The July issue of Ultrasound in Obstetrics & Gynecology contains 13 Original Articles; two Editorials; and a Systematic Review.
Please see below a selection of articles from the July issue of the Journal chosen specially by the UOG team. To view all UOG content become an ISUOG member today.
Preterm birth: prediction and prevention
Preterm birth, defined as birth before 37 weeks of gestation, is the leading cause of neonatal mortality worldwide and can have long-term effects on survivors. In this issue of UOG are a number of articles that discuss screening for and prevention of preterm birth. In an Editorial, Hughes et al. evaluate the current evidence for cervical length as a predictor of spontaneous preterm birth, Szychowski et al. assess a continuum of cervical length cut-offs for the efficacy of ultrasound-indicated cerclage in women with previous spontaneous preterm birth and Pagani et al. study the optimal cut-off value of cervical length for predicting spontaneous preterm birth before 32 weeks’ gestation in twin pregnancy. In a secondary analysis of the ProTWIN trial that found prophylactic use of a cervical pessary reduced the risk of adverse perinatal outcome in women with a multiple pregnancy and a cervical length <38 mm, Tajik et al. developed a multivariable logistic model to assess whether other maternal or pregnancy characteristics collected at baseline can improve identification of women most likely to benefit from pessary placement.
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In a prospective cohort study, Min et al. evaluate the ability of a preterm surveillance clinic to risk-stratify women for preterm birth by comparing outcomes of those admitted to hospital with those not admitted on the basis of asymptomatic testing at the clinic. They found that gestational age at delivery was significantly later and the incidence of preterm birth < 30 weeks was significantly lower in those managed as outpatients compared to those admitted electively following assessment at the surveillance clinic. The incidence of other complications such as neonatal death, 5-min Apgar score<7, special care baby unit/neonatal intensive care unit admission, respiratory distress syndrome, intraventricular hemorrhage and low birth weight were significantly lower in those managed as outpatients than in those admitted electively.
This article was chosen for Journal Club. View the
full article and accompanying Journal Club slides
Diagnostic imaging tools to elucidate decreased cephalic biometry and fetal microcephaly
In routine practice, any decrease in cephalic biometry to <5th percentile raises suspicion of underlying microcephaly. However, distinction must be made between suspicion of microcephaly and true microcephaly, especially in this era of Zika virus infection. In an Editorial, Guibaud and Lacalm outline a systematic approach to the management of patients referred due to an unexplained decrease in cephalic biometry. Their approach is based on a set of diagnostic tools to diagnose and elucidate a decrease in fetal cephalic biometry, which may lead to suspicion of microcephaly with underlying central nervous system structural anomalies. The tools are tailored for ultrasound examination but can be applied to investigations by magnetic resonance imaging.
View the full article.
Delayed rotation of the cerebellar vermis
Two cases of delayed rotation of the cerebellar vermis that simulated a Dandy–Walker malformation (DWM) on early second-trimester magnetic resonance imaging (MRI) are described in a case report by Pinto et al. In both cases, upward rotation of the cerebellar vermis was noted, cerebellar morphometry showed a reduced vermian anteroposterior diameter compared to reference data and the posterior fossa appeared to be mildly enlarged, while all other findings were normal. Follow-up MRI and developmental assessment at 1 year of age showed completely normal findings. Incomplete rotation of the cerebellar vermis can be a physiological finding on early second-trimester fetal MRI examination and can simulate DWM or other forms of cerebellar hypoplasia. Follow-up imaging at a later gestational age is crucial to ensure that this condition is not over-reported and to avoid unnecessary pregnancy interruption. View the full article.
This article is only available to subscribers of UOG; remember to login to the ISUOG website to access this article, or become an ISUOG member to subscribe to UOG.