The Kristeller maneuver is associated with an increased risk of LAM avulsion when applied in women during their first vaginal delivery. This should be taken into account when deciding to use fundal pressure to accelerate the second stage of labor and when counseling women following childbirth. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Introduction Oral contraceptives (OCs) induce mood and libido changes. Aim The aim of this study was to evaluate in young, eumenorrheic, healthy women the sexual behavior and the genital vascular effects of an OC containing 30 µg ethinylestradiol (EE) and 3 mg drospirenone (DRSP). Main Outcome Measures The main outcome measures are McCoy Female Sexuality Questionnaire (MFSQ), the labia minora thickness and vaginal introitus area, the pulsatility index (PI) of clitoral and labia minora arteries, and hormonal and biochemical assays. Methods Twenty-two adult, eumenorrheic, healthy women were administered the two-factor Italian MFSQ. The labia minora thickness was studied by two-dimensional ultrasonographic, and the clitoral and labia minora arteries were evaluated by color Doppler; three-dimensional static volumes of the vulvar area were calculated. Hormonal (estradiol, androstenedione, and testosterone) and biohumoral (sex hormone binding globulin) parameters were assayed. Subjects were studied in baseline conditions and after 3 months of therapy with an OC (Yasmin®, Bayer-Schering Italia, Milan, Italy; −30 µg EE + 3 mg DRSP). Results After 3-month treatment, the labia minora thickness and the vaginal introitus area significantly decreased in comparison with the baseline values, whereas the PI of the dorsal clitoral artery and the posterior labial artery significantly increased. The OC use induced a significant decrease of the two-factor Italian MFSQ score, a reduction of the number of intercourse/week, and a reduction of the frequency of orgasm during intercourse. The item 18 (pain during intercourse) worsened after OC. Conclusions The treatment with Yasmin® (Bayer-Schering Italia) is associated with increased pain during intercourse, with decreased libido and spontaneous arousability, and with diminished frequency of sexual intercourse and orgasm.

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Aims To test the different formulae to calculate the bladder volume using ultrasound; the accuracy of patients hearing/feeling “bubbles” at the end of urodynamics testing as a measure of being empty; and how good we are at estimating PVR using X‐ray at the end of video urodynamics testing. Methods This was a prospective cohort study. Using Sonosite 180 plus, bladder volumes were calculated as, height × width × depth × proportionality constant (0.52, 0.625, 0.65, and 0.7) Patients were asked whether the patient heard or felt “bubbles” at the end of the investigation. Each patient was fluoroscopically screened and the clinician estimated the volume and compared with single‐use catheter volume. Results A total of 85 patients were assessed. All four formulae were significantly correlated. The PC, 0.52, correlated best (r = 0.938, P < 0.001) with no significant difference with the actual volumes ( P = 0.275). The “bubbles test” had a positive predictive value of 93%. A video postvoid residual (PVR) estimation significantly correlated with catheterised bladder volume ( r = 0.842, P < 0.001). There was no significant difference between the estimated and actual bladder volumes ( P = 0.579). Conclusion This study showed that although all four formulae correlated significantly, the PC of 0.52 was the only formula without a significant difference from the actual volume. More work is needed to produce patient individualised PC. Our clinicians were able to accurately estimate the PVR on X‐ray. This study has identified the best formula to accurately estimate bladder volume and that video estimation along with the “bubbles” test can avoid unnecessary intervention.

Objectives:To evaluate the effect of the Kristeller manoeuvre on female pelvic organ prolapse and pelvic dysfunction symptoms in primiparous women 3-6 months after delivery. Methods: Prospective case-control trial. Patients who underwent fundal pressure in the second stage of labour were recruited as ''cases''. For every case a matched ''control'' patient with spontaneous vaginal delivery was enrolled. All patients were evaluated 3-6 months after vaginal delivery through a 3D/4D transperineal ultrasound clinical assessment, to evaluate the presence and the degree of pelvic organ prolapse using the Pelvic Organ Prolapse quantification system (POP-q) both performed by an operator blinded to the patient's history. Results: Overall, 134 cases and 128 controls underwent the postpartum assessment. No significant difference was demonstrated between the 2 groups as regards maternal age, BMI, gestational age at delivery, birthweight, epidural analgesia, second stage length, and labour length, while maternal weight was significantly higher in the Kristeller group. Women who underwent Kristeller manoeuvre had a higher incidence of operative delivery, mediolateral episiotomy and the presence of III IV degree perineal lacerations.There were no statistically significant differences in terms of development of clinical nor ultrasonographic pelvic organs prolapse between the two groups. Furthermore, no statistically significant difference was found between the 2 groups regarding pelvic floor dysfunction symptoms. Conclusions: In this short follow-up study, the use of Kristeller manoeuvre does not seem to be associated with a higher risk of prolapse or pelvic floor dysfunction symptoms. were generated for both groups of examiners. General and specific to each anomaly eye tracking parameters were recorded for all cases (time to first fixation, first fixation duration, fixation duration, and fixation count) together with voice conclusions. Results: Heat maps demonstrated evident differences in perception of fetal echocardiograms between BE and EE in terms of abnormal cases. No differences were observed in general eye tracking parameters for normal cases (mean total fixation duration for BE was 5.39s vs 5.36s for EE) and for anomalies (mean total fixation duration for BE was 7.51s vs 7.32s for EE). Clear differences were noted in specific areas for each anomaly by eye tracking parameters and in voice recordings. Conclusions: This is the first study aimed at perception understanding between basic and experienced examiner in fetal echocardiography. Eye tracking modalities may be helpful in teaching, because they allow for demonstrating examiner's pattern recognition process. Objectives: The Thermal Index (TI) and Mechanical Index (MI) were introduced to provide the operator with an indication of the potential for ultrasound induced bio-effects. Most of the safety regulations stipulate limits for these two parameters that should be fulfilled during the examination. We analysed historical information from an archive of recorded examinat...

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