The October issue of Ultrasound in Obstetrics & Gynecology includes a Systematic Review on the predictive accuracy of the cerebroplacental ratio for adverse outcome in suspected fetal growth restriction (FGR), a Systematic Review on the prediction of preterm delivery using biomarker tests, and Original Articles on percutaneous fetoscopic closure of large open spina bifida, maternal hemodynamics, fetal biometry and Doppler indices in pregnancies with suspected FGR, and the effect of the freeze-all policy on in-vitro fertilization outcome in poor ovarian responders.

Please see below a selection of articles from the October issue of Ultrasound in Obstetrics & Gynecology chosen specially by the UOG team. To view all UOG content, become an ISUOG member today or login and upgrade.

Predictive accuracy of cerebroplacental ratio for adverse perinatal and neurodevelopmental outcomes in suspected fetal growth restriction: systematic review and meta-analysis

The clinical management of suspected fetal growth restriction (FGR) is challenging and no consensus exists for the best way to monitor fetal wellbeing in these pregnancies. While the cerebroplacental ratio (CPR) has been proposed for this purpose, its ability to predict adverse perinatal outcome in this entity has been questioned. In this Systematic Review, Conde-Agudelo et al. aimed to determine the accuracy of the CPR for predicting adverse perinatal and neurodevelopmental outcomes in suspected FGR. It was found to have moderate-to-high predictive accuracy for perinatal death but low accuracy for the other outcomes considered, while an abnormal CPR result increased the pretest probability of adverse perinatal outcome from 25% to 45%.

Prediction of preterm delivery in symptomatic women using PAMG-1, fetal fibronectin and phIGFBP-1 tests: systematic review and meta-analysis

Alongside cervical length, the most notable methods for the prediction of preterm birth include biomarker tests based on fetal fibronectin, phosphorylated insulin-like growth factor-binding protein-1 (phIGFBP-1) and placental alpha microglobulin-1 (PAMG-1), although the performance of these tests shows considerable variation between studies. In this Systematic Review, Melchor et al. assessed the accuracy of these biomarker tests in predicting spontaneous preterm birth within 7 days of testing in women with symptoms of preterm labor. It was found that PAMG-1 was associated with the highest positive predictive value, while other diagnostic accuracy measures did not differ between the three biomarker tests.

Percutaneous fetoscopic closure of large open spina bifida using a bilaminar skin substitute

Approximately 20–30% of open spina bifida defects are too large for primary antenatal or postnatal skin closure. In this Original Article, Lapa et al. report their experience with a percutaneous fetoscopic technique using a bilaminar skin substitute over a biocellulose patch for the prenatal correction of large open spina bifida in which skin approximation was not possible. It was found that, although the operating time was longer, surgical outcome using this technique was similar to that in cases closed primarily. View the accompanying video summary:

Maternal hemodynamics, fetal biometry and Doppler indices in pregnancies followed up for suspected fetal growth restriction 

In small-for-gestational-age fetuses, the risk of adverse outcome is particularly marked in those with birth weight < 3rd percentile, and in those with evidence of impaired placentation and fetal oxygenation. In this Orignal Article, Roberts et al. assessed whether, in pregnancies with estimated fetal weight ≤ 10th percentile, maternal hemodynamics, fetal biometry and Doppler indices at presentation can predict the subsequent development of an abnormal fetal Doppler index or delivery of a baby with birth weight < 3rd percentile. Prediction of birth weight < 3rd percentile at first visit was improved by the assessment of maternal hemodynamic function along with maternal history and demographics, fetal biometry, Doppler indices and amniotic fluid volume (download the accompanying Journal Club slides).

Does freeze-all policy affect IVF outcome in poor ovarian responders?

The freeze-all strategy for in-vitro fertilization (IVF) avoids the potential adverse effects on the endometrium associated with controlled ovarian stimulation (COS) in fresh embryo transfer. However, it is unknown whether this strategy can be used for all patients, irrespective of their ovarian response and hormone levels during COS. In this Original Article, Roque et al. compared these strategies in poor ovarian responders to evaluate whether the freeze-all policy affects IVF outcome, finding it to have no impact.

Coming soon… An ISUOG Guideline on the role of ultrasound in screening for and follow-up of pre-eclampsia.