Virtual fetal holography for parental counseling and education: applications, limitations, and future directions

Overall approach

This review was designed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement (Figure 1), ensuring transparency and reproducibility. The objective was to synthesize peer-reviewed evidence on virtual fetal holography, focusing on technical foundations, clinical applications, ethical considerations, and educational value. Literature published between January 2015 and May 2025 was considered to capture recent technological developments and clinical applications relevant to prenatal counseling and education.

Literature search and study selection

A comprehensive search was performed using PubMed, IEEE Xplore, ScienceDirect, and Google Scholar. Search terms included “virtual fetal holography,” “3D/4D ultrasound hologram,” “AI-based image segmentation,” and “holography in fetal imaging.” References of retrieved articles were screened to identify additional studies. Inclusion criteria were studies reporting empirical applications of holography based on medical imaging, integration of artificial intelligence for image processing, or descriptions of clinical feasibility and educational applications. Exclusion criteria were articles focused on speculative or hypothetical applications without empirical data, studies unrelated to medical imaging, animal experiments, and papers lacking an English full text.

The search yielded 362 unique records. After duplicate removal and screening, 55 full-text articles were reviewed, resulting in 31 studies that met the inclusion criteria (Figure 1). These include systematic reviews, observational studies, technical prototypes, and AI-based imaging workflow studies [18], [19], [20], [21].

Data extraction and quality assessment

Two reviewers independently extracted study characteristics, objectives, imaging modality, outcomes, and conclusions. Methodological quality and risk of bias were assessed using validated tools: AMSTAR-2 for systematic reviews, ROBIS for narrative reviews, and the Newcastle–Ottawa Scale (NOS) for observational and feasibility studies. Quality ratings and evidence weighting are summarized in Table 3, while key insights and detailed characteristics are presented in Table 1 and Table 2 respectively. Disagreements were resolved by consensus.

Workflow of virtual fetal holography

The technical foundation of virtual fetal holography integrates advanced imaging acquisition and artificial intelligence–driven processing. High-resolution 3D and 4D ultrasound datasets are captured, providing static morphology and dynamic fetal motion. These images undergo AI-based segmentation and volumetric reconstruction to create anatomically accurate digital fetal models, which are subsequently rendered as interactive holographic visualizations. The resulting models are projected through mixed reality headsets or holographic displays, enabling real-time interactive exploration during prenatal counseling. An example of a rendered fetal hologram is shown in Figure 2, illustrating its life-like detail and spatial realism. The complete step-by-step workflow, from patient identification to AI processing and holographic projection, is presented in Figure 3.

Data synthesis

Studies were categorized into four thematic areas: technological advancements, clinical and educational applications, workflow integration, and ethical considerations. Due to heterogeneity in design and outcome measures, narrative synthesis was chosen. The critical appraisal and thematic analysis are detailed in the Results section, supported by Tables 1–3.

Literature screening and study characteristics

The literature search identified 362 records, of which 79 were duplicates and 228 were excluded after title and abstract screening. Fifty-five full texts were assessed, and 31 studies met the inclusion criteria (Figure 1). These included systematic reviews, observational feasibility studies, technical prototypes, and AI-driven imaging workflow studies. Study characteristics are summarized in Table 2, while critical insights and limitations of the most influential 25 studies are detailed in Table 1. Methodological quality and risk of bias assessments are presented in Table 3.

Technical advancements in holographic imaging

The reviewed literature demonstrates major technological progress in converting 3D and 4D ultrasound datasets into interactive holographic models. AI-powered segmentation and noise reduction algorithms have improved anatomical delineation of fetal structures such as the brain, heart, limbs, and umbilical vessels, enhancing visual clarity and diagnostic reliability [18], [19], [20], [21]. Integration of color Doppler and multimodal overlays enables more accurate cardiac and vascular mapping, exemplified by fetal heart holograms used in congenital anomaly counseling (Figure 4). Advances in rendering software and display platforms, including the Microsoft HoloLens and mixed reality projectors, have enabled real-time, interactive visualization from multiple angles [4], 11]. A representative AI-generated fetal hologram demonstrating anatomical realism and spatial depth is illustrated in Figure 2, while the complete data acquisition and holographic workflow is shown in Figure 3.

Figure 4:

This figure illustrates the integration of AI-driven holographic imaging for detailed fetal heart assessment, showcasing the system’s ability to create dynamic, real-time 3D visualizations. On the left, various ultrasound perspectives highlight anatomical and blood flow assessments, while on the right, advanced cardiac metrics and diagnostic overlays demonstrate comprehensive functional analysis. The central holographic representation of the fetal heart is enhanced with color Doppler data, allowing clinicians to observe critical flow patterns. By combining volumetric holography with real-time diagnostic intelligence, this technology supports confident, accurate assessments of fetal cardiac health. It not only enhances clinical decision-making but also facilitates better patient understanding during consultations about congenital heart anomalies or other conditions.

Clinical applications of virtual fetal holography

Clinical applications primarily focus on enhancing prenatal counseling, parental education, and multidisciplinary team collaboration. Several studies report improved parental comprehension when holographic fetal visualizations supplement standard ultrasound, particularly when counseling on congenital anomalies and growth restriction [7], 8], 10]. Interactive holograms provide expectant parents with a clearer spatial understanding of fetal position, anatomy, and movement compared to conventional 2D/3D imaging, supporting informed decision-making and strengthening maternal–fetal bonding. In professional settings, holograms have facilitated more effective multidisciplinary discussions by offering shared 3D anatomical references during complex case reviews [4], 11]. A clinical counseling scenario using complete fetal holographic visualization is demonstrated in Figure 5.

Figure 5:

Demonstration of the breadth of virtual holography applications in obstetrics, gynecology, and reproductive medicine. Each panel represents a distinct clinical domain where interactive 3D holograms enhance diagnostic visualization and patient counseling. Top panels show gynecological anatomy, including uterine cavity evaluation and ovarian and fallopian tube imaging, facilitating fertility assessments and adnexal pathology counseling. Middle panels highlight hysterosalpingo-contrast sonography (HyCoSy) for tubal patency evaluation, brain vascularization and volumetry for fetal neuroimaging, fetal vertebral column assessment for structural anomalies, and placental vasculature with uterine anatomy for high-risk pregnancy evaluation. Bottom panels demonstrate multimodal virtual imaging of the cervix and uterine myomas, as well as urogynaecological mapping of bladder and pelvic floor structures. By converting complex diagnostic data into interactive holograms, this technology improves patient comprehension, strengthens emotional engagement, and supports informed decision-making while promoting multidisciplinary collaboration in managing fetal anomalies, gynecological disorders, and fertility-related issues.

Real-world examples from related medical fields

Adoption of holography in other specialties provides insight into its broader translational potential. Bruckheimer et al. demonstrated improved procedural accuracy in cardiac interventions using real-time holographic models of cardiac structures [2]. Dental education programs using holographic models showed superior knowledge retention and spatial reasoning among students compared to traditional teaching methods [7], and neurosurgical planning studies reported improved understanding of complex spatial relationships [4], 12]. These examples, while outside prenatal care, suggest comparable benefits when adapted to fetal imaging and counseling.

Strengths of current evidence

The strongest evidence supports holography’s role in improving patient comprehension and emotional engagement during clinical encounters. Studies consistently report positive subjective feedback from parents and clinicians when holographic models supplement traditional imaging [7], 10]. AI-enhanced segmentation increases anatomical fidelity, ensuring accurate diagnostic visualization [18], [19], [20], [21]. Additionally, the versatility of display platforms allows integration across educational, diagnostic, and training contexts [4], 11]. These findings indicate that virtual fetal holography is technically feasible and well-received by both clinicians and patients.

Limitations of current evidence

Despite promising potential, existing studies are mostly small-scale, feasibility-focused, or descriptive, with limited empirical validation of impacts on clinical outcomes or decision quality [1], 26]. Costs of acquisition, specialized software, and operator training remain significant barriers, particularly in resource-limited settings [4], 23]. Ethical concerns persist, including potential patient anxiety from viewing detailed holographic anomalies, data security issues, and the need for robust informed consent processes [22], 27]. Addressing these limitations through rigorous clinical trials, standardized workflow protocols, cost-benefit analyses, and comprehensive training programs will be essential to integrating holography into routine prenatal care.

Patient education and emotional engagement

The findings of this review support the primary hypothesis that virtual fetal holography enhances patient comprehension and emotional engagement compared with conventional 2D and 3D ultrasound imaging [7], 8], 10], 24]. Holographic models provide a highly immersive, three-dimensional visualization of fetal structures, improving patient understanding of complex anatomy and fostering maternal–fetal bonding. Emotional engagement is further strengthened by the interactive nature of holographic projections, allowing parents to explore fetal anatomy dynamically during consultations (Figure 5). This enhanced visualization has been associated with increased patient satisfaction and adherence to prenatal care recommendations [8], 24].

Multidisciplinary collaboration and clinical decision-making

Virtual fetal holography facilitates more effective multidisciplinary collaboration by offering shared visual references during case discussions. Obstetricians, radiologists, maternal–fetal medicine specialists, and genetic counselors can simultaneously view and manipulate holographic models, supporting consensus-building and timely decision-making [12], 16], 17]. Experiences from neurosurgery and cardiac surgery, where similar holographic approaches have improved spatial orientation and procedural planning [2], 4], 12], suggest a high potential for comparable benefits in prenatal anomaly assessment and perinatal surgical planning. These applications complement structured workflows as described in Figure 3, demonstrating integration into clinical pathways.

Applications in obstetrics, gynaecology, and perinatal care

Holography has shown value in diverse areas of perinatal care, including fetal anomaly counseling, fetal echocardiography, assessment of fetal movements and blood flow, and maternal pelvic anatomy evaluation. Interactive holographic models (Figure 2) enhance parental understanding of complex anomalies, such as congenital heart disease, by presenting life-like fetal heart models (Figure 4) and facilitating discussions of potential interventions. Multimodal integration of ultrasound, Doppler, and MRI data allows for holistic fetal and maternal assessment [5], 9], 27], improving diagnostic accuracy and aiding decision-making. In high-risk pregnancies, these tools could support earlier intervention planning, reducing complications and improving outcomes [22], 26].

Role in professional training

Virtual fetal holography provides a powerful platform for education and training. Medical students, sonographers, and obstetric trainees can interact with dynamic fetal models, improving spatial reasoning and diagnostic accuracy [7], 14], 17]. These benefits mirror positive outcomes from other specialties where holographic training has demonstrated improved knowledge retention and procedural skill development [14], 26]. Widespread adoption in educational curricula could accelerate clinical competency and enhance quality of care.

Ethical and practical considerations

Despite its promise, holography poses unique ethical challenges. High-resolution, life-like representations can evoke emotional stress, particularly when abnormalities are present [12], 27]. Standardized counseling protocols and professional training are required to ensure visual data is presented sensitively and interpreted accurately. Data privacy and cybersecurity concerns must be addressed through robust encryption and secure storage [4], 22]. High cost, specialized equipment, and the need for skilled operators remain significant barriers to widespread implementation, particularly in low-resource settings [15], 23], 25]. Emerging solutions, including mobile holographic projectors and lightweight mixed-reality headsets, may offer cost-effective and scalable alternatives.

Addressing current gaps and future directions

The current evidence base is limited by a predominance of feasibility studies and descriptive case reports rather than randomized trials or longitudinal outcome studies (Tables 1–3). Future research should focus on rigorous clinical trials comparing conventional counseling with holography-based counseling, cost-effectiveness analyses, and studies evaluating its impact on long-term maternal and neonatal outcomes. Additionally, training frameworks for integrating holography into clinical practice and education require development and validation.

Key takeaways

1. Virtual fetal holography enhances parental understanding of fetal anatomy and fosters stronger emotional bonding.

2. AI-driven segmentation and rendering improve anatomical fidelity and diagnostic precision.

3. Interactive holographic visualization supports multidisciplinary decision-making and education.

4. High costs, technical complexity, and ethical considerations are major barriers to routine clinical adoption.

5. Rigorous clinical validation, cost-effectiveness analyses, and standardized training are essential next steps.

Implementation checklist

1. Establish standardized workflows for fetal image acquisition, segmentation, and holographic rendering (Figure 3).

2. Implement structured counseling protocols to manage emotional impact when presenting abnormal findings.

3. Ensure data security and privacy compliance during storage and transmission of holographic datasets.

4. Provide professional training for clinicians on holographic interpretation and counseling techniques.

5. Explore cost-reduction strategies through mobile and portable holographic systems for resource-limited settings.

Strengths of this review

This review is the first to comprehensively synthesize evidence on virtual fetal holography for parental counseling and education, explicitly following PRISMA guidelines (Figure 1) and incorporating a formal quality assessment (Table 3). The scope extends beyond obstetrics to draw lessons from cardiology, neurosurgery, dental education, and orthopedics, highlighting the broad translational potential of holographic imaging (Tables 1 and 2). Additionally, this review emphasizes the integration of AI-powered image processing, an innovation critical to producing clinically accurate and interactive holograms (Figure 2). By combining workflow analysis (Figure 3), clinical exemplars (Figures 4 and 5), and critical appraisal, this review provides a holistic perspective on the current state and future promise of this emerging technology.

Limitations of the evidence

The current evidence base is limited by several factors. Most included studies are feasibility-based or descriptive, with small sample sizes and limited outcome measures, which restrict generalizability. Few studies directly compare holographic counseling with conventional ultrasound-based counseling. Additionally, there is a lack of standardized protocols for holographic workflow, including segmentation, rendering, and display methods, and a limited understanding of potential psychological effects on parents viewing life-like fetal holograms, especially when anomalies are present. Cost analyses, training frameworks, and ethical guidelines remain underdeveloped.

Future directions