Reference Ranges for the Fetal Cardiac Circumference Derived by Cardio Spatiotemporal Image Correlation From 14 to 40 Weeks Gestation
|
|
- Darlene Copeland
- 7 years ago
- Views:
Transcription
1 ORIGINAL RESEARCH Reference Ranges for the Fetal Cardiac Circumference Derived by Cardio Spatiotemporal Image Correlation From 14 to 40 Weeks Gestation Kuntharee Traisrisilp, MD, Fuanglada Tongprasert, MD, Kasemsri Srisupundit, MD, Suchaya Luewan, MD, Theera Tongsong, MD Objectives The purpose of this study was to construct reference ranges for the fetal cardiac circumference derived from volume data sets obtained by cardio spatiotemporal image correlation. Methods A prospective descriptive study was conducted on normal singleton pregnancies with certain dates from 14 to 40 weeks gestation. All underwent cardio spatiotemporal image correlation to acquire volume data sets for subsequent analysis. Cardiac circumferences were measured offline in a multiplanar view with 4-dimensional imaging software. The reference ranges were constructed against gestational weeks and the biparietal diameter as independent variables, using regression models for both the mean and SD. Results A total of 678 satisfactory volumes were analyzed. Normal reference ranges for predicting means and SDs of the fetal cardiac circumference were established based on best-fitted equations. The mean cardiac circumference (millimeters) was modeled as a function of gestational age (weeks) and biparietal diameter (centimeters) as follows: cardiac circumference = gestational age gestational age 2 (SD = gestational age) and biparietal diameter (SD = biparietal diameter). Equations for z score calculation were also provided, and percentile charts for predicting the cardiac circumference at various points of gestational age and biparietal diameter were constructed. Conclusions Normal reference ranges and z scores for the fetal cardiac circumference have been provided. These normative data may be useful tools for assessment of fetal cardiac size, especially in cardiomegaly due to fetal anemia. Key Words fetal cardiac circumference; 4-dimensional sonography; prenatal; reference range; spatiotemporal image correlation; z scores Received February 10, 2011, from the Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. Revision requested March 2, Revised manuscript accepted for publication April 6, This work was supported by the Thai Research Fund and the National Research University Project under Thailand s Office of the Higher Education Commission. Address correspondence to Theera Tongsong, MD, Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand. ttongson@mail.med.cmu.ac.th A ssessment of fetal cardiac size is essential in prenatal diagnosis of various cardiac anomalies, especially cardiomegaly secondary to fetal anemia of various causes. For example, our experience shows that the cardiac diameter for cardiac size assessment is very helpful in early diagnosis of cardiomegaly due to hemoglobin Bart disease. 1 Theoretically, measurement of the cardiac circumference is certainly more accurate than the cardiac diameter because it better represents the cardiac size in all dimensions. In the past, we rarely measured the cardiac circumference because it is more time-consuming and subject to measurement error because of a poor border outline, especially in early gestation. Therefore, a only few studies on cardiac circumference have been 2011 by the American Institute of Ultrasound in Medicine J Ultrasound Med 2011; 30:
2 published. 2 6 Additionally, most included only short gestational periods or small sample sizes. Moreover, only a study reported by Lee et al 5 provided z scores as a quantitative assessment for clinical purposes. Importantly, z scores allow the examiner to quantify the cardiac size without the limitations of traditional confidence intervals. However, the study by Lee et al 5 was based on a retrospective database assessment, and their z score reference ranges were derived from 2-dimensional fetal echocardiography, with which it is relatively difficult to get a precise plane for a cardiac study compared to 4-dimensional sonography with spatiotemporal image correlation (cardio spatiotemporal image correlation). With cardio spatiotemporal image correlation, the focused structures can be shown in all dimensions, leading to more precise measurement. 7 Therefore, we conducted this prospective study to develop z scores and percentile reference ranges for the fetal cardiac circumference derived from cardio spatiotemporal image correlation. To our best knowledge, reference ranges for the cardiac circumference derived from cardio spatiotemporal image correlation have not been reported previously. Materials and Methods This prospective descriptive study was conducted between September 1, 2007, and October 31, 2010, at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, with approval from the institute s Ethics Committee. Normal singleton pregnancies were recruited from the antenatal care unit, and written informed consent was obtained. The inclusion criteria were as follows: (1) gestational age between 14 and 40 weeks, (2) accurate gestational age based on sonographic fetal biometric measurements in the first half of pregnancy and consistent with a reliable menstrual period, and (3) low-risk pregnancies without known medical or obstetric complications. The exclusion criteria were as follows: (1) multifetal pregnancies, (2) fetal anomalies, (3) abnormal fetal growth (fetal growth restriction [<10th percentile] or macrosomia [>90th percentile]), and (4) inability to obtain satisfactory cardio spatiotemporal image correlation volume data sets. All patients underwent standard sonographic examinations, including fetal biometric measurements with an anatomic survey, and cardio spatiotemporal image correlation volumes were acquired using a real-time machine with 2- to 5-MHz curvilinear transabdominal transducers (Voluson E8; GE Healthcare, Milwaukee, WI). The volume data sets were acquired with transverse sweeps through the fetal chest, which included the proper apical and transverse 4-chamber views. Acquisition times ranged from 7.5 to 15 seconds, and acquisition angles ranged from 20 to 40 depending on the gestational age and cardiac size. All of the cardio spatiotemporal image correlation volumes were stored in the ultrasound machine s hard drive for subsequent offline analysis. The volume data set analysis was systematically performed to identify the exact 4-chamber view, according to instructions described elsewhere, 8,9 using 4D View version 9.0 software (GE Healthcare, Zipf, Austria), as shown in Figure 1. The analysis is summarized as follows: Dynamic images of the fetal heart were simultaneously visualized in the 3 orthogonal planes on panels A, B, and C of the multiplanar views. Images of the 4-chamber view were minutely maneuvered by moving the reference dot and rotating the fetal heart around the 3 orthogonal axes (x, y, and z) to get the interventricular septum in the exact horizontal plane in all 3 panels. The proper image could be checked by showing that the interventricular septum in panel A was on the same line as in panel B, and a total en face view of the interventricular septum was visualized in panel C (Figure 1). The typical 4-chamber view in panel A was frozen at end-diastole and then was displayed and magnified as a single image on the screen. The cardiac circumference was measured at end-diastole using the area point or area trace function in 4D View. Regression analysis of the fetal cardiac circumference was performed to identify the best-fitted equation using SPSS version 17.0 software (SPSS Inc, Chicago, IL). The procedure followed instructions published by Royston and Wright. 10 Briefly, regression models were fitted separately to the mean and SD of the cardiac circumference (depen- Figure 1. Fetal cardiac circumference displayed in multiplanar views of a cardio spatiotemporal image correlation volume in the 4-chamber view. Note that the interventricular septum in panel A is set to be on the same line in panel B to get the exact 4-chamber view in panel A J Ultrasound Med 2011; 30:
3 dent variables) to generate the best-fitted regression equations. The best-fitted models for the SD were derived from regression of scaled absolute residuals which were obtained as: scaled absolute residual = 1.25 absolute (measured value predicted value). Normality and goodness-of-fit regression models were assessed by examination of the scatter patterns of points relative to fitted means and SDs, expressed as z scores (measured value estimated mean/estimated SD). The z scores were tested for normality using the Sharpiro-Wilk W test and Q-Q plots. Percentile curves and tables of reference ranges were constructed by the formula percentile = mean + K SD, where K was the corresponding percentile of the standard Gaussian distribution. Results A total of 710 cardio spatiotemporal image correlation volumes were successfully acquired and available for offline analysis; however, only 678 volume data sets from 678 fetuses had satisfactory cardiac circumference measurements. The mean maternal age ± SD was ± 6.31 years (range, years), and most of them (395 [58.26%]) were nulliparous. The number of participants at each gestational age is shown in Table 1. A quadratic regression model was the best description of the predicted mean of the cardiac circumference based on gestational weeks, whereas linear regression was the best-fitted model for predicting the mean based on the biparietal diameter and SD of both independent variables, as presented in Table 2 and Figures 2 and 3. These equations were validated by constructing a z score for each variable. The normalcy of the z scores was evident in a Q-Q plot. The Sharpiro-Wilk W test showed normality in the distribution (P =.58). Additionally, the z scores were evenly distributed above and below 0 across the entire range of gestational ages and biparietal diameters and had a standard normal distribution. The z scores that were outside the range of ±2 SD did not differ significantly from the expected 10% of the values (Figure 4). Percentile models for the cardiac circumference as a function of gestational age in weeks and biparietal diameter in centimeters are shown in Tables 1 and 3, respectively. The z score for each actual cardiac circumference value can be calculated as follows: z score = (measured cardiac circumference value predicted value)/predicted SD. Example of a z score calculation: actual measured biparietal diameter = 4.0 cm; cardiac circumference = 68 mm. Using the formula in Table 2: predicted cardiac circumference = ( ) = mm; predicted SD of cardiac circumference = ( ) = 4.07 mm; and z score = (68 53)/4 = Therefore, the fetuses had an enlarged cardiac circumference at 3.75 SD above the predicted mean cardiac circumference for a fetus whose biparietal diameter was 4 cm (out of the normal range). Discussion Although our cardiac diameter measurement is simple, more practical, reproducible, less time-consuming, and very helpful for early diagnosis of cardiomegaly secondary to various causes, especially fetal anemia, 1 theoretically, the cardiac circumference better represents the fetal heart size than the cardiac diameter. However, in practice, the measurement is more time-consuming and subject to error in cases with a poor cardiac border. Currently, high-resolution sonography allows tracing of the heart perimeter with higher reliability than ever before. Normal reference ranges for the cardiac circumference are very limited, especially z Table 1. Fetal Cardiac Circumference as a Function of Gestational Age GA, Cardiac Circumference, mm wk n 2.5th 5th 10th 50th 90th 95th 97.5th GA indicates gestational age; and n, sample size for each gestational week. J Ultrasound Med 2011; 30:
4 Table 2. Regression Models for Prediction of the Mean and SD of the Fetal Cardiac Circumference Based on Gestational Age and Biparietal Diameter Parameter Model Derived From Regression Analysis r Gestational age (GA), wk Cardiac circumference, mm GA GA SD of cardiac circumference, mm GA 0.28 Biparietal diameter (BPD), cm Cardiac circumference, mm BPD 0.97 SD of cardiac circumference, mm BPD 0.25 Figure 2. Quadratic function relationship between gestational age and the cardiac circumference. The lines represent the 2.5th, 5th, 10th, 50th, 90th, 95th, and 97.5th percentiles. Figure 3. Linear relationship between the biparietal diameter (BPD) and cardiac circumference. The lines represent the 2.5th, 5th, 10th, 50th, 90th, 95th, and 97.5th percentiles. scores for quantitative assessment of fetal cardiac size. On the basis of this study and previous reports, 2,3,5,11 the cardiac size increases steadily through gestational age. However, our results are somewhat different from those of other studies in that the best-fitted model for gestational age was a quadratic function rather than linear, as in other studies. We found that the SD of the cardiac circumference was greater with increasing gestational age. Therefore, we had to analyze and regress the SD separately. To our knowledge, SD analysis was not performed in most previous studies; however, it is critically important for z score assessment. 10,12 In addition to providing z score assessment, another main difference from other studies was that our data were derived from cardio spatiotemporal image correlation. With conventional 2-dimensional sonography, it is difficult to get a proper plane in the 4-chamber view, even with the ultrasound beam exactly perpendicular to the interventricular septum, because the depicted image on the screen, although appearing to be perfect in the x- and y- axes, can be tilted toward or away from the examiner in the Figure 4. Distribution of calculated z scores for the cardiac circumference against gestational age, indicating an adequate level of fit J Ultrasound Med 2011; 30:
5 z-axis, resulting in asymmetry of the left and right sides of the heart and leading to an inaccurate circumference. Obtaining a perfect 4-chamber view is often time-consuming and sometimes impossible. With the innovative cardio spatiotemporal image correlation, this problem has been solved. It is very simple, less time-consuming, and highly reliable for getting the proper orientation. Unlike an examination with 2-dimensional sonography, in which we have to orient the transducer to visualize the proper plane, with the offline analysis of cardio spatiotemporal image correlation, we can control and orient the virtual heart volume to get the proper plane and not have to orient the transducer. The interventricular septum can be simply maneuvered to be on the exact horizontal line in panels A and B, and a total en face view can be displayed in panel C, resulting in more reliable measurements. In this study, we used the area point or area trace function available in 4D View version 9.0 to trace the cardiac outline as meticulously as we wanted. We chose this technique because the heart shape is too complex, not symmetrically geometric, to be accurately assessed with a simple eclipse tool or computed from two diameters, as in previous studies. 5,11 One limitation of the cardio spatiotemporal image correlation used in this study was that the resolution of the volume data sets may have been somewhat compromised in some cases because of fetal movement and maternal breathing. Additionally, even with a high-resolution ultra- Table 3. Fetal Cardiac Circumference as a Function of Biparietal Diameter BPD, Cardiac Circumference, mm BPD, Cardiac Circumference, mm cm 2.5th 5th 10th 50th 90th 95th 97.5th cm 2.5th 5th 10th 50th 90th 95th 97.5th BPD indicates biparietal diameter. J Ultrasound Med 2011; 30:
6 sound machine, the small cardiac structures early in the second trimester could not be clearly distinguished from surrounding structures, and several volume data sets in early gestation were excluded because of unsatisfactory quality for analysis. Moreover, it was sometimes impossible to obtain satisfactory volumes in fetuses with very active and long movement or when they were poorly accessible, especially in a supine position. The strengths of this study included first its large sample size (678), ranging from 15 to 38 examinations per gestational week; constructing a normal reference range with a +1 to 3 SD curve and restricting the SE of the limits of the reference range to 10% of the SD requires a sample size of about 550 fetuses (14 40 weeks). 10 Second, measurement based on offline analysis with cardio spatiotemporal image correlation did not have a time limit, allowing us to obtain reliable planes of exact 4-chamber views. Third, our normative tables included fetuses in early and late gestation, unlike in most previous reports. Finally, z scores for quantitative evaluation were also provided, and the z score distribution against gestational age and biparietal diameter indicated an adequate model fit. In conclusion, reference ranges for the fetal cardiac circumference at each gestational age and biparietal diameter from 14 to 40 weeks were constructed on the basis of cardio spatiotemporal image correlation volume data sets. These reference ranges may be useful tools for assessment of fetal cardiac size, especially when fetal cardiomegaly is suspected. However, the effectiveness of this fetal parameter is yet to be validated by further studies. 7. Chaoui R, Heling KS. New developments in fetal heart scanning: threeand four-dimensional fetal echocardiography. Semin Fetal Neonatal Med 2005; 10: DeVore GR, Polanco B, Sklansky MS, Platt LD. The spin technique: a new method for examination of the fetal outflow tracts using threedimensional ultrasound. Ultrasound Obstet Gynecol 2004; 24: Gonçalves LF, Lee W, Espinoza J, Romero R. Examination of the fetal heart by four-dimensional (4D) ultrasound with spatio-temporal image correlation (STIC). Ultrasound Obstet Gynecol 2006; 27: Royston P, Wright EM. How to construct normal ranges for fetal variables. Ultrasound Obstet Gynecol 1998; 11: Awadh AM, Prefumo F, Bland JM, Carvalho JS. Assessment of the intraobserver variability in the measurement of fetal cardiothoracic ratio using ellipse and diameter methods. Ultrasound Obstet Gynecol 2006; 28: Silverwood RJ, Cole TJ. Statistical methods for constructing gestational age-related reference intervals and centile charts for fetal size. Ultrasound Obstet Gynecol 2007; 29:6 13. References 1. Tongsong T, Wanapirak C, Sirichotiyakul S, Chanprapaph P. Sonographic markers of hemoglobin Bart disease at midpregnancy. J Ultrasound Med 2004; 23: Gembruch U, Shi C, Smrcek JM. Biometry of the fetal heart between 10 and 17 weeks gestation. Fetal Diagn Ther 2000; 15: Guariglia L, Rosati P, Bartolozzi F. Cardiac circumference measurement: possible screening tool in early pregnancy for anomalous cardiac development. Fetal Diagn Ther 2006; 21: Jordaan HV. Cardiac size during prenatal development. Obstet Gynecol 1987; 69: Lee W, Riggs T, Amula V, et al. Fetal echocardiography: z-score reference ranges for a large patient population. Ultrasound Obstet Gynecol 2010; 35: Smrcek JM, Berg C, Geipel A, Fimmers R, Diedrich K, Gembruch U. Early fetal echocardiography: heart biometry and visualization of cardiac structures between 10 and 15 weeks gestation. J Ultrasound Med 2006; 25: J Ultrasound Med 2011; 30:
Charts of fetal size: limb bones
BJOG: an International Journal of Obstetrics and Gynaecology August 2002, Vol. 109, pp. 919 929 Charts of fetal size: limb bones Lyn S. Chitty a, *, Douglas G. Altman b Objective To construct new size
More informationSonographic Accuracy of Estimated Fetal Weight in Twins
ORIGINAL RESEARCH Sonographic Accuracy of Estimated Fetal Weight in Twins Lorie M. Harper, MD, MSCI, Kimberly A. Roehl, MPH, Methodius G. Tuuli, MD, MPH, Anthony O. Odibo, MD, MSCE, Alison G. Cahill, MD,
More informationUmbilical Artery Doppler Waveform Indices in Normal Pregnancies
Thai Journal of Obstetrics and Gynaecology June 2000, Vol. 12, pp. 103-107 OBSTETRICS Umbilical Artery Doppler Waveform Indices in Normal Pregnancies Pharuhas Chanprapaph MD, Chanane Wanapirak MD, Theera
More informationEffect of Increased Body Mass Index on the Accuracy of Estimated Fetal Weight by Sonography in Twins
Article Effect of Increased Body Mass Index on the Accuracy of Estimated Fetal Weight by Sonography in Twins Manisha Gandhi, MD, Lauren Ferrara, MD, Victoria Belogolovkin, MD, Erin Moshier, MS, Andrei
More informationFetal size and dating: charts recommended for clinical obstetric practice
Fetal size and dating: charts recommended for clinical obstetric practice Pam Loughna 1, Lyn Chitty 2, Tony Evans 3 & Trish Chudleigh 4 1 Academic Division of Obstetrics and Gynaecology, Nottingham University
More informationEstimation of Fetal Weight: Mean Value from Multiple Formulas
Estimation of Fetal Weight: Mean Value from Multiple Formulas Michael G. Pinette, MD, Yuqun Pan, MD, Sheila G. Pinette, RPA-C, Jacquelyn Blackstone, DO, John Garrett, Angelina Cartin Mean fetal weight
More informationUltrasonography of the Fetal Thyroid
Article Ultrasonography of the Fetal Thyroid Nomograms Based on Biparietal Diameter and Gestational Age Angela C. Ranzini, MD, Cande V. Ananth, PhD, MPH, John C. Smulian, MD, MPH, Michelle Kung, Anita
More informationThree-dimensional Ultrasound Imaging
NELSON - 3D/4D ULTRASOUND IMAGING - UIA ANNUAL MEETING, 3/2006 1 Three-dimensional Ultrasound Imaging Thomas R. Nelson, Ph.D. University of California, San Diego La Jolla, California Abstract Three-dimensional
More informationDepartment of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, United States
78 Four Dimensional Fetal Echocardiography, 2010, 78-83 CHAPTER 9 Automated Echocardiography Elena Sinkovskaya and Alfred Abuhamad Department of Obstetrics and Gynecology, Eastern Virginia Medical School,
More informationPrognosis of Very Large First-Trimester Hematomas
Case Series Prognosis of Very Large First-Trimester Hematomas Juliana Leite, MD, Pamela Ross, RDMS, RDCS, A. Cristina Rossi, MD, Philippe Jeanty, MD, PhD Objective. The aim of this study was to evaluate
More informationThree-Dimensional Inversion Rendering
Image Presentation Three-Dimensional Inversion Rendering New Sonographic Technique and Its Use in Gynecology Ilan E. Timor-Tritsch, MD, RDMS, na Monteagudo, MD, RDMS, Tanya Tsymbal,, RDMS, Irina Strok,
More informationGE Healthcare VOLUSON 730 PRO The Diamond Release
GE Healthcare VOLUSON 730 PRO The Diamond Release imagination at work VOLUSON 730 PRO The Standard in Women's Healthcare 4D Dedication Dimensional Diagnostic Digital GE Healthcare continues to elevate
More informationHow To Use A Voluson Compact Ultrasound System
Voluson i Extraordinary vision Compact series Extraordinary vision to care for your patients. Your needs shape the future of ultrasound. It s your feedback that drives every technological advancement that
More informationFetal Lateral Ventricular Width: What Should Be Its Upper Limit?
Article Fetal Lateral Ventricular Width: What Should Be Its Upper Limit? A Prospective Cohort Study and Reanalysis of the Current and Previous Data Benny Almog, MD, Ronni Gamzu, MD, PhD, Reuven Achiron,
More information3D Ultrasound. Outline. What is 3D US? Volume Sonography. 3D Ultrasound in Obstetrics: Current Modalities & Future Potential. Alfred Abuhamad, M.D.
in Obstetrics: Current Modalities & Future Potential Outline What is 3D US? What are obvious advantages of 3D US? What is the future of 3D US? Alfred Abuhamad, M.D. Eastern Virginia Medical School 2D US
More informationFrontomaxillary and mandibulomaxillary facial angles at 11 + 0to13+ 6 weeks in fetuses with trisomy 18
Ultrasound Obstet Gynecol 2007; 30: 928 933 Published online 1 November 2007 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.2/uog.5188 Frontomaxillary and mandibulomaxillary facial angles
More informationIntrauterine sonographic assessments of embryonic heart diameter
Human Reproduction vol.12 no.10 pp.2286 2291, 1997 Intrauterine sonographic assessments of embryonic heart diameter Toshiyuki Hata 1, Daisaku Senoh, Kohkichi Hata and Kohji Miyazaki Department of Obstetrics
More informationViewPoint 6. Clarify your View
ViewPoint 6 Clarify your View Clear information helps you see the bigger picture Using over 20 years of experience and feedback from customers across the globe, we ve simplified ultrasound reporting and
More informationSonographic screening for trisomy 13 at 11 to 13 D6 weeks of gestation
American Journal of Obstetrics and Gynecology (2006) 194, 397 401 www.ajog.org Sonographic screening for trisomy 13 at 11 to 13 D6 weeks of gestation Aris T. Papageorghiou, MD, a Kyriaki Avgidou, MD, a
More informationVoluson E8. Extraordinary vision
Voluson E8 Extraordinary vision Voluson E8 Your foundation for extraordinary vision. Throughout the years, your feedback has driven Voluson * technological advancements, helping to make GE Healthcare a
More informationRisk Calculation Software Requirements for Down's Syndrome Screening
Screening Programmes Fetal Anomaly Risk Calculation Software Requirements for Down's Syndrome Screening Version 1 January 2013 Created by: Dave Wright, Barry Nix, Steve Turner, David Worthington and Andy
More informationA. Evidence for an individually adjustable standard to assess birth weight:
Customised antenatal growth charts are designed to facilitate better supervision of fetal growth. The chart is printed out in early pregnancy, after confirmation of pregnancy dates, and allows serial plotting
More informationF. I. VOS*, E. A. P. DE JONG-PLEIJ, L. S. M. RIBBERT, E. TROMP and C. M. BILARDO*
Ultrasound Obstet Gynecol 2012; 39: 636 641 Published online 10 April 2012 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/uog.10058 Three-dimensional ultrasound imaging and measurement
More informationArticle. Anthony O. Odibo, MD, Christopher Riddick, Emmanuelle Pare, MD, David M. Stamilio, MD, MSCE, George A. Macones, MD, MSCE
Article Cerebroplacental Doppler Ratio and Adverse Perinatal Outcomes in Intrauterine Growth Restriction Evaluating the Impact of Using Gestational Age Specific Reference Values Anthony O. Odibo, MD, Christopher
More informationEvaluation and Follow-up of Fetal Hydronephrosis
Evaluation and Follow-up of Fetal Hydronephrosis Deborah M. Feldman, MD, Marvalyn DeCambre, MD, Erin Kong, Adam Borgida, MD, Mujgan Jamil, MBBS, Patrick McKenna, MD, James F. X. Egan, MD Objective. To
More informationScreening for chromosomal abnormalities at 10 14 weeks: the role of ductus venosus blood flow
Ultrasound Obstet Gynecol 1998;12:380 384 Screening for chromosomal abnormalities at 10 14 weeks: the role of ductus venosus blood flow A. Matias*, C. Gomes*, N. Flack*, N. Montenegro and K. H. Nicolaides*
More informationSchool of Diagnostic Medical Sonography
Semester 1 Orientation - 101 This class is an introduction to sonography which includes a basic anatomy review, introduction to sonographic scanning techniques and physical principles. This curriculum
More informationReference intervals of gestational sac, yolk sac and embryo volumes using three-dimensional ultrasound
Ultrasound Obstet Gynecol 29; 34: 53 59 Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 1.12/uog.7348 Reference intervals of gestational sac, yolk sac and embryo volumes using
More informationWhat is the diagnostic value of ultrasound for determining a viable intrauterine pregnancy?
What is the diagnostic value of ultrasound for determining a viable intrauterine pregnancy? Full citation Sample size Tests Methods Results Limitations Steinkampf,M.P., Guzick,D.S., Hammond,K.R., Blackwell,R.E.,
More informationA single center experience with 1000 consecutive cases of multifetal pregnancy reduction
A single center experience with 1000 consecutive cases of multifetal pregnancy reduction Joanne Stone, MD, Keith Eddleman, MD, Lauren Lynch, MD, and Richard L. Berkowitz, MD New York, NY, and San Juan,
More informationClinical Significance of First Trimester Umbilical Cord Cysts
Clinical Significance of First Trimester Umbilical Cord Cysts Waldo Sepulveda, MD, Sergio Leible, MD, Angel Ulloa, MD, Milenko Ivankovic, MD, Carlos Schnapp, MD A cystic mass of the umbilical cord was
More informationUltrasound evaluation of fetal gender at 12 14 weeks
Ultrasound evaluation of fetal gender at 12 14 weeks Marek Lubusky a,b, Martina Studnickova a, Ales Skrivanek a, Katherine Vomackova c, Martin Prochazka a Aims. The aim of this study was to assess the
More informationUncontrolled Diabetes Mellitus and Fetal Heart
Uncontrolled Diabetes Mellitus and Fetal Heart Ehab H. Nashaat, MD*, Ghada M. Mansour, MD** *Department of internal medicine, **Department of Obstetrics and Gynecology Ain Shams University ehabnashaat@hotmail.com
More informationAccuracy of Ultrasound Estimation of Fetal Weight by Obstetrics and Gynaecology Residents and Maternal-fetal Medicine Subspecialists
Ultrasound Estimation of Fetal Weight Accuracy of Ultrasound Estimation of Fetal Weight by Obstetrics and Gynaecology Residents and Maternal-fetal Medicine Subspecialists PKS YAU MBChB, MRCOG (UK) WK SIN
More informationechocardiography practice and try to determine the ability of each primary indication to identify congenital heart disease. Patients and Methods
29 ABNORMAL CARDIAC FINDINGS IN PRENATAL SONOGRAPHIC EXAMINATION: AN IMPORTANT INDICATION FOR FETAL ECHOCARDIOGRAPHY? RIMA SAMI BADER Aim: The present study was conducted to evaluate the most common indications
More informationFetal Left Ventricular Mass Determination on 2-Dimensional Echocardiography Using Area-Length Calculation Methods
ORIGINAL RESEARCH Fetal Left Ventricular Mass Determination on 2-Dimensional Echocardiography Using Area-Length Calculation Methods Xiao-Zhi Zheng, PhD, MD, Bin Yang, PhD, MD, Jing Wu, MD Received May
More informationCurrent Standard: Mathematical Concepts and Applications Shape, Space, and Measurement- Primary
Shape, Space, and Measurement- Primary A student shall apply concepts of shape, space, and measurement to solve problems involving two- and three-dimensional shapes by demonstrating an understanding of:
More informationUltrasonographic Diagnosis of Trisomy 18: Is It Practical in the Early Second Trimester?
Ultrasonographic Diagnosis of Trisomy 18: Is It Practical in the Early Second Trimester? Laurence E. Shields, MD, Leslie A. Carpenter, MS, CGC, Karin M. Smith, RDMS, Hanh V. Nghiem, MD The objective of
More informationScreening for trisomy 21 by fetal tricuspid regurgitation, nuchal translucency and maternal serum free β-hcg and PAPP-A at 11 + 0to13+ 6 weeks
Ultrasound Obstet Gynecol 2006; 27: 151 155 Published online 30 December 2005 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.2699 Screening for trisomy 21 by fetal tricuspid regurgitation,
More informationGE Healthcare. Vivid 7 Dimension Cardiovascular Ultrasound System
GE Healthcare Vivid 7 Dimension Cardiovascular Ultrasound System New dime Introducing multi-dimensional and 4D imaging. The ability to incorporate multi-dimensional and 4D imaging into your clinical routine
More informationFetal Prognosis in Varix of the Intrafetal Umbilical Vein
Fetal Prognosis in Varix of the Intrafetal Umbilical Vein Waldo Sepulveda, MD, Antonio Mackenna, MD, Jorge Sanchez, MD, Edgardo Corral, MD, Eduardo Carstens, MD To assess the clinical significance of varix
More informationPreparation iagnostic Medical Sonographer Overview"
Diagnostic Medical Sonographer Overview The Field - Preparation - Specialty Areas - Day in the Life - Earnings - Employment - Career Path Forecast - Professional Organizations The Field Diagnostic imaging
More informationAssessment of Fetal Growth
Assessment of Fetal Growth Unit / Trust: 1. INTRODUCTION The aim of this guideline template is to outline the methods used to assess fetal growth and the referral pathways utilising customised antenatal
More informationClinical Studies Abstract Booklet
Clinical Studies Abstract Booklet The Harmony Prenatal Test is a non-invasive prenatal test (NIPT) that assesses the risk of trisomies by analyzing cell-free DNA (cfdna) in maternal blood. Since January
More informationUltrasound of Fetal Biometrics and Growth
1 of 10 5/3/2005 8:30 PM Ultrasound of Fetal Biometrics and Growth Contents: Section 1: Ultrasound Measure of Fetal Size: Biometrics Section 2: Individual Measurement Characteristics and Techniques Section
More informationINTERGROWTH-21 st International Fetal and Newborn Growth Standards for the 21 st Century
INTERGROWTH-21 st CRL standardization 1 INTERGROWTH-21 st International Fetal and Newborn Growth Standards for the 21 st Century The International Fetal and Newborn Growth Consortium Correct measurement
More informationDESCRIPTIVE STATISTICS. The purpose of statistics is to condense raw data to make it easier to answer specific questions; test hypotheses.
DESCRIPTIVE STATISTICS The purpose of statistics is to condense raw data to make it easier to answer specific questions; test hypotheses. DESCRIPTIVE VS. INFERENTIAL STATISTICS Descriptive To organize,
More informationDifferentiation between normal and abnormal fetal growth
Differentiation between normal and abnormal fetal growth JASON GARDOSI MD FRCSE FRCOG Director, West Midlands Perinatal Institute, St Chad s Court, 213 Hagley Road, Birmingham B16 9RG, U.K. Tel +44 (0)121
More informationDiagnostic Medical Sonography
Diagnostic Medical Sonography 130 Diagnostic Medical Sonography Location: Trenholm Campus - Bldg. H Program Information Diagnostic Medical Sonography (DMS) is a diagnostic procedure that uses high frequency
More informationAn introduction to fetal neurosonography using three-dimensional ultrasound
An introduction to fetal neurosonography using three-dimensional ultrasound Taddei F, Fratelli N, Prefumo F, Franceshetti L, Signorelli M and Frusca T Maternal Fetal Medicine Unit, Department of Obstetrics
More informationSupplementary Fetal Growth Curves
Supplementary Fetal Growth Curves John G. Archie, Julianne S. Collins, and Robert Roger Lebel June 19, 2006 The following growth curves are described in the manuscript entitled Quantitative Standards for
More informationDevelopment of the human fetal corpus callosum: a high-resolution, cross-sectional sonographic study
Ultrasound Obstet Gynecol 1; 18: 33 37 Development of the human fetal corpus callosum: Blackwell Science Ltd a high-resolution, cross-sectional sonographic study R. ACHIRON and A. ACHIRON* Department of
More informationCALCULATIONS & STATISTICS
CALCULATIONS & STATISTICS CALCULATION OF SCORES Conversion of 1-5 scale to 0-100 scores When you look at your report, you will notice that the scores are reported on a 0-100 scale, even though respondents
More informationVoluson E8 Extraordinary vision
Voluson E8 Extraordinary vision Innovation for early detection Throughout the years, your feedback has driven all our technological advancements, helping to make GE Healthcare a leader in women s health
More informationCONGENITAL heart disease is
601 This is the second in a series of technical bulletins to be published by the American Institute of Ultrasound in Medicine (). The is a multidisciplinary organization dedicated to promoting the safe
More informationApplications of Doppler Ultrasound in Fetal Growth Assessment. David Cole
Applications of Doppler Ultrasound in Fetal Growth Assessment David Cole Aims The aim of this presentation is to consider the use of Doppler ultrasound to investigate and monitor those pregnancies at risk
More informationyour questions answered the reassurance of knowing A guide for parents-to-be on noninvasive prenatal testing.
your questions answered the reassurance of knowing A guide for parents-to-be on noninvasive prenatal testing. Accurate answers about your baby s health simply, safely, sooner. What is the verifi Prenatal
More informationDoppler Ultrasound in the Management of Fetal Growth Restriction Chukwuma I. Onyeije, M.D. Atlanta Perinatal Associates
Doppler Ultrasound in the Management of Fetal Growth Restriction Chukwuma I. Onyeije, M.D. Atlanta Perinatal Associates 1 For your convenience a copy of this lecture is available for review and download
More informationRobot Perception Continued
Robot Perception Continued 1 Visual Perception Visual Odometry Reconstruction Recognition CS 685 11 Range Sensing strategies Active range sensors Ultrasound Laser range sensor Slides adopted from Siegwart
More informationBE-SAFE: Bedside Sonography for Assessment of the Fetus in. Fetus in Emergencies: Educational Intervention for Latepregnancy. Obstetric Ultrasound
BE-SAFE: Bedside Sonography for Assessment of the Fetus in Emergencies: Educational Intervention for Late-pregnancy Obstetric Ultrasound The Harvard community has made this article openly available. Please
More informationFETAL HEART ASSESSMENT USING THREE-DIMENSIONAL ULTRASOUND
FETAL HEART ASSESSMENT USING THREE-DIMENSIONAL ULTRASOUND 1 2 3 T.R. Nelson, Ph.D., M.S. Sklansky, M.D., D.H. Pretorius, M.D. 1 3 Divisions of Physics and Ultrasound, Department of Radiology 2 Division
More informationLong-Term Prognosis of Pregnancies Complicated by Slow Embryonic Heart Rates in the Early First Trimester
Long-Term Prognosis of Pregnancies Complicated by Slow Embryonic Heart Rates in the Early First Trimester Peter M. Doubilet, MD, PhD, Carol B. Benson, MD, Jeanne S. Chow, MD Slow embryonic heart rates
More informationThree Dimensional Ultrasound Imaging
Three Dimensional Ultrasound Imaging Hans Torp/ Sevald Berg/Kjell Kristoffersen m/flere Department of circulation and medical imaging NTNU Hans Torp NTNU, Norway Acquisition Reconstruction Filtering Collecting
More informationChapter 10. Key Ideas Correlation, Correlation Coefficient (r),
Chapter 0 Key Ideas Correlation, Correlation Coefficient (r), Section 0-: Overview We have already explored the basics of describing single variable data sets. However, when two quantitative variables
More informationUltrasonographic Estimation of Fetal Weight
Article Ultrasonographic Estimation of Fetal Weight Acquiring Accuracy in Residency Mladen Predanic, MD, MSc, Angel Cho, MD, Flores Ingrid, MD, John Pellettieri, MD Objective. Ultrasonographic imaging
More informationUniversal Fetal Cardiac Ultrasound At the Heart of Newborn Well-being
Universal Fetal Cardiac Ultrasound At the Heart of Newborn Well-being Optimizes detection of congenital heart disease (chd) in the general low risk obstetrical population Daniel J. Cohen, M.D. danjcohen@optonline.net
More informationThree-Dimensional Sonography of the Endometrium and Adjacent Myometrium
Technical dvance Three-Dimensional Sonography of the Endometrium and djacent Myometrium Preliminary Observations Rochelle F. ndreotti, MD, rthur C. Fleischer, MD, Lawrence E. Mason, Jr, MD Objective. y
More informationCONFIDENT CODING FOR OB/GYN CONFIDENT CODING FOR OB/GYN
Arlene J. Smith, CPC AAPC National Advisory Board 2007-2009 1 So when exactly does the global period start? Unraveling the confusion in antepartum care coding Correct coding for multiple gestations! Vaginal
More informationNEW MEXICO Grade 6 MATHEMATICS STANDARDS
PROCESS STANDARDS To help New Mexico students achieve the Content Standards enumerated below, teachers are encouraged to base instruction on the following Process Standards: Problem Solving Build new mathematical
More informationREGISTRATION OF 3D ULTRASOUND IMAGES TO SURFACE MODELS OF THE HEART
To appear in: Proceedings of the Interface to Real & Virtual Worlds (Montpellier, France, May 28-30, 1997) REGISTRATION OF 3D ULTRASOUND IMAGES TO SURFACE MODELS OF THE HEART Stefan Pieper, Michael Weidenbach*,
More informationPIPELINE INSPECTION UTILIZING ULTRASOUND TECHNOLOGY: ON THE ISSUE OF RESOLUTION By, M. Beller, NDT Systems & Services AG, Stutensee, Germany
ABSTRACT: PIPELINE INSPECTION UTILIZING ULTRASOUND TECHNOLOGY: ON THE ISSUE OF RESOLUTION By, M. Beller, NDT Systems & Services AG, Stutensee, Germany Today, in-line inspection tools are used routinely
More informationDoppler. Doppler. Doppler shift. Doppler Frequency. Doppler shift. Doppler shift. Chapter 19
Doppler Doppler Chapter 19 A moving train with a trumpet player holding the same tone for a very long time travels from your left to your right. The tone changes relative the motion of you (receiver) and
More informationMaternity Care Primary C-Section Rate Specifications 2014 (07/01/2013 to 06/30/2014 Dates of Service)
Summary of Changes Denominator Changes: Two additions were made to the denominator criteria. The denominator was changed to include patients who had: a vertex position delivery AND a term pregnancy of
More informationREPRODUCTIVE ENDOCRINOLOGY
FERTILITY AND STERILITY VOL. 82, NO. 5, NOVEMBER 2004 Copyright 2004 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. REPRODUCTIVE ENDOCRINOLOGY
More informationMinnesota Academic Standards
A Correlation of to the Minnesota Academic Standards Grades K-6 G/M-204 Introduction This document demonstrates the high degree of success students will achieve when using Scott Foresman Addison Wesley
More informationEveryday Mathematics GOALS
Copyright Wright Group/McGraw-Hill GOALS The following tables list the Grade-Level Goals organized by Content Strand and Program Goal. Content Strand: NUMBER AND NUMERATION Program Goal: Understand the
More informationNEW YORK STATE TEACHER CERTIFICATION EXAMINATIONS
NEW YORK STATE TEACHER CERTIFICATION EXAMINATIONS TEST DESIGN AND FRAMEWORK September 2014 Authorized for Distribution by the New York State Education Department This test design and framework document
More informationSimple linear regression
Simple linear regression Introduction Simple linear regression is a statistical method for obtaining a formula to predict values of one variable from another where there is a causal relationship between
More informationBELIEVE MIDWIFERY SERVICES, LLC
, LLC TITLE: ESTABLISHING the GESTATIONAL AGE & ROUTINE ULTRASOUND EFFECTIVE DATE: November 11th, 2013 POLICY STATEMENT Establishing accurate pregnancy dating impacts the management of normal and abnormal
More informationScatter Plots with Error Bars
Chapter 165 Scatter Plots with Error Bars Introduction The procedure extends the capability of the basic scatter plot by allowing you to plot the variability in Y and X corresponding to each point. Each
More informationUsing Four-Quadrant Charts for Two Technology Forecasting Indicators: Technology Readiness Levels and R&D Momentum
Using Four-Quadrant Charts for Two Technology Forecasting Indicators: Technology Readiness Levels and R&D Momentum Tang, D. L., Wiseman, E., & Archambeault, J. Canadian Institute for Scientific and Technical
More informationCharlesworth School Year Group Maths Targets
Charlesworth School Year Group Maths Targets Year One Maths Target Sheet Key Statement KS1 Maths Targets (Expected) These skills must be secure to move beyond expected. I can compare, describe and solve
More informationASSESSMENT REPORT. Program: AAS Diagnostic Medical Sonography Cardiac Vascular Tract
ASSESSMENT REPORT Date Submitted: February 9, 2015 School: Engelstad School of Health Sciences Program: AAS Diagnostic Medical Sonography Cardiac Vascular Tract Submitted By: Tracy Lopez, Program Director
More informationPhysics Lab Report Guidelines
Physics Lab Report Guidelines Summary The following is an outline of the requirements for a physics lab report. A. Experimental Description 1. Provide a statement of the physical theory or principle observed
More informationSession 7 Bivariate Data and Analysis
Session 7 Bivariate Data and Analysis Key Terms for This Session Previously Introduced mean standard deviation New in This Session association bivariate analysis contingency table co-variation least squares
More informationSurface area measurement using rendered three-dimensional ultrasound imaging: an in-vitro phantom study
Ultrasound Obstet Gynecol 211; 38: 445 449 Published online 13 September 211 in Wiley Online Library (wileyonlinelibrary.com). DOI: 1.12/uog.8984 Surface area measurement using rendered three-dimensional
More informationExamples of Data Representation using Tables, Graphs and Charts
Examples of Data Representation using Tables, Graphs and Charts This document discusses how to properly display numerical data. It discusses the differences between tables and graphs and it discusses various
More informationAlgebra 1 2008. Academic Content Standards Grade Eight and Grade Nine Ohio. Grade Eight. Number, Number Sense and Operations Standard
Academic Content Standards Grade Eight and Grade Nine Ohio Algebra 1 2008 Grade Eight STANDARDS Number, Number Sense and Operations Standard Number and Number Systems 1. Use scientific notation to express
More informationCAMI Education linked to CAPS: Mathematics
- 1 - TOPIC 1.1 Whole numbers _CAPS curriculum TERM 1 CONTENT Mental calculations Revise: Multiplication of whole numbers to at least 12 12 Ordering and comparing whole numbers Revise prime numbers to
More informationFactor Analysis. Chapter 420. Introduction
Chapter 420 Introduction (FA) is an exploratory technique applied to a set of observed variables that seeks to find underlying factors (subsets of variables) from which the observed variables were generated.
More informationThis document covers the principles behind Gestation Adjusted Optimal Weight (GROW) for the following applications
This document covers the principles behind Gestation Adjusted Optimal Weight (GROW) for the following applications GROW-CC (customised centiles) - for calculating weight centiles individually or in a spreadsheet;
More informationNon-Invasive Prenatal Testing (NIPT) Factsheet
Introduction NIPT, which analyzes cell-free fetal DNA circulating in maternal blood, is a new option in the prenatal screening and testing paradigm for trisomy 21 and a few other fetal chromosomal aneuploidies.
More informationImaging of placental vasculature using three-dimensional ultrasound and color power Doppler: a preliminary study
Ultrasound Obstet Gynecol 1998;12:45 49 Imaging of placental vasculature using three-dimensional ultrasound and color power Doppler: a preliminary study D. H. Pretorius, T. R. Nelson, R. N. Baergen, E.
More informationFetal Echocardiography
AIUM Practice Guideline for the Performance of Fetal Echocardiography Guideline developed in conjunction with the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal
More informationMANA Home Birth Data 2004-2009: Consumer Considerations
MANA Home Birth Data 2004-2009: Consumer Considerations By: Lauren Korfine, PhD U.S. maternity care costs continue to rise without evidence of improving outcomes for women or babies. The cesarean section
More informationEveryday Mathematics CCSS EDITION CCSS EDITION. Content Strand: Number and Numeration
CCSS EDITION Overview of -6 Grade-Level Goals CCSS EDITION Content Strand: Number and Numeration Program Goal: Understand the Meanings, Uses, and Representations of Numbers Content Thread: Rote Counting
More informationPrentice Hall Mathematics Courses 1-3 Common Core Edition 2013
A Correlation of Prentice Hall Mathematics Courses 1-3 Common Core Edition 2013 to the Topics & Lessons of Pearson A Correlation of Courses 1, 2 and 3, Common Core Introduction This document demonstrates
More informationPlacental Surface Cysts Detected on Sonography
Article Placental Surface Cysts Detected on Sonography Histologic and Clinical Correlation Douglas L. Brown, MD, Donald N. DiSalvo, MD, Mary C. Frates, MD, Karen M. Davidson, MD, David R. Genest, MD Objective.
More informationGlencoe. correlated to SOUTH CAROLINA MATH CURRICULUM STANDARDS GRADE 6 3-3, 5-8 8-4, 8-7 1-6, 4-9
Glencoe correlated to SOUTH CAROLINA MATH CURRICULUM STANDARDS GRADE 6 STANDARDS 6-8 Number and Operations (NO) Standard I. Understand numbers, ways of representing numbers, relationships among numbers,
More informationReference values for umbilical cord diameters in placenta specimens
1 2 3 Reference values for umbilical cord diameters in placenta specimens H. Pinar 1, Murat Iyigün 2 4 5 6 7 8 9 10 Halit Pinar, MD Brown Medical School Women and Infants Hospital Division of Perinatal
More information