Anna Maria Dückelmann

Transperineal ultrasound imaging in prolonged second stage of labor with occipitoanterior presenting fetuses: how well does the ‘angle of progression’ predict the mode of delivery?

To compare the angle of progression on transperineal ultrasound imaging between different modes of delivery in prolonged second stage of labor with occipitoanterior fetal position.

Measurement of fetal head descent using the 'angle of progression' on transperineal ultrasound imaging is reliable regardless of fetal head station or ultrasound expertise.

To assess whether ultrasound experience or fetal head station affects the reliability of measurement of fetal head descent using the angle of progression on intrapartum ultrasound images obtained by a single experienced operator, and to determine reliability of measurements when images were acquired by different operators with variable ultrasound experience.

Relationship between fetal head station established using an open magnetic resonance imaging scanner and the angle of progression determined by transperineal ultrasound

We investigated the correlation between the angle of progression measured by transperineal ultrasound and fetal head station measured by open magnetic resonance imaging (MRI), the gold standard, in pregnant women at full term.

Three‐dimensional ultrasound in evaluating the fetus

In recent years three‐dimensional (3D) ultrasound has made a place in clinical practice and has become a major field of research in obstetrics. In this article we will review the diagnostic performance of the most widely used 3D ultrasound applications in the assessment of fetal anomalies, explain the technique to gain correct 3D images and offer some practical advice for their efficient use. Examples are given to demonstrate the applicability and vividness of 3D in daily routine. Copyright

Impact of intrapartal ultrasound to assess fetal head position and station on the type of obstetrical interventions at full cervical dilatation

Objectives: Recent ultrasound studies have shown that it is feasible to objectively and reproducibly assess fetal head position and station within the pelvis. We sought to evaluate the impact of this new approach on decision making by physicians in a cohort of women with a prolonged second stage of labor. Methods: This was a retrospective cohort study that included all women with fetuses in cephalic presentation, who were diagnosed with a prolonged second stage of labor, and who delivered in a 1-year period. We compared a group of women (n = 121) with a prolonged second stage of labor who underwent intrapartal ultrasound prior to obstetrical intervention (Group A, n = 43) with a group of women for whom the delivery modus was decided upon after clinical digital examination alone (Group B, n = 78). Results: There were no significant differences in maternal and neonatal morbidity between both groups. The rate of second-stage cesarean section was significantly higher (p < 0.50) in Group B without ultrasound compared to Group A with ultrasound prior to operative delivery (20/78 vs. 7/43). Seven patients in Group A delivered spontaneously, but none of the patients in Group B had spontaneous deliveries. Conclusions: Intrapartal ultrasound in patients with a prolonged second stage of labor may change obstetrical practice by reducing the number of second stage cesarean section without increasing maternal and neonatal morbidity.

Doppler in obstetrics: beyond the umbilical artery.

Doppler analysis of the umbilical and uterine arteries has long been performed in perinatal medicine to assess fetal health and maternal risk for preeclampsia. Several other vessels can be interrogated to obtain additional, vital information. Velocimetry in the fetal middle cerebral artery can yield evidence of the presence or absence of anemia and, in cases of delayed growth, of the risk of hypoxic damage. Ductus venosus waveforms are a very good indicator of impeding fetal jeopardy and should be used when umbilical artery waveforms become abnormal. Early pregnancy uterine artery Doppler reflects the status of the placental vasculature and, as such, is an excellent tool for predicting the risk of preeclampsia or intrauterine growth restriction.

Angle of progression measurements of fetal head at term: a systematic comparison between open magnetic resonance imaging and transperineal ultrasound

OBJECTIVE During labor, transperineal sonography is increasingly used to evaluate fetal head descent. The aim of this study was to compare the angle of progression assessed by open magnetic resonance imaging (MRI) vs transperineal ultrasound. STUDY DESIGN A total of 31 pregnant women at term (>37 weeks), who were not in labor, underwent MRI in an open 1.0-T system. A midsagittal plane of the maternal pelvis was stored. Immediately after, without changing the supine position, a transperineal ultrasound was performed. The angle of progression was measured offline by transperineal ultrasound and MRI. RESULTS The angles of progression measured by transperineal ultrasound (mean, 79.05 degrees; SD 11.44) and MRI (mean, 80.48 degrees; SD 11.06) correlated significantly (P < .001). The intraclass correlation coefficient between the 2 methods was 0.89 (95% confidence interval, 0.78-0.94). CONCLUSION The angle of progression measurements obtained by transperineal ultrasound and open MRI showed very good agreement.

Fetal Progression in Birth Canal: State of the Art

Spontaneous vaginal delivery is associated with the lowest mortality and morbidity for both mother and child compared to operative delivery. Therefore, it is the preferred outcome for most pregnancies [1–5]. Most women wish to have a spontaneous delivery without obstetric intervention [6]. Obstetricians and midwifes should support pregnant woman in achieving this goal. However, despite intensive effort, some women fail to progress in the second stage of labor, and thus, they require an operative delivery.

Fehlbildungsdiagnostik und Ultraschalluntersuchung im 2. Trimenon

Die Mehrzahl der fetalen Fehlbildungen wird im 2. Trimenon diagnostiziert. Gemas den Mutterschafts-Richtlinien kann entweder eine „Basis-Ultraschalluntersuchung“ (Biometrie, Ausschluss einer tiefsitzenden Plazenta) erfolgen oder die „erweiterte Basis-Ultraschalluntersuchung“ (zusatzlich die fetalen Organe entsprechend den Kriterien der Deutschen Gesellschaft fur Ultraschall in der Medizin, DEGUM). Bei der Untersuchung des zentralen Nervensystems werden u. a. Ventrikulomegalie, Dandy-Walker-Komplex und Corpus-callosum-Dysgenesie ausgeschlossen. Das Herz wird hinsichtlich des Vorhandenseins eines hypoplastischen Linksherzsyndroms, eines atrioventrikularen Septumdefekts, der Transposition der grosen Gefase und von Arrhythmien beurteilt. Weiters werden Lippen-Kiefer-Gaumen-Bereich (Spaltbildung), Extremitaten, Skelettsystem inkl. Wirbelsaule, Bauchwand, Lunge und Zwerchfell begutachtet, und wir gehen auf die Untersuchung von Fruchtwasser, Nabelschnur, Plazenta und mutterlicher Zervix ein.

An atypical manifestation of inguinal endometriosis in the extra pelvic part of the round ligament: a case report

Establishing the diagnostic and surgical management of the inguinal Endometriosis, with further investigation of the biological character. The imaging findings of CT and PET-CT, biopsy, ultrasound, open surgery of the inguinal region with intraoperative cryosection, confirmation and evaluation of tissue infiltration by endometriosis, laparoscopic removal of all endometriotic lesions, reconstruction of the groin. Based on the history of the 29-year-old patient, suffering from a painful growing induration of the inguinal region. Immunohistochemistry performed, in order to analyze the character of the inguinal endometriosis. CT, PET-CT and biopsy did not confirm the diagnosis of endometriosis. Considering, the progressive symptoms of the patient, was performed the surgical intervention. Open surgery of the inguinal region, with a preparation and separation of the groin fibrotic mass lead to the finding of an affected extra-peritoneal portion of the round ligament. Intraoperative cryosection confirmed endometriosis. Simultaneous laparoscopy showed peritoneal endometriosis (rASRM I) and an alteration of the inner round ligament, involving the inner inguinal channel in this process. All endometriotic lesions were removed and the inguinal region reconstructed. The immunohistochemical staining gave evidence of the endometriotic tissue, surrounded by smooth muscle metaplasia. We consider that, reporting this rare case of endometriosis, based on a case report and a literature review, affecting intra and extra peritoneal portion of the round ligament, is an important aid to avoid a wrong diagnosis and method of therapy in future. Our data demonstrated the fully recovery of the patient, after surgical treatment, reporting symptom-free status.