Ultrasound has the potential to predict labor outcome in women with prolonged second stage of labor. The information obtained could guide whether vacuum delivery should be attempted or if cesarean is preferable, whether senior staff should be in attendance, and if the vacuum attempt should be performed in the operating theater.

Objectives To investigate if descent of the fetal head during active pushing is associated with duration of operative vaginal delivery, mode of delivery and neonatal outcome in nulliparous women with prolonged second stage of labor. Methods This was a prospective cohort study of nulliparous women with prolonged second stage of labor, conducted between November 2013 and July 2016 in five European countries. Fetal head descent was measured using transperineal ultrasound. Head–perineum distance (HPD) was measured between contractions and on maximum contraction during active pushing, and the difference between these values (ΔHPD) was calculated. The main outcome was duration of operative vaginal delivery, estimated using survival analysis to calculate hazard ratios (HRs) for vaginal delivery, with values > 1 indicating a shorter duration. HR was adjusted for prepregnancy body mass index, maternal age, induction of labor, augmentation with oxytocin and use of epidural analgesia. Pregnancies were grouped according to ΔHPD quartile, and delivery mode and neonatal outcome were compared between groups. Results The study population comprised 204 women. Duration of vacuum extraction was shorter with increasing ΔHPD. Estimated mean duration was 10.0, 9.0, 8.8 and 7.5 min in pregnancies with ΔHPD in the first to fourth quartiles, respectively, and the adjusted HR for vaginal delivery, using increasing ΔHPD as a continuous variable, was 1.04 (95% CI, 1.01–1.08). Mean ΔHPD was 7 mm (range, −10 to 37 mm). ΔHPD was either negative or ≤ 2 mm in the lowest quartile. In this group, 7/50 (14%) pregnancies were delivered by Cesarean section, compared with 8/154 (5%) of those with ΔHPD > 2 mm (P < 0.05). There was no significant association between umbilical artery pH < 7.10 or 5‐min Apgar score < 7 and ΔHPD quartile. Conclusion Minimal or no fetal head descent during active pushing was associated with longer duration of operative vaginal delivery and higher frequency of Cesarean section in nulliparous women with prolonged second stage of labor. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Pleural effusion is the most common fluid-accumulation in the fetus with a prevalence of 1:15.000-24.000 pregnancies. The clinical picture is highly variable ranging from spontaneous resolution to lung hypoplasia, hydrops and death. Treatment options include thoracocentesis, thoraco-amniotic shunting and pleurodesis using OK-432. The conventional thoraco-amniotic shunts are applied using a 13-16G trochar. Somatex® Intrauterine Shunt (IUS) was launched in 2014 and consists of a self-expanding nitinol wire mesh with an inner silicone coating to be inserted through an 18G/1.2 mm needle.

groups, indicating that this condition has been common for decades. This finding is supported by data from hospital records and published data that pregnancy and miscarriage under age 14 is substantially higher in Izabal 4,5 compared with Guatemala City and other major cities in the country. Puerto Barrios is located on the Caribbean coast and is geographically isolated from the rest of Guatemala. The Puerto Barrios study population was recruited from a public, urban hospital in a city of over 106,000 inhabitants, made up of admixed Amerindians/Europeans, Native Mayans (mostly speaking Q'eqchi'), and Garifuna, a population of African origin. The diversity of the population makes a genetic cause unlikely. Several plausible environmental causes may contribute to the earlier observed age at menarche in our study population, including water contamination, plant toxins related to the estrogenic compound zearalenone-a mycotoxin produced by numerous species of Fusarium growing on corn, or fumonisin, which is more prevelant in lowland areas of Guatemala, including Puerto Barrios. 6 Precocious menarche is associated with adverse reproductive outcomes in young women, including an early age of pregnancy or miscarriage, and the early age at menarche we describe warrants further investigation. Understanding the factors contributing to precocious menarche in this population may be useful in helping to reduce adverse reproductive outcomes in Guatemala.