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Objective: To assess and compare the value of antenatally determined observed‐to‐expected (O/E) lung‐area‐to‐head‐circumference ratio (LHR) on ultrasound examination vs O/E total fetal lung volume (TFLV) on magnetic resonance imaging (MRI) examination to predict postnatal survival of fetuses with isolated, expectantly managed left‐sided congenital diaphragmatic hernia (CDH). Methods: This was a multicenter retrospective study including all consecutive fetuses with isolated CDH that were managed expectantly in Mannheim, Germany, and in five other European centers, that underwent at least one ultrasound examination for measurement of O/E‐LHR and one MRI scan for measurement of O/E‐TFLV during pregnancy. All MRI data were centralized, and lung volumes were measured by two experienced operators blinded to the pre‐ and postnatal data. Multiple logistic regression analyses were performed to examine the effect on survival at hospital discharge of various perinatal variables, including the center of management. In left‐sided CDH with intrathoracic herniation of the liver, receiver‐operating‐characteristics (ROC) curves were constructed separately for cases from Mannheim and the other five European centers and were used to compare O/E‐TFLV and O/E‐LHR in the prediction of postnatal survival. Results: From Mannheim, 309 patients were included with a median gestational age (GA) at ultrasound examination of 29.6 (range, 19.7–39.1) weeks and median GA at MRI examination of 31.1 (range, 18.0–39.9) weeks. From the other five European centers, 116 patients were included with a median GA at ultrasound examination of 26.7 (range, 20.6–37.6) weeks and median GA at MRI examination of 27.7 (range, 21.3–37.9) weeks. Regression analysis demonstrated that the survival rates at discharge were lower in left‐sided CDH (odds ratio (OR), 0.349 (95% CI, 0.133–0.918), P = 0.033) and those with intrathoracic liver (OR, 0.297 (95% CI, 0.141–0.628), P = 0.001), and higher with increasing O/E‐TFLV (OR, 1.123 (95% CI, 1.079–1.170), P < 0.001), advanced GA at birth (OR, 1.294 (95% CI, 1.055–1.588), P = 0.013) and when birth occurred in Mannheim (OR, 7.560 (95% CI, 3.368–16.967), P < 0.001). Given the difference in survival rate between Mannheim and the five other European centers, ROC curve comparisons between the two imaging modalities were presented separately. For cases of left‐sided CDH with intrathoracic herniation of the liver, pairwise comparison showed no significant difference between the area under the ROC curves for the prediction of postnatal survival between O/E‐TFLV and O/E‐LHR in Mannheim (mean difference = 0.025, P = 0.610, standard error = 0.050), whereas there was a significant difference in the other European centers studied (mean difference = 0.056, P = 0.033, standard error = 0.056). Conclusions: In fetuses with left‐sided CDH and intrathoracic herniation of the liver, the predictive value for postnatal survival of O/E‐TFLV on MRI examination and O/E‐LHR on ultrasound examination was similar in one center (Mannheim), but O/E‐TFLV had better predictive value compared to O/E‐LHR in the five other European centers. Hence, in these five European centers, MRI should be included in the diagnostic process for left‐sided CDH. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article examines the use of observed-to-expected (O/E) lung area to head circumference ratio (LHR) at ultrasound and total fetal lung volume (TFLV) at MRI in predicting postnatal survival in fetuses with left-sided congenital diaphragmatic hernia (CDH). The study included 309 patients from Mannheim and 116 from five other European centers. The results showed that O/E TFLV had a better predictive value compared to O/E LHR in the five other European centers, while in Mannheim, both methods had similar predictive values. The higher survival rate of infants with CDH born in Mannheim compared to other centers may explain this difference. [Extracted from the article]

This article, titled "Timing of magnetic resonance imaging in pregnancy for congenital diaphragmatic hernia," examines the impact of the timing of MRI on the prediction of survival and morbidity in patients with CDH. The study, conducted in Germany and Italy, included 354 patients with isolated CDH. The results showed that the timing of MRI did not affect the prediction of survival rate or morbidity, as the observed to expected total fetal lung volume (o/e TFLV) did not change during pregnancy. Clinicians can choose any gestational age starting in the mid-second trimester for the assessment of severity and counseling. [Extracted from the article]

Purpose: To evaluate the impact of the timing of MRI on the prediction of survival and morbidity in patients with CDH, and whether serial measurements have a beneficial value., Methods: This retrospective cohort study was conducted in two perinatal centers, in Germany and Italy. It included 354 patients with isolated CDH having at least one fetal MRI. The severity was assessed with the observed-to-expected total fetal lung volume (o/e TFLV) measured by two experienced double-blinded operators. The cohort was divided into three groups according to the gestational age (GA) at which the MRI was performed (< 27, 27-32, and  > 32 weeks' gestation [WG]). The accuracy for the prediction of survival at discharge and morbidity was analyzed with receiver operating characteristic (ROC) curves. Multiple logistic regression analyses and propensity score matching examined the population for balance. The effect of repeated MRI was evaluated in ninety-seven cases., Results: There were no significant differences in the prediction of survival when the o/e TFLV was measured before 27, between 27 and 32, and after 32 WG (area under the curve [AUC]: 0.77, 0.79, and 0.77, respectively). After adjustment for confounding factors, it was seen, that GA at MRI was not associated with survival at discharge, but the risk of mortality was higher with an intrathoracic liver position (adjusted odds ratio [aOR]: 0.30, 95% confidence interval [95%CI] 0.12-0.78), lower GA at birth (aOR 1.48, 95%CI 1.24-1.78) and lower o/e TFLV (aOR 1.13, 95%CI 1.06-1.20). ROC curves showed comparable prediction accuracy for the different timepoints in pregnancy for pulmonary hypertension, the need of extracorporeal membrane oxygenation, and feeding aids. Serial measurements revealed no difference in change rate of the o/e TFLV according to survival., Conclusion: The timing of MRI does not affect the prediction of survival rate or morbidity as the o/e TFLV does not change during pregnancy. Clinicians could choose any gestational age starting mid second trimester for the assessment of severity and counseling., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The treatment of fetuses with a congenital diaphragmatic hernia is challenging, but there is evidence that fetoscopic endoluminal tracheal occlusion has a benefit over expectant care. In addition, standardization and expertism have a great impact on survival and are probably crucial in centers that rely on expectant management with extracorporeal membrane oxygenation after birth., Objective: This study aimed to examine the survival and morbidity rates of fetuses with a severe isolated left-sided congenital diaphragmatic hernia who underwent fetoscopic endoluminal tracheal occlusion vs expectant management in high-volume centers., Study Design: This was a multicenter, retrospective study that included all consecutive fetuses with severe isolated left-sided congenital diaphragmatic hernia who were expectantly managed in a German center or who underwent fetoscopic endoluminal tracheal occlusion in 3 other European centers (Belgium, France, and Italy). Severe congenital diaphragmatic hernia was defined as having an observed to expected total fetal lung volume ≤35% with intrathoracic position of the liver diagnosed with magnetic resonance imaging. All magnetic resonance images were centralized, and lung volumes were measured by 2 experienced operators who were blinded to the pre- and postnatal data. Multiple logistic regression analyses were performed to examine the effect of the management strategy in the 2 groups on the short- and long-term outcomes., Results: A total of 147 patients who were managed expectantly and 47 patients who underwent fetoscopic endoluminal tracheal occlusion were analyzed. Fetuses who were managed expectantly had lower observed to expected total fetal lung volumes (20.6%±7.5% vs 23.7%±6.8%; P=.013), higher gestational age at delivery (median weeks of gestation, 37.4; interquartile range, 36.6-38.00 vs 35.1; interquartile range, 33.1-37.2; P<.001), and more frequent use of extracorporeal membrane oxygenation (55.8% vs 4.3%; P<.001) than the fetuses who underwent fetoscopic endoluminal tracheal occlusion. The survival rates at discharge and at 2 years of age in the expectant management group were higher than the survival rates of the fetoscopic endoluminal tracheal occlusion group (74.3% vs 44.7%; P=.001 and 72.8% vs 42.5%; P=.001, respectively). After adjustment for maternal age, gestational age at birth, observed to expected total fetal lung volume, and birth weight Z-score, the odds ratios were 4.65 (95% confidence interval, 1.9-11.9; P=.001) and 4.37 (95% confidence interval, 1.8-11.0; P=.001), respectively., Conclusion: Fetuses with a severe isolated left-sided congenital diaphragmatic hernia had a higher survival rate when treated in an experienced center in Germany with antenatal expectant management and frequent use of extracorporeal membrane oxygenation during the postnatal period than fetuses who were treated with fetoscopic endoluminal tracheal occlusion in 3 centers in Belgium, France, and Italy., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: To evaluate various signal intensity ratios in isolated congenital diaphragmatic hernia (CDH) and to compare their potential in predicting survival with that of the observed-to-expected (O/E) ratio of total fetal lung volume (TFLV) using magnetic resonance imaging (MRI) measurements. Our second objective was to evaluate the impact of operator's experience in comparing the prediction of postnatal survival by O/E-TFLV., Methods: In 75 conservatively managed CDH fetuses and in 50 who underwent fetoscopic endoluminal tracheal occlusion (FETO), the fetal lung-to-amniotic fluid, lung-to-liver, lung-to-muscle, lung-to-spinal fluid signal intensity ratios, respectively LAFSIR, LLSIR, LMSIR, and LSFSIR, were measured, as was O/E-TFLV. Receiver operating characteristic (ROC) curves were constructed and used to compare the various signal intensity ratios with O/E-TFLV in the prediction of postnatal survival. In 72 MRI lung volumes assessed by the referring radiologists in Paris and Lille and secondarily by our expert radiologist in Brussels (M.M.C.) using the same MRI examinations, ROC curves were constructed and used to compare the value of O/E-TFLV determined by the two centers in the prediction of postnatal survival., Results: In the total cohort of CDH fetuses, O/E-TFLV and LLSIR were predictive of postnatal survival whereas in the conservatively managed group O/E-TFLV, LLSIR, and LMSIR predicted postnatal survival. O/E-TFLV predicted postnatal survival far better than the signal intensity ratios: area under the ROC curve for prediction by O/E-TFLV in the total cohort was 0.866 ( p  < .001; standard error = 0.031). The area under the ROC curve for prediction of postnatal survival using O/E-TFLV by MRI evaluated at the referral centers was 0.640 ( p  = 102; standard error = 0.085), and with O/E-TFLV reevaluated by M.M.C., it was 0.872 ( p  < .001; standard error = 0.061). Pairwise comparison showed a significant difference between the areas under the ROC curves (difference = 0.187, p  = .012; standard error = 0.075)., Conclusion: In fetuses with CDH with/without FETO, LLSIR was significantly correlated with the prediction of postnatal survival. However, measurement of O/E-TFLV was far better in predicting postnatal outcome. Operator experience in measurement of lung volumes using MRI seem to play a role in the predictive value of the technique.

Background: Large-for-gestational-age fetuses are at increased risk of perinatal morbidity and mortality. Magnetic resonance imaging seems to be more accurate than ultrasound in the prediction of macrosomia; however, there is no well-powered study comparing magnetic resonance imaging with ultrasound in routine pregnancies., Objective: This study aimed to prospectively compare estimates of fetal weight based on 2-dimensional ultrasound and magnetic resonance imaging with actual birthweights in routine pregnancies., Study Design: From May 2016 to February 2019, women received counseling at the 36-week clinic. Written informed consent was obtained for this Ethics Committee-approved study. In this prospective, single-center, blinded study, pregnant women with singleton pregnancies between 36 0/7 and 36 6/7 weeks' gestation underwent both standard evaluation of estimated fetal weight with ultrasound according to Hadlock et al and magnetic resonance imaging according to the formula developed by Baker et al, based on the measurement of the fetal body volume. Participants and clinicians were aware of the results of the ultrasound but blinded to the magnetic resonance imaging estimates. Birthweight percentile was considered as the gold standard for the ultrasound and magnetic resonance imaging-derived percentiles. The primary outcome was the area under the receiver operating characteristic curve for the prediction of large-for-gestation-age neonates with birthweights of ≥95th percentile. Secondary outcomes included the comparative prediction of large-for-gestation-age neonates with birthweights of ≥90th, 97th, and 99th percentiles and small-for-gestational-age neonates with birthweights of ≤10th, 5th, and 3rd percentiles for gestational age and maternal and perinatal complications., Results: Of 2914 women who were initially approached, results from 2378 were available for analysis. Total fetal body volume measurements were possible for all fetuses, and the time required to perform the planimetric measurements by magnetic resonance imaging was 3.0 minutes (range, 1.3-5.6). The area under the receiver operating characteristic curve for the prediction of a birthweight of ≥95th percentile was 0.985 using prenatal magnetic resonance imaging and 0.900 using ultrasound (difference=0.085, P<.001; standard error, 0.020). For a fixed false-positive rate of 5%, magnetic resonance imaging for the estimation of fetal weight detected 80.0% (71.1-87.2) of birthweight of ≥95th percentile, whereas ultrasound for the estimation of fetal weight detected 59.1% (49.0-68.5) of birthweight of ≥95th percentile. The positive predictive value was 42.6% (37.8-47.7) for the estimation of fetal weight using magnetic resonance imaging and 35.4% (30.1-41.1) for the estimation of fetal weight using ultrasound, and the negative predictive value was 99.0% (98.6-99.3) for the estimation of fetal weight using magnetic resonance imaging and 98.0% (97.6-98.4) for the estimation of fetal weight using ultrasound. For a fixed false-positive rate of 10%, magnetic resonance imaging for the estimation of fetal weight detected 92.4% (85.5-96.7) of birthweight of ≥95th percentile, whereas ultrasound for the estimation of fetal weight detected 76.2% (66.9-84.0) of birthweight of ≥95th percentile. The positive predictive value was 29.9% (27.2-32.8) for the estimation of fetal weight using magnetic resonance imaging and 26.2% (23.2-29.4) for the estimation of fetal weight using ultrasound, and the negative predictive value was 99.6 (99.2-99.8) for the estimation of fetal weight using magnetic resonance imaging and 98.8 (98.4-99.2) for the estimation of fetal weight using ultrasound. The area under the receiver operating characteristic curves for the prediction of large-for-gestational-age neonates with birthweights of ≥90th, 97th, and 99th percentiles and small-for-gestational-age neonates with birthweights of ≤10th, 5th, and 3rd percentiles was significantly larger in prenatal magnetic resonance imaging than in ultrasound (P<.05 for all)., Conclusion: At 36 weeks' gestation, magnetic resonance imaging for the estimation of fetal weight performed significantly better than ultrasound for the estimation of fetal weight in the prediction of large-for-gestational-age neonates with birthweights of ≥95th percentile for gestational age and all other recognized cutoffs for large-for-gestational-age and small-for-gestational-age neonates (P<.05 for all)., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: To prospectively compare magnetic resonance (MR) estimation of fetal weight (MR-EFW) performed at third trimester with ultrasound (US) estimation of fetal weight (US-EFW) and actual birth weight, and to evaluate factors influencing fetal growth rate near term., Methods: US-EFW and MR-EFW were calculated at a median of 33.0 and 37.7 weeks of gestation in 37 fetuses and plotted on curve centiles to predict birth weights at 39.3 weeks of gestation. The median absolute relative errors for predicted US-EFW and MR-EFW were calculated. Regression analysis was used to investigate the effect of different variables on fetal growth rate at 35.2 weeks of gestation., Results: The relative error of actual birth weight as predicted by US at 33.0 weeks was significantly higher compared with MR (7.33 vs. 4.11%; p = 0.001). This was also the case for fetal weight predicted by US at 37.7 weeks as compared with MR (6.63 vs. 2.60%; p < 0.01). Fetal growth rate was significantly and independently positively associated with the mother's weight and with gestational age at estimation (p < 0.05 for both variables)., Conclusion: Fetal weight estimates predicted using MR at third trimester are better than those given by prenatal US. Fetal growth rate depends on fetal and maternal characteristics., (© 2017 S. Karger AG, Basel.)

Objective: The aim of this study was to apply a semi-automated calculation method of fetal body volume and, thus, of magnetic resonance-estimated fetal weight (MR-EFW) prior to planned delivery and to evaluate whether the technique of measurement could be simplified while remaining accurate., Methods: MR-EFW was calculated using a semi-automated method at 38.6 weeks of gestation in 36 patients and compared to the picture archiving and communication system (PACS). Per patient, 8 sequences were acquired with a slice thickness of 4-8 mm and an intersection gap of 0, 4, 8, 12, 16, or 20 mm. The median absolute relative errors for MR-EFW and the time of planimetric measurements were calculated for all 8 sequences and for each method (assisted vs. PACS), and the difference between the methods was calculated., Results: The median delivery weight was 3,280 g. The overall median relative error for all 288 MR-EFW calculations was 2.4% using the semi-automated method and 2.2% for the PACS method. Measurements did not differ between the 8 sequences using the assisted method (p = 0.313) or the PACS (p = 0.118), while the time of planimetric measurement decreased significantly with a larger gap (p < 0.001) and in the assisted method compared to the PACS method (p < 0.01)., Conclusion: Our simplified MR-EFW measurement showed a dramatic decrease in time of planimetric measurement without a decrease in the accuracy of weight estimates., (© 2017 S. Karger AG, Basel.)

Background: Complementary and alternative methods (CAMs) are frequently used during pregnancy and delivery. We were interested to find out how frequently CAMs were used and if they were used for specific indications., Methods: We assessed the use of various CAMs and the background of use. Here we differentiated between the treatment of psychological problems, physical problems and the treatment of foetal problems., Results: The response rate was 49.2 % (229/465). Attendance of a delivery preparation class was significantly associated with a higher CAM use in general. Herbal teas and dietary interventions were most frequently used during pregnancy and predominantly for the treatment of physical problems (e.g. nausea, back pain). Earlier deliveries were associated with a significantly decreased demand for complementary methods during delivery but not during pregnancy., Conclusion: Although we found some correlations between some methods and certain treatment indications, most methods were used like panaceas. We believe that the fact that earlier deliveries were associated with a significantly decreased demand for CAM should lead to the question of whether women should receive more reassuring information on delivery and be offered methods like massage or relaxation techniques, which provide proven efficacy without potential side effects that may be associated with CAM methods.