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To identify the differentiating features in clinical presentation, management, and maternal/fetal outcome in complete hydatidiform mole and coexistent fetus compared with placental mesenchymal dysplasia. Between 1997 and 2015, five women with complete hydatidiform mole and coexistent fetus and four women with placental mesenchymal dysplasia were managed at the University of California San Francisco. Clinical features were analyzed and compared with previously published data. Of the five cases of complete hydatidiform mole and coexistent fetus, two had live births. β-hCG levels were > 200,000 IU/L in all cases. On imaging, a clear plane between the cystic component and the placenta favored a diagnosis of complete hydatidiform mole and coexistent fetus. None of the patients went on to develop gestational trophoblastic neoplasia (GTN), with a range of follow-up from 2 to 38 months. Combining this data with previously published work, the live birth rate in these cases was 38.8%, the rate of persistent GTN was 36.2%, and the rate of persistent GTN in patients with reported live births was 27%. Of the four cases of placental mesenchymal dysplasia, all four had live births. One patient developed HELLP syndrome and intrauterine growth restriction; the remaining three were asymptomatic. Maternal symptoms, fetal anomalies, β-hCG level, and placental growth pattern on imaging may help differentiate between complete hydatidiform mole and coexistent fetus and placental mesenchymal dysplasia. There was not an increased risk of gestational trophoblastic neoplasia in patients with complete hydatidiform mole and coexistent fetus who opted to continue with pregnancy.

Objective: This study sought to evaluate how a high-fidelity computer-based sonography simulator (FCBSS) can be used in training obstetrics and gynecology residents and evaluate efficacy of high-fidelity CBSS in enhancing resident's sonographic knowledge, psychomotor skills, and level of confidence in performing sonographic fetal assessments. Materials and Methods: Eleven postgraduate year 1 residents (PGY1s) and ten PGY2s were assessed on sonographic performance by measuring psychomotor skills and evaluating the accuracy of the sonographic images. PGY2s received traditional sonography training while PGY1s received three individualized training sessions on a high-fidelity CBSS. At the conclusion, all residents received feedback and completed a survey to establish their current confidence level in performing and interpreting sonograms. Results: PGY2s scored a median of 33/66 points on the assessment, while PGY1s scored a median of 64/66 points. Statistical analysis performed from motion analysis metrics between cohorts revealed a statistically significant difference, with PGY1s demonstrating higher psychomotor skills. Interquartile ranges of PGY1s' scores were smaller than PGY2s', revealing consistency in knowledge and skills among the PGY1 cohort. Conclusion: Findings suggests that high-fidelity CBSS can be used effectively in training residents. It also demonstrates that implementation of formalized sonography training, using a high-fidelity CBSS, can be achieved and potentially expedite and enhance the learning of novice learners. [ABSTRACT FROM AUTHOR]

The deep learning methods in the field of computer vision and big data are becoming more and more mature. Through the application of big data and deep learning technology, the diagnosis of artificial intelligence medical image can be realized, which provides a new opportunity for the automatic analysis of obstetrics medical image and the assistance of doctors to realize high-precision intelligent diagnosis of diseases. The current medical obstetric image diagnosis platform mainly targets low-resolution medical obstetric image files, and does not consider the data-sharing problem of the distributed file system in different storage nodes, which greatly reduces the efficiency of obstetric image storage and diagnosis. Based on this, this article designs an obstetric image diagnostic platform based on cloud computing technology. First, a medical imaging platform was designed by combining cloud computing technology, caching technology, and a distributed file system. Secondly, the use of contrast-enhanced ultrasound technology provides a more accurate ultrasound image for assessing the structure, size, location, and developmental abnormalities of the placenta. Finally, the effectiveness of the obstetric imaging diagnostic platform proposed in this paper is verified by experiments. The results show that the platform has fast data processing speed and convenient use, which greatly reduces the cost of medical equipment and improves efficiency. The hospital only needs to collect the obstetric image of the patient at the front end, transfer it to the cloud for image processing, and finally diagnose the disease.

To identify the differentiating features in clinical presentation, management, and maternal/fetal outcome in complete hydatidiform mole and coexistent fetus compared with placental mesenchymal dysplasia.Between 1997 and 2015, five women with complete hydatidiform mole and coexistent fetus and four women with placental mesenchymal dysplasia were managed at the University of California San Francisco. Clinical features were analyzed and compared with previously published data.Of the five cases of complete hydatidiform mole and coexistent fetus, two had live births. β-hCG levels were > 200,000 IU/L in all cases. On imaging, a clear plane between the cystic component and the placenta favored a diagnosis of complete hydatidiform mole and coexistent fetus. None of the patients went on to develop gestational trophoblastic neoplasia (GTN), with a range of follow-up from 2 to 38 months. Combining this data with previously published work, the live birth rate in these cases was 38.8%, the rate of persistent GTN was 36.2%, and the rate of persistent GTN in patients with reported live births was 27%. Of the four cases of placental mesenchymal dysplasia, all four had live births. One patient developed HELLP syndrome and intrauterine growth restriction; the remaining three were asymptomatic.Maternal symptoms, fetal anomalies, β-hCG level, and placental growth pattern on imaging may help differentiate between complete hydatidiform mole and coexistent fetus and placental mesenchymal dysplasia. There was not an increased risk of gestational trophoblastic neoplasia in patients with complete hydatidiform mole and coexistent fetus who opted to continue with pregnancy.

Objective: To identify factors influencing sonographers' practices in communicating adverse obstetric findings and to understand their views on the need for standardized national policies and guidelines. Methods: Qualified and trainee sonographers who currently perform obstetric sonography were invited to complete a survey through the Australasian Sonographers Association. Closed-ended questions sought information on the demographic profile of the participants and their experiences on a range of issues related to workplace practices and policies. Open-ended questions allowed respondents to elaborate on workplace interactions and their views on the communication roles of sonologists (radiologists and obstetricians) and sonographers. Results: The practice setting, the background of the sonologist, the type of adverse finding, and the trimester in which a patient is scanned have an impact on the level of difficulty for sonographers in obstetric communication. These findings highlight a lack of uniformity of sonographer and sonologist communication with patients due to limited training, lack of formalized departmental policies, inadequate support, and communication practices by radiologists. As a result, respondents strongly supported the development of a standardized national policy. Conclusion: In the current environment of patient-centered care, sonographers are in a challenging position as they do not have policies supporting them as independent health care professionals, autonomously deciding on the best approach to communicate findings with their patients. This may lead to anxiety and stress if they lack control over the interaction. More support from sonologists in a radiology setting is needed. These findings should encourage professional bodies to address these issues by working collaboratively and to recognize the importance of the sonographers' role and their unique position with pregnant patients. [ABSTRACT FROM AUTHOR]

Summary: Caesarean scar ectopic pregnancies are rare but growing in incidence due to increasing rates of caesarean deliveries. These cases have historically been treated with either medical or surgical management which both have significant limitations. More recently, uterine artery embolisation (UAE) has shown significant promise in the treatment of this condition. We present the case of a complex patient with a caesarean scar ectopic successfully managed with combined UAE and surgery. [ABSTRACT FROM AUTHOR]

This paper presents a novel variational segmentation framework combining shape priors and parametric intensity distribution modeling for extracting the fetal envelope on 3D obstetric ultrasound images. To overcome issues related to poor image quality and missing boundaries, we inject three types of information in the segmentation process: tissue-specific parametric modeling of pixel intensities, a shape prior for the fetal envelope and a shape model of the fetus’ back. The shape prior is encoded with Legendre moments and used to constraint the evolution of a level-set function. The back model is used to post-process the segmented fetal envelope. Results are presented on 3D ultrasound data and compared to a set of manual segmentations. The robustness of the algorithm is studied, and both visual and quantitative comparisons show satisfactory results obtained by the proposed method on the tested dataset. [ABSTRACT FROM AUTHOR]

A 32-year-old primiparous woman presented with severe abdominal pain at 21 weeks’ gestation. Background history of laparoscopy for chronic pelvic pain and a spontaneous miscarriage was noted. On examination, she was peritonitic and tachycardic with low grade fever and anemia. MRI abdomen demonstrated a uterine rupture with a large cap of clotted blood overlying the uterine fundus with the appearance of a “shower cap” and large volume haemoperitoneum, the presumptive diagnosis was uterine rupture with placental extrusion. Emergency laparotomy confirmed a two litre haemoperitoneum due to a 3cm defect at the uterine fundus through which a portion of placenta and membrane were extruding. Hysterotomy and delivery of the non-viable fetus was performed. The defect was repaired. It is important to remember that there are many causes of acute abdominal pain in pregnant patients, obstetric and other. Uterine rupture is a rare but life-threatening cause. An underlying risk factor is usually identified. [ABSTRACT FROM AUTHOR]

Prior authorization is a process requiring health care providers to obtain advance approval from a payer before a patient undergoes a procedure for the study to be covered. Prior authorization was introduced to decrease overutilization of ultrasound procedures. However, it has led to unanticipated consequences such as impeding access to obstetric imaging, increased administrative overhead without reimbursement, and contribution to physician frustration and burnout. Payers often use intermediary radiology benefit management companies without providing specialty-specific review in a timely manner as is requisite when practicing high-risk obstetrics. This article proposes a number of potential solutions to this problem: (1) consider alternative means to monitor overutilization; (2) create and evaluate data regarding providers in the highest utilization; (3) continue to support and grow the educational efforts of speciality societies to publish clinical guidelines; and (4) emphasize the importance of practicing evidence-based medicine. Understanding that not all health plans may be willing or able to collaborate with health care providers, we encourage physicians to advocate for policies and legislation to limit the implementation of prior authorization within their own states. [ABSTRACT FROM AUTHOR]