ABSTRACT
Objective:To analyze the consistency and repeatability for quantitative evaluation of normal fetal posterior fossa anatomy using transabdominal three-dimensional ultrasound, and assess the clinical value.Methods:The midsagittal planes of fetal brain from 127 normal singleton fetuses with 22-34 weeks of gestation were obtained using transabdominal three-dimensional ultrasound between May, 2020 and May, 2021. The quantitative three-dimensional indicators were measured by two observers, then were measured twice by one of the two observers. The double blind was performed in course of measuring procedures. The intraobserver and interobserver agreements were evaluated. The relationships between three-dimensional indicators and gestational age were analyzed.Results:The quantitative three-dimensional indicators expressing the size of vermis, including area, perimeter, suprainferior diameter and anteroposterior diameter, had positive correlations with advanced gestational age ( r=0.934, 0.936, 0.920, 0.879; all P<0.001). The intra- and interobserver reproducibilities of measurements were very good with all intraclass correlation coefficients >0.80 (all P<0.001). Brainstem-vermis (BV) angle and Brainstem-tentorium (BT) angle had negative and positive correlations with advanced gestational age respectively ( r=-0.317, 0.366; both P<0.001). The intra-and interobserver reproducibilities of measurements were moderate or poor. Conclusions:The quantitative three-dimensional indicators describing the size of vermis are worthy of clinical application for evaluation of fetal posterior fossa owing to the excellent reproducibility and simple and feasible method of measurement. BV angle and BT angle are not applicable for junior physicians due to the poor reproducibility of measurement.
ABSTRACT
Background: Despite enormous volume of research devoted to the skeletogenous and to the quantitative studies of the developing and mature skeleton, the growth of skull in respect to its surface area is still never been comprehensively studied. Since classical study of Streeter reported gestational age estimation from crown-rump length (CRL), numerous investigators have studied and reported various measures of fetal growth during pregnancy such as biparietal diameter, diaphyseal length of long bones and even cephalometric growth analysis. Present study was done in dried fetal skull bones by calculation of their external surface area and estimation of linear correlation with crown-rump length and hence determination of gestational age. Aim: To establish the correlation between the external surface area of right parietal bone and crown-rump length, to predict fetal age from crown-rump length and circulation of growth rate of right parietal bone. Material and methods: Fifty apparently normal fetuses ranging from 12 cm -42 cm CR length of both sexes were obtained from the Departmen of Obstetrics and Gynecology, of our native hospital. After measuring crown-rump length of each fetal skull after removing brain tissue via foramen magnum was then kept for maceration in running tap water. After complete maceration and separation of right parietal skull bone, measurement of external surface area of right parietal skull bone was obtained using wet cotton cloth, marker pen and graph paper. Results: The regression values were plotted in the graph and these values were found to cluster around the standard straight line and are in hand with the straight line indicating highly significant results. Conclusion: In the present study, CR length was estimated from external surface area of right parietal bone. A definite correlation was observed between external surface area of right parietal bone and CR length.
ABSTRACT
Pregnancies consisting of complete hydatidiform mole with a coexisting fetus are relatively rare and associated with a risk of persistent gestational trophoblastic tumor. Recently, hydatidiform moles with a fetus have become more and more common due to utilization of induction agents for ovulation, and many clinicians have been confronted with the difficulty of determining whether to undergo immediate intervention or expectant management. However, there are limited data to guide the antenatal management of complete hydatidiform mole coexisting with a fetus. We experienced a case of complete hydatidiform mole with a coexistent live fetus, which was diagnosed by ultrasonography at 19 gestational weeks, showing a molar pattern and normal fetal structure, and confirmed normal karyotype of the coexistent fetus. Antenatal management was done with an additional serial check of beta-hCG levels and blood pressure. The levels of serum beta-hCG in serum level were progressively decreased after 19 gestational weeks and fell within normal range during advancing gestation. Pregnancy was terminated at 30 gestational weeks due to fetal hypoxia resulting from severe pre-eclampsia with a live small for gestational age infant. We report our case with a literature review to provide a guideline of management about complete hydatidiform mole with a coexisting fetus. Our result suggest that the pregnancy of complete mole with a coexisting live fetus may be allowed to continue when the fetal karyotype and development are normal and serum beta-hCG titers are falling with advancing gestational age.