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Keywords = intrapartum ultrasonography

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11 pages, 703 KiB  
Perspective
Dystocia, Delivery, and Artificial Intelligence in Labor Management: Perspectives and Future Directions
by Antonio Malvasi, Lorenzo E. Malgieri, Michael Stark and Andrea Tinelli
J. Clin. Med. 2024, 13(21), 6410; https://doi.org/10.3390/jcm13216410 - 25 Oct 2024
Cited by 1 | Viewed by 2467
Abstract
Labor management remains a critical issue in obstetrics, with dystocic labor presenting significant challenges in both management and outcomes. Recent advancements in intrapartum ultrasound have facilitated substantial progress in monitoring labor progression. This paper explores the integration of artificial intelligence (AI) into obstetric [...] Read more.
Labor management remains a critical issue in obstetrics, with dystocic labor presenting significant challenges in both management and outcomes. Recent advancements in intrapartum ultrasound have facilitated substantial progress in monitoring labor progression. This paper explores the integration of artificial intelligence (AI) into obstetric care, focusing on the Artificial Intelligence Dystocia Algorithm (AIDA) for assessing spatial dystocia during labor. The AIDA utilizes intrapartum ultrasonography to measure four geometric parameters: the angle of progression, the degree of asynclitism, the head–symphysis distance, and the midline angle. These measurements are analyzed using machine learning techniques to predict delivery outcomes and stratify risk. The AIDA classification system categorizes labor events into five classes, providing a nuanced assessment of labor progression. This approach offers several potential advantages, including objective assessment of fetal position, earlier detection of malpositions, and improved risk stratification, placing labor events within a broader context of labor dystocia and obstetric care and discussing their potential impact on clinical practice. This paper serves as a more comprehensive overview and discussion of the AIDA approach, its implications, perspectives, and future directions. However, challenges such as the technological requirements, training needs, and integration with clinical workflows are also addressed. This study emphasizes the necessity for additional validation across diverse populations and careful consideration of its ethical implications. The AIDA represents a significant advancement in applying AI to intrapartum care, potentially enhancing clinical decision-making and improving outcomes in cases of suspected dystocia. This paper explicates the key methodological approaches underpinning the AIDA, illustrating the integration of artificial intelligence and clinical expertise. The innovative framework presented offers a paradigm for similar endeavors in other medical specialties, potentially catalyzing advancements in AI-assisted healthcare beyond obstetrics. Full article
(This article belongs to the Section Obstetrics & Gynecology)
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17 pages, 3251 KiB  
Article
Artificial Intelligence, Intrapartum Ultrasound and Dystocic Delivery: AIDA (Artificial Intelligence Dystocia Algorithm), a Promising Helping Decision Support System
by Antonio Malvasi, Lorenzo E. Malgieri, Ettore Cicinelli, Antonella Vimercati, Antonio D’Amato, Miriam Dellino, Giuseppe Trojano, Tommaso Difonzo, Renata Beck and Andrea Tinelli
J. Imaging 2024, 10(5), 107; https://doi.org/10.3390/jimaging10050107 - 29 Apr 2024
Cited by 5 | Viewed by 3839
Abstract
The position of the fetal head during engagement and progression in the birth canal is the primary cause of dystocic labor and arrest of progression, often due to malposition and malrotation. The authors performed an investigation on pregnant women in labor, who all [...] Read more.
The position of the fetal head during engagement and progression in the birth canal is the primary cause of dystocic labor and arrest of progression, often due to malposition and malrotation. The authors performed an investigation on pregnant women in labor, who all underwent vaginal digital examination by obstetricians and midwives as well as intrapartum ultrasonography to collect four “geometric parameters”, measured in all the women. All parameters were measured using artificial intelligence and machine learning algorithms, called AIDA (artificial intelligence dystocia algorithm), which incorporates a human-in-the-loop approach, that is, to use AI (artificial intelligence) algorithms that prioritize the physician’s decision and explainable artificial intelligence (XAI). The AIDA was structured into five classes. After a number of “geometric parameters” were collected, the data obtained from the AIDA analysis were entered into a red, yellow, or green zone, linked to the analysis of the progress of labor. Using the AIDA analysis, we were able to identify five reference classes for patients in labor, each of which had a certain sort of birth outcome. A 100% cesarean birth prediction was made in two of these five classes. The use of artificial intelligence, through the evaluation of certain obstetric parameters in specific decision-making algorithms, allows physicians to systematically understand how the results of the algorithms can be explained. This approach can be useful in evaluating the progress of labor and predicting the labor outcome, including spontaneous, whether operative VD (vaginal delivery) should be attempted, or if ICD (intrapartum cesarean delivery) is preferable or necessary. Full article
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11 pages, 2308 KiB  
Technical Note
A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements
by Marta Domínguez-Moreno, Ángel Chimenea, María Remedios Viegas-González, Clara Morales-Muñoz, Lutgardo García-Díaz and Guillermo Antiñolo
Surg. Tech. Dev. 2024, 13(1), 76-86; https://doi.org/10.3390/std13010005 - 23 Feb 2024
Cited by 3 | Viewed by 3016
Abstract
The Ex Utero Intrapartum Treatment (EXIT) procedure has long been an invaluable tool in managing complex fetal conditions requiring airway interventions during the transition from intrauterine to extrauterine life. This technical note offers an in-depth examination of the EXIT procedure, emphasizing the refinements [...] Read more.
The Ex Utero Intrapartum Treatment (EXIT) procedure has long been an invaluable tool in managing complex fetal conditions requiring airway interventions during the transition from intrauterine to extrauterine life. This technical note offers an in-depth examination of the EXIT procedure, emphasizing the refinements and innovations introduced at our center. The technique focuses on meticulous preoperative assessment and uses distinctive techniques and anesthetic methodologies. A multidisciplinary team assembles to plan the EXIT procedure, emphasizing patient communication and risk discussion. Our technique involves atraumatic access to the uterine cavity, achieved through the application of a uterine progressive distractor developed for this purpose. Following the use of this distractor, vascular clamps and a stapling device (Premium Poly Cs-57 Autosuture®, Medtronic) are employed. Our anesthetic approach employs general anesthesia with epidural catheter placement. Maternal operation involves low transverse laparotomy and intraoperative ultrasonography-guided hysterotomy. Fetal exposure includes gentle extraction or external version, ensuring airway access. After securing fetal airway access, umbilical cord clamping and maternal abdominal closure conclude the procedure. By revisiting the core principles of EXIT and incorporating center-specific advancements, we enhance our understanding and technical expertise. To our knowledge, this is the first time a detailed description of the technique has been published. Full article
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12 pages, 1356 KiB  
Article
Prolonged Dystocic Labor in Neuraxial Analgesia and the Role of Enkephalin Neurotransmitters: An Experimental Study
by Antonio Malvasi, Ettore Cicinelli, Giorgio Maria Baldini, Antonella Vimercati, Renata Beck, Miriam Dellino, Gianluca Raffaello Damiani, Gerardo Cazzato, Eliano Cascardi and Andrea Tinelli
Int. J. Mol. Sci. 2023, 24(4), 3767; https://doi.org/10.3390/ijms24043767 - 13 Feb 2023
Cited by 9 | Viewed by 2462
Abstract
The investigation studied the enkephalinergic neuro fibers (En) contained in the Lower Uterine Segment (LUS) during the prolonged dystocic labor (PDL) with Labor Neuraxial Analgesia (LNA). PDL is generally caused by fetal head malpositions in the Occiput Posterior Position (OPP), Persistent Occiput Posterior [...] Read more.
The investigation studied the enkephalinergic neuro fibers (En) contained in the Lower Uterine Segment (LUS) during the prolonged dystocic labor (PDL) with Labor Neuraxial Analgesia (LNA). PDL is generally caused by fetal head malpositions in the Occiput Posterior Position (OPP), Persistent Occiput Posterior Position (POPP), in a transverse position (OTP), and asynclitism (A), and it is detected by Intrapartum Ultrasonography (IU). The En were detected in the LUS samples picked up during cesarean section (CS) of 38 patients undergoing urgent CS in PDL, compared to 37 patients submitted to elective CS. Results were statistically evaluated to understand the differences in En morphological analysis by scanning electron microscopy (SEM) and by fluorescence microscopy (FM). The LUS samples analysis showed an important reduction in En in LUS of CS for the PDL group, in comparison with the elective CS group. The LUS overdistension, by fetal head malpositions (OPP, OTP, A) and malrotations, lead to dystocia, modification of vascularization, and En reduction. The En reduction in PDL suggests that drugs used during the LNA, usually local anesthetics and opioids, cannot control the “dystocic pain”, that differs from normal labor pain. The IU administration in labor and the consequent diagnosis of dystocia suggest stopping the numerous and ineffective top-up drug administration during LNA, and to shift the labor to operative vaginal delivery or CS. Full article
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8 pages, 1252 KiB  
Article
Can Intrapartum Ultrasonography Improve the Placement of the Vacuum Cup in Operative Vaginal Deliveries?
by Rocio Garcia-Jimenez, Irene Valero, Carlota Borrero, Jose Antonio Garcia-Mejido, Ana Fernandez-Palacin, Rosa Serrano and Jose Antonio Sainz-Bueno
Tomography 2023, 9(1), 247-254; https://doi.org/10.3390/tomography9010019 - 27 Jan 2023
Cited by 3 | Viewed by 5916
Abstract
Although the fetal head position has traditionally been evaluated by digital examination (DE), it has a failure rate ranging between 20 and 70%; hence, intrapartum transabdominal ultrasonography (TUS) has become relevant. We aimed to evaluate the utility of the TUS to identify the [...] Read more.
Although the fetal head position has traditionally been evaluated by digital examination (DE), it has a failure rate ranging between 20 and 70%; hence, intrapartum transabdominal ultrasonography (TUS) has become relevant. We aimed to evaluate the utility of the TUS to identify the fetal head positions in vacuum-assisted deliveries. We performed a prospective observational study including 101 pregnant patients in active labor who required a vacuum-assisted delivery. The fetal head position was assessed by a DE and a TUS prior to vacuum cup placement. After delivery, the optimal vacuum cup placement was evaluated as the distance between the chignon and the flexion point ≤2 cm. The general concordance rate between the DE and TUS was 72.2%, with the poorest concordance rate for occiput posterior positions at 46.1%. In five cases (4.9%), it was not possible to determine the fetal head position through the DE. The correlation was higher in low and medium planes, with 77% and 68.1% concordance rates, respectively, while it was lower in high planes (60%). In 90.1% of cases, the vacuum cup placement was optimal. Our findings show that intrapartum transabdominal ultrasonography is a useful technique to identify the fetal head position allowing optimal placement of the vacuum cup necessary for correct vacuum-assisted delivery. Full article
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16 pages, 2233 KiB  
Review
Asynclitism and Its Ultrasonographic Rediscovery in Labor Room to Date: A Systematic Review
by Antonio Malvasi, Marina Vinciguerra, Bruno Lamanna, Eliano Cascardi, Gianluca Raffaello Damiani, Giuseppe Muzzupapa, Ioannis Kosmas, Renata Beck, Maddalena Falagario, Antonella Vimercati, Ettore Cicinelli, Giuseppe Trojano, Andrea Tinelli, Gerardo Cazzato and Miriam Dellino
Diagnostics 2022, 12(12), 2998; https://doi.org/10.3390/diagnostics12122998 - 30 Nov 2022
Cited by 7 | Viewed by 5505
Abstract
Asynclitism, the most feared malposition of the fetal head during labor, still represents to date an unresolved field of interest, remaining one of the most common causes of prolonged or obstructed labor, dystocia, assisted delivery, and cesarean section. Traditionally asynclitism is diagnosed by [...] Read more.
Asynclitism, the most feared malposition of the fetal head during labor, still represents to date an unresolved field of interest, remaining one of the most common causes of prolonged or obstructed labor, dystocia, assisted delivery, and cesarean section. Traditionally asynclitism is diagnosed by vaginal examination, which is, however, burdened by a high grade of bias. On the contrary, the recent scientific evidence highly suggests the use of intrapartum ultrasonography, which would be more accurate and reliable when compared to the vaginal examination for malposition assessment. The early detection and characterization of asynclitism by intrapartum ultrasound would become a valid tool for intrapartum evaluation. In this way, it will be possible for physicians to opt for the safest way of delivery according to an accurate definition of the fetal head position and station, avoiding unnecessary operative procedures and medication while improving fetal and maternal outcomes. This review re-evaluated the literature of the last 30 years on asynclitism, focusing on the progressive imposition of ultrasound as an intrapartum diagnostic tool. All the evidence emerging from the literature is presented and evaluated from our point of view, describing the most employed technique and considering the future implication of the progressive worldwide consolidation of asynclitism and ultrasound. Full article
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9 pages, 1296 KiB  
Article
Dystocic Labor and Adrenergic and Noradrenergic Neurotransmitters: A Morphological Experimental Study
by Antonio Malvasi, Antonella Vimercati, Ilaria Ricci, Nico Picardi, Ettore Cicinelli, Ioannis Kosmas, Giorgio Maria Baldini and Andrea Tinelli
Int. J. Mol. Sci. 2022, 23(19), 11379; https://doi.org/10.3390/ijms231911379 - 27 Sep 2022
Cited by 6 | Viewed by 2347
Abstract
Authors investigated the catecholaminergic neurotransmitters (chNs) quantitative modifications in pregnant uterine Lower Uterine Segment (LUS) during prolonged labor (PL) with the fetus in an occiput-posterior position (OPP), in occiput transverse position (OTP) and in fetal head asynclitism, all diagnosed by Intrapartum Ultrasonography (IU). [...] Read more.
Authors investigated the catecholaminergic neurotransmitters (chNs) quantitative modifications in pregnant uterine Lower Uterine Segment (LUS) during prolonged labor (PL) with the fetus in an occiput-posterior position (OPP), in occiput transverse position (OTP) and in fetal head asynclitism, all diagnosed by Intrapartum Ultrasonography (IU). The chNs neurotransmitters, particularly adrenaline (or epinephrine-A) and noradrenaline (or norepinephrine-N), were evaluated in LUS fragments sampled during CS of 34 patients undergoing urgent cesarean section (CS) in PL, compared to chNs fibers in the LUS of 36 women submitted to elective CS. All results were statistically analyzed to understand the differences in neurotransmitters morphological analysis by scanning electronic microscopy examination (SEM). The LUS fragments analysis revealed a reduction of A and N fibers in LUS during PL, compared with the expression of A and N fibers in LUS during elective CS. The PL for OPP, the OTP and asynclitism, all positions causing dystocia in labor lead to a reduction in neurotransmitters in LUS, with a uterine vascularization modification and a reduction in the contractility of smooth uterine cells. The A and N neurotransmitters reduction observed in PL negatively interferes with uterine contraction during labor. Full article
(This article belongs to the Special Issue Molecular Research in Uterine Biology and Pathophysiology)
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18 pages, 2238 KiB  
Article
The Importance of the Novel Postpartum Uterine Ultrasonographic Scale in Numerical Assessments of Uterine Involution Regarding Perinatal Maternal and Fetal Outcomes
by Roxana Covali, Demetra Socolov, Alexandru Carauleanu, Ioana Pavaleanu, Mona Akad, Lucian Vasile Boiculese and Razvan Vladimir Socolov
Diagnostics 2021, 11(9), 1731; https://doi.org/10.3390/diagnostics11091731 - 21 Sep 2021
Cited by 4 | Viewed by 3820
Abstract
Background: Uterine involution assessments are critical for the prevention of postpartum hemorrhage. Various methods have been used worldwide. Methods: The PUUS (Postpartum Uterine Ultrasonographic Scale) method evaluates, by transabdominal ultrasonography, the length of the endometrium of the uterine cavity occupied by blood or [...] Read more.
Background: Uterine involution assessments are critical for the prevention of postpartum hemorrhage. Various methods have been used worldwide. Methods: The PUUS (Postpartum Uterine Ultrasonographic Scale) method evaluates, by transabdominal ultrasonography, the length of the endometrium of the uterine cavity occupied by blood or debris, from grade 0 (no blood) to grade 4 (over three-quarters of the endometrial length occupied by blood/debris). A total of 131 consecutive patients admitted for delivery in the Elena Doamna Obstetrics and Gynecology University Hospital in Iasi, Romania, were prospectively evaluated using the PUUS method. The mean age was 27.72 years old, and they were examined during the first 24–48 h after vaginal delivery, or in the first 48–72 h after cesarean delivery. For patients with a PUUS grade greater than 1, re-examination was preformed daily in the following days, until the PUUS grade decreased to 1 or 0. Results: By standardizing uterine involution in a numerical fashion, we precisely demonstrate that uterine involution varied with the method of delivery (vaginal/cesarean) and with the number of vials of oxytocin received intrapartum, but not with the number of vials of ergometrine maleate received, and not with the origin of the parturient (rural/urban). Full article
(This article belongs to the Section Medical Imaging and Theranostics)
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