The January issue of Ultrasound in Obstetrics & Gynecology is completely free to read! The issue includes a systematic review evaluating the diagnostic accuracy of first-trimester ultrasound examination in the detection of fetal cardiac abnormalities, a study reporting on clinical experience with non-invasive prenatal screening for single-gene disorders, a study developing and validating a model for prediction of placental dysfunction-related stillbirth from maternal factors, fetal weight and uterine artery Doppler at mid-gestation, an analysis of 13,062 SARS-CoV-2-positive pregnancies evaluating comorbidities and social vulnerability as risk factors of maternal death in Mexico, and a prospective study assessing first-trimester screening for placenta accreta spectrum in women with prior Cesarean delivery using transvaginal ultrasound assessment of the lower uterine segment scar.
First-trimester ultrasound detection of fetal heart anomalies: systematic review and meta-analysis
Congenital cardiac abnormalities are the most prevalent structural malformation and constitute a major cause of infant death. The risk of morbidity and mortality may be mitigated by prenatal diagnosis. In a systematic review of 63 studies and 328,262 fetuses, Karim et al. investigated the diagnostic accuracy of two-dimensional ultrasound at 11–14 weeks’ gestation in the detection of fetal cardiac abnormalities. First-trimester examination identified over half of the fetuses with cardiac anomaly. Screening performance was improved by the use of outflow-tract views and color-flow Doppler imaging and varied according to the type of cardiac anomaly under evaluation.
Clinical experience with non-invasive prenatal screening for single-gene disorders
Single-gene disorders (SGD) are present in approximately 1% of births. Non-invasive prenatal testing (NIPT) based on cell-free fetal DNA analysis may assist in the early detection of a broad range of SGD. A currently available NIPT-SGD panel screens for 25 diseases that result from variants across 30 genes, with a combined population incidence of 1 in 600. The conditions screened include Noonan spectrum disorders, skeletal disorders, craniosynostosis syndromes, Cornelia de Lange syndrome, Alagille syndrome, tuberous sclerosis, epileptic encephalopathy, SYNGAP1-related intellectual disability, CHARGE syndrome, Sotos syndrome and Rett syndrome. Mohan et al. reported on their clinical experience with the NIPT-SGD panel in a cohort enriched for pregnancies at high risk of these disorders. In their study, 5.7% of cases tested positive, highlighting that NIPT has the potential to aid early diagnosis of SGD, particularly in pregnancies with ultrasound abnormalities or a family history of one of these disorders.
Development and validation of model for prediction of placental dysfunction-related stillbirth from maternal factors, fetal weight and uterine artery Doppler at mid-gestation
Antepartum stillbirths can be subdivided into those that are thought to be the consequence of impaired placentation and those that occur due to other causes or are unexplained. Accurate categorization of stillbirths according to the likely underlying cause can lead to more effective antenatal interventions and preventive strategies. Ashoor et al. assessed the performance of a model combining maternal risk factors, estimated fetal weight and uterine artery pulsatility index at mid-gestation in the prediction of all antepartum stillbirths and those due to impaired placentation. This screening strategy predicted a high proportion of placental dysfunction-related stillbirths and, in particular, those that occurred preterm. The model was not effective in predicting unexplained antepartum stillbirth or stillbirth due to other causes.
Comorbidity, poverty and social vulnerability as risk factors for mortality in pregnant women with confirmed SARS-CoV-2 infection: analysis of 13,062 positive pregnancies including 176 maternal deaths in Mexico
In Mexico, COVID-19 is currently the leading cause of maternal death, overtaking obstetric hemorrhage and pre-eclampsia. In a nationwide prospective study on pregnant women with confirmed SARS-CoV-2 infection in Mexico, Torres-Torres et al. sought to identify the clinical and socioeconomic factors associated with COVID-19-related mortality in pregnancy. In one of the largest cohorts to date, the authors demonstrated that advanced maternal age, pre-existing diabetes, chronic hypertension, obesity, high social vulnerability and low socioeconomic status are risk factors for COVID-19-related maternal mortality. These findings should help identify high-risk women who would particularly benefit from increased monitoring, SARS-CoV-2 vaccination and other measures to reduce disease transmission and can guide the development of heath policies to protect vulnerable groups.
Lower uterine segment scar assessment at 11–14 weeks’ gestation to screen for placenta accreta spectrum in women with prior Cesarean delivery
Placenta accreta spectrum (PAS) is a complex obstetric disorder that impacts maternal health globally. Early diagnosis of PAS is desirable to avoid the associated mortality and morbidity. In a prospective cohort of women with previous Cesarean section, Bhatia et al. aimed to assess the value of transvaginal ultrasound (TVS) assessment of the lower uterine segment (LUS) scar at the time of first-trimester aneuploidy screening in stratifying women according to the risk of PAS disorder. The study demonstrated that LUS scar assessment using TVS was feasible and accurate in identifying women at risk of developing PAS. Routine implementation of this tool may facilitate the planning of management for high-risk pregnancies and reassure those women who would otherwise be considered as high-risk based on their history of Cesarean section. Watch the accompanying video abstract:
Coming up next month…
- A study evaluating the postnatal outcome of cases with prenatal diagnosis of apparently isolated agenesis of the septum pellucidum. Preview the Accepted Article.
- A study investigating the risk of fetal loss following chorionic villus sampling in twin pregnancy using propensity score matching analysis. Preview the Accepted Article.
- A prospective study evaluating the association of sFlt-1 and PlGF markers with the severity of COVID-19 in pregnancy. Preview the Accepted Article.
- An updated meta-analysis on the use of vaginal progesterone for the prevention of preterm birth in twin pregnancy.
- A prospective study comparing the performance of ultrasound, computed tomography and whole-body MRI with diffusion weighted sequence in preoperative staging of ovarian cancer. Preview the Accepted Article.