Abstract Background Extremely preterm birth (24–28 weeks of gestation) carries high perinatal risk. While intrapartum cardiotocography (CTG) is routinely used at term, its interpretation in extremely preterm birth remains unclear. This study aims to explore the relationship between intrapartum CTG characteristics and perinatal outcomes in extremely preterm birth. Methods An exploratory retrospective cohort study, part of the NIEM-O study, was conducted at the Obstetrics Department of a tertiary referral hospital. Intrapartum CTG recordings of 73 women with a spontaneous onset of birth between 24 and 28 weeks of gestation were included. Signal loss (n = 73) and CTG characteristics during the last hour of the first stage of labor (n = 55), and during second stage of labor (n = 24) were assessed using computerized analysis. CTG characteristics (baseline fetal heart rate, heart rate variability, accelerations, decelerations, uterine contractions, and combinations of these characteristics) were compared between fetuses with neonatal outcome of low 5-minute Apgar score (< 7) and a group with 5-minute Apgar score > 7. Results CTG tracings in preterm fetuses frequently displayed recognizable features, including baseline variability (median 18 bpm) and both accelerative (median five/hour) and decelerative (median 11/hour) responses. Preterm fetuses with a low 5-minute Apgar score (n = 20) exhibited significantly more variable decelerations (median 14/hour vs. six/hour) and uterine contractions (19/hour vs. 13/hour), compared to those without this outcome. CTG characteristics commonly described as indicators of hypoxia in term fetuses were not consistently observed in the studied preterm population. Conclusions Although CTG features were often identifiable in preterm fetuses, their presentation differed from those commonly described at term, particularly in those with low 5-minute Apgar score. These findings highlight the need for gestational age-specific CTG reference ranges. Adapting CTG interpretation to reflect the unique physiology of this group is essential for improving timely clinical decision-making and reducing perinatal morbidity and mortality. Trial registration Registered on 22 November 2023 in Clinicaltrails.gov (Number: NCT06151613) via https://clinicaltrials.gov/study/NCT06151613 and on 18 October 2022 to the Central Committee on Research Involving Human Subjects (NL82869.015.22).

Abstract Introduction Labor epidural analgesia (LEA) is widely used for intrapartum pain management, but its effects on uterine activity (UA) remain unclear. Electrohysterography (EHG) is a promising non‐invasive method for intrapartum UA monitoring. The aim of this study was to explore the effect of LEA on UA by means of EHG, to develop better understanding of labor physiology, and inform clinical decision‐making. Material and Methods Patients in active labor with singleton, term pregnancies who received electrophysiological monitoring from 60 min before until 120 min after LEA initiation were included. Contraction parameters such as frequency, duration, area under the curve (AUC), baseline, and maximum amplitude were obtained from an EHG‐derived tocogram using a computer‐based algorithm. The primary outcome was the difference in mean uterine contraction frequency before and after initiation of LEA. Secondary outcomes included the comparison of various contraction parameters, derived from EHG, before and after LEA initiation, as well as their temporal changes over time. The effect of possible confounders on UA was examined. Mixed effects models were used for statistical analyses. Results In total, 86 patients were included. No significant difference in mean uterine contraction frequency and contraction duration was found before and after LEA initiation. Nevertheless, start of LEA was associated with a significant reduction in AUC, baseline activity, and signal amplitude. Conclusions LEA initiation does not affect uterine contraction frequency or duration, but it is associated with a significant reduction in relative EHG‐derived amplitude parameters (AUC, baseline tone, and maximum amplitude), which could potentially affect progression of labor. Further studies are required to explore these parameters and their clinical implications.

Abstract Introduction Isolated single umbilical artery (iSUA) is associated with a fivefold increased risk for perinatal mortality, even though placental blood flow is not reduced compared to healthy fetuses. In recent work, the umbilical cord was shown to have a protective effect against intrapartum fetal acidosis, which is reduced in the case of relevant cord anomalies like iSUA. This study aimed to investigate the protective effect of the umbilical cord against fetal acidosis by comparing cardiotocogram (CTG) characteristics of fetuses with iSUA against controls. Material and Methods In this retrospective, matched case–control study in a tertiary care center in the Netherlands, computerized CTG analyses were performed on intrapartum registrations for 9 iSUA patients and 35 case‐matched controls. CTGs were analyzed for stages of hypoxia classification, CTG characteristics of fetal heart rate such as baseline, variability, (late) decelerations, overshoots, FHR recovery duration, and characteristics of uterine contractions. Linear regression analyses were performed for the CTG parameters, adjusted for uterine contraction frequency and average inter‐contraction duration. Neonatal outcome parameters were compared between the iSUA group and healthy controls. Results The prevalence of decelerations followed by an overshoot was two to three times higher in the iSUA group (p = 0.011 for stage 1 and p = 0.001 for stage 2 of labor) and a longer average fetal heart rate recovery duration for stage 1 of labor was found as well (p = 0.001). Furthermore, iSUA was found to have a higher prevalence of late decelerations in stage 1 (p = 0.042) and shorter decelerations (p = 0.046) along with less decelerations exceeding 1 min (p = 0.017) during stage 2. No differences in hypoxia staging or the presence of saltatory patterns were found. Neonatal outcomes indicative of birth asphyxia did not occur in the study population. Conclusions These findings support epidemiological findings that term fetuses with iSUA are more susceptible to hypoxia, warranting further research into tailored management strategies.

INTRODUCTION:The incidence of postpartum hemorrhage (PPH) has increased despite consistent use of prophylactic treatment. To date, little is known about postpartum uterine activity. This study investigates the association between various uterine activity parameters and blood loss in the first 30 min postpartum. MATERIAL AND METHODS:Term pregnant patients who received postpartum continuous electrophysiological uterine monitoring were included. Postpartum blood loss was measured using weighting. From a 30-min electrohysterography-derived tocogram, a computer-based algorithm was used to extract uterine activity parameters. These included total area under the curve (AUC), AUC from baseline, maximum amplitude and baseline tone. Scatterplots between various UA parameters and logarithmically transformed total blood loss were made and Pearson correlation coefficients were calculated. UA-parameters were compared between non-PPH patients and patients with PPH, including the different PPH etiologies. RESULTS:119 patients were included of which 24 had PPH (blood loss ≥500 mL). Total blood loss showed no significant association with the various UA-parameters. Patients with PPH due to a retained placenta (n = 6) showed significantly higher total UA-AUC (5.5 vs 5.2, p = 0.007), UA-AUC from baseline (5.4 vs 5.1, p = 0.003) and maximum amplitude (3.0 vs 2.9, p = 0.024) compared to patients without PPH. CONCLUSION:Increased postpartum uterine activity may reflect compensatory but ineffective myometrial activation in patients with PPH due to a retained placenta. Due to the limited sample size and exploratory nature of the analyses, these results should be interpreted with caution.

Objective:To minimize risks of postpartum hemorrhage, understanding normal postpartum uterine activity is essential. This scoping review summarizes literature on postpartum uterine activity to provide insight into uterine activity (patho)physiology, characteristics of objective postpartum uterine monitoring methods and the effect of uterotonics on postpartum uterine activity. Data sources:A systematic search was conducted in PubMed, Embase and Cochrane in August 2024 and repeated in January 2025. No filter restrictions were applied. Systematic article selection was performed by two independent reviewers. Eligibility criteria:Articles were included if study participants were ≥ 18 years old and had external tocodynamometry (TOCO), intrauterine pressure catheter (IUPC) and/or electrohysterography (EHG) monitoring postpartum. Reviews, case reports, conference papers, technical modeling methods, guidelines, grey literature and duplicates were excluded, as were articles describing non-pregnant, non-human, non-labor studies and intrapartum studies. Study appraisal and synthesis methods:The Newcastle-Ottawa Quality Assessment Scale and the revised Cochrane risk-of-bias tool were conducted to assess study quality. Data was collected and systematically organized by two independent reviewers. Results:Twenty-nine articles were included after evaluation of 5,826 articles. Data analysis included 23 articles (IUPC n = 16, EHG n = 6 and TOCO n = 1) after risk of bias selection. Uterine contraction frequency without uterotonics ranges between 2.4 and 2.8 contractions per 10 min and between 3.7 and 4.6 contractions per 10 min with oxytocin, both decreasing over time. Normal baseline activity after childbirth is ≤ 15 mmHg and normal uterine intensity varies between 51-58 mmHg and 336-396 Montevideo Units. Studies conducted prior to 2020, measuring uterine activity with IUPC or TOCO, report no significant correlation between uterine activity and total blood loss. However, a small study using EHG conducted in 2024, cautiously suggests a positive relationship. This review highlights the need for a uniform and objective method to monitor postpartum uterine activity to adequately investigate the impact of different uterotonics on uterine activity. Conclusion:The (patho)physiology of postpartum uterine activity remains largely underexplored. EHG shows potential in enhancing our understanding of normal postpartum uterine activity as well as in postpartum hemorrhage recognition and prediction.

A reliable early risk prediction of gestational diabetes mellitus (GDM) allows for early lifestyle modifications during pregnancy to reduce the risk of developing GDM. In this retrospective study, we developed a logistic regression machine learning model with heart rate variability (HRV) characteristics during overnight sleep in early pregnancy as predictors for GDM prediction. The study used the nuMoM2b dataset from 2748 nulliparous women in the USA who underwent a standardized home sleep test between 6 and 15 weeks’ gestation with subsequent GDM assessment at 24–28 weeks. A total of 52 overnight HRV features were analyzed alongside the baseline risk factors recommended by the National Institutes of Health (NIH). The model combining baseline and HRV features achieved an area under the receiver operating characteristic curve (AUC) of 0.73, outperforming the model using only baseline features (AUC = 0.69) and that using only HRV features (AUC = 0.65). These machine learning models all performed better than the early GDM risk assessment based on the NIH guidelines (AUC = 0.63). The findings suggest that overnight maternal HRV characteristics can be used as early predictors of GDM.

Randomized controlled trials (RCTs) are regarded as the highest level of evidence in medical research, but RCTs also have their drawbacks. Over the years, several alternative study designs have been introduced to address these problems. However, many of the alternative designs are often regarded as inferior to RCTs or currently not suitable for widespread implementation due to, for example, ethical or statistical problems. Thus, there is a need for study designs that have the same level of validity as RCTs, but are also suitable for large-scale implementation. The cohort intervention random sampling study (CIRSS) with historical controls meets these requirements, by combining the strengths of abovementioned designs. The CIRSS with historical controls has the potential to optimize implementation of promising new treatments as fluidly and rapidly as possible, representing real-world clinical population. Further research is required to address the range of analyses, implementation, issues, barriers and facilitators and ethical questions related to CIRSS.

BACKGROUND:Continuous antepartum fetal monitoring has been proposed as an alternative to the current practice of intermittent monitoring of fetal well-being in high-risk pregnancies. Healthcare professionals, however, do not yet fully embrace the concept of continuous monitoring. In order to optimize implementation of continuous fetal monitoring, the current study investigates caregivers' opinions towards continuous fetal monitoring, devices to use, and the implementation in clinical care. METHODS:This single center cross-sectional study was conducted at the Obstetric High Care unit of a tertiary referral center in the Netherlands, between July 2024 and October 2024. All caregivers working at the Obstetric High Care were sent a Dutch digital survey to measure caregivers' perspective of (1) antepartum continuous fetal monitoring, (2) two devices used in fetal monitoring, and (3) the implementation of continuous fetal monitoring on the Obstetric High Care. RESULTS:Caregivers have an overall neutral opinion on the significance and impact of continuous fetal monitoring on obstetric management, maternal experience, and perinatal outcomes. They agree that, with greater knowledge of CTG characteristics in preterm fetuses, continuous fetal monitoring could enhance birth timing compared to intermittent monitoring. Preferences for CTG devices vary, influenced by factors such as ease of use, signal quality, and efficacy in monitoring obese women and preterm pregnancies. CONCLUSIONS:Caregivers hold a neutral position on continuous fetal monitoring but recognize its potential with improved knowledge and technical optimization. Implementation strategies should focus on training, device usability, and addressing signal loss.

Background:Emergency obstetric simulation-based training has increasingly been used to improve emergency obstetric care provision in sub-Saharan Africa. For determining the optimal methodology for effective training sessions in resource-constrained settings, it is crucial to conduct high-quality research. Objective:We aim to investigate the impact of a train-the-trainer model for providing technology-enhanced, mono-professional, simulation-based training in obstetrics in a resource-constrained setting on maternal and perinatal outcomes. Methods:A stepped-wedge cluster randomized trial was conducted from October 2014 until March 2016 at the medium- to high-risk ward at Mulago National Referral Hospital, Uganda, with an annual delivery rate of over 23,000. The intervention consisted of a train-the-trainer model in which training was cascaded down from master trainers to local facilitators (obstetric senior staff members) to learners (senior house officers). The training of senior house officers was provided to 7 fixed clusters by a computer-generated random sequential roll-out. The training comprised a 1-day (8 h), mono-professional, simulation-based training in obstetrics, and half-day repetition training sessions targeted at every 7 weeks. Both medical technical skills and teamwork skills were taught. The primary outcome comprised a combined maternal and perinatal mortality rate. Secondary outcomes comprised the maternal mortality rate, the perinatal mortality rate, the percentage of births by vacuum extraction and cesarean section, and the Weighted Adverse Outcome Score. Results:Overall, there were 17,496 births. The combined mortality rate was 9.05% (95% CI 8.37%-9.77%) in the intervention group, and 8.73% (95% CI 8.21%-9.28%) in the control group (odds ratio [OR] 0.98, 95% CI 0.86-1.12; P=.81). No statistically significant change was found in the maternal mortality rate (OR 0.80, 95% CI 0.27-2.32; P=.68) or the perinatal mortality rate (OR 0.99, 95% CI 0.87-1.13; P=.87). This study did not identify any difference in the percentage of vacuum extractions, the percentage of cesarean sections, or Weighted Adverse Outcome Scores. Conclusions:This train-the-trainer model for providing technology-enhanced, mono-professional, simulation-based training in obstetrics was not able to change maternal and perinatal mortality outcomes. This study, in combination with literature, suggests that future research should consider multiprofessional team training in obstetrics involving all staff within their units.

INTRODUCTION:Women with high-risk pregnancies (eg, pre-eclampsia, imminent preterm birth) are often hospitalised due to the need for foetal and maternal monitoring. They are monitored for 30-45 min up to three times a day with conventional cardiotocography (CTG). In the meantime, they reside at the hospital, but the foetal status is not monitored. Continuous foetal monitoring is currently not recommended using CTG, due to the potential temperature rise from consistent exposure to ultrasound waves. For safe 24/7 monitoring, newly developed devices using non-invasive electrophysiological cardiotocography (eCTG) instead of conventional CTG offer a promising alternative. Previous research into eCTG has shown favourable results in monitoring foetal heart rate throughout both pregnancy and labour. This study aims to investigate the effect of implementing continuous antepartum eCTG monitoring in hospitalised high-risk pregnancies on perinatal and maternal outcome. METHODS AND ANALYSIS:In this single centre prospective cohort intervention random sampling study, eligible women will be included on the Obstetric High Care of Máxima MC Veldhoven, the Netherlands. In total, 511 pregnant women with a singleton pregnancy between 23+0 and 32+0 weeks of gestation requiring hospitalisation will be recruited. Eligible women will be prospectively included in the cohort receiving standard treatment: intermittent CTG monitoring. From these women, a random sample of the prospective cohort will be offered a new monitoring method: 24/7 eCTG monitoring. For the eCTG monitoring, a wireless abdominal electrode patch, the Nemo Foetal Monitoring System will be used. Additional data from a historical cohort (2014-2019) of 1400 women receiving standard treatment will be included. Perinatal and maternal outcome, along with satisfaction levels of both patient and caregivers, will be compared between groups. ETHICS AND DISSEMINATION:The study is registered on 18 October 2022 to the Central Committee on Research Involving Human Subjects (NL82869.015.22) via https://www.toetsingonline.nl/to/ccmo_monitor.nsf/conceptabr?OpenForm and approved by the Medical Ethics Committee of Máxima MC (W22.070) on 7 November 2023. Results of the study will be disseminated in peer-reviewed scientific journals and conference presentations. TRIAL REGISTRATION NUMBER:NCT06151613.

BACKGROUND:Prior research has demonstrated the impact of environmental influences, including seasonal patterns, as determinants of preterm birth, although relationships vary. This study aims to determine whether there is an association between month of conception and preterm birth or gestational age at birth in the Netherlands. METHODS:This was a population-based retrospective cohort study with data collected between 2015-2019. Data originated from the national perinatal registry in The Netherlands, of which 828,574 deliveries were included. Relationships between month of conception and birth with gestational age at delivery were investigated. Furthermore, trends in the preterm birth rate among women diagnosed with imminent preterm birth were investigated. Additionally, the relationship between outdoor temperature, humidity, hours of sunlight with preterm birth was examined to investigate their possible role in preterm birth's pathophysiology. RESULTS:The distribution of gestational age at birth showed significant variation over the months of conception when all births, spontaneous onset of delivery, or iatrogenic onset of delivery were considered (all p < 0.001). Preterm and term births were more common for conception between January and June, whereas birth >41 weeks of gestation was most common for conception between July and December. Seasonal or monthly variation in preterm birth rate among women diagnosed with imminent preterm birth was not significant (p = 0.103). Higher humidity was associated with higher preterm birth rates (HR = 1.003, 95% CI: 1.001-1.005), whereas higher outdoor temperature (HR = 0.998, 95% CI: 0.996-1.000) and more sunlight exposure (HR = 0.994, 95% CI: 0.995-0.998) were associated with lower preterm birth rates. CONCLUSIONS:Pregnancies conceived in January through June are associated with a higher risk of preterm birth. These outcomes demonstrate a seasonal pattern and identify environmental risk factors for preterm birth. These patterns might be a result of fluctuations in melatonin levels, governed by variation in the hours of daily sunshine over the year in the Netherlands.

Introduction The human umbilical cord at term typically consists of two arteries and one vein. Fetuses with a single umbilical artery are known to have increased risk of perinatal morbidity and mortality. However, the role of the dual umbilical artery in reducing these risk remains poorly understood. In this work, we hypothesize that the increased arterial wall surface provided by the dual umbilical artery facilitates the diffusion of carbon dioxide (CO2) between the fetal blood and Wharton's jelly to allow temporary CO2 storage. Methods We flushed blood plasma with high and low CO2 content through umbilical cord segments, and measured the blood gas content of the outflowing liquid periodically. Results The hypothesized diffusion was proven by a linear relationship between estimated diffusion capacity and cord length for three different experimental analyses (all p < 0.001). Discussion This diffusion capacity provides a threefold protection of the fetus from acidosis during uterine contractions. Firstly, the cord dampens the increase in CO2 in the fetal blood during a contraction, thereby protecting against acute acidosis. Secondly, the diffusion of CO2 from Wharton's jelly back into the arterial blood accelerates fetal recovery after a contraction through its interaction with the Bohr and Haldane effects. Finally, our results indicate a diffusion capacity for oxygen as well, through which the umbilical cord may act as a fetal oxygen reserve. Since the study design does not allow for estimation of the clinical relevance of this threefold effect, future research should focus on determining the clinical impact of this diffusion capacity, enabling the adaptation of obstetric management strategies for fetuses with relevant cord anomalies.

Fetal well-being during labor is currently assessed by medical professionals through visual interpretation of the cardiotocogram, a simultaneous recording of Fetal Heart Rate and Uterine Activity. This method is disputed due to high inter- and intra-observer variability and a resulting high number of unnecessary interventions. Recently, an unsupervised deep learning model for automated anomaly detection in the cardiotocogram was presented. Anomalies were defined as out-of-distribution behaviour or deviations from subject-specific behaviour and the model was based on the WaveNet architecture, but required a twostep training. The current work improves this previous work by leveraging Contrastive Predictive Coding (CPC), which uses a contrastive loss to make latent predictions without requiring a decoder network. In this work, CPC was extended with a stochastic, recurrent, and conditioned (upon Uterine Activity) future predictor. We, moreover, introduce a new training objective that was found better suitable for the task of anomaly detection. Evaluated on annotations made by experienced gynecologists, all proposed extensions were shown to be beneficial, and the proposed method is shown to rival or outperform the WaveNet-based method on different annotation categories.

Background: Owing to the association between dysfunctional maternal autonomic regulation and pregnancy complications, assessing non-invasive features reflecting autonomic activity—e.g., heart rate variability (HRV) and the morphology of the photoplethysmography (PPG) pulse wave—may aid in tracking maternal health. However, women with early pregnancy complications typically receive medication, such as corticosteroids, and the effect of corticosteroids on maternal HRV and PPG pulse wave morphology is not well-researched. Methods: We performed a prospective, observational study assessing the effect of betamethasone (a commonly used corticosteroid) on non-invasively assessed features of autonomic regulation. Sixty-one women with an indication for betamethasone were enrolled and wore a wrist-worn PPG device for at least four days, from which five-minute measurements were selected for analysis. A baseline measurement was selected either before betamethasone administration or sufficiently thereafter (i.e., three days after the last injection). Furthermore, measurements were selected 24, 48, and 72 h after betamethasone administration. HRV features in the time domain and frequency domain and describing heart rate (HR) complexity were calculated, along with PPG morphology features. These features were compared between the different days. Results: Maternal HR was significantly higher and HRV features linked to parasympathetic activity were significantly lower 24 h after betamethasone administration. Features linked to sympathetic activity remained stable. Furthermore, based on the PPG morphology features, betamethasone appears to have a vasoconstrictive effect. Conclusions: Our results suggest that administering betamethasone affects maternal autonomic regulation and cardiovasculature. Researchers assessing maternal HRV in complicated pregnancies should schedule measurements before or sufficiently after corticosteroid administration.

Objective After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks’ gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed. Design Population-based cohort study. Setting All neonatal intensive care units in the Netherlands. Patients All infants born between 24 0/7 and 26 6/7 weeks’ gestation who were 5.5 years’ corrected age (CA) in 2018–2020 were included. Main outcome measures Main outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme. Results In the 3-year period, a total of 632 infants survived to 5.5 years’ CA. Data were available for 484 infants (77%). At 5.5 years’ CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks’ gestation, respectively (p<0.001). Conclusions After lowering the threshold for supporting active treatment from 25 to 24 completed weeks’ gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years’ CA.

IntroductionExtra-uterine life support technology could provide a more physiologic alternative for the treatment of extremely premature infants, as it allows further fetal growth and development ex utero. Animal studies have been carried out which involved placing fetuses in a liquid-filled incubator, with oxygen supplied through an oxygenator connected to the umbilical vessels. Hence, by delaying lung exposure to air, further lung development and maturation can take place. This medical intervention requires adjustments to current obstetric procedures to maintain liquid-filled lungs through a so-called transfer procedure.MethodsOur objective was to develop obstetric device prototypes that allow clinicians to simulate this birth procedure to safely transfer the infant from the mother's uterus to an extra-uterine life support system. To facilitate a user-centered design, implementation of medical simulation during early phase design of the prototype development was used. First, the requirements for the procedure and devices were established, by reviewing the literature and through interviewing direct stakeholders. The initial transfer device prototypes were tested on maternal and fetal manikins in participatory simulations with clinicians.Results & discussionThrough analysis of recordings of the simulations, the prototypes were evaluated on effectiveness, safety and usability with latent conditions being identified and improved. This medical simulation-based design process resulted in the development of a set of surgical prototypes and allowed for knowledge building on obstetric care in an extra-uterine life support context.

Successful placentation is crucial for fetal development and maintaining a healthy pregnancy. Placental insufficiency can cause a variety of obstetric complications. Despite the many efforts to enhance diagnosing placental insufficiency, no imaging technique has proven satisfactory. A promising imaging technique is contrast-enhanced ultrasound (CEUS) using microbubbles which has proven capable of (micro)vascular imaging. Its use for placental vascularization assessment in human pregnancies remains constrained by limited evidence and safety concerns. This scoping review aims to demonstrate the safety of CEUS used in human pregnancy in the published literature to date.A systematic search using PubMed, Medline, Embase, and Cochrane databases was performed. All studies where contrast-enhanced ultrasound was used in pregnant humans were included. Studies, where there was a planned termination of pregnancy, were excluded. To assess the safety of CEUS during pregnancy, relevant outcomes were divided into the following 3 categories; fetal outcome, maternal outcome, and pregnancy and neonatal outcomes.A total of 13 articles were included, in which 256 women underwent CEUS during pregnancy. No clinically significant maternal or fetal adverse events or negative pregnancy or neonatal outcomes associated with CEUS were described.Based on our findings, we consider expanding the knowledge of this promising diagnostic technique in future larger clinical studies to be safe and relevant.

Background Fetal two-dimensional speckle tracking echocardiography (2D-STE) is an emerging technique for assessing fetal cardiac function by measuring global longitudinal strain. Alterations in global longitudinal strain may serve as early indicator of pregnancy complications, making 2D-STE a potentially valuable tool for early detection. Early detection can facilitate timely interventions to reduce fetal and maternal morbidity and mortality. Therefore, the aim of this study was to investigate the feasibility of performing 2D-STE at 16 weeks gestational age. Methods This pilot study utilized 50 ultrasound clips of the fetal four-chamber view recorded between 15+5 and 16+2 weeks gestational age from a prospective cohort study. A strict protocol assessed three parameters essential for 2D-STE analysis: fetal four-chamber view ultrasound clip quality, region of interest, and frame rates. Two independent researchers measured global longitudinal strain in all adequate fetal four-chamber view ultrasound clips to determine inter- and intra-operator reliability. Results Out of the 50 ultrasound clips, 37 (74%) were feasible for 2D-STE analysis. The inter-operator reliability for global longitudinal strain measurements of the left and right ventricles was moderate (ICC of 0.64 and 0.74, respectively), while the intra-operator reliability was good (ICC of 0.76 and 0.79, respectively). Conclusions Our findings demonstrate that fetal 2D-STE analysis at 16 weeks gestational age is feasible when adhering to a strict protocol. However, further improvements are necessary to enhance the inter- and intra-operator reliability of 2D-STE at this gestational age.

OBJECTIVE:To assess whether artificial intelligence, inspired by clinical decision-making procedures in delivery rooms, can correctly interpret cardiotocographic tracings and distinguish between normal and pathological events.STUDY DESIGN:A method based on artificial intelligence was developed to determine whether a cardiotocogram shows a normal response of the fetal heart rate to uterine activity (UA). For a given fetus and given the UA and previous FHR, the method predicts a fetal heart rate response, under the assumption that the fetus is still in good condition and based on how that specific fetus has responded so far. We hypothesize that this method, when having only learned from fetuses born in good condition, is incapable of predicting the response of a compromised fetus or an episode of transient fetal distress. The (in)capability of the method to predict the fetal heart rate response would then yield a method that can help to assess fetal condition when the obstetrician is in doubt. Cardiotocographic data of 678 deliveries during labor were selected based on a healthy outcome just after birth. The method was trained on the cardiotocographic data of 548 fetuses of this group to learn their heart rate response. Subsequently it was evaluated on 87 fetuses, by assessing whether the method was able to predict their heart rate responses. The remaining 43 cardiotocograms were segment-by-segment annotated by three experienced gynecologists, indicating normal, suspicious, and pathological segments, while having access to the full recording and neonatal outcome. This future knowledge makes the expert annotations of a quality that is unachievable during live interpretation.RESULTS:The comparison between abnormalities detected by the method (only using past and present input) and the annotated CTG segments by gynecologists (also looking at future input) yields an area under the curve of 0.96 for the distinction between normal and pathological events in majority-voted annotations.CONCLUSION:The developed method can distinguish between normal and pathological events in near real-time, with a performance close to the agreement between three gynecologists with access to the entire CTG tracing and fetal outcome. The method has a strong potential to support clinicians in assessing fetal condition in clinical practice.