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The use of assisted reproductive technology has increased in the United States in the past several decades. Although most of these pregnancies are uncomplicated, in vitro fertilization is associated with an increased risk for adverse perinatal outcomes primarily caused by the increased risks of prematurity and low birthweight associated with in vitro fertilization pregnancies. This Consult discusses the management of pregnancies achieved with in vitro fertilization and provides recommendations based on the available evidence. The recommendations by the Society for Maternal-Fetal Medicine are as follows: (1) we suggest that genetic counseling be offered to all patients undergoing or who have undergone in vitro fertilization with or without intracytoplasmic sperm injection (GRADE 2C); (2) regardless of whether preimplantation genetic testing has been performed, we recommend that all patients who have achieved pregnancy with in vitro fertilization be offered the options of prenatal genetic screening and diagnostic testing via chorionic villus sampling or amniocentesis (GRADE 1C); (3) we recommend that the accuracy of first-trimester screening tests, including cell-free DNA for aneuploidy, be discussed with patients undergoing or who have undergone in vitro fertilization (GRADE 1A); (4) when multifetal pregnancies do occur, we recommend that counseling be offered regarding the option of multifetal pregnancy reduction (GRADE 1C); (5) we recommend that a detailed obstetrical ultrasound examination (CPT 76811) be performed for pregnancies achieved with in vitro fertilization and intracytoplasmic sperm injection (GRADE 1B); (6) we suggest that fetal echocardiography be offered to patients with pregnancies achieved with in vitro fertilization and intracytoplasmic sperm injection (GRADE 2C); (7) we recommend that a careful examination of the placental location, placental shape, and cord insertion site be performed at the time of the detailed fetal anatomy ultrasound, including evaluation for vasa previa (GRADE 1B); (8) although visualization of the cervix at the 18 0/7 to 22 6/7 weeks of gestation anatomy assessment with either a transabdominal or endovaginal approach is recommended, we do not recommend serial cervical length assessment as a routine practice for pregnancies achieved with in vitro fertilization (GRADE 1C); (9) we suggest that an assessment of fetal growth be performed in the third trimester for pregnancies achieved with in vitro fertilization; however, serial growth ultrasounds are not recommended for the sole indication of in vitro fertilization (GRADE 2B); (10) we do not recommend low-dose aspirin for patients with pregnancies achieved with IVF as the sole indication for preeclampsia prophylaxis; however, if 1 or more additional risk factors are present, low-dose aspirin is recommended (GRADE 1B); (11) given the increased risk for stillbirth, we suggest weekly antenatal fetal surveillance beginning by 36 0/7 weeks of gestation for pregnancies achieved with in vitro fertilization (GRADE 2C); (12) in the absence of studies focused specifically on timing of delivery for pregnancies achieved with IVF, we recommend shared decision-making between patients and healthcare providers when considering induction of labor at 39 weeks of gestation (GRADE 1C). [ABSTRACT FROM AUTHOR]

Objectives: To determine whether a novel, noninvasive quantitative ultrasound (US) technique can detect differences in proximal and distal cervical tissue echogenicity in women with and without a shortened cervical length (CL). Methods: We conducted a retrospective case‐control study of singleton pregnancies at 16 to 26 weeks' gestation in which a transvaginal US examination was performed to measure CL from 2013 to 2015. Initial CLs in cases and controls were less than 2.5 cm and 2.5 cm or greater, respectively. For each US image, a region of interest was selected in the proximal and distal cervical stroma, in both the anterior and posterior cervical lips. The Floyd‐Steinberg dithering algorithm transformed grayscale pixels in each region of interest into a binary map. A histogram tabulated the number of black and white pixels, allowing determination of the percent echogenicity. The difference in the percent echogenicity was calculated by subtracting the distal cervical echogenicity (average of anterior and posterior lips) from the proximal cervical echogenicity (average of anterior and posterior lips). Results: Ultrasound images from 177 women were analyzed. There was a difference in the percent echogenicity (P < .0001) when comparing women with a short cervix (mean ± SD, 9.8 ± 10.1; n = 102) to women with a normal CL (17.2 ± 9.5; n = 75). Differences were attributable to changes in proximal (P < .008) rather than distal cervical echogenicity. Regardless of CL, the proximal cervix was more echogenic than the distal cervix. Conclusions: A quantitative US analysis of cervical tissue can detect differences in echogenicity between the proximal and distal cervix in the second trimester. Proximal cervical echogenicity is lower with CL of less than 2.5 cm compared to a normal CL. [ABSTRACT FROM AUTHOR]

Around the world, ultrasound in the specialty of obstetrics and gynecology (Ob/Gyn) has been performed and interpreted by a spectrum of healthcare providers: obstetrician-gynecologists, radiologists, sonographers, midwives and nurses. Depending on training and tradition, and practice differs not only between countries, but even within countries. [ABSTRACT FROM AUTHOR]

Objectives: To identify the incidence and resolution rates of a low‐lying placenta or placenta previa and to assess the optimal time to perform follow‐up ultrasonography (US) to assess for resolution. Methods: We conducted a retrospective cohort study of women with a diagnosis of a low‐lying placenta or placenta previa at routine anatomic screening. Follow‐up US examinations were reviewed to estimate the proportion of women who had resolution. A Kaplan‐Meier survival curve was generated to estimate the median time to resolution. The distance of the placental edge from the internal cervical os was used to categorize the placenta as previa or low‐lying (0.1–10 or ≥ 10–20 mm). A time‐to‐event analysis was used to estimate predictive factors and the time to resolution by distance from the os. Results: A total of 1663 (8.7%) women had a diagnosis of a low‐lying placenta or placenta previa. The cumulative resolution for women who completed 1 or more additional US examinations was 91.9% (95% confidence interval, 90.2%‐93.3%). The median time to resolution was 10 (interquartile range [IQR], 7–13) weeks. The distance from the internal cervical os was known for 658 (51.0%) women. The probability of resolution was inversely proportional to the distance from the internal os: 99.5% (≥10–20 mm), 95.4% (0.1–10 mm), and 72.3% (placenta previa; P < .001). The median times to resolution were 9 (IQR, 7–12) weeks for 10 to 20 mm, 10 (IQR, 7–13) weeks for 0.1 to 10 mm, and 12 (IQR, 9–15) weeks for placenta previa (P = .0003, log rank test). Conclusions: A low‐lying placenta or placenta previa diagnosed at the midtrimester anatomy survey resolves in most patients. Resolution is near universal in patients with an initial distance from the internal os of 10 mm or greater. [ABSTRACT FROM AUTHOR]

Background: Ultrasound is a tool of increasing importance in maternity care. Midwives have a central position in the care of pregnant women. However, studies regarding their experiences of the use of ultrasound in this context are limited. The purpose of this study was to explore Australian midwives' experiences and views of the role of obstetric ultrasound particularly in relation to clinical management of complicated pregnancy, and situations where maternal and fetal health interests conflict. Methods: A qualitative study was undertaken in Victoria, Australia in 2012, based on six focus group discussions with midwives (n = 37) working in antenatal and intrapartum care, as part of the CROss-Country Ultrasound Study (CROCUS). Data were analysed using qualitative content analysis. Results: One overarching theme emerged from the analysis: Obstetric ultrasound - a routine tool with far-reaching influence, and it was built on three categories. First, the category'Experiencing pros and cons of ultrasound' highlighted that ultrasound was seen as having many advantages; however, it was also seen as contributing to increased medicalisation of pregnancy, to complex and sometimes uncertain decision-making and to parental anxiety. Second, 'Viewing ultrasound as a normalised and unquestioned examination' illuminated how the use of ultrasound has become normalised and unquestioned in health care and in wider society. Midwives were concerned that this impacts negatively on informed consent processes, and at a societal level, to threaten acceptance of human variation and disability. Third, 'Reflecting on the fetus as a person in relation to the pregnant woman' described views on that ultrasound has led to increased 'personification' of the fetus, and that women often put fetal health interests ahead of their own. Conclusions: The results reflect the significant influence ultrasound has had in maternity care and highlights ethical and professional challenges that midwives face in their daily working lives concerning its use. Further discussion about the use of ultrasound is needed, both among health professionals and in the community, in order to protect women's rights to informed decision-making and autonomy in pregnancy and childbirth and to curb unnecessary medicalisation of pregnancy. Midwives' experiences and views play an essential role in such discussions. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To investigate the volume of intracranial structures in fetuses with congenital heart disease ( CHD). Methods Total intracranial volume, frontal lobes volume, thalamus volume and cerebellar volume were prospectively evaluated and compared in 73 fetuses with CHD and 168 normal fetuses using three-dimensional ultrasound combined with post-processing software at 20 + 0 to 36 + 6 weeks of gestation. Multiple regression analyses were performed to identify risk factors for reduced volume of intracranial structures. Results From the 28th week of gestation onwards, total brain volumes and those of specific structures became progressively smaller in fetuses with CHD relative to those in controls ( P < 0.05). The decrease was largest in frontal lobes volume, followed by total intracranial volume and cerebellar volume, and the smallest decrease was in thalamus volume ( P < 0.05). Multivariable analysis showed that the diagnostic category ( P < 0.001) was independently associated with smaller brain volumes in fetuses with CHD. The largest differences from controls occurred in hypoplastic left heart syndrome ( HLHS), followed by aortic hypoplasia, transposition of the great arteries ( TGA) and tetralogy of Fallot ( TOF). Conclusions The volume of intracranial structures is smaller in fetuses with CHD, particularly in those with HLHS, aortic hypoplasia or TGA. This study highlights the need for routine brain screening and early intervention to improve neurodevelopmental outcomes in fetuses with CHD. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives To assess the diagnostic accuracy of placental growth factor ( PlGF) and ultrasound parameters to predict delivery of a small-for-gestational-age ( SGA) infant in women presenting with reduced symphysis-fundus height ( SFH). Methods This was a multicenter prospective observational study recruiting 601 women with a singleton pregnancy and reduced SFH between 24 and 37 weeks' gestation across 11 sites in the UK and Canada. Plasma PlGF concentration < 5th centile, estimated fetal weight ( EFW) < 10th centile, umbilical artery Doppler pulsatility index > 95th centile and oligohydramnios (amniotic fluid index < 5 cm) were compared as predictors for a SGA infant < 3rd customized birth-weight centile and adverse perinatal outcome. Test performance statistics were calculated for all parameters in isolation and in combination. Results Of the 601 women recruited, 592 were analyzed. For predicting delivery of SGA < 3rd centile ( n = 78), EFW < 10th centile had 58% sensitivity (95% CI, 46-69%) and 93% negative predictive value ( NPV) (95% CI, 90-95%), PlGF had 37% sensitivity (95% CI, 27-49%) and 90% NPV (95% CI, 87-93%); in combination, PlGF and EFW < 10th centile had 69% sensitivity (95% CI, 55-81%) and 93% NPV (95% CI, 89-96%). The equivalent receiver-operating characteristics ( ROC) curve areas were 0.79 (95% CI, 0.74-0.84) for EFW < 10th centile, 0.70 (95% CI, 0.63-0.77) for low PlGF and 0.82 (95% CI, 0.77-0.86) in combination. Conclusions For women presenting with reduced SFH, ultrasound parameters had modest test performance for predicting delivery of SGA < 3rd centile. PlGF performed no better than EFW < 10th centile in determining delivery of a SGA infant. © 2015 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]

ABSTRACT Objectives To compare bladder volumes determined by three different formulae using measurements obtained from two-dimensional translabial ultrasound ( 2D-US), with true bladder volumes, in women with advanced pelvic organ prolapse ( POP). Methods This was a prospective observational multicenter study of consecutive women on the waiting list for prolapse surgery in 24 gynecology departments. All women had a symptomatic genital prolapse Stage 2 or higher according to the Pelvic Organ Prolapse Quantification System ( POP-Q). Bladder volumes were calculated before and after spontaneous voiding by 2D-US, and true bladder volumes were determined by micturition and catheterization. Volumes determined by US were calculated using three formulae (Haylen, Dietz and Dicuio). Correlation was calculated between the volume determined by US measurement before micturition and the true volume, and also between the volume determined by US measurements after micturition and the true volume. Correlations (Spearman's rho) and concordance (intraclass correlation coefficient ( ICC)) were estimated for each of the three formulae considered. Results One-hundred and eighty-six women with POP were included in the study. A total of 349 bladder volumes (186 before micturition and 163 after micturition) were obtained. Good correlation (rho, 0.818-0.849) and concordance ( ICC, 0.827-0.898) were found between total measured volume (volume of spontaneous bladder voiding + volume obtained from catheterization) and the volume determined by US using the three different formulae, as well as between the post-void residual volume measured by catheterization and the post-void volume calculated by US using the three formulae (rho, 0.739-0.777; ICC, 0.840-0.877). Conclusions Bladder volumes in women with advanced POP can be measured easily by 2D-US. Volumes determined using the three different formulae show good correlations and concordance with true bladder volume. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective To investigate the potential value of serum placental growth factor ( PlGF), soluble fms-like tyrosine kinase-1 ( sFlt-1), pregnancy-associated plasma protein-A ( PAPP-A), free β-human chorionic gonadotropin (β- hCG) and α-fetoprotein ( AFP) at 30-34 weeks' gestation in the prediction of delivery of small-for-gestational-age ( SGA) neonates, in the absence of pre-eclampsia ( PE). Methods This was a screening study in singleton pregnancies at 30-34 weeks' gestation, including 490 that delivered SGA neonates and 9360 cases that were unaffected by SGA, PE or gestational hypertension (normal outcome). Multivariable logistic regression analysis was used to determine if screening by serum PlGF, sFlt-1, PAPP-A, free β- hCG and AFP, individually or in combination, improved the prediction of SGA neonates provided by screening with maternal characteristics and medical history (maternal factors), and estimated fetal weight ( EFW) from fetal head circumference, abdominal circumference and femur length. Results Compared to the normal group, the mean log10 multiples of the median ( MoM) values of PlGF and AFP were significantly lower and the mean log10 MoM values of sFlt-1 and free β- hCG were significantly higher in the SGA group with a birth weight < 5th percentile ( SGA < 5th) delivering < 5 weeks following assessment. The best model for prediction of SGA was provided by a combination of maternal factors, EFW and serum PlGF. Such combined screening, predicted, at a 10% false-positive rate, 85%, 93% and 92% of SGA neonates delivering < 5 weeks following assessment with birth weight < 10th, < 5th and < 3rd percentiles, respectively; the respective detection rates of combined screening for SGA neonates delivering ≥ 5 weeks following assessment were 57%, 64% and 71%. Conclusion Combined screening by maternal factors, EFW and serum PlGF at 30-34 weeks' gestation can identify a high proportion of pregnancies that subsequently deliver SGA neonates. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To investigate the potential value of maternal serum placental growth factor ( PlGF) and soluble fms-like tyrosine kinase-1 ( sFlt-1) at 35-37 weeks' gestation in the prediction of delivery of small-for-gestational-age ( SGA) neonates, in the absence of pre-eclampsia ( PE). Methods This was a screening study in singleton pregnancies at 35-37 weeks, including 158 that delivered SGA neonates with birth weight < 5th percentile and 3701 cases unaffected by SGA, PE or gestational hypertension. Multivariable logistic regression analysis was used to determine if measuring serum levels of PlGF and sFlt-1 improved the prediction of delivery of SGA neonates provided by screening with maternal characteristics and medical history (maternal factors), and estimated fetal weight ( EFW) from fetal head circumference, abdominal circumference and femur length. Results Compared to the normal group, the median PlGF multiples of the median ( MoM) was significantly lower and the median sFlt-1 MoM was significantly higher in the SGA group. Combined screening by maternal factors and EFW at 35-37 weeks predicted, at 10% false-positive rate ( FPR), 90%, 92% and 94% of SGA neonates with birth weight < 10th, < 5th and < 3rd percentiles, respectively, delivering < 2 weeks following assessment; the respective values for SGA delivering ≥ 37 weeks were 66%, 73% and 80%. When PlGF and sFlt-1 were added to a model that combines maternal factors and EFW, sFlt-1 did not remain as a significant independent predictor of SGA < 5th. Combined screening by maternal factors, EFW and serum PlGF, predicted, at a 10% FPR, 88%, 96% and 94% of SGA neonates with birth weight < 10th, < 5th and < 3rd percentiles, respectively, delivering < 2 weeks following assessment and the respective values for SGA delivering ≥ 37 weeks were 64%, 75% and 80%. Conclusion sFlt-1 does not provide significant independent prediction of SGA, in the absence of PE, in addition to combined testing by maternal factors and fetal biometry at 35-37 weeks; whilst the addition of PlGF alone marginally improves the performance of screening. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To evaluate whether the antral follicle count ( AFC) is underestimated in the presence of an endometrioma. Methods This was a retrospective cohort study assessing all women undergoing in-vitro fertilization ( IVF) or intracytoplasmic sperm injection ( ICSI) at our clinic between January 2011 and December 2012 who had both ovaries and unilateral endometrioma. The primary outcome of the study was the difference between AFC and the number of oocytes retrieved per ovary. Results Within the study period 787 women underwent IVF/ ICSI at our clinic. Sixty of these women had at least one endometrioma, but 23 were excluded from the analysis as six had only one ovary and 17 had bilateral endometriomas. Therefore a total of 37 women were included in this study and analysis. Compared with the contralateral ovaries, ovaries with an endometrioma were significantly larger in volume (median, 10.3 (interquartile range ( IQR), 4.7-18.9) cm3 vs median, 3.6 ( IQR, 2.7-6.5) cm3; P < 0.001) and presented a significantly lower AFC (median, 3.0 ( IQR, 1.0-6.0) vs median, 5.0 ( IQR, 2.0-6.5); P = 0.001). However, the median number of oocytes retrieved was similar ( P = 0.60) between ovaries with an endometrioma (2.0 ( IQR, 0.5-5.0)) and the contralateral ovaries (2.0 ( IQR, 0.0-4.0)). Accordingly, the median difference between AFC and number of oocytes retrieved was significantly smaller ( P = 0.005) for ovaries with an endometrioma (0.0 ( IQR, −1.0 to 1.5) than for those without (2.0 ( IQR, 0.0-4.0)). Conclusions Although the AFC is reduced in ovaries with an endometrioma, the number of oocytes retrieved is similar, suggesting that the AFC is underestimated in such ovaries. We believe that this is a consequence of an impaired ability to detect small follicles in the presence of an endometrioma. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective To investigate time intervals of the ductus venosus ( DV) flow velocity waveform ( FVW) and those of the cardiac cycle that correspond with each DV-FVW component in fetuses with intrauterine growth restriction ( IUGR) due to placental insufficiency. Methods Women with a pregnancy complicated by IUGR were recruited into the study, as was a normal control group. Time intervals for systolic (S) and diastolic (D) components were measured in DV-FVW as follows: SDV, from the nadir of the a-wave during atrial contraction to the nadir between the S-wave and D-wave; DDV, from the nadir between S-wave and D-wave to the nadir of the a-wave. Regarding cardiac cycles, the following variables were measured from ventricular inflow through the tricuspid valve ( TV) and mitral valve ( MV): STV and SMV, from the second peak of ventricular inflow caused by atrial contraction (A-wave) to the opening of the atrioventricular valve; DTV and DMV, from the opening of the atrioventricular valve to the peak of the A-wave. In the IUGR group, only the last examination performed within 1 week of delivery was used for analysis. All variables were analyzed statistically using Z-scores. Results Data were obtained from 249 normal fetuses and 26 fetuses with IUGR. Compared to normal fetuses, SDV showed a significant decrease ( P < 0.001), while DDV showed a significant increase ( P < 0.001) in the IUGR group. Regarding cardiac cycles, STV and SMV showed significant decreases ( P = 0.014 and P < 0.001, respectively) and DTV and DMV showed significant increases ( P = 0.008 and P = 0.002, respectively) in fetuses with IUGR. Conclusion Time-interval alterations of DV-FVW in growth-restricted fetuses reflect the hemodynamic events caused by placental insufficiency. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives To describe a method of quantifying the amount of liver herniation in fetuses with isolated congenital diaphragmatic hernia ( CDH) using two-dimensional ultrasonography and to correlate this finding with neonatal outcome. Methods Ultrasound images obtained from 77 consecutive fetuses that presented with isolated CDH between January 2004 and July 2012 were reviewed. Liver herniation and thoracic area were measured in a cross-sectional plane of the fetal chest at the level of the four-chamber view of the heart (the same section as is used to measure the lung area-to-head circumference ratio) and the ultrasound-derived liver-to-thoracic area ratio ( US-LiTR) was calculated by dividing the liver herniation area by the thoracic area. Receiver-operating characteristics ( ROC) curve analysis was used to evaluate the performance of US-LiTR in predicting neonatal outcome (survival to 6 months after delivery and need for extracorporeal membrane oxygenation ( ECMO)). In addition, the US-LiTR was compared with the magnetic resonance imaging ( MRI)-derived volume ratio ( MRI-LiTR) and percentage of liver herniation ( MRI-% LH). Results The overall neonatal mortality in the 77 cases with isolated CDH was 20.8% (16/77). ECMO was needed in 35.5% (27/76) of the newborns, with a survival rate of 52%. The US-LiTR was associated statistically with mortality ( P < 0.01) and with the need for ECMO ( P < 0.01). Good correlations were observed between US-LiTR and MRI-LiTR ( r = 0.87; P < 0.001) and between US-LiTR and MRI-% LH ( r = 0.90; P < 0.001). Based on ROC curve analysis, all three parameters had similar accuracy in predicting mortality ( US-LiTR: area under the ROC curve ( AUC), 0.78 (95% CI, 0.65-0.92), P < 0.01; MRI-LiTR: AUC, 0.77 (95% CI, 0.63-0.90), P < 0.01; MRI-%LH: AUC, 0.79 (95% CI, 0.65-0.92), P < 0.01, respectively) as well as the need for ECMO ( US-LiTR: AUC, 0.72 (95% CI, 0.60-0.84), P < 0.01; MRI-LiTR: AUC, 0.73 (95% CI, 0.60-0.88), P < 0.01; MRI-% LH: AUC, 0.77 (95% CI, 0.64-0.89), P < 0.01, respectively). Conclusions Two-dimensional ultrasound measurement of the amount of liver herniation in fetuses with isolated CDH is feasible and demonstrates a predictive accuracy for neonatal outcome similar to that of MRI. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To determine the most cost-effective timing of delivery in pregnancies complicated by gastroschisis, using a decision-analytic model. Methods We created a decision-analytic model to compare planned delivery at 35, 36, 37, 38 and 39 weeks' gestation. Outcomes considered were stillbirth, death within 1 year of birth and respiratory distress syndrome ( RDS). Probability estimates of events (stillbirth, complex gastroschisis and RDS for each gestational age at delivery and risk of death with simple and complex gastroschisis), utilities and costs assigned to the outcomes were obtained from the published literature. Cost analysis was assessed from a societal perspective, using a willingness-to-pay threshold of $100 000 per surviving infant. Outcomes and costs were considered throughout 1 year of postnatal life. Multiway sensitivity analysis was performed to address uncertainties in baseline assumptions. Results In the base-case analysis, delivery at 38 weeks' gestation was the most cost-effective strategy. Planned delivery at 35 weeks was associated with the fewest stillbirths and deaths within 1 year of delivery, owing largely to a lower ongoing risk of stillbirth. In Monte Carlo simulation when every variable was varied over its entire range, delivery at 38 weeks was cost-effective compared to delivery at 39 weeks in 76% of trials and delivery at 37 weeks was cost-effective in 69% of trials. Delivery at 38 weeks resulted in three additional cases of RDS for every 100 stillbirths or deaths within 1 year that were prevented. Conclusions For pregnancies complicated by gastroschisis, the most cost-effective timing of delivery is at 38 weeks. Few additional cases of RDS are caused for every one stillbirth or death within 1 year that was prevented with delivery at 37-38 weeks compared with at 39 weeks. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives To investigate the use of the maxilla-nasion-mandible ( MNM) angle and fetal profile ( FP) line to assess the degree of midfacial hypoplasia in Down-syndrome fetuses in the second and third trimesters of pregnancy. Methods The MNM angle and FP line were measured retrospectively in stored two-dimensional images or three-dimensional volumes of fetuses with Down syndrome. Data collected from January 2006 to July 2013 were retrieved from the digital databases of participating units. The MNM angle was expressed as a continuous variable (degrees) and the FP line as positive, negative or zero. Measurements were obtained from stored images in the midsagittal plane by two experienced examiners and compared with our previously reported normal ranges for euploid fetuses. A MNM angle below the 5th centile of the reference range and a positive or negative FP line were considered as abnormal. Results A total of 133 fetuses with Down syndrome were available for analysis, eight of which were subsequently excluded because of inadequate images. The MNM angle was not influenced by gestational age ( P = 0.48) and was significantly smaller in Down-syndrome fetuses than in euploid fetuses (mean, 12.90° vs 13.53°, respectively; P = 0.015). The MNM angle was below the 5th centile for euploid fetuses in 16.8% of fetuses with Down syndrome ( P < 0.01). In the cohort of Down-syndrome fetuses, a positive FP line was present in 41.6% of cases (with a false-positive rate ( FPR) of 6.3%) and was positively correlated with Down syndrome and gestational age ( P < 0.01). There was no case with a negative FP line. In cases of Down syndrome, a positive FP line was correlated with a small MNM angle ( P < 0.01). Conclusions A small MNM angle and a positive FP line can be regarded as novel markers for Down syndrome. The FP line is an easy marker to measure, has a low FPR, does not require knowledge of normal reference values and has the potential to differentiate between Down syndrome and trisomy 18, as, in the latter, the FP line is often negative. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives To evaluate the diagnostic accuracy of ultrasound in predicting the location of an intrauterine pregnancy before visualization of the yolk sac is possible. Methods This was a systematic review conducted in accordance with the PRISMA statement and registered with PROSPERO. We searched MEDLINE, EMBASE and The Cochrane Library for relevant citations. Studies were selected in a two-stage process and their data extracted by two reviewers. Accuracy measures were calculated for each ultrasound sign, i.e. gestational sac, double decidual sac sign, intradecidual sign, chorionic rim sign and yolk sac. Individual study estimates were plotted in summary receiver-operating characteristics curves and forest plots for examination of heterogeneity. The quality of included studies was assessed. Results Seventeen studies including 2564 women were selected from 19 959 potential papers. Following meta-analysis, the presence of a gestational sac on ultrasound examination was found to predict an intrauterine pregnancy with a sensitivity of 52.8% (95% CI, 38.2-66.9%) and specificity of 97.6% (95% CI, 94.3-99.0%). The corresponding performance of the double decidual sac sign, intradecidual sign, chorionic rim sign and yolk sac were: 81.8% (95% CI, 68.1-90.4%) and 97.3% (95% CI, 76.1-99.8%); 66.1% (95% CI, 58.9-72.8%) and 100% (95% CI, 91.0-100%); 79.9% (95% CI, 73.0-85.7%) and 97.1% (95% CI, 89.9-99.6%); and 42.2% (95% CI, 27.7-57.9%) and 100% (95% CI, 54.1-100%), respectively. Conclusion Visualization of a gestational sac, double decidual sac sign, intradecidual sign or chorionic rim sign increases the probability of an intrauterine pregnancy but is not as accurate for diagnosis as the detection of the yolk sac. However, the findings were limited by the small number and poor quality of the studies included and heterogeneity in the index test and reference standard. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To determine, by expert consensus, the essential substeps of fetoscopic laser surgery ( FLS) for twin-twin transfusion syndrome ( TTTS) that could be used to create an authority-based curriculum for training in this procedure among fetal medicine specialists. Methods A Delphi survey was conducted among an international panel of experts ( n = 98) in FLS. Experts rated the substeps of FLS on a five-point Likert-type scale to indicate whether they considered them to be essential, and were able to comment on each substep, using a dedicated online platform accessed by the invited tertiary care facilities that specialize in fetal therapy. Responses were returned to the panel until consensus was reached (Cronbach's α ≥ 0.80). All substeps that were rated ≥ 4 by 80% of the experts were included in the evaluation instrument. Results After the first iteration of the Delphi procedure, a response rate of 74% (73/98) was reached, and in the second and third iterations response rates of 90% (66/73) and 81% (59/73) were reached, respectively. Among a total of 81 substeps rated in the first round, 21 substeps had to be re-rated in the second round. Finally, from the initial list of substeps, 55 were agreed by experts to be essential. In the third round, the 18 categorized substeps were ranked in order of importance, with 'coagulation of all anastomoses that cross the equator' and 'determination of fetoscope insertion site' as the most important. Conclusions A total of 55 substeps of FLS for TTTS were defined by a panel of experts to be essential in the procedure. This list is the first authority-based evidence to be used in the development of a final training model for future fetal surgeons. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [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]

Foetal magnetic resonance imaging (MRI) plays an increasingly important role in the diagnosis of foetal abnormalities. Over the years, we have successfully applied bi-parametric MRI (bp-MRI) to the following obstetric conditions: (1) neurologic vascular diseases; (2) assessment of lung parenchyma maturation; (3) renal pathologies, such as polycystic kidney, suspected renal infarction, unilateral or bilateral renal agenesis; (4) placental pathologies, as twin-twin transfusion syndrome or placenta accreta; (5) benignant and malignant congenital tumours or cysts of the liver, such as haemangioendothelioma, hepatoblastoma or metastatic neuroblastoma, of the kidney (e.g. mesoblastic nephroma) and of the retroperitoneum, such as teratoma. The information derived from bp-MRI, and concerned with water motions in different tissues, improved the morphologic details provided by conventional foetal MRI. It has the potential to increase the value of MRI in the assessment of a wide range of foetal pathologies, particularly in renal diseases, allowing an adequate management decision and therapy. [ABSTRACT FROM AUTHOR]

Since its introduction, the role of ultrasound has continuously evolved for the past 40 years. New developments in the field of screening for pregnancy disorders have led to changes in the clinical application of ultrasound in the care of women with normal and complicated pregnancies. At the recommended intensities for obstetric examination, ultrasound is safe, without adverse effects on mother, fetus or operator. This review highlights the validated uses of ultrasound in obstetrics, such as pregnancy dating, screening for aneuploidy, diagnosis of fetal abnormality, placental localization, diagnosis of chorionicity in multiple pregnancy, assessment of fetal growth and well-being and fetal therapy. Knowledge of the evidence base for the role of ultrasound will result in effective and appropriately timed interventions in pathological pregnancies. [Copyright &y& Elsevier]

Study Objective: To determine the impact of sonographically identified large uterine fibroids (>5 cm in diameter) on obstetric outcomes. Design: Retrospective cohort study. Setting: University teaching hospital. Patient(s): Women with singleton gestations (n = 95) noted to have uterine fibroids on obstetric ultrasonography from September 2009 through April 2010 and age-matched controls (n = 95). Intervention(s): None. Main Outcome Measure(s): Obstetric outcomes including short cervix, preterm premature rupture of membranes, and preterm delivery. Result(s): Compared to women with no fibroids or small fibroids (≤5 cm), women with large fibroids (>5 cm) delivered at a significantly earlier gestational age (38.6 vs. 38.4 vs. 36.5 weeks). Short cervix, preterm premature rupture of membranes, and preterm delivery were also significantly more frequent in the large fibroid group, and were associated with number of fibroids >5 cm in diameter. Blood loss at delivery was significantly higher in the large fibroid group (486.8 vs. 535.6 vs. 645.1 mL), as was need for postpartum blood transfusion (1.1 vs. 0.0 vs. 12.2%). Conclusion(s): Women with large uterine fibroids in pregnancy are at significantly increased risk for delivery at an earlier gestational age compared to women with small or no fibroids, as well as obstetric complications including excess blood loss and increased frequency of postpartum blood transfusion. [ABSTRACT FROM AUTHOR]

The article focuses on the use of ultrasound in the delivery room for fetal and maternal care and in diagnosing several obstetric complications.

Obstetric ultrasound has revolutionized the management of pregnancy and gynaecological conditions for women worldwide, leading to its acceptance as the imaging modality of choice (Goldberg, 2000). However, alongside technical advances in imaging equipment, there has been a serious increase in medical litigation with obstetrics claims accounting for 60-70% of total (malpractice) sums paid by the NHS Litigation Authority. While midwives seek to extend the limits of their own practice to meet the needs of a constantly changing health service, the wider ramifications of this adjustment to practice need to be considered with regards to preparation for that role, and will be discussed in this review. [ABSTRACT FROM AUTHOR]

The article presents a study on the sonographic features of decidua basalis in the first trimester of pregnancy. It is conducted through reviewing the images of 159 first-trimester ultrasound examinations of 105 women with uncomplicated pregnancies. The results concluded that there is a possibility for the sonographic examination of deciduas in the first trimester of pregnancy.

Background: Personal-device-based point-of-care-ultrasound (P-POCUS) probes plug directly into a cell phone or tablet to function as its display, creating the potential to increase access to obstetric ultrasonography in complex healthcare settings (COVID units, low resource settings); however, new technology must be proven to be reliable in the obstetric setting before integrating into practice.Objective: To evaluate the intraclass correlation (reliability) of personal-device-based-point-of-care-ultrasound devices as compared with standard ultrasound machines in obstetrics.Study Design: This was a prospective, observational study of patients between 19-39 weeks gestation in an urban, prenatal ultrasound diagnosis center. Each patient underwent assessment by an expert sonographer using standard ultrasound machines and personal-device-based-point-of-care-ultrasound devices to determine estimated fetal weight. The statistical reliability and agreement between the estimated fetal weights was assessed through intraclass correlation coefficients, Bland-Altman plots, and Pearson correlation coefficients.Results: 100 paired sets of scans were performed from October 2020 to December 2020. For the estimated fetal weights, there was near-perfect agreement, with an intraclass correlation coefficient of 0.99 (P<.0001). Bland-Altman analysis showed an average difference of 53 grams, with 95% limit of agreement between -178 grams and 283 grams. Pearson correlation showed near-perfect correlation between the measurements (r=0.99, P<.0001).Conclusion: personal-device-based point-of-care-ultrasound devices are reliable tools for performing basic obstetrical ultrasound and have the potential to increase access to obstetrical ultrasound worldwide. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the use of medical literature reporting on ultrasound factors as predictive factors for the outcome of an attempt at external cephalic version (CEV). The researchers found out that the success of an ECV attempt is linked to ultrasound parameters such as fetal position, amniotic fluid and placental location. Moreover, these findings can be used to develop prognostic model to predict successful ECV.

This report describes a case of prenatally diagnosed bilateral diaphragmatic hernia. At 22 weeks’ gestation, ultrasound revealed a cystic structure behind the fetus's heart on the axial image at the level of the cardiac four-chamber view. This suggested a left-sided congenital diaphragmatic hernia with herniation of the stomach into the left hemithorax. However, the left-to-right midline shift of the heart was minimal, which is not typical of left-sided congenital diaphragmatic hernia. Throughout the 30th week of gestation, the right and left branches of the pulmonary artery were hypoplastic compared with the values in normal fetuses of the same gestational age. The presumptive diagnosis was bilateral congenital diaphragmatic hernia. A female newborn weighing 2900 g was delivered at 37 weeks’ gestation, and she died at 7 h of age. An autopsy revealed large defects on both sides of the diaphragm. In conclusion, prenatal diagnosis of bilateral diaphragmatic hernia is possible with fetal sonography. [ABSTRACT FROM AUTHOR]

Ultrasound is the most valuable imaging modality in evaluating the female presenting with pelvic infection The appropriate interpretation of the ultrasound study requires correlation with the patient's clinical history and laboratory values. Pelvic sonography is commonly performed in patients with a clinical diagnosis of pelvic inflammatory disease. Sonography can also help to distinguish acute from chronic abnormalities in the fallopian tubes. Though the study may be normal or sometimes non-specific, there are a variety of findings that are characteristic of this process. Understanding of the sonographic features of pelvic inflammation, salpingitis, pyosalpinx, tubo-ovarian complex and tubo-ovarian abscess will allow the interpreter to make more specific, clinically useful diagnoses. [ABSTRACT FROM AUTHOR]

The spinal cord is an important part of the central nervous system as well as the brain. The vertebral structure develops remarkably early during embryonal and fetal periods. As the cranium develops from early pregnancy with ossification and gradual closure of the fontanelles and sutures, the vertebral bony structure is also formed with ossification and gradual closure of the neural arches during the fetal period. Open spina bifida, which results from a failure of neural arch closure, has been demonstrated by ultrasound and magnetic resonance imaging in utero . Postnatal neurological deficit is greatly dependent on the lesion level of spina bifida and the condition of the exposed spinal cord. Therefore, accurate detection of the lesion level and spinal cord appearance before birth has an important role in predicting neurological prognosis. Because it is hard to demonstrate fetal bony structure including vertebral arches and ribs on a single image by two-dimensional (2D) ultrasound, precise diagnosis of spinal lesion is difficult for examiners. Several reports have been published on two-dimensional detection of the spinal lesion level. After introduction of three-dimensional (3D) ultrasound technology in the field of fetal neuroimaging diagnosis, however, more accurate, objective and comprehensive information has been added on fetal vertebra/spine development and spine lesion such as open spina bifida even in the first and early second trimesters. Multiplanar image analysis and rendering of bony structure by 3D ultrasound technology have contributed greatly to the precise demonstration of normal/abnormal vertebra and spinal cord. Exact and objective diagnosis of spina bifida during pregnancy leads to the prediction of postnatal neurological deficit and to proper management. [ABSTRACT FROM AUTHOR]

Human placental circulation in the first trimester of pregnancy remains a subject of scientific debate. Most of the acquired knowledge on the physiological background of maternal-fetal interface relies on old studies, most of them performed in non-hemochorial placentas and using light and electron microscopy for the pathological specimens' evaluation. Recently, some ultrasonographic research in this field, using pulsed-wave and/or colour Doppler, yielded contradictory results. The availability of these non-invasive methods should allow the in vivo investigation of placental circulation since early phases of human pregnancy. A more recent technique – Power Doppler – should be preferred considering its resolution, angle-independence, higher sensitivity for lower velocities and absence of known harmful bioeffects in the early periods of gestation. We provide an overview on first trimester maternal-fetal circulation, assessed by non-invasive techniques, namely by transvaginal power Doppler ultrasonography, trying to contribute to a better understanding of the anatomo-physiological aspects of human placental circulation. [ABSTRACT FROM AUTHOR]

The advantages of high resolution ultrasonography are that it allows more precise diagnosis of any abnormalities in early pregnancy. The frequency of spontaneous interruptions of the development of the reproductive process is very high, especially during the initial stages. It is calculated that, considering the shortcoming of the fecundation, of each 100 potential pregnancies, only 31 will reach full term with a live fetus. The frequency of abortion, considering this as the spontaneous interruption of a pregnancy before the fetus has reached viability, depends therefore on the approach that we use to define that pregnancy exists. [ABSTRACT FROM AUTHOR]

Background:Parents feel strongly about whether or not to learn the sex of their fetus. We sought to determine which factors are significantly associated with parents’ desire to know or not to know the fetal sex during a prenatal ultrasound.Methods:All women undergoing prenatal ultrasound examinations, except for those with suspected failed pregnancies, were invited to answer a questionnaire at an outpatient referral center for diagnostic ultrasound in obstetrics and gynecology in Boston, Massachusetts. The survey asked about demographic factors, current pregnancy, and past pregnancies, and an open-ended question about whether and why the parents wished to learn, or did not learn, the sex of their fetus. Factors significantly associated with parents’ desire to learn the fetal sex prenatally were determined and analyzed.Results:A total of 1,340 questionnaires were completed. Overall, 761/1,302(58%) of mothers and 747/1,295(58%) of fathers learned or planned to learn the fetal sex before delivery. Factors most associated with wanting to learn the fetal sex were conceiving accidentally, finding out the sex in a previous pregnancy, not planning to breastfeed, influence of sex on future childbearing plans, planning a move or renovation dependent on sex, and specific parental sex preference. Demographic factors most associated with wanting to learn the fetal sex were father without full-time job, lower household income, unwed mother, maternal age less than 22 or greater than 40 years, no college degree, race other than white, and religion other than Catholic.Conclusions:Specific demographic and socioeconomic characteristics predicted whether or not parents chose to know the sex of their unborn child. Families in which the pregnancy was unplanned, those in which fetal sex would influence living arrangements or future childbearing plans, and those of lower socioeconomic status wished to know the sex more frequently. Further study is needed to understand parents’ motivations underlying the desire to know or not know fetal sex before delivery. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to compare the performance of the transabdominal versus the transvaginal route for the multifetal pregnancy reductions. Study design: Two hundred ninety consecutive cases of multifetal pregnancy reduction were reviewed. Two hundred three reductions (70.0%) were done transabdominally; 75 cases (25.9%) were done transvaginally, and 12 cases (4.1%) used both routes. The indications for the transvaginal route were extreme obesity, abdominal scars, or if the lower fetus could not be reached transabdominally. Two hundred seventy-one women were delivered of live born babies after 24 weeks (group 1). Nineteen cases had pregnancy losses ≤24 weeks (group 2). Results: The complete pregnancy loss rate was 6.5% (19/290 cases). Total pregnancy loss rates of multifetal pregnancy reduction were 3.5% (7/203 reductions) for the transabdominal route and 13.3% (10/75 reductions) for the transvaginal route (P = .004). Overall pregnancy losses were 4.8% for starting with twins, 6.6% for starting with triplets, 1.8% for starting with quadruplets, 14.3% for starting with quintuplets, and 14.3% with starting numbers of ≥ 6 fetuses. For finishing numbers, total pregnancy losses were 5.1% for ending with a singleton infant, 6.6% for ending with twins, and 0% for ending with triplets. Significant differences in complete pregnancy loss were observed between transabdominal and transvaginal routes for starting with triplets (2.7% for transabdominal versus 16.7% for transvaginal; P = .006) and for finishing with a single fetus (0% for transabdominal versus 20% for transvaginal; P < .004). Conclusion: The multifetal pregnancy reduction success rate was higher with the transabdominal route compared with the transvaginal route. Significant differences in favor of the transabdominal route were observed for starting with triplets or finishing with a single fetus. The transvaginal route should be reserved only for cases in which the transabdominal approach is hard or impossible to perform. The performance of the procedure at 12 to 13 weeks of gestation enables structural evaluation of the fetuses before reduction. [ABSTRACT FROM AUTHOR]

The practice of obstetric ultrasound scans has undergone significant expansion in the last two decades and is now a standard part of many women's antenatal care in Australia as elsewhere. This article reviews recent evidence about the value of obstetric ultrasound, summarizing debates and contradictions in research literature and practitioner guidelines. Pregnant women's interpretations of the significance of ultrasound are examined through multiple interviews with 34 study participants. We find that ultrasound has become an integral part of women's embodied experience of pregnancy, with its own pleasures and dilemmas. The increasing use of the technology has augmented the role of scientific biomedicine in the government of pregnancy. This must be understood in the light of trends toward individualized risk management in which the pregnant woman increasingly takes responsibility for the successful outcome of the pregnancy, in a context where pregnancy is discursively constructed as a risky domain of gendered experience in contemporary Australian society. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the present state of fetal ultrasound training in the United States from the perspective of obstetrics and gynecology ultrasound program directors and residents. METHODS: One hundred thirty-six ultrasound program directors from 254 accredited obstetrics and gynecology residency programs completed a web-based survey regarding obstetric ultrasound training for residents. Questions were presented in yes-or-no, ranking, short-answer, and open-comment formats that examined general teaching environment and curriculum content. These results were compared with a mandatory fetal ultrasound training survey that was independently administered to 4,666 obstetrics and gynecology residents during the 2003 Council on Resident Education in Obstetrics and Gynecology (CREOG) In-Training Examination. Friedman one-way analysis of variance was used to compare ranked nonparametric data with the Dunn posttest. Statistical significance was taken at the P < .05 level. RESULTS: Fifty-four percent of accredited obstetrics and gynecology residencies responded to the survey of ultrasound directors from November 2000 to April 2003. Nearly all responding directors were obstetrician-gynecologists, many of whom had subspecialty training in maternal-fetal medicine. Full-time faculty and sonographers were the most important individuals contributing to ultrasound training for obstetrics and gynecology residents. Hands-on scanning and observation were the most significant educational activities for ultrasound training. Ultrasound program directors generally rated the overall preparedness of residents as ranging from adequate to excellent. The most important learning obstacles were limited curriculum and faculty time. Most programs evaluated competency by direct observation of scanning skills. According to the CREOG survey, only 16.3% of residents indicated that the performance and interpretation of fetal ultrasound examinations were mandatory program requirements. Nearly two thirds of residents believed that their training would be adequate by the time of graduation. Only 18.4% of residents, however, were planning to perform or interpret fetal ultrasound scans in clinical practice. CONCLUSION: Fetal ultrasound training for obstetrics and gynecology residents is perceived by most ultrasound program directors and residents to be adequate. Future development of standardized guidelines and competency assessment tools should consider that approximately one fifth of obstetrics and gynecology residents are currently planning to use this diagnostic modality in clinical practice. [ABSTRACT FROM AUTHOR]

A total of 2741 high-risk pregnant mothers underwent invasive prenatal procedures, and in 94 of them (3·4%), fetal chromosomal or genetic anomalies were detected. In this study, we report on single pericentric inversions of chromosome 9 as well as translocations, which constituted 32% (30 of 94) and 16% (15 of 94) of all identified chromosomal or genetic abnormalities, respectively. In six fetuses of the 30 with an inversion of chromosome 9, ultrasound findings were abnormal and consisted of hydramnios, anhydramnios, hydroureter, hydronephrosis, encephalocele and prune belly syndrome, occurring singly or in combination. Among the 15 fetuses with chromosomal translocations, five had sonographic abnormalities. In conclusion, we found detailed ultrasound survey of fetuses with either translocations or inversions of chromosome 9 to be an additional source of useful information concerning fetal status that could be of value in genetic counselling of affected parents. [ABSTRACT FROM AUTHOR]

Reports on the use of the Internet to access information about obstetric and gynecological imaging. Basics of the Internet and the World Wide Web; Examples of Web sites related to ultrasonic imaging; Value of online information on ultrasound in obstetrics and gynecology.

Presents topics of studies published in the February 1999 issue of the periodical 'Journal of Obstetrics and Gyneacology,'. Desirability of informed choice for ultrasound screening; Alteration of the IGF-1 receptor in the microvillous membrane of the placenta in fetal growth restriction; Persistence of the right umbilical vein in a case of suspected Noonan's syndrome.

Objective: Technologic advances in ultrasonographic imaging have revolutionized the management of women's health care. We recently began to evaluate the clinical applications of three-dimensional ultrasonography.Study Design: This study prospectively evaluated 161 obstetric and gynecologic patients. Both two- and three-dimensional imaging data were acquired from real-time ultrasonography. Three orthogonal planes were displayed on a monitor and were used to create the rendered three-dimensional images.Results: To date, 201 three-dimensional ultrasonographic studies have been performed, 165 transabdominally and 36 transvaginally. Transabdominally, an average of eight acquisitions per patient were obtained. Of the clinically suspected abnormalities, 29 of 32 (91%) were confirmed by three-dimensional imaging. Three of 32 (9%) improved the diagnostic capabilities or changed the diagnosis. Of the 36 transvaginal studies, an average of four acquisitions per patient were done. Thirty (83%) of these patients had suspected abnormalities and all were confirmed.Conclusions: Three-dimensional ultrasonographic imaging appears to be highly promising in the clinical setting. [ABSTRACT FROM AUTHOR]

Midtrimester premature rupture of membranes (PROM) is an unusual complication of multiple gestation that most often results in poor obstetric outcome. Presented are four cases of twin pregnancy complicated by preterm PROM and umbilical cord prolapse at 16 to 21 weeks' gestation. After a period of expectant management, dilation and evacuation of only the presenting fetus was performed with careful ultrasound guidance, to attempt delayed interval delivery. This resulted in pregnancy prolongation of 42 to 133 days for the remaining cotwins. Dilation and evacuation of a single demised fetus in twin pregnancy complicated by PROM and cord prolapse can be accomplished with favorable clinical outcome. [ABSTRACT FROM AUTHOR]

Examines the use of extended field-of-view (FOV) ultrasound imaging in obstetrics and gynecology. Appearance of a complete extended FOV image immediately following completion of lprobe movement of a few seconds; Absence of any clinical significance of extended-FOV imaging in patients with small fibroids or ovarian massess; Panoramic view of the interior of the uterus provided by extended-FOV imaging.

A letter to the editor is presented in response to an article on twisted head position lateral asynclitism in the first stage of labor.

The author emphasizes the importance of quality monitoring and remediation of nuchal translucency measurement in obstetrics. She discusses an article which revealed the prevalence of nuchal translucency undermeasurement, by Evans and colleagues, published within the issue. She commends the article's authors for raising the issue of nuchal translucency undermeasurement to the public. The author argues that providers who will perform nuchal transparency measurements should be trained and credentialed.