Artificial intelligence (AI) has gained prominence in medical imaging, particularly in obstetrics and gynecology (OB/GYN), where ultrasound (US) is the preferred method. It is considered cost effective and easily accessible but is time consuming and hindered by the need for specialized training. To overcome these limitations, AI models have been proposed for automated plane acquisition, anatomical measurements, and pathology detection. This study aims to overview recent literature on AI applications in OB/GYN US imaging, highlighting their benefits and limitations. For the methodology, a systematic literature search was performed in the PubMed and Cochrane Library databases. Matching abstracts were screened based on the PICOS (Participants, Intervention or Exposure, Comparison, Outcome, Study type) scheme. Articles with full text copies were distributed to the sections of OB/GYN and their research topics. As a result, this review includes 189 articles published from 1994 to 2023. Among these, 148 focus on obstetrics and 41 on gynecology. AI-assisted US applications span fetal biometry, echocardiography, or neurosonography, as well as the identification of adnexal and breast masses, and assessment of the endometrium and pelvic floor. To conclude, the applications for AI-assisted US in OB/GYN are abundant, especially in the subspecialty of obstetrics. However, while most studies focus on common application fields such as fetal biometry, this review outlines emerging and still experimental fields to promote further research.

Medical devices directly exposed to blood are commonly used to treat cardiovascular diseases. However, these devices are associated with inflammatory reactions leading to delayed healing, rejection of foreign material or device-associated thrombus formation. We developed a novel recombinant fusion protein as a new biocompatible coating strategy for medical devices with direct blood contact. We genetically fused human serum albumin (HSA) with ectonucleoside triphosphate diphosphohydrolase-1 (CD39), a promising anti-thrombotic and anti-inflammatory drug candidate. The HSA-CD39 fusion protein is highly functional in degrading ATP and ADP, major pro-inflammatory reagents and platelet agonists. Their enzymatic properties result in the generation of AMP, which is further degraded by CD73 to adenosine, an anti-inflammatory and anti-platelet reagent. HSA-CD39 is functional after lyophilisation, coating and storage of coated materials for up to 8 weeks. HSA-CD39 coating shows promising and stable functionality even after sterilisation and does not hinder endothelialisation of primary human endothelial cells. It shows a high level of haemocompatibility and diminished blood cell adhesion when coated on nitinol stents or polyvinylchloride tubes. In conclusion, we developed a new recombinant fusion protein combining HSA and CD39, and demonstrated that it has potential to reduce thrombotic and inflammatory complications often associated with medical devices directly exposed to blood.

Background: The Birth Satisfaction Scale-Revised (BSS-R) is a validated questionnaire for assessment of childbirth experience which has been translated into many languages. It is the instrument of choice in the International Consortium for Health Outcomes Measurement (ICHOM) standard set for ‘Pregnancy and Childbirth’. Translation of the key outcome measures from English into German language was previously performed, but its validation is pending. Aim and Objectives: To analyze the key psychometric properties of the German version of the BSS-R (Ger-BSS-R), and to evaluate its application in women with chronic conditions. Methods: 248 women with pre-existing medical conditions were provided with the Ger-BSS-R during hospital inpatient stay for childbirth. The 10-item measurement contains three sub-scales for assessing quality of care provision (QC), women’s personal attributes (WA), and stress experienced during labor (SE). Results: Complete data was available in N = 224 cases. After removal of four multivariate outliers, N = 220 were available for psychometric evaluation. The cesarean section rate was 50.5%, prematurity occurred in 14.5% of deliveries and induction of labor was performed in 49.7% of cases with planned vaginal delivery. Mean total BSS-R score was 25.7 (SD 5.94). In the confirmatory factor analysis, the tri-dimensional measurement model was found to offer a good fit to Ger-BSS-R data. For internal consistency, the total, SE and QC sub-scale Cronbach’s alphas were significantly lower than those of the founder version. Conclusions: The Ger-BSS-R is a robust instrument for assessing birth satisfaction. This is the first study to apply the BSS-R in women with pre-existing medical conditions. Compared to the founder UK version, differences in total BSS-R scores and sub-scales for experience of stress and quality of care are present, requiring further investigations.

Background: Pregnancies in women with pre-existing medical conditions are on the rise. These pregnancies are characterized by an increased rate of maternal and perinatal complications, which can result in higher health care expenditures and altered pregnancy experiences. The purpose of this study is to integrally analyze maternity care for women with pre-existing conditions in the framework of a risk-adapted, interdisciplinary care by recording three substantial parts of maternity care: (1) maternal and perinatal outcome; (2) hospital costs and reimbursements covering the period from preconception counseling or initial antenatal visit to discharge after birth; and (3) women’s experience of reproductive choice and becoming a mother in the presence of a pre-existing condition.Methods: In this observational, prospective, longitudinal, and monocentric cohort study, we aim to include a total of 1,500 women over a recruitment period of 15 months. Women registering for care at the Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Germany, are allocated to three groups based on their health and risk status: women with pre-existing conditions, as well as healthy women with obstetric risk factor and healthy women with a low-risk pregnancy. Participants are observed from time of initial consultation until discharge after birth. Analysis focuses on (1) maternal and perinatal outcome, especially rate of severe maternal and neonatal morbidity; (2) costs and reimbursements; and (3) surveys to capture of women’s experience and health-related quality of life during the time of reproductive choice, pregnancy, and childbirth in the presence of pre-existing medical conditions.Discussion: With its complex three-dimensional design, the ForMaT-Trial is aiming to provide a comprehensive analysis of pregnancy and childbirth in women with pre-existing conditions. The results may serve as a basis for counseling and care of these women. By analyzing costs of specialized care, data for discussing reimbursement are generated. Lastly, our results may increase awareness for the perception of reproductive choice, pregnancy and motherhood in this continuously rising population.Clinical trial registration: German Clinical Trials Register, DRKS00030061, October 28, 2022.

Objectives: Pregnancies in women with Fontan circulation are on the rise, and they are known to imply high maternal and fetal complication rates. The altered hemodynamic profile of univentricular circulation affects placental development and function. This study describes placental sonomorphologic appearance and Doppler examinations and correlates these to histopathologic findings and pregnancy outcomes in women with Fontan circulation. Methods: A single-center retrospective analysis of pregnancies in women with Fontan circulation was conducted between 2018 and 2023. Maternal characteristics and obstetric and neonatal outcomes were recorded. Serial ultrasound examinations including placental sonomorphologic appearance and Doppler studies were assessed. Macroscopic and histopathologic findings of the placentas were reviewed. Results: Six live births from six women with Fontan physiology were available for analysis. Prematurity occurred in 83% (5/6 cases) and fetal growth restriction and bleeding events in 66% (4/6 cases) each. All but one placenta showed similar sonomorphologic abnormalities starting during the late second trimester, such as thickened globular shape, inhomogeneous echotexture, and hypoechoic lakes, resulting in a jelly-like appearance. Uteroplacental blood flow indices were within normal range in all women. The corresponding histopathologic findings were non-specific and consisted of intervillous and subchorionic fibrin deposition, villous atrophy, hypoplasia, or fibrosis. Conclusions: Obstetric and perinatal complication rates in pregnancies of women with Fontan circulation are high. Thus, predictors are urgently needed. Our results suggest that serial ultrasound examinations with increased awareness of the placental appearance and its development, linked to the Doppler sonographic results of the uteroplacental and fetomaternal circulation, may be suitable for the early identification of cases prone to complications.

Background B-Lynch sutures for treatment of postpartum hemorrhage still seem to be unidentified as a possible risk factor for uterine rupture. Our rare case highlights the fact that knowing risk factors for uterine rupture is essential for patient’s management. Clinical history/findings A 38-year-old GII/PI at 34+4 weeks of gestation was admitted with acute abdominal pain and circulatory disorders. No trauma or uterine contractions were reported. The patient had a history of a caesarean section 34 months earlier with application of B-Lynch sutures. The cardiotocography detected a normal fetal heart rate. An abdominal ultrasound showed a transverse fetal position, free fluid and an abrupt discontinuation of the myometrium in the lower uterine segment. The decision to perform an urgent caesarean section has been taken. Diagnosis Intraoperatively, a hemoperitoneum and a dehiscence of the scar in the lower uterine segment was found. Moreover, the uterine fundus showed the pictured rupture in between the grooves of the previous B-Lynch sutures, extending through all uterine wall layers. Management/outcome: The delivery of the newborn was performed by a low transverse uterine incision without complications (APGAR 7/8/8). The defect was repaired in two layers. Both were discharged in good condition. Article published online: 11 October 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany