What are the novel findings of this work? We describe a new sonographic sign, the 'superimposedline' sign, for evaluation of the fetal secondary palate in early gestation on two-dimensional imaging of the vomeromaxillary junction in the midsagittal view. What are the clinical implications of this work? Inclusion of this sign during the routine nuchal translucency scan should improve screening and early detection of secondary palatine clefts. This sign also facilitates evaluation of cleft extension into the secondary palate when a defect in the premaxilla is identified.
The purpose of the study is to report on the application of tomographic ultrasound imaging (TUI) in prenatal sonographic study of fetal palate in 11–14 week scan. TUI is a technology that allows the examiner to obtain a volume data set that allows the display of numerous 2D slices from a given volume on any of the three orthogonal planes. It allows automatic slicing of the volume datasets displaying multiple parallel images. The fetal palate was examined with TUI in thirteen abnormal volumes and in ninety-four normal volumes. The appearance of maxillary line in sagittal sections and the base of the retronasal triangle in coronal sections serve as key landmarks in evaluating palatine clefts. The intact palatal line in sagittal sections was observed in all the ninety-four normal volumes. The midline anatomy of the palate has been described in the study emphasising that the vomer can mimic palate in midsagittal section in secondary palatine clefts. The parasagittal sections truly reflects the presence or absence of the palate without the confounding factor of the vomer bone which was demonstrated in the abnormal volumes with TUI. The potential advantage of TUI in evaluating palate is that it allows the display of both midsagittal and parasagittal sections simultaneously. The different types of cleft have a constant reproducible pattern in TUI imaging which can be used to diagnose palatine clefts including isolated cleft of palate. Prospective studies are needed to confirm these promising results.
One of the most promising screening tools in detection of PE and FGR is uterine artery Doppler velocimetry. The underlying pathology for the development of PE is thought to be due to defective trophoblastic invasion of uterine spiral arteries. Increased impedance during mid-trimester is known to be associated with a high incidence of adverse pregnancy outcomes. High resistance in uterine arteries can be observed as early in the first trimester in cases with impaired placentation. The predictive efficacy of first trimester UtA Doppler has improved after the development of risk specific algorithm by including maternal characteristics, biophysical and biochemical parameters. With the understanding of late onset FGR and PE, it was realised that first trimester UtA Doppler may not serve as an efficient marker to identify this group which led to the evolution of its assessment in third trimester. The importance of UtA Doppler in third trimester is its ability to differentiate a physiologically small baby from a pathologically small fetus, which is growth restricted. PE and FGR remains an important cause of maternal and fetal mortality and its prediction is a challenging task which needs to be done early in gestation.Low dose aspirin when started before 16 weeks in the truly high risk population has proven to significantly reduce PE and FGR. To initiate aspirin therapy, the development of first trimester risk prediction model remains the key component. This paper is a review of the predictive efficacy of UtA Doppler in detecting uteroplacental insufficiency in each of the three trimesters.
Poster discussion hub abstracts dioxide (p=0.015) were significantly elevated in winter and spring seasons compared to summer and fall. There were no differences in incidence of different types of congenital anomalies among different seasons. There were no differences in concentrations of air pollutants among different types of anomalies. Conclusions: Our findings suggest no association between maternal exposure to air pollutants at the time of conception according to different types of congenital anomalies.
Objectives: We compared simultaneous fetal echo AV intervals (E-AV) and magentocardiogram (fMCG) PR intervals (M-PR) in SSA+ and control pregnancies to determine if an AV interval of + 2 z-scores correlated with a prolonged M-PR interval and 1 • AV block. Methods: We searched the database of the University of Wisconsin Biomagnetism laboratory for pregnant women referred for fMCG with SSA antibodies. Maternal and pregnancy data were obtained from the mother's medical record. Fetal MCGs were performed using a 37-channel biomagnetometer (Magnes, 4D Neuroimaging, Inc). During the same session, we measured and averaged PR and cardiac RR intervals from 5 rhythm tracings and compared results to Echo Doppler AV interval (mitral inflow/aortic outflow) and RR intervals. Results were normalised for RR interval and compared by paired t-test. Regression analysis was used to test associations between gestational age (GA) and cardiac intervals. Results: The mean M-PR was 23.3 ms less than the mean E-AV (95% CI: 20.1,26.5, p<0.001); this statistically significant difference persisted when normalised for RR interval. There were no significant differences between SSA and controls for RR, PR, or AV intervals. Neither E-RR interval or GA were associated with predicting E-AV; nor were M-RR or GA associated with predicting M-PR. However, the interaction between E-AV interval and GA were significantly associated with the AV-PR difference of 23.3 ms. Conclusions: Our results suggests that E-AV overestimates M-PR in both SSA and controls. Using the previous definition of 1 • AVB (an AV interval of 150 ms) may result in unnecessary treatment of SSA+ normal fetuses.
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