The February issue of Ultrasound in Obstetrics & Gynecology includes a systematic review on the impact of low-dose aspirin on adverse perinatal outcome, a study on non-invasive prenatal testing for aneuploidy in 31 515 singleton pregnancies, a study on the value of routine ultrasound examination at 35–37 weeks in the diagnosis of non-cephalic presentation, and a study on the learning curve for detection of the pelvic parts of the ureters on transvaginal sonography.
Impact of low-dose aspirin on adverse perinatal outcome: meta-analysis and meta-regression
Low-dose aspirin (LDA) is beneficial in preventing pre-eclampsia (PE) and its related complications, although it is not clear if the improvement in perinatal outcome is independent of the primary role of LDA in preventing this disease. In a meta-analysis and metaregression of randomized controlled trials, Turner et al. evaluated the impact of LDA on perinatal outcome, independent of its effect on PE, preterm birth and low birth weight. It was found that aspirin intake, when commenced at ≤16 weeks’ gestation at a dose ≥100 mg, results in a reduction in the risk of perinatal death, independently of its concomitant beneficial effect on reducing the risk of PE and preterm birth.
Non-invasive cell-free fetal DNA testing for aneuploidy: multicenter study of 31 515 singleton pregnancies in southeastern China
Over the last few years, non-invasive prenatal testing (NIPT) has fast become the first-choice methodology in many settings for routine screening in pregnancy for fetal chromosomal abnormalities. Xu et al. analyzed the NIPT results of 31 515 singleton pregnancies in southeastern China, and assessed its performance for screening in low-, moderate- and high-risk pregnancies. High sensitivity and specificity and moderate or high positive predictive values were found for the detection of trisomies 21, 18 and 13 and sex chromosome aneuploidy, supporting the clinical application of NIPT for reliable and accurate detection of clinically significant fetal aneuploidy in the general population of reproductive-age Chinese women.
Value of routine ultrasound examination at 35–37 weeks’ gestation in diagnosis of non-cephalic presentation
Undiagnosed non-cephalic presentation in labor carries increased risks for both the mother and baby. Routine pregnancy care based on maternal abdominal palpation fails to detect the majority of cases of non-cephalic presentation. In 45 847 singleton pregnancies, De Castro et al. reported the incidence of non-cephalic presentation at a routine scan at 35–37 weeks’ gestation and subsequent management. The incidence of non-cephalic presentation at this scan was found to be about 5%, but, in about 40% of these cases, the presentation at birth was cephalic, mainly due to subsequent spontaneous rotation and, to a lesser extent, as a consequence of successful external cephalic version. Such diagnosis could therefore potentially improve pregnancy outcome by preventing unexpected abnormal presentation in labor and, through external cephalic version, reducing the incidence of non-cephalic presentation.
Learning curve for detection of pelvic parts of ureters by transvaginal sonography: feasibility study
Urinary tract endometriosis affecting the ureters is rare and often with non-specific symptoms, but can confer significant morbidity due to renal damage if left undiagnosed and untreated. Several studies have proposed that assessment of the ureters should be part of the transvaginal sonography (TVS) examination in women with suspected deep infiltrating endometriosis. Aas-Eng et al. evaluated the learning curve for TVS-based detection of the pelvic parts of the ureters. It was found that sonographers and/or gynecologists who are familiar with gynecological TVS should be able to become proficient in identifying both ureters after 40–50 TVS examinations (view the accompanying Journal Club slides).
Coming up in the next issue…
- Studies on the development and validation of the prediction models for the QUiPP App v.2, a tool for predicting preterm birth, in: high-risk asymptomatic women and women with symptoms of threatened preterm labor.
- A randomized controlled trial comparing antral follicle count and serum anti-Müllerian hormone level for determination of gonadotropin dosing in women undergoing in-vitro fertilization. Preview the Accepted Article.