AUTHORS:
Prof. M. Iaccarino *
Prof. R. N. Laurini **
Dott. E. Varvarigos *

Dott. G. Cappellino ***
Dott.ssa S. Iaccarino *
Dott.ssa R. Russo ****
Dott. E. Soscia *

* Unità funzionale di
Ostetricia e Ginecologia
Clinica Mediterranea
Napoli - Italy

** Department of
Obstetrics and Gynecology
University Hospital
San Joao Medical School
Porto - Portugal

*** Reparto di ecografia e
senologia della
Osteo&Imaging
Palermo - Italy

**** Anatomia ed Istologia Patologica
A.O. S. Giovanni di Dio e
Ruggi d'Aragona
Salerno - Italy

Pregnancy
at 8th week

Three dimensional ultrasound allows us to see the product of conception, which in this period is called embryo, at as little as two months of pregnancy, when the embryo measures only 15mm! Note how, in this animated sequence, it is possible to see the embryo inside the gestational sac. The head is clearly visible, as are the trunk and the stumps that will become the four limbs. The small sphere nearby is the yolk sac: Its purpose is to nourish the embryo in this initial stage. The embryo is connected to the yolk sac through the small umbilical cord, which is barely visible. The embryo is completely surrounded by the uterus.

Pregnancy at 8th week

Pregnancy
at 10th week

In this period the product of conception is called fetus. Its initial growth is remarkable, the small stumps that were visible two weeks before have now developed into well formed legs and arms; the face, the eyes, nose, mouth and ears are already well defined. Notice the position of the head, slightly bent to one side, and the upper and lower limbs. We can even get a 360° view!

Here we are in the fifth month, and we see the fetus making coordinated automatic movements, which give it a 'human' air. In these images the hand and the thumb, the arm, neck and trunk are clearly visible. Notice how the face is still thin in this period - the baby will have puffier cheeks after the 7th month.

Pregnancy
at 20th week

It is interesting to see the various positions the fetus can take. Through the face we can see the cranium: This is due to the fact that the face and skin are thin, and therefore not too visible on the scan, whereas the underlying bones are more visible.

For this reason the face can have a skeletal aspect in some positions and at this stage of the pregnancy!

In the 5th month it is possible to see the fetus sucking its thumb. Notice how the cheeks are still lean and the facial expressions scarce. In 2 more months the cheeks will look puffier and the face will begin to have very human expressions!

Pregnancy
at 20th week

Pregnancy
at 25th week

We are in the 6th month here and the fetus is better defined on the ultrasound. It is still thin but the cheeks are beginning to get rounder. Notice the tiny lips, nose and eyes. The hands are held in front of the face as if to hide from the ultrasound. Those dark lines on the cranium are the cranial sutures, which will close after the baby’s birth.

At 6 months and half the face is already better defined and the cheeks are beginning to become fuller.

Pregnancy at 28th week

At 7 months and one week the fetus shows fleshy cheeks and lips and an expressive face.

Pregnancy at 32nd week

In some moments the fetus protects itself from the moderate pressure of the ultrasound probe...

Pregnancy
at 32nd week

Pregnancy
at 34th week

... it can change facial expression and position suddenly and unexpectedly...

Pregnancy
at 33rd week

...or even scratch its ear...

Pregnancy
at 32nd week

...and the ear is clearly visible and can be studied...

... it may yawn...

Pregnancy at 34th week

Pregnancy at
36th week

...or it may suck its finger, awaiting to be breastfed.

Obviously it is possible to see if it is a boy...

Pregnancy at 32nd week

Pregnancy at 32nd week

...or a girl!

Pregnancy at 15th week

MOVIE

Live 3d: a new method by which fetal movements and initial behavioural activities can be visualised and evaluated during this period. Fetal activity is still simple and uncoordinated Please wait for download: it takes about 1 minute.

Pregnancy at 32nd week

MOVIE

In this movie better organised movements of arms, mimic of the face and intrauterine behaviour are here appreciated. Please wait for download: it takes about 1 minute and half.

Yawning...

MOVIE Live 3D

This movie shows the fetus crying

MOVIE Live 3D

Hand movements...

MOVIE Live 3D

And at birth, the resemblance is obvious!!!

BUT THAT’S NOT WHAT 3D- AND MP- (MULTIPLANAR) ULTRASOUND IS ALL ABOUT! IT IS ALSO A POWERFUL DIAGNOSTIC INSTRUMENT THAT ALLOWS MORE IN-DEPTH EXAMINATION OF SOME STRUCTURES OF THE FETUS IN THE WOMB.

The three dimensional ultrasound acquires an ultrasonographic volume and not just a simple section. It is as if we converted the real baby into an ultrasonographic baby to be able to examine it with precise sections and compare these to the other two perpendicular sections.

WHAT IS THREE DIMENSIONAL ULTRASOUND?

The three dimensional ultrasound is a new technique that improves the diagnostic potential of ultrasound in various medical fields. This website describes the experience gained by our group in the field of obstetrics and gynaecology, particularly focusing on our studies of the fetal brain, heart, skeleton, and on the advantages of the early diagnosis of fetal malformations, comparing the use of 3D ultrasound with the conventional bidimensional technique.

WHEN WAS 3D ULTRASOUND FIRST INTRODUCED?

The first ultrasound equipment on the market, for volume acquisition and multiplanar examination, was presented in Paris, at the World Congress for Diagnostic Imaging in 1989. Successively in 1991 Combison 530 allows the first 3D rendering of fetal face. Since then, there has been much improvement – the most remarkable one being the introduction of digital equipment, which, compared to the initial analog technology, provide much better images.

WHEN WAS IT INTRODUCED IN ITALY?

In 1995, more or less. Our group, together with another team from Bari, were the first in Italy to use 3D ultrasound to perform research in obstetrics and gynaecology.

ITALIAN 3D ULTRASOUND TEXT

In 1998 our group edited the first Italian text and atlas on Three Dimensional Ultrasound In Obstetrics And Gynaecology, published by CIC (Centro Italiano Congressi), which also publish the Italian Journal of Ultrasound, edited by SIEOG (Italian Society of Ultrasound in Obstetrics and Gynecology). In addition we also organised two workshops on 3D ultrasound in Obstetrics and Gynaecology in 1998 and 1999, the latter one sponsored by SIEOG.

WHICH ARE THE FIELDS OF APPLICATION FOR 3D AND MP ULTRASOUND IN OBSTETRICS AND GYNAECOLOGY?

In obstetrics the technique can be employed to study:
• The fetal brain and its malformations
• The fetal heart and its malformations
• The facial features (lips, dental palate and arc)
• The fetal ears (auricle)
• The spinal column and its malformations
• Limbs, hands and feet.
In gynaecology the technique can be employed to study:
• The uterus, its related malformations and pathologies
• The ovaries and related pathologies.