The July issue of Ultrasound in Obstetrics & Gynecology includes a systematic review and meta-analysis evaluating perinatal outcome of triplet pregnancies following fetoscopic laser surgery for twin–twin transfusion syndrome, a new study exploring the role of ophthalmic artery Doppler in the prediction of pregnancy complications, a prospective study comparing fetal growth in IVF/ICSI pregnancies following frozen–thawed vs fresh blastocyst transfer and a Delphi study providing revised definitions of the MUSA features of adenomyosis. This issue also includes an Opinion providing an overview of our current understanding of monkeypox infection in pregnancy and recommendations for the management of suspected or confirmed cases.

Please see below a selection of articles from the July 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 outcomes of fetoscopic laser surgery for twin–twin transfusion syndrome in triplet pregnancy: cohort study, systematic review and meta-analysis

Current data on triplet pregnancies with twin–twin transfusion syndrome (TTTS) are limited and lack head-to-head comparisons of cases according to chorionicity. Mustafa et al. present findings of their cohort study and systematic review of the literature on the perinatal outcome of triplet pregnancies complicated by TTTS and managed by fetal laser photocoagulation (FLP). The study demonstrates that triplet pregnancies with TTTS are at high risk of adverse perinatal outcome and preterm birth, regardless of chorionicity. It also suggests that the rate of survival after FLP in monochorionic triamniotic triplets has increased in the recent years, which may be due to improvement in surgical skills. The findings should facilitate counseling of parents with a triplet pregnancy complicated by TTTS about management by FLP.

Ophthalmic artery Doppler at 19–23 weeks’ gestation in pregnancies that deliver small-for-gestational-age neonates

Pregnancies complicated by small-for-gestational age (SGA) at birth share features with pregnancies complicated by pre-eclampsia, including impaired placentation and endothelial dysfunction. The study by Abdel Azim et al. explores hemodynamic differences between women delivering a SGA neonate and those who develop hypertensive disorders of pregnancy (HDP) by assessing ophthalmic artery Doppler parameters and markers of placental perfusion and function. The findings of the study demonstrate that, in midgestation, both SGA and HDP are associated with abnormal uteroplacental measurements and increased maternal ophthalmic artery peak systolic velocity ratio compared with unaffected pregnancies, suggesting similar pathophysiology in the two conditions. However, the observed changes are of smaller magnitude in pregnancies with SGA.

Greater estimated fetal weight and birth weight in IVF/ICSI pregnancy after frozen–thawed vs fresh blastocyst transfer: prospective cohort study with novel unified modeling methodology

Conception via in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) has been shown to be associated with altered fetal growth. In this prospective study, Cavoretto et al. investigate the differences in fetal growth trajectories following fresh vs frozen–thawed blastocyst transfer (BT). According to their findings, both IVF/ICSI groups have increased estimated fetal weight (EFW) compared to naturally conceived pregnancies, with the EFW Z-scores being the highest in the midtrimester and decreasing with advancing gestation. Furthermore, the study demonstrates higher EFW Z-scores in the frozen–thawed compared with the fresh BT group. Mean birth-weight Z-scores are negative in both groups, with lower values in preterm fetuses; they increase with advancing gestation, becoming positive at term in the frozen–thawed BT group. These findings highlight the impact of the mode of conception on fetal growth and may improve prediction models for small- and large-for-gestational age at birth.

Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure

In 2015, the international Morphological Uterus Sonographic Assessment (MUSA) group published a consensus aiming to provide terminology for ultrasound features of adenomyosis. To date, studies have shown poor inter-rater agreement when using the MUSA definitions. In this modified Delphi study by Harmsen et al., consensus between 13 experts in ultrasound diagnosis of adenomyosis was achieved regarding revised definitions of the MUSA features of adenomyosis and on the classification of MUSA features as direct or indirect signs of adenomyosis. These updated recommendations should facilitate recognition and diagnosis of adenomyosis in clinical practice and provide standardized definitions of its features for future studies.

Coming up next month…

  • A multicenter study developing and validating ultrasound-based radiomics models for predicting high-risk endometrial cancer. Preview the Accepted Article.
  • Two studies aiming to predict preterm birth using first-trimester markers of pre-eclampsia. Preview the two Accepted Articles by Chiu et al. and Giorgione et al.