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Background Prediction of neonatal respiratory morbidity may be useful to plan delivery in complicated pregnancies. The limited predictive performance of the current diagnostic tests together with the risks of an invasive procedure restricts the use of fetal lung maturity assessment. Objective The objective of this study was to evaluate the performance of quantitative ultrasound texture analysis of the fetal lung (quantusFLM) to predict neonatal respiratory morbidity in preterm and early-term (<39.0 weeks) deliveries. Study Design This was a prospective multicenter study conducted in 20 centers worldwide. Fetal lung ultrasound images were obtained at 25.0-38.6 weeks of gestation within 48 hours of delivery, stored in Digital Imaging and Communication in Medicine format, and analyzed with quantusFLM. Physicians were blinded to the analysis. At delivery, perinatal outcomes and the occurrence of neonatal respiratory morbidity, defined as either respiratory distress syndrome or transient tachypnea of the newborn, were registered. The performance of the ultrasound texture analysis test to predict neonatal respiratory morbidity was evaluated. Results A total of 883 images were collected, but 17.3% were discarded because of poor image quality or exclusion criteria, leaving 730 observations for the final analysis. The prevalence of neonatal respiratory morbidity was 13.8% (101/730). The quantusFLM predicted neonatal respiratory morbidity with a sensitivity, specificity, and positive and negative predictive values of 74.3% (75/101), 88.6% (557/629), 51.0% (75/147), and 95.5% (557/583), respectively. Accuracy was 86.5% (632/730), and the positive and negative likelihood ratios were 6.5 and 0.3, respectively. Conclusion The quantusFLM predicted neonatal respiratory morbidity with an accuracy similar to that previously reported for other tests with the advantage of being a non-invasive technique.

<b><i>Objectives:</i></b> The aim of the study was to describe the feasibility of open fetal microneurosurgery for intrauterine spina bifida (SB) repair and to compare perinatal outcomes with cases managed using the classic open fetal surgery technique. <b><i>Methods:</i></b> In this study, we selected a cohort of consecutive fetuses with isolated open SB referred to our fetal surgery center in Queretaro, Mexico, during a 3.5-year period (2016–2020). SB repair was performed by either classic open surgery (6- to 8-cm hysterotomy with leakage of amniotic fluid, which was replaced before uterine closure) or open microneurosurgery, which is a novel technique characterized by a 15- to 20-mm hysterotomy diameter, reduced fetal manipulation by fixing the fetal back, and maintenance of normal amniotic fluid and uterine volume during the whole surgery. Perinatal outcomes of cases operated with the classic open fetal surgery technique and open microneurosurgery were compared. <b><i>Results:</i></b> Intrauterine SB repair with a complete 3-layer correction was successfully performed in 60 cases either by classic open fetal surgery (<i>n</i> = 13) or open microneurosurgery (<i>n</i> = 47). No significant differences were observed in gestational age (GA) at fetal intervention (25.4 vs. 25.1 weeks, <i>p</i> = 0.38) or surgical times (107 vs. 120 min, <i>p</i> = 0.15) between both groups. The group with open microneurosurgery showed a significantly lower rate of oligohydramnios (0 vs. 15.4%, <i>p</i> = 0.01), preterm rupture of the membranes (19.0 vs. 53.8%, <i>p</i> = 0.01), higher GA at birth (35.1 vs. 32.7 weeks, <i>p</i> = 0.03), lower rate of preterm delivery &#x3c;34 weeks (21.4 vs. 61.5%, <i>p</i> = 0.01), and lower rate of perinatal death (4.8 vs. 23.1%, <i>p</i> = 0.04) than the group with classic open surgery. During infant follow-up, the rate of hydrocephalus requiring ventriculoperitoneal shunting was similar between both groups (7.5 vs. 20%, <i>p</i> = 0.24). All patients showed an intact hysterotomy site at delivery. <b><i>Conclusion:</i></b> Intrauterine spina repair by open fetal microneurosurgery is feasible and was associated with better perinatal outcomes than classic open fetal surgery.

Objectives The objectives of the study are to evaluate longitudinal changes in lung size and intrapulmonary‐artery (IPa) Doppler in fetuses with congenital diaphragmatic hernia (CDH) and assess their contribution in predicting neonatal survival. Methods The observed/expected lung‐to‐head ratio (O/E‐LHR) and IPa–pulsatility index (PI) and peak early diastolic reversed flow (PEDRF) were evaluated in a cohort of left‐sided CDH fetuses managed expectantly during pregnancy. Longitudinal changes were analyzed by multilevel analysis, and their value to predict survival using the multiple logistic regression and decision‐tree analysis was assessed. Results A total of 232 scans were performed on 69 CDH fetuses. The O/E‐LHR values remained unchanged during fetal monitoring, whereas IPa–PI and PEDRF showed a progressive increase throughout follow‐up, becoming abnormal on average at 30 weeks of gestation. Absent/reversed end‐diastolic velocity (EDV) in the IPa was observed in 20.3%. O/E‐LHR and IPa Doppler indices were significantly associated with probability of survival (O/E‐LHR ≥ 26%, odds ratio [OR] 19.0; IPa–PI <+2.0 z score, OR 3.0; and positive EDV, OR 7.4). All cases with IPa‐reversed EDV died after birth. Conclusion While lung size remains stable during pregnancy, CDH fetuses show progressive deterioration in intrapulmonary blood flow. IPa Doppler evaluation may aid in predicting survival of CDH fetuses managed expectantly during pregnancy.

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