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The August issue of Ultrasound in Obstetrics & Gynecology contains 14 original papers including a number of gynecological articles, plus an Editorial focusing on the diagnosis and management of intrauterine adhesions; one free-access Systematic Review on the accuracy of first-trimester ultrasound to diagnose an intrauterine pregnancy; five articles on the prediction of small-for-gestational age; and three articles reporting on congenital diaphragmatic hernia.

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

 Accuracy of first-trimester ultrasound in diagnosis of intrauterine pregnancy prior to visualization of the yolk sac

The gestational sac is the earliest reliable sonographic sign of an intrauterine pregnancy, however many healthcare professionals wait until the yolk sac can be observed within the gestational sac before confirming a true intrauterine pregnancy. Yet during this time interval potential diagnoses of an early intrauterine pregnancy of uncertain viability or an ectopic pregnancy could be made. Visualization of several sonographic signs (intradecidual, double decidual sac and chorionic rim signs) has been proposed for differentiation of a true gestational sac from a pseudosac, observed in 15% of ectopic pregnancies. In this systematic review by Alison Richardson et al., 17 studies were included to determine the accuracy of these sonographic signs to diagnose a viable or non-viable intrauterine pregnancy.

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A novel ultrasound-based approach for diagnosis and management of intrauterine adhesions

Intrauterine adhesions (IUAs) involving both the myometrial and endometrial layers are relatively rare compared to other uterine abnormalities. Over the years, a number of studies have focused on IUAs, however their etiology, prevalence and effect on women’s reproductive outcome remain uncertain. Although high-resolution ultrasound is one of the most used diagnostic tests in gynecology, there is lack of data on its value for detection and management of IUAs. In this Editorial by Tejal Amin et al., the causes and effects of IUAs on endometrial function and consequently reproductive outcome are discussed, and a novel structured ultrasound-based approach to its diagnosis and management is proposed.

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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Placental growth factor and ultrasound parameters to predict small-for-gestational-age infant in women presenting with reduced symphysis–fundus height

Identifying small-for-gestational-age (SGA) infants, defined as those with a birth weight < 10th, < 5th or < 3rd centile, remains difficult in low-risk pregnancies, with imprecise techniques being relied on, such as measurement of the symphysis–fundus height. Placental insufficiency accounts for many cases of SGA, therefore markers of placental function could provide additional information to current techniques to identify those at high risk of SGA. So far, no biomarker has sufficient accuracy for incorporation into clinical practice. In this article by Melanie Griffin et al., the diagnostic accuracy of placental growth factor (PlGF) and ultrasound parameters were assessed in 592 women with suspected SGA across 11 sites in UK and Canada providing an indication of the parameters that could predict delivery of SGA infants at a sensitivity of 69%.

View the full article and Journal Club slides

This month’s Journal Club slides were compiled by Dr Shireen Meher
GoogleAd keywords: estimated fetal weight; fetal growth restriction; placental growth factor; small-for-gestational age

 Prediction of small-for-gestational-age neonates: screening by placental growth factor and soluble fms-like tyrosine kinase-1 at 35–37 weeks

Prenatal identification of small-for-gestational-age neonates can substantially reduce associated morbidity and mortality through close monitoring, timely delivery and prompt neonatal care. In this screening study by Kypros Nicolaides’ group,  the potential value of serum placental growth factor (PlGF) and serum fms-like tyrosine kinase-1 (sFlt-1) for improving the prediction of SGA neonates achieved by maternal factors and estimated fetal weight was investigated. The results demonstrated significant changes in maternal serum PIGF and sFIT-1 levels in SGA pregnancies at 35–37 weeks’ gestation, however in prediction of SGA there was little additional benefit.

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Ultrasound-guided percutaneous aspiration of hyperreactio luteinalis avoids laparoscopic untwisting of ovarian torsion

In this case report, Chieko Sakae et al. describe a case of hyperreactio luteinalis (HL), multicystic bilateral enlargement of the ovaries, complicated by ovarian torsion that was treated successfully without surgical intervention. HL is a self-limiting benign condition associated with pregnancy or trophoblastic disease and regresses spontaneously over time. It is managed conservatively unless torsion of the enlarged ovaries occurs, at which point surgical intervention may be pursued. However, in this case, volume reduction of the left ovarian cyst was performed by percutaneous aspiration and subsequent spontaneous detorsion of the ovary was observed.

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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