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Re: High‐intensity focused ultrasound applied to the placenta using a toroidal transducer: a preliminary ex‐vivo study. J. Caloone, C. Huissoud, J. Vincenot, A. Kocot, C. Dehay, J. Y. Chapelon, R. C. Rudigoz and D. Melodelima. Ultrasound Obstet Gynecol 2015; 45: 313–319
Brezinka, C.
Ultrasound in obstetrics & gynecology,
March 2015, 2015-Mar, 2015-03-00, 20150301, Letnik:
45, Številka:
3
Journal Article
Linked Comment: Ultrasound Obstet Gynecol 2015; 45: 313–319
2.
Perinatal morbidity and mortality in early‐onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE)
Lees, C.; Marlow, N.; Arabin, B. ...
Ultrasound in obstetrics & gynecology,
October 2013, Letnik:
42, Številka:
4
Journal Article
ABSTRACT
Objectives
Few data exist for counseling and perinatal management of women after an antenatal diagnosis of early‐onset fetal growth restriction. Yet, the consequences of preterm delivery and ...
its attendant morbidity for both mother and baby are far reaching. The objective of this study was to describe perinatal morbidity and mortality following early‐onset fetal growth restriction based on time of antenatal diagnosis and delivery.
Methods
We report cohort outcomes for a prospective multicenter randomized management study of fetal growth restriction (Trial of Randomized Umbilical and Fetal Flow in Europe (TRUFFLE)) performed in 20 European perinatal centers between 2005 and 2010. Women with a singleton fetus at 26–32 weeks of gestation, with abdominal circumference < 10th percentile and umbilical artery Doppler pulsatility index > 95th percentile, were recruited. The main outcome measure was a composite of fetal or neonatal death or severe morbidity: survival to discharge with severe brain injury, bronchopulmonary dysplasia, proven neonatal sepsis or necrotizing enterocolitis.
Results
Five‐hundred and three of 542 eligible women formed the study group. Mean ± SD gestational age at diagnosis was 29 ± 1.6 weeks and mean ± SD estimated fetal weight was 881 ± 217 g; 12 (2.4%) babies died in utero. Gestational age at delivery was 30.7 ± 2.3 weeks, and birth weight was 1013 ± 321 g. Overall, 81% of deliveries were indicated by fetal condition and 97% were by Cesarean section. Of 491 liveborn babies, outcomes were available for 490 amongst whom there were 27 (5.5%) deaths and 118 (24%) babies suffered severe morbidity. These babies were smaller at birth (867 ± 251 g) and born earlier (29.6 ± 2.0 weeks). Death and severe morbidity were significantly related to gestational age, both at study entry and delivery and also with the presence of maternal hypertensive morbidity. The median time to delivery was 13 days for women without hypertension, 8 days for those with gestational hypertension, 4 days for pre‐eclampsia and 3 days for HELLP syndrome.
Conclusions
Fetal outcome in this study was better than expected from contemporary reports: perinatal death was uncommon (8%) and 70% survived without severe neonatal morbidity. The intervals to delivery, death and severe morbidity were related to the presence and severity of maternal hypertensive conditions. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.
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3.
ISUOG Practice Guidelines (updated): use of Doppler velocimetry in obstetrics
Bhide, A.; Acharya, G.; Baschat, A. ...
Ultrasound in obstetrics & gynecology,
August 2021, Letnik:
58, Številka:
2
Journal Article, Conference Proceeding
The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages sound clinical practice, teaching and research related to diagnostic imaging ...
in women's healthcare. The ISUOG Clinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statements as educational recommendations that provide healthcare practitioners with a consensus-based approach for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practice at the time at which they are issued. Although ISUOG has made every effort to ensure that Guidelines are accurate when issued, neither the Society nor any of its employees or members accepts any liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. They are not intended to establish a legal standard of care because interpretation of the evidence that underpins the Guidelines may be influenced by individual circumstances and available resources. Approved Guidelines can be distributed freely with the permission of ISUOG (info@isuog.org).
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Ultrasound that does something
Brezinka, C.
Ultrasound in obstetrics & gynecology,
April 2011, 2011-Apr, 2011-04-00, 20110401, Letnik:
37, Številka:
4
Journal Article
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How to monitor pregnancies complicated by fetal growth restriction and delivery before 32 weeks: post‐hoc analysis of TRUFFLE study
Ganzevoort, W.; Mensing Van Charante, N.; Thilaganathan, B. ...
Ultrasound in obstetrics & gynecology,
June 2017, 2017-Jun, 2017-06-00, 20170601, Letnik:
49, Številka:
6
Journal Article
ABSTRACT
Objectives
In the recent TRUFFLE study, it appeared that, in pregnancies complicated by fetal growth restriction (FGR) between 26 and 32 weeks' gestation, monitoring of the fetal ductus ...
venosus (DV) waveform combined with computed cardiotocography (CTG) to determine timing of delivery increased the chance of infant survival without neurological impairment. However, concerns with the interpretation were raised, as DV monitoring appeared to be associated with a non‐significant increase in fetal death, and some infants were delivered after 32 weeks, at which time the study protocol no longer applied. This secondary sensitivity analysis of the TRUFFLE study focuses on women who delivered before 32 completed weeks' gestation and analyzes in detail the cases of fetal death.
Methods
Monitoring data of 317 pregnancies with FGR that delivered before 32 weeks were analyzed, excluding those with absent outcome data or inevitable perinatal death. Women were allocated randomly to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate short‐term variation (STV) on CTG; (2) early changes in fetal DV waveform; and (3) late changes in fetal DV waveform. Primary outcome was 2‐year survival without neurological impairment. The association of the last monitoring data before delivery and infant outcome was assessed by multivariable analysis.
Results
Two‐year survival without neurological impairment occurred more often in the two DV groups (both 83%) than in the CTG‐STV group (77%), however, the difference was not statistically significant (P = 0.21). Among the surviving infants in the DV groups, 93% were free of neurological impairment vs 85% of surviving infants in the CTG‐STV group (P = 0.049). All fetal deaths (n = 7) occurred in the groups with DV monitoring. Of the monitoring parameters obtained shortly before fetal death in these seven cases, an abnormal CTG was observed in only one case. Multivariable regression analysis of factors at study entry demonstrated that a later gestational age, higher estimated fetal weight‐to‐50th percentile ratio and lower umbilical artery pulsatility index (PI)/fetal middle cerebral artery‐PI ratio were significantly associated with normal outcome. Allocation to DV monitoring had a smaller effect on outcome, but remained in the model (P < 0.1). Abnormal fetal arterial Doppler before delivery was significantly associated with adverse outcome in the CTG‐STV group. In contrast, abnormal DV flow was the only monitoring parameter associated with adverse outcome in the DV groups, while fetal arterial Doppler, STV below the cut‐off used in the CTG‐STV group and recurrent decelerations in fetal heart rate were not.
Conclusions
In accordance with the findings of the TRUFFLE study on monitoring and intervention management of very preterm FGR, we found that the proportion of infants surviving without neuroimpairment was not significantly different when the decision for delivery was based on changes in DV waveform vs reduced STV on CTG. The uneven distribution of fetal deaths towards the DV groups was probably a chance effect, and neurological outcome was better among surviving children in these groups. Before 32 weeks, delaying delivery until abnormalities in DV‐PI or STV and/or recurrent decelerations in fetal heat rate occur, as defined by the study protocol, is likely to be safe and possibly benefits long‐term outcome. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Linked Comment: Ultrasound Obstet Gynecol 2017; 49: 694–695
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