The November issue of Ultrasound in Obstetrics & Gynecology includes a Systematic Review on outcome reporting in studies evaluating treatments for twin–twin transfusion syndrome, and Original Articles on the association between birth-weight discordance and neonatal morbidity in twin pregnancy, longitudinal change of sFlt-1/PlGF ratio in singleton pregnancy with early-onset fetal growth restriction, and the ‘sliding sign’ of the uterus as a simple sonographic marker for the prediction of intra-abdominal adhesions in women undergoing repeat Cesarean section.
Outcome reporting across randomized trials and observational studies evaluating treatments for twin–twin transfusion syndrome: systematic review
This article is part of the CROWN initiative, which aims to facilitate consistent outcome reporting in women’s health research. Given the high potential for morbidity and mortality in twin–twin transfusion syndrome (TTTS), there is a need for robust guidance on the safest course of management, particularly in the refinement of new treatment techniques. However, there is no consensus amongst key stakeholders on which outcomes should be collected and reported in studies on TTTS treatments. In this Systematic Review, Perry et al. evaluated outcome reporting across observational studies and randomized controlled trials assessing treatments for TTTS. It was found that many different outcomes were reported with varying definitions, and that studies often neglected to report clinically important outcomes. The authors advise that the development of a core outcome set could help standardize outcome collection and reporting in TTTS studies.
Birth-weight discordance and neonatal morbidity in twin pregnancy: analysis of STORK multiple pregnancy cohort
Birth-weight discordance is one of the major determinants of perinatal mortality in twin pregnancy, irrespective of chorionicity, while its role in determining neonatal morbidity remains controversial. In this study, D’Antonio et al. investigated the association between birth-weight discordance and neonatal morbidity in twin pregnancy progressing to at least 34 weeks, as well as the predictive accuracy of different birth-weight discordance thresholds. While intertwin birth-weight discordance was found to be associated independently with neonatal morbidity in twins born after 34 weeks’ gestation, irrespective of chorionicity, its predictive accuracy was poor.
Longitudinal change of sFlt-1/PlGF ratio in singleton pregnancy with early-onset fetal growth restriction
Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) are angiogenic-related biomarkers of placental dysfunction. Preliminary reports support the hypothesis that serial measurements of sFlt-1/PlGF ratio may be useful for monitoring patients already diagnosed with placental dysfunction-related disease. In this Original Article, Herraiz et al. described the evolution of the sFlt-1/PlGF ratio in the last 5 weeks prior to delivery in singleton pregnancy complicated by early-onset fetal growth restriction, with or without pre-eclampsia. Elevated sFlt-1/PlGF ratio was observed in most pregnancies from 4 weeks before delivery, and values were even higher if there was concurrent pre-eclampsia. However, serial sFlt-1/PlGF ratio measurements were of limited value, being useful only to anticipate the need for imminent delivery in cases of fetal growth restriction with pre-eclampsia when sFlt-1/PlGF values ≥ 655 were reached.
Sliding sign in third-trimester sonographic evaluation of intra-abdominal adhesions in women undergoing repeat Cesarean section: a novel technique
Intra-abdominal adhesions are associated with an increased risk of complications during repeat Cesarean section, such as bladder and bowel injury, hemorrhage, infection and hysterectomy, and it is therefore important for surgeons to identify patients at high risk of adhesions. In this issue of the Journal, Baron et al. present a simple transabdominal sonographic marker, the ‘sliding sign’ of the uterus, for the prediction of intra-abdominal adhesions in the third trimester in women undergoing repeat Cesarean section. It was found that, in such women, the sign may be able to discriminate between high and low risk for intra-abdominal adhesions and that the technique may aid clinical decision-making.
Coming up in the next issue of UOG…
- A Systematic Review by Kalafat et al. on metformin for the prevention of hypertensive disorders of pregnancy in women with gestational diabetes and obesity. Preview the Accepted Article.
- A Randomized Controlled Trial by Ghi et al. on whether ultrasound diagnosis of fetal head position reduces the risk of failed vacuum delivery and improves labor outcome. Preview the Accepted Article.
- UOG referees 2018 – find out who were the essential behind-the-scenes contributors to UOG’s peer-review process this year.
Now available online is a new ISUOG Guideline on the role of ultrasound in screening for and follow-up of pre-eclampsia.