Three-Dimensional Volume Ultrasound Assessment of Cesarean Scar Niche and Cervix in Pregnant Women: A Reproducibility Study.

Objective: To assess the reproducibility of standardized 3-dimensional (3D) ultrasound volume analysis of the dimensions and the position of cesarean birth (CB) scar niche relative to the cervix in pregnant women.

Methods: This prospective single-center study in women with 1 previous CB ≥8 cm cervical dilatation acquired ultrasound volumes between 11 and 24 weeks' gestation in a mid-sagittal plane. Two experienced operators processed the volumes using virtual organ computer-aided analysis.

Prediction of spontaneous preterm birth in women with previous full dilatation cesarean delivery.

Background: A previous term (≥37 weeks' gestation), full-dilatation cesarean delivery is associated with an increased risk for a subsequent spontaneous preterm birth. The mechanism is unknown. We hypothesized that the cesarean delivery scar characteristics and scar position relative to the internal cervical os may compromise cervical function, thereby leading to shortening of the cervical length and spontaneous preterm birth.

Reproducibility of assessment of full-dilatation Cesarean section scar in women undergoing second-trimester screening for preterm birth.

Objective: To assess the reproducibility of a standardized method of measuring the Cesarean section (CS) scar, CS scar niche and their position relative to the internal os of the uterine cervix by transvaginal ultrasound in pregnant women with a previous full-dilatation CS.

Methods: This was a prospective, single-center reproducibility study on women with a singleton pregnancy and a previous full-dilatation CS who underwent transvaginal ultrasound assessment of cervical length and CS scar characteristics at 14-24 weeks' gestation. The CS scar was identified as a hypoechogenic linear discontinuity of the myometrium at the anterior wall of the lower uterine segment or cervix.

Factors associated with preterm birth in women undergoing cervical cerclage.

Objectives: Cervical cerclage is used to manage women at high risk of late miscarriage (LM) and spontaneous preterm birth (PTB) due to factors such as history of cervical insufficiency (CI), uterine anomaly, cervical surgery and ultrasound (US) diagnosed cervical shortening. Urinary tract infection (UTI) and subsequent pyelonephritis, and bacterial infection are associated with PTB, but their role in PTB after cervical cerclage is unknown. We examined the relationship between UTI and bacterial vaginosis (BV), fetal fibronectin (fFN) test and PTB in women undergoing elective- or US-indicated cervical cerclage.

Implementing an obstetric ultrasound training program in rural Africa.

Objective: To evaluate the feasibility and sustainability of basic obstetric ultrasound training in rural Africa.

Methods: An 8-week training course, led by UK-based sonographers, was supported by training videos and followed by 10 months of remotely supported scanning in Mandimba, Mozambique. Data were collected prospectively using an Android tablet and the EpiCollect web application.

A prospective study of ultrasound screening for molar pregnancies in missed miscarriages.

Objective: To examine the relationship between ultrasound and histological features in the screening for molar changes in missed miscarriage.

Methods: A prospective cohort study was conducted on all missed miscarriages, with features suspicious of molar pregnancy, on transvaginal ultrasound and/or on histological examination over a 5-year period. All cases of molar pregnancy diagnosed histologically were examined and cross-referenced with cases diagnosed on ultrasound and with the supplementary report from the regional referral center.

Human fetal nongonadal tissues contain human chorionic gonadotropin/luteinizing hormone receptors.

Human chorionic gonadotropin (hCG), a heterodimeric glycoprotein hormone produced in abundance by placental syncytiotrophoblasts, is preferentially secreted into maternal circulation. Fetal circulation also contains low levels of hCG that are probably derived from fetal kidney, liver, anterior pituitary gland, etc. In addition, the fetus has access to hCG present in exocoelomic and amniotic fluids.

The contribution of placental oxidative stress to early pregnancy failure.

In cases of miscarriage, onset of the maternal blood flow to the placenta is precocious and disorganized compared with this event in normal pregnancy. We sought to determine whether this difference is associated with excessive levels of oxidative damage and stress in the placental tissues. Morphological and immunohistochemical markers of cellular stress and damage, including expression of heat shock protein 70, formation of N-Tyr residues, and lipid peroxidation, were increased in tissues obtained from missed miscarriages compared with controls.

Relationship among maternal serum endocrinology, placental karyotype, and intervillous circulation in early pregnancy failure.

Objective: To evaluate the relationship among maternal serum endocrinology, placental karyotype, and intervillous blood flow in missed miscarriage.

Design: Cross-sectional study of maternal serum, transvaginal ultrasound/Doppler, and placental cytogenetic and immunohistochemical investigations.

Setting: Tertiary care academic hospital.

Comparison of ultrasonographic and Doppler mapping of the intervillous circulation in normal and abnormal early pregnancies.

Objective: To assess the value of ultrasonography and Doppler imaging in characterizing the intervillous circulation in normal and abnormal early pregnancy.

Design: Cross-sectional study.

Setting: Tertiary care academic hospital.

Trophoblastic oxidative stress in relation to temporal and regional differences in maternal placental blood flow in normal and abnormal early pregnancies.

Onset of the maternal-placental circulation was studied by Doppler ultrasonography in 65 pairs of age-matched normal and abnormal pregnancies. In normal pregnancies intervillous blood flow increased with gestational age, being detected in 9 of 25 cases at 8 to 9 weeks but in 18 of 20 at 12 to 13 weeks (P = 0.001).

Circulating levels of inhibin A, activin A and follistatin in missed and recurrent miscarriages.

Background: The aim of this study was to investigate the changes in circulating levels and the clinical use of inhibin A, activin A and follistatin as endocrine markers of early pregnancy loss.

Methods: Blood samples were collected from women presenting with a sporadic missed miscarriage (n = 10), and controls having pregnancy termination at 8-12 weeks (n = 15) and from women with a history of unexplained recurrent miscarriages (n = 12) at 6-12 weeks gestation. All samples were assayed for inhibin A, inhibin B, activin A, follistatin, hCG, estradiol and progesterone.

Collection of villous tissue under ultrasound guidance to improve the cytogenetic study of early pregnancy failure.

Background: The cytogenetic study of spontaneous miscarriage has been limited by poor karyotype success rates obtained from cell culture after surgical evacuation of retained products of conception. The aim of this study was to assess the effect of improving the method of collection of villous tissues at the time of surgery on the karyotype success rate of cell culture.

Methods: Villous samples were obtained prospectively from a cohort of 170 spontaneous miscarriages at the beginning of the surgical procedure using small biopsy forceps guided into the placenta by ultrasound imaging.

Detection of the immunoregulator p43-placental isoferritin in the human embryo and fetus.

Human placental isoferritin (PLF) is known to exert an immunosuppressive activity in vitro and is involved in the down-regulation of the maternal immune system during pregnancy. We have investigated the presence of PLF in the human embryo and early fetus and its secretion into amniotic fluid (AF) and fetal blood. Immunohistochemistry was performed on 25 normal embryos and fetuses, at 7-22 weeks gestation, using the CM-H9 monoclonal antibody (mAb), generated specifically against the human p43-PLF protein.

Diminished expression of placental isoferritin p43 component in first trimester abnormal pregnancies.

Human placental isoferritin (PLF) is a sub-type of human ferritin mainly composed of a 43 kD protein, which has an immunosuppressive activity and may be involved in the downregulation of the maternal immune system during pregnancy. The aim of this study was to evaluate the distribution of p43 in the placental tissue of abnormal first trimester pregnancies. Samples of villous and decidual tissues were collected between 7 and 12 weeks' gestation from 28 missed abortions and eight complete moles.

Localization of p43 placental isoferritin in human maternal-fetal tissue interface.

Objective: Human placental isoferritin, which is composed of a 43-kd protein subunit, is exclusively reactive with the CM-H9 monoclonal antibody. The p43 exerts immunosuppressive activity during pregnancy. The aim of this study was to localize the expression of p43 in the maternal-fetal tissue interface during normal gestation.