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OBJECTIVES: To compare the efficiency, ease of use and user satisfaction of two methods of transvaginal ultrasound probe high-level disinfection: ultraviolet-C radiation (UV-C) and a chlorine dioxide multistep wipe system. METHODS: This was a prospective survey study. UV-C units were introduced into a busy early pregnancy assessment service and compared with a multiwipe system for disinfection. Before seeing each patient, healthcare professionals (HCPs) measured with a stopwatch the time taken to complete a cycle of disinfection using either UV-C or chlorine dioxide multistep wipes and responded to a quick-response (QR) code-linked survey. Additional essential tasks that could be completed before seeing the next patient during probe disinfection were also documented. Using another QR code-linked survey, data on ease of use, satisfaction with the system used and preferred system were collected. The ease of use and satisfaction with the system were rated on a 0 to 10 Likert scale (0 poor, 10 excellent). A free-text section for comments was then completed. RESULTS: Disinfection using UV-C (n = 331) was 60% faster than the chlorine dioxide multiwipe system (n = 332) (101 vs 250 s; P

Objective To describe and compare the characteristics of ectopic pregnancies (EPs) in the year prior to vs during the coronavirus disease 2019 (COVID‐19) pandemic. Methods This was a retrospective analysis of women diagnosed with an EP on transvaginal sonography conducted at a center in London, UK, providing early‐pregnancy assessment, between 1 January 2019 and 31 December 2020. Women were identified via the Astraia ultrasound reporting system using coded and non‐coded outcomes of EP or pregnancy outside the uterine cavity. Data related to predefined outcomes were collected using Astraia and Cerner electronic reporting systems. Main outcome measures included clinical, ultrasound and biochemical features of EP, in addition to reported complications and management. Results There were 22 683 consultations over the 2‐year period. Following consultation, a similar number and proportion of EPs were diagnosed in 2019 (141/12 657 (1%)) and 2020 (134/10 026 (1%)). Both cohorts were comparable in age, ethnicity, weight and method of conception. Gestational age at the first transvaginal sonography scan and at diagnosis were similar, and no difference in location, size or morphology of EP was found between the two cohorts. Serum human chorionic gonadotropin (hCG) levels at the time of EP diagnosis were higher in 2020 than in 2019 (1005 IU/L vs 665 IU/L; P = 0.03). The proportions of women according to type of final EP management were similar, but the rate of failed first‐line management was higher during vs before the pandemic (16% vs 6%; P = 0.01). The rates of blood detected in the pelvis (hemoperitoneum) on ultrasound (23% vs 26%; P = 0.58) and of ruptured EP confirmed surgically (9% vs 3%; P = 0.07) were similar in 2019 vs 2020. Conclusions No difference was observed in the location, size, morphology or gestational age at the first ultrasound examination or at diagnosis of EP between women diagnosed before vs during the COVID‐19 pandemic. Complication rates and final management strategy were also unchanged. However, hCG levels and the failure rate of first‐line conservative management measures were higher during the pandemic. Our findings suggest that women continued to access appropriate care for EP during the COVID‐19 pandemic, with no evidence of diagnostic delay or an increase in adverse outcome in our population. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Introduction Polyhydramnios is common; the majority of cases are idiopathic, but maybe associated with fetal abnormality. Literature suggests the volume of amniotic fluid discriminates idiopathic from pathological polyhydramnios but is not unanimous. We assessed fetal anomaly incidence amongst women with polyhydramnios and the role of discriminatory variables in identifying pathological cases. Methods Retrospective observational cohort study at an inner‐city London fetal medicine centre. Records for patients referred and/or diagnosed with polyhydramnios were reviewed as well as maternal/fetal demographics, amongst singleton pregnancies using the Astraia™ database from January 2015–2016. Estimated fetal weight was calculated using the Hadlock model (biometry undertaken at diagnosis). Student's t‐test/one‐way ANOVA compared means; chi‐squared tests compared proportions. Results 120 cases were identified. 36 (30%) had fetal abnormality. There was no difference in AFI between fetuses with an abnormality and without (26.7 vs 25.2 cm, P = 0.22). AFI was normalised for weight (AFI (cm)/estimated fetal weight (kg)): AFI/kg was significantly different between cases with fetal abnormality and without (24.4 vs 16.7 cm/kg, P

ispartof: ULTRASOUND IN OBSTETRICS & GYNECOLOGY vol:55 issue:6 pages:871-878 ispartof: location:England status: published

INTRODUCTION: There is no global agreement on how to best determine pregnancy of unknown location viability and location using biomarkers. Measurements of progesterone and β human chorionic gonadotropin (βhCG) are still used in clinical practice to exclude the possibility of a viable intrauterine pregnancy (VIUP). We evaluate the predictive value of progesterone, βhCG, and βhCG ratio cut-off levels to exclude a VIUP in women with a pregnancy of unknown location. MATERIAL AND METHODS: This was a secondary analysis of prospective multicenter study data of consecutive women with a pregnancy of unknown location between January 2015 and 2017 collected from dedicated early pregnancy assessment units of eight hospitals. Single progesterone and serial βhCG measurements were taken. Women were followed up until final pregnancy outcome between 11 and 14 weeks of gestation was confirmed using transvaginal ultrasonography: (1) VIUP, (2) non-viable intrauterine pregnancy or failed pregnancy of unknown location, and (3) ectopic pregnancy or persisting pregnancy of unknown location. The predictive value of cut-off levels for ruling out VIUP were evaluated across a range of values likely to be encountered clinically for progesterone, βhCG, and βhCG ratio. RESULTS: Data from 2507 of 3272 (76.6%) women were suitable for analysis. All had data for βhCG levels, 2248 (89.7%) had progesterone levels, and 1809 (72.2%) had βhCG ratio. The likelihood of viability falls with the progesterone level. Although the median progesterone level associated with viability was 59 nmol/L, VIUP were identified with levels as low as 5 nmol/L. No single βhCG cut-off reliably ruled out the presence of viability with certainty, even when the level was more than 3000 IU/L, there were 39/358 (11%) women who had a VIUP. The probability of viability decreases with the βhCG ratio. Although the median βhCG ratio associated with viability was 2.26, VIUP were identified with ratios as low as 1.02. A progesterone level below 2 nmol/L and βhCG ratio below 0.87 were unlikely to be associated with viability but were not definitive when considering multiple imputation. CONCLUSIONS: Cut-off levels for βhCG, βhCG ratio, and progesterone are not safe to be used clinically to exclude viability in early pregnancy. Although βhCG ratio and progesterone have slightly better performance in comparison, single βhCG used in this manner is highly unreliable. ispartof: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA vol:101 issue:1 pages:46-55 ispartof: location:United States status: published

ispartof: ULTRASOUND IN OBSTETRICS & GYNECOLOGY vol:55 issue:6 pages:879-885 ispartof: location:England status: published

OBJECTIVE: The M6 risk-prediction model was published as part of a two-step protocol using an initial progesterone level of ≤ 2 nmol/L to identify probable failing pregnancies (Step 1) followed by the M6 model (Step 2). The M6 model has been shown to have good triage performance for stratifying women with a pregnancy of unknown location (PUL) as being at low or high risk of harboring an ectopic pregnancy (EP). This study validated the triage performance of the two-step protocol in clinical practice by evaluating the number of protocol-related adverse events and how effectively patients were triaged. METHODS: This was a prospective multicenter interventional study of 3272 women with a PUL, carried out between January 2015 and January 2017 in four district general hospitals and four university teaching hospitals in the UK. The final pregnancy outcome was defined as: a failed PUL (FPUL), an intrauterine pregnancy (IUP) or an EP (including persistent PUL (PPUL)). FPUL and IUP were grouped as low-risk and EP/PPUL as high-risk PUL. Serum progesterone and human chorionic gonadotropin (hCG) levels were measured at presentation in all patients. If the initial progesterone level was ≤ 2 nmol/L, patients were discharged and were asked to have a follow-up urine pregnancy test in 2 weeks to confirm a negative result. If the progesterone level was > 2 nmol/L or a measurement had not been taken, hCG level was measured again at 48 h and results were entered into the M6 model. Patients were managed according to the outcome predicted by the protocol. Those classified as 'low risk, probable FPUL' were advised to perform a urine pregnancy test in 2 weeks and those classified as 'low risk, probable IUP' were invited for a scan a week later. When a woman with a PUL was classified as high risk (i.e. risk of EP ≥ 5%) she was reviewed clinically within 48 h. One center used a progesterone cut-off of ≤ 10 nmol/L and its data were analyzed separately. If the recommended management protocol was not adhered to, this was recorded as a protocol deviation and classified as: unscheduled visit for clinician reason, unscheduled visit for patient reason or incorrect timing of blood test or ultrasound scan. The classifications outlined in the UK Good Clinical Practice (GCP) guidelines were used to evaluate the incidence of adverse events. Data were analyzed using descriptive statistics. RESULTS: Of the 3272 women with a PUL, 2625 were included in the final analysis (317 met the exclusion criteria or were lost to follow-up, while 330 were evaluated using a progesterone cut-off of ≤ 10 nmol/L). Initial progesterone results were available for 2392 (91.1%) patients. In Step 1, 407 (15.5%) patients were classified as low risk (progesterone ≤ 2 nmol/L), of whom seven (1.7%) were ultimately diagnosed with an EP. In 279 of the remaining 2218 women with a PUL, the M6 model was not applied owing to protocol deviation or because the outcome was already known (usually on the basis of an ultrasound scan) before a second hCG reading was taken; of these patients, 30 were diagnosed with an EP. In Step 2, 1038 women with a PUL were classified as low risk, of whom eight (0.8%) had a final outcome of EP. Of 901 women classified as high risk at Step 2, 275 (30.5%) had an EP. Therefore, 275/320 (85.9%) EPs were correctly classified as high risk. Overall, 1445/2625 PUL (55.0%) were classified as low risk, of which 15 (1.0%) were EP. None of these cases resulted in a ruptured EP or significant clinical harm. Sixty-two women participating in the study had an adverse event, but no woman had a serious adverse event as defined in the UK GCP guidelines. CONCLUSIONS: This study has shown that the two-step protocol incorporating the M6 model effectively triaged the majority of women with a PUL as being at low risk of an EP, minimizing the follow-up required for these patients after just two visits. There were few misclassified EPs and none of these women came to significant clinical harm or suffered a serious adverse clinical event. The two-step protocol incorporating the M6 model is an effective and clinically safe way of rationalizing the management of women with a PUL. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. ispartof: ULTRASOUND IN OBSTETRICS & GYNECOLOGY vol:55 issue:1 pages:105-114 ispartof: location:England status: published

BACKGROUND The configuration of watermelon fruit quality was analysed in a multi-factorial approach accounting for the effects of grafting, harvest maturity and postharvest storage. Diploid, seeded, hybrid cv. Pegasus, cultivated as scion on interspecific hybrid squash rootstock TZ148 and as non-grafted control, was stored at 25 °C following sequential harvests from the onset of ripening to over-maturity. RESULTS Delayed rootstock-mediated climax in pulp lycopene and chroma was observed, while both were heightened by postharvest storage when harvest preceded full maturity. Pulp firmness was increased by 46.5% on TZ148, while postharvest decrease in firmness was non-significant. Non-grafted fruits attained their peak in pulp carbohydrate content earlier during ripening. Monosaccharide content declined and sucrose content increased both preharvest and postharvest; overall sugar content declined by 4.3% during storage. Pulp acidity decreased steadily with ripening but was moderately increased by grafting. Citrulline content increased by 12.5% on TZ148; moreover, it climaxed with ripening and declined with storage only in grafted fruit. CONCLUSION Grafting enhances pulp texture and bioactive composition. Potential suppression of sugar content as a result of grafting is minimized at full commercial maturity. Brief postharvest ambient storage enhances pulp lycopene and chroma, especially in early-picked fruit, notwithstanding the depletion of monosaccharides and citrulline and a limited deterioration of texture. © 2015 Society of Chemical Industry

Grafting on disease-resistant rootstocks is a growing practice in watermelon cultivation worldwide. Reports on effects of grafting on watermelon fruit postharvest performance are scarce. The current work examined postharvest performance at 25C of four diploid cultivars grown nongrafted or grafted onto three Cucurbita maxima × C. moschata rootstocks. Despite sucrose accumulation throughout storage at the expense of fructose and glucose, total soluble carbohydrates and soluble solids content declined. Lycopene content peaked 7 days postharvest and intensity of flesh color increased concomitantly; yellowing of flesh was detected at 14 days. Rootstocks reduced soluble solids content only in the second year of experiments by 0.8–1.0°Brix. Rootstocks improved postharvest flesh firmness and lycopene content and enhanced flesh color. Rind was minimally thickened by rootstocks and declined with storage. Grafting diploid cultivars on interspecific rootstocks improved fruit quality and storability. Potential reduction in soluble solids content in response to grafting is limited and not detrimental to fruit quality. Practical Applications Grafting on disease-resistant rootstock has become an imperative for intensive watermelon production since chlorofluorocarbon-based soil fumigants were banned from use. Accordingly, most information on the effects of grafting on watermelon fruit quality derives from rootstock selection studies with emphasis on disease resistance and field performance. However, impaired fruit quality, notably low flesh firmness, constitutes a common problem for the commercial summer crop of field-cultivated watermelon with blame commonly placed on grafting. Moreover, watermelons worldwide are handled postharvest under adverse nonrefrigerated conditions. There remains, however, a paucity of information on the effects of grafting on watermelon postharvest performance. The main objective of this work was to assess the impact of cucurbit hybrid rootstocks, which constitute a major class of disease-resistant commercial rootstocks, on quality and postharvest performance of watermelon. The results could be applicable to improve the quality and postharvest handling of the watermelon fruit.

BACKGROUND: Crop management has been implicated in tuber sugar accumulation and potato processing quality. However, reports on potato postharvest behaviour, tuber composition and processing quality in response to crop nitrogen (N) fertilisation have been sparse and inconclusive. In this study, chipping potato cv. Hermes was treated with four preplanting N rates (0, 100, 200 and 300 kg ha−1) to evaluate the effect of N fertilisation on sugar accumulation profiles and processing quality at harvest, after cold storage at 4.5 °C for up to 200 days and after reconditioning at 16 °C for 10–30 days. RESULTS: Preharvest leaf petiole analysis and tuber nitrate analysis at harvest confirmed crop response to N rates. At harvest, tuber specific gravity decreased marginally beyond 200 kg N ha−1. Chip colour as well as tuber sucrose and reducing sugar (RS) content was unaffected by N fertilisation rate. During cold storage and reconditioning, tuber fresh weight loss and sprout growth were unaffected by N rate, while its effect on tuber sugar levels was either statistically or practically insignificant. Tuber sucrose and RS contents correlated highly with chip colour (r = − 0.729, P

BACKGROUND: The reconditioning potential of four potato cultivars (Diamant, Hermes, Lady Rosetta and Spunta) was evaluated in three years of crop production. After 30, 60, 120 and 150 days of storage at 4.5 ◦ C, cultivars were reconditioned at 16 ◦ Cf or 0, 15 and 30 days before being evaluated for sprout growth, tuber fresh weight loss (FWL), sucrose content, reducing sugar (RS) content (sum of glucose and fructose contents) and chip fry colour (FCL). RESULTS: Reconditioning induced rapid sprouting and pronounced FWL after 120 days of storage. Storage (30 – 150 days) was not critical to FCL and RS but affected sucrose levels. All cultivars showed an improvement in FCL and a reduction in RS and sucrose after reconditioning. The increment in FCL improvement and RS and sucrose depletion was greater between days 0 and 15 of reconditioning than between days 15 and 30 of reconditioning. Year contribution was significant to FCL and RS but not to sucrose variance. Acceptable FCL was attained after 15 days of reconditioning of Hermes and after 30 days for Lady Rosetta, while Diamant and Spunta remained substandard. RS levels in response to reconditioning were lowest in Hermes and Lady Rosetta. CONCLUSION: FCL conformed to tuber RS accumulation profiles. Cultivar RS ranking following reconditioning remained unaltered from year to year throughout storage. RS and FCL during the first 30 days of cold storage may be a reliable comparative index of reconditioning potential, as high-RS-accumulating and poor-chipping cultivars exhibit inadequate response to reconditioning. Tuber sucrose appeared of little significance as an index of the reconditioning ability of cultivars. c � 2009 Society of Chemical Industry

BACKGROUND: The efficacy of hot water treatment in facilitating successful reconditioning of processing potato (Solanum tuberosum L.) cultivar Hermes following 6 months cold storage at 4.5 °C was examined. Tubers were subjected to hot water treatments (HWTs) at 52.5, 55.0, 57.5 and 60.0 °C for 0–60, 0–50, 0–40 and 0–20 min, respectively, and then reconditioned for 20 days at 16 °C before evaluated for sprouting, fresh weight loss, membrane permeability, sugar content and processing quality. RESULTS: The study demonstrates that in order to achieve complete inhibition of sprouting during potato reconditioning HWTs must exceed the thermal tolerance threshold of the tubers. Short-duration HWT was effective in retarding sprout growth and tuber dehydration without significantly affecting storage parenchyma membrane permeability, tuber sugar content or processing quality. On the contrary, prolonged HWT caused extensive heat damage, loss of membrane integrity and induced an increase in tuber sucrose and reducing sugar content resulting in deterioration of chip colour in proportion to treatment duration. CONCLUSION: Although HWT at 52.5–60 °C following long-term cold storage did not improve the processing quality of potato tubers after 20 days of reconditioning, future work is needed to evaluate the effect of short-duration HWT on the permissible extent of reconditioning and subsequent processing quality. Copyright © 2008 Society of Chemical Industry