Aortopulmonary window (APW) is a rare conotruncal cardiac anomaly that is rarely diagnosed prenatally. We report a case of APW identified by detailed fetal echocardiography and confirmed after birth, associated with esophageal atresia with distal tracheoesophageal fistula, duodenal atresia, and anal atresia. Prenatal imaging demonstrated an abnormal communication between the ascending aorta and the main pulmonary artery, allowing delivery planning at a tertiary center and early multidisciplinary management. This case highlights the importance of careful assessment of the great arteries during fetal echocardiography and the value of prenatal diagnosis for optimizing perinatal management.
BACKGROUND:Transplacental mammalian target of rapamycin (mTOR) inhibition has emerged as a promising therapeutic strategy for severe fetal cardiac rhabdomyomas in tuberous sclerosis complex (TSC). However, its impact on neonatal cardiovascular adaptation and long-term neurological outcomes remains poorly understood. CASE PRESENTATION:We report a fetus with clinically diagnosed TSC presenting with multiple large cardiac rhabdomyomas causing progressive hemodynamic compromise. Transplacental sirolimus therapy was initiated at 30 weeks of gestation and continued for 7 weeks, resulting in marked regression of cardiac tumors, improved left ventricular outflow tract patency, and recovery of fetal cardiac function. In contrast, serial fetal imaging demonstrated no apparent change in the size or number of intracranial lesions. Elective cesarean delivery was performed at 38 weeks of gestation. Despite favorable prenatal structural improvement, the neonate developed severe left ventricular dysfunction immediately after birth, requiring ductal-dependent circulatory support and intensive cardiovascular management. Postnatal everolimus therapy was initiated on the day of birth, leading to complete regression of cardiac rhabdomyomas by 5 months of age. However, central nervous system lesions persisted, epilepsy developed during infancy, and cognitive and language delays remained evident at 30 months of follow-up. Wolff-Parkinson-White syndrome was also identified during infancy. Genetic analysis ultimately revealed a heterozygous deletion involving exons 11-16 of TSC2. CONCLUSIONS:This case demonstrates organ- and tissue-specific therapeutic responses to prenatal and postnatal mTOR inhibition in TSC. Although transplacental mTOR inhibition may be life-saving for severe fetal cardiac involvement, prenatal structural improvement may not necessarily predict neonatal cardiovascular stability or favorable long-term neurological outcomes. These findings underscore the importance of careful perinatal planning, realistic prenatal counseling, and extended multidisciplinary follow-up.
OBJECTIVE:To identify distinct longitudinal change patterns of maternal placental growth factor (PlGF) across pregnancy and evaluate their independent associations with adverse perinatal outcomes. METHODS:In this retrospective cohort study, 229 women with singleton pregnancies complicated by preeclampsia and complete PlGF measurements in early (11+0 to 13+6 weeks), mid- (20+0 to 24+6 weeks), and late (28+0 to 34+6 weeks) pregnancy were included. Latent class mixed models (LCMM) were used to identify distinct non-linear trajectories of PlGF. Model selection was based on Bayesian Information Criterion (BIC). Stepwise multivariable logistic regression models were applied to assess associations between PlGF trajectory groups and adverse outcomes, including small-for-gestational-age (SGA), preterm delivery, and neonatal intensive care unit (NICU) admission. RESULTS:Three distinct PlGF trajectories were identified: (1) standard escalating trajectory (79.5%), (2) chronic low-slope growth (15.3%), and (3) late-term precipitous decline (5.2%). Absolute event counts were 15/182, 11/35, and 4/12 for Small-for-gestational-age (SGA). 25/182, 5/35, and 9/12 for preterm delivery. 19/182, 5/35, and 8/12 for NICU admission in the standard escalating, chronic low-slope, and late-term decline groups, respectively. Compared with the standard trajectory, both abnormal patterns were significantly associated with increased odds of SGA, with adjusted odds ratios (aOR) of 6.54 (95% CI: 2.49-17.41) for chronic low-slope growth and 9.25 (95% CI: 2.03-40.13) for late-term decline. Late-term precipitous decline was strongly associated with preterm delivery (aOR: 32.37, 95% CI: 7.79-180.58) and NICU admission (aOR: 23.86, 95% CI: 6.09-112.02). Chronic low-slope growth was not significantly associated with preterm delivery or NICU admission. CONCLUSIONS:Distinct longitudinal patterns of maternal PlGF provide important prognostic information beyond single time-point measurements. In particular, a late-term precipitous decline in PlGF identifies pregnancies at markedly elevated risk for preterm birth and neonatal morbidity.
INTRODUCTION:Cystic fibrosis (CF) can present prenatally as fetal hyperechogenic bowel (FEB) or meconium ileus (MI), indicating early CFTR dysfunction. Elexacaftor/tezacaftor/ivacaftor (ETI) partially restores CFTR function and limited reports suggest it may benefit fetuses when administered maternally. CASE PRESENTATION:We report four pregnancies in CF carrier mothers with confirmed or presumed fetal CF after FEB detection, treated off-label with ETI. Fetal bowel status was monitored via ultrasound and MRI, and maternal safety was assessed. In Case 1, ETI from 26-36 weeks normalized bowel appearance; the infant had normal meconium passage. In Case 2, ETI at 30 weeks improved bowel findings in a fetus with CF and congenital diaphragmatic hernia, but the neonate died from hernia complications. Case 3 involved a single ETI dose before preterm birth at 28 weeks; the infant had severe MI and died from neurological complications. In Case 4, ETI at 35 weeks briefly improved bowel status; delivery at 37 weeks was required for progressive distension, followed by MI surgery with full recovery. Maternal therapy was well tolerated. CONCLUSIONS:Prenatal ETI may improve fetal bowel abnormalities and reduce MI risk, particularly with early, sustained exposure. Imaging effectively monitored response. Further studies are required to define optimal timing, protocols, and long-term safety.
INTRODUCTION:Perinatal outcomes were compared for patients treated with fetoscopic laser ablation for vasa previa (VP) type II versus III. In type II VP, fetal vessels connect the main placenta to an accessory lobe, and in type III, these vessels exit and reenter a single-lobed placenta without velamentous cord insertion. Vessel ablation can be challenging in the presence of an accessory placental lobe. METHODS:This was a retrospective cohort study (2013-2025) of women with singleton pregnancies ≥31 gestational weeks who underwent laser ablation treatment for VP type II vs. III. RESULTS:Of 32 study patients, 14 (43.8%) had type II and 18 (56.2%) had type III VP. All patients had successful VP occlusion (1 required a second attempt) and were managed as outpatients. Perinatal outcomes were similar for VP types. All neonates were liveborn and survived at least 30 days; 2 required hyperbilirubinemia treatment and 3 had respiratory distress syndrome. There were no cases of intraventricular hemorrhage, patent ductus arteriosus, neonatal blood transfusion, or sepsis. CONCLUSION:For 32 VP patients treated with fetoscopic laser ablation, perinatal outcomes for types II and III VP were favorable and did not differ by VP type.
INTRODUCTION:Alagille syndrome (ALGS) is a rare autosomal dominant multisystem condition. This study focuses on the prenatal sonographic findings observed in cases confirmed to have ALGS through the molecular detection of JAG1 variants, either prenatally or postnatally. METHODS:This retrospective study enrolled 13 cases of ALGS, diagnosed either prenatally or postnatally. Comprehensive medical records were systematically reviewed, with emphasis on pregnancy-related data, including serial fetal ultrasound examinations throughout gestation, molecular genetic test results, and pregnancy outcomes. RESULTS:Among the 13 cases, 10 demonstrated abnormal sonographic findings during the second trimester: unilateral multicystic dysplastic kidney (MCDK) in two (2/13), left MCDK with concomitant right renal agenesis in one (1/13), left MCDK associated with butterfly vertebrae in one (1/13), isolated butterfly vertebrae in three (3/13), non-visualized gallbladder in two (2/13), and supravalvar aortic stenosis with persistent left superior vena cava in one (1/13). The remaining three cases exhibited normal second-trimester ultrasound examinations but developed abnormal sonographic features in the third trimester: intrauterine growth restriction (IUGR) was identified in two cases (2/13), and one case showed co-occurring pulmonary artery stenosis and butterfly vertebrae (1/13). CONCLUSION:This study demonstrates that individuals with ALGS lack definitive prenatal ultrasound markers. When abnormalities are present, they are often subtle and nonspecific, which may not prompt clinicians to pursue genetic testing.
Introduction: Pregnant people carrying fetuses with congenital anomalies are at increased risk for perinatal mood and anxiety disorders (PMADs). Limited data exists regarding the impact of maternal-fetal surgery on maternal mental health. This study aimed to evaluate PMAD symptoms in pregnant people who opted for open maternal-fetal surgery (OMFS) for fetal myelomeningocele (fMMC) repair Methods: Retrospective cohort study of patients who underwent OMFS for fMMC repair at a level III fetal center. The Postpartum Depression Screening Scale (PDSS) and Impact of Event Scale-Revised (IES-R) were administered at initial evaluation and one day post birth. Demographics, perioperative factors, surgical and delivery outcomes, and type of psychosocial support interactions were collected. Results: Of 171 pregnant people who underwent OMFS, 91 (50.8%) screened positive for depressive symptoms and 27 (15.1%) for anxiety/traumatic stress at the initial evaluation, prior to OMFS. After delivery 45 (25.1%) screened positive for depressive symptoms and 2 (0.01%) for anxiety/traumatic stress symptoms. There was a statistically significant decrease in positive screen rates in the postpartum period for depressive and anxiety/traumatic stress (p<0.001). Conclusions: Women undergoing OMFS for fMMC repair are at a high risk for PMAD symptoms in the perinatal period. Routine mental health screening in pregnancy and integrated psychosocial support are essential in caring for this unique population.
Objective: Posterior fossa anomalies (PFAs) encompass a spectrum of central nervous system malformations affecting the cerebellum, brainstem, and surrounding cerebrospinal fluid spaces. This study evaluates the prenatal diagnosis, genetic findings, and pregnancy outcomes of PFAs in a tertiary care setting in India. Methods: A retrospective analysis was conducted on 35 cases of PFAs diagnosed via prenatal ultrasound and fetal MRI between January 2023 and May 2024. Anomalies were classified based on standard criteria, and genetic testing (karyotypte, chromosomal microarray analysis and whole exome sequencing) was offered. Pregnancy outcomes, including termination, live birth, and neonatal survival, were documented, with short-term neurodevelopmental follow-up conducted via telephonic inquiries. Results: The most common PFAs identified were Vermian Agenesis/Hypoplasia (VA/VH) and Cerebellar Hypoplasia (CH), each accounting for 25.71% of cases, followed by Dandy-Walker Malformation (20%). Isolated PFAs were observed in 37.14% of cases, while 62.85% had additional anomalies. Genetic testing was performed in 74.2% of cases, revealing variants in 5.71%. Karyotyping was performed in all tested cases and yielded normal results, while additional molecular testing with chromosomal microarray analysis (5 cases) and whole-exome sequencing (3 cases) detected clinically relevant variants in selected fetuses with posterior fossa anomalies. Among the 35 pregnancies, 65.71% opted for termination, facilitated by the Medical Termination of Pregnancy (MTP) Act, particularly for cases diagnosed beyond 24 weeks of gestation. Of the 9 live births, 2 neonates with vermian hypoplasia (5.71%) died within one month, while 6 (17.14%) had normal developmental milestones at 6 months including 6 babies with mega cisterna magna and one with an arachnoid cyst. One infant exhibited delayed milestones. Conclusion: PFAs present with diverse prognostic implications, necessitating detailed imaging, genetic evaluation, and individualized counseling. The MTP Amendment Act, played a crucial role in providing extended access to termination in pregnancies with severe PFAs and poor prognoses.
INTRODUCTION:Evidence on fetal surgery in mothers living with HIV is limited. All intrauterine invasive procedures carry a risk of fetal exposure to maternal blood, and therefore, a theoretical risk of vertical transmission must be considered. Currently, there is no published data on fetoscopic procedures in mothers living with HIV. CASE PRESENTATION:We present a multicenter case series of three monochorionic diamniotic twin pregnancies in mothers living with HIV, all complicated by twin-to-twin transfusion syndrome and treated with fetoscopic laser surgery. The procedures were performed between 18.4 and 23.0 weeks of gestation, and all patients were receiving effective combination antiretroviral therapy. At the time of fetal surgery, maternal viral load was 52 copies/mL in two cases and <50 copies/mL in the remaining case. Prophylactic intraoperative zidovudine was administered in one of the two cases with a viral load of 52 copies/mL. At the time of delivery, none of the patients received intrapartum zidovudine prophylaxis, as viral loads were <50 copies/mL in all cases. Deliveries occurred between 29.0 and 37.6 weeks of gestation, including both cesarean and vaginal deliveries. Neonatal antiretroviral prophylaxis was administered in all cases, and postnatal follow-up revealed no evidence of vertical transmission. CONCLUSION:Fetoscopic laser surgery for complicated monochorionic twin pregnancies in mothers living with HIV receiving effective antiretroviral therapy and having undetectable or low viral loads appears to be safe. The theoretical risk of vertical transmission in such cases is likely negligible and should not be considered a contraindication to the procedure under optimal conditions.
INTRODUCTION:Pulmonary hypoplasia and severe pulmonary hypertension associated with severe oligo/anhydramnios may be mitigated by amnioinfusion in fetal bilateral renal agenesis (BRA). We report fetal cardiovascular testing in live-born BRA subjects of the Renal Anhydramnios Fetal Therapy (RAFT) trial. METHODS:Fetuses in the BRA RAFT trial cohort underwent third trimester echocardiography with maternal hyperoxia (MH). Echocardiographic parameters, compared between baseline and MH, are presented for expectant management and amnioinfusion participants using descriptive and inferential statistics. RESULTS:Of 20 BRA pregnancies, 17 had amnioinfusions and 3 expectant management; 13 had fetal echocardiograms. Middle cerebral artery pulsatility index (PI) increased with MH (1.82 vs. 2.12, p = 0.032), as did umbilical artery PI (0.89 vs. 1.02, p = 0.056), without change in cardiac output or right ventricular percentage of the output, as expected. Fetuses in the intervention arm showed significant decrease in pulmonary artery PI compared to no decrease or an increase in the control arm. All fetuses with clear reactivity had favorable respiratory status at 30 days of life. Minimal reactivity (<10%) was not predictive of poor outcome. Pulmonary artery branch dimensions were significantly larger in the treated fetuses. CONCLUSION:Fetal echocardiography with MH provides antenatal evidence of rescued pulmonary phenotype in BRA fetuses undergoing serial percutaneous amnioinfusions.
INTRODUCTION:We compare adverse pregnancy outcomes after the Solomon technique versus selective laser surgery for twin-twin transfusion syndrome (TTTS). METHODS:A retrospective cohort study of monochorionic-diamniotic twin pregnancies that underwent laser surgery for TTTS at two centers between 2006 and 2024. Pregnancy outcomes were compared between patients treated with the Solomon versus the selective laser technique. The primary outcomes were delivery <4 weeks after surgery and delivery <28 weeks. Secondary outcomes included placental abruption and recurrent TTTS or twin anemia polycythemia sequence requiring additional surgery. Multivariable robust Poisson regression models were used to estimate relative risks (RRs) for outcomes adjusted for TTTS stage, selective fetal growth restriction, and cervical length, among other covariables. Solomonization' s effect on surgery-to-delivery interval was evaluated via Cox regression. p < 0.05 was used. RESULTS:Of 1,680 TTTS cases, 80 were excluded due to dual fetal death (n = 47) or missing laser technique or delivery data (n = 33). In the remaining 1,600 cases, 44.9% (n = 719) underwent the Solomon technique. Multivariable robust Poisson regression showed that Solomonization was independently associated with delivery <4 weeks after surgery (RR: 2.46; 95% CI: 1.31-4.60; p = 0.005), delivery <28 weeks (RR: 1.67; 95% CI: 1.15-2.51; p = 0.008), and placental abruption (RR: 1.74; 95% CI: 1.02-2.97; p = 0.04). Cox regression demonstrated a shorter surgery-to-delivery interval with the Solomon technique (hazard ratio: 1.66; 95% CI: 1.49-1.84; p < 0.001). The Solomon group had higher laser time, energy consumption, and PPROM rates, earlier gestational age at delivery, and lower 30-day survival rate of at least one twin. Recurrent TTTS or post-laser twin anemia polycythemia sequence requiring additional surgery were similar between groups. CONCLUSION:The Solomon technique is associated with increased risks, including extreme preterm delivery, shorter surgery-to-delivery interval, and placental abruption.
Introduction: To date, only case reports regarding prenatal diagnosis of Silver-Russell syndrome (SRS) have been documented in the literature. In this study, we aimed to elucidate the prenatal characteristics associated with SRS along with their molecular aspects. Methods: This was a retrospective study of 23 cases with SRS. All cases received either prenatal or postnatal diagnoses of SRS with molecular confirmation harboring disease-causing defects in the mechanisms known to be associated with SRS. The medical records of patients were meticulously collected and reviewed. Results: Of the 12 prenatally diagnosed cases, seven were identified due to intrauterine growth restriction (IUGR), two were detected following positive non-invasive prenatal testing results indicating trisomy 7, and three diagnoses were prompted by advanced maternal age. Of the 11 postnatally diagnosed cases, all exhibited IUGR in utero. Among all 18 cases presenting with IUGR, four were classified as early-onset IUGR, while the remaining 14 were diagnosed in the third trimester. Maternal uniparental disomy 7 accounted for the molecular defect in SRS in fifteen instances, followed by loss of imprinting center 1 methylation at 11p15 in five instances and maternal duplication of chromosome region 11p15.5 in another three instances. Conclusion: Our findings highlight the significance of IUGR as a prenatal marker for SRS. Targeted molecular testing for SRS, including methylation-specific assays at key imprinted loci, should be integrated into the standard genetic evaluation of fetuses with unexplained IUGR.
INTRODUCTION:Crown-rump length discrepancy (CRLd) is commonly used to predict selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twins, but its predictive value is limited. This study aimed to determine whether a first-trimester growth rate (GR) variable is associated with later sFGR. METHODS:Retrospective cohort included MCDA-twin pregnancies with first-trimester ultrasound data. CRLd was calculated for each fetus dividing the delta CLR by the bigger CRL; GR was calculated for each fetus dividing CRL by gestational age. Pregnancies were classified as normal and sFGR. Generalized estimating equations were used to evaluate the independent associations of GR and CRLd with sFGR. RESULTS:Among 335 pregnancies, 235 (70.1%) were normal, and 100 (29.85%) were sFGR. GR was lower in pregnancies that developed sFGR and differed within sFGR pairs. Pearson's correlation showed no significant relationship between GR and CRLd. After accounting for co-twin correlation, both lower GR and higher CRLd were independently associated with higher odds of sFGR. CONCLUSION:Reduced first-trimester GR and increased CRLd are independent early indicators of sFGR, and their combined assessment yields the best model fit.
INTRODUCTION:Approximately half of twin-to-twin transfusion syndrome (TTTS) cases are complicated by selective fetal growth restriction (sFGR). Although fetoscopic laser photocoagulation (FLP) is the standard treatment, perinatal outcomes in cases with concomitant sFGR - particularly according to single or dual fetal survival after laser - are not well established. The objective of this study was to compare post-FLP obstetrical and neonatal outcomes between TTTS+sFGR and isolated TTTS, with separate analyses in pregnancies with immediate single or dual fetal survival. METHODS:This was a retrospective cohort study including all TTTS cases treated with FLP at a single institution between November 2011 and April 2023. TTTS was diagnosed according to Quintero criteria. sFGR was defined as an estimated fetal weight <10th percentile in one twin with an inter-twin weight discordance ≥25% at the time of FLP. Outcomes included immediate post-FLP fetal demise (within 48 h after FLP), preterm premature rupture of membranes (PPROM), gestational age (GA) at delivery, and neonatal survival at birth and at 30 days, analyzed according to post-FLP single or dual fetal survival. RESULTS:Among 424 cases, 188 (44.3%) had TTTS + sFGR. GA and cervical length at FLP were similar between groups, but TTTS+sFGR cases showed more severe disease, with a higher proportion of Quintero stage III. Dual fetal survival after FLP was lower in TTTS+sFGR compared with isolated TTTS (iTTTS; 79.6% vs. 88.5%). In pregnancies with single fetal survival post-FLP, TTTS+sFGR was associated with higher rates of delivery before 32 weeks (p = 0.03) and increased post-FLP PPROM (p = 0.03). Ex-donor fetuses in this group had significantly lower survival at birth and at 30 days compared with iTTTS. Even in cases with dual survival post-FLP, ex-donor survival at birth and at 30 days remained lower in TTTS + sFGR, while no other perinatal outcomes differed. CONCLUSION:When stratified by immediate single or dual post-FLP survival, pregnancies with TTTS complicated by sFGR showed consistently worse obstetrical and neonatal outcomes compared with isolated TTTS, particularly due to reduced ex-donor survival across both groups. Further studies are needed to elucidate the mechanisms underlying these findings.
INTRODUCTION:We aim to describe the feasibility and outcomes of fetuses with occipital encephalocele treated with intrauterine repair by open microneurosurgery. METHODS:Between 2021 and 2025, a consecutive cohort of fetuses with occipital encephalocele referred to 2 fetal surgery centers in Nicaragua and Mexico were selected for intrauterine correction by open fetal microneurosurgery. Inclusion criteria were fetuses at less than 28 weeks with isolated occipital encephalocele, Chiari III malformation (obliteration of the cisterna magna with protrusion of cerebral tissue), and microcephaly. We report the procedure-related characteristics, perinatal and neurological outcomes (hydrocephalus, meningitis, seizures, cognitive delay, motor dysfunction, and visual impairment) within the first 12 months of age. RESULTS:Twelve cases were evaluated during the study period but only 6 cases were selected for fetal intervention. Open fetal microneurosurgery was successfully performed in all cases at a median gestational age (GA) of 25+2 weeks+days, with a median surgical time of 93 min. Regression of Chiari and reversal of microcephaly was observed in 4/6 and 6/6 cases, respectively. The median GA at birth was 36+5 weeks+days. Preterm rupture of the membranes and preterm delivery was reported in 3/6 cases. No cases of perinatal death were reported. Within the first 12 months of age, none of the children developed meningitis, cognitive delay, or hydrocephalus requiring ventriculoperitoneal shunting. Motor dysfunction, seizures, and visual disorders were reported in 1/6, 1/6, and 3/6 cases, respectively. CONCLUSION:In this small series of fetuses with occipital encephalocele, open fetal microneurosurgery was feasible and was associated with promising outcomes.
INTRODUCTION:We report a case of primary pyruvate dehydrogenase complex deficiency (PPDCD) presenting with prenatal neuroimaging features highly suggestive of cytomegalovirus (CMV) fetopathy, highlighting an important alternative diagnosis when infectious investigations are negative. CASE PRESENTATION:A 32-year-old patient was referred at 29 weeks' gestation for fetal microcephaly, borderline ventriculomegaly, and a short corpus callosum. Detailed neurosonography and fetal MRI demonstrated a clastic pattern including a periventricular echogenic halo, germinolysis pseudocysts, delayed sylvian operculation, and reduced transverse cerebellar diameter - findings classically associated with congenital CMV infection. Despite this highly suggestive imaging phenotype, extensive infectious work-up was negative. Given the severity of cerebral lesions, pregnancy termination was elected. Neuropathological examination confirmed clastic lesions and showed inferior olivary nuclei heterotopia, dentato-olivary dysplasia, thalamic microcalcifications, and hypoplastic pyramidal tracts. This distinctive combination raised suspicion of a metabolic disorder affecting cerebral energy metabolism. Subsequent exome sequencing identified a de novo pathogenic duplication in the PDHA1 gene, confirming the diagnosis of PPDCD. CONCLUSION:This case demonstrates that PPDCD can closely mimic CMV fetopathy on prenatal brain imaging that one should evocate in case of such an imaging pattern and negative infectious testing. Its recognition has major implications for counseling and recurrence risk assessment.
INTRODUCTION:Prenatal diagnoses of congenital anomalies of the kidney and urinary tract (CAKUT) are critical for counseling families about potential postnatal outcomes. While ultrasound (US) remains the gold standard for prenatal diagnosis of CAKUT, fetal magnetic resonance imaging (MRI) has been increasingly used for complex anomalies. However, diagnostic accuracy of fetal MRI for CAKUT remains uncertain. This study aimed to compare prenatal US and MRI for the diagnosis of CAKUT. METHODS:We reviewed charts of gravid mothers with fetuses having suspected CAKUT seen at a tertiary fetal care center between 2012 and 2020. Data included prenatal US, fetal MRI, prenatal intervention, postnatal US, postnatal MRI, postnatal voiding cystourethrogram, postnatal diagnosis, and postnatal surgical intervention. Prenatal imaging and postnatal diagnoses were categorized into kidney, ureteral, and/or bladder anomalies. Diagnostic accuracy of prenatal imaging for identifying postnatal anomalies was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Anatomic categories were stratified based on concordance between prenatal imaging findings and postnatal diagnosis (concordant, incomplete - imaging that captured accurate details but missed key nuances, or discordant). RESULTS:Fetal MRI had statistically significant fewer rates of incomplete results compared to US. When anatomic categories were grouped together, fetal MRI had greater sensitivity, PPV, and NPV, and equivalent specificity compared to US. This relationship held true for kidney and ureteral anomalies. In the bladder, MRI and US had equivalent diagnostic accuracy. However, these results of sensitivity, specificity, PPV, and NPV within anatomic categories were not statistically significant. CONCLUSION:Although fetal MRI showed greater sensitivity, PPV, and NPV for detecting kidney and ureteral anomalies, these differences were not statistically significant. MRI should nonetheless be considered complementary to prenatal US as it may provide more detailed information, particularly for complex congenital kidney and ureteral anomalies. The data demonstrate meaningful clinical differences between US and MRI in diagnosing CAKUT. Further work is needed to validate these findings in a larger cohort.
