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Background: Occiput-posterior (OP) position is associated with labor arrest, need of operative delivery and failed instrumental vaginal delivery with resulting adverse peripartum outcomes. Vacuum extraction (VE) is the most commonly performed type of instrumental delivery worldwide. This study aimed to investigate the outcome of VE in fetuses with sonographically confirmed OP position prior to the procedure., Methods: Singleton pregnancies at term with sonographically confirmed fetal OP position prior to the vacuum extraction were enrolled in three academic maternity units. Fetal head station was assessed using transperineal sonography measuring the angle of progression (AoP) and the head-perineum distance (HPD). The primary outcome was failed VE, defined as the need for cesarean delivery. Secondary outcomes included adverse maternal and/or adverse neonatal outcomes and complicated VE, the latter defined as failed VE or at least three out of six parameters - Apgar <7 at 5 minutes, neonatal acidemia, admission to the neonatal intensive care unit, neonatal trauma, postpartum hemorrhage, and obstetric anal sphincter injuries., Results: Of 98 patients included in the study, VE was successful in 94 (96%). Logistic regression analysis showed that the measurement of the head-perineum distance (HPD) only was independently associated with failed VE (OR 1.25, 95% CI (1.02-1.55), p=0.03) with an area-under the curve was of 0.79, (p=0.04). A HPD cut-off value of 38.5 mm discriminated between successful and failed VE, yielding a sensitivity of 75.0% (3/4), specificity of 84.0% (79/94), LHR+ of 4.7 , LHR- of 0.3., Conclusions: Vacuum extraction (VE) is successful in 95% of fetuses with occiput posterior position confirmed at ultrasound. The head-perineum distance (HPD) measured at transperineal ultrasound has a significant albeit weak association with the outcome of VE., (Copyright © 2024. Published by Elsevier Inc.)

Research Question: What is the relationship between sonographic diagnosis of isolated adenomyosis and placenta-associated obstetric outcomes?, Design: In this 12-year retrospective cohort study (2010-2022), patients presenting with adenomyosis-related symptoms were assessed via ultrasound. The study included 59 women diagnosed with adenomyosis and 62 controls, leading to 203 births (90 in the adenomyosis group and 113 in the control group). Patients with endometriosis, uterine fibroids and anomalies, and those using assisted reproductive technology were excluded. The primary outcome focused on a composite of placenta-associated adverse outcomes, including preterm birth, small-for-gestational-age fetuses, hypertensive disorders of pregnancy, placental abruption and post-partum haemorrhage., Results: No clinically significant differences in demographic characteristics were noted between the two groups. However, the adenomyosis group showed a significantly higher rate of adverse placental function outcomes (27%) compared with the control group (11%, P = 0.005). Adjusted analyses for maternal age, parity and aspirin usage revealed increased risk of hypertensive disorders (adjusted OR 5.91, 95% CI 1.50-30.0; P = 0.017) and adverse placental function outcomes (adjusted OR 3.44, 95% CI 1.53-8.09; P = 0.003) in the adenomyosis group., Conclusion: Adenomyosis is significantly associated with increased risk of adverse placental function outcomes and hypertensive disorders of pregnancy. These findings suggest that adenomyosis may have a distinct impact on pregnancy, underscoring the need for further research to elucidate specific sonographic characteristics of adenomyosis and their effects on placental function., (Copyright © 2024 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)