Objective This study aimed to provide a clinical reference for prenatal diagnosis by summarizing the ultrasound manifestations and classifications of fetal limb-body wall complex (LBWC).Methods We retrospectively reviewed cases of LBWC diagnosed through prenatal ultrasound examination at Peking Union Medical College Hospital and Xuzhou Maternal and Child Health Hospital between 2012 and 2023. The primary prenatal ultrasound imaging features and associated malformations were recorded and classified into two categories based on the presence (type I) or absence (type II) of craniofacial anomalies.Results Among 37 fetuses with LBWC, 4 were classified as type I, 31 were classified as type II, and 2 exhibited features of both type I and type II concurrently. All fetuses had varying degrees of thoracoschisis or gastroschisis with visceral herniation. A total of 35 fetuses had limb abnormalities, and 11 had craniofacial abnormalities. All fetuses showed varying degrees of spinal curvature, and 23 had umbilical cord abnormalities. In addition, 32 fetuses had other abnormalities, including a persistent extraembryonic coelom in 12 fetuses, an amniotic band in 9 fetuses, nuchal translucency thickening in 5 fetuses, nuchal cystic hygroma in 3 fetuses, an invisible bladder in 2 fetuses, and external genital anomalies in 1 fetus. All cases resulted in induced termination.Conclusion Fetal LBWC has characteristic ultrasonographic features and can be diagnosed in the first trimester. An accurate prenatal ultrasound assessment is essential to enable clinicians to offer future parents the necessary information and counseling concerning the prognosis of this type of anomaly.

INTRODUCTION:To evaluate the association between longitudinal changes in Observed-to-Expected Lung-to-Head Ratio (O/E LHR) measured by ultrasound and postnatal survival in fetuses with Congenital Diaphragmatic Hernia (CDH). METHODS:A total of 74 pregnant women carrying fetuses with CDH were retrospectively analyzed. The change in O/E LHR (ΔO/E LHR) was assessed as a continuous variable using univariate and multivariate logistic regression analyses. Hernia lateralization and liver herniation were combined into a single categorical variable to account for their clinical and statistical correlation. Receiver Operating Characteristic (ROC) analysis was performed to evaluate the discriminative ability of ΔO/E LHR for survival. RESULTS:The majority of patients (86% and 74% according to the first and last ultrasound examinations, respectively) in this cohort had mild CDH, with an overall survival rate of 73.0%. ΔO/E LHR differed significantly between survivors and non-survivors (13.32±22.09 vs. -13.93±17.59, p < 0.001). In multivariate analysis, ΔO/E LHR (OR = 1.089, 95% CI 1.024-1.158; p = 0.007), gestational age at diagnosis (OR = 1.462, 95% CI 1.041-2.053; p = 0.029), and the combined variable of hernia lateralization and liver herniation (p = 0.011) were associated with survival. ROC analysis of ΔO/E LHR yielded an AUC of 0.836 (95% CI 0.725-0.948). CONCLUSION:In this single-center cohort of fetuses with predominantly mild CDH, ΔO/E LHR was associated with postnatal survival and showed good discriminative performance. Gestational age at diagnosis and the combined variable of hernia lateralization and liver herniation were also associated with outcomes. However, estimates for individual anatomical subgroups were imprecise because of the limited number of cases and should not be used for individual risk prediction. These findings suggest that longitudinal assessment of O/E LHR may be more informative than a single measurement in this specific population. Further validation in larger cohorts is warranted.

OBJECTIVE:To evaluate the clinical utility of serial foetal echocardiographic surveillance, specifically atrioventricular interval (AVI) monitoring, in managing anti-SSA/Ro-SSB/La-Positive SLE pregnancies. METHODS:SLE pregnancies with positive anti-SSA/Ro-SSB/La antibodies were retrospectively included (n = 50). Pregnancies were stratified into two groups based on whether optimal pre-gestational conditions were met. All pregnancies underwent serial foetal echocardiography, including structural assessment and precise AVI measurement. RESULTS:The overall incidence of foetal cardiac conduction abnormalities was 12% (6/50). The incidence was significantly higher in the suboptimal-conditions group (Group 2, 26% [5/19]) compared with the optimal-conditions group (Group 1, 3% [1/31]) (P = 0.024). Through close monitoring, one foetus with persistent AVI prolongation received dexamethasone and intravenous immunoglobulin, successfully preventing progression to advanced heart block; the other five cases normalized spontaneously upon short-term follow-up, avoiding overtreatment. CONCLUSION:SLE pregnancies with anti-SSA/Ro-SSB/La antibodies and suboptimal gestational conditions constitute a distinct high-risk subgroup. A management strategy through risk-stratified serial foetal AVI monitoring allows for precise treatment identification, significantly improving neonatal outcomes while avoiding unnecessary interventions.

This study aimed to develop a new ultrasonographic dating formula to estimate gestational age (GA) based on fetal crown–rump length (CRL) in a Chinese population, evaluate model accuracy and compare its performance with established dating formulas. A prospective, multicenter study was conducted across mainland China. Participants included healthy, low-risk women with spontaneously conceived singleton pregnancies and a regular menstrual cycle in the preceding year. Ultrasonography was performed between 11 and 14 weeks of gestation, with GA determined based on the last menstrual period. Participants were randomly assigned to a development or validation cohort in a 7:3 ratio. A best-fit regression model was constructed for GA estimation based on CRL in the development cohort. For validation, mean differences between the new estimated GA and menstrual age were calculated and compared with those obtained using five established CRL-based dating formulas in the validation cohort. All participants were followed through to delivery. The study recruited 4,710 women with singleton pregnancies, with 3,297 in the development cohort and 1,413 women in the validation cohort. The mean and standard deviation values of CRL changed linearly with GA during 11–14 weeks. CRL demonstrated a linear relationship with GA between 11 and 14 weeks, yielding the regression equation GA = 59.590085 + 0.458539×CRL (R2 = 0.8042). The mean difference between estimated GA and menstrual age was 0.32 days (95

Objective: Measurement of fetal left ventricular myocardial performance index (MPI) in pulsed-wave Doppler (PWD) ultrasound is important while challenging, which relies on the localization of four peaks of mitral valve (MV) and aortic valve (AV) opening/closure clicks. The objective of this study is to explore a new method for automatic fetal MPI detection in PWD images. Methods: We proposed a fully-automated method for fetal MPI measurement in PWD images based on tubular structure (TS) enhancement and intensity projection waveform peak detection. The four clicks were considered as TSs in PWD images and were significantly enhanced with a multiscale vesselness filter. Horizontal intensity projection (HIP) was performed to the TS-enhanced image to produce a TS intensity waveform, where local peaks were automatically detected as potential click peak locations. To identify the desired click peak locations, the proposed method also incorporated peak detection of main lobes and GS intensity waveforms based on HIP of PWD images. Results: PWD images collected from 32 patients were included, with manually labeled MPI ranging from 0.41 to 0.71. The proposed method had a satisfying agreement with the manual method, with a mean absolute error of 0.06 and a mean absolute percentage error of 11.96 %. The average running time was 0.82 s. Conclusions: The feasibility of the proposed method in automatically measuring fetal MPI on PWD images has been demonstrated. The findings of this study may shed light on the four click enhancement and may provide insight for automatic fetal left ventricular MPI measurement in PWD ultrasound.

ObjectiveTo evaluate the role of prenatal ultrasound and three-dimensional ultrasound in the diagnosis of fetal congenital auricular malformations.MethodsThe ultrasonographic features of 14 fetuses diagnosed with auricular malformations at Peking Union Medical College Hospital between May 2019 and May 2024 were retrospectively reviewed, and pregnancy outcomes were followed up.ResultsThe median gestational age at which congenital auricle deformities were detected by ultrasound was 24 weeks 5 days. Of the 14 cases, 5 had bilateral deformities, 5 had right-sided deformities, and 4 had left-sided deformities. The auricular abnormalities detected included microtia, low set ears, accessory auricles, abnormal ear helix and question mark ear, all of which were confirmed by postnatal follow-up or pathological examination after termination. Ten fetuses underwent three-dimensional ultrasound, which provided additional diagnostic details. Eight fetuses presented with other systemic deformities: three had facial deformities such as micrognathia, nasal bone absence, and facial cleft, while five had additional structure anomalies including diaphragmatic hernia, cardiac anomalies, and polydactyly. Genetic testing was performed in nine cases: one fetus had complete trisomy 18, one had Xp22.31 duplication, and seven had normal results. Six pregnancies were electively terminated, while eight fetuses were carried to term. Among the newborns, four had no significant hearing impairment, four others (three with microtia and one with a question mark ear) had hearing loss and required further reconstructive treatment.ConclusionCongenital auricular deformities exhibit characteristic ultrasound features, and in most cases, prenatal diagnosis and evaluation can be achieved through ultrasound. This provides valuable information to support clinical decision-making and prenatal counseling.

Congenital portosystemic shunt (CPSS) is a rare vascular malformation which results in anomalous communication between the portal venous system and the systemic vein. The objective of this review is to describe the prenatal ultrasonic characteristics and postnatal outcomes of CPSS diagnosed prenatally, along with providing some suggestions for perinatal monitoring. A systematic literature search was conducted in PubMed and Ovid electronic databases in a period from January 2012 to May 2024, using the terms: “congenital portosystemic shunt”, “ductus venosus”, “Abernethy malformation” and “umbilical-portal-systemic venous shunt”. All original studies reporting CPSS patients diagnosed prenatally were included. Studies published in languages other than English or studies that did not report the clinical information of patients were excluded. Two reviewers independently screened articles for inclusion and extracted data. A total of 39 studies which included 525 cases were enrolled in the systematic review. Among the included patients, 49 (9

Objective:The purpose of this study was to assess the quality of 11-14-week fetal ultrasound images and physician scanning performance in a large general hospital to inform future quality improvement initiatives. Methods:A retrospective audit of ultrasound scans of normal fetuses at 11-14 weeks was conducted from November 2021 to March 2023 at a large tertiary general hospital in Beijing, China. Ten anatomical views were analyzed by two experienced assessors. Scan completeness and view completeness rates ≥ 70%, and logbook quality scores ≥ 42 (i.e., ≥ 70% of the maximum possible score), were considered acceptable. Results:The overall scan completeness of 256 logbooks was 77.4%. The scan completeness of 189 logbooks (73.8%) was acceptable. The median image quality score for the 256 logbooks was 37 (interquartile range, 28-46), and 96 logbooks (37.5%) had acceptable image quality, with a score ≥ 42. The scan completeness of 23 sonographers (63.9%) was > 70%. Sonographers with intermediate titles performed a higher average number of fetal ultrasound scans than those with senior titles (148 vs. 115 scans), and their scan completeness and logbook image quality scores were also superior (87% vs. 69% and 43.24 ± 6.38 vs. 31.62 ± 11.28, respectively; both p < 0.05). Conclusion:The majority of sonographers met the expectations of the audit. Sonographers performing more fetal ultrasound scans may have an advantage in terms of scan completeness and image quality.

Objective:This study retrospectively analyzed the prenatal ultrasound features and outcomes of fetal neck masses to improve the understanding of fetal neck masses and provide evidence for prenatal consultation, prognosis assessment, delivery mode selection, and clinical intervention. Methods:From January 2018 to November 2023, 18 patients who underwent routine prenatal ultrasonography in the ultrasound department of Peking Union Medical College Hospital or who were referred to our hospital for the diagnosis of a fetal neck mass were retrospectively identified. Their prenatal ultrasound characteristics and pregnancy outcomes were examined and follow-up was conducted. Results:There were 18 cases of fetal neck masses. The mean gestational age at which the fetal neck mass was first detected was 27 ± 6 weeks (range 17-38 weeks). There were seven (39%) male fetuses, nine (50%) female fetuses, and two (11%) fetuses of undetermined sex. The clinical diagnosis was lymphangioma in 14 cases (78%), hemangioma in two (11%), teratoma in one (6%), and congenital goiter in one (6%). The maximum diameter of the fetal neck mass at the first ultrasound examination was 1.8-8.6 cm, and the median diameter was 4.3 (2.5, 6.5) cm. The median mass volume was 17.0 (3.5, 59.0) cm3 (range 1.0-219.0 cm3). The neck mass was cystic in nine cases, a cystic solid mass with compartmentalization in five cases, and a solid mass with a blood flow signal in four cases. Sixteen fetuses were delivered by elective cesarean section, while two were born via induced labor. The average postnatal follow-up time was 27 months, and the longest follow-up was 6 years. There were 13 cases (72%) with a favorable outcome and five (28%) with an unfavorable outcome. Conclusion:A fetal neck mass is a rare benign lesion. Accurate evaluation of the size and location of the cervical mass by prenatal ultrasound, auxiliary examinations such as magnetic resonance imaging, and assessments of clinical manifestations and related complications are crucial for appropriate prenatal consultation, prognosis assessment, delivery mode selection, and postpartum management. Multidisciplinary treatment is essential for the successful management of fetal cervical masses.

OBJECTIVE:Congenital diaphragmatic hernia (CDH) is a rare abnormality with highly heterogeneous genetic causes. This study investigated chromosomal and monogenic abnormalities in fetal CDH patients and evaluated the efficacy of chromosomal microarray analysis (CMA) and whole-exome sequencing (WES) for genetic diagnosis. The clinical features of the patients were also evaluated. METHODS:We evaluated the genetic and clinical data of 51 prenatally diagnosed fetuses with CDH. CMA was performed for every patient. If CMA did not yield diagnostic results, the samples were subjected to WES. RESULTS:Compared with fetuses with isolated CDH (n = 42), those with non-isolated CDH (n = 9) presented a higher genetic diagnostic rate (22.2% vs. 2.4%). The overall diagnostic yield was 5.9%, comprising 3.9% from chromosomal microarray analysis (CMA) and an additional 2.0% from whole exome sequencing (WES). CMA identified (1) mosaic trisomy 18 in a patient with isolated CDH; and (2) 4q terminal deletion syndrome in a patient with non-isolated CDH. WES identified a novel missense mutation, PLS3 c.1763A > G, associated with X-linked CDH in a patient with non-isolated CDH and a family history of recurrent CDH. CONCLUSION:Genetic testing should be offered for all fetuses with CDH, regardless of whether the cases are isolated or non-isolated. WES should be considered if CMA fails to provide a diagnostic result, particularly in patients with non-isolated CDH and a family history of recurrent CDH.

BACKGROUND:Schwannomas are benign usually encapsulated nerve sheath tumors derived from the Schwann cells, and affecting single or multiple nerves. The tumors commonly arise from the cranial nerves as acoustic neurinomas but they are extremely rare in the pelvis and the retroperitoneal area. Retroperitoneal pelvic schwannomas often present with non-specific symptoms leading to misdiagnosis and prolonged morbidity. CASE PRESENTATION:We report the case of a 59-year-old woman presenting with a feeling of heaviness in the lower abdomen who was found to have a retroperitoneal pelvic schwannoma originating from the right femoral nerve. She had a history of two resections of peripheral schwannomas at four different sites of limbs. After conducting magnetic resonance imaging, this pelvic schwannoma was misdiagnosed as a gynecological malignancy. The tumor was successfully removed by laparoscopic surgery. Pathological analysis of the mass revealed a benign schwannoma of the femoral nerve sheath with demonstrating strong, diffuse positivity for S-100 protein. CONCLUSIONS:Although retroperitoneal pelvic schwannoma is rare, it should be considered in the differential diagnosis of pelvic masses, especially in patients with a history of neurogenic mass or the presence of neurogenic mass elsewhere.

BACKGROUND:To observe and assess the diagnostic value of the venous phase enhancement patterns of contrast-enhanced ultrasounds (CEUS) in patients with solid pancreatic lesions that show iso- to hyperenhancement in the arterial phase of the CEUS.METHODS:Patients who underwent CEUS for pancreatic lesions in the Peking Union Medical College Hospital between April 2017 and August 2019 were identified from the dynamic CEUS imaging database in the hospital. A total of 57 patients with pathologically or clinically diagnosed pancreatic lesions were retrospectively included in this study, and the CEUS images from these patients were evaluated. The enhancement patterns in each phase were analyzed, and each lesion was classified as malignant or benign using a five-point scale of confidence based on morphology, boundary, vascular invasion, blood flow, and enhancement patterns in ultrasound (US) and CEUS images.RESULTS:Rapid washout in the venous phase of CEUS images was detected in 30 malignant lesions and 4 benign lesions with malignant potential. The specificity for determining malignancy was 77.8%. Continuous isoenhancement with normal pancreatic tissues in the venous phase achieved a high specificity of 95.0% for determining benign lesions. Early hyperenhancement in the arterial phase followed by slow washout in the venous phase showed high specificity of 98.1% for determining metastasis. The diagnostic confidence improved after reviewing CEUS scans (area under the receiver operating characteristic curve was 0.737 for baseline US and 0.910 for CEUS; P=0.056).CONCLUSIONS:Enhancement patterns in the venous phase of CEUS images were beneficial in the differential diagnosis of solid pancreatic lesions with iso- to hyperenhancement in the arterial phase on CEUS.

A 25-year-old female presented with a 2-month history of a Blaschko-linear erythema on the forehead. The lesion gradually enlarged to nasal root without any discomfort. No skin inflammation or trauma was observed at the same location. She was in good health and stated no prior medical history. The complete blood count, routine urine test and antinuclear antibody were normal. Dermoscopy manifested scattered follicular plugs, perifollicular whitish halo and irregular dotted vessels presented on the light red background. Reflectance confocal microscopy (RCM) showed liquefaction of basal cells, a few melanophagocytes and lymphocyte infiltration can be seen in the dermis. Histopathology revealed slight atrophy of epidermis, liquefaction of basal cells, a few melanophagocytes in the superficial dermis, lots of lymphocytes infiltration can be seen in the appendages and around the blood vessels in the dermis. A diagnosis of linear cutaneous lupus erythematosus was made. The patient was treated with hydroxychloroquine orally and 0.1% tacrolimus ointment externally, it is still under follow-up.

Background:Ultrasonography of the uterine artery (UtA) in the first and second trimesters of pregnancy can assess uterine-placental blood perfusion and guide early clinical prevention. Establishing normal ranges of the UtA pulsatility index (UtA-PI) at 11-14 weeks of pregnancy is helpful for the early identification of high-risk pregnant women and improving the prognosis. This study aimed to establish a reference range of UtA-PI based on crown-rump length (CRL) for spontaneous and in vitro fertilization (IVF) singleton pregnancy during 11-14 weeks, respectively.Methods:A prospective study was performed at Peking Union Medical College Hospital. Healthy, low-risk women with a singleton pregnancy at 11-14 gestational weeks were consecutively recruited for this study from December 2017 to December 2020. All participants underwent routine prenatal ultrasound examination. The CRL of the fetus and the UtA-PI were measured in both uterine arteries, and average values were calculated. The LMS method was used to fit the percentile (P)5, P10, P25, P50, P75, P90, and P95 curves of the UtA-PI value of spontaneous and IVF singleton pregnancy with CRL changes, respectively.Results:A total of 1,962 pregnant women with normal fetuses were included in this study, including 1,792 pregnancies conceived naturally and 170 IVF fetuses. The UtA-PI reference range in the spontaneous pregnancy group was consistently higher than that in the IVF group during 11-14 weeks, and showed a statistically significant difference in UtA-PI for spontaneous and IVF pregnancies (P<0.001). According to the LMS method, each percentile curve of UtA-PI decreased with the increase of CRL in both the natural pregnancy group and the IVF group. The P95 range of UtA-PI for pregnant women with naturally conceived and IVF pregnancy was 2.74 to 2.11 and 2.50 to 1.94, respectively. The overall change of UtA-PI differentials of the two groups showed a downward trend and decreased slightly with the increase of CRL.Conclusions:This study provided a single-center, large sample of data and constructed a CRL-based reference value of UtA-PI for spontaneous and IVF singleton pregnancy, which provides a reliable basis for early UtA evaluation and early clinical decision-making during 11-14 gestational weeks.

Objective:To establish the normal range of fetal bowel width during middle and late pregnancy to provide a reference for the diagnosis of abnormal intestinal dilatation and intestinal malformations.Methods:Singleton pregnant women who underwent routine middle and late prenatal ultrasound were selected at Peking Union Medical College Hospital from September 2020 to March 2021. Fetal bowel width was measured, and pregnancy outcome was followed up. Based on gestational age, the percentile curves of fetal bowel width (P3, P5, P10, P25, P50, P75, P90, P95, and P97) were fitted by the LMS statistical method.Results:A total of 224 women with singleton pregnancy were enrolled in this study. The curves of the 95th percentile of the maximum width of the fetal bowel ranged from 8.00 mm to 21.76 mm, and the 97th percentile of the maximum width of the fetal intestine was 8.22 mm to 22.97 mm at 25 to 40 weeks.Conclusion:The reference value and growth curve of normal singleton fetal bowel width during middle and late pregnancy have been obtained. The P95 and P97 values providea a basis for the diagnosis of abnormal intestinal dilatation, which is of great significance for clinical applications.

Objective:To evaluate the quality of ultrasonic diagnosis of retroperitoneal schwannomas and its influencing factors to find the measures to improve the diagnosis quality.Methods:From January 2015 to April 2022, patients with retroperitoneal schwannomas who underwent surgery at Peking Union Medical College Hospital were studied. All of the cases were confirmed by pathology. The results of preoperative ultrasound reports were summarized, and the quality of ultrasound diagnosis was evaluated by localization diagnosis and qualitative diagnosis.Results:There were 21 cases of retroperitoneal schwannomas with preoperative ultrasound report, all of them were single, and one case (4.8%) was missed by preoperative ultrasound. The maximal diameter of the 20 schwannomas diagnosed by preoperative ultrasound was (6.7±3.6) cm, of which 16 (80.0%) were located in the abdominal retroperitoneum and 4 (20.0%) were located in the pelvic retroperitoneum; 14 (70.0%) manifested as a heterogeneous solid and cystic mass, and 6 (30.0%) presented as a hypoechoic solid mass. Among the 20 cases, 17 (85.0%) were in accordance with the localization diagnosis and 3 (15.0%) were not; 2 (10.0%) were qualified for qualitative diagnosis and 18 (90.0%) were not.Conclusion:Ultrasound has a high accuracy for the localization diagnosis of retroperitoneal schwannomas. Retroperitoneal schwannomas lack typical sonogram characteristics, and sonographers should be familiar with the anatomy and pay attention to the medical history collection to further improve the accuracy of its qualitative diagnosis.

BackgroundInfantile myofibromatosis (IM) is a rare disorder characterized by the formation of nodules in the skin, muscle, bone, and, more rarely, visceral organs. Very few cases are detected prenatally, and the final diagnosis cannot be made until pathology is completed after birth. Here, we present a case of disseminated form IM (DFIM) with a diagnosis established on prenatal genetic grounds.Case presentationA woman at 23 weeks of gestation was referred for ultrasound evaluation of fetal kidney abnormality. Generalized masses in the skin and muscle of the fetus developed at 28 weeks. Prenatal genetic testing identified the pathogenic heterozygous variant c.1681C > T (p.R561C) of the PDGFRB gene inherited from the asymptomatic father. Intrauterine demise occurred at 31 weeks. Autopsy confirmed DFIM with involvement of the heart and kidney. All cases of prenatally detected IM were reviewed, revealing an association of high mortality with DFIM.ConclusionsPrenatal IM diagnosis is difficult. Initial detection is always based on ultrasound. DFIM has high mortality. The germline p.R561C mutation in PDGFRB may cause fetal demise due to severe visceral involvement of IM. Prenatal genetic testing provides a diagnosis before pathological results are available, leading to better counseling and management of pregnancy with a fetus with IM.

Objective:To explore the changes of obstetric ultrasound workload during the epidemic period of Corona Virus Disease 2019 (COVID-19).Methods:A retrospective analysis was conducted on the obstetrics ultrasound workload at the Department of Ultrasonography of Peking Union Medical College Hospital from February to May 2020 (the epidemic period), which was compared with that from February to May 2019 (the same period in 2019) and from October 2019 to January 2020 (the pre-epidemic period). Chi-square test was used to compare the proportion of workload between different periods and between different stages of pregnancy.Results:During the epidemic period, the total workload of the ultrasound department decreased by 60.1% and 61.3%, respectively, compared with that in the same period in 2019 and that in the pre-epidemic period. The total number of examinations of obstetric ultrasound was 7684, with a year-on-year decrease of 23.0% and a decrease of 19.2% from the pre-epidemic period. The proportion of obstetric ultrasound workload increased sharply, and was positively correlated with the severity of the epidemic. From February to May 2020, the proportion of obstetric ultrasound workload was 35.8%, 15.3%, 9.8%, and 7.4%, respectively. Among them, the workload proportion in February 2020 increased by 5.0 times year-on-year and 5.3 times than the pre-epidemic proportion. There were significant changes in the proportion of prenatal ultrasound examinations in different stages of pregnancy. The proportion in the first trimester decreased by 6.8% year-on-year, and decreased by 5.8% compared with the pre-epidemic proportion. The proportion in the third trimester increased by 5.2% year-on-year, and increased by 3.1% compared with the pre-epidemic proportion. During the epidemic period, the number of obstetric ultrasound referrals was 301, accounting for 3.9% of the total obstetric ultrasound workload, and there was no significant difference compared with that in the same period in 2019 (4.1%; χ2=0.331, P=0.588) and the pre-epidemic period (3.4%; χ2=2.895, P=0.093).Conclusion:During the epidemic period of COVID-19, the total workload of ultrasound department declines sharply, while the proportion of obstetric ultrasound workload increases significantly.

Purpose To investigate the impact of COVID-19 on the treatment of children with congenital diaphragmatic hernia (CDH). Methods We retrospectively collected and compared the data of patients with CDH admitted between January 1, 2020 and December 31, 2021(study group) with the CDH patients admitted before the pandemic between January 1, 2018 and December 31, 2019 (control group). Results During the pandemic, 41 patients with CDH diagnosed prenatally were transferred to our hospital, and 40 underwent surgical repair. The number of patients treated in our hospital increased by 24.2% compared with the 33 patients before the pandemic. During the pandemic, the overall survival rate, postoperative survival rate and recurrence rate were 85.4%, 87.5% and 7.3%, respectively, and there were no significant differences compared with the control group (75.8%, 83.3% and 9.1%, respectively). The average length of hospital stay in patients admitted during the pandemic was longer than that in the control group (31 days vs. 16 days, P < 0.001), and the incidence of nosocomial infection was higher than that in the control group (19.5% vs. 3%, P = 0.037). Conclusions CDH patients confirmed to be SARS-CoV-2 infection-free can receive routine treatment. Our data indicate that the implementation of protective measures during the COVID-19 pandemic, along with appropriate screening and case evaluation, do not have a negative impact on the prognosis of children.

Objective:To compare the characteristics of uterine artery blood flow spectrum between early pregnant women at different altitudes.Methods:A total of 144 pregnant women at different altitudes who received routine prenatal examination at the People's Hospital of Tibet Autonomous Region and Peking Union Medical College Hospital from June 2019 to January 2020 were prospectively included. Uterine artery Doppler spectrum was measured at 11+0~13+6 weeks of pregnancy. Paired t-test was used to compare the spectrum of bilateral uterine arteries. Independent sample t-test was used to compare the parameters of the uterine artery in pregnant women at difference altitudes, and pregnant women of different ethnic groups in high altitudes.Results:There was no significant difference in Doppler parameters between the left and right uterine arteries in the same pregnant woman (P＞0.05). There was no significant difference in uterine artery pulsatility index (PI) between 43 pregnant women at a high altitude and 101 pregnant women at a low altitude (1.892±0.495 and 1.824±0.404, respectively, P＞0.05). In the high altitude area, the uterine artery PI of 28 Tibetan pregnant women (2.016±0.521) was higher than that of 15 Han pregnant women (1.661±0.351), the difference was statistically significant (t=-2.366, P=0.023).Conclusion:There is no significant difference in the spectral characteristics of uterine artery blood flow in pregnant women at different altitudes, but the average PI of bilateral uterine arteries in Tibetan pregnant women at a high altitude is higher. The influencing factors of uterine artery blood flow spectrum characteristics need to be further studied.