The February issue of Ultrasound in Obstetrics & Gynecology includes State-of-the-Art Reviews on pharmacologic considerations for COVID-19 in pregnancy and the technique and diagnostic potential of first-trimester fetal neurosonography, an individual participant data meta-analysis of Foley catheter vs oral misoprostol for induction of labor, a propensity score matched analysis of the risk of COVID-19-related outcomes in pregnant vs non-pregnant women, a study on the prediction of pre-eclampsia in twin pregnancy by maternal factors and biomarkers at 11–13 weeks’ gestation using data from the EVENTS trial, and a study on vessel morphology depicted by 3D power Doppler ultrasound as a second-stage test in adnexal tumors that are difficult to classify.
Pregnancy and COVID-19: pharmacologic considerations
The COVID-19 pandemic has sparked controversies surrounding the use of certain pharmacologic interventions in pregnancy. In this State-of-the-Art Review, D’Souza et al. summarize published evidence and critically appraise international guidelines in order to provide an expert opinion regarding pharmacologic considerations unique to the care of pregnant and postpartum women with COVID-19. The interventions covered include antenatal corticosteroids, magnesium sulfate, low-dose aspirin for prevention of placenta-mediated conditions, indomethacin for prevention of preterm birth, thromboprophylaxis, intrapartum analgesia and anesthesia, mechanical ventilation and experimental drugs for COVID-19 in the setting of clinical trials.
First-trimester fetal neurosonography: technique and diagnostic potential
Most brain abnormalities are present in the first trimester, but only a few are detected so early in gestation. In the axial planes, a ‘basic’ examination of the fetal brain may be performed in accordance with current ISUOG guidelines for first-trimester ultrasound examination. However, using this approach, only the most severe or lethal brain abnormalities can be picked up sonographically at 11–13 weeks. In this State-of-the-Art Review, Volpe et al. describe how best to assess the normal fetal brain by first-trimester expert multiplanar neurosonography and demonstrate the early sonographic findings that characterize some major fetal brain abnormalities, including ventriculomegaly, open spina bifida, Dandy–Walker malformation and agenesis of the corpus callosum.
Foley catheter vs oral misoprostol for induction of labor: individual participant data meta-analysis
While a number of randomized controlled trials comparing Foley catheter and oral misoprostol use for induction of labor (IOL) have been conducted, results regarding which is the safer and more efficient method are inconclusive. Kemper et al. performed an individual participant data meta-analysis of randomized controlled trials to compare the effectiveness and safety of Foley catheter and oral misoprostol for IOL. For women undergoing IOL, Foley catheter was found to be less effective than oral misoprostol, as it was associated with fewer vaginal births. However, while no significant difference was found in maternal safety, Foley catheter induction may reduce adverse perinatal outcomes. The choice of using Foley catheter or oral misoprostol for IOL should therefore be personalized. Watch the accompanying video abstract:
Pregnant women with SARS-CoV-2 infection are at higher risk of death and pneumonia: propensity score matched analysis of a nationwide prospective cohort (COV19Mx)
There are limited, unmatched data reporting low complication rates in pregnant women with COVID-19. Martinez-Portilla et al. compared COVID-19-related outcomes between 5183 pregnant and 5183 non-pregnant women after adjusting for potential risk factors for severe outcomes using propensity score matched analysis, representing the largest cohort of pregnant women with COVID-19 at the time. It was found that pregnancy is a risk factor for death, pneumonia and intensive care unit admission in SARS-CoV-2-infected women of reproductive age. The information from this study strengthens the evidence that pregnant women are indeed at higher risk of severe adverse outcomes.
Prediction of pre-eclampsia in twin pregnancy by maternal factors and biomarkers at 11–13 weeks’ gestation: data from EVENTS trial
Using data from 1798 twin pregnancies in the EVENTS trial, Benkő et al. validated a previously developed model for screening for pre-eclampsia (PE) by maternal characteristics and medical history in twin pregnancies, and developed and examined the predictive performance of new models based on maternal characteristics and history, MAP, UtA-PI, PlGF and PAPP-A in screening for PE with delivery at <32 and <37 weeks’ gestation. In the assessment of risk for PE in twin pregnancy, the same prior model based on maternal characteristics and medical history as reported previously can be used, but in the calculation of posterior risks it is necessary to use the new distributions of log10 MoM values of UtA-PI, MAP and PlGF according to gestational age at delivery with PE.
Vessel morphology depicted by three-dimensional power Doppler ultrasound as second-stage test in adnexal tumors that are difficult to classify: prospective diagnostic accuracy study
For tumors that are difficult to classify as benign or malignant using subjective assessment or using the IOTA LR-1 model, a second-stage test capable of correctly classifying difficult tumors as benign or malignant would be valuable. Sladkevicius et al. assessed whether vessel morphology depicted by 3D power Doppler ultrasound improves discrimination between benignity and malignancy if used as a second-stage test in adnexal masses that are difficult to classify. It was found that vessel morphology may slightly improve discrimination between benign and malignant adnexal tumors that are difficult to classify by subjective ultrasound assessment. For tumors in which the IOTA LR-1 model yields an ambiguous result, subjective assessment is superior to vessel morphology as a second-stage test.
Coming up next month…
- A European multicenter study finding that fetal endoscopic tracheal occlusion reverses the natural history of right-sided congenital diaphragmatic hernia. Preview the Accepted Article.
- A prospective cohort study, and an accompanying Opinion, finding that the position and integrity of the uterine scar is determined by cervical dilation at the time of Cesarean section.