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BackgroundFetal growth restriction (FGR) is a condition that affects 5–10% of pregnancies and is the second most common cause of perinatal mortality. This review presents the most recent knowledge on FGR and focuses on the etiology, classification, prediction, diagnosis, and management of the condition, as well as on its neurological complications.MethodsThe Pubmed, SCOPUS, and Embase databases were searched using the term “fetal growth restriction”.ResultsFetal growth restriction (FGR) may be classified as early or late depending on the time of diagnosis. Early FGR (<32 weeks) is associated with substantial alterations in placental implantation with elevated hypoxia, which requires cardiovascular adaptation. Perinatal morbidity and mortality rates are high. Late FGR (≥32 weeks) presents with slight deficiencies in placentation, which leads to mild hypoxia and requires little cardiovascular adaptation. Perinatal morbidity and mortality rates are lower. The diagnosis of FGR may be clinical; however, an arterial and venous Doppler ultrasound examination is essential for diagnosis and follow-up. There are currently no treatments to control FGR; the time at which pregnancy is interrupted is of vital importance for protecting both the mother and fetus.ConclusionEarly diagnosis of FGR is very important, because it enables the identification of the etiology of the condition and adequate monitoring of the fetal status, thereby minimizing risks of premature birth and intrauterine hypoxia.

Three- and four-dimensional (3D/4D) ultrasonography with spatio-temporal image correlation (4D-STIC) allows obtaining fetal cardiac volumes and their static and real-time analysis in multiplanar and rendering modes. Cardiac biometrics and Doppler-echocardiographic parameters for evaluation of fetal heart function, including cardiac output and stroke volume, can be analyzed using M-mode, two-dimensional (2D), and 3D/4D cardiac ultrasound. In recent years, functional echocardiography has been used to study fetuses without a structurally cardiac defect but who are at risk of heart failure due to the presence of extra-cardiac conditions, such as, fetal growth restriction, tumors/masses, twin-to-twin transfusion syndrome, fetal anemia (Rh alloimmunization), congenital infections, or maternal diabetes mellitus. The assessment of cardiac function provides important information on hemodynamic status and can help optimize the best time for delivery and reduce perinatal morbidity and mortality. Since 2003, with the advent of the 4D-STIC software, it is possible to evaluate the fetal heart in multiplanar, and rendering modes. This technology associated with virtual organ computer-aided analysis (VOCAL) enables determining the ventricular volume (end-diastole, end-systole), the stroke-volume, the ejection fraction, and the cardiac output of each ventricle. Since 2004, several studies demonstrated that the 4D-STIC and VOCAL had good reproducibility to measure cardiac volumes This study reviews published studies that evaluated the fetal cardiac function by 3D ultrasound using 4D-STIC and VOCAL software.

In Perinatal Cardiology, fetal cardiology experts provide key information on tools for fetal evaluation through echocardiography / cardiac ultrasonography, with a primary focus on the nature and prenatal detection of structural and functional cardiac heart defects (CHDs). In this two-part book, readers will find details about different types of fetal cardiac abnormalities along with important updates on the diagnosis, management, planning delivery, and postnatal treatment in CHD cases. This information is supplemented with guidelines for the clinical management of patients with a fetus affected by cardiovascular defects, and surgical procedures in neonates. Key Features: -presents information gathered by experts in perinatal cardiology, organized into 26 topic-based chapters - explores the cardiac development, fetal cardiovascular hemodynamics, genetic and environmental factors associated with congenital heart defects (CHD), perinatal management, planning delivery, and postnatal treatment of newborns with CHD - presents information about normal cardiac functions and heart defects to give readers a clear and detailed picture of abnormal cardiac function - presents information about perinatal ultrasound physiology - gives practical guidelines for ultrasound and echography parameters required for evaluating fetal heart anatomy and diagnosing diseases - includes a new system of classifying prenatal CHDs based on the stratification of the risk level of care - features a straightforward and accessible style of presentation suitable for all readers - provides references in each chapter for further reading Part 2 of this two-part set delves into different fetal anomalies such as ventricular inflow anomalies, myocardial and pericardial diseases, cardiac tumors, extra-cardiac conditions, cardiac failure, and environmental factors associated with CHD. The latter chapters cover clinical topics such as labor management for patients bearing a child with CHD, fetal cardiac interventions, clinical management of neonates with CHD and postnatal surgery. Perinatal Cardiology is an essential reference for postgraduate medical students seeking to improve their knowledge of fetal and pediatric cardiology as part of their residency and professional training. The book equips readers with the information necessary to understand the role of the perinatal cardiologist and goes further to facilitate the ability to perform adequate risk assessments for fetal CHD.

In Perinatal Cardiology, fetal cardiology experts providekey information on tools for fetal evaluation through echocardiography /cardiac ultrasonography, with a primary focus on the nature and prenataldetection of structural and functional cardiac heart defects (CHDs). In this two-partbook, readers will find details about different types of fetal cardiacabnormalities along with important updates on the diagnosis, management, planning delivery, and postnatal treatment in CHD cases. This information issupplemented with guidelines for the clinical management of patients with a fetusaffected by cardiovascular defects, and surgical procedures in neonates. Key Features: -presents information gathered by experts in perinatal cardiology, organized into 26 topic-based chapters- explores the cardiac development, fetal cardiovascular hemodynamics, genetic and environmental factors associated with congenital heart defects(CHD), perinatal management, planning delivery, and postnatal treatment ofnewborns with CHD- presents information about normal cardiac functions and heart defects to give readers a clear and detailed picture of abnormal cardiac function- presents information about perinatal ultrasound physiology- gives practical guidelines for ultrasound and echography parametersrequired for evaluating fetal heart anatomy and diagnosing diseases- includes a new system of classifying prenatal CHDs based on thestratification of the risk level of care- features a straightforward and accessible style of presentationsuitable for all readers- provides references in each chapter for further reading Part 1 of this two-part set covers the basics of perinatal cardiology which chapters that introduce readersto CHD classification, fetal heart and placental physiology and pathology, diagnosisof fetal cardiac malposition and anomalies and some congenital heart defects suchas septal defects, cardiac anomalies of the left and right sides, conotruncalanomalies and aortic arch anomalies. Perinatal Cardiology is an essential reference for postgraduatemedical students seeking to improve their knowledge of fetal and pediatriccardiology as part of their residency and professional training. The bookequips readers with the information necessary to understand the role of theperinatal cardiologist and goes further to facilitate the ability to performadequate risk assessments for fetal CHD.

Congenitally corrected transposition of the great arteries is a rare and complex congenital heart disease. It essentially occurs with atrioventricular and ventriculoarterial discordance, in which the great vessels become parallel. Cases of corrected transposition of the great arteries are more frequently associated with other cardiac anomalies. In the fetus, corrected transposition of the great arteries may not be diagnosed on obstetric cardiac ultrasound, especially in the absence of other cardiac malformations (isolated corrected transposition of the great arteries). In this manuscript, we describe a case of isolated corrected transposition of the great arteries diagnosed in utero, and highlight the clues to make this diagnosis.

Parvovirus B19, a member of the Parvoviridae family, is a human pathogenic virus. It can be transmitted by respiratory secretions, hand-to-mouth contact, blood transfusion, or transplacental transmission. Most patients are asymptomatic or present with mild symptoms such as erythema infectiosum, especially in children. In rare cases, moderate-to-severe symptoms may occur, affecting blood cells and other systems, resulting in anemia, thrombocytopenia, and neutropenia. Non-immune pregnant women are at risk for fetal infection by parvovirus B19, with greater complications if transmission occurs in the first or second trimester. Infected fetuses may not show any abnormalities in most cases, but in more severe cases, there may be severe fetal anemia, hydrops, and even pregnancy loss. Maternal diagnosis of intrauterine parvovirus B19 infection includes IgG and IgM antibody testing. For fetal diagnosis, PCR is performed through amniocentesis. In addition to diagnosing the infection, it is important to monitor the peak of systolic velocity of the middle cerebral artery (PVS-MCA) Doppler to assess the presence of fetal anemia. There is no vaccine for parvovirus B19, and fetal management focuses on detecting moderate/severe anemia by fetal PVS-MCA Doppler, which, if diagnosed, should be treated with intrauterine transfusion by cordocentesis. Prevention focuses on reducing exposure in high-risk populations, particularly pregnant women.

The recent epidemic of Zika virus (ZIKV) infection in Central and South America is one of the most serious global public health emergencies since the Ebola outbreak in West Africa. In Brazil, especially in the north, northeast, and southeast parts of the country, the ZIKV outbreak is a cause of concern for pregnant women because ZIKV intrauterine infection has been found to be associated with multiple brain malformations and microcephaly. In Brazil, the number of newborns with confirmed microcephaly per year recorded during the ZIKV outbreak, has been approximately 15 times greater than previously reported. Considering that the infection is self-limiting and symptomatic, it is usually diagnosed at the time of routine prenatal scan, especially in the third trimester. In other cases, the disease is detected after childbirth through neuroimaging. This study provides an insight into the history and evolution of ZIKV in Brazil, including current knowledge concerning the transmission, diagnosis, and pathogenesis of the infection. In addition, this review describes the pre- and postnatal neuroimaging findings obtained using ultrasound, magnetic resonance imaging, and computed tomography. (J Turk Ger Gynecol Assoc 2018; 19: 39-47)

Cytomegalovirus (CMV) infection is the most common congenital infection worldwide, affecting between 0.7% and 1% of all live births. Approximately 11% of infected newborns are symptomatic at birth, and between 30% and 40% of these are at risk of developing long-term neurological sequelae. Until recently, the lack of an effective treatment did not justify universal testing of pregnant women. In recent years, however, valacyclovir at a dose of 8 g/day has been shown to be effective in preventing vertical transmission, and ganciclovir has been shown to be effective in preventing long-term sequelae in the treatment of symptomatic neonates. The aim of this article is to review congenital CMV infection, from its epidemiology to its treatment, using the most recent studies in the literature, and to help in the decision to modify protocols for universal testing of pregnant women according to the possibilities of each locality.

To evaluate the influence of pre-existing maternal diabetes mellitus on fetal myocardial performance index and systolic-to-diastolic duration ratio. Prospective cohort study included 179 pregnant women between 20 and 36w6d, divided into 3 groups: Group 1 (120, normal), Group 2 (31, type 1 diabetes mellitus), and Group 3 (28, type 2 diabetes mellitus). Systolic-to-diastolic duration ratio was calculated as the sum of isovolumic contraction time and ejection time divided by the sum of isovolumic relaxation time and ventricular filling time. Spectral Doppler was used to assess left ventricle systolic-to-diastolic duration ratio. Tissue Doppler was used to assess right ventricular filling time. Using spectral Doppler, left ventricle myocardial performance index was calculated as the sum of isovolumic contraction time and isovolumic relaxation time divided by ejection time. Pre-existing maternal diabetes mellitus had a significant influence on fasting glucose levels ( < 0.001), left ventricle isovolumic contraction time ( < 0.001), left ventricle ejection time ( = 0.025), and left ventricle myocardial performance index ( < 0.001). Group 2 had higher left ventricle isovolumic contraction time (0.036 vs. 0.031 sec, = 0.001) and left ventricle myocardial performance index (0.487 vs. 0.453, = 0.003) compared with Group 1. Group 3 showed higher left ventricle myocardial performance index (0.492 vs. 0.449, = 0.006) and lower left ventricle ejection time (0.161 vs. 0.169 sec, = 0.038) than Group 1. Left ventricle systolic-to-diastolic duration ( = 0.704), right ventricle systolic-to-diastolic duration ratio' ( = 0.757), left ventricle isovolumic contraction time ( = 0.163), left ventricle ejection time ( = 0.093), and left ventricle myocardial performance index ( = 0.087) were not useful parameters in predicting composite neonatal outcomes. Pre-existing maternal diabetes mellitus had significant influence on fetal left ventricle myocardial performance index, but no effect on systolic-to-diastolic duration ratio. Systolic-to-diastolic duration ratio was not useful in predicting adverse perinatal outcomes.

To assess the impact of overweight and obesity in the second and third trimesters of pregnancy on fetal cardiac function parameters. We performed a prospective cohort study of 374 singleton pregnant women between 20w0d and 36w6d divided into three groups: 154 controls (body mass index - BMI < 25 kg/m ), 140 overweight (BMI 25-30 kg/m ) and 80 obese (BMI ≥ 30 kg/m ). Fetal left ventricular (LV) modified myocardial performance index (Mod-MPI) was calculated according to the following formula: (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. Spectral tissue Doppler was used to determine LV and right ventricular (RV) myocardial performance index (MPI'), peak myocardial velocity during systole (S'), early diastole (E'), and late diastole (A'). We found significant differences between the groups in maternal age (p < 0.001), maternal weight (p < 0.001), BMI (p < 0.001), number of pregnancies (p < 0.001), parity (p < 0.001), gestational age (p = 0.013), and estimated fetal weight (p = 0.003). Overweight pregnant women had higher LV Mod-MPI (0.046 versus 0.044 seconds, p = 0.009) and LV MPI' (0.50 versus 0.47 seconds, p < 0.001) than the control group. Obese pregnant women had higher RV E' than control (6.82 versus 6.33 cm/sec, p = 0.008) and overweight (6.82 versus 6.46 cm/sec, p = 0.047) groups. There were no differences in 5-min APGAR score < 7, neonatal intensive care unit admission, hypoglycemia and hyperglobulinemia between the groups. We observed fetal myocardial dysfunction in overweight and obese pregnant women with higher LV Mod-MPI, LV MPI' and RV E' compared to fetuses from normal weight pregnant women.