Fetal surgery for congenital diaphragmatic hernia in the post-TOTAL trial era.

Today, prenatal therapy for congenital diaphragmatic hernia (CDH) primarily centers on fetoscopic endoluminal tracheal occlusion (FETO). This procedure involves the temporary occlusion of the fetal trachea to promote lung development. The TOTAL (Tracheal Occlusion to Accelerate Lung Growth) trial demonstrated a significant improvement in survival rates for fetuses with severe CDH following FETO.

Diagnosis and management of large placental chorioangiomas.

Large chorioangiomas, benign vascular tumors of the placenta measuring ≥ 4 cm in greatest diameter, may pose significant risks to an ongoing pregnancy and warrant thorough sonographic evaluation to assess for evidence of fetal cardiac compromise and fetal anemia. Significant perinatal morbidity and mortality has been associated with large chorioangiomas. Key sonographic markers indicative of fetal compromise in the setting of a large chorioangioma include 1) polyhydramnios, 2) elevated middle cerebral artery (MCA) PSV (multiples of the median [MoM] ≥ 1.

Lung Growth and Intrapulmonary Circulation in Fetuses With Anhydramnios Due to Severe Renal Anomalies Treated With Serial Amnioinfusions.

Objective: To evaluate changes in fetal lung size/volume and intrapulmonary circulation after serial amnioinfusions (AMI) in fetuses with early anhydramnios.

Methods: Ten fetuses with anhydramnios due to renal agenesis (n = 4) or renal dysplasia (n = 6) were treated with serial AMIs. Before AMI, the following ultrasound parameters were obtained: fetal lung area, total lung volume (TLV), O/E LHR, thorax circumference (TC), cardiothoracic ratio (CTR), and pulsatility index of the main intrapulmonary artery (IPA).

Prenatal Diagnosis, In Utero Management, and Perinatal Outcomes of Congenital Diaphragmatic Hernia.

Congenital diaphragmatic hernia (CDH) is a complex malformation complicating 0.02% to 0.03% of live births.

The Volume of Fluid Corresponding to Each Centimeter of Amniotic Fluid Index Changes throughout Pregnancy: A Prospective Cohort Observational Study.

Introduction: The normal values of the amniotic fluid index (AFI) throughout pregnancy have been established as 5-24 cm. However, a similar AFI may correspond to a different AF volume at different gestational ages. The aim of this study was to calculate the amount of fluid corresponding to each cm of AFI when a known volume of fluid is infused into the uterine cavity.

Double-blind randomised trial of saline solution for gargling and nasal rinsing in SARS-CoV-2 infection.

Background: Previous studies have shown that hypertonic saline nasal irrigation and gargling reduced the duration of symptoms in upper respiratory infections caused by coronavirus. This study aims to investigate the effects of two saline regimens on symptoms associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

Methods: Between 2020 and 2022, individuals aged 18-65 years who tested positive for SARS-CoV-2 infection via polymerase chain reaction (PCR) were randomly assigned to either low- or high-saline regimens for 14 days.

Quantifying placenta accreta spectrum severity and its associated blood loss: a novel transvaginal ultrasound scoring system.

Background: Hemorrhage associated with placenta accreta spectrum (PAS) is a leading cause of maternal morbidity and mortality. Estimating blood loss in these individuals is a critical component of comprehensive preoperative planning.

Objective: A semiquantitative score based on transvaginal ultrasound was developed and tested to predict PAS, estimate its severity, and blood loss in individuals with clinical and ultrasound evidence suggesting PAS.

Plasma soluble fms-like tyrosine kinase 1 to placental growth factor ratio of 11.5 multiples of median predicts preeclampsia with severe features within 2 weeks of testing.

Background: Angiogenic imbalances, characterized by an excess of antiangiogenic factors (soluble fms-like tyrosine kinase 1) and reduced angiogenic factors (vascular endothelial growth factor and placental growth factor), contribute to the mechanisms of disease in preeclampsia. The ratio of soluble fms-like tyrosine kinase 1 to placental growth factor has been used as a biomarker for preeclampsia, but the cutoff values may vary with gestational age and assay platform.

Objective: This study aimed to compare multiples of the median of the maternal plasma soluble fms-like tyrosine kinase 1 to placental growth factor ratio, soluble fms-like tyrosine kinase 1, placental growth factor, and conventional clinical and laboratory values in their ability to predict preeclampsia with severe features.

Signs or symptoms of suspected preeclampsia - A retrospective national database study of prevalence, costs, and outcomes.

Background: Most patients with signs or symptoms (s/s) of suspected preeclampsia are not diagnosed with preeclampsia. We sought to determine and compare the prevalence of s/s, pregnancy outcomes, and costs between patients with and without diagnosed preeclampsia.

Methods: This retrospective cohort study analyzed a large insurance research database.

Abnormal Shape and Size of the Cardiac Ventricles Are Associated with a Higher Risk of Neonatal Death in Fetuses with Isolated Left Congenital Diaphragmatic Hernia.

Introduction: The objective of this study was to evaluate the association between fetal cardiac deformation analysis (CDA) and cardiac function with severe adverse perinatal outcomes in fetuses with isolated left congenital diaphragmatic hernia (CDH).

Methods: CDA in each ventricle (contractility, size, and shape), evaluated by speckle tracking and novel FetalHQ software, and markers of cardiac function (E/A ratios, pulmonary and aortic peak systolic velocities, and sigmoid annular valve diameters), were evaluated in fetuses with isolated left CDH. Two evaluations were performed: at referral (CDA and function) and within 3 weeks of delivery (CDA).

The NICHD Fetal 3D Study: A Pregnancy Cohort Study of Fetal Body Composition and Volumes.

There's a paucity of robust normal fractional limb and organ volume standards from a large and diverse ethnic population. The Fetal 3D Study was designed to develop research and clinical applications for fetal soft tissue and organ volume assessment. The NICHD Fetal Growth Studies (2009-2013) collected 2D and 3D fetal volumes.

Basal Plate Myofibers and the Risk of Placenta Accreta Spectrum in the Subsequent Pregnancy: A Large Single-Center Cohort.

Objective: We aimed to evaluate whether there is a significant association between a placental pathology diagnosis basal plate myofibers (BPMF) in an index pregnancy with placenta accreta spectrum (PAS) in the subsequent pregnancy.

Study Design: We conducted a retrospective nested cohort study of all cases with a histopathological finding of BPMF between August 2012 and March 2020 at a single tertiary referral center. Data were collected for all subjects (cases and controls) with at least two consecutive pregnancies (the initial index pregnancy and at least one subsequent pregnancy) accompanied by a concomitant record of histopathological study of the placenta at our center.

Fetal bladder morphology as a predictor of outcome in fetal lower urinary tract obstruction.

Objective: We evaluate survival of fetuses with severe Lower Urinary Tract Obstruction (LUTO) based on bladder morphology. We hypothesize that fetuses with a "floppy" appearing bladder on initial prenatal ultrasound will have worse infant outcomes than fetuses with full/rounded bladders.

Method: We retrospectively reviewed all cases of LUTO evaluated in our fetal center between January 2013 and December 2021.

Simulation training for urgent postnatal fetal tracheal balloon removal: Two learning methods.

Objective: In fetuses with severe congenital diaphragmatic hernia, fetal endoluminal tracheal occlusion (FETO) with balloon increases survival and reduces morbidity. Balloon removal is often scheduled electively. In urgent cases, in-utero removal is impossible and removal immediately after delivery has to occur, posing risk of death from airway obstruction.

Fetoscopic laser surgery for twin-to-twin transfusion syndrome in DCTA triplets compared to MCDA twins: collaborative study and literature review.

Objective: To compare the outcomes of dichorionic triamniotic (DCTA) triplets with that of monochorionic diamniotic (MCDA) twin gestations undergoing fetoscopic laser surgery (FLS) for treatment of twin-to-twin transfusion syndrome (TTTS).

Methods: Retrospective cohort study of prospectively collected data of consecutive DCTA triplet and MCDA twin pregnancies with TTTS that underwent FLS at two fetal treatment centers between 2012 and 2020. Preoperative, operative and, postoperative variables were collected.