: In this report, the second-generation high-intensity focused ultrasound HIFU systems were clinically evaluated for human fetal therapy in two cases of twin reversed arterial perfusion sequence. The HIFU systems comprised an improved lead zirconate-titanate transducer with an imaging phase array sector probe, a Sonachill cooling system, and three phases of HIFU exposure : a trigger pulse, a continuous heating wave, and an idle period to obtain images with the imaging probe set on the transducer. To evaluate skin surface temperature, a thermal camera was used. To evaluate vessel occlusions, blood ow was measured at xed timings after exposures. Target vessel occlusion was achieved with HIFU in only one of the cases, but recanalization occurred the following day. Both cases were nally treated with radiofrequency ablation and one infant was successfully delivered without any complications. This case highlighted three advantages with the change to second-generation HIFU systems in human fetal therapy : the simplicity of maneuvers by reduced range of motion disturbance ; the ability to observe in real time during the exposure ; and a decrease in total ultrasonic output. Treatment interruption due to burns or complaints of heat sensation represented an obstruction to treatment completion. This remains an issue to be addressed in the future.

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We present the second reported case of left pulmonary artery sling with dextrocardia, right pulmonary hypoplasia, and total pulmonary venous connection in a fetus. This case highlights the importance of the determination of pulmonary artery arrangement by fetal echocardiography if right pulmonary hypoplasia and/or congenital heart disease is suspected.

Aim: We conducted a retrospective analysis of summary medical reports of children diagnosed with cerebral palsy (CP) to identify clinical features of antenatal onset of CP secondary to transient ischemia in utero. Methods: The 658 brief summary reports available in the Japan Obstetric Compensation System for Cerebral Palsy were screened, and we identified cases of singleton pregnancy, delivered at gestational age ≥ 33 weeks and those with cord blood gas pH ≥ 7.20. Of the 137 cases identified, 84 were excluded for the following reasons: no evidence of ischemic brain lesion, clear post-natal causative factor of CP, presence of a congenital condition, and sentinel hypoxic event, such as uterine rupture. The demographic profiles of the 53 cases included in our analysis were compared to identify those with and without an abnormal variability in fetal heart rate. Results: Between-group comparison identified an association between abnormal heart rate variability and a lower Apgar score at 1 min (2 vs 6; P < 0.001) and 5 min (5.5 vs 8; P = 0.002), and more frequent episodes of fetal movement loss (41% vs 10%; P = 0.027). An hypoxic event ≤ 1 week before delivery was more likely to be associated with abnormal heart rate variability (89%) and low Apgar score (82%), while events at > 1 week were associated with development of polyhydramnios (44%). Conclusion: In utero transient ischemic events can contribute to term or near-term CP. Careful follow-up is recommended for fetuses with a history of fetal movement loss, abnormal variability in heart rate, and polyhydramnios of unknown causes.

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