Ultrasound in Obstetrics & Gynecology最新文献

{"title":"Ongoing outbreak of maternal parvovirus B19 infections in Germany since end of 2023: consequence of COVID-19 pandemic?","authors":"J Jiménez Cruz, R Axt-Fliedner, C Berg, F Faschingbauer, K O Kagan, J Knabl, A Lauten, H Lehmann, H Stepan, M Tavares de Sousa, S Verlohren, U Germer, J Weichert, B Strizek, A Geipel","doi":"10.1002/uog.29197","DOIUrl":"https://doi.org/10.1002/uog.29197","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the ongoing parvovirus B19 (B19V) outbreak among pregnant women in Germany and its connection to the coronavirus disease 2019 (COVID-19) pandemic.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed anonymous data regarding serologically confirmed B19V infections during pregnancy between January 2014 and April 2024 across 13 major fetal medicine centers in Germany. We evaluated the yearly frequency of B19V cases, cases that underwent intrauterine transfusion (IUT), cases presenting with hydrops fetalis and cases of intrauterine fetal death (IUFD) related to B19V infection, and stratified these variables by event occurrence < 20 weeks' gestation or ≥ 20 weeks' gestation. Variables were compared across three subperiods: pre COVID-19 pandemic, during the COVID-19 pandemic and post COVID-19 pandemic.</p><p><strong>Results: </strong>Data from 918 pregnant women with confirmed B19V infection revealed a significant B19V outbreak since the end of 2023. The mean ± SD number of annual cases was 57.3 ± 20.7 pre COVID-19, 20.3 ± 13.5 during COVID-19 and surged to 384.8 ± 299.8 post COVID-19 (P < 0.01). Correspondingly, the number of cases in which the fetus underwent IUT increased post COVID-19. The proportion of B19V diagnoses made before 20 weeks' gestation increased from 32.3% pre COVID-19 to 53.2% post COVID-19 (P < 0.001).</p><p><strong>Conclusions: </strong>These results demonstrate an unforeseen increase in B19V infections during pregnancy after the COVID-19 pandemic, with a consequent rise in B19V cases with fetal anemia. The introduced policies during the COVID-19 pandemic reduced the B19V infection rate but likely conditioned the present ongoing upsurge. Counseling, early detection and access to specialized centers performing IUT are essential measures required to address this outbreak. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.</p>","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pop-off mechanisms in fetal megacystis: extravasation, umbilical cord cyst, ureterocele and megaureter.","authors":"L A M Brinkman, L K Duin, P N Adama van Scheltema, T E Cohen-Overbeek, E Pajkrt, M N Bekker, C Willekes, E J T Verweij, C Bilardo, F Fontanella","doi":"10.1002/uog.29200","DOIUrl":"https://doi.org/10.1002/uog.29200","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To analyze comprehensively the incidence, antenatal ultrasound characteristics and prognostic implications of antenatal pop-off mechanisms of the fetal urinary system in pregnancies with suspected fetal megacystis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a retrospective multicenter study of pregnancies with suspected fetal megacystis conducted across all academic hospitals in The Netherlands. Three antenatal pop-off mechanisms were identified: presence of an umbilical cord cyst (UCC), extravasation of urine into the intraperitoneal space (ascites) or perirenal subcapsular (urinoma), and megaureter/ureterocele. Cases that exhibited two different pop-off mechanisms, underwent vesicoamniotic shunt placement or had unclear information regarding shunt placement were excluded. We compared the antenatal ultrasound characteristics and outcomes among pregnancies with UCC, those with extravasation, those with megaureter/ureterocele and those without a pop-off mechanism. Logistic regression analysis was used to evaluate the association of pop-off mechanisms with antenatal characteristics and postnatal outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 543 fetuses with suspected megacystis, 76% exhibited no pop-off mechanism, 7% presented with UCC only, 9% presented with extravasation only, 7% presented with a megaureter/ureterocele only and 1% presented with two pop-off mechanisms. Following exclusions, 511 cases were included in the analysis. The identification of UCC (n = 39) was associated with early-onset megacystis (odds ratio (OR), 4.2 (95% CI, 1.9-9.1); P &lt; 0.001), severe megacystis (OR 2.3 (95% CI, 1.1-5.0); P = 0.033), normal amniotic fluid index (AFI) (OR, 3.3 (95% CI, 1.3-8.2); P = 0.011) and additional associated anomaly (OR, 3.3 (95% CI, 1.7-6.4); P &lt; 0.001), and thus with the highest prevalence of complex diagnosis (66%), primarily represented by anorectal malformation. Extravasation (n = 42) was associated with severe megacystis (OR, 2.4 (95% CI, 1.1-5.4); P = 0.030), abnormal AFI (OR, 2.8 (95% CI, 1.2-6.8); P = 0.022), the keyhole sign (OR, 2.5 (95% CI, 1.1-5.8); P = 0.033) and additional associated anomaly (OR, 2.1 (95% CI, 1.1-4.1); P = 0.026). Megaureter/ureterocele (n = 36) was associated with late-onset megacystis (OR, 4.0 (95% CI, 1.6-9.7); P = 0.003), a thickened bladder wall during pregnancy (OR, 6.6 (95% CI, 1.9-23.1); P = 0.003) and the lowest prevalence of additional associated anomaly (22%). Intrauterine fetal demise was most prevalent in fetuses with UCC (15%), while termination of pregnancy and non-survivors were most common in cases with extravasation (50% and 17%, respectively). The majority of fetuses with megacystis associated with megaureter/ureterocele were still alive during follow-up (72%) and the odds of survival were the highest for this group (OR, 2.7 (95% CI, 1.3-5.7); P = 0.010).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Antenatal pop-off mechanisms may alleviate high intraluminal pressure wi","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of human cytomegalovirus cell-free DNA in pregnant women with symptomatically infected fetuses: proof-of-concept study.","authors":"B H W Faas, T Meuleman, G Astuti, A Reuss, K Stol, E A Sistermans, J Linthorst, E van Leeuwen, J Rahamat-Langendoen, F A Wilmink","doi":"10.1002/uog.29199","DOIUrl":"https://doi.org/10.1002/uog.29199","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the presence and levels of cytomegalovirus (CMV) cell-free DNA (cfDNA) fragments in women pregnant with a fetus with symptomatic congenital CMV (cCMV).</p><p><strong>Methods: </strong>The study comprised nine women whose fetuses were diagnosed with cCMV between June 2019 and July 2024 at 20 + 4 to 34 + 1 weeks' gestation (n = 8) or neonatally (n = 1) after primary or non-primary maternal infection. In eight women, cfDNA sequencing data from a single timepoint were analyzed, either retrospectively, on data generated from 11-13 weeks' gestation (n = 5) or prospectively, on data generated from 20-26 weeks' gestation (n = 3), upon the diagnosis of cCMV. In one woman (Case 6), CMV-cfDNA analysis was performed at four timepoints: at 12 + 5 weeks (routine non-invasive prenatal testing); 23 + 3 weeks (cCMV diagnosis); and 30 min and 12 h after termination of pregnancy (TOP) at 23 + 6 weeks.</p><p><strong>Results: </strong>CMV-cfDNA was detectable in all cases. Mostly low levels of CMV-cfDNA were observed in samples obtained at 11-13 weeks' gestation and consistently high levels of CMV-cfDNA were present in samples obtained at cCMV diagnosis. In Case 6, the level of maternal CMV-cfDNA decreased substantially in the samples tested after TOP, compared with samples obtained before TOP.</p><p><strong>Conclusions: </strong>Low levels of CMV-cfDNA detected between 11 and 13 weeks may be a biomarker for severe fetal cCMV. CMV-cfDNA analysis in the first trimester could be of added value in CMV screening, particularly for non-primary maternal infections that cannot be identified using other methods. However, as CMV-cfDNA is detectable in many pregnant women in the first trimester, further studies are needed to determine the predictive value of CMV-cfDNA as a biomarker for the development of severe fetal cCMV. High levels of CMV-cfDNA at fetal cCMV diagnosis and low levels directly after TOP suggest that the level of CMV-cfDNA in maternal plasma may not necessarily reflect an active maternal infection, but could indicate a placental infection. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.</p>","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does three-dimensional fetal ultrasound enhance maternal-fetal bonding?","authors":"W Abdallah, G E Chalouhi","doi":"10.1002/uog.27718","DOIUrl":"10.1002/uog.27718","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"395-396"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High success rate in demonstration of soft palate in early and late mid-trimester ultrasound scans.","authors":"D A Lasry, D V Valsky, N Cohen, A Nahum, S M Cohen, S Yagel","doi":"10.1002/uog.29164","DOIUrl":"10.1002/uog.29164","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"388-389"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrahepatic portosystemic shunt: salvage mechanism for oligohydramnios complicating fetal growth restriction.","authors":"Y Gilboa, L Drukker, J Bar, D Berbing-Goldstein, Y Geron, Y Mozer Glassberg, E Hadar, R Charach, R Bardin","doi":"10.1002/uog.29163","DOIUrl":"10.1002/uog.29163","url":null,"abstract":"<p><strong>Objective: </strong>Portosystemic shunts in growth-restricted fetuses are more common than previously thought. We aimed to describe fetuses with growth restriction and transient oligohydramnios in which a congenital intrahepatic portosystemic shunt (CIPSS) was noted during follow-up.</p><p><strong>Methods: </strong>This was a retrospective study of all fetuses diagnosed with growth restriction and transient oligohydramnios during a 5-year period in a large tertiary referral center. Our routine evaluation of growth-restricted fetuses includes monitoring of estimated fetal weight, assessment of biophysical profile, Doppler imaging, thorough examination of the umbilical-portal system and evaluation of cardiac function using fetal tricuspid annular plane systolic excursion (f-TAPSE). We compared these parameters before and after the resolution of the oligohydramnios using descriptive statistics and the Wilcoxon signed-rank test for paired non-parametric variables. During the surveillance of fetuses with transient oligohydramnios, we noted the appearance of a CIPSS and followed up such cases after birth.</p><p><strong>Results: </strong>A total of 2144 women with a singleton pregnancy with suspected fetal growth restriction were referred to our center between January 2018 and December 2022. In 12 fetuses, oligohydramnios was evident upon initial assessment, and a CIPSS was diagnosed with normalization of amniotic fluid level. The median gestational age at diagnosis of growth restriction and oligohydramnios was 25 (range, 21-30) weeks. The estimated fetal weight was at the 1^st percentile in 10/12 fetuses. The median amniotic fluid index was 5 (range, 2-5) cm at the initial appointment and improved significantly to 13 (range, 11-20) cm following the shunt diagnosis (P = 0.002). Among fetuses with f-TAPSE data available, the f-TAPSE increased significantly from 4.0 (range, 3.0-5.0) mm before the diagnosis of CIPSS to 8.0 (range, 5.0-9.4) mm following the diagnosis (P = 0.043). The median gestational age at delivery was 36.3 (range, 30.8-38.4) weeks. In nine (75%) fetuses, the diagnosed shunt was left portal to left hepatic vein. Neonatal follow-up revealed spontaneous shunt resolution within 30 months in all newborns. One newborn required embolization owing to suspected shunt, however, no shunt was detected during the procedure.</p><p><strong>Conclusions: </strong>The development of CIPSS in growth-restricted fetuses with oligohydramnios appears to improve hemodynamic status as evidenced by normalization of amniotic fluid index and increase in f-TAPSE. Evaluation of the liver portal system in fetuses with growth restriction offers an understanding of the shunt salvage phenomenon. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.</p>","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"311-316"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Will radiomics or visual assessment prevail?","authors":"A C Testa","doi":"10.1002/uog.29168","DOIUrl":"10.1002/uog.29168","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"385-386"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vertebroplacental ratio for prediction of perinatal outcome and operative delivery for suspected fetal compromise: prospective observational cohort study.","authors":"B Packet, R Van Severen, J Richter","doi":"10.1002/uog.29189","DOIUrl":"10.1002/uog.29189","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate differences in fetal vertebroplacental ratio (VPR) depending on the occurrence of operative delivery for suspected fetal compromise (ODFC) and composite perinatal outcome (CPO) at delivery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a prospective observational cohort study conducted in the Department of Obstetrics and Gynecology at the University Hospitals of Leuven, Leuven, Belgium, between December 2022 and April 2024. Women with a term (37-42 gestational weeks) singleton pregnancy with an appropriate-for-gestational-age (AGA) fetus were recruited, before cervical dilatation reached 5 cm, for sonographic fetal weight estimation (EFW) and Doppler sonography of the umbilical artery (UA), umbilical vein (UV), middle cerebral artery (MCA) and vertebral artery (VA). The primary outcomes were differences in VPR multiples of the median (MoM) depending on the occurrence of ODFC and CPO at delivery (based on UA cord blood pH and base excess, 1-min and 5-min Apgar score, and neonatal intensive care unit admission). We explored the technical feasibility of fetal Doppler sonography in this setting and differences in Doppler findings from individual fetal vessels (UA, UV blood flow (UVF), MCA, VA) and related parameters (UVF/EFW and cerebroplacental ratio (CPR)). We also investigated whether adding individual sonographic variables to baseline clinical prediction models could improve discriminatory power (using the area under the receiver-operating-characteristics curve (AUC)) and predictive accuracy (using the Brier score) for both outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 161 women were recruited. The mean ± SD maternal age was 32.2 ± 3.8 years and approximately half (53.4%) of the women were nulliparous. Most (88.2%) women had labor induced. The mean ± SD gestational age at delivery was 39.3 ± 1.0 weeks and the mean ± SD ultrasound-to-delivery interval was 10.4 ± 2.75 h. An adverse CPO occurred in 13.3% of cases and ODFC occurred in 17.4%. No difference in mean VPR MoM was observed between cases with normal vs adverse CPO (1.04 ± 0.26 vs 1.17 ± 0.25; P = 0.09), or between cases which underwent ODFC vs those which did not (1.06 ± 0.29 vs 1.06 ± 0.26; P = 0.97). Likewise, no differences in other Doppler variables (UA pulsatility index (PI) MoM, MCA-PI MoM, VA-PI MoM, CPR MoM) were observed for both outcomes, except for significantly higher UVF rates in the adverse CPO group (both absolute (P = 0.02) and corrected for EFW (P = 0.048)). For both outcomes, adding VPR MoM or any other sonographic variable to baseline prediction models, which consisted solely of clinical variables, did not improve predictive accuracy or discriminatory power. The baseline model AUC and Brier score values were 0.68 (95% CI, 0.57-0.79) and 0.14 for adverse CPO, and 0.72 (95% CI, 0.61-0.83) and 0.13 for ODFC, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Although technically feasible to measure in most women with an AGA fetu","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"334-343"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postinterventional fetal aortic regurgitation: prevalence, outcome and effects on fetal circulation in large single-center cohort.","authors":"A Tulzer, J Hochpoechler, I Scharnreitner, V Tomek, R Weber, E Sames-Dolzer, M Kreuzer, R Mair, R Mair, G Tulzer","doi":"10.1002/uog.29182","DOIUrl":"10.1002/uog.29182","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To analyze the prevalence and severity of fetal aortic regurgitation (AR) after undergoing successful fetal aortic valvuloplasty (FAV) and to evaluate its effects on fetal circulation and left ventricular (LV) growth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a retrospective review of all fetuses with critical aortic stenosis who underwent successful FAV at our center between 2010 and 2024 for whom postnatal echocardiograms were available in digital format. Fetal and postnatal echocardiographic examinations were analyzed for ventricular and valvular dimensions and characteristics, and Z-scores were calculated for middle cerebral artery (MCA) pulsatility index (PI), umbilical artery (UA) PI and cerebroplacental ratio. AR severity was classified into no/mild AR or significant (moderate/severe) AR. The balloon-to-aortic valve ratio (BVR) was calculated as the ratio between the maximum actual balloon diameter and the aortic valve (AV) annulus diameter. The primary endpoints of this study were the prevalence, severity and risk factors for fetal AR following successful FAV.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Ninety-nine fetuses who underwent successful FAV were included. Immediate post-FAV echocardiograms showed that 87% of fetuses developed some degree of AR, including 45% of all fetuses with significant AR. BVR was significantly higher in fetuses with significant AR compared to those with no/mild AR (mean, 1.09 (95% CI, 1.06-1.12) vs 1.02 (95% CI, 0.99-1.04); P &lt; 0.001). In a subgroup of 66/99 fetuses with available postnatal echocardiograms, the prevalence of AR decreased significantly from 86% before birth to 58% after birth (P &lt; 0.001), with the proportion of fetuses with significant AR reducing from 47% before birth to 17% after birth (P &lt; 0.001). In the overall cohort of fetuses, AV maximum velocity (Vmax) increased significantly from post-FAV to after birth (mean, 1.93 (95% CI, 1.75-2.11) m/s vs 3.21 (95% CI, 2.89-3.55) m/s; P &lt; 0.001), regardless of AR severity, but Vmax after birth was lower in the significant-AR group compared with the no/mild-AR group (mean, 2.85 m/s vs 3.55 m/s; P = 0.020). Fetuses with significant AR exhibited higher relative LV length increases from immediately post-FAV to after birth than did those with no/mild AR (25% (95% CI, 16-33%) vs 14% (95% CI, 6-21%); P = 0.044), although there was no significant difference in mean LV length Z-score after birth between the two groups. FAV led to significant short-term increases in MCA-PI and UA-PI Z-scores, with greater increases observed in fetuses with significant AR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;FAV is associated with a high prevalence of fetal AR, which lessens in severity over the course of gestation. Significant fetal AR had the largest association with greater BVR and had significant impact on fetal hemodynamics. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Soci","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"325-333"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transvaginal cervical cerclage: double monofilament modified Wurm vs single braided McDonald technique.","authors":"V Donadono, P Koutikwar, A Banerjee, M Ivan, C S Colley, M Sciacca, D Casagrandi, A Tetteh, N Greenwold, L M Kindinger, K Maksym, A L David, R Napolitano","doi":"10.1002/uog.29184","DOIUrl":"10.1002/uog.29184","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare pregnancy outcome in women at high risk of preterm birth undergoing the modified Wurm (two monofilament sutures) vs those undergoing the McDonald (single braided suture) transvaginal cervical cerclage technique.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a single-center prospective observational study of all women with a singleton pregnancy attending a prematurity surveillance clinic because of an increased risk of preterm birth, and undergoing history- or ultrasound-indicated transvaginal cervical cerclage. Two cerclage techniques were evaluated and the choice of cerclage was at the physician's discretion. In the modified Wurm technique using monofilament material, two circumferential sutures are placed with two insertions each (four in total). Outcomes were compared vs those of women undergoing the McDonald technique (single braided suture using a diamond-type insertion method with four insertions in total). Primary outcome was the rate of preterm birth at &lt; 32 weeks' gestation, with planned subanalyses according to cervical cerclage indication (history- or ultrasound-indicated), preterm birth rate at any gestational age (&lt; 37, &lt; 34, &lt; 28 and &lt; 24 weeks), and sonographic cervical length (CL) of ≤ 25 mm and ≤ 15 mm. Secondary outcome measures included maternal and neonatal adverse events and outcomes, including the pre- and postsurgical characteristics. In addition, a reproducibility analysis using Bland-Altman plots was performed to evaluate the intra- and interobserver reproducibility in assessment of CL on ultrasound examination before and after cerclage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 147 patients were included in the final analysis: 55 (37%) received modified Wurm cerclage and 92 (63%) received McDonald cerclage. Other than race, demographic characteristics were comparable between the two groups. Of these, 22 (40%) women in the modified Wurm group had history-indicated cerclage, vs 50 (54%) women in the McDonald group; the remaining cerclages were ultrasound-indicated. In women with a short CL (≤ 25 mm), there was a significantly lower rate of preterm birth at &lt; 32 weeks' gestation after modified Wurm compared with the McDonald technique (3 (9%) vs 14 (29%); adjusted odds ratio (aOR), 0.25 (95% CI, 0.06-0.95); P = 0.042). However, the study was underpowered to provide definitive conclusions. In the overall population, there was no significant difference in preterm birth rate for &lt; 32 weeks' gestation between the two techniques (7 (13%) vs 22 (24%); aOR, 0.51 (95% CI, 0.20-1.33); P = 0.169). There was no difference in overall surgical complications between the two techniques. The pregnancy loss rate and composite neonatal morbidity/mortality rate were comparable between the two groups (2 (4%) vs 7 (8%); odds ratio (OR), 0.47 (95% CI, 0.09-2.33); P = 0.485; and 5 (9%) vs 11 (13%); OR, 0.68; (95% CI, 0.22-2.09); P = 0.593, respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In high-risk women w","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"344-352"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}