Congenital hemangiomata are rare benign vascular tumors, presenting as fully mature lesions at birth. Three types have been described; the “rapidly involuting congenital hemangioma” (RICH), the “non-involuting congenital hemangioma” (NICH)and the “partially involuting congenital hemangioma” (PICH). We herein report on a RICH type congenital hemangioma, identified during a fetal morphology ultrasound performed at 19 weeks’ gestation. Early diagnosis allowed close surveillance of the fetus and neonate and observation of the natural course of this lesion. Although being a potentially life-threatening condition, no intervention was required. It presented as a 4 cm vascular tumor on the forehead at time of the cesarean section and diminished rapidly over the first 4 neonatal months, resulting in some skin excess and discoloration which is expected to entirely resolve by 14 months of age.
Objectives:To estimate the risk of miscarriage and stillbirth following first trimester risk assessment among women pregnant after in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) or intrauterine insemination (IUI) compared to spontaneously conceived pregnancies (SCP) Objectives: To develop an intervention to assist operators to improve their NT (nuchal translucency) technique with the aim of having a NT distribution within the appropriate range. Methods: All Australian operators who are accredited to measure NT undergo annual review of their clinical practice. Their NT data is assessed to check that an acceptable proportion of measurements (40-60%) lie above the gestation-related median. Operators with NT distributions falling outside of the acceptable range undertook a teleconference tutorial.Tutorials were offered on a fortnightly basis and involved two tutors, a sonographer experienced in NT education and the quality program manager. The tutorial lasted 60 minutes. By using desktop sharing software the operators and the tutors were able to review a series of images together and establish a mechanism for improving operator technique. The quality program manager reinforced the concepts of audit, how performance is measured and how the first trimester screening software program calculates the risks for Down syndrome and other chromosome abnormalities. Discussion was encouraged in an attempt to dispel some common misconceptions. Results: In 2011 there were 1254 operators performing NT scans in Australia. After the annual audit in 2011, 106 operators were found to have a NT distribution falling outside the acceptable range, 98 operators were under-measuring and 8 were over-measuring (range: 8.43% -83.33% above the median), these operators undertook a teleconference tutorial.In the 2012 audit of results 103 of these106 operators remained active, 69/103 (71.07%) had improved their distributions to the acceptable range. Conclusions: Teleconference Tutorials are an effective way of improving operator distributions for NT measurement.
Objective: To develop reference ranges for the ductus venosus (DV) and tricuspid valve (TV) waveforms at 11-14 weeks and define auditable standards to assess operator measurement performance. Materials and methods: A single operator prospectively obtained quantitative measurements of a number of DV and TV Doppler indices to develop medians and 90% reference intervals (RIs). Measurement agreement studies between two experienced operators were also performed. The measurement bias of three additional operators was subsequently assessed using the newly defined auditable standards. Results: Doppler measurements were obtained in 292 patients (DV) and 321 patients (TV). Reference ranges were constructed for DV pulsatility index for veins (PIV) which did not change over gestation (mean 1.06; 90% RI 0.86-1.23) and for the TV E-A ratio reference range which was positively correlated with gestation. Measurement agreement studies on 30 additional patients showed the within-operator agreement was almost perfect for DV PIV (ICC, intraclass correlation 0.82-0.86) and strong for TV E-A ratio (ICC 0.68-0.78) while the between-operator agreement was good for both DV PIV and TV E-A ratio measurements (ICC 0.46 for both). Discussion: Development of local reference ranges enabled the definition of quantitative auditable standards that can be utilised in assessment of operator training and ongoing Doppler measurement quality assurance. Measurements of DV PIV and TV E-A ratio by experienced operators were found to be reproducible.
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