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Objectives To evaluate the feasibility and impact of using a software-supported protocol for routine second-trimester ultrasound scanning. Methods We conducted a comparative observational study of 2 sets of 25 randomly selected normal routine second-trimester examinations performed by the same expert sonographer before and 1 year after the introduction of a software-supported protocol. The scanning protocol was identical during both periods and conformed to International Society of Ultrasound in Obstetrics and Gynecology guidelines. Two independent expert sonographers reviewed the temporal sequences of fetal anatomic visualization. The examination duration, number of images, time per stored image, and number of recorded anatomic features according to the International Society of Ultrasound in Obstetrics and Gynecology guidelines were compared between the periods. Results The mean examination duration and the number of images stored ± SD were both significantly higher during the period with the software-supported protocol than during the previous period (18.9 ± 5.3 versus 15.3 ± 2.8 minutes, respectively; P = .005; and 52.0 ± 2.4 versus 35.2 ± 3.4; P

Objective To evaluate the predictive value of angle of progression (AoP) of the fetal head for a failed vacuum delivery. Methods This was a prospective observational study that included women with a singleton pregnancy of ≥ 37 weeks' gestation, in cephalic presentation requiring vacuum extraction. Transperineal ultrasound was performed immediately before vacuum extraction, although AoP was measured on stored images after delivery. Vacuum extraction was defined as failed when the duration of extraction exceeded 20 min or the vacuum cup detached more than three times. We compared the demographic and ultrasound data of failed vacuum deliveries with those that were successful. The predictive value of AoP for failure of vacuum delivery was calculated. Results AoP was measured in 235 women. Vacuum extractions failed in 30 (12.8%) women (29/184 nulliparous and 1/51 parous) and resulted in 28 vaginal deliveries by forceps and two Cesarean deliveries. Median AoP was significantly lower in the vacuum failure group compared with those with successful vacuum delivery (136.6° (interquartile range (IQR), 129.8–144.1°) vs 145.9° (IQR, 135.0–158.4°); P

To evaluate the feasibility and impact of using a software-supported protocol for routine second-trimester ultrasound scanning.We conducted a comparative observational study of 2 sets of 25 randomly selected normal routine second-trimester examinations performed by the same expert sonographer before and 1 year after the introduction of a software-supported protocol. The scanning protocol was identical during both periods and conformed to International Society of Ultrasound in Obstetrics and Gynecology guidelines. Two independent expert sonographers reviewed the temporal sequences of fetal anatomic visualization. The examination duration, number of images, time per stored image, and number of recorded anatomic features according to the International Society of Ultrasound in Obstetrics and Gynecology guidelines were compared between the periods.The mean examination duration and the number of images stored ± SD were both significantly higher during the period with the software-supported protocol than during the previous period (18.9 ± 5.3 versus 15.3 ± 2.8 minutes, respectively; P = .005; and 52.0 ± 2.4 versus 35.2 ± 3.4; P .001). The mean time per image was also shorter with the software-supported protocol (19 ± 7 versus 26 ± 4 seconds; P .001). Recording of the placental location, amniotic fluid quantification, cavum septi pellucidi, thoracic shape, both kidneys, both arms, and genitalia was significantly more consistent with the software-supported protocol (P .001; P = .001; P = .022; P = .050; P = .022; P .001; and P = .048).This pilot study suggests that a software-supported protocol standardizing image acquisition may improve operator efficiency during second-trimester ultrasound scans.

by transperineal ultrasound as a predictive factor of instrumental extraction success Thierry Bultez, Thomas Popowski, Philippe Bouhanna, Patrick Rozenberg Poissy Saint-Germain Hospital, Obstetrics and Gynecology, Poissy, France OBJECTIVE: Several small studies have suggested that the angle of progression of the fetal head might predict the diagnosis of fetal head engagement in occipito-anterior position. We sought to evaluate the angle of progression measured by transperineal ultrasound (TPU) as a predictive factor of VE success in a large series whatever the fetal head position. STUDY DESIGN: The angle of progression is defined as the angle between the long axis of the pubic symphysis and the line extending from its most inferior portion tangentially to the fetal skull by TPU. Women with a singleton pregnancy and a gestational age 34 weeks of gestation necessiting a vacuum-assisted vaginal delivery were included in this prospective cohort study. TPU was performed immediately before the operative vaginal delivery. Picture was frozen and the angle was measured after the delivery to allow blind condition. In cases of failed vacuum extraction, either a caesarean section (CS) or a trial of forceps delivery was performed. Mann-Whitney test and ROC curve were used to statistical analysis. RESULTS: Among the 83 women, 40 vacuum extractions were performed for nonreassuring fetal heart rate and 43 for failure to progress. Fetal head was in occipito-anterior position in 65 cases (78.3%) and in occipito-posterior or tranverse position in 18 cases (21.7%). Nine (10.8%) vacuum extractions failed leading to 7 forceps and 2 CS. The mean (SD) angle of progression were 144.5 16.0 and 136.7 13.1 among the VE successes and failures (p 0.16), respectively. The area under the ROC curve of the angle of progression was 0.64, 95%CI [0.46, 0.83]. For a cut-off value of 120, 140 and 160 respectively; sensitivity was 91.9%, 67.6%, 14.9% and specificity 0.0%, 66.7%, 100.0%. Positive and negative predictive values were 88.3%, 94.3%, 100.0% and 0.0%, 20.0%, 12.5% respectively. CONCLUSION: The ultrasonographic angle of progression measurement can help the obstetrician to predict the VE success: beyond 160, no VE failure was found. However, its clinical utility is limited by the need of using a large angle to predict the VE success.