The November 2016 issue of Ultrasound in Obstetrics & Gynecology is a special issue on Pregnancy Loss containing six Original Articles on stillbirth from Great Ormond Street Hospital, with an accompanying press release and Opinion article, five from King’s College Hospital and a number of articles on miscarriage, pregnancy of unknown location and ectopic pregnancy.
Stillbirth and intrauterine fetal death
The primary aim of postmortem investigation of intrauterine death is to determine the cause of death to facilitate counseling of parents, management of subsequent pregnancies and future interventions. There have been many attempts to classify cause of death in stillbirths, however a significant proportion remain unexplained, despite postmortem examinations. In a series of six papers from Great Ormond Street Hospital, analyzing over 1000 intrauterine deaths, a detailed analysis of which aspects of the examinations provide the most information about cause of death was carried out. It was found that clinical review identified the cause of death in about 20% of cases, with placental examination providing a cause in another 20%, whilst carrying out invasive postmortem examination identified the cause of death in only a small percentage of cases. In addition, the authors found that weight loss occurs after intrauterine death and the stillbirth may have actually occurred when the baby was normal in size and thus the importance of an apparently small fetus as a risk factor for stillbirth may have been overestimated. This finding questions the fundamental rationale and potential effectiveness of current health policy that is focused on the detection and elective birth of small fetuses to reduce the risk of stillbirth.
Three of these articles are available only to subscribers of UOG; remember to login to the ISUOG website to read all six papers or become an ISUOG member to subscribe to UOG.
Read the accompanying Opinion article by Michael McDermot and press release on the series of stillbirth papers. Two of these articles were chosen for Journal Club; view the accompanying Journal Club slides.
Prediction of stillbirth
In a series of papers from King’s College Hospital, maternal and pregnancy characteristics and biophysical and biochemical markers at different stages in pregnancy were assessed for their ability to predict stillbirth. The authors found that a high proportion of stillbirths can be identified effectively in the second trimester of pregnancy using a combination of factors. Incorporation of placental growth factor, measured in either the first or second trimesters, into the algorithm used for predicting stillbirth improved performance.
These articles are available only to subscribers of UOG; remember to login to the ISUOG website to read all five papers or become an ISUOG member to subscribe to UOG.
High miscarriage rate in women treated with Essure® for hydrosalpinx before embryo transfer
Hydrosalpinx is a distally blocked Fallopian tube filled with serous or clear fluid. The condition is found in 10–30% of women with infertility due to tubal factors and is also associated with a large reduction in pregnancy rates following in-vitro fertilization and an increased risk of miscarriage. Essure® has been tested as an alternative treatment for hydrosalpinx before embryo transfer in women undergoing assisted reproduction techniques. However, persistence of a foreign body inside the uterine cavity might have a negative impact on the outcome of pregnancy. In a systematic review and meta-analysis, Barbosa et al. summarize the available evidence regarding the effectiveness and safety of using Essure prior to embryo transfer, with regards to clinical pregnancy, miscarriage and live birth rates, comparing it with other interventions or no intervention.
Virtual pathological examination of the human fetal kidney using micro-CT
Antenatal ultrasound examinations and postmortem magnetic resonance imaging can identify accurately many fetal renal tract anomalies, however invasive perinatal autopsy for histological examination remains important to determine a specific diagnosis. Microcomputed tomography (micro-CT) is a new imaging modality for small samples, including ex-vivo organs and whole fetuses. It may be particularly useful for postmortem imaging of early fetuses, providing three-dimensional image volumes with equivalent resolution to low-power histology. In a Letter to the Editor, Hutchinson et al. describe their experience with micro-CT for ex-vivo imaging of a normal fetal kidney, a polycystic fetal kidney and a multicystic dysplastic kidney with comparative histology.