Noonan syndro me is a rare autosomal dominant congenital abnormality associated with a gene defect located on the short arm of chromosome 12. It is characterized by dysmorphic facies, webbed neck, short stature, lymphatic obstruction, cardiac anomalies, and intellectual disability. Prenatal diagnosis of Noonan syndrome is rare because there are no pathognomonic sonographic signs. Studies on the prenatal sonographic features of Noonan syndrome have been reported in very limited numbers. This case series of severe fetal Noonan syndrome, together with a literature review, was conducted to establish prenatal sonographic features highly suggestive of Noonan syndrome to facilitate early detection by clinicians. This study reveals that Noonan syndrome has a relatively specific pattern, which facilitates prenatal molecular genetic diagnosis. Increased nuchal translucency (NT) in the late first trimester and fluid collection in the early second trimester could be warning signs for follow-up, prompting further investigation to detect late-onset features and leading to molecular genetic confirmation. Most structural abnormalities appear in the second trimester, with progressive changes noted throughout gestation. This review better characterizes the sonographic features of fetal Noonan syndrome based on a larger sample size, illustrating a wider spectrum of prenatal phenotypes, including lymphatic drainage disorders, cardiac abnormalities, polyhydramnios, and absent ductus venosus.

Background: Pelvic organ prolapse is a common condition of pelvic floor dysfunction in women, especially in adult vaginally parous and elderly women. Because of its anatomy, the anterior compartment has a significant effect on urinary symptoms. Anterior colporrhaphy and colpocleisis are major anterior compartment prolapse-related surgeries. As we know, postoperative urinary retention (POUR) is one of the most common complications following pelvic floor surgery. To prevent this complication, indwelling bladder catheterization is routinely applied. In contrast, to minimize risk of infection and the patient’s discomfort, the catheter should be removed as soon as possible. However, there is a lack of clarity regarding the optimal timing for catheter removal. Therefore, the aim of this trial is to compare the rate of POUR after anterior prolapse surgery between early transurethral catheter removal (24 h postoperatively) and our standard practice (on postoperative day 3). Methods: We conducted a randomized controlled trial among patients undergoing anterior compartment prolapse surgery between 2020 and 2021 at a university hospital. Women were randomized into two groups. After removal, if the second void residual urine volume exceeded 150 mL, POUR was diagnosed, and intermittent catheterization was performed. The primary outcome was the POUR rate. The secondary outcomes included urinary tract infection, asymptomatic bacteriuria, time to ambulation, time to spontaneous voiding, length of hospitalization, and patient satisfaction. Analysis was performed according to the intention to treat principle. The calculated sample size was 68 patients (34 patients in each group) for a 95% confidence interval, 80% power, 5% probability of type I error, and 10% data loss. Discussion: This study demonstrated that early catheter removal was comparable in POUR rate to conventional treatment with shorter hospitalization among patients undergoing anterior compartment prolapse surgery. Additionally, we observed no re-hospitalization owing to POUR. Therefore, early transurethral catheter removal is preferable following anterior compartment prolapse-related surgery.

The ex‐utero intrapartum treatment (EXIT) procedure is a specialized delivery strategy that extends utero–placental–fetal circulation to convert a potential neonatal emergency condition into a condition that is compatible with postnatal life. Cesarean section with operation on placental support is an EXIT technique that requires a relatively short duration of placental support and few skilled medical personnel and specialized instruments; it can successfully treat selected fetal indications. In the present study, we report a case of fetal thyroid goiter as an example of a fetal anomaly requiring the procedure. We then review all cases published in the medical literature that were similar to our procedure (15 cases including our new case). Twelve (80%) cases of fetal anomalies and three prophylactic cases of extremely low birth weight were delivered using a procedure adapted from the standard EXIT procedure. All 12 cases of fetal anomalies were treated by airway intervention. In 12 of the 15 cases (80%), direct laryngoscopy and endotracheal intubation were attempted; intubation was successful in seven of these 12 cases (58%). There was only one case of postpartum hemorrhage caused by uterine incisional bleeding, with a consequence of delayed hysterotomy closure. In summary, cesarean section with operation on placental support is a promising alternative delivery technique for neonates with airway obstructive lesions, especially in resource‐limited settings.

Purpose To compare the rate of postoperative urinary retention (POUR) after anterior prolapse surgery between early transurethral catheter removal (24 hours postoperatively) and our standard practice (on postoperative day 3)Methods We conducted a randomized controlled trial among patients undergoing anterior compartment prolapse surgery between 2020 and 2021 at a university hospital. Women were randomized into two groups. After removal, if the second void residual urine volume exceeded 150 mL, POUR was diagnosed and intermittent catheterization was performed. The primary outcome was the POUR rate. The secondary outcomes included urinary tract infection, asymptomatic bacteriuria (AB), time to ambulation, time to spontaneous voiding, length of hospitalization, and patient satisfaction.Results Sixty-eight women were enrolled. There were no significant differences in baseline characteristics, intraoperative blood loss, operative time, anesthetic modalities, opioid use, and complications. The overall POUR rate was 29.4%. The POUR rate in the conventional group was 18.2% higher than that in the early-removal group; however, this was not statistically significant. (32.4% vs. 26.5%, RR 0.82; 95% CI: 0.39–1.72). There was no significant difference between groups for postoperative AB rate (14.7 vs. 0%, p=0.053). The early-removal group had shorter lengths of hospital stay (1 day vs. 3 days, p<0.001) and 3.8 hours earlier time to ambulation (p=0.2), without significant differences in postoperative patient satisfaction. Conclusion Among patients undergoing anterior compartment prolapse surgery, early catheter removal was comparable in POUR rate to conventional treatment, with shorter hospitalization. Therefore, early transurethral catheter removal is preferable following anterior compartment prolapse surgery. Clinical trial registration number thaiclinicaltrials.org, TCTR20210309003, 09 March 2021, retrospectively registered.

Background/Objectives: First-trimester anatomical screening (FTAS) enables early detection of fetal structural anomalies. However, data on transvaginal ultrasound performance across different operator experience levels remains limited. The primary objective was to compare the performance of transvaginal FTAS between inexperienced and experienced operators by comparing complete scan rates and anatomical visualization scores. The secondary objectives were to compare scan duration and learning curves between the two operators and to identify factors associated with successful examinations. Methods: In this randomized controlled trial, participants underwent transvaginal FTAS performed either by a first-year maternal–fetal medicine (MFM) fellow (inexperienced operator) or an MFM specialist (experienced operator) according to International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines. Complete scan rates, anatomical visualization scores, scan duration, factors affecting visualization, and learning curves were compared between groups. Results: A total of 139 participants were included in the analysis, with 70 and 69 examinations performed by the inexperienced and experienced operators, respectively. Complete scan rates and visualization scores were not significantly different between groups (41.4% vs. 44.9% and 86.4% vs. 91.2%, respectively). On multivariate analysis, operator experience was independently associated with higher visualization scores (p = 0.010), but not complete scan rates. Scan duration was similar between groups (median (IQR): 20 (17) vs. 20 (15) min; p = 0.211). Fetal presentation and uterine position significantly influenced visualization outcomes. The inexperienced operator demonstrated a trend of gradual improvement over time, though not significantly, whereas the experienced operator maintained stable performance throughout the study period. Conclusions: After training, no statistically significant differences were observed between less experienced and experienced operators with respect to complete scan rate, scan duration, and learning curve, although visualization score was significantly higher in the experienced examiner on multivariate analysis. However, our findings should be interpreted with caution, as the conclusions were based on the performance of only one examiner in each group.

Objectives: To primarily determine the effect of a previous cesarean section on Doppler studies of the uterine artery, umbilical artery, and umbilical vein. Patients and Methods: This prospective study was conducted on singleton pregnancies between 18 and 22 weeks of gestation, including both women with and without a previous cesarean section. Doppler studies of the uterine artery, umbilical artery, and umbilical vein indices were performed during mid-trimester fetal ultrasound scans. Doppler indices and pregnancy outcomes were compared between the two groups. Results: A total of 351 pregnancies, including 74 women with a previous cesarean section and 277 women with an unscarred uterus, underwent Doppler studies. The uterine artery pulsatility index (PI) and resistance index (RI) were significantly higher in women with a previous cesarean section (p < 0.001). Moreover, both univariate and multivariate analyses demonstrated that a previous cesarean section was significantly associated with an increase in uterine artery PI, RI, and the rate of abnormal uterine artery PI, defined as values above the 95th percentile (p = 0.034). Other Doppler study results, as well as pregnancy outcomes, were comparable between the two groups. Conclusions: Pregnant women with a previous cesarean section have significantly higher uterine artery resistance, and a higher rate of abnormal uterine artery PI during mid-pregnancy. Therefore, a cesarean section may be detrimental to uterine arterial health. However, no significant adverse clinical outcomes were observed.