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Article ; Online: Added value of intrapartum recording of the maternal heart rate as an adjunct to fetal monitoring using external ultrasound transducer: not only about artifacts.

Dall'Asta, Andrea / Volpi, Lavinia / Morganelli, Giovanni / Ghi, Tullio

American journal of obstetrics and gynecology

2024

Language	English
Publishing date	2024-03-06
Publishing country	United States
Document type	Letter
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2024.02.313
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Article ; Online: Correlation between intrapartum CTG findings and interleukin-6 levels in the umbilical cord arterial blood: A prospective cohort study.

di Pasquo, Elvira / Fieni, Stefania / Chandraharan, Edwin / Dall'Asta, Andrea / Morganelli, Giovanni / Spinelli, Marta / Bettinelli, Maria Laura / Aloe, Rosalia / Russo, Annalisa / Galli, Letizia / Perrone, Serafina / Ghi, Tullio

European journal of obstetrics, gynecology, and reproductive biology

2024 Volume 294, Page(s) 128–134

Abstract: Objective: to investigate the correlation between the intrapartum CardioTocoGraphic (CTG) findings "suggestive of fetal inflammation" ("SOFI") and the interleukin (IL)-6 level in the umbilical arterial blood.: Study design: prospective cohort study ... ...

Abstract	Objective: to investigate the correlation between the intrapartum CardioTocoGraphic (CTG) findings "suggestive of fetal inflammation" ("SOFI") and the interleukin (IL)-6 level in the umbilical arterial blood. Study design: prospective cohort study conducted at a tertiary maternity unit and including 447 neonates born at term. Methods: IL-6 levels were systematically measured at birth from a sample of blood taken from the umbilical artery. The intrapartum CTG traces were retrospectively reviewed by two experts who were blinded to the postnatal umbilical arterial IL-6 values as well as to the neonatal outcomes. The CTG traces were classified into "suggestive of fetal inflammation (SOFI)" and "no evidence of fetal inflammation (NEFI) according to the principles of physiologic interpretation the CTG traces. The CTG was classified as "SOFI" if there was a persistent fetal heart rate (FHR) increase > 10 % compared with the observed baseline FHR observed at the admission or at the onset of labor without any preceding repetitive decelerations. The occurrence of Composite Adverse Outcome (CAO) was defined as Neonatal Intensive Care Unit (NICU) or Special Care Baby Unit (SCBU) admission due to one or more of the following: metabolic acidaemia, Apgar score at 5 min ≤ 7, need of neonatal resuscitation, respiratory distress, tachypnoea/polypnea, jaundice requiring phototherapy, hypotension, body temperature instability, poor perinatal adaptation, suspected or confirmed early neonatal sepsis. Main outcome measures: To compare the umbilical IL-6 values between the cases with intrapartum CTG traces classified as "SOFI" and those classified as "NEFI"; to assess the correlation of umbilical IL-6 values with the neonatal outcome. Results: 43 (9.6 %) CTG traces were categorized as "SOFI"; IL-6 levels were significantly higher in this group compared with the "NEFI" group (82.0[43.4-325.0] pg/ml vs. 14.5[6.8-32.6] pg/mL; p <.001). The mean FHR baseline assessed 1 h before delivery and the total labor length showed an independent and direct association with the IL-6 levels in the umbilical arterial blood (p <.001 and p = 0.005, respectively). CAO occurred in 33(7.4 %) cases; IL-6 yielded a good prediction of the occurrence of the CAO with an AUC of 0.72 (95 % CI 0.61-0.81). Conclusion: Intrapartum CTG findings classified as "SOFI" are associated with higher levels of IL-6 in the umbilical arterial blood.
MeSH term(s)	Pregnancy ; Infant, Newborn ; Humans ; Female ; Interleukin-6 ; Retrospective Studies ; Prospective Studies ; Cardiotocography ; Resuscitation ; Umbilical Arteries ; Inflammation ; Heart Rate, Fetal
Chemical Substances	Interleukin-6
Language	English
Publishing date	2024-01-13
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	190605-7
ISSN	1872-7654 ; 0301-2115 ; 0028-2243
ISSN (online)	1872-7654
ISSN	0301-2115 ; 0028-2243
DOI	10.1016/j.ejogrb.2024.01.018
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Article ; Online: Effect of the "shoulder-up" bundle on the incidence of spontaneous perineal injury after vaginal delivery: comparison of 2 historic cohorts after propensity score matching.

Morganelli, Giovanni / Fieni, Stefania / Dall'Asta, Andrea / di Pasquo, Elvira / Capozzi, Vito Andrea / Valenti, Alissa / Pezzani, Alessandra / Kiener, Ariane Jeanne Odette / Ghi, Tullio

American journal of obstetrics & gynecology MFM

2023 Volume 5, Issue 8, Page(s) 101038

Abstract: Background: Perineal injury following vaginal delivery represents a major cause of long-term maternal morbidity, and its prevention is among the priorities of modern obstetrical practice.: Objective: This study aimed to investigate whether the ... ...

Abstract	Background: Perineal injury following vaginal delivery represents a major cause of long-term maternal morbidity, and its prevention is among the priorities of modern obstetrical practice. Objective: This study aimed to investigate whether the systematic implementation of a bundle of maneuvers to prevent perineal injury (ie, the "shoulder-up" bundle) may reduce the rate of spontaneous perineal tears in women delivering at a single tertiary maternity unit. Study design: This was a single-center retrospective intervention study including all vaginal deliveries between April 1, 2020 and March 31, 2022. On March 1, 2021, a bundle focused on perineal injury prevention in vaginal deliveries was implemented and introduced as a standard of care. The "shoulder-up" bundle includes the addition of a hands-on technique for the delivery of the posterior shoulder, which is slowly lifted up under the direct visualization of the perineal body, immediately after the disengagement of the anterior shoulder. The labor ward staff underwent dedicated training to acquire expertise on the "shoulder-up" bundle. Little changes in terms of medical and midwifery staffing were recorded during the study period. The incidence of spontaneous second-degree or higher perineal tears was compared between the patients who gave birth before the clinical implementation of the bundle (standard-care group) and those who were delivered following the implementation of the bundle (shoulder-up group). A 1:1 propensity score matching of the 2 groups was done for the variables that proved to be independently associated with the perineal outcome. Results: From April 1, 2020 to March 31, 2022, 3671 patients had a vaginal birth at our tertiary care unit (1786 in the standard-care group and 1885 in the "shoulder-up" group) and were enrolled in the study population. Of these, 1191 (32.4%) had a spontaneous second-degree or higher perineal tear. At univariate analysis, nulliparity (59.6% vs 39.1%; P<.001), higher gestational age at delivery (39.8±1.28 vs 39.4±1.97 weeks; P<.001), epidural analgesia (40.6% vs 31.2%; P<.001), vacuum-assisted delivery (9.6% vs 4.0%; P<.001), and birthweight >4 kg (11.0% vs 6.3%; P<.001) were independently associated with the perineal outcome. Following propensity score matching for the above cited factors, the 1703 patients of each group were compared. A significant increase in the rate of intact perineum (71.0% vs 64.1%; P=.014) and a reduction in the incidence of second- (27.2% vs 32.9%; P=.006) and third to fourth-degree perineal tears (1.3% vs 3.0%; P<.001) was demonstrated in the "shoulder-up" group. Among the subgroup of patients undergoing vacuum-assisted delivery, a borderline significant reduction in the rate of obstetrical anal sphincter injury (10.4% vs 2.9%; P=.052) was also observed. Conclusion: Our study showed that the clinical implementation of the "shoulder-up" bundle at vaginal delivery is associated with a significant reduction in the incidence of spontaneous second-degree or higher perineal tears.
MeSH term(s)	Pregnancy ; Humans ; Female ; Infant ; Retrospective Studies ; Shoulder ; Perineum/injuries ; Incidence ; Propensity Score ; Delivery, Obstetric/adverse effects ; Delivery, Obstetric/methods
Language	English
Publishing date	2023-05-26
Publishing country	United States
Document type	Journal Article
ISSN	2589-9333
ISSN (online)	2589-9333
DOI	10.1016/j.ajogmf.2023.101038
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Article ; Online: The sonographic measurement of the ratio between the fetal head circumference and the obstetrical conjugate is accurate in predicting the risk of labor arrest: results from a multicenter prospective study.

Di Pasquo, Elvira / Morganelli, Giovanni / Volpe, Nicola / Labadini, Corinne / Ramirez Zegarra, Ruben / Abou-Dakn, Michael / Mappa, Ilenia / Rizzo, Giuseppe / Dall'Asta, Andrea / Ghi, Tullio

American journal of obstetrics & gynecology MFM

2022 Volume 4, Issue 6, Page(s) 100710

Abstract: Background: Labor arrest is estimated to account for approximately one-third of all primary cesarean deliveries, and is associated with an increased risk of adverse maternal and perinatal outcomes. One of the main causes is the mismatch between the size ...

Abstract	Background: Labor arrest is estimated to account for approximately one-third of all primary cesarean deliveries, and is associated with an increased risk of adverse maternal and perinatal outcomes. One of the main causes is the mismatch between the size of the birth canal and that of the fetus, a condition usually referred to as cephalopelvic disproportion. Objective: This study aimed to describe a new ultrasound predictor of labor arrest leading to cesarean delivery because of suspected cephalopelvic disproportion. Study design: This was a multicenter prospective study conducted at 3 maternity units from January 2021 to January 2022. A nonconsecutive series of singleton pregnancies with cephalic-presenting fetuses, gestational age of 34 weeks+0 days or above, and no contraindication to vaginal delivery attending at the antenatal clinics of each institution were considered eligible. Between 34+0 and 38+0 weeks of gestation, all eligible patients were submitted to transabdominal 2D ultrasound measurement of the obstetrical conjugate. On admission to the labor ward, the fetal head circumference was measured on the standard transthalamic plane by transabdominal ultrasound. The primary outcome of the study was the accuracy of the ratio between the fetal head circumference and the obstetrical conjugate measurement (ie, head circumference/obstetrical conjugate ratio) in predicting the occurrence of cesarean delivery secondary to labor arrest. The secondary outcome was the relationship between the head circumference/obstetrical conjugate ratio and labor duration. Results: A total of 263 women were included. Cesarean delivery for labor arrest was performed in 7.6% (20/263) of the included cases and was associated with more frequent use of epidural analgesia (95.0% vs 45.7%; P<.001), longer second stage of labor (193 [120-240] vs 34.0 [13.8-66.5] minutes; P=.002), shorter obstetrical conjugate (111 [108-114] vs 121 [116-125] mm; P<.001), higher head circumference/obstetrical conjugate ratio (3.2 [3.2-3.35] vs 2.9 [2.8-3.0]; P<.001), and higher birthweight (3678 [3501-3916] vs 3352 [3095-3680] g; P=.003) compared with vaginal delivery. At logistic regression analysis, the head circumference/obstetrical conjugate ratio expressed as Z-score was the only parameter independently associated with risk of cesarean delivery for labor arrest (odds ratio, 8.8; 95% confidence interval, 3.6-21.7) and had higher accuracy in predicting cesarean delivery compared with the accuracy of fetal head circumference and obstetrical conjugate alone, with an area under the curve of 0.91 (95% confidence interval, 81.7-99.5; P<.001). A positive correlation between the head circumference/obstetrical conjugate ratio and length of the second stage of labor was found (Pearson coefficient, 0.16; P=.018). Conclusion: Our study, conducted on an unselected low-risk population, demonstrated that the head circumference/obstetrical conjugate ratio is a reliable antenatal predictor of labor arrest leading to cesarean delivery.
MeSH term(s)	Female ; Pregnancy ; Humans ; Infant ; Prospective Studies ; Cephalopelvic Disproportion/diagnosis ; Cephalopelvic Disproportion/epidemiology ; Cephalopelvic Disproportion/etiology ; Ultrasonography, Prenatal/methods ; Labor, Obstetric ; Risk Factors
Language	English
Publishing date	2022-08-12
Publishing country	United States
Document type	Multicenter Study ; Journal Article
ISSN	2589-9333
ISSN (online)	2589-9333
DOI	10.1016/j.ajogmf.2022.100710
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Article ; Online: STAN: a reappraisal of its clinical usefulness.

Cagninelli, Greta / Dall'asta, Andrea / DI Pasquo, Elvira / Morganelli, Giovanni / Degennaro, Valentina A / Fieni, Stefania / Frusca, Tiziana / Ghi, Tullio

Minerva obstetrics and gynecology

2020 Volume 73, Issue 1, Page(s) 34–44

Abstract: The automatic analysis of fetal ECG in labor has been introduced as an adjunct of traditional cardiotocography with the aim to improve the identification of fetuses with intrapartum hypoxia. Several randomized controlled trials and meta-analyses have ... ...

Abstract	The automatic analysis of fetal ECG in labor has been introduced as an adjunct of traditional cardiotocography with the aim to improve the identification of fetuses with intrapartum hypoxia. Several randomized controlled trials and meta-analyses have produced conflicting results, with the most recent randomized controlled trial not demonstrating any improvement in either neonatal outcomes or reduction in operative birth rates. The objective of this review article is to present the state of art about the use of STAN technology in labor ward.
MeSH term(s)	Cardiotocography ; Electrocardiography ; Female ; Humans ; Hypoxia ; Infant, Newborn ; Labor, Obstetric ; Parturition ; Pregnancy
Language	English
Publishing date	2020-11-30
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	3062815-5
ISSN	2724-6450
ISSN (online)	2724-6450
DOI	10.23736/S2724-606X.20.04690-0
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Article ; Online: Antepartum evaluation of the obstetric conjugate at transabdominal 2D ultrasound: A feasibility study.

Di Pasquo, Elvira / Volpe, Nicola / Labadini, Corinne / Morganelli, Giovanni / Di Tonto, Andrea / Schera, Giovanni B L / Rizzo, Giuseppe / Frusca, Tiziana / Ghi, Tullio

Acta obstetricia et gynecologica Scandinavica

2021 Volume 100, Issue 10, Page(s) 1917–1923

Abstract: Introduction: The obstetric conjugate represents the shortest anteroposterior diameter of the birth canal and it reflects the capacity of the pelvic inlet to allow the passage and the engagement of the fetal head. The antepartum evaluation of this ... ...

Abstract	Introduction: The obstetric conjugate represents the shortest anteroposterior diameter of the birth canal and it reflects the capacity of the pelvic inlet to allow the passage and the engagement of the fetal head. The antepartum evaluation of this parameter may be attempted at digital examination to predict the risk of cephalopelvic disproportion, but the accuracy of clinical pelvimetry is notoriously poor. The aim of our study was to describe the sonographic measurement of the obstetric conjugate at transabdominal 2D-ultrasound and to assess its reproducibility. Material and methods: This is a prospective cohort study conducted at a tertiary University hospital. A non-consecutive series of pregnant women with uncomplicated singleton pregnancies attending the antenatal clinic for routine booking from 34 weeks of gestation onward were included. The ultrasound probe was longitudinally placed above the level of the symphysis and the interpubic fibrocartilaginous disk was visualized. Then the promontory was identified as the most prominent segment of the sacral vertebral column. The obstetric conjugate was measured as the distance between the inner edge of the interpubic disk and the promontory. The inter- and intraobserver repeatability of this measurement was calculated using the intraclass correlation coefficient (ICC) and the Bland-Altman method. Results: In all, 119 women were considered eligible for the study; of these, 111/119 (93.3%) women were included in the analysis with a median gestational age of 36.0 (35.0-37.0) weeks. The mean obstetric conjugate measurement was 11.4 ± 0.93 mm for the first operator and 11.4 ± 0.91 mm for the second operator. The overall interobserver ICC was 0.95 (95% [confidence interval] CI 0.92-0.96) and the overall intraobserver ICC was 0.97 (95% CI 0.96-0.98). Limits of agreement ranged from -0.84 to 0.80 for interobserver measures and from -0.64 to 0.62 for intraobserver measures. The degree of reliability was also analyzed for women with a body mass index ≥30 and for women with a gestational age ≥37 weeks. The inter- and intraobserver ICCs were respectively 0.97 (95% CI 0.90-0.98) and 0.98 (0.95-0.99) in the former group and 0.96 (95% CI 0.93-0.98) and 0.97 (95% CI 0.95-0.98) in the latter group. Conclusions: Our study demonstrated that among pregnant women at term gestation, sonographic measurement of the obstetric conjugate is feasible and reproducible.
MeSH term(s)	Adult ; Cephalopelvic Disproportion/diagnostic imaging ; Cohort Studies ; Female ; Humans ; Infant, Newborn ; Pregnancy ; Prenatal Care ; Prospective Studies ; Reproducibility of Results ; Ultrasonography, Prenatal
Language	English
Publishing date	2021-07-26
Publishing country	United States
Document type	Evaluation Study ; Journal Article
ZDB-ID	80019-3
ISSN	1600-0412 ; 0001-6349
ISSN (online)	1600-0412
ISSN	0001-6349
DOI	10.1111/aogs.14226
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Article ; Online: Confounding factors of transvaginal ultrasound accuracy in endometrial cancer.

Capozzi, Vito Andrea / Merisio, Carla / Rolla, Martino / Pugliese, Martina / Morganelli, Giovanni / Cianciolo, Alessandra / Gambino, Giulia / Armano, Giulia / Sozzi, Giulio / Riccò, Matteo / Berretta, Roberto

Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology

2020 Volume 41, Issue 5, Page(s) 779–784

Abstract: Endometrial cancer is the most frequently diagnosed gynecological tumour. Transvaginal ultrasound has a leading role in the preoperative evaluation of endometrial cancer patients. The study aimed to identify factors that can worsen the diagnostic ... ...

Abstract	Endometrial cancer is the most frequently diagnosed gynecological tumour. Transvaginal ultrasound has a leading role in the preoperative evaluation of endometrial cancer patients. The study aimed to identify factors that can worsen the diagnostic accuracy of transvaginal ultrasound in endometrial cancer patients. We retrospectively analysed 290 patients with histological diagnosis of endometrial adenocarcinoma. Two-dimensional (2D) gray-scale ultrasound and power Doppler imaging were performed. Age, menopause status, obesity, parity, Figo stage and benign uterine disorders were evaluated as possible factors worsening the diagnostic accuracy of the ultrasonography. FIGO stage IB was the main significant confounding factor in the univariate analysis (
MeSH term(s)	Adenocarcinoma/diagnostic imaging ; Adenocarcinoma/pathology ; Adult ; Confounding Factors, Epidemiologic ; Endometrial Neoplasms/diagnostic imaging ; Endometrial Neoplasms/pathology ; Female ; Humans ; Middle Aged ; Neoplasm Staging ; Preoperative Care ; Preoperative Period ; Reproducibility of Results ; Retrospective Studies ; Ultrasonography/methods ; Ultrasonography/statistics & numerical data ; Vagina/diagnostic imaging ; Vagina/pathology
Language	English
Publishing date	2020-10-16
Publishing country	England
Document type	Evaluation Study ; Journal Article
ZDB-ID	604639-3
ISSN	1364-6893 ; 0144-3615
ISSN (online)	1364-6893
ISSN	0144-3615
DOI	10.1080/01443615.2020.1799342
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Article ; Online: Intrapartum sonographic assessment of the fetal head flexion in protracted active phase of labor and association with labor outcome: a multicenter, prospective study.

Dall'Asta, Andrea / Rizzo, Giuseppe / Masturzo, Bianca / Di Pasquo, Elvira / Schera, Giovanni Battista Luca / Morganelli, Giovanni / Ramirez Zegarra, Ruben / Maqina, Pavjola / Mappa, Ilenia / Parpinel, Giulia / Attini, Rossella / Roletti, Enrica / Menato, Guido / Frusca, Tiziana / Ghi, Tullio

American journal of obstetrics and gynecology

2021 Volume 225, Issue 2, Page(s) 171.e1–171.e12

Abstract: Background: To date, no research has focused on the sonographic quantification of the degree of flexion of the fetal head in relation to the labor outcome in women with protracted active phase of labor.: Objective: This study aimed to assess the ... ...

Abstract	Background: To date, no research has focused on the sonographic quantification of the degree of flexion of the fetal head in relation to the labor outcome in women with protracted active phase of labor. Objective: This study aimed to assess the relationship between the transabdominal sonographic indices of fetal head flexion and the mode of delivery in women with protracted active phase of labor. Study design: Prospective evaluation of women with protracted active phase of labor recruited across 3 tertiary maternity units. Eligible cases were submitted to transabdominal ultrasound for the evaluation of the fetal head position and flexion, which was measured by means of the occiput-spine angle in fetuses in nonocciput posterior position and by means of the chin-to-chest angle in fetuses in occiput posterior position. The occiput-spine angle and the chin-to-chest angle were compared between women who had vaginal delivery and those who had cesarean delivery. Cases where obstetrical intervention was performed solely based on suspected fetal distress were excluded. Results: A total of 129 women were included, of whom 43 (33.3%) had occiput posterior position. Spontaneous vaginal delivery, instrumental delivery, and cesarean delivery were recorded in 66 (51.2%), 17 (13.1%), and 46 (35.7%) cases, respectively. A wider occiput-spine angle was measured in women who had vaginal delivery compared with those submitted to cesarean delivery owing to labor dystocia (126±14 vs 115±24; P<.01). At the receiver operating characteristic curve, the area under the curve was 0.675 (95% confidence interval, 0.538-0.812; P<.01), and the optimal occiput-spine angle cutoff value discriminating between cases of vaginal delivery and those delivered by cesarean delivery was 109°. A narrower chin-to-chest angle was measured in cases who had vaginal delivery compared with those undergoing cesarean delivery (27±33 vs 56±28 degrees; P<.01). The area under the curve of the chin-to-chest angle in relation to the mode of delivery was 0.758 (95% confidence interval, 0.612-0.904; P<.01), and the optimal cutoff value discriminating between vaginal delivery and cesarean delivery was 33.0°. Conclusion: In women with protracted active phase of labor, the sonographic demonstration of fetal head deflexion in occiput posterior and in nonocciput posterior fetuses is associated with an increased incidence of cesarean delivery owing to labor dystocia. Such findings suggest that intrapartum ultrasound may contribute in the categorization of the etiology of labor dystocia.
MeSH term(s)	Adult ; Cesarean Section/statistics & numerical data ; Delivery, Obstetric/statistics & numerical data ; Dystocia/diagnostic imaging ; Dystocia/therapy ; Extraction, Obstetrical/statistics & numerical data ; Female ; Fetus/diagnostic imaging ; Head/diagnostic imaging ; Humans ; Labor Presentation ; Labor Stage, First ; Logistic Models ; Neck/diagnostic imaging ; Pregnancy ; Spine/diagnostic imaging ; Ultrasonography
Language	English
Publishing date	2021-03-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2021.02.035
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Article ; Online: Cardiotocographic findings in the second stage of labor among fetuses delivered with acidemia: a comparison of two classification systems.

Ghi, Tullio / Morganelli, Giovanni / Bellussi, Federica / Rucci, Paola / Giorgetta, Francesca / Rizzo, Nicola / Frusca, Tiziana / Pilu, Gianluigi

European journal of obstetrics, gynecology, and reproductive biology

2016 Volume 203, Page(s) 297–302

Abstract: Background: The RCOG classification system of CTG trace is widely used for the analysis of the fetal heart rate during the first and second stage of labor. Other authors proposed specific classification systems for the second stage traces.: Objective!# ...

Abstract	Background: The RCOG classification system of CTG trace is widely used for the analysis of the fetal heart rate during the first and second stage of labor. Other authors proposed specific classification systems for the second stage traces. Objective: To evaluate the accuracy of RCOG and Piquard cardiotocographic patterns classification systems in predicting fetal acidemia in the second stage of labor. Study design: This was a nested retrospective case-control study including fetuses delivered with metabolic acidemia in the second stage of labor and a matched group of non-acidemic fetuses as controls. Cases and controls were selected from the electronic medical records of the University Hospital of Bologna between 2008 and 2013. The last 60min of the cardiotocograms recorded during the second stage of labor were independently classified by a senior consultant and a trainee according to RCOG and Piquard classifications. The inter-observer agreement and the accuracy of the two classifications in predicting fetal acidemia were evaluated. Results: In all, 82 acidemic fetuses and 164 controls were recruited in the study period. Regarding the CTG traces assessment, the inter-observer agreement was moderate for both the categorizations (RCOG κ=0.584). Unclassifiable CTG patterns were more frequent among acidemic fetuses vs controls either at RCOG and at Piquard evaluation (26.8% vs 7.9%, p<0.001). Both systems yielded a moderate and comparable ability to predict fetal acidemia (RCOG ROC AUC=0.731; 95% CI 0.660-0.795; Piquard ROC AUC=0.773; 95% CI 0.704-0.833. DeLong z-test=1.186, p=0.236). Conclusions: RCOG and Piquard systems have a moderate accuracy in identifying acidemic fetuses during the second stage of labor. The occurrence of unclassifiable findings seems significantly more common among the acidemic fetuses.
MeSH term(s)	Acidosis/physiopathology ; Adult ; Cardiotocography/classification ; Case-Control Studies ; Female ; Heart Rate, Fetal/physiology ; Humans ; Labor Stage, Second/physiology ; Pregnancy ; Retrospective Studies
Language	English
Publishing date	2016-08
Publishing country	Ireland
Document type	Comparative Study ; Journal Article
ZDB-ID	190605-7
ISSN	1872-7654 ; 0301-2115 ; 0028-2243
ISSN (online)	1872-7654
ISSN	0301-2115 ; 0028-2243
DOI	10.1016/j.ejogrb.2016.06.028
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Article ; Online: Sequential analysis of the normal fetal fissures with three-dimensional ultrasound: a longitudinal study.

Contro, Elena / Salsi, Ginevra / Montaguti, Elisa / Morganelli, Giovanni / Pilu, Gianluigi / Rizzo, Nicola / Bonasoni, Paola / Ghi, Tullio

Prenatal diagnosis

2015 Volume 35, Issue 5, Page(s) 493–499

Abstract: Objective: To perform a sequential analysis of the main cortical fissures in normal fetuses using 3D ultrasound.: Methods: A cohort of patients with uncomplicated singleton pregnancies underwent three consecutive transabdominal scans at 19-21, 26-28 ... ...

Abstract	Objective: To perform a sequential analysis of the main cortical fissures in normal fetuses using 3D ultrasound. Methods: A cohort of patients with uncomplicated singleton pregnancies underwent three consecutive transabdominal scans at 19-21, 26-28 and 30-34 weeks. Volumes of the fetal head were acquired and searched in the multiplanar mode for the following cortical fissures: sylvian, parieto-occipital, calcarine, hippocampus and cingulate. A qualitative analysis of these sulci was performed in each volume by an experienced operator (A) and a trainee (B). By placing the dot on the sulcus in one plane, it was evaluated whether it was visible also in other planes. Results: Fifty patients were included in the study. At 19-21 weeks, the sylvian and parieto-occipital sulci were visualized on at least one plane by both operators in all cases. At 26-28 weeks, all fissures were visualized by both operators on at least one plane, with no significant difference between the performances of the two operators. At 30-34 weeks, a mild overall decline in the accuracy of identification of all the cerebral fissures was observed. Conclusions: 3D multiplanar mode allows a systematic evaluation of the cortical fissures in normal fetuses since midtrimester.
MeSH term(s)	Adult ; Cerebral Cortex/diagnostic imaging ; Cerebral Cortex/embryology ; Cohort Studies ; Echoencephalography ; Female ; Gestational Age ; Humans ; Imaging, Three-Dimensional ; Longitudinal Studies ; Occipital Lobe/diagnostic imaging ; Occipital Lobe/embryology ; Pregnancy ; Prospective Studies ; Ultrasonography, Prenatal
Language	English
Publishing date	2015-05
Publishing country	England
Document type	Journal Article
ZDB-ID	82031-3
ISSN	1097-0223 ; 0197-3851
ISSN (online)	1097-0223
ISSN	0197-3851
DOI	10.1002/pd.4565
Database	MEDical Literature Analysis and Retrieval System OnLINE

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