The December issue of Ultrasound in Obstetrics & Gynecology includes an article outlining the top 10 global research priorities for multiple pregnancy, a systematic review on the performance of middle cerebral artery peak systolic velocity for the prediction of anemia in transfused and untransfused fetuses, a study describing a new first-trimester sonographic marker of spina bifida, and a study on the impact of three definitions of septate uterus. Also out this month is a new video abstract accompanying a randomized controlled trial of elective delivery vs routine obstetric care in fetal gastroschisis.
Research priorities for the future health of multiples and their families: The Global Twins and Multiples Priority Setting Partnership
The Global Twins and Multiples Priority Setting Partnership was formed with the aim of identifying the top unanswered questions in health research for multiples. To do this, the partnership appealed globally to twins, parents of twins, clinicians, health professionals, and researchers to undertake an initial survey, asking them to identify their most pressing unanswered questions relating to multiple-birth health. Over 1100 participants from 31 countries responded, suggesting 2891 wide-ranging questions. Lam et al. outline how these questions were narrowed down in a subsequent survey and workshop, and present the top 10 global research priorities identified.
Performance of fetal middle cerebral artery peak systolic velocity for prediction of anemia in untransfused and transfused fetuses: systematic review and meta-analysis
While Doppler assessment of middle cerebral artery peak systolic velocity (MCA-PSV) is now widely accepted as the best non-invasive tool for the prediction of fetal anemia, there is conflicting evidence regarding its accuracy, and its reliability after several intrauterine transfusions has been called into question. Martinez-Portilla et al. performed a systematic review to evaluate the performance of MCA-PSV ≥1.5 MoM for the prediction of moderate–severe anemia, in untransfused and transfused fetuses, finding it to have moderate accuracy (86% sensitivity and 71% specificity) in untransfused fetuses, which declines with increasing number of intrauterine transfusions.
Crash sign: new first-trimester sonographic marker of spina bifida
Open spina bifida is usually detected in pregnancy on second-trimester ultrasound examination. A number of sonographic signs have been described to aid early detection of spina bifida, although they have yet to become well established in clinical practice. Ushakov et al. describe a new first-trimester marker of spina bifida, the ‘crash sign’, which is the posterior displacement of the mesencephalon and deformation against the occipital bone in the axial view. The crash sign was present in 48 out of 53 confirmed cases of spina bifida and was not reported in any of the control fetuses. The crash sign is based entirely on pattern recognition rather than measurements, and therefore has the potential to be easily assessed and adopted during a first-trimester scan.
Septate uterus according to ESHRE/ESGE, ASRM and CUME definitions: association with infertility and miscarriage, cost and warnings for women and healthcare systems
One of the most important issues regarding septate uterus is the lack of a universally accepted means of defining this condition. Ludwin et al. assessed the impact of three definitions of septate uterus on the frequency of diagnosis of the condition and its association with infertility and/or previous miscarriage and cost of allocation to surgery. Considerable differences in the prevalence of septate uterus were found between the definitions, with a high rate of overdiagnosis using the ESHRE/ESGE criteria, which may lead to unnecessary surgery and costs to healthcare systems. A limitation of the ASRM-2016 criteria was found to be the relatively high proportion of unclassifiable uteri. While septate uterus was found to be associated with previous miscarriage, it did not seem to be related to infertility (download the accompanying Journal Club slides).
Also out this month…
New video abstract on a randomized controlled trial of elective delivery at 34 weeks vs routine obstetric care in fetal gastroschisis
Coming up in the next issue…
- A study by Litwinska et al. on the outcome of twin pregnancy with two live fetuses at 11–13 weeks. Preview the Accepted Article.
- A study by de Sonnaville et al. on the impact of the HYPITAT-I trial in The Netherlands, concluding that inducing labor is the optimal management strategy for women with a hypertensive disorder of pregnancy. Read the Early View article.
- A study by Ficara et al. finding that routine ultrasound examination at 35–37 weeks' gestation may reveal new fetal abnormalities that could not be diagnosed at earlier examinations. Read the Early View article.
- A study by Wang et al. in which copy-number variations associated with early pregnancy loss are systematically analyzed. Preview the Accepted Article.