Three‐dimensional HDlive rendering of fetal perineum in anorectal atresia

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Three-dimensional HDlive rendering of fetal perineum in anorectal atresiaAnorectal atresia (ARA) is a relatively common congenital malformation that is usually diagnosed by perineal inspection after birth 1 .HDlive is a new surface-rendering mode in ultrasound imaging which uses an adjustable light source to increase depth perception 2,3 .We present our experience of HDlive imaging for prenatal perineal inspection in a fetus with ARA.A 32-year-old Japanese woman, gravida 2, para 1, was referred to our institution at 31 + 1 weeks' gestation because she wished to deliver in our hospital.Her pregnancy course was uneventful and first-and second-trimester sonographic examinations performed at another institution were reportedly unremarkable.An initial ultrasound examination of the fetus revealed moderate polyhydramnios, a small stomach, left renal dysplasia, mild lumbar kyphosis and a single umbilical artery.A tangential two-dimensional (2D) ultrasound scan of the fetal perineum revealed the absence of a perianal muscular complex (PAMC; Figure 1a).Three-dimensional (3D) HDlive imaging revealed a normal perineum but no anal dimple (Figure 1b).Thus, ARA was strongly suspected.Fetal echocardiography revealed pulmonary atresia with ventricular septal defect (VSD).Follow-up ultrasound at 33 weeks revealed an esophageal pouch in the neck, suggestive of esophageal atresia.These findings pointed towards a diagnosis of VATER association.A 2110-g female was delivered at 38 + 1 weeks' gestation, with 1-min and 5-min Apgar scores of 7 and 8, respectively.Postnatal perineal inspection revealed ARA with a rectovestibular fistula (Figure 1c).Postnatal radiography

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