The December issue of Ultrasound in Obstetrics & Gynecology includes a systematic review on the management and outcome of fetal abdominal cyst in the first trimester, a Danish cohort study on the validation of Fetal Medicine Foundation charts for fetal growth in twin pregnancies, a study comparing biparietal diameter vs crown–rump length for late first-trimester pregnancy dating and a pilot study evaluating the use of the two-step International Ovarian Tumor Analysis group strategy for classifying adnexal masses identified in pregnancy.
Please see below a selection of articles from the December issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today or login and upgrade.
Management and outcome of fetal abdominal cyst in first trimester: systematic review of the literature
Fetal intra-abdominal cysts are rarely identified in the first trimester and, as such, their natural history and prognosis are often unknown and unpredictable. Passananti et al. identified a case of a first-trimester fetal abdominal cyst and performed a systematic review with the aim to better define the prognosis and improve the management of such cysts. From a total of 60 cases only 37% of all cases and 54% of cases of isolated cyst had a live birth with a normal outcome and were not associated with additional anomalies. These findings underscore the importance of further ultrasound surveillance and genetic testing upon identification of a fetal abdominal cyst in the first trimester, as it is likely that cysts which appear to be isolated may be early markers of associated abnormalities.
Validation of Fetal Medicine Foundation charts for fetal growth in twins: nationwide Danish cohort study
The Fetal Medicine Foundation (FMF) has recently introduced a reference for fetal growth in twins on a singleton percentile scale, enabling assessment of twins against both singleton and twin references to offer a more accurate assessment of growth in these pregnancies. This external validation study by Kristensen et al., including 8542 dichorionic (DC) and 1675 monochorionic diamniotic (MCDA) twin pregnancies, reported that, by juxtaposing singleton and chorionicity-specific twin growth distributions, the FMF models for both DC twins and for MCDA twins exhibited good alignment with the validation cohort. This evidence supports the use of the FMF models as a standardized approach for evaluating fetal growth in twin pregnancies, and future research should aim to further improve the accuracy, validity and clinical utility of these models.
Biparietal diameter vs crown–rump length as standard parameter for late first-trimester pregnancy dating
Advances in ultrasound technology have enabled pregnancy dating earlier in pregnancy, with the use of crown–rump length (CRL) measurement for dating proving to be precise prior to week 10. This study by Gjessing et al. evaluates the use of biparietal diameter (BPD) measurement as an alternative to CRL for pregnancy dating in the late first trimester. Results revealed almost identical precision of CRL and BPD for term prediction, with a difference in predicted gestational age of 1 day or less in 50.8% of ultrasound examinations. Given these findings, the authors suggest the replacement of CRL measurement with BPD measurement for late first-trimester dating, as it is less complicated to perform and less time-consuming to measure.
Evaluating use of two-step International Ovarian Tumor Analysis strategy to classify adnexal masses identified in pregnancy: pilot study
Safe expectant management of adnexal masses in pregnancy relies on accurate ultrasound classification, which is supported by the International Ovarian Tumor Analysis (IOTA) group single benign descriptors (BDs) model. In this pilot study, Barcroft et al. aimed to validate the IOTA two-step strategy for classifying adnexal masses during pregnancy, which employs the Assessment of Different NEoplasias in the adneXa (ADNEX) model if BDs cannot be applied. The two-step strategy had a specificity of 90.2% and a sensitivity of 63.6% for classification of masses, however, the BDs were applicable in 68.9% of adnexal masses and correctly classified 99.5% of masses while the ADNEX model correctly classified only 66.3%. Although the BDs perform well and should be the first-line approach for classification of adnexal masses during pregnancy, evaluation of the ADNEX model was limited by the low malignancy rate and a larger multicenter study is required to evaluate its use.