Search

The COVID-19 pandemic has stressed patients and healthcare givers alike and challenged our practice of antenatal care, including fetal diagnosis and therapy. This document aims to review relevant recent information to allow us to optimize prenatal care delivery. We discuss potential modifications to obstetric management and fetal procedures in SARS-CoV2-negative and SARS-CoV2-positive patients with fetal anomalies or disorders. Most fetal therapies are time sensitive and cannot be delayed. If personnel and resources are available, we should continue to offer procedures of proven benefit, acknowledging any fetal and maternal risks, including those to health care workers. There is, to date, minimal, unconfirmed evidence of spontaneous vertical transmission, though it may theoretically be increased with some procedures. Knowing a mother's preoperative SARS-CoV-2 status would enable us to avoid or defer certain procedures while she is contagious and to protect health care workers appropriately. Some fetal conditions may alternatively be managed neonatally. Counseling regarding fetal interventions which have a possibility of additional intra- or postoperative morbidity must be performed in the context of local resource availability. Procedures of unproven benefit should not be offered. We encourage participation in registries and trials that may help us to understand the impact of COVID-19 on pregnant women, their fetuses, and neonates.

Objective: To assess contemporary outcomes of fetuses who underwent open fetal spina bifida surgery in Canada. Methods: Our clinical program prospectively collected outcomes of all consecutive fetuses who underwent open fetal spina bifida closure at the Ontario Fetal Center in Toronto and who were at least 1 year of age at the time of postnatal follow‐up. We gathered information on the need for hydrocephalus treatment, motor function, bladder function, as well as neurodevelopment (Ages and Stages Questionnaire and Bayley's scales of infant development). Developmental outcomes were categorized as "Typical Development," "Possible Delay," or "Significantly Delayed." Results: Between 2017 and 2022, 41 fetuses underwent open fetal spina bifida closure. Twenty‐four patients (58.5%) responded to the questionnaire at a median age of 46.5 months. Eight children (33.3%) required CSF diversion procedures. Bladder management included clean intermittent catheterization (43.5%), spontaneous voiding (34.8%), or both (21.7%), with 43.5% needing medication for overactive bladder. All patients could sit independently, with 50% walking outside and 50% crawling indoors. Among those walking outdoors (50%), 25% did so without orthotics or aid, 58.3% with orthotics, and 16.7% required additional walking aids. Most children demonstrated typical communication and problem‐solving skills (79.2%), while gross motor development was significantly delayed in 91.7% of cases. Fine motor skills varied, with 56.5% showing typical development and 34.8% possibly experiencing delays. Conclusions: This study showed a mixed developmental profile among patients who underwent open fetal spina bifida repair, consistent with the MOMs trial findings. [ABSTRACT FROM AUTHOR]

Objectives: To investigate short‐term neonatal developmental outcomes in fetuses with an isolated wide or narrow cavum septi pellucidi (CSP) using new reference ranges. Methods: A cross‐sectional study on fetuses at 16 + 0 to 36 + 6 weeks of gestation between December 2020 and January 2022. CSP width reference ranges were constructed from low‐risk pregnancies. Wide and narrow CSPs were defined as measurements above the 95th percentile and below the 5th percentile, respectively. For the primary outcome fetuses with normal neurosonograms were included. Neonatal developmental outcomes were assessed using the Survey of Well‐being of Young Children (SWYC). Results: A total of 352 fetuses were included in this study, of whom 138 were healthy and had uncomplicated neonatal outcomes. These fetuses constituted the control group and were used to construct the CSP width reference ranges. Of 185 fetuses in the neurosonography group, 9.7% had wide and 7.6% had narrow CSPs, of whom 33.3% and 22.2%, respectively, scored below the SWYC threshold for expected developmental milestones, a rate similar to that reported in the general population. Conclusions: The presence of a prenatally isolated wide or narrow CSP does not appear to increase the risk of neonatal neurodevelopmental delay. [ABSTRACT FROM AUTHOR]

Objective: To evaluate maternal and perinatal outcomes following fetal intervention in the context of maternal "mirror" syndrome. Study Design: A multicenter retrospective study of all cases of fetal hydrops complicated by maternal "mirror" syndrome and treated by any form of fetal therapy between 1995 and 2022. Medical records and ultrasound images of all cases were reviewed. "Mirror" syndrome was defined as fetal hydrops and/or placentomegaly associated with the maternal development of pronounced edema, with or without pre‐eclampsia. Fetal hydrops was defined as the presence of abnormal fluid collections in ≥2 body cavities. Results: Twenty‐one pregnancies met the inclusion criteria. Causes of fetal hydrops and/or placentomegaly included fetal lung lesions (n = 9), twin‐twin transfusion syndrome (n = 6), severe fetal anemia (n = 4), and others (n = 2). Mean gestational age at "mirror" presentation was 27.0 ± 3.8 weeks. Maternal "mirror" syndrome was identified following fetal therapeutic intervention in 14 cases (66.6%). "Mirror" symptoms resolved or significantly improved before delivery in 8 (38.1%) cases with a mean interval from fetal intervention to maternal recovery of 13.1 days (range 4–35). Three women needed to be delivered because of worsening "mirror" syndrome. Of the 21 pregnancies treated (27 fetuses), there were 15 (55.5%) livebirths, 7 (25.9%) neonatal deaths and 5 (18.5%) intra‐uterine deaths. Conclusion: Following successful treatment and resolution of fetal hydrops, maternal "mirror" syndrome can improve or sometimes completely resolve before delivery. Furthermore, the recognition that "mirror" syndrome may arise only after fetal intervention necessitates hightened patient maternal surveillance in cases of fetal hydrops. Key points: What's already known about this topic? "Mirror" syndrome, where maternal symptoms reflect fetal hydrops, affects 20%–30% of fetal hydrops cases. Case studies show maternal condition improvement following successful fetal therapy. However, comprehensive research to understand fetal therapy's effect on maternal and fetal outcomes is lacking. What does this study add? This study provides new insights into the efficacy of fetal interventions for "mirror" syndrome and, in particular, underscores the importance of patient counseling, given the significant maternal morbidity involved. [ABSTRACT FROM AUTHOR]

Introduction: A nomogram for predicting the diagnosis of lower urinary tract obstruction (LUTO) based on an antenatal ultrasound index generated from a Bayesian Meta‐regression analysis has been in development and noted with superior diagnostic accuracy compared to the keyhole sign (KHS). We aim to assess the accuracy of the nomogram in expanded diagnostic utilization to predict LUTO. Methodology: The validation of the nomogram for expanded diagnostic utilization was based on data from a prospective institutional antenatal clinic database between January 2020 and June 2022. Diagnostic accuracy indices were determined for confirmed postnatal diagnosis of LUTO or prune belly syndrome (PBS). Receiver operating characteristics (ROC) curves were generated to compare the area under the curve (AUC) of the nomogram versus KHS. Results: Based on 84 male fetuses with antenatal ultrasound of moderate‐severe hydronephrosis (PUV n = 15, PBS n = 4), the KHS had 26.3% (95%CI 9.1–51.2) sensitivity and 100% (95%CI 94.4%–100%) specificity, with 14 false‐negatives. The nomogram showed a 84.2 (95%CI 60.4%–96.6%) sensitivity and 95.4 (95%CI 87.1%–99%) specificity with three false‐positives. The nomogram also had a superior AUC compared to KHS (0.98 vs. 0.63). Conclusion: The nomogram can be used as a valuable tool to trigger further postnatal screening and provide individualized risk assessments to families during prenatal counseling. Key points: What's already known about the topic?When fetuses with LUTO do not exhibit all of the classic prenatal ultrasound features, the diagnosis is often missed, resulting in infants being born outside high‐risk fetal centers. There are serious implications including early presentation in the neonatal period with infections and urosepsis and already compromised kidney function What does this study add?This work reports a tool for the early, and accurate prediction of LUTO using fetal ultrasound features. This nomogram allows for personalized risk stratification based on individual ultrasound features, which will improve the long‐term outcomes of children with LUTO [ABSTRACT FROM AUTHOR]

Objectives: To determine simple prenatal imaging parameters that can easily be acquired to predict the need for postnatal CSF diversion (PCD) surgery in fetuses undergoing open fetal surgery for open spina bifida (OSB). Methods: All fetuses with OSB that underwent open fetal surgery between June 2017 and June 2021 with available follow‐up outcomes were included. Imaging parameters including clivus‐supraocciput angle (CSA) on magnetic resonance imaging, transcerebellar diameter (TCD) and lateral ventricle size (Vp) on ultrasound (US), were collected pre‐ and postoperatively. The requirement for PCD surgery was determined at 1 year of age. The predictive strength of each parameter was determined by Receiver Operating Characteristic curve analysis. Results: Among 36 babies eligible for the analyses, 41.7% required PCD by one year of age. Pre‐operative Vp (AUC 0.71; 95% confidence interval [CI] 0.54–0.88; p = 0.03), TCD (AUC 0.72; 95% CI 0.55–0.89; p = 0.02) and CSA (AUC 0.72; 95% CI 0.51–0.93; p = 0.04) were fair predictors for PCD surgery. After fetal surgery, TCD (AUC 0.93; 95% CI 0.83–1.00; p < 0.0001) and CSA (AUC 0.94; 95% CI 0.83–1.00; p = 0.0005) were outstanding predictors of PCD, whereas post‐operative Vp was a fair predictor (AUC 0.71, 95% CI 0.54–0.88, p = 0.03). Conclusion: Post‐operative CSA and TCD were outstanding predictors for the need for PCD surgery. Key points: What is already known about this topic? Fetuses with preoperative severe ventriculomegaly (≥15 mm) have a 79% risk of requiring postnatal shunt placement.Persistence of hindbrain herniation on magnetic resonance imaging (MRI) 6 weeks after fetal surgery for open spina bifida (OSB) predicts the need for postnatal cerebrospinal fluid (CSF) diversion surgery. What does this study add? Fetal clivus‐supraocciput angle (CSA) measured on MRI and transcerebellar diameter measured on ultrasound after fetal surgery OSB have excellent predictive value for requiring postnatal CSF diversion (PCD) surgery at 1 year of age.Preoperative transcerebellar diameter has a fair predictive value for the requirement of PCD surgery at 1 year of age. [ABSTRACT FROM AUTHOR]