The November issue of Ultrasound in Obstetrics & Gynecology includes a systematic review on the outcome of non-visualization of the fetal gallbladder on second-trimester ultrasound, a cost-effectiveness analysis of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities, a study on the prediction of adverse perinatal outcome by serum placental growth factor and soluble fms-like tyrosine kinase-1 in women undergoing induction of labor, and a study on the impact of placenta previa with placenta accreta spectrum disorder on fetal growth.
Outcome of non-visualization of fetal gallbladder on second-trimester ultrasound: cohort study and systematic review of literature
Non-visualization of the fetal gallbladder (NVFGB) in the second trimester is a rare condition. In most cases, visualization can be achieved later in the pregnancy. Persistent NVFGB can be isolated or associated with other ultrasound abnormalities. di Pasquo et al. investigated the ultrasound characteristics and outcome of fetuses with NVFGB. NVFGB was found to be associated with additional structural anomalies in about 20% of cases, and associated anomalies increased the risk not only of chromosomal anomalies but also of biliary atresia and cystic fibrosis. It was therefore concluded that, in cases of NVFGB, a detailed ultrasound scan should be offered and parents tested for cystic fibrosis gene mutation, and an invasive test and measurement of liver enzymes before 22 weeks constitutes a reasonable work-up.
Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities: model-based analysis
The economic impact of a cell-free DNA (cfDNA)-based screening strategy has been explored extensively for the main trisomies, but rarely for other abnormalities. Whilst cfDNA testing may increase the number of cases of trisomy detected, its exclusive use may reduce the detection of other types of abnormality that can be identified on full karyotyping following invasive testing. Le Bras et al. performed a model-based cost-effectiveness analysis of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities following the introduction of cfDNA analysis. It was found that extending cfDNA testing to a larger population would result in the detection of more trisomies but fewer unbalanced chromosomal abnormalities, with an additional economic burden and no benefit in terms of miscarriage rate (view the accompanying Journal Club slides).
Prediction of adverse perinatal outcome by serum placental growth factor and soluble fms-like tyrosine kinase-1 in women undergoing induction of labor
The contradictory findings concerning the performance of biomarkers for prediction of adverse outcome may at least in part be attributed to different intervals between assessment and delivery. To overcome this problem, Fiolna et al. investigated the additive value of serum placental growth factor and soluble fms-like tyrosine kinase-1, measured within 24 h prior to induction of labor, to the performance of screening for adverse outcome provided by maternal risk factors and cerebroplacental ratio, finding no significant additional contribution to maternal risk factors in the prediction of Cesarean section for suspected fetal compromise in labor or surrogate markers of adverse perinatal outcome.
Impact of placenta previa with placenta accreta spectrum disorder on fetal growth
Placenta previa and placenta accreta spectrum (PAS) disorder are associated with high risks of prenatal and perinatal maternal complications but there are limited data on their impact on fetal growth. Jauniaux et al. evaluated fetal growth in pregnancies complicated by placenta previa with or without PAS disorder, compared with in pregnancies with a low-lying placenta. No difference was found in fetal growth or incidence of a small- or large-for-gestational-age neonate and there was no difference in fetal growth between adherent and invasive PAS disorder subgroups. It was therefore concluded that adverse neonatal outcome in pregnancies complicated by placenta previa and PAS disorder is primarily linked to premature delivery and not to impaired fetal growth.
Coming up in the next issue…
- A systematic review on the performance of fetal middle cerebral artery peak systolic velocity for the prediction of fetal anemia in untransfused and transfused fetuses. Preview the Accepted Article.
- A study on the diagnosis of septate uterus using update ESHRE/EDGE, ASRM and CUME definitions. Preview the Accepted Article.
- UOG referees 2019 – find out who were the essential behind-the-scenes contributors to UOG’s peer-review process this year.