The October issue of Ultrasound in Obstetrics & Gynecology includes a State-of-the-Art Review on artificial intelligence in ultrasound in obstetrics and gynecology, a study on the survival outcome in severe left-sided congenital diaphragmatic hernia with and without FETO in a country with suboptimal neonatal management, a study on translabial ultrasound for grading of obstetric anal sphincter injury, and a study on the utility of lung ultrasound assessment for probable SARS-CoV-2 infection during pregnancy and universal screening of asymptomatic individuals.
Introduction to artificial intelligence in ultrasound imaging in obstetrics and gynecology
Deep learning, a leading tool of artificial intelligence (AI), performs particularly well in image pattern recognition and, therefore, can be of great benefit to doctors who rely heavily on images, yet AI has had little impact on the field of obstetrics and gynecology so far. In this State-of-the-Art Review, Drukker et al. present an overview of AI technology and some of the issues related to the introduction of this emerging technology into clinical practice, in the context of ultrasound in obstetrics and gynecology. Promising workload-changing advancements include automatic acquisition of standard planes and quality assurance in fetal ultrasound, measurement of endometrial thickness in gynecology and automatic classification of ovarian cysts. The challenges of introducing AI into clinical practice are discussed, including the impact on the job market, its applicability in situations in which imaging features alone may be insufficient to determine a diagnosis and management, the dependence of the model performance on the process of annotation, and ethical concerns.
Survival outcome in severe left-sided congenital diaphragmatic hernia with and without fetal endoscopic tracheal occlusion in a country with suboptimal neonatal management
Fetal endoscopic tracheal occlusion (FETO) has been shown to increase neonatal survival in cases of congenital diaphragmatic hernia (CDH), when compared with standard postnatal management. Cruz-Martínez et al. evaluated the impact of FETO on neonatal survival in fetuses with isolated severe left-sided CDH, as compared with contemporaneous matched cases managed expectantly, in a country with suboptimal neonatal management, finding FETO to be associated with improved neonatal survival. The outcomes reported in this study may be of interest to centers in which termination of pregnancy is illegal and neonatal management is considered suboptimal, as they demonstrate that fetal intervention in experienced fetal surgery centers represents an improvement in neonatal survival for fetuses with isolated severe left-sided CDH. Watch the accompanying Video Abstract:
The topic of fetal surgery for severe CDH is debated in this issue of the Journal in an Opinion and Counter Opinion. Yves Ville criticizes ongoing randomized controlled trials of FETO, and argues that FETO centers should make their own decisions, based on their own results and the individual patient’s utility choices. On the other side of the debate, Jan Deprest defends the TOTAL trial, and argues that the controversies regarding the management of CDH can be concluded only by properly designed trials.
How comparable is clinical grading of obstetric anal sphincter injury with that determined by four-dimensional translabial ultrasound?
Four-dimensional translabial ultrasound (4D-TLUS) is increasingly used to evaluate the anal sphincter. However, most studies have focused on assessing residual anal sphincter defects, and no attempt has been made to classify obstetric anal sphincter injuries (OASI) using TLUS. Gillor et al. evaluated the agreement between grading of OASI on 4D-TLUS, using a newly developed algorithm, and grading on postpartum examination. They found fair agreement between the clinical and sonographic classification of OASI. Potential clinical over-diagnosis was noted in about one third of the patients, but under-diagnosis might still occur in a significant minority.
Utility of lung ultrasound assessment for probable SARS-CoV-2 infection during pregnancy and universal screening of asymptomatic individuals
False-positive and false-negative results are not uncommon in RT-PCR testing for SARS-CoV. Anecdotal reports suggest that the adjunct use of imaging modalities can help manage cases in which molecular testing results and the clinical presentation are conflicting. Kalafat et al. assessed the added utility of lung ultrasound to symptoms and exposure history for predicting a positive RT-PCR test result. It was found that lung ultrasound scoring could facilitate the early diagnosis of symptomatic women with probable SARS-CoV-2 infection. Lung ultrasound could therefore be useful for managing patients and rationing resources in cases in which waiting for the RT-PCR results is not an option or when testing capacity is strained.
Coming up next month…
- A study on trends in ventricle size during pregnancy and its use for prediction of ventriculoperitoneal shunt in fetal myelomeningocele. Preview the Accepted Article.
- A study, with an accompanying Video Abstract, on follow‐up ultrasound in second‐trimester low‐positioned anterior and posterior placentas. Preview the Accepted Article.
- A study on ophthalmic artery Doppler in the prediction of pre-eclampsia at 35–37 weeks’ gestation. Preview the Accepted Article.