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October 2016

The October issue of Ultrasound in Obstetrics & Gynecology contains 13 Original Articles on a range of topics including the fetal brain, fetal lower urinary tract obstruction, maternal vascular function and pelvic floor biometry; an Editorial on fetoplacental mosaicism in cell-free DNA testing; one Systematic Review of surgical treatment for hydrosalpinx prior to IVF and one of perinatal outcomes following fetal intervention for congenital heart disease; and a Case Report of Robert’s uterus.
 
Please see below a selection of articles from the October issue of the Journal chosen specially by the UOG team. To view all UOG content become an ISUOG member today.

Implications of fetoplacental mosaicism on cell-free DNA testing
Cell-free DNA (cfDNA) testing for fetal aneuploidy is a major development in prenatal care and its uptake has increased rapidly. Health professionals offering this screening test must provide comprehensive prenatal counseling prior to the test, including the risk of possible discordances between the cfDNA result and the ultrasound examination and/or the actual fetal genetic chromosomal constitution. In an Editorial by Francesca Romana Grati, the current knowledge of placental genetics that has been acquired from years of prenatal diagnostic cytogenetics is translated into the new cfDNA testing paradigm to assist in pretest prenatal counseling, when the limits and advantages of the are explained, and post-test counseling, when there is discordance between a screening result and the real genetic constitution.
This article is only available to subscribers of UOG; remember to login to the ISUOG website to read the Editorial or become an ISUOG member to subscribe to UOG.

Surgical treatment for hydrosalpinx prior to in-vitro fertilization embryo transfer
Hydrosalpinx is the condition of a blocked Fallopian tube dilated with fluid. Its presence has been shown to have negative effects on the outcome of in-vitro fertilization (IVF). Surgical treatment of hydrosalpinx prior to IVF embryo transfer aims to eliminate the detrimental effect of the hydrosalpingeal fluid, either by aspirating it, or by removing the Fallopian tubes altogether (salpingectomy) or isolating them from the uterine cavity (laparoscopic proximal occlusion). Tsiami et al. performed a network meta-analysis on randomized controlled trials of women with hydrosalpinx before IVF embryo transfer, comparing the effects of ultrasound-guided aspiration of the fluid, tubal occlusion, salpingectomy or no intervention on ongoing pregnancy, clinical pregnancy, ectopic pregnancy and miscarriage. They found that proximal tubal occlusion, salpingectomy and aspiration for treatment of hydrosalpinx scored consistently better than did no intervention for the outcome of IVF-ET and, in terms of relative ranking, proximal tubal occlusion appeared to be the most effective treatment.
This article was chosen for Journal Club. View the full article and accompanying Journal Club slides.

Perinatal outcomes and intrauterine complications following fetal intervention for congenital heart disease
Congenital heart defects (CHD) are a common finding, reported to affect 5–10 in every 1000 live births. It can impair physical capacity and life expectancy for those affected and most types of CHD result in extensive care being required. Some CHDs progress during pregnancy, and if left untreated can result in intrauterine death. In a systematic review and meta-analysis of 29 studies, perinatal outcomes (fetal death, live birth, preterm delivery <37 weeks’ gestation and neonatal death) and intrauterine complications (bradycardia requiring treatment and hemopericardium requiring drainage) after fetal interventions for CHD were assessed.
Read the full article.

Robert’s uterus: modern imaging techniques and ultrasound-guided hysteroscopic treatment without laparoscopy or laparotomy
Ludwin et al. report a case of Robert’s uterus, a unique malformation described as a septate uterus with a non-communicating hemicavity, consisting of a blind uterine horn, a contralateral unicornuate uterine cavity and a normally shaped external uterine fundus. Three-dimensional sonohysterography with volume-contrast imaging, HDLive rendering mode and automatic volume calculation were used for the diagnosis, surgical planning and postoperative evaluation. These techniques provide visualization of the internal and external uterine structures, enabling treatment by minimally invasive procedures without the need for laparotomy or laparoscopy.
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.

Fetal dental panorama on three-dimensional ultrasound imaging
Improvement in the quality of ultrasound imaging has enabled the study of the dental organ within the jaws during fetal development. A dental ultrasound image, known as a ‘fetal dental panorama’, could help determine normal and pathological development of the dental organ and thus aid in the diagnosis of syndromes involving dental dysmorphology. In this Picture of the Month article, Couly et al. describe their novel technique of acquiring a virtual dental panoramic radiograph of the fetal jaws by prenatal ultrasound imaging. The main application of the fetal dental panorama is to assess the number, location and shape of the deciduous teeth, and prenatal dental anomalies may be a sign of sporadic or familial teeth agenesis or a concomitant sign of congenital malformations, genetic syndromes and chromosomal abnormalities.
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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