Ultrasound diagnostic imaging, having been used in Germany in the trauma setting for more than 15 years, has unique qualities that give it distinct advantages over other tests (DPL, CT), and is gradually gaining acceptance by surgeons in the United States. In this prospective study, experienced surgeon sonographers successfully used ultrasound as the primary adjuvant modality to detect hemoperitoneum and pericardial effusion in injured patients. The ultrasound evaluations of 371 patients demonstrated that in 65 patients with significant injuries, ultrasound detected 53, that is, had an 81.5% sensitivity and 99.7% specificity. They conclude that ultrasound should be the primary adjuvant instrument for the evaluation of injured patients because it is rapid, accurate, and is potentially cost-effective.

Our objective was to determine the incidence and rate of persistence of placenta previa diagnosed at 15-20 weeks' gestation by using transvaginal sonography (TVS), and to describe the characteristics of TVS that predict placenta previa at delivery. Patients having placental tissue within 20 mm of the cervical os were prospectively identified by transabdominal ultrasound and underwent TVS. The distance of the placental edge from the cervical os was measured in millimeters. Characteristics of TVS predicting placenta previa at delivery were analyzed by logistic regression. The incidence of placenta previa diagnosed by TVS at 15-20 weeks was 1.1%; 14% persisted until delivery. Gestational age at the time of TVS and the distance of the placental edge to the cervical os helped predict placenta previa at delivery. Between 15 and 24 weeks' gestation, placenta overlapping the internal os by > or = 10 mm identified patients at risk of placenta previa at delivery with 100% sensitivity and 85% specificity. The use of TVS in the second trimester to diagnose placenta previa resulted in a lower incidence than was historically reported with the use of transabdominal ultrasound. The distance of the placental edge from the cervical os helps identify patients at risk of previa at delivery.

The purpose of this study was to determine in what percentage of cases the assessment of placental localization using transabdominal sonography (TAS) was changed after transvaginal sonography (TVS) was applied. TVS was prospectively performed on all pregnant women of at least 15 weeks' gestation, when the placental edge using TAS appeared to be over or within 2 cm (low-lying) of the internal cervical os. The time required for the TVS scan and the distance of the placental edge from the internal cervical os were recorded. Of the 168 patients entered into the study, 131 were analyzed. Landmarks were poorly seen in 50% of the cases when using TAS. In 66 cases, the placenta appeared low or possibly over the internal cervical os using TAS, but a definitive diagnosis could not be made due to suboptimal visualization. In the remaining 65 cases, visualization of the internal os and placental edge was possible using both TAS and TVS. In this group, there was a change in the diagnosis in 26% of the cases after TVS was performed. Our results suggest that optimal visualization of the placental edge and internal cervical os is usually difficult with TAS when the placenta appears low-lying or over the internal cervical os. The assessment of placental localization was changed in over one-quarter of cases (26%) after transvaginal sonography was performed. The use of transvaginal ultrasound should be seriously considered when the placenta appears to be low or over the internal cervical os by transabdominal ultrasound.

Although left cardiac axis deviation can occur as an isolated sonographic finding in an otherwise normal fetus, most cases will demonstrate abnormalities of cardiac and/or extracardiac anatomy. Left cardiac axis deviation is largely associated with cardiac abnormalities, especially conotruncal anomalies, which may not be detectable by a four-chamber view alone. Therefore, the cardiac axis should be examined routinely as part of the four-chamber view of the fetal heart.

No abstract

The sensitivity of sonographic screening to defect fetal cardiac anomalies varies with the type of lesion. Isolated septal defects are the most difficult lesions to detect.

Cardiac asymmetry was present in two-thirds of fetuses with cardiac anomalies diagnosed prenatally. If cardiac asymmetry is found, a more thorough examination of the fetal heart is indicated.

Our validation study examined a three-dimensional ultrasonographic phantom that contained irregularly shaped volume targets ranging from 0.5 to 76.1 milliliters. Four different examiners made blinded measurements from volume datasets that were acquired by 4 and 7 MHz transducers. Birthweight predictions using abdominal and thigh volumes from 18 term fetuses also were compared with twodimensional ultrasonographic methods. In vitro volume measurements were accurate, precise, and repeatable despite a small systematic overestimation with increasing object size. Mean systematic error and precision for birthweight predictions by three-dimensional ultrasonography (-0.03% ± 6.1 %) were not significantly different from those by two-ABBREVIATIONS 3DU5, Three-dimensional