Search Results (20)

Urethral diverticulum (UD) during pregnancy is a rare clinical condition, with limited literature available to guide standardized management. Fewer than a dozen well-documented cases have been reported, but they reflect a wide range of clinical approaches from antenatal surgery to postpartum intervention. We report the case of a 36-year-old woman diagnosed at 34 weeks of gestation with a 5.5 cm urethral diverticulum, presenting with suprapubic pain, urinary dribbling, and green vaginal discharge. Conservative management was pursued due to obstetric concerns, including multiple uterine fibroids and risk of preterm labor. Advanced ultrasonographic techniques—biplane transvaginal imaging, transperineal ultrasound, and 3D surface rendering—enabled a detailed anatomical assessment of parameters including the lesion’s size, shape, and relationship to the urethra, without resorting to invasive diagnostics. The diverticulum was found to cause 90° urethral angulation and had a C-shaped configuration, with a volume of 11.5 cm³. Following antibiotic treatment, the patient’s symptoms improved, and she remained clinically stable. She was scheduled for vaginal delivery followed by postpartum diverticulectomy. This case illustrates the diagnostic value of high-resolution ultrasound in pregnancy and supports literature recommendations favoring conservative treatment and delayed surgery to reduce maternal and fetal risk. Vaginal delivery remains a viable option in select UD cases. Full article

Succenturiate placenta is a rare anatomical variant characterized by one or more accessory lobes connected to the main placental mass by fetal vessels. While frequently asymptomatic, this condition can lead to serious maternal–fetal complications if not diagnosed prenatally. Early detection through advanced ultrasonographic techniques plays a critical role in guiding obstetric management and reducing adverse outcomes. Objective: To describe and analyze the prenatal diagnosis, sonographic characteristics, clinical management, and maternal–fetal outcomes of succenturiate placenta cases diagnosed over a ten-year period at a tertiary care center. Methods: We conducted a retrospective observational study of nine pregnancies diagnosed with succenturiate placenta between 2014 and 2024. Data collected included maternal demographics, ultrasound findings, type of cord insertion, presence of associated anomalies such as velamentous cord insertion or vasa previa, vaginal or cesarean delivery, complications, and neonatal outcomes. Ultrasound evaluation was scored based on a four-point checklist assessing key diagnostic steps. Results: Five of the nine cases (55.6%) presented isolated succenturiate placenta, while four (44.4%) were associated with velamentous cord insertion. No cases of vasa previa were identified. Obstetric outcomes included three vaginal deliveries (33.3%), two instrumental (22.2%), and four cesarean sections (44.4%), one of which was emergent due to fetal distress. Complications occurred in 44.4% of cases, with intrapartum bradycardia being the most common. One neonatal death was reported due to placental abruption. The quality of the ultrasound diagnosis was high in most cases, though transvaginal scanning was inconsistently applied. Conclusions: Prenatal identification of succenturiate placenta via detailed ultrasound, including color Doppler and targeted assessment of cord insertion, is essential to minimize risks associated with this condition. Standardized diagnostic protocols can improve detection rates and enable timely clinical decisions, ultimately improving maternal and neonatal outcomes. Full article

Background/Objectives: The objective is to assess if transvaginal infiltration with anaesthetic only is non-inferior compared to anaesthetic plus corticosteroid for the treatment of myofascial pelvic pain. Methods: A randomised, double-blind, parallel-group (1:1) clinical trial was set at the Department of Obstetrics and Gynaecology, Hospital Universitario “Príncipe de Asturias” from December 2017 to June 2023. Women presenting myofascial perineal pain ≥ 4 on the visual analogue scale (VAS) 2 months after delivery, with instrumental delivery or prolonged second stage (>3 h) or foetal weight > 4000 g, were randomised into two groups to receive levobupivacaine 5 mg/mL or levobupivacaine 5 mg/mL plus betamethasone 3 mg/mL. For each trigger point detected, a transvaginal infiltration was performed using the corresponding treatment. The patients were followed up to 6 months. The primary endpoint was a change in the VAS score from baseline at 6 months. Results: A total of 114 women were enrolled, with 57 randomly assigned to each group. The median (IQR) VAS 2 weeks after infiltration decreased by a similar magnitude: median (IQR) 2 (1–3) in the levobupivacaine group and 2 (1–4) in the levobupivacaine + betamethasone group (p-value = 0.33). The same trend was observed at 6 months: median (IQR) 1 (1–4) in the levobupivacaine group and 1 (1–2) in the levobupivacaine + betamethasone group (p-value = 0.85). Conclusions: This study provides evidence that the use of anaesthetic-only infiltration is non-inferior compared to anaesthetic plus corticosteroid for the treatment of myofascial perineal pain. Full article

Background: Gestational trophoblastic diseases comprise the hydatiform moles (HMs), complete or partial, an abnormal development of trophoblastic tissue. HMs derive from a gametogenesis error during conception leading to an anomalous chromosomal asset. In the complete hydatiform mole (CHM), when one or two spermatozoa enter an empty oocyte, the karyotype, paternally derived, is diploid 46,XX or 46,XY. CHM is characterized by massive hydropic degeneration of the villi, with no fetal structures, easily detected by ultrasound (US) in early gestation, confirmed by elevated maternal beta-hCG levels. CHM with coexistent fetus (CHMCF) is an exceptional event with a high risk of malignant progression, and severe complications such as massive vaginal bleeding, preeclampsia, and fetal death. Methods/Results: We present a case of CHMCF in a 29-year-old woman, which resulted in a liveborn and healthy baby at 38 weeks of gestation. The patient was prenatally carefully monitored with biweekly US and periodic beta-hCG levels. Post-partum follow-up consisted of transvaginal US and beta-hCG levels at 1, 3, and 6 months. After 1 year post-delivery, both the mother and the newborn were healthy. Conclusions: CHMCF management can be challenging as shared guidelines are currently lacking and the case described may be helpful in adding more data. Full article

Background and Clinical Significance: A vesicocervical fistula is an abnormal connection between the urinary tract and the cervix. With the increased prevalence of cesarean sections in recent years, the incidence of vesicocervical fistulas has also increased. The objective of this study was to evaluate the available evidence regarding the laparoscopic approach and to present a case study of a patient who underwent minimally invasive repair of a vesicocervical fistula after vacuum delivery. Case Presentation: A 32-year-old mother was admitted to our center with symptoms of urine leakage through the cervix uteri 5 days after vacuum-assisted delivery. In particular, the patient had recently undergone a vacuum-assisted delivery and cesarean section. A positive methylene blue staining test and transvaginal ultrasonography demonstrated an anatomical connection between the bladder and the cervix. Surgical repair of the vesicocervical fistula was performed under general anesthesia and a Foley catheter was inserted for 7 days. Urodynamic studies conducted seven days postoperative and six weeks post-surgery showed normal bladder function and capacity. Conclusions: Early detection and surgical correction of vesicocervical fistulas using a minimally invasive approach is crucial for the treatment of this condition. This case report emphasizes the importance of considering vesicocervical fistulas, particularly in patients with a history of cesarean section who have undergone vacuum-assisted delivery. Full article

Background/Objectives: Fetal membrane prolapse can occur due to advanced cervical insufficiency. We investigated the yet unclear predictors of prolonged pregnancy in women with prolapsed fetal membranes. Methods: This retrospective observational study included 100 pregnant women with prolapsed fetal membranes between November 2017 and March 2023. We examined the correlation between transvaginal ultrasound findings at the time of admission and the duration of prolonged pregnancy, which was defined as the period from admission to delivery. We defined five transvaginal ultrasound indices: (1) width of the external os, (2) maximum width of the prolapsed fetal membrane, (3) distance from the external os to the presenting part of the fetus, (4) thickness of the posterior uterine lip, and (5) morphology of the prolapsed fetal membrane. Results: Women who underwent cervical cerclage comprised the cerclage group (n = 17), while those who underwent conservative management comprised the non-cerclage group (n = 83). The pregnancy period was significantly longer in the cerclage group than in the non-cerclage group (81.4 days vs. 9.1 days, p < 0.001). Multiple regression analysis revealed that type A morphology was a significant factor for prolonged pregnancy in the non-cerclage group (p < 0.05), which was significantly associated with a prolonged pregnancy period of over 7 days (p = 0.037). Conclusions: In cases of prolapsed fetal membranes, cerclage is challenging because of the high risk of iatrogenic preterm rupture of the membrane; however, if successful, a significant prolongation of the pregnancy period can be obtained. Morphological evaluation using ultrasonography is simple and easy to understand and correlates well with pregnancy outcomes, making it very useful. Full article

Background/Objectives: Several factors, such as age, parity, body mass index, a favorable cervix, and fetal birth weight, are known to be related to the success of labor induction. With advancements in ultrasound technology, these factors have been studied to predict the success of vaginal delivery. However, there has been limited research on ultrasound measures that can effectively predict entry into the active phase of labor. Thus, we aimed to assess the use of cervical quantitative strain sonoelastography to predict entry into the active phase of labor induction. Methods: This prospective study included nulliparous term singleton pregnant women scheduled for labor induction between July 2018 and July 2022. Sonographic parameters were obtained using a transvaginal ultrasound approach with semiautomatic quantitative strain elastography software (E-Cervix; Samsung WS80A ultrasound device with a VR5-9 transducer, Samsung Medison Co., Ltd., Seoul, Republic of Korea), which provides objective measurements through the pixel-based analysis of elastographic maps. Univariate and multivariate logistic regression and area-under-the-curve analyses were used to evaluate the diagnostic performance of the variables under consideration in predicting the onset of the active phase of labor. Results: A total of 71 women were included in the study, and 29 progressed to the active phase. The cervical length, angle of progression, and mean strain from the external cervical os were significantly associated with successful entry into the active phase. The receiver operating characteristic (ROC) curve model also indicated a higher predictive value when the elastographic parameters were combined. Conclusions: Cervical elastography can be used as a sonographic index to predict progression to the active phase of labor. Full article

A 40-year-old woman who had obstetric history of one vaginal delivery and two surgical abortions to terminate early pregnancy received regular prenatal care without any systemic maternal diseases. During the detailed second trimester ultrasound, a homogenous adhesion-induced pseudocystic lesion of 8.6 × 7.4 cm was found between the inlet of the endocervix and the uterine cavity in the lower segment of the uterus. There was a clear septum with an inlet of about 2.6 cm near the right lower segment of the uterus. Transvaginal sonography showed a cervical length of 3.29 cm without dilatation. No gross fetal anomalies were found. Sometimes, the fetal head or limbs moved into this cystic space. At 36 3/7 weeks of gestation, a cesarean section was arranged for fetal breech presentation and pre-labor rupture of the membrane. After the delivery of the baby and its placenta, there was no obvious septum in the uterine cavity but only a very short fibrous tissue from the posterior wall of uterus, which could be destroyed when the baby was delivered. No adverse outcomes for the mother or the neonate were observed. Full article

Background and Objectives: The incidence of labor induction is steadily increasing worldwide. The main aim of this study was to evaluate the ultrasound parameters and their mutual correlation and to analyze the parameters’ predictive capability in assessing the success of labor induction. The secondary goal was to assess patients’ tolerability and acceptance of transvaginal ultrasound and digital gynecological examination. Materials and Methods: This prospective observational follow-up study included 252 women selected for labor induction. The transvaginal ultrasound examination measured the posterior cervical angle, cervical length, the length and width funneling of the cervix, the distance between the head of the fetus and the external uterine os, and the position of the fetal occiput. After the ultrasound, a digital vaginal examination was performed (according to the Bishop score), and the women were asked to rate their perception of pain for each procedure. Results: The most common indication for labor induction was post-term pregnancy (57.59%), and the most common method of labor induction was oxytocin with amniotomy (70%). The results showed that a significant independent prediction of vaginal delivery could be provided based on the Bishop score and cervical length. Other investigated ultrasound parameters, the length and width of the funneling of the cervix (p < 0.001), the fetal head stage (p < 0.001), and the size of the posterior cervical angle (p < 0.05), showed statistical significance in relation to the success of labor induction. Patients reported lower discomfort and pain during transvaginal ultrasound examination (mean score 2, IQR 3) compared to digital examination (mean score 5, IQR 4), with p < 0.001. Conclusions: The results imply that the assessment of ultrasound parameters before induction of labor is necessary to predict the outcome and reduce the possibility of complications. In terms of tolerability and choice by the patients, the transvaginal ultrasound examination was better rated than the vaginal gynecological examination. Full article

Objective: This study aimed to clarify the relationship between fluctuations in uterine stiffness during the third stage of labor and blood loss upon placenta delivery using shear wave elastography. Methods: This prospective cohort study enrolled consecutive singleton pregnant women above 37 weeks of gestation who delivered infants transvaginally at a single perinatal center. Shear wave velocities (SWV) were continuously measured during the third stage of transvaginal labor using transabdominal ultrasound and these values were compared between groups with large (≥500 g) and small amounts of bleeding during this stage. Results: In total, 8 cases of large bleeding and 47 cases of small bleeding were compared. The large amount of bleeding group had a significantly lower median of minimum SWV values (0.97 [0.52–1.01] m/s than the small amount of bleeding group (1.25 [1.04–1.48] m/s p = 0.02). However, no significant differences were observed between the two groups in terms of median, mean, and maximum SWV values. The time from delivery of the infant to placental delivery was significantly longer in the large amount of bleeding group (median time: 370.5 s vs. 274 s, p < 0.05). Conclusion: Ultrasound quantification of uterine stiffness using shear wave elastography demonstrated that uterine contractions may influence the biological hemostasis of the uterus during the third stage of labor. Baseline uterine stiffness was weak and a longer duration of placental separation might be associated with cases of large amounts of bleeding during this stage. Full article

Background and Objectives: This study aims to report the location of the placenta in the first trimester of pregnancy in groups of women according to the number of previous caesarean deliveries and the visibility of the caesarean scar niche. Materials and Methods: The prospective observational research included adult women aged 18 to 41 years during pregnancy after one or more previous caesarean sections (CSs). Transvaginal (TVS) and transabdominal sonography (TAS) was used to examine the uterine scar and placental location during 11–14 weeks. The CS scar niche (“defect”) was bordered in the sagittal plane as a notch at the previous CS scar’s site with a depth of 2.0 mm or more. A comparative analysis of the placental location (high or low and anterior or posterior) was performed between groups of women according to the CS number and the CS scar niche. Results: A total of 122 participants were enrolled during the first-trimester screening. The CS scar defect (“niche”) was visible in 40.2% of cases. In cases after one previous CS, the placenta was low in the uterine cavity (anterior or posterior) at 77.4%, and after two or more CSs, it was at 67.9%. Comparing the two groups according to the CS scar niche, the placenta was low in 75.5% of cases in the participant group with a CS scar niche and in 75% of cases without a CS scar niche (p = 0.949). Conclusions: The number of previous caesarean deliveries has no effect on the incidence rate of low-lying placentas in the first trimester. Moreover, the presence of the CS scar niche is not associated with anterior low-lying placentas. Full article

(1) Objective: This study aimed to determine whether qualitative fetal fibronectin and transvaginal sonographic measurement of cervical length are effective in predicting delivery in term pregnancies within 5 days of the test. (2) Methods: We examined 268 women with singleton pregnancies presenting themselves at 37⁺⁰–40⁺⁴ weeks (median 38 weeks + 1 day) of gestation with irregular and painful uterine contractions, intact membranes and cervical dilatation less than 2 cm. All women were admitted to hospital up to 72 h after birth. On admission, a qualitative fetal fibronectin test was performed in cervicovaginal secretions and transvaginal sonographic measurement of cervical length was carried out. The primary outcome measure was delivery within 5 days of presentation. RESULTS: Among the women who delivered within 5 days after admission, 65.2% had positive fFN assessment, 43.5% had cervical length below 26 mm, 52.2% had the age > 32.5 years, 34.8% were nulliparous and 56.5% had gestational age ≥ 275 days. Logistic regression analysis demonstrated that significant contributors to the prediction of delivery within 5 days were fibronectin positivity, cervical length ≤ 26 mm, maternal age > 32.5 years and gestational age ≥ 275 days, with no significant contribution from parity. (3) Conclusions: Qualitative fetal fibronectin test and transvaginal cervical length measurement in term pregnancies are useful tests for predicting spontaneous onset of labour within 5 days. It helps women and healthcare providers to determine the optimum time for hospital admission. Full article

Background and Objectives: The aim of this study is to evaluate changes in uterine scar thickness after previous cesarean delivery longitudinally during pregnancy, and to correlate cesarean section (CS) scar myometrial thickness in the first trimester in two participants groups (CS scar with a niche and CS scar without a niche) with the low uterine segment (LUS) myometrial thickness changes between the second and third trimesters. Materials and Methods: In this prospective longitudinal study, pregnant women aged 18–41 years after at least one previous CS were included. Transvaginal sonography (TVS) was used to examine uterine scars after CS at 11–14 weeks. The CS scar niche (“defect”) was defined as an indentation at the site of the CS scar with a depth of at least 2 mm in the sagittal plane. Scar myometrial thickness was measured, and scars were classified subjectively as a scar with a niche (niche group) or without a niche (non-niche group). In the CS scar niche group, RMT (distance from the serosal surface of the uterus to the apex of the niche) was measured and presented as CS scar myometrial thickness in the first trimester. The myometrial thickness at the internal cervical os was measured in the non-niche group. The full LUS and myometrial LUS thickness at 18–20 and 32–35 weeks of gestation were measured in the thinnest part of the scar area using TVS. Friedman’s ANOVA test was used to analyse scar thickness during pregnancy and Mann–Whitney test to compare scar changes between CS scar niche and non-niche women groups. For a pairwise comparison in CS scar thickness measurements in the second and third trimesters, we used Wilcoxon Signed Ranks test. Results: A total of 122 eligible participants were recruited to the study during the first trimester of pregnancy. The scar niche was visible in 40.2% of cases. Uterine scar myometrial thickness decreases during pregnancy from 9.9 (IQR, 5.0–12.9) at the first trimester to 2.1 (IQR, 1.7–2.7) at the third trimester of pregnancy in the study population (p = 0.001). The myometrial CS scar thickness in the first trimester (over the niche) was thinner in the women’s group with CS scar niche compared with the non-niche group (at internal cervical os) (p < 0.001). The median difference between measurements in the CS scar niche group and non-niche group between the second and third trimester was 2.4 (IQR, 0.8–3.4) and 1.1 (IQR, 0.2–2.6) (p = 0.019), respectively. Myometrial LUS thickness as percentage decreases significantly between the second and third trimester in the CS scar niche group compared to the non-niche group (U = 1225; z = −2.438; p = 0.015). Conclusions: CS scar myometrial thickness changes throughout pregnancy and the appearance of the CS scar niche was associated with a more significant decrease in LUS myometrial thickness between the second and third trimesters. Full article

Umbilical cord abnormalities are not rare, and are often associated with structural or chromosomal abnormalities, fetal intrauterine growth restriction, and poor pregnancy outcomes; the latter can be a result of prematurity, placentation deficiency or, implicitly, an increased index of cesarean delivery due to the presence of fetal distress, higher admission to neonatal intensive care, and increased prenatal mortality rates. Even if the incidence of velamentous insertion, vasa praevia and umbilical knots is low, these pathologies increase the fetal morbidity and mortality prenatally and intrapartum. There is a vast heterogeneity among societies’ guidelines regarding the umbilical cord examination. We consider the mandatory introduction of placental cord insertion examination in the first and second trimester to practice guidelines for fetal ultrasound scans. Moreover, during the mid-trimester scan, we recommend a transvaginal ultrasound and color Doppler assessment of the internal cervical os for low-lying placentas, marginal or velamentous cord insertion, and the evaluation of umbilical cord entanglement between the insertion sites whenever it is incidentally found. Based on the pathological description and the neonatal outcome reported for each entity, we conclude our descriptive review by establishing a new, clinically relevant classification of these umbilical cord anomalies. Full article

Accurate prediction of failure to progress and rapid decision making regarding the mode of delivery can improve pregnancy outcomes. We examined the value of sonographic cervical markers in the prediction of successful vaginal delivery beyond 34 weeks of gestation. A retrospective chart review was carried out. Medical information of singleton gestations delivered at a single center from 1 July 2019 to 30 August 2020 was collected. Transvaginal sonographic records of cervical length, anterior and posterior cervical angles, and cervical dilatation were obtained and re-measured. The value of these markers and clinical characteristics of mother and baby on vaginal delivery were investigated and compared to women who underwent cesarean section. A total of 90 women met the inclusion criteria. The rate of vaginal delivery was 75.6%. There were no differences found in terms of maternal age, rate of abortion, induction of labor, premature rupture of membranes, preterm labor, hypertension, diabetes, cervical length, and neonatal sex and weight. The prediction of vaginal delivery was provided by parity, maternal body mass index, and posterior cervical angle. The area under the receiver operating characteristic curve for prediction of vaginal delivery was 0.667 (95% CI 0.581–0.864, p = 0.017) for the posterior cervical angle, with a cutoff of 96.5°. Regression analysis revealed a posterior cervical angle ≥96.5° in the prediction of vaginal delivery (adjusted odds ratio: 6.24; 95% confidence interval: 1.925–20.230, p = 0.002). Posterior cervical angle ≥96.5° is associated with successful vaginal delivery. It is simple and easy to measure and can be useful in determining the mode of delivery. Full article