The October issue of Ultrasound in Obstetrics and Gynecology includes a systematic review on the timing of induction of labor in suspected macrosomia, a randomized controlled trial on improving the performance of inexperienced ultrasound operators using an artificial intelligence training system, a nationwide cohort study on the use of combined first-trimester screening and invasive diagnostics for detection of atypical chromosomal aberrations and a study assessing the impact of uterine fibroids on non-informative cell-free DNA screening results.
Please see below a selection of articles from the October issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today or login and upgrade.
Timing of induction of labor in suspected macrosomia: retrospective cohort study, systematic review and meta-analysis
Macrosomia is associated with a variety of adverse outcomes, including Cesarean delivery and shoulder dystocia, and while early induction of labor (IOL) has been proposed to mitigate against these complications, no current guidelines support such a clinical strategy without other risk factors present. In this systematic review and meta-analysis, Badr et al. assessed whether the timing of IOL in large-for-gestational-age fetuses improves perinatal outcomes and evaluated the benefits and risks of IOL for suspected macrosomia. When considered irrespective of gestational age, the timing of IOL in patients with suspected macrosomia was shown to increase the risk of Cesarean delivery, but there was no effect on the rate of shoulder dystocia. However, when IOL was performed before 40 + 0 weeks, the risk of shoulder dystocia decreased without increasing the risk of Cesarean delivery. The authors conclude that early IOL should be considered in cases of suspected macrosomia.
Enhancing trainee performance in obstetric ultrasound through an artificial intelligence system: randomized controlled trial
Artificial intelligence (AI) algorithms have been proposed as a method of providing real-time training guidance to junior ultrasound operators, acting as a surrogate expert during scans to standardize and enhance training efficiency. In their randomized controlled trial, Lei et al. evaluate the use of an AI system during obstetric scan training. It was found that the AI-assisted trainee group required significantly fewer training cycles to meet quality requirements and showed superior ability in acquiring standard imaging views compared with the conventional training group. These results demonstrate that AI systems have the potential to improve the effectiveness of training inexperienced ultrasound operators in acquiring and interpreting standard basic obstetric ultrasound views.
Combined first-trimester screening and invasive diagnostics for atypical chromosomal aberrations: Danish nationwide study of prenatal profiles and detection compared with NIPT
For many years, invasive testing by combined first-trimester screening (cFTS) enabled the diagnosis of common trisomies, other aneuploidies and major structural chromosomal rearrangements; however, in some countries, there has been a move towards non-invasive prenatal testing (NIPT) as the primary screening test for aneuploidies. Gadsbøll et al. aimed to quantify the performance of cFTS and a second-trimester anomaly scan in detecting all pathogenic chromosomal aberrations and estimate the consequences of using NIPT instead of invasive testing for high-risk pregnancies. They report that, by screening for trisomies 21, 18 and 13 by cFTS, most triploidies, atypical sex-chromosome aberrations, rare autosomal trisomies and mosaicisms are detected before birth. Furthermore, by replacing invasive testing with NIPT for high-risk pregnancies, 27% of the chromosomal aberrations diagnosed on cFTS would not be detectable. These findings emphasize the potential limitations of NIPT and contribute to the ongoing debate about the optimal prenatal screening strategy.
Uterine fibroids and non-informative cell-free DNA screening results
Uterine fibroids have been shown previously to affect the accuracy of cell-free DNA (cfDNA) screening, particularly for rare autosomal trisomies and copy-number variants, but a possible association between fibroids and non-informative cfDNA screening results has not yet been investigated adequately. This study by Rolnik et al. found that the presence of uterine fibroids was significantly associated with lower fetal fraction, which is a known determinant of cfDNA test accuracy, and an increased risk of cfDNA screening failure when using both chromosome-selective and genome-wide analyses. The strength of this association increased with increasing fibroid number and volume. However, it should be noted that most women with fibroids did successfully obtain a risk assessment with cfDNA screening.