Ultrasound Obstet Gynecol [JOURNAL]
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Dall'Asta A, Capurso M, D'Amario P
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, Gallinelli A, Scebba D, Berretta R
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42250230
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Cai X, Liu J, Zheng W
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, Jiao Y, Lou Y, Deng M, Zhao W, Yan K, Sun L
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 42249814
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OBJECTIVE: To identify prenatal predictors of tuberous sclerosis complex (TSC) in fetuses with one or more cardiac rhabdomyomas (CR), evaluate an integrated multimodal diagnostic workflow using fetal magnetic resonance i...OBJECTIVE: To identify prenatal predictors of tuberous sclerosis complex (TSC) in fetuses with one or more cardiac rhabdomyomas (CR), evaluate an integrated multimodal diagnostic workflow using fetal magnetic resonance imaging (MRI) and trio whole-exome sequencing (trio-WES) and characterize perinatal outcomes. METHODS: This was a retrospective cohort study of 80 fetuses that were diagnosed prenatally with one or more CR between February 2016 and December 2024 at a single tertiary center and that received a definitive TSC diagnosis either prenatally (via genomic or clinical criteria) or by postnatal pathological verification. All fetuses underwent routine high-resolution echocardiography. Those in which a CR was suspected were then offered the option of further investigation via fetal brain MRI and trio-WES, to identify pathogenic variants in TSC1/TSC2 genes. A definitive prenatal TSC diagnosis was assigned based on genetic testing or the presence of two major clinical features. Clinical, imaging, genetic and perinatal data were retrieved and compared between the TSC-positive and TSC-negative groups. Postnatal or postmortem verification was only required in cases that lacked a definitive prenatal diagnosis. Performance metrics, including sensitivity, specificity and positive (PPV) and negative (NPV) predictive values, were calculated to evaluate the diagnostic utility of tumor multiplicity and fetal brain MRI in prediction of TSC. RESULTS: Forty-eight (60.0%) fetuses were diagnosed with TSC and 32 (40.0%) were TSC-negative. Tumor multiplicity had a sensitivity of 87.5% (95% CI, 74.8-95.3%) but low specificity (50.0%; 95% CI, 31.9-68.1%) for the prediction of TSC. Seventy fetuses underwent brain MRI. Among these, MRI achieved a specificity of 100.0% (95% CI, 89.1-100.0%) and identified central nervous system lesions in 89.4% of those with TSC that underwent the MRI examination, of which 81.0% were occult on ultrasound examination. Trio-WES was performed in 31 cases. Among these, pathogenic variants were identified in 20 cases, with 85.0% of these affecting the TSC2 gene. Trio-WES identified pathogenic variants in five TSC-positive cases that presented with normal fetal brain MRI, demonstrating its essential additive value for fetuses with occult imaging phenotypes, while MRI detected structural lesions in four trio-WES-negative cases. TSC2 variants were associated with more severe phenotypes, including subependymal giant cell astrocytoma, whereas TSC1 variants typically presented with milder manifestations. Sixty-two fetuses underwent termination of pregnancy (TOP); the TOP rate was 87.5% in the TSC-positive group and 62.5% in the TSC-negative group. Eighteen fetuses were liveborn (six TSC-positive and 12 TSC-negative). The TSC-positive infants had significantly lower birth weight compared with the TSC-negative infants (median, 3050 g vs 3500 g; P = 0.025), despite the two groups having a similar gestational age at delivery. All liveborn TSC-positive infants developed postnatal epilepsy. CONCLUSION: Multiple CR at screening ultrasound examination and a major lesion at fetal brain MRI are key prenatal predictors of TSC, but accurate diagnosis requires not only MRI but also trio-WES, to overcome the developmental limitations imposed by the late appearance of some fetal anomalies associated with TSC and genetic limitations inherent in standard molecular analysis. Given the severe perinatal outcomes associated with TSC observed in this study, including high termination rates and postnatal epilepsy in all liveborn infants, definitive prenatal diagnosis is essential for accurate risk stratification, parental counseling and proactive neurological management. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Castro PT, Matos APP, Ribeiro G
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, Fazecas T, Araujo Júnior E, Werner H
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42241714
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Sarno L, De Robertis V, Dall'Asta A
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42241711
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Kyhl-Svart F, Jensen JS, Vøgg ROB
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, Vassard D, Forman J, Boyd HA, Hjortdal V, Sillesen AS, Raja AA, Dannesbo S, Mariager AF, Torp-Pedersen C, Andersen MP, Iversen K, Bundgaard H, Madsen PL, Pinborg A
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 42223195
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OBJECTIVE: Infertility affects up to 20% of couples in high-income countries, which has led to an increased use of assisted reproductive technology (ART). While previous studies have linked ART to a higher risk of major...OBJECTIVE: Infertility affects up to 20% of couples in high-income countries, which has led to an increased use of assisted reproductive technology (ART). While previous studies have linked ART to a higher risk of major congenital heart defects (CHD), less is known about the associated risk of minor CHD. As minor CHD are associated with premature early-onset cardiac morbidity and mortality, this study aimed to evaluate the risk of minor CHD in singleton infants conceived via ART compared with in those conceived spontaneously. METHODS: The Copenhagen Baby Heart Study (CBHS) is a Danish, prospective, multicenter study of neonates delivered between 1 April 2016 and 31 October 2018. Included in this cohort study based on CBHS data were singleton infants who met the inclusion criteria and had undergone neonatal transthoracic echocardiography (TTE) within 60 days after birth. Infants conceived via ART, defined as either in-vitro fertilization or intracytoplasmic sperm injection, were matched randomly, based on sex and maternal age, in a 1:4 ratio with spontaneously conceived singleton infants, who formed the control group. The primary outcome was the diagnosis of minor CHD, defined as a ventricular septal defect (VSD), bicuspid aortic valve (BAV) and/or atrial septal defect (ASD), detected on neonatal TTE. For analysis of ASD, we assessed a subgroup of the matched infants included within the overall cohort who were evaluated using TTE from 15 May 2017 onwards using an algorithm for the TTE classification of interatrial communications implemented in the CBHS. Using multiple logistic regression analysis, we compared the risk of minor CHD in infants conceived via ART vs those conceived spontaneously, adjusting for maternal age, parental CHD, pregestational diabetes mellitus and maternal body mass index. RESULTS: Of 23 493 infants who met the inclusion criteria, 1630 singletons were conceived by ART. These were matched with 6520 controls who were conceived spontaneously. The subgroup of infants evaluated using the algorithm for TTE classification of interatrial communications comprised 862 infants conceived by ART and 3448 matched infants who were conceived spontaneously. The risk of minor CHD overall (VSD, BAV and/or ASD) in the subcohort evaluated using this algorithm was not significantly different between singleton infants conceived via ART and those conceived spontaneously (adjusted odds ratio, 1.07 (95% CI, 0.83-1.38)). Furthermore, we observed no significant differences in the risk of specific minor CHD subtypes (VSD, BAV and/or ASD) between singleton infants conceived via ART and those conceived spontaneously. Similarly, no significant differences in the risk of minor CHD were observed between ART subtypes, including conception via fresh in-vitro fertilization, fresh intracytoplasmic sperm injection and fresh- and frozen-embryo transfer, or between each ART subtype and infants conceived spontaneously. CONCLUSION: There was no increased risk of minor CHD in singleton infants conceived via ART compared with singleton infants conceived spontaneously. These findings provide reassuring evidence that ART is unlikely to impose an increased long-term cardiovascular risk attributable to subclinical minor CHD that would otherwise remain undiagnosed in the absence of screening. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Stampalija T, Butera G, Hecher K
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, Lees C
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42220314
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Boujenah J, Bouhanna P, Oyelese Y
Ultrasound Obstet Gynecol
· 2026 May · PMID 42202341
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Lertvutivivat S, Gotha L, Papneja K
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, Dutil N, Stennett L, Hiraki LT, Freud L
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 42202300
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Shamshirsaz AA, Fathallah AH, Zargarzadeh N
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, Mustafa H, Oyelese Y, Khalil A
Ultrasound Obstet Gynecol
· 2026 May · PMID 42178987
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Frühauf F, Fischerová D, Moro F
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, Kocián R, Ptáčník V, Wagnerová M, Lambert L, Testa AC, Bizzarri N, Perez RO, Teodorico E, Cibula D, Collaborators
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42178785
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OBJECTIVE: To determine whether ultrasound is non-inferior to positron-emission tomography/computed tomography (PET/CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) in terms of overall diagnostic accuracy f...OBJECTIVE: To determine whether ultrasound is non-inferior to positron-emission tomography/computed tomography (PET/CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) in terms of overall diagnostic accuracy for the preoperative assessment of pelvic lymph-node status in cervical cancer. METHODS: This prospective multicenter study reports the primary results of the CANNES trial (NCT05573451), which was conducted at three European gynecological oncology centers and included women with histopathologically confirmed cervical cancer (International Federation of Gynecology and Obstetrics Stage IA1 with lymphovascular space invasion to Stage IIIC2) who underwent ultrasound and PET/CT imaging, with optional DW-MRI, before surgery between January 2021 and December 2023. The diagnostic accuracy for detecting pelvic lymph-node macrometastases (maximum diameter, > 2 mm) was compared with final histopathology (primary reference standard). Furthermore, the diagnostic accuracy for detecting pelvic lymph-node metastases, including both micrometastases (maximum diameter, > 0.2 to ≤ 2 mm) and macrometastases, was compared with final histopathology, or postoperative imaging performed selectively in cases of discordance, specifically when radiologically positive lymph nodes contradicted negative histopathology (secondary reference standard). Sensitivity, specificity and diagnostic accuracy were calculated using the Clopper-Pearson exact method. The diagnostic accuracy of ultrasound for detecting pelvic lymph-node macrometastases and overall lymph-node metastases (including both micro- and macrometastases) was compared with that of PET/CT and that of DW-MRI using McNemar's test; non-inferiority was defined as the lower bound of the 95% CI for the difference in diagnostic accuracy being greater than -10%. RESULTS: During the study period, 141 patients were examined for suspicion of cervical cancer, of whom 120 were analyzed for pelvic lymph-node involvement. All patients underwent ultrasound and PET/CT imaging and 108 (90.0%) also underwent DW-MRI. Pelvic lymph-node macrometastases were confirmed at final histopathology in 29 (24.2%) patients, of whom seven had synchronous micrometastases. An additional seven (5.8%) patients had only micrometastases, resulting in a total of 36 (30.0%) patients with histologically confirmed nodal involvement. Postoperative imaging identified persistent nodal disease in two additional patients, yielding 38 (31.7%) patients with overall pelvic lymph-node involvement. Using the primary reference standard, the sensitivity, specificity and diagnostic accuracy for the detection of pelvic lymph-node macrometastases (per-patient analysis) were 79.3% (95% CI, 60.3-92.0%), 87.9% (95% CI, 79.4-93.8%) and 85.8% (95% CI, 78.3-91.5%), respectively, for ultrasound; 75.9% (95% CI, 56.5-89.7%), 86.8% (95% CI, 78.1-93.0%) and 84.2% (95% CI, 76.4-90.2%), respectively, for PET/CT; and 70.8% (95% CI, 48.9-87.4%), 90.5% (95% CI, 82.1-95.8%) and 86.1% (95% CI, 78.1-92.0%), respectively, for DW-MRI. Using the secondary reference standard, the sensitivity, specificity and diagnostic accuracy values for overall pelvic lymph-node involvement were 68.4% (95% CI, 51.3-82.5%), 90.2% (95% CI, 81.7-95.7%) and 83.3% (95% CI, 75.4-89.5%), respectively, for ultrasound; 65.8% (95% CI, 48.6-80.4%), 89.0% (95% CI, 80.2-94.9%) and 81.7% (95% CI, 73.6-88.1%), respectively, for PET/CT; and 66.7% (95% CI, 48.2-82.0%), 96.0% (95% CI, 88.8-99.2%) and 87.0% (95% CI, 79.2-92.7%), respectively, for DW-MRI. Ultrasound met the predefined non-inferiority margin for overall diagnostic accuracy compared with PET/CT and DW-MRI for both pelvic lymph-node macrometastases and overall pelvic lymph-node involvement. CONCLUSIONS: In this first prospective multicenter trial to directly compare ultrasound, PET/CT and DW-MRI for detecting pelvic nodal disease, ultrasound was non-inferior to PET/CT and DW-MRI in overall diagnostic accuracy, with comparable sensitivity. These findings support ultrasound as a widely accessible and reliable option for preoperative pelvic lymph-node assessment in cervical cancer. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Kalafat E, Ata B, Del Gallego R
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, Freedman A, Hoyos LR, Elkhatib I, Miller KA, Fatemi H, Lawrenz B
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42177810
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OBJECTIVES: To determine the prognostic value of serum β-human chorionic gonadotropin (β-hCG) for predicting live birth following single euploid frozen-embryo transfer (FET), and to develop and validate a prognostic mode...OBJECTIVES: To determine the prognostic value of serum β-human chorionic gonadotropin (β-hCG) for predicting live birth following single euploid frozen-embryo transfer (FET), and to develop and validate a prognostic model (iHOPE) for this purpose. METHODS: This retrospective cohort study used data from two large fertility practices. The model development cohort included 1581 women with a positive β-hCG test after single euploid FET in the United Arab Emirates between March 2017 and June 2023. The external validation cohort comprised 1171 women who underwent FET (with or without preimplantation genetic testing for aneuploidy (PGT-A)) resulting in a positive β-hCG test between January 2020 and December 2023 in the USA. β-hCG level was measured on approximately day 10 after FET and was repeated thereafter, allowing estimation of the daily increase in β-hCG. The association of clinical and embryological factors with initial β-hCG level and subsequent daily β-hCG increase was evaluated using multivariable linear regression analysis. The iHOPE prognostic model for live birth was built using repeated measurements of β-hCG following single euploid FET, and was validated internally and externally. Model performance was evaluated using the area under the receiver-operating-characteristics curve (AUC) and calibration slope. RESULTS: Of 1581 pregnancies in the model development cohort, 1191 (75.3%) resulted in live birth. Of 1171 pregnancies in the external validation cohort, 395 were from an untested embryo, of which 261 (66.1%) resulted in live birth, and 776 were from a PGT-A-tested embryo, of which 566 (72.9%) resulted in live birth. In the model development cohort, trophectoderm quality was associated significantly with initial β-hCG level Z-score among pregnancies resulting in live birth (Grade B vs Grade A: β, -0.19 (95% CI, -0.34 to -0.04), P = 0.011; Grade C vs Grade A: β, -0.59 (95% CI, -0.83 to -0.35), P < 0.001). Women with a higher body mass index (BMI) had a lower initial β-hCG level Z-score and lower subsequent β-hCG increase among pregnancies resulting in live birth (P < 0.001 for both). Compared with pregnancy resulting in live birth, early clinical pregnancy loss, biochemical pregnancy and pregnancy of unknown location/ectopic pregnancy had significantly lower initial β-hCG level Z-scores and lower subsequent β-hCG increases (P < 0.001 for all). On internal cross-validation, the iHOPE prognostic model based on repeated β-hCG measurements had a mean ± SD AUC of 0.79 ± 0.04 and good calibration for probabilistic estimation of live birth. In the external validation cohort, trophectoderm quality (Grade B vs Grade A: β, -0.19 (95% CI, -0.34 to -0.05), P = 0.007; Grade C vs Grade A: β, -0.63 (95% CI, -0.90 to -0.37), P < 0.001), time of expanded blastulation (β, -0.02 (95% CI, -0.02 to -0.01), P < 0.001), patient BMI (β, -0.04 (95% CI, -0.05 to -0.03), P < 0.001) and PGT-A testing (β, -0.16 (95% CI, -0.30 to -0.03), P = 0.017) were associated significantly with initial β-hCG level Z-score. On external validation, the AUC for the prediction of live birth using the repeated-measurements model was 0.79 (95% CI, 0.75-0.83) and 0.84 (95% CI, 0.80-0.88) for PGT-A-tested and untested embryos, respectively. Calibration in the external validation cohort was better for PGT-A-tested embryos compared with untested embryos, as the model slightly overpredicted live-birth probabilities in the latter group. The iHOPE model is available for use online and as a mobile application. CONCLUSIONS: Initial serum β-hCG level following FET is affected by PGT-A. The iHOPE prognostic model, using repeated β-hCG measurements, demonstrates robust calibration and acceptable predictive capability for live birth. It may prove to be a useful tool for clinical monitoring and managing patient expectations, and could aid in the early detection of abnormal early pregnancy development. iHOPE is intended for prognostic purposes only and predicted probabilities should not be considered diagnostic. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Kjaer ASL, Riishede I, Rode L
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, Jensen RB, Pihl K, Sperling L, Overgaard M, Pedersen NG, Roslev AC, Sandager P, Tabor A, Pinborg A, Ekelund CK, PRESIDE Study Group
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42177627
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OBJECTIVE: To investigate the incidence of pre-eclampsia (PE) and the predictive performance of the Fetal Medicine Foundation (FMF) first-trimester PE screening algorithm across pregnancies conceived using assisted repro...OBJECTIVE: To investigate the incidence of pre-eclampsia (PE) and the predictive performance of the Fetal Medicine Foundation (FMF) first-trimester PE screening algorithm across pregnancies conceived using assisted reproductive technology (ART), after ovulation induction (OI) and through spontaneous conception (SC). METHODS: This prospective multicenter study included women with a singleton pregnancy undergoing routine combined first-trimester screening for aneuploidies at six Danish university hospitals from May 2019 to December 2020. Data on maternal characteristics, including mode of conception, medical history, mean arterial pressure (MAP), uterine artery pulsatility index, serum pregnancy-associated plasma protein-A (PAPP-A) and placental growth factor, were collected to calculate an individual risk of PE using the FMF algorithm, without any clinical intervention based on the risk estimate. Obstetric outcomes, including PE diagnosis, were collected from the national birth registry. Women were categorized into three conception groups: ART, OI and SC. The ART group was further subdivided into ART using frozen embryo transfer (FET), fresh embryo transfer (fresh ET) or oocyte donation (OD). Detection rates (DRs) of the FMF algorithm were calculated using the risk cut-off that defined a screen-positive rate of 10% in the overall population and compared across conception groups. Differences in screen-positive rates and individual risk markers were further investigated. RESULTS: Of the 8157 women included in the study, 535 conceived using ART, 235 after OI and 7387 through SC. The incidence of PE was highest in the ART group (7.3%) compared with the OI (5.1%; P = 0.34) and SC (3.4%; P < 0.001) groups. Among ART subgroups, the incidence of PE was 8.3% in FET, 6.4% in fresh ET and 12.3% in OD pregnancies (P > 0.05). However, the distribution of preterm vs term PE differed significantly across ART subgroups, with FET pregnancies showing a larger proportion of term PE (preterm, 11.1%; term, 88.9%) and OD pregnancies a larger proportion of preterm PE (preterm, 57.1%; term, 42.9%) (P = 0.03). The DR for preterm PE was 81.8% (95% CI, 48.2-97.7%) in ART pregnancies and 64.3% (95% CI, 48.0-78.4%) in SC pregnancies (P = 0.47). For overall PE, the DR was significantly higher in ART pregnancies (69.2% (95% CI, 52.4-83.0%)) than in SC pregnancies (35.7% (95% CI, 29.8-42.0%)) (P < 0.001). There was no significant difference in DRs for overall PE across ART subgroups. The corresponding screen-positive rates for PE varied significantly across conception groups: 22.8% in ART, 14.5% in OI and 8.9% in SC pregnancies (P < 0.01 for all). Significant differences in individual risk markers were observed across the ART subgroups, with higher MAP in OD pregnancies and higher PAPP-A in FET pregnancies. CONCLUSIONS: A higher incidence of PE was observed in women who conceived using ART and notable differences in the distribution of preterm and term PE were observed among the ART subgroups. The FMF first-trimester PE screening algorithm showed high DRs across all conception groups. However, differences in screen-positive rates and individual risk marker profiles suggest that the incorporation of ART-subgroup-specific adjustments could improve the predictive performance of the model in ART pregnancies, and underscore the need for tailored clinical management and patient communication. Given the high incidence of term PE in FET pregnancies, alternative interventions to acetylsalicylic acid may be necessary, given that this primarily prevents preterm PE. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Besson R, Fries N, Oyelese Y
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, Khalil A, Stirnemann J, Ville Y, Collaborators
Ultrasound Obstet Gynecol
· 2026 May · PMID 42175650
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Karmegaraj B, Vijayakumar S, Krishnakumar R
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, Kottayil B
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 42142392
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Guibaud L, Pilu G
Ultrasound Obstet Gynecol
· 2026 May · PMID 42139694
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Shi H, Prayer D, Kienast P
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, Stepponat R, Mitter C, Tischer J, Li X, Binder J, Kasprian G
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42139668
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OBJECTIVE: Despite the high incidence of fetal growth restriction (FGR) in gastroschisis (GS) associated with placental fetal vascular malperfusion (FVM), the underlying mechanism remains unclear. We aimed to investigate...OBJECTIVE: Despite the high incidence of fetal growth restriction (FGR) in gastroschisis (GS) associated with placental fetal vascular malperfusion (FVM), the underlying mechanism remains unclear. We aimed to investigate whether umbilical vein (UV) stenosis at the abdominal wall defect impairs fetoplacental circulation, leading to FGR. METHODS: A single-center retrospective review of magnetic resonance imaging (MRI) scans in fetuses with GS was performed. The presence of FGR and complex GS was recorded after birth. Systematic measurements of UV diameter were collected, as well as placental characteristics. Multivariable analysis identified in-utero risk factors for FGR. Area under the receiver-operating-characteristics curves (AUC) for the predictive performance of predictors of FGR was calculated. In addition, 1:1 age-matched omphalocele and healthy control cases were included for comparison with GS cases with and without FGR, examining UV diameter, placental features and T2* signal intensity (SI) differences between the left and right hepatic lobes. Co-occurrence network analysis integrated prenatal MRI findings with postnatal outcomes. RESULTS: A total of 86 GS cases, 27 omphalocele cases and 27 age-matched healthy control cases were included. The incidence of FGR was 66.3% (57/86) in all GS cases, 86.7% (26/30) in complex GS cases and 18.5% (5/27) in omphalocele cases. Multivariable analysis identified the following independent risk factors for FGR: Z-score of UV diameter at the defect (adjusted odds ratio (aOR), 0.76 (95% CI, 0.65-0.89); P = 0.001); placental thickness (aOR, 1.57 (95% CI, 1.13-2.05); P = 0.015); placental lobulation (aOR, 1.84 (95% CI, 1.45-2.32); P = 0.026); and the presence of complex GS (aOR, 2.33 (95% CI, 1.85-2.96); P = 0.003). The Z-score of the UV diameter at the abdominal wall defect had an AUC of 0.81 (95% CI, 0.73-0.84) for the presence of FGR. Compared to the GS without FGR, omphalocele and healthy control groups, the GS with FGR group exhibited significantly reduced UV diameter at the abdominal wall defect, greater placental thickness, increased placental lobulation and larger T2* SI differences between the left and right hepatic lobes, reflecting hypoxia-driven circulatory redistribution. Network analysis demonstrated interdependencies among UV stenosis, FGR, placental FVM and adverse outcomes. CONCLUSION: There is strong association between UV stenosis at the abdominal wall defect and the development of FGR in cases of GS. UV diameter measurements and placental assessment may constitute important imaging biomarkers for FGR prediction in cases of GS. Ultimately, future research is required to evaluate potential benefits of fetal intervention to reduce severe UV stenosis. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Sorrenti S, Yaghi O, Prasad S
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, Mohammed D, Fathima F, Boorman H, Selvakumar J, Khalil A
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42126513
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OBJECTIVE: To evaluate the diagnostic performance of the Delphi consensus definition for selective fetal growth restriction (sFGR), compared with the traditional definition recommended by the International Society of Ult...OBJECTIVE: To evaluate the diagnostic performance of the Delphi consensus definition for selective fetal growth restriction (sFGR), compared with the traditional definition recommended by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), in predicting adverse perinatal outcome in monochorionic diamniotic (MCDA) twin pregnancy. METHODS: This was a retrospective cohort study of MCDA twin pregnancies followed at a tertiary fetal medicine unit between January 2000 and January 2024. Cases diagnosed with twin-to-twin transfusion syndrome or twin anemia-polycythemia sequence before or at the time of sFGR diagnosis and those with fetal structural or genetic anomaly were excluded. Fetal growth was assessed using chorionicity-specific twin reference charts and sFGR was diagnosed using the ISUOG or Delphi definition. Logistic regression analysis was used to evaluate the performance of each constituent criterion of the Delphi definition in identifying cases at risk of adverse outcome. The diagnostic performance of the ISUOG and Delphi criteria was assessed using receiver-operating-characteristics (ROC)-curve analysis. RESULTS: The final analysis included 363 MCDA twin pregnancies, of which 110 (30.3%) were diagnosed with sFGR using the Delphi consensus definition. The ISUOG criteria identified only 53/363 (14.6%) cases as sFGR. The rate of intact survival of both twins was significantly lower among the 53 cases diagnosed using ISUOG criteria compared with the 57 cases diagnosed solely using Delphi criteria (26.4% vs 63.2%), with significantly lower neonatal morbidity in the latter group. Logistic regression analysis showed that each constituent criterion of the Delphi definition was associated independently with significantly reduced intact survival of both twins. All combinations of Delphi criteria showed low-to-moderate discriminative ability in predicting the demise of the smaller and/or larger twin (all areas under the ROC curve > 0.6). The Delphi criteria had slightly higher sensitivity (0.840 vs 0.789) but lower specificity (0.743 vs 0.877) compared with the ISUOG criteria for predicting the demise of the smaller twin. Similar results were obtained for the prediction of larger twin demise and double fetal demise. CONCLUSIONS: While the detection rate of sFGR was higher using the Delphi criteria compared with the ISUOG criteria, the additional cases identified solely using the Delphi definition had significantly lower perinatal morbidity and mortality compared with those meeting the ISUOG definition for sFGR. Nonetheless, each constituent criterion within the Delphi definition was independently associated with adverse outcome in sFGR twin pregnancy. Further research is needed to elucidate the most appropriate tools for diagnosing and classifying MCDA twin pregnancies complicated by sFGR. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Sirico A, Mappa I, Maruotti GM
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, Cobellis L, Rizzo G
Ultrasound Obstet Gynecol
· 2026 May · PMID 42113889
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OBJECTIVES: To evaluate alterations in fetal cardiac function in pregnancies complicated by fetal growth restriction (FGR) by synthesizing evidence on myocardial performance index (MPI) and its constituent parameters for...OBJECTIVES: To evaluate alterations in fetal cardiac function in pregnancies complicated by fetal growth restriction (FGR) by synthesizing evidence on myocardial performance index (MPI) and its constituent parameters for both the left and right ventricles. The secondary objective was to explore the influence of timing of FGR onset (early vs late) on these parameters. METHODS: We conducted a systematic review and meta-analysis of observational studies by searching PubMed/MEDLINE, EMBASE, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception until August 2025. Eligible studies compared fetal MPI, isovolumetric contraction time (ICT), ejection time (ET), isovolumetric relaxation time (IRT) and/or peak early-to-late diastolic filling velocity ratio (E/A ratio) between FGR fetuses and healthy controls. Data reported in original publications as median with interquartile range, range or 95% CI were converted to mean ± SD. A random-effects model was used to calculate the pooled standardized mean difference (SMD) with 95% CI. Prespecified subgroup analyses were performed based on ventricular laterality, timing of FGR onset and data presentation type. The protocol was registered with PROSPERO (registration number: CRD420251075193). RESULTS: Fifteen studies, comprising 709 FGR fetuses and 867 controls, were included. Compared with controls, FGR fetuses exhibited significant left ventricular dysfunction, characterized by a higher left MPI (SMD, 0.85 (95% CI, 0.53-1.16)), prolonged left ICT (SMD, 0.53 (95% CI, 0.08-0.99)) and shorter left ET (SMD, -0.56 (95% CI, -0.84 to -0.29)). The most profound alteration was a prolongation of the left IRT in FGR cases (SMD, 2.48 (95% CI, 1.55-3.41)). Right ventricular assessment revealed a prolonged right IRT in FGR fetuses compared with controls (SMD, 1.90 (95% CI, 0.72-3.07)). Subgroup analysis showed that myocardial functional alterations affect both early- and late-onset FGR phenotypes, with early cases showing a non-significant trend toward more pronounced impairment. Sensitivity analysis including only studies that employed stricter diagnostic criteria for FGR confirmed these findings. Significant publication bias was detected for the analysis of left MPI and left IRT. CONCLUSIONS: FGR is associated with significant biventricular cardiac dysfunction, characterized primarily by impaired myocardial relaxation, as indicated by a markedly prolonged IRT. The IRT appears to be a more sensitive marker of cardiac compromise in FGR compared with the traditional E/A ratio. These findings support the use of MPI and its components as valuable adjunctive tools in the surveillance of FGR pregnancies. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Vergote S, Van der Veeken L, Van den Eede E
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, Arai T, Watananirun K, Brenders A, Deprest J, Bleeser T, Collaborators
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42113685
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OBJECTIVES: To evaluate the combined effect of maternal general anesthesia and vasopressor support on uterine hemodynamics during the second trimester in pregnancies undergoing fetal spina bifida repair and to determine...OBJECTIVES: To evaluate the combined effect of maternal general anesthesia and vasopressor support on uterine hemodynamics during the second trimester in pregnancies undergoing fetal spina bifida repair and to determine whether fetal spina bifida repair alters uteroplacental perfusion. METHODS: This was a prospective single-center study conducted at the Fetal Medicine Unit of University Hospitals Leuven, Leuven, Belgium between August 2021 and April 2025. All participants underwent fetal spina bifida repair under general anesthesia with vasopressor support, titrated to maintain a mean arterial pressure ≥ 90% of the preoperative baseline value. Uterine artery (UtA) and umbilical artery Doppler measurements were obtained at six timepoints: (1) the day before surgery to establish preoperative baseline values; (2) immediately after epidural catheter placement, initiation of general anesthesia and intubation (at the initiation of noradrenaline); (3) 5 min after initiation of general anesthesia with vasopressor support; (4) at the end of surgery, after maternal skin closure and before extubation; (5) on postoperative day 1; and (6) on postoperative day 6. The primary outcome was the change in UtA pulsatility index (PI) 5 min after initiation of general anesthesia compared with the preoperative baseline value. Secondary outcomes included UtA blood flow estimated from time-averaged maximum velocity and vessel diameter and fetal umbilical artery Doppler parameters. Statistical analysis included paired t-tests, Wilcoxon signed-rank tests and mixed-effects models. RESULTS: A total of 33 women undergoing fetal spina bifida repair were included, of whom 23 underwent open repair and 10 underwent fetoscopic repair. At the preoperative baseline, median UtA-PI was 0.77 (interquartile range (IQR), 0.64-0.95), median UtA resistance index (RI) was 0.52 (IQR, 0.45-0.59) and median UtA blood flow was 307.5 (IQR, 209.8-542.2) mL/min. At 5 min after the initiation of general anesthesia with vasopressor support, UtA-PI (median, 0.87 (IQR, 0.68-1.04)) and UtA blood flow (median, 310.7 (IQR, 199.0-421.4) mL/min) were comparable to baseline values (both P > 0.05). At this timepoint, umbilical artery PI was higher than the baseline value (P = 0.008) while fetal heart rate decreased. At the end of surgery, UtA-PI (median, 1.46 (IQR, 1.04-2.21)) and UtA-RI (median, 0.76 (IQR, 0.62-0.91)) were elevated compared with baseline values (both P < 0.001) and UtA blood flow was reduced (median, 182.1 (IQR, 79.8-351.5) mL/min; P = 0.031). Elevation of UtA-PI and UtA-RI persisted on postoperative days 1 and 6, but umbilical artery indices generally normalized back to preoperative baseline levels. There were no significant differences in UtA or fetal Doppler parameters between surgical techniques. CONCLUSIONS: General anesthesia with vasopressor support preserved uterine perfusion and blood flow without increasing vascular resistance. During fetal spina bifida repair, UtA resistance increased and UtA blood flow decreased. These parameters did not normalize back to preoperative baseline values within 6 days after surgery. In contrast, perioperative fetal Doppler changes resolved immediately postoperatively © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Sgayer I, Garel K, Miremberg H
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, Malinger G, Haratz KK, Perlman S
Ultrasound Obstet Gynecol
· 2026 May · PMID 42098994
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