First trimester umbilical cord and vitelline duct measurements using virtual reality
Introduction
First-trimester ultrasound evaluation is predominantly used for the establishment of normal intrauterine fetal development and verification of gestational age (GA). Several biometric measurements are used, crown-rump length (CRL) being the most important.
However, structures such as the umbilical cord and vitelline duct are rarely the subject of first trimester ultrasound evaluation, although their function is of vital importance for embryogenesis. This can be explained by the fact that these structures are difficult to evaluate from two-dimensional (2D) media (such as a regular computer screen) due to their complex shape and morphology.
The Erasmus MC in Rotterdam operates a Barco I-Space, an innovative virtual reality (VR) system. This system allows depth perception and the V-Scope volume rendering application is used to create holograms from three-dimensional (3D) datasets. We have already demonstrated its use in the assignment of Carnegie Stages during fetal life [1], its use in the demonstration of fetal developmental delay [2] and in complex anatomical fetal malformations [3], [4]. Furthermore, it is shown that the length and volume measurement tools of V-Scope are reliable and accurate [5], [6], [7].
Depth perception enables measurement of structures that have not been measured routinely before, mainly due to technical limitations. This enables us to efficiently measure the umbilical cord length (UCL) and vitelline duct length (VDL) in the early fetal life. The umbilical cord and vitelline duct are of vital importance to the developing fetus. Abnormalities in the umbilical cord may affect the fetus adversely, and some are associated with fetal malformations and chromosomal anomalies [8], [9], [10]. Therefore early detection seems clinically useful [11], which has also been described in classical studies about pathology of miscarriages [12], [13]. Knowledge of the development of these structures in the first trimester may eventually also serve as a background for early detection of abnormal fetal development.
The aim of this study is to measure the UCL, VDL and other related structures in relation to GA and the CRL in normal and uncomplicated first trimester pregnancies. The relation between the VDL and yolk sac volume (YSV) is also studied.
Section snippets
Patient selection
Over a time period of seven months a total of 47 female volunteers were included for longitudinal 3D ultrasound evaluation of early pregnancy [1], [14], [15]. The regional medical ethics review board approved this study and written consent was obtained. Two patients conceived with intra-uterine insemination (IUI) and 22 with in vitro fertilization (IVF)/intra-cytoplasmatic sperm injection (ICSI) treatment. The other 23 patients all conceived spontaneously. Ultrasound scans were performed, when
Results
All pregnancies selected for this study resulted in the birth of a healthy child. There were no significant differences in general characteristics (maternal age, GA at birth, mean birth weight, maternal body mass index) between the group with assisted fertility treatment and the group who conceived spontaneously (Table 1).
The GA ranged from 42 to 97 days (median: 70 days). The CRL measurements could be performed in 124 (99.2%) of the cases and ranged from 3.04 to 91.11 mm (median: 32.48 mm).
Table 2
Discussion
The present study is the first to provide an in-vivo longitudinal description of normal fetal growth of the human umbilical cord and vitelline duct, facilitated by a VR system.
The UCL is in most studies measured after miscarriage or birth. In our search for relevant studies concerning ultrasonic UCL measurements during the first trimester of pregnancy we found only one study where the umbilical cord was measured using 2D ultrasound in 53 normal fetus and 15 fetus with an intrauterine demise [18]
Conflict of interest statement
We declare that we have no conflict of interest.
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