V Donadono, P Koutikwar, A Banerjee, M Ivan, C S Colley, M Sciacca, D Casagrandi, A Tetteh, N Greenwold, L M Kindinger, K Maksym, A L David, R Napolitano
<p><strong>Objective: </strong>To compare pregnancy outcome in women at high risk of preterm birth undergoing the modified Wurm (two monofilament sutures) vs those undergoing the McDonald (single braided suture) transvaginal cervical cerclage technique.</p><p><strong>Methods: </strong>This was a single-center prospective observational study of all women with a singleton pregnancy attending a prematurity surveillance clinic because of an increased risk of preterm birth, and undergoing history- or ultrasound-indicated transvaginal cervical cerclage. Two cerclage techniques were evaluated and the choice of cerclage was at the physician's discretion. In the modified Wurm technique using monofilament material, two circumferential sutures are placed with two insertions each (four in total). Outcomes were compared vs those of women undergoing the McDonald technique (single braided suture using a diamond-type insertion method with four insertions in total). Primary outcome was the rate of preterm birth at < 32 weeks' gestation, with planned subanalyses according to cervical cerclage indication (history- or ultrasound-indicated), preterm birth rate at any gestational age (< 37, < 34, < 28 and < 24 weeks), and sonographic cervical length (CL) of ≤ 25 mm and ≤ 15 mm. Secondary outcome measures included maternal and neonatal adverse events and outcomes, including the pre- and postsurgical characteristics. In addition, a reproducibility analysis using Bland-Altman plots was performed to evaluate the intra- and interobserver reproducibility in assessment of CL on ultrasound examination before and after cerclage.</p><p><strong>Results: </strong>In total, 147 patients were included in the final analysis: 55 (37%) received modified Wurm cerclage and 92 (63%) received McDonald cerclage. Other than race, demographic characteristics were comparable between the two groups. Of these, 22 (40%) women in the modified Wurm group had history-indicated cerclage, vs 50 (54%) women in the McDonald group; the remaining cerclages were ultrasound-indicated. In women with a short CL (≤ 25 mm), there was a significantly lower rate of preterm birth at < 32 weeks' gestation after modified Wurm compared with the McDonald technique (3 (9%) vs 14 (29%); adjusted odds ratio (aOR), 0.25 (95% CI, 0.06-0.95); P = 0.042). However, the study was underpowered to provide definitive conclusions. In the overall population, there was no significant difference in preterm birth rate for < 32 weeks' gestation between the two techniques (7 (13%) vs 22 (24%); aOR, 0.51 (95% CI, 0.20-1.33); P = 0.169). There was no difference in overall surgical complications between the two techniques. The pregnancy loss rate and composite neonatal morbidity/mortality rate were comparable between the two groups (2 (4%) vs 7 (8%); odds ratio (OR), 0.47 (95% CI, 0.09-2.33); P = 0.485; and 5 (9%) vs 11 (13%); OR, 0.68; (95% CI, 0.22-2.09); P = 0.593, respectively).</p><p><strong>Conclusions: </strong>In high-risk women w
{"title":"Transvaginal cervical cerclage: double monofilament modified Wurm vs single braided McDonald technique.","authors":"V Donadono, P Koutikwar, A Banerjee, M Ivan, C S Colley, M Sciacca, D Casagrandi, A Tetteh, N Greenwold, L M Kindinger, K Maksym, A L David, R Napolitano","doi":"10.1002/uog.29184","DOIUrl":"https://doi.org/10.1002/uog.29184","url":null,"abstract":"<p><strong>Objective: </strong>To compare pregnancy outcome in women at high risk of preterm birth undergoing the modified Wurm (two monofilament sutures) vs those undergoing the McDonald (single braided suture) transvaginal cervical cerclage technique.</p><p><strong>Methods: </strong>This was a single-center prospective observational study of all women with a singleton pregnancy attending a prematurity surveillance clinic because of an increased risk of preterm birth, and undergoing history- or ultrasound-indicated transvaginal cervical cerclage. Two cerclage techniques were evaluated and the choice of cerclage was at the physician's discretion. In the modified Wurm technique using monofilament material, two circumferential sutures are placed with two insertions each (four in total). Outcomes were compared vs those of women undergoing the McDonald technique (single braided suture using a diamond-type insertion method with four insertions in total). Primary outcome was the rate of preterm birth at < 32 weeks' gestation, with planned subanalyses according to cervical cerclage indication (history- or ultrasound-indicated), preterm birth rate at any gestational age (< 37, < 34, < 28 and < 24 weeks), and sonographic cervical length (CL) of ≤ 25 mm and ≤ 15 mm. Secondary outcome measures included maternal and neonatal adverse events and outcomes, including the pre- and postsurgical characteristics. In addition, a reproducibility analysis using Bland-Altman plots was performed to evaluate the intra- and interobserver reproducibility in assessment of CL on ultrasound examination before and after cerclage.</p><p><strong>Results: </strong>In total, 147 patients were included in the final analysis: 55 (37%) received modified Wurm cerclage and 92 (63%) received McDonald cerclage. Other than race, demographic characteristics were comparable between the two groups. Of these, 22 (40%) women in the modified Wurm group had history-indicated cerclage, vs 50 (54%) women in the McDonald group; the remaining cerclages were ultrasound-indicated. In women with a short CL (≤ 25 mm), there was a significantly lower rate of preterm birth at < 32 weeks' gestation after modified Wurm compared with the McDonald technique (3 (9%) vs 14 (29%); adjusted odds ratio (aOR), 0.25 (95% CI, 0.06-0.95); P = 0.042). However, the study was underpowered to provide definitive conclusions. In the overall population, there was no significant difference in preterm birth rate for < 32 weeks' gestation between the two techniques (7 (13%) vs 22 (24%); aOR, 0.51 (95% CI, 0.20-1.33); P = 0.169). There was no difference in overall surgical complications between the two techniques. The pregnancy loss rate and composite neonatal morbidity/mortality rate were comparable between the two groups (2 (4%) vs 7 (8%); odds ratio (OR), 0.47 (95% CI, 0.09-2.33); P = 0.485; and 5 (9%) vs 11 (13%); OR, 0.68; (95% CI, 0.22-2.09); P = 0.593, respectively).</p><p><strong>Conclusions: </strong>In high-risk women w","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Objective: </strong>To investigate differences in fetal vertebroplacental ratio (VPR) depending on the occurrence of operative delivery for suspected fetal compromise (ODFC) and composite perinatal outcome (CPO) at delivery.</p><p><strong>Methods: </strong>This was a prospective observational cohort study conducted in the Department of Obstetrics and Gynecology at the University Hospitals of Leuven, Leuven, Belgium, between December 2022 and April 2024. Women with a term (37-42 gestational weeks) singleton pregnancy with an appropriate-for-gestational-age (AGA) fetus were recruited, before cervical dilatation reached 5 cm, for sonographic fetal weight estimation (EFW) and Doppler sonography of the umbilical artery (UA), umbilical vein (UV), middle cerebral artery (MCA) and vertebral artery (VA). The primary outcomes were differences in VPR multiples of the median (MoM) depending on the occurrence of ODFC and CPO at delivery (based on UA cord blood pH and base excess, 1-min and 5-min Apgar score, and neonatal intensive care unit admission). We explored the technical feasibility of fetal Doppler sonography in this setting and differences in Doppler findings from individual fetal vessels (UA, UV blood flow (UVF), MCA, VA) and related parameters (UVF/EFW and cerebroplacental ratio (CPR)). We also investigated whether adding individual sonographic variables to baseline clinical prediction models could improve discriminatory power (using the area under the receiver-operating-characteristics curve (AUC)) and predictive accuracy (using the Brier score) for both outcomes.</p><p><strong>Results: </strong>A total of 161 women were recruited. The mean ± SD maternal age was 32.2 ± 3.8 years and approximately half (53.4%) of the women were nulliparous. Most (88.2%) women had labor induced. The mean ± SD gestational age at delivery was 39.3 ± 1.0 weeks and the mean ± SD ultrasound-to-delivery interval was 10.4 ± 2.75 h. An adverse CPO occurred in 13.3% of cases and ODFC occurred in 17.4%. No difference in mean VPR MoM was observed between cases with normal vs adverse CPO (1.04 ± 0.26 vs 1.17 ± 0.25; P = 0.09), or between cases which underwent ODFC vs those which did not (1.06 ± 0.29 vs 1.06 ± 0.26; P = 0.97). Likewise, no differences in other Doppler variables (UA pulsatility index (PI) MoM, MCA-PI MoM, VA-PI MoM, CPR MoM) were observed for both outcomes, except for significantly higher UVF rates in the adverse CPO group (both absolute (P = 0.02) and corrected for EFW (P = 0.048)). For both outcomes, adding VPR MoM or any other sonographic variable to baseline prediction models, which consisted solely of clinical variables, did not improve predictive accuracy or discriminatory power. The baseline model AUC and Brier score values were 0.68 (95% CI, 0.57-0.79) and 0.14 for adverse CPO, and 0.72 (95% CI, 0.61-0.83) and 0.13 for ODFC, respectively.</p><p><strong>Conclusions: </strong>Although technically feasible to measure in most women with an AGA fetu
{"title":"Vertebroplacental ratio for prediction of perinatal outcome and operative delivery for suspected fetal compromise: prospective observational cohort study.","authors":"B Packet, R Van Severen, J Richter","doi":"10.1002/uog.29189","DOIUrl":"https://doi.org/10.1002/uog.29189","url":null,"abstract":"<p><strong>Objective: </strong>To investigate differences in fetal vertebroplacental ratio (VPR) depending on the occurrence of operative delivery for suspected fetal compromise (ODFC) and composite perinatal outcome (CPO) at delivery.</p><p><strong>Methods: </strong>This was a prospective observational cohort study conducted in the Department of Obstetrics and Gynecology at the University Hospitals of Leuven, Leuven, Belgium, between December 2022 and April 2024. Women with a term (37-42 gestational weeks) singleton pregnancy with an appropriate-for-gestational-age (AGA) fetus were recruited, before cervical dilatation reached 5 cm, for sonographic fetal weight estimation (EFW) and Doppler sonography of the umbilical artery (UA), umbilical vein (UV), middle cerebral artery (MCA) and vertebral artery (VA). The primary outcomes were differences in VPR multiples of the median (MoM) depending on the occurrence of ODFC and CPO at delivery (based on UA cord blood pH and base excess, 1-min and 5-min Apgar score, and neonatal intensive care unit admission). We explored the technical feasibility of fetal Doppler sonography in this setting and differences in Doppler findings from individual fetal vessels (UA, UV blood flow (UVF), MCA, VA) and related parameters (UVF/EFW and cerebroplacental ratio (CPR)). We also investigated whether adding individual sonographic variables to baseline clinical prediction models could improve discriminatory power (using the area under the receiver-operating-characteristics curve (AUC)) and predictive accuracy (using the Brier score) for both outcomes.</p><p><strong>Results: </strong>A total of 161 women were recruited. The mean ± SD maternal age was 32.2 ± 3.8 years and approximately half (53.4%) of the women were nulliparous. Most (88.2%) women had labor induced. The mean ± SD gestational age at delivery was 39.3 ± 1.0 weeks and the mean ± SD ultrasound-to-delivery interval was 10.4 ± 2.75 h. An adverse CPO occurred in 13.3% of cases and ODFC occurred in 17.4%. No difference in mean VPR MoM was observed between cases with normal vs adverse CPO (1.04 ± 0.26 vs 1.17 ± 0.25; P = 0.09), or between cases which underwent ODFC vs those which did not (1.06 ± 0.29 vs 1.06 ± 0.26; P = 0.97). Likewise, no differences in other Doppler variables (UA pulsatility index (PI) MoM, MCA-PI MoM, VA-PI MoM, CPR MoM) were observed for both outcomes, except for significantly higher UVF rates in the adverse CPO group (both absolute (P = 0.02) and corrected for EFW (P = 0.048)). For both outcomes, adding VPR MoM or any other sonographic variable to baseline prediction models, which consisted solely of clinical variables, did not improve predictive accuracy or discriminatory power. The baseline model AUC and Brier score values were 0.68 (95% CI, 0.57-0.79) and 0.14 for adverse CPO, and 0.72 (95% CI, 0.61-0.83) and 0.13 for ODFC, respectively.</p><p><strong>Conclusions: </strong>Although technically feasible to measure in most women with an AGA fetu","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Thoughts on the contribution of artificial intelligence (AI) to assessment of the fetal heart: a true scientific odyssey.","authors":"E Quarello, E Corno","doi":"10.1002/uog.29185","DOIUrl":"https://doi.org/10.1002/uog.29185","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C Mégier, I Mediouni, V Huynh Ho, T Legrand, L Guibaud, A Benachi
{"title":"Prenatal treatment of axillary cystic lymphatic malformation using rapamycin.","authors":"C Mégier, I Mediouni, V Huynh Ho, T Legrand, L Guibaud, A Benachi","doi":"10.1002/uog.29191","DOIUrl":"https://doi.org/10.1002/uog.29191","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A Ludwin, M Loboda, L Zaborowska, W P Martins, I Ludwin
{"title":"Twin pregnancy in woman with T-shaped uterus from CUME study.","authors":"A Ludwin, M Loboda, L Zaborowska, W P Martins, I Ludwin","doi":"10.1002/uog.29196","DOIUrl":"https://doi.org/10.1002/uog.29196","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advancing fetal cardiac insights: extended implications of iron deficiency anemia on diastolic function and cardiac maturation.","authors":"B Li, Y Feng, R Chen","doi":"10.1002/uog.29193","DOIUrl":"https://doi.org/10.1002/uog.29193","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R Ramirez Zegarra, B Valentini, I F Carbone, L Angeli, F Gigli, C Di Ilio, O Barba, O Cassardo, E Ferrazzi, T Ghi
{"title":"Correlation between abnormal umbilical vein flow and birth-weight percentile in low-risk term pregnancies: secondary analysis of multicenter prospective study.","authors":"R Ramirez Zegarra, B Valentini, I F Carbone, L Angeli, F Gigli, C Di Ilio, O Barba, O Cassardo, E Ferrazzi, T Ghi","doi":"10.1002/uog.29192","DOIUrl":"https://doi.org/10.1002/uog.29192","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A Sotiriadis, E Demertzidou, A Ververi, E Tsakmaki, C Chatzakis, F Mone
Objective: To critically review the literature and synthesize evidence on the incremental yield of prenatal exome sequencing (PES) in fetuses with an apparently normal phenotype with a normal G-banded karyotype or chromosomal microarray (CMA).
Methods: This systematic review and meta-analysis was conducted using a predetermined protocol and registered with PROSPERO (ID: CRD42024593349). We included observational cohort studies reporting on the incremental yield of PES in fetuses with an apparently normal phenotype and a previously normal G-banded karyotype/CMA. The risk of bias of the included studies was assessed using the Newcastle-Ottawa Scale. The pooled proportion of events was calculated using generalized linear mixed models, using the metaprop function in R version 2.15.1.
Results: Four studies (1916 fetuses) were included in this systematic review and meta-analysis, of which 32 cases had a pathogenic or likely pathogenic variant. The pooled incremental yield of PES in fetuses with an apparently normal phenotype was 1.6% (95% CI, 1.0-2.6%); the majority of variants were de novo within genes associated with autosomal dominant inherited conditions (pooled incremental yield, 0.9% (95% CI, 0.5-1.7%)). Based on the expected severity of the associated disease, the pooled incremental yield was 0.5% (95% CI, 0.1-1.5%) for severe disease and 0.5% (95% CI, 0.2-1.5%) for moderate disease. There were insufficient data to conduct the predefined secondary analyses according to normality of phenotype at birth, variants of uncertain significance and expected age of disease onset.
{"title":"Clinical utility of prenatal exome sequencing for isolated short long bones and isolated small-for-gestational age.","authors":"B Jordan, S A Graham, S Allen, V Harrison","doi":"10.1002/uog.29188","DOIUrl":"https://doi.org/10.1002/uog.29188","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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