Review article
RECENT ADVANCES IN THE ASSESSMENT OF MULTIFETAL PREGNANCIES BY 3D/4D SONOGRAPHY
Asim Kurjak
; Department of Gynaecology and Obstetrics, Medical School Zagreb, General Hospital
Wiku Andonotopo
; Department of Gynaecology and Obstetrics, Medical School Zagreb, General Hospital
Branko Radaković
; Department of Obstetrics and Gynecology, Clinical Hospital Centre, Medical School University of Zagreb, Croatia
Milan Stanojević
; Department of Gynaecology and Obstetrics, Medical School Zagreb, General Hospital
Abstract
Introduction of ultrasound has revolutionized the antenatal diagnosis of multiple pregnancies. Indeed, two-dimensional sonography (2D) is still the primary modality for the diagnosis and evaluation of multiple pregnancies. However, 2D sonography may be replaced by three- (3D) and four-dimensional (4D) sonography whenever appropriate. New technique should be accepted as a complementary to 2D sonography, because additional information which assists in the clinical management could sometimes be provided. 3D sonography improves counting of gestational sacs, without any risk of undercounting even for less experienced ultrasonographers. The rate of determinations of appropriate chorionicity by 3D is almost 100% in the second and in the third trimester, as it enables the achievement of »perfectly« oriented picture, which is not always the case with 2D. 3D US improves the visualization of both twins, while the use of volumetric calculations might improve the diagnosis of discordant growth. It also improves the diagnostic capability by offering more diagnostic information in the detection and the evaluation of fetal malformations of the cranium, face, spine, extremities and body surface. 3D and 3D power Doppler permit depiction of curvatures of the umbilical cord and visualization of the number of loops involved in entanglement. The main benefits of 4D sonography include: accurate recognition of an isolated motor activity of a single fetus; distinguishing between spontaneous and stimulated motor activity; and spatial visualization of the inter-twin area. By 4D US, types of movements, isolated movements of each twin or high order multiples, inter-twin contacts and interactions can be easily recognized from early gestation. Studies have shown that twins were at approximately 4-fold increased risk for cerebral palsy compared with singletons, which is important, but not yet solved issue. 4D US is undoubtedly a new powerful imaging tool whose potential in scientific and clinical area should be searched for. In the meantime true clinical value of this new modality should be neither underestimated nor overestimated.
Keywords
multifetal pregnacies 3D/4D ultrasound; chorionicity; amnionicity; fetal behavior
Hrčak ID:
23854
URI
Publication date:
1.9.2006.
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