Divine Care Fetal Medicine Centre

Happy to announce for 2 days Hands on simulator based 2D ultrasound course in your city Nagpur

Early pregnancy and Gynecology ultrasound scan...from knobology to advanced diagnosis... learn from experts in the field.

Limited seats ...

Mark the dates - 24th and 25th June.
https://www.empower-us.in/epg/
Or contact on +91 98450 30105

Mark the date👇
FMF UK certified fetal abnormalities theory course by fetal medicine foundation India 11-12 Feb 2023.
Register at

Fetal Abnormalities – Theory Course ( FMF-UK Certified) Date: 26-27th February, 2022 Via Online ZOOM WEBINAR The Fetal Abnormalities/Anomaly scan is considered as the most important scan in pregnancy and it is medico-legally important to perform it to the best of standards, with proper documentation of images.Enhance your skills at detecting birth defect...

Posers

Mercedes - Benz sign of normal aortic valve seen on fetal ultrasound.

Not always lucky to get this view of aortic valve. RVOT view showing normal 3 cusps of Aortic valve in the centre of image.

I like it ☮️

The January issue is completely FREE TO READ for the whole month and is online now! View the highlights and access the issue here: https://bit.ly/3vDEINO

One page says it all...

International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) Practice Guidelines (updated): performance of 11–14-week scan!

https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1002/uog.26106

If we can look for corpus callosum in 3D , definitely we can try for conus medullaris in spine!!

And here it is.... BRAVOOO

Patience, persistence and perseverance makes an unbeatable combination for success.
Happy learning.

https://www.facebook.com/isuog.org/photos/a.328924782050/10158615674737051/?type=3

June: Basso et al. demonstrate , with or without a small-for-gestational-age fetus, is associated with altered fetal cortical development, manifested by reduced Sylvian fissure depth and increased insular depth https://bit.ly/3tXOqeB

7th FUP on-site at NAGPUR centre! Contact details in the brochure!

Starting JUNE 2022

UNDER MENTORSHIP OF Dr Vaishali Mundhe!!

Fetal and Gynae Imaging Institute offers our flagship Fetal Ultrasound Program ( FUP), 7th course in India. This is an Onsite-Ultrasound skill enhancing program designed for practising Obstetricians, Radiologists & Sonologists. Discounted Early bird registration rates are available ONLY till 10th May 2022. So "Hurry Up" as the seats are limited.

Apply Now for Nagpur Center: https://forms.gle/6MfVYe4eJRi2tf6k6

For details-Please call Priya/Mahalakshmi on the number on the brochure or Email

Here is wonderful ISUOG lecture directory.

Happy learning 😇

https://drive.google.com/drive/mobile/folders/1nCgUL8run1QJpPON4lHVCLrd5GgXueu0?usp=sharing

Obsessed with 3D!
Wanted to show cervical stitch on USG to my patient.

Clinical interpretation and implementation of the sFlt-1/PlGF ratio in the prediction, diagnosis and management of preeclampsia Preeclampsia is associated with significant morbidity and mortality for mother and baby. Although around 30% of all pregnancies are evaluated for pree…

Do not miss the new WAPM Practice Guidelines on the examination of the fetal central nervous system! Now freely available on the JPM!

https://buff.ly/3cEjoyq

Acrania-exencephaly-anencephaly( Images below at CRL-29mm)

Absence of cranial vault ( Acrania) causes exposure of the amorphous brain mass to amniotic fluid(exencephaly) further leading to no recognisable brain tissue( Anencephaly) .

USG-In the early scans the brain tissue without calvarium in coronal plane looks like ears of Mickey Mouse (semicircular tissue masses- Mickey Mouse sign) above fetal face.

Therotically can be detected on USG as early as 8 wks but sensitivity and specificity increases close to 12 wks.

Chromosomal defects in isolated acrania are rare but it can be a part of genetic disorders(genes associated with phenotype of anencephaly spectrum) if recurrent or along with other abnormalities.

Recurrence increases with number of affected siblings.
Associated abnormalities-
CNS or other -50% of cases
Spina bifida - 25%. of cases

Lethal condition with death within the first week of life.

Supplementation of the maternal diet with folate (5 mg/day) for 3 months before and 3 months after is supposed to reduce the risk of recurrence by about 75%.

I got following images for discussions and opinions. On the top most side of the collage are 2D and 3D images on normal 9 wks fetus(CRL-25mm) , below which are 9 wks(CRL-29mm) 2D and 3D of fetus with Acrania exencephaly.

Is there any cut off for the lowest CRL so that above which we can diagnose Acrania with 100% sensitivity? Is 3D , 4D helpful in these cases?
Will you terminate the pregnancy if we get findings as we got in the abnormal images below or you will wait and rescan after 1-2 wks?
In recurrent anencephaly what will be your management protocol? Genetic testing? Maternal serum AFP, Amniotic fluid AFP, maternal folic acid level,homocystine metabolism?
Role of vitamin B12 supplementation ?

Courtesy:

GE VOLUSON ULTRASOUND

6 wks 5 days.
Dichorionic diamniotic triplets ( one pair as monochorionic monoamniotic)

...and finally a poser ..

Some more 3D clicks on Voluson Swift at NT scan.
12 wk Fetus on steering🚔

Ectopic kidney/ renal ectopia,
Congenital renal anomaly characterized by the abnormal location of one or both of the kidneys.

Forms of renal ectopia-

cross fused renal ectopia
pelvic kidney
Thoracic kidney

Epidemiology of pelvic kidney- 1 in 3,000

Pelvic kidney- opposite to the sacrum below the aortic bifurcation ( Lumbar kidney- anterior to iliac vessels)

Babies are most often asymptomatic. Normal pathology (e.g. infection, calculus) can affect ectopic kidneys

Cause -
Result of arrested migration at embryonic stage.
Since the process of renal ascent is accomplished during about 10th week of pregnancy, fetal pelvic kidney can be diagnosed during routine 1st trimester scan with the help of TVS.

During an arrested ascent the ectopic kidney retains some of the older aortoiliac vessels.

Associations:
Anomalies of the vertebral column, lower GIT, GUT or spinal cord and meninges

Ultrasound
First modality to diagnose the ectopic kidney

Once the diagnosis is confirmed, careful survey of other structural abnormalities is mandatory. If no associated abnormality, then the parents can be assured that normal renal function is highly probable.

Sharing an old case with unilateral malrotated pelvic kidney. The contralateral kidney, bladder and amniotic fluid was normal.
I am unable to find stored 2D images hence sharing this STIC loop.

Unfortunately lost to F/U postnatally.

GE Voluson Swift...first pic.
I hope I am not disturbing this one.

Important mid-sagittal plane in fetal neurosonography

Imgae 1
Gray scale
CC - corpus callosum( r- rostrum, g-genu, b- body, s-splenium) , VM- vermis, CSP- cavum septum pellucidum, 3V- 3rd ventricle, T- Thalamus, BS- brain stem, 4 V-4rth ventricle, CM- Cisterna Magna.

Image 2
Colour Doppler
BA- basilar artery, ICA- internal carotid artery, ACA- anterior cerebral artery, PCA- pericallosal artery, SSI- inferior saggital sinus, VCI- internal cerebral vein, VG- vein of Galen

Very easy demonstration of LVOT with the relationship of pulmonary artery and aorta in 3D. Go through flow chart of steps of evaluation of TOF.

12 wks primi, non-consanguineous marriage. No h/o diabetes. Following are the findings at NT scan.
Microarray awaited.