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Objective: To establish a normal reference interval for amniotic sac diameter (ASD) between 7 + 0 and 9 + 6 weeks' gestation and its relative size in relation to gestational sac diameter (GSD) and the embryo crown–rump length (CRL). Methods: This was a prospective, cross‐sectional study of consecutive women presenting to the Early Pregnancy Unit, University College Hospital, London, UK, between August 2022 and June 2023. We included live, normally sited, singleton pregnancies with a normal 20‐week anomaly scan. We collected 120 cases per gestational week, from 7 + 0 to 9 + 6 weeks' gestation, totaling 360 cases. We performed an inter‐ and intraobserver variability assessment in the measurement of mean ASD in 30 patients. Regression analyses were used to establish reference intervals for GSD and CRL, ASD and CRL, GSD and ASD, and GSD/ASD ratio and CRL. A fitted regression line was calculated, along with a 90% prediction interval and R2 value. Results: There was good interobserver agreement (mean ± SD difference, 0.007 ± 1.105 mm (95% limits of agreement (LoA), −2.160 to 2.174 mm)) and good intraobserver agreement for Observer A (mean ± SD difference, −0.080 ± 0.741 mm (95% LoA, −1.532 to 1.372 mm)) and Observer B (mean ± SD difference, −0.014 ± 0.919 mm (95% LoA, −1.814 to 1.786 mm)) in the measurement of mean ASD. Regression analyses showed a statistically significant association between each pair of values (P < 0.001 for all). There was a significant quadratic association between mean GSD and CRL (R2 = 56%), mean GSD and ASD (R2 = 60%) and GSD/ASD ratio and CRL (R2 = 68%), and a significant cubic association between mean ASD and CRL (R2 = 90%). The regression equations were used to quantify the values of ASD and GSD/ASD ratios for a range of CRL values and gestational ages. Conclusion: Our study has produced comprehensive reference intervals for amniotic sac size in early pregnancy, which could be used in routine clinical practice. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To determine the natural progression of ovarian endometrioma in women who are managed expectantly. Methods: This was a retrospective cohort study of 83 women with evidence of ovarian endometrioma who were managed expectantly between April 2007 and May 2022. The study was conducted in the Department of Women's Health, University College London Hospitals and The Gynecology Ultrasound Centre, London, UK. We searched our ultrasound clinic databases to identify women aged 18 years or older with evidence of ovarian endometrioma who were managed expectantly for ≥ 6 months. All women attended for a minimum of two ultrasound scans performed by a single expert ultrasound operator. In addition to patient demographics, we recorded the number, mean diameter and location of each cyst. The cyst growth rate was expressed as annual change in the mean diameter. Results: A total of 1922 women who attended our gynecology clinic during the study period were found to have evidence of moderate or severe endometriosis on pelvic ultrasound examination. Of those, 83 women had evidence of ovarian endometrioma and were managed expectantly. The median age of women was 39 (range, 26–51) years at the initial visit. Each woman had at least two ultrasound scans performed by a single expert operator at a minimum interval of ≥ 6 months. Of 83 women diagnosed with endometrioma, 50 (60% (95% CI, 49–71%)) had a single cyst and the remainder had multiple cysts. The median number of endometriomas per patient was 1 (range, 1–5) and the median follow‐up time was 634 (range, 187–2984) days. A total of 39/83 (47% (95% CI, 36–58%)) women experienced an overall reduction in size of cysts, in 18/83 (22% (95% CI, 13–32%)) the cysts increased in size and in 26/83 (31% (95% CI, 22–42%)) women, no meaningful change in size was observed. The median change in mean cyst diameter per woman during the study period was −2.7 (range, −57.7 to 39.3) mm, with a median annual regression rate of −1.7 (range, −24.6 to 42.0) mm/year/woman. Overall, when compared with the initial visit, cysts were significantly smaller at follow‐up (median diameter, 22.3 (range, 6.7–77.0) mm vs 18.5 (range, 5.0–72.0) mm; P = 0.009). We did not identify any clinical characteristics that could reliably predict the chance of endometrioma progression. Conclusions: In the majority of women with an ultrasound diagnosis of ovarian endometrioma, the cysts do not increase in size significantly over time and they could be managed expectantly. This evidence may help clinicians when counseling asymptomatic or minimally symptomatic women about management of ovarian endometrioma. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical, ultrasound and biochemical characteristics of ovarian ectopic pregnancy (OEP) with those of tubal ectopic pregnancy (TEP). Methods: This was a retrospective case–control study of women with OEP and those with TEP seen at a single center between December 2010 and February 2021. OEP was defined as a pregnancy located completely or partially within the ovarian parenchyma, seen separately to a corpus luteum, if a corpus luteum was present within the ipsilateral ovary. We compared demographic features, risk factors, clinical presentation, ultrasound findings and outcomes, such as blood loss at surgery, need for blood transfusion, length of hospital stay, follow‐up and future pregnancy outcome, between cases of OEP and TEP. Results: Overall, 20 women with OEP were identified and compared to 100 women with TEP. A total of 15/20 (75%) OEPs were diagnosed correctly on the first ultrasound scan. There was no difference between the groups in terms of maternal age, gestational age, gravidity, parity or risk factors. Compared with TEP, OEP was more likely to present with abdominal pain without vaginal bleeding (12/20 (60%) vs 13/100 (13%); odds ratio (OR), 10.0 (95% CI, 3.45–29.20); P < 0.01), contain an embryo with cardiac activity (3/20 (15%) vs 2/100 (2%); OR, 8.7 (95% CI, 1.34–55.65); P = 0.02) and have severe hemoperitoneum on ultrasound (9/20 (45%) vs 8/100 (8%); OR, 9.4 (95% CI, 3.01–29.40); P < 0.01), and had a higher volume of blood loss at surgery (median, 700 mL vs 100 mL; P < 0.01). All surgically managed OEPs had successful laparoscopic treatment (18 excisions, one wedge resection) with preservation of the ovary. Only one (5%) case of OEP required a blood transfusion. Conclusions: OEP is more likely than TEP to contain an embryo and to present with severe hemoperitoneum. In a dedicated early pregnancy setting, the majority of OEPs were detected on an ultrasound scan at the initial visit, facilitating optimal minimally invasive surgical management, reducing the risk of blood transfusion and oophorectomy. Our findings can be used as a reference for clinicians who may not otherwise encounter this rare condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article, titled "Development of deep endometriosis following acute hemoperitoneum: a prospective ultrasound study," presents the findings of a single-center observational cohort study conducted between August 2019 and March 2022. The study aimed to determine if acute hemoperitoneum, managed conservatively, is a precursor of deep endometriosis. The results showed that 47% of women with acute hemoperitoneum developed sonographic evidence of deep endometriosis, compared to 0% of women without hemoperitoneum. The study suggests that endometrial cells trapped under blood clots may play a role in the development of deep endometriosis. Further research is needed to investigate preventative treatments and assess women's symptoms and quality of life over a longer period. [Extracted from the article]

This article, published in the journal Ultrasound in Obstetrics & Gynecology, explores the clinical significance of left to right uterine venous shunting. The study involved 216 premenopausal patients without gynecological pathology who underwent routine transvaginal ultrasound (TVUS) to assess uterine venous circulation. The researchers found that uterine venous shunting was observed in 20.4% of the patients, and it was significantly associated with a lower BMI and the presence of a dilated left uterine vein. The combination of non-cyclical pelvic pain and dilated uterine veins was also significantly associated with shunting. The findings suggest that left to right uterine shunting may be a causative factor in pelvic congestion syndrome and further investigation is warranted. [Extracted from the article]

This article, titled "OC21.02: Endometrial assessment on ultrasound: why transvaginal scan alone is not good enough?" discusses the effectiveness of a multimodal (MM) sonographic approach compared to transvaginal ultrasound (TVS) alone in assessing endometrial thickness (ET) in women with abnormal uterine bleeding (AUB). The study found that TVS alone resulted in suboptimal ET assessment in 37% of cases, with the most common reasons being adenomyosis, suboptimal angle, and submucosal fibroids. The MM approach was more likely to achieve optimal ET assessment and resulted in significantly lower ET measurements. This could potentially reduce the need for invasive interventions such as hysteroscopy or endometrial biopsy. [Extracted from the article]

A study published in the journal Ultrasound in Obstetrics & Gynecology aimed to validate the accuracy of the "amniotic sac sign" in diagnosing early miscarriage. The study involved 1897 pregnancies from 1890 women across five centers. The results showed that the presence of an amniotic sac without a live embryo had 100% specificity for the diagnosis of miscarriage. Implementing this sign could potentially reduce the number of follow-up visits for pregnancies of uncertain viability by 10%, providing benefits in terms of patient anxiety and financial costs. [Extracted from the article]

This article, titled "Correlation between pelvic pain symptoms and the presence of deep or ovarian endometriosis: a prospective ultrasound study," examines whether women with deep or ovarian endometriosis are more likely to experience pelvic pain symptoms and a lower quality of life compared to women without this condition. The study involved 514 women, 28.4% of whom were diagnosed with endometriosis. The results showed that menstrual dyschezia and difficulty emptying the bladder occurred significantly more frequently in women with endometriosis. However, most pelvic pain symptoms were comparable between the groups with and without endometriosis, suggesting that endometriosis may not always be the source of pain. The study emphasizes the importance of investigating other causes of pain in symptomatic patients before considering high-risk procedures and providing appropriate patient counseling. [Extracted from the article]

Objective: To investigate a possible association between increased uterine venous plexus diameter and chronic pelvic pain in women attending the gynecology clinic.Methods: This was a retrospective study conducted in a tertiary university hospital in London, U.K. Women presenting to the gynecology clinic undergoing transvaginal ultrasound examinations were recruited into the study. The largest trunk of the uterine venous plexus was measured on each side. Blood flow within the uterine veins was categorized into continuous or interrupted flow and evaluated using color and spectral Doppler during normal respiration and Valsalva to demonstrate the presence of reflux. The larger uterine vein diameter and its corresponding blood flow were used for the analysis. The main outcome measures were chronic pelvic pain, uterine venous diameters and type of blood flow.Results: We included 1500 women into the study, 584 [38.9% (95% CI 36.5% to 41.5%)] of whom reported chronic pelvic pain. Dysmenorrhea was the most common type of pelvic pain. Age (p < 0.001), menopausal status (p = 0.02), varicose veins (p = 0.01), adenomyosis (p < 0.001) and endometriosis (p < 0.001) were found to be independently associated with the occurrence of pain. There was no difference in uterine venous diameters between women with and without pain (p = 0.10). Neither vessel diameter (p = 0.47) or type of blood flow (p = 0.07) were significantly associated with the occurrence of pelvic pain.Conclusion: Our findings show that uterine venous diameter alone is not associated with pelvic pain. This article is protected by copyright. All rights reserved. [ABSTRACT FROM AUTHOR]

This article, titled "EP16.26: Outcome of expectantly managed CSP continued to viability: data from the international Caesarean scar pregnancy registry," examines the outcomes of women with a viable Caesarean scar pregnancy (CSP) who continued their pregnancy to at least 23 weeks. The study compares the outcomes between women who had third-trimester ultrasound signs of placenta accreta spectrum (PAS) and those who did not. The results show that women with a viable CSP have a high risk of requiring a peripartum hysterectomy, even if they do not have signs of PAS. The study suggests that women continuing their CSP should deliver in a tertiary obstetric center with a dedicated PAS service. [Extracted from the article]

This article discusses a study conducted at University College London Hospital to evaluate the use of 3D ultrasound scar features in predicting spontaneous preterm birth (SPTB) in women with previous advanced labor Caesarean delivery. The study analyzed cervical length and Caesarean scar characteristics in pregnant women using transvaginal ultrasound. The results showed that the addition of 3D scar features did not significantly improve the prediction of SPTB or the development of short cervical length. The study suggests that clinical information combined with scar ultrasound features can be used to predict SPTB and short cervical length in pregnant women who have had a previous Caesarean delivery. [Extracted from the article]

This article discusses a study that aimed to explore the relationship between maternal and peripartum factors and the appearance of Caesarean scars on ultrasound within the first year postpartum. The study found that scars located at or below the internal cervical os were significantly more likely to have poor healing compared to lower segment scars. Factors such as uterine hypoperfusion, birthweight over 4000g, and scar position were associated with an increased risk of niche development and reduced healing ratio. The findings suggest that poor healing of Caesarean scars in these locations may potentially affect cervical support in subsequent pregnancies and lead to spontaneous preterm birth. [Extracted from the article]

This article, titled "Intramural ectopic pregnancy: emerging from obscurity – an extended series," presents a retrospective cohort study on intramural pregnancy (IMP). The study analyzed the clinical and sonographic characteristics of IMP, as well as treatment outcomes. The results showed that out of the 21 patients included in the study, 43% had partial IMP and 57% had complete IMP. The majority of patients had previous uterine surgery or concomitant uterine pathology as risk factors. Conservative management was successful in most cases, but it was associated with prolonged resolution times. The article concludes that early diagnosis is crucial for good clinical outcomes, and the management approach depends on factors such as gestation, site, and clinical presentation. [Extracted from the article]