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Linked article: This Correspondence comments on Lapa et al. Click here to view the article. [ABSTRACT FROM AUTHOR]

This policy set an overall goal of reducing the national multiple-birth rate following conception by IVF to 10% and set a maximum multiple-birth rate that clinics must not exceed. However, according to a HFEA report, the multiple-birth rate following IVF has decreased, as fertility clinics moved towards more single-embryo transfers. Most research papers and editorials on twin pregnancy published in the past 10 years began by acknowledging the global rise in the rate of twin pregnancy, primarily due to increasing maternal age and more widespread use of assisted conception. [Extracted from the article]

The article presents notes for contributors including manuscript style, copyright, and issue's editors.

The article presents instructions for contributors to the journal "Ultrasound in Obstetrics and Gynecology" including manuscript style, manuscript submission and reference style.

Obliteration of intracranial translucency (IT) is an excellent marker for detecting open spina bifida (OSB) and inclusion of IT in routine screening has helped in its early detection. Once the Chiari malformation is confirmed focus is on the spine to visualise the defect. This paper illustrates 3D evaluation of the normal and abnormal anatomy of brain and spine in OSB. [Extracted from the article]

The purpose of this study is to evaluate the repeatability of real-time shear wave elastography in measuring the elastic modulus of puborectalis muscle. IBM SPSS Statistics 20 software was used for statistical analysis, and the measurement data were expressed by mean value standard deviation. In this paper, the internal repeatability of the SWE technique in the resting state to determine the young's modulus of the puborectalis was studied, and the results showed that the repeatability was good. [Extracted from the article]

The article presents a reply to the clarification of the article "Three-dimensional ultrasound imaging of intra-abdominal cervical-isthmus cerclage" presented in the Ultrasound Obstet Gynecol 2018.

The world was very different in 1990 compared to today; there was no web, internet, Twitter, social media or mobile phones. Not only was I to host the first world congress, in London, in a year's time, but I was to set up a new international journal, covering obstetric and gynecological ultrasound, to be published in time for the congress delegates to find in their bag. GLO:F0Y/01jan21:uog23556-fig-0001.jpg PHOTO (COLOR): 1 Collage from ISUOG's First World Congress on Ultrasound in Obstetrics and Gynecology. Gl Our Journal Early in 1990, the creation of a new journal now became a priority if the deadline of having the first issue ready for the start of the First World Congress was to be met. [Extracted from the article]

Objective To assess the performance of contrast-enhanced ultrasound ( CE-US) in the differential diagnosis of malignant and benign ovarian tumors. Methods We conducted a comprehensive literature search of PubMed and EMBASE to identify published articles evaluating the diagnostic potential of CE-US for the differentiation of benign and malignant ovarian tumors. Inclusion criteria were: (1) the study assessed the accuracy (or sensitivity and specificity) of CE-US for diagnosis of benign and malignant ovarian tumors; (2) it used surgery and histopathology as the reference standard for distinguishing between benign and malignant tumors; (3) it included data allowing construction of a 2×2 contingency table for true- and false-positives and negatives. We present summary sensitivity, specificity, diagnostic odds ratio (OR) and areas under the summary receiver-operating characteristics curves ( AUCs). Results Preliminary screening identified 103 papers, of which 11 fulfilled our predefined inclusion criteria and underwent final analysis. The pooled sensitivity and specificity of CE-US for diagnosis of benign and malignant ovarian tumors were 93% (95% CI, 89-96%) and 95% (95% CI, 92-96%), respectively. The pooled diagnostic OR was 171.2 (95% CI, 65.9-444.6) and the AUC was 0.98. I2 values of sensitivity, specificity and diagnostic OR were 38.3%, 31.7% and 48.4%, respectively, all indicating moderate heterogeneity. Conclusions The evidence from available studies suggests CE-US is useful for discriminating between benign and malignant ovarian tumors; however, further studies are needed to examine whether CE-US has improved diagnostic test accuracy compared with that of standard two-dimensional Doppler sonography. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives To evaluate the diagnostic accuracy of ultrasound in predicting the location of an intrauterine pregnancy before visualization of the yolk sac is possible. Methods This was a systematic review conducted in accordance with the PRISMA statement and registered with PROSPERO. We searched MEDLINE, EMBASE and The Cochrane Library for relevant citations. Studies were selected in a two-stage process and their data extracted by two reviewers. Accuracy measures were calculated for each ultrasound sign, i.e. gestational sac, double decidual sac sign, intradecidual sign, chorionic rim sign and yolk sac. Individual study estimates were plotted in summary receiver-operating characteristics curves and forest plots for examination of heterogeneity. The quality of included studies was assessed. Results Seventeen studies including 2564 women were selected from 19 959 potential papers. Following meta-analysis, the presence of a gestational sac on ultrasound examination was found to predict an intrauterine pregnancy with a sensitivity of 52.8% (95% CI, 38.2-66.9%) and specificity of 97.6% (95% CI, 94.3-99.0%). The corresponding performance of the double decidual sac sign, intradecidual sign, chorionic rim sign and yolk sac were: 81.8% (95% CI, 68.1-90.4%) and 97.3% (95% CI, 76.1-99.8%); 66.1% (95% CI, 58.9-72.8%) and 100% (95% CI, 91.0-100%); 79.9% (95% CI, 73.0-85.7%) and 97.1% (95% CI, 89.9-99.6%); and 42.2% (95% CI, 27.7-57.9%) and 100% (95% CI, 54.1-100%), respectively. Conclusion Visualization of a gestational sac, double decidual sac sign, intradecidual sign or chorionic rim sign increases the probability of an intrauterine pregnancy but is not as accurate for diagnosis as the detection of the yolk sac. However, the findings were limited by the small number and poor quality of the studies included and heterogeneity in the index test and reference standard. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives To evaluate differences between international fetal centers in their treatment of twin-twin transfusion syndrome ( TTTS) by fetoscopic placental laser coagulation. Methods Fetal therapy centers worldwide were sent a web-based questionnaire. Participants were identified through networks and through scientific presentations and papers. Questions included physician and center demographics, treatment criteria, operative technique and instrumentation. Laser treatment was compared between low-volume (< 20 procedures/year) and high-volume (≥ 20 procedures/year) centers. Data were analyzed using descriptive statistics. Results Of 106 fetal therapy specialists approached, 76 (72%) from 64 centers in 25 countries responded. Of these, 48% (31/64) of centers and 63% (48/76) of operators performed fewer than 20 laser procedures annually. Comparison of low- and high-volume centers showed differences in technique, gestational age limits for treatment and geography. High-volume centers more often used the Solomon technique and applied wider gestational age limits for treatment. Europe and Asia had more high-volume centers, whereas South America, the Middle East and Australia had mainly low-volume centers. Conclusion This survey revealed significant differences between fetal centers in several aspects of fetoscopic placental laser therapy for TTTS. Increasing awareness of TTTS, and of laser coagulation as its preferred treatment, will lead to an increase in centers offering this modality, especially in Asia, Africa, South America and the Middle East. Considering the rarity of TTTS and the relative complexity of the procedure, developing international guidelines for techniques, instrumentation and suggested minimum volumes per center may aid in optimizing perinatal outcome. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

The article comments on a paper which examines the use of Z-scores in the analysis of fetal cardiac dimensions. He stresses that Z-scores allow for a more precise evaluation of complex heart defects that alter cardiac dimensions. He emphasizes that the provision of a graphical display of Z-scores in the paper may be inconvenient for some to compute. He believes that the study is a significant contribution to the evaluation of the size of cardiac structures during fetal development.

The author reflects on the importance of citations and reference lists. According to the author, the list of references is an indispensable part of a publication. It puts the study, its results and the ensuing discussion into the appropriate context. Previous and related results are acknowledged, compared and discussed.

The article offers notes to contributors of the journal including file types and illustrations, manuscript style and reference style. The need for manuscripts to be submitted to the main web-based submission, peer review and manuscript tracking system is tackled. Information about color publication, copyright and ethical review is also presented.

The article offers information on the periodical including details for authors regarding submission of manuscripts; editors of the periodical such as Basky Thilaganathan, Ranjit Akolekar and Roberto Romero; and its copyright information.

ABSTRACT Objective To review systematically the medical literature reporting on the prevalence of a niche at the site of a Cesarean section ( CS) scar using various diagnostic methods, on potential risk factors for the development of a niche and on niche-related gynecological symptoms in non-pregnant women. Methods The PubMed and EMBASE databases were searched. All types of clinical study reporting on the prevalence, risk factors and/or symptoms of a niche in non-pregnant women with a history of CS were included, apart from case reports and case series. Results Twenty-one papers were selected for inclusion in the review. A wide range in the prevalence of a niche was found. Using contrast-enhanced sonohysterography in a random population of women with a history of CS, the prevalence was found to vary between 56% and 84%. Nine studies reported on risk factors and each study evaluated different factors, which made it difficult to compare studies. Risk factors could be classified into four categories: those related to closure technique, to development of the lower uterine segment or location of the incision or to wound healing, and miscellaneous factors. Probable risk factors are single-layer myometrium closure, multiple CSs and uterine retroflexion. Six out of eight studies that evaluated niche-related symptoms described an association between the presence of a niche and postmenstrual spotting. Conclusions The reported prevalence of a niche in non-pregnant women varies depending on the method of detection, the criteria used to define a niche and the study population. Potential risk factors can be categorized into four main categories, which may be useful for future research and meta-analyses. The predominant symptom associated with a niche is postmenstrual spotting. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To review systematically the literature on diagnostic tests and performance of second-trimester sonographic assessment of nasal bone ( NB) in identifying fetuses affected by Down syndrome. Methods A search of studies involving screening tests for NB evaluation and measurements was carried out in the main international bibliographic databases ( MEDLINE, EMBASE and CINAHL). Those considered to be relevant were then subjected to critical reading, following Critical Appraisal Skills Programme ( CASP) criteria, by at least three independent observers. All data were extracted and tabulated by two independent investigators. A statistical synthesis of sensitivity, specificity and likelihood ratios was performed using specific software (Meta- DiSc). Results From an initial list of 852 articles referring to ultrasound markers for Down syndrome, 207 relevant papers were selected. Following exclusions, 21 studies were included in the quantitative synthesis. The pooled estimates of positive and negative likelihood ratios were 40.08 (95% CI, 18.10-88.76) and 0.71 (95% CI, 0.64-0.79), respectively, for absent NB and 15.15 (95% CI, 8.15-28.16) and 0.47 (95% CI, 0.34-0.64), respectively, for hypoplastic NB. No relevant differences were found between the various means of defining nasal hypoplasia (multiples of the median ( MoM) or percentiles). The biparietal diameter/nasal bone length ( BPD/ NBL) ratio showed somewhat higher sensitivity but lower specificity with a threshold effect. Conclusions NB absence or hypoplasia show high specificity and low but acceptable sensitivity in identifying fetuses with Down syndrome. Screening performance is better with NB measurements as a function of MoM or percentiles rather than as the BPD/NBL ratio. Classification of women into various risk groups for Down syndrome does not affect diagnostic performance. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]

As we celebrate the 30 SP th sp anniversary of ISUOG and its Journal I Ultrasound in Obstetrics & Gynecology i (UOG), I cannot help but feel proud of the impressive evolution of the Journal over these years. This issue also includes high-impact research papers which highlight the breadth of topics the Journal now covers and in which ultrasound plays an instrumental or supporting role. Ultrasound Obstet Gynecol 2021; 57: 43 - 51. 3 Basurto D, Sananès N, Bleeser T, Valenzuela I, De Leon N, Joyeux L, Verbeken E, Vergote S, Van der Veeken L, Russo FM, Deprest J. Safety and efficacy of smart tracheal occlusion device in diaphragmatic hernia lamb model. Ultrasound Obstet Gynecol 1991; 1: 53 - 59. 11 Farren J, Jalmbrant M, Falconieri N, Mitchell-Jones N, Bobdiwala S, Al-Memar M, Tapp S, Van Calster B, Wynants L, Timmerman D, Bourne T. Differences in post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy between women and their partners: multicenter prospective cohort study. [Extracted from the article]

ABSTRACT Objective To evaluate the accuracy of antenatal sonographic measurement of lower uterine segment ( LUS) thickness in the prediction of risk of uterine rupture during a trial of labor ( TOL) in women with a previous Cesarean section ( CS). Methods PubMed and EMBASE were searched to identify articles published on the subject of sonographic LUS measurement and occurrence of a uterine defect after delivery. Four independent researchers performed identification of papers and data extraction. Selected studies were scored on methodological quality, and sensitivity and specificity of measurement of LUS thickness in the prediction of a uterine defect were calculated. We performed bivariate meta-analysis to estimate summary receiver-operating characteristics ( sROC) curves. Results We included 21 studies with a total of 2776 analyzed patients. The quality of included studies was good, although comparison was difficult because of heterogeneity. The estimated sROC curves showed that measurement of LUS thickness seems promising in the prediction of occurrence of uterine defects (dehiscence and rupture) in the uterine wall. The pooled sensitivity and specificity of myometrial LUS thickness for cut-offs between 0.6 and 2.0 mm was 0.76 (95% CI, 0.60-0.87) and 0.92 (95% CI, 0.82-0.97); cut-offs between 2.1 and 4.0 mm reached a sensitivity and specificity of 0.94 (95% CI, 0.81-0.98) and 0.64 (95% CI, 0.26-0.90). The pooled sensitivity and specificity of full LUS thickness for cut-offs between 2.0 and 3.0 mm was 0.61 (95% CI, 0.42-0.77) and 0.91 (95% CI, 0.80-0.96); cut-offs between 3.1 and 5.1 mm reached a sensitivity and specificity of 0.96 (95% CI, 0.89-0.98) and 0.63 (95% CI, 0.30-0.87). Conclusions This meta-analysis provides support for the use of antenatal LUS measurements in the prediction of a uterine defect during TOL. Clinical applicability should be assessed in prospective observational studies using a standardized method of measurement. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

The aim of this paper is to analyse the removed polyps, in infertile women, to detect the presence of malignancy in the analysed polyps. The study has been done at GAK "Narodni Front" in Belgrade, reviewing 100 infertile patients, after hysteroscopic polypectomy and the material has been sent to histopathological analysis in order to detect malignancy at the polyp. Hystopathological analysis of polyps removed by hysteroscopy, of 100 examined patients, found one endometrial carcinoma, and in one patient intraepithelial neoplasia. [Extracted from the article]

This paper summarised the outcomes of children with complete transposition of the great arteries treated in our hospital in the past 8 years and analysed the survival chances of children with this disease after birth. The condition, operation time, hospitalisation time and outcomes of these children were summarised and analysed. Most children with TGA without other severe cardiac malformations would successfully survive from the ASO surgery and have good prognosis if they are diagnosed and treated timely. [Extracted from the article]

The L1 cell adhesion molecule (L1CAM) gene (OMIM 308840), encodes the L1 cell adhesion molecule, is involved in the central nervous system development (ref). Loss of function mutations found in L1CAM may result in L1 syndrome which is associated with brain malformation and developmental delay. The findings in this paper were consistent with L1 syndrome which should be considered while hydrocephalus or agenesis of the corpus callosum was detected by fetal ultrasound during pregnancy. [Extracted from the article]

Objective Being small for gestational age (SGA) or having fetal growth restriction (FGR) may be associated with poorer neurodevelopmental outcomes compared to being appropriate for gestational age (AGA). The aim of this paper was to evaluate the existence and magnitude of decrease in neurodevelopmental scores in SGA and FGR infants born at term from a systematic review of the existing literature. Methods Studies of neurodevelopment in SGA/FGR babies were identified from a search of the internet scientific databases. Studies that included preterm births and those that did not define absolute indices of standardized cognitive outcome were excluded. SGA was defined as birth weight below the 10 th centile for gestation and FGR as the same birth-weight standard with abnormal umbilical artery Doppler ultrasound or evidence of abnormal placentation on pathology specimen studies. Effect size was calculated as the standardized mean difference between neurodevelopment scores of controls and SGA/FGR children. Results There were 28 studies of SGA, with a total of 7861 SGA and 91 619 control AGA babies, and three studies of FGR, with a total of 119 FGR and 49 control AGA babies. Data synthesis showed that standardized neurodevelopmental scores in SGA babies were 0.32 SD (95% CI, 0.25-0.38) below those for normal controls, though with heterogeneity between studies (I2 = 68.3%). Insufficient data were available for FGR babies. Conclusion The findings of the study demonstrate that among babies born at term, being SGA is associated with lower scores on neurodevelopmental outcomes compared to AGA controls. A trial designed to evaluate the effects of intervention in small fetuses born at term in order to improve the neurodevelopmental outcome is urgently needed. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To explore, using 4D ultrasound, the importance of location and tension of transobturator sub- urethral tape (TOT) with respect to surgical outcome. Methods Enrolled into the study were 56 women who had undergone TOT placement in the treatment of urodynamic stress incontinence. Tape location and tension were assessed by 4D ultrasound with the women at rest, during straining and during coughing. Ultrasound parameters representing tape location included the sagittal tape-symphysis pubis distance (sTSD), sagittal tape-symphysis pubis angle (sTSA) and tape percentile (an indication of tape position along the urethra with respect to urethral length), while those representing tape tension included urethral encroachment, sagittal tape-urethra distances at the upper end (sTUDu), center (sTUDc) and lower end (sTUDl) of the tape and axial urethral central echolucent area at the tape center (aUCEAc). Results In women in whom the tape procedure had been successful, during increased intra-abdominal pressure sTSA and the incidence of urethral encroachment increased, while sTUDu, sTUDc, sTUDl and aUCEAc decreased. Compared with those reporting no stress urinary incontinence (SUI) symptoms, women who reported SUI postoperatively had lower tape percentile. Women with SUI postoperatively demonstrated no manifestation on ultrasound of urethral encroachment at rest or during increased intra-abdominal pressure. Women with postoperative overactive bladder (OAB) symptoms had shorter resting sTSD and larger resting sTSA than did women without OAB symptoms. Women reporting postoperative de novo or worsening voiding difficulty had larger resting sTSA and higher incidence of urethral encroachment at rest than did women without this difficulty. Conclusions Both tape location and tape tension are associated with surgical outcome of TOT procedures. Assessment of tape location and tension can be achieved using 4D ultrasound. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The venous compartment has an important function in regulation and control of cardiac output. Abnormalities of cardiac output have been found in early gestational stages of both early- and late-onset pre-eclampsia. The venous compartment also maintains the balance between circulating and non-circulating blood volumes and regulates the amount of reserve blood stored in the splanchnic venous bed. It is well known that adaptive regulation of maternal blood volume is disturbed in pre-eclampsia. Abnormal venous hemodynamics and venous congestion are responsible for secondary dysfunction of several organs, such as the kidneys in cardiorenal syndrome and the liver in cardiac cirrhosis. Renal and liver dysfunctions are among the most relevant clinical features of pre-eclampsia. Doppler sonography studies have shown that the maternal venous compartment is subject to gestational adaptation, and that blood flow characteristics at the level of renal interlobar and hepatic veins are different in pre-eclampsia compared with uncomplicated pregnancy. In comparison to late-onset pre-eclampsia, in early-onset pre-eclampsia venous Doppler flow abnormalities are more prominent and present up to weeks before clinical symptoms. This paper reviews the growing evidence that dysfunction of maternal venous hemodynamics is part of the pathophysiology of pre-eclampsia and may perhaps be more important than is currently considered. Doppler sonography is a safe and easily performed method with which to study maternal venous hemodynamics. Therefore, exploring the role of maternal venous hemodynamics using Doppler sonography is an exciting new research topic for those who are interested in cardiovascular background mechanisms, as well as prediction and clinical work-up of pre-eclampsia. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article introduces papers about short femur published within the issue, including "Outcome of fetuses with antenatally diagnosed short femur," by A.T. Papageorghiou and colleagues, and "Association of isolated short femur in the mid-trimester fetus with perinatal outcome," by B. Weisz and colleagues.

Objective To determine the effect of in-utero pulmonary drainage on perinatal survival in fetuses with primary hydrothoraces and/or congenital cystic lung lesions. Methods Relevant papers were identified by searching MEDLINE (1966-2004), EMBASE (1988-2004) and the Cochrane Library (2004 issue 2). Studies were selected if the effect of prenatal pulmonary drainage (shunt, surgery or drainage) on perinatal survival was compared with no treatment, in fetuses with ultrasonic evidence of lung pathology. Study selection, quality assessment and data abstraction were performed independently amid in duplicate. Results Of a total number of 7958 articles, there were 16 controlled observational studies involving 608 fetuses. Study characteristics and quality were recorded for each study. Data were abstracted to generate 2 x 2 tables to compare the effect of pulmonary drainage vs. no drainage on perinatal survival. Pooled odds ratios (ORs) were used as summary measures of effect and the results were stratified according to predicted fetal prognoses. Pulmonary drainage did not improve perinatal survival in cystic lung lesions compared with no drainage (OR 0.56, 95% Cl 0.32–0.97, P = 0.04) overall. However there was a marked improvement with this therapy in a subgroup of fetuses with fetal hydrops fetalis (OR 19.28, 95% Cl 3.67–101.27, p = 0.0005) but not in the subgroup uncomplicated by fetal hydrops fetalis (OR 0.04, 95% Cl 0.01–0.32, P = 0.002). Conclusion Percutaneous, in-utero pulmonary drainage in fetuses with ultrasonic evidence of congenital pulmonary cystic malformations was associated with improved perinatal survival among fetuses with hydrops fetalis and therefore poor predicted survival. [ABSTRACT FROM AUTHOR]

Focuses on the presentation of the 2000 Ian Donald Medal for Technical Development to John J. Wild, a pioneer of diagnostic ultrasound in the United States. Family background of Wild; Details on the efforts of Wild and Jack Reid to publish a series of papers describing the major developments in ultrasound technology and its clinical applications; Move of Wild to construct a transducer for transvaginal scanning.

The article discusses improvements within the "Ultrasound in Obstetrics & Gynecology," the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). Due to the dearth of papers in ultrasound's application on gynecological disease imaging, ISUOG will be publishing a series of papers under the banner "Imaging in Gynecological Disease" in the journal. The section is intended to educate specialists on the benefits and harms of gynecological ultrasound.

Objective To determine the accuracy with which the absence of fetal breathing movements on ultrasound examination predicts spontaneous preterm birth in women with threatened preterm labor. Methods Data sources included Medline, Em base, Pascal, Biosis, Cochrane Library, Medion, National Research Register, SciSearch, conference papers, and manual searching of bibliographies of known primary and review articles. A study was selected if it used absence of fetal breathing movements on ultrasound to predict spontaneous preterm birth in women with threatened preterm labor but before advanced cervical dilatation. Two reviewers independently selected studies and extracted data on their characteristics, quality and accuracy. Accuracy data were used to form 2 × 2 contingency tables with birth within 48 h and within 7 days of testing as the reference standards. Likelihood ratios for a positive test (LR+) and negative test (LR-) were calculated as a measure of accuracy. Results There were eight studies, which included a total of 328 women, evaluating the accuracy of absence of fetal breathing movements in predicting spontaneous preterm birth in women with threatened preterm labor. There were differences in the methodological quality among the included studies. All were lacking in one or more item that make up an ideal test accuracy study. For women presenting with threatened preterm labor, meta-analysis showed a summary LR+ of 14.80 (95% CI, 6.30–34.79) with a corresponding summary LR- of 0.46 (95% CI, 0.3 6–0.58) for predicting preterm birth within 7 days, and summary LR+ of 7.84(95% CI, 1.12–54.99) and summary LR- of 0.25 (95% CI, 0.13–0.48) for predicting preterm birth within 48 h of testing. Conclusion Absence of fetal breathing movements has the potential to be a useful test in predicting preterm birth both within 7 days and within 48 h of testing. However, the available studies were deficient in their sample size and quality of methodology. Future research should be undertaken to evaluate this technology and to address the methodological deficiencies. [ABSTRACT FROM AUTHOR]

Background Celocentesis is the ultrasound-guided aspiration of fluid from the extra-amniotic cavity at 7–8 weeks of gestation. This paper reports on the clinical application of celocentesis for early prenatal diagnosis. Methods Celocentesis was successfully performed in nine pregnancies and 1–2 mL of fluid were obtained after one needle insertion. The indications were prenatal diagnosis of β-thalassemia or sickle cell disease (n = 6), Marfan syndrome (n = 1) and paternity testing (n 2). Molecular biological techniques were used to analyze the celomic fluid and this was successfully carried out in all cases. Results In two cases pregnancy termination was performed at the request of the mother because in one case the fetus was found to have sickle cell anemia and in the second case paternity testing demonstrated that the father was not the woman's husband. In both cases the results were confirmed using the placental samples collected after pregnancy termination. In six of the seven pregnancies with desirable results, amniocentesis was performed at 16 weeks and the results were concordant with those obtained from celocentesis. All pregnancies were uneventful and resulted in the delivery of healthy and appropriately grown babies. Conclusion Celocentesis may be a viable alternative to the currently used tests of chorionic villus sampling and amniocentesis. [ABSTRACT FROM AUTHOR]

Congenitally corrected transposition of the great arteries (ccTGA) is an uncommon cardiac defect characterized by the atria connecting with the anatomically discordant ventricles and the ventricles connecting with discordant and transposed great arteries. Parallel vessels are evident in corrected TGA, but as this sign is also present in complete TGA, a heart anomaly requiring major cardiac surgery in the postnatal period, it is important to differentiate between the entities prenatally. Most cases of ccTGA have associated anomalies but isolated forms or those with a mild associated cardiac anomaly are infrequently detected prenatally. We report on three cases detected between 21 and 25 weeks' gestation on screening ultrasound with associated mild findings. One fetus had an isolated ventricular septal defect (VSD) first detected at 34 weeks. The child developed heart block at 4 years of age. The second case was associated with a small VSD, a tiny pulmonary trunk and a persistent right umbilical vein. After birth, mild pulmonary stenosis was found as an additional cardiac finding at 4 months of age. The third fetus had no additional cardiac anomalies prenatally, but after birth a bicuspid aortic valve was detected. The first case needed pacemaker implantation but the other two children required no cardiac surgery. Two of the cases were referred because abnormal vessel anatomy was detected on screening ultrasound. As prenatal detection of TGA is becoming a more frequent occurrence, this paper aims to present clues aiding in the prenatal diagnosis of atrioventricular and ventriculoarterial discordance, especially in its differentiation from complete transposition. These details are crucial for counseling and perinatal management. [ABSTRACT FROM AUTHOR]

Editorial. Comments on the problems and opportunities of three-dimensional scanning and four dimensional imaging in obstetrics in Great Britain. Provision of images of fetal surface anatomy; Areas of parental and fetal behavior using the 4D ultrasound equipment; Level of 4D scanning benefit in terms of detection rates for fetal anomalies.

To assess the subjective interpretation of the echogenicity of fetal bowel compared to bone from antenatal ultrasound images taken during examinations conducted between 17 and 22 weeks of gestation. Eighty-seven women attending for their antenatal scan were selected in a random prospective manner over a 9-month period. Images of the fetal bowel were taken and evaluated by 10 sonographers, one consultant obstetrician and one consultant radiologist. Images from a further 13 fetuses, in which the subjective assessment of echogenic bowel was made, were also included. All ultrasound images were acquired on a dedicated ultrasound scanner, with a standard transducer, thermal paper printer and single operator using standardized equipment settings and reproducible image sections. Questionnaires with 100 sets of images of fetal bowel were distributed to the participants. Performance was assessed by means of percentage agreement and levels of chance corrected agreement (Kappa). The subjective assessment of fetal bowel echogenicity is very variable. Intra- and inter‐observer variation discrepancies in the assessment of bowel echogenicity compared to bone were demonstrated between the sonographers. Good agreement was identified between the consultants with good to almost perfect intra‐observer agreement. Overall, only moderate agreement was observed between the sonographers and the consultants. The lack of agreement demonstrated between sonographers when evaluating the echogenicity of fetal bowel should be addressed if this ultrasound marker is to be incorporated into routine fetal screening programs. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to investigate, identify and discuss artifacts and their sources arising in three-dimensional ultrasound (3D US) in clinical practice in order to increase the awareness of clinicians and sonographers with respect to common 3D US artifacts and to use this increased awareness to avoid or reduce the occurrence of misdiagnosis in 3D US studies. Patient 3D US data were acquired using several different scanners and reviewed interactively on the scanner and graphics workstations. Artifacts were catalogued according to artifact origin. Two-dimensional ultrasound (2D US) artifacts were classified whether they were of a B-mode or color/power Doppler origin and their presentation in the original scan planes and the resulting volume re-sliced planes and rendered images was identified. Artifacts unique to 3D US were observed, noted and catalogued on the basis of whether they arose during acquisition, rendering or volume editing operations. Acoustic artifacts identified included drop-out, shadowing, etc. whose presentation depended on the relationship between slice and imaging plane orientation. Color/power Doppler artifacts were related to gain, aliasing, and flash which could add apparent structure or confusion to the volume images. Rendered images also demonstrated artifacts due to shadowing and motion of adjacent structures, cardiac motion or pulsatility of the cardiac septum or vessel walls. Editing artifacts potentially removed important structures. Three-dimensional ultrasound is prone to the same types of artifacts encountered in 2D US imaging plus others unique to volume acquisition and visualization. The consequences of these diagnostically significant artifacts include mimicking of abnormal development, masses, or missing structures thus requiring careful study before reaching a diagnosis. [ABSTRACT FROM AUTHOR]

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Objective: Monochorionic (MC) triplet pregnancies are extremely rare and information on these pregnancies and their complications is limited. We aimed to investigate the risk of early and late pregnancy complications, perinatal outcome and the timing and methods of fetal intervention in these pregnancies. Methods: This was a multicenter retrospective cohort study of MC triamniotic (TA) triplet pregnancies managed in 21 participating centers around the world from 2007 onwards. Data on maternal age, mode of conception, diagnosis of major fetal structural anomalies or aneuploidy, gestational age (GA) at diagnosis of anomalies, twin‐to‐twin transfusion syndrome (TTTS), twin anemia–polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) sequence and or selective fetal growth restriction (sFGR) were retrieved from patient records. Data on antenatal interventions were collected, including data on selective fetal reduction (three to two or three to one), laser surgery and any other active fetal intervention (including amniodrainage). Data on perinatal outcome were collected, including numbers of live birth, intrauterine demise, neonatal death, perinatal death and termination of fetus or pregnancy (TOP). Neonatal data such as GA at birth, birth weight, admission to neonatal intensive care unit and neonatal morbidity were also collected. Perinatal outcomes were assessed according to whether the pregnancy was managed expectantly or underwent fetal intervention. Results: Of an initial cohort of 174 MCTA triplet pregnancies, 11 underwent early TOP, three had an early miscarriage, six were lost to follow‐up and one was ongoing at the time of writing. Thus, the study cohort included 153 pregnancies, of which the majority (92.8%) were managed expectantly. The incidence of pregnancy affected by one or more fetal structural abnormality was 13.7% (21/153) and that of TRAP sequence was 5.2% (8/153). The most common antenatal complication related to chorionicity was TTTS, which affected just over one quarter (27.6%; 42/152, after removing a pregnancy with TOP < 24 weeks for fetal anomalies) of the pregnancies, followed by sFGR (16.4%; 25/152), while TAPS (spontaneous or post TTTS with or without laser treatment) occurred in only 4.6% (7/152) of pregnancies. No monochorionicity‐related antenatal complication was recorded in 49.3% (75/152) of pregnancies. Survival was apparently associated largely with the development of these complications: there was at least one survivor beyond the neonatal period in 85.1% (57/67) of pregnancies without antenatal complications, in 100% (25/25) of those complicated by sFGR and in 47.6% (20/42) of those complicated by TTTS. The overall rate of preterm birth prior to 28 weeks was 14.5% (18/124) and that prior to 32 weeks' gestation was 49.2% (61/124). Conclusion: Monochorionicity‐related complications, which can impact adversely perinatal outcome, occur in almost half of MCTA triplet pregnancies, creating a challenge with regard to counseling, surveillance and management. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective was to perform a systematic review of predictive factors for obstetric anal sphincter injury (OASI) occurrence at first vaginal delivery, with the diagnosis made by ultrasound (US‐OASI). The secondary objective was to report on incidence rates of sonographic anal sphincter (AS) trauma, including trauma that was not clinically reported at childbirth, among the studies providing data for our primary objective. Methods: We conducted a systematic search of MEDLINE, EMBASE, Web of Science, CINAHL, The Cochrane Library and ClinicalTrials.gov databases. Both observational cohort studies and interventional trials were eligible for inclusion. Study eligibility was assessed independently by two authors. Random‐effects meta‐analyses were performed to pool effect estimates from studies reporting on similar predictive factors. Summary odds ratio (OR) or mean difference (MD) is reported with 95% CI. Heterogeneity was assessed using the I2 statistic. Methodological quality was assessed using the Quality in Prognosis Studies tool. Results: A total of 2805 records were screened and 21 met the inclusion criteria (16 prospective cohort studies, three retrospective cohort studies and two interventional non‐randomized trials). Increasing gestational age at delivery (MD, 0.34 (95% CI, 0.04–0.64) weeks), shorter antepartum perineal body length (MD, −0.60 (95% CI, −1.09 to −0.11) cm), labor augmentation (OR, 1.81 (95% CI, 1.21–2.71)), instrumental delivery (OR, 2.13 (95% CI, 1.13–4.01)), in particular forceps extraction (OR, 3.56 (95% CI, 1.31–9.67)), shoulder dystocia (OR, 12.07 (95% CI, 1.06–137.60)), episiotomy use (OR, 1.85 (95% CI, 1.11–3.06)) and shorter episiotomy length (MD, −0.40 (95% CI, −0.75 to −0.05) cm) were associated with US‐OASI. When pooling incidence rates, 26% (95% CI, 20–32%) of women who had a first vaginal delivery had US‐OASI (20 studies; I2 = 88%). In studies reporting on both clinical and US‐OASI rates, 20% (95% CI, 14–28%) of women had AS trauma on ultrasound that was not reported clinically at childbirth (16 studies; I2 = 90%). No differences were found in maternal age, body mass index, weight, subpubic arch angle, induction of labor, epidural analgesia, episiotomy angle, duration of first/second/active‐second stages of labor, vacuum extraction, neonatal birth weight or head circumference between cases with and those without US‐OASI. Antenatal perineal massage and use of an intrapartum pelvic floor muscle dilator did not affect the odds of US‐OASI. Most (81%) studies were judged to be at high risk of bias in at least one domain and only four (19%) studies had an overall low risk of bias. Conclusion: Given the ultrasound evidence of structural damage to the AS in 26% of women following a first vaginal delivery, clinicians should have a low threshold of suspicion for the condition. This systematic review identified several predictive factors for this. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. A video abstract of this article is available online here [ABSTRACT FROM AUTHOR]

Objective: The published literature reports mostly on the outcome of twin pregnancies complicated by twin–twin transfusion syndrome (TTTS) without considering whether the pregnancy is also complicated by another pathology, such as selective fetal growth restriction (sFGR). The aim of this systematic review was to report on the outcome of monochorionic diamniotic (MCDA) twin pregnancies undergoing laser surgery for TTTS that were complicated by sFGR and those not complicated by sFGR. Methods: MEDLINE, EMBASE and Cochrane databases were searched. The inclusion criteria were studies reporting on MCDA twin pregnancies with TTTS undergoing laser therapy that were complicated by sFGR and those not complicated by sFGR. The primary outcome was the overall fetal loss following laser surgery, defined as miscarriage and intrauterine death. The secondary outcomes included fetal loss within 24 h after laser surgery, survival at birth, preterm birth (PTB) prior to 32 weeks of gestation, PTB prior to 28 weeks, composite neonatal morbidity, neurological and respiratory morbidity, and survival free from neurological impairment. All outcomes were explored in the overall population of twin pregnancies complicated by sFGR vs those not complicated by sFGR in the setting of TTTS and in the donor and recipient twins separately. Random‐effects meta‐analysis was used to combine data and the results are reported as pooled odds ratios (OR) with 95% CI. Results: Five studies (1710 MCDA twin pregnancies) were included in the qualitative synthesis and four in the meta‐analysis. The overall risk of fetal loss after laser surgery was significantly higher in MCDA twin pregnancies with TTTS complicated by sFGR (20.90% vs 14.42%), with a pooled OR of 1.6 (95% CI, 1.3–1.9) (P < 0.001). The risk of fetal loss was significantly higher in MCDA twin pregnancies with TTTS and sFGR for the donor but not for the recipient twin. The rate of live twins was 79.1% (95% CI, 72.6–84.9%) in TTTS pregnancies with sFGR and 85.6% (95% CI, 81.0–89.6%) in those without sFGR (pooled OR, 0.6 (95% CI, 0.5–0.8)) (P < 0.001). There was no significant difference in the risk of PTB prior to 32 weeks of gestation (P = 0.308) or prior to 28 weeks (P = 0.310). Assessment of short‐ and long‐term morbidity was affected by the small number of cases. There was no significant difference in the risk of composite (P = 0.506) or respiratory (P = 0.531) morbidity between twins complicated by TTTS with vs those without sFGR, while the risk of neurological morbidity was significantly higher in those with TTTS and sFGR (pooled OR, 1.8 (95% CI, 1.1–2.9)) (P = 0.034). The risk of neurological morbidity was significantly higher for the donor twin (pooled OR, 2.4 (95% CI, 1.1–5.2)) (P = 0.029) but not for the recipient twin (P = 0.361). Survival free from neurological impairment was observed in 70.8% (95% CI, 45.0–91.0%) of twin pregnancies with TTTS complicated by sFGR and in 75.8% (95% CI, 51.9–93.3%) of those not complicated by sFGR, with no difference between the two groups. Conclusions: sFGR in MCDA pregnancies with TTTS represents an additional risk factor for fetal loss following laser surgery. The findings of this meta‐analysis may be useful for individualized risk assessment of twin pregnancy complicated by TTTS and tailored counseling of the parents prior to laser surgery. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To develop a core set of prenatal and neonatal outcomes for clinical studies evaluating perinatal interventions for congenital diaphragmatic hernia, using a validated consensus‐building method. Methods: An international steering group comprising 13 leading maternal–fetal medicine specialists, neonatologists, pediatric surgeons, patient representatives, researchers and methodologists guided the development of this core outcome set. Potential outcomes were collected through a systematic review of the literature and entered into a two‐round online Delphi survey. A call was made for stakeholders with experience of congenital diaphragmatic hernia to review the list and score outcomes based on their perceived relevance. Outcomes that fulfilled the consensus criteria defined a priori were discussed subsequently in online breakout meetings. Results were reviewed in a consensus meeting, during which the core outcome set was defined. Finally, the definitions, measurement methods and aspirational outcomes were defined in online and in‐person definition meetings by a selection of 45 stakeholders. Results: Overall, 221 stakeholders participated in the Delphi survey and 198 completed both rounds. Fifty outcomes met the consensus criteria and were discussed and rescored by 78 stakeholders in the breakout meetings. During the consensus meeting, 93 stakeholders agreed eventually on eight outcomes, which constituted the core outcome set. Maternal and obstetric outcomes included maternal morbidity related to the intervention and gestational age at delivery. Fetal outcomes included intrauterine demise, interval between intervention and delivery and change in lung size in utero around the time of the intervention. Neonatal outcomes included neonatal mortality, pulmonary hypertension and use of extracorporeal membrane oxygenation. Definitions and measurement methods were formulated by 45 stakeholders, who also added three aspirational outcomes: duration of invasive ventilation, duration of oxygen supplementation and use of pulmonary vasodilators at discharge. Conclusions: We developed with relevant stakeholders a core outcome set for studies evaluating perinatal interventions in congenital diaphragmatic hernia. Its implementation should facilitate the comparison and combination of trial results, enabling future research to better guide clinical practice. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To examine the implications of third‐trimester small‐for‐gestational‐age (SGA) screening accuracy on severe adverse perinatal outcome (SAPO) and obstetric intervention in a low‐risk population. Furthermore, we aimed to explore the additive value of third‐trimester sonographic growth‐trajectory measurements in predicting SAPO and obstetric intervention. Methods: This was a secondary analysis of a Dutch national multicenter stepped‐wedge‐cluster randomized trial among 11 820 low‐risk pregnant women. Using multilevel multivariable logistic regression analysis, we compared SAPO and obstetric interventions in SGA neonates with and without SGA suspected prenatally (true positives and false negatives) and non‐SGA neonates with and without SGA suspected prenatally (false positives and true negatives). In a subsample (n = 7989), we analyzed the associations of abdominal circumference (AC) and estimated fetal weight (EFW) < 10th centile (p10) and third‐trimester growth‐trajectory indicators AC and EFW crossing > 20 and AC crossing > 50 centiles and the lowest decile of AC growth‐velocity Z‐scores (ACGV < 10%) with SAPO and obstetric interventions. Results: SGA infants, i.e. the true‐positive and false‐negative cases, had an increased risk of SAPO (adjusted odds ratio (aOR), 4.46 (95% CI, 2.28–8.75) and aOR 2.61 (95% CI, 1.74–3.89), respectively), and obstetric intervention (aOR for: induction of labor, 2.99 (95% CI, 2.15–4.17) and 1.38 (95% CI, 1.14–1.66); Cesarean section, 1.82 (95% CI, 1.25–2.66) and 1.27 (95% CI, 1.05–1.54); medically indicated preterm delivery, 2.67 (95% CI, 1.97–3.62) and 1.20 (95% CI, 1.03–1.40)). The false‐positive cases did not differ from the true negatives for all outcomes, including obstetric intervention. Of the third‐trimester growth‐trajectory indicators, only ACGV < 10% was associated moderately with SAPO (aOR, 2.15 (95% CI, 1.17–3.97)), while AC and EFW crossing > 20 and AC crossing > 50 centiles were not. Both EFW < p10 alone (aOR, 1.95 (95% CI, 1.13–3.38)) and EFW < p10 combined with ACGV < 10% (aOR, 4.69 (95% CI, 1.99–11.07)) were associated with SAPO, and they performed equally well in predicting SAPO (area under the receiver‐operating‐characteristics curve, 0.71 (95% CI, 0.65–0.76) vs 0.72 (95% CI, 0.67–0.77), P = 0.51). Conclusion: Neonates who had been suspected falsely of being SGA during pregnancy had no higher rates of obstetric intervention than did those without suspicion of SGA prenatally. Our results do not support that third‐trimester low fetal growth velocity (ACGV < 10%) may be of additive value for the identification of fetuses at risk of SAPO in populations remaining at low risk throughout pregnancy. AC and EFW crossing > 20 and AC crossing > 50 centiles performed poorly in identifying abnormal fetal growth. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

The development of the genetic non-invasive prenatal tests (NIPT) has been an issue during the last years all over the world, in order to reduce the number of invasive investigations for fetal aneuploidies. From the 120 papers identified, 23 presented data on the prenatal detection rate of the fetal aneuploidies using several non-invasive prenatal tests and matched our inclusion criteria. The use of the non-invasive prenatal tests promises an encouraging accuracy and precision, the sensitivity and specificity in prenatal detection of the fetal aneuploidies being superior to the known screening tests such as the double test with a detection rate of 90-95% and with 3-5% of false positive results. [Extracted from the article]

The aim of this paper is to investigate the added value of the fluid-attenuated inversion recovery (FLAIR) sequence in the diagnosis of lissencephaly using fetal MRI. Visualisation of lamination and gyration were assessed, and adequacy to GA determined, as well as it's degree of certainty (0-5) in the diagnosis. By improving visualisation of brain lamination, FLAIR sequences over the fetal brain may help in the diagnosis of migrational disorders, and specifically of lissencephaly. [Extracted from the article]

Ovarian cancer mortality remains high mainly due to late diagnosis. The purpose of this paper is to assess the efficiency of CDTV ultrasound to detect ovarian cancer in early stages. Sixty-five percent of the patients had normal levels of CA 125, measured after the lesions were detected by CDTV ultrasound study. [Extracted from the article]