Diagnosis, Management, and Therapy of Fetal Ovarian Cysts Detected by Prenatal Ultrasonography: A Report of 36 Cases and Literature Review

Background: Fetal ovarian cysts are the most frequently diagnosed intra-abdominal cysts; however, the evidence for perinatal management remains controversial. Methods: We retrospectively reviewed cases of fetal ovarian cysts diagnosed by prenatal ultrasonography at our institution between January 2010 and January 2020. The following were investigated: gestational age at diagnosis, cyst size, appearance, prenatal ultrasound findings, and postnatal outcomes. Prior to 2018, expectant management was applied in all cases; after 2018, in utero aspiration (IUA) of simple cysts ≥ 40 mm was performed. Results: We diagnosed 29 and seven simple and complex cysts, respectively. Fourteen patients had simple cysts with a maximum diameter < 40 mm, and two of them progressed to complex cysts during follow-up; however, when the diameter was limited to < 35 mm, no cases showed progression to complex cyst. Fifteen of the simple cysts were ≥ 40 mm; three progressed to complex cysts, and two of them were confirmed to be ovarian necrosis. In four patients who underwent IUA, the ovaries could be preserved. Conclusions: IUA is a promising therapy for preserving ovaries with simple cysts ≥ 40 mm in diameter; however, the indications for fetal surgery and the appropriate timing of intervention require further study.

Reasons Pregnant Women seek Prenatal Sonographic Gender Disclosure in Makurdi, Nigeria

Fetal gender disclosure, a non-medical prenatal ultrasonography indication, although largely ethically unjustifiable, continues to grow and thrive in demand due to its request by pregnant women. The study aims at establishing the proportion of women who want to know fetal gender during prenatal ultrasound. This was twelve months` prospective study of all pregnant women, 16weeks and above who presented at our facility for antenatal ultrasound in Makurdi from 7th May 2019 to 6th May 2020. A structured questionnaire was used to obtain information on factors influencing their willingness to know the gender of their unborn children. The information collated was entered into statistical package for social science (SPSS) version 23.0 for analysis. P-values=0.005 was considered significant for the study population. Two hundred and fifty (250) pregnant women were recruited for the study. Majority of the women 233(93.2%) showed marked interest in knowing the gender of the fetus, while 17(6.8%) did not. The main reason for wanting to know the sex of the fetus was for easier choice of clothing and naming; whereas the main reason for not wanting sex disclosure was because any child is good. There was no statistically significant correlation between gender preferences and the other variables such as age, educational attainment, tribe and previous miscarriages (P=0.136, 0.485, 0.275 and 0.942 respectively). Majority of the women 233(93.2%) want fetal gender disclosure due to ease of choice of clothing and naming. The deliberate policy of non-disclosure on account of non-medical indication during prenatal ultrasonography is untenable in our environment.

Morphology and Morphometry of Foetal Corpus Callosum Using MRI – A Retrospective Study

Introduction: Corpus callosum (CC) is the largest commissural white fibres interconnecting cerebral hemispheres. The corpus callosum is responsible for interhemispheric transfer of information which is essential for cognitive function. The foetal corpus callosum serves as sensitive indicator for normal brain development and maturation. As the corpus callosum is a part of the highest order latest maturing mental network of the brain, its measurements are important to assess normal brain development and to locate structural changes. A comprehensive evaluation of normal human foetal corpus callosal development is essential to detect and understand the congenital anomalies of the brain. Thus, the prenatal diagnosis of partial or complete agenesis of the corpus callosum is important for predicting the normal development of the foetus. Foetal neural anomalies that are suspected on prenatal ultrasonography (USG) can be detected in early stage using foetal MRI. This imaging technique is highly useful for detailed visualization of normal neural development. Certain conditions like colpocephaly and widening of interhemispheric fissure can be clearly visualized using foetal MRI when compared to prenatal ultrasonography. Aim and objective: Was to establish the normal reference values for the measurement of foetal corpus callosum. The length and thickness of the foetal CC was measured corresponding to gestational age (GA) between 18-36weeks. Materials and methods: A retrospective MRI study was carried out in Radiology department of Sri Ramachandra Hospital. The study was conducted on 50 pregnant women with GA of 18-32 weeks and morphology of foetal corpus callosum was measured using MRI. The corpus callosum was visualized in a mid-sagittal plane as an anechoic structure, delimited by two echogenic lines superiorly by sulcus of the corpus callosum and inferiorly by the septum pellucidum. The length of corpus callosum was measured from the anterior most aspect of genu to the posterior most aspect of the splenium and the width of individual parts were measured and correlated with gestational age. The values obtained from the study were statistically calculated using regression coefficient method. Results: In the present study following parameters were observed such as length and width of diverse parts of Corpus callosum. The length of foetal CC ranged from 25.96 to 47.2 mm in 18 to 32 weeks of gestational age. The range of width of rostrum, genu, body and splenium were 1.2 to 2.2 mm, 1.2-2.8mm, 1.3-3.1mm and 1.36-3.2mm respectively. Conclusion: The periodic development of nervous system can be calculated more effectively with the morphometric measurement of foetal CC and its correlation with BPD. It is considered to be accurate than using BPD measurement of head circumference in USG. Hence, with the normative data of foetal CC measurements correlated with gestational age would give us accurate details of neuronal growth rather than measuring biparietal diameter (BPD) alone using USG. This knowledge will be highly helpful for the gynaecologists to predict the abnormal development of the foetus and it is advised to include foetal CC parameters as a one of the tools for early detection of CNS anomalies.

A study of the clearness rate of fetal Sylvian fissure shown on different sections by prenatal ultrasound

Objective To compare the clearness rate of fetal Sylvian fissure revealed by prenatal ultrasonography on trans-cerebellar section and trans-thalamic section, and to provide scientific basis for selecting the best section of prenatal ultrasound to evaluate the developmental parameters related to fetal Sylvian fissure. Methods This was a retrospective study. We analyzed all the fetal images on trans-cerebellar section and trans-thalamic section stored in the imaging system who were undergoing grade III prenatal ultrasound examination in our hospital from January 2017 to December 2018. The gestational age was divided into three groups which were 21 to 24 weeks, 25 to 28 weeks and 29 to 32 weeks respectively. The evaluation criteria for the clear appearance of the Sylvian fissure were complete morphology of the Sylvian fissure and clear apical and anteriorly edges of the Sylvian fissure. The results of showing Sylvian fissure clearly were divided into four groups: only on trans-cerebellar section shown clear, only on trans-thalamic section shown clear, both on trans-cerebellar section and trans-thalamic section shown clear, and both on trans-cerebellar section and trans-thalamic section not shown clear. The clearness rate of each group and the total clearness rate of each section were analyzed statistically. Results The clearness rates of showing Sylvian fissure only on trans-cerebellar section were 62.3% at 21 to 24 weeks, 70.1% at 25 to 28 weeks and 63.6% at 29 to 32 weeks. The clearness rates of showing Sylvian fissure only on trans-thalamic section were 11.1% at 21 ~ 24 weeks, 10.5% at 25 ~ 28 weeks and 9.1% at 29 ~ 32 weeks. The clearness rates of showing Sylvian fissure both on trans-cerebellar and trans-thalamic sections were 22.1% at 21 to 24 weeks, 15.0% at 25 to 28 weeks and 13.0% at 29 to 32 weeks. The unclearness rates of showing Sylvian fissure both on trans-cerebellar and trans-thalamic sections were 4.5%at 21 ~ 24 weeks, 4.4% at 25 ~ 28 weeks and 14.3% at 29 ~ 32 weeks. The clearness rate of showing Sylvian fissure on trans-cerebellar section was significantly higher than on trans-thalamic section (P < 0.05). The total clearness rate of showing Sylvian fissure on trans-cerebellar section and trans-thalamic section were 83.1% and 28.3% respectively. Conclusion In this study, it was suggested that prenatal ultrasound selection of trans-cerebellar section is better than trans-thalamic section in evaluating the developmental parameters related to the Sylvian fissure. Key words fetus; Sylvian fissure; clearness rate; trans-cerebellar section; trans-thalamic section

Necrotizing funisitis and calcification of umbilical vein: case report and review

Background Necrotising funisitis (NF) is a rare, chronic stage of funisitis, a severe inflammation of the umbilical cord and an important risk factor for fetal adverse outcomes. NF is characterized by yellow-white bands running parallel to the umbilical blood vessels. These bands consist of inflammatory cells, necrotic debris, and calcium deposits. Calcification is visible in ultrasonography, which makes it possible to suspect NF when umbilical vascular wall calcification is detected by prenatal ultrasonography. Case presentation Ultrasonography revealed calcification of the umbilical venous wall in an expectant 31-year-old woman who was gravida 1, para 0. The woman required emergency cesarean section because of fetal distress and suspected umbilical cord torsion at 31 weeks gestation. The root of the umbilical cord was quite fragile and broke during the operation. The pathological results on the placenta showed histologic chorioamnionitis and NF. The infant was diagnosed to have neonatal sepsis and acidosis after delivery but was discharged without severe complications after a one-month hospitalization that included antibiotic and supportive therapy. Conclusion NF is a rare and severe inflammation of the umbilical cord. Umbilical vascular wall calcification discovered in prenatal ultrasonography is diagnostically helpful.

Prenatal ultrasound diagnosis of fetal giant left ventricular aneurysm： A case report

Fetal ventricular aneurysm is a rare congenital cardiac malformation that can occur in various cardiac cavities and often exists in isolation without other malformations. Modern ultrasound technology can assist the prenatal diagnosis of ventricular aneurysm. Herein, we will present a rare case of a giant left ventricular aneurysm detected by prenatal ultrasonography.