FETALFusion: Resolution-Aware State-Space Modeling for Multi-Domain Fetal Head Segmentation

Head circumference (HC) measured from 2D ultrasound is a routine marker of fetal growth, and automating it needs segmentations whose boundaries hold up on individual scans, not only on average. We present FETALFusion, a dual-path CNN-Mamba encoder-decoder for fetal head segmentation across acquisition types. It applies four-directional state-space scans only at the two highest-resolution stages, routes bottleneck features through domain-specific channel gates that are averaged at test time, and adds a weak landmark shape prior. We train jointly on transabdominal (HC-18) and transperineal (PSFHS) images and compare ten methods on a held-out test set of 471 images, each trained under one schedule and scored by surface distances at native resolution. FETALFusion reaches a Dice score of 0.963 and an HD95 of 2.10 mm without test-time augmentation or a domain label. It improves on U-Mamba on all five reported metrics (HD95 reduced by 0.31 mm; Holm-corrected ($p < 10^{-4}$), a lead that holds under test-time augmentation and across two independent training runs, and in the mean on U-Net, Attention U-Net and TransUNet. Residual encoders close the gap: a ResNet-34 UNet++ exceeds FETALFusion, and an ImageNet initialised ResNet-34 U-Net is best overall (HD95 1.75 mm). The ablation agrees. Calibrated against run-to-run variation, it attributes FETALFusion's measurable gains to the landmark shape prior and, on transperineal images, to the domain gates, while removing the state-space branch does not measurably change accuracy. HC from the predicted masks agrees with the clinical reference at an intraclass correlation of 0.9986.