Background/Objectives: Cerebroplacental ratio (CPR) is mainly a contemporaneous hemodynamic and prognostic marker but has also been proposed as a marker of impaired growth velocity. We quantified how much third-trimester CPR constrains an individual fetus’s preceding measured growth. Methods: In a retrospective single-center cohort, conditional estimated fetal weight growth (cEFW) was derived in 920 singleton pregnancies and analyzed in 760 fetuses appropriate for gestational age (AGA) at the third-trimester scan (median 32.9 weeks), with umbilical and middle cerebral artery Doppler measurements obtained during the same examination. Quantile regression estimated the conditional/unconditional 10th–90th percentile width of cEFW (width ratio) by within-cohort CPR z-score. Results: Each 1 SD increase in CPR corresponded to 0.100 SD higher cEFW (95% CI 0.040–0.160); the AUC for cEFW ≤ −1 SD was 0.553 (0.479–0.619). Point-estimate width ratios ranged from 0.968 to 1.194 between CPR z −2 and +1, with wide intervals at low CPR. The modeled probability of cEFW ≤ −1 SD was 14.4% (8.5–22.1) at z −2 and 10.5% (8.4–12.9) at z 0. Without AGA restriction (n = 878), the association was stronger (AUC 0.615), but point-estimate width ratios likewise showed no narrowing at low CPR. Conclusions: In AGA fetuses scanned mainly at 31–34 weeks, CPR provided limited individual-level information about preceding measured growth in terms of central 80% width, discrimination and lower-tail probabilities; at very low CPR, meaningful narrowing cannot be excluded. Prognostic value for perinatal outcome was not assessed.

The fetal fraction (FF) of cell-free DNA determines the reliability of non-invasive prenatal testing (NIPT); whether first-trimester placental biomarkers add information beyond maternal factors is unclear. We linked NIPT samples from a single fetal medicine center over ten years (1162 pregnancies) to first-trimester screening records and modeled log FF with hierarchical regression (maternal/technical covariates → PAPP-A → free β-hCG), cluster-robust standard errors, and an order-independent bootstrapped partition of the biomarker contribution. In the primary complete-case model (n = 292), FF was 3.4% lower per kg/m² of BMI (95% CI −4.4 to −2.3) and 24% lower after IVF/ICSI. Free β-hCG was independently associated with FF (+11.0% per doubling of MoM, 95% CI +5.3 to +16.9; semi-partial R² = 0.046), whereas the PAPP-A association was weaker and less consistent (+4.8%, 95% CI −0.6 to +10.4; semi-partial R² = 0.010). The β-hCG association persisted after excluding high-risk NIPT calls, documented multiple gestation and IVF/ICSI, within platform-restricted subsets and with a restricted documentation-to-draw interval. No independent association with gestational age was identified in the primary model; low-FF and no-call results were too few for adjusted inference. Free β-hCG carries independent information on FF, consistent with, but not proof of, a link to syncytiotrophoblast biology.

Background/Objectives: First-trimester screening for preeclampsia (PE) with the Fetal Medicine Foundation (FMF) competing-risks algorithm assigns each pregnancy a numeric risk (1:X), which is compared against a threshold to decide aspirin eligibility. What proportion of a real-world screened population a given numeric threshold actually selects—its screen-positive rate (SPR)—depends on which markers were available and on the population’s underlying risk distribution, independently of how well that threshold detects PE. We audited this relationship directly from routine data from a single centre. Methods: Retrospective cohort of 5493 singleton pregnancies with a first-trimester PE risk calculated at 11–14 weeks (2020–2026) in one Romanian fetal-medicine centre. Pregnancies were stratified into five groups according to which markers were available at screening (maternal factors ± biochemistry [PAPP-A] ± uterine artery pulsatility index [UtA-PI] ± mean arterial pressure [MAP]), and the centre-specific SPR at fixed risk thresholds and the risk threshold corresponding to fixed SPR targets of 5%, 10%, 15% and 20% were computed for each group. The operational clinical threshold (1:150 before and 1:100 after the introduction of systematic MAP measurement in October 2023) was benchmarked against this map. Outcome ascertainment was quantified to determine whether these data could support any estimate of detection performance. Results: Among pregnancies screened with the maternal factors + MAP + UtA-PI + PAPP-A combination now used in routine practice (n = 1797), the operational threshold of 1:100 corresponded to an SPR of 16.7%, closer to the 15% than the 10% mapping point (local threshold for SPR = 10%: 1:66); the same numeric threshold corresponded to an SPR of only 11.0% among pregnancies screened with maternal factors and UtA-PI alone (n = 317). The historical reduction in SPR from 25.0% (pre-October 2023, threshold 1:150) to 16.1% (post-October 2023, threshold 1:100) was attributable mainly to the threshold change itself, since a same-era comparison at an identical fixed threshold (1:100) showed little difference in SPR between examinations with and without MAP (16.2% vs. 16.0%). Documented pregnancy outcome was available for only 13.5% of pregnancies (742/5493) and was strongly enriched for complicated pregnancies (documented PE prevalence 5.53% in this subset versus 0.87% in the whole cohort and 0.87–1.2% in published Romanian single-centre series). Consequently, outcome data in this dataset were considered unsuitable for local estimation of detection performance or treatment effect, and no such estimate is offered. Conclusions: The numeric risk threshold used clinically does not correspond to a fixed screen-positive rate across marker combinations in routine practice; local mapping of this relationship is a low-cost, outcome-independent audit that any screening centre can perform on its own data before, and independently of, any attempt to validate detection performance.

Background and Objectives: The 11–13⁺⁶-week scan has evolved from a nuchal translucency (NT) measurement into an early anatomical survey, and the anomalies it identifies increasingly shape prenatal counselling and management. Data from Central and Eastern European screening populations are scarce. Materials and Methods: Retrospective cohort of all pregnancies undergoing first-trimester combined screening in a single fetal medicine centre in Romania between August 2009 and April 2026, with a crown–rump length of 45–84 mm. The centre provides routine screening but also receives women referred after an abnormal finding elsewhere; the cohort is therefore described as a screening population with referral enrichment. Structural anomalies recorded prospectively in the ultrasound database at the first-trimester scan were classified by organ system and by first-trimester detectability category. NT, combined risk, karyotype and pregnancy outcome were extracted from the same database. Associations were quantified with odds ratios (OR) from logistic regression with cluster-robust standard errors by woman. Results: 11,229 pregnancies (10,015 women; 408 multiple pregnancies) were included. A structural anomaly was identified at 11–13⁺⁶ weeks in 197 (17.5 per 1000; 95% CI 15.3–20.1); 16.1 per 1000 (13.8–18.7) after exclusion of the years 2009–2012 and 16.9 per 1000 (14.6–19.5) in singleton pregnancies. A further 44 pregnancies had isolated cystic hygroma/hydrops or soft markers only. Cardiac defects (81; 7.2 per 1000) and abdominal-wall defects (74; 6.6 per 1000, of which 67 exomphalos) were present in 145 pregnancies (74%), followed by central nervous system (27), facial (23), skeletal (23), thoracic (10) and urogenital (10) anomalies; 37 pregnancies (19%) had anomalies in two or more systems. NT ≥ 3.5 mm was present in 59/197 (30%) anomalous versus 203/11,032 (1.8%) non-anomalous pregnancies (OR 22.8, 95% CI 16.3–31.9), and in 51% of cardiac defects. Among 37 karyotyped fetuses, 15 (41%) had a chromosomal abnormality. Pregnancy outcome was known for 87 anomalous pregnancies: 46 terminations, 33 live births and 8 fetal or neonatal deaths; 17 of 30 exomphalos cases with known outcome were live-born. Conclusions: In a screening population with referral enrichment, about 1 in 57 pregnancies had a structural anomaly identified at the 11–13⁺⁶-week scan, dominated by cardiac and abdominal-wall defects; the figure describes prenatally identified anomalies in this setting and is not a population-based prevalence. One third of these fetuses had increased NT and a high proportion of those tested had an abnormal karyotype, supporting the integration of systematic anatomical assessment and genetic evaluation into first-trimester screening.

Background/Objectives: Vaginal progesterone reduces preterm birth in women with a short mid-trimester cervix, and the treatment threshold has moved from 15–20 mm to 25 mm; how this change reached everyday practice is rarely documented. We describe cervical length (CL) distribution, short-cervix prevalence, preterm-birth and neonatal outcomes and the evolution of progesterone counselling in routine screening. Methods: Retrospective cohort of singleton pregnancies with a CL measurement at 16⁺⁰–24⁺⁶ weeks in one Romanian fetal-medicine centre (2011–2026). CL was measured transabdominally and, when <30 mm, transvaginally (FMF criteria). Documented counselling was extracted from the structured report text by keyword search; delivery outcome was available for 20.3% of pregnancies, so outcome analyses describe the outcome-ascertained subgroup. Results: Among 20,168 pregnancies, median CL was 35.8 mm; CL was <25 mm in 1.92% (95% CI 1.74–2.12) and <15 mm in 0.60%, and five times more frequent after a previous late miscarriage or preterm birth. In 4087 pregnancies with known delivery, birth < 34 weeks rose from 1.9% at CL ≥ 35 mm to 26.1% at <15 mm; CL < 25 mm carried an adjusted odds ratio of 9.1 (4.6–17.9) for birth < 34 weeks and birth weight < 1500 g in 8/92 (8.7%) vs. 41/3894 (1.1%), yet identified only 12% of births < 34 weeks (AUC 0.59); 88% (95% CI 79–93%) of births < 34 weeks followed a CL ≥ 25 mm. An explicit progesterone mention at 20–24.9 mm rose from 49.2% in 2011–2016 to 73.3% in 2017–2026 (p = 0.002); a data-driven change-point search located the shift in 2017–2019 (81% of clustered bootstrap samples), as a level change without trend, and the period effect persisted after adjustment for population composition (OR 5.0, 2.3–10.9). Before 2017 the operational threshold was ≈22 mm. Conclusions: A short cervix is rare but carries nine-fold adjusted odds of early preterm birth; screening identifies a small very-high-risk group rather than most preterm births. The structured report captured, in real time, the migration of documented counselling to the full ≤25 mm range between 2017 and 2019; neonatal findings are exploratory.

Background/Objectives: First-trimester screening combines a haemodynamic marker, the uterine artery pulsatility index (UtA-PI), with two serum markers, pregnancy-associated plasma protein A (PAPP-A) and free β-human chorionic gonadotropin (free β-hCG). For the serum markers, it is known that the value measured in one pregnancy correlates with the value measured in the same woman’s next pregnancy. For UtA-PI, only decreases in the mean value in second pregnancies have been reported. This study quantifies how much of a woman’s standardised UtA-PI persists from one pregnancy to the next and compares this persistence with that of the serum markers measured in the same woman. Methods: We performed a retrospective longitudinal analysis of the screening database of a single foetal medicine unit (August 2010–August 2026). Among 8925 eligible singleton pregnancies, 864 women were screened in two or more pregnancies (1757 pregnancies; 893 pairs of successive pregnancies; median interval 2.9 years, range 0.4–10.7 years). Marker values, expressed as multiples of the median (MoM) and log-transformed, were analysed with random-intercept models that split the total variation into a component between women and a component between the pregnancies of the same woman. The intraclass correlation coefficient (ICC), the fraction of the variation that lies between women, was estimated with bootstrap confidence intervals. Results: The ICC was 0.349 (95% confidence interval 0.280–0.412) for PAPP-A, 0.339 (0.274–0.397) for UtA-PI and 0.392 (0.290–0.478) for free β-hCG; that is, about one-third of the variation in each marker lay between women and about two-thirds between the pregnancies of the same woman. Adjustment for maternal age, body mass index, parity, smoking, gestational age, calendar time, biochemical analyser and examiner did not change the estimates (0.350 and 0.352). No weakening of the between-pregnancy correlation with a longer interval was detected (interaction p = 0.698 and 0.153), although statistical power was limited for the longest intervals. UtA-PI was lower in the next pregnancy by 6.3% on average (95% confidence interval 4.5–8.2%), whereas PAPP-A did not change. A previous PAPP-A below 0.4 MoM recurred in 17.4% of next pregnancies, and a previous UtA-PI above the 95th centile in 6%. Conclusions: Two distinct phenomena coexist in UtA-PI: a systematic fall at the population level in the next pregnancy, and a modest persistence of the individual value. Approximately one-third of the variation in UtA-PI reflects persistent differences between women—no more than for the serum markers—whereas two-thirds arises between the pregnancies of the same woman. A previous value carries some information about the next pregnancy but cannot replace a new measurement.