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Lust EER, Bronsgeest K, Henneman L, Crombag N, Bilardo CM, van Vliet-Lachotzki EH, Galjaard RJH, Sikkel E, Haak MC, Bekker MN. Informed choice and routinization of the second-trimester anomaly scan: a national cohort study in the Netherlands. BMC Pregnancy Childbirth 2023; 23:694. [PMID: 37752446 PMCID: PMC10521538 DOI: 10.1186/s12884-023-05981-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Since 2007 all pregnant women in the Netherlands are offered the second-trimester anomaly scan (SAS) in a nationwide prenatal screening program. This study aims to assess the level of informed choice of women opting for the SAS and to evaluate the presence of routinization 16 years after its implementation. It further explores decisional conflict and women's decision making. METHODS This prospective national survey study consisted of an online questionnaire which was completed after prenatal counseling and before undergoing the SAS. Informed choice was measured by the adapted multidimensional measure of informed choice (MMIC) and was defined in case women were classified as value-consistent, if their decision for the SAS was deliberated and made with sufficient knowledge. RESULTS A total of 894/1167 (76.6%) women completed the questionnaire. Overall, 54.8% made an informed choice, 89.6% had good knowledge, 59.8% had deliberated their choice and 92.7% held a positive attitude towards the SAS. Women with low educational attainment (p=0.004) or respondents of non-Western descent (p=0.038) were less likely to make an informed choice. Decisional conflict was low, with a significantly lower decisional conflict score in women that made an informed choice (p<0.001). Most respondents (97.9%) did not perceive pressure to undergo the SAS. CONCLUSIONS Our study showed a relatively low rate of informed choice for the SAS, due to absence of deliberation. Therefore, some routinization seem to be present in the Netherlands. However, most women had sufficient knowledge, did not perceive pressure and experienced low decisional conflict.
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Affiliation(s)
- Eline E R Lust
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, 3508 AB, The Netherlands
| | - Kim Bronsgeest
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lidewij Henneman
- Department of Human Genetics and Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Neeltje Crombag
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, 3508 AB, The Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Robert-Jan H Galjaard
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Esther Sikkel
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique C Haak
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, 3508 AB, The Netherlands.
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Hui L, Bilardo CM. The First Trimester: The new focal point for prenatal screening and diagnosis. Prenat Diagn 2023. [PMID: 37309089 DOI: 10.1002/pd.6395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
N/A This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lisa Hui
- Dept of Obstetrics and Gynaecology, University of Melbourne VIC Australia, Melbourne, Victoria, Australia, 3010
- Reproductive Epidemiology group, Murdoch Children's Research Institute VIC Australia, Melbourne, Victoria, Australia, 3010
- Dept of Perinatal Medicine, Mercy Hospital for Women VIC Australia, Melbourne, Victoria, Australia, 3010
- Dept of Obstetrics and Gynaecology, Northern Health, Melbourne, Victoria, Australia, 3010
| | - Caterina M Bilardo
- Amsterdam UMC, Amsterdam, Noord-Holland, Netherlands
- UMCG Groningen, University of Groningen, Amsterdam, Noord-Holland, Netherlands
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Bronsgeest K, Lust EER, Henneman L, Crombag N, Bilardo CM, Stemkens D, Galjaard RJH, Sikkel E, van der Hout SH, Bekker MN, Haak MC. Current practice of first-trimester ultrasound screening for structural fetal anomalies in developed countries. Prenat Diagn 2023. [PMID: 37269059 DOI: 10.1002/pd.6389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/12/2023] [Accepted: 05/20/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES First-trimester ultrasound screening is increasingly performed to detect fetal anomalies early in pregnancy, aiming to enhance reproductive autonomy for future parents. This study aims to display the current practice of first-trimester ultrasound screening in developed countries. METHOD An online survey study among 47 prenatal screening experts in developed countries. RESULTS First-trimester structural anomaly screening is available in 30 of the 33 countries and mostly offered to all women with generally high uptakes. National protocols are available in 23/30 (76.7%) countries, but the extent of anatomy assessment varies. Monitoring of scan quality occurs in 43.3% of the countries. 23/43 (53.5%) of the respondents considered the quality of first-trimester ultrasound screening unequal in different regions of their country. CONCLUSIONS First-trimester screening for structural fetal anomalies is widely offered in developed countries but large differences are reported in availability and use of screening protocols, extent of anatomy assessment, training and experience of sonographers and quality monitoring systems. Consequently, this results in an unequal offer to parents in developed countries, sometimes even within the same country. Furthermore, as offer and execution differ so widely, this has to be taken into account when results of screening policies are scientifically published or compared. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kim Bronsgeest
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Eline E R Lust
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lidewij Henneman
- Department of Human Genetics and Amsterdam Reproduction and Development Research Institute, location Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Neeltje Crombag
- Department of Obstetrics and Gynaecology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics and Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - D Stemkens
- VSOP-Patient Alliance for Rare and Genetic Diseases, Soest, The Netherlands
| | - Robert-Jan H Galjaard
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Esther Sikkel
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sanne H van der Hout
- Department of Health, Ethics & Society, Maastricht University Medical Centre/Maastricht University, Maastricht, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique C Haak
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, The Netherlands
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Bardi F, Bakker M, Elvan-Taşpınar A, Kenkhuis MJA, Fridrichs J, Bakker MK, Birnie E, Bilardo CM. Organ-specific learning curves of sonographers performing first-trimester anatomical screening and impact of score-based evaluation on ultrasound image quality. PLoS One 2023; 18:e0279770. [PMID: 36730474 PMCID: PMC9894388 DOI: 10.1371/journal.pone.0279770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 12/13/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION First-trimester anatomical screening (FTAS) by ultrasound has been introduced in many countries as screening for aneuploidies, but also as early screening for fetal structural abnormalities. While a lot of emphasis has been put on the detection rates of FTAS, little is known about the performance of quality control programs and the sonographers' learning curve for FTAS. The aims of the study were to evaluate the performance of a score-based quality control system for the FTAS and to assess the learning curves of sonographers by evaluating the images of the anatomical planes that were part of the FTAS protocol. METHODS Between 2012-2015, pregnant women opting for the combined test in the North-Netherlands were also invited to participate in a prospective cohort study extending the ultrasound investigation to include a first-trimester ultrasound performed according to a protocol. All anatomical planes included in the protocol were documented by pictures stored for each examination in logbooks. The logbooks of six sonographers were independently assessed by two fetal medicine experts. For each sonographer, logbooks of examination 25-50-75 and 100 plus four additional randomly selected logbooks were scored for correct visualization of 12 organ-system planes. A plane specific score of at least 70% was considered sufficient. The intra-class correlation coefficient (ICC), was used to measure inter-assessor agreement for the cut-off scores. Organ-specific learning curves were defined by single-cumulative sum (CUSUM) analysis. RESULTS Sixty-four logbooks were assessed. Mean duration of the scan was 22 ± 6 minutes and mean gestational age was 12+6 weeks. In total 57% of the logbooks graded as sufficient. Most sufficient scores were obtained for the fetal skull (88%) and brain (70%), while the lowest scores were for the face (29%) and spine (38%). Five sonographers showed a learning curve for the skull and the stomach, four for the brain and limbs, three for the bladder and kidneys, two for the diaphragm and abdominal wall and one for the heart and spine and none for the face and neck. CONCLUSION Learning curves for FTAS differ per organ system and per sonographer. Although score-based evaluation can validly assess image quality, more dynamic approaches may better reflect clinical performance.
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Affiliation(s)
- Francesca Bardi
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail: (FB); (CMB)
| | - Merel Bakker
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ayten Elvan-Taşpınar
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Monique J. A. Kenkhuis
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jeske Fridrichs
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marian K. Bakker
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erwin Birnie
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Caterina M. Bilardo
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- * E-mail: (FB); (CMB)
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Mylrea-Foley B, Wolf H, Stampalija T, Lees C, Arabin B, Berger A, Bergman E, Bhide A, Bilardo CM, Breeze AC, Brodszki J, Calda P, Cetin I, Cesari E, Derks J, Ebbing C, Ferrazzi E, Ganzevoort W, Frusca T, Gordijn SJ, Gyselaers W, Hecher K, Klaritsch P, Krofta L, Lindgren P, Lobmaier SM, Marlow N, Maruotti GM, Mecacci F, Myklestad K, Napolitano R, Prefumo F, Raio L, Richter J, Sande RK, Thornton J, Valensise H, Visser GHA, Wee L. Longitudinal Doppler Assessments in Late Preterm Fetal Growth Restriction. Ultraschall Med 2023; 44:56-67. [PMID: 34768305 DOI: 10.1055/a-1511-8293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To assess the longitudinal variation of the ratio of umbilical and cerebral artery pulsatility index (UCR) in late preterm fetal growth restriction (FGR). MATERIALS AND METHODS A prospective European multicenter observational study included women with a singleton pregnancy, 32+ 0-36+ 6, at risk of FGR (estimated fetal weight [EFW] or abdominal circumference [AC] < 10th percentile, abnormal arterial Doppler or fall in AC from 20-week scan of > 40 percentile points). The primary outcome was a composite of abnormal condition at birth or major neonatal morbidity. UCR was categorized as normal (< 0.9) or abnormal (≥ 0.9). UCR was assessed by gestational age at measurement interval to delivery, and by individual linear regression coefficient in women with two or more measurements. RESULTS 856 women had 2770 measurements; 696 (81 %) had more than one measurement (median 3 (IQR 2-4). At inclusion, 63 (7 %) a UCR ≥ 0.9. These delivered earlier and had a lower birth weight and higher incidence of adverse outcome (30 % vs. 9 %, relative risk 3.2; 95 %CI 2.1-5.0) than women with a normal UCR at inclusion. Repeated measurements after an abnormal UCR at inclusion were abnormal again in 67 % (95 %CI 55-80), but after a normal UCR the chance of finding an abnormal UCR was 6 % (95 %CI 5-7 %). The risk of composite adverse outcome was similar using the first or subsequent UCR values. CONCLUSION An abnormal UCR is likely to be abnormal again at a later measurement, while after a normal UCR the chance of an abnormal UCR is 5-7 % when repeated weekly. Repeated measurements do not predict outcome better than the first measurement, most likely due to the most compromised fetuses being delivered after an abnormal UCR.
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Affiliation(s)
- Bronacha Mylrea-Foley
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London W12 0HS
| | - Hans Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Christoph Lees
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London W12 0HS
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - B Arabin
- Department of Obstetrics Charite, Humboldt University Berlin and Clara Angela Foundation, Berlin, Germany
| | - A Berger
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - E Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, location VUMC, Amsterdam, The Netherlands
| | - A C Breeze
- Fetal Medicine Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Brodszki
- Department of Pediatric Surgery and Neonatology, Lund University, Skane University Hospital, Lund, Sweden
| | - P Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - I Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - J Derks
- Department of Perinatal Medicine, University of Utrecht, Utrecht, The Netherlands
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - E Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium, Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk and Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - L Krofta
- Institute for the Care of Mother and Child, Prague, Czech Republic and Third Medical Faculty, Charles University, Prague, Czech Republic
| | - P Lindgren
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - S M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - G M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples 'Federico II', Naples, Italy
| | - F Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | | | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - F Prefumo
- Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - L Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - J Richter
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - R K Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - H Valensise
- Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata, University, Policlinico Casilino Hospital, Rome, Italy
| | - G H A Visser
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - L Wee
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
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Bilardo CM, Chaoui R, Hyett JA, Kagan KO, Karim JN, Papageorghiou AT, Poon LC, Salomon LJ, Syngelaki A, Nicolaides KH. ISUOG Practice Guidelines (updated): performance of 11-14-week ultrasound scan. Ultrasound Obstet Gynecol 2023; 61:127-143. [PMID: 36594739 DOI: 10.1002/uog.26106] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 05/27/2023]
Affiliation(s)
- C M Bilardo
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, and Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - J A Hyett
- Western Sydney University, Sydney, Australia
| | - K O Kagan
- Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen, Germany
| | - J N Karim
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | | | - L C Poon
- Department of Obstetrics and Gynaecology, Chinese University of Hong Kong, Hong Kong SAR, China
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Paris Cité University, Assistance Publique-Hopitaux de Paris, Hopital Necker-Enfants Malades, Paris, France
| | - A Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Kristalijn SA, White K, Eerbeek D, Kostenko E, Grati FR, Bilardo CM. Patient experience with non-invasive prenatal testing (NIPT) as a primary screen for aneuploidy in the Netherlands. BMC Pregnancy Childbirth 2022; 22:782. [PMID: 36266611 PMCID: PMC9585792 DOI: 10.1186/s12884-022-05110-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 10/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Non-invasive prenatal testing (NIPT) as a screening method for trisomy 21 and other chromosomal abnormalities has been adopted widely across the globe. However, while many clinical validation studies have been performed, less is known regarding the patient experience with NIPT. This study explored how individuals experience NIPT in a pre- and post-test setting, where NIPT is broadly available as a primary screening method with the option of reporting beyond common trisomies. Methods Participants were recruited using social media with a strategy designed to select individuals who had the option to have NIPT as part of the TRIDENT-2 study (In the Netherlands, NIPT is only available within the TRIDENT studies executed by the NIPT consortium. This research was done independently from the NIPT consortium.) in the Netherlands. The study used online questionnaires and semi-structured interviews. Both were developed around a patient experience framework consisting of seven themes: information, patient as active participant, responsiveness of services, lived experience, continuity of care and relationships, communication, and support. Results Overall, 4539 questionnaire responses were analyzed and 60% of the respondents had experienced NIPT. Of those, 1.7% received a high-risk result for trisomy or another chromosomal copy number variant (referred to as an “additional finding”). Overall, participants felt they had received sufficient information and had control over their decision regarding whether or not to choose NIPT. The vast majority of respondents who had NIPT were positive about their experience and would use it again. Those with results showing an increased probability for trisomy or additional findings were more likely to report negative feelings such as tension and anxiety, and less likely to feel that they had been sufficiently prepared for the implications of their results. Conclusions The patient experience with first-tier NIPT in the Netherlands was largely positive. Areas for improvement included counseling on the implications of screening and the different possible outcomes of NIPT, including additional findings that may be uncovered by expanding NIPT beyond the common trisomies. The experiences reported in this study may be useful for other countries intending to implement NIPT.
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Affiliation(s)
| | | | - Deanna Eerbeek
- Management Policy Analysis and Entrepreneurship, VU University Amsterdam, Amsterdam, The Netherlands
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Bardi F, Bet BB, Pajkrt E, Linskens IH, Bekker MN, Sistermans EA, Bilardo CM, Elvan‐Taşpınar A. Additional value of advanced ultrasonography in pregnancies with two inconclusive cell-free DNA draws. Prenat Diagn 2022; 42:1358-1367. [PMID: 36097374 PMCID: PMC9828350 DOI: 10.1002/pd.6238] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/09/2022] [Accepted: 09/05/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We aimed to evaluate the additional value of advanced fetal anatomical assessment by ultrasound in pregnancies with twice inconclusive noninvasive testing (NIPT) due to low fetal fraction (FF). METHODS We performed a multicenter-retrospective study between 2017 and 2020 including 311 pregnancies with twice inconclusive NIPT due to low FF ≤ 1%. Women were offered invasive testing and advanced fetal anatomical assessment at ≤18 weeks' gestation. Ultrasound findings, genetic testing, and pregnancy/postnatal outcomes were evaluated. RESULTS Ninety-two/311 (29.6%) women underwent invasive testing. Structural anomalies were diagnosed in 13/311 (4.2%) pregnancies (nine at the first scan and four at follow-up). In 6/13 (46.2%) cases, genetic aberrations were confirmed (one case of Trisomy 13 (detectable by NIPT), two of Triploidy, one of 16q12-deletion, HCN4-mutation and UPD(16) (nondetectable by NIPT). Genetic aberrations were found in 4/298 (1.3%) structurallynormal pregnancies (one 47XYY, two microscopic aberrations, one monogenic disorder found postpartum). Structural anomalies in genetically normal fetuses (2.0%) were not more prevalent compared to the general pregnant population (OR 1.0 [0.4-2.2]). CONCLUSION In pregnancies with twice inconclusive NIPT due to low FF, fetal structural anomalies are not more prevalent than in the general obstetric population. The detailed anatomical assessment has the added value to detect phenotypical features suggestive of chromosomal/genetic aberrations and identify pregnancies where advanced genetic testing may be indicated.
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Affiliation(s)
- Francesca Bardi
- Department of Obstetrics and GynecologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Bo B. Bet
- Department of Obstetrics and GynaecologyAmsterdam UMC Location University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Reproduction and DevelopmentAmsterdamThe Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and GynaecologyAmsterdam UMC Location University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Reproduction and DevelopmentAmsterdamThe Netherlands
| | - Ingeborg H. Linskens
- Amsterdam Reproduction and DevelopmentAmsterdamThe Netherlands
- Department of Obstetrics and GynaecologyAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Mireille N. Bekker
- Department of Obstetrics and GynecologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Erik A. Sistermans
- Department of Human Genetics and Amsterdam Reproduction & Development Research InstituteAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Caterina M. Bilardo
- Department of Obstetrics and GynecologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Department of Obstetrics and GynaecologyAmsterdam UMC Location University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Reproduction and DevelopmentAmsterdamThe Netherlands
| | - Ayten Elvan‐Taşpınar
- Department of Obstetrics and GynecologyUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
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Salomon LJ, Alfirevic Z, Berghella V, Bilardo CM, Chalouhi GE, Da Silva Costa F, Hernandez-Andrade E, Malinger G, Munoz H, Paladini D, Prefumo F, Sotiriadis A, Toi A, Lee W. ISUOG Practice Guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2022; 59:840-856. [PMID: 35592929 DOI: 10.1002/uog.24888] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 06/15/2023]
Affiliation(s)
- L J Salomon
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Cité University, Paris, France
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - V Berghella
- Thomas Jefferson University, Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Philadelphia, PA, USA
| | - C M Bilardo
- University Medical Centre, Fetal Medicine Unit, Department of Obstetrics & Gynecology, Groningen, The Netherlands
| | - G E Chalouhi
- Maternité Necker-Enfants Malades, Université Paris Descartes, AP-HP, Paris, France
| | - F Da Silva Costa
- Maternal Fetal Medicine Unit, Gold Coast University Hospital and School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | | | - G Malinger
- Division of Ob-Gyn Ultrasound, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Munoz
- University of Chile Hospital, Fetal Medicine Unit, Obstetrics & Gynecology, Santiago, Chile
| | - D Paladini
- Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - F Prefumo
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Toi
- Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - W Lee
- Baylor College of Medicine, Department of Obstetrics and Gynecology, Houston, TX, USA
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Lees CC, Romero R, Stampalija T, Dall'Asta A, DeVore GA, Prefumo F, Frusca T, Visser GHA, Hobbins JC, Baschat AA, Bilardo CM, Galan HL, Campbell S, Maulik D, Figueras F, Lee W, Unterscheider J, Valensise H, Da Silva Costa F, Salomon LJ, Poon LC, Ferrazzi E, Mari G, Rizzo G, Kingdom JC, Kiserud T, Hecher K. Clinical Opinion: The diagnosis and management of suspected fetal growth restriction: an evidence-based approach. Am J Obstet Gynecol 2022; 226:366-378. [PMID: 35026129 PMCID: PMC9125563 DOI: 10.1016/j.ajog.2021.11.1357] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/01/2022]
Abstract
This study reviewed the literature about the diagnosis, antepartum surveillance, and time of delivery of fetuses suspected to be small for gestational age or growth restricted. Several guidelines have been issued by major professional organizations, including the International Society of Ultrasound in Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine. The differences in recommendations, in particular about Doppler velocimetry of the ductus venosus and middle cerebral artery, have created confusion among clinicians, and this review has intended to clarify and highlight the available evidence that is pertinent to clinical management. A fetus who is small for gestational age is frequently defined as one with an estimated fetal weight of <10th percentile. This condition has been considered syndromic and has been frequently attributed to fetal growth restriction, a constitutionally small fetus, congenital infections, chromosomal abnormalities, or genetic conditions. Small for gestational age is not synonymous with fetal growth restriction, which is defined by deceleration of fetal growth determined by a change in fetal growth velocity. An abnormal umbilical artery Doppler pulsatility index reflects an increased impedance to flow in the umbilical circulation and is considered to be an indicator of placental disease. The combined finding of an estimated fetal weight of <10th percentile and abnormal umbilical artery Doppler velocimetry has been widely accepted as indicative of fetal growth restriction. Clinical studies have shown that the gestational age at diagnosis can be used to subclassify suspected fetal growth restriction into early and late, depending on whether the condition is diagnosed before or after 32 weeks of gestation. The early type is associated with umbilical artery Doppler abnormalities, whereas the late type is often associated with a low pulsatility index in the middle cerebral artery. A large randomized clinical trial indicated that in the context of early suspected fetal growth restriction, the combination of computerized cardiotocography and fetal ductus venosus Doppler improves outcomes, such that 95% of surviving infants have a normal neurodevelopmental outcome at 2 years of age. A low middle cerebral artery pulsatility index is associated with an adverse perinatal outcome in late fetal growth restriction; however, there is no evidence supporting its use to determine the time of delivery. Nonetheless, an abnormality in middle cerebral artery Doppler could be valuable to increase the surveillance of the fetus at risk. We propose that fetal size, growth rate, uteroplacental Doppler indices, cardiotocography, and maternal conditions (ie, hypertension) according to gestational age are important factors in optimizing the outcome of suspected fetal growth restriction.
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Affiliation(s)
- Christoph C Lees
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI
| | - Tamara Stampalija
- Department of Obstetrics and Gynecology, Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, Scientific Institute for Research, Hospitalization and Healthcare Burlo Garofolo, Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Andrea Dall'Asta
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Greggory A DeVore
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Gerard H A Visser
- Department of Obstetrics, University Medical Center, Utrecht, The Netherlands
| | - John C Hobbins
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
| | - Ahmet A Baschat
- Department of Gynecology and Obstetrics, John Hopkins Center for Fetal Therapy, Johns Hopkins University, Baltimore, MD
| | - Caterina M Bilardo
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands
| | - Henry L Galan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO; Colorado Fetal Care Center, Children's Hospital of Colorado, Aurora, CO
| | | | - Dev Maulik
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Francesc Figueras
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX
| | - Julia Unterscheider
- Department of Maternal-Fetal Medicine, Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Australia
| | - Herbert Valensise
- University of Rome Tor Vergata, Rome, Italy; Department of Surgery, Policlinico Casilino, Rome, Italy
| | - Fabricio Da Silva Costa
- Maternal-Fetal Medicine Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia; School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Laurent J Salomon
- Obstétrique et Plateforme LUMIERE, Hôpital Necker-Enfants Malades (AP-HP) et Université de Paris, Paris, France
| | - Liona C Poon
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region of China
| | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Mari
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Giuseppe Rizzo
- Università di Roma Tor Vergata, Department of Obstetrics and Gynecology, Fondazione Policinico Tor Vergata, Rome, Italy; The First I.M. Sechenov Moscow State Medical University, Department of Obstetrics and Gynaecology, Moscow, Russian Federation
| | - John C Kingdom
- Placenta Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Torvid Kiserud
- Department of Obstetrics and Gynecology, Haukeland University Hospital, and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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11
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Siegmund AS, Bilardo CM, van Veldhuisen DJ, Dickinson MG, Gyselaers W. Right-heart dysfunction in women with congenital heart disease and pre-eclampsia. Ultrasound Obstet Gynecol 2022; 59:406. [PMID: 35239218 DOI: 10.1002/uog.24867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Affiliation(s)
- A S Siegmund
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M G Dickinson
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Department of Obstetrics, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Physiology, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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12
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Siegmund AS, Pieper PG, Bilardo CM, Gordijn SJ, Khong TY, Gyselaers W, van Veldhuisen DJ, Dickinson MG. Cardiovascular determinants of impaired placental function in women with cardiac dysfunction. Am Heart J 2022; 245:126-135. [PMID: 34902313 DOI: 10.1016/j.ahj.2021.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 01/22/2023]
Abstract
Female heart disease has for a long time been an underrecognized problem in the field of cardiology. With an ever-growing number of these patients getting pregnant, cardiac dysfunction during pregnancy is an increasingly large medical problem. Previous work has shown that maternal heart disease may have an adverse effect on pregnancy outcome in both mother and child. The placenta forms the connection and it is postulated that cardiac dysfunction negatively affects the placenta, and consequently, neonatal outcome. Given the paucity of data in this field, more research on the influence of cardiac (mal)function on placental (mal)function is needed. The present review describes placental function in women with various types of cardiac dysfunction, thereby aiming to provide more insight into possible underlying mechanisms of placental malfunction. Organ dysfunction in patients with heart failure is for an important part based on reduced perfusion and venous congestion. This has been shown in other organs such as kidneys, liver and brain. In pregnant women with cardiac dysfunction, placental dysfunction may follow similar patterns. Moreover, other factors, such as pre-existing hypertension and chronic hypoxia may lead to further impairment of placental function, through abnormal vascular remodeling of the uterine spiral arteries. The pathophysiology of placental dysfunction in pregnant women with cardiac dysfunction may thus be multifactorial. It is therefore important to monitor closely cardiac and placental function in such high-risk pregnancies. Gaining a better understanding of the underlying pathophysiological mechanisms may have important clinical implications in terms of pregnancy counseling, monitoring and outcome.
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Abstract
In the Netherlands prenatal screening is offered as a mean to increase reproductive choices of couples. All women are counseled on the existing options by trained midwives. The government puts a great emphasis on informed choice and on womens' opinions and reactions to screenings options. Since 2017 non-invasive prenatal testing (NIPT, cf-DNA) is offered as first tier screening for aneuploidies in the genome-wide (GW) variant at the cost of 175 Euro's. Uptake is around 50%. This screenings offer is perceived as unconventional for the traditionally cautious Dutch system.
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Bhide A, Acharya G, Baschat A, Bilardo CM, Brezinka C, Cafici D, Ebbing C, Hernandez-Andrade E, Kalache K, Kingdom J, Kiserud T, Kumar S, Lee W, Lees C, Leung KY, Malinger G, Mari G, Prefumo F, Sepulveda W, Trudinger B. ISUOG Practice Guidelines (updated): use of Doppler velocimetry in obstetrics. Ultrasound Obstet Gynecol 2021; 58:331-339. [PMID: 34278615 DOI: 10.1002/uog.23698] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Affiliation(s)
- A Bhide
- Fetal Medicine Unit, St George's University Hospital and St George's University of London, London, UK
| | - G Acharya
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet & Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Faculty of Medicine, University of Tromsø and University Hospital of Northern Norway, Tromsø, Norway
| | - A Baschat
- Johns Hopkins Center for Fetal Therapy, Department of Gynecology & Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - C M Bilardo
- Department of Obstetrics and Gynecology Amsterdam UMC, Amsterdam and Academic Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C Brezinka
- Univ Klinik fuer Gynaekologie und Geburtshilfe, Innsbruck, Austria
| | - D Cafici
- Sociedad Argentina de Ultrasonografía en Medicina y Biología, Argentina
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - E Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - K Kalache
- Gynaecology, Charité, CBF, Berlin, Germany
| | - J Kingdom
- Maternal-Fetal Medicine Division, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - T Kiserud
- Department of Clinical Science, University of Bergen and Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - S Kumar
- Mater Research Institute/University of Queensland, Brisbane, Australia
| | - W Lee
- Texas Children's Fetal Center, Texas Children's Hospital Pavilion for Women, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - C Lees
- Centre for Fetal Care, Queen Charlotte's & Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Development & Regeneration KU Leuven, Leuven, Belgium
| | - K Y Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong
| | - G Malinger
- Division of Ob-Gyn Ultrasound, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Mari
- Women's Health Institute, Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - F Prefumo
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - W Sepulveda
- FETALMED - Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - B Trudinger
- Department of Obstetrics and Gynaecology, University of Sydney, Sydney, Australia
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Siegmund AS, Pieper PG, Bouma BJ, Rosenberg FM, Groen H, Bilardo CM, van Veldhuisen DJ, Dickinson MG. Early N-terminal pro-B-type natriuretic peptide is associated with cardiac complications and function during pregnancy in congenital heart disease. Neth Heart J 2021; 29:262-272. [PMID: 33534113 PMCID: PMC8062639 DOI: 10.1007/s12471-021-01540-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at 20 weeks’ gestation predict adverse cardiovascular (CV) complications during pregnancy in women with congenital heart disease (CHD). To improve early risk assessment in these women, we investigated the predictive value of first-trimester NT-proBNP for CV complications and its association with ventricular function during pregnancy. Methods Pregnant women with CHD, previously enrolled in a prospective national study or evaluated by an identical protocol, were included. Clinical data, echocardiographic evaluation and NT-proBNP measurements were obtained at 12, 20 and 32 weeks’ gestation. Elevated NT-proBNP was defined as > 235 pg/ml (95th percentile reference value of healthy pregnant women in the literature). Results We examined 126 females (mean age 29 years). Elevated NT-proBNP at 12 weeks was associated with CV complications (n = 7, 5.6%, odds ratio 10.9, p = 0.004). Arrhythmias were the most common complication (71%). The negative predictive value of low NT-proBNP to exclude CV complications was 97.2%. In women with CV complications, NT-proBNP levels remained high throughout pregnancy, while a decrease was seen in women without CV complications (p < 0.001 for interaction between group and time). At 12 weeks, higher NT-proBNP levels were associated with impaired subpulmonary ventricular function (p < 0.001) and also with a decline in subpulmonary ventricular function later in pregnancy (p = 0.012). Conclusions In this study, first-trimester NT-proBNP levels were associated with adverse CV complications and a decline in subpulmonary ventricular function later in pregnancy in women with CHD. Early NT-proBNP evaluation is useful for tailored care in pregnant women with CHD.
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Affiliation(s)
- A S Siegmund
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - P G Pieper
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - B J Bouma
- Department of Cardiology, Heart Centre, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - F M Rosenberg
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - H Groen
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - M G Dickinson
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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Bardi F, Bakker M, Kenkhuis MJA, Ranchor AV, Bakker MK, Elvan A, Birnie E, Bilardo CM. Psychological outcomes, knowledge and preferences of pregnant women on first-trimester screening for fetal structural abnormalities: A prospective cohort study. PLoS One 2021; 16:e0245938. [PMID: 33503072 PMCID: PMC7840026 DOI: 10.1371/journal.pone.0245938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/10/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The primary aim of this study is to investigate the impact of a 13-week anomaly scan on the experienced levels of maternal anxiety and well-being. Secondly, to explore women's knowledge on the possibilities and limitations of the scan and the preferred timing of screening for structural abnormalities. MATERIAL AND METHODS In a prospective-cohort study conducted between 2013-2015, pregnant women in the North-Netherlands underwent a 13-week anomaly scan. Four online-questionnaires (Q1, Q2, Q3 and Q4) were completed before and after the 13- and the 20-week anomaly scans. In total, 1512 women consented to participate in the study and 1118 (74%) completed the questionnaires at Q1, 941 (64%) at Q2, 807 (55%) at Q3 and 535 (37%) at Q4. Psychological outcomes were measured by the state-trait inventory-scale (STAI), the patient's positive-negative affect (PANAS) and ad-hoc designed questionnaires. RESULTS Nine-nine percent of women wished to be informed as early as possible in pregnancy about the absence/presence of structural abnormalities. In 87% of women levels of knowledge on the goals and limitations of the 13-week anomaly scan were moderate-to-high. In women with a normal 13-week scan result, anxiety levels decreased (P < .001) and well-being increased over time (P < .001). In women with false-positive results (n = 26), anxiety levels initially increased (STAI-Q1: 39.8 vs. STAI-Q2: 48.6, P = 0.025), but later decreased around the 20-week anomaly scan (STAI-Q3: 36.4 vs. STAI-Q4: 34.2, P = 0.36). CONCLUSIONS The 13-week scan did not negatively impact the psychological well-being of pregnant women. The small number of women with screen-positive results temporarily experienced higher anxiety after the scan but, in false-positive cases, anxiety levels normalized again when the abnormality was not confirmed at follow-up scans. Finally, most pregnant women have moderate-to-high levels of knowledge and strongly prefer early screening for fetal structural abnormalities.
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Affiliation(s)
- Francesca Bardi
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Merel Bakker
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Monique J. A. Kenkhuis
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adelita V. Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marian K. Bakker
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ayten Elvan
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erwin Birnie
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Caterina M. Bilardo
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Zwertbroek EF, Groen H, Fontanella F, Maggio L, Marchi L, Bilardo CM. Performance of the FMF First-Trimester Preeclampsia-Screening Algorithm in a High-Risk Population in The Netherlands. Fetal Diagn Ther 2021; 48:103-111. [PMID: 33401268 DOI: 10.1159/000512335] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 02/28/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the performance of the first-trimester Fetal Medicine Foundation (FMF) screening algorithm, including maternal characteristics and medical history, blood pressure, pregnancy-associated plasma protein A and placenta growth factor, crown rump length, and uterine artery pulsatility index, for the prediction of preeclampsia in a high-risk population in the Netherlands. METHODS This is a prospective cohort including nulliparous women and women with preeclampsia or intrauterine growth restriction in previous pregnancy. We screened patients at 11-14 weeks of gestation to calculate the risk for preeclampsia. The primary outcome was preeclampsia and gestational age at delivery. Performance of the model was evaluated by area under the receiver operating characteristic (ROC) curves (AUCs) and calibration graphs; based on the ROC curves, optimal predicted risk cutoff values for our study population were defined. RESULTS We analyzed 362 women, of whom 22 (6%) developed preeclampsia. The algorithm showed fair discriminative performance for preeclampsia <34 weeks (AUC 0.81; 95% CI 0.65-0.96) and moderate discriminative performance for both preeclampsia <37 weeks (AUC 0.71; 95% CI 0.51-0.90) and <42 weeks (AUC 0.71; 95% CI 0.61-0.81). Optimal cutoffs based on our study population for preeclampsia <34, <37, and <42 weeks were 1:250, 1:64, and 1:22, respectively. Calibration was poor. CONCLUSIONS Performance of the FMF preeclampsia algorithm was satisfactory to predict early and preterm preeclampsia and less satisfactory for term preeclampsia in a high-risk population. However, by addressing some of the limitations of the present study, the performance can potentially improve. This is essential before implementation is considered.
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Affiliation(s)
- Eva F Zwertbroek
- Obstetrics & Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,
| | - Henk Groen
- Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Federica Fontanella
- Obstetrics & Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Luana Maggio
- Obstetrics & Gynaecology, Ospedale Buccheri la Ferla FBF Palermo, Palermo, Italy
| | - Laura Marchi
- Obstetrics & Gynaecology, Azienda Unità Sanitaria Locale Toscana Centro, City Hospital, Prato, Italy
| | - Caterina M Bilardo
- Fetal Medicine, University Medical Centre, University of Groningen, Groningen, The Netherlands.,Fetal Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Stampalija T, Thornton J, Marlow N, Napolitano R, Bhide A, Pickles T, Bilardo CM, Gordijn SJ, Gyselaers W, Valensise H, Hecher K, Sande RK, Lindgren P, Bergman E, Arabin B, Breeze AC, Wee L, Ganzevoort W, Richter J, Berger A, Brodszki J, Derks J, Mecacci F, Maruotti GM, Myklestad K, Lobmaier SM, Prefumo F, Klaritsch P, Calda P, Ebbing C, Frusca T, Raio L, Visser GHA, Krofta L, Cetin I, Ferrazzi E, Cesari E, Wolf H, Lees CC. Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study. Ultrasound Obstet Gynecol 2020; 56:173-181. [PMID: 32557921 DOI: 10.1002/uog.22125] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. METHODS This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored. RESULTS The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33 weeks and 1.0 at 34-36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association. CONCLUSION In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - T Pickles
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk and Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - H Valensise
- Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - R K Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - P Lindgren
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - E Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - B Arabin
- Department of Obstetrics Charite, Humboldt University Berlin and Clara Angela Foundation, Berlin, Germany
| | - A C Breeze
- Fetal Medicine Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - L Wee
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - J Richter
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - A Berger
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Brodszki
- Department of Pediatric Surgery and Neonatology, Lund University, Skane University Hospital, Lund, Sweden
| | - J Derks
- Department of Perinatal Medicine, University of Utrecht, Utrecht, The Netherlands
| | - F Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - G M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples 'Federico II', Naples, Italy
| | | | - S M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - F Prefumo
- Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - P Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - L Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - G H A Visser
- Department of Obstetrics, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Krofta
- Institute for the Care of Mother and Child, Prague, Czech Republic and Third Medical Faculty, Charles University, Prague, Czech Republic
| | - I Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - E Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - H Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - C C Lees
- Imperial College School of Medicine, Imperial College London and Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS trust, London, UK
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Siegmund AS, Willems TP, Pieper PG, Bilardo CM, Gorter TM, Bouma BJ, Jongbloed MRM, Sieswerda GT, Roos-Hesselink JW, van Dijk APJ, van Veldhuisen DJ, Dickinson MG. Reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of Fallot. J Cardiovasc Magn Reson 2020; 22:52. [PMID: 32669114 PMCID: PMC7364780 DOI: 10.1186/s12968-020-00645-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Maternal right ventricular (RV) dysfunction (measured by echocardiography) is associated with impaired uteroplacental circulation, however echocardiography has important limitations in the assessment of RV function. We therefore aimed to investigate the association of pre-pregnancy RV and left ventricular (LV) function measured by cardiovascular magnetic resonance with uteroplacental Doppler flow parameters in pregnant women with repaired Tetralogy of Fallot (ToF). METHODS Women with repaired ToF were examined, who had been enrolled in a prospective multicenter study of pregnant women with congenital heart disease. Clinical data and CMR evaluation before pregnancy were compared with uteroplacental Doppler parameters at 20 and 32 weeks gestation. In particular, pulsatility index (PI) of uterine and umbilical artery were studied. RESULTS We studied 31 women; mean age 30 years, operated at early age. Univariable analyses showed that reduced RV ejection fraction (RVEF; P = 0.037 and P = 0.001), higher RV end-systolic volume (P = 0.004) and higher LV end-diastolic and end-systolic volume (P = 0.001 and P = 0.003, respectively) were associated with higher uterine or umbilical artery PI. With multivariable analyses (corrected for maternal age and body mass index), reduced RVEF before pregnancy remained associated with higher umbilical artery PI at 32 weeks (P = 0.002). RVEF was lower in women with high PI compared to women with normal PI during pregnancy (44% vs. 53%, p = 0.022). LV ejection fraction was not associated with uterine or umbilical artery PI. CONCLUSIONS Reduced RV function before pregnancy is associated with abnormal uteroplacental Doppler flow parameters. It could be postulated that reduced RV function on pre-pregnancy CMR (≤2 years) is a predisposing factor for impaired placental function in women with repaired ToF.
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Affiliation(s)
- Anne S Siegmund
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Tineke P Willems
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Petronella G Pieper
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thomas M Gorter
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Berto J Bouma
- Department of Cardiology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Gertjan Tj Sieswerda
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, University of Rotterdam, Rotterdam, the Netherlands
| | - Arie P J van Dijk
- Department of Cardiology, Radboud University Medical Center, Radboud University, Nijmegen, the Netherlands
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michael G Dickinson
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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Abu-Rustum RS, Akolekar R, Sotiriadis A, Salomon LJ, Costa FDS, Wu Q, Frusca T, Bilardo CM, Prefumo F, Poon LC. ISUOG Consensus Statement on organization of routine and specialist obstetric ultrasound services in context of COVID-19. Ultrasound Obstet Gynecol 2020; 55:863-870. [PMID: 32233049 DOI: 10.1002/uog.22029] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- R S Abu-Rustum
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - R Akolekar
- Fetal Medicine Unit, Medway NHS Foundation Trust, Gillingham, UK
- Institute of Medical Sciences, Canterbury Christ Church University, Kent, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - L J Salomon
- Obstétrique et Plateforme LUMIERE, Hôpital Necker-Enfants Malades (AP-HP) et Université de Paris, Paris, France
| | - F Da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Department of Obstetrics and Gynaecology, Monash University, Meulbourne, Australia
| | - Q Wu
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, P.R. China
| | - T Frusca
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - C M Bilardo
- Department of Obstetrics, Gynaecology and Fetal Medicine, AmsterdamUmc, Location VUmc, Amsterdam, The Netherlands
| | - F Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - L C Poon
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong SAR
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21
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Petersen OB, Smith E, Van Opstal D, Polak M, Knapen MFCM, Diderich KEM, Bilardo CM, Arends LR, Vogel I, Srebniak MI. Nuchal translucency of 3.0-3.4 mm an indication for NIPT or microarray? Cohort analysis and literature review. Acta Obstet Gynecol Scand 2020; 99:765-774. [PMID: 32306377 PMCID: PMC7318216 DOI: 10.1111/aogs.13877] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 12/15/2022]
Abstract
Introduction Currently fetal nuchal translucency (NT) ≥3.5 mm is an indication for invasive testing often followed by chromosomal microarray. The aim of this study was to assess the risks for chromosomal aberrations in fetuses with an NT 3.0‐3.4 mm, to determine whether invasive prenatal testing would be relevant in these cases and to assess the residual risks in fetuses with normal non‐invasive prenatal test (NIPT) results. Material and methods A retrospective study and meta‐analysis of literature cases with NT between 3.0 and 3.4 mm and 2 cohorts of pregnant women referred for invasive testing and chromosomal microarray was performed: Rotterdam region (with a risk >1:200 and NT between 3.0 and 3.4 mm) tested in the period July 2012 to June 2019 and Central Denmark region (with a risk >1:300 and NT between 3.0 and 3.4 mm) tested between September 2015 and December 2018. Results A total of 522 fetuses were referred for invasive testing and chromosomal microarray. Meta‐analysis indicated that in 1:7.4 (13.5% [95% CI 8.2%‐21.5%]) fetuses a chromosomal aberration was diagnosed. Of these aberrant cases, 47/68 (69%) involved trisomy 21, 18, and 13 and would potentially be detected by all NIPT approaches. The residual risk for missing a (sub)microscopic chromosome aberration depends on the NIPT approach and is highest if NIPT was performed only for common trisomies–1:21 (4.8% [95% CI 3.2%‐7.3%]). However, it may be substantially lowered if a genome‐wide 10‐Mb resolution NIPT test was offered (~1:464). Conclusions Based on these data, we suggest that the NT cut‐off for invasive testing could be 3.0 mm (instead of 3.5 mm) because of the high risk of 1:7.4 for a chromosomal aberration. If women were offered NIPT first, there would be a significant diagnostic delay because all abnormal NIPT results need to be confirmed by diagnostic testing. If the woman had already received a normal NIPT result, the residual risk of 1:21 to 1:464 for chromosome aberrations other than common trisomies, dependent on the NIPT approach, should be raised. If a pregnant woman declines invasive testing, but still wants a test with a broader coverage of clinically significant conditions then the genome‐wide >10‐Mb resolution NIPT test, which detects most aberrations, could be proposed.
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Affiliation(s)
- Olav B Petersen
- Center for Fetal Medicine, Pregnancy and Ultrasound, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Eric Smith
- Center for Prenatal Ultrasound Screening BovenMaas, Rotterdam, The Netherlands
| | - Diane Van Opstal
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Marike Polak
- Department of Psychology, Education & Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maarten F C M Knapen
- Department of Obstetrics and Fetal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Caterina M Bilardo
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Lidia R Arends
- Department of Psychology, Education & Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University, Aarhus, Denmark.,Department for Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
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22
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Siegmund AS, Pieper PG, Mulder BJM, Sieswerda GT, van Dijk APJ, Roos-Hesselink JW, Jongbloed MRM, Konings TC, Bouma BJ, Groen H, Sollie-Szarynska KM, Kampman MAM, Bilardo CM, van Veldhuisen DJ, Aalberts JJJ. Doppler gradients, valve area and ventricular function in pregnant women with aortic or pulmonary valve disease: Left versus right. Int J Cardiol 2020; 306:152-157. [PMID: 31785953 DOI: 10.1016/j.ijcard.2019.11.118] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 09/12/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Little is known about the course of echocardiographic parameters used for the evaluation of valvular heart disease (VHD) during pregnancy, hampering interpretation of possible changes (physiological vs. pathophysiological). Therefore we studied the course of these parameters and ventricular function in pregnant women with aortic and pulmonary VHD. METHODS The cohort comprised 66 pregnant women enrolled in the prospective ZAHARA studies or evaluated by an identical protocol who had pulmonary VHD or aortic VHD (stenosis/prosthetic valve). The control group comprised 46 healthy pregnant women. Echocardiography was performed preconception, during pregnancy and 1 year postpartum. Peak gradient, mean gradient, aortic valve area (AVA)/effective orifice area (EOA), left ventricular ejection fraction (LVEF) and right ventricular function (RVF; TAPSE) were assessed. RESULTS Peak and mean gradients increased during pregnancy compared to preconception in women with aortic VHD and controls (p < 0.0125), but not in women with pulmonary VHD. AVA/EOA remained unchanged. Preconception and postpartum gradients were comparable in all groups. Mean LVEF was normal in pregnant women with VHD and controls. Mean TAPSE was lower (p < 0.001) in women with pulmonary VHD compared to women with aortic VHD and controls (<20 mm vs. ≥23 mm; p < 0.001). In women with pulmonary VHD a decrease of TAPSE was observed during pregnancy (p = 0.005). CONCLUSION Physiological changes during pregnancy lead to increased Doppler gradients in women with aortic VHD. This increase was not found in women with pulmonary VHD, probably caused by impaired RVF. Therefore, evaluation of RVF during pregnancy might be important to prevent underestimation of the degree of stenosis.
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Affiliation(s)
- Anne S Siegmund
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Petronella G Pieper
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Gertjan Tj Sieswerda
- Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Arie P J van Dijk
- Department of Cardiology, Radboud University Medical Center, Radboud University, Nijmegen, the Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, University of Rotterdam, Rotterdam, the Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden University, Leiden, the Netherlands
| | - Thelma C Konings
- Department of Cardiology, Amsterdam University Medical Center, location VU University Medical Center, VU University Amsterdam, Amsterdam, the Netherlands
| | - Berto J Bouma
- Department of Cardiology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Krystyna M Sollie-Szarynska
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marlies A M Kampman
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jan J J Aalberts
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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23
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Jani JC, Gil MM, Benachi A, Prefumo F, Kagan KO, Tabor A, Bilardo CM, Di Renzo GC, Nicolaides KH. Reply. Ultrasound Obstet Gynecol 2020; 55:696-697. [PMID: 32356932 DOI: 10.1002/uog.22032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- J C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M M Gil
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón, Torrejón de Ardoz, Universidad Francisco de Vitoria, Madrid, Spain
| | - A Benachi
- Department of Obstetrics and Gynecology, Antoine-Béclère Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Sud, Clamart, France
| | - F Prefumo
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - K O Kagan
- Tuebingen University Hospital, Department of Obstetrics and Gynaecology, Tuebingen, Germany
| | - A Tabor
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - C M Bilardo
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - G C Di Renzo
- Department of Obstetrics and Gynecology, Centre for Perinatal and Reproductive Medicine, University Hospital, University of Perugia, Perugia, Italy
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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24
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Jani JC, Gil MM, Benachi A, Prefumo F, Kagan KO, Tabor A, Bilardo CM, Di Renzo GC, Nicolaides KH. Genome-wide cfDNA testing of maternal blood. Ultrasound Obstet Gynecol 2020; 55:13-14. [PMID: 31894638 DOI: 10.1002/uog.21945] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- J C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M M Gil
- Obstetrics and Gynecology Department, Hospital Universitario de Torrejón, Torrejón de Ardoz, Universidad Francisco de Vitoria, Madrid, Spain
| | - A Benachi
- Department of Obstetrics and Gynecology, Antoine-Béclère Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Sud, Clamart, France
| | - F Prefumo
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - K O Kagan
- Tuebingen University Hospital, Obstetrics and Gynaecology, Tuebingen, Germany
| | - A Tabor
- Center of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - C M Bilardo
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - G C Di Renzo
- Department of Obstetrics and Gynecology, Centre for Perinatal and Reproductive Medicine, University Hospital, University of Perugia, Perugia, Italy
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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25
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Richter AE, Salavati S, Kooi EMW, den Heijer AE, Foreman AB, Schoots MH, Bilardo CM, Scherjon SA, Tanis JC, Bos AF. Fetal Brain-Sparing, Postnatal Cerebral Oxygenation, and Neurodevelopment at 4 Years of Age Following Fetal Growth Restriction. Front Pediatr 2020; 8:225. [PMID: 32435629 PMCID: PMC7218090 DOI: 10.3389/fped.2020.00225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/15/2020] [Indexed: 01/06/2023] Open
Abstract
Objectives: To assess the role of fetal brain-sparing and postnatal cerebral oxygen saturation (rcSO2) as determinants of long-term neurodevelopmental outcome following fetal growth restriction (FGR). Methods: This was a prospective follow-up study of an FGR cohort of 41 children. Prenatally, the presence of fetal brain-sparing (cerebroplacental ratio < 1) was assessed by Doppler ultrasound. During the first two days after birth, rcSO2 was measured with near-infrared spectroscopy. At 4 years of age, intelligence (IQ points), behavior (T-scores), and executive function (T-scores) were assessed using the Wechsler Preschool and Primary Scale of Intelligence, Child Behavior Checklist, and Behavior Rating Inventory of Executive Function-Preschool Version, respectively. Using linear regression analyses, we tested the association (p < 0.05) between brain-sparing/rcSO2 and normed neurodevelopmental scores. Results: Twenty-six children (gestational age ranging from 28.0 to 39.9 weeks) participated in the follow-up at a median age of 4.3 (range: 3.6 to 4.4) years. Autism spectrum disorder was reported in three children (11.5%). Fetal brain-sparing was associated with better total and externalizing behavior (betas: -0.519 and -0.494, respectively). RcSO2 levels above the lowest quartile, particularly on postnatal day 2 (≥ 77%), were associated with better total and internalizing behavior and executive functioning (betas: -0.582, -0.489, and -0.467, respectively), but also lower performance IQ (beta: -0.530). Brain-sparing mediated some but not all of these associations. Conclusions: In this FGR cohort, fetal brain-sparing and high postnatal rcSO2 were-independently, but also as a reflection of the same mechanism-associated with better behavior and executive function. Postnatal cerebral hyperoxia, however, was negatively associated with brain functions responsible for performance IQ.
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Affiliation(s)
- Anne E Richter
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, Netherlands
| | - Sahar Salavati
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, Netherlands
| | - Elisabeth M W Kooi
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, Netherlands
| | - Anne E den Heijer
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, Netherlands
| | - Anne B Foreman
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, Netherlands
| | - Mirthe H Schoots
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, Netherlands
| | - Caterina M Bilardo
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, Netherlands.,Department of Obstetrics and Gynecology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Sicco A Scherjon
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, Netherlands
| | - Jozien C Tanis
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, Netherlands
| | - Arend F Bos
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, Groningen, Netherlands
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van der Meij KR, Sistermans EA, Macville MV, Stevens SJ, Bax CJ, Bekker MN, Bilardo CM, Boon EM, Boter M, Diderich KE, de Die-Smulders CE, Duin LK, Faas BH, Feenstra I, Haak MC, Hoffer MJ, den Hollander NS, Hollink IH, Jehee FS, Knapen MF, Kooper AJ, van Langen IM, Lichtenbelt KD, Linskens IH, van Maarle MC, Oepkes D, Pieters MJ, Schuring-Blom GH, Sikkel E, Sikkema-Raddatz B, Smeets DF, Srebniak MI, Suijkerbuijk RF, Tan-Sindhunata GM, van der Ven AJE, van Zelderen-Bhola SL, Henneman L, Galjaard RJH, Van Opstal D, Weiss MM. TRIDENT-2: National Implementation of Genome-wide Non-invasive Prenatal Testing as a First-Tier Screening Test in the Netherlands. Am J Hum Genet 2019; 105:1091-1101. [PMID: 31708118 DOI: 10.1016/j.ajhg.2019.10.005] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/02/2019] [Indexed: 12/30/2022] Open
Abstract
The Netherlands launched a nationwide implementation study on non-invasive prenatal testing (NIPT) as a first-tier test offered to all pregnant women. This started on April 1, 2017 as the TRIDENT-2 study, licensed by the Dutch Ministry of Health. In the first year, NIPT was performed in 73,239 pregnancies (42% of all pregnancies), 7,239 (4%) chose first-trimester combined testing, and 54% did not participate. The number of trisomies 21 (239, 0.33%), 18 (49, 0.07%), and 13 (55, 0.08%) found in this study is comparable to earlier studies, but the Positive Predictive Values (PPV)-96% for trisomy 21, 98% for trisomy 18, and 53% for trisomy 13-were higher than expected. Findings other than trisomy 21, 18, or 13 were reported on request of the pregnant women; 78% of women chose to have these reported. The number of additional findings was 207 (0.36%); these included other trisomies (101, 0.18%, PPV 6%, many of the remaining 94% of cases are likely confined placental mosaics and possibly clinically significant), structural chromosomal aberrations (95, 0.16%, PPV 32%,) and complex abnormal profiles indicative of maternal malignancies (11, 0.02%, PPV 64%). The implementation of genome-wide NIPT is under debate because the benefits of detecting other fetal chromosomal aberrations must be balanced against the risks of discordant positives, parental anxiety, and a potential increase in (invasive) diagnostic procedures. Our first-year data, including clinical data and laboratory follow-up data, will fuel this debate. Furthermore, we describe how NIPT can successfully be embedded into a national screening program with a single chain for prenatal care including counseling, testing, and follow-up.
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Vrachnis N, Papageorghiou AT, Bilardo CM, Abuhamad A, Tabor A, Cohen-Overbeek TE, Xilakis E, Mates F, Johnson SP, Hyett J. International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) - the propagation of knowledge in ultrasound for the improvement of OB/GYN care worldwide: experience of basic ultrasound training in Oman. BMC Med Educ 2019; 19:434. [PMID: 31752883 PMCID: PMC6873715 DOI: 10.1186/s12909-019-1866-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The aim of this study is to evaluate effectiveness of a new ISUOG (International Society of Ultrasound in Obstetrics and Gynecology) Outreach Teaching and Training Program delivered in Muscat, Oman. METHODS Quantitative assessments to evaluate knowledge and practical skills were administered before and after an ultrasound course for sonologists attending the ISUOG Outreach Course, which took place in November, 2017, in Oman. Trainees were selected from each region of the country following a national vetting process conducted by the Oman Ministry of Health. Twenty-eight of the participants were included in the analysis. Pre- and post-training practical and theoretical scores were evaluated and compared. RESULTS Participants achieved statistically significant improvements, on average by 47% (p < 0.001), in both theoretical knowledge and practical skills. Specifically, the mean score in the theoretical knowledge test significantly increased from 55.6% (± 14.0%) to 81.6% (± 8.2%), while in the practical test, the mean score increased from 44.6% (± 19.5%) to 65.7% (± 23.0%) (p < 0.001). Performance was improved post-course among 27/28 participants (96.4%) in the theoretical test (range: 14 to 200%) and among 24/28 (85.7%) trainees in the practical skills test (range: 5 to 217%). CONCLUSION Application of the ISUOG Basic Training Curriculum and Outreach Teaching and Training Course improved the theoretical knowledge and practical skills of local health personnel. Long-term re-evaluation is, however, considered imperative to ascertain and ensure knowledge retention.
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Affiliation(s)
- Nikolaos Vrachnis
- National and Kapodistrian University of Athens, Health Sciences School, Medical School, 124B Vasilissis Sophias Ave, 115 26, Athens, Greece.
- St George's NHS Foundation Trust Teaching Hospitals, St George's Medical School, University of London, London, UK.
| | - Aris T Papageorghiou
- St George's NHS Foundation Trust Teaching Hospitals, St George's Medical School, University of London, London, UK
| | - Caterina M Bilardo
- Department of Obstetrics and Prenatal Diagnosis Amsterdam University Medical Centres, Amsterdam and University Medical Centre Groningen, University van Groningen, Groningen, The Netherlands
| | - Alfred Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Ann Tabor
- Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Titia E Cohen-Overbeek
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | | | - Jon Hyett
- RPA Women and Babies, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Palen RL, Zee C, Vink AS, Knobbe I, Jurgens SJ, Leeuwen E, Bax CJ, Marchie Sarvaas GJ, Blom NA, Haak MC, Bilardo CM, Clur SB. Cover Image. Prenat Diagn 2019. [DOI: 10.1002/pd.5604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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van der Palen RL, van der Zee C, Vink AS, Knobbe I, Jurgens SJ, van Leeuwen E, Bax CJ, du Marchie Sarvaas GJ, Blom NA, Haak MC, Bilardo CM, Clur SB. Transposition of the great arteries: Fetal pulmonary valve growth and postoperative neo-aortic root dilatation. Prenat Diagn 2019; 39:1054-1063. [PMID: 31351016 PMCID: PMC6900129 DOI: 10.1002/pd.5539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/05/2019] [Accepted: 07/16/2019] [Indexed: 12/04/2022]
Abstract
AbstractObjectivesDocumentation of semilunar valve growth in fetal transposition of the great arteries (TGA) and the relationship between neo‐aortic root (NAoR) dilatation, a cause for postoperative reinterventions after the arterial switch operation (ASO), and pulmonary valve (PV) annulus dimensions prenatally.MethodsThis retrospective multicenter observational study included TGA fetuses suitable for ASO. Semilunar valve annuli pre‐ASO and NAoR diameters (post‐ASO) were measured. Trends in annulus diameters were analyzed using a linear mixed‐effects model and compared with normal values. Prenatal semilunar valve Z‐scores were correlated with NAoR diameters post‐ASO.ResultsWe included 137 TGA fetuses (35.8% with significant ventricular septal defects [VSDs]). One hundred twenty‐one underwent ASO. Fetal TGA‐PV diameters were significantly larger than control aortic valve (AoV) and PV annuli from 23 and 27 weeks, respectively, especially when a VSD was present. Fetal TGA‐AoV annuli were significantly larger than control AoV and PV annuli from 26 and 30 weeks, respectively.Z‐scores of fetal TGA‐PV and NAoR diameter at last follow‐up correlated significantly (P < .001 at 26‐30 wk).ConclusionFetal TGA semilunar valve annuli are larger than control annuli, especially when there is a significant VSD. Factors besides postoperative hemodynamics, including fetal anatomy, PV Z‐score, prenatal flow, connective tissue properties, and genetics, may influence the risk for late reintervention in these fetuses.
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Affiliation(s)
- Roel L.F. van der Palen
- Division of Pediatric Cardiology, Department of PediatricsLeiden University Medical CentreLeidenThe Netherlands
| | - Carlijn van der Zee
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Arja S. Vink
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
- Heart Centre, Department of CardiologyAcademic Medical Centre, Amsterdam UMCAmsterdamThe Netherlands
| | - Ingmar Knobbe
- Department of Pediatric CardiologyAmsterdam UMC, Free UniversityAmsterdamThe Netherlands
| | - Sean J. Jurgens
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Elizabeth van Leeuwen
- Department of Prenatal DiagnosisAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Caroline J. Bax
- Department of Prenatal DiagnosisAmsterdam UMC, Free UniversityAmsterdamThe Netherlands
| | | | - Nico A. Blom
- Division of Pediatric Cardiology, Department of PediatricsLeiden University Medical CentreLeidenThe Netherlands
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Monique C. Haak
- Department of Prenatal DiagnosisLeiden University Medical CentreLeidenThe Netherlands
| | - Caterina M. Bilardo
- Department of Prenatal DiagnosisUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Sally‐Ann B. Clur
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
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30
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Duin LK, Fontanella F, Groen H, Adama van Scheltema PN, Cohen-Overbeek TE, Pajkrt E, Bekker M, Willekes C, Bax CJ, Oepkes D, Bilardo CM. Prediction model of postnatal renal function in fetuses with lower urinary tract obstruction (LUTO)-Development and internal validation. Prenat Diagn 2019; 39:1235-1241. [PMID: 31659787 DOI: 10.1002/pd.5573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 08/30/2019] [Accepted: 09/07/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To develop a prediction model of postnatal renal function in fetuses with lower urinary tract obstruction (LUTO) based on fetal ultrasound parameters and amniotic fluid volume. METHODS Retrospective nationwide cohort study of fetuses with postnatally confirmed LUTO and known eGFR. Fetuses treated with fetal interventions such as vesico-amniotic shunting or cystoscopy were excluded. Logistic regression analysis was used to identify prognostic ultrasound variables with respect to renal outcome following multiple imputation of missing data. On the basis of these fetal renal parameters and amniotic fluid volume, a model was developed to predict postnatal renal function in fetuses with LUTO. The main study outcome was an eGFR less than 60 mL/min * 1.73 m2 based on the creatinine nadir during the first year following diagnosis. Model performance was evaluated by receiver operator characteristic (ROC) curve analysis, calibration plots, and bootstrapping. RESULTS Hundred one fetuses with a confirmed diagnosis of LUTO were included, eGFR less than 60 was observed in 40 (39.6%) of them. Variables predicting an eGFR less than 60 mL/min * 1.73m2 included the following sonographic parameters: hyperechogenicity of the renal cortex and abnormal amniotic fluid volume. The model showed fair discrimination, with an area under the ROC curve of 0.70 (95% confidence interval, 0.59-0.81, 0.66 after bootstrapping) and was overall well-calibrated. CONCLUSION This study shows that a prediction model incorporating ultrasound parameters such as cortical appearance and abnormal amniotic fluid volume can fairly discriminate an eGFR above or below 60 mL/min * 1.73m2 . This clinical information can be used in identifying fetuses eligible for prenatal interventions and improve counseling of parents.
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Affiliation(s)
- Leonie K Duin
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center Groningen, Groningen, The Netherlands
| | - Federica Fontanella
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Phebe N Adama van Scheltema
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Titia E Cohen-Overbeek
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Mireille Bekker
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christine Willekes
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center, Grow School for Oncology and Medical Biology, Maastricht, The Netherlands
| | - Caroline J Bax
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, VU University Medical Center, Amsterdam, The Netherlands.,Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick Oepkes
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center Groningen, Groningen, The Netherlands.,Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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31
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Hijkoop A, Lap CCMM, Aliasi M, Mulder EJH, Kramer WLM, Brouwers HAA, van Baren R, Pajkrt E, van Kaam AH, Bilardo CM, Pistorius LR, Visser GHA, Wijnen RMH, Tibboel D, Manten GTR, Cohen-Overbeek TE. Using three-dimensional ultrasound in predicting complex gastroschisis: A longitudinal, prospective, multicenter cohort study. Prenat Diagn 2019; 39:1204-1212. [PMID: 31600419 PMCID: PMC6972561 DOI: 10.1002/pd.5568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/28/2019] [Accepted: 09/07/2019] [Indexed: 12/29/2022]
Abstract
Objective To determine whether complex gastroschisis (ie, intestinal atresia, perforation, necrosis, or volvulus) can prenatally be distinguished from simple gastroschisis by fetal stomach volume and stomach‐bladder distance, using three‐dimensional (3D) ultrasound. Methods This multicenter prospective cohort study was conducted in the Netherlands between 2010 and 2015. Of seven university medical centers, we included the four centers that performed longitudinal 3D ultrasound measurements at a regular basis. We calculated stomach volumes (n = 223) using Sonography‐based Automated Volume Count. The shortest stomach‐bladder distance (n = 241) was determined using multiplanar visualization of the volume datasets. We used linear mixed modelling to evaluate the effect of gestational age and type of gastroschisis (simple or complex) on fetal stomach volume and stomach‐bladder distance. Results We included 79 affected fetuses. Sixty‐six (84%) had been assessed with 3D ultrasound at least once; 64 of these 66 were liveborn, nine (14%) had complex gastroschisis. With advancing gestational age, stomach volume significantly increased, and stomach‐bladder distance decreased (both P < .001). The developmental changes did not differ significantly between fetuses with simple and complex gastroschisis, neither for fetal stomach volume (P = .85), nor for stomach bladder distance (P = .78). Conclusion Fetal stomach volume and stomach‐bladder distance, measured during pregnancy using 3D ultrasonography, do not predict complex gastroschisis. What's already known about this topic?
Infants with complex gastroschisis have a higher risk of morbidity than those with simple gastroschisis. Many attempts have been made to prenatally predict complex gastroschisis, using two‐dimensional ultrasound parameters.
What does this study add?
This longitudinal prospective multicenter study is the first to evaluate the possible benefit of the use of three‐dimensional ultrasound in fetuses with gastroschisis. Fetal stomach volume and stomach‐bladder distance, measured during pregnancy using three‐dimensional ultrasound, cannot predict complex gastroschisis.
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Affiliation(s)
- Annelieke Hijkoop
- Department of Pediatric Surgery and Intensive Care Children, Erasmus Medical Center-Sophia Children's Hospital, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Chiara C M M Lap
- Department of Obstetrics, Division Woman and Baby, University Medical Center UtrechtUtrecht University, Utrecht, The Netherlands
| | - Moska Aliasi
- Department of Obstetrics, Division Woman and Baby, University Medical Center UtrechtUtrecht University, Utrecht, The Netherlands
| | - Eduard J H Mulder
- Department of Obstetrics, Division Woman and Baby, University Medical Center UtrechtUtrecht University, Utrecht, The Netherlands
| | - William L M Kramer
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hens A A Brouwers
- Department of Neonatology, Division Woman and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Robertine van Baren
- Department of Pediatric Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lourens R Pistorius
- Department of Obstetrics and Gynecology, University of Stellenbosch, Stellenbosch, South Africa
| | - Gerard H A Visser
- Department of Obstetrics, Division Woman and Baby, University Medical Center UtrechtUtrecht University, Utrecht, The Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery and Intensive Care Children, Erasmus Medical Center-Sophia Children's Hospital, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care Children, Erasmus Medical Center-Sophia Children's Hospital, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Gwendolyn T R Manten
- Department of Obstetrics, Division Woman and Baby, University Medical Center UtrechtUtrecht University, Utrecht, The Netherlands
| | - Titia E Cohen-Overbeek
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC-Sophia Children's Hospital, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Siegmund AS, Kampman MAM, Oudijk MA, Mulder BJM, Sieswerda GTJ, Koenen SV, Hummel YM, de Laat MWM, Sollie-Szarynska KM, Groen H, van Dijk APJ, van Veldhuisen DJ, Bilardo CM, Pieper PG. Maternal right ventricular function, uteroplacental circulation in first trimester and pregnancy outcome in women with congenital heart disease. Ultrasound Obstet Gynecol 2019; 54:359-366. [PMID: 30334300 DOI: 10.1002/uog.20148] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/25/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Pregnant women with congenital heart disease (CHD) have an increased risk of abnormal uteroplacental flow, measured from the second trimester onwards, which is associated with pregnancy complications affecting the mother and the fetus. Maternal right ventricular (RV) dysfunction has been suggested as a predisposing factor for impaired uteroplacental flow in these women. The aim of this study was to investigate the association of first-trimester uteroplacental flow measurements with prepregnancy maternal cardiac function and pregnancy complications in women with CHD, with particular focus on the potential role of RV (dys)function. METHODS This study included 138 pregnant women with CHD from the prospective ZAHARA III study (Zwangerschap bij Aangeboren HARtAfwijkingen; Pregnancy and CHD). Prepregnancy clinical and echocardiographic data were collected. Clinical evaluation, echocardiography (focused on RV function, as assessed by tricuspid annular plane systolic excursion (TAPSE)) and uterine artery (UtA) pulsatility index (PI) measurements were performed at 12, 20 and 32 weeks of gestation. Univariable and multivariable regression analyses were performed to assess the association between prepregnancy variables and UtA-PI during pregnancy. The association between UtA-PI at 12 weeks and cardiovascular, obstetric and neonatal complications was also assessed. RESULTS On multivariable regression analysis, prepregnancy TAPSE was associated negatively with UtA-PI at 12 weeks of gestation (β = -0.026; P = 0.036). Women with lower prepregnancy TAPSE (≤ 20 mm vs > 20 mm) had higher UtA-PI at 12 weeks (1.5 ± 0.5 vs 1.2 ± 0.6; P = 0.047). Increased UtA-PI at 12 weeks was associated with obstetric complications (P = 0.003), particularly hypertensive disorders (pregnancy-induced hypertension and pre-eclampsia, P = 0.019 and P = 0.026, respectively). CONCLUSIONS In women with CHD, RV dysfunction before pregnancy seems to impact placentation, resulting in increased resistance in UtA flow, which is detectable as early as in the first trimester. This, in turn, is associated with pregnancy complications. Early monitoring of uteroplacental flow might be of value in women with CHD with pre-existing subclinical RV dysfunction to identify pregnancies that would benefit from close obstetric surveillance. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A S Siegmund
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M A M Kampman
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M A Oudijk
- Department of Obstetrics, University of Amsterdam, Amsterdam Universities Medical Centre, location Academic Medical Center, Amsterdam, The Netherlands
| | - B J M Mulder
- Department of Cardiology, University of Amsterdam, Amsterdam Universities Medical Centre, location Academic Medical Center, Amsterdam, The Netherlands
| | - G T J Sieswerda
- Department of Cardiology, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S V Koenen
- Department of Obstetrics, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y M Hummel
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M W M de Laat
- Department of Obstetrics, University of Amsterdam, Amsterdam Universities Medical Centre, location Academic Medical Center, Amsterdam, The Netherlands
| | - K M Sollie-Szarynska
- Department of Obstetrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A P J van Dijk
- Department of Cardiology, Radboud University, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P G Pieper
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Bekkering I, Leeuwerke M, Tanis JC, Schoots MH, Verkaik-Schakel RN, Plösch T, Bilardo CM, Eijsink JJH, Bos AF, Scherjon SA. Differential placental DNA methylation of VEGFA and LEP in small-for-gestational age fetuses with an abnormal cerebroplacental ratio. PLoS One 2019; 14:e0221972. [PMID: 31469872 PMCID: PMC6716778 DOI: 10.1371/journal.pone.0221972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/15/2019] [Indexed: 12/19/2022] Open
Abstract
Background In Fetal Growth Restriction ‘fetal programming’ may take place via DNA methylation, which has implications for short-term and long-term health outcomes. Small-for-gestational age fetuses are considered fetal growth restricted, characterized by brain-sparing when fetal Doppler hemodynamics are abnormal, expressed as a cerebroplacental ratio (CPR) <1. We aimed to determine whether brain-sparing is associated with altered DNA methylation of selected genes. Methods We compared DNA methylation of six genes in 41 small-for-gestational age placentas with a normal or abnormal CPR. We selected EPO, HIF1A, VEGFA, LEP, PHLDA2, and DHCR24 for their role in angiogenesis, immunomodulation, and placental and fetal growth. DNA methylation was analyzed by pyrosequencing. Results Growth restricted fetuses with an abnormal CPR showed hypermethylation of the VEGFA gene at one CpG (VEGFA-309, p = .001) and an overall hypomethylation of the LEP gene, being significant at two CpGs (LEP-123, p = .049; LEP-51, p = .020). No differences in methylation were observed for the other genes. Conclusions VEGFA and LEP genes are differentially methylated in placentas of small-for-gestational age fetuses with brain-sparing. Hypermethylation of VEGFA-309 in abnormal CPR-placentas could indicate successful compensatory mechanisms. Methylation of LEP-51 is known to suppress LEP expression. Hypomethylation in small-for-gestational age placentas with abnormal CPR may result in hyperleptinemia and predispose to leptin-resistance later in life.
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Affiliation(s)
- Iris Bekkering
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Mariëtte Leeuwerke
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jozien C. Tanis
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mirthe H. Schoots
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rikst Nynke Verkaik-Schakel
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Torsten Plösch
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Caterina M. Bilardo
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jasper J. H. Eijsink
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arend F. Bos
- Department of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sicco A. Scherjon
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Fontanella F, van Scheltema PNA, Duin L, Cohen-Overbeek TE, Pajkrt E, Bekker MN, Willekes C, Oepkes D, Bilardo CM. Antenatal staging of congenital lower urinary tract obstruction. Ultrasound Obstet Gynecol 2019; 53:520-524. [PMID: 29978555 DOI: 10.1002/uog.19172] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To propose a staging system for congenital lower urinary tract obstruction (LUTO) capable of predicting the severity of the condition and its prognosis. METHODS This was a national retrospective study carried out at the eight Academic Hospitals in The Netherlands. We collected prenatal and postnatal data of fetuses at high risk of isolated LUTO that were managed conservatively. Postnatal renal function was assessed by the estimated glomerular filtration rate (eGFR), calculated using the Schwartz formula, considering the length of the infant and the creatinine nadir in the first year after birth. Receiver-operating characteristics (ROC) curve analysis, univariate analysis and multivariate logistic regression analysis with stepwise backward elimination were performed in order to identify the best antenatal predictors of perinatal mortality and postnatal renal function. RESULTS In total, 261 fetuses suspected of having LUTO and managed conservatively were included in the study. The pregnancy was terminated in 110 cases and perinatal death occurred in 35 cases. Gestational age at appearance of oligohydramnios showed excellent accuracy in predicting the risk of perinatal mortality with an area under the ROC curve of 0.95 (P < 0.001) and an optimal cut-off at 26 weeks' gestation. Fetuses with normal amniotic fluid (AF) volume at 26 weeks' gestation presented with low risk of poor outcome and were therefore defined as cases with mild LUTO. In fetuses referred before the 26th week of gestation, the urinary bladder volume (BV) was the best unique predictor of perinatal mortality. ROC curve analysis identified a BV of 5.4 cm3 and appearance of oligohydramnios at 20 weeks as the best threshold for predicting an adverse outcome. LUTO cases with a BV ≥ 5.4 cm3 or abnormal AF volume before 20 weeks' gestation were defined as severe and those with BV < 5.4 cm3 and normal AF volume at the 20 weeks' scan were defined as moderate. Risk of perinatal mortality significantly increased according to the stage of severity, from mild to moderate to severe stage, from 9% to 26% to 55%, respectively. Similarly, risk of severely impaired renal function increased from 11% to 31% to 44%, for mild, moderate and severe LUTO, respectively. CONCLUSIONS Gestational age at appearance of oligo- or anhydramnios and BV at diagnosis can accurately predict mortality and morbidity in fetuses with LUTO. Our proposed staging system can triage reliably fetuses with LUTO and predict the severity of the condition and its prognosis. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Fontanella
- Department of Obstetrics, Gynecology and Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - L Duin
- Department of Obstetrics, Gynecology and Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - T E Cohen-Overbeek
- Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - E Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - M N Bekker
- Department of Obstetrics, Gynecology and Prenatal Diagnosis, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Obstetrics, Gynecology and Prenatal Diagnosis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Willekes
- Department of Obstetrics, Gynecology and Prenatal Diagnosis, University Medical Center, Grow School for Oncology and Medical Biology, Maastricht, The Netherlands
| | - D Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, Gynecology and Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Obstetrics, Gynecology and Prenatal Diagnosis, VU University Medical Center, Amsterdam, The Netherlands
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Bilardo CM. Reply. Ultrasound Obstet Gynecol 2018; 52:550-551. [PMID: 30284364 DOI: 10.1002/uog.20091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- C M Bilardo
- Department of Obstetrics & Gynecology, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands; University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Mebius MJ, Oostdijk NJE, Kuik SJ, Bos AF, Berger RMF, Bilardo CM, Kooi EMW, Ter Horst HJ. Amplitude-integrated electroencephalography during the first 72 h after birth in neonates diagnosed prenatally with congenital heart disease. Pediatr Res 2018; 83:798-803. [PMID: 29244798 DOI: 10.1038/pr.2017.311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 11/29/2017] [Indexed: 11/09/2022]
Abstract
BackgroundLittle is known on amplitude-integrated electroencephalography (aEEG) during the first few days after birth in neonates with congenital heart disease (CHD). Our aim was, therefore, to assess electrocortical activity using aEEG within the first 72 h after birth in neonates diagnosed prenatally with CHD, and to define independent prenatal and postnatal predictors for abnormal aEEG.MethodsNeonates with CHD who were admitted to the neonatal intensive care unit between 2010 and 2017 were retrospectively included. We assessed aEEG background patterns, sleep-wake cycling, and epileptic activity during the first 72 h after birth and defined prenatal and postnatal clinical parameters associated with aEEG patterns.ResultsSeventy-two neonates were included. Twenty-six (36%) had mildly abnormal and six (8%) had severely abnormal aEEG background patterns at some point during the study period. Sleep-wake cycling was present in 97% of the neonates. Subclinical seizures were common (15%), whereas none of the neonates had clinical seizures. Only treatment with sedatives was a significant predictor for abnormal aEEG background patterns, explaining 56% of the variance.ConclusionAbnormal aEEG background patterns are common and are strongly associated with treatment with sedatives in neonates with prenatally diagnosed CHD. Future studies should assess the association between early postnatal aEEG abnormalities and neurodevelopmental outcome.
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Affiliation(s)
- Mirthe J Mebius
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatrics, Divison of Neonatology, Groningen, The Netherlands
| | - Nathalie J E Oostdijk
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatrics, Divison of Neonatology, Groningen, The Netherlands
| | - Sara J Kuik
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatrics, Divison of Neonatology, Groningen, The Netherlands
| | - Arend F Bos
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatrics, Divison of Neonatology, Groningen, The Netherlands
| | - Rolf M F Berger
- University of Groningen, University Medical Center Groningen, Center for Congenital Heart Diseases, Pediatric Cardiology, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Caterina M Bilardo
- University of Groningen, University Medical Center Groningen, Department of Obstetrics & Gynecology, Groningen, The Netherlands
| | - Elisabeth M W Kooi
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatrics, Divison of Neonatology, Groningen, The Netherlands
| | - Hendrik J Ter Horst
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatrics, Divison of Neonatology, Groningen, The Netherlands
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Kenkhuis MJA, Bakker M, Bardi F, Fontanella F, Bakker MK, Fleurke-Rozema JH, Bilardo CM. Effectiveness of 12-13-week scan for early diagnosis of fetal congenital anomalies in the cell-free DNA era. Ultrasound Obstet Gynecol 2018; 51:463-469. [PMID: 28397377 DOI: 10.1002/uog.17487] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/28/2017] [Accepted: 03/31/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The main aim of this study was to assess the proportion and type of congenital anomalies, both structural and chromosomal, that can be detected at an early scan performed at 12-13 weeks' gestation, compared with at the 20-week structural anomaly scan offered under the present screening policy. Secondary aims were to evaluate the incidence of false-positive findings and ultrasound markers at both scans, and parental choice regarding termination of pregnancy (TOP). METHODS Sonographers accredited for nuchal translucency (NT) measurement were asked to participate in the study after undergoing additional training to improve their skills in late first-trimester fetal anatomy examination. The early scans were performed according to a structured protocol, in six ultrasound practices and two referral centers in the north-east of The Netherlands. All women opting for the combined test (CT) or with an increased a-priori risk of fetal anomalies were offered a scan at 12-13 weeks' gestation (study group). All women with a continuing pregnancy were offered, as part of the 'usual care', a 20-week anomaly scan. RESULTS The study group consisted of 5237 women opting for the CT and 297 women with an increased a-priori risk of anomalies (total, 5534). In total, 51 structural and 34 chromosomal anomalies were detected prenatally in the study population, and 18 additional structural anomalies were detected after birth. Overall, 54/85 (63.5%) anomalies were detected at the early scan (23/51 (45.1%) structural and all chromosomal anomalies presenting with either an increased risk at first-trimester screening or structural anomalies (31/34)). All particularly severe anomalies were detected at the early scan (all cases of neural tube defect, omphalocele, megacystis, and multiple severe congenital and severe skeletal anomalies). NT was increased in 12/23 (52.2%) cases of structural anomaly detected at the early scan. Of the 12 cases of heart defects, four (33.3%) were detected at the early scan, five (41.7%) at the 20-week scan and three (25.0%) after birth. False-positive diagnoses at the early scan and at the 20-week scan occurred in 0.1% and 0.6% of cases, respectively, whereas ultrasound markers were detected in 1.4% and 3.0% of cases, respectively. After first- or second-trimester diagnosis of an anomaly, parents elected TOP in 83.3% and 25.8% of cases, respectively. CONCLUSIONS An early scan performed at 12-13 weeks' gestation by a competent sonographer can detect about half of the prenatally detectable structural anomalies and 100% of those expected to be detected at this stage. Particularly severe anomalies, often causing parents to choose TOP, are amenable to early diagnosis. The early scan is an essential part of modern pregnancy care. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M J A Kenkhuis
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - M Bakker
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - F Bardi
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - F Fontanella
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - M K Bakker
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Eurocat Northern Netherlands, Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J H Fleurke-Rozema
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - C M Bilardo
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Haveman I, Fleurke-Rozema JH, Mulder EJ, Benders M, du Marchie Sarvaas G, ter Heide H, de Heus RH, Bilardo CM. Growth patterns in fetuses with isolated cardiac defects. Prenat Diagn 2018; 38:328-336. [DOI: 10.1002/pd.5242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/09/2018] [Accepted: 02/21/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Ilse Haveman
- Department of Obstetrics and Gynaecology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Johanna H. Fleurke-Rozema
- Department of Obstetrics; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
| | - Eduard J.H. Mulder
- Department of Obstetrics and Gynaecology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Manon Benders
- Department of Neonatology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Gideon du Marchie Sarvaas
- Department of Pediatric Cardiology; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
| | - Henriette ter Heide
- Department of Pediatric Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Roel H. de Heus
- Department of Obstetrics and Gynaecology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Caterina M. Bilardo
- Department of Obstetrics; University Medical Center Groningen, University of Groningen; Groningen The Netherlands
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Frusca T, Todros T, Lees C, Bilardo CM. Outcome in early-onset fetal growth restriction is best combining computerized fetal heart rate analysis with ductus venosus Doppler: insights from the Trial of Umbilical and Fetal Flow in Europe. Am J Obstet Gynecol 2018; 218:S783-S789. [PMID: 29422211 DOI: 10.1016/j.ajog.2017.12.226] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Early-onset fetal growth restriction represents a particular dilemma in clinical management balancing the risk of iatrogenic prematurity with waiting for the fetus to gain more maturity, while being exposed to the risk of intrauterine death or the sequelae of acidosis. OBJECTIVE The Trial of Umbilical and Fetal Flow in Europe was a European, multicenter, randomized trial aimed to determine according to which criteria delivery should be triggered in early fetal growth restriction. We present the key findings of the primary and secondary analyses. STUDY DESIGN Women with fetal abdominal circumference <10th percentile and umbilical pulsatility index >95th percentile between 26-32 weeks were randomized to 1 of 3 monitoring and delivery protocols. These were: fetal heart rate variability based on computerized cardiotocography; and early or late ductus venosus Doppler changes. A safety net based on fetal heart rate abnormalities or umbilical Doppler changes mandated delivery irrespective of randomized group. The primary outcome was normal neurodevelopmental outcome at 2 years. RESULTS Among 511 women randomized, 362/503 (72%) had associated hypertensive conditions. In all, 463/503 (92%) of fetuses survived and cerebral palsy occurred in 6/443 (1%) with known outcome. Among all women there was no difference in outcome based on randomized group; however, of survivors, significantly more fetuses randomized to the late ductus venosus group had a normal outcome (133/144; 95%) than those randomized to computerized cardiotocography alone (111/131; 85%). In 118/310 (38%) of babies delivered <32 weeks, the indication was safety-net criteria: 55/106 (52%) in late ductus venosus, 37/99 (37%) in early ductus venosus, and 26/105 (25%) in computerized cardiotocography groups. Higher middle cerebral artery impedance adjusted for gestation was associated with neonatal survival without severe morbidity (odds ratio, 1.24; 95% confidence interval, 1.02-1.52) and infant survival without neurodevelopmental impairment at 2 years (odds ratio, 1.33; 95% confidence interval, 1.03-1.72) although birthweight and gestational age were more important determinants. CONCLUSION Perinatal and 2-year outcome was better than expected in all randomized groups. Among survivors, 2-year neurodevelopmental outcome was best in those randomized to delivery based on late ductus venosus changes. Given a high rate of delivery based on the safety-net criteria, deciding delivery based on late ductus venosus changes and abnormal computerized fetal heart rate variability seems prudent. There is no rationale for delivery based on cerebral Doppler changes alone. Of note, most women with early-onset fetal growth restriction develop hypertension.
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Affiliation(s)
- Tiziana Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Tullia Todros
- Department of Obstetrics and Gynecology, University of Turin, Turin, Italy
| | - Christoph Lees
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom; Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Caterina M Bilardo
- Department of Obstetrics, Gynecology, and VU University Medical Centre, Amsterdam and University Medical Centre Groningen, University of Groningen, The Netherlands
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Bakker MK, Bergman JEH, Fleurke-Rozema H, Streefland E, Gracchi V, Bilardo CM, De Walle HEK. Prenatal diagnosis of urinary tract anomalies, a cohort study in the Northern Netherlands. Prenat Diagn 2018; 38:130-134. [PMID: 29240244 DOI: 10.1002/pd.5200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 12/01/2017] [Accepted: 12/10/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe prevalence, time of diagnosis, and type of birth in children and fetuses with urinary tract (UT) anomalies after the introduction of the anomaly scan in the Netherlands in 2007. METHODS We selected, from a population-based congenital anomaly registry, children and fetuses with UT anomalies born between 2008 and 2014. Cases were defined according to type of UT anomaly and whether isolated or with associated anomalies. Information was collected on time of diagnosis and type of birth. RESULTS We included 487 cases. Total prevalence increased from 34.0 in 2008 to 42.3 per 10 000 births in 2014, mainly by an increase in anomalies of the collecting system. Almost 70% presented as isolated. Anomalies of the renal parenchyma were more often associated with genetic or other anomalies (47.3%) than anomalies of the collecting system (19.0%). The proportion of prenatally diagnosed cases increased from 59.3% in 2008 to 80.9% in 2014. Termination of pregnancy occurred in 14.8%, of which the majority were UT anomalies associated with a genetic disorder or other anomalies. CONCLUSION In the period after the introduction of the anomaly scan, we observed an increasing prevalence of anomalies of the collecting system, but no increase in termination of pregnancies.
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Affiliation(s)
- Marian K Bakker
- Eurocat Northern Netherlands, Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynaecology/Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jorieke E H Bergman
- Eurocat Northern Netherlands, Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hanneke Fleurke-Rozema
- Department of Obstetrics and Gynaecology/Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther Streefland
- Department of Obstetrics and Gynaecology/Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Valentina Gracchi
- Department of Paediatric Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics and Gynaecology/Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hermien E K De Walle
- Eurocat Northern Netherlands, Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Bakker MK, Bergman JEH, Fleurke-Rozema H, Streefland E, Gracchi V, Bilardo CM, De Walle HEK. Prenatal diagnosis of urinary tract anomalies, a cohort study in the Northern Netherlands. Prenat Diagn 2018. [PMID: 29240244 DOI: 10.3969/j.issn.1673-534x.2018.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To describe prevalence, time of diagnosis, and type of birth in children and fetuses with urinary tract (UT) anomalies after the introduction of the anomaly scan in the Netherlands in 2007. METHODS We selected, from a population-based congenital anomaly registry, children and fetuses with UT anomalies born between 2008 and 2014. Cases were defined according to type of UT anomaly and whether isolated or with associated anomalies. Information was collected on time of diagnosis and type of birth. RESULTS We included 487 cases. Total prevalence increased from 34.0 in 2008 to 42.3 per 10 000 births in 2014, mainly by an increase in anomalies of the collecting system. Almost 70% presented as isolated. Anomalies of the renal parenchyma were more often associated with genetic or other anomalies (47.3%) than anomalies of the collecting system (19.0%). The proportion of prenatally diagnosed cases increased from 59.3% in 2008 to 80.9% in 2014. Termination of pregnancy occurred in 14.8%, of which the majority were UT anomalies associated with a genetic disorder or other anomalies. CONCLUSION In the period after the introduction of the anomaly scan, we observed an increasing prevalence of anomalies of the collecting system, but no increase in termination of pregnancies.
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Affiliation(s)
- Marian K Bakker
- Eurocat Northern Netherlands, Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynaecology/Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jorieke E H Bergman
- Eurocat Northern Netherlands, Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hanneke Fleurke-Rozema
- Department of Obstetrics and Gynaecology/Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Esther Streefland
- Department of Obstetrics and Gynaecology/Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Valentina Gracchi
- Department of Paediatric Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics and Gynaecology/Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hermien E K De Walle
- Eurocat Northern Netherlands, Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Fontanella F, Duin L, Adama van Scheltema PN, Cohen-Overbeek TE, Pajkrt E, Bekker M, Willekes C, Bax CJ, Bilardo CM. Fetal megacystis: prediction of spontaneous resolution and outcome. Ultrasound Obstet Gynecol 2017; 50:458-463. [PMID: 28133847 DOI: 10.1002/uog.17422] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/19/2016] [Accepted: 01/20/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To investigate the natural history of fetal megacystis from diagnosis in utero to postnatal outcome, and to identify prognostic indicators of spontaneous resolution and postnatal outcome after resolution. METHODS This was a national retrospective cohort study. Fetal megacystis was defined in the first trimester as a longitudinal bladder diameter (LBD) ≥ 7 mm, and in the second and third trimesters as an enlarged bladder failing to empty during the entire extended ultrasound examination. LBD and gestational age (GA) at resolution were investigated with respect to likelihood of resolution and postnatal outcome, respectively. Sensitivity, specificity and area under the receiver-operating characteristics curve (AUC) were calculated. RESULTS In total, 284 cases of fetal megacystis (93 early megacystis, identified before the 18th week, and 191 late megacystis, identified at or after the 18th week) were available for analysis. Spontaneous resolution occurred before birth in 58 (20%) cases. In cases with early megacystis, LBD was predictive of the likelihood of spontaneous resolution (sensitivity, 80%; specificity, 79%; AUC, 0.84), and, in the whole population, GA at regression was predictive of postnatal outcome, with an optimal cut-off at 23 weeks (sensitivity, 100%; specificity, 82%; AUC, 0.91). In the group with early megacystis, the outcome was invariably good when resolution occurred before the 23rd week of gestation, whereas urological sequelae requiring postnatal surgery were diagnosed in 3/8 (38%) cases with resolution after 23 weeks. In the group with late megacystis, spontaneous resolution was associated with urological complications after birth, ranging from mild postnatal hydronephrosis in infants with resolution before 23 weeks, to more severe urological anomalies requiring postnatal surgery in those with resolution later in pregnancy. This supports the hypothesis that an early resolution of megacystis is often related to a paraphysiological bladder enlargement that resolves early in pregnancy without consequences, while antenatal resolution occurring later in pregnancy (after the 23rd week of gestation) should suggest a pathological condition with urological sequelae. CONCLUSIONS In fetal megacystis, LBD and GA at regression can be used as predictors of resolution and outcome, respectively. These parameters could help in fine-tuning the prognosis and optimizing the frequency of follow-up scans. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Fontanella
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - L Duin
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - P N Adama van Scheltema
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Leiden University Medical Centre, Leiden, The Netherlands
| | - T E Cohen-Overbeek
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - E Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - M Bekker
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - C Willekes
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Centre, Grow School for Oncology and Medical Biology, Maastricht, The Netherlands
| | - C J Bax
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, VU University Medical Centre, Amsterdam, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Bilardo CM, Hecher K, Visser GHA, Papageorghiou AT, Marlow N, Thilaganathan B, Van Wassenaer-Leemhuis A, Todros T, Marsal K, Frusca T, Arabin B, Brezinka C, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Ganzevoort W, Martinelli P, Ostermayer E, Schlembach D, Valensise H, Thornton J, Wolf H, Lees C. Severe fetal growth restriction at 26-32 weeks: key messages from the TRUFFLE study. Ultrasound Obstet Gynecol 2017; 50:285-290. [PMID: 28938063 DOI: 10.1002/uog.18815] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Indexed: 06/07/2023]
Affiliation(s)
- C M Bilardo
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G H A Visser
- University Medical Center, Division of Woman and Baby, Utrecht, The Netherlands
| | - A T Papageorghiou
- St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - N Marlow
- Department of Academic Neonatology, UCL Institute for Women's Health, London, UK
| | - B Thilaganathan
- St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - A Van Wassenaer-Leemhuis
- Department of Neonatology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
| | - T Todros
- Department of Obstetrics & Gynecology, University of Turin, Turin, Italy
| | - K Marsal
- Department of Obstetrics and Gynecology, Lund University, University Hospital, Lund, Sweden
| | - T Frusca
- Maternal-Fetal Medicine Unit, University of Parma, Parma, Italy
| | - B Arabin
- Department of Perinatology, Isala Clinics, Zwolle, The Netherlands
- Center for Mother and Child of the Philipps University, Marburg, Germany
| | - C Brezinka
- Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - J B Derks
- Perinatal Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J J Duvekot
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - E Ferrazzi
- Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - P Martinelli
- Department of Gynecology and Obstetrics, University Federico II of Naples, Naples, Italy
| | - E Ostermayer
- Section of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - D Schlembach
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - H Valensise
- Department of Biomedicine, Tor Vergata University, Policlinico Casilino, Rome, Italy
| | - J Thornton
- Department of Obstetrics and Gynaecology, City Hospital, Nottingham, UK
| | - H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Visser GHA, Bilardo CM, Derks JB, Ferrazzi E, Fratelli N, Frusca T, Ganzevoort W, Lees CC, Napolitano R, Todros T, Wolf H, Hecher K. Fetal monitoring indications for delivery and 2-year outcome in 310 infants with fetal growth restriction delivered before 32 weeks' gestation in the TRUFFLE study. Ultrasound Obstet Gynecol 2017; 50:347-352. [PMID: 27854382 DOI: 10.1002/uog.17361] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 10/17/2016] [Accepted: 11/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE In the TRUFFLE (Trial of Randomized Umbilical and Fetal Flow in Europe) study on the outcome of early fetal growth restriction, women were allocated to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate (FHR) short-term variation (STV) on cardiotocography (CTG); (2) early changes in fetal ductus venosus (DV) waveform (DV-p95); and (3) late changes in fetal DV waveform (DV-no-A). However, many infants per monitoring protocol were delivered because of safety-net criteria, for maternal or other fetal indications, or after 32 weeks of gestation when the protocol was no longer applied. The objective of the present posthoc subanalysis was to investigate the indications for delivery in relation to 2-year outcome in infants delivered before 32 weeks to further refine management proposals. METHODS We included all 310 cases of the TRUFFLE study with known outcome at 2 years' corrected age and seven fetal deaths, excluding seven cases with inevitable perinatal death. Data were analyzed according to the allocated fetal monitoring strategy in combination with the indication for delivery. RESULTS Overall, only 32% of liveborn infants were delivered according to the specified monitoring parameter for indication for delivery; 38% were delivered because of safety-net criteria, 15% for other fetal reasons and 15% for maternal reasons. In the CTG-STV group, 51% of infants were delivered because of reduced STV. In the DV-p95 group, 34% of infants were delivered because of abnormal DV and, in the DV-no-A group, only 10% of infants were delivered accordingly. The majority of infants in the DV groups were delivered for the safety-net criterion of spontaneous decelerations in FHR. Two-year intact survival was highest in the DV groups combined compared with the CTG-STV group (P = 0.05 for live births only, P = 0.21 including fetal death), with no difference between DV groups. A poorer outcome in the CTG-STV group was restricted to infants delivered because of FHR decelerations in the safety-net subgroup. Infants delivered because of maternal reasons had the highest birth weight and a non-significantly higher intact survival. CONCLUSIONS In this subanalysis of infants delivered before 32 weeks, the majority were delivered for reasons other than the allocated monitoring strategy indication. Since, in the DV group, CTG-STV criteria were used as a safety net but in the CTG-STV group, no DV safety-net criteria were applied, we speculate that the slightly poorer outcome in the CTG-STV group might be explained by the absence of DV data. The optimal timing of delivery of fetuses with early intrauterine growth restriction may therefore be best determined by monitoring them longitudinally, with both DV and CTG monitoring. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G H A Visser
- Department of Perinatology, University Medical Center, Utrecht, The Netherlands
| | - C M Bilardo
- Department of Obstetrics and Gynaecology, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - J B Derks
- Department of Perinatology, University Medical Center, Utrecht, The Netherlands
| | - E Ferrazzi
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - N Fratelli
- Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - T Frusca
- Department of Obstetrics and Gynecology, University Hospital, Parma, Italy
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - R Napolitano
- Department of Gynecology and Obstetrics, University Federico II of Naples, Naples, Italy
| | - T Todros
- Department of Obstetrics and Gynecology, Sant' Anna Hospital, Turin, Italy
| | - H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Wolf H, Arabin B, Lees CC, Oepkes D, Prefumo F, Thilaganathan B, Todros T, Visser GHA, Bilardo CM, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Frusca T, Hecher K, Marlow N, Martinelli P, Ostermayer E, Papageorghiou AT, Scheepers HCJ, Schlembach D, Schneider KTM, Valcamonico A, van Wassenaer-Leemhuis A, Ganzevoort W. Longitudinal study of computerized cardiotocography in early fetal growth restriction. Ultrasound Obstet Gynecol 2017; 50:71-78. [PMID: 27484356 DOI: 10.1002/uog.17215] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/03/2016] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To explore whether, in early fetal growth restriction (FGR), the longitudinal pattern of fetal heart rate (FHR) short-term variation (STV) can be used to identify imminent fetal distress and whether abnormalities of FHR recordings are associated with 2-year infant outcome. METHODS The original TRUFFLE study assessed whether, in early FGR, delivery based on ductus venosus (DV) Doppler pulsatility index (PI), in combination with safety-net criteria of very low STV on cardiotocography (CTG) and/or recurrent FHR decelerations, could improve 2-year infant survival without neurological impairment in comparison with delivery based on CTG monitoring only. This was a secondary analysis of women who delivered before 32 weeks and had consecutive STV data recorded > 3 days before delivery and known infant outcome at 2 years of age. Women who received corticosteroids within 3 days of delivery were excluded. Individual regression line algorithms of all STV values, except the last one before delivery, were calculated. Life tables and Cox regression analysis were used to calculate the daily risk for low STV or very low STV and/or FHR decelerations (below DV group safety-net criteria) and to assess which parameters were associated with this risk. Furthermore, it was assessed whether STV pattern, last STV value or recurrent FHR decelerations were associated with 2-year infant outcome. RESULTS One hundred and forty-nine women from the original TRUFFLE study met the inclusion criteria. Using the individual STV regression lines, prediction of a last STV below the cut-off used by the CTG monitoring group had sensitivity of 42% and specificity of 91%. For each day after study inclusion, the median risk for low STV (CTG group cut-off) was 4% (interquartile range (IQR), 2-7%) and for very low STV and/or recurrent FHR decelerations (below DV group safety-net criteria) was 5% (IQR, 4-7%). Measures of STV pattern, fetal Doppler (arterial or venous), birth-weight multiples of the median and gestational age did not usefully improve daily risk prediction. There was no association of STV regression coefficients, a low last STV and/or recurrent FHR decelerations with short- or long-term infant outcomes. CONCLUSION The TRUFFLE study showed that a strategy of DV monitoring with safety-net criteria of very low STV and/or recurrent FHR decelerations for delivery indication could increase 2-year infant survival without neurological impairment. This post-hoc analysis demonstrates that, in early FGR, the daily risk of abnormal CTG, as defined by the DV group safety-net criteria, is 5%, and that prediction is not possible. This supports the rationale for CTG monitoring more often than daily in these high-risk fetuses. Low STV and/or recurrent FHR decelerations were not associated with adverse infant outcome and it appears safe to delay intervention until such abnormalities occur, as long as DV-PI is within normal range. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - B Arabin
- Center for Mother and Child of the Phillips University, Marburg, Germany
| | - C C Lees
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - D Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - F Prefumo
- Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - B Thilaganathan
- Fetal Medicine Unit, St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - T Todros
- Department of Obstetrics and Gynaecology, University of Turin, Turin, Italy
| | - G H A Visser
- Department of Perinatal Medicine, University Medical Center, Utrecht, The Netherlands
| | - C M Bilardo
- Department of Obstetrics and Gynaecology, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - J B Derks
- Department of Perinatal Medicine, University Medical Center, Utrecht, The Netherlands
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg, Eppendorf, Germany
| | - J J Duvekot
- Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - E Ferrazzi
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - T Frusca
- Department of Obstetrics and Gynecology, Maggiore Hospital, University of Parma, Parma, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg, Eppendorf, Germany
| | - N Marlow
- Department of Neonatology, Institute for Women's Health, University College Hospitals London, London, UK
| | - P Martinelli
- Department of Neuroscience, Dentistry and Reproductive Sciences, University of Naples Federico II, Naples, Italy
| | - E Ostermayer
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's, University of London and St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - H C J Scheepers
- Department of Obstetrics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - D Schlembach
- Department of Obstetrics, Vivantes Clinic Neukölln, Berlin, Germany
| | - K T M Schneider
- Division of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - A Valcamonico
- Maternal-Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - A van Wassenaer-Leemhuis
- Department of Neonatology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
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van Schendel RV, Page-Christiaens GCML, Beulen L, Bilardo CM, de Boer MA, Coumans ABC, Faas BHW, van Langen IM, Lichtenbelt KD, van Maarle MC, Macville MVE, Oepkes D, Pajkrt E, Henneman L. Women's Experience with Non-Invasive Prenatal Testing and Emotional Well-being and Satisfaction after Test-Results. J Genet Couns 2017; 26:1348-1356. [PMID: 28667567 PMCID: PMC5672853 DOI: 10.1007/s10897-017-0118-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 05/26/2017] [Indexed: 12/17/2022]
Abstract
Increasingly, high-risk pregnant women opt for non-invasive prenatal testing (NIPT) instead of invasive diagnostic testing. Since NIPT is less accurate than invasive testing, a normal NIPT result might leave women less reassured. A questionnaire study was performed among pregnant women with elevated risk for fetal aneuploidy based on first-trimester combined test (risk ≥1:200) or medical history, who were offered NIPT in the nationwide Dutch TRIDENT study. Pre- and post-test questionnaires (n = 682) included measures on: experiences with NIPT procedure, feelings of reassurance, anxiety (State-Trait Anxiety Inventory, STAI), child-related anxiety (PRAQ-R), and satisfaction. The majority (96.1%) were glad to have been offered NIPT. Most (68.5%) perceived the waiting time for NIPT results (mean: 15 days, range 5–32) as (much) too long. Most women with a normal NIPT result felt reassured (80.9%) or somewhat reassured (15.7%). Levels of anxiety and child-related anxiety were significantly lower after receiving a normal NIPT result as compared to the moment of intake (p < 0.001). Women with inadequate health literacy or a medical history (e.g. previous child with trisomy) experienced significantly higher post-test-result anxiety (Mean (M) STAI = 31.6 and 30.0, respectively) compared to those with adequate health literacy (M = 28.6) and no medical history (M = 28.6), indicating these women might benefit from extra information and/or guidance when communicating NIPT test-results. Introducing NIPT as an alternative to invasive testing, led to an offer that satisfied and largely reassured high-risk pregnant women.
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Affiliation(s)
- Rachèl V van Schendel
- Department of Clinical Genetics, Section Community Genetics and Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | | | - Lean Beulen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Caterina M Bilardo
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marjon A de Boer
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, the Netherlands
| | - Audrey B C Coumans
- Department of Obstetrics and Gynaecology, Maastricht UMC +, Maastricht, the Netherlands
| | - Brigitte H W Faas
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Irene M van Langen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Klaske D Lichtenbelt
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Merel C van Maarle
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands
| | - Merryn V E Macville
- Department of Clinical Genetics, Maastricht UMC +, Maastricht, the Netherlands
| | - Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Eva Pajkrt
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section Community Genetics and Amsterdam Public Health Research Institute, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
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47
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Ganzevoort W, Mensing Van Charante N, Thilaganathan B, Prefumo F, Arabin B, Bilardo CM, Brezinka C, Derks JB, Diemert A, Duvekot JJ, Ferrazzi E, Frusca T, Hecher K, Marlow N, Martinelli P, Ostermayer E, Papageorghiou AT, Schlembach D, Schneider KTM, Todros T, Valcamonico A, Visser GHA, Van Wassenaer-Leemhuis A, Lees CC, Wolf H. How to monitor pregnancies complicated by fetal growth restriction and delivery before 32 weeks: post-hoc analysis of TRUFFLE study. Ultrasound Obstet Gynecol 2017; 49:769-777. [PMID: 28182335 DOI: 10.1002/uog.17433] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 01/22/2017] [Accepted: 01/23/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES In the recent TRUFFLE study, it appeared that, in pregnancies complicated by fetal growth restriction (FGR) between 26 and 32 weeks' gestation, monitoring of the fetal ductus venosus (DV) waveform combined with computed cardiotocography (CTG) to determine timing of delivery increased the chance of infant survival without neurological impairment. However, concerns with the interpretation were raised, as DV monitoring appeared to be associated with a non-significant increase in fetal death, and some infants were delivered after 32 weeks, at which time the study protocol no longer applied. This secondary sensitivity analysis of the TRUFFLE study focuses on women who delivered before 32 completed weeks' gestation and analyzes in detail the cases of fetal death. METHODS Monitoring data of 317 pregnancies with FGR that delivered before 32 weeks were analyzed, excluding those with absent outcome data or inevitable perinatal death. Women were allocated randomly to one of three groups of indication for delivery according to the following monitoring strategies: (1) reduced fetal heart rate short-term variation (STV) on CTG; (2) early changes in fetal DV waveform; and (3) late changes in fetal DV waveform. Primary outcome was 2-year survival without neurological impairment. The association of the last monitoring data before delivery and infant outcome was assessed by multivariable analysis. RESULTS Two-year survival without neurological impairment occurred more often in the two DV groups (both 83%) than in the CTG-STV group (77%), however, the difference was not statistically significant (P = 0.21). Among the surviving infants in the DV groups, 93% were free of neurological impairment vs 85% of surviving infants in the CTG-STV group (P = 0.049). All fetal deaths (n = 7) occurred in the groups with DV monitoring. Of the monitoring parameters obtained shortly before fetal death in these seven cases, an abnormal CTG was observed in only one case. Multivariable regression analysis of factors at study entry demonstrated that a later gestational age, higher estimated fetal weight-to-50th percentile ratio and lower umbilical artery pulsatility index (PI)/fetal middle cerebral artery-PI ratio were significantly associated with normal outcome. Allocation to DV monitoring had a smaller effect on outcome, but remained in the model (P < 0.1). Abnormal fetal arterial Doppler before delivery was significantly associated with adverse outcome in the CTG-STV group. In contrast, abnormal DV flow was the only monitoring parameter associated with adverse outcome in the DV groups, while fetal arterial Doppler, STV below the cut-off used in the CTG-STV group and recurrent decelerations in fetal heart rate were not. CONCLUSIONS In accordance with the findings of the TRUFFLE study on monitoring and intervention management of very preterm FGR, we found that the proportion of infants surviving without neuroimpairment was not significantly different when the decision for delivery was based on changes in DV waveform vs reduced STV on CTG. The uneven distribution of fetal deaths towards the DV groups was probably a chance effect, and neurological outcome was better among surviving children in these groups. Before 32 weeks, delaying delivery until abnormalities in DV-PI or STV and/or recurrent decelerations in fetal heat rate occur, as defined by the study protocol, is likely to be safe and possibly benefits long-term outcome. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- W Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - N Mensing Van Charante
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - B Thilaganathan
- Fetal Medicine Unit, St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - F Prefumo
- Maternal Fetal Medicine Unit, University of Brescia, Brescia, Italy
| | - B Arabin
- Center for Mother and Child of the Phillips University, Marburg, Germany
| | - C M Bilardo
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University Medical Centre Groningen, Groningen, The Netherlands
| | - C Brezinka
- Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - J B Derks
- Perinatal Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J J Duvekot
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - E Ferrazzi
- Children's Hospital, Buzzi, University of Milan, Milan, Italy
| | - T Frusca
- Department of Obstetrics and Gynecology, Maggiore Hospital, University of Parma, Parma, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Marlow
- University College London Institute for Women's Health Ringgold Standard Institution - Neonatology, London, UK
| | - P Martinelli
- Department of Gynecology and Obstetrics, University Federico II of Naples, Naples, Italy
| | - E Ostermayer
- Section of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's, University of London & St George's University Hospitals NHS Foundation Trust, Molecular and Clinical Sciences Research Institute, London, UK
| | - D Schlembach
- Department of Obstetrics, Vivantes Clinic Neukölln, Berlin, Germany
| | - K T M Schneider
- Section of Perinatal Medicine, Department of Obstetrics and Gynecology, Technical University, Munich, Germany
| | - T Todros
- Department of Obstetrics and Gynecology, University of Turin, Turin, Italy
| | - A Valcamonico
- Department of Obstetrics and Gynecology, Maggiore Hospital, University of Parma, Parma, Italy
| | - G H A Visser
- Perinatal Center, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - A Van Wassenaer-Leemhuis
- Department of Neonatology, Emma Children's Hospital Academic Medical Centre, Amsterdam, The Netherlands
| | - C C Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - H Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, The Netherlands
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Bilardo CM. Re: Increased nuchal translucency thickness and risk of neurodevelopmental disorders. S. G. Hellmuth, L. H. Pedersen, C. B. Miltoft, O. B. Petersen, S. Kjaergaard, C. Ekelund and A. Tabor. Ultrasound Obstet Gynecol 2017; 49: 592-598. Ultrasound Obstet Gynecol 2017; 49:564. [PMID: 28471024 DOI: 10.1002/uog.17477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- C M Bilardo
- Fetal Medicine Unit, Department of Obstetrics & Gynaecology, University Medical Center Groningen, University of Groningen, Hanzelplein 1, 9700 RB, Groningen, The Netherlands
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Stampalija T, Arabin B, Wolf H, Bilardo CM, Lees C, Brezinka C, Derks J, Diemert A, Duvekot J, Ferrazzi E, Frusca T, Ganzevoort W, Hecher K, Kingdom J, Marlow N, Marsal K, Martinelli P, Ostermayer E, Papageorghiou A, Schlembach D, Schneider K, Thilaganathan B, Thornton J, Todros T, Valcamonico A, Valensise H, van Wassenaer-Leemhuis A, Visser G, Aktas A, Borgione S, Chaoui R, Cornette J, Diehl T, van Eyck J, Fratelli N, van Haastert I, Lobmaier S, Lopriore E, Missfelder-Lobos H, Mansi G, Martelli P, Maso G, Maurer-Fellbaum U, Mensing van Charante N, Mulder-de Tollenaer S, Napolitano R, Oberto M, Oepkes D, Ogge G, van der Post J, Prefumo F, Preston L, Raimondi F, Reiss I, Scheepers L, Skabar A, Spaanderman M, Weisglas-Kuperus N, Zimmermann A. Is middle cerebral artery Doppler related to neonatal and 2-year infant outcome in early fetal growth restriction? Am J Obstet Gynecol 2017; 216:521.e1-521.e13. [PMID: 28087423 DOI: 10.1016/j.ajog.2017.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Reduced fetal middle cerebral artery Doppler impedance is associated with hypoxemia in fetal growth restriction. It remains unclear as to whether this finding could be useful in timing delivery, especially in the third trimester. In this regard there is a paucity of evidence from prospective studies. OBJECTIVES The aim of this study was to determine whether there is an association between middle cerebral artery Doppler impedance and its ratio with the umbilical artery in relation to neonatal and 2 year infant outcome in early fetal growth restriction (26+0-31+6 weeks of gestation). Additionally we sought to explore which ratio is more informative for clinical use. STUDY DESIGN This is a secondary analysis from the Trial of Randomized Umbilical and Fetal Flow in Europe, a prospective, multicenter, randomized management study on different antenatal monitoring strategies (ductus venosus Doppler changes and computerized cardiotocography short-term variation) in fetal growth restriction diagnosed between 26+0 and 31+6 weeks. We analyzed women with middle cerebral artery Doppler measurement at study entry and within 1 week before delivery and with complete postnatal follow-up (374 of 503). The primary outcome was survival without neurodevelopmental impairment at 2 years corrected for prematurity. Neonatal outcome was defined as survival until first discharge home without severe neonatal morbidity. Z-scores were calculated for middle cerebral artery pulsatility index and both umbilicocerebral and cerebroplacental ratios. Odds ratios of Doppler parameter Z-scores for neonatal and 2 year infant outcome were calculated by multivariable logistic regression analysis adjusted for gestational age and birthweight p50 ratio. RESULTS Higher middle cerebral artery pulsatility index at inclusion but not within 1 week before delivery was associated with neonatal survival without severe morbidity (odds ratio, 1.24; 95% confidence interval, 1.02-1.52). Middle cerebral artery pulsatility index Z-score and umbilicocerebral ratio Z-score at inclusion were associated with 2 year survival with normal neurodevelopmental outcome (odds ratio, 1.33; 95% confidence interval, 1.03-1.72, and odds ratio, 0.88; 95% confidence interval, 0.78-0.99, respectively) as were gestation at delivery and birthweight p50 ratio (odds ratio, 1.41; 95% confidence interval, 1.20-1.66, and odds ratio, 1.86; 95% confidence interval, 1.33-2.60, respectively). When comparing cerebroplacental ratio against umbilicocerebral ratio, the incremental range of the cerebroplacental ratio tended toward zero, whereas the umbilicocerebral ratio tended toward infinity as the values became more abnormal. CONCLUSION In a monitoring protocol based on ductus venosus and cardiotocography in early fetal growth restriction (26+0-31+6 weeks of gestation), the impact of middle cerebral artery Doppler and its ratios on outcome is modest and less marked than birthweight and delivery gestation. It is unlikely that middle cerebral artery Doppler and its ratios are informative in optimizing the timing of delivery in fetal growth restriction before 32 weeks of gestation. The umbilicocerebral ratio allows for a better differentiation in the abnormal range than the cerebroplacental ratio.
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Bakker M, Birnie E, Robles de Medina P, Sollie KM, Pajkrt E, Bilardo CM. Total pregnancy loss after chorionic villus sampling and amniocentesis: a cohort study. Ultrasound Obstet Gynecol 2017; 49:599-606. [PMID: 27255564 DOI: 10.1002/uog.15986] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To identify maternal-, operator- and procedure-related variables that affect procedure-related pregnancy loss after transcervical (TC) and transabdominal (TA) chorionic villus sampling (CVS) and amniocentesis and to estimate the rates of spontaneous and procedure-related loss in comparable subgroups of women. METHODS This was a retrospective cohort study conducted at the University Medical Center Groningen and the Academic Medical Center, The Netherlands. Databases of both centers were searched to identify singleton pregnancies that had undergone a combined test and/or anomaly scan at around 20 weeks' gestation, or an invasive procedure (CVS and/or amniocentesis) between January 2001 and December 2011. Maternal characteristics, obstetric history, technical aspects of the invasive procedure, ultrasound examinations and fetal and neonatal outcomes were available for 29 201 cases. Women were categorized, according to the type of examination they had received, into the following five groups: first-trimester combined test (and 20-week anomaly scan); 20-week anomaly scan only; CVS; amniocentesis; amniocentesis after unsuccessful CVS. Rates of fetal loss were compared between groups. RESULTS Variables significantly associated with a higher rate of fetal loss were, for CVS, repeat attempts during the procedure, use of TC cannula instead of biopsy forceps, gestational age at procedure ≥ 13 weeks and a pregnancy after assisted reproductive techniques, and, for amniocentesis, if indication was fetal anomaly or family history of anomalies and repeat attempts during the procedure. In women aged ≥ 36 years who did not undergo an invasive procedure, spontaneous fetal loss rate (FLR) after first-trimester combined test was 1.40%, whereas after CVS, FLR was 2.76% and 2.43% for a TC and TA approach, respectively. The additional risk of fetal loss with TC-CVS was therefore 1.36% (1 : 74), which varied according to the instrument used (0.27% for forceps and 3.12% for cannula), and with TA-CVS was 1.03% (1 : 97). In women aged ≥ 36 years who underwent a 20-week anomaly scan only, spontaneous FLR was 0.63%. In women who underwent amniocentesis solely because of advanced maternal age, FLR was 1.11%. The additional risk of fetal loss with amniocentesis was 0.48% (1 : 208). CONCLUSION The total rate of procedure-related fetal loss after TA- and TC-CVS and amniocentesis appears lower than the risks on which women are currently counseled. There was a trend for a decrease in risk when the level of experience of the operator increased. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Bakker
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E Birnie
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P Robles de Medina
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - K M Sollie
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E Pajkrt
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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