The November issue of Ultrasound in Obstetrics & Gynecology includes a systematic review identifying perinatal risk factors for neurodevelopmental impairment after laser surgery for twin–twin transfusion syndrome, a study showing a reduction in the rate of preterm birth during COVID-19 pandemic restriction measures in Melbourne, Australia, a cost-effectiveness analysis demonstrating a reduction in disease prevalence and health-service costs associated with a model of first-trimester prediction and prevention of preterm pre-eclampsia, and a secondary analysis of a RCT finding no difference in psychological response to early miscarriage and treatment satisfaction after expectant management vs misoprostol treatment.
Perinatal risk factors of neurodevelopmental impairment after fetoscopic laser photocoagulation for twin–twin transfusion syndrome: systematic review and meta-analysis
Prenatal risk factors associated with neurodevelopmental impairment (NDI) in twin–twin transfusion syndrome (TTTS) survivors have not been investigated extensively. In a systematic review of nine studies including 1499 TTTS survivors, Hessami et al. investigated the prevalence of and perinatal risk factors for NDI in TTTS survivors treated with fetoscopic laser photocoagulation. TTTS survivors with later gestational age at the time of laser surgery, earlier gestational age at delivery and lower birth weight were found to be at higher risk of developing NDI. No significant association was found between Quintero stage of TTTS and risk of NDI. The findings may be helpful for parental counseling and highlight the need for future studies to understand better the risk factors for NDI in TTTS survivors.
Impact of COVID-19 pandemic restrictions on pregnancy duration and outcome in Melbourne, Australia
While the effects of SARS-CoV-2 infection itself on pregnant women remain uncertain, restriction measures implemented to reduce SARS-CoV-2 transmission during the COVID-19 pandemic have been associated unexpectedly with a fall in the rate of preterm birth in some studies. In a setting with low COVID-19 rates and strict restriction measures implemented to mitigate SARS-CoV-2 transmission, Rolnik et al. followed women from conception of pregnancy and found a significant reduction in the rate of preterm birth compared with that in women who were pregnant prior to these restrictions. This was driven by a lower rate of spontaneous prematurity, and the effect was stronger in women with a previous preterm birth. The reduction was not associated with an increased stillbirth rate.
Cost-effectiveness analysis of a model of first-trimester prediction and prevention of preterm pre-eclampsia compared with usual care
Recent research suggests that a first-trimester multivariate model is highly predictive of preterm pre-eclampsia and can be combined successfully with targeted prophylaxis (low-dose aspirin), resulting in an 80% reduction in prevalence of disease. Park et al. examined the potential health outcomes and cost implications following introduction of first-trimester prediction and prevention of preterm pre-eclampsia within a public healthcare setting, compared with usual care, and conducted a cost-effectiveness analysis to inform health-service decisions regarding implementation of such a program. The findings demonstrated a reduction in prevalence of preterm pre-eclampsia and substantial cost savings associated with a population-based program of first-trimester prediction and prevention of pre-eclampsia, and supports implementation of such a policy.
Psychological impact of early miscarriage and client satisfaction with treatment: comparison between expectant management and misoprostol treatment in a randomized controlled trial
The success rates and side effects of various miscarriage treatments have been studied extensively. Less studied is the impact of miscarriage treatment on the emotional response of the women and their satisfaction with treatment. In a preplanned analysis of data collected during a randomized controlled trial, Fernlund et al. compared short- and long-term emotional distress (grief, anxiety and depressive symptoms) after early miscarriage and satisfaction with treatment between women randomized to expectant management vs vaginal misoprostol treatment. It was found that the psychological response to and recovery after early miscarriage did not differ between women treated with misoprostol and those managed expectantly. Satisfaction with treatment was high in both treatment groups. The findings support patient involvement when deciding on the management of early miscarriage.
Coming up next month…
- A State-of-the-Art Review on complex gastroschisis as a new indication for fetal surgery. Preview the Accepted Article.
- A study demonstrating evidence of possible vertical SARS-CoV-2 transmission according to the World Health Organization criteria in asymptomatic pregnant women. Preview the Accepted Article.
- A study on the ultrasound characteristics, serum biochemistry and outcomes of ectopic pregnancies presenting during the SARS-CoV-2 pandemic. Preview the Accepted Article.
- A study demonstrating that transvaginal sonography accurately determines the extent of infiltration of rectosigmoid deep endometriosis. Preview the Accepted Article.