Pregnancy involves profound endocrine and metabolic adaptations, such as the increase in maternal cortisol levels, which plays a central role in fetal maturation and appropriate fetal development. However, at high levels, evidence suggests that exposure to maternal cortisol can be harmful to fetal growth and subsequent infant neurodevelopment. This study examined the associations between maternal serum cortisol levels during gestation and fetal anthropometry, assessed by ultrasonography, both measured simultaneously in either the second or the third trimester of pregnancy. It also explored potential relationships between gestational cortisol and infant cognitive development at three months of age, evaluated using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). This study is nested within a larger project involving mother-child dyads from southern Brazil. The data presented here refers to 632 dyads with complete fetal anthropometric measurements, serum cortisol data, and last menstrual period information. Among the 632 included dyads, 520 infants were assessed for cognitive development at three months of age. In adjusted analyses, higher gestational cortisol levels remained significantly and positively associated with fetal head circumference (B = 0.12, 95% CI: 0.05; 0.19, p = 0.001), abdominal circumference (B = 0.09, 95% CI: 0.02; 0.16, p = 0.015), femur length (B = 0.02, 95% CI: 0.00; 0.04, p = 0.013), and biparietal diameter (B = 0.03, 95% CI: 0.01; 0.05, p = 0.005). No significant association was observed for estimated fetal weight. Additionally, higher maternal cortisol levels during pregnancy were significantly associated with lower infant cognitive scores at three months (B = -0.05, 95% CI: -0.09; -0.01, p = 0.038). These findings suggest that gestational cortisol may exert distinct influences on fetal growth and early cognitive functioning, highlighting the importance of understanding its underlying biological mechanisms.

Multimodality imaging features and surgical correlation of fetus in fetu: An retrospective study with long-term follow-up.

Smallness for gestational age and reduced head circumference at birth are consistently associated with later neurodevelopmental disorders (NDD), but it is unclear whether similar associations are present at foetal biometry in mid-gestation. To investigate associations between second-trimester foetal biometric measurements and later NDD. We conducted a population-based cohort study using data from routine second-trimester ultrasound scans (gestational weeks 18-21) in Denmark. We included all singleton euploid live births from 2008 to 2015. Foetal biometrics included head circumference, biparietal diameter (BPD), abdominal circumference (AC), femur length, estimated foetal weight (EFW), and the head-abdomen ratio. NDD comprised cerebral palsy (CP), epilepsy, intellectual disability, and autism spectrum disorders (ASD). Children were followed from birth until diagnosis, death, emigration, or 31 December 2022. Associations were examined using multivariable Cox proportional hazards models, and cumulative incidence through age 10 years was estimated accounting for death as a competing risk. Adjusted mean differences in biometric Z-scores were examined using multivariable linear regression. Among 337,028 children, 13,414 (4.0%; 69.7% males) were diagnosed with at least one NDD. Larger BPD was associated with higher hazards of epilepsy, intellectual disability, and ASD. Larger AC and EFW were associated with lower hazard of intellectual disabilities. Individuals with epilepsy, ASD, and intellectual disabilities had slightly larger mean BPD Z-score at their second-trimester scans, compared to children without NDD. Furthermore, smaller HC was associated with lower hazards and cumulative incidence of epilepsy, whereas shorter FL was associated with higher hazards of CP and epilepsy. Mid-gestation head size did not follow the expected risk pattern. These findings propose a rethinking of the relationship between restricted brain growth and neurodevelopmental impairment, suggesting that atypical early brain development may be reflected in accelerated rather than reduced growth, or that restricted growth-related causes of NDD act later in pregnancy.

Despite the high incidence of fetal growth restriction (FGR) in gastroschisis (GS) associated with placental fetal vascular malperfusion (FVM), the underlying mechanism remains unclear. We aimed to investigate whether umbilical vein (UV) stenosis at the abdominal wall defect impairs fetoplacental circulation, leading to FGR. A single-center retrospective review of magnetic resonance imaging (MRI) scans in fetuses with GS was performed. The presence of FGR and complex GS was recorded after birth. Systematic measurements of UV diameter were collected, as well as placental characteristics. Multivariable analysis identified in-utero risk factors for FGR. Area under the receiver-operating-characteristics curves (AUC) for the predictive performance of predictors of FGR was calculated. In addition, 1:1 age-matched omphalocele and healthy control cases were included for comparison with GS cases with and without FGR, examining UV diameter, placental features and T2* signal intensity (SI) differences between the left and right hepatic lobes. Co-occurrence network analysis integrated prenatal MRI findings with postnatal outcomes. A total of 86 GS cases, 27 omphalocele cases and 27 age-matched healthy control cases were included. The incidence of FGR was 66.3% (57/86) in all GS cases, 86.7% (26/30) in complex GS cases and 18.5% (5/27) in omphalocele cases. Multivariable analysis identified the following independent risk factors for FGR: Z-score of UV diameter at the defect (adjusted odds ratio (aOR), 0.76 (95% CI, 0.65-0.89); P = 0.001); placental thickness (aOR, 1.57 (95% CI, 1.13-2.05); P = 0.015); placental lobulation (aOR, 1.84 (95% CI, 1.45-2.32); P = 0.026); and the presence of complex GS (aOR, 2.33 (95% CI, 1.85-2.96); P = 0.003). The Z-score of the UV diameter at the abdominal wall defect had an AUC of 0.81 (95% CI, 0.73-0.84) for the presence of FGR. Compared to the GS without FGR, omphalocele and healthy control groups, the GS with FGR group exhibited significantly reduced UV diameter at the abdominal wall defect, greater placental thickness, increased placental lobulation and larger T2* SI differences between the left and right hepatic lobes, reflecting hypoxia-driven circulatory redistribution. Network analysis demonstrated interdependencies among UV stenosis, FGR, placental FVM and adverse outcomes. There is strong association between UV stenosis at the abdominal wall defect and the development of FGR in cases of GS. UV diameter measurements and placental assessment may constitute important imaging biomarkers for FGR prediction in cases of GS. Ultimately, future research is required to evaluate potential benefits of fetal intervention to reduce severe UV stenosis. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

To evaluate the diagnostic performance of the Delphi consensus definition for selective fetal growth restriction (sFGR), compared with the traditional definition recommended by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), in predicting adverse perinatal outcome in monochorionic diamniotic (MCDA) twin pregnancy. This was a retrospective cohort study of MCDA twin pregnancies followed at a tertiary fetal medicine unit between January 2000 and January 2024. Cases diagnosed with twin-to-twin transfusion syndrome or twin anemia-polycythemia sequence before or at the time of sFGR diagnosis and those with fetal structural or genetic anomaly were excluded. Fetal growth was assessed using chorionicity-specific twin reference charts and sFGR was diagnosed using the ISUOG or Delphi definition. Logistic regression analysis was used to evaluate the performance of each constituent criterion of the Delphi definition in identifying cases at risk of adverse outcome. The diagnostic performance of the ISUOG and Delphi criteria was assessed using receiver-operating-characteristics (ROC)-curve analysis. The final analysis included 363 MCDA twin pregnancies, of which 110 (30.3%) were diagnosed with sFGR using the Delphi consensus definition. The ISUOG criteria identified only 53/363 (14.6%) cases as sFGR. The rate of intact survival of both twins was significantly lower among the 53 cases diagnosed using ISUOG criteria compared with the 57 cases diagnosed solely using Delphi criteria (26.4% vs 63.2%), with significantly lower neonatal morbidity in the latter group. Logistic regression analysis showed that each constituent criterion of the Delphi definition was associated independently with significantly reduced intact survival of both twins. All combinations of Delphi criteria showed low-to-moderate discriminative ability in predicting the demise of the smaller and/or larger twin (all areas under the ROC curve > 0.6). The Delphi criteria had slightly higher sensitivity (0.840 vs 0.789) but lower specificity (0.743 vs 0.877) compared with the ISUOG criteria for predicting the demise of the smaller twin. Similar results were obtained for the prediction of larger twin demise and double fetal demise. While the detection rate of sFGR was higher using the Delphi criteria compared with the ISUOG criteria, the additional cases identified solely using the Delphi definition had significantly lower perinatal morbidity and mortality compared with those meeting the ISUOG definition for sFGR. Nonetheless, each constituent criterion within the Delphi definition was independently associated with adverse outcome in sFGR twin pregnancy. Further research is needed to elucidate the most appropriate tools for diagnosing and classifying MCDA twin pregnancies complicated by sFGR. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.

Associations of brain MRI and perinatal factors with 2-year neurodevelopment in very preterm infants.

Objectives Preeclampsia is a severe form of hypertensive disorder of pregnancy, with adverse outcomes for both mothers and their foetuses worldwide. This disorder affects South Africa disproportionately due to socio-economic challenges. This study aimed to evaluate the impact of maternal preeclampsia on foetal growth and vascular function in the Eastern Cape Province of South Africa. Methods A cross-sectional study design recruiting 30 preeclamptic and 30 normotensive pregnant women aged 18–35 years with singleton pregnancies was used. A lifestyle/health questionnaire was administered to all participants. Foetal biometry, including head circumference, abdominal circumference, biparietal diameter, femur length, estimated foetal weight, and Doppler velocimetry parameters, were assessed using transabdominal and Doppler ultrasound. Results Preeclamptic women demonstrated a higher incidence of tobacco (25% vs 7%, p < 0.001) and alcohol use (65% vs 13%, p < 0.001) and a history of preeclampsia (64% vs 17%, p < 0.001). Foetal measurements showed reduced head circumference (255 ± 74.41 mm vs 293.85 ± 13.18 mm, p = 0.05) and estimated foetal weight (1609 ± 326.91 g vs 1987.53 ± 403.43 g, p = 0.05) in preeclamptic pregnancies, while Doppler indices, such as uterine artery pulsatile index and middle cerebral artery resistive index, were elevated (1.52 ± 0.70 and 0.88 ± 0.12). Multiple linear regression outcomes showed that the middle cerebral artery pulsatile index (MCA PI) positively predicted foetal head circumference (β = 0.568, p = 0.02). Conversely, the MCA resistive index negatively predicted foetal head circumference (β = −0.716, p = 0.004), suggesting that each unit increase in the resistive index results in a 0.716 cm decrease in foetal head circumference. Conclusion The findings of this study showed that foetal growth and development are directly affected by maternal preeclampsia, emphasising the importance of using specialised techniques such as Doppler velocimetry to predict foetal outcomes and potentially designing targeted interventions to improve perinatal care strategies in high-risk populations.

The purpose of this study was to report our cases of umbilical-portal-systemic venous shunt (UPSVS) and to evaluate the utility of fetal magnetic resonance imaging (MRI) to diagnose this rare anomaly. This retrospective study included the fetuses with umbilical-portal venous system anomalies. All the cases were performed at 1.5 T magnetic resonance unit including the steady-state free precession (SSFP) and single-shot fast spin echo (SSFSE) sequences. We analyzed the abnormal anatomical findings by fetal MRI and compared them with the prenatal ultrasound (US). 15 cases with prenatally diagnosed UPSVS based on MRI or US were enrolled. Eight cases were identified by both MRI and US, including umbilical-systemic shunts (n = 3), ductus venosus-systemic shunt (n = 1), intrahepatic portal-systemic shunts (n = 3) and extrahepatic portal-systemic shunt (n = 1). Six cases were only identified by MRI including intrahepatic portal-systemic shunts (n = 5) and ductus venosus-systemic shunt (n = 1). In the remaining single case, prenatal ultrasound findings were suspicious for an intrahepatic portal-systemic shunt, without corresponding fetal MRI abnormalities. Follow-up data were obtained from thirteen patients. Two cases were lost to follow up. Of the thirteen patients undergoing follow-up, two cases of UPSVS were surgically confirmed. Postnatal imaging failed to identify any abnormalities of portal venous system in nine cases. The rest two cases demonstrated normal development and liver function after birth. Umbilical-portal-systemic venous shunt can be diagnosed prenatally via MRI. Fetal MRI can serve as a valuable adjunct to prenatal US and improve the diagnostic accuracy.

To evaluate alterations in fetal cardiac function in pregnancies complicated by fetal growth restriction (FGR) by synthesizing evidence on myocardial performance index (MPI) and its constituent parameters for both the left and right ventricles. The secondary objective was to explore the influence of timing of FGR onset (early vs late) on these parameters. We conducted a systematic review and meta-analysis of observational studies by searching PubMed/MEDLINE, EMBASE, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception until August 2025. Eligible studies compared fetal MPI, isovolumetric contraction time (ICT), ejection time (ET), isovolumetric relaxation time (IRT) and/or peak early-to-late diastolic filling velocity ratio (E/A ratio) between FGR fetuses and healthy controls. Data reported in original publications as median with interquartile range, range or 95% CI were converted to mean ± SD. A random-effects model was used to calculate the pooled standardized mean difference (SMD) with 95% CI. Prespecified subgroup analyses were performed based on ventricular laterality, timing of FGR onset and data presentation type. The protocol was registered with PROSPERO (registration number: CRD420251075193). Fifteen studies, comprising 709 FGR fetuses and 867 controls, were included. Compared with controls, FGR fetuses exhibited significant left ventricular dysfunction, characterized by a higher left MPI (SMD, 0.85 (95% CI, 0.53-1.16)), prolonged left ICT (SMD, 0.53 (95% CI, 0.08-0.99)) and shorter left ET (SMD,-0.56 (95% CI, -0.84 to -0.29)). The most profound alteration was a prolongation of the left IRT in FGR cases (SMD, 2.48 (95% CI, 1.55-3.41)). Right ventricular assessment revealed a prolonged right IRT in FGR fetuses compared with controls (SMD, 1.90 (95% CI, 0.72-3.07)). Subgroup analysis showed that myocardial functional alterations affect both early- and late-onset FGR phenotypes, with early cases showing a non-significant trend toward more pronounced impairment. Sensitivity analysis including only studies that employed stricter diagnostic criteria for FGR confirmed these findings. Significant publication bias was detected for the analysis of left MPI and left IRT. FGR is associated with significant biventricular cardiac dysfunction, characterized primarily by impaired myocardial relaxation, as indicated by a markedly prolonged IRT. The IRT appears to be a more sensitive marker of cardiac compromise in FGR compared with the traditional E/A ratio. These findings support the use of MPI and its components as valuable adjunctive tools in the surveillance of FGR pregnancies. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

To evaluate the combined effect of maternal general anesthesia and vasopressor support on uterine hemodynamics during the second trimester in pregnancies undergoing fetal spina bifida repair and to determine whether fetal spina bifida repair alters uteroplacental perfusion. This was a prospective single-center study conducted at the Fetal Medicine Unit of University Hospitals Leuven, Leuven, Belgium between August 2021 and April 2025. All participants underwent fetal spina bifida repair under general anesthesia with vasopressor support, titrated to maintain a mean arterial pressure ≥ 90% of the preoperative baseline value. Uterine artery (UtA) and umbilical artery Doppler measurements were obtained at six timepoints: (1) the day before surgery to establish preoperative baseline values; (2) immediately after epidural catheter placement, initiation of general anesthesia and intubation (at the initiation of noradrenaline); (3) 5 min after initiation of general anesthesia with vasopressor support; (4) at the end of surgery, after maternal skin closure and before extubation; (5) on postoperative day 1; and (6) on postoperative day 6. The primary outcome was the change in UtA pulsatility index (PI) 5 min after initiation of general anesthesia compared with the preoperative baseline value. Secondary outcomes included UtA blood flow estimated from time-averaged maximum velocity and vessel diameter and fetal umbilical artery Doppler parameters. Statistical analysis included paired t-tests, Wilcoxon signed-rank tests and mixed-effects models. A total of 33 women undergoing fetal spina bifida repair were included, of whom 23 underwent open repair and 10 underwent fetoscopic repair. At the preoperative baseline, median UtA-PI was 0.77 (interquartile range (IQR), 0.64-0.95), median UtA resistance index (RI) was 0.52 (IQR, 0.45-0.59) and median UtA blood flow was 307.5 (IQR, 209.8-542.2) mL/min. At 5 min after the initiation of general anesthesia with vasopressor support, UtA-PI (median, 0.87 (IQR, 0.68-1.04)) and UtA blood flow (median, 310.7 (IQR, 199.0-421.4) mL/min) were comparable to baseline values (both P > 0.05). At this timepoint, umbilical artery PI was higher than the baseline value (P = 0.008) while fetal heart rate decreased. At the end of surgery, UtA-PI (median, 1.46 (IQR, 1.04-2.21)) and UtA-RI (median, 0.76 (IQR, 0.62-0.91)) were elevated compared with baseline values (both P < 0.001) and UtA blood flow was reduced (median, 182.1 (IQR, 79.8-351.5) mL/min; P = 0.031). Elevation of UtA-PI and UtA-RI persisted on postoperative days 1 and 6, but umbilical artery indices generally normalized back to preoperative baseline levels. There were no significant differences in UtA or fetal Doppler parameters between surgical techniques. General anesthesia with vasopressor support preserved uterine perfusion and blood flow without increasing vascular resistance. During fetal spina bifida repair, UtA resistance increased and UtA blood flow decreased. These parameters did not normalize back to preoperative baseline values within 6 days after surgery. In contrast, perioperative fetal Doppler changes resolved immediately postoperatively © 2026 International Society of Ultrasound in Obstetrics and Gynecology.

Glutaric acidemia type 1 (GA-1) is a severe, life-threatening organic acidemia. This study aimed to evaluate fetal ultrasound findings as early clues for GA-1. A GA-1 case identified via newborn screening in Beijing and confirmed by exome sequencing was analyzed. His prenatal ultrasound records were retrospectively reviewed. A scoping review was performed following PRISMA-ScR guidelines to identify fetal GA-1 cases with prenatal imaging data from PubMed, Embase, and Scopus. Findings were summarized using the terminology reported in the original publications. In the present case, both biparietal diameter (BPD) and head circumference (HC) exceeded the 97th percentile by 32+1week of gestation. At 36+1week, BPD remained above the 97th percentile, while HC was near it. Genetic analysis revealed two novel heterozygous GCDH variants: c.492C>G and c.648G>A. The scoping review identified six fetal GA-1 cases. Reported prenatal abnormalities included macrocephaly (5/6), enlarged Sylvian fissures (3/6), temporal lobe hypoplasia (2/6), cerebrospinal fluid (CSF) widening in the temporal fossa (1/6), and subependymal cysts (2/6). Specific prenatal cranial findings, particularly fetal macrocephaly, may serve as early clues for GA-1. The diagnostic indication is strengthened when macrocephaly coexists with features such as Sylvian fissure widening. Recognition of these features could facilitate earlier identification and diagnosis of GA-1.

The risk of delivering a small-for-gestational-age (SGA) neonate is increased after Roux-en-Y gastric bypass (RYGB). Because glucose is the foetus's primary energy source and postprandial hypoglycemia is common after RYGB, the Bariatric surgery And consequences for Mother and Baby In pregnancy (BAMBI) study examined associations between trimester specific maternal hypoglycemia and offspring birthweight as well as other perinatal outcomes. Twenty-three pregnant women with RYGB and 23 BMI- and parity-matched controls were followed prospectively with continuous glucose monitoring (CGM) and foetal ultrasounds in each trimester. At birth, neonatal anthropometric measures, including skinfold measurements, were obtained. Exposure to hypoglycaemia was defined as spending > 4% of the time with interstitial glucose < 3.5 mmol/L. Multivariable regression was used to examine associations between exposure to hypoglycaemia in each trimester and birthweight, adjusting for maternal age, parity, pre-pregnancy body mass index, gestational weight gain and surgery-to-conception interval. Baseline characteristics were similar regardless of exposure to hypoglycemia. Spending > 4% of the time in hypoglycemia during the second or third trimester was associated with a 550 g lower birthweight (95% CI [-1031--69], p = 0.03), while no such association was observed for the first trimester. Infants exposed to second/third trimester hypoglycemia had lower abdominal circumference percentiles (20th vs. 55th, p = 0.01) and lighter placentas (580 g vs. 705 g, p = 0.01). Increased maternal hypoglycemia in the second or third trimester of pregnancy post-RYGB appears to be associated with reduced foetal growth. Optimising glucose levels through CGM may help prevent SGA births in this population. ClinicalTrials.gov identifier: NCT03713060.

Objective: This study aimed to describe gestational age-specific biometric and estimated fetal weight (EFW) patterns derived from a multicenter cohort of fetuses with gastroschisis and to evaluate the agreement between prenatal EFW and birth weight. Methods: This retrospective study included singleton pregnancies with a prenatal diagnosis of gastroschisis and at least two ultrasound evaluations between 20 and 37 weeks. Data were collected from four Brazilian tertiary centers between 2010 and 2024. Biometric parameters (biparietal diameter, head circumference [HC], abdominal circumference, and femur length) and EFW were recorded. EFW was calculated using Hadlock IV and Siemer formulas. Polynomial regression models were applied to generate gestational age-specific curves for HC, femur length (FL), and EFW. Agreement between prenatal EFW and birth weight (in cases assessed within 14 days of delivery) was analyzed using Bland–Altman plots and the concordance correlation coefficient (CCC). Results: A total of 116 pregnancies and 355 ultrasound tests were included. Polynomial models showed a strong association between gestational age and EFW (R2 = 0.837 for Siemer; R2 = 0.728 for Hadlock), HC (R2 = 0.849), and FL (R2 = 0.877). The 50th percentile curves for gastroschisis were consistently lower than those from standard growth charts. In the birthweight concordance analysis (n = 46), the Siemer formula showed low agreement (CCC = 0.55), while the Hadlock formula showed even lower concordance (CCC = 0.44), with both formulas underestimating actual birth weight. Conclusions: Fetuses with gastroschisis have distinct growth patterns not captured by standard references. Tailored growth curves and careful interpretation of EFW are essential to improve prenatal assessment in this population.

This longitudinal, prospective, multicenter observational cohort study investigates the associations between maternal nutritional status-assessed using the first trimester SIMPLE score and pregestational BMI-and fetal growth trajectories and velocity, as proxies for intrauterine development. Healthy women with singleton pregnancies undergoing first trimester screening were enrolled. Adherence to a healthy lifestyle was evaluated using the SIMPLE score, categorizing participants into low (<6) and high (≥6) adherence groups. Fetal growth parameters - including biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW)- were assessed during second and third trimester ultrasounds, and birth outcomes were recorded. Multi-adjusted linear mixed models examined associations between SIMPLE score groups, individual score items, pregestational BMI, and fetal growth, with analyses stratified by fetal sex. Out of 938 enrolled women, 109 (11.6%) were classified as the low adherence group. Multi-adjusted linear mixed models showed that low adherence was associated with decreased EFW acceleration from the second to the third trimester. Stratification by fetal sex confirmed the association only among male fetuses. Analysis of pregestational BMI and individual SIMPLE score items revealed significant positive associations between pregestational BMI, AC, and EFW growth velocity, and a negative association between first trimester hemoglobin [>110 g/l] and EFW growth velocity. Overall, these findings confirm the clinical utility of the SIMPLE score, demonstrating significant associations with intrauterine growth trajectories and velocity, independent of other markers of nutritional status (e.g., pregestational BMI).

Objective: Fetal sonography is a cornerstone of prenatal care, enabling noninvasive monitoring of fetal growth and early detection of congenital anomalies. Despite its clinical value, its effectiveness can be limited by operator dependency, subjective interpretation, and variability in image quality. To address these issues, researchers have suggested using deep learning (DL) models as a maneuver to assist sonographers. Materials and Methods: A search of the current literature was conducted using PubMed, IEEE Xplore, SpringerLink, and Scopus, to create a targeted and current review on the use of DL in obstetric sonography. These platforms are renowned for their high-quality, peer-reviewed publications in both medical imaging and artificial intelligence. The timeframe is selected between 2019 and May 2025, which aligned with the period that DL experienced rapid expansion, into clinical applications. Results: The systematic review found that DL has numerous therapeutic uses in prenatal imaging, including classifying aberrant and normal anatomy and measuring fetal biometry. This review consolidated recent developments in the application of DL such as classification, segmentation, and automation in obstetric processes. Conclusion: Deep learning has a great potential to guide future diagnostic directions for sonographers, clinicians, and researchers involved in fetal sonography.

Cytomegalovirus (CMV) is the leading cause of congenital infectious neurosensory impairment. We aimed to present national epidemiological data on maternal CMV infection during pregnancy in France, focusing in particular on primary infection in the periconceptional period or first trimester, and to assess the impact of changes in screening practices and clinical management of affected pregnant women and their newborns. In this retrospective, multicenter study, we retrieved data from the electronic database of the French National Reference Center for Herpesviruses from cases of maternal CMV infection diagnosed during pregnancy between January 2017 and December 2023, with known neonatal infection status (infected or non-infected) at birth. Maternal, fetal and neonatal data in cases with maternal primary infection during the periconceptional period or first trimester were compared between the periods before and after publication of a pivotal randomized controlled trial (RCT) in September 2020 that demonstrated that valacyclovir reduced vertical transmission by two-thirds when administered to women with first-trimester primary CMV infection. Among 451 documented cases of maternal CMV infection during pregnancy with known fetal/newborn CMV status, there were 220 pregnancies (222 fetuses) with periconceptional or first-trimester primary maternal infection (PI), among which maternal-fetal transmission occurred in 176 (79.3%). Compared with the period from 2017 to 2020, in the period from 2021 to 2023 there was a significant increase in both systematic CMV screening (from 22.0% to 40.0%; P = 0.001) and maternal requests for testing (from 0% to 4.2%; P = 0.02). Among cases of maternal infection during the periconceptional period or in the first trimester, antiviral therapy (generally valacyclovir) was administered more frequently in the period from 2021 to 2023 (27.7% vs 59.8%; P < 0.0001). The overall rate of termination of pregnancy (TOP) for early maternal CMV-PI was 20.7% (40/193 with known pregnancy outcome), with significantly fewer TOPs being performed in the period from 2021 to 2023 (25.9% vs 13.0%; P = 0.03). Notably, women who did not receive valacyclovir treatment had higher rates of TOP overall compared with women who had received valacyclovir (22.1% vs 8.1%; P = 0.01). Congenital CMV infection is a major public health problem. Despite the lack of national guidelines for systematic maternal CMV screening until mid-2025, the uptake of maternal CMV screening and preventive treatment increased significantly in France after publication of the pivotal RCT in 2020, apparently without an associated rise in the rate of TOP. These findings support the safety and potential benefits of offering CMV serological testing during pregnancy, particularly in the context of evidence-based therapeutic options. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Meckel-Gruber syndrome is a rare autosomal recessive ciliopathy characterized by the triad of occipital encephalocele, polycystic kidney dysplasia, and postaxial polydactyly, with an estimated incidence of 1:13,250 to 1:140,000 live births. Pathogenic variants inCC2D2A, encoding a ciliary transition zone protein, account for 5-15% of MGS cases. This report highlights the diagnostic utility of whole-exome sequencing (WES) in delineating molecular etiologies of MGS and reviews genotype-phenotype correlations associated withCC2D2Amutations. A 30-year-old Chinese primigravida (G1P0) from Shandong Province was referred at 23week gestation following prenatal ultrasound detection of fetal anomalies. Key findings included bilateral enlarged hyperechoic kidneys (renal transverse diameter: 35mm, > 95th percentile), occipital meningoencephalocele (29 × 25 × 12mm) and bilateral postaxial hexadactyly. Prenatal counseling confirmed the fetal prognosis, and the parents chose to terminate the pregnancy. Postmortem WES revealed compound heterozygousCC2D2Avariants. This case highlights that prenatal ultrasonography remains critical for early detection of MGS hallmarks, especially in resource-limited Settings. Second, WES-based molecular autopsy is crucial for definitive diagnosis and genetic counseling.

To evaluate the characteristics and outcomes of pregnancies with a prenatally detected fetal or placental tumor with associated fetal anemia that underwent intrauterine transfusion (IUT). We searched PubMed, EMBASE, Web of Science, Scopus and Google Scholar databases for studies reporting on singleton pregnancies with a prenatally detected fetal or placental tumor complicated by fetal anemia that underwent IUT, published from inception to October 2024. Only articles written in the English language were considered eligible for inclusion. We excluded multiple gestations, fetuses with concomitant structural anomaly, cases that underwent IUT to treat fetal anemia secondary to intraoperative tumor bleeding and cases that received blood products other than red blood cells. Cases in which the tumor was detected postnatally, cases that underwent termination of pregnancy, studies with incomplete data and systematic reviews were also excluded. The primary outcome was perinatal death, defined as intrauterine fetal demise (IUFD) > 22 weeks' gestation or neonatal death within 28 days after birth. Secondary outcomes included IUFD, neonatal death, preterm labor (PTL), preterm prelabor rupture of membranes (PPROM), placental abruption, and spontaneous or medically indicated live preterm birth (PTB). We performed exploratory subgroup analyses, including differences in tumor size according to the presence or absence of additional non-structural complications, as well as differences in baseline characteristics according to perinatal death status and differences in obstetric and perinatal outcomes according to whether the patient underwent prenatal tumor resection, embolization or ablation in addition to IUT. We included 43 cases in our analysis, including 42 cases from 34 articles identified in the literature search and an additional case managed at our institution. The median hemoglobin level before the initial IUT was 7.0 (interquartile range, 6.0-8.8) g/dL. Most cases (92.5%) had an additional non-structural complication at baseline. Prenatal tumor resection, embolization or ablation was performed as an adjunct to IUT in 40.0% of cases. PTL, PPROM or placental abruption complicated 43.2% of cases. PTB occurred in 81.1% of cases. Perinatal death occurred in 11 (25.6%) cases. We identified a higher likelihood of perinatal death in cases with fetal hydrops (odds ratio (OR), 6.3 (95% CI, 1.1-37.7); P = 0.04) or cardiomegaly (OR, 6.3 (95% CI, 1.1-36.9); P = 0.04), and a lower likelihood of perinatal death was associated with higher fetal hemoglobin after the initial IUT (OR, 0.4 (95% CI, 0.2-0.8), P = 0.01). Perinatal death rates were similar regardless of management strategy (12.5% for IUT as a standalone therapy vs 31.3% for IUT as an adjunct to tumor resection, embolization or ablation; P = 0.1). Pregnancies with a prenatally detected fetal or placental tumor, complicated by fetal anemia that underwent IUT, have a high rate of additional non-structural complications. The rate of perinatal death in this population is high, likely due to the severity of the fetal condition at baseline and high rates of obstetric complications and PTB. IUT as a standalone therapy may be reasonable in selected cases. However, ideal candidates for this approach and the best management strategies remain to be determined. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.

To evaluate the clinical and economic impact of universal screening for cytomegalovirus (CMV) in pregnant women in Italy, with valacyclovir (VCV) therapy in the case of maternal primary CMV infection, compared with no screening. We developed a decision-analytic model using a deterministic decision tree and compared the no-screening strategy (Scenario 1) with universal screening until 13 + 6 weeks' gestation (Scenario 2), and universal screening until 23 + 6 weeks' gestation (Scenario 3) as recommended by the Italian National Health Service. The model was applied in a hypothetical population of 400 000 pregnant women, representative of the annual number of women giving birth in Italy. Only women susceptible to primary CMV infection were considered, in whom CMV screening by serological testing (IgG/IgM testing ± IgG avidity), followed by VCV treatment (8 g/day) in the case of primary CMV infection, is recommended. Outcomes included the numbers of primary maternal CMV infections diagnosed, fetal congenital CMV (cCMV) infections, terminations of pregnancy (TOPs) and symptomatic and asymptomatic neonatal cCMV infections, and the cost per symptomatic cCMV caseavoided (in Euros (€)) from the perspective of the Italian National Health Service. Universal screening until 13 + 6 weeks' gestation would identify 910 maternal primary CMV infections. Compared with no screening, it would prevent 92% of symptomatic cCMV infections (183 vs 15 cases) and prevent 70% of TOPs (33 vs 10 cases). Extending the universal screening period to 23 + 6 weeks' gestation would result in 280 additional diagnoses of maternal primary CMV infection and a further 2% and 9% reduction in symptomatic cCMV infections and TOPs, respectively. Both screening strategies would increase costs by approximately €7 million compared with Scenario 1, with a cost per symptomatic cCMV case avoided of ~ €45 500 for Scenario 2 and ~ €44 400 for Scenario 3. Universal serological CMV screening in pregnancy until 24 weeks' gestation, with VCV treatment in the case of maternal primary infection, substantially reduces the burden of cCMV-related disabilities and appears economically justifiable in the Italian healthcare context. These findings may inform policy decisions in countries with a similar CMV seroprevalence and National Health Service. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

To compare gestational age (GA) dating models for pregnancies conceived via assisted reproductive technology (ART), assess whether 14 or 15 days more accurately reflects the median follicular-phase duration in ART pregnancies and evaluate whether the gestational timelines of ART pregnancies are comparable with that of spontaneously conceived pregnancies. We employed population data from the Medical Birth Registry of Norway (2015-2021), including 163 544 children conceived spontaneously, 2067conceived via fresh embryo transfer (ET) and 2080 conceived via frozen ET. Among ART pregnancies, we compared two GA dating methods: a population-based ultrasound model (GAUS) and an ART-based formula based on the known oocyte fertilization date. Statistical agreement was evaluated by calculating individual pairwise differences in GA estimates. Bias and precision in the estimated date of delivery (EDD) were assessed by constructing cumulative birth distribution (Kaplan-Meier) curves for fresh and frozen ET pregnancies separately, employing time-to-event analysis to account for nonspontaneous births. The absolute individual GA differences between ultrasound and ART-based dating, considering a 14-day median follicular-phase duration,were ≤ 1 day for 969/2067 (46.9%) fresh ET pregnancies and for 874/2080 (42.0%) frozen ET pregnancies. An approximatesystematic difference of 1 day was observed, which we corrected by employing a 15-day median follicular-phase duration in the ART-based formula (GAART,15). There was a median pairwise difference between GAUS and GAART,15 of -0.4 (95% CI, -0.5 to -0.3) days in fresh ET pregnancies and -0.2 (95% CI, -0.4 to -0.1) days in frozen ET pregnancies. Both models demonstrated equivalent precision in the EDD. Measured using the ultrasound model, frozen ET pregnancies had a median pregnancy duration of 286.1 (95% CI, 285.5-286.7) days, which was 3.2 (95% CI, 2.4-3.9) days longer than that in fresh ET pregnancies, and 2.6(95% CI, 2.0-3.2) days longer than that in spontaneously conceived pregnancies. We found close statistical agreement between ultrasound and ART-based dating models for both GA and EDD. However, 15 (not 14) days of follicular-phase duration should be utilized in the ART-based formula to avoid systematic bias in ART-based GA estimates. Fresh and frozen ET pregnancies had different birth distributions and median pregnancy durations, underscoring that they are not comparable with spontaneously conceived pregnancies and they should be evaluated separately. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.