The April issue of Ultrasound in Obstetrics & Gynecology includes a systematic review and meta-analysis evaluating perinatal and maternal outcomes of extremely early-onset fetal growth restriction, a prospective multicenter cohort study assessing single-cell-based non-invasive prenatal testing for detecting fetal pathogenic microimbalances, a retrospective cohort study investigating the predictive value of gB2-specific antibodies for maternal–fetal transmission following primary cytomegalovirus infection treated with valacyclovir, and a multicenter case–control study developing a radiomics-based ultrasound model for differentiating uterine sarcomas from leiomyomas.
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.
Perinatal and maternal outcomes of extremely early-onset fetal growth restriction (≤ 26 weeks): systematic review and meta-analysis
Extremely early-onset fetal growth restriction (FGR) (diagnosed ≤ 26 weeks’ gestation) has been associated with perinatal mortality and morbidity, however evidence is limited by small sample sizes and heterogeneous study design. In this systematic review and meta-analysis, Piergianni et al. evaluated the maternal and perinatal outcomes in singleton pregnancies complicated by extremely early-onset FGR. Across 13 studies comprising over 2500 pregnancies, genetic and structural anomalies occurred in approximately 10% and 23% of cases, respectively, while umbilical artery Doppler anomalies and pre-eclampsia were each reported in 22%. Over half of pregnancies with extremely early-onset FGR were delivered preterm (≤ 32 weeks’ gestation) and perinatal death occurred in 16% of all included cases, with intrauterine and neonatal death reported in 8.8% and 6.2% of cases, respectively. Overall, these findings highlight the high risk of adverse maternal and perinatal outcomes associated with extremely early-onset FGR and may support improved prenatal counseling and risk stratification in affected pregnancies.
Single-cell-based non-invasive screening for fetal pathogenic microimbalances using maternal blood: comparison with invasive prenatal diagnosis
Pathogenic or likely pathogenic copy-number variants (p/lpCNVs), particularly microimbalances, are a major cause of perinatal morbidity and mortality, yet most remain undetected by current cell-free DNA-based screening methods. In this prospective multicenter cohort study, Stampalija et al. evaluated the clinical performance of a novel single-cell-sequencing-based non-invasive prenatal testing (scsbNIPT) approach using circulating extravillous trophoblasts to detect genome-wide fetal p/lpCNVs. Among 1390 high-risk pregnancies undergoing invasive testing, scsbNIPT demonstrated high accuracy for detecting microimbalances measuring ≥ 300 kb to < 8 Mb, with a sensitivity of 92.9% and specificity of 98.2%, increasing to 100% sensitivity in those screened in the first trimester. Performance for trisomy 21 was similarly high (sensitivity, 98.0%; specificity, 99.7%). Notably, the method enabled detection of submicroscopic imbalances at a resolution comparable to that of chromosomal microarray analysis, which are largely missed by conventional screening approaches. These findings suggest that scsbNIPT may substantially reduce the residual risk of undetected genomic abnormalities early in pregnancy and could represent a significant advance in non-invasive prenatal screening, pending further validation in broader populations.
Predictive value of gB2 antibodies for maternal–fetal transmission after primary cytomegalovirus infection treated with valacyclovir
Primary maternal cytomegalovirus (CMV) infection in early pregnancy carries a substantial risk of maternal–fetal transmission, even with antiviral prophylaxis, and tools to refine residual risk remain limited. In this retrospective single-center cohort study, Kagan et al. evaluated the residual risk of CMV transmission in women with periconceptional or first-trimester infection treated with valacyclovir, and assessed whether the presence of gB2-specific immunoglobulin (Ig)-G on immunoblot improves fetal risk prediction. Among 85 women treated before 14 weeks’ gestation, the overall rate of maternal–fetal transmission at amniocentesis was 8.2%, with higher rates observed following first-trimester compared with periconceptional infection (15.8% vs 2.1%). Notably, all cases of transmission occurred in women without gB2-specific IgG antibodies (12.7%), while no transmissions were observed in those with detectable gB2-specific IgG, suggesting a strong association between antibody status and fetal risk. On multivariable analysis, the presence of gB2-specific IgG was independently associated with a markedly reduced likelihood of transmission. These findings indicate that incorporating gB2-specific IgG status into the assessment of early CMV infection may enhance risk stratification, enabling more individualized patient counseling and informing clinical management decisions.
Radiomics-based ultrasOund Model for differentiating Uterine Sarcomas from leiomyomas (ROMUS): a retrospective pilot Multicenter Italian Trials in Ovarian Cancer (MITO) study
Accurate preoperative differentiation between uterine sarcomas and leiomyomas remains challenging, yet is crucial for appropriate surgical management. In this retrospective multicenter case–control study, Ciccarone et al. developed machine-learning models combining clinical data and radiomics features extracted from ultrasound images to distinguish between these tumors. Among 200 patients (100 with uterine sarcoma and 100 with usual-type leiomyoma), eight non-redundant radiomics features were selected for inclusion in model building. The best-performing model, an extreme gradient boosting model, incorporated these features together with patient age, achieving an area under the receiver-operating-characteristics curve (AUC) of 0.93, with sensitivity of 0.93 and specificity of 0.83. The same model including only radiomics features performed slightly less well (AUC, 0.87; sensitivity, 0.87; specificity, 0.83), while subjective assessment by the original ultrasound examiner showed similar sensitivity but higher specificity. These findings suggest that a model integrating eight radiomics features and patient age can discriminate well between uterine sarcomas and leiomyomas, with performance comparable to expert assessment, and may support improved preoperative risk stratification pending validation in larger prospective studies.