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Ultraschall Med 2015; 36(01): 47-53
DOI: 10.1055/s-0033-1350327
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Novel Insights into Early Embryonic Demise via 3D Surface Rendered Imaging in 107 Cases

Neue Aspekte bei der dreidimensionalen, oberflächenbearbeiteten Darstellung von 107 Embryonen und Feten bei verhaltenem Abort
D. R. Hartge
,
A. Schröer
,
J. Weichert
Further Information

Publication History

18 December 2012

08 July 2013

Publication Date:
13 January 2014 (online)

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Abstract

Purpose: Sonographic imaging techniques including 3 D volumetry were evaluated in women with missed abortion. Special emphasis was put on the impact of additional information regarding the etiology of the demise and improved visualization of embryonic and fetal anomalies due to the application of the latest imaging tools, e. g. HD live™. Parental acceptance of a more realistic display of the embryo/fetus in missed abortion was analyzed.

Materials and Methods: Between 09/2009 and 09/2012, 107 pregnancies with a missed abortion in the first trimester were included in this prospective survey. Using a transvaginal approach, all 2 D and 3 D studies were carried out with high-resolution 5 – 9 and 6 – 12 MHz probes.

Results: The mean gestational age was 70.3 days (49 – 110 days). The difference between estimated gestational age and sonographic age at evaluation for missed abortion was 13.5 days (–13 – 40 days). Additional information via three-dimensional volume acquisition, like craniofacial deformities, clefts, neural tube defects, abdominal wall defects and caudal regression syndrome, could be documented in 23/107 cases (21.5 %). In 2/107 cases the parents disapproved of the 3 D visualization due to the more realistic presentation.

Conclusion: 3 D ultrasound in cases of missed abortion can provide additional information regarding the presence of structural anomalies. It may give further details regarding the timing of embryonic/fetal demise in early pregnancy. Sufficient informational value is regularly obtained in cases having a CRL > 8 mm. In counseling parents, 3 D ultrasound is a useful tool and is generally well accepted.

Zusammenfassung

Ziel: Das Ziel dieser Untersuchung war zu prüfen, welchen Stellenwert die Qualitätsverbesserung der dreidimensionalen sonografischen Bildgebung von embryonalen und fetalen Oberflächenstrukturen bei verhaltenen Aborten im ersten Trimenon hat und welche zusätzlichen Informationen durch die Anwendung neuester Techniken zur Oberflächendarstellung, z. B. HDliveTM, bezüglich der Ursache der verhaltenen Aborte gewonnen werden können. Zusätzlich wurde die Akzeptanz dieser realistischeren Darstellung des Embryos und Feten bei verhaltenem Abort bei den betroffenen Eltern ausgewertet.

Material und Methoden: Zwischen 09/2009 und 09/2012 wurden insgesamt 107 Schwangerschaften mit einem verhaltenen Abort in diese prospektive Untersuchung eingeschlossen. Die sonografische, transvaginale 2-D- und 3-D-Evaluierung erfolgte über hochauflösende 5 – 9 und 6 – 12 MHz Ultraschallsonden.

Ergebnisse: Das durchschnittliche Schwangerschaftsalter betrug 70,3 Tage (49 – 110 Tage). Die Differenz zwischen geschätztem und sonografischem Gestationsalter bei Eintritt des embryonalen und fetalen Ablebens betrug 13,5 Tage (–13 – 40 Tage). Durch die zusätzliche 3-D-Sonografie ließen sich kranio-faziale Deformitäten und Spaltbildungen, Neuralrohr- und Bauchwanddefekte, sowie ein kaudales Regressionssyndrom in 23/107 (21,5 %) Fällen nachweisen. Bei 2/107 Fällen lehnten die Eltern die 3-D-Sonografie wegen der realistischeren Darstellung ab.

Schlussfolgerung: Die Hinzunahme der dreidimensionalen Ultrasonographie kann wertvolle Zusatzinformationen bei Fehlbildungen von Embryonen und Feten bei verhaltenem Abort liefern. Sie kann zudem Hinweise zum Zeitpunkt des Eintritts des verhaltenen Abortes in der Frühschwangerschaft geben. Die ausreichende Darstellbarkeit von embryonalen Strukturen scheint ab einer SSL von über 8 mm gegeben zu sein. Bei der Beratung der betroffenen Eltern hat sich der 3-D-Ultraschall als sinnvolle Maßnahme bewährt.

Key words

ultrasound 3 D/4 D - malformation - chromosomal aberration - abortion

Table 1/Tabelle 1

 

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