المؤلفون: Di Pasquo, Elvira, Volpe, Nicola, Labadini, Corinne, Morganelli, Giovanni, Di Tonto, Andrea, Schera, Giovanni B. L., Rizzo, Giuseppe, Frusca, Tiziana, Ghi, Tullio

المصدر: Acta Obstetricia et Gynecologica Scandinavica ; volume 100, issue 10, page 1917-1923 ; ISSN 0001-6349 1600-0412

الوصف: Introduction The obstetric conjugate represents the shortest anteroposterior diameter of the birth canal and it reflects the capacity of the pelvic inlet to allow the passage and the engagement of the fetal head. The antepartum evaluation of this parameter may be attempted at digital examination to predict the risk of cephalopelvic disproportion, but the accuracy of clinical pelvimetry is notoriously poor. The aim of our study was to describe the sonographic measurement of the obstetric conjugate at transabdominal 2D‐ultrasound and to assess its reproducibility. Material and methods This is a prospective cohort study conducted at a tertiary University hospital. A non‐consecutive series of pregnant women with uncomplicated singleton pregnancies attending the antenatal clinic for routine booking from 34 weeks of gestation onward were included. The ultrasound probe was longitudinally placed above the level of the symphysis and the interpubic fibrocartilaginous disk was visualized. Then the promontory was identified as the most prominent segment of the sacral vertebral column. The obstetric conjugate was measured as the distance between the inner edge of the interpubic disk and the promontory. The inter‐ and intraobserver repeatability of this measurement was calculated using the intraclass correlation coefficient (ICC) and the Bland–Altman method. Results In all, 119 women were considered eligible for the study; of these, 111/119 (93.3%) women were included in the analysis with a median gestational age of 36.0 (35.0–37.0) weeks. The mean obstetric conjugate measurement was 11.4 ± 0.93 cm for the first operator and 11.4 ± 0.91 cm for the second operator. The overall interobserver ICC was 0.95 (95% [confidence interval] CI 0.92–0.96) and the overall intraobserver ICC was 0.97 (95% CI 0.96–0.98). Limits of agreement ranged from −0.84 to 0.80 for interobserver measures and from −0.64 to 0.62 for intraobserver measures. The degree of reliability was also analyzed for women with a body mass index ≥30 and for ...

الإتاحة: https://doi.org/10.1111/aogs.14226Test

المؤلفون: Wertaschnigg, Dagmar, Ramkrishna, Jayshree, Ganesan, Sujatha, Tse, Cheryl, Scheier, Matthias, Volpe, Nicola, Ghi, Tullio, Meagher, Simon, Rolnik, Daniel L.

المصدر: Prenatal Diagnosis ; volume 40, issue 3, page 365-372 ; ISSN 0197-3851 1097-0223

الوصف: Objectives To compare the sonographic signs of spina bifida obtained on axial and sagittal views of the fetal head between 11 and 13+6 weeks of gestation. Methods This was a retrospective study including 27 cases of spina bifida and 1003 randomly selected controls. Indirect markers of spina bifida were evaluated on stored ultrasound images. Intracranial translucency (IT), ratio between the brainstem and the brainstem–occipital bone distance (BS/BSOB), and maxillo‐occipital (MO) line were assessed on sagittal view, whereas biparietal diameter (BPD), BPD to abdominal circumference ratio (BPD/AC), and aqueduct to occipital bone (aqueduct of Sylvius [AoS]) distance were measured on the axial plane. Reference ranges were developed, and cases of spina bifida were examined in relation to the reference range. Results On the sagittal view, detection rates for IT below the fifth percentile, BS/BSOB above the 95th percentile, and an abnormal MO line were 52.3%, 96.3%, and 96.3%, respectively. On the axial view, detection rates for BPD, BPD/AC, and AoS below the fifth percentile were 66.7%, 70.4%, and 77.8%, respectively. Conclusion The MO line and the BS/BSOB ratio appear to be the best indirect ultrasound markers of spina bifida and can be easily obtained during the routine first‐trimester scan.

الإتاحة: https://doi.org/10.1002/pd.5614Test

المؤلفون: Volpe, Nicola, Dall'Asta, Andrea, Schera, Giovanni Battista Luca, Di Pasquo, Elvira, Frusca, Tiziana, Ghi, Tullio

المصدر: Prenatal Diagnosis ; volume 39, issue 4, page 303-307 ; ISSN 0197-3851 1097-0223

الوصف: Objective The “Fetal Brain Tutor 4us” (FBTApp) is a recently developed application for interactive multiplanar navigation through the normal fetal brain. The purpose of this work was to assess its impact on normal anatomy learning. Methods A multiple‐choice quiz (MCQ) was administered to first‐year resident doctors in Obstetrics and Gynecology in two separate sessions, before and 2 weeks after downloading the FBTApp. For each MCQ, the junior trainee was asked to use one out of five items to label a specific cerebral structure on an ultrasound image of a normal midtrimester fetal brain. Six sonographic images of the fetal brain on each of the three scanning planes (axial, sagittal, and coronal) were shown to the participants at either session. The results of the two sessions were analysed and compared. Results Overall, 216 questions were administered to the trainees in the 2‐week study, 108 before and 108 after the use of the FBTApp. From the first to the second sessions, a significant increase of correct answers was noted (from 47/108 or 43% to 77/108 or 71%, P < 0.01). Particularly, a better improvement was obtained in the correct labelling of cerebral structures on the nonaxial (from 32% to 67%, +35%) vs axial (from 67% to 81%, +14%) view planes of the brain ( P < 0.01). Conclusion The use of FBTApp seems capable to improve the knowledge of the normal fetal brain anatomy in subjects naive to dedicated prenatal ultrasound. This improvement seems greater on nonaxial planes.

الإتاحة: https://doi.org/10.1002/pd.5426Test

المؤلفون: Saccone, Gabriele, Ciardulli, Andrea, Xodo, Serena, Dugoff, Lorraine, Ludmir, Jack, Pagani, Giorgio, Visentin, Silvia, Gizzo, Salvatore, Volpe, Nicola, Maruotti, Giuseppe Maria, Rizzo, Giuseppe, Martinelli, Pasquale, Berghella, Vincenzo

المصدر: Journal of Ultrasound in Medicine ; volume 36, issue 8, page 1535-1543 ; ISSN 0278-4297 1550-9613

الوصف: Objectives To evaluate the effectiveness of cervical pessary for preventing spontaneous preterm birth (SPTB) in singleton gestations with a second trimester short cervix. Methods Electronic databases were searched from their inception until February 2016. We included randomized clinical trials (RCTs) comparing the use of the cervical pessary with expectant management in singletons pregnancies with transvaginal ultrasound cervical length (TVU CL) ≤25 mm. The primary outcome was incidence of SPTB <34 weeks. The summary measures were reported as relative risk (RR) with 95% confidence interval (CI). Results Three RCTs (n = 1,420) were included. The mean gestational age (GA) at randomization was approximately 22 weeks. The Arabin pessary was used as intervention in all three trials, and was removed by vaginal examination at approximately 37 weeks. Cervical pessary was not associated with prevention of SPTB <37 (20.2% vs 50.2%; RR 0.50, 95% CI 0.23 to 1.09), <34, <32, and <28 weeks, compared to no pessary. No differences were found in the mean of GA at, interval from randomization to delivery, incidence of preterm premature rupture of membranes and of cesarean delivery, and in neonatal outcomes. The Arabin pessary was associated with a significantly higher risk of vaginal discharge. Conclusions In singleton pregnancies with a TVU CL ≤25mm at 20 0 –24 6 weeks, the Arabin pessary does not reduce the rate of spontaneous preterm delivery or improve perinatal outcome. Individual patient data meta‐analysis may clarify whether cervical pessary may be beneficial in subgroups, such as only singleton gestations without prior SPTB or by different CL cutoffs.

الإتاحة: https://doi.org/10.7863/ultra.16.08054Test

المؤلفون: Dall'Asta, Andrea, Cavalli, Claudio, Galli, Letizia, Volpe, Nicola, Weiss, Adi, Kaihura, Christine Tita, Agnetti, Aldo, Frusca, Tiziana, Ghi, Tullio

المصدر: Prenatal Diagnosis ; volume 37, issue 2, page 156-161 ; ISSN 0197-3851

الإتاحة: https://doi.org/10.1002/pd.4981Test

المؤلفون: Volpe, Paolo, Ubaldo, Passamonti, Volpe, Nicola, Campobasso, Gianluca, Robertis, Valentina De, Tempesta, Annalisa, Volpe, Grazia, Rembouskos, Georgios

المصدر: Prenatal Diagnosis ; volume 31, issue 11, page 1054-1061 ; ISSN 0197-3851 1097-0223

الوصف: Objective The aim of this study was to evaluate the detection rate of congenital heart diseases (CHD) in a low‐risk population by performing cardiac evaluation during the first‐trimester screening for chromosomal abnormalities. In this context, the role of four‐chamber view, tricuspid regurgitation and abnormal ductus venosus flow in the screening for cardiac anomalies in a low‐risk population was also investigated. Method The cardiac examination was performed by obstetricians with extensive experience in first‐ and second‐trimester ultrasound (US). Follow‐up US evaluations during the second and third trimesters were offered to all patients. In case of abnormal findings during routine assessment, fetal echocardiography was performed by a fetal cardiologist. Results Among the 4445 fetuses included in the study, 42 CHD were detected (39 diagnosed prenatally and 3 postnatally). In 27 cases, the fetal cardiologist confirmed the type of CHD diagnosed at US screening. In 1 case, the diagnosis was slightly different in the second trimester, and in 3 of the 26 correctly diagnosed in the first‐trimester cases, the CHD developed and progressed in severity. A significant association of major CHD and US first‐trimester markers was observed. Conclusions First‐trimester assessment of the fetal heart is feasible in a low‐risk population when performed by experienced obstetricians. However, although most types of CHD can be diagnosed early in pregnancy, some may become apparent later in gestation. Copyright © 2011 John Wiley & Sons, Ltd.

الإتاحة: https://doi.org/10.1002/pd.2831Test