International Society of Ultrasound in Obstetrics and Gynecology

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The October issue of Ultrasound in Obstetrics & Gynecology contains 14 Original Articles, an Editorial, two Systematic Reviews, and a Randomized Controlled Trial, several of which deal with neurodevelopmental outcome of small-for-gestational-age fetuses.

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

  Fetal cerebral redistribution: a marker of fetal compromise regardless of fetal size

The incidence of stillbirth in the final weeks of pregnancy increases in parallel with that of late-onset fetal growth restriction (FGR), suggesting the two are likely related; FGR from placental insufficiency accounts for half of all stillbirth cases in high-income countries. Consequently, screening for fetal compromise is performed by   comparing individual growth with population centiles. However, prevention of stillbirth occurring after 32 weeks’ gestation is unlikely, as the majority of these fetuses are not small in size. In this Editorial by Morales-Roselló and Khalil, a novel approach is proposed using the evidence that fetal cerebral redistribution is associated with a risk of adverse pregnancy outcome, regardless of fetal size, in order to improve identification of adverse outcomes at term.

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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.

Ultrasound screening for fetal growth restriction at 36 vs 32 weeks’ gestation

Fetal growth restriction (FGR) in late pregnancy is largely overlooked, although it accounts for the largest fraction of adverse outcomes and stillbirths. Third-trimester ultrasound monitoring of fetal growth is routine in some countries, with detection rates as high as 40–80%. However, the impact on perinatal outcome remains unclear and the optimal gestational age for the third-trimester examination is yet to be determined. In this randomized controlled trial, healthy women with uncomplicated pregnancies were assigned to undergo a routine third-trimester ultrasound examination at either 32 or 36 weeks’ gestation for detection of FGR. Elinor Roma et al. found that detection rates in these low-risk pregnancies were significantly superior at 36 weeks than at 32 weeks, with a sensitivity of 38.8% vs 22.5%.

View the full article and Journal Club slides.
This month’s Journal Club slides were compiled by Dr Aly Youssef 

Impact of cerebral redistribution on neurodevelopmental outcome in small-for-gestational-age or growth-restricted babies

Increased cerebral redistribution has been considered a protective autoregulatory mechanism, referred to as ‘brain sparing’, with preferential delivery of nutrients and oxygen to the brain through vasodilatation of the cerebral vasculature. However, evidence suggests that cerebral redistribution may be associated with an increased risk of adverse neurodevelopmental outcomes. In this systematic review by Shireen Meher et al., nine studies, including 1198 fetuses, were reviewed to evaluate whether fetal cerebral redistribution, as assessed by middle cerebral artery Doppler indices, in growth-restricted or small-for-gestational age (SGA) fetuses is associated with an increased risk of neurological morbidity compared with fetuses without cerebral redistribution. Evidence was found that SGA fetuses with cerebral redistribution are at increased risk of neurodevelopmental problems and, if true, timing of delivery in the management of SGA fetuses should be re-evaluated, particularly when cerebral redistribution is found at term.

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Transvaginal ultrasound for preoperative assessment of myometrial invasion in patients with endometrial cancer

Endometrial cancer is the sixth most common form of cancer in women, with the most important prognostic features being FIGO stage, myometrial infiltration (MI), histological type and differentiation grade. MI ≥ 50% is associated with both pelvic lymph-node involvement and extension into the parametrium. Thus, preoperative identification of low-risk cases based on MI assessment may contribute to surgical planning and avoid unnecessary lymph-node dissections. However, to assess the depth of MI, a number of imaging methods have been used; as of yet none has been found superior in regard to diagnostic performance. In this systematic review of 24 articles, Juan-Luis Alcazar et al. evaluate the diagnostic accuracy of transvaginal ultrasound, comparing objective and subjective approaches, in the preoperative detection of deep MI in patients with endometrial cancer.

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HDlive imaging of circumvallate placenta

Circumvallate placenta is a morphological abnormality in which the chorionic plate is smaller than the basal plate, causing the placental and fetal membranes to fold back on themselves. AboEllail et al. report on the first experience of diagnosing circumvallate placenta prenatally using HDlive and HDlive silhouette mode. The increased depth perception of HDlive mode via the use of light and shadow effects from an adjustable light source provides a clear image of the placenta. This imaging method appears to be a useful supplement to two-dimensional ultrasound for the diagnosis of placental abnormalities.

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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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