The October issue of Ultrasound in Obstetrics & Gynecology includes a mini-series of papers on first-trimester screening for pre-eclampsia, a prospective cohort study and meta-analysis demonstrating the substantial incremental yield of exome sequencing over CMA or karyotyping in fetal hydrops, a study confirming the benefit of valacyclovir administration from the first trimester for secondary prevention of congenital CMV infection, a study evaluating which maneuver for managing umbilical cord prolapse provides the greatest effect on fetal head elevation, a study demonstrating the anatomical features that prevent reliable assessment of endometrial thickness on transvaginal ultrasound, and a study showing that long-term neurological outcomes after percutaneous fetoscopic open spina bifida repair are similar to those after hysterotomy-assisted repair.
First-trimester screening for pre-eclampsia
This issue of UOG contains a series of papers on first-trimester screening for pre-eclampsia using The Fetal Medicine Foundation (FMF) competing-risks model, including:
- A prospective study by Hu et al., demonstrating the effectiveness of the FMF model in screening for preterm pre-eclampsia in a Chinese population including 10,899 pregnancies
- A study by Noël et al., finding that PAPP-A and PlGF had a similar screening performance for pre-eclampsia when used as part of first-trimester screening that also included maternal characteristics, blood pressure and UtA Doppler
- A secondary analysis of data from the ASPRE trial, by Shen et al., demonstrating the risk factors for development of preterm pre-eclampsia despite aspirin prophylaxis in pregnancies at high risk of preterm pre-eclampsia
Fetal hydrops and the Incremental yield of Next-generation sequencing over standard prenatal Diagnostic testing (FIND) study: prospective cohort study and meta-analysis
While individual cohort studies have assessed the diagnostic yield of exome sequencing (ES) over chromosomal microarray analysis (CMA) or karyotyping in non-immune hydrops fetalis (NIHF), they are heterogeneous in relation to the populations assessed and the genetic platforms used. Mone et al. performed a prospective cohort study and meta-analysis to determine the incremental yield of ES over CMA or karyotyping in prenatally diagnosed NIHF. A substantial incremental yield of 29% was demonstrated. The authors concluded that prenatal ES should be considered in prenatally diagnosed NIHF that is unexplained by standard genetic testing, in both isolated cases and in those associated with an additional fetal structural anomaly.
Secondary prevention of congenital cytomegalovirus infection with valacyclovir following maternal primary infection in early pregnancy
A recent RCT showed that treatment with high-dosage oral valacyclovir after first-trimester maternal primary cytomegalovirus (CMV) infection resulted in a significant reduction in fetal infection. Faure-Bardon et al. evaluated, in a single center offering CMV serological screening at 11–14 gestational weeks, secondary prevention of congenital CMV infection by administration of high-dosage maternal oral valacyclovir in the first trimester of pregnancy. The findings confirm the acceptability, tolerance and benefit of administering valacyclovir from the first trimester of pregnancy for secondary prevention of congenital CMV infection in a clinical setting with a well-established routine maternal serum screening policy.
Percutaneous fetoscopic spina bifida repair: effect on ambulation and need for postnatal cerebrospinal fluid diversion and bladder catheterization
A percutaneous fetoscopic approach to prenatal open spina bifida repair provides a potentially safer method than the open approach. Lapa et al. investigated the impact of a novel neurosurgical technique for percutaneous fetoscopic repair of fetal open spina bifida, the skin-over-biocellulose for antenatal fetoscopic repair (SAFER) technique, on long-term postnatal outcome. Neurological outcomes were found to be similar to those reported in the literature after hysterotomy-assisted repair. The majority of children did not require a ventriculoperitoneal shunt or third ventriculostomy within the first 12 months of age, were ambulating independently at 30 months of age and did not require chronic intermittent catheterization of the bladder at 30 months of age.
Transperineal ultrasound assessment of fetal head elevation by maneuvers used for managing umbilical cord prolapse
Various maneuvers to elevate or disengage the fetal presenting part during umbilical cord prolapse have been proposed. However, it is unknown which maneuver is the most effective. Kwan et al. used transperineal ultrasound measurements to assess objectively the degree of fetal head elevation achieved by different maneuvers commonly used to relieve cord compression during cord prolapse. The knee-chest position was found to provide the best effect, followed by filling the maternal urinary bladder with 500mL then 300mL of fluid, respectively. Filling the bladder with 100mL of fluid, the Trendelenburg position and elevation of the maternal buttocks had modest effects.
Ability to successfully image endometrium on transvaginal ultrasound in asymptomatic postmenopausal women
Although numerous studies have indicated that endometrial thickness of ≤4mm on transvaginal ultrasound is a reliable test to exclude endometrial cancer in women with postmenopausal bleeding, not all postmenopausal women have anatomy that allows reliable measurement of endometrial thickness. Goldstein and Khafaga evaluated the frequency of, and the reasons for, an inability to adequately visualize the endometrium on transvaginal ultrasound in asymptomatic postmenopausal women. It was found that a significant minority of women displayed anatomical features that prevent reliable assessment of endometrial thickness. Such features included fibroids, adenomyosis and an axial uterus.
Coming up next month…
- A RCT on the psychological impact and client satisfaction with treatment after early miscarriage in women randomized to expectant management or misoprostol treatment. Preview the Accepted Article.
- A Systematic Review on the diagnostic accuracy of sonography for detecting parametrial involvement in women with pelvic endometriosis. Preview the Accepted Article.