The September issue of Ultrasound in Obstetrics & Gynecology contains a Systematic Review on placental histopathology associated with pre-eclampsia and an accompanying Opinion commentary on the article, an updated Systematic Review and Meta-Analysis on maternal serum cell-free DNA screening for aneuploidy and an Original Article on the QUiPP app, showing it to be a safe alternative to a treat-all strategy for threatened preterm labor.
Placental histopathology associated with pre-eclampsia
In normal pregnancy, the maternal uterine spiral arteries undergo remodeling by invading trophoblast and perfusion of the intervillous placental space increases. Pre-eclampsia (PE) is associated with abnormal trophoblast invasion and failure of these physiological modifications, resulting in hypoxia and/or stress and the typical vascular and villous placental lesions associated with PE. There is a lack of agreement on the prevalence, nature and severity of these lesions in PE. In a new systematic review and meta-analysis of eight studies, Falco et al. quantify the prevalence of placental histopathological lesions in pregnancies complicated by PE. Accompanying this article is an Opinion piece by N. Sebire, who provides insightful commentary on the problems in the reporting of these lesions.
Analysis of cell-free DNA in maternal blood in screening for aneuploidy
Gil et al. have updated their previous systematic review and meta-analysis which reported the clinical validation and/or implementation of analyzing cell-free DNA in maternal blood in screening for trisomies 21, 18 and 13 and sex chromosome aneuploidies (SCA), to include studies published up to 31 December 2016. For this update, they extended their review to case–control studies and identified 35 relevant publications. Pooled detection rates of trisomy 21, 18, 13, monosomy X and other SCAs by cell-free DNA screening were 99.7%, 97.9%, 99.0%, 95.8% and 100%, respectively.
The QUiPP app: a safe alternative to a treat-all strategy for threatened preterm labor
There are various prediction methods for directing management of women with threatened preterm labor (PTL). Recent UK guidance has proposed a treat-all policy for those presenting before 30 weeks’ gestation, supporting the use of cervical length or fetal fibronectin (fFN) only after 30 weeks, however, the harm of a false-negative result or the harm of overtreating symptomatic women was not evaluated. In a new study, Watson et al. assess the impact of triaging women at risk of spontaneous preterm birth (sPTB) using the QUiPP app, a freely downloadable mobile application, which incorporates a predictive model combining history of sPTB, gestational age and qunatitiative fFN, comparing this against the treat-all policy. They found that all women presenting with threatened PTL would have been appropriately managed if their risk has been assessed using the app.
Coming up in the next issue of UOG…
- A systematic review by Grob et al. on the quality of reporting of diagnostic accuracy studies on pelvic floor transperineal three-dimensional ultrasound. Preview the accepted article here.
- A systematic review of first-trimester ultrasound screening in detecting fetal structural anomalies and the factors that affect screening performance. Preview the accepted article here.
- A Picture of the Month article by Ludwin et al. that describes a novel method for imaging the cervix in women with an intact hymen or uterovaginocervical complex malformation, providing point-by-point steps for volumetric sonovaginocervicography with tomographic ultrasound imaging and virtual speculoscopy with HDlive. Preview the accepted article here.