Christian Bamberg

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.

Three-Dimensional Multi-Slice View New Prospects for Evaluation of Congenital Anomalies in the Fetus

Objectives. The purpose of this study was to describe the use and potential of Multi‐Slice View 3‐dimensional (3D) ultrasonographic software (Medison Co, Ltd, Seoul, Korea) in showing fetal congenital anomalies. Methods. Fetuses with congenital anomalies diagnosed by means of 2‐dimensional ultrasonography were prospectively included in the study. Good‐quality 3D volumes of the region of interest were obtained in each case. Subsequently, these volumes were reviewed with use of 3D eXtended Imaging with Multi‐Slice View and SonoMR (Medison Co, Ltd). Image processing was performed through the use of off‐line software (Medison XI Viewer, version 1.0.0.218). Results. A total of 6 fetuses (median gestational age, 27 weeks; range, 16–35 weeks) with the following anomalies were examined: dacryocystocele, esophageal atresia, right‐sided aortic arch, hydrometrocolpos, horseshoe kidney, and hemivertebra. Images of diagnostic quality were obtained from all patients. According to the respective underlying anomalies and the positions of the fetuses, images were obtained from the initial axial plane in 2 cases (esophageal atresia and right‐sided aortic arch) and from reconstructed planes in the remaining 4 cases (dacryocystocele, hydrometrocolpos, horseshoe kidney, and hemivertebra). Conclusions. Three‐dimensional Multi‐Slice View can deliver informative images of the region of interest regardless of fetal position. It may be particularly helpful for evaluation of difficult anomalies in the fetus.

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.

Pregnancy on Intensified Hemodialysis: Fetal Surveillance and Perinatal Outcome

Objectives: To evaluate the effect of intensive fetal surveillance via Doppler ultrasound and fetal non-stress test on the perinatal outcome of pregnant women undergoing an intensified hemofiltration scheme. Methods: Five consecutive pregnancies of women undergoing intensified hemodialysis were analyzed due to the following parameters: maternal background, hemodialysis schedule during pregnancy, blood pressure, occurrence of fetal complications, occurrence of obstetric complications, gestational week at delivery, mode of delivery, and newborn outcome and follow-up. Results: All pregnancies resulted in a live birth, mean gestational age was 32 weeks. Intrauterine growth restriction occurred in 4 fetuses, pathological umbilical artery flow velocity waveforms in 2. The mean birth weight was 1,764 g (range 1,274–2,465 g). Cesarean section was performed in 3 patients because of fetal distress. None of the patients developed severe complications like pre-eclampsia. Conclusions: Although intensified dialysis enables the maintenance of stable uteroplacental and fetal perfusion, intensive fetal monitoring is mandatory to reduce perinatal morbidity and mortality in pregnant women on maintenance dialysis.

Human birth observed in real-time open magnetic resonance imaging

OBJECTIVE Knowledge about the mechanism of labor is based on assumptions and radiographic studies performed decades ago. The goal of this study was to describe the relationship between the fetus and the pelvis as the fetus travels through the birth canal, using an open magnetic resonance imaging (MRI) scanner. STUDY DESIGN The design of the study used a real-time MRI series during delivery of the fetal head. RESULTS Delivery occurred by progressive head extension. However, extension was a very late movement that was observed when the occiput was in close contact with the inferior margin of the symphysis pubis, occurring simultaneously with gliding downward of the fetal head. CONCLUSION This observational study shows, for the first time, that birth can be analyzed with real-time MRI. MRI technology allows assessment of maternal and fetal anatomy during labor and delivery.

Three-dimensional ultrasonographic reslicing of the fetal brain to assist prenatal diagnosis of central nervous system anomalies

Objectives. The purpose of this study was to evaluate the potential of 3‐dimensional ultrasonographic planar and nonplanar reslicing techniques. Methods. Fetuses with severe brain anomalies diagnosed by means of 2‐dimensional ultrasonography were prospectively included in the study. Good‐quality 3‐dimensional volumes of the fetal head were obtained in each case. Subsequently, these volumes were reviewed with use of 3‐dimensional extended imaging with Oblique View and DynamicMR (Medison Co, Ltd, Seoul, Korea). Results. Eight fetuses (mean gestational age, 23 weeks; range, 20–30 weeks) with the following central nervous system anomalies were examined: semilobar holoprosencephaly, absent cavum septum pellucidum, porencephaly in twin‐to‐twin transfusion syndrome, partial agenesis of the corpus callosum, Dandy‐Walker variant, open‐lip schizencephaly, aneurysm of the vein of Galen, and dilated cavum vergae. Conclusions. Planar and nonplanar reslicing of the volumes delivered informative images in any reconstructed plane. One important prerequisite, however, was the absence of acoustic shadowing during data acquisition.

Correlation of midtrimester amniotic fluid cytokine concentrations with adverse pregnancy outcome in terms of spontaneous abortion, preterm birth, and preeclampsia

Objective: To assess midtrimester amniotic fluid concentrations of three major proinflammatory cytokines (IL-6, IL-8, and TNF-α) in asymptomatic pregnancies with adverse outcomes. Methods: A prospective follow up study at the Charité University Hospital, Berlin, Germany of women with uncomplicated singleton pregnancies at second trimester and amniocentesis. Concentrations of IL-6, IL-8, and TNF-α were measured by enzyme-linked immunosorbent assay following amniotic fluid assessment by midtrimester amniocentesis performed from gestation days 15 weeks 0 days up to 20 weeks 6 days. Values from normal pregnancies were compared to those from pregnancies having adverse outcomes of spontaneous abortion, preterm delivery, preeclampsia, or eclampsia. Main outcome measure IL-6, IL-8 and TNF-α in relation to adverse pregnancy outcome. Results: A total of 298 consecutive patients were evaluated. Median patient age was 35 years (range 19–43). Controls consisted of 273 women who delivered without further complications after 37 weeks gestation. The range values of IL-6, IL-8, and TNF-α in the control group were 4.9–2620 pg/mL, 36.2–5843 pg/mL, and 8.0–28.2 pg/mL, respectively. Patients with adverse pregnancy outcome (n = 25) were classified into three groups: spontaneous abortion group (n = 4), preterm delivery group (n = 17), and preeclampsia/eclampsia group (n = 4). There were no significant differences in IL-6, IL-8, and TNF-α between controls and study groups, regardless of the type of complication (p > 0.05). Conclusion: Midtrimester amniotic fluid concentrations of the proinflammatory cytokines IL-6, IL-8, and TNF-α are not predictive of adverse pregnancy outcome in terms of spontaneous abortion, preterm delivery or preeclampsia/eclampsia in our study population.

Impaired somatic growth and delayed lung development in infants with congenital diaphragmatic hernia—evidence from a 10-year, single center prospective follow-up study

PURPOSE In infants with congenital diaphragmatic hernia (CDH), somatic growth and pulmonary development are key issues beyond the time of intensive care treatment. The aim of the study was to investigate the somatic growth and pulmonary function after discharge and to compare CDH patients with a group of matched controls. METHODS Anthropometric measurements and lung function tests were performed in 26 infants after surgical repair of CDH and 26 non-CDH intensive care patients, matched for gestational age and birth weight. Spontaneously breathing infants were tested at a mean of 44 weeks postconceptional age (range, 36-58 weeks). Body weight, body length, respiratory rate (RR), tidal volume (V(T)), functional residual capacity by body plethysmography (FRC(pleth)), respiratory compliance (C(rs)), and respiratory resistance (R(rs)) were measured. RESULTS The mean (SD) weight gain per week in the CDH infants was significantly lower compared to non-CDH infants (89 [39] g vs 141 [49] g; P = .002). The breathing pattern between both groups differed considerably. In CDH infants, V(T) was significantly lower (P < .001) and RR significantly higher (P = .005). The respiratory compliance was also significantly (P < .001) reduced, whereas R(rs) did not differ significantly. No statistically significant differences were seen in FRC(pleth) related to the body weight between CDH and non-CDH infants (20.3 [4.4] mL/kg vs 21.5 [4.9] mL/kg). CONCLUSION Despite apparently well-inflated lungs after surgery, evidence of early and significantly reduced weight gain and impaired lung function in CHD patients should prompt careful dietary monitoring and regular lung function testing.

Use of intrapartum ultrasound in the prediction of complicated operative forceps delivery of fetuses in non-occiput posterior position.

To evaluate the hypothesis that intrapartum ultrasound (ITU) measurements, including the angle of progression (AOP), progression distance (PD) and head direction (HD), can predict complicated forceps delivery in non‐occiput posterior deliveries.

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.