ISUOG World Congress

SYDNEY – A shift in practice away from elective late preterm delivery to early term deliveries has shown little effect on neonatal outcomes such as intensive care length of stay, neonatal morbidity, or mortality in a population with major congenital heart disease, a study has found.

Researchers at Columbia University Medical Center and Morgan Stanley Children’s Hospital, both in New York, sought to evaluate the effect of a change in delivery practice that was introduced following the 2009 publication of a study showing improved outcomes in infants delivered after 39 weeks.

A review of the medical records of infants with critical congenital heart disease compared outcomes in 878 infants born at a single tertiary center during 2004-2008 to outcomes in 124 infants born in 2010, after the change in practice had been implemented.

There was a significant increase in the mean gestational age (37.8 weeks vs. 38.4 weeks, respectively; P less than .01) and in mean birth weight (2,975 grams vs. 3,134 grams; P less than .01).

However there were no significant differences between 2004-2008 and 2010 data in 5-minute APGAR scores (8.5 vs. 8.6; P = .11), median length of stay (14 days [1-197] vs. 16 days [1-144]; P = .18) and neonatal mortality (6% vs. 11%; P = .07), according to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

"After the 2009 paper came out, there was a real shift in practice among obstetricians – and also pushed by neonatologists – to try to not deliver patients before 39 weeks," said researcher and fetal cardiologist Dr. Ismee Williams, of New York–Presbyterian Hospital/Columbia University Medical Center.

"Then our goal, instead of being 38 weeks, was 39 weeks, and we would not schedule anybody for induction or a cesarean section unless they were 39 weeks and change," Dr. Williams said in an interview.

As a result of the change in practice, there were significant decreases in scheduled cesarean delivery from 2004-2008 to 2010 and in scheduled induction, but significant increases in urgent inductions, urgent cesarean deliveries, and cesarean deliveries after labor.

"We were happy to see that the change did affect a consequent increase in gestational age and birth weight, but we were somewhat surprised that it didn’t affect length of stay," Dr. Williams said.

Given that the study was conducted in a population with congenital heart disease, she said a likely explanation was that most of the infants would require surgery before they were discharged from hospital.

Dr. Williams said that the study didn’t look at maternal length of stay in hospital or other indicators of maternal morbidity, but she noted perhaps the next step would be to examine more closely the effect of the change in practice on mothers.

"However, it’s possible that, in the congenital heart disease population, whether or not you deliver at 38 or 39 weeks, we’re not seeing that big of a difference in terms of the neonatal outcomes or a big impact on big markers of morbidity like length of stay," Dr. Williams said.

There were no conflicts of interest declared.

SYDNEY – A shift in practice away from elective late preterm delivery to early term deliveries has shown little effect on neonatal outcomes such as intensive care length of stay, neonatal morbidity, or mortality in a population with major congenital heart disease, a study has found.

Researchers at Columbia University Medical Center and Morgan Stanley Children’s Hospital, both in New York, sought to evaluate the effect of a change in delivery practice that was introduced following the 2009 publication of a study showing improved outcomes in infants delivered after 39 weeks.

A review of the medical records of infants with critical congenital heart disease compared outcomes in 878 infants born at a single tertiary center during 2004-2008 to outcomes in 124 infants born in 2010, after the change in practice had been implemented.

There was a significant increase in the mean gestational age (37.8 weeks vs. 38.4 weeks, respectively; P less than .01) and in mean birth weight (2,975 grams vs. 3,134 grams; P less than .01).

However there were no significant differences between 2004-2008 and 2010 data in 5-minute APGAR scores (8.5 vs. 8.6; P = .11), median length of stay (14 days [1-197] vs. 16 days [1-144]; P = .18) and neonatal mortality (6% vs. 11%; P = .07), according to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

"After the 2009 paper came out, there was a real shift in practice among obstetricians – and also pushed by neonatologists – to try to not deliver patients before 39 weeks," said researcher and fetal cardiologist Dr. Ismee Williams, of New York–Presbyterian Hospital/Columbia University Medical Center.

"Then our goal, instead of being 38 weeks, was 39 weeks, and we would not schedule anybody for induction or a cesarean section unless they were 39 weeks and change," Dr. Williams said in an interview.

As a result of the change in practice, there were significant decreases in scheduled cesarean delivery from 2004-2008 to 2010 and in scheduled induction, but significant increases in urgent inductions, urgent cesarean deliveries, and cesarean deliveries after labor.

"We were happy to see that the change did affect a consequent increase in gestational age and birth weight, but we were somewhat surprised that it didn’t affect length of stay," Dr. Williams said.

Given that the study was conducted in a population with congenital heart disease, she said a likely explanation was that most of the infants would require surgery before they were discharged from hospital.

Dr. Williams said that the study didn’t look at maternal length of stay in hospital or other indicators of maternal morbidity, but she noted perhaps the next step would be to examine more closely the effect of the change in practice on mothers.

"However, it’s possible that, in the congenital heart disease population, whether or not you deliver at 38 or 39 weeks, we’re not seeing that big of a difference in terms of the neonatal outcomes or a big impact on big markers of morbidity like length of stay," Dr. Williams said.

There were no conflicts of interest declared.

SYDNEY – A shift in practice away from elective late preterm delivery to early term deliveries has shown little effect on neonatal outcomes such as intensive care length of stay, neonatal morbidity, or mortality in a population with major congenital heart disease, a study has found.

Researchers at Columbia University Medical Center and Morgan Stanley Children’s Hospital, both in New York, sought to evaluate the effect of a change in delivery practice that was introduced following the 2009 publication of a study showing improved outcomes in infants delivered after 39 weeks.

A review of the medical records of infants with critical congenital heart disease compared outcomes in 878 infants born at a single tertiary center during 2004-2008 to outcomes in 124 infants born in 2010, after the change in practice had been implemented.

There was a significant increase in the mean gestational age (37.8 weeks vs. 38.4 weeks, respectively; P less than .01) and in mean birth weight (2,975 grams vs. 3,134 grams; P less than .01).

However there were no significant differences between 2004-2008 and 2010 data in 5-minute APGAR scores (8.5 vs. 8.6; P = .11), median length of stay (14 days [1-197] vs. 16 days [1-144]; P = .18) and neonatal mortality (6% vs. 11%; P = .07), according to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

"After the 2009 paper came out, there was a real shift in practice among obstetricians – and also pushed by neonatologists – to try to not deliver patients before 39 weeks," said researcher and fetal cardiologist Dr. Ismee Williams, of New York–Presbyterian Hospital/Columbia University Medical Center.

"Then our goal, instead of being 38 weeks, was 39 weeks, and we would not schedule anybody for induction or a cesarean section unless they were 39 weeks and change," Dr. Williams said in an interview.

As a result of the change in practice, there were significant decreases in scheduled cesarean delivery from 2004-2008 to 2010 and in scheduled induction, but significant increases in urgent inductions, urgent cesarean deliveries, and cesarean deliveries after labor.

"We were happy to see that the change did affect a consequent increase in gestational age and birth weight, but we were somewhat surprised that it didn’t affect length of stay," Dr. Williams said.

Given that the study was conducted in a population with congenital heart disease, she said a likely explanation was that most of the infants would require surgery before they were discharged from hospital.

Dr. Williams said that the study didn’t look at maternal length of stay in hospital or other indicators of maternal morbidity, but she noted perhaps the next step would be to examine more closely the effect of the change in practice on mothers.

"However, it’s possible that, in the congenital heart disease population, whether or not you deliver at 38 or 39 weeks, we’re not seeing that big of a difference in terms of the neonatal outcomes or a big impact on big markers of morbidity like length of stay," Dr. Williams said.

There were no conflicts of interest declared.

SYDNEY, AUSTRALIA – Embryonic growth discordance at 7.0-9.6 weeks’ gestation is predictive of spontaneous single fetal loss in the first trimester, regardless of chorionicity, a retrospective study has found.

Researchers examined the association between crown rump length (CRL) discordance in 1,356 twin pregnancies, measured by ultrasound at 7.0-9.6 weeks, and spontaneous single fetal demise diagnosed at the 11- to 14-week scan, and presented the data at the International Society of Ultrasound in Obstetrics and Gynecology world congress,.

Data from the STORK (Southwest Thames Obstetric Research Collaborative) cohort showed CRL discordance was associated with a significant increase in single fetal loss at 11-14 weeks (odds ratio, 1.2).

Bianca Nogrady/IMNG Medical Media

The study found a predictive accuracy of CRL discordance at 7.0-9.6 weeks of area under the curve (AUC) equals 0.93, and the degree of discordance was significantly associated with the likelihood of early fetal loss.

At least one twin having a CRL below the fifth centile also was significantly associated with single fetal loss (OR, 2.21). However, there was no relationship between single fetal loss and maternal age or chorionicity.

At the same time, another retrospective cohort study of 1,733 dichorionic twin pregnancies presented in the same session concluded that CRL discordance at 11-14 weeks was associated with, but was not a strong predictor of, adverse outcomes such as fetal loss or preterm birth.

Dr. Francesco D’Antonio, a researcher for the first study, said evidence was building that CRL discordance at the 11- to 14-week mark was not a useful indicator of pregnancy outcomes.

"This is a big issue, because most of the doctors believe that actually this is useful, and they counsel the patient about a possible occurrence of adverse outcomes," said Dr. D’Antonio of the fetal medicine unit at St George’s, University of London.

"If you see there is a discrepancy in the first trimester, don’t tell the patient that the baby is going to die, or something bad is going to happen, because the predictivity is poor," Dr. D’Antonio said in an interview.

Dr. D’Antonio said the association between CRL discordance at 7.0-9.6 weeks and fetal loss by 11-14 weeks likely reflected the fact that a not-insignificant proportion of singleton pregnancies started as multiple pregnancies, but one fetus was lost before the 11- to 14-week scan.

"We didn’t pick these up in the past because we used to scan patients at 11 weeks, so when the IVF specialists started to scan patients at 4-5-6 weeks, this phenomenon became evident," he said.

The study observed 111 cases (8.2%) of single fetal loss at 11-14 weeks.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Embryonic growth discordance at 7.0-9.6 weeks’ gestation is predictive of spontaneous single fetal loss in the first trimester, regardless of chorionicity, a retrospective study has found.

Researchers examined the association between crown rump length (CRL) discordance in 1,356 twin pregnancies, measured by ultrasound at 7.0-9.6 weeks, and spontaneous single fetal demise diagnosed at the 11- to 14-week scan, and presented the data at the International Society of Ultrasound in Obstetrics and Gynecology world congress,.

Data from the STORK (Southwest Thames Obstetric Research Collaborative) cohort showed CRL discordance was associated with a significant increase in single fetal loss at 11-14 weeks (odds ratio, 1.2).

Bianca Nogrady/IMNG Medical Media

The study found a predictive accuracy of CRL discordance at 7.0-9.6 weeks of area under the curve (AUC) equals 0.93, and the degree of discordance was significantly associated with the likelihood of early fetal loss.

At least one twin having a CRL below the fifth centile also was significantly associated with single fetal loss (OR, 2.21). However, there was no relationship between single fetal loss and maternal age or chorionicity.

At the same time, another retrospective cohort study of 1,733 dichorionic twin pregnancies presented in the same session concluded that CRL discordance at 11-14 weeks was associated with, but was not a strong predictor of, adverse outcomes such as fetal loss or preterm birth.

Dr. Francesco D’Antonio, a researcher for the first study, said evidence was building that CRL discordance at the 11- to 14-week mark was not a useful indicator of pregnancy outcomes.

"This is a big issue, because most of the doctors believe that actually this is useful, and they counsel the patient about a possible occurrence of adverse outcomes," said Dr. D’Antonio of the fetal medicine unit at St George’s, University of London.

"If you see there is a discrepancy in the first trimester, don’t tell the patient that the baby is going to die, or something bad is going to happen, because the predictivity is poor," Dr. D’Antonio said in an interview.

Dr. D’Antonio said the association between CRL discordance at 7.0-9.6 weeks and fetal loss by 11-14 weeks likely reflected the fact that a not-insignificant proportion of singleton pregnancies started as multiple pregnancies, but one fetus was lost before the 11- to 14-week scan.

"We didn’t pick these up in the past because we used to scan patients at 11 weeks, so when the IVF specialists started to scan patients at 4-5-6 weeks, this phenomenon became evident," he said.

The study observed 111 cases (8.2%) of single fetal loss at 11-14 weeks.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Embryonic growth discordance at 7.0-9.6 weeks’ gestation is predictive of spontaneous single fetal loss in the first trimester, regardless of chorionicity, a retrospective study has found.

Researchers examined the association between crown rump length (CRL) discordance in 1,356 twin pregnancies, measured by ultrasound at 7.0-9.6 weeks, and spontaneous single fetal demise diagnosed at the 11- to 14-week scan, and presented the data at the International Society of Ultrasound in Obstetrics and Gynecology world congress,.

Data from the STORK (Southwest Thames Obstetric Research Collaborative) cohort showed CRL discordance was associated with a significant increase in single fetal loss at 11-14 weeks (odds ratio, 1.2).

Bianca Nogrady/IMNG Medical Media

The study found a predictive accuracy of CRL discordance at 7.0-9.6 weeks of area under the curve (AUC) equals 0.93, and the degree of discordance was significantly associated with the likelihood of early fetal loss.

At least one twin having a CRL below the fifth centile also was significantly associated with single fetal loss (OR, 2.21). However, there was no relationship between single fetal loss and maternal age or chorionicity.

At the same time, another retrospective cohort study of 1,733 dichorionic twin pregnancies presented in the same session concluded that CRL discordance at 11-14 weeks was associated with, but was not a strong predictor of, adverse outcomes such as fetal loss or preterm birth.

Dr. Francesco D’Antonio, a researcher for the first study, said evidence was building that CRL discordance at the 11- to 14-week mark was not a useful indicator of pregnancy outcomes.

"This is a big issue, because most of the doctors believe that actually this is useful, and they counsel the patient about a possible occurrence of adverse outcomes," said Dr. D’Antonio of the fetal medicine unit at St George’s, University of London.

"If you see there is a discrepancy in the first trimester, don’t tell the patient that the baby is going to die, or something bad is going to happen, because the predictivity is poor," Dr. D’Antonio said in an interview.

Dr. D’Antonio said the association between CRL discordance at 7.0-9.6 weeks and fetal loss by 11-14 weeks likely reflected the fact that a not-insignificant proportion of singleton pregnancies started as multiple pregnancies, but one fetus was lost before the 11- to 14-week scan.

"We didn’t pick these up in the past because we used to scan patients at 11 weeks, so when the IVF specialists started to scan patients at 4-5-6 weeks, this phenomenon became evident," he said.

The study observed 111 cases (8.2%) of single fetal loss at 11-14 weeks.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Assisted reproductive technologies are associated with cardiovascular remodeling that is present early in fetal life, a study has shown.

The prospective cohort study of 70 fetuses conceived using assisted reproductive technologies (ART) and 70 fetuses conceived spontaneously found significantly increased aortic mean intima-media thickness in ART fetuses compared with controls (0.55 vs. 0.46 mm, P = 0.016).

ART fetuses had dilated atria compared with controls, as measured by the right atrium/heart ratio (1.6% vs. 1.45%, P = 0.011), more globular hearts, thicker myocardial walls (interventricular septum thickness, 2.8 vs. 2.4 mm; P = 0.001), and impaired relaxation (mitral e’, 8 vs. 8.4 cm/s, P = 0.002).

While the results were statistically highly significant, Dr. Fátima Crispi said that clinically these changes did not represent a disease state, but rather a risk factor.

"To have, for example, increased intima-media thickness or a more hypertrophic heart is not a disease, so it doesn’t mean that these children will have symptoms or problems in the short term, but some of the changes that we are reporting are well-known risk factors for later in life," Dr. Crispi said in an interview.

The study also found ART fetuses had significantly decreased tricuspid ring displacement (5.5 vs. 6.5 mm, P less than 0.001), according to a presentation at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

Dr. Crispi said awareness of cardiovascular issues in ART children had come about only relatively recently, with studies suggesting an increased incidence of hypertension and vascular dysfunction. However, she said this was the first study to examine the cardiovascular systems of ART babies in utero.

"Just by our experience in other prenatal conditions that are remodeling [the cardiovascular system], then you could see that the children have hypertension, so we could infer that if these [in vitro fertilization] children had changes in blood pressure, we would be able to see something prenatally," said Dr. Crispi, a fetal medicine specialist at the fetal medicine research center, Hospital Clinic of Barcelona.

"We did echocardiography and we looked at everything that could be measured; we looked at all the function because we really didn’t know what we were going to find."

Researchers conducted fetal echocardiography at 28 weeks’ gestation, including cardiac morphometry and tissue Doppler ultrasound, and the results were adjusted for birth weight and preeclampsia.

The mechanism of the association is unclear; however, Dr. Crispi suggested it was likely to be a combination of maternal risk and the impact of fertility treatments.

"We have these couples who have some infertility problems; usually the mothers are older – although we adjusted by age; they have more medical diseases, and they have most probably more genetic predisposition to have problems," Dr. Crispi said. "Then this couple goes through all this manipulation of the embryo, and then they receive treatment – hormones and things that could also affect the fetus – so we don’t know if it’s one factor or several factors."

While Dr Crispi stressed that the cardiovascular remodeling did not represent cardiovascular disease, she said awareness of the potential increased risk could help with early prevention and risk factor management in later life.

No conflicts of interest were reported.

SYDNEY, AUSTRALIA – Assisted reproductive technologies are associated with cardiovascular remodeling that is present early in fetal life, a study has shown.

The prospective cohort study of 70 fetuses conceived using assisted reproductive technologies (ART) and 70 fetuses conceived spontaneously found significantly increased aortic mean intima-media thickness in ART fetuses compared with controls (0.55 vs. 0.46 mm, P = 0.016).

ART fetuses had dilated atria compared with controls, as measured by the right atrium/heart ratio (1.6% vs. 1.45%, P = 0.011), more globular hearts, thicker myocardial walls (interventricular septum thickness, 2.8 vs. 2.4 mm; P = 0.001), and impaired relaxation (mitral e’, 8 vs. 8.4 cm/s, P = 0.002).

While the results were statistically highly significant, Dr. Fátima Crispi said that clinically these changes did not represent a disease state, but rather a risk factor.

"To have, for example, increased intima-media thickness or a more hypertrophic heart is not a disease, so it doesn’t mean that these children will have symptoms or problems in the short term, but some of the changes that we are reporting are well-known risk factors for later in life," Dr. Crispi said in an interview.

The study also found ART fetuses had significantly decreased tricuspid ring displacement (5.5 vs. 6.5 mm, P less than 0.001), according to a presentation at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

Dr. Crispi said awareness of cardiovascular issues in ART children had come about only relatively recently, with studies suggesting an increased incidence of hypertension and vascular dysfunction. However, she said this was the first study to examine the cardiovascular systems of ART babies in utero.

"Just by our experience in other prenatal conditions that are remodeling [the cardiovascular system], then you could see that the children have hypertension, so we could infer that if these [in vitro fertilization] children had changes in blood pressure, we would be able to see something prenatally," said Dr. Crispi, a fetal medicine specialist at the fetal medicine research center, Hospital Clinic of Barcelona.

"We did echocardiography and we looked at everything that could be measured; we looked at all the function because we really didn’t know what we were going to find."

Researchers conducted fetal echocardiography at 28 weeks’ gestation, including cardiac morphometry and tissue Doppler ultrasound, and the results were adjusted for birth weight and preeclampsia.

The mechanism of the association is unclear; however, Dr. Crispi suggested it was likely to be a combination of maternal risk and the impact of fertility treatments.

"We have these couples who have some infertility problems; usually the mothers are older – although we adjusted by age; they have more medical diseases, and they have most probably more genetic predisposition to have problems," Dr. Crispi said. "Then this couple goes through all this manipulation of the embryo, and then they receive treatment – hormones and things that could also affect the fetus – so we don’t know if it’s one factor or several factors."

While Dr Crispi stressed that the cardiovascular remodeling did not represent cardiovascular disease, she said awareness of the potential increased risk could help with early prevention and risk factor management in later life.

No conflicts of interest were reported.

SYDNEY, AUSTRALIA – Assisted reproductive technologies are associated with cardiovascular remodeling that is present early in fetal life, a study has shown.

The prospective cohort study of 70 fetuses conceived using assisted reproductive technologies (ART) and 70 fetuses conceived spontaneously found significantly increased aortic mean intima-media thickness in ART fetuses compared with controls (0.55 vs. 0.46 mm, P = 0.016).

ART fetuses had dilated atria compared with controls, as measured by the right atrium/heart ratio (1.6% vs. 1.45%, P = 0.011), more globular hearts, thicker myocardial walls (interventricular septum thickness, 2.8 vs. 2.4 mm; P = 0.001), and impaired relaxation (mitral e’, 8 vs. 8.4 cm/s, P = 0.002).

While the results were statistically highly significant, Dr. Fátima Crispi said that clinically these changes did not represent a disease state, but rather a risk factor.

"To have, for example, increased intima-media thickness or a more hypertrophic heart is not a disease, so it doesn’t mean that these children will have symptoms or problems in the short term, but some of the changes that we are reporting are well-known risk factors for later in life," Dr. Crispi said in an interview.

The study also found ART fetuses had significantly decreased tricuspid ring displacement (5.5 vs. 6.5 mm, P less than 0.001), according to a presentation at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

Dr. Crispi said awareness of cardiovascular issues in ART children had come about only relatively recently, with studies suggesting an increased incidence of hypertension and vascular dysfunction. However, she said this was the first study to examine the cardiovascular systems of ART babies in utero.

"Just by our experience in other prenatal conditions that are remodeling [the cardiovascular system], then you could see that the children have hypertension, so we could infer that if these [in vitro fertilization] children had changes in blood pressure, we would be able to see something prenatally," said Dr. Crispi, a fetal medicine specialist at the fetal medicine research center, Hospital Clinic of Barcelona.

"We did echocardiography and we looked at everything that could be measured; we looked at all the function because we really didn’t know what we were going to find."

Researchers conducted fetal echocardiography at 28 weeks’ gestation, including cardiac morphometry and tissue Doppler ultrasound, and the results were adjusted for birth weight and preeclampsia.

The mechanism of the association is unclear; however, Dr. Crispi suggested it was likely to be a combination of maternal risk and the impact of fertility treatments.

"We have these couples who have some infertility problems; usually the mothers are older – although we adjusted by age; they have more medical diseases, and they have most probably more genetic predisposition to have problems," Dr. Crispi said. "Then this couple goes through all this manipulation of the embryo, and then they receive treatment – hormones and things that could also affect the fetus – so we don’t know if it’s one factor or several factors."

While Dr Crispi stressed that the cardiovascular remodeling did not represent cardiovascular disease, she said awareness of the potential increased risk could help with early prevention and risk factor management in later life.

No conflicts of interest were reported.

SYDNEY, AUSTRALIA – Women undergoing surgery for endometriosis have a high prevalence of sonographic signs of adenomyosis, which has significant implications for fertility treatment and secondary prevention, said the lead author of a new study.

Of 103 women having surgery for endometriosis, 91 (88.4%) showed at least one sonographic sign of adenomyosis, according to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

An irregular endometrial-myometrial junction was the most common finding (86.3%), followed by myometrial cysts (85.3%), hyperechoic islands (80%), and asymmetrical myometrial thickening (75.6%). Other sonographic signs included parallel shadowing, localized adenomyomas, and linear striations.

The presence of sonographic findings of adenomyosis was associated with age, dysmenorrhea, dyspareunia, and infertility.

Adenomyosis has long been associated with endometriosis, but lead author Dr. Vered Eisenberg said she was still surprised by the high prevalence of the sonographic signs of adenomyosis in this population of women.

"We know that they coexist, and I noticed when I was doing the scans that there was a lot of adenomyosis in the women that I was seeing, as opposed to women that I knew did not have endometriosis who had less adenomyosis," said Dr. Eisenberg, senior obstetrician and gynecologist at the Sheba Medical Centre, Tel Hashomer, Israel. She is a specialist in obstetric and gynecologic ultrasound.

The average age of the patients in the study was 34 years, and just over half were nulliparous. Nearly one-third of the patients presented with infertility, and 23% were undergoing in vitro fertilization (IVF).

Dr. Eisenberg said the finding had direct implications for treatment of these women, both for the adenomyosis and fertility problems, with growing awareness that adenomyosis may be independently responsible for fertility problems.

"There are several reviews that have looked into that, suggesting that the structure of the endometrial lining, which is affected by adenomyosis, is hindering the implantation of the embryo; that could be how it affects fertility," Dr. Eisenberg said in an interview.

"If you treat the endometriosis and you send the woman for IVF, for example, you might not manage to get her pregnant because the lining will still be problematic; so if you know that in advance, you may adjust your IVF accordingly," she said.

The coexistence of adenomyosis and endometriosis, as well as the patient’s fertility desires, may influence surgeons’ treatment decisions, Dr. Eisenberg said.

"When you consider operating on a woman [with endometriosis], you would either operate on her for intractable pain or for infertility. If she desires fertility, then you would want to save time, so you would end up doing the surgery much sooner," she said.

However, surgery would not resolve the adenomyosis, which would still require treatment.

In women who are not concerned about fertility, it might instead be possible to delay or avoid an operation altogether, and instead manage both the endometriosis and adenomyosis with treatments such as Mirena, a levonorgestrel-releasing intrauterine system.

Dr. Eisenberg stressed that the findings were sonographic only and were not histologically confirmed, as none of the women underwent a hysterectomy.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Women undergoing surgery for endometriosis have a high prevalence of sonographic signs of adenomyosis, which has significant implications for fertility treatment and secondary prevention, said the lead author of a new study.

Of 103 women having surgery for endometriosis, 91 (88.4%) showed at least one sonographic sign of adenomyosis, according to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

An irregular endometrial-myometrial junction was the most common finding (86.3%), followed by myometrial cysts (85.3%), hyperechoic islands (80%), and asymmetrical myometrial thickening (75.6%). Other sonographic signs included parallel shadowing, localized adenomyomas, and linear striations.

The presence of sonographic findings of adenomyosis was associated with age, dysmenorrhea, dyspareunia, and infertility.

Adenomyosis has long been associated with endometriosis, but lead author Dr. Vered Eisenberg said she was still surprised by the high prevalence of the sonographic signs of adenomyosis in this population of women.

"We know that they coexist, and I noticed when I was doing the scans that there was a lot of adenomyosis in the women that I was seeing, as opposed to women that I knew did not have endometriosis who had less adenomyosis," said Dr. Eisenberg, senior obstetrician and gynecologist at the Sheba Medical Centre, Tel Hashomer, Israel. She is a specialist in obstetric and gynecologic ultrasound.

The average age of the patients in the study was 34 years, and just over half were nulliparous. Nearly one-third of the patients presented with infertility, and 23% were undergoing in vitro fertilization (IVF).

Dr. Eisenberg said the finding had direct implications for treatment of these women, both for the adenomyosis and fertility problems, with growing awareness that adenomyosis may be independently responsible for fertility problems.

"There are several reviews that have looked into that, suggesting that the structure of the endometrial lining, which is affected by adenomyosis, is hindering the implantation of the embryo; that could be how it affects fertility," Dr. Eisenberg said in an interview.

"If you treat the endometriosis and you send the woman for IVF, for example, you might not manage to get her pregnant because the lining will still be problematic; so if you know that in advance, you may adjust your IVF accordingly," she said.

The coexistence of adenomyosis and endometriosis, as well as the patient’s fertility desires, may influence surgeons’ treatment decisions, Dr. Eisenberg said.

"When you consider operating on a woman [with endometriosis], you would either operate on her for intractable pain or for infertility. If she desires fertility, then you would want to save time, so you would end up doing the surgery much sooner," she said.

However, surgery would not resolve the adenomyosis, which would still require treatment.

In women who are not concerned about fertility, it might instead be possible to delay or avoid an operation altogether, and instead manage both the endometriosis and adenomyosis with treatments such as Mirena, a levonorgestrel-releasing intrauterine system.

Dr. Eisenberg stressed that the findings were sonographic only and were not histologically confirmed, as none of the women underwent a hysterectomy.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Women undergoing surgery for endometriosis have a high prevalence of sonographic signs of adenomyosis, which has significant implications for fertility treatment and secondary prevention, said the lead author of a new study.

Of 103 women having surgery for endometriosis, 91 (88.4%) showed at least one sonographic sign of adenomyosis, according to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

An irregular endometrial-myometrial junction was the most common finding (86.3%), followed by myometrial cysts (85.3%), hyperechoic islands (80%), and asymmetrical myometrial thickening (75.6%). Other sonographic signs included parallel shadowing, localized adenomyomas, and linear striations.

The presence of sonographic findings of adenomyosis was associated with age, dysmenorrhea, dyspareunia, and infertility.

Adenomyosis has long been associated with endometriosis, but lead author Dr. Vered Eisenberg said she was still surprised by the high prevalence of the sonographic signs of adenomyosis in this population of women.

"We know that they coexist, and I noticed when I was doing the scans that there was a lot of adenomyosis in the women that I was seeing, as opposed to women that I knew did not have endometriosis who had less adenomyosis," said Dr. Eisenberg, senior obstetrician and gynecologist at the Sheba Medical Centre, Tel Hashomer, Israel. She is a specialist in obstetric and gynecologic ultrasound.

The average age of the patients in the study was 34 years, and just over half were nulliparous. Nearly one-third of the patients presented with infertility, and 23% were undergoing in vitro fertilization (IVF).

Dr. Eisenberg said the finding had direct implications for treatment of these women, both for the adenomyosis and fertility problems, with growing awareness that adenomyosis may be independently responsible for fertility problems.

"There are several reviews that have looked into that, suggesting that the structure of the endometrial lining, which is affected by adenomyosis, is hindering the implantation of the embryo; that could be how it affects fertility," Dr. Eisenberg said in an interview.

"If you treat the endometriosis and you send the woman for IVF, for example, you might not manage to get her pregnant because the lining will still be problematic; so if you know that in advance, you may adjust your IVF accordingly," she said.

The coexistence of adenomyosis and endometriosis, as well as the patient’s fertility desires, may influence surgeons’ treatment decisions, Dr. Eisenberg said.

"When you consider operating on a woman [with endometriosis], you would either operate on her for intractable pain or for infertility. If she desires fertility, then you would want to save time, so you would end up doing the surgery much sooner," she said.

However, surgery would not resolve the adenomyosis, which would still require treatment.

In women who are not concerned about fertility, it might instead be possible to delay or avoid an operation altogether, and instead manage both the endometriosis and adenomyosis with treatments such as Mirena, a levonorgestrel-releasing intrauterine system.

Dr. Eisenberg stressed that the findings were sonographic only and were not histologically confirmed, as none of the women underwent a hysterectomy.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Women at high risk of early preeclampsia who show signs of abnormal hemodynamic function earlier in pregnancy may be more likely to have adverse pregnancy outcomes, new data suggest.

A prospective cohort study in 36 women at high risk for early preeclampsia (at less than 34 weeks’ gestation) showed that those who experienced adverse outcomes had significantly higher total peripheral resistance at 14 weeks (1,710 vs. 1,307 dyne/sec/cm^–5, P = .02), 24 weeks (1,564 vs. 1,305 dyne/sec/cm^–5, P less than .001), and 30 weeks (1,603 vs. 1,323 dyne/sec/cm^–5, P = .002) of gestation, compared with high-risk women who had normal outcomes.

According to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, cardiac output also was significantly lower at 14 weeks (4.41 vs. 5.18 L/min, P = .04) and 30 weeks (4.79 vs. 5.36 L/min, P = .04) of gestation in women who experienced adverse outcomes.

The results suggest that women at high risk for early preeclampsia and a subsequent adverse pregnancy outcome show signs of abnormal cardiac function as early as 14 weeks’ gestation, the researchers said.

Researcher Kate Russo said the results could help to differentiate between those who are likely to have a normal outcome and those who may develop an adverse outcome, in women who have already been identified as high risk through preeclampsia screening.

"We want to reduce the 10% false-positive rate of this screening, which has a 90% detection rate for early-onset preeclampsia," said Ms. Russo, a sonographer and Ph.D. candidate in the fetal medicine unit at the Royal Prince Alfred Hospital in Sydney.

"Performing a maternal echocardiogram in high-risk women is an easy, well-tolerated examination that can be utilized for the assessment of the women’s hemodynamic profile," she said.

The adverse outcomes, observed in 15 (42%) of the women enrolled in the study, included preeclampsia (11%), gestational hypertension (14%), low birth weight (14%), and preterm birth (3%).

Being able to identify women who were at greater risk of adverse pregnancy outcomes might help reduce the anxiety of some women deemed at high risk of early preeclampsia, as well as guide treatment, Ms. Russo said in an interview.

"You know who to look at, and potentially, if women develop hypertension, you can target their antihypertensive medication depending on their hemodynamic profile," she said.

The study is continuing to recruit participants, with the aim of comparing the hemodynamic profiles of women with early-onset preeclampsia, late-onset preeclampsia, and small-for-gestational-age babies.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Women at high risk of early preeclampsia who show signs of abnormal hemodynamic function earlier in pregnancy may be more likely to have adverse pregnancy outcomes, new data suggest.

A prospective cohort study in 36 women at high risk for early preeclampsia (at less than 34 weeks’ gestation) showed that those who experienced adverse outcomes had significantly higher total peripheral resistance at 14 weeks (1,710 vs. 1,307 dyne/sec/cm^–5, P = .02), 24 weeks (1,564 vs. 1,305 dyne/sec/cm^–5, P less than .001), and 30 weeks (1,603 vs. 1,323 dyne/sec/cm^–5, P = .002) of gestation, compared with high-risk women who had normal outcomes.

According to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, cardiac output also was significantly lower at 14 weeks (4.41 vs. 5.18 L/min, P = .04) and 30 weeks (4.79 vs. 5.36 L/min, P = .04) of gestation in women who experienced adverse outcomes.

The results suggest that women at high risk for early preeclampsia and a subsequent adverse pregnancy outcome show signs of abnormal cardiac function as early as 14 weeks’ gestation, the researchers said.

Researcher Kate Russo said the results could help to differentiate between those who are likely to have a normal outcome and those who may develop an adverse outcome, in women who have already been identified as high risk through preeclampsia screening.

"We want to reduce the 10% false-positive rate of this screening, which has a 90% detection rate for early-onset preeclampsia," said Ms. Russo, a sonographer and Ph.D. candidate in the fetal medicine unit at the Royal Prince Alfred Hospital in Sydney.

"Performing a maternal echocardiogram in high-risk women is an easy, well-tolerated examination that can be utilized for the assessment of the women’s hemodynamic profile," she said.

The adverse outcomes, observed in 15 (42%) of the women enrolled in the study, included preeclampsia (11%), gestational hypertension (14%), low birth weight (14%), and preterm birth (3%).

Being able to identify women who were at greater risk of adverse pregnancy outcomes might help reduce the anxiety of some women deemed at high risk of early preeclampsia, as well as guide treatment, Ms. Russo said in an interview.

"You know who to look at, and potentially, if women develop hypertension, you can target their antihypertensive medication depending on their hemodynamic profile," she said.

The study is continuing to recruit participants, with the aim of comparing the hemodynamic profiles of women with early-onset preeclampsia, late-onset preeclampsia, and small-for-gestational-age babies.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Women at high risk of early preeclampsia who show signs of abnormal hemodynamic function earlier in pregnancy may be more likely to have adverse pregnancy outcomes, new data suggest.

A prospective cohort study in 36 women at high risk for early preeclampsia (at less than 34 weeks’ gestation) showed that those who experienced adverse outcomes had significantly higher total peripheral resistance at 14 weeks (1,710 vs. 1,307 dyne/sec/cm^–5, P = .02), 24 weeks (1,564 vs. 1,305 dyne/sec/cm^–5, P less than .001), and 30 weeks (1,603 vs. 1,323 dyne/sec/cm^–5, P = .002) of gestation, compared with high-risk women who had normal outcomes.

According to data presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, cardiac output also was significantly lower at 14 weeks (4.41 vs. 5.18 L/min, P = .04) and 30 weeks (4.79 vs. 5.36 L/min, P = .04) of gestation in women who experienced adverse outcomes.

The results suggest that women at high risk for early preeclampsia and a subsequent adverse pregnancy outcome show signs of abnormal cardiac function as early as 14 weeks’ gestation, the researchers said.

Researcher Kate Russo said the results could help to differentiate between those who are likely to have a normal outcome and those who may develop an adverse outcome, in women who have already been identified as high risk through preeclampsia screening.

"We want to reduce the 10% false-positive rate of this screening, which has a 90% detection rate for early-onset preeclampsia," said Ms. Russo, a sonographer and Ph.D. candidate in the fetal medicine unit at the Royal Prince Alfred Hospital in Sydney.

"Performing a maternal echocardiogram in high-risk women is an easy, well-tolerated examination that can be utilized for the assessment of the women’s hemodynamic profile," she said.

The adverse outcomes, observed in 15 (42%) of the women enrolled in the study, included preeclampsia (11%), gestational hypertension (14%), low birth weight (14%), and preterm birth (3%).

Being able to identify women who were at greater risk of adverse pregnancy outcomes might help reduce the anxiety of some women deemed at high risk of early preeclampsia, as well as guide treatment, Ms. Russo said in an interview.

"You know who to look at, and potentially, if women develop hypertension, you can target their antihypertensive medication depending on their hemodynamic profile," she said.

The study is continuing to recruit participants, with the aim of comparing the hemodynamic profiles of women with early-onset preeclampsia, late-onset preeclampsia, and small-for-gestational-age babies.

No conflicts of interest were declared.

SYDNEY, AUSTRALIA – Short fetal femur length in the second trimester was associated with a significantly increased risk of Down syndrome, trisomy 13 and 18, and unbalanced autosomal structural abnormality in a large population study.

The study of 147,766 Danish singleton pregnancies with a second-trimester malformation scan showed that short femur length – defined as below the fifth percentile – was present in 16.2% of the fetuses affected by trisomy 21 (odds ratio, 10.3).

The data were collected from the Danish National Fetal Medicine database and presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

Individuals with trisomy 13/18 also had a significantly higher incidence of short femur length (OR, 7.3), as did individuals with unbalanced autosomal structural abnormality (OR, 23.8).

Researchers also found that pregnancies in which the fetus had a short femur length also were more likely to result in delivery before 34 weeks’ gestation (OR, 4.2) and small-for-gestational-age infants (OR, 4.3).

Dr. Ann Tabor said the first-trimester screening program in Denmark was extremely rigorous, resulting in detection of the vast majority of cases of Down syndrome; some cases, however, still slip through the net.

"We only have a detection rate of around 90%-92%, so we inform women that we will not be able to detect all of the Down syndrome fetuses," said Dr. Tabor, professor of fetal medicine at Copenhagen University Hospital. "This would offer a way to pick up some of the ones we haven’t found the first time."

The overall incidence of short femur length in the cohort was 2,718 cases (1.8%).

Dr. Tabor said that short femur length was a well-known feature of Down syndrome, although she was surprised by the strength of the association between short femur length and unbalanced autosomal structural abnormality.

"Every day in your clinical life, when you have a fetus where you measure this short femur length, you wonder ‘Should I do something about it or do I just ignore it?’ " Dr. Tabor said in an interview. "Do you want to do an amniocentesis if you don’t have a karyotype for the fetus, or should you really monitor the growth because they are more likely to be growth retarded or to be delivered preterm?"

Dr. Tabor said her decision about whether to act on a short femur length detected in the second trimester would depend a lot on the mother’s risk of abnormality in the first trimester.

"So if she had a risk estimate like 1 in 10,000, you probably wouldn’t do anything, but if it was 1 in 400, then you’d have to counsel her," she said.

There were no conflicts of interest declared.

[email protected]

SYDNEY, AUSTRALIA – Short fetal femur length in the second trimester was associated with a significantly increased risk of Down syndrome, trisomy 13 and 18, and unbalanced autosomal structural abnormality in a large population study.

The study of 147,766 Danish singleton pregnancies with a second-trimester malformation scan showed that short femur length – defined as below the fifth percentile – was present in 16.2% of the fetuses affected by trisomy 21 (odds ratio, 10.3).

The data were collected from the Danish National Fetal Medicine database and presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

Individuals with trisomy 13/18 also had a significantly higher incidence of short femur length (OR, 7.3), as did individuals with unbalanced autosomal structural abnormality (OR, 23.8).

Researchers also found that pregnancies in which the fetus had a short femur length also were more likely to result in delivery before 34 weeks’ gestation (OR, 4.2) and small-for-gestational-age infants (OR, 4.3).

Dr. Ann Tabor said the first-trimester screening program in Denmark was extremely rigorous, resulting in detection of the vast majority of cases of Down syndrome; some cases, however, still slip through the net.

"We only have a detection rate of around 90%-92%, so we inform women that we will not be able to detect all of the Down syndrome fetuses," said Dr. Tabor, professor of fetal medicine at Copenhagen University Hospital. "This would offer a way to pick up some of the ones we haven’t found the first time."

The overall incidence of short femur length in the cohort was 2,718 cases (1.8%).

Dr. Tabor said that short femur length was a well-known feature of Down syndrome, although she was surprised by the strength of the association between short femur length and unbalanced autosomal structural abnormality.

"Every day in your clinical life, when you have a fetus where you measure this short femur length, you wonder ‘Should I do something about it or do I just ignore it?’ " Dr. Tabor said in an interview. "Do you want to do an amniocentesis if you don’t have a karyotype for the fetus, or should you really monitor the growth because they are more likely to be growth retarded or to be delivered preterm?"

Dr. Tabor said her decision about whether to act on a short femur length detected in the second trimester would depend a lot on the mother’s risk of abnormality in the first trimester.

"So if she had a risk estimate like 1 in 10,000, you probably wouldn’t do anything, but if it was 1 in 400, then you’d have to counsel her," she said.

There were no conflicts of interest declared.

[email protected]

SYDNEY, AUSTRALIA – Short fetal femur length in the second trimester was associated with a significantly increased risk of Down syndrome, trisomy 13 and 18, and unbalanced autosomal structural abnormality in a large population study.

The study of 147,766 Danish singleton pregnancies with a second-trimester malformation scan showed that short femur length – defined as below the fifth percentile – was present in 16.2% of the fetuses affected by trisomy 21 (odds ratio, 10.3).

The data were collected from the Danish National Fetal Medicine database and presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress.

Individuals with trisomy 13/18 also had a significantly higher incidence of short femur length (OR, 7.3), as did individuals with unbalanced autosomal structural abnormality (OR, 23.8).

Researchers also found that pregnancies in which the fetus had a short femur length also were more likely to result in delivery before 34 weeks’ gestation (OR, 4.2) and small-for-gestational-age infants (OR, 4.3).

Dr. Ann Tabor said the first-trimester screening program in Denmark was extremely rigorous, resulting in detection of the vast majority of cases of Down syndrome; some cases, however, still slip through the net.

"We only have a detection rate of around 90%-92%, so we inform women that we will not be able to detect all of the Down syndrome fetuses," said Dr. Tabor, professor of fetal medicine at Copenhagen University Hospital. "This would offer a way to pick up some of the ones we haven’t found the first time."

The overall incidence of short femur length in the cohort was 2,718 cases (1.8%).

Dr. Tabor said that short femur length was a well-known feature of Down syndrome, although she was surprised by the strength of the association between short femur length and unbalanced autosomal structural abnormality.

"Every day in your clinical life, when you have a fetus where you measure this short femur length, you wonder ‘Should I do something about it or do I just ignore it?’ " Dr. Tabor said in an interview. "Do you want to do an amniocentesis if you don’t have a karyotype for the fetus, or should you really monitor the growth because they are more likely to be growth retarded or to be delivered preterm?"

Dr. Tabor said her decision about whether to act on a short femur length detected in the second trimester would depend a lot on the mother’s risk of abnormality in the first trimester.

"So if she had a risk estimate like 1 in 10,000, you probably wouldn’t do anything, but if it was 1 in 400, then you’d have to counsel her," she said.

There were no conflicts of interest declared.

[email protected]

SYDNEY, AUSTRALIA – A single round of endometrial scratching during oral contraceptive pill pretreatment can significantly increase the clinical pregnancy rate in women undergoing assisted reproductive treatment, a randomized controlled trial showed.

The study, presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, showed an 83% increase in the chance of a live birth (41.8% vs. 22.8%) and a 70% increase in the chance of clinical pregnancy (49.4% vs. 29.1%) in women who had endometrial scratching, compared with women who underwent a sham procedure.

Endometrial scratching did not have any significant effect on the rate of miscarriage (15.4% vs. 21.7%,) and multiple pregnancy (22.5% vs. 25.0%), according to data that was also published online in the Sept. 2 issue of Ultrasound in Obstetrics and Gynecology (2013;42:375-82 [doi: 10.1002/uog.12539]).

The 77 women randomized to endometrial scratching reported significantly higher pain scores during the procedure than the 79 women given the sham therapy. No major fetal malformations were reported by study participants.

The procedure, which was performed 7-14 days before the planned start of controlled ovarian stimulation, involved introducing the Pipelle suction curette through the cervix and up to the uterine fundus, then applying suction and moving the device around with the aim of covering the entire endometrium.

The sham procedure consisted of drying the cervix with gauze for 30 seconds.

A link between endometrial scratching and the increased chance of pregnancy was first identified in 2003; however, coauthor Dr. Wellington Martins said this was the first study to examine its use during oral contraceptive pill (OCP) pretreatment.

"No previous study has studied endometrial injury performed during OCP pretreatment, only in natural cycles, but in our center we use OCP pre-treatment for all women undergoing assisted reproductive therapy," said Dr. Martins of the University of São Paolo (Brazil).

Dr. Martins said the study also included all women undergoing assisted reproductive therapy, not just those with repeated implantation failure, although the majority of participants had had at least two previous, unsuccessful embryo transfers.

The effect of endometrial scratching is thought to be possibly mediated by inflammation, with the injury causing increased secretion of cytokines, interleukins, growth factors, and dendritic cells, which could aid embryo implantation.

Another mechanism may be the improved synchronization between the endometrium and implanted embryo.

"In assisted reproduction, the higher estrogen levels make the endometrium a little advanced, but it is possible that the injury or the healing process retard the maturity and development of the endometrium and promote a better synchronization," Dr. Martins said in an interview.

The study was terminated before full enrollment was achieved because of the significant benefit noted in an interim analysis, and while research is continuing, Dr. Martins said the treatment was already being offered to women attending their clinic.

No financial conflicts were reported.

This story was updated on October 29, 2013.

SYDNEY, AUSTRALIA – A single round of endometrial scratching during oral contraceptive pill pretreatment can significantly increase the clinical pregnancy rate in women undergoing assisted reproductive treatment, a randomized controlled trial showed.

The study, presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, showed an 83% increase in the chance of a live birth (41.8% vs. 22.8%) and a 70% increase in the chance of clinical pregnancy (49.4% vs. 29.1%) in women who had endometrial scratching, compared with women who underwent a sham procedure.

Endometrial scratching did not have any significant effect on the rate of miscarriage (15.4% vs. 21.7%,) and multiple pregnancy (22.5% vs. 25.0%), according to data that was also published online in the Sept. 2 issue of Ultrasound in Obstetrics and Gynecology (2013;42:375-82 [doi: 10.1002/uog.12539]).

The 77 women randomized to endometrial scratching reported significantly higher pain scores during the procedure than the 79 women given the sham therapy. No major fetal malformations were reported by study participants.

The procedure, which was performed 7-14 days before the planned start of controlled ovarian stimulation, involved introducing the Pipelle suction curette through the cervix and up to the uterine fundus, then applying suction and moving the device around with the aim of covering the entire endometrium.

The sham procedure consisted of drying the cervix with gauze for 30 seconds.

A link between endometrial scratching and the increased chance of pregnancy was first identified in 2003; however, coauthor Dr. Wellington Martins said this was the first study to examine its use during oral contraceptive pill (OCP) pretreatment.

"No previous study has studied endometrial injury performed during OCP pretreatment, only in natural cycles, but in our center we use OCP pre-treatment for all women undergoing assisted reproductive therapy," said Dr. Martins of the University of São Paolo (Brazil).

Dr. Martins said the study also included all women undergoing assisted reproductive therapy, not just those with repeated implantation failure, although the majority of participants had had at least two previous, unsuccessful embryo transfers.

The effect of endometrial scratching is thought to be possibly mediated by inflammation, with the injury causing increased secretion of cytokines, interleukins, growth factors, and dendritic cells, which could aid embryo implantation.

Another mechanism may be the improved synchronization between the endometrium and implanted embryo.

"In assisted reproduction, the higher estrogen levels make the endometrium a little advanced, but it is possible that the injury or the healing process retard the maturity and development of the endometrium and promote a better synchronization," Dr. Martins said in an interview.

The study was terminated before full enrollment was achieved because of the significant benefit noted in an interim analysis, and while research is continuing, Dr. Martins said the treatment was already being offered to women attending their clinic.

No financial conflicts were reported.

This story was updated on October 29, 2013.

SYDNEY, AUSTRALIA – A single round of endometrial scratching during oral contraceptive pill pretreatment can significantly increase the clinical pregnancy rate in women undergoing assisted reproductive treatment, a randomized controlled trial showed.

The study, presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, showed an 83% increase in the chance of a live birth (41.8% vs. 22.8%) and a 70% increase in the chance of clinical pregnancy (49.4% vs. 29.1%) in women who had endometrial scratching, compared with women who underwent a sham procedure.

Endometrial scratching did not have any significant effect on the rate of miscarriage (15.4% vs. 21.7%,) and multiple pregnancy (22.5% vs. 25.0%), according to data that was also published online in the Sept. 2 issue of Ultrasound in Obstetrics and Gynecology (2013;42:375-82 [doi: 10.1002/uog.12539]).

The 77 women randomized to endometrial scratching reported significantly higher pain scores during the procedure than the 79 women given the sham therapy. No major fetal malformations were reported by study participants.

The procedure, which was performed 7-14 days before the planned start of controlled ovarian stimulation, involved introducing the Pipelle suction curette through the cervix and up to the uterine fundus, then applying suction and moving the device around with the aim of covering the entire endometrium.

The sham procedure consisted of drying the cervix with gauze for 30 seconds.

A link between endometrial scratching and the increased chance of pregnancy was first identified in 2003; however, coauthor Dr. Wellington Martins said this was the first study to examine its use during oral contraceptive pill (OCP) pretreatment.

"No previous study has studied endometrial injury performed during OCP pretreatment, only in natural cycles, but in our center we use OCP pre-treatment for all women undergoing assisted reproductive therapy," said Dr. Martins of the University of São Paolo (Brazil).

Dr. Martins said the study also included all women undergoing assisted reproductive therapy, not just those with repeated implantation failure, although the majority of participants had had at least two previous, unsuccessful embryo transfers.

The effect of endometrial scratching is thought to be possibly mediated by inflammation, with the injury causing increased secretion of cytokines, interleukins, growth factors, and dendritic cells, which could aid embryo implantation.

Another mechanism may be the improved synchronization between the endometrium and implanted embryo.

"In assisted reproduction, the higher estrogen levels make the endometrium a little advanced, but it is possible that the injury or the healing process retard the maturity and development of the endometrium and promote a better synchronization," Dr. Martins said in an interview.

The study was terminated before full enrollment was achieved because of the significant benefit noted in an interim analysis, and while research is continuing, Dr. Martins said the treatment was already being offered to women attending their clinic.

No financial conflicts were reported.

This story was updated on October 29, 2013.

SYDNEY, AUSTRALIA – The brain shadowing sign – a sharply demarcated area of acoustic shadowing on ultrasound – is a novel and easily identifiable marker for fetal craniosynostosis, a small multicenter retrospective study showed.

An analysis of ultrasound images from 16 patients with a postnatal diagnosis of fetal craniosynostosis, presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, showed the brain shadowing sign was clearly depicted in all cases, even when the suture was only partly closed.

Coauthor Gustavo Malinger, director of the ob.gyn. ultrasound unit at the Tel Aviv Sourasky Medical Centre, said prenatal diagnosis of fetal craniosynostosis is often difficult, particularly if it involves the sagittal suture and occurs in the absence of a family history. As a result, most cases are delivered without a diagnosis.

"With the metopic suture, you have a chance to make a diagnosis because the shape of the head is quite characteristic. So with the third-trimester examination, when you perform a weight estimation or something like that, you see that something is wrong," Dr. Malinger said in an interview.

"But when the sagittal suture is closed, you don’t see it because you come from the side; you obtain axial planes and you never reach the sagittal suture."

The brain shadowing sign occurs because of a failure of the acoustic wave to cross the cortical bone, and appears as a line separating a zone of clearly defined brain anatomy and a zone of relative shadow.

The sign is easily identifiable, is not dependent on fetal position, and does not require visualization with high-definition 3D transducers.

All patients underwent a multiplanar neurosonographic exam with transvaginal and transabdominal ultrasound.

The mean gestational age at diagnosis was 29 weeks, and the diagnosis was made in the second trimester in only five cases. Dr. Malinger said that while it was possible in some cases to diagnose very severe cases at 22 weeks, fetal craniosynostosis tends to develop later in the pregnancy.

Prenatal diagnosis did not necessarily enable any kind of intervention, he added, but it was important in enabling counselling to be provided to families to prepare them for what to expect.

"They are ready to know, and we send them to a neurosurgical consultation in utero, so the neurosurgeon can explain that in most of the cases, it’s going to be OK, and that we’ll follow up," Dr. Malinger said.

Of the 16 patients included in the study, 14 presented with single-suture craniosynostosis: 6 involved metopic suture; 5, sagittal suture; and 3, coronal suture.

Nine cases were isolated fetal craniosynostosis, three were cases of Apert syndrome, and four also presented with associated CNS and non-CNS anomalies.

Dr. Malinger said the earlier diagnosis of fetal craniosynostosis could enable discovery of other related malformations that might otherwise have been missed.

No financial conflicts were reported.

SYDNEY, AUSTRALIA – The brain shadowing sign – a sharply demarcated area of acoustic shadowing on ultrasound – is a novel and easily identifiable marker for fetal craniosynostosis, a small multicenter retrospective study showed.

An analysis of ultrasound images from 16 patients with a postnatal diagnosis of fetal craniosynostosis, presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, showed the brain shadowing sign was clearly depicted in all cases, even when the suture was only partly closed.

Coauthor Gustavo Malinger, director of the ob.gyn. ultrasound unit at the Tel Aviv Sourasky Medical Centre, said prenatal diagnosis of fetal craniosynostosis is often difficult, particularly if it involves the sagittal suture and occurs in the absence of a family history. As a result, most cases are delivered without a diagnosis.

"With the metopic suture, you have a chance to make a diagnosis because the shape of the head is quite characteristic. So with the third-trimester examination, when you perform a weight estimation or something like that, you see that something is wrong," Dr. Malinger said in an interview.

"But when the sagittal suture is closed, you don’t see it because you come from the side; you obtain axial planes and you never reach the sagittal suture."

The brain shadowing sign occurs because of a failure of the acoustic wave to cross the cortical bone, and appears as a line separating a zone of clearly defined brain anatomy and a zone of relative shadow.

The sign is easily identifiable, is not dependent on fetal position, and does not require visualization with high-definition 3D transducers.

All patients underwent a multiplanar neurosonographic exam with transvaginal and transabdominal ultrasound.

The mean gestational age at diagnosis was 29 weeks, and the diagnosis was made in the second trimester in only five cases. Dr. Malinger said that while it was possible in some cases to diagnose very severe cases at 22 weeks, fetal craniosynostosis tends to develop later in the pregnancy.

Prenatal diagnosis did not necessarily enable any kind of intervention, he added, but it was important in enabling counselling to be provided to families to prepare them for what to expect.

"They are ready to know, and we send them to a neurosurgical consultation in utero, so the neurosurgeon can explain that in most of the cases, it’s going to be OK, and that we’ll follow up," Dr. Malinger said.

Of the 16 patients included in the study, 14 presented with single-suture craniosynostosis: 6 involved metopic suture; 5, sagittal suture; and 3, coronal suture.

Nine cases were isolated fetal craniosynostosis, three were cases of Apert syndrome, and four also presented with associated CNS and non-CNS anomalies.

Dr. Malinger said the earlier diagnosis of fetal craniosynostosis could enable discovery of other related malformations that might otherwise have been missed.

No financial conflicts were reported.

SYDNEY, AUSTRALIA – The brain shadowing sign – a sharply demarcated area of acoustic shadowing on ultrasound – is a novel and easily identifiable marker for fetal craniosynostosis, a small multicenter retrospective study showed.

An analysis of ultrasound images from 16 patients with a postnatal diagnosis of fetal craniosynostosis, presented at the International Society of Ultrasound in Obstetrics and Gynecology world congress, showed the brain shadowing sign was clearly depicted in all cases, even when the suture was only partly closed.

Coauthor Gustavo Malinger, director of the ob.gyn. ultrasound unit at the Tel Aviv Sourasky Medical Centre, said prenatal diagnosis of fetal craniosynostosis is often difficult, particularly if it involves the sagittal suture and occurs in the absence of a family history. As a result, most cases are delivered without a diagnosis.

"With the metopic suture, you have a chance to make a diagnosis because the shape of the head is quite characteristic. So with the third-trimester examination, when you perform a weight estimation or something like that, you see that something is wrong," Dr. Malinger said in an interview.

"But when the sagittal suture is closed, you don’t see it because you come from the side; you obtain axial planes and you never reach the sagittal suture."

The brain shadowing sign occurs because of a failure of the acoustic wave to cross the cortical bone, and appears as a line separating a zone of clearly defined brain anatomy and a zone of relative shadow.

The sign is easily identifiable, is not dependent on fetal position, and does not require visualization with high-definition 3D transducers.

All patients underwent a multiplanar neurosonographic exam with transvaginal and transabdominal ultrasound.

The mean gestational age at diagnosis was 29 weeks, and the diagnosis was made in the second trimester in only five cases. Dr. Malinger said that while it was possible in some cases to diagnose very severe cases at 22 weeks, fetal craniosynostosis tends to develop later in the pregnancy.

Prenatal diagnosis did not necessarily enable any kind of intervention, he added, but it was important in enabling counselling to be provided to families to prepare them for what to expect.

"They are ready to know, and we send them to a neurosurgical consultation in utero, so the neurosurgeon can explain that in most of the cases, it’s going to be OK, and that we’ll follow up," Dr. Malinger said.

Of the 16 patients included in the study, 14 presented with single-suture craniosynostosis: 6 involved metopic suture; 5, sagittal suture; and 3, coronal suture.

Nine cases were isolated fetal craniosynostosis, three were cases of Apert syndrome, and four also presented with associated CNS and non-CNS anomalies.

Dr. Malinger said the earlier diagnosis of fetal craniosynostosis could enable discovery of other related malformations that might otherwise have been missed.

No financial conflicts were reported.

SYDNEY – The presence of subchorionic bleeding around the gestational sac does not appear to increase the risk of miscarriage, according to data from a prospective observational study.

In a study of 1,115 women in early pregnancy, 142 (13%) had documented subchorionic hematoma. The women were diagnosed either after presenting with bleeding or during a routine dating scan. Researchers looked at the outcomes of pregnancy in both groups at the end of the first trimester and the final pregnancy outcome. They found no statistically significant association between the presence of subchorionic bleeding and miscarriage, according to findings presented at the International Society on Ultrasound in Obstetrics and Gynecology world congress.

Lead author Dr. Nicole Stamatopoulos said the study came about because she observed a significant number of women attending the unit with subchorionic hematoma.

Looking at viable pregnancies that later miscarry, "we wondered if the bleeding around the gestational sac was one of the reasons why these women were miscarrying," said Dr. Stamatopoulos, a researcher at Nepean Hospital in Penrith, Sydney.

Dr. Stamatopoulos said that a diagnosis of subchorionic hematoma – which is one of the most common sonographic abnormalities with live embryos – often caused women a lot of concern, particularly when it was accompanied by vaginal bleeding.

She said the findings should offer some reassurance to these women.

"If you’ve got an embryo that’s got a heart rate, and someone’s come in with bleeding, and there is a subchorionic hematoma, I think you can reassure those women," Dr. Stamatopoulos said in an interview.

However, she said that reassurance could not necessarily be extended to women in whom a viable pregnancy was yet to be established.

The causes of subchorionic hematoma are not well understood, but the condition may result from trauma or may be related to the process of the trophoblast embedding into the uterus, Dr. Stamatopoulos said.

The next step in the study is to explore a possible relationship between the size of the hematoma and pregnancy outcomes.

"I’ve got data relating to the actual size of the subchorionic hematoma, to see whether or not, if it’s a really large one, does that increase the risk of miscarriage? Or if it’s just small, is it not a problem?" she said.

There were no relevant financial conflicts of interest declared.

SYDNEY – The presence of subchorionic bleeding around the gestational sac does not appear to increase the risk of miscarriage, according to data from a prospective observational study.

In a study of 1,115 women in early pregnancy, 142 (13%) had documented subchorionic hematoma. The women were diagnosed either after presenting with bleeding or during a routine dating scan. Researchers looked at the outcomes of pregnancy in both groups at the end of the first trimester and the final pregnancy outcome. They found no statistically significant association between the presence of subchorionic bleeding and miscarriage, according to findings presented at the International Society on Ultrasound in Obstetrics and Gynecology world congress.

Lead author Dr. Nicole Stamatopoulos said the study came about because she observed a significant number of women attending the unit with subchorionic hematoma.

Looking at viable pregnancies that later miscarry, "we wondered if the bleeding around the gestational sac was one of the reasons why these women were miscarrying," said Dr. Stamatopoulos, a researcher at Nepean Hospital in Penrith, Sydney.

Dr. Stamatopoulos said that a diagnosis of subchorionic hematoma – which is one of the most common sonographic abnormalities with live embryos – often caused women a lot of concern, particularly when it was accompanied by vaginal bleeding.

She said the findings should offer some reassurance to these women.

"If you’ve got an embryo that’s got a heart rate, and someone’s come in with bleeding, and there is a subchorionic hematoma, I think you can reassure those women," Dr. Stamatopoulos said in an interview.

However, she said that reassurance could not necessarily be extended to women in whom a viable pregnancy was yet to be established.

The causes of subchorionic hematoma are not well understood, but the condition may result from trauma or may be related to the process of the trophoblast embedding into the uterus, Dr. Stamatopoulos said.

The next step in the study is to explore a possible relationship between the size of the hematoma and pregnancy outcomes.

"I’ve got data relating to the actual size of the subchorionic hematoma, to see whether or not, if it’s a really large one, does that increase the risk of miscarriage? Or if it’s just small, is it not a problem?" she said.

There were no relevant financial conflicts of interest declared.

SYDNEY – The presence of subchorionic bleeding around the gestational sac does not appear to increase the risk of miscarriage, according to data from a prospective observational study.

In a study of 1,115 women in early pregnancy, 142 (13%) had documented subchorionic hematoma. The women were diagnosed either after presenting with bleeding or during a routine dating scan. Researchers looked at the outcomes of pregnancy in both groups at the end of the first trimester and the final pregnancy outcome. They found no statistically significant association between the presence of subchorionic bleeding and miscarriage, according to findings presented at the International Society on Ultrasound in Obstetrics and Gynecology world congress.

Lead author Dr. Nicole Stamatopoulos said the study came about because she observed a significant number of women attending the unit with subchorionic hematoma.

Looking at viable pregnancies that later miscarry, "we wondered if the bleeding around the gestational sac was one of the reasons why these women were miscarrying," said Dr. Stamatopoulos, a researcher at Nepean Hospital in Penrith, Sydney.

Dr. Stamatopoulos said that a diagnosis of subchorionic hematoma – which is one of the most common sonographic abnormalities with live embryos – often caused women a lot of concern, particularly when it was accompanied by vaginal bleeding.

She said the findings should offer some reassurance to these women.

"If you’ve got an embryo that’s got a heart rate, and someone’s come in with bleeding, and there is a subchorionic hematoma, I think you can reassure those women," Dr. Stamatopoulos said in an interview.

However, she said that reassurance could not necessarily be extended to women in whom a viable pregnancy was yet to be established.

The causes of subchorionic hematoma are not well understood, but the condition may result from trauma or may be related to the process of the trophoblast embedding into the uterus, Dr. Stamatopoulos said.

The next step in the study is to explore a possible relationship between the size of the hematoma and pregnancy outcomes.

"I’ve got data relating to the actual size of the subchorionic hematoma, to see whether or not, if it’s a really large one, does that increase the risk of miscarriage? Or if it’s just small, is it not a problem?" she said.

There were no relevant financial conflicts of interest declared.