BACKGROUND:This study aimed to evaluate maternal and neonatal outcomes following immediate delivery or expectant management of preterm premature rupture of membranes (PPROM) during the late preterm period at 34⁺⁰-36⁺⁶ weeks of gestation. METHODS:We conducted a retrospective study of singleton pregnancies with PPROM during the late preterm period using medical records from 12 tertiary medical centers in the republic of Korea between January 2007 and December 2016. Demographic characteristics and outcome measures were also recorded. The primary outcomes were maternal sepsis, neonatal sepsis, and neonatal death for neonatal outcomes. RESULTS:Among 1,072 women with late PPROM, 782 (72.9%) underwent immediate delivery and 290 (27.1%) received expectant management. The incidence of clinical neonatal sepsis was significantly lower in the immediate delivery group than in the expectant management group (3.8% vs. 15.8%, P < 0.001). There were no significant differences in culture-proven neonatal sepsis (P = 0.211), neonatal death (P = 0.390), or maternal sepsis (P = 0.542) between groups. Although antenatal corticosteroids were more frequently administered in the expectant management group, the need for mechanical ventilation was not significantly higher (P = 0.414). However, the need for surfactant administration was lower (P = 0.010). Expectant management was associated with a lower rate of primary cesarean section (P = 0.002) but a higher incidence of antepartum fever and elevated C-reactive protein levels (P = 0.048 and P < 0.001, respectively). CONCLUSION:In women with late PPROM, expectant management does not increase the risk of severe maternal or neonatal morbidity or mortality compared to immediate delivery. Therefore, with close surveillance for complications, such as chorioamnionitis and fetal compromise, particularly clinical neonatal sepsis, expectant management can be a judicious treatment option in clinical practice.

Estimating the remaining time to delivery could aid intrapartum counseling. We derived a model relating the intrapartum angle of progression (AOP) to this interval in Korean nulliparous women in active labor. In this prospective study, 102 women with singleton, term, cephalic pregnancies were enrolled at the first examination documenting cervical dilatation ≥ 6 cm. Twenty-two underwent intrapartum cesarean delivery; the remaining 80, all of whom had spontaneous vaginal delivery, formed the derivation cohort. The predictor was enrollment AOP, and the outcome was log-transformed time to delivery (TTD). Higher enrollment AOP was associated with a shorter remaining time: β = − 0.134 per 1° (95% CI, − 0.166 to − 0.102); TTD = exp(21.04 − 0.134 × AOP); optimism-corrected R2 = 0.44 (95% CI, 0.26–0.63); optimism-corrected calibration slope = 1.01 (95% CI, 1.00–1.05); and median absolute error = 36 min (95% CI, 26–43). Fetal station as recorded in routine practice explained essentially none of the variation in ln(TTD): apparent R2 = 0.001 (95% CI, 0.000–0.049); adding enrollment AOP increased the apparent R2 by 0.498 (95% CI, 0.364–0.641). The study was not registered. This single-center derivation model estimates TTD conditional on subsequent spontaneous vaginal delivery and requires external validation before clinical use.

BACKGROUND:The proportion of mothers older than 35 years is increasing; however, research examining the age at which pregnancy is considered high risk across different races and countries is limited. Therefore, this study aimed to determine the cut-off age at which adverse obstetric outcomes significantly increase by investigating age-specific incidence rates of major adverse obstetric outcomes in Republic of Korea (South Korea). METHODS:We analyzed the Korean National Health Insurance claims database between 2015 and 2021, focusing on women with obstetric complications classified using the International Classification of Diseases, Tenth Edition. The maternal cut-off age was defined as the age at which the outcome was most predictive in receiver operating characteristic curve analysis. Multivariate logistic regression was used to estimate the adjusted odds ratio (OR) and 95% confidence interval (CI) for the association between maternal age and adverse obstetric outcomes. RESULTS:The study included 1,862,393 women with singleton pregnancies. Of these, 33.67% were aged ≥ 35 years and 5.07% were aged ≥ 40 years. The incidence of adverse obstetric outcomes increased linearly and positively with maternal age. The maternal cut-off age, determined using receiver operating characteristics analysis, was 35 years for pregnancy-induced hypertension (PIH), 33 for gestational diabetes mellitus (GDM), 33 for placenta previa, 32 for placental abruption, 34 for preterm delivery, and 34 for low birth weight (LBW). In multivariate analyses, adjusted OR revealed adverse obstetric outcomes: PIH (OR, 1.29; 95% CI, 1.27-1.32), GDM (OR, 1.73; 95% CI, 1.72-1.75), placenta previa (OR, 1.81; 95% CI, 1.78-1.85), placental abruption (OR, 1.30; 95% CI, 1.24-1.36), preterm delivery (OR, 1.32; 95% CI, 1.29-1.34), and LBW (OR, 1.33; 95% CI, 1.31-1.35). For the composite outcome, maternal cut-off age was found to be 33 years (OR, 1.57; 95% CI, 1.56-1.59), with an area under the curve of 0.573. CONCLUSION:This nationwide study defined the cut-off age for advanced maternal age in Korean women, showing that obstetric risks begin to increase in the early 30s. These population-specific thresholds may help guide clinical practice and improve maternal and perinatal outcomes.

BackgroundPlacenta accreta spectrum (PAS), an abnormal placental invasion into the myometrium or beyond the uterine serosa, is associated with adverse pregnancy outcomes. Placenta previa is the most significant individual risk factor for PAS, and Ultrasonography (US) and Magnetic resonance imaging (MRI) are widely used to detecting PAS. However, limited data exist on the effectiveness of US and MRI in predicting maternal and neonatal morbidity. This study evaluated the utility of these imaging modalities, not only in detecting PAS but also in predicting adverse perinatal outcomes.MethodsThis retrospective cohort study included 150 pregnant women with placenta previa who underwent US and MRI at a tertiary hospital between December 2019 and December 2023. PAS was diagnosed clinically or histopathologically after delivery. The predictive performance of US, MRI, and their combination was assessed using McNemar's test, receiver operating characteristic analysis, and trend analysis.ResultsForty-one patients were diagnosed with PAS. The PAS group had significantly higher rates of prior caesarean section, maternal hemorrhagic outcomes, and neonatal complications than the non-PAS group. PAS-suspected on US group also showed increased estimated blood loss (EBL) and number of transfusion units administered, as well as a higher incidence of transfusion requirement, use of intrauterine balloon tamponade, hysterectomy, preterm birth before 37 weeks of gestation, neonatal ventilatory support and 1-minutes Apgar scores (AS) <7 compared to those with PAS-unsuspected on US group. PAS-suspected on MRI group had a significantly increased number of transfusion units administered and higher rates of hysterectomy, maternal ICU admission, preterm birth and neonatal complications. US plus MRI yielded progressively higher detection rates, outperforming either modality alone. A linear trend was observed in the increase of adverse perinatal outcomes when PAS was suspected on both US and MRI.ConclusionsUS and MRI showed complementary strengths. US, but not MRI, is informative for predicting higher EBL, transfusion requirement, and use of intrauterine balloon tamponade, whereas MRI, but not US, predicts maternal ICU admission, preterm birth before 34 weeks of gestation, NICU admission, and 5-minute AS <7. Combining both imaging modalities yields better performance than either modality alone in detecting PAS and predicting adverse perinatal outcomes.

OBJECTIVES:Accurate nuchal translucency (NT) measurement for assessing the risk of fetal genetic abnormalities requires precise acquisition of the mid-sagittal plane (MSP). However, achieving an appropriate MSP is technically challenging due to anatomical variability and operator dependence inherent in conventional 2-dimensional (2D) ultrasound. This study aimed to develop and validate a novel deep learning algorithm for automated fetal MSP extraction from 3-dimensional (3D) ultrasound volumes utilizing intracranial structure segmentation to overcome the limitations of conventional methods reliant on facial landmarks. METHODS:In this prospective study, we developed and evaluated "3D MSP-net," a convolutional neural network (CNN)-based model for automated MSP extraction, involving singleton pregnant women undergoing first-trimester NT screening. Using achieved 3D volume data, 3D MSP-net was validated against the conventional 2D manual method and a commercially available rule-based automated system (5D NT™). Two maternal-fetal medicine (MFM) specialists independently assessed the resulting MPSs to determine the performance for demonstrating the feasibility and high reproducibility of the 3D MSP-net. RESULTS:3D MSP-net achieved an MSP extraction success rate of 91.6%, comparable to that of the conventional 2D manual method and significantly superior to the rule-based 3D algorithm. NT measurements were comparable between the conventional 2D manual approach and MSPs derived from 3D MSP-net (1.4 ± 0.5 mm versus 1.4 ± 0.4 mm; p = .444). These results were reproducible on external validation. Moreover, the 3D MSP-net maintained robust performance even under challenging conditions, such as increased maternal body mass index and different scan deviation angles. CONCLUSION:The 3D MSP-net, our artificial intelligence (AI) model that utilizes intracranial landmarks for MSP reconstruction, enables improved efficiency, standardization, and reliability for first-trimester fetal screening addressing a key challenge in prenatal diagnostics.

Objectives: Prenatal diagnosis of horseshoe kidney (HSK), a common congenital renal fusion anomaly of the upper urinary tract, remains challenging. Most cases are identified only after birth; however, the clinical significance of prenatal detection and its impact on postnatal outcomes remains unknown. Methods: We investigated infants with postnatally confirmed HSK born at a tertiary referral center between January 2009 and August 2025. Prenatal ultrasonographic findings and postnatal outcomes were reviewed. Patients were classified into three groups according to prenatal detection status: missed HSK (group 1), prenatally detected renal abnormalities without recognition of HSK (group 2), and prenatally identified HSK (group 3). Perinatal outcomes, postnatal urological complications, renal function, and associated anomalies were compared. Results: Overall, 29 infants were included in this study. Perinatal outcomes, including gestational age at delivery, birth weight, preterm birth, Apgar scores, need for ventilatory support, and neonatal sex, did not differ significantly among the groups. Hydronephrosis and renal scarring were more frequently observed in group 2 than in the other groups. Other urological outcomes, renal function parameters, and mortality rates were comparable between the groups. Conclusions: This adds to the limited longitudinal evidence linking the prenatal to postnatal period and evaluating the full spectrum of prenatal detection in HSK, as well as its association with postnatal outcomes. Postnatal outcomes are closely associated with the presence of renal abnormalities. Therefore, prenatal imaging is more appropriate for identifying associated renal abnormalities than for establishing a definitive diagnosis of HSK.

Background/Objectives: Diagnosing interstitial pregnancy (IP) using ultrasonography can be challenging, as it is often mistaken for eccentrically located intrauterine pregnancy (IUP). In this retrospective cohort study, we aimed to develop a predictive scoring model using multiple clinical factors to enhance the diagnosis of IP and facilitate timely interventions in suspected cases. Methods: We enrolled 63 pregnant women with a diagnosis of suspected IP who visited a single tertiary center between January 2006 and December 2023. Data on the clinical risk factors, symptoms, laboratory test results, and ultrasound findings were analyzed. A statistical predictive score was developed using logistic regression analysis with feature selection based on the least absolute shrinkage and selection operator to optimize the predictive accuracy and clinical applicability. Results: From a total of 12 factors, a scoring model was constructed from the three most prominent factors-ultrasound findings showing no surrounding endometrium, myometrial thinning of less than 5 mm, and vaginal bleeding-all of which demonstrated high feature importance. This predictive score identified IP with a negative predictive value of 0.950 in the low-risk group and a positive predictive value of 1.000 in the high-risk group, whereas the overall area under the curve was 0.998 (95% confidence interval, 0.992-1.000). Conclusions: The statistically derived predictive model--ultrasound showing no surrounding endometrium and myometrial thinning < 5 mm combined with vaginal bleeding--demonstrated high accuracy and practical applicability for IP diagnosis, providing a robust tool to enhance clinical decision-making and optimize routine management strategies for IP.

Background/Objective: Accurately identifying women at high risk for preterm birth among those with threatened preterm labor (PTL) is crucial for effective interventions or tocolytic management to reduce preterm birth and its complications. This study aimed to determine the predictive value of cervical elastography for preterm delivery before 37 weeks of gestation in patients with threatened PTL and a cervical length greater than 15 mm. Methods: This prospective cohort study included pregnant women presenting with threatened PTL at between 24 and 34 weeks gestation. All participants underwent cervical elastography at diagnosis. We compared cervical elastography parameters between women who delivered spontaneously preterm (<37 weeks) and those who delivered at full term and assessed the ability of these parameters to predict spontaneous preterm delivery. Results: Among the 107 enrolled individuals with threatened PTL and a cervical length of ≥15 mm, 55 (42%) experienced preterm birth (<37 weeks). Internal os stiffness (IOS), internal-to-external os stiffness ratio (IOS/EOS ratio), and elasticity contrast index (ECI) were significantly associated with a risk of preterm birth compared to full-term birth. The IOS/EOS ratio was associated with 10-fold higher odds of preterm birth at < 37 weeks (95% confidence interval [CI], 1.82–59.98), and ECI was associated with 1.5-fold higher odds (95% CI, 1.01–2.37). The IOS/EOS ratio demonstrated good predictive value (area under the curve (AUC) = 0.678) and the combination of CL ≤ 25 mm and the IOS/EOS ratio had good diagnostic performance for predicting preterm birth (AUC = 0.708). Conclusions: Cervical elastography using the E-Cervix™ system appears to improve the ability to predict preterm birth in pregnant women with threatened PTL and a cervical length greater than 15 mm.

Cervical length (CL) measurement using transvaginal ultrasound is an effective screening tool to assess the risk of preterm birth. An adequate assessment of CL is crucial, however, manual sonographic CL measurement is highly operator-dependent and cumbersome. Therefore, a reliable and reproducible automatic method for CL measurement is in high demand to reduce inter-rater variability and improve workflow. Despite the increasing use of artificial intelligence techniques in ultrasound, applying deep learning (DL) to analyze ultrasound images of the cervix remains a challenge due to low signal-to-noise ratios and difficulties in capturing the cervical canal, which appears as a thin line and with extremely low contrast against the surrounding tissues. To address these challenges, we have developed CL-Net, a novel DL network that incorporates expert anatomical knowledge to identify the cervix, similar to the approach taken by clinicians. CL-Net captures anatomical features related to CL measurement, facilitating the identification of the cervical canal. It then identifies the cervical canal and automatically provides reproducible and reliable CL measurements. CL-Net achieved a success rate of 95.5% in recognizing the cervical canal, comparable to that of human experts (96.4%). Furthermore, the differences between the CL measurements of CL-Net and ground truth were considerably smaller than those made by non-experts and were comparable to those made by experts (median 1.36 mm, IQR 0.87-2.82 mm, range 0.06-6.95 mm for straight cervix; median 1.31 mm, IQR 0.61-2.65 mm, range 0.01-8.18 mm for curved one).

BACKGROUND:The aim of our study was to investigate the clinical characteristics, discrepancies in postnatal diagnosis, and outcomes of prenatally diagnosed arachnoid cysts without extra-CNS anomalies. METHODS:This study was a multi-center retrospective cohort study from 16 participating university hospitals in South Korea, with patient data pooled from January 2010 to December 2019. This study focused on cases with prenatally diagnosed arachnoid cysts and analyzed postnatal diagnoses related to CNS anomalies, the need for surgery, and clinical outcomes. RESULTS:Thirty-seven fetuses with fetal arachnoid cysts were ultimately included in our analysis. These included 27 supratentorial cysts and 10 posterior fossa cysts, with 11 cases (29.7%) presenting associated CNS anomalies. The most common associated anomalies were ventriculomegaly (18.9%) and callosal abnormalities (10.8%). No chromosomal abnormalities were detected during antenatal care. Postnatal regression was observed in 14.8% of supratentorial cysts and 10.0% of posterior fossa cysts. Neurologic complications, present in 21.6% of all cases, were more prevalent in cases with associated CNS anomalies compared to isolated arachnoid cysts. CONCLUSION:In cases diagnosed with prenatal arachnoid cysts, ventriculomegaly and callosal anomalies are the most commonly associated CNS anomalies. The presence of additional CNS anomalies is the most critical factor affecting neurologic outcomes.

Background Endocrine-disrupting chemicals (EDCs) are environmental pollutants that may impair maternal and fetal health by disrupting hormonal systems, including the thyroid. Both iodine deficiency and excess are associated with thyroid dysfunction and adverse obstetrical outcomes. However, the combined impacts of EDCs and iodine exposure on maternal-fetal thyroid homeostasis remain undetermined. We established the Investigating Birth and Thyroid Outcomes of Maternal-Fetal Environmental Exposures (IBM-E) cohort to prospectively assess the effects of maternal exposures to dietary iodine and EDCs on thyroid function, pregnancy complications, and offspring growth and development. Methods In this prospective observational study, we aim to enroll 556 pregnant women between 2024 and 2027 at a tertiary hospital in Korea. Maternal blood and urine samples will be collected at six time points, spanning from early pregnancy through 15 months postpartum, with infant samples collected at three time points. EDCs will be quantified using ultra-high performance liquid chromatography-tandem mass spectrometry. Thyroid function and urinary iodine concentration will be measured in both mothers and infants. Results As of the current interim analyses of 193 mothers and 229 neonates, 15.0% of mothers had thyroid dysfunction and 11.4% developed preeclampsia. Preterm birth occurred in 23.8% of cases, and 16.6% of neonates were small for gestational age. Conclusion The IBM-E cohort is designed to enable the longitudinal assessment of gestational environmental exposures and their potential impacts on maternal and fetal thyroid function, as well as pregnancy and neonatal outcomes. The findings of this study may inform preventive strategies and guide policy development in perinatal environmental health.

OBJECTIVE:Prolapsed cervical myoma with uterine distortion during pregnancy are rare. CASE PRESENTATION:A 45-year-old woman at 30 weeks of gestation presented with a prolapsed mass and vaginal fluid leakage. A 9 × 8 × 8 cm3 prolapsed mass was observed outside the vaginal orifice, and preterm premature rupture of membranes (PPROM) was suspected. Transabdominal ultrasonography revealed an elongated cervix. Magnetic resonance imaging (MRI) indicated a cervical myoma causing mechanical pulling of the amniotic membrane, resulting in cervical elongation. The patient underwent antepartum vaginal myomectomy and manual reduction of uterine prolapse, which led to spontaneous resolution of PPROM. The subsequent pregnancy course was unremarkable. CONCLUSIONS:Prolapsed myoma with uterine distortion during pregnancy are extremely rare. Antepartum vaginal myomectomy should be considered with caution to reduce the risk of preterm births.

Background/Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary renal disorder; it is typically diagnosed in adulthood, but occasionally presents antenatally as very-early onset ADPKD. Despite advances in prenatal ultrasonography, knowledge regarding the postnatal course of fetal ADPKD remains limited, restricting reliable prognostic assessment and prenatal counselling. This study aimed to evaluate the prenatal sonographic features of fetal ADPKD and their correlation with postnatal outcomes. Materials and Methods: We retrospectively reviewed 20 cases of prenatally suspected ADPKD diagnosed at a single tertiary referral center between 2006 and 2024. Prenatal ultrasonographic findings including renal size, cortical echogenicity, corticomedullary differentiation (CMD), and cortical cysts were analyzed and correlated with postnatal clinical and genetic outcomes. Postnatal follow-up data, including renal function and progression to chronic kidney disease (CKD), were collected with a median follow-up of 93.6 months. Results: The most consistent prenatal ultrasonographic findings were increased cortical echogenicity (85%), increased CMD (75%), and renal enlargement (35%), with cortical cysts detected in 45% of cases. Amniotic fluid volume was preserved in most cases (80%). Postnatally, most infants maintained normal or near-normal renal function, although two progressed to CKD. Both CKD cases demonstrated absent CMD on prenatal imaging. Sonographic features resembling autosomal recessive polycystic kidney disease (ARPKD) were associated with adverse outcomes. Although CMD severity showed no correlation with short-term neonatal outcomes, loss of CMD may still serve as a potential early indicator of long-term renal dysfunction. Conclusions: Fetal ADPKD was associated with heterogeneous postnatal outcomes. Loss of CMD and ARPKD-like sonographic appearances may be associated with adverse prognosis, whereas most infants maintained preserved renal function. Early recognition of ADPKD is crucial for accurate counselling, appropriate perinatal management, and long-term surveillance.

During pregnancy, exposure to fine particulate matter (PM2.5), particularly diesel exhaust particles (DEPs), elevates the risk of placental dysfunction-related pregnancy complications; however, the underlying cellular mechanisms have yet to be fully elucidated. The objective of this study was to assess the effects of PM2.5 exposure on trophoblast functions and their interaction with endometrial stromal cells. We utilized a three-dimensional (3D) model in which human first-trimester trophoblasts (Sw71) formed blastocyst-like spheroids and were cultured with human endometrial stromal cells (HESCs). Trophoblast proliferation, migration, invasion, and 3D network formation following DEP exposure (0.5–20 μg/mL) were assessed using methyl thiazolyl diphenyl-tetrazolium bromide (MTT), wound healing, migration, and invasion assays. The expression levels of genes related to the epithelial-mesenchymal transition (EMT) were quantified by real-time reverse-transcription quantitative polymerase chain reaction (RT-qPCR). DEP exposure significantly inhibited trophoblast proliferation, migration, and invasion. DEP treatment dysregulated the EMT program by significantly decreasing the expression of key mesenchymal markers (SNAI1, SNAI2, SOX2, and KLF4) while upregulating epithelial markers. These changes may be related to inhibited trophoblast migration toward HESC monolayers and 3D invasive network formation. DEP directly impairs critical trophoblast functions that are essential for successful pregnancy. Disruption of the EMT program represents a molecular mechanism by which traffic-related air pollution contributes to placental dysfunction and pregnancy complications, highlighting the significant reproductive risks posed by ambient air pollution.

Objective: The study aimed to investigate the clinical outcomes of fetuses diagnosed with isolated mega cisterna magna in utero. Methods: A multicenter retrospective cohort study was conducted across 18 university hospitals from 2010 to 2019. Cases diagnosed with isolated mega cisterna magna, defined as a cisterna magna >10 mm with a normal cerebellar vermis and no cystic dilation of the fourth ventricle, were included. Cases with other central nervous system (CNS) anomalies, extra-central nervous system anomalies, chromosomal abnormalities, or congenital infections were excluded. Maternal demographics, prenatal findings, delivery outcomes, and postnatal outcomes were analyzed. Results: The mean gestational age at initial diagnosis was 28.6 ± 3.9 weeks, and the mean anteroposterior diameter of the cisterna magna was 12.5 ± 3.2 mm. Of the 71 cases initially assessed, 48 (67.6%) showed self-regression in utero. Postnatally, 13 cases (18.3%) had persistent isolated mega cisterna magna, whereas 10 cases (14.1%) were diagnosed with other central nervous system anomalies. Among the persistent isolated mega cisterna magna cases, one child exhibited delayed neurodevelopment. There was a higher incidence of isolated mega cisterna magna in male fetuses, which exhibited a significantly larger mean cisterna magna diameter compared with female fetuses (P = .045). Conclusion: Male fetuses exhibited a higher incidence of isolated mega cisterna magna compared with female fetuses and had larger anteroposterior diameters of the cisterna magna. The study demonstrated favorable neurodevelopmental outcomes associated with isolated mega cisterna magna, with self-regression observed in two-thirds of the cases. However, consecutive prenatal and postnatal evaluations for additional central nervous system or extra-central nervous system malformations need to be performed, considering the differences between prenatal and postnatal diagnoses.

Objectives: To determine the effects of cerclage on twin pregnancies. Methods: A multicenter, retrospective, cohort study was conducted at 10 tertiary centers using a web-based data collection platform. The study population included twin pregnancies delivered after 20 weeks of gestation. Patients with one or two fetal deaths before 20 weeks of gestation were excluded. Maternal characteristics, including prenatal cervical length (CL) and obstetric outcomes, were retrieved from the electronic medical records. Results: A total of 1,473 patients had available data regarding the CL measured before 24 weeks of gestation. Seven patients without CL data obtained prior to cerclage were excluded from the analysis. The study population was divided into two groups according to the CL measured during the mid-trimester: the CL <= 2.5 cm group (n = 127) and the CL >2.5 cm group (n = 1,339). A total of 127 patients (8.7%) were included in the CL <= 2.5 cm group, including 41.7% (53/127) who received cerclage. Patients in the CL >2.5 cm group who received cerclage had significantly lower gestational age at delivery than the control group (hazard ratio (HR): 1.8; 95% confidence interval (CI): 1.11-2.87; p = .016). Patients in the CL <= 2.5 cm group who received cerclage had a significantly higher gestational age at delivery than the control group (HR: 0.5; 95% CI: 0.30-0.82; p value = .006). Conclusions: In twin pregnancies with a CL <= 2.5 cm, cerclage significantly prolongs gestation. However, unnecessary cerclage in women with a CL >2.5 cm may result in a higher risk of preterm labor and histologic chorioamnionitis although this study has a limitation originated from retrospective design.

OBJECTIVE:To assess prenatal ultrasonographic findings and postnatal outcomes in fetuses with intracranial hemorrhage (ICH). METHODS:This retrospective study included fetuses prenatally diagnosed with ICH between December 2012 and August 2023. Maternal characteristics, prenatal ultrasonographic findings, and postnatal outcomes were reviewed. RESULTS:Twenty-seven fetuses with ICH were reviewed. Intracranial hemorrhage was classified as grade 3 and 4 in 24 fetuses. Twenty-two fetuses had ICH, four had ICH with subdural hemorrhage, and one had ICH with subarachnoid hemorrhage. Ventriculomegaly was the most common ultrasonographic finding, and was observed in 22 of the 27 (81.5%) fetuses. Seven fetuses were lost to follow-up, and four intrauterine fetal deaths occurred. The remaining 16 fetuses were delivered at a median gestational age of 35+2 weeks. The infants were followed-up for 40.1 months (range, 4-88). Nine of the 16 infants underwent ventriculoperitoneal placement. One infant underwent brain surgery for severe epilepsy. Motor impairment, including cerebral palsy, was observed in 13 infants (81.2%). Neurologic impairment occurred in six infants (37.5%), developmental delay in nine (56.2%), and epilepsy in 11 (68.7%). CONCLUSION:Fetal ICH is a rare complication diagnosed during pregnancy, which results in subsequent fetal neurological sequelae or death. This study demonstrated that the common ultrasonographic findings in fetal ICH were progressive ventriculomegaly and increased periventricular echogenicity. Fetuses diagnosed with prenatal ICH, especially those affected by higher-grade ICH, may be at an increased risk of long-term neurodevelopmental problems.