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Journal Name Change

Vol. 1-4 (1986-1989) were published under the journal's former title Fetal Therapy.

Fetal Diagnosis and Therapy 2023, Vol. 50, No. 4

Prenatal Diagnosis

Fetal Diagn Ther (2023) 50 (4): 225–235. https://doi.org/10.1159/000529945
Mini-Summary

  • What does this study add to current knowledge?

    • • In contrast to the proposal of tissue Doppler imaging (TDI)-Myocardial Performance Index (MPI) to be robust for the detection of subclinical fetal cardiac dysfunction with improved reproducibility over conventional Doppler, we found that MPI measured from TDI and pulsed wave Doppler (PWD) have a weak correlation and cannot be used interchangeably, even with the exclusion of suboptimal TDI-MPI scans from the analysis. TDI produced significantly lower right MPI values yet significantly higher left MPI values, potentially reflecting their evaluation of physiologically different events, myocardial contraction versus blood flow.

  • What are the main clinical implications?

    • • Given the lack of correlation between TDI- and PWD-MPI, the high variation in TDI waveform, and the lack of unified approach to TDI analysis, we feel further research is needed before this technique can be adopted for the clinical measurement of MPI.

Fetal Diagn Ther (2023) 50 (4): 236–247. https://doi.org/10.1159/000530862
Mini-Summary

  • What does this study add to current knowledge?

    • Approximately 47% of patients diagnosed with an episode of preterm labor deliver at term. However, infants born to these women are more likely to be small for gestational age and are at greater risk for neurodevelopmental disorders. Herein, we report that women with an episode of premature labor, regardless of whether they delivered preterm or at term, had higher plasma concentrations of pregnancy-associated plasma protease (PAPP)-A2 and insulin-like growth factor-binding protein 1 (IGFBP-1).

  • What are the main clinical implications?

    • The insulin-like growth factor system is involved in the pathologic nature of an episode of premature labor, even when pregnancy reaches its full term.

Fetal Diagn Ther (2023) 50 (4): 248–258. https://doi.org/10.1159/000531583
Mini-Summary

  • What does this study add to current knowledge?

    • An additional first-trimester scan could have a significant impact on prenatal detection rate and outcome of pregnancies complicated by isolated severe congenital heart defect (CHD).

    • The higher detection rate after two consecutive scans leads to an increased number of pregnancy terminations but does not affect the gestational age at termination.

  • What are the clinical implications of this work?

    • Early detection of isolated severe CHDs provides additional time for counseling, advanced genetic testing, and contemplation. More time between detection and decision allows expectant parents to make well-informed decisions and thus empowers reproductive autonomy.

Fetal Diagn Ther (2023) 50 (4): 259–268. https://doi.org/10.1159/000531594
Mini‐Summary

  • What does this study add to current knowledge?

    • The three-dimensional ultrasound lung volume (LV) in fetuses with abdominal wall defects (AWDs) is smaller than in normal fetuses. In addition, fetuses with omphalocele have smaller LV than gastroschisis fetuses.

  • What are the main clinical implications?

    • In AWD fetuses, a smaller LV is associated with neonatal morbidity.

Fetal Diagn Ther (2023) 50 (4): 269–275. https://doi.org/10.1159/000531677
Established Facts

  • Sprengel’s deformity can be diagnosed prenatally using both an ultrasound and magnetic resonance imaging.

  • It can be accompanied by deformities of vertebral bodies, including Klippel-Feil syndrome, deformities in or the absence of ribs, genitourinary anomalies, and spinal dysraphism (myelomeningocele, posterior meningocele, tethered cord), but to date these anomalies have been described postnatally.

Original Paper: Prenatal Diagnosis

Fetal Diagn Ther (2023) 50 (4): 276–281. https://doi.org/10.1159/000531694
Mini-Summary

  • What does this study add to current knowledge?

    • Our study adds more information and data needed to terminate routine cord blood RhD typing of the newborns to give postnatal anti-D immunoglobulin (Ig) to RhD-negative women, based on the result of fetal RHD genotyping, when genotyping predicts an RhD-positive fetus. This approach will streamline the maternity care.

  • What are the main clinical implications?

    • NIPT using cell-free fetal DNA in maternal plasma to determine fetal RhD blood type aims identifying RhD-negative pregnant women with alloimmunization risk as they carry RhD-positive fetuses. We have shown high sensitivity of the fetal RHD genotyping assay that is essential not to risk false-negative results that will expose women to higher alloimmunization risk following discontinuation of cord blood RhD typing of the newborns. These women will then neither receive antenatal nor postnatal prophylaxis with anti-D Ig.

Fetal Therapy

Fetal Diagn Ther (2023) 50 (4): 282–288. https://doi.org/10.1159/000531180
Mini-Summary

  • What does this study add to current knowledge?

    • Mental health is an important perinatal variable but has not been a focus of attention for medical providers until recently. Symptoms of depression and anxiety, as discovered by validated screening tools, are common in women who transfer care due to fetal anomaly. Women frequently had antepartum anxiety or depression symptoms but then improved postpartum; conversely, other women had negative antepartum screening but symptoms appeared postpartum. Risk factors for positive screens are identified. Clinical outcomes did not differ by screening results.

  • What are the main clinical implications?

    • Clinicians caring for women who transfer their care to a tertiary care facility should be alert before and after delivery for mental health symptoms because patients may develop different reasons for these symptoms. Antepartum symptoms may stem from uncertainty or trauma from the adverse diagnosis, while postpartum symptoms can stem from neonatal events such as loss or critical care. Universal screening for perinatal depression is recommended. Tertiary care centers should create referral patterns for care of maternal mental health.

Fetal Diagn Ther (2023) 50 (4): 289–298. https://doi.org/10.1159/000531450
Mini-Summary

  • What does this study add to current knowledge?

    • The rate of intertwin membrane perforation after laser surgery for twin-twin transfusion syndrome is 16%. Iatrogenic monoamniotic twins were born at a lower gestational age, leading to more severe cerebral injury. In only 20% of iatrogenic monoamniotic twins, cord entanglement was observed and it was not associated with adverse outcome.

  • What are the main clinical implications?

    • The rate of cerebral injury related to the lower gestational age at birth in iatrogenic monoamniotic twins demands a critical review of the management of these pregnancies. An early elective caesarean section as performed in spontaneous monoamniotic twins to prevent cord entanglement should be weighed against the risks of premature birth.

Clinical Fetal Medicine

Fetal Diagn Ther (2023) 50 (4): 299–308. https://doi.org/10.1159/000531451
Mini‐Summary

  • What does this study add to current knowledge?

    • When ART pregnancies were compared with spontaneous conception according to oocyte origin, those conceived with donated oocytes showed a significantly lower estimated fetal weight (EFW) z-velocity from the second trimester to delivery and a higher frequency of EFW z-velocity in the lowest decile.

  • What are the main clinical implications?

    • An abnormal growth velocity from the second trimester to delivery supports the development of placental dysfunction on ART gestations, especially in those conceived with donated oocytes. The former represents a sub-group at the highest risk of placental dysfunction that may warrant closer follow-up.

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