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Background: Academic advancement of the midwifery profession highlights the need to establish standardized qualifications in obstetric ultrasound diagnosis, being a central part of prenatal care. Thus, introduction of an evidence-based training program is warranted. We aimed to reviewed curriculum designs used in midwifery ultrasound education. Methods: A systematic literature research was conducted. Embase, PubMed and Google Scholar database was reviewed for publications using the terms "[midwife], [midwives], [midwifery students], [obstetric ultrasound], [midwife sonographer] and [education], [teaching], [program], [course], [curriculum] and [learning]". Papers with full description of curriculum designs or educational programs on obstetrical ultrasound for midwives were included and scrutinized against pre-defined criteria according to the PICO (Population, Intervention, Comparator, Outcomes) scheme. Results: 29 publications were included. Studies demonstrated a significant disparity according to course concepts being used. Differing parameters included: Duration, structure, learning approaches, course content, examination concepts and target groups (practising midwives vs. midwives in education). Conclusion: An evidence-based ultrasound educational program for midwives remains to be developed, including further educational guidelines. Clinical applications by midwives, as well as the distinctions from medical practise, particularly in terms of legal considerations, needs to be defined. [ABSTRACT FROM AUTHOR]

Background: While there is an increasing interest in incorporating ultrasound in undergraduate medical education and the use of student tutors in conveying this medical skill to assist faculty members, little is known about undergraduate ultrasound teaching in obstetrics and gynecology. Methods: After a 3 week training of the student tutors, the student tutors joined an undergraduate ultrasound educational program to teach practical round students. After being certified, the student tutors organized a pre-test, gave a presentation about ultrasound, and then supervised the hands on ultrasound course under faculty staff supervision for round students. Finally, the practical round students had to answer a post-test with image recognition. The practical round students had to evaluate the course using a Likert scale. Results: 111 students joined this ultrasound course. The objective theoretical and practical multiple-choice questions' (MCQ) test showed a statistically significant improvement (50 vs. 90%, p < 0.05). The practical round students expressed a high acceptance (Likert 1.7) and subjective medical skill learning (Likert 1.8). The students also positively graded the student tutors (Likert 1.3). Conclusion: Student tutor-based undergraduate obstetrical and gynecological ultrasound course is a useful method to teach a medical skill and is well accepted by students. [ABSTRACT FROM AUTHOR]

This article explores the ways in which ultrasound screening influences the temporal dimensions of prevention in the obstetrical management of pregnancy. Drawing on praxeographic perspectives and empirically based on participant observation of ultrasound examinations in obstetricians' offices, it asks how ultrasound scanning facilitates anticipatory modes of pregnancy management, and investigates the entanglement of different notions of time and temporality in the highly risk-oriented modes of prenatal care in Germany. Arguing that the paradoxical temporality of prevention-acting now in the name of the future-is intensified by ultrasound screening, I show how the attribution of risk regarding foetal growth in prenatal check-ups is based on the fragmentation of procreative time and ask how time standards come into play, how pregnancy is located in calendrical time, and how notions of foetal time and the everyday life times of pregnant women clash during negotiations between obstetricians and pregnant women about the determination of the due date. By analysing temporality as a practical accomplishment via technological devices such as ultrasound, the paper contributes to debates in feminist STS studies on the role of time in reproduction technologies and the management of pregnancy and birth in contemporary societies. [ABSTRACT FROM AUTHOR]

This study aims to retrospectively evaluate the right lower quadrant ultrasounds in women presenting during the second or third trimester of pregnancy for the frequency of appendix visualization and accuracy in diagnosing appendicitis. Institutional Review Board approval was obtained for this Health Insurance Portability and Accountability Act-compliant study. We reviewed imaging records from 99 consecutive pregnant women from 2001 to 2011 who presented during the second (≥14 weeks gestation) or third trimester for right lower quadrant ultrasound to evaluate the appendix. Visualization of the appendix as well as the size and compressibility, if identified, were recorded. The medical records and labs related to the initial patient presentation, subsequent management, and follow-up were reviewed for surgical and clinical outcomes. Pathology records were reviewed to determine if appendicitis was present when appendectomy was performed. Patients who underwent appendectomy were considered to have appendicitis based on pathology results, and patients managed non-operatively with symptom improvement and those with a normal appendix at pathology were considered to not have appendicitis. During the study period, 99 women meeting inclusion criteria presented to our institution for right lower quadrant ultrasound to evaluate the appendix during the second or third trimester of pregnancy. The mean gestational age at presentation was 23 weeks (±7 weeks). The mean maternal age was 28 years (±6.6 years). The appendix was not visualized in 97% (96/99) of right lower quadrant ultrasound examinations. Of the three studies in which the appendix was visualized, two were considered positive for appendicitis and one was considered negative. Eight patients in this group ultimately underwent appendectomy, including the two patients with positive right lower quadrant ultrasounds, and appendicitis confirmed at pathology in seven of these cases (87.5%). Right lower quadrant ultrasound successfully demonstrated an abnormal appendix in 28.7% (two of seven) of surgically confirmed cases; however, this technique did not detect appendicitis in 71% (five of seven) of patients with surgically proven disease due to nonvisualization of the appendix. Retrospective review of right lower quadrant ultrasounds performed during the second and third trimester of pregnancy suggests that this modality has limited utility for diagnosing appendicitis due to infrequent visualization of the appendix. [ABSTRACT FROM AUTHOR]

Introduction: No consensus exists about the upper limit of normal (ULN) of the cross-sectional area (CSA) of the median nerve in diagnosing carpal tunnel syndrome (CTS). Previously, we demonstrated a strong positive correlation between wrist circumference and CSA. ULN depending on wrist circumference turned out to have a low sensitivity, which was hypothesized to be caused by an age mismatch. The aim of this study was to re-evaluate the found invariance by augmentation of the healthy control group, adding older subjects, and to determine the diagnostic accuracy of the updated normal values.Methods: CSA and wrist circumference were measured in an additional 42 healthy controls in the ages of 40-60. Univariable and multivariable linear regression analyses were applied to determine predicting factors for CSA. Diagnostic accuracy was assessed in a prospective cohort of 253 patients.Results: A strong correlation was found between wrist circumference and CSA (r = 0.61). Wrist circumference is the most important independent predictor for ULN (r2 = 0.37). We managed to simplify our newly derived regression equations, which turned out to be unrelated to age. Sensitivity of our new equations is low, but higher than a general fixed cut-off value (53.4% and 47.4%, respectively).Discussion: Wrist circumference is the most important independent predicting factor of CSA. By using our updated equations and taking wrist circumference into account, one can determine a more precise ULN for each individual, which will lead to the improvement of the diagnostic accuracy of ultrasonography (US). Sensitivity for US in diagnosing CTS remains low and it can therefore not replace EDX. [ABSTRACT FROM AUTHOR]

This paper explores the rhetoric of obstetric ultrasound technology as it relates to the abortion debate, specifically the interpretation given to ultrasound images by opponents of abortion. The tenor of the anti-abortion approach is precisely captured in the videotape, Ultrasound: A Window to the Womb. Aspects of this videotape are analyzed in order to tease out the assumptions about the (female) body and about the access to truth yielded by scientific technology (ultrasound) held by militant opponents of abortion. It is argued that the ultrasound images do not offer transparent confirmation of the ontological status of the embryo and fetus. Rather, the "window" of ultrasound is constructed through a complex combination of visual and verbal devices: ultrasound images, photographic images, verbal argument, and emotional appeal. [ABSTRACT FROM AUTHOR]

Purpose: First trimester risk assessment for chromosomal abnormalities plays a major role in the contemporary pregnancy care. It has evolved significantly since its introduction in the 1990s, when it essentially consisted of just the nuchal translucency measurement. Today, it involves the measurement of several biophysical and biochemical markers and it is often combined with a cell-free DNA (cfDNA) analysis as a secondary test.Methods: A search of the Medline and Embase databases was done looking for articles about first trimester aneuploidy screening. We performed a detailed review of the literature to evaluate the screening tests currently available and their respective test performance.Results: Combined screening for trisomy 21 based on maternal age, fetal NT, and the serum markers free beta-hCG and PAPP-A results in a detection rate of about 90% for a false positive of 3-5%. With the addition of further ultrasound markers, the false positive rate can be roughly halved. Screening based on cfDNA identifies about 99% of the affected fetuses for a false positive rate of 0.1%. However, there is a test failure rate of about 2%. The ideal combination between combined and cfDNA screening is still under discussion. Currently, a contingent screening policy seems most favorable where combined screening is offered for everyone and cfDNA analysis only for those with a borderline risk result after combined screening.Conclusion: Significant advances in screening for trisomy 21 have been made over the past 2 decades. Contemporary screening policies can detect for more than 95% of affected fetuses for false positive rate of less than 3%. [ABSTRACT FROM AUTHOR]

Purpose: To assess the predictive power of the cerebro-placental ratio (CPR) and the venous-arterial index (VAI) for the development of intrapartum fetal distress (FD) and neonatal intensive care unit (NICU) admission.Methods: Fetal umbilical artery, middle cerebral artery and umbilical vein Doppler measurements were obtained before the active phase of labor in 311 singleton pregnancies at ≥37 weeks. A continuous electronic fetal monitorization was applied, and an umbilical cord blood sample was obtained for each participant. FD and NICU admission were the primary outcomes.Results: Labor was concluded as uncomplicated spontaneous vaginal delivery (SVD) in 261 (83.9%) cases. The 22 (7.1%) FD cases were subdivided into FD with NICU admission (n: 7; 2.3%) and without NICU admission (n: 15; 4.8%). Six out of 7 (85.8%) FD with NICU admission cases were from nulliparous pregnancies. The combinatory indices (VAI and CPR) reached the highest sensitivity (31.8%) and negative predictive value (94.7%). None of the fetuses, distressed or non-distressed, with CPR ≤ 10th percentile was born with a cord pH < 7.20.Conclusion: FD frequency was increased in fetuses with a low CPR or low VAI. However, the Doppler patterns were heterogeneous in both subgroups: FD with and without NICU admission. FD seems to be a common endpoint of different circulatory-metabolic disturbances. Parity affects the FD frequency in a manner related but not limited to fetal arterial and venous circulation. Low CPR could be a part of the adaptive mechanisms providing metabolic preparedness for hypoxic episodes. [ABSTRACT FROM AUTHOR]

Congenital complete atrioventricular block (CCAVB) is a rare condition with an incidence of 1 of 20,000 live births. Hypoplastic left heart syndrome (HLHS) occurs more frequently than CCAVB and occurs in 1 of 5000 live births. HLHS in association with CCAVB is exceedingly rare. In this report, we describe a rare case of HLHS and CCAVB diagnosed in utero. Postnatal diagnosis, management and outcome are presented as well as review of the medical literature. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the feasibility and acceptance of a model of direct interaction between radiologist and patients in the emergency department (ED) setting. The study population was comprised of pregnant patients accrued in a non-consecutive prospective manner from June 2014 to September 2015, who had an obstetrical ultrasound performed in the radiology department of an inner-city tertiary care hospital at the request of the ED. The feasibility and approval of direct communication between radiologist and patient were evaluated by means of a questionnaire presented by an independent observer to the ED provider, patient, and radiologist. The exam enrolled 54 patients. Ultrasound (US) exam results were divided into (31) normal live intrauterine gestation (group 1), (7) abnormal failed intrauterine gestation or ectopic pregnancy (group 2), and (16) indeterminate pregnancies that could not be placed in the former categories and may require a follow-up exam (group 3). Forty-five (83 %) ED providers approved of the radiologist's direct communication with patients. Fifty (93 %) patients stated a better understanding of the radiologist's role in their care after than before the interaction. The radiologists found the interaction with patients to be positive in 52 (96 %) cases. Direct communication between radiologist and patient yielded a good acceptance by the radiologist, ED provider, and patient. More importantly, after the encounter, the vast majority of patients reported a better understanding of the radiologist's role in their care. [ABSTRACT FROM AUTHOR]

Purpose: The accuracy of sonographic estimation of birth weight (EBW) is compromised by the precision of the biometrical measurements and the quality of the algorithms. This prospective study was to evaluate technical aspects to derive new equations for the EBW. Methods: Three consecutive phases were carried out (1) to recruit a homogenous population, (2) to derive eight new algorithms using a multiple stepwise mathematical/statistical method, and (3) to test the accuracy of the developed equations. Only those patients with a singleton pregnancy who delivered within 48 h from the scan were considered for the analysis. Results: The study population was made of 473 women. Four polynomial, two square root and two logarithmic algorithms were derived from a balanced study group of 200 women selected from the original study population. These formulas were subsequently applied and compared between them and showed a significant correlation with birth weight ( p < 0.0001) and satisfactory statistical performances ( r > 0.9), nevertheless they performed similarly to other equations previously published. Conclusions: The present findings define better the limitations associated with the intrinsic properties of algorithms and highlight that the possibility to improve the precision of sonographic measurements remains the only point at issue to increase the accuracy in the prediction of birth weight. [ABSTRACT FROM AUTHOR]

Case report: We report a case of Candida glabrata infection in an in vitro fertilization-assisted pregnancy complicated by pre-term pre-labor rupture of the membranes. We found C. glabrata in gastric fluid, amniotic fluid and maternal vaginal swab. Neonatal and maternal isolates showed indistinguishable molecular patterns analyzed by fingerprint DNA multilocus. Discussion: Strong consideration should be given to perform a screening test C. glabrata. Multiple treatments, even in pregnancy, should be considered in women who have positive cultures results. [ABSTRACT FROM AUTHOR]

Purpose: To describe the prenatal findings, treatments and outcomes of fetuses with pulmonary sequestrations (PS), which were retrospectively studied. Methods: From May 2010 to January 2013, 292 women were referred to the Guangdong Women and Children Hospital, Guangzhou because obstetric ultrasound had demonstrated fetal lung lesions. In 68 fetuses, the echogenic lung masses were pulmonary sequestrations deriving arterial blood supply from clearly identifiable systemic arteries rather than the pulmonary artery. We examined records of the 68 fetuses and measured the lesions and congenital cystic adenomatoid malformation volume ratio (CVR), provided prenatal counseling and treatment, documented the CVR, location of lesion, gestational age at diagnosis, need for fetal intervention, perinatal clinical course (including the development of hydrops, effusions, and neonatal respiratory distress), gestational age at delivery, postnatal ultrasound and CT, operation treatment, survival and pathology. Results: There were 68 PS in our study. All of 56 cases with CVR ≤1.6, survived without prenatal hydrops or postnatal respiratory symptoms. In 12 cases with CVR >1.6, 7 cases (58.3 %, 7/12) had hydrops, 10 cases (83.3 %, 10/12) survived, 2 cases (16.7 %, 2/12) of induced abortion, 8 cases (66 %, 8/12) were postnatal symptomatic. There was statistical significant difference in the incidence rate of hydrops and postnatal respiratory symptoms between the PS with CVR ≤1.6 and that with CVR >1.6. 66 cases postnatal survived, two cases of induced abortion. 64 cases had no prenatal treatment, two cases underwent thoracoamniotic shunt. The mean gestational age at birth was 38 weeks (range 34-40 weeks). 21 asymptomatic cases had no surgery. 45 cases (8 symptomatic and 37 asymptomatic) underwent surgical resections, 43 cases without postoperative complications, two cases of postoperative pneumothorax, no wound infection. Postoperative follow-up showed good growth in all surgery cases. Conclusion: PS specific absence of hydrop was a congenital disorder with an excellent prognosis. CVR >1.6 was associated with fetal hydrops and postnatal symptoms. However, absolute CVR value cannot be used to select fetuses for fetal treatment before the development of hydrops. Surgery of PS in neonates or infants presented a good outcome. [ABSTRACT FROM AUTHOR]

Abstract: Background: Aortic pulse wave velocity (aPWV) has been found to be increased in preeclampsia when compared to normal pregnancy. Preeclampsia is associated with increased risk of later cardiovascular disease and, as such, study of the aortic stiffness in pregnancy, and its hypertensive disorders, is important to the understanding the underlying vascular changes. We compared two different techniques to measure aPWV in the mid-trimester of pregnancy. Methods: 58 women were recruited from the obstetric ultrasound clinic, mean (±SD) age 33 (±6) years and gestation 27 (±1) weeks. Aortic PWV was measured using SphygmoCor and Vicorder devices. Results: We found that both devices provided similar aPWV values with no significant difference between devices: mean difference (±SD), 0.1 (±0.9)m/s, p = 0.4. We found good correlation between devices (r = 0.6, p < 0.001). Good intra-observer variability was observed for both SphygmoCor and Vicorder devices, coefficients of variation 5.69% and 2.67%, respectively. Conclusions: The SphygmoCor and Vicorder devices produce similar readings for aPWV in the second trimester of pregnancy, with good intra-observer variability. Due to its simpler technique the Vicorder device may be more suited to the clinical setting, particularly in advanced pregnancy or obesity. [Copyright &y& Elsevier]

Purpose: We evaluated the performance of the placental alpha-microglobulin-1 immunoassay (AmniSure, AT) in cervicovaginal secretions in patients with uncertain rupture of membranes (ROM) and investigated the influence of the examiners experience. Methods: This prospective cohort study was performed in pregnant women (17-42 weeks of gestation) with signs of possible ROM. Evaluation included clinical assessment, examination for cervical leakage, Nitrazine test and measurement of the amniotic fluid index by ultrasound and AT. ROM occurrence was based on review of the medical records after delivery. Results: 199 women were included. AT had a sensitivity of 94.4%; specificity of 98.6%; positive predictive value, 96.2%; negative predictive value, 98.0%. Clinical assessment showed a sensitivity of 72.2%; specificity of 97.8%; positive predictive value, 92.9%; negative predictive value, 90.6%. AT was more sensitive for diagnosing ROM ( p = 0.00596) compared to clinical assessment, independent of the examiners experience. Furthermore, the sole use of AT reduced costs by 58.4% compared to clinical assessment. Conclusions: AT was more sensitive compared to clinical assessment, independent of the examiners experience and gestational age. Our data extend its use in patients with uncertain ROM. Moreover, AT seems to be a cost-effective approach in the assessment of these patients. [ABSTRACT FROM AUTHOR]

Purpose: To determine the frequency of aberrant right subclavian artery among the low-risk fetuses and to evaluate its association with chromosomal abnormalities and the other congenital heart diseases. Methods: A total of 4,125 consecutive fetuses were examined for the presence of aberrant right subclavian artery that arises from the descending aorta distal to the left subclavian artery. Results: Aberrant right subclavian artery was detected in 17 cases (0.4%). In nine cases it was an isolated finding. In four cases (23.5%) it was accompanied by another cardiac defect. Extracardiac malformations were present in three fetuses (17.6%). Among the 13 cases of aberrant right subclavian artery in which the karyotypes were known, one case presented with Down syndrome (7.6%). In this fetus, aberrant right subclavian artery was the only finding. Conclusion: These findings suggest that aberrant right subclavian may be an isolated finding in trisomy 21. The visualization of subclavian artery should be a part of fetal echocardiographic examination as it may be a valuable marker for Down syndrome. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the accuracy of the working diagnosis in emergent laparoscopies and identify variables associated with an accurate or faulty preoperative diagnosis. Methods: A retrospective cohort study including 217 consecutive women who underwent emergent laparoscopy for acute abdominal pain in 2000-2007. Each case was designated a preoperative-postoperative diagnostic match or mismatch by file review. The agreement between the clinical and preoperative ultrasound findings was analyzed according to the circumstances of imaging tests (Doppler-ultrasound examination performed by a specialist or ultrasound performed by the on-call physician without Doppler examination). Results: On multivariate logistic stepwise regression analysis, the significant independent variables for prediction of preoperative-postoperative diagnostic match (n = 63, 29%) were pregnant state, preoperative clinical-ultrasound match, and duration of symptoms. The circumstances of imaging tests were not a significant predictor for accurate preoperative diagnosis. Conclusions: In this retrospective analysis, Doppler-ultrasound examination performed by a specialist was not associated with higher accuracy of the preoperative diagnosis in women undergoing emergent laparoscopy for acute abdominal pain. These data should be further validated in future prospective cohorts. Doppler-ultrasound examination performed by a specialist does not add to the accuracy of the preoperative diagnosis in women undergoing emergent gynecological laparoscopy for acute abdominal pain. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between maternal plasma noradrenaline levels at a mean gestational age of 29 weeks and gestational age and weight at birth. Design: Original research. Sample: Seventy-four pregnant women with a mean gestational age of 29 weeks. Methods: Psychological anxiety levels (Spielberger State and Trait questionnaire) and plasma stress hormone levels (noradrenaline and adrenaline) were measured in pregnant women at a mean gestational age of 29 weeks. Statistical analysis was applied to investigate links between these variables and gestational age and weight at birth. Outcome measures: Self-rating anxiety, State and Trait Spielberger questionnaire, maternal noradrenaline and adrenaline levels, gestational age and weight at birth. Results: There was a significant inverse relationship between maternal noradrenaline levels and the infant gestational age at birth ( r = 0.09, p = 0.05). There was no relationship between maternal noradrenaline levels and weight at birth. Conclusions: There was a significant inverse relationship between maternal noradrenaline levels and gestational age at birth, suggesting the possibility of underlying mechanisms linking maternal noradrenaline and timing of delivery. [ABSTRACT FROM AUTHOR]

Objective: To compare endotracheal tube tip-to-carina distance obtained by ultrasonography vs. that obtained by chest X-ray in neonates. Methods: After endotracheal intubation of 40 neonates, chest X-ray and, within one hour, ultrasonography was obtained for each patient for measurement of endotracheal tube tip-to-carina distance. Results: Means of endotracheal tube tip-to-carina distances were not significantly different by both modalities (mean difference 0.157 cm, P= 0.06). In addition, an intraclass correlation was observed between them (r= 0.61, 95% CI= 0.26, 0.79). Conclusion: Ultrasonography and chest X-ray are equally accurate for determination of endotracheal tube tip-to-carina in infants. As ultrasonography is more easily available and is safer than X-ray, it may be a better modality for confirming proper placement of endotracheal tube in neonates. [ABSTRACT FROM AUTHOR]

Obstetric ultrasound forms an integral part of modern obstetric care. This includes the use of ultrasound for screening as well as in diagnostic and therapeutic roles. Radiologists involved in this field must have the appropriate training and expertise to match the type of investigation or screening procedure to be undertaken. There should be an explicit understanding of this training and expertise both for the referring obstetrician and expectant mother. All radiologists involved in the care of women should have a thorough understanding of the normal and abnormal appearances of the first trimester as early pregnancy disorders present to the generalist; however, a smaller number of radiologists are involved in anomaly screening and management of growth disorders and still fewer in tertiary referral work. Obstetric medical practice is increasingly litigious and the aims of screening ultrasound and the limitations (false-negative and false-positive rates) should be explicit not only to the referring clinician but also to the expectant parents prior to screening. The diagnostic accuracy of ultrasound should be known in order that the expectant mother can give informed consent. [ABSTRACT FROM AUTHOR]

Reports the success of pregnancies and births after zona-free blastocysts in oocyte donations in humans. Preparation of endometrium following pituitary function suppression; Exposure of normal fertilized embryos to Earle's culture medium; Confirmation of a gestational sac with a fetal heart by ultrasound.

The article announces the conference on obstetric ultrasound, "Obstetric Ultrasound Setting the Standard for 2005," to be held from February 18-20, 2005, at Marriott Toronto Downtown Eaton Centre, Toronto, Ontario, Canada. Contact information is also given.

Abstract  The possibility of predicting undesirable postinfarction remodeling of the left ventricle from parameters of tissue doppler echocardiography was evaluated in 55 patients with a history of acute myocardial infarction. Low diastolic rates of normal segments and the absence of the peak of isovolumetric contraction in the dysfunction zone were the most significant predictors of unfavorable remodeling. [ABSTRACT FROM AUTHOR]

The article discusses research conducted by Therese Hesketh and colleagues of the University College London on the sex ratio in China that has resulted due to sex-selected abortions that began with the introduction of low-cost ultrasound in the late 1980's. A 2005 census shows that there are almost 33 million more Chinese males than females in the under-20 age group.

The article describes an ultrasound scan of a 75-kilogram elephant fetus which is already decked out with foot pads and a trunk. The fetus was already gestating for almost 19 months and began kicking and exercising its legs approximately 14 months earlier. The image was taken as part of the documentary entitled "In the Womb," which will be shown on the National Geographic Channel in the U.S. and Europe, and on Channel 4 in Great Britain.

Antepartum haemorrhage is defined as bleeding from the genital tract from 24 weeks of gestation onwards. The incidence is around 2–5% of all pregnancies progressing beyond 24 weeks. Placenta praevia and placental abruption are of great clinical importance as causes of antepartum haemorrhage. Placenta praevia occurs when the placenta is totally or partly inserted in the lower uterine segment. The aetiology of placenta praevia may merely represent an accident of nature but is associated with advanced maternal age, multiparity and previous uterine damage such as in a previous caesarean section. Usually, the initial bleed is painless and mild, but it may be severe. Screening and diagnosis are normally by ultrasound. A dilemma exists as to whether hospitalisation should be offered to women with an asymptomatic placenta praevia. Caesarean section is the recommended mode of delivery for major placenta praevia. Haemorrhage arising from premature separation of a normally situated placenta is known as abruptio placentae. Risk factors include placental abruption in a previous pregnancy, pre-eclampsia, cigarette smoking, and trauma. The patient typically develops pain over the uterus, and this may not be associated with apparent bleeding at first. The diagnosis is mainly clinical and confirmed by the demonstration of a retroplacental clot after delivery. In the obvious case of abruption, early delivery is of crucial importance. If the baby is still alive and the gestation compatible with survival upon delivery, it is recommended that urgent caesarean section should be performed. However, if the fetus is dead, one should expedite vaginal delivery. Complications of antepartum haemorrhage include maternal shock, especially due to the increased risk of postpartum bleeding. There is a greater risk of premature delivery, fetal hypoxia and sudden fetal death. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Gynecology is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical & Biological Engineering (0025696X) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)