E. Maroni

Fetal head–symphysis distance: a simple and reliable ultrasound index of fetal head station in labor

To assess the reproducibility of measurement of a new sonographic index of fetal head station in labor, the fetal head–symphysis distance (HSD), using three‐dimensional ultrasound, and its correlation with digital assessment of fetal head descent and with the angle of progression (AoP).

Intrapartum transperineal ultrasound assessment of fetal head progression in active second stage of labor and mode of delivery

To compare longitudinal changes in angle of progression (AoP) and midline angle (MLA) during the active second stage of labor according to the mode of delivery.

The pregnancy outcome in women with incidental diagnosis of septate uterus at first trimester scan

BACKGROUND Septate uterus seems to be strongly associated with an adverse pregnancy outcome. However, the possible relationship between septate uterus and miscarriage has only been retrospectively ascertained. The aim of our study was to describe the reproductive outcome in women with incidental diagnosis of malformed uterus at first trimester scan. METHODS Women at their first pregnancy attending our centre for a routine viability scan with an incidental suspicion of uterine anomaly at standard sonography were submitted to transvaginal volume ultrasound. All the cases with a 3D diagnosis of septate uterus were prospectively recruited and followed up. RESULTS Overall 24 patients with a single intrauterine pregnancy were included at a median gestational age of 8.2 weeks. The cumulative pregnancy progression rate, as quoted by Kaplan-Meier algorithm, was 33.3% due to the occurrence of early (≤ 13 weeks) or late miscarriages (14-22 weeks) in 13 and 3 cases, respectively. CONCLUSION The pregnancy outcome is poor if a septate uterus is incidentally diagnosed in the early stage of a viable intrauterine pregnancy.

Maternal cardiac function in normal twin pregnancy: a longitudinal study

To investigate maternal cardiac function in a cohort of uncomplicated twin gestations assessed longitudinally.

Ultrasound in labor: a caregiver's perspective.

In the last decade, the use of ultrasound in labor has been the subject of much research. Suggested applications include confirmation of fetal viability, identification of fetal presentation and assessment of fetal occiput position and head descent. Nevertheless, it is not clear whether this has changed the practice of caregivers outside the research context; and if it has, it is not clear how. In order to assess this, we performed a survey in April 2012 among participants on courses on prenatal medicine and obstetric ultrasound at the Department of Obstetrics and Gynecology of the Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. Participants whose duties included management of labor were invited to answer an online questionnaire. In total, 264 attending physicians completed the questionnaire. The most relevant results are displayed in Table 1. According to our survey, the most popular application of ultrasound in labor was for assessment of fetal occiput position (Table 1). This finding is not surprising given that transabdominal sonographic identification of fetal occiput position is easy to achieve through visualization of anatomical landmarks, such as fetal orbits and the spine, as well as requiring minimal time1–3. Furthermore, a number of studies have demonstrated the superiority of ultrasound over digital examination for this aim, and are consistent and unequivocal in their support of its use as the gold standard for this clinically important variable1–3. Sonographic assessment of fetal head position can offer extremely valuable information in certain clinical situations, for instance before instrumental delivery, whereas it seems to be a poor predictor of mode of delivery3,4. On the other hand, ultrasound was less widely used among survey participants for the assessment of fetal head station and progression (Table 1). We suggest three main obstacles to the application of sonography for this purpose. The first is accessibility to ultrasound equipment; less than half of the participants had an ultrasound

Intrapartum three‐dimensional ultrasonographic imaging of face presentations: report of two cases

The term ‘right aortic arch’ (RAA) refers to a congenital abnormal position of the aortic arch, that is, to the right of the trachea, with or without an abnormal branching pattern, and is one of the least frequently prenatally diagnosed cardiac abnormalities1–3. The main clue for the detection of RAA in large population studies and small case series has been absence of the normal ‘V’shaped confluence of the ductal and aortic arches (both to the left of the trachea) in the axial three vessels and trachea (3VT) view1–7, as a RAA and left ductus form an abnormal ‘U’-shape. Reviewing papers that have evaluated the associated conditions and outcomes of the different types of RAA, its occurrence with a right ductus arteriosus (RDA) has been reported with severe cardiac anomalies (tetralogy of Fallot, pulmonary atresia with ventricular septal defect, common arterial trunk)3,7,8 and high rates of 22q11 deletions7,9,10. We describe here a case of RAA with a RDA in which the heart was normal. This was easily recognizable in the 3VT view from the first trimester onwards, independent of the angle of insonation. Sonographic evaluations and image acquisitions were performed transabdominally using a Voluson 730 ultrasound machine (GE Medical Systems, Zipf, Austria). A 31-yearold low-risk pregnant woman, gravida 1 para 0, attended for first-trimester screening at our center. A cardiac transverse sweep showed an anatomically and functionally normal fetal heart, but a right-sided aortic arch and a V-shaped confluence with a patent RDA were observed on the 3VT view (Figure 1). Offline analysis by examiners experienced in fetal echocardiography resulted in similar conclusions. Invasive tests ruled out karyotype and 22q11 abnormalities. During the second and third trimesters normal views of the fetal heart were found on the standard axial approach (situs, area, axis, cardiac chambers, emergence of great vessels) (Figures 2a–c and Videoclip S1) and, in accordance with previous findings, an RAA and patent RDA were identified as a V-shaped

Agreement between two‐ and three‐dimensional transperineal ultrasound methods for assessment of fetal head–symphysis distance in active labor

To assess the intermethod agreement between two‐dimensional (2D) and three‐dimensional (3D) transperineal ultrasound methods in measuring a new index of fetal head station (the fetal head–symphysis distance (HSD)) in active labor, and to assess potential factors that may affect their agreement.

Sonographic pattern of fetal head descent: relationship with duration of active second stage of labor and occiput position at delivery

The objectives of this study were firstly to assess the longitudinal changes of various sonographic parameters of fetal head progression in relation to length of active second stage of labor, and secondly to compare ultrasound findings obtained longitudinally among fetuses with persistent occiput posterior (OP) vs those with persistent occiput anterior (OA) position.

Mode of delivery in the preterm gestation and maternal and neonatal outcome.

Objective. To determine if the mode of delivery in preterm gestations is associated with changes in maternal and neonatal outcome. Methods. A retrospective cohort study that included all singleton deliveries occurring after spontaneous onset of labour between 25 + 0 and 32 + 6 weeks of gestation. Cases of early preterm delivery were identified from clinical records and classified according to the mode of delivery. The following outcomes were derived for each case and compared between caesarean and vaginal deliveries: perinatal death, cranial findings compatible with haemorrhage or white matter disease in the neonate, new-onset of maternal severe anaemia or pyrexia. Results. From 1990 to 2007, 109 cases of spontaneous preterm labour were retrospectively selected, including 50 (45.8%) caesarean sections and 59 (54.2%) vaginal deliveries. Perinatal death occurred in 10 infants (9.1%), whereas among survivors abnormal cerebral findings were detected in 20, including 6 cases with haemorrhage, 12 with white matter findings and 2 with both. At multiple logistic regression, a birthweight lower than 1100 g was the only predictor of all adverse outcomes, whereas male sex increased the risk of white matter findings. Caesarean section compared to vaginal delivery conferred a higher risk of maternal complications (23/50 or 46% vs. 6/59 or 10.2%; OR: 11.9, CI 95%: 4.2–333; p < 0.0005). Conclusions. In severely premature infants born after spontaneous onset of labour, the risk of adverse perinatal outcome does not seem to depend upon the mode of delivery, whereas the risk of maternal complications is significantly increased after Caesarean section.

Ultrasound in labor: is it time for a more simplified approach?

The use of transperineal intrapartum ultrasound assessment has been introduced in recent years to complement traditional digital evaluation, with the aim of providing an objective evaluation of fetal head descent1−5. Despite an increasing number of studies on the subject, the application of this method in everyday clinical practice remains difficult, probably because of the technical difficulty in obtaining most of the sonographic parameters that have been suggested thus far6,7. However, Eggebø et al. have proposed a measurement that is simply obtained, i.e. the distance between the fetal skull and the perineum on transperineal ultrasound (the head–perineum distance (HPD))3 (Figure 1a). More recently we have proposed another simple index of fetal head station inspired by the obstetric literature, i.e. the distance between the lower edge of the maternal symphysis pubis and the fetal skull, along the infrapubic line (the fetal head–symphysis distance (HSD)) (Figure 1b)8. We studied HSD with threedimensional ultrasound which gave us the opportunity to measure both HPD and HSD retrospectively using the volume datasets we had stored (Figure 2). As shown in Figure 3, we found good correlation between the two measurements (Pearson’s r coefficient, 0.826; P < 0.001),