Bishop score versus ultrasound of the cervix before induction of labor for prolonged pregnancy: which one is better for prediction of cesarean delivery.

OBJECTIVES: To find an effective way to predict Cesarean section (CS) before induction of labor. METHODS: Nulliparous women at ≥ 41 weeks of pregnancy were enrolled in the study. Bishop score (BS), cervical length (CL), posterior cervical angle (PCA), quantification of the cervical stromal echogenicity by tissue histograms and opening of the internal cervical os (funnelling) were recorded. The vaginal delivery and CS groups were then compared in terms of the clinical and ultrasonographic cervical findings. RESULTS: BS, CL, PCA and funnelling were the significant predictors of CS, whereas no such relationship existed for the quantitative echogenicity of the cervical stroma. Although the difference was not statistically significant, the area under the curve was higher for the BS than that for sonographic CL and PCA in the prediction of all CSs. The best cut-off values to predict CS for BS, CL and PCA were <5, >27 mm and <98°, respectively. Combination of all three parameters had a sensitivity of 83.3%, specificity of 100%, positive predictive value of 100% and a negative predictive value of 82% for the prediction of CS. CONCLUSIONS: In nulliparous women with prolonged pregnancy, the BS predicts the need for CS better than the ultrasonographic assessment of the cervix.

Cardiac rhabdomyoma with tuberous sclerosis: a case report.

BACKGROUND: Rhabdomyomas are the most common benign cardiac neoplasms occurring in the fetus and neonate, with most of them identified within the first year of life. Cardiac rhabdomyomas are frequently associated with tuberous sclerorosis. CASE: A 25-year-old, pregnant woman with no remarkable personal or family history was referred to us for a suspected fetal cardiac anomaly. Ultrasonographic examination of the fetus revealed multiple solid masses consistent with rhabdomyoma in the ventricular septum and ventricular wall. No other anomalies could be detected. Postnatal echocardiography confirmed the presence of cardiac rhabdomyoma, and periventricular subependymal multiple hamartomas were diagnosed by postnatal magnetic resonance imaging. CONCLUSION: When fetal cardiac rhabdomyoma is diagnosed, careful evaluation of other fetal structures, including brain and renal parenchyma, should be performed to search for signs of tuberous sclerosis.

Nasal bone measurement during the 1st trimester: is it useful?

The aim of this study was to present our preliminary data about nasal bone measurements at 11-14 weeks of pregnancy. This study was conducted in our prenatal unit between 2000 and 2003. A total of 642 pregnant women (single pregnancies) were enrolled into the study. During the first trimester of pregnancy, crown-rump length, nuchal translucency thickness, and fetal nasal bone length measurements and ductus venosus Doppler images were evaluated. The distribution of absent or small nasal bones in both normal fetuses and in those having some pathological conditions was compared by statistical analysis. p < 0.05 was considered significant. Nasal bone evaluation was successful in 600 of 642 (93.4%) ultrasound examinations. The linear regression line showed a significant positive slope with increasing crown-rump length (r=0.54, p < 0.001). Absent or small nasal bones were more common in abnormal than in normal fetuses (p=0.007). It is clear that the fetal nasal bone is becoming a powerful tool in prenatal screening for aneuploidy. Larger studies to be performed in a low-risk population are needed to assess whether the measurement of the nasal bone length provides additional benefits beyond the assessment of the presence or absence of the nasal bone.