ABSTRACT
Objective:To explore the relationship between the changes of anorectal angle (ARA) under 3 physiological states and pelvic organ prolapse(POP) in postpartum women by transperineal ultrasound.Methods:The retrospective study enrolled 147 female in 6-8 weeks after delivery examined by pelvic floor ultrasound examinations in Fujian Medical University Second Affiliated Hospital from November 2019 to June 2021, who were divided into POP group and control group. Volume data of pelvic floor ultrasound examinations were obtained at rest, during contraction and during maximal Valsalva maneuver. The differences in the changes of ARA under 3 physiological states between the two groups were compared, and the correlation between the change state of ARA during maximal Valsalva maneuver and POP was analyzed.Results:Compared with ARA at rest, ARA decreased during contraction (χ 2=42.64, P<0.001) and increased during maximal Valsalva maneuver (χ 2=38.43, P<0.001). There was no difference of ARA between the POP group and control group in the 3 physiological states ( P>0.05). However, the risk of POP increased when ARA decreased during maximal Valsalva maneuver ( OR=2.690, 95% CI=1.074-6.739, P<0.05). Conclusions:The decrease of ARA during maximal Valsalva maneuver may increase the risk of POP, and the change of ARA during maximal Valsalva maneuver can be brought into the ultrasonic observation indicators of POP.
ABSTRACT
Objective To investigate the value of prenatally quantitative sonography in diagnosing clubfoot.Methods By routine sonography totally 32 feet diagnosed doubtfully with clubfoot were chosen as case group,and 414 normal feet between 16 and 38 weeks'gestation were enrolled in control group stochastically.The length of foot(FL)and width of the foot(FW)in both group were measured,and then the length-to-width ratio(FL、FW)was calculated.On the basis of the research of Glotzbecker,the angle that the long-axis of the foot made with the long-axis of the lower leg was measured and classified into mild, moderate,severe degree in control group.The length and width of the foot and the length-to-width ratio in both groups were compared.After birth,the fetuses of case group were followed up and Dimeglio score was recorded.The FL、FW and the angle that the long-axis of the foot made with the long-axis of the lower leg were subjected to the correlation analysis with Dimeglio score,respectively.Results Twenty-six of the 32 feet with prenatal diagnosis had a clubfoot documented at birth(false positive equals to 18.8%).According to Glotzbecker's classification,13,13 and 5 of 32 feet respectively were classified as mild,moderate,severe degree.The FL and FL、FW in case group were smaller than those in the other group(FL:Z=-2.10,P <0.05;FL、FW:Z=-8.46,P <0.001),and the foot width was wider(Z=-2.06,P <0.05).Significant negative correlation was identified between the FL、FW and the Dimeglio score(r =-0.600,P <0.01) and significant positive correlation was identified between the angle that the long-axis of the foot made with the long-axis of the lower leg and the Dimeglio score(r=0.764,P <0.01).Conclusions The angle that the long-axis of the foot made with the long-axis of the lower leg,FL,FW and FL、FW can provide more information for prenatally sonography in diagnosing clubfoot without more section of the examination.
ABSTRACT
Objective To determine the normal position of the fetal conus medullaris and assess its clinical significance.Methods A total of 550 singleton pregnant women who were examined by fetal ultrasonography in the Department of Ultrasound at the Second Hospital of Fujian Medical University from June 1, 2013 to September 31, 2014 were included.Inclusion criteria were pregnancies with regular menstruation cycle and known last menstrual period, gestational age (GA) confirmed by ultrasonographic examinations, and neonate abnormality excluded by pediatrician after born.Routine obstetric ultrasound examinations were performed to measure the biparietal diameter (BPD), femur length (FL), head circumference (HC) and abdominal circumference (AC).The conus distance (CD) was determined by measuring the distance between the distal end of the conus medullaris and the caudal end of the last vertebra.The average value was calculated for each group according to GA.Fifty normal fetuses were randomly selected for quality control.For inter-observer reliability assessment, the same data were collected and analyzed by two different operators.For intra-observer reliability assessment, the data were collected and analyzed twice by the same operator with an interval of half an hour.Linear regression correlation analysis was performed to analyze the relationship between CD and GA, BPD, FL, HC and AC.Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to analyze the repeatability of the analysis.Results In 518 (94.2％) of 550 fetuses, the CD was successfully measured.Positively correlations between the conus distance and the gestational age was observed.The CD was (10.0± 3.3) mm at ＞ 14-≤ 15 weeks (n=17), (27.7±3.8) mm at ＞ 20-≤ 21 weeks of gestation (n=18), (41.5±2.4) mm at ＞ 26-≤ 27 weeks (n=8), (54.7±3.0) mm at ＞ 32-≤ 33 weeks (n=17), and (71.9±2.7) mm at ＞ 41-≤ 42 weeks (n=6).Linear regression correlations between CD (mm) and FL, AC, HC, BPD and GA were:CD=1.04× FL (mm)-8.71, CD=0.23 × AC (mm)-10.11, CD=0.28× HC (mm)-18.10, CD=0.90× BPD (mm)-17.65, CD=2.34× GA (weeks)-20.94 (r=0.990, 0.985, 0.978, 0.974 and 0.973, respectively, all P ＜ 0.01).The measurement of the conus distance exhibited good reproducibility between different operators (ICC=0.984, 95％CI: 0.972-0.991) and for the same operator (ICC=0.992, 95％CI: 0.985-0.995) with the 95％ limits of agreement of-1.8 to 3.5 mm and-4.3 to 2.1 mm.Bland-Altman analysis showed that most of the measured values were within 95％ confidence interval suggesting good consistency.Conclusions The distance, between the end of the conus medullaris and the end of the last vertebral body under ultrasound scan, is positively correlated with FL and other ultrasonographic indicators, which implies that it could be used as a new index for position of fetal conus medullaris.
ABSTRACT
Objective To establish normative data for the fetal cisterna magna septa (CMS) at various gestational age,and to evaluate its clinical significance.Methods A total of consecutive fetal between 14 and 40 gestational week(GW) were included in this prospective study.The length and width of CMS were measured by two-dimensional ultrasonography.Regression analysis was used to study the relationship between the width and length of the fetal cisterna magna septa and gestational age.Twenty-five case of fetuses with the absence of CMS and 12 case of fetuses with the enlargement of CMS were retrospectively analyzed in the past six years in our hospital.Results ①The fetal CMS length and width increased gradually between 14 and 22 GW,then plateaued between 23 GW and 36 GW,and decreased after 37 GW.This ultrasonographic pattern was in agreement with normal development of rhombencephalon.②The absence of CMS in the fetuses were common in Dandy-Walker syndrome,holoprosencephaly,severe hydrocephalus,neural tube defects,rhombencephalon synapsis and Arnold-Chiari malformation.The enlargement of CMS in the fetuses may be shown in physiologic enlargement of posterior fossa.ConclusionsCMS is a potential new marker for normal development of rhombencephalon.The enlargement and absence of CMS are related to various malformations of central neural system,especially in the abnormalities of posterior fossa.
ABSTRACT
Objective To establish normal reference indexes of aorta during gestation and cut-points for detection of fetuses with coarctation of aorta.Methods From long-axis views of the aortic arch,the internal diameter of the aortic root,ascending aorta,transverse aortic arch,aortic isthmus,descending aorta,anonyma,left common carotid artery,left subclavian artery were measured in 234 normal fetuses at different time ranging from 14 to 41 weeks during gestation.Reference values of each aortic segment were constructed by linear regression analysis.The ratio of each aortic segment to the ascending aorta were calculated.ResultsThe internal diameter in each aortic segments increased as pregnancy progressed (P<0.01).In the prenatal diagnosis of fetus with coarctation of the aorta,the ratio of the aortic isthmus to the ascending aorta and descending aorta to the ascending aorta were significantly lower than the normal fetuses(all P<0.01).Conclusions The ratio of the aortic isthmus to the ascending aorta and ratio of descending aorta to the ascending aorta detected by echocardiography may be helpful in the prenatal diagnosis of coarctation of aorta.