The March issue of Ultrasound in Obstetrics & Gynecology contains, among other articles, a Randomized Controlled Trial on fetal middle cerebral artery Doppler for timing of intrauterine transfusion in red-cell alloimmunization, a Systematic Review on prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome, and an Original Article reporting on an expert review of sonographer self-reported visualization of normal postmenopausal ovaries on transvaginal ultrasound.
Fetal middle cerebral artery Doppler to time intrauterine transfusion in red-cell alloimmunization: a randomized trial
Red-cell alloimmunization can be treated successfully with intrauterine fetal blood transfusion (IUT). Doppler measurement of fetal middle cerebral artery (MCA) peak systolic velocity (PSV) is a non-invasive test that can identify fetuses at risk of anemia and in need of IUT. Traditionally, the timing of subsequent IUTs involves assessing the reduction in either fetal hematocrit (Hct) or fetal hemoglobin. This Randomized Controlled Trial by Dodd et al. compared measurement of MCA-PSV to estimation of decrease in fetal Hct or hemoglobin level for determining timing of subsequent IUTs in fetuses that had undergone one IUT for anemia secondary to red-cell alloimmunization. It was found that both Doppler MCA-PSV and fetal Hct or hemoglobin level can be used to time subsequent IUTs. However, MCA-PSV measurement may have greater resource implications for the woman and healthcare facilities.
View the full article
Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcome: systematic review and meta-analysis
Doppler ultrasonographic assessment of the cerebroplacental ratio (CPR) and middle cerebral artery (MCA) has been proposed as an adjunct to umbilical artery (UA) Doppler to identify fetuses at risk of adverse perinatal outcome. While they are gradually becoming integrated into clinical practice and international guidelines, reported estimates of their accuracy vary considerably. This Systematic Review by Vollgraff Heidweiller-Schreurs et al. compared the prognostic accuracies of CPR and MCA Doppler to that of UA Doppler for prediction of adverse perinatal outcome. It was found that sensitivity of CPR is superior to that of UA Doppler and that its prognostic accuracy is higher for some outcomes, while MCA Doppler performed significantly worse than both other measures for most outcomes.
Sonographers’ self-reported visualization of normal postmenopausal ovaries on transvaginal ultrasound is not reliable: results of expert review of archived images in UKCTOCS
Transvaginal sonography (TVS) is used widely for pelvic imaging in ovarian cancer screening. Visualization rate (VR) of the ovaries is a quality control metric used commonly in such scanning. However, visualization of the ovaries can be challenging in older women and sonographer self-reported visualization is sensitive to inter- and intraobserver variation. In this Original Article, Stott et al. assessed self-reported VR using expert review of a random sample of archived images of TVS examinations from UKCTOCS, and constructed software based on these data to measure VR automatically. It was found that, in a significant proportion of TVS annual screens, the sonographers may have mistaken other structures for normal ovaries, leading the authors to conclude that quality control metrics based on self-reported visualization of normal ovaries are unreliable.
View the full article
Also out this month is a Virtual Issue on Cesarean scar pregnancy and abnormal invasion of the placenta.
Coming up in next issue is a series of papers reporting on the role of first-trimester ultrasound and combined screening in the cfDNA era and the impact of high-resolution genetic technologies in identification of atypical chromosomal abnormalities.