The Week in MFM
For patients and families
Each week our physicians review the newest research in high-risk pregnancy care. This week, a large clinical trial analysis showed that two common variations of the cervical cerclage procedure (a stitch that helps prevent early delivery) are equally safe, which is reassuring news if you or your doctor have discussed this procedure. Researchers also studied better ways to monitor babies who are measuring small, and how to interpret certain unusual results on the cell-free DNA blood test (NIPT).
None of this week's findings change the care you are receiving today. If you have questions about how new research applies to your pregnancy, please bring them to your next visit; we are always glad to walk through the evidence with you.
The most useful result of the week comes from the C-STICH trial: in a secondary analysis published in BJOG, pregnancy loss did not differ between high and low placement of transvaginal cerclage, a directly counselable answer to a long-standing technique debate. The rest of the week belonged largely to fetal growth, with new work on growth velocity in term small-for-gestational-age fetuses, a guideline appraisal for selective fetal growth restriction in twins, and early-stage Doppler refinements. Prenatal genetics contributed a practical series on rare autosomal trisomies detected by genome-wide cell-free DNA screening.
Preconception counseling was quiet, and no new ACOG, SMFM, USPSTF, or FDA guidance relevant to MFM appeared this week. Several items below are epub-ahead-of-print with abstracts not yet fully indexed; where exact figures could not be confirmed, takeaways are scoped to each study's design and question.
Cerclage height does not change pregnancy loss: C-STICH secondary analysis
Van der Krogt and colleagues compared pregnancy outcomes after high versus low placement of transvaginal cerclage among C-STICH participants at high risk of preterm birth. Pregnancy loss rates did not differ significantly between placement heights (BJOG, Aug 20).
Practice impact: Reassuring for technique variation between operators; there is no basis to prefer high placement for loss reduction, and no protocol change is needed. Trial-grade evidence, though secondary and not randomized by placement height.
DiGest follow-up: third-trimester energy restriction after GDM and body composition at one year
Dib and colleagues report one-year postnatal maternal and child body composition from the DiGest follow-up study, examining whether imposed third-trimester energy restriction or natural weight loss in GDM pregnancies alters later outcomes (Diabetes Care, Aug 27). Full effect sizes were not retrievable at press time.
Practice impact: DiGest is the key randomized trial of antenatal calorie restriction in GDM; this follow-up will inform whether third-trimester dietary energy targets have durable maternal or offspring effects. Review the full paper before adjusting nutrition counseling.
Growth velocity adds predictive value to Doppler in term SGA fetuses
Meler, Figueras and colleagues tested whether estimated fetal weight growth velocity, assessed with interval-specific standards, improves prediction of adverse perinatal outcome beyond standard criteria in term fetuses with EFW below the 10th centile (BJOG, Aug 26; retrospective cohort).
Practice impact: Supports incorporating serial growth velocity, not just cross-sectional centile plus Doppler, when risk-stratifying term SGA for delivery timing. Hypothesis-strengthening work from an experienced group, but retrospective; no protocol change yet.
Selective FGR in twins: guideline appraisal finds the field unsettled
Sorrenti, Deuster and Khalil systematically appraised clinical practice guidelines on selective fetal growth restriction in twin pregnancies (UOG, Aug 23), an area where definitions, Doppler classification, and delivery thresholds diverge across societies.
Practice impact: A useful companion when aligning twin surveillance and delivery-timing protocols across the practice. No practice change, but worth keeping on hand at protocol review.
Multisite umbilical artery Doppler scoring in early and late FGR
Bulan and colleagues propose a modified umbilical artery Doppler scoring system based on multisite assessment and report its association with perinatal outcome in early- and late-onset fetal growth restriction (UOG, Aug 25).
Practice impact: Hypothesis-generating. Single-site free-loop umbilical artery Doppler remains the standard; no change to surveillance protocols.
Gestational age, fetal size, and neurodevelopment from infancy to adolescence
Zhao and colleagues examine how gestational age at delivery and fetal size relate to neurodevelopmental outcomes tracked from infancy through adolescence (AJOG, Aug 26). The abstract is not yet indexed, so the takeaway is scoped to the study question.
Practice impact: Potentially useful for counseling on long-horizon outcomes in SGA and early-term delivery decisions once full results are reviewable. No practice change yet.
Intertwin umbilical venous differences track placental sharing in monochorionic twins with sFGR
Noll and colleagues report that intertwin differences in umbilical venous diameter and flow reflect placental sharing and perinatal outcome in monochorionic twins with selective fetal growth restriction (AJOG MFM, Aug 22).
Practice impact: A physiologic insight that may eventually refine sFGR prognostication; not a surveillance parameter to adopt now.
Rare autosomal trisomies on genome-wide NIPT: performance and outcomes
Liu and colleagues characterize rare autosomal trisomies detected by genome-wide cell-free DNA screening, their clinical significance, and an exploratory "theoretical mosaicism ratio" derived from sequencing parameters (Prenatal Diagnosis, Aug 22).
Practice impact: Adds to the evidence base for post-test counseling after a RAT result, including confined placental mosaicism versus fetal involvement, uniparental disomy workup, and growth surveillance. Exploratory; current SMFM-consistent counseling stands.
Quiet zones this week: preconception counseling produced nothing substantive in the major journals, and there were no new professional-society or regulatory releases (ACOG, SMFM, USPSTF, FDA) relevant to MFM.
The Week in MFM is compiled from the week's maternal-fetal medicine literature for the physicians and patients of Advanced Perinatology.
It is an educational digest, not medical advice. Discuss any questions with your care team.
