WHAT IS 3D/4D ULTRASONOGRAPHY?

3D/4D ultrasonography is a modern diagnostic ultrasound technique that allows to obtain three-dimensional image of the examined structures. The technique allows to obtain 3D images of immobile structures such as tumours. In the case of 4D technique, the image is observed in real time, which means that we observe the changes in the examined structure ‘live’. For obvious reasons, it is most relevant in the foetus examination: we can observe the baby's movements, his facial expressions, etc. 3D technique also enables the evaluation of the structure and the capacity of the uterus and the endometrium, ovarian cysts or tumours. Such scanning technology requires high quality ultrasonograph because it needs a computer of massive computing power.

In SOFIMED we perform an ultrasound examination with the use of a professional Voluson 730 Expert device equipped with the high frequency heads, designed from the outset to perform 3D/4D ultrasonography. The Voluson 730 Expert features allow to achieve unparalleled image quality in comparison with other devices. The device is ideal for the foetus diagnostics, including ‘genetic ultrasound’ tests in the first and the second trimester of pregnancy. At the request of the patient, the course of the examination is recorded on a DVD disc. The best images are printed with the dye sublimation printer, which allows to preserve them for a long time. They are also saved on a CD disc. You and your relatives can also watch the entire examination on the additional monitor.

For the purpose of determining the risk of genetic defects, except for using Voluson 730 Expert ultrasonograph, a special program is implemented in SOFIMED which was developed by the Foetal Medicine Foundation and is implemented ONLY by ultrasonographists qualified with FMF certificate to perform such examinations.
SEE THE LIST OF CERTIFIED ULTRASONOGRAPHISTS

What is the foetus genetic ultrasonography?

Such testing is performed in the first trimester (from 11 weeks and 1 day to 13 weeks and day 6 of pregnancy) and in the second trimester, in mid-pregnancy (from 18 weeks to 22 weeks of pregnancy). Such a test is meaningful only when it is performed by a well-trained ultrasonographist with the use of high-class ultrasonograph.
The aims of foetus genetic ultrasonography are:

1. Early detection of congenital defects (heart defects, skeletal, nervous and urinary defects, the defects of gastrointestinal tract and others such as so-called lethal defects which minimise the survival chances of the child after birth). In some cases, the treatment of child's defects can begin in even in the uterus. The other defects may be an indication for termination of pregnancy by cesarean section and early specialist intervention just after the birth (such as some heart defects).

Genetic ultrasonography makes sense only if it is combined with a statistical analysis of the appearance of genetic syndromes in the foetus, with the use of special programs.
SOFIMED as the first in Cracow owns a license for a computer program called Astraia, recommended by the Foetal Medicine Foundation to assess the foetus in the first and second trimesters of pregnancy.
The program allows to calculate the risk of appearance of genetic syndromes (Down's Pateau and Edwards syndromes) in the foetus based on the data from ultrasound foetal examination both in the first and in the second trimester of pregnancy. The program also provides full information about the structure of the foetus, its biometry, flow in the vessels, etc., showing also the norm range of a particular feature for the gestational age. After the examination, the patient receives a comprehensive description of the examination together with the genetic risk assessment of the appearance of genetic syndromes, a set of examination photographs and CD and DVD discs with the test recording. (visit also: www.astraia.com.pl, www.foetalmedicine.com)

2. Determination of the so-called trisomy risk (chromosome defects) which are Down, Pateau and Edwards syndromes. In particular, the most common of them, Down syndrome provides very subtle symptoms in most cases which are known as the markers of genetic defects, such as nuchal translucency (NT), the absence of foetal nasal bone (NB) and many others. The risk of Down syndrome increases with mother’s age. The exclusion of these symptoms significantly reduces the likelihood of chromosomal defects and enables the avoidance of unnecessary fears or invasive
diagnosis of the foetus for many of the mothers, especially after 35 years of age. The occurrence of these markers is not synonymous with a diagnosis of trisomy, but significantly increases its likelihood.

3. We perform the mother’s blood tests that allow further increase of the accuracy of prenatal diagnosis: PAPPA test (pregnancy-associated plasma protein A) and the triple test (the Kettering test). In combination with genetic ultrasonography, the tests give 90% sensitivity in detecting Down syndrome and other trisomies.

4. In addition, during genetic testing, we assess the amniotic fluid, umbilical cord and placenta. We also perform Doppler echocardiography of the brain vessels and the umbilical cord.

Mother and foetus Doppler venous ultrasound

This test assess, in particular, the nature of blood flow through, for example: mother’s uterine arteries, umbilical arteries, middle cerebral arteries and venous cord. The nature of blood flow in the vessels informs us of oxygenation of the foetus, foetus circulatory state and even the risk of Down syndrome.

BREAST ULTRASONOGRAPHY

In this examination, the doctor assesses the construction of the breast: the proportion of adipose tissue to the glandular and connective tissue contents. The doctor also assesses regional lymph nodes and, what is the most important, looks for so called focal lesions and breast tumours. Some of them are mild and do not require treatment (e.g., simple cysts), others are usually an indication for breast biopsy. Breast ultrasound examination helps to assess the size, structure and blood supply of the tumour. Such features allow us to assess the risk of malignant tumour. Visualization of a small tumour by ultrasonography allows for precise removal of tissue for histopathological examination by fine needle aspiration and core needle biopsy. In addition to mammography, breast ultrasound is the most important test in the early detection of breast cancer, especially in women before the age of 40.

TRANSVAGINAL ULTRASONOGRAPHY

Transvaginal ultrasonography is a type of gynaecological examination, now commonly used, in which intravaginal head is used. Owing to the use of intravaginal head, the examined organ is located just a few inches from the head of the ultrasound that allows to produce incomparably better images of the uterus and ovaries, as compared to the examination by the stomach. Furthermore, this examination does not require filling the bladder. The test is completely painless. Transvaginal examination may be performed by a 3D if there is such need.