trimester. Still, the continuous training process is impaired by the lack of specialists or their limited availability. Therefore, in our study design, the sonographer benefits from a second opinion provided by the developed software, which may be very helpful, especially if a more experienced colleague is unavailable. In addition, the software may be implemented on the ultrasound device so that the process could take place during the live examination. Trial registration The study is registered under the name „Learning deep architectures for the Interpretation of Fetal Echocardiography (LIFE)”, project number 408PED/2020, project code PN-III-P2–2.1-PED-2019. Trial registration: ClinicalTrials.gov, unique identifying number NCT05090306, date of registration 30.10.2020.
Intrauterine devices (IUDs) represent one of the most important methods used for contraception. The methods vary in terms of efficiency, acceptability, costs, and potential complications. Early methods have been improved, and ultrasound (US) evaluation has become an important tool to diagnose the clear majority of IUDs complications. This chapter presents a comprehensive and up-to-date status regarding the use of intrauterine devices (IUDs) for birth control and family planning. The topics discussed in the manuscript will involve the current knowledge on the history, types, mechanisms, health benefits, and risks. More, the present paper presents the medical techniques for inserting and removing a IUD, and the role of US to confirm proper IUD placement. Also, this chapter offers practical guidance in managing problems of continuing users and discusses the clinical circumstances that require reconsideration of the contraception methods.
Open spina bifida (OSB) is a non-lethal fetal anomaly, yet often leads to severe disability. Most cases of open spina bifida are detected at the second trimester fetal anomaly ultrasound scan. The 11 to 13 weeks of amenorrhea scan evolved over the last 20 years from essentially a dating scan, to a genetic scan, and recently to one which includes, in addition to the genetic markers, a basic checklist for examination of the whole fetal anatomy. The direct visualization of the spine at the first trimester (FT) scan remained difficult, despite the wider use of high-reso lution ultrasound machines and the volumetric approach. Thus, indirect intracranial morphological markers for OSB were proposed to diagnose this neural tube defect.The present review aims to describe the specific anatomical feature of the spine and the posterior brain, both on parasagittal and on axial planes, recently proposed for the early detection of OSB.Specialists involved in the prenatal diagnosis will eventually elaborate in the future a screening protocol for OSB in the FT of pregnancy, using the most valuable and easy to obtain marker, in a single 2D plane.The offer of an early diagnosis of possible severe anomalies, such as OSB, is a tool enhancing the autonomy of the pregnant woman.
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