The April issue of Ultrasound in Obstetrics & Gynecology includes a study evaluating the diagnosis of fetal abnormalities at a routine 36-week scan, a study reporting on the COVID-19-related outbreak of maternal parvovirus B19 infection in Germany, a proof-of-concept study demonstrating the potential of cytomegalovirus cell-free DNA testing as a first-trimester screening test, and a Consensus Statement on ultrasound-guided biopsy in gynecological oncology.
Please see below a selection of articles from the April issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today or login and upgrade.
Routine 36-week scan: diagnosis of fetal abnormalities
Fetal abnormalities are routinely diagnosed at two ultrasound scans: the first at around 12 weeks' gestation and the second at around 20 weeks' gestation. In line with increasing evidence that a routine scan should also be performed at 36 weeks, Syngelaki et al. investigated further the incidence and types of fetal abnormalities identified by a routine 36-week ultrasound examination in a large population of 104 151 pregnant women. Of all fetuses/neonates with detected abnormality, 803 (31.5%) were diagnosed for the first time at the 36-week scan; the incidence of fetal abnormality detected for the first time at the 36-week scan was 0.77% (803/104 151), indicating that one new abnormality was detected for every 130 routine scans performed. Such a finding provides further support for a routine 36-week anomaly scan, in addition to those performed at 12 weeks and 20 weeks' gestation.
Ongoing outbreak of maternal parvovirus B19 infections in Germany since end of 2023: consequence of COVID-19 pandemic?
Parvovirus B19 (B19V) infection poses a substantial threat to fetal health if transmitted to a susceptible pregnant woman, potentially causing fetal anemia, hydrops fetalis and intrauterine fetal death. An increase in B19V cases has been identified since 2023, after 3 years of a noticeable reduction that coincided with the COVID-19 pandemic period. Jiménez Cruz et al. report that, in Germany, the mean ± SD number of B19V cases significantly increased after COVID-19, from 57.3 ± 20.7 pre COVID-19 and 20.3 ± 13.5 during COVID-19, to 384.8 ± 299.8 post COVID-19. Correspondingly, the number of cases in which the fetus underwent intrauterine transfusion for fetal anemia increased post COVID-19. The relevant decrease in infections during COVID-19 shows that the introduced public health policies reduced the B19V infection rate, but likely conditioned the present upsurge. Long-term data regarding the neurodevelopmental integrity of exposed infants are inconsistent and the authors call for systematic follow-up to explore this outcome.
Detection of human cytomegalovirus cell-free DNA in pregnant women with symptomatically infected fetuses: proof-of-concept study
Non-invasive prenatal testing (NIPT) is routinely used in many countries for screening of fetal aneuploidies from 10 weeks' gestation onwards. Cell-free DNA (cfDNA) sequencing data is generated as part of this process, from which research shows that cytomegalovirus (CMV)-cfDNA fragments can be detected. To gain more insight on the relevance of these fragments, Faas et al. evaluated the presence and levels of CMV cell-free DNA (cfDNA) in pregnant women with symptomatic congenital CMV-infected fetuses and found that CMV-cfDNA was detectable in all cases, with mostly low levels detected at 11-13 weeks’ gestation. These results demonstrate the potential for CMV-cfDNA testing as a first-trimester screening test. However, as CMV-cfDNA is detectable in many pregnant women in the first trimester, further studies are needed to determine the predictive value of CMV-cfDNA as a biomarker for the development of severe fetal congenital CMV.
ISUOG/ESGO Consensus Statement on ultrasound-guided biopsy in gynecological oncology
The lack of information on best practice in ultrasound-guided biopsy in gynecology and the growing need for this service in every gynecological oncology center led to the initiation of the process that produced this Consensus Statement, developed by 16 experts nominated by ISUOG/ESGO. Fischerova et al. evaluated the available literature and evidence to report on the currently accepted approaches for ultrasound-guided biopsy. The document discusses 48 statements regarding: general recommendations; image-guided biopsy (imaging guidance, sampling methods); indications and contraindications; technique; reporting; and training and quality assurance, for ultrasound-guided biopsy. Consensus was reached that core-needle biopsy is preferable over fine-needle aspiration, and the Consensus Statement aims to facilitate the implementation of this technique in gynecological oncology practice and improve patient outcome and care.