ObjectiveThe aim of the study was to evaluate fetal head-perineum distance measured by transperineal ultrasound imaging as a predictive factor for successful induction of labor. Patients and methodsIn all, 100 women scheduled for induction of labor with the head engaged were examined by both transvaginal and transperineal ultrasound together with the Bishop score. Follow-up was performed and outcome was compared. Receiver operating characteristic (ROC) curve was performed to estimate the best cutoff value. ResultsAreas under the ROC curve for prediction of vaginal delivery were 78% [95% confidence interval (CI), 61-95%] for fetal head-perineum distance (P = 0.04), 73% (95% CI, 61-94%) for cervical length (P = 0.05), 42% (95% CI, 26-60%) for cervical width (P = 0.044), and 59% (95% CI, 34-85%) for Bishop score (P = 0.046). The ROC curves indicated that fetal head-perineum distance of 8.6 cm or less and cervical length of 3.3 cm or less were the best cutoff levels for predicting the mode of delivery. Conclusion Fetal head-perineum distance measured by transperineal ultrasound imaging is a good predictive factor for successful induction of labor in pregnant women with engaged head.

A 49-year-old woman presented to the hospital with shortness of breath 2 weeks after a left total hip replacement. She was found to have a submassive pulmonary embolism (PE), with her case complicated by the detection of a large mobile clot in transit extending through a patent foramen ovale between the right and left atria. The presence of this free-floating right heart thrombus (FFRHT) increases her risks of stroke and mortality, yet the optimal approach to her treatment was unclear. Ultimately, intravenous tissue plasminogen activator was administered with resolution of the clot. Treatment was complicated by haemodynamically insignificant bleeding at the site of recent surgery. Herein, we further discuss the implications and treatment options for patients with an FFRHT in the setting of an acute PE.

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B-lines on lung ultrasound are an early finding in patients with decompensated heart failure. Hence, monitoring heart failure patients in their home environment with lung ultrasound could help to prevent hospital admissions. The aim of this project is to investigate whether tele-guided patient-performed lung ultrasound in the home environment is feasible. METHODS:Stable ambulatory patients with heart failure NYHA class 1-3 were included in the study. Patients received a handheld ultrasound probe connected to a tablet (patients 1 to 3) or a smartphone. Initial instructions were given during either a clinic visit or a remote visit. Patients each performed between 10 and 12 daily tele-guided ultrasound sessions, interrupted by weekends and occasional days of unavailability. During each session, patients were guided via verbal and visual instructions by a remotely connected physician. Over each side of the chest, 3 locations within the 3 rd intercostal space were examined, moving from the mid-clavicular line to the anterior and the mid axillary line. Patients also reported their weight and level of dyspnea, graded on a 5-point scale. Ultrasound clips were reviewed by two independent reviewers, and graded as interpretable if the pleural line plus at least one A-line or any B-lines were visible. Gain and depth were graded as appropriate or inappropriate.RESULTS: Eight patients, 2 of them female, performed a total of 89 tele-guided lung ultrasound sessions. There were no major technical problems, and 88% (reviewer 1) and 84% (reviewer 2) of all clips were interpretable. A total of 92% (reviewer 1) and 90% (reviewer 2) of lung ultrasound exams had at least 4 out of 6 interpretable clips. Inter-reviewer agreement was substantial with 93% of observations and a Cohen's Kappa of 0.7. More than 97% of all clips had appropriate gain and depth settings. No patient had abnormal B-lines at any exam, and none was admitted for heart failure exacerbation. Most patients (6 of 8) reported stable dyspnea scores of 1 throughout. No patient had a dyspnea score of more than 3 or weight gain more than 3% above dry weight.CONCLUSIONS: Tele-guided patient-performed lung ultrasound in heart failure patients in their home environment is feasible. High quality ultrasound clips were obtained, as evidenced by 90% or more of exams being diagnostically usable with at least 4 out of 6 interpretable clips. No heart failure decompensations were observed, and no false positive B-lines were recorded. To determine whether this technology can be used to early detect decompensations, more unstable patients need to be included with a longer study period.CLINICAL IMPLICATIONS: Tele-guided patient-performed lung ultrasound is feasible. This could have far-reaching diagnostic implications, not just for heart failure patients.