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To estimate the position of the appendix in term pregnancy using magnetic resonance imaging (MRI) technique.Appendiceal distance from the iliac crest and axis rotation were determined in women between 39 and 40 weeks of gestation who were undergoing scheduled repeat cesarean delivery. A single-shot fast spin-echo MRI sequence of the maternal pelvis was performed without gadolinium contrast. A board-certified radiologist interpreted the MRIs and measured the distance from the base of appendix (or cecum) to the iliac crest in centimeters as well as the axis of the appendix using clock position annotation.Seventy-two women had optimal imaging for interpretation. The mean displacement of the appendix above the iliac crest was 45 mm and was significantly higher than previously described in the term pregnant woman (P.001).Despite recent studies supporting the contrary view, the upward displacement of the appendix in term pregnancy is confirmed in this study.II.

OBJECTIVE: To evaluate prospectively whether salineinfusion sonography endometrial sampling will improve diagnosis of benign and malignant endometrial disease compared with blind endometrial biopsy in perimenopausal and postmenopausal women with abnormal uterine bleeding. METHODS: After initial assessments and endometrial biopsies, women aged 40 or older with abnormal uterine bleeding were referred for transvaginal ultrasonography. Patients with abnormal endometrial evaluations were offered sonohysterography and invited to enter the saline-infusion sonography endometrial sampling study. Saline-infusion sonography endometrial sampling was performed at the end of sonohysterography using an endometrial sampling curette at the sight of the endometrial abnormality or at a representative site in the endometrial cavity if the cavity was normal. Histopathologic diagnoses of blind endometrial biopsy and saline-infusion sonography endometrial sampling were compared with final outcomes. Kappa values for the two sampling techniques were calculated for diagnostic accuracy. RESULTS: A total of 88 saline-infusion sonography endometrial samples were obtained; final outcomes were attained in 80 cases. When comparing saline-infusion sonography endometrial sampling with final outcomes, saline-infusion sonography endometrial sampling provided a diagnosis 89% of the time (95% confidence interval [CI] 82–95%) compared with endometrial biopsy at 52% (95% CI 42–62%). Forty-five patients with endometrial biopsies had final outcomes. When comparing endometrial biopsy with final outcomes, endometrial biopsy underestimated the incidence of pathology, especially when focal lesions and malignancy were present. This difference was statistically significant (P

Objective To study whether magnetic resonance imaging (MRI) pelvimetry has the ability to identify those women who require cesarean delivery for labor dystocia. Methods From July 2003 to April 2004, nulliparous women scheduled for a labor induction for prolonged pregnancy (42 weeks) were asked to participate in a pelvimetry study. Those who consented underwent fast-acquisition MRI that included two 90-second acquisitions to evaluate fetal biometry and volumetry and maternal pelvimetry, including novel measurements of pelvic bony and soft tissue volumes as determined by MRI. Information about each patient's pregnancy, labor course, and neonatal outcome was prospectively collected. Pelvimetry results for those women undergoing operative delivery for labor dystocia were compared with those who did not. Single fetal and maternal pelvic measurements, as well as ratios of both, were analyzed. In addition, previously described radiographic pelvimetry techniques and formulas to predict dystocia were used. Results One hundred one women underwent MRI, and 22 of these underwent cesarean delivery for dystocia. No single fetal measurement was statistically associated with dystocia. Several maternal pelvic measures, fetal-to-maternal ratios, and previously reported pelvimetric techniques were significantly associated with dystocia. The ratio of magnetic resonance (MR) fetal head volume to pelvic soft tissue volume had statistical significance (P = .04). Receiver operator characteristic curves were developed for the different measurements, ratios, and formulas studied to assess whether any of the techniques could accurately predict labor dystocia requiring operative delivery. The area under the curve values ranged from 0.6 to 0.8, with the ratio of MR head volume to pelvic soft tissue being 0.7. These values suggest that MRI can identify those women at greatest risk for dystocia, but it cannot with accuracy predict which ones will require a cesarean. Conclusion We found significant associations with MRI pelvimetry and labor dystocia, but MRI was not a significant improvement over previously described pelvimetric techniques. Level of evidence II-3.

Objective: To describe the anatomic and technical difficulties encountered with transvaginal ultrasound imaging of the cervix in a consecutive series of women at risk for preterm delivery. Methods: Three groups of women had cervical ultrasound examinations: those with histories of preterm birth, those with incompetent cervices, and those admitted for preterm labor that did not progress. Standardized ultrasound examinations of the cervix involved measuring the length of the endocervical canal, funneling length, and internal os dilation with and without fundal pressure. Results: Sixty consecutive women had transvaginal ultrasound examinations for assessment of the cervix. Forty-six had histories of preterm birth, five had incompetent cervices, and nine had arrested preterm labor. Six types of problems arose, which can be divided into anatomic or technical considerations, with an overall frequency of 27% (95% confidence interval 16%, 40%). Anatomic pitfalls that hampered identification of the internal os included an undeveloped lower uterine segment (n = 5), a focal myometrial contraction (n = 1), rapid and spontaneous cervical change (n = 1), and an endocervical polyp (n = 1). Technical pitfalls included incorrect interpretation of internal os dilation because of vaginal probe orientation (n = 7) and artificial lengthening of the endocervical canal because of distortion of the cervix by the transducer (n = 1). Conclusion: We caution those who perform cervical length examinations to be wary of falsely reassuring findings due to potential anatomic and technical pitfalls.

Objective To evaluate standardized developmental test performance of infants and children who as fetuses had mild isolated cerebral ventriculomegaly diagnosed by ultrasound. Methods Ultrasound records from 1990 to 1996 were searched for cases of mild isolated ventriculomegaly, and standardized developmental testing of the children was offered to their parents. Each consented child was matched to a normal antepartum subject with respect to sex, race, indication for ultrasound, and gestational age (±2 weeks) at the time of ultrasound. Tests of cognitive, motor, and adaptive behavior were then administered by examiners blinded to the subjects' case or comparison status. Results Twenty-two cases and an equal number of matched comparison subjects completed the testing. The ventriculomegaly and comparison groups were similar with respect to parental age, maternal education, and household income. The ventriculomegaly subjects scored significantly lower than the comparison group on both the Bayley Scales of Infant Development: mental development index (88.95 versus 99.68, P = .017) and psychomotor development index (95.55 versus 103.95, P = .039). Eight of the 22 ventriculomegaly children were classified as developmentally delayed on the mental development index compared with one of 22 children in the comparison group ( P = .021). Adaptive behavior skills, as measured by the Vineland Behavior Scales (99.64 versus 102.68), were not significantly different between the groups ( P = .571). Conclusion Mild isolated ventriculomegaly detected on antepartum sonographic examination is associated with a significant risk for developmental delay. Insofar as these children were judged to be completely normal at birth, our findings represent an important application of antepartum sonography for identifying infants who could be targeted for early childhood intervention.

Objective To measure cerebral blood flow in women with eclampsia and severe preeclampsia using phase-contrast magnetic resonance imaging (MRI). Methods Women with eclampsia and severe preeclampsia were studied and compared with normotensive cohorts. Magnetic resonance imaging studies were performed initially in hypertensive women after seizure treatment or prophylaxis was given. Magnetic resonance imaging flow measurements were made using a phase contrast velocity imaging technique in each middle and posterior cerebral artery. Conventional brain MRI and magnetic resonance angiography of the circle of Willis were performed at the time of flow measurement. Women with preeclampsia and eclampsia served as their own controls and were matched with normotensive cohorts. All of the hypertensive women were studied again 4–5 weeks postpartum. Paired t test analysis and an analysis of variance were performed. Considering a 20% minimum detectable difference in flow, the power was 0.80, 0.92, 0.86, and 0.96 for the left and right middle cerebral arteries and the left and right posterior cerebral arteries, respectively. Results All 28 women enrolled were studied initially within 24 hours of delivery or of their most recent seizure. There were no significant differences in blood flow in either the posterior or middle cerebral arteries in women with eclampsia or severe preeclampsia between the initial studies and those 4–5 weeks postpartum, or compared with their normal counterparts. No findings of vasospasm were seen. T 2 -weighted brain images were markedly abnormal in all eight women with eclampsia, mildly abnormal in two of ten with severe preeclampsia, and normal in all ten controls. Conclusions No flow changes were seen in the posterior or middle cerebral arteries of women with eclampsia and severe preeclampsia despite the presence of remarkable brain lesions in all women with eclampsia. These findings question the role of vasospasm and cerebral hypoperfusion, although a vasodilatory effect of magnesium could not be excluded.

To determine the correlation between transperineal or translabial ultrasound and digital examination of the cervix in the third trimester in women presenting to the obstetrical triage area complaining of uterine contractions and/or rupture of membranes.One hundred women were evaluated initially with an ultrasound unit using a 5-MHz glove-covered curvilinear transducer applied to the perineum in the sagittal plane. Immediately after the ultrasound evaluation, another examiner assessed the cervix digitally, blinded to the sonographic results. Cervical dilatation, length, and station were assessed.Transperineal ultrasound correlated (P.001) with digital cervical examination in the assessment of dilatation (Pearson correlation coefficient 0.87), length (Pearson correlation coefficient 0.80), and corrected station (Pearson correlation coefficient 0.69).There is a statistically significant correlation between the digital cervical examination and the sonographic assessment of cervical dilatation, length, and station by the transperineal approach.

Background: Coarctation of the aorta is rare, affecting one per 2000-3000 women. Abdominal coarctation is more commonly identified in women than in men, but only two cases have been reported in pregnancy. Case: A 26-year-old woman was diagnosed with hypertension at 15 years of age. Her blood pressure was controlled adequately with beta-blockers. During her pregnancy, she was found to have coarctation of the abdominal aorta by magnetic resonance imaging. Conclusion: Magnetic resonance imaging is a safe, reliable means by which to confirm clinically suspected coarctation of the aorta during pregnancy.