The November issue of Ultrasound in Obstetrics & Gynecology includes a systematic review and meta-analysis collating evidence on the performance of magnetic resonance imaging and ultrasound in detecting cervical and deep myometrial invasion in endometrial cancer, a multicenter study reporting on the incidence, clinical features and perinatal outcome of anomalous fetuses with late-onset growth restriction, and two studies on open spina bifida, focusing on prenatal treatment and the relationship between white matter development and motor deficits in the affected cases.

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

Three-dimensional transvaginal ultrasound vs magnetic resonance imaging for preoperative staging of deep myometrial and cervical invasion in patients with endometrial cancer: systematic review and meta-analysis

Accurate imaging assessment is essential for adequate surgical planning in patients with endometrial cancer. In particular, cervical and myometrial invasion are fundamental factors to consider when determining the correct surgical management for this condition. In the new UOG Journal issue, Spagnol et al. present the first systematic review to compare the diagnostic accuracy of three-dimensional transvaginal ultrasound (3D-TVS) and magnetic resonance imaging (MRI) in the assessment of myometrial and cervical invasion. The study demonstrates comparable performance between 3D-TVS and MRI, indicating that both techniques may be used for the detection of deep myometrial and cervical invasion as part of the preoperative staging and surgery planning in patients with endometrial cancer.

Incidence, clinical features and perinatal outcome in anomalous fetuses with late-onset growth restriction: cohort study

There is currently limited evidence on the incidence and prognosis of fetal smallness diagnosed after 32 weeks and associated with fetal anomalies. The new study by Dall’Asta et al. presents a cohort of 1246 cases with late-onset fetal growth restriction (FGR), of which 120 (9.6%) were classified as anomalous following diagnosis of a genetic condition, structural malformation or congenital infection. The authors report that the majority of cases with anomalous late-onset FGR involve isolated structural malformations. When compared to non-anomalous fetuses with late-onset FGR, anomalous fetuses with this condition are more likely to experience adverse perinatal outcome, including need for respiratory support at birth, intubation, admission to the neonatal intensive care unit and prolonged hospital stay. These findings are important for parental counseling in pregnancies complicated by anomalous late-onset FGR.

Association between ambulatory skills and diffusion tensor imaging of corpus callosal white matter in infants with spina bifida

Fewer than 50% of individuals with open neural tube defect (ONTD) are able to live independently as adults due to associated motor and sensory neurological deficits. In their new study, Sanz Cortes et al. employ diffusion tensor imaging (DTI) in infants with ONTD, demonstrating a significant association between white matter integrity of connecting fibers of the corpus callosum and ambulation at 30 months of age in these cases. The findings of this study indicate that DTI of white matter may serve as a useful biomarker of neurological outcome in children with ONTD. It should also help elucidate the underlying mechanisms of white matter development in the affected cases.

Primary vs patch-based skin closure for in-utero spina bifida repair

In-utero open fetal spina bifida repair has become the standard-of-care option for selected patients. When compared with postnatal repair, in-utero repair is associated with reduced need for hydrocephalus-related shunting and improvement in unassisted ambulation postpartum. The new prospective study by Fishel Bartal et al. investigates the outcome of fetuses following primary vs patch-based skin closure for in-utero spina bifida repair. According to the study, there is no difference in the need for ventriculoperitoneal shunt placement or surgery for tethered cord between the patch-based and primary closure groups. However, the study suggests that patch-based closure is associated with a longer stay in the neonatal intensive care unit and increased need for perinatal wound revision within the first year after birth when compared with primary skin closure. Patch-based closure during in-utero spina bifida repair is often needed in cases with myeloschisis or large myelomeningocele. Given its apparent drawbacks, further studies are needed to improve patches for spina bifida repair and assess alternative methods to improve care for affected neonates.

Coming up next month…

  • A systematic review and meta-analysis investigating the outcome of fetal premature atrial contractions and an associated Editorial by Julene Carvalho advising on management of affected cases. Preview the Accepted Article.
  • A prospective study presenting a new MRI method for in-vivo examination of the placenta and assessment of intraplacental oxygenation. Preview the Accepted Article.

Two studies focusing on anal sphincter trauma, including:

  • A secondary analysis of the PERINEAL study comparing the diagnostic accuracy of endoanal and transperineal ultrasound for anal sphincter defect. Preview the Accepted Article.  
  • A study investigating the prevalence of major perineal trauma in a urogynecological population using a new ultrasound algorithm. Preview the Accepted Article.