Ultrasound Obstet Gynecol [JOURNAL]
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Tan SY, Au N, Peel MD
… +11 more
, Dodd JM, Deussen A, Le Roux PA, Young DC, Tessier F, Dallenbäch P, Croll DMR, Patabendige M, Palmer K, Li W, Mol BW
Ultrasound Obstet Gynecol
· 2026 May · PMID 41206516
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OBJECTIVE: To compare the effectiveness and safety of oral misoprostol vs vaginal dinoprostone for the induction of labor (IOL) using an individual participant data (IPD) meta-analysis. METHODS: We used a Cochrane review...
OBJECTIVE: To compare the effectiveness and safety of oral misoprostol vs vaginal dinoprostone for the induction of labor (IOL) using an individual participant data (IPD) meta-analysis. METHODS: We used a Cochrane review and searched Ovid MEDLINE, Ovid Embase, Ovid Emcare, CINAHL Plus, Scopus and ClinicalTrials.gov to identify randomized controlled trials (RCTs) that compared oral misoprostol with vaginal dinoprostone for IOL in viable singleton pregnancies. We invited the authors of eligible trials to share their anonymized data. Primary outcomes were vaginal delivery, a composite measure of adverse maternal outcomes and a composite measure of adverse perinatal outcomes. IPD meta-analysis was conducted using a two-stage random-effects model. An intention-to-treat approach was used for all analyses. Aggregate-data meta-analysis was undertaken with RCTs stratified by Trustworthiness in RAndomised Clinical Trials (TRACT) score. RESULTS: Of 18 eligible RCTs, eight provided IPD, of which five (1892 participants) met the TRACT criteria. IPD meta-analysis showed similar rates of vaginal delivery after IOL with oral misoprostol or vaginal dinoprostone (odds ratio (OR), 0.99 (95% CI, 0.80-1.22); I = 0%). The rates of composite adverse perinatal outcome (adjusted odds ratio (aOR), 1.02 (95% CI, 0.61-1.72); I = 0%) and composite adverse maternal outcome (aOR, 1.39 (95% CI, 0.72-2.69); I = 0%) were also comparable between the groups. Of 10 RCTs that did not share IPD, seven met the TRACT criteria. Aggregate-data meta-analysis of the 12 RCTs (five with IPD and seven without IPD) meeting the trustworthiness criteria also showed comparable rates of vaginal delivery after oral misoprostol and after vaginal dinoprostone (OR, 1.08 (95% CI, 0.92-1.27)). In contrast, six studies not meeting the trustworthiness criteria (three with and three without IPD) reported a higher rate of vaginal delivery following oral misoprostol (OR, 1.34 (95% CI, 1.22-1.48)), resulting in an inflated overall estimate of the vaginal delivery rate after oral misoprostol based on all data (OR, 1.19 (95% CI, 1.05-1.36)). CONCLUSION: IOL with oral misoprostol or vaginal dinoprostone results in comparable rates of vaginal delivery and composite perinatal and maternal adverse outcomes. © 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.
Nijjar S, Kastora S, Bajrami A
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, Solangon S, Widschwendter M, Jurkovic D
Ultrasound Obstet Gynecol
· 2026 Jan · PMID 41189455
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OBJECTIVE: To evaluate the proportion of optimal assessments of endometrial thickness (ET) achieved by transvaginal ultrasound (TVS) compared with a multimodal (MM) sonographic approach in women with abnormal uterine ble...
OBJECTIVE: To evaluate the proportion of optimal assessments of endometrial thickness (ET) achieved by transvaginal ultrasound (TVS) compared with a multimodal (MM) sonographic approach in women with abnormal uterine bleeding (AUB). METHODS: This prospective observational study was a subset of the EPI-SURE study conducted between June and November 2022 in a tertiary gynecology diagnostic referral center in the UK. All women aged ≥ 45 years with AUB who underwent TVS assessment of the endometrium were included. If the endometrium could not be visualized optimally on TVS, women were offered another method of endometrial assessment (MM approach), namely transabdominal ultrasound, transrectal ultrasound and/or saline contrast sonohysterography. We assessed the diagnostic performance of TVS compared with the MM approach in terms of the quality of endometrial visualization and measurement of ET, and used uni- and multivariable logistic regression analyses to evaluate associations between patient characteristics and imaging outcome. RESULTS: We included 387 women who underwent TVS for endometrial assessment. In 245/387 (63.3%) cases, ET measurement was deemed optimal on TVS. The most common standalone reasons for suboptimal TVS were adenomyosis (37/142, 26.1%) and unfavorable uterine position (37/142, 26.1%), followed by uterine fibroids (21/142, 14.8%) and other pathologies or presence of intrauterine system (6/142, 4.2%). In 41/142 (28.9%) women, the reason for suboptimal TVS was multifactorial. The median angle of insonation on TVS in women with an unfavorable uterine position was 33° (interquartile range (IQR), 15-52°), which increased to 86° (IQR, 78-90°) on MM imaging (P < 0.0001). In cases with suboptimal TVS due to inadequate imaging of the uterine cavity and/or a suboptimal angle of insonation, ET measurement was significantly higher on TVS compared with the MM approach (median difference, -1.3 (95% CI, -1.7 to -0.9) mm; P < 0.0001). On multivariable analysis, factors associated significantly with suboptimal TVS included fibroids distorting the uterine cavity and younger age; women with fibroids had 10 times the odds of a suboptimal TVS assessment of the endometrium compared to those without. Cavity-distorting fibroids and higher body mass index were associated significantly with suboptimal MM imaging on multivariable analysis, with fibroids increasing the odds of this outcome by 4.2 times. A prespecified ET cut-off of ≥ 4.5 mm yielded a specificity of 85.8% (95% CI, 78.0-91.7%) with the MM approach for the diagnosis of endometrial cancer. Using the MM sonographic approach avoided the need for further procedures to assess the endometrium in 118/387 (30.5%) cases. CONCLUSION: The MM sonographic approach is a better way to assess the endometrium compared with TVS alone in women presenting with AUB. The MM approach improved endometrial assessment by optimizing the angle of insonation and visualization of the uterine cavity, which resulted in significantly lower ET measurements and a higher specificity for endometrial cancer, thereby potentially reducing the number of invasive interventions, such as hysteroscopy and endometrial biopsy. © 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.
Fischerova D, Pinto P, Alcázar Zambrano JL
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, Vara-Garcia J, Chiappa V, Raspagliesi F, Franchi D, Urbinati AV, Testa AC, Jarkovsky J, Cibula D, Moro F, Collaborators
Ultrasound Obstet Gynecol
· 2026 Feb · PMID 41189428
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OBJECTIVE: To test the non-inferiority of extended abdominopelvic ultrasound examination compared with contrast-enhanced computed tomography (CT) and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI)...
OBJECTIVE: To test the non-inferiority of extended abdominopelvic ultrasound examination compared with contrast-enhanced computed tomography (CT) and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) in discriminating preoperatively between resectable and non-resectable disease based on the European Society for Medical Oncology (ESMO) and European Society of Gynecological Oncology (ESGO)-defined criteria in patients with tubo-ovarian carcinoma. METHODS: The Imaging Study on Advanced ovArian Cancer was a prospective multicenter observational study conducted in five European gynecological oncology centers. All centers had ESGO accreditation to perform advanced ovarian cancer surgery, and ultrasound examinations were performed by a European Federation of Societies for Ultrasound in Medicine and Biology level-III examiner in a standardized manner. Included in the analysis were patients enrolled between 2020 and 2022 with suspected or histologically proven primary tubo-ovarian (including peritoneal) carcinoma who, for the purposes of the study, underwent ultrasound and CT imaging, as well as WB-DWI/MRI if available, prior to surgery. The index tests, which included the preoperative imaging modalities as well as intraoperative exploration at the start of surgery, supplemented by biopsy or follow-up imaging for extra-abdominal locations, evaluated the presence of disease at eight anatomical sites that, if infiltrated, would indicate non-resectability of the tumor according to the ESMO-ESGO criteria. Surgical outcome, described by the surgeons at the end of the procedure, was used as the reference standard and non-resectability was defined as the presence of residual disease > 1 cm or when debulking surgery was not feasible. The area under the receiver-operating-characteristics curve (AUC) and F score were used to assess the performance of the preoperative imaging methods and surgical exploration in discriminating between patients with resectable and those with non-resectable disease, based on the ESMO-ESGO criteria. We also calculated the percentage agreement between imaging findings and surgical exploration findings at the start of surgery, supplemented when applicable by biopsy or follow-up imaging for extra-abdominal locations, regarding the presence of tumor infiltration at each of the eight anatomical sites associated with non-resectability. RESULTS: Of 279 patients enrolled during the study period, 242 were included in the final analysis. In the subgroup of 167 patients who underwent surgery and had been examined by all three imaging methods, the AUC of the three imaging modalities and surgical exploration for discriminating between resectable and non-resectable disease based on the ESMO-ESGO criteria was 0.835 (95% CI, 0.756-0.915) for ultrasound, for CT it was 0.754 (95% CI, 0.664-0.843), for WB-DWI/MRI it was 0.720 (95% CI, 0.626-0.814) and for surgical exploration it was 0.952 (95% CI, 0.915-0.988). Ultrasound was not inferior to CT or WB-DWI/MRI, based on the AUC and F score, in discriminating between patients with resectable and those with non-resectable tubo-ovarian carcinoma. At surgical exploration, at least one non-resectability criterion was present in 32.2% cases. The criteria observed most frequently at surgical exploration were small-bowel involvement (23.6% of cases), diffuse deep infiltration of the root of the small-bowel mesentery (18.2% of cases) and hepatic hilum involvement (5.4% of cases). The percentage agreement between ultrasound and surgical exploration in assessing the presence of disease in at least one of the eight anatomical sites that, if infiltrated, would indicate non-resectability of tumor, was 83.9%, surpassing the percentage agreement with surgical exploration of both CT (77.7%) and WB-DWI/MRI (75.8%). CONCLUSION: When performed by an experienced examiner, ultrasound is not inferior to either CT or WB-DWI/MRI in discriminating between resectable and non-resectable disease in patients with tubo-ovarian carcinoma, based on evaluation of the presence of the disease in at least one of eight anatomical sites that, if infiltrated, would indicate non-resectability of the tumor. © 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.
Espinoza J, LeMoine F, Backley S
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, Papanna R, Johnson A, Vilchez Lagos G, Hernandez-Andrade E, Zhu S, Miao Z, Naranjo S, Llanes A, Chmait RH
Ultrasound Obstet Gynecol
· 2025 Dec · PMID 41189346
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OBJECTIVE: To identify preoperative risk factors associated with postlaser fetal death of the donor twin in a large cohort of pregnancies complicated by twin-twin transfusion syndrome (TTTS). METHODS: This retrospective...
OBJECTIVE: To identify preoperative risk factors associated with postlaser fetal death of the donor twin in a large cohort of pregnancies complicated by twin-twin transfusion syndrome (TTTS). METHODS: This retrospective cohort study of prospectively collected data included monochorionic diamniotic pregnancies complicated by TTTS that underwent laser surgery between March 2006 and May 2024 at two specialized referral centers. Patients underwent a comprehensive ultrasound examination, including fetal Doppler evaluation, to assign a Quintero stage and to obtain the middle cerebral artery (MCA) peak systolic velocity (PSV) for each twin within 24 h before laser surgery. An isolated elevation of the donor MCA-PSV was defined as having an MCA-PSV > 1.5 multiples of the median (MoM) in the absence of twin anemia-polycythemia sequence (TAPS). TAPS was defined as donor MCA-PSV > 1.5 MoM and recipient MCA-PSV < 1.0 MoM or intertwin MCA-PSV difference of > 0.5 MoM. Patients underwent postoperative ultrasound the day after surgery to document cardiac activity in each twin. Univariate logistic and multivariable Poisson (Zou's method) regression models were used to estimate the odds ratio and adjusted relative risk (aRR) for donor twin demise, adjusted for TAPS, TTTS stage, selective fetal growth restriction (sFGR), donor MCA pulsatility index < 10 percentile, gestational age < 18 weeks at surgery and other risk factors. RESULTS: Fetal demise of the donor twin was noted in 14.3% (229/1602) of the study population. Preoperative isolated elevation of donor MCA-PSV conferred the highest aRR of any risk factor for postlaser donor fetal demise (aRR, 2.69 (95% CI, 1.91-3.81); P < 0.001) compared with Stage-III TTTS (aRR, 2.34 (95% CI, 1.36-4.02); P = 0.002), MCA pulsatility index < 10 percentile (aRR, 1.91 (95% CI, 1.48-2.46); P < 0.001), velamentous cord insertion in the donor twin (aRR, 1.86 (95% CI, 1.43-2.41); P < 0.001), TAPS (aRR, 1.63 (95% CI, 1.19-2.23); P = 0.001), gestational age < 18 weeks at laser surgery (aRR, 1.59 (95% CI, 1.21-2.08); P = 0.001) and sFGR (aRR, 1.58 (95% CI, 1.19-2.07); P = 0.001). The observed frequency of fetal demise of the donor twin increased with each additional concomitant risk factor included. CONCLUSION: Isolated elevation of donor MCA-PSV prior to laser surgery for TTTS conferred the highest aRR for donor fetal demise among risk factors including TAPS, TTTS staging, sFGR and other covariates. This risk increased progressively when more than one risk factor was present in pregnancies complicated by TTTS. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.
De Robertis V, Bilardo CM, Abu-Rustum R
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, Poon LC, Kamel R, Manieri Rocha R, Syngelaki A, Stampalija T, Collaborators
Ultrasound Obstet Gynecol
· 2026 Jan · PMID 41185159
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Taksøe-Vester CA, Mikolaj K, Petersen OB
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, Ekelund CK, Vejlstrup NG, Vedel C, Christensen AN, Feragen A, Nielsen M, Tolsgaard MG
Ultrasound Obstet Gynecol
· 2026 Apr · PMID 41164991
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OBJECTIVE: Pre-eclampsia (PE) and fetal growth restriction (FGR) have been shown to impact fetal cardiac remodeling in the third trimester and postnatally, with evidence to suggest that this leads to increased long-term...
OBJECTIVE: Pre-eclampsia (PE) and fetal growth restriction (FGR) have been shown to impact fetal cardiac remodeling in the third trimester and postnatally, with evidence to suggest that this leads to increased long-term cardiovascular risk. This study aimed to examine fetal cardiac remodeling in pregnancies with PE and/or FGR during the second trimester. METHODS: This was a retrospective nationwide cohort study of ultrasound images from routine screening at 18-22 weeks of gestation in Denmark. We included 139 430 singleton pregnancies that were conceived spontaneously for which at least one relevant standardized cardiac plane (four-chamber view and/or three-vessel view) was available from the second-trimester scan. An artificial intelligence model performed automated segmentation and extraction of fetal cardiac biometric measurements. Data were collected for four groups: the reference group, defined as appropriate-for-gestational-age (AGA) fetuses from a normotensive pregnancy (n = 131 150); AGA fetuses from a PE pregnancy (AGA + PE group; n = 3095); FGR fetuses from a normotensive pregnancy (normotensive + FGR group; n = 4572); and FGR fetuses from a PE pregnancy (PE + FGR group; n = 613). Differences between groups in cardiac biometric measurements were presented as Z-scores adjusted for abdominal circumference at the second-trimester scan. RESULTS: Compared with the reference group, fetuses in the PE + AGA group had significantly larger right-sided heart structures, and the main pulmonary artery (MPA) and ventricular septum were wider. Fetuses in the normotensive + FGR group displayed significantly smaller cardiac structures, including smaller MPA and ascending aorta diameters, and increased left ventricular sphericity compared with the reference group. Fetuses in the PE + FGR group differed significantly from the reference group only in terms of smaller left atrial area, narrower ascending aorta and increased left ventricular sphericity. However, PE + FGR fetuses had significantly wider MPA and ventricular septum and larger right-sided structures compared with normotensive + FGR fetuses, mimicking the features of the PE + AGA group, suggesting a distinct effect of PE on fetal cardiac remodeling. CONCLUSIONS: Cardiac remodeling is evident as early as the second trimester, with distinct patterns of modulation in fetuses from pregnancies affected by PE vs FGR. In particular, PE is associated with an enlarged right heart and greater MPA diameter. Understanding these early differences in fetal cardiac morphology may improve risk prediction models and guide early intervention to improve long-term cardiovascular outcome. © 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.
Horgan R, Sinkovskaya E, Kalafat E
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, Saade G, Abuhamad A
Ultrasound Obstet Gynecol
· 2025 Dec · PMID 41139401
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OBJECTIVE: Although spectral tissue Doppler imaging is recognized as the optimal method for assessing the fetal myocardial performance index (MPI), longitudinal reference ranges for fetal MPI measured using spectral tiss...
OBJECTIVE: Although spectral tissue Doppler imaging is recognized as the optimal method for assessing the fetal myocardial performance index (MPI), longitudinal reference ranges for fetal MPI measured using spectral tissue Doppler have not been established. Our objective was to use spectral tissue Doppler data to establish gestational-age-specific reference ranges from 12-33 weeks for left and right ventricular fetal MPI. METHODS: This was a prospective longitudinal study of women aged 18-35 years, with a body mass index below 30 kg/m and a singleton pregnancy conceived spontaneously. Fetal MPI measurements were obtained in the first, second and third trimesters and MPI was determined using spectral tissue Doppler imaging. A generalized additive model for location, scale and shape (GAMLSS) was used to explore the relationship between fetal MPI and gestational age. Model fit was assessed by checking the normality of estimated Z-scores across the fitted range and independency from gestational age. RESULTS: Median fetal MPI was determined for the right and left ventricles at 12-13 weeks, 20-21 weeks and 32-33 weeks' gestation in 90 fetuses. Using multilevel regression modeling, weekly reference ranges for each gestational age were created to provide a continuous characterization of normal fetal MPI assessed using spectral tissue Doppler throughout pregnancy. Percentile reference ranges (5, 10, 25, 50, 75, 90 and 95) for right and left ventricular fetal MPI were generated from these models, capturing normal variability across gestation. CONCLUSION: We have established gestational-age-specific reference ranges for left and right ventricular fetal MPI using spectral tissue Doppler imaging, thus providing clinicians with an important tool for the early detection of fetal cardiac dysfunction in high-risk pregnancies. © 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.
Granfors M, Mantel Ä, Axelsson O
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, Cnattingius S, Lindström L
Ultrasound Obstet Gynecol
· 2025 Dec · PMID 41134311
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OBJECTIVE: Ultrasound-based fetal growth assessment is an essential part of clinical decision-making in modern obstetric care. This study aimed to evaluate the impact of maternal and fetal characteristics on the accuracy...
OBJECTIVE: Ultrasound-based fetal growth assessment is an essential part of clinical decision-making in modern obstetric care. This study aimed to evaluate the impact of maternal and fetal characteristics on the accuracy and precision of sonographic fetal weight estimation. METHODS: We included 31 521 singleton pregnancies registered in the Swedish Pregnancy Register between January 2014 and December 2021, with delivery ≥ 22 + 0 weeks' gestation and estimated fetal weight (EFW) assessed using ultrasound within 2 days before delivery. Fetal biometric ultrasound measurements were used to calculate EFW according to the formula of Persson and Weldner. Mean percentage error (MPE) and the proportion of EFW within ± 10% of the birth weight were calculated and stratified by maternal body mass index (BMI), fetal sex, fetal presentation at birth, gestational age (GA) at ultrasound and standardized EFW (estimated small-for-gestational age (SGA), appropriate-for-gestational age (AGA) or large-for-gestational age). Univariable and adjusted risk ratios (aRRs) for poor EFW assessment, defined as EFW deviating more than ± 10% from the birth weight, were calculated. RESULTS: All investigated fetal characteristics, but not maternal BMI, affected the precision of EFW. The inaccuracies of fetal weight estimation were most pronounced in fetuses estimated as severe SGA (< 3 percentile) across all subgroups of GA at ultrasound (overall MPE, -5.4 ± 9.8%; 67% of estimates within ± 10% of birth weight). The risk of poor fetal weight estimation was highest for severe-SGA-estimated vs AGA-estimated fetuses (aRR, 1.44 (95% CI, 1.38-1.51)). Additionally, the risk of poor fetal weight estimation was higher for male vs female fetuses (aRR, 1.09 (95% CI, 1.05-1.14)), non-cephalic vs cephalic presentation (aRR, 1.20 (95% CI, 1.13-1.28)) and preterm vs late term (39 + 0 to 40 + 6 weeks) GA at ultrasound, with the highest risk observed for those with GA of 22 + 0 to 27 + 6 weeks at ultrasound (aRR, 1.30 (95% CI, 1.13-1.50)). CONCLUSIONS: All assessed fetal characteristics, especially standardized EFW, affected the accuracy of ultrasonographic fetal weight estimation. Understanding systematic errors in the EFW formula used is of utmost importance in clinical decision-making to prevent unnecessary or missed obstetric interventions. © 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.
Buca D, Jauniaux E, Lucidi A
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, Khalil A, Di Tizio L, Liberati M, D'Antonio F
Ultrasound Obstet Gynecol
· 2026 May · PMID 41128367
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Landolfo C, Froyman W, Testa AC
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, Fischerova D, Franchi D, Yazbek J, Saso S, Fruscio R, Chiappa V, Czekierdowski A, Van Gorp T, Moro F, Savelli L, Zannoni GF, Bourne T, Timmerman D, Valentin L, Collaborators
Ultrasound Obstet Gynecol
· 2026 Jan · PMID 41118662
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OBJECTIVE: To describe the clinical and ultrasound characteristics at the time of diagnosis of primary ovarian immature teratoma with no other germ cell tumor components described on histopathology. METHODS: This was a r...
OBJECTIVE: To describe the clinical and ultrasound characteristics at the time of diagnosis of primary ovarian immature teratoma with no other germ cell tumor components described on histopathology. METHODS: This was a retrospective study of women with a histological diagnosis of primary ovarian immature teratoma who had undergone a preoperative ultrasound examination between 1998 and 2024. Cases were identified from the databases of 17 contributing ultrasound centers and the International Ovarian Tumor Analysis (IOTA) database. The descriptions of the ultrasound images of the tumors made by the original ultrasound examiners using IOTA terminology were reported. In addition, grayscale and color or power Doppler ultrasound images or videoclips were retrieved for all tumors. Two independent ultrasound examiners reviewed the retrieved material and searched for specific ultrasound characteristics of immature teratomas using pattern recognition. We present their agreed description of the tumors. RESULTS: In total, 64 patients with ovarian immature teratoma were included, of which 38 (59.4%) were obtained from the IOTA database (IOTA studies phase 1, 1b, 2, 3, 5 and 7). The median age of the patients at diagnosis was 24.5 (interquartile range (IQR), 18.8-31.0; range, 12-50) years. The most common presenting symptoms were abdominal or pelvic pain (38/60, 63.3%) and abdominal swelling (30/60, 50.0%). All immature teratomas were unilateral. The median largest diameter of the tumor was 149.5 (IQR, 125.0-183.8; range, 27-400) mm. Using IOTA terminology, most tumors were described as multilocular-solid (32/64, 50.0%) or solid lesions (22/64, 34.4%). When present, the solid component had a median largest diameter of 98.5 (IQR, 59.8-146.8; range 6-400) mm. Most masses showed minimal (19/63, 30.2%) or moderate (35/63, 55.6%) vascularization on color or power Doppler ultrasound examination. Using pattern recognition, the most typical ultrasound feature was heterogeneous, bizarre echogenicity of the solid components, with hyperechogenic areas, cystic spaces and acoustic shadows. This feature, which we consider pathognomonic, was present in 48/57 (84.2%) immature teratomas in which the solid components were adequately assessable. CONCLUSIONS: The typical ultrasound appearance of an ovarian immature teratoma is a large unilateral adnexal mass with large solid components that is poorly or moderately vascularized. The pathognomonic feature is heterogeneous echogenicity of the solid components with hyperechogenic areas, cystic spaces and acoustic shadows. Preoperative suspicion of immature teratoma can guide treatment, such as offering fertility-sparing surgery. © 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.
Vedel C, Steensberg J, Petersen OB
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, Andersen H, Barbosa M, Christiansen M, Gjørup V, Jensen AN, Munk K, Nyborg K, Olesen AW, Ravn F, Sperling L, Thyregod HGH, Vejlstrup N, Ekelund CK
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 41118659
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OBJECTIVE: To evaluate the Danish prenatal screening program for major fetal congenital heart defects (mCHD), focusing on incidence, detection rates (DRs), pregnancy outcomes and postnatal mortality. METHODS: This was a...
OBJECTIVE: To evaluate the Danish prenatal screening program for major fetal congenital heart defects (mCHD), focusing on incidence, detection rates (DRs), pregnancy outcomes and postnatal mortality. METHODS: This was a 5-year nationwide cohort study conducted from January 2018 to December 2022 in Denmark. We included pregnancies suspected of and/or with a confirmed mCHD and children with a confirmed mCHD, and excluded those who were not screened, false-positive cases and those who emigrated before delivery. The main outcome was the prenatal DR of mCHD. Secondary outcomes were rate of termination of pregnancy, liveborn incidence of mCHD, gestational age at delivery, neonatal surgery rate and postnatal mortality. RESULTS: Data from a total of 645 pregnancies and children with mCHD were retrieved from local databases and 602 were included in the final analysis. The prenatal DR of mCHD was 82.6% (497/602), with one of the highest DRs observed for univentricular heart (99.4% (159/160)) and the lowest DR for total anomalous pulmonary venous return (7.7% (1/13)). Termination of pregnancy occurred in 43.4% (261/602) of cases, with 52.5% (261/497) of prenatally detected cases opting for termination. The liveborn incidence of mCHD was 0.11% (1.1 per 1000 births), and the median gestational age at delivery was 39 + 2 weeks. Surgery was performed in 92.0% (300/326) of liveborn children, primarily within the first month after birth. The postnatal follow-up time was between 8 months and 5 years, with a mortality rate of 9.8% (32/326), of which 50.0% occurred neonatally without surgery. CONCLUSIONS: This study highlights increased prenatal DRs and a declining liveborn incidence of mCHD in Denmark, underscoring the efficacy of the national screening program and centralized care. Furthermore, the vast majority of patients were treated surgically, and the mortality rate was low. The declining liveborn incidence of mCHD should be monitored and potential causes explored further. © 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.
Xue S, Zheng Y, Cao Y
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, Cheung SWH, Chung CY, Zhao Y, Zhu X, Lo IFM, Luk HM, Leung TY, Kong X, Choy KW
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41118657
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OBJECTIVE: To investigate the incidence and clinical significance of a positive result on genome-wide non-invasive prenatal screening (NIPS) for trisomy 15. METHODS: We conducted a prospective cohort study of singleton p...
OBJECTIVE: To investigate the incidence and clinical significance of a positive result on genome-wide non-invasive prenatal screening (NIPS) for trisomy 15. METHODS: We conducted a prospective cohort study of singleton pregnancies that underwent genome-wide NIPS at a single center in Hong Kong between January 2020 and April 2023. The incidence of a positive genome-wide NIPS result for trisomy 15, positive predictive value (PPV) for trisomy 15 and risk of uniparental disomy 15 (UPD15) were assessed based on cytogenetic and molecular analyses at amniocentesis. Adverse fetal outcomes were reviewed. Furthermore, a systematic review of cohort studies reporting positive trisomy 15 results from genome-wide NIPS was performed, including data from our prospective cohort. Random-effects meta-analysis was used to obtain pooled estimates of incidence and PPV. The risk of UPD15 and adverse pregnancy outcomes was also evaluated. Heterogeneity was evaluated using Higgins' I statistic. RESULTS: In our cohort of 36 466 singleton pregnancies that underwent genome-wide NIPS, 10 (0.027%) cases were screen-positive for trisomy 15 (2.7 per 10 000 singleton pregnancies). Results from invasive diagnostic testing were available for all screen-positive cases. The PPV of genome-wide NIPS for trisomy 15 was 40.0% (4/10), and 3/10 (30.0%) cases were confirmed to have maternal UPD15. Together with our study, a total of 30 cohorts from 29 studies were included in the systematic review and meta-analysis, comprising 175 pregnancies that were screen-positive for trisomy 15. In 26 cohorts in which the total number of cases screened using NIPS were specified, the pooled incidence of trisomy 15 was 145/1 009 301 (0.013% (95% CI, 0.009-0.019%; I = 78.4%)), or 1.3 per 10 000 singleton pregnancies. The pooled incidence was significantly higher among women screened in the first trimester compared with those tested in the second trimester. Among 102 cases with a diagnostic result from invasive testing, 22 were confirmed as having fetal trisomy 15, including eight with full trisomy 15 and 14 with true fetal mosaicism. The pooled PPV for fetal trisomy 15 was 17.4% (95% CI, 4.0-35.0%; I = 51.5%). Among 69 cases with a result from UPD15 testing, 14 (20.3%) had maternal UPD15. Assuming that all diploid cases that did not undergo UPD15 testing had normal biparental inheritance of chromosome 15, the pooled PPV for either fetal trisomy 15 or UPD15 was 32.6% (95% CI, 14.4-53.0%; I = 55.3%), and the residual risk of UPD15 after a fetal normal karyotype was at least 11.3%. Among patients with clinical follow-up, 68.4% experienced an adverse pregnancy outcome, including fetal loss (29.1%), termination of pregnancy (21.5%) and/or pregnancy complication (17.7%). CONCLUSIONS: Although the PPV of genome-wide NIPS for fetal trisomy 15 was relatively low, a significant proportion of cases with a positive NIPS result for trisomy 15 had maternal UPD15 or fetal mosaicism, underscoring the need for diagnostic confirmation via amniocentesis. Amniocentesis should be strongly recommended for any case with a positive NIPS result for trisomy 15 to investigate UPD15 and true fetal mosaicism and guide subsequent clinical management. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.
Castro PT, Callado GY, Araujo Júnior E
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, da Silva Ribeiro ET, de Andrade CV, Peixoto-Filho FM, Werner H
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 41105795
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Cioffi R, Cavoretto PI, Mangili G
Ultrasound Obstet Gynecol
· 2026 Feb · PMID 41105465
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Li B, Ding H, Sun H
Ultrasound Obstet Gynecol
· 2026 Feb · PMID 41105445
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Zloto K, Cohen S, Batsry L
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, Schwartz A, Weissbach T, Avnet H, Weisz B, Yinon Y
Ultrasound Obstet Gynecol
· 2025 Dec · PMID 41097884
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OBJECTIVE: To evaluate the effectiveness of antenatal intravenous immunoglobulin (IVIG) treatment for recurrent fetal and neonatal alloimmune thrombocytopenia (FNAIT) and to determine factors associated with a good respo...
OBJECTIVE: To evaluate the effectiveness of antenatal intravenous immunoglobulin (IVIG) treatment for recurrent fetal and neonatal alloimmune thrombocytopenia (FNAIT) and to determine factors associated with a good response to treatment. METHODS: This was a retrospective cohort study of pregnant women diagnosed with FNAIT and managed at a single tertiary referral center between 1992 and 2024. Affected pregnancies were treated non-invasively with weekly IVIG (1 g/kg maternal body weight) from 18-24 weeks until delivery, without platelet count monitoring. All cases were monitored with serial ultrasound for intracranial hemorrhage (ICH). Fetal blood sampling was offered at 37 weeks' gestation to determine the mode of delivery; vaginal delivery was allowed when the fetal platelet count was ≥ 50 000/μL. A good response to treatment was defined by the absence of ICH and a platelet count ≥ 50 000/μL at birth. Neonatal and maternal outcomes were assessed, and clinical characteristics were compared between pregnancies with a good response to treatment vs non-responders. RESULT: During the study period, 91 women (225 pregnancies) were diagnosed with FNAIT. Of these, 121 (53.8%) pregnancies were treated with IVIG: 48 patients had one IVIG-treated pregnancy, 17 had two, six had three, four had four and one patient had five consecutive IVIG-treated pregnancies. Only two women were treated during their first affected pregnancy based on family history; the remaining 89 women were diagnosed after the delivery of an affected neonate. IVIG treatment was declined in 15/134 (11.2%) subsequent pregnancies. Among the IVIG-treated pregnancies, 100/121 (82.6%) exhibited a good response to IVIG, with a median platelet count at birth of 172 000/μL, while 21/121 (17.4%) did not respond to treatment, with a median platelet count at birth of 27 000/μL. None of the treated pregnancies was complicated by ICH. Human platelet antigen (HPA)-1a alloimmunization was significantly more common in the group of non-responders (95.2% vs 60.0%, P < 0.01), while HPA-5 alloimmunization was significantly more common among those who responded to treatment (29.0% vs 4.8%, P = 0.02). A comparison of consecutive IVIG-treated pregnancies (totaling 115 pregnancies) revealed no significant differences between the first, second and third pregnancy with respect to platelet count at birth. However, among 11 women with at least three IVIG-treated pregnancies, four exhibited variable responses to treatment, with some pregnancies resulting in severe thrombocytopenia (platelet count < 50 000/μL) despite a good response in the preceding pregnancy. Five (5.5%) patients experienced ICH, all during their first untreated pregnancy. In subsequent pregnancies, no case of ICH was reported in either treated or untreated pregnancies. CONCLUSION: A good response to IVIG in one FNAIT-affected pregnancy does not guarantee successful treatment in subsequent pregnancies. The reason why IVIG may be effective in one pregnancy but ineffective in a later pregnancy for the same patient remains unclear. © 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.
Hasegawa K, Suenaga K, Ohta N
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, Mizoguchi T, Matsuo W, Mochimaru Y, Arase T
Ultrasound Obstet Gynecol
· 2026 Jan · PMID 41092432
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Robalo Cordeiro M, Branco M
Ultrasound Obstet Gynecol
· 2026 Jan · PMID 41088749
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De Robertis V, Stampalija T, Abuhamad AZ
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, Bosco M, Chaoui R, Formigoni C, Moon-Grady AJ, Paladini D, Pilu G, Ramezzana IG, Rychik J, Volpe P
Ultrasound Obstet Gynecol
· 2026 Jan · PMID 41088747
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Buongiorno S, Salvi S, Di Ilio C
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, Capanna G, Merola P, Ghi T
Ultrasound Obstet Gynecol
· 2026 Jan · PMID 41082633
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