Ultrasound Obstet Gynecol [JOURNAL]
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200 papers
Changing trends in prenatal screening and treatment of cytomegalovirus infection in France: 7-year national cohort study (2017-2023).
Coste-Mazeau P, Ribot E, Hantz S … +4 more , Ville Y, Leruez-Ville M, Alain S, French Congenital Infection database group
Ultrasound Obstet Gynecol · 2026 Jun · PMID 42076947 · Publisher ↗
OBJECTIVES: Cytomegalovirus (CMV) is the leading cause of congenital infectious neurosensory impairment. We aimed to present national epidemiological data on maternal CMV infection during pregnancy in France, focusing in...
OBJECTIVES: Cytomegalovirus (CMV) is the leading cause of congenital infectious neurosensory impairment. We aimed to present national epidemiological data on maternal CMV infection during pregnancy in France, focusing in particular on primary infection in the periconceptional period or first trimester, and to assess the impact of changes in screening practices and clinical management of affected pregnant women and their newborns. METHODS: In this retrospective, multicenter study, we retrieved data from the electronic database of the French National Reference Center for Herpesviruses from cases of maternal CMV infection diagnosed during pregnancy between January 2017 and December 2023, with known neonatal infection status (infected or non-infected) at birth. Maternal, fetal and neonatal data in cases with maternal primary infection during the periconceptional period or first trimester were compared between the periods before and after publication of a pivotal randomized controlled trial (RCT) in September 2020 that demonstrated that valacyclovir reduced vertical transmission by two-thirds when administered to women with first-trimester primary CMV infection. RESULTS: Among 451 documented cases of maternal CMV infection during pregnancy with known fetal/newborn CMV status, there were 220 pregnancies (222 fetuses) with periconceptional or first-trimester primary maternal infection (PI), among which maternal-fetal transmission occurred in 176 (79.3%). Compared with the period from 2017 to 2020, in the period from 2021 to 2023 there was a significant increase in both systematic CMV screening (from 22.0% to 40.0%; P = 0.001) and maternal requests for testing (from 0% to 4.2%; P = 0.02). Among cases of maternal infection during the periconceptional period or in the first trimester, antiviral therapy (generally valacyclovir) was administered more frequently in the period from 2021 to 2023 (27.7% vs 59.8%; P < 0.0001). The overall rate of termination of pregnancy (TOP) for early maternal CMV-PI was 20.7% (40/193 with known pregnancy outcome), with significantly fewer TOPs being performed in the period from 2021 to 2023 (25.9% vs 13.0%; P = 0.03). Notably, women who did not receive valacyclovir treatment had higher rates of TOP overall compared with women who had received valacyclovir (22.1% vs 8.1%; P = 0.01). CONCLUSIONS: Congenital CMV infection is a major public health problem. Despite the lack of national guidelines for systematic maternal CMV screening until mid-2025, the uptake of maternal CMV screening and preventive treatment increased significantly in France after publication of the pivotal RCT in 2020, apparently without an associated rise in the rate of TOP. These findings support the safety and potential benefits of offering CMV serological testing during pregnancy, particularly in the context of evidence-based therapeutic options. © 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.
Perinatal outcomes following intrauterine transfusion for fetal anemia secondary to fetal or placental tumor: systematic review.
Schenone CV, Fishman SJ, Kim HB … +3 more , Odibo A, Shamshirsaz AA, Krispin E
Ultrasound Obstet Gynecol · 2026 Jun · PMID 42070963 · Publisher ↗
OBJECTIVE: To evaluate the characteristics and outcomes of pregnancies with a prenatally detected fetal or placental tumor with associated fetal anemia that underwent intrauterine transfusion (IUT). METHODS: We searched...
OBJECTIVE: To evaluate the characteristics and outcomes of pregnancies with a prenatally detected fetal or placental tumor with associated fetal anemia that underwent intrauterine transfusion (IUT). METHODS: We searched PubMed, EMBASE, Web of Science, Scopus and Google Scholar databases for studies reporting on singleton pregnancies with a prenatally detected fetal or placental tumor complicated by fetal anemia that underwent IUT, published from inception to October 2024. Only articles written in the English language were considered eligible for inclusion. We excluded multiple gestations, fetuses with concomitant structural anomaly, cases that underwent IUT to treat fetal anemia secondary to intraoperative tumor bleeding and cases that received blood products other than red blood cells. Cases in which the tumor was detected postnatally, cases that underwent termination of pregnancy, studies with incomplete data and systematic reviews were also excluded. The primary outcome was perinatal death, defined as intrauterine fetal demise (IUFD) > 22 weeks' gestation or neonatal death within 28 days after birth. Secondary outcomes included IUFD, neonatal death, preterm labor (PTL), preterm prelabor rupture of membranes (PPROM), placental abruption, and spontaneous or medically indicated live preterm birth (PTB). We performed exploratory subgroup analyses, including differences in tumor size according to the presence or absence of additional non-structural complications, as well as differences in baseline characteristics according to perinatal death status and differences in obstetric and perinatal outcomes according to whether the patient underwent prenatal tumor resection, embolization or ablation in addition to IUT. RESULTS: We included 43 cases in our analysis, including 42 cases from 34 articles identified in the literature search and an additional case managed at our institution. The median hemoglobin level before the initial IUT was 7.0 (interquartile range, 6.0-8.8) g/dL. Most cases (92.5%) had an additional non-structural complication at baseline. Prenatal tumor resection, embolization or ablation was performed as an adjunct to IUT in 40.0% of cases. PTL, PPROM or placental abruption complicated 43.2% of cases. PTB occurred in 81.1% of cases. Perinatal death occurred in 11 (25.6%) cases. We identified a higher likelihood of perinatal death in cases with fetal hydrops (odds ratio (OR), 6.3 (95% CI, 1.1-37.7); P = 0.04) or cardiomegaly (OR, 6.3 (95% CI, 1.1-36.9); P = 0.04), and a lower likelihood of perinatal death was associated with higher fetal hemoglobin after the initial IUT (OR, 0.4 (95% CI, 0.2-0.8), P = 0.01). Perinatal death rates were similar regardless of management strategy (12.5% for IUT as a standalone therapy vs 31.3% for IUT as an adjunct to tumor resection, embolization or ablation; P = 0.1). CONCLUSION: Pregnancies with a prenatally detected fetal or placental tumor, complicated by fetal anemia that underwent IUT, have a high rate of additional non-structural complications. The rate of perinatal death in this population is high, likely due to the severity of the fetal condition at baseline and high rates of obstetric complications and PTB. IUT as a standalone therapy may be reasonable in selected cases. However, ideal candidates for this approach and the best management strategies remain to be determined. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Clinical and economic impact of universal screening for cytomegalovirus infection among pregnant women in Italy.
Ornaghi S, Zammarchi L, Fernicola F … +3 more , Tavanti M, de Chaurand VP, Boccalini S
Ultrasound Obstet Gynecol · 2026 Jun · PMID 42069344 · Publisher ↗
OBJECTIVE: To evaluate the clinical and economic impact of universal screening for cytomegalovirus (CMV) in pregnant women in Italy, with valacyclovir (VCV) therapy in the case of maternal primary CMV infection, compared...
OBJECTIVE: To evaluate the clinical and economic impact of universal screening for cytomegalovirus (CMV) in pregnant women in Italy, with valacyclovir (VCV) therapy in the case of maternal primary CMV infection, compared with no screening. METHODS: We developed a decision-analytic model using a deterministic decision tree and compared the no-screening strategy (Scenario 1) with universal screening until 13 + 6 weeks' gestation (Scenario 2), and universal screening until 23 + 6 weeks' gestation (Scenario 3) as recommended by the Italian National Health Service. The model was applied in a hypothetical population of 400 000 pregnant women, representative of the annual number of women giving birth in Italy. Only women susceptible to primary CMV infection were considered, in whom CMV screening by serological testing (IgG/IgM testing ± IgG avidity), followed by VCV treatment (8 g/day) in the case of primary CMV infection, is recommended. Outcomes included the numbers of primary maternal CMV infections diagnosed, fetal congenital CMV (cCMV) infections, terminations of pregnancy (TOPs) and symptomatic and asymptomatic neonatal cCMV infections, and the cost per symptomatic cCMV case avoided (in Euros (€)) from the perspective of the Italian National Health Service. RESULTS: Universal screening until 13 + 6 weeks' gestation would identify 910 maternal primary CMV infections. Compared with no screening, it would prevent 92% of symptomatic cCMV infections (183 vs 15 cases) and prevent 70% of TOPs (33 vs 10 cases). Extending the universal screening period to 23 + 6 weeks' gestation would result in 280 additional diagnoses of maternal primary CMV infection and a further 2% and 9% reduction in symptomatic cCMV infections and TOPs, respectively. Both screening strategies would increase costs by approximately €7 million compared with Scenario 1, with a cost per symptomatic cCMV case avoided of ~ €45 500 for Scenario 2 and ~ €44 400 for Scenario 3. CONCLUSION: Universal serological CMV screening in pregnancy until 24 weeks' gestation, with VCV treatment in the case of maternal primary infection, substantially reduces the burden of cCMV-related disabilities and appears economically justifiable in the Italian healthcare context. These findings may inform policy decisions in countries with a similar CMV seroprevalence and National Health Service. © 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.
Neonatal outcomes following chronotropic rescue and delayed umbilical cord clamping in fetal complete atrioventricular block with low heart rate.
Londono-Obregon C, Holmes S, Galan HL … +8 more , Gein J, Kinsella JP, Bucholz EM, Behrendt N, Zaretsky MV, Kaizer AM, Murphy M, Cuneo BF
Ultrasound Obstet Gynecol · 2026 Jul · PMID 42069152 · Publisher ↗
Fetal complete atrioventricular block (f-CAVB) with ventricular bradycardia of ≤ 55 bpm is associated with increased perinatal mortality. With the goal of increasing perinatal survival of f-CAVB cases, we initiated a del...
Fetal complete atrioventricular block (f-CAVB) with ventricular bradycardia of ≤ 55 bpm is associated with increased perinatal mortality. With the goal of increasing perinatal survival of f-CAVB cases, we initiated a delivery room protocol to increase fetal heart rate (HR) and cardiac output using intramuscular and intravenous epinephrine given immediately before Cesarean delivery and prior to umbilical cord clamping. We tested the safety and efficacy of this concept of 'chronotropic rescue' in the delivery management of seven fetuses with f-CAVB meeting fetal HR criteria of ≤ 55 bpm in the 12 h prior to delivery. The combination of exogenous epinephrine and delayed umbilical cord clamping increased neonatal HR and stabilized the neonates who received an epicardial pacemaker < 24 h to 5 days after delivery. Based on the findings of this Case Series, chronotropic rescue with delayed umbilical cord clamping may improve survival and should be considered in the perinatal management of high-risk f-CAVB cases with very low fetal HR. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Biology matters in gestational age dating: lessons from assisted reproductive technology pregnancies.
Cavoretto PI, Candiani M, Farina A
Ultrasound Obstet Gynecol · 2026 May · PMID 42060992 · Publisher ↗
Abstract loading — click title to view on PubMed.
Gestational age determination in pregnancies conceived via assisted reproductive technology.
Gjerdevik M, Hanevik HI, Håberg SE … +1 more , Gjessing HK
Ultrasound Obstet Gynecol · 2026 May · PMID 42060947 · Full text
OBJECTIVES: To compare gestational age (GA) dating models for pregnancies conceived via assisted reproductive technology (ART), assess whether 14 or 15 days more accurately reflects the median follicular-phase duration i...
OBJECTIVES: To compare gestational age (GA) dating models for pregnancies conceived via assisted reproductive technology (ART), assess whether 14 or 15 days more accurately reflects the median follicular-phase duration in ART pregnancies and evaluate whether the gestational timelines of ART pregnancies are comparable with that of spontaneously conceived pregnancies. METHODS: We employed population data from the Medical Birth Registry of Norway (2015-2021), including 163 544 children conceived spontaneously, 2067 conceived via fresh embryo transfer (ET) and 2080 conceived via frozen ET. Among ART pregnancies, we compared two GA dating methods: a population-based ultrasound model (GA) and an ART-based formula based on the known oocyte fertilization date. Statistical agreement was evaluated by calculating individual pairwise differences in GA estimates. Bias and precision in the estimated date of delivery (EDD) were assessed by constructing cumulative birth distribution (Kaplan-Meier) curves for fresh and frozen ET pregnancies separately, employing time-to-event analysis to account for nonspontaneous births. RESULTS: The absolute individual GA differences between ultrasound and ART-based dating, considering a 14-day median follicular-phase duration, were ≤ 1 day for 969/2067 (46.9%) fresh ET pregnancies and for 874/2080 (42.0%) frozen ET pregnancies. An approximate systematic difference of 1 day was observed, which we corrected by employing a 15-day median follicular-phase duration in the ART-based formula (GA). There was a median pairwise difference between GA and GA of -0.4 (95% CI, -0.5 to -0.3) days in fresh ET pregnancies and -0.2 (95% CI, -0.4 to -0.1) days in frozen ET pregnancies. Both models demonstrated equivalent precision in the EDD. Measured using the ultrasound model, frozen ET pregnancies had a median pregnancy duration of 286.1 (95% CI, 285.5-286.7) days, which was 3.2 (95% CI, 2.4-3.9) days longer than that in fresh ET pregnancies, and 2.6 (95% CI, 2.0-3.2) days longer than that in spontaneously conceived pregnancies. CONCLUSIONS: We found close statistical agreement between ultrasound and ART-based dating models for both GA and EDD. However, 15 (not 14) days of follicular-phase duration should be utilized in the ART-based formula to avoid systematic bias in ART-based GA estimates. Fresh and frozen ET pregnancies had different birth distributions and median pregnancy durations, underscoring that they are not comparable with spontaneously conceived pregnancies and they should be evaluated separately. © 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.
Antenatal diagnosis of twin anemia-polycythemia sequence: current challenges and need for standardization.
da Silva MN, Sarian LO, Oliveira APM … +1 more , Bennini JR
Ultrasound Obstet Gynecol · 2026 Jun · PMID 42057582 · Publisher ↗
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Decidualized posterior compartment deep endometriosis: three-dimensional rendering and Doppler-based vascular assessment.
Barra F, Maramai M, Olcese F … +3 more , Beleva D, Gustavino C, Ferrero S
Ultrasound Obstet Gynecol · 2026 Apr · PMID 42035490 · Publisher ↗
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Point-of-care ultrasound in obstetrics and gynecology: a powerful instrument calling for standardization and validation studies.
De Robertis V, Bilardo CM, Stampalija T
Ultrasound Obstet Gynecol · 2026 Jun · PMID 42035416 · Publisher ↗
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Optimal umbilical artery Doppler chart for predicting placenta-mediated fetal growth restriction.
Vayenas A, Kingdom J, Kongkham N … +4 more , Stratulat V, Nevo O, Rahimi S, Melamed N
Ultrasound Obstet Gynecol · 2026 Jun · PMID 42008820 · Publisher ↗
OBJECTIVE: To compare the predictive accuracy of selected umbilical artery (UA) pulsatility index (PI) reference charts for outcomes associated with placenta-mediated fetal growth restriction (FGR). METHODS: This was a r...
OBJECTIVE: To compare the predictive accuracy of selected umbilical artery (UA) pulsatility index (PI) reference charts for outcomes associated with placenta-mediated fetal growth restriction (FGR). METHODS: This was a retrospective cohort study of individuals with a singleton pregnancy who underwent UA Doppler assessment ≥ 20 weeks' gestation between January 2012 and December 2022 at a single tertiary referral center, at which UA Doppler is measured routinely regardless of fetal size. Using 10 different UA-PI reference charts, we compared the predictive accuracy of an abnormal UA-PI (> 95 percentile) for two primary outcomes that are considered specific and gestational-age-independent indicators of placenta-mediated FGR: (1) late-stage UA Doppler abnormalities (defined as absent or reversed end-diastolic flow); and (2) maternal vascular malperfusion (MVM) on placental pathology. We also investigated the ability of these 10 charts to predict the secondary outcome of composite adverse perinatal outcome, defined as the presence of at least one of the following: stillbirth, 5-min Apgar score < 7, UA pH < 7.1, need for neonatal resuscitation and/or admission to the neonatal intensive care unit. Generalized estimating equations were used to calculate the predictive accuracy of the UA-PI reference charts, accounting for repeated measurements within the same patient. To identify the best-performing reference chart, we ranked each chart based on its Youden index at the 95 percentile cut-off for UA-PI for the two primary outcomes. Given the distinct phenotypes of early- and late-onset FGR, we also performed an analysis stratified by gestational age at ultrasound examination (< 32 vs ≥ 32 weeks). RESULTS: A total of 15 841 patients, with 38 398 ultrasound examinations, were included in the analysis. The proportion of small-for-gestational-age (SGA) fetuses classified as FGR based on an abnormal UA-PI varied widely depending on which reference chart was applied, ranging from 2.2% to 25.7%. Similarly, the predictive accuracy of the 10 different reference charts for placenta-mediated FGR outcomes differed considerably. The predictive performance for late-stage UA Doppler abnormalities varied substantially across charts, with sensitivity ranging from 20.7% to 76.3% and specificity from 75.2% to 98.0%. Likewise, for the prediction of MVM on placental pathology, the sensitivity of the charts ranged from 6.8% to 42.0% and specificity from 77.5% to 98.6%. For most of the charts, sensitivity and specificity remained comparable between the overall cohort and gestational-age subgroups. When ranked according to overall predictive performance for the two primary outcomes using the Youden index, the UA-PI reference charts of Rahimi et al., Drukker et al. and Flatley et al. demonstrated the best overall predictive accuracy. These same three charts retained the top performance ranking for the prediction of primary study outcomes in the subgroup of cases examined < 32 weeks. CONCLUSIONS: We observed substantial variation among 10 UA-PI reference charts in both the proportion of SGA fetuses classified as growth restricted and the predictive accuracy of each chart for outcomes considered specific to placenta-mediated FGR. Among the charts evaluated, those of Rahimi et al., Drukker et al. and Flately et al. demonstrated the best overall performance for predicting all three study outcomes. If confirmed in external cohorts, these findings would support the ongoing efforts to standardize the diagnosis of FGR, which is crucial for both clinical and research purposes. © 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.
Effects of Mediterranean diet and stress-reduction interventions during pregnancy on fetal brain development detected using magnetic resonance imaging.
Nakaki A, Gomez Y, Marra MC … +10 more , Youssef L, Castro-Barquero S, Casas R, Vieta E, Estruch R, Eixarch E, Gratacos E, Crispi F, Crovetto F, IMPACT BCN Trial Investigators
Ultrasound Obstet Gynecol · 2026 May · PMID 41999106 · Publisher ↗
OBJECTIVE: To assess whether lifestyle interventions based on Mediterranean diet or stress reduction during pregnancy are associated with differences in fetal brain development detectable by two-dimensional magnetic reso...
OBJECTIVE: To assess whether lifestyle interventions based on Mediterranean diet or stress reduction during pregnancy are associated with differences in fetal brain development detectable by two-dimensional magnetic resonance imaging (MRI) in a high-risk population for small-for-gestational-age neonates. METHODS: This was a secondary analysis of the randomized controlled clinical trial, Improving Mothers for a better PrenAtal Care Trial BarCeloNa (IMPACT BCN), which enrolled 1221 singleton pregnancies at high-risk for a small-for-gestational-age neonate between February 2017 and March 2020. At midgestation, participants were randomly allocated into three groups: a Mediterranean diet intervention; a stress-reduction program; or usual care. A randomly selected subgroup (n = 124) underwent fetal brain MRI between 36.1 and 39.1 weeks' gestation and were analyzed offline. Offline analysis included measurements of biparietal diameter, occipitofrontal diameter, cortical sulci depth, corpus callosum length, vermis height and cerebellar transverse diameter. Differences in brain measurement between groups were analyzed by regression models adjusted for baseline maternal characteristics, gestational age at MRI assessment, fetal sex, fetal head size and MRI scanner model. RESULTS: Fetuses in the Mediterranean-diet group (n = 36) showed a significantly deeper right insula (mean ± SD, 28.78 ± 1.16 mm vs 27.88 ± 1.23 mm; P = 0.03), a deeper left insula (mean ± SD, 28.60 ± 1.21 mm vs 27.49 ± 1.26 mm; P = 0.01) and a longer corpus callosum (mean ± SD, 42.24 ± 2.50 mm vs 40.61 ± 2.13 mm; P < 0.01) compared with fetuses in the usual-care group (n = 44). Fetuses in the stress-reduction group (n = 44) also had a deeper left insula (mean ± SD, 28.39 ± 1.13 mm vs 27.49 ± 1.26 mm; P = 0.04) compared with those in the usual-care group. CONCLUSION: Structured maternal lifestyle interventions during pregnancy may influence fetal neurodevelopment. Although the effect sizes were submillimetric, these effects were detectable using two-dimensional MRI, which highlights its potential as a sensitive tool for detecting subtle brain changes during fetal life. Future studies are warranted to truly reveal the clinical meaning of these findings. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Normative ranges of MRI-based placental volume and placental-to-fetal-volume ratio at 16-36 weeks: prospective study.
Bouachba A, Bartin R, Virfollet J … +5 more , De Jesus Neves J, Bussières L, Grévent D, Salomon LJ, Gorincour G
Ultrasound Obstet Gynecol · 2026 May · PMID 41987663 · Publisher ↗
OBJECTIVE: The placenta plays a crucial role in fetal development, yet normal placental volumetric growth trajectories remain poorly characterized, as most studies focus on pathological pregnancies or limited gestational...
OBJECTIVE: The placenta plays a crucial role in fetal development, yet normal placental volumetric growth trajectories remain poorly characterized, as most studies focus on pathological pregnancies or limited gestational-age (GA) ranges. We aimed to establish magnetic reference imaging (MRI)-based normative reference curves for placental volume (PV) and the placental-to-fetal-volume ratio (PFR) between 16 and 36 weeks' gestation. METHODS: This single-center, prospective study conducted as part of the 'LUMIERE on the Fetus' project included healthy pregnant women with a low-risk, singleton, 16-36-week fetus evaluated between December 2021 and June 2022. Additional participants with MRI data available at 16 weeks were recruited between January 2023 and October 2025. MRI was performed using a standardized protocol, and placental and fetal volumes were segmented using three-dimensional imaging software. Mean fetal body volume across 16-36 weeks was derived from our previously published normative MRI-based dataset obtained from the same cohort. Mean PV and PFR were calculated for each week of gestation. PV growth across gestation was modeled using logarithmic regression, while PFR growth was modeled using a quadratic term, and percentile curves were generated. RESULTS: The study cohort comprised 265 MRI datasets from 247 healthy pregnant women with a singleton fetus. Mean PV increased from 149 cm at 16 weeks to 890 cm at 36 weeks, following the function: PV(GA) = (911.3 × ln(GA)) - 2375.7, where GA is in weeks. Over the same period, fetal body volume increased 22-fold, leading to a progressive decline in PFR. Specifically, mean PFR decreased from 1.22 at 16 weeks to 0.31 at 36 weeks, confirming its downward trajectory as fetal growth progresses. The relationship between PFR and GA was modeled using the quadratic function: PFR(GA) = 4.03 - (0.215 × GA) + (0.00313 × GA), where GA is in weeks. CONCLUSION: This study establishes MRI-based normative percentile curves for PV and PFR, from 16 to 36 weeks' gestation, confirming the physiological decline in PFR with advancing gestation. These benchmarks may aid in detecting placental dysfunction and characterizing fetal growth restriction. Further validation is needed in pathological and multiple pregnancies. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Intrapartum sonographic evaluation of fetal head descent in relation to maternal position: comparison between dorsal lithotomy and kneeling squat positions.
Melito C, Rizzo L, Yurhel L … +7 more , Corno E, Renzetti S, Malvezzi MC, Frati F, Neri S, Ghi T, Dall'Asta A
Ultrasound Obstet Gynecol · 2026 May · PMID 41987572 · Full text
OBJECTIVE: To evaluate the impact of maternal position on the sonographic indicators of fetal head descent in the latent phase of the second stage of labor. METHODS: This was a prospective, single-center, cohort study co...
OBJECTIVE: To evaluate the impact of maternal position on the sonographic indicators of fetal head descent in the latent phase of the second stage of labor. METHODS: This was a prospective, single-center, cohort study conducted at the University of Parma, Parma, Italy, between November 2023 and October 2024, including a consecutive series of non-anomalous, low-risk, singleton pregnancies at ≥ 37 + 0 weeks' gestation in the latent phase of the second stage of labor. Sonographic assessment of the fetal head position and station was performed by two dedicated and trained research midwives; the former was evaluated using transabdominal ultrasound, and the latter by measuring the head-to-perineum distance (HPD) and the angle of progression (AoP) on transperineal ultrasound. The sonographic indicators of fetal head station were measured between uterine contractions, with the mother first in the dorsal lithotomy position and then in the kneeling squat position. The Wilcoxon signed-rank test and linear mixed-effects models were applied to compare the measurements of AoP and HPD between the dorsal lithotomy and kneeling squat positions. Generalized additive models (GAMs) were utilized to describe the relationship and estimate the predicted change in AoP and HPD when transitioning from the dorsal lithotomy to the kneeling squat position. RESULTS: Overall, 55 patients underwent measurement of the sonographic indicators of fetal head station in both maternal positions. Occiput posterior position was recorded in only two cases (3.6%), with the remaining cases in occiput anterior position. Both the Wilcoxon signed-ranked test and linear mixed-effects models showed that HPD was significantly shorter when measured in the kneeling squat compared with the dorsal lithotomy position (30.3 ± 8.2 vs 35.5 ± 8.9 mm, P < 0.01). Consistently, a wider mean AoP was recorded in the kneeling squat compared with the dorsal lithotomy position (135.4° ± 15.1° vs 125.6° ± 11.9°, P < 0.01). GAMs highlighted an increasing non-linear relationship between measurements of AoP and HPD obtained in the dorsal lithotomy and kneeling squat positions. CONCLUSION: During the latent phase of the second stage of labor, maternal mobilization into upright positions, such as the kneeling squat position, is associated with more favorable sonographic indicators of fetal head station. However, this study supports such findings only in the event of fetal occiput anterior position. Sonographic studies with larger cohorts are warranted to evaluate the clinical relevance of these findings, as well as the role of maternal mobilization in the second stage of labor in relation to the position of the fetal occiput. © 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.
Morphological patterns of fetal lateral ventricular border irregularities: descriptive study.
Hadi E, Sorotzkin A, Haddad L … +10 more , Kassif E, Hoffmann C, Shrot S, Shoob S, Shariv A, Mizrachi Y, Levy M, Leibovitz Z, Lerman-Sagie T, Gindes L
Ultrasound Obstet Gynecol · 2026 May · PMID 41987549 · Full text
OBJECTIVES: Alterations in the lateral ventricular borders have been documented in the prenatal diagnosis of certain fetal brain conditions. This study aimed to describe and classify the morphological patterns of lateral...
OBJECTIVES: Alterations in the lateral ventricular borders have been documented in the prenatal diagnosis of certain fetal brain conditions. This study aimed to describe and classify the morphological patterns of lateral ventricular border irregularities (LVBI) and to discuss possible etiologies. METHODS: This multicenter retrospective study reviewed all cases of prenatally diagnosed LVBI at three centers between January 2014 and December 2022. Neurosonography and fetal magnetic resonance imaging were used to determine the type of LVBI, its location and the presence of other ependymal abnormalities. Data regarding other prenatally diagnosed malformations, maternal TORCH serology, genetic testing, autopsy findings and postnatal outcomes were collected. RESULTS: Sixty-six fetuses were included in the analysis. Genetic testing was performed in 30/66 (45.5%) cases. Termination of pregnancy was elected in 33/66 (50.0%) of cases, and 28/66 (42.4%) were liveborn (mean ± SD age at postnatal neurodevelopmental follow-up, 3.4 ± 1.2 years). Four main LVBI patterns were identified: protrusions (nodular or non-nodular), indentations (round or wedge-shaped), undulations and mixed. Nodular protrusions (19/66 (28.8%)) were observed with neuronal migration disorders (periventricular nodular heterotopia or tuberous sclerosis complex), whereas non-nodular protrusions (4/66 (6.1%)) were observed in cases of disruptive injury (intraventricular hemorrhage or intrauterine fetal cytomegalovirus infection). Round indentations (7/66 (10.6%)) were observed in the context of porencephalic cysts, whereas wedge indentations (15/66 (22.7%)) were typically consistent with either periventricular venous hemorrhagic infarction or cleft (schizencephaly) with an abnormal ependymal lining. Undulating or mixed patterns (21/66 (31.8%)) were often observed in association with other malformations of cortical development. CONCLUSIONS: Characterizing the pattern of LVBI can provide a framework for describing fetal brain anomalies and suggesting their etiologies. These morphological configurations may represent different developmental or disruptive etiologies, but causal relationships require further study. © 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.
Longitudinal maternal hemodynamics in high-risk pregnancies with different subtypes of pre-eclampsia.
Lin J, Wang X, Chen Y … +8 more , Nguyen-Hoang L, Tai AST, Wong IS, Chen XY, Ng MH, Leung HHY, Lee APW, Poon LC
Ultrasound Obstet Gynecol · 2026 May · PMID 41964160 · Full text
OBJECTIVE: To evaluate maternal cardiac adaptation during pregnancy by comparing longitudinal hemodynamic profiles between women identified as high risk for preterm pre-eclampsia (PE) who subsequently developed preterm P...
OBJECTIVE: To evaluate maternal cardiac adaptation during pregnancy by comparing longitudinal hemodynamic profiles between women identified as high risk for preterm pre-eclampsia (PE) who subsequently developed preterm PE, term PE or remained unaffected, as well as low-risk women. METHODS: This was a prospective longitudinal study of 1078 Chinese women with a singleton pregnancy who were enrolled in a first-trimester screen-and-prevent program for preterm PE at the Prince of Wales Hospital, Hong Kong SAR, China, between January 2020 and June 2024. Participants were classified as high or low risk for preterm PE based on the Fetal Medicine Foundation first-trimester combined test. Participants were followed up at 12 + 0 to 15 + 6 weeks' gestation, 20 + 0 to 24 + 6 weeks and 30 + 0 to 37 + 6 weeks to measure hemodynamic variables, including heart rate (HR), stroke volume (SV), cardiac output (CO), systemic vascular resistance (SVR) and mean arterial pressure (MAP). Participants were categorized into four groups according to risk status for preterm PE and subsequent development of PE: low risk who did not develop PE (Group 1, n = 407); high risk who did not develop PE (Group 2, n = 598); high risk who developed term PE (Group 3, n = 29); and high risk who developed preterm PE (Group 4, n = 44). Hemodynamic variables were log transformed and analyzed using linear mixed-effects models, adjusting for maternal characteristics and clinical visits. Estimated marginal means of log-transformed values for hemodynamic variables were compared between the groups throughout pregnancy and at each clinical visit. RESULTS: Compared with Group 1, all high-risk groups exhibited lower SV and CO and higher SVR and MAP throughout pregnancy (all P < 0.05), while HR was significantly elevated in Group 2 (P < 0.001). Compared with Group 2, Group 4 had lower HR, SV and CO and higher SVR and MAP throughout pregnancy (all P < 0.01). In contrast, Group 3 showed no significant differences in HR, SV, CO and SVR compared with Group 2 (all P > 0.05), although there was an increase in MAP from midgestation onwards (P < 0.001). Compared with Group 3, Group 4 exhibited lower CO and higher SVR and MAP throughout pregnancy (all P < 0.05). CONCLUSIONS: Compared with low-risk women who do not develop PE, high-risk women with or without preterm or term PE exhibit distinct cardiac maladaptation profiles from early to late gestation. These findings offer insight into the different pathophysiological mechanisms underlying PE subtypes and should inform risk stratification. © 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.
Retinal imaging in gestational diabetes mellitus: systematic review.
Kitmiridou D, Mitrogiannis I, Charakida M … +1 more , Nicolaides KH
Ultrasound Obstet Gynecol · 2026 Jun · PMID 41956059 · Publisher ↗
OBJECTIVE: To examine the differences in retinal structure and vasculature between women with gestational diabetes mellitus (GDM) and normoglycemic pregnant controls. METHODS: This was a systematic review of the availabl...
OBJECTIVE: To examine the differences in retinal structure and vasculature between women with gestational diabetes mellitus (GDM) and normoglycemic pregnant controls. METHODS: This was a systematic review of the available literature on retinal assessment in pregnancies with GDM compared with non-GDM controls, conducted in PubMed, EMBASE via Ovid, The Cochrane Library and Scopus databases in November 2025, following an a-priori designed and prospectively registered protocol. Studies examining the retina using any non-interventional method of retinal assessment in women with GDM compared to non-GDM controls were identified. Potentially eligible studies included prospective and retrospective cohort, case-control and population-based studies, as well as randomized controlled trials. The Risk Of Bias In Non-randomized Studies of Interventions version 2 (ROBINS-I V2) tool was used to evaluate the risk of bias of the included studies. A meta-analysis was not performed due to considerable heterogeneity in the reported methods of retinal assessment, retinal parameters examined, disease severity, diagnostic criteria for GDM and gestational age at the time of retinal examination. RESULTS: The electronic database search yielded 1326 results, of which 21 were eligible for full-text review and nine were included. Following citation screening for additional eligible studies, 10 studies were ultimately included in the systematic review. The methods of retinal assessment utilized in the included studies were cross-sectional and structural optical coherence tomography (OCT), optical coherence tomography angiography (OCTA) and retinal fundus photography. Each method examined various retinal structural and vascular parameters. Studies examining retinal vascular metrics using retinal fundus photography and cross-sectional OCT found similar retinal arteriolar parameters, increased retinal venular parameters and a reduced retinal arteriovenous ratio in women with GDM compared with normoglycemic controls. Studies utilizing structural OCT reported that the retinal nerve fiber layer (RNFL) thickness was decreased or similar in women with GDM vs non-GDM controls. Combinations of the ganglion cell layer (GCL) thickness, inner plexiform layer thickness and macular RNFL thickness were found to be lower in women with GDM. All studies reporting on other OCT parameters (acircularity index and retinal, macular and GCL thickness) found them to be similar between the two groups. The superficial and deep capillary plexus vessel densities, assessed using OCTA, were reported to be lower in women with GDM in some studies, whereas others found no significant difference between the two groups. For the remaining OCTA parameters (choriocapillaris vessel density, outer retinal vessel density, whole-image vessel density, foveal avascular zone area, foveal density and choriocapillaris flow area), no study identified significant differences between women with GDM and non-GDM controls. The ROBINS-I V2 tool found the risk of bias to be serious in six studies and moderate in four studies. CONCLUSION: Existing studies provide inconsistent evidence to clearly establish retinal structural or functional changes in pregnancies complicated by GDM. Future large-scale prospective studies are required to confirm these findings and evaluate whether the retinal changes observed in GDM persist postpartum. Such evidence may clarify their potential role as biomarkers of cardiovascular insult severity and inform stratified surveillance. © 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.
Can we define a cut-off for external anal sphincter defect angle?
Dietz HP, Shek KL, Descallar J
Ultrasound Obstet Gynecol · 2026 May · PMID 41955738 · Publisher ↗
OBJECTIVES: Obstetric anal sphincter injury is a common complication of childbirth and the primary etiological factor for anal incontinence in young women. On endoanal ultrasound, a significant defect of the external ana...
OBJECTIVES: Obstetric anal sphincter injury is a common complication of childbirth and the primary etiological factor for anal incontinence in young women. On endoanal ultrasound, a significant defect of the external anal sphincter (EAS) has arbitrarily been defined as a gap of greater than 30° in its hyperechogenic ring structure. This study was designed to validate a cut-off value for defining a significant EAS defect on tomographic exoanal imaging. METHODS: This was a retrospective study involving women attending a tertiary urogynecological unit between January 2015 and December 2021. Analysis was limited to premenopausal women to reduce confounders. The assessment included obtaining the St Mark's incontinence score and visual analog scale (VAS) bother score of anal incontinence, and performance of four-dimensional transperineal exoanal ultrasound. Tomographic ultrasound imaging (TUI) was used to evaluate the EAS; offline analysis was performed at a later date, with the assessor blinded against all other clinical data. The primary measure to assess EAS defects was defect angle. Associations between this parameter and anal incontinence, VAS bother score and St Mark's score were estimated using univariable logistic or linear regression models. Receiver-operating-characteristics (ROC)-curve analysis was performed to determine the optimal cut-off value of the EAS defect angle for defining a significant defect. RESULTS: A total of 915 premenopausal women were seen during the study period. Ultrasound volumes of the anal canal were missing in 64 women and one patient was excluded due to muscular dystrophy, leaving 850 women included in the analysis. The mean age was 42 (range, 18-56) years and the mean body mass index was 29 (range, 16-57) kg/m at assessment. Anal incontinence was reported by 133 (16%) women, with a median St Mark's score of 10 (interquartile range, 6-14) and a mean VAS bother score of 6.6 (range, 0-10). On TUI, six slices were scored per patient (total of 5100 assessments). EAS defects were seen in 111 (13%) patients and 368 slices, with an average defect angle of 32° (range, 2-155°) and a mean maximum defect angle of 67° (range, 14-167°). Average defect angle showed the strongest correlation with anal incontinence, St Mark's score and VAS bother score (all P < 0.001). ROC-curve analysis suggested a cut-off of 30° for the definition of a significant EAS defect. CONCLUSION: In premenopausal women, EAS defects on TUI were associated significantly with all investigated measures of anal incontinence. Average defect angle was the best predictor of anal incontinence and enabled ROC-curve analysis. The 30° defect angle criterion empirically used for endoanal ultrasound seemed to be valid as a cut-off for the diagnosis of significant anal sphincter defect on exoanal imaging. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Risk factors for partial placental retention after Cesarean delivery: a preliminary report.
Berg L, Igielman M, Jurkovic D … +1 more , Jauniaux E
Ultrasound Obstet Gynecol · 2026 May · PMID 41955637 · Full text
OBJECTIVE: To identify risk factors for partial placental retention (PPR) after Cesarean delivery (CD). METHODS: This was a retrospective case-control study of patients with suspected complications after CD, including 25...
OBJECTIVE: To identify risk factors for partial placental retention (PPR) after Cesarean delivery (CD). METHODS: This was a retrospective case-control study of patients with suspected complications after CD, including 25 cases of PPR and 75 controls without evidence of PPR. The diagnosis of PPR was made using high-resolution ultrasound and was confirmed histologically in all cases. To identify potential risk factors for PPR, we compared demographic and clinical data between cases of PPR and controls. RESULTS: Mode of conception, congenital uterine anomaly (CUA) and clinical indication for postpartum ultrasound assessment were all significantly associated with PPR after CD on univariable analysis. Patients with PPR were more likely to have conceived using assisted reproductive technology (9/22 (40.9%) vs 13/75 (17.3%); odds ratio (OR), 3.30 (95% CI, 1.17-9.33); P = 0.02), have a CUA (3/25 (12.0%) vs 1/75 (1.3%); OR, 10.1 (95% CI, 1.00-101.93); P = 0.05), and present with prolonged postpartum bleeding as the main indication for ultrasound assessment (20/25 (80.0%) vs 25/75 (33.3%)) as compared to acute bleeding (3/25 (12.0%) vs 7/75 (9.3%); OR, 0.54 (95% CI, 0.12-2.34)) or other indications (2/25 (8.0%) vs 43/75 (57.3%); OR, 0.06 (95% CI, 0.01-0.27)) (P < 0.001). Both indication for ultrasound assessment and presence of a CUA were retained in the multivariable analysis. In 19/20 (95.0%) cases with PPR for which data on placental location were available, the placenta was located in the upper uterine cavity antenatally, and none of the patients with PPR had antenatal ultrasound signs suggestive of a high probability of placenta accreta spectrum at birth. In all cases of PPR, the retained placental tissue was removed entirely using polyp or ovum forceps under ultrasound guidance, indicating that the placenta was not abnormally attached to the myometrium. CONCLUSIONS: Patients with a known CUA should be advised that they are at higher risk of PPR, and the obstetric team should take measures to minimize this risk. Prolonged postpartum bleeding is predictive of PPR after CD, and patients experiencing this should be referred for ultrasound assessment without delay. PPR after CD is not diagnostic of placenta accreta spectrum and surgical evacuation of the uterus is unlikely to be complicated. © 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.
How to facilitate ultrasound examination of the fetal heart: the 5-4-3-2-1 method.
Levy M, Stos B
Ultrasound Obstet Gynecol · 2026 Jul · PMID 41955346 · Full text
We propose a new standardized, systematic method of fetal cardiac screening, the step-by-step '5-4-3-2-1' method. This method is based on understanding the cardiac structures through a process of navigating between the d...
We propose a new standardized, systematic method of fetal cardiac screening, the step-by-step '5-4-3-2-1' method. This method is based on understanding the cardiac structures through a process of navigating between the different recommended views during an abdominothoracic sweep, following a user-friendly checklist to identify the main ultrasound features associated with congenital heart defects (CHD). The components (or 'points') that form the checklist in each of the views have been selected in order to cover most CHD, with particular focus on abnormalities associated with genetic disorders and critical CHD. This easy-to-remember 5-4-3-2-1 method provides an overview of the fetal heart at the start of the abdominothoracic sweep by checking 5 points, then assesses the four-chamber view checking 4 points, the three-vessel and three-vessel-and-trachea views checking 3 points and the two outflow tracts checking 2 points, and then uses color Doppler to check 1 final point. © 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.
Terms, definitions and measurements to describe the sonographic features of adnexal tumors: updated consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group.
Timmerman D, Valentin L, Testa AC … +7 more , Froyman W, Landolfo C, Kotlarz A, Fischerova D, Van Calster B, Bourne T, Collaborators
Ultrasound Obstet Gynecol · 2026 May · PMID 41947373 · Full text
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