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Llurba E, Crispi F, Crovetto F, Youssef L, Delgado JL, Puig I, Mora J, Krofta L, Mackova K, Martinez-Varea A, Tubau A, Ruiz A, Paya A, Prat M, Chantraine F, Comas C, Kajdy A, Lopez-Tinajero MF, Figueras F, Gratacos E. Multicentre randomised trial of screening with sFlt1/PlGF and planned delivery to prevent pre-eclampsia at term: protocol of the PE37 study. BMJ Open 2024; 14:e076201. [PMID: 38458783 DOI: 10.1136/bmjopen-2023-076201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Pre-eclampsia affects ~5%-7% of pregnancies. Although improved obstetric care has significantly diminished its associated maternal mortality, it remains a leading cause of maternal morbidity and mortality in the world. Term pre-eclampsia accounts for 70% of all cases and a large proportion of maternal-fetal morbidity related to this condition. Unlike in preterm pre-eclampsia, the prediction and prevention of term pre-eclampsia remain unsolved. Previously proposed approaches are based on combined third-trimester screening and/or prophylactic drugs, but these policies are unlikely to be widely implementable in many world settings. Recent evidence shows that the soluble fms-like tyrosine kinase-1 (s-Flt-1) to placental growth factor (PlGF) ratio measured at 35-37 weeks' gestation predicts term pre-eclampsia with an 80% detection rate. Likewise, recent studies demonstrate that induction of labour beyond 37 weeks is safe and well accepted by women. We hypothesise that a single-step universal screening for term pre-eclampsia based on sFlt1/PlGF ratio at 35-37 weeks followed by planned delivery beyond 37 weeks reduces the prevalence of term pre-eclampsia without increasing the caesarean section rates or worsening the neonatal outcomes. METHODS AND ANALYSIS We propose an open-label randomised clinical trial to evaluate the impact of a screening of term pre-eclampsia with the sFlt-1/PlGF ratio followed by planned delivery in asymptomatic nulliparous women at 35-37 weeks. Women will be assigned 1:1 to revealed (sFlt-1/PlGF known to clinicians) versus concealed (unknown) arms. A cut-off of >90th centile is used to define the high risk of subsequent pre-eclampsia and offer planned delivery from 37 weeks. The efficacy variables will be analysed and compared between groups primarily following an intention-to-treat approach, by ORs and their 95% CI. This value will be computed using a Generalised Linear Mixed Model for binary response (study group as fixed effect and the centre as intercept random effect). ETHICS AND DISSEMINATION The study is conducted under the principles of Good Clinical Practice. This study was accepted by the Clinical Research Ethics Committee of Hospital Clinic Barcelona on 20 November 2020. Subsequent approval by individual ethical committees and competent authorities was granted. The study results will be published in peer-reviewed journals and disseminated at international conferences. TRIAL REGISTRATION NUMBER NCT04766866.
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Affiliation(s)
- Elisa Llurba
- Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Fatima Crispi
- BCNatal, Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | | | | | - Juan Luis Delgado
- Unidad Medicina Fetal Murcia, IMIB Arrixaca, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Isabel Puig
- Unidad Medicina Fetal Murcia, IMIB Arrixaca, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Ladislav Krofta
- Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katerina Mackova
- Institute for the Care of Mother and Child, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Albert Tubau
- Obstetrician, Son Llàtzer Hospital, Palma de Mallorca, Illes Balears, Spain
| | - Aina Ruiz
- Obstetrician, Son Llàtzer Hospital, Palma de Mallorca, Illes Balears, Spain
| | | | | | | | | | - Anna Kajdy
- Centre of Postgraduate Medical Education, Obstetrics and Gynecology and Perinatal Medicine, Warsaw, Poland
| | | | - Francesc Figueras
- BCNatal, Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
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Garcia-Manau P, Mendoza M, Bonacina E, Martin-Alonso R, Martin L, Palacios A, Sanchez ML, Lesmes C, Hurtado I, Perez E, Tubau A, Ibañez P, Alcoz M, Valiño N, Moreno E, Borrero C, Garcia E, Lopez-Quesada E, Diaz S, Broullon JR, Teixidor M, Chulilla C, Gil MM, Lopez M, Candela-Hidalgo A, Salinas-Amoros A, Moreno A, Morra F, Vaquerizo O, Soriano B, Fabre M, Gomez-Valencia E, Cuiña A, Alayon N, Sainz JA, Vives A, Esteve E, Ocaña V, López MÁ, Maroto A, Carreras E. Management of fetal Growth Restriction at term by Angiogenic Factors versus feto-maternal Doppler (GRAFD) to avoid adverse perinatal outcomes: multicenter open-label randomized controlled trial study protocol (Preprint). JMIR Res Protoc 2022; 11:e37452. [PMID: 36222789 PMCID: PMC9597418 DOI: 10.2196/37452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/20/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Fetal smallness affects 10% of pregnancies. Small fetuses are at a higher risk of adverse outcomes. Their management using estimated fetal weight and feto-maternal Doppler has a high sensitivity for adverse outcomes; however, more than 60% of fetuses are electively delivered at 37 to 38 weeks. On the other hand, classification using angiogenic factors seems to have a lower false-positive rate. Here, we present a protocol for the Fetal Growth Restriction at Term Managed by Angiogenic Factors Versus Feto-Maternal Doppler (GRAFD) trial, which compares the use of angiogenic factors and Doppler to manage small fetuses at term. Objective The primary objective is to demonstrate that classification based on angiogenic factors is not inferior to estimated fetal weight and Doppler at detecting fetuses at risk of adverse perinatal outcomes. Methods This is a multicenter, open-label, randomized controlled trial conducted in 20 hospitals across Spain. A total of 1030 singleton pregnancies with an estimated fetal weight ≤10th percentile at 36+0 to 37+6 weeks+days will be recruited and randomly allocated to either the control or the intervention group. In the control group, standard Doppler-based management will be used. In the intervention group, cases with a soluble fms-like tyrosine kinase to placental growth factor ratio ≥38 will be classified as having fetal growth restriction; otherwise, they will be classified as being small for gestational age. In both arms, the fetal growth restriction group will be delivered at ≥37 weeks and the small for gestational age group at ≥40 weeks. We will assess differences between the groups by calculating the relative risk, the absolute difference between incidences, and their 95% CIs. Results Recruitment for this study started on September 28, 2020. The study results are expected to be published in peer-reviewed journals and disseminated at international conferences in early 2023. Conclusions The angiogenic factor–based protocol may reduce the number of pregnancies classified as having fetal growth restriction without worsening perinatal outcomes. Moreover, reducing the number of unnecessary labor inductions would reduce costs and the risks derived from possible iatrogenic complications. Additionally, fewer inductions would lower the rate of early-term neonates, thus improving neonatal outcomes and potentially reducing long-term infant morbidities. Trial Registration ClinicalTrials.gov NCT04502823; https://clinicaltrials.gov/ct2/show/NCT04502823 International Registered Report Identifier (IRRID) DERR1-10.2196/37452
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Affiliation(s)
- Pablo Garcia-Manau
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Mendoza
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Erika Bonacina
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raquel Martin-Alonso
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitario de Torrejón, Madrid, Spain
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Lourdes Martin
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari de Tarragona Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
| | - Ana Palacios
- Department of Obstetrics, Alicante University General Hospital, Miguel Hernandez University, Alicante, Spain
- Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - Maria Luisa Sanchez
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Cristina Lesmes
- Maternal Fetal Medicine Unit, Department of Obstetrics, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Ivan Hurtado
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Esther Perez
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitario de Cabueñes, Universidad de Oviedo, Gijón, Spain
| | - Albert Tubau
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Son Llàtzer, Universitat de les Illes Balears, Palma de Mallorca, Spain
| | - Patricia Ibañez
- Aragon Institute for Health Research, Department of Obstetrics, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Marina Alcoz
- Maternal Fetal Medicine Unit, Department of Obstetrics, Fundació Althaia, Universitat de Vic, Manresa, Spain
| | - Nuria Valiño
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitario de A Coruña, Universidade da Coruña, A Coruña, Spain
| | - Elena Moreno
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, Spain
| | - Carlota Borrero
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitario Virgen de Valme, Universidad de Sevilla, Sevilla, Spain
| | - Esperanza Garcia
- Maternal Fetal Medicine Unit, Department of Obstetrics, Consorci Sanitari de Terrassa, Universitat Internacional de Catalunya, Terrassa, Spain
| | - Eva Lopez-Quesada
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Sonia Diaz
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitario de Getafe, Universidad Europea de Madrid, Getafe, Spain
| | - Jose Roman Broullon
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, Spain
| | - Mireia Teixidor
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari de Girona Doctor Josep Trueta, Universitat de Girona, Girona, Spain
| | - Carolina Chulilla
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Maria M Gil
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitario de Torrejón, Madrid, Spain
- School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Monica Lopez
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari de Tarragona Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
| | - Amparo Candela-Hidalgo
- Department of Obstetrics, Alicante University General Hospital, Miguel Hernandez University, Alicante, Spain
- Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - Andrea Salinas-Amoros
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Anna Moreno
- Maternal Fetal Medicine Unit, Department of Obstetrics, Parc Taulí Hospital Universitari, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Francesca Morra
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Oscar Vaquerizo
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitario de Cabueñes, Universidad de Oviedo, Gijón, Spain
| | - Beatriz Soriano
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Son Llàtzer, Universitat de les Illes Balears, Palma de Mallorca, Spain
| | - Marta Fabre
- Aragon Institute for Health Research, Department of Obstetrics, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Elena Gomez-Valencia
- Maternal Fetal Medicine Unit, Department of Obstetrics, Fundació Althaia, Universitat de Vic, Manresa, Spain
| | - Ana Cuiña
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitario de A Coruña, Universidade da Coruña, A Coruña, Spain
| | - Nicolas Alayon
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, Spain
| | - Jose Antonio Sainz
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitario Virgen de Valme, Universidad de Sevilla, Sevilla, Spain
| | - Angels Vives
- Maternal Fetal Medicine Unit, Department of Obstetrics, Consorci Sanitari de Terrassa, Universitat Internacional de Catalunya, Terrassa, Spain
| | - Esther Esteve
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Terrassa, Spain
| | - Vanesa Ocaña
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitario de Getafe, Universidad Europea de Madrid, Getafe, Spain
| | - Miguel Ángel López
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, Spain
| | - Anna Maroto
- Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari de Girona Doctor Josep Trueta, Universitat de Girona, Girona, Spain
| | - Elena Carreras
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
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Juan-Clar M, Torrent M, Santandreu P, Arejola E, Ibarra J, Tubau A. Effectiveness of ultrasound screening for placenta accreta spectrum using standard ultrasound criteria in a secondary care setting. Fetal Diagn Ther 2022; 49:52-59. [PMID: 35016178 DOI: 10.1159/000521738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/23/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Ultrasound detection of placenta accreta spectrum (PAS) among women at risk is a key goal to reduce obstetric morbidity, but there is scarce information of its performance in real clinical settings. We report the effectiveness of a standardized ultrasound protocol to detect PAS in women with placenta previa in a secondary-level hospital. METHODS A retrospective analysis, including a cohort of 126 women with persistent placenta previa among 27,975 pregnancies between 2008 and 2020. All 126 women underwent standardized transabdominal and transvaginal ultrasound assessing 5 criteria: 1) loss of hypoechoic retroplacental zone and/or myometrial thinning <1 mm; 2) lacunar images with flow >15 cm/sec; 3) thick and bulging placenta; 4) thinning or interruption of the uterine-bladder serous interface; and 5) placental or uterovesical hypervascularity. The presence of at least one criterion was considered a high-risk for PAS. Diagnosis of PAS was confirmed during caesarean section and by histopathological analysis. RESULTS Among 126 women with placenta previa, 11 (8.7%) cases of PAS were diagnosed, of which 10 were detected prenatally by ultrasound. This resulted in a sensitivity of 90,9%, a specificity of 98,3%, a positive predictive value (PPV) of 83,3%, and negative predictive value (NPV) of 99,1%. Histopathological assessment showed six placenta increta (54.5%), four percreta (36.4%) and one accreta (9.1%). All 10 cases of invasive placenta presented more than three ultrasound criteria. CONCLUSIONS Standardized ultrasound screening protocol in women at risk due to placenta previa in the third trimester was highly effective in detecting PAS in a secondary-level hospital setting.
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Affiliation(s)
- Miquel Juan-Clar
- Department of Obstetrics and Gynaecology, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Marta Torrent
- Department of Obstetrics and Gynaecology, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Pere Santandreu
- Department of Obstetrics and Gynaecology, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Eva Arejola
- Department of Radiology, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Javier Ibarra
- Department of Pathology, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Albert Tubau
- Department of Obstetrics and Gynaecology, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
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Pauta M, Campos B, Segura-Puimedon M, Arca G, Nadal A, Tubau A, Perez SP, Marimon E, Martín L, López-Quesada E, Sabrià J, Muñoz B, Garcia E, Paz Y Miño F, Borobio V, Gomez O, Eixarch E, Lopez M, Comas Rovira M, Borrell A. Next-Generation Sequencing Gene Panels and "Solo" Clinical Exome Sequencing Applied in Structurally Abnormal Fetuses. Fetal Diagn Ther 2021; 48:746-756. [PMID: 34775388 DOI: 10.1159/000519701] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to assess the diagnostic yield of 2 different next-generation sequencing (NGS) approaches: gene panel and "solo" clinical exome sequencing (solo-CES), in fetuses with structural anomalies and normal chromosomal microarray analysis (CMA), in the absence of a known familial mutation. METHODOLOGY Gene panels encompassing from 2 to 140 genes, were applied mainly in persistent nuchal fold/fetal hydrops and in large hyperechogenic kidneys. Solo-CES, which entails sequencing the fetus alone and only interpreting the Online Mendelian Inheritance in Man genes, was performed in multisystem or recurrent structural anomalies. RESULTS During the study period (2015-2020), 153 NGS studies were performed in 148 structurally abnormal fetuses with a normal CMA. The overall diagnostic yield accounted for 35% (53/153) of samples and 36% (53/148) of the fetuses. Diagnostic yield with the gene panels was 31% (15/49), similar to 37% (38/104) in solo-CES. CONCLUSIONS A monogenic disease was established as the underlying cause in 35% of selected fetal structural anomalies by gene panels and solo-CES.
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Affiliation(s)
- Montse Pauta
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), BCNatal, Barcelona, Spain,
| | - Berta Campos
- qGenomics. Esplugues de Llobregat, Catalonia, Spain
| | | | - Gemma Arca
- DepartmentofNeonatology, BCNatal, Hospital Clinic Barcelona, Barcelona, Spain
| | - Alfons Nadal
- Department of Pathology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Albert Tubau
- Department of Obstetrics and Gynecology, Son Llàtzer Hospital, Palma de Mallorca, Spain
| | - Silvia Pina Perez
- Department of Obstetrics and Gynecology, Parc Taulí Hospital, Sabadell, Catalonia, Spain
| | - Edda Marimon
- Department of Obstetrics and Gynecology, Hospital Sant Joan de Déu, BCNatal, Esplugues de Llobregat, Catalonia, Spain
| | - Lourdes Martín
- Department of Obstetrics and Gynecology, Hospital Joan XXIII de Tarragona, Catalonia, Spain
| | - Eva López-Quesada
- Department of Obstetrics and Gynecology, Hospital Mútua de Terrassa, Terrassa, Spain
| | - Joan Sabrià
- Department of Obstetrics and Gynecology, Hospital Sant Joan de Déu, BCNatal, Esplugues de Llobregat, Catalonia, Spain
| | - Begoña Muñoz
- Department of Obstetrics and Gynecology, Hospital Sant Joan de Reus, Reus, Spain
| | - Esperanza Garcia
- Department of Obstetrics and Gynecology, Hospital Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Fernanda Paz Y Miño
- Department of Obstetrics and Gynecology, BCNatal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Virginia Borobio
- Department of Obstetrics and Gynecology, BCNatal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Olga Gomez
- Department of Obstetrics and Gynecology, BCNatal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Elisenda Eixarch
- Department of Obstetrics and Gynecology, BCNatal, Hospital Clínic de Barcelona, Barcelona, Spain.,Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Monica Lopez
- Department of Obstetrics and Gynecology, Hospital Joan XXIII de Tarragona, Catalonia, Spain
| | | | - Antoni Borrell
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), BCNatal, Barcelona, Spain.,Department of Obstetrics and Gynecology, BCNatal, Hospital Clínic de Barcelona, Barcelona, Spain
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5
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Maiz N, Tajada M, Rodríguez MÁ, Irasarri A, Molina FS, Tubau A, Burgos J, Alonso I, Plasencia W, Rodó C, Pijoan JI, Belar M, De Paco Matallana C. Three-dimensional ultrasonography for advanced neurosonography (neurosofe-3D): Validation of a brain volume acquisition guideline. Acta Obstet Gynecol Scand 2020; 100:84-90. [PMID: 32970823 DOI: 10.1111/aogs.13996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study aimed to evaluate the quality of the brain volumes acquired following an evidence-based guideline for the acquisition of brain volumes. MATERIAL AND METHODS This was a prospective multicenter study. Five centers recruited five cases each, acquiring two volumes per case, at different gestational age ranges. From the collected volumes, 10 operators performed an advanced neurosonography of each case. The evaluable anatomic structures were counted in each volume and expressed as a percentage. The results were compared with those obtained in a previous study where no recommendations had been made for the acquisition of the volumes. RESULTS Five hundred evaluations were included in the study. In the axial plane, 91.5% of the structures were satisfactorily evaluated, 81.8% in the coronal plane and 89.9% in the sagittal plane. These results were significantly better than those obtained in a previous study where the volumes had been acquired without any guidelines and the percentage of evaluable structures were 80% (P < .001), 67.1% (P < .001) and 55.1% (P < .001) in the axial, coronal and sagittal planes, respectively. CONCLUSIONS The application of an evidence-based guideline for the acquisition of brain volumes improves the quality of these by increasing the number of evaluable structures in the volume.
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Affiliation(s)
- Nerea Maiz
- Fetal Medicine Unit, Obstetrics and Gynecology Service, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), Barakaldo, Spain
| | - Mauricio Tajada
- Fetal Medicine Unit, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - María Á Rodríguez
- Fetal Medicine Unit, Obstetrics, Gynecology and Reproductive Medicine Department, Institut Universitari Quirón-Dexeus, Barcelona, Spain
| | - Ana Irasarri
- Clinical Epidemiology Unit, Hospital Universitario Cruces, BioCruces Health Research Institute, Barakaldo, Spain
| | - Francisca S Molina
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, San Cecilio University Hospital, Granada, Spain
| | - Albert Tubau
- Fetal Medicine Unit, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Jorge Burgos
- Fetal Medicine Unit, Obstetrics and Gynecology Service, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country (UPV/EHU), Barakaldo, Spain
| | | | | | - Carlota Rodó
- Maternal-Fetal Medicine Unit, Department of Obstetrics, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José I Pijoan
- Clinical Epidemiology Unit, Hospital Universitario Cruces, BioCruces Health Research Institute, Barakaldo, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Belar
- Prenatal Diagnosis Unit, Obstetrics and Gynecology Service, Hospital Universitario Donostia, San Sebastián, Spain
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6
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Viñals F, Correa F, Tubau A, Alonso I, Serra V, Herraiz I, Hormazabal L, Quiroz G, Saint-Jean C, Diaz L, Zambrano B, Galindo A. New Insights into the Anterior Complex. Fetal Diagn Ther 2020; 47:514-518. [PMID: 31931505 DOI: 10.1159/000504980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/25/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To introduce visualization of the germinal matrix (GM), external angle of the frontal horn, and periventricular white matter while evaluating the anterior complex (AC) during basic ultrasound assessment of the fetal brain. CASE PRESENTATIONS This is a retrospective observational study of healthy women with singleton pregnancies, with no increased risk of fetal central nervous system anomalies, attending routine ultrasound screening at 20-32 weeks' gestation. Seventeen cases are presented in which an abnormal aspect of the GM or external angle of the frontal horn or periventricular white matter on AC evaluation has allowed a prenatal diagnosis of peri-intraventricular hemorrhage, subependymal cysts, connatal cysts, periventricular venous hemorrhagic infarction, and white matter injury. CONCLUSION An extended AC evaluation could significantly improve the -diagnosis of hemorrhagic/cystic/hypoxic-ischemic lesions during the performance of a basic ultrasound study of the fetal brain.
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Affiliation(s)
- Fernando Viñals
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile,
| | - Flavia Correa
- Fetal and Neonatal Ultrasonography Department, Hospital Lusíadas, Lisbon, Portugal
| | - Albert Tubau
- Obstetrics Unit, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | | | - Vicente Serra
- Instituto Universitario IVI Valencia, IVIRMA, Universidad de Valencia, Valencia, Spain
| | - Ignacio Herraiz
- Fetal Medicine Unit - Maternal and Child Health and Development Network, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
| | - Lorena Hormazabal
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Gabriel Quiroz
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Constanza Saint-Jean
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Linder Diaz
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Belkys Zambrano
- Centro AGB Ultrasonografía, Clínica Sanatorio Alemán, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Alberto Galindo
- Fetal Medicine Unit - Maternal and Child Health and Development Network, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, 12 de Octubre Research Institute (imas12), Complutense University of Madrid, Madrid, Spain
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Ruiz A, Robles A, Salva F, Filgueira A, Díaz C, Juan M, Tubau A. Prenatal Nonvisualization of the Gallbladder: A Diagnostic and Prognostic Dilemma. Fetal Diagn Ther 2017; 42:150-152. [DOI: 10.1159/000456614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 01/03/2017] [Indexed: 11/19/2022]
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Maiz N, Alonso I, Belar M, Burgos J, Irasarri A, Molina FS, de Paco C, Pijoan JI, Plasencia W, Rodó C, Rodríguez MA, Tajada M, Tubau A. Three dimensional ultrasonography for advanced neurosonography (Neurosofe-3d). Analysis of acquisition-related factors influencing the quality of the brain volumes. Prenat Diagn 2016; 36:1054-1060. [DOI: 10.1002/pd.4933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/13/2016] [Accepted: 09/26/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Nerea Maiz
- Fetal Medicine Unit, Obstetrics and Gynecology Service, BioCruces Health Research Institute; Hospital Universitario Cruces. University of the Basque Country (UPV/EHU); Barakaldo Spain
| | | | - María Belar
- Prenatal Diagnosis Unit, Obstetrics and Gynecology Service; Hospital Universitario Donostia; San Sebastián Spain
| | - Jorge Burgos
- Fetal Medicine Unit, Obstetrics and Gynecology Service, BioCruces Health Research Institute; Hospital Universitario Cruces. University of the Basque Country (UPV/EHU); Barakaldo Spain
| | - Ana Irasarri
- Clinical Epidemiology Unit; Hospital Universitario Cruces, BioCruces Health Research Institute; Barakaldo Spain
| | - Francisca S. Molina
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology; San Cecilio University hospital; Granada Spain
| | - Catalina de Paco
- Fetal Medicine Unit; La Arrixaca University Hospital; Murcia Spain
| | - José I. Pijoan
- Clinical Epidemiology Unit; Hospital Universitario Cruces, BioCruces Health Research Institute; Barakaldo Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP); Madrid Spain
| | | | - Carlota Rodó
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology; Vall d'Hebrón University Hospital; Barcelona Spain
| | - M. Angeles Rodríguez
- Fetal Medicine Unit, Obstetrics, Gynecology and Reproductive Medicine Department; Institut Universitari Quirón-Dexeus; Barcelona Spain
| | - Mauricio Tajada
- Fetal Medicine Unit; Hospital Clínico Universitario Lozano Blesa; Zaragoza Spain
| | - Albert Tubau
- Fetal Medicine Unit; Hospital Son Llàtzer; Palma de Mallorca Spain
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9
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Torres-Juan L, Rosell J, Morla M, Vidal-Pou C, García-Algas F, de la Fuente MA, Juan M, Tubau A, Bachiller D, Bernues M, Perez-Granero A, Govea N, Busquets X, Heine-Suñer D. Mutations in TBX1 genocopy the 22q11.2 deletion and duplication syndromes: a new susceptibility factor for mental retardation. Eur J Hum Genet 2007; 15:658-63. [PMID: 17377518 DOI: 10.1038/sj.ejhg.5201819] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A screen for TBX1 gene mutations identified two mutations in patients with some features compatible with the 22q11.2-deletion syndrome but with no deletions. One is a de novo missense mutation and the other is a 5' untranslated region (5'UTR) C>T change that affects a nucleotide with a remarkable trans-species conservation. Computer modelling shows that the 5'UTR change is likely to affect the mRNA structure and in vitro translation experiments demonstrate that it produces a twofold increase in translation efficiency. Recently, duplications in the 22q11.2 region were reported in patients referred for fragile-X determination because of cognitive and behavioural problems. Because the 5'UTR nucleotide change may be a functional equivalent of a duplication of the TBX1 gene, we decided to screen 200 patients who had been referred for fragile-X determination and 400 healthy control individuals. As a result, we found the 5'UTR mutation to be present in three patients with mental retardation or behavioural problems and absent in control individuals of the same ethnic background. This observation suggests that it may be reasonable to screen for such mutation among patients with unspecific cognitive deficits and we provide an easy and quick way to do it with an amplification refractory mutation system (ARMS) approach. To our knowledge, this is the first human mutation showing that TBX1 is a candidate causing mental retardation associated with the 22q11.2 duplication syndrome.
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Affiliation(s)
- Laura Torres-Juan
- Section of Genetics, Hospital Universitari Son Dureta, Andrea Doria 55, Palma de Mallorca 07014, Balearic Islands, Spain
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Tubau A, Grau J, Filgueira A, Juan M, Estremera A, Ferrer MI, Dorao M, Hernández MI, Ferragut MA, Freixas N. Prenatal and postnatal imaging in isolated interruption of the inferior vena cava with azygos continuation. Prenat Diagn 2006; 26:872-4. [PMID: 16941517 DOI: 10.1002/pd.1516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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