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February highlights

The February issue of Ultrasound in Obstetrics & Gynecology contains 12 Original Articles; an Opinion; a Systematic Review; plus new ISUOG Practice Guidelines

Please see below a selection of articles from the February issue of the Journal chosen specially by the UOG team. To view all UOG content become an ISUOG member today.

Cell-free DNA testing for 22q11.2 deletion syndrome

In this Opinion article by Lisa Hui, the viability, effectiveness and appropriateness of screening for 22q11.2 deletion syndrome is discussed, referring to the large non-invasive prenatal screening study by Gross et al. free to access in this issue.
View the Opinion.

ISUOG Practice Guidelines: role of ultrasound in twin pregnancy

The ISUOG Practice Guidelines address the role of ultrasound in the care of uncomplicated twin pregnancy and those complicated by twin–twin transfusion syndrome (TTTS), selective fetal growth restriction, twin anemia–polycythemia sequence (TAPS), twin reversed arterial perfusion sequence, conjoined twins and single intrauterine death. The document provides guidance on the methods used to determine gestational age and chorionicity, screening for chromosomal and structural abnormalities, and screening for TTTS, TAPS, growth abnormalities and preterm birth.
View the full article.

GnRH agonist during luteal phase in women undergoing assisted reproductive techniques

Assisted reproductive techniques (ART) frequently involve controlled ovarian stimulation to promote multiple follicle development. This results in very high steroid levels which inhibits the secretion of luteinizing hormone from the pituitary gland, shortening the luteal phase. To overcome this, pharmacological support during the luteal phase is used; more recently by administration of gonadotropin releasing hormone (GnRH) agonist. In this systematic review and meta-analysis by Martins et al., the evidence from eight randomized controlled trials which compared the addition of GnRH agonist during luteal phase to standard luteal-phase support were evaluated to determine the effect of GnRH agonist on the outcome of the pregnancy.
View the full article and Journal Club slides

Fetal therapy for spina bifida

In this issue of UOG are three studies reporting on different approaches for prenatal assessment and treatment of spina bifida: Graf et al. evaluate the need for postnatal neurosurgical intervention following fetoscopic patch repair of spina bifida; Carreras et al. report their preliminary experience of ultrasound examination to assess lower-limb movement in fetuses with myelomeningocele to determine its accuracy for establishing the segmental level of the lesion, which is the best known predictor of future ability to walk; and Papanna et al. identify a promising regenerative patch for in-utero repair of  spina bifida, modelled in sheep fetuses.
Link to three studies: http://onlinelibrary.wiley.com/doi/10.1002/uog.14937/abstract (Graf)
http://onlinelibrary.wiley.com/doi/10.1002/uog.15732/abstract (Carreras)
http://onlinelibrary.wiley.com/doi/10.1002/uog.15790/abstract (Papanna)
These articles are 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.

Development and validation of a tool incorporating quantitative fetal fibronectin and cervical length to predict spontaneous preterm birth in symptomatic women

Prediction of preterm birth in women at risk should enable targeted intervention. Assessment of fetal fibronectin and cervical length have superseded previous risk assessments for spontaneous preterm birth (sPTB) in both symptomatic and asymptomatic women. Kuhrt et al. have created a highly accurate algorithm that includes quantitative fetal fibronectin and cervical length measurements to predict sPTB, which has been incorporated into a downloadable App (QUiPP). Further work has been done to update the model for use in asymptomatic women, which was published in last month’s issue.
View the full articles: http://onlinelibrary.wiley.com/doi/10.1002/uog.14894/full  and http://onlinelibrary.wiley.com/doi/10.1002/uog.14865/full anddownload the App.
View the press release and commentary by senior author Prof. Andrew Shennan.

IONA® test for detection of trisomies 21, 18 and 13

Two studies evaluate the performance of screening for trisomies 21, 18 and 13 by cell-free DNA analysis of maternal blood using the IONA® test, comparing test results against fetal karyotype: Poon et al. performed a nested case–control study of cfDNA analysis of maternal plasma at 11–13 weeks’ gestation in a cohort of euploid and trisomy pregnancies and Papageorghiou et al. performed a multicenter blinded study in which plasma samples from pregnant women at increased risk of trisomy 21 underwent cell-free DNA analysis.
LINKS: http://onlinelibrary.wiley.com/doi/10.1002/uog.15749/abstract (Poon)
http://onlinelibrary.wiley.com/doi/10.1002/uog.15791/abstract (Papageorghiou)
These articles are 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.

Quality assurance and its impact on ovarian visualization rates in the multicenter United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS)

One of the concerns regarding the use of ultrasound in cancer screening has been the considerable interobserver variability reported in visualization of the ovaries in large screening studies, and that the accuracy of interpretation depends on operator experience. Based on a cohort of 50 639 women, aged 50–74 years, who were randomized to undergo annual transvaginal ultrasound examinations, Sharma et al. describe the methods used to ensure delivery of high-quality ultrasound scanning in a multicenter setting, define parameters for quality assurance (QA) during transvaginal ultrasound examination of postmenopausal ovaries and assess the impact of QA processes over time on visualization rates of the ovary for individual sonographers and regional centers.
View the full article

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