Ultrasound Obstet Gynecol [JOURNAL]
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Agudogo S, McMahon C, Rolnik DL
… +1 more
, Oyelese Y
Ultrasound Obstet Gynecol
· 2026 Feb · PMID 41546609
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OBJECTIVE: To evaluate national and international obstetric ultrasound guidelines regarding their recommendations for vasa previa (VP) screening, and to assess the consistency, scope and evidence base of the recommendati...OBJECTIVE: To evaluate national and international obstetric ultrasound guidelines regarding their recommendations for vasa previa (VP) screening, and to assess the consistency, scope and evidence base of the recommendations. METHODS: We conducted a comprehensive review of accessible national obstetric imaging guidelines from 15 countries worldwide, as well as two international guidelines by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). Guidelines were assessed for whether they explicitly mentioned VP, recommended screening for VP or incorporated VP detection strategies, such as placental cord insertion assessment, color flow Doppler assessment of the lower uterine segment or third-trimester transvaginal ultrasound with color flow Doppler in patients with second-trimester placenta previa or low-lying placenta. Additionally, we evaluated whether any national societies or international organizations had specific guidelines on VP, which were then assessed for whether they included recommendations for VP screening and outlined specific screening policies or strategies. RESULTS: Of 20 national and two international obstetric imaging guidelines reviewed, 12 mentioned VP and none explicitly recommended routine screening for VP in pregnant individuals. Nine national obstetric imaging guidelines recommended routine assessment of the placental cord insertion, while none endorsed routine color flow Doppler assessment of the lower uterine segment. Five national guidelines recommended third-trimester transvaginal ultrasound examination with color flow Doppler to rule out VP in pregnancies with a second-trimester low-lying placenta or placenta previa. In our search, only five national societies were found to have developed dedicated VP guidelines, although some of their recommendations were inconsistent with recent evidence. For example, the 2019 guideline from the Royal College of Obstetricians and Gynaecologists in the UK does not recommend routine VP screening, citing insufficient evidence and an uncertain balance of benefit vs harm. CONCLUSIONS: Despite the high mortality rate associated with undiagnosed VP and the mounting evidence supporting the feasibility of screening, many national and international obstetric imaging guidelines either omit mention of VP or fall short of recommending a structured screening approach. Given the demonstrated accuracy of VP screening, its remarkable impact in reducing the rate of VP-related stillbirth and the minimal additional resources required for VP detection strategies, current imaging guidelines should be updated to incorporate evidence-based VP screening strategies into routine obstetric imaging protocols to reduce preventable perinatal deaths. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Ebbing C, Halmoy A, Jauniaux E
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, Einum A, Rasmussen S, Moster D
Ultrasound Obstet Gynecol
· 2026 Feb · PMID 41546561
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OBJECTIVE: A single umbilical artery (SUA) is associated with a risk of adverse perinatal outcome. Around 11% of fetuses with SUA present with an associated major anomaly, including those of the central nervous system. H...OBJECTIVE: A single umbilical artery (SUA) is associated with a risk of adverse perinatal outcome. Around 11% of fetuses with SUA present with an associated major anomaly, including those of the central nervous system. However, studies on the associations between SUA and childhood neurodevelopmental disorders (NDD), such as intellectual disability (ID), attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, epilepsy, impaired hearing and impaired vision, are limited. We aimed to evaluate the risk of NDD in children presenting with an isolated SUA (iSUA) at birth and the possible impact of sex, and to examine the extent to which gestational age at birth and birth weight mediate the effect of iSUA on NDD. METHODS: This was a historical national cohort study linking data from the Medical Birth Registry of Norway with other mandatory national registries. We included all singleton live births in Norway between 1 January 1999 and 31 December 2013, and follow-up of the study cohort was concluded on 31 December 2019. We included all newborns diagnosed with iSUA. Data regarding NDD diagnosis were obtained from the Norwegian National Insurance Scheme and the Norwegian Patient Registry. We used multilevel logistic regression to calculate odds ratios (ORs) with 95% CIs, and performed sex-stratified analyses. A causal mediation analysis of the relationship between iSUA and NDD with preterm birth (live birth < 37 weeks' gestation) and small-for-gestational age (SGA) (birth weight < 5 percentile) was performed. RESULTS: The cohort of 858 397 singleton live births included 3532 cases diagnosed with iSUA (0.41%), of which 1802 (51.3%) were male, 253 (7.2%) were born preterm and 249 (7.0%) were SGA. iSUA was associated with increased odds of subsequent ID (OR, 1.56 (95% CI, 1.09-2.23)) and ADHD (OR, 1.22 (95% CI, 1.02-1.47)), but there was no observed association with other NDD. In sex-stratified analyses, the associations with iSUA were observed in females but not in males. Preterm birth and SGA were each found to mediate < 10% of the total effect of iSUA on ID. CONCLUSION: iSUA was weakly associated with ID and ADHD, but not with other NDD. These associations were influenced by sex and were mediated by < 10% by preterm birth or SGA. The absence of associations of iSUA with other NDD is reassuring, and this finding is useful in the counseling of expectant parents of fetuses with iSUA. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Van den Bosch T, Heremans R, Landolfo C
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, Epstein E, Leone FPG, Bourne T, Timmerman D, Collaborators
Ultrasound Obstet Gynecol
· 2026 Feb · PMID 41542753
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Kitmiridou D, Mitrogiannis I, Charakida M
… +1 more
, Nicolaides KH
Ultrasound Obstet Gynecol
· 2026 Apr · PMID 41531381
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OBJECTIVE: To explore potential changes in retinal structures in pregnant women with pre-eclampsia (PE). METHODS: This was a systematic review of the literature on retinal assessment in pregnancies complicated by PE. Pub...OBJECTIVE: To explore potential changes in retinal structures in pregnant women with pre-eclampsia (PE). METHODS: This was a systematic review of the literature on retinal assessment in pregnancies complicated by PE. PubMed, EMBASE via Ovid, The Cochrane Library and Scopus databases were searched in July 2025 using an a-priori-designed protocol for studies examining the retina of pregnant women with an established diagnosis of PE or those who developed PE following retinal assessment. Randomized controlled trials and prospective and retrospective cohort, case-control and population-based studies were eligible. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions version 2 (ROBINS-I V2) tool. Due to substantial heterogeneity observed between studies in the methods of retinal assessment, retinal parameters studied and gestational age at retinal examination, a meta-analysis was not performed. RESULTS: The electronic database search yielded 1544 results, of which 75 were eligible for full-text review and 24 studies were included in the systematic review. The methods of retinal assessment utilized in the included studies were optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), retinal fundus photography and central retinal artery Doppler. Each method examined a variety of retinal parameters. Studies using OCT reported that the choroidal thickness was decreased, increased or not significantly different in women with PE vs non-PE controls. With regard to retinal thickness, retinal nerve fiber layer thickness, macular thickness, ganglion cell layer thickness, choroidal vessel density and total retinal volume, most studies reported similar values in PE and non-PE groups. For OCTA parameters, including foveal avascular zone area, vessel density in the deep and superficial capillary plexuses and choriocapillaris blood flow, some studies reported reduced values in the PE group, while others reported no significant differences between groups. Retinal fundus photography was performed in two studies; one reported reduced arteriolar and venular equivalents in women with PE, and the other reported reduced arteriole-to-vein ratio in women with severe PE vs without PE. One study used Doppler to assess the central retinal artery and reported a higher resistance index in those with PE compared to non-PE controls. According to the ROBINS-I V2 tool, the risk of bias was moderate in eight studies and serious in 16 studies. CONCLUSIONS: Findings on the changes in retinal structure and function in pregnancies complicated by PE are inconclusive. The degree of change, and whether the changes precede the clinical onset of PE or are a result of hypertension and associated cardiovascular sequalae, is uncertain. There is an unmet need for large-scale prospective studies to address this uncertainty. © 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.
Youssef L, Paolucci S, Crovetto F
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, Miranda J, Lobmaier S, Figueras F, Crispi F, Gratacos E
Ultrasound Obstet Gynecol
· 2026 Feb · PMID 41505741
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OBJECTIVE: Angiogenic factors are elevated in fetal growth restriction (FGR), but their clinical value for assessing the severity of FGR and the potential influence of coexisting pre-eclampsia has scarcely been investiga...OBJECTIVE: Angiogenic factors are elevated in fetal growth restriction (FGR), but their clinical value for assessing the severity of FGR and the potential influence of coexisting pre-eclampsia has scarcely been investigated. In this study, our aim was to investigate the profile of maternal angiogenic factors across severity stages of fetal smallness compared with controls, analyzed overall and stratified by the presence or absence of pre-eclampsia, and to investigate whether values of these angiogenic factors, such as placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and the sFlt-1/PlGF ratio, are helpful in determining the severity stage of fetal smallness. METHODS: This was a prospective cohort study of women with a singleton pregnancy diagnosed with fetal smallness (defined as birth weight < 10 centile) (n = 604) between October 2010 and December 2017, compared with a control group of pregnant women with an appropriate-for-gestational-age (AGA) singleton fetus (defined as birth weight ≥ 10 centile) (n = 424). At diagnosis, ultrasound was performed to assess estimated fetal weight (EFW) and Doppler pulsatility indices (PI) of the uterine artery (UtA), umbilical artery (UA), fetal middle cerebral artery (MCA) and ductus venosus (DV), and these parameters were monitored regularly until delivery. Cerebroplacental ratio (CPR) was calculated as MCA-PI/UA-PI. Small fetuses were classified as: small-for-gestational age (SGA) if EFW ≥ 3 and < 10 centile, with normal Doppler parameters; FGR Stage I if either EFW < 3 centile, persistent MCA-PI < 5 centile, UA-PI > 95 centile, CPR < 5 centile or UtA-PI > 95 centile; FGR Stage II if there was absent end-diastolic flow in the UA; FGR Stage III if there was reversed end-diastolic flow in the UA or DV-PI ≥ 95 centile; or FGR Stage IV if there was non-reassuring cardiotocography or absent/reversed DV atrial flow. Maternal peripheral venous blood concentrations of PlGF and sFlt-1 were determined using enzyme-linked immunosorbent assay, and the sFlt-1/PlGF ratio was calculated. Linear trend of proportions was tested using the Mantel-Haenszel chi-square test. RESULTS: Among AGA controls (n = 424), SGA (n = 192), FGR Stage I (n = 380), FGR Stage II (n = 16) and FGR Stages III-IV (n = 16) fetuses, the proportion of cases with a sFlt-1/PlGF ratio > 95 centile was 12.7%, 7.8%, 30.8%, 43.8% and 62.5%, respectively (P = 0.0001), and the median multiples of the median (MoM) values for the sFlt-1/PlGF ratio were 0.55 (interquartile range (IQR), 0.19-2.00), 1.00 (IQR, 0.31-2.67), 3.03 (IQR, 0.91-8.20), 3.94 (IQR, 0.85-9.13) and 7.32 (IQR, 1.44-16.29), respectively (P = 0.24). Pre-eclampsia was diagnosed at any time between inclusion and delivery in 1.9% of controls, 3.6% of SGA, 21.1% of FGR Stage I, 37.5% of FGR Stage II and 50.0% of FGR Stages III-IV fetuses. Among all small fetuses with vs without pre-eclampsia, the proportion of pregnancies with sFlt-1/PlGF ratio > 95 centile was 56.9% vs 15.4% (P < 0.001) and the median MoM of the sFlt-1/PlGF ratio was 8.11 (IQR, 3.83-27.09) vs 1.59 (IQR, 0.52-5.04) (P = 0.18). CONCLUSIONS: Serum levels of angiogenic factors became more abnormal as the severity stage of fetal smallness increased. This association with severity was stronger in the presence of pre-eclampsia. However, absolute values of serum levels showed substantial overlap in both the presence and the absence of pre-eclampsia, making their use in determining the severity stage of fetal smallness challenging. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Haavaldsen C, Thomas O, Eskild A
Ultrasound Obstet Gynecol
· 2026 Feb · PMID 41499673
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OBJECTIVES: To determine the risk of pre-eclampsia in ongoing pregnancies according to gestational age. We also studied whether the gestational-age-specific risks of developing pre-eclampsia have changed over recent deca...OBJECTIVES: To determine the risk of pre-eclampsia in ongoing pregnancies according to gestational age. We also studied whether the gestational-age-specific risks of developing pre-eclampsia have changed over recent decades. METHODS: This was a population-based study using data from the Medical Birth Registry of Norway. The study population included all singleton pregnancies in Norway delivered between 21 and 43 weeks' gestation during the period 1984-2019. We calculated the proportion of pregnancies with pre-eclampsia at each week of gestation. The numerator was the number of pre-eclamptic pregnancies that were delivered during the gestational week being studied, and the denominator included all pregnancies still ongoing at the same gestational week. We analyzed the study period as a whole and subdivided it into four time periods (1984-1989, 1990-1999, 2000-2009 and 2010-2019). RESULTS: A total of 1 955 082 pregnancies were included, of which 3.2% developed pre-eclampsia. The risk of pre-eclampsia increased with advancing gestational age. The risk per 1000 ongoing pregnancies was 0.2 at 28 weeks, 5.2 at 38 weeks and 13.6 at 42 weeks. The gestational-age-specific risk of developing pre-eclampsia was lower at all gestational ages during the period 2010-2019 compared with 2000-2009, and the absolute decrease was greatest in term and post-term pregnancies. CONCLUSIONS: The risk of developing pre-eclampsia increased almost exponentially with advancing gestational age. During the last decade of the study period, the risk of pre-eclampsia decreased, particularly in term pregnancies. This decrease may be explained by the use of obstetric interventions to shorten the duration of pregnancy among women at high risk of developing pre-eclampsia. © 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.
Mathewlynn S, Starck LN, Yin Y
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, Soltaninejad M, Swinburne M, Nicolaides KH, Syngelaki A, Contreras AG, Bigiotti S, Woess EM, Gerry S, Collins S
Ultrasound Obstet Gynecol
· 2026 Feb · PMID 41499517
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OBJECTIVE: To establish a comprehensive reference range for first-trimester placental three-dimensional (3D) single-vessel fractional moving blood volume (svFMBV) using the OxNNet toolkit, based on values observed in hea...OBJECTIVE: To establish a comprehensive reference range for first-trimester placental three-dimensional (3D) single-vessel fractional moving blood volume (svFMBV) using the OxNNet toolkit, based on values observed in healthy pregnancies. METHODS: This study utilized data from the First-trimester Placental Ultrasound (FirstPLUS) study, a longitudinal observational cohort study conducted between March and November 2022 at King's College Hospital, London, UK. Participants underwent 3D ultrasound assessment of the placenta, including power Doppler imaging, during routine first-trimester screening. The OxNNet toolkit was used for automated placental segmentation and 3D-svFMBV calculation. Quality control was performed in three stages to ensure image completeness and segmentation accuracy. Quantile regression and lambda-mu-sigma (LMS) modeling were used to construct reference charts for 3D-svFMBV. Model fit was assessed using the Akaike information criterion, and centile curves were constructed. RESULTS: The final cohort comprised 2547 cases. Visual assessment of histograms and quantile-quantile plots revealed positive skew in 3D-svFMBV determined at five specific locations within the uteroplacental vasculature. LMS modeling provided the best fit for constructing centile charts, with the Box-Cox Power Exponential original distribution used in most cases. The resulting centile charts demonstrated close agreement between predicted and observed centiles, with minimal deviation across all target centiles. CONCLUSIONS: This study provides novel reference ranges for first-trimester placental 3D-svFMBV at five locations within the uteroplacental vasculature. These findings offer a valuable foundation for future research into placental function and pregnancy outcome. © 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.
Bergøy Ø, Dalen I, Kiserud T
… +2 more
, Kessler J, Sande RK
Ultrasound Obstet Gynecol
· 2026 Feb · PMID 41489412
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OBJECTIVE: Blood flow to the fetal adrenal arteries is shown to increase during placental dysfunction in animal studies. Reference ranges of fetal adrenal blood flow parameters are needed to explore the diagnostic possib...OBJECTIVE: Blood flow to the fetal adrenal arteries is shown to increase during placental dysfunction in animal studies. Reference ranges of fetal adrenal blood flow parameters are needed to explore the diagnostic possibilities of this concept in humans. The aim of this study was to establish longitudinal reference ranges for pulsatility index (PI), peak systolic velocity (PSV), time-averaged maximum velocity (TAmax) and end-diastolic velocity (EDV) of the inferior adrenal artery of human fetuses across the second half of gestation. METHODS: This was a prospective longitudinal cohort study conducted at Stavanger University Hospital, Stavanger, Norway, of women with a singleton low-risk pregnancy presenting for routine second-trimester screening between June 2020 and May 2023. Participants were examined every 4 weeks, from 19 to 41 weeks' gestation, to establish longitudinal reference ranges for the abovementioned blood velocity parameters, covering the second half of pregnancy. We used the visualization and blood flow velocity measurement techniques, as well as the definition of the inferior adrenal artery, as described in our previous study. Each assessment included ultrasound examination with SlowFlow™ power Doppler to visualize the fetal inferior adrenal artery and pulsed-wave Doppler to record blood velocity parameters in this artery, with one to six assessments per participant over the course of the second half of pregnancy. At each assessment, PSV, EDV and TAmax were measured and the PI was calculated. Mixed linear models were used to estimate the longitudinal reference ranges. RESULTS: In total, 146 participants were examined and the blood velocity in the fetal inferior adrenal artery was measured successfully in 542/608 examinations, yielding a success rate of 89%. Based on this dataset, we constructed longitudinal reference ranges for PI and PSV, as well as for EDV and TAmax, of the fetal inferior adrenal artery throughout the second half of gestation. The PI of the fetal inferior adrenal artery increased slightly throughout the second trimester and declined towards term. The PSV of the fetal inferior adrenal artery was stable throughout the second trimester, but increased from 30 weeks' gestation until the end of the third trimester. CONCLUSION: We present longitudinal reference ranges for PI and PSV of the fetal inferior adrenal artery in low-risk singleton pregnancies across the second half of pregnancy. Additionally, we provide terms, including formulae and the conditions under which they apply, for calculating individualized conditional reference ranges for serial measurements of blood velocity parameters. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Della Valle L, Pilu G, Khalil A
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, Rizzo G, Pooh R, Galindo A, Grisolia G, Duncan JR, Timor-Tritsch IE, D'Antonio F
Ultrasound Obstet Gynecol
· 2026 Apr · PMID 41489173
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Bennett S, Hornberger LK, Kaur A
… +2 more
, Fruitman D, Eckersley LG
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 41483458
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OBJECTIVE: Increased remoteness of residence (RoR) and lower socioeconomic status (SES) negatively impact the rate and gestational age (GA) at the diagnosis of major congenital heart disease (mCHD). We examined the direc...OBJECTIVE: Increased remoteness of residence (RoR) and lower socioeconomic status (SES) negatively impact the rate and gestational age (GA) at the diagnosis of major congenital heart disease (mCHD). We examined the direct and indirect relationships of RoR from a tertiary fetal cardiology center and Chan SES index with the rate of termination of pregnancy (TOP). METHODS: We conducted a retrospective population-based cohort study of all pregnancies with a prenatal diagnosis of mCHD in Alberta, Canada, from January 2008 to December 2021. Maternal RoR from the nearest tertiary fetal cardiology center and Chan SES index were primary exposures and GA at diagnosis of mCHD was examined as a potential mediator. The outcome was TOP. RoR, SES and GA at diagnosis were analyzed using structural equation modeling and mediation analysis, adjusting for maternal age, parity and presence of syndromic diagnosis. RESULTS: Of 1091 included pregnancies with mCHD and known pregnancy outcome, 203 (18.6%) ended in TOP. A lower rate of TOP was associated with diagnosis ≥ 22 weeks' gestation (47/532 (8.8%)) compared with diagnosis < 22 weeks (156/559 (27.9%)) (P < 0.001). There was a significant reduction in the rate of TOP among those with RoR ≥ 100 km (relative risk (RR), 0.94 (95% CI, 0.89-0.99); P = 0.022), and a trend towards an association between higher SES and increased likelihood of TOP (RR, 1.11 (95% CI, 1.00-1.22); P = 0.053), mediated by GA at diagnosis. There was no direct effect of RoR or SES on the rate of TOP. Diagnosis ≥ 22 weeks was associated with younger nulliparous (P = 0.018) and parous (P = 0.036) mothers, but not with maternal age overall. When stratified by the presence of a comorbid syndromic diagnosis, lower rates of TOP were indirectly associated with greater RoR and lower SES in fetal mCHD with syndromic diagnosis, mediated by GA at diagnosis (P = 0.057 and P = 0.02 respectively). CONCLUSIONS: The parental decision to terminate pregnancy was related directly to GA at diagnosis of mCHD and related indirectly to greater RoR when mediated by GA at diagnosis. These findings should prompt further exploration of factors responsible for the later diagnosis of mCHD in those residing remotely. © 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.
Bonacina E, Armengol-Alsina M, Dalmau M
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, Casellas A, Roldán E, Temprado J, Del Barco E, Arias A, Ferrer-Costa R, Maiz N, Mendoza M
Ultrasound Obstet Gynecol
· 2026 Feb · PMID 41483012
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OBJECTIVE: Pre-eclampsia (PE) is a leading cause of maternal and neonatal morbidity and mortality worldwide. Early identification of high-risk pregnancies in the first trimester allows preventive treatment with low-dose...OBJECTIVE: Pre-eclampsia (PE) is a leading cause of maternal and neonatal morbidity and mortality worldwide. Early identification of high-risk pregnancies in the first trimester allows preventive treatment with low-dose aspirin. This study aimed to evaluate whether multivariable Gaussian algorithm-based PE screening strategies, with and without placental growth factor (PlGF), are cost beneficial compared with no screening. METHODS: The cost-benefit analysis estimated the total healthcare savings for the two screening strategies compared with no screening, considering both the costs associated with implementing the screening and the savings derived from the number of cases of PE and preterm infants prevented. The analysis was based on real-world data from Catalan maternity centers applied to a cohort of 56 344 pregnancies (annual birth rate in 2023). Univariable sensitivity and best- and worst-case scenario analyses were also conducted. RESULTS: Both screening strategies resulted in cost savings compared with no screening. The Gaussian algorithm without PlGF yielded greater healthcare savings (€3.38 million) than did the Gaussian algorithm with PlGF (€3.29 million). However, the addition of PlGF provided greater clinical benefit, preventing a higher number of PE cases. Sensitivity analysis identified PE incidence and preterm birth rates as the primary cost drivers. For the PlGF strategy to be cost beneficial, the PlGF reagent cost per unit should not exceed €4.31. CONCLUSIONS: Although the Gaussian algorithm without PlGF demonstrated the highest cost savings compared with no screening, incorporating PlGF further improved PE prevention, supporting its broader adoption. A PlGF reagent cost per unit below €4.31 may make this strategy cost-beneficial, enhancing its clinical implementation. © 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.
Setty T, Kastora SL, Tellum T
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, Farren J, Jauniaux E, Jurkovic D
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41482994
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OBJECTIVE: To investigate whether combining abnormal morphological features observed on ultrasound in live pregnancies that ended in a first-trimester miscarriage can predict an abnormal karyotype. METHODS: This retrospe...OBJECTIVE: To investigate whether combining abnormal morphological features observed on ultrasound in live pregnancies that ended in a first-trimester miscarriage can predict an abnormal karyotype. METHODS: This retrospective observational cohort study was conducted at the early-pregnancy assessment unit at University College London Hospital, London, UK, between January 2017 and February 2024. Cytogenetic testing was offered routinely to patients experiencing recurrent miscarriage (at least two miscarriages) or was made available through self-funding. Eligible participants had a singleton, normally sited pregnancy with evidence of cardiac activity on at least one ultrasound scan, and were subsequently diagnosed with a first-trimester miscarriage, with successful cytogenetic testing of pregnancy tissue. Crude ultrasound measurements of gestational sac mean diameter (GSMD), yolk sac mean diameter (YSMD), crown-rump length (CRL) and embryonic heart rate from the last live ultrasound scan were converted to centiles according to established biometric reference data. Univariable and multivariable logistic regression analysis was used to assess associations between sonographic features and karyotype result. RESULTS: Among 158 cases included in the final analysis, 46 (29.1%) had a normal karyotype and 112 (70.9%) had an abnormal karyotype. Those with an abnormal karyotype had a significantly higher median maternal age at conception (38 (interquartile range (IQR), 34-41) years vs 35 (IQR, 33-38) years; P = 0.0005). Median GSMD centile (P = 0.005) and median CRL centile (P = 0.003) were lower in pregnancies with an abnormal karyotype, while bradycardia (heart rate < 5 centile) (P = 0.04) and enlarged YSMD (≥ 95 centile) (P = 0.03) were more common in this group. A combination of four abnormal morphological features (GSMD < 5 centile + YSMD ≥ 95 centile + CRL < 5 centile + bradycardia), termed the 'tetrad of aneuploidy', predicted an abnormal karyotype (odds ratio, 7.51 (95% CI, 2.41-140.22); P < 0.001), with a specificity of 100% (95% CI, 92.29-100%), for cases last examined sonographically ≤ 10 weeks' gestation. CONCLUSIONS: The presence of a specific combination of abnormal early-pregnancy ultrasound markers, termed the tetrad of aneuploidy, is a strong predictor of chromosomal abnormality in pregnancies presenting initially with a live embryo. Recognition of this pattern could improve patient counseling and inform clinical decision-making in early pregnancy. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Chivers S, Zidere V, Vigneswaran TV
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, Ananthan K, Whitaker J, Bastiaenen R, Regan W, Rosenthal E, Lloyd DFA, Day TG, Homfray T, de Marvao A, Williamson C, Simpson JM
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 41482982
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OBJECTIVES: Fetal bradycardia may be defined as a ventricular rate more than 2 SD below the gestational-age-specific mean. Sinus bradycardia, functional 2:1 atrioventricular block (AVB) and/or polymorphic ventricular tac...OBJECTIVES: Fetal bradycardia may be defined as a ventricular rate more than 2 SD below the gestational-age-specific mean. Sinus bradycardia, functional 2:1 atrioventricular block (AVB) and/or polymorphic ventricular tachycardia (VT) are recognized as potential presentations of fetal long QT syndrome (LQTS). The objectives of this study were to describe the associations with LQTS and outcomes of fetuses presenting with isolated sinus bradycardia, 2:1 AVB or VT. METHODS: This was a retrospective review of all cases presenting with sinus bradycardia, non-immune mediated 2:1 AVB or VT on referral to our tertiary fetal cardiology center between January 2018 and November 2023. Cases with maternal anti-Ro/anti-La antibodies, blocked atrial ectopic beats or major congenital heart disease were excluded. Data were collected on patient demographics, fetal echocardiography findings, clinical genetic results, family screening and postnatal outcome. The left ventricular isovolumetric relaxation time (LVIRT) and LVIRT normalized as a proportion of cycle length (N-LVIRT) were derived using pulsed-wave Doppler tracings to estimate the QT interval. RESULTS: In total, 22 fetuses were included in the study, with a presenting rhythm of sinus bradycardia in 16, 2:1 AVB in two, both sinus bradycardia and 2:1 AVB in two and VT in two. None had a family history of LQTS. Genetic testing was performed in 14 cases of which 12 were tested prenatally. There were 13 cases with a positive LQTS genotype (eight KCNQ1, one KCNE1, two KCNH2, one SCN5A and one CALM2). Median presenting fetal heart rate (FHR) and FHR Z-score in sinus rhythm was 120 (range, 100-139) bpm and -3.04 (range, -4.98 to -0.91), respectively. In the 13 cases with genetically confirmed LQTS, N-LVIRT and LVIRT were persistently above threshold in two and six cases, respectively. CONCLUSIONS: The most common finding in fetuses with persistent sinus bradycardia without major congenital heart disease or autoimmune disease is LQTS. Prenatal genetic testing enables tailored parental counseling and management of the pregnancy. Although N-LVIRT and LVIRT were not above the threshold values in most cases, they remain important measures for investigation in future studies. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Horgan R, Sinkovskaya E, Kalafat E
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, Heeze A, Abuhamad A, Saade G
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41452116
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Barreto Farias CV, Pereira Leite MDF, Lopes Moreira ME
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, Peixoto Filho FM, Ribeiro G, Werner H
Ultrasound Obstet Gynecol
· 2026 Apr · PMID 41416812
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Favre G, Kamal M, Deren Ö
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, Suresh S, Vrachnis N, Valencia C, Tolosa J, Chalouhi GE
Ultrasound Obstet Gynecol
· 2026 Feb · PMID 41389276
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Achiron R, Kivilevitch Z
Ultrasound Obstet Gynecol
· 2026 Mar · PMID 41387366
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Mathewlynn S, Starck LN, Wright D
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, Yin Y, Soltaninejad M, Nicolaides KH, Syngelaki A, Contreras AG, Bigiotti S, Woess EM, Swinburne M, Collins S
Ultrasound Obstet Gynecol
· 2026 Jan · PMID 41351882
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OBJECTIVES: To develop predictive models for fetal growth restriction (FGR) with and without the inclusion of OxNNet-derived first-trimester placental volume (FTPV), thereby evaluating the contribution of FTPV to these m...OBJECTIVES: To develop predictive models for fetal growth restriction (FGR) with and without the inclusion of OxNNet-derived first-trimester placental volume (FTPV), thereby evaluating the contribution of FTPV to these models and the extent to which FTPV percentile is associated with subsequent FGR. METHODS: This study utilized data from the First-trimester Placental Ultrasound (FirstPLUS) study, a longitudinal observational cohort study conducted at King's College Hospital NHS Foundation Trust, London, UK, between March and November 2022. Participants underwent routine ultrasound assessment between 11 + 2 and 14 + 1 weeks' gestation, in addition to three-dimensional placental sonography. The OxNNet toolkit was used for automated placental segmentation and volume calculation. Multivariable logistic regression models were developed to predict FGR, incorporating maternal factors, first-trimester biomarkers (serum pregnancy-associated plasma protein-A, mean arterial blood pressure and uterine artery pulsatility index) and FTPV. RESULTS: The final cohort comprised 3500 pregnancies, of which 250 (7.1%) developed FGR. Low FTPV was found to be a risk factor for FGR, with an odds ratio of 1.736 (95% CI, 1.499-2.015) per unit decrease in FTPV Z-score. Incorporating FTPV into the predictive model based on maternal factors and biomarkers significantly increased the area under the receiver-operating-characteristics curve (AUC) for predicting all cases of FGR, from 0.78 (95% CI, 0.75-0.81) to 0.79 (95% CI, 0.76-0.82) (P = 0.005). Subgroup analysis of normotensive and hypertensive cases demonstrated a statistically significant effect size for the prediction of FGR by FTPV Z-score in both groups. The addition of FTPV to the model based on maternal factors and biomarkers for the prediction of normotensive FGR increased the AUC from 0.77 (95% CI, 0.74-0.80) to 0.78 (95% CI, 0.75-0.81) (P = 0.01). For preterm FGR, the AUC was 0.85 (95% CI, 0.78-0.92) with FTPV and 0.85 (95% CI, 0.79-0.92) without (P = 0.93); the absence of a significant difference may be due to a lack of power. CONCLUSIONS: FTPV Z-score is a predictor of FGR. Integrating FTPV into predictive models significantly enhanced the discriminative ability for all cases of FGR, as well as for the subgroup of normotensive FGR. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
De Robertis V, Stampalija T, Abuhamad AZ
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, Bosco M, Chaoui R, Formigoni C, Moon-Grady AJ, Paladini D, Pilu G, Ramezzana IG, Rychik J, Volpe P
Ultrasound Obstet Gynecol
· 2026 Jan · PMID 41351876
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Vigneswaran TV, Jowett V, Akolekar R
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, Simpson JM
Ultrasound Obstet Gynecol
· 2026 Jan · PMID 41351875
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Abstract loading — click title to view on PubMed.