The August issue of Ultrasound in Obstetrics & Gynecology includes a systematic review on the benefits and complications of fetal and postnatal surgery for open spina bifida, an external validation of the QUiPP App in three independent European cohorts, a description of the clinical and ultrasound characteristics of serous and mucinous cystadenomas in the adnexa and a study on the screening, diagnosis, management and outcomes of vasa previa.
Please see below a selection of articles from the August issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today or login and upgrade.
Benefits and complications of fetal and postnatal surgery for open spina bifida: systematic review and proportional meta-analysis
Fetal surgery for open spina bifida (OSB) offers substantial potential advantages over standard postnatal surgery, however it also has the potential for significant maternal morbidity. Alternative surgical approaches have been developed to mitigate maternal risks while preserving fetal benefits, such as open minihysterotomy and hybrid and percutaneous fetoscopy. In this proportional meta-analysis, Kunpalin et al. derived pooled estimates of maternal, fetal and pediatric outcomes up to the age of 30 months associated with all currently used perinatal surgical approaches for OSB. Each surgical approach was associated with a specific constellation of procedure-related complications. While none the included studies reported maternal death following prenatal surgery for OSB, perinatal and infant death rates were similar regardless of whether the surgery was performed pre- or postnatally. The authors report that, while there is currently no single perinatal surgical approach for OSB repair that demonstrates clear superiority over the others, these findings should serve to inform clinical decision analysis to identify the best surgical approach for OSB cases.
External validation of QUiPP App in three independent European cohorts of symptomatic women
The QUantitative Innovation in Predicting Preterm birth (QUiPP™) App v.2 is a tool used for assessing the risk of spontaneous preterm birth (sPTB) in symptomatic women with regular contractions and intact membranes. As it was developed and validated using only data from the UK, Fischer et al. conducted an external validation of the QuiPP App v.2 using three different populations to assess its predictive performance in other countries with different diagnostic and treatment policies., The predictive performance of the QUiPP App v.2 for sPTB within 1 week after testing was highest in the European and Dutch cohorts when using the combined model of cervical length (CL) and quantitative fetal fibronectin, and in the Belgian cohort when using the CL-only model. Predictive performance was greater for shorter-term outcomes, specifically sPTB < 30 weeks, compared with longer-term outcomes, such as sPTB < 37 weeks. The results of this external validation suggest that, although very low-risk patients are identified accurately by the app, calibration for higher-risk patients displays more unpredictable behavior and clinical judgment should remain the primary basis for decision-making in such high-risk cases.
Imaging in gynecological disease (28): clinical and ultrasound characteristics of serous and mucinous cystadenomas in the adnexa
In order to enhance ultrasound knowledge of the histological subtypes of ovarian tumors to improve preoperative diagnosis and optimize management, Moro et al. describe the typical clinical and ultrasound characteristics of serous and mucinous cystadenomas in the adnexa, using standardized International Ovarian Tumor Analysis (IOTA) terminology. The study analyzed the findings from 1318 patients (687 (52.1%) with serous cystadenomas and 631 (47.9%) with mucinous cystadenomas, four of which were seromucinous cystadenomas), making it the largest study describing the ultrasound characteristics of serous and mucinous cystadenomas. Recognizing these typical features allows examiners to assign a correct diagnosis and avoid misdiagnosing cystadenomas as malignant, therefore preventing surgery for these benign tumors in asymptomatic patients. These findings should establish the foundation for prospective studies estimating the ability of ultrasound examiners to assign a correct specific diagnosis to adnexal masses using pattern recognition.
Vasa previa screening, diagnosis, management and outcomes: single-center study
Since the era of prenatal diagnosis of vasa previa (VP), the associated high risk of stillbirth has been reduced, owing to planned Cesarean delivery before labor or rupture of the membranes. However, there are limited data to guide the diagnosis and management of VP, with the largest single-center study including only 96 patients. Lueck et al. conducted this study in a cohort of 205 patients with VP at a single center in which routine VP screening is performed, reporting on the screening, diagnosis, management and outcomes. There was near-universal perinatal survival, with the single death occurring in one of a set of monochorionic diamniotic twins that underwent laser photocoagulation for twin–twin transfusion syndrome. Delivery ≥ 36 weeks (but no later than 37 weeks) resulted in improved neonatal outcomes when compared with patients delivering < 36 weeks. These findings strongly support the implementation of a screening program for VP, which has the potential to significantly reduce the high rate of stillbirth associated with this condition by diagnosing cases prenatally.