The June issue of Ultrasound in Obstetrics & Gynecology includes a systematic review on the trimester-specific diagnostic performance of ultrasound in placenta accreta spectrum, a neuroimaging study investigating brain injury in pregnancies with twin–twin transfusion syndrome, a longitudinal evaluation of cervical stiffness in women who undergo spontaneous preterm delivery and a study comparing the characteristics of ovarian and tubal ectopic pregnancies.

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

Trimester-specific diagnostic accuracy of ultrasound for detection of placenta accreta spectrum: systematic review and meta-analysis

Placenta accreta spectrum (PAS) is usually diagnosed in the second or third trimester, but first-trimester detection would enable earlier referral for specialist management. This systematic review and meta-analysis by Hessami et al. investigated the diagnostic accuracy of ultrasound assessment in the first trimester vs second and third trimesters for the detection of PAS in a high-risk population. Sensitivity and specificity were similar in both gestational-age windows, with lower uterine hypervascularity and myometrial thinning showing the highest sensitivity for PAS in the first trimester. The authors contend that introducing first-trimester ultrasound as a complement to existing screening protocols for PAS would increase detection rates and reduce maternal and fetal morbidity and mortality.

Fetal and neonatal neuroimaging in twin–twin transfusion syndrome

The incidence of brain injury in twin–twin transfusion syndrome (TTTS) is disputed and data on its long-term consequences are lacking. In this study, Spruijt et al. investigated the rate of brain injury, perinatal mortality and neurodevelopmental impairment in a large cohort of TTTS pregnancies that underwent laser treatment. Based on dedicated neurosonography and limited use of magnetic resonance imaging, brain injury was diagnosed in 2% of fetuses and 5% of neonates. Over half of these cases experienced adverse outcome, and recurrent TTTS, post-laser twin anemia–polycythemia sequence and preterm birth were identified as risk factors for brain injury. The authors recommend standardized fetal and neonatal neuroimaging in TTTS cases alongside long-term neurodevelopmental follow-up.

Longitudinal evaluation of cervical length and shear wave elastography in women with spontaneous preterm birth

Shear wave elastography has emerged as a promising tool for evaluating the mechanical stiffness of cervical tissue and predicting the risk of spontaneous preterm birth (sPTB). In this prospective study, Nguyen-Hoang et al. evaluated temporal changes in cervical stiffness and length throughout gestation in women who underwent sPTB. Overall, the cervix was shorter and softer in sPTB cases compared with those who delivered at term. While significant shortening was observed from the late second trimester onwards, significant softening was noted only in the first trimester, suggesting that the cervix undergoes a softening process prior to shortening. Therefore, low cervical stiffness may be an early indicator of sPTB risk and could be addressed by targeted intervention aimed at strengthening the cervical architecture.

Ovarian ectopic pregnancy: clinical characteristics, ultrasound diagnosis and management

Ovarian ectopic pregnancy (OEP) is a rare form of extrauterine ectopic pregnancy diagnosed mostly at emergency surgery. In this study, Solangon et al. reviewed the clinical, ultrasound and biochemical characteristics of OEP to provide a reference for clinicians who may not have encountered this condition. Compared with tubal ectopic pregnancy, OEP was more likely to present with an embryo, severe hemoperitoneum and abdominal pain as the only symptom. In a dedicated early pregnancy setting, most cases of OEP were diagnosed accurately on preoperative transvaginal ultrasound and those that underwent surgical management had good outcome. These findings highlight the value of early non-invasive diagnosis of OEP in enabling optimal surgical planning and minimally invasive intervention.

Coming up next month…

  • A systematic review and meta-analysis evaluating the diagnostic accuracy of first-trimester ultrasound in screening for a range of non-cardiac fetal anomalies. Preview the Accepted Article.
  • A study using automated cardiac biometry at 18–22 weeks’ gestation to build an artificial intelligence model to screen prenatally for coarctation of the aorta. Preview the Accepted Article.
  • An analysis of the effect of in-utero exposure to hypertensive disorders of pregnancy on cardiovascular risk profile in early childhood. Preview the Accepted Article.
  • An 8-year longitudinal study investigating the impact of successive vaginal deliveries on levator ani muscle avulsion. Preview the Accepted Article.