The June issue of Ultrasound in Obstetrics & Gynecology includes ISUOG Guidelines on ultrasound assessment of fetal biometry and growth, an article on how to assess the ureters during pelvic ultrasound, a Systematic Review on cell-free DNA analysis for trisomy screening in twins, a study assessing a prenatal ultrasound staging system for placenta accreta spectrum disorders, a study on routine ultrasound at 32 vs 36 weeks’ gestation in the prediction of small-for-gestational-age neonates, and a Consortium Report on the proceedings of the First Annual Meeting of the International Fetoscopic Myelomeningocele Repair Consortium.

Please see below a selection of articles from the June issue of Ultrasound in Obstetrics and Gynecology chosen specially by the UOG team. To view all UOG content, become an ISUOG member today or login and upgrade.

ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth

Screening for and adequate management of fetal growth abnormalities are essential components of antenatal care, and fetal ultrasound plays a key role in assessment of these conditions. New ISUOG Guidelines provide recommendations on ultrasound assessment of fetal biometry and growth, including terminology, evaluation of estimated fetal weight and growth, quality-control measures, growth standards and metrics.

How to assess the ureters during pelvic ultrasound

While the main aim of transvaginal ultrasound examination is to assess gynecological organs, recent advances in examination technique have facilitated routine assessment of non-gynecological structures in the pelvis, including the ureters, which are now a recommended component of the imaging work-up for women with endometriosis. In this Opinion, Bean et al. provide a step-by-step guide for identification and assessment of the distal ureters during pelvic ultrasound.

Screening for trisomies by cfDNA testing of maternal blood in twin pregnancy: update of The Fetal Medicine Foundation results and meta-analysis

Cell-free DNA (cfDNA) analysis provides effective screening for trisomy in singleton pregnancy, while data in twins are limited. Gil et al. report their updated experience with cfDNA testing in twins and carried out a meta-analysis of all studies on cfDNA testing in twin pregnancy. The performance for trisomy 21 was found to be similar to that reported in singleton pregnancy and is superior, both in terms of higher detection rate and substantially lower false-positive rate, to that of the first-trimester combined test or second-trimester biochemical testing. These findings are particularly important in the case of dichorionic twins, in which both the incidence of aneuploidy and the invasive procedure-related risk of pregnancy loss are increased compared to in singletons. View the press release and accompanying video abstract:

Prenatal ultrasound staging system for placenta accreta spectrum disorders

While placenta accreta spectrum (PAS) disorders are commonly classified according to depth of placental invasion, there is large variability in the clinical course of women presenting with the same degree of invasion. Cali et al. developed a prenatal ultrasound staging system for PAS disorders, based upon the presence of different imaging signs, in women with placenta previa. It was found that the staging system is feasible, correlates with surgical outcome, irrespective of the depth of placental invasion, and is associated with the clinical staging system for PAS disorders proposed by the International Federation of Gynecology and Obstetrics (FIGO).

Routine ultrasound at 32 vs 36 weeks’ gestation: prediction of small-for-gestational-age neonates

While there are extensive reports on how best to manage pregnancies with a small-for-gestational-age (SGA) fetus, there is uncertainty as to the best approach for their identification. Ciobanu et al. evaluated and compared the performance of routine ultrasonographic estimated fetal weight (EFW) and fetal abdominal circumference at 31+0 to 33+6 and 35+0 to 36+6 weeks in the prediction of a SGA neonate born within 2 weeks and at any stage after assessment. The predictive performance was found to be higher if the scan is carried out at 35+0 to 36+6 weeks, the method of screening is EFW, the outcome measure is birth weight <3rd than <10th percentile, and if delivery occurs within 2 weeks after assessment (download the accompanying Journal Club slides).

Proceedings of the First Annual Meeting of the International Fetoscopic Myelomeningocele Repair Consortium

Fetoscopic in-utero spina bifida repair was introduced with the aim of reducing the risks associated with open hysterotomy repair while preserving the neurologic benefits. In 2018, a Consortium was formed to facilitate a forum in which all groups performing fetoscopic myelomeningocele repair can work together transparently and collaboratively in order to advance knowledge on this repair technique. The proceedings of the first annual meeting are detailed in this Consortium Report, including the results of the procedures carried out to date by each of the participating groups, and the discussion points arising from these.

Coming up in the next issue of UOG…

  • A Consensus Statement from the International Working Group on Maternal Hemodynamics on methods and considerations concerning cardiac output measurement in pregnant women (preview the Accepted Article).
  • An Original Article on artificial intelligence and amniotic fluid multiomics in the prediction of perinatal outcome in asymptomatic women with a short cervix (preview the Accepted Article).