The December issue of Ultrasound in Obstetrics & Gynecology includes a State-of-the-Art Review discussing the rationale for fetoscopic repair of complex gastroschisis, a study demonstrating evidence of SARS-CoV-2 vertical transmission according to the WHO criteria, a study showing similar characteristics of ectopic pregnancies prior to vs during the COVID-19 pandemic and a study finding that transvaginal sonography determines accurately the extent of infiltration of rectosigmoid deep endometriosis. Also in the issue, find out who were the all-important contributors to UOG’s peer-review process in 2021.

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 or login and upgrade.

Complex gastroschisis: a new indication for fetal surgery?

Gastroschisis can be classified as either simple or complex, with the latter requiring multiple neonatal surgeries and being associated with significantly greater postnatal morbidity and mortality. In this State-of-the-Art Review, Joyeux et al. discuss the rationale for fetoscopic repair of complex gastroschisis to improve outcome, based on the five criteria of the International Fetal Medicine and Surgery Society. These criteria include an established natural history, ability to achieve accurate prenatal diagnosis, absence of fully effective perinatal treatment due to prolonged need for neonatal intensive care, experimental evidence that fetoscopic repair may mitigate adverse effects and improve fetal and neonatal outcomes, and demonstration of the maternal and fetal safety of fetoscopy in high-volume expert fetal centers. The authors also propose a research agenda to help overcome barriers to progress and provide a pathway toward clinical implementation.

Evidence of possible SARS-CoV-2 vertical transmission according to World Health Organization criteria in asymptomatic pregnant women

Recently, the World Health Organization (WHO) published strict criteria to classify the timing of mother-to-child transmission of SARS-CoV-2 into different categories. Sevilla-Montoya et al. investigated the possibility of vertical transmission in asymptomatic SARS-CoV-2-positive pregnant women, based on the WHO criteria. In 12% of cases, amniotic fluid samples and neonatal samples at birth and at 24 hours after birth were positive for SARS-CoV-2, demonstrating strong evidence of intrauterine transmission of SARS-CoV-2, according to the WHO criteria. The findings also showed that 40–60% of infected neonates would have been undetected if only one swab (oral or rectal) was tested, therefore highlighting the importance of testing more than one neonatal sample in order to increase the detection rate of SARS-CoV-2 in affected cases.

Ultrasound characteristics, serum biochemistry and outcome of ectopic pregnancies presenting during COVID-19 pandemic

There are concerns that a fear of attending hospital due to the risk of SARS-CoV-2 infection may have led women to delay accessing care for early pregnancy and acute gynecological problems. Kyriacou et al. described and compared the characteristics of ectopic pregnancies in the year prior to vs during the COVID-19 pandemic. Among 22,683 consultations, no difference was observed in the location, size, morphology or gestational age at the first ultrasound examination or at diagnosis of ectopic pregnancy between women diagnosed before vs during the COVID-19 pandemic. Complication rates and final management strategy were also unchanged. However, hCG levels and the failure rate of first-line conservative management measures were higher during the pandemic. The findings suggest that women continued to access appropriate care for ectopic pregnancy during the COVID-19 pandemic, with no evidence of diagnostic delay or an increase in adverse outcome.

Transvaginal sonography determines accurately extent of infiltration of rectosigmoid deep endometriosis

Measurement of all three diameters of rectosigmoid deep endometriosis (DE) lesions is pivotal and recommended by the IDEA group, with lesion length being the most important of the three diameters in determining surgical technique. In a prospective multicenter study, Aas-Eng et al. investigated the agreement of measurements of the three diameters of rectosigmoid DE lesions between presurgical evaluation using transvaginal sonography, in accordance with the IDEA group consensus statement, and postsurgical specimen measurement. It was found that preoperative transvaginal sonography determines accurately rectosigmoid DE lesion length but is less reliable for lesion thickness and transverse diameter measurements. Transvaginal sonography can thereby contribute to optimal planning of surgical treatment options in women with rectosigmoid DE. 

Acknowledgment of Referees

We would like to express our gratitude to the reviewers who participated in the peer-review process of UOG in 2021. This year, UOG achieved an Impact Factor of 7.299, ranking 5th in the category of obstetrics and gynecology. Owing to our impressive Impact Factor and the high quality and clinical relevance of the material we publish, we have continued to receive a growing number of submissions. Despite the tremendous workload, the average time for a manuscript to be reviewed by the Journal remains at under 30 days. The continued success of UOG is largely attributable to the expertise, hard work and timeliness of our willing reviewers. A list of these essential contributors can be found here.

Coming up next month…

  • A study reporting clinical experience with non-invasive prenatal screening for single-gene disorders. Preview the Accepted Article.
  • A study developing and validating a model for prediction of placental dysfunction-related stillbirth from maternal factors, fetal weight and uterine artery Doppler at mid-gestation. Preview the Accepted Article.
  • A study evaluating comorbidities, poverty and social vulnerability as risk factors for maternal mortality in 13,062 SARS-CoV-2-positive pregnancies including 176 maternal deaths in Mexico. Preview the Accepted Article.
  • A planned secondary analysis of a RCT comparing reproductive outcome after early miscarriage between vaginal misoprostol treatment and expectant management. Preview the Accepted Article.