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Montaguti E, Petrachi B, Youssef A, Pilu G. Pearl in a shell: a peculiar case of fetal ovarian cyst. Ultrasound Obstet Gynecol 2024. [PMID: 38528738 DOI: 10.1002/uog.27645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/05/2024] [Accepted: 03/09/2024] [Indexed: 03/27/2024]
Affiliation(s)
- E Montaguti
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - B Petrachi
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - A Youssef
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - G Pilu
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Di Mascio D, D'Antonio F, Rizzo G, Pilu G, Khalil A, Papageorghiou AT. Counseling in fetal medicine: update on mild and moderate fetal ventriculomegaly. Ultrasound Obstet Gynecol 2024; 63:153-163. [PMID: 38301072 DOI: 10.1002/uog.26251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/31/2023] [Accepted: 05/07/2023] [Indexed: 02/03/2024]
Affiliation(s)
- D Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - F D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - G Pilu
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, UK
| | - A T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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Angeli L, Fieni S, Dall'Asta A, Ghi T, De Carolis S, Sorrenti S, Rizzo F, Della Gatta AN, Simonazzi G, Pilu G, Benvenuti M, Luchi C, Simoncini T, Gaibazzi N, Niccoli G, Ardissino D, Frusca T. Mode of delivery and peripartum outcome in women with heart disease according to the ESC guidelines: an Italian multicenter study. J Matern Fetal Neonatal Med 2023; 36:2184221. [PMID: 36935360 DOI: 10.1080/14767058.2023.2184221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
INTRODUCTION The European Society of Cardiology (ESC) guidelines (GL) provide indications on the mode of delivery in women with heart disease. However available data suggests that the rate of Cesarean Delivery (CD) is high and widely variable among such patients. In this study, we aimed to investigate the degree of adherence to the ESC recommendations among women delivering in four tertiary maternity services in Italy and how this affects the maternal and neonatal outcomes. MATERIAL AND METHODS Retrospective multicenter cohort study including pregnant women with heart disease who gave birth between January 2014 and July 2020. Composite adverse maternal outcome (CAM) was defined by the occurrence of one or more of the following: major postpartum hemorrhage, thrombo-embolic or ischemic event, de novo arrhythmia, heart failure, endocarditis, aortic dissection, need for re-surgery, sepsis, maternal death. Composite Adverse Neonatal outcome (CAN) was defined as cord arterial pH <7.00, APGAR <7 at 5 min, admission to the intensive care unit, and neonatal death. We compared the incidence of CAM and CAN between the cases with planned delivery in accordance (group "ESC consistent") or in disagreement (group "ESC not consistent") with the ESC GL. RESULTS Overall, 175 women and 181 liveborn were included. A higher frequency of CAN was found when delivery was not planned accordingly to the ESC guidelines [("ESC consistent" 9/124 (7.2%) vs "ESC not consistent" 13/57 (22.8%) p = 0.002 OR 3.74 (CI 95% 1.49-9.74) , while the occurrence of CAM was comparable between the two groups. At logistic regression analysis, the gestational age at delivery was the only parameter independently associated with the occurrence of CAN (p = 0.006). CONCLUSION Among pregnant women with heart disease, deviating from the ESC guidelines scheduling cesarean delivery does not seem to improve maternal outcomes and it is associated with worse perinatal outcomes, mainly due to lower gestational age at birth.
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Affiliation(s)
- L Angeli
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - S Fieni
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - A Dall'Asta
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - T Ghi
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - S De Carolis
- UOC of Obstetric Pathology, Departement of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - S Sorrenti
- UOC of Obstetric Pathology, Departement of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - F Rizzo
- UOC of Obstetric Pathology, Departement of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - A N Della Gatta
- Obstetric Unit, Department of Medical and Surgical Sciences (DIMEC) IRCSS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Simonazzi
- Obstetric Unit, Department of Medical and Surgical Sciences (DIMEC) IRCSS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences (DIMEC) IRCSS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - M Benvenuti
- Unità di Medicina Materno-Fetale, UOC Ginecologia ed Ostetricia University of Pisa, Pisa, Italy
| | - C Luchi
- Unità di Medicina Materno-Fetale, UOC Ginecologia ed Ostetricia University of Pisa, Pisa, Italy
| | - T Simoncini
- Unità di Medicina Materno-Fetale, UOC Ginecologia ed Ostetricia University of Pisa, Pisa, Italy
| | - N Gaibazzi
- Cardiology Department, University of Parma, Parma, Italy
| | - G Niccoli
- Cardiology Department, University of Parma, Parma, Italy
| | - D Ardissino
- Cardiology Department, University of Parma, Parma, Italy
| | - T Frusca
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
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Montaguti E, Angilletta E, Doroldi S, Fabbri E, Montedoro C, Petrillo F, Pilu G. Differential diagnosis of paracervical vascular anomalies in pregnancy. Ultrasound Obstet Gynecol 2023; 61:542-544. [PMID: 36647615 DOI: 10.1002/uog.26162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/24/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Affiliation(s)
- E Montaguti
- Obstetric Unit, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - E Angilletta
- Obstetric Unit, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - S Doroldi
- Obstetric Unit, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - E Fabbri
- Obstetric Unit, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - C Montedoro
- Obstetric Unit, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - F Petrillo
- Obstetric Unit, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
| | - G Pilu
- Obstetric Unit, IRCCS Azienda Ospedaliero, Universitaria di Bologna, Bologna, Italy
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Youssef A, Brunelli E, Fiorentini M, Lenzi J, Pilu G, El-Balat A. Breech progression angle: new feasible and reliable transperineal ultrasound parameter for assessment of fetal breech descent in birth canal. Ultrasound Obstet Gynecol 2021; 58:609-615. [PMID: 33847431 DOI: 10.1002/uog.23649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/20/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the feasibility and reliability of transperineal ultrasound in the assessment of fetal breech descent in the birth canal, by measuring the breech progression angle (BPA). METHODS Women with a singleton pregnancy with the fetus in breech presentation between 34 and 41 weeks' gestation were recruited. Transperineal ultrasound images were acquired in the midsagittal view for each woman, twice by one operator and once by another. Each operator measured the BPA after anonymization of the transperineal ultrasound images. BPA was defined as the angle between a line running along the long axis of the pubic symphysis and another line extending from the most inferior portion of the pubic symphysis tangentially to the lowest recognizable fetal part in the maternal pelvis. Each operator was blinded to all other measurements performed for each woman. Intra- and interobserver reproducibility of BPA measurement was evaluated using the intraclass correlation coefficient (ICC). To investigate the presence of any bias, intra- and interobserver agreement was also analyzed using Bland-Altman analysis. Student's t-test and Levene's W0 test were used to investigate whether a number of different clinical factors had an effect on systematic differences and homogeneity, respectively, between BPA measurements. RESULTS Overall, 44 women were included in the analysis. BPA was measured successfully by both operators on all images. Both intra- and interobserver agreement analyses showed excellent reproducibility in BPA measurement, with ICCs of 0.88 (95% CI, 0.80-0.93) and 0.83 (95% CI, 0.71-0.90), respectively. The mean difference between measurements was 0.4° (95% CI, -1.4 to 2.2°) for intraobserver repeatability and -0.4° (95% CI, -2.6 to 1.8°) for interobserver repeatability. The upper limits of agreement were 12.0° (95% CI, 8.9-15.1°) and 13.6° (95% CI, 9.9-17.3°) for intra- and interobserver repeatability, respectively. The lower limits of agreement were -11.2° (95% CI, -14.3 to -8.1°) and -14.4° (95% CI, -18.2 to -10.7°) for intra- and interobserver repeatability, respectively. No systematic difference between BPA measurements was found on either intra- or interobserver agreement analysis. None of the clinical factors examined (maternal body mass index, maternal age, gestational age at the ultrasound scan and parity) showed a statistically significant effect on intra- or interobserver reliability. CONCLUSIONS BPA represents a new feasible and highly reproducible measurement for the evaluation of fetal breech descent in the birth canal. Future studies assessing its usefulness in the prediction of successful external cephalic version and breech vaginal delivery are needed. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Youssef
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Brunelli
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - M Fiorentini
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - J Lenzi
- Section of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - G Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, IRCCS Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - A El-Balat
- Department of Obstetrics and Gynecology, Goethe University Frankfurt, Frankfurt, Germany
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Youssef A, Brunelli E, Azzarone C, Di Donna G, Casadio P, Pilu G. Fetal head progression and regression on maternal pushing at term and labor outcome. Ultrasound Obstet Gynecol 2021; 58:105-110. [PMID: 32730691 DOI: 10.1002/uog.22159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/13/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The aim of our study was two-fold. First, to evaluate the association between the change in the angle of progression (AoP) on maternal pushing and labor outcome. Second, to assess the incidence and clinical significance of the reduction of AoP on maternal pushing. METHODS This was a prospective cohort study of nulliparous women with singleton pregnancy at term. AoP was measured at rest and on maximum Valsalva maneuver before the onset of labor, and the difference between AoP on maximum Valsalva and that at rest (ΔAoP) was calculated for each woman. Following delivery and data collection, we assessed the association between ΔAoP and various labor outcomes, including Cesarean section (CS), duration of the first, second and active second stages of labor, Apgar score and admission to the neonatal intensive care unit (NICU). The prevalence of women with reduction of AoP on maximum Valsalva maneuver (AoP-regression group) was calculated and its association with the mode of delivery and duration of different stages of labor was assessed. RESULTS Overall, 469 women were included in the analysis. Among these, 273 (58.2%) had spontaneous vaginal birth, 65 (13.9%) had instrumental delivery and 131 (27.9%) underwent CS. Women in the CS group were older, had narrower AoP at rest and on maximum Valsalva, higher rate of epidural administration and lower 1-min and 5-min Apgar scores in comparison with the vaginal-delivery group. ΔAoP was comparable between the two groups. On Pearson's correlation analysis, AoP at rest and on maximum Valsalva maneuver had a significant negative correlation with the duration of the first stage of labor. ΔAoP showed a significant negative correlation with the duration of the active second stage of labor (Pearson's r, -0.125; P = 0.02). Cox regression model analysis showed that ΔAoP was associated independently with the duration of the active second stage (hazard ratio, 1.014 (95% CI, 1.003-1.025); P = 0.012) after adjusting for maternal age and body mass index. AoP reduction on maximum Valsalva was found in 73 (15.6%) women. In comparison with women who showed no change or an increase in AoP on maximum Valsalva, the AoP-regression group did not demonstrate significant difference in maternal characteristics, mode of delivery, rate of epidural analgesia, duration of the different stages of labor or rate of NICU admission. CONCLUSIONS In nulliparous women at term before the onset of labor, narrower AoP at rest and on maximum Valsalva, reflecting fetal head engagement, is associated with a higher risk of Cesarean delivery. The increase in AoP from rest to Valsalva, reflecting more efficient maternal pushing, is associated with a shorter active second stage of labor. Fetal head regression on maternal pushing is present in about 16% of women and does not appear to have clinical significance. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, IRCCS, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Brunelli
- Department of Obstetrics and Gynecology, IRCCS, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - C Azzarone
- Department of Obstetrics and Gynecology, IRCCS, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Di Donna
- Department of Obstetrics and Gynecology, IRCCS, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - P Casadio
- Department of Obstetrics and Gynecology, IRCCS, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, IRCCS, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
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Paladini D, Malinger G, Birnbaum R, Monteagudo A, Pilu G, Salomon LJ, Timor-Tritsch IE. ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 2: performance of targeted neurosonography. Ultrasound Obstet Gynecol 2021; 57:661-671. [PMID: 33734522 DOI: 10.1002/uog.23616] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
Affiliation(s)
- D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - G Malinger
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Centre, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Birnbaum
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Centre, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Monteagudo
- Carnegie Imaging for Women, Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - G Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - L J Salomon
- Hôpital Necker Enfants Malades, AP-HP, and LUMIERE platform, EA 7328 Université de Paris, Paris, France
| | - I E Timor-Tritsch
- Division of Obstetrical and Gynecological Ultrasound, NYU School of Medicine, New York, NY, USA
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Malinger G, Paladini D, Haratz KK, Monteagudo A, Pilu G, Timor-Tritsch IE. Reply. Ultrasound Obstet Gynecol 2021; 57:174-175. [PMID: 33387405 DOI: 10.1002/uog.23564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- G Malinger
- Division of Ob-Gyn Ultrasound, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - K K Haratz
- Division of Ob-Gyn Ultrasound, Lis Maternity Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - A Monteagudo
- Carnegie Imaging for Women, Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - G Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - I E Timor-Tritsch
- Division of Obstetrical and Gynecological Ultrasound, NYU School of Medicine, New York, NY, USA
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Youssef A, Brunelli E, Montaguti E, Di Donna G, Dodaro MG, Bianchini L, Pilu G. Transperineal ultrasound assessment of maternal pelvic floor at term and fetal head engagement. Ultrasound Obstet Gynecol 2020; 56:921-927. [PMID: 31975450 DOI: 10.1002/uog.21982] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/17/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the association between pelvic floor dimensions in nulliparous women at term and fetal head engagement, as assessed by transperineal ultrasound. METHODS This was a prospective observational study of nulliparous women at term. Before the onset of labor, transperineal ultrasound was used to measure the anteroposterior diameter (APD) of the levator hiatus and the angle of progression (AoP) at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver (before and after visual feedback). We assessed the correlation between pelvic floor static and dynamic dimensions (levator hiatal APD and levator ani muscle coactivation) and AoP, which is an objective index of fetal head engagement. RESULTS In total, 282 women were included in the analysis. Among these, 211 (74.8%) women had a vaginal delivery while 71 (25.2%) had a Cesarean delivery. AoP was narrower in the Cesarean-delivery group at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva, whereas no differences in levator hiatal APD were found between the two groups. We found a negative correlation between levator hiatal APD at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva and the duration of the second stage of labor. There was a positive correlation between AoP and levator hiatal APD on maximum Valsalva maneuver after visual feedback (r = 0.15, P = 0.01). Women with levator ani muscle contraction on Valsalva maneuver (i.e. coactivation), both pre and post visual feedback, had a narrower AoP at rest and on maximum Valsalva. After visual feedback, women with levator ani muscle coactivation had a longer second stage of labor than did those without (80.8 ± 61.4 min vs 62.9 ± 43.4 min (P = 0.04)). CONCLUSIONS Smaller pelvic floor dimensions and levator ani muscle coactivation are associated with higher fetal head station and with a longer second stage of labor in nulliparous women at term. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Brunelli
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Montaguti
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Di Donna
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - M G Dodaro
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - L Bianchini
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
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Contro E, Larcher L, Balducci A, Prandstraller D, Perolo A, Lenzi J, Farina A, Donti A, Gargiulo G, Pilu G, Gatta AD. OC01.01: Foramen ovale morphology at fetal echocardiography may predict neonatal outcome in fetuses with complete transposition of the great arteries. Ultrasound Obstet Gynecol 2020; 56 Suppl 1:1-378. [PMID: 33063402 DOI: 10.1002/uog.22195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/09/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Affiliation(s)
- E Contro
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - L Larcher
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - A Balducci
- Department of Cardiac Pediatric Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - D Prandstraller
- Department of Cardiac Pediatric Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A Perolo
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - J Lenzi
- Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A Farina
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - A Donti
- Department of Cardiac Pediatric Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Gargiulo
- Department of Cardiac Pediatric Surgery, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - A Della Gatta
- Department of Obstetrics and Perinatal Medicine, University degli Studi di Bologna, Bologna, Italy
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Casadio P, Youssef A, Arena A, Gamal N, Pilu G, Seracchioli R. Increased rate of ruptured ectopic pregnancy in COVID-19 pandemic: analysis from the North of Italy. Ultrasound Obstet Gynecol 2020; 56:289. [PMID: 32573042 PMCID: PMC7361714 DOI: 10.1002/uog.22126] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Affiliation(s)
- P. Casadio
- Gynecology and Human Reproduction Physiopathology, Department of Obstetrics and Gynecology, DIMECSant'Orsola‐Malpighi University HospitalBolognaItaly
| | - A. Youssef
- Obstetrics and Prenatal Medicine UnitSant'Orsola‐Malpighi University HospitalBolognaItaly
| | - A. Arena
- Gynecology and Human Reproduction Physiopathology, Department of Obstetrics and Gynecology, DIMECSant'Orsola‐Malpighi University HospitalBolognaItaly
| | - N. Gamal
- Immunohematology and Transfusion Medicine ServiceAzienda Ospedaliero‐Universitaria Policlinico di ModenaModenaItaly
| | - G. Pilu
- Obstetrics and Prenatal Medicine UnitSant'Orsola‐Malpighi University HospitalBolognaItaly
| | - R. Seracchioli
- Gynecology and Human Reproduction Physiopathology, Department of Obstetrics and Gynecology, DIMECSant'Orsola‐Malpighi University HospitalBolognaItaly
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Youssef A, Montaguti E, Dodaro MG, Kamel R, Rizzo N, Pilu G. Levator ani muscle coactivation at term is associated with longer second stage of labor in nulliparous women. Ultrasound Obstet Gynecol 2019; 53:686-692. [PMID: 30353589 DOI: 10.1002/uog.20159] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/05/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the effect of levator ani muscle (LAM) coactivation at term on outcome of labor in nulliparous women. METHODS This was a prospective study of 284 low-risk nulliparous women with a singleton pregnancy at term recruited before the onset of labor. The anteroposterior diameter of the levator hiatus was measured in each woman on transperineal ultrasound at rest, on maximum pelvic floor muscle contraction and on maximum Valsalva maneuver before and after visual feedback. LAM coactivation was defined as a reduction in the anteroposterior diameter of the levator hiatus on maximum Valsalva maneuver in comparison with that at rest. The association of pelvic hiatal diameter values and LAM coactivation with mode of delivery and duration of labor was assessed. RESULTS No significant difference was found between women who underwent Cesarean delivery and those who had a vaginal delivery with regard to the anteroposterior diameter of the levator hiatus at rest, on pelvic floor muscle contraction and on Valsalva maneuver. Longer second stage of labor was associated with shorter anteroposterior diameter of the levator hiatus on all assessments, but in particular at rest and on Valsalva both before and after visual feedback. LAM coactivation was found in 89 (31.3%) and 75 (26.4%) women before and after visual feedback, respectively. Post visual feedback, women with LAM coactivation had a significantly longer second stage of labor than did those without LAM coactivation (83 ± 63 vs 63 ± 42 min; P = 0.006). On Cox regression analysis, LAM coactivation post visual feedback was an independent predictor of longer second stage of labor (adjusted hazard ratio, 1.499 (95% CI, 1.076-2.087); P = 0.017). CONCLUSION LAM coactivation in nulliparous women at term is associated with a longer second stage of labor. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Montaguti
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - M G Dodaro
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - R Kamel
- Department of Obstetrics and Gynecology, Kasr Al-Ainy University Hospital, Cairo University, Egypt
| | - N Rizzo
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
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Youssef A, Salsi G, Cataneo I, Pacella G, Azzarone C, Paganotto MC, Krsmanovic J, Montaguti E, Cariello L, Bellussi F, Rizzo N, Pilu G. Fundal pressure in second stage of labor (Kristeller maneuver) is associated with increased risk of levator ani muscle avulsion. Ultrasound Obstet Gynecol 2019; 53:95-100. [PMID: 29749657 DOI: 10.1002/uog.19085] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/16/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the association between application of fundal pressure during the second stage of labor (Kristeller maneuver) and the risk of levator ani muscle (LAM) injury. METHODS This was a prospective case-control study of women recruited immediately after their first vaginal delivery in our university hospital between March 2014 and September 2016. Women who underwent the Kristeller maneuver were recruited as cases. For each case, a control (no Kristeller) was recruited matched for body mass index, use of epidural analgesia, duration of second stage of labor and birth weight. All women were invited to undergo four-dimensional (4D) transperineal ultrasound (TPU) 3-6 months postpartum. The main outcome measure was the presence of LAM avulsion on 4D-TPU. TPU results were compared between cases and controls. Multivariate logistic regression analysis was performed to identify independent risk factors for LAM avulsion. RESULTS During the study period, 134 women in the Kristeller maneuver group and 128 women in the control group underwent TPU assessment. Women who underwent the Kristeller maneuver had a higher prevalence of LAM avulsion than did controls (38/134 (28.4%) vs 18/128 (14.1%); P = 0.005). In addition, women in the Kristeller-maneuver group had a larger hiatal area on maximum Valsalva maneuver and a greater increase in hiatal area from rest to maximum Valsalva. On multivariate logistic regression analysis, use of the Kristeller maneuver was the only independent factor associated with LAM avulsion (odds ratio, 2.5 (95% CI, 1.29-4.51)). CONCLUSION The Kristeller maneuver is associated with an increased risk of LAM avulsion when applied in women during their first vaginal delivery. This should be taken into account when deciding to use fundal pressure to accelerate the second stage of labor and when counseling women following childbirth. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Salsi
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - I Cataneo
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pacella
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - C Azzarone
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
- Department of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria Integrata di Verona, Verona, Italy
| | - M C Paganotto
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - J Krsmanovic
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
- Clinic for Gynecology and Obstetrics, University of Southampton, Kassel School of Medicine, Kassel, Germany
| | - E Montaguti
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - L Cariello
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - F Bellussi
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - N Rizzo
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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Volpe N, Migliavacca C, Dall'Asta A, Politi S, Schera GBL, Pilu G, Frusca T, Ghi T. Intrapartum ultrasound examination of fetal shoulder following head delivery. Ultrasound Obstet Gynecol 2018; 52:803-805. [PMID: 29479753 DOI: 10.1002/uog.19031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 06/08/2023]
Affiliation(s)
- N Volpe
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy
| | - C Migliavacca
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy
| | - A Dall'Asta
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy
| | - S Politi
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy
| | - G B L Schera
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - T Frusca
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy
| | - T Ghi
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, Unit of Surgical Sciences, Maggiore Hospital, University of Parma, Parma, Italy
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Ghi T, Dall'Asta A, Masturzo B, Tassis B, Martinelli M, Volpe N, Prefumo F, Rizzo G, Pilu G, Cariello L, Sabbioni L, Morselli-Labate AM, Todros T, Frusca T. Randomised Italian Sonography for occiput POSition Trial Ante vacuum (R.I.S.POS.T.A.). Ultrasound Obstet Gynecol 2018; 52:699-705. [PMID: 29785716 DOI: 10.1002/uog.19091] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 05/10/2018] [Accepted: 05/10/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess whether sonographic diagnosis of fetal head position before instrumental vaginal delivery can reduce the risk of failed vacuum extraction and improve delivery outcome. METHODS Randomised Italian Sonography for occiput POSition Trial Ante vacuum (R.I.S.POS.T.A.) is a randomized controlled trial of term (37 + 0 to 41 + 6 weeks' gestation) singleton pregnancies with cephalic presentation requiring instrumental delivery by vacuum extraction, which was conducted between April 2014 and June 2017 and involved 13 Italian maternity hospitals. Patients were randomized to assessment of fetal head position before attempted instrumental delivery by either vaginal examination (VE) alone or VE plus transabdominal sonography (TAS). Primary outcome was incidence of emergency Cesarean section due to failed vacuum extraction. A sample size of 653 women per group was planned to compare the primary outcome between the two groups. The sample size estimation was based on the hypothesis that the risk of failed vacuum delivery in the VE group would be 5% and that ultrasound assessment of fetal position prior to vacuum extraction would decrease this risk to 2%. RESULTS On interim analysis, the trial was stopped for futility. During this period, 222 women were randomized and 221 were included in the final data analysis, of whom 132 (59.7%) were randomized to evaluation of fetal head position by VE only and 89 (40.3%) to assessment by VE plus TAS prior to vacuum extraction. No significant differences were observed between the two groups with respect to incidence of emergency Cesarean section due to failed instrumental delivery and other maternal and fetal outcomes. Women randomized to assessment by VE plus TAS showed higher incidence of non-occiput anterior position of the fetal head at randomization and lower incidence of incorrect diagnosis of occiput position compared with women undergoing assessment by VE alone. A higher rate of episiotomy was noted in the women undergoing both VE and TAS compared with those in the VE-only group. CONCLUSIONS Our prematurely discontinued randomized controlled trial did not demonstrate any benefit in terms of reduced risk of failed instrumental delivery or maternal and fetal morbidity in women undergoing sonographic assessment of fetal head position prior to vacuum extraction. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- T Ghi
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - A Dall'Asta
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - B Masturzo
- Department of Obstetrics and Gynecology, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - B Tassis
- Department of Obstetrics and Gynecology, Mangiagalli University Hospital, Milan, Italy
| | - M Martinelli
- Department of Obstetrics and Gynecology, Fatebenefratelli San Peter Hospital, Rome, Italy
| | - N Volpe
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - F Prefumo
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - L Cariello
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - L Sabbioni
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - A M Morselli-Labate
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - T Todros
- Department of Obstetrics and Gynecology, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - T Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
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Guasina F, Bellussi F, Morganelli G, Salsi G, Pilu G, Simonazzi G. Electronic spatiotemporal image correlation improves four-dimensional fetal echocardiography. Ultrasound Obstet Gynecol 2018; 51:357-360. [PMID: 28337810 DOI: 10.1002/uog.17474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/06/2017] [Accepted: 03/17/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To compare the efficiency of electronic spatiotemporal image correlation (eSTIC) with that of conventional STIC to acquire four-dimensional (4D) fetal cardiac volumes of diagnostic quality. METHODS This was a randomized controlled trial of 100 patients in mid-gestation with normal sonograms. In half of the cases, STIC volumes of the fetal heart were obtained with a conventional mechanical 4D probe and in the remaining cases eSTIC volumes were obtained with an electronic 4D probe. Examinations were kept within the timeframe allotted for a standard examination of fetal anatomy, and a maximum of two attempts were made at obtaining a 4D cardiac volume. Datasets were stored on a computer and subsequently analyzed and categorized as being of optimal, satisfactory or inadequate quality, depending on whether or not it was possible to perform an extended basic cardiac examination, including obtaining a three vessels and trachea view, as well as a clear reconstruction of both the aortic and ductal arches in the sagittal plane. RESULTS The eSTIC volume datasets were more frequently of optimal or satisfactory diagnostic quality compared with conventional STIC (94% vs 76%, P < 0.0001). Failure to obtain an eSTIC volume of adequate quality was in all cases the consequence of an unfavorable position of the fetus. CONCLUSIONS Compared with a standard mechanical probe, the electronic 4D probe facilitates acquisition of sonographic cardiac volumes in mid-trimester fetuses. In our hands, eSTIC volumes of optimal or satisfactory diagnostic quality, allowing a detailed offline evaluation of the fetal heart, were obtained in more than 90% of cases within the time frame of a standard examination of fetal anatomy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Guasina
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
- GynePro Medical Centers, Bologna, Italy
| | - F Bellussi
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
- GynePro Medical Centers, Bologna, Italy
| | - G Morganelli
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - G Salsi
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
- GynePro Medical Centers, Bologna, Italy
| | - G Simonazzi
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
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Malinger G, Paladini D, Pilu G, Timor-Tritsch IE. Fetal cerebral magnetic resonance imaging, neurosonography and the brave new world of fetal medicine. Ultrasound Obstet Gynecol 2017; 50:679-680. [PMID: 28568972 DOI: 10.1002/uog.17538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/18/2017] [Accepted: 05/25/2017] [Indexed: 06/07/2023]
Affiliation(s)
- G Malinger
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Paladini
- Fetal Medicine & Surgery Unit, G. Gaslini Children's Hospital, Genoa, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - I E Timor-Tritsch
- Division of Obstetrical & Gynecological Ultrasound, Department of Obstetrics and Gynecology, NYU School of Medicine, New York, NY, USA
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18
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Raimondo D, Youssef A, Mabrouk M, Del Forno S, Martelli V, Pilu G, Rizzo N, Zannoni L, Paradisi R, Seracchioli R. Pelvic floor muscle dysfunction on 3D/4D transperineal ultrasound in patients with deep infiltrating endometriosis: a pilot study. Ultrasound Obstet Gynecol 2017; 50:527-532. [PMID: 27718502 DOI: 10.1002/uog.17323] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 08/27/2016] [Accepted: 09/12/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Pelvic floor muscle (PFM) dysfunction seems to play an important role in the pathophysiology of pelvic pain, including that associated with deep infiltrating endometriosis (DIE). The aim of this study was to evaluate the static and dynamic morphometry of the PFM using three-dimensional (3D) and four-dimensional (4D) transperineal ultrasound in women with DIE compared with asymptomatic healthy women. METHODS This was a pilot, prospective study conducted at our tertiary center between March and November 2015. Fifty nulliparous women with DIE (study group) and 35 nulliparous asymptomatic healthy women (control group) were included. 3D/4D transperineal ultrasound examination of the PFM was performed in both groups. Levator hiatal area (LHA) and anteroposterior and left-right transverse diameters were evaluated at rest, on maximum PFM contraction and on maximum Valsalva maneuver. Persistent levator ani muscle (LAM) coactivation during Valsalva maneuver was investigated. RESULTS Compared with the control group, women with DIE had a smaller LHA at rest (P = 0.03) and during Valsalva maneuver (P < 0.01). Furthermore, reduction in LHA during PFM contraction (P < 0.001) and enlargement in LHA during Valsalva maneuver (P = 0.01) were significantly less marked. In comparison with controls, women with DIE presented a higher frequency of LAM coactivation during Valsalva maneuver, although this difference did not reach statistical significance (P = 0.05). CONCLUSIONS 3D and 4D transperineal ultrasound is an objective and non-invasive method for PFM morphometry and may have a role in detecting PFM dysfunction in women with DIE. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D Raimondo
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - A Youssef
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - M Mabrouk
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - S Del Forno
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - V Martelli
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - N Rizzo
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - L Zannoni
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - R Paradisi
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - R Seracchioli
- Department of Obstetrics and Gynecology, DIMEC, S. Orsola Hospital, University of Bologna, Bologna, Italy
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Youssef A, Cavalera M, Pacella G, Salsi G, Morganelli G, Montaguti E, Cataneo I, Pilu G, Rizzo N. Is curved three-dimensional ultrasound reconstruction needed to assess the warped pelvic floor plane? Ultrasound Obstet Gynecol 2017; 50:388-394. [PMID: 27642724 DOI: 10.1002/uog.17304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/12/2016] [Accepted: 09/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Caudal distension of the female pelvic floor is common and results in perineal descent and a caudally curved levator hiatus (warping). Image reconstruction of the pelvic floor using currently available ultrasound techniques involves a linear approach (flat-plane reconstruction). We aimed to evaluate the feasibility, reproducibility and potential usefulness of a new three-dimensional (3D) technique capable of reconstructing a curved plane of the levator hiatus. METHODS Primiparous women were recruited to undergo a 3D/four-dimensional transperineal ultrasound examination 3-6 months after delivery. Levator ani muscle warping was evaluated on Valsalva maneuver by measuring the distance between the plane extending from the pubic rami to the anorectal angle and the plane of minimal hiatal dimensions on the coronal plane. Warping distance was used to reconstruct a curved plane of the levator hiatus using the curved OmniView volume contrast imaging (VCI) technique (C-OV). Intra- and interobserver reproducibility of the C-OV technique were assessed, as was intermethod agreement between the C-OV technique and the linear OmniView-VCI (L-OV) technique, for the measurement of levator hiatal area on Valsalva maneuver. RESULTS Measurement of the levator hiatal area using C-OV was feasible in all 84 women recruited. The warping distance ranged from -3.5 to 9.7 mm, confirming that the 1-2-cm slice thickness traditionally used for linear reconstruction was adequate for proper assessment of levator hiatal area in our population. C-OV showed excellent intra- and interobserver reproducibility, as well as excellent agreement with the L-OV technique for measuring levator hiatal area. No systematic difference was demonstrated in any of the reproducibility studies performed. CONCLUSIONS 3D reconstruction of the warped levator hiatal plane is feasible and highly reproducible. In our population, reconstruction of a curved plane to correct for levator hiatal warping did not offer any benefit over the traditionally performed linear reconstruction. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - M Cavalera
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pacella
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - G Salsi
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Morganelli
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Montaguti
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - I Cataneo
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - N Rizzo
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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Tutschek B, Pilu G. Pocket Brain, an interactive, web-based ultrasound atlas of normal and abnormal fetal brain development. Ultrasound Obstet Gynecol 2017; 49:431-432. [PMID: 27071832 DOI: 10.1002/uog.15937] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/04/2016] [Accepted: 04/07/2016] [Indexed: 06/05/2023]
Affiliation(s)
- B Tutschek
- Prenatal Zurich, Gladbachstr. 95, 8044, Zürich, Switzerland
- Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - G Pilu
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
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D'Antonio F, Khalil A, Garel C, Pilu G, Rizzo G, Lerman-Sagie T, Bhide A, Thilaganathan B, Manzoli L, Papageorghiou AT. Reply. Ultrasound Obstet Gynecol 2016; 48:804-805. [PMID: 27933708 DOI: 10.1002/uog.17314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- F D'Antonio
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - A Khalil
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - C Garel
- Hopital d'Enfants Armand-Trousseau - Service de Radiologie, Cedex, Paris, France
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, Universita di Roma, Tor Vergata, Rome, Italy
| | - T Lerman-Sagie
- Fetal Neurology Clinic and Paediatric Neurology Unit, Wolfson Medical Center, Holon, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Bhide
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - L Manzoli
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, and EMISAC, CeSI Biotech, Chieti, Italy
| | - A T Papageorghiou
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
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Ghi T, Youssef A, Martelli F, Bellussi F, Aiello E, Pilu G, Rizzo N, Frusca T, Arduini D, Rizzo G. Narrow subpubic arch angle is associated with higher risk of persistent occiput posterior position at delivery. Ultrasound Obstet Gynecol 2016; 48:511-515. [PMID: 26565728 DOI: 10.1002/uog.15808] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/04/2015] [Accepted: 11/09/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine whether the subpubic arch angle (SPA) measured by three-dimensional ultrasound is associated with the fetal occiput position at delivery and the mode of delivery. METHODS Nulliparous women with an uncomplicated singleton pregnancy at ≥ 37 weeks' gestation were recruited from two tertiary centers between September 2013 and August 2015. All women underwent a three-dimensional transperineal ultrasound examination and the SPA was measured using the previously validated Oblique View Extended Imaging software. Data on the outcome of labor were obtained prospectively in all cases and the correlations between SPA and the fetal occiput position at delivery and the incidence of operative delivery were investigated. RESULTS Overall, 368 women were included in the study. Fetal position at delivery was occiput anterior in 339 (92.1%) cases and occiput posterior (OP) in 29 (7.9%) cases. A significantly narrower SPA was found in the OP group compared with the occiput anterior group (104.4 ± 16.8° vs 116.4 ± 11.9°; P < 0.0001). The SPA was significantly narrower in women requiring obstetric intervention compared with in women with a spontaneous vaginal delivery. From multivariable logistic regression analysis, SPA and maternal height appeared to be significant predictors of both the fetal occiput position at delivery and the risk of operative delivery. The best cut-off value of SPA for predicting an OP position at delivery was 90.5°. CONCLUSION A narrow SPA is associated with a higher risk of persistent OP position at delivery and of operative delivery. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- T Ghi
- Department of Obstetrics, University of Parma, Parma, Italy.
| | - A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - F Martelli
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - F Bellussi
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Aiello
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - N Rizzo
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - T Frusca
- Department of Obstetrics, University of Parma, Parma, Italy
| | - D Arduini
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
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Perolo A, De Robertis V, Cataneo I, Volpe N, Campobasso G, Frusca T, Ghi T, Prandstraller D, Pilu G, Volpe P. Risk of 22q11.2 deletion in fetuses with right aortic arch and without intracardiac anomalies. Ultrasound Obstet Gynecol 2016; 48:200-203. [PMID: 26411878 DOI: 10.1002/uog.15766] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess the risk of 22q11.2 deletion in fetuses with a prenatal diagnosis of right aortic arch without intracardiac anomalies (RAA-no ICA). METHODS This was a retrospective study of all fetuses with RAA-no ICA diagnosed prenatally at three referral centers, between 2004 and 2014. A detailed sonographic examination was performed in each case, including visualization of the thymus and of the head and neck vessels to identify the presence of an aberrant left subclavian artery (ALSA). Karyotyping and fluorescence in situ hybridization analysis for diagnosis of 22q11.2 deletion were always offered either prenatally or postnatally. Clinical and echocardiographic examinations were performed in livebirths and a postmortem examination in cases of termination of pregnancy. RESULTS During the study period, 85 fetuses were diagnosed prenatally with RAA-no ICA. Genetic or clinical data were not available for three cases and these were excluded from analysis. 22q11.2 deletion was found in 7/82 cases (8.5% (95% CI, 3.8-17.3%)). The thymus was small or non-visualized in all seven cases and additional abnormal sonographic findings were present in four. CONCLUSION 22q11.2 deletion is present in a clinically significant proportion of fetuses with a prenatal diagnosis of RAA-no ICA. In such cases, a detailed sonographic examination, with assessment of the thymus in particular, may be useful to further define the level of risk for 22q11.2 deletion. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Perolo
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - V De Robertis
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL Bari, Bari, Italy
| | - I Cataneo
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - N Volpe
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - G Campobasso
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL Bari, Bari, Italy
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Ghi
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - D Prandstraller
- Department of Pediatric Cardiology, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - P Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL Bari, Bari, Italy
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D'Antonio F, Khalil A, Garel C, Pilu G, Rizzo G, Lerman-Sagie T, Bhide A, Thilaganathan B, Manzoli L, Papageorghiou AT. Systematic review and meta-analysis of isolated posterior fossa malformations on prenatal imaging (part 2): neurodevelopmental outcome. Ultrasound Obstet Gynecol 2016; 48:28-37. [PMID: 26394557 DOI: 10.1002/uog.15755] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 08/10/2015] [Accepted: 09/16/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Diagnosis of isolated posterior fossa anomalies in children is biased by the fact that only those that are symptomatic are brought to the attention of the appropriate clinical personnel, and the reported rate is often affected by the adoption of different nomenclature, diagnostic criteria, outcome measures, duration of follow-up and neurodevelopmental tools. The aim of this systematic review was to explore the neurodevelopmental outcome of fetuses with a prenatal diagnosis of isolated posterior fossa anomalies. METHODS MEDLINE and EMBASE were searched electronically, utilizing combinations of the relevant medical subject heading terms for 'posterior fossa' and 'outcome'. Studies assessing the neurodevelopmental outcome in children with a prenatal diagnosis of isolated posterior fossa malformations were considered eligible. The posterior fossa anomalies analyzed included Dandy-Walker malformation (DWM), mega cisterna magna (MCM), Blake's pouch cyst (BPC) and vermian hypoplasia (VH). Two authors reviewed all abstracts independently. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale for cohort studies. Meta-analyses of proportions were used to combine data, and between-study heterogeneity was explored using the I(2) statistic. RESULTS A total of 1640 articles were identified; 95 were assessed for eligibility and a total of 16 studies were included in the systematic review. The overall rate of abnormal neurodevelopmental outcome in children with a prenatal diagnosis of DWM was 58.2% (95% CI, 21.8-90.0%) and varied from 0-100%. In those with a prenatal diagnosis of MCM, the rate of abnormal neurodevelopmental outcome was 13.8% (95% CI, 7.3-21.9%), with a range of 0-50%. There was no significant association between BPC and the occurrence of abnormal neurodevelopmental delay, with a rate of 4.7% (95% CI, 0.7-12.1%) and range of 0-5%. Although affected by the very small number of studies, there was a non-significant occurrence of abnormal neurodevelopmental delay in children with a prenatal diagnosis of VH, with a rate of 30.7% (95% CI, 0.6-79.1%) and range of 0-100%. CONCLUSIONS Fetuses diagnosed with isolated DWM are at high risk of abnormal neurodevelopmental outcome, while isolated MCM or BPC have a generally favorable outcome. The risk of abnormal developmental delay in cases with isolated VH needs to be further assessed. In view of the wide heterogeneity in study design, time of follow-up, neurodevelopmental tests used and the very small number of included cases, further future large prospective studies with standardized and objective protocols for diagnosis and follow-up are needed in order to ascertain the rate of abnormal neurodevelopmental outcome in children with isolated posterior fossa anomalies. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F D'Antonio
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - A Khalil
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - C Garel
- Hôpital d'Enfants Armand-Trousseau - Service de Radiologie, Cedex 12, Paris, France
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, Università di Roma, Tor Vergata, Rome, Italy
| | - T Lerman-Sagie
- Fetal Neurology Clinic and Paediatric Neurology Unit, Wolfson Medical Center, Holon, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Bhide
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - L Manzoli
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, and EMISAC, CeSI Biotech, Chieti, Italy
| | - A T Papageorghiou
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
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D'Antonio F, Khalil A, Garel C, Pilu G, Rizzo G, Lerman-Sagie T, Bhide A, Thilaganathan B, Manzoli L, Papageorghiou AT. Systematic review and meta-analysis of isolated posterior fossa malformations on prenatal ultrasound imaging (part 1): nomenclature, diagnostic accuracy and associated anomalies. Ultrasound Obstet Gynecol 2016; 47:690-7. [PMID: 25970099 DOI: 10.1002/uog.14900] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/07/2015] [Accepted: 04/17/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the outcome in fetuses with prenatal diagnosis of posterior fossa anomalies apparently isolated on ultrasound imaging. METHODS MEDLINE and EMBASE were searched electronically utilizing combinations of relevant medical subject headings for 'posterior fossa' and 'outcome'. The posterior fossa anomalies analyzed were Dandy-Walker malformation (DWM), mega cisterna magna (MCM), Blake's pouch cyst (BPC) and vermian hypoplasia (VH). The outcomes observed were rate of chromosomal abnormalities, additional anomalies detected at prenatal magnetic resonance imaging (MRI), additional anomalies detected at postnatal imaging and concordance between prenatal and postnatal diagnoses. Only isolated cases of posterior fossa anomalies - defined as having no cerebral or extracerebral additional anomalies detected on ultrasound examination - were included in the analysis. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale for cohort studies. We used meta-analyses of proportions to combine data and fixed- or random-effects models according to the heterogeneity of the results. RESULTS Twenty-two studies including 531 fetuses with posterior fossa anomalies were included in this systematic review. The prevalence of chromosomal abnormalities in fetuses with isolated DWM was 16.3% (95% CI, 8.7-25.7%). The prevalence of additional central nervous system (CNS) abnormalities that were missed at ultrasound examination and detected only at prenatal MRI was 13.7% (95% CI, 0.2-42.6%), and the prevalence of additional CNS anomalies that were missed at prenatal imaging and detected only after birth was 18.2% (95% CI, 6.2-34.6%). Prenatal diagnosis was not confirmed after birth in 28.2% (95% CI, 8.5-53.9%) of cases. MCM was not significantly associated with additional anomalies detected at prenatal MRI or detected after birth. Prenatal diagnosis was not confirmed postnatally in 7.1% (95% CI, 2.3-14.5%) of cases. The rate of chromosomal anomalies in fetuses with isolated BPC was 5.2% (95% CI, 0.9-12.7%) and there was no associated CNS anomaly detected at prenatal MRI or only after birth. Prenatal diagnosis of BPC was not confirmed after birth in 9.8% (95% CI, 2.9-20.1%) of cases. The rate of chromosomal anomalies in fetuses with isolated VH was 6.5% (95% CI, 0.8-17.1%) and there were no additional anomalies detected at prenatal MRI (0% (95% CI, 0.0-45.9%)). The proportions of cerebral anomalies detected only after birth was 14.2% (95% CI, 2.9-31.9%). Prenatal diagnosis was not confirmed after birth in 32.4% (95% CI, 18.3-48.4%) of cases. CONCLUSIONS DWM apparently isolated on ultrasound imaging is a condition with a high risk for chromosomal and associated structural anomalies. Isolated MCM and BPC have a low risk for aneuploidy or associated structural anomalies. The small number of cases with isolated VH prevents robust conclusions regarding their management from being drawn. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F D'Antonio
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - A Khalil
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - C Garel
- Hôpital d'Enfants Armand-Trousseau - Service de Radiologie, Cedex 12, Paris, France
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, Università di Roma, Tor Vergata, Rome, Italy
| | - T Lerman-Sagie
- Fetal Neurology Clinic and Paediatric Neurology Unit, Wolfson Medical Center, Holon, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Bhide
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
| | - L Manzoli
- Department of Medicine and Aging Sciences, University of Chieti-Pescara, and EMISAC, CeSI Biotech, Chieti, Italy
| | - A T Papageorghiou
- Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, UK
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Volpe P, Contro E, Fanelli T, Muto B, Pilu G, Gentile M. Appearance of fetal posterior fossa at 11-14 weeks in fetuses with Dandy-Walker malformation or chromosomal anomalies. Ultrasound Obstet Gynecol 2016; 47:720-725. [PMID: 25914043 DOI: 10.1002/uog.14883] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/08/2015] [Accepted: 04/16/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe the sonographic appearance of fetal posterior fossa anatomy at 11-14 weeks of pregnancy and to assess the outcome of fetuses with increased intracranial translucency (IT) and/or brainstem-to-occipital bone (BSOB) diameter. METHODS Reference ranges for brainstem (BS), IT and cisterna magna (CM) measurements, BSOB diameter and the BS : BSOB ratio were obtained from the first-trimester ultrasound examination of 233 fetuses with normal postnatal outcome (control group). The intraobserver and interobserver variability of measurements were investigated using 73 stored ultrasound images. In addition, a study group of 17 fetuses with increased IT and/or BSOB diameter was selected to assess outcome. RESULTS No significant intraobserver or interobserver variability was found for any measurement in the control group. In the study group, IT was increased in all cases and BSOB diameter was above the 95(th) centile of the calculated normal range in all but two (88%) cases. In 13/17 study cases, only two of the three posterior brain spaces were recognized on ultrasound. These 13 fetuses had a larger BSOB diameter than did the four cases that showed all three posterior brain spaces, and had severe associated anomalies including Dandy-Walker malformation (DWM) and/or chromosomal anomalies. CONCLUSIONS Visualization of the fetal posterior fossa anatomy at 11-14 weeks' gestation is feasible. Increased fluid in the posterior brain at 11-14 weeks, particularly in the case of non-visibility of the septation that divides the future fourth ventricle from the CM, is an important risk factor for cystic posterior fossa malformations, in particular DWM, and/or chromosomal aberrations. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- P Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy
| | - E Contro
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - T Fanelli
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy
| | - B Muto
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - M Gentile
- Medical Genetics Unit, Di Venere Hospital, ASL BA, Bari, Italy
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Youssef A, Montaguti E, Sanlorenzo O, Cariello L, Salsi G, Morganelli G, Azzarone C, Pilu G, Rizzo N. Reliability of new three-dimensional ultrasound technique for pelvic hiatal area measurement. Ultrasound Obstet Gynecol 2016; 47:629-635. [PMID: 26105710 DOI: 10.1002/uog.14933] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess the reproducibility of a new technique for three-/four-dimensional (3D/4D) ultrasound imaging of the pelvic floor: OmniView™ volume contrast imaging (VCI) for measurement of the pelvic hiatal area on maximum contraction and Valsalva maneuver. In addition, we aimed to study the intermethod agreement between the new technique and the 3D/4D render method. METHODS We acquired one static 3D and two dynamic 4D transperineal volumes (one obtained during contraction and one during Valsalva maneuver) from 35 nulliparous asymptomatic healthy volunteers and 35 women with symptoms of pelvic floor dysfunction. Each 3D dataset was analyzed using the OmniView-VCI technique to measure the pelvic hiatal area at rest, on maximum contraction and on maximum Valsalva. Analysis was performed twice by the same operator and once by another operator in order to assess intra- and interobserver reproducibility. All measurements were repeated by one operator using the 3D/4D render method to evaluate the intermethod agreement. Reproducibility and intermethod agreement were studied by means of intraclass correlation coefficients (ICC) and the Bland-Altman method. RESULTS Measurement of hiatal area using the OmniView-VCI technique showed excellent intraobserver and interobserver reproducibility in both asymptomatic and symptomatic women at rest, on contraction and on Valsalva maneuver. In addition, excellent agreement was demonstrated between OmniView-VCI and 3D/4D render in both groups (ICCs on Valsalva in asymptomatic and symptomatic women were 0.894 and 0.975, respectively). No systematic difference was noted in any of the reliability studies performed. CONCLUSIONS OmniView-VCI is a reliable method for pelvic hiatal area measurement. Both rendering mode and OmniView-VCI can be used interchangeably for assessing pelvic hiatal area. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - E Montaguti
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - O Sanlorenzo
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - L Cariello
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Salsi
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Morganelli
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - C Azzarone
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - N Rizzo
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
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Youssef A, Pilu G. Knowledge, understanding and fetal occiput position. Ultrasound Obstet Gynecol 2016; 47:523-524. [PMID: 27062977 DOI: 10.1002/uog.15874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 01/22/2016] [Indexed: 06/05/2023]
Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, University of Bologna and Bologna University Hospital Sant'Orsola-Malpighi, Via Massarenti, 13, Bologna, 40138, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, University of Bologna and Bologna University Hospital Sant'Orsola-Malpighi, Via Massarenti, 13, Bologna, 40138, Italy
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Youssef A, Salsi G, Curti A, Bellussi F, Elbarbary NA, Locatelli F, Lima M, Pilu G, Rizzo N. Prenatal ultrasonographic features of mature cystic teratoma in undescended testicle. Ultrasound Obstet Gynecol 2016; 47:527-529. [PMID: 26423204 DOI: 10.1002/uog.15769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/21/2015] [Accepted: 09/26/2015] [Indexed: 06/05/2023]
Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Salsi
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - A Curti
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - F Bellussi
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - N A Elbarbary
- Department of Obstetrics and Gynecology, El-Shatby Hospital, University of Alexandria, Alexandria, Egypt
| | - F Locatelli
- Department of Pathology, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - M Lima
- Department of Pediatric Surgery, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - N Rizzo
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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Di Donato N, Bartolini L, Pilu G, Rizzo N. A case report of a large placental lake in a woman affected by complex cardiac disease. J OBSTET GYNAECOL 2015; 36:386-7. [PMID: 26467782 DOI: 10.3109/01443615.2015.1073233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- N Di Donato
- a Minimally Invasive Gynaecological Surgery Unit, S.Orsola Hospital, University of Bologna , Italy
| | - L Bartolini
- a Minimally Invasive Gynaecological Surgery Unit, S.Orsola Hospital, University of Bologna , Italy
| | - G Pilu
- b Department of Obstetrics and Gynaecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Italy
| | - N Rizzo
- b Department of Obstetrics and Gynaecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Italy
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Contro E, Nanni M, Bellussi F, Salsi G, Grisolia G, Sanz-Cortès M, Righini A, Rizzo N, Pilu G, Ghi T. The hippocampal commissure: a new finding at prenatal 3D ultrasound in fetuses with isolated complete agenesis of the corpus callosum. Prenat Diagn 2015; 35:919-22. [DOI: 10.1002/pd.4645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/18/2015] [Accepted: 06/25/2015] [Indexed: 11/07/2022]
Affiliation(s)
- E. Contro
- Fetal Medicine Unit, S. Orsola-Malpighi Hospital; University of Bologna; Italy
| | - M. Nanni
- Fetal Medicine Unit, S. Orsola-Malpighi Hospital; University of Bologna; Italy
- Department of Obstetrics and Gynaecology; Carlo Poma Hospital; Mantova Italy
| | - F. Bellussi
- Fetal Medicine Unit, S. Orsola-Malpighi Hospital; University of Bologna; Italy
| | - G. Salsi
- Fetal Medicine Unit, S. Orsola-Malpighi Hospital; University of Bologna; Italy
| | - G. Grisolia
- Department of Obstetrics and Gynaecology; Carlo Poma Hospital; Mantova Italy
| | - M. Sanz-Cortès
- Maternal-Fetal Medicine Department, Hospital Clinic; University of Barcelona; Spain
| | - A. Righini
- Department of Radiology and Neuroradiology; Children's hospital V. Buzzi; Italy
| | - N. Rizzo
- Fetal Medicine Unit, S. Orsola-Malpighi Hospital; University of Bologna; Italy
| | - G. Pilu
- Fetal Medicine Unit, S. Orsola-Malpighi Hospital; University of Bologna; Italy
| | - T. Ghi
- Fetal Medicine Unit, S. Orsola-Malpighi Hospital; University of Bologna; Italy
- Department of Obstetrics, Maggiore Hospital; University of Parma; Italy
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Youssef A, Saleem SN, Pilu G. Reply: To PMID 25044258. Ultrasound Obstet Gynecol 2015; 45:354-355. [PMID: 25736851 DOI: 10.1002/uog.14781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
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Ghi T, Bellussi F, Pilu G. Sonographic diagnosis of lateral asynclitism: a new subtype of fetal head malposition as a main determinant of early labor arrest. Ultrasound Obstet Gynecol 2015; 45:229-231. [PMID: 24753011 DOI: 10.1002/uog.13385] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 03/28/2014] [Accepted: 04/04/2014] [Indexed: 06/03/2023]
Abstract
We report on the sonographic appearance of a new type of fetal head malposition in labor that has not been previously described systematically. In some circumstances, the fetal lie is characterized by a lateral orientation of the head with respect to the trunk and, on suprapubic ultrasound, a transverse section of the fetal chest together with the facial profile can be seen on the same image. These sonographic findings were documented in five cases of first-stage labor arrest. This report illustrates how, in these circumstances, ultrasound might be helpful in clarifying the precise cause of obstructed labor.
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Affiliation(s)
- T Ghi
- Department of Obstetrics and Gynecology, St Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
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Youssef A, Zagonari S, Salsi G, Saleem SN, Krsmanovic J, Pacella G, Ghi T, Rizzo N, Pilu G. Prenatal diagnosis of isolated butterfly vertebra. Ultrasound Obstet Gynecol 2014; 44:725-726. [PMID: 25044258 DOI: 10.1002/uog.13457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 06/03/2023]
Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
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Ghi T, Bellussi F, Eggebø T, Tondi F, Pacella G, Salsi G, Cariello L, Piastra A, Youssef A, Pilu G, Rizzo N. Sonographic assessment of fetal occiput position during the second stage of labor: how reliable is the transperineal approach? J Matern Fetal Neonatal Med 2014; 28:1985-8. [DOI: 10.3109/14767058.2014.974539] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Youssef A, Salsi G, Ragusa A, Ghi T, Pacella G, Rizzo N, Pilu G. Caregiver's satisfaction with a video tutorial for shoulder dystocia management algorithm. J OBSTET GYNAECOL 2014; 35:461-4. [PMID: 25357086 DOI: 10.3109/01443615.2014.969208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In our questionnaire, a video tutorial illustrating the management of shoulder dystocia was considered by health personnel as a useful complementary training tool. We prepared a 5-min video tutorial on the management of shoulder dystocia, using a simulator that includes maternal pelvic and baby models. We performed a survey among obstetric personnel in order to assess their opinion on the tutorial by inviting them to watch the video tutorial and answer an online questionnaire. Five multiple-choice questions were set, focusing on the video's main objectives: clarity, simplicity and usefulness. Following the collection of answers, global and category-weighted analyses were conducted for each question. Out of 956 invitations sent, 482 (50.4%) answered the survey. More than 90% of all categories found the video tutorial to be clinically relevant and clear. For revising the management of shoulder dystocia most obstetric personnel would use the video tutorial together with traditional textbooks. In conclusion, our video tutorial was considered by health personnel as a useful complementary training tool.
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Affiliation(s)
- A Youssef
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - G Salsi
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - A Ragusa
- b Department of Obstetrics and Gynecology , Niguarda Hospital , Milan , Italy
| | - T Ghi
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - G Pacella
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - N Rizzo
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - G Pilu
- a Department of Obstetrics and Gynecology , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
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Ghi T, Maroni E, Youssef A, Morselli-Labate AM, Paccapelo A, Montaguti E, Rizzo N, Pilu G. Sonographic pattern of fetal head descent: relationship with duration of active second stage of labor and occiput position at delivery. Ultrasound Obstet Gynecol 2014; 44:82-89. [PMID: 24496823 DOI: 10.1002/uog.13324] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 11/17/2013] [Accepted: 01/22/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The objectives of this study were firstly to assess the longitudinal changes of various sonographic parameters of fetal head progression in relation to length of active second stage of labor, and secondly to compare ultrasound findings obtained longitudinally among fetuses with persistent occiput posterior (OP) vs those with persistent occiput anterior (OA) position. METHODS From a series of nulliparous low-risk women at term attending the labor ward of our university hospital, transperineal ultrasound volumes were prospectively acquired at the beginning of the active second stage (T1) and at 40-min intervals thereafter until delivery (T2, T3). Sonographic parameters were derived from offline analysis of each volume, including the angle of progression (AoP), progression distance (PD), head-symphysis distance (HSD), head direction (HD) and midline angle. These parameters were compared between patients who delivered within 60 min from the beginning of the active second stage of labor (early delivery) and those who remained undelivered by that time (late delivery). Fetal head position was determined from stored digital images of transabdominal examinations performed at the beginning of the active second stage. Comparison was performed between fetuses with OA and those with persistent OP position at delivery. RESULTS Spontaneous vaginal delivery was achieved in 58 (81.7%) cases, whereas vacuum extraction and Cesarean section were performed in eight (11.3%) and five (7.0%) cases, respectively. Delivery was achieved within 60 min from the beginning of the active second stage in 44 (62.0%) patients. In the early vs late delivery groups, measurements of AoP, HSD and PD at T1 were significantly different (AoP, 143.9 ± 20.5° vs 125.3 ± 15.0°, P < 0.001; HSD, 14.8 ± 4.5 mm vs 20.9 ± 5.8 mm, P < 0.001; PD, 44.0 ± 14.1 vs 35.0 ± 13.1 mm, P = 0.008). On logistic regression analysis of data obtained at T1, maternal body mass index, oxytocin administration, neonatal birth weight and HSD appeared to predict independently duration of the active second stage. Among fetuses delivering in the OP position (n = 10, 13.5%), Cesarean delivery was significantly more common than in those delivering in the OA position (n = 5 (50.0%) vs n = 2 (3.1%), P = 0.001). Women with persistent OP position compared with OA showed a significantly different AoP at T1 (122 ± 17° vs 138 ± 20°, P = 0.016), HD and HSD at T1 (HD, 112 ± 17 mm vs 86 ± 19 mm, P < 0.001; HSD, 16.5 ± 5.4 mm vs 22.8 ± 6.6 mm, P = 0.008) and at T2 (HD, 120 ± 16 vs 82 ± 27 mm, P = 0.008; HSD, 12.6 ± 3.4 mm vs 18.5 ± 5.4 mm, P = 0.038). CONCLUSIONS AoP, PD and HSD are significantly different between patients undergoing delivery before or after 60 min from the beginning of the active second stage of labor. Ultrasound parameters are among the significant predictors of duration of the active second stage. Moreover, in fetuses persisting in the OP position vs those delivering in the OA position, fetal head progression seems to differ at early phases of the active second stage.
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Affiliation(s)
- T Ghi
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, Alma Mater-University of Bologna, Bologna, Italy
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Youssef A, Bellussi F, Montaguti E, Maroni E, Salsi G, Morselli-Labate AM, Paccapelo A, Rizzo N, Pilu G, Ghi T. Agreement between two- and three-dimensional transperineal ultrasound methods for assessment of fetal head-symphysis distance in active labor. Ultrasound Obstet Gynecol 2014; 43:183-188. [PMID: 24006290 DOI: 10.1002/uog.13204] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/24/2013] [Accepted: 08/30/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To assess the intermethod agreement between two-dimensional (2D) and three-dimensional (3D) transperineal ultrasound methods in measuring a new index of fetal head station (the fetal head-symphysis distance (HSD)) in active labor, and to assess potential factors that may affect their agreement. METHODS HSD was measured by transperineal ultrasound in 86 women in active labor, once using a 2D and once using a 3D technique. 2D images were acquired first in 43 cases and 3D images were acquired first in the other 43 women. Intermethod agreement between 2D and 3D methods was analyzed by means of intraclass correlation coefficient (ICC) and Bland-Altman analysis. In addition, potential factors affecting the intermethod reproducibility were investigated including fetal occiput position, order of acquisition, fetal head station, stage of labor, maternal body mass index and use of epidural analgesia, using the ANOVA test to check for systematic bias and Levene's test for homoscedasticity. RESULTS Good agreement was demonstrated between 2D and 3D measurements of HSD (ICC, 0.949 (95% CI, 0.914-0.984)). No evidence of systematic difference was shown between the two methods (average difference ± SD = 0.03 ± 2.29 mm; P = 0.888). The only factor that had a significant effect on systematic difference between 2D and 3D methods was order of acquisition (P = 0.042); the first observation was higher regardless of the method used. Fetal head station had a significant effect on the homogeneity between the two methods (P = 0.004) with a better 2D-3D agreement obtained at lower head stations (SD of differences: 1.63 vs 2.59 mm). CONCLUSIONS There is very good agreement between 2D and 3D methods of assessing HSD. Agreement is better in lower fetal head stations.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy
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Contro E, Volpe P, De Musso F, Muto B, Ghi T, De Robertis V, Pilu G. Open fourth ventricle prior to 20 weeks' gestation: a benign finding? Ultrasound Obstet Gynecol 2014; 43:154-158. [PMID: 24151160 DOI: 10.1002/uog.13227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 10/12/2013] [Accepted: 10/16/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate the role of the brainstem-vermis (BV) angle in the diagnosis of fetal posterior fossa abnormalities at 15-18 weeks' gestation. METHODS We examined retrospectively three-dimensional (3D) ultrasound volumes acquired at 15-18 gestational weeks in fetuses with normal posterior fossa (controls) and in those with cystic posterior fossa. Whether the fourth ventricle appeared open posteriorly in axial views was noted and the BV angle was measured. A detailed follow-up was obtained in all cases. RESULTS Of the 139 controls, 46 cases were excluded because of inadequate quality of the 3D volumes. Of the 93 remaining normal fetuses, 84 (90.3%) had a closed fourth ventricle and a BV angle < 20°, whereas 9/93 (9.7%) had an open fourth ventricle and a BV angle between 20° and 37°. The study group of 11 fetuses included seven with Dandy-Walker malformation and four with Blake's pouch cyst. In abnormal cases as a whole, the BV angle was significantly increased compared with that in controls (P < 0.0001). However, fetuses with Blake's pouch cyst and normal fetuses with an open fourth ventricle had strikingly similar sonograms: the BV angle was between 20° and 37° and the fourth ventricle appeared open only when viewed using a more steeply angulated scanning plane than that of the standard transcerebellar plane; in fetuses with Dandy-Walker malformation the fourth ventricle was widely open posteriorly, even in the standard transcerebellar view, and the BV angle was > 45°, significantly increased compared both with that in normal fetuses (P < 0.0001) and with that in fetuses with Blake's pouch cyst (P = 0.004). CONCLUSION An open fourth ventricle is found in about 10% of normal fetuses at 15-18 weeks' gestation. Measurement of the BV angle is useful in such cases, as a value ≥ 45° is associated with a very high risk of severe posterior fossa malformation.
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Affiliation(s)
- E Contro
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
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Youssef A, Bellussi F, Rizzo N, Pilu G, Ghi T. Cyst of the filum terminale: two cases detected on prenatal ultrasound. Ultrasound Obstet Gynecol 2013; 42:363-364. [PMID: 23733516 DOI: 10.1002/uog.12524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 05/21/2013] [Indexed: 06/02/2023]
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Papageorghiou AT, Sarris I, Ioannou C, Todros T, Carvalho M, Pilu G, Salomon LJ. Ultrasound methodology used to construct the fetal growth standards in the INTERGROWTH-21st Project. BJOG 2013; 120 Suppl 2:27-32, v. [PMID: 23841904 DOI: 10.1111/1471-0528.12313] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2012] [Indexed: 12/01/2022]
Abstract
A unified protocol is essential to ensure that fetal ultrasound measurements taken in multicentre research studies are accurate and reproducible. This paper describes the methodology used to take two-dimensional, ultrasound measurements in the longitudinal, fetal growth component of the INTERGROWTH-21(st) Project. These standardised methods should minimise the systematic errors associated with pooling data from different study sites. They represent a model for carrying out similar research studies in the future.
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Affiliation(s)
- A T Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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Youssef A, Bellussi F, Maroni E, Pilu G, Rizzo N, Ghi T. Ultrasound in labor: is it time for a more simplified approach? Ultrasound Obstet Gynecol 2013; 41:710-711. [PMID: 23280777 DOI: 10.1002/uog.12373] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Ghi T, Youssef A, Maroni E, Arcangeli T, De Musso F, Bellussi F, Nanni M, Giorgetta F, Morselli-Labate AM, Iammarino MT, Paccapelo A, Cariello L, Rizzo N, Pilu G. Intrapartum transperineal ultrasound assessment of fetal head progression in active second stage of labor and mode of delivery. Ultrasound Obstet Gynecol 2013; 41:430-435. [PMID: 23288706 DOI: 10.1002/uog.12379] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To compare longitudinal changes in angle of progression (AoP) and midline angle (MLA) during the active second stage of labor according to the mode of delivery. METHODS A three-dimensional transperineal ultrasound volume was acquired in a series of nulliparous women at the beginning of the active second stage (T1) and every 20 min thereafter (T2, T3, T4, T5 and T6). Following delivery, all ultrasound volumes were analyzed and AoP and MLA were measured. RESULTS Among 71 women included in the study, 58 underwent spontaneous vaginal delivery (group A) and 13 underwent operative delivery (group B) (eight by vacuum extraction and five by Cesarean section). When compared with Group B, Group A had a wider AoP only at T1 (140.0 ± 20.2° vs. 122.9 ± 16.7°; P = 0.010) and T2 (149.7 ± 20.7° vs. 126.9 ± 17.5°; P = 0.006). MLA was narrower in group A only at T3 (21.2 ± 11.7° vs. 40.8 ± 27.9°; P = 0.043), T4 (18.2 ± 15.0° vs. 47.4 ± 29.6°; P = 0.020) and T5 (18.3 ± 6.0° vs. 34.7 ± 4.2°; P = 0.034). On stepwise forward multiple logistic regression analysis, both AoP and MLA were independently associated with operative delivery (OR = 0.955 and OR = 1.018, respectively). CONCLUSION Ultrasonographic assessment of fetal head descent in the second stage of labor may play a role in the prediction of the mode of delivery.
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Affiliation(s)
- T Ghi
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
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Youssef A, Ghi T, Awad EE, Maroni E, Montaguti E, Rizzo N, Pilu G. Ultrasound in labor: a caregiver's perspective. Ultrasound Obstet Gynecol 2013; 41:469-470. [PMID: 22807171 DOI: 10.1002/uog.12267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant’Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
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Youssef A, Maroni E, Ragusa A, De Musso F, Salsi G, Iammarino MT, Paccapelo A, Rizzo N, Pilu G, Ghi T. Fetal head-symphysis distance: a simple and reliable ultrasound index of fetal head station in labor. Ultrasound Obstet Gynecol 2013; 41:419-424. [PMID: 23124698 DOI: 10.1002/uog.12335] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To assess the reproducibility of measurement of a new sonographic index of fetal head station in labor, the fetal head-symphysis distance (HSD), using three-dimensional ultrasound, and its correlation with digital assessment of fetal head descent and with the angle of progression (AoP). METHODS Three-dimensional (3D) ultrasound volumes were acquired from 47 nulliparous women in active labor following assessment of fetal head station with digital examination. The HSD (the distance between the lower edge of the pubic symphysis and the nearest point of the fetal skull) was measured independently by two operators in order to evaluate intra- and interobserver reproducibility. The correlation between HSD, AoP and fetal head station was evaluated using regression analysis. Using 3D tomographic ultrasound imaging (TUI), measurements of the HSD were obtained in different parasagittal planes to evaluate the influence of inaccurate alignment of the probe with the midline of the pelvis. RESULTS Measurement of HSD showed high intraobserver (intraclass correlation coefficient (ICC) = 0.995; 95% CI, 0.991-0.997) and interobserver (ICC = 0.991; 95% CI, 0.984-0.995) reliability. In addition, a high correlation was demonstrated between mid-sagittal and parasagittal HSD measurements. HSD showed significant negative correlation with both fetal head station and AoP. CONCLUSION Fetal HSD is a simple and reliable method for the assessment of fetal head descent in labor.
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Affiliation(s)
- A Youssef
- Department of Obstetrics and Gynecology, Sant'Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy.
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Conturso R, Giorgetta F, Bellussi F, Youssef A, Tenore A, Pilu G, Rizzo N, Ghi T. Horizontal stomach: a new sonographic clue to the antenatal diagnosis of right-sided congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2013; 41:340-341. [PMID: 22903526 DOI: 10.1002/uog.12283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Simonazzi G, Curti A, Cattani L, Rizzo N, Pilu G. Outcome of severe placental insufficiency with abnormal umbilical artery Doppler prior to fetal viability. BJOG 2013; 120:754-7. [DOI: 10.1111/1471-0528.12133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2012] [Indexed: 12/01/2022]
Affiliation(s)
- G Simonazzi
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
| | - A Curti
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
| | - L Cattani
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
| | - N Rizzo
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
| | - G Pilu
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
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Santo S, D'Antonio F, Homfray T, Rich P, Pilu G, Bhide A, Thilaganathan B, Papageorghiou AT. Counseling in fetal medicine: agenesis of the corpus callosum. Ultrasound Obstet Gynecol 2012; 40:513-521. [PMID: 23024003 DOI: 10.1002/uog.12315] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/25/2012] [Indexed: 06/01/2023]
Abstract
In this Review, we aim to provide up-to-date and evidence-based answers to common questions regarding the diagnosis and prognosis of prenatally detected agenesis of the corpus callosum (ACC). A systematic literature search was performed to identify all reports of ACC and reference lists of articles were identified. ACC involves partial or complete absence of the main commissural pathway that connects the two cerebral hemispheres, and can be isolated (with no other abnormalities) or complex (coexisting with other abnormalities). It is a rare finding and the prevalence is difficult to estimate because of selection bias in reported series. The corpus callosum (CC) can be assessed on ultrasound by direct visualization, but indirect features, such as ventriculomegaly, absence of the cavum septi pellucidi or widening of interhemispheric fissure, are often the reason for detection in a screening population. Careful imaging in a center with a high level of expertise is required to make a full assessment and to exclude coexisting abnormalities, which occur in about 46% of fetuses. When available, magnetic resonance imaging appears to be an important adjunct as it allows direct visualization. It can reduce false-positive rates on ultrasound and can confirm ACC, it can assess whether this is complete or partial and it can help in detecting coexisting brain abnormalities not seen on ultrasound. The overall rate of chromosomal abnormality in fetuses with ACC is 18%, but this high rate includes both isolated and complex ACC; more recent studies suggest that chromosomal abnormalities are rare in isolated cases. Nevertheless, postnatal follow-up studies suggest that about 15% of cases thought to be isolated prenatally were found to have associated abnormalities after birth. Neurodevelopmental outcome in isolated ACC was recently reported in a systematic review and suggested normal outcome in about 65-75% of cases. Findings need to be considered in light of the several limitations of existing studies, in terms of study design, selection bias, varying definitions and imaging protocols, ascertainment bias and lack of control groups. These uncertainties mean that antenatal counseling is difficult and further large prospective studies are needed.
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Affiliation(s)
- S Santo
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's, University of London, London, UK
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