O. Naji

Limitations of current definitions of miscarriage using mean gestational sac diameter and crown–rump length measurements: a multicenter observational study

There is significant variation in cut‐off values for mean gestational sac diameter (MSD) and embryo crown–rump length (CRL) used to define miscarriage, values suggested in the literature ranging from 13 to 25 mm for MSD and from 3 to 8 mm for CRL. We aimed to define the false‐positive rate (FPR) for the diagnosis of miscarriage associated with different CRL and MSD measurements with or without a yolk sac in a large study population of patients attending early pregnancy clinics. We also aimed to define cut‐off values for CRL and MSD that, on the basis of a single measurement, can definitively diagnose a miscarriage and so exclude possible inadvertent termination of pregnancy.

Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review

To review systematically the medical literature reporting on the prevalence of a niche at the site of a Cesarean section (CS) scar using various diagnostic methods, on potential risk factors for the development of a niche and on niche‐related gynecological symptoms in non‐pregnant women.

Standardized approach for imaging and measuring Cesarean section scars using ultrasonography

Incomplete healing of the scar is a recognized sequel of Cesarean section (CS) and may be associated with complications in later pregnancies. These complications can include scar pregnancy, a morbidly adherent placenta, scar dehiscence or rupture. To date there is uncertainty relating to the factors that lead to poor scar healing and how to recognize it. In recent years, there has been an increase in studies using ultrasound that describe scars as deficient, or poorly, incompletely or inadequately healed with few data to associate the morphology of the scar with the functional integrity of the lower segment of the uterus. There have been multiple attempts to describe CS scars using ultrasonography. Different terminology, methods and results have been reported, yet there is still no consensus regarding the prevalence, clinical significance or most appropriate method to describe the appearances of these scars. Developing a test that can predict the likelihood of women having problems associated with a CS scar is becoming increasingly important. On the other hand, understanding whether the ultrasound appearances of the scar can tell us anything about its integrity is not well supported by the research evidence. In this article we present an overview of ultrasound‐based definitions and methods used to describe CS scars. We also present information relating to the performance of alternative techniques used to evaluate CS scars. Having examined the current evidence we suggest a standardized approach to describe CS scars using ultrasound so that future studies can be meaningfully compared. Copyright

Gestational sac and embryonic growth are not useful as criteria to define miscarriage: a multicenter observational study

We studied changes in mean gestational sac diameter (MSD) and embryonic crown–rump length (CRL) in intrauterine pregnancies of uncertain viability (IPUVs). We aimed to establish cut‐off values for MSD and CRL growth that could be definitively associated with either viability or miscarriage, and to establish the relationship between growth in MSD and appearance of embryonic structures in the gestational sac.

Abdominal radical trachelectomy in West London

Please cite this paper as: Saso S, Ghaem‐Maghami S, Chatterjee J, Naji O, Farthing A, Mason P, McIndoe A, Hird V, Ungar L, Del Priore G, Smith J. Abdominal radical trachelectomy in West London. BJOG 2012;119:187–193.

A multicenter prospective external validation of the diagnostic performance of IOTA simple descriptors and rules to characterize ovarian masses

OBJECTIVES To evaluate the diagnostic performance of the IOTA (International Ovarian Tumor Analysis group) (clinically oriented three-step strategy for preoperative characterization of ovarian masses when ultrasonography is performed by examiners with different background training and experience. METHODS A 27-month prospective multicenter cross-sectional study was performed. 36 level II ultrasound examiners contributed in three UK hospitals. Transvaginal ultrasonography was performed using a standardized approach. Step one uses simple descriptors (SD), step two ultrasound simple rules (SR) and step three subjective assessment of ultrasound images (SA) by examiners. The final outcome was findings at surgery and the histological diagnosis of surgically removed masses. RESULTS 1165 women with adnexal masses underwent transvaginal ultrasonography, 301 had surgery. Prevalence of malignancy was 31% (n=92). SD were able to classify 46% of the masses into benign or malignant (step one), with a sensitivity of 93% and specificity of 97%. Applying SD followed by SR to residual unclassified masses by SD enabled 89% of all masses (n=268) to be classified with a sensitivity 95% of and specificity of 95%. SA was then used to evaluate the rest of the masses. Compared to the risk of malignancy index (RMI), the sensitivity and specificity for the three-step (SD+SR+SA) strategy were 93% (95% CI: 86-97%) and 92% (95% CI: 87-95%) vs. 72% (95% CI: 62-80%) and 95% (95% CI: 91-97%) for RMI, respectively. CONCLUSION The IOTA three-step strategy shows good test performance on external validation in the hands of ultrasonography examiners with different background training and experience. This performance is considerably better than the RMI.

Predicting successful vaginal birth after Cesarean section using a model based on Cesarean scar features examined by transvaginal sonography: TVS of Cesarean scar to predict successful vaginal birth

To develop a model to predict the success of a trial of vaginal birth after Cesarean section (VBAC) based on sonographic measurements of Cesarean section (CS) scar features, demographic variables and previous obstetric history.

Changes in Cesarean section scar dimensions during pregnancy: a prospective longitudinal study

To describe changes in Cesarean section (CS) scars longitudinally throughout pregnancy, and to relate initial scar measurements, demographic variables and obstetric variables to subsequent changes in scar features and to final pregnancy outcome.

Visibility and measurement of Cesarean section scars in pregnancy: a reproducibility study

To evaluate the visibility of Cesarean section (CS) scars by transvaginal sonography (TVS) in pregnant women, to apply a standardized approach for measuring CS scars and to test its reproducibility throughout the course of pregnancy.

Does the presence of a Cesarean section scar influence the site of placental implantation and subsequent migration in future pregnancies: a prospective case–control study

To describe placental location in the first trimester of pregnancy and subsequent placental migration in women with and without a history of previous Cesarean delivery.