The July issue of Ultrasound in Obstetrics & Gynecology includes a systematic review investigating the prevalence of adenomyosis in women with subfertility, a review focusing on the definition of the uterine junctional zone and its appearance in adenomyosis, a study proposing sonographic descriptors for instant diagnosis of 20 major fetal anomalies and a population-level study evaluating the incidence, risk factors and timing of pregnancy loss in major congenital heart disease.

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.

Prevalence of adenomyosis in women with subfertility: systematic review and meta-analysis

Increasing evidence suggests that adenomyosis can occur earlier in life and may be associated with subfertility. The systematic review and meta-analysis by Mishra et al. provides an up-to-date analysis of the prevalence of the condition in women with subfertility based on data from 21 studies including 25,600 patients. The study reports a prevalence of 10% for isolated adenomyosis and 1–7% for adenomyosis with endometriosis and/or fibroids among subfertile women, varying further according to geographical region and diagnostic criteria used. The meta-analysis highlights the heterogeneity of studies investigating the prevalence of adenomyosis and emphasizes the importance of the use of standardized, uniform diagnostic criteria (such as MUSA consensus criteria) to diagnose adenomyosis.

Uterine junctional zone and adenomyosis: comparison of MRI, transvaginal ultrasound and histology

Alterations in the appearance of the uterine junctional zone are associated with adenomyosis. However, lack of a uniform description of the appearance of the junctional zone limits its role in the diagnosis of adenomyosis. Harmsen et al. conducted a comprehensive literature review to compare the definition of the junctional zone and its appearance in the context of adenomyosis on magnetic resonance imaging, transvaginal sonography and histology. The State-of-the-Art Review demonstrates the inconsistencies in the definitions used across the diagnostic modalities and highlights the need for uniform criteria to diagnose and classify adenomyosis reliably.

INDIAMAN-20 (INstant DIAgnosis of 20 Major ANomalies) protocol: application of IOTA diagnostic strategy to fetal anomalies

There are a number of congenital anomalies of which the sonographic appearance is so typical and unambiguous that it leads directly to an unequivocal diagnosis, with no need to consider differential diagnoses. In this study, Paladini et al. identified and validated sonographic features that enable instant recognition of 20 major lethal or life-threatening congenital malformations. The proposed protocol should facilitate focused training of less experienced operators and may be incorporated into artificial-intelligence algorithms for instant prenatal recognition of these malformations.

Pregnancy loss in major fetal congenital heart disease: incidence, risk factors and timing

It has been demonstrated that fetuses with congenital heart disease (CHD) are at increased risk of pregnancy loss compared with the general population. However, the reported incidence of pregnancy loss in the overall CHD population varies from 1% to 20% and the lesion-specific risk is unknown. The population-level study by Jepson et al. estimates that the incidence of pregnancy loss in major CHD population is 5.3%, much higher compared with the reported rate of 1.6% in the general population. Their findings indicate that the increase in the risk of pregnancy loss is particularly prominent in the presence of additional fetal anomalies and specific cardiac diagnoses, such as hypoplastic left heart syndrome and single-ventricle heart disease. The study also identifies clinical and demographic risk factors of pregnancy loss in CHD cases and provides novel information on the timing of pregnancy loss in this population. These findings should inform patient counseling, antenatal surveillance and delivery planning in fetal CHD.

UOG video abstract

Coming up next month…

  • A systematic review of studies developing reference ranges of the fetal corpus callosum. Preview the Accepted Article.
  • A secondary analysis of a randomized trial investigating the impact of small-for-gestational age screening accuracy and the additive value of third-trimester growth trajectory in predicting severe adverse perinatal outcome in a low-risk population. Preview the Accepted Article.
  • A prospective study focusing on the prediction of adverse neonatal outcome. Preview the Accepted Article.