The December issue of Ultrasound in Obstetrics & Gynecology includes a systematic review collating the current evidence on prenatal diagnosis and perinatal outcome of congenital knee dislocation, a multicenter study proposing a new model for prediction of adverse outcome in extremely preterm growth-restricted fetuses requiring early delivery, a large regional study evaluating the role of SARS-CoV-2 infection as a cause of fetal death, a study assessing the impact of choroid plexus size in cases with an abnormal closure of the fourth ventricle, and a prospective study demonstrating the potential of photoacoustic imaging in improving O-RADS risk assessment of adnexal lesions. Also in the issue, we celebrate the award winners announced at the 33rd World Congress on Ultrasound in Obstetrics and Gynecology and thank all contributors to the Journal’s peer-review process in 2023.
Prenatal diagnosis and postnatal outcome of fetal congenital knee dislocation: systematic review of literature
Congenital knee dislocation (CKD) is a rare condition, whose development, prenatal diagnosis and postnatal outcome have not been described extensively in the literature. In this systematic review, Cavoretto et al. collate the currently available evidence on this condition. The findings of this study suggest that diagnosis of CKD is possible from the early second trimester and the prognosis is highly dependent on the presence of associated anomalies, being excellent in isolated cases and poor in complex cases, with the latter showing about 80% risk of a genetic syndrome. Early postnatal conservative treatment of CKD is effective in isolated cases, achieving resolution after manipulation, serial casting and physiotherapy, while surviving cases with associated anomalies may require surgery. Based on this review of the literature, the authors propose a comprehensive protocol for prenatal counseling and perinatal management of CKD cases.
Mortality and severe neurological morbidity in extremely preterm growth-restricted fetuses
Intensive monitoring and elective delivery constitute standard management of cases with fetal growth restriction. However, the likelihood of survival without major sequelae following an early delivery is uncertain and represents a great challenge for counseling. In this multicenter study, Mazarico et al. developed a model for the prediction of adverse perinatal outcome in growth-restricted fetuses requiring delivery before 28 weeks. The new model is based on fetal weight, sex, Doppler status and gestational age at delivery, and performs significantly better compared with a model including only gestational age. This study indicates that considering additional fetal parameters, beyond gestational age at delivery, could facilitate more comprehensive patient counseling and shared decision-making in affected cases.
SARS-CoV-2 infection as cause of in-utero fetal death: regional multicenter cohort study
SARS-CoV-2 infection during pregnancy has been associated with an increased risk of pre-eclampsia, need for mechanical ventilation, preterm birth, Cesarean delivery and fetal death. In this multicenter study, Nkobetchou et al. aimed to quantify the role of SARS-CoV-2 infection as a cause of fetal demise in a large cohort of 147,722 deliveries occurring over a 2-year period in the Paris region. The study demonstrates that, during the COVID-19 pandemic, 2.8% of cases of fetal demise labeled as being of placental or undetermined origin in this cohort were due to severe SARS-CoV-2 placentitis. The authors also report a strong correlation between SARS-CoV-2 placentitis and presence of chronic intervillositis and/or massive fibrin deposits in the placenta. Given these findings, the authors emphasize the need for SARS-CoV-2 screening in stillbirth assessment, especially when a specific histological pattern is identified.
Impact of choroid plexus size in prenatal diagnosis of normal and abnormal closure of fourth ventricle
Detection of the cisterna magna channeling into the fourth ventricle (4V) (a finding commonly referred to as an open 4V) at the anomaly scan of the fetal brain may suggest agenesis, hypoplasia, upward displacement or upward rotation of the cerebellar vermis and presence of a cystic anomaly of the posterior fossa. In this study, Volpe et al. assess the role of the choroid plexus (CP) of the 4V in fetuses with an open 4V and a normal cerebellar vermis. The authors report that, in 12% of the evaluated cases, an open 4V is due to a small CP, which is associated with a good outcome. This study suggests that the closure of the 4V is dependent on the 4V-CP and not only on the cerebellar vermis. Therefore, separate visualization of these two structures is crucial to improve discrimination between the different causes of an open 4V and its clinical implications.
Characterization of adnexal lesions using photoacoustic imaging to improve sonographic O-RADS risk assessment
The Ovarian-Adnexal Reporting and Data System (O-RADS) risk stratification and management system provides guidelines for sonographic reporting of ovarian and other adnexal masses, allowing accurate assignment of risk of malignancy to each lesion and informing management recommendations. However, the system has lower accuracy in certain cases, such as benign solid lesions. Photoacoustic imaging is applied increasingly in different types of cancer; however, its value in the setting of adnexal malignancy risk stratification has not been explored. This prospective study by Zhu et al. demonstrates that photoacoustic imaging parameters, including relative total hemoglobin concentration and blood oxygen saturation, improve significantly the diagnostic accuracy of the ultrasound-based O-RADS. Incorporating photoacoustic imaging information as part of O-RADS may improve risk management of patients with certain adnexal lesions, potentially avoiding surgery and thereby reducing healthcare costs and surgical complications.
Coming up next month…
- ISUOG Practice Guidelines on performance of third-trimester obstetric ultrasound scan.
- A systematic review assessing the incremental yield of whole-genome sequencing over chromosomal microarray analysis and exome sequencing for congenital anomaly. Preview the Accepted Article.
- A randomized controlled trial investigating the effectiveness of visual biofeedback in shortening the second stage of labor and reducing the need for instrumental delivery. Preview the Accepted Article.
- A study evaluating the performance of transvaginal ultrasound in diagnosing superficial endometriosis by visualizing the peritoneum of the pouch of Douglas. Preview the Accepted Article.
- A study examining the utility of a deep-learning model in prenatal detection of congenital heart disease. Preview the Accepted Article.