The July issue of Ultrasound in Obstetrics & Gynecology includes a systematic review on the detection of non-cardiac fetal anomalies at the 11–14-week scan, a study proposing an artificial intelligence model for detection of coarctation of the aorta, a longitudinal analysis of levator ani muscle avulsion after vaginal delivery and a study of cardiovascular function in children from hypertensive pregnancy.

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.

Detection of non-cardiac fetal abnormalities on ultrasound at 11–14 weeks: systematic review and meta-analysis

In most developed countries, pregnant women are offered a first-trimester ultrasound scan for pregnancy dating, identifying multiple pregnancy and aneuploidy screening. In this systematic review and meta-analysis, Karim et al. assessed the diagnostic accuracy of two-dimensional ultrasound at 11–14 weeks’ gestation as a screening test for non-cardiac fetal anomalies and identified factors impacting on screening performance. From 52 studies, comprising 527,837 fetuses, an overall detection rate of 67.33% for 16 predefined major fetal anomalies was reported. Specificity was > 99% for all anomalies, although detection rates varied widely for individual anomalies. Therefore, whilst the accurate detection of a number of congenital anomalies using first-trimester ultrasound is feasible, the detection and false-positive rates vary depending on the type of anomaly under examination.

Role of artificial-intelligence-assisted automated cardiac biometrics in prenatal screening for coarctation of aorta

Recent advancements in ultrasound include the incorporation of artificial intelligence (AI); however, a gap remains in the literature regarding AI-assisted screening of hard-to-identify congenital heart diseases, such as coarctation of the aorta (CoA). In this multicenter study, Taksøe-Vester et al. developed an AI algorithm to recognize standard cardiac planes and perform automated cardiac biometric measurements for use during the 18–22-week scan. Compared to healthy controls, fetuses with CoA displayed significantly larger right ventricular dimensions, smaller ascending and descending aorta diameters, and higher ratios of right ventricular/left ventricular area and main pulmonary artery/ascending aorta diameter. Using logistic regression and backward feature selection, the AI prediction model had a specificity of 88.9% at a sensitivity of 90.4%. Overall, these findings indicate that the integration of AI with automated cardiac biometric measurements obtained during the 18–22-week anomaly scan has the potential to improve the detection of CoA.

Levator ani muscle avulsion and subsequent vaginal delivery: 8-year longitudinal follow-up

Injury to the levator ani muscle (LAM) may occur during vaginal delivery, with most studies on LAM avulsion following primiparous women up to 1 year after delivery. This longitudinal study by Siafarikas et al. investigated the evolution of LAM avulsion from 1 year to 8 years after first delivery in women with subsequent vaginal delivery compared to those without. In women who gave birth vaginally again, more LAM avulsions were found 8 years after first delivery vs 1 year after first delivery. Except for one primipara, all women without subsequent vaginal delivery demonstrated unchanged LAM avulsion status between the two timepoints after first delivery. Larger LAM hiatal area was found in women with avulsion, which may be one of the mechanisms that contribute to pelvic organ prolapse development in women with avulsion later in life.

Impact of hypertensive disorders of pregnancy on offspring cardiovascular function: from fetal life to early childhood

Hypertensive disorders of pregnancy (HDP), particularly pre-eclampsia, can affect fetal growth and cardiac development; however, whether these changes persist postnatally and render these children at increased long-term cardiovascular risk remains unknown. In this longitudinal study, Dimopoulou et al. assessed cardiovascular function in the offspring of mothers with HDP and those from an uncomplicated pregnancy, from midgestation to 2 years of age. The two groups showed similar cardiac changes at 2 years of age and no differences in left ventricular systolic or diastolic dysfunction. These findings suggest that, in asymptomatic offspring of mothers with HDP, there is no clinical need for echocardiographic assessment at 2 years of age.

Coming up next month…

  • A systematic review and meta-analysis on the role of transvaginal ultrasound in the detection of lymph-node metastasis in gynecological cancer. Preview the Accepted Article.
  • A prospective study investigating whether fetuses with early increased nuchal translucency are at risk for adverse pregnancy outcome. Preview the Accepted Article.
  • A study evaluating the influence of maternal ethnicity and socioeconomic deprivation on placenta-mediated adverse pregnancy outcome. Preview the Accepted Article.
  • A study assessing whether height, weight and body mass index are associated with levator–urethra gap measurement. Preview the Accepted Article.