G. Salsi

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 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.

Normal morphometry of fetal posterior fossa at midtrimester: brainstem–tentorium angle and brainstem–vermis angle

To standardize the evaluation of normal tentorium insertion and normal rotation of the cerebellar vermis over the brainstem, using two novel measurements: the brainstem–tentorium angle (BT angle) and the brainstem–vermis angle (BV angle). We also aimed to test the reproducibility of these measurements.

Reliability of new three-dimensional ultrasound technique for pelvic hiatal area measurement

To assess the reproducibility of a new technique for three‐/four‐dimensional (3D/4D) ultrasound imaging of the pelvic floor: OmniView™ volume contrast imaging (VCI) for measurement of the pelvic hiatal area on maximum contraction and Valsalva maneuver. In addition, we aimed to study the intermethod agreement between the new technique and the 3D/4D render method.

Reliability of a new 3D ultrasound technique for pelvic hiatal area measurement

To assess the reproducibility of a new technique for three‐/four‐dimensional (3D/4D) ultrasound imaging of the pelvic floor: OmniView™ volume contrast imaging (VCI) for measurement of the pelvic hiatal area on maximum contraction and Valsalva maneuver. In addition, we aimed to study the intermethod agreement between the new technique and the 3D/4D render method.

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.

Post-partum evaluation of maternal cardiac function after severe preeclampsia.

Abstract Objective: To evaluate the post-partum maternal cardiac function in patients with history of severe preeclampsia. Methods: A series of women with previous singleton pregnancy complicated by severe preeclampsia underwent transthoracic echocardiography at 6–12 months from delivery. A group of women with previous uncomplicated pregnancy was selected as controls. Results: Sixteen women with history of severe preeclampsia were enrolled in the study group whereas 18 patients were selected as controls. In the study group systolic (p = 0.002) and diastolic blood pressure (p = 0.044) were significantly higher. Significant differences were observed in systolic left ventricular (LV) parameters, such as cardiac output (p = 0.034), LV mass indexed to BSA (p = 0.024) and longitudinal contraction, expressed by tissue Doppler (TD) S1 wave, which resulted relatively impaired in former preeclamptic women (p = 0.049). As regards as diastolic parameters, pulsed Doppler A-wave velocity was increased (p = 0.036). TD E-wave velocity was significantly lower in study group (p < 0.001) and E/E1 ratio (E = peak early diastole transmitral wave velocity/E1 = peak early diastolic velocity at mitral valve annulus at TD) was higher respect to controls (p < 0.001). Conclusions: LV contractility and diastolic function, although within normal reference ranges, show slight but significant impairment among women who experienced a severe preeclampsia. TD seems to be a sensible tool to identify these precocious signs of potential LV dysfunction.

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.

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.