The September issue of Ultrasound in Obstetrics & Gynecology includes a systematic review evaluating the impact of endometrial thickness on the reproductive outcomes of embryo transfer treatments, a cost-utility analysis modeling the clinical and economic impact of cervical-length screening strategies among twin pregnancies, a study on the association between adverse perinatal outcome and the recent parvovirus B19 infection upsurge, a study comparing the diagnostic accuracy of sonography-based risk models in assessing pediatric adnexal lesions, and a ‘How To’ article on the 20 + 2-planes method.
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.
Impact of endometrial thickness on reproductive outcome in fresh and frozen–thawed embryo transfer: systematic review and meta-analysis
Ultrasonographic measurement of endometrial thickness during the advanced proliferative phase of the ovarian cycle is a known prognostic factor for endometrial receptivity to embryo implantation, however, no definitive threshold for endometrial thickness associated with critical rates of embryo implantation, clinical pregnancy and other pregnancy outcomes has been identified. In this systematic review of 67 studies, Pérez-Milán et al. evaluated the impact of endometrial thickness on the reproductive outcomes of fresh and frozen–thawed embryo transfer (ET) cycles. In fresh ET cycles, endometrial thickness was correlated positively with the rates of live birth, clinical pregnancy and embryo implantation, and inversely with miscarriage rate, while there was no correlation with the rate of ectopic pregnancy. Similar findings were reported for frozen–thawed ET cycles. The results show that endometrial thickness demonstrates a gradient of effectiveness as a prognostic indicator, rather than offering a critical threshold below which ET should be avoided. Given the low certainty of evidence supporting these findings, the authors call for well-designed and adequately powered randomized controlled trials to further investigate this association.
Universal cervical-length screening to prevent preterm birth in twin pregnancy: cost-utility analysis
Preterm birth (PTB) is the leading cause of neonatal morbidity and mortality among twins. Although cervical length (CL) screening can identify patients at increased risk of PTB, universal screening protocols present a burden to the healthcare system, but there have been no decision-analytic evaluations of universal CL screening for twin pregnancies to determine the optimal approach. Khaikin et al. conducted this cost-utility analysis to model the clinical and economic impact of three cervical-length screening strategies among low-risk twin pregnancies: two-step universal screening (at 18–20 and 20–22 weeks), one-step universal screening (at 18–20 weeks) and no screening. Compared with no screening, the two-step screening strategy was found to increase the quality-adjusted life years (0.62 (95% credible interval (CrI), −0.16 to 1.41)) and decrease lifetime costs (−$2460 (95% CrI, −$4850 to $251)) by reducing the rate of PTB. Although sensitivity analysis supported these findings, the authors state that more reliable predictions of long-term costs and quality of life require more twin-specific lifetime data.
Is parvovirus B19 infection upsurge in 2023–2024 associated with adverse pregnancy outcome?
Cyclical peaks of parvovirus B19 infection are seen to occur every 3 to 4 years, but an alarming surge in parvovirus B19 cases occurred in 2023–2024 across Europe and the USA. This surge was also accompanied by an increase in severe perinatal outcomes which raises concerns about the possibility of a new, more virulent strain, making it crucial to compare the perinatal outcomes of cases of parvovirus B19 infection in the current surge with those from historical cohorts. Prasad et al. found that the rate of fetal hydrops and perinatal mortality were similar between the pre-2023 cohort and the 2023–2024 cohort, but the proportion of fetuses with persistent fetal anemia requiring a second IUT was significantly higher in the 2023–2024 cohort (46.0% vs 19.4%; P = 0.011), indicating the increased severity of cases. In this cohort, the presence of fetal hydrops at presentation was a significant independent predictor of perinatal mortality, underscoring the importance of early identification and close monitoring to enable timely intervention and reduce adverse perinatal outcomes following maternal parvovirus B19 infection.
Diagnostic accuracy of Ovarian-Adnexal Reporting and Data System, IOTA Simple Rules and Pediatric Risk of Malignancy Index for pediatric adnexal lesions: comparative study
Despite the low risk of malignancy of adnexal lesions in the pediatric population (3–8%), each new adnexal mass must be carefully assessed owing to the high mortality associated with ovarian cancer. Various risk stratification models have been developed to standardize and enhance the accuracy of sonographic evaluation of adnexal masses, including the Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound risk stratification and management tool, the International Ovarian Tumor Analysis (IOTA) Simple Rules (SR) followed by expert assessment for inconclusive cases in a two-step strategy, and the Pediatric Risk of Malignancy Index (PRMI) model. In this study, including 364 patients with a total of 375 adnexal lesions, Wu et al. reported areas under the receiver-operating-characteristics curve for the O-RADS tool, IOTA two-step strategy and the PRMI model as 0.989 (95% CI, 0.980–0.999), 0.992 (95% CI, 0.985–0.998) and 0.806 (95% CI, 0.626–0.985), respectively. These findings suggest that both the O-RADS model and the IOTA-SR followed by expert assessment for inconclusive cases in a two-step strategy offer high diagnostic accuracy and high sensitivity in the pediatric population, with performance comparable to that of the models currently used in adult populations. The authors do not recommend the PRMI scoring system as a standalone diagnostic tool.
How to apply the 20 + 2-planes method for identification of 65 fetal abnormalities during routine second-trimester fetal ultrasound examination
Ultrasound students and newly qualified practitioners find difficulty in understanding, and being able to apply, the correct qualitative and/or quantitative criteria when deciding whether the part of the fetal anatomy being examined is ‘normal’ for the gestational age at which the routine second-trimester anomaly scan is being performed. To address this, Chudleigh and Cohen-Overbeek developed the 20 + 2-planes method as a practically focused, time-efficient approach to the routine second-trimester scan in accordance with ISUOG guidelines. In this overview, they offer practical guidance on how to apply the method for the identification of 65 fetal abnormalities during routine second-trimester ultrasound. By applying the 20 + 2-planes method correctly, the operator is equipped with a logical and comprehensive approach to the routine second-trimester anomaly scan.