The May issue of Ultrasound in Obstetrics & Gynecology contains 15 Original Articles, including a number of articles on microcephaly and on the pregnancy complication pre-eclampsia; an Opinion and Systematic Review on the prevention of pre-eclampsia by a combination of heparin and aspirin; plus an Editorial on the benefits of contingent vs primary screening by cell-free DNA.
Please see below a selection of articles from the May issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today.
Zika virus and microcephaly
Evidence linking Zika virus infection in pregnancy with fetal microcephaly is being increasingly reported. The definition of microcephaly at birth is, however, not uniform and the yield of the commonly used head circumference reference charts for prediction of microcephaly at birth is considered low. Two articles in this issue study reference ranges for microcephaly: in an article by Leibovitz et al., three reference ranges for fetal head circumference to predict microcephaly at birth are compared in order to identify the most accurate and ultimately improve prenatal diagnosis; and a second article by Leibovitz et al. proposes the use of a novel prenatal vertical cranial biometric measurement to improve the accuracy of an in-utero diagnosis of microcephaly. In addition, Werner et al. correlate prenatal imaging of intrauterine Zika virus infection and microcephaly with three-dimensional virtual physical models in our Picture of the Month article.
Screening and prevention of pre-eclampsia
Pre-eclampsia (PE) occurs in 2–8% of pregnancies and is associated with impaired placentation. The ability to both predict and prevent its development is one of the major objectives in fetal–maternal medicine. Meta-analyses of randomized controlled trials (RCTs) have reported that the prophylactic use of low-dose aspirin, started ≤ 16 weeks' gestation, can reduce the prevalence of PE and SGA in high risk pregnancies. It is becoming increasingly apparent that heparin plays a similar role in the prevention of these conditions. In a systematic review of eight RCTs, Roberge et al. investigate the impact of adding low-molecular-weight heparin (LMWH) or unfractionated heparin to low-dose aspirin on the prevalence of PE and delivery of a small-for-gestational-age SGA neonate. They found that, in women with a history of PE, treatment with LMWH and aspirin, compared with aspirin alone, was associated with a significant reduction in development of PE and delivery of a SGA neonate.
View the full article and an associated Opinion piece by UOG’s Editor, Alexandros Sotiriadis.
This article has also been converted into this month’s Journal Club slides by Dr Maddalena Morlando.
A new study by Kypros Nicolaides’ group has explored the possibility of carrying out a two-stage screening program for preterm pre-eclampsia, in which second-stage screening is contingent on the results of first-stage screening. In this study, Wright et al. propose that routine screening by maternal factors and mean arterial pressure (MAP) is performed in all pregnancies and measurements of uterine artery pulsatility index and placental growth factor are reserved for a subgroup of the population, selected on the basis of the risk derived from screening by maternal factors and MAP alone. The consequence of such a screening strategy achieved a similarly high detection rate (81%), at substantially lower costs, than carrying out screening with all biomarkers in the whole population.
View the full article here.
For further material on pre-eclampsia please see the following May articles:
First- and second-trimester maternal serum markers of pre-eclampsia in twin pregnancy, by Svirsky et al.
Uterine artery pulsatility index at 12, 22, 32 and 36 weeks' gestation in screening for pre-eclampsia, by O’Gorman et al.
Mean arterial pressure at 12, 22, 32 and 36 weeks' gestation in screening for pre-eclampsia, by Tayyar et al.
Placental histological patterns and uterine artery Doppler velocimetry in pregnancies complicated by early or late pre-eclampsia, by Orabona et al.