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Objectives: To describe the sonographic features of the caudothalamic groove in the third trimester of pregnancy in a group of structurally normal fetuses and to report a small series of cases with abnormal appearance of the caudothalamic groove at antenatal cranial ultrasound. Methods: This was an observational study conducted at two fetal medicine referral units in Italy. A non‐consecutive cohort of pregnant women with a singleton non‐anomalous pregnancy were recruited prospectively and underwent three‐dimensional (3D) ultrasound assessment of the fetal brain at 28–32 weeks' gestation. At offline analysis, the ultrasound volumes were adjusted in the multiplanar mode, according to a standardized methodology, until the caudothalamic groove was visible in the parasagittal plane. To evaluate interobserver agreement, two operators were asked independently to indicate if the caudothalamic groove was visible unilaterally or bilaterally on each volume and Cohen's kappa (κ) coefficient was calculated. The digital archives of the two centers were also searched retrospectively to retrieve cases with abnormal findings at the level of the caudothalamic groove on antenatal cranial ultrasound that were confirmed postnatally. Results: A total of 180 non‐consecutive cases were included. At offline analysis of the 3D ultrasound volumes, the caudothalamic groove was identified in the parasagittal plane by both operators at least unilaterally in 176 (97.8%) cases and bilaterally in 174 (96.7%) cases. The κ‐coefficient for the agreement between the two independent operators in recognizing the caudothalamic groove was 0.89 and 0.83 for one and both hemispheres, respectively. The retrospective search of our archives yielded five cases with an abnormal appearance of the caudothalamic groove at antenatal cranial ultrasound, including two cases of hemorrhage and three cases of cyst. Conclusions: The caudothalamic groove is consistently seen in normal fetuses on multiplanar neurosonography in the third trimester, and abnormal findings in this region may be detected antenatally. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article provides information on fetal growth restriction (FGR), a condition where a fetus does not reach its full growth potential due to a pathological factor. It discusses the classification of FGR based on gestational age at diagnosis and explores the causes and outcomes of pre- and periviable FGR. The article emphasizes the importance of genetic counseling and testing in cases of FGR and provides information on the prevalence of genetic anomalies, structural defects, and congenital infections in these cases. It also discusses the incidence and outcome of placental insufficiency as a cause of FGR. The article highlights the varying frequency of hypertensive disorders of pregnancy (HDP) in pre- and periviable FGR and their impact on maternal and fetal/neonatal health. It concludes by discussing the management of pre- and periviable FGR, including the consideration of termination of pregnancy in certain cases and the determination of the mode of delivery for fetuses alive at birth. [Extracted from the article]

Objective: To investigate the relationship of umbilical vein flow (UVF) measured close to term with abnormal fetal growth and adverse perinatal outcome in a cohort of pregnancies at low risk of placental insufficiency. Methods: This was a prospective multicenter observational study conducted across two tertiary maternity units. Patients with a singleton appropriate‐for‐gestational‐age fetus between 35 and 38 weeks' gestation were included. Pregnancies at higher risk of placental insufficiency or with fetal anomalies were excluded. At ultrasound examination, the abdominal circumference (AC), umbilical vein diameter and peak velocity of the umbilical vein were measured, and, using these variables, a new variable, UVF/AC, was calculated. The primary outcome was the occurrence of severely stunted fetal growth, defined as a greater than 40‐percentile drop between estimated fetal weight at the third‐trimester ultrasound and birth weight. The occurrence of adverse perinatal outcome (defined as one of the following: neonatal acidosis (umbilical artery pH < 7.15 and/or base excess > 12 mmol/L) at birth, 5‐min Apgar score < 7, neonatal resuscitation or neonatal intensive care unit admission) was analyzed as a secondary outcome. Results: Between April 2021 and March 2023, 365 women were included in the study. The mean UVF/AC at enrolment was 6.4 ± 2.6 mL/min/cm, and 35 (9.6%) cases were affected by severely stunted fetal growth. Severely stunted fetal growth was associated with a lower mean UVF/AC (5.4 ± 2.6 vs 6.5 ± 2.6 mL/min/cm; P = 0.02) and a higher frequency of UVF/AC < 10th percentile (8/35 (22.9%) vs 28/330 (8.5%); P = 0.01). Moreover, UVF/AC showed an area under the receiver‐operating‐characteristics curve (AUC) of 0.65 (95% CI, 0.55–0.75; P = 0.004) in predicting the occurrence of severely stunted fetal growth, and the optimal cut‐off value of UVF/AC for discriminating between normal and severely stunted fetal growth was 7.2 mL/min/cm. This value was associated with a sensitivity and specificity of 0.77 (95% CI, 0.60–0.90) and 0.33 (95% CI, 0.28–0.39), and positive and negative predictive values of 0.11 (95% CI, 0.07–0.15) and 0.93 (95% CI, 0.87–0.97), respectively. Regarding the occurrence of adverse perinatal outcome, this was associated independently with maternal age (adjusted odds ratio (aOR), 0.93 (95% CI, 0.87–0.99); P = 0.04), UVF/AC Z‐score (aOR, 0.53 (95% CI, 0.30–0.87); P = 0.01) and augmentation of labor (aOR, 2.69 (95% CI, 1.28–5.69); P = 0.009). UVF/AC showed an AUC of 0.65 (95% CI, 0.56–0.73; P = 0.005) in predicting the occurrence of adverse perinatal outcome, and the optimal cut‐off value of UVF/AC for discriminating between normal and adverse perinatal outcome was 6.7 mL/min/cm. This value was associated with a sensitivity and specificity of 0.70 (95% CI, 0.54–0.83) and 0.40 (95% CI, 0.34–0.45), and positive and negative predictive values of 0.14 (95% CI, 0.09–0.19) and 0.91 (95% CI, 0.85–0.95), respectively. Conclusions: Our data demonstrate an association between reduced UVF close to term, severely stunted fetal growth and adverse perinatal outcome in a cohort of low‐risk pregnant women, with a moderate ability to rule out and a poor ability to rule in either outcome. Further studies are needed to establish whether the assessment of UVF can improve the identification of fetuses at risk of subclinical placental insufficiency and adverse perinatal outcome. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article discusses the use of Doppler ultrasound technology to assess the cerebral vessels in the fetal central nervous system (CNS) during prenatal imaging. The development of Doppler technologies that are highly sensitive for low-velocity flow has allowed for the visualization of the intracerebral venous system, including the medullary veins. The article presents a case study where Doppler tools were used to identify a CNS anomaly in a pregnant woman, leading to a diagnosis of subarachnoid hemorrhage. The authors suggest that Doppler technology has the potential to aid in the differential diagnosis of cerebral anomalies and further research is needed to explore its role in assessing fetal CNS health. [Extracted from the article]

Objectives: To investigate the rate and outcome of emergency Cesarean delivery (CD) in women with placenta previa with or without placenta accreta spectrum disorders (PAS) and to elucidate the diagnostic accuracy of ultrasound in predicting emergency CD. Methods: This was a secondary analysis of a multicenter prospective study involving 16 referral hospitals in Italy (ADoPAD study). Inclusion criteria were women with placenta previa minor (< 20 mm from the internal cervical os) or placenta previa major (covering the os), aged ≥ 18 years, who underwent transabdominal and transvaginal ultrasound assessment at ≥ 26 + 0 weeks of gestation. The primary outcome was the occurrence of emergency CD, defined as the need for immediate surgical intervention performed for emergency maternal or fetal indication, including active labor, cumulative maternal bleeding > 500 mL, severe and persistent vaginal bleeding such that maternal hemodynamic stability could not be achieved or maintained, or category‐III fetal heart rate tracing unresponsive to resuscitative measures. The primary outcome was reported separately in the population of women with placenta previa and no PAS confirmed after birth and in those with PAS. The secondary aim was to report on the strength of association and to test the diagnostic accuracy of ultrasound in predicting emergency CD. Univariate, multivariate and diagnostic accuracy analyses were used to analyze the data. Results: A total of 450 women, including 97 women with placenta previa and PAS and 353 with placenta previa only, were analyzed. In women with placenta previa and PAS, emergency CD was required in 20.6% (95% CI, 14–30%), and 60.0% (12/20) delivered before 34 weeks of gestation. The mean gestational age at delivery was 32.3 ± 2.7 weeks in women undergoing emergency CD and 34.9 ± 1.8 weeks in those undergoing elective CD (P < 0.001). Women undergoing emergency CD had a higher median estimated blood loss (2500 (interquartile range (IQR), 1350–4500) vs 1100 (IQR, 625–2500) mL; P = 0.012), mean units of blood transfused (7.3 ± 8.8 vs 2.5 ± 3.4; P = 0.02) and more frequent placement of a mechanical balloon (50.0% vs 16.9%; P = 0.002) compared with those undergoing elective CD. On univariate analysis, the presence of interrupted retroplacental space, interrupted bladder line and placental lacunae was more common in women not experiencing emergency CD. No comprehensive multivariate analysis could be performed in this subgroup of women. Ultrasound signs of PAS, including presence of interrupted retroplacental space, interrupted bladder line and placental lacunae, were not predictive of emergency CD. In women with placenta previa but no PAS, emergency CD was required in 31.2% (95% CI, 26.6–36.2%), and 32.7% (36/110) delivered before 34 weeks of gestation. The mean gestational age at delivery was lower in women undergoing emergency CD compared with those undergoing elective CD (34.2 ± 2.9 vs 36.7 ± 1.6 weeks; P < 0.001). Pregnancies complicated by emergency CD were associated with a lower birth weight (2330 ± 620 vs 2800 ± 480 g; P < 0.001) and had a higher risk of need for blood transfusion (22.7% vs 10.7%; P = 0.003) compared with those who underwent elective CD. On multivariate analysis, only placental thickness (odds ratio (OR), 1.02 (95% CI, 1.00–1.03); P = 0.046) and cervical length < 25 mm (OR, 3.89 (95% CI, 1.33–11.33); P = 0.01) were associated with emergency CD. However, a short cervical length showed low diagnostic accuracy for predicting emergency CD in these women. Conclusion: Emergency CD occurred in about 20% of women with placenta previa and PAS and 30% of those with placenta previa only and was associated with worse maternal outcome compared with elective intervention. Prenatal ultrasound is not predictive of the risk of emergency CD in women with these disorders. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the relationship between the attitude of the fetal head quantified by means of the chin‐to‐chest angle (CCA) in fetuses in occiput posterior (OP) position at the beginning of the second stage of labor, and persistent OP position at birth. Methods: This was a single‐center, prospective observational study conducted at the University Hospital of Parma, Parma, Italy. We included singleton pregnancies at term with fetuses in the OP position at the beginning of the second stage of labor. The fetal head position, station by means of angle of progression and head‐to‐perineum distance, and attitude by means of CCA were assessed using transabdominal or transperineal ultrasound. The primary outcome was persistent OP position at birth. Results: Between January and July 2022, 76 women were included in the study. There were 48 (63.2%) spontaneous rotations of the fetal head and spontaneous vaginal delivery occurred in all. Among the 28 (36.8%) fetuses that did not rotate spontaneously into an occiput anterior position, eight (28.6%) had a spontaneous vaginal delivery, while operative vaginal delivery and Cesarean delivery was performed in 11 (39.3%) and nine (32.1%) cases, respectively. Multivariable logistic regression analysis showed that the CCA (adjusted odds ratio (aOR), 2.15 (95% CI, 1.22–3.78); P = 0.008) and nulliparity (aOR, 0.20 (95% CI, 0.06–0.76); P = 0.02) were associated independently with persistent OP position at birth. Moreover, the CCA showed an area under the receiver‐operating‐characteristics curve of 0.69 (95% CI, 0.56–0.82); P = 0.005) for the prediction of persistent OP position. The optimal cut‐off value of the CCA was 36.5°, and was associated with a sensitivity of 0.82 (95% CI, 0.63–0.94), specificity of 0.50 (95% CI, 0.35–0.65), positive predictive value of 0.49 (95% CI, 0.34–0.64), negative predictive value of 0.83 (95% CI, 0.64–0.94), positive likelihood ratio of 1.64 (95% CI, 1.18–2.29) and negative likelihood ratio of 0.36 (95% CI, 0.15–0.83). Conclusions: Our data show that, within a population of women with fetal OP position at the beginning of the second stage of labor, the sonographic fetal head attitude measured by means of the CCA might help in the identification of fetuses at risk of persistent OP position. Such findings can be useful for patient counseling when OP position is diagnosed at full cervical dilatation. Further studies should investigate if the CCA might select patients who may benefit from manual rotation of the fetal head. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

The article discusses the use of manual rotation of the fetal occiput posterior (MROP) position as a prophylactic or therapeutic maneuver to correct malposition of the fetal head during labor, potentially reducing the need for operative delivery. While controversial, MROP is endorsed by medical organizations like ACOG and SMFM for preventing primary Cesarean delivery. The effectiveness of MROP varies, with success rates dependent on the operator's experience level and fetal attitude, and intrapartum ultrasound can assist in confirming fetal head malposition and guiding the MROP procedure. The article presents a case study of a successful MROP procedure aided by real-time sonographic guidance. [Extracted from the article]

Objectives: To describe the appearance and size of the ganglionic eminence (GE) in normal fetuses on midtrimester three‐dimensional (3D) neurosonography and to report on the association between GE alterations (cavitation or enlargement) and malformation of cortical development (MCD). Methods: This was a prospective multicenter cohort study of normal fetuses and a retrospective analysis of pathological cases with MCD. From January 2022 to June 2022, patients attending our tertiary centers for an expert fetal brain scan were recruited for the purpose of the study. A 3D volume of the fetal head, starting from the sagittal plane, was acquired in apparently normal fetuses using a transabdominal or transvaginal approach. Stored volume datasets were then evaluated independently by two expert operators. Two measurements (longitudinal diameter and transverse diameter) of the GE in the coronal view were obtained twice by each operator. Intra‐ and interobserver measurement variation was calculated. Reference ranges for GE measurements were calculated in the normal population. A previously stored volume dataset of 60 cases with MCD was also analyzed independently by the two operators using the same method in order to assess if GE abnormalities (cavitation or enlargement) were present. Postnatal follow‐up was obtained in all cases. Results: In the study period, 160 normal fetuses between 19 and 22 weeks of gestation were included in the study. The GE was visible in the coronal plane on 3D neurosonography in 144 (90%) cases and was not clearly visible in the remaining 16 (10%) cases. The intra‐ and interobserver agreement was almost perfect for the longitudinal diameter, with an intraclass correlation coefficient (ICC) of 0.90 (95% CI, 0.83–0.93) and 0.90 (95% CI, 0.86–0.92), respectively, and substantial for the transverse diameter, with an ICC of 0.80 (95% CI, 0.70–0.87) and 0.64 (95% CI, 0.53–0.72), respectively. A retrospective analysis of 50 cases with MCD in the second trimester showed that GE enlargement was present in 12 cases and GE cavitation was present in four cases. Conclusions: Systematic assessment of the GE in fetuses at 19–22 weeks of gestation is feasible on 3D neurosonography, with good reproducibility in normal cases. Cavitation or enlargement of the GE can be demonstrated in fetuses with MCD. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Deep learning is considered the leading artificial intelligence tool in image analysis in general. Deep‐learning algorithms excel at image recognition, which makes them valuable in medical imaging. Obstetric ultrasound has become the gold standard imaging modality for detection and diagnosis of fetal malformations. However, ultrasound relies heavily on the operator's experience, making it unreliable in inexperienced hands. Several studies have proposed the use of deep‐learning models as a tool to support sonographers, in an attempt to overcome these problems inherent to ultrasound. Deep learning has many clinical applications in the field of fetal imaging, including identification of normal and abnormal fetal anatomy and measurement of fetal biometry. In this Review, we provide a comprehensive explanation of the fundamentals of deep learning in fetal imaging, with particular focus on its clinical applicability. © 2022 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: The prediction of adverse perinatal outcomes in low‐risk pregnancies is poor, mainly owing to the lack of reliable biomarkers. Uterine artery (UtA) Doppler is closely associated with placental function and may facilitate the peripartum detection of subclinical placental insufficiency. The objective of this study was to evaluate the association of mean UtA pulsatility index (PI) measured in early labor with obstetric intervention for suspected intrapartum fetal compromise and adverse perinatal outcome in uncomplicated singleton term pregnancies. Methods: This was a prospective multicenter observational study conducted across four tertiary maternity units. Low‐risk term pregnancies with spontaneous onset of labor were included. The mean UtA‐PI was recorded between uterine contractions in women admitted for early labor and converted into multiples of the median (MoM). The primary outcome of the study was the occurrence of obstetric intervention, i.e. Cesarean section or instrumental delivery, for suspected intrapartum fetal compromise. Secondary outcomes were the occurrence of adverse perinatal outcomes, including 5‐min Apgar score < 7, low cord arterial pH, raised cord arterial base excess, admission to the neonatal intensive care unit (NICU) and postnatal diagnosis of small‐for‐gestational‐age fetus. Composite adverse perinatal outcome was defined as the occurrence of at least one of the following: acidemia in the umbilical artery, defined as pH < 7.10 and/or base excess > 12 mmol/L, 5‐min Apgar score < 7 or admission to the NICU. Results: Overall, 804 women were included, of whom 40 (5.0%) had abnormal mean UtA‐PI MoM. Women who had an obstetric intervention for suspected intrapartum fetal compromise were more frequently nulliparous (72.2% vs 53.6%; P = 0.008), had a higher frequency of increased mean UtA‐PI MoM (13.0% vs 4.4%; P = 0.005) and had a longer duration of labor (456 ± 221 vs 371 ± 192 min; P = 0.01). On logistic regression analysis, only increased mean UtA‐PI MoM (adjusted odds ratio (aOR), 3.48 (95% CI, 1.43–8.47); P = 0.006) and parity (aOR, 0.45 (95% CI, 0.24–0.86); P = 0.015) were independently associated with obstetric intervention for suspected intrapartum fetal compromise. Increased mean UtA‐PI MoM was associated with a sensitivity of 0.13 (95% CI, 0.05–0.25), specificity of 0.96 (95% CI, 0.94–0.97), positive predictive value of 0.18 (95% CI, 0.07–0.33), negative predictive value of 0.94 (95% CI, 0.92–0.95), positive likelihood ratio of 2.95 (95% CI, 1.37–6.35) and negative likelihood ratio of 0.91 (95% CI, 0.82–1.01) for obstetric intervention for suspected intrapartum fetal compromise. Pregnancies with increased mean UtA‐PI MoM also showed a higher incidence of birth weight < 10th percentile (20.0% vs 6.7%; P = 0.002), NICU admission (7.5% vs 1.2%; P = 0.001) and composite adverse perinatal outcome (15.0% vs 5.1%; P = 0.008). Conclusion: Our study, conducted in a cohort of low‐risk term pregnancies enrolled in early spontaneous labor, showed an independent association between increased mean UtA‐PI and obstetric intervention for suspected intrapartum fetal compromise, albeit with moderate capacity to rule in, and poor capacity to rule out, this condition. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article, titled "Circulating angiogenic factors levels in women with hypertensive disorders of pregnancy according to the baseline hemodynamic findings," explores the relationship between hemodynamic phenotype and the predictive value of sFLT‐1/PlGF ratio for adverse outcomes in women with hypertensive disorders of pregnancy (HDP). The study included a cohort of women with new-onset HDP and assessed their hemodynamic parameters using USCOM-1A. The results showed that the sFLT1/PlGF ratio was significantly higher in women with a hypodynamic profile, and there was a significant association between the ratio and adverse maternal and neonatal outcomes in this group. Overall, the findings suggest that the sFLT1/PlGF ratio is associated with adverse outcomes only in women with a hypodynamic profile. [Extracted from the article]

This article, titled "Speckle tracking assessment of the fetal cardiac function in early labour: pathophysiology and association with adverse outcome," explores the relationship between speckle tracking echocardiography (STE) assessment of fetal cardiac function, cardiotocography (CTG), and labor outcome in a group of singleton term pregnancies. The study found that there was a negative correlation between the right ventricle (RV) global radial strain (GRS) and baseline fetal heart rate (FHR) and birthweight percentile. Additionally, higher left ventricle (LV) and RV myocardial and endocardial global longitudinal strain (MyoGLS and EndoGLS) were observed in cases that underwent operative delivery (OD) due to suspected intrapartum fetal compromise (IFC). The study concludes that an increased RV strain was observed with reducing birthweight and baseline FHR, and higher cardiac strain was shown in cases undergoing OD due to suspected IFC, regardless of birthweight. [Extracted from the article]

This article discusses a study that aimed to evaluate the role of speckle tracking echocardiography (STE) in distinguishing between small-for-gestational age (SGA) and fetal growth restriction (FGR) in fetuses at risk for late-onset FGR. The study included non-anomalous singleton pregnancies with suspected late-onset FGR and used ultrasound clips of the fetal heart to perform offline STE. The results showed differences in right ventricular strain between SGA, FGR, and evolving FGR, suggesting increased cardiac deformation in the latter group. However, no differences in STE parameters were found between SGA and FGR. [Extracted from the article]

This article, published in the journal Ultrasound in Obstetrics & Gynecology, examines the association between abnormal umbilical vein flow (UVF) and undetected small for gestational age (SGA) in low-risk pregnancies. The study found that undetected SGA was more common in fetuses with abnormal UVF compared to those with normal UVF. The researchers measured UVF/AC (umbilical vein flow to abdominal circumference) and found that a lower UVF/AC was associated with undetected SGA. The study suggests that if UVF/AC falls below the 20th percentile, there is a higher likelihood of abnormal fetal growth patterns. [Extracted from the article]

This article, titled "EP08.14: Computerised CTG features in small for gestational age and fetal growth restriction between 32+0 and 36+6 weeks," explores the characteristics of computerized cardiotocography (cCTG) in suspected late-onset fetal smallness and compares cCTG analysis in small-for-gestational age (SGA) and fetal growth restriction (FGR). The study, which included 105 cases and 367 cCTG recordings, found a negative correlation between umbilical artery PI and UCR and long-term variability (LTV) and short-term variability (STV), as well as a positive correlation between these parameters and the length of recording. FGR fetuses showed a longer duration of cCTG recording and lower STV compared to SGA fetuses. The study concludes that there is a relationship between cCTG and fetal Doppler parameters, and that pathological cCTG is mainly accounted for by FGR cases. [Extracted from the article]

This article discusses a study conducted on fetuses with late-onset fetal growth restriction (FGR) to investigate patterns of cardiac remodeling and evaluate fetal cardiac function using speckle tracking fetal echocardiography (STE). The study found three distinct cardiac remodeling phenotypes: a morphologically normal heart, a morphologically elongated heart, and a morphologically globular heart. The comparison of cardiac functional parameters using STE showed differences in left and right ventricular strain among the phenotypes. This study highlights the existence of different cardiac remodeling phenotypes in fetuses with late-onset FGR and their association with variations in ventricular strain. [Extracted from the article]

This article discusses a study that aims to develop an artificial intelligence (AI) algorithm for the automatic classification of ultrasound images of the fetal brain in the first trimester. The algorithm focuses on identifying abnormal sonographic findings of the posterior cranial fossa (PCF), which can be early markers of open spina bifida or Dandy Walker malformation. The study used a dataset of 251 images and achieved promising results, demonstrating the potential for the AI algorithm to support clinicians in detecting major central nervous system anomalies during early pregnancy. The next phase of the study will assess the algorithm's clinical applicability in routine practice. [Extracted from the article]

This article discusses a study that aims to demonstrate the scientific validity of a novel cell-based non-invasive prenatal testing (cbNIPT) method for detecting fetal copy number variants (CNVs) using single cell sequencing of circulating extravillous trophoblasts (cEVTs). The study enrolled 1388 high-risk pregnancies and found a screen positive rate of 18.9% for aneuploidies and 11.2% for pCNVs. The results showed that cbNIPT was able to detect pCNVs <1 Mb in size, which is below the resolution of cell-free DNA screening. The authors conclude that analyzing cEVTs from maternal blood could significantly reduce the residual risk for pCNVs in early gestational weeks. [Extracted from the article]

CPM-I and CPM-II have been shown to have little or no impact on fetal growth, while CPM-III has been associated with preterm birth, small-for-gestational-age newborns and adverse pregnancy outcomes[28]. 53 Tsuge M, Hida AI, Minematsu T, Honda N, Oshiro Y, Yokoyama M, Kondo Y. Prospective cohort study of congenital cytomegalovirus infection during pregnancy with fetal growth restriction: serologic analysis and placental pathology. However, to date, it is uncertain whether suboptimal maternal cardiac adaptation to pregnancy directly impacts the development of uteroplacental circulation[76] or indirectly affects fetal growth through insufficient provision of oxygen and nutrients[76]. Fetal growth is determined by maternal provision of substrate, placental transfer of substrates and fetal growth potential[1]. [Extracted from the article]

The European Society of Cardiology (ESC) guidelines (GL) provide indications on the mode of delivery in women with heart disease. However available data suggests that the rate of Cesarean Delivery (CD) is high and widely variable among such patients. In this study, we aimed to investigate the degree of adherence to the ESC recommendations among women delivering in four tertiary maternity services in Italy and how this affects the maternal and neonatal outcomes. Retrospective multicenter cohort study including pregnant women with heart disease who gave birth between January 2014 and July 2020. Composite adverse maternal outcome (CAM) was defined by the occurrence of one or more of the following: major postpartum hemorrhage, thrombo-embolic or ischemic event, de novo arrhythmia, heart failure, endocarditis, aortic dissection, need for re-surgery, sepsis, maternal death. Composite Adverse Neonatal outcome (CAN) was defined as cord arterial pH <7.00, APGAR <7 at 5 min, admission to the intensive care unit, and neonatal death. We compared the incidence of CAM and CAN between the cases with planned delivery in accordance (group "ESC consistent") or in disagreement (group "ESC not consistent") with the ESC GL. Overall, 175 women and 181 liveborn were included. A higher frequency of CAN was found when delivery was not planned accordingly to the ESC guidelines [("ESC consistent" 9/124 (7.2%) vs "ESC not consistent" 13/57 (22.8%) p = 0.002 OR 3.74 (CI 95% 1.49–9.74) , while the occurrence of CAM was comparable between the two groups. At logistic regression analysis, the gestational age at delivery was the only parameter independently associated with the occurrence of CAN (p = 0.006). Among pregnant women with heart disease, deviating from the ESC guidelines scheduling cesarean delivery does not seem to improve maternal outcomes and it is associated with worse perinatal outcomes, mainly due to lower gestational age at birth. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between the fetal head‐circumference‐to‐maternal‐height (HC/MH) ratio measured shortly before delivery and the occurrence of Cesarean section (CS) for labor dystocia. Methods: This was a multicenter prospective cohort study involving four tertiary maternity hospitals. An unselected cohort of women with a singleton fetus in cephalic presentation, at a gestational age beyond 36 + 0 weeks and without any contraindication for vaginal delivery, was enrolled between September 2020 and November 2021. The MH and fetal HC were measured on admission of the patient to the labor ward. The primary outcome of the study was the performance of the HC/MH ratio in the prediction of CS for labor dystocia. Women who underwent CS for any indication other than failed labor progression, including fetal distress, were excluded from the final analysis. Results: A total of 783 women were included in the study. Vaginal delivery occurred in 744 (95.0%) women and CS for labor dystocia in 39 (5.0%). CS for labor dystocia was associated with shorter MH (mean ± SD, 160.4 ± 6.6 vs 164.5 ± 6.3 cm; P < 0.001), larger fetal HC (339.6 ± 9.5 vs 330.7 ± 13.0 mm; P < 0.001) and a higher HC/MH ratio (2.12 ± 0.11 vs 2.01 ± 0.10; P < 0.001) compared with vaginal delivery. Multivariate logistic regression analysis showed that the HC/MH ratio was associated independently with CS for labor dystocia (adjusted odds ratio, 2.65 (95% CI, 1.85–3.79); P < 0.001). The HC/MH ratio had an area under the receiver‐operating‐characteristics curve of 0.77 and an optimal cut‐off value for discriminating between vaginal delivery and CS for labor dystocia of 2.09, which was associated with a sensitivity of 0.62 (95% CI, 0.45–0.77), specificity of 0.79 (95% CI, 0.76–0.82), positive predictive value of 0.13 (95% CI, 0.09–0.19) and negative predictive value of 0.98 (95% CI, 0.96–0.99). Conclusions: In a large cohort of unselected pregnancies, the HC/MH ratio performed better than did fetal HC and MH alone in identifying those cases that will undergo CS for labor dystocia, albeit with moderate predictive value. The HC/MH ratio could assist in the evaluation of women at risk for CS for labor dystocia. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To describe the incidence, clinical features and perinatal outcome of late-onset fetal growth restriction (FGR) associated with genetic syndrome or aneuploidy, structural malformation or congenital infection.Methods: This was a retrospective multicenter cohort study of patients who attended one of four tertiary maternity hospitals in Italy. We included consecutive singleton pregnancies between 32 + 0 and 36 + 6 weeks' gestation with either fetal abdominal circumference (AC) or estimated fetal weight < 10th percentile for gestational age or a reduction in AC of > 50 percentiles from the measurement at an ultrasound scan performed between 18 and 32 weeks. The study group consisted of pregnancies with late-onset FGR and a genetic syndrome or aneuploidy, structural malformation or congenital infection (anomalous late-onset FGR). The presence of congenital anomalies was ascertained postnatally in neonates with abnormal findings on antenatal investigation or detected after birth. The control group consisted of pregnancies with structurally and genetically normal fetuses with late-onset FGR. Composite adverse perinatal outcome was defined as the presence of at least one of stillbirth, 5-min Apgar score < 7, admission to the neonatal intensive care unit (NICU), need for respiratory support at birth, neonatal jaundice and neonatal hypoglycemia. The primary aims of the study were to assess the incidence and clinical features of anomalous late-onset FGR, and to compare the perinatal outcome of such cases with that of fetuses with non-anomalous late-onset FGR.Results: Overall, 1246 pregnancies complicated by late-onset FGR were included in the study, of which 120 (9.6%) were allocated to the anomalous late-onset FGR group. Of these, 11 (9.2%) had a genetic syndrome or aneuploidy, 105 (87.5%) had an isolated structural malformation, and four (3.3%) had a congenital infection. The most frequent structural defects associated with late-onset anomalous FGR were genitourinary malformations (28/105 (26.7%)) and limb malformation (21/105 (20.0%)). Compared with the non-anomalous late-onset FGR group, fetuses with anomalous late-onset FGR had an increased incidence of composite adverse perinatal outcome (35.9% vs 58.3%; P < 0.01). Newborns with anomalous, compared to those with non-anomalous, late-onset FGR showed a higher frequency of need for respiratory support at birth (25.8% vs 9.0%; P < 0.01), intubation (10.0% vs 1.1%; P < 0.01), NICU admission (43.3% vs 22.6%; P < 0.01) and longer hospital stay (median, 24 days (range, 4-250 days) vs 11 days (range, 2-59 days); P < 0.01).Conclusions: Most pregnancies complicated by anomalous late-onset FGR have structural malformations rather than genetic abnormality or infection. Fetuses with anomalous late-onset FGR have an increased incidence of complications at birth and NICU admission and a longer hospital stay compared with fetuses with isolated late-onset FGR. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the performance of third-trimester ultrasound for the diagnosis of clinically significant placenta accreta spectrum disorder (PAS) in women with low-lying placenta or placenta previa.Methods: This was a prospective multicenter study of pregnant women aged ≥ 18 years who were diagnosed with low-lying placenta (< 20 mm from the internal cervical os) or placenta previa (covering the internal cervical os) on ultrasound at ≥ 26 + 0 weeks' gestation, between October 2014 and January 2019. Ultrasound suspicion of PAS was raised in the presence of at least one of these signs on grayscale ultrasound: (1) obliteration of the hypoechogenic space between the uterus and the placenta; (2) interruption of the hyperechogenic interface between the uterine serosa and the bladder wall; (3) abnormal placental lacunae. Histopathological examinations were performed according to a predefined protocol, with pathologists blinded to the ultrasound findings. To assess the ability of ultrasound to detect clinically significant PAS, a composite outcome comprising the need for active management at delivery and histopathological confirmation of PAS was considered the reference standard. PAS was considered to be clinically significant if, in addition to histological confirmation, at least one of these procedures was carried out after delivery: use of hemostatic intrauterine balloon, compressive uterine suture, peripartum hysterectomy, uterine/hypogastric artery ligation or uterine artery embolization. The diagnostic performance of each ultrasound sign for clinically significant PAS was evaluated in all women and in the subgroup who had at least one previous Cesarean section and anterior placenta. Post-test probability was assessed using Fagan nomograms.Results: A total of 568 women underwent transabdominal and transvaginal ultrasound examinations during the study period. Of these, 95 delivered in local hospitals, and placental pathology according to the study protocol was therefore not available. Among the 473 women for whom placental pathology was available, clinically significant PAS was diagnosed in 99 (21%), comprising 36 cases of placenta accreta, 19 of placenta increta and 44 of placenta percreta. The median gestational age at the time of ultrasound assessment was 31.4 (interquartile range, 28.6-34.4) weeks. A normal hypoechogenic space between the uterus and the placenta reduced the post-test probability of clinically significant PAS from 21% to 5% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 9% in the subgroup with previous Cesarean section and anterior placenta. The absence of placental lacunae reduced the post-test probability of clinically significant PAS from 21% to 9% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 36% in the subgroup with previous Cesarean section and anterior placenta. When abnormal placental lacunae were seen on ultrasound, the post-test probability of clinically significant PAS increased from 21% to 59% in the whole cohort and from 62% to 78% in the subgroup with previous Cesarean section and anterior placenta. An interrupted hyperechogenic interface between the uterine serosa and bladder wall increased the post-test probability for clinically significant PAS from 21% to 85% in women with low-lying placenta or placenta previa and from 62% to 88% in the subgroup with previous Cesarean section and anterior placenta. When all three sonographic markers were present, the post-test probability for clinically significant PAS increased from 21% to 89% in the whole cohort and from 62% to 92% in the subgroup with previous Cesarean section and anterior placenta.Conclusions: Grayscale ultrasound has good diagnostic performance to identify pregnancies at low risk of PAS in a high-risk population of women with low-lying placenta or placenta previa. Ultrasound may be safely used to guide management decisions and concentrate resources on patients with higher risk of clinically significant PAS. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Differences emerged regarding the clinical context in which cCTG was used before labor and whether antepartum cCTG was used only in preterm gestations, only in term gestations or in both preterm and term gestations (Appendix S1). Regarding the cCTG parameters used for management, 75.5% of Italian practitioners used both STV and Dawes-Redman criteria, 23.6% used only STV and 0.9% used other criteria. Among the parameters derived from cCTG, reduced short-term variation (STV) is the best predictor of fetal hypoxemia, acidemia and stillbirth in pregnancies complicated byfetal growth restriction (FGR)[[3], [5]]. [Extracted from the article]