Objective: To evaluate uterine artery blood flow during the first trimester of pregnancy in women with a history of chronic endometritis (CE).

Materials and Methods. A retrospective analysis included 331 pregnant women with previously diagnosed and treated CE. The control group comprised 219 pregnant women with no  history of endometrial inflammation. Doppler parameters of uterine artery blood flow were assessed, including the calculation of the uterine arterial perfusion index (UAPI), at 5–7⁺⁶, 8–10⁺⁶, and 11–13⁺⁶ weeks of gestation.

Results. Following CE treatment, no significant increase in blood flow velocities was observed between 5–7⁺⁶ and 8–10⁺⁶ weeks of gestation; however, a significant increase occurred by 11–13⁺⁶ weeks (p < 0.05). In the study group, no decrease in pulsatility index (PI) and resistance index (RI) was observed from week 5 to week 11, but values in both groups became comparable after 11 weeks. Between 5 and 11 weeks of gestation, the UAPI significantly decreased in the CE group and was lower than in controls (p < 0.05). In these patients UAPI increased significantly on first-trimester screening, but remained lower than in the control group. The relative risk of adverse pregnancy outcomes in the CE group was: 3.52 (95% CI: 0.82–15.09) at 5–7⁺⁶ weeks, 4.50 (95% CI: 0.59–34.08) at 8–10⁺⁶ weeks and 1.49 (95% CI: 0.58–3.84) at 11–13⁺⁶ weeks.

Conclusion. Abnormal uterine artery blood flow patterns in women with prior CE may indicate impaired placentation, potentially contributing to adverse pregnancy outcomes.

Objective: to establish ultrasound diagnostic criteria for labor dystocia (uterine inertia) during the second stage of labor.

Materials and Methods. A prospective study was conducted involving 253 patients. The study group consisted of 73 women whose labor was complicated by second-stage labor dystocia. Within this group, oxytocin augmentation was effective in 40 (54.8%) patients, resulting in vaginal delivery; in 11 (15.1%) patients, augmentation was entirely ineffective, and delivery was completed by Cesarean section. In 22 (30.1%) patients diagnosed with labor dystocia, delivery was completed by vacuum extraction; among these, 17 underwent oxytocin augmentation, and 5 were subsequently excluded from the data analysis due to the development of fetal hypoxia. In 5 cases, labor dystocia was recorded when the fetal head was already on the pelvic floor with conditions met for vacuum extraction, leading to the decision to forego oxytocin augmentation. The control group consisted of 180 patients with an uncomplicated second stage of labor. Starting from the onset of the second stage, all patients underwent hourly transperineal ultrasound to determine the angle of progression (AoP) and the delta angle of progression (ΔAoP). The diagnosis of labor dystocia was established clinically using digital vaginal examination based on the classical criteria that the fetal head should normally progress through the birth canal at a rate of one pelvic plane or more per hour.

Results. In uncomplicated labor (“green zone”), the AoP at the beginning of the second stage is ≥120°, and the leading point of the fetal head is located below the interspinal plane, with hourly increases in AoP and ΔAoP being ≥20° and ≥16°, respectively. In cases where the AoP was ≤110° at the beginning of the second stage, labor was complicated by dystocia in all patients, requiring prolonged augmentation; the hourly increase in AoP did not exceed 10° (median 5.6° [0–10°]). The median ΔAoP at the time of labor dystocia diagnosis was 7° [0–10°] ("red zone"), and these parameters differed significantly between the study and control groups (p < 0.01). Thus, objective ultrasound criteria for the development of labor dystocia were defined as: AoP ≤110°, AoP dynamics ≤10°/hour, and ΔAoP ≤10°. A diagnosis of labor dystocia is established when two or more criteria were identified during hourly measurements. If AoP and ΔAoP values fell between the boundaries of the “green” and “red” zones (“yellow zone”), measurements were performed hourly for the following 2 hours; a diagnosis of labor dystocia was made if the values remained within the yellow zone upon repeated assessment.

Conclusion. Dynamic ultrasound during the second stage of labor provides the opportunity for timely diagnosis of labor dystocia based on objective criteria. This approach reduces the number of digital vaginal examinations, thereby decreasing the risk of maternal and fetal infectious complications, improving maternal birth satisfaction, and preventing unnecessary interventions such as unjustified augmentation or operative delivery, which may ultimately improve perinatal outcomes.

Preterm birth (PTB) is the leading cause of neonatal and infant morbidity and mortality. This review summarizes current advances in ultrasound (US) for the prediction of spontaneous PTB. Special attention is paid to the methodology of transvaginal cervicometry, as well as other US features such as intra-amniotic "sludge," the uterocervical angle, the endocervix, fetal membrane assessment, elastography, and fetal response markers. The review also emphasizes the necessity of developing standardized protocols and performing validation studies to improve the reproducibility and clinical efficacy of US parameters used to predict spontaneous PTB.

To date, it has been established that ultrasound cervicometry performed between 15 and 24 weeks of gestation effectively predicts extremely early PTB due to cervical insufficiency (CI); however, these standards of examination are often not followed in routine clinical practice.

The assessment of elastography paremeters, the uterocervical angle, and the glandular index as predictors of CI-related PTB remains controversial, as does the assessment of fetal membranes, the presence of “sludge”, and fetal organ evaluation as predictors of infectious-related PTB. Although these markers hold certain potential for risk stratification, their prognostic value does not exceed that of transvaginal cervicometry, necessitating the development of models based on multifactorial analysis.

Conclusion. Given the multi-etiological nature of the PTB syndrome, further research is required to identify independent, highly specific ultrasound predictors based on the probable etiology and their combination with other clinical and laboratory markers within multifactorial prognostic models. This will allow for timely and differentiated prophylaxis of spontaneous preterm birth in high-risk patients and, if necessary, facilitate patient triage to specialized centers capable of providing high-tech care for low-birth-weight preterm neonates.

Objective: to determine the diagnostic value of ultrasound features in chronic endometritis (CE) and identify the most significant features of the disease.

Materials and Methods. The study included 130 patients. The main group consisted of 98 women aged 23–45 years with infertility and recurrent pregnancy loss. CE was morphologically confirmed in all cases. The patients were divided according immunohistochemistry data into subgroups of CE with autoimmune component (n = 50) and CE without autoimmune component (n = 48). The control group included 32 women with normal endometrial morphology undergoing evaluation before assisted reproductive technology (ART) cycles due to male-factor infertility. Pelvic ultrasound was performed on days 6–9 and 18–23 of the menstrual cycle. From day 6 to day 9 of the cycle, the following ultrasound parameters were assessed: hyperechoic inclusions in the basal layer of the endometrium; an indistinct, irregular, or non-visualized endometrial midline; a hyperechoic endometrial midline; and free fluid in the uterine cavity. From day 18 to day 23 of the cycle, the following were evaluated: endometrial thickness, the vascularization coefficient of the uterine junctional zone, an indistinct outer endometrial contour, discordance between the endometrial structure and the menstrual cycle phase, and the presence of intrauterine synechiae. Factor analysis was performed to determine the significance of the aforementioned CE predictors in forecasting CE with and without an autoimmune component. The strength of the correlation coefficients was evaluated using the Chaddock scale. Subsequently, binary logistic regression was used to develop prognostic models for the probability of detecting various forms of CE for each of the identified features.

Results. According to the factor analysis results, the following features showed a strong correlation with chronic endometritis (CE): a vascularization coefficient of less than 20.9% and an endometrial thickness of less than 7 mm during the window of implantation (WOI). A moderate correlation was observed for the “indistinct outer endometrial contour” marker. All other features showed a weak correlation. Subsequently, binary logistic regression was used to develop prognostic models for the probability of identifying various forms of CE for each marker. For the detection of CE with an autoimmune component, the sensitivity and specificity of the model based on “endometrial thickness < 7 mm” were 84.4% and 80.0%, respectively; for the “vascularization coefficient < 20.9%” – 82.7% and 90.0%; and for the “indistinct outer endometrial contour”, 66.0% and 93.3%, respectively. In predicting CE without an autoimmune component, the sensitivity and specificity were: 38.5% and 88.2% for “endometrial thickness < 7 mm”; 68.7% and 87.5% for “vascularization coefficient < 20.9%”; and 61.0% and 84.0% for “indistinct outer endometrial contour”, respectively. Prognostic models based on features with weak correlation, such as discordance between the endometrial structure and the menstrual cycle phase or the presence of intrauterine synechiae, showed low sensitivity and specificity, often failing to reach statistical significance.

Conclusions. Among the ultrasound features of CE (both with and without an autoimmune component), the following demonstrated the highest predictive value: the vascularization coefficient of the uterine junctional zone, an endometrial thickness of less than 7 mm, and an indistinct outer endometrial contour during the window of implantation.

Current guidelines for patients after transcatheter aortic valve implantation (TAVI) recommend a multiparametric echocardiographic assessment to detect structural valve disorders (SVD). The article highlights the specific features of echocardiographic evaluation post-TAVI. It describes the nuances of visual assessment regarding the prosthesis position and shape. The calculation of hemodynamic characteristics is presented, taking into account critical methodological aspects in TAVI patients, as well as the features of quantitative assessment for both of intraprosthetic and paraprosthetic regurgitation flows.

The review presents current literature data and authors clinical cases on the use of the artificial intelligence-based S-Detect software for automated breast lesion detection and analysis. According to the literature data, the diagnostic accuracy of S-Detect for breast malignancy reaches 86–93%. False-positive results of S-Detect frequently occurred in large benign lesions and in lesions containing calcifications. False-negative results were observed in small malignant tumors and in the absence of calcifications. Several studies report improved diagnostic accuracy in differentiating small (≤20 mm) breast lesions using S-Detect. Inter-plane discordance (inconsistent results across different imaging planes) suggests cautious interpretation. Overall, diagnostic accuracy of S-Detect is comparable to contrast-enhanced ultrasound (CEUS) and superior to elastography. The “High Accuracy” mode appears optimal among available modes (High Sensitivity, High Accuracy, High Specificity). S-Detect demonstrates significantly higher specificity than physicians, particularly for BI-RADS 4a lesions, although 1–7% of malignant tumors may be missed. Most authors note that sensitivity of S-Detect is generally lower than that of experienced physicians. Diagnostic accuracy exceeds that of less experienced physicians (1–2 years of practice) but is comparable to experts.

S-Detect proved to be more effective when used by clinicians with limited experience (1–2 years), which may significantly reduce the number of unnecessary invasive procedures. No significant increase in diagnostic accuracy was observed when experts used S-Detect. Several authors suggest that S-Detect can be utilized as a training tool for novice physicians and holds promise for use in resource-limited regions to reduce the workload on medical staff.

These guidelines may have been translated, from the originals published by ISUOG, by recognized experts in the field and have been independently verified by reviewers with a relevant first language. Although all reasonable endeavors have been made to ensure that no fundamental meaning has been changed the process of translation may naturally result in small variations in words or terminology and so ISUOG makes no claim that translated guidelines can be considered to be an exact copy of the original and accepts no liability for the consequence of any variations. The guidelines are only officially approved by the ISUOG in their English published form.