The April issue of Ultrasound in Obstetrics & Gynecology includes a systematic review on the diagnostic performance of prenatal ultrasound in coarctation of the aorta, a nationwide cohort study on the outcome of multifetal reduction in quadruplet pregnancy, a study validating the IETA-1 model for intracavitary uterine pathology in women without abnormal uterine bleeding and a summary of the findings of a systematic review on cervical cerclage in twin pregnancy.

Please see below a selection of articles from the April issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today or login and upgrade.

Diagnostic accuracy of prenatal ultrasound in coarctation of aorta: systematic review and individual participant data meta-analysis

Coarctation of the aorta accounts for 7% of neonatal cardiac defects but remains difficult to diagnose on fetal echocardiography. This systematic review and meta-analysis by Villalaín et al. investigates the diagnostic performance of prenatal sonography for aortic coarctation in the neonate. Several biometric parameters, including those indicative of valvular disproportion and a narrow aortic arch, were associated independently with a postnatal diagnosis. However, the parameters had only moderate diagnostic accuracy, even when considered in combination. Nevertheless, given the potentially fatal implications of a false-negative diagnosis, the authors conclude that cardiac asymmetry on prenatal ultrasound should still prompt detailed follow-up for coarctation of the aorta.

Quadruplet pregnancy outcome with and without fetal reduction: Danish national cohort study (2008–2018) and comparison with dichorionic twins

The rarity of quadruplet pregnancy has hindered the development of robust recommendations for antenatal management, despite the high risk of pregnancy loss and growth restriction. This nationwide cohort study by Rasmussen et al. compares the outcome of 30 quadrichorionic quadriamniotic quadruplet pregnancies undergoing fetal reduction with that of three non-reduced quadruplets seen over a 10-year period. The rates of adverse outcome, low birth weight and preterm delivery were lower in pregnancies reduced to twins or singletons compared with non-reduced quadruplets. Although quadruplets reduced to twins did not achieve equivalent pregnancy outcomes to those of dichorionic diamniotic twins, the significant improvement over expectant management and the low rate of miscarriage support the safety of multifetal reduction in quadruplet pregnancy.

Estimating risk of endometrial malignancy and other intracavitary uterine pathology in women without abnormal uterine bleeding using IETA-1 multinomial regression model: validation study

There is no consensus on the appropriate work-up for abnormal endometrium detected incidentally on ultrasound in women without abnormal uterine bleeding. This study by Heremans et al. of the International Endometrial Tumor Analysis (IETA) Consortium evaluates the performance of the IETA-1 multivariable risk-prediction model, developed in women presenting with abnormal bleeding, in an asymptomatic population. The IETA-1 model outperformed endometrial thickness in discriminating between benign and malignant intracavitary uterine conditions. The model was well-calibrated for endometrial polyps and intracavitary myoma, although it overestimated the risk of malignancy. Provided that clinicians acknowledge its limitations, the IETA-1 model could be used to guide patient counseling following an incidental finding of abnormal endometrium.

Role of cerclage in twin and singleton pregnancy: evidence from systematic review and meta-analysis

The unique pathophysiology of preterm birth in twin pregnancy means that preventive strategies developed in singleton pregnancy do not necessarily retain their efficacy when applied to twins. In this report, D’Antonio et al. review the literature on the performance of cervical cerclage in twin compared with singleton pregnancy. Compiling data from 13 studies, they found that the risk of preterm birth in twin pregnancies undergoing cerclage was similar to that in their singleton counterparts. Moreover, there was no significant difference between groups in the risk of complications, such as chorioamnionitis and preterm prelabor rupture of membranes. These findings support the use of cervical cerclage in asymptomatic twin pregnancies presenting with short cervical length or cervical dilatation on ultrasound. 

Coming up next month…

  • A randomized controlled trial on the effect of maternal supplementation with docosahexaenoic acid during pregnancy on constriction of the fetal ductus arteriosus. Preview the Accepted Article.
  • A systematic review comparing the performance of externally validated prediction models for pre-eclampsia. Preview the Accepted Article.
  • A cohort study delineating the ultrasound features of uterine sarcoma and benign leiomyoma using MUSA terminology. Preview the Accepted Article.
  • A study evaluating the prediction of adverse outcome using different charts and definitions of fetal growth restriction.  Preview the Accepted Article.