How to perform a sonographic morphological assessment of the fetus at 11-14 weeks of gestation.

INTRODUCTION: First-trimester ultrasound is widely accepted as part of standard care in many countries. With improvements in equipment, expertise and increasing number of technical studies describing imaging techniques, the detection rate for major fetal anomalies in the first trimester continues to rise and can be as high as 60% in high-risk populations. METHODS: We set out to create a systematic pictorial guide for trained ultrasound providers to describe the common anatomical structures that are identifiable in the first trimester with provided images. In addition to normal anatomical structures, a number of anomalies with high detection rates are listed. CONCLUSION: A large proportion of the major fetal abnormalities can be detected in the first trimester. A systematic approach is essential to ensure that anomalies are equally likely to be detected for patients of any risk background.

How to perform first trimester combined screening for pre-eclampsia.

Pre-eclampsia is a common condition that affects 2-5% of pregnancies and is associated with significant maternal and perinatal morbidity, and cost to the healthcare system. In those at high risk for pre-eclampsia, interventions such as aspirin intake have been shown to reduce prevalence of disease. However, to implement these interventions, it is essential that high-risk women be identified early in pregnancy. A combined first trimester screening model for pre-eclampsia that includes maternal history, mean arterial pressure, uterine artery Doppler and PlGF has been shown to be the most effective at identifying the population at greatest risk of pre-eclampsia. This article will explore the most appropriate methods of measuring the components of first trimester screening and discuss the use of aspirin for prevention of pre-eclampsia in pregnancy.

Customised management of the third stage of labour.

BACKGROUND: Postpartum haemorrhage (PPH) rates are increasing worldwide. The rate is particularly high in women undergoing an induced or augmented labour. In response to this, we altered our hospital's protocol for the management of the third stage of labour to recommend Syntometrine, in preference to oxytocin alone, for women being induced or augmented. We set out to assess the impact of the protocol change on the PPH rate. MATERIALS AND METHODS: A random sample of 1200 women who had a singleton, term vaginal birth before and after the protocol change was taken. Exclusion criteria were then applied to match PPH risk status. Using a quasi-experimental study design, PPH rates were compared between women who had received oxytocin or Syntometrine for third stage management. RESULTS: Five hundred and forty-nine women received oxytocin prior to the protocol change and were compared with 333 women who received Syntometrine after protocol change. There was no difference in the PPH rate with respect to uterotonic used (P = 0.9). There was no evidence of an interaction between labour type, third stage uterotonic and PPH (P = 0.4). PPH rates were lowest for women who laboured spontaneously and received Syntometrine (19% oxytocin, 14% Syntometrine). The PPH rate was unchanged by uterotonic in women whose labour was augmented (34% for both). PPH was more common in women being induced who received Syntometrine (22% oxytocin, 27% Syntometrine). None of these differences were statistically significant. CONCLUSION: Compared to oxytocin, Syntometrine did not reduce the rate of PPH in women with augmented or induced labour. Other approaches to reducing PPH rates are required.