The May issue of Ultrasound in Obstetrics & Gynecology includes a combined cohort analysis evaluating first-trimester prediction and aspirin prevention of preterm pre-eclampsia in women with chronic hypertension, an individual participant data meta-analysis comparing oral misoprostol with vaginal dinoprostone for induction of labor, a prospective longitudinal study assessing maternal hemodynamic profiles in pregnancies at high risk of pre-eclampsia, an international multicenter observational study evaluating the diagnostic performance of the four-step International Deep Endometriosis Analysis protocol for detecting deep endometriosis, and a Consensus Statement from the International Ovarian Tumor Analysis (IOTA) Group updating terms, definitions and measurements for the sonographic assessment of adnexal tumors.
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.
First-trimester prediction and prevention of preterm pre-eclampsia in women with chronic hypertension
Pregnancies complicated by chronic hypertension are at high risk of pre-eclampsia, yet the role of aspirin prophylaxis and individualized first-trimester risk assessment in this subgroup remains uncertain. In this combined analysis of the ASPRE and SPREE cohorts, including 556 women with chronic hypertension, Rolnik et al. evaluated the effect of aspirin on gestational age at delivery due to preterm pre-eclampsia and assessed the performance of the Fetal Medicine Foundation (FMF) competing-risks model. Among women with chronic hypertension, 10.4% developed preterm pre-eclampsia. Bayesian analysis indicated that aspirin delayed delivery due to preterm pre-eclampsia by a mean of 3.6 weeks, with a high probability of benefit. The FMF model demonstrated good discrimination and adequate calibration, with higher net benefit than a treat-all approach. Overall, 21.8% of women were classified as low risk (< 1 in 100), comprising predominantly nulliparous women and parous women without previous pre-eclampsia, with a low incidence of preterm disease in this group. Risk estimates were driven primarily by mean arterial pressure and placental growth factor, with a lesser contribution from uterine artery Doppler indices. These findings suggest that, in women with chronic hypertension, aspirin may delay disease progression and that first-trimester risk stratification can identify a substantial subgroup at low risk, supporting a more individualized approach to management.
Oral misoprostol (PGE1) vs vaginal dinoprostone (PGE2) for labor induction: individual participant data meta-analysis of randomized controlled trials
The effectiveness of different pharmacological induction of labor (IOL) methods and, specifically, the optimal route of administration of artificial prostaglandins is widely debated. In this individual participant data meta-analysis, comprising 1892 viable singleton pregnancies across five high-quality randomized controlled trials, Tan et al. investigated the effectiveness of oral misoprostol vs vaginal dinoprostone for IOL. No significant difference was found in rates of vaginal delivery (odds ratio (OR), 0.99 (95% CI, 0.80–1.22); I² = 0%). Similarly, rates of composite adverse perinatal outcome (adjusted OR, 1.02 (95% CI, 0.61–1.72)) and composite adverse maternal outcome (adjusted OR, 1.39 (95% CI, 0.72–2.69)) were comparable between the two groups. Aggregate-data meta-analysis restricted to RCTs meeting trustworthiness criteria confirmed these findings (OR for vaginal delivery, 1.08 (95% CI, 0.92–1.27)). In contrast, inclusion of lower-quality studies resulted in an apparent increase in vaginal delivery rates with oral misoprostol (OR, 1.34 (95% CI, 1.22–1.48)), inflating the overall effect estimate. Overall, these findings demonstrate that oral misoprostol and vaginal dinoprostone have similar effectiveness and safety profiles for IOL.
Longitudinal maternal hemodynamics in high-risk pregnancies with different subtypes of pre-eclampsia
Pre-eclampsia (PE), which affects 2–5% of pregnancies, remains a major cause of maternal and perinatal morbidity, and its underlying cardiovascular adaptations are not fully understood. In this prospective longitudinal study, Lin et al. evaluated maternal hemodynamic profiles across gestation in 1078 Chinese women stratified by risk of preterm PE according to the Fetal Medicine Foundation first-trimester combined test. Compared with low-risk women who did not develop PE, all high-risk groups exhibited a hypodynamic profile, with lower stroke volume (SV) and cardiac output (CO) and higher systemic vascular resistance (SVR) and mean arterial pressure (MAP) throughout pregnancy (all P < 0.05), while heart rate (HR) was elevated only in high-risk women who did not develop PE (P < 0.001). Among high-risk women, those who developed preterm PE showed the most marked abnormalities, with lower HR, SV and CO and higher SVR and MAP compared with unaffected high-risk women (all P < 0.01). In contrast, women who developed term PE had largely similar hemodynamic profiles to unaffected high-risk women, except for a progressive increase in MAP from midgestation onwards (P < 0.001). Overall, these findings demonstrate distinct patterns of cardiovascular maladaptation according to PE subtype, with more severe and persistent hypodynamic changes in preterm PE, which may inform risk stratification and targeted antenatal management.
Diagnostic test accuracy of each of the four IDEA ultrasound steps in predicting presence of deep endometriosis
Deep endometriosis (DE) affects up to 20% of individuals with endometriosis and can be challenging to diagnose non-invasively, highlighting the importance of standardized imaging approaches. In this international multicenter observational cohort study, McClenahan et al. evaluated the incremental diagnostic performance of each step of the four-step International Deep Endometriosis Analysis (IDEA) consensus protocol for predicting DE on transvaginal ultrasound, using laparoscopic findings as the reference standard. With the addition of each step, cumulative sensitivity for detecting DE increased from 0.65 (95% CI, 0.59–0.71) for Step 1 alone to 0.94 (95% CI, 0.90–0.97) for the full four-step protocol, while specificity decreased from 0.78 (95% CI, 0.72–0.84) to 0.58 (95% CI, 0.52–0.65). Overall accuracy improved modestly (from 0.71 to 0.78), with a corresponding increase in negative predictive value (from 0.65 to 0.89) and decrease in negative likelihood ratio (from 0.44 to 0.10), indicating strong performance in excluding disease. Among individual steps, assessment for DE nodules (Step 4) demonstrated the highest sensitivity (0.82) and accuracy (0.83), while evaluation of the pouch of Douglas sliding sign (Step 3) showed the highest specificity (0.89). Overall, these findings support the use of the comprehensive four-step IDEA protocol for the detection of DE, with progressive gains in sensitivity and rule-out capability as additional steps are included, which may aid clinical decision-making and referral for specialist imaging.
Terms, definitions and measurements to describe the sonographic features of adnexal tumors: updated consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group
Ultrasonographic assessment of adnexal masses is essential for distinguishing benign from malignant pathology and guiding appropriate clinical management. Building on the standardized terminology developed by the International Ovarian Tumor Analysis (IOTA) group, this Consensus Statement of Timmerman et al. provides updated and clarified terms, definitions and measurement criteria to ensure consistent description of adnexal lesions, incorporating refinements to morphological and vascular features and their interpretation. With a particular focus on the correct application of IOTA models, including the Assessment of Different NEoplasias in the adneXa (ADNEX) model and benign descriptors, to support risk stratification and reporting within systems such as the Ovarian-Adnexal Reporting and Data System (O-RADS), the Consensus Statement is of interest not only to gynecologists specializing in ultrasonography, but also to general gynecologists, radiologists, gynecological oncologists and other clinicians involved in the diagnosis and management of adnexal pathology.