Ultrasound in Obstetrics & Gynecology最新文献

Angle between vein of Galen and straight sinus: a novel marker on microvascular flow imaging for prenatal assessment of tentorium cerebelli position. 盖伦静脉与直窦之间的夹角：用于产前评估大脑触角位置的微血管血流成像新标记。

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology

Pub Date : 2024-11-18 DOI: 10.1002/uog.29132

L Sun, Y Cui, C Guo, L Feng, Z Jia, J Wang, T Zhang, Y Liu, K Wang, X Wang, L Yao, J Han, L Wang, Q Wu

Objectives: Posterior fossa anomalies (PFAs) are associated with a wide spectrum of neurodevelopmental disabilities, with presentation ranging from no obvious clinical symptoms to severe neurodevelopmental delay. The differential diagnosis of fetal PFAs using imaging is crucial for prenatal counseling and prognostic evaluation. Imaging of the tentorium cerebelli (TC) is critical for the differential diagnosis of fetal PFAs; however, achieving this using prenatal grayscale ultrasound is challenging. This study aimed to establish a reference range for a new measurement, the angle between the vein of Galen and the straight sinus (AVGS), measured using microvascular flow imaging, and to evaluate prospectively the effectiveness of AVGS for assessment of the position of the fetal TC.Methods: This was a single-center prospective validation study including singleton pregnancies examined between 16 and 38 gestational weeks at Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, between January 2022 and July 2023. AVGS was measured in normal fetuses and used to establish a reference range. AVGS was then used to predict prospectively the position of the TC in 50 fetuses with one or more intracranial malformations, using cut-offs of ≤ 5th centile or ≥ 95th centile to define abnormal AVGS. All intracranial malformations and the position of the TC in these fetuses were confirmed using fetal brain magnetic resonance imaging. The sensitivity, specificity, positive and negative predictive values and likelihood ratios were calculated to assess the performance of AVGS in the prediction of abnormal position of the fetal TC.Results: The study group comprised 602 singleton pregnancies, including 522 normal fetuses and 50 fetuses with an intracranial anomaly. A reference range for fetal AVGS was established. Fetal AVGS decreased with advancing gestational age. Ten of the 50 fetuses with an intracranial anomaly had an abnormally positioned TC. The sensitivity and specificity of AVGS for the prediction of abnormal position of the TC in fetuses with an intracranial malformation were 90.0% (95% CI, 71.4-100.0%) and 95.0% (95% CI, 88.2-100.0%), respectively. The positive and negative predictive values were 81.8% (95% CI, 47.8-96.8%) and 97.4% (95% CI, 84.9-99.9%), respectively, and the positive and negative likelihood ratios were 18.000 (95% CI, 4.590-70.592) and 0.105 (95% CI, 0.016-0.677), respectively.Conclusions: AVGS is a new and useful marker for the prenatal evaluation of fetal TC position. Increased AVGS (≥ 95th centile) suggests an abnormally elevated position of the TC, while decreased AVGS (≤ 5th centile) suggests an abnormally low TC. AVGS is helpful for differential diagnosis in fetuses with PFA and can inform appropriate prenatal counseling. © 2024 Internation

目的：后窝畸形（PFAs）与多种神经发育障碍有关，表现为从无明显临床症状到严重神经发育迟缓。利用影像学对胎儿前脑叶畸形进行鉴别诊断对于产前咨询和预后评估至关重要。大脑触角（Tencorium cerebelli，TC）成像对于胎儿脑积水的鉴别诊断至关重要；然而，利用产前灰阶超声实现这一目标具有挑战性。本研究旨在为一种新的测量方法--利用微血管血流成像测量的盖伦静脉与直窦之间的夹角（AVGS）--建立参考范围，并前瞻性地评估 AVGS 在评估胎儿 TC 位置方面的有效性：这是一项单中心前瞻性验证研究，包括2022年1月至2023年7月期间在首都医科大学附属北京妇产医院、北京妇幼保健院接受检查的16至38孕周的单胎妊娠。对正常胎儿的 AVGS 进行测量，并建立参考范围。然后用AVGS对50个有一个或多个颅内畸形的胎儿的TC位置进行前瞻性预测，以≤第5百分位数或≥第95百分位数为临界值来定义异常AVGS。这些胎儿的所有颅内畸形和 TC 的位置均通过胎儿脑磁共振成像确认。通过计算敏感性、特异性、阳性预测值、阴性预测值和似然比来评估 AVGS 在预测胎儿 TC 位置异常方面的表现：研究组由 602 名单胎妊娠组成，包括 522 名正常胎儿和 50 名颅内异常胎儿。建立了胎儿 AVGS 的参考范围。胎儿 AVGS 随孕龄的增加而降低。在 50 个颅内异常胎儿中，有 10 个胎儿的 TC 位置异常。AVGS 预测颅内畸形胎儿 TC 位置异常的敏感性和特异性分别为 90.0%（95% CI，71.4-100.0%）和 95.0%（95% CI，88.2-100.0%）。阳性和阴性预测值分别为81.8%（95% CI，47.8-96.8%）和97.4%（95% CI，84.9-99.9%），阳性和阴性似然比分别为18.000（95% CI，4.590-70.592）和0.105（95% CI，0.016-0.677）：AVGS是产前评估胎儿TC位置的一种新的有用标记物。AVGS增高（≥第95百分位数）提示TC位置异常升高，而AVGS降低（≤第5百分位数）提示TC位置异常降低。AVGS 有助于 PFA 胎儿的鉴别诊断，并为适当的产前咨询提供信息。© 2024 国际妇产科超声学会。

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引用次数: 0

Congenital heart defects during COVID-19 pandemic. COVID-19 大流行期间的先天性心脏缺陷。

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology

Pub Date : 2024-11-14 DOI: 10.1002/uog.29126

A Khalil, I Painter, V Souter

引用次数: 0

Transabdominal sonographic sliding signs for preoperative prediction of dense intra-abdominal adhesions in women undergoing repeat Cesarean delivery. 经腹超声滑动征象用于术前预测再次剖宫产产妇腹腔内的致密粘连。

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology

Pub Date : 2024-11-12 DOI: 10.1002/uog.29133

M Mayibenye, G A B Buga, M L Mdaka, M K Nanjoh

Objectives: To assess the accuracy and utility of transabdominal sonographic paraumbilical and suprapubic sliding signs in predicting intra-abdominal adhesions in women undergoing repeat Cesarean section (CS) and the association of repeat CS with short-term maternal and neonatal outcomes.Methods: This was a prospective observational study of pregnant women with a history of CS who were scheduled for third-trimester elective or emergency CS at a tertiary referral and teaching hospital between July 2021 and June 2022. In order to evaluate the role of transabdominal sonographic paraumbilical and suprapubic sliding signs in the prediction of intra-abdominal adhesions, participants underwent a high-resolution transabdominal ultrasound scan prior to repeat CS. Free cephalad and caudad gliding of the uterus under the abdominal wall during deep inhalation and exhalation in each area was considered a positive sliding sign, suggesting a low risk of intra-abdominal adhesions. The absence of such movement was considered a negative sliding sign, suggesting a high risk of intra-abdominal adhesions. The presence or absence of intra-abdominal adhesions was then confirmed during surgery by physicians who were blinded to the sonographic sliding-sign findings. The type of adhesion, structures involved, method of adhesiolysis, incision-to-delivery time, 1-min and 5-min Apgar scores, maternal and neonatal injury and other short-term complications were also reported.Results: Of 419 women with a history of at least one previous CS who underwent repeat CS, the preoperative sonographic paraumbilical and suprapubic sliding signs were negative in 173 (41.3%) and 178 (42.5%) women, respectively. On repeat CS, 224 (53.5%) women had intra-abdominal adhesions, of which 165 (39.4%) had dense adhesions and 59 (14.1%) had only filmy adhesions. The sensitivity and specificity of a negative preoperative paraumbilical sliding sign in predicting the presence of dense intra-abdominal adhesions in women undergoing repeat CS were 94.6% (95% CI, 92.4-96.7%) and 93.3% (95% CI, 90.9-95.7%), respectively. A negative suprapubic sliding sign also showed high sensitivity (95.2% (95% CI, 93.1-97.2%)) and specificity (91.7% (95% CI, 89.1-94.4%)). Additionally, a negative sliding sign at both locations in the same patient had robust sensitivity (90.2% (95% CI, 87.3-93.0%)) and specificity (96.3% (95% CI, 94.5-98.1%)). We found that the risk of dense intra-abdominal adhesions increased with parity and the number of previous CS. Dense intra-abdominal adhesions were associated with increased incision-to-delivery time, higher risk of maternal bladder injury, intraoperative bleeding and postpartum hemorrhage.Conclusions: Dense intra-abdominal adhesions are common in women with a previous history of CS and are associated with delayed delivery of the neonate and increased risk of adverse maternal outcomes. The tr

目的评估经腹超声脐旁和耻骨上滑动征预测再次剖宫产（CS）妇女腹腔内粘连的准确性和实用性，以及再次剖宫产与短期孕产妇和新生儿结局的关联：这是一项前瞻性观察研究，研究对象是2021年7月至2022年6月期间在一家三级转诊和教学医院计划进行第三孕期择期或急诊剖宫产的有剖宫产史的孕妇。为了评估经腹超声脐旁和耻骨上滑动征象在预测腹腔内粘连中的作用，参与者在再次CS前接受了高分辨率经腹超声扫描。在每个区域深吸气和呼气时，子宫在腹壁下的头侧和尾侧自由滑动被视为阳性滑动征象，表明腹腔内粘连的风险较低。没有这种移动被视为阴性滑动信号，表明腹腔内粘连的风险很高。腹腔内粘连的存在与否在手术过程中由对超声滑动信号结果保密的医生进行确认。此外，还报告了粘连类型、涉及结构、粘连溶解方法、切口到分娩时间、1 分钟和 5 分钟 Apgar 评分、产妇和新生儿损伤及其他短期并发症：结果：在 419 名既往至少有过一次剖宫产史并再次进行剖宫产的产妇中，术前声像图脐带旁和耻骨上滑动征阴性的产妇分别为 173 人（41.3%）和 178 人（42.5%）。在再次进行腹腔镜手术时，224 名（53.5%）女性腹腔内有粘连，其中 165 名（39.4%）有致密粘连，59 名（14.1%）仅有丝状粘连。术前脐旁滑动征阴性对预测再次进行CS的女性腹腔内出现致密粘连的敏感性和特异性分别为94.6%（95% CI，92.4-96.7%）和93.3%（95% CI，90.9-95.7%）。耻骨上滑动征阴性的敏感性（95.2% (95% CI, 93.1-97.2%)）和特异性（91.7% (95% CI, 89.1-94.4%)）也很高。此外，同一患者两个位置的滑动征均为阴性也具有很高的灵敏度（90.2% (95% CI, 87.3-93.0%)）和特异性（96.3% (95% CI, 94.5-98.1%)）。我们发现，腹腔内致密粘连的风险随胎次和前次 CS 的次数而增加。腹腔内密集粘连与从切口到分娩的时间延长、产妇膀胱损伤、术中出血和产后出血的风险升高有关：腹腔内粘连致密在既往有 CS 史的产妇中很常见，与新生儿分娩延迟和产妇不良预后风险增加有关。经腹超声脐旁征象和耻骨上滑动征象是准确预测有 CS 史患者术前腹腔内致密粘连的可靠方法。由于该技术易学易用，滑动征应更广泛地用于腹腔内高密度粘连高风险患者的分流，以制定适当的术前计划。© 2024 国际妇产科超声学会。

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引用次数: 0

Ultrasound assessment of lymph nodes for staging of gynecological cancer: consensus opinion on terminology and examination technique. 妇科癌症分期中的淋巴结超声评估：术语和检查技术的共识意见。

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology

Pub Date : 2024-11-08 DOI: 10.1002/uog.29127

D Fischerova, E Gatti, C Culcasi, Z Ng, G Szabó, L Zanchi, A Burgetova, O Nanka, G Gambino, M R Kadajari, G Garganese

The lymphatic pathway is an important route of metastasis in gynecological malignancy. Therefore, the examination of lymph nodes is an essential part of the ultrasound evaluation in patients with known or suspected gynecological malignancy. The lymph nodes most frequently involved in gynecological malignancy (apart from vulvar cancer) are parietal (retroperitoneal) and visceral abdominopelvic lymph nodes. In advanced disease, more distant lymph-node regions, such as the inguinal, axillary and supraclavicular lymph nodes, can also be involved. The standardized description of lymph nodes has been published previously by the Vulvar International Tumor Analysis (VITA) collaborative group. Herein, a collaborative group of gynecologists and gynecological oncologists with extensive ultrasound experience presents a systematic methodology for ultrasonographic lymph-node assessment performed as part of the locoregional and distant work-up to assess the extent of gynecological malignancy. The aim of this consensus opinion is also to describe the anatomical classification and drainage pathways of the lymphatic system as relevant to the gynecological organs. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

淋巴途径是妇科恶性肿瘤转移的重要途径。因此，对已知或疑似妇科恶性肿瘤患者进行超声评估时，淋巴结检查是必不可少的一部分。妇科恶性肿瘤（除外阴癌外）最常累及的淋巴结是腹膜旁（腹膜后）和内脏腹盆腔淋巴结。在晚期疾病中，腹股沟淋巴结、腋窝淋巴结和锁骨上淋巴结等更远处的淋巴结区域也可能受累。外阴国际肿瘤分析（VITA）协作组曾发表过淋巴结的标准化描述。在此，由具有丰富超声经验的妇科专家和妇科肿瘤专家组成的协作组提出了一套系统的淋巴结超声评估方法，作为局部和远处检查的一部分，用于评估妇科恶性肿瘤的范围。本共识意见还旨在描述与妇科器官相关的淋巴系统解剖学分类和引流途径。作者：© 2024。妇产科超声》由 John Wiley & Sons Ltd 代表国际妇产科超声学会出版。

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引用次数: 0

Comprehensive prenatal ultrasound for surgical risk assessment: differentiating placenta accreta spectrum from uterine scar dehiscence for improved clinical decision-making. 用于手术风险评估的产前综合超声波检查：区分胎盘早剥和子宫瘢痕开裂以改进临床决策。

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology

Pub Date : 2024-11-07 DOI: 10.1002/uog.29138

R A Aryananda, T K Adu-Bredu

引用次数: 0

Ultrasound assessment of the pelvic sidewall: methodological consensus opinion. 骨盆侧壁超声评估：方法学共识意见。

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology

Pub Date : 2024-11-05 DOI: 10.1002/uog.29122

D Fischerova, C Culcasi, E Gatti, Z Ng, A Burgetova, G Szabó

A standardized methodology for the ultrasound evaluation of the pelvic sidewall has not been proposed to date. Herein, a collaborative group of gynecologists and gynecological oncologists with extensive ultrasound experience presents a systematic methodology for the ultrasonographic evaluation of structures within the pelvic sidewall. Five categories of anatomical structures are described (muscles, vessels, lymph nodes, nerves and ureters). A step-by-step transvaginal ultrasound (or, when this is not feasible, transrectal ultrasound) approach is outlined for the evaluation of each anatomical landmark within these categories. Accurate assessment of the pelvic sidewall using a standardized approach improves the detection and diagnosis of non-gynecological pathologies that may mimic gynecological tumors, reducing the risk of unnecessary and even harmful intervention. Furthermore, it plays an important role in completing the staging of malignant gynecological conditions. Transvaginal or transrectal ultrasound therefore represents a viable alternative to magnetic resonance imaging in the preoperative evaluation of lesions affecting the pelvic sidewall, if performed by an expert sonographer. A series of videoclips showing normal and abnormal findings within each respective category illustrates how establishing a universally applicable approach for evaluating this crucial region will be helpful for assessing both benign and malignant conditions affecting the pelvic sidewall. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

迄今为止，尚未提出盆腔侧壁超声评估的标准化方法。在此，一个由具有丰富超声经验的妇科专家和妇科肿瘤专家组成的合作小组提出了一套系统的盆腔侧壁结构超声评估方法。描述了五类解剖结构（肌肉、血管、淋巴结、神经和输尿管）。概述了经阴道超声（或在无法经阴道超声时经直肠超声）评估这些类别中每个解剖标志物的步骤。使用标准化方法对盆腔侧壁进行准确评估，可提高对可能与妇科肿瘤相似的非妇科病变的检测和诊断，减少不必要甚至有害的干预风险。此外，它在完成恶性妇科疾病的分期方面也发挥着重要作用。因此，在对影响盆腔侧壁的病变进行术前评估时，如果由专业超声技师操作，经阴道或经直肠超声是磁共振成像的一种可行替代方法。一系列视频短片显示了每个类别中的正常和异常结果，说明了建立一种普遍适用的方法来评估这一关键区域将如何有助于评估影响盆腔侧壁的良性和恶性病变。©2024作者：姚俊涛妇产科超声》由 John Wiley & Sons Ltd 代表国际妇产科超声学会出版。

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引用次数: 0

Enhanced recovery after fetal spina bifida surgery: global practice. 加强胎儿脊柱裂手术后的恢复：我们的全球实践是什么？

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology

Pub Date : 2024-11-01 Epub Date: 2024-10-10 DOI: 10.1002/uog.27701

K Nulens, Y Kunpalin, K Nijs, J C A Carvalho, L Pollard, N Abbasi, G Ryan, T Van Mieghem

Objectives: Enhanced recovery after surgery (ERAS) protocols are multimodal evidence-based care plans that have been adopted for multiple surgical procedures to promote faster and better patient recovery and shorter hospitalization. This study aimed to explore whether worldwide fetal therapy centers offering prenatal myelomeningocele repair implement the ERAS principles and to provide recommendations for improved perioperative management of patients.

Methods: In this survey study, a total of 53 fetal therapy centers offering prenatal surgery for open spina bifida were identified and invited to complete a digital questionnaire covering their pre-, intra- and postoperative management. An overall score was calculated per center based on compliance with 20 key ERAS principles, extrapolated from ERAS guidelines for Cesarean section, gynecological oncology and colorectal surgery. Each item was awarded a score of 1 or 0, depending, respectively, on whether the center did or did not comply with that principle, with a maximum score of 20.

Results: The questionnaire was completed by 46 centers in 17 countries (response rate, 87%). In total, 22 (48%) centers performed exclusively open fetal surgery (laparotomy and hysterotomy), whereas 14 (30%) offered both open and fetoscopic procedures and 10 (22%) used only fetoscopy. The perioperative management of patients undergoing fetoscopic and open surgery was very similar. The median ERAS score was 12 (range, 8-17), with a mean ± SD of 12.5 ± 2.4. Center compliance was the highest for the use of regional anesthesia (98%), avoidance of bowel preparation (96%) and thromboprophylaxis (96%), while the lowest compliance was observed for preoperative carbohydrate loading (15%), a 2-h fasting period for clear fluids (20%), postoperative nausea and vomiting prevention (33%) and early feeding (35%). ERAS scores were similar in centers with a short (2-5 days), medium (6-10 days) and long (≥ 11 days) hospital stay (mean ± SD, 12.9 ± 2.4, 12.1 ± 2.0 and 10.3 ± 3.2, respectively, P = 0.15). Furthermore, there was no significant association between ERAS score and surgical technique or case volume.

Conclusions: The perioperative management of fetal spina bifida surgery is highly variable across fetal therapy centers worldwide. Standardized protocols integrating ERAS principles may improve patient recovery, reduce maternal morbidity and shorten the hospital stay after fetal spina bifida surgery. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

目的：与产后手术相比，产前脊柱裂闭合术可改善胎儿的预后，但与孕产妇的严重发病率相关。对接受胎儿脊柱裂手术的产妇进行围手术期护理优化可改善产妇和妊娠结局。术后恢复强化方案（ERAS）是以证据为基础的多模式护理计划，已被多种外科手术采用，以促进患者更快、更好地恢复并缩短住院时间。本研究旨在探讨胎儿中心是否在此环境中实施了ERAS原则。此外，我们还为脊柱裂胎儿手术患者的围手术期管理提供了建议：方法：我们确定了 53 家提供开放性脊柱裂产前手术的胎儿治疗中心，并邀请他们填写一份数字问卷，内容包括术前、术中和术后管理。根据中心对ERAS 20项主要原则的遵守情况计算出每个中心的总分，这些原则是从ERAS剖宫产、妇科肿瘤和结直肠手术指南中推导出来的。当中心符合或不符合每项原则时，每项得分1或0，最高分为20分：17 个国家的 46 个中心完成了问卷调查（回复率为 87%）。22个中心（48%）只进行开腹胎儿手术（开腹和宫腔手术），14个中心（30%）同时进行开腹和胎儿镜手术，10个中心（22%）只进行胎儿镜手术。胎儿镜手术和开腹手术患者的围手术期管理非常相似。ERAS评分的中位数为12分（平均12.5分，标差2.4分，范围8-17分）。各中心对使用区域麻醉（98%）、避免肠道准备（96%）和血栓预防（96%）的依从性最高，而对术前碳水化合物负荷（15%）、术后恶心呕吐预防（33%）、避免隔夜禁食（33%）和禁食2小时饮用清水（20%）的依从性最低。短期（2-5 天）、中期（6-10 天）和长期（≥11 天）住院中心的 ERAS 评分相似（分别为 12.8 ± 2.4、12.1 ± 2.0 和 10.3 ± 3.2，P=0.15）。此外，ERAS评分与手术技术或中心规模无明显关联：结论：世界各地的胎儿治疗中心对胎儿脊柱裂手术的围手术期管理差异很大。结论：世界各地的胎儿治疗中心对胎儿脊柱裂手术的围手术期管理差异很大，根据ERAS原则制定标准化方案可改善患者的恢复、降低产妇的发病率并缩短胎儿脊柱裂手术后的住院时间。本文受版权保护。保留所有权利。

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引用次数: 0

Association between adenomyosis volume and adverse perinatal outcomes: multicenter cohort study. 子宫腺肌症体积与围产期不良预后之间的关系：多中心队列研究。

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology

Pub Date : 2024-11-01 DOI: 10.1002/uog.29108

X Ni, X Su, Y Shi, P Ru, Y Liu, S Lei, Y Gu, M Liu, T Duan

Objective: To assess the association between adenomyosis volume, as a reflection of its severity, and the risk of adverse perinatal outcomes.Methods: This multicenter retrospective cohort study was conducted at a comprehensive tertiary care institution and a tertiary maternal and child healthcare hospital, which are the main types of hospital providing maternal medical care in China. The study included pregnant women without adenomyosis (non-AD cohort) who delivered between 1 January 2021 and 31 December 2021, and women with pregnancy complicated by adenomyosis (AD cohort) who delivered between 1 January 2020 and 31 December 2022. Adenomyosis was diagnosed and measured using transvaginal or transabdominal ultrasound up to 14 weeks of gestation. The adenomyosis volume (V) was calculated based on the sonographic measurement of three dimensions, using the formula V = (length × width × thickness) × 4/3π. Univariate and multivariate logistic regression analyses were conducted to assess the association between adenomyosis and the risk of pregnancy complications. We also performed a sensitivity analysis among 226 pregnancies complicated by adenomyosis that had volume measurements available and 10 507 pregnancies without adenomyosis, using as a threshold for severe adenomyosis the 3rd quartile of adenomyosis volume.Results: The study group included 10 507 pregnant women in the non-AD cohort and 321 in the AD cohort. Pregnancies complicated by adenomyosis had an increased risk of preterm birth < 37 weeks of gestation (adjusted odds ratio (aOR), 2.39 (95% CI, 1.65-3.48)), spontaneous preterm birth < 37 weeks of gestation (aOR, 2.57 (95% CI, 1.54-4.28)), placenta previa (aOR, 2.57 (95% CI, 1.41-4.67)), cervical incompetence (aOR, 9.70 (95% CI, 4.00-23.55)) and abnormal fetal presentation (aOR, 2.04 (95% CI, 1.39-3.00)), and there was also a non-significant trend toward increased risk of pre-eclampsia (aOR, 1.64 (95% CI, 0.94-2.85)). Sensitivity analysis revealed there was a greater risk in pregnancies with severe (≥ 757.5 cm3) vs mild adenomyosis of preterm birth < 37 weeks of gestation (aOR, 5.50 (95% CI, 2.80-10.82) vs aOR, 1.73 (95% CI, 0.98-3.05)), pre-eclampsia (aOR, 4.94 (95% CI, 2.11-11.58) vs aOR, 1.03 (95% CI, 0.41-2.58)), placenta previa (aOR, 6.37 (95% CI, 2.39-17.04) vs aOR, 1.58 (95% CI, 0.60-4.19)) and cervical incompetence (aOR, 12.79 (95% CI, 2.87-56.93) vs aOR, 4.97 (95% CI, 1.25-19.77)) compared to pregnancies without adenomyosis. The risk of spontaneous preterm birth < 37 weeks and the risk of abnormal fetal presentation was similar between the two subgroups.Conclusion: Pregnancies complicated by adenomyosis, particularly those with severe adenomyosis, have an increased risk of pregnancy complications, including preterm birth, spontaneous preterm birth, placenta previa, cervical incompetence and abnormal fetal presentation. ©

摘要评估反映子宫腺肌症严重程度的子宫腺肌症体积与围产期不良结局风险之间的关系：这项多中心回顾性队列研究在一家综合性三级医疗机构和一家三级妇幼保健医院进行，这两家医院是中国提供孕产妇医疗服务的主要医院类型。研究对象包括 2021 年 1 月 1 日至 2021 年 12 月 31 日期间分娩的无腺肌症孕妇（非腺肌症队列），以及 2020 年 1 月 1 日至 2022 年 12 月 31 日期间分娩的腺肌症并发症孕妇（腺肌症队列）。腺肌症的诊断和测量采用经阴道或经腹部超声波检查，直至妊娠 14 周。腺肌症的体积（V）是根据超声测量的三个维度计算得出的，计算公式为：V=（长×宽×厚）×4/3π。我们进行了单变量和多变量逻辑回归分析，以评估子宫腺肌症与妊娠并发症风险之间的关系。我们还对 226 例有子宫腺肌症并发症的妊娠和 10 507 例无子宫腺肌症的妊娠进行了敏感性分析，以子宫腺肌症体积的第 3 个四分位数作为严重子宫腺肌症的阈值：研究组包括 10 507 名非子宫腺肌症孕妇和 321 名子宫腺肌症孕妇。与轻度子宫腺肌症相比，子宫腺肌症并发症孕妇的早产风险增加了3%：子宫腺肌症孕妇，尤其是重度子宫腺肌症孕妇，发生妊娠并发症的风险增加，包括早产、自然早产、前置胎盘、宫颈机能不全和胎儿畸形。© 2024 国际妇产科超声学会。

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引用次数: 0

Dynamic prediction of pregnancy outcome after previous stillbirth or perinatal death: pilot study to establish proof-of-concept and explore method feasibility. 动态预测死产或围产期死亡后的妊娠结局：旨在验证概念和探索方法可行性的试点研究。

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology

Pub Date : 2024-11-01 Epub Date: 2024-10-15 DOI: 10.1002/uog.29104

A E P Heazell, N Graham, M J Parkes, J Wilkinson

Objective: To establish proof-of-concept for the dynamic prediction of adverse pregnancy outcome in women with a history of stillbirth or perinatal death, repeatedly throughout the pregnancy.

Methods: A retrospective cohort study of women in a subsequent pregnancy following previous perinatal loss, who received antenatal care at a tertiary hospital between January 2014 and December 2017, was used as the basis for exploratory prognostic model development. Models were developed to repeatedly predict a composite adverse outcome (stillbirth or neonatal death, 5-min Apgar score < 7, umbilical artery pH ≤ 7.05, admission to the neonatal intensive care unit for longer than 24 h, preterm birth (< 37 completed weeks) or birth weight < 10^th centile) using the findings of sequential ultrasound scans for fetal biometry and umbilical and uterine artery Doppler.

Results: In total, 506 participants were eligible, of whom 504 were included in the analysis. An adverse pregnancy outcome was experienced by 110 (22%) participants. The ability to predict the composite outcome using repeated head circumference and estimated fetal weight measurements improved as the pregnancy progressed (e.g. area under the receiver-operating-characteristics curve improved from 0.59 at 24 weeks' gestation to 0.74 at 36 weeks' gestation), supporting proof-of-concept. Predictors to include in dynamic prediction models were identified, including ultrasound measurements of fetal biometry, umbilical and uterine artery Doppler and placental size and shape.

Conclusion: The present study supports proof-of-concept for dynamic prediction of adverse outcome in pregnancy following prior stillbirth or perinatal death, which could be used to identify risks earlier in pregnancy, while highlighting methodological challenges and requirements for subsequent large-scale model development studies. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

目的对有死胎或围产期死亡史的妇女在整个孕期反复出现的不良妊娠结局进行动态预测的概念验证：方法：以一项回顾性队列研究为基础，对2014年1月至2017年12月期间在一家三甲医院接受产前护理的围产期死亡产妇进行探索性预后模型开发。利用胎儿生物测量、脐动脉和子宫动脉多普勒的连续超声扫描结果，建立了重复预测综合不良结局（死胎或新生儿死亡、5分钟Apgar评分th百分位数）的模型：共有 506 人符合条件，其中 504 人被纳入分析。110名参与者（22%）出现了不良妊娠结局。随着妊娠的进展，使用重复头围和估计胎儿体重测量值预测综合结果的能力有所提高（例如，受体运算特征曲线下面积从妊娠24周时的0.59提高到妊娠36周时的0.74），支持概念验证。结论：本研究支持概念验证：本研究支持对死胎或围产儿死亡后妊娠不良结局进行动态预测的概念验证，可用于在妊娠早期识别风险，同时强调了后续大规模模型开发研究在方法学方面的挑战和要求。© 2024 作者姓名妇产科超声》由 John Wiley & Sons Ltd 代表国际妇产科超声学会出版。

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引用次数: 0

Prenatal diagnosis of Walker-Warburg syndrome: ultrasound, magnetic resonance imaging and three-dimensional reconstruction. 沃克-瓦尔堡综合征的产前诊断：超声波、磁共振成像和三维重建。

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology

Pub Date : 2024-11-01 Epub Date: 2024-10-12 DOI: 10.1002/uog.27648

P T Castro, T Fazecas, A P P Matos, C Hygino, E Araujo Júnior, H Werner

引用次数: 0