The August issue of Ultrasound in Obstetrics & Gynecology contains 13 Original Articles; an Editorial; two Systematic Reviews; and ISUOG Practice Guidelines on Invasive Procedures for Prenatal Diagnosis
Please see below a selection of articles from the August issue of the Journal chosen specially by the UOG team. To view all UOG content become an ISUOG member today.
Fetal repair of spina bifida
Open spina bifida is one of the most common birth defects. It is characterized by non-closure of the elements that protect the medulla, leaving it exposed to amniotic fluid throughout pregnancy. The consequences of such a defect are lifelong impairment of the control of sphincters and motor function at or below the level of the lesion, occasionally including paralysis. In an Editorial by Pedreira et al., they discuss the science behind the current management of prenatally diagnosed open spina bifida, the rationale for considering a minimally invasive approach as an alternative to open fetal surgery, the technical challenges associated with this approach and the results of a preliminary study using fetoscopically applied skin-over-biocellulose technique. Also in this issue of UOG is a Systematic Review and Meta-analysis by Araujo Junior et al. comparing the rate of procedure-related complications after intrauterine treatment of spina bifida by open versus endoscopic fetal surgery.
Read the free-access Editorial and become an ISUOG member to read the Systematic Review.
The effects of dydrogesterone vs progesterone for luteal-phase support in assisted reproduction
Early pregnancy is maintained by the corpus luteum until the luteal–placental shift at 7–9 weeks of gestation. For women conceiving by assisted reproductive techniques, the irregularly high levels of estradiol following ovarian stimulation has a negative feedback effect, resulting in low serum progesterone levels from the multiple corpora lutea that are formed. Luteal-phase support (LPS) is therefore provided to increase the success of implantation and embryogenesis. In a systematic review and meta-analysis by Barbosa et al., the effects of dydrogesterone and progesterone for LPS on ongoing and clinical pregnancy rates were compared. Eight randomized controlled trials provided evidence that oral dydrogesterone seems to be as effective as vaginal progesterone for LPS and appears to be better tolerated by patients.
This article was chosen for Journal Club. View the full article and accompanying Journal Club slides.
Ultrasound examination of the fetal face for detection of anomalies
First-trimester screening for major fetal defects can identify about half of all anomalies at 11–13 weeks’ gestation and examination of the fetal profile in the second and third trimesters of pregnancy enables the assessment of several facial measurements. The fetal profile and lips are included as suggested anatomy for assessment to achieve early detection of facial defects. In a new study, Kagan et al. examined the frontal space (FS) distance in first-trimester fetuses with bilateral, unilateral or median cleft lip and palate and in those with retrognathia and compared the measurements to a normal population. Measurements were ≥99th and ≤1st centiles in all but one (98.1%) case, leading them to the conclusion that FS distance appears to be a helpful tool in the detection of facial clefts at 11–13 weeks’ gestation. In another study, Cossellu et al. compared the distance between the sphenoid and frontal bones in euploid and trisomy-21 fetuses at 16–24 weeks’ gestation, and found that the sphenofrontal distance was significantly smaller than in normal cases and was below the 5th percentile in 96.7% of trisomy-21 fetuses.
These articles are only available to subscribers of UOG; remember to login to the ISUOG website to access these articles, or become an ISUOG member to subscribe to UOG.
ISUOG Practice Guidelines: invasive procedures for prenatal diagnosis
ISUOG have published new Practice Guidelines to describe the main aspects of invasive fetal procedures for prenatal diagnosis, including amniocentesis, chorionic villus sampling and fetal blood sampling. Technical issues, clinical indications, diagnostic capabilities and possible complications are considered in light of the available literature. In this new era dominated by cell-free fetal DNA testing, the number of invasive procedures for fetal testing is decreasing dramatically and this is having a considerable impact on clinical practice. This Guideline summarizes current information regarding when, how and why practitioners perform invasive procedures for prenatal diagnosis.
View the full Guidelines.