Human cytomegalovirus (CMV) is an ubiquitous pathogen, with a high worldwide seroprevalence. When acquired in the prenatal period, congenital CMV (cCMV) is a major cause of neurodevelopmental sequelae and hearing loss. cCMV remains an underdiagnosed condition, with no systematic screening implemented in pregnancy or in the postnatal period. Therefore, imaging takes a prominent role in prenatal diagnosis of cCMV. With the prospect of new viable therapies, accurate and timely diagnosis becomes paramount, as well as identification of fetuses at risk for neurodevelopmental sequelae. Fetal magnetic resonance imaging (MRI) provides a complementary method to ultrasound (US) in fetal brain and body imaging. Anterior temporal lobe lesions are the most specific finding, and MRI is superior to US in their detection. Other findings such as ventriculomegaly, cortical malformations and calcifications, as well as hepatosplenomegaly, liver signal changes and abnormal effusions are unspecific. However, when seen in combination these should raise the suspicion of fetal infection, highlighting the need for a full fetal assessment. Still, some fetuses deemed normal on prenatal imaging are symptomatic at birth or develop delayed cCMV-associated symptoms, leaving room for improvement of diagnostic tools. Advanced MR sequences may help in this field and in determining prognosis, but further studies are needed.

Pregnancies complicated by type II sFGR are diagnosed significantly earlier and are associated with increased risk of adverse perinatal outcomes when compared to type I. Co-existing TTTS has no significant impact on the perinatal outcome of pregnancies diagnosed with either type I or type II sFGR. Earlier GA at diagnosis, type II sFGR and higher DV PI z scores are significantly associated with increased risk of adverse perinatal outcome for the smaller twin.

High UtA-PI at term is associated independently with an increased risk of adverse perinatal outcome, regardless of fetal size. These results suggest that perinatal mortality at term is related not only to EFW and fetal redistribution (CPR), but also to indices of uterine perfusion. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

The sFlt-1 (soluble fms-like tyrosine kinase-1), PlGF (placental growth factor), and their ratio are useful for predicting delivery because of preeclampsia in singleton pregnancies. Evidence on the utility of sFlt-1/PlGF ratio in twin pregnancies is lacking. We aimed to evaluate the predictive value of sFlt-1/PlGF ratio for delivery because of preeclampsia in twins. A retrospective data analysis of 164 twin pregnancies with suspected preeclampsia was performed. The sFlt-1/PlGF ratio, which was known to clinicians, was significantly higher in women who delivered within 1 and 2 weeks compared with those who did not (median: 98.9 and 84.2 versus 23.5 pg/mL, respectively; P <0.001). The area under the curve values sFlt-1/PlGF ratio levels were 0.88 (95% CI, 0.83–0.84) and 0.88 (95% CI, 0.83–0.93) for predicting delivery because of preeclampsia within 1 and 2 weeks of blood sampling, respectively. The predictive accuracy of sFlt-1/PlGF was independent of gestational age at sampling and chorionicity ( P >0.100 for interaction). The area under the curve values of sFlt-1/PlGF were significantly higher than for PlGF alone (mean 0.88 and 0.88 versus 0.81 and 0.80) for predicting delivery because of preeclampsia within 1 and 2 weeks of blood sampling ( P =0.055 and 0.001, respectively). sFlt-1/PlGF ratio lower than 38 was able to rule-out delivery within 1 and 2 weeks with a negative predictive value of 98.8% and 96.4% for delivery because of preeclampsia within 1 and 2 weeks, respectively. A cutoff of 38 is applicable for ruling out delivery because of preeclampsia in twin pregnancies.

Background Pregnant women are at increased risk of mortality and morbidity due to coronavirus disease 2019 (COVID-19). Many studies reported on the association of COVID-19 with pregnancy specific adverse outcomes but prediction models utilizing large cohort of pregnant women are still lacking for estimating the risk of maternal morbidity and other adverse events. Objective The main aim of this study was to develop a prediction model to quantify the risk of progression to critical COVID-19 and intensive care unit admission in pregnant women with symptomatic infection. Study design This was a multicenter retrospective cohort study including eight hospitals from four countries (UK, Austria, Greece and Turkey). Data extraction was from February 2020 until May 2021. Included were consecutive pregnant and early postpartum women (within 10 days of birth), reverse transcriptase polymerase chain reaction confirmed SARS-CoV-2 infection. The primary outcome was progression to critical illness requiring intensive care. Secondary outcomes included maternal death, preeclampsia and stillbirth. The association between the primary outcome and 12 candidate predictors with known association with severe COVID-19 in pregnancy, was analyzed with log-binomial mixed-effects regression and reported as adjusted risk ratios (aRR). All potential predictors were evaluated in one model and only baseline factors in another. Predictive accuracy were assessed by the area under the receiver operating characteristic curves (AUROC). Results Of 793 pregnant women positive for SARS-CoV-2 and symptomatic, 44 (5.5%) were admitted to intensive care, of whom 10 died (1.3%). The ‘mini-COvid Maternal Intensive Therapy’ model included demographic and clinical variables available at disease onset: maternal age (aRR: 1.45, 95% CI: 1.07–1.95, P=0.015); body-mass index (aRR: 1.34, 95% CI: 1.06–1.66, P=0.010); and diagnosis in the third trimester of pregnancy (aRR: 3.64, 95% CI: 1.78–8.46, P=0.001). The optimism-adjusted AUROC was 0.73. The ‘full-COvid Maternal Intensive Therapy’ model included body-mass index (aRR: 1.39, 95% CI: 1.07–1.95, P=0.015), lower respiratory symptoms (aRR: 5.11, 95% CI: 1.81–21.4, P=0.007), neutrophil/lymphocyte ratio (aRR: 1.62, 95% CI: 1.36–1.89, P<0.001); and serum C-reactive protein (aRR: 1.30, 95% CI: 1.15–1.44, P<0.001), with an optimism-adjusted AUROC 0.85. Neither model showed signs of poor fit (P>0.05). Categorization as high risk by either model was associated with a shorter diagnosis to ICU admission interval (log-rank test P<0.001, both), higher maternal death (5.2% vs. 0.2%; P<0.0001) and preeclampsia (5.7% vs. 1.0%; P=0.0003). A spreadsheet calculator is available for risk estimation. Conclusion At presentation with symptomatic COVID-19, pregnant and recently postpartum women can be stratified into high and low-risk for progression to critical disease, even where resources are limited. This ...

In MCMA twins surviving beyond 24 weeks of gestation, there was a higher survival rate compared to previous decades presumably due to early diagnosis, close surveillance and elective birth around 32-34 weeks of gestation. High perinatal mortality at early gestations was mainly attributed to extreme prematurity due to preterm spontaneous labour. This article is protected by copyright. All rights reserved.

Angiogenic markers such as PlGF (placental growth factor) and sFlt-1 (soluble Fms-like tyrosine kinase-1) have been shown to be useful for predicting adverse outcome in women suspected of having preeclampsia. The aim of the current study was to evaluate the prognostic value of angiogenic markers and maternal risk factors in pregnant women with hypertension. This was a prospective study of pregnancies complicated by preeclampsia, gestational hypertension, or chronic hypertension presenting to 1 of 2 tertiary referral hospitals between May 2013 and May 2018. Maternal characteristics along with blood samples for angiogenic marker analysis were obtained from participants. The primary outcome was delivery related to preeclampsia within 1 and 2 weeks. In total, 302 women with hypertension were included in the study cohort. The baseline model included maternal body mass index, mean arterial pressure, and clinical diagnosis at the time of assessment. The use of sFlt-1/PIGF ratio combined with the baseline model significantly improved the area under the curve values for predicting delivery within a week (0.83 versus 0.88; P =0.025) or in 2 weeks (0.86 versus 0.93; P =0.001) due to preeclampsia-related events in gestational ages <35 weeks. The magnitude of increase in accuracy was 7.9% (−0.5% to 16.4%, posterior probability of increase: 96.7%) for sFlt-1/PlGF ratio. Our results emphasize the additive value of angiogenic biomarkers and the superior performance of a continuous scale of sFlt-1/PlGF ratio in the model. The added utility of angiogenic markers diminishes after 35 weeks’ gestation.

The findings of our study suggest that cardiac function is significantly altered in morbidly obese pregnant women. In order to make appropriate comparisons between individuals, it is imperative that hemodynamic parameters are indexed for BSA, as is standard practice in pediatric cardiology. The novel finding of reduced CI in morbidly obese pregnant women may explain the predisposition to pre-eclampsia and other adverse outcomes in this population and warrants further investigation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.