To mark Pre-eclampsia Awareness Month, the May issue of Ultrasound in Obstetrics & Gynecology includes a series of research papers investigating the impact of pre-eclampsia on maternal health and potential biomarkers of the disorder. The issue also includes a systematic review and a retrospective study on the outcome of patients with aortic stenosis following fetal aortic valvuloplasty, a prospective study evaluating genetic causes of skeletal system abnormalities and a study validating IOTA models and O-RADS tool for preoperative assessment of adnexal lesions in a North American population.
Role of placental, fetal and maternal cardiovascular markers in predicting adverse outcome in women with suspected or confirmed pre-eclampsia
Pre-eclampsia increases the risk of maternal and perinatal adverse outcomes. Currently, there are no reliable prediction models that would allow stratification of patients according to both perinatal and maternal risk. The prospective study by Reddy et al. investigates the performance of placental, fetal and maternal cardiovascular markers in the prediction of adverse perinatal and maternal outcomes in women with suspected or confirmed pre-eclampsia. The findings of the study demonstrate the potential utility of the sFlt-1/PlGF ratio in predicting adverse perinatal outcome but not adverse maternal outcome. According to the study, fetal and maternal cardiovascular parameters, alone or in combination with sFlt-1/PlGF ratio, do not improve prognostic performance. Further research is required to delineate the role of the sFlt-1/PlGF ratio in the management of women with pre-eclampsia and develop optimal prognostic models for this disorder.
Postnatal circulation in patients with aortic stenosis undergoing fetal aortic valvuloplasty: systematic review and meta-analysis
Fetal aortic stenosis poses a significant risk of morbidity and mortality. As a result of advances in prenatal imaging and surgery, fetal valvuloplasty (FAV) has become a treatment option for critical fetal aortic stenosis. However, it is currently uncertain whether fetal intervention can improve the outcome of affected cases. In their systematic review and meta-analysis on patients with aortic stenosis undergoing FAV, Vorisek et al. report a live-birth rate of 79% and a biventricular outcome rate of 46% among liveborn patients, with the latter improving to 52% in subjects that underwent a technically successful procedure. The study emphasizes the importance of conducting controlled, prospective studies to determine the benefit of this fetal intervention.
Extended genetic testing in fetuses with sonographic skeletal system abnormalities
Skeletal system abnormalities are a heterogeneous group of disorders with diverse etiology. In a prospective study by Kucińska-Chahwan et al., 76% of fetuses with a skeletal anomaly on ultrasound had a genetic abnormality, with chromosomal anomaly being the most common genetic diagnosis. The authors demonstrate the importance of exome sequencing in these cases, which increases the diagnostic yield over that of chromosomal microarray and polyploidy testing, and present a diagnostic protocol in fetuses with sonographic abnormality of the skeletal system.
Performance of IOTA Simple Rules, Simple Rules risk assessment, ADNEX model and O-RADS in differentiating between benign and malignant adnexal lesions in North American women
The International Ovarian Tumor Analysis (IOTA) models and Ovarian-Adnexal Reporting and Data System (O-RADS) provide guidance and terminology for standardized transvaginal ultrasound examination of adnexal lesions. In their study, Hiett et al. validate the IOTA models and O-RADS tool in a North American population and compare their performance in preoperative differentiation between benign and malignant adnexal lesions. The authors report that IOTA models and O-RADS performed well in this cohort, in line with published IOTA results in other populations. The models have a similar sensitivity, but the IOTA models have superior specificity in differentiating between benign and malignant lesions, when compared with O-RADS. Further multicenter studies are necessary to support adoption of these models into clinical practice in North America.
Valvuloplasty in 103 fetuses with critical aortic stenosis: outcome and new predictors for postnatal circulation
In another study on fetal aortic valvuloplasty (FAV), Tulzer et al. review their 19-year experience of 125 FAV procedures in patients with critical aortic stenosis and evolving hypoplastic left heart syndrome. At their center, FAV was performed successfully in 87% of cases, achieving biventricular outcome in 55% of liveborn patients that underwent successful FAV. The authors also demonstrate that pre-FAV right to left ventricular length ratio combined with left ventricular pressure can predict biventricular outcome at 1 year of age with high sensitivity and specificity, highlighting the potential utility of these markers in patient selection for FAV. Overall, the findings of the study indicate that FAV can be performed with a high success rate and an acceptable risk, with results improving after a learning curve.
Coming up next month…
- Updated ISUOG Practice Guidelines for performance of the routine mid-trimester fetal ultrasound scan.
- A systematic review and meta-analysis evaluating the diagnostic yield of exome sequencing in fetuses with multisystem malformations. Preview the Accepted Article.
- A multicenter study investigating the predictors of fetal death in monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction. Preview the Accepted Article.
- A study aiming to estimate the cost-effectiveness of strategies to prevent spontaneous preterm delivery in asymptomatic singleton pregnancies in Sweden. Preview the Accepted Article.