The December issue of Ultrasound in Obstetrics & Gynecology contains, among other articles, an opinion piece on neurosonography vs fetal cerebral magnetic resonance imaging, a study describing progressive lesions of the central nervous system in microcephalic fetuses with suspected congenital Zika virus infection and an original article reporting on fetal survival rate following fetoscopic laser coagulation in the treatment of twin-to-twin transfusion syndrome.
Please see below a selection of articles from the December issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today.
Fetal cerebral magnetic resonance imaging, neurosonography and the brave new world of fetal medicine
Magnetic resonance imaging (MRI) and sonography are two imaging techniques commonly used in the diagnosis of fetal cerebral malformations. However, there has been much debate over which is the superior technique. Published data suggesting a superiority of MRI have previously received criticism for being the outcome of biased studies. In particular, a lack of differentiation between basic and dedicated sonographic exams has been noted. In this opinion piece, Malinger et al. addressed such biases with respect to the recent work of the MERIDIAN group, articles from which are published in the current issue. The authors argue that, whilst MRI is a powerful diagnostic tool, it is by no means a replacement for high-quality ultrasound in the diagnosis of fetal cerebral anomalies.
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Progressive lesions of central nervous system in microcephalic fetuses with suspected congenital Zika virus syndrome
Congenital infections are a leading cause of microcephaly in fetuses, and Zika virus (ZIKV) has become one of the latest reported as causing the condition when maternal infection occurs during pregnancy. Fetal abnormalities have been shown to be more prevalent in ZIKV-positive women, and present even when maternal infection occurs in the second or third trimester. However, characteristics of central nervous system (CNS) lesions in affected fetuses are not well characterized. In this original article, Sarno et al. reported on serial ultrasound examinations performed on 52 microcephalic fetuses with suspected ZIKV infection. From this, the group described the pattern and progression of a range of severe, progressive CNS lesions frequently presenting alongside microcephaly.
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Fetoscopic laser coagulation in 1020 pregnancies with twin–twin transfusion syndrome demonstrates improvement in double-twin survival rate
Fetoscopic laser coagulation of placental vascular anastomoses in twin-to-twin transfusion syndrome directly treats the abnormal placental blood vessel connections underlying the condition. The technique was first demonstrated over 25 years ago and perinatal survival rate has significantly improved since that time. There is, however, large variation in survival rates following the procedure between individual centers. In this original article, Diehl et al. reported on perinatal outcome following laser therapy in 1020 pregnancies performed at a single center over an 18-year period. The authors investigated the effect of factors, including experience and technique refinement, on fetal survival rate over this period, and made clinical practice recommendations accordingly.
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Coming up in the next issue of UOG…
- A randomized controlled trial on misoprostal treatment vs expectant management in women with early non-viable pregnancy and vaginal bleeding. Preview the accepted article here. This article has been chosen for Journal Club, so look out for the accompanying downloadable slides next month.
- A systematic review by Giorgione et al. on increased risk of congenital heart defects in IVF/ICSI pregnancy as compared with pregnancies conceived spontaneously. Preview the accepted article here.
- An expert international consensus on antral follicle counting, suggesting minimum standards and proposing a standardized report to describe antral follicle evaluation. Preview the accepted article here.