VP11.04: Widened umbilical artery‐aorta angle with intra‐abdominal cyst as a novel marker of cloacal abnormalities in the first trimester

AbstractThis second part on Doppler sonography in prenatal medicine and obstetrics reviews its clinical applications. While this has not become the initially anticipated screening tool, it is used for the diagnosis and surveillance of a variety of fetal pathologies. For example, the sonography-based determination of uterine artery blood flow indices is an important parameter for the first trimester multimodal preeclampsia risk assessment, increasing accuracy and providing indication for the prophylactic treatment with aspirin. It also has significant implications for the diagnosis and surveillance of growth-restricted fetuses in the second and third trimesters through Doppler-sonographic analysis of umbilical artery, middle cerebral artery and ductus venosus. Here, especially the hemodynamics of the ductus venosus provides a critical criterium for birth management of severe, early-onset FGR before 34 + 0 weeks of gestation. Further, determination of maximum blood flow velocity of the middle cerebral artery is a central parameter in fetal diagnosis of anemia which has been significantly improved by this analysis. However, it is important to note that the mentioned improvements can only be achieved through highest methodological quality. Importantly, all these analyses are also applied to twins and higher order multiples. Here, for the differential diagnosis of specific complications such as TTTS, TAPS and TRAP, the application of Doppler sonography has become indispensable. To conclude, the successful application of Doppler sonography requires both exact methodology and precise pathophysiological interpretation of the data.

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Intracerebral, aortic, and umbilical artery flow velocity waveforms in the late-first-trimester fetus

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(92)91827-w ◽

1992 ◽

Vol 166 (1) ◽

pp. 46-49 ◽

Cited By ~ 24

Author(s):

Juriy W. Wladimiroff ◽

Tjeerd W.A. Huisman ◽

Patricia A. Stewart

Keyword(s):

Flow Velocity ◽

Umbilical Artery ◽

First Trimester ◽

Artery Flow

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Fetal Sirenomelia Associated with an Abdominal Cyst Originating from a Saccular Cloaca

Case Reports in Obstetrics and Gynecology ◽

10.1155/2018/7513287 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Yui Kinjo ◽

Hitoshi Masamoto ◽

Hayase Nitta ◽

Tadatsugu Kinjo ◽

Tomoko Tamaki ◽

...

Keyword(s):

Umbilical Artery ◽

Color Doppler ◽

Abdominal Cavity ◽

External Genitalia ◽

Duodenal Atresia ◽

Lower Limbs ◽

Single Umbilical Artery ◽

Normal Bladder ◽

Anorectal Atresia ◽

Abdominal Cyst

A 40-year-old pregnant woman presented with a fetal abdominal cyst and oligohydramnios. Color Doppler scan revealed a single blood vessel from the fetal aorta into a single umbilical artery. Severe oligohydramnios limited ultrasonographic evaluation of the fetal lower limbs, kidneys, or bladder. The pregnancy was terminated; the fetus showed fused lower limbs, bulging abdomen, and absent external genitalia and was diagnosed with type III sirenomelia. On autopsy, no normal bladder was observed, but duodenal atresia, anorectal atresia, and right renal agenesis were found. An intra-abdominal cyst, diagnosed histologically as a saccular cloaca, occupied the abdominal cavity. Ultrasonographic diagnosis of fetal sirenomelia is difficult due to poor depiction of the lower limbs. A vitelline artery leading to a single umbilical artery and a fetal abdominal cyst occupying most of the abdominal cavity are considered fetal sirenomelia associated with large defects of the gastrointestinal and genitourinary tracts.

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OP23.05: Diagnosis and counseling of women with single umbilical artery should be confined to first-trimester

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.8140 ◽

2010 ◽

Vol 36 (S1) ◽

pp. 119-119

Author(s):

J. Szabó ◽

E. Horváth ◽

J. Szabó ◽

K. Szili ◽

J. Sikovanyecz

Keyword(s):

Umbilical Artery ◽

First Trimester ◽

Single Umbilical Artery

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ABSENT END-DIASTOLIC FLOW IN FIRST TRIMESTER UMBILICAL ARTERY

The Lancet ◽

10.1016/s0140-6736(88)90854-9 ◽

1988 ◽

Vol 332 (8622) ◽

pp. 1256-1257 ◽

Cited By ~ 31

Author(s):

NicholasM Fisk ◽

Neil Maclachlan ◽

Cheryl Ellis ◽

Yuen Tannirandorn ◽

H Margaret Tonge ◽

...

Keyword(s):

Umbilical Artery ◽

First Trimester ◽

Diastolic Flow

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GIANT OVARIAN CYST IN PREGNANCY

Journal of Surgical Sciences ◽

10.33695/jss.v3i1.43 ◽

2016 ◽

Vol 3 (1) ◽

pp. 23-28

Author(s):

G. Radu ◽

Nicoleta Prună ◽

S. Prună ◽

Mirela Moarcăș ◽

Adriana Andrei ◽

...

Keyword(s):

Abdominal Pain ◽

Acute Abdominal Pain ◽

Correct Diagnosis ◽

First Trimester ◽

Maximum Diameter ◽

Abdominal Mri ◽

Giant Tumor ◽

Adnexal Tumors ◽

Abdominal Cyst ◽

In Pregnancy

Before the use of ultrasound, many ovarian tumors remained undiagnosed until cesarean section oruntil they became symptomatic. Now, many symptomatic or non-symptomatic adnexal tumors arediagnosed by ultrasound during pregnancy follow-up.In most cases, the adnexal tumors discoveredduring pregnancy are benign with a maximum diameter of 5 cm. Approximately 70% of the cysticadnexal tumors identified in the first trimester resorb spontaneously until the beginning of thesecond trimester (usually those are functional cysts). Persistent adnexal tumors larger than 5 cmare generally mature teratomas (dermoid).In this case, at the emergency room a 34 year-old-women came with almost 20 weeks pregnancy, accusing acute abdominal pain, nausea andvomiting. One week before, the patient went for a routine ultrasound for pregnancy and the doctordiscovered a giant tumor larger than 15 cm (due to the size it could not be measured) with fluidcontent. Two days before the symptoms, the patient went for an abdominal MRI where a voluminouspelvic-abdominal cyst with almost 30 cm in diameter was discovered. Differential diagnosis:ovarian torsion or ruptured cyst complicating pregnancy. What is the correct diagnosis and what isto be done since there is a 20 weeks pregnancy?

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Can Anorectal Atresia Be Diagnosed in the First Trimester of Pregnancy? A Systematic Literature Review

Medicina ◽

10.3390/medicina56110583 ◽

2020 ◽

Vol 56 (11) ◽

pp. 583

Author(s):

Liana Ples ◽

Radu Chicea ◽

Mircea-Octavian Poenaru ◽

Adrian Neacsu ◽

Romina Marina Sima ◽

...

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

First Trimester ◽

Vitro Fertilization ◽

Detailed Evaluation ◽

First Trimester Of Pregnancy ◽

Anorectal Atresia ◽

Abdominal Cyst ◽

First Trimester Scan

Anorectal atresia (ARA) is a common congenital anomaly, but prenatal diagnosis is difficult, late, and unspecific. Utilizing a case of a 46 year old primipara with an egg donation In Vitro Fertilization (IVF) pregnancy, diagnosed at the first trimester scan with an anechoic isolated structure, which indicates anal atresia, we performed a systematic literature review in order to evaluate early prenatal ARA diagnosis. A total of 16 cases were reported as first trimester ARA suspicion, and only three had no associated anomalies. The most frequent ultrasound (US) sign was the presence of a cystic, anechoic pelvic structure of mainly tubular shape, or a plain abdominal cyst. In the majority of cases, structures were thin-walled and delimitated from the bladder. The presence of hyperechoic spots signifying enterolithiasis and peristaltic movements were helpful in order to establish the bowel origin of the lesion. Considering the high eventuality that the lesion is transitory, meaning later in pregnancy the fetus looks normal, early detection of such a sign should prompt further structural detailed evaluation, karyotyping, and appropriate pregnancy and postnatal counselling.

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