Routine Ultrasound Examination Research Articles

Competing‐risks model for prediction of small‐for‐gestational‐age neonate from maternal characteristics, serum pregnancy‐associated plasma protein‐A and placental growth factor at 11–13 weeks' gestation

To expand a new competing-risks model for prediction of a small-for-gestational-age (SGA) neonate, by the addition of pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor (PlGF), and to evaluate and compare PAPP-A and PlGF in predicting SGA. This was a prospective observational study of 60 875 women with singleton pregnancy undergoing routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation. We fitted a folded-plane regression model for the PAPP-A and PlGF likelihoods. A previously developed maternal history model and the likelihood models were combined, according to Bayes' theorem, to obtain individualized distributions for gestational age (GA) at delivery and birth-weight Z-score. We assessed the discrimination and calibration of the model. McNemar's test was used to compare the detection rates for SGA with, without or independently of pre-eclampsia (PE) occurrence, of different combinations of maternal history, PAPP-A and PlGF, for a fixed false-positive rate. The distributions of PAPP-A and PlGF depend on both GA at delivery and birth-weight Z-score, in the same continuous likelihood, according to a folded-plane regression model. The new approach offers the capability for risk computation for any desired birth-weight Z-score and GA at delivery cut-off. PlGF was consistently and significantly better than PAPP-A in predicting SGA delivered before 37 weeks, especially in cases with co-existence of PE. PAPP-A had similar performance to PlGF for the prediction of SGA without PE. At a fixed false-positive rate of 10%, the combination of maternal history, PlGF and PAPP-A predicted 33.8%, 43.8% and 48.4% of all cases of a SGA neonate with birth weight < 10th percentile delivered at ≥ 37, < 37 and < 32 weeks' gestation, respectively. The respective values for birth weight < 3rd percentile were 38.6%, 48.7% and 51.0%. The new model performed well in terms of risk calibration. The combination of PAPP-A and PlGF values with maternal characteristics, according to Bayes' theorem, improves prediction of SGA. PlGF is a better predictor of SGA than PAPP-A, especially when PE is present. The new competing-risks model for SGA can be tailored to each pregnancy and to the relevant clinical requirements. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Fetal sigmoid colon mesentery made visible by routine ultrasound in the first and second trimester of pregnancy

BackgroundUltrasound is a routine procedure performed during pregnancy to monitor the status of the human fetus, including the development of the digestive tract. The aim of this publication was to determine the shape of the fetal sigmoid colon mesentery during the first and second trimester of pregnancy by means of ultrasound. MethodsThe study was performed in 45 pregnant women (age: 36.4 years on average, range 25–45) during a routine ultrasound examination. The fetuses were between 12 and 22 weeks of pregnancy. The shape of the fetal sigmoid colon mesentery was analyzed. ResultsWe visualized the triangular shape of the mesentery in all 45 cases. A prevalence of scalene or isosceles acute triangles was found in both trimesters. At the 12−13 weeks we observed 5 different forms of mesenteric triangles – the scalene or isosceles acute triangles appeared at 33.3% and 28.6%, respectively. The obtuse scalene was present in 23.8 %. In the 2nd trimester (20−22 weeks) 4 types were found, among them 37.5 % acute scalene and 33.3 % acute isosceles. ConclusionsThe fetal sigmoid colon mesentery can be visualized from the 12th week of pregnancy. The triangular shape of the sigmoid colon mesentery is easy to follow during routine ultrasound examinations.

Development and Validation of an Easy-to-Use Risk Scoring System for Screening High-Risk Varices in Patients with HBV-Related Compensated Advanced Chronic Liver Disease

BackgroundA large portion of patients with compensated advanced chronic liver disease (cACLD) do not have varices or only have low risk varices.AimsTo create and validate an easy-to-use risk scoring system to identify high-risk varices (HRV) and spare esophagogastroduodenoscopy (EGD) in patients with hepatitis B virus (HBV)-related cACLD.MethodsIn total, 334 patients with HBV-related cACLD who had undergone routine laboratory tests and ultrasound examination were enrolled. Multivariate logistic regression analysis was used to determine which variables were the independent risk factors for the presence of HRV, so as to establish the scoring system for screening HRV. The criteria were tested in a training cohort with 221 patients and validated in a validation cohort with 113 patients.ResultsIn the training cohort, the prevalence of HRV was 29.5%. Albumin (ALB) [OR 0.83; 95% confidence index (CI) 0.77–0.90; P < 0.0001], platelet count (PLT) (OR 0.96, 95% CI 0.96–0.99; P < 0.0001) and portal vein diameter (OR 1.40; 95% CI 1.15–1.71; P = 0.001) were independent risk factors for the presence of HRV. The negative predictive value was > 95%, when albumin-platelet-portal vein diameter varices scores (APP score) were < 0.24. One hundred twenty-five of 221 (56.6%) patients met an APP score < 0.24 with a 4.8% HRV miss rate. In the validation cohort, 59 of 113 (51.3%) patients met the APP score < 0.24 with a 1.7% HRV miss rate.ConclusionsAPP score is a potential model for safely screening HRV and sparing EGDs in patients with HBV-related cACLD.

Good practices for ultrasound examinations in gynecology and obstetrics during the COVID-19 pandemic.

Routine ultrasound examinations by specialists are an essential part of prenatal care and should be performed even in the extraordinary situation of the COVID-19 pandemic.

Accuracy of prenatal ultrasound screening to identify fetuses infected by cytomegalovirus which will develop severe long-term sequelae.

To compare the ability of detailed routine ultrasound examination, performed without knowledge of maternal serology and fetal status, with that of targeted prenatal imaging performed in prenatal diagnostic units in cases of known fetal infection to identify cytomegalovirus (CMV)-infected fetuses that will develop long-term sequelae. All prenatal imaging reports were collected for 255 children with congenital CMV in a registered cohort between 2013 and 2017 (NCT01923636). All women had undergone detailed routine fetal ultrasound examination at 20-24 and 30-34 weeks as part of routine antenatal care. All cases of known fetal CMV infection had also undergone targeted prenatal ultrasound examination. Postnatal structured follow-up for up to 48 months of age involved clinical, audiological and neurological assessment, including Brunet-Lezine scoring. Long-term sequelae (> 12 months) were considered to be mild in cases with isolated unilateral hearing loss and/or vestibular disorders, and severe in cases with bilateral hearing loss and/or neurological sequelae. All imaging reports were analyzed retrospectively with the knowledge of congenital CMV infection, searching for reference to findings that were, or could have been, related to fetal infection. Findings were analyzed in relation to whether the cases were diagnosed with CMV in utero or only postnatally. There were 237 children with complete follow-up data (> 12 months), for a median of 24(range, 12-48) months. Of these, 30% (71/237) were diagnosed with CMV prenatally and 70% (166/237) were diagnosed within 3 weeks after birth. 72.5% (29/40) of children with long-term sequelae, including 74% (14/19) with severe long-term sequelae, were not identified in the prenatal period. Among those diagnosed prenatally, the sensitivity of prenatal imaging for predicting long-term sequelae and severe long-term sequelae was 91% and 100%, respectively, while, in the group diagnosed only postnatally, non-specific infection-related ultrasound findings had been reported without raising suspicion in 48% of cases with long-term sequelae and 64% of those with severe long-term sequelae. Routine detailed ultrasound examination in pregnancy is not an appropriate screening tool for congenital CMV infection that leads to long-term sequelae, in contrast with the high performance of targeted prenatal imaging in known cases of fetal infection. The non-specific nature of ultrasound features of CMV and their evolution, and a lack of awareness of caregivers about congenital CMV, are likely explanations. Awareness of the sonologist regarding congenital CMV and knowledge of the maternal serological status in the first trimester seem key to the performance of prenatal ultrasound. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Left heart function evaluation of patients with essential hypertension and paroxysmal atrial fibrillation by two-dimensional speckle tracking imaging combined with real-time three-dimensional ultrasound imaging.

BackgroundThis study aims to assess the value of two-dimensional speckle tracking imaging (2D-STI) combined with real-time 3-dimensional echocardiography (RT-3DE) in evaluating left heart function in patients with combined ETH and PAF.MethodsA prospective study was designed, and the research period was from January 2017 to January 2020. A PAF observation group comprised of patients with ETH and PAF, a PAF control group of patients with ETH but without PAF, and a healthy volunteer group referred to as the healthy group, each comprised of 50 patients was established. All patients underwent routine ultrasound imaging examination using 2D-STI and RT-3DE. The interventricular septum thickness (IVST), left and right atrioventricular diameter (LAD), left ventricular posterior wall thickness (PWT), left ventricular ejection fraction (LVEF), the mean left atrium peak strain (mSs, mSe, mSa), strain rate (mSRs, mSRe, mSRa), the left ventricular mass (LVM), left ventricular mass index (LVMI), and left atrial total emptying volume (LATEV), the left atrial volume index (LAVI), left atrial total emptying fraction (LATEF), left atrium expansion index (LAEI), left atrium passive ejection fraction (LAPEF), and left atrial active ejection fraction (LAAEF) were calculated. Patients in the PAF observation group received telmisartan combined with rosuvastatin after diagnosis and 12- and 24-month-follow up visits were conducted. During these visits, 2D-STI combined with RT-3DE was used to evaluate cardiac function and each patient’s blood pressure was monitored.ResultsPatients in the PAF observation group had a significantly longer course of ETH than patients in the PAF control group (13.5±4.4 vs. 10.32±5.6, P=0.002). The comparison of routine 2D-STI and RT-3DE ultrasound indexes among the three groups also showed significant differences (P<0.01). During the 2-year follow-up period, the IVST, LAD, PWT, and LVEF of remaining patients significantly improved as treatment progressed (P<0.05). The LAVI, LATEF, and LAEI also improved significantly as the treatment progressed (P<0.05). After 12 months of treatment, the recurrence rate of atrial fibrillation was 16.33% (8/45) and after 24 months this was 34.21% (13/38).ConclusionsCardiac function could be evaluated comprehensively by 2D-STI combined with RT-3DE in patients with ETH combined with PAF at initial diagnosis and follow-up.

Prediction of fetal weight based on back propagation neural network optimized by genetic algorithm.

Fetal weight is an important index to judge fetal development and ensure the safety of pregnant women. However, fetal weight cannot be directly measured. This study proposed a prediction model of fetal weight based on genetic algorithm to optimize back propagation (GA-BP) neural network. Using random number table method, 80 cases of pregnant women in our hospital from September 2018 to March 2019 were divided into control group and observation group, 40 cases in each group. The doctors in the control group predicted the fetal weight subjectively according to routine ultrasound and physical examination. In the observation group, the continuous weight change model of pregnant women was established by using the regression model and the historical physical examination data obtained by feature normalization pretreatment, and then the genetic algorithm (GA) was used to optimize the initial weights and thresholds of back propagation (BP) neural network to establish the fetal weight prediction model. The coincidence rate of fetal weight was compared between the two groups after birth. Results: The prediction error of GA-BPNN was controlled within 6%. And the accuracy of GA-BPNN was 76.3%, which were 14.5% higher than that of traditional methods. According to the error curve, GA-BP is more effective in predicting the actual fetal weight. Conclusion: The GA-BPNN model can accurately and quickly predict fetal weight.

Influence of birth weight on fetal cardiac indices at 35–37 weeks' gestation

Echocardiographic studies have reported that fetuses with low birth weight, compared to those with normal birth weight, have globular hearts and reduced cardiac function. Dichotomizing continuous variables, such as birth weight, may be helpful in describing pathology in small studies but can prevent us from identifying physiological responses in relation to change in size. The aim of this study was to explore associations between fetal cardiac morphology and function and birth weight, as a continuous variable, as well as uterine artery (UtA) pulsatility index (PI), as an indirect measure of placental perfusion, and the cerebroplacental ratio (CPR), as an indirect measure of fetal oxygenation. This was a prospective study of 1498 women with singleton pregnancy undergoing routine ultrasound examination at 35 + 0 to 36 + 6 weeks' gestation. Pregnancies complicated by pregestational or gestational diabetes mellitus, chronic hypertension, pregnancy-induced hypertension or pre-eclampsia were excluded from the analysis. Conventional and more advanced echocardiographic modalities, such as speckle tracking, were used to assess fetal cardiac function in the right and left ventricles. The morphology of the fetal heart was assessed by calculating the right and left sphericity indices. In addition, the PI of the UtA, umbilical artery (UA) and fetal middle cerebral artery (MCA) was determined and the CPR was calculated by dividing MCA-PI by UA-PI. Multiple linear regression models were used to assess determinants of fetal echocardiographic parameters. The study population included 146 (9.7%) small-for-gestational-age (SGA) fetuses with birth weight < 10th percentile and 68 (4.5%) with fetal growth restriction (FGR). In the SGA and FGR groups, compared to the non-SGA and non-FGR fetuses, respectively, there was a more globular right ventricle and reduced left and right ventricular systolic function, and, from the left ventricular diastolic functional indices, the E/A ratio was increased. There was a linear association of right ventricular sphericity index, indices of left and right ventricular systolic function and E/A ratio with birth-weight Z-score. There were no significant associations between cardiac morphological and functional indices and UtA-PI Z-score or CPR Z-score. This screening study at 35-37 weeks' gestation has demonstrated that birth weight is a determinant of fetal cardiac morphology and function but UtA-PI and CPR, as indirect measures of placental perfusion and fetal oxygenation, are not. This suggests that the differences in fetal cardiac indices between small and appropriately grown fetuses may be part of a normal physiological response to change in fetal size rather than part of a pathological adaptation to abnormal placental perfusion and fetal oxygenation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Competing-risks model for prediction of small-for-gestational-age neonate from biophysical and biochemical markers at 11-13 weeks' gestation.

To develop a new competing-risks model for the prediction of a small-for-gestational-age (SGA) neonate, based on maternal factors and biophysical and biochemical markers at 11-13 weeks' gestation. This was a prospective observational study in 60 875 women with singleton pregnancy undergoing routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation. All pregnancies had pregnancy-associated plasma protein-A and placental growth factor (PlGF) measurements, 59 001 had uterine artery pulsatility index (UtA-PI) measurements and 58 479 had mean arterial pressure measurements; 57 131 cases had complete data for all biomarkers. We used a previously developed competing-risks model for the joint distribution of gestational age (GA) at delivery and birth-weight Z-score, according to maternal demographic characteristics and medical history. The likelihoods of the biophysical markers were developed by fitting folded-plane regression models, a technique that has already been used in previous studies for the likelihoods of biochemical markers. The next step was to modify the prior distribution by the likelihood, according to Bayes' theorem, to obtain individualized distributions for GA at delivery and birth-weight Z-score. We used the 57 131 cases with complete data to assess the discrimination and calibration of the model for predicting SGA with, without or independently of pre-eclampsia, by different combinations of maternal factors and biomarkers. The distribution of biomarkers, conditional to both GA at delivery and birth-weight Z-score, was best described by folded-plane regression models. These continuous two-dimensional likelihoods update the joint distribution of birth-weight Z-score and GA at delivery that has resulted from a competing-risks approach; this method allows application of user-defined cut-offs. The best biophysical predictor of preterm SGA was UtA-PI and the best biochemical marker was PlGF. The prediction of SGA was consistently better for increasing degree of prematurity, greater severity of smallness, coexistence of PE and increasing number of biomarkers. The combination of maternal factors with all biomarkers predicted 34.3%, 48.6% and 59.1% of all cases of a SGA neonate with birth weight < 10th percentile delivered at ≥ 37, < 37 and < 32 weeks' gestation, at a 10% false-positive rate. The respective values for birth weight < 3rd percentile were 39.9%, 53.2% and 64.4%, and for birth weight < 3rd percentile with pre-eclampsia they were 46.3%, 66.8% and 80.4%. The new model was well calibrated. This study has presented a single continuous two-dimensional model for prediction of SGA for any desired cut-offs of smallness and GA at delivery, laying the ground for a personalized antenatal plan for predicting and managing SGA, in the milieu of a new inverted pyramid of prenatal care. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

The ability of Micropure® ultrasound technique to identify microcalcifications in carotid plaques

ObjectivesTo study the ability of Micropure® ultrasound technique to identify microcalcifications in carotid plaques. MethodsForty-four carotids in 22 patients were enrolled in this study and were detected by routine ultrasound examination and Micropure® examination at the same time to identify microcalcifications in plaques. The results were compared with the tissue-background ratio (TBR) in 18F-NaF PET-CT imaging, which was performed one or two days after the ultrasound examination. ResultsIn the 44 carotids, plaques were detected in 37 carotids. Microcalcifications were detected by the Micropure® technique in 32 carotids, which were located surrounded by macrocalcifications in 23 carotids, in the fibre cap in 12 carotids, and in the base of the plaque in 6 carotids. Microcalcifications were not detected in 12 carotids. In 18F-NaF PET-CT examination, TBR > 1.61 (range 1.62–3.99, mean 2.25 ± 0.58) was detected in 37 carotids, and TBR < 1.61 was detected in 7 carotids. There were no significant differences between the two methods in detecting microcalcifications (p = 0.180). The sensitivity of the Micropure® technique in detecting microcalcifications was 81.08 %, and the specificity was 71.43 %. ConclusionsMicrocalcifications in the carotid artery detected by the Micropure® technique were well in accordance with 18F-NaF PET-CT scanning, with better sensitivity and specificity.

Quantification of Hepatic and Splenic Stiffness After Fontan Procedure in Children and Clinical Implications.

We aimed to investigate Fontan associated liver disease in children by shear wave elastography (SWE). This is a single-center, prospective case-control study included 41 patients with Fontan physiology and 30 healthy controls. Hepatic and splenic shear wave elasticity values were exhibited both as kPa and m/s. The mean hepatic SWE values of Fontan patients (n = 41; 15.8 ± 3.2 kPa or 2.5 ± 1.8 m/s) were significantly higher than the control group (n = 30; 5.59 ± 0.6 kPa or 1.37 ± 0.07 m/s) (P < 0.001). The mean splenic SWE values of Fontan patients were (25.6 ± 4.61 kPa or 2.85 ± 0.22 m/s) significantly higher than the control group (15.9 ± 1.44 kPa or 2.29 ± 0.1 m/s) (P < 0.001). There were statistically significant positive correlations among the follow-up duration after the Fontan procedure with NT-proBNP (P = 0.008, r = 1) and prothrombin time (P = 0.009, r = 0.4) as well as the hepatic SWE values with alanine aminotransferase (P = 0.039, r = 0.32), gamma-glutamyl transferase (P = 0.045, r = 0.31), and PT (P = 0.011, r = 0.39). There has been statistically significant moderate positive correlations of splenic stiffness values with PT (P = 0.047, r = 0.34), and INR (P = 0.038, r = 0.35). The sensitivity and specificity of liver stiffness cutoff value as 11.1 kPa for detection of Fontan associated liver disease were 95% and 100%, respectively. The hepatic and splenic stiffness increase independently in Fontan patients due to parenchymal disease. Hepatic SWE is a reliable and noninvasive predictor of early hepatic alterations that could not be detected only by biochemical results or routine ultrasound examinations.

The psychological burden of routine prenatal ultrasound on women’s state anxiety across the three trimesters of pregnancy

ObjectiveAlthough obstetric ultrasound examination has recognizable clinical and psychological benefits, it also involves some psychological burdens, mainly in terms of the woman’s state anxiety, the level of which can change during pregnancy. This research aimed to study the influence of routine ultrasound examination on the woman’s state anxiety and its relation with her personality background in the three trimesters of pregnancy. Study designThis work was a prospective interventional study. Women who underwent routine-screening ultrasound examinations in the first, second, or third trimester of pregnancy were recruited. The state anxiety level was assessed using the State-Trait Anxiety Inventory - subscale S (S-Anxiety), administered immediately before and after the exams. More stable personality characteristics were evaluated before ultrasound, assessing trait anxiety by State-Trait Anxiety Inventory - subscale T (T-Anxiety) and psychological coping by Coping Orientations to Problem Experienced (COPE). The S-Anxiety scores, collected immediately before and after the exams, were compared by two-tailed paired t-test. Moreover, S-Anxiety scores collected in each one of the three-trimester groups immediately before and after the exams were compared by one-way between groups ANOVA. Relations among S-Anxiety scores with more stable aspects of personality (T-Anxiety and COPE scores) were also studied, by correlation analysis. ResultsA total of 285 women were recruited. In all trimesters, S-Anxiety scores decreased significantly after the exam (P < 0.001), with a more relevant reduction in women with higher T-Anxiety scores (P < 0.001). A gradual decrease in S-Anxiety scores before the examination was seen across the three trimesters, with significantly higher scores in the first trimester (P = 0.016). Before ultrasound, S-Anxiety score resulted positively correlated with avoidance coping strategies (P < 0.001), while it was inversely related to active coping style (P < 0.001) and positive aptitude (P < 0.001). ConclusionsThe psychological burden of prenatal ultrasound in the different trimesters of pregnancy was studied. Clinicians should be sensitive to women’s state anxiety during prenatal routine-screening ultrasound examination, using a personalized approach. Particular attention should be paid to the psychological burden associated with ultrasound evaluation of the first trimester, when the level of the anxiety state is higher.

Fetal Echocardiography as a Screening Method for Detection of Congenital Heart Disease

Background: Congenital heart diseases (CHDs) are among the most common congenital abnormalities. They are frequently missed on routine obstetric ultrasound (US) examination. Although fetal echocardiography is reserved only for high-risk cases, many cases with cardiac abnormalities are born to mothers with no identifiable risk factors. Aim of work: is to assess fetal echocardiography as a screening method for prenatal detection of cardiac abnormalities in an un-selected group of pregnant females. Patients and Methods: During the period of March 2108 to March 2019, 150 fetuses for 149 un-selected pregnant female (there was a set of twin pregnancy) underwent a detailed fetal echocardiographic examination; cases that had maternal, fetal or familial risk factors for CHD were categorized as high risk, others with no known risk factors were low risk. Results: Structural heart defects were found in 6 (4%) fetuses in both high and low risk groups. The prevalence of prenatally detected cardiac abnormalities was 3.5% in the low-risk group and 5.5 % % in the high-risk group. The difference in the incidence of CHD between the two groups was not statistically significant (P=0.4). Conclusion: Our study shows no difference in the incidence of CHDs between pregnancies associated with high risk factors compared to those with no risk factors, so we advocate fetal echocardiography to be included in any fetal anomaly scanning for every pregnant woman regardless the presence of risk factors

Rethinking Prenatal Screening for Anomalies of Placental and Umbilical Cord Implantation.

The most common anomalies of implantation of the placenta and umbilical cord include placenta previa, placenta accreta spectrum, and vasa previa, and are associated with considerable perinatal and maternal morbidity and mortality. There is moderate quality evidence that prenatal diagnosis of these conditions improves perinatal outcomes and the performance of ultrasound imaging in diagnosing them is considered excellent. The epidemiology of placenta previa is well known, and it is standard clinical practice to assess placental location at the routine screening second-trimester detailed fetal anatomy ultrasound examination. In contrast, the prevalence of placenta accreta spectrum and vasa previa in the general population is more difficult to evaluate because detailed confirmatory histopathologic data are not available in most studies. The sensitivity and specificity of ultrasonography for the diagnosis of these anomalies is also difficult to assess. Recent epidemiologic studies show an increase in the incidence of placental and umbilical cord implantation anomalies, which may be the result of increased use of assisted reproductive technology and cesarean delivery. There is good evidence to support targeted standardized protocols for women at high risk and that screening and diagnosing placenta accreta spectrum and vasa previa should be integrated into obstetric ultrasound training programs.

A Study on Histopathological Pattern of Ovarian Tumours in Chittagong Medical College Hospital

Background: Ovarian tumours may either be asymptomatic, found on the routine ultrasound examination or symptoms may be vague till the patient has an acute emergency like torsion or rupture of a benign cyst. The worst is late presentation of malignant ovarian tumour. There is marked variation in the presentation of the tumour as well as in histological types. This study was under taken to analyse modes of presentation and various histopathological patterns of ovarian tumour.&#x0D; Materials and Methods: A total of 69 cases were selected consecutively. The age range was 13-70 years. This study was carried out in the Department of Pathology, Chittagong Medical College and Department of Gynaecology and obstetrics, Chittagong Medical College Hospital during the period from July 2013 to June 2014. The specimens of ovarian tumours were subjected to histopathological examination in the histopathology section.&#x0D; Results : Out of 69 cases, 54(78.3%) were benign and 15(21.7%) were malignant tumour. There was no borderline malignancy in our study. The commonest histological pattern in this study was surface epithelial tumour 49(70.6%) including both benign and malignant tumour followed by germ cell tumour 6(8.7%). The commonest benign tumour was serous cyst cyst adenoma 23(33.4) and malignant tumour was serous cyst adenocarcinoma 5(7.2%).&#x0D; Conclusion : Surface epithelial tumours are the commonest variety of ovarian tumour followed by germ cell tumour. The histological type of ovarian tumour correlates with the prognosis of the tumour.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.19 (2); July 2020; Page 13-17

New approach for estimating risk of miscarriage after chorionic villus sampling.

ABSTRACTObjectiveTo estimate the risk of miscarriage associated with chorionic villus sampling (CVS).MethodsThis was a retrospective cohort study of women attending for routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation at one of eight fetal‐medicine units in Spain, Belgium and Bulgaria, between July 2007 and June 2018. Two populations were included: (1) all singleton pregnancies undergoing first‐trimester assessment at Hospital Clínico Universitario Virgen de la Arrixaca in Murcia, Spain, that did not have CVS (non‐CVS group); and (2) all singleton pregnancies that underwent CVS following first‐trimester assessment at one of the eight participating centers (CVS group). We excluded pregnancies diagnosed with genetic anomalies or major fetal defects before or after birth, those that resulted in termination and those that underwent amniocentesis later in pregnancy. We used propensity score (PS) matching analysis to estimate the association between CVS and miscarriage. We compared the risk of miscarriage of the CVS and non‐CVS groups after PS matching (1:1 ratio). This procedure creates two comparable groups balancing the maternal and pregnancy characteristics that are associated with CVS, in a similar way to that in which randomization operates in a randomized clinical trial.ResultsThe study population consisted of 22 250 pregnancies in the non‐CVS group and 3613 in the CVS group. The incidence of miscarriage in the CVS group (2.1%; 77/3613) was significantly higher than that in the non‐CVS group (0.9% (207/22 250); P < 0.0001). The PS algorithm matched 2122 CVS with 2122 non‐CVS cases, of which 40 (1.9%) and 55 (2.6%) pregnancies in the CVS and non‐CVS groups, respectively, resulted in a miscarriage (odds ratio (OR), 0.72 (95% CI, 0.48–1.10); P = 0.146). We found a significant interaction between the risk of miscarriage following CVS and the risk of aneuploidy, suggesting that the effect of CVS on the risk of miscarriage differs depending on background characteristics. Specifically, when the risk of aneuploidy is low, the risk of miscarriage after CVS increases (OR, 2.87 (95% CI, 1.13–7.30)) and when the aneuploidy risk is high, the risk of miscarriage after CVS is paradoxically reduced (OR, 0.47 (95% CI, 0.28–0.76)), presumably owing to prenatal diagnosis and termination of pregnancies with major aneuploidies that would otherwise have resulted in spontaneous miscarriage. For example, in a patient in whom the risk of aneuploidy is 1 in 1000 (0.1%), the risk of miscarriage after CVS will increase to 0.3% (0.2 percentage points higher).ConclusionsThe risk of miscarriage in women undergoing CVS is about 1% higher than that in women who do not have CVS, although this excess risk is not solely attributed to the invasive procedure but, to some extent, to the demographic and pregnancy characteristics of the patients. After accounting for these risk factors and confining the analysis to low‐risk pregnancies, CVS seems to increase the risk of miscarriage by about three times above the patient's background risk. Although this is a substantial increase in relative terms, in pregnancies without risk factors for miscarriage, the risk of miscarriage after CVS remains low and similar to, or slightly higher than, that in the general population. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Prevention of Stillbirth: Impact of Two-Stage Screening for Vasa Previa

OBJECTIVES To examine the feasibility and effectiveness of a two-stage ultrasound screening strategy for detection of vasa previa and to estimate the potential impact of screening on prevention of stillbirth. METHODS This was a retrospective study of data from prospective screening for vasa previa in singleton pregnancies, undertaken at the Fetal Medicine Unit at Medway Maritime Hospital, UK, between 2012 and 2018. Women booked for prenatal care and delivery in our hospital had routine ultrasound examinations at 11-13 and 20-22 weeks' gestation. Those with velamentous cord insertion at the inferior part of the placenta at the first-trimester scan and those with low-lying placenta at the second-trimester scan were classified as high-risk for vasa previa and had transvaginal sonography searching specifically for vasa previa, at the time of the 20-22-week scan. The management and outcome of cases with suspected vasa previa is described. We excluded cases of miscarriage or termination at < 24 weeks' gestation. RESULTS The study population of 26 830 singleton pregnancies included 21 (0.08%; 1 in 1278) with vasa previa. In all cases of vasa previa, the diagnosis was made at the 20-22-week scan and confirmed postnatally by gross and histological examination of the placenta. At the 11-13-week scan, cord insertion was classified as central in 25 071 (93.4%) cases, marginal in 1680 (6.3%), and velamentous in 79 (0.3%). In 16 (76.2%) of the 21 cases of vasa previa, cord insertion at the first-trimester scan was classified as velamentous at the inferior part of the placenta, in two cases (9.5%) as marginal and in three cases (14.3%) as central. The 21 cases of vasa previa were managed on an outpatient basis with serial scans for measurement of cervical length and elective Cesarean section at 34 weeks' gestation; all babies were liveborn but there was one neonatal death. In the study population, there were 83 stillbirths, none of which had evidence of vasa previa on postnatal examination. On the assumption that, if we had not diagnosed prenatally all 21 cases of vasa previa in our population, half of these cases would have resulted in stillbirth, then the potential impact of screening is prevention of 10.6% (10/94) of stillbirths. CONCLUSION A two-stage strategy of screening for vasa previa can be incorporated into routine clinical practice, and such a strategy could potentially reduce the rate of stillbirth. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

VP26.16: Antenatal diagnosis and fetal pathology examination of alobar holoprosencephaly: a case report

Holoprosencephaly is a rare congenital anomaly, which occurs due to the failure of prosencephalon to develop into two hemispheres. A series of facial anomalies are frequently associated, owing to the common origin of the embryonic forebrain and mid-face from the prechordal mesoderm, along with some other anomalies. Holoprosencephaly is estimated to occur in 1.31 per 10,000 births. We report a case of a 20-year-old primigravida presented to the department of obstetrics and gynecology for a routine obstetric ultrasound examination. There was a history of consanguinity of marriage. Her mother had seven misscarriages. Ultrasonography revealed a single live intrauterine fetus of 19 weeks. A large monoventricle was noticed with centrally fused thalami and peripherally compressed cerebral parenchyma; interhemispheric fissure, falx cerebri and corpus callosum were completely absent; hypotelorism was noticed; the spine, heart, limbs and umbilical cord were sonologically normal; the amniotic fluid around the fetus was normal in quantity. Biological assessment as well as serology eliminated maternal diabetes and recent toxoplasmosis or rubella infection; FISH test was done and was normal. Pregnancy termination was performed at 21 weeks with vaginal delivery of a dead female fetus. Fetal pathology examination showed facial abnormalities: macrocrania, hypotelorism and premaxillary agenesis; dissection confirmed alobar holoprosencephaly; trunk and limbs were normal.

Allergic disease and risk of stress in pregnant women: a PreventADALL study.

BackgroundMaternal stress during pregnancy may negatively affect the health of mother and child. We therefore aimed to identify the proportion of women reporting high maternal stress in mid and late pregnancy and explore whether symptoms of maternal allergic disease are associated with perceived maternal stress in late pregnancy.MethodThe population-based Preventing Atopic Dermatitis and Allergy in Children (PreventADALL) study enrolled 2697 pregnant women at their 18-week routine ultrasound examination in Norway and Sweden. Information about sociodemographic factors, symptoms and doctor-diagnosed asthma, allergic rhinitis, atopic dermatitis, food allergy, and anaphylaxis and stress using the 14-item perceived stress scale (PSS) was collected at 18 weeks (mid) and 34 weeks (late) pregnancy. High stress was defined as a PSS score ≥29. Scores were analysed using multivariate logistic and linear regression.ResultsAmong the 2164 women with complete PSS data, 17% reported asthma, 20% atopic dermatitis, 23% allergic rhinitis, 12% food allergy and 2% anaphylaxis. The proportion of women reporting high stress decreased from 15% at mid to 13% at late pregnancy (p<0.01). The adjusted odds ratio for high stress in late pregnancy was 2.25 (95% CI 1.41–3.58) for self-reported symptoms of asthma, 1.46 (95% CI 1.02–2.10) for allergic rhinitis and 2.25 (95% CI 1.32–3.82) for food allergy. A multivariate linear regression model confirmed that symptoms of asthma (β coefficient 2.11; 0.71–3.51), atopic dermatitis (β coefficient 1.76; 0.62–2.89) and food allergy (β coefficient 2.24; 0.63–3.84) were independently associated with increased PSS score.ConclusionAllergic disease symptoms in pregnancy were associated with increased stress, highlighting the importance of optimal disease control in pregnancy.

Competing-risks model for prediction of small-for-gestational-age neonate from maternal characteristics and serum pregnancy-associated plasma protein-A at 11-13 weeks' gestation.

To develop a continuous likelihood model for pregnancy-associated plasma protein-A (PAPP-A), in the context of a new competing-risks model for prediction of a small-for-gestational-age (SGA) neonate, and to compare the predictive performance of the new model for SGA to that of previous methods. This was a prospective observational study of 60 875 women with singleton pregnancy undergoing routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation. The dataset was divided randomly into a training dataset and a test dataset. The training dataset was used for PAPP-A likelihood model development. We used Bayes' theorem to combine the previously developed prior model for the joint Gaussian distribution of gestational age (GA) at delivery and birth-weight Z-score with the PAPP-A likelihood to obtain a posterior distribution. This patient-specific posterior joint Gaussian distribution of GA at delivery and birth-weight Z-score allows risk calculation for SGA defined in terms of different birth-weight percentiles and GA. The new model was validated internally in the test dataset and we compared its predictive performance to that of the risk-scoring system of the UK National Institute for Health and Care Excellence (NICE) and that of logistic regression models for different SGA definitions. PAPP-A has a continuous association with both birth-weight Z-score and GA at delivery according to a folded-plane regression. The new model, with the addition of PAPP-A, was equal or superior to several logistic regression models. The new model performed well in terms of risk calibration and consistency across different GAs and birth-weight percentiles. In the test dataset, at a false-positive rate of about 30% using the criteria defined by NICE, the new model predicted 62.7%, 66.5%, 68.1% and 75.3% of cases of a SGA neonate with birth weight < 10th percentile delivered at < 42, < 37, < 34 and < 30 weeks' gestation, respectively, which were significantly higher than the respective values of 46.7%, 55.0%, 55.9% and 52.8% achieved by application of the NICE guidelines. Using Bayes' theorem to combine PAPP-A measurement data with maternal characteristics improves the prediction of SGA and performs better than logistic regression or NICE guidelines, in the context of a new competing-risks model for the joint distribution of birth-weight Z-score and GA at delivery. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.