Antenatal Imaging Research Articles

Identification and stratification of placenta percreta with gynecologic oncologist management

ObjectiveGynecologic oncologist involvement in the surgical team of patients with placenta percreta has shown improved patient outcomes. Yet, stratification of cases is dependent on identification of placenta percreta by ultrasonography...

Generation Victoria (GenV): Creating a large consented longitudinal infrastructure for discovery and intervention research

Designed to help solve complex problems facing children and adults, Generation Victoria is Australia’s largest-ever birth cohort, and the only such cohort mounted internationally during the COVID-19 pandemic. Here, we describe progress in bringing together this ‘cell-to-society’ consented cohort with diverse existing data and biosamples assets. GenV is a whole-of-state consented cohort open to all Victorian children born October 2021-October 2023 and their parents. With over 117,000 participants to date (babies, mothers, fathers and non-binary parents), GenV closely reflects Australia's diverse demographics. At recruitment parents consent to GenV accessing (a) government managed and routinely collected administrative datasets across health, primary care, education, social care and geospatial and clinical datasets, (b) residual biosamples, (c) clinical and other service records and (d) spatial data. To date, GenV has developed protocols, governance and technical requirements for linking birthing hospitals clinical data, state based administrative datasets and residual samples from statewide pathology labs. In pilot studies we have achieved high linkages rate (over 98%) with the state-based linkage spine and with clinical records from one birthing hospital. Universal newborn blood spot linkage is nearing completion. We are developing methods to include our natural and built environment exposome platform, antenatal imaging and trials data. While challenging, GenV has encountered no significant barriers in creating an enduring, linked and secure data resource to advance future evidence-based decision making for child, family and adult outcomes. Our collaborative approach welcomes partnerships to co-build and enhance the muti-sectoral data and its utility.

Prenatal diagnosis of tracheo-oesophageal fistula/oesophageal atresia: is MRI helpful?

Oesophageal atresia (OA) with or without tracheo-oesophageal fistula (TOF) affects 2.75 per 10,000 births within the UK. It is most frequently suspected on antenatal imaging when the stomach is absent or appears small. Studies have shown fetal magnetic resonance imaging (MRI) has greater diagnostic accuracy than ultrasound; however, there remains uncertainty over what size constitutes a small stomach and how frequently this correlates with a diagnosis of TOF/OA. A retrospective study of patients referred for fetal MRI due to suspicions of TOF/OA on antenatal ultrasound from 2011 to 2022. We also included patients with a fetal MRI suspecting TOF/OA who had been referred for other reasons. The indication, MRI findings and postnatal outcome were compared to assess diagnostic accuracy. For each case, the size of the stomach bubble was measured on MRI, and stomach volumes in a control group were measured for comparison. The positive predictive value for USS was 45.5% and 51.7% for fetal MRI. Fetal MRI had a negative predictive value and sensitivity of 100% (p = 0.027). The control group showed a strong positive correlation between stomach size and increasing gestational age (R2 = 0.69, p < 0.001), but this correlation was less positive in the TOF/OA group (R2 = 0.26, p = 0.03), and the stomach volumes in TOF/OA were consistently lower than the control group. The receiver operating characteristic curve illustrates that an absent stomach or unmeasurably small stomach is more diagnostic of TOF/OA as volumes ≤0.06 ml had 90% sensitivity. Fetal MRI can accurately exclude TOF/OA but only has marginally improved positive predictive value over ultrasound. Research with larger numbers is required to further aid the development of a cut-off value for what can be considered a pathologically small stomach. There are several features on imaging that raise the suspicion of TOF/OA. Fetal MRI has some improved diagnostic accuracy compared with antenatal ultrasound alone; however, it is only marginally better. Absence of stomach bubble and presence of oesophageal dilatation combined on fetal MRI are more diagnostic of TOF/OA.

Congenital cervical teratoma

: Teratoma, originating from the Greek word "teras" meaning "monster," reflects its diverse tissue composition, often containing ectodermal, mesodermal, and endodermal tissues. These embryonic germ layers contribute to the rarity of teratomas in the neck, though they are more commonly found in the sacrococcygeal area. Notably, teratomas occurring in the cervical region can lead to life-threatening symptoms due to their mass effect.: A 26-year-old multiparous woman highlighted the challenges of managing cervical teratomas. During her 38th week of gestation, an ultrasound revealed a tumour on the foetus's neck, measuring 5.2 x 4.7 cm with doppler, neovascularization, and solid parts suspected to be a teratoma. The patient, despite no prior illness, had not taken prescribed vitamins during pregnancy. She underwent a caesarean section, delivering a baby girl weighing 3100 grams with an Apgar score of 8, who was found to have a solid mass in the posterior neck. The baby underwent surgery three days later, where 200-gram mass was removed and identified as a mature teratoma through anatomical pathology examination. The successful surgery allowed the mother and baby to return home in good condition.: Teratomas emphasized their diverse nature, with cervical teratomas mostly affecting females and originating from early aberrant germ cells. These tumours, often neuroepithelial, rarely become malignant. Diagnosis involves prenatal ultrasonography, aiding in intervention planning, while postnatal imaging guides surgical approaches.: Congenital teratomas pose challenges in prenatal diagnosis and management, requiring a multidisciplinary approach. Early detection through antenatal imaging, surgical excision, and meticulous follow-up are crucial for optimal outcomes, emphasizing the importance of comprehensive care and collaboration across medical specialties.

Utilizing Fetal MRI and Prenatal Medical Exome Sequencing for Prenatal Diagnosis of Kinked Brainstem: A Case Series

Objective: Utilizing fetal MRI and prenatal Medical Exome Sequencing (pMES) for prenatal diagnosis in fetuses exhibiting a kinked or 'z-shaped' brainstem. Methods: A retrospective analysis was conducted on cases of brainstem kinking identified on antenatal imaging between January 2013 and December 2022. Systematic review was performed on clinical data from these cases, encompassing maternal demographics, indications for invasive prenatal diagnosis, ultrasound findings, SNP-array results, Trio-Medical Exome Sequencing (Trio-MES) results, QF-PCR results, pregnancy outcomes and follow-ups. Results: Two cases of fetuses presenting with a "kinked brainstem," along with other CNS abnormalities in fetal MRI were identified using Trio pMES. Prenatal phenotype features observed in our case series include "Z" shaped brainstem, hydrocephalus, hyperechogenic kidneys and generalized skin edema, cobblestone lissencephaly, cerebellar dysplasia, cerebral arachnoid cyst. Trio pMES identified a homozygous variant at c.815_816del (p.Leu272ArgfsTer117) in the FKRP gene for Patient 1. For Patient 2, a de novo heterozygous variant c.848A&gt;G (p.H283R) was detected in the TUBA1A gene. Both variants were predicted to be likely pathogenic or pathogenic. Conclusion: A kinked or "z-shaped" brainstem is a finding that can be more easily delineated on fetal MRI compared to fetal ultrasound, indicating an underlying dystroglycanopathy (Walker-Warburg phenotype) or tubulinopathy. Prenatal exome sequencing can aid in achieving early prenatal genetic diagnosis for cases of "kinked brainstem". Moreover, our study expands its scope by incorporating additional features such as hyperechogenic kidneys and generalized skin edema into the prenatal findings of Walker-Warburg syndrome.

An Imperative Role of Fetal Autopsy in Previable Fetuses - ADAM Complex Revisited

Abstract Objective To identify the occurrence of the amniotic deformity adhesions, mutilation (ADAM) complex and imperative role of fetal autopsy in diagnosing this condition. Methods A retrospective descriptive study spanning nine years, from January 2014 to January 2022, was conducted at the Department of Pathology within a tertiary care hospital in South India. The study focused on analyzing the clinical presentation, prenatal ultrasonogram, and morphological features of fetuses with the ADAM complex, limb body wall complex, or amniotic bands. Results Among the 438 fetuses assessed during the study period, five fetuses showed features of the ADAM complex (0.01%). The most frequent gestational age observed was 12–18 weeks and most fetuses were female. The common anomaly encountered was limb defects, followed by abdominal and cranial anomalies. Conclusion The diagnosis of the ADAM complex relies primarily on fetal autopsy to differentiate it from similar conditions like anencephaly or body-stalk anomalies. The pathologist plays a crucial role in understanding the complexities of the ADAM complex. Advanced antenatal imaging and therapies offer potential for prevention through improved counseling.

The influence of antenatal imaging on prenatal bonding in uncomplicated pregnancies: a mixed methods analysis

BackgroundPrenatal bonding describes the emotional connection expectant parents form to their unborn child. Research acknowledges the association between antenatal imaging and enhanced bonding, but the influencing factors are not well understood, particularly for fathers or when using advanced techniques like fetal magnetic resonance imaging (MRI). This study aimed to identify variables which may predict increased bonding after imaging.MethodsFirst-time expectant parents (mothers = 58, fathers = 18) completed a two-part questionnaire (QualtricsXM™) about their expectations and experiences of ultrasound (n = 64) or fetal MRI (n = 12) scans in uncomplicated pregnancies. A modified version of the Prenatal Attachment Inventory (PAI) was used to measure bonding. Qualitative data were collected through open-ended questions. Multivariate linear regression models were used to identify significant parent and imaging predictors for bonding. Qualitative content analysis of free-text responses was conducted to further understand the predictors’ influences.ResultsBonding scores were significantly increased after imaging for mothers and fathers (p < 0.05). MRI-parents reported significantly higher bonding than ultrasound-parents (p = 0.02). In the first regression model of parent factors (adjusted R2 = 0.17, F = 2.88, p < 0.01), employment status (β = -0.38, p < 0.05) was a significant predictor for bonding post-imaging. The second model of imaging factors (adjusted R2 = 0.19, F = 3.85, p < 0.01) showed imaging modality (β = -0.53), imaging experience (β = 0.42) and parental excitement after the scan (β = 0.29) were significantly (p < 0.05) associated with increased bonding. Seventeen coded themes were generated from the qualitative content analysis, describing how scans offered reassurance about fetal wellbeing and the opportunity to connect with the baby through quality interactions with imaging professionals. A positive scan experience helped parents to feel excited about parenthood. Fetal MRI was considered a superior modality to ultrasound.ConclusionsAntenatal imaging provides reassurance of fetal development which affirms parents’ emotional investment in the pregnancy and supports the growing connection. Imaging professionals are uniquely positioned to provide parent-centred experiences which may enhance parental excitement and facilitate bonding.

Prenatal diagnosis of microcephaly through combined MRI and ultrasonography: Analysis of a case series.

Intrauterine microcephaly is a complex and lifelong condition that poses significant ethical challenges for clinicians and parents. The prognosis of microcephaly is highly variable and depends on the underlying cause and severity. In addition, microcephaly is often associated with various comorbidities, including intellectual disability, developmental delay, and epilepsy. Ultrasonography (US) is currently the most commonly used imaging modality for detecting microcephaly in the second trimester of pregnancy. However, antenatal brain magnetic resonance imaging (MRI) is increasingly being used as a more sensitive tool to identify structural abnormalities that may suggest a specific diagnosis. In this study, we report a case series of microcephaly diagnosed through the combination of MRI and US. How to utilize a combination of MRI and US to screen for fetal microcephaly. Based on the results of US and MRI examinations, patient 1 was found to have other craniocerebral malformations, patient 2 demonstrated macrogyria, and patient 3 exhibited skull irregularities. The pregnancies of all 3 patients were terminated through the induction of labor by injecting Rivanol into the amniotic cavity. The 3 patients were discharged after a period of observation. US is an important tool for diagnosing fetal microcephaly. However, MRI can overcome the limitations of US and detect additional brain structural abnormalities, thereby providing more specific and valuable prenatal diagnostic information. Therefore, combining MRI and US has significant diagnostic value for fetal microcephaly.

“It's not just the medical aspects that are important”: A qualitative exploration of first-time parents' experiences of antenatal imaging and their influence on parent-fetal bonding

IntroductionAntenatal imaging provides clinical information regarding fetal growth and development. The additional benefit afforded by imaging for expectant parents in developing an emotional connection (bond) to the unborn baby is also acknowledged. However, the relationship between imaging and bonding is not fully understood, particularly where there are differing parental and pregnancy circumstances, for example use of advanced imaging techniques or the prenatal diagnosis of a congenital fetal condition. This study aimed to explore the role of antenatal imaging in enhancing the developing parent-fetal bond in first-time parents. MethodsA descriptive, qualitative methodology was used. Semi-structured telephone interviews were conducted with first-time expectant parents attending a London hospital for clinical ultrasound (n = 20) or research MRI (n = 8) imaging during pregnancy. The sample included parents receiving specialist antenatal care for a diagnosed fetal cardiac condition (n = 8). Thematic analysis was conducted. ResultsThe analysis generated three themes: 1) Our baby, our scan too; 2) Destination parenthood; and 3) Being in the dark, then finding the light. These themes highlight the important, but transient role of antenatal imaging in enhancing parent-fetal bonding, as well as the differing care needs of expectant parents. The integral role of healthcare professionals in providing a personalised, supportive, imaging experience to facilitate bonding is also reflected. ConclusionAdopting parent-centred care approaches which involve expectant parents in fetal imaging influences bonding by helping parents to consider the reality of their impending parenthood. Knowledge acquired during scans is used to create an identity for the unborn baby, which parents can develop an emotional connection to. Implications for practiceTo optimise the potential for enhanced parent-fetal bonding, care provision in fetal imaging should be tailored to the individual needs of expectant parents.

Mature Cystic Oral Teratoma in a Neonate- A Case Report.

Neonatal oral cavity masses present complex diagnostic and management challenges, often involving respiratory distress. We present a case of a 1-day-old male neonate with an oral cavity mass and respiratory distress, whose antenatal scan revealed polyhydramnios and a nasopalatine cyst. Clinical examination revealed a 5 * 5cm cystic swelling arising from the right hard palate. CT scans confirmed an intraoral cystic lesion with a complete cleft palate and excluded oropharyngeal/neck extension. Aspiration of cystic fluid facilitated surgical excision, leading to a histopathological diagnosis of mature cystic teratoma. Primary closure of the soft palate defect was performed. Histopathological examination revealed it to be mature cystic teratoma. This case underscores the intricate interplay between antenatal imaging, clinical assessment, and surgical intervention in managing neonatal oral cavity masses. The successful excision and histopathological confirmation of a mature cystic teratoma highlights the significance of accurate diagnosis and timely intervention. The complexities surrounding neonatal oral cavity masses necessitate a comprehensive approach to optimize patient outcomes.

Antenatal ultrasound needs-analysis survey of Australian rural/remote healthcare clinicians: recommendations for improved service quality and access

BackgroundUltrasound is the primary diagnostic tool in pregnancy, capable of identifying high-risk pregnancies and life-threatening conditions, allowing for appropriate management to prevent maternal and fetal morbidity and mortality. Women and babies from rural and remote Australia and low-resource areas worldwide experience poorer health outcomes and barriers to accessing antenatal care and imaging services. Healthcare clinicians working in these regions face significant challenges practising with limited resources and accessing training opportunities.ObjectiveTo perform an exploratory needs-analysis survey investigating the availability, accessibility and use of antenatal ultrasound in rural Australia, exploring rural clinicians’ interest in and access to ultrasound training opportunities.MethodsThe survey tool for this cross-sectional study was designed and distributed as an anonymous online questionnaire targeting healthcare clinicians (doctors, nurses, midwives, clinic managers, Aboriginal healthcare workers) providing antenatal care in rural regions. Descriptive analysis was applied to quantitative data and thematic analysis was used to explore qualitative components.ResultsA total of 114 valid survey responses were analysed. Overall, 39% (43/111) reported ultrasound was not used when providing antenatal care to patients at their clinic, stating ‘Lack of ultrasound equipment (73%,29/40) and inaccessibility of training opportunities (47%,19/40) as the main reasons. For those with ultrasound (61%,68/111), estimating due date (89%,57/64) was the main use, and limited training/skills to operate the equipment (59%,38/64) and inaccessibility/distance of training opportunities (45%,29/64) were the most commonly reported barriers. Clinicians described a lack of childcare options (73%,74/102), long distances to reach ultrasound services (64%,65/102), appointment (59%,60/102) and transport availability/times (46%,47/102) as the main obstacles to patient access. Increased attendance, compliance with care directives, parental bonding and improved lifestyle choices were described by respondents as positive outcomes of antenatal ultrasound use.ConclusionsFuture efforts to combat inequitable service access must adopt a coordinated approach to meet the needs of pregnant women in low-resource settings. Providing portable ultrasound equipment, training in antenatal Point-of-Care ultrasound (PoCUS) with ongoing support/mentoring and accreditation of health professionals could strengthen rural workforce capacity. This, along with addressing the complex economic, environmental and socio-cultural barriers faced by patients, could improve service access and pregnancy outcomes in rural and remote communities.

The “cortical invagination sign”: a midtrimester sonographic marker of unilateral cortical focal dysgyria in fetuses with complete agenesis of the corpus callosum

Agenesis of the corpus callosum is associated with several malformations of cortical development. Recently, features of focal cortical dysgyria have been described in fetuses with agenesis of the corpus callosum. This study aimed to describe the "cortical invagination sign," a specific sonographic feature of focal cortical dysgyria, which is consistently seen at midtrimester axial brain ultrasound in fetuses with complete agenesis of the corpus callosum. This was a retrospective analysis of prospectively collected data from 2018 to 2021, including patients referred to 5 fetal medicine centers in the second trimester of pregnancy (19 0/7 to 22 0/7 weeks of gestation) with suspected complete agenesis of the corpus callosum. All cases with the diagnosis of complete agenesis of the corpus callosum were submitted to an axial sonographic assessment of the fetal brain on the transventricular plane. In this scanning section, the mesial profile of both cerebral hemispheres at the level of the frontal-parietal cortex was investigated. In this area, the operator looked for an abnormal invagination of the cortical surface along the widened interhemispheric fissure, which was referred to as the "cortical invagination sign." All fetuses were submitted to dedicated antenatal magnetic resonance imaging to reassess the ultrasound findings. Cases with additional brain anomalies, which did not involve the cortex, were excluded. The final diagnosis was confirmed at postnatal brain magnetic resonance imaging or postmortem examination, for cases undergoing termination of pregnancy. The primary outcome of this study was to evaluate the presence and laterality of the "cortical invagination sign" in fetuses with complete agenesis of the corpus callosum at antenatal ultrasound and magnetic resonance imaging. During the study period, 64 cases of complete agenesis of the corpus callosum were included; of those cases, 50 (78.1%) resulted in termination of pregnancy, and 14 (21.9%) resulted in a live birth. The "cortical invagination sign" was detected at ultrasound in 13 of 64 cases (20.3%) and at targeted brain magnetic resonance imaging in 2 additional cases (23.4%), all of which were electively terminated. Moreover, the "cortical invagination sign" was found to be exclusively unilateral and on the left cerebral hemisphere in all the cases. There was a predominant number, although nonsignificant, of male fetuses (80.0% of cases; P=.06) in the group of complete agenesis of the corpus callosum with the "cortical invagination sign." The "cortical invagination sign" is a specific marker of focal cortical dysgyria, which seems to characterize at midtrimester of pregnancy in a large group of fetuses with complete agenesis of the corpus callosum. The etiology, pathophysiology, and prognostic significance of this finding remain to be elucidated.

Reliability of Magnetic Resonance Imaging in the Detection of Congenital Anomalies of Iraqi Women

Background: Prior to birth, fetal anomalies must be identified using antenatal imaging so that during utero interventions may be planned and the baby's postpartum care can be chosen. Aim: This paper aims to study the reliability of magnetic resonance imaging in the detection of congenital anomalies of Iraqi women. Patients and methods: This study was a cross-sectional study in the analysis of the reliability of magnetic resonance imaging in the detection of congenital anomalies of Iraqi women in the Baghdad-Iraq from 17th August 2021 to 24th May 2022. The collected data of the MRI technique for using with congenital anomalies of Iraqi women was analysed into 90 patients by the SPSS program. Results and Discussion: 26 participants (28.89%) in our study had hydrocephalus. As a result, MRI can be used in addition to ultrasonography to diagnose embryonic genitourinary abnormalities, particularly in cases of oligohydramnios. In one instance of the diaphragm eventration, MRI was helpful in making the diagnosis. In 70 cases, MRI was successful; in the other 20, it was not. Our findings indicated that CNS received helpful information with 66% and without useful information with 34%, Gut received useful information with 77% and without useful information with 33%, and Multiple received useful information with 57% and without useful information with 43%. Conclusion: According to the findings, MRI showed the highest scored for detecting ventriculomegaly and the worst score for detecting cerebral haemorrhage and cortical abnormalities. Additionally, our study discovered that prenatal MRI has become a more potent tool for detecting fetal defects when ultrasound results are insufficient or equivocal.

Efficacy of Systematic Early-Second-Trimester Ultrasound Screening for Facial Anomalies: A Comparison between Prenatal Ultrasound and Postmortem Findings.

Second-trimester 2D ultrasound (US) assessment of the fetal anatomy, as proposed by worldwide guidelines, allows detecting the majority of fetal malformation. However, the detection rates of fetal facial anomalies seem to still be low, mostly in cases of isolated facial malformation. The purpose of this research was to assess and analyze the concordance between the antenatal imaging findings from second-trimester US screening and the results of fetal postmortem autopsy. Between January 2010 and January 2020, there were 43 cases where fetuses with prenatal ultrasound diagnosis of a face abnormality, associated or not with a genetic syndrome or chromosomal disorder, following intrauterine death (IUD) or termination of pregnancy (TOP) after the 13 weeks of pregnancy, underwent autopsy in the Pathological Anatomy section of Bari Polyclinic specializing in feto-placental autopsies. The diagnosis of the fetal facial defects at ultrasound was compared with the findings at autopsy in all cases. A very high level of agreement between prenatal ultrasound and autopsy findings was found for facial abnormalities associated with genetic syndromes or numerical abnormality of chromosomes. A lower level of concordance was instead found in isolated facial defects or those associated with other organ anomalies, but not associated with genetic syndrome or numerical chromosome anomaly. A detailed examination of aborted fetuses led to successful quality control of early-second-trimester ultrasound detection of facial anomalies; however, it was less accurate for the isolated ones. It is, thus, reasonable to propose a systematic early-second-trimester prenatal ultrasound screening for facial anatomy by operators specialized in fetal medicine field, using 2D, 3D, and 4D techniques (two-, three-, and four-dimensional ultrasound).

Incidental finding of Posterior Urethral Valve during routine antenatal ultrasound: Diagnostic imaging case report in Botswana

Medical ultrasound is a particularly useful imaging method used in the diagnosis of urinary foetal anomalies. One such foetal anomaly is the posterior urethral valve (PUV), which is a congenital malformation of the male urethra occurring early in gestation life. PUV is a common cause of obstructive uropathy in males and foetal death during pregnancy. We report from a medical imaging perspective on a rare and high-risk case of a PUV detected during routine antenatal ultrasound imaging in Botswana. The first scan performed at 16 weeks of gestation age was unremarkable. However, subsequent antenatal ultrasound scans at and after 20 weeks demonstrated bilateral hydronephrosis, distended ureters, and a urinary bladder which gradually increased with the gestation age. There was also a corresponding reduction in amniotic fluid and foetal movements. As a result of these complications, the pregnancy was classified as a “high-risk.” At 30 weeks, spontaneous labour occurred and a fresh still birth was delivered.

Establishing a Fetal Center in a Freestanding Pediatric Hospital.

Advances in antenatal imaging have allowed early and accurate diagnosis of many fetal anomalies. This, together with the increasing understanding of the natural history of many fetal diseases, has opened the door to the possibility of offering timely fetal interventions in progressive or life-threatening conditions with the intention of improving perinatal outcomes. These interventions can occur at an adult hospital with obstetrical services (with or without pediatric care) or at a freestanding pediatric hospital. In this article, we provide an overview of the approach to develop a comprehensive fetal care center in a freestanding pediatric hospital. Services included prenatal consultation, advanced diagnostics, innovative fetal therapy, research, and special delivery services. We also review the importance of continuous improvement in achieving this goal.

Imaging the Uterus in Placenta Accreta Spectrum Disorder.

Antenatal diagnosis of placenta accreta spectrum (PAS) improves maternal and neonatal outcomes by allowing for multidisciplinary planning and preparedness. Ultrasound is the primary imaging tool. Simplification and standardization of placental evaluation and reporting terminology allows improved communication and understanding between teams. Prior to 10 weeks of gestation, gestational sac position and least myometrial thickness surrounding the gestational sac help PAS diagnosis very early in pregnancy. Late first-, second-, and third-trimester evaluation includes comprehensive evaluation of the placenta, transabdominal and transvaginal with partially full maternal urinary bladder, and by color Doppler. Subsequently, the sonologist should indicate whether the evaluation was optimal or suboptimal; the level of suspicion as low, moderate, or high; and the extent as focal, global, or extending beyond the uterus. Other complementary imaging modalities such as 3D-power Doppler ultrasound, magnetic resonance imaging (MRI), and vascular topography mapping strive to improve antenatal placental evaluation but remain investigational at present. KEY POINTS: · Antenatal imaging, primarily using ultrasound with partially full maternal urinary bladder, is an essential means of evaluation of those at risk for PAS.. · Simplification and standardization of placental evaluation and reporting will allow improved communication between the multidisciplinary teams.. · Gestational sac location prior to 10 weeks of gestation and four markers after that (placental lacunae and echostructure, myometrial thinning, hypoechoic zone with or without bulging between placenta and myometrium, and increased flow on color Doppler)..

Placenta Accreta Spectrum.

Placenta accreta spectrum (PAS) is one of the most dangerous conditions in pregnancy and is increasing in frequency. The risk of life-threatening bleeding is present throughout pregnancy but is particularly high at the time of delivery. Although the exact cause is unknown, the result is clear: Severe PAS distorts the uterus and surrounding anatomy and transforms the pelvis into an extremely high-flow vascular state. Screening for risk factors and assessing placental location by antenatal ultrasonography are essential for timely diagnosis. Further evaluation and confirmation of PAS are best performed in referral centers with expertise in antenatal imaging and surgical management of PAS. In the United States, cesarean hysterectomy with the placenta left in situ after delivery of the fetus is the most common treatment for PAS, but even in experienced referral centers, this treatment is often morbid, resulting in prolonged surgery, intraoperative injury to the urinary tract, blood transfusion, and admission to the intensive care unit. Postsurgical complications include high rates of posttraumatic stress disorder, pelvic pain, decreased quality of life, and depression. Team-based, patient-centered, evidence-based care from diagnosis to full recovery is needed to optimally manage this potentially deadly disorder. In a field that has relied mainly on expert opinion, more research is needed to explore alternative treatments and adjunctive surgical approaches to reduce blood loss and postoperative complications.

The effect of the COVID-19 pandemic on UK parent experiences of pregnancy ultrasound scans and parent-fetal bonding: A mixed methods analysis.

Companionship in antenatal care is important for facilitating positive parental experiences. During the COVID-19 pandemic, restrictions on partner attendance at fetal ultrasound scans were introduced nationally to minimise transmission of the virus. This study aimed to explore the effect of these restrictions on maternal and paternal experiences of pregnancy scans and evaluate their potential effect on parent-fetal bonding. A UK-wide, anonymous cross-sectional survey was completed by new and expectant parents (n = 714) who had, or were awaiting a pregnancy scan during the COVID-19 pandemic. The CORE-10 and an adapted version of the Prenatal Attachment Inventory were used to evaluate psychological distress and prenatal bonding. Additional survey questions captured parental experiences of scans. Separate statistical and thematic analyses of the data were undertaken. A joint display matrix was used to facilitate integration of quantitative and qualitative claims to generate a comprehensive interpretation of study findings. When fathers did not attend the scan, feelings of excitement and satisfaction were significantly reduced (p<0.001) and feelings of anxiety increased (p<0.001) in both parents. Mothers were concerned about receiving unexpected news alone and fathers felt excluded from the scan. Mean paternal bonding (38.22, SD 10.73) was significantly lower compared to mothers (47.01, SD 7.67) although no difference was demonstrated between those who had attended the scan and those who had not. CORE-10 scores suggested low-to-mild levels of psychological distress, although the mean difference between mothers and fathers was not significant. Key themes described both parents' sense of loss for their desired pregnancy scan experience and reflected on sonographers' central role in providing parent-centred care during scans. Restrictions on partner attendance at scans during the COVID-19 pandemic had a negative effect on parental experiences of antenatal imaging. Provision of parent-centred care, which is inclusive of partners, is essential for improved parental experiences.

Congenital heart anomalies in the first trimester: From screening to diagnosis.

Congenital heart defects occur in approximately 1% of liveborn children and represent the most common form of congenital malformation. Due to the small size and complexity of the heart structures, prenatal diagnosis is most often made in the second trimester of pregnancy. Early diagnosis however offers significant advantages regarding the timing of further investigations, prenatal counseling, and access to management options. In the last decade, advances in antenatal imaging have improved the detection of cardiac malformations with increasing emphasis on earlier pregnancy screening and diagnosis. We aim to summarize current "state of the art" imaging of the fetal heart in the first trimester.