The September issue of Ultrasound in Obstetrics & Gynecology includes a systematic review on maternal prepregnancy weight as an independent risk factor for congenital heart defect, a prospective study of cardiovascular adaptation in women with previous pregnancy complicated by a hypertensive disorder, an analysis of the discriminative performance of the ADNEX model and IOTA two-step strategy for adnexal masses in a low-risk population and a study assessing postnatal outcome following fetal aortic valvuloplasty for critical aortic stenosis.
Please see below a selection of articles from the September issue of the Journal chosen specially by the UOG team. To view all UOG content, become an ISUOG member today or login and upgrade.
Maternal prepregnancy weight as an independent risk factor for congenital heart defect: systematic review and meta-analysis stratified by subtype and severity of defect
Congenital heart defects (CHD) are the most prevalent congenital malformation among neonates and are a significant cause of neonatal morbidity and mortality worldwide. Pregnancy in overweight women has been linked to adverse outcomes for both the mother and neonate, therefore, in this systematic review and meta-analysis, Salmeri et al. aimed to quantify the risk of CHD in the offspring of women with varying degrees of increased prepregnancy body mass index (BMI). A progressive increase in the risk of CHD was found in offspring with rising maternal prepregnancy BMI (overweight to moderate obesity to severe obesity), compared to pregnancy with normal weight, independent of the mother’s diabetic status. The authors recommend classifying obesity as a high-risk pregnancy and to perform routine fetal echocardiography in these pregnancies to help combat this growing issue of public health.
Long-term cardiovascular assessment of women with previous pregnancy complicated by hypertensive disorder
Previous studies have indicated that development of a hypertensive disorder of pregnancy (HDP) increases maternal cardiovascular risk during their lifetime, but it remains unknown whether HDP occurrence can accelerate or modify the trajectory of maternal cardiovascular adaptation in the long term. In this prospective study, Dimopoulou et al. monitored women in midgestation and at 2 years postpartum to identify maternal cardiovascular alterations before and after the HDP event. Women who developed HDP were found to have increased ophthalmic artery peak systolic velocity ratio in midgestation, as well as mild cardiac functional and morphological alterations that persisted 2 years postpartum. However, these cardiac changes were determined to likely be a consequence of pre-existing maternal cardiovascular risk factors rather than an adverse consequence of HDP.
Validation of ADNEX and IOTA two-step strategy and estimation of risk of complications during follow-up of adnexal masses in low-risk population
While the majority of adnexal masses are benign and can safely be followed conservatively, patients with lesions suspicious for malignancy require timely referral to a gynecological oncology center. As part of the IOTA Phase-5 study, Pascual et al. aimed to validate the diagnostic performance of the ADNEX model and the IOTA two-step strategy in a low-risk population and to estimate the risk of complications for masses with a benign appearance on ultrasound. Both ADNEX and the IOTA two-step strategy were shown to have excellent discriminative performance when applied to adnexal masses detected in a low-risk population. The risk of complications in patients managed conservatively on the basis of benign ultrasound morphology determined by pattern recognition was very low. This study was the first to determine that these strategies are suitable to predict the outcome of adnexal masses detected in a low-risk outpatient population, and that it is safe to manage tumors with a benign ultrasound appearance using clinical and ultrasound follow-up.
Postnatal outcome following fetal aortic valvuloplasty for critical aortic stenosis
Fetal aortic valvuloplasty (FAV) is a therapeutic option for fetal aortic stenosis, a complex disease with multiple phenotypes, although it is associated with varying rates of biventricular circulation at birth. In this study, Corroenne et al. describe the neonatal and longer-term outcomes of liveborn infants after a FAV procedure for critical aortic stenosis. FAV led to an increase in antegrade aortic flow in 86% of fetuses, with biventricular circulation achieved in 48%. Among those with biventricular circulation, while the rate of reintervention was high, long-term survival was satisfactory, with 79% alive at the latest follow-up. These findings could help to improve the prediction of obstetric and neonatal outcomes when FAV is being considered.
Don’t miss the How To… article in the September issue on performing standardized sonographic examination of Cesarean scar pregnancy in the first trimester.
How To... articles provide practical guidance on imaging-based techniques and investigations. In the September issue of UOG, find the latest open-access How To… article, providing a step-by-step tutorial on the standardized ultrasound examination of Cesarean scar pregnancy (CSP) in the first trimester, which emphasizes the importance of scanning in two planes (sagittal and transverse), utilizing color or power Doppler and differentiating CSP from other low-lying pregnancies.