The June issue of Ultrasound in Obstetrics & Gynecology includes a systematic review and meta-analysis evaluating the diagnostic performance of exome sequencing in fetuses with multisystem malformations, a comprehensive study evaluating the cost-effectiveness of strategies for prevention of preterm birth and a study presenting a new algorithm for stratification of monochorionic twin pregnancies with Type-III sFGR according to fetal death risk. Also in the issue are a nationwide study on postnatal outcome of late-preterm twins in South Korea and an accompanying Editorial on the optimal timing of delivery in twin pregnancies. Finally, in this issue, look out for the newly updated ISUOG Guidelines for the performance of the routine mid-trimester fetal scan and an Opinion providing recommendations for fetal cardiac imaging in patients with degraded acoustic windows.
Diagnostic yield of exome sequencing in fetuses with multisystem malformations: systematic review and meta-analysis
There is an increasing interest in the use of exome sequencing (ES) in the prenatal setting. In the June UOG issue, Pauta et al. report the results of a systematic review of the literature assessing the diagnostic yield of ES in fetuses with multisystem malformations and a negative result on chromosomal microarray analysis or karyotyping. Their results reveal a 33% incremental yield of ES and demonstrate no significant differences between the solo and trio approaches to ES. These findings support the increasingly recognized role of ES in prenatal diagnostics.
Short-term neonatal and long-term infant outcome of late-preterm twins: nationwide population-based study
In twin pregnancies, late-preterm delivery may reduce perinatal death but may also be associated with higher risk of neonatal morbidity. In a study of 17,189 twin pregnancies, Cho et al. demonstrate that twins delivered in the late-preterm period (34+0 to 36+6 weeks), compared with those born at term (≥37 weeks), have an increased risk for adverse short-term outcome and long-term neurodevelopmental outcome. These findings highlight that the increased risk of morbidity associated with late-preterm delivery should be considered when deciding on the optimal timing of delivery in uncomplicated twin pregnancy.
Cost-effectiveness of cervical length screening and progesterone treatment to prevent spontaneous preterm delivery in Sweden
Universal mid-trimester sonographic cervical length (CL) screening of women with a singleton pregnancy has been proposed to reduce the risk of preterm delivery. The study by Wikström et al. is the first to evaluate the cost-effectiveness of CL ultrasound screening and progesterone treatment outside the USA. Their study evaluates four different CL screening strategies and demonstrates that all of them are associated with better health outcomes compared with a ‘no-screening’ strategy. It also suggests that CL screening with progesterone treatment is likely to be cost-effective in the Swedish healthcare setting. Low-risk-based screening at 18+0 to 20+6 weeks, in which high-risk women are treated with vaginal progesterone and all other women are offered CL screening, is associated with the best health outcome and is also 71% more likely to be cost-effective compared with when no screening is undertaken.
Prediction of fetal death in monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction
Monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction (sFGR) are at high risk of fetal death. In an international multicenter study, Van Mieghem et al. investigate predictors of fetal death in monochorionic twin pregnancies with Type-III sFGR and presents a new approach for stratification of these pregnancies according to risk. Their findings suggest that pregnancies with oligohydramnios, large intertwin weight discordance and, most prominently, early gestational age at diagnosis and deterioration in umbilical artery Doppler flow are at high risk of fetal death and may benefit from close monitoring and fetal intervention.
Coming up next month…
- A Delphi study featuring updated morphological uterus sonographic assessment (MUSA) definitions and classification of features of adenomyosis. Preview the Accepted Article.
- A prospective study comparing fetal growth in IVF/ICSI pregnancies following thawed vs fresh blastocyst transfer. Preview the Accepted Article.
- A multicenter study developing and validating ultrasound-based radiomics models for predicting high-risk endometrial cancer. Preview the Accepted Article.