How better imaging technology for prenatal diagnoses can improve outcomes

 

We live during an unprecedented time in the history of ob.gyn. practice. Only a relatively short time ago, the only way ob.gyns. could assess the health of the fetus was through the invasive and risky procedures of the amniocentesis and, later, chorionic villus sampling. A woman who might eventually have had a baby with a congenital abnormality would not have known of her fetus’s defect until after birth, when successful intervention might have been extremely difficult to achieve or even too late. At the time, in utero evaluation could be done only by static, low-resolution sonographic images of the fetus. By today’s standards of imaging technology, these once-revolutionary pictures are almost tantamount to cave paintings.

Because of the advances in imaging technology, software, and training of specialists, we now have an array of tools available to truly care for our fetal patients. Because we also can screen earlier and more precisely for certain anomalies, many complications of pregnancy no longer lead to inevitable stillbirth or neonatal death. However, new challenges have arisen. For example, color Doppler has facilitated diagnosis of ventricular septal defects in the fetal heart, but detecting these anomalies is not always possible and is sometimes dependent on the resolution power of the ultrasound machine’s transducer. Prenatal diagnosis of unilateral renal agenesis can be difficult because a sonographer could mistake large fetal adrenals for an absent kidney. Even with the most modern technology, visualization of isolated cleft soft palate is usually impossible. In addition, once a defect has been detected, the ob.gyn.’s task is to work with the patient to determine whether operative intervention is warranted, when surgery (that is, pre- or postnatally) should occur, and if the risks and rewards to both our patients – the mother and her unborn child – remain balanced.

Therefore, while it is imperative that we employ all available technologies and techniques possible to detect and diagnose potential fetal developmental defects, we must also bear in mind that no test is ever infallible. It is our obligation to provide the very best information based on expert and thorough review.

This month we have invited Mary Donofrio, MD, director of the fetal heart program at Children’s National Medical Center, Washington, to discuss how the latest advances in imaging technology have enabled us to screen for and diagnose congenital heart diseases, and improve outcomes for mother and baby.

Dr. Reece, who specializes in maternal-fetal medicine, is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. Dr. Reece said he had no relevant financial disclosures. He is the medical editor of this column. Contact him at [email protected].

 

We live during an unprecedented time in the history of ob.gyn. practice. Only a relatively short time ago, the only way ob.gyns. could assess the health of the fetus was through the invasive and risky procedures of the amniocentesis and, later, chorionic villus sampling. A woman who might eventually have had a baby with a congenital abnormality would not have known of her fetus’s defect until after birth, when successful intervention might have been extremely difficult to achieve or even too late. At the time, in utero evaluation could be done only by static, low-resolution sonographic images of the fetus. By today’s standards of imaging technology, these once-revolutionary pictures are almost tantamount to cave paintings.

Because of the advances in imaging technology, software, and training of specialists, we now have an array of tools available to truly care for our fetal patients. Because we also can screen earlier and more precisely for certain anomalies, many complications of pregnancy no longer lead to inevitable stillbirth or neonatal death. However, new challenges have arisen. For example, color Doppler has facilitated diagnosis of ventricular septal defects in the fetal heart, but detecting these anomalies is not always possible and is sometimes dependent on the resolution power of the ultrasound machine’s transducer. Prenatal diagnosis of unilateral renal agenesis can be difficult because a sonographer could mistake large fetal adrenals for an absent kidney. Even with the most modern technology, visualization of isolated cleft soft palate is usually impossible. In addition, once a defect has been detected, the ob.gyn.’s task is to work with the patient to determine whether operative intervention is warranted, when surgery (that is, pre- or postnatally) should occur, and if the risks and rewards to both our patients – the mother and her unborn child – remain balanced.

Therefore, while it is imperative that we employ all available technologies and techniques possible to detect and diagnose potential fetal developmental defects, we must also bear in mind that no test is ever infallible. It is our obligation to provide the very best information based on expert and thorough review.

This month we have invited Mary Donofrio, MD, director of the fetal heart program at Children’s National Medical Center, Washington, to discuss how the latest advances in imaging technology have enabled us to screen for and diagnose congenital heart diseases, and improve outcomes for mother and baby.

Dr. Reece, who specializes in maternal-fetal medicine, is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. Dr. Reece said he had no relevant financial disclosures. He is the medical editor of this column. Contact him at [email protected].

 

We live during an unprecedented time in the history of ob.gyn. practice. Only a relatively short time ago, the only way ob.gyns. could assess the health of the fetus was through the invasive and risky procedures of the amniocentesis and, later, chorionic villus sampling. A woman who might eventually have had a baby with a congenital abnormality would not have known of her fetus’s defect until after birth, when successful intervention might have been extremely difficult to achieve or even too late. At the time, in utero evaluation could be done only by static, low-resolution sonographic images of the fetus. By today’s standards of imaging technology, these once-revolutionary pictures are almost tantamount to cave paintings.

Because of the advances in imaging technology, software, and training of specialists, we now have an array of tools available to truly care for our fetal patients. Because we also can screen earlier and more precisely for certain anomalies, many complications of pregnancy no longer lead to inevitable stillbirth or neonatal death. However, new challenges have arisen. For example, color Doppler has facilitated diagnosis of ventricular septal defects in the fetal heart, but detecting these anomalies is not always possible and is sometimes dependent on the resolution power of the ultrasound machine’s transducer. Prenatal diagnosis of unilateral renal agenesis can be difficult because a sonographer could mistake large fetal adrenals for an absent kidney. Even with the most modern technology, visualization of isolated cleft soft palate is usually impossible. In addition, once a defect has been detected, the ob.gyn.’s task is to work with the patient to determine whether operative intervention is warranted, when surgery (that is, pre- or postnatally) should occur, and if the risks and rewards to both our patients – the mother and her unborn child – remain balanced.

Therefore, while it is imperative that we employ all available technologies and techniques possible to detect and diagnose potential fetal developmental defects, we must also bear in mind that no test is ever infallible. It is our obligation to provide the very best information based on expert and thorough review.

This month we have invited Mary Donofrio, MD, director of the fetal heart program at Children’s National Medical Center, Washington, to discuss how the latest advances in imaging technology have enabled us to screen for and diagnose congenital heart diseases, and improve outcomes for mother and baby.

Dr. Reece, who specializes in maternal-fetal medicine, is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of the school of medicine. Dr. Reece said he had no relevant financial disclosures. He is the medical editor of this column. Contact him at [email protected].