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Objective Intrapartum transperineal ultrasound is considered useful in judging fetal head descent; however, the inability to detect ischial spines on ultrasound images has been a drawback to its legitimacy. The current study aimed to determine the anatomical location of ischial spines, which can be directly applied to intrapartum transperineal ultrasound images. Method Based on magnetic resonance imaging (MRI) of 67 pregnant women at 33+2 [31+6-34+0] weeks gestation (median [interquartile range: IQR]), we calculated the angle between the pubic symphysis and the midpoint of ischial spines (midline symphysis-ischial spine angle; mSIA), which is theoretically equivalent to the angle of progression at fetal head station 0 on ITU, by determining spatial coordinates of pelvic landmarks and utilizing spatial vector analysis. Furthermore, we measured symphysis-ischial spine distance (SID), defined as the distance between the vertical plane passing the lower edge of the pubic symphysis and the plane that passes the ischial spines. Results As a result, mSIA was 109.6° [105.1–114.0] and SID 26.4 mm [19.8–30.7] (median, [IQR]). There was no correlation between mSIA or SID and maternal characteristics, including physique. Conclusions We established a novel method to measure the components of the pelvic anatomy by analyzing the three-dimensional coordinates of MRI data and identified the anatomical location of ischial spines which can be applied to ultrasound images. Our results provide valuable evidence to enhance the reliability of intrapartum transperineal ultrasound in assessing fetal head descent by considering the location of ischial spines. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the potential impact of adenomyosis on the pregnancy outcomes by retrospectively investigating adenomyosis-complicated pregnancy cases. Methods: We performed a retrospective case-control study. Forty-nine singleton pregnancy cases complicated with adenomyosis were included in this study. The controls (n = 245) were singleton pregnant women without adenomyosis and were frequency matched to adenomyosis cases by age, parity, and the need for assisted reproductive technology for this conception. The incidence of obstetrical complications and delivery and neonatal outcomes were examined. Results: Patients in the adenomyosis group were significantly more likely to have a second trimester miscarriage (12.2% vs 1.2%, odds ratio (OR): 11.2, 95% confidence interval (95% CI): 2.2-71.2), preeclampsia (18.3% vs 1.2%, OR: 21.0, 95% CI: 4.8-124.5) , placental malposition (14.2% vs 3.2%, OR: 4.9, 95% CI: 1.4-16.3), and preterm delivery (24.4% vs 9.3%, OR: 3.1, 95% CI: 1.2-7.2), compared with the control group. Conclusion: Adenomyosis was associated not only with an increased incidence of preterm delivery, as previously reported, but also with an increased risk of second trimester miscarriage, preeclampsia , and placental malposition, which could lead to poor perinatal outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Patients with Marfan syndrome (MFS) show a substantially increased risk of pregnancy-related aortic dissection (AD). Prophylactic aortic root replacement (ARR) is recommended for patients with aortic root dilatation to decrease cardiovascular risk during the peripartum period. However, evidence supporting the management of parturients with MFS who have received ARR is limited. This study was aimed to investigate pregnancy outcomes, especially the risk of pregnancy-related aortic dissection (AD), in patients with Marfan syndrome (MFS) after prophylactic aortic root replacement (ARR). Methods: The pregnancy outcomes of all patients with MFS managed at our institute between 1982 and September 2016 were retrospectively reviewed based on medical records. Results: Among 22 patients (28 pregnancies) who had been managed as potential MFS or related disorders, 14 (17 pregnancies) fulfilled the revised Ghent nosology (2010) criteria for MFS and were enrolled in this study. Five patients (5 pregnancies) had received ARR before conception, of which 3 (60%) developed type B aortic dissection [AD(B)] during the peripartum period, whereas only one of 10 patients (12 pregnancies) without ARR (8.3% of pregnancies) developed AD(B) in the peripartum period (p < 0.05, chi-square test). Conclusions: Our study results suggested that MFS patients after prophylactic ARR are still at high risk of AD(B) during the peripartum period. Careful pre-pregnancy counseling and multidisciplinary care throughout the peripartum period are essential for the management of MFS, even after surgical repair of ascending aortic aneurysm. Key Words: Marfan syndrome, pregnancy, aortic dissection, aortic root replacement. [ABSTRACT FROM AUTHOR]