The September issue of Ultrasound in Obstetrics & Gynecology includes a systematic review and meta-analysis examining the maternal and perinatal outcomes in cases of hypertensive disorders of pregnancy that received hemodynamics-guided treatment, a retrospective cohort study evaluating the ability of the umbilical artery Doppler-based classification system for selective fetal growth restriction to predict adverse outcomes in affected monochorionic twin pregnancies, a longitudinal cohort study assessing lung growth patterns in cases of left- and right-sided congenital diaphragmatic hernia over a 6-week period following fetoscopic endoluminal tract occlusion and a retrospective cohort study evaluating the coexistence of polycystic ovarian morphology and endometriosis among patients at a tertiary gynecological ultrasound clinic.
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.
Hemodynamics-guided treatment of hypertensive disorders of pregnancy: systematic review and meta-analysis
Current treatment for hypertensive disorders of pregnancy typically involves administration of guideline-recommended antihypertensive drugs solely targeting maternal blood pressure values, chosen according to clinician preference rather than based on hemodynamic data. In this systematic review and meta-analysis, Novelli et al. investigated whether the incidence of adverse pregnancy outcomes in women with hypertensive disorders of pregnancy could be reduced by using the patient’s unique maternal hemodynamic profile to guide treatment instead of standard care. It was reported that hemodynamics-guided therapy significantly reduced the odds of pre-eclampsia/eclampsia, fetal growth restriction and composite adverse outcomes, with no observed heterogeneity between studies for these outcomes, as well as reducing the odds of severe hypertension and preterm birth with moderate and substantial heterogeneity between studies, respectively. However, the overall certainty of evidence according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was low to very low, indicating that these findings should be interpreted as hypothesis-generating.
Prognostic performance of umbilical artery Doppler-based classification in monochorionic pregnancies complicated by selective fetal growth restriction
Since its publication in 2007, the umbilical artery (UA) Doppler-based classification system by Gratacós et al. has been used to stratify risk in cases of selective fetal growth restriction (sFGR) in monochorionic (MC) twin pregnancies. In this retrospective cohort study, Sorrenti et al. assessed the ability of this classification system to predict adverse perinatal outcomes in MC pregnancies with sFGR, both alone and in combination with other risk factors. Receiver-operating-characteristics-curve analysis indicated that the ability of UA Doppler-based classification alone to discriminate between cases with and without composite adverse perinatal outcome in the smaller twin was limited. However, the discriminatory performance improved when combined with other risk factors (early diagnosis of sFGR, fetal weight discordance and estimated fetal weight of one twin < 3rd centile) in a model adjusted for gestational age at delivery, laser photocoagulation and classification stage progression. This indicates that the combination of this classification system with other ultrasound parameters could improve the prediction of adverse outcomes in sFGR pregnancies and therefore improve its value in clinical practice.
Effect of right- vs left-sided congenital diaphragmatic hernia and duration of tracheal occlusion on longitudinal lung-size changes
Evidence indicates that fetoscopic endoluminal tracheal occlusion (FETO) can induce lung growth and improve survival in cases of congenital diaphragmatic hernia (CDH); however, longitudinal data on lung-size changes after FETO, particularly in the less common form of right-sided CDH (RCDH), are limited. Watananirun et al., aimed to address this through a tricentric longitudinal observational cohort study investigating patterns of lung-size changes over a 6-week period following FETO, comparing cases of left-sided CDH (LCDH) and RCDH. Similar patterns of proportional lung size and lung growth rate were observed. The proportional growth rate over the entire observation period was comparable between RCDH and LCDH cases but RCDH cases showed a slower initial growth rate and a greater overall increase in lung size compared with baseline measurements. The continued increase in lung size observed after FETO supports previous observations that the duration of occlusion may influence the treatment response in cases of CDH.
Challenging prior assumptions: coexistence of polycystic ovarian morphology and endometriosis on transvaginal ultrasound
Recent conceptual frameworks have proposed that endometriosis and polycystic ovary syndrome (now known as polyendocrine metabolic ovarian syndrome (PMOS)) may represent biologically divergent reproductive phenotypes: higher fetal androgen exposure may contribute to development of PMOS and lower fetal androgen exposure may contribute to the development of endometriosis. Romeo et al. investigated this framework by examining the overlap between polycystic ovarian morphology (PCOM) and endometriosis among patients undergoing advanced transvaginal ultrasound examination for suspected or previously diagnosed endometriosis. It was reported that the frequency of any endometriosis did not differ significantly between patients with and without PCOM. However, additional analyses indicated that age, rather than a distinct clinical profile, was the principal factor associated with concurrent PCOM. These findings indicate that endometriosis and PCOM can coexist on ultrasound in a tertiary referral cohort and between-group differences are influenced by age.