The May issue of Ultrasound in Obstetrics & Gynecology includes a randomized controlled trial on the effect of docosahexaenoic acid supplementation on fetal ductal constriction, a systematic review and meta-analysis examining the performance of externally validated risk-prediction models for pre-eclampsia, a cohort study delineating the ultrasound features of benign and malignant mesenchymal uterine tumors and a study comparing the performance of different fetal weight charts and definitions of fetal growth restriction in predicting adverse outcome. 

Please see below a selection of articles from the May issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today or login and upgrade.

Maternal supplementation with docosahexaenoic acid does not cause constriction of fetal ductus arteriosus: randomized controlled trial

The benefit to fetal brain development of maternal consumption of docosahexaenoic acid (DHA) during pregnancy is well documented. However, it is unclear whether this potent anti-inflammatory agent interferes with maternal prostaglandins, which maintain the patency of the fetal ductus arteriosus. This double-blind randomized controlled trial by Zielinsky et al. investigates the effect of 8-week DHA supplementation in late pregnancy on prostaglandin metabolism and fetal ductus arteriosus flow dynamics. Compared with the placebo group, women receiving a clinically recommended dose of DHA showed no difference in prostaglandin E2 level or fetal ductal flow parameters. Concluding that DHA does not cause ductal constriction, the authors call for further postmarket surveillance studies to establish fully the safety profile of DHA.

Externally validated prediction models for pre-eclampsia: systematic review and meta-analysis

External validation of risk-prediction models is an essential precursor to clinical implementation. In this systematic review and meta-analysis, Tiruneh et al. evaluate the performance of 52 externally validated prediction models for pre-eclampsia. Most had been validated externally three or fewer times, predominantly in high-income countries, with the exception of the Fetal Medicine Foundation (FMF) competing-risks model for preterm pre-eclampsia, which had been validated in 16 different settings. The FMF model demonstrated outstanding performance, while other prediction models showed poor-to-good discrimination and a tendency towards overfitting. The authors highlight the need for more external validation studies, particularly in low-resource settings, to draw conclusions on the generalizability and clinical utility of prediction models for pre-eclampsia. 

Ultrasound features using MUSA terms and definitions in uterine sarcoma and leiomyoma: cohort study

Accurate differentiation between malignant uterine sarcoma and benign uterine leiomyoma is essential to facilitate early and radical surgery in the former and implement conservative management in the latter. In this study, De Bruyn et al. contrast the ultrasound features of these two types of mesenchymal uterine tumor, using the terminology of the Morphological Uterus Sonographic Assessment (MUSA) group. Uterine sarcoma was more likely to exhibit cystic areas, irregular tumor borders, moderate-to-abundant intralesional vascularity and an absence of calcifications, although ultrasound features had only moderate interobserver agreement. These findings should help clinicians to assess the risk of malignancy in myometrial lesions, enabling timely referral of high-risk cases to tertiary centers for optimal surgical management. 

Prenatal prediction of adverse outcome using different charts and definitions of fetal growth restriction

Despite much attention on the antenatal detection of fetal smallness, there is still no consensus on how to distinguish between normal and pathological fetal growth. This study by Mascherpa et al. evaluates the strength of association between three different definitions of fetal growth restriction, in combination with various fetal weight charts/standards, and adverse perinatal outcome. The apparent prevalence of growth restriction varied between 1.5% and 10.6% according to the definition and size reference used, and all combinations had low sensitivity for adverse outcome. Only low estimated fetal weight and abnormal Doppler parameters were associated consistently with adverse outcome. The authors advocate integrating these predictors into a compound algorithm for improved detection of at-risk pregnancies.

Coming up next month…
•    A systematic review and meta-analysis on the diagnostic accuracy of ultrasound before and after 14 weeks of gestation for the detection of placenta accreta spectrum. Preview the Accepted Article
•    A study evaluating the incidence of brain injury and neurodevelopmental impairment in pregnancies with twin–twin transfusion syndrome. Preview the Accepted Article
•    A study comparing the clinical, ultrasound and biochemical characteristics of ovarian ectopic pregnancy with those of tubal ectopic pregnancy. Preview the Accepted Article
•    A longitudinal evaluation of cervical length and stiffness using shear-wave elastography in pregnancies complicated by spontaneous preterm birth. Preview the Accepted Article