In pregnancies with vasa previa, prenatal diagnosis and pre-labor cesarean delivery are associated with significantly improved perinatal outcomes compared to undetected cases. However, a universally accepted ultrasonographic definition of vasa previa is lacking. Specifically, the distance from the cervical internal os beyond which vaginal delivery can be safely recommended remains to be determined. Field experts and recently published societal guidelines agree that a 2 cm cut-off is suboptimal, given that complete cervical dilation during labor risks unprotected fetal vessels within a 5 cm radius from the internal os. Thus, in the setting of a scarcity of evidence and case reports of perinatal death with unprotected fetal vessels beyond 2 cm from the internal os, a more conservative definition that includes unprotected fetal vessels located within 5 cm of the internal os is imperative to improve outcomes.

Advances in prenatal diagnostics, imaging, and surgical techniques have accelerated maternal-fetal interventions (MFI), fetal care centers, and expanded options for families. Progress in this field has also raised ethical issues surrounding maternal autonomy, informed consent and decision-making, innovation versus research, equitable access, and disability and reproductive rights. We review ethical frameworks to evaluate MFIs, from innovation to research and, ideally, clinical practice. Necessary oversight and resources are summarized to promote ethical, equitable innovation and research while protecting maternal autonomy and supporting the informed consent and decision-making process. Additional implications amidst abortion restrictions are discussed, along with areas for future research.

Strongyloidiasis is a parasitic infection with a high global burden of disease. Hyperinfection syndrome is a life-threatening complication that predominantly affects immunosuppressed individuals, such as those receiving corticosteroid treatment. Despite its worldwide prevalence, little is known about the clinical effects of this condition on the feto-maternal dyad during pregnancy. We present a case of placental abruption leading to preterm delivery in a pregnancy complicated by Strongyloides stercoralis hyperinfection syndrome following antenatal corticosteroid use. Although rare, this condition is associated with high mortality rates and adverse pregnancy outcomes. Therefore, screening at-risk individuals may be warranted in pregnancies where antenatal corticosteroid administration is considered.

We investigated associations between pre-conception cardiovascular risk factor burden and adverse pregnancy outcomes (APOs) in women with cardiovascular disease (CVD). We created a patient registry from our cardio-obstetrics program. APOs were defined as intrauterine growth restriction (IUGR), hypertensive disorder of pregnancy (HDP), and pre-term birth. Analysis included 63 women. 42 (66.7 %) experienced no APOs, while 21 (33.3 %) did; 18 (28.6 %), 3 (4.8 %), and 12 (19.0 %) developed an HDP, IUGR, or delivered pre-term, respectively. Pre-conception risk burden was not a significant predictor of APO development (p = 0.139). However, patients with pre-term delivery had a significantly higher number of risk factors (p < 0.001), as did patients with chronic hypertension with superimposed HDP (p < 0.001). Women delivering pre-term have higher risk factor burdens. Since pre-term birth is associated with future CVD in women independent of cause, optimization of preconception cardiovascular health could help mitigate these risks in an already vulnerable population.