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The July issue of Ultrasound in Obstetrics & Gynecology contains 13 original papers including a number of gynecological articles, plus an Editorial focusing on diagnostic tools to explain ‘isolated’ ventroculomegaly; two free-access Systematic Reviews on the reliability of reproducibility studies and on maternal cardiac function, abnormal placentation and pregnancy outcome, plus much more supplementary content.

ISUOG News: 02 July 2015

Please see below a selection of free- and open-access articles from the July issue of the Journal specially chosen by the UOG team. To view all UOG content, become an ISUOG member, today.

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Etiological diagnostic tools to elucidate ‘isolated’ ventriculomegaly
Ventriculomegaly, a brain condition that occurs when the lateral ventricles become dilated, is the most common abnormal finding that leads to a diagnosis of fetal central nervous system pathology and the most common indication for second-level neurosonography and fetal MRI. Its severity is based on strict criteria according to the atrial width of the lateral ventricle. An Editorial by Laurent Guibaud and Audrey Lacalm propose a diagnostic algorithm based on a set of etiological diagnostic tools to elucidate isolated, or unexplained, ventriculomegaly. They have found that, since the introduction of this approach into routine practice, the number of cases with unexplained ventriculomegaly encountered in their department has decreased substantially.

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This article is only available to subscribers of UOG; remember to log into the ISUOG website to access this article, or become an ISUOG member to subscribe to UOG.

True reproducibility of ultrasound techniques in obstetrics and gynecology
Studies that evaluate reproducibility tests help discriminate between the instruments available, helping clinicians to make informed decisions on which treatment methods to pursue. However, these studies need to be well designed, performed and properly interpreted to prevent false confidence in certain methods. A systematic review by Marcela Coelho Neto et al. examined the quality of methods and accuracy of interpretation in one hundred and fourteen published reliability studies on ultrasound measurements and judgements in obstetrics and gynecology, of which only 16 were found to be both well designed and accurately evaluated. The majority of published studies were found to have errors in study design and inaccuracies in interpretation which may jeopardize clinical practice and future research as treatment decisions, such as surgery, may be based on unreliable results.

View the full free access article.

To complement the free-access Systematic Review this month on the reliability of reproducibility, we are pleased to make the presentation 'True Reproducibility of Ultrasound Techniques' by co-author W. Martins open access for July.

Maternal cardiovascular status influences the process of placentation and pregnancy outcome
Women with pre-existing heart disease experience more pregnancy-related complications than do healthy pregnant women. This systematic review by Marlies Kampman et al. aimed to identify a relationship between abnormal uteroplacental Doppler flow patterns, maternal cardiac function, before and during pregnancy, and poor perinatal outcome. From the 10 studies included in the analysis, Kampman found that perhaps there is a role for routine uteroplacental Doppler investigations in women with known cardiac dysfunction, as early recognition of risk factors can help adapt pregnancy care in these women. In addition, it may be beneficial to subject women with hypertension, abnormal uterine artery Doppler measurements and subsequent complicated pregnancy outcome to a detailed cardiac assessment in order to diagnose cardiac dysfunction and unrecognized cardiac defects and modify treatment to prevent progression to overt clinical heart failure.

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Cerebroplacental ratio at 35–37 weeks’ gestation in the prediction of adverse perinatal outcome
Doppler assessment of impedance to flow in the umbilical artery, fetal middle cerebral artery and the ratio of the pulsatility index in these vessels, or cerebroplacental ratio (CPR), are used to assess fetal oxygenation. Fetal blood sampling studies have shown that low CPR is associated with fetal hypoxemia and acidemia. It could therefore be argued that, if adverse outcome is the consequence of impaired placentation, prenatal care should be directed at identifying hypoxemic rather than small fetuses and, consequently, screening should focus on the detection of pregnancies with low CPR rather than those with low estimated fetal weight. This screening study, published by Kypros Nicolaides’ group found that umbilical and fetal middle cerebral artery Doppler measured at 35–37 weeks’ gestation have poor prediction rates (6 – 15%) and a false-positive rate of about 6% in the prediction of poor perinatal outcome.

View the full free access article and Journal Club slides. This month’s Journal Club slides were compiled by Dr Aly Youssef. ISUOG members can earn CME points for our Journal club articles.

Ultrasound examination after insertion of intrauterine contraceptive device immediately after delivery could predict success of its retention
Contraceptive prevalence in the majority of developed countries is a high as 70% and, in 2007, there were an estimated total of 162 680 000 women using intrauterine contraceptive devices (IUDs) worldwide. Insertion of an IUD immediately after delivery is promising as women are highly motivated to use contraception and the setting at the time of delivery is convenient for both the woman and the provider. Expulsion rate of IUDs varies between 7% and 15%, indicating a higher rate of unsuccessful retention when an IUD is inserted at the time of delivery compared to insertion 6 weeks after delivery. In addition, a malpositioned device can greatly increase the risk of pregnancy due to a reduction in efficacy. Therefore the use of ultrasound in predicting successful retention could be invaluable. In this globally relevant article by Tiran Dias et al., it was determined that ultrasound could be used to predict the success of postvaginal delivery and post-Cesarean section IUD insertion and an optimal distance between the lower end of the IUD and the internal os was identified.

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This article is only available to subscribers of UOG; remember to log into the ISUOG website to access this article, or become an ISUOG member to subscribe to UOG.

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