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Objectives: To describe the sonographic features of the caudothalamic groove in the third trimester of pregnancy in a group of structurally normal fetuses and to report a small series of cases with abnormal appearance of the caudothalamic groove at antenatal cranial ultrasound. Methods: This was an observational study conducted at two fetal medicine referral units in Italy. A non‐consecutive cohort of pregnant women with a singleton non‐anomalous pregnancy were recruited prospectively and underwent three‐dimensional (3D) ultrasound assessment of the fetal brain at 28–32 weeks' gestation. At offline analysis, the ultrasound volumes were adjusted in the multiplanar mode, according to a standardized methodology, until the caudothalamic groove was visible in the parasagittal plane. To evaluate interobserver agreement, two operators were asked independently to indicate if the caudothalamic groove was visible unilaterally or bilaterally on each volume and Cohen's kappa (κ) coefficient was calculated. The digital archives of the two centers were also searched retrospectively to retrieve cases with abnormal findings at the level of the caudothalamic groove on antenatal cranial ultrasound that were confirmed postnatally. Results: A total of 180 non‐consecutive cases were included. At offline analysis of the 3D ultrasound volumes, the caudothalamic groove was identified in the parasagittal plane by both operators at least unilaterally in 176 (97.8%) cases and bilaterally in 174 (96.7%) cases. The κ‐coefficient for the agreement between the two independent operators in recognizing the caudothalamic groove was 0.89 and 0.83 for one and both hemispheres, respectively. The retrospective search of our archives yielded five cases with an abnormal appearance of the caudothalamic groove at antenatal cranial ultrasound, including two cases of hemorrhage and three cases of cyst. Conclusions: The caudothalamic groove is consistently seen in normal fetuses on multiplanar neurosonography in the third trimester, and abnormal findings in this region may be detected antenatally. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article provides information on fetal growth restriction (FGR), a condition where a fetus does not reach its full growth potential due to a pathological factor. It discusses the classification of FGR based on gestational age at diagnosis and explores the causes and outcomes of pre- and periviable FGR. The article emphasizes the importance of genetic counseling and testing in cases of FGR and provides information on the prevalence of genetic anomalies, structural defects, and congenital infections in these cases. It also discusses the incidence and outcome of placental insufficiency as a cause of FGR. The article highlights the varying frequency of hypertensive disorders of pregnancy (HDP) in pre- and periviable FGR and their impact on maternal and fetal/neonatal health. It concludes by discussing the management of pre- and periviable FGR, including the consideration of termination of pregnancy in certain cases and the determination of the mode of delivery for fetuses alive at birth. [Extracted from the article]

This article discusses the use of Doppler ultrasound technology to assess the cerebral vessels in the fetal central nervous system (CNS) during prenatal imaging. The development of Doppler technologies that are highly sensitive for low-velocity flow has allowed for the visualization of the intracerebral venous system, including the medullary veins. The article presents a case study where Doppler tools were used to identify a CNS anomaly in a pregnant woman, leading to a diagnosis of subarachnoid hemorrhage. The authors suggest that Doppler technology has the potential to aid in the differential diagnosis of cerebral anomalies and further research is needed to explore its role in assessing fetal CNS health. [Extracted from the article]

Objectives: To investigate the rate and outcome of emergency Cesarean delivery (CD) in women with placenta previa with or without placenta accreta spectrum disorders (PAS) and to elucidate the diagnostic accuracy of ultrasound in predicting emergency CD. Methods: This was a secondary analysis of a multicenter prospective study involving 16 referral hospitals in Italy (ADoPAD study). Inclusion criteria were women with placenta previa minor (< 20 mm from the internal cervical os) or placenta previa major (covering the os), aged ≥ 18 years, who underwent transabdominal and transvaginal ultrasound assessment at ≥ 26 + 0 weeks of gestation. The primary outcome was the occurrence of emergency CD, defined as the need for immediate surgical intervention performed for emergency maternal or fetal indication, including active labor, cumulative maternal bleeding > 500 mL, severe and persistent vaginal bleeding such that maternal hemodynamic stability could not be achieved or maintained, or category‐III fetal heart rate tracing unresponsive to resuscitative measures. The primary outcome was reported separately in the population of women with placenta previa and no PAS confirmed after birth and in those with PAS. The secondary aim was to report on the strength of association and to test the diagnostic accuracy of ultrasound in predicting emergency CD. Univariate, multivariate and diagnostic accuracy analyses were used to analyze the data. Results: A total of 450 women, including 97 women with placenta previa and PAS and 353 with placenta previa only, were analyzed. In women with placenta previa and PAS, emergency CD was required in 20.6% (95% CI, 14–30%), and 60.0% (12/20) delivered before 34 weeks of gestation. The mean gestational age at delivery was 32.3 ± 2.7 weeks in women undergoing emergency CD and 34.9 ± 1.8 weeks in those undergoing elective CD (P < 0.001). Women undergoing emergency CD had a higher median estimated blood loss (2500 (interquartile range (IQR), 1350–4500) vs 1100 (IQR, 625–2500) mL; P = 0.012), mean units of blood transfused (7.3 ± 8.8 vs 2.5 ± 3.4; P = 0.02) and more frequent placement of a mechanical balloon (50.0% vs 16.9%; P = 0.002) compared with those undergoing elective CD. On univariate analysis, the presence of interrupted retroplacental space, interrupted bladder line and placental lacunae was more common in women not experiencing emergency CD. No comprehensive multivariate analysis could be performed in this subgroup of women. Ultrasound signs of PAS, including presence of interrupted retroplacental space, interrupted bladder line and placental lacunae, were not predictive of emergency CD. In women with placenta previa but no PAS, emergency CD was required in 31.2% (95% CI, 26.6–36.2%), and 32.7% (36/110) delivered before 34 weeks of gestation. The mean gestational age at delivery was lower in women undergoing emergency CD compared with those undergoing elective CD (34.2 ± 2.9 vs 36.7 ± 1.6 weeks; P < 0.001). Pregnancies complicated by emergency CD were associated with a lower birth weight (2330 ± 620 vs 2800 ± 480 g; P < 0.001) and had a higher risk of need for blood transfusion (22.7% vs 10.7%; P = 0.003) compared with those who underwent elective CD. On multivariate analysis, only placental thickness (odds ratio (OR), 1.02 (95% CI, 1.00–1.03); P = 0.046) and cervical length < 25 mm (OR, 3.89 (95% CI, 1.33–11.33); P = 0.01) were associated with emergency CD. However, a short cervical length showed low diagnostic accuracy for predicting emergency CD in these women. Conclusion: Emergency CD occurred in about 20% of women with placenta previa and PAS and 30% of those with placenta previa only and was associated with worse maternal outcome compared with elective intervention. Prenatal ultrasound is not predictive of the risk of emergency CD in women with these disorders. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the relationship between the attitude of the fetal head quantified by means of the chin‐to‐chest angle (CCA) in fetuses in occiput posterior (OP) position at the beginning of the second stage of labor, and persistent OP position at birth. Methods: This was a single‐center, prospective observational study conducted at the University Hospital of Parma, Parma, Italy. We included singleton pregnancies at term with fetuses in the OP position at the beginning of the second stage of labor. The fetal head position, station by means of angle of progression and head‐to‐perineum distance, and attitude by means of CCA were assessed using transabdominal or transperineal ultrasound. The primary outcome was persistent OP position at birth. Results: Between January and July 2022, 76 women were included in the study. There were 48 (63.2%) spontaneous rotations of the fetal head and spontaneous vaginal delivery occurred in all. Among the 28 (36.8%) fetuses that did not rotate spontaneously into an occiput anterior position, eight (28.6%) had a spontaneous vaginal delivery, while operative vaginal delivery and Cesarean delivery was performed in 11 (39.3%) and nine (32.1%) cases, respectively. Multivariable logistic regression analysis showed that the CCA (adjusted odds ratio (aOR), 2.15 (95% CI, 1.22–3.78); P = 0.008) and nulliparity (aOR, 0.20 (95% CI, 0.06–0.76); P = 0.02) were associated independently with persistent OP position at birth. Moreover, the CCA showed an area under the receiver‐operating‐characteristics curve of 0.69 (95% CI, 0.56–0.82); P = 0.005) for the prediction of persistent OP position. The optimal cut‐off value of the CCA was 36.5°, and was associated with a sensitivity of 0.82 (95% CI, 0.63–0.94), specificity of 0.50 (95% CI, 0.35–0.65), positive predictive value of 0.49 (95% CI, 0.34–0.64), negative predictive value of 0.83 (95% CI, 0.64–0.94), positive likelihood ratio of 1.64 (95% CI, 1.18–2.29) and negative likelihood ratio of 0.36 (95% CI, 0.15–0.83). Conclusions: Our data show that, within a population of women with fetal OP position at the beginning of the second stage of labor, the sonographic fetal head attitude measured by means of the CCA might help in the identification of fetuses at risk of persistent OP position. Such findings can be useful for patient counseling when OP position is diagnosed at full cervical dilatation. Further studies should investigate if the CCA might select patients who may benefit from manual rotation of the fetal head. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

The article discusses the use of manual rotation of the fetal occiput posterior (MROP) position as a prophylactic or therapeutic maneuver to correct malposition of the fetal head during labor, potentially reducing the need for operative delivery. While controversial, MROP is endorsed by medical organizations like ACOG and SMFM for preventing primary Cesarean delivery. The effectiveness of MROP varies, with success rates dependent on the operator's experience level and fetal attitude, and intrapartum ultrasound can assist in confirming fetal head malposition and guiding the MROP procedure. The article presents a case study of a successful MROP procedure aided by real-time sonographic guidance. [Extracted from the article]