M. Lipschuetz

Fetal head circumference and length of second stage of labor are risk factors for levator ani muscle injury, diagnosed by 3-dimensional transperineal ultrasound in primiparous women.

OBJECTIVE We evaluated rate of levator ani muscle (LAM) avulsion among primiparae using 3-dimensional transperineal ultrasound to identify possible risk factors for such trauma. STUDY DESIGN We conducted a prospective observational study. Three-dimensional transperineal ultrasound was performed on all subjects. Primiparae were evaluated 24-72 hours after vaginal delivery. In all, 32 nulliparous gravidae (35-41 weeks) and 15 elective cesarean delivery primiparae were evaluated as methodological controls. We compared newborn head circumference (HC), birthweight, second stage duration, maternal age, baby sex, episiotomy, and instrumental delivery. RESULTS LAM trauma was observed in 39 of 210 (18.8%) patients and no controls. Odds ratio for LAM trauma when newborn HC >or= 35.5 cm was 3.343 (95% confidence interval, 1.33-8.42); when second stage duration >or= 110 minutes, odds ratio was 2.27 (95% confidence interval, 1.07-4.81). Logistic regression showed that HC >or= 35.5 and second stage duration >or= 110 minutes increased odds of LAM trauma by a factor of 5.32. CONCLUSION Large HC and prolonged second stage duration are risk factors in LAM trauma. Elective cesarean delivery may prevent LAM trauma.

Added value of three-/four-dimensional ultrasound in offline analysis and diagnosis of congenital heart disease.

Many published studies have shown that application of three‐dimensional (3D) and real‐time 3D (4D) ultrasound modalities can improve certain aspects of fetal echocardiography, but have left open the question of whether these modalities improved the accuracy of prenatal detection of anatomical fetal cardiovascular malformations. We aimed to determine whether 3D/4D ultrasound improved diagnostic ability in cases of congenital heart disease (CHD).

Shunt diameter in agenesis of the ductus venosus with extrahepatic portosystemic shunt impacts on prognosis

Agenesis of the ductus venosus (ADV) is a rare condition in which there are two variants of umbilical vein drainage: intrahepatic shunt or extrahepatic (portosystemic) shunt. It has been posited that the extrahepatic variant carries a poorer prognosis. However, in the absence of associated anomalies there is still a wide variation in outcome. We evaluated the portal system in cases of ADV and aimed to identify parameters that might predict outcome.

Added value of the gray-scale whirlpool sign in the diagnosis of adnexal torsion.

Adnexal torsion is a common gynecologic emergency affecting females of all ages. Expedient diagnosis and treatment are important, particularly in young fertile patients to preserve ovarian viability. Classical parameters for the clinical and sonographic diagnosis of adnexal torsion have very high false‐positive rates, approaching 50%. The sonographic ‘whirlpool’ sign has been shown to be effective for visualizing the torsed part in the prenatal diagnosis of malrotation of the midgut with volvulus, as well as scrotal and ovarian torsion. We aimed to evaluate the efficacy of the whirlpool sign in the diagnosis of torsion, as compared to a protocol based on ‘classic’ sonographic signs of torsion alone.

Three-dimensional transperineal ultrasound findings associated with anal incontinence after intrapartum sphincter tears in primiparous women

Three‐dimensional transperineal sonography (3D‐TPS) performed in women following third‐ or fourth‐degree intrapartum tears repaired with the overlapping technique demonstrates characteristic signs. The aim of this study was to investigate the correlation of these signs with clinical complaints of incontinence.

Fetal heart ventricular mass obtained by STIC acquisition combined with inversion mode and VOCAL

Estimation of fetal heart ventricular mass is important for fetal cardiac evaluation in cases of structural or functional cardiac disorders or extracardiac factors. It may be used with other cardiac parameters to ascertain the severity and prognosis of such disorders, or the nature and timing of intervention. We applied a novel technique combining spatiotemporal image correlation (STIC) with three‐dimensional inversion mode and Virtual Organ Computer‐aided AnaLysis (VOCAL™) for fetal cardiac mass assessment in healthy fetuses in the second and third trimesters.

Fetal tricuspid annular plane systolic excursion (f‐TAPSE): evaluation of fetal right heart systolic function with conventional M‐mode ultrasound and spatiotemporal image correlation (STIC) M‐mode

Fetal tricuspid annular plane systolic excursion (f‐TAPSE) is a modified method to measure the vertical movement of the tricuspid valve annulus by M‐mode ultrasound, in order to assess the fetal right heart. Evaluation of right heart function is well‐recognized in pediatric and adult cardiology, but has not been studied widely in the fetus. We aimed to study f‐TAPSE in the second half of gestation in normal fetuses, to establish reference ranges for this measure, to evaluate the usefulness of spatiotemporal image correlation (STIC) M‐mode in obtaining it, and to compare conventional M‐mode and STIC M‐mode‐based measures of f‐TAPSE.

Underdiagnosed Menorrhagia in Adolescents is Associated with Underdiagnosed Anemia

OBJECTIVE To test the hypothesis that adolescent girls with menorrhagia rarely seek medical attention. STUDY DESIGN A total of 705 adolescent girls attended a lecture on menorrhagia, completed an initial anonymous questionnaire, and were asked to participate in a more comprehensive study comprising a detailed bleeding questionnaire, a pictorial blood loss assessment chart, and blood tests. RESULTS A total of 105 adolescents (15%) reported they had heavy periods on the initial questionnaire. Among the 94 girls who completed the full questionnaire, 34 reported menorrhagia (36%; 95% CI, 26.5%-46.7%). Almost one-third (11 of 34) of these girls did not perceive having menorrhagia according to their response to the initial questionnaire. Menorrhagia was not related to age, years since menarche, or family history of menorrhagia. Among the 62 girls who consented to blood testing, 6 had anemia (9.6%; 95% CI, 3.6%-19.6%), all of whom had bleeding symptoms. CONCLUSION Using standardized questionnaires, we were able to identify adolescents with menorrhagia associated with anemia. Importantly, some of these adolescents were not aware of having menorrhagia and/or anemia. Screening programs for menorrhagia in schools could result in better detection of menorrhagia among adolescents and consequent appropriate referral for medical consultation.

Whirlpool sign in the diagnosis of adnexal torsion with atypical clinical presentation.

. The term denotes the widened intestinalloops spiraling around a central axis composed of themesentery and superior mesenteric arteries, with the supe-rior mesenteric vein twisted around them. This pathologyis characterized by mechanical bowel obstruction withsecondary venous engorgement of the intestinal wall.The sonographic appearance of a tissue mass twistedaround a central axis has also been described in casesof acute scrotum with twisted testicle

Detailed Transabdominal Fetal Anatomic Scanning in the Late First Trimester Versus the Early Second Trimester of Pregnancy

To compare visualization rates for early targeted organ scanning at gestational ages ranging from 11 weeks 3 days to 13 weeks 2 days versus 14 weeks 3 days to 16 weeks 2 days.