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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., (© 2019 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Objective: To investigate the intraobserver and interobserver reproducibility of a novel sonographic parameter named facial maxillary angle (FMA) and to establish nomograms of FMA, inferior facial angle (IFA), frontal nasal-mental angle (FNMA), maxilla-nasion-mandible angle (MNMA), and fetal profile line (FPL) in Chinese fetuses., Methods: In this prospective cross-sectional study, FMA, IFA, FNMA, MNMA, and FPL were measured in 592 normal fetuses between 16 and 36 gestational weeks. FMA was measured twice by the same and another operator with a blinded method on the first 50 cases. The reference interval was defined as ±2SD. The efficacy of five sonographic markers was tested in 10 fetuses with micrognathia retrieved from the database of our unit., Results: The intraclass correlation coefficient (95% CI) of intraobserver and interobserver reproducibility of FMA was 0.937 (0.890-0.964) and 0.891 (0.809-0.938), respectively. FMA, FNMA, and IFA increased slightly from 16 weeks till 28-31 weeks and decreased minimally thereafter. FMA and FNMA made correct diagnosis in all affected fetuses; MNMA and IFA identified nine and eight cases respectively, and FPL only detected five cases., Conclusion: A fixed cutoff of 66° for FMA and 136° for FNMA may be adopted as simple screening criteria of micrognathia., (© 2018 John Wiley & Sons, Ltd.)

Background: To compare the degree of force applied during external cephalic version, between different patients' characteristic and outcomes of version., Methods: It is a prospective observational study in a cohort of patients undergoing external cephalic version at or above 36 weeks of gestation. During external cephalic version, the operator wore a pair of pressure-sensing gloves which had ultra-thin piezo-resistive pressure sensors positioned on the palmer surface. Readings from each of the sensors were recorded in real time throughout each version attempt and analyzed by a computer program. The pressure exerted on individual sensors over time, the pressure-time integral (PTI; mmHg s), was calculated for each sensor from the start to the end of each version attempted. The degree of force applied for each attempt (PTI-A) was represented by the sum of pressure-time integrals across all sensors. PTI-A was analyzed in relation to different patients' characteristics and outcome of version., Results: Ninety-two patients were recruited, 73% of whom had a successful external cephalic version. The median PTI-A of the successful attempt in women who completed version after 1 and 2 attempts were 17,180 and 17,736 mmHg s, respectively. They were significantly lower than that of the women who required 3 or more attempts for a successful version (32,351 mmHg s), as well as the highest PTI-A among all attempts received by women who finally had a failed version (31,638 mmHg s) (p <0.05, Kruskal-Wallis Test and Dunn test). Within the same subject, there was no difference in PTI-A between the successful attempt and the preceding failed attempt, suggesting that the failure may not be due to insufficient force but rather to inefficient application of the force. Uterine tone was found to be the only clinical variable that was significantly associated with the degree of applied force during a version (p < 0.05). A tenser uterus was associated with a stronger applied force., Conclusion: The degree of force required for a successful version is highly variable, being lowest when version can be completed within 2 attempts, but doubled when 3 or more attempts are required. Failure of version is usually not due to inadequate force but inefficient application of force. Uterine tone is significantly related to the degree of applied force, with stronger force being exerted when the uterus is tense.