Ultrasound Obstet Gynecol [JOURNAL]
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Karmegaraj B, Vijayakumar S
Ultrasound Obstet Gynecol
· 2026 Feb · PMID 41723870
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Bonacina E, Armengol-Alsina M, Casellas A
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, Dalmau M, Diaz P, Roldán E, Temprado J, Duaso M, Ampurdanes Q, San José M, Armengol T, Lizarraga Z, Maiz N, Mendoza M
Ultrasound Obstet Gynecol
· 2026 Apr · PMID 41723869
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OBJECTIVES: To assess the predictive performance of angiogenic factors and fetal Doppler, alone and in combination, for composite adverse perinatal outcome (CAPO) in early-onset small-for-gestational age (SGA) and fetal...OBJECTIVES: To assess the predictive performance of angiogenic factors and fetal Doppler, alone and in combination, for composite adverse perinatal outcome (CAPO) in early-onset small-for-gestational age (SGA) and fetal growth restriction (FGR), in cases both with and without pre-eclampsia (PE), in order to evaluate the ability of these markers to predict adverse outcomes beyond their established association with PE and to better delineate the specific contribution of PE to their predictive value. METHODS: This was a retrospective observational study conducted at Vall d'Hebron University Hospital, Barcelona, Spain, between January 2016 and January 2022. The study population included singleton pregnancies with an estimated fetal weight < 10 percentile, diagnosed with fetal smallness between 20 + 0 and 31 + 6 weeks' gestation, with fetal Doppler ultrasound data and available angiogenic factor measurements obtained at diagnosis. Placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) were measured at initial assessment. CAPO was defined as the presence of at least one of the following: 5-min Apgar score < 7; umbilical cord arterial pH < 7.0; admission to the neonatal intensive care unit for > 48 h; stillbirth; neonatal death; respiratory distress syndrome; bronchopulmonary dysplasia; neonatal sepsis; necrotizing enterocolitis; Grade-III-IV retinopathy of prematurity; Grade-III-IV intraventricular hemorrhage; or periventricular leukomalacia. Predictive performance for CAPO and subsequent PE was assessed using receiver-operating-characteristics (ROC)-curve analysis and area under the ROC curve (AUC) comparisons for fetal Doppler and angiogenic factors, alone and combined, within logistic regression models. Sensitivity, false-positive rate, positive predictive value and negative predictive value were calculated. All analyses were stratified according to PE development at any time before delivery. RESULTS: Overall, 469 women with an early-onset small fetus were included. PE was present at diagnosis in 74/469 (15.8%) cases and developed later in 83 (17.7%) cases. CAPO occurred in 46.5% of cases. In the overall cohort, PlGF combined with fetal Doppler findings showed the highest predictive performance for CAPO (AUC, 0.866 (95% CI, 0.833-0.899)), outperforming fetal Doppler alone. Notably, the performance of the combined model was not significantly different from PlGF alone (AUC, 0.862 (95% CI, 0.828-0.895); P = 0.621). These findings were consistent in pregnancies without PE, in which PlGF remained the best-performing single predictor of CAPO (AUC, 0.797 (95% CI, 0.740-0.854)). In pregnancies with PE at any time, the best-performing single predictor was the sFlt-1/PlGF ratio (AUC, 0.802 (95% CI, 0.728-0.876)). For the prediction of subsequent PE after enrolment, the sFlt-1/PlGF ratio alone (AUC, 0.861 (95% CI, 0.821-0.901)) and in combination with fetal Doppler (AUC, 0.862 (95% CI, 0.822-0.902)) achieved the highest predictive performance. Combining fetal Doppler findings with angiogenic factors reduced false-positive rates, but did not improve sensitivity. CONCLUSION: This study confirmed the robust predictive performance of PlGF and the sFlt-1/PlGF ratio for identifying CAPO and PE in early-onset SGA/FGR. The predictive value of PlGF and fetal Doppler remained consistent irrespective of PE status, while the sFlt-1/PlGF ratio showed reduced predictive accuracy in non-PE pregnancies, but still outperformed Doppler. These findings support the integration of angiogenic factors into the clinical assessment of early-onset SGA/FGR, for both cases with and those without 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.
Tartaglia S, Neri C, Policriti MA
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, Riccetti C, Familiari A, Ghi T
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 41717897
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Prasad S, Sileo FG, Binder J
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, Brunelli E, Chianchiano N, Coutinho CM, D'Antonio F, Döbert M, Fichera A, Gielchinsky Y, Hecher K, Iacovella C, Malone S, Martinez-Varea A, Nørgaard LN, Rodo C, Simões T, Slaghekke F, Yinon Y, Khalil A, Collaborators
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41691618
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OBJECTIVE: Data on early-onset twin-to-twin transfusion syndrome (TTTS) are scarce and, therefore, evidence-based counseling and management of these pregnancies are challenging. This study aimed to investigate survival r...OBJECTIVE: Data on early-onset twin-to-twin transfusion syndrome (TTTS) are scarce and, therefore, evidence-based counseling and management of these pregnancies are challenging. This study aimed to investigate survival rates and establish predictors of survival after fetoscopic laser surgery (FLS) for early-onset TTTS. METHODS: This was an international multicenter retrospective cohort study of monochorionic diamniotic twin pregnancies complicated by TTTS diagnosed before 18 + 0 weeks' gestation that underwent FLS. The primary outcome was dual-twin survival at 28 days after birth. Secondary outcomes included survival of at least one twin and dual-twin demise at 28 days after birth. Monoamniotic twin, triplet and higher-order multiple pregnancies, pregnancies with chromosomal or structural fetal anomaly and TTTS cases not treated by FLS were excluded. Pre-, intra- and postoperative characteristics were analyzed using multivariable logistic regression analysis. Discriminative performance was assessed using receiver-operating-characteristics-curve analysis. RESULTS: A total of 485 cases of early-onset TTTS that underwent FLS were included. The rates of dual-twin survival and survival of at least one twin at 28 days after birth were 51.5% (250/485) and 76.7% (372/485), respectively, while 23.3% (113/485) of cases resulted in dual-twin demise. Multivariable logistic regression analysis showed that absent or reversed end-diastolic flow (AREDF) in the donor umbilical artery (adjusted odds ratio (aOR), 0.487 (95% CI, 0.273-0.867)) and absent or reversed a-wave in the donor ductus venosus (aOR, 0.299 (95% CI, 0.110-0.810)) at the time of TTTS diagnosis were associated independently with decreased odds of dual-twin survival, while higher gestational age at birth was associated with increased odds of both dual-twin survival (aOR, 1.172 (95% CI, 1.117-1.229)) and survival of at least one twin (aOR, 2.053 (95% CI, 1.699-2.481)). The model for dual-twin survival showed modest discriminative performance with poor overall fit. CONCLUSIONS: The presence of AREDF in the donor umbilical artery and absent or reversed a-wave in the donor ductus venosus, at the time of diagnosis of TTTS, and lower gestational age at birth were independent adverse predictors for dual-twin survival following FLS in cases of TTTS diagnosed before 18 weeks. Future studies should explore the impact of surgical technique on survival rates. © 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.
Martins WP, Nastri CO
Ultrasound Obstet Gynecol
· 2026 May · PMID 41684184
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Vergote S, Van der Veeken L, Chitayat D
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, Jaeggi E, Ryan G, Miller E, Shinar S
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41674351
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OBJECTIVE: To document the natural progression of fetal cardiac rhabdomyomas and evaluate the impact of prenatal sirolimus (PNS) on tumor size, cardiac complications and brain-tuber size. METHODS: This was a single-cente...OBJECTIVE: To document the natural progression of fetal cardiac rhabdomyomas and evaluate the impact of prenatal sirolimus (PNS) on tumor size, cardiac complications and brain-tuber size. METHODS: This was a single-center retrospective cohort study of pregnancies with suspected fetal cardiac rhabdomyoma referred to our center from April 2013 to May 2024. Serial ultrasound and echocardiography reports were reviewed to obtain tumor characteristics, such as diameter and location, and cardiac complications, including inflow or outflow obstruction, arrhythmia and hydrops. The tumor-to-femur length (TFL) ratio was calculated to correct for fetal growth. Prenatal neurosonography reports were collected from clinical records. Pre- and postnatal brain magnetic resonance imaging (MRI) scans were reviewed by two observers who were blinded to PNS treatment. Brain-lesion severity was assessed based on the presence of subependymal nodules, the EPISTOP score, the maximum diameter of the largest subcortical tuber, the maximum diameter of the largest subependymal giant cell astrocytoma (SEGA) and the diameter of the largest lateral ventricle. Prenatal or postnatal genetic testing results were documented when available. RESULTS: Twenty-seven pregnancies were included in the study, seven of which received PNS. Prior to initiation of treatment, the diameter of the largest cardiac tumor at diagnosis was similar between the non-PNS and PNS groups (mean, 15.2 mm vs 14.3 mm; P = 0.72), with the left ventricle the most frequently affected location. Without treatment, rhabdomyomas grew rapidly from 20 + 0 to 27 + 6 weeks' gestation (mean, 2.58 mm/week) but growth slowed after 28 weeks (mean, 0.44 mm/week). Hydrops was reported in four cases and occurred at a mean tumor diameter of 31.7 ± 6.2 mm, mean TFL ratio of 0.68 ± 0.15 and at a mean growth rate of 4.3 ± 1.7 mm/week. In the seven women treated with PNS, treatment for > 7 days (n = 3) resulted in tumor regression and/or resolution of outflow obstruction, and a reduction in TFL ratio; however, prenatal cessation of treatment resulted in rebound growth (n = 2). Treatment for ≤ 7 days (n = 4) did not impact tumor size or resolve existing cardiac complications. Among the 12 cases that underwent prenatal MRI, the median EPISTOP score was 7 (interquartile range (IQR), 1-15) and the median largest lateral ventricle diameter was 8.9 (IQR, 7.0-9.7) mm; subcortical tubers and subependymal nodules were each identified in 67% of cases, and SEGAs were identified in 58%. Among the 13 cases that underwent postnatal MRI, the median EPISTOP score was 14 (IQR, 3-16) and the median largest lateral ventricle diameter was 7 (IQR, 7-8) mm; brain tubers were identified in 92% of cases. In cases with both pre- and postnatal MRI findings who received PNS for > 7 days (n = 3), on postnatal MRI compared with prenatal MRI, one patient showed no change in findings, one demonstrated a mild increase in the largest subcortical tuber diameter and one had no detectable brain tubers. CONCLUSIONS: Early and sustained PNS treatment was associated with reduced cardiac rhabdomyoma size and/or resolution of cardiac complications. Rebound tumor growth was observed after discontinuation of treatment. Brain tubers appeared unchanged with PNS treatment, although the sample size was too small to draw a definitive conclusion. © 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.
Birnbaum R, Malinger G, Miremberg H
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, Brusilov M, Pooh RK, Rybak-Krzyszkowska M, Viñals F, Vo TS, Gupta R, Gupta S, Dimri N, Ochoa JH, Weissbach T, Lanzarone V, Quinton A, Levy M, Kidron D, Krajden Haratz K
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41674274
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OBJECTIVES: To characterize the sonographic features of fetal ganglionic eminence (GE) cysts diagnosed during the late first and early second trimesters, assess their association with additional brain and extracranial ma...OBJECTIVES: To characterize the sonographic features of fetal ganglionic eminence (GE) cysts diagnosed during the late first and early second trimesters, assess their association with additional brain and extracranial malformations, investigate their genetic etiologies and evaluate fetal outcomes. METHODS: This retrospective, multicenter case series included fetuses with a diagnosis of GE cyst, following referral for targeted transvaginal ultrasound examination, before 23 + 0 weeks' gestation at one of nine medical centers across eight countries between January 2015 and April 2023. All fetuses had been referred after either the first-trimester ultrasound screening examination or an early second-trimester anatomical scan diagnosed a GE cyst or raised suspicion of a cystic brain anomaly. All ultrasound images and three-dimensional ultrasound volumes for each case were retrieved and reviewed to identify brain and extracranial anomalies. Associated brain anomalies were classified into: cerebral midline; hemispheric parenchyma and lamination; lateral ventricles; sulcation pattern; and midbrain-hindbrain abnormalities. Genetic evaluations included chromosomal microarray analysis, exome sequencing and/or whole-genome sequencing, when available. Pregnancy outcomes and postnatal or autopsy data were reviewed when available. RESULTS: In total, 25 fetuses with a diagnosis of GE cyst were included in the study. Cysts were bilateral in 64.0% of cases. In 36.0% of cases, the diagnosis was made between 11 + 3 and 13 + 6 weeks' gestation. Additional brain abnormalities were identified in 18 of the 22 (81.8%) cases in which these were assessed. These included midline anomalies in 72.2% of those with additional brain abnormalities, hemispheric abnormalities in 77.8%, abnormalities of the lateral ventricles in 55.6%, midbrain-hindbrain abnormalities in 72.2% and sulcation abnormalities in 55.6%. Extracranial anomalies were present in 17/25 (68.0%) fetuses, of which fetal growth restriction was observed in 35.3%. Genetic testing revealed pathogenic or likely pathogenic variants in 70.6% of the 17 cases tested, predominantly affecting mitochondrial functions. The pregnancy was terminated in 64.0% of cases and the fetus was liveborn in 32.0%; one case was lost to follow-up during pregnancy. Of the seven surviving neonates with follow-up, five (71.4%) experienced adverse outcomes. Four of the 25 fetuses were initially diagnosed with an isolated unilateral GE cyst. In three of these cases, the cyst regressed and transformed into a GE enlargement, though their clinical courses differed: two cases developed growth restriction, of which one also had a postnatally repaired ventricular septal defect and the other a short femur length, and the third case had additional extracranial findings. In the fourth case, the cyst resolved completely, with an apparently normal brain observed at follow-up fetal magnetic resonance imaging. CONCLUSIONS: Late first- or early second-trimester suspicion of GE cysts should trigger a transvaginal neurosonographic examination. The presence of early GE cysts appears to be associated with additional severe brain and extracranial anomalies, including fetal growth restriction. Comprehensive genetic testing is crucial for identifying underlying etiologies, which are often linked to mitochondrial dysfunction. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Badr DA, Carlin A, Kang X
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, Cos T, Vuckovic A, Barglazan D, Jani JC
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41664568
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OBJECTIVE: To evaluate the clinical effectiveness and economic impact of implementing first-trimester screening involving placental growth factor (PlGF) followed by aspirin prophylaxis for the prevention of preterm pre-e...OBJECTIVE: To evaluate the clinical effectiveness and economic impact of implementing first-trimester screening involving placental growth factor (PlGF) followed by aspirin prophylaxis for the prevention of preterm pre-eclampsia in routine obstetric practice. METHODS: This retrospective cohort study was conducted at a tertiary maternal-fetal medicine center that implemented a first-trimester screen-and-prevent strategy for preterm pre-eclampsia. Two time periods were compared: a preimplementation phase (August 2011 to June 2014), during which risk assessment for pre-eclampsia was performed for research purposes without prophylactic aspirin administration; and a postimplementation phase (July 2017 to February 2024), during which women who screened as high risk for preterm pre-eclampsia were given aspirin prophylaxis (160 mg daily until 36 weeks' gestation). Risk assessment was based on the Fetal Medicine Foundation competing-risks algorithm, applied with and without the inclusion of PlGF. The primary outcome was the incidence of preterm pre-eclampsia (< 37 weeks). Secondary outcomes included preterm birth (< 37 weeks), overall pre-eclampsia and estimated healthcare cost savings based on national birth data. This model included the direct medical costs of neonatal management of preterm birth and lifetime costs of cerebral palsy. Adjusted odds ratios (aORs) for preterm pre-eclampsia were estimated using multivariable logistic regression analysis. RESULTS: Among 11 061 singleton pregnancies screened between 11 + 0 and 13 + 6 weeks' gestation, 3216 were screened during the preimplementation period and 7845 during the postimplementation period. The incidence of preterm pre-eclampsia declined from 1.1% to 0.6% between phases (aOR, 0.41 (95% CI, 0.25-0.68)). The overall rate of pre-eclampsia also decreased between phases (2.5% vs 1.4%; aOR, 0.51 (95% CI, 0.37-0.70)), as did that of preterm birth (5.9% vs 4.7%; aOR, 0.76 (95% CI, 0.63-0.92)). The protective effect of aspirin was most pronounced among women identified as high risk using a PlGF-based screening algorithm (aOR, 0.51 (95% CI, 0.28-0.92)), while no significant effect was observed in the group identified as high risk using an algorithm without PlGF. An economic model projected that this strategy would prevent 403 cases of preterm pre-eclampsia annually in a national cohort of 110 000 pregnancies, with estimated cost savings of €27.7 million. CONCLUSIONS: Real-world implementation of PlGF-based screening with aspirin prophylaxis significantly reduced the incidence of preterm pre-eclampsia and preterm birth, and was associated theoretically with substantial health-system cost savings. These findings support consideration of the nationwide adoption of early screen-and-prevent strategies for hypertensive disorders of pregnancy. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Backley S, Chmait RH, Bergh EP
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, Agarwal N, Llanes A, Hamadeh G, Hernandez-Andrade E, Johnson A, Espinoza J, Salazar A, Zhu S, Papanna R
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41643072
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OBJECTIVE: The standard management (SM) for vasa previa (VP) includes antepartum inpatient admission at 28-32 weeks' gestation followed by Cesarean delivery at 34-37 weeks. Case reports and case series have reported on f...OBJECTIVE: The standard management (SM) for vasa previa (VP) includes antepartum inpatient admission at 28-32 weeks' gestation followed by Cesarean delivery at 34-37 weeks. Case reports and case series have reported on fetoscopic laser ablation (FLA) as an alternative management approach for Types-II and -III VP. This study compared maternal and neonatal outcomes in patients with Type-II or -III VP who underwent third-trimester FLA with those who underwent SM. METHODS: This was a cohort study of all antenatally diagnosed cases of Type-II or -III VP identified by ultrasound at, or referred to, two large referral centers in the USA between September 2016 and December 2023. Patients undergoing elective FLA were prospectively followed in both centers, while patients in the SM cohort were selected retrospectively from a single center. The primary outcome was gestational age at delivery. Comparative analysis was performed between SM and FLA cohorts. RESULTS: There were 67 singleton pregnancies complicated by Type-II or -III VP, of which 35 (52.2%) underwent FLA. There were no differences in baseline demographics between the two cohorts. The median gestational age at delivery was 36.0 (interquartile range (IQR), 35.0-37.6) weeks in the FLA cohort and 34.4 (IQR, 33.4-35.0) weeks in the SM cohort (P < 0.001). The rate of vaginal delivery in the FLA cohort was 62.9%. Individuals who underwent FLA had a shorter maternal antepartum stay than did those with SM (median, 1 (IQR, 0-3) days vs 16 (IQR, 7-23) days; P < 0.001). The probability of preterm delivery was higher with SM than with FLA (hazard ratio, 0.24 (95% CI, 0.14-0.44)). The need for neonatal blood transfusion was lower in the FLA cohort than in the SM cohort (0% vs 18.8%; P = 0.009). CONCLUSIONS: Third-trimester FLA offers an alternative to SM for pregnancies complicated by Type-II or -III VP, as it is associated with delivery at a later gestational age and facilitates the option of vaginal delivery. Further research is needed to assess the efficacy of FLA and to provide adequate power to evaluate the potential benefits for both maternal and neonatal outcomes. © 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.
Fiorentini M, Lanzoni G, Micciche A
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, Youssef A, Simonazzi G, Montaguti E
Ultrasound Obstet Gynecol
· 2026 Apr · PMID 41642969
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Banken F, Dewilde K, Van den Bosch T
Ultrasound Obstet Gynecol
· 2026 Apr · PMID 41642829
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López-Mármol R, Ávila-Cabreja JA, Ocón-Hernández O
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, González O, Figueras F, Molina FS
Ultrasound Obstet Gynecol
· 2026 Apr · PMID 41642764
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Parent M, Maurice P, Van den Eede E
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, Mattern J, Sanchez M, Paret L, Dumery G, Badr D, Devlieger R, Calda P, Quibel T, Vauloup-Fellous C, Benachi A, Jouannic JM, Vivanti AJ
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41630156
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OBJECTIVE: Congenital parvovirus B19 (PB19) infection can lead to severe fetal anemia and hydrops fetalis, necessitating in-utero transfusion (IUT) as a life-saving intervention. This study aimed to identify risk factors...OBJECTIVE: Congenital parvovirus B19 (PB19) infection can lead to severe fetal anemia and hydrops fetalis, necessitating in-utero transfusion (IUT) as a life-saving intervention. This study aimed to identify risk factors associated with unfavorable perinatal outcome following IUT in hydropic fetuses with PB19 infection, with the goal of optimizing transfusion strategies and improving fetal survival. METHODS: A retrospective, multicenter, international cohort study was conducted across nine specialized fetal medicine centers in France, Belgium and the Czech Republic. This study included pregnant women with a fetus diagnosed with hydrops due to PB19 infection that underwent at least one IUT for severe fetal anemia between January 2014 and May 2024. Clinical, demographic and procedural data were analyzed. The primary outcome was to identify maternal, fetal, obstetric or IUT-related risk factors associated with adverse fetal or neonatal outcome, defined by a composite criterion of unfavorable outcome that included perinatal mortality and/or severe and persistent fetal anomalies, including severe fetal brain injury at follow-up. Statistical analysis was conducted using logistic regression models to assess potential risk factors. RESULTS: Of the 84 eligible cases, 78 pregnancies were included in the final analysis. The rate of perinatal survival without severe brain injury was 59.0% (46/78), while 41.0% (32/78) of cases had an unfavorable outcome, including 20 (25.6%) cases of stillbirth, nine (11.5%) cases of termination of pregnancy, one (1.3%) case of continuation of pregnancy despite severe prenatal neurological findings and two (2.6%) cases of neonatal death. Notably, a higher fetal hemoglobin (Hb) level (> 9.3 g/dL) after the first or second IUT was significantly associated with a reduced risk of unfavorable outcome (adjusted odds ratio (aOR), 0.6 (95% CI, 0.4-0.8)). A femur length Z-score of < -2 was associated with unfavorable outcome (aOR, 5.4 (95% CI, 1.3-27.0)). Transplacental vs transamniotic funicular puncture was not significantly associated with perinatal survival. CONCLUSIONS: IUT remains a cornerstone intervention for managing severe fetal anemia caused by PB19 infection; however, rates of perinatal loss continue to be substantial, especially in the presence of severe hydrops. Achieving higher post-transfusion Hb levels appears to be an important factor in improving survival outcomes for hydropic fetuses with PB19 infection. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Giles-Clark HJ, Rolnik DL, Skinner SM
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, Mol BW
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41628402
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Reid S, Lee P, Madan N
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, Takeoka E, Samura O, Craig A, Grant PE, Im K, Tarui T, Collaborators
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41628372
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Chandrasekar H, Kaplinski M, Maskatia SA
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, Beattie MJ, Ho DY, Reddy CD, Punn R
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 41614972
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OBJECTIVES: In dextro-transposition of the great arteries (D-TGA) and double outlet right ventricle with subpulmonary ventricular septal defect (DORV-SPV) and predicted transposition physiology, the presence of associate...OBJECTIVES: In dextro-transposition of the great arteries (D-TGA) and double outlet right ventricle with subpulmonary ventricular septal defect (DORV-SPV) and predicted transposition physiology, the presence of associated lesions, such as ventricular septal defect (VSD), coarctation of the aorta (CoA) or pulmonary stenosis (PS), impacts prenatal counseling and complicates neonatal surgery. This study aimed to evaluate the diagnostic accuracy of fetal echocardiography (FE) and its ability to predict the postnatal surgical plan in fetuses with D-TGA or DORV-SPV. METHODS: This was a single-center retrospective cohort study of fetuses with D-TGA or DORV-SPV who were liveborn, had a recorded plan for postnatal intervention and were managed at Lucile Packard Children's Hospital, Palo Alto, CA, USA, between January 2013 and January 2024. In cases with serial FE examinations, all available FE reports were included in the analysis, in addition to the first postnatal echocardiogram report. For echocardiograms with incomplete measurement data, a single reader retrospectively obtained FE and postnatal echocardiogram measurements while blinded to clinical outcomes. Prenatal predictions for postnatal surgical repair were extracted from the fetal cardiology consultation notes and postnatal clinical data were obtained by chart review. Final FE and postnatal echocardiogram diagnoses, as well as prenatal surgical-plan predictions and subsequent postnatal surgical repairs performed, were compared and the percentage concordance was calculated to obtain FE diagnostic accuracy. Receiver-operating-characteristics (ROC) curves were generated to evaluate the association of FE aortic and pulmonary measurements with postnatal CoA repair. RESULTS: The study included 99 fetuses, of which 45 were diagnosed postnatally with simple D-TGA with no associated lesions (i.e. D-TGA with intact ventricular septum), 38 with complex D-TGA with associated lesions and 15 with DORV, and one neonate was diagnosed prenatally with DORV-SPV but postnatally diagnosed with truncus arteriosus. In the majority (65%) of patients, serial FE was performed. The percentage concordance between fetal and postnatal echocardiogram diagnoses was high for simple D-TGA (95% (42/44)) and D-TGA with VSD and PS (100% (3/3)). The concordance was progressively lower for diagnoses of D-TGA with VSD (93% (25/27)), DORV-SPV (60% (3/5)), DORV-SPV with CoA (40% (4/10)), D-TGA with VSD and CoA (29% (2/7)), D-TGA with isolated CoA (0% (0/2)) and DORV-SPV with PS (0% (0/1)). Similarly, surgical-plan accuracy between prenatal prediction and postnatal repair performed was highest for cases of simple D-TGA and D-TGA with VSD and PS, while it was lower for other diagnoses. Qualitative descriptions of VSD size changed frequently over serial FE examinations, with VSDs generally described as larger on later FE. However, between the final FE and postnatal echocardiogram, in those with discordance, the description of VSD size usually became smaller. Only 50% of small VSDs identified on postnatal echocardiography required repair. All patients who underwent postnatal repair of CoA had a VSD present. All area under the ROC curve values for aortic measurements and for ratios of aortic-to-pulmonary dimensions in predicting the need for postnatal CoA repair were greater than 0.9. CONCLUSIONS: Challenges remain in the accurate diagnosis and prediction of the postnatal surgical plan in fetuses with complex D-TGA and DORV-SPV. The assessment of qualitative VSD size description changed frequently over serial FE evaluations, and between final FE and postnatal echocardiogram, with small defects often not requiring repair. Aortic and aortic-to-pulmonary ratio measurements in fetuses with D-TGA or DORV-SPV appear to have improved the discriminatory ability in identifying cases that undergo postnatal CoA repair relative to fetuses with isolated CoA. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Corroenne R, Huisman TAGM, Whitehead WE
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, Nassr AA, Munoz JL, Castillo J, Castillo H, Johnson RM, Donepudi RV, Belfort MA, Sanz-Cortes M
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41581239
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OBJECTIVE: Myelomeningocele (MMC) is associated with significant alterations of the brain microstructure, which can impair long-term neurodevelopmental outcomes. By measuring the random displacement of water molecules wi...OBJECTIVE: Myelomeningocele (MMC) is associated with significant alterations of the brain microstructure, which can impair long-term neurodevelopmental outcomes. By measuring the random displacement of water molecules within the brain, magnetic resonance imaging (MRI)-based diffusion-weighted imaging (DWI) can provide objective metrics, such as apparent diffusion coefficient (ADC) values, which allow the fetal brain microstructure to be characterized. The aim of this study was to compare prenatal brain ADC values, obtained using MRI-DWI, between infants with prenatally repaired MMC who had normal vs impaired neurodevelopmental outcomes, assessed ≥ 18 months of age. METHODS: This retrospective study included children who underwent prenatal MMC repair using either a fetoscopic or open-hysterotomy surgical approach between July 2012 and June 2022, at a single tertiary hospital. A 1.5-Tesla MRI-DWI scan of the fetal brain was performed using standard departmental protocols 6 weeks after surgery. ADC values were measured in the right and left hemispheric white matter of the frontal, parietal, temporal and occipital lobes, as well as within the basal ganglia, pons, cerebellar hemispheres and vermis. Neurodevelopment was evaluated by a developmental pediatrician at or after 18 months of age, using the Capute Scales (Clinical Adaptive Test (CAT) for problem-solving skills and fine motor skills and Clinical Linguistic and Auditory Milestone Scale (CLAMS) test for language) and the gross motor domain of the Revised Gesell Developmental Schedules. The Developmental Profile-3 (DP-3) test was also conducted during parental interview at or after 18 months of age, which evaluates five qualities of development: physical, adaptive behavior, social-emotional, cognitive and communication skills. Developmental quotients were calculated as: (age equivalent on Capute Scales, gross motor or DP-3 test/age at assessment) × 100. A normal developmental quotient score was defined as ≥ 85 and a score of < 85 indicated neurodevelopmental impairment (NDI), compared with reference values. ADC values measured in each brain region were compared between children who later had a normal developmental quotient score vs those with a score < 85, using the Mann-Whitney U-test and logistic regression analysis, adjusting for the child's age at the time of neurodevelopmental testing, gestational age at the time of MRI-DWI and gestational age at delivery. RESULTS: A total of 50 children were included (39 that underwent prenatal fetoscopic repair and 11 that underwent prenatal open-hysterotomy repair). A prenatal MRI-DWI scan was performed after surgery at a median of 30.9 (interquartile range (IQR), 30.5-31.4) weeks' gestation. The Capute Scales and gross motor scores were available in 31/50 (62.0%) and 29/50 (58.0%) cases, respectively, and were obtained at a median age of 23.0 (IQR, 18.0-25.5) months and 23.0 (IQR, 21.0-26.2) months, respectively. Among these cases, 22/31 (71.0%), 19/31 (61.3%) and 3/29 (10.3%) scored ≥ 85 on the CLAMS test, CAT and gross motor test, respectively. The DP-3 test score was available in 42/50 (84.0%) children and was conducted at a median age of 24.5 (IQR, 19.0-26.7) months. Among these children, 18/42 (42.9%), 28/42 (66.7%), 38/42 (90.5%), 35/42 (83.3%) and 33/42 (78.6%) had a score ≥ 85 for the physical, adaptive behavior, social-emotional, cognitive and communication domains, respectively. After adjustment, fetal ADC values obtained 6 weeks after surgery were significantly higher in all fetal brain regions studied (P < 0.05 for all), except for the vermis (P = 0.12) and pons (P = 0.05), in infants who later had a CLAMS test score indicating NDI compared to those with a score ≥ 85. Additionally, fetal ADC values were significantly higher in all fetal brain regions, except for the left temporal lobe (P = 0.05), left occipital lobe (P = 0.06), pons (P = 0.30), right and left cerebellum (P = 0.55 and 0.24, respectively) and vermis (P = 0.76), in infants who later had a CAT score indicating NDI compared to those with a normal score. Fetal ADC values were also significantly higher in the parietal and temporal lobes as well as in the pons (P < 0.05 for all) in infants who later had a DP-3 cognitive and communication score indicating NDI compared to those with a normal score. There was no difference in fetal ADC values in any of the brain regions studied between children with scores indicating normal vs impaired neurodevelopment on the gross motor test, the DP-3 physical, adaptive behavior and social-emotional domains or the DP-3 general development score. CONCLUSION: Infants with NDI in problem-solving, cognitive and communication skills exhibited significant differences in their brain microstructure, as demonstrated by higher ADC values measured in utero 6 weeks after prenatal MMC repair, compared to those with normal neurodevelopmental outcomes as assessed at or after 18 months of age. These findings have significant clinical implications, especially for the early identification and management of children at risk for NDI after prenatal MMC repair. © 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.
Miremberg H, Feldman N, Malinger G
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, Krajden Haratz K, Perlman S
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41575831
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Meijerink L, Wyburd M, Namburete AIL
… +5 more
, Alderliesten T, Groenendaal F, Benders M, Terstappen F, Bekker MN
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41575808
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OBJECTIVES: To quantify fetal brain maturation in fetuses with early-onset fetal growth restriction (FGR) by estimating gestational age (GA) based on the appearance of gyrification and individual brain structures from th...OBJECTIVES: To quantify fetal brain maturation in fetuses with early-onset fetal growth restriction (FGR) by estimating gestational age (GA) based on the appearance of gyrification and individual brain structures from three-dimensional (3D) ultrasound volumes using a deep-learning model trained on optimally developing subjects. The association of altered fetal brain maturation, as a potential marker of cumulative intrauterine stress, with an increased risk of neonatal complications was also explored. METHODS: This was a prospective, observational, single-center cohort study of singleton pregnancies with early-onset FGR conducted at the University Medical Center Utrecht between June 2022 and June 2024. Early-onset FGR was defined as an estimated fetal weight (EFW) and/or abdominal circumference below the 10 percentile before 32 weeks' gestation, and brain sparing was defined as an umbilical artery pulsatility index (PI) above the 95 percentile in combination with a middle cerebral artery PI below the 5 percentile or a cerebroplacental ratio (CPR) < 1. Fetal brain maturation was determined using a deep-learning model, which was trained on data from an optimally developing cohort at GAs of between 18 + 0 and 28 + 6 weeks, collected by the INTERGROWTH-21 Consortium. Therefore, only fetuses with a GA of < 29.0 weeks at the time of the scan were included in the analysis. Estimation of brain maturation was based on the size and shape of the Sylvian fissure (SF), parieto-occipital fissure (POF) and calcarine sulcus (CLC), cerebellum (CB) and the combination of all fissures using the whole-brain ultrasound scan. The mean difference between estimated GA and actual GA (ΔGA) in days was calculated. In a subgroup analysis, ΔGA for brain-sparing FGR was compared with ΔGA for non-brain-sparing FGR. Regression analysis was performed to examine the relationship between brain maturation data and potential covariates. RESULTS: The study included 43 growth-restricted fetuses with high-quality 3D ultrasound scans (13 of which had brain-sparing FGR) at a median GA of 27.1 (interquartile range (IQR), 26.1-27.7) weeks. The estimated GA was significantly lower than the actual GA in early-onset FGR, with ΔGA of -4.6 (IQR, -9.8 to -1.0) days based on the whole scan, ΔGA of -4.9 (IQR, -9.0 to -1.2) days based on the SF, ΔGA of -5.4 (IQR, -7.4 to -1.7) days based on the POF and CLC, and ΔGA of -3.2 (IQR, -6.8 to 0.3) days based on the CB (P < 0001 for all). There was no significant difference in brain maturation between fetuses with brain-sparing and those with non-brain-sparing FGR or between male and female fetuses. The EFW percentile correlated significantly with the degree of delayed maturation (whole-scan data, r = 0.377; P = 0.013) and contributed to our multivariable model. Socioeconomic status, fetal sex and CPR were not associated with the delay in maturation. Seventeen neonates were born < 32.0 weeks' gestation and admitted to the neonatal intensive care unit. The ΔGA was higher in the neonates with perinatal complications, indicating greater delay in brain maturation. CONCLUSIONS: Delayed fetal brain maturation in early-onset FGR has been demonstrated using a 3D ultrasound deep-learning model. These findings highlight the potential role of 3D ultrasound in the assessment of fetal brain maturation and support the need for continued research into these findings and their long-term neurodevelopmental consequences in early-onset FGR. © 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.
Creswell L, Napolitano R, Pandya P
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41569226
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