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An abstract of the article "Gestational diabetes: a possible protective role in placental insufficiency" by E. Contro and colleagues is presented.

An abstract of the article "Pelvic hiatal area measured by a novel 3D ultrasound technique in women with and without symptoms of pelvic floor dysfunction" by A. Youssef and others is presented.

An abstract of the article "Customised fetal growth charts by quantile regression analysis: a cross-sectional multicentric Italian study" by G. Pedrazzi and others is presented.

Objective: To investigate the association between application of fundal pressure during the second stage of labor (Kristeller maneuver) and the risk of levator ani muscle (LAM) injury.Methods: This was a prospective case-control study of women recruited immediately after their first vaginal delivery in our university hospital between March 2014 and September 2016. Women who underwent the Kristeller maneuver were recruited as cases. For each case, a control (no Kristeller) was recruited matched for body mass index, use of epidural analgesia, duration of second stage of labor and birth weight. All women were invited to undergo four-dimensional (4D) transperineal ultrasound (TPU) 3-6 months postpartum. The main outcome measure was the presence of LAM avulsion on 4D-TPU. TPU results were compared between cases and controls. Multivariate logistic regression analysis was performed to identify independent risk factors for LAM avulsion.Results: During the study period, 134 women in the Kristeller maneuver group and 128 women in the control group underwent TPU assessment. Women who underwent the Kristeller maneuver had a higher prevalence of LAM avulsion than did controls (38/134 (28.4%) vs 18/128 (14.1%); P = 0.005). In addition, women in the Kristeller-maneuver group had a larger hiatal area on maximum Valsalva maneuver and a greater increase in hiatal area from rest to maximum Valsalva. On multivariate logistic regression analysis, use of the Kristeller maneuver was the only independent factor associated with LAM avulsion (odds ratio, 2.5 (95% CI, 1.29-4.51)).Conclusion: The Kristeller maneuver is associated with an increased risk of LAM avulsion when applied in women during their first vaginal delivery. This should be taken into account when deciding to use fundal pressure to accelerate the second stage of labor and when counseling women following childbirth. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: To assess whether sonographic diagnosis of fetal head position before instrumental vaginal delivery can reduce the risk of failed vacuum extraction and improve delivery outcome.Methods: Randomised Italian Sonography for occiput POSition Trial Ante vacuum (R.I.S.POS.T.A.) is a randomized controlled trial of term (37 + 0 to 41 + 6 weeks' gestation) singleton pregnancies with cephalic presentation requiring instrumental delivery by vacuum extraction, which was conducted between April 2014 and June 2017 and involved 13 Italian maternity hospitals. Patients were randomized to assessment of fetal head position before attempted instrumental delivery by either vaginal examination (VE) alone or VE plus transabdominal sonography (TAS). Primary outcome was incidence of emergency Cesarean section due to failed vacuum extraction. A sample size of 653 women per group was planned to compare the primary outcome between the two groups. The sample size estimation was based on the hypothesis that the risk of failed vacuum delivery in the VE group would be 5% and that ultrasound assessment of fetal position prior to vacuum extraction would decrease this risk to 2%.Results: On interim analysis, the trial was stopped for futility. During this period, 222 women were randomized and 221 were included in the final data analysis, of whom 132 (59.7%) were randomized to evaluation of fetal head position by VE only and 89 (40.3%) to assessment by VE plus TAS prior to vacuum extraction. No significant differences were observed between the two groups with respect to incidence of emergency Cesarean section due to failed instrumental delivery and other maternal and fetal outcomes. Women randomized to assessment by VE plus TAS showed higher incidence of non-occiput anterior position of the fetal head at randomization and lower incidence of incorrect diagnosis of occiput position compared with women undergoing assessment by VE alone. A higher rate of episiotomy was noted in the women undergoing both VE and TAS compared with those in the VE-only group.Conclusions: Our prematurely discontinued randomized controlled trial did not demonstrate any benefit in terms of reduced risk of failed instrumental delivery or maternal and fetal morbidity in women undergoing sonographic assessment of fetal head position prior to vacuum extraction. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: 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.Methods: We acquired one static 3D and two dynamic 4D transperineal volumes (one obtained during contraction and one during Valsalva maneuver) from 35 nulliparous asymptomatic healthy volunteers and 35 women with symptoms of pelvic floor dysfunction. Each 3D dataset was analyzed using the OmniView-VCI technique to measure the pelvic hiatal area at rest, on maximum contraction and on maximum Valsalva. Analysis was performed twice by the same operator and once by another operator in order to assess intra- and interobserver reproducibility. All measurements were repeated by one operator using the 3D/4D render method to evaluate the intermethod agreement. Reproducibility and intermethod agreement were studied by means of intraclass correlation coefficients (ICC) and the Bland-Altman method.Results: Measurement of hiatal area using the OmniView-VCI technique showed excellent intraobserver and interobserver reproducibility in both asymptomatic and symptomatic women at rest, on contraction and on Valsalva maneuver. In addition, excellent agreement was demonstrated between OmniView-VCI and 3D/4D render in both groups (ICCs on Valsalva in asymptomatic and symptomatic women were 0.894 and 0.975, respectively). No systematic difference was noted in any of the reliability studies performed.Conclusions: OmniView-VCI is a reliable method for pelvic hiatal area measurement. Both rendering mode and OmniView-VCI can be used interchangeably for assessing pelvic hiatal area. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: To compare the accuracy of transperineal (TP) ultrasound with transabdominal (TA) approach in the sonographic assessment of fetal occiput position during the second stage of labour.Methods: A series of low-risk women at term attending the labour ward of three university hospitals were prospectively recruited for the purpose of this study. During the second stage of labor patients were evaluated first by TP and than by TA ultrasound to determine the fetal position. The occiput position was labelled as DOA (direct occiput anterior), ROA (right occiput anterior), LOA (left occiput anterior), DOP (direct occiput posterior), ROP (right occiput posterior), LOP (left occiput posterior), ROT (right occuput transverse) and LOT (left occiput transverse). The agreement between the two techniques was assessed.Results: Overall 80 patients were recruited in the study group. Ultrasound examination was performed at 21(± 8) minutes from the beginning of the active pushing. The ultrasound findings of the fetal occiput position were recorded. In all cases TA ultrasound confirmed the fetal occiput position as determined at TP approach except in one case of ROA that had been recorded as ROT using TP ultrasound.Conclusions: Ultrasound TP examination is accurate in the diagnosis of fetal occiput position during the second stage of labor. [ABSTRACT FROM AUTHOR]

An abstract of the article "The effect of fundal pressure (Kristeller manoeuvre) on pelvic floor in primiparous women" by A. Youssef and others is presented.

An abstract of the article "Customised fetal growth curves in uncomplicated twin pregnancies" by L. Franchi and others is presented.

An abstract of the article "Reliability of a novel 3D ultrasound technique for pelvic hiatal area in women with symptoms of pelvic floor dysfunction" by G. Pilu and others, is presented.

An abstract of the research paper "A New Simple Technique for 3D Ultrasound Visualization of the Pelvic Floor Muscles ," by A. Youssef and colleagues is presented.

Objective 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. Methods A three-dimensional transperineal ultrasound volume was acquired in a series of nulliparous women at the beginning of the active second stage (T1) and every 20 min thereafter (T2, T3, T4, T5 and T6). Following delivery, all ultrasound volumes were analyzed and AoP and MLA were measured. Results Among 71 women included in the study, 58 underwent spontaneous vaginal delivery (Group A) and 13 underwent operative delivery (Group B) (eight by .vacuum extraction and five by Cesarean section). When compared with Group B, Group A had a wider AoP only at T1 (140.0±20.2° vs 122.94-16.7°; P=O.010) and T2 (149.7±20.7° vs 126.9 ± 17.5°; P = 0.006). MLA was narrower in Group A only at T3 (21.2±11.7° vs 40.8±27.9°; P=0.043), T4 (18.2±15.0° vs 47.4±29.6°; P=0.020) and T5 (18.3±6.0° vs 34.7±4.2°; P=0.034). On stepwise forward multiple logistic regression analysis, both AoP and MLA were independently associated with operative delivery (OR = 0.955 and OR = 1.018, respectively). Conclusion Ultrasonographic assessment of fetal head descent in the second stage of labor may play a role in the prediction of the mode of delivery. [ABSTRACT FROM AUTHOR]

An abstract of the article "Velum interpositi cyst: is it a benign finding?," by E. Contro, P. Volpe, L. Cariello, G. Volpe, G. Salsi, T. Ghi, N. Rizzo and G. Pilu is presented.

The aim of the present study was to assess the feasibility and reproducibility of HPD measurements in the mid-sagittal view. HPD measurements showed excellent intra- and interobserver reproducibility, both at rest and under maximum maternal pushing. Mid-sagittal HPD measurement were significantly smaller in comparison with axial HPD at rest (31.5±7.9 vs. 36.0±8.5, P < 0.001) and under maternal pushing (23.7±8.3 vs. 27.7±8.5, P < 0.001), indicating a systematic difference. [Extracted from the article]

Multivariable logistic regression analysis showed that, in our hands, the sonographic diagnosis of fetal head deflexion was an independent risk factors for Caesarean section regardless the occiput position (OR 5.83, 95% CI 2.47-13.73). According to our data, the sonographic diagnosis of fetal head deflexion performed at the beginning of the second stage is the most consistent predictor of Caesarean section. [Extracted from the article]

OC05.04: Dynamic two-dimensional transperineal ultrasound prior to perineal suturing as a screening tool for anal sphincter injury and fecal incontinence 69 women were enrolled: In 14 cases (20%) it was not possible to identify anal sphincter contraction at dynamic 2D-TPUS (group A), while in 55 women (80%) there was evidence of proper anal sphincter contraction (group B). Anal incontinence at 4-5 months post-partum is more frequent among women who are unable to perform an anal sphincter contraction detectable at ultrasound after delivery. [Extracted from the article]

An abstract of the article "Prospective validation of the use of three-dimensional ultrasound for fetal gender determination in the first trimester," by A. Youssef, F. De Musso, E. Montaguti, L. Cariello, G. Salsi, E.Maroni, G. Pilu, N. Rizzo and T. Ghi is presented.

An abstract of the article "Intrapartum transperineal ultrasound assessment of the fetal head-symphysis pubis distance in the active second stage and the mode of delivery," by A. Youssef, E. Maroni, A. Ragusa, G. Salsi, L. Cariello, E.Montaguti, N. Rizzo, G. Pilu and T. Ghi is presented.

The article presents two case studies related to the face presentation of fetuses through intrapartum three-dimensional (3D) ultrasonographic imaging. It highlights the case of a 36-year-old pregnant woman who was admitted to the hospital due to active labor onset. It notes another case, a 34-year-old pregnant woman who was diagnosed with extremely deflexed fetal head and neck.

An abstract of the article "Does fundal pressure in the second stage (Kristeller manoeuvre) increase the risk of pelvic floor damage? A prospective case-control study," by A. Youssef and colleagues is presented.

An abstract of the article "Risk factors associated to fetal loss after chorionic villus sampling" by T. Ghi and colleagues is presented.

An abstract of the article "The fetal head-symphysis distance correlates well with fetal head perineum distance on three-dimensional intrapartum ultrasound," by A. Youssef, F. Lostritto, E. Maroni, F. Bellussi, L. Cariello, F. De Musso, S. Gabrielli, N. Rizzo, G. Pilu, and T. Ghi is presented.

An abstract of the article "3D ultrasound evaluation of progression angle, progression distance and midline angle changes in nulliparous women according to second stage length," by E. Maroni, F. De Musso, M. Nanni, F. Giorgetta, A. Youssef, et al. is presented.

An abstract of the article "Post-partum evaluation of maternal cardiac function in a cohort of severe pre-eclamptic women," by M. Nanni, E. Montaguti, F. De Musso, T. Arcangeli, E. Maroni, A. Youssef, L. Cariello, G. Salsi, D. Degli Esposti, C. Borghi, N. Rizzo, G. Pilu, and T. Ghi is presented.

An abstract of the article "Neonatal respiratory morbidity in twins versus singletons after elective late-preterm cesarean section," by M. Nanni and colleagues is presented.