Anatomical structure characterization of fetal ultrasound images using texture-based segmentation technique via an interactive MATLAB application.

OBJECTIVE: To describe the texture characteristics in several anatomical structures within fetal ultrasound images by applying an image segmentation technique through an application developed in MATLAB mathematical processing software. METHODS: Prospective descriptive observational study with an analytical component. 2D fetal ultrasound images were acquired in patients admitted to the Maternal Fetal Medicine Unit of the Hospital de San José, Bogotá-Colombia. These images were loaded into the developed application to carry out the segmentation and characterization stages by means of 23 numerical texture descriptors. The data were analyzed with central tendency measures and through an embedding process and Euclidean distance. RESULTS: Forty ultrasound images were included, characterizing 54 structures of the fetal placenta, skull, thorax, and abdomen. By embedding the descriptors, the differentiation of biologically known structures as distinct was achieved, as well as the non-differentiation of similar structures, evidenced using 2D and 3D graphs and numerical data with statistical significance. CONCLUSION: The texture characterization of the labeled structures in fetal ultrasound images through the numerical descriptors allows the accurate discrimination of these structures.

The Management of Acardiac Twinning: Twin Reverse Arterial Perfusion Sequence - An International Survey.

INTRODUCTION: The optimal approach and therapy method for the acardiac twin with a reverse arterial perfusion sequence has not yet been established. The aim of this study was to determine the clinical practice patterns among international fetal therapy units in their management of these cases. METHODS: A survey was sent to fetal centers across the world via email between December 2020 and December 2021. RESULTS: Responses were obtained from 77% contacted centers. The most frequent ultrasound variables used in the evaluation of twin reverse arterial perfusion sequence include echocardiographic assessment of the pump twin and umbilical artery Doppler waveforms in the acardiac and pump twins, in 90% and 80% of the centers, respectively. Most centers in Europe and Latin America propose an in utero intervention in all cases. Most centers in Europe and Latin America prefer interstitial laser ablation, whereas radiofrequency ablation (RFA) is preferred in North America. The earliest gestational age for an intervention is on mean 13 weeks in Europe, which is earlier than the other geographic areas (p = 0.001). CONCLUSIONS: Most centers agreed that antenatal evaluation should include echocardiography along with the UA Doppler waveform measurements, and the most frequently used interventions were interstitial laser ablation or RFA at a median between 14 and 26 weeks.

Tratamiento farmacológico en la restricción del crecimiento fetal: revisión de la bibliografía / Pharmacological management for fetal growth restriction: literature review

Resumen OBJETIVO: Explorar las diferentes estrategias de tratamiento farmacológico de la restricción del crecimiento fetal propuestas a lo largo del tiempo. METODOLOGÍA: Revisión cuasi-sistemática de la evidencia científica histórica disponible acerca del tratamiento médico descrito para la atención de mujeres embarazadas con restricción del crecimiento fetal. RESULTADOS: Entre los tratamientos médicos descritos para tratar la restricción del crecimiento fetal, los donadores de óxido nítrico, las estatinas y la aspirina asociada con omega 3, han tenido desenlaces no consistentes en estudios con limitado tamaño de muestra. Por lo que se refiere a los inhibidores de la 5-fosfodiesterasa, el sildenafilo no se ha asociado con un aumento de la velocidad de crecimiento fetal pero sí con alarmas respecto de su seguridad debidas al incremento de los casos de hipertensión pulmonar fetal y mortalidad perinatal. Por su parte, el tadalafilo ha mostrado desenlaces iniciales favorables y se esperan estudios con mayor tamaño de muestra que permitan emitir recomendaciones claras con respecto a su indicación. También se esperan los desenlaces de estudios clínicos en curso, para definir la indicación de la heparina de bajo peso molecular en este escenario en virtud de sus prometedores resultados iniciales. Los procedimientos más invasivos, como la inyección de factor de crecimiento endotelial vascular y la plasmaféresis, permanecen en estudio como propuestas terapéuticas por los resultados de estudios preclínicos y clínicos con pocos pacientes. CONCLUSIÓN: Por ahora, ninguna estrategia farmacológica propuesta ha conseguido generar recomendaciones fuertes para su indicación; sin embargo, se esperan nuevos estudios con alta calidad metodológica que generen evidencia científica lo suficientemente contundente para recomendar su indicación.

Abstract OBJECTIVE: To explore the different pharmacological treatment strategies for fetal growth restriction proposed over time. METHODOLOGY: Quasi-systematic review of the available historical scientific evidence on the medical treatment described for the care of pregnant women with fetal growth restriction. RESULTS: Among the medical treatments described to treat fetal growth restriction, nitric oxide donors, statins, and aspirin associated with omega-3 have had inconsistent outcomes in studies with limited sample size. As for 5-phosphodiesterase inhibitors, sildenafil has not been associated with an increase in fetal growth velocity, but there have been alarms regarding its safety due to the increase in cases of fetal pulmonary hypertension and perinatal mortality. On the other hand, tadalafil has shown favorable initial outcomes and studies with a larger sample size are awaited to issue clear recommendations regarding its indication. The results of ongoing clinical studies are also awaited to define the indication of low molecular weight heparin in this setting, given its promising initial results. More invasive procedures, such as vascular endothelial growth factor injection and plasmapheresis, remain under study as therapeutic proposals due to the results of preclinical and clinical studies with few patients. CONCLUSION: For now, no proposed pharmacological strategy has managed to generate strong recommendations for its indication; however, new studies with high methodological quality are expected to generate scientific evidence strong enough to recommend its indication.

Síndrome de respuesta inflamatoria fetal: fisiopatología, desenlaces y estudio ecográfico prenatal / Feltal inflamatory response syndrome: Pathophysiology, outcomes, and prenatal ultrasound study

Resumen OBJETIVO: Ofrecer al lector información amplia y suficiente acerca de este síndrome, con hincapié en el reconocimiento del daño multiorgánico fetal, que permita darle herramientas para establecer el diagnóstico oportuno y disminuir la morbilidad y mortalidad fetal y neonatal. METODOLOGÍA: Estudio retrospectivo con base en la búsqueda en las bases de datos de PubMed, EBSCO y Ovid de 2016 a 2021 de artículos de revisión, investigaciones originales, guías de práctica clínica y protocolos. Además, artículos clásicos y los correspondientes a búsquedas manuales para lograr la contextualización de los puntos tratados. RESULTADOS: Cuando la infección llega al feto, se despliega una respuesta proinflamatoria con secreción de citocinas, que son la base para el diagnóstico de síndrome de respuesta inflamatoria fetal. Cuando esta respuesta a la infección es desregulada, termina por generar un daño multiorgánico que puede ser reconocido por medio de herramientas no invasivas, como el ultrasonido fetal avanzado. Este reconocimiento permite iniciar la atención oportuna a fin de reducir las tasas de morbilidad y mortalidad perinatal. CONCLUSIÓN: La infección microbiana de la cavidad amniótica y del feto, con la generación subsecuente del síndrome de respuesta inflamatoria fetal, se asocia con daño multiorgánico que puede reconocerse en el ultrasonido avanzado y lograr la atención óptima y mejores desenlaces perinatales.

Abstract OBJECTIVE: To provide the reader with ample and sufficient information about this syndrome, with emphasis on the recognition of fetal multiorgan damage, to provide tools to establish a timely diagnosis and reduce fetal and neonatal morbidity and mortality. METHODOLOGY: Retrospective study based on the search in PubMed, EBSCO and Ovid databases from 2016 to 2021 of review articles, original research, practice guidelines and protocols. In addition, classic articles and those corresponding to manual searches to achieve contextualization of the points discussed. RESULTS: When infection reaches the fetus, a proinflammatory response with cytokine secretion unfolds, which are the basis for the diagnosis of fetal inflammatory response syndrome. When this response to infection is deregulated, it ends up generating multiorgan damage that can be recognized by means of noninvasive tools, such as advanced fetal ultrasound. This recognition allows initiating timely care in order to reduce perinatal morbidity and mortality rates. CONCLUSION: Microbial infection of the amniotic cavity and fetus, with subsequent generation of fetal inflammatory response syndrome, is associated with multiorgan damage that can be recognized on advanced ultrasound and achieve optimal care and better perinatal outcomes.

Asociación VACTERL de presentación inusual: reporte de caso / VACTERL Association with Unusual Presentation: Case Report / Associação VACTERL de apresentação rara: relato de caso

Resumen: En el contexto de Asociación VACTERL, el diagnóstico prenatal de atresia esofágica concomitante con atresia duodenal es poco común. En el presente artículo se realiza el reporte de un caso con la descripción de los hallazgos ecográficos encontrados a partir semana doce de gestación, con la aparición del signo de doble burbuja intraabdominal compatible con atresia duodenal y una arteria umbilical única; y hacia la semana 31 el hallazgo de imagen anecóica y dilatación esofágica del tercio distal con comunicación con la cámara gástrica en corte longitudinal, representando una atresia esofágica, asociada además a polihidramnios. Desde el momento del nacimiento por examen físico y estudios complementarios, se evidenció además ano imperforado con fístula recto vestibular, arcos costales derechos fusionados y hemivértebras. Por los anteriores hallazgos clínicos y radiológicos, se considera que se trata de una asociación VACTERL; sin embargo, sin alteraciones cardiacas, que es una de las características más frecuentemente encontradas. Se realiza una revisión del estado del arte con respecto a la asociación VACTERL y el diagnóstico prenatal de la atresia esofágica y duodenal.

Abstract: In the context of the VACTERL Association, prenatal diagnosis of concomitant esophageal atresia with duodenal atresia is rare. In this article, a case report is described with the description of the ultrasound findings found from week twelve of gestation, with the appearance of the intra-abdominal double bubble sign compatible with duodenal atresia and a single umbilical artery; and towards week 31 the finding of anechoic image and esophageal dilation of the distal-third with communication with the gastric chamber in longitudinal section, representing esophageal atresia, also associated with polyhydramnios. Physical examination and complementary studies from birth showed an imperforate anus with a rectovestibular fistula, and hemivertebrae. Based on the above clinical and radiological findings, it is considered to be a VACTERL association; however, without cardiac abnormalities, which is one of the most frequently found characteristics. A review of the state of the art is carried out with regard to the VACTERL association and the prenatal diagnosis of esophageal and duodenal atresia.

Resumo: No contexto da Associação VACTERL, o diagnóstico pré-natal de atrésia do esôfago concomitante com atrésia de duodeno é pouco comum. Neste artigo, é realizado relato de um caso com a descrição dos achados ecográficos encontrados a partir da 12a semana de gestação, com o surgimento do sinal de dupla bolha intra-abdominal compatível com a atrésia duodenal e uma artéria umbilical única; na 3ia semana, o achado de imagem anecoica e dilatação esofágica do rádio distai com comunicação com a câmara gástrica em corte longitudinal, o que representa atrésia esofágica, associada, ainda, a polidrâmnio. Desde o momento do nascimento por exame físico e estudos complementares, é evidenciado ânus imperfurado com fístula retal vestibular, arcos costais direitos fusionados e hemivértebras. A partir dos achados clínicos e radiológicos, é considerado que se trata de uma associação VACTERL; contudo, sem alterações cardíacas, que é uma das características mais frequentemente encontradas. É realizada uma revisão do estado da arte a respeito da associação VACTERL e o diagnóstico pré-natal da atrésia esofágica e duodenal.