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Topics in Spotlight

The Syndromic Brain
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Ventriculomegaly is a nonspecific finding common to several pathologies with varying prognoses. It can be benign with no pathological significance or a part of the spectrum of cases with major cerebral and extra-cerebral structural defects, aneuploidy, genetic syndromes, infections, hypoxia-ischemia, etc. Similarly, CSP is an important landmark in the evaluation of the fetal brain and its isolated absence may be innocuous or may indicate absent corpus callosum or septo-optic dysplasia. Uncertainty of etiology and prognosis makes parental counseling and further management particularly complicated.

Management of Monochorionic Twins – TTTS, sIUGR, and TAPS
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MC twins have much higher rates of complications than dichorionic twins due to their specific placental angioarchitecture. The detection rates of these anomalies have improved significantly due to close surveillance, and this has allowed for the introduction of treatments such as fetoscopic laser ablation of placental anastomoses, bipolar cord occlusion, and radiofrequency ablation. This segment aims to fill gaps in our knowledge of twin pregnancies to care optimally for these pregnancies.

Pre-eclampsia Screening
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Includes a live demo on the correct measurement of Uterine Artery Dopplers.

Thickened NT and Genetic Testing
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NT ultrasound remains important in the detection of aneuploidy and structural anomalies; however, the optimal management of pregnancies with an isolated increased NT measurement in an era of advanced genomic testing options is a new dilemma for clinicians.

Diagnostic Testing After Positive Results on Cell-Free DNA Screening: CVS or Amnio/CMA, WES, or More?
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Diagnostic testing options after a positive cfDNA screen include CVS, which can be performed as early as 10 weeks, and amniocentesis, which can be performed at 15 weeks’ gestation or later. While CVS can provide an earlier answer, it may not always be the appropriate test given the potential for confined placental mosaicism, the rate of which varies with specific aneuploidies. In genetic diagnostics, the current toolbox includes a great variety of cytogenetic and molecular methodologies. CMA has long been the first-tier test used to identify copy number variants (CNVs) in fetuses with structural anomalies, WES can elucidate the responsible pathogenic variants in an additional 20–80% of cases when standard genetic testing (karyotype and CMA) is normal.

Cesarean Scar Pregnancy
Placenta Accreta: Screening, Diagnosis, And Management
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Placenta accreta is perhaps one of the greatest surgical challenges in obstetric practice today. Antepartum diagnosis is of paramount importance. Obstetric outcomes can be modified with accurate early prenatal diagnosis, and timely referral to tertiary care centers. Screening at the first trimester is desirable for early reassurance of most pregnant women with previous surgery and optimizing the resources at the same time for providing appropriate follow-ups to high-risk women for early antenatal diagnosis and peripartum management.

Intracranial Hemorrhage and Late Onset Ventriculomegaly
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Intracranial hemorrhage may occur within the lateral ventricles or in the subdural space. The sonographic appearance changes with time. An echogenic collection is first seen, and in the following days, it develops into a complex mass frequently complicated by severe ventriculomegaly. In the most severe forms, the hemorrhage may be complicated by an infarct in the brain parenchyma. The etiology is variable and prenatal counseling is complicated due to late diagnosis and associated uncertainties.

Ventricular Septal Defects
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Isolated ventricular septal defect (VSD) is the commonest congenital heart lesion (about 30% of all CHD) detected postnatally, with the incidence of 2/1000 live birth. The diagnosis of VSD during fetal life presents several challenges with the potential for both false-positive and false-negative diagnoses. A confident diagnosis for some VSD types is quite difficult during fetal life. For example, in cases of doubly committed sub arterial defect, the required sonographic views may not be readily obtainable in the fetus.

Third Trimester Ultrasound
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Third-trimester ultrasound has long been in obstetrics a topic of debate. The primary objective of a third-trimester ultrasound examination is typically focused on fetal growth, the position of the placenta, and the assessment of amniotic fluid. Besides this, the third-trimester scan may reveal new fetal abnormalities that could not be diagnosed at earlier examinations. Such diagnosis and subsequent management, including a selection of timing and place for delivery and postnatal investigations, could potentially improve postnatal outcomes.

This session includes a Live Demonstration of the third-trimester scan.