Sonography of the fetal cranium.
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Brain↗
Biomedical subjects
L Bovicelli
Publications and source records attributed to L Bovicelli.
Transabdominal chorionic villus sampling: analysis of 350 consecutive cases.
We report a series of 350 patients submitted to transabdominal chorionic villus sampling (CVS). A technique using two ultrasound-guided needles and a suction pump was used. In most cases, the procedure was performed between 9 and 13 weeks. Twenty-one pregnancies were selectively terminated; nine spontaneous abortions followed the procedure and one fetal loss after 28 weeks was recorded; 153 pregnancies are in progress and 169 delivered fetuses are alive and well. Transabdominal biopsy is a feasible and effective technique for CVS.
Abdominal Muscles↗
Subnormal cerebellum in fetuses with spina bifida.
The results of a prospective ultrasound study of the posterior fossa structures in 19 fetuses with spina bifida are reported. The transverse cerebellar diameter is below the normal limits and the cisterna magna is obliterated in all cases. Decreased cerebellar size and failure to visualize the cerebellum appear to be specific findings for spina bifida since they are not present in a group of 17 fetuses with isolated hydrocephalus. The results of this study indicate that ultrasound investigation of the posterior fossa may prove useful in the prenatal diagnosis of spina bifida.
Arnold-Chiari Malformation↗
Pelvic ultrasonography in girls with precocious puberty, congenital adrenal hyperplasia, obesity, or hirsutism.
Real-time ultrasonography of the pelvic organs was performed on 151 girls with various complete and incomplete forms of precocious puberty, 20 girls with congenital adrenal hyperplasia, 20 with hirsutism, 18 with obesity, and 133 age-matched normal girls. Uterine and ovarian volumes were calculated and the ovarian morphologic picture was classified as homogeneous, nonhomogeneous (less than three small cystic areas), microcystic (four or more small cystic areas less than 9 mm in diameter), follicular (at least one cystic area greater than 9 mm), and macrocystic (large cystic area greater than 20 mm). Ultrasound imaging allowed an easy distinction between true precocious puberty and premature thelarche or idiopathic premature adrenarche. It was also helpful in the diagnosis of transient sexual precocity, although in these cases the differential diagnosis of precocious puberty can be difficult. In postmenarcheal patients with congenital adrenal hyperplasia, ultrasound study showed a low uterine volume and, frequently, a macrocyst in the ovary. In hirsute girls and in a few obese patients, ovaries had an increased volume and a microcystic structure, similar to those in polycystic ovary syndrome. Pelvic ultrasonography can be useful not only in diagnosing disorders in sexual development but also for greater understanding of the pathogenesis of these and other disorders.
Adrenal Hyperplasia, Congenital↗
Sonographic diagnosis of agenesis of the corpus callosum in the fetus and newborn infant.
The sonographic findings in nine cases of agenesis of the corpus callosum examined before and after birth are reported. Agenesis of the corpus callosum was suspected in utero due to a typical configuration of the lateral ventricles, which included enlargement of the atria and occipital horns and marked separation of the bodies. In three cases pregnancy was terminated because of severe associated anomalies. In the remaining six cases postnatal ultrasound examination allowed a certain diagnosis by demonstrating the abnormal configuration of the lateral ventricles, varying degrees of enlargement, and upward displacement of the third ventricle and absence of the corpus callosum.
Agenesis of Corpus Callosum↗
Intravascular intrauterine transfusion for severe erythroblastosis fetalis using different techniques.
Over a 3-year period, 44 ultrasound-guided intravascular transfusions were performed between 18 and 32 weeks on 15 patients with severe erythroblastosis fetalis due to Rh immunization. In 4 fetuses, the first transfusion was performed before 20 weeks, in 6 between 20 and 25 weeks and in the remaining 5 between 25 and 31 weeks. Eight of the 15 fetuses were hydropic at the time of referral. Five transfusions were done in the intrahepatic umbilical vein, 6 were simple transfusions via percutaneous umbilical cord puncture, and 33 were partial exchange. There were 4 intrauterine deaths before 26 weeks, despite successfully performed transfusions: 3 of these fetuses were severely hydropic, while in the remaining fetus hydrops had been reversed in utero. Following delivery by cesarean section at 32 weeks of gestation, 1 of the neonates developed respiratory distress syndrome and died 17 h after birth. The overall survival rate was 67% (10 of 15 cases): 4 of the 8 hydropic fetuses (50%) and 6 of the 7 nonhydropic fetuses (83%) were alive at birth and survived the perinatal period. Three of the 5 losses occurred among the first 4 cases, while in the last 11 cases the survival rate increased to 82% (9 of 11).
Blood Transfusion, Intrauterine↗
Psychological reactions to ultrasound. Examination during pregnancy.
Twenty women underwent ultrasound examination three times during low-risk pregnancy. Before and after ultrasonography, the Symptom Questionnaire was applied to evaluate changes in psychological distress. Anxiety, depression, somatic symptoms, and hostility significantly decreased after the patients received video and verbal feedback during the first ultrasound examination. Such changes were consistently observed also during the subsequent two examinations.
Adaptation, Psychological↗
Sonographic evaluation of the normal developmental anatomy of fetal cerebral ventricles: I. The frontal horn.
A prospective ultrasound study was conducted in 179 normal pregnant women with gestational ages ranging from 15-40 weeks. Several biometric measurements were obtained throughout pregnancy, including the cerebrofrontal horn distance of the lateral ventricle, the frontal hemispheric width, and the calculated ratio of cerebrofrontal horn distance/hemispheric width. Curvilinear relationships were found between cerebrofrontal horn distance and gestational age (R2 = 0.597; P less than .0001) and between cerebrofrontal horn distance and the biparietal diameter (R2 = 0.618; P less than .0001). In addition, a curvilinear relationship existed between cerebrofrontal horn distance/hemispheric width ratio and gestational age (R2 = 0.492; P less than .0001) and biparietal diameter (R2 = 0.930; P less than .0001). These data represent a comprehensive characterization of normal growth of the fetal frontal horns. They provide a method by which variations from the norm can be assessed and early prenatal diagnosis of developmental anomalies of the fetal ventricular system can be made.
Cerebral Ventricles↗
Prenatal diagnosis and obstetrical management of multicystic dysplastic kidney disease.
Multicystic dysplastic kidney disease (MDKD) is one of the most common congenital renal anomalies. We report 16 consecutive cases of MDKD recognized in the antenatal period by sonography. Diagnosis is usually easy as MDKD has in the vast majority of cases a striking ultrasound appearance including enlargement of the kidney and multiple renal cysts. However, differentiation from obstructive uropathy may be difficult, and we made a total of five erroneous diagnoses. Unilateral MDKD has almost invariably a good prognosis. However, severe life-threatening associated anomalies were found in six cases. Therefore, a detailed survey of fetal anatomy and determination of karyotype are strongly recommended.
Diagnostic Errors↗
Cerebellar measurements with ultrasonography in the evaluation of fetal growth and development.
A prospective study of ultrasonography was conducted in 371 normal pregnant women, with gestational ages ranging from 13 weeks to 40 weeks. Several biometric measurements were obtained including the transverse cerebellar diameter, the biparietal diameter, the occipitofrontal diameter, and the calculated head circumference. Curvilinear relationships were found between the transverse diameter of the cerebellum (measured in millimeters), and the gestational age (R2 = 0.948; P = 0.001), the biparietal diameter (R2 = 0.956; P = 0.0001), and the head circumference (R2 = 0.969; P = 0.0001). A nomogram of cerebellar measurements estimating gestational age and predicting the biparietal diameter and head circumference was generated. Throughout pregnancy the establishment of normative cerebellar measurements allows for the estimation of gestational age that is independent of the shape of the fetal head and offers potential for evaluation of abnormal fetal growth and anomalous development of the central nervous system.
Anthropometry↗
Criteria for the prenatal diagnosis of holoprosencephaly.
Holoprosencephaly is a congenital anomaly of the central nervous system whose prenatal sonographic appearance may to similar to that of ventriculomegaly. A clear differential diagnosis is extremely important because the two conditions have different prognoses and therefore require different obstetric management. Eight cases of prenatally recognized holoprosencephaly are analyzed and criteria for a specific diagnosis proposed. The specificity and limitations of ultrasound findings, such as identification of a holoventricle, presence of a dorsal sac, and facial anomalies are discussed.
Brain↗
Intrinsic intrathoracic malformations of the fetus: sonographic detection and clinical presentation.
Intrinsic intrathoracic malformations are a rare group of congenital anomalies associated with high fetal and neonatal mortality rates. The antenatal sonographic appearance and the adequacy of diagnosis in 15 affected fetuses were evaluated. An accurate prenatal diagnosis was made in 12 cases; the precise nature of the intrathoracic defect was incorrectly categorized in two fetuses, and the defect was missed entirely in one affected fetus. Antenatal detection and characterization of intrinsic intrathoracic congenital malformations seems possible, but requires a high index of suspicion, familiarity with their sonographic appearances, and meticulous attention to detail.
Bronchogenic Cyst↗
Transabdominal versus transcervical routes for chorionic villus sampling.
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Abdomen↗
Vertical transmission of HTLV-III.
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Acquired Immunodeficiency Syndrome↗
Prenatal diagnosis of craniofacial malformations with ultrasonography.
Although the utility of ultrasound in the prenatal diagnosis of many congenital anomalies is well established, its accuracy in detecting craniofacial malformations has not been examined in a large series. Sonographic examinations of 223 patients at risk for fetuses with craniofacial malformations were performed between 18 and 40 weeks. The risk factors included a familial history of craniofacial malformations, extrafacial anomalies diagnosed on ultrasound, fetal chromosomal aberrations, and maternal drug intake. Sonographic diagnosis was possible in 151 (67.7%) patients on the first scan and in 47 (21.1%) patients on the second scan and was not possible in 25 patients (11.2%). Of the 198 cases diagnosed antenatally, craniofacial malformation was detected in 14 and confirmed postnatally. No false positive diagnoses were made. A negative diagnosis of craniofacial malformation was made in 184 cases with two false negative results (1.0%). Anomalies diagnosed sonographically included anophthalmia, anterior cleft lip and/or palate, hypotelorism, hypertelorism, and micrognathia. The results of this study demonstrate that ultrasound is an accurate and reliable tool for the prenatal diagnosis of craniofacial malformations.
Face↗
Antenatal recognition of cerebral anomalies.
Modern ultrasound equipments allow a detailed investigation of the fetal brain from a very early stage of development. Congenital anomalies arising from or involving the central nervous system can be accurately predicted. On the basis of their personal experience, which includes 48 cases, and of a review of the current literature, the authors discuss criteria for the intrauterine diagnosis and obstetrical management of intracranial anomalies such as hydrocephalus, holoprosencephaly, cephaloceles, porencephaly, hydranencephaly, and microcephaly.
Brain↗
The successful use of human amniotic fluid for mouse embryo culture and human in vitro fertilization, embryo culture, and transfer.
The development of mouse and human embryos was assessed in human amniotic fluid to determine its suitability as a culture medium for human in vitro fertilization (IVF). Two-cell mouse embryos developed to blastocysts after 72 hours at rates similar to that in Whittingham's T6 + 10% fetal calf serum. Significantly more mouse embryos hatched in amniotic fluid. No difference was found between individual patient's amniotic fluids obtained at 16 to 21 weeks' gestation. A preliminary trial comparing amniotic fluid with T6 + maternal serum in human IVF showed no significant difference in fertilization rate and embryo development during 42 to 48 hours in vitro. Expanded blastocysts were obtained in amniotic fluid after 5 days in vitro. Four pregnancies were obtained in 9 patients' transferred embryos grown in amniotic fluid and with 2 or 12 patients' transferred embryos grown in T6 + maternal serum.
Amniotic Fluid↗
The management of the malformed fetus.
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Congenital Abnormalities↗