The November issue of Ultrasound in Obstetrics & Gynecology includes a systematic review on the postnatal outcome of fetal cortical malformations, an intermanufacturer assessment on the predictive performance of angiogenic ratio vs glycosylated fibronectin for pre-eclampsia, a Delphi consensus study with a core outcome set on the management of fetal lower urinary tract obstruction and a study characterizing the appearance of uterine perivascular epithelioid cell tumors on ultrasound using standardized terminology.
Please see below a selection of articles from the November issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today or login and upgrade.
Postnatal outcome of fetal cortical malformations: systematic review
The prognosis of fetal malformations of cortical development (MCD) is usually poor as it is extrapolated from postnatal studies, which may not be relevant to prenatally diagnosed cases. In this systematic review, Abadia-Cuchi et al. aimed to evaluate the existing data on neurodevelopmental outcome in fetuses diagnosed with MCD, but found there was a marked lack of data regarding postnatal neurodevelopment. Within the available data, comprising only 30 cases, normal neurodevelopment or mild neurodevelopmental delay was reported in one-third of infants with prenatally diagnosed MCD. The paucity of data contributes to a high rate of termination, and the authors call for an urgent evaluation of postnatal neurodevelopment in fetal MCD.
Intermanufacturer assessment of diagnostic performance of angiogenic ratio vs glycosylated fibronectin in women with suspected pre-eclampsia
Pre-eclampsia (PE) is a leading cause of perinatal and maternal morbidity and mortality, yet efficient diagnosis in women with suspected PE remains a challenge. In this double-blinded study of East Asian women, Wah et al. carried out an intermanufacturer assessment of the diagnostic performance of the soluble fms-like tyrosine kinase-1 (sFlt-1)-to-placental growth factor (PlGF) ratio compared with a point-of-care test for glycosylated fibronectin (GlyFn) to rule in and rule out PE. When standardized to a common threshold, the diagnostic performance of the sFlt-1/PlGF ratio was not impacted by choice of assay manufacturer. Both the sFlt-1/PlGF ratio and GlyFn tests demonstrated similar diagnostic performance for ruling out PE within 7 days when using a cut-off of 263 μg/mL, suggesting the GlyFn test could be used as a point-of-care alternative in resource-limited settings.
Fetal lower urinary tract obstruction: international Delphi consensus on management and core outcome set
Reported data regarding prognosis, intervention candidacy, outcomes and procedural details are sparse and inconsistent for fetal lower urinary tract obstruction (LUTO), for which a core outcome set is currently absent. In this international Delphi study by Mustafa et al., consensus was reached for various LUTO parameters, enabling the development of a core outcome set that can be utilized for the evaluation of fetal LUTO, including for diagnostic criteria and management strategies. The authors highlight that the core outcome set and the devised management workflow pathway should be integrated into clinical care and prospective research studies to optimize and standardize perinatal outcomes.
Clinical and ultrasound features of uterine perivascular epithelioid cell tumors: case series and literature review
Preoperative diagnosis of uterine perivascular epithelioid cell tumors (PEComas) is challenging due to their unique morphological, histological, immunohistochemical and genetic features, and they can often be misdiagnosed as uterine fibroids or other uterine tumors. In this case series and literature review, Wang et al. described the sonographic appearance of uterine PEComas using standardized terminology of the Morphological Uterus Sonographic Assessment (MUSA) and International Endometrial Tumor Analysis (IETA) groups, and report that moderate-to-abundant vascularity, dispersed intratumoral vessels and a peripheral circular vascular distribution may serve as diagnostic clues for uterine PEComa. Although, as most sonographic characteristics were fairly non-specific, accurate preoperative ultrasound diagnosis remains a challenge. This description of the sonographic features of uterine PEComas may aid diagnosis and management until further larger-scale studies can establish a standardized description and broaden understanding of this disease.