(Am J Obstet Gynecol. 2017;217(1):63.e1–63.e10) Cesarean delivery rates are on the rise in the United States, in part because of the increased use of cesarean delivery rather than forceps and vacuum deliveries for fetal distress and arrest disorders in the second stage of labor. However, cesarean delivery in the second stage of labor can be risky due to the difficulty of delivering a deeply impacted fetal head. Cohort studies have shown increased risk of extensions of the uterine incision, bladder injury, and postpartum hemorrhage in such deliveries. Surgical trauma to the cervix from other procedures has been demonstrated to significantly increase the risk of subsequent premature delivery. For these reasons, the authors hypothesized that second-stage cesarean deliveries may increase the rate of subsequent spontaneous preterm delivery.

The findings of this study suggest that there is no difference in the rate of fetal intolerance of labor in pregnancies with a borderline AFI and those with a normal AFI. Pregnancies complicated by a borderline AFI are more likely to undergo antepartum testing, yet the benefit is unclear. Significantly more patients with a borderline AFI had underlying growth restriction, which may provide a useful tool for risk stratification in the management of a borderline AFI.

An increasing BMI category was associated with decreased completion of standard and detailed anatomic surveys by 20 weeks' estimated GA. Strategies to improve early visualization of the fetal head, chest, and abdomen in obese women should be investigated to promote anomaly detection and appropriate counseling.

As the concept of cervical insufficiency has evolved from a poorly defined clinical/anatomic entity into 1 component of the spontaneous preterm birth syndrome, so have cerclage applications. Originally developed to treat history-defined cervical insufficiency and acute cervical insufficiency, cerclage is now utilized on a larger scale for the prevention of recurrent spontaneous preterm birth. As its role expands, the need for prospective data evaluating cerclage techniques and modifications is emphasized. Herein, we will review the techniques, modifications, risks, efficacy, and evidence-based applications of the cerclage procedure in contemporary clinical practice.

Over 90% of anomalies are detected on the initial fetal anatomic survey. The incremental diagnostic yield then decreases, requiring appreciably more repeat scans to detect one anomaly.