The February issue of Ultrasound in Obstetrics & Gynecology includes a meta-analysis evaluating the risk of adverse perinatal outcomes following single intrauterine death in monochorionic twin pregnancy, a prospective study comparing the use of ultrasound with CT and MRI for the prediction of surgical outcome in tubo-ovarian carcinoma patients, a population-based study assessing how pre-eclampsia risk varies with gestational age, a multicenter cross-sectional study examining the association of sling location with cure, satisfaction and complications 10–20 years after midurethral sling surgery, and an ISUOG Consensus Statement outlining how to perform a gynecological ultrasound scan and report the findings.
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.
Perinatal outcome after single intrauterine death in monochorionic twin pregnancy: systematic review and meta-analysis
Monochorionic twin pregnancies are at higher risk of perinatal mortality than dichorionic gestations due to their unique physiology, the consequences of which can be substantial for the surviving twin. In this systematic review and meta-analysis, Dessole et al. reviewed the literature to assess the risk of adverse perinatal outcomes, neurodevelopmental outcomes and abnormal pre- and postnatal brain imaging in monochorionic twin pregnancy after single intrauterine fetal death (IUFD). Across 23 studies, including 1294 monochorionic twin pregnancies complicated by single IUFD, it was found that single IUFD was associated with high risks of preterm birth, abnormal brain imaging and adverse neurodevelopmental outcome in the surviving cotwin, therefore emphasizing the importance of careful prenatal and postnatal management in these cases. It was also noted that all cotwins with normal prenatal imaging later presented with normal neurodevelopment, highlighting the potential prognostic role of prenatal brain assessment after single IUFD in clinical settings.
Comparison of ultrasound with computed tomography and whole-body diffusion-weighted MRI in prediction of surgical outcome using ESMO-ESGO criteria in patients with tubo-ovarian carcinoma: prospective ISAAC study
More than 90% of cases of malignant ovarian cancer present as tubo-ovarian carcinoma. Accurate imaging to preoperatively classify these tumors and guide the acquisition of biopsy samples is essential for improving patient outcomes. In this prospective study, Fischerova et al. tested the non-inferiority of extended abdominopelvic ultrasound examination compared with contrast-enhanced computed tomography (CT) and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) in predicting surgical outcome using ESMO-ESGO criteria in patients with tubo-ovarian carcinoma. It was concluded that extended abdominopelvic ultrasound was not inferior to CT nor WB-DWI/MRI in discriminating preoperatively between patients with resectable vs non-resectable tubo-ovarian carcinoma, thus supporting the role of this ultrasound examination as an effective alternative to these imaging modalities.
Risk of pre-eclampsia according to gestational age across three decades: population-based study
Pre-eclampsia is one of the leading causes of fetal and maternal death worldwide. In order to design cost-effective pre-eclampsia screening programs it is important to know how its risk varies with gestational age. In this population-based study, Haavaldsen et al. reviewed all singleton pregnancies in Norway delivered between 21 and 43 weeks’ gestation during the period 1984–2019, evaluating the risk of pre-eclampsia according to gestational age and whether gestational-age-specific risks have changed over recent decades. A total of 1 955 082 pregnancies were included in the study, 3.2% of which developed pre-eclampsia. The risk of developing pre-eclampsia was shown to increase almost exponentially with advancing gestational age: risk per 1000 ongoing pregnancies was 0.2 at 28 weeks, 5.2 at 38 weeks and 13.6 at 42 weeks. In addition, the overall risk of pre-eclampsia was found to decline during the last decade of the study (2010–2019), which may be explained by the use of obstetric interventions to shorten the duration of pregnancy among patients at high risk of developing pre-eclampsia.
Association of sling location and bladder descent on ultrasound with cure, satisfaction and complications 10–20 years after midurethral sling surgery: multicenter cross-sectional study
Midurethral sling (MUS) surgery is the first line of surgical treatment for stress urinary incontinence. However, few studies have evaluated the potential relationship between sling location and long-term patient outcomes. This multicenter cross-sectional study of Solhaug et al. sought to investigate the association between sling location (sling-to-symphysis distance and sling-to-bladder-neck distance) with cure, satisfaction and complications in patients 10-20 years after MUS surgery. Upon sonographic and clinical evaluation, no association was found between sling location and subjective or objective cure, satisfaction with MUS surgery or persisting pain after MUS surgery. However, it was found that a shorter sling-to-symphysis distance was significantly associated with urgency urinary incontinence (UUI) and frequent urinary tract infections (UTIs). Therefore, while smaller differences in sling location seem to have little impact on long-term patient outcomes, clinicians should be aware that tighter slings may be associated with UUI and UTI.
ISUOG Consensus Statement on sonographic assessment of the endometrium: how to perform a gynecological ultrasound scan and report the findings
Ultrasonography of the endometrial cavity is important for evaluating physiological and pathological changes of the endometrium and detecting intracavity lesions. Building on the structured lexicon developed by the International Tumor Analysis (IETA) consortium to standardize the description of endometrial sonographic features, this ISUOG Consensus Statement, developed by Van den Bosch et al., collated the expertise of 20 gynecological experts to outline how to perform a gynecological ultrasound scan and report the findings. With a particular focus on the clinical relevance of sonographic endometrial assessment for diagnosis and management, the Consensus Statement is of interest not only to gynecologists specializing in ultrasonography, but also to general gynecologists, those performing hysteroscopy, gynecological oncologists and fertility specialists.