The April issue of Ultrasound in Obstetrics & Gynecology includes a State-of-the-Art Review on ultrasound imaging of slings and meshes in urogynecology, a study finding that women with advanced pelvic organ prolapse and levator ani muscle avulsion would benefit from mesh repair surgery, a registry study on the pregnancy and neonatal outcomes of COVID-19, a study on perinatal outcome after planned vaginal delivery in monochorionic compared with dichorionic twin pregnancy, and newly updated ISUOG Practice Guidelines (Part 2) on the performance of targeted neurosonography.
Ultrasound imaging of slings and meshes in urogynecology
Widespread use of synthetic implants for both urinary incontinence and prolapse has caused a rise in implant-related complications and increasing negative publicity and litigation, with many products removed from the market. There is therefore increasing demand for the assessment and evaluation of sling and mesh implants using imaging. In this State-of-the-Art Review, Shek and Dietz discuss the role of translabial/transperineal ultrasound in the evaluation of synthetic implants used in the treatment of urinary incontinence and pelvic organ prolapse. The discussion focuses on those applications of the technique that are useful for surgeons dealing with patients after mesh and/or sling placement. Ultrasound is an effective tool for determining the presence or absence of synthetic implants, evaluating pelvic floor muscle status and assessing the type of sling or mesh and its functionality, location and course in the pelvis, especially in women with complications, providing an inexpensive and non-invasive imaging technique to aid in diagnosis and patient management.
Women with advanced pelvic organ prolapse and levator ani muscle avulsion would significantly benefit from mesh repair surgery
Mesh repair surgery for pelvic organ prolapse (POP) has been suspended in some countries owing to concerns about its associated complications. However, mesh repair has been shown to reduce the risk of prolapse recurrence after surgery. In view of this controversy, Wong et al. assessed the incidence of subjective and objective recurrence of POP following mesh repair surgery vs native-tissue repair in women with Stage-III or Stage-IV POP. Mesh repair surgery was associated with a 5-fold reduction in the risk of subjective recurrence and a 6-fold reduction in the risk of objective recurrence of prolapse. In women with concomitant levator ani muscle avulsion, mesh repair surgery was associated with a 4-fold reduction in both objective and subjective recurrence of POP. The rate of mesh-related complications was low, and mesh exposure could be treated conservatively or by minor surgery. The benefit of mesh surgery for these high-risk women appears to outweigh the risks of mesh complications, and it could be a treatment option for this group of women.
Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries
Few large cohort studies have reported data on maternal, fetal, perinatal and neonatal outcomes associated with SARS-CoV-2 infection in pregnancy. Mullins et al. report the outcome of infected pregnancies from a collaboration formed early during the pandemic between the investigators of two registries, the UK and Global Pregnancy and Neonatal outcomes in COVID-19 (PAN-COVID) study and the American Academy of Pediatrics (AAP) Section on Neonatal–Perinatal Medicine (SONPM) National Perinatal COVID-19 Registry. The findings of the study, in over 4000 pregnant women, showed that COVID-19 in pregnancy is not associated with stillbirth or early neonatal death, but infected women are more likely to deliver prematurely, particularly because of medically indicated rather than spontaneous delivery. The data presented support strong guidance for enhanced precautions to prevent SARS-CoV-2 infection in pregnancy, and for priority vaccination of pregnant women and women planning pregnancy.
Perinatal outcome after planned vaginal delivery in monochorionic compared with dichorionic twin pregnancy
Several studies failed to show higher perinatal morbidity and mortality associated with uncomplicated monochorionic compared with dichorionic twin pregnancy in cases undergoing planned vaginal delivery. However, the level of evidence is low. In a planned secondary analysis of the large national prospective JUMODA cohort, Schmitz et al. aimed to obtain higher-quality evidence by comparing perinatal outcome between uncomplicated monochorionic and dichorionic twin pregnancies in which vaginal delivery was planned that delivered at ≥32 weeks with the first twin in cephalic presentation. The rate of composite intrapartum mortality and neonatal morbidity and mortality did not differ between uncomplicated monochorionic and dichorionic pregnancies. The choice of the planned mode of delivery in twin pregnancy should therefore not be based on chorionicity. Watch the accompanying video abstract:
ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 2: performance of targeted neurosonography
It is commonly accepted that targeted fetal neurosonography has a much greater diagnostic potential than does the basic screening examination, and is particularly helpful in the evaluation of complex malformations. Newly updated ISUOG Practice Guidelines describe the protocol for the diagnostic ultrasound examination that should be performed in any case in which there is an increased risk of CNS malformation. A detailed list of indications for this targeted fetal neurosonography was published in Part 1 of these guidelines.
Coming up next month…
- An RCT on the effect of pelvic floor muscle physiotherapy on pelvic floor muscle changes assessed using 3D/4D transperineal ultrasound in women with deep infiltrating endometriosis and superficial dyspareunia. Preview the Accepted Article.
- A State-of-the-Art Review on counseling in maternal‐fetal medicine: SARS‐CoV‐2 infection in pregnancy. Preview the Accepted Article.
- A study on the relationship between ophthalmic artery Doppler and maternal cardiovascular function. Preview the Accepted Article.
- A ‘How To’ article on screening for vasa previa. Preview the Accepted Article.