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Introduction: This study aims to address the radiation exposure incurred by lung scintigraphy in pregnant patients suspected of pulmonary embolism and to investigate the dose variations due to different body habitus of the fetus. Material and Methods: In this respect, seven computational models of pregnant women and fetus in three trimesters of pregnancy were used and Monte Carlo calculations were performed using Monte Carlo nparticle -extended (MCNPX) code version 2.6.0 to assess absorbed dose coefficients. Time-integrated activities for three radiopharmaceuticals considered in this study were also extracted from the available reference biokinetic data. Results: Fetal dose coefficients (mGy/MBq) for three radiopharmaceuticals labeled with 99mTc were estimated for reference pregnant phantoms at three trimesters of gestation and 10th, and 90th fetal growth percentiles were also considered during the last two trimesters. The results show that the fetal dose coefficients were 2.09 × 10-2, 5.71 × 10-3, and 4.44 × 10-3 mGy/MBq for 99mTc MAA, 8.31 × 10-4, 8.68 × 10-4, and 1.27 × 10-3 mGy/MBq for 99mTc Technegas, and 7.85 × 10-3, 2.42 × 10-3, and 2.66 × 10-3 mGy/MBq for 99mTc DTPA aerosol, respectively. According to the results the factor of fetal body habitus adds variation to the fetal dose within ±15%. Conclusion: Considering one of the uncertainty components of fetal dose, that is the fetal body habitus, the dose variations were well below the safety threshold for the fetus (the threshold from ICRP Publication 84 for fetal cancer risk). Therefore, to check the safety of the diagnostic examination in terms of radiation dose to the fetus, it is sufficient to take into account the reference dose values in clinical practice. [ABSTRACT FROM AUTHOR]

In the central nervous system (CNS) there are a greater number of glial cells than neurons (between five and ten times more). Furthermore, they have a greater number of functions (more than eight functions). Glia comprises different types of cells, those of neural origin (astrocytes, radial glia, and oligodendroglia) and differentiated blood monocytes (microglia). During ontogeny, neurons develop earlier (at fetal day 15 in the rat) and astrocytes develop later (at fetal day 21 in the rat), which could indicate their important and crucial role in the CNS. Analysis of the phylogeny reveals that reptiles have a lower number of astrocytes compared to neurons and in humans this is reversed, as there have a greater number of astrocytes compared to neurons. These data perhaps imply that astrocytes are important and special cells, involved in many vital functions, including memory, and learning processes. In addition, astrocytes are involved in different mechanisms that protect the CNS through the production of antioxidant and anti-inflammatory proteins and they clean the extracellular environment and help neurons to communicate correctly with each other. The production of inflammatory mediators is important to prevent changes in brain homeostasis. On the contrary, excessive, or continued production appears as a characteristic element in many diseases, such as Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and in neurodevelopmental diseases, such as bipolar disorder, schizophrenia, and autism. Furthermore, different drugs and techniques have been developed to reverse oxidative stress and/or excess of inflammation that occurs in many CNS diseases, but much remains to be investigated. This review attempts to highlight the functional relevance of astrocytes in normal and neuropathological conditions by showing the molecular and cellular mechanisms of their role in the CNS. [ABSTRACT FROM AUTHOR]

Objective: The aim was to demonstrate the prevalence of fetal myocardial hypertrophy (FMH) in diabetes mellitus (DM) pregnant women using spatio-temporal image correlation (STIC) M-mode. Material and Methods: This prospective descriptive study was conducted at Bhumibol Adulyadej Hospital (BAH) Royal Thai Air Force between April and December 2022. Participants were singleton DM pregnant women with gestational age (GA) between 18 and 40 weeks who had antenatal care and delivery at BAH. DM screening was randomized blood sugar obtained from all participants. All participants underwent fetal heart exams by four-dimension ultrasound with STIC M-mode. Results: One hundred and forty-five participants were recruited and classified as pregestational (PDM) and gestational DM (GDM) at 31 and 114 cases, respectively. The mean age of participants was 31.7 years old. Fasting blood sugar (FBS) of PDM was significantly higher than GDM (105.1 vs 87.0 mg%). GDMA2 had more elevated FBS than GDMA1 (p < 0.001). PDM had significantly greater FBS and two-hour postprandial blood sugar (2hr-PP) than GDM (105.1/87.0 and 151.5/117.9 mg%, respectively). FBS and 2hr-PP of GDMA2 were more than GDMA1 with statistical significance. Good glycemic control of GDM was significantly better than PDM. GDMA1 had better glycemic control than GDMA2 with statistical significance. Four-fifth (115/145) of participants had FMH. FMH and estimated fetal weight among PDM and GDM were comparable. Both good and poor glycemic control had similar FMH. Neonatal outcomes of FMH or non-FMH infants were similar. Conclusion: The prevalence of FMH in diabetic pregnant women was 79.3%. Glycemic control had no correlation to FMH. [ABSTRACT FROM AUTHOR]

Objectives: Our objective was to examine the pregnancy course and immediate neonatal outcome of fetuses with an isolated extension of choroid plexus (CP) to the anterior horn during the second trimester. Methods: We prospectively collected the cases referred to us between July 2012 and January 2021 with isolated finding of CP extension to the anterior horn. Relevant clinical and demographic information was recorded, and a full anatomy scan including a comprehensive neurosonogram was performed. In cases of confirmed isolated extension of CP to the anterior horns, women were offered further investigation including fetal MRI, and ultrasound follow up. Results: We collected 29 eligible cases for analysis. The mean gestational age (GA ± SD) for diagnosis and referral was 19.24 ± 2.3 weeks. No other intracranial anomalies were detected in any of the cases, and the finding resolved at 25 ± 2.6 weeks. The average extension length and width to the anterior horn were 0.7 ± 0.3 cm, and 0.5 ± 0.1 cm, respectively. Eleven fetuses (38%) had choroid plexus cyst (CPC) in addition to the extension. Ten patients (35%) completed a fetal brain MRI, with no identified abnormalities. Gross neurological exam and Apgar score at birth were normal. Conclusion: Extension of CP to anterior horn with or without CPC at mid‐trimester seems to have spontaneous resolution with likely a good prognosis and no further implications. [ABSTRACT FROM AUTHOR]

Introduction Fetomaternal Hemorrhage is a condition in which a fetus blood mixes with the patient's during pregnancy due to a disruption in the barrier that keeps the fetus' and patient's blood separate. In this case, the patient visited her OBGYN's office and complained that she had recently noticed decreased fetal movement. Ultrasound revealed negative fetal heart tones. A stillborn fetus was delivered the next day and Kleihauer-Betke test indicated complete fetal exsanguination. Case Description A 24 year old female, G2P1001, presented to her OBGYN's office for routine checkup. At this visit, gestation was noted to be 35 weeks and 2 days. The patient reported that she had not felt the fetus move in the recent days, so an ultrasound was performed which showed no fetal heart movement. She was immediately induced and the fetus was delivered shortly after with a diagnosis of intrauterine fetal demise. It was determined that fetomaternal hemorrhage had occurred. Pathology report showed no obvious causes, but a Kleihauer-Betke test revealed that 300mL of the fetus' blood had mixed with the patient's, indicating complete fetal exsanguination. After careful calculation, the mother was given 8 vials of RhoGAM, which is a significantly larger dose of RhoGAM than the recommended empiric dose (12,000 IU's in our case vs the recommended 1500 IU empiric dose) Discussion This case illustrates an unusually large amount of fetal blood loss into the patient's circulation, but the use of Rhogam was able to prevent the patient from developing anti-D antibodies that would otherwise have affected future pregnancies. [ABSTRACT FROM AUTHOR]

The development of connectivity between the thalamus and maturing cortex is a fundamental process in the second half of human gestation, establishing the neural circuits that are the basis for several important brain functions. In this study, we acquired high-resolution in utero diffusion magnetic resonance imaging (MRI) from 140 fetuses as part of the Developing Human Connectome Project, to examine the emergence of thalamocortical white matter over the second to third trimester. We delineate developing thalamocortical pathways and parcellate the fetal thalamus according to its cortical connectivity using diffusion tractography. We then quantify microstructural tissue components along the tracts in fetal compartments that are critical substrates for white matter maturation, such as the subplate and intermediate zone. We identify patterns of change in the diffusion metrics that reflect critical neurobiological transitions occurring in the second to third trimester, such as the disassembly of radial glial scaffolding and the lamination of the cortical plate. These maturational trajectories of MR signal in transient fetal compartments provide a normative reference to complement histological knowledge, facilitating future studies to establish how developmental disruptions in these regions contribute to pathophysiology. [ABSTRACT FROM AUTHOR]

Background: The developing nervous system in utero is exposed to various stimuli with effects that may be carried forward to the neonatal period. This study aims to investigate the effects of sound stimulation (music and speech) on fetal memory and learning, which was assessed later in neonatal period. Methods: The MEDLINE (pubmed), Scopus, EMBASE, and Cochrane Library were searched. Two reviewers selected the studies and extracted the data independently. The quality of eligible studies was assessed using The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials (RCTs). Results: Overall 3930 articles were retrieved and eight studies met the inclusion criteria. All of the included studies had good general quality; however, high risk of selection and detection bias was detected in most of them. Fetal learning was examined through neonatal electrocardiography (ECG), electroencephalography (EEG), habituation tests, and behavioral responses. Seven studies showed that the infants had learned the fetal sound stimulus and one study indicated that the prenatally stimulated infants performed significantly better on a neonatal behavior test. There was considerable diversity among studies in terms of sound stimulation type, characteristics (intensity and frequency), and duration, as well as outcome assessment methods. Conclusions: Prenatal sound stimulation including music and speech can form stimulus-specific memory traces during fetal period and effect neonatal neural system. Further studies with precisely designed methodologies that follow safety recommendations, are needed. [ABSTRACT FROM AUTHOR]

(1) Background: The objective of this study was to investigate the diagnostic value of chromosomal microarray analysis (CMA) for congenital heart defects (CHDs) with different cardiac phenotypes and extracardiac abnormalities (ECAs) and to explore the pathogenic genetic factors of CHDs. (2) Methods: We collected fetuses diagnosed with CHDs by echocardiography at our hospital from January 2012 to December 2021. We analyzed the CMA results of 427 fetuses with CHDs. We then categorized the CHD into different groups according to two dimensions: different cardiac phenotypes and whether it was combined with ECAs. The correlation between the numerical chromosomal abnormalities (NCAs) and copy number variations (CNVs) with CHDs was analyzed. Statistical analyses, including Chi-square tests and t-tests, were performed on the data using IBM SPSS and GraphPad Prism. (3) Results: In general, CHDs with ECAs increased the detection rate for CA, especially the conotruncal defects. CHD combined with the thoracic and abdominal walls and skeletal, thymic and multiple ECAs, were more likely to exhibit CA. Among the CHD phenotypes, VSD and AVSD were associated with NCA, while DORV may be associated with NCA. The cardiac phenotypes associated with pCNVs were IAA (type A and B), RAA, TAPVC, CoA and TOF. In addition, IAA, B, RAA, PS, CoA and TOF were also associated with 22q11.2DS. The length distribution of the CNV was not significantly different between each CHD phenotype. We detected twelve CNV syndromes, of which six syndromes may be related to CHDs. The pregnancy outcome in this study suggests that termination of pregnancy with fetal VSD and vascular abnormality is more dependent on genetic diagnosis, whereas the outcome in other phenotypes of CHDs may be associated with other additional factors. (4) Conclusions: CMA examination for CHDs is still necessary. We should identify the existence of fetal ECAs and specific cardiac phenotypes, which are helpful for genetic counseling and prenatal diagnosis. [ABSTRACT FROM AUTHOR]

Objective: To investigate the ultrasonographic classification of fetal umbilical-portal-systemic venous shunts (UPSVS) and the correlations with fetal chromosomal abnormalities. Methods: We retrospectively analyzed the ultrasound characteristics and the corresponding chromosomal abnormalities of 26 cases of fetal UPSVS prenatally diagnosed. Results: A total of 26 fetuses diagnosed as UPSVS were included, including four cases of type I UPSVS, ten of type II, three of type IIIA, and nine of type IIIB. Four cases of type I were all complicated by fetal heart enlargement and heart insufficiency, of which one case had multiple malformations, and all four cases terminated pregnancies. Six of ten cases of type II terminated pregnancies, including four of Down's syndrome, one of twin reversed arterial perfusion sequence, one of fetal edema but with normal copy number variation (CNV) by chorionic villus sampling. The other four of ten cases were isolated type II with normal chromosomes, which were delivered at full term and were normal in growth and development when followed up 34 months after birth. Three cases of type IIIA all terminated pregnancies, of which one had multiple malformations, one had right multicystic dysplastic kidney, and one had fetal heart enlargement and heart failure. Among nine of type IIIB, seven with chromosomal abnormalities and/ or complicated malformations terminated pregnancies, and two with isolated type IIIB and normal chromosomes were delivered at full term, and were normal in growth and development (one was followed up to 33 months after birth and the other 20 months after birth). Conclusion: Fetal UPSVS can be clearly diagnosed and typed by prenatal ultrasonography. Fetal prognosis is determined by the types of UPSVS and complicated malformations and/ or chromosomal abnormalities. The probability of fetal chromosomal abnormalities in UPSVS fetuses is related to the ultrasonographic classification. [ABSTRACT FROM AUTHOR]

Simple Summary: Congenital heart defect (CHD) is the most common birth defect that affects the structure of the heart from birth. A possible reason for this occurrence could be alterations in the properties of the stem cells associated with fetal heart development. In this study, we compared the growth and cardiomyogenic potential of fetal-derived amniotic fluid mesenchymal stem cells (AF-MSCs) from isolated congenital heart defective fetuses (ICHD) with AF-MSCs of normal fetuses. The ICHD AF-MSCs showed a defect in the ability to grow efficiently and displayed increased senescence and DNA damage processes compared to normal AF-MSCs. Furthermore, the ICHD AF-MSCs showed cardiomyogenic differentiation defects that were accompanied by decreased expression of various proteins, including cardiac progenitor markers, transcription factors, and structural proteins, which are necessary for proper heart development. Overall, our study highlights that these defects in AF-MSCs of ICHD fetuses possibly contribute to CHDs and may lead to improper heart development. Amniotic fluid mesenchymal stromal cells (AF-MSCs) represent an autologous cell source to ameliorate congenital heart defects (CHDs) in children. The AF-MSCs, having cardiomyogenic potential and being of fetal origin, may reflect the physiological and pathological changes in the fetal heart during embryogenesis. Hence, the study of defects in the functional properties of these stem cells during fetal heart development will help obtain a better understanding of the cause of neonatal CHDs. Therefore, in the present study, we compared the proliferative and cardiomyogenic potential of AF-MSCs derived from ICHD fetuses (ICHD AF-MSCs) with AF-MSCs from structurally normal fetuses (normal AF-MSCs). Compared to normal AF-MSCs, the ICHD AF-MSCs showed comparable immunophenotypic MSC marker expression and adipogenic and chondrogenic differentiation potential, with decreased proliferation, higher senescence, increased expression of DNA-damaged genes, and osteogenic differentiation potential. Furthermore, the expression of cardiac progenitor markers (PDGFR-α, VEGFR-2, and SSEA-1), cardiac transcription factors (GATA-4, NKx 2-5, ISL-1, TBX-5, TBX-18, and MeF-2C), and cardiovascular markers (cTNT, CD31, and α-SMA) were significantly reduced in ICHD AF-MSCs. Overall, these results suggest that the AF-MSCs of ICHD fetuses have proliferation defects with significantly decreased cardiomyogenic differentiation potential. Thus, these defects in ICHD AF-MSCs highlight that the impaired heart development in ICHD fetuses may be due to defects in the stem cells associated with heart development during embryogenesis. [ABSTRACT FROM AUTHOR]

According to modern view, susceptibility to diseases, specifically to cognitive and neuropsychiatric disorders, can form during embryonic development. Adverse factors affecting mother during the pregnancy increase the risk of developing pathologies. Despite the association between elevated maternal blood homocysteine (Hcy) and fetal brain impairments, as well as cognitive deficits in the offspring, the role of brain plasticity in the development of these pathologies remains poorly studied. Here, we review the data on the negative impact of hyperhomocysteinemia (HHcy) on the neural plasticity, in particular, its possible influence on the offspring brain plasticity through epigenetic mechanisms, such as changes in intracellular methylation potential, activity of DNA methyltransferases, DNA methylation, histone modifications, and microRNA expression in brain cells. Since placenta plays a key role in the transport of nutrients and transmission of signals from mother to fetus, its dysfunction due to aberrant epigenetic regulation can affect the development of fetal CNS. The review also presents the data on the impact of maternal HHcy on the epigenetic regulation in the placenta. The data presented in the review are not only interesting from purely scientific point of view, but can help in understanding the role of HHcy and epigenetic mechanisms in the pathogenesis of diseases, such as pregnancy pathologies resulting in the delayed development of fetal brain, cognitive impairments in the offspring during childhood, and neuropsychiatric and neurodegenerative disorders later in life, as well as in the search for approaches for their prevention using neuroprotectors. [ABSTRACT FROM AUTHOR]

Purpose: To determine the recurrence risk and risk factors for monozygotic splitting after elective single-embryo transfers (eSET). Methods: A retrospective cohort study was performed investigating 65,664 eSET cycles that resulted in a clinical pregnancy as reported in the Society for Assisted Reproductive Technology (SART) Clinical Outcomes Reporting System (CORS) between 2004 and 2017. Monozygosity was defined as more than one fetal heart tone by the first-trimester ultrasound and concordant sex at live birth. The primary outcome was recurrence risk, with recurrence defined as one patient having two or more cycles of eSET resulting in monozygotic multiples. The secondary objective was to identify factors associated with smonozygotic splitting, using a multivariable logistic regression model and a stepwise purposeful model selection. Results: There were 1355 (2.05%) pregnancies that resulted in two or more fetal heart tones after SET, including 840 monozygotic twins and triplets at birth. Recurrence occurred in two cases—0.0001% of patients with multiple eSET cycles. One case resulted from embryos created from a single cohort with intracytoplasmic sperm injection (ICSI), assisted hatching (AH), and blastocyst transfers. The second case resulted from donor egg embryos with ICSI and blastocyst transfers. Risk factors associated with monozygotic live birth were blastocyst transfer (OR 1.23, 95% CI 1.04–1.47, P = 0.0176) and AH (OR 1.23, 95% CI 1.05–1.44, P = 0.0081). Conclusion: Recurrence of monozygotic live births in eSET was very rare. Blastocyst transfer and AH were confirmed to be risk factors for monozygotic live births, while ICSI, PGT, and FET do not appear to be associated. [ABSTRACT FROM AUTHOR]

Purpose: Accurate estimations of fetal absorbed dose and radiation risks are crucial for radiation protection and important for radiological imaging research owing to the high radiosensitivity of the fetus. Computational anthropomorphic models have been widely used in patient-specific radiation dosimetry calculations. In this work, we aim to build the first digital fetal library for more reliable and accurate radiation dosimetry studies. Acquisition and validation methods: Computed tomography (CT) images of abdominal and pelvic regions of 46 pregnant females were segmented by experienced medical physicists. The segmented tissues/organs include the body contour, skeleton, uterus, liver, kidney, intestine, stomach, lung, bladder, gall bladder, spleen, and pancreas for maternal body, and placenta, amniotic fluid, fetal body, fetal brain, and fetal skeleton. Nonuniform rational B-spline (NURBS) surfaces of each identified region was constructed manually using 3D modeling software. The Hounsfield unit values of each identified organs were gathered from CT images of pregnant patients and converted to tissue density. Organ volumes were further adjusted according to reference measurements for the developing fetus recommended by the World Health Organization (WHO) and International Commission on Radiological Protection. A series of anatomical parameters, including femur length, humerus length, biparietal diameter, abdominal circumference (FAC), and head circumference, were measured and compared with WHO recommendations. Data format and usage notes: The first fetal patient-specific model library was developed with the anatomical characteristics of each model derived from the corresponding patient whose gestational age varies between 8 and 35 weeks. Voxelized models are represented in the form of MCNP matrix input files representing the three-dimensional model of the fetus. The size distributions of each model are also provided in text files. All data are stored on Zenodo and are publicly accessible on the following link: https://zenodo.org/record/6471884. Potential applications: The constructed fetal models and maternal anatomical characteristics are consistent with the corresponding patients. The resulting computational fetus could be used in radiation dosimetry studies to improve the reliability of fetal dosimetry and radiation risks assessment. The advantages of NURBS surfaces in terms of adapting fetal postures and positions enable us to adequately assess their impact on radiation dosimetry calculations. [ABSTRACT FROM AUTHOR]

Elevated circulating progesterone (P4) concentrations in the first week after conception have been associated with accelerated post-hatching conceptus elongation. However, the consequences, if any, on the development of the fetus are unknown. The objective of this study was to determine the relationship between early circulating P4 and fetal and placental morphometric characteristics at 42 days of gestation. A previously validated model of asynchronous embryo transfer (ET), known to alter uterine exposure to P4, was used in 107 heifers divided in two replicates (replicate 1: n = 51, replicate 2: n = 56). Heifers were randomly assigned to one of the two following groups: those receiving a Day 7 embryo on Day 7 of the cycle (synchronous; ET_D7, n = 49) and those transferred a Day 7 embryo on Day 9 of the cycle (asynchronous; ET_D9, n = 58). The synchronization protocol was started two days earlier for heifers in the ET_D9 group such that ET was done on the same day for both groups. P4 concentrations were determined from Day 3 after estrus to the day of ET. Pregnant heifers were slaughtered at Day 42 of gestation for fetal and placental morphometric measurements. The effects of the group, replicate, fetal sex, and interactions between these variables on fetal and placental characteristics were determined by ANOVA, while Pearson correlation was employed to assess the linear relationship between P4 concentrations two days before and on the day of ET on the fetal parameters. The uteri of heifers in the ET_D9 group were exposed to higher concentrations (P < 0.0001) of P4 from four days before ET, than heifers in the ET_D7 group. Both group and fetal sex variables impacted on fetal crown-rump length (CRL) (group: P < 0.0001, sex: P = 0.001) and fetal weight (group: P = 0.006, sex: P = 0.003). Fetal sex influenced the amniotic sac area (P = 0.003) and amniotic sac weight (P = 0.004); while the group affected the number of cotyledons (P = 0.0009), and the fetal heart weight (P = 0.018). All these parameters were larger in the ET_D9 group compared with ET_D7, and in males compared with females. There was a positive correlation between P4 concentrations two days before ET and fetal weight and CRL, for each sex or considering all fetuses (R2 ∼0.4, p < 0.05). In conclusion, bovine embryos transferred into a uterus primed with higher P4 concentrations underwent enhanced development reflected in higher weight and size at the beginning of the fetal period. • An optimal embryo-maternal interaction is mainly driven by progesterone (P4). • Asynchronous embryo transfer (ET) primes the uterus with high P4 concentrations. • This model accelerates conceptus elongation but the effect on the fetus was unknown. • We found a positive correlation between P4 before ET and fetal size at 42 days. • P4 concentrations early in gestation regulate conceptus and fetal development. [ABSTRACT FROM AUTHOR]

The helix angle configuration of the myocardium is understood to contribute to the heart function, as finite element (FE) modeling of postnatal hearts showed that altered configurations affected cardiac function and biomechanics. However, similar investigations have not been done on the fetal heart. To address this, we performed image-based FE simulations of fetal left ventricles (LV) over a range of helix angle configurations, assuming a linear variation of helix angles from epicardium to endocardium. Results showed that helix angles have substantial influence on peak myofiber stress, cardiac stroke work, myocardial deformational burden, and spatial variability of myocardial strain. A good match between LV myocardial strains from FE simulations to those measured from 4D fetal echo images could only be obtained if the transmural variation of helix angle was generally between 110 and 130°, suggesting that this was the physiological range. Experimentally discovered helix angle configurations from the literature were found to produce high peak myofiber stress, high cardiac stroke work, and a low myocardial deformational burden, but did not coincide with configurations that would optimize these characteristics. This may suggest that the fetal development of myocyte orientations depends concurrently on several factors rather than a single factor. We further found that the shape, rather than the size of the LV, determined the manner at which helix angles influenced these characteristics, as this influence changed significantly when the LV shape was varied, but not when a heart was scaled from fetal to adult size while retaining the same shape. This may suggest that biomechanical optimality would be affected during diseases that altered the geometric shape of the LV. [ABSTRACT FROM AUTHOR]

Background: Among all fetal heart block patients, > 50% cases are associated with maternal autoimmune diseases, and such patients should receive treatment. However, nearly half of fetal heart block cases involve a mother with negative results following autoimmune antibody screening. A few studies have reported long QT syndrome (LQTS) can also present as a severe fetal bradycardia, which does not respond to fetal treatment. Herein, we reported a rare case of an infant who presented with high-degree autoimmune-mediated fetal atrioventricular block (AVB) with LQTS induced by a novel KCNH2 variant. This case led us to review our prenatal therapeutic strategy. Case presentation: A 1-year-old boy presented to our heart center having experienced syncope 5 times in the past year. He had previously presented with fetal bradycardia during the fetal stage from 27 + 3 gestational weeks. The fetal echocardiography demonstrated AVB (2:1 transmission). As the maternal autoimmune antibody results were positive, his mother had received dexamethasone treatment during pregnancy; subsequently, the fetal AVB had changed from 2:1 to 4:3 transmission with elevated ventricular beating rates. However, this patient was identified to have complete AVB after birth. The initial electrocardiogram and Holter measurements at hospital administration showed complete AVB, pleomorphic ventricular tachycardia, a prolonged QT interval (QT = 602 ms, corrected QT = 538 ms), and wide and deep inverted T-waves. Meanwhile, torsades de pointes could be observed in several transit ventricular tachycardias based on Holter monitoring review. Genetic testing revealed KCNH2 c.2483G > A variant–induced LQTS. An implantable cardioverter defibrillator device and permanent pacemaker were both considered as therapeutic alternations; his parents ultimately accepted the implantation of a permanent pacemaker. Conclusions: For fetuses with autoimmune-mediated AVB, intrauterine treatment should still be pursued immediately. However, once the treatment outcomes are deemed unacceptable or unexpected, other genetic variant–related channelopathies should be highly suspected. If the fetus lacks a positive family history, fetal genetic testing should be recommended to improve the prognosis of such patients by introducing integrative therapeutic strategies between the prenatal and postnatal phases. [ABSTRACT FROM AUTHOR]

Fetal ventriculomegaly is the most common antenatally-diagnosed brain abnormality. Imaging studies in antenatal isolated ventriculomegaly demonstrate enlarged ventricles and cortical overgrowth which are also present in children with autism-spectrum disorder/condition (ASD). We investigate the presence of ASD traits in a cohort of children (n = 24 [20 males/4 females]) with isolated fetal ventriculomegaly, compared with 10 controls (n = 10 [6 males/4 females]). Neurodevelopmental outcome at school age included IQ, ASD traits (ADOS-2), sustained attention, neurological functioning, behaviour, executive function, sensory processing, co-ordination, and adaptive behaviours. Pre-school language development was assessed at 2 years. 37.5% of children, all male, in the ventriculomegaly cohort scored above threshold for autism/ASD classification. Pre-school language delay predicted an ADOS-2 autism/ASD classification with 73.3% specificity/66.7% sensitivity. Greater pre-school language delay was associated with more ASD symptoms. In this study, the neurodevelopment of children with isolated fetal ventriculomegaly, associated with altered cortical development, includes ASD traits, difficulties in sustained attention, working memory and sensation-seeking behaviours. Isolated fetal ventriculomegaly is the most common antenatally-diagnosed brain abnormality. Here, the authors show that isolated fetal ventriculomegaly is associated with autism spectrum disorder traits. [ABSTRACT FROM AUTHOR]

The heart is a vital and complex organ in the human body that forms with most organs between the second week of pregnancy, and fetal heart rate is an important indicator or biological index to know the condition of fetal well-being. In general, long-term measurement of fetal heart rate is the most widely used method of providing information about fetal health. In addition to fetal life, growth, and maturity, information such as congenital heart disease, often due to structural or functional defects in heart structure that often occur during the first trimester of pregnancy during fetal development, can be detected by continuous monitoring of fetal heart rate. The gold standard for monitoring the fetus's health is the use of non-invasive methods and portable devices so that while maintaining the health of the mother and fetus, it provides the possibility of continuous monitoring, especially for mothers who have a high-risk pregnancy. Therefore, the present study aimed to propose a low-cost, compact, and portable device for recording the heart rate of 18-day-old fetal mouse heart cells. Introduced device allows non-invasive heart rate monitoring instantly and without side effects for mouse fetal heart cells. One-dimensional gold-plated plasmonic specimens as a physiological signal recorder are mainly chips with nanoarray of resonant nanowire patterns perform in an integrated platform. Here the surface plasmon waves generated in a one-dimensional plasmonic sample are paired with an electrical wave from the heart pulse, and this two-wave pairing is used to record and detect the heart rate of fetal heart cells with high accuracy and good sensitivity. This measurement was performed in normal mode and two different stimulation modes. Stimulation of cells was performed once using adrenaline and again with electrical stimulation. Our results show that our sensor is sensitive enough to detect heart rate in both standard and excitatory states and is also well able to detect and distinguish between changes in heart rate caused by different excitatory conditions. [ABSTRACT FROM AUTHOR]

Background: After the longest time opposing all transfers of embryos by preimplantation genetic testing for aneuploidy (PGT-A) diagnosed as "chromosomal-abnormal," the field has over recent years slowly been moving toward selective transfers of by PGT-A as "mosaic" diagnosed embryos, but is still rejecting transfers of embryos by PGT-A defined as "aneuploid." Methods: Upon review of the literature, we report published cases of euploid pregnancies following transfers of PGT-A as "aneuploid" diagnosed embryos and add several additional, ongoing cases at our center. Results: Among the published cases from our center, we identified seven euploid pregnancies from "aneuploid" embryos, four of which preceded the PGT-A industry's 2016 switch from binary "euploid" – "aneuploid" reporting to "euploid," "mosaic," and "aneuploid" reporting. That those four cases post 2016 PGT-A definition involving "mosaic" embryos, therefore, cannot be ruled out. Since then, we recently established three additional ongoing pregnancies from transfers of "aneuploid" embryos which still await confirmation of euploidy after delivery. A recent fourth pregnancy from the transfer of a trisomy 9 embryo miscarried before a fetal heart. Outside our own center's experience, the literature revealed only one additional such transfer, involving PGT-A as a "chaotic-aneuploid" diagnosed embryo with six abnormalities, leading to normal euploid delivery. In reviewing the literature, we furthermore demonstrate why current PGT-A reporting that differentiates between "mosaic" and "aneuploid" embryos based on relative percentages of euploid and aneuploid DNA in a single trophectoderm biopsy of on average 5-6 cells, is biologically non-sensical. Conclusion: Basic biological evidence and a clinically still very limited experience with transfers of PGT-A as "aneuploid" labeled embryos demonstrate beyond reasonable doubt that at least some "aneuploid" embryos can lead to healthy euploid births. Therefore, this observation establishes beyond reasonable doubt that the rejection of all "aneuploid" embryos from transfer reduces pregnancy and live birth chances for IVF patients. Whether (and to what possible degree) pregnancy and live birth chances differ between "mosaic" and "aneuploid" embryos, remains to be determined. The answer will likely depend on the aneuploidy(ies) of an embryo and to what degree percentages of "mosaicism" in a single, on average 5/6-cell trophectoderm biopsy can reflect the ploidy-status of a complete embryo. [ABSTRACT FROM AUTHOR]

Objective: This study sought to compare the efficacy and outcomes of fetal intracardiac intraventricular and interventricular septal potassium chloride (KCl) injections during the induced fetal demise process in a cohort of pregnant women with severe fetal abnormality who opted for late termination of pregnancy (TOP). Materials and methods: This study consisted of 158 pregnant women who requested late TOP for severe fetal abnormality between 22 and 36 weeks of pregnancy. Participants were randomly assigned with the simple randomization procedure to one of two feticide procedure groups: the intraventricular KCl injection group and the interventricular septal KCl administration group. We studied the clinical outcomes of both the feticide procedures. Results: The median total dose of strong KCl was significantly lower in the interventricular septal KCl administration group (3 mL) than in the intraventricular KCl injection group (5 mL, p < 0.001). The median time to reach asystole and the median total duration of the procedure was significantly shorter in the interventricular septal KCl administration group (42 s and 85 s, respectively) than in the intraventricular KCl injection group (115 s and 150 s, respectively, p < 0.001). We detected a statistically significant correlation between the gestational week at feticide and the total dose of KCl (r = 0.705, p < 0.001), time to reach asystole (r = 0.653, p < 0.001), and total duration of the procedure (r = 0.683, p < 0.001). Conclusion: KCl administered directly into the interventricular septum induces immediate and permanent fetal cardiac asystole with a 100% of success rate without comprising maternal safety. We did not observe any maternal complications related to the procedure in our cases. Since the consequences of failed feticide procedure are challenging for both parents and healthcare providers, and providers are also concerned about potential legal implications regarding an unintended live birth, it is crucial to guide a strict protocol to confirm permanent fetal cardiac asystole. [ABSTRACT FROM AUTHOR]

Maternal urogenital infections during pregnancy are worldwide frequent problem. The aim was to analyze influence of maternal genitourinary infection on fetal cardiac function, pregnancy development and obstetrical outcomes. This was a single-center cohort study on fetuses (average at 28th week) in two groups: with maternal urogenital infections (study group n=49) and control group with no infections (n=59). Parvovirus B19, toxoplasmosis, cytomegalovirus, herpes simplex infections, congenital malformations, fetal growth restriction, chronic maternal diseases, as well as patients with body mass index (BMI) >25 kg/m2 were excluded. We analyzed: maternal age, time of delivery, neonatal birth weight, Apgar scores, average time of hospitalization of newborns after birth and several fetal echocardiographic parameters. The only statistical differences was found for shorter isovolumetric relaxation time (IRT) (40 ± 10 vs. 45 ± 9; p=0.03) and longer ejection time (ET) [ms] for right ventricle (RV) (176 ± 24 vs. 164 ± 18; p=0.01). Thick placenta was observed more frequent in study group than in controls (36.7 vs. 16.9%; p= 0.02). The missing link for explanation of these findings was coincidence with thick placenta. This is probably the first observation suggesting that thick placenta (>5 cm) may affect fetal RV function in normal heart anatomy: prolongation of right ventricular ET and shortening of fetal right ventricular IVRT. [ABSTRACT FROM AUTHOR]

This work studied, for the first time, the time–frequency characteristics of the vibrations underlying the first fetal heart sound (S1). To this end, the continuous wavelet transform was used to produce time-energy and time–frequency representations of S1 from where five vibrations were studied by their timing, energy, and frequency characteristics in three gestational age groups (early, G1, preterm, G2, and term, G3). Results on a dataset of 1111 S1s (9 phonocardiograms between 33 and 40 weeks) indicate that such representations uncovered a set of five well-defined, non-overlapped, and large-energy vibrations whose features presented interesting behaviors. Thus, for each group, while the timing characteristics of the five vibrations were likely to be statically different, their frequencies were similar. Also, the energies of the vibrations were likely to be different only in G2 and G3. Alternatively, while the frequencies and energies of each vibration were likely to statistically change among groups (excluding the energy of the third vibration), the timings were more likely to change only from G1 to G2 and from G2 to G3. Therefore, this methodology seems suitable to detect and study the generating vibrations of S1. Future work will test the correlation between these vibrations and the valvular events. [ABSTRACT FROM AUTHOR]

Hyperglycemia during gestation can disrupt fetal heart development and increase postnatal cardiovascular disease risk. It is therefore imperative to identify early biomarkers of hyperglycemia during gestation-induced fetal heart damage and elucidate the underlying molecular pathomechanisms. Clinical investigations of diabetic adults with heart dysfunction and transgenic mouse studies have revealed that overexpression or increased expression of TNNI3K, a heart-specific kinase that binds troponin cardiac I, may contribute to abnormal cardiac remodeling, ventricular hypertrophy, and heart failure. Optimal heart function also depends on the precise organization of contractile and excitable tissues conferred by intercellular occlusive, adherent, and communicating junctions. The current study evaluated changes in embryonic heart development and the expression levels of sarcomeric proteins (troponin I, desmin, and TNNI3K), junctional proteins, glucose transporter-1, and Ki-67 under fetal hyperglycemia. Stage 22HH Gallus domesticus embryos were randomly divided into two groups: a hyperglycemia (HG) group, in which individual embryos were injected with 30 mmol/L glucose solution every 24 h for 10 days, and a no-treatment (NT) control group, in which individual embryos were injected with physiological saline every 24 h for 10 days (stage 36HH). Embryonic blood glucose, height, and weight, as well as heart size, were measured periodically during treatment, followed by histopathological analysis and estimation of sarcomeric and junctional protein expression by western blotting and immunostaining. Hyperglycemic embryos demonstrated delayed heart maturation, with histopathological analysis revealing reduced left and right ventricular wall thickness (−39% and −35% vs. NT). Immunoexpression levels of TNNI3K and troponin 1 increased (by 37% and 39%, respectively), and desmin immunofluorescence reduced (by 23%). Embryo-fetal hyperglycemia may trigger an increase in the expression levels of TNNI3K and troponin I, as well as dysfunction of occlusive and adherent junctions, ultimately inducing abnormal cardiac remodeling. [ABSTRACT FROM AUTHOR]

In recent years, abortion regulations have been tightened in several countries (Poland, USA). As of 15th September 2022, a legislative amendment in Hungary will require women seeking abortion to present a fetal heart sound.1 This provision is unique in Europe, especially considering that Hungarian law allows essentially anyone to terminate a pregnancy on request. What exactly does the amendment mean? How can we assess this rule: can it be seen as a legitimate measure for the protection of the foetus, and is it in line with international human rights standards? [ABSTRACT FROM AUTHOR]

Simple Summary: Our study represents an innovative attempt to describe fetal skeleton development during the first part of gestation in sheep using ultrasonography associated with a differential staining technique that allows the observation of the first ossification processes. The timing of ossification and the growth rate of skeletal components are very important to assess normal prenatal growth. This knowledge may be useful for gestational management and early diagnosis of skeletal diseases, especially in the early period of pregnancy when bone growth is very fast in the ovine species. Increased knowledge of the developmental processes during gestation could provide valuable information on potential alterations in embryonic/fetal development. We examined the development of ovine conceptus between the 20th and 70th day of gestation with three convergent analyses: (1) uterus ultrasound examination and measurement (eco) of crown–rump length (CRL) and biparietal diameter (BPD) of the conceptus; (2) direct measurement (vivo) of CRL and BPD of the conceptus outside the uterus (3) osteo–cartilage dynamics during development by differential staining. No significant differences were observed between eco and vivo measurements for CRL and BPD in all examined concepti. CRL and BPD, instead, showed a significant positive linear correlation with gestational age. The study of osteogenesis dynamics has demonstrated a completely cartilaginous ovine fetus at up to 35 days of gestation. The ossification begins in the skull (40th day) and is almost complete between the 65th and the 70th of pregnancy. Our study highlighted that CRL and BPD are accurate parameters for gestational age estimation in the first part of sheep pregnancy and provides an overview of osteochondral temporal dynamics. Furthermore, tibia ossification is a valid parameter to estimate fetal age by ultrasound. [ABSTRACT FROM AUTHOR]

We report a three-year-old male child who presented with congenital valvular defects, right ventricular malformation, and initial developmental delay. Genome sequencing showed rare deleterious biallelic missense variants in PLD1. In his parents' second pregnancy, echocardiogram at 13 weeks gestation revealed right-sided cardiac malformations resembling the clinical presentation of the family's first child. Targeted DNA analysis showed that the fetus carried the same biallelic PLD1 variants as their older sibling. This case helps to further delineate the clinical spectrum of PLD1-related defects and highlights the value of both genome sequencing in congenital heart disease and early fetal echocardiography to establish phenotype. [ABSTRACT FROM AUTHOR]

To date, cardiotocography (CTG) is the only non-invasive and cost-effective tool available for continuous monitoring of the fetal health. In spite of a marked growth in the automation of the CTG analysis, it still remains a challenging signal processing task. Complex and dynamic patterns of fetal heart are poorly interpreted. Particularly, the precise interpretation of the suspected cases is fairly low by both visual and automated methods. Also, the first and second stage of labor produce very different fetal heart rate (FHR) dynamics. Thus, a robust classification model takes both stages into consideration separately. In this work, the authors propose a machine-learning-based model, which was applied separately to both the stages of labor, using standard classifiers such as SVM, random forest (RF), multi-layer perceptron (MLP), and bagging to classify the CTG. The outcome was validated using the model performance measure, combined performance measure, and the ROC-AUC. Though AUC-ROC was sufficiently high for all the classifiers, the other parameters established a better performance by SVM and RF. For suspicious cases the accuracies of SVM and RF were 97.4% and 98%, respectively, whereas sensitivity was 96.4% and specificity was 98% approximately. In the second stage of labor the accuracies were 90.6% and 89.3% for SVM and RF, respectively. Limits of agreement for 95% between the manual annotation and the outcome of SVM and RF were (−0.05 to 0.01) and (−0.03 to 0.02). Henceforth, the proposed classification model is efficient and can be integrated into the automated decision support system. [ABSTRACT FROM AUTHOR]

Maternal autoantibody-related complete heart block in the fetus is considered irreversible. During prenatal care for a 25-year-old nulliparous Hispanic woman with newly diagnosed nephrotic-range proteinuria and positive anti-nuclear antigen antibody, complete fetal heart block with a ventricular rate of 60 beats per minute was detected on a fetal echocardiogram at 28-week gestation. A small pericardial effusion and ascites were noted consistent with fetal hydrops. Dexamethasone and hydroxychloroquine were initiated. Fetal rhythm improved to Mobitz type 1 second-degree heart block, with a ventricular rate of 91 beats per minute. The fetus was born prematurely at 34-week gestation with second-degree heart block which improved to first-degree heart block prior to hospital discharge. First-degree heart block persisted at 2 years of age with a P-R interval of 185 ms. Transplacental treatment with dexamethasone and hydroxychloroquine was associated with sustained reversal of complete heart block to sinus rhythm. [ABSTRACT FROM AUTHOR]

To determine reference values for the foramen ovale (FO) area of fetal hearts by three-dimensional (3D) ultrasound using spatio-temporal image correlation (STIC) method in the rendering mode, as well as applicability in fetuses with congenital heart disease (CHD). A retrospective and prospective study was performed of 242 normal fetuses and 36 fetuses with CHD between 20 and 33 + 6 weeks of gestation. The FO area was determined in the four-chamber view with manual delineation. To determine the reference curve of the FO area as a function of gestational age (GA), a linear regression model was utilized with an adjusted coefficient of determination (R2). For intra- and interobserver reproducibility calculations, the concordance correlation coefficient (CCC) was used. The mean ± standard deviation (SD) of the FO measurement area was 21.2 ± 1.8 and 48.1 ± 1.9 mm2 at 20 and 33 weeks' gestation, respectively. A linear correlation was observed between the FO area and GA (1.924*GA - 17.95; R2 = 0.91). Good intra- (CCC = 0.97) and interobserver (CCC = 0.94) agreement was observed for the FO area measurement. The mean difference in FO area between normal and CHD fetuses was - 14.4 mm2 (p < 0.001). Reference values for the FO area of fetal hearts were determined by 3D ultrasound using STIC in the rendering mode. This method showed good intra- and interobserver reproducibility and could be used to assess different CHD types. [ABSTRACT FROM AUTHOR]

Background: The ultrasound scan represents the first tool that obstetricians use in fetal evaluation, but sometimes, it can be limited by mobility or fetal position, excessive thickness of the maternal abdominal wall, or the presence of post-surgical scars on the maternal abdominal wall. Artificial intelligence (AI) has already been effectively used to measure biometric parameters, automatically recognize standard planes of fetal ultrasound evaluation, and for disease diagnosis, which helps conventional imaging methods. The usage of information, ultrasound scan images, and a machine learning program create an algorithm capable of assisting healthcare providers by reducing the workload, reducing the duration of the examination, and increasing the correct diagnosis capability. The recent remarkable expansion in the use of electronic medical records and diagnostic imaging coincides with the enormous success of machine learning algorithms in image identification tasks. Objectives: We aim to review the most relevant studies based on deep learning in ultrasound anomaly scan evaluation of the most complex fetal systems (heart and brain), which enclose the most frequent anomalies.

This study evaluates the impact of extended cardiac views on examination time, repeat imaging, and anomaly detection before and after implementation of 76811 guidelines (American Institute of Ultrasound in Medicine Consensus 2014). It is a retrospective study of singleton pregnancies undergoing detailed ultrasound imaging at 18 weeks' gestation or greater before and after the protocol change in an academic, tertiary care fetal center. Views required prior to 2014: 4-chamber, left outflow tract, right outflow tract. Additional views required after 2014: bicaval, aortic arch, 3-vessel, and 3-vessel trachea. Fetuses with known anomalies were excluded. Rates of detection of congenital heart disease (CHD), examination completion, repeat examination recommendation, fetal echocardiogram recommendation, completion by body mass index, and cardiac examination time were determined. Six hundred twenty-four subjects were included, 217 before and 407 after protocol change. Views obtained were as stated in the American Institute of Ultrasound in Medicine/Society for Maternal-Fetal Medicine consensus. Detection of CHD was not improved. Examination times increased by 20% (6.4 vs 7.7 minutes, P < 0.05). Number of incomplete studies increased by 130% (11% to 26%, P < 0.05). Twice as many patients were referred for repeat examination (6% vs 13%, P < 0.05). Completion rates were negatively correlated with body mass index. Recommendations for fetal echocardiogram were unchanged (5% vs 6%, P = 0.6). Additional imaging did not increase detection rate of CHD (3% vs 2%, P = 0.3). Extended cardiac views resulted in increased examination time, more incomplete examinations, and more repeat examinations without changing detection rates of CHD.

The aims of this study were to demonstrate the feasibility of obtaining additional cardiac views as proposed on an extended fetal cardiac examination and to see if there was any variation in individual components of that examination stratified by sonographer training, patient body habitus, or equipment. We retrospectively reviewed 200 consecutive detailed second-trimester high-risk fetal obstetric sonograms that included additional extended cardiac views. We analyzed the percentage of the time individual views were obtained, with variation based on (1) a sonographer with greater than 3 years of training compared with a group with 6 to 12 months of training, (2) 2 different ultrasound units, and (3) different body mass indices. Overall, the highest rate of visualization was achieved with the 4-chamber view (98.2%), whereas the 3-vessel tracheal view had the lowest percentage of visualization (40.2%), among the less experienced sonographers. Differences in successful completion of the extended cardiac views were not statistically different between the sonographer with a level of training greater than 3 years as compared with those with 6 to 12 months' training except for the 3-vessel tracheal view (P < 0.001). There is no statistically significant difference in our ultrasound equipment, when considering only inexperienced sonographers. Increasing body mass index had an inverse relationship with obtaining the components of the detailed cardiac examination. Using state-of-the-art ultrasound equipment and with focused additional training of obstetric sonographers, the majority of extended cardiac views can be obtained. There are exceptions.

BackgroundHigh altitude hypoxia (HAH) exposure affects fetal development. However, the fetal cardiovascular responses to the HAH are not well understood. We have tested the hypothesis that long-term HAH exposure alters the hypoxia/ischemia-sensitive gene expressions, leading to an increase in fetal heart susceptibility to ischemia/reperfusion (I/R) injury and cardiac dysfunction.MethodsTime-dated pregnant sheep were exposed to high-altitude (3820 m) or were maintained at sea level (~300 m) for 110 days. Fetal hearts were isolated from the near-term ewes and subjected to I/R in a Langendorff preparation.ResultsHAH decreased the fetal body and heart weights in the female but not male fetuses. HAH had no effect on the left ventricle (LV) function at baseline, but increased the LV infarct size and attenuated the post-ischemic recovery of LV function in both male and female fetuses, as compared with the normoxic groups. HAH increased the protein levels of hypoxia-inducible factor (HIF)-1α and DNA methyltransferases type 3b (DNMT3b), but attenuated protein kinase C epsilon (PKCε) levels in the fetal hearts. AHA induced a 4.3 fold increase of miR-210 in the males and a 2.9 fold increase in female hearts. In addition, HAH had no effect on mTOR protein and phosphorylation levels but increased the autophagy biomarker, LC3B-II protein levels and LC3B-II/LC3B-I ratio in the fetal hearts.ConclusionThe results suggest that gestational HAH exposure induces in utero programming of the hypoxia/ischemia-sensitive gene expression pattern in the developing heart and increases cardiac susceptibility to I/R injury.

This pictorial review describes the assessment of a great variety of types of congenital heart disease by three-dimensional ultrasonography with spatiotemporal image correlation using HDlive and the HDlive Flow silhouette rendering mode. These technologies provide fetal heart surface patterns by using a fixed virtual light source that propagates into the tissues, permitting a detailed reconstruction of the heart structures. In this scenario, ultrasound operators can freely select a better light source position to enhance the anatomical details of the fetal heart. HDlive and the HDlive Flow silhouette rendering mode improve depth perception and the resolution of anatomic cardiac details and blood vessel walls compared to standard two-dimensional ultrasonography.

A correction to the article "Pre-intervention Myocardial Stress Is a Good Predictor of Aortic Valvuloplasty Outcome for Fetal Critical Aortic Stenosis and Evolving HLHS," by L. Green and colleagues is presented.

ObjectivesCongenital ventricular aneurysms or diverticulum (VA/VD) are rare cardiac anomalies with lack prenatal evaluation data. The present study aimed to provide the prenatal characteristics and outcomes from a tertiary center and the use of new techniques to evaluate the shape and contractility of these fetuses.MethodsTen fetuses were diagnosed with VA or VD, and 30 control fetuses were enrolled. Fetal echocardiography was performed to make the diagnosis. The prenatal echo characteristics and follow-up data were carefully reviewed. The shape and contractility measurements of the four-chamber view (4CV) and both ventricles were measured and computed using fetal fetal heart quantification (HQ).ResultsA total of 10 fetuses were enrolled, including 4 cases of left ventricular diverticulum, 5 cases of left ventricular aneurysm, and 1 case of right ventricular aneurysm (RVA). Four cases chose to terminate the pregnancy. The RVA was associated with a perimembranous ventricular septal defect. Two cases had fetal arrhythmia, and one case had pericardial effusion. After birth, one case underwent surgical resection at five years old. The 4CV global sphericity index (SI) of free-wall located ventricular outpouching (VO) was significantly lower than the apical ones and the control group (p 95th centile) SI in base segments, and three of four left VOs in the free-wall had significant lower (< 5th centile) SI in the majority of 24 segments. Compared to the control group, the left ventricle (LV) global longitudinal strain, ejection fraction, and fractional area change were significantly decreased (p

ObjectiveThis study aimed to report our experience in qualitative and quantitative evaluation of fetal complete vascular ring (CVR) using fetal cardiovascular magnetic resonance imaging (MRI) to improve prenatal diagnosis and make early postnatal management possible.MethodsA retrospective case-control study was performed on cases of CVR diagnosed using fetal cardiovascular MRI, and confirmed by postnatal imaging diagnosis. Associated abnormalities were recorded. The diameters of aortic arch isthmus (AoI) and ductus arteriosus (DA), and tracheal diameters in fetuses with tracheal compression were measured and compared with those of the control group.ResultsAll fetal CVR cases in this study included right aortic arch (RAA) with aberrant left subclavian artery (ALSA) and left DA (n = 93), double aortic arch (DAA) (n = 29), RAA with mirror-image branching and retroesophageal left ductus arteriosus (RLDA) (n = 8). Compared with the control group, the diameters of AoI in fetuses with DAA were decreased (p

ObjectiveTo quantify fetal cardiovascular parameters utilizing fetal-specific 2D speckle tracking technique and to explore the differences in size and systolic function of the left and right ventricles in low-risk pregnancy.MethodsA prospective cohort study was performed in 453 low-risk single fetuses (28+0–39+6 weeks) to evaluate ventricular size [i.e., end-diastolic length (EDL), end-systolic length (ESL), end-diastolic diameter (ED), end-systolic diameter (ES), end-diastolic area, end-systolic area, end-diastolic volume (EDV), and end-systolic volume (ESV)] and systolic function [i.e., ejection fraction (EF), stroke volume (SV), cardiac output (CO), cardiac output per kilogram (CO/KG), and stroke volume per kilogram (SV/KG)].ResultsThis study showed that (1) the reproducibility of the interobserver and intraobserver measurements was good to excellent (ICC 0.626–0.936); (2) with advancing gestation, fetal ventricular size and systolic function increased, whereas right ventricular (RV) EF decreased and left ventricular (LV) EF was not significantly changed; (3) LV length was longer than RV length in diastole (2.24 vs. 1.96 cm, P

Recent studies in experimental animals found that oral exposure to micro- and nano-plastics (MNPs) during pregnancy had multiple adverse effects on outcomes and progeny, although no study has yet identified the translocation of ingested MNPs to the placenta or fetal tissues, which might account for those effects. We therefore assessed the placental and fetal translocation of ingested nanoscale polystyrene MNPs in pregnant rats. Sprague Dawley rats (N = 5) were gavaged on gestational day 19 with 10 mL/kg of 250 µg/mL 25 nm carboxylated polystyrene spheres (PS25C) and sacrificed after 24 h. Hyperspectral imaging of harvested placental and fetal tissues identified abundant PS25C within the placenta and in all fetal tissues examined, including liver, kidney, heart, lung and brain, where they appeared in 10–25 µm clusters. These findings demonstrate that ingested nanoscale polystyrene MNPs can breach the intestinal barrier and subsequently the maternal–fetal barrier of the placenta to access the fetal circulation and all fetal tissues. Further studies are needed to assess the mechanisms of MNP translocation across the intestinal and placental barriers, the effects of MNP polymer, size and other physicochemical properties on translocation, as well as the potential adverse effects of MNP translocation on the developing fetus. [ABSTRACT FROM AUTHOR]

Fetal heart failure (FHF) is a condition of inability of the fetal heart to deliver adequate blood flow for tissue perfusion in various organs, especially the brain, heart, liver and kidneys. FHF is associated with inadequate cardiac output, which is commonly encountered as the final outcome of several disorders and may lead to intrauterine fetal death or severe morbidity. Fetal echocardiography plays an important role in diagnosis of FHF as well as of the underlying causes. The main findings supporting the diagnosis of FHF include various signs of cardiac dysfunction, such as cardiomegaly, poor contractility, low cardiac output, increased central venous pressures, hydropic signs, and the findings of specific underlying disorders. This review will present a summary of the pathophysiology of fetal cardiac failure and practical points in fetal echocardiography for diagnosis of FHF, focusing on essential diagnostic techniques used in daily practice for evaluation of fetal cardiac function, such as myocardial performance index, arterial and systemic venous Doppler waveforms, shortening fraction, and cardiovascular profile score (CVPs), a combination of five echocardiographic markers indicative of fetal cardiovascular health. The common causes of FHF are reviewed and updated in detail, including fetal dysrhythmia, fetal anemia (e.g., alpha-thalassemia, parvovirus B19 infection, and twin anemia-polycythemia sequence), non-anemic volume load (e.g., twin-to-twin transfusion, arteriovenous malformations, and sacrococcygeal teratoma, etc.), increased afterload (intrauterine growth restriction and outflow tract obstruction, such as critical aortic stenosis), intrinsic myocardial disease (cardiomyopathies), congenital heart defects (Ebstein anomaly, hypoplastic heart, pulmonary stenosis with intact interventricular septum, etc.) and external cardiac compression. Understanding the pathophysiology and clinical courses of various etiologies of FHF can help physicians make prenatal diagnoses and serve as a guide for counseling, surveillance and management. [ABSTRACT FROM AUTHOR]

BACKGROUND: Evidence remains limited about the association of maternal exposure to ambient fine particulate matter (airborne particles with an aerodynamic diameter ≤2.5 µm [PM2.5]) with fetal congenital heart defects (CHDs) in highly polluted regions, and few studies have focused on preconception exposure. METHODS: Using a nationwide surveillance-based case-control design in China, we examined the association between maternal exposure to PM2.5 during periconception (defined as 3 months before conception until 3 months into pregnancy) and risk of CHD in offspring. The study included 1 434 998 births involving 7335 CHDs from 2014 through 2017 on the basis of the National Population-Based Birth Defects Surveillance System, covering 30 provinces, municipalities, or municipal districts in China. We assigned maternal PM2.5 exposure during the periconception period to each participant using satellite-based PM2.5 concentrations at 1-km spatial resolution. Multilevel logistic regression models were used to calculate the multivariable-adjusted odds ratio and 95% CI for CHDs in offspring associated with maternal PM2.5 exposure, and the exposure–response association was investigated using restricted cubic spline analysis. Subgroup or sensitivity analyses were conducted to identify factors that may modify the association. RESULTS: The average maternal exposure to PM2.5 levels across all participants was 56.51 µg/m³ (range, 10.95 to 182.13 µg/m3). For each 10 µg/m³ increase in maternal PM2.5 exposure, the risk of CHDs in offspring was increased by 2% (odds ratio, 1.02 [95% CI, 1.00 to 1.05]), and septal defect was the most influenced subtype (odds ratio, 1.04 [95% CI, 1.01 to 1.08]). The effect of PM2.5 on CHD risk was more pronounced during the preconception period. Mothers <35 years of age, those living in northern China, and those living in low-income areas were more susceptible to PM2.5 exposure than their counterparts (all P<0.05). PM2.5 exposure showed a linear association with total CHDs or specific CHD types. CONCLUSIONS: High maternal PM2.5 exposure, especially during the preconception period, increases risk of certain types of CHD in offspring. These findings are useful for CHD prevention and highlight the public health benefits of improving air quality in China and other highly polluted regions. [ABSTRACT FROM AUTHOR]

Down syndrome (DS), a complex disorder that is caused by the trisomy of chromosome 21 (Hsa21), is a major cause of congenital heart defects (CHD). Interestingly, only about 50% of individuals with Hsa21 trisomy manifest CHD. Here we review the genetic basis of CHD in DS, focusing on genes that regulate extracellular matrix (ECM) organization. The overexpression of Hsa21 genes likely underlies the molecular mechanisms that contribute to CHD, even though the genes responsible for CHD could only be located in a critical region of Hsa21. A role in causing CHD has been attributed not only to protein-coding Hsa21 genes, but also to genes on other chromosomes, as well as miRNAs and lncRNAs. It is likely that the contribution of more than one gene is required, and that the overexpression of Hsa21 genes acts in combination with other genetic events, such as specific mutations or polymorphisms, amplifying their effect. Moreover, a key function in determining alterations in cardiac morphogenesis might be played by ECM. A large number of genes encoding ECM proteins are overexpressed in trisomic human fetal hearts, and many of them appear to be under the control of a Hsa21 gene, the RUNX1 transcription factor. [ABSTRACT FROM AUTHOR]

A precise understanding of human diaphragm development is essential in fetal medicine. To our knowledge, no previous study has attempted a three‐dimensional (3‐D) analysis and evaluation of diaphragmatic morphogenesis and development from the embryonic to the early fetal period. This study aimed to evaluate the morphogenesis and fibrous architecture of the developing human diaphragm during the late embryonic and early fetal periods. Fifty‐seven human embryos and fetuses (crown‐rump length [CRL] = 8–88 mm) preserved at the Congenital Anomaly Research Center of Kyoto University and Shimane University were analyzed. 3‐D morphogenesis and fiber orientation of the diaphragm were assessed using phase‐contrast X‐ray computed tomography, T1‐weighted magnetic resonance imaging (T1W MRI), and diffusion tensor imaging (DTI). T1W MR images and DTI scans were obtained using a 7‐T MR system. The diaphragm was completely closed at Carnegie stage (CS) 20 and gradually developed a dome‐like shape. The diaphragm was already in contact with the heart and liver ventrally in the earliest CS16 specimen observed, and the adrenal glands dorsally at CS19 or later. In the fetal period, the diaphragm contacted the gastric fundus in samples with a CRL ≥41 mm, and the spleen in samples with a CRL ≥70 mm. The relative position of the diaphragm with reference to the vertebrae changed rapidly from CS16 to CS19. The most cranial point of the diaphragm was located between the 4th and 8th thoracic vertebrae, regardless of fetal growth, in samples with a CRL of ≥16 mm. Diaphragmatic thickness was nearly uniform (0.15–0.2 mm) across samples with a CRL of 8–41 mm. The sternal, costal, lumbar parts, and the area surrounding the esophageal hiatus thickened with growth in samples with a CRL of ≥46 mm. The thickness at the center of the diaphragm and the left and right hemidiaphragmatic domes did not increase with growth. Tractography showed that the fiber orientation of the sternal, costal, and lumbar parts became more distinct as growth progressed in CS19 or later. All fibers in the costal and lumbar regions ran toward the left and right hemidiaphragmatic domes, except for those running to the caval opening and esophageal hiatus. The fiber orientation patterns from the right and left crura surrounding the esophageal hiatus were classified into three types. Distinct fiber directions between the costal and sternal and between the costal and lumbar diaphragmatic parts were observable in samples with a CRL of ≥46 mm. Anterior costal and sternal fibers ran toward the center. Fiber tracts around the center and the left and right hemidiaphragmatic domes; between the costal and lumbar orientations; and between the costal and sternal orientations showed a tendency for decreasing fractional anisotropy values with fetal growth and showed less density than other areas. In conclusion, we used 3‐D thickness assessment and DTI tractography to identify qualitative changes in the muscular and tendonous regions of the diaphragm during the embryonic and early fetal periods. This study provides information on normal human diaphragm development for the progression of fetal medicine and furthering the understanding of congenital anomalies. [ABSTRACT FROM AUTHOR]

Congenital heart defect, accounting for about 30% of congenital defects, is the most common one. Data shows that congenital heart defects have seriously affected the birth rate of healthy newborns. In Fetal andNeonatal Cardiology, medical imaging technology (2D ultrasonic, MRI) has been proved to be helpful to detect congenital defects of the fetal heart and assists sonographers in prenatal diagnosis. It is a highly complex task to recognize 2D fetal heart ultrasonic standard plane (FHUSP)manually. Compared withmanual identification, automatic identification through artificial intelligence can save a lot of time, ensure the efficiency of diagnosis, and improve the accuracy of diagnosis. In this study, a feature extraction method based on texture features (Local Binary Pattern LBP and Histogram of Oriented Gradient HOG) and combined with Bag of Words (BOW) model is carried out, and then feature fusion is performed. Finally, it adopts Support VectorMachine (SVM) to realize automatic recognition and classification of FHUSP. The data includes 788 standard plane data sets and 448 normal and abnormal plane data sets. Compared with some other methods and the single method model, the classification accuracy of our model has been obviously improved, with the highest accuracy reaching 87.35%. Similarly, we also verify the performance of the model in normal and abnormal planes, and the average accuracy in classifying abnormal and normal planes is 84.92%. The experimental results show that thismethod can effectively classify and predict different FHUSP and can provide certain assistance for sonographers to diagnose fetal congenital heart disease. [ABSTRACT FROM AUTHOR]

Simple Summary: The presentation of equine dystocias to a referral clinic varies significantly. This case report describes the clinical and postmortem findings of a case of uterine body constriction in a late gestation mare that precluded normal vaginal delivery, ultimately resulting in fetal mortality with humane euthanasia of the mare. Gross examination revealed a circumferential, tan, fibrous band at the base of the uterine body that constricted the uterus and was adhered to the left and right ovaries, supporting the diagnosis of a uterine body constriction. A 13-year-old multiparous Quarter Horse mare was presented to the Michigan State University's, Large Animal Emergency service for dystocia. Clinical evaluation revealed a minimally dilated cervix on vaginal examination, with a palpable deceased fetus. Postmortem evaluation following owner-elected humane euthanasia revealed a circumferential, tan, fibrous band at the base of the uterine body that constricted the uterus and was adhered to the left and right ovaries. A routine histologic section of the incarcerating cord attached to the ovary consisted predominately of dense fibrous connective tissue, large blood vessels, and a central oviduct suggestive of a rent in the broad ligament. To the authors' knowledge, this is the first case report to describe uterine body constriction that precluded vaginal delivery of a fetus in a late gestation mare. [ABSTRACT FROM AUTHOR]

Congenital heart defect (CHD) refers to the overall structural abnormality of the heart or large blood vessels in the chest cavity. It is the most common type of fetal congenital defects. Prenatal diagnosis of congenital heart disease can improve the prognosis of the fetus to a certain extent. At present, prenatal diagnosis of CHD mainly uses 2D ultrasound to directly evaluate the development and function of fetal heart and main structures in the second trimester of pregnancy. Artificial recognition of fetal heart 2D ultrasound is a highly complex and tedious task, which requires a long period of prenatal training and practical experience. Compared with manual scanning, computer automatic identification and classification can significantly save time, ensure efficiency, and improve the accuracy of diagnosis. In this paper, an effective artificial intelligence recognition model is established by combining ultrasound images with artificial intelligence technology to assist ultrasound doctors in prenatal ultrasound fetal heart standard section recognition. The method data in this paper were obtained from the Second Affiliated Hospital of Fujian Medical University. The fetal apical four-chamber heart section, three vessel catheter section, three vessel trachea section, right ventricular outflow tract section, and left ventricular outflow tract section were collected at 20-24 weeks of gestation. 2687 image data were used for model establishment, and 673 image data were used for model validation. The experiment shows that the map value of this method in identifying different anatomical structures reaches 94.30%, the average accuracy rate reaches 94.60%, the average recall rate reaches 91.0%, and the average F1 coefficient reaches 93.40%. The experimental results show that this method can effectively identify the anatomical structures of different fetal heart sections and judge the standard sections according to these anatomical structures, which can provide an auxiliary diagnostic basis for ultrasound doctors to scan and lay a solid foundation for the diagnosis of congenital heart disease. [ABSTRACT FROM AUTHOR]

The fetus movements play an important role in fetal well-being. With the continuous advancement of real-time scanning machines, it is feasible to observe the fetus movement in detail. The characteristics of fetal lower limb movements in prenatal examination have not been systematically investigated. This review proposes the patterns of fetal lower limb movements, the maternal influence on fetal lower limb movements, and the application of fetal lower limb movements for the diagnosis of prenatal diseases. A systematic search of literature on the lower limb movements of the fetus in uterus was performed in the databases, namely, Web of Science and Scopus. Thirty-four publications were selected. This review demonstrates that isolated fetal lower limb movements are rare and always accompanied with the movements of other body segments. Detection of the presence of fetal leg movements seems to be of no diagnostic value for fetuses with prenatal diseases. The isolated lower limb movement was statistically significant different between fetuses of low- and high-risk pregnant women. The coordinated movements of the fetal lower limbs and other parts should be considered when analyzing fetal movements in the future study. [ABSTRACT FROM AUTHOR]

Fetal brain tissue segmentation is essential for quantifying the presence of congenital disorders in the developing fetus. Manual segmentation of fetal brain tissue is cumbersome and time-consuming, so using an automatic segmentation method can greatly simplify the process. In addition, the fetal brain undergoes a variety of changes throughout pregnancy, such as increased brain volume, neuronal migration, and synaptogenesis. In this case, the contrast between tissues, especially between gray matter and white matter, constantly changes throughout pregnancy, increasing the complexity and difficulty of our segmentation. To reduce the burden of manual refinement of segmentation, we proposed a new deep learning-based segmentation method. Our approach utilized a novel attentional structural block, the contextual transformer block (CoT-Block), which was applied in the backbone network model of the encoder–decoder to guide the learning of dynamic attentional matrices and enhance image feature extraction. Additionally, in the last layer of the decoder, we introduced a hybrid dilated convolution module, which can expand the receptive field and retain detailed spatial information, effectively extracting the global contextual information in fetal brain MRI. We quantitatively evaluated our method according to several performance measures: dice, precision, sensitivity, and specificity. In 80 fetal brain MRI scans with gestational ages ranging from 20 to 35 weeks, we obtained an average Dice similarity coefficient (DSC) of 83.79%, an average Volume Similarity (VS) of 84.84%, and an average Hausdorff95 Distance (HD95) of 35.66 mm. We also used several advanced deep learning segmentation models for comparison under equivalent conditions, and the results showed that our method was superior to other methods and exhibited an excellent segmentation performance. [ABSTRACT FROM AUTHOR]