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Introduction: Bishop score, the traditional method to assess cervical condition, is not a promising predictive tool of the outcome of labor induction. As an objective assessment tool, many cervical ultrasound measurements have been proposed to represent the individual components of the Bishop score, but none of them can measure the cervical stiffness. Cervical shear wave elastography is a novel tool to assess the cervical stiffness quantitatively.Material and Methods: A total of 475 women who required labor induction were studied prospectively. Prior to routine digital assessment of the Bishop score, transvaginal sonographic measurement of cervical length, posterior cervical angle, angle of progression and shear wave elastography was performed. Shear wave elastography measurement was made at the inner, middle and outer regions of the cervix to assess homogeneity. Association of labor induction outcomes including the overall cesarean section and subgroups of cesarean section for failure to enter active phase, with cervical sonographic parameters and the Bishop score, were assessed using multivariate regression analyses. The predictive accuracy of the outcomes using models based on ultrasound measurement and the Bishop score was compared using the area under the receiver-operating characteristics curves.Results: Among 475 women, 82 (17.3%) required cesarean section. Shear wave elasticity was significantly higher in the inner cervical region than in other regions, indicating a greater stiffness (P < 0.001). Both inner cervical shear wave elasticity and cervical length were independent predictors of overall cesarean section (respective adjusted odds ratio [95% CI] 1.338 [1.001-1.598] and 1.717 [1.077-1.663]) and cesarean section for failure to enter active phase (respective adjusted odds ratio [95% CI] 1.689 [1.234-2.311] and 2.556 [1.462-4.467]), after adjusting for other covariates. Outcome prediction models using inner cervical shear wave elasticity and cervical length, had increased area under curve compared with models using the Bishop score (0.888 vs 0.819, P = 0.009).Conclusions: The cervix is not a homogenous structure, with the inner cervix having the highest stiffness, which is an independent predictor of overall cesarean section, and specifically for those indicated because of failure to enter active phase. Models based on shear wave elastography and cervical length had higher predictive accuracy than models based on the Bishop score. [ABSTRACT FROM AUTHOR]

A retrospective audit identified 10 cases of massive idiopathic subchorionic thrombohematoma. The incidence was 1:3,133. Only six of these pregnancies resulted in a livebirth and only two reached term. In eight cases there were ultrasound abnormalities, including two cases of placentomegaly both of which resulted in a pregnancy loss. There was one placental abruption. Seven of the women were nulliparous. Massive subchorionic thrombohematoma is associated with poor pregnancy outcome. Ultrasound findings of placentomegaly might be a bad prognostic sign. [ABSTRACT FROM AUTHOR]

Objective: To determine the performance of trained midwives in second trimester ultrasound screening for fetal structural abnormalities in a low-risk population. Design: Retrospective study. Setting: University Department of Obstetrics and Gynecology. Population: About 13,882 women with singleton pregnancies. Methods: The findings of routine second trimester anomaly scan performed by midwives were reviewed. Reasons for referral to maternal fetal medicine (MFM) specialists for further assessment were analyzed. Main Outcome Measures: The detection, false positive and false alarm rates for fetal anomalies. Results: One hundred and eighty-nine pregnancies with unknown outcome were excluded from the final analysis. Overall, 617 (4.51%) women were referred to MFM specialists for further assessment, of which 470 (70.2%) were for soft markers alone and 147 (23.8%) for suspected fetal structural abnormalities. In these 13,693 fetuses with known outcome, malformed fetuses were present in 185, a prevalence of 1.35%. Of these, 115 were detected during the second trimester scan and two were detected in the third trimester. The remaining 68 malformed fetuses, most of which had minor anomalies, were identified after birth. The detection rate for a malformed fetus in second trimester scan was 62.2% (115/185) (95% CI 55.2-69.2). There were four cases of false positives and 33 cases of false alarm. Conclusions: Experienced midwives with proper training can detect the majority of major structural abnormalities. Continuous audit and quality control plays a significant role in optimizing the fetal structural examination. [ABSTRACT FROM AUTHOR]

The amount of force exerted on the uterus and fetus during external cephalic version (ECV) may be associated with fetal effects or complications. We have designed an instrument to quantify the contact pressure exerted during the performance of ECV, as an indirect measurement of the applied force. We have designed a pair of custom-made gloves. Each glove contains 16 piezo-resistive sensors positioned on the palmer surface of the fingers, thenar and hypothenar areas. Pressure readings were recorded simultaneously from all sensors every 0.22 s during each version procedure. Each recording was analyzed with a computer program written according to specified algorithms to ascertain the number of attempts in a version operation, and the duration and pressure changes of each attempt during the operation. Ten subjects having a singleton breech presentation at term underwent an operation of ECV. The number of attempts of version in each operation ranged from one to four. The median pressure–time integral and the duration of an attempt were 19 227 mmHg s (range 5089–42 597 mmHg s) and 42.5 s (range 11.9–80.3 s), respectively. The median pressure–time integral of a whole version operation was 38 110 mmHg s (range 5089–107 511 mmHg s). Subjects with a failed version operation received a higher pressure–time integral ( p < 0.05). The number of attempts of each operation was accurately identified by the program. Measurement of force applied during ECV can be quantified indirectly in terms of contact surface pressure. The indirect measurement of the applied force may further improve the safety of this procedure by preventing excessive use of force by the operator. [ABSTRACT FROM AUTHOR]