The May issue of Ultrasound in Obstetrics & Gynecology includes a systematic review investigating the outcome following early vs late selective termination in dichorionic twin pregnancies, a prospective study aiming to estimate the prevalence of endometriosis using transvaginal ultrasound, a study proposing new criteria for predicting outcome in cases of tricuspid valve dysplasia and Ebstein’s anomaly using fetal tricuspid regurgitation waveform analysis, and a large prospective midgestation study examining cardiac function and morphology of fetuses conceived via in-vitro fertilization. The May issue also features a randomized controlled trial evaluating the impact of predictive information regarding the likely outcome of pregnancy on psychological wellbeing of women with a pregnancy of uncertain viability during the waiting period to final diagnosis.
Pregnancy and perinatal outcomes of early vs late selective termination in dichorionic twin pregnancy: systematic review and meta-analysis
Selective termination (ST) of a twin pregnancy has been shown to reduce the risk of preterm birth, Cesarean delivery, low birth weight and hypertensive disorders of pregnancy. In this systematic review, Sorrenti et al. investigate the impact of gestational age at ST on the outcome of dichorionic twin pregnancies. The study demonstrates that early (< 18 weeks) ST is associated with significantly lower rates of pregnancy loss before 24 weeks and preterm birth before 37, 34 and 32 weeks compared with late (≥ 18 weeks) ST. Both early and late ST appear to be safe in terms of neonatal survival of the non-reduced twin. These findings highlight the importance of early diagnosis of fetal anomalies in twin pregnancies in order to allow ST to be performed in the earliest gestational-age window.
Psychological impact of simple scoring system for predicting early pregnancy outcome in pregnancy of uncertain viability: randomized controlled trial
In the UK, 10–28% of women seen in early pregnancy units are found to have an intrauterine pregnancy of uncertain viability at initial assessment. Absence of a certain diagnosis has been shown to be associated with increased anxiety in pregnant women. In this randomized controlled trial, Lawson et al. aimed to establish whether psychological wellbeing of women with an intrauterine pregnancy of uncertain viability can be modified during the waiting period to final diagnosis by offering predictive information regarding the likely outcome of the pregnancy. The study shows no difference in anxiety, depression or worry scores between women who received a prediction score for ongoing viability vs those who underwent routine care. Although prediction tools may be useful for healthcare professionals to guide management and optimize utilization of resources, they do not appear to have an objective positive impact on the patients’ psychological wellbeing during the waiting period.
Prevalence of deep and ovarian endometriosis in women attending a general gynecology clinic: prospective cohort study
Previous studies aiming to estimate the prevalence of endometriosis focused on populations of women undergoing surgery, leading to selection bias. Transvaginal ultrasound has emerged as an alternative diagnostic tool for endometriosis, and its diagnostic accuracy is now deemed similar to that of laparoscopy. In this prospective study of 1026 women, using transvaginal ultrasound as a diagnostic tool, Chaggar et al. demonstrate that deep and/or ovarian endometriosis is present in nearly one in five women attending a general gynecology clinic. The prevalence of almost 20% is higher than that reported previously and demonstrates that transvaginal ultrasound should be offered routinely to women during their initial outpatient visit to facilitate timely diagnosis and treatment of endometriosis.
Fetal cardiac function at midgestation and conception by in-vitro fertilization
Emerging evidence suggests that fetuses conceived via in-vitro fertilization (IVF) are at increased risk of cardiovascular and metabolic abnormalities. The prospective study by Huluta et al. aims to provide further insight into the possible differences in fetal cardiac morphology and function in midgestation between cases conceived via IVF and those conceived spontaneously. The study demonstrates that the fetal heart is globular and left ventricular systolic function assessed by speckle tracking is mildly reduced following IVF conception, independent of the type of embryo transfer (frozen vs fresh) and changes in placental perfusion and function. Future studies should confirm whether these cardiac changes persist later in pregnancy and the postnatal period.
Late-gestation prediction of outcome in tricuspid valve dysplasia and Ebstein’s anomaly using fetal tricuspid regurgitation waveform analysis
Accurate prediction of outcome in prenatally diagnosed cases of tricuspid valve dysplasia and Ebstein’s anomaly is important, as it allows planning of management during late gestation and surgical intervention after birth. In this study, Ikegawa et al. present a new approach to predicting outcome in affected cases, which is based on fetal tricuspid regurgitation (TR) waveform analysis in late gestation. The approach combines TR maximum velocity and change in pressure over time of the TR jet (dP/dt), allowing more accurate prediction of biventricular circulation after birth in fetuses with tricuspid valve dysplasia or Ebstein’s anomaly.
Coming up next…
- Newly updated ISUOG Practice Guidelines on performance of fetal cardiac screening.
- A multicenter study comparing outcome following selective termination of presenting vs non-presenting twin. Preview the Accepted Article.
- A systematic review evaluating the prevalence of adenomyosis in women with subfertility. Preview the Accepted Article.
- A systematic review examining the outcome following fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia. Preview the Accepted Article.