The May issue of Ultrasound in Obstetrics & Gynecology includes a State-of-the-Art Review on the management of SARS-CoV-2 infection in pregnancy, a ‘How To’ article on screening for vasa previa, a RCT on pelvic floor physiotherapy in women with deep infiltrating endometriosis and superficial dyspareunia, a study on the relationship between ophthalmic artery Doppler and maternal cardiovascular function, and a study on the predictive value of fetal cardiac parameters for urgent neonatal balloon atrial septostomy in simple transposition of the great arteries.
Counseling in maternal–fetal medicine: SARS-CoV-2 infection in pregnancy
Although numerous cohort studies and systematic reviews have evaluated the impact of SARS-CoV-2 infection on maternal and perinatal outcomes, the evidence on several aspects of the prenatal management of these pregnancies remains conflicting. In this State-of-the-Art Review, Di Mascio et al. provide an up-to-date review of the literature and evaluate the quality of available evidence on the management of pregnancies complicated by SARS-CoV-2 infection. Topics covered include the signs and symptoms of SARS-CoV-2 infection in pregnancy, the risk of severe infection in pregnant women, the fetal risks, the risk of vertical transmission, the optimal therapeutic strategy, the use of prophylactic anticoagulation, the optimal timing of delivery, the optimal mode of delivery, intrapartum care and vaccination.
How to screen for vasa previa
Vasa previa can be identified by ultrasound examination and, when it is identified prenatally and patients are delivered prior to the onset of labor or rupture of membranes, the outcome for the baby is typically excellent. In this ‘How To’ article, Ranzini and Oyelese discuss practical points and useful tips for screening for vasa previa. The three necessary screening steps are evaluation of the umbilical cord insertion site into the placenta, ensuring at each ultrasound examination that there is no suspicion of a bilobed or succenturiate placenta, and careful re-evaluation later in pregnancy of the lower uterine segment in all cases of resolving low-lying placenta or placenta previa. While it may not be possible to identify all cases of vasa previa, these steps will identify the vast majority of cases, thus improving the neonatal outcome.
Assessment of levator hiatal area using 3D/4D transperineal ultrasound in women with deep infiltrating endometriosis and superficial dyspareunia treated with pelvic floor muscle physiotherapy: randomized controlled trial
Pelvic floor physiotherapy seems to be promising in women with deep infiltrating endometriosis (DIE), leading to an improvement in dyspareunia and pelvic floor muscle relaxation. In this randomized controlled trial, Del Forno et al. evaluated the effect of pelvic floor physiotherapy on levator hiatal area during Valsalva maneuver in women with DIE suffering from superficial dyspareunia. Pelvic floor physiotherapy was found to result in increased levator hiatal area on Valsalva maneuver, as observed by 3D/4D transperineal ultrasound, leading to improved superficial dyspareunia, chronic pelvic pain and pelvic floor muscle relaxation. In the context of tailored multidisciplinary care, pelvic floor physiotherapy may therefore represent an additional valid, minimally invasive, innovative and well-tolerated therapeutic option for women with DIE.
Relationship between ophthalmic artery Doppler and maternal cardiovascular function
In mid-gestation, the finding of an increase in the ophthalmic artery second to first peak of systolic velocity ratio (PSV ratio) provides useful prediction of subsequent development of pre-eclampsia. Gibbone et al. examined the possible association between the ophthalmic artery PSV ratio and maternal cardiovascular function in a prospective screening study of an unselected population of 2835 pregnancies at 19–23 weeks’ gestation. The findings suggest that Doppler assessment of PSV ratio in the ophthalmic artery provides information about peripheral vascular status. The increase in PSV ratio in women who develop pre-eclampsia is associated with increased afterload and an increase in left ventricular thickness.
Urgent neonatal balloon atrial septostomy in simple transposition of the great arteries: predictive value of fetal cardiac parameters
Prenatal prediction of the need for an urgent balloon atrial septostomy (BAS) after birth in fetuses with simple transposition of the great arteries (TGA) may help to optimize perinatal management and pregnancy outcome and to reduce the risks of postnatal cardiovascular complications. Patey et al. investigated the impact of abnormal perinatal loading conditions on cardiac geometry and function in term fetuses and neonates with simple TGA, and explored the predictive value of fetal cardiac parameters for an urgent BAS after birth. Term fetuses and neonates with simple TGA exhibited an altered cardiac phenotype and different functional perinatal adaptations compared with controls, with more profound alterations after birth. Several cardiac indices showed high sensitivity and specificity for the prediction of urgent BAS after birth, reflecting compensatory cardiovascular responses to late-gestation pathophysiology and fetal hypoxemia.
Coming up next month…
- A Consensus Opinion from the Vulvar International Tumor Analysis (VITA) group on the terms, definitions and measurements to describe the sonographic features of lymph nodes.
- A randomized controlled trial on routine third-trimester ultrasound for the detection of small-for-gestational age in low-risk pregnancies. Preview the Accepted Article.
- Debate on the relative merits of the SMFM and ISUOG guidelines for diagnosing FGR.