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September 2016

September 2016

The September issue of Ultrasound in Obstetrics & Gynecology contains 9 Original Articles including a number on fetal growth restriction; two Opinion pieces; two Randomized Controlled trials; two Systematic Reviews; and a Consensus Statement on the sonographic evaluation of women with suspected endometriosis
 
Please see below a selection of articles from the September issue of the Journal chosen specially by the UOG team. To view all UOG content become an ISUOG member today.

Ultrasound-guided embryo transfer
Embryo transfer (ET) has been performed traditionally using tactile senses and judgment to determine when the transfer catheter is in the correct position, referred to as ‘clinical touch’. Alternatively, ultrasound imaging can be used to guide placement of the catheter during ET. It has been claimed that several technical aspects of ET affect the probability of pregnancy in human in-vitro fertilization, including the type of catheter, operator’s skill, site of embryo discharge and level of difficulty in passing through the cervix. In a randomized controlled trial, also chosen for Journal Club, Revelli et al. compare ET techniques based on uterine length measurement before transfer (ULMbET), in which transvaginal ultrasound was used to calculate the optimal site of embryo discharge prior to rather than during ET, with transabdominal ultrasound-guided embryo transfer (TA-UGET). They found comparable clinical and ongoing pregnancy rates and implantation rates; however the level of discomfort during the procedure was greater for TA-UGET. In an Opinion piece on this RCT, Nastri and Martins recommend the use of ULMbET over clinical touch and TA-UGET and support Revelli’s findings.
Read the Journal Club article and accompanying slides, and become an ISUOG member to read the Opinion.


Vaginal progesterone decreases preterm birth ≤ 34 weeks in singleton pregnancy with short cervix
Neonates born preterm are at increased risk of both short-term complications, attributed to immaturity of multiple organ systems, and long-term adverse health outcomes in adult life. Since 2012, vaginal progesterone has been recommended for use in asymptomatic pregnant women with a short cervix and it has been suggested that its use has contributed to the reduction in the rate of preterm birth (PTB) in the USA in the last 7 years. In an updated meta-analysis, including data from the OPPTIMUM study which found vaginal progesterone to have no benefit on PTB, the efficacy of vaginal progesterone administration for preventing this outcome and perinatal morbidity and mortality in asymptomatic women with a singleton gestation and a mid-trimester sonographic cervical length ≤ 25 mm was evaluated. Compared to placebo, vaginal progesterone significantly reduced the risk of PTB ≤ 34 weeks (18.1% vs 27.5%; RR, 0.66 (95% CI, 0.52–0.83); P=0.0005).
This article was chosen for Journal Club. View the full article and accompanying Journal Club slides.

Consensus Statement: Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis
The International Deep Endometriosis Analysis (IDEA) group have published a consensus opinion on the terms, definitions and measurements to describe the sonographic features of the different phenotypes of endometriosis. At present, it is difficult to compare results between published studies because authors use different terms when describing the same structures and anatomical locations. Adoption of these terms and definitions would result in consistent nomenclature when describing the ultrasound location and extent of endometriosis and enable meaningful comparisons between future studies in women with an ultrasound diagnosis of endometriosis.
Read the full article.

HDlive imaging of a giant omphalocele
Omphalocele is a ventral abdominal wall defect with herniation of abdominal contents that results from failure of the lateral ectomesodermal folds to join in the midline of the abdomen during the third and fourth weeks of gestation. It occurs in approximately 1 in 4000–7000 live births. In the Picture of the Month article, Blumenfeld et al. describe a case of giant omphalocele, which refers to defects with a diameter that exceeds 5 cm or those that contain liver within the herniated sac, that was diagnosed using two-dimensional prenatal ultrasound and confirmed with HDlive imaging.
Read the full article. 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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