The February issue contains 13 Original Articles, a Randomized Controlled Trial comparing single-dose systemic methotrexate with expectant management for treatment of tubal ectopic pregnancy, a Systematic Review on the physiological adaptation of maternal plasma volume during pregnancy and an Opinion article on the unexpected resolution of first-trimester fetal valve stenosis.
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.
Single dose methotrexate vs expectant management for treatment of ectopic pregnancy
Ectopic pregnancy is a common condition affecting 1–2% of pregnancies worldwide. Fatalities are rare in developed countries however the burden of disease is high owing to the costs of diagnostic work-up and expensive treatment. In this randomized controlled trial, Jurkovic et al. assess whether medical treatment with methotrexate is more successful than expectant management in clinically stable women presenting with tubal ectopic pregnancy and a serum beta human chorionic gonadotropin level of <1500 IU/L. Among a total of 80 women, 42 were randomized to methotrexate and 38 to placebo. The rates of success were similar for the two study arms: 83% with methotrexate and 76% with placebo, suggesting that routine use of methotrexate for the treatment of tubal ectopic pregnancy is not supported.
View the full article and accompanying Journal Club slides.
This month’s Journal Club slides were compiled by Dr Joel Naftalin.
Physiological adaptation of maternal plasma volume during pregnancy
During pregnancy, significant changes in the maternal cardiovascular and hemodynamic systems are induced, with all changes resulting from systemic vascular vasodilatation. Consequently, maternal blood volume increases during pregnancy because of a rise in plasma volume and red cell volume. In this systematic review and meta-analysis, de Haas et al. analysed 30 studies to describe the physiological pattern of plasma volume adjustments in normal singleton pregnancy and compare this with the pattern in pregnancies complicated by pregnancy-induced hypertension, pre-eclampsia or fetal growth restriction. They found that, during normal pregnancy, plasma volume increases by more than 1L as compared with non-pregnant conditions, and in complicated pregnancies, plasma volume increase in the third trimester is 13.3% lower than in normal pregnancy. The normal plasma volume values presented in this study may be useful as a tool to identify a pathological pattern in pregnant women before clinical onset of a hypertensive complication later in pregnancy.
View the full article.
Screening for pre-eclampsia and clinical management
In this issue of UOG are four studies reporting on different screening models for pre-eclampsia (PE). Scazzocchio et al. validate a previously constructed first-trimester predictive model, which includes maternal factors, uterine artery Doppler, blood pressure and pregnancy-associated plasma protein-A, in an unselected population. Wright et al. estimate the patient-specific risk of PE at 30–34 weeks’ gestation by a combination of maternal characteristics and biomarkers to stratify women into high-, intermediate- and low-risk groups for appropriate management. Tan et al. compare the performance of screening for PE at 31–34 weeks by the ratio of soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) and by a method combining maternal factors with sFlt-1 and PlGF. Dragan et al. assess the performance of screening for PE by sFlt-1/PlGF > 38 at 31–34 weeks vs 35–37 weeks.
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 for full access to UOG.
Ultrasound in preoperative assessment of pelvic and abdominal spread of ovarian cancer
Ovarian cancer is the fifth most common cancer diagnosed among women in developed regions. Complete resection to no residual disease at primary or interval debulking surgery is the single most important prognostic factor in advanced ovarian cancer. The important information on tumor resectability is provided by preoperative imaging. Computed tomography is the preferred imaging technique for preoperative staging of ovarian cancer, however ultrasound is being used increasingly following the development of high-resolution probes, enabling detailed visualization of pelvic anatomy. Further advantages of ultrasound are its high availability and low cost and it does not pose risk or discomfort to the patient. In a novel study by Fischerova et al., the diagnostic performance of ultrasound was evaluated in 394 patients undergoing treatment for ovarian cancer to analyze its accuracy and limitations in preoperative assessment of pelvic and intra-abdominal spread.
View 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 for full access to UOG.
ISUOG consensus statement on current understanding of the association of neurodevelopmental delay and congenital heart disease: impact on prenatal counseling
An association between congenital heart disease (CHD) and neurodevelopmental delay (NDD) has long been recognized, but remains poorly understood. A recent survey was conducted by an ISUOG Task Force to gauge the attitudes and perceptions of health professionals from leading referral units for CHD worldwide and found significant differences in the way in which prenatal counseling is conducted. Consequently, the ISUOG Clinical Standards Committee have compiled a Consensus Statement on the current knowledge of CHD and NDD and provide clinical standards for prenatal counseling in such cases.
View the Consensus Statement.
Coming up in the next issue of UOG…
• An updated meta-analysis of individual patient data by Romero et al., bevaluating the effect of vaginal progesterone on preterm birth and neonatal morbidity and mortality in women with a twin pregnancy and short cervix. Preview the accepted article here.
• A systematic review and meta-analysis of randomized controlled trials by Berghella et al., comparing the impact of cervical length screening vs no screening on preterm birth in singleton pregnancies with threatened preterm labor. Preview the accepted article here.
• An Editorial by Vintzileos and Visser in which they describe the different interventions available for women with mid-trimester short cervix and discuss which are most effective. Preview the Editorial here.