The September issue of Ultrasound in Obstetrics & Gynecology includes a systematic review examining the impact of concurrent selective fetal growth restriction on the outcome of pregnancies with twin–twin transfusion syndrome following laser surgery, a study investigating the prevalence, pathophysiology and impact of a midline cystic structure recently reported in some fetuses with open spina bifida, a prospective study aiming to determine the best strategy for prediction of hypertensive disorders at 36 weeks’ gestation, and a large study of 25,329 patients evaluating the effect of reproductive history on the outcome of in-vitro fertilization.
Outcome following laser surgery of twin–twin transfusion syndrome complicated by selective fetal growth restriction: systematic review and meta-analysis
It is estimated that one-third of cases with twin–twin transfusion syndrome (TTTS) are complicated by selective fetal growth restriction (sFGR). In this systematic review and meta-analysis, D’Antonio et al. aimed to ascertain the perinatal outcome of monochorionic diamniotic twin pregnancies complicated by both TTTS and sFGR following laser surgery. The study demonstrates an overall higher risk of fetal loss and neurological morbidity in pregnancies with both TTTS and sFGR compared to those with TTTS alone. Further subgroup analyses reveal that the risk is significantly higher for the donor but not for the recipient twin. Given these findings, sFGR should be considered during individualized risk assessment and tailored counseling of the parents in cases with TTTS. Limited evidence is currently available for the long-term outcome of TTTS pregnancies with sFGR, and further research into the topic is warranted.
Midline suprapineal pseudocyst in brain of fetuses with open spina bifida
Fetal open spina bifida can be associated with various brain abnormalities. Recently, it has been reported that some fetuses with open spina bifida present with an intracranial midline cystic structure on ultrasound. The significance of this structure, including its impact on surgical and long-term outcomes, is currently unknown. In this study, Kunpalin et al. demonstrate that a midline suprapineal pseudocyst is present in almost three-quarters of cases and is associated with the degree of hindbrain herniation but not with the presence of other brain anomalies or adverse outcome. Although the size of the pseudocyst increases with gestation, surgical management related to the pseudocyst is not required in the postnatal period. Parents can be informed that the midline suprapineal pseudocyst is common in fetuses with open spina bifida and does not require treatment. Affected cases with a suprapineal pseudocyst should be eligible to undergo open fetal surgery. Additional research may be required on the long-term neurological outcome related to the presence of this finding.
Prediction of hypertensive disorders after screening at 36 weeks’ gestation: comparison of angiogenic markers with competing-risks model
Pre-eclampsia is one of the leading causes of maternal and perinatal mortality and morbidity, highlighting the importance of predicting and preventing this condition. In this prospective study, Schiattarella et al. focused on determining the best strategy for identifying women at increased risk of pre-eclampsia or gestational hypertension at 35 + 0 to 36 + 6 weeks’ gestation. The study demonstrates that the best prediction of hypertensive disorders is achieved by the competing-risks model triple test, which combines maternal risk factors with mean arterial pressure, serum placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1). The performance of the triple test is superior to that of PlGF alone or the sFlt-1/PlGF ratio for the development of disease within 1 week, within 2 weeks and at any time from screening. Given these findings, clinicians should take into account information that is already available, namely maternal characteristics, medical history and blood pressure, along with angiogenic markers, to improve screening for hypertensive disorders.
Reproductive history does not compromise subsequent live birth and perinatal outcome following in-vitro fertilization: analysis of 25,329 first frozen–thawed embryo transfer cycles without preimplantation genetic testing for aneuploidy
The rate of live birth following in-vitro fertilization (IVF) treatment for infertility has been reported to be relatively low. Hence, knowledge of the factors that influence the chances of successful outcome following IVF and tailored counseling are of paramount importance. The present study by Chen et al. including 25,329 women evaluates the effect of reproductive history on the pregnancy outcome following first frozen–thawed embryo transfer cycle without preimplantation genetic testing for aneuploidy. The study demonstrates that history of termination of pregnancy, pregnancy loss or ectopic pregnancy does not compromise the rate of live birth or perinatal outcome following IVF, with the exception of an increased risk of ectopic pregnancy in those with prior termination of pregnancy or ectopic pregnancy. Overall, these findings suggest that women can be reassured during counseling that their reproductive history, even if they have experienced prior adverse pregnancy events, does not influence future IVF outcome.
Coming up next month…
- A systematic review aiming to identify predictive factors for obstetric anal sphincter injury following a first vaginal delivery. Preview the Accepted Article.
- A study evaluating the efficacy and safety of in-utero treatment of sustained fetal supraventricular arrhythmia in late preterm and term fetuses. Preview the Accepted Article.
- A study reporting on a series of twin pregnancies undergoing prenatal repair for open spina bifida. Preview the Accepted Article.
- Two studies reporting on the utility of maternal serum glycosylated fibronectin in first-trimester prediction of pre-eclampsia. Preview the article by Moungmaithong et al. and Sokratous et al..