Beyond anatomy: can elastography measure functional fetal lung maturity?

Accurate assessment of fetal lung maturity remains one of the most important challenges in perinatal medicine. Although advances in obstetric and neonatal care have substantially improved outcomes of preterm infants, respiratory distress syndrome (RDS) continues to be a major cause of neonatal morbidity worldwide. The ability to identify fetuses at risk for surfactant deficiency before birth could improve decisions regarding timing of delivery, antenatal corticosteroid administration, maternal transfer to tertiary centers, and postnatal respiratory management. In this issue, Huang and colleagues provide compelling experimental evidence that two-dimensional shear wave elastography (2D-SWE) may serve as a novel non-invasive approach to assessing fetal lung maturity. Their findings suggest that lung elasticity may reflect not only structural maturation but also surfactant-related functional readiness for postnatal respiration. 1