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Objectives: To introduce a two‐dimensional sonographic method to assess the fetal anus, and to evaluate the feasibility of this method to diagnose anal atresia prenatally and identify the presence or absence of anoperineal fistula (in males) and anovestibular fistula (in females). Methods: This was an observational study of suspected cases of anal atresia referred to a single center in Israel between August 2018 and October 2023. In addition to conventional evaluation of the perineum in the axial plane, fetuses referred to our center for suspected malformation were scanned with a new method termed the 'infracoccygeal/transperineal window'. This window consisted of a midsagittal view of the fetal pelvis, including the distal rectum and the anal canal. Normal anatomy was confirmed when the anal canal was continuous with the rectum and terminated at the expected location on the perineum. In female fetuses, the normal anal canal runs parallel to the vaginal canal and diverges posteriorly, terminating at the perineal skin, distant from the vestibule. In male fetuses, the normal anal canal diverges posteriorly in relation to the corpora cavernosa, terminating at the perineal skin, distant from the scrotum. High anal atresia was identified when a blind‐ending rectal pouch was demonstrated in the pelvis without a fistula to the perineum or vestibule. Low anal atresia was determined when a rectal pouch was continuous with an anteriorly deflected fistula. In females, the fistula converges with the vaginal canal, terminating at the vestibule; in males, the fistula deflects anteriorly, terminating at the base of the scrotum. Postnatally, the diagnosis and type of anal atresia were confirmed through physical examination with direct visualization of the fistula, radiographic studies, surgical examination and/or postmortem autopsy. Results: Of the 16 fetuses diagnosed prenatally with anal atresia, eight were suspected to have low anal atresia and eight were suspected to have high anal atresia. The median gestational age at diagnosis was 23 (range, 14–37) weeks. All cases showed additional structural malformation. Eleven patients opted for termination of pregnancy, of which four had low anal atresia and seven had high anal atresia. Postnatal confirmation was not available in four cases due to curettage‐induced mutilation or in‐utero degradation following selective termination of the affected twin, leaving 12 cases for analysis, of which seven were diagnosed with low anal atresia and five with high anal atresia. In these 12 cases, all prenatal diagnoses were confirmed as correct, rendering 100% sensitivity and 100% specificity in this high‐risk fetal population. Conclusions: The infracoccygeal/transperineal window is an effective method to detect and classify the level of anal atresia prenatally. This may improve prediction of postnatal fetal continence and optimize prenatal counseling. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the changes in the ultrasound characteristics of decidualized non‐ovarian endometriotic lesions that occur during pregnancy and after delivery. Methods: This was a prospective observational cohort study carried out at a single tertiary center between December 2018 and October 2021. Pregnant women with endometriosis underwent a standardized transvaginal ultrasound examination with color Doppler imaging once in every trimester and after delivery. Non‐ovarian endometriotic lesions were measured and evaluated by subjective semiquantitative assessment of blood flow. Lesions with moderate‐to‐marked blood flow were considered decidualized. The size and vascularization of decidualized and non‐decidualized lesions were compared between the gravid state and after delivery. Only patients with non‐ovarian endometriotic lesion(s) who underwent postpartum examination were included in the final analysis. Results: Overall, 26 pregnant women with a surgical or sonographic diagnosis of endometriosis made prior to conception were invited to participate in the study, of whom 24 were recruited. Of those, 13 women with non‐ovarian endometriosis who attended the postpartum examination were included. In 7/13 (54%) cases, the lesion(s) were decidualized. In 4/7 (57%) women with decidualized lesion(s), the size of the largest lesion increased during pregnancy, while in 3/7 (43%), the size was unchanged. The size of non‐decidualized lesions did not change during pregnancy. On postpartum examination, only seven lesions were observed, of which three were formerly decidualized and four were formerly non‐decidualized. Lesions that were detected after delivery appeared as typical endometriotic nodules and were smaller compared with during pregnancy. The difference in maximum diameter between the gravid and postpartum states was statistically significant in decidualized lesions (P < 0.01), but not in non‐decidualized lesions (P = 0.09). The reduction in mean diameter was greater in decidualized compared with non‐decidualized lesions (P = 0.03). Conclusions: Decidualization was observed in 54% of women with non‐ovarian endometriotic lesion(s) and resolved after delivery. Our findings suggest that the sonographic features of decidualization, which might mimic malignancy, are pregnancy‐related and that expectant management and careful monitoring should be applied in these cases. Clinicians should be aware of the changes observed during pregnancy to avoid misdiagnosing decidualized lesions as malignancy and performing unnecessary surgery. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To determine the accuracy of sonographic fetal weight estimation in predicting birth weight (BW) and BW discordance in twin gestations, and to evaluate maternal and fetal characteristics that may affect the accuracy of this assessment. Methods: This was a retrospective cohort study of all twins delivered at a single tertiary medical center between 2010 and 2021. Twin gestations for which sonographic estimation of fetal weight was performed within the week preceding delivery were included. Statistical analysis was performed to evaluate the strength of the correlation between sonographic estimated fetal weight (EFW) and BW, and to determine the impact of maternal and fetal factors on the accuracy of sonographic estimation. Results: The study included 2154 twin pregnancies. There was a strong correlation between sonographic EFW and corresponding BW for all twins (r = 0.922; P < 0.001). Strong correlations were observed for both the presenting and non‐presenting cotwin (r = 0.921 and r = 0.922, respectively; both P < 0.001), as well as the larger and smaller cotwin (r = 0.928 and r = 0.934, respectively; both P < 0.001). The overall mean ± SD absolute error of sonographic EFW was 7.41 ± 6.81%. This error was greater for the non‐presenting cotwin compared with the presenting cotwin (7.99 ± 6.12% vs 7.17 ± 5.64%; P < 0.001), and for the smaller cotwin compared with the larger cotwin (8.56 ± 7.50% vs 6.58 ± 5.47%; P < 0.001). Advanced gestational age at scanning was correlated inversely with the mean absolute error of sonographic EFW. Multivariate logistic regression indicated that an earlier gestational age at scanning, being the non‐presenting cotwin and being the smaller cotwin were independent risk factors for sonographic EFW inaccuracy. Pregnancies in which the presenting twin was estimated to be the smaller cotwin had twice the rate of false‐positive BW discordance compared with pregnancies in which the presenting twin was estimated to be the larger cotwin (36.0% vs 13.0% for BW discordance > 15%, 35.0% vs 17.0% for BW discordance > 20% and 37.7% vs 12.1% for BW discordance > 25%; all P < 0.001). The error in sonographic EFW discordance was not related to chorionicity, the position of the presenting fetus or gestational age at the time of fetal weight estimation. Conclusions: Sonographic estimation of fetal weight within 7 days before delivery accurately predicts BW in twin pregnancy. Sonographic EFW accuracy is reduced for the non‐presenting twin, the smaller cotwin and when delivery occurs at an earlier gestational age. Sonographic estimation of fetal weight discordance is less accurate when the presenting twin is the smaller cotwin. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: Congenital hypotonic conditions are rare and heterogeneous, and some are severely debilitating or lethal. Contrary to its prominent postnatal manifestation, the prenatal presentation of hypotonia is frequently subtle, inhibiting prenatal detection. We aimed to characterize the prenatal sonographic manifestation of congenital hypotonia throughout pregnancy, evaluate the yield of diagnostic tests and propose diagnostic models to increase its prenatal detection. Methods: This was a retrospective observational study of singleton pregnancies with congenital hypotonia, diagnosed either prenatally or immediately after birth, at a single tertiary center between the years 2012 and 2020. Prenatally, hypotonia was diagnosed if a fetus showed sonographic or clinical signs suggestive of hypotonia and had a confirmed underlying genetic condition, or in the absence of a known genetic abnormality if the fetus exhibited multiple prominent signs suggestive of hypotonia. Postnatally, it was diagnosed in neonates displaying reduced muscle tone leading to reduced spontaneous movement, reduced swallowing or feeding difficulty. We reviewed the medical records of pregnant patients carrying fetuses subsequently diagnosed with congenital hypotonia and assessed the yield of ultrasound scans, fetal magnetic resonance imaging, computed tomography and genetic tests. The detection rate of sonographic signs suggesting fetal hypotonia was calculated. The prevalence of non‐specific signs, including polyhydramnios, persistent breech presentation, intrauterine growth restriction and maternal perception of reduced fetal movement, were compared between the study group and the local liveborn singleton population. Potential detection rates of different theoretical semiotic diagnostic models, differing in the threshold for referral for a targeted scan, were assessed based on the cohort's data. Results: The study group comprised 26 cases of congenital hypotonia, of which 10 (38.5%) were diagnosed prenatally, and the controls included 95 105 singleton live births, giving a prevalence of congenital hypotonia of 1:3658. Nuchal translucency thickness and the early anomaly scan at 13–17 weeks were normal in all 22 and 23 cases, respectively, in which this was performed. The mid‐trimester scan performed at 19–25 weeks was abnormal in four of 24 (16.7%) cases. The overall prenatal detection rate of congenital hypotonic conditions in our cohort was 38.5%. Only cases which underwent a targeted scan were detected and, among the 16 cases which underwent this scan, the prenatal detection rate was 62.5% compared with 0% in pregnancies that did not undergo this scan (P = 0.003). An abnormal genetic diagnosis was obtained in 21 (80.8%) cases using the following modalities: chromosomal microarray analysis (CMA) in two (9.5%), whole‐exome sequencing (WES) in 14 (66.7%) and methylation analysis in five (23.8%). CMA was abnormal in 8% (2/25) of the cases and WES detected a causative genetic mutation in 87.5% (14/16) of the cases in which these were performed. Comparison of non‐specific signs in the study group with those in the local singleton population showed that hypotonic fetuses had significantly more polyhydramnios (64.0% vs 3.0%, P < 0.0001), persistent breech presentation (58.3% vs 4.2%, P < 0.0001), intrauterine growth restriction (30.8% vs 3.0%, P < 0.0001) and maternal perception of reduced fetal movement (32.0% vs 4.7%, P < 0.0001). Prenatally, the most commonly detected signs supporting a diagnosis of hypotonia were structural anomaly (62.5%, 10/16), reduced fetal movement (46.7%, 7/15), joint contractures (46.7%, 7/15) and undescended testes ≥ 30 weeks (42.9%, 3/7 males). Proposed diagnostic strategies that involved performing a targeted scan for a single non‐specific ultrasound sign or two such signs, and then carrying out a comprehensive genetic evaluation for any additional sign, offered theoretical detection rates in our cohort of 88.5% and 57.7%, respectively. Conclusions: Congenital hypotonic conditions are rare and infrequently detected prenatally. Sonographic signs are visible from the late second trimester. A targeted scan increases prenatal detection significantly. Comprehensive genetic testing, especially WES, is the cornerstone of diagnosis in congenital hypotonia. Theoretical diagnostic models which may increase prenatal detection are provided. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

A study published in the journal "Ultrasound in Obstetrics & Gynecology" evaluated the effectiveness of virtual reality (VR) in reducing pain and anxiety during transvaginal sonography (TVS) for endometriosis. The study involved 55 women who were randomly assigned to either VR-assisted or conventional TVS. The results showed that the proportion of women who took analgesics before the examination was significantly lower in the VR-assisted group. Additionally, the VR group experienced greater improvements in pain and anxiety scores. The study suggests that VR could be a beneficial tool for managing pain and anxiety during TVS for endometriosis, but larger studies are needed to establish its standard use. [Extracted from the article]

This article compares the perinatal outcomes of active management versus routine management in cases of true knot of the umbilical cord (TKUC). The study included singletons born beyond 22 6/7 weeks with TKUC and compared outcomes between those with prenatally detected TKUC receiving active management and those with postnatally detected TKUC receiving routine management. The results showed that active management did not confer a proven benefit over routine management, and in fact, active management was associated with higher rates of cesarean section, prematurity, induced prematurity, and neonatal intensive care unit admissions. The authors recommend avoiding labor induction before 37 weeks. [Extracted from the article]

This article, titled "EP17.25: The outcomes of fetal intraumbilical vein varix: one comparative study," examines the perinatal outcomes of fetal intra-abdominal umbilical vein varix (FIUVV), a rare malformation characterized by a dilated umbilical vein. The study compares the outcomes of pregnancies with FIUVV to those of a control group without the condition. The results show that FIUVV is associated with growth restriction and congenital anomalies, but the overall perinatal outcome is similar to that of the normal fetal population. The study recommends targeted anomaly scans and growth assessments for pregnancies with FIUVV and does not support labor induction before 39 weeks. [Extracted from the article]