Eran Barzilay

Objective: Postpartum retained products of conception (RPOC) are a major health concern. The aim of our study was to assess whether a single postpartum measurement of uterine artery blood flow can predict postpartum RPOC. Methods: As part of our routine practice, parturients considered at risk for RPOC underwent a series of sequential ultrasounds followed by hysteroscopy if needed. In this study, we measured uterine artery Pulsatility Index (PI) bilaterally at day 1–3 postpartum. Both the patients and the clinical team were blinded to the Doppler measurements. Cases in which RPOC was identified in hysteroscopy were compared with cases in which RPOC was ruled out. Results: Minimal uterine PI was strongly associated with RPOC (median PI 0.78 [interquartile range 0.69–0.85] vs. 1.19 [interquartile range 0.88–1.4], P = 0.004). Receiver operating characteristic analysis demonstrated an area under the curve of 0.837 (95% confidence interval 0.731–0.942). Minimal uterine artery PI was the best predictor of RPOC. A uterine PI value <0.95 had a sensitivity of 100% and specificity of 68.3% in predicting RPOC. Conclusions: Low uterine artery PI, when measured in the first days after delivery, is the best single‐parameter predictor of RPOC.

Objective: To assess whether, and to what extent, performing triplicate measurements can improve accuracy of estimation of fetal weight (EFW) compared to single measurements.Methods: This was a prospective study conducted at a single medical center. A total of 100 term parturients with an anticipated delivery within 72 hours were recruited for EFW measurements. All examinations were done with adherence to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines. EFW was calculated using the Hadlock formula. Triplicate measurements from three different images were obtained for each parameter and the averaged values were used for clinical purposes. EFW calculated using average measurements was compared to EFW calculated using the first measurements.Results: There was a small but significant improvement in EFW when using averaged measurements compared to single measurements (mean improvement 34 ± 105 g, P = .002). Deviance from birthweight in single measurements was significantly higher compared to averaged measurements (median deviance 198 versus 148 g, respectively, P = .005). This difference was more pronounced when assessing the 75th centile (348 versus 282 g, respectively).Conclusions: Using triplicate measurements instead of single measurements when performing EFW confers a small, but statistically significant, improvement to EFW accuracy. Using triplicate measurements for assessing EFW should be thus considered, especially in cases suspected of growth disorders.

Objective: To determine whether visual biofeedback can be used during labor as an effective tool for shortening the second stage of labor and reducing the need for instrumental delivery.Methods: This was a single‐center randomized controlled trial. Nulliparous women under epidural anesthesia were randomized at the point of full dilation into the biofeedback group (n = 50) or the control group (n = 50). Both groups received coached maternal pushing during four consecutive contractions, while an experienced obstetrician performed transperineal ultrasound. Only women in the biofeedback group observed the ultrasound display screen. Following this intervention, labor was managed routinely by the obstetric team. Angle of progression (AOP) was measured at rest and while pushing, before and during the first and fourth contractions. Second‐stage duration and delivery outcomes were compared between groups.Results: Visual biofeedback did not affect the duration of the second stage, which lasted for a median of 2.28 (interquartile range (IQR), 1.25–3.10) h in the biofeedback group vs 2.08 (IQR, 1.58–3.02) h in the control group (P = 0.981). AOP was significantly higher in the biofeedback group compared with the control group, both at rest before the fourth contraction (mean ± SD, 142.6° ± 15.9° vs 136.8° ± 13.1°; P = 0.049) and while pushing during the fourth contraction (mean ± SD, 159.3° ± 19.2° vs 149.4° ± 15.1°; P = 0.005). The increase in AOP was significantly higher in the biofeedback compared with the control group between rest and pushing at the last push (mean ± SD, 16.6° ± 11.0° vs 12.6° ± 8.3°; P = 0.041) and between the first rest and last push (mean ± SD, 24.4° ± 13.6° vs 17.9° ± 11.3°; P = 0.011). The rate of intact perineum was similar between groups (12% vs 8%; P = 0.505).Conclusions: Visual biofeedback during the second stage of labor may facilitate descent of fetal head during maternal pushing without affecting second‐stage duration, possibly due to the short duration of the intervention. Future studies should focus on continuous intervention throughout the second stage of labor. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Purpose Fetal growth assessment is a key component of prenatal care. Sex-specific fetal brain nomograms on ultrasound are available and are clinically used. In recent years, the use of fetal MRI has been increasing; however, there are no sex-specific fetal CNS nomograms on MRI. The study aimed to assess the differences in fetal brain biometry and growth trajectories and to create population-based standards of the fetal brain on MRI. Methods In this cross-sectional study, brain structures of singleton fetuses with normal brain MRI scans were analyzed: biparietal diameter, occipitofrontal diameter, trans-cerebellar diameter, and the corpus callosum were measured and converted into centiles. Sex-specific nomograms were created. Results A total of 3848 MRI scans were performed in one tertiary medical center between 2011 and 2019; of them, 598 fetuses met the inclusion criteria, 300 males and 298 females between 28- and 37-weeks’ gestation. Males had significantly larger occipitofrontal diameter than females (median 75%, IQR 54–88%; median 61%, IQR 40–77%) and biparietal diameter (median 63%, IQR 42–82%; median 50%, IQR 25–73%), respectively (p < 0.001). The cerebellum had the greatest growth rate, with a 1.5-fold increase in diameter between 28 and 37 weeks’ gestation, with no measurement difference between the sexes (p = 0.239). No significant difference was found in the corpus callosum (p = 0.074). Conclusion Measuring both sexes on the same nomograms may result in over-estimation of male fetuses and under-estimation of females. We provide fetal sex-specific nomograms on two-dimensional MRI.

Background: Transition of clear amniotic fluid to meconium‐stained fluid is a relatively common occurrence during labor. However, data regarding the clinical significance and the prognostic value of the presence of meconium‐stained amnionic fluid (MSAF) are scarce. This study aimed to investigate delivery and neonatal outcomes according to the presence of MSAF and the timing of the meconium passage.Methods: We used an historical cohort study at a single tertiary medical center in Israel between the years 2011 and 2018. Women were divided into two groups according to timing of meconium passage: primary MSAF (MSAF present at membrane rupture) and secondary MSAF (clear amnionic fluid that transitioned to MSAF during labor). Neonatal complication rates were compared between groups. Composite adverse neonatal outcome was defined as arterial cord blood pH p < 0.001) compared with primary MSAF.Conclusions: In this sample, secondary MSAF was associated with more adverse neonatal outcomes than primary MSAF. Closer monitoring of fetal well‐being may be prudent in these cases.

Objectives: Measuring the posterior horn of the lateral ventricle in the fetus during ultrasound scans may be challenging. We aimed to examine this measurement feasibility, in relation to gestational age.Methods: A cross‐sectional study was conducted, including nonanomalous fetuses, in which both lateral ventricles measured less than 10 mm during anomaly scans. The measurements were performed according to the International Society of Ultrasound in Obstetrics and Gynecology guidelines. Success rate of measuring both ventricles was assessed at different gestational ages. Association between lateral ventricle width with contralateral ventricle width, gender, gestational age, and fetal head position were assessed.Results: A total of 156 cases were recruited. The lateral ventricle distal to the probe was measured in all cases. In 10 cases proximal lateral ventricle could not be adequately measured (failed proximal ventricle measurement group). In 146 scans both ventricle measurements were available. All 10 cases of failed proximal ventricle measurement were in third trimester (30–38 weeks). Success rate of measurement of both ventricles was 100%, 96.2%, 71.4%, and 37.5% for gestational week 14–29, 30–32, 33–35, and 36–38, respectively (P <.001). Proximal lateral ventricle width was strongly associated with the distal ventricle width (B = 0.422, 95% confidence interval 0.29, 0.555, P <.001), but not with head position, fetal gender, or gestational age.Conclusions: Measurement of the proximal lateral ventricle is feasible in most cases, even during late third trimester scans. Efforts should be made to visualize both ventricles in every evaluation of the fetal brain.