Ultrasound Plane Pose Regression: Assessing Generalized Pose Coordinates in the Fetal Brain.

In obstetric ultrasound (US) scanning, the learner's ability to mentally build a three-dimensional (3D) map of the fetus from a two-dimensional (2D) US image represents a significant challenge in skill acquisition. We aim to build a US plane localization system for 3D visualization, training, and guidance without integrating additional sensors. This work builds on top of our previous work, which predicts the six-dimensional (6D) pose of arbitrarily oriented US planes slicing the fetal brain with respect to a normalized reference frame using a convolutional neural network (CNN) regression network. Here, we analyze in detail the assumptions of the normalized fetal brain reference frame and quantify its accuracy with respect to the acquisition of transventricular (TV) standard plane (SP) for fetal biometry. We investigate the impact of registration quality in the training and testing data and its subsequent effect on trained models. Finally, we introduce data augmentations and larger training sets that improve the results of our previous work, achieving median errors of 2.97 mm and 6.63° for translation and rotation, respectively.

Surgical management of isthmocele symptom relief and fertility.

OBJECTIVE: To describe symptoms and fertility and quality of life outcomes after isthmocele surgery. STUDY DESIGN: We conducted a retrospective study on from January 2012 to December 2017 in two tertiary referral centers in Rennes (France). All the patients diagnosed with isthmocele and operated were included. They all underwent isthmocele surgery by hysteroscopy, vaginal way or laparotomy. RESULTS: The following data were collected: surgical procedure, symptoms and fertility before and after surgery, patient satisfaction about the surgery, and quality of life after surgery. Eighteen patients were included. The mean duration of follow-up was 15 months. Surgical procedures consisted of hysteroscopy (n = 5/18, 27.8%), vaginal surgery (n = 8/18, 44.4%) and laparotomy (n = 5/18, 27.8%). Surgical indications were: secondary infertility (n = 10/18, 55 %), pelvic pain (n = 5/18, 28%) and abnormal uterine bleeding (n = 3/18, 17%). Among patients with abnormal uterine bleeding, improvement was obtained after hysteroscopy, laparotomy and vaginal surgery for 83.3%, 75% and 50%, respectively. Among those with pelvic pain, improvement was obtained after hysteroscopy, laparotomy and vaginal surgery for 80%, 81% and 66%, respectively. One patient (1/18, 5.5%) had post-operative complication. Of the 12 patients who wished to conceive eleven pregnancies were obtained (91.7%). Of the 10 patients with secondary infertility, six became pregnant (60%). Five pregnancies (5/11, 45.4%) were carried to full term, including four in patients whose surgical indication was infertility. Among these, one patient had a vaginal delivery (after vaginal surgery) without obstetric complication. All patients operated on by hysteroscopy would recommend this surgery versus 75% of patients with vaginal surgery and 60% of patients with laparotomy (p = 0.24). Pain and quality-of-life scores were comparable between the three groups. CONCLUSION: Isthmocele surgery is effective for abnormal uterine bleeding, pain and infertility regardless of the surgical route.

Direct vs. standard method of insertion of an intrauterine contraceptive device: insertion pain and outcomes at 6 months.

Objectives: The direct method is a procedure designed to cause less pain during insertion of an intrauterine contraceptive device (IUCD). It was first reported in 2005 and differs from the standard method of insertion recommended by IUCD manufacturers. In France, the direct method is well known and used by experienced practitioners, but it has never been evaluated against the standard method of insertion. The aim of the study was therefore to compare the direct method with the standard method in terms of pain experienced during insertion and the side effects and satisfaction rates over 6 months. Methods: A prospective observational study was conducted in France between June and December 2016 to compare the direct and standard methods of IUCD insertion. Results: The study included 535 women: 281 in the direct method group (DM group) and 254 in the standard method group (SM group). Women in the DM group reported less pain. This difference was assessed by multilevel multivariate analysis (-8.3 mm, 95% confidence interval (CI) -14.3, -2.3). There was no difference in the occurrence of infection (1.4% vs. 2.8%; p = .366) and 6-month continuation rates (89.4% vs. 89.2%; p = .936). Satisfaction rates at 6 months were higher in the DM group (93.6% vs. 87.4%; p = .019). Conclusions: The results of the study suggest that the direct method of IUCD insertion is associated with less pain and does not increase the risk of adverse effects. Widespread adoption of the direct method could improve women's comfort and lead to a higher uptake of the IUCD as a form of contraception.