The May issue of Ultrasound in Obstetrics & Gynecology includes a study presenting a sonographic classification and reporting system for diagnosing adenomyosis, a Randomized Controlled Trial on the impact of exercise during pregnancy on maternal weight gain and fetal cardiac function, a Systematic Review on the additional value of chromosomal microarray analysis over conventional karyotyping in stillbirth, and a study investigating premature placental aging in term small-for-gestational-age and growth-restricted fetuses.
Sonographic classification and reporting system for diagnosing adenomyosis
In women with adenomyosis, management is often based on ultrasound diagnosis alone. Van den Bosch et al. propose a consensus-based uniform reporting system for ultrasound findings of adenomyosis, consisting of identification of its presence, determination of its location, differentiation between focal and diffuse disease, differentiation between cystic and non-cystic lesion, determination of myometrial layer involvement, classification of disease extent and measurement of size of lesion.
Does exercise during pregnancy impact on maternal weight gain and fetal cardiac function? A randomized controlled trial
Increased gestational weight gain has been associated with adverse maternal and neonatal outcomes. Physical activity during pregnancy has been suggested to restrict gestational weight gain and may impact fetal health. In this Randomized Controlled Trial, Brik et al. assessed the effect of exercise during and after pregnancy on maternal gestational weight gain and fetal cardiac function. Exercise was found not to be associated with a reduction in maternal weight gain during pregnancy but may increase weight loss after delivery. With respect to fetal cardiac function, exercise during pregnancy was found to be associated with increased ductus arteriosus pulsatility index at 20 weeks and ejection fraction at 36 weeks.
Added value of chromosomal microarray analysis over conventional karyotyping in stillbirth work-up: systematic review and meta-analysis
Identification of a genetic cause of stillbirth is useful in assessing the risk of recurrence. Chromosomal microarray analysis (CMA) allows far better resolution than that achievable using conventional karyotyping. In this Systematic Review, Martinez-Portilla et al. assessed the added value of CMA over normal karyotyping in fetal loss after 20 weeks. CMA was found to provide informative results in an extra 15% of cases, with an increase in test success rate from 75% to 90%. In structurally normal fetuses, CMA provided a 3% incremental yield for pathogenic copy-number variants and a 10% incremental yield for variants of unknown significance, while the respective values in structurally abnormal fetuses were 6% and 8%.
Premature placental aging in term small-for-gestational-age and growth-restricted fetuses
Placental aging has been demonstrated in pregnancies complicated by fetal growth restriction (FGR). In this study, Paules et al. assessed placental aging in small term fetuses classified as being small-for-gestational age (SGA) or having FGR, through analysis of senescence and apoptosis markers. Accelerated placental aging was observed in both forms of fetal smallness, including lower telomerase activity, shorter telomeres, reduced Sirtuin-1 RNA expression and increased p53 RNA expression. The findings support a common pathophysiology of these forms of fetal smallness and challenge the concept of SGA fetuses being constitutionally small (download the accompanying Journal Club slides).
Coming up in the next issue of UOG…
- An ISUOG Guideline on ultrasound assessment of fetal biometry and growth.
- A Systematic Review and accompanying Video Abstract on screening for trisomies by cfDNA testing of maternal blood in twin pregnancy.