Contrast-Enhanced Ultrasound in Obstetrics: A Systematic Review

Contrast-enhanced ultrasound (CEUS) has emerged as a promising imaging modality in obstetrics, offering new insights into placental and maternal vascular function. We conducted a systematic review, registered in PROSPERO (CRD42024508860), to summarize the current clinical and research applications of CEUS during pregnancy. A comprehensive search of PubMed, Embase, ClinicalTrials.gov, the International Clinical Trials Registry Platform and the Cochrane Central Register of Controlled Trials identified 11 studies including 361 pregnant women. Most investigations focused on the placenta (54.5%), while four studies explored non-obstetric maternal pathologies and only one involved twin pregnancies. Across all reports, CEUS was applied both qualitatively and quantitatively, mainly to characterize placental perfusion and vascularization. The mean gestational age at imaging was 24.1 wk. Importantly, no adverse maternal or fetal effects were reported in the exposed groups, including when the fetus was directly assessed by CEUS via intravascular injection. Despite its limited current use, CEUS shows substantial potential to enhance our understanding of placental physiology and maternal hemodynamics. These encouraging results highlight the need for innovative and methodologically rigorous clinical studies to better define its role in pregnancy care and research.