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Magnetic resonance imaging has potential as an imaging technique in obstetrics. Its application has been limited by the amount of image degradation that occurs as a result of fetal movement during the long imaging times. By use of a fast-scan imaging technique good images are obtained of fetal anatomy in 3 to 14 seconds per image, depending on the setting used. Different organs could be visualized by varying the setting. Magnetic resonance imaging complements the role of ultrasonography in fetal visualization. It also allows clear fetal imaging in such high-risk situations as maternal obesity and oligohydramnios, where it may be difficult to produce clear images by ultrasonography. This technique will allow wider application of magnetic resonance imaging in obstetrics and give additional information about the developing fetus.
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PMID:Fast-scan magnetic resonance imaging in fetal visualization. 203 59

Fifty four fetal echocardiography studies were done in 50 fetuses of ultrasonographically normal and healthy mothers between 16 and 36 weeks of pregnancy. In all cases there was no family history of any congenital heart defects. The purpose was to define normal fetal cardiac anatomy and detect any congenital heart defects. Two dimensional echocardiographic examination was done in long axis, apical four chamber, short axis and subcostal views. M-Mode examination of aorta, left atrium and ventricles was carried out. In majority of cases echos were satisfactory; however, the quality was poor in maternal obesity and oligohydramnios. The technique of cardiac examination differs from that in postnatal life. Two abnormalities were detected in this study, namely, ventricular septal defect (VSD) and paroxysmal atrial tachycardia (PAT). The VSD patient continued the pregnancy and at birth the diagnosis was confirmed, The mother with fetal PAT was put on oral digitalis. She delivered a normal baby with a normal heart rate.
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PMID:Fetal echocardiography in normal pregnancies--a basis for prenatal detection of cardiac malformations. 224 45

Three hundred and twenty-two percutaneous umbilical blood samplings were performed over 4 years in our prenatal diagnostic centre. A 3.5 MHz sector ultrasound transducer was used to guide a 22.5-gauge needle under local anaesthesia. Sampling was performed for rapid fetal karyotyping (within 72 h) in 120 cases, for diagnosis of fetal toxoplasmosis in 133 cases, for determination of the severity of Rh immunization in 15 cases, and for diagnosis of congenital rubella in 4 cases. Pure fetal blood was obtained in 98.7 per cent of the cases after two attempts. The approach to the cord was either transamniotic or transplacental. Puncturing was preferentially done at the placental insertion of the cord (72.2 per cent of the cases) and the mean blood sample volume was 3.5 ml. The rate of fetal death in utero was 1.9 per cent, including two cases of amnionitis, one trisomy 18, and one severe bradycardia. The failures were due to sampling at an early stage of pregnancy (before gestation week 18), to maternal obesity, oligohydramnios, and the inexperience of the operator.
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PMID:Pure fetal blood samples obtained by cordocentesis: technical aspects of 322 cases. 234 27

In conclusion, it is unlikely that MRI will replace ultrasound as the primary obstetric imaging modality in the near future. Ultrasound has a proven record of accuracy and safety in addition to its easy access and low cost. MRI has promise, however, in providing crucial information in patients with underlying medical or surgical conditions that would ordinarily require ionizing radiation for evaluation. Currently, MRI is helpful in evaluating gross fetal anomalies and disturbances of fetal growth and development when ultrasound is limited by oligohydramnios or maternal obesity. Further experience is required to determine the value of spectroscopy and quantitative relaxation times regarding fetal metabolism and fetal well-being. Technologic improvements and software updates will reduce imaging time and increase spatial resolution, thus rendering MRI more competitive with existing imaging techniques. The ultimate role, however, that MRI will have in the evaluation of the fetus is currently undefined.
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PMID:Prenatal diagnosis of fetal anomalies using ultrasound and MRI. 327 24

In summary, accurate identification of fetal growth disorders remains a difficult clinical challenge. Many diagnostic parameters have been devised to diagnose these conditions, however, no single test alone allows a confident antenatal diagnosis of IUGR or macrosomia to be established. Until new criteria or new methods such as Doppler analysis of umbilical artery flow permit a more accurate prediction of growth disturbances, multiple parameters should be monitored. Evaluation of the amniotic fluid volume, BPD, FL, AC, and EFW should be included in all studies. In high risk cases (unexplained oligohydramnios, previous history of growth retardation, poor nutritional status, abnormal sonographic parameters, maternal obesity, diabetes mellitus, etc.) additional measurements such as the HC/AC ratio and the FL/AC ratio should also be evaluated. Similarly, evaluation of suspected excessive fetal growth requires careful evaluation of AC measurements. Patients with suspected growth disorders should be reevaluated with serial scans at 2 to 3 weeks intervals. Careful monitoring of fetuses with suspected IUGR and macrosomia may decrease much of the morbidity and mortality associated with these conditions.
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PMID:Sonographic diagnosis of fetal growth disorders. 328 40

In six pregnancies accompanied by oligohydramnios (three cases) or decreased amniotic fluid and maternal obesity (three cases), needles specifically designed for use with ultrasound were successfully utilized in combination with real-time ultrasound guidance for amniocentesis. There was successful fluid retrieval in all six, with two requiring more than one needle pass. All three cases accompanied by oligohydramnios later resulted in fetal death. In the three cases accompanied by decreased amniotic fluid and maternal obesity, the amniocentesis results were helpful in ensuring the existence of a normal pregnancy. A specially designed ultrasound needle used in combination with a real-time guidance system is helpful in the performance of difficult amniocentesis.
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PMID:Ultrasound needle guidance for amniocentesis in pregnancies with low amniotic fluid. 330 28

Fetal weight was estimated clinically and by two ultrasonographic methods in 62 patients in labor at term. Maternal obesity precluded clinical estimation of fetal weight in eight patients (12.9%) and a combination of maternal obesity, anterior placentation, and oligohydramnios prevented ultrasonographic fetal measurement in four patients (6.5%). In 43 patients, in whom all three methods of estimate were obtainable, a regression equation using ultrasonically measured fetal abdominal circumference provided the greatest accuracy. However, significant interpatient variability affecting the accuracy of all three methods of estimating fetal weight may limit the clinical application of these measurement techniques.
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PMID:Estimation of fetal weight during labor. 388 61

One hundred unselected pregnant women underwent M mode and two-dimensional fetal echocardiographic studies between 14 and 43 weeks' gestation. The following cross-sectional views were obtained: high parasternal short axis, parasternal long axis, four chamber view, and an extended long axis to assess the aorta. These views successfully identified great vessel orientation and size (90%), atrial and ventricular size and function (90%), presence of atrioventricular valves (92%) and semilunar valves (75%), and presence and continuity of ventricular and atrial septa (91%) and the aortic arch (68%). Factors that limited visualization were persistent unfavorable lie, maternal obesity, and oligohydramnios. Disturbances in cardiac rhythm were the prevalent abnormal findings (16%). In addition, several anatomic defects were detected in utero and confirmed at autopsy. These included a biventricular cardiomyopathy, atrial septal defect, pericardial effusion, and hypoplastic heart. The potential applications of our ability to detail human fetal cardiac anatomy and dimensions are discussed.
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PMID:Two-dimensional and M mode echocardiography in the human fetus. 670 33

Transabdominal amnioinfusion improves the diagnostic accuracy of ultrasonography in pregnancies complicated by second-trimester oligohydramnios. Needle localization may be difficult because of patient obesity or the absence of an acoustic window. The two cases presented demonstrate that color Doppler imaging facilitates amnioinfusion by visualizing the injection jet of free-flowing infusate, confirming intraamniotic needle placement.
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PMID:Adjunctive color Doppler ultrasonography in second-trimester transabdominal amnioinfusion. 953 41

Aside from recognized overgrowth syndromes, instances of visceromegaly are not uncommon at perinatal autopsy. The database of the University of Michigan Teratology Unit was screened for individual viscera exceeding the 90th centile for body and brain weight standards. The data were stratified for several maternal (hypertension, diabetes, obesity), gestational (chorioamnionitis, oligohydramnios, amniorrhaea, polyhydramnios), and fetal (body wall defect, cardiac malformation, renal malformation, diaphragmatic hernia, nonimmune hydrops, twin transfusion syndrome) characteristics and tested for statistically significant excessive numbers of heavy organs. The most striking associations were heavy adrenal glands and liver with chorioamnionitis, heavy heart with polyhydramnios and in the twin transfusion syndrome, and heavy heart and liver with nonimmune hydrops. Excessive brain weight for body weight had a number of correlations, each most likely reflecting growth restriction with sparing of brain growth.
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PMID:Correlates of prenatal visceromegaly. 978 3


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