Einleitung Im Rahmen der PETN-Studie wurde in einer randomisierten, doppelblinden, placebokontrollierten Mulitzenter-Studie die Wirksamkeit und Sicherheit des NO-Donors Pentaerytrithyltetranitrat (PETN) zur Vorbeugung von fetaler Wachstumsrestriktion (FGR) und perinatalem Tod bei Schwangerschaften mit pathologischer uteriner Perfusion zum Zeitpunkt der Feindiagnostik, untersucht. Die Studie konnte den zuvor gezeigten Effekt einer Reduktion der Häufigkeit des kombinierten Endpunktes von FGR und/oder perinatalem Tod nicht bestätigen, zeigte aber eine signifikante Reduktion der Frühgeburtlichkeit [1]. Hier zeigen wir die Daten zum Outcome der Neugeborenen, die auf die neonatologische Intensivstation (NICU) aufgenommen wurden, sowie die Ergebnisse der pädiatrischen Vorsorgeuntersuchungen im Alter von 12 Monaten. Zusätzlich berichten wir über die im Verlauf der Studie erfassten, die Kinder betreffenden, unerwünschten Ereignisse.
We used two 3D ultrasound volumes of fetal heads at 13 weeks to create live-size 3D-printed phantoms with a view to training or assessment of diagnostic abilities for normal and abnormal nuchal translucency measurements. The phantoms are suitable for use in a water bath, imitating a real-life exam. They were then used to study measurement accuracy and reproducibility in examiners of different skill levels.
Fragestellung: Supraventrikuläre Tachykardien können ab einer kritischen Herzfrequenz von ca. 210 SpM über eine Erhöhung des zentralvenösen Drucks zu einem Hydrops fetalis mit konsekutiver Mortalität in bis zu 40% führen. Gerade bei Auftreten eines Hydrops ist eine Therapie mit Digoxin häufig nicht mehr wirksam. In dieser Studie sollen Effektivität und Zeit bis zum Therapieerfolg in einer Kohorte von mit Flecainid behandelten Feten untersucht werden.
Hintergrund: Extrapulmonale arterielle Gefäßverschlüsse sind in der Schwangerschaft extrem selten. Wir berichten über eine Schwangere mit rezidivierenden arteriellen Gefäßverschlüssen des linken Arms.
Abstract Purpose: To evaluate deep learning (DL) denoising reconstructions for image quality improvement of Doppler ultrasound (DUS)-gated fetal cardiac MRI in congenital heart disease (CHD). Methods: Twenty-five fetuses with CHD (mean gestational age: 35±1 weeks) underwent fetal cardiac MRI at 3 Tesla. Cine imaging was acquired using a balanced steady-state free precession (bSSFP) sequence with Doppler ultrasound gating. Images were reconstructed using both compressed SENSE (bSSFP CS) and a pre-trained convolutional neural network trained for deep-learning denoising (bSSFP DL). Images were compared qualitatively based on a 5-point Likert scale (from 1=non-diagnostic to 5=excellent) and quantitatively by calculating the apparent signal-to-noise ratio (aSNR) and contrast-to-noise ratio (aCNR). Diagnostic confidence was assessed for the atria, ventricles, foramen ovale, valves, great vessels, aortic arch, and pulmonary veins. Results: Fetal cardiac cine MRI was successful in 23 fetuses (92%). Image quality of bSSFP DL cine reconstructions compared with standard bSSFP CS cine images was rated significantly higher regarding contrast (3 [interquartile range: 2-4] vs 5 [4-5], P<0.001) and endocardial edge definition (3 [2-4] vs 4 [4-5], P<0.001), whereas the level of artifacts deemed comparable (4 [3-4.75] vs 4 [3-4], P=0.40). bSSFP DL images had higher aSNR and aCNR compared with the bSSFP CS images (aSNR: 13.4±6.9 vs 8.3±3.6, P<0.001; aCNR: 26.6±15.8 vs 14.4±6.8, P<0.001). Diagnostic confidence of the bSSFP DL images was superior for the evaluation of cardiovascular structures (e.g., atria and ventricles: P=0.003). Conclusion: DL image denoising provides superior quality for DUS-gated fetal cardiac cine imaging of CHD compared to standard CS image reconstruction.
Thoracoamniotic shunting (TAS) for fetal hydrothorax has improved perinatal survival but still has high rates of dislocation with previously used shunt systems. We investigated outcomes after thoracoamniotic shunting with the Somatex shunt and compared them to a historical cohort from the same centre treated with a Harrison shunt. This is a retrospective study of all TAS from 2014-2018 using the Somatex shunt. We included all patients with primary hydrothorax with hydrops or hemodynamic compromise. Obstetrics and neonatal charts were reviewed for dislocation rate, complications, perinatal survival and neonatal outcome. The outcomes of the Harrison group have been published (Mallmann 2017). 37 patients underwent TAS with a Somatex shunt during the study period, hydrops was present in 51%. TAS was performed at 26.7 (19-33) weeks. Dislocation or occlusion occured in 46% and 24 %. Chorioamnionitis developed in 1/37 patients. 97% neonates were born alive (36/37) at a median age of 34 weeks. Complete resolution of hydrothorax occured in 43% (16/37). Final diagnosis was chylothorax in 40%, unclear in 35%, genetic in 19% and other etiologies in 6%. Neonatal survival was 81% (30/37). Compared to the historical Harrison shunt cohort dislocation rates were similar (45 vs. 46%), however the rate of complete resolution of the hydrothorax was significanty higher with the Somatex shunt (43 vs. 16%). In our cohort perinatal survival was > 80% after thoracoamniotic shunting for fetal hydrothorax, even in a high risk cohort. Compared to the historical cohort, dislocation rates appear to be similar for both Somatex and Harrison shunts, but the Somatex intrauterine shunt showed a higher rate of complete resolution of hydrothorax compared to the Harrison shunt. Thoracoamniotic shunting leads to increased neonatal survival, but which shunt types is the best option still needs to be evaluated. Where the Somatex shunt is available, it can be considered a valid alternative for thoracoamniotic shunting and might even be superior to other types of shunts.
Einleitung und Fragestellung Urinome sind abgekapselte Urinansammlungen in der perirenalen Faszie. Hauptursache sind vor allem Harnwegsobstruktionen, etwa durch LUTO (lower urinary tract obstruction, Verengungen der unteren ableitenden Harnwege) oder Ureterabgangs- bzw. Uretermündungsstenosen (UPJO, ureteropelvic junction obstruction bzw. UVJO, ureterovesical junction obstruction). Die Bedeutung pränataler Urinome wird teilweise noch kontrovers diskutiert.
