Fetal Diagnosis and Therapy最新文献

{"title":"Folic Acid Supplementation in Spina Bifida Prophylaxis: Results from the Zurich Fetal Surgery Cohort.","authors":"Martina Hofmann, Julia Wawrla-Zepf, Ladina Rüegg, Nele Strübing, Martin Meuli, Ueli Moehrlen, Nicole Ochsenbein-Kölble, Ladina Vonzun","doi":"10.1159/000547609","DOIUrl":"10.1159/000547609","url":null,"abstract":"<p><strong>Introduction: </strong>Since preconceptional folic acid (FA) supplementation is known to reduce the risk of fetal spina bifida (fSB), the aim of this study was to systematically analyze the FA supplementation in a cohort of women with fSB repair in affected and subsequent pregnancies.</p><p><strong>Methods: </strong>A total of 198 women, that underwent open fSB repair between 2010 and 2023, were compared in two groups (group 1 = correct FA and group 2 = incorrect FA preconceptionally) regarding maternal and fetal characteristics. Additionally, compliance to high dose FA supplementation in subsequent pregnancies was analyzed.</p><p><strong>Results: </strong>Sixty-five women (32.8%) had correct preconceptional FA supplementation (group 1), and 63 women (31.8%) had incorrect FA supplementation (group 2). The two groups did not significantly differ regarding maternal and fetal characteristics. Thirty-nine women had 48 subsequent pregnancies. FA was initiated prior to conception in 35 (72.9%) of these pregnancies, in 9 (18.7%) cases, FA supplementation was incorrect.</p><p><strong>Conclusion: </strong>This study focuses on better awareness of FA supplementation as correct FA supplementation was low in women with fSB and suboptimal in high-risk situations after fSB pregnancies. However, these results also show that 1/2 of fSB occurs despite correct FA intake; thus, further research is needed to better understand the complex, multifactorial causes of this debilitating condition.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"1-7"},"PeriodicalIF":1.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal Dilated Jugular Lymphatic Sacs on First-Trimester Ultrasound and Their Implications in Antenatal Screening.","authors":"Ruxanda Rusu, Daniel L Rolnik, Valentina De Robertis, Maurizio Guido, Tamara Stampalija, Paolo Volpe, Ilaria Fantasia","doi":"10.1159/000547030","DOIUrl":"10.1159/000547030","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to investigate clinical significance, rate of genetic anomalies, and fetal malformations in fetuses with dilated jugular lymphatic sacs (JLS) in the first trimester, overall and according to nuchal translucency (NT) thickness.</p><p><strong>Methods: </strong>This is a retrospective multicenter cohort study of fetuses with dilated JLS at the first-trimester scan. NT thickness, genetic evaluation, and fetal malformation data were collected. Logistic regression analysis was performed to evaluate impact of NT measurement on adverse outcomes.</p><p><strong>Results: </strong>Eighty-four fetuses were included. Dilated JLS was associated with an increased NT in 75 (89.3%) fetuses; fetal structural malformations in 38 (45.2%); and genetic anomalies in 49 (64.5%). NT measurement remains the strongest predictor of genetic or structural abnormalities (OR 1.567, 95% confidence interval: 1.226-2.124; p = 0.001). Significantly fewer live births observed in the group with NT >99th percentile (p < 0.001). Among cases with isolated JLS, a normal postnatal outcome was reported in 6 (66.7%).</p><p><strong>Conclusion: </strong>The first-trimester dilated JLS are highly associated with genetic disorders and/or fetal malformations, but an increased NT remains the most important predictive factor. In cases with normal NT, dilated JLS is mostly a transient finding but approximately one-third of cases are at increased risk of adverse outcomes.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"1-9"},"PeriodicalIF":1.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Dual Twin Survival after Laser for Twin-to-Twin Transfusion Syndrome.","authors":"Wael Abdallah, Marie-Aude Picard-Turcot, Isabelle Lafontaine-Trudel, Elisabeth Codsi, Sandrine Wavrant, Laurence Carmant, Marie-Josée Raboisson, Asma Khalil, François Audibert","doi":"10.1159/000547995","DOIUrl":"10.1159/000547995","url":null,"abstract":"<p><strong>Introduction: </strong>Twin-to-twin transfusion syndrome (TTTS) is associated with high perinatal morbidity and mortality. Krispin et al. [Ultrasound Obstet Gynecol. 2023;61(4):511-7] developed a prediction model to estimate the likelihood of dual twin survival after fetoscopic laser photocoagulation (FLPC). This study aimed to evaluate the predictive value of sonographic parameters at diagnosis of TTTS treated with FLPC for postnatal dual twin survival and to validate Krispin et al.'s calculator.</p><p><strong>Methods: </strong>This is a retrospective cohort study of cases of TTTS treated by FLPC. The primary outcome was dual survival 30 days after delivery. The calculator used preoperative variables: donor's estimated fetal weight (EFW) <10th centile, intertwin growth discordance >25%, anterior placenta, pulsatility index (PI) in the umbilical artery (UA), ductus venosus (DV), and middle cerebral artery (MCA), with scores ranging 0-300.</p><p><strong>Results: </strong>Among 157 patients, 84 (53.5%) had dual twin survival (Group A), compared to 73 (46.5%) with one or no survivors (Group B). No significant differences were seen in donor's EFW <10th centile (57.1% [A] vs. 57.5% [B], p = 0.96), intertwin growth discordance (26.2% [A] vs. 38.4% [B] p = 0.95), rates of PI >95th centile in the donor's UA and DV, and PI <5th centile in the MCA (p > 0.05). However, a significant difference was found for anterior placenta (38.1% [A] vs. 58.9% [B], p = 0.009). The observed dual survival was higher than predicted for scores ≥100.</p><p><strong>Conclusion: </strong>We were not able to externally validate the calculator of dual survival after laser for TTTS, especially for elevated scores. Among the parameters analyzed, only anterior placenta was significantly associated with poorer outcomes.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"1-9"},"PeriodicalIF":1.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"sFlt-1/PlGF Ratio Predicts Serious Outcomes in Early-Onset Fetal Growth Restriction.","authors":"Satoshi Shinohara, Rei Sunami, Genki Yasuda, Mayuko Kasai","doi":"10.1159/000547695","DOIUrl":"10.1159/000547695","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to identify a cutoff value for the soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio to predict adverse outcomes in early-onset fetal growth restriction (FGR).</p><p><strong>Methods: </strong>In this single-center, non-blinded, retrospective cohort study, maternal serum sFlt-1/PlGF ratios were measured at the time of early-onset FGR diagnosis (<34 weeks) using Roche Elecsys® assays. The optimal cutoff for predicting severe adverse outcomes within 2 weeks was determined using receiver operating characteristic analysis. The Kaplan-Meier analysis assessed delivery probability, and Cox proportional hazards models evaluated factors associated with pregnancy continuation.</p><p><strong>Results: </strong>Among 332 patients, 61 (18.4%) delivered within 2 weeks due to worsening FGR. An sFlt-1/PlGF ratio ≥99.0 predicted adverse outcomes leading to an inability to continue the pregnancy, with 85.3% sensitivity and 91.5% specificity (area under the curve: 0.92). Women with ratios ≥99.0 had a significantly shorter time to delivery (p < 0.001). The ratio remained a significant predictor of adverse outcomes in both asymptomatic and preeclampsia-complicated FGR.</p><p><strong>Conclusion: </strong>The sFlt-1/PlGF ratio is a strong predictor of short-term adverse outcomes in early-onset FGR, aiding in risk stratification and clinical decision-making.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"1-11"},"PeriodicalIF":1.6,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144872183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful perinatal management of a large fetal intrapericardial teratoma by serial fetal echocardiogram and ex-utero intrapartum treatment.","authors":"Jaime Alkon, Eva Hoffmann, Sandeep Sainathan, Leonardo Mulinari, Rodrigo Ruano","doi":"10.1159/000547933","DOIUrl":"https://doi.org/10.1159/000547933","url":null,"abstract":"<p><strong>Introduction: </strong>Pericardial teratomas are rare tumors located in the pericardial space compressing the heart from the outside and usually associated with pericardial effusions. When these tumors are diagnosed in utero, there are some management challenges, including the best approach of prenatal follow-up, the ideal timing of delivery and the perinatal therapeutic strategies. The tumors although benign, tend to grow considerably prenatally, imposing increased risk of worsening pericardial effusion, compression of the heart and potentially compromising cardiac output, leading to intrauterine death.</p><p><strong>Case presentation: </strong>We are presenting an extremely large pericardial teratoma diagnosed at 20 weeks' gestation that was followed serially and closely by fetal echocardiogram and ultrasound throughout the gestation. The baby was successfully delivered by EXIT-to-resection procedure because of sudden progression to fetal hydrops associated with maternal mirror syndrome. On placental-fetal circulation, the pericardial teratoma was completely resected allowing for successful maternal-fetal outcome.</p><p><strong>Conclusion: </strong>Serial fetal echocardiogram is a key prenatal tool to evaluate fetal cardiac function in intrapericardial teratomas. EXIT procedure with intrapartum resection of large pericardial teratoma is a safe perinatal strategic option to improve the outcomes of those babies.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"1-15"},"PeriodicalIF":1.6,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144872184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for Term Preeclampsia at 35 to 37 Weeks of Gestation: A Single-Center Experience.","authors":"Selina Manuela Diethelm, Thabea Musik, Cécile Monod, Lysann Hildebrandt, Olav Lapaire, Gwendolin Manegold-Brauer, Sofia Amylidi-Mohr, Beatrice Mosimann","doi":"10.1159/000547694","DOIUrl":"10.1159/000547694","url":null,"abstract":"<p><strong>Introduction: </strong>Prevention of preeclampsia has short- and long-term benefits for maternal health. Recent data suggest that combined screening at 35-37 weeks of gestation with anamnestic risk factors, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), and angiogenic profile (sFlt-1/PlGF) detects up to 80% of all tPE. The aim of this retrospective analysis was to test the performance of third-trimester screening for tPE in a single center in Switzerland.</p><p><strong>Methods: </strong>Singleton pregnancies with complete background risk assessments, MAP, and, if available, UtA-PI and sFlt-1/PlGF from 2018 to 2023 were included and risks were calculated on the FMF London website.</p><p><strong>Results: </strong>1,121 pregnancies, including 22 (2.0%) with tPE, were analyzed. Median MAP-MoM [IQR] in tPE was 1.08 [1.00-1.14], compared to 0.98 [0.92-1.04] in controls (p < 0.0001). Median UtA-PI-MoM [IQR] in tPE was 1.04 [0.85-1.27] versus 0.99 [0.82-1.15] (p = 0.56). No sFlt-1/PlGF recordings in tPE were available for analysis. The detection rate in combined screening was 15/22 (68.2%) compared to screening by anamnestic risk factors only of 9/22 (40.9%).</p><p><strong>Conclusion: </strong>This analysis shows that combined screening at 35-37 weeks of gestation including anamnestic risk factors and MAP performs better than screening by anamnestic risk factors alone. These results should further be verified in a prospective trial including all markers.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"1-10"},"PeriodicalIF":1.6,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Third-Trimester Screening for Preeclampsia in Twins: Comparative Performance of Fetal Medicine Foundation Algorithm, Roche, and Quidel Triages.","authors":"Adeline Walter, Annegret Geipel, Corinna Simonini, Brigitte Strizek, Adi Sharabi-Nov, Nadav Kugler, Ran Svirsky, Jacob Segal, Marina Mor-Shalom, Lea Valinsky, Shaden Naser, Ramzia Abu Hamed, Hamutal Meiri, Howard Cuckle, Ron Maymon","doi":"10.1159/000546981","DOIUrl":"10.1159/000546981","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to compare three preeclampsia screening methods in the third trimester: (a) Fetal Medicine Foundation (FMF) multi-marker algorithm (maternal factors, biophysical markers, serum placental growth factor [PlGF], and soluble fms-like tyrosine kinase-1 [sFLT-1]); (b) Roche triage (sFLT-1/PlGF), on fresh and stored samples; and (c) Quidel triage (PlGF) on stored samples.</p><p><strong>Methods: </strong>Women with two live fetuses were enrolled at a twin clinic at 11-13 weeks' gestation. They visited the clinic every 2-4 weeks until delivery for examination. Blood testing was conducted at enrollment in the first trimester at 11-13 weeks' gestation, and at 20-22 and 32-34 weeks' gestations. Here we evaluated the screening characteristics in the third trimester and the detection rate (DR), false-positive rate (FPR), and positive and negative predictive values (PPV and NPV) and compared the screening efficacy based on recommended cutoffs and area under the receiver operation characteristic curve (AUROC).</p><p><strong>Results: </strong>Third-trimester analysis included 146 women with twin pregnancies, of which 24 (16.4%) had preeclampsia. Preeclampsia prediction was conducted by three methods. (1) A prospective prediction was conducted on fresh samples using the FMF algorithm risk assessment in the third trimester for twin pregnancies, which had a DR of 79.2% and a FPR of 5.3%, with PPV and NPV of 76.0% and 95.5%, respectively. (2) Roche triage was tested on fresh samples prospectively using soluble fms-like tyrosine kinase-1 (sFLT-1) versus placental growth factor (PlGF), with a cutoff ratio >38, had a DR of 62.5% and a FPR of 22.1%, with PPV and NPV of 37.5% and 90.7%, respectively. In addition, we repeated the testing with Roche's Triage using stored samples and the same sFLT-1/PlGF ratio>38. (3) Quidel triage was performed retrospectively using stored samples, acting according to the definition of high risk according to PlGF <12 pg/mL and medium risk according to PlGF 12-100 pg/mL, and subsequently combined the high and medium risk groups into one. The AUROC for the FMF algorithm was 0.91 (95% CI: 0.82-0.99), which was statistically significantly higher (p < 0.0001) compared to the Roche triage of fresh samples at 0.74 (0.61-0.84) and stored samples at 0.76 (0.65-0.86). The AUROC for Quidel triage was 0.75 (0.64-0.86).</p><p><strong>Conclusions: </strong>In twin pregnancy, the third-trimester FMF multi-marker algorithm is more effective for preeclampsia screening than Roche or Quidel triages. It is up to medical centers or professional societies to decide which preeclampsia screening method to adopt, according to local resources. This study describes the strength and limitations of each screening method.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"1-13"},"PeriodicalIF":1.6,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Ventriculoamniotic Shunting for Fetal Hydrocephalus in the Ovine Model.","authors":"Stephen P Emery, Yongjae Chun, Stephanie Greene, Nika M Hazen, Lora H Rigatti","doi":"10.1159/000547610","DOIUrl":"10.1159/000547610","url":null,"abstract":"<p><strong>Introduction: </strong>Recent technological advances in fetal medicine have led some investigators to reconsider ventriculoamniotic shunting for fetal hydrocephalus, an intervention that was attempted in the 1980s but was abandoned due to perceived lack of effect. The objective of this manuscript describes outcomes after induction of hydrocephalus followed by ventriculoamniotic shunt placement and postmortem analysis in the ovine model.</p><p><strong>Methods: </strong>Mixed-breed fetal sheep underwent induction of hydrocephalus by injection of BioGlue® into the cisterna magna at ∼85 days gestation followed by ventriculoamniotic shunt placement at ∼100 days gestation. Brains were inspected by transcranial ultrasound at the time of shunt placement and after delivery using the ventricle to hemisphere ratio (VHR). The VHR at the time of shunting was compared to the VHR at end of study. Pathologic analysis was performed on gestational age-matched normal brains, shunted brains, and unshunted hydrocephalic controls.</p><p><strong>Results: </strong>Twenty-five fetal sheep underwent induction of hydrocephalus. Two fetuses were lost immediately. Of the 23 remaining fetuses, 20 (87%) developed hydrocephalus. Five fetuses served as hydrocephalic controls. Eighteen fetuses who developed hydrocephalus were assessed for a VHR by transcranial ultrasound at the time of shunt placement. The mean VHR was 0.71. Of the 20 fetuses that developed hydrocephalus, 12 underwent shunt placement. Eight shunted fetuses were available for VHR and pathologic analysis at end of study. The mean VHR at the time of shunt placement was compared to the VHR at end of study (n = 8, 0.70 ± 0.10 vs. 0.50 ± 0.16, p = 0.016). Histologically, shunted brains had better neuropreservation than unshunted hydrocephalic controls.</p><p><strong>Conclusion: </strong>Hydrocephalus was induced in 87% of fetal sheep using this model. In an ovine model, ventriculoamniotic shunting both decreased the degree of hydrocephalus sonographically and improved brain histology compared to hydrocephalic controls. These findings demonstrate proof of concept in the animal model and support ongoing research in cerebrospinal fluid diversion for fetal obstructive hydrocephalus.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"1-10"},"PeriodicalIF":1.6,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intertwin Membrane Placental Cord Insertions in a Dichorionic Diamniotic Twin Pregnancy: Case Report.","authors":"May Abiad, Ryne Didier, Yinka Oyelese, Alireza A Shamshirsaz, Eyal Krispin","doi":"10.1159/000547561","DOIUrl":"10.1159/000547561","url":null,"abstract":"<p><strong>Introduction: </strong>Intertwin membrane cord insertion (IMCI) is a rare variation of velamentous cord insertion (VCI) that can be seen in dichorionic twin pregnancies. This condition exposes fetal vessels to risks such as compression and rupture, which can lead to complications including fetal growth restriction (FGR) and preterm delivery.</p><p><strong>Case presentation: </strong>A 30-year-old woman, gravida 1 para 0, was referred at 19+5 weeks for evaluation of a dichorionic diamniotic twin pregnancy due to an abdominal cyst in twin A, transposition of the great arteries in twin B, and suspected abnormal cord insertions. Ultrasound evaluation confirmed IMCI, with both umbilical cords inserting into the intertwin membrane before reaching the placenta. MRI corroborated the findings. Doppler studies remained normal until 34+2 weeks, when signs of severe FGR and abnormal umbilical artery Dopplers prompted delivery by cesarean section. The twins were delivered preterm, and postnatal evaluation confirmed VCI.</p><p><strong>Conclusion: </strong>This case highlights the importance of early identification of IMCI as it necessitates close monitoring and timely intervention to optimize perinatal outcomes.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"1-4"},"PeriodicalIF":1.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetoscopic Endoluminal Tracheal Occlusion versus Expectant Management for Severe Congenital Diaphragmatic Hernia at a Single Center.","authors":"Sierra Land, Sabrina Flohr, Leny Mathew, Anne M Ades, Beverly G Coleman, Juliana S Gebb, Julie S Moldenhauer, Olivia Nelson, Edward R Oliver, Emily A Partridge, William H Peranteau, Thomas A Reynolds, Natalie E Rintoul, Kha Tran, K Taylor Wild, Holly L Hedrick","doi":"10.1159/000546160","DOIUrl":"10.1159/000546160","url":null,"abstract":"<p><strong>Introduction: </strong>The TOTAL trial showed survival benefit in patients with severe congenital diaphragmatic hernia (CDH) who underwent fetoscopic endoluminal tracheal occlusion (FETO). We aim to add to the current literature by describing implementation, feasibility, and outcomes of patients treated with FETO compared to a contemporary cohort of expectantly managed maternal-child dyads.</p><p><strong>Methods: </strong>A single-center, retrospective cohort study evaluated patients with a prenatal diagnosis of isolated left-CDH with an observed/expected lung-to-head ratio (O/E LHR) <30% referred to our center from September 2016 to January 2023.</p><p><strong>Results: </strong>Twelve patients who underwent FETO were compared to 35 expectantly managed patients. At initial evaluation, FETO patients had a lower O/E LHR value (21.7% versus 24.9%) compared to the expectant management patients. Chorioamniotic membrane separation occurred in half of the FETO patients (6/12) compared with 1 patient in the expectant management group and most FETO patients (75.0%) experienced preterm prelabor rupture of membranes compared to only 4 (11.4%) expectant management patients. FETO patients had a lower median gestational age at delivery compared to expectant management patients (35.0 vs. 38.9 weeks). Fewer FETO patients were treated with extracorporeal-membrane oxygenation (ECMO; 25.0% vs. 60.0% expectant management). FETO patients also had higher survival (91.7% vs. 71.4%) and longer duration of hospitalization (135 vs. 94.8 days). At time of discharge, no FETO patients required pulmonary hypertension (PH) medications while 28.0% of expectant management patients were on PH medications.</p><p><strong>Conclusion: </strong>FETO for severe CDH was feasible in our single center setting. FETO may increase risk of obstetric complications and prematurity, but improved ECMO use, PH, and survival of infants with severe CDH.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"1-12"},"PeriodicalIF":1.6,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}