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To investigate outcomes of fetuses with hypoplastic left heart syndrome (HLHS) with an intact or restrictive atrial septum (I/RAS) managed expectantly or with fetal atrial septal intervention (FASI PubMed, Scopus, and Web of Science were searched systematically from inception until April 2023. Outcomes were classified by those who had FASI and those who had expectant management (EM). To estimate the overall proportion of each endpoint, a meta‐analysis of proportions was employed using a random‐effects model. Heterogeneity was assessed using the I2 value. Thirty‐two studies reporting on 746 fetuses with HLHS and I/RAS met our inclusion criteria. Eleven studies (123 fetuses) were in the FASI group and 21 studies (623 fetuses) were in the EM group. Among the 123 FASI cases, 107 (87%) were reported to be technically successful. The mean gestational age (GA) at diagnosis was comparable between the groups (26.2 weeks FASI vs. 24.4 weeks EM group). The mean GA at FASI was 30.4 weeks (95% CI 28.5, 32.5). The mean GA at delivery was also comparable (37.7 weeks FASI vs. 38.1 weeks EM group). Neonatal outcomes, including live birth, neonatal death, and survival to hospital discharge pooled proportions, were also comparable between groups (live birth: 92% (95% CI 64, 99) FASI versus 93% (95% CI 79, 98) in EM, neonatal death: 32% (95% CI 11, 65) FASI versus 30% (95% CI 21, 41) EM, survival to hospital discharge: 37% (95% CI 25, 52) FASI versus 52% (95% CI 42, 61) EM). Age at neonatal death was higher in the FASI group (mean: 17 days FASI vs. 7.2 days EM group). There was a lower rate of postnatal atrial restrictive septum in the FASI group 38% (95% CI 17, 63) compared to the EM group 88% (95% CI 57, 98). Our review shows variations across centers in the selection criteria and techniques used for FASI. Although survival including livebirth, neonatal death, and survival to hospital discharge did not differ between groups, the procedure may translate into a less restrictive septum at birth. Future multicenter studies are needed to better identify the subset of cases that might have improved outcomes, use standardized definitions, unified techniques, utilize core outcome set, and assess long‐term benefits. Key points: What's already known about this topic? In the setting of hypoplastic left heart syndrome (HLHS), the patency of the inter‐atrial septum is essential to ensure unobstructed drainage of pulmonary venous blood from the left to the right atrium.Prenatal consequences of HLHS with severe atrial restriction include marked elevation in left atrial and pulmonary venous pressures, reduced lung perfusion, and pulmonary lymphangiectasia.Left atrial decompression by the fetal atrial septal intervention (FASI) may offer a means of avoiding or reversing severe pulmonary damage and, thus, a more favorable postnatal outcome. What does this study add? Our review shows variations across centers in their selection criteria and techniques used for fetal atrial septal intervention (FASI) for prenatal hypoplastic left heart syndrome (HLHS) with intact or restrictive atrial septum (I/RAS).There was slightly higher fetal demise in the FASI group.GA at delivery was comparable between FASI and expectant management.Survival outcomes including livebirth, neonatal death, and survival to hospital discharge pooled proportions were also comparable between the two groups.Age at neonatal death was later in the FASI group (mean: 17 days in the FASI vs. 7.5 days in the EM group).47% of FASI cases had postnatal atrial restrictive septum compared to 89% in the expectant group. [ABSTRACT FROM AUTHOR]

The objective is to summarize the current use of artificial intelligence (AI) in obstetric ultrasound. PubMed, Cochrane Library, and ClinicalTrials.gov databases were searched using the following keywords "neural networks", OR "artificial intelligence", OR "machine learning", OR "deep learning", AND "obstetrics", OR "obstetrical", OR "fetus", OR "foetus", OR "fetal", OR "foetal", OR "pregnancy", or "pregnant", AND "ultrasound" from inception through May 2022. The search was limited to the English language. Studies were eligible for inclusion if they described the use of AI in obstetric ultrasound. Obstetric ultrasound was defined as the process of obtaining ultrasound images of a fetus, amniotic fluid, or placenta. AI was defined as the use of neural networks, machine learning, or deep learning methods. The authors' search identified a total of 127 papers that fulfilled our inclusion criteria. The current uses of AI in obstetric ultrasound include first trimester pregnancy ultrasound, assessment of placenta, fetal biometry, fetal echocardiography, fetal neurosonography, assessment of fetal anatomy, and other uses including assessment of fetal lung maturity and screening for risk of adverse pregnancy outcomes. AI holds the potential to improve the ultrasound efficiency, pregnancy outcomes in low resource settings, detection of congenital malformations and prediction of adverse pregnancy outcomes. Key points: What is already known about this topic?The development of artificial intelligence (AI) in obstetric ultrasound is currently in its infancy, as fetal ultrasound poses a number of unique challenges including the mobility of the fetus, the developing fetal anatomy, the requirement to obtain specific planes for diagnosis, which can be both difficult to obtain and limited by fetal positioning and maternal body habitus. What does this study add?This is the first scoping literature review of AI in obstetric ultrasound. We have provided a comprehensive overview of the current capabilities, challenges and potential future uses of AI in obstetric ultrasound.AI holds the potential to improve the ultrasound efficiency, pregnancy outcomes in low resource settings, detection of congenital malformations and prediction of adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]