The March issue of Ultrasound in Obstetrics & Gynecology includes a randomized trial comparing antral follicle count with serum anti-Müllerian hormone level for determination of gonadotropin dosing in in-vitro fertilization, studies on development and validation of the QUiPP App v.2 for prediction of spontaneous preterm birth in asymptomatic high-risk women and women with symptoms of threatened preterm labor, and a study on expected-value bias in routine third-trimester growth scans.
Comparison of antral follicle count and serum anti-Müllerian hormone level for determination of gonadotropin dosing in in-vitro fertilization: randomized trial
In women undergoing in-vitro fertilization using a long gonadotropin-releasing hormone (GnRH) agonist protocol, the proportion achieving a desired ovarian response has been shown to be the same when gonadotropin dosing is determined based on antral follicle count (AFC) or serum anti-Müllerian hormone (AMH) level. Yet, the GnRH-antagonist protocol has been adopted increasingly in recent years. Li et al. compared the proportion of women achieving a desired ovarian response following ovarian stimulation when gonadotropin dosing was determined based on AFC vs serum AMH level, in women undergoing in-vitro fertilization using the GnRH-antagonist protocol. No difference was found, confirming that clinicians can choose to use either biomarker (view the accompanying Journal Club slides).
Development and validation of predictive models for QUiPP App v.2
Predictive modeling was incorporated in 2015 into a decision-support tool, the QUiPP App, that provides an individualized risk of delivery within prespecified time frames for asymptomatic women at risk of preterm labor based on the use of cervical length (CL) and quantitative fetal fibronectin (qfFN) in combination. Advancing the QUiPP App prototype, QUiPP App v.2 aims to provide individualized risk of delivery based on CL, qfFN or both tests combined, taking into account further risk factors, such as multiple pregnancy. In two studies in this issue of the Journal, the developers of the QUiPP App v.2 report its development and validation for use in asymptomatic high-risk women, as well as in women with symptoms of threatened preterm labor. All six algorithms (CL and qfFN alone or in combination in asymptomatic or symptomatic women) demonstrated good accuracy for the prediction of spontaneous preterm birth at <30, <34 and <37 weeks’ gestation and within different time periods post-testing. The QUiPP App v.2 is demonstrated to be an enhanced, reliable risk assessment tool that could increase confidence in clinical decisions, improve targeting and timing of interventions to reduce preterm birth and its associated morbidities, and limit unnecessary intervention and women’s anxiety (read the press release).
Download the QUiPP App v.2:
Expected-value bias in routine third-trimester growth scans
Operators performing fetal growth scans are usually aware of the gestational age of the pregnancy, which may lead to expected-value bias when performing biometric measurements. Drukker et al. evaluated the incidence of expected-value bias in routine fetal growth scans and assess its impact on standard biometric measurements. Expected-value bias was found to occur in 91.4% of the saved standard biometric plane measurements, and operators were more likely to adjust the measurements towards the expected value than away from it. When making clinical decisions, clinicians should therefore be aware that estimated fetal weight may be inaccurate due to expected-value bias, and ultrasound operators should be aware of this potential bias while performing biometric measurements.
Coming up next month…
- New ISUOG Practice Guidelines on the role of ultrasound in congenital infections.
- A study on the effect of one fetal death on pregnancy outcome in twin pregnancy with two live fetuses at 11–13 weeks. Preview the Accepted Article.
- A video abstract on intracervical lakes as a sonographic marker of placenta accreta spectrum disorder in patients with placenta previa and low-lying placenta. Preview the Accepted Article.