F. Bellussi

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.

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.

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),

A narrow subpubic arch angle is associated with a higher risk of persistent posterior occiput position at birth

To determine whether the subpubic arch angle (SPA) measured by three‐dimensional ultrasound is associated with the fetal occiput position at delivery and the mode of delivery.

Fetal head–symphysis distance and mode of delivery in the second stage of labor

To evaluate whether the fetal head–symphysis distance measured by three‐dimensional transperineal ultrasound during the active second stage predicts operative delivery.

Accuracy of fetal gender determination in the first trimester using three-dimensional ultrasound

To evaluate the accuracy of three‐dimensional (3D) ultrasound in fetal gender assignment in the first trimester.

Narrow subpubic arch angle is associated with higher risk of persistent occiput posterior position at delivery

To determine whether the subpubic arch angle (SPA) measured by three‐dimensional ultrasound is associated with the fetal occiput position at delivery and the mode of delivery.

Subpubic Arch Angle and Mode of Delivery in Low-Risk Nulliparous Women.

Objective: To assess whether subpubic arch angle (SPA) measurement before labor onset can predict labor outcome among low-risk pregnant women. Methods: 3D ultrasound volume was transperineally acquired from a series of nulliparous women with uncomplicated pregnancy at term before the onset of labor. SPA was measured offline using Oblique View Extended Imaging (OVIX) on each volume performed by an investigator not involved in the clinical management. Labor outcome was prospectively investigated in the whole study group. Results: Overall, 145 women were enrolled in the study. Of these, 83 underwent spontaneous vaginal delivery, whereas obstetric intervention was performed in 62 cases (Cesarean section in 40 and vacuum extraction in 22). The SPA appeared to be significantly narrower in the women submitted to obstetric intervention compared with those undergoing spontaneous vaginal delivery (116.8 ± 10.3° vs. 123.7 ± 9.6°, p < 0.01). At multivariate analysis SPA and maternal age were identified as independent predictors of the mode of delivery. On the other hand, the duration of labor did not show a significant relationship with SPA. Conclusions: In low-risk nulliparous women at term gestation, SPA measurement obtained by 3D ultrasound before the onset of labor seems to predict the likelihood of an obstetric intervention but not the duration of labor.

Sonographic diagnosis of lateral asynclitism: a new subtype of fetal head malposition as a main determinant of early labor arrest

We report on the sonographic appearance of a new type of fetal head malposition in labor that has not been previously described systematically. In some circumstances, the fetal lie is characterized by a lateral orientation of the head with respect to the trunk and, on suprapubic ultrasound, a transverse section of the fetal chest together with the facial profile can be seen on the same image. These sonographic findings were documented in five cases of first‐stage labor arrest. This report illustrates how, in these circumstances, ultrasound might be helpful in clarifying the precise cause of obstructed labor. [[ArtCopyrightmsg]]

Significance of uteroplacental Doppler at midtrimester in patients with favourable obstetric history

Objective: To reassess the usefulness of midtrimester uterine Doppler in low-risk multiparous women. Methods: We prospectively recruited low-risk pregnant women at 20–22 weeks attending our clinic. Among those, women with a favourable obstetric history (group A) were distinguished from nulliparous (group B) and of each group we measured uterine artery Doppler (pulsatility index (PI)). We evaluated the accuracy of uterine artery Doppler in the prediction of preeclampsia and small for gestational age (SGA) neonates. Results: Between January 2009 and October 2010, 382 women were included in the study of which 147 in group A and 235 in group B. Overall, 26/382 (6.8%) women presented preeclampsia and SGA occurred in 59/382 (15.4%) cases. In our population, at a 10% false positive rate (FPR) uterine artery Doppler showed a detection rate (DR) of 19.2% for preeclampsia and of 37.3% for SGA, with a higher sensitivity for SGA neonates delivered ≤ vs. >34 weeks (87% vs. 29.4%). The univariable receiver operating characteristics (ROC) curve by uterine artery PI yielded a significant prediction only for SGA in nulliparous women (areas under the curve (AUC) of 0.70; 95% CI 0.60–0.79). Conclusions: Our data confirmed that midtrimester uterine artery Doppler is not an efficient strategy in anticipating the risk of pregnancy complications among low-risk multiparous women.