The June issue of Ultrasound in Obstetrics & Gynecology includes a systematic review presenting the differences in indications for fetal echocardiography between guidelines and consensuses of experts, a study evaluating the assessment of risk for pre-eclampsia at mid-gestation, a study assessing maternal stress and fetoplacental cortisol regulation in small-for-gestational-age pregnancy, and a nationwide study in the USA reporting on the racial and ethnic disparities in obstetric anal sphincter injury.
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.
Indications for fetal echocardiography: consensus and controversies among evidence-based national and international guidelines
Fetal echocardiography (FE) is the primary tool used for the diagnosis and management of congenital heart disease, however there is no straightforward definition of the parental and/or fetal risk factors classed as indications for FE. In this systematic review, De Robertis et al. reviewed the recently published guidelines and consensuses of experts to assess the differences in recommended indications for FE. Among six guidelines and consensuses, 17 risk factors were identified as an indication for FE. Complete agreement between all six documents was reached for 3/17 (17.6%) risk factors, all of which are fetal risk factors, with partial agreement noted for 8/17 (47.1%) and complete disagreement recorded for 6/17 (35.3%) risk factors. The lack of unanimous consensus on indications for FE identified in this systematic review warrants the construction of an internationally standardized multisocietal agreement on the risk factors that represent the latest evidence-based indications for FE.
Assessment of risk for pre-eclampsia at mid-gestation to define subsequent care
For the prevention of pre-eclampsia (PE), screening is typically conducted at 12 weeks’ gestation for preterm PE, and at 36 weeks’ gestation for subsequent term PE; it has been recently proposed that additional screening should be carried out at around 20 weeks for the identification of a high-risk PE group that would benefit from close monitoring at 24–36 weeks' gestation. In aid of this proposal, Adjahou et al. stratified pregnancy care based on the estimated risk of delivery with PE at < 28, < 32 and < 36 weeks' gestation from screening at 19–24 weeks' gestation. The best performance of screening was achieved by a combination of maternal risk factors, mean arterial pressure and uterine artery pulsatility index, with screen-positive rates of 11.0%, 18.3% and 38.8% for the prediction of about 90% of cases of delivery with PE at < 28, < 32 and < 36 weeks, respectively. The demonstrated approach for the stratification of the population based on predicted risk of delivery with PE should be assessed in future studies as to whether its implementation can improve perinatal outcome.
Maternal stress and fetoplacental cortisol regulation in small-for-gestational-age newborns
Recent research has identified an association between maternal stress, fetal growth and the expression of glucocorticoid-related genes in the placenta, particularly 11-beta hydroxysteroid dehydrogenase-2 (HSD11β2). However, the relationship between maternal stress, placental expression and methylation of HSD11β2, and fetal cortisol metabolites according to fetal growth are still unknown. In this study, Miranda et al. found that, in SGA vs non-SGA pregnancies, median maternal perceived stress and anxiety state scores were significantly higher (P < 0.001) there was a significant reduction in median placental HSD11β2 RNA expression (P = 0.013). A metabolism shift in the fetal cortisol axis was also observed in SGA cases, characterized by increased 5α-reductase activity and diminished CYP3A7 activity. These findings suggest a consistent association between SGA, maternal stress and altered fetoplacental cortisol metabolism, emphasizing the need for preventive strategies to mitigate the impact of maternal stress on fetal growth.
Racial and ethnic disparities in obstetric anal sphincter injury: cross-sectional study in the USA
Obstetric anal sphincter injury (OASI) is a serious yet understudied complication of vaginal birth, for which the racial and ethnic disparities are poorly understood. To bridge this research gap, Rajasingham et al. conducted a cross-sectional study of 12 501 183 vaginal births in the USA over a 5-year period. They found that Asian primiparae had higher OASI hazards compared with White primiparae, irrespective of mode of delivery, and in multiparous individuals without a previous Cesarean delivery, was consistently associated with a 1.5–2.1-times higher hazard of OASI in Asian compared with White individuals. The rate of OASI varied widely between Asian race subgroups, with the highest rate noted among individuals with origins and/or ancestry from India, and the OASI rate was higher among foreign-born vs USA-born residents. The authors conclude that future research is needed to understand the reasons behind the disproportionately higher OASI rates among Asian and, more specifically, Indian individuals, ultimately to design healthcare services for populations most at risk for OASI that are culturally sensitive, trauma-informed and implemented across the continuum of care.