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The purpose of this study was to estimate the frequency of post-caesarean section scar defects (PCSD) on transvaginal ultrasound and to correlate these with the presence of abnormal menstrual bleeding. We reviewed the pelvic ultrasound images of 318 women referred for a gynaecological scan in a private women's ultrasound clinic. The incidence of defects at the expected location of a caesarean scar was evaluated and then correlated with patient responses to a questionnaire on abnormal menstrual bleeding. Of the 318 patients, 71 had a history of caesarean section and technically adequate pelvic ultrasound images. Fluid-filled defects in the hysterotomy incision were noted in 29 (40%). The presence of a PCSD was significantly associated with patients reporting prolonged periods or post-menstrual spotting. The larger the defect, the higher was the incidence of abnormal vaginal bleeding. [ABSTRACT FROM AUTHOR]

Objective: To date, the evidence on pelvic floor injury in labor remains sketchy due to a lack of prospective studies comparing pelvic floor imaging before and after childbirth. We intended to define the incidence of major trauma to the pubovisceral muscle. Methods: A total of 61 nulliparous women were seen at 36-40 weeks of gestation in a prospective observational study. The assessment included an interview and 3-dimensional translabial ultrasound and was repeated 2-6 months postpartum. Results: Fifty women (82%) were seen postpartum. Of the 39 women delivered vaginally, levator avulsion was diagnosed in 14 (36%, 95% confidence interval 21-51%). Among those delivered vaginally, there were associations with higher maternal age (P = .10), vaginal operative delivery (P = .07), and worsened stress incontinence postpartum (P = .02). Conclusions: Avulsion of the inferomedial aspects of the levator ani from the pelvic sidewall occurred in approximately one third of all women delivered vaginally and was associated with stress incontinence 3 months after childbirth. [ABSTRACT FROM AUTHOR]

An abstract of the article "How accurate is ultrasound imaging in the diagnosis of deep infiltrating endometriosis," by C. Phua and colleagues is presented.

An abstract for the article "Accuracy of ultrasound for the preoperative evaluation of deep infiltrating endometriosis" by E. Dorney, S. Rajendran, K. Graham and others is presented.

An abstract of the research paper "Gelofusin as an ultrasound contrast agent for HyCoSy tubal patency assessment: discussion and review of first 100 cases," by V. Lanzarone is presented.

An abstract of the research paper "Ultrasound Measurement of Central Subcutaneous Adiposity to Assess Risk of Adverse Outcome in Pregnancy," by N. Kennedy and colleagues is presented.

An abstract of the research paper "Same day ultrasound imaging and laparoscopic surgery for the diagnosis of deep infiltrating endometriosis," by J. Ludlow and colleagues is presented.

An abstract of the article "Retained fetal bone following surgical termination at 12-16 weeks gestation: a series of 4 case reports," by B. J. Mein, R. Magotti, V. Lanzarone, M. Peek and R. Benzie is presented.

Introduction: A large fall in insulin requirements (FIR) in women with diabetes is associated with adverse clinical outcomes but previous studies have not examined its relation with serial ultrasound parameters., Objective: To determine whether FIR is associated with alteration in umbilical artery Doppler parameters and fetal growth restriction (FGR) in women with preexisting diabetes., Methods: Serial obstetric Doppler ultrasounds were conducted 2 weekly from 28 weeks gestation in women with Type 1 and Type 2 diabetes who were being treated with insulin. Estimated fetal weight (EFW), head circumference:abdominal circumference (HC:AC) ratio and umbilical artery doppler parameters ( SD ratio) and pulsatility index (PI) were measured. Information on insulin dose was collected prospectively throughout pregnancy and women with FIR ≥ 15% were considered cases. Linear mixed effect models were used to assess the association between FIR and ultrasound parameters., Results: One hundred and forty two women were included in the study (type 1 diabetes n  = 41, type 2 diabetes n  = 101). Thirty women demonstrated FIR ≥ 15%. There was no significant difference in the change of S/D ratio or PI over the third trimester in cases with FIR ≥ 15%, compared to the rest of the cohort, before or after adjusting for type of diabetes. Likewise there was no difference in EFW and HC:AC ratio with advancing gestation before or after adjusting for variables known to influence fetal growth. FGR rates (3.3 vs 8% p  = 0.298) and high S/D ratio > 95% (13.3 vs 8%, p  = 0.296) were similar between the two groups., Conclusions: FIR ≥ 15% was not associated with changes in placental flow or FGR however larger studies are needed to evaluate this further.

Background: Endometriosis-specific (advanced gynaecological) ultrasound is recommended as part of preoperative work-up of women with suspected endometriosis., Aim: To evaluate the awareness and utilisation of advanced gynaecological ultrasound in the preoperative work-up of women with suspected endometriosis among active RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists) fellows and trainees., Materials and Methods: Anonymous online survey invitations were emailed to all active RANZCOG fellows in Australia and New Zealand. Descriptive analysis of responses and multivariate analysis where appropriate were performed. P < 0.05 was considered statistically significant., Results: A 17% (437/2567) survey response rate and 93% (409/437) completion rate were recorded; 59% (248/421) of respondents identified as generalists, whereas 15% (63/421) identified as advanced laparoscopic surgeons. Routine pelvic ultrasound (88.9%, 361/406) was the most common imaging modality requested by respondents; 32% (128/405) of respondents would also always request advanced gynaecology ultrasound. Respondents' self-reported practice type was significantly associated with utilisation of advanced gynaecological ultrasound (P = 0.03); 79.6% (348/437) agreed with our proposed definition of advanced gynaecological ultrasound for endometriosis. A major limitation to the utilisation of advanced gynaecological ultrasound for endometriosis was the lack of local expertise (63.8%, 233/356)., Conclusion: The utilisation of advanced gynaecological ultrasound for endometriosis is significantly influenced by respondents' self-reported practice type and limited by the lack of local expertise., (© 2021 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Aim: Estimations of central adiposity in pregnancy is a difficult undertaking due to physiological changes that occur in the body. Therefore, the value of some anthropometric measures particularly in pregnancy, such as body mass index (BMI), waist and hip measures are in doubt. The aim was to compare ultrasound (US) measured abdominal subcutaneous fat (USSFT) with other simple anthropometric methods for obesity assessment, evaluating these measures in pregnancy., Method: Recruited from a larger study, anthropometric measurements were performed between 11-14 weeks' gestation on 575 women. Measuring height, weight, hip, waist circumference, skin-folds of the triceps, thigh and supra -iliac and USSFT. Percentage maternal fat mass was calculated using skin-fold measures. Correlations of these measures were performed to gauge relationships., Results: The anthropometric measures demonstrated good correlation (0.54-0.93) between individual adipose measures skin-folds, waist, hip, waist to height ratio (WSR) and USSFT with BMI, percentage fat mass and weight. USSFT correlated well with all anthropometric measures (0.54-0.73) correlating best with waist, WSR, BMI and weight. Waist/hip ratio demonstrated a poor correlation with USSFT, BMI, percentage fat mass and weight (0.3-0.41). Mean anthropometric measures were stratified across BMI categories describing adiposity distribution., Conclusion: USSFT correlates well with most anthropometric measures in early pregnancy. Limitations of the gravid uterus on waist measurements, hydration and compressibility of skin-fold measures and pregnancy influences on weight and BMI assessments could be overcome using US measures. There is a potential for post hoc evaluation using US for pregnancy complications. Maternal research could benefit from a more accurate measure of adiposity., (© 2018 Australasian Society for Ultrasound in Medicine.)

Objective: To investigate the association of falling insulin requirements (FIR) among women with preexisting diabetes with adverse obstetric outcomes and maternal biomarkers longitudinally in pregnancy., Research Design and Methods: A multicenter prospective cohort study of 158 women (41 with type 1 diabetes and 117 with type 2 diabetes) was conducted. Women with FIR of ≥15% from the peak total daily dose after 20 weeks' gestation were considered case subjects ( n = 32). The primary outcome was a composite of clinical markers of placental dysfunction (preeclampsia, small for gestational age [≤5th centile], stillbirth, premature delivery [<30 weeks], and placental abruption). Maternal circulating angiogenic markers (placental growth factor [PlGF] and soluble fms-like tyrosine kinase 1 [sFlt-1]), placental hormones (human placental lactogen, progesterone, and tumor necrosis factor-α), HbA 1c , and creatinine were studied serially during pregnancy., Results: FIR ≥15% were associated with an increased risk of the composite primary outcome (odds ratio [OR] 4.38 [95% CI 1.9-10.3]; P < 0.001), preeclampsia (OR 6.76 [95% CI 2.7-16.7]; P < 0.001), and was more common among women with type 1 diabetes (36.6 vs. 14.5%; P = 0.002). Creatinine was modestly elevated among women with FIR ≥15%; however, there was no difference in HbA 1c . The ratio of sFlt-1 to PlGF was significantly higher among women with FIR at 25, 30, and 36 weeks, with differences maintained in the subgroup that developed preeclampsia. There was no difference in placental hormones between the groups., Conclusions: This is the first prospective study to associate FIR with altered expression of placental antiangiogenic factors and preeclampsia. FIR are an important clinical sign, among women with preexisting diabetes, that should alert the clinician to investigate underlying placental dysfunction., (© 2017 by the American Diabetes Association.)

Objective: To assess maternal abdominal subcutaneous fat thickness (SFT) measured by ultrasound as an independent predictor of adverse pregnancy outcomes., Design: A prospective longitudinal cohort study performed on pregnancies delivered between 2012 and 2014., Setting: Sydney, Australia., Population: About 1510 pregnant women attending routine obstetric ultrasounds., Methods: Maternal SFT was measured on routine ultrasounds at 11-14 weeks' gestation (SFT1) and 18-22 weeks' gestation (SFT2). SFT measurements were assessed for estimating risks for obesity-related pregnancy outcomes using logistic regression modelling adjusted for maternal age, parity, smoking status and body mass index (BMI)., Main Outcome Measures: Hypertensive disease, gestational diabetes, caesarean section, low birthweight, preterm delivery, neonatal respiratory distress, Apgar scores, and admission to a neonatal intensive care unit., Results: SFT1 and SFT2 were measured on 1461 and 1363 women, respectively. Mean thickness (range) were 21.2 mm (6.9-73.9) for SFT1 and 20.3 mm (7.5-68.0) for SFT2. Complete outcome data were available for 1385 pregnancies. In all, 54% of the women were overweight/obese. The SFT measures decreased from early to mid-pregnancy in overweight/obese women. There was moderate correlation between BMI and SFT1 (R(2) = 0.56) and BMI and SFT2 (R(2) = 0.55). In a multivariate model, SFT1 and SFT2 were better predictors for adverse pregnancy outcomes than BMI., Conclusion: Maternal SFT is a significant independent predictor of adverse pregnancy outcomes. Incorporation of SFT into future models for adverse pregnancy outcome may prove valuable., (© 2015 Royal College of Obstetricians and Gynaecologists.)