Ultrasound in Obstetrics & Gynecology最新文献

Objective: To evaluate the validity of two-dimensional (2D) oblique parasagittal ultrasound imaging to assess levator ani muscle avulsion.

Methods: This was a cross-sectional prospective study of women attending a tertiary urogynecological service between February 2021 and August 2022. All women underwent a standardized interview, pelvic organ prolapse quantification (POP-Q) assessment and four-dimensional transperineal ultrasound. 2D oblique parasagittal ultrasound imaging was performed by rotating the transducer 10-20° from the midline to line up the main transducer axis with the fiber direction of the puborectalis muscle, followed by a full parasagittal sweep of the hiatus at rest. Postprocessing of archived ultrasound volume data was performed at a later date, blinded to all other data. Findings were compared with levator ani assessment results obtained previously using three-dimensional tomographic ultrasound imaging (TUI). Diagnosis of levator ani avulsion on TUI and oblique parasagittal imaging was analyzed for associations with pelvic organ prolapse (POP).

Results: The datasets of 484 women were analyzed. Mean age was 58 (range, 16-94) years, mean body mass index was 30 (range, 17-65) kg/m² and mean parity was 2.6 (range, 0-8). POP symptoms were reported by 278 (57%) women. Clinically and sonographically significant POP was found in 385 (80%) and 350 (72%) women, respectively. Levator ani avulsion was diagnosed in 77 (16%) women on TUI and in 90 (18.6%) women on oblique parasagittal ultrasound imaging, with fair agreement between the two methods (Cohen's kappa of 0.365). There were significant associations between levator ani avulsion on 2D ultrasound imaging and POP diagnosis on clinical examination (odds ratio (OR), 2.88 (95% CI, 1.34-6.18); P = 0.005) and on ultrasound (OR, 2.92 (95% CI, 1.53-5.55); P = 0.001), but these associations were much stronger for TUI (P < 0.001 for both).

Conclusion: There was limited agreement between tomographic and oblique parasagittal ultrasound diagnosis of levator ani muscle avulsion. The latter technique has some validity for levator ani assessment but is clearly less valid than TUI. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Objective: To evaluate the perinatal outcome after spontaneous single intrauterine fetal demise (IUFD) in monochorionic twin pregnancies with twin anemia-polycythemia sequence (TAPS).

Methods: This was a retrospective study of all monochorionic twin pregnancies with TAPS that underwent spontaneous single IUFD and were registered in the international TAPS Registry between 2014 and 2023. The primary outcomes were mortality and severe neonatal cerebral injury in the surviving cotwin.

Results: A total of 39 twin pregnancies with TAPS that underwent spontaneous single IUFD were included, of which 77% (30/39) developed TAPS after laser surgery for twin-twin transfusion syndrome and 23% (9/39) developed TAPS spontaneously. Single IUFD occurred mostly in the donor twin (35/39 (90%)). The median gestational age at single IUFD was 23.0 (interquartile range (IQR), 20.7-27.9) weeks. The median gestational age at birth of the surviving cotwin was 34.3 (IQR, 32.2-36.0) weeks. Cotwin death occurred in one (3%) case and was due to extreme prematurity and intrauterine fetal infection. None of the surviving cotwins had severe neonatal cerebral injury, nor did any require rescue intrauterine transfusion.

Conclusions: In twin pregnancy with TAPS, the risk of mortality and severe neonatal cerebral injury in the surviving cotwin after spontaneous single IUFD appears to be low, which is probably owing to reduced perimortem transfusion through minuscule placental anastomoses. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Objectives: The ultrasound diagnosis of placental site trophoblastic tumor (PSTT) is challenging owing to a lack of pathognomonic features. Differential diagnosis from other forms of gestational trophoblastic neoplasia (GTN) is critical owing to major differences in prognosis and treatment. Doppler measurement of uterine artery (UtA) pulsatility index (PI) has been proposed for the diagnosis and management of GTN. The aim of this study was to evaluate the added value of UtA-PI Doppler measurement during the standard transvaginal ultrasound (TVS) assessment, in patients with PSTT as compared to those with other GTN.

Methods: This was a single-center prospective cohort study involving ultrasound assessment of all GTN cases referred to and treated at the trophoblast unit of San Raffaele Hospital, Milan, Italy, between 2011 and 2023. TVS assessment included: grayscale analysis for the detection of myometrial or endometrial abnormalities, color and power Doppler assessment of lesions with scoring of vascularization, and spectral pulsed-wave Doppler for measurement of mean UtA-PI from the left and right UtAs. Sonographic findings were compared between patients with PSTT and those with other forms of GTN (postmolar, invasive mole or choriocarcinoma), using non-parametric two-tailed statistical analysis.

Results: A total of 73 GTN cases were recruited, comprising nine (12.3%) with PSTT and 64 (87.7%) with other GTN. A significant difference was detected between other-GTN and PSTT cases when comparing rates of substantial endometrial vascularity on Doppler (50% vs 0%; P = 0.013) and mean UtA-PI measurements (median, 1.5 (interquartile range (IQR), 1.0-2.4) vs 2.2 (IQR, 1.5-2.7); P = 0.014; area under the receiver-operating-characteristics curve, 0.768 (95% CI, 0.610-0.888)).

Conclusions: This study describes UtA-PI as a novel and effective marker allowing for the ultrasound differentiation of PSTT from other forms of GTN. The significantly higher mean UtA-PI and lower endometrial vascularity observed in PSTT as compared with other GTN suggests a unique vascularization pattern, with a potential role in differential diagnosis and management. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.