The June issue of Ultrasound in Obstetrics & Gynecology includes a prospective study investigating the applicability of the Fetal Medicine Foundation screening algorithm to pre-eclampsia screening in Denmark, a study evaluating the clinical value of expanded non-invasive prenatal screening compared with chromosomal microarray analysis, a systematic review examining the impact of fetal endoscopic tracheal occlusion in cases with congenital diaphragmatic hernia according to disease severity, and a study comparing the outcome following selective termination of the presenting twin vs non-presenting twin. This issue also includes the newly updated ISUOG Practice Guideline on the performance of fetal cardiac screening.
Pre-eclampsia screening in Denmark (PRESIDE): national validation study
The current pre-eclampsia (PE) screening strategy in Denmark is based on single major maternal risk factors, but the performance of the screening method is modest. The prospective study by Riishede et al. evaluates the predictive performance of the Fetal Medicine Foundation (FMF) first-trimester screening algorithm for PE in a Danish population of 8783 women. At a fixed screen-positive rate of 3.4%, the FMF algorithm has detection rates of 60.5% for PE with delivery < 34 weeks and 45.2% for PE with delivery < 37 weeks, much higher compared with the respective detection rates of 25.0% and 19.6% using the current Danish screening strategy. This study supports the applicability of screening for preterm PE in the first trimester using the FMF algorithm and provides evidence for a national implementation of this screening approach in Denmark.
Clinical utility of expanded non-invasive prenatal screening compared with chromosomal microarray analysis in over 8000 pregnancies
Non-invasive prenatal screening (NIPS) has become one of the most extensively used tests in prenatal diagnostics. In this study, Maya et al. assess the clinical utility of the commonly used NIPS for chromosomes 13, 18, 21, X and Y (5-NIPS) and expanded NIPS, compared with chromosomal microarray analysis. Their findings suggest that 5-NIPS misses 64% of clinically significant findings on chromosomal microarray analysis and the added value of expanded NIPS is low. These findings should be taken into consideration when counseling patients regarding the choice between invasive testing and NIPS.
Fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review and meta-analysis
Fetal endoscopic tracheal occlusion (FETO) has been shown to improve outcome in severe cases of congenital diaphragmatic hernia (CDH). However, the efficacy of FETO in moderate CDH and its association with pregnancy complications are still topics of debate. In this systematic review and meta-analysis of 20 studies, Chen et al. demonstrate that FETO reduces mortality in both moderate and severe CDH but is associated with a reduction in the rates of pulmonary hypertension and extracorporeal membrane oxygenation usage only in severe CDH. The study also shows that FETO increases the risk of late prematurity (< 37 weeks) but does not result in extreme prematurity (< 32 weeks). The authors conclude that FETO should be recommended primarily for severe CDH to improve outcome, whereas the risk/benefit ratio of FETO in moderate CDH may need further investigation.
UOG video abstract
Adverse outcome following selective termination of presenting twin vs non-presenting twin
Data are lacking on the impact on pregnancy outcome of the position of the abnormal fetus in a discordant twin pregnancy undergoing selective termination. The new study by Miremberg et al. demonstrates that selective termination of the presenting twin is associated with a significantly higher risk of postprocedural complications and pregnancy loss compared with termination of the non-presenting twin. These findings should be acknowledged during patient counseling and, if legislation permits, taken into consideration when planning selective termination.
UOG video abstract
Coming up next month…
- A population-level study investigating the incidence, risk factors and timing of pregnancy loss in major fetal congenital heart disease. Preview the Accepted Article.
- A systematic review and meta-analysis on the prevalence of adenomyosis in women with subfertility. Preview the Accepted Article.
- A State-of-the-Art Review providing an overview of the literature on the uterine junctional zone in adenomyosis. Preview the Accepted Article.