First trimester screening can predict adverse pregnancy outcomes

Abstract

Methods: We retrospectively reviewed and performed 4D-HDFI in 204 normal and 33 fetuses with confirmed diagnosis of cardiac anomalies of the great arteries. Cardiac volumes were available for post-analysis to obtain 4D rendered images of the great arteries. For the normal fetuses, two other traditional modalities including colour Doppler and HDFI were used to detect aortic arch and its branches and comparisons were made between each of these traditional methods and 4D-HDFI. Results: Two cases of interrupted aortic arch (IAA) type A, 3 cases of IAA type B, 5 cases of tetralogy of Fallot, 3 cases of double outlet right ventricle, 2 cases of truncus arteriosus, 2 cases of transposition of the great arteries, 2 cases of double aortic arch, 11 cases of right aortic arch with aberrant left subclavian arteries, 1 case of right aortic arch with mirror-image branching, and 2 cases of aberrant right subclavian artery were included in the current study. The 4D rendered images vividly depicted the origination, course, and the spatial relationship of the great arteries. For the normal fetuses, HDFI modality was superior to colour Doppler in detecting more brachiocephalic arteries throughout the gestational period. 4D-HDFI was the best method during the second trimester of pregnancy in identifying the greatest number of brachiocephalic arteries. Conclusions: HDFI and the advanced 4D-HDFI technique could facilitate identification of the anatomical features of the great arteries in both normal and abnormal fetuses, 4D-HDFI therefore provides additional and more precise information than conventional sonography techniques. Objectives: Prediction of pre-eclampsia (PE) before 34 and 37 weeks' at 11-14 weeks' in nulliparous women. Methods: All nulliparous women attending routine first-trimester ultrasound examination who delivered in our department between 2009 and 2016 were offered the 2016' FMF prediction model for PE before 34 and 37 weeks'. Risk assessment for PE included maternal factors, pregnancy-associated plasma protein-A (PAPP-A), mean maternal arterial blood pressure (MAP) and uterine artery Doppler (UtAPI). Risk was calculated for all nulliparous women optimally with all variables: PAPP-A + MAP + Ut IP, or pragmatically using only available parameters. Models performance was evaluated using receiver-operating characteristics (ROC) curve analysis in both groups. Results: 6,260 nulliparous women were included, 108 (1.7%) developed PE, including13 (0.2 %) and 41 (0.6%) before 34 and 37 weeks' respectively. Prediction models for PE before 34 and 37 weeks were optimal and suboptimal for 2080 (33.2%) and 4180 (66.8%) respectively. Prevalences were similar in both groups, 0.19% & 0.67% and 0.21% & 0.64%, respectively. The optimal model showed better AUC (95% CI) at predicting PE<34 and 37 weeks': 0.84 (0.66-1) V. 0.76 (0.50-1) and 0.91 (0.84-0.98) V. 0.81 (0.70-0.92), respectively. For a 10% false positive rate, the detection rate (95% CI) when using the optimal model was 20% higher than when using a suboptimal model <37 weeks'...

Systematic review on first trimester three‐dimensional placental volumetry predicting small for gestational age infants

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