Ultrasound Obstet Gynecol [JOURNAL]
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Moon-Grady AJ, Sarkola T
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 42390216
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Patel SR, Madan N, Eckersley L
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, Roytman Z, Perez M, Gindes L, Hornberger LK
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 42390214
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Perez M, Sklansky M, Anton T
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, Stauffer KJ, Basu R, Pretorius D
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 42390213
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Accurate prenatal detection of congenital heart disease continues to be challenging in routine obstetric practice, despite established screening guidelines. Missed diagnoses are frequently associated with suboptimal imag...
Accurate prenatal detection of congenital heart disease continues to be challenging in routine obstetric practice, despite established screening guidelines. Missed diagnoses are frequently associated with suboptimal image acquisition and inconsistent application of fundamental ultrasound optimization principles. High-quality fetal cardiac assessment requires intentional optimization of technical parameters, in addition to acquiring the recommended anatomical views. We describe, in the context of fetal cardiac imaging, the 'DAZE' (Depth, Angle, Zoom, Enhancement) technique, an organized and reproducible approach for systematically optimizing two-dimensional ultrasound imaging and the application of color Doppler. The DAZE technique consists of four sequential steps: 'D', adjustment of Depth and focal-zone placement; 'A', optimization of sector Angle width and Angle of insonation; Z, appropriate Zoom magnification; and E, Enhancement of ultrasound system settings. Practical application of each component is described, with an emphasis on optimizing spatial and temporal resolution on two-dimensional grayscale imaging, as well as optimizing the application of color Doppler. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Haberer K, Al Naabi H, Silversides CK
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 42390212
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Cohen SM, Shwartz T, Valsky DV
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, Yagel S
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 42390209
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Simpson J, Hall K, Chivers S
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, Zidere V, Vigneswaran T
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 42390207
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Enriquez EM, Grinenco S, Samad S
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, Rakha S, Martínez-García A, Hoodbhoy Z, Mattos S, Vaidyanathan B, Lai WW
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 42390206
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Abu-Rustum RS
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 42390204
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Timor-Tritsch IE, Monteagudo A, Platt LD
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, Shwayder JM, Maymon R, Kedem MR, Jauniaux E
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42373088
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OBJECTIVE: To explore the role of circulating human chorionic gonadotropin (hCG) in the pathophysiology of enhanced myometrial vascularity (EMV) postpregnancy and the usefulness of determining hCG level in the clinical e...
OBJECTIVE: To explore the role of circulating human chorionic gonadotropin (hCG) in the pathophysiology of enhanced myometrial vascularity (EMV) postpregnancy and the usefulness of determining hCG level in the clinical evaluation and management of this condition. METHODS: This was a retrospective observational case series of patients managed clinically at our centers who had postpregnancy EMV diagnosed using ultrasound by the observation of a dilated vascular web in the myometrium, with or without retained products of conception (RPOC), that persisted beyond 4-6 weeks following a failed or terminated pregnancy. We retrieved serial maternal serum hCG measurements and noted the highest maternal serum hCG level measured, as well as the time for hCG to reach non-pregnancy levels, defined as hCG ≤ 5 mIU/mL. The time to resolution of the EMV was recorded; this was determined by normal ultrasound findings (when imaging was available), or assumed if a procedure had been performed to resolve the EMV or when hCG reached non-pregnancy levels. When available, we retrieved peak systolic velocity (PSV) values measured in the vascular web. A PSV of ≥ 20 cm/s was considered elevated. Representative ultrasound and color Doppler images were evaluated. RESULTS: Sixteen patients with sonographically diagnosed EMV that was still present over 4-6 weeks after failure or termination of a pregnancy (i.e. persistent EMV) were included. The median duration from diagnosis of EMV until resolution was 113 (range, 58-293) days. Persistence of EMV was associated with prolonged detectable levels of hCG, with a time for hCG to reach non-pregnancy levels of 97 (range, 58-271) days. In the 13 cases in which this was measured, Doppler studies revealed elevated PSV, with a median highest PSV of 80.8 (range, 46.7-146.3) cm/s. One patient was managed expectantly from the outset of their presentation. Four additional patients were followed expectantly for the EMV after they underwent surgical procedures at presentation; seven patients required uterine artery embolization and four required dilatation and curettage to remove the residual placental tissue. CONCLUSIONS: Our findings suggest that pathological persistence of EMV is associated with the prolonged presence of circulating hCG, probably produced by residual trophoblastic tissue. Furthermore, we believe that persistent EMV is potentially maintained, in major part, by the vasodilatory and angiogenic effects of circulating hCG. Recognition of this association provides a physiological explanation for the natural history of EMV and supports expectant management in hemodynamically stable patients. Monitoring of maternal serum hCG and Doppler PSV may help to distinguish self-resolving EMV from cases requiring intervention, and high PSV levels can alert the practitioner to the potential for hemorrhage following intervention. These findings highlight the importance of differentiating EMV from congenital arteriovenous malformation and RPOC without EMV, and may inform more tailored, less invasive clinical management strategies. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Gomez Y, Pomar L, Zalevsky V
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, Saliou G, Nakaki A, Eixarch E, Sichitiu J, Collaborators
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42373081
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Tinajero MF, Faraci C, Cuenca M
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, Ferrer M, Paolucci S, Gratacos E, Crovetto F, Figueras F
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42366540
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OBJECTIVES: First, to evaluate whether the ratio of soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) is associated with hemodynamic changes in ophthalmic artery (OA) Doppler in near-term pregna...
OBJECTIVES: First, to evaluate whether the ratio of soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) is associated with hemodynamic changes in ophthalmic artery (OA) Doppler in near-term pregnancy. Second, to assess the performance of OA Doppler to rule in and rule out angiogenic factor imbalance. METHODS: This was a cross-sectional cohort study nested within the PE37 randomized controlled trial, involving nulliparous women recruited between January 2023 and January 2025 who underwent sFlt-1/PlGF ratio measurement between 35 + 0 and 36 + 6 weeks' gestation. We included a subsample of women who underwent OA Doppler evaluation, including measurement of OA peak systolic velocity (PSV) ratio and OA pulsatility index (PI), as well as assessment of mean arterial pressure (MAP) and mean uterine artery (UtA) PI. The operator was blinded to sFlt-1/PlGF ratio values. Trends in median values of OA and maternal-fetal Doppler parameters across sFlt-1/PlGF tertiles were analyzed using the Jonckheere-Terpstra test and quantile regression, adjusting for maternal body mass index, age and smoking status. The predictive performance of the OA-PSV ratio for sFlt-1/PlGF ratio ≥ 38 was evaluated using receiver-operating-characteristics-curve analysis. RESULTS: We included 203 women, of whom 62, 71 and 70 were in the lowest, middle and highest tertiles of the sFlt-1/PlGF ratio, respectively. With increasing sFlt-1/PlGF ratio tertile, there was a significant increase in the OA-PSV ratio (median, 0.45 (interquartile range (IQR), 0.39-0.53) vs 0.48 (IQR, 0.41-0.58) vs 0.59 (IQR, 0.50-0.66); adjusted P < 0.001), a significant decrease in OA-PI (median, 2.20 (IQR, 1.92-2.61) vs 2.13 (IQR, 1.86-2.37) vs 1.86 (IQR, 1.60-2.26); adjusted P = 0.031) and a significant increase in MAP (median, 87.0 (IQR, 82.7-92.0) mmHg vs 88.7 (IQR, 83.7-93.7) mmHg vs 94.7 (IQR, 89.3-100.0) mmHg; adjusted P < 0.001). In contrast, no significant trend was observed in mean UtA-PI across sFlt-1/PlGF ratio tertiles. Among those individuals with an OA-PSV ratio < 0.61, 90.5% truly had a sFlt-1/PlGF ratio < 38, at a 15% false-positive rate. CONCLUSIONS: This study provides new evidence of a significant association between the sFlt-1/PlGF ratio and OA Doppler parameters in near-term pregnancies, suggesting that OA Doppler indices, particularly the PSV ratio, reflect angiogenic imbalance. Given its non-invasive nature, accessibility and low cost, OA Doppler emerges as a promising surrogate tool for ruling out angiogenic imbalance. © 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.
Zhu L, Tao G
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42366531
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Alson S, Neringer S, Valentin L
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42333499
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Nair A, Doughty V, Vazquez-Garcia L
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, Till J, Carvalho JS
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 42333052
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OBJECTIVE: Fetal sinus bradycardia (FSB) is usually a benign antenatal finding but it can be a marker of an underlying serious condition that manifests in later life. The aim of this study was to report the antenatal cou...
OBJECTIVE: Fetal sinus bradycardia (FSB) is usually a benign antenatal finding but it can be a marker of an underlying serious condition that manifests in later life. The aim of this study was to report the antenatal course and postnatal outcome of FSB. METHOD: This study was a retrospective review of all cases of persistent FSB, defined as a fetal heart rate (FHR) < 3 percentile for gestational age (GA) with 1:1 atrioventricular conduction on at least two consecutive fetal echocardiograms, diagnosed between January 2014 and December 2024 at the Brompton Centre for Fetal Cardiology, London, UK. Cases of isomerism were excluded, but fetuses with congenital heart disease (CHD) and normal situs were included. Antenatal data retrieved included GA at diagnosis, indication for referral, family history of any CHD or inherited arrythmia, maternal history of medication or medical conditions, fetal echocardiographic findings and sequential FHR measurements. Postnatal data included the results of 12-lead electrocardiography, echocardiography, 24-h Holter monitoring, genetic testing and final diagnosis. RESULTS: The final cohort comprised 34 cases with persistent FSB, resulting in 33 live births and one termination of pregnancy for multiple extracardiac anomalies. Indications for referral included fetal bradycardia (n = 20), suspected CHD (n = 5), maternal anti-Ro antibodies (n = 1) and a family history of long QT syndrome (LQTS) (n = 5), cardiomyopathy (n = 2) or CHD (n = 1). Associated structural cardiac abnormalities were present in seven fetuses, including biventricular hypertrophy related to hypothyroidism (n = 2), hypertrophic cardiomyopathy (n = 1), hypoplastic left heart syndrome(n = 1), bilateral superior vena cava (n = 1), left ventricular non-compaction (LVNC) (n = 1) and a small ventricular septal defect (n = 1). Postnatal diagnoses included LQTS (n = 10), sinus-node dysfunction (SND) (n = 6), LVNC (n = 2), Albright's hereditary osteodystrophy with hypothyroidism (n = 2), histiocytoid cardiomyopathy (n = 1), catecholaminergic polymorphic ventricular tachycardia (n = 1) and myotonic muscular dystrophy (n = 1). The remaining 11 cases were classified as 'normal'. Genetic reports were available in 22 patients, of whom seven had mutations in KCNQ1, three in KCNH2, two in GNAS1 and one each in NDUFB11, RYR2, CDH7 and DMPK; one patient had a variant of unknown significance and five had normal results. Cascade testing detected affected family members in 2/4 de-novo cases of LQTS and in the one case of catecholaminergic polymorphic ventricular tachycardia. Only one neonate, who had SND (anti-Ro related), required a pacemaker at 4 years of age. CONCLUSION: FSB could be the first manifestation of serious underlying cardiac conditions, including inherited arrhythmia syndromes, cardiomyopathy and SND, and needs careful antenatal and postnatal evaluation. Cascade testing allows the identification of potentially at-risk first-degree relatives, thereby enabling prompt intervention and appropriate management. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Heazell AEP, Sobolewski N, Aalai E
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, Glover SW, Wolffs K, Storey C, Stillbirth Priority Setting Partnership Steering Group
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42323800
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OBJECTIVES: Despite UK targets to reduce stillbirth, there has been comparatively less research focused on stillbirth than on other pregnancy complications. This study aimed to ensure that future research addresses the m...
OBJECTIVES: Despite UK targets to reduce stillbirth, there has been comparatively less research focused on stillbirth than on other pregnancy complications. This study aimed to ensure that future research addresses the most important contemporary questions regarding stillbirth by updating the 2015 UK Stillbirth Priority Setting Partnership (PSP), in accordance with the James Lind Alliance (JLA), in collaboration with over 30 professional and stakeholder organizations. METHODS: The Stillbirth PSP was accepted by the JLA for a refreshed list of priorities in June 2024, and a steering group was formed. A survey was then developed in English to identify potential research questions regarding stillbirth and perinatal death in the UK. The initial survey was open from 3 February 2025 to 7 April 2025, during which professionals and people affected by stillbirth were invited to submit research questions relating to either the causes, impact, prevention or management of stillbirth or pregnancy loss after 20 weeks' gestation. The questionnaire was publicized via social media and by stakeholder organizations. Participants' responses were analyzed, duplicate or out-of-scope questions were removed, and indicative questions were formulated from those submitted. Literature searches were carried out in MEDLINE, EMBASE, CINAHL, Cochrane Library and PsychInfo to identify which of the submitted questions had been answered in previously published work. The remaining unanswered research questions were carried forward into a second prioritization survey, which was hosted online from 15 September 2025 to 16 October 2025. The research questions at the highest priority level were determined by consensus at a face-to-face workshop in November 2025, involving participants with lived experience and healthcare professionals. RESULTS: The initial survey received 1261 responses from 525 participants. A further 24 research questions were identified from 10 clinical practice guidelines. Of these 1285 questions, 120 were out of scope. After removing duplicates and combining responses, there were 89 indicative questions. Literature searches determined that 10 questions had been answered previously. The remaining 79 questions were carried forward into the second prioritization survey and were ranked by 441 participants. The top 26 questions were taken to the face-to-face workshop, which prioritized 12 research questions by consensus. The prioritized topics for future research included prediction, prevention, understanding of the causes and management of stillbirth. CONCLUSIONS: This updated Stillbirth PSP indicates that researchers should prioritize studies addressing the identified research priorities, because these reflect the most important research questions for those affected by stillbirth and frontline professionals. © 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.
Backley S, Chmait RH, Papanna R
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42281387
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Oyelese Y
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42281365
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Moon-Grady AJ, Tulzer A, Armstrong AK
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, Cruz-Martinez R, Cuneo B, Dangel J, Galindo A, Gardiner H, Gelehrter S, Gembruch U, Grinenco S, Haak M, Herberg U, Kilby MD, Malekzadeh-Milani S, Mellander M, Morris SA, Otaño L, Pruetz J, Strainic J, Texter K, Tulzer G, Vigneswaran T, Wilkins-Haug L, IFCIR Collaborators
Ultrasound Obstet Gynecol
· 2026 Jul · PMID 42281210
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OBJECTIVE: To describe the pregnancy and postnatal outcomes of a large, retrospectively analyzed case-cohort series of pregnancies complicated by congenital heart disease (CHD) and fetal hydrops that were assessed for po...
OBJECTIVE: To describe the pregnancy and postnatal outcomes of a large, retrospectively analyzed case-cohort series of pregnancies complicated by congenital heart disease (CHD) and fetal hydrops that were assessed for potential for fetal cardiac intervention (FCI). METHODS: The International Fetal Cardiac Intervention Registry (IFCIR) collects diagnostic and procedure-related data on maternal-fetal dyads with CHD that are considered by fetal specialists to be potentially capable of benefiting from FCI, with data submitted voluntarily by local institutions. For this retrospective analysis, the IFCIR database was searched for all case entries of pregnancies with a diagnosis of CHD and coexistent non-immune fetal hydrops, defined as abnormal fluid or edema involving at least two compartments, between January 2001 and September 2024. Data on the underlying cardiac diagnosis, procedures performed and pregnancy and postnatal outcomes were collated. RESULTS: At the time of data extraction, the IFCIR contained 864 recorded maternal-fetal dyads, of which 91 (10.5%) had fetal hydrops at initial evaluation. Of these, 73 (80.2%) underwent FCI, including aortic (n = 61) or pulmonary (n = 5) balloon valvuloplasty, atrial septal intervention and/or stent placement (n = 4) and other FCI (n = 3), at a median gestational age of 28.3 (range, 19.6-34.7) weeks. The overall rate of procedure-related fetal loss was 20.5% (15/73). There were an additional 10 intrauterine fetal deaths, and two cases were either terminated (n = 1) or lost to follow-up (n = 1). Overall, 21 neonates were liveborn preterm (< 37 weeks) and 25 were liveborn at term (≥ 37 weeks), with a median latency post-procedure to delivery of 8.9 (range, 0.3-18.4) weeks. Of the 73 cases that underwent FCI, 26 (35.6%) survived to first hospital discharge, including 39.3% (24/61) of patients who underwent aortic valvuloplasty, one patient who underwent atrial septal intervention and one patient who underwent pulmonary valvuloplasty. The majority of survivors had biventricular circulation (15/20 with available outcome) at the last follow-up. No procedure-related maternal complications were recorded. Only 1/18 patients managed expectantly without FCI survived to hospital discharge. CONCLUSIONS: Our findings suggest a potential benefit of FCI in patients with hydrops, although the procedure-related loss rate of 1 in 5 was significant. While the survival rate was lower than that reported in non-hydropic cohorts with FCI, approximately one-third of hydropic fetuses that underwent FCI included in our analysis survived to hospital discharge. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.
Patibandla Y, Ivanov S, Snyder K
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, Rupke T, Straub H
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42277999
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Novelli GP, Vasapollo B, Attini R
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, Valensise H, Natale A, Ghi T, Mecacci F, Chianchiano N, Castellini G, Stampalija T, Collaborators
Ultrasound Obstet Gynecol
· 2026 Jun · PMID 42277996
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OBJECTIVE: To determine whether antihypertensive therapy guided by maternal hemodynamic assessment improves maternal and perinatal outcomes in women with hypertensive disorders of pregnancy (HDP) compared with standard c...
OBJECTIVE: To determine whether antihypertensive therapy guided by maternal hemodynamic assessment improves maternal and perinatal outcomes in women with hypertensive disorders of pregnancy (HDP) compared with standard care based on blood-pressure thresholds. METHODS: This was a systematic review and meta-analysis of randomized and non-randomized comparative studies comparing hemodynamics-guided management vs standard antihypertensive care in women with HDP. PubMed/MEDLINE and The Cochrane Library were searched from inception until 15 June 2025 for eligible studies. Outcome data were extracted for pre-eclampsia/eclampsia, HELLP syndrome, severe hypertension, fetal growth restriction, placental abruption, preterm birth and perinatal death. The composite adverse outcome included all abovementioned outcomes. The risk of bias was assessed using the Risk Of Bias In Non-Randomized Studies of Interventions tool, the revised Cochrane Risk-of-Bias tool and the Newcastle-Ottawa scale. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Odds ratios (OR) were pooled using random-effects models, with heterogeneity quantified by I. Leave-one-out analyses were performed to investigate sensitivity to outliers. RESULTS: The literature search retrieved six studies, including one randomized controlled trial, four non-randomized comparative studies and one multicenter prospective cohort study. Depending on the outcome analyzed, 418-614 patients were included in the intervention group and 617-731 patients in the control group. Compared with standard care, hemodynamics-guided therapy reduced the odds of pre-eclampsia/eclampsia by 53% (OR, 0.47 (95% CI, 0.33-0.65); I = 0%), severe hypertension by 61% (OR, 0.39 (95% CI, 0.18-0.88); I = 31%), fetal growth restriction by 46% (OR, 0.54 (95% CI, 0.38-0.76); I = 0%) and preterm birth by 60% (OR, 0.40 (95% CI, 0.16-0.99); I = 80%). The OR for the composite adverse outcome was 0.27 (95% CI, 0.21-0.36) (I = 0%). The overall certainty of evidence according to the GRADE framework was low to very low. CONCLUSIONS: Hemodynamics-guided antihypertensive management of women with HDP was associated with reductions in several adverse maternal and perinatal outcomes compared with standard care. Given the predominance of non-randomized study designs, measurement heterogeneity and risk of residual confounding, these associations should be interpreted as hypothesis-generating and require confirmation in adequately powered randomized controlled trials. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.