The September issue of Ultrasound in Obstetrics & Gynecology includes a study on the impact of crown–rump measurement error on assessment of fetal growth, a study on the safety and efficacy of the Pfizer/BioNTech COVID-19 vaccine in pregnant women, a study presenting reference ranges and calculators for fetal cardiac relative size and geometry parameters, and a study assessing the combination of the Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE) with sonographic and demographic characteristics in the preoperative prediction of recurrence or progression of endometrial cancer.
Crown–rump length measurement error: impact on assessment of growth
Knowledge of gestational age is of major importance in many, if not all, aspects of obstetric care. Gadsbøll et al. examined the impact of first-trimester crown–rump length (CRL) measurement error on the interpretation of estimated fetal weight (EFW). It was found that even small errors in the first-trimester measurement of CRL significantly affect second- and third-trimester EFW. For example, a measurement error of −2mm in first-trimester CRL shifts an EFW on the 10th percentile at the 20-week scan to around the 20th percentile. As published data suggest that CRL measurement errors of 2mm or more are common in clinical practice, misclassification as small-, appropriate- or large-for-gestational age will commonly occur and affect clinical assessment, patient management and research results. There is therefore a need to increase awareness of the impact of CRL measurement error and to reduce measurement error variation through standardization and quality control.
Also on the topic of CRL measurement is an Editorial by Stirnemann et al., in which the authors emphasize the importance of the dating formula used, in addition to careful measurement of CRL.
Short-term outcome of pregnant women vaccinated with BNT162b2 mRNA COVID-19 vaccine
Crucial data for decision-making and counseling regarding COVID-19 vaccination in pregnancy are still limited. Bookstein Peretz et al. assessed the immunogenicity and reactogenicity of the Pfizer/BioNTech BNT162b2 mRNA COVID-19 vaccine among pregnant women compared with non-pregnant women, and evaluated obstetric outcome following vaccination. The adverse-effect profile and short-term obstetric and neonatal outcomes among pregnant women who were vaccinated with the BNT162b2 vaccine at any stage of pregnancy do not indicate any safety concerns. The vaccine is effective in generating a humoral immune response in pregnant women, although SARS-CoV-2 IgG levels were lower than those observed in non-pregnant vaccinated women. Recommending COVID-19 vaccination of pregnant women should therefore be strongly considered in view of the maternal morbidity associated with COVID-19 in pregnancy.
Reference ranges for fetal cardiac, ventricular and atrial relative size, sphericity, ventricular dominance, wall asymmetry and relative wall thickness from 18 to 41 gestational weeks
Assessment of fetal atrial size and geometry is essential to assess the patterns of cardiac remodeling and help understand and monitor fetal cardiac adaptations to an adverse environment. Garciá-Otero et al. constructed nomograms for fetal cardiac, ventricular and atrial relative size and geometry parameters from 18 to 41 weeks’ gestation using a low-risk population of singleton pregnancies. The assessment of cardiac, ventricular and atrial relative size and geometry was found to be feasible and reproducible in the fetus. The provided standardized reference ranges for these parameters enable the accurate assessment of cardiac remodeling patterns during fetal life. Z-score and centile calculators for fetal cardiac relative size and geometry parameters are available in the supporting information of this article (download the calculators according to gestational age and estimated fetal weight).
Combination of Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE) with sonographic and demographic characteristics in preoperative prediction of recurrence or progression of endometrial cancer
The Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE) has been developed and validated as a clinically applicable molecular classification system for endometrial cancer, rendering four prognostic subgroups. Eriksson et al. evaluated the ability of demographic (age, waist circumference) and sonographic (tumor size and extension) variables and the ProMisE classification to predict preoperatively tumor recurrence or progression in women with endometrial cancer. The combination of demographic characteristics, sonographic findings and ProMisE subtype had better preoperative predictive ability than did the ESMO classification based on ultrasound findings and tumor histotype and grade, supporting their use in the preoperative risk stratification of women with endometrial cancer. The combination of p53 status with ultrasound tumor size was found to have the potential to identify preoperatively a large group of women with a very low risk of recurrence or progression.
Coming up next month…
- A meta-analysis of the incremental yield of exome sequencing over CMA/karyotyping in non-immune hydrops fetalis. Preview the Accepted Article.
- A study on the effect of percutaneous fetoscopic open spina bifida repair on postnatal ambulation and need for cerebrospinal fluid diversion and bladder catheterization. Preview the Accepted Article.
- 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 series of papers on first-trimester screening for pre-eclampsia.