Heron Werner

Objectives: Gestational diabetes mellitus (GDM) is associated with fetal hyperinsulinemia, excessive adiposity, and adverse perinatal outcomes; sonographic markers of fetal adiposity, liver enlargement, and septal thickening may allow direct assessment of fetal metabolic adaptation. This study aimed to develop an ultrasound-based fetal metabolic score (FMS) estimating the risk of fetal hyperinsulinemia. Methods: The FMS was developed from a prospective cohort of 223 pregnant women (128 with GDM, 95 controls). Sonographic markers of neonatal hyperinsulinemia were identified using umbilical cord C-peptide above the 75th percentile as the reference outcome: thigh soft tissue thickness, abdominal subcutaneous fat thickness, fetal liver length, and interventricular septal thickness. Odds ratios from logistic regression were converted into weighted integer coefficients, and continuous measurements were categorized by gestational age-adjusted percentiles into a composite score. Results: Fetuses of GDM mothers showed significantly greater abdominal adiposity, liver length, and interventricular septal thickness than controls. Thigh soft tissue thickness (OR 1.62; 95 % CI 1.25–2.09; p<0.001), abdominal subcutaneous fat thickness (OR 1.57; 95 % CI 1.23–1.99; p<0.001), fetal liver length (OR 1.06; 95 % CI 1.02–1.11; p=0.004), and interventricular septal thickness (OR 1.35; 95 % CI 1.01–1.82; p=0.040) independently predicted elevated cord blood C-peptide. The FMS ranged from 0 to 44 points, integrating weighted contributions from adiposity, visceral growth, and cardiac remodeling markers. Conclusions: The FMS is a novel ultrasound-based approach for estimating fetal hyperinsulinemia risk. By integrating multiple manifestations of the fetal metabolic response to maternal hyperglycemia, it may assess fetal metabolic health more comprehensively than conventional biometry alone.

Background/Objectives: The primary objective was to assess reference intervals for fetal Global Longitudinal Strain (GLS) using bidimensional speckle-tracking echocardiography (2D-STE), including only prospective studies specifically designed for this purpose. An additional objective was to evaluate studies’ methodological quality and reproducibility. Methods: This is a systematic review registered at PROSPERO (CRD420251038889). Five electronic databases (Web of Science, Scopus, MEDLINE/PubMed, EMBASE and LILACS) were searched, from inception to May 2025. Prospective studies specifically designed to establish 2D-STE GLS reference intervals in low-risk singleton pregnancies with normal fetuses were included. Data were independently extracted by two reviewers. Risk of bias was assessed using an adapted tool, including study design and statistical and reporting methods. Results: After the initial identification of 187 records, nine studies published between 2012 and 2025 were included. There was marked heterogeneity among the studies. Four articles achieved high-quality scores (>70%) and three of them reported similar left ventricular (LV) GLS at 24 weeks (−22%). Right ventricular absolute GLS values were slightly lower than LV numbers. Regression models for both ventricles showed GLS absolute values decreased with gestation across studies. The 2D-STE algorithm (endocardial versus myocardial) was the main source of discrepancy between studies. Conclusions: High-quality prospective studies show a consistent pattern of biventricular GLS variation with gestational age. However, technical heterogeneity, lack of standardization, operator subjectivity and vendor-specific algorithm differences currently limit the applicability of the method. Multicentric studies with large sample sizes, standardized protocols and artificial intelligence-assisted tools are needed to consolidate this technique.

Toxoplasmosis remains one of the most common parasitic infections affecting humans, with significant implications for pregnancy and fetal health. Maternal primary infection during gestation can result in transplacental transmission of Toxoplasma gondii, leading to a wide spectrum of congenital disease. The risk of vertical transmission increases with gestational age, whereas disease severity is inversely related—early infections causing severe neurological and ocular damage, and late infections often resulting in subclinical forms. Advances in serological testing, including IgG avidity assays and molecular diagnostics such as PCR on amniotic fluid, have improved early detection and management. Prenatal treatment with spiramycin or pyrimethamine–sulfadiazine–folinic acid combinations has been associated with reduced transmission and less severe fetal disease in several studies, although the magnitude of benefit remains debated. Long-term follow-up is essential, as late-onset manifestations, particularly chorioretinitis and neurodevelopmental impairment, are common. This narrative review was based on a comprehensive literature search of major medical databases and summarizes current knowledge on the epidemiology, pathophysiology, diagnosis, treatment, and outcomes of toxoplasmosis in pregnancy. Particular emphasis is placed on high-prevalence countries, where greater parasite genetic diversity, distinct epidemiological patterns, and a higher burden of congenital disease pose unique clinical and public health challenges. Despite progress in understanding parasite biology, pathogenesis, and treatment efficacy, congenital toxoplasmosis continues to be underdiagnosed and underreported, especially in low-resource settings. Ongoing challenges include optimizing screening strategies, ensuring access to standardized therapies, and strengthening surveillance systems.

Gestational trophoblastic disease (GTD) comprises a heterogeneous group of disorders arising from abnormal proliferation of placental trophoblastic tissue. This spectrum includes benign forms, prim...

We describe a case report of prenatal presentation of membranous aplasia cutis congenita on the vertex by magnetic resonance imaging, the conflict between the prenatal presentation, the postnatal features, and the long-term follow-up.

Background: Collis gastroplasty for esophageal lengthening is a complex adjunct to hiatal hernia repair in patients with esophageal foreshortening. Aims: To study the final morphology of the repair using state-of-the-art imaging: computed tomography with three-dimensional reconstruction. Methods: Nine patients with prior Collis gastroplasty and hiatal hernia repair were studied with three-dimensional computed tomography reconstruction to evaluate the anatomy of the repair and screen for hiatal hernia recurrence. Secondary outcomes were quality of life and surgical morbidity. Results: After a medium follow-up of 34 months, objective recurrence of the hiatal hernia was observed in three patients (1.5, 2.2, and 3 cm), and two patients were symptomatic. The gastroesophageal junction tube (neo-esophagus) created by the gastroplasty was similar in shape and volume to the native esophagus in all patients. The fundoplication previously performed covered the neo-esophagus in only two of the nine patients. No fistulas or mortality were observed. Conclusions: Three-dimensional computed tomography reconstruction of the gastroesophageal junction following hiatal hernia repair with Collis gastroplasty and fundoplication reliably demonstrates postoperative anatomy and helps better understand hiatal hernia recurrence.

Congenital anomalies of the digestive system, particularly in the esophagus and stomach, present significant challenges to neonatal health due to their complex management and associated risks of morbidity and mortality. This narrative review explores esophageal and gastric anomalies, addressing the embryology, prevalence, diagnostic methods, and treatment approaches, with an emphasis on early detection and improved outcomes. Because of recent advances in prenatal imaging, such as ultrasonography and magnetic resonance, diagnostic accuracy has increased, allowing better clinical planning and management. Studies reveal that gastrointestinal anomalies account for approximately 20% of congenital malformations globally, having a substantial impact on neonatal health and healthcare systems. This review discusses critical anomalies, including esophageal atresia, tracheoesophageal fistula, antral stenosis, and antral atresia, with a focus on diagnostic criteria, surgical interventions, and prognostic factors. By highlighting current knowledge and best practices, we aim to underscore the importance of early, accurate diagnosis and continuous follow-up, which can ultimately improve neonatal outcomes and quality of life.