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The November issue of Ultrasound in Obstetrics & Gynecology contains 12 Original Articles; an Editorial; and two Systematic Reviews; plus a Randomized Controlled Trial and three Original Articles that focus on ultrasound assessment in labor.

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

How to choose which laboratory to use for cell-free DNA testing

Over the past year there has been a rapid increase in the number of laboratories offering cell-free DNA (cfDNA) testing to screen for fetal aneuploidies; however, with the increased availability of testing, it is essential that optimum quality is maintained.  In this Editorial, Jacques Jani et al. discuss the main factors that should be taken into consideration by clinicians when choosing a cfDNA-testing provider: 1) laboratory experience, 2) the methodology used and 3) whether the technology was developed internally or purchased.

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

Influence of ultrasound determination of fetal head position on mode of delivery

Fetal head position is usually assessed during labor by digital vaginal examination, the results of which are considered essential for managing labor and determining the need for operative delivery. Recent evidence from the use of ultrasound examination in the delivery room has shown that prediction of fetal head position by digital vaginal examination is inaccurate in a high percentage of cases, and that ultrasound examination should be the standard of care for determination, especially when instrumental delivery is required. In this randomized controlled trial by Popowski et al., women were assigned to undergo either a digital vaginal examination or both digital vaginal and ultrasound examinations to determine fetal head position in order to evaluate the influence of ultrasound determination on subsequent mode of delivery.

View the full article and Journal Club slides.

This month’s Journal Club slides were compiled by Dr Katherine Goetzinger

Prediction of delivery mode by ultrasound-assessed fetal position in prolonged first stage of labor

Ultrasound assessment of fetal head position in labor has a higher accuracy than does digital vaginal examination, and the technique is much easier to learn. About 30% of fetuses are in the occiput posterior position before or early in labor, with the majority rotating spontaneously, therefore it has been concluded that ultrasound assessment of fetal position in early labor has little value. In this study, Eggebø et al. investigated whether transabdominal ultrasound assessment of fetal head position was associated with the rate of Cesarean section in nulliparous women with prolonged first stage of labor.

View the full article and Journal Club slides.

This month’s Journal Club slides were compiled by Dr Katherine Goetzinger

For further material on ultrasound assessment in labor please see the following November article:

Prospective multicenter study of ultrasound-based measurements of fetal head station and position throughout labor, by Vitner et al. 

  Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder

Deep infiltrating endometriosis (DIE) is the infiltration of endometrial implants of ≥ 5 mm outside the uterus. Non-invasive methods, including magnetic resonance imaging and transvaginal ultrasound (TVS), for diagnosis of DIE have been proposed for use in daily practice. Currently, TVS is the first-line technique however with inconsistent results. In this systematic review of 11 studies reporting on the use of TVS for diagnosis of DIE in locations other than the rectosigmoid, i.e. in the uterosacral ligaments, rectovaginal septum, vagina and bladder, Guerriero et al. found TVS to have a fair performance and high specificity for diagnosis of DIE.

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Fetoscopic laser surgery to decompress distal urethral obstruction caused by prolapsed ureterocele

Torres Montebruno et al. report on the successful use of fetoscopic laser surgery to treat a case of prolapsed ureterocele in a female fetus that was referred to their center because of progressive megacystis, due to urethral obstruction with bilateral hydronephrosis, associated with increasing oligohydramnios. Fetal surgery was performed at 25 + 4 weeks, perforating the prolapsed ureterocele by contact with a diode laser fiber, under combined endoscopic and ultrasound guidance.

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

Prenatal diagnosis of Abernethy malformation by 3D ultrasound

Abernethy malformation is an abnormal portosystemic shunt and prognosis depends on the extent of the portal system development, which classifies the malformation into Type 1or Type 2. With three-dimensional (3D) power Doppler rendered images, Athanasiadis et al. were able to conclude the origin of an abnormal abdominal blood vessel in a fetus that was referred to their center at 23 weeks’ gestation. Initially, the origin of the aberrant vessel was assumed incorrectly on two-dimensional ultrasound. This important differentiation between the vessel’s origin established the diagnosis of a portosystemic shunt, and 3D power Doppler and four-dimensional STIC rendered images enabled visual reconstruction of the complex course of the vessel in the fetal pelvis.

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

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