Özgür Kara

Objective: To compare middle cerebral artery (MCA) Doppler parameters in patients diagnosed with idiopathic polyhydramnios and those with a normal amniotic fluid index (AFI) and to investigate the effects of MCA Doppler findings on neonatal outcomes. Materials and Methods: This study was designed as a prospective case–control study and conducted at a single tertiary care center. A total of 166 patients, including 83 with idiopathic polyhydramnios and 83 healthy controls between 24 and 35 weeks of gestation were included. We divided the patients diagnosed with polyhydramnios into three groups as mild, moderate, and severe. MCA Doppler evaluations were performed for each patient. Results: MCA Doppler parameters pulsatility index (PI) and resistive index (RI) were significantly lower in pregnancies with idiopathic polyhydramnios ( p < 0.05). A significant difference was observed in neonatal intensive care unit (NICU) admissions between the two groups ( p < 0.05). Receiver operating characteristic analysis showed that the optimal cut‐off value of the MCA PI for predicting NICU admissions was 1.37, with a sensitivity of 69% and a specificity of 50% (area under the curve = 0.759; p = 0.021). There was no difference in UA‐PI and CPR levels between both groups ( p > 0.05). Univariable regression analysis showed that polyhydramnios was associated with a 7.48‐fold increase in the odds of NICU admission. The MCA PI level, gestational age at birth, and first minute Apgar score were lower in the severe polyhydramnios group compared to the mild polyhydramnios group. Conclusion: MCA PI and RI values were found to be lower in fetuses with idiopathic polyhydramnios compared to those with a normal AFI, suggesting altered fetal cerebral vascular resistance that may be compatible with blood‐flow redistribution. MCA Doppler parameters showed an exploratory association with NICU admission and may provide additional information for neonatal risk assessment; they do not prove fetal hypoxia.

Objective: The primary objective of this study is to compare the fetal caval aortic (IVC/Ao) index and left brachiocephalic vein (LBCV) diameter between pregnancies with preeclampsia (PE) and healthy controls. The study also assesses their association with disease severity and perinatal outcomes. Methods: In this prospective case–control study, 60 pregnancies complicated by PE were compared with 60 gestational age‐matched healthy controls. The fetal IVC/Ao index, LBCV diameter, Doppler parameters, and perinatal outcomes were assessed. Subgroup analyses in the PE group considered admission blood pressure, symptoms, proteinuria, and neonatal outcomes. Results: The PE group had a lower IVC/Ao index and larger LBCV diameter ( P = 0.043 and P = 0.025, respectively). The umbilical artery pulsatility index was higher ( P = 0.008), and the cerebroplacental ratio was lower ( P = 0.005) in PE. Smaller ascending aorta diameter was noted in severe hypertension ( P = 0.042), and the LBCV diameter was greater in symptomatic cases ( P = 0.007). Proteinuria ≥+2 was associated with earlier delivery ( P = 0.014) and lower birth weight ( P  < 0.001). Neonates admitted to the neonatal intensive care (NICU) had lower fetal inferior vena cava (IVC) diameters and lower IVC/Ao indices. An IVC/Ao index cutoff of 0.79 was associated with NICU admission, demonstrating moderate discriminatory performance (sensitivity 72.2%, specificity 73.8%, area under the curve = 0.762; 95% confidence interval 0.61–0.90; P = 0.001). Conclusion: Fetuses of PE pregnancies had decreased IVC/Ao index and enlarged LBCV diameter, potentially linked to impaired fetal hemodynamics. The IVC/Ao index might help identify pregnancies complicated by PE that are at increased risk of NICU admission.

Purpose: Fetal echocardiography requires systematic anatomical assessment, segmental interpretation, and high‐level clinical reasoning. This study aimed to compare the performance of contemporary artificial intelligence (AI) systems and clinicians with different levels of expertise in a standardized fetal echocardiography knowledge‐based assessment. Methods: This cross‐sectional comparative assessment study used a 60‐item, single‐best‐answer multiple‐choice examination covering eight fetal echocardiography subdomains: general principles of fetal echocardiography, general fetal cardiac anatomy, left‐sided cardiac pathologies, conotruncal anomalies, isomerism and heterotaxy syndromes, fetal arrhythmias, anomalies of venous return, and pulmonary malformations/right‐sided cardiac pathologies. The same examination was administered to seven publicly accessible AI systems and three clinicians: one senior perinatologist, one junior perinatologist, and one junior obstetrician. All AI systems were accessed during the same predefined evaluation period in January 2026. The primary outcome was response correctness. Secondary analyses included total accuracy, domain‐specific performance, and AI–clinician group comparisons. Results: A total of 600 group–question response entries were analyzed, comprising 420 AI‐generated responses and 180 clinician responses. The senior perinatologist achieved the highest total score among all participants, with 53 correct responses out of 60, followed by GPT‐5 with 52 correct responses. Overall accuracy was 78.8% for AI systems and 73.3% for clinicians. The mean domain‐level score was 5.91 for AI systems and 5.50 for clinicians, without a statistically significant difference using either unequal‐variance t ‐test or Mann–Whitney U ‐test. AI systems showed higher mean performance in general fetal echocardiography principles and general fetal cardiac anatomy, whereas the senior perinatologist performed best in complex integrative domains, particularly conotruncal anomalies and isomerism/heterotaxy syndromes. Conclusions: In a structured text‐based fetal echocardiography knowledge assessment, AI systems achieved overall performance comparable to clinicians, particularly in standardized knowledge domains. However, the senior perinatologist retained the strongest performance in complex fetal cardiac categories requiring integrative clinical reasoning. These findings support the potential role of AI as an adjunctive educational and structured decision‐support tool in fetal echocardiography, while emphasizing that performance in a multiple‐choice format should not be interpreted as equivalent to autonomous real‐world fetal cardiac diagnosis.

ObjectivesTo evaluate the role of tibial artery pulsatility index (TA-PI) and tibial-placental ratio (TPR) in distinguishing fetal growth restriction (FGR) from normal pregnancies and to assess their predictive value for adverse neonatal outcomes.MethodsThis prospective observational cohort study was conducted at a tertiary perinatology clinic between 2024 and 2025. A total of 42 pregnant women at 37 weeks of gestation were enrolled and categorized into two groups: FGR (n = 21) and non-FGR controls (n = 21). Doppler ultrasonography was used to assess middle cerebral artery, umbilical artery, cerebroplacental ratio, and tibial artery parameters. Statistical analyses included t-tests, chi-square tests, and receiver operating characteristic curve analysis to evaluate the diagnostic performance of TA-PI and TPR.ResultsTA-PI was significantly higher in the FGR group, indicating increased peripheral vascular resistance, while peak systolic velocity in the tibial artery was significantly lower, suggesting compromised peripheral circulation. Both cerebroplacental and tibial-placental ratios were elevated in FGR fetuses, indicating circulatory redistribution. Tibial-placental ratio showed strong predictive value for distinguishing FGR from normal pregnancies. Neonates with FGR had significantly lower birth weights and lower APGAR scores at one and five minutes. Although neonatal intensive care unit admissions were more frequent in the FGR group, the difference was not statistically significant.ConclusionsTibial artery Doppler measurements reflect peripheral vasoconstriction and may indicate fetal adaptation to hypoxia in FGR. Tibial-placental ratio demonstrates potential as a non-invasive tool for detecting fetal compromise.Advances in knowledgeThis study introduces tibial artery Doppler parameters as promising indicators of fetal hemodynamic adaptation, offering a novel approach to enhancing non-invasive FGR surveillance.

Purpose: To investigate the ultrasonographic characteristics and perinatal outcomes of fetuses diagnosed with FIUVV and compare isolated FIUVV cases with low‐risk pregnancies. Methods: This retrospective study was conducted among patients diagnosed with FIUVV at a tertiary referral center between 2020 and 2024, along with a control group of low‐risk pregnancies. The gestational age at the diagnosis and birth, the presence of additional structural and/or chromosomal anomalies in the fetus, and neonatal outcomes were recorded. Results: A total of 66 fetuses were included in the study, comprising 26 diagnosed with FIUVV and 40 in the control group. Additional structural abnormalities were identified in 23.1% of FIUVV cases, and chromosomal abnormalities were detected in three nonisolated cases. In the comparison of isolated FIUVV cases with the control group, fetal growth restriction (FGR) and preterm birth were significantly higher in FIUVV cases. Conclusion: FIUVV, even when identified as an isolated finding, may be associated with an increased risk of adverse perinatal outcomes. Careful prenatal surveillance for fetal growth, along with screening for additional structural abnormalities, may contribute to more effective clinical management of these cases.

Objective: To evaluate fetomaternal Doppler changes in pregnancies complicated by maternal anemia and to investigate the predictive value of the cerebroplacental–uterine ratio (CPUR) for composite adverse perinatal outcomes (CAPOs). Methods: This prospective case–control study included 203 singleton pregnancies at ≥ 28 weeks of gestation. Participants were categorized according to third‐trimester hemoglobin levels as moderate anemia (hemoglobin 6–9 g/dL, n = 23), mild anemia (hemoglobin 9–11 g/dL, n = 41), and non‐anemic controls (hemoglobin ≥ 11 g/dL, n = 139). Umbilical artery pulsatility index (UA‐PI), middle cerebral artery pulsatility index (MCA‐PI), and uterine artery pulsatility index (UtA‐PI) were measured. The cerebroplacental ratio (CPR) was calculated as MCA‐PI/UA‐PI, and CPUR was calculated as CPR/mean UtA‐PI. CAPO was defined as the presence of at least one of the following: preterm birth, low birth weight, small for gestational age, low fifth‐minute Apgar score, abnormal umbilical artery cord blood gas values, or neonatal intensive care unit admission. Results: Women with moderate anemia had significantly lower gestational age at birth, lower birth weight, lower first‐ and fifth‐minute Apgar scores, and worse umbilical artery cord blood gas parameters than controls. The prevalence of small for gestational age neonates, neonatal intensive care unit admission, and CAPO increased progressively with anemia severity. UA‐PI and UtA‐PI were significantly higher, whereas CPR and CPUR were significantly lower in pregnancies complicated by moderate anemia. Hemoglobin alone showed moderate predictive performance for CAPO prediction (AUC = 0.724, 95% CI: 0.643–0.801, p < 0.001). CPUR demonstrated higher discriminative ability than CPR for predicting CAPO (AUC = 0.841 vs. 0.791, both p < 0.001). In multivariable logistic regression analysis, hemoglobin level, gestational age at birth, UA‐PI, UtA‐PI, and CPUR remained independent predictors of CAPO. Conclusion: Maternal anemia is associated with impaired uteroplacental and fetoplacental hemodynamics and increased adverse perinatal outcomes. CPUR demonstrates superior predictive performance compared with CPR and hemoglobin alone and may serve as a useful adjunctive Doppler marker in the surveillance of pregnancies complicated by maternal anemia.