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Copyright of Ultrasound in Obstetrics & Gynecology is the property of Wiley-Blackwell 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.)

Endorsed by the Australasian Society for Ultrasound in Medicine (ASUM), the British Medical Ultrasound Society(BMUS), the Society and College of Radiographers (SCoR), Sociedad Española de Ginecología y Obstetricia (SEGO) and Società Italiana di Ecografia Ostetrica e Ginecologica e Metodologie Biofisiche (SIEOG). Nonetheless, the rapid spread of the disease across countries and continents, as well as the evidence of existence of asymptomatic carriers[16], has led to circumstances in which all patients are to be considered at risk of infection and hence potential carriers of the SARS-CoV-2 virus. When managing patients with confirmed or suspected COVID-19 infection, or if there is widespr... To avoid infection through respiratory droplets, practitioners should don appropriate PPE, including a surgical mask, upon entering the ultrasound room. Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. https://apps.who.int/iris/bitstream/handle/10665/112656/9789241507134 eng.pdf;jsessionid=403613D204AC57EDB11B41001DED8149?sequence=1 9 COVID-19 Guidance for infection prevention and control in healthcare settings. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment data/file/874316/Infection prevention and control guidance for pandemic coronavirus.pdf 10 Istituto Superiore di Sanità. [Extracted from the article]

Objectives: To determine intra- and interrater reliability and agreement for ultrasound measurements of pelvic floor muscle contraction and to assess the correlation between ultrasound and vaginal palpation. We also aimed to develop an ultrasound scale for assessment of pelvic floor muscle contraction.Methods: This was a cross-sectional study of 195 women scheduled for stress urinary incontinence (n = 65) or prolapse (n = 65) surgery or who were primigravid (n = 65). Pelvic floor muscle contraction was assessed by vaginal palpation using the Modified Oxford Scale (MOS) and by two- and three-dimensional (2D/3D) transperineal ultrasound. Proportional change in 2D and 3D levator hiatal anteroposterior (AP) diameter and 3D levator hiatal area between rest and contraction were used as measures of pelvic floor muscle contraction. One rater repeated all ultrasound measurements on stored volumes, which were used for intrarater reliability and agreement analysis, and three independent raters analyzed 60 ultrasound volumes for interrater reliability and agreement analysis. Reliability was assessed using the intraclass correlation coefficient (ICC) and agreement using Bland-Altman analysis. Tomographic ultrasound was used to identify women with major levator injury. Spearman's rank correlation coefficient (rS ) was used to assess the correlation between ultrasound measurements of pelvic floor muscle contraction and MOS score. The proportion of women allocated to each category of muscle contraction (absent, weak, moderate or strong) by palpation was used to determine the cut-offs for the ultrasound scale.Results: Intrarater ICC was 0.81 (95% CI, 0.74-0.85) for proportional change in 2D levator hiatal AP diameter. Interrater ICC was 0.82 (95% CI, 0.72-0.89) for proportional change in 2D AP diameter, 0.80 (95% CI, 0.69-0.88) for proportional change in 3D AP diameter and 0.72 (95% CI, 0.56-0.83) for proportional change in hiatal area. The prevalence of major levator injury was 22.6%. The strength of correlation (rS ) between ultrasound measurements and MOS score was 0.52 for 2D AP diameter, 0.62 for 3D AP diameter and 0.47 for hiatal area (P < 0.001 for all). On the ultrasound contraction scale, proportional change in 2D levator hiatal AP diameter of < 1% corresponds to absent, 2-14% to weak, 15-29% to normal and > 30% to strong contraction.Conclusions: Ultrasound seems to be an objective and reliable method for evaluation of pelvic floor muscle contraction. Proportional change in 2D levator hiatal AP diameter had the highest ICC and moderate correlation with MOS score assessed by vaginal palpation, and we constructed an ultrasound scale for assessment of pelvic floor muscle contraction based on this measure. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives: To investigate if descent of the fetal head during active pushing is associated with duration of operative vaginal delivery, mode of delivery and neonatal outcome in nulliparous women with prolonged second stage of labor.Methods: This was a prospective cohort study of nulliparous women with prolonged second stage of labor, conducted between November 2013 and July 2016 in five European countries. Fetal head descent was measured using transperineal ultrasound. Head-perineum distance (HPD) was measured between contractions and on maximum contraction during active pushing, and the difference between these values (ΔHPD) was calculated. The main outcome was duration of operative vaginal delivery, estimated using survival analysis to calculate hazard ratios (HRs) for vaginal delivery, with values > 1 indicating a shorter duration. HR was adjusted for prepregnancy body mass index, maternal age, induction of labor, augmentation with oxytocin and use of epidural analgesia. Pregnancies were grouped according to ΔHPD quartile, and delivery mode and neonatal outcome were compared between groups.Results: The study population comprised 204 women. Duration of vacuum extraction was shorter with increasing ΔHPD. Estimated mean duration was 10.0, 9.0, 8.8 and 7.5 min in pregnancies with ΔHPD in the first to fourth quartiles, respectively, and the adjusted HR for vaginal delivery, using increasing ΔHPD as a continuous variable, was 1.04 (95% CI, 1.01-1.08). Mean ΔHPD was 7 mm (range, -10 to 37 mm). ΔHPD was either negative or ≤ 2 mm in the lowest quartile. In this group, 7/50 (14%) pregnancies were delivered by Cesarean section, compared with 8/154 (5%) of those with ΔHPD > 2 mm (P < 0.05). There was no significant association between umbilical artery pH < 7.10 or 5-min Apgar score < 7 and ΔHPD quartile.Conclusion: Minimal or no fetal head descent during active pushing was associated with longer duration of operative vaginal delivery and higher frequency of Cesarean section in nulliparous women with prolonged second stage of labor. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Copyright of Ultrasound in Obstetrics & Gynecology is the property of Wiley-Blackwell 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.)

Objective: To study possible associations between pelvic floor muscle contraction, levator ani muscle (LAM) trauma and/or pelvic organ prolapse (POP) ≥ Stage 2 in parous women recruited from a general population.Methods: This was a secondary analysis of data from a cross-sectional study of 608 parous women from a general population examined using the POP quantification system (POP-Q) and three-dimensional/four-dimensional transperineal ultrasound for identification of LAM macrotrauma (avulsion) and microtrauma (distension of levator hiatal area > 75th percentile on Valsalva maneuver). Muscle contraction was assessed using the modified Oxford scale (MOS), perineometry and ultrasound measurement of proportional change of anteroposterior hiatal diameter and levator hiatal area at rest and on pelvic floor muscle contraction. The Mann-Whitney U-test was used to study associations between pelvic floor muscle contraction, LAM trauma and POP.Results: Women with macrotrauma (n = 113) had significantly weaker median pelvic floor muscle contraction, as measured using MOS and perineometry, than did women with an intact LAM (n = 493) (contraction strength was 1.5 (range, 0.0-5.0) vs 3.5 (range, 0.0-5.0) on MOS, and vaginal squeeze pressure was 15.0 (range, 0.0-78.0) cmH2 O vs 28.0 (range, 0.0-129.0) cmH2 O on perineometry; P < 0.001). This was also demonstrated by ultrasound measurement, with a proportional change in hiatal area of 19.9% (range, 4.1-48.0%) vs 34.0% (range, 0.0-64.0%) (P < 0.001) and proportional change in anteroposterior diameter of 16.2% (range, -5.7 to 42.6%) vs 26.0% (range, -3.4 to 49.4%) (P < 0.001). No statistically significant difference between women with (n = 65), and those without (n = 378), microtrauma was found after excluding women with macrotrauma. Women with POP had weaker muscle contraction than those without; in those with POP-Q ≥ 2 (n = 275) compared with those with POP-Q < 2 (n = 333), muscle contraction strength was 3.0 (range, 0.0-5.0) vs 3.5 (range, 0.0-5.0) on MOS, vaginal squeeze pressure was 21.0 (range, 0.0-98.0) cmH2 O vs 28.0 (range, 3.0-129.0) cmH2 O on perineometry, proportional change in hiatal area was 29.6% (range, 0.0-60.9%) vs 33.8% (range, 0.0-64.4%) and proportional change in anteroposterior diameter was 22.8% (range, -5.7 to 49.4%) vs 25.7% (range, -3.4 to 49.4%) (P < 0.001 for all).Conclusions: LAM macrotrauma was associated with weaker pelvic floor muscle contraction measured using palpation, perineometry and ultrasound. Women with POP had weaker contraction than did women without POP. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives: To establish the prevalence of external (EAS) and internal (IAS) anal sphincter defects present 15-24 years after childbirth according to mode of delivery, and their association with development of fecal incontinence (FI). The study additionally aimed to compare the proportion of women with obstetric anal sphincter injuries (OASIS) reported at delivery with the proportion of women with sphincter defect detected on ultrasound 15-24 years later.Methods: This was a cross-sectional study including 563 women who delivered their first child between 1990 and 1997. Women responded to a validated questionnaire (Pelvic Floor Distress Inventory) in 2013-2014, from which the proportion of women with FI was recorded. Information about OASIS was obtained from the National Birth Registry. Study participants underwent four-dimensional transperineal ultrasound examination. Defect of EAS or IAS of ≥ 30° in at least four of six slices on tomographic ultrasound was considered a significant defect and was recorded. Four study groups were defined based on mode of delivery of the first child. Women who had delivered only by Cesarean section (CS) constituted the CS group. Women in the normal vaginal delivery (NVD) group had NVD of their first child and subsequent deliveries could be NVD or CS. The forceps delivery (FD) group included women who had FD, NVD or CS after FD of their first born. The vacuum delivery (VD) group included women who had VD, NVD or CS after VD of their first born. Multiple logistic regression was used to calculate adjusted odds ratios (aORs) for comparison of prevalence of an EAS defect following different modes of delivery and to test its association with FI. Fisher's exact test was used to calculate crude odds ratios (ORs) for IAS defects.Results: Defects of EAS and IAS were found after NVD (n = 201) in 10% and 1% of cases, respectively, after FD (n = 144) in 32% and 7% of cases and after VD (n = 120) in 15% and 4% of cases. No defects were found after CS (n = 98). FD was associated with increased risk of EAS defect compared with NVD (aOR = 3.6; 95% CI, 2.0-6.6) and VD (aOR = 3.0; 95% CI, 1.6-5.6) and with increased risk of IAS defect compared with NVD (OR = 7.4; 95% CI, 1.5-70.5). The difference between VD and NVD was not significant for EAS or IAS. FI was reported in 18% of women with an EAS defect, in 29% with an IAS defect and in 8% without a sphincter defect. EAS and IAS defects were associated with increased risk of FI (aOR = 2.5 (95% CI, 1.3-4.9) and OR = 4.2 (95% CI, 1.1-13.5), respectively). Of the ultrasonographic sphincter defects, 80% were not reported as OASIS at first or subsequent deliveries.Conclusions: Anal sphincter defects visualized on transperineal ultrasound 15-24 years after first delivery were associated with FD and development of FI. Ultrasound revealed a high proportion of sphincter defects that were not recorded as OASIS at delivery. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: To validate a prediction model for successful vaginal birth after Cesarean delivery (VBAC) based on sonographic assessment of the hysterotomy scar, in a Swedish population.Methods: Data were collected from a prospective cohort study. We recruited non-pregnant women aged 18-35 years who had undergone one previous low-transverse Cesarean delivery at ≥ 37 gestational weeks and had had no other uterine surgery. Participants who subsequently became pregnant underwent transvaginal ultrasound examination of the Cesarean hysterotomy scar at 11 + 0 to 13 + 6 and at 19 + 0 to 21 + 6 gestational weeks. Thickness of the myometrium at the thinnest part of the scar area was measured. After delivery, information on pregnancy outcome was retrieved from hospital records. Individual probabilities of successful VBAC were calculated using a previously published model. Predicted individual probabilities were divided into deciles. For each decile, observed VBAC rates were calculated. To assess the accuracy of the prediction model, receiver-operating characteristics curves were constructed and the areas under the curves (AUC) were calculated.Results: Complete sonographic data were available for 120 women. Eighty (67%) women underwent trial of labor after Cesarean delivery (TOLAC) with VBAC occurring in 70 (88%) cases. The scar was visible in all 80 women at the first-trimester scan and in 54 (68%) women at the second-trimester scan. AUC was 0.44 (95% CI, 0.28-0.60) among all women who underwent TOLAC and 0.51 (95% CI, 0.32-0.71) among those with the scar visible sonographically at both ultrasound examinations.Conclusion: The prediction model demonstrated poor accuracy for prediction of successful VBAC in our Swedish population. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To compare the appearance and measurement of Cesarean hysterotomy scar before pregnancy and at 11–14 weeks in a subsequent pregnancy. Methods: This was a prospective cohort study of women aged 18–35 years who had one previous Cesarean delivery (CD) at ≥ 37 weeks. Women were examined with saline contrast sonohysterography 6–9 months after CD. A scar defect was defined as large if scar thickness was ≤ 2.5 mm. Women were followed up and those who became pregnant were examined by transvaginal ultrasound at 11–14 weeks. Scar thickness was measured and scars were classified subjectively as a scar with or without a large defect. A receiver–operating characteristics curve was constructed to determine the best cut‐off value for scar thickness to define a large scar defect at the 11–14‐week scan. Results: A total of 111 women with a previous CD were scanned in the non‐pregnant state and at 11–14 weeks in a subsequent pregnancy. The best cut‐off value for scar thickness to define a large scar defect at 11–14 weeks was 2.85 mm, which had 90% sensitivity (18/20), 97% specificity (88/91) and 95% accuracy (106/111). In the non‐pregnant state, large scar defects were found in 18 (16%) women and all were confirmed at the 11–14‐week scan. In addition, a large defect was found in three women at 11–14 weeks that was not identified in the non‐pregnant state. Conclusion: The appearance of the Cesarean hysterotomy scar was similar in the non‐pregnant state and at 11–14 weeks in a subsequent pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: To study the correlation between palpation, perineometry and transperineal ultrasound for assessment of pelvic floor muscle contraction and to define a contraction scale for ultrasound measurements.Methods: This was a cross-sectional study of 608 women examined with palpation of pelvic floor muscle contraction, using the Modified Oxford Scale, and measurement of the vaginal squeeze pressure with a vaginal balloon connected to a fiber-optic microtip transducer (perineometry). Transperineal ultrasound was used for measurements of levator hiatal area and anteroposterior (AP) diameter in the plane of minimal hiatal dimensions, at rest and on contraction. The pelvic floor muscle contraction was expressed as the percentage difference between values at rest and on contraction. Spearman's rank was used to test for correlation between the different methods of assessment.Results: Significant correlations were found between all assessment methods (P < 0.001). Palpation correlated with perineometry (rs = 0.74) and with proportional change in hiatal area (rs = 0.67) and AP diameter (rs = 0.69) on ultrasound. Perineometry correlated with proportional change in hiatal area (rs = 0.60) and AP diameter (rs = 0.66) on ultrasound. We defined a contraction scale based on the proportional change in AP diameter. In this population, a change in AP diameter of < 7% corresponded to absence of contractions, 7-18% corresponded to weak contractions, 18-35% corresponded to normal contractions and > 35% corresponded to strong contractions.Conclusions: We found moderate to strong correlation between ultrasound measurements, palpation and perineometry for assessing pelvic floor muscle contraction. The proportional change in levator hiatal AP diameter was the ultrasound measurement with strongest correlation to palpation and perineometry and formed the basis for the contraction scale for ultrasound measurements. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives: To determine intra- and interobserver reliability of evaluating the appearance and measurement of Cesarean hysterotomy scars using transvaginal ultrasound (TVS), with and without saline contrast sonohysterography (SCSH), in non-pregnant women. Methods: Fifty-six women with one previous Cesarean delivery were examined by TVS, with and without contrast enhancement, 6-9 months after the Cesarean delivery. Two observers, blinded to their own and each other's measurements, evaluated the appearance of the hysterotomy scar and measured the myometrial thickness adjacent to the scar or scar defect (MTS). If a scar defect was noted, the remaining myometrial thickness over the defect (RMT) was measured. A scar defect was defined as large if RMT was ≤ 2.2 mm on conventional TVS and ≤ 2.5 mm when SCSH was performed. Intra- and interobserver reliability of conventional TVS and SCSH were assessed. Results: Intraobserver reliability was good, with intraclass correlation coefficients (ICCs) of ≥ 0.97 for measurements of MTS and RMT on conventional TVS and SCSH. Interobserver ICCs for measurements obtained on SCSH were 0.85 (95% CI, 0.76-0.91) for MTS and 0.96 (95% CI, 0.93-0.98) for RMT, compared with 0.82 (95% CI, 0.72-0.89) for MTS and 0.87 (95% CI, 0.68-0.95) for RMT measured on conventional TVS. The kappa coefficient for measurements obtained on SCSH was 0.92, compared with 0.85 for conventional TVS. Intermethod ICC was 0.86 (95% CI, 0.78-0.92) for measurement of MTS and 0.89 (95% CI, 0.78-0.95) for measurement of RMT, with a kappa coefficient of 0.57. Conclusions: Measurement of RMT using SCSH is a reliable method for assessing Cesarean hysterotomy scars in non-pregnant women and can be used in clinical practice. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives: To ascertain if fetal head position on transabdominal ultrasound is associated with delivery by Cesarean section in nulliparous women with a prolonged first stage of labor.Methods: This was a prospective observational study performed at Stavanger University Hospital, Norway, and Addenbrooke's Hospital, Cambridge, UK, between January 2012 and April 2013. Nulliparous pregnant women with a singleton cephalic presentation at term and prolonged labor had fetal head position assessed by ultrasound. The main outcome was Cesarean section vs vaginal delivery, and secondary outcomes were association of fetal head position with operative vaginal delivery and duration of remaining time in labor.Results: Fetal head position was assessed successfully by ultrasound examination in 142/150 (95%) women. In total, 19/50 (38%) women with a fetus in the occiput posterior (OP) position were delivered by Cesarean section compared with 16/92 (17%) women with a fetus in a non-OP position (P = 0.01). On multivariable logistic regression analysis, the OP position predicted delivery by Cesarean section with an odds ratio (OR) of 2.9 (95% CI, 1.3-6.7; P = 0.01) and induction of labor with an OR of 2.4 (95% CI, 1.0-5.6; P = 0.05). Fetal head position was not associated with operative vaginal delivery or with remaining time in labor. The agreement between a digital and an ultrasound assessment of OP position was poor (Cohen's kappa = 0.19; P = 0.18).Conclusion: OP fetal head position assessed by transabdominal ultrasound was significantly associated with delivery by Cesarean section. [ABSTRACT FROM AUTHOR]

Objectives: To study possible associations between mode of delivery and pelvic organ prolapse (POP) and pelvic floor muscle trauma 16-24 years after first delivery and, in particular, to identify differences between forceps and vacuum delivery.Methods: This was a cross-sectional study including 608 women who delivered their first child in 1990-1997 and were examined with POP quantification (POP-Q) and pelvic floor ultrasound in 2013-2014. Outcome measures were POP ≥ Stage 2 or previous prolapse surgery, levator avulsion and levator hiatal area on Valsalva. Univariable and multivariable logistic regression analyses and ANCOVA were applied to identify outcome variables associated with mode of delivery.Results: Comparing forceps to vacuum delivery, the adjusted odds ratios (aOR) were 1.72 (95% CI, 1.06-2.79; P = 0.03) for POP ≥ Stage 2 or previous prolapse surgery and 4.16 (95% CI, 2.28-7.59; P < 0.01) for levator avulsion. Hiatal area on Valsalva was larger, with adjusted mean difference (aMD) of 4.75 cm(2) (95% CI, 2.46-7.03; P < 0.01). Comparing forceps with normal vaginal delivery, the adjusted odds ratio (aOR) was 1.74 (95% CI, 1.12-2.68; P = 0.01) for POP ≥ Stage 2 or surgery and 4.35 (95% CI, 2.56-7.40; P < 0.01) for levator avulsion; hiatal area on Valsalva was larger, with an aMD of 3.84 cm(2) (95% CI, 1.78-5.90; P < 0.01). Comparing Cesarean delivery with normal vaginal delivery, aOR was 0.06 (95% CI, 0.02-0.14; P < 0.01) for POP ≥ Stage 2 or surgery and crude OR was 0.00 (95% CI, 0.00-0.30; P < 0.01) for levator avulsion; hiatal area on Valsalva was smaller, with an aMD of -8.35 cm(2) (95% CI, -10.87 to -5.84; P < 0.01). No differences were found between vacuum and normal vaginal delivery.Conclusions: We found that mode of delivery was associated with POP and pelvic floor muscle trauma in women from a general population, 16-24 years after their first delivery. Forceps was associated with significantly more POP, levator avulsion and larger hiatal areas than were vacuum and normal vaginal deliveries. There were no statistically significant differences between vacuum and normal vaginal deliveries. Cesarean delivery was associated with significantly less POP and pelvic floor muscle trauma than were normal or operative vaginal delivery. [ABSTRACT FROM AUTHOR]

In population 1, maternal BMI, maternal age, HPD, gestational age and birthweight were the strongest contributors to the first principal component which accounted for 19% of data variation. Principle Component Analysis (PCA) was used in patients without missing data(n = 391) to establish which characteristics were the main contributors to the first principal component which accounts for the largest possible variance in the data for the combined datasets. To compare the predictive value of labour parameters for mode of delivery in two geographically and demographically different populations. [Extracted from the article]

Objective To investigate whether head-perineum distance (HPD) measured by transperineal ultrasound is predictive of vaginal delivery and time remaining in labor in nulliparous women with prolonged first stage of labor and to compare the predictive value with that of angle of progression (AoP). Methods This was a prospective observational study at Stavanger University Hospital, Norway and Addenbrooke's Hospital, Cambridge, UK from January 2012 to April 2013, of nulliparous women with singleton pregnancies with cephalic presentation at term with prolonged first stage of labor. We used transperineal ultrasound to measure HPD (shortest distance between the outer bony limit of the fetal skull and the perineum) and AoP (angle between a line through the long axis of the symphysis and the tangent to the fetal head) and transabdominal ultrasound to classify fetal head position. The main outcomes were vaginal delivery and time remaining in labor. Results Of 150 women enrolled, 39 underwent delivery by Cesarean section. The area under the receiver-operating characteristics curve for the prediction of vaginal delivery was 81% (95% CI, 73-89%) using HPD as the test variable and 72% (95% CI, 63-82%) using AoP. HPD was ≤ 40 mm in 84 (56%) women, of whom 77 (92%; 95% CI, 84-96%) delivered vaginally. HPD was > 40 mm in the other 66 (44%) women, of whom 34 (52%; 95% CI, 40-63%) delivered vaginally. AoP was ≥ 110° in 84 of the 145 (58%) in whom this was available and, of these, 74 (88%; 95% CI, 79-93%) delivered vaginally. AoP was < 110° in the other 61 (42%) women, of whom 35 (57%; 95% CI, 45-69%) delivered vaginally. Multivariable logistic regression analysis showed that HPD ≤ 40 mm (odds ratio (OR), 4.92; 95% CI, 1.54-15.80), AoP ≥ 110° (OR, 3.11; 95% CI, 1.01-9.56), non-occiput posterior position (OR, 3.36; 95% CI, 1.24-9.12) and spontaneous onset of labor (OR, 4.44; 95% CI, 1.42-13.89) were independent predictors for vaginal delivery. Both ultrasound methods were predictive for the time remaining in labor. Conclusion Transperineal ultrasound measurement of HPD and AoP provide important information about the likelihood of vaginal delivery and the time remaining in labor in nulliparous women with prolonged labor. [ABSTRACT FROM AUTHOR]

Objective To determine if postmortem examinations of fetuses and infants change the diagnosis obtained at prenatal ultrasound and affect counseling of future pregnancies, and if there has been a change over recent years in the accuracy of prenatal ultrasound diagnosis. Methods This was a retrospective review of 455 autopsies of fetuses and infants with developmental anomalies performed at Trondheim University Hospital between 1995 and 2004 and with a prenatal ultrasound examination performed at a tertiary referral center. The routine ultrasound examinations were performed by specially trained midwives and obstetricians, referral scans by fetal medicine experts and autopsies by consultant pathologists with experience in perinatal pathology. The results of this study were also compared with those of a previous similar study performed between 1985 and 1995, with fetuses and infants coming from the same population and diagnosed at the same center. Results Of all cases analyzed during the study period, there was complete agreement between prenatal ultrasound and postmortem findings in 84% (384/455), i.e. prenatal ultrasound diagnoses were supplemented by postmortem examinations in 16% (71/455). Autopsy findings in four of these cases influenced further counseling. There was agreement regarding the main diagnosis in 98% (445/455) of cases. In the previous 10-year period, there was complete agreement in 75% and the main diagnosis was correct in 90% of cases. These differences between the two time periods were statistically significant ( P = 0.0004 and P < 0.0001, respectively). The most frequent defects involved the central nervous system, heart and urinary tract. For these defects, detection rates for the main diagnoses were significantly better in 1995-2004 compared with in the previous 10-year period ( P = 0.0125, P = 0.0111 and P = 0.0241, respectively). Conclusion The accuracy of prenatal sonographic detection of developmental anomalies has increased in recent years. However, postmortem examination is still necessary to verify or improve the prenatal diagnosis and may influence future counseling. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

All cases of ichthyosis prematurity syndrome (IPS), registered at the National Center for Fetal Medicine in Trondheim, Norway between 1987 and 2010 were identified and the findings analyzed. Five fetuses with IPS were identified between 1988 and 2000. All five developed polyhydramnios between 28 and 31 weeks. The fetal stomach appeared to be empty in four cases, and was not described in one case. The fetal skin was described as 'uneven' at ultrasound examination in two cases. Separation of chorionic and amniotic membranes with a peculiar appearance of echo-free fluid in the chorionic cavity and echogenic sediment in the amniotic cavity were observed between 28 + 5 and 32 + 3 weeks in all cases. All fetuses were delivered prematurely between 30 and 34 weeks. All neonates had difficulties in breathing, two developed aspiration pneumonia, and one had bilateral pneumothorax after intubation and died at 6 months because of pulmonary and cardiac sequelae. Prenatal sonographic signs of IPS are separation of the membranes, echogenic amniotic fluid and echo-free chorionic fluid occurring between 28 and 32 weeks' gestation. Delivery occurs at 30-34 weeks and, as there is a high risk of asphyxia, an experienced neonatal intensive care unit team should be present at delivery. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To study intraobserver repeatability and intermethod agreement between two- (2D) and three-dimensional (3D) transperineal ultrasound methods in assessing fetal head descent during the first stage of labor. Methods Fetal head descent was measured with transperineal ultrasound as the fetal head-perineum distance and the angle of progression in 106 primiparous women with prolonged first stage of labor. A single obstetrician performed all the scans, and another obstetrician analyzed the acquired 2D images and 3D volumes, blinded to clinical assessments and labor outcome. Intraobserver repeatability and intermethod agreement between 2D and 3D methods were analyzed. Results The repeatability coefficient was ± 4.1 mm in 2D acquisitions and ± 1.7 mm in 3D acquisitions of fetal head-perineum distance. The intraclass correlation coefficients (ICC) were 0.94 for 2D and 0.99 for 3D measurements. The angle of progression repeatability coefficients were ± 6.7° using 2D and ± 5.7° using 3D ultrasound and ICCs were 0.91 and 0.94, respectively. The intermethod ICC for fetal head-perineum distance in 2D vs 3D acquisitions was 0.95 and for angle of progression it was 0.93; the intermethod 95% limits of agreement were − 5.8 mm to + 7.2 mm and − 8.9° to + 13.7°, respectively. Cohen's kappa for 2D vs 3D acquisitions was 0.85 using 40 mm as a cut-off level for fetal head-perineum distance and 0.79 using 110° as cut-off level for angle of progression. Conclusions For one ultrasound operator the intraobserver repeatability and agreement between 2D and 3D ultrasound methods in prolonged first stage of labor were good. Given that 2D methods are simpler to learn and can be analyzed quickly online, 2D equipment might therefore be preferred in the labor room. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To study the association between exposure to ultrasound in pregnancy and non-right handedness in children with available data from randomized trials. Methods Follow-up data of 8865 children aged 8-14 years from three randomized trials on routine ultrasonography at 15-20 weeks' gestation were available. Handedness was assessed through questionnaires to the parents and classified according to five, 10 or 11 questions. Children not classified as right handed were regarded as non-right handed. Results There was a statistically significant increased prevalence of non-right handedness in ultrasonographically screened children compared with controls (odds ratio (OR) 1.15; 95% CI, 1.03-1.29). The results in subgroups according to gender are consistent with the overall results, with no significant differences between boys and girls. Among boys, the association became stronger when an exploratory analysis according to ultrasound exposure before 19-22 weeks' gestation was done (OR 1.30; 95% CI, 1.10-1.53). Conclusion There is a statistically significant-albeit weak-association between ultrasound screening during pregnancy and being non-right handed later in life. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In this article, the authors discuss the issue on the use of Doppler ultrasound during the 13 + 6-week fetus scan. Statement from International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) cites that the use of Doppler follows precautionary measures during first trimester of fetus gestation. It mentions questions regarding Doppler's use to refine risks of trisomies. According to ISUOG, Doppler examination should not be performed without clinical indications.

Objective To investigate if fetal head-perineum distance and angle of progression measured with two-dimensional (2D) and three-dimensional (3D) transperineal ultrasound could predict outcome of labor in primiparous women with prolonged first stage of labor. Methods This was a prospective observational study of 110 primiparous women with singleton cephalic presentation at term diagnosed with prolonged first stage of labor. Digital assessment of fetal station was related to the ischial spine. Fetal head descent was measured with transperineal ultrasound as the shortest distance from the fetal head to the perineum, and the angle between the pubic symphysis and the fetal head. Receiver-operating characteristics (ROC) curves were constructed and 2D and 3D data acquisitions were compared. The stored 3D volumes were assessed by an examiner blinded to all other data. Vaginal delivery vs. Cesarean section was the primary outcome. Results Cesarean section was performed in 25% of the women. Areas under the ROC curves for prediction of vaginal delivery were 81% (95% confidence interval (CI), 71-91%) (P < 0.01) and 76% (95% CI, 66-87%) (P < 0.01) for fetal head-perineum distance and angle of progression, respectively, as measured by 2D ultrasound and 66% (95% CI, 54-79%) for digital assessment of fetal station (P = 0.01). In 50% of women fetal head-perineum distance was ⩽40 mm and 93% (95% CI, 83-97%) of them delivered vaginally vs. 18% (95% CI, 5-48%) with distance >50 mm. In 48% of women the angle of progression was ⩾110° and 87% (95% CI, 75-93%) of them delivered vaginally vs. 38% (95% CI, 21-57%) with angle <100°. Results from 2D and 3D acquisitions were similar. Conclusion Fetal head-perineum distance and angle of progression measured with 2D or 3D ultrasound can predict labor outcome, with similar predictive values for the two techniques. [ABSTRACT FROM AUTHOR]

The authors reflect on the state of basic ultrasound training on obstetrics and gynecology in Europe. The authors argue that all obstetricians and gynecologists should attend basic training to avoid diagnostic errors in the use of ultrasound. They mention that basic training in Europe differs in every European country. Furthermore, the definition of basic level of competence, the development of easy and consistent process of assessment, and the harmonization of training in Europe are suggested.

In light of the growing number of SARS-CoV-2 infections and in particular the highly infectious Omicron VOC, the USA Centers for Disease Control and Prevention has predicted and provided strategies to limit the effects of healthcare staff shortages5. ISUOG Safety Committee updated recommendation on use of respirators by practitioners undertaking obstetric and gynecological ultrasound in context of SARS-CoV-2 Omicron variant of concern In view of the rapid spread of the Omicron variant of concern (VOC) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)1, the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) has decided to revise its position statements on use of personal protective equipment for the safe performance of obstetric and gynecological ultrasound2,3, particularly in relation to the protection of healthcare workers. [Extracted from the article]

The article presents a study which evaluates fetal head-perineum distance measured by transperineal ultrasound imaging as a predictive factor for induction of labor (IOL), and to compare this distance with maternal factors, Bishop score and ultrasound measurements of cervical length, cervical angle and occiput position. Findings reveal that fetal head-perineum distance can predict vaginal delivery after IOL, with a predictive value similar to that of Bishop score and ultrasound measurements.

Objectives To study a possible effect of metformin on the utero placental circulation. Methods Forty pregnant women with polycystic ovary syndrome (PCOS) were enrolled in a randomized, double-blind, placebo-controlled trial of metformin (1700 mg/day) during pregnancy. Doppler ultrasound examinations of the uterine arteries were performed at 12, 19, 24, 32 and 36 gestational weeks and of the umbilical artery at 19, 24, 32 and 36 gestational weeks. Results There was a greater mean bilateral uterine artery pulsatility index (PI) at 12 weeks (1.95 vs. 1.58, P = 0.02), and a greater reduction in mean PI from 12 to 19 weeks (P = 0.03) in metformin-treated women. There were no differences in mean PI values between groups at 19, 24, 32 or 36 gestational weeks. Pregnancy complications, such as preterm delivery before 32 weeks, severe pre-eclampsia or serious postpartum events, occurred only in the placebo group (7 of 22 vs. 0 of 18, P = 0.01). There were no associations between uterine artery Doppler measurements and pregnancy complications. We found no differences between groups in mean umbilical artery PI at 19, 24, 32 or 36 gestational weeks. Conclusions In this small randomized trial, metformin treatment in pregnancy reduced uterine artery impedance between 12 and 19 weeks of gestation, and this was associated with reduced complication rate. [ABSTRACT FROM AUTHOR]

The aim of this randomized controlled trial was to evaluate the effect of preoperative optimization of pelvic floor contraction and increased pelvic floor muscle contraction on the outcome after pelvic organ prolapse (POP) surgery. A single examination during which women received instructions on how to perform a proper pelvic floor muscle contraction is probably insufficient to induce changes in pelvic floor contraction 6 months after surgery. In a previous study, we assessed the reliability of ultrasound for measurement of pelvic floor muscle contraction and its correlation with vaginal palpation[4]. [Extracted from the article]

Objective To evaluate whether engagement of the fetal head or cervical length in women with premature rupture of membranes (PROM) at term, are associated with time from PROM to delivery or need for operative delivery. Methods A transperineal ultrasound examination was performed in 152 women with a single live fetus in cephalic presentation after PROM (at >37 gestational weeks). The shortest distance front the outer bony limit of the fetal skull to the skin surface of the perineum was measured in a transverse view, and the cervical length was measured in a sagittal view. The time from PROM to delivery was tested in a Cox regression analysis with ultrasound measurements, parity, maternal age, body mass index and birth weight as possible predictive factors. Results The head-perineal distance was associated with the time front PROM to delivery (log rank test, P < 0.001). Thirty-six hours after PROM, 32% (95% CI, 15–49) of women with a short head-perineal distance (<45 mm) and 43% (95% CI, 24–62) of women with a long distance (≥45 mm) were still in labor. Women with a short head-perineal distance had fewer Cesarean sections, less use of epidural analgesia and a shorter time in active labor, and their babies had a higher pH in the umbilical artery. The measured cervical length was not associated independently with time to delivery. Conclusion Transperineal ultrasound measurements of fetal head engagement may help clinicians to predict the course of labor in women with PROM. [ABSTRACT FROM AUTHOR]

Objectives Infants with gastroschisis have a high survival rate. However, the rate (10–15%) of intrauterine fetal death (IUFD) is considerable, and the association with fetal distress is well known. The aim of this study was to describe the outcome of fetuses with a prenatal diagnosis of gastroschisis. The impact of correct prenatal diagnosis, surveillance and signs of complicating risk factors were evaluated. Methods All fetuses with prenatally diagnosed gastroschisis at the National Center for Fetal Medicine from January 1988 to August 2002 were registered and prospectively evaluated with regular ultrasound examinations. From 34–36 completed gestational weeks the fetuses were monitored daily to every second day with cardiotocography (CTG). Results Gastroschisis was diagnosed in 64 fetuses at a mean gestational age of 19 + 2 weeks. All had normal karyotype. Associated anomalies were found in four cases (6.3%). Three pregnancies (4.7%) were terminated, all for reasons other than gastroschisis. One fetus (1.6%) died in utero. Thirteen fetuses (22%) had abnormal CTG leading to subsequent Cesarean sections. Mean gestational age at delivery was 36 + 1 weeks. Mean birth weight was 2586 g. Thirteen infants (22%) were small for gestational age (SGA). In 15 cases (25%) meconium-stained amniotic fluid was found; 14 of these had abnormal CTG and/or were SGA. Small bowel atresia was found in four infants (6.7%). Four infants died postnatally at the age of 0–9 months. Conclusions CTG surveillance of fetuses with gastroschisis may improve the outcome through detection of fetal distress thereby reducing the risk of IUFD. Other clinical situations of importance that are associated with gastroschisis are described and discussed. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives The aim of this study was to describe the outcome of fetuses with duodenal obstruction diagnosed prenatally and to compare the outcome with the results of studies of newborns. Methods All fetuses with a prenatal diagnosis of duodenal obstruction were registered and evaluated prospectively from January 1985 to December 2000. Results Duodenal obstruction was found in 29 fetuses at a mean gestational age of 29+2 weeks. Polyhydramnios was found in 24 cases (83%). Six fetuses (21%) had trisomy 21. Associated anomalies, including trisomy 21, were found in 18 cases (62%). Four fetuses with normal karyotype died in utero at 31–35 gestational weeks. Two of them had associated anomalies, but the anomalies could not explain the prenatal deaths and the deaths occurred suddenly and unexpectedly. Three infants died postnatally; all three had associated anomalies. Four infants with normal karyotype had neurological impairment suggesting that they might have had intrauterine asphyxia. Conclusions The present study indicates that duodenal obstruction is a more serious condition than previously believed, with an increased risk of prenatal asphyxia and death, even when the karyotype is normal and no associated anomalies are present. We consider the possibility that it could be caused by bradycardia/asystole following vagal overactivity due to distension of the upper gastrointestinal tract. [ABSTRACT FROM AUTHOR]

Editorial. Comments on the association between prenatal ultrasound and left-handedness among males. Relevant studies on the possible adverse effects of ultrasound during pregnancy; Evidence from randomized controlled trials; Judgment of causality.

ABSTRACTObjectiveTo investigate the prenatal appearance of the holoprosencephaly spectrum. MethodsA database of 1750 fetuses with congenital anomalies identified by ultrasound was prospectively collected from 1987 to 2000. Among them, 30 cases (1.7%) with holoprosencephaly were prenatally identified and described. ResultsThe prevalence of holoprosencephaly in the Health Region of the National Center for Fetal Medicine in Norway was 1.26 : 10 000; the sex distribution (male : female) was 1.4 : 1. Holoprosencephaly was found in one dichorionic twin pregnancy and one pair of conjoined twins. Among the 30 cases of holoprosencephaly, 18 were alobar, five were semilobar, two were lobar, two were lobar variants, and three were anencephalic. The facial features varied considerably. Sixty-seven per cent (20/30) had associated structural anomalies that were not related to the cerebral and facial holoprosencephaly condition. Thirty-seven per cent (11/30) had detectable chromosome aberrations and 23% (7/30) had nonchromosomal syndromal origin. The size or shape of the head was abnormal in 83% (25/30) of holoprosencephaly cases. ConclusionThis study indicates that holoprosencephaly represents a heterogeneous entity with different etiologies and clinical appearances. The fact that holoprosencephaly features are found associated with particular conditions such as fronto-nasal dysplasia (2/30; 6.7%), agnathia-otocephaly (3/30; 10%), and anencephaly (3/30; 10%), suggests that these may be underreported conditions in other large holoprosencephaly series. [ABSTRACT FROM AUTHOR]

Comments on issues regarding the diagnosis of fetal abdominal wall defects in 19 European Congenital Malformation Registries. Prevalence rates of gastroschisis and omphalocele; Termination of pregnancy; Mode and timing of delivery.

Objective To evaluate the possible benefits of the routine use of ultrasound screening in pregnancy. Design A randomized controlled trial was designed to detect a 50% difference in the incidence of induction for apparent post-term pregnancies between women who were screened with ultrasound and unscreened women. A total of 1628 pregnant women from the general population were included. Eight hundred and twenty-five were allocated to an ultrasound examination at the 18th and 32nd week of pregnancy in addition to receiving routine antenatal care. The remaining 803 women received standard antenatal care, but could only be referred for ultrasound examination on clinical indication. Results The incidence of induced labor due to apparent post-term pregnancies was approximately 70% lower in the ultrasound-screened group. Inductions from all causes were also less frequent among ultrasound-screened women. There were six perinatal deaths among the screened and seven among the controls after excluding three lethal malformations among the controls. There was no difference in Apgar score after 1 min, but the proportion with Apgar score less than 8 after 5 min was lower among the screened group (P = 0.04). The need for positive pressure ventilation for more than 1 min was lower among the screened group (P = 0.02). Birth weight was slightly higher in the screened group (39 g), but the difference was not statistically significant. Among the controls three pairs of twins remained undiagnosed until the mothers were admitted to the hospital in labor at between 36 and 38 weeks gestation. Conclusion These results suggest that for women who were screened with ultrasound, obstetricians were less likely to induce labor due to apparent post-term pregnancy, than for women who were not screened. All 10 pairs of twins in the screened group were diagnosed at the routine examination. These data also suggest that perinatal morbidity might be slightly lower in the screened group. [ABSTRACT FROM AUTHOR]

Conclusions The addition of data from a new centre provided a good AUC labour prediction curve despite different baseline population characteristics. To investigate whether the addition of population data from a different site to a labour prediction model changed prediction. [Extracted from the article]

A multivariable analysis of initial assessment: gestational age, HPD, cervical dilatation and caput gave AUC 0.72. Conclusions The most promising prognostic parameters for intrapartum Caesarean delivery are initial HPD, cervical dilatation at initial assessment and on repeat assessment change in cervical dilatation. [Extracted from the article]

Objective A possible association between ultrasound during pregnancy and subsequent non-right handedness among children has been suggested. The association has been reported to be stronger among boys. The aim of the present study was to explore this further through a meta-analysis of two follow-up studies of three randomized controlled trials of routine ultrasonography during pregnancy. Design Handedness was assessed through a questionnaire to the parents, and 4715 children at the age of 8–9 years were included in the meta-analysis. Results There was no statistically significant difference in the prevalence of non-right handedness between the ultra-sound-screened children and the controls, but there was a statistically significant difference in a subgroup analysis among the boys. Exploratory analyses according to exposure or non-exposure indicated an even stronger association between ultrasound and non-right handedness. Conclusions A conservative analytical approach indicates no association between ultrasound in utero and subsequent non-right handedness. The results from the exploratory analyses must be interpreted with caution. There is still a need for further research. [ABSTRACT FROM AUTHOR]

Head-Perineum Distance (HPD) was measured between contractions and during maximum contraction during active pushing, and the difference was calculated as delta-HPD. The main outcome was duration of operative delivery. Secondary outcomes were mode of delivery and neonatal outcome. [Extracted from the article]

In this context, the distinction between clinics offering diagnostic obstetric or gynecological ultrasound performed by practitioners who are trained, certified and recognized by national and/or professional bodies and those settings undertaking ultrasound scans without these safeguards, whose primary intent is "souvenir ultrasound", is important. In light of well-publicized concerns about ultrasound safety and the potential for anxiety to be caused by incorrect diagnosis and, in certain cases, for false reassurance to be given, the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) does not endorse ultrasound scans undertaken solely for non-diagnostic purposes in these settings. In recent years, ultrasound clinics whose primary purpose is to provide souvenir two-dimensional or three-dimensional (3D) images or video recordings of the developing baby have become commonplace. [Extracted from the article]

ISUOG statement on the safe use of Doppler for fetal ultrasound examination in the first 13 + 6 weeks of pregnancy (updated) Spectral Doppler, color flow imaging, power imaging and other Doppler ultrasound modalities should not be used routinely in the embryonic period. Uterine artery Doppler When scanning maternal uterine arteries at any point in the first trimester, there are unlikely to be any fetal safety implications as long as the embryo/fetus lies outside the Doppler ultrasound beam. [Extracted from the article]

The author provides explanation why he suggests "transperineal ultrasound" be given for the method involving ultrasound imaging of the pelvic floor. The author said that the name is a general and not gender-specific and is a frequently used term in the medical literature. The suggested name is similar to other universally accepted names of ultrasound modalities that is strongly favored for its use.

Our objective was to explore the effect of pelvic floor exercise on contraction, anatomical and symptomatic POP in women scheduled for POP surgery. Exercise prior to surgery was associated with stronger contraction evaluated by MOS, but not by ultrasound and had no effect on anatomical POP or sensation of bulge. [Extracted from the article]

A response by W. Gyselaers to a letter to the editor regarding his article "Role of dysfunctional maternal venous hemodynamics in the pathophysiology of pre-eclampsia: a review" in the 2011 issue is presented.

A letter to the editor is presented in response to the article "Sonographic assessment of fetal spine and head position during the first and second stages of labor for the diagnosis of persistent occiput posterior position: a pilot study" by I. Blasi, V. Fenu, I. Fuchs and colleagues in the 2010 issue is presented.

The author reflects on the article "Maternal outcomes at 3 months after planned caesarean section versus planned vaginal birth for twin pregnancies in the Twin Birth Study: a randomised controlled trial," by E. K. Hutton and colleagues in the 2015 issue. Topics include the difficulty of counselling due to the association of outcomes with mode of delivery in twins, maternal health after the first year of twin births, and the difference between a planned vaginal birth and caesarean section.