The January 30th anniversary special issue of Ultrasound in Obstetrics & Gynecology is completely free to access. The issue includes a number of insightful Opinions from leaders in the field, including Stuart Campbell’s recollections of how ISUOG and the Journal were born, Katia Bilardo’s reflections on how the Society has evolved, Kurt Hecher’s account of how intrauterine surgery has advanced over the last three decades and Roberto Romero’s commentary on the prediction and prevention of preterm birth. Also included are high-impact research papers from influential groups which highlight the breadth of topics in which ultrasound plays an instrumental or supporting role. In addition, find out who won our cover-image competition and admire the shortlisted images in our Gallery.

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

Looking back on the last 30 years

To celebrate the 30th anniversary of UOG, we have compiled a free-access special issue that looks back on the last three decades of ultrasound in obstetrics and gynecology and highlights the advancements that have been achieved during this time.

A series of insightful Opinions from leaders in the field includes a personal account of how ISUOG and the White Journal were born, by the person who started it all, Stuart Campbell, as well as a reflection on the evolution of the Society and the field of obstetrics and gynecology by ISUOG’s (now) past president, Katia Bilardo. You can also read Kurt Hecher’s account of how intrauterine surgery has advanced over the last three decades and Roberto Romero’s commentary on the prediction and prevention of preterm birth. Opinion papers from other leaders in the field and longstanding contributors to the journal, who were invited to share their experience, in a brief commentary, with the development of their respective area of expertise over the last three decades, include those of Beryl Benacerraf, Ilan Timor-Tritsch and Simcha Yagel, who published in the very first issues of UOG in 1991. The other invited contributors have been influential in the key subspecialties of fetal cardiology (Rabih Chaoui) and fetal growth (Ahmet Baschat) or are pioneers in new subject areas that have evolved over the Journal’s lifespan, such as the field of urogynecology (Hans Peter Dietz) and intrapartum ultrasound (Tullio Ghi).

This issue also includes high-impact research papers which highlight the breadth of topics the Journal now covers and in which ultrasound plays an instrumental or supporting role. A selection of research papers from the issue are highlighted below.

Ophthalmic artery Doppler in combination with other biomarkers in prediction of pre-eclampsia at 19–23 weeks’ gestation

The ophthalmic artery, which has anatomical and functional similarities with the intracranial vasculature, is an easily accessible vessel for Doppler assessment that provides information on the less accessible intracranial circulation. Ophthalmic artery Doppler has been shown to provide useful prediction of pre-eclampsia at 35–37 weeks’ gestation. Sapantzoglou et al. examined the potential value of maternal ophthalmic artery Doppler at 19–23 weeks’ gestation on its own and in combination with the established biomarkers of pre-eclampsia, including uterine artery pulsatility index, mean arterial pressure, serum placental growth factor and serum soluble fms-like tyrosine kinase-1, in the prediction of subsequent development of pre-eclampsia. It was found that ophthalmic artery Doppler at 19–23 weeks’ gestation improves the prediction of pre-eclampsia, especially preterm pre-eclampsia with delivery at <37 weeks, and could therefore be incorporated into second-trimester screening for subsequent development of pre-eclampsia. Watch the accompanying video abstract:

Effectiveness of contingent screening for placenta accreta spectrum disorders based on persistent low-lying placenta and previous uterine surgery

Maternal mortality related to placenta accreta spectrum (PAS) disorders remains substantial when diagnosed unexpectedly at delivery. Coutinho et al. evaluated the effectiveness of a routine contingent ultrasound screening program for PAS, in which referrals and women with persistent low-lying placenta (i.e. placenta previa) in the third trimester and previous uterine surgery were assessed by the PAS diagnostic service. It was found that a contingent screening strategy for PAS is feasible and can identify >95% of all affected pregnancies in a routine healthcare setting. When linked to a PAS diagnostic and surgical management service, adoption of such a screening strategy has the potential to reduce the maternal morbidity and mortality associated with this condition. Watch the accompanying video presentation:

Safety and efficacy of smart tracheal occlusion device in diaphragmatic hernia lamb model

One of the drawbacks of the current tracheal occlusion procedure is the need for a second invasive intervention to re-establish airway patency. An alternative occlusion device, referred to as ‘smart’ tracheal occlusion (Smart-TO) was developed recently, which has a magnetic valve which opens under the influence of the magnetic field present around any magnetic resonance scanner. Basurto et al. investigated the efficacy and safety of the Smart-TO device in fetal lambs with diaphragmatic hernia. It was found that tracheal occlusion using the Smart-TO balloon reverses effectively pulmonary hypoplasia after 3 weeks in the diaphragmatic hernia lamb model, and the balloon is spontaneously expelled out of the fetal respiratory tract and does not leave obvious tracheal damage on histology. In fetal lambs with diaphragmatic hernia, tracheal occlusion using the Smart-TO balloon is therefore effective and safe. This research represents the last stage before in-woman study of the device in a clinical setting.

Differences in post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy between women and their partners: multicenter prospective cohort study

Both partners may grieve the loss of a wanted pregnancy. However, differences in emotional response are to be expected. Farren et al. investigated and compared post-traumatic stress (PTS), depression and anxiety in women and their partners over a 9-month period following miscarriage or ectopic pregnancy. It was found that some partners report clinically relevant levels of PTS, anxiety and depression after pregnancy loss, though to a far lesser extent than women physically experiencing the loss. Although many partners do not reach the threshold for being classified as having PTS or moderate or severe anxiety or depression, many partners endorsed a number of symptom clusters in the PTS diagnostic scale without passing the threshold for PTS.

Ultrasound image analysis using deep neural networks for discriminating between benign and malignant ovarian tumors: comparison with expert subjective assessment

Expert ultrasound examination has become the main imaging technique for assessing ovarian lesions, although there is a shortage of expert examiners. Deep neural networks (DNNs) have been shown to be able to discriminate between benign and malignant tumors in other domains, as well as diagnose breast and thyroid tumors using ultrasound images. Christiansen et al. developed and tested the performance of computerized ultrasound image analysis using DNNs in discriminating between benign and malignant ovarian tumors and compared its diagnostic accuracy with that of subjective assessment by an ultrasound expert. It was found that computerized ultrasound image analysis using DNNs can discriminate between benign and malignant ovarian lesions with a diagnostic accuracy comparable to that of a human expert examiner.

UOG Art Gallery

The image featured on the cover of the anniversary issue is the winner of the cover-image competition that was held in the autumn of 2020. With over 150 entries from all over the world, it was a formidable task to select our winner. However, we succeeded, and are delighted to announce that it was submitted by Rafael Peters from Brazil. The image, which is of an 8-week embryo, impressed the Editors because it provides an artistic yet realistic window into the amniotic sac and showcases how far ultrasound technology has come to allow intricate features of a 21-mm embryo to be distinguished. A number of striking images were shortlisted, which we felt deserved publication and are displayed in an Image Gallery. The two runners up, submitted by Heron Werner (Brazil) and Artur Ludwin (Poland), will feature on the covers of the February and March issues. Watch a video compilation of the images:

“This beautiful image of an 8-week embryo was chosen for its esthetic and technical attributes. Exposure to Doppler was for only a few seconds but publication of the picture provides an opportunity to remind ourselves that ISUOG does not recommend the routine use of pulsed-wave or color flow Doppler in the embryonic period. The revised ISUOG guidance on Doppler in the embryonic period (up until 10+6 weeks) and early fetal period (11–13 weeks) will very shortly be available on the ISUOG website. We hope this strikes the right balance between recognizing the importance of clinical advances whilst safeguarding against indiscriminate use of Doppler prior to 11 weeks. Christoph Lees, Chair ISUOG Safety and Bioethics Committee”

Coming up next month…

  • A series of papers and accompanying Opinion on COVID-19 in pregnancy.
  • A study on the influence of birth weight on fetal cardiac indices at 35–37 weeks’ gestation, the findings of which challenge the concept that differences in cardiac indices are a consequence of pathological adaptation to abnormal placental perfusion and fetal oxygenation. Preview the Accepted Article.
  • A Picture of the Month article featuring one of the two runners up from our cover-image competition, in which three imaging modalities were combined to create a virtual maternal–fetal model. Preview the Accepted Article.