The November issue of Ultrasound in Obstetrics & Gynecology includes an international Delphi consensus on the prenatal evaluation, diagnosis and management of fetal corpus callosal abnormalities, a systematic review examining the association between borderline oligohydramnios and adverse perinatal outcome, a geometric morphometry study evaluating pelvic shape as a risk factor for pelvic organ prolapse, a study investigating the predictive value of maximum trophoblast thickness in vertical congenital cytomegalovirus transmission, and a Consensus Statement on maternal hemodynamic assessment in hypertensive disorders of pregnancy and fetal growth restriction.
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.
Prenatal evaluation, diagnosis and management of fetal corpus callosal abnormalities: international Delphi consensus
Anomalies of the corpus collosum (CC) are among the most common brain malformations identified on prenatal imaging, however, there is currently no unified clinical approach to the diagnosis and management of such abnormalities. In this study, Corroenne et al. sought to establish an international consensus on the prenatal evaluation, diagnosis and management of fetal CC abnormalities using a structured Delphi methodology amongst a panel of experts. Consensus was reached on several key aspects of prenatal evaluation, including recommendations to obtain a sagittal view of the brain in routine ultrasound and allow referral of a suspected anomaly to a specialist without requiring measurements. In terms of diagnostic ultrasound, agreement was reached that three-dimensional and transvaginal ultrasound imaging should be performed, but there was no consensus on the reference chart or cut-off values to define abnormal CC length. Meanwhile, consensus was reached that invasive genetic workup and magnetic resonance imaging (MRI) should be offered if dysgenesis of the CC is suspected, and MRI should be performed if CC appears too short, thin or thick. Collectively, these findings provide a comprehensive foundational framework for the standardized management of CC abnormalities, supporting future clinical implementation.
Association between borderline amniotic fluid levels and adverse perinatal outcome: systematic review and meta-analysis
Whilst the association between oligohydramnios and adverse perinatal outcomes is well-established, there is less evidence on the effect of borderline oligohydramnios and the best management practice for this condition. In this systematic review, Sgayer et al. evaluated the relationship between borderline oligohydramnios and adverse perinatal outcomes in low-risk singleton pregnancies. Analysis revealed an association between borderline oligohydramnios and risk of a number of adverse outcomes, including Cesarean delivery, 5-min Apgar score < 7, low birth weight and neonatal intensive care unit admission (P < 0.01), compared to pregnancies with normal amniotic fluid index, therefore highlighting a need for more frequent monitoring in pregnancies with borderline amniotic fluid levels. However, further research is required to fully understand the implications of borderline oligohydramnios, and to develop and establish management guidelines.
Pelvic shape predisposes for pelvic organ prolapse: a geometric morphometry study
Pelvic organ prolapse (POP) affects approximately one in 10 women over the age of 50 – an incidence level that is predicted to increase in the coming decades due to growing life expectancy. Developing accurate risk-prediction tools for POP is therefore important for counseling women earlier in life about pregnancy management and delivery options. In this study, Stansfield et al. investigated whether morphological features of the pelvic floor soft tissue and the bony pelvis were associated with risk of developing POP. Combined principal component analysis of soft tissue and pelvic shape revealed significant differences between those with POP, controls without POP and nulliparous participants. When the shape of the bony pelvis was considered alone in cases and controls, POP was significantly associated with a mediolaterally wider pelvis with relatively short anteroposterior craniocaudal diameters; a finding that was generalizable to younger women (those in their 30s) in the secondary dataset. These results therefore contribute to a growing body of literature that suggests pelvic canal size and shape can affect risk of postpartum POP.
Non-invasive prenatal diagnosis of congenital cytomegalovirus infection using maximum trophoblast thickness and biomarkers in maternal blood and urine in first trimester
Congenital cytomegalovirus (CMV) infection is the most prevalent congenital infection and is a leading cause of sensorineural hearing loss and neurological damage. Typically, CMV is diagnosed by amniocentesis in the second trimester, which delays clinical-decision making and limits opportunities to mitigate maternal-fetal transmission, whilst earlier screening currently requires invasive testing. In this retrospective cohort study, Bourgon et al. assessed the predictive value of maximum trophoblast thickness (MTT), in combination with maternal biomarkers, as a non-invasive early predictor of CMV vertical transmission. In an analysis of 127 pregnant women, MTT measured using three-dimensional multiplanar ultrasound between 11 + 0 and 14 + 6 weeks' gestation was significantly higher in cases with a positive CMV polymerase chain reaction (PCR) result in amniotic fluid and chorionic villi, compared to those with a negative result (P = 0.017). Receiver-operating-characteristics curve analysis identified 19.0mm as the optimal MTT threshold for predicting vertical CMV transmission, and the predictive performance of MTT improved when combined with a maternal virological marker and the timing of initiation of secondary prevention with valacyclovir. The authors suggest that a combined screening test using both MTT and maternal biomarkers could therefore be developed to predict vertical CMV transmission.
ISUOG Consensus Statement on maternal hemodynamic assessment in hypertensive disorders of pregnancy and fetal growth restriction
During pregnancy, the maternal cardiovascular system must undergo major adjustments to accommodate the developing fetus whilst simultaneously maintaining healthy maternal homeostasis. If this hemodynamic change is unsuccessful, this can lead to hypertensive disorders of pregnancy (HDP) or fetal growth restriction (FGR) – hence, hemodynamic assessment is key in the monitoring and management of these conditions. In this Consensus Statement, members of the International Working Group of Maternal Hemodynamics provide an update on the role of maternal hemodynamic assessment in HDP and FGR. Stampalija et al. present key statements regarding hemodynamic assessment methodology, interpretation and evaluation of results, and its implications for HDP and FGR prediction and prevention. Together, these statements aim to elucidate the value of maternal hemodynamic assessment in understanding and managing maternal hemodynamic maladaptation during pregnancy.