The October issue of Ultrasound in Obstetrics & Gynecology includes a systematic review comparing the reproductive outcome between luteal-phase support protocols for frozen embryo transfer cycles with hormone replacement therapy, a decision analysis aiming to determine the optimal surgical approach for fetal open spina bifida, a prospective study evaluating the added value of cell-free DNA-based scores in estimating the risk of ovarian malignancy, and a morphometric analysis of spina bifida lesions.
Please see below a selection of articles from the September issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today or login and upgrade.
Reproductive outcome after frozen embryo transfer with hormone replacement therapy according to luteal-phase support protocol: systematic review and network meta-analysis of randomized controlled trials
In hormone replacement therapy (HRT)-frozen embryo transfer (FET) cycles, multiple routes of progesterone administration are available with variable results, yet the optimal protocol for luteal-phase support (LPS) remains undefined. In this systematic review of 10 randomized controlled trials (RCTs), comprising 4216 patients assigned to nine different LPS approaches, Etrusco et al. compared the reproductive outcome between LPS protocols for HRT-FET cycles. Regarding the combined outcome of ongoing pregnancy and live birth, oral dydrogesterone combined with gonadotropin-releasing hormone agonist was found to be significantly more efficacious compared with all other LPS protocols (very low to low certainty evidence). However, the authors highlight that inconsistencies across different outcome measures and the very low to low certainty of evidence underscore the need for further research and call for additional high-quality RCTs to further define optimal LPS strategy and tailored treatment approaches.
Comparison of open fetal, fetoscopic and postnatal surgical repair for open spina bifida: decision analysis
There are a range of management strategies for fetal open spina bifida (OSB), with different trade-offs for the pregnant woman and the fetus, and a structured framework to systematically analyze and compare these diverse treatment options is needed. To address this, Kunpalin et al. performed a decision analysis to determine the optimal surgical approach for OSB by objectively weighing the benefits and risks associated with open fetal surgery, fetoscopic surgery and postnatal surgery. Fetoscopic and open fetal surgery resulted in an identical number of expected quality adjusted life years (QALYs), which translated into a QALY gain of 1.70 per dyad compared with postnatal repair, and probabilistic analyses showed that fetoscopic surgery was the preferred strategy in the majority (51%) of simulations. The results show that both fetoscopic and open fetal surgery demonstrate superior QALY gains compared with postnatal repair, largely related to a reduced number of individuals who use a wheelchair or require cerebrospinal fluid diversion surgery, and that given the similar effectiveness of these two management options, an individual risk assessment is essential to guide decision-making.
Added value of cell-free DNA over clinical and ultrasound information for diagnosing ovarian cancer
The authors of this study have previously proposed two cfDNA-based biomarkers, the genome-wide Z-score and the nucleosome score, to improve presurgical detection of ovarian malignancy. Although it has been hypothesized that cfDNA-based biomarkers may display increased test specificity, the data for ovarian cancer have not been convincing. In this prospective cohort study, Vanderstichele et al. investigated the added value of these cfDNA-based scores in combination with the clinical and ultrasound predictors of the Assessment of Different NEoplasias in the adneXa (ADNEX) model to estimate the risk of ovarian malignancy. While multivariable analysis yielded statistically significant likelihood ratio tests when adding the cfDNA markers to ADNEX variables, the increase in discrimination was marginal. Overall, the results of this study indicate that cfDNA analysis using genome-wide Z-score and the nucleosome score has limited clinical utility above established clinical and ultrasound-based predictors for discriminating between benign and malignant ovarian masses.
Morphometric analysis of spina bifida after fetal repair shows new subtypes with associated outcomes
Spina bifida lesions can be classified as myelomeningocele (with cerebrospinal fluid-filled sac) or myeloschisis (without sac), but these two lesion types belie a spectrum of morphologies. As a detailed typology of spina bifida lesions, with associated characteristics and outcomes, is lacking, Mann et al. sought to identify and characterize lesion types during in-utero repair and correlate them with preoperative presentation and postoperative outcome. In the analysis of intraoperative images, five types of lesion were distinguished according to the extent of nerve root stretching and neural placode exposure, with fetal characteristics and surgical and perinatal outcomes differing significantly according to lesion type. The results suggest that severity of ventriculomegaly is associated with lesion type, rather than tonsillar herniation level. Importantly, these finding have expanded the classification of spina bifida to reveal a distinct phenotypic spectrum that warrants further study.
Recently published online….
- Check out the new Virtual Issue on Congenital Heart Disease, curated by UOG editors in support of the ISUOG Every Little Heart Matters campaign, featuring the latest research and expert guidance on prenatal screening, management, novel diagnostic methods and more.
- Read the new ISUOG Consensus Statement on maternal hemodynamic assessment in hypertensive disorders of pregnancy and fetal growth restriction by Stampalija et al.