Twenty‐one patients with the clinical diagnosis of varicocele were evaluated with static and superficial organ scanners. The sonogram was able to image the dilated scrotal veins in all of these cases. The small, clinically subtle varicocele could be demonstrated only with high‐resolution, dedicated real‐time small‐parts scanners, whereas larger lesions could also be imaged with B‐mode contact equipment. Varicoceles are a well‐documented cause of male infertility amenable to surgical treatment. From this study it is felt that ultrasonography can accurately detect varicoceles. It can be used as a screening procedure so that only those men requiring therapy need undergo more extensive and complicated diagnostic procedures.

Objective To evaluate the accuracy of antenatal diagnosis of congenital heart disease (CHD) using screening methods including a combination of elevated hemoglobin A1c, detailed anatomy ultrasound, and fetal echocardiography. Study Design This is a retrospective cohort study of all pregnancies complicated by pregestational diabetes from January 2012 to December 2016. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each screening regimen. The incremental cost-effectiveness ratio (ICER) was calculated for each regimen with effectiveness defined as additional CHD diagnosed. Results A total of 378 patients met inclusion criteria with an overall prevalence of CHD of 4.0% (n = 15). When compared with a detailed ultrasound, fetal echocardiography had a higher sensitivity (73.3 vs. 40.0%). However, all cases of major CHD were detected by detailed ultrasound (n = 6). Using an elevated early A1c > 7.7% and a detailed ultrasound resulted in a sensitivity and specificity of 60.0 and 99.4%, respectively. The use of selective fetal echocardiography for an A1c > 7.7% or abnormal detailed anatomy ultrasound would result in a 63.3% reduction in cost per each additional minor CHD diagnosed (ICER: $18,290.52 vs. $28,875.67). Conclusion Fetal echocardiography appears to have limited diagnostic value in women with pregestational diabetes. However, these results may not be generalizable outside of a high-volume academic setting.

Hand malformations characterize many congenital syndromes, including mendelian disorders, skeletal dysplasias, and karyotype abnormalities. Although identification of a hand anomaly alters obstetrical management, evaluation of the fetal hands is not included in current ultrasonographic guidelines. We prospectively studied the utility of allotting up to 5 min to examine fetal hands during obstetrical ultrasonography. Both hands were visualized in 87% of patients (188 of 215). Eight hand abnormalities were present at delivery. Six had been identified antenatally, four during the study with ultrasonography. There were no false positives. Four fetuses with hand malformations were aneuploid. Fetal hands should be examined during a comprehensive obstetrical sonographic evaluation, especially when risk factors for aneuploidy are present.

Sonographic measurement of fetal humeral soft tissue thickness (STT) was performed in 93 women with gestational diabetes mellitus during the third trimester. STT measurements revealed accelerated growth in large for gestational age infants at 31 wk gestation. This new measurement proved to be the most accurate predictor of excessive fetal size compared with other standard ultrasound parameters (sensitivity 82%, specificity 95%, positive predictive value 90%). Asymmetrical growth was more evident in infants with large STT measurements in utero. Humeral STT measurement may distinguish large fetuses with truncal obesity from those that are symmetrically large, thereby allowing prediction of risk for birth trauma before delivery.

Inaccuracies in total intmuterine volumes calculated using the prolate el~ lipse equation have been reported. No previous study has examined all the sources of error. In this study, a comprehensive approach was undertaken. Measurements were obtained from scans of the pregnant uterus in the prone position using an automated water-path scanner (Octoson) and in the supine position using standard static B-mode scanners. Several conclusions could be drawn : 1) From the Octoson prone scans, uterine volumes obtained using the prolate ellipse formula were markedly different from the true uterine volumes obtained by the summation of stepped areas. This showed that the prolate ellipse formula was inaccurate. 2) From the static supine scans, many observer inconsistencies were found in uterine volumes obtained from the prolate ellipse formula. This made the prolate ellipse formula unreliable. 3) Previously published graphs calculated from the prolate ellipse equation, comparing fetal age with total intrauterine volume, were found to vary accuracy, presumably as a result of 1 and 2. A more accurate approach is proposed. Using the outer uterine wall as the boundary, the stepped areato-volume values of transverse scans taken at 3-cm intervals were found to closely approximate true volumes, with an average error ofonly 3.5 per cent. Since these measurements encompass the intrauterine contents and the myometrium , it is suggested that the term •'total uterine volume'" be used instead of "total intrauterine volume."