CONTRIBUTIONWhat are the novel findings of this work? Trophoblast volume (TV) measured prior to 11 weeks' gestation is decreased significantly in pregnancy that subsequently develops maternal hypertension. What are the clinical implications of this work?The inclusion of TV in predictive algorithms for maternal hypertensive disorders has the potential to improve the value of current models used in clinical practice and to improve fetal and maternal outcomes. ABSTRACTObjectives Maternal hypertensive disorders (MHD), including pregnancy-induced hypertension and preeclampsia, are estimated to occur in 7-10% of pregnancies worldwide and have significant short-and long-term implications for both mother and fetus. This study aimed to determine the association of conventional and novel early first-trimester ultrasound measures with MHD and whether these ultrasound measures, combined with maternal characteristics and biochemistry, improve the prediction of MHD. MethodsThis was a prospective cohort study of consecutive women with a singleton pregnancy, attending for an early (5 + 1 to 11 + 0 weeks' gestation) ultrasound examination at a private obstetric ultrasound practice between February 2016 and August 2018. Recorded ultrasound measurements included mean sac diameter, yolk sac diameter, crown-rump length, fetal heart rate (FHR), trophoblast thickness, trophoblast volume (TV) and meanCorrespondence to: Ms T. J. Hanchard, South Coast Ultrasound for Women, uterine artery pulsatility index. Maternal biochemistry was assessed at 10-14 weeks and included beta-human chorionic gonadotropin, pregnancy-associated plasma protein-A (PAPP-A), placental growth factor (PlGF) and maternal serum alpha-fetoprotein. Regression models were fitted for each ultrasound parameter and multiples of the median (MoM) were calculated. All measures were compared between women who had a normotensive outcome and those who subsequently developed MHD. Logistic regression analysis was used to create a prediction model for MHD based on maternal characteristics, ultrasound measurements at 5 + 1 to 11 + 0 weeks' gestation and maternal biochemistry at 10-14 weeks. ResultsIn total, 1141 women were included in the analysis, of whom 1086 (95.2%) were normotensive at delivery and 55 (4.8%) developed MHD. Women who developed MHD weighed significantly more than did normotensive women (P < 0.0001). Mean MoM values for TV (P = 0.006), PAPP-A (P = 0.031) and PlGF (P = 0.044) were decreased significantly in pregnancies that subsequently developed MHD. The proposed logistic regression model includes maternal weight and height and MoM values for TV, FHR and PlGF, resulting in an area under the receiver-operating-characteristics curve of 0.80 (95% CI, 0.75-0.86). ConclusionThe combination of maternal weight and height, TV and FHR, measured prior to 11 weeks' gestation, and first-trimester PlGF appears to have good predictive value for development of MHD later in pregnancy.

Endometriosis is defined as the presence of endometrium‐like epithelial cells and/or stroma located outside the uterus, generally with associated inflammatory response. Commonly located on the ovaries and peritoneum, endometriosis can also infiltrate the retroperitoneal space and pelvic organs, known as deep endometriosis (DE). This narrative review aims to compare the accuracy of transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) for detecting deep endometriosis. A literature search was performed mid‐2021 and again in December 2022 using PubMed, SAGE and Wiley databases, and limited to studies published between 2011 and 2021. Key words deep infiltrating endometriosis, transvaginal ultrasound, magnetic resonance imaging and diagnostic accuracy identified 16 studies which addressed the aim. The authenticity and reliability were determined by the Standards for Reporting of Diagnostic Accuracy. When the studies were analysed, the diagnosis of DE mean sensitivity values ranged from 40% to 100% for TVUS and 50% to 100% for MRI. Mean specificity values ranged from 81.5% to 99.9% and 84.4% to 97.5%, respectively. This indicates that both MRI and TVUS have similarly accurate performance in the detection of DE. Endometriosis detection is possible with TVUS and MRI, however accuracy is dependent on the location and severity as well as limitations due to operator and image interpretation reliability. In the presence of a correctly performed dynamic TVUS examination for the diagnosis of DE, MRI adds little diagnostic value. Further research is recommended using a standardised protocol in a wider study of affected patients, including accurate clinical assessments for each location of endometriosis to inform the choice of imaging for that region.

Introduction Ultrasound (USS) and magnetic resonance imaging (MRI) have been used as screening tools for rotator cuff tears with MRI reported as superior. When comparing USS and MRI for supraspinatus tears, less data is available. Aim Compare the diagnostic sensitivity of USS and MRI in the pre‐operative diagnosis of partial thickness tears (PTT) and full thickness tears (FTT) of supraspinatus tendons compared to gold‐standard shoulder arthroscopy to assess if differences in detection rates exist. Method Retrospective study of deidentified electronic medical records including post‐operative surgical notes and pre‐operative imaging USS and MRI results. Results N = 103 participants, male: female ratio of 63:40, mean age 64 years. FTT were diagnosed by arthroscopy in 63/103 (61.2%), PTT <5 mm in 18/103 (17.5%), PTT >5 mm in 22/103 (21.4%). USS and MRI sensitivity were both 95.2% for FTT. PTT <5 mm sensitivity for USS and MRI were 83.3% and 77.7%, and PTT >5 mm sensitivity were 73.3% and 86.4% respectively. Overall supraspinatus tears USS sensitivity was 88.4% and MRI 90.3%. Discussion Comparable sensitivity was demonstrated for FTT for USS and MRI. USS had better sensitivity than MRI for PTT <5 mm, MRI performed better for PTT >5 mm. Pre‐operative evaluation of suspected supraspinatus tears could include USS as a first line imaging modality, due to its low cost and easier availability. Conclusion USS has high diagnostic accuracy for diagnosing supraspinatus FTT and PTT. MRI may be used where significant glenohumeral joint osteoarthritis needs to be assessed. Further studies with larger numbers are needed to verify these results.