Australasian Journal of Ultrasound in Medicine最新文献_第6页

Comparing transabdominal and transvaginal cervical length measurements at mid-trimester fetal anomaly scan: The impact of bladder fullness and lower uterine contractions 比较经腹和经阴道宫颈长度测量在中期胎儿异常扫描：膀胱充盈和子宫收缩的影响。

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-08-29 DOI: 10.1002/ajum.12409

Heidi Beaver, Valeria Lanzarone, Gary KK Low

Purpose

To assess the effects of bladder fullness and lower uterine contractions ultrasound on transabdominal and transvaginal cervical length measurements at the mid-trimester fetal anomaly scan (FAS).

Methods

Transabdominal and transvaginal cervical length measurements from 925 mid-trimester FAS examinations were retrospectively analysed. Images were assessed for lower uterine contraction and bladder fullness using a novel qualitative assessment. Bland–Altman plots and single-score interclass correlation (ICC) were used to determine correlation between transabdominal and transvaginal measurements. Sensitivity and specificity of transabdominal cut-offs were calculated.

Results

Transabdominal and transvaginal measurements of the cervix correlated poorly (ICC 0.306). An overfilled bladder and lower uterine contractions on average increased the length of transabdominal cervical length measurements. Removing these variables did not significantly improve correlation between transabdominal and transvaginal measurements of the cervix but resulted in an improved sensitivity of transabdominal assessment to detect a clinically relevant short cervix.

Discussion

Resolving the confounding factors of an overfilled bladder and lower uterine contractions can help improve the our ability to detect a short cervix on transabdominal ultrasound. Our data set supported a two-stage approach to cervical length screening which would allow 100% sensitivity when a cut-off of ≤35 mm is used on transabdominal ultrasound and would limit the need for transvaginal scanning to approximately 39% of patients. This cut-off is in line with the findings of other studies. The low prevalence of short cervix in our study did however make it difficult to extrapolate reliable calculations.

Conclusion

Although transabdominal measurements correlate poorly with transvaginal measurements of the cervix, we demonstrated an improved sensitivity for detecting a short cervix using a transabdominal approach when no contractions or overfilled bladder is present. This potential could be explored in a future study with a larger sample size.

目的：探讨膀胱充盈和子宫下缩超声对妊娠中期胎儿异常扫描（FAS）经腹和经阴道宫颈长度测量的影响。方法：回顾性分析925例中期妊娠FAS检查的经腹和经阴道宫颈长度测量结果。图像评估下子宫收缩和膀胱充盈使用新的定性评估。Bland-Altman图和单评分类间相关（ICC）用于确定经腹和经阴道测量之间的相关性。计算经腹切断的敏感性和特异性。结果：经腹和经阴道宫颈测量相关性较差（ICC 0.306）。膀胱过度充盈和子宫收缩较低平均增加长度经腹宫颈长度测量。去除这些变量并没有显著提高经腹和经阴道宫颈测量之间的相关性，但却提高了经腹评估检测临床相关短宫颈的敏感性。讨论：解决膀胱过度充盈和子宫收缩较低的混杂因素有助于提高经腹超声检测短宫颈的能力。我们的数据集支持宫颈长度筛查的两阶段方法，当截断≤35 mm用于经腹超声时，该方法允许100%的灵敏度，并将经阴道扫描的需要限制在约39%的患者。这一临界值与其他研究的结果一致。然而，在我们的研究中，短子宫颈的低患病率确实使推断可靠的计算变得困难。结论：虽然经腹测量与经阴道测量宫颈相关性较差，但我们证明了在没有收缩或膀胱过度充盈的情况下，经腹入路检测短宫颈的灵敏度提高。这种可能性可以在未来更大样本量的研究中探索。

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引用次数: 0

Case report of recurrent vasa previa 复发性前置胎盘的病例报告。

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-08-27 DOI: 10.1002/ajum.12405

Michelle J. Wang, Cassandra R. Duffy, Yinka Oyelese

Introduction

Vasa previa is a complication of pregnancy, which affects approximately 1:1200 pregnancies, and when undiagnosed prenatally, it can be associated with significant perinatal mortality. This condition is thought to be a sporadic entity without known genetic or familial associations and thus considered to carry a negligible recurrence risk.

Key Findings

We present a case of a 42-year-old gravida 3 para 2 diagnosed on transvaginal ultrasound with a vasa previa at 34 weeks associated with vaginal bleeding, which required an urgent caesarean in a prior spontaneous pregnancy. In the current pregnancy conceived with in vitro fertilisation, she was again diagnosed with a vasa previa at 30 weeks’ gestation at transvaginal ultrasound. She ultimately delivered at 37 weeks’ gestation via an uncomplicated repeat caesarean.

Discussion

Patients with vasa previa in one pregnancy may be at risk for recurrence in subsequent pregnancy and thus should be screened in future pregnancies. Further research should be done to explore and identify any risk factors for recurrence of vasa previa.

前置瓦萨是一种妊娠并发症，其影响约1:1200的妊娠，如果产前未确诊，则可能与显著的围产期死亡率相关。这种情况被认为是一种散发性的实体，没有已知的遗传或家族关联，因此被认为具有可忽略的复发风险。主要发现：我们报告了一例42岁的孕妇，经阴道超声诊断为34周时伴有阴道出血的前置血管，需要紧急剖腹产。在本次体外受精妊娠中，她在妊娠30周时再次经阴道超声诊断为前置血管。她最终在怀孕37周时通过简单的重复剖腹产分娩。讨论：在一次妊娠中有前置血管的患者在后续妊娠中可能有复发的危险，因此应在以后妊娠中进行筛查。进一步的研究应探讨和确定任何前置血管复发的危险因素。

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引用次数: 0

Acute aortic occlusion: A point-of-care ultrasound case report 急性主动脉阻塞：一个即时超声病例报告。

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-07-29 DOI: 10.1002/ajum.12404

Erin Newman

Introduction

Acute aortic occlusion (AAO) is a rare vascular emergency with significant associated morbidity and mortality

Methods

This case report discusses a 39-year-old gentleman with methamphetamine-associated cardiomyopathy (MACM) who presented with bilateral lower limb ischaemia. A POCUS was performed to rapidly evaluate the patient on arrival, which demonstrated AAO. A literature review was conducted to identify similar cases where AAO was detected by POCUS.

Results

POCUS showed a left ventricular thrombus (LVT), an embolus in the distal abdominal aorta and no flow distal to the embolus, which is consistent with AAO. The patient was successfully reperfused and had a good outcome after a timely diagnosis and management.

Discussion

This case report outlines a rare pathology in an uncommon age group where POCUS can expedite diagnosis and management.

Conclusion

POCUS is a valuable tool, which can expedite and facilitate rapid revascularisation of AAO.

简介：急性主动脉阻塞（AAO）是一种罕见的血管急症，发病率和死亡率都很高。方法：本病例报告讨论了一名患有甲基苯丙胺相关心肌病（MACM）的39岁男士，他表现为双侧下肢缺血。到达时进行POCUS快速评估患者，结果显示AAO。我们进行了文献回顾，以确定POCUS检测到AAO的类似病例。结果：POCUS示左心室血栓（LVT），腹主动脉远端栓子，栓子远端无血流，与AAO一致。经及时诊断和处理，患者再灌注成功，预后良好。讨论：本病例报告概述了一个罕见的病理在一个不寻常的年龄组，POCUS可以加快诊断和管理。结论：POCUS是一种有价值的工具，可以加速和促进AAO的快速血运重建。

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引用次数: 0

Ultrasound imaging of the femoral and saphenous nerves 股神经和隐神经的超声成像。

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-07-29 DOI: 10.1002/ajum.12403

Michelle Fenech, Bridie Roche, Jerome Boyle

Introduction

Iatrogenic and traumatic injuries to the femoral and saphenous nerves, and their branches are uncommon but can be a cause of clinically pertinent lower limb dysfunction and neuralgia. Despite this, direct sonographic imaging of these nerves is not commonly requested or performed.

Methods

A review of the literature regarding the detailed relative anatomy, sonographic technique to image these nerves and their branches and their normal and abnormal appearances was conducted.

Discussion

These nerves are often in the direct imaging field of many ultrasound examinations including the assessment of the groin and lower limb vasculature and musculoskeletal studies. They can become entrapped at certain points throughout their path, where particular attention should be provided to these nerves.

Conclusion

Improved knowledge regarding the sonographic imaging of the femoral and saphenous nerves and their branches can assist identification and discrimination between normal and abnormal appearances, and subsequent ultrasound-guided nerve blockades or radiofrequency ablations for pain management where required.

医源性和外伤性股骨神经和隐神经及其分支的损伤并不常见，但可能是临床相关下肢功能障碍和神经痛的原因。尽管如此，这些神经的直接超声成像通常不被要求或执行。方法：对相关解剖、超声成像技术、正常与异常表现等方面的文献进行综述。讨论：这些神经经常出现在许多超声检查的直接成像领域，包括评估腹股沟和下肢血管系统和肌肉骨骼研究。它们可能会被困在路径中的某些点上，在这些点上应该特别注意这些神经。结论：提高对股神经和隐神经及其分支的超声成像知识有助于识别和区分正常和异常表现，并在需要时进行超声引导下的神经阻滞或射频消融治疗。

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引用次数: 0

EUS-guided tissue acquisition from gastric subepithelial lesions—The optimal technique still remains undecided EUS 引导下的胃上皮下病变组织采集--最佳技术仍未确定

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-07-19 DOI: 10.1002/ajum.12398

Suprabhat Giri, Sridhar Sundaram

引用次数: 0

Ultrasound-assisted and landmark-based nusinersen delivery in spinal muscular atrophy adults: A retrospective analysis 成人脊髓性肌肉萎缩症患者的超声辅助和地标式努西那生给药：回顾性分析

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-07-15 DOI: 10.1002/ajum.12401

Bruno Antonio Zanfini, Agata Katia Patanella, Francesco Vassalli, Stefano Catarci, Marika Pane, Luciano Frassanito, Matteo Biancone, Mariangela Di Muro, Chiara Bravetti, Eugenio Maria Mercuri, Mario Sabatelli, Gaetano Draisci

Introduction/Purpose

Nusinersen, the first treatment approved for all spinal muscular atrophy (SMA) types, is administered intrathecally through lumbar puncture. We used ultrasound assistance or a landmark-based technique to access the lumbar intrathecal space in adult SMA patients. This study aimed to evaluate the technical success and adverse events (AEs) in such patients using either technique over a long observation period.

Methods

Fifty-one adult patients received 507 consecutive interlaminar nusinersen administrations. Patients presented with both ‘uncomplicated spines’ or ‘complicated spines’; two patients had previous back surgery. Technical success and AEs were recorded using either technique. A generalised linear mixed model was applied to evaluate predictors of technical success and complications.

Results

An overall success rate of 99.6%, with only two procedures failing to reach the intrathecal space, and an overall optimal procedure rate of 90.3% have been reported. A total of 455 procedures (89.7%) were uneventfully performed. One (0.2%) case of severe AE (puncture of a bulky abdominal annexal cyst) was recorded. Twenty-seven episodes (5.3%) of post-dural puncture headache (PDPH) and 24 episodes (4.7%) of radicular or back pain, both successfully treated with medical therapy, have also been reported. Technical success was significantly associated with ‘complicated spines’ (P = 0.022) and the use of ultrasound assistance (P = 0.01), and the use of ultrasound was the only independent predictor of uncomplicated procedures (P = 0.007).

Discussion

In adult patients with SMA both landmark-based and ultrasound-assisted techniques are safe and effective even in the long term. The use of assistance is associated with technical success and can predict uncomplicated procedures.

Conclusion

Our results support the use of ultrasonography in order to improve the success and reduce the burden of nusinersen intrathecal administration.

Nusinersen是首款获准用于所有脊髓性肌萎缩症（SMA）类型的治疗药物，通过腰椎穿刺进行鞘内给药。我们使用超声辅助或基于地标的技术对成年 SMA 患者进行腰椎腔内穿刺。这项研究旨在评估在长期观察期内，使用这两种技术对此类患者的技术成功率和不良事件（AEs）。51名成年患者连续接受了507次层间纽西奈森治疗，患者既有 "不复杂的脊柱"，也有 "复杂的脊柱"；其中两名患者曾接受过背部手术。两种技术均记录了技术成功率和不良反应。应用广义线性混合模型评估了技术成功率和并发症的预测因素。据报道，总体成功率为 99.6%，仅有两次手术未能到达鞘内间隙，总体最佳手术率为 90.3%。共有 455 例手术（89.7%）顺利完成。记录到一例（0.2%）严重AE（穿刺到腹部巨大附件囊肿）。此外，还报告了 27 例（5.3%）硬膜穿刺后头痛（PDPH）和 24 例（4.7%）根痛或背痛，均通过药物治疗成功治愈。技术成功与 "复杂脊柱"（P = 0.022）和使用超声辅助（P = 0.01）明显相关，而使用超声是不复杂手术的唯一独立预测因素（P = 0.007）。我们的研究结果支持使用超声波检查来提高努西那生鞘内给药的成功率并减轻其负担。

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引用次数: 0

Cutaneous ultrasound in the diagnosis and assessment of inflammatory activity in tinea capitis 皮肤超声在诊断和评估头癣炎症活动中的应用

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-07-10 DOI: 10.1002/ajum.12402

Francisco José Rodríguez-Cuadrado, Gaston Roustan-Gullón, Fernando Alfageme-Roldán

Introduction

Although the diagnosis of tinea capitis is mainly microbiological, the risk of evolution towards cicatricial alopecia in the most severe cases requires empirical treatment based on physical examination and complementary examinations.

Methods

Two patients were evaluated by physical examination, cutaneous ultrasound and microbiological examination.

Results

Ultrasound showed follicular widening and increased vascularization in Doppler mode. In one of them, the finding of severe inflammatory activity led to the indication of oral corticotherapy.

Discussion

Cutaneous ultrasound could play a role not only in supporting the clinical diagnosis but that it may even guide the indication of treatment in the presence of severe inflammation that sometimes may not manifest itself clinically.

Conclusion

Cutaneous ultrasound may constitute an additional test of considerable usefulness in the diagnosis and evaluation of inflammatory activity in cases such as the ones presented, fast, non-invasive and of high accessibility.

虽然头癣的诊断主要是微生物学诊断，但最严重的病例有可能演变为卡他性脱发，因此需要在体格检查和辅助检查的基础上进行经验性治疗。皮肤超声波不仅能辅助临床诊断，甚至还能在出现严重炎症（有时临床表现并不明显）时指导治疗指征。皮肤超声波可作为诊断和评估炎症活动的额外检测手段，在上述病例中非常有用，而且快速、无创、方便。

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引用次数: 0

Management change following transthoracic echocardiogram in the intensive care unit 重症监护病房经胸超声心动图检查后的管理变化

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-06-25 DOI: 10.1002/ajum.12397

Jeremy A Smith, Ravi Mistry

Introduction/Purpose

The optimal utilisation of echocardiography in intensive care units (ICU) is not yet known; however, its use is becoming more frequent. Management change from transthoracic echocardiography (TTE) in ICU is quoted to be from 3% to 50%.

Methods

A retrospective review of clinical practice was performed over a 2-month period in a tertiary adult ICU, to explore the utilisation of formal TTEs and the findings of these. The rate of management change and critical findings were investigated, along with the indication for TTE and the patient cohort.

Results

Sixty-three TTEs were performed in 54 patients. A change in management occurred in 25.4% (16/63) of TTEs, with critical findings being found in 47.6% (30/63) of all TTEs. The most common indications for formal TTEs were incompletely differentiated or further evaluation of shock, and post arrest cardiac function.

Discussion

Almost half of the TTEs performed had critical findings, with common critical findings being severe LV dysfunction, severe RV dysfunction and regional wall motion abnormalities. Despite critical findings being seen frequently, there was only management change in 25%, suggesting that several of the critical findings were already suspected, clinically confirmed or had anticipatory management prior to TTE.

Conclusion

Critical findings are common in critically ill patients. However, not all critical findings will lead to a change in management. Formal TTEs in the ICU should be focussed to the clinical question being asked and a screening intensivist performed bedside TTE may be appropriate in certain situations to decrease workload of cardiology department.

导言/目的目前尚不清楚重症监护病房（ICU）中超声心动图的最佳使用率，但其使用正变得越来越频繁。据估计，重症监护病房中经胸超声心动图（TTE）对管理的改变从 3% 到 50% 不等。方法在一个三级成人重症监护病房进行了为期两个月的临床实践回顾，以探讨正式 TTE 的使用情况和结果。研究还调查了管理变化率和关键结果，以及 TTE 的适应症和患者群。结果对 54 名患者进行了 63 次 TTE 检查。25.4%（16/63）的 TTE 患者改变了治疗方案，47.6%（30/63）的 TTE 患者发现了危急病症。正式 TTE 最常见的适应症是休克分化不完全或进一步评估，以及骤停后的心脏功能。讨论近一半的 TTE 检查有危重发现，常见的危重发现是严重左心室功能障碍、严重左心室功能障碍和区域室壁运动异常。尽管危重结果经常出现，但只有 25% 的患者改变了治疗方案，这表明一些危重结果在进行 TTE 之前就已被怀疑、临床证实或进行了预期治疗。结论危重病人常见危重结果。然而，并非所有的危重发现都会导致管理的改变。在重症监护病房进行正式的 TTE 检查时，应重点关注所提出的临床问题，在某些情况下，由重症监护医生进行床旁 TTE 筛选可能是合适的，可减少心脏科的工作量。

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引用次数: 0

Diagnostic role of sonography in early detection and surgical intervention of an epidural abscess: A case report 超声在硬膜外脓肿早期发现和手术干预中的诊断作用：1例报告。

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-06-25 DOI: 10.1002/ajum.12400

Issac Cheong, Francisco Marcelo Tamagnone

Introduction

Intracranial epidural abscesses require swift diagnosis and treatment. While magnetic resonance imaging (MRI) is preferred for its detailed visualisation, it is costly and time-consuming. Transcranial sonography offers a rapid, portable and cost-effective alternative for assessing brain lesions.

Methods

We present a case study involving the diagnosis and management of an intracranial epidural abscess in a 25-year-old man with a traumatic brain injury who underwent a craniectomy and later developed fever and drowsiness in the intensive care unit.

Results

Using transcranial point-of-care ultrasound, a hypoechoic collection was identified at the surgical site, prompting further imaging with computed tomography (CT) and MRI, which confirmed the diagnosis of an epidural abscess. Prompt surgical intervention led to the resolution of symptoms and a favourable clinical outcome.

Conclusion

This case highlights the potential utility of brain sonography as an efficient and cost-effective initial diagnostic tool for detecting intracranial complications, particularly in postoperative patients with altered sensorium and fever, where timely intervention is crucial.

简介：颅内硬膜外脓肿需要快速诊断和治疗。虽然磁共振成像（MRI）是其详细可视化的首选，但它既昂贵又耗时。经颅超声为评估脑损伤提供了一种快速、便携和经济的替代方法。方法：我们报告了一个病例研究，涉及诊断和处理一个25岁的男性外伤性脑损伤，他接受了颅骨切除术，后来在重症监护室出现发烧和嗜睡。结果：使用经颅即时超声，在手术部位发现低回声收集，提示进一步进行计算机断层扫描（CT）和MRI成像，确认诊断为硬膜外脓肿。及时的手术干预导致症状的解决和良好的临床结果。结论：该病例强调了脑超声作为检测颅内并发症的有效且经济的初始诊断工具的潜在效用，特别是在术后感觉改变和发烧患者中，及时干预至关重要。

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引用次数: 0

Placental cord insertion migration: Implications for ultrasound documentation and follow-up of abnormal placental cord insertion site 胎盘脐带插入迁移：异常胎盘脐带插入部位的超声记录和随访的意义

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-06-14 DOI: 10.1002/ajum.12399

Samantha Ward, Zhonghua Sun, Sharon Maresse

Introduction/Purpose

It is well-documented in the literature that the placenta migrates during pregnancy; however, studies regarding placental cord insertion (PCI) migration are scarce. This longitudinal, prospective study aimed to determine whether PCI migration is a true phenomenon, to assess whether the PCI can change classification during pregnancy and to determine the validity of PCI site documentation including follow-up of abnormal PCI.

Methods

Eighty-three participants who had first, second and third trimester ultrasound examinations at a Western Australian private imaging practice over a 12-month period between November 2021 and November 2022 were recruited. The measured distance of the lower margin of the placenta to the cervix, the distance of the PCI to the closest placental edge and the PCI classification were documented in each trimester. Data analysis was conducted to determine PCI migration rates during pregnancy and to test for association between PCI migration and maternal and placental factors.

Results

The PCI migrated during pregnancy and the PCI classification has the potential to evolve. All identifiable PCIs that were normal in first trimester remained so throughout the pregnancy. The majority (67.6%) of cord insertions that were marginal in first trimester progressed to a normal insertion site by third trimester; 23.5% remained marginal and 8.8% evolved to a velamentous insertion. Three velamentous cord insertions were recorded in first trimester, none of which normalised—two remained velamentous during the pregnancy and one evolved to marginal in second trimester. Marginal cord insertions (MCIs) ≤10 mm from the placental edge in second trimester remained marginal in third trimester; MCIs that were >15 mm from the placental edge in second trimester normalised in third trimester.

Conclusions

Placental cord insertion migration is a phenomenon that occurs during pregnancy with the potential for PCI classification to evolve. Due to the association between abnormal PCI and perinatal complications, coupled with the potential for marginal cord insertion to evolve, documentation of PCI and follow-up of abnormal PCI is beneficial, particularly in cases of velamentous insertion and marginal insertion at the placental edge or in the lower uterus.

妊娠期间胎盘移位的文献记载很多，但有关胎盘脐带插入（PCI）移位的研究却很少。这项纵向前瞻性研究旨在确定PCI迁移是否是一种真实现象，评估PCI是否会在孕期改变分类，并确定PCI部位记录的有效性，包括对异常PCI的随访。这项研究招募了83名参与者，他们在2021年11月至2022年11月的12个月期间，在西澳大利亚一家私人影像诊所接受了第一、第二和第三孕期超声检查。每个孕期都记录了胎盘下缘到宫颈的测量距离、PCI到最近胎盘边缘的距离以及PCI分类。进行数据分析以确定妊娠期间的 PCI 迁移率，并检验 PCI 迁移与母体和胎盘因素之间的关联性。所有在妊娠头三个月正常的可识别 PCI 在整个孕期都保持正常。大多数（67.6%）脐带在妊娠头三个月时是边缘性的，到妊娠第三个三个月时发展为正常的插入部位；23.5%仍然是边缘性的，8.8%发展为绒毛状插入。在妊娠头三个月有三例绒毛状脐带插入，其中两例在妊娠期间仍为绒毛状，一例在妊娠后三个月演变为边缘性。第二孕期距胎盘边缘≤10毫米的边缘性脐带插入（MCIs）在第三孕期仍为边缘性；第二孕期距胎盘边缘>15毫米的MCIs在第三孕期恢复正常。由于异常 PCI 与围产期并发症之间存在关联，再加上边缘脐带插入可能会发生变化，因此记录 PCI 和随访异常 PCI 是有益的，尤其是在绒毛状插入和边缘插入胎盘边缘或子宫下段的情况下。

{"title":"Placental cord insertion migration: Implications for ultrasound documentation and follow-up of abnormal placental cord insertion site","authors":"Samantha Ward, Zhonghua Sun, Sharon Maresse","doi":"10.1002/ajum.12399","DOIUrl":"10.1002/ajum.12399","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction/Purpose</h3>\u0000 \u0000 <p>It is well-documented in the literature that the placenta migrates during pregnancy; however, studies regarding placental cord insertion (PCI) migration are scarce. This longitudinal, prospective study aimed to determine whether PCI migration is a true phenomenon, to assess whether the PCI can change classification during pregnancy and to determine the validity of PCI site documentation including follow-up of abnormal PCI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eighty-three participants who had first, second and third trimester ultrasound examinations at a Western Australian private imaging practice over a 12-month period between November 2021 and November 2022 were recruited. The measured distance of the lower margin of the placenta to the cervix, the distance of the PCI to the closest placental edge and the PCI classification were documented in each trimester. Data analysis was conducted to determine PCI migration rates during pregnancy and to test for association between PCI migration and maternal and placental factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The PCI migrated during pregnancy and the PCI classification has the potential to evolve. All identifiable PCIs that were normal in first trimester remained so throughout the pregnancy. The majority (67.6%) of cord insertions that were marginal in first trimester progressed to a normal insertion site by third trimester; 23.5% remained marginal and 8.8% evolved to a velamentous insertion. Three velamentous cord insertions were recorded in first trimester, none of which normalised—two remained velamentous during the pregnancy and one evolved to marginal in second trimester. Marginal cord insertions (MCIs) ≤10 mm from the placental edge in second trimester remained marginal in third trimester; MCIs that were >15 mm from the placental edge in second trimester normalised in third trimester.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Placental cord insertion migration is a phenomenon that occurs during pregnancy with the potential for PCI classification to evolve. Due to the association between abnormal PCI and perinatal complications, coupled with the potential for marginal cord insertion to evolve, documentation of PCI and follow-up of abnormal PCI is beneficial, particularly in cases of velamentous insertion and marginal insertion at the placental edge or in the lower uterus.</p>\u0000 </section>\u0000 </div>","PeriodicalId":36517,"journal":{"name":"Australasian Journal of Ultrasound in Medicine","volume":"27 4","pages":"200-209"},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajum.12399","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141339337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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