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Nguyen Duy Anh,1,2 Ho Sy Hung,2 Nguyen Thi Sim,1 Nguyen Thi Thu Ha,3 Duc Lam Nguyen,2 Nguyen Duy Bac,4 Hoang Van Tong,5 Yves Ville,6 Phan Thi Huyen Thuong2,7 1Fetal Medicine Centre, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam; 2Hanoi Medical University, Hanoi, Vietnam; 3Department of Assisted Reproductive and Andrology, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam; 4Department of Education and Training, Vietnam Military Medical University, Hanoi, Vietnam; 5Biomedical and Pharmaceutical Applied Research Center, Vietnam Military Medical University, Hanoi, Vietnam; 6Department of Obstetrics and Fetal Medicine at Necker-Enfants-Malades Hospital at the Paris Descartes University, Paris, France; 7Department of Delivery, Hanoi Obstetrics and Gynecology Hospital, Hanoi, VietnamCorrespondence: Phan Thi Huyen Thuong, Hanoi Medical University, Hanoi, Vietnam, Tel +84 989 330139, Email dr.phanhuyenthuong@hogh.vnObjective: To evaluate the surgery outcomes of fetoscopic laser ablation (FLA) for selective umbilical cord in treating twin-twin transfusion syndrome (TTTS) with special conditions and neonatal outcomes post-operation.Methods: A prospective study, 21 monochorionic diamniotic (MCDA) twins diagnosed with TTTS stage II–IV according to Quintero classification from 16 to 26 weeks of gestation, among that, 12 cases of TTTS stage II with selective intrauterine growth restriction (sIUGR), 6 cases of TTTS stage II with proximate cord insertions, 3 cases of TTTS stage IV underwent fetoscopic laser ablation for the selective fetal reduction at Hanoi Obstetrics and Gynecology Hospital from September 2019 to July 2021. Complications and surgical outcomes were noted. Prenatal care was carried out every 2 weeks post operation until birth. Newborn neurologic complications were assessed at birth, three months, and six months after birth using Denver II test and magnetic resonance imaging (MRI).Results: The mean gestational age at operation was 20.30 weeks. The average operation duration was 39.52 minutes. No complications of operation, such as bleeding or infection, were recorded. The mean gestational age at birth was 34.70 ± 4.33 weeks, with a mean duration of 12.97 ± 6.87 weeks between intervention and delivery. The survival rate of newborns after the operation was 90.48%. There were two stillbirths (9.52%) within seven days after the operation. No short-term neurological complications have been reported with follow-up of the newborn to 6 months after birth.Conclusion: Our study showed that fetoscopic laser ablation of selected fetal reduction surgery for treatment of special conditions of TTTS had no complications of operation, high neonatal survival result (90.48%), no short-term neurological complications. This should be considered for TTTS in cases of indication.Keywords: laser ablation, selective fetal reduction, twin-twin transfusion syndrome, new fetal medicine center

Objective: To report our experience of fetal aortic valvuloplasty (FAV) for critical aortic stenosis (AS), with a focus on the postnatal evolution of the patients. Methods: This was a retrospective study including all fetuses with critical AS which underwent FAV in a single center between January 2011 and June 2022. FAV was performed under ultrasound guidance. Technical success was based upon balloon inflation across the aortic valve and improvement of the antegrade aortic flow across the aortic valve. At birth, a biventricular circulation (BVC) strategy was decided assuming the left ventricular (LV) systolic and diastolic function would ensure the systemic circulation. Results: Sixty‐three FAV procedures were performed in 58 fetuses, at a median (range) gestational age of 26.2 (20.3–32.2) weeks. The procedure was technically successful in 50/58 (86.2%) fetuses. There were 11/58 (19.0%) cases of in‐utero demise and 9/58 (15.5%) terminations of pregnancy. No patient was liveborn after an unsuccessful procedure. Thirty‐eight (65.5%) infants were liveborn, at a median (range) gestational age of 38.1 (29.0–40.6) weeks, of whom 21 (55.3%) required prostaglandin treatment. Twenty‐eight of the 38 (73.7%) liveborn children (48.3% of the study population) entered the BVC pathway at birth. Among them, 20 (71.4%) required an aortic valvuloplasty procedure at birth (11 (55.0%) percutaneous balloon, nine (45.0%) surgical) and eight (28.6%) did not require any treatment at birth, but, of these, five (62.5%) underwent surgical valvuloplasty between day 26 and day 1200 of age. Eleven (39.3%) of the infants with BVC at birth required a second intervention and four (14.3%) of them required a third intervention. Two (7.1%) infants who entered the BVC pathway at birth underwent conversion to univentricular circulation (UVC). None of the surviving children with BVC developed pulmonary hypertension. The overall survival rate in those with BVC at birth was 22/28 (78.6%) at a median (range) follow‐up of 23.3 (2.0–112.6) months. Ten of the 58 (17.2%) patients had UVC at birth. Among these, six (60.0%) received compassionate care from birth and four (40.0%) underwent surgery. Three of the 10 patients who had UVC at birth were still alive at the latest follow‐up assessment, at a median (range) gestational age of 24.3 (8.3–48.7) months. Conclusions: FAV for critical AS led to increase of antegrade aortic flow in 86.2% of fetuses, with BVC being achieved in 48.3% (73.7% of the liveborn cases). Among patients with BVC at birth, the rate of reintervention was high, but 78.6% of these children were alive at the latest evaluation. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article discusses the performance of an artificial intelligence (AI) software in automatically detecting anatomical structures and characteristics on fetal ultrasound images. The study collected 643 fetal ultrasound exams from various centers in North America and Europe. The AI software showed high sensitivity and specificity in detecting different anatomical structures, such as fetal brain, thorax and heart, CRL/NT/Profile, placenta, and sex. The findings suggest that this AI software could be a valuable tool in supporting fetal ultrasound practitioners by providing objective evaluation of captured images for quality assessment. [Extracted from the article]

This article discusses a new bioinformatics research tool that is being developed to identify genes involved in prenatal syndromes based on ultrasound phenotypes. The tool uses an internal database that links ultrasound fetal phenotypes to genes curated by experts in prenatal diagnosis of rare diseases. The tool was tested on 10 cases of CHARGE Syndrome and accurately identified the gene and syndrome in 90% of the cases. Comparative analyses with other available solutions showed that the research tool outperformed other apps in finding the correct gene and/or syndrome. The article concludes that early gene detection of rare syndromes can be significantly improved using research tools specifically designed for prenatal phenotypes. [Extracted from the article]

This article discusses the feasibility of using off-line MRI-US fusion imaging in cases of common fetal abnormalities. The study included patients referred for fetal abnormalities and used a standard fetal MRI protocol followed by 3D ultrasound imaging of the same anatomical district. Fusion images were generated using dedicated software. The results showed that fusion imaging was feasible in 70% of cases and significantly enhanced diagnostic confidence in several cases. The authors suggest that MRI-US fusion imaging offers several advantages in clinical practice, including enhanced diagnostic confidence and simultaneous evaluation of ultrasound and MRI findings. The potential for tele-expertise and education using this technique should be further evaluated. [Extracted from the article]

This article discusses a study that aimed to identify non-invasive markers for predicting fetal infection with cytomegalovirus (CMV) following maternal primary infection (MPI) before 14 weeks of gestation. The researchers conducted a retrospective study and found that the maximum trophoblast thickness (MTT) measured using three-dimensional ultrasound was significantly larger in cases where CMV was detected in the trophoblast and amniotic fluid. The study suggests that MTT could be a relevant and reproducible marker for diagnosing fetal CMV infection, but further research is needed to determine the threshold for MTT. The article was written by N. Bourgon, M. Jacquier, J. Fourgeaud, T. Guillerminot, L. Bussières, M. Leruez-Ville, and Y. Ville. [Extracted from the article]