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Objectives: Prior studies show conflicting evidence as to whether obesity in the absence of other medical or pregnancy‐related conditions contributes to amniotic fluid disorders. The purpose of this study is to determine the association between late‐pregnancy obesity with oligohydramnios (amniotic fluid index [AFI] ≤5 cm or maximum vertical pocket [MVP] <2 cm) and/or polyhydramnios (AFI ≥24 cm or MVP ≥8 cm). Methods: This is a retrospective cohort study of 961 women with singleton gestations who had one or more obstetrical ultrasounds at a single institution at 36 0/7 weeks gestation or beyond between August 1, 2015, and May 1, 2020. Patients were included if they had valid pregnancy dating and a documented AFI and/or MVP. Patients were categorized based on body mass index or BMI (eg, normal, overweight, Class I Obesity, Class II Obesity, or Class III Obesity). Results: A total of 6.2% of patients met criteria for oligohydramnios based on AFI, MVP or both (n = 60). There was no significant association between oligohydramnios and increasing BMI, regardless of obesity class (P =.21). In terms of polyhydramnios, 5.6% of patients met criteria based on AFI, MVP, or both (n = 54). Similarly, there was also no significant association between polyhydramnios and increasing BMI, regardless of obesity class (P =.66). Conclusions: Elevated maternal BMI was not significantly associated with disorders of amniotic fluid, regardless of the severity of obesity. [ABSTRACT FROM AUTHOR]

This article presents the findings of a national audit conducted in France to assess the quality of ultrasound practices related to fetal heart assessment in obstetrical ultrasounds. The researchers used deep learning tools to analyze 9,626 anonymized ultrasound files, consisting of 228,036 images at T2 and 161,535 images at T3, performed by 912 operators across the country. The results showed that 37.5% of the files were complete, with significant differences between regions. The average number of images per scan and the qualitative assessment of exam quality also varied significantly between regions. The study concludes that there is room for improvement in the overall quality of ultrasound reports. [Extracted from the article]

Background: Academic advancement of the midwifery profession highlights the need to establish standardized qualifications in obstetric ultrasound diagnosis, being a central part of prenatal care. Thus, introduction of an evidence-based training program is warranted. We aimed to reviewed curriculum designs used in midwifery ultrasound education. Methods: A systematic literature research was conducted. Embase, PubMed and Google Scholar database was reviewed for publications using the terms "[midwife], [midwives], [midwifery students], [obstetric ultrasound], [midwife sonographer] and [education], [teaching], [program], [course], [curriculum] and [learning]". Papers with full description of curriculum designs or educational programs on obstetrical ultrasound for midwives were included and scrutinized against pre-defined criteria according to the PICO (Population, Intervention, Comparator, Outcomes) scheme. Results: 29 publications were included. Studies demonstrated a significant disparity according to course concepts being used. Differing parameters included: Duration, structure, learning approaches, course content, examination concepts and target groups (practising midwives vs. midwives in education). Conclusion: An evidence-based ultrasound educational program for midwives remains to be developed, including further educational guidelines. Clinical applications by midwives, as well as the distinctions from medical practise, particularly in terms of legal considerations, needs to be defined. [ABSTRACT FROM AUTHOR]

Background: The optimal management of breech presentation remains a debate among obstetricians worldwide. The Term Breech Trial (2000) highlighted elective caesarean section as a preferable method over vaginal delivery for breech presentations. This study investigates delivery modes in women who had an elective caesarean section for breech presentation in their first pregnancy. Objective was to evaluate delivery outcomes in the second pregnancy of women who had an elective caesarean section for breech presentation in their first pregnancy. Methods: A cross-sectional study was conducted at Jinnah International Hospital Abbottabad from October 10, 2018, to April 10, 2019. Data was collected from 321 women who had an elective caesarean section for breech presentation during their first pregnancy. The study used per-abdominal examination and obstetrical ultrasound to assess foetal presentation and recorded the mode of delivery in the second pregnancy. Results: Participants' ages ranged from 18 to 49 years, with a mean age of 28.87±4.07 years. The average interval between deliveries was 1.92±0.92 years, labour duration averaged 5.56±2.41 hours, and foetal head engagement averaged 2.92±1.35. Of the participants, 18.7% achieved a vaginal delivery, while 81.3% had a repeat caesarean section. Reasons for repeat caesarean included recurrent breech presentation in 44.9% and foetal distress in 32.4%. Conclusion: Approximately 18.7% of women who had an elective caesarean section for breech presentation in their first pregnancy achieved vaginal delivery in their second pregnancy, whereas the majority underwent another elective caesarean section [ABSTRACT FROM AUTHOR]

Diagnostic ultrasound visualization was initially developed and introduced as a more benign alternative to X-rays and is today established as a harmless routine procedure and tool for risk management, but as this article shows, it took several decades to overcome the popular notion that ultrasound itself was a high-risk technology, a potentially deadly weapon. Swedish newspaper material provides a window into internationally circulated narratives portraying ultrasound as both a frightening and promising phenomenon. These ideas also constituted an important context for risk assessment during the early adoption and development of obstetrical ultrasound imaging, as shown by the case of Lund, Sweden, where the still-experimental technology was first imported from Scotland in the early 1960s. The article repositions ultrasound in the history of risk and risk management in modern societies and also sheds new light on the history of ultrasound visualization by situating it in a broader context of media culture. [ABSTRACT FROM AUTHOR]

In Bucharest University Emergency Hospital every day we deal with difficult cases either presented per primam in our setting or, even more difficult situations, cases that were intended to be treated in other hospitals but due to lack of infrastructure are sent towards our multidisciplinary hospital, as a final stop. Conditions that our teams have to deal in a very restricted amount of time in the Emergency Room are: submucous myoma with heavy bleeding acquired uterine arteriovenous fistulae, ovarian ruptured cyst, ovarian hyperstimulation syndrome, adnexal torsion, tuboovarian abscess, classical tubal ectopic pregnancy, Cesarean scar ectopic pregnancy, molar pregnancy, incomplete abortion, ruptured uterus post minimally invasive procedures performed before pregnancy, placental abruption, placenta praevia with heavy bleeding, and the PAS – Placenta Accreta Spectrum. All these conditions recquire a rapid differential diagnosis where ultrasonography is useful in adopting a tailored management either conservative or radical, in avoidance of haemorhagic accidents or even death and, when needed, in fertility sparing. [ABSTRACT FROM AUTHOR]

Although the prevalence of incidental findings revealed during an obstetric ultrasound examination is low, the findings may include adnexal and cervical masses, uterine or urinary congenital malformations, free fluid in the pouch of Douglas or tortuous vessels (varices). Adnexal masses are the most common finding and vary in imaging characteristics. They are mainly unilateral, cystic masses with a low risk of malignancy that are treated conservatively. The International Ovarian Tumor Analysis scoring models may be helpful in differentiating benign from malignant masses. For those masses >5 cm, follow-up is recommended, and resection could be considered to avoid risk of torsion, rupture and hemorrhage, which may compromise pregnancy outcome. Uterine masses such as fibroids are commonly diagnosed early in the first trimester and should be followed up during pregnancy to evaluate any changes. Transabdominal and transvaginal ultrasound is the first-line test for the diagnosis of such incidentalomas; however, magnetic resonance ultrasound may have a useful role in excluding malignancy potential. As a result of their low frequency and the lack of good evidence, there are no specific guidelines on the management of incidentalomas detected at obstetric scans. Their management should follow the related general guidelines for ovarian, cervical and uterine masses, with individualized management depending on the pregnancy status. [ABSTRACT FROM AUTHOR]

Introduction Routine prenatal screening ultrasounds primarily serve to diagnose major fetal anomalies which may prompt further testing and inform clinical decision-making, including possible pregnancy termination. Meanwhile, expectant parents may view the ultrasound experience and information gained differently from their clinicians. In this setting, how to best counsel patients, especially regarding the increasing findings of indeterminant clinical significance, is unclear. Greater understanding of women's views before undergoing their ultrasound may help to guide anticipatory counseling about the purpose of screening and interpretation of results. Methods We surveyed 289 patients presenting for scheduled prenatal ultrasounds at an academic tertiary care center. Discrete and open-ended questions assessed views surrounding the receipt of abnormal results and management of the pregnancy once fetal anomalies are detected. Qualitative responses were analyzed using thematic analysis. Results Most (95%) desired information about abnormal sonographic findings, although only half would consider pregnancy termination for anomalies. Reasons for wanting return of abnormal results included preparedness, valuing knowledge, and to a lesser extent, informing decision-making. When considering potential termination as a result of ultrasound findings, participants' rationales demonstrated deontological (seeing termination as inherently impermissible or permissible), relational (duties arising from the role of being a mother), and consequentialist (weighing harms and benefits) reasoning. Conclusion This study highlights women's perceptions of prenatal ultrasounds as an inherently valuable source of information and preparedness, beyond their role in informing clinical decision-making. Identifying the ethical constructs underpinning patients' perspectives may help direct development of counseling tools responsive to individual needs and values regarding prenatal ultrasound findings., Author(s): Margot Kelly-Hedrick [sup.1] , Gail Geller [sup.2] [sup.3] [sup.4] [sup.5] , Angie C. Jelin [sup.6] , Marielle S. Gross [sup.2] [sup.7] [sup.8] Author Affiliations: (1) grid.26009.3d, 0000 0004 1936 [...]

Aim: The association between echogenic intracardiac focus (EIF) and fetal aneuploidy is well established, with a recognized ethnic variation. This study aimed to investigate the prevalence of EIF in Turkish pregnancies and examine its association with fetal aneuploidy and adverse pregnancy outcomes. Material and Methods: We conducted a retrospective cohort study of second-trimester obstetric ultrasonography (16-24 weeks) at a university hospital for over 4 years. During the evaluation, all pregnancies with and without EIF were divided into three groups; Group 1: control group (randomly selected patients without EIF, n = 100); Group 2: isolated EIF group, (EIF is the sole finding, n = 45) and Group 3: non-isolated EIF group, (EIF with accompanying other ultrasound findings for fetal aneuploidy and/or presence of congenital anomalies, n = 21). The pregnancy outcomes of patients with isolated and non-isolated EIF and control group were compared. Results: Overall, 2590 obstetric sonograms were examined, with an EIF prevalence of 2.55%. The presence of other ultrasonography findings and/or congenital anomalies accompanying EIF was associated with an increased risk of fetal aneuploidy, and 2 of 21 (9.5%) pregnancies in the non-isolated EIF group had fetal aneuploidy. In addition, non-isolated EIF was associated with perinatal mortality, preterm delivery, and polyhydramnios when compared to controls and isolated EIF pregnancies. There was no difference in the pregnancy outcomes between control and patients with isolated EIF. Conclusion: EIF is a rare occurrence in Turkish pregnancies and as a sole finding, it is not associated with fetal aneuploidy or other adverse pregnancy outcomes. However, the presence of ultrasonography findings and/or congenital anomalies accompanying EIF was associated with an increased rate of fetal aneuploidy and adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Objective: To assess the frequency of atypical chromosomal and submicroscopic anomalies, as well as fetal structural abnormalities, observed on first-trimester ultrasound scan in fetuses with nuchal translucency (NT) thickness > 99th centile, in order to evaluate the suitability of using standard cell-free DNA (cfDNA) testing as the sole screening test in these pregnancies.Methods: This was a retrospective cohort study of 226 fetuses with NT > 99th centile at 11-14 weeks' gestation, between January 2013 and December 2017, in a clinical setting in which greater than 95% of pregnant women receive first-trimester combined screening. All patients underwent genetic testing by means of quantitative fluorescence polymerase chain reaction and chromosomal microarray analysis, mainly in chorionic villus samples. We assessed the theoretical yield of two cfDNA testing models, targeted cfDNA (chromosomes 21, 18 and 13) and extended cfDNA (chromosomes 21, 18, 13 and sex chromosomes), and compared it with that of cytogenetic testing and ultrasound assessment in the first and second or third trimesters.Results: In the 226 fetuses analyzed, cytogenetic testing revealed 84 (37%) anomalies, including 68 typical aneuploidies (involving chromosomes 13, 18 or 21), six sex chromosome aneuploidies (four cases of monosomy X and two of trisomy X), three clinically relevant atypical chromosomal anomalies (one trisomy 22, one trisomy 21 mosaicism and one unbalanced translocation), five submicroscopic pathogenic variants and two cases with Noonan syndrome. Targeted and extended cfDNA testing would miss at least 12% (10/84) and 19% (16/84), respectively, of genetic anomalies, accounting for 4.4% and 7.1% of the fetuses with an increased NT, respectively. Finally, of the 142 fetuses with no identified genetic anomaly, a major fetal malformation was observed in 15 (10.6%) fetuses at the early anomaly scan, and in 19 (13.4%) in the second or third trimester.Conclusions: cfDNA does not appear to be the appropriate genetic test in fetuses with NT > 99th centile, given that it would miss 12-19% of genetic anomalies in this group. Additionally, first-trimester ultrasound will identify a major structural abnormality in 11% of the fetuses with NT > 99th centile and no genetic anomaly. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

This article, published in the journal Ultrasound in Obstetrics & Gynecology, presents the findings of a randomized controlled trial conducted at the First Affiliated Hospital of Sun Yat‐sen University. The study aimed to investigate the benefits of using an artificial intelligence (AI) system to enhance the efficiency of obstetric scan training. The results showed that the AI-assisted training group required fewer cycles to meet quality requirements compared to the conventional training group. Additionally, the AI-assisted group exhibited superior ability in acquiring standard views in the third and fourth stages of training. The study suggests that the use of an AI-assisted system has the potential to improve training effectiveness, especially for trainees without prior experience in obstetric scans. [Extracted from the article]

We report the case of a massive fetal cardiac rhabdomyoma recently occurred at our clinic. A woman at 23 weeks of gestational age was referred to our center for a fetal cardiac echogenic mass of 26 mm detected at the second-trimester screening ultrasound. During pregnancy, though, the mass progressively increased its dimensions until reaching 48 mm in diameter at 37 weeks of gestation. Fetal echoencephalography and brain magnetic resonance did not show any further fetal anomalies, but molecular genetic testing at amniocentesis revealed a heterozygotic missense variant of gene TSC2 associated with Tuberous Sclerosis. The mass was therefore most likely preferable to a single large rhabdomyoma of gradually increasing dimensions. The baby was delivered at term with a cesarean section. Because of the rhabdomyoma remarkable size and newborn ECG electrical alterations, postnatal therapies with Flecainide and Everolimus were started. Everolimus treatment led to a significant and progressive reduction in the cardiac mass volume. This case, therefore, shows the efficacy of what seems to be a promising treatment in pediatric patients with large rhabdomyomas. Rhabdomyomas may present with different features: most often they appear as multiple masses along the interventricular sept, but they may also appear as a single large thoracic mass. When a rhabdomyoma is suspected, genetic counseling is recommended. Both before and after birth, a multidisciplinary approach is useful to choose the appropriate therapy for the newborn. mTOR inhibitors therapies look like promising therapeutic approaches to stimulate the involution of rhabdomyomas. [ABSTRACT FROM AUTHOR]

Background: While there is an increasing interest in incorporating ultrasound in undergraduate medical education and the use of student tutors in conveying this medical skill to assist faculty members, little is known about undergraduate ultrasound teaching in obstetrics and gynecology. Methods: After a 3 week training of the student tutors, the student tutors joined an undergraduate ultrasound educational program to teach practical round students. After being certified, the student tutors organized a pre-test, gave a presentation about ultrasound, and then supervised the hands on ultrasound course under faculty staff supervision for round students. Finally, the practical round students had to answer a post-test with image recognition. The practical round students had to evaluate the course using a Likert scale. Results: 111 students joined this ultrasound course. The objective theoretical and practical multiple-choice questions' (MCQ) test showed a statistically significant improvement (50 vs. 90%, p < 0.05). The practical round students expressed a high acceptance (Likert 1.7) and subjective medical skill learning (Likert 1.8). The students also positively graded the student tutors (Likert 1.3). Conclusion: Student tutor-based undergraduate obstetrical and gynecological ultrasound course is a useful method to teach a medical skill and is well accepted by students. [ABSTRACT FROM AUTHOR]

Second- and third-trimester obstetrical ultrasound examinations include an amniotic fluid volume assessment. Professional organizations' clinical guidance recommends using semiquantitative techniques, such as the single deepest vertical pocket or amniotic fluid index, for this purpose. The single deepest vertical pocket is described as the preferred method of assessing amniotic fluid volume based on fewer oligohydramnios diagnoses and labor inductions with no demonstrable difference in pregnancy outcomes compared with the amniotic fluid index. We offer an alternative interpretation of the evidence for this advice, drawn from 6 randomized clinical trials and 2 meta-analyses comparing the single deepest vertical pocket to the amniotic fluid index. Individually and collectively, these reports are underpowered to detect significant differences in maternal and perinatal outcomes by study group. Moreover, randomized clinical trials comparing maternal and perinatal outcomes resulting from a policy of labor induction at or beyond 37 weeks of gestation vs expectant care consistently favor labor induction, the very intervention paradoxically cited as favoring the single deepest vertical pocket vs the amniotic fluid index. We conclude that the amniotic fluid index should be considered a reasonable method for third-trimester amniotic fluid assessment and diagnosing oligohydramnios. [ABSTRACT FROM AUTHOR]

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The article announces presentations and awards given during the 28th World Congress on Ultrasound in Obstetrics and Gynecology held on October 20-24, 2018 in Singapore. The Ian Donald Gold Medal was presented to professor Jan Deprest. Free communications presented at the congress that are acknowledged as best presentations in their categories including top abstract winner, best oral communications, and young investigator award winner, are cited.

A certain level of theoretical knowledge is required when performing basic obstetrical and gynecological ultrasound. To assess the adequacy of trainees' basic theoretical knowledge, the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) has developed a theoretical test of 49 Multiple Choice Questionnaire (MCQ) items for their basic training courses. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the diagnostic accuracy of ultrasound in detecting abnormally invasive placenta (AIP) during the first trimester of pregnancy (11-14 weeks' gestation) in women at risk for this condition.Methods: This was a retrospective analysis of data collected prospectively from women at risk for AIP based upon the presence of at least one prior Cesarean section (CS) and/or uterine surgery and placenta previa, who had ultrasound assessment for AIP at the time of the 11-14-week scan. The ultrasound signs explored in the present study were: loss of the clear zone, placental lacunae, bladder wall interruption and uterovesical hypervascularity. The potential of ultrasound and different ultrasound signs to predict the different types of AIP was assessed by computing summary estimates of sensitivity, specificity, diagnostic odds ratio (DOR) and positive (LR+) and negative (LR-) likelihood ratios.Results: One hundred and eighty-eight women with placenta previa and at least one previous CS or uterine surgery were included in the study. All the explored ultrasound signs were associated significantly with the occurrence of AIP. Overall, when at least one ultrasound sign was used to make the diagnosis, ultrasound had a sensitivity of 84.3% (95% CI, 74.7-91.4%), specificity of 61.9% (95% CI, 51.9-71.2%), DOR of 8.6 (95% CI, 4.1-19.3), LR+ of 2.2 (95% CI, 1.7-2.9) and LR- of 0.3 (95% CI, 0.1-0.4) in detecting AIP. Using two ultrasound signs to label a case as positive increased the diagnostic accuracy in terms of specificity, although it did not affect sensitivity. Among the different ultrasound signs, loss of the clear zone had a sensitivity of 84.3% (95% CI, 74.7-91.4%) and a specificity of 81.9% (95% CI, 73.2-88.7%) in detecting AIP, while sensitivities for placental lacunae and bladder wall interruption were 78.3% (95% CI, 67.9-86.6%) and 75.9% (95% CI, 65.3-84.6%), respectively, and specificities were 81.0% (95% CI, 72.1-88.0%) and 99.1% (95% CI, 94.8-100.0%), respectively. The optimal combination of sensitivity and specificity was achieved when at least two imaging signs of AIP were used in the diagnostic algorithm.Conclusions: AIP can be detected from the first trimester of pregnancy in women at risk for this condition, and ultrasound performed between 11 and 14 weeks' gestation has an overall good diagnostic accuracy for detecting all types of AIP. However, these findings are applicable only to women with placenta previa and prior uterine scar. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [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]

Abstract: Introduction: Routine third‐trimester ultrasound (T3US) is not recommended in evidence‐based clinical guidelines despite occurring frequently. This study investigated the incidence, indication for, results and follow‐up needs of T3US performed at a Sydney metropolitan teaching hospital. Methods: Audit of T3US amongst singleton pregnancies at St George Hospital, Sydney: retrospective review October–December 2012, prospective cohort with clinician survey February–April 2013. Data included are as follows: maternal demographics, aneuploidy screening results, T3US ordering patterns, results, follow‐up management and pregnancy outcomes. Comparison of demographic characteristics and pregnancy outcomes was performed for women undergoing T3US vs. no T3US. Results: One thousand and thirty‐five women (623 retrospective, 412 prospective) were included, of whom 560 (54%) received at least one T3US. Characteristics of retrospective and prospective cohorts were similar, so combined data are presented. Most initial T3USs were for valid indications (463 of 560; 83%), most frequently low‐lying placenta at morphology (19%), reduced fundal height (10%) and to follow‐up fetal concerns at morphology ultrasound (9%). One hundred and sixty‐two out of 560 (29%) of initial T3US were not normal, predominantly related to accelerated or reduced fetal growth. Detection of SGA babies was significantly higher in the T3US group (32% SGA babies detected vs. 0% if no T3US, P < 0.001). However, overall detection rates remained low, with 5.2% and 3.0% of babies who had a T3US unexpectedly <10th and <3rd centile birthweight, respectively. Discussion/Conclusion: The majority of women received at least one, usually indicated, T3US in routine practice at our metropolitan Sydney hospital. This may impact obstetric care, resource allocation and patient well‐being. Detection of small for gestational age fetuses was poor. [ABSTRACT FROM AUTHOR]

This article presents the findings of a retrospective analysis of prenatal ultrasound reports in the South France region for newborns and children diagnosed with congenital heart disease (CHD) postnatally. The study aimed to assess the quality of the ultrasound images and their relationship to the type of heart disease. The analysis revealed that while the intrinsic image quality was satisfactory, the quality of obtaining anatomical landmarks was suboptimal. Additionally, 15% of CHDs could have been identified through better image quality. The study highlights the importance of improving the quality of prenatal ultrasound for the early detection of CHD. [Extracted from the article]

This article discusses a case study involving a 34-year-old pregnant woman with diabetes who was referred for a fetal echocardiography evaluation. The ultrasound revealed abnormal outflow tracts, indicating a suspicion of transposition of the great arteries (TGA). The diagnosis was confirmed by the anatomical characteristics of the arteries. The researchers used 3D ultrasound imaging and software to create virtual and physical models of the fetal heart, which were used as additional diagnostic tools for counseling and surgical planning. The male neonate was born by Caesarean section and underwent surgical correction for TGA. Currently, he is in good health with mild aortic insufficiency. [Extracted from the article]

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]

Objective: Evaluate two new 3D and two new 2D ultrasound formulae for fetal weight estimation against the modified Hadlock formula and compare their estimation to the actual fetal weight.Methods: Fifty pregnant females were included.Inclusion Criteria: singleton pregnancy, within five days of delivery and normal or IUGR pregnancy. 3D evaluation of the fetal thigh and arm was done to calculate mid-thigh and mid-arm volumes. The actual fetal weight was recorded at delivery and compared to the estimated weights.Results: Modified Hadlock formula had higher accuracy, whereas fractional limb volume method had higher precision. Systematic errors for the modified Hadlock formula, Model 6 of fractional limb volume and the original mid-thigh soft tissue thickness methods were 2.3%, -4.8% and 11%, respectively, whereas the random errors were 7.7%, 6.2% and 13.8%, respectively. The percentage of cases estimated within 5%, 10% and 15% of actual fetal weight were 48%, 86% and 92%, respectively, for the modified Hadlock method, whereas for the fractional limb volume method, these were 40%, 78% and 98%, respectively.Conclusion: Fractional limb volume method is a very promising method for fetal weight estimation. Its performance is not significantly different from the modified Hadlock method. [ABSTRACT FROM AUTHOR]

Objective: Laparoscopic sacrocolpopexy is becoming an increasingly popular surgical approach for repair of apical vaginal prolapse. The aim of this study was to document the postoperative anterior mesh position after laparoscopic sacrocolpopexy and to investigate the relationship between mesh location and anterior compartment support.Methods: This was an external audit of patients who underwent laparoscopic sacrocolpopexy for apical prolapse ≥ Stage 2 or advanced prolapse ≥ Stage 3, between January 2005 and June 2012. All patients were assessed with a standardized interview, clinical assessment using the International Continence Society Pelvic Organ Prolapse quantification and four-dimensional transperineal ultrasound to evaluate pelvic organ support and mesh location. Mesh position was assessed with respect to the symphysis pubis whilst distal mesh mobility was assessed using the formula √[(XValsalva - Xrest )2 + (YValsalva - Yrest )2 ], where X is the horizontal distance and Y is the vertical distance between the mesh and the inferior symphyseal margin, measured at rest and on Valsalva.Results: Ninety-seven women were assessed at a mean follow-up of 3.01 (range, 0.13-6.87) years after laparoscopic sacrocolpopexy, 88% (85/97) of whom considered themselves to be cured or improved, and none had required reoperation. On clinical examination, prolapse recurrence in the apical compartment was not diagnosed in any patient; however, 60 (62%) had recurrence in the anterior compartment and 43 (44%) in the posterior compartment. On ultrasound examination, mesh was visualized in the anterior compartment in 60 patients. Both mesh position and mobility on Valsalva were significantly associated with recurrent cystocele on clinical and on ultrasound assessment (all P < 0.01). For every mm that the mesh was located further from the bladder neck on Valsalva, the likelihood of cystocele recurrence increased by 6-7%.Conclusion: At an average follow-up of 3 years, laparoscopic sacrocolpopexy was highly effective for apical support; however, cystocele recurrence was common despite an emphasis on anterior mesh extension. Prolapse recurrence seemed to be related to mesh position and mobility, suggesting that the lower the mesh is from the bladder neck, the lower the likelihood of anterior compartment prolapse recurrence. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Significant management decisions in triplet pregnancies are made based mainly on ultrasound measurements of fetal growth, although there is a paucity of data examining the accuracy of fetal weight measurements in these gestations. To evaluate accuracy of prenatal ultrasound to diagnose growth abnormalities (intrauterine growth restriction, severe growth discordance) in triplet pregnancies, a retrospective cohort study of 78 triplet pregnancies (234 fetuses) delivered at a single tertiary hospital from January 2004 to May 2015 was performed. Growth percentiles from the last ultrasound were derived from estimated fetal weight using Hadlock's formula for each triplet. Growth discordance was calculated for each triplet set using the formula {(estimated fetal weight largest triplet - estimated fetal weight smallest)/estimated fetal weight largest}. These estimations were compared to birth weights. Sensitivity of ultrasound to predict ≥1 growth restricted fetus in a triplet set was 55.6% [95% CI 35.3, 74.5]; specificity was 100% [95% CI 93.0, 100]; positive predictive value (PPV) 100% [95% CI 74.7, 100]; negative predictive value (NPV) 81.0% [95% CI 73.2, 85.7%]. Sensitivity of ultrasound to detect fetal growth discordance >25% in a triplet set was 80.0% [95% CI 44.4, 97.5], specificity 94.1% [95% CI 85.6, 98.4]; PPV 66.7% [95% CI 42.4, 84.5]; NPV 97.0% [95% CI 90.2, 99.1]. Prenatal ultrasound currently remains the most reliable tool to screen for growth anomalies in triplet pregnancies; however, it appears to have less than ideal sensitivity, missing a number of cases of intra-uterine growth restriction and significant growth discordance. [ABSTRACT FROM PUBLISHER]

INTRODUCTION: Prior studies show conflicting evidence as to whether obesity in the absence of other medical or pregnancy-related conditions contributes to amniotic fluid disorders. The purpose of this study is to determine the association between late-pregnancy obesity with oligohydramnios (amniotic fluid index [AFI]<5 or maximum vertical pocket [MVP]<2) and/or polyhydramnios (AFI>24 or MVP>8). METHODS: This is a retrospective cohort study of 966 women with singleton gestations who had one or more obstetrical ultrasounds at Mount Sinai South Nassau at 36 0/7 weeks of gestation or beyond between August 1, 2015, and May 1, 2020. Patients were included if they had valid pregnancy dating and a documented AFI and/or MVP. Patients were categorized based on body mass index (BMI) (eg, normal, overweight, class I obesity, class II obesity, or class III obesity). Chi-square analyses were performed to evaluate whether there was a relationship between BMI and AFI. A logistic regression analysis was then performed for any confounding variables. RESULTS: There was no significant association between oligohydramnios and increasing BMI, whether patients had overweight (P =.17), class I (P =.46), class II (P =.49), or class III obesity (P =.99). The same was true for polyhydramnios and increasing BMI, whether patients had overweight (P =.68), class I (P =.74), class II (P =.94), or class III obesity (P =.99). CONCLUSION: Elevated maternal BMI was not significantly associated with disorders of amniotic fluid, regardless of the severity of obesity. [ABSTRACT FROM AUTHOR]

Ultrasound imaging is an essential component of healthcare services. This study sought to explore perceptions of access, and factors which shape access, to ultrasound imaging in two northern, remote, Indigenous communities in Canada. Using interpretive description as a methodological approach and a multi-dimensional conceptualisation of access to care as a theoretical framework, 15 semi-structured interviews were conducted in the northern Canadian communities of Stony Rapids and Black Lake, Saskatchewan. All participants had an obstetrical or non-obstetrical ultrasound exam performed in the past 10 years. Interviews were audio recorded and interview transcripts were analysed using constant comparative analysis. Geographic isolation from imaging facilities was a central barrier to participants accessing ultrasound imaging. Other barriers became apparent when participants had to travel for ultrasound, including fear of air travel, isolation from family, financial means, and unfamiliarity with larger cities. Barriers such as family and work responsibilities were exacerbated by the barrier of geography. Participants overcame these barriers as they were motivated by potential diagnostic benefits of ultrasound imaging. This study highlights disparities in access to ultrasound for northern, remote, Indigenous populations. Future efforts to improve access to imaging should consider barriers of distance to imaging facilities and strategies to bridge these barriers. [ABSTRACT FROM AUTHOR]