The October issue of Ultrasound in Obstetrics & Gynecology includes a systematic review evaluating the incidence and predictive factors of obstetric anal sphincter injury in primiparous women, a study providing preliminary evidence supporting the feasibility and efficacy of prenatal open spina bifida repair in twin pregnancy and two studies assessing the utility of glycosylated fibronectin as a new biomarker for pre-eclampsia screening in mixed and Asian populations. The issue also features a study demonstrating the efficacy and safety of in-utero treatment of sustained fetal supraventricular arrhythmia in late preterm and term fetuses and an accompanying Editorial on the topic.
Biocellulose patch technique for fetoscopic repair of open spina bifida in twin pregnancy
Twin pregnancy has been considered an exclusion criterion for prenatal open spina bifida (OSB) repair due to unclear benefits to the affected fetus, the unknown maternal and fetal risks and the potential technical challenges of performing the procedure in a twin pregnancy. In this novel study, Lapa et al. report on the outcome of seven twin pregnancies including eight fetuses with OSB that were treated using the skin-over-biocellulose for antenatal fetoscopic repair (SAFER) technique. The authors demonstrate a good outcome for both twins following the procedure, with none of the cases requiring additional repair and with 13/14 twins having a normal short-term neurodevelopment outcome. The findings of the study suggest that prenatal surgery for OSB using the SAFER technique is a feasible, efficacious treatment option in twin pregnancy, with low risk to both twins and their mother when performed by a highly experienced team. Larger series should be conducted to confirm the findings and assess long-term neurodevelopment of the twins.
Screening for pre-eclampsia by maternal serum glycosylated fibronectin at 11–13 weeks’ gestation
It has been found recently that serum glycosylated fibronectin (GlyFn) levels are increased in women with pre-eclampsia. The increase is apparent from 7–11 weeks’ gestation and is present throughout gestation, suggesting GlyFn as a potentially useful biomarker of pre-eclampsia at any stage of pregnancy. In this study, Sokratous et al. demonstrate that the performance of screening for preterm pre-eclampsia at 11–13 weeks using the triple test, comprising mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and serum placental growth factor (PlGF), is similar to that of MAP, UtA-PI and GlyFn or MAP, PlGF and GlyFn. The performance of screening for term pre-eclampsia or gestational hypertension by any combination of biomarkers is poor. These findings suggest that GlyFn may be a useful alternative biomarker to use in screening for preterm pre-eclampsia if PlGF or UtA-PI measurement is not possible. The results of this case–control study should be validated by prospective screening studies.
Glycosylated fibronectin improves first-trimester prediction of pre-eclampsia
It has been demonstrated that the sensitivity of the Fetal Medicine Foundation triple test for preterm pre-eclampsia is lower in East Asian women than in the European population. Therefore, additional biomarkers are needed to improve the performance of screening in this ethnic group. Moungmaithong et al. show that adding glycosylated fibronectin to the triple test as a fourth biomarker increases the screening sensitivity for both preterm and any-onset pre-eclampsia in an Asian population. The study provides further evidence to support the utility of the novel biomarker in screening for pre-eclampsia and emphasizes the need for prospective studies to confirm these findings.
Treatment, not delivery, of the late preterm and term fetus with supraventricular arrhythmia
In-utero treatment of sustained fetal supraventricular arrhythmia (SVA) is standard practice in previable and preterm fetuses. However, data are limited on best practice for late preterm and term fetuses with SVA. Holmes et al. report that transplacental treatment in near term and term (≥35-week) fetuses with SVA is highly successful, even in the presence of hydrops, with the majority of cases delivered vaginally closer to term, thereby avoiding unnecessary Cesarean section. These preliminary results suggest that prenatal treatment of late preterm and term fetuses with SVA should be considered, given the high likelihood of success, low risk of adverse outcome and reduced need for operative delivery.
Predictive factors for obstetric anal sphincter injury in primiparous women: systematic review and meta-analysis
Obstetric anal sphincter injury (OASI) has been suggested to occur in 5–7% of first vaginal deliveries. Improved understanding of factors affecting the likelihood of OASI is necessary to mitigate the risks and enable accurate counseling of pregnant women. This systematic review of 21 studies by Packet et al. demonstrates that higher gestational age at delivery, shorter antepartum perineal body length, labor augmentation, forceps extraction, shoulder dystocia, episiotomy use and shorter episiotomy length are significant risk factors for structural anal sphincter damage following a first vaginal delivery. The study also reveals that ultrasound evidence of structural damage to the anal sphincter is present in 26% of primiparous women. Clinicians should have a low threshold of suspicion for the condition and take into account the identified risk factors during counseling.
Coming up next month…
- Two studies investigating the effect of intrapartum epidural analgesia on emergency delivery rates for fetal compromise and an accompanying Editorial. Preview the Accepted Articles by Tabernee Heijtmeijer et al. and Damhuis et al..
- A systematic review evaluating the incidence of urological complications in women undergoing surgery for placenta accreta spectrum disorders. Preview the Accepted Article.
- A study presenting a novel marker for prenatal diagnosis of agenesis of the corpus callosum. Preview the Accepted Article.