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Objective. Fetal heart rate (fHR) evaluation is fundamental to guarantee timely medical intervention in case of pregnancy complications. Due to the limitations of traditional cardiotocography, multichannel electrophysiological recording was proposed as a viable alternative, which requires Blind Source Separation (BSS) techniques. Yet effective and reliable separation of the fetal ECG remains challenging due to multiple noise sources and the effects of varying fetal position. In this work, we demonstrate that the adopted electrode configuration plays a key role in the effectiveness of BSS and propose guidelines for optimal electrode positioning. Moreover, a model is proposed to automatically predict the most suited configuration for accurate BSS-based fHR estimation with a minimal number of leads, to facilitate practical implementation. Methods. We compared fHR estimation accuracy with different electrode configurations on in-silico data, identifying the optimal configuration for a recent BSS method. Based on features extracted from raw signals, we proposed a support vector regression model to automatically identify the best electrode configuration in terms of fHR estimation accuracy and to dynamically adjust it to varying fetal presentation. Evaluation was performed on real and synthetic data. Results. Guidelines for the optimal electrode configuration are proposed by using 4 leads. Prediction of configuration quality shows 80.9% accuracy; the optimal configuration is recognized in 92.2% of the subjects. Conclusion. The proposed method successfully predicts the quality of the configurations, demonstrating the impact of the electrode configuration on the BSS performance. Significance. The method holds potential for long-term fetal monitoring, by dynamically choosing the optimal configuration.

Limb body wall complex (LBWC) is a rare, lethal malformation characterised by body wall defects, craniofacial and limb anomalies with or without various other organ anomalies. We report a case of dichorionic diamniotic twin pregnancy discordant for LBWC, diagnosed by ultrasound (US) and confirmed by MRI at 21 weeks’ gestation, managed expectantly and delivered at 35 weeks by emergency caesarean section with a favourable outcome of the unaffected twin. The anomalous twin, who died soon after birth, had a sizeable thoracoabdominal wall defect, eviscerated liver and bowel loops attached to the placenta, short cord, ectopia cordis, lung hypoplasia, kyphoscoliosis, right upper limb amelia and left clubfoot with polydactyly. MRI helps to demonstrate the fetal morphology better when there are limitations to the US due to unfavourable fetal position, multifetal gestation, maternal obesity or reduced liquor. In twin pregnancies, the management will depend on ensuring the survival of the unaffected twin.

Background: Fetal head “attitude” (relationship of fetal head to spine) in the first stage of labor may have a substantial impact on labor outcome. The diagnosis of fetal head deflexion traditionally is based on digital examination in labor. Objectives: To quantify the degree of fetal head deflection via the use of Ultrasound during the first stage of labor, and the relationship with the course and outcome of labor. Patients and methods: This was a prospective study conducted at Sayed Galal Hospital, Al-Azhar University from June 2019 to December 2019. Nonconsecutive series of women with uncomplicated singleton pregnancies at term gestation (37 weeks or more) were submitted to trans-abdominal ultrasound during the first stage of labor. Fetal position was occipito-anterior, and the angle between the fetal occiput and the cervical spine (the occiput-spine angle) was sonographically obtained on the sagittal plane. The measurements of the occipito-spine-angle were performed offline by an operator who was blinded to the labor outcome. The intra- and inter observer reproducibility and the correlation between the occipito-spine angle and the mode of delivery were evaluated. Results: A total of 400 pregnant women were recruited, 350 of which underwent a spontaneous vaginal delivery, and 50 were submitted to cesarean delivery. The mean value of the occipito-spine angle measured in the active phase of the first stage was 126° ± 2.79° (SD). The occipito-spine angle was significantly narrower in women who underwent CS delivery due to labor arrest. A larger occipito-spine angle (i.e. >126°) showed to be significantly associated with a shorter duration of labor. Conclusion: Fetuses with smaller occipito-spine angle (

Labor is a known risk factor for pelvic floor dysfunction (PFD); however, the impact of operative vaginal delivery (OVD), particularly spatulas, remains unclear. The aim of this study was to compare postpartum PFD symptoms in women undergoing spontaneous vaginal delivery (SVD) and those undergoing OVD. An observational prospective study (MOODS: Maternal-neonatal Outcomes in Operative Vaginal Delivery) was enrolled at Hospital de Braga from February to October 2018. All singleton term OVD (Thierry spatulas and vacuum extractor) and a convenience SVD sample were recruited, in a 2:1 ratio. To assess PFD symptoms Pelvic Floor Distress Inventory-20 (PFDI-20) was applied at 3, 6, and 12 months postpartum. The questionnaire is divided into three subscales: Urinary (UDI), Colorectal-Anal (CRADI), and Pelvic Organ Prolapse Distress Inventory (POPDI). Of the 304 women recruited, 207 were included, 34.3% with SVD and 65.7% with OVD. Thierry spatulas were used in 53.7% of women undergoing OVD. Frequency of nulliparous (p

Objective To report antenatal, intrapartum, and postnatal factors associated with breech birth from our Breech Program at South Health Campus, Calgary. Methods We reviewed all maternal and neonatal patient records where breech birth was documented from 2013 to 2018. Neonatal blood gas values, Apgar scores, birth weight, admissions to NICU, antenatal ultrasound reports, inpatient electronic medical records, and operative and delivery reports, were reviewed. Any indices known as indications, contraindications, or outcomes associated with breech birth were recorded and summarized. Results Among the 499 breech births that occurred over the study period, there were109 attempted external cephalic versions, 411 planned and 39 unplanned cesarean deliveries, and 49 vaginal deliveries. Unplanned cesarean delivery was performed for newly diagnosed breech presentation in labour (14), footling presentation in labour (9), abnormal fetal heart rate (4), labour dystocia (8), ultrasound findings of low fluid (2) or unfavourable fetal position (1), and worsening maternal hypertension (1). Conclusion Despite the absence of reported contraindications in the majority of patients and the presence of a program that supported vaginal breech delivery, cesarean delivery was more common. Mothers who chose to labour were highly successful in achieving vaginal birth with excellent maternal and neonatal outcomes.

* Abbreviations: CICU: : cardiac intensive care unit d-TGA: : dextro-transposition of the great arteries FIO2: : fraction of inspired oxygen A 20-year-old gravida 2, para 1 pregnant woman was referred to our fetal care center because of a diagnosis of structural heart disease in the fetus. The woman’s medical history included asthma, seasonal allergies, and depression, with no surgical history. She had 1 prior term vaginal delivery. This pregnancy had been complicated by late presentation to prenatal care at 20 weeks’ gestation. Her medications included asthma maintenance medications and prenatal vitamins. Pertinent family history included her partner who had a ventricular septal defect and a paternal male first cousin with transposition of the great arteries. Prenatal laboratory test results were unremarkable and genetic screening was declined. Imaging at the referring obstetrician’s office was significant for transposition of the great arteries with an intact ventricular septum and normal fetal biometry. She was referred to our center at 21 1/7 weeks’ gestation, with imaging and consultation with fetal cardiology at 21 6/7 weeks’ gestation. The following tests were performed: Figure 1. Four-chamber view of the heart at 21 weeks’ gestation, swept to the outflow tracts showing parallel arrangement of the great arteries with the pulmonary artery (PA) located posteriorly and arising from the left ventricle (LV) and the aorta (Ao) arising from the right ventricle (RV). Fetal position: right (R), left (L), anterior (A), posterior (P). At …

Placenta previa is one dangerous disease which threatens the health of pregnant women and their fetuses. The purpose of this study was to evaluate the clinical value of ultrasound combined with magnetic resonance imaging (MRI) in screening for placenta previa complicated by placenta accreta.Seventy patients with abnormal fetal position admitted to our hospital from January 2019 to January 2020 were selected for the study. Patients were diagnosed by ultrasound alone, MRI alone, and ultrasound combined with MRI. Diagnostic accuracy, sensitivity, specificity and false positive and negative diagnosis rates were evaluated against the postoperative pathological examinations of the patients.The diagnostic accuracy, sensitivity and false negative rate for ultrasound combined with MRI were 86.27%, 97.78% and 72.00%, respectively. These results were significantly superior to those of MRI or ultrasound alone (P0.05). The specificity and false positive rate for ultrasound combined with MRI were 13.73% and 5.26%, respectively, which were not significantly different from those for MRI or ultrasound alone (P0.05).Compared with ultrasound or MRI alone, ultrasound combined with MRI has higher accuracy and sensitivity in the diagnosis of placenta previa with placenta accreta, along with lower false positive diagnosis rates. These findings are clinically important for improving the diagnostic efficiency.

BACKGROUND: This study aimed to investigate the biomechanical effects of different interventions on astronauts lumbar intervertebral discs in a microgravity environment during spaceflight and in a gravity environment when the astronaut returns.METHODS: A finite element model of the L4L5 lumbar segment was developed with eight loading schemes representing different interventions. The loading schemes included no intervention, wearing a penguin suit, sleeping in a fetal position, wearing a penguin suit combined with sleeping in the fetal position, reclining for 4 or 16 h/d, and maintaining upright posture for 4 or 16 h/d.RESULTS: Without intervention, the microgravity environment led to increased central pore pressure, radial displacement, and water content in the lumbar intervertebral disc. Wearing a penguin suit combined with sleeping in the fetal position can reduce disc pore pressure, axial stress, radial displacement, and water content to 0.156 MPa, 11.50 kPa, 0.538 mm, and 1.390%, respectively. When astronauts return to the gravity environment, staying upright for 4 h can reduce the pore pressure, axial stress, radial displacement, and water content of the intervertebral disc to 0.222 MPa, 10.72 kPa, 0.373 mm, and 0.219%, respectively.CONCLUSION: This study showed that wearing a penguin suit and sleeping in the fetal position both have the potential to protect the lumbar intervertebral disc from the negative effects caused by microgravity. Remaining in the upright posture for 4 h per day may help squeeze out the water in the intervertebral disc safely when astronauts return to the gravity environment.Zhang S, Wang K, Zhu R, Jiang C, Niu W. Penguin suit and fetal position finite element model to prevent low back pain in spaceflight. Aerosp Med Hum Perform. 2021; 92(5):312318.

Accurate acquisition of end-systolic (ES) and end-diastolic (ED) frames from ultrasound videos of fetal echocardiograms is a key procedure in the automated biometric measurement and diagnosis in obstetric examination. Compared with adults, the fetal detection task remains an additional challenge due to the variation of cardiac anatomy with fetal position and sound-beam angle, variations in cardiac views of different gestational weeks, and faster heart rates. These challenges have led to multi-resource fetal echocardiogram data, which means that adult detection methods may not be applicable. We formulate this problem as a classification problem and present a deep-learning hybrid framework that uses class score to localize the ES and ED frames. To the best of our knowledge, this is the first framework that utilizes a hybrid classification framework for the detection task. The proposed architecture integrates the extracting region-of-interest (ROI) component based on target detection, retaining a temporal dependency module and classification module based on a domain-transferred deep convolutional neural network (CNN). We conduct YOLOv3 as a ROI module (RD) to extract attention regions for improving classification performance and determining the four-chamber view. Meanwhile, the temporal dependence is not lost by the merged neighbor frame difference into image channels. Different CNN architectures are explored herein, i.e., Xeception, ResNet, InceptionV3, MobileNet, NasNetmobile, and different channel fusion strategies, i.e., SF, DF, and MDF. The optimal deep-learning model consists of a MobileNet, MDF, and RD trained by adding a transition class strategy. On average, 94.84% accuracy of classification results was achieved, and the average detection errors of ES and ED frames are 1.25 and 0.80 frame, respectively.

We present a method for classifying tasks in fetal ultrasound scans using the eye-tracking data of sonographers. The visual attention of a sonographer captured by eye-tracking data over time is defined by a scanpath. In routine fetal ultrasound, the captured standard imaging planes are visually inconsistent due to fetal position, movements, and sonographer scanning experience. To address this challenge, we propose a scale and position invariant task classification method using normalised visual scanpaths. We describe a normalisation method that uses bounding boxes to provide the gaze with a reference to the position and scale of the imaging plane and use the normalised scanpath sequences to train machine learning models for discriminating between ultrasound tasks. We compare the proposed method to existing work considering raw eye-tracking data. The best performing model achieves the F1-score of 84% and outperforms existing models.

Background Improved information about the evolution of fetal head rotation during labor is required. Ultrasound methods have the potential to provide reliable new knowledge about fetal head position. Objective The aim of the study was to describe fetal head rotation in women in spontaneous labor at term using ultrasound longitudinally throughout the active phase. Study Design This was a single center, prospective cohort study at Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland, from January 2016 to April 2018. Nulliparous women with a single fetus in cephalic presentation and spontaneous labor onset at ≥37 weeks’ gestation were eligible. Inclusion occurred when the active phase could be clinically established by labor ward staff. Cervical dilatation was clinically examined. Fetal head position and subsequent rotation were determined using both transabdominal and transperineal ultrasound. Occiput positions were marked on a clockface graph with 24 half-hour divisions and categorized into occiput anterior (≥10- and ≤2-o’clock positions), left occiput transverse (>2- and 8- and Results We followed the fetal head rotation relative to the initial position in the pelvis in 99 women, of whom 75 delivered spontaneously, 16 with instrumental assistance, and 8 needed cesarean delivery. At inclusion, the cervix was dilated 4 cm in 26 women, 5 cm in 30 women, and ≥6 cm in 43 women. Furthermore, 4 women were examined once, 93 women twice, 60 women 3 times, 47 women 4 times, 20 women 5 times, 15 women 6 times, and 3 women 8 times. Occiput posterior was the most frequent position at the first examination (52 of 99), but of those classified as posterior, most were at 4- or 8-o’clock position. Occiput posterior positions persisted in >50% of cases throughout the first stage of labor but were anterior in 53 of 80 women (66%) examined by and after full dilatation. The occiput position was anterior in 75% of cases at a head-perineum distance of ≤30 mm and in 73% of cases at an angle of progression of ≥125° (corresponding to a clinical station of +1). All initial occiput anterior (19), 77% of occiput posterior (40 of 52), and 93% of occiput transverse positions (26 of 28) were thereafter delivered in an occiput anterior position. In 6 cases, the fetal head had rotated over the 6-o’clock position from an occiput posterior or transverse position, resulting in a rotation of >180°. In addition, 6 of the 8 women ending with cesarean delivery had the fetus in occiput posterior position throughout the active phase of labor. Conclusion We investigated the rotation of the fetal head in the active phase of labor in nulliparous women in spontaneous labor at term, using ultrasound to provide accurate and objective results. The occiput posterior position was the most common fetal position throughout the active phase of the first stage of labor. Occiput anterior only became the most frequent position at full dilatation and after the head had descended below the midpelvic plane.

The goal of this study was to determine the feasibility of identifying the anal dimple (AD) on routine prenatal ultrasound. Using the presence, absence, appearance, and location of the anal dimple as an indirect sign for possible underlying anorectal malformations (ARM), we hypothesize that evaluation of the anal dimple as part of the fetal anatomic survey may increase the sensitivity in detecting less severe ARMs. In a prospective longitudinal observational study, pregnant women who underwent prenatal ultrasound (US) at the Colorado Fetal Care Center between January 2019 and 2020 were enrolled. The variables recorded included gestational age, singleton versus multiple pregnancy, gender of the fetus, visualization of the AD, and reason for non-visualization of the AD. A total of 900 ultrasounds were performed, evaluating 1044 fetuses, in 372 different pregnant women. Gestational ages ranged from 16 to 38 weeks. The AD was visualized in 612 fetuses (58.6%) and not seen in 432 (41.4%). The two most common reasons for non-visualization were extremes in gestational age (n = 155; 36%) and fetal position (n = 152; 35.3%). The optimal gestational age range for AD visualization was 28–33 weeks + 6 days, with 78.1% visualization rate. Visualization of the anal dimple by ultrasound is feasible and may aid in the detection of less severe ARMs, ultimately impacting pregnancy management and family counseling. The optimal timing for anal dimple visualization is late second and third trimester.

Fetal cardiac monitoring is one of the cornerstones of modern obstetric care. Noninvasive fetal electrocardiography (NI-FECG) is an emerging modality for monitoring fetal well-being using electrical signals recorded from the maternal abdomen. However, the reliability of NI-FECG extraction techniques remains highly variable due to a range of technical and clinical factors, such as sensor placement and interindividual anatomic variations. In this work, we propose, develop, and validate an open-source method for modeling these variations, including changes in maternal body structure and fetal position using two clinical NI-FECG databases. To validate our model’s accuracy, we first assess its performance in characterizing the fetal QRS (fQRS) complex amplitude in six private NI-FECG recordings with detailed anatomic information. To demonstrate its clinical utility, we next apply our model to predict an optimal sensor placement in a separate open-access database of 60 24-channel NI-FECG recordings. The optimal six sensor positions predicted by our model achieve similar reliability for fetal heart rate (FHR) monitoring compared to the entire 24-sensor array. The presented results indicate our model provides a suitable method for estimating the influence of anatomic variations on NI-FECG signals and optimizing sensor placement in a simulated setting. The code for the developed model has been made available under an open-source GPL license and contributed to the fecgsyn toolbox.

From 2012 to 2017, serial ultrasonographic evaluation of 5 healthy bottlenose dolphins, Tursiops truncatus, were performed over the course of 6 pregnancies in Enoshima Aquarium. A total of 98 ultrasonographic examinations were included in the study. In three out of six cases, two embryos were observed between umbilicus and genital slit, and side of umbilicus in the dam's body. All embryos were located in right below the peritoneum and observed from 308 to 325 days pre-partum. These days were corresponding to from 58 to 61 days after copulation respectively. The diameter of the embryo sac was approximately 4 cm. In three cases, the fetal head was located in the dam's left lateral between umbilicus and genital slit from approximately 90 days pre-partum to the parturition. A snout of fetus is at the top of the uterine horn, and the tail lies close to the cervix. All six calves were fluke-first births (breech presentation). It was conjectured that the contraction of the dam's uterus during parturition forced the fetus to invert, and the fetal tail fluke was expelled from the dam's body. In three cases, judging from orientation of fetal tail fluke faced towards left side of the dam, a fetal position might be RSL (Right Sacrum-Lateral) within the birth canal. In the other three cases, the left and right positions of the fetus and the dam's body are reversed during pregnancy and parturition.

Placenta accreta is one of the emergency conditions and has resulted in increased mortality and morbidity of pregnant women due to the massive obstetric hemorrhage. Placenta accreta can lead to secondary complications including coagulopathy, multisystem organ failure, acute respiratory distress syndrome, need for repeat surgery, and death. Assessment by anesthesia should be carried out as early as possible before surgery to reduce or even eliminate morbidity and mortality. In this report, we present the case of a patient with total placenta previa and high-risk MAP score with a transverse lie fetal position. The various anesthetic treatments and transfusion strategies are discussed with a multidisciplinary approach to delivery.

OBJECTIVES We investigated the feasibility of a semiautomatic approach for assessments of the fetal heart (fetal intelligent navigation echocardiography [FINE]) in cases of optimal and unfavorable fetal spine positions. METHODS In this study, a total of 1693 spatiotemporal image correlation volumes of first-, second-, and third-trimester fetuses were evaluated by experts using the FINE approach. The data were analyzed regarding proper reconstruction of the diagnostic cardiac planes depending on the fetal spine position. RESULTS A total of 1531 volumes were included. The volumes were divided into 4 groups depending on the fetal spine position: 5-7 o'clock, 4 + 8 o'clock, 3 + 9 o'clock, and 2 + 10 o'clock. In total, 93.2% of the diagnostic planes were displayed properly. Between 5 and 7 o'clock, 94.9% of the diagnostic planes were displayed properly. The correct depiction rates in the other groups were 92.4% (4 + 8 o'clock; n = 538; P = 0.0027), 88.3% (3 + 9 o'clock; n = 156; P

Trauma of the levator ani muscle (LAM) is common after vaginal birth and can most reliably be diagnosed by 3-dimensional (3D) translabial ultrasound (TLUS). Multiple risk factors are known in general, but not in association to a specific side of the body. Therefore, our aim was to evaluate different impact factors which cause LAM trauma on either side of the body or bilateral by focusing on the fetal position at birth.As part of a prospective cohort study between 3/2017 and 4/2019, we analyzed vaginal births of nulliparous women with singletons in vertex presentation≥36+0 gestational weeks. We evaluated their pelvic floor for hematomas, partial and complete LAM avulsions by 3D TLUS 2-4 days postpartum and searched for an association between the affected body side and different fetal, maternal and obstetrical factors.71 out of 213 women (33.3%) suffered from LAM trauma - 17 (23.9%) on the right side, 20 (28.2%) on the left side and 34 (47.9%) bilateral. No association between the different evaluated factors and the affected body side could be identified, except for the quality of fetal heart rate tracing.No significant impact factors of LAM trauma could be associated with a specific side of the body. Other possible mechanisms need investigation in the future, such as the time of the birth canal and the fetus to adapt to each other, including adequate time for the tissue to stretch and the fetus to rotate into the ideal position within the LAM hiatus.Levatormuskelverletzungen sind häufig nach Vaginalgeburten und können zuverlässig mittels translabialem 3D-Ultraschall diagnostiziert werden. Diverse Risikofaktoren sind hierfür bekannt, allerdings keine hinsichtlich der Assoziation zu einer der beiden Körperseiten. Daher war das Ziel dieser Arbeit, verschiedene Einflussfaktoren im Rahmen vaginaler Geburten zu evaluieren, welche eine Levatorverletzung auf einer der beiden Körperseiten bzw. beidseitig begünstigen, v. a. hinsichtlich der Kindsposition im Geburtskanal.In einer prospektiven Kohortenstudie analysierten wir von 3/2017-4/2019 Erstgebärende mit vaginalen Einlingsgeburten aus Schädellage≥36+0 SSW. Wir evaluierten 2-4 Tage postpartal ihren Beckenboden mittels 3D-Ultraschall hinsichtlich Hämatomen sowie partiellen und kompletten Levatoravulsionen und suchten nach Assoziationen zwischen der betroffenen Körperseite und fetalen, maternalen und geburtshilflichen Einflussfaktoren.Von 213 Frauen erlitten 71 (33.3%) eine Levatorverletzung - 17 (23.9%) rechtsseitig, 20 (28.2%) linksseitig und 34 (47.9%) beidseitig. Es wurden keine Assoziationen zwischen den untersuchten Einflussfaktoren und der betroffenen Körperseite gefunden, bis auf die Qualität der fetalen Herzfrequenz.Es konnten keine signifikanten Einflussfaktoren für das Auftreten einer Levatorverletzung einer spezifischen Körperseite eruiert werden. Daher bedarf es in Zukunft der Untersuchung weiterer Mechanismen, wie der Adaptationsvorgänge von Geburtskanal und Fet und der adäquaten Zeit für das Gewebe zur notwendigen Dehnung, v. a. im Bereich der Levatoröffnung.Trauma of the levator ani muscle (LAM) is common after vaginal birth and can most reliably be diagnosed by 3-dimensional (3D) translabial ultrasound (TLUS). Multiple risk factors are known in general, but not in association to a specific side of the body. Therefore, our aim was to evaluate different impact factors which cause LAM trauma on either side of the body or bilateral by focusing on the fetal position at birth.As part of a prospective cohort study between 3/2017 and 4/2019, we analyzed vaginal births of nulliparous women with singletons in vertex presentation≥36+0 gestational weeks. We evaluated their pelvic floor for hematomas, partial and complete LAM avulsions by 3D TLUS 2–4 days postpartum and searched for an association between the affected body side and different fetal, maternal and obstetrical factors.71 out of 213 women (33.3%) suffered from LAM trauma – 17 (23.9%) on the right side, 20 (28.2%) on the left side and 34 (47.9%) bilateral. No association between the different evaluated factors and the affected body side could be identified, except for the quality of fetal heart rate tracing.No significant impact factors of LAM trauma could be associated with a specific side of the body. Other possible mechanisms need investigation in the future, such as the time of the birth canal and the fetus to adapt to each other, including adequate time for the tissue to stretch and the fetus to rotate into the ideal position within the LAM hiatus.Levatormuskelverletzungen sind häufig nach Vaginalgeburten und können zuverlässig mittels translabialem 3D-Ultraschall diagnostiziert werden. Diverse Risikofaktoren sind hierfür bekannt, allerdings keine hinsichtlich der Assoziation zu einer der beiden Körperseiten. Daher war das Ziel dieser Arbeit, verschiedene Einflussfaktoren im Rahmen vaginaler Geburten zu evaluieren, welche eine Levatorverletzung auf einer der beiden Körperseiten bzw. beidseitig begünstigen, v. a. hinsichtlich der Kindsposition im Geburtskanal.In einer prospektiven Kohortenstudie analysierten wir von 3/2017–4/2019 Erstgebärende mit vaginalen Einlingsgeburten aus Schädellage≥36+0 SSW. Wir evaluierten 2–4 Tage postpartal ihren Beckenboden mittels 3D-Ultraschall hinsichtlich Hämatomen sowie partiellen und kompletten Levatoravulsionen und suchten nach Assoziationen zwischen der betroffenen Körperseite und fetalen, maternalen und geburtshilflichen Einflussfaktoren.Von 213 Frauen erlitten 71 (33.3%) eine Levatorverletzung – 17 (23.9%) rechtsseitig, 20 (28.2%) linksseitig und 34 (47.9%) beidseitig. Es wurden keine Assoziationen zwischen den untersuchten Einflussfaktoren und der betroffenen Körperseite gefunden, bis auf die Qualität der fetalen Herzfrequenz.Es konnten keine signifikanten Einflussfaktoren für das Auftreten einer Levatorverletzung einer spezifischen Körperseite eruiert werden. Daher bedarf es in Zukunft der Untersuchung weiterer Mechanismen, wie der Adaptationsvorgänge von Geburtskanal und Fet und der adäquaten Zeit für das Gewebe zur notwendigen Dehnung, v. a. im Bereich der Levatoröffnung.

Congenital heart disease (CHD) is the leading organ-specific birth defect, as well as the leading cause of infant morbidity and mortality from congenital malformations. Therefore, a comprehensive screening examination of the fetal heart should be performed in all women to maximize the detection of CHD. Four-dimensional sonography with spatiotemporal image correlation (STIC) technology displays a cine loop of a complete single cardiac cycle in motion. A novel method known as Fetal Intelligent Navigation Echocardiography (or FINE) was previously developed to interrogate STIC volume datasets using "intelligent navigation" technology. Such method allows the automatic display of nine standard fetal echocardiography views required to diagnose most cardiac defects. FINE considerably simplifies fetal cardiac examinations and reduces operator dependency. It has both high sensitivity and specificity for the detection of CHD. Indeed, FINE has been integrated into several commercially available ultrasound platforms.Recently, eight novel and advanced features have been developed for the FINE method and they will be described herein. Such features can be categorized based upon their broad goals. The first goal is to simplify FINE further, and consists of the following features: (1) Auto fetal positioning (or FINE align); (2) Skip points; (3) Predictive cursor; (4) Static mode volume; and (5) Breech sweep. The second goal is to allow quantitative measurements to be performed on the cardiac views generated by FINE: (6) Automatic cardiac axis; and (7) Cardiac biometry. Finally, the last goal is to improve the success of obtaining fetal echocardiography view(s); and consists of (8) Maestro planar navigation.

Objective The aim of this study was to evaluate the validity of a semiautomated volumetric approach (5DCNS+) for the detailed assessment of the fetal brain in a clinical setting. Methods Stored 3D volumes of > 1100 consecutive 2nd and 3rd trimester pregnancies (range 15–36 gestational weeks) were analyzed using a workflow-based volumetric approach 5DCNS+, enabling semiautomated reconstruction of diagnostic planes of the fetal central nervous system (CNS). All 3D data sets were examined for plane accuracy, the need for manual adjustment, and fetal-maternal characteristics affecting successful plane reconstruction. We also examined the potential of these standardized views to give additional information on proper gyration and sulci formation with advancing gestation. Results Based on our data, we were able to show that gestational age with an OR of 1.085 (95% CI 1.041–1.132) and maternal BMI with an OR of 1.022 (95% CI 1.041–1.054) only had a slight impact on the number of manual adjustments needed to reconstruct the complete volume, while maternal age and fetal position during acquisition (p = 0.260) did not have a significant effect. For the vast majority (958/1019; 94%) of volumes, using 5DCNS+ resulted in proper reconstruction of all nine diagnostic planes. In less than 1% (89/9171 planes) of volumes, the program failed to give sufficient information. 5DCNS+ was able to show the onset and changing appearance of CNS folding in a detailed and timely manner (lateral/parietooccipital sulcus formation seen in Conclusions The 5DCNS+ method provides a reliable algorithm to produce detailed, 3D volume–based assessments of fetal CNS integrity through a standardized reconstruction of the orthogonal diagnostic planes. The method further gives valid and reproducible information regarding ongoing cortical development retrieved from these volume sets that might aid in earlier in utero recognition of subtle structural CNS anomalies.

Purpose: This research was carried out to determine the influence of kangaroo care, fetal position, and swaddling on pain and comfort levels in preterm infants during peripheral vascular access. Design and methods: The study was conducted as a randomized experimental study with a control group. It included 148 premature infants (kangaroo group = 37, swaddling group = 37, fetal position = 37, control group = 37) of 32–37 weeks of age who had peripheral vascular access in the NICU of a state hospital in eastern Turkey between December 2019 and June 2020. While the infants in the experimental group received kangaroo care, fetal position, and swaddling procedures during and after peripheral vascular access, the infants in the control group received conventional peripheral vascular access without extra intervention. “Newborn Infant Pain Scale (NIPS)” and “Premature Infant Comfort Scale (PICS)” were used to collect data. Data were analyzed using percentile, chi-square and ANOVA tests. Results: Further analysis revealed that the fetal position was the most beneficial intervention for reducing NIPS scores and boosting PICS scores during and after peripheral vascular access in the experimental groups, followed by kangaroo care and lastly swaddling. Conclusion: It was discovered that kangaroo care, fetal position, and swaddling were useful in lowering discomfort and boosting comfort levels in premature infants during and after peripheral vascular access. Practice implications: Kangaroo care, fetal position and swaddling methods can be used in clinical practice in order to reduce the pain level and increase the comfort level during and after peripheral vascular access in prematures. © 2022 Elsevier Inc.

Tez No: 728142 Bu araştırmada, term bebeklere venöz kan alınması sırasında beyaz gürültü dinletilmesi, cenin pozisyonu verilmesi ve iki uygulamanın birlikte yapılmasının bebekte oluşan akut ağrı, oksijen saturasyonu ve yaşam bulgularına etkisini belirlemek amaçlanmıştır. Araştırma Karaman Eğitim ve Araştırma Hastanesi Yenidoğan Yoğun Bakım Ünitesinde, 01 Ağustos-30 Aralık 2021 tarihleri arasında üniteye yatışı yapılan term bebekler dahil edilerek gerçekleştirilmiştir. Bu araştırmada dört grup yer almaktadır. Bunlar; kontrol grubu, beyaz gürültü grubu, cenin pozisyonu grubu ve beyaz gürültü ve cenin pozisyonu grubudur. Venöz kan alma işlemi, aynı hemşire tarafından yapılmıştır. Yenidoğanlar gruba rastgele atanmıştır. Veri toplama sürecine post hoc güç analizinde beklenen veri doygunluğuna ulaşıncaya kadar devam edilmiştir. Toplam 160 bebek değerlendirilmiştir. İşlem sırasında kontrol grubunda yer alan yenidoğanların diğer tüm gruplardaki yenidoğanlardan anlamlı düzeyde daha yüksek ağrı yaşadığı belirlenmiştir. İşlem sonrası ise en yoğun ağrı yaşayanın yine kontrol grubunda yer alan yenidoğanlar olduğu görülmüştür. Daha sonra sırasıyla cenin pozisyonu, beyaz gürültü ve beyaz gürültü ve cenin pozisyonunda yer alan yenidoğanlar olduğu belirlenmiştir. Beyaz gürültü ve cenin pozisyonunun venöz kan alımı sırasında kullanılmasının; bebeğin ağrısına ve yaşam bulgularına olumlu etkisi sebebiyle uygulanması önerilir. It was aimed to determine the effect of white noise listening, fetal position giving and two applications together on acute pain, oxygen saturation and signs of life in a newborn during venous blood collection from term infants. December August 01-December 30, 2021, term babies who were admitted to the unit were included in the study conducted in the Neonatal Intensive Care Unit of Karaman Training and Research Hospital. dec. 2021, term babies were admitted to the unit was included in the study. Four groups are involved in this research. These are the control group, the white noise group, the fetal position group and the white noise and fetal position group. Venous blood collection was performed by the same nurse. Newborns were randomly assigned to the group. The data collection process was continued until the expected data saturation was reached in the post hoc power analysis. A total of 160 babies were evaluated. It was determined that newborns in the control group experienced significantly higher pain during the procedure than newborns in all other groups. After the procedure, it was observed that the newborns in the control group were the ones who experienced the most intense pain. Then, it was determined that there were newborns in the fetal position, white noise and white noise andfetal position, respectively. It is recommended that the use of white noise and fetal position during venous blood intake be applied due to its positive effect on the baby's pain and signs of life.

Placenta accreta is one of the emergency conditions and has resulted in increased mortality and morbidity of pregnant women due to the massive obstetric hemorrhage. Placenta accreta can lead to secondary complications including coagulopathy, multisystem organ failure, acute respiratory distress syndrome, need for repeat surgery, and death. Assessment by anesthesia should be carried out as early as possible before surgery to reduce or even eliminate morbidity and mortality. In this report, we present the case of a patient with total placenta previa and high-risk morbidly adherent placenta score with a transverse lie fetal position. The various anesthetic treatments and transfusion strategies are discussed with a multidisciplinary approach to delivery.

Background: Prediction of the mode of delivery is crucial for better labour outcome. Recent studies suggest that the angle of progression (AOP), measured using transperineal ultrasound, can substantially aid the assessment of fetal head descent during labor, thereby predicting the mode of delivery. Objective: To assess the ability of the AOP measured by transperineal ultrasound to predict the mode of delivery in nulliparous women before the onset of labor. Methods: A prospective observational study was conducted at our hospital, of nulliparous women who had presented to the antenatal clinic at ≥ 38 weeks of gestation but not in labor. AOP was measured using transperineal ultrasonography and compared among the women having Caesarean section (CS) due to labor dystocia and vaginal delivery (VD). Various other confounding factors which increase the risk of caesarean section were analyzed. Results: Among total 120 nulliparous women, the mean AOP was narrower in patients undergoing CS (n = 28) compared to those with VD (n = 92) (91.6 ± 6.1° vs. 100.7 ± 6.9°; P < 0.01). Multivariable logistic regression analysis revealed that narrow AOP values (OR 3.66; P < 0.001; 95% CI 1.7- 14.5) and occiput-posterior fetal position (OR 1.63; P = 0.04; 95% CI 1.0-7.5) were the independent risk factors for CS. An AOP ≥ 96° (calculated from the ROC curve) was associated with VD in 95% (76/80) of women and an AOP < 96° was observed among 60% (24/40) of women who underwent CS. Conclusion: Narrow AOP (< 96°) and occiput-posterior fetal position are at higher risk for CS due to labor dystocia. AOP measured at the antenatal period could accurately predict the mode of delivery, thereby modifying labor outcome.

Ultrasound (US) is the principal imaging modality used to diagnose and evaluate congenital heart disease (CHD), which is the most common birth defect worldwide, affecting 9.410 per 1000 newborns. Mother’s BMI, amniotic fluid index, and fetal mobility and position are factors that influence the precision and difficulty of prenatal US examination. In our study we considered whether fetuses with CHD have a predilection to any position. It has never been reported before. We analysed results of 1620 (control – 835, isolated CHD – 321, non-isolated CHD – 464) fetal cardiac US performed between June 2016 and September 2019 at the Department of Prenatal Cardiology. The following parameters: gestational age, fetal position, CHD, and non-cardiac anomalies/defects were taken into consideration for further statistical analysis. We observed a statistically higher frequency of right cephalic position (CII) among fetuses with CHD, as well as isolated and non-isolated CHD in comparison to healthy controls (p < 0.0001, p < 0.0001, and p = 0.0015, respectively; n = 1620). These findings may be an effect of more advanced gestational age of CHD patients. Hence, we performed further analysis in the age group ≥ 33 weeks of gestation, which also revealed statistically significant differences in the CII position in the group of CHD fetuses, especially isolated ones when compared to healthy controls (p = 0.0292 and p = 0.0049, respectively; n = 674). Fetuses with CHD had a predilection to right cephalic position more often than healthy fetuses. Because this factor determines the high-quality of US examination, it should be mentioned in medical reports of prenatal ultrasound.

Background Pituitary tumors and/or their treatment are associated with multiple pituitary hormone deficiency (MPHD) in adults, but the distinct pituitary hormone profile of MPHD in Chinese children and adolescents remains unclear. Methods Patients with MPHD were divided into four groups according to their MRI results: 1) pituitary stalk interruption syndrome (PSIS); 2) hypoplasia; 3) normal; and 4) tumor survivor. Results Among the 184 patients, 93 patients (50.5%) were with PSIS, 24 (13.0%) had hypoplastic pituitary gland, 10 (5.4%) patients were normal, and 57 (31.0%) were tumor survivors. There was an association between abnormal fetal position and PSIS (P ≤ 0.001). The CA/BA in PSIS, hypoplasia, normal, tumor survivor groups were 2.27 ± 1.05, 1.48 ± 0.39, 1.38 ± 0.57, 1.49 ± 0.33, and HtSDS were − 3.94 ± 1.39, − 2.89 ± 1.09, − 2.50 ± 1.05, − 1.38 ± 1.63. Patients in PSIS group had the largest CA/BA (P ≤ 0.001 vs. hypoplasia group, P = 0.009 vs. normal group, P ≤ 0.001 vs. tumor survivors) and lowest HtSDS (P ≤ 0.001 vs. hypoplasia group, P = 0.003 vs. normal group, P ≤ 0.001 vs. tumor survivors). The levels of TSH in the PSIS, hypoplasia, normal, and tumor survivor groups were 1.03 ± 1.08 (P = 0.149 vs. tumor survivors), 1.38 ± 1.47 (P = 0.045 vs. tumor survivors), 2.49 ± 1.53 (P P ≤ 0.001 vs. PSIS group, P = 0.002 vs. hypoplasia group, P ≤ 0.001 vs. normal group) and ACTH (all the P ≤ 0.001 vs. the other three groups). Conclusion The frequency of PSIS is high among children and adolescents with MPHD. The severity of hormone deficiencies in patients with MPHD was more important in the tumor survivor group compared with the other groups.

This study analyses, in children born in twin births, the relationship between reading, writing and arithmetic learning, on the one hand, and type of delivery, on the other, controlling for the effect of interaction and/or confusion of third variables (maternal age at delivery, gestational age, fetal position, birthweight, 1-min Apgar score). In the planned retrospective cohort design, the exposed cohort consisted of children born by caesarean section, and the non-exposed cohort was comprised of children born vaginally. One hundred and twenty-four children born of twin births were evaluated during their first year of primary school: K-BIT tests were used to measure intelligence; the Evalúa-1 battery was used to assess reading, writing, and arithmetic ability; and the children's clinical histories were analysed for obstetric and neonatal variables. After applying binary logistic regressions for each dependent variable, it was found that caesarean delivery in twin births appeared as a possible independent risk factor for specific learning disabilities (LDs) in reading, writing, and arithmetic. Based on these results, further research using larger samples and at more advanced ages is required in order to analyse the influence of obstetric and neonatal variables on the processes underlying specific LDs.

Objective: To develop a model to predict the risk of postpartum hemorrhage (PPH) following cesarean delivery in women with a scarred uterus. Methods: A total of 4,637 pregnant women with scarred uterus who underwent a cesarean delivery at a large hospital between January 2014 and December 2017 were enrolled. The women were divided into PPH (n = 287) and non-PPH (n = 4,350) groups. A model to predict PPH (blood loss ≥1,000 mL within 24 h following cesarean delivery) was developed using multivariate logistic regression analysis. Receiver operating characteristic curve was drawn, and the area under curve (AUC) was calculated. Results: The incidence of PPH was 6.19% (287 of 4,637 women). Seven independent risk factors were associated with PPH: maternal age (odds ratio [OR]= 1.42, 95% confidence interval [CI]: 1.02-1.97), previous gravidity (OR = 1.24, 95% CI: 1.01-1.50), placental location (posterior wall of uterus, OR= 0.69, 95% CI: 0.47-1.02; other locations, OR= 1.21, 95% CI: 0.81-1.80), placenta previa (incomplete placenta previa, OR = 10.51, 95% CI: 5.99-18.42; complete placenta previa, OR = 31.65, 95% CI: 21.07-47.54), placenta accreta (OR = 6.39, 95% CI: 4.02-10.16), hypertensive disorders of pregnancy (OR = 2.27, 95% CI: 1.40-3.68), and fetal position (breech position, OR = 2.07, 95% CI: 1.19-3.60; transverse position, OR = 1.07, 95% CI: 0.48-2.41). A predictive model with AUC of 0.89 was developed (95% CI: 0.86-0.91, P < 0.001). Conclusions: A model was developed to predict PPH following cesarean delivery in women with a scarred uterus. Key words: Cesarean Delivery; Logistic Regression; Postpartum Hemorrhage; Prediction; Risk Factors

To describe, evaluate and validate the diagnostic performance of a new clinical sign, the sleeper’s sign, for the diagnosis of a medial submeniscal flap tear (MSMFT). This retrospective single-center series included patients aged 18–55 years old who underwent arthroscopic treatment in 2013–2015 for a medial meniscal tear. This study was performed according to STARD (standards for reporting of diagnostic accuracy) guidelines, and the reference test was a peroperative diagnosis of a MSMFT. The preoperative consultation reports were all analyzed to search for the sleeper’s sign, defined as night time medial tibiofemoral pain when the patient is in the fetal position with both knees in contact and no pain during daytime activities. Three-hundred and ten patients responded to the study criteria, mean age 41.7 ± 9.7 years old. The sleeper’s sign was identified in 39 (12.6%) patients and a MSMFT was confirmed during arthroscopy in 47 (15.2%) cases, with significant agreement between this sign, arthroscopy (kappa = 0.78, p = 10–4) and MR-imaging (kappa = 0.72, p

Background Vulnerable groups, such as pregnant women, are not used in immersive simulation. This can limit opportunities for students to practice real-life clinical examinations. Nonpregnant simulated patient involvement is of limited value if realistic physiological presentations that reflect body changes in pregnancy are unavailable to perform examinations. Methods The authors present an innovative and cost-effective high-fidelity method to create a wearable simulated maternity model that can be worn by nonpregnant actors to simulate pregnancy in immersive simulations in midwifery. Results In this article, we provide step-by-step instructions for constructing a wearable model simulating pregnancy. This enables students to palpate fetal position, listen to the fetal heart, and assess cervical dilation. Conclusion This simulation resource is cost-effective, is simple to implement, and is a highly effective means for simulating pregnancy and teaching skills and critical thinking in higher fidelity complex immersive scenarios.

In fetal echocardiography, conventional parameters for assessing cardiac function are limited because of limited echocardiographic windows or the fetus' position. We aimed to evaluate the feasibility and reproducibility of fetal left ventricular (LV) twist by two-dimensional, speckle-tracking echocardiography (2DSTE) in a Japanese population.We included 55 normal fetuses at gestational ages between 21 and 36 weeks. Subjects with adverse maternal health issues were excluded. LV twist was calculated as the net difference between LV basal and apical rotation at end-systole estimated with 2DSTE.We were able to analyze the 2DSTE images in 44 cases (80%). The mean (±SE) apical rotation, basal rotation, and LV twist were 7.88 ± 0.77, -3.68 ± 0.50, and 11.1 ± 0.75 degrees, respectively. We could not analyze 11 cases (20%) because of poor image quality due to fetal position in five cases (45.5%), failure to track the endocardium because of blurred images in five cases (45.5%), and failure to obtain images of the heart due to the presence of the placenta in front of the fetus in one case (9.1%). There were no significant differences in the demographic data between pregnant women in whom LV twist analysis was feasible and not feasible. The intra- and interobserver intraclass correlation coefficients were 0.67 and 0.64, respectively.LV twist analysis by 2DSTE in the fetus was feasible in a substantial population and may provide new insight into cardiac function during the prenatal period. On the other hand, its reproducibility was moderate and needs to be improved.

Summary Limited visualization of the fetal heart and vessels by fetal ultrasound due to suboptimal fetal position, patient habitus and skeletal calcification may lead to missed diagnosis, overdiagnosis and parental uncertainty. Counselling and delivery planning may in those cases also be tentative. The recent fetal cardiac magnetic resonance (CMR) reconstruction method utilizing tiny golden‐angle iGRASP (iterative Golden‐angle RAdial Sparse Parallel MRI) allows for cine imaging of the fetal heart for use in clinical practice. This case describes an unbalanced common atrioventricular canal where limited ultrasound image quality and visibility of the aortic arch precluded confirming or ruling out presence of a ventricular septal defect. Need of prostaglandins or neonatal intervention was thus uncertain. Cardiovascular magnetic resonance imaging confirmed ultrasound findings and added value by ruling out a significant ventricular septal defect and diagnosing arch hypoplasia. This confirmed the need of patient relocation for delivery at a paediatric cardiothoracic surgery centre and prostaglandins could be initiated before the standard postnatal ultrasound. The applied CMR method can thus improve diagnosis of complicated fetal cardiac malformation and has direct clinical impact.

PURPOSE: This study investigates whether two-channel radiofrequency (RF) shimming can improve imaging without increasing specific absorption rate (SAR) for fetal MRI at 3T. METHODS: Transmit field [Formula: see text] average and variation in the fetus was simulated in seven numerical pregnant body models. Safety was quantified by maternal and fetal peak local SAR and fetal average SAR. The shim parameter space was divided into improved [Formula: see text] (magnitude and homogeneity) and improved SAR regions, and an overlap where RF shimming improved both classes of metrics compared with birdcage mode was assessed. Additionally, the effect of fetal position, tissue detail, and dielectric properties on transmit field and SAR was studied. RESULTS: A region of subject-specific RF shim parameter space improving both [Formula: see text] and SAR metrics was found for five of the seven models. Optimizing only [Formula: see text] metrics improved [Formula: see text] efficiency across models by 15% on average and 28% for the best-case model. [Formula: see text] variation improved by 26% on average and 49% for the best case. However, for these shim settings, fetal SAR increased by up to 106%. The overlap region, where both [Formula: see text] and SAR metrics improve, showed an average [Formula: see text] efficiency improvement of 6% on average across models and 19% for the best-case model. [Formula: see text] variation improved by 13% on average and 40% for the best case. RFS could also decrease maternal/fetal SAR by up to 49%/58%. CONCLUSION: RF shimming can improve imaging compared with birdcage mode without increasing fetal and maternal SAR when a patient-specific SAR model is incorporated into the shimming procedure.

Background: Maternal-fetal attachment is intangible connection and maintains a bond between mother and baby in her womb which is considered an important part of fetal development and this attachment can be affected by different factors. This study was aimed to identify the factors affecting the maternal-fetal attachment during pregnancy. Design: A descriptive design was used. Subjects: A purposive sample including 100 pregnant women were participated. Setting: Antenatal Clinics of Al-Azhar University Hospital in New Damietta City, Damietta Governorate, in Egypt. Tools: A structure Interview Questionnaire, Cranley’s Maternal-Fetal attachment Scale (CMFAS), Fetal position awareness scale (FPAS). Results: There was a positive and significant relationship between the mean of MFA in mothers with the history of fetal loss and presence of support provider and strong attachment to mother, on the other hand this study confirmed that a statistically significant negative correlation between MFA and pregnant woman's gravidity. Conclusion: Maternal fetal attachment is associated significantly and positively with multiple factors: previous fetal loss, presence of support provider, and strong attachment to mother. Education level and history of previous low birth weight baby come in the second level of significant in this study. Additionally, increased gravidity contributed to a decreased MFA level. Recommendation: Early and effective interventions should be applied for the expectant mother to achieve a physically and psychologically wellbeing during pregnancy to reach best optimize maternal and fetal health .

Autonomous fetal ultrasonography with a robotic ultrasound (US) can potentially solve the issue of the shortage of ob-gyn physicians in prenatal care. In fetal cardiac diagnosis, acoustic shading derived from the fetal skeleton makes the scanning procedure using a robotic US cumbersome. We hypothesize that fetal bone distribution can be used for determining the fetal position and for subsequently estimating the heart position. This paper serves a method for estimating fetal heart position for autonomous cardiac diagnosis. Our proposed system is comprised of following three processes. First, the fetal bone distribution is generated by following steps: detect shadow areas derived from fetal bones; calculate the three-dimensional (3D) position of the bones; and identify bone types (skull, spine, and others) based on its shadow features. Next, the fetal head position and body axis are estimated based on the generated 3D bone distribution. Finally, the fetal chest position and thoracic sagittal axis of the fetus are estimated based on anatomical structures, and the position of the heart is determined. We validated the proposed method by evaluating the accuracies of bone detection and heart position estimation with three pregnant volunteers. The false positive rate of bone detection is less than 10%, which is sufficient for the proposed method; further, the estimation error for the heart position was within an acceptable error of 15 mm. These results demonstrate the sufficient accuracy of the proposed estimation method and suggest the potential of autonomous fetal cardiac diagnosis using robotic US scanning.