The August issue of Ultrasound in Obstetrics & Gynecology includes a systematic review and meta-analysis evaluating fetal cardiac function in growth-restricted fetuses using left and right myocardial performance indices, a prospective study examining the incidence and predictors of hypertension at 5 months postpartum in women with previous gestational diabetes mellitus, an evaluation of whether the ratio of soluble fms-like tyrosine kinase-1 to placental growth factor is associated with hemodynamic changes in ophthalmic artery Doppler in near-term pregnancy and a prospective study externally validating the diagnostic performance of ADNEX model for distinguishing between malignant and benign adnexal masses when used by non-expert ultrasound examiners in general gynecological settings.
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.
Hypertension at 5 months postpartum in women with gestational diabetes
Gestational diabetes mellitus (GDM) is linked to a higher risk of adverse maternal and neonatal outcomes, with emerging evidence suggesting that women with GDM are also at an increased risk for small- and large-vessel vascular dysfunction, cardiovascular disease and metabolic syndrome and its components, including hypertension, in the postpartum period. However, predictors of postpartum hypertension in women with prior GDM are unknown. In this prospective cohort study, Gómez Fernández et al. invited women who developed GDM during index pregnancy to a 5-month postpartum visit, at which assessment was undertaken for hypertension. One in four women with recent GDM were reported to have developed hypertension at 5 months postpartum. However, risk prediction from factors observed in early pregnancy was only modest, underscoring the need for universal postpartum blood pressure assessment.
Left and right myocardial performance indices in growth-restricted fetuses: systematic review and meta-analysis
Hemodynamic compensation associated with the pathophysiology of fetal growth restriction (FGR) can contribute to progressive deterioration of fetal cardiac function and myocardial remodeling. As the myocardial performance index (MPI) has emerged as a promising non-invasive tool for evaluating global fetal cardiac function, this systematic review and meta-analysis by Sirico et al. aimed to evaluate differences in MPI and its constituent parameters for both the left and right ventricles between fetuses diagnosed with FGR and controls. FGR was found to be associated with significant biventricular cardiac dysfunction, characterized primarily by impaired myocardial relaxation, as indicated by a markedly prolonged isovolumetric relaxation time (IRT). The authors report that IRT appears to be a more sensitive marker of cardiac compromise in FGR than the traditional E/A ratio, with their findings supporting the use of MPI and its components as valuable adjunctive tools in the surveillance of FGR pregnancies.
Ophthalmic artery Doppler as potential surrogate marker of angiogenic imbalance in near-term pregnancy
The relatively high cost of using the sFlt-1/PlGF ratio to rule out pre-eclampsia and its limited accessibility in low-resource settings have prompted evaluation of other non-invasive tests for predicting endothelial damage and pre-eclampsia, including the ophthalmic artery (OA) Doppler. In line with this, Tinajero et al. assessed whether the sFlt-1/PlGF ratio is associated with hemodynamic changes in OA Doppler in near-term pregnancy and evaluated the performance of OA Doppler in ruling in and ruling out angiogenic factor imbalance. Their findings provide new evidence of a significant association between the sFlt-1/PlGF ratio and OA Doppler parameters in near-term pregnancies, suggesting that OA Doppler indices, particularly the peak systolic velocity ratio, reflect angiogenic imbalance. Given its non-invasive nature, accessibility and low cost, these findings support OA Doppler as a promising surrogate tool for ruling out angiogenic imbalance.
Prospective external validation of ADNEX and RMI for estimating risk of malignancy in adnexal masses in general gynecological settings: Danish multicenter study
Optimal management of adnexal masses relies on the initial ultrasound assessment, which is typically performed by general gynecologists (non-expert examiners). However, the diagnostic performance of the Assessment of Different NEoplasias in the adneXa (ADNEX) model and the Risk of Malignancy Index (RMI) in routine gynecological practice, in which non-expert examiners care for patients with predominantly benign masses, has not been investigated thoroughly. In this prospective study, Dueholm Hjorth et al. externally validated the ADNEX model for distinguishing between malignant and benign adnexal masses, when used by non-expert ultrasound examiners in general gynecological settings, and compared its performance with that of the RMI and serum CA 125 alone. The ADNEX model demonstrated excellent diagnostic performance for identifying adnexal malignancy when used prospectively in routine clinical practice by non-expert ultrasound examiners in a general gynecological setting who were trained in IOTA terminology, and significantly outperformed the RMI and serum CA 125 alone.