The April issue of Ultrasound in Obstetrics & Gynecology includes an overview of the available clinical and research data on COVID-19 infection in pregnancy, a study on the value of first-trimester ultrasound in the prediction of third-trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome, a study on diagnosis of fetal defects in twin pregnancies at routine 11–13-week ultrasound examination, and a study on the effect of one fetal death on pregnancy outcome in twin pregnancy with two live fetuses at 11–13 weeks.
Novel coronavirus infection and pregnancy
The novel coronavirus infection (COVID-19) is a global public health emergency. Over and above the impact of COVID-19 infection on a pregnant woman, there are concerns relating to the potential effect on fetal and neonatal outcome. Yang et al. reviewed the clinical manifestation, neonatal outcome and risk of vertical transmission of COVID-19 infection during pregnancy. Based on the available clinical and research data at the time of writing, the clinical characteristics of patients with COVID-19 infection presenting from the mid-trimester onwards are similar to those of non-pregnant adults. They found no evidence that pregnant women are more susceptible to COVID-19 infection nor that those with COVID-19 infection are more prone to developing severe pneumonia. There was also no evidence of vertical mother-to-baby transmission of COVID-19 infection when the maternal infection manifests in the third trimester.
Value of first-trimester ultrasound in prediction of third-trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome
It has been shown recently that early first-trimester ultrasound assessment can predict the possibility of developing placenta accreta spectrum (PAS) disorder in women at high risk for this anomaly. Cali et al. investigated whether early first-trimester assessment of the position of the gestational sac in relation to the prior Cesarean scar correlates with the stage of PAS disorder on third-trimester ultrasound. Presence of the crossover sign Type 1 (COS-1), implantation of the gestational sac in the niche of the prior Cesarean scar and position of the sac below the midline of the uterus were found to be associated independently with, and predictive of, severe stages of PAS disorder in the third-trimester of pregnancy and of adverse surgical outcome.
Diagnosis of fetal defects in twin pregnancies at routine 11–13-week ultrasound examination
Studies on the detection of fetal defects on first-trimester ultrasound examination in twin pregnancy are limited and have reported varying detection rates. Syngelaki et al. examined the performance of the routine 11–13-week scan in detecting fetal defects in 6366 twin pregnancies. It was found that, first, fetal defects are more common in monochorionic (MC) than in dichorionic (DC) twin pregnancies, second, first-trimester detection of fetal defects in DC twin pregnancies is similar to that in singleton pregnancies, third, first-trimester detectability of defects in MC twins is higher than in DC twins, and, fourth, in twin pregnancies with a fetal defect, there is higher intertwin discordance in crown–rump length and incidence of increased nuchal translucency, but the predictive performance of screening by these markers is poor (view the accompanying Journal Club slides).
Twin pregnancy with two live fetuses at 11–13 weeks: effect of one fetal death on pregnancy outcome
Previous small and heterogeneous studies on the outcome of twin pregnancy with single fetal death have reported contradictory results. Cimpoca et al. investigated the effect of one fetal death on pregnancy outcome in 4896 dichorionic (DC) and 1329 monochorionic (MC) twin pregnancies. In MC twin pregnancies, the risk of single or double fetal death was found to be higher than in DC twins. In both MC and DC twin pregnancies, the rate of early preterm birth was higher in those with one fetal death than in those with two live fetuses. In both MC and DC twins with one fetal death, the interval to delivery was related inversely to gestational age at fetal death. These findings should be useful in counseling parents as to the likely outcome of their pregnancy after single fetal death and in defining strategies for surveillance in the management of these types of twin pregnancy.
Also online this month are a number of papers on coronavirus infection in pregnancy:
- ISUOG Interim Guidance on 2019 novel coronavirus infection during pregnancy and puerperium: information for healthcare professionals
- Coronavirus in pregnancy and delivery: rapid review
- How to perform lung ultrasound in pregnant women with suspected COVID‐19 infection
- ISUOG Safety Committee Position Statement: safe performance of obstetric and gynecological scans and equipment cleaning in the context of COVID‐19
- ISUOG Consensus Statement on organization of routine and specialist obstetric ultrasound services in the context of COVID‐19
Also online this month is a video abstract on intracervical lakes as sonographic marker of placenta accreta spectrum disorder in patients with placenta previa or low-lying placenta. Read the free-access article.
Coming up next month…
- A study on UK stillbirth trends in over 11 million births, finding no evidence to support the effectiveness of the Growth Assessment Protocol program.
- A study on the antenatal detection of fetal growth restriction and stillbirth risk. Preview the Accepted Article.
- A study on first‐trimester ultrasound features prior to 11 weeks’ gestation and maternal factors for the prediction of maternal hypertensive disorders. Preview the Accepted Article.
- An Opinion piece on the sonographic detection of fetal abnormalities before 11 weeks of gestation. Preview the Accepted Article.