The February issue of Ultrasound in Obstetrics & Gynecology includes a systematic review evaluating the postnatal outcome of fetuses with a rare diagnosis of apparently isolated agenesis of the septum pellucidum, an intriguing study assessing the risk of miscarriage in twin pregnancy following chorionic villus sampling using a statistical approach that simulates a RCT and a new study on COVID-19, investigating predictors of adverse outcome in affected pregnancies. The issue also includes the first prospective study to compare ultrasound, CT and a novel technique, whole-body diffusion-weighted MRI, for preoperative assessment of advanced ovarian cancer and an updated meta-analysis on the efficacy of vaginal progesterone for the prevention of adverse outcome in women with twin pregnancy and a short cervix.
Prenatal diagnosis and outcome of fetuses with isolated agenesis of septum pellucidum: cohort study and meta-analysis
Prenatal diagnosis of apparently isolated agenesis of the septum pellucidum (ASP) may be associated with septo-optic dysplasia or major neurological disability, such as neurodevelopmental delay, which makes antenatal counseling challenging. Di Pasquo et al. carried out a cohort study followed by a meta-analysis combining published data to evaluate the postnatal outcome of fetuses with apparently isolated ASP. The study demonstrated that, in the vast majority of cases, the prognosis was favorable. However, an additional anomaly was detected postnatally in approximately 14% of cases. The authors emphasize the importance of detailed antenatal assessment of the brain and optic pathways to identify the presence of associated anomalies in cases with prenatal diagnosis of apparently isolated ASP.
Risk of fetal loss after chorionic villus sampling in twin pregnancy derived from propensity score matching analysis
Several studies have explored the risk of spontaneous fetal loss following chorionic villus sampling (CVS) in twin pregnancy, reporting contradictory results. Gil et al. investigated the risk of CVS-related fetal loss in twin pregnancy using propensity score matching analysis, which allowed them to emulate an RCT study design by creating comparable CVS and non-CVS study groups and to adjust for maternal and pregnancy risk factors. The analysis demonstrated that, in women with a high background risk of fetal loss, the risk was paradoxically lower in the CVS vs non-CVS group, which could be due to diagnosis of aneuploidy using CVS resulting in pregnancy termination in cases that would otherwise have resulted in miscarriage. When examining women with a low background risk, the authors estimated that CVS may be associated with a 3.5% increase in the risk of fetal loss.
Increased levels of soluble fms-like tyrosine kinase-1 are associated with adverse outcome in pregnant women with COVID-19
The placenta and endothelium have been shown to be affected by SARS-CoV-2 infection. In a prospective cohort study of 113 pregnant women with COVID-19 conducted in Mexico, Torres-Torres et al. aimed to investigate the association between angiogenic markers of endothelial dysfunction, sFlt-1 and PlGF, and severity of COVID-19 in pregnancy. The study showed that higher sFlt-1, but not PlGF, was associated with an increased risk of severe pneumonia, intensive care unit admission, viral sepsis and maternal death and had the capability to predict these adverse events. Larger prospective studies should validate the potential of sFlt-1 as a biomarker for adverse outcome in pregnant women with COVID-19.
Preoperative staging of ovarian cancer: comparison between ultrasound, CT and whole-body diffusion-weighted MRI (ISAAC study)
In women with ovarian cancer, accurate mapping by imaging of tumor burden and distribution of disease plays a key role in treatment planning. In a prospective study, Fischerova et al. compared the diagnostic accuracy of ultrasound, whole-body diffusion-weighted MRI (WB-DWI/MRI) and CT in preoperative staging of ovarian cancer. The study demonstrated superior performance of ultrasound and WB-DWI/MRI compared with CT in the assessment of peritoneal involvement and similar performance among the three imaging modalities in retroperitoneal lymph-node staging and prediction of non-resectability. Importantly, the study highlighted that ultrasound can be a useful alternative to CT and WB-DWI/MRI for preoperative ovarian cancer staging.
Vaginal progesterone for the prevention of preterm birth and adverse perinatal outcomes in twin gestations with a short cervix: an updated individual patient data meta-analysis
In 2017, UOG published the results of a meta-analysis of six RCTs evaluating the efficacy of vaginal progesterone in reducing the risk of preterm birth and other adverse outcomes in women with twin pregnancy and cervical length ≤25 mm. In this issue, Romero et al. report the findings of an updated meta-analysis following retraction of one study included in the original meta-analysis and identification of one additional relevant study published in 2021. The authors demonstrate that vaginal progesterone lowers the risk of preterm birth at < 33 weeks’ gestation as well as other adverse outcomes. Evidence from an ongoing RCT (PROSPECT study) should help determine whether vaginal progesterone is to be recommended to women with twin pregnancy and a short cervix.
Coming up next month…
- A study evaluating fetal growth patterns in monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction. Preview the Accepted Article.
- A prospective multicenter study assessing the accuracy of ultrasound for detection of ovarian and deep endometriosis using #Enzian classification. Preview the Accepted Article.
- A study validating a novel AI tool for detection of CNS abnormalities. Preview the Accepted Article.