Objectives To evaluate the performance of ultrasonographic estimated fetal weight (EFW) at 35 + 0 to 36 + 6 weeks' gestation in the prediction of delivery of a small-for-gestational-age (SGA) neonate and assess the additive value of, first, maternal risk factors and, second, fetal growth velocity between 20 and 36 weeks' gestation in improving such prediction.Methods This was a prospective study of 44 043 singleton pregnancies undergoing routine ultrasound examination at 19 + 0 to 23+ 6 and at 35 + 0 to 36+ 6 weeks' gestation. Multivariable logistic regression analysis was used to determine whether addition of maternal risk factors and growth velocity, the latter defined as the difference in EFW Z-score or fetal abdominal circumference (AC) Z-score between the third-and second-trimester scans divided by the time interval between the scans, improved the performance of EFW Z-score at 35 + 0 to 36 + 6 weeks in the prediction of delivery of a SGA neonate with birth weight < 10 th and < 3 rd percentiles within 2 weeks and at any stage after assessment.Results Screening by EFW Z-score at 35 + 0 to 36 + 6 weeks' gestation predicted 63.4% (95% CI, 62.0-64.7%) of neonates with birth weight < 10 th percentile and 74.2% (95% CI, 72.2-76.1%) of neonates with birth weight < 3 rd percentile born at any stage after assessment, at a screen-positive rate of 10%. The respective values for SGA neonates born within 2 weeks after assessment were 76.8% (95% CI, 74.4-79.0%) and 81.3% (95% CI, 78.2-84.0%). For a desired 90% detection rate of SGA neonate delivered at any stage after assessment, the necessary screen-positive rate would be 33.7% for SGA < 10 th percentile and 24.4% for SGA < 3 rd percentile. Multivariable logistic regression analysis demonstrated that, in the prediction of a SGA neonate with birth weight < 10 th and < 3 rd percentiles, there was a significant contribution from EFW Z-score at 35 + 0 to 36 + 6 weeks' gestation, maternal risk factors and AC growth velocity, but not EFW growth velocity. However, the area under the receiver-operating characteristics curve for prediction of delivery of a SGA neonate by screening with maternal risk factors and EFW Z-score was not improved by addition of AC growth velocity.Conclusion Screening for SGA neonates by EFW at 35 + 0 to 36+ 6 weeks' gestation and use of the 10 th percentile as the cut-off predicts 63% of affected neonates. Prediction of 90% of SGA neonates necessitates classification of about 35% of the population as being screen positive. The predictive performance of EFW is not improved by addition of estimated growth velocity between the second and third trimesters of pregnancy.

CONTRIBUTIONWhat are the novel findings of this work? This study reports the incidence of non-cephalic presentation at a routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation and subsequent management of such pregnancies. What are the clinical implications of this work?Routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation detects non-cephalic presentation in about 5% of pregnancies. Such diagnosis could potentially improve pregnancy outcome by preventing unexpected abnormal presentation in labor and, through external cephalic version, reducing the incidence of non-cephalic presentation. ABSTRACTObjective Undiagnosed non-cephalic presentation in labor carries increased risks for both the mother and baby. Routine pregnancy care based on maternal abdominal palpation fails to detect the majority of cases of non-cephalic presentation. The aim of this study was to report the incidence of non-cephalic presentation at a routine scan at 35 + 0 to 36 + 6 weeks' gestation and the subsequent management of such pregnancies. MethodsThis was a retrospective analysis of prospectively collected data in 45 847 singleton pregnancies that had undergone routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. Patients with breech or transverse/oblique presentation were divided into two groups; first, those who would have elective Cesarean section for fetal or maternal indications other than the abnormal presentation, and, second, those who would potentially require external cephalic version (ECV). The latter group was reassessed after 1-2 weeks and, if there was persistence of abnormal presentation, the parents were offered the option of ECV or elective Cesarean section at 38-40 weeks' gestation. Multivariable logistic regression analysis was carried out to determine which of the factors from maternal and pregnancy characteristics provided a significant contribution in the prediction of, first, non-cephalic presentation at the 35 + 0 to 36 + 6-week scan, second, successful ECV from non-cephalic to cephalic presentation, and, third, spontaneous rotation from non-cephalic to cephalic presentation that persisted until delivery.Results First, at 35 + 0 to 36+ 6 weeks, the fetal presentation was cephalic in 43 416 (94.7%) pregnancies, breech in 1987 (4.3%) and transverse or oblique in 444 (1.0%). Second, multivariable analysis demonstrated that the risk of non-cephalic presentation increased with increasing maternal age and weight, decreasing height and earlier gestational age at scan, was higher in the presence of placenta previa, oligohydramnios or polyhydramnios and in nulliparous than parous women, and was lower in women of South Asian or mixed racial origin than in white women. Third, 22% of cases of non-cephalic presentation were not eligible for ECV because of planned Cesarean section for indications other than the malpresentation. Fourth, of those eligible for ECV, only 48.5% (646/1332) agreed to the procedure, which was successful in 39.0% (252/646) of cases. Fifth, the chance of successful...

Abstract:Objective: Benign breast disease includes a wide spectrum of lesions different for histology and natural history, whose association with oral contraceptives is of great interest because there are no univocal results in literature. Subjects and Methods: The purpose of our study is to assess the relationship between women who used long-term estro-progestin (for at least 12 consecutive months up to a maximum of 60 months) and the develop of benign breast disease comparing with a case-control group composed by patients with benign breast disease, non-users of oral contraceptives. The study included 263 women attending, from 2009 to 2012, the Gynecological Endocrinology and Ultrasounds outpatients of our Department, who used oestroprogestative pills for Contraception, treatment of acne, hirsutism and treatment of dysmenorrheal and a control group of 200 patients with benign breast disease, non-users of Oral Contraceptives.Results: According to recent trials we did not observe statistically significant morphological and anatomical alterations of the breast in the group treated with estrogen-progestin therapy in comparison with the control group. Conclusion: If the woman presents a nodular breast mass during estro-progestin therapy she should be evaluated ultrasonographically to assess if the formation grows. If there is an increase in volume of the mass the patient should suspend the therapy.

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