Introduction: Over the past years, intrafetal laser (IFL) therapy has been increasingly used in the management of various prenatal conditions. The aim of our research is to clarify the effectiveness and safety of this technique. Methods: A systematic review of the literature was carried out using MEDLINE/PubMed over a period of 20 years (2001-2021). Results: A total of 41 articles were selected in the literature search, including 194 cases of twin reversed arterial perfusion (TRAP) sequence, 56 cases of bronchopulmonary sequestrations (BPS), 5 cases of placental chorioangiomas (PCA), 11 cases of sacrococcygeal teratoma (SCT), and 103 cases of embryo reduction (ER) managed using IFL. In TRAP sequence, perfusion of the acardiac twin was successfully disrupted in all cases. Preterm premature rupture of membranes (p-PROM) occurred in 6 out of 79 pregnancies (7.5%), and preterm birth (PTB) in 36 out of 122 pregnancies (29.5%). In BPS IFL was successfully performed in all cases with no significant complications. The rate of p-PROM and PTB were respectively 3.2% and 12.5%. All PCA IFL treated cases resulted in successful pregnancy outcomes; no cases of p-PROM were reported, but the rate of PTB reached a peak of 60% due to fetal complications. In SCT cases, complete cessation of blood flow was achieved in 4 patients (36.4%); p-PROM occurred in two cases (18.2%), whereas the rate of PTB was 87.5%. In ER no intraoperative or major maternal complications were described in the literature. Rates of miscarriage and PTB differed between initial trichorionic triamniotic and dichorionic triamniotic triplet pregnancies. Discussion: Our analysis suggests that IFL is a feasible technique for the management of different fetal conditions. However, the overall risk of PTB and its related morbidity and mortality, ranges from 12.5% in BPS to 87.5% in SCT. This could aid in decision making during prenatal counselling. However final perinatal outcome depends on the severity of the disease itself.

Objective To evaluate fetal brain development using MRI (magnetic resonance imaging) in CDH (congenital diaphragmatic hernia). Methods 52 isolated left CDH and 104 control fetuses were imaged using MRI. Brain morphometry (Biparietal diameter—BPD, brain fronto‐occipital diameter—BFOD, third ventricle, posterior ventricles, transcerebellar diameter—TCD, anteroposterior and craniocaudal cerebellar vermis diameter—AP and CC) and cortical structures (bilateral cingulate fissure—CF, insular fissure—IF, insular depth ‐ ID) were compared with controls using Mann–Whitney test. Results Median gestational age at MRI (p = 0.95)and the median biparietal diameter (p = 0.737) were comparable. Among morphometric parameters, only the brain fronto‐occipital diameter was significantly smaller in CDH (p = 0.001) and the third ventricle was significantly greater in CDH (<0.0001). Among cortical structures, the cingulate and insular fissures were significantly deeper in CDH fetuses (p < 0.0001) as the insular depth ID was smaller in CDH (p < 0.03). Conclusions CDH fetuses have a smaller fronto‐occipital diameter, reduced insular depth, deeper cingulate and insular fissure, and greater third ventricle width as compared to controls. These findings suggest that left CDH may have an impact on fetal brain development with an overall reduction in brain volume.

What are the novel findings of this work?Applying International Ovarian Tumor Analysis (IOTA) terminology provided a more detailed and accurate description of fetal ovarian cysts compared with the original classification into 'simple' and 'complex' categories. Resolution was observed of most cysts described as unilocular with anechoic content (described as simple cysts by the original ultrasound examiner) and in most described as having low-level content (described as complex by the original ultrasound examiner). Resolution was not observed in any other cyst type (ground-glass, hemorrhagic, mixed or undefined cyst content; all described as complex by the original ultrasound examiner), of which all required surgery and most had evidence of necrosis. What are the clinical implications of this work?Applying IOTA terminology to fetal ovarian cysts could be useful in predicting their evolution and guiding clinical management of pregnant women with this diagnosis.