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Objectives: To establish the best timing for the realization of first-trimester-morphologic-evaluation, following routine midtrimester fetal-ultrasound-scan-recommendations (RFUSR), by performing exclusive transabdominal exploration, and to determine the sensitivity of the mentioned scan for diagnosis of major structural abnormalities. Method: Prospective observational study with 512 pregnant women with singleton gestations (438 low-risk, 74 high-risk) was conducted. Early fetal morphological evaluation (EFME) is performed in line with RFUSR (18-22 weeks) (ISUOG 2010) and a check-list structured evaluation was followed, between 11-13 + 6 weeks. Its performance is assessed in the correct identification of normal fetal anatomy, and its effectiveness in the detection of structural defects Results: Five hundred and four pregnant women were evaluated, of which, 58.3% EFME are considered complete fetal anatomical surveys. Complete fetal anatomical surveys scans rise from 23.1% at 11-11 + 6 weeks to 63.8% at 13 + 3-13 weeks, with a clear turning point at 12 + 6-13 + 3 weeks (63.8%) ( p  < .05). From 12 + 6-13 + 3 weeks only renal (26.3%) and cardiac assessments (31.6%) present an inconclusive evaluation greater than 20%. Body mass index (23.9 versus 29.8) and estimated fetal weight (63 versus 86.7 g) influence EMFE's ability of identifying fetal structures ( p  < .05). EMFE presents sensitivity for the identification of structural malformations of 83.3% (20/24). Conclusions: From 12 + 6 weeks of gestation onwards, a complete fetal morphological evaluation can be performed in 63.8% of cases following the routine midtrimester fetal ultrasound scan recommendations (ISUOG's 20 weeks scan).

Objectives: To estimate the effect of maternal body mass index (BMI) on the completion of fetal anatomic surveys before 20 weeks' estimated gestational age (GA)., Methods: We conducted a retrospective cohort study of singletons undergoing standard or detailed anatomic sonographic examinations from 2006 to 2014. Patients were categorized by ranges of BMI. The primary outcomes were completion of standard and detailed anatomic surveys before 20 weeks' estimated GA. The effect of the BMI category was assessed by the χ 2 test for trends and analysis of variance., Results: Of 15,313 patients, 5917 (38%) were obese, and 1581 (10%) had a BMI of 40 kg/m 2 or higher. Standard (P < .01) and detailed (P < .01) surveys were less likely to be completed as the BMI category increased. Suboptimal visualization of the fetal chest (P < .01), abdomen (P < .01), and extremities (P < .01) significantly contributed to the decreased standard survey completion rates. Suboptimal visualization of the fetal head (P < .01) and chest (P < .01) significantly contributed to the decreased detailed survey completion rates. There was no statistically significant difference in the sensitivity of a completed standard or detailed anatomic survey for the detection of fetal anomalies., Conclusions: An increasing BMI category was associated with decreased completion of standard and detailed anatomic surveys by 20 weeks' estimated GA. Strategies to improve early visualization of the fetal head, chest, and abdomen in obese women should be investigated to promote anomaly detection and appropriate counseling., (© 2016 by the American Institute of Ultrasound in Medicine.)

Objectives: To evaluate fetal anomaly detection in pregnancies with pregestational diabetes, according to the gestational age at the time of specialized sonography, use of follow‐up sonography, maternal body mass index, and organ system(s) involved. Methods: Women with pregestational diabetes who received prenatal care and delivered a live‐born or stillborn neonate at our hospital from October 2011 through April 2017 were ascertained. We included all pregnancies with at least 1 confirmed structural anomaly (EUROCAT classification) who had detailed sonography at 18 weeks' gestation or later. We analyzed detection of anomalous fetuses at the initial detailed sonogram and, if no abnormality was identified, during any follow‐up sonograms. Statistical analyses were performed with the χ2 test and Mantel‐Haenszel χ2 test for trend. Results: Seventy‐two anomalous neonates (72 of 1060 [6.8%]) were born. Overall detection was 55 of 72 (76%); 49 of 72 (68%) were detected at the initial detailed sonogram, compared to 6 of 15 (40%) of follow‐up examinations (P =.04). Recognition at the initial or follow‐up examination was not dependent on gestational age or body mass index category (all P >.05). Of individual organ system anomalies, 67 of 89 (75%) were identified. Detection exceeded 85% for central nervous system, genitourinary, and musculoskeletal abnormalities and 43% for craniofacial anomalies. Sixty‐five percent of cardiac anomalies were detected, and 14 of 17 (82%) requiring specialized care in the immediate neonatal period were recognized. Conclusions: Approximately three‐fourths of anomalous fetuses were identified, with greater detection at the initial detailed examination. Fetuses with central nervous system, genitourinary, musculoskeletal abnormalities and those with cardiac anomalies requiring specialized cardiac care were more likely to come to attention. [ABSTRACT FROM AUTHOR]

Objective: To determine postnatal neurodevelopmental (ND) outcomes for children with congenital lower urinary tract obstruction (LUTO) based on disease severity.Methods: Twenty male infants with LUTO were classified prenatally as Stage 1 (normal amniotic fluid and renal function; n = 5), Stage 2 (signs of obstruction with preserved renal function; n = 13), and Stage 3 (signs of severe renal damage; n = 2). ND status was assessed using the Developmental Profile-3 test in 5 developmental domains (physical, adaptive behavior, social-emotional, cognitive, and communication). Each domain was considered to be delayed if standard scores were 2 or more SD below the mean. ND outcomes were compared between cases with an expected normal renal function (LUTO Stage 1) and those with impaired renal function (LUTO Stages 2 and 3). Results from cases with Stage 2 were also compared to those from Stage 3. ORs were calculated to predict risk for adverse ND outcome for each domain considering prenatal and postnatal factors.Results: Gestational age (GA) at the diagnosis of LUTO was similar between both groups (Stage 1: 24.85 ± 7.87 vs. Stages 2 and 3: 21.4 ± 4.31 weeks; p = 0.24). Twelve of 15 cases with Stage 2 or 3 underwent vesicoamniotic shunt placement compared to none of Stage 1 fetuses (p < 0.01). No differences in GA at delivery were detected between the groups (37.9 ± 1.6 vs. 35.1 ± 3.6 weeks; p = 0.1). One of the infants in the Stage 2 and 3 groups received a kidney transplant during follow-up. One case (20%) from Stage 1 group required dialysis during the first 6 months of life, and 1 case from Stage 2 to 3 group required it during the first 6 months (p = 1.0), whereas 3 additional cases needed dialysis from 6 to 24 months (p = 0.6). Mean age at Developmental Profile 3 (DP-3) testing was 20.3 ± 12.3 months (Stage 1: 11.2 ± 8.6 vs. Stages 2 and 3: 23.4 ± 13.4 months; p = 0.07). Fifteen of the 20 patients (75%) had no ND delays. Of the 5 patients with ND delays, 4 received dialysis. No differences in ND outcomes between infants with LUTO Stage 1 and those with Stages 2 and 3 were detected except for a trend toward better physical development in Stage 1 (102.6 ± 11.6 vs. 80.7 ± 34.9; p = 0.05). Infants diagnosed with LUTO Stage 3 showed significantly lower adaptive scores than those diagnosed with Stage 2 (Stage 2: 101.9 ± 22.3 vs. Stage 3: 41.5 ± 30.4; p = 0.04) and a nonsignificant trend for lower results in physical (85.8 ± 33.0 vs. 47.5 ± 38.9; p = 0.1) and socio-emotional (94.7 ±17.9 vs. 73.5 ± 13.4; p = 0.1) domains. Infants who received dialysis showed 15-fold increased risk (95% CI 0.89-251) for delayed socio-emotional development (p = 0.06). Diagnosis of fetal renal failure increased the risk for delays in the adaptive domain 30-fold (95% CI 1.29-93.1; p = 0.03). Infants with abnormal renal function had 19 times (95% CI 1.95-292) increased risk for delays in the physical domain (p = 0.03).Conclusions: While most patients with LUTO do not exhibiting ND delays, our results support the importance of ND monitoring, especially in severe forms of LUTO, as increased severity of this condition may be associated with poorer ND outcomes. [ABSTRACT FROM AUTHOR]

Objective  To compare labor patterns in pregnancies affected by fetal anomalies to low-risk singletons. Study Design  Labor data from the Consortium on Safe Labor, a multicenter retrospective study from 19 U.S. hospitals, including 98,674 low-risk singletons compared with 6,343 pregnancies with fetal anomalies were analyzed. Repeated-measures analysis constructed mean labor curves by parity, gestational age, and presence of fetal anomaly in women who reached full dilation. Interval-censored regression analysis adjusted for covariables was used to determine the median traverse times for labor progression. Results  Labor curves for all groups indicated slower labor progress for patients with fetal anomalies. The most significant trends in median traverse times were observed in the preterm nulliparous and term multiparous groups. The median traverse times from 4 cm to complete dilation in the preterm nulliparous control versus anomaly groups were 5.0 and 5.4 hours (p  < 0.0001). Conclusion  Labor proceeds at a slower rate in pregnancies affected by anomalies. [ABSTRACT FROM AUTHOR]

Objective: To assess fetal abnormalities leading to very late termination of pregnancy (VLTOP) performed after 32 weeks' gestation.Method: The study population included all pregnant women with singleton pregnancy that underwent VLTOP in our institute because of fetal indications between the years 1998 and 2015.Results: Fifty-seven cases (2.0%) were at ≥32 weeks' gestation and are the subjects of the current study. Our VLTOP cases were subdivided into four categories according to the sequence of events that led to the decision for VLTOP: (1) No routine prenatal screening with an incidental fetal finding discovered after 32 weeks' gestation (9 fetuses ∼16%); (2) Routine early prenatal care raised suspicion of abnormalities, and the final diagnosis was established by additional tests (8 fetuses, ∼14%); (3) Developmental findings detected during the third trimester (21 fetuses; ∼37%), and (4) fetal abnormalities that could have been detected earlier during pregnancy (19 fetuses; ∼33%).Conclusions: The two categories in which the pregnant women did not underwent any fetal evaluation (i.e. group 1) or those that could have been detected earlier (i.e. group 4) consists ∼49% from our cohort in which VLTOP could have been avoided. [ABSTRACT FROM AUTHOR]

Objectives: To introduce a new sonographic marker of intrathoracic liver herniation in fetuses with left-sided congenital diaphragmatic hernia (CDH).Methods: In a consecutive series of fetuses with isolated CDH, an ultrasound volume of the fetal abdomen was acquired. On this volume, offline calculation of the angle formed by the midline of the abdomen (joining the center of the vertebral body to the abdominal insertion of the umbilical cord) and a second line joining the center of the vertebral body to the intra-abdominal convexity of the umbilical vein was carried out to give the umbilical vein deviation angle (UVDA). The UVDA was measured in a group of normal fetuses selected as controls. At follow-up, the presence of liver herniation was investigated in all cases of CDH. UVDA values were compared between the CDH group and controls, and between CDH 'liver-up' vs 'liver-down' cases. A receiver-operating characteristics (ROC) curve was constructed to identify a cut-off value of the UVDA with the highest accuracy in predicting liver herniation in the CDH group.Results: Between 2009 and 2015, 22 cases of left-sided CDH were included in the study group, of which nine cases had liver herniation. Eighty-eight normal fetuses were recruited as controls. The UVDA was significantly higher in the cases vs controls (15.25 ± 7.91° vs 7.68 ± 1.55°; P < 0.0001). Moreover, the UVDA was significantly increased in CDH fetuses with liver-up vs liver-down (21.77 ± 8.79° vs 10.75 ± 2.10°; P < 0.0001). On ROC curve analysis the UVDA showed good prediction of liver herniation (area under the ROC curve, 0.94; P < 0.0001) with the best cut-off of 15.2°, yielding a sensitivity of 89% and a specificity of 100% (P < 0.0001).Conclusions: In fetuses with CDH, umbilical vein bowing may be quantified by measuring the UVDA using three-dimensional ultrasound. This sonographic marker seems to be an accurate predictor of liver herniation in left-sided CDH. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Aim: To analyze the impact of counseling on antenatal congenital surgical anomalies (ACSA).Methods: Cases presenting with ACSA for fetal counseling and those presenting in post-natal period following diagnosis of ACSA (PACSA) for surgical opinion were analyzed for spectrum, presentation and outcome.Results: 117 cases including ACSA(68);PACSA(49) were analyzed. Gestational age at diagnosis of ACSA;PACSA was 17-37;17-39 weeks (median 24;32 weeks). Diagnoses in ACSA;PACSA included urological (26;31), neurological (10;5), congenital diaphragmatic hernia (CDH)(5;1), gastrointestinal (5;5), lung and chest anomalies (5;1), intraabdominal cysts (4;1), abdominal wall defects (4;0), tumors (3;3), limb anomaly (1;1), esophageal atresia (1;1), conjoint twins (1;0), hepatomegaly (1;0), and major cardiac anomalies (2;0). Two antenatal interventions were done for ACSA; vesicoamniotic shunt and amnioinfusion for oligohydramnios. 17;24 ACSA;PACSA required early surgical intervention in post-natal period. Nine ACSA underwent medical termination of pregnancy and 4 had intrauterine demise. Nine ACSA babies died including two CDH, one gastroschisis, one duodenal atresia, one conjoint twins, one megacystitis with motility disorder and three posterior urethral valves. All PACSA babies survived.Conclusion: Fetal counseling for CSA portrays true outcome of ACSA with 32.3% (22/68) mortality versus 0% for PACSA due to selection bias. However, fetal counseling ensures optimal perinatal care. [ABSTRACT FROM AUTHOR]

Objective: To assess the risks of fetal anomalies, fetal loss and adverse perinatal outcome in a cohort of first-trimester intertwin crown-rump length (CRL) discordant twins, stratified by chorionicity and the degree of CRL discordance. Method: Four-hundred-and-seventy-one twin pregnancies were scanned during an 8-year period at 11–14 weeks, and those with an intertwin CRL discordance ≥10% were compared with concordant twins. Outcomes were also compared between monochorionic and dichorionic twins and between moderate (10–16%) and severe (>16%) discordance. Results: Four-hundred-and-five twin pregnancies, 65 discordant and 340 concordant, were follow-up. Discordant twin pregnancies were at significant higher risk of chromosomal (OR = 11.42; 95% CI: 2.78–46.94) and structural anomalies (OR = 5.91; 95% CI: 2.25–15.54), spontaneous fetal loss (OR = 4.23; 95% CI: 1.79–10.01), birthweight discordance (OR = 2.8; 95% CI: 1.48–5.65) and small-for-gestational age (OR = 3.48; 95% CI: 1.78–6.79). Similar differences (except for birthweight discordance) were observed among dichorionic twins. Among monochorionic, increased frequencies were only seen for structural anomalies, birthweight discordance and small newborns. Severe CRL discordance presented with higher rates of structural anomalies, stillbirth, birthweight discordance and small newborns. Conclusion: Intertwin CRL discordance (≥10%) results in an increased risk of fetal anomalies and growth restriction that increases in severe CRL discordance (≥16%). [ABSTRACT FROM PUBLISHER]

Objective The objective was to ascertain the practices and opinions of US maternal–fetal medicine specialists regarding termination of pregnancy as a management option following late diagnosis of lethal fetal anomalies. Study design We conducted a cross-sectional mail survey of all US members of the Society of Maternal Fetal Medicine to ascertain how they manage pregnancies diagnosed with lethal fetal anomalies after 24 weeks of gestation. We analyzed the proportion of respondents that discuss termination of pregnancy as a management option, barriers to offering or accessing late termination services, and respondents’ opinions about what anomalies are lethal and when pregnancy termination should be permitted. Results The response rate was 41% (869/2119). Nearly all (93%) respondents discuss delivery near term or when complications arise, while 75% discuss the option of termination of pregnancy soon after the diagnosis of lethal fetal anomalies. Only 52% of the physicians indicated that their patients could obtain termination of pregnancy after 24 weeks at their affiliated medical centers or through providers within 50 miles. Real or perceived legal restrictions represented the most common reason for lack of local services. The proportion of respondents that felt strongly or very strongly that termination of pregnancy should be allowed was 76% for lethal anomalies and 58% for anomalies likely to result in significant long-term impairment. Conclusion Although limited by a modest response rate, our study found that physicians do not consistently discuss immediate termination of pregnancy as an option following late diagnosis of lethal fetal anomalies, and they face numerous barriers to providing these services. Implications This national survey supports the need for improved services for pregnant women who desire later termination of pregnancy following diagnosis of serious fetal anomalies. Helpful efforts might include educating physicians about the laws and regulations governing late termination of pregnancy, forging more consistent standards of care, and improving collaboration between MFM specialists and family planning providers to enhance access to care. [ABSTRACT FROM AUTHOR]

Introduction: Cisterna magna (CM) measurement constitutes part of the sonographic assessment of the posterior fossa. CM enlargement (ECM) is defined as a measurement exceeding 10 mm, although it has previously been noted that the CM varies in size with gestation. Existing data do not appear to reflect observations regarding CM biometry within our population and this study was therefore undertaken in order to re-evaluate CM biometry. Materials and Methods: Data from 4,750 normal pregnancies between 15 and 32 weeks of gestation were collected and used to construct a reference range for the CM. Results: Regression analysis was used to model CM across gestational age and thereby define the upper limits for normal CM measurements across gestation. The CM increases with gestation. These data suggest that a 10-mm cut-off underestimates ECM, notably in the gestational age period below 24 weeks, whilst overestimating isolated ECM beyond this. Differences in CM measurements between genders were confirmed (p < 0.0001). Conclusions: Defining ECM based upon a cut-off of 10 mm across all gestations may be inappropriate given the variation observed with gestational age. More accurate identification of fetuses with, in particular, isolated ECM may facilitate more precise evaluation of the clinical significance of this finding. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Background: A significant proportion of second-trimester abortions are done for fetal anomalies. Our objective was to evaluate the impact of ultrasound at <14 weeks on the gestational age at abortion for structural fetal abnormalities. Study Design: Retrospective review identified all patients undergoing abortion following sonographic diagnosis of structural fetal anomalies at a single institution from 2004–2011. First-trimester ultrasound findings were reviewed, and abnormalities were categorized as “diagnostic” or “nondiagnostic.” Chi-square analysis and Mann–Whitney U test were used for statistical comparison. Results: One hundred thirty-two patients who underwent abortion due to structural fetal abnormalities were included, 109 of whom underwent ultrasound at 11–13 weeks. In those scanned at <14 weeks, there were diagnostic findings in 36 cases (33.0%) and abnormal nuchal translucency or other nondiagnostic finding leading to early second-trimester ultrasound in 16 cases (14.7%). In those scanned at <14 weeks, median gestational age at abortion was earlier compared to those who underwent initial anatomic evaluation in the second trimester, 19 weeks (13.5–21) versus 21 weeks (19–22), p=.001. Conclusion: Ultrasound at <14 weeks was associated with an earlier gestational age at abortion in pregnancies with structural fetal abnormalities. [Copyright &y& Elsevier]

Background and purpose: Ultra sonography is the method of choice in pre-natal diagnosis of fetal anomalies; however, sonography has limitations in oligohydramnios, maternal obesity and complex fetal anomalies. MRI, is a method with high contrast resolution, large FOV for fetus, placenta and uterine, along with multiplanar images. The aim of our study is to compare the sonographic and MRI findings in fetal anomalies by two radiologists who perform MRI test to show additional data relative to sonograpgy. Materials and methods: This research was a case series study and performed in Imam Khomeini Hospital in Sari in year 84-86. All pregnant women with gestational age of more than 20 years were evaluated with sono-graphically for fetal anomalies by one radiologist. Additionally, patients with abnormal fetuses were evaluated with MRI testing and the MRI films were examined again after birth. The sonographic and MRI findings were matched together. Results: The fetal anomalies in this study include: CNS abnormalities 47%, urinary tract abnormalities 39% and gastrointestinal abnormalities 14%. Conclusion: The sonography and MRI findings were similar in 60.8% of cases studied; sonographic findings were more than MRI in 8.6% of cases. MRI findings showed more than sonography in 30.4% of cases presented. Thus, MRI has a complimentary role in pre-natal diagnosis of fetal anomalies. [ABSTRACT FROM AUTHOR]

Objective To assess the diagnostic efficacy of the first-trimester anomaly scan including first-trimester fetal echocardiography as a screening procedure in a ‘medium-risk’ population. Methods In a prospective study, we evaluated 3094 consecutive fetuses with a crown—rump length (CRL) of 45-84 mm and gestational age between 11 + 0 and 13 + 6 weeks, using transabdominal and transvaginal ultrasonography. The majority of patients were referred without prior abnormal scan or increased nuchal translucency (NT) thickness, the median maternal age was, however, 35 (range, 15-46) years, and 53.8% of the mothers (1580/2936) were 35 years or older. This was therefore a self-selected population reflecting an increased percentage of older mothers opting for prenatal diagnosis. The follow-up rate was 92.7% (3117/3363). Results The prevalence of major abnormalities in 3094 fetuses was 2.8% (86/3094). The detection rate of major anomalies at the 11 + 0 to 13 + 6-week scan was 83.7% (72/86), 51.9% (14/27) for NT < 2.5 mm and 98.3% (58/59) for NT ⩾ 2.5 mm. The prevalence of major congenital heart defects (CHD) was 1.2 % (38/3094). The detection rate of major CHD at the 11 to 13 + 6-week scan was 84.2% (32/38), 37.5% (3/8) for NT > 2.5 mm and 96.7% (29/30) for NT ⩾ 2.5 mm. Conclusion The overall detection rate of fetal anomalies including fetal cardiac defects following a specialist scan at 11 + 0 to 13 + 6 weeks' gestation is about 84% and is increased when NT ⩾ 2.5 mm. This extends the possibilities of a first-trimester scan beyond risk assessment for fetal chromosomal defects. In experienced hands with adequate equipment, the majority of severe malformations as well as major CHD may be detected at the end of the first trimester, which offers parents the option of deciding early in pregnancy how to deal with fetuses affected by genetic or structural abnormalities without pressure of time. [ABSTRACT FROM AUTHOR]

Introduction. Nuchal translucency (NT) is the normal fluid occupying the subcutaneous space between the back of the fetal skin and the overlying skin. An increased NT was first described as a measure greater than the 95th percentile for a given crown rump length. However, reports have highlighted that opposing results are much more common with an NT that exceeds a set threshold of 3.5mm, a measurement that essentially represents the 99th percentile or more throughout the gestational age window for the first-trimester screening. Assessing the thickness of NT has become a well-established method in early pregnancy for the detection of aneuploidy. NT measurement technique. Most experts recommend that NT should be measured between 11 and 13+6 weeks, corresponding to a CRL measurement between 45 and 84 mm. This gestational age window is chosen because NT as a screening test performs optimally and fetal size allows the diagnosis of major fetal abnormalities, thus providing women who are carrying an affected fetus with the option of an early termination of pregnancy. How to measure NT? A transabdominal or transvaginal route can measure NT. The fetus should be in the neutral position, a sagittal section should be obtained and the image should be magnified in order to include only the fetal head and the upper thorax. Furthermore, the amniotic membrane should be identified separately from the fetus. The median view of the fetal face is defined by the presence of the echogenic tip of the nose and the rectangular shape of the palate anteriorly, the translucent diencephalon in the center and the nuchal membrane posteriorly. If the section is not strictly median, the tip of the nose will not be seen and the orthogonal osseous extension at the frontal end of the maxilla will appear. The ultrasound machine should allow a measurement precision of 0.1 mm. Calipers would be positioned perfectly (on-on) to measure NT as the maximum distance between the nuchal membrane and the edge of the soft tissue overlying the cervical spine. If more than one measurement meeting all the criteria is achieved, the maximum one should be recorded and used for risk assessment. Conclusions. NT detection by ultrasound is considered as a powerful prenatal screening strategy to diagnose early fetal anomalies. [ABSTRACT FROM AUTHOR]

Background: Data regarding pregnancy outcomes in sickle cell disease are conflicting. Previous studies are limited by small sample size, narrow geographic area, and a wide range of resource availability.Objective: The purpose of this study was to examine the association between maternal sickle cell disease and adverse pregnancy outcomes in a contemporary North American cohort.Study Design: We performed a retrospective cohort study of 2,027,323 women with singleton pregnancies delivered in California from 2005-2008. Deliveries at <24 or >42 6/7 weeks of gestation were excluded. Women with sickle cell disease were compared with control subjects. Maternal outcomes of interest included preeclampsia, preterm delivery, placental abruption, oligohydramnios, and cesarean delivery; neonatal outcomes included small for gestational age, anomalies, stillbirth, neonatal death, and infant death.Results: The prevalence of sickle cell disease was 0.017%. Compared with control subjects, women with sickle cell disease were more likely to have limited prenatal care (7.4 vs 3.8%; P=.001), underlying chronic hypertension (2.3% vs 1.1%; P=.038), and fetal anomalies (14.0 vs 6.4%; P<.001). The increased odds of fetal anomalies persisted after adjustment for multiple confounders (odds ratio, 1.73; 95% confidence interval, 1.26-2.38). Women with sickle cell disease also had higher odds of severe preeclampsia (odds ratio, 3.75; 95% confidence interval, 2.21-6.38), preterm delivery (odds ratio, 2.50; 95% confidence interval, 1.93-3.21), small for gestational age (odds ratio, 1.96; 95% confidence interval, 1.18-3.25), and cesarean delivery (odds ratio, 1.93; 95% confidence interval, 1.40-2.67).Conclusion: Women with sickle cell disease are at high risk of maternal and neonatal morbidity. Low rates of fetal and neonatal death may reflect improved antenatal surveillance and management as compared with previous studies. The association between sickle cell disease and fetal anomalies warrants further investigation. [ABSTRACT FROM AUTHOR]