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Synopsis: We describe the case of Aarskog‐Scott syndrome in a twin pregnancy with the prenatal finding of shortened fetal long bones. [ABSTRACT FROM AUTHOR]

Objective: To study how adenomyosis changes during pregnancy and to possibly correlate these changes to maternal and fetal outcomes. Methods: Retrospective exploratory cohort study including 254 women with a pre‐conceptional/first‐trimester scan to document adenomyosis and known obstetric outcome. If visible, adenomyosis signs were documented in each trimester and postpartum. Mann–Whitney U tests or χ2 tests were used for continuous and categorical variables, respectively. Results: A globular uterus was reported in 79% (n = 52) of women with adenomyosis in the first trimester, in 38% (n = 20) and 2% (n = 1) of women in the second and third trimesters, respectively, and postpartum in 77% (n = 34) of women. Asymmetrical thickening (n = 20, 30%) and cysts (n = 15, 23%) were only visible in 1st trimester. Adenomyosis was associated with miscarriage (odds ratio [OR] 5.9, 95% confidence interval [CI] 2.4–14.9, P < 0.001) also in normal conception only (OR 5.1, 95% CI 1.8–14.2, P = 0.002) or adjusting for maternal age (adjusted OR 5.9, 95% CI 2.3–15.2, P < 0.001). Gestational age at delivery was lower in adenomyosis (P = 0.004); the cesarean section rate was higher than in controls (OR 2.5, 95% CI 1.3–4.8, P = 0.007) also adjusting for age (adjusted OR 2.07, 95% CI 1.06–4.08, P = 0.035). Conclusions: Signs of adenomyosis were visible but progressively disappeared in pregnancy; adenomyosis was associated with an increased risk of early miscarriage. Prospective studies are needed to confirm our results. Synopsis: Sonographic signs of adenomyosis are visible in pregnancy although they progressively disappear; adenomyosis was associated with an increased risk of early miscarriage. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of a quality improvement project with an educational/motivational intervention in northern Italy on the implementation of the trial of labor after cesarean section (CS). Method: A pre‐post study design was used. Every birth center (n = 23) of the Emilia‐Romagna region was included. Gynecologist opinion leaders were first trained about Italian CS recommendations. Barriers to implementation were discussed and shared. Educational/motivational interventions were implemented. Data of multipara with previous CS, with a single, cephalic pregnancy at term, were collected during two periods, before (2012–2014) and after (2017–2019) the intervention (2015–2016). The primary outcome was the rate of vaginal birth after CS (VBAC) and perinatal outcomes. Results: A total of 20 496 women were included. The VBAC rate increased from 18.1% to 23.1% after intervention (P < 0.001). The likelihood of VBAC—adjusted for age 40 years or older, Caucasian, body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) at least 30, previous vaginal delivery, and labor induction—was increased by the intervention by 42% (odds ratio 1.42, 95% confidence interval 1.31–1.54). Neonatal well‐being was improved by intervention; neonates requiring resuscitation decreased from 2.1% to 1.6% (P = 0.001). Conclusion: Educating and motivating gynecologists toward the trial of labor after CS is worth pursuing. Health quality improvement is demonstrated by increased VBAC even improving neonatal well‐being. Synopsis: Educating gynecologists toward trial of labor after cesarean section is an intervention that leads to increasing vaginal birth after cesarean section, even improving neonatal well‐being. [ABSTRACT FROM AUTHOR]