Objective: Children with congenital diaphragmatic hernia (CDH) are at risk for neurodevelopmental delay. Herein we report on prenatal changes in biometry and brain perfusion in fetuses with isolated CDH.Study Design: This retrospective study evaluated fetuses with isolated, left-sided CDH in three European referral centers. Abdominal circumference (AC), femur length (FL), head circumference (HC), transcerebellar diameter (TCD), middle cerebral artery (MCA) Doppler, and ventricular width (VW) were assessed during four gestational periods (<24 weeks, 25-28 weeks, 29-32 weeks, >33 weeks). Z-scores were calculated, and growth curves were created based on longitudinal data. Results:In 367 fetuses, HC, AC and FL were within normal ranges throughout gestation. The TCD diminished with advancing gestational age to fall below the fifth percentile after 32 weeks. A less pronounced but similar trend was seen in VW. The peak systolic velocity of the MCA was consistently approximately 10% lower than normal. Disease severity was correlated to TCD (p = 0.002) and MCA doppler values (p = 0.002). There were no differences between fetuses treated with FETO and those managed expectantly.

Maternal surgery during pregnancy has a negative effect on fetal brain development both histologic and neurobehavioral but with time these differences fade out.

Objective: To establish maternal complication rates for fetoscopic or open fetal surgery.Methods: We conducted a systematic literature review for studies of fetoscopic or open fetal surgery performed since 1990, recording maternal complications during fetal surgery, the remainder of pregnancy, delivery, and after the index pregnancy. Results: One hundred sixty-six studies were included, reporting outcomes for open fetal (n = 1193 patients) and fetoscopic surgery (n = 9403 patients). No maternal deaths were reported. The risk of any maternal complication in the index pregnancy was 20.9% (95%CI, 15.22-27.13) for open fetal and 6.2% (95%CI, 4.93-7.49) for fetoscopic surgery. For severe maternal complications (grades III to V Clavien-Dindo classification of surgical complications), the risk was 4.5% (95% CI 3.24-5.98) for open fetal and 1.7% (95% CI, 1.19-2.20) for fetoscopic surgery. In subsequent pregnancies, open fetal surgery increased the risk of preterm birth but not uterine dehiscence or rupture. Nearly one quarter of reviewed studies (n = 175, 23.3%) was excluded for failing to report the presence or absence of maternal complications. Conclusions: Maternal complications occur in 6.2% fetoscopic and 20.9% open fetal surgeries, with serious maternal complications in 1.7% fetoscopic and 4.5% open procedures.Reporting of maternal complications is variable. To properly quantify maternal risks, outcomes should be reported consistently across all fetal surgery studies. | INTRODUCTIONThe last 35 years have witnessed an expansion of fetal therapy options, 1,2 with surgery on the fetus, placenta, or cord now relatively common in tertiary-level fetal medicine units. Enabled by advancements in imaging, surgical instrumentation and techniques, early diagnosis, and treatment of fetal anomalies are now possible for a wide range of conditions. 3 The mother has been called an "innocent bystander" in fetal surgery, 4 and generally, fetal therapy is almost exclusively offered to women who are healthy themselves. Fetal surgery poses risks to the mother not only during the procedure itself but also throughout the

(Abstracted from Ultrasound Obstet Gynecol 2019;53:293–301) Spina bifida aperta is characterized by a congenital defect in the vertebral arches, with protrusion of the meninges and, in the case of myelomeningocele, protrusion of the spinal cord as well. In the majority of cases, spina bifida is not lethal in the neonatal period, although it is associated with higher mortality than in the normal population (44,000 deaths in 150,000 affected newborns per year worldwide).