P Chaggar, T Tellum, N Thanatsis, L V De Braud, T Setty, D Jurkovic
{"title":"Impact of deep or ovarian endometriosis on pelvic pain and quality of life: prospective cross-sectional ultrasound study.","authors":"P Chaggar, T Tellum, N Thanatsis, L V De Braud, T Setty, D Jurkovic","doi":"10.1002/uog.29150","DOIUrl":"10.1002/uog.29150","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether premenopausal women diagnosed with deep or ovarian endometriosis on transvaginal sonography (TVS) were more likely to suffer from dyspareunia and pelvic pain symptoms, and have a lower quality of life, compared to women without sonographically diagnosed deep or ovarian endometriosis.</p><p><strong>Methods: </strong>This was a prospective, cross-sectional study carried out between February 2019 and October 2020 at the general gynecology clinic at University College London Hospital, London, UK. All premenopausal women aged 18-50 years, who were examined consecutively by a single experienced examiner and underwent a detailed TVS scan, were eligible for inclusion. Pregnant women and those who had received a previous diagnosis of endometriosis or who had experienced a hysterectomy or unilateral/bilateral oophorectomy were excluded. Sonographic findings consistent with deep or ovarian endometriosis were noted. All women completed the British Society of Gynaecological Endoscopy pelvic pain questionnaire. The primary outcome was to determine whether women with sonographic evidence of endometriosis were more likely to experience moderate-to-severe levels of dyspareunia (score of ≥ 4 on an 11-point numerical rating scale (NRS)). Secondary outcomes included assessing moderate-to-severe levels of other pelvic pain symptoms (NRS score of ≥ 4), bowel symptoms (score of ≥ 2 on a 5-point Likert scale) and quality of life, which was measured using the EuroQol-5D-3L (EQ-5D) questionnaire. The number of women with pain scores ≥ 4 and bowel scores ≥ 2, as well as the mean EQ-5D scores, were compared between the group with and that without sonographic evidence of endometriosis using logistic regression analysis, and multivariable analysis was used to adjust for demographic and clinical variables.</p><p><strong>Results: </strong>A total of 514 women were included in the final study population, of whom 146 (28.4%) were diagnosed with deep or ovarian endometriosis on TVS. On multivariable analysis, the presence of moderate-to-severe dyspareunia was not found to be associated with endometriosis. Moderate-to-severe dyspareunia was significantly associated with lower age (odds ratio (OR), 0.70 (95% CI, 0.56-0.89); P = 0.003) and a history of migraine (OR, 3.52 (95% CI, 1.42-8.77); P = 0.007), and it occurred significantly less frequently in women with non-endometriotic ovarian cysts (OR, 0.47 (95% CI, 0.28-0.78); P = 0.003). There was also a trend towards a positive association between anxiety/depression and moderate-to-severe dyspareunia (OR, 1.94 (95% CI, 0.93-4.03); P = 0.08). Following multivariable analysis, the only symptoms that were significantly more common in women with endometriosis compared to those without were menstrual dyschezia (OR, 2.44 (95% CI, 1.59-3.78); P < 0.001) and difficulty emptying the bladder (OR, 2.56 (95% CI, 1.52-4.31); P < 0.001). Although not reaching statistical significance on multivariable","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"372-383"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984774","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}
A Deslandes, J C Avery, H-T Chen, M Leonardi, S Knox, G Lo, R O'Hara, G Condous, M L Hull
{"title":"Intra- and interobserver agreement of proposed objective transvaginal ultrasound image-quality scoring system for use in artificial intelligence algorithm development.","authors":"A Deslandes, J C Avery, H-T Chen, M Leonardi, S Knox, G Lo, R O'Hara, G Condous, M L Hull","doi":"10.1002/uog.29178","DOIUrl":"10.1002/uog.29178","url":null,"abstract":"<p><strong>Objectives: </strong>The development of valuable artificial intelligence (AI) tools to assist with ultrasound diagnosis depends on algorithms developed using high-quality data. This study aimed to test the intra- and interobserver agreement of a proposed image-quality scoring system to quantify the quality of gynecological transvaginal ultrasound (TVS) images, which could be used in clinical practice and AI tool development.</p><p><strong>Methods: </strong>A proposed scoring system to quantify TVS image quality was created following a review of the literature. This system involved a score of 1-4 (2 = poor, 3 = suboptimal and 4 = optimal image quality) assigned by a rater for individual ultrasound images. If the image was deemed inaccurate, it was assigned a score of 1, corresponding to 'reject'. Six professionals, including two radiologists, two sonographers and two sonologists, reviewed 150 images (50 images of the uterus and 100 images of the ovaries) obtained from 50 women, assigning each image a score of 1-4. The review of all images was repeated a second time by each rater after a period of at least 1 week. Mean scores were calculated for each rater. Overall interobserver agreement was assessed using intraclass correlation coefficient (ICC), and interobserver agreement between paired professionals and intraobserver agreement for all professionals were assessed using weighted Cohen's kappa and ICC.</p><p><strong>Results: </strong>Poor levels of interobserver agreement were obtained between the six raters for all 150 images (ICC, 0.480 (95% CI, 0.363-0.586)), as well as for assessment of the uterine images only (ICC, 0.359 (95% CI, 0.204-0.523)). Moderate agreement was achieved for the ovarian images (ICC, 0.531 (95% CI, 0.417-0.636)). Agreement between the paired sonographers and sonologists was poor for all images (ICC, 0.336 (95% CI, -0.078 to 0.619) and 0.425 (95% CI, 0.014-0.665), respectively), as well as when images were grouped into uterine images (ICC, 0.253 (95% CI, -0.097 to 0.577) and 0.299 (95% CI, -0.094 to 0.606), respectively) and ovarian images (ICC, 0.400 (95% CI, -0.043 to 0.669) and 0.469 (95% CI, 0.088-0.689), respectively). Agreement between the paired radiologists was moderate for all images (ICC, 0.600 (95% CI, 0.487-0.693)) and for their assessment of uterine images (ICC, 0.538 (95% CI, 0.311-0.707)) and ovarian images (ICC, 0.621 (95% CI, 0.483-0.728)). Weak-to-moderate intraobserver agreement was seen for each of the raters with weighted Cohen's kappa ranging from 0.533 to 0.718 for all images and from 0.467 to 0.751 for ovarian images. Similarly, for all raters, the ICC indicated moderate-to-good intraobserver agreement for all images overall (ICC ranged from 0.636 to 0.825) and for ovarian images (ICC ranged from 0.596 to 0.862). Slightly better intraobserver agreement was seen for uterine images, with weighted Cohen's kappa ranging from 0.568 to 0.808 indicating weak-to-strong agreement, and ICC ranging","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"364-371"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11872342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034177","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":"Reply.","authors":"M L Larsen, S Kumar","doi":"10.1002/uog.29157","DOIUrl":"10.1002/uog.29157","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"394"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048086","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}
L Youssef, F Crispi, S Paolucci, J Miranda, S Lobmaier, F Crovetto, F Figueras, E Gratacos
{"title":"Angiogenic factors alone or in combination with ultrasound Doppler criteria for risk classification among late-onset small fetuses with or without pre-eclampsia.","authors":"L Youssef, F Crispi, S Paolucci, J Miranda, S Lobmaier, F Crovetto, F Figueras, E Gratacos","doi":"10.1002/uog.29181","DOIUrl":"10.1002/uog.29181","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the prognostic value of maternal angiogenic factors in late-onset small fetuses, alone or in combination with the ultrasound and Doppler parameters currently used for the classification of low-risk small-for-gestational-age (SGA) fetuses or high-risk fetal growth restriction (FGR), overall and according to the presence or absence of pre-eclampsia.</p><p><strong>Methods: </strong>This was a prospective cohort study of women with a singleton pregnancy with a diagnosis of late-onset fetal smallness (defined as birth weight < 10<sup>th</sup> centile) and a gestational age of ≥ 34 weeks at delivery. Ultrasound assessment of estimated fetal weight (EFW) and Doppler assessment of uterine artery pulsatility index (UtA-PI) and cerebroplacental ratio (CPR) were performed every 1-2 weeks. Biochemical analysis of the angiogenic factors placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) in maternal peripheral venous blood samples was performed using enzyme-linked immunosorbent assay within 1-2 weeks after diagnosis of SGA or FGR. The primary outcome was adverse perinatal outcome, defined as a composite of emergency Cesarean section for non-reassuring fetal status, metabolic acidosis (umbilical artery pH < 7.0), neonatal unit admission and/or perinatal death. The predictive value of EFW < 3<sup>rd</sup> centile, Doppler parameters (UtA-PI > 95<sup>th</sup> centile and CPR < 5<sup>th</sup> centile) and sFlt-1/PlGF ratio > 95<sup>th</sup> centile, alone or in combination, was assessed using logistic regression analysis in the overall population and stratified by presence or absence of pre-eclampsia developing at any time before delivery.</p><p><strong>Results: </strong>Among the 602 included cases, 91 (15.1%) developed pre-eclampsia and 511 (84.9%) did not. In the overall study population, all parameters were associated independently with adverse perinatal outcome: EFW < 3<sup>rd</sup> centile (adjusted odds ratio (aOR), 2.58 (95% CI, 1.67-4.00)), UtA-PI > 95<sup>th</sup> centile (aOR, 1.92 (95% CI, 1.25-2.94)), CPR < 5<sup>th</sup> centile (aOR, 2.35 (95% CI, 1.46-3.78)) and sFlt-1/PlGF ratio > 95<sup>th</sup> centile (aOR, 1.71 (95% CI, 1.09-2.69)). Only sFlt-1/PlGF ratio > 95<sup>th</sup> centile was associated independently with adverse perinatal outcome in cases with pre-eclampsia, whereas in those without pre-eclampsia, only EFW < 3<sup>rd</sup> centile and CPR < 5<sup>th</sup> centile were associated independently with adverse perinatal outcome. In the overall population, the detection rate (DR) and false-positive rate for adverse perinatal outcome were, respectively: 39.8% (95% CI, 31.7-47.9%) and 16.9% (95% CI, 10.7-23.1%) for sFlt-1/PlGF ratio > 95<sup>th</sup> centile alone; 86.8% (95% CI, 83.4-90.2%) and 61.9% (95% CI, 57.1-66.7%) for a combined model of EFW < 3<sup>rd</sup> centile, UtA-PI > 95<sup>th</sup> centile and CPR < 5<sup>th</sup> centile; 81.3% (95% CI, 77.3-85.3%) a","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"317-324"},"PeriodicalIF":6.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068194","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":"Comprehensive prenatal ultrasound for surgical risk assessment: differentiating placenta accreta spectrum from uterine scar dehiscence for improved clinical decision-making.","authors":"R A Aryananda, T K Adu-Bredu","doi":"10.1002/uog.29138","DOIUrl":"10.1002/uog.29138","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"241-242"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606627","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":"Posterior complex: clue for suspicion of partial agenesis of corpus callosum at fetal brain screening.","authors":"F Viñals, F Correa","doi":"10.1002/uog.29136","DOIUrl":"10.1002/uog.29136","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"239-241"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547754","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}
A Khalil, A Sotiriadis, A Baschat, A Bhide, E Gratacós, K Hecher, L Lewi, L J Salomon, B Thilaganathan, Y Ville
{"title":"ISUOG Practice Guidelines (updated): role of ultrasound in twin pregnancy.","authors":"A Khalil, A Sotiriadis, A Baschat, A Bhide, E Gratacós, K Hecher, L Lewi, L J Salomon, B Thilaganathan, Y Ville","doi":"10.1002/uog.29166","DOIUrl":"10.1002/uog.29166","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"253-276"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012364","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":"Performance evaluation of computerized antepartum fetal heart rate monitoring: Dawes-Redman algorithm at term.","authors":"G Davis Jones, B Albert, W Cooke, M Vatish","doi":"10.1002/uog.29167","DOIUrl":"10.1002/uog.29167","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the effectiveness of the Dawes-Redman algorithm in identifying fetal wellbeing at term by analyzing 30 years of retrospective clinical data, comparing normal and adverse pregnancy outcomes, evaluating key metrics and testing its performance when used 0-48 h before delivery.</p><p><strong>Methods: </strong>Antepartum fetal heart rate (FHR) traces from term singleton pregnancies at 37 + 0 to 41 + 6 weeks' gestation obtained between 1991 and 2024 were extracted from the Oxford University Hospitals database. Traces with > 30% of their signal information missing or with incomplete Dawes-Redman analyses were excluded. Only traces performed within 48 h prior to delivery were considered. A cohort of pregnancies with subsequent normal pregnancy outcome (NPO) was established using rigorous inclusion and exclusion criteria. Another cohort of pregnancies with adverse pregnancy outcome (APO) was developed if the neonate experienced at least one of seven APOs after delivery. Propensity score matching (PSM) facilitated a balanced comparison between NPO and APO cohorts using six factors: gestational age at FHR monitoring, fetal sex, maternal body mass index at presentation, maternal age at delivery, parity and time interval between FHR trace and delivery. FHR traces were categorized as either 'criteria met' (indicating fetal wellbeing) or 'criteria not met' (indicating a need for further evaluation) according to the Dawes-Redman algorithm, which informed the evaluation of predictive performance metrics. Performance was assessed using accuracy, sensitivity, specificity, positive predictive value, and negative predictive value (NPV) adjusted for various population risk prevalences of APO.</p><p><strong>Results: </strong>A balanced dataset of 3316 antepartum FHR traces was developed with PSM (standardized mean difference < 0.10). The Dawes-Redman algorithm showed a high specificity of 90.7% (95% CI, 89.2-92.0%) for ruling out APO. Sensitivity was 18.2% (95% CI, 16.3-20.0%). The NPV varied with the population prevalence of APO and was high in very-low-risk settings (NPV, 99.1% (95% CI, 98.9-99.3%) at 1% APO prevalence) and decreased with increasing risk of APO (NPV, 72.1% (95% CI, 67.7-76.1%) at 30% APO prevalence). Temporal proximity of FHR assessment to delivery indicated robust specificity, which was similar for assessments performed at 0-24 h and 24-48 h prior to delivery (specificity at 0-24 h, 90.8% (95% CI, 88.8-92.7%); specificity at 24-48 h, 90.3% (95% CI, 88.2-92.3%); P = 0.898). Across the different adverse outcomes comprising the APO cohort, the performance of the Dawes-Redman algorithm remained consistent, with high specificity (ranging from 87.7% to 94.7%) and NPVs (ranging from 95.4% to 96.0%), confirming its utility in identifying fetal wellbeing.</p><p><strong>Conclusion: </strong>These findings indicate that the Dawes-Redman algorithm is effective for its intended purpose: identifying a state of fetal wellb","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":"65 2","pages":"191-197"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081178","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":"Perinatal diagnosis of renal agenesis in female fetus: implication for investigation of OHVIRA syndrome in adolescence.","authors":"A Ludwin, L Zaborowska","doi":"10.1002/uog.27714","DOIUrl":"10.1002/uog.27714","url":null,"abstract":"","PeriodicalId":23454,"journal":{"name":"Ultrasound in Obstetrics & Gynecology","volume":" ","pages":"249-252"},"PeriodicalIF":6.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761229","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}