Cover Image © Marijana Tadic. Reproduced with permission.

The study of the fetal heart is no longer based only on the evaluation of its anatomy but increasingly, thanks to the increasingly advanced technologies, its functionality especially in some conditions of fetal maternal pathology.

Early ultrasound detection of most major congenital heart diseases is feasible during first-trimester ultrasonography cardiac evaluation. Three-dimensional ultrasound is a feasible method for the diagnosis of congenital heart diseases on the first trimester of pregnancy.

Fetuses affected from HLHS and D-TGA with RFO have a poor prognosis, RFO or cFO in an otherwise structurally normal heart if found in later gestation have an overall good outcome. Clinicians should be aware and plan the optimal multi specialized care in order to assess the best medical or surgery treatment for these patients. BAS, Balloon Atrial Septostomy; dTGA, dextro-transposition of great arteries; FECG, Fetal Echocardiographic; FO, foramen ovale; HLHS, hypoplastic left heart syndrome; PV, pulmonary venous; RA, right atrium; RV, right ventricle; TR, tricuspid regurgitation; US, ultrasound; SE, sensibility; SP, specificity; PPV, Positive Predictive Value.

The named “second hit hypothesis” postulates that a predisposed individual -that has already suffered a first hit during fetal life-, postnatally, will more easily fail to cope with a second hit and will be at major risk of cardiovascular disease/failure.

Pre-eclampsia and fetal growth restriction (FGR) have been long related to primary placental dysfunction, caused by abnormal trophoblast invasion. Nevertheless, emerging evidence has led to a new hypothesis for the origin of pre-eclampsia and FGR. Suboptimal maternal cardiovascular adaptation has been shown to result in uteroplacental hypoperfusion, ultimately leading to placental hypoxic damage with secondary dysfunction. In this review, we summarize current evidence on maternal cardiac hemodynamics in FGR and pre-eclampsia. We also discuss the different approaches for antihypertensive treatment according to the hemodynamic phenotype observed in pre-eclampsia and FGR.

Patient receiving maternal hyperoxygenation as part of fetal echocardiography protocol.

Fetal MRI is an important tool for the prenatal diagnosis of brain malformations and is often requested after second-trimester ultrasonography reveals a possible abnormality. Despite the immature state of the fetal brain at this early stage, early suggestive signs of the presence of brain malformations can be recognized.

We discuss the basis for a basic, early examination of fetal brain during the first-trimester scan using a four-step technique. This includes the focused visualization of the cranial contour, choroid plexuses of the lateral ventricles, midline, aqueduct of Sylvius, brainstem, fourth ventricle, and the choroid plexus of the fourth ventricle.

Placenta accreta spectrum (PAS) disorders are associated with a high risk of adverse maternal surgical outcomes, especially if not diagnoses. The aim of this paper is to provide an up to date on prenatal diagnosis of PAS disorders and to report whether integration between first- and third-trimester ultrasound can predict the presence and severity of these anomalies.

The aim of this review is to refresh basic elements of the physiology of umbilical vein blood flow, in order to prove that its clinical value cast a background of important pathophysiology basis and studies, promising to be useful in the diagnosis and management of fetuses with abnormal fetal growth.

Systematic examination of the fetal stomach, umbilical vein and gallbladder during the second- and third trimester sonography provides a simple technique for detecting several anomalies of the fetal upper abdomen.

Protocol for the fetal face examination during the second- and third-trimester scans

Postpartum hemorrhage is the leading cause of maternal mortality. Its management requires a prompt diagnosis of the underlying cause and a close monitoring of maternal condition. In this review, we will describe the role of ultrasound in managing PPH.