Reference values for the cervical length measurement in the second trimester of pregnancy using the transvaginal ultrasound in a large Brazilian population

( Alberto Borges Peixoto ),( Taciana Mara Rodrigues Da Cunha Caldas ),( Ana Helena Bittencourt Alamy ),( Wellington P. Martins ),( Rafael Frederico Bruns ),( Edward Araujo Junior ) 대한산부인과학회 2016 Obstetrics & Gynecology Science Vol.59 No.4

To establish reference values for the cervical length (CL) measurement by transvaginal ultrasound between 20 and 24+6 weeks of gestation in a large Brazilian population. A retrospective cross-sectional study was performed with 996 singleton pregnancies. The CL measurement (mm) using the transvaginal ultrasound was obtained in a sagittal view and the calipers positioned to measure the linear distance between the triangular area of echodensity at the external os and the internal os. The median±standard deviation and ranges for the CL measurement (mm) was 37.0±10.7 (range, 8 to 51). CL measurement did not modify significantly with gestational age. The observed percentiles for the CL measurement (mm) considering all number case were the following: 5th, 28 mm; 50th, 37 mm; and 95th, 45 mm. Reference values for the CL measurement by transvaginal ultrasound between 20 and 24+6 weeks of gestation in a large heterogeneous Brazilian population were established.

The impact of first-trimester intrauterine hematoma on adverse perinatal outcomes

Alberto Borges Peixoto,Edward Araujo Júnior,Taciana Mara Rodrigues da Cunha Caldas,Caetano Galvão Petrini,Ana Cecília Palma Romero,Luciano Eliziário Borges Júnior,Wellington P. Martins 대한초음파의학회 2018 ULTRASONOGRAPHY Vol.37 No.4

Purpose: The aim of this study was to evaluate whether the presence of an intrauterinehematoma (IUH) on an early pregnancy ultrasound scan showing a live fetus was related toadverse perinatal outcomes. Methods: We performed a retrospective cohort study to evaluate pregnant women whounderwent an ultrasound examination in early pregnancy, between 6 weeks 0 days and 10weeks 6 days. We compared the perinatal outcomes between women with and without firsttrimester IUH using the Mann-Whitney and Fisher exact tests. Furthermore, we performed astepwise regression analysis to identify possible predictors of miscarriage among maternalcharacteristics, ultrasound parameters, and IUH. Results: During the study period, data from 783 pregnancies were included, and the incidence ofIUH was 4.5% (35 of 783). We observed a higher proportion of miscarriage following the scan(28.6% vs. 10%, P=0.003) and a larger yolk sac diameter during the scan (4.8 mm vs. 3.8 mm,P<0.001) in the pregnant women with first-trimester IUH. There was no significant differenceregard the prevalence of low birth weight (LBW; P=0.091), very LBW (P=0.370), or extremelyLBW (P=0.600) between cases with IUH and without IUH, the cesarean section rate (68% vs. 81%, P=0.130), preterm delivery (16% vs. 16%, P>0.999), or the incidence of first-trimestervaginal bleeding (31% vs. 20%, P=0.130). Moreover, heart rate (HR) was the only variable thatpredicted miscarriage with statistical significance (P=0.017). Conclusion: Women with first-trimester IUH had a higher risk of miscarriage after the ultrasoundscan. HR was the only variable that predicted miscarriage with statistical significance.

Second trimester cervical length measurement for prediction spontaneous preterm birth in an unselected risk population

( Alberto Borges Peixoto ),( Taciana Mara Rodrigues Da Cunha Caldas ),( Luisa Almeida Tahan ),( Caetano Galvao Petrini ),( Wellington P Martins ),( Fabricio Da Silva Costa ),( Edward Araujo Junior ) 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.4

Objective To assess the predictive capacity of cervical length (CL) measurement underwent during the second trimester ultrasound for prediction preterm birth <32, 34, and 37 weeks of gestation in an unselected risk population. Methods A retrospective cohort study was performed with 751 singleton pregnancies between 20 and 24+6 weeks of gestation. The CL measurement (mm) using the transvaginal route was obtained in a sagittal view and the calipers positioned to measure the linear distance between the triangular area of echodensity at the external os and the internal os. To compare the preterm (<37 weeks) and term births (≥37 weeks), we used unpaired t test. We assessed whether the CL measurement was dependent of gestational age by performing a linear regression and assessing the coefficient of determination (R²). We additionally assessed the accuracy of CL measurement to predict preterm birth by assessing the area under receiver operating characteristics curves with its respective confidence intervals (CIs) 95%. Results Preterm birth <37 weeks was found in 13.6% (102/751) of pregnant women. Short cervix (≤25 mm) was found in 2.7% (20/751) of pregnancies. Only 30% (6/20) of pregnant women with short cervix have used progesterone to prevent preterm birth. There was a weak correlation between CL measurement and gestational age at delivery (R2=0.01, P=0.002). Receiver operating characteristics curve analysis of the ability of CL measurement to predict preterm birth <32, 34, and 37 weeks, showed an area under the curve of 0.693 (95% CI, 0.512 to 0.874), 0.472 (95% CI, 0.353 to 0.591), 0.490 (95% CI, 0.426 to 0.555), respectively. Conclusion There was a weak correlation between CL measurement and gestational age at delivery. In an unselected population, CL measurement screening at 20 to 24+6 weeks of gestation does not seem to be a good predictor of preterm birth.

Fetal Interventricular Septum Volume Evaluated by Three-Dimensional Ultrasound Using Spatiotemporal Image Correlation and Virtual Organ Computer-Aided Analysis in Fetuses From Pre-Gestational Diabetes Mellitus Pregnant Women

Nathalie Jeanne Bravo-Valenzuela,Alberto Borges Peixoto,Rosiane Mattar,Edward Araujo Júnior 한국심초음파학회 2022 Journal of Cardiovascular Imaging (J Cardiovasc Im Vol.30 No.2

BACKGROUND: To assess the interventricular septum (IVS) volume of fetuses from pre-gestational diabetes mellitus (DM) pregnant women by 3-dimensional ultrasound using spatiotemporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods. METHODS: This was a prospective cross-sectional study of 45 fetuses from pre-gestational DM and 45 fetuses from healthy pregnant women (controls). Only singleton pregnancies between 20 and 34 + 6 weeks of gestation were included. The fetal IVS volumes were obtained off-line using STIC and VOCAL methods. To analyze differences among variables, the Student’s t-test and Mann-Whitney U test were used. The correlation among continuous variables was determine using Spearman’s correlation test (r). RESULTS: The median of fetal IVS volume was significantly higher in pre-gestational DM than in healthy pregnant women (0.3 cm3 vs. 0.2 cm3, p = 0.032). A strong positive correlation was observed between fetal IVS volume and gestational age at the time of ultrasound examination (r = 0.75, R2 = 0.48, p < 0.0001) and between fetal IVS volume and estimated fetal weight (r = 0.63, R2 = 0.37, p < 0.0001). No significant correlation was noted between fetal IVS volume and glycated hemoglobin levels (r = −0.16, R2 = 0.01, p = 0.540) in the pre-gestational DM pregnant women. CONCLUSIONS: Significant differences were observed in fetal IVS volumes between pre-gestational and healthy mothers, with higher values in the fetuses of pre-gestational DM pregnant women.

Prenatal diagnosis of transposition of the great arteries: an updated review

Nathalie Jeanne Bravo-Valenzuela,Alberto Borges Peixoto,Edward Araujo Júnior 대한초음파의학회 2020 ULTRASONOGRAPHY Vol.39 No.4

Simple transposition of the great arteries (TGA) is a cyanotic heart disease that accounts for 5% to 7% of all congenital heart diseases. It is commonly underdiagnosed in utero, with prenatal detection rates of less than 50%. Simple TGA is characterized by ventriculoarterial discordance, atrioventricular concordance, and a parallel relationship of TGA. The prenatal diagnosis of TGA influences postnatal outcomes and therefore requires planned delivery and perinatal management. For these reasons, it is important to identify the key ultrasound markers of TGA to improve the prenatal diagnosis and consequently provide perinatal assistance. The presence of two vessels instead of three in the three-vessel tracheal view, a parallel course of TGA, and identification of the origin of each of TGA are the key markers for diagnosing TGA. In addition to the classical ultrasound signs, other two-dimensional ultrasound markers such as an abnormal right convexity of the aorta, an I-shaped aorta, and the "boomerang sign" may also be used to diagnose TGA in the prenatal period. When accessible, an automatic approach using fourdimensional technologies such as spatio-temporal image correlation and sonographically-based volume computer-aided analysis may improve the prenatal diagnosis of TGA. This study aimed to review the ultrasound markers that can be used in the antenatal diagnosis of TGA, with a focus on the tools used by ultrasonographers, the obstetric and fetal medicine team, and perinatal cardiologists to improve the diagnosis of this condition.

Fetal cardiac function by mitral and tricuspid annular plane systolic excursion using spatio-temporal image correlation M‐mode and left cardiac output in fetuses of pregestational diabetic mothers

Nathalie Jeanne Magioli Bravo-Valenzuela,Alberto Borges Peixoto,Rosiane Mattar,Edward Araujo Júnior 대한산부인과학회 2021 Obstetrics & Gynecology Science Vol.64 No.3

ObjectiveTo assess the mitral and tricuspid annular plane systolic excursions (MAPSE and TAPSE, respectively) and cardiacoutput (CO) in fetuses of pregnant women with pregestational diabetes mellitus (DM) using spatio-temporal imagecorrelation M-mode (STIC-M) and virtual organ computer-aided analysis (VOCAL). MethodsThis study was prospective and cross-sectional. It included 45 fetuses each from mothers with pregestational DMand healthy mothers, with gestation ages ranging from 20 to 36.6 weeks. The fetal cardiac volumes were obtainedand analyzed by STIC and VOCAL methods. MAPSE and TAPSE were measured by STIC-M in the apical or basal fourchamberview. The values of the right (RV) and left ventricular (LV) CO were calculated by STIC and VOCAL. ResultsThe median values of TAPSE were 6.1 and 6.2 mm in the diabetic and control groups (P<0.001), respectively. The medianvalues of MAPSE were 4.6 mm in the fetuses of mothers with diabetes and 4.8 mm in fetuses of healthy mothers. The fetal LV CO (60.4 L/min vs. 71.1 L/min; P=0.033, respectively) and RV CO (65.2 vs. 70.1 L/min; P=0.026, respectively)were lower in the pregestational DM group than in the control group. A significant effect of pregestational DM wasobserved in all functional parameters after adjusting, with fetal heart rate as covariant. There was moderate significantpositive correlation between MAPSE and LV CO (r=0.53; P=0.0001) and between TAPSE and RV CO (r=0.46; P=0.0001). ConclusionSignificant difference in functional parameters (TAPSE, MAPSE and LV CO) obtained by STIC and VOCAL wereobserved in the fetuses of the pregestational DM group compared to those of the control group.

Antenatal diagnosis of congenital heart disease by 3D ultrasonography using spatiotemporal image correlation with HDlive Flow and HDlive Flow silhouette rendering modes

André Souza Malho,Nathalie Jeanne Bravo-Valenzuela,Renato Ximenes,Alberto Borges Peixoto,Edward Araujo Júnior 대한초음파의학회 2022 ULTRASONOGRAPHY Vol.41 No.3

This pictorial review describes the assessment of a great variety of types of congenital heart disease by three-dimensional ultrasonography with spatiotemporal image correlation using HDlive and the HDlive Flow silhouette rendering mode. These technologies provide fetal heart surface patterns by using a fixed virtual light source that propagates into the tissues, permitting a detailed reconstruction of the heart structures. In this scenario, ultrasound operators can freely select a better light source position to enhance the anatomical details of the fetal heart. HDlive and the HDlive Flow silhouette rendering mode improve depth perception and the resolution of anatomic cardiac details and blood vessel walls compared to standard two-dimensional ultrasonography.