Vacuum extraction is successful in 95% of cases with an occiput posterior position: the results of a prospective, multi-center study.

Background: Occiput-posterior (OP) position is associated with labor arrest, need of operative delivery and failed instrumental vaginal delivery with resulting adverse peripartum outcomes. Vacuum extraction (VE) is the most commonly performed type of instrumental delivery worldwide. This study aimed to investigate the outcome of VE in fetuses with sonographically confirmed OP position prior to the procedure.

Ultrasound evaluation of the size of the umbilical cord vessels and Wharton's jelly and correlation with intrapartum CTG findings.

Objective: To compare the sonographic measurement of the umbilical cord between women with or without repetitive decelerations during the first stage of labor.

Study Design: Prospective study including a non-consecutive cohort of women at term gestation carrying a normal sized fetus at term in cephalic presentation. The cross-sectional area of the umbilical cord, of its vessels and the amount of the Wharton's jelly were assessed at 2D ultrasound upon labor admission.

Interobserver agreement of intrapartum cardiotocography interpretation by midwives using current FIGO and physiology-based guidelines.

Objectives: To investigate the interobserver agreement among midwives for the interpretation of intrapartum CTG traces, using both the 2015 FIGO guidelines and the physiology-based guidelines.

Material And Methods: Retrospective, single-center, observational study conducted at the Maternity Hospital of the University of Parma, Italy, between November 2022 and July 2023. We selected 100 nonconsecutive intrapartum CTG traces from women undergoing operative delivery (cesarean or instrumental vaginal delivery).

The "Preeclampsia and Hypertension Target Treatment" study: a multicenter prospective study to evaluate the effectiveness of the antihypertensive therapy based on maternal hemodynamic findings.

Background: Despite major advances in the pharmacologic treatment of hypertension in the nonpregnant population, treatments for hypertension in pregnancy have remained largely unchanged over the years. There is recent evidence that a more adequate control of maternal blood pressure is achieved when the first given antihypertensive drug is able to correct the underlying hemodynamic disorder of the mother besides normalizing the blood pressure values.

Objective: This study aimed to compare the blood pressure control in women receiving an appropriate or inappropriate antihypertensive therapy following the baseline hemodynamic findings.

Correlation between intrapartum CTG findings and interleukin-6 levels in the umbilical cord arterial blood: A prospective cohort study.

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 "cortical invagination sign": a midtrimester sonographic marker of unilateral cortical focal dysgyria in fetuses with complete agenesis of the corpus callosum.

Background: Agenesis of the corpus callosum is associated with several malformations of cortical development. Recently, features of focal cortical dysgyria have been described in fetuses with agenesis of the corpus callosum.

Objective: This study aimed to describe the "cortical invagination sign," a specific sonographic feature of focal cortical dysgyria, which is consistently seen at midtrimester axial brain ultrasound in fetuses with complete agenesis of the corpus callosum.

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.

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.

An update on maternal cardiac hemodynamics in fetal growth restriction and pre-eclampsia.

Pre-eclampsia and fetal growth restriction (FGR) have been long related to primary placental dysfunction, caused by abnormal trophoblast invasion. Nevertheless, emerging evidence has led to a new hypothesis for the origin of pre-eclampsia and FGR. Suboptimal maternal cardiovascular adaptation has been shown to result in uteroplacental hypoperfusion, ultimately leading to placental hypoxic damage with secondary dysfunction.

Association between the cervical sliding sign and successful induction of labor in women with an unfavorable cervix: A prospective observational study.

Objectives: To evaluate the role of the cervical sliding sign (CSS) in the prediction of the outcome of induction of labor (IOL).

Study Design: Two-center prospective observational cohort study involving a non-consecutive series of uncomplicated singleton term pregnancies, planned for IOL, with a fetus in cephalic presentation and unfavorable cervix as defined by a Bishop score ≤ 6. The Bishop score was evaluated by transvaginal digital examination and the cervical length and CSS by transvaginal ultrasound.

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.

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.

Short-term morbidity and types of intrapartum hypoxia in the newborn with metabolic acidaemia: a retrospective cohort study.

Objectives: To assess labour characteristics in relation to the occurrence of Composite Adverse neonatal Outcome (CAO) within a cohort of fetuses with metabolic acidaemia.

Design: Retrospective cohort study.

Setting: Three Italian tertiary maternity units.

Achieving an appropriate cesarean birth (CB) rate and analyzing the changes using the Robson Ten-Group Classification System (TGCS): Lessons from a Tertiary Care Hospital in Italy.

Background: To describe the interventions that were implemented at a Tertiary University Hospital and how they affected the rate of cesarean birth (CB) and main obstetrics and neonatal outcomes.

Study Design: An analysis of the contemporaneously collected data from all deliveries that occurred from 2014 to 2018. Major obstetric and neonatal outcomes were analyzed and grouped according to the Ten-Group Classification System (TGCS).

Antepartum evaluation of the obstetric conjugate at transabdominal 2D ultrasound: A feasibility study.

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.

First assessment of bone mineral density in healthy pregnant women by means of Radiofrequency Echographic Multi Spectrometry (REMS) technology.

Objective: The maternal bone structure is the largest calcium reserve for the fetus during pregnancy, and this is claimed to lead to a bone mineral density (BMD) reduction in pregnant women. The primary outcome of the present work was to assess the BMD in a group of healthy pregnant women.

Study Design: In this prospective case - control observational study, a non-consecutive group of pregnant women with uncomplicated pregnancy at or >37 weeks were enrolled at the unit of Obstetrics and Gynecology, University of Parma, from February to December 2020.

Three-Dimensional Sonographic Evaluation of the Position of the Fetal Conus Medullaris at First Trimester.

Objective: The objective of this study was to assess the position of the conus medullaris (CM) at the first trimester 3D ultrasound in a cohort of structurally normal fetuses.

Methods: This was a multicenter prospective study involving a consecutive series of structurally normal fetuses between 11 and 13 weeks of gestation (CRL between 45 and 84 mm). All fetuses were submitted to 3D transvaginal ultrasound using a sagittal view of the spine as the starting plane of acquisition.

Intrapartum sonographic assessment of the fetal head flexion in protracted active phase of labor and association with labor outcome: a multicenter, prospective study.

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.

Usefulness of an Intrapartum Ultrasound Simulator (IUSim™) for Midwife Training: Results from an RCT.

Introduction: We conducted a randomized study to determine whether a training session on a dedicated simulator (IUSim™) would facilitate the midwives in learning the technique of transperineal intrapartum ultrasound.

Methods: Following a 30-min multimedia presentation including images and videos on how to obtain and measure the angle of progression (AoP) and the head-perineum distance (HPD), 6 midwives with no prior experience in intrapartum ultrasound were randomly split into 2 groups: 3 of them were assigned to the "training group" and 3 to the "control group." The midwives belonging to the former group were taught to measure the 2 sonographic parameters during a 3-h practical session conducted on IUSim™ under the supervision of an expert obstetrician.

Impact of ultrasound guided training in the diagnosis of the fetal head position during labor: A prospective observational study.

Objectives: To assess whether the additional training with transabdominal ultrasound may improve the accuracy of the transvaginal digital examination in the assessment of the fetal head position during the active stage of labor.

Methods: Prospective observational study involving 2 residents in their 1 st year of training in Obstetrics with no prior experience in neither transvaginal digital examination nor ultrasound. Women with term, cephalic presenting fetus and active labor with cervical dilation ≥ 8 cm and ruptured membranes were included.

STAN: a reappraisal of its clinical usefulness.

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.

Hyperechoic amniotic membranes in patients with preterm premature rupture of membranes (p-PROM) and pregnancy outcome.

Objectives: The early identification of women with preterm premature rupture of membranes (p-PROM) who are at higher risk of imminent delivery remains challenging. The aim of our study was to evaluate if an increased echogenicity of the amniotic membranes may represent a sonographic marker of impending delivery in women with p-PROM.

Methods: This was a prospective study including women with singleton pregnancies and diagnosis of p-PROM between 22 and 37 gestational weeks.