UNASSIGNED: This study aimed to measure the Cobb angle of the fetal spine using three-dimensional ultrasound (3D-US) and to assess the relationship between the Cobb angle and the prognosis of congenital scoliosis.
UNASSIGNED: From March 2015 to June 2019, 77 pregnant women whose fetuses had suspected spinal skeletal dysplasia consented to undergo 3D-US examinations, and 54 fetuses were selected for the analysis group. The study protocol was approved by the review board of the Institutional Ethics Committee for Fetal Medicine. 3D-US was used to show the structure of the fetal spine in 3 planes, and the Cobb angle was measured on the coronal plane. The diagnostic efficacy of 3D-US was compared to that of X-ray for 33 fetuses.
UNASSIGNED: In the diagnosis of congenital scoliosis, the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of 3D-US were 91.7%, 90.0%, 90.7%, 88.0%, and 93.1%, respectively. The area under the receiver operating characteristic (ROC) curve with 3D-US was 0.908. The Spearman correlation coefficient between the Cobb angle measurement on an X-ray image and on the coronal plane image acquired by 3D-US was 0.84, which showed a significant correlation (P<0.05).
UNASSIGNED: 3D-US was successful in the diagnosis of congenital scoliosis. It is feasible to measure the Cobb angle on the coronal plane of the fetal spine by using 3D-US. The Cobb angle has the potential to become an auxiliary index for evaluating the prognosis of congenital scoliosis.

Artificial intelligence (AI) can support clinical decisions and provide quality assurance for images. Although ultrasonography is commonly used in the field of obstetrics and gynecology, the use of AI is still in a stage of infancy. Nevertheless, in repetitive ultrasound examinations, such as those involving automatic positioning and identification of fetal structures, prediction of gestational age (GA), and real-time image quality assurance, AI has great potential. To realize its application, it is necessary to promote interdisciplinary communication between AI developers and sonographers. In this review, we outlined the benefits of AI technology in obstetric ultrasound diagnosis by optimizing image acquisition, quantification, segmentation, and location identification, which can be helpful for obstetric ultrasound diagnosis in different periods of pregnancy.

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OBJECTIVE: The purpose of this study was to evaluate the diagnostic utility of karyotype analysis of amniotic fluid for fetuses with abnormal sonographic findings and to determine the detection rates of abnormal karyotypes.
METHODS: We conducted a retrospective study of 5328 fetuses with abnormal sonographic findings in the first or second trimester enrolled from October 1998 and September 2015. Cytogenetic results from amniotic fluid were obtained in all of these pregnancies. Sonographic abnormalities were stratified according to anatomic system involvement.
RESULTS: A total of 238 abnormal karyotypes were encountered in the 5328 fetuses (4.5%). The highest rate of chromosomal anomalies was in fetuses with structural abnormalities in multiple organ systems (25.7%), followed by an abnormal amniotic fluid volume (7.9%), structural abnormalities in a single system (7.3%), multiple nonstructural anomalies (7.2%), isolated placental abnormalities (7.1%), and isolated soft markers for aneuploidy (2.4%; P < .01). Among abnormalities in a single system, gastrointestinal and neck/body fluids had particularly high detection rates (26.1% and 26.2%, respectively). A detailed analysis suggested that the probability of an abnormal karyotype among every anatomic system was statistically significant (P < .01). This study identified several common indications with extremely high abnormal rates: duodenal atresia (53.1%), holoprosencephaly (48.8%), fetal hydrops (39.5%), cerebellar hypoplasia (32.0%), cystic hygroma (31.5%), absent/short nasal bone (11.0%), and bilateral choroid plexus cysts (8.5%).
CONCLUSIONS: Cytogenetic analysis has important clinical utility in a wide range of settings, such as prenatal diagnosis. For fetuses with indications of a highly abnormal detection rate, karyotype analysis should be suggested.

α-Thalassemia prevails in Southeast Asia, where α-thalassemia major is a lethal type. Sonography is a helpful and cost-effective screening tool for detecting α-thalassemia major fetuses. The cardiothoracic ratio, placental thickness, and middle cerebral artery peak systolic velocity are most used in clinical practice. These sensitive markers are helpful for evaluation of the hemodynamic status and cardiovascular function of the affected fetuses. They can predict fetal α-thalassemia major and assess the efficacy of treatment noninvasively; therefore, the medical costs as well as the possibility of fetal loss caused by invasive procedures can be reduced. Other potentially useful sonographic markers need further studies, although previous preliminary research suggests their usefulness. This article will review those sonographic markers.

OBJECTIVE: To investigate changes in fetal myocardial deformation in intrahepatic cholestasis of pregnancy.
METHODS: Patients with intrahepatic cholestasis of pregnancy were divided into 2 groups according to the total maternal serum bile acid concentration: mild cholestasis (10-40 μmol/L) and severe cholestasis (>40 μmol/L). Fetal echocardiography and velocity vector imaging were performed on women with cholestasis and control patients. The left ventricular global longitudinal strain and strain rate were measured. Clinical characteristics, maternal serum bile acid levels, and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in umbilical vein blood were compared between groups. The relationships among fetal myocardial deformation, maternal total bile acids, and cord NT-proBNP were analyzed.
RESULTS: Twenty women with mild cholestasis, 20 with severe cholestasis, and 40 control patients were enrolled. There were no significant differences in maternal and gestational ages between the case and control groups. Maternal bile acids and NT-proBNP were significantly higher in fetuses of mothers with cholestasis than control fetuses. The left ventricular longitudinal strain (-10.56% ± 1.83% versus -18.36% ± 1.11%; P < .01), systolic strain rate (-1.63 ± 0.18 versus -2.04 ± 0.18 secondsz(-1); P < .01), and diastolic strain rate (1.37 ± 0.18 versus 1.83 ± 0.14 seconds(-1); P < .01) were significantly decreased in fetuses with severe cholestasis compared with control fetuses. There were positive correlations between fetal myocardial deformation and maternal total bile acids (r = 0.705, 0.643, and 0.690, respectively; P < .01) and between myocardial deformation and NT-proBNP (r = 0.672, 0.643, and 0.647; P < .01).
CONCLUSIONS: Fetal myocardial deformation is impaired in severe intrahepatic cholestasis of pregnancy. Further investigation is needed to determine whether fetal echocardiography and velocity vector imaging can help predict which fetuses of mothers with cholestasis are likely to have poor outcomes.

OBJECTIVE: To analyze the characteristics, associations, and outcomes of prevalence of the right heart and to evaluate the use of sonography to predict the risk of a poor prognosis in fetuses with this condition.
METHODS: We conducted a retrospective cohort study of 182 fetuses with prevalence of the right heart. At the initial evaluation, the left ventricle (LV) and right ventricle (RV) sizes, left atrium and right atrium sizes, great artery diameters, appearance of the aortic arch and ductus arteriosus arch, and flow direction across the foramen ovale and aortic arch were documented. Malformations were documented in fetuses with intracardiac anomalies, who were divided into groups with and without coexisting extracardiac defects. The RV-LV diameter ratio and main pulmonary artery-to-aortic root diameter ratio were calculated and compared. The following variables were analyzed: coexisting intracardiac anomalies, associated extracardiac anomalies, diagnosis before 24 gestational weeks, fetal growth restriction, reversed flow across the foramen ovale, reversed flow in the aortic arch, and RV-LV ratio greater than 2.0. Relationships between these sonographic findings and the prognosis were evaluated by multivariable logistic regression.
RESULTS: Of the 182 fetuses, 1 (0.5%) had intrauterine death, and 25 (13.7%) had neonatal death; 1 (0.5%) had selective reduction, and 106 (58.2%) underwent termination of pregnancy; 49 (26.9%) survived at this writing. The mean RV-LV ratio was 1.67. Multivariable logistic regression revealed that only 2 sonographic parameters, coexisting intracardiac anomalies (odds ratio, 17.75; 95% confidence interval, 4.18-75.26) and diagnosis before 24 weeks (odds ratio, 17.26; 95% confidence interval, 1.80-165.39) were significantly associated with a poor prognosis.
CONCLUSIONS: The sonographic parameters of coexisting intracardiac anomalies and diagnosis before 24 gestational weeks are significant independent predictors of a poor prognosis in fetuses with prevalence of the right heart. Combinations of these risk factors may be useful in prenatal consultation.

OBJECTIVE: Fetal cardiac examination is an important part of fetal malformation screening. The purposes of this study were to describe the left ventricular (LV) mass in the second and third trimesters by 2-dimensional echocardiography using area-length calculation methods and to examine the clinical usefulness of this procedure in evaluation of gestational age (GA)- and fetal weight-related LV mass changes.
METHODS: Five hundred healthy fetuses were divided into 2 groups (250 participants per group): second- and third-trimester groups. The estimated fetal weight (EFW) was computed according to the Hadlock formula (Radiology 1984; 150:535-540). The LV mass at end diastole (LVd mass) and LV mass at end systole (LVs mass) were measured, and the difference between the LVd mass and LVs mass [LV(d-s) mass], LVd mass/EFW ratio, and LVs mass/EFW ratio were calculated.
RESULTS: The EFW, LVd mass, LVs mass, and LV(d-s) mass were all significantly greater in the third-trimester group than the second-trimester group (P < .05), whereas the LVd mass/EFW and LVs mass/EFW ratios did not differ between the groups (P > .05). The LVd mass, LVs mass, and LV(d-s) mass all significantly correlated with GA and weight (P< .001), but the LVd mass/EFW and LVs mass/EFW ratios did not (P > .05).
CONCLUSIONS: Two-dimensional echocardiography using area-length calculation methods can effectively provide measurements for LV mass and can sensitively indicate fetal weight- and GA -related changes in LV mass. Fetal cardiac mass measurement is a useful parameter for evaluation of fetal heart development.