Activity

To estimate the level of interobserver agreement in the calculation of placenta accreta index (PAI) as well as to evaluate the accuracy of PAI in prediction of morbidly adherent placenta.

This was a prospective study where 45 pregnant women (from 28 to 37 weeks of gestational age) with at least one previous Caesarean section and ultrasound-proven placenta previa were included. A known and previously published scoring system, the PAI, was evaluated independently by two radiologists and the cases were followed for the delivery and histopathology outcome. The accuracy of the PAI and the level of interrater agreement was analysed using cross-table analysis, intraclass correlation efficient and Cohen’s kappa as statistical variables.

Adherent placenta was found in 15 patients accounting for 33% of cases. The PAI showed nearly 90% sensitivity, specificity and the predictive values. Interrater agreement in calculation of PAI by the two radiologists was perfect with an intraclass correlation efficient of 0.959. An easy-to-use morbid adherent placenta score was also predicted to simplify the results of PAI, which showed moderate agreement (κ = 0.746).

The PAI can be helpful in stratifying the individual risk of placental invasion above the baseline risk. The PAI-derived, simplified scoring system called morbid adherent placenta score can be used as a simple tool to interpret and convey the results of PAI.

The PAI can be helpful in stratifying the individual risk of placental invasion above the baseline risk. The PAI-derived, simplified scoring system called morbid adherent placenta score can be used as a simple tool to interpret and convey the results of PAI.

Third trimester growth scans represent a significant proportion of the workload in obstetric ultrasound departments. The objective of these serial growth scans is to improve the antenatal detection of babies with fetal growth restriction. The aim of this paper is to describe a method of peer review for third trimester abdominal circumference measurements which is realistic within busy obstetric ultrasound departments in the UK.

Twenty-two, third trimester, measured abdominal circumference images were randomly selected. Images were assessed subjectively by 12 sonographers using the image Criteria Achieved Score. For quantitative assessment, termed the Inter-operator Variability Score, three of the abdominal circumference (AC) images were blindly remeasured. Following this, a questionnaire was used to ascertain which image criteria sonographers considered most important and to reach an agreement on correct caliper placement.

The least frequently met image criteria with the lowest Criteria Achieved Score related to an oblique abdominal circumference section. These included fetal kidney present (Criteria Achieved Score 24.6%), multiple oblique ribs (Criteria Achieved Score 39.4%) and oblique spine (Criteria Achieved Score 37.5%). Caliper placement was also identified as inconsistent.

This study demonstrates that the perfect AC section is not always possible and sonographers use their professional judgement to determine whether an image is acceptable. Seventy-three percent of the images reviewed were of an acceptable standard. There can be inconsistencies in sonographer opinion regarding what is an acceptable third trimester abdominal circumference image. KRpep-2d molecular weight These differences need to be addressed to maximise the effectiveness of the third trimester ultrasound examination.

Peer review can be used to monitor scan quality and identify areas of inconsistency.

Peer review can be used to monitor scan quality and identify areas of inconsistency.

The quantification of heating effects during exposure to ultrasound is usually based on laboratory experiments in water and is assessed using extrapolated parameters such as the thermal index. In our study, we have measured the temperature increase directly in a simulator of the maternal-fetal environment, the ‘ISUOG Phantom’, using clinically relevant ultrasound scanners, transducers and exposure conditions.

The study was carried out using an instrumented phantom designed to represent the pregnant maternal abdomen and which enabled temperature recordings at positions in tissue mimics which represented the skin surface, sub-surface, amniotic fluid and fetal bone interface. We tested four different transducers on a commercial diagnostic scanner. The effects of scan duration, presence of a circulating fluid, pre-set and power were recorded.

The highest temperature increase was always at the transducer-skin interface, where temperature increases between 1.4°C and 9.5°C were observed; lower temperature rise studies showed that the temperature rises observed fell within the recommendations of international regulatory bodies. However, it is important that the operator should be aware of factors affecting the temperature increase.

Multiple primary outcomes are commonly used in randomized controlled trials (RCTs) of Chinese herbal medicine (CHM). Analysis and interpretation of the results of CHM RCTs with many outcomes are not clear. No previous studies have systematically assessed the use of multiple primary outcomes in this area. This study aimed to assess the reporting of multiple primary outcomes and the statistical methods used to adjust multiplicity in RCTs of CHM.

Search for RCTs of CHM published in English between January 2010 and December 2019 in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) was undertaken. We randomly selected 20% of the included RCTs as the analyzing sample of this study. The number of multiple primary outcomes, the methods used to adjust the multiplicity in statistical analysis and sample size estimate, and the trial information were collected. For RCTs that adopted multiple primary outcomes without the multiplicity adjustment, we used Bonferroni correction to adjust.

primary outcomes is still lacking. These issues complicate the interpretability of trial results and can lead to spurious conclusions. Guidelines to improve analyzing and reporting for multiple primary outcomes in CHM RCTs are warranted.