The August issue of Ultrasound in Obstetrics & Gynecology includes a systematic review on the role of ultrasound in the detection of lymph-node metastasis in gynecological cancer, a study on the influence of ethnicity and socioeconomic deprivation on adverse pregnancy outcomes, a prospective analysis of the screening performance of increased nuchal translucency before 11 weeks’ gestation for adverse pregnancy outcome and a study investigating the need for individualization of levator–urethra gap measurement for diagnosis of levator avulsion.
Please see below a selection of articles from the August issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today or login and upgrade.
Role of ultrasound in detection of lymph-node metastasis in gynecological cancer: systematic review and meta-analysis
During diagnosis of gynecological cancer, it is strongly advised that tumor spread is evaluated on imaging prior to therapy, with the extent of disease generally assessed using computed tomography (CT), magnetic resonance imaging (MRI) or whole-body positron emission tomography CT. With growing interest in ultrasound as a method for gynecological cancer staging, this systematic review and meta-analysis by Borges et al. aimed to assess the diagnostic performance of transvaginal sonography for the preoperative evaluation of lymph-node metastasis in cervical, endometrial and ovarian cancer. Transvaginal ultrasound showed high pooled specificity (98% (95% CI, 93–99%)) for the detection of pelvic lymph-node metastasis, but low pooled sensitivity (41% (95% CI, 26–58%)). Therefore, ultrasound imaging has moderate diagnostic performance for the detection of pelvic lymph-node metastasis and could be considered as an alternative imaging technique to CT and MRI to assess gynecological cancer spread.
Maternal ethnicity and socioeconomic deprivation: influence on adverse pregnancy outcomes
Pregnancy complications such as pre-eclampsia and perinatal mortality are more prevalent in women of black and South Asian ethnicity compared with white women, and socioeconomic deprivation is also known to be a key driver for general and pregnancy-specific adverse outcomes. In this study, Minopoli et al. evaluate the relative importance of ethnicity and socioeconomic deprivation in determining the likelihood and prevalence of placentally derived composite of adverse pregnancy outcomes (CAPO). Using data from 13,165 singleton pregnancies, the prevalence of CAPO was higher in black (29.3%) and South Asian (29.3%) women compared to white women (16.3%), although the burden of disease was concentrated in white women (51.7%), who represented the majority of the population. There was also a strong interaction between ethnicity and socioeconomic deprivation, both of which influenced the prevalence of CAPO. These results imply that pregnancy risk assessment algorithms should consider both ethnicity and deprivation when predicting placenta-mediated complications.
Adverse pregnancy outcome in fetuses with early increased nuchal translucency: prospective cohort study
Increased nuchal translucency (NT) thickness is a well-established marker for congenital anomalies and adverse pregnancy outcome between 11 and 14 weeks’ gestation. In this prospective study, Bet et al. investigate the screening performance of increased NT thickness before 11 weeks’ gestation for adverse pregnancy outcome. Of those fetuses with an increased NT thickness before 11 weeks, 35.8% had an adverse pregnancy outcome. Furthermore, those with persistently increased NT at follow-up had a higher risk of adverse outcome compared to fetuses with a normalized NT (65.2% vs 14.3%). Overall, fetuses with an early increased NT thickness are at greater risk of an adverse pregnancy outcome, even if the NT normalizes after 11 weeks. Consequently, the authors advise that expectant parents of fetuses with a NT ≥ 2.5 mm and crown–rump length < 45 mm should be referred to a fetal medicine unit for detailed ultrasonography and counseling.
Levator–urethra gap: is there a need for individualization of cut-offs?
Levator ani muscle avulsion is a serious complication of vaginal birth and is commonly diagnosed by tomographic ultrasound imaging, which is internationally standardized, and in ambiguous cases can be supplemented by determination of the levator–urethra gap (LUG). In this study, Dietz et al. investigate whether LUG measurement is dependent on individual biometric measurements, such as weight, height and body mass index (BMI), and test whether these factors confound the relationship between LUG and symptoms and signs of pelvic organ prolapse. The mean LUG measurement was associated with symptoms and signs of prolapse, both on clinical examination and imaging, but not with height, weight or BMI. These findings suggest that LUG measurement does not need to be individualized for the diagnosis of levator ani muscle avulsion.
Coming up next month…
• A systematic review and meta-analysis investigating whether maternal prepregnancy weight is an independent risk factor for congenital heart defects. Preview the Accepted Article.
• A study evaluating the ability of ADNEX and the IOTA two-step strategy to predict malignancy in adnexal masses detected in an outpatient low-risk population. Preview the Accepted Article.
• A prospective study assessing long-term cardiovascular function in women who had a pregnancy complicated by a hypertensive disorder. Preview the Accepted Article.
• A study focusing on the postnatal outcome of fetal aortic valvuloplasty for critical aortic stenosis. Preview the Accepted Article.