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First trimester detection of fetal open spina bifida using BS/BSOB ratio

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Abstract

Background

Despite the well-known second trimester ultrasound signs, current possibilities of in utero surgical repair of open spina bifida require a timely detection of the spine defect.

Objective

To evaluate the diagnostic accuracy of the ratio between brain stem (BS) diameter and its distance to the occipital bone (BSOB) (BS/BSOB ratio) in the detection of fetuses with open spina bifida at first trimester ultrasound.

Methods

A systematic review and meta-analysis of diagnostic accuracy was performed by searching seven electronic databases from their inception to February 2019 for all studies assessing the association between BS/BSOB ratio and diagnosis of spine bifida. Diagnostic accuracy of BS/BSOB ratio in prenatal diagnosis of spine bifida was assessed as sensitivity, specificity, positive and negative likelihood ratios (LR + and LR−), and area under the curve (AUC) on SROC curves.

Results

Four studies, including 17,598 fetuses with 23 cases of open spina bifida, were included in the meta-analysis. BS/BSOB ratio showed pooled sensitivity of 0.70 (95% CI 0.47–0.87; I2 = 78.3%), specificity of 1.00 (95% CI 0.99–1.0; I2 = 99.2%), LR + and LR− of 51.44 (95% CI 9.53–277.64; I2 = 85.5%) and 0.23 (95% CI 0.04–1.17; I2 = 64.8%), respectively, and an AUC of 0.9649.

Conclusion

First trimester BS/BSOB ratio has a high diagnostic accuracy in detecting fetuses with open spina bifida.

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Funding

No financial support was received for this study.

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Authors and Affiliations

  1. Obstetrics and High-Risk Unit, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy

    Angelo Sirico & Antonio Lanzone

  2. Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive and Dentistry Sciences, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy

    Angelo Sirico, Antonio Raffone, Gabriele Saccone, Laura Sarno, Fulvio Zullo & Giuseppe Maria Maruotti

  3. Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy

    Antonio Travaglino

  4. Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergada, Rome, Italy

    Giuseppe Rizzo

Authors
  1. Angelo Sirico
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  2. Antonio Raffone
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  4. Gabriele Saccone
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  8. Fulvio Zullo
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  9. Giuseppe Maria Maruotti
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Contributions

AS: study conception, search strategy, data extraction and analysis, and risk of bias assessment. AR: study design, search strategy, data extraction and analysis, and risk of bias assessment. GS: study design, disagreements resolution, and manuscript preparation. AL: data collection and manuscript preparation. AT: data collection and manuscript preparation. LS: study design, manuscript preparation, and whole-study supervision. GR: search strategy, data extraction and analysis, and risk of bias assessment. GMM: study design, methods supervision, and manuscript preparation. FZ: study design, methods supervision, and whole-study supervision.

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Correspondence to Antonio Raffone.

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Sirico, A., Raffone, A., Lanzone, A. et al. First trimester detection of fetal open spina bifida using BS/BSOB ratio. Arch Gynecol Obstet 301, 333–340 (2020). https://doi.org/10.1007/s00404-019-05422-3

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  • DOI: https://doi.org/10.1007/s00404-019-05422-3

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