The January issue of Ultrasound in Obstetrics & Gynecology includes a meta-analysis evaluating the use of transvaginal ultrasound for diagnosing parametrial involvement in deep pelvic endometriosis, a retrospective study comparing the use of intertwin estimated fetal weight discordance vs singleton and twin fetal growth charts for predicting adverse perinatal outcomes in twins, a paper assessing the effectiveness of the first-trimester anomaly scan, and a prospective study examining the efficacy of a multimodal sonographic approach compared with transvaginal ultrasound for endometrial assessment in abnormal uterine bleeding.
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.
Transvaginal ultrasound for detecting parametrial involvement in suspected deep pelvic endometriosis: updated meta-analysis
The accurate diagnosis of parametrial involvement in deep pelvic endometriosis is essential for adequate management, however, the use of transvaginal ultrasound (TVS) to assess the parametrium in these cases has been chronically underutilized. In this meta-analysis, Alcázar et al. sought to evaluate the diagnostic performance of TVS for detecting lateral parametrial involvement in women with suspected deep pelvic endometriosis. Across eight studies including a total of 6728 women, the pooled sensitivity and specificity of TVS was found to be 63% (95% CI, 31–86%) and 98% (95% CI, 96–99%), respectively. Higher pooled sensitivity and specificity was reported in subgroup analysis including only studies that assessed parametrial laterality. Overall, the diagnostic performance of TVS for detecting parametrial involvement in women with suspected deep pelvic endometriosis was better than reported previously, suggesting its use could help to improve surgical planning and patient outcomes.
Adverse perinatal outcomes in twins: comparison of intertwin fetal size discordance vs singleton and twin fetal growth charts
Twin pregnancies are at an elevated risk of adverse perinatal outcomes, such as preterm birth; however, there is debate over whether growth charts or intertwin estimated fetal weight (EFW) discordance are better predictors of such. In this retrospective study, Giorgione et al. compared the ability of intertwin EFW discordance and EFW centiles derived from the Fetal Medicine Foundation singleton and twin-specific growth charts to predict adverse perinatal outcomes in dichorionic and monochorionic twin pregnancies. In both dichorionic and monochorionic twins, predictive models of composite adverse perinatal outcome (CAPO) using EFW discordance achieved significantly higher areas under the receiver-operating-characteristics curve (AUC) than using both singleton and twin-specific growth charts. At a 20% false-positive rate, the sensitivity for CAPO in dichorionic twin pregnancies was 74%, 81% and 93% using singleton charts, twin-specific charts and intertwin EFW discordance; for monochorionic twin pregnancies these sensitivity values were 75%, 79% and 98%, respectively. Accordingly, it was concluded that intertwin IFW discordance is a more reliable and robust predictor of adverse perinatal outcome in twins than EFW centile based on either singleton or twin-specific growth charts. Hence, the authors emphasize the need to incorporate intertwin EFW discordance into routine monitoring protocols for twin pregnancies.
Undetected cases after implementation of first-trimester anomaly scan in low-risk population: insights from the IMITAS study
Although the second-trimester anomaly scan is standard in developed countries, many major fetal structural anomalies may be detectable earlier in pregnancy using a first-trimester anomaly scan (FTAS). However, the efficacy of the FTAS is uncertain due to its context-dependence. This study of Bronsgeest et al. aimed to assess the effectiveness of the FTAS performed as part of a national screening program in The Netherlands, by investigating false-negative cases with a fetal structural anomaly not detected on FTAS. Of the 127 979 cases classified as normal at the FTAS, a fetal structural anomaly was later diagnosed before 24 weeks’ gestation in 1164 (0.9%) cases, including 23 cases with major anomalies which should have been detected at FTAS and a further 126 cases with anomalies that are often detectable in the first trimester. It was concluded that missing mandatory planes and acquisition of suboptimal planes were the main reasons for false-negative results, therefore indicating areas for future improvement of the protocol.
Endometrial assessment in abnormal uterine bleeding: transvaginal ultrasound alone may not be good enough
Transvaginal ultrasound (TVS) is currently recommended as the first-line investigation for assessing endometrial thickness (ET) in women with abnormal uterine bleeding (AUB). However, there is evidence to suggest that TVS alone may lack specificity, resulting in ET overestimates and leading to unnecessary invasive further investigation. In this prospective observational study, Nijjar et al. evaluated whether a multimodal (MM) sonographic approach of assessing ET is more efficacious than traditional TVS. Of 387 included women who underwent TVS for ET assessment, approximately one third of results were suboptimal. However, when referred for MM imaging, 84.3% of these cases for whom ET assessment was considered suboptimal on TVS alone then garnered an optimal result. This suggested that the MM sonographic approach is an effective way to measure ET in women with AUB for whom TVS is suboptimal, and it may therefore reduce the need for further investigations compared with the sole use of TVS.