The January issue of Ultrasound in Obstetrics & Gynecology is completely free to access and includes ISUOG Guidelines on the role of ultrasound in screening for and follow-up of pre-eclampsia, a Systematic Review on outcome after elective induction of labor at 39 weeks in uncomplicated singleton pregnancy, an Original Article on a fetal fraction-based risk algorithm for aneuploidy screening in women with low cell-free fetal DNA, and an Original Article presenting guidance for sonographic evaluation of uterine niche in non-pregnant women.
ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia
Given that timely and effective care can improve the outcome of pre-eclampsia, the development of effective prediction and prevention strategies has been a major objective of prenatal care and of research. In these ISUOG Guidelines, the latest evidence regarding the role of ultrasound in screening for and follow-up of pre-eclampsia is reviewed and evidence-based recommendations are made, focusing on technical and clinical aspects of screening. Areas covered include screening using ultrasound, combined screening strategies, assessment of maternal hemodynamics, management after screening and multiple pregnancy.
Maternal and perinatal outcomes after elective induction of labor at 39 weeks in uncomplicated singleton pregnancy: a meta-analysis
The rate of maternal and perinatal complications increases after 39 weeks’ gestation in both unselected and complicated pregnancies. Induction of labor at 39 weeks has therefore been proposed, although there are concerns regarding failed induction and the concomitant risk for maternal and neonatal complications. In this Systematic Review of randomized controlled trials, Sotiriadis et al. assessed the impact of elective induction of labor at 39 weeks in uncomplicated singleton pregnancies on maternal and fetal outcomes. It was found that, compared with expectant management, elective induction of labor in uncomplicated singleton pregnancy at 39 weeks’ gestation is not associated with maternal or perinatal complications and may reduce the need for Cesarean section, risk of hypertensive disease of pregnancy and need for neonatal respiratory support.
Fetal fraction-based risk algorithm for non-invasive prenatal testing: screening for trisomies 13 and 18 and triploidy in women with low cell-free fetal DNA
Accurate non-invasive prenatal testing (NIPT) is facilitated by a high proportion of fetal cell-free DNA, i.e. high fetal fraction (FF). FF is lower in cases of trisomy 13, trisomy 18 and triploidy, however, not all pregnancies with low FF are at high risk as there are many other potential causes, such as increased maternal weight. McKanna et al. developed a FF-based risk (FFBR) algorithm for singleton pregnancies, which differs from the standard short nucleotide polymorphism-based NIPT algorithm in that it considers FF, gestational age, maternal weight and prior risk to identify no-result cases at increased risk. It was found that the FFBR algorithm identified a subset of cases at increased risk for trisomy 13, trisomy 18 or triploidy. For the remainder of cases, the risk of a fetal chromosomal abnormality was unchanged from that expected based on maternal and gestational age.
Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure
Cesarean section (CS) rates are increasing worldwide, with a corresponding increase in associated complications. The CS scar defect or ‘niche’ has been reported as an important feature that is associated with future complications. In this study, Jordans et al. used a modified Delphi procedure to generate guidance for detailed uterine niche evaluation by ultrasonography in non-pregnant women. Consensus was achieved for all 42 items, including definitions, relevance, method of measurement and tips for visualization of the niche regarded as relevant for ultrasonographic niche evaluation. Based on the consensus findings, a definition for uterine niche was formulated and guidance for its various measurements was produced (download the accompanying Journal Club slides).
Coming up in the next issue of UOG is a series of papers reporting on twin pregnancy.
Also to look out for in February is a Virtual Issue on multiple pregnancy, containing a selection of relevant articles from UOG.