The March issue of Ultrasound in Obstetrics & Gynecology includes a systematic review on the definition, prevalence, clinical relevance and treatment of T-shaped uterus, a European multicenter study on the outcome of right-sided congenital diaphragmatic hernia according to prenatal severity indicators and antenatal management, a study on fetal cardiac function at 35–37 weeks’ gestation in pregnancies that subsequently develop pre-eclampsia, and a study on the 2-year outcomes of infants born to women with a short cervix treated with progesterone.
Definition, prevalence, clinical relevance and treatment of T-shaped uterus: systematic review
The prevalence of T-shaped uterus and its impact on reproductive outcome remain unknown. In a systematic review, Coelho Neto et al. summarize the current evidence regarding definitions, diagnosis, prevalence, etiology, clinical relevance and impact of surgical treatment for T-shaped uterus not related to diethylstilbestrol (DES) exposure, and highlight areas on which future research should focus. In the included studies, the prevalence of T-shaped uterus ranged between 0.2% and 10%. The etiology of T-shaped uterus is still unknown, being considered to be of primary origin or secondary to adhesions or adenomyosis in different studies. Moreover, there is no universal definition for T-shaped uterus, and its diagnosis is performed by different methods, mainly by 3D ultrasound. The authors concluded that expectant management should be considered the most appropriate choice for everyday practice until randomized controlled trials show a benefit of intervention. Watch the accompanying video abstract:
Fetal endoscopic tracheal occlusion reverses the natural history of right-sided congenital diaphragmatic hernia: European multicenter experience
Previous studies in fetuses with isolated left-sided congenital diaphragmatic hernia (CDH) have reported that there is a strong association between prenatally assessed lung size and postnatal survival, and, in cases of severe disease, the prognosis could be improved by fetal endoscopic tracheal occlusion (FETO). Right-sided CDH is far less common than left-sided CHD, and solid data concerning this condition are scarce. In an extended series of patients with a prenatal diagnosis of isolated right-sided CDH from four European FETO centers with standardized prenatal and postnatal management strategies, Russo et al. evaluated neonatal outcome based on prenatal severity indicators and antenatal management. It was found that antenatal measurement of lung size can predict survival in isolated right-sided CDH, and, in fetuses with severe lung hypoplasia, FETO was associated with a significant increase in survival without an associated increase in neonatal morbidity.
Fetal cardiac function at 35–37 weeks’ gestation in pregnancies that subsequently develop pre-eclampsia
Fetal echocardiographic studies in pregnancies with pre-eclampsia, compared to normotensive controls, have reported impairment in fetal cardiac function, which has been attributed to placental vascular resistance and increased cardiac afterload. However, it is uncertain whether this dysfunction precedes or coincides with the clinical onset of the disease. Semmler et al. compared fetal cardiac morphology and function between pregnancies that subsequently developed pre-eclampsia and those that remained normotensive. It was found that, although the etiology of the observed fetal cardiac changes in pregnancies that subsequently develop pre-eclampsia remains unclear, it is possible that the reduction in right-heart systolic function is the consequence of high afterload due to increased placental resistance, whilst the early left ventricular diastolic changes could be due to fetal hypoxia-induced redistribution in the fetal circulation.
Progesterone for prevention of preterm birth in women with short cervical length: 2-year infant outcomes
Progesterone treatment in women with a short cervix has been shown to reduce the rate of PTB. Studying the developmental outcomes after in-utero exposure to progesterone is important, both in preterm and term infants. In this follow-up study of the Triple P trial, Cuijpers et al. compared the 2-year neurodevelopmental and other health outcomes of infants born to women with a short cervix and an otherwise low risk for preterm birth, after antenatal exposure to vaginal progesterone vs placebo. No relevant differences in neurodevelopmental, behavioral, health-related and physical outcomes were found between offspring exposed to vaginal progesterone and those exposed to placebo. Antenatal exposure to progesterone therefore does not seem to indicate major concerns for the neurodevelopment and health of infants at 2 years of age.
Coming up next month…
- Updated ISUOG Practice Guidelines on the sonographic examination of the fetal central nervous system. Part 2: guidelines for performing targeted neurosonography.
- Two papers (Wong et al. and Taithongchai et al.) and a State-of-the-Art Review on the most appropriate group of women for mesh repair surgery and the role of ultrasound in the evaluation of synthetic implants in the treatment of urinary incontinence and pelvic organ prolapse.
- A systematic review on the outcome of fetuses with congenital cytomegalovirus infection and normal ultrasound and the time of diagnosis. Preview the Accepted Article.
- A study on the outcome of pregnancies with a very recent primary cytomegalovirus infection in the first trimester treated with hyperimmunoglobulin. Preview the Accepted Article.