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The greatest body of scientific evidence has been accumulated for the simple ratio of the MCA-PI divided by the umbilical artery PI (i.e. the CPR), and the second most commonly utilized ratio is its inverse, i.e. the umbilical artery PI divided by the MCA-PI (umbilicocerebral ratio (UCR)). Second- and third-trimester uterine artery evaluation (Figure 2) GLO:F0Y/01aug21:uog23698-fig-0002.jpg PHOTO (COLOR): 2 Waveforms from uterine artery obtained transabdominally in second trimester. First-trimester uterine artery evaluation (Figure 1) GLO:F0Y/01aug21:uog23698-fig-0001.jpg PHOTO (COLOR): 1 Waveform from uterine artery obtained transabdominally in first trimester. gl 1. In Doppler waveforms showing dynamic changes in the systolic or diastolic components (i.e. in case of uterine artery waveform with presence of notching, or reversed EDV in umbilical artery waveform), PI gives a better estimate of the characteristics of the waveform than do RI or S/D ratio. [Extracted from the article]

Endorsed by the Australasian Society for Ultrasound in Medicine (ASUM), the British Medical Ultrasound Society(BMUS), the Society and College of Radiographers (SCoR), Sociedad Española de Ginecología y Obstetricia (SEGO) and Società Italiana di Ecografia Ostetrica e Ginecologica e Metodologie Biofisiche (SIEOG). Nonetheless, the rapid spread of the disease across countries and continents, as well as the evidence of existence of asymptomatic carriers[16], has led to circumstances in which all patients are to be considered at risk of infection and hence potential carriers of the SARS-CoV-2 virus. When managing patients with confirmed or suspected COVID-19 infection, or if there is widespr... To avoid infection through respiratory droplets, practitioners should don appropriate PPE, including a surgical mask, upon entering the ultrasound room. Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. https://apps.who.int/iris/bitstream/handle/10665/112656/9789241507134 eng.pdf;jsessionid=403613D204AC57EDB11B41001DED8149?sequence=1 9 COVID-19 Guidance for infection prevention and control in healthcare settings. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment data/file/874316/Infection prevention and control guidance for pandemic coronavirus.pdf 10 Istituto Superiore di Sanità. [Extracted from the article]

In view of the challenges of the current coronavirus (COVID-19) pandemic and to protect both patients and ultrasound providers (physicians, sonographers, allied professionals), the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) has compiled the following expert-opinion-based guidance for the performance of ultrasound investigations in pregnancy and for gynecological indications. BACKGROUND The novel coronavirus infection spreads very easily and even asymptomatic patients or caregivers can be a route of transmission. PROTECTING THE PATIENT AND ULTRASOUND PROVIDERS Screen all patients and visitors using standardized checklists for symptoms of acute respiratory infection and risk factors based on travel history, occupation, contact and cluster (TOCC) [11]. [Extracted from the article]

The article focuses on the Trial of Randomized Umbilical and Fetal Flow in Europe (TRUFFLE) study which analyzed singleton pregnancies at 26–32weeks of gestation with a diagnosis of fetal growth restriction. The study primarily concluded survival without cerebral palsy or neurosensory impairment. It discusses neurodevelopmental impairment change with gestational age and its relation to neonatal morbidity.

Objective: In the TRUFFLE (Trial of Randomized Umbilical and Fetal Flow in Europe) study on the outcome of early fetal growth restriction, women were allocated to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate (FHR) short-term variation (STV) on cardiotocography (CTG); (2) early changes in fetal ductus venosus (DV) waveform (DV-p95); and (3) late changes in fetal DV waveform (DV-no-A). However, many infants per monitoring protocol were delivered because of safety-net criteria, for maternal or other fetal indications, or after 32 weeks of gestation when the protocol was no longer applied. The objective of the present posthoc subanalysis was to investigate the indications for delivery in relation to 2-year outcome in infants delivered before 32 weeks to further refine management proposals.Methods: We included all 310 cases of the TRUFFLE study with known outcome at 2 years' corrected age and seven fetal deaths, excluding seven cases with inevitable perinatal death. Data were analyzed according to the allocated fetal monitoring strategy in combination with the indication for delivery.Results: Overall, only 32% of liveborn infants were delivered according to the specified monitoring parameter for indication for delivery; 38% were delivered because of safety-net criteria, 15% for other fetal reasons and 15% for maternal reasons. In the CTG-STV group, 51% of infants were delivered because of reduced STV. In the DV-p95 group, 34% of infants were delivered because of abnormal DV and, in the DV-no-A group, only 10% of infants were delivered accordingly. The majority of infants in the DV groups were delivered for the safety-net criterion of spontaneous decelerations in FHR. Two-year intact survival was highest in the DV groups combined compared with the CTG-STV group (P = 0.05 for live births only, P = 0.21 including fetal death), with no difference between DV groups. A poorer outcome in the CTG-STV group was restricted to infants delivered because of FHR decelerations in the safety-net subgroup. Infants delivered because of maternal reasons had the highest birth weight and a non-significantly higher intact survival.Conclusions: In this subanalysis of infants delivered before 32 weeks, the majority were delivered for reasons other than the allocated monitoring strategy indication. Since, in the DV group, CTG-STV criteria were used as a safety net but in the CTG-STV group, no DV safety-net criteria were applied, we speculate that the slightly poorer outcome in the CTG-STV group might be explained by the absence of DV data. The optimal timing of delivery of fetuses with early intrauterine growth restriction may therefore be best determined by monitoring them longitudinally, with both DV and CTG monitoring. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objectives: In the recent TRUFFLE study, it appeared that, in pregnancies complicated by fetal growth restriction (FGR) between 26 and 32 weeks' gestation, monitoring of the fetal ductus venosus (DV) waveform combined with computed cardiotocography (CTG) to determine timing of delivery increased the chance of infant survival without neurological impairment. However, concerns with the interpretation were raised, as DV monitoring appeared to be associated with a non-significant increase in fetal death, and some infants were delivered after 32 weeks, at which time the study protocol no longer applied. This secondary sensitivity analysis of the TRUFFLE study focuses on women who delivered before 32 completed weeks' gestation and analyzes in detail the cases of fetal death.Methods: Monitoring data of 317 pregnancies with FGR that delivered before 32 weeks were analyzed, excluding those with absent outcome data or inevitable perinatal death. Women were allocated randomly to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate short-term variation (STV) on CTG; (2) early changes in fetal DV waveform; and (3) late changes in fetal DV waveform. Primary outcome was 2-year survival without neurological impairment. The association of the last monitoring data before delivery and infant outcome was assessed by multivariable analysis.Results: Two-year survival without neurological impairment occurred more often in the two DV groups (both 83%) than in the CTG-STV group (77%), however, the difference was not statistically significant (P = 0.21). Among the surviving infants in the DV groups, 93% were free of neurological impairment vs 85% of surviving infants in the CTG-STV group (P = 0.049). All fetal deaths (n = 7) occurred in the groups with DV monitoring. Of the monitoring parameters obtained shortly before fetal death in these seven cases, an abnormal CTG was observed in only one case. Multivariable regression analysis of factors at study entry demonstrated that a later gestational age, higher estimated fetal weight-to-50th percentile ratio and lower umbilical artery pulsatility index (PI)/fetal middle cerebral artery-PI ratio were significantly associated with normal outcome. Allocation to DV monitoring had a smaller effect on outcome, but remained in the model (P < 0.1). Abnormal fetal arterial Doppler before delivery was significantly associated with adverse outcome in the CTG-STV group. In contrast, abnormal DV flow was the only monitoring parameter associated with adverse outcome in the DV groups, while fetal arterial Doppler, STV below the cut-off used in the CTG-STV group and recurrent decelerations in fetal heart rate were not.Conclusions: In accordance with the findings of the TRUFFLE study on monitoring and intervention management of very preterm FGR, we found that the proportion of infants surviving without neuroimpairment was not significantly different when the decision for delivery was based on changes in DV waveform vs reduced STV on CTG. The uneven distribution of fetal deaths towards the DV groups was probably a chance effect, and neurological outcome was better among surviving children in these groups. Before 32 weeks, delaying delivery until abnormalities in DV-PI or STV and/or recurrent decelerations in fetal heat rate occur, as defined by the study protocol, is likely to be safe and possibly benefits long-term outcome. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Endocrine disrupting chemicals (EDCs) can cause adverse effects in individuals and their offspring. In 2017 and 2018, we performed a survey on representative samples of Austrian drinking water (n = 20), groundwater (n = 22), and surface water (n = 12), the latter including bathing water (n = 5) and rivers (n = 7). We analyzed 54 samples for 28 parameters, including estrogens, polybrominated diphenylethers (PBDEs), phthalates, perfluoroalkyl substances, alkylphenols, bisphenol A and triclosan, correlating to 1512 measurements. In 39 of the 54 samples (72.2%), at least one endocrine disrupting or potentially disrupting chemical was found at or above the limit of quantification. None of the samples yielded estrogens or triclosan in detectable levels. Bisphenol A (BPA) was detected in 4 (20.0%) samples of drinking water, in 1 (4.5%) groundwater sample, and in 1 (20%) bathing water sample, with a maximum concentration of 0.021 μg/l found in one drinking water. Two drinking water samples yielded BPA in concentrations above the limit value of 0.01 μg/l, recently proposed by the European Commission for drinking water. Therefore, the ultimate public health goal must be to further reduce and restrict the production of EDCs and therewith decrease and eventually eliminate the contamination of drinking water resources.

Objective: To measure skin thickness in patients with polycystic ovary syndrome (PCOS) in comparison to controls and to examine a possible association with sex steroids, body mass index, lipid profile and hyperinsulinemia. Methods: Thirty patients with confirmed PCOS were compared to thirty-two women presenting for infertility workup. Skin thickness was measured using high-resolution ultrasound in a standardized area, blood samples were collected once at presentation. Results: Patients with PCOS showed a statistically significant thicker skin than women in the control group (0.95 mm (±0.093 mm) versus 0.85 mm (±0.077 mm, p < 0.0001)). LH, estradiol, testosterone, the free androgen index, triglycerides, cholesterol, LDL-cholesterol and body mass index were significantly increased in PCOS - patients. No correlation between hyperinsulinemia and skin thickness was seen. Conclusions: PCOS - patients showed a greater skin thickness in comparison to women without PCOS. This might be due to proliferative effects of sex steroids such as estrogens and testosterone and metabolic derangements on skin thickness. [ABSTRACT FROM AUTHOR]

Objective To establish the nature and gestational age dependency of the pulmonary venous flow velocity pattern into the left atrium relative to systolic and diastolic phases of the cardiac cycle. Design This was a cross-sectional study of Doppler measurements of fetal pulmonary venous inflow velocities, which were correlated with simultaneous recordings of transmitral and aortic flow velocity waveforms based on an equal cardiac cycle length (±5%). Results Successful recordings were obtained in 28 out of 60 (47%) normal singleton pregnancies at 20–36 weeks of gestation. Reproducibility of waveform analysis of the various phases of the cardiac cycle was satisfactory, within-patient variance ranging between 1.7% and 6.5%. A statistically significant increase (p <0.05) in pulmonary venous time average velocity and velocity integral with advancing gestational age was established. A statistically significant increase (p <0.05) of the pulmonary flow velocity integral was also found when related to each of the systolic and diastolic segments of the cardiac cycle, with the exception of isovolemic relaxation time. The duration of each of the diastolic and systolic segments of the cardiac cycle, as well as the pulmonary venous velocity integral expressed as a percentage of the cardiac cycle, remained constant with advancing gestational age. Conclusions The second half of pregnancy is characterized by pulmonary venous inflow into the left atrium throughout the cardiac cycle. Pulmonary venous inflow into the left atrium occurs predominantly during the filling and ejection phases of the cardiac cycle. Absolute cardiac diastolic and systolic time intervals as well as the percentage distribution of pulmonary venous flow velocity integrals between these cardiac time intervals remain unchanged with advancing gestational age. [ABSTRACT FROM AUTHOR]

A 22-year-old para I/gravida II developed psychiatric symptoms at 8 weeks of gestation. Subsequently neurological symptoms with seizures developed leading to a status epilepticus with continuing seizures at week 14. Anticonvulsive therapy had little effect in alleviating the seizures and the condition of the patient rapidly deteriorated. A sudden reddening of her urine lead to the diagnosis of acute hepatic porphyria confirmed by laboratory tests. After extensive discussion with the patient’s family it was decided to terminate the pregnancy at week 16. Within hours after pregnancy termination the seizures stopped and the patient recovered without any neurological deficits. Acute hepatic porphyria can be triggered by pregnancy and usually presents with gastrointestinal symptoms and personality changes. In its rare neurological manifestation it can lead to untreatable convulsions which leave no option but to terminate the pregnancy. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Presents information on a study which examined several lawsuits related to obstetric ultrasound and malpractice in medicine. Information on lawsuits based on ultrasound-biometry based pregnancy dating; Discussion on cerebral palsy lawsuits; Principles of risk management.

In this article the author discusses the use of high intensity focused ultrasound (HIFU) for treating uterine fibroids. He comments that HIFU can be used to treat women with fibroids and want to get pregnant. He mentions a research where HIFU was used to make holes in the ventricular septa of rabbits. He states that the advancement in ultrasonic techniques will help in the growth of treatment options in the field of obstetrics and gynecology.

An abstract of the research paper "The ISUOG Phantom Pilot Study: Does the Preset Matter?" by R.G. Axell and colleagues is presented.

An abstract of the research paper "The ISUOG phantom pilot study: does flow matter?," by S.F. Smith and colleagues is presented.

An abstract of the research paper "The ISUOG Phantom Pilot Study: Does Time Matter," by S.F. Smith and colleagues is presented.