Aim of the study was to establish methodological procedures and standards for evaluating cerebral gyri and sulci formation in very preterm infants using three-dimensional neurosonography. 40 preterm infants (16 from singleton and 24 from a multiple pregnancy) born during the period from 25 to 31 week of gestation were investigated (295 ultrasound examinations in total). Three-dimensional neurosonography was performed weekly starting from 1-3 days of newborn life (Voluson i, GE Healthcare, USA). Cerebral structures, timing of appearance, and peculiarities of sulci formation were studied. Cingulate sulcus was visualized at 27 week of postconceptional age, superior frontal sulcus - at 32 week in 27 (67.5%) and at 33 weeks in 39 (97.5%) patients. Fragments of parieto-occipital and calcarine sulci were visualized from the birth. Superior temporal sulcus in most cases was clearly visualized at 31 week of postconceptional age, insular sulci - at 34 weeks, olfactory sulci - at 27 week, orbital sulci - at 32 week in 5 (12.5%) and at 34 week in 39 (97.5%) patients. Statistically significant differences in terms of initial identification of studied infants brain sulci in multiple and singleton pregnancies have not been found.

The review of literature on pathoanatomical, echographic and fetoscopic features of the proximate cord insertions to the placenta in a monochorionic twins is presented. According to the recent data proximate cord insertion is considered when the distance between the cord insertions is less than 4 cm. The outcomes of clinical cases with proximate cord insertion as well as contraindications for fetoscopic laser coagulation of anastomoses are discussed. Two clinical cases of diamniotic and monoamniotic monochorionic pregnancies with proximate cord insertion are presented. Proximate cord insertion is quite a rare variant of cord insertion at twins, and in this paper we demonstrate that it is possible to make the correct diagnosis of proximate cord insertion during the ultrasound scan at different gestational age. In the first case of diamniotic monochorionic twin pregnancy there was the empty lambda sign instead of ultrasound images of the T sign typical for a diamniotic monochorionic pregnancy. In the second case of monoamniotic monochorionic pregnancy the cord entanglement and umbilical cord knots were documented sonographically. In both clinical observations, a favorable outcome was recorded.

Ovarian pregnancy is a rare form of ectopic pregnancy. Two cases of ovarian pregnancy are presented. Both cases were successfully diagnosed by preoperative transvaginal ultrasound. Gray-scale and Doppler signs of ovarian pregnancy in two-dimensional and three-dimensional ultrasound are described. Ultrasound strain elastography results are also presented. Transvaginal ultrasound revealed gestational sac-like ovarian structure with stiffness higher in compare with adjacent tissues. Ovarian resection preserving as much ovarian tissue as possible was performed in both cases. Diagnosis was confirmed histologically. Literature review with a focus on the ovarian pregnancy diagnosis and clinical outcomes is presented.

Case of fetal goiter is presented. At 39 week of gestation because of the labor beginning the patient underwent caesarean section. Diagnosis was established after birth. Ultrasound signs of fetal goiter at 32 weeks 5 days of gestation are described. A solid mass was identified in the anterior aspect of neck. The mass was located symmetrically in relation to the median line. Head hyperextension due to the large size of the mass and polyhydramnios associated with the esophagus compression were also marked. Brief literature review is presented. In the world practice, for prenatal thyroid function assessment cordocentesis for fetal serum sampling with determination of thyroid hormones is recommended. For fetal therapy of hypothyroidism intra-amniotic injections of thyroxine is used. As a result of treatment fetal thyroid function normalizes, fetal thyroid size decreases, fetal head flexion improves, which contributes to the ability to natural childbirth. In our case, fetus treatment was not spending due to the lack of a clear understanding about the nature of identified mass.

240 patients who underwent a routine hip or knee replacement surgery were investigated. 63.3% of patients among them were more than 65 years old. 72.5% of patients had a history of cardiovascular disease. Transthoracic echocardiography was performed according to standard protocol using tissue Doppler imaging and speckle tracking. Follow up period for cardiac complications assessment was 30 days after the intervention. Cardiac complications were revealed in 50 (20.8%) patients: major cardiovascular complications in 12 (5.0%) patients, minor - in 38 (15.8%). Major cardiovascular complications included: 3 (1.3%) cases of cardiovascular death, 6 (2.5%) cases of non-fatal myocardial infarction, and 3 (1.3%) cases of non-fatal stroke. Global longitudinal strain <17% was significant risk factor for major cardiovascular complications (sensitivity - 91%, specificity - 80%, AUC - 0.887). Speckle tracking transthoracic echocardiography allowed revealing patients with high perioperative cardiovascular risk in noncardiac surgery (hip or knee replacement elective surgery).

There are many articles about prenatal diagnosis of various fetal abnormalities in the Russian medical literature. However, there are no articles or clinical recommendation on breaking bad news to the family with fetal abnormalities or intrauterine demise diagnosed on ultrasound scan. There are no practical trainings on breaking bad news to the patient in the programs of high medical school or postgraduate medical education. The aim of this article is to analyze the clinical recommendations existing in the international practice and to summarize the author’s personal experience of work in Russia and UK.