Assuntos
Coração Fetal, Cardiopatias Congênitas, Imageamento Tridimensional, Ultrassonografia Pré-Natal, Humanos, Cardiopatias Congênitas/diagnóstico por imagem, Feminino, Gravidez, Ultrassonografia Pré-Natal/métodos, Imageamento Tridimensional/métodos, Coração Fetal/diagnóstico por imagem, Análise Espaço-TemporalRESUMO
The segmentation of the fetal head (FH) and pubic symphysis (PS) from intrapartum ultrasound images plays a pivotal role in monitoring labor progression and informing crucial clinical decisions. Achieving real-time segmentation with high accuracy on systems with limited hardware capabilities presents significant challenges. To address these challenges, we propose the real-time segmentation network (RTSeg-Net), a groundbreaking lightweight deep learning model that incorporates innovative distribution shifting convolutional blocks, tokenized multilayer perceptron blocks, and efficient feature fusion blocks. Designed for optimal computational efficiency, RTSeg-Net minimizes resource demand while significantly enhancing segmentation performance. Our comprehensive evaluation on two distinct intrapartum ultrasound image datasets reveals that RTSeg-Net achieves segmentation accuracy on par with more complex state-of-the-art networks, utilizing merely 1.86 M parameters-just 6 % of their hyperparameters-and operating seven times faster, achieving a remarkable rate of 31.13 frames per second on a Jetson Nano, a device known for its limited computing capacity. These achievements underscore RTSeg-Net's potential to provide accurate, real-time segmentation on low-power devices, broadening the scope for its application across various stages of labor. By facilitating real-time, accurate ultrasound image analysis on portable, low-cost devices, RTSeg-Net promises to revolutionize intrapartum monitoring, making sophisticated diagnostic tools accessible to a wider range of healthcare settings.
Assuntos
Cabeça, Sínfise Pubiana, Ultrassonografia Pré-Natal, Humanos, Feminino, Gravidez, Cabeça/diagnóstico por imagem, Ultrassonografia Pré-Natal/métodos, Sínfise Pubiana/diagnóstico por imagem, Aprendizado Profundo, Feto/diagnóstico por imagemRESUMO
Congenital heart defects (CHD) are one of the serious problems that arise during pregnancy. Early CHD detection reduces death rates and morbidity but is hampered by the relatively low detection rates (i.e., 60%) of current screening technology. The detection rate could be increased by supplementing ultrasound imaging with fetal ultrasound image evaluation (FUSI) using deep learning techniques. As a result, the non-invasive foetal ultrasound image has clear potential in the diagnosis of CHD and should be considered in addition to foetal echocardiography. This review paper highlights cutting-edge technologies for detecting CHD using ultrasound images, which involve pre-processing, localization, segmentation, and classification. Existing technique of preprocessing includes spatial domain filter, non-linear mean filter, transform domain filter, and denoising methods based on Convolutional Neural Network (CNN); segmentation includes thresholding-based techniques, region growing-based techniques, edge detection techniques, Artificial Neural Network (ANN) based segmentation methods, non-deep learning approaches and deep learning approaches. The paper also suggests future research directions for improving current methodologies.
Assuntos
Aprendizado Profundo, Cardiopatias Congênitas, Redes Neurais de Computação, Ultrassonografia Pré-Natal, Humanos, Cardiopatias Congênitas/diagnóstico por imagem, Ultrassonografia Pré-Natal/métodos, Gravidez, Feminino, Processamento de Imagem Assistida por Computador/métodos, Ecocardiografia/métodos, Algoritmos, Coração Fetal/diagnóstico por imagem, Feto/diagnóstico por imagemRESUMO
OBJECTIVE: To evaluate the performance of maternal factors, biophysical and biochemical markers at 11-13 + 6 weeks' gestation in the prediction of gestational diabetes mellitus with or without large for gestational age (GDM ± LGA) fetus and great obstetrical syndromes (GOS) among singleton pregnancy following in-vitro fertilisation (IVF)/embryo transfer (ET). MATERIALS AND METHODS: A prospective cohort study was conducted between December 2017 and January 2020 including patients who underwent IVF/ET. Maternal mean arterial pressure (MAP), ultrasound markers including placental volume, vascularisation index (VI), flow index (FI) and vascularisation flow index (VFI), mean uterine artery pulsatility index (mUtPI) and biochemical markers including placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured at 11-13 + 6 weeks' gestation. Logistic regression analysis was performed to determine the significant predictors of complications. RESULTS: Among 123 included pregnancies, 38 (30.9%) had GDM ± LGA fetus and 28 (22.8%) had GOS. The median maternal height and body mass index were significantly higher in women with GDM ± LGA fetus. Multivariate logistic regression analysis demonstrated that in the prediction of GDM ± LGA fetus and GOS, there were significant independent contributions from FI MoM (area under curve (AUROC) of 0.610, 95% CI 0.492-0.727; p = 0.062) and MAP MoM (AUROC of 0.645, 95% CI 0.510-0.779; p = 0.026), respectively. CONCLUSION: FI and MAP are independent predictors for GDM ± LGA fetus and GOS, respectively. However, they have low predictive value. There is a need to identify more specific novel biomarkers in differentiating IVF/ET pregnancies that are at a higher risk of developing complications.
Assuntos
Diabetes Gestacional, Placenta, Primeiro Trimestre da Gravidez, Ultrassonografia Pré-Natal, Humanos, Feminino, Gravidez, Adulto, Estudos Prospectivos, Placenta/diagnóstico por imagem, Placenta/irrigação sanguínea, Ultrassonografia Pré-Natal/métodos, Fertilização in vitro, Biomarcadores/sangue, Macrossomia Fetal/diagnóstico por imagem, Fator de Crescimento Placentário/sangue, Valor Preditivo dos Testes, Idade Gestacional, Transferência Embrionária, Artéria Uterina/diagnóstico por imagem, Complicações na Gravidez/diagnóstico por imagem, Técnicas de Reprodução AssistidaRESUMO
OBJECTIVE: Monochorionic-triamniotic (MCTA) triplet pregnancies following artificial reproductive technologies are uncommon. We report a case in which one of two transferred embryos differentiated into an MCTA triplet. This study aimed to investigate the potential factors contributing to MCTA triplet pregnancy. CASE REPORT: A 39-year-old woman underwent her second frozen embryo transfer with hatching blastocysts, which resulted in the detection of an MCTA triplet on ultrasonography. She delivered by cesarean section at 32 weeks of gestation, resulting in the birth of three live male infants. Her medical history and in vitro fertilization treatment were reviewed to identify potential causes. CONCLUSION: The etiology of MCTA triplet pregnancy remains multifactorial. In the presented case, prolonged in vitro culture to the blastocyst stage and inner cell mass splitting were potential contributing factors. Further research is needed to fully understand the complexity of MCTA triplet pregnancy.
Assuntos
Transferência Embrionária, Gravidez de Trigêmeos, Humanos, Feminino, Gravidez, Adulto, Transferência Embrionária/métodos, Taiwan, Fertilização in vitro/métodos, Masculino, Cesárea, Recém-Nascido, Âmnio, Ultrassonografia Pré-NatalAssuntos
Cardiomegalia, Síndrome de Dandy-Walker, Retardo do Crescimento Fetal, Derrame Pericárdico, Primeiro Trimestre da Gravidez, Segundo Trimestre da Gravidez, Ultrassonografia Pré-Natal, Humanos, Feminino, Gravidez, Ultrassonografia Pré-Natal/métodos, Síndrome de Dandy-Walker/diagnóstico por imagem, Síndrome de Dandy-Walker/embriologia, Síndrome de Dandy-Walker/genética, Adulto, Cardiomegalia/diagnóstico por imagem, Cardiomegalia/genética, Retardo do Crescimento Fetal/diagnóstico, Retardo do Crescimento Fetal/diagnóstico por imagem, Derrame Pericárdico/diagnóstico por imagem, Megalencefalia/genética, Artéria Umbilical Única/diagnóstico por imagem, Triploidia, Anormalidades Múltiplas/genética, Anormalidades Múltiplas/diagnóstico por imagem, Reações Falso-Negativas, Teste Pré-Natal não Invasivo/métodosRESUMO
OBJECTIVE: Herein, we present a case of mosaic trisomy 6 detected by amniocentesis. CASE REPORT: Amniocentesis (G-banding) was performed at 17 weeks of gestation; the results were 47,XY,+6[3]/46,XY[12]. Fetal screening ultrasonography showed no morphological abnormalities, and the parents desired to continue the pregnancy. The infant was delivered vaginally at 39 weeks' gestation. The male infant weighed 3002 g at birth with no morphological abnormalities. G-banding karyotype analysis performed on the infant's peripheral blood revealed 46,XY[20]. FISH analysis revealed trisomy signals on chromosome 6 in 1-4 out of 100 cells from the placenta. The single nucleotide polymorphism microarray of the umbilical cord blood revealed no abnormalities. Methylation analysis of umbilical cord blood revealed no abnormalities in PLAGL1. No disorders were observed at one year of age. CONCLUSION: When amniocentesis reveals chromosomal mosaicism, it is essential to provide a thorough fetal ultrasound examination and careful genetic counseling to support the couples' decision-making.
Assuntos
Amniocentese, Cromossomos Humanos Par 6, Mosaicismo, Trissomia, Humanos, Mosaicismo/embriologia, Feminino, Gravidez, Trissomia/genética, Trissomia/diagnóstico, Masculino, Adulto, Cromossomos Humanos Par 6/genética, Recém-Nascido, Ultrassonografia Pré-Natal, Cariotipagem, Hibridização in Situ FluorescenteRESUMO
BACKGROUND: Absent or hypoplastic nasal bone (AHNB) on first or second-trimester ultrasonography (USG) is an important soft marker of Down syndrome. However, due to its varied incidence in euploid and aneuploid fetuses, there is always a dilemma of whether to go for invasive fetal testing for isolated AHNB. This study aims to assess outcomes specifically within the context of Indian ethnicity women. MATERIALS AND METHODS: This was a prospective observational study. All patients who reported with AHNB in the first- or second-trimester USG were included. Genetic counseling was done, and noninvasive and invasive testing was offered. Chromosomal anomalies were meticulously recorded, and pregnancy was monitored. RESULTS: The incidence of AHNB in our study was 1.16% (47/4051). Out of 47 women with AHNB, the isolated condition was seen in 32 (0.78%) cases, while AHNB with structural anomalies was seen in nine cases (0.22%). Thirty-nine women opted for invasive testing. Six out of 47 had aneuploidy (12.7%), while two euploid cases (4.25%) developed nonimmune hydrops. The prevalence of Down syndrome in fetuses with AHNB was 8.5% (4/47) and 0.42% (17/4004) in fetuses with nasal bone present. This difference was statistically significant (p = .001). CONCLUSION: The results indicate that isolated AHNB cases should be followed by a comprehensive anomaly scan rather than immediately recommending invasive testing. However, invasive testing is required when AHNB is associated with other soft markers or abnormalities. As chromosomal microarray is more sensitive than standard karyotype in detecting chromosomal aberrations, it should be chosen over karyotype.
Assuntos
Síndrome de Down, Osso Nasal, Ultrassonografia Pré-Natal, Humanos, Feminino, Osso Nasal/anormalidades, Osso Nasal/diagnóstico por imagem, Gravidez, Estudos Prospectivos, Síndrome de Down/genética, Adulto, Ultrassonografia Pré-Natal/métodos, Aneuploidia, Índia, Aconselhamento Genético, Diagnóstico Pré-Natal/métodos, Pais, Segundo Trimestre da Gravidez, Aberrações CromossômicasRESUMO
OBJECTIVE: To estimate the prevalence of neural tube defects among all birth outcomes in Odisha during 2016-2022. Additionally, to estimate the identification rate of neural tube defects during Pradhan Mantri Surakshit Matritva Abhiyan sessions. DESIGN: A population-based cross-sectional study with a household survey for neural tube defects using pictorial card as well as a hospital-based study for antenatal ultrasonography data. SETTING: The sample population was selected through multistage random sampling. In the first stage, one district from each zone was selected randomly. In the second stage, using simple random sampling, one community health centre and one urban primary health centre were selected from each district. In the third stage, the population from a block and ward were picked from the selected rural and urban settings, respectively. PARTICIPANTS: All married women in the reproductive age group (18-49 years) residing in these cluster villages in the selected districts were enrolled. RESULTS: The study surveyed 49 215 women and recorded 50 196 birth outcomes, including 49 174 live births, 890 stillbirths and 132 medical terminations of pregnancy. A total of 30 neural tube defect cases were detected. The overall prevalence rate of neural tube defect was 0.59 per 1000 birth outcomes. Spina bifida was the most prevalent neural tube defect with the prevalence of, followed by anencephaly and encephalocele. Despite 26 860 mothers receiving antenatal ultrasonography Pradhan Mantri Surakshit Matritva Abhiyan session, data on neural tube defects and other birth defects detected through these scans is unavailable. CONCLUSION: This study found a low prevalence of neural tube defect in Odisha, which is far lower compared with the older studies from India. There is an urgent need to strengthen the quality of antenatal care services provided under Pradhan Mantri Surakshit Matritva Abhiyan through better training regarding anomaly scans and better data keeping at public healthcare facilities. TRIAL REGISTRATION NUMBER: CTRI/2021/06/034487.
Assuntos
Defeitos do Tubo Neural, Humanos, Estudos Transversais, Feminino, Índia/epidemiologia, Gravidez, Adulto, Defeitos do Tubo Neural/epidemiologia, Prevalência, Adulto Jovem, Adolescente, Pessoa de Meia-Idade, Ultrassonografia Pré-Natal, Anencefalia/epidemiologia, Encefalocele/epidemiologia, Encefalocele/diagnóstico por imagem, Disrafismo Espinal/epidemiologiaRESUMO
Our center has observed a substantial increase in the detection rate of fetal left-right(LR) asymmetry disorders between March and May 2023. This finding has raised concerns because these pregnant women experienced the peak outbreak of SARS-CoV-2 in China during their first trimester. To explore the relationship between maternal SARS-CoV-2 infection and fetal LR asymmetry disorders. A retrospective collection of clinical and ultrasound data diagnosed as fetal LR asymmetry disorders was conducted from January 2018 to December 2023. The case-control study involved fetuses with LR asymmetry disorders and normal fetuses in a 1:1 ratio. We evaluated and compared the clinical and fetal ultrasound findings in pregnant women with SARS-CoV-2 infection and pregnant women without infection. The Student t-test was utilized to compare continuous variables, while the chi-squared test was employed for univariable analyses. The incidence rate of LR asymmetry disorders from 2018 to 2023 was as follows: 0.17, 0.63, 0.61, 0.57, 0.59, and 3.24, respectively. A total of 30 fetuses with LR asymmetry disorders and 30 normal fetuses were included. This case-control study found that SARS-CoV-2 infection (96.67% vs 3.33%, P = .026) and infection during the first trimester (96.55% vs 3.45%, P = .008) were identified as risk factors. The odds ratio values were 10.545 (95% CI 1.227, 90.662) and 13.067 (95% CI 1.467, 116.419) respectively. In cases of SARS-CoV-2 infection in the first trimester, the majority of infections (88.1%, 37/42) occurred between 5 and 6 weeks of gestation. We found that 43.7% (66/151) of fetuses with LR asymmetry disorder had associated malformations, 90.9% (60/66) exhibited cardiac malformations. SARS-CoV-2 infection during the first trimester significantly increases the risk of fetal LR asymmetry disorders, particularly when the infection occurs between 5 and 6 gestation weeks. The most common associated malformation is heart malformation.
Assuntos
COVID-19, Complicações Infecciosas na Gravidez, Primeiro Trimestre da Gravidez, SARS-CoV-2, Humanos, Feminino, Gravidez, COVID-19/epidemiologia, COVID-19/complicações, Complicações Infecciosas na Gravidez/epidemiologia, Adulto, Estudos Retrospectivos, Estudos de Casos e Controles, China/epidemiologia, Ultrassonografia Pré-Natal, Fatores de Risco, Feto/virologia, Doenças Fetais/epidemiologia, Doenças Fetais/virologiaRESUMO
BACKGROUND: Pathogenic copy number variants (pCNVs) are associated with fetal ultrasound anomalies, which can be efficiently identified through chromosomal microarray analysis (CMA). The primary objective of the present study was to enhance understanding of the genotype-phenotype correlation in fetuses exhibiting absent or hypoplastic nasal bones using CMA. METHODS: Enrolled in the present study were 94 cases of fetuses with absent/hypoplastic nasal bone, which were divided into an isolated absent/hypoplastic nasal bone group (n = 49) and a non-isolated group (n = 45). All pregnant women enrolled in the study underwent karyotype analysis and CMA to assess chromosomal abnormalities in the fetuses. RESULTS: Karyotype analysis and CMA detection were successfully performed in all cases. The results of karyotype and CMA indicate the presence of 11 cases of chromosome aneuploidy, with trisomy 21 being the most prevalent among them. A small supernumerary marker chromosome (sSMC) detected by karyotype analysis was further interpreted as a pCNV by CMA. Additionally, CMA detection elicited three cases of pCNVs, despite normal findings in their karyotype analysis results. Among them, one case of Roche translocation was identified to be a UPD in chromosome 15 with a low proportion of trisomy 15. Further, a significant difference in the detection rate of pCNVs was observed between non-isolated and isolated absent/hypoplastic nasal bone (24.44% vs. 8.16%, p < .05). CONCLUSION: The present study enhances the utility of CMA in diagnosing the etiology of absent or hypoplastic nasal bone in fetuses. Further, isolated cases of absent or hypoplastic nasal bone strongly suggest the presence of chromosomal abnormalities, necessitating genetic evaluation through CMA.
Assuntos
Variações do Número de Cópias de DNA, Cariotipagem, Análise em Microsséries, Osso Nasal, Segundo Trimestre da Gravidez, Diagnóstico Pré-Natal, Humanos, Feminino, Osso Nasal/diagnóstico por imagem, Osso Nasal/anormalidades, Gravidez, Análise em Microsséries/métodos, Adulto, Diagnóstico Pré-Natal/métodos, Variações do Número de Cópias de DNA/genética, Cariotipagem/métodos, Feto, Aberrações Cromossômicas/embriologia, Ultrassonografia Pré-Natal/métodos, Estudos de Associação Genética/métodosRESUMO
OBJECTIVES: To evaluate the clinical utility of two dimensional (2D) ultrasound combined with spatiotemporal image correlation (STIC) in diagnosing interrupted aortic arch (IAA) in fetal life. METHODS: A total of 53 cases of fetal IAA were diagnosed using 2D ultrasound combined with STIC, and 53 normal fetuses of the same gestational week were selected. These cases were retrospectively analyzed to assess the utility of employing 2D ultrasound combined with STIC in the diagnosis of IAA. RESULTS: 2D ultrasound combined with STIC detected 22 cases of type A IAA, 24 cases of type B IAA, and seven cases of type C IAA. Furthermore, combining 2D ultrasound with STIC enabled dynamic visualization of the IAA, aiding in prenatal diagnosis. The diagnostic coincidence rate of IAA was found to be higher in the HD-flow combined with STIC than that in the 2D combined with HD-flow. CONCLUSION: HD-flow combined with STIC can assist in diagnosing fetal IAA, and this technique has important clinical value.
Assuntos
Aorta Torácica, Ultrassonografia Pré-Natal, Humanos, Feminino, Ultrassonografia Pré-Natal/métodos, Gravidez, Aorta Torácica/diagnóstico por imagem, Aorta Torácica/anormalidades, Aorta Torácica/embriologia, Estudos Retrospectivos, Adulto, Reprodutibilidade dos Testes, Coração Fetal/diagnóstico por imagemRESUMO
Placental mesenchymal dysplasia (PMD) is an exceptionally rare placental anomaly characterised by placentomegaly and grape-like vesicles resembling partial mole on ultrasonography, yet it can coexist with a viable fetus. We present the case of a primigravida who presented at 22 weeks gestation with a suspected partial mole but with a normally growing fetus. The differential diagnoses considered included placental mesenchymal disease, partial mole and twin pregnancy with molar pregnancy. With normal beta HCG levels and prenatal invasive testing reports, a probable diagnosis of PMD was made, and after thorough counselling, the decision was made to continue the pregnancy. The pregnancy progressed until 37 weeks, culminating in the uneventful delivery of a 2.4 kg healthy male infant. Histopathology confirmed PMD. Early recognition and management of PMD pose significant challenges, given its rarity. Prenatal identification of PMD during both early and late gestation could avert unnecessary termination of pregnancy.
Assuntos
Mola Hidatiforme, Doenças Placentárias, Placenta, Humanos, Gravidez, Feminino, Mola Hidatiforme/diagnóstico, Mola Hidatiforme/diagnóstico por imagem, Diagnóstico Diferencial, Doenças Placentárias/diagnóstico, Doenças Placentárias/diagnóstico por imagem, Placenta/patologia, Placenta/diagnóstico por imagem, Adulto, Masculino, Recém-Nascido, Ultrassonografia Pré-Natal, Resultado da GravidezRESUMO
INTRODUCTION: Cervical teratomas are rare congenital neoplasms that can cause neonatal airway obstruction if large. CASE PRESENTATION: The female Persian neonate displayed respiratory distress at birth, with a 7 cm × 8 cm cystic solid mass identified on the left side of the neck. Antenatal ultrasonography revealed polyhydramnios. Despite initial stabilization, the infant required intubation and mechanical ventilation due to persistent respiratory distress. Imaging confirmed a cystic mass compressing the trachea, ruling out cystic hygroma. Surgical resection on postnatal day 17 revealed a 10 cm × 10 cm solid cystic structure, histologically identified as an immature teratoma. CONCLUSION: Despite risks of poor fetal and postnatal outcome from large cervical teratomas, early surgical resection after airway stabilization can result in recovery. Proper multidisciplinary management of respiratory distress from such tumors is paramount.
Assuntos
Neoplasias de Cabeça e Pescoço, Teratoma, Ultrassonografia Pré-Natal, Humanos, Teratoma/cirurgia, Teratoma/diagnóstico por imagem, Teratoma/diagnóstico, Teratoma/congênito, Feminino, Recém-Nascido, Gravidez, Neoplasias de Cabeça e Pescoço/diagnóstico, Neoplasias de Cabeça e Pescoço/cirurgia, Neoplasias de Cabeça e Pescoço/diagnóstico por imagem, Neoplasias de Cabeça e Pescoço/congênito, Neoplasias de Cabeça e Pescoço/patologia, Obstrução das Vias Respiratórias/etiologia, Obstrução das Vias Respiratórias/cirurgia, Obstrução das Vias Respiratórias/diagnóstico por imagem, Poli-HidrâmniosRESUMO
The development of neurons is regulated by several spatiotemporally changing factors, which are crucial to give the ability of neurons to form functional networks. While external physical stimuli may impact the early developmental stages of neurons, the medium and long-term consequences of these influences have yet to be thoroughly examined. Using an animal model, this study focuses on the morphological and transcriptome changes of the hippocampus that may occur as a consequence of fetal ultrasound examination. We selectively labeled CA1 neurons of the hippocampus with in-utero electroporation to analyze their morphological features. Furthermore, certain samples also went through RNA sequencing after repetitive ultrasound exposure. US exposure significantly changed several morphological properties of the basal dendritic tree. A notable increase was also observed in the density of spines on the basal dendrites, accompanied by various alterations in individual spine morphology. Transcriptome analysis revealed several up or downregulated genes, which may explain the molecular background of these alterations. Our results suggest that US-derived changes in the dendritic trees of CA1 pyramidal cells might be connected to modification of the transcriptome of the hippocampus and may lead to an increased dendritic input.
