Extracorporeal membrane oxygenation (ECMO) is important for congenital diaphragmatic hernia (CDH), in case of adequate oxygenation is not achieved with conventional management. In the present study, we evaluated the changes of survival outcome in neonates with left-sided CDH who supported with ECMO over 10 years. Newborns diagnosed prenatally with left-sided CDH between January 2013 and December 2022 were studied retrospectively. Cases with concomitant congenital heart disease requiring surgery or multiple congenital anomaly were excluded. We compared survival after ECMO treatment at the last five years with the previous five years. Of the 122 neonates diagnosed with L-CDH, 22 received ECMO according to indications for initiation of extracorporeal life-support for CDH. In the first five years, a total of 9 received ECMO. One of them died before surgery, and the remaining 8 underwent surgery after ECMO (88.89%), but none of them survived. In the last five years, 13 received ECMO, 5 of whom died before surgery (38.46%). The other 8 underwent CDH repair after a stabilisation period on ECMO, 6 of whom survived (75%). Of the two cases that died after surgery, one case was in good condition after CDH repair but died after surgery for combined anormaly (laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis) and the O/E LHR were 18% and 18% (longest diameter and trace method) in the other case. In our study, prenatal fetal ultrasound data showed significant differences between the ECMO and non-ECMO groups, but no significant differences between the survivor and non-survivor groups. Prenatal measurements can predict disease severity and the need for ECMO, but may not be associated with mortality after the initiation of ECMO. Standardising care, involving multidisciplinary teams, and individualising care have improved survival outcomes over the past five years and additional effort will be required.

Pregnancies complicated with fetal growth restriction (FGR) have increased risk of short- and long-term neonatal morbidities. To determine altered Doppler ultrasound findings that are associated with composite adverse perinatal outcome (CAPO) of early- and late-onset FGR with estimated fetal weight (EFW) < 3rd centile. A multicentre retrospective study was conducted on women with FGR of EFW < 3rd centile by Hadlock standard. Ultrasound findings were obtained typically by one week before birth. As Doppler indices change with gestational age, values were expressed into z-scores. CAPO was defined as the occurrence of at least two of 5-min Apgar score < 7, umbilical artery (UA) pH < 7.10, neonatal care unit (NICU) admission, respiratory distress, neonatal enterocolitis, intraventricular hemorrhage, sepsis, perinatal loss, and emergency Caesarean section for fetal distress. Logistic regression analysis was used to determine the association between Doppler ultrasound variables and CAPO. In early onset, 114 singleton pregnancies were included. On multivariable logistic regression analysis, z-score of cerebroplacental ratios (CPR) (p = 0.021) was associated independently with CAPO. Z-score of UA pulsatility index (PI) and middle cerebral artery (MCA) PI were not significant. In late onset, 86 singleton pregnancies were included. Z-score of MCA PI (p = 0.021) and of CPR (p = 0.008) were associated independently with CAPO. When compared between groups with CPR < 5th centile and those without. In the group with CPR < 5th centile, emergency Caesarean section for fetal distress was significantly high and UA pH was low at early-onset FGR. In late-onset FGR, low UA pH, stay in NICU, and pre-eclampsia in pregnancy were increased. In FGR of EFW < 3rd centile, z-score of CPR is associated independently with CAPO in early-onset FGR. Along with z-score of CPR, z-score of MCA PI is also associated independently with CAPO in late-onset FGR.

Prenatally, the cavum septi pellucidi (CSP) should be visible until close to term. Non-visualisation, particularly during the second trimester, is considered to be a marker of agenesis of the corpus callosum (CC). Failure to visualise the CSP during pregnancy may stem from agenesis of the septa or lack of formation or obliteration of the space between them. The cases with non-visualisation of CSP have been reported, presenting lipomas, cysts, hematoma, and other structures in CSP. Cases in which CSP is not confirmed, including the above cases, have very low incidence and are not frequently reported, so there are many limitations in predicting and consulting postnatal prognosis. The purpose of this study was to present our experience with a cohort of fetuses without callosal agenesis in which absence of fluid or increased echogenicity in the expected region of the CSP was observed and to evaluate the significance of this finding. 31 cases have reviewed and the mean value of maternal age at delivery was 32.54. The gestational age at diagnosis were reported as 20-24 weeks (17), 25-29 weeks (7), 30-34 weeks (5), less than 37 weeks (1) and 37 weeks or more (1). The ventricle was of normal size excepting 4 cases, and all the cisterna magna were within the normal range. Postnatal diagnoses were reported in 15 cases, including right hemimegalencephaly and left hemiparesis (1), normal (3), tiny subependymal cysts in bilateral caudothalamic grooves (1), absent septum pellucidum (2), small germinal matrix hemorrhage (1), bilateral subpendymal cyst (1), thin corpus callosum, but normal morphology (1), septo-optic dysplasia (1), and corpus callosum agenesis (4). In conclusion, although this study is a relatively small number of cases, multicentre review in Korea with non-visualisation CSP analysed prenatal and postpartum prognosis adding the reviews of international cases, which will be helpful for perinatal prognosis counselling.

areas; ventricular widths, lengths, and areas; and annular diameters of the tricuspid and mitral valves.In the outflow tract view, annular diameters of the aortic and pulmonary valves when open and closed and the diameter of the ascending aorta were measured.In the three vessel view, diameters of the pulmonary artery, aorta, superior vena cava, and thymus were measured.In the three-vessel tracheal view, diameters of the aortic isthmus and ductus arteriosus were measured.In the aortic arch view, the diameters of the ascending aorta, proximal and distal transverse aortic arches, aortic isthmus, and descending aorta were measured.The HeartAssist™ (Samsung Medison Co. Ltd., Seoul, Republic of Korea) was used for all measurements, which were further modified manually by two experts in fetal echocardiography.Results: We analysed video clips from 350 fetuses and designed scatterplots for each parameter according to GA.The cardiac axis was constant throughout gestation, with a mean value of 37.2 • .All other parameters increased gradually with advancing GA.The mean ratios of the left ventricular width and length to the right ventricular width and length were 0.96 and 1.09, respectively.Annular diameters of the aortic valve and pulmonary valve were larger when the valves were closed than when open.Conclusions: We established comprehensive reference ranges for fetal cardiac parameters by using HeartAssist™. EP24.21Comparison of the left and right ventricular size and systolic function of low-risk fetuses in the third trimester: which is more dominant?

The traditional fetal growth restriction is defined as an estimated fetal weight (EFW) or abdominal circumference < 10th percentile for gestational age and associated with adverse perinatal outcomes. Sometimes, fetuses with 10-15th percentile of EFW have a similar prognosis and outcomes as traditional FGR fetuses. So, we compare Doppler findings and perinatal outcomes in fetuses according to EFW near 10th percentile. (3-10th vs. 10-15th percentile). This multicentre study included fetuses, whose EFW was under 15th and above 3rd percentile. All recruited fetuses underwent sonographic assessment of fetal weight and Doppler studies before birth. We evaluated Doppler findings and perinatal outcomes of early- and late-onset FGR, separately, according to EFW percentile (3rd-10th percentile vs. 10th-15th percentile). Total 348 fetuses with EFW around 10th percentile were included. In early-onset FGR, EFW of 59 fetuses was under 10th and above 3rd percentile (Group A) and that of 17 fetuses was under 15th and above 10th percentile (Group B). Systolic/diastolic ratio of umbilical artery was higher in group A than in group B (3.0 vs. 2.5, p = 0.011). However, percentiles of UA-PI, MCA-PI and CPR were not significantly different between two groups. Neonatal outcomes except NICU hospitalisation were not significantly different between two groups. In late-onset FGR, EFW percentile of 176 fetuses was under in group A and that of 96 fetuses was in group B. Doppler findings were not different. The rate of NICU admission was higher and mean duration of NICU hospitalisation was longer in group A than in group B. However, other neonatal outcomes were not significantly different, like early-onset FGR. In both early- and late-onset FGR, there is no difference in Doppler findings around 10th percentile of EFW. Although, the rate of NICU admission was high in group A than in the group B, there is no difference in other neonatal outcomes.

To provide reference ranges for fetal cardiac parameters by using HeartAssist™, an automated system for measuring such parameters, in 17 large referral centres in South Korea. This prospective study included normal singleton fetuses between 16.0 and 36.6 weeks of gestational age (GA) from October 2022 to February 2023. Video clips of the fetal hearts were collected, and a total of 34 parameters were measured in six cardiac views. In the four chamber view, we measured cardiac axis; thoracic area and circumference; heart area and circumference; atrial widths and areas; ventricular widths, lengths, and areas; and annular diameters of the tricuspid and mitral valves. In the outflow tract view, annular diameters of the aortic and pulmonary valves when open and closed and the diameter of the ascending aorta were measured. In the three vessel view, diameters of the pulmonary artery, aorta, superior vena cava, and thymus were measured. In the three-vessel tracheal view, diameters of the aortic isthmus and ductus arteriosus were measured. In the aortic arch view, the diameters of the ascending aorta, proximal and distal transverse aortic arches, aortic isthmus, and descending aorta were measured. The HeartAssist™ (Samsung Medison Co. Ltd., Seoul, Republic of Korea) was used for all measurements, which were further modified manually by two experts in fetal echocardiography. We analysed video clips from 350 fetuses and designed scatterplots for each parameter according to GA. The cardiac axis was constant throughout gestation, with a mean value of 37.2°. All other parameters increased gradually with advancing GA. The mean ratios of the left ventricular width and length to the right ventricular width and length were 0.96 and 1.09, respectively. Annular diameters of the aortic valve and pulmonary valve were larger when the valves were closed than when open. We established comprehensive reference ranges for fetal cardiac parameters by using HeartAssist™.

Accurate prenatal assessment of fetal trachea could provide relevant information for perinatal management.This study aimed to quantitatively evaluate tracheal compression caused by VR in fetuses using prenatal ultrasound.Methods: The data of fetuses with VR diagnosed by ultrasound were retrospectively analysed, which were divided as those with complete VR including double aortic arch (DAA), right aortic arch with an aberrant left subclavian artery and a left patent ductus arteriosus (RAA-ALS), and those with incomplete VR as aberrant right subclavian artery (ARS).Pregnancies with normal fetuses were recruited as control.Tracheal internal diameters (TID) and z scores against gestational age was assessed.The Fetuses were divided into two groups based on tracheal compression for the comparison of z scores.The ROC curve for z score cut-offs and prediction of significant trachea compression was plotted.Results: A total of 80 fetuses with VR were diagnosed.67 normal fetuses were enrolled.The difference in normal group and incomplete VR group ( 43) was not significant (2.4 ± 0.5 vs. 2.4 ± 0.4, P > 0.05), while TID and z scores were significantly lower in fetuses with complete VR (37)(1.4± 0.5 vs. 2.4 ± 0.5, P < 0.05; -1.2 (-1.5, -0.8) vs. 0.3 (-0.1, 0.6), P < 0.05).The AUC was 0.946 (95% CI, 0.90-1.00).Using a TID z scores cut-off of -0.44, the sensitivity was 89%, and the specificity was 92%.Conclusions: Prenatal tracheal compression may happen in infants with VR and cause clinical symptoms.We found that complete VR could lead to even more severe compression of fetal trachea.Prenatal surveillance of TID and comparison to z score reference ranges could be necessary in this subset of fetuses.

the MC twin and the DC twin growth chart, both are significantly smaller than the KSGC, but among them, the MC twin slightly smaller than the DC twin growth chart.The 50 percentile values of the Korean DC twin growth chart and are similar to NICHD but the KTGH has a smaller 90 percent value and a larger 10 percent value than NICHD chart. Conclusions:The KTGH has different patterns from the KSGC, and it has a very similar value to the 50 percentile of NICHD.However, the width of the distribution is narrow compared to the NICHD chart.Korean twins will need to apply a new chart that fits Korean standards clinically.

To investigate prenatal ultrasonographic and postnatal computed tomography angiographic (CTA) characteristics of the double aortic arch (DAA) to determine predictors of postnatal outcome. After excluding patients with major anomalies, loss of follow-up, and misdiagnosis, we retrospectively enrolled patients who were prenatally diagnosed with DAA at Asan Medical Center between 2011 and 2021. Using prenatal echocardiographic features, the maximal inner diameter of the aortic arch in three-vessel-trachea view was measured to calculate the right-to-left aortic arch diameter ratio. Using classification of postnatal CTA features, clinical outcomes were evaluated by DAA subtype. Of 48 prenatally diagnosed DAA fetuses, DAA was confirmed by postnatal investigation in 41 patients and included 41 (85.4%) isolated DAA cases. No genetic abnormalities were identified. Among 41 postnatally confirmed DAA cases, compression symptoms were present in 20 (48.8%, average age 11.5 months), with 19 (46.3%) receiving surgical treatment by 22.5 months on average. The right-to-left aortic arch diameter ratio tended to be low in symptomatic DAA cases. Thirty-two who were investigated by CTA were classified as right-arch dominant, double-arch dominant and atretic left arch, respectively, with the highest symptom-appearance frequency and earliest onset time in double-arch dominant DAA. Despite no chromosomal abnormality and rare with anomalies, half of the prenatally diagnosed DAA cases had symptoms and underwent surgery in infancy. A right-to-left aortic arch diameter ratio on prenatal ultrasound findings and postnatal CTA-based classification can predict clinical outcomes. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

To determine the diagnostic accuracy of coarctation of the aorta (CoA) using several defined z-scores for fetal cardiac parameters, including the new Korean z-scores. This retrospective study included fetuses prenatally suspected with CoA between January 2010 and December 2021 at Asan Medical Center. CoA was suspected prenatally when the z-score of aortic isthmus was < −2 according to previously reported z-scores in the three-vessel-trachea view (3VTV) or sagittal view on fetal echocardiography. Study population were further evaluated whether to be suspected to have CoA using the new Korean z-scores. The final diagnosis was confirmed using echocardiography or cardiac computed tomography performed postbirth. The diagnostic accuracy, Kappa score, and area under the curve (AUC) were compared using different z-scores of aortic isthmus. A total of 228 fetuses were evaluated. On 3VTV, the Korean z-scores of aortic isthmus based on EFW showed the highest diagnostic accuracy of 68.0%, along with Kappa score and AUC (0.4 and 0.73, respectively), indicating higher diagnostic validity compared with previously reported z-scores (0.22 and 0.63, respectively). On sagittal view, Korean z-scores of aortic isthmus based on EFW showed the highest diagnostic accuracy of 57.0%, along with Kappa score and AUC (0.24 and 0.65, respectively), compared with previous findings. Evaluation of aortic isthmus using the new Korean z-scores may improve the diagnostic accuracy of CoA.

During Caesarean sections (CS), hypotension is a common complication that can lead to adverse fetal outcomes. Early prediction and intervention can help prevent intraoperative hypotension, but there is currently no available method to accurately predict hypotension. This study aims to predict intraoperative hypotension during CS with deep learning-based models from intraoperative non-invasive hemodynamic data which are routinely monitored. A multicentre retrospective study was conducted on pregnant women who underwent CS under spinal anesthesia: (1) Seoul National University Hospital (SNUH, n = 987) and (2) Boramae Medical Center (BMC, n = 180). Intraoperative hypotension was defined as a mean arterial pressure of less than 65mm Hg at any point during surgery. A deep learning-based prediction models (DLPM) for intraoperative hypotension was developed, using preoperative variables and non-invasive hemodynamic monitoring data. The prediction model calculated the risk of intraoperative hypotension after 1 and 5 minutes in real-time. In SNUH, 39,239 and 37,852 were extracted at 1 and 5 minutes prior to the event, respectively, and the incidence of hypotension for each segment was 8.54% and 8.77%. In BMC, the incidence of hypotension was found to be 3.58% and 3.56% from 5,643 and 5,614 segments analysed at 1 and 5 minutes prior to the event, respectively. The DLPM successfully predicted the risk of hypotension at 1 and 5 minutes prior to occurrence, with areas under the receiver operating characteristic curve of 0.80 and 0.74 in SNUH internal validation, and 0.76 and 0.72 in BMC external validation set, respectively. The deep learning-based algorithm has been successful in predicting intraoperative hypotension during CS and might be used for early intervention. However, further studies are required to explore the clinical usefulness of prediction model for prevention of adverse outcomes.

Conclusions: There is a remarkable difference in the sensitivity of fetal anomaly screening by F+STS, compared to s-STS.This result may reflect a difference in the spectrum of anomalies present at the time of screening, rather than a true difference in sensitivity.