scholarly journals Analysis of Quality of Nuchal Translucency Measurements: Its Role in Prenatal Diagnosis

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Carmen Comas Gabriel ◽  
M. Echevarria ◽  
I. Rodríguez ◽  
B. Serra
Keyword(s):  
Positive Impact ◽  
Quality Standards ◽  
First Trimester ◽  
Nuchal Translucency ◽  
Screening Strategy ◽  
Crown Rump Length ◽  
Fetal Medicine ◽  
Operator Experience ◽  
Professional Profile

Objective. Quantitative analysis of the quality of nuchal translucency (NT) measurements.Methods. First-trimester combined screening for Down syndrome was performed to all pregnant women attended in our Department from October 2003 to November 2009. NT was measured according to the Fetal Medicine Foundation (FMF) criteria by 20 trained obstetricians. The performance of NT measurements was retrospectively analyzed with regard to several quality control standards. Accuracy according to experience, professional profile, crown rump length (CRL) values, and FMF certification was statistically tested.Results. A total of 14978 NT measurements were assessed. (1) The mean operator-specific median NT-MoM values was 0,98. (2) Mean percentage of cases >95th and <5th centiles were 5,0% and 4,2%, respectively. (3) Logarithmic mean and SD of the NT MoM values were 0,00 and 0,13, respectively. (4) The DR for trisomy 21 at screening time was 90,7% for a FPR of 6,7% for standard screening strategy. (5) According to Cumulative SUM (CUSUM) figures, the performance was more acceptable in FMF-certified operators.Conclusion. Overall, quality standards show optimal NT measurements in our unit. Operator experience, a dedicated profile to fetal medicine, CRL over 60 mm, and FMF certification have a significant positive impact on the quality standards.

scholarly journals Analysis of Quality of Nuchal Translucency Measurements

2011 ◽  
Vol 5 (2) ◽  
pp. 127-132 ◽  
Author(s):  
Mónica Echevarria ◽  
Carmen Comas ◽  
Bernat Serra ◽  
Ignacio Rodríguez ◽  
Joan Sabrià
Keyword(s):  
Positive Impact ◽  
Quality Standards ◽  
Nuchal Translucency ◽  
Screening Strategy ◽  
Crown Rump Length ◽  
Fetal Medicine ◽  
Operator Experience ◽  
Single Center Study ◽  
Professional Profile

ABSTRACT Objective Quantitative analysis of the quality of nuchal translucency (NT) measurements. Methods This is a retrospective single-center study. NT was measured according to the Fetal Medicine Foundation (FMF) criteria by 20 trained obstetricians (October 2003-November 2009). The performance of NT measurements was analyzed with regard to several quality control standards. Accuracy according to experience, professional profile, crown-rump length (CRL) values and FMF certification was statistically tested. Results A total of 14,978 NT measurements were assessed. (1) The mean operator-specific median NT-MoM values was 0.98. (2) Mean percentage of cases >95th and <5th percentiles were 5.0 and 4.2% respectively. (3) Logarithmic mean and SD of the NT-MoM values were 0.00 and 0.13 respectively. (4) The DR for trisomy 21 at screening time was 90.7% for a FPR of 6.7% for standard screening strategy. (5) According to cumulative SUM (CUSUM) figures, the performance was more acceptable in FMF-certified operators. Operator experience, exclusive dedication to FM, FMF certification and a range of CRL values > 60 mm had a statistical impact improving these standards. Conclusion Overall quality standards show optimal NT measurements in our unit. Experience a dedicated profile to fetal medicine ultrasound, CRL over 60 mm and FMF certification has a significant positive impact on the quality standards.

scholarly journals Frontomaxillary Facial Angle Measurement in Screening for Trisomy 18 at 11 + 0 to 13 + 6 Weeks of Pregnancy: A Double-Centre Study

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Bartosz Czuba ◽  
Wojciech Cnota ◽  
Agata Wloch ◽  
Piotr Wegrzyn ◽  
Krzysztof Sodowski ◽  
...  
Keyword(s):  
Final Analysis ◽  
First Trimester ◽  
Nuchal Translucency ◽  
Angle Measurement ◽  
Trisomy 18 ◽  
Crown Rump Length ◽  
Beta Hcg ◽  
Large Populations ◽  
Trimester Screening ◽  
Independent Marker

Objective. The aim of this study was to evaluate the effectiveness of prenatal screening for trisomy 18 with the use of the frontomaxillary facial angle (FMF angle) measurement.Material and Methods. The study involved 1751 singleton pregnancies at 11–13 + 6 weeks, examined between 2007 and 2011. Serum PAPP-A and free beta-hCG levels were assessed, and crown-rump length, nuchal translucency, and FMF angle were measured in all patients. 1350 fetuses with known follow-up were included in the final analysis.Results. Highly significant (P<0.01) negative correlation between the CRL and the FMF angle was found. There were 30 fetuses with trisomy 18. FMF angle was highly significantly larger (P<0.0001) in fetuses with trisomy 18 as compared to chromosomally normal fetuses. Two models of first trimester screening were compared: Model 1 based on maternal age, NT, and first trimester biochemistry test (DR 80–85% and FPR 0.3–0.6%), and Model 2 = Model 1 + FMF angle measurement (DR 87.3–93.3% and FPR 0.8–1.3%).Conclusions. The use of FMF angle measurement increases the effectiveness of the screening for trisomy 18. Introduction of the FMF angle as an independent marker for fetal trisomy 18 risk requires further prospective research in large populations.

scholarly journals Impact of Ductus Venosus Assessment in Screening Down Syndrome Protocols: An Improved Strategy in a Fetal Medicine Unit

2009 ◽  
Vol 3 (2) ◽  
pp. 10-17 ◽  
Author(s):  
Mónica Echevarria ◽  
Carmen Comas ◽  
M Angeles Rodríguez ◽  
Joan Nicolau ◽  
Bernat Serra ◽  
...  
Keyword(s):  
Down Syndrome ◽  
First Trimester ◽  
Nuchal Translucency ◽  
Serum Biochemistry ◽  
Screening Strategy ◽  
Maternal Serum ◽  
Ductus Venosus ◽  
Early Evaluation ◽  
Invasive Test ◽  
Screening Efficiency

ABSTRACT Objective To estimate the improvement in screening efficiency when ductus venosus (DV) Doppler studies are added to existing Down syndrome (DS) screening protocols. Methods First-trimester combined screening for trisomy 21 was prospectively carried out, from October 2003 to March 2008, in 8842 consecutive singleton pregnancies attended in our tertiary reference center. The nuchal translucency (NT) and the pulsatility index for veins for DV were calculated. The maternal serum biochemistry was measured using the Kryptor analyzer, at the same time of the scan (one step strategy) or before it (two step strategy). The detection rate (DR) and false-positive rates for standard screening strategy (maternal age, NT and biochemistry) and the same strategy but including DV assessment were calculated. Results Successful DV assessment was possible in the 95.3% of cases, representing a total of 8426 cases. Down syndrome was identified in 34 pregnancies (prevalence of DS 1:250). For a fixed screen positive rate of 5%, the addition of the DV assessment improves the DR from 85 to 94% and, for a fixed DR of 85%, it reduces the number of unnecessary invasive tests from 3.7 to 3.2%. Conclusion Early evaluation of DV can be introduced to standard DS screening strategies in experienced centers as a first level test to reduce invasive test rate derived from the existing protocols.

scholarly journals Effectiveness of Ultrasound Simulation in Obstetrics and Gynecology Education: A State-of-the-Art Review

2017 ◽  
Vol 11 (2) ◽  
pp. 115-125 ◽  
Author(s):  
Zuber D Mulla ◽  
Alok Dwivedi
Keyword(s):  
State Of The Art ◽  
Positive Impact ◽  
Meta Analysis ◽  
Nuchal Translucency ◽  
Obstetrics And Gynecology ◽  
Crown Rump Length ◽  
Ultrasound Simulation ◽  
Advantages And Disadvantages ◽  
The Us ◽  
The Cost

ABSTRACT Introduction The benefi ts and uses of ultrasound (US) are well documented for procedural and diagnostic purposes. A number of studies have evaluated the utility of simulation-based US training in achieving competency and improving safety. To the best of our knowledge, no previous studies have attempted to synthesize the effectiveness of US simulation in Obstetrics and Gynecology (OB GYN) education using a systematic method. This review article summarizes the effect of US simulation on learning outcomes in OB GYN with three objectives: (1) To review and summarize the available evidence on the effectiveness of US simulation in OB GYN; (2) determine the validity and usefulness of US simulation in OB GYN training; and (3) describe advantages and disadvantages of various US simulators available in OB GYN as of 2016. Materials and methods We performed a literature search using different search engines, such as Medline PubMed and EMBACE using appropriate keywords. The data were extracted from all published eligible studies. A meta-analysis was conducted in order to obtain a pooled estimate of effect of US simulation in OB GYN education based on the availability of data on common outcomes. Results The majority of the included studies supported the usefulness or validity of simulation training in OB GYN for the enhancement of US skills. The US simulation signifi cantly improved the skills necessary to measure crown-rump length and nuchal translucency accurately. Conclusion Despite the cost, integration of US simulators in medical education appears to have a positive impact on the scanning and interpretation skills of trainees. This study may assist in preparing a dedicated curriculum for OB GYN US education via the inclusion of US simulation. How to cite this article Arya S, Dwivedi A, Mulla ZD, Kupesic Plavsic S. Effectiveness of Ultrasound Simulation in Obstetrics and Gynecology Education: A State-of-the-Art Review. Donald School J Ultrasound Obstet Gynecol 2017;11(2):115-125.

scholarly journals Early Prediction of Twin-to-Twin Transfusion Syndrome with the use of First Trimester Ultrasound Markers: Is it Possible?

2013 ◽  
Vol 7 (1) ◽  
pp. 66-72
Author(s):  
Panagiotis Antsaklis ◽  
Marianna Theodora ◽  
Aristides Antsaklis ◽  
Vasileios Pergialiotis ◽  
Vasileios Papazefkos
Keyword(s):  
Prospective Studies ◽  
Obstet Gynecol ◽  
Reference Lists ◽  
First Trimester ◽  
Nuchal Translucency ◽  
Ductus Venosus ◽  
Early Prediction ◽  
Crown Rump Length ◽  
Assisted Reproduction Techniques ◽  
First Trimester Ultrasound

ABSTRACT Background The incidence of multifetal gestation and particularly of twin pregnancy has raised as a result of the introduction of assisted reproduction techniques (ART). Twinto- twin transfusion syndrome (TTTS) is a serious complication observed in monochorionic pregnancies producing severe morbidity and ultimately resulting in loss of one or all fetuses. We assessed the potential of early prediction of TTTS among three markers screened early in pregnancy [nuchal translucency (NT)] and its discrepancy and discordance, crown-rump length (CRL) and its discrepancy and discordance among twins and ductus venosus (DV) Doppler abnormalities. Materials and methods We conducted a systematic review searching Medline (1966-2011) and Scopus (2004-2011) engines, as well as reference lists from all included studies. Twelve studies were finally enrolled in the present review, including seven prospective studies, three prospective studies and one that could not be defined either as prospective or retrospective. Conclusion It seems that DV Doppler may denote this syndrome's possible future development and should be assessed early in monochorionic pregnancies. Further studies are definitely needed in order to evaluate the place of CRL and NT discrepancy and discordance in predicting TTTS. How to cite this article Antsaklis A, Pergialiotis V, Theodora M, Papazefkos V, Antsaklis P. Early Prediction of Twin-to-Twin Transfusion Syndrome with the use of First Trimester Ultrasound Markers: Is it Possible? Donald School J Ultrasound Obstet Gynecol 2013;7(1):66-72.

scholarly journals First Trimester Ultrasound Screening: An Update

2010 ◽  
Vol 4 (2) ◽  
pp. 97-116 ◽  
Author(s):  
JD Sonek ◽  
M Glover ◽  
M Zhou ◽  
KH Nicolaides
Keyword(s):  
Gestational Age ◽  
Nasal Bone ◽  
First Trimester ◽  
Nuchal Translucency ◽  
Maternal Serum ◽  
Ductus Venosus ◽  
Great Promise ◽  
Ultrasound Screening ◽  
Detection Rates ◽  
Crown Rump Length

Abstract For many years, the main use of ultrasound in the first trimester of pregnancy was to confirm viability and to establish gestational age. Indeed, the crown-rump length measurement in the first trimester remains the most accurate method to estimate the gestational age even today. However, improvements in ultrasound equipment and improvement in our understanding of normal and abnormal fetal development allows us now to perform a much more complete first trimester fetal evaluation. This pertains not only to the diagnosis of fetal anomalies but also to screening for fetal defects. The combination of the nuchal translucency measurement and maternal serum biochemistries (free β-hCG and PAPP-A) has been shown to be an extremely efficient way to screen for fetal aneuploidy. The addition of other first trimester markers such as the nasal bone evaluation, frontomaxillary facial angle measurement, and Doppler evaluation of blood flow across the tricuspid valve and through the ductus venosus improves the screening performance even further by increasing the detection rates and decreasing the false positive rates. Several of the first trimester markers also are useful in screening for cardiac defects. Furthermore, significant nuchal translucency thickening has been associated with a variety of genetic and nongenetic syndromes. A recently described first trimester marker called the intracerebral translucency appears to hold great promise in screening for open spine defects. Finally, it appears that a first trimester evaluation (uterine artery Doppler and the measurement of certain biochemical markers in the maternal serum) significantly improves the assessment of the risk of preeclampsia.

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