The July issue of Ultrasound in Obstetrics & Gynecology includes a cohort study on determining the optimal sonographic dating approach in twin pregnancies beyond the first trimester, an assessment of the effect of interpregnancy interval on the odds of tubal ectopic pregnancy recurrence after expectant or surgical management, an investigation on the impact of aspirin administration on the incidence of preterm birth and an international multicenter cohort study evaluating fetal and neonatal outcomes in cases of monochorionic diamniotic twins with selective fetal growth restriction and either continuous or intermittent absent or reversed end-diastolic umbilical artery flow.
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.
Estimating due date in twin pregnancy by second- and third-trimester ultrasound
To deliver high-quality obstetric care it is essential to establish an accurate estimated due date, this is especially important for twin gestations owing to their increased risk for complications; however, few studies have evaluated the optimal strategy for dating twin pregnancies presenting beyond the first trimester. In this study, Rittenhouse et al. included ultrasound studies of twin pregnancies with complete biometry conducted ≥ 14 weeks' gestation and assessed the accuracy of gestational-age dating using the biometric data of the smaller twin, larger twin and an average of both cotwins. The mean error ± standard error showed that all three measurements underestimated gestational age, with measurement of the larger twin exhibiting the least bias. These results indicate that in the second and third trimester, gestational-age dating in twin pregnancies is the most accurate and the least biased when using the biometry of the larger twin.
Interpregnancy interval and risk of recurrence following tubal ectopic pregnancy: retrospective cohort study from UK tertiary center
Women with a history of tubal ectopic pregnancy (TEP) have been shown to have a five-fold increased risk of recurrent TEP, but there have been no studies to date assessing the impact of interpregnancy interval after expectant or surgical management. In this study, Dooley et al. conducted univariate and multivariate regression analyses to explore the association between the odds of recurrence of ectopic pregnancy and various factors, including interpregnancy interval and management method of their index TEP. The odds of recurrent tubal ectopic pregnancy were reported to be higher in women with a longer interpregnancy interval, with recurrence in 3.3% of women with an interval of ≤ 3 months between pregnancies compared to 16.5% of women with an interval of > 18 months. The authors conclude that rapid conception after TEP is associated with low odds of recurrence; therefore, purposeful delay to conception after TEP, including those managed expectantly, should not be recommended.
Aspirin delays preterm birth in pregnancies at high risk for preterm pre-eclampsia: evidence from randomized clinical trial in Asia
There is conflicting evidence as to whether the use of aspirin reduces the incidence of preterm birth. To investigate the impact of aspirin administration, Leung et al. performed a secondary analysis of a randomized trial of a first-trimester screen-and-prevent strategy for preterm pre-eclampsia, in which the treatment effect of aspirin on the rate of preterm birth, stratified by gestational age at birth, type of delivery and presence of pregnancy complications, was estimated by computing the relative risks between the aspirin and non-aspirin groups. It was found that early administration of aspirin in pregnancies at high risk for preterm pre-eclampsia effectively reduced the risk of early preterm birth by 42%. The findings of this study support the hypothesis that aspirin helps to prevent preterm birth by delaying the timing of delivery.
Outcome of monochorionic diamniotic twin pregnancy with selective fetal growth restriction and continuous or intermittent absent or reversed end-diastolic umbilical artery flow: international multicenter cohort study
Monochorionic diamniotic (MCDA) twins with selective fetal growth restriction (sFGR) and either continuous (cAREDF) or intermittent (iAREDF) absent or reversed end-diastolic flow in the umbilical artery face significant fetal and neonatal risks; however, the rarity of cAREDF and iAREDF cases, relative to positive end-diastolic flow cases, has led to a shortage of large, observational cohort studies assessing their management and outcome. In this international cohort study, Noll et al. describe the fetal and neonatal outcomes of MCDA twin pregnancies complicated by sFGR with cAREDF or iAREDF, and assess outcomes for the larger twin after selective reduction or expectant management. A substantial risk of adverse outcomes of twins with sFGR and iAREDF or cAREDF was demonstrated, with a particularly high risk for the smaller twin with cAREDF. Furthermore, selective reduction significantly improved the chance of the larger twin being born at ≥ 32 weeks and surviving without severe morbidity. The authors suggest that these data should inform patient counseling and management decisions.