The September issue of Ultrasound in Obstetrics & Gynecology contains the latest research on fetal macrosomia, including articles on the associated maternal and neonatal complications and its prediction by third-trimester ultrasound. Articles on other topics include a study on cardiac maladaptation in obese pregnant women at term and a study on hemoperitoneum as a precursor of deep pelvic endometriosis. Also out this month are a new Virtual Issue on non-invasive prenatal testing and a study on the impact of the HYPITAT-I trial on obstetric management and outcome in pregnancies complicated by gestational hypertension or mild pre-eclampsia in The Netherlands, which has an accompanying press release.
While there is a general awareness of the association of maternal and neonatal complications with fetal macrosomia, there is no clear guidance on accurate evidence-based estimates of these risks. In a large cohort study, Beta et al. assessed the risks of maternal and neonatal complications in pregnancies with fetal macrosomia (view the accompanying Journal Club slides). This study, along with 16 others, were included in a subsequent systematic review by the same group in order to determine accurate estimates of these risks to aid in pregnancy management. It was found that macrosomia is associated with serious maternal and neonatal complications, with the risk being greater for the neonate than the mother and in pregnancies with birth weight >4500g than in those with birth weight >4000g.
While there is a well-established association between small-for-gestational-age pregnancies and stillbirth, the risk of stillbirth in pregnancies with a large-for-gestational-age (LGA) fetus remains unclear. Carter et al. assessed this association to determine if the LGA fetus may benefit from antenatal testing with non-stress test or biophysical profile, finding that pregnancies complicated by LGA are at significantly increased risk for stillbirth at or beyond 36 weeks, independent of maternal diabetes status, and may benefit from antenatal testing.
The risk of complications associated with LGA pregnancy could potentially be reduced by elective Cesarean section or early induction of labor. However, there is uncertainty as to the best approach for identifying such LGA fetuses. Khan et al. investigated the optimal timing and method of examination for third-trimester screening for LGA, as well as the additive value of fetal growth velocity and the predictive performance of different estimated fetal weight cut-offs. The predictive performance was found to be higher if the scan is carried out at 36 than at 32 weeks, the method of screening is estimated fetal weight than abdominal circumference, the outcome measure is birth weight >97th percentile than >90th percentile and if delivery occurs within 10 days than at any stage after assessment. Based on their findings, the authors present a two-stage strategy for maximizing the prediction of a LGA neonate.
Articles on other topics
Cardiac maladaptation in obese pregnant women at term
While obesity has well-recognized detrimental effects on cardiovascular health and is associated with a number of adverse pregnancy outcomes, little is known about its effect on cardiovascular adaptation to pregnancy. Buddeberg et al. compared biventricular cardiac function at term between obese pregnant women and pregnant women with normal body weight, utilizing conventional echocardiography and speckle-tracking assessment. It was found that morbidly obese, but otherwise apparently healthy, pregnant women had significant left ventricular hypertrophy with evidence of diastolic dysfunction and impaired deformation indices, which are likely to represent a maladaptive response of the heart to volume overload in obese pregnancy and may explain the increased prevalence of adverse pregnancy outcomes related to uteroplacental dysfunction observed in obese pregnant women.
Hemoperitoneum as a precursor of deep pelvic endometriosis: prospective cohort study
The cause of deep endometriosis is unknown and there are currently no effective strategies to prevent its development. Based on their observation that several women who were referred to their department with symptoms of chronic pelvic pain following conservative management of hemoperitoneum were found to have developed deep endometriosis at follow-up, Bean et al. investigated whether the presence of significant hemoperitoneum may be a precursor of the condition in non-pregnant women presenting with acute lower abdominal pain. It was found that, in the presence of functional hemorrhagic ovarian cysts, significant hemoperitoneum may precipitate the development of deep endometriosis. These findings could facilitate detection of women who are at risk of developing deep endometriosis, which opens the possibility for further research into its pathophysiology and targeted preventative strategies.
Also out this month…
- A free Virtual Issue on non-invasive prenatal testing, containing a selection of relevant articles from The White Journal.
- A study which found that, following the HYPITAT-I trial, there was a higher rate of induction of labor and improved obstetric outcome in term pregnancies complicated by gestational hypertension or mild pre-eclampsia in The Netherlands, which has an accompanying press release.
Coming up in the next issue…
- Latest research on the procedure-related risk of miscarriage following amniocentesis and chorionic villus sampling, including a cohort study, systematic review and an Opinion article which urges caution and offers advice when meta-analyzing the evidence on this topic.
- A study on the detection of fetal abnormalities in the first trimester using a standardized protocol in 100,000 pregnancies.