Ultrasound Obstet Gynecol [JOURNAL]
Sun
200 papers
Early first-trimester detection of thoracopagus conjoined twins using transvaginal 2D/3D ultrasound and augmented reality.
Tonni G, Lituania M, Grisolia G … +5 more , Araujo Júnior E, Ruano R, Werner H, Sepulveda W, Raffaelli R
Ultrasound Obstet Gynecol · 2026 Jan · PMID 41082349 · Publisher ↗
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Ultrasound-defined adenomyosis subtypes and their impact on outcomes following frozen embryo transfer: a propensity score-matched cohort study.
Wang L, Zheng H, Weng C … +3 more , Su Q, Yang F, Wang F
Ultrasound Obstet Gynecol · 2025 Dec · PMID 41081491 · Publisher ↗
OBJECTIVE: To evaluate the association of adenomyosis subtypes defined by ultrasound using the revised Morphological Uterus Sonographic Assessment (MUSA) criteria, with reproductive and obstetric outcomes following froze...
OBJECTIVE: To evaluate the association of adenomyosis subtypes defined by ultrasound using the revised Morphological Uterus Sonographic Assessment (MUSA) criteria, with reproductive and obstetric outcomes following frozen embryo transfer (FET). METHODS: This retrospective, single-center cohort study included women who underwent their first FET cycle, as well as transvaginal ultrasound evaluation for the diagnosis of adenomyosis using the revised MUSA criteria, between August 2022 and June 2024. We included only FET cycles in which transferred embryos were of high quality. Adenomyosis subtypes were defined as follows: external (confined to the outer myometrium), internal (involving the inner myometrium, corresponding to the endometrial-myometrial junction, and/or the middle myometrium) and mixed (affecting both inner and outer myometrium). Controls were selected from women without ultrasound evidence of adenomyosis who underwent FET during the same period. Propensity score matching (1:1) was performed using patient age, body mass index, anti-Müllerian hormone level, infertility type, embryo stage, cause of infertility, FET protocol and number of embryos transferred. Comparative analyses were conducted to assess differences in reproductive and obstetric outcomes in women with adenomyosis, both overall and its subtypes, vs matched controls. The primary outcome was live birth, defined as delivery of at least one live infant at ≥ 28 weeks' gestation. Secondary outcomes were: implantation, clinical pregnancy, ectopic pregnancy, early pregnancy loss (< 12 weeks), late pregnancy loss (12-28 weeks), multiple pregnancy, preterm birth (< 37 weeks), low birth weight (< 2500 g), fetal growth restriction, hypertensive disorders of pregnancy, gestational diabetes mellitus, placenta previa, placenta accreta, placental abruption, premature rupture of membranes and delivery by Cesarean section. RESULTS: Of 4146 eligible women, 879 with adenomyosis and 879 matched controls without adenomyosis were included in the analysis. Their age ranged from 20 to 42 years. The rate of live birth was significantly lower in the group with adenomyosis compared to controls (35.38% vs 45.16%, P < 0.001; odds ratio (OR), 0.67 (95% CI, 0.55-0.81)). Women with external adenomyosis, accounting for over 50% of cases, had a live-birth rate comparable with that of their matched controls (45.80% vs 46.85%, P = 0.795; OR, 0.96 (95% CI 0.74-1.24)), whereas the live-birth rate was significantly lower for women with internal adenomyosis (27.44% vs 42.33%, P = 0.002; OR, 0.52 (95% CI, 0.34-0.77)) and even lower for those with mixed-type adenomyosis (18.09% vs 44.15%, P < 0.001; OR, 0.28 (95% CI, 0.17-0.45)) compared with controls. The rate of early pregnancy loss was higher in adenomyosis patients compared with controls (22.25% vs 15.65% of clinical pregnancies, P = 0.011; OR, 1.54 (95% CI, 1.10-2.15)). There were no significant differences in most of the other secondary outcomes in women with a live birth, between those with adenomyosis and controls. However, subgroup analysis revealed several significant associations between adenomyosis phenotypes, mainly internal and mixed-type adenomyosis, and specific obstetric outcomes. CONCLUSIONS: Adenomyosis, particularly internal and mixed-type, is associated with a reduced live-birth rate and an increased risk of early pregnancy loss in those achieving clinical pregnancy following FET. Ultrasound-based phenotyping of adenomyosis prior to FET may support individualized assisted reproductive technology management. Further prospective studies are needed to validate these results. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.
Isolated retroaortic left brachiocephalic vein imitating vertical vein: prenatal insights from 4D surface rendering.
Karmegaraj B, Vijayakumar S
Ultrasound Obstet Gynecol · 2025 Oct · PMID 41070888 · Publisher ↗
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Pelvic shape predisposes for pelvic organ prolapse: a geometric morphometry study.
Stansfield E, Phan K, Fischer B … +2 more , Delancey JO, Umek W
Ultrasound Obstet Gynecol · 2025 Nov · PMID 41066791 · Full text
OBJECTIVE: To identify morphological features of the soft tissue and bony pelvis that could serve as predictive risk factors for the development of pelvic organ prolapse (POP) in adult women. METHODS: This case-control s...
OBJECTIVE: To identify morphological features of the soft tissue and bony pelvis that could serve as predictive risk factors for the development of pelvic organ prolapse (POP) in adult women. METHODS: This case-control study compared the shapes of the pelvic floor soft tissue and bony pelvis between three groups: parous women with POP (cases); parous women without symptoms of POP (controls); and nulliparous women. The primary dataset comprised 21 women around 50 years of age (mean ± SD, 50.3 ± 1.3 years), with seven participants in each group. Landmarks on the pelvis and urogenital hiatus were collected on magnetic resonance imaging scans. Pelvic shape was analyzed using geometric morphometry and principal component analysis. The findings were validated in a small secondary dataset of four parous women in their 30s, of whom two had POP and two were controls. RESULTS: Significant differences were observed between cases, controls and nulliparae in the primary dataset when soft tissue shape and pelvic shape were analyzed together on principal component analysis. When the shape of the bony pelvis was considered alone, a significant difference was observed between cases and controls, with the former group exhibiting a mediolaterally wider pelvis with relatively short anteroposterior and craniocaudal diameters. This difference was generalizable to younger women in the secondary dataset. CONCLUSION: The shape of the pelvis in adult women affects their risk for postpartum POP. © 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.
Multiple pregnancy with complete hydatidiform mole and coexisting normal fetus: systematic review and meta-analysis of clinical outcomes from non-randomized studies.
Salmeri N, Pizzetti A, Grassi E … +6 more , Cioffi R, Mangili G, Seckl M, Sotiriadis A, Candiani M, Cavoretto PI
Ultrasound Obstet Gynecol · 2026 Mar · PMID 41066778 · Full text
OBJECTIVE: Complete hydatidiform mole and coexisting normal fetus (CHMCF) is a rare condition for which there is significant heterogeneity in diagnosis, counseling and management of complications. The objective of this s...
OBJECTIVE: Complete hydatidiform mole and coexisting normal fetus (CHMCF) is a rare condition for which there is significant heterogeneity in diagnosis, counseling and management of complications. The objective of this study was to summarize the prevalence of clinical outcomes in reported cases of CHMCF. METHODS: A systematic literature search was conducted in PubMed, Embase and Scopus databases from inception until 1 October 2024. Case series and cohort studies including at least three cases of histologically confirmed CHMCF were included. A random-effects model was used for meta-analysis of proportions and heterogeneity was estimated using Higgins' I index. The Newcastle-Ottawa scale and the Joanna Briggs Institute critical appraisal checklist were used to assess study quality, while certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The study was registered in the PROSPERO database (CRD42023431734). RESULTS: Quantitative synthesis included 19 studies and 417 cases of CHMCF. Diagnosis was made using ultrasound in 76.0% (95% CI, 58.5-90.6%) of cases and occurred in the first trimester in 52.7% (95% CI, 34.0-71.0%). Symptoms at diagnosis were present in 80.5% (95% CI, 66.1-92.3%) of cases, with vaginal bleeding being the most common symptom both at diagnosis and later in pregnancy. The pooled proportion of elective pregnancy termination was 48.8% (95% CI, 32.7-65.1%), with 6.2% (95% CI, 1.0-13.9%) due to maternal complications. The pooled proportion of live births was 46.5% (95% CI, 36.1-57.1%), with most being delivered by Cesarean section (71.2% (95% CI, 42.4-94.4%)). Preterm birth (< 37 weeks) occurred in 67.8% (95% CI, 44.7-88.1%) of cases, very preterm birth (< 32 weeks) in 12.4% (95% CI, 0.2-33.9%) and miscarriage (fetal death < 24 weeks) in 32.7% (95% CI, 26.1-39.6%). Pre-eclampsia was present in 17.8% (95% CI, 5.9-32.7%) of cases and postpartum hemorrhage occurred in 42.7% (95% CI, 5.1-84.8%). A small-for-gestational-age neonate (birth weight < 10 percentile) was delivered in 40.6% (95% CI, 12.9-70.8%) of cases. Rates of neonatal and maternal mortality were negligible. The pooled proportion of gestational trophoblastic neoplasia was 33.8% (95% CI, 25.6-42.5%); among elective terminations, continued pregnancies and live births, the rates were 14.1% (95% CI, 5.4-24.9%), 20.3% (95% CI, 12.0-29.9%) and 5.9% (95% CI, 1.9-11.2%), respectively. The evidence level according to GRADE was low to very low. CONCLUSIONS: Pregnancies with CHMCF present a high risk of maternal, obstetric and neonatal complications, including miscarriage, pre-eclampsia, small-for-gestational age, postpartum hemorrhage and preterm birth. The risk of developing gestational trophoblastic neoplasia was not clearly mitigated by early pregnancy termination. Early diagnosis, referral to a maternal-fetal medicine unit with expertise in trophoblastic disorders and extensive implementation of screening protocols for preterm birth and pre-eclampsia are recommended to facilitate timely intervention aimed at outcome improvement. © 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.
Non-invasive prenatal diagnosis of congenital cytomegalovirus infection using maximum trophoblast thickness and biomarkers in maternal blood and urine in first trimester.
Bourgon N, Fernandez M, Chatzakis C … +7 more , Jacquier M, Fourgeaud J, Guilleminot T, Bussieres L, Salomon LJ, Leruez-Ville M, Ville Y
Ultrasound Obstet Gynecol · 2025 Nov · PMID 41047886 · Publisher ↗
OBJECTIVE: Congenital cytomegalovirus (CMV) infection, a leading cause of sensorineural hearing loss and neurological impairment, is typically diagnosed by second-trimester amniocentesis, delaying clinical decision-makin...
OBJECTIVE: Congenital cytomegalovirus (CMV) infection, a leading cause of sensorineural hearing loss and neurological impairment, is typically diagnosed by second-trimester amniocentesis, delaying clinical decision-making. This study aimed to assess the predictive value of maximum trophoblast thickness (MTT) measured by first-trimester three-dimensional (3D) ultrasound, in combination with maternal biomarkers, for the early prediction of CMV vertical transmission. METHODS: This was a retrospective cohort study of pregnant women, not previously seropositive for CMV, who were referred to Necker-Enfants malades Hospital between October 2019 and May 2024 for maternal primary infection (MPI) with CMV in early pregnancy. Multiple pregnancies and fetuses with genetic anomaly were excluded. MTT measurement was performed using 3D multiplanar ultrasound between 11 + 0 and 14 + 6 weeks' gestation by two independent observers. Interobserver agreement for MTT measurement was assessed using the intraclass correlation coefficient (ICC). We recorded maternal characteristics, including first-trimester maternal biomarkers (pregnancy-associated plasma protein-A, free β-human chorionic gonadotropin and placental growth factor) and CMV polymerase chain reaction (PCR) status in the maternal blood and urine. Vertical transmission was confirmed by CMV-PCR in chorionic villi (CV) and/or amniotic fluid (AF). The predictive value of MTT, alone and in combination with relevant covariables, was assessed using logistic regression models and receiver-operating-characteristics (ROC)-curve analysis. RESULTS: A total of 127 pregnant women with a median gestational age (GA) at CMV-MPI of 2.0 (interquartile range, -2.5 to 7.0) weeks were included, of whom 120 (94.5%) received valacyclovir for secondary prevention. CMV-PCR was positive in 7.1% of CV samples (median GA at sampling, 13.7 weeks) and 9.4% of AF samples (median GA at sampling, 17.4 weeks). MTT was significantly higher in cases with a positive CMV-PCR result in AF compared to those with a negative result (median, 21.3 mm vs 17.1 mm; P = 0.017). The ICC for MTT measurement was 0.827 (95% CI, 0.763-0.875), indicating good interobserver reproducibility. ROC-curve analysis identified 19.0 mm as the optimal MTT threshold, yielding a sensitivity of 83.33% (95% CI, 62.25-100%) for predicting vertical transmission. When combined with CMV-PCR positivity in the maternal blood in the first trimester and delayed valacyclovir initiation beyond 10 weeks, the predictive model achieved an area under the ROC curve of 0.94 (95% CI, 0.87-0.99) for CMV-PCR positivity in AF, with a sensitivity of 80.00% (95% CI, 44.39-97.48%), specificity of 93.26% (95% CI, 85.90-97.49%), positive predictive value of 57.14% (95% CI, 36.71-75.40%) and negative predictive value of 97.65% (95% CI, 92.31-99.31%). CONCLUSION: Increased MTT measured by 3D ultrasound in the first trimester is associated with CMV vertical transmission and may serve as an early non-invasive marker. Combining MTT with CMV-PCR status in the maternal blood and timing at initiation of treatment improves predictive accuracy and could guide early counseling and targeted invasive testing. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.
Fetal neurosonography: technique and feasibility of external cephalic version.
Paladini D, Giani S, Turatello G … +1 more , Parodi S
Ultrasound Obstet Gynecol · 2025 Nov · PMID 41044903 · Publisher ↗
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Timing of blood sample collection in combined first-trimester screening for chromosomal aberrations and pre-eclampsia screening.
Riishede I, Ekelund CK, Overgaard M … +7 more , Sundberg K, Vedel C, Hedermann G, Tabor A, Petersen OB, Gadsbøll K, Rode L
Ultrasound Obstet Gynecol · 2026 Jan · PMID 41044887 · Publisher ↗
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Uniform early first-trimester sonography: the time has arrived.
Sherer DM, Kheyman M, Hsieh V … +1 more , Dalloul M
Ultrasound Obstet Gynecol · 2025 Nov · PMID 41037668 · Publisher ↗
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Abnormal flow patterns in ascending aorta in fetuses with tetralogy of Fallot: evaluation by blood speckle-tracking echocardiography.
Zhou D, Liu Y, Xu G … +2 more , Yang Y, Zeng S
Ultrasound Obstet Gynecol · 2025 Nov · PMID 41014168 · Publisher ↗
OBJECTIVES: To evaluate the blood flow pattern in the ascending aorta (AAo) of fetuses with tetralogy of Fallot (ToF) using high-frame-rate ultrasound with blood speckle-tracking echocardiography (BST), and to investigat...
OBJECTIVES: To evaluate the blood flow pattern in the ascending aorta (AAo) of fetuses with tetralogy of Fallot (ToF) using high-frame-rate ultrasound with blood speckle-tracking echocardiography (BST), and to investigate its relationship with cardiac geometry. METHODS: Included in this cross-sectional study were 35 fetuses with ToF and 35 gestational-age-matched normal fetuses (controls) who underwent routine obstetric ultrasound examination and complete echocardiography between April 2022 and August 2023. Flow patterns in the AAo were recorded and assessed using BST in all fetuses. Left ventricular (LV) inflow and outflow tract angle (IOA) was measured in both groups. The association between the presence and number of vortices in the AAo and cardiac geometry in the ToF group was also determined. RESULTS: On BST, at a median gestational age of 24.9 (interquartile range (IQR), 23.7-28.7) weeks for all fetuses, vortex flow in the AAo was detected in 91.4% (32/35) of fetuses with ToF and 17.1% (6/35) of normal fetuses (P < 0.001). Compared with the controls, the median number of vortices in the AAo was significantly higher in fetuses with ToF (1 (range, 0-3) vs 0 (range, 0-1); P < 0.001). There was no significant difference in vortex duration between the two groups. The fetuses with ToF exhibited significantly smaller median LV-IOA compared with the control fetuses (36.06° (IQR, 32.55°-41.24°) vs 42.90° (IQR, 36.30°-46.37°); P = 0.006). Correlation analysis indicated that the presence of vortices was associated significantly with aortic valve size in fetuses with ToF (r = 0.54 (P = 0.001)), as well as the LV-IOA (r = - 0.376 (P = 0.026)). The number of vortices correlated significantly with aortic valve size (r = 0.476 (P = 0.004)). There was no correlation between the presence and number of vortices and pulmonary valve size. CONCLUSIONS: On BST, fetuses with ToF exhibited a higher incidence and a greater number of blood flow vortices in the AAo compared with gestational-age-matched controls. The association between the abnormal flow pattern in the AAo and LV outflow tract morphology, as well as cardiac geometry, may help to elucidate the pathophysiology of the aorta in fetuses with ToF. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.
ISUOG Consensus Statement on maternal hemodynamic assessment in hypertensive disorders of pregnancy and fetal growth restriction.
Stampalija T, Lees C, Ghi T … +8 more , Cornette J, Gyselaers W, Ferrazzi E, Mousa T, Spaanderman M, Thilaganathan B, Valensise H, Collaborators
Ultrasound Obstet Gynecol · 2025 Nov · PMID 40997762 · Full text
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sFlt-1/PlGF ratio thresholds for diagnosing pre-eclampsia in pregnant women with high blood pressure.
Pan X, Peng J, Chen Y … +4 more , Di X, Li P, Zhang G, Liu H
Ultrasound Obstet Gynecol · 2025 Nov · PMID 40992360 · Full text
OBJECTIVE: An imbalance between soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) is characteristic of the progression of hypertensive disorder of pregnancy (HDP) to pre-eclampsia (PE). Monit...
OBJECTIVE: An imbalance between soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) is characteristic of the progression of hypertensive disorder of pregnancy (HDP) to pre-eclampsia (PE). Monitoring the sFlt-1/PlGF ratio to determine whether HDP progresses to PE can aid clinical management and decision-making. This study aimed to determine the diagnostic thresholds of the sFlt-1/PlGF ratio for early-onset and late-onset PE in pregnant Chinese women with high blood pressure. METHODS: This single-center, prospective, observational cohort study was conducted among pregnant women with high blood pressure (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg) at a tertiary hospital in Southern China, from January 2020 to December 2023. Women with a singleton pregnancy and complete follow-up records were assigned to the derivation cohort or the validation cohort depending on their date of enrolment. Initial cut-offs of the sFlt-1/PlGF ratio to predict the development of early-onset or late-onset PE within 1 week after biomarker measurement were determined using receiver-operating-characteristics-curve analysis in the derivation cohort. This analysis was performed separately for pregnancies with gestational age (GA) < 34 weeks and those with GA ≥ 34 weeks at the time of biomarker measurement. Subsequently, the derived cut-offs were validated in the validation cohort. The rate of adverse maternal and perinatal outcomes was compared according to whether the sFlt-1/PlGF ratio was above or below the validated cut-off, stratified by GA at biomarker measurement, in both the derivation and validation cohorts. RESULTS: A total of 1329 women with a singleton pregnancy complicated by high blood pressure, presenting between 24 + 0 and 38 + 6 weeks' gestation, were recruited during the study period. Participants were stratified into the derivation (n = 814 (61.2%)) and validation (n = 515 (38.8%)) cohorts, which had comparable PE incidence within 1 week after sFlt-1/PlGF measurement (35.5% vs 38.6%, respectively; P = 0.267). In the derivation cohort, the optimal sFlt-1/PlGF ratio cut-offs were determined to be 74 for predicting early-onset PE (diagnosis < 34 weeks) and 95 for predicting late-onset PE (diagnosis ≥ 34 weeks). In the validation cohort, the predetermined sFlt-1/PlGF ratio cut-off of ≥ 74 showed a sensitivity of 87.7% (95% CI, 77.9-94.2%) and a specificity of 97.0% (95% CI, 91.6-99.4%) for predicting early-onset PE within 1 week after biomarker measurement, while a sFlt-1/PlGF ratio of ≥ 95 demonstrated a sensitivity of 36.5% (95% CI, 28.1-45.6%) and a specificity of 95.0% (95% CI, 91.0-97.4%) for the prediction of late-onset PE within 1 week. Additionally, these ratios (≥ 74 for GA < 34 weeks and ≥ 95 for GA ≥ 34 weeks at biomarker measurement) significantly predicted adverse maternal and perinatal outcomes in both cohorts. CONCLUSIONS: In pregnant women with high blood pressure presenting between 24 + 0 and 38 + 6 weeks' gestation, the validated sFlt-1/PlGF ratio cut-offs for predicting early-onset PE and late-onset PE diagnosis within 1 week after biomarker measurement were 74 and 95, respectively. Furthermore, sFlt-1/PlGF ratios ≥ 74 and ≥ 95 were associated with increased risks of adverse maternal and perinatal outcomes, suggesting clinical utility for these cut-offs for risk stratification in Chinese women with a singleton pregnancy and high blood pressure. © 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.
Association of unexplained recurrent implantation failure with obstetric and neonatal outcomes: cohort study of 37 888 singleton live births.
Huang J, Yin Y, Huang L … +9 more , Wan Z, Liu Y, Wu H, Lin J, Zhu J, Tian L, Xia L, Zhao Y, Wang J
Ultrasound Obstet Gynecol · 2025 Nov · PMID 40991952 · Publisher ↗
OBJECTIVE: To investigate the risk of adverse obstetric and neonatal outcomes in patients with unexplained recurrent implantation failure (uRIF) who had a singleton live birth. METHODS: This multicenter retrospective coh...
OBJECTIVE: To investigate the risk of adverse obstetric and neonatal outcomes in patients with unexplained recurrent implantation failure (uRIF) who had a singleton live birth. METHODS: This multicenter retrospective cohort study reviewed 49 372 embryo-transfer cycles leading to a singleton live birth at three fertility centers in China between January 2014 and July 2021. Patients were categorized into the uRIF group if they had a history of at least three failed transfers of unknown cause with at least four good-quality embryos, while the control group comprised women who had experienced fewer than three failed implantation cycles. Obstetric and neonatal outcomes were collected via telephone interviews using a standardized questionnaire. Propensity score matching (PSM) and multivariate logistic regression analysis were used to control for potential confounders. RESULTS: After exclusions, 1244 patients with a history of uRIF and 36 644 controls were included in the study. All baseline characteristics were balanced following PSM, with 1243 patients retained in each group. Compared with the control group, the uRIF group exhibited significantly higher odds of placenta previa (2.7% vs 1.4%; adjusted odds ratio (aOR), 2.01 (95% CI, 1.01-4.00)), placental abruption (0.3% vs 0%; aOR, 6.51 (95% CI, 1.57-26.91)), Cesarean delivery (76.6% vs 71.8%; aOR, 1.27 (95% CI, 1.06-1.53)) and preterm birth (10.1% vs 7.3%; aOR, 1.44 (95% CI, 1.08-1.91)). The results remained consistent on sensitivity analysis using prematched data with multivariate adjustment. CONCLUSIONS: A history of uRIF was associated with increased risks for placenta previa, placental abruption, Cesarean delivery and preterm birth. While statistically significant, the absolute differences in the rates of these complications were modest and the clinical relevance of our findings should be interpreted with caution. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.
Impact of delivery indication on levator ani muscle avulsion in forceps- and vacuum-assisted deliveries: prospective cohort study.
Grindheim S, Volløyhaug I, Siafarikas F … +2 more , Kessler J, Baghestan E
Ultrasound Obstet Gynecol · 2025 Dec · PMID 40986417 · Publisher ↗
OBJECTIVES: The primary aim was to assess the prevalence of levator ani muscle (LAM) avulsion after forceps- and vacuum-assisted deliveries, adjusting for indication for assisted vaginal delivery (AVD) and including spon...
OBJECTIVES: The primary aim was to assess the prevalence of levator ani muscle (LAM) avulsion after forceps- and vacuum-assisted deliveries, adjusting for indication for assisted vaginal delivery (AVD) and including spontaneous vaginal deliveries for comparison. The secondary aim was to compare neonatal injury between forceps and vacuum deliveries. METHODS: This prospective observational cohort study was conducted at Haukeland University Hospital, Bergen, Norway. Primiparous women were recruited shortly after delivery, between June 2021 and April 2023, and LAM avulsion was assessed using transperineal ultrasound 9-12 months later. Delivery and neonatal data were collected from patient electronic health records. The risk of LAM avulsion was compared between forceps, vacuum and spontaneous vaginal deliveries using multivariable logistic regression analysis. Assisted deliveries were stratified by indication (fetal distress or protracted second stage of labor) and subgroup analyses were conducted for each indication, comparing forceps with vacuum delivery. RESULTS: A total of 736 women were examined using transperineal ultrasound at a median of 307 (interquartile range, 279-332) days after delivery. The 252 women who delivered by forceps had a higher prevalence of LAM avulsion (29.8%) compared with the 252 women who delivered by vacuum (17.5%) and the 232 women who underwent spontaneous vaginal delivery (11.2%). The adjusted odds ratio (aOR) of LAM avulsion after forceps vs vacuum delivery was 1.99 (95% CI, 1.26-3.18). After a protracted second stage of labor, the odds of LAM avulsion after forceps vs vacuum delivery were even greater (aOR, 3.09 (95% CI, 1.53-6.46)). Among those who underwent AVD for fetal distress, no significant difference in the odds of LAM avulsion was observed between forceps and vacuum deliveries (aOR, 1.63 (95% CI, 0.83-3.23)). The odds of neonatal trauma were lower after forceps compared with vacuum delivery (aOR, 0.49 (95% CI, 0.25-0.92)). CONCLUSIONS: There was no significant difference in the prevalence of LAM avulsion between forceps and vacuum deliveries when the indication for AVD was fetal distress, but the odds of LAM avulsion were 3-fold higher for forceps delivery when the indication was protracted second stage of labor. Forceps delivery was associated with a 51% reduction in the odds of neonatal injury compared with vacuum delivery, independent of indication for AVD. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.
Rate of prenatal diagnosis of critical congenital heart disease continued to improve despite COVID-19 pandemic: multicenter Canadian study.
Eckersley L, Lad M, Rose H … +11 more , Lougheed J, Poolsaar H, Szabo A, Nield L, Fruitman D, Mansuskani G, Hornberger LK, Arya B, Dover D, Blagdon E, Freud L
Ultrasound Obstet Gynecol · 2025 Nov · PMID 40975049 · Full text
OBJECTIVE: Travel restrictions, reallocation of health resources and physical distancing during the coronavirus disease 2019 (COVID-19) pandemic caused extraordinary strain on healthcare systems. The overall impact of pu...
OBJECTIVE: Travel restrictions, reallocation of health resources and physical distancing during the coronavirus disease 2019 (COVID-19) pandemic caused extraordinary strain on healthcare systems. The overall impact of public health measures during COVID-19 on the prenatal diagnosis of congenital heart disease (CHD) has received limited attention. We sought to determine the rate of prenatal diagnosis and the pregnancy and postnatal outcomes of critical CHD prior to and during the COVID-19 pandemic. METHODS: Cases of critical CHD with estimated due date between 1 January 2016 and 31 March 2022 that required or were expected to require neonatal intervention were identified from all tertiary fetal cardiac centers in Ontario and Alberta, Canada. Pregnancies were stratified based on reaching 18 weeks' gestation before (pre-COVID-19) or after 1 March 2020 (during COVID-19), as the latter group would require ultrasound scanning under COVID-19 pandemic restrictions. Outcomes included timing of critical CHD diagnosis (prenatal or postnatal), gestational age at prenatal diagnosis, pregnancy outcome and infant mortality at 30 days and 1 year after birth. The rate of prenatal diagnosis was assessed using Cox proportional hazard modeling with time-varying and time-invariant cofactors. RESULTS: Prenatal diagnosis occurred in 1238/1774 (69.8%) cases of critical CHD overall, of which 858/1257 (68.3%) cases were in the pre-COVID-19 group and 380/517 (73.5%) cases were in the COVID-19 exposure group (P = 0.03). There was no difference between the pre-COVID-19 group and the COVID-19 exposure group in median gestational age at obstetric ultrasound (20.1 (interquartile range (IQR), 19.0-22.0) weeks vs 19.8 (IQR, 19.1-21.3) weeks; P = 0.07), median time from obstetric ultrasound to diagnosis of critical CHD (1.2 (IQR, 0.6-2.2) weeks vs 1.2 (IQR, 0.6-2.2) weeks; P = 0.59) and prenatal diagnosis < 22 weeks' gestation (454/848 (53.5%) vs 221/378 (58.5%); P = 0.11). Termination of pregnancy was more common in the COVID-19 exposure group (pre-COVID-19, 20.9% vs during COVID-19, 27.5%; P = 0.01). Infant mortality at 30 days (pre-COVID-19, 2.5% vs COVID-19, 1.8%; P = 0.44) and at 1 year after birth (pre-COVID-19, 8.9% vs COVID-19, 8.6%; P = 0.86) did not differ between eras. Once adjusted for province, trends in calendar time, week of gestation, distance to closest tertiary fetal cardiac service and genetic diagnosis, the rate of prenatal diagnosis of critical CHD continued to increase, with a trend towards an increased rate during the COVID-19 pandemic compared with the pre-COVID-19 era. CONCLUSIONS: Despite the reduction in clinical services during the COVID-19 pandemic, the rate of prenatal diagnosis of critical CHD continued to increase during the pandemic in two of Canada's largest provinces. These findings provide reassurance regarding the impact of refined fetal cardiology referral indications for resource-limited scenarios. © 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.
Role of aspirin therapy in modulating uterine artery resistance and placental growth between first and second trimesters of pregnancy.
Trilla C, Platero J, Mora J … +5 more , Nan MN, Medina C, Alejos O, Parra J, Llurba E
Ultrasound Obstet Gynecol · 2025 Nov · PMID 40974599 · Full text
OBJECTIVE: To evaluate the impact of low-dose aspirin (LDA) on placental size and uterine artery pulsatility index (UtA-PI) by analyzing longitudinal changes between the first and second trimesters in pregnancies at high...
OBJECTIVE: To evaluate the impact of low-dose aspirin (LDA) on placental size and uterine artery pulsatility index (UtA-PI) by analyzing longitudinal changes between the first and second trimesters in pregnancies at high risk for early-onset pre-eclampsia (PE). METHODS: This was a prospective observational cohort study of 631 singleton pregnancies. Women at high risk of early-onset PE (delivery ≤ 33 + 6 weeks) were identified using maternal factors or a multivariate screening protocol and were prescribed LDA. Placental size was assessed using two- and three-dimensional ultrasonography, and UtA-PI was measured using transabdominal Doppler, with measurements obtained in the first and second trimesters. Differences in placental measurements and UtA-PI between high-risk women receiving LDA and low-risk untreated women were analyzed. RESULTS: Among the 631 participants, 53 (8.4%) women were prescribed LDA for the prevention of early-onset PE. Placental size in the first trimester was significantly smaller in the LDA group compared with the untreated group, as exemplified by placental volume (mean ± SD, 68.46 ± 25.19 cm vs 76.31 ± 23.63 cm; P = 0.022), and this trend persisted into the second trimester. However, no significant differences in placental growth from the first to the second trimester were observed between the groups. UtA-PI was significantly higher in the LDA group in both trimesters, but a greater decrease in UtA-PI multiples of the median values between trimesters was noted in these women (mean ± SD, -14.0 ± 0.28% vs -4.5 ± 0.31%; P = 0.021). Perinatal outcomes were similar between the groups, with the exception of a higher rate of Cesarean delivery in the LDA group (38.5% vs 21.1%; P = 0.008). CONCLUSIONS: Women at high risk for early-onset PE have a smaller placenta and higher UtA-PI in the first and second trimesters. Treatment of high-risk women with LDA did not affect placental growth but was associated with a greater reduction in UtA-PI, suggesting a positive effect of LDA on placental perfusion. These findings provide insight into the mechanism of action of LDA in the prevention of PE. © 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.
Ultrasound characteristics of sarcoma in the uterine cervix: 'ballet tutu' sign.
Hovsepyan L, Stepanyan A, Saradyan A … +6 more , Asilbekyan N, Tevosyan S, Mazmanian I, Tonyan G, Mirzoyan A, Valentin L
Ultrasound Obstet Gynecol · 2025 Dec · PMID 40966104 · Publisher ↗
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Effect of aspirin on maternal hemodynamics in Chinese women at high risk for preterm pre-eclampsia: longitudinal study.
Wang X, Lin J, Chen Y … +9 more , Wong IS, Liu J, Liu F, Lau SL, Zhang Q, Xu X, Sahota DS, Lee APW, Poon LC
Ultrasound Obstet Gynecol · 2025 Nov · PMID 40939581 · Full text
OBJECTIVES: To compare the maternal hemodynamics of Chinese women at low and at high risk for preterm pre-eclampsia (PE) and assess the differences in hemodynamic parameters between high-risk women with or without prophy...
OBJECTIVES: To compare the maternal hemodynamics of Chinese women at low and at high risk for preterm pre-eclampsia (PE) and assess the differences in hemodynamic parameters between high-risk women with or without prophylactic aspirin. METHODS: This was a prospective longitudinal case-control study of 857 Chinese women with a singleton pregnancy who participated in the first-trimester screen-and-prevent program for PE at the Prince of Wales Hospital, Hong Kong SAR, China, between February 2020 and March 2023. The risk of developing preterm PE (delivery before 37 weeks) was determined using the Fetal Medicine Foundation combined test (maternal factors combined with mean arterial pressure (MAP), uterine artery pulsatility index and placental growth factor). The study population comprised three groups of women: (1) women at high risk (adjusted risk ≥ 1:100) for preterm PE who received 100 mg or 160 mg of aspirin according to maternal weight (< 40 kg or ≥ 40 kg, respectively), starting before 16 weeks' gestation until 36 weeks' gestation, until delivery or until PE was diagnosed if before 36 weeks; (2) women at high risk for preterm PE who did not receive aspirin; and (3) women at low risk (adjusted risk < 1:100) for preterm PE who were matched 1:1 to high-risk women, according to maternal age, weight and date of the scan. MAP was measured using a device validated for use in pregnancy, and heart rate (HR), stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR) were evaluated using two-dimensional transthoracic echocardiography at 12 + 0 to 15 + 6 weeks, 20 + 0 to 24 + 6 weeks and 30 + 0 to 37 + 6 weeks' gestation. Log transformation was applied to fit the data to a Gaussian distribution. An adjusted multilevel linear mixed-effects analysis was performed to compare the longitudinal changes of maternal hemodynamics across gestation between the three study groups. RESULTS: This study comprised 389 women at low risk of preterm PE, 379 women at high risk of preterm PE who received aspirin and 89 women at high risk who did not receive aspirin. There was no significant difference in the estimated marginal mean (EMmean) of log HR across gestation among the three study groups. Compared with the low-risk group, both high-risk groups (with and without aspirin) exhibited consistently higher EMmean of log MAP and log SVR, and lower EMmean of log CO and log SV throughout gestation (all P < 0.001). Although maternal hemodynamic trajectories differed across the EMmean of log SV, CO, MAP and SVR between high-risk women with aspirin and those without, there were no significant differences in these parameters between the two high-risk groups. CONCLUSION: This study highlights the significant differences in maternal hemodynamic adaptation during pregnancy between Chinese women at high risk and those at low risk for preterm PE. Compared with low-risk women, high-risk women exhibited increased MAP and SVR, along with reduced SV and CO as early as the first trimester, and these alterations persisted throughout gestation. Notably, aspirin prophylaxis showed a limited effect on improving maternal hemodynamics in women at high risk for preterm PE, highlighting the need for alternative strategies to address the hemodynamic maladaptation in high-risk women. © 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.
Perinatal outcome after single intrauterine death in monochorionic twin pregnancy: systematic review and meta-analysis.
Dessole S, Khalil A, Shamshirsaz A … +7 more , Galindo A, Prefumo F, Fichera A, Rizzo G, Mappa I, D'Antonio F, Collaborators
Ultrasound Obstet Gynecol · 2026 Feb · PMID 40934452 · Publisher ↗
OBJECTIVE: To report perinatal and neurodevelopmental outcomes in monochorionic twin pregnancy after single intrauterine fetal death (IUFD), according to gestational age at single IUFD and the presence of twin-twin trans...
OBJECTIVE: To report perinatal and neurodevelopmental outcomes in monochorionic twin pregnancy after single intrauterine fetal death (IUFD), according to gestational age at single IUFD and the presence of twin-twin transfusion syndrome (TTTS). METHODS: MEDLINE, EMBASE and The Cochrane Library were searched for studies reporting the outcome of monochorionic twin pregnancy complicated by single IUFD. The collected outcomes included preterm birth (PTB) < 34, < 32 and < 28 weeks' gestation, cotwin IUFD and neonatal death (NND), cerebral anomaly detected at follow-up prenatal ultrasound examination, fetal magnetic resonance imaging (MRI) or postnatal imaging (ultrasound or MRI) and adverse neurodevelopmental outcome. Subgroup analyses were conducted according to the presence of TTTS and gestational age at single IUFD. We reported the association of various risk factors, namely signs of fetal anemia, TTTS and selective fetal growth restriction (sFGR), with the risk of abnormal brain imaging. Random-effects meta-analysis of proportions was used to analyze the data, and results were reported as pooled proportions or odds ratios (ORs) with 95% CI. RESULTS: Twenty-three studies, comprising 1294 monochorionic twin pregnancies complicated by single IUFD, were included. PTB < 34, < 32 and < 28 weeks' gestation occurred in 45.8% (95% CI, 34.0-57.8%), 28.0% (95% CI, 16.3-41.4%) and 10.9% (95% CI, 5.6-17.6%) of cases, respectively. Cotwin IUFD and NND were reported in 6.2% (95% CI, 2.6-11.0%) and 4.1% (95% CI, 2.6-5.9%) of cases, respectively. Cerebral anomaly at fetal MRI was reported in 20.0% (95% CI, 14.2-26.4%) of cases, most of which were severe. Adverse neurodevelopmental outcome was documented in 11.0% (95% CI, 4.7-19.6%) of infants, but in none of those with normal prenatal imaging. When comparing pregnancies without TTTS to those with TTTS that did not undergo laser therapy, PTB < 34 weeks occurred in 47.7% (95% CI, 29.8-65.9%) and 40.0% (95% CI, 17.2-65.4%), respectively. The corresponding figures for cotwin IUFD were 7.3% (95% CI, 1.4-17.3%) and 5.7% (95% CI, 0.4-23.2%); those for cotwin NND were 2.5% (95% CI, 0.6-5.6%) and 13.9% (95% CI, 3.9-28.7%); and those for adverse neurodevelopmental outcome were 34.5% (95% CI, 5.1-73.3%) and 34.5% (95% CI, 12.5-60.8%). Signs of fetal anemia in the surviving fetus were associated with significantly higher odds of abnormal brain imaging (OR, 4.3 (95% CI, 1.7-10.9); P = 0.003), while TTTS (P = 0.104) and sFGR (P = 0.283) were not associated with higher odds of cerebral anomaly on imaging. CONCLUSIONS: Single IUFD in monochorionic twin pregnancy is associated with high risks of PTB, abnormal brain imaging and adverse neurodevelopmental outcome in the surviving cotwin, although the risks are lower than those reported previously. All cotwins with normal prenatal imaging had normal neurodevelopment, highlighting the prognostic role of prenatal brain assessment after single IUFD. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.
ChatGPT in the delivery room: proof-of-concept for live video-assisted clinical decision support in intrapartum ultrasound.
Dominsky O, Krajden Haratz K, Lavie A … +3 more , Miremberg H, Yogev Y, Perlman S
Ultrasound Obstet Gynecol · 2025 Dec · PMID 40929574 · Publisher ↗
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