International Society of Ultrasound in Obstetrics and Gynecology

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The September issue of Ultrasound in Obstetrics & Gynecology contains 10 original papers including a number of gynecological articles; a Consensus Statement from the MUSA group for describing ultrasonographic features of the myometrium and uterine masses; two Systematic Reviews; plus an Editorial and two Original Articles that focus on the use of ultrasound simulators in obstetrics and gynecology.

 ISUOG News: 03 September 2015

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

Ultrasound simulators in obstetrics and gynecology
Ultrasound is the primary method of imaging in obstetrics and gynecology, yet, worldwide, there is a lack of standardization in training and assessment of skill. In this Editorial by Chalouhi et al., the application of ultrasound simulators in medicine, particularly in the field of obstetrics and gynecology, is discussed, and scientific publications that report on such simulators are reviewed. Here, ultrasound simulators are proposed as a valid and reliable method for training in the clinical setting and for assessment of skills; however, their use might never replace completely patient-centered training.
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.

View the article.

For further material on simulators in obstetrics and gynecology please see the following September articles:

Sustained effect of simulation-based ultrasound training on clinical performance, by Tolsgaard et al.
Simulator training in fetoscopic laser surgery for TTTS by Peeters et al.

Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses
For both clinical practice and research, standardized reporting and common terminology of ultrasound findings is essential to reduce intra- and interobserver variability in the evaluation of pathology, to assess the effect of medical or surgical treatment and to compare ultrasound imaging with other imaging techniques. Currently, for describing ultrasound images of normal or pathological myometrium or uterine masses, there is no standardized terminology. The MUSA (Morphological Uterus Sonographic Assessment) group have provided a consensus statement on terms, definitions and measurements to describe and report the sonographic features of the myometrium, to facilitate consistent reporting of myometrial lesions when using ultrasonography in both daily clinical practice and for research purposes.

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Aberrant right subclavian artery in fetuses with Down syndrome
During embryonic development, the aortic arch normally generates three branches, the brachiocephalic trunk, the left common carotid artery and the left subclavian artery, with the right subclavian and right common artery arising from the brachiocephalic artery. In rare cases, the aortic arch divides into four, and the right subclavian artery arises independently from the descending aorta and crosses posterior to the mediastinum, usually behind the esophagus, as it courses towards the right shoulder, the abnormality known as aberrant right subclavian artery (ARSA). In this systematic review by Scala et al., the prevalence of ARSA in Down-syndrome fetuses was found to be 23.6%, whereas in euploid fetuses it was only 1.2%. Meta-analysis of the pooled study results found ARSA to be a significant risk factor for Down syndrome and should therefore be used as a marker in fetal echocardiography and genetic ultrasound scans for risk assessment of Down syndrome.
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Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta
Morbidly adherent placenta (MAP) is a rare but serious pregnancy complication in which the placental tissue invades abnormally into the uterine wall. It can cause massive postpartum hemorrhage and is the second highest cause of hemorrhage resulting in peripartum hysterectomy in the UK. Traditional management consisted of Cesarean delivery followed by peripartum hysterectomy. In 2007, prophylactic occlusion balloon catheters were introduced into clinical practice, inserted into both internal iliac arteries prior to Cesarean delivery to limit blood flow to the uterus in an attempt to prevent hemorrhage. In 2010, the surgical aspect of this technique was modified from non-placental separation to placental resection, with the affected myometrium being excised with the majority of the placenta. This adapted management is known as the Triple-P procedure. Here, Teixidor Viñas et al. compare the outcomes in women with MAP, before and after introduction of the conservative Triple-P procedure.

View the full article: and Journal Club slides.

This month’s Journal Club slides were compiled by Dr Joel Naftalin

Natural history of early first-trimester pregnancies implanted in Cesarean scars
In this case series, Zosmer et al. describe a series of 10 women diagnosed at their center with a pregnancy implanted within or on a Cesarean section scar, who continued the pregnancy without intervention. In continuing Cesarean scar pregnancies, there is a risk of developing morbidly adherent placenta, severe hemorrhage and Cesarean hysterectomy at the time of delivery; therefore the majority of Cesarean scar pregnancies (CSP) diagnosed in the first trimester are terminated. As a result, the natural history of common forms of CSP is uncertain. The group compared first-trimester ultrasound findings to the clinical outcome of the pregnancy with the aim of identifying predictors of poor outcome.
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.
View the article

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