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Adverse perinatal outcomes are strongly associated with degree of abnormality in uterine artery Doppler pulsatility index. 不利的围产期结果与子宫动脉多普勒搏动指数的异常程度密切相关。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-10-01 Epub Date: 2024-09-05 DOI: 10.1002/uog.27668
S Dockree, C Aye, C Ioannou, A Cavallaro, R Black, L Impey

Objective: To investigate the association between varying degrees of abnormality in the Doppler uterine artery pulsatility index (UtA-PI) and adverse perinatal outcome.

Methods: This was a prospective study of women with a singleton, non-anomalous pregnancy in whom UtA-PI was measured universally in midpregnancy and who gave birth in Oxford University Hospitals, Oxford, UK, between 2016 and 2023. Relative risk ratios (RRR) for the primary outcomes of extended perinatal mortality and live birth with a severe small-for-gestational-age (SGA) neonate were calculated using multinomial logistic regression, for early preterm birth (before 34 + 0 weeks' gestation) and late preterm/term birth (at or after 34 + 0 weeks). Risks were also investigated for iatrogenic preterm birth and a composite adverse outcome before 34 + 0 weeks.

Results: Overall, 33 364 pregnancies were included in the analysis. Compared to those with a normal UtA-PI, the risk of extended perinatal mortality with delivery before 34 + 0 weeks was higher in women with UtA-PI ≥ 90th percentile (RRR, 4.7 (95% CI, 2.7-8.0); P < 0.001), but this was not demonstrated in births at or after 34 + 0 weeks. The risk of live birth with severe SGA was associated strongly with abnormal UtA-PI for early births (RRR, 26.0 (95% CI, 11.6-58.2); P < 0.001) and later births (RRR, 2.3 (95% CI, 1.8-2.9); P < 0.001). Women with raised UtA-PI were more likely to have an early iatrogenic birth (RRR, 7.8 (95% CI, 5.5-11.2); P < 0.001). For each outcome before 34 + 0 weeks and the composite outcome, the risk increased significantly in association with the degree of abnormality in the UtA-PI (from < 90th, 90-94th, 95-98th to ≥ 99th percentile) (Ptrend < 0.001). When using the 90th percentile as opposed to the 95th, there was a significant improvement in the overall predictive accuracy (as determined by the area under the receiver-operating-characteristics curve) for the composite adverse outcome (χ2 = 6.64, P = 0.01) and iatrogenic preterm birth (χ2 = 4.10, P = 0.04).

Conclusions: Elevated UtA-PI is a key predictor of iatrogenic preterm birth, severe SGA and perinatal loss up to 34 + 0 weeks' gestation. The 90th percentile for UtA-PI should be used, and management should be tailored according to the degree of abnormality, as pregnancies with very raised UtA-PI measurement constitute a group at extreme risk of adverse outcome. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

目的研究子宫动脉多普勒搏动指数(UtA-PI)不同程度的异常与围产期不良结局之间的关系:方法:对 33,364 名在牛津出生的单胎非畸形婴儿的妇女进行前瞻性研究,在孕中期对 UtA-PI 进行普遍测量。通过多项式逻辑回归计算了早期早产(+0)和晚期早产/早产(≥34+0)的围产期死亡率延长和活产时出现严重小于胎龄(SGA)的主要结果的相对风险比。此外,还对先天性早产或 34+0 周前的综合不良结果的风险进行了调查:结果:与 UtA-PI 正常的妇女相比,UtA-PI > 90th 百分位数的妇女在 34+0 周前围产期死亡的风险更高(RRR 4.7,95% CI 2.7-8.0,pth、90-94th、95-99th 和 >99th 百分位数):UtA-PI升高是预测34+0周以内的先天性早产、严重SGA和围产期死亡的关键指标。应使用第 90 百分位数,并应根据异常程度进一步调整管理,因为 UtA-PI 测量值非常高的孕妇构成了一个极度危险的群体。本文受版权保护。保留所有权利。
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引用次数: 0
Ultrasound prediction of perinatal morbidity in fetal sacrococcygeal teratoma. 胎儿骶尾部畸胎瘤围产期发病率的超声预测。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-10-01 DOI: 10.1002/uog.27617
J L Munoz, C Buskmiller, A A Nassr, M Sanz Cortes, S Keswani, A King, T Lee, M A Belfort, L Joyeux, R V Donepudi
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引用次数: 0
Intramural twin pregnancy after in-vitro fertilization. 体外受精后的腹腔内双胎妊娠。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-10-01 Epub Date: 2024-08-29 DOI: 10.1002/uog.27626
Y Ouyang, J Xiao, Q Wang, Y Wen, H Chen, F Gong, X Li
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引用次数: 0
Infracoccygeal/transperineal window: new method to prenatally diagnose and classify level of anal atresia. 尾骨下/经会阴窗:产前诊断和分类肛门闭锁程度的新方法。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-10-01 Epub Date: 2024-09-01 DOI: 10.1002/uog.29094
T Elkan Miller, T Weissbach, M Elkan, M Zajicek, D Kidron, R Achiron, S Mazaki-Tovi, B Weisz, E Kassif
<p><strong>Objectives: </strong>To introduce a two-dimensional sonographic method to assess the fetal anus, and to evaluate the feasibility of this method to diagnose anal atresia prenatally and identify the presence or absence of anoperineal fistula (in males) and anovestibular fistula (in females).</p><p><strong>Methods: </strong>This was an observational study of suspected cases of anal atresia referred to a single center in Israel between August 2018 and October 2023. In addition to conventional evaluation of the perineum in the axial plane, fetuses referred to our center for suspected malformation were scanned with a new method termed the 'infracoccygeal/transperineal window'. This window consisted of a midsagittal view of the fetal pelvis, including the distal rectum and the anal canal. Normal anatomy was confirmed when the anal canal was continuous with the rectum and terminated at the expected location on the perineum. In female fetuses, the normal anal canal runs parallel to the vaginal canal and diverges posteriorly, terminating at the perineal skin, distant from the vestibule. In male fetuses, the normal anal canal diverges posteriorly in relation to the corpora cavernosa, terminating at the perineal skin, distant from the scrotum. High anal atresia was identified when a blind-ending rectal pouch was demonstrated in the pelvis without a fistula to the perineum or vestibule. Low anal atresia was determined when a rectal pouch was continuous with an anteriorly deflected fistula. In females, the fistula converges with the vaginal canal, terminating at the vestibule; in males, the fistula deflects anteriorly, terminating at the base of the scrotum. Postnatally, the diagnosis and type of anal atresia were confirmed through physical examination with direct visualization of the fistula, radiographic studies, surgical examination and/or postmortem autopsy.</p><p><strong>Results: </strong>Of the 16 fetuses diagnosed prenatally with anal atresia, eight were suspected to have low anal atresia and eight were suspected to have high anal atresia. The median gestational age at diagnosis was 23 (range, 14-37) weeks. All cases showed additional structural malformation. Eleven patients opted for termination of pregnancy, of which four had low anal atresia and seven had high anal atresia. Postnatal confirmation was not available in four cases due to curettage-induced mutilation or in-utero degradation following selective termination of the affected twin, leaving 12 cases for analysis, of which seven were diagnosed with low anal atresia and five with high anal atresia. In these 12 cases, all prenatal diagnoses were confirmed as correct, rendering 100% sensitivity and 100% specificity in this high-risk fetal population.</p><p><strong>Conclusions: </strong>The infracoccygeal/transperineal window is an effective method to detect and classify the level of anal atresia prenatally. This may improve prediction of postnatal fetal continence and optimize prenatal
目的介绍一种评估胎儿肛门的二维声像图方法,并评估该方法在产前诊断肛门闭锁以及确定是否存在肛瘘(男性)和肛门瘘(女性)的可行性:这是一项观察性研究,研究对象是2018年8月至2023年10月期间转诊至以色列一家中心的肛门闭锁疑似病例。除了在轴向平面对会阴部进行常规评估外,我们还采用一种新方法对转诊至本中心的疑似畸形胎儿进行扫描,这种方法被称为 "尾骨下/会阴窗"。该窗口包括胎儿骨盆的中矢状面,包括直肠远端和肛管。当肛管与直肠连续并终止于会阴部的预期位置时,即可确认解剖结构正常。在女性胎儿中,正常的肛管与阴道管平行,向后分叉,止于会阴部皮肤,远离前庭。在男性胎儿中,正常肛管与海绵体向后分叉,止于会阴部皮肤,远离阴囊。当骨盆中出现盲端直肠袋而没有瘘管通向会阴部或前庭时,可确定为肛门高度闭锁。低度肛门闭锁是指直肠袋与前倾的瘘管相连接。女性的瘘管与阴道管汇合,止于前庭;男性的瘘管向前方偏转,止于阴囊底部。出生后,通过直接观察瘘管的体格检查、放射学检查、手术检查和/或尸体解剖来确诊肛门闭锁和肛门闭锁的类型:结果:在产前确诊为肛门闭锁的16个胎儿中,8个被怀疑为低位肛门闭锁,8个被怀疑为高位肛门闭锁。确诊时的中位胎龄为23周(14-37周)。所有病例均显示有其他结构畸形。11名患者选择了终止妊娠,其中4人肛门低位闭锁,7人肛门高位闭锁。其中四例由于刮宫导致的残损或选择性终止受影响双胎后的胎儿宫内退化而无法进行产后确认,因此有 12 例进行了分析,其中七例被诊断为低位肛门闭锁,五例为高位肛门闭锁。在这12个病例中,所有产前诊断都被证实是正确的,在这一高风险胎儿群体中,敏感性为100%,特异性为100%:尾骨下/会阴窗是产前检测和分类肛门闭锁程度的有效方法。结论:尾骨下/会阴透视窗是产前检测和分类肛门闭锁程度的有效方法,可提高对产后胎儿大小便失禁的预测并优化产前咨询。© 2024 国际妇产科超声学会。
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引用次数: 0
Enhancing trainee performance in obstetric ultrasound through an artificial intelligence system: randomized controlled trial 通过人工智能系统提高产科超声培训学员的成绩:随机对照试验
IF 7.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-09-18 DOI: 10.1002/uog.29101
T. Lei, Q. Zheng, J. Feng, L. Zhang, Q. Zhou, M. He, M. Lin, H. N. Xie
ObjectivePerforming obstetric ultrasound scans is challenging for inexperienced operators; therefore, the prenatal screening artificial intelligence system (PSAIS) software was developed to provide real‐time feedback and guidance for trainees during their scanning procedures. The aim of this study was to investigate the potential benefits of utilizing such an artificial intelligence system to enhance the efficiency of obstetric ultrasound training in acquiring and interpreting standard basic views.MethodsA prospective, single‐center randomized controlled study was conducted at The First Affiliated Hospital of Sun Yat‐sen University. From September 2022 to April 2023, residents with no prior obstetric ultrasound experience were recruited and assigned randomly to either a PSAIS‐assisted training group or a conventional training group. Each trainee underwent a four‐cycle practical scan training program, performing 20 scans in each cycle on pregnant volunteers at 18–32 gestational weeks, focusing on acquiring and interpreting standard basic views. At the end of each cycle, a test scan evaluated trainees' ability to obtain standard ultrasound views without PSAIS assistance, and image quality was rated by both the trainees themselves and an expert (in a blinded manner). The primary outcome was the number of training cycles required for each trainee to meet a certain standard of proficiency (i.e. end‐of‐cycle test scored by the expert at ≥ 80%). Secondary outcomes included the expert ratings of the image quality in each trainee's end‐of‐cycle test and the discordance between ratings by trainees and the expert.ResultsIn total, 32 residents and 1809 pregnant women (2720 scans) were recruited for the study. The PSAIS‐assisted trainee group required significantly fewer training cycles compared with the non‐PSAIS‐assisted group to meet quality requirements (P = 0.037). Based on the expert ratings of image quality, the PSAIS‐assisted training group exhibited superior ability in acquiring standard imaging views compared with the conventional training group in the third (P = 0.012) and fourth (P < 0.001) cycles. In both groups, the discordance between trainees' ratings of the quality of their own images and the expert's ratings decreased with increasing training time. A statistically significant difference in overall trainee–expert rating discordance between the two groups emerged at the end of the first training cycle and remained at every cycle thereafter (P < 0.013).ConclusionBy assisting inexperienced trainees in obtaining and interpreting standard basic obstetric scanning views, the use of artificial intelligence‐assisted systems has the potential to improve training effectiveness. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
产前筛查人工智能系统(PSAIS)软件可在扫描过程中为学员提供实时反馈和指导。本研究旨在探讨利用该人工智能系统提高产科超声培训中获取和解释标准基本视图的效率的潜在益处。方法在中山大学附属第一医院开展了一项前瞻性、单中心随机对照研究。从 2022 年 9 月至 2023 年 4 月,中山大学附属第一医院招募了没有产科超声经验的住院医师,并将他们随机分配到 PSAIS 辅助培训组或传统培训组。每位受训者接受四个周期的实际扫描培训,每个周期对18-32孕周的孕妇志愿者进行20次扫描,重点是获取和解释标准的基本视图。每个周期结束时,都会进行一次测试扫描,评估受训者在没有 PSAIS 辅助的情况下获取标准超声图像的能力,图像质量由受训者本人和专家(以盲法)共同评定。主要结果是每位学员达到一定熟练标准所需的培训周期数(即专家对周期结束测试的评分≥80%)。次要结果包括专家对每位学员周期终了测试图像质量的评分,以及学员评分与专家评分之间的不一致性。结果本研究共招募了 32 名住院医师和 1809 名孕妇(2720 次扫描)。与非 PSAIS 辅助组相比,PSAIS 辅助组学员为达到质量要求所需的培训周期明显减少(P = 0.037)。根据专家对图像质量的评分,与传统训练组相比,PSAIS 辅助训练组在第三个周期(P = 0.012)和第四个周期(P < 0.001)获得标准成像视图的能力更强。在两组中,随着训练时间的增加,学员对自己图像质量的评分与专家评分之间的不一致性降低。在第一个培训周期结束时,两组学员与专家的总体评分不一致程度出现了统计学意义上的显著差异,并在此后的每个培训周期都保持了这一差异(P < 0.013)。© 2024 国际妇产科超声学会。
{"title":"Enhancing trainee performance in obstetric ultrasound through an artificial intelligence system: randomized controlled trial","authors":"T. Lei, Q. Zheng, J. Feng, L. Zhang, Q. Zhou, M. He, M. Lin, H. N. Xie","doi":"10.1002/uog.29101","DOIUrl":"https://doi.org/10.1002/uog.29101","url":null,"abstract":"ObjectivePerforming obstetric ultrasound scans is challenging for inexperienced operators; therefore, the prenatal screening artificial intelligence system (PSAIS) software was developed to provide real‐time feedback and guidance for trainees during their scanning procedures. The aim of this study was to investigate the potential benefits of utilizing such an artificial intelligence system to enhance the efficiency of obstetric ultrasound training in acquiring and interpreting standard basic views.MethodsA prospective, single‐center randomized controlled study was conducted at The First Affiliated Hospital of Sun Yat‐sen University. From September 2022 to April 2023, residents with no prior obstetric ultrasound experience were recruited and assigned randomly to either a PSAIS‐assisted training group or a conventional training group. Each trainee underwent a four‐cycle practical scan training program, performing 20 scans in each cycle on pregnant volunteers at 18–32 gestational weeks, focusing on acquiring and interpreting standard basic views. At the end of each cycle, a test scan evaluated trainees' ability to obtain standard ultrasound views without PSAIS assistance, and image quality was rated by both the trainees themselves and an expert (in a blinded manner). The primary outcome was the number of training cycles required for each trainee to meet a certain standard of proficiency (i.e. end‐of‐cycle test scored by the expert at ≥ 80%). Secondary outcomes included the expert ratings of the image quality in each trainee's end‐of‐cycle test and the discordance between ratings by trainees and the expert.ResultsIn total, 32 residents and 1809 pregnant women (2720 scans) were recruited for the study. The PSAIS‐assisted trainee group required significantly fewer training cycles compared with the non‐PSAIS‐assisted group to meet quality requirements (<jats:italic>P</jats:italic> = 0.037). Based on the expert ratings of image quality, the PSAIS‐assisted training group exhibited superior ability in acquiring standard imaging views compared with the conventional training group in the third (<jats:italic>P</jats:italic> = 0.012) and fourth (<jats:italic>P</jats:italic> &lt; 0.001) cycles. In both groups, the discordance between trainees' ratings of the quality of their own images and the expert's ratings decreased with increasing training time. A statistically significant difference in overall trainee–expert rating discordance between the two groups emerged at the end of the first training cycle and remained at every cycle thereafter (<jats:italic>P</jats:italic> &lt; 0.013).ConclusionBy assisting inexperienced trainees in obtaining and interpreting standard basic obstetric scanning views, the use of artificial intelligence‐assisted systems has the potential to improve training effectiveness. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":7.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264043","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}
引用次数: 0
Management of fetal cardiac resuscitation during fetal cardiac intervention. 胎儿心脏介入治疗期间的胎儿心脏复苏管理。
IF 7.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-09-17 DOI: 10.1002/uog.29111
B Yilmaz Furtun,A M Qureshi,T Niaz,C D Sutton,M Sanz Cortes,M A Belfort,S Morris,
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引用次数: 0
Proposed simplified protocol for initial assessment of endometriosis with transvaginal ultrasound 经阴道超声初步评估子宫内膜异位症的拟议简化方案
IF 7.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-09-12 DOI: 10.1002/uog.29115
A. Deslandes, M. Leonardi
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引用次数: 0
Ultrasound study of natural progression of ovarian endometrioma. 卵巢子宫内膜异位症自然进展的超声波研究。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-09-01 Epub Date: 2024-08-07 DOI: 10.1002/uog.27607
J Knez, E Bean, S Nijjar, D Mavrelos, D Jurkovic

Objective: To determine the natural progression of ovarian endometrioma in women who are managed expectantly.

Methods: This was a retrospective cohort study of 83 women with evidence of ovarian endometrioma who were managed expectantly between April 2007 and May 2022. The study was conducted in the Department of Women's Health, University College London Hospitals and The Gynecology Ultrasound Centre, London, UK. We searched our ultrasound clinic databases to identify women aged 18 years or older with evidence of ovarian endometrioma who were managed expectantly for ≥ 6 months. All women attended for a minimum of two ultrasound scans performed by a single expert ultrasound operator. In addition to patient demographics, we recorded the number, mean diameter and location of each cyst. The cyst growth rate was expressed as annual change in the mean diameter.

Results: A total of 1922 women who attended our gynecology clinic during the study period were found to have evidence of moderate or severe endometriosis on pelvic ultrasound examination. Of those, 83 women had evidence of ovarian endometrioma and were managed expectantly. The median age of women was 39 (range, 26-51) years at the initial visit. Each woman had at least two ultrasound scans performed by a single expert operator at a minimum interval of ≥ 6 months. Of 83 women diagnosed with endometrioma, 50 (60% (95% CI, 49-71%)) had a single cyst and the remainder had multiple cysts. The median number of endometriomas per patient was 1 (range, 1-5) and the median follow-up time was 634 (range, 187-2984) days. A total of 39/83 (47% (95% CI, 36-58%)) women experienced an overall reduction in size of cysts, in 18/83 (22% (95% CI, 13-32%)) the cysts increased in size and in 26/83 (31% (95% CI, 22-42%)) women, no meaningful change in size was observed. The median change in mean cyst diameter per woman during the study period was -2.7 (range, -57.7 to 39.3) mm, with a median annual regression rate of -1.7 (range, -24.6 to 42.0) mm/year/woman. Overall, when compared with the initial visit, cysts were significantly smaller at follow-up (median diameter, 22.3 (range, 6.7-77.0) mm vs 18.5 (range, 5.0-72.0) mm; P = 0.009). We did not identify any clinical characteristics that could reliably predict the chance of endometrioma progression.

Conclusions: In the majority of women with an ultrasound diagnosis of ovarian endometrioma, the cysts do not increase in size significantly over time and they could be managed expectantly. This evidence may help clinicians when counseling asymptomatic or minimally symptomatic women about management of ovarian endometrioma. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

研究目的本研究旨在确定接受预产期管理的妇女卵巢子宫内膜异位症的自然病史:这是一项回顾性队列研究,研究对象是2007年4月至2022年5月期间接受预产期管理的83名有卵巢子宫内膜异位症证据的妇女。研究在英国伦敦大学学院医院妇女健康部和妇科超声中心进行。我们搜索了超声诊所的数据库,以确定年龄在 18 岁或以上、有证据表明患有卵巢子宫内膜异位症且接受预产期管理≥ 6 个月的妇女。所有妇女都接受了至少两次超声波扫描,由一名超声波专家操作。除了患者的人口统计学特征外,我们还记录了每个囊肿的数量、平均直径和位置。囊肿生长率以平均直径的年变化率表示:在研究期间,有1922名妇女到我们的妇科诊所就诊,她们在盆腔超声检查中被发现患有中度或重度子宫内膜异位症。共有 83 名妇女有卵巢子宫内膜异位症的证据,并接受了预期治疗。妇女的中位年龄为 39 岁(26 - 51 岁不等)。每名妇女至少由一名专家操作员进行了两次超声波扫描,扫描间隔至少≥6个月。50/83(60%,95% CI 49-71)名妇女为单发囊肿,其余为多发囊肿。每位患者子宫内膜异位症的中位数为 1 个(1 - 5 个不等),中位随访时间为 634 天(187 - 2984 天不等)。39/83(47%,95% CI 36 - 58)名妇女的囊肿整体缩小,18/83(22%,95% CI 13 - 32)名妇女的囊肿增大,26/83(31%,95% CI 22 - 42)名妇女的囊肿没有明显变化。在研究期间,每位妇女的囊肿平均直径变化中位数为-2.7毫米(-57.7 - +39.3),年增长率为-1.7毫米/年/妇女(-24.6 - +42.0)。总体而言,随访时的囊肿更小[中位直径为 22.3 毫米(6.7 - 77)对 18.5 毫米(5 - 72),P = 0.009]。我们没有发现任何临床特征可以可靠地预测子宫内膜异位症进展的几率:结论:大多数经超声诊断为卵巢子宫内膜异位症的妇女的囊肿不会随着时间的推移而明显增大,可以对其进行预期管理。这一证据可能有助于临床医生向无症状或症状轻微的妇女提供卵巢子宫内膜异位症的治疗方案。本文受版权保护。保留所有权利。
{"title":"Ultrasound study of natural progression of ovarian endometrioma.","authors":"J Knez, E Bean, S Nijjar, D Mavrelos, D Jurkovic","doi":"10.1002/uog.27607","DOIUrl":"10.1002/uog.27607","url":null,"abstract":"<p><strong>Objective: </strong>To determine the natural progression of ovarian endometrioma in women who are managed expectantly.</p><p><strong>Methods: </strong>This was a retrospective cohort study of 83 women with evidence of ovarian endometrioma who were managed expectantly between April 2007 and May 2022. The study was conducted in the Department of Women's Health, University College London Hospitals and The Gynecology Ultrasound Centre, London, UK. We searched our ultrasound clinic databases to identify women aged 18 years or older with evidence of ovarian endometrioma who were managed expectantly for ≥ 6 months. All women attended for a minimum of two ultrasound scans performed by a single expert ultrasound operator. In addition to patient demographics, we recorded the number, mean diameter and location of each cyst. The cyst growth rate was expressed as annual change in the mean diameter.</p><p><strong>Results: </strong>A total of 1922 women who attended our gynecology clinic during the study period were found to have evidence of moderate or severe endometriosis on pelvic ultrasound examination. Of those, 83 women had evidence of ovarian endometrioma and were managed expectantly. The median age of women was 39 (range, 26-51) years at the initial visit. Each woman had at least two ultrasound scans performed by a single expert operator at a minimum interval of ≥ 6 months. Of 83 women diagnosed with endometrioma, 50 (60% (95% CI, 49-71%)) had a single cyst and the remainder had multiple cysts. The median number of endometriomas per patient was 1 (range, 1-5) and the median follow-up time was 634 (range, 187-2984) days. A total of 39/83 (47% (95% CI, 36-58%)) women experienced an overall reduction in size of cysts, in 18/83 (22% (95% CI, 13-32%)) the cysts increased in size and in 26/83 (31% (95% CI, 22-42%)) women, no meaningful change in size was observed. The median change in mean cyst diameter per woman during the study period was -2.7 (range, -57.7 to 39.3) mm, with a median annual regression rate of -1.7 (range, -24.6 to 42.0) mm/year/woman. Overall, when compared with the initial visit, cysts were significantly smaller at follow-up (median diameter, 22.3 (range, 6.7-77.0) mm vs 18.5 (range, 5.0-72.0) mm; P = 0.009). We did not identify any clinical characteristics that could reliably predict the chance of endometrioma progression.</p><p><strong>Conclusions: </strong>In the majority of women with an ultrasound diagnosis of ovarian endometrioma, the cysts do not increase in size significantly over time and they could be managed expectantly. This evidence may help clinicians when counseling asymptomatic or minimally symptomatic women about management of ovarian endometrioma. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.</p>","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":null,"pages":null},"PeriodicalIF":6.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139713127","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}
引用次数: 0
Predictive capacity of fetal pancreatic circumference for gestational diabetes mellitus. 胎儿胰腺周长对妊娠糖尿病的预测能力。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-09-01 Epub Date: 2024-08-01 DOI: 10.1002/uog.27719
Y Gilboa, Y Geron, S Perlman, L Drukker, K Ofir, A Ellert, R Bardin, R Achiron, Z Kivilevitch

Objective: To assess the capacity of fetal pancreatic size, before standard blood glucose testing for screening and diagnosis, to predict maternal gestational diabetes mellitus (GDM).

Methods: This was a retrospective cohort study of low-risk pregnant women recruited during routine second-trimester fetal anatomical screening at 20-25 weeks' gestation at two ultrasound units in Israel between 2017 and 2020. The predictive performance of fetal pancreatic circumference ≥ 80th and ≥ 90th centiles and glucose challenge test (GCT) was examined for the outcome of GDM. The independent-samples t-test was used to compare mean pancreatic circumference centile between pregnancies with GDM and those without GDM. Diagnostic performance was evaluated with 2 × 2 contingency tables and receiver-operating-characteristics (ROC) curves.

Results: Overall, 195 women were selected for statistical analysis. Twenty-four (12.3%) women were diagnosed subsequently with GDM. The mean ± SD fetal pancreatic circumference centile was significantly higher in the GDM group compared with the non-GDM group (82.4 ± 14.6 vs 62.8 ± 27.6; P < 0.001). The pancreatic circumference centile was correlated positively with the estimated fetal weight centile (Pearson's coefficient, 0.243; P = 0.001). The 80th centile cut-off for pancreatic circumference had the highest sensitivity (70.8%) and positive predictive value (23.3%) for future maternal GDM, with the best trade-off between sensitivity and specificity achieved at the 75th centile cut-off (sensitivity, 79%; specificity, 60%). The GCT had better specificity (90.2%) and negative predictive value (97.9%) compared with both cut-offs in pancreatic circumference. The area under the ROC curve was higher for pancreatic circumference compared with GCT (0.71 vs 0.64) and only the former was statistically significant (P = 0.001).

Conclusions: Fetal pancreatic circumference has a higher positive predictive capacity compared with GCT. Measuring pancreatic circumference can identify pregnancies at high risk for maternal GDM, thereby promoting earlier diagnosis and treatment, decreasing the time period during which the fetus is exposed to high maternal glucose levels and improving infant outcome. © 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.

目的评估在标准血液检测筛查和诊断前,胎儿胰腺大小预测母体妊娠糖尿病(GDM)的能力:这是一项回顾性队列研究,研究对象是 2017 年至 2020 年期间在以色列两家超声波单位对妊娠 20-25 周的低危孕妇进行常规二胎胎儿解剖学筛查时招募的孕妇。研究了胎儿胰岛周长≥第80和≥第90百分位数以及葡萄糖挑战试验(GCT)对GDM结果的预测性能。采用独立样本 t 检验比较有 GDM 和无 GDM 孕妇的平均胰周百分位数。用 2 × 2 或然率表和接收者操作特征曲线(ROC)评估诊断性能:共有 195 名妇女被选中进行统计分析。24名妇女(12.3%)随后被诊断为 GDM。与非 GDM 组相比,GDM 组胰腺周长的平均值(± SD)百分位数明显更高(82.4 ± 14.6 vs 62.8 ± 27.6;胰腺周长的第 3 个百分位数截断值对未来孕产妇 GDM 的敏感性(70.8%)和阳性预测值(23.3%)最高,第 75 个百分位数截断值在敏感性和特异性之间达到最佳平衡(敏感性 79%;特异性 60%)。与胰腺周长的两个临界值相比,GCT 具有更好的特异性(90.2%)和阴性预测值(97.9%)。与 GCT 相比,胰周率的 ROC 曲线下面积更高(0.71 vs 0.64),且只有前者具有统计学意义(P = 0.001):结论:与 GCT 相比,胎儿胰腺周径具有更高的阳性预测能力。结论:胎儿胰岛周径与 GCT 相比具有更高的阳性预测能力,测量胰岛周径可以识别母体 GDM 的高风险孕妇,从而促进早期诊断和治疗,减少胎儿暴露于母体高血糖水平的时间,改善婴儿的预后。© 2024 作者。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
Abstracts of the 34th World Congress on Ultrasound in Obstetrics and Gynecology, 15-18 September 2024, Budapest, Hungary. 第 34 届世界妇产科超声大会摘要,2024 年 9 月 15-18 日,匈牙利布达佩斯。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-09-01 DOI: 10.1002/uog.28523
P N Merkely, N Ács, G Leipold, Z Benko, G Molnár, C Demendi, G T Marton, L Tigharghar, L Keszthelyi, V Hermányi-Csiki
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引用次数: 0
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Ultrasound in Obstetrics & Gynecology
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