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Maternal vascular indices at 36 weeks' gestation in pregnancy with small or growth-restricted fetus. 妊娠 36 周时,矮小胎儿和生长受限胎儿的母体血管指数。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-10-01 Epub Date: 2024-09-17 DOI: 10.1002/uog.27678
A Szczepkowska, S Adjahou, I Papastefanou, M De Pauli, K H Nicolaides, M Charakida

Objective: To compare maternal vascular indices and hemodynamic parameters at 35-37 weeks' gestation in pregnancies complicated by delivery of a small-for-gestational-age (SGA) or growth-restricted (FGR) neonate.

Methods: This was a prospective observational study of women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The visit included recording of maternal demographic characteristics, medical history, vascular indices and hemodynamic parameters, which were obtained using a non-invasive operator-independent device and included pulse-wave velocity, augmentation index, cardiac output, stroke volume, central systolic and diastolic blood pressure, total peripheral resistance and heart rate. Women with hypertensive disorders of pregnancy were excluded. SGA was diagnosed if birth weight was < 10th percentile. FGR was diagnosed if, in addition to birth weight < 10th percentile, at the 35-37-week scan, uterine artery or umbilical artery pulsatility index (PI) was > 95th percentile or fetal middle cerebral artery PI was < 5th percentile.

Results: Among the 6413 women included in the study, there were 605 (9.4%) cases of SGA, 133 (2.1%) cases of FGR and 5675 (88.5%) cases that were unaffected by SGA or FGR. Women with SGA or FGR, compared to unaffected pregnancies, had increased peripheral vascular resistance and reduced cardiac output. Central systolic and diastolic blood pressure were increased in the FGR group compared with the unaffected group. Aortic stiffness, as assessed by pulse-wave velocity, and augmentation index did not differ between affected and unaffected pregnancies. In the FGR group, compared with the SGA group, central systolic and diastolic blood pressure were higher, whereas heart rate was lower.

Conclusions: SGA and FGR pregnancies exhibit deranged maternal hemodynamic responses compared with unaffected pregnancies. Pregnancies with FGR have higher central blood pressure compared to those with SGA, but it remains unclear whether these differences are driven by the size of the fetus or pathological fetal growth. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

目的比较妊娠 35-37 周时因胎龄小 (SGA) 胎儿和胎儿生长受限 (FGR) 并发症的孕妇的血管指数和血液动力学参数:这是一项前瞻性非干预观察研究,对象是妊娠 35+0 至 36+6 周到医院进行常规检查的单胎妊娠妇女。访视内容包括记录孕产妇的人口统计学特征和病史、血管指数以及由独立于操作者的无创设备获得的血液动力学参数,包括脉搏波速度、增强指数、心输出量、每搏量、中心收缩压和舒张压、总外周阻力和胎儿心率。妊娠高血压疾病被排除在外,SGA组和FGR组的数值与未受影响的妊娠进行了比较。SGA 的诊断依据是胎儿出生时体重低于胎龄第 10 百分位数。对于 FGR,除了出生体重低于第 10 百分位数外,在 35-37 周扫描时,多普勒研究显示子宫动脉或脐动脉搏动指数(PI)高于胎龄第 95 百分位数,或胎儿大脑中动脉 PI 低于第 5 百分位数:在 6413 名参与研究的妇女中,有 605 例(9.4%)患有 SGA,133 例(2.1%)患有 FGR,5675 例(88.5%)未受 SGA 或 FGR 影响。与未受影响的孕妇相比,SGA 或 FGR 孕妇的外周血管阻力增加,心输出量减少。中心收缩压和舒张压也升高,而通过脉搏波速度和增强指数评估的主动脉僵硬度在受影响和未受影响的孕妇之间没有差异。与 SGA 组相比,FGR 组的中心收缩压和舒张压较高,而心率较低:结论:与正常妊娠相比,SGA 和 FGR 孕妇的血流动力学反应失常。与 SGA 孕妇相比,FGR 孕妇的中心血压更高,但目前还不清楚这些差异是由胎儿大小还是病理胎儿生长引起的。本文受版权保护。保留所有权利。
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引用次数: 0
Prospective external validation of IOTA methods for classifying adnexal masses and retrospective assessment of two-step strategy using benign descriptors and ADNEX model: Portuguese multicenter study. 前瞻性外部验证 IOTA 附件肿块分类方法,回顾性评估使用良性描述符和 ADNEX 的两步策略:一项葡萄牙多中心研究。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-10-01 Epub Date: 2024-09-04 DOI: 10.1002/uog.27641
A L Borges, M Brito, P Ambrósio, R Condeço, P Pinto, B Ambrósio, F Mahomed, J M R Gama, M J Bernardo, A I Gouveia, D Djokovic
<p><strong>Objectives: </strong>To externally and prospectively validate the International Ovarian Tumor Analysis (IOTA) Simple Rules (SRs), Logistic Regression model 2 (LR2) and Assessment of Different NEoplasias in the adneXa (ADNEX) model in a Portuguese population, comparing these approaches with subjective assessment and the risk-of-malignancy index (RMI), as well as with each other. This study also aimed to retrospectively validate the IOTA two-step strategy, using modified benign simple descriptors (MBDs) followed by the ADNEX model in cases in which MBDs were not applicable.</p><p><strong>Methods: </strong>This was a prospective multicenter diagnostic accuracy study conducted between January 2016 and December 2021 of consecutive patients with an ultrasound diagnosis of at least one adnexal tumor, who underwent surgery at one of three tertiary referral centers in Lisbon, Portugal. All ultrasound assessments were performed by Level-II or -III sonologists with IOTA certification. Patient clinical data and serum CA 125 levels were collected from hospital databases. Each adnexal mass was classified as benign or malignant using subjective assessment, RMI, IOTA SRs, LR2 and the ADNEX model (with and without CA 125). The reference standard was histopathological diagnosis. In the second phase, all adnexal tumors were classified retrospectively using the two-step strategy (MBDs + ADNEX). Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and overall accuracy were determined for all methods. Receiver-operating-characteristics curves were constructed and corresponding areas under the curve (AUC) were determined for RMI, LR2, the ADNEX model and the two-step strategy. The ADNEX model calibration plots were constructed using locally estimated scatterplot smoothing (LOESS).</p><p><strong>Results: </strong>Of the 571 patients included in the study, 428 had benign disease and 143 had malignant disease (prevalence of malignancy, 25.0%), of which 42 had borderline ovarian tumor, 93 had primary invasive adnexal cancer and eight had metastatic tumors in the adnexa. Subjective assessment had an overall sensitivity of 97.9% and a specificity of 83.6% for distinguishing between benign and malignant lesions. RMI showed high specificity (95.6%) but very low sensitivity (58.7%), with an AUC of 0.913. The IOTA SRs were applicable in 80.0% of patients, with a sensitivity of 94.8% and specificity of 98.6%. The IOTA LR2 had a sensitivity of 84.6%, specificity of 86.9% and an AUC of 0.939, at a malignancy risk cut-off of 10%. At the same cut-off, the sensitivity, specificity and AUC for the ADNEX model with vs without CA 125 were 95.8% vs 98.6%, 82.5% vs 79.7% and 0.962 vs 0.960, respectively. The ADNEX model gave heterogeneous results for distinguishing between benign masses and different subtypes of malignancy, with the highest AUC (0.991) for discriminating benign masses from primary invasive adnexal cancer Stag
研究目的本研究旨在对葡萄牙人群中的国际卵巢肿瘤分析(IOTA)简单规则(SRs)、逻辑回归模型 2(LR2)和 ADneXa 中不同 NEoplasias 的评估(ADNEX)进行外部和前瞻性验证,并将它们与操作者主观评估(SA)、恶性风险指数(RMI)以及它们之间的相互关系进行比较。这项研究还旨在回顾性地验证 IOTA 两步策略,即在使用改良良性描述因子(MBDs)后,在 MBDs 不适用的病例中应用 ADNEX(MBDs + ADNEX):在 2016 年 1 月至 2021 年 12 月期间进行的这项多中心诊断准确性研究中,三个三级转诊中心前瞻性地纳入了超声诊断为至少一种附件肿瘤并接受手术的连续患者。所有超声评估均由获得 IOTA 认证的二级或三级超声专家进行。患者的临床数据和血清癌抗原(CA125)水平均来自医院数据库。使用SA、RMI、IOTA SRs、LR2和ADNEX(含CA125和不含CA125)对每个附件肿块进行良性或恶性分类。参考标准是组织病理学诊断。第二阶段,采用两步策略(MBDs + ADNEX)对所有附件肿瘤进行回顾性分类。确定了SA、RMI、IOTA SRs、LR2、ADNEX和两步策略(MBDs + ADNEX)的敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)、阳性似然比(LR+)和阴性似然比(LR-)以及总体准确性。为 RMI、LR2、ADNEX 和两步法(MBDs + ADNEX)绘制了接收器-操作者特征曲线,并确定了相应的曲线下面积(AUC)。构建了ADNEX校准图,并通过LOESS平滑器进行了估算:在纳入的 571 名患者中,428 人患有良性疾病,42 人患有边缘性卵巢肿瘤,93 人患有原发性浸润性附件癌,8 人患有附件转移性肿瘤(恶性肿瘤发生率:25.0%)。在区分良性和恶性病变方面,操作者 SA 的总体灵敏度为 97.9%,特异性为 83.6%。RMI 显示出较高的特异性(95.6%),但灵敏度很低(58.7%),AUC 为 0.913。IOTA SR适用于80.0%的患者,灵敏度为94.8%,特异性为98.6%。当恶性风险临界值为 10%时,LR2 的灵敏度为 84.6%,特异性为 86.9%,AUC 为 0.939。在同一临界值下,含CA125和不含CA125的ADNEX灵敏度分别为95.8%和98.6%,特异性分别为82.5%和79.7%。含 CA125 和不含 CA125 的 ADNEX 的 AUC 分别为 0.962 和 0.960。ADNEX模型在区分良性肿瘤和不同亚型恶性肿瘤方面提供了不同的结果,区分良性肿块和原发性附件癌II-IV期的AUC最高(0.991),区分原发性附件癌I期和附件转移病灶的AUC最低(0.696)。ADNEX 校准图显示,与观察到的恶性肿瘤比例相比,预测风险被低估了。MBD适用于26.3%的病例(150/571个肿瘤,其中无恶性肿瘤)。与适用于所有患者的ADNEX模型相似,仅在第二步中使用ADNEX的两步策略(含CA125和不含CA125)的AUC分别为0.964和0.961:我们的研究结果表明,在所研究的葡萄牙人群中,IOTA 方法具有良好到卓越的性能,优于 RMI。ADNEX在准确性方面更胜一筹,但对其区分恶性亚型能力的解释不仅受到样本量的限制,还受到肿瘤亚型流行率差异较大的限制。IOTA MBD 在鉴别良性疾病方面已被证明是可靠的。事实证明,以应用 MBDs 为基础的两步策略适用于日常实践,无需对所有患者使用电子支持。本文受版权保护。保留所有权利。
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引用次数: 0
Challenging common misconceptions in vasa previa screening and diagnosis. 挑战前置胎盘筛查和诊断中的常见误解。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-10-01 Epub Date: 2024-07-25 DOI: 10.1002/uog.27567
D Srinivasan, E Daly-Jones, Y Oyelese, K Papanikolaou, C C Lees
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引用次数: 0
Standardized IETA criteria enhance accuracy of junior and intermediate ultrasound radiologists in diagnosing malignant endometrial and intrauterine lesions. 标准化的 IETA 标准提高了初级和中级超声放射医师诊断恶性子宫内膜和子宫内病变的准确性。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-10-01 Epub Date: 2024-09-01 DOI: 10.1002/uog.29102
B Chen, P Wang, W He, P Yang, Z Kong, D Wang, L Huang, X Chen, Y Zheng, Q Chen, H Xu, J Qi

Objectives: To transform the standardized descriptions of the ultrasound characteristics of endometrial and intrauterine lesions devised by the International Endometrial Tumor Analysis (IETA) group into a practical scoring method and to investigate whether application of this method enhances the diagnostic accuracy of ultrasound radiologists with different levels of experience in detecting malignancy compared with subjective assessment.

Methods: This was a retrospective study of 855 patients with endometrial and/or intrauterine lesions, who were divided into a training (n = 600) and a validation (n = 255) set. Ultrasound radiologists with varying levels of experience (expert, intermediate and junior) evaluated all lesions by subjective assessment and according to IETA rules. Using IETA rules, the experts identified signs of malignancy in the training set, assigned scores for each indicator and validated the scoring method in the validation set. The intermediate-level and junior ultrasound radiologists reassessed the malignancy of the lesions using the IETA scoring method and compared their classifications with those made previously by subjective assessment. Postsurgical pathological evaluation was used as the reference standard.

Results: Using subjective assessment, the experts demonstrated the highest level of diagnostic accuracy, with a sensitivity of 85.0%, specificity of 94.3% and an area under the receiver-operating-characteristics curve (AUC) of 0.897. Applying the IETA scoring method (comprising eight ultrasound characteristics that contributed to the total score) with a threshold of > 25 points for the diagnosis of malignancy achieved a sensitivity of 84.7%, specificity of 94.7% and AUC of 0.9533 in the training set, with similar performance in the validation set, when performed by experts. Using the IETA scoring method, both junior and intermediate ultrasound radiologists showed improvement in sensitivity (from 55.5% to 74.8% and from 70.2% to 77.1%, respectively), specificity (from 88.4% to 91.5% and from 87.4% to 92.2%, respectively) and AUC (from 0.704 to 0.827 and from 0.793 to 0.841, respectively) for diagnosing malignant lesions.

Conclusions: The IETA scoring method exhibits high diagnostic efficacy for malignant endometrial and intrauterine lesions. This method compensates for the lack of experience among junior and intermediate-level ultrasound radiologists, enhancing their diagnostic skill to a level nearing that of experienced senior ultrasound radiologists. Further research is essential to validate the practicality of implementing this method and to confirm its clinical value. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

研究目的将国际子宫内膜肿瘤分析(IETA)小组设计的子宫内膜和子宫内病变超声特征标准化描述转化为实用的评分方法,并研究与主观评估相比,应用该方法是否能提高具有不同经验水平的超声放射医师在检测恶性肿瘤方面的诊断准确性:这是一项回顾性研究,研究对象是855名子宫内膜和/或宫腔内病变患者,他们被分为训练组(n = 600)和验证组(n = 255)。具有不同经验水平(专家、中级和初级)的超声放射医师根据 IETA 规则对所有病变进行主观评估。利用 IETA 规则,专家们在训练集中识别出恶性肿瘤的迹象,为每个指标分配分数,并在验证集中验证评分方法。中级和初级超声放射医师使用 IETA 评分法重新评估病变的恶性程度,并将其分类与之前通过主观评估做出的分类进行比较。结果:通过主观评估,专家的诊断准确率最高,灵敏度为 85.0%,特异性为 94.3%,受体运算特征曲线下面积(AUC)为 0.897。采用 IETA 评分法(由八个超声波特征组成总分),以大于 25 分为恶性肿瘤诊断阈值,在训练集中的灵敏度为 84.7%,特异性为 94.7%,AUC 为 0.9533,在验证集中由专家进行评分时也有类似的表现。使用 IETA 评分法,初级和中级超声放射医师诊断恶性病变的敏感性(分别从 55.5% 提高到 74.8%,从 70.2% 提高到 77.1%)、特异性(分别从 88.4% 提高到 91.5%,从 87.4% 提高到 92.2%)和 AUC(分别从 0.704 提高到 0.827,从 0.793 提高到 0.841)均有所提高:结论:IETA评分法对子宫内膜和宫腔内恶性病变具有很高的诊断效力。该方法弥补了初级和中级超声放射医师经验不足的缺陷,使他们的诊断技能接近经验丰富的高级超声放射医师的水平。要验证这种方法的实用性并确认其临床价值,还需要进一步的研究。© 2024 国际妇产科超声学会。
{"title":"Standardized IETA criteria enhance accuracy of junior and intermediate ultrasound radiologists in diagnosing malignant endometrial and intrauterine lesions.","authors":"B Chen, P Wang, W He, P Yang, Z Kong, D Wang, L Huang, X Chen, Y Zheng, Q Chen, H Xu, J Qi","doi":"10.1002/uog.29102","DOIUrl":"10.1002/uog.29102","url":null,"abstract":"<p><strong>Objectives: </strong>To transform the standardized descriptions of the ultrasound characteristics of endometrial and intrauterine lesions devised by the International Endometrial Tumor Analysis (IETA) group into a practical scoring method and to investigate whether application of this method enhances the diagnostic accuracy of ultrasound radiologists with different levels of experience in detecting malignancy compared with subjective assessment.</p><p><strong>Methods: </strong>This was a retrospective study of 855 patients with endometrial and/or intrauterine lesions, who were divided into a training (n = 600) and a validation (n = 255) set. Ultrasound radiologists with varying levels of experience (expert, intermediate and junior) evaluated all lesions by subjective assessment and according to IETA rules. Using IETA rules, the experts identified signs of malignancy in the training set, assigned scores for each indicator and validated the scoring method in the validation set. The intermediate-level and junior ultrasound radiologists reassessed the malignancy of the lesions using the IETA scoring method and compared their classifications with those made previously by subjective assessment. Postsurgical pathological evaluation was used as the reference standard.</p><p><strong>Results: </strong>Using subjective assessment, the experts demonstrated the highest level of diagnostic accuracy, with a sensitivity of 85.0%, specificity of 94.3% and an area under the receiver-operating-characteristics curve (AUC) of 0.897. Applying the IETA scoring method (comprising eight ultrasound characteristics that contributed to the total score) with a threshold of > 25 points for the diagnosis of malignancy achieved a sensitivity of 84.7%, specificity of 94.7% and AUC of 0.9533 in the training set, with similar performance in the validation set, when performed by experts. Using the IETA scoring method, both junior and intermediate ultrasound radiologists showed improvement in sensitivity (from 55.5% to 74.8% and from 70.2% to 77.1%, respectively), specificity (from 88.4% to 91.5% and from 87.4% to 92.2%, respectively) and AUC (from 0.704 to 0.827 and from 0.793 to 0.841, respectively) for diagnosing malignant lesions.</p><p><strong>Conclusions: </strong>The IETA scoring method exhibits high diagnostic efficacy for malignant endometrial and intrauterine lesions. This method compensates for the lack of experience among junior and intermediate-level ultrasound radiologists, enhancing their diagnostic skill to a level nearing that of experienced senior ultrasound radiologists. Further research is essential to validate the practicality of implementing this method and to confirm its clinical value. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.</p>","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"528-537"},"PeriodicalIF":6.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112446","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
Exploring the relationship between trimester-specific exercise intensity and fetal growth patterns. 探索特定孕期运动强度与胎儿生长模式之间的关系。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-10-01 DOI: 10.1002/uog.29112
W-Z Tang, T-H Liu, X Lan
{"title":"Exploring the relationship between trimester-specific exercise intensity and fetal growth patterns.","authors":"W-Z Tang, T-H Liu, X Lan","doi":"10.1002/uog.29112","DOIUrl":"https://doi.org/10.1002/uog.29112","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":"64 4","pages":"557-558"},"PeriodicalIF":6.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366709","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
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
{"title":"Ultrasound prediction of perinatal morbidity in fetal sacrococcygeal teratoma.","authors":"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","doi":"10.1002/uog.27617","DOIUrl":"10.1002/uog.27617","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"555-556"},"PeriodicalIF":6.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139747520","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
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
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
{"title":"Intramural twin pregnancy after in-vitro fertilization.","authors":"Y Ouyang, J Xiao, Q Wang, Y Wen, H Chen, F Gong, X Li","doi":"10.1002/uog.27626","DOIUrl":"10.1002/uog.27626","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"553-555"},"PeriodicalIF":6.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029033","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
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。
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引用次数: 0
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Ultrasound in Obstetrics & Gynecology
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