The June issue of Ultrasound in Obstetrics & Gynecology includes a consensus opinion from the VITA group on terms, definitions and measurements to describe the sonographic features of lymph nodes, a debate on the relative merits of the SMFM and ISUOG guidelines for diagnosing and managing fetal growth restriction, a State-of-the-Art Review on controversies in the management of twin pregnancy, and a RCT on routine third-trimester ultrasound for the detection of small-for-gestational age in low-risk pregnancies.
Terms, definitions and measurements to describe sonographic features of lymph nodes: consensus opinion from the Vulvar International Tumor Analysis (VITA) group
In centers with access to high-end ultrasound machines and expert sonologists, ultrasound is used to detect metastases in regional lymph nodes from melanoma, breast cancer and vulvar cancer. There is, as yet, no international consensus on ultrasound assessment of lymph nodes in any disease or medical condition. In this consensus opinion, the Vulvar International Tumor Analysis (VITA) collaborative group describe the terms, definitions and measurements which may be used to describe inguinal lymph nodes on grayscale and color/power Doppler ultrasound. The consensus opinion covers lymph-node anatomy, the ultrasound technique for examining lymph nodes in the groin, VITA terminology for standardized description of lymph nodes in vulvar cancer, and ultrasound characteristics of infiltrated and non-infiltrated lymph nodes. Watch the accompanying video presentation:
Debate: SMFM vs ISUOG guidelines for diagnosing and managing FGR
Both the SMFM and ISUOG have recently published guidelines on the prenatal diagnosis and management of fetal growth restriction (FGR). There are important differences between the two guidelines, which are in many places contradictory. In this issue of the Journal, Abuhamad et al. and Lees et al. discuss the relative merits of the SMFM and ISUOG guidelines for diagnosing and managing FGR. Abuhamad et al. explain the rationale for the definition of FGR in the SMFM guidelines (estimated fetal weight or abdominal circumference <10th percentile), while Lees et al. argue that the definition adopted by the ISUOG guidelines, which additionally incorporates growth trajectory and Doppler functional indices and seeks to differentiate FGR from SGA, better identifies high-risk fetuses. Also discussed is the discrepancy between the guidelines in the use of Doppler assessment of the fetal middle cerebral artery and ductus venosus for the clinical management of FGR, which is not recommended in the SMFM guidelines but has an important role in the ISUOG guidelines.
Controversies in the management of twin pregnancy
Despite many advances in antenatal care, twin pregnancies still experience more adverse outcomes, in particular perinatal morbidity and mortality. In this State-of-the-Art Review, Khalil and Liu provide a comprehensive overview of the multitude of challenges and controversies posed by twin pregnancies. Topics covered include screening for aneuploidy, assessment of fetal growth, management of complications such as selective fetal growth restriction, twin–twin transfusion syndrome, twin anemia–polycythemia sequence, twin reversed arterial perfusion sequence and single intrauterine demise, management of monochorionic monoamniotic pregnancy, screening for and prevention of pre-eclampsia and preterm birth, and timing and mode of delivery. The authors also comment on the importance of standardizing diagnostic criteria and outcome reporting in studies on twin pregnancy, as well as the top 10 research priorities.
Routine third-trimester ultrasound for the detection of small-for-gestational age in low-risk pregnancies (ROTTUS study): randomized controlled trial
Existing evidence on routine third-trimester ultrasound in low-risk pregnant women is limited and there is substantial inconsistency between countries in their third-trimester ultrasound policy. In this randomized controlled trial, Wanyonyi et al. compared the proportion of small-for-gestational-age infants detected by routine third-trimester ultrasound vs those detected by selective ultrasound based on serial symphysis–fundus height measurements (standard care) in low-risk pregnancy, finding routine third-trimester ultrasound to be superior, with high specificity. Considering the association between stillbirth and undetected fetal growth abnormalities, especially in underserved areas, the routine use of ultrasound for fetal growth monitoring between 36+0 and 37+6 weeks should therefore be considered to inform prenatal management.
Coming up next month…
- ESGO/ISUOG/IOTA/ESGE Consensus Statement on the preoperative diagnosis of ovarian tumors.
- A series of papers on fetal corpus callosal abnormalities.
- A study on fetal loss after chorionic villus sampling in twin pregnancy. Preview the Accepted Article.