pinecone/core-2020-05-10-deduplication huggingface dataset:
Risk of Cesarean scar defect following single- vs double-layer uterine closure: systematic review and meta-analysis of randomized controlled trials

OBJECTIVE:\ud
There is a growing body of evidence that suggests that the surgical technique for uterine closure following Cesarean delivery influences the healing of the Cesarean scar, but there is still no consensus on the optimal technique. The aim of this systematic review and meta-analysis was to compare the effect of single- vs double-layer uterine closure on the risk of uterine scar defect.\ud
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METHODS:\ud
MEDLINE, Scopus, ClinicalTrials.gov, PROSPERO, EMBASE and the Cochrane Central Register of Controlled Trials were searched from inception of each database until May 2016. All randomized controlled trials (RCTs) evaluating the effect of single- vs double-layer uterine closure following low transverse Cesarean section on the risk of uterine scar defect were included. The primary outcome was the incidence of uterine scar defects detected on ultrasound. Secondary outcomes were residual myometrial thickness evaluated by ultrasound and the incidence of uterine dehiscence and/or rupture in subsequent pregnancy. Summary measures were reported as relative risk (RR) or mean difference (MD), with 95% CIs. Quality of the evidence was assessed using the GRADE approach.\ud
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RESULTS:\ud
Nine RCTs (3969 participants) were included in the meta-analysis. The overall risk of bias of the included trials was low. Statistical heterogeneity within the studies was low, with no inconsistency in the primary and secondary outcomes. Women who received single-layer uterine closure had a similar incidence of uterine scar defects as did women who received double-layer closure (25% vs 43%; RR, 0.77 (95% CI, 0.36-1.64); five trials; 350 participants; low quality of evidence). Compared with double-layer uterine closure, women who received single-layer closure had a significantly thinner residual myometrium on ultrasound (MD, -2.19 mm (95% CI, -2.80 to -1.57 mm); four trials; 374 participants; low quality of evidence). No difference was found in the incidence of uterine dehiscence (0.4% vs 0.2%; RR, 1.34 (95% CI, 0.24-4.82); three trials; 3421 participants; low quality of evidence) or uterine rupture (0.1% vs 0.1%; RR, 0.52 (95% CI, 0.05-5.53); one trial; 3234 participants; low quality of evidence) in a subsequent pregnancy.\ud
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CONCLUSIONS:\ud
Single- and double-layer closure of the uterine incision following Cesarean delivery are associated with a similar incidence of Cesarean scar defects, as well as uterine dehiscence and rupture in a subsequent pregnancy. However, the quality level of summary estimates, as assessed by GRADE, was low, indicating that the true effect may be, or is even likely to be, substantially different from the estimate of the effect
Prediction of delivering a small for gestational age infant and adverse perinatal outcome in women with suspected pre-eclampsia

Objective: To evaluate the test performance of 47 biomarkers and ultrasound parameters to predict subsequent delivery of an SGA infant and adverse perinatal outcome in women presenting with suspected preeclampsia. Methods: In a prospective, multicentre observational study, 47 biomarkers and ultrasound parameters were measured in 397 women presenting with suspected preterm preeclampsia, with the objective of evaluating them as predictors of subsequent delivery of an SGA infant and adverse perinatal outcome. Factor analysis and stepwise logistic regression were performed in two pre-specified groups. Results: In 274 women presenting at 20+0 to 34+6 weeks’ gestation (Group 1), 96 (35%) delivered an SGA infant <3rd customised birthweight centile (SGA-3). For prediction of SGA-3, low maternal Placental Growth Factor (PlGF) concentrations had a sensitivity of 93% (95%CI 84% to 98%) and negative predictive value (NPV) of 90% (95%CI 76% to 97%) compared to a sensitivity of 71% (95%CI 58% to 82%) and a NPV of 79% (95%CI 68% to 87%) for ultrasound parameters (estimated fetal weight or abdominal circumference <10th centile). No individual biomarker evaluated had superior performance to PlGF and combinations added only small increments to test performance. Similar results were found in 123 women presenting between 35+0 to 36+6 weeks’ gestation (Group 2). Conclusions: In women presenting with suspected preterm preeclampsia, measurement of PlGF offers a useful adjunct for identifying those at high risk of delivering an SGA infant, allowing appropriate surveillance and timely intervention
Comparison of three commercially available placental growth factor-based tests in women with suspected preterm pre-eclampsia: the COMPARE study

ABSTRACT Objective To compare the performance of three placental growth factor (PlGF)-based tests in predicting delivery within 14 days from testing in women with suspected preterm pre-eclampsia before 35 weeks' gestation. Methods: This was a retrospective analysis of samples collected from three prospective pregnancy cohort studies. Participants were pregnant women with suspected preterm pre-eclampsia recruited in tertiary maternity units in the UK and Ireland. Samples were analyzed simultaneously according to the manufacturers' directions. The tests compared were the DELFIA Xpress PlGF 1-2-3 test, the Triage PlGF test and the Elecsys immunoassay soluble fms-like tyrosine kinase-1 (sFlt-1)/PlGF ratio. Areas under receiver–operating characteristics curves (AUCs) were compared. The main outcome measure was detection of a difference of 0.05 in AUC between tests for delivery within 14 days of testing. Results Plasma samples from 396 women and serum samples from 244 women were assayed. In predicting delivery within 14 days secondary to suspected pre-eclampsia prior to 35 weeks' gestation, no significant differences were observed in AUCs (P = 0.795), sensitivities (P = 0.249), positive predictive values (P = 0.765) or negative predictive values (P = 0.920) between the three tests. The specificity of the Elecsys sFlt-1/PlGF ratio test was higher than that of the other two tests (P < 0.001). Conclusions: The tests perform similarly in their prediction of need for delivery within 14 days in women with suspected pre-eclampsia. The high negative predictive values support the role of PlGF-based tests as ‘rule-out’ tests for pre-eclampsia
Tumor angiogenesis assessed by three-dimensional power Doppler ultrasound in early, advanced and metastatic ovarian cancer: a preliminary study

Objective To evaluate tumor vascularity by threedimensional
power Doppler ultrasound (3D-PDU) in
early and advanced stage primary ovarian cancers and
in metastatic tumors to the ovary.
Patients and methods This was a retrospective analysis
of clinical and sonographic data from 49 women
with primary ovarian cancers or metastatic tumors to
the ovary. All women underwent 3D-PDU prior to
surgery. Vascularization index (VI), flow index (FI) and
vascularization flow index (VFI) from solid portions or
papillary projections in the tumors were calculated using
the Virtual Organ Computer-aided AnaLysis (VOCALTM)
program. Definitive histological diagnosis was obtained
in each case.
Results Among the 49 women, 10 had stage I primary
cancers (five low-malignant potential tumors and five
invasive tumors), 26 had advanced stage primary ovarian
cancers and 13 had metastatic tumors to the ovary. Mean
VI and VFI were significantly higher in advanced stage
tumors and metastatic tumors as compared with early
stage tumors. No differences in 3D-PDU indices were
found between advanced stage and metastatic cancers.
Conclusions Vascular indices derived from 3D-PDU tend
to be higher in advanced stage and metastatic ovarian
cancers as compared with early stage ovarian tumors
Triage for surgical management of ovarian tumors in asymptomatic women: assessment of an ultrasound-based scoring system.

OBJECTIVES:

To prospectively evaluate an ultrasound-based scoring system as a method for triaging asymptomatic women presenting with an adnexal mass for surgical treatment.
METHODS:

Two hundred and four adnexal masses in 189 asymptomatic women undergoing elective surgical treatment at our institution were included in this prospective study. Patients were evaluated by transvaginal power Doppler ultrasound imaging before surgery. Patients were classified as low risk or high risk for malignancy according to an ultrasound-based scoring system. Women with a low risk for malignancy were scheduled for laparoscopy and patients with a high risk for malignancy were scheduled for laparotomy. However, patients classified as low risk by the ultrasound scoring system, but with a tumor size >or= 10 cm or clinical suspicion of pelvic adhesions, were instead considered to be at intermediate risk and were scheduled for laparotomy. Some patients classified as high risk were scheduled for an operative laparoscopy by an expert in gynecological oncology.
RESULTS:

One hundred and thirty-four (65.7%) masses were considered to be low risk and were treated by a laparoscopically guided procedure. All these tumors were benign. Forty-seven (23%) masses were classified as high risk, of which 39 tumors were malignant and eight benign. Twenty-three (11.3%) tumors were considered to be intermediate risk and were scheduled for primary laparotomy. In this group, 21 (91.3%) tumors proved to be benign and two (8.7%) were malignant.
CONCLUSIONS:

Ultrasound-based triage of asymptomatic women diagnosed with a persistent adnexal mass is effective for selecting the surgical approach
Sonographic prediction of macrosomia cannot be improved by combination with pregnancy-specific characteristics

OBJECTIVE: To evaluate the predictive value of a combination of sonographic, clinical and demographic data for detecting fetal macrosomia compared to ultrasound fetal weight estimation alone. METHODS: Retrospective cohort data were obtained from 1062 pregnancies in an unselected population. Estimated fetal sonographic weight was obtained within the last week prior to delivery. Two different combination models-published by Mazouni et al. and Nahum and Stanislaw-were employed to predict the presence of macrosomia at birth in these infants. Receiver-operating characteristics (ROC) curves were generated to compare the prediction of macrosomia when using different observation methods and sensitivity, specificity, positive predictive value, negative predictive value (NPV) and accuracy were calculated. RESULTS: Macrosomia (birth weight >/= 4000 g) was present in 135/1062 (12.7%) newborns. ROC curve analysis revealed the prediction of macrosomia using ultrasound alone to be significantly superior to the combined method of Mazouni et al. (area under the curve (AUC) 0.922, 95% CI 0.902-0.943 vs. 0.747, 95% CI 0.700-0.794, respectively; P < 0.0005), whereas the performance of the Nahum and Stanislaw equation was similar but not superior to ultrasound alone (AUC 0.895, 95% CI 0.839-0.950 vs. 0.912, 95% CI 0.867-0.958, respectively; P > 0.05). The accuracy of macrosomia prediction was similar for ultrasound alone and the Nahum and Stanislaw equation ( approximately 90%), whereas the nomogram of Mazouni et al. reached only 51.7% accuracy (using a probability cut-off level of 50%). The NPV was found to be over 90% for all methods. CONCLUSIONS: Combination of sonographic estimates with clinical and demographic variables does not improve the prediction of macrosomia at delivery in comparison with a routine ultrasound scan within a week before delivery, at least in unselected populations. Copyright (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd
Aspects of the primary assessment and management of anal incontinence

The papers of this thesis are not available in Munin: <br/>1. Norderval S, Dehli T, Vonen B.: 'Three-dimensional endoanal ultrasonography: intraobserver and interobserver agreement using scoring systems for classification of anal sphincter defects', Ultrasound in Obstetrics and Gynecology (2009), vol. 33 (3): 337-43. Available at <a href=http://dx.doi.org/10.1002/uog.6295>http://dx.doi.org/10.1002/uog.6295</a> <br/>2. Dehli T, Martinussen M, Mevik K, Stordahl A, Sahlin Y, Lindsetmo RO, Vonen B.: 'Translation and validation of the Norwegian version of the fecal incontinence quality-of-life scale', Scandinavian Journal of Surgery (2011), vol. 100 (3): 190-5. Available at <a href=http://www.fimnet.fi/sjs/articles/SJS32011-190.pdf>http://www.fimnet.fi/sjs/articles/SJS32011-190.pdf</a> <br/>3. Dehli T, Stordahl A, Vatten LJ, Romundstad PR, Sahlin Y, Lindsetmo RO, Vonen B.: 'Sphincter training or anal injections of dextranomer for treatment of anal incontinence: a randomized trial', Scandinavian Journal of Gastroenterology (2013) Vol. 48, No. 3. Available at <a href=http://dx.doi.org/10.3109/00365521.2012.758770>http://dx.doi.org/10.3109/00365521.2012.758770</a>Avhandlingens tittel er ”Aspects of the primary assessment and management of anal incontinence - The introduction of a new treatment”. Disputas for graden Ph.D. finner sted 05.04.2013. 
Ufrivillig lekkasje av luft og avføring er en relativt vanlig og belastende tilstand, og kan gi redusert livskvalitet. Det er utviklet en ny metode for å behandle denne lidelsen, som består i å injisere et rom-oppfyllende stoff i endetarmskanalen. Det sentrale målet i prosjektet har vært å vurdere om denne nye behandlingen er bedre enn eksisterende metoder. I tillegg har prosjektgruppen ønsket å utvikle metoder til å vurdere anal inkontinens bedre
Evaluation of two different methods for vascular sampling by three-dimensional power Doppler angiography in solid and cystic-solid adnexal masses

Objective To analyze two different methods for performing
three-dimensional power Doppler angiography
(3D-PDA) vascular sampling in solid and cystic-solid
adnexal masses.
Methods Twenty-one 3D-PDA volumes from 18 consecutive
and unselected solid or cystic-solid adnexal masses
(13 malignant and five benign) were analyzed. A single
examiner (J. L. A.) acquired all the volumes according to a
predetermined scanning protocol. Two different observers
(one inexperienced and the other experienced) calculated
3D-PDA vascular indices (vascularization index (VI), flow
index (FI) and vascularization flow index (VFI)) from
solid tumor areas. First, manual sampling (Plane A, 15◦
rotation-step) was performed, and 1 week later 5-cm3
sphere sampling from the most vascularized area was carried
out. The observers made a record of any difficulty
that they encountered in delineating the solid areas of
tumors or in distinguishing true tumor vessels from preexisting
vessels, the time spent performing each analysis
was recorded and inter- and intraobserver reproducibility
was evaluated for each method using intraclass correlation
coefficients (ICC).
Results In four (19.0%) of the 21 volumes sphere
sampling could not be performed because it was not
possible to obtain a sphere smaller than 5.5 cm3. This
happened in cases in which image zooming was used when
acquiring the 3D volume. The inexperienced observer
encountered more difficulty, but not significantly more,
than the experienced observer when analyzing 3D-PDA
volumes both by manual sampling (29% vs. 14% of
cases) and 5-cm3 sphere sampling (35% vs. 18% of cases).
The mean time spent by the inexperienced observer was
significantly greater (P < 0.001) than that spent by the
experienced observer both for manual sampling (6.11 min
vs. 1.85 min) and 5-cm3 sphere sampling (2.93 min vs.
2.15 min). Contrary to the findings for the experienced
observer, the inexperienced observer required less time to
perform sphere sampling than they did manual sampling.
Interobserver agreement was high for both methods: ICC
for manual volume, 0.993; manual VI, 0.908; manual
FI, 0.913; manual VFI, 0.914; sphere volume, 0.949;
sphere VI, 0.954; sphere FI 0.850; and sphere VFI, 0.953.
Intraobserver reproducibility was also high, with all ICCs
above 0.99.
Conclusions Manual and 5-cm3 sphere sampling are
reproducible methods for 3D-PDA vascular sampling.
Caution is required when image zoom is used at the time
of acquiring the volume because this may prevent sphere
sampling. Difficulties found in performing both manual
and sphere sampling do not seem to significantly affect the
reproducibility of Doppler index calculations
Is the non-respect of ethical principles by health professionals during first-trimester sonographic Down syndrome screening damaging to patient autonomy?

International audienceOBJECTIVES: To evaluate the understanding of health professionals involved in first-trimester ultrasound screening of the ethical stakes involved by addressing three questions regarding: how much these professionals know about Down syndrome screening by nuchal translucency thickness measurement; their personal opinion with respect to this screening test; and their attitude with respect to their patients, in order to answer the question: 'Are ethical principles respected when women are proposed ultrasound screening during the first trimester of pregnancy?' METHODS: We studied the medical population in the east part of France by sending a questionnaire to each of 460 medical correspondents. This questionnaire attempted to evaluate the respondent's level of medical knowledge, their personal opinion with respect to first-trimester screening and their attitude towards their patients. We adapted the three-dimensional diagram designed by Marteau et al. to develop a measure of informed choice regarding screening. Only health professionals who were relatively well informed and adopted an autonomy-oriented approach were considered to be in a position to obtain true consent from their patients, respecting ethical principles in terms of competence and the autonomy of patients. RESULTS: We received 276 (60%) responses to the questionnaire. Only 31.9% of health professionals had an approach that facilitated obtaining true consent from their patients and respected the ethical principles of competence and patient autonomy; 46% were in favor of the screening test and adopted an autonomy-oriented approach but were poorly informed; and 15.4% had a directive-authoritarian approach combined with poor knowledge. Regression analysis showed that two independent factors (speciality (P = 0.031) and location of practice (P = 0.034)) affected the level of medical knowledge, and two independent factors (location of practice (P = 0.034) and the type of medical practice i.e. public or private (P < 0.05)) affected the opinion of health professionals about the screening test. Two independent factors (speciality (P < 0.001) and the age of the health professional (P = 0.02)) affected the attitudes of health professionals towards their patients. CONCLUSION: The answer to the question 'Are ethical principles respected when women are proposed ultrasound screening during the first trimester of pregnancy?' is clearly 'No'. Major effort is required to ensure that the decisions made by patients are based on a possibility of true choice
Assessment of cyst content using mean gray value for discriminating endometrioma from other unilocular cysts in premenopausal women

Objective To assess whether the analysis of cyst content
using mean gray value (MGV) can discriminate ovarian
endometriomas from other unilocular ovarian cysts in
premenopausal women.
Methods Stored three-dimensional (3D) volumes from 54
unilocular ovarian cysts diagnosed in 50 premenopausal
women (mean age, 37 (range, 22–50) years) were
analyzed to calculate the MGV from cyst content. Cysts
with solid components or septations were excluded.
MGV was calculated in all cases with the Virtual
Organ Computer-aided AnaLysisTM technique. The Bmode
presumptive diagnosis based on the examiner’s
subjective impression was also recorded.
Results Sixteen of the cysts resolved spontaneously and
were given a final clinical diagnosis of hemorrhagic
functional cyst, while 38 cysts were removed surgically
(diagnosed histologically as seven simple cysts, three
hemorrhagic cysts, 20 endometriomas, five mucinous
cysts and three paraovarian cysts). B-mode diagnoses
were as follows: seven simple cysts, 18 hemorrhagic
cysts, 24 endometriomas, three mucinous cysts and two
paraovarian cysts. MGV was significantly higher in
ovarian endometrioma when compared with all other
kinds of cyst. The receiver–operating characteristics
curve showed that using an MGV cut-off ≥15.560
had a sensitivity of 85% and a specificity of 76.5%
for diagnosing ovarian endometrioma (area under the
curve, 0.831; 95% CI, 0.718–0.944). These figures were
similar to those for B-mode diagnosis (sensitivity, 90%;
specificity, 82%) (McNemar test, P = 1.000). Combining
B-mode and MGV gave a sensitivity of 80% and a
specificity of 91%.
Conclusion Cyst content MGV is higher in ovarian
endometrioma than it is in other unilocular ovarian cysts.
The diagnostic performance of MGV is similar to that of
the examiner’s subjective impression. The combination of
both criteria achieves the highest specificit
Continuous independent quality control for fetal ultrasound biometry provided by the cumulative summation technique

OBJECTIVE: To apply the cumulative summation (CUSUM) technique for an evaluation of the learning process of sonographic fetal weight estimation at term in combination with the z-scores of biometry determinants and to assess the time of appearance and sources of errors.\ud
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METHODS: Learning curve (LC-CUSUM) and double CUSUM charts for systematic error detection based on absolute and signed mean percentage error were generated to retrospectively estimate the longitudinal accuracy of sonographic fetal weight estimation conducted by three trainees and one experienced examiner. For LC-CUSUM analysis an examination was considered to be a failure when there was an absolute error in birth weight estimation >/= 15%. Fetal biometry measurements (head circumference, abdominal circumference (AC) and femur length (FL)) from 227 routine ultrasound scans of one examiner were separately transformed into z-scores and double CUSUM charts were generated to assess the systematic errors for each determinant.\ud
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RESULTS: The LC-CUSUM charts revealed that different numbers of scans are required for different examiners to achieve competence in estimating birth weight. AC and FL deviated most significantly from expected values (P < 0.05). The double CUSUM charts revealed exact periods of systematic errors in the measurement of biometry determinants, clearly reflecting errors of fetal weight estimation.\ud
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CONCLUSIONS: The use of CUSUM techniques in the analysis of sonographic data allows observation of the development of an examiner's skill and maintenance of competence. The CUSUM technique not only allows the reasons for impaired fetal weight estimation to be revealed but also allows determination of the exact time when inaccurate measurements start to occur. We suggest that CUSUM charts should be implemented in routine clinical practice as a measure of objective quality evaluation of sonographic fetal biometry