The November issue of Ultrasound in Obstetrics & Gynecology includes a systematic review evaluating the incidence of urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders, a study proposing a new marker to facilitate identification of fetuses with agenesis of the corpus callosum, and two studies providing evidence of an association between epidural analgesia and increased risk of emergency delivery for fetal compromise. The potentially significant impact of the findings of the latter two studies are countered in an accompanying Editorial by Cavoretto and colleagues and in a series of Correspondence articles.
Urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders: systematic review and meta-analysis
It has been established that placenta accreta spectrum disorders (PAS) at birth are associated with an increased risk of hemorrhagic complications during surgical delivery. However, the incidence of urological complications in affected women has not been evaluated systematically. This systematic review of 62 studies by Lucidi et al. estimates the overall incidence of urological complications in women undergoing Cesarean section for PAS to be 15%, with cystotomy being the most common type of complication. The occurrence of urological complications is particularly high in women undergoing hysterectomy (19%), those undergoing an emergency intervention (25%) and those with placenta percreta (39%). The findings of the systematic review may be limited by the high heterogeneity of the included studies, highlighting the need for a standardized protocol for the diagnosis of PAS. Nevertheless, the high risk of urological complications reported underscores the importance of multidisciplinary management of these anomalies in centers with expertise in surgery for PAS.
Effect of intrapartum epidural analgesia on rate of emergency delivery for presumed fetal compromise: nationwide registry-based cohort study
Epidural analgesia is the most effective method of pain relief during labor, and its worldwide use has increased substantially in recent decades. However, its use is associated with suppression of maternal blood pressure, which may in turn affect uteroplacental perfusion and the fetus. In this nationwide registry-based study of 629,951 pregnancies, Damhuis et al. demonstrate that a higher rate of emergency delivery for presumed fetal compromise is observed following intrapartum epidural analgesia compared with alternative analgesia and no analgesia. According to the study, the risk of fetal compromise after epidural analgesia is higher in parous women and increases with decreasing birth-weight centile, indicating that reduced placental reserves exacerbate the adverse effect of maternal hemodynamic changes induced by epidural analgesia. Given these findings, the authors caution that alternative strategies for pain management may be preferable, especially in pregnancies with a high background risk of fetal compromise.
Epidural analgesia and emergency delivery for presumed fetal compromise: post-hoc analysis of RAVEL multicenter randomized controlled trial
The RAVEL multicenter randomized controlled trial demonstrated the superiority of epidural analgesia in terms of patient satisfaction with pain relief when compared with patient-controlled remifentanil analgesia (PCRA). However, the trial did not conduct an in-depth exploration of the potential side effects associated with epidural analgesia. This post-hoc analysis of the trial by Tabernée Heijtmeijer et al. provides further evidence that intrapartum epidural analgesia is associated with a higher rate of emergency delivery for presumed fetal compromise when compared with PCRA, with the highest rate of emergency delivery observed in those with the lowest birth-weight quintile. Future studies should seek to replicate these findings and explore alternative strategies of pain relief in labor.
Tela-choroidea-to-anterior-cerebral-artery distance (TACAD): novel marker on color Doppler to identify fetuses with complete or partial agenesis of corpus callosum
Agenesis of the corpus callosum (ACC) is one of the most common congenital brain anomalies. Despite the relatively high prevalence, its antenatal diagnosis remains challenging. In the midsagittal plane, one of the reported features of ACC is an abnormal course of the anterior cerebral artery on color Doppler, but its evaluation is mainly subjective. In this study, Karl and Chaoui propose a new marker, the tela-choroidea-to-anterior-cerebral-artery distance (TACAD), to enable objective assessment. The study provides reference ranges for this parameter based on a normal population of fetuses and demonstrates a significantly shorter TACAD in ACC cases. The authors suggest that TACAD is an easily measurable parameter on color Doppler neurosonography, which enables quantification of the course of the anterior cerebral artery and may facilitate detection of ACC early in gestation.
Coming up next month…
- A systematic review of the available literature on the prenatal diagnosis and postnatal outcome of congenital knee dislocation. Preview the Accepted Article.
- A prospective study assessing the impact of photoacoustic imaging on ultrasound assessment of adnexal lesions using the sonographic ovarian-adnexal imaging-reporting-data system (O-RADS). Preview the Accepted Article.
- A series of studies on fetal growth in singleton and twin pregnancy by Gardosi et al., Kamphof et al., Rosen et al. and Deter et al..