The November issue of Ultrasound in Obstetrics & Gynecology includes a randomized controlled trial investigating the impact of coaching maternal pushing using transperineal ultrasound-guided visual biofeedback on the duration of the second stage of labor, a systematic review evaluating long-term outcomes of infants who underwent fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia, a prospective diagnostic accuracy study validating and comparing the ultrasound-based International Ovarian Tumor Analysis – Assessment of Different NEoplasias in the adneXa (IOTA-ADNEX) model with the MRI-based ADNEX MR scoring system as second-line imaging modalities for estimating the risk of adnexal malignancy and a prospective cohort study assessing regional growth patterns of the fetal corpus callosum using three-dimensional transvaginal neurosonography (with and without volume contrast imaging).
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.
Effect of ultrasound-guided visual biofeedback performed by midwives on duration of second stage of labor: randomized controlled trial
Transperineal ultrasound (TPUS) has emerged as a valuable tool for the objective assessment of labor progress, fetal head descent and fetal head position, aiding clinical decision-making during the second stage of labor, which is important as prolonged second stage of labor is associated with increased maternal and neonatal morbidity. In this randomized controlled trial, Avrahami et al. investigated whether coaching maternal pushing using TPUS-guided visual biofeedback, performed by midwives, reduces the duration of the second stage of labor and affects the mode of delivery in nulliparous women receiving epidural analgesia, compared with coaching using the traditional vaginal technique. Significantly reduced duration of the second stage of labor as well as reduced rates of second-degree or higher perineal tears and intrapartum fever were observed in the TPUS-coached group. This indicates that TPUS-coaching by midwives could be beneficial for reducing the risk of prolonged second stage of labor, but larger studies are warranted to further assess its impact on delivery outcome.
Long-term outcome after fetal endoscopic tracheal occlusion for congenital diaphragmatic hernia: systematic review
Treatment for congenital diaphragmatic hernia (CDH), one of the most common life-threatening birth defects, has shifted from open fetal surgery to percutaneous fetal endoscopic tracheal occlusion (FETO), but data regarding long-term outcomes of this technique are limited. Shah et al. has addressed this gap in knowledge in a systematic review which evaluated infant outcomes ≥ 1 year post-FETO in fourteen studies. A significant prevalence of gastrointestinal morbidity, respiratory complications and growth failure was noted (although improvements in the latter two complications were observed over time), while neurodevelopmental outcomes were generally reassuring and some studies reported no significant differences in long-term outcome between infants that underwent FETO and those that did not after adjusting for disease severity. Overall, the results of the review indicated that FETO-treated CDH survivors may experience substantial multisystem morbidity that may improve over time and may be driven by factors independent of the intervention itself, but the need for long-term multidisciplinary follow-up was noted.
Ultrasonography (IOTA-ADNEX) vs magnetic resonance imaging (ADNEX MR) for diagnosing ovarian cancer in high-risk patients: a prospective study
When adnexal lesions are suspicious for malignancy on first-line ultrasound examination, patients should be offered referral for a second-line assessment, which may be expert ultrasonography or magnetic resonance imaging (MRI); however, there is a lack of studies directly comparing standardized ultrasound and standardized MRI for differentiating between benign and malignant masses within the same patient population. In this prospective diagnostic accuracy study designed as a head-to-head comparison, Dueholm Hjorth et al. systematically validated and compared ultrasonography, using the ultrasound-based International Ovarian Tumor Analysis – Assessment of Different NEoplasias in the adneXa (IOTA-ADNEX) model, with magnetic resonance imaging (MRI), using the MRI-based ADNEX MR scoring system, as second-line imaging modalities for estimating the risk of adnexal malignancy in patients identified as being at risk of malignancy on first-line ultrasound examination. The area under the receiver-operating-characteristics curve for distinguishing patients with benign tumors from those with malignant tumors was comparable for the IOTA-ADNEX and ADNEX MR models, with similar performance regardless of lesion morphology or size, and agreement for key morphological features and lesion size measurements was moderate to substantial and good to excellent, respectively. These findings indicate that both modalities may be used for second-line assessment of adnexal masses deemed at risk of malignancy on first-line ultrasound examination.
Regional growth patterns of fetal corpus callosum at 18–32 weeks' gestation assessed by three-dimensional transvaginal neurosonography
Characterizing the normal growth trajectories of the corpus callosum (CC) during pregnancy allows for a better understanding of its developmental biology. Chen et al. defined five vertical CC segments and assessed growth trajectories of fetal CC biometry using three-dimensional transvaginal neurosonography, with and without volume contrast imaging (VCI), between 18 and 32 weeks' gestation in this prospective cohort study. Distinct, non-linear growth patterns in CC length, total area, genu, body and splenium thicknesses and the areas of the five segments were reported, with the splenium demonstrating the most pronounced absolute area growth. VCI and non-VCI measurements were comparable and most measurements demonstrated high reproducibility. However, the authors noted that the reported trajectories should be regarded as descriptions of normal developmental patterns rather than as reference charts for isolated clinical decision-making, as the clinical significance of regional CC measurements remains uncertain and further longitudinal studies incorporating postnatal neurodevelopmental assessment are required to determine their prognostic value.