Lorenzo Vasciaveo

Transverse fetal head position during labor is associated with increased rates of operative deliveries and cesarean sections. Traditional assessment methods rely on digital examination, which can be inaccurate in cases of prolonged labor. Intrapartum ultrasound offers improved diagnostic capabilities, but standardized interpretation frameworks are needed. This study aimed to evaluate the significance of appropriate assessment and management of transverse fetal head position during labor, with particular emphasis on the correlation between geometric parameters and delivery outcomes. Additionally, the investigation analyzed the potential role of Artificial Intelligence Dystocia Algorithm (AIDA) as an innovative decision support system in standardizing diagnostic approaches and optimizing clinical decision-making in cases of fetal malposition. This investigation was conducted as a focused secondary analysis of data originally collected for the development and validation of the Artificial Intelligence Dystocia Algorithm (AIDA). The study examined 66 cases of transverse fetal head position from a cohort of 135 nulliparous women with prolonged second-stage labor across three Italian hospitals. Cases were stratified by Midline Angle (MLA) measurements into classic transverse (≥75°), near-transverse (70–74°), and transitional (60–69°) positions. Four geometric parameters (Angle of Progression, Head–Symphysis Distance, Midline Angle, and Asynclitism Degree) were evaluated using the AIDA classification system. The predictive capabilities of three machine learning algorithms (Support Vector Machine, Random Forest, and Multilayer Perceptron) were assessed, and delivery outcomes were analyzed. The AIDA system successfully categorized labor dystocia into five distinct classes, with strong predictive value for delivery outcomes. A clear gradient of cesarean delivery risk was observed across the spectrum of transverse positions (100%, 93.1%, and 85.7% for near-transverse, classic transverse, and transitional positions, respectively). All cases classified as AIDA Class 4 required cesarean delivery regardless of the specific MLA value. Machine learning algorithms demonstrated high predictive accuracy, with Random Forest achieving 95.5% overall accuracy across the study cohort. The presence of concurrent asynclitism with transverse position was associated with particularly high rates of cesarean delivery. Among the seven cases that achieved vaginal delivery despite transverse positioning, none belonged to the classic transverse positions group, and five (71.4%) exhibited at least one parameter classified as favorable. The integration of artificial intelligence through AIDA as a decision support system, combined with intrapartum ultrasound, offered a promising approach for objective assessment and management of transverse fetal head position. The AIDA classification system’s integration of multiple geometric parameters, with particular emphasis on precise Midline Angle (MLA) measurement in degrees, provided superior predictive capability for delivery outcomes compared to qualitative position assessment alone. This multidimensional approach enabled more personalized and evidence-based management of malpositions during labor, potentially reducing unnecessary interventions while identifying cases where expectant management might be futile. Further prospective studies are needed to validate the predictive capability of this decision support system and its impact on clinical decision-making in real-time labor management.

Background: Ectopic pregnancy (EP) is defined as the implantation of an embryo outside the uterine cavity, which can lead to high morbidity and mortality if not diagnosed and treated promptly. A rare form of EP is myomectomy scar pregnancy (MSP), where the embryo implants in a scar from a prior myomectomy. Due to its rarity, MSP presents unique diagnostic and therapeutic challenges. This scoping review aims to map the existing literature on MSP to better understand the diagnostic strategies, management options, and clinical outcomes associated with this condition, and to identify gaps in current research. Methods: We conducted a scoping review by searching databases such as PubMed, Scopus, Web of Science, and MEDLINE for studies published between 2003 and 2023. Keywords used in combination included “myomectomy scar pregnancy”, “scar pregnancy”, “leiomyoma”, “uterine myomectomy”, “PAS disorders”, “placenta previa”, and “placenta accreta”. Studies were screened for relevance and eligibility by two independent reviewers. Data were extracted from case reports, retrospective studies, and reviews discussing MSP. Results: From an initial set of 111 studies, 28 papers met the inclusion criteria, comprising 4 retrospective studies and 24 case reports. A total of 44 cases of MSP were analyzed. The majority of diagnoses were made through ultrasound, with magnetic resonance imaging (MRI) used in more complex cases. Surgical interventions, primarily cesarean sections and myometrial repairs, were the most common treatments, while medical therapy with methotrexate was less frequently applied. Conclusions: This scoping review highlights the challenges of diagnosing and managing MSP due to its rarity. Although surgical management remains the primary approach, there is a lack of consensus on the optimal treatment for different clinical scenarios. Further research is needed to establish standardized diagnostic and therapeutic protocols for MSP and to evaluate the long-term outcomes of affected patients.

Background: Hodgkin lymphoma (HL) is a common malignancy among women of reproductive age. Some pregnancies occur during oncological treatments or diagnostic follow-ups, often involving contraindicated procedures. HL is fluorodeoxyglucose-avid; therefore, its staging is generally performed with ¹⁸F-FDG PET/CT, a diagnostic method contraindicated during pregnancy. Immune checkpoint inhibitors (ICIs), such as pembrolizumab, are innovative therapies for relapsed HL (rHL) with significant efficacy. However, ICIs can impair immune tolerance, potentially increasing immune-related adverse events. The PD-1/PD-L1 pathway, targeted by pembrolizumab, plays a critical role in maternal–fetal immune adaptation, raising concerns about its safety during pregnancy. Case Report: We report the case of a 36-year-old woman diagnosed with rHL who unknowingly became pregnant during treatment with pembrolizumab and ¹⁸F-FDG PET/CT scans. The pregnancy was diagnosed at 24 weeks, after five cycles of pembrolizumab during the first two trimesters and an ¹⁸F-FDG PET/CT scan in the first trimester. Following multidisciplinary counseling, the pregnancy was closely monitored, culminating in the delivery of a healthy male infant at 37.5 weeks. Conclusions: This case highlights a favorable maternal–fetal outcome despite exposure to pembrolizumab and ¹⁸F-FDG PET/CT during pregnancy. Given the limited data on such exposures, case reports like this are essential for improving counseling and management strategies. Further research and registries are crucial to provide robust evidence for clinical decision-making in these complex scenarios.

Intraplacental choriocarcinoma (IC) is a gestational trophoblastic neoplasia located within the placenta. Due to its silent presentation, more than half of the cases are diagnosed incidentally. An association with fetomaternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction has been found. The aim of this review is to describe the clinical management of this rare condition stemming from a case report of an incidental diagnosis following an emergency cesarean section, and taking into account the available literature. Emergency interventions and examination of the placenta, even for the smallest IC lesion can ensure timely treatment and improve maternal and fetal outcomes.

Objectives: To evaluate the prevalence of chromosomal anomalies in fetuses affected by increased nuchal translucency(iNT >99Th centile), cystic hygroma (CH) and cases progressing to fetal hydrops (NIHF) in order to correlate this result to prognosis and perinatal fetal outcomes, improving patient's counseling.Methods: From January 2020 to December 2023, first trimester screening according to FMF criteria were performed in “Maternal fetal medicine Unit” of Foggia's hospital. We studied and collected clinical data of fetuses affected by nuchal translucency >99th centile (iNT), CH and cases progressing to Fetal Hydrops (non‐immune fetal hydrop, NIFH). In these selected cases, we evaluated fetal Karyotype to demonstrate the presence of chromosomal abnormalities, associated to fetal structural anomalies and different pregnancy outcome.Results: We have evaluated 45 cases of iNT, CH, and NIFH, identified by ultrasound during first trimester screening. Of these 45 pregnant women, four were lost to follow‐up. Of the 41 pregnancies, 20 cases (48.8%) delivered at our division with newborns discharged in good health. Of the 21 patients (51.2%) who miscarried, only two miscarried spontaneously; the other 19 decided on a medical termination of pregnancy (MTP). The 19 patients who decided for MTP showed genetic abnormalities and/or malformation. The 20 cases of fetuses discharged as healthy newborns were enrolled with the following diagnoses: 5 had a diagnosis of CH (20% of cases), 1 case of NIFH (5% of cases), and 14 of iNT (75% of cases). All these fetuses had a normal karyotype and no major malformations.Conclusions: Isolated CH diagnosis is more frequent than described in Literature (5 cases out of 12: 41.7%) and their prognosis are better than previously described, with the same outcomes of fetuses with iNT without associated anomalies. The possibility of early diagnosis of chromosomal anomalies, associated malformations or the evolution into hydrops is essential for a complete consultation.

The aim of this review is to provide an up to date on the current use of fetal echocardiography in assessing the fetal cardiac function and its potential research and clinical applications. Despite classically is been used for prenatal diagnosis of fetal heart defects, assessment of fetal cardiac function has been recently proposed as a fundamental tool to assess pregnancies complicated by several disorders with long‐term impact on post‐natal cardiovascular health, such as placental insufficiency and fetal growth restriction. In this review we present anatomical and functional fetal cardiac development mechanisms and an overview of the currently available techniques for evaluating fetal heart function.

Entanglement of two umbilical cords in a MCMA twin pregnancy.

Interstitial pregnancy (IP) accounts for 2% of all ectopic pregnancies and has a mortality rate of 2–2.5%. The diagnosis is made by a transvaginal ultrasound and the treatment can be medical or surgical. We report the case of a 36-year-old primigravida who was 6 + 5 weeks pregnant, diagnosed with interstitial pregnancy by ultrasound, who had a very high serum β-hCG level (31,298 mIU/mL) and wanted to preserve her fertility. The patient was treated with one dose of mifepristone and a double dose of methotrexate since the decrease in the β-hCG serum level was less than 15% after the first dose. At the beginning, medical therapy was effective, as no embryonal cardiac activity was detected and serum β-hCG levels decreased early, but on the 20th day of hospitalization, the patient underwent surgery for her clinical symptoms and the evidence of free fluid in the Douglas pouch at a transvaginal ultrasound exam. Our experience showed that medical treatment should be considered, especially in women wishing to preserve their fertility. Further studies are needed to establish a standardized protocol and maybe a clinical score that can be useful in predicting the patients in which medical therapy could be most successful.

In recent decades, the rate of caesarean deliveries has increased worldwide. The reasons for this trend are still largely misunderstood and controversial among researchers. The decision often depends on the obstetrician, his beliefs and experience, the characteristics of the patients, the hospital environment and its internal protocols, the increasing use of induction of labor, the medico-legal implications, and, finally, the mother’s ability to request delivery by caesarean section without medical indication. This review aims to describe the reasons behind the increasing demand for caesarean sections by patients (CDMR) and strategies aimed at reducing caesarean section rates and educating women about the risks and benefits of CS.

Objectives: To report the rate of visualization of the pericallosal artery (PCA) in the first trimester of pregnancy (11–14 weeks).Methods: Prospective observational study of consecutive fetuses undergoing first trimester risk assessment for chromosomal anomalies. The presence of PCA was assessed in a midsagittal view of fetal brain using high‐definition power Color Doppler. A normal course of the PCA was defined as the visualization of an artery emerging from the anterior cerebral artery running parallel the corpus callosum (CC). The reference standard was the visualization of CC and PCA between the 20 and 22 weeks of gestation. We also performed a systematic review and meta‐analysis of the published literature. Multivariate logistic regression and random‐effect meta‐analyses of proportion were used to analyze the data.Results: Cohort study: Five‐hundred women were included. PCA was identified trans‐abdominally or transvaginally at 11–14 weeks of gestation in 98.8% (95% CI 97.4–99.6: 494/500); of the four cases of PCA not identified one had a diagnosis of complete agenesis of the corpus callosum during the anomaly scan which was confirmed at birth.Systematic review of the published literature: Six studies (1093 fetuses, including the present series) were included. The PCA was detected at the 11–14 weeks scan and confirmed to co‐exist with a normal CC at time of the anomaly scan in 96.9% (95% CI 93.8–99.0); 20.6% (95% CI 5.7–41.7) of fetuses with no clear identification of the PCA at the 11–14 weeks scan had a normal appearance of the CC at the time of anomaly scan.Conclusion: Prenatal ultrasonography has a high diagnostic accuracy in detecting PCA in the first trimester. Visualization of the PCA at the time of 11–14 scan is highly specific for the presence of a normal CC later in pregnancy.