Issues

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  What are the novel findings of this work?

  • Fetuses infected with cytomegalovirus during the first trimester of pregnancy have significant risks of sequelae, which may persist into the second trimester, particularly for sensorineural disorders. Differentiating prenatal mild from severe imaging features is of major importance for prenatal counseling.

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  What are the clinical implications of this work?

  • Severe prenatal imaging features clearly correlate with major clastic cerebral lesions. Isolated mild imaging features are associated with a high risk of mild sequelae, mainly hearing loss or vestibular deficit, in at least half of patients. Identification of such mild imaging features by expert neurosonographer is crucial since such findings should subsequently prompt targeted postnatal follow-up for early diagnosis of sensorineural disorders. Fetuses with normal prenatal imaging have a low risk of sensorineural deficit.

• Prenatal ultrasound findings of cloacal abnormalities include cystic pelvic mass, urinary tract abnormalities, oligohydramnios, fetal ascites, and bowel distension.

• In patients with persistent urinary ascites, they are likely to have a long or narrow common channel and compromised lower urinary function.

• An increasing number of fetuses with absent septi pellucidi (ASP) can be potentially identified prenatally as a result of routine second-trimester ultrasound examination of the fetal brain.

• Isolated ASP usually carries a good prognosis. However, some fetuses with isolated ASP actually have septo-optic dysplasia (SOD), which is associated with optic nerve hypoplasia, hypothalamic-pituitary dysfunction, and developmental delay.

• Differentiating isolated ASP from SOD is therefore imperative for adequate prenatal counseling, which is not always possible with high-resolution prenatal ultrasound.

• Prenatal screening is routine assessment for fetal aneuploidies and helps with pregnancy fate determination at earliest.

• The screening efficacy is highly sensitive and specific, still provides false-negative results.

• What does this study add to current knowledge?

  • When observed in isolation, lateral ventricular asymmetry has been regarded as a normal variant. Currently, prenatal evaluations have been conducted using ultrasonography. This study aimed to describe the condition using magnetic resonance imaging (MRI) findings, as well as document the progression of the asymmetry and perinatal outcomes of fetuses diagnosed with ventricular asymmetry. From this study, MRI showed isolated ventricular asymmetry associated with low-grade intraventricular hemorrhage in >75% of the study patients.

• What are the main clinical implications?

  • The finding in this study indicates a need for carefully examining for evidence of intracranial hemorrhage and follow-up scans in fetuses with isolated ventricular asymmetry. Fetal MRI should be considered a superior modality compared to ultrasonography for identifying low-grade intraventricular hemorrhage.

What does this study add to current knowledge?

• Twin-to-twin transfusion syndrome (TTTS) is associated with increased perinatal mortality and morbidity rates, especially in donors. Whether TTTS donors are also more at risk for developing retinopathy of prematurity (ROP) is not well known.

• Within-pair analysis showed TTTS donors to have a two-fold increased risk for any stage ROP and severe ROP compared to recipients.

• Donor status, lower gestational age at birth, and increased duration of mechanical ventilation are independent risk factors for any stage ROP in monochorionic twins with TTTS.

What are the main clinical implications?

• Our study emphasizes the need for risk profile enhancement and increased awareness for ROP in TTTS donors, especially those with a lower gestational age at birth and longer duration of mechanical ventilation, and the necessity for acknowledgement in counseling.

• What does this study add to current knowledge?

  • This study compares neurodevelopmental outcomes between two groups of fetuses undergoing an IUT. The study shows that there is a higher rate of abnormal fetal neuroimaging findings in the parvo B19 population, but the long-term significance of those findings is not clear.

• What are the main clinical implications?

  • Patients diagnosed with intrauterine parvo B19 infection should be followed up closely with neuroimaging studies, as there are higher rates of abnormal fetal neuroimaging findings in those fetuses.