The September issue of Ultrasound in Obstetrics & Gynecology includes a systematic review and meta-analysis presenting unexpected findings regarding the relationship between severe smallness and perinatal outcome, a State-of-the-Art Review that collates the most up-to-date evidence on diagnostic tools for endometriosis, and a multicenter, prospective study demonstrating the value of third-trimester ultrasound for diagnosing clinically significant placenta accreta spectrum disorders. Additionally, the new issue features two novel studies on North American populations and an accompanying Editorial shedding light on the sociodemographic barriers to prenatal detection of congenital heart disease and their impact on women’s reproductive choices and perinatal outcome.
Severe smallness as predictor of adverse perinatal outcome in suspected late small-for-gestational-age fetuses: systematic review and meta-analysis
Multiple studies have suggested that severe small-for-gestational age (SGA), usually defined as estimated fetal weight or abdominal circumference below the 3rd percentile, is associated with an increased risk of adverse perinatal outcome and long-term neurological problems in the affected child. In a systematic review and meta-analysis of 12 studies, Meler et al. find a similar association but demonstrate that severe SGA performs poorly as a standalone predictor of adverse perinatal outcome. According to the authors, future research should investigate whether the combination of severe SGA and abnormal Doppler parameters can improve the prediction of abnormal perinatal outcome.
Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research
Endometriosis is a serious condition, associated with pain, infertility and reduced quality of life, which remains challenging to diagnose. In their State-of-the-Art Review, Pascoal et al. report the results of a comprehensive literature review on the strengths and limitations of the diagnostic modalities currently used for endometriosis. Their review suggests that, although non-invasive diagnostic methods, such as clinical assessment, ultrasound and magnetic resonance imaging, do not yet qualify formally as replacement tests for surgery and histology in diagnosing all subtypes of endometriosis, they are likely to be appropriate for advanced endometriosis. The authors conclude that each diagnostic method has its strengths and limitations, and recommend using a multimodal approach to diagnosing endometriosis instead of relying on a single diagnostic method.
Third-trimester ultrasound for antenatal diagnosis of placenta accreta spectrum in women with placenta previa: results from the ADoPAD study
The multicenter prospective study by Fratelli et al. investigates the value of ultrasound in the diagnosis of placenta accreta spectrum disorders (PAS) in a high-risk population with low-lying placenta or placenta previa. The study demonstrates good performance of grayscale ultrasound in ruling out the diagnosis of clinically significant PAS, with the probability of the disorder decreasing from 21% to 11%, 9% and 5%, respectively, when the uterine serosa–bladder wall interface is normal, when placental lacunae are absent and when the hypoechogenic retroplacental space is non-interrupted. In high-risk patients, third-trimester ultrasound can be safely used to guide decision-making and resource allocation to patients with higher risk of clinically significant PAS.
Impact of maternal social vulnerability and timing of prenatal care on outcome of prenatally detected congenital heart disease
Early prenatal detection of congenital heart disease (CHD) is associated with reduced morbidity and mortality and facilitates patient counseling and pregnancy planning. The study by Perez et al. of 441 patients recruited from five hospitals in Boston, MA, explores the relationship between maternal and fetal characteristics, timing of prenatal diagnosis of CHD and perinatal outcome. The study demonstrates that women with high social vulnerability are more likely to have a delayed prenatal diagnosis of CHD (after 24 weeks’ gestation), which in turn is associated with lower rates of pregnancy termination and higher rates of postnatal death. The authors suggest that prompt fetal echocardiography following abnormal obstetric screening, particularly in women with high social vulnerability and other at-risk populations, may have a positive impact on pregnancy and postnatal outcome.
Impact of rural residence and low socioeconomic status on rate and timing of prenatal detection of major congenital heart disease in a jurisdiction of universal health coverage
The study by Kaur et al., conducted in the Canadian province of Alberta, echoes the findings of Perez et al. This large population-based study of 1405 cases demonstrates that low socioeconomic status in metropolitan areas and residence in rural areas are associated with lower rates of fetal detection of congenital heart disease and higher rates of delayed diagnosis (after 22 weeks’ gestation). These findings suggest that the negative impact of socioeconomic and regional inequalities on prenatal care persists even in the setting of universal healthcare coverage. Future research focusing on strategies to reduce these gaps in obstetric care is warranted.
Coming up next month…
- A systematic review and meta-analysis evaluating the performance of the sliding sign on transvaginal ultrasound in detecting pouch of Douglas obliteration and bowel involvement in patients with suspected endometriosis. Preview the Accepted Article.
- Studies examining the state of the blood–brain barrier (Accepted Article) and functional organization of the brain (Accepted Article) in formerly pre-eclamptic women.
- A study investigating the potential of a deep-learning tool for automatic assessment of the urogenital hiatus. Preview the Accepted Article.