Eco-friendly Fluorescent Sensor for Sensitive and Selective Detection of Zn2+ and Fe3+ Ions: Applications in Human Hair Samples.

A new eco-friendly sensor, 3-((6-((4-chlorobenzylidene)amino)pyridin-2-yl)imino)indolin-2-one (CBAPI) was synthesized and well characterized. The CBAPI sensor was employed for detecting Zn2+ and Fe3+ ions. It exhibited a low limit of detection at pH 6.0, with values of 2.90, for Zn2+ and 3.59 nmol L-1 for Fe3+ ions. The sensor demonstrated high selectivity over other interfering cations. Additionally, the high binding constants reflect the great affinity of sensor towards Zn2+ and Fe3+ ions. To further validate its quantification ability for Zn2+ ions, the synthesized CBAPI sensor was used to determine Zn levels in human hair samples, and the results were confirmed using atomic absorption spectroscopy (AAS). The AGREE metric tool was used to assess the method's environmental impact and practical applicability. These positive outcomes indicated that the new method for detecting Zn2+ and Fe3+ ions is environmentally friendly and safe for humans. The developed CBAPI sensor represents a potential development in metal ion detection, combining sensitivity, selectivity, and rapidity.

Fabrication of Luminescent Microtiterplate Using Terbium Complex for Phenol Screening in Seawater Samples.

Tb(III)-2-aminoterphthalate complex Tb2-(ATPh)3 was synthesized and characterized using FT-IR, thermal analysis and elemental analysis. Tb2(ATPh)3 microtiter plate was fabricated through embedding Tb(III) complex in polyvinyl chloride membrane and used for environmental determination of phenol in sea water samples. The calculated detection (DL), quantification (QL) limits, and binding constant (KD) were 00.63 µmol L- 1, 2.10 µmol L- 1 and 1.32 × 104 mol- 1 L, respectively. The fabricated microtiter plates exhibited high selectivity towards phenol over other hydrocarbon compounds. Furthermore, AGREE metric tool was used to assess the method's green nature as well as its practicability and applicability. These merit outcomes provide that the new method for phenol detection was environmentally benign and safe to humans. The prepared Tb2(ATPh)3 MTP was validated through using gas chromatography for monitoring phenol in Suez Bay water accurately with high precision. The obtained results encouraged using Tb2(ATPh)3 MTP for efficient, fast, selective, and direct screening of phenol in real samples.

Kidney Segmentation from Dynamic Contrast-Enhanced Magnetic Resonance Imaging Integrating Deep Convolutional Neural Networks and Level Set Methods.

The dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) technique has taken on a significant and increasing role in diagnostic procedures and treatments for patients who suffer from chronic kidney disease. Careful segmentation of kidneys from DCE-MRI scans is an essential early step towards the evaluation of kidney function. Recently, deep convolutional neural networks have increased in popularity in medical image segmentation. To this end, in this paper, we propose a new and fully automated two-phase approach that integrates convolutional neural networks and level set methods to delimit kidneys in DCE-MRI scans. We first develop two convolutional neural networks that rely on the U-Net structure (UNT) to predict a kidney probability map for DCE-MRI scans. Then, to leverage the segmentation performance, the pixel-wise kidney probability map predicted from the deep model is exploited with the shape prior information in a level set method to guide the contour evolution towards the target kidney. Real DCE-MRI datasets of 45 subjects are used for training, validating, and testing the proposed approach. The valuation results demonstrate the high performance of the two-phase approach, achieving a Dice similarity coefficient of 0.95 ± 0.02 and intersection over union of 0.91 ± 0.03, and 1.54 ± 1.6 considering a 95% Hausdorff distance. Our intensive experiments confirm the potential and effectiveness of that approach over both UNT models and numerous recent level set-based methods.

Cost-effective removal of toxic methylene blue dye from textile effluents by new integrated crosslinked chitosan/aspartic acid hydrogels.

Chitosan/aspartic acid hydrogels were synthesized for MB dye removal from textile aqueous effluents with different ratios by gelation of chitosan with non-toxic gelling agent, crosslinker, glutaraldehyde (Glu). The obtained hydrogels were characterized by spectral and morphological techniques. The characterization techniques confirmed successful preparations and MB dye adsorption. Batch experiments were done to investigate the effects of adsorbent dose, pH, contact time, temperature, and initial MB dye concentration. The optimum conditions were: adsorbent dose 0.1 g, pH 5, contact time 30 min, and temperature 25 °C for Chitosan-Aspartic Acid Hydrogel 1 (CSAA-HG1) and adsorbent dose 0.4 g, pH 2, contact time 60 min, temperature 25 °C for Chitosan-Aspartic Acid Hydrogel 2 (CSAA-HG2). Adsorption capacity of newly hydrogels CSAA-HG1,2 was compared with each other. Adsorption efficiencies reached 99.85 % for CSAA-HG1 and 99.88 % for CSAA-HG2. MB dye adsorption on CSAA-HG1,2 followed Freundlich isotherm model (R2 = 0.94 and 0.92, respectively). Both adsorbents exhibited pseudo-second-order kinetics for MB dye adsorption (R2 = 1). The negative ΔHo indicated that the MB dye adsorption was exothermic, negative ΔGo confirmed that MB dye adsorption process was spontaneous and low values of ∆So indicated low degree of freedom, ordered MB dye molecules on CSAA-HG1,2 surfaces.

A comprehensive review on sustainable clay-based geopolymers for wastewater treatment: circular economy and future outlook.

In the present era of significant industrial development, the presence and dispersal of countless water contaminants in water bodies worldwide have rendered them unsuitable for various forms of life. Recently, the awareness of environmental sustainability for wastewater treatment has increased rapidly in quest of meeting the global water demand. Despite numerous conventional adsorbents on deck, exploring low-cost and efficient adsorbents is interesting. Clays and clays-based geopolymers are intensively used as natural, alternative, and promising adsorbents to meet the goals for combating climate change and providing low carbon, heat, and power. In this narrative work, the present review highlights the persistence of some inorganic/organic water pollutants in aquatic bodies. Moreover, it comprehensively summarizes the advancement in the strategies associated with synthesizing clays and their based geopolymers, characterization techniques, and applications in water treatment. Furthermore, the critical challenges, opportunities, and future prospective regarding the circular economy are additionally outlined. This review expounded on the ongoing research studies for leveraging these eco-friendly materials to address water decontamination. The adsorption mechanisms of clays-based geopolymers are successfully presented. Therefore, the present review is believed to deepen insights into wastewater treatment using clays and clays-based geopolymers as a groundbreaking aspect in accord with the waste-to-wealth concept toward broader sustainable development goals.

New nano materials-based optical sensor for application in rapid detection of Fe(II) and Pd(II) ions.

For the analytical determination of Fe(II) and Pd(II) concentrations, a novel optical sensor based on spectrophotometric technique was used. The optical sensor was prepared by direct immobilization of a novel synthesized chromophore, 5-amino-phenanthrolin-3 formyl salicylic acid, onto nanocellulose. Human vision can identify the color associated with Fe II ions, and spectrophotometric methods can measure it with detection and quantification limits of 0.239 and 0.796 ppb, respectively. Pd(II) detection and quantification limits were 0.318 ppb and 1.06 ppb, respectively. The effects of various parameters on the detection of Fe(II) or Pd(II) ion content were investigated and optimized. The optical phenanthroline-nanocellulose (5-Phen) sensor could be reproduced multiple times and used with a higher capacity each time. The results demonstrated that the 5-Phen sensor could measure Fe(II) in human blood serum accurately and successfully even without any pre-concentration.

Level-Set-Based Kidney Segmentation from DCE-MRI Using Fuzzy Clustering with Population-Based and Subject-Specific Shape Statistics.

The segmentation of dynamic contrast-enhanced magnetic resonance images (DCE-MRI) of the kidney is a fundamental step in the early and noninvasive detection of acute renal allograft rejection. In this paper, a new and accurate DCE­MRI kidney segmentation method is proposed. In this method, fuzzy c-means (FCM) clustering is embedded into a level set method, with the fuzzy memberships being iteratively updated during the level set contour evolution. Moreover, population­based shape (PB-shape) and subject-specific shape (SS-shape) statistics are both exploited. The PB-shape model is trained offline from ground-truth kidney segmentations of various subjects, whereas the SS-shape model is trained on the fly using the segmentation results that are obtained for a specific subject. The proposed method was evaluated on the real medical datasets of 45 subjects and reports a Dice similarity coefficient (DSC) of 0.953 ± 0.018, an intersection-over-union (IoU) of 0.91 ± 0.033, and 1.10 ± 1.4 in the 95-percentile of Hausdorff distance (HD95). Extensive experiments confirm the superiority of the proposed method over several state-of-the-art level set methods, with an average improvement of 0.7 in terms of HD95. It also offers an HD95 improvement of 9.5 and 3.8 over two deep neural networks based on the U-Net architecture. The accuracy improvements have been experimentally found to be more prominent on low-contrast and noisy images.

Kidney segmentation from DCE-MRI converging level set methods, fuzzy clustering and Markov random field modeling.

Early diagnosis of transplanted kidney function requires precise Kidney segmentation from Dynamic Contrast-Enhanced Magnetic Resonance Imaging images as a preliminary step. In this regard, this paper aims to propose an automated and accurate DCE-MRI kidney segmentation method integrating fuzzy c-means (FCM) clustering and Markov random field modeling into a level set formulation. The fuzzy memberships, kidney's shape prior model, and spatial interactions modeled using a second-order MRF guide the LS contour evolution towards the target kidney. Several experiments on real medical data of 45 subjects have shown that the proposed method can achieve high and consistent segmentation accuracy regardless of where the LS contour was initialized. It achieves an accuracy of 0.956 ± 0.019 in Dice similarity coefficient (DSC) and 1.15 ± 1.46 in 95% percentile of Hausdorff distance (HD95). Our quantitative comparisons confirm the superiority of the proposed method over several LS methods with an average improvement of more than 0.63 in terms of HD95. It also offers HD95 improvements of 9.62 and 3.94 over two deep neural networks based on the U-Net model. The accuracy improvements are experimentally found to be more profound on low-contrast images as well as DCE-MRI images with high noise levels.

Fetal echocardiographic parameters in pregnancies complicated by diabetes: a case control study.

BACKGROUND: At present, the prevalence of pregestational diabetes is 2.2% with an overall prevalence of hyperglycaemia in pregnancy of about 16.2%. Fetuses of diabetic mothers are at risk of functional cardiac abnormalities without structural cardiac anomalies especially in the third trimester. The main aim of this study was to assess the association of diabetes with different fetal echocardiographic parameters. METHODS: A case control study comprising a total of 120 pregnant women (60 cases and 60 controls). The cases group included fetuses of mothers known to have pre-gestational type 2 diabetes (DM group) while the control group included fetuses of euglycaemic healthy pregnant women. They were examined twice at 23-24 weeks' gestation (visit 1) and followed up at 27-28 weeks' gestation (visit 2). The Modified Myocardial Performance Index (Mod MPI) was obtained in all fetuses. Also, M-mode echocardiography was used to measure the interventricular septum thickness at diastole in a transverse four chamber view. RESULTS: There was a significant increase in Iso-volumetric contraction time (ICT) (45.4 ms ± 8.9), Iso-volumetric relaxation time (IRT) (54.7 ms ± 11.22), Interventricular septal thickness (IVST) (4.08 mm ± 0.8), aortic acceleration time (AAT) (54.16 ms ± 12.77) and MPI (0.64 ± 0.09) in the diabetic group compared to the normal control group ICT (38.5 ms ± 9.59), IRT (46.13 ms ± 10.29), IVST (3.17 mm ± 0.6), AAT (49.73 ms ± 10.68) and MPI (0.5 ± 0.1) (all P values were < 0.001). When comparing parameters assessed at both visits among diabetic patients, there was a significant increase in IVST in the second visit (4.74 ± 0.78 mm) compared to the first visit (4.08 ± 0.8 mm) (P value < 0.05). The incidence of hypertrophic cardiomyopathy (HCM) was significantly higher in diabetic patients than in the control group. This is was observed in both first and second visit (33.4% and 56.7%) (P value < 0.001). CONCLUSIONS: Fetuses of diabetic pregnant females show a significant increase in MPI, decrease in E\A ratio and HCM. These alterations in cardiac functions and structure were found to be continuous throughout the period of time between the two visits.

Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation.

This recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for standardization to implement the ultrasound evaluation in labor ward and improve the clinical management of labor. Ultrasound in labor can be performed using a transabdominal or a transperineal approach depending upon which parameters are being assessed. During transabdominal imaging, fetal anatomy, presentation, liquor volume, and placental localization can be determined. The transperineal images depict images of the fetal head in which calculations to determine a proposed fetal head station can be made.

A global perspective on management of bacterial infections in pregnancy: a systematic review of international guidelines.

INTRODUCTION: Maternal sepsis is a leading cause of maternal and neonatal mortality. Despite the availability of management protocols, there is disparity in case fatality rates for pregnancy-related sepsis compared to other maternity-related complications. The main aim of this systematic review was to assess concordance between international evidence-based guidelines for the prevention and management of childbirth-related bacterial infections. MATERIAL AND METHODS: The PRISMA statement was followed during the conduct and reporting of this review. PubMed was searched electronically from 2009 to November 2019 for clinical guidelines covering the topic of childbirth-related infections and specific searches for relevant guidelines on the websites of the top five international professional bodies most commonly identified by our searches. We did not apply any language restrictions. Guidelines were included if they provided any information about the prevention or management of childbirth-related bacterial infections irrespective of whether the guideline stated a recommendation or not. Two independent reviewers undertook study selection, decisions about inclusion of selected guidelines and data extraction. Extracted information was synthesized under the following topics: Asymptomatic bacteriuria; group B streptococcal infection (GBS); preterm premature rupture of membranes (P-PROM); intrauterine infection; procedures; maternal sepsis; miscellaneous. Concordance was defined as absence of contradictory information between the different guidelines with regards to a specific topic, subtopic or recommendation. Quality of included guidelines was assessed against the AGREE II guideline reporting domains. RESULTS: A total of 43 guidelines were selected of which 11 were excluded leaving 32 guidelines that fulfilled our inclusion criteria. None of the guidelines fulfilled all the quality assessment domains and 11 (34%) of the guidelines satisfied 1-2 of domains only. Two guidelines covered the topic of asymptomatic bacteriuria, nine for GBS, five for P-PROM and three covered each of intra-amniotic infections maternal sepsis, obstetric procedures and interventions topics. The remaining guidelines covered miscellaneous topics. CONCLUSIONS: There was concordance between guidelines with regards to several aspects in the prophylaxis and treatment of bacteriological infections in pregnancy. Nevertheless, there were several areas of discordance, some of which reached the extent of contradictory information as in the case of antenatal screening for GBS.

The value of three-dimensional ultrasound in identifying Mullerian anomalies at risk of adverse pregnancy outcomes.

OBJECTIVE: To examine the reliability of three-dimensional ultrasound (3 D-US) in the differentiation between subseptate and arcuate uteri, due to the different associated pregnancy outcomes; refine the existing 3 D-US parameters and evaluate the concordance between 3 D-US and MRI in diagnosing these anomalies. STUDY DESIGN: This was a prospective cohort study of 455 women suspected of having a Mullerian anomaly. The diagnosis of subseptate, bicornuate or arcuate uterus was made by 3 D-US in 55 women. Two independent examiners manipulated the 3 D-US volume datasets and recorded the internal intercornual distance, indentation length, indentation tip angle, and myometrial wall thickness in the coronal plane of the uterus. Subsequently, 48 women underwent MRI which was used as the reference test for diagnosis. We calculated the degree of correlation between the two ultrasound assessors' 3 D-US measurements using interclass correlation coefficient and as well as a Bland-Altman plot. The mean values of the four parameters were used to create receiver operating characteristic curves for determining the best cutoff values for differentiation between subseptate and arcuate uterui. We used the Cohen's Kappa test to measure the level of agreement between 3 D-US and MRI. RESULTS: There was good interobserver agreement between the two 3 D-US assessors for all four parameters. There was a substantial level of agreement between 3 D-US and MRI in differentiating between bicornuate, subseptate and arcuate uteri with a kappa value of 0.727 (95% CI 0.443-0.856). Distinction between subseptate and arcuate uterus was improved when using an indentation length ≥12.5 mm (AUC 0.99) and indentation tip angle ≤89.25 degrees (AUC 0.97) as cutoffs for diagnosis but not the internal intercornual distance or myometrial wall thickness. CONCLUSION: 3 D-US evaluation of the coronal view of the uterus can be relied upon to make a noninvasive, accurate differentiation between subseptate and arcuate uteri. The fundal indentation length and indentation tip angle cut offs of ≥12.5 mm and ≤88 mm, respectively were found to be most accurate for distinction. Thus, allowing for individualizing pre-pregnancy management plans and patient-informed healthcare choices.HighlightsThere are no agreed upon criteria for differentiating arcuate from subseptate uteri. Such differentiation is critical for counseling and management due to the substantial difference in pregnancy outcome.We aimed to propose cut off values for ultrasound measurements standardized against MRI diagnostic criteria for accurate differentiation between arcuate and subseptate uteri.We demonstrated substantial agreement between 3D-US and MRI in differentiating between bicornuate, subseptate and arcuate uteri.3D-US evaluation of the coronal view of the uterus is reliable to make an accurate differentiation between subseptate and arcuate uteri.Using the indentation length ≥12.5 mm and indentation tip angle ≤89.25 degrees as parameters to be measured on the coronal view by 3D-US increases its diagnostic accuracy for distinction between arcuate and subseptate uteri.

High-throughput sensor microtiter plate of new terbium complexes for the determination of anthracene in seawater.

A new fluorescent sensing microtiter plate (MTP) was developed for high sensitivity monitoring of anthracene in seawater samples. For this purpose, two ternary complexes of Tb(III) ions with dibenzoylmethane and neocuproine [Tb(DBM)2(MePhen)] or with dibenzoylmethane and bathocuproine [Tb(DBM)2(PhMePhen)] were synthesized. Elemental analysis, energy dispersive X-ray analysis, X-ray diffraction, infrared and ultraviolet-visible emission, and thermal analysis were conducted on the Tb(III) complexes. The limits of detection (DL) were 0.14 and 1.05 µmol L-1 for [Tb(DBM)2(MePhen)] and [Tb(DBM)2(PhMePhen)], respectively. [Tb(DBM)2(PhMePhen)] MTP is embedded in a membrane made of cellulose acetate. The first high-throughput anthracene sensor MTP, based on [Tb(DBM)2(PhMePhen)] sensor showed a linear range, from 0.2 to 20 µmol L-1. [Tb(DBM)2(PhMePhen)] MTP was validated for accurate and precise monitoring of anthracene using gas chromatography. The selectivity of the [Tb(DBM)2(PhMePhen)] MTP toward anthracene was examined. The data indicated that [Tb(DBM)2(PhMePhen)] MTP is suitable for rapid and direct detection of anthracene.

Fetal head descent assessed by transabdominal ultrasound: a prospective observational study.

BACKGROUND: Determining fetal head descent, expressed as fetal head station and engagement is an essential part of monitoring progression in labor. Assessing fetal head station is based on the distal part of the fetal skull, whereas assessing engagement is based on the proximal part. Prerequisites for assisted vaginal birth are that the fetal head should be engaged and its lowermost part at or below the level of the ischial spines. The part of the fetal head above the pelvic inlet reflects the true descent of the largest diameter of the skull. In molded (reshaped) fetal heads, the leading bony part of the skull may be below the ischial spines while the largest diameter of the fetal skull still remains above the pelvic inlet. An attempt at assisted vaginal birth in such a situation would be associated with risks. Therefore, the vaginal or transperineal assessments of station should be supplemented with a transabdominal examination. We suggest a method for the assessment of fetal head descent with transabdominal ultrasound. OBJECTIVE: To investigate the correlation between transabdominal and transperineal assessment of fetal head descent, and to study fetal head shape at different labor stages and head positions. STUDY DESIGN: Women with term singleton cephalic pregnancies admitted to the labor ward for induction of labor or in spontaneous labor, at the Cairo University Hospital and Oslo University Hospital from December 2019 to December 2020 were included. Fetal head descent was assessed with transabdominal ultrasound as the suprapubic descent angle between a longitudinal line through the symphysis pubis and a line from the upper part of the symphysis pubis extending tangentially to the fetal skull. We compared measurements with transperineally assessed angle of progression and investigated interobserver agreement. We also measured the part of fetal head above and below the symphysis pubis at different labor stages. RESULTS: The study population comprised 123 women, of whom 19 (15%) were examined before induction of labor, 8 (7%) in the latent phase, 52 (42%) in the active first stage and 44 (36%) in the second stage. The suprapubic descent angle and the angle of progression could be measured in all cases. The correlation between the transabdominal and transperineal measurements was -0.90 (95% confidence interval, -0.86 to -0.93). Interobserver agreement was examined in 30 women and the intraclass correlation coefficient was 0.98 (95% confidence interval, 0.95-0.99). The limits of agreement were from -9.5 to 7.8 degrees. The fetal head was more elongated in occiput posterior position than in non-occiput posterior positions in the second stage of labor. CONCLUSION: We present a novel method of examining fetal head descent by assessing the proximal part of the fetal skull with transabdominal ultrasound. The correlation with transperineal ultrasound measurements was strong, especially early in labor. The fetal head was elongated in the occiput posterior position during the second stage of labor.

Variational Approach for Joint Kidney Segmentation and Registration from DCE-MRI Using Fuzzy Clustering with Shape Priors.

The dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) technique has great potential in the diagnosis, therapy, and follow-up of patients with chronic kidney disease (CKD). Towards that end, precise kidney segmentation from DCE-MRI data becomes a prerequisite processing step. Exploiting the useful information about the kidney's shape in this step mandates a registration operation beforehand to relate the shape model coordinates to those of the image to be segmented. Imprecise alignment of the shape model induces errors in the segmentation results. In this paper, we propose a new variational formulation to jointly segment and register DCE-MRI kidney images based on fuzzy c-means clustering embedded within a level-set (LSet) method. The image pixels' fuzzy memberships and the spatial registration parameters are simultaneously updated in each evolution step to direct the LSet contour toward the target kidney. Results on real medical datasets of 45 subjects demonstrate the superior performance of the proposed approach, reporting a Dice similarity coefficient of 0.94 ± 0.03, Intersection-over-Union of 0.89 ± 0.05, and 2.2 ± 2.3 in 95-percentile of Hausdorff distance. Extensive experiments show that our approach outperforms several state-of-the-art LSet-based methods as well as two UNet-based deep neural models trained for the same task in terms of accuracy and consistency.

The usefulness of ultrasound before induction of labor.

The indications for induction of labor have been consistently on the rise. These indications are mainly medical (maternal or fetal) or social or related to convenience or maternal preferences. With the increase in the prevalence of these indications, the incidence rates of induction of labor are expected to rise continuously. This poses a substantial workload and financial burden on maternity healthcare systems. Failure rates of induction of labor are relatively high, especially when considering the maternal, fetal, and neonatal risks associated with emergency cesarean deliveries in cases of failure. Therefore, it is essential for obstetricians to carefully select women who are eligible for induction of labor, particularly those with no clinical contraindication and who have a reasonable chance of ending up with a successful noncomplicated vaginal delivery. Ultrasound has an established role in the various areas of obstetrical care. It is available, accessible, easy to perform, and acceptable to the patient. In addition, the learning curve for skillful obstetrical ultrasound scanning is rather easy to fulfill. Ultrasound has always had an important role in the assessment of maternal and fetal well-being. Indeed, it has been extensively explored as a reliable, reproducible, and objective tool in the management of labor. In this review, we aimed to provide a comprehensive update on the different applications and uses of ultrasound before induction of labor for the prediction of its success and the potential improvement of its health-related maternal and fetal outcomes.

Predicting cesarean delivery for failure to progress as an outcome of labor induction in term singleton pregnancy.

BACKGROUND: Induction of labor is one of the most common interventions in modern obstetrics, and its frequency is expected to continue to increase. There is inconsistency as to how failed induction of labor is defined; however, the majority of studies define success as the achievement of vaginal delivery. Induction of labor in nulliparous women poses an additional challenge with a 15% to 20% incidence of failure, ending in emergency operative deliveries. The Bishop score has been traditionally used before decisions for induction of labor. Nonetheless, it is subjective and prone to marked interobserver variation. Several studies have been conducted to find alternative predictors, yet a reliable, objective method still remains to be introduced and validated. Hence, there is still a need for the development of new predictive tools to facilitate informed decision making, optimization of resources, and minimization of potential risks of failure. Furthermore, a peripartum transperineal ultrasound scan has been proven to provide objective, noninvasive assessment of labor. OBJECTIVE: This study aimed to assess the feasibility of developing and validating an objective and reproducible model for the prediction of cesarean delivery for failure to progress as an outcome of labor induction in term singleton pregnancies. STUDY DESIGN: This was a prospective observational cohort study conducted in Cairo University Hospitals and University of Bologna Hospitals between November 2018 and November 2019. We recruited 382 primigravidae with singleton term pregnancies in cephalic presentation. All patients had baseline Bishop scoring together with various transabdominal and transperineal ultrasound assessments of the fetus, maternal cervix, and pelvic floor. The managing obstetricians were blinded to the ultrasound scan findings. The method and indication of induction of labor, the total duration of stages of labor, mode of birth, and neonatal outcomes were all recorded. Women who had operative delivery for fetal distress or indications other than failure to progress in labor were excluded from the final analysis, leaving a total of 344 participants who were randomly divided into 243 and 101 pregnancies that constituted the model development and cross-validation groups, respectively. RESULTS: It was possible to perform transabdominal and transperineal scans and assess all the required parameters on all study participants. Univariate and multivariate analyses were used for selection of potential predictors and model fitting. The independent predictive variables for cesarean delivery included maternal age (odds ratio, 1.12; P=.003), cervical length (odds ratio, 1.08; P=.04), angle of progression at rest (odds ratio, 0.9; P=.001), and occiput posterior position (odds ratio, 5.7; P=.006). We tested the performance of the prediction model on our cross-validation group. The calculated areas under the curve for the ability of the model to predict cesarean delivery were 0.7969 (95% confidence interval, 0.71-0.87) and 0.88 (95% confidence interval, 0.79-0.97) for the developed and validated models, respectively. CONCLUSION: Maternal age and sonographic fetal occiput position, angle of progression at rest, and cervical length before labor induction are very good predictors of induction outcome in nulliparous women at term.

The role of the angle of progression in the prediction of the outcome of occiput posterior position in the second stage of labor.

BACKGROUND: Occiput posterior position is the most frequent cephalic malposition, and its persistence at delivery is associated with a higher risk of maternal and perinatal morbidity. Diagnosis and management of occiput posterior position remain a clinical challenge. This is partly caused by our inability to predict fetuses who will spontaneously rotate into occiput anterior from those who will have persistent occiput posterior position. The angle of progression, measured with transperineal ultrasound, represents a reliable tool for the evaluation of fetal head station during labor. The relationship between the persistence of occiput posterior position and fetal head station in the second stage of labor has not been previously assessed. OBJECTIVE: This study aimed to evaluate the role of fetal head station, as measured by the angle of progression, in the prediction of persistent occiput posterior position and the mode of delivery in the second stage of labor. STUDY DESIGN: We recruited a nonconsecutive series of women with posterior occiput position diagnosed by transabdominal ultrasound in the second stage of labor. For each woman, a transperineal ultrasound was performed to measure the angle of progression at rest. We compared the angle of progression between women who delivered fetuses in occiput anterior position and those with persistent occiput posterior position at delivery. Receiver operating characteristics curves were performed to evaluate the accuracy of the angle of progression in the prediction of persistent occiput posterior position. Finally, we performed a multivariate logistic regression to determine independent predictors of persistent occiput posterior position. RESULTS: Overall, 63 women were included in the analysis. Among these, 39 women (62%) delivered in occiput anterior position, whereas 24 (38%) delivered in occiput posterior position (persistent occiput posterior position). The angle of progression was significantly narrower in the persistent occiput posterior position group than in women who delivered fetuses in occiput anterior position (118.3°±12.2° vs 127.5°±10.5°; P=.003). The area under the receiver operating characteristics curve was 0.731 (95% confidence interval, 0.594-0.869) with an estimated best cutoff range of 121.5° (sensitivity of 72% and specificity of 67%). On logistic regression analysis, the angle of progression was found to be independently associated with persistence of occiput posterior position (odds ratio, 0.942; 95% confidence interval, 0.889-0.998; P=.04). Finally, women who underwent cesarean delivery had significantly narrower angle of progression than women who had a vaginal delivery (113.5°±8.1 vs 128.0°±10.7; P<.001). The area under the receiver operating characteristics curve for the prediction of cesarean delivery was 0.866 (95% confidence interval, 0.761-0.972). At multivariable logistic regression analysis including the angle of progression, parity, and gestational age at delivery, the angle of progression was found to be the only independent predictor associated with cesarean delivery (odds ratio, 0.849; 95% confidence interval, 0.775-0.0930; P<.001). CONCLUSION: In fetuses with occiput posterior at the beginning of the second stage of labor, narrower values of the angle of progression are associated with higher rates of persistent occiput posterior position at delivery and a higher risk of cesarean delivery.

Reliability of transperineal ultrasound for the assessment of the angle of progression in labor using parasagittal approach versus midsagittal approach.

OBJECTIVE: To assess the inter-method agreement between midsagittal (msAoP) and parasagittal (psAoP) measurements of the angle of progression (AoP) during labor. In addition, we aimed to evaluate the correlation between AoP measurements by both midsagittal and parasagittal approaches with the mode of delivery. METHODS: We recruited a nonconsecutive series of women in active labor with a singleton uncomplicated term pregnancy with fetuses in vertex presentation. Women underwent transperineal ultrasound in the absence of uterine contractions or maternal pushing to measure both msAoP and psAoP. The inter-method agreement between the two acquisitions was then assessed. Lastly, both measurements were compared between women who had a vaginal delivery versus those who underwent cesarean section (CS). RESULTS: Overall, 151 women were included in the study. We found an excellent agreement between msAoP and psAoP (ICC 0.935; 95% CI 0.912-0.953, p < .001). On the other hand, psAoP overestimated the measurements in comparison with msAoP (101.2 ± 15.6 versus 98.2 ± 16.0, p < .001). There was a significant correlation between both methods of AoP assessment and duration of the active second stage of labor and AoP measured by either method was significantly wider in patients who delivered vaginally compared to those who had a CS. CONCLUSIONS: Our data showed a significant difference in the measured angle between the psAoP and the originally described msAoP. The automated measurements of AoP that have been introduced are designed using the parasagittal visualization of the more echogenic pubic arch, rather than the hypoechogenic pubic symphysis. We think that in the light of our data, care should be taken before applying data from midsagittal measurement in centers using the parasagittal automated approach.

Ultrasound in labor: impact of a theoretical and practical course on caregiver's perspective and accuracy.

Objective: The aim of the present study was two-fold; first is to assess the impact of a theoretical and practical course on the caregiver's perspective on the use of ultrasound in labor. Second is to evaluate the impact of the course on the measurement of the angle of progression.Materials and methods: Obstetricians participating in the course responded twice to a questionnaire addressing the caregiver's perspective on the use of ultrasound in labor, before and at the end of the course. In addition, all participants measured the angle of progression on a digital simulation software once following the theoretical part and a second time after the conclusion of both the theoretical and practical sessions. All answers to the questionnaire were compared before versus after the course. The angle of progression assessments after the theoretical part and those after the course were compared with those performed by an expert operator.Results: Overall, data from 51 participants were analyzed. In comparison with the pre-course questionnaire, more participants after the course believed ultrasound can be a useful instrument for fetal occiput presentation diagnosis (45; 88.2% versus 26; 51%, p < .001) and for fetal head progression evaluation (37; 72.5% versus 19; 37.3%; p < .001). Although before the course, most participants (32; 62.7%) thought that the transperineal parameters were too complex to be applied, only 19 (37.3%) still considered the complexity of the ultrasound indices, an obstacle against their application in clinical practice after the course (p = .002). Regarding the angle of progression, precourse measurements showed a systematic overestimation in comparison with the gold standard. Furthermore, the coefficient of variation, more than halved following the practical simulation reflecting at least a doubling of the angle of progression (AoP) measurement precision (14.2 versus 5.5%).Conclusions: A theoretical and practical course conducted by expert operators may positively change obstetricians' perspective on the use of ultrasound in labor. Moreover, a practical session seems to improve the participants' accuracy and precision in the assessment of fetal head descent by transperineal ultrasound.