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Role of gestational age at time of placental laser surgery in outcome of twin-to-twin transfusion syndrome. 胎盘激光手术时的胎龄对双胎输血综合征结果的影响。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2025-01-01 Epub Date: 2024-12-07 DOI: 10.1002/uog.27679
C O Brock, S Backley, S Snowise, E P Bergh, A Johnson, J Fisher, J Espinoza, S Eyerly-Webb, N Juckel, E Nisius, E A Hernandez-Andrade, R Papanna

Objective: There are conflicting data on whether fetoscopic laser photocoagulation (FLP) of placental anastomoses for the treatment of twin-to-twin transfusion syndrome (TTTS) is associated with lower rates of overall survival. The objective of this study was to characterize twin survival and associated morbidity according to the gestational age at which FLP was performed.

Methods: This was a secondary analysis of data collected prospectively on patients with a monochorionic diamniotic (MCDA) twin pregnancy who underwent FLP for TTTS at two centers between January 2011 and December 2022. Patients were divided into six groups according to gestational age at the time of FLP: < 18 weeks, 18 + 0 to 19 + 6 weeks, 20 + 0 to 21 + 6 weeks, 22 + 0 to 23 + 6 weeks, 24 + 0 to 25 + 6 weeks and ≥ 26 weeks. Demographic characteristics, sonographic characteristics of TTTS and operative characteristics were compared across the gestational age epochs. Outcomes, including overall survival, preterm delivery (PTD), preterm prelabor rupture of membranes (PPROM), intrauterine fetal demise (IUFD) and neonatal demise (NND), were also compared across gestational age epochs. Multivariate analysis was performed by fitting logistic regression models for these outcomes. Kaplan-Meier curves were constructed to compare the interval from PPROM to delivery between gestational age epochs.

Results: There were 768 patients that met the inclusion criteria. The rate of dual twin survival was 61.3% for cases in which FLP was performed before 18 weeks, compared with 78.0%-86.7% when FLP was performed at ≥ 18 weeks' gestation. This appears to be driven by an increased rate of donor IUFD following FLP performed before 18 weeks (28.0%) compared with ≥ 18 weeks (9.3-14.1%). Rates of recipient IUFD and NND and donor NND were similar regardless of gestational age at FLP. The rate of PPROM was higher for FLP conducted at earlier gestational ages, ranging from 45.6% for FLP before 18 weeks to 11.9% for FLP performed at 24 + 0 to 25 + 6 weeks' gestation. However, gestational age at delivery was similar across gestational age epochs, with a median of 31.7 weeks. On multivariate analysis, donor twin loss was associated with FLP before 18 weeks, even after adjusting for selective fetal growth restriction, Quintero stage and other covariates. PPROM and PTD were also associated with FLP performed before 18 weeks after adjusting for cervical length, placental location, trocar size, laser energy and amnioinfusion.

Conclusions: FLP performed at earlier gestational ages is associated with lower overall survival, which is driven by the increased risk of donor IUFD, as opposed to differences in the rate of PPROM or PTD. Parental counseling regarding twin survival should account for the gestational age at which patients present with TTTS. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

目的:关于胎儿镜激光光凝胎盘吻合口(FLP)治疗双胎输血综合征(TTTS)是否与较低的总存活率有关,目前存在相互矛盾的数据。本研究的目的是描述FLP术后不同妊娠年龄段的存活率和其他相关发病率:本研究是对 2011 年至 2022 年期间在两个中心收集到的因 TTTS 而进行 FLP 的单绒毛膜羊膜双胎患者的前瞻性数据进行的二次分析。患者被分为18周前、18 0/7 - 19 6/7周、20 0/7 - 21 6/7周、22 0/7 - 23 6/7周、24 0/7 - 25 6/7周和26周后的FLP胎龄。比较了不同孕周的人口统计学特征、TTTS 声像图特征和手术特征。此外,还比较了不同孕周的总体存活率、早产、早产胎膜早破(PPROM)、宫内胎儿死亡(IUFD)和新生儿死亡(NND)等结果。通过拟合这些结果的逻辑回归模型进行了多变量分析。通过构建 Kaplan-Mejer 曲线,比较了各孕龄组从 PPROM 到分娩的间隔时间:结果:共有 768 名患者符合纳入标准。在 18 周前进行 FLP 的双存活率为 61.3%,而在较晚的孕周进行 FLP 的双存活率为 78.0% - 86.7%。这似乎与18周前和18周后进行FLP后供体IUFD的比率增加有关(28.0% vs. 9.3% - 14.1%)。无论FLP的胎龄如何,受体IUFD/NND和供体NND的比率相似。胎儿娩出前早产的比率较高,从18周前娩出胎儿的45.6%到胎龄24-26周娩出胎儿的11.9%不等。然而,各胎龄段的分娩胎龄相似,中位数均为 31.7 周。在多变量分析中,在调整了选择性胎儿生长受限、金特罗分期和其他协变量后,供体丢失与18周前的FLP独立相关。在对宫颈长度、胎盘位置、套管尺寸、激光能量和羊膜腔注射进行调整后,PPROM和PTD也与18周前的FLP相关:结论:在较早孕龄进行FLP与较低的总体存活率有关,其原因是供体IUFD的风险较高,而不是PPROM或PTD的差异。有关存活率的咨询应考虑到妊娠年龄。本文受版权保护。保留所有权利。
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引用次数: 0
Near-miss criteria for stillbirth in global research: the 'In Utero' consensus. 全球研究中的死胎近似标准:"子宫内 "共识。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2025-01-01 Epub Date: 2024-10-10 DOI: 10.1002/uog.29120
S J Gordijn, A T Papageorghiou, A L David, S Ali, W Ganzevoort
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引用次数: 0
Prediction of vesicouterine adhesions by transvaginal sonographic sliding sign technique: validation study. 通过经阴道超声滑动征技术预测膀胱阴道粘连:验证研究。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2025-01-01 Epub Date: 2024-11-25 DOI: 10.1002/uog.29128
N Min, J van Keizerswaard, R H Visser, N B Burger, J W T Rake, J W M Aarts, T Van den Bosch, M Leonardi, J A F Huirne, R A de Leeuw
<p><strong>Objective: </strong>Adhesions between the uterus, bladder and anterior abdominal wall are associated with clinical sequelae, including chronic pelvic pain and dyspareunia, and can also yield complications during surgery. The transvaginal sonographic (TVS) sliding bladder sign is a minimally invasive diagnostic tool to evaluate the presence of vesicouterine adhesions. This study aimed to determine the predictive value and intra- and interobserver variation of the TVS sliding bladder sign in the assessment of vesicouterine adhesions.</p><p><strong>Methods: </strong>This was a prospective observational double-blind diagnostic accuracy study conducted at the Amsterdam University Medical Center. Patients scheduled for gynecological laparoscopic surgery for a benign disorder between January 2020 and December 2022 were included consecutively. All patients underwent preoperative TVS, including a dynamic sliding bladder sign examination in our outpatient clinic. Videoclips of the TVS scans were stored for offline assessment and used as an index test. The recordings of both TVS and laparoscopy were evaluated for diagnostic characteristics of vesicouterine adhesions by independent assessors, who were blinded to the clinical situation in addition to the laparoscopic findings when assessing recordings of TVS and vice versa. The presence of adhesions on laparoscopy was used as the reference standard. The positive predictive value (PPV), negative predictive value (NPV), specificity and sensitivity of the sliding bladder sign were calculated. In addition, inter- and intraobserver variability of the sliding bladder sign on TVS were assessed.</p><p><strong>Results: </strong>Of 116 included women, 57 had a negative sliding bladder sign on TVS, while on laparoscopy, 51 women had mild and 28 had severe vesicouterine adhesions. A negative sliding bladder sign had a PPV of 94.7% (95% CI, 88.9-100%) for the presence of any vesicouterine adhesions, and a positive sliding bladder sign had a specificity of 91.9% (95% CI, 83.1-100%). For severe adhesions, the negative sliding bladder sign had a sensitivity of 89.3% (95% CI, 77.8-100%) and a positive sliding bladder sign had a NPV of 94.9% (95% CI, 89.3-100%). When using Cohen's kappa coefficient, inter- and intraobserver agreement between assessors was good.</p><p><strong>Conclusions: </strong>Sliding bladder sign evaluation using TVS is a reliable diagnostic tool for the prediction of vesicouterine adhesions on laparoscopy. A negative sliding bladder sign indicates the presence of vesicouterine adhesions, while a positive sliding bladder sign makes the presence of severe adhesions unlikely. Establishing vesicouterine adhesions by TVS may optimize preoperative planning, and can be used for future studies to evaluate the relationship between symptomatology and vesicouterine adhesions and, subsequently, the effect of adhesion-prevention interventions. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology publis
目的:子宫、膀胱和前腹壁之间的粘连与临床后遗症有关,包括慢性盆腔疼痛和排便困难,还可能在手术过程中产生并发症。经阴道超声(TVS)滑动膀胱征是一种微创诊断工具,用于评估是否存在膀胱阴道粘连。本研究旨在确定 TVS 滑动膀胱征在评估膀胱阴道粘连时的预测价值以及观察者内部和观察者之间的差异:这是一项前瞻性观察性双盲诊断准确性研究,在阿姆斯特丹大学医学中心进行。研究连续纳入了 2020 年 1 月至 2022 年 12 月期间因良性疾病而计划接受妇科腹腔镜手术的患者。所有患者都在门诊接受了术前TVS检查,包括动态滑动膀胱征检查。TVS 扫描的视频片段被保存起来以进行离线评估,并用作指标测试。TVS和腹腔镜检查记录由独立评估人员进行评估,以确定膀胱输尿管粘连的诊断特征,评估人员在评估TVS记录时,除了腹腔镜检查结果外,还对临床情况进行盲测,反之亦然。腹腔镜检查是否存在粘连被作为参考标准。计算了滑动膀胱征的阳性预测值(PPV)、阴性预测值(NPV)、特异性和敏感性。此外,还评估了 TVS 上滑动膀胱征的观察者之间和观察者内部的差异性:结果:在纳入的 116 名妇女中,有 57 名妇女的膀胱滑动征在 TVS 上呈阴性,而在腹腔镜检查中,51 名妇女有轻度膀胱粘连,28 名妇女有重度膀胱粘连。阴性滑动膀胱标志对任何膀胱阴道粘连的PPV为94.7%(95% CI,88.9-100%),阳性滑动膀胱标志的特异性为91.9%(95% CI,83.1-100%)。对于严重粘连,阴性滑动膀胱征的敏感性为 89.3%(95% CI,77.8-100%),阳性滑动膀胱征的 NPV 为 94.9%(95% CI,89.3-100%)。使用科恩卡帕系数(Cohen's kappa coefficient)计算,评估者之间和评估者内部的一致性良好:结论:使用 TVS 评估滑动膀胱征是预测腹腔镜膀胱粘连的可靠诊断工具。滑动膀胱征阴性表明存在膀胱阴道粘连,而滑动膀胱征阳性则不可能存在严重粘连。通过 TVS 确定膀胱输尿管粘连可优化术前计划,并可用于未来的研究,以评估症状学与膀胱输尿管粘连之间的关系,进而评估预防粘连干预措施的效果。© 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
Retroperitoneal cyst with iliac stent involvement as primary manifestation of cystic echinococcosis. 髂骨支架受累的腹膜后囊肿是囊性棘球蚴病的主要表现。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2025-01-01 Epub Date: 2024-12-07 DOI: 10.1002/uog.27672
E Teodorico, F Moro, A Santoro, G Scaglione, A Infante, C Silvi, M Granata, G Zannoni, G Scambia, A C Testa
{"title":"Retroperitoneal cyst with iliac stent involvement as primary manifestation of cystic echinococcosis.","authors":"E Teodorico, F Moro, A Santoro, G Scaglione, A Infante, C Silvi, M Granata, G Zannoni, G Scambia, A C Testa","doi":"10.1002/uog.27672","DOIUrl":"10.1002/uog.27672","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"128-129"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946118","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
Prenatal diagnosis of rare case of macrostomia initially suspected as retrognathia. 产前诊断最初被怀疑为后颌畸形的罕见大畸形病例。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2025-01-01 Epub Date: 2024-11-27 DOI: 10.1002/uog.27683
M S Scalia, A Traunero, L Travan, F Cossovel, L Lo Bello, T Stampalija
{"title":"Prenatal diagnosis of rare case of macrostomia initially suspected as retrognathia.","authors":"M S Scalia, A Traunero, L Travan, F Cossovel, L Lo Bello, T Stampalija","doi":"10.1002/uog.27683","DOIUrl":"10.1002/uog.27683","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"123-125"},"PeriodicalIF":6.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946135","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
Assessment of interindividual follicular size variation at ovulation in natural-cycle frozen embryo transfer. 评估自然周期冷冻胚胎移植排卵时个体间卵泡大小的变化。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2025-01-01 Epub Date: 2024-10-10 DOI: 10.1002/uog.29123
J Edades, E Kalafat, B Ata, R Del Gallego, H Fatemi, B Lawrenz
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引用次数: 0
Critical procedural steps in intrauterine transfusion: Delphi survey of international experts. 宫内输血的关键程序步骤:国际专家德尔菲调查。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2025-01-01 DOI: 10.1002/uog.29151
E Moise, K J Moise, M Nwokocha, K Lowry, E Hutson, D P de Winter

Objective: To determine consensus, using Delphi methodology, on the critical procedural steps for intravascular intrauterine transfusion (IUT) for the treatment of fetal anemia.

Methods: We conducted a two-part Delphi survey of international experts in fetal intervention. The first round of the survey proposed 32 potentially critical steps for the IUT procedure. Participants were asked to rate all steps on a Likert scale ranging from 1 (not important) to 5 (absolutely essential). We calculated the mean Likert score and 95% CI for all steps. Procedural steps were determined to be critical if the lower bound of the 95% CI was ≥ 3.0 and were excluded if the upper bound of the 95% CI was ≤ 3.5. In the second round of the survey, participants were asked specific questions regarding parameters associated with the procedural steps determined to be critical in the first round.

Results: Overall, 49 individuals from 24 different countries (six continents) participated in both rounds of the Delphi survey. The median length of experience in fetal medicine was 21 (range, 4-38) years. The median number of IUT procedures performed annually per respondent was 20 (range, 2-80). Of the 32 proposed procedural steps, 20 were determined to be critical and 12 non-critical procedural steps were excluded. Respondents indicated that an individual should perform a median of 20 (range, 10-50) IUT procedures during training to attain competency, and that the median number of IUT procedures required annually to maintain competency was 10 (range, 5-20). There was marked variation between respondents in how they performed the following critical IUT procedural steps: preparation of donor blood, preoperative medication, maternal anesthesia, site chosen for cordocentesis, use of fetal paralysis, method for determining fetal hematocrit, postoperative care and decision to schedule a subsequent IUT.

Conclusions: The findings of this international Delphi survey can be used to standardize the approach to performing IUT. An experienced fetal interventionist should perform the procedure, and in centers in which IUT is performed infrequently, referral to a more experienced center should be considered. Calculating the specific volume of blood to transfuse at the start of the procedure and undertaking continuous fetal heart-rate monitoring once the gestational-age threshold for viability is reached were ranked highest in the intra- and postoperative phases of the procedure, respectively. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

目的:采用德尔菲方法,对治疗胎儿贫血的血管内宫内输注(IUT)的关键程序步骤达成共识。方法:对国际胎儿干预专家进行德尔菲调查。第一轮调查提出了宫内节育术的32个潜在关键步骤。参与者被要求对所有步骤进行李克特评分,从1(不重要)到5(绝对必要)。我们计算了所有步骤的平均李克特评分和95% CI。如果95% CI的下界≥3.0,则确定程序步骤为关键步骤;如果95% CI的上界≤3.5,则排除程序步骤。在第二轮调查中,参与者被问及与在第一轮中被确定为关键的程序步骤有关的参数的具体问题。结果:总的来说,来自24个不同国家(六大洲)的49个人参加了两轮德尔菲调查。胎儿医学经验的中位数为21年(范围4-38年)。每位应答者每年实施IUT手术的中位数为20例(范围2-80例)。在32个拟议的程序步骤中,20个被确定为关键程序步骤,12个非关键程序步骤被排除。受访者指出,个人在培训期间应进行20次(范围10-50次)的中位数IUT程序以获得能力,并且每年需要进行10次(范围5-20次)的中位数IUT程序以保持能力。在如何执行以下关键的IUT程序步骤方面,受访者之间存在显著差异:供体血液的准备、术前用药、产妇麻醉、脐带穿刺的选择、胎儿瘫痪的使用、测定胎儿红细胞压积的方法、术后护理和决定安排后续IUT。结论:本国际德尔菲调查结果可用于规范实施IUT的方法。经验丰富的胎儿介入医师应执行该程序,在不经常执行IUT的中心,应考虑转诊到更有经验的中心。在手术开始时计算输血的比血量,以及在达到生存能力的胎龄阈值后进行持续的胎儿心率监测,分别在手术内和术后阶段排名最高。©2024国际妇产科超声学会。
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引用次数: 0
Hypoplastic left heart complex with restrictive foramen ovale: challenges in predicting clinical outcome. 左心发育不良伴卵圆孔限制:预测临床结果的挑战。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2025-01-01 Epub Date: 2024-12-05 DOI: 10.1002/uog.29146
B T Haughian, L C Mills, L K Hornberger
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引用次数: 0
Re: Role of artificial-intelligence-assisted automated cardiac biometrics in prenatal screening for coarctation of aorta. 人工智能辅助心脏生物识别技术在产前主动脉缩窄筛查中的作用。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-12-15 DOI: 10.1002/uog.29158
G R DeVore
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引用次数: 0
Reply. 回复。
IF 6.1 1区 医学 Q1 ACOUSTICS Pub Date : 2024-12-15 DOI: 10.1002/uog.29160
K Mikolaj, C A Taksøe-Vester, O B B Petersen, N G Vejlstrup, A N Christensen, A Feragen, M Nielsen, M B S Svendsen, M G Tolsgaard
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引用次数: 0
期刊
Ultrasound in Obstetrics & Gynecology
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