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Ruican D, Petrescu AM, Istrate-Ofiţeru AM, Roșu GC, Zorilă GL, Dîră LM, Nagy RD, Mogoantă L, Pirici D, Iliescu DG. Confirmation of Heart Malformations in Fetuses in the First Trimester Using Three-Dimensional Histologic Autopsy. Obstet Gynecol 2023:00006250-990000000-00767. [PMID: 37141594 PMCID: PMC10184816 DOI: 10.1097/aog.0000000000005169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/09/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND We aimed to evaluate the usefulness of three-dimensional (3D) reconstruction of histology slides to confirm congenital heart disease (CHD) detected by first-trimester fetal cardiac ultrasonography. Conventional autopsy is hindered by the small size of the first-trimester fetal heart, and current CHD confirmation studies employ the use of highly specialized and expensive methods. TECHNIQUE An extended first-trimester ultrasound examination protocol was used to diagnose fetal heart anomalies. Medical termination of pregnancies was followed by fetal heart extraction. The specimens were sliced, and the histology slides were stained and scanned. The resulting images were processed, and volume rendering was performed using 3D reconstruction software. The volumes were analyzed by a multidisciplinary team of maternal-fetal medicine subspecialists and pathologists and compared with ultrasound examination findings. EXPERIENCE Six fetuses with heart malformations were evaluated using histologic 3D imaging: two with hypoplastic left heart syndrome, two with atrioventricular septal defects, one with an isolated ventricular septal defect, and one with transposition of the great arteries. The technique allowed us to confirm ultrasound-detected anomalies and also identified additional malformations. CONCLUSION After pregnancy termination or loss, histologic 3D imaging can be used to confirm the presence of fetal cardiac malformations detected during first-trimester ultrasound examination. Additionally, this technique has the potential to refine the diagnosis for counseling regarding recurrence risk and retains the advantages of standard histology.
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Affiliation(s)
- Dan Ruican
- Department of Obstetrics and Gynecology, University Emergency County Hospital, and the Doctoral School, the Department of Histology, the Research Centre for Microscopic Morphology and Immunology, and the Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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First Trimester Ultrasound Detection of Fetal Central Nervous System Anomalies. Brain Sci 2023; 13:brainsci13010118. [PMID: 36672099 PMCID: PMC9857041 DOI: 10.3390/brainsci13010118] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To evaluate the potential of the first-trimester ultrasound (US) features for the detection of central nervous system (CNS) anomalies. Methods/Methodology: This is a prospective one-center three-year study. Unselected singleton pregnant women were examined using an extended first-trimester anomaly scan (FTAS) that included the CNS assessment: the calvaria shape, the septum (falx cerebri), the aspect of the lateral ventricles, the presence of the third ventricle and aqueduct of Sylvius (AS) and the posterior brain morphometry: the fourth ventricle, namely intracranial translucency (IT), brain stem/brain stem-occipital bone ratio (BS/BSOB) and cisterna magna (CM). The spine and underlying skin were also evaluated. The cases were also followed during the second and third trimesters of pregnancy and at delivery. FTAS efficiency to detect major CNS abnormalities was calculated. RESULTS We detected 17 cases with CNS major abnormalities in a population of 1943 first-trimester (FT) fetuses, including spina bifida with myelomeningocele, exencephaly-anencephaly, holoprosencephaly, hydrocephaly, cephalocele and Dandy-Walker malformation. The CNS features in the abnormal group are presented. In the second trimester (ST), we further diagnosed cases of corpus callosum agenesis, cerebellar hypoplasia, vein of Galen aneurysm and fetal infection features (ventriculomegaly, intraventricular bands, intraventricular cyst and hyperechoic foci), all declared normal at the FTAS. During the third trimester (TT) scan we identified a massive fetal cerebral haemorrhage absent at previous investigations. We report a detection rate of 72.7% of fetal brain anomalies in the FT using the proposed CNS parameters. The sensitivity of the examination protocol was 72.7%, and the specificity was 100%. CONCLUSION A detailed FT CNS scan is feasible and efficient. The majority of cases of major CNS abnormalities can be detected early in pregnancy. The visualization rates of the CNS parameters in the FT are great with short, if any, additional investigation time. FT cerebral disorders such as haemorrhage or infections were missed in the FT even when an extended evaluation protocol was used.
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Nagy RD, Cernea N, Dijmarescu AL, Manolea MM, Zorilă GL, Drăgușin RC, Vrabie SC, Dîră LM, Sîrbu OC, Novac MB, Drăgoescu NAM, Gheonea M, Stoica GA, Căpitănescu RG, Iliescu DG. Ductus Venosus Agenesis and Portal System Anomalies-Association and Outcome. BIOLOGY 2022; 11:548. [PMID: 35453747 PMCID: PMC9031854 DOI: 10.3390/biology11040548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
To evaluate the prenatal diagnosis of agenesis of ductus venosus (ADV) and portal venous system (PVS) anomalies and describe the outcome of these cases, either isolated or associated. We evaluated the intrahepatic vascular system regarding the presence of normal umbilical drainage and PVS characteristics in the second and third trimester of pregnancy. The associated anomalies and umbilical venous drainage were noted. Follow-up was performed at six months follow-up. Ultrasonography was performed in 3517 cases. A total of 19 cases were prenatally diagnosed: 18 ADV cases, seven abnormal PVS cases, and six associations of the two anomalies. We noted an incidence of 5.1‱ and 1.9‱ for ADV and PVS anomalies, respectively. Out of the 18 ADV cases, 27.7% were isolated. Five cases (26.3%) presented genetic anomalies. PVS anomalies were found in 33.3% of the ADV cases. ADV was present in 85.7% of the PVS anomalies. DV and PVS abnormalities were found with a higher than reported frequency. Normal DV is involved in the normal development of the PVS. Additional fetal anomalies are the best predictor for the outcome of ADV cases. Evaluation of PVS represents a powerful predictor for ADV cases and addresses the long-term prognosis.
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Affiliation(s)
- Rodica Daniela Nagy
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (R.D.N.); (L.M.D.)
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Nicolae Cernea
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
| | - Anda Lorena Dijmarescu
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Department of Obstetrics and Gynecology, Clinical Municipal Hospital “Filantropia” of Craiova, 200143 Craiova, Romania
| | - Maria-Magdalena Manolea
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Department of Obstetrics and Gynecology, Clinical Municipal Hospital “Filantropia” of Craiova, 200143 Craiova, Romania
| | - George-Lucian Zorilă
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Roxana Cristina Drăgușin
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Sidonia Cătălina Vrabie
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
- Department of Obstetrics and Gynecology, Clinical Municipal Hospital “Filantropia” of Craiova, 200143 Craiova, Romania
| | - Laurențiu Mihai Dîră
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (R.D.N.); (L.M.D.)
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Ovidiu Costinel Sîrbu
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Marius Bogdan Novac
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.B.N.); (N.A.M.D.)
- Department of Anesthesia and Intensive Care, Clinical Municipal Hospital “Filantropia” of Craiova, 200143 Craiova, Romania
| | - Nicoleta Alice Marinela Drăgoescu
- Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.B.N.); (N.A.M.D.)
- Department of Anesthesia and Intensive Care, University Emergency County Hospital, 200642 Craiova, Romania
| | - Mihaela Gheonea
- Department of Neonatology, University Emergency County Hospital, 200642 Craiova, Romania;
- Department of Neonatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - George Alin Stoica
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
- Department of Pediatric Orthopedic Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Pediatric Orthopedic Surgery, University Emergency County Hospital, 200642 Craiova, Romania
| | - Răzvan Grigoraș Căpitănescu
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
| | - Dominic-Gabriel Iliescu
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (N.C.); (R.C.D.); (O.C.S.); (R.G.C.); (D.-G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.L.D.); (M.-M.M.); (S.C.V.)
- Ginecho Clinic, Medgin SRL, 200333 Craiova, Romania;
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Prenatal Diagnosis and Outcome of Umbilical–Portal–Systemic Venous Shunts: Experience of a Tertiary Center and Proposal for a New Complex Type. Diagnostics (Basel) 2022; 12:diagnostics12040873. [PMID: 35453921 PMCID: PMC9027129 DOI: 10.3390/diagnostics12040873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023] Open
Abstract
Aims: To share our experience in the prenatal diagnosis of umbilical–portal–systemic venous shunts (UPSVS) and to study the prognostic factors for proper prenatal and perinatal management. Material and Methods: A five-year prospective study regarding the detection of UPSVS was conducted in two referral centers, Medgin Ginecho Clinic and the Prenatal Diagnostic Unit of the tertiary center, University Emergency County Hospital Craiova, Romania. We included in the analysis a series of agenesis of ductus venosus (ADV) cases previously reported by our center. We analyzed the incidence of the UPSVS types, their associations, and outcome predictors. Results: UPSVS were diagnosed in all 16 cases that were presented to our center at the time of first trimester anomaly scan, except one (94.12%). We diagnosed: 19 type I (61.2%), 4 type II (12.9%) and 5 type IIIa (16.1%) UPSVS. In three cases (9.6%) we noted multiple shunts, which we referred to as type IV (a new UPSVS type). Type IIIa-associated fetal growth restriction (FGR) was found in 60% of cases. Major anomalies worsened the outcome. Of the UPVSS cases, 57.1% were associated with PVS anomalies. Genetic anomalies were present in 40% of the tested cases. Conclusions: The incidence of UPSVS in our study was 0.2%. Early detection is feasible. The postnatal outcome mainly depends on the presence of structural, genetic and PVS anomalies. FGR may be associated. The new category presented a poor outcome secondary to poor hemodynamic and major associated anomalies.
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