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The Benefits of Early Fetal Heart Screening

What first trimester ultrasound can reveal about tiny hearts

A look at the structures of the fetal heart in the first trimester of a pregnancy can enable early genetic testing, early decision-making about the pregnancy and earlier planning for appropriate management during and after pregnancy, according to Shifa Turan, MD, Associate Professor of Obstetrics, Gynecology and Reproductive Sciences at the University of Maryland School of Medicine and Director of the Fetal Heart Program at the University of Maryland Medical Center.

In this Newsmaker segment, Dr. Turan expands on the benefits of early fetal heart ultrasound screening, and one of Dr. Turan’s patients, Kelly Linderman, shares her experience through two pregnancies.

A prenatal ultrasound uses sound waves to show a picture on a computer screen of the fetus in the uterus. While a full-term pregnancy is 40 weeks, most women get their first ultrasound at 18-20 weeks, during the second trimester of pregnancy, to check heartbeat, muscle tone and overall development.

Dr. Turan says current guidelines in the U.S. do not require assessment of the fetal heart structure in the first trimester, but she says the chambers of the fetal heart are fully formed at eight weeks, and an ultrasound in the first trimester (11-14 weeks) can detect the majority of problems with the heart’s structure present at birth, known as congenital heart defects (CHDs).

CHDs are the most common birth defects, affecting nearly 40,000 infants born in the United States each year. Nearly 75 percent of CHDs occur without identifiable risk factors, either in the mother, family history or the fetus itself. CHDs can range from holes inside the walls of the heart to more severe forms, such as hypoplastic left heart syndrome (HLHS), where the left side of the heart does not form correctly.

Kelly Linderman says the birth of her first child, Stella, now four, was normal, but in 2018, she gave birth to a boy, Jaxson, with HLHS. She learned of the diagnosis in her 20th week. At that point, she came to the University of Maryland Medical Center to seek treatment and met Dr. Turan. This year, another boy, Beau, was born. Ms. Linderman explains how a detailed first trimester fetal heart evaluation made quite a difference for her and her family.

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A More Targeted Approach to Diagnosing Prostate Cancer

Advanced Imaging Helps Doctors Identify Aggressive Tumors that Require Treatment

In a standard biopsy, doctors take 12 random tissue samples from throughout the prostate, guided by ultrasound. A newer, more targeted approach uses magnetic resonance imaging (MRI), fused with real-time ultrasound images, to precisely pinpoint areas of suspected cancer that can be biopsied and analyzed. This method increases the chances of identifying aggressive tumors that require immediate treatment and not overtreating slower-growing cancers that may never prove deadly.

“This has really revolutionized the confidence that we have in a diagnosis of prostate cancer, in understanding the true burden of disease that the patient has,” says Dr. M. Minhaj Siddiqui, Associate Professor of Surgery at the University of Maryland School of Medicine and Director of Urologic Oncology and Robotic Surgery at the University of Maryland Greenebaum Comprehensive Cancer Center. “If we want to take a more conservative approach, one that is less likely to cause complications, we can do it.

Dr. Siddiqui has co-authored several studies about MRI-targeted prostate biopsy as a collaborating member of a National Cancer Institute (NCI) research team. The latest study, published in the New England Journal of Medicine in March, found that using this newer approach, combined with standard biopsy, is significantly more likely to detect the most aggressive prostate cancers than standard biopsy alone.

With increased confidence in the diagnosis, doctors are able “to offer a wider variety of treatments in a more personalized way to treat the tumor in a less aggressive way or a more aggressive way than we otherwise would have done,” Dr. Siddiqui says.

Options include surgery to remove the prostate; focal therapies to treat only the cancer, such as cryoablation (freezing); hormone therapy to thwart cancer growth: and active surveillance to monitor for progression.

More than 200,000 American men are diagnosed with prostate cancer each year. September is National Prostate Cancer Awareness Month.

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Addition of MRI-Targeted Biopsy Leads to more Reliable Diagnosis of Prostate Cancer / Press Release

Safety never blinks: Eye checkups during COVID-19

Ophthalmologist, engineer team up to make eye exams safer

Media Contact: Bill Seiler bseiler@umm.edu

It is not lost on Roni Levin, MD, Assistant Professor of Ophthalmology & Visual Sciences and Pediatrics at the University of Maryland School of Medicine, that an ophthalmologist working in Wuhan was one of the first victims of SARS-CoV-2, the virus that causes COVID-19.

The coronavirus has not stopped the need for eye exams. As a practicing ophthalmologist at the University of Maryland Medical Center, Dr. Levin continues to see patients with eye emergencies, babies in the neonatal intensive care unit at the University of Maryland Children’s Hospital born prematurely and at risk of eye problems, and patients with retinal disease who need monthly injections to prevent blindness.

At the same time, Dr. Levin sees the need to reduce the risk of infection for both patient and doctor during a microscopic eye exam, as they face each other just inches apart.

Dr. Levin turned to a network of friends and colleagues on social media for ideas and one caught her eye. A college friend she had not seen in 20 years said her husband, an engineer at the Johns Hopkins Applied Physics Laboratory, could help. Blake Schreurs had access to the APL’s Maker Center, filled with a number of tools, including a laser cutter, freely available to employees to make what they want on their own time.

The video shows their solution.

Additional Resources for Reporters:

  1. Complete video with CGs
  2. No CG Version
  3. APL media contact
  4. Photos

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