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Objective: To determine whether a reinforcing cerclage (RC) for a short cervix measured after the primary cerclage procedure prolonged pregnancy., Methods: We conducted a retrospective cohort study of 157 women with singleton gestations who underwent cerclage for standard indications. Women were grouped according to cervical length (CL) at the time of follow-up 1-2 weeks after the initial cerclage placement: ≥25 mm (106 women) and <25 mm with (20 women) or without RC (31 women). Gestational age (GA) at delivery was compared by ANOVA. Survival risk analysis was applied to model GA at delivery adjusted for indication and CL before and after the first cerclage., Results: Women with CL ≥25mm delivered later than women with CL < 25mm after the first cerclage (p < 0.01). RC did not delay delivery for women with CL < 25 mm (p = 0.17) after the primary procedure. Indication for the primary cerclage (p < 0.01) and CL (p < 0.01) after the primary cerclage were the best predictors for GA at delivery., Conclusion: Placement of RC for short cervix did not prolong duration of pregnancy, GA at delivery or modify the probability of preterm birth.

Objectives: Routine ultrasonography can detect congenital femoral deficiency (CFD) and fibular hemimelia (FH), but prenatal detection rate and its relation to deformity severity have never been reported. Whether mothers prefer prenatal diagnosis is also unknown. We aimed to determine whether mothers prefer prenatal diagnosis, to report detection rates for CFD and/or FH, and to correlate detection rates to severity of limb shortening., Methods: Surveys were mailed to 171 mothers who gave birth to children with CFD/FH between 2000 and 2008. Bilateral femoral and tibial lengths were measured on postnatal radiographs. We calculated corresponding femoral/tibial lengths at gestational weeks 20 and 30., Results: Sixty-five surveys were returned, and 56 radiographs were reviewed. Most mothers (63%) preferred prenatal diagnosis as it enables prenatal counseling. Congenital limb shortening was detected in 24 cases (37%) and was not detected in 41 cases (63%). Detection rate was 52% (12 of 23) in CFD cases, 23% (three of 13) in FH cases, and 30% (six of 20) in combined cases. CFD cases with severe shortening had a higher detection rate., Conclusions: Ultrasonographers should measure both femoral and tibial lengths. Unilateral shortening should result in pediatric orthopedic consultation to estimate limb-length discrepancy at maturity and discuss treatment., (© 2014 John Wiley & Sons, Ltd.)

Objectives: To examine maternal attitudes towards prenatal diagnosis of idiopathic clubfoot and to determine the incidence of false-negative ultrasound examinations., Methods: Surveys were mailed to mothers of patients with clubfoot born between 2000 and 2007 who were treated at either Sinai Hospital of Baltimore or Orthopaedic Hospital Speising. Exclusion criteria were underlying syndrome, genetic abnormality and multiple pregnancy. The survey asked the mother whether she had had any ultrasound examinations before her child was born, whether any of these had shown clubfoot, and whether she would have preferred to find out about her child's clubfoot before birth or after birth., Results: Mothers completed 220 (USA, 105 surveys; Austria, 115 surveys) of 401 mailed surveys. The prenatal detection rate was 60% in the USA compared with 25% in Austria (P = 0.001). Overall, 74% of mothers indicated a preference for prenatal diagnosis and 24% indicated a preference for postnatal diagnosis of the condition. Of 92 patients diagnosed prenatally, 96% of mothers indicated a preference for a prenatal diagnosis. Of 128 patients diagnosed postnatally, 58% of mothers indicated a preference for prenatal diagnosis, 38% for postnatal diagnosis and 4% were undecided., Conclusions: The diagnosis of clubfoot is still often missed during routine ultrasound examination. When a prenatal diagnosis is made, most mothers appreciate having this information. However, when prenatal diagnosis is missed, a significant proportion of mothers seem to accept the false-negative diagnosis retrospectively., (Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.)

Objective: The aims of this study were to assess the accuracy of uterine contraction palpation, determine whether the accuracy of palpation improves with experience, determine clinical factors that affect the accuracy of palpation, and evaluate the range of intrauterine pressure present when an observer notes the contraction to be mild, moderate, or strong., Study Design: A total of 236 observations were obtained by use of intrauterine pressure catheters on 46 laboring patients in the first stage of labor. The blinded observers (obstetrics and gynecology residents, maternal-fetal medicine fellows and faculty, and labor and delivery nurses) were asked to label a contraction as mild, moderate, or strong. Patient's height, weight, parity, and gestational age, use of oxytocin, use of epidural anesthesia, and laboring position, and the level of training of the observer were noted., Results: Mild, moderate, and strong contractions had intrauterine pressures of 35.2 +/- 33.8 mm Hg (+/- 2 SD), 44.9 +/- 35.4 mm Hg, and 55.5 +/- 28.0 mm Hg, respectively. The observers were accurate in predicting contraction strength 49% of the time. There was no improvement in accuracy with increased physician experience. All physicians as a group were more accurate than nurses (p < 0.05). Accuracy was not affected by clinical variables., Conclusion: Manual palpation of uterine contractions is an inaccurate means of determining contraction strength.