Fetal Heart Quantification (FetalHQ^®) is a novel speckle tracking software that permits the study of global and regional ventricular shape and function from a 2D four-chamber-view loop. The 4D-Spatio Temporal Image Correlation (STIC) modality enables the offline analysis of optimized and perfectly aligned cardiac planes. We aimed to evaluate the feasibility and reproducibility of 4D-STIC speckle tracking echocardiography (STE) using FetalHQ^® and to compare it to 2D STE. We conducted a prospective study including 31 low-risk singleton pregnancies between 20 and 40 weeks of gestation. Four-chamber view volumes and 2D clips were acquired with an apex pointing at 45° and with a frame rate higher than 60 Hz. Morphometric and functional echocardiography was performed by FetalHQ^®. Intra- and interobserver reproducibility were evaluated by the intraclass correlation coefficient (ICC). Our results showed excellent reproducibility (ICC > 0.900) for morphometric evaluation (biventricular area, longitudinal and transverse diameters). Reproducibility was also good (ICC > 0.800) for functional evaluation (biventricular strain, Fractional Area Change, left ventricle volumes, ejection fraction and cardiac output). On the contrary, the study of the sphericity index and shortening fraction of the different ventricular segments showed lower reproducibility (ICC < 0.800). To conclude, 4D-STIC is feasible, reproducible and comparable to 2D echocardiography for the assessment of cardiac morphometry and function.

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Introduction: Tetralogy of Fallot (ToF) shows variability in neonatal outcomes, and identifying reliable prenatal predictors is essential for optimizing perinatal management. The aim of this study was to determine the prognostic value of feto‐placental data and prenatal echocardiography in the third trimester in ToF and to compare these findings with a matched control population. Material and Methods: Multicenter prospective cohort study (2011–2023) at two referral centers (BCNatal and University Hospital of Gießen and Marburg). The cohort included 63 fetuses with isolated ToF and 66 healthy controls. All fetuses underwent a third trimester ultrasound and comprehensive echocardiography with 2D speckle tracking. Severe small‐for‐gestational age (SGA) was defined as estimated fetal weight (EFW) below the third percentile. Adverse composite outcomes were defined as the need for prostaglandin infusion, surgery or ductal stenting, corrective surgery before 3 months, and/or neonatal intensive care unit stay ≥7 days. The association of feto‐placental and cardiac data with adverse composite outcome was evaluated. Results: Compared with controls, ToF fetuses showed higher rates of severe SGA (19% vs. 0%, p < 0.001). Cardiac findings showed mild biventricular concentric hypertrophy (relative wall thickness ToF 0.7 [0.5–0.9] vs. controls 0.5 [0.5–0.6], p = 0.001), and reduced deformation (right and left ventricular global longitudinal strain: ToF ‐17.3% ± 3.8 vs. controls −19.3% ± 3.1, p = 0.001; ToF ‐18.0% ± 3.8 vs. controls −20.9% ± 3.45, p < 0.001), regardless of placental dysfunction. The adverse composite outcome occurred in 29.3% of ToF cases with pulmonary stenosis. Within this group, EFW 70 cm/s when EFW was 144 cm/s when EFW was above the 3rd centile. Conclusions: Combining EFW with PV artery Doppler may allow identification of a high‐risk subgroup of ToF‐PS fetuses who may benefit from closer prenatal monitoring and prompt neonatal care.

Objective: To establish and assess the reproducibility of standardized echocardiographic nomenclature and the protocol for comprehensive evaluation of fetal aortic morphology. Methods: This was a prospective cohort study of fetuses with a normal three‐vessel branching pattern of the aortic arch, evaluated from 18–40 weeks' gestation at a single center between January 2024 and November 2024. Alongside standard two‐dimensional views, four‐dimensional spatiotemporal image correlation cardiac volumes were acquired to establish the correspondence between the longitudinal aortic‐arch view and the three‐vessel‐and‐trachea (3VT) view. A comprehensive nomenclature, based on clear anatomical landmarks, and stringent measurement protocol were defined for fetal aortic dimensions and angles measured in the left ventricular outflow tract (LVOT), the longitudinal aortic‐arch and the 3VT echocardiographic views. Measurements were performed independently by two observers, with a repeat analysis by a single observer, to assess intra‐ and interobserver reproducibility, respectively, using intraclass correlation coefficients (ICCs). Results: A total of 45 singleton fetuses with normal three‐vessel branching were randomly selected to comprise the study population. Parameters measured in the LVOT view demonstrated good‐to‐excellent intra‐ and interobserver reproducibility (ICC > 0.8), with excellent reproducibility observed for the sinotubular junction and mid‐ascending aorta diameters (except the interobserver reproducibility for mid‐ascending aorta diameter (ICC, 0.883 (95% CI, 0.739–0.945)), which was good). Good‐to‐excellent intra‐ and interobserver reproducibility (ICC, 0.8–0.9) was also demonstrated for longitudinal aortic‐arch diameters and distances between supra‐aortic vessels, whereas the ascending‐to‐descending aorta angle showed moderate intra‐ and interobserver reproducibility (ICC, 0.652 (95% CI, 0.435–0.798) and 0.593 (95% CI, 0.199–0.776), respectively). In the 3VT view, the standardized aortic diameters and the 3VT angle had good‐to‐excellent intraobserver reproducibility (ICC, 0.75–0.9). There was also good agreement between the aortic isthmus diameter in the longitudinal aortic‐arch view and the 3VT view (ICC, 0.870 (95% CI, 0.458–0.995); P < 0.001). No significant differences or systematic bias were found between observers. Conclusion: A standardized echocardiographic protocol with uniform nomenclature and anatomical landmarks would enable reliable and reproducible fetal aortic morphometry across multiple echocardiographic views, and would be a significant step towards harmonizing fetal aorta imaging, enabling meaningful comparisons across studies and promoting collaborative research. © 2026 International Society of Ultrasound in Obstetrics and Gynecology.

Advances in prenatal diagnosis have improved the perinatal management of congenital heart disease (CHD). However postnatal comorbidities still persist due to multifactorial causes, which limits prenatal prediction of individual outcomes. Oxidative stress (OS), particularly lipid peroxidation, has been suggested to play a role in the development and progression of CHD, with 8-iso-prostaglandin F₂α (8-iso-PGF₂α) serving as a biomarker of oxidative injury. This prospective case–control study aimed to evaluate OS in fetuses with isolated major CHD by comparing amniotic fluid (AF) 8-iso-PGF₂α concentrations with controls. A total of 123 fetuses (83 CHD, 40 controls) were included at a tertiary CHD referral center. CHD cases were subclassified according to anatomical type and expected fetal brain perfusion under placental circulation. Controls were gestational age-matched pregnancies undergoing amniocentesis for indications unlikely to affect OS. All pregnant women underwent standardized fetal biometry, Doppler assessment, and detailed echocardiography. AF samples were obtained by amniocentesis and analyzed for free 8-iso-PGF₂α using a competitive ELISA, with values normalized to creatinine. Clinical, obstetric, and Doppler characteristics were comparable between groups. CHD fetuses showed significantly higher AF 8-iso-PGF₂α concentrations than controls (2849 ± 1377 vs. 2088 ± 1087 ng/mg Cr, p = < 0.001), and remained significant after adjustment for GA, smoking status, diabetes and maternal age and body mass index (BMI). No consistent differences were observed across anatomical or hemodynamic CHD subgroups. These findings provide the first intrauterine evidence of increased lipid peroxidation in fetuses with CHD as reflected by elevated amniotic fluid 8-iso-PGF₂α concentrations.