The May issue new ISUOG Practice Guidelines on performing fetal MRI, an Editorial highlighting the need for standardized classification of morbidly adherent placenta, a Randomized Controlled Trial on prevention of preterm birth with pessary in twins, a Systematic Review on reproductive outcomes of blastocyst vs cleavage-stage embryo transfer, and a range of articles on risk factors, prediction and outcome of twin–twin transfusion syndrome.
Please see below a selection of articles from the May issue of the Journal chosen specially by the UOG team. To view all UOG content become an ISUOG member today .
ISUOG Practice Guidelines: performance of fetal MRI
Fetal magnetic resonance imaging (MRI) is an important diagnostic imaging adjunct to ultrasonography, particularly for assessment of the fetal brain. In 2014, fetal MRI was being performed in one or more centers in at least 27 countries worldwide. However, imaging quality, sequences used and operator experience were found to differ widely between centers. To reduce the impact of such differences, the ISUOG Clinical Standards Committee has developed guidelines for performing and interpreting fetal MRI.
View the ISUOG Guidelines
Need for standardization of morbidly adherent placenta
Morbidly adherent placenta (MAP) is a rare but serious complication of pregnancy when the placenta fails to detach from the uterine wall after delivery due to abnormal implantation at the basal plate. This can lead to massive obstetric hemorrhage and is associated with significant maternal morbidity and mortality.The ability to diagnose MAP antenatally is imperfect, partly due to a lack of uniform nomenclature and partly due to significant overlap of the sonographic appearance of MAP with that of normally implanted placentae. In this Editorial, Bhide et al. describe the different sonographic features of invasive implantation, highlight the problems with the current methods for ascertainment of MAP and suggest future developments for standardization to enable definitive prenatal diagnosis.
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Effect of blastocyst vs cleavage-stage embryo transfer on reproductive outcomes
Embryo transfer following in-vitro fertilization is performed typically either at the cleavage stage, on
days 2–3 after fertilization, or at the blastocyst stage, on days 5–6. There are certain advantages and disadvantages for postponing embryo transfer. To assess the effect of timing of embryo transfer on reproductive outcomes, Martins et al. performed a systematic review and meta-analysis of 12 randomized controlled trials, including 1200 women undergoing blastocyst transfer and 1218 undergoing cleavage-stage embryo transfer. They found no difference in clinical/ongoing pregnancy, live birth or miscarriage when comparing the transfer of blastocysts against the transfer of cleavage-stage embryos.
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Risk factors, prediction and outcome of twin–twin transfusion syndrome
In this issue of UOG are a number of articles on twin–twin transfusion syndrome (TTTS): 1) in a systematic review by Stagnati et al., the role of first- and early second-trimester markers for early prediction of TTTS were evaluated and an intertwin discrepancy in nuchal translucency thickness (NT), NT > 95th percentile, an intertwin discrepancy in crown–rump length >10% and abnormal ductus venosus flow on first-trimester ultrasound examination were all found to be associated with a significantly increased risk of developing TTTS; 2) Snowise et al. explored the incidence, clinical course, risk factors and outcomes of preterm prelabor rupture of membranes after fetoscopic laser surgery (FLS) for TTTS, however no suspected variable was found to be significantly associated with PPROM after FLS; 3) Malshe et al. investigated the causative factors leading to preterm delivery
after FLS for TTTS, as better knowledge of the risk factors could reduce complications.
Coming up in the next issue of UOG…
• An updated ISUOG Consensus Statement on the impact of non-invasive prenatal testing of cell-free DNA on screening policies and prenatal ultrasound practice.
• A study by O’Gorman et al. on multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11–13 weeks, comparing its performance with that of NICE guidelines and ACOG recommendations. Preview the accepted article here. This article has been chosen for Journal Club, so look out for the accompanying downloadable slides next month.
• A post-hoc sensitivity analysis of the Trial of Randomized Umbilical and Fetal FLow in Europe (TRUFFLE) study to determine the optimal monitoring strategy before 32 weeks for pregnancies with intrauterine growth restriction. Preview the accepted article here.