Three-dimensional transvaginal sonography in third-trimester evaluation of placenta previa.

In cases of placenta previa, the distance from the placental edge to the internal os is determinant in deciding on the mode of delivery that will minimize the risk of hemorrhage. The reproducibility and interobserver reliability of this measure are unknown. The internal os is not a point, as two-dimensional (2D) ultrasonography might suggest, but an oval patch that has a measurable width, which may be as wide as the distance separating it from the placenta. It is therefore difficult to determine the exact location of the os using a 2D sectional plane. We report the case of a nulliparous woman admitted for vaginal bleeding at 37 weeks' gestation in whom transvaginal ultrasound examination showed placenta previa, but for which two sonographers reported different measurements for the distance between the placental edge and the internal os. We describe a technique to measure this distance using multiplanar three-dimensional (3D) ultrasound imaging, which allows the smallest distance between the middle of the os and the edge of the placenta, which appears as a line, to be determined. In this case, measurement using 3D ultrasound showed a shorter distance than was suggested by 2D examination. This led us to schedule a Cesarean section delivery, during which there was minimal bleeding. Standardization of 3D measurements should make it possible to define more relevant cut-offs for determining the management of cases of placenta previa.

[Ultrasound in monitoring of the second stage of labour]. / Le suivi échographique de la deuxième partie du travail.

In the second stage of labor, fetal head rotation and fetal head position are determinant for the management of labor to attempt a vaginal delivery or a cesarean section. However, digital examination is highly subjective. Nowadays, delivery rooms are often equipped with compact and high performance ultrasound systems. The clinical examination can be easily completed by quantified and reproducible methods. Transabdominal ultrasonography is a well-known and efficient way to determine the fetal head position. Nevertheless, ultrasound approach to assess fetal head descent is less widespread. We can use translabial or transperineal way to evaluate fetal head position. We describe precisely two different types of methods: the linear methods (3 different types) and the angles of progression (4 different types of measurement). Among all those methods, the main pelvic landmarks are the symphysis pubis and the fetal skull. The angle of progression appears promising but the assessment was restricted to occipitoanterior fetal position cases. In the coming years, ultrasound will likely play a greater role in the management of labor.

[Specimen radiography assessment of surgical margins status in subclinical breast carcinoma: a diagnostic study]. / Évaluation radiographique du statut des marges de résection dans le carcinome in situ du sein: une étude diagnostique.

OBJECTIVE: This study aimed to determine the accuracy of specimen radiography in evaluating the surgical margins of impalpable breast carcinoma. DESIGN AND SETTING: Retrospective study from June 2009 to June 2010 in Orleans Hospital Center. PATIENTS AND METHODS: The study involved patients with impalpable in situ breast carcinoma diagnosed by mammography. Only patients with larger in situ carcinoma than invasive carcinoma were included. Patients underwent a breast conserving surgery after preoperative localization of the lesion. PRIMARY ENDPOINT: Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the specimen radiography are determined by correlation between radiologic and histologic margins. RESULTS AND DISCUSSION: The following results were obtained from 46 patients: 36 DCIS cases (78%), six DCIS with IDC cases (13%), two LCIS cases (4%) and two biopsy suggested DCIS (4%). A radiologic margin of 2mm (by analogy with the histological margins) results in a NPV of 73%. NPV, sensibility and specificity were respectively 79, 60 and 74% for a radiologic margin of 5mm. The measure or inter-rater reliability found a moderate agreement (kappa: 0.62). The systematic review on this topic found only eight articles (small samples and only two prospective studies). We could not make any recommendations from the literature review on a threshold to define excision margin status. CONCLUSION: The specimen radiography is a useful tool to assess margins of impalpable breast carcinoma. However, further studies are necessary as this point to determine a threshold for those radiologic margins.