The February issue of Ultrasound in Obstetrics & Gynecology includes a systematic review and meta-analysis investigating neonatal and long-term outcomes of pregnancies with cytomegalovirus infection and negative amniocentesis, a national cohort study exploring the association of cerebral palsy with placental and umbilical cord disorders, and a systematic review of studies reporting on maternal and perinatal outcomes of pregnancies complicated by poxvirus infections, including monkeypox. Also in the issue are a new study from the IOTA collaboration describing a novel strategy allowing to reliably discriminate between benign and malignant ovarian tumors and an accompanying Editorial on the topic by Prof. Davor Jurkovic. Finally, the February issue includes the newly updated ISUOG Practice Guideline on the performance of fetal magnetic resonance imaging.

Please see below a selection of articles from the February issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today or login and upgrade.

Neonatal and long-term outcomes of infants with congenital cytomegalovirus infection and negative amniocentesis: systematic review and meta-analysis

Although several studies have reported cases of congenital neonatal cytomegalovirus (CMV) infection following a negative amniocentesis result, the clinical outcome of such cases has not been studied systematically to date. Chatzakis et al. conducted a systematic review and meta-analysis focusing on the postnatal outcome of pregnancies with CMV infection and a negative amniocentesis result, revealing a pooled false-negative rate of amniocentesis of 8.0% (95% CI, 5.0–13.0%). In these cases, the authors report 0% pooled rates of severe neonatal symptoms, severe sensorineural hearing loss, neurodevelopmental impairment at follow-up and termination of pregnancy due to the presence of CMV-associated central nervous system findings or multiorgan involvement on imaging. These findings highlight that a negative amniocentesis result in pregnant women with CMV infection ensures lack of fetal insult and long-term sequelae to the child, even if transmission has occurred.

Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in IOTA5 multicenter cohort

Accurate diagnosis of ovarian cancer is important for patient counseling and decision-making regarding optimal management. In this work using the interim data from the IOTA Phase-5 study, Landolfo et al. validate a modified version of ultrasound-based benign descriptors (BDs), which have been shown to reliably exclude malignancy. The authors also propose a new two-step strategy for classification of adnexal lesions, which includes the modified BDs followed by the previously validated ADNEX model if modified BDs do not apply. Their work suggests that almost 40% of adnexal masses can be reliably classified without computer support by the modified BDs as having a very low risk of malignancy, while the ADNEX model can calculate the risk of malignancy in the remaining cases. The two-step strategy has excellent discriminative ability and is convenient for clinical use.

Association of placental and umbilical cord characteristics with cerebral palsy: national cohort study

Recent literature has suggested a potential link between placental and umbilical cord abnormalities and the risk of cerebral palsy. In this study, Ebbing et al. investigate the potential association using nationwide data of all singleton live births in Norway between 1999 and 2017, including a total of 1,087,486 patients. Their findings indicate an increased risk of cerebral palsy associated with velamentous cord insertion, cord knots and placental abnormalities (retained placenta, placental abruption and placenta previa). When stratified by gender, their analysis indicates a significantly increased risk of cerebral palsy associated with single umbilical artery and cord knots among females only, while retained placenta is associated with cerebral palsy among males only. Given these results, the authors believe that the detection of placental and umbilical cord abnormalities may help identify children at increased risk of cerebral palsy.  

Maternal and perinatal outcomes of pregnancies complicated by poxvirus infection

The recent outbreak of monkeypox has highlighted the need for more research on the impact of poxvirus infections on pregnant individuals and their infants. In this UOG issue, D’Antonio et al. present the results of a systematic review of studies investigating the maternal and perinatal outcomes of pregnancies complicated by poxvirus infections. The report includes 22 studies focusing on smallpox, and its results suggest that maternal death and fetal loss occurred in 34% and 28% of affected cases, respectively. Furthermore, the authors analyze four studies reporting on a small number of monkeypox cases, demonstrating no cases of maternal death but some association with adverse fetal outcome, including miscarriage, intrauterine demise and fetal anomaly (especially, fetal hydrops). The paper highlights the importance of careful monitoring of suspected cases, as well as appropriate pregnancy management, including Cesarean delivery, and detailed neonatal assessment in confirmed cases of monkeypox.

Coming up next month…

  • A systematic review and meta-analysis evaluating the diagnostic accuracy of different ultrasound signs for adnexal torsion. Preview the Accepted Article.
  • A prospective cohort study nested within the DESiGN randomized controlled trial investigating the characteristics associated with missed prenatal diagnosis of small-for-gestational age. Preview the Accepted Article.
  • A study evaluating the impact of prenatal exome sequencing findings on perinatal outcome. Preview the Accepted Article.