The August issue of Ultrasound in Obstetrics & Gynecology includes a multicenter study developing and validating radiomics models to predict high-risk endometrial cancer, a prospective study providing insight into ultrasound features observed in asymptomatic women with endometrial pathology, and a systematic review and meta-analysis investigating the true incidence and outcomes of brain abnormality in surviving children following laser surgery for twin-to-twin transfusion syndrome. The August issue also features two novel studies providing complementary evidence supporting the role of uteroplacental dysfunction in preterm birth and discussing the potential of placental biomarkers in the prediction of preterm delivery in the first trimester. This month also sees the release of an Early View version of ISUOG Practice Guidelines on the role of ultrasound in the prediction of spontaneous preterm birth.
Developing and validating ultrasound-based radiomics models for predicting high-risk endometrial cancer
Preoperative risk stratification of endometrial cancer is of paramount importance for the selection of optimal treatment. The study by Moro et al. validates new radiomics models for differentiation among different risk groups of endometrial cancer, defined according to ESMO-ESGO-ESTRO consensus. The radiomics model appears to have moderate ability to distinguish low-risk endometrial cancer and better ability to discriminate high-risk endometrial cancer from other endometrial cancers. However, the addition of radiomics features to clinical-ultrasound models does not improve the models’ performance, highlighting the need for further research and validation.
Ultrasound features of endometrial pathology in women without abnormal uterine bleeding: results from the International Endometrial Tumor Analysis study (IETA3)
Most of the research on endometrial pathology focuses on women with abnormal bleeding. In their new prospective multicenter study, Heremans et al. are the first to describe sonographic features of endometrial pathology using the IETA3 terminology in premenopausal and postmenopausal women without abnormal uterine bleeding. The authors also report that the presence of polyps or endometrial cancer in asymptomatic women may be accompanied by thinner and less intensely vascularized endometrium compared to that observed in women with abnormal bleeding. These findings should facilitate the diagnosis of endometrial pathology in asymptomatic women.
Incidence and outcome of prenatal brain abnormality in twin-to-twin transfusion syndrome: systematic review and meta-analysis
Although laser surgery for twin-to-twin transfusion syndrome (TTTS) improves the overall perinatal outcome, it also increases the risk of brain lesions and neurodevelopmental delay in survivors. Sileo et al. present a systematic review and meta-analysis of studies reporting on perinatal outcome of laser surgery for TTTS. According to the findings of the study, the true incidence of brain abnormality following laser surgery is around 2% and the most common type of abnormality is ischemic (30%). In more than 50% of cases with prenatal diagnosis of brain abnormality following laser surgery for TTTS, parents opt for termination of pregnancy, while fetal and neonatal death occur in 13% and 15% of cases, respectively. This review demonstrates that currently available studies on the topic of laser surgery for TTTS rarely report on neonatal morbidity outcomes, such as neurodevelopmental delay, highlighting the urgent need for long-term follow-up of affected children.
Routine first-trimester pre-eclampsia screening and risk of preterm birth
In a new study on preterm birth (PTB), Giorgione et al. demonstrate that women who are classified in the first trimester as being at high risk of preterm pre-eclampsia using the FMF algorithm, which includes maternal factors, mean arterial pressure, UtA-PI and PAPP-A, are also at increased risk of both iatrogenic and spontaneous PTB. These findings suggest that the two PTB subtypes may have a common uteroplacental etiology. The authors also present a new model for prediction of PTB based on the uteroplacental factors used to predict pre-eclampsia risk, which shows acceptable performance in predicting PTB at <33 weeks. The authors conclude that women who are identified to be at high risk of preterm pre-eclampsia should undergo additional monitoring and preventive management to reduce their risk of PTB.
Prediction of spontaneous preterm birth and preterm prelabor rupture of membranes using maternal factors, obstetric history and biomarkers of placental function at 11–13 weeks
A retrospective analysis of data from a prospective cohort study by Chiu et al. demonstrates that first-trimester maternal serum PAPP-A and PlGF levels are reduced in cases of spontaneous preterm birth and preterm prelabor rupture of membranes (PPROM) at <37 weeks. Similar to findings of Giorgione et al., the results of this study support the role of placental insufficiency in the pathophysiology of PPROM and preterm birth and emphasize the value of placental markers in the prediction and prevention of preterm birth.
Coming up next month…
- Two studies and an accompanying Editorial on the impact of location and socioeconomic status on prenatal detection of congenital heart disease. Preview the two Accepted Articles by Perez et al. and Kaur et al.
- A prospective study evaluating the role of ultrasound in detection of clinically significant placenta accreta spectrum disorder. Preview the Accepted Article.
- A State-of-the-Art Review discussing diagnostic modalities in endometriosis. Preview the Accepted Article.
- ISUOG Practice Guidelines on the role of ultrasound in the prediction of spontaneous preterm birth. Preview the Early View version.