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Hernandez-Andrade E, Huntley ES, Sibai B, Blackwell SC, Soto-Torres EE. Reduction in cervical length after vaginal progesterone in women with short cervix is significantly associated with preterm delivery at ≤ 34 weeks and < 37 weeks of gestation. Ultrasound Obstet Gynecol 2024; 63:644-649. [PMID: 37916641 DOI: 10.1002/uog.27527] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/05/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To evaluate the association between changes in cervical length (CL) after vaginal progesterone treatment and preterm delivery (PTD). METHODS This was a retrospective cohort study that included 197 singleton pregnancies without (n = 178) and with (n = 19) a history of PTD which were found to have a short cervix (≤ 25 mm) between 18 + 0 and 23 + 6 weeks' gestation with a follow-up transvaginal CL measurement taken at least 1 week after vaginal progesterone treatment started. Receiver-operating-characteristics (ROC)-curve analysis was performed and three CL shortening patterns were evaluated: (1) ≥ 10% reduction; (2) ≥ 20% reduction; and (3) ≥ 5 mm reduction relative to the first CL measurement. The predictive performance of each CL reduction cut-off and its association with PTD ≤ 34 weeks and PTD < 37 weeks were evaluated. RESULTS Overall, the rate of PTD ≤ 34 weeks was 16.8% (33/197) and that of PTD < 37 weeks was 36.5% (72/197). The area under the ROC curve of cervical shortening expressed in % for predicting PTD ≤ 34 weeks and PTD < 37 weeks was 0.703 and 0.608, respectively. Cervical shortening was observed in 60/197 (30.5%) patients, with 49/60 (81.7%) women showing ≥ 10% reduction, 32/60 (53.3%) ≥ 20% reduction and 27/60 (45.0%) ≥ 5 mm reduction in CL. Sensitivity and specificity for PTD ≤ 34 weeks were, respectively, 48.5% and 79.9% for ≥ 10% reduction; 36.4% and 87.8% for ≥ 20% reduction; and 27.3% and 89.0% for ≥ 5 mm reduction in CL. For PTD < 37 weeks, sensitivity and specificity were, respectively, 36.1% and 81.6% for ≥ 10% reduction; 27.8% and 90.4% for ≥ 20% reduction; and 20.8% and 90.4% for ≥ 5 mm reduction in CL. The highest positive likelihood ratios for PTD ≤ 34 and < 37 weeks were for ≥ 20% CL reduction (2.98 (95% CI, 1.62-5.49) and 2.89 (95% CI, 1.52-5.57), respectively). Despite significant differences in sensitivity among the different cut-offs for cervical shortening, favoring the ≥ 10% reduction cut-off, a reduction of ≥ 20% in CL showed the strongest association with PTD ≤ 34 weeks (odds ratio (OR), 4.11 (95% CI, 1.75-9.62)) and < 37 weeks (OR, 3.62 (95% CI, 1.65-7.96)), as compared with a less pronounced reduction in CL. CONCLUSIONS In women with a short cervix treated with vaginal progesterone, a reduction in CL on a subsequent ultrasound scan can predict PTD ≤ 34 and < 37 weeks. A ≥ 20% reduction in CL had the highest positive likelihood ratio and strongest association with PTD ≤ 34 and < 37 weeks compared with ≥ 10% or ≥ 5 mm reduction. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Hernandez-Andrade
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - E S Huntley
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - B Sibai
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - S C Blackwell
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - E E Soto-Torres
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
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Espinoza J, Agarwal N, Johnson A, Hernandez-Andrade E, Backley S, Papanna R, Bergh EP. Risk stratification for donor twin fetal death by evaluating middle cerebral artery in twin-to-twin transfusion syndrome in absence of twin anemia polycythemia sequence. Ultrasound Obstet Gynecol 2024. [PMID: 38437460 DOI: 10.1002/uog.27629] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/29/2024] [Accepted: 02/18/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To determine the association of high middle cerebral artery peak systolic velocity (MCA-PSV) with fetal demise in donor twins among pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) in the absence of twin anemia polycythemia sequence (TAPS). METHODS This prospective cohort study included TTTS cases that underwent laser surgery between 2011 and 2022 at a single center. TAPS cases were excluded from the study. The primary objective was to explore the association of high MCA-PSV (>1.5 multiples of the median) with fetal demise of the donor twin among pregnancies complicated by TTTS. Secondary objectives were: 1) to evaluate if donor or recipient MCA-PSV is associated with an increased risk for their corresponding fetal death using receiving operator characteristic curve analysis; and 2) to compare the proportion of fetuses with low MCA pulsatility index among donor twins with high MCA-PSV and in those with normal MCA-PSV to evaluate the contribution of blood flow redistribution to high MCA-PSV. Multivariable and Poisson regression analysis were performed to explore the association of isolated high donor MCA-PSV and fetal demise, adjusted for TTTS stage, selective fetal growth restriction (sFGR), and other confounders. p<0.05 was considered significant. RESULTS Out of 660 TTTS cases, donor MCA-PSV was unavailable in 48 (7.3%) cases. Of the remaining 612 patients, 9 (1.5%) were lost to follow-up, and 96 TAPS cases were excluded. High donor MCA-PSV was seen in 6.5% (33/507) of the study population. High donor MCA-PSV was an independent risk factor for donor fetal demise (adjusted relative risk (aRR) of 4.52; 95% CI: 2.72-7.50), adjusted for confounders. Regression analysis restricted to each Quintero TTTS stage demonstrated that high donor MCA-PSV was an independent risk factor for donor fetal demise in Quintero stage II (aRR of 14.21; 95% CI: 1.09-186.2) and Quintero stage III (aRR of 3.41; 95% CI: 1.82-6.41). Donor MCA-PSV was associated with donor fetal demise (AUC: 0.69; p<0.001), but recipient MCA-PSV was not associated with its corresponding fetal demise (AUC: 0.54; p=0.44). A higher proportion of donor twins in the group with high MCA-PSV had a low MCA pulsatility index than in those with normal MCA-PSV (33.3% vs. 15.5%; p=0.016). CONCLUSIONS Elevated donor MCA-PSV without TAPS prior to laser surgery is associated with a 4-fold increased risk for donor fetal demise, adjusted for sFGR, TTTS stage, and other confounders. Doppler evaluation of donor MCA-PSV prior to laser surgery can further stratify TTTS staging to evaluate the risk for donor fetal demise. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- J Espinoza
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - N Agarwal
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - A Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E Hernandez-Andrade
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - S Backley
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - R Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E P Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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Agarwal N, Papanna R, Bergh EP, Hernandez-Andrade E, Backley S, Salazar A, Johnson A, Espinoza J. Management of large placental chorioangioma: two-port laser approach for fetal intervention. Ultrasound Obstet Gynecol 2023; 62:882-890. [PMID: 37448172 DOI: 10.1002/uog.26307] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/09/2023] [Accepted: 05/12/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES There is a paucity of literature providing evidence-based guidelines for the management of large placental chorioangioma (≥ 4 cm in diameter). The objectives of this study were to compare outcomes between patients managed expectantly and those undergoing in-utero intervention and to describe the different in-utero techniques used for cessation of blood flow to the tumor and the associated outcome. METHODS This was a retrospective cohort study of 34 patients referred for the management of large placental chorioangioma in a single center between January 2011 and December 2022, who were managed expectantly or underwent in-utero intervention. In-utero intervention was performed when the fetus developed any signs of impending compromise, including high combined cardiac output (CCO), worsening polyhydramnios or abnormal fetal Doppler velocimetry findings. Interventions included radiofrequency ablation (RFA), interstitial laser ablation (ILA) and single-port or two-port fetoscopic laser photocoagulation (FLP). Treatment selection was dependent on the proximity of the tumor to the umbilical cord insertion (UCI) and placental location. The two-port technique was performed in patients with a chorioangioma with large feeding vessels (≥ 3 mm) located in the posterior placenta, in which one port was used for occlusion using bipolar forceps and the other port was used for laser photocoagulation of the feeding vessels downstream. The single-port technique was used for chorioangioma with small feeding vessels (< 3 mm) located in the posterior placenta. ILA or RFA was performed in cases with an anterior placenta. Supportive treatments, including amnioreduction and intrauterine transfusion (IUT), were performed for worsening polyhydramnios and suspected fetal anemia based on middle cerebral artery Doppler flow studies, respectively. Comparative statistical analysis between cases undergoing expectant management vs in-utero intervention was performed. Descriptive details were provided for patients who underwent in-utero intervention. RESULTS Thirty-four cases of large chorioangioma were evaluated, of which 25 (73.5%) were managed expectantly and nine (26.5%) underwent intervention. The frequency of polyhydramnios was significantly higher in the intervention group compared with the expectant-management group (66.7% vs 8.0%, P < 0.001). The live-birth rate among expectantly managed cases with large chorioangioma was significantly higher compared with that in cases that underwent in-utero intervention (96.0% vs 62.5%, P = 0.01). In the intervention group, preoperative CCO was elevated in all cases with available information and preoperative hydrops was present in 33.3% (3/9) of cases. One patient experienced fetal demise following IUT prior to planned FLP. Among the remaining eight patients, four underwent two-port FLP, two underwent single-port FLP, one underwent ILA and one underwent both ILA and RFA. All three cases in which hydrops was present at the time of intervention resulted in fetal demise. CONCLUSIONS In-utero interventions aimed at cessation of blood flow in the feeding vessels are a therapeutic option for the management of cases with large chorioangioma. The two-port percutaneous technique appears to improve the efficiency of FLP when a large chorioangioma with large feeding vessels is located in the posterior placenta. We propose that in-utero interventions for large chorioangioma should be initiated prior to the development of fetal hydrops. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N Agarwal
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - R Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E P Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E Hernandez-Andrade
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - S Backley
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - A Salazar
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - A Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - J Espinoza
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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Hernandez-Andrade E, Huntley ES, Bartal MF, Soto E, Johnson A. Fetal coronary circulation: the middle cardiac vein. Ultrasound Obstet Gynecol 2023; 61:269-270. [PMID: 36056766 DOI: 10.1002/uog.26060] [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: 03/30/2022] [Revised: 07/05/2022] [Accepted: 08/24/2022] [Indexed: 05/27/2023]
Affiliation(s)
- E Hernandez-Andrade
- The Fetal Center, Department of Obstetrics and Gynecology and Reproductive Sciences, Division of Fetal Intervention, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E S Huntley
- The Fetal Center, Department of Obstetrics and Gynecology and Reproductive Sciences, Division of Fetal Intervention, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - M F Bartal
- The Fetal Center, Department of Obstetrics and Gynecology and Reproductive Sciences, Division of Fetal Intervention, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E Soto
- The Fetal Center, Department of Obstetrics and Gynecology and Reproductive Sciences, Division of Fetal Intervention, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - A Johnson
- The Fetal Center, Department of Obstetrics and Gynecology and Reproductive Sciences, Division of Fetal Intervention, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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Fishel Bartal M, Bergh EP, Tsao K, Austin MT, Moise KJ, Fletcher SA, Garnett J, Mann L, Hernandez-Andrade E, Johnson A, Papanna R. Primary vs patch-based skin closure for in-utero spina bifida repair. Ultrasound Obstet Gynecol 2022; 60:666-672. [PMID: 35751885 DOI: 10.1002/uog.26018] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/31/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE During in-utero spina bifida (SB) repair, closure of large defects is often challenging, requiring tissue graft for watertight skin closure. No prior studies have compared primary skin closure vs patch-based repair. Our objective was to compare neonatal and 1-year outcomes associated with these two types of skin closure for in-utero SB repair. METHODS This was a prospective cohort study of 102 patients undergoing open prenatal SB repair from September 2011 to August 2021 at a single institution. All patients met the inclusion criteria of the Management of Myelomeningocele Study (MOMS), and the surgical procedure for in-utero SB repair was similar to that described in the MOMS trial. During the surgery, if primary skin approximation was not feasible due to the large size of the defect, the decision was at the discretion of the pediatric neurosurgeon to utilize a patch for closure. Neonatal outcomes at birth and 1-year outcomes were compared between the primary skin and patch-based closure groups. RESULTS Of 102 patients included in the study, 70 (68.6%) underwent primary skin closure and 32 (31.4%) patch-based closure. The patch type included acellular bovine skin matrix (Durepair®; n = 31) and human acellular dermal matrix (Alloderm®; n = 1). Fetuses with myeloschisis were more likely to require patch-based repair than those with myelomeningocele. The median time of fetal repair was 4 min longer for patch-based compared with primary skin closure (37 vs 33 min; P = 0.001). Following patch-based repair, neonates had a longer length of stay in the neonatal intensive care unit (NICU) by 24 days (adjusted risk ratio, 2.40 (95% CI, 1.41-4.29)) compared to those that underwent primary skin closure. There was no difference between the two groups in the other neonatal outcomes, including the need for ventriculoperitoneal shunt placement and cerebrospinal fluid leakage. Outcome at 1 year of age was available for 90 infants. Need for wound revision within their first year after birth was more common in infants who underwent patch-based vs those with primary skin closure (19.4% vs 5.1%; P = 0.05). There was no difference between the two groups in other 1-year outcomes, including the need for ventriculoperitoneal shunt placement by 1 year of age and surgery for tethered cord. CONCLUSIONS Patch-based closure during SB repair is often needed in fetuses with myeloschisis and is associated with prolonged fetal surgery time, long NICU stay and need for wound revision within the first year after birth. Further studies are required to identify optimal patches for SB repair or alternative methods to improve outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Fishel Bartal
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - E P Bergh
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K Tsao
- Department of Pediatric Surgery, Children's Memorial Hermann Hospital, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - M T Austin
- Department of Pediatric Surgery, Children's Memorial Hermann Hospital, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - K J Moise
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - S A Fletcher
- Pediatric Neurosurgery, Department of Pediatric Surgery, Children's Memorial Hermann Hospital, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J Garnett
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - L Mann
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - E Hernandez-Andrade
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - A Johnson
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - R Papanna
- The Fetal Center, Children's Memorial Hermann Hospital, Department of Obstetrics and Gynecology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Hernandez-Andrade E, Huntley ES, Bartal MF, Soto-Torres EE, Tirosh D, Jaiman S, Johnson A. Doppler evaluation of normal and abnormal placenta. Ultrasound Obstet Gynecol 2022; 60:28-41. [PMID: 34806234 DOI: 10.1002/uog.24816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/12/2021] [Indexed: 06/13/2023]
Abstract
Doppler techniques are needed for the evaluation of the intraplacental circulation and can be of great value in the diagnosis of placental anomalies. Highly sensitive Doppler techniques can differentiate between the maternal (spiral arteries) and fetal (intraplacental branches of the umbilical artery) components of the placental circulation and assist in the evaluation of the placental functional units. A reduced number of placental functional units can be associated with obstetric complications, such as fetal growth restriction. Doppler techniques can also provide information on decidual vessels and blood movement. Abnormal decidual circulation increases the risk of placenta accreta. Doppler evaluation of the placenta greatly contributes to the diagnosis and clinical management of placenta accreta, vasa previa, placental infarcts, placental infarction hematoma, maternal floor infarction, massive perivillous fibrin deposition and placental tumors. However, it has a limited role in the diagnosis and clinical management of placental abruption, placental hematomas, placental mesenchymal dysplasia and mapping of placental anastomoses in monochorionic twin pregnancies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- 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
| | - E S Huntley
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - M F Bartal
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - E E Soto-Torres
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - D Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - S Jaiman
- Department of Obstetrics and Gynecology Wayne State University, Detroit, MI, USA
| | - A Johnson
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
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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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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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Ghose I, Hernandez-Andrade E, Soto-Torres E. Concomitant spontaneous chorioamniotic membrane separation, velamentous cord insertion and vasa previa. Ultrasound Obstet Gynecol 2021; 58:133-134. [PMID: 32770677 DOI: 10.1002/uog.22168] [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: 06/30/2020] [Revised: 07/10/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Affiliation(s)
- I Ghose
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - 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
| | - E Soto-Torres
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
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Docheva N, Cruz-Martinez R, Hernandez-Andrade E. Vaginal azygos artery: commonly unrecognized finding during transvaginal ultrasound in pregnancy. Ultrasound Obstet Gynecol 2021; 57:843-844. [PMID: 32449263 DOI: 10.1002/uog.22098] [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: 03/26/2020] [Revised: 05/06/2020] [Accepted: 05/17/2020] [Indexed: 06/11/2023]
Affiliation(s)
- N Docheva
- Department of Obstetrics and Gynecology, The University of Toledo, Toledo, OH, USA
| | - R Cruz-Martinez
- Fetal Medicine Research Center, Fetal Medicine Mexico, Queretaro, Mexico
| | - E Hernandez-Andrade
- Fetal Medicine Research Center, Fetal Medicine Mexico, Queretaro, Mexico
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
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Wheelock MD, Hect JL, Hernandez-Andrade E, Hassan SS, Romero R, Eggebrecht AT, Thomason ME. Sex differences in functional connectivity during fetal brain development. Dev Cogn Neurosci 2019; 36:100632. [PMID: 30901622 PMCID: PMC6944279 DOI: 10.1016/j.dcn.2019.100632] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [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: 05/31/2018] [Revised: 02/15/2019] [Accepted: 03/02/2019] [Indexed: 01/12/2023] Open
Abstract
Sex-related differences in brain and behavior are apparent across the life course, but the exact set of processes that guide their emergence in utero remains a topic of vigorous scientific inquiry. Here, we evaluate sex and gestational age (GA)-related change in functional connectivity (FC) within and between brain wide networks. Using resting-state functional magnetic resonance imaging we examined FC in 118 human fetuses between 25.9 and 39.6 weeks GA (70 male; 48 female). Infomap was applied to the functional connectome to identify discrete prenatal brain networks in utero. A consensus procedure produced an optimal model comprised of 16 distinct fetal neural networks distributed throughout the cortex and subcortical regions. We used enrichment analysis to assess network-level clustering of strong FC-GA correlations separately in each sex group, and to identify network pairs exhibiting distinct patterns of GA-related change in FC between males and females. We discovered both within and between network FC-GA associations that varied with sex. Specifically, associations between GA and posterior cingulate-temporal pole and fronto-cerebellar FC were observed in females only, whereas the association between GA and increased intracerebellar FC was stronger in males. These observations confirm that sexual dimorphism in functional brain systems emerges during human gestation.
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Affiliation(s)
- M D Wheelock
- Department of Psychiatry, Washington University in St. Louis, St. Louis, United States
| | - J L Hect
- Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, United States
| | - E Hernandez-Andrade
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI 48201, United States; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48202, United States
| | - S S Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI 48201, United States; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48202, United States; Department of Physiology, Wayne State University School of Medicine, Detroit, MI 48202, United States
| | - R Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD 20847, United States; Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI 48201, United States; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48104, United States; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48825, United States; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI 48201, United States
| | - A T Eggebrecht
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, United States.
| | - M E Thomason
- Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, United States; Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI 48201, United States; Institute for Social Research, University of Michigan, Ann Arbor, MI 48109, United States.
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Sotiriadis A, Hernandez-Andrade E, da Silva Costa F, Ghi T, Glanc P, Khalil A, Martins WP, Odibo AO, Papageorghiou AT, Salomon LJ, Thilaganathan B. ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia. Ultrasound Obstet Gynecol 2019; 53:7-22. [PMID: 30320479 DOI: 10.1002/uog.20105] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/15/2018] [Accepted: 07/22/2018] [Indexed: 06/08/2023]
Affiliation(s)
- A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Hernandez-Andrade
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hutzel Women Hospital, Wayne State University, Detroit, MI, USA
| | - F da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; and Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - T Ghi
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - P Glanc
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK; and Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - W P Martins
- SEMEAR Fertilidade, Reproductive Medicine and Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - A O Odibo
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK; and Nuffield Department of Obstetrics and Gynecology, University of Oxford, Women's Center, John Radcliffe Hospital, Oxford, UK
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK; and Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Welsh AW, Maheshwari P, Wang J, Henry A, Chang D, Crispi F, Gardiner HM, Hernandez-Andrade E, Meriki N, Redmond S, Yagel S. Evaluation of an automated fetal myocardial performance index. Ultrasound Obstet Gynecol 2016; 48:496-503. [PMID: 26423314 DOI: 10.1002/uog.15770] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 08/06/2015] [Revised: 09/17/2015] [Accepted: 09/26/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare automated measurements of the fetal left myocardial performance index (MPI) with manual measurements for absolute value, repeatability and waveform acceptability. METHODS This was a multicenter international online study using images from uncomplicated, morphologically normal singleton pregnancies (16-38 weeks' gestation). Single Doppler ultrasound cardiac cycle images of 25 cases were selected, triplicated and randomized (n = 75). Six senior observers, unaware of the repetition of images, manually calculated MPI for each waveform and the results were compared with automation. Intraobserver repeatability and interobserver reproducibility were assessed using intraclass correlation coefficients (ICCs) and 95% CI. The agreement between each observer's manual MPI measurements and corresponding automated measurements was evaluated using Bland-Altman plots and ICCs with 95% CI. The degree of variation between experts in the classification of fetal MPI waveform quality was assessed using individual cardiac cycle left MPI images previously classified by two authors as 'optimal', 'suboptimal' or 'unacceptable', with 30 images selected for each quality group. Ten images in each category were duplicated and the resulting 120 images were randomized and then classified online by five observers. The kappa statistic (κ) was used to demonstrate interobserver and intraobserver agreement and agreement of classifications by the five observers. RESULTS The automated measurement software returned the same value for any given image, resulting in an ICC of 1.00. Manual measurements had intraobserver repeatability ICC values ranging from 0.69 to 0.97, and the interobserver reproducibility ICC was 0.78. Comparison of automated vs manual MPI absolute measurements for each observer gave ICCs ranging from 0.77 to 0.96. Interobserver image quality classification agreement gave k = 0.69 (P < 0.001), and the intraobserver agreement was variable (κ ranging from 0.40 to 0.81). CONCLUSIONS Automated fetal MPI provides superior repeatability and reproducibility to manual methodology. Additionally, experts vary significantly when classifying suitability of fetal MPI waveforms. Automated MPI may facilitate clinical translation by removing human subjectivity. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A W Welsh
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, Sydney, New South Wales, Australia.
- School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - P Maheshwari
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - J Wang
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - A Henry
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - D Chang
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - F Crispi
- Maternal-Fetal Medicine, Hospital Clinica Barcelona, Barcelona, Spain
| | | | - E Hernandez-Andrade
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Wayne State University School of Medicine Detroit, Detroit, MI, USA
| | - N Meriki
- School of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - S Redmond
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - S Yagel
- Obstetrics and Gynaecology, Hadassah University Hospital, Mt Scopus, Jerusalem, Israel
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Meher S, Hernandez-Andrade E, Basheer SN, Lees C. Impact of cerebral redistribution on neurodevelopmental outcome in small-for-gestational-age or growth-restricted babies: a systematic review. Ultrasound Obstet Gynecol 2015; 46:398-404. [PMID: 25683973 DOI: 10.1002/uog.14818] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [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: 07/10/2014] [Revised: 01/31/2015] [Accepted: 02/03/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To review systematically the evidence on impact of cerebral redistribution, as assessed by fetal middle cerebral artery (MCA) Doppler, on neurological outcomes in small-for-gestational-age (SGA) or growth-restricted fetuses. METHODS For this systematic review, MEDLINE was searched for all controlled studies reporting neurological outcomes in SGA or growth-restricted babies with cerebral redistribution based on MCA Doppler indices, from inception to September 2013. We used relative risk or odds ratios, with 95% CI, to identify the association of cerebral redistribution with neurological outcomes. RESULTS The search yielded 1180 possible citations, of which nine studies were included in the review, with a total of 1198 fetuses. Definitions of SGA and cerebral redistribution were variable, as was study quality. Data could not be synthesized in meta-analyses because of heterogeneity in outcome reporting. Cerebral redistribution was not associated with increased risk of intraventricular hemorrhage in neonates (five studies; n = 806). When present in preterm fetuses, cerebral redistribution was associated with normal Neonatal Behavioral Assessment Scale (NBAS) scores at 40 weeks (one study; n = 62) but abnormal psychomotor development at 1 year of age on the Bayley scale (one study; n = 172). When present in term SGA fetuses, cerebral redistribution was associated with increased risk of motor and state organizational problems on NBAS (two studies; n = 158), and lower mean percentile scores in communication and problem solving at 2 years of age on the Ages and Stages Questionnaire (one study; n = 125). CONCLUSIONS SGA fetuses with cerebral redistribution may be at higher risk of neurodevelopmental problems. More data are needed from adequately controlled studies with long-term follow-up before conclusions can be drawn. If these findings are true, there is a need to re-evaluate timing of delivery in the management of SGA fetuses, particularly when cerebral redistribution is found at term gestation.
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Affiliation(s)
- S Meher
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - E Hernandez-Andrade
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, MI, USA
| | - S N Basheer
- Department of Paediatric Neurology and Neonatal Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - C Lees
- Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Hernandez-Andrade E. Re: Assessment by three-dimensional power Doppler ultrasound of cerebral blood flow perfusion in fetuses with congenital heart disease. S. Zeng, J. Zhou, Q. Peng, L. Tian, G. Xu, Y. Zhao, T. Wang and Q. Zhou. Ultrasound Obstet Gynecol 2015; 45: 649-656. Ultrasound Obstet Gynecol 2015; 45:629. [PMID: 26032709 DOI: 10.1002/uog.14887] [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: 06/04/2023]
Affiliation(s)
- E Hernandez-Andrade
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, School of Medicine, Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, USA.
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16
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Hernandez-Andrade E. Optimal strategies for managing fetal growth restriction. Minerva Ginecol 2015; 67:47-63. [PMID: 25323420] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Early dating of pregnancy by ultrasound is necessary to establish the adequate fetal growth. Customized or individualized estimation of fetal growth is probably a better option than population based curves to identify fetuses at a higher risk of perinatal complications. Biological maternal markers and placental evaluation might contribute in the identification of fetuses at risk of abnormal growth. There is no specific Doppler pattern of fetal deterioration; however, in early growth restriction it is mainly expressed in the umbilical artery, and in late growth restriction (>34 weeks) in the middle cerebral artery. Abnormal biophysical profile and/or non-stress test can be considered as acute signs of fetal decompensation. Magnetic resonance imaging can provide information of fetuses at risk of abnormal neurodevelopment. Neonatal body composition in low birthweight newborns can be used to identify children at risk of metabolic complications. Gestational age at delivery is the most important parameter associated with perinatal morbidity and mortality; however, waiting until the ductus venosus is severely abnormal might reduce the possibilities of survival of preterm fetuses with abnormal growth.
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Affiliation(s)
- E Hernandez-Andrade
- Division of Maternal Fetal Medicine Department of Obstetrics and Gynecology Wayne State University School of Medicine Detroit, MI, USA -
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Hernandez-Andrade E, Figueroa R, Cerbulo-Vazquez A, Benavides-Serralde JA, Borbón GP, Ramírez JM. Fetal hemodynamic changes in pregnant women with influenza AH1N1 infection and reduced arterial partial pressure of oxygen. Ultrasound Obstet Gynecol 2014; 44:492-494. [PMID: 24862227 DOI: 10.1002/uog.13417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/08/2014] [Accepted: 05/09/2014] [Indexed: 06/03/2023]
Affiliation(s)
- E Hernandez-Andrade
- National Institute of Perinatology, Mexico City, Mexico; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Wayne State University, 3990 John R, 4 Brush, Detroit, MI, 48201, USA
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Hernandez-Andrade E, Jansson T, Lingman G, Liuba K, Ley D, Maršál K. Blood-flow streams in the fetal inferior vena cava: experimental animal study using ultrasound contrast agent. Ultrasound Obstet Gynecol 2014; 43:353-354. [PMID: 24123593 DOI: 10.1002/uog.13215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 09/14/2013] [Accepted: 09/17/2013] [Indexed: 06/02/2023]
Affiliation(s)
- E Hernandez-Andrade
- Department of Obstetrics and Gynecology, Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, MI, USA
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Hernandez-Andrade E. Re: Childhood cognitive development after fetal growth restriction. E. Llurba, A. A. Baschat, O. M. Turan, J. Harding and L. M. McCowan. Ultrasound obstet gynecol 2013; 41: 383-389. Ultrasound Obstet Gynecol 2013; 41:364-365. [PMID: 23616349 DOI: 10.1002/uog.12452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- E Hernandez-Andrade
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Perinatology Research Branch NICH/NIH/DHHS, Wayne State University, Detroit, MI, USA.
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Thomason ME, Dassanayake MT, Shen S, Katkuri Y, Alexis M, Anderson AL, Yeo L, Mody S, Hernandez-Andrade E, Hassan SS, Studholme C, Jeong JW, Romero R. Cross-hemispheric functional connectivity in the human fetal brain. Sci Transl Med 2013; 5:173ra24. [PMID: 23427244 PMCID: PMC3618956 DOI: 10.1126/scitranslmed.3004978] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Compelling evidence indicates that psychiatric and developmental disorders are generally caused by disruptions in the functional connectivity (FC) of brain networks. Events occurring during development, and in particular during fetal life, have been implicated in the genesis of such disorders. However, the developmental timetable for the emergence of neural FC during human fetal life is unknown. We present the results of resting-state functional magnetic resonance imaging performed in 25 healthy human fetuses in the second and third trimesters of pregnancy (24 to 38 weeks of gestation). We report the presence of bilateral fetal brain FC and regional and age-related variation in FC. Significant bilateral connectivity was evident in half of the 42 areas tested, and the strength of FC between homologous cortical brain regions increased with advancing gestational age. We also observed medial to lateral gradients in fetal functional brain connectivity. These findings improve understanding of human fetal central nervous system development and provide a basis for examining the role of insults during fetal life in the subsequent development of disorders in neural FC.
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Affiliation(s)
- ME Thomason
- Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, MI 48202
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48202, USA
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)/National Institutes of Health (NIH)/Department of Health and Human Services (DHHS), Detroit, MI 48202
| | - MT Dassanayake
- Basic Medical Sciences Program, Wayne State University School of Medicine, Detroit, MI 48202, USA
| | - S Shen
- Wayne State University School of Medicine, Detroit, MI 48202 USA
| | - Y Katkuri
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI 48202, USA
| | - M Alexis
- Basic Medical Sciences Program, Wayne State University School of Medicine, Detroit, MI 48202, USA
| | - AL Anderson
- Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, MI 48202
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)/National Institutes of Health (NIH)/Department of Health and Human Services (DHHS), Detroit, MI 48202
| | - L Yeo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)/National Institutes of Health (NIH)/Department of Health and Human Services (DHHS), Detroit, MI 48202
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48202, USA
| | - S Mody
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI 48202, USA
| | - E Hernandez-Andrade
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)/National Institutes of Health (NIH)/Department of Health and Human Services (DHHS), Detroit, MI 48202
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48202, USA
| | - SS Hassan
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)/National Institutes of Health (NIH)/Department of Health and Human Services (DHHS), Detroit, MI 48202
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48202, USA
| | - C Studholme
- Department of Pediatrics and Neonatology, University of Washington, Seattle, WA 98105 USA
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - JW Jeong
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48202, USA
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI 48202, USA
| | - R Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)/National Institutes of Health (NIH)/Department of Health and Human Services (DHHS), Detroit, MI 48202
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD 20814, USA and Detroit, MI 48202
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Bhide A, Acharya G, Bilardo CM, Brezinka C, Cafici D, Hernandez-Andrade E, Kalache K, Kingdom J, Kiserud T, Lee W, Lees C, Leung KY, Malinger G, Mari G, Prefumo F, Sepulveda W, Trudinger B. ISUOG practice guidelines: use of Doppler ultrasonography in obstetrics. Ultrasound Obstet Gynecol 2013; 41:233-239. [PMID: 23371348 DOI: 10.1002/uog.12371] [Citation(s) in RCA: 282] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- A Bhide
- Fetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George’s, University of London, London, UK
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22
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Cruz-Martinez R, Figueras F, Hernandez-Andrade E, Oros D, Gratacos E. Changes in myocardial performance index and aortic isthmus and ductus venosus Doppler in term, small-for-gestational age fetuses with normal umbilical artery pulsatility index. Ultrasound Obstet Gynecol 2011; 38:400-405. [PMID: 21567514 DOI: 10.1002/uog.8976] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/15/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate the changes in myocardial performance index (MPI) and aortic isthmus (AoI) and ductus venosus (DV) Doppler in term, small-for-gestational age (SGA) fetuses with normal umbilical artery (UA) Doppler. METHODS MPI, AoI and DV pulsatility indices (PI) were measured within 1 week prior to delivery in a cohort of 178 term singleton consecutive SGA fetuses with normal UA-PI (< 95(th) percentile) and 178 controls matched by gestational age. Cardiovascular parameters were converted into Z-scores and values above the 95(th) centile defined as abnormal. RESULTS Median gestational age at inclusion and at delivery was 35.7 and 38.6 weeks, respectively. Compared to controls, SGA fetuses showed significantly higher values in MPI and AoI-PI and similar values in DV-PI. SGA fetuses showed a significantly higher proportion of increased MPI (28.1 vs. 6.7%; P < 0.01) and abnormal AoI-PI (14.6 vs. 5.1%; P < 0.01) than controls. The proportion of cases with abnormal DV-PI was similar between SGA cases and controls. Retrograde net blood flow in the AoI was observed in 7.3% of the SGA cases and in none of the controls. CONCLUSION A proportion of SGA fetuses show cardiovascular Doppler abnormalities. This information might be of clinical relevance in improving the detection and management of late-onset intrauterine growth restriction.
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Affiliation(s)
- R Cruz-Martinez
- Department of Maternal-Fetal Medicine, Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases, Barcelona, Spain
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Cruz-Martinez R, Figueras F, Benavides-Serralde A, Crispi F, Hernandez-Andrade E, Gratacos E. Sequence of changes in myocardial performance index in relation to aortic isthmus and ductus venosus Doppler in fetuses with early-onset intrauterine growth restriction. Ultrasound Obstet Gynecol 2011; 38:179-184. [PMID: 21154784 DOI: 10.1002/uog.8903] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To explore the sequence of changes in myocardial performance index (MPI) and aortic isthmus (AoI) and ductus venosus (DV) flow in fetuses with early-onset intrauterine growth restriction (IUGR). METHODS MPI and AoI and DV pulsatility indices (PI) were evaluated every 1-7 days in a cohort of IUGR fetuses with abnormal umbilical artery Doppler PI (> 95(th) percentile) delivered before 34 weeks' gestation. The longitudinal changes were analyzed in the last 30 days before delivery by multilevel and survival analysis. RESULTS A total of 430 scans were performed on 115 IUGR fetuses. MPI, AoI-PI and DV-PI showed increases with the progression of fetal deterioration throughout the follow-up study period, but the rates of progression were different. On average, MPI, AoI-PI and DV-PI crossed the 95(th) percentile at 26 days, 12 days and 5 days before delivery, respectively. At the last examination before delivery, the proportion of increased MPI (70.4%) was significantly higher than that of abnormal AoI-PI (55.7%; P < 0.01) and DV-PI (47.8%; P < 0.01). CONCLUSION In early-onset IUGR, MPI and AoI and DV Doppler indices all increase but at different rates, which could provide the basis for further research on their use for improving in-utero monitoring and prediction of long-term outcome.
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Affiliation(s)
- R Cruz-Martinez
- Department of Maternal-Fetal Medicine, ICGON, Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Ierullo AM, Fernandez S, Palacio M, Gratacos E, Hernandez-Andrade E. Cervical blood perfusion assessed using power Doppler-derived estimation of fractional moving blood volume: a reproducibility study. Ultrasound Obstet Gynecol 2011; 38:57-61. [PMID: 21584885 DOI: 10.1002/uog.8974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/11/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate the reproducibility of estimation of power Doppler-derived fractional moving blood volume (FMBV) in the uterine cervix of women with uncomplicated pregnancies. METHODS Two experienced operators evaluated 30 uncomplicated singleton pregnancies at 20-24 weeks of gestation. The PDU box was positioned in a mid-sagittal view of the cervix, including the internal os and external os, in the same plane as that in which cervical length is measured. Two consecutive examinations were performed by each operator, in each of which the cervical length was measured and five consecutive good-quality images with PDU information were obtained. The region of interest (ROI) (cervix) was delineated offline and FMBV, which expresses the percentage of blood occupying the ROI, was calculated with purpose-designed software. Intra- and interobserver intraclass correlation coefficients (ICCs) and mean differences with 95% limits of agreement (LOA) were calculated. RESULTS The median gestational age at examination was 22 + 0 weeks. Measurements (median ± SD) obtained for cervical length and FMBV were as follows: Operator A: 37 ± 7.4 mm and 8.11 ± 2.9%; Operator B: 37.5 ± 9.3 mm and 7.9 ± 3.3%, respectively. The intra- and interobserver ICCs for FMBV were 0.88 (95% CI, 0.75-0.94) and 0.82 (95% CI, 0.64-0.94), respectively. There was a mean difference in FMBV measurement between operators of - 0.2 ± 1.75% (95% LOA, - 3.7 to 3.2%). CONCLUSIONS Reproducible assessment of cervical blood perfusion through estimation of FMBV can be achieved while cervical length is being measured.
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Affiliation(s)
- A M Ierullo
- Department of Maternal-Fetal Medicine, ICGON, Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Hernandez-Andrade E, Benavides-Serralde JA, Guzmán Huerta ME, Moreno-Alvarez O, Mancilla-Ramírez J. Social and economic factors influencing a fetal surgery program for complicated monochorionic twin pregnancies in a developing country. Fetal Diagn Ther 2011; 29:224-8. [PMID: 21358168 DOI: 10.1159/000322111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 10/10/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze social and economic factors affecting the implementation of a fetal surgery program in a developing country. MATERIALS AND METHODS During an 18-month period, 30 women with complicated monochorionic diamniotic twin pregnancies were evaluated. 27 women had twin-to-twin transfusion syndrome (TTTS), 2 women had a selective intrauterine growth restriction, and 1 a discordant twin pregnancy with 1 fetus with a severe open neural tube defect. The TTTS cases were treated with fetoscopic laser ablation of the interplacental vascular communications and the remaining 3 cases with bipolar cord occlusion of the affected twin. The patients were evaluated using family income levels (very low, low, median, and high income). Demographic characteristics, gestational age at referral, the prevalence of infections, tocolysis care with hospital readmission, prolonged hospital stay until delivery, and gestational age at delivery were evaluated. RESULTS The overall survival rate of fetuses treated with laser ablation was 60% (32/54). Survival of at least 1 twin was achieved in 21/27 pregnancies (77%), and survival of both twins in 12/27 pregnancies (44%). The 3 pregnancies treated with cord occlusion had survival of the normal twin. Patients with low and very low family income showed a significantly higher prevalence of vaginal infections, increased periods of tocolysis requiring hospitalization, prolonged hospital stay until the end of pregnancy, and lower gestational age at delivery. CONCLUSION When a fetal surgery program is implemented in a developing country, social and economic factors will influence the overall healthcare costs and treatment outcomes.
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Affiliation(s)
- E Hernandez-Andrade
- National Institute of Perinatal Medicine (INPer), Mexico City, Mexico. ehernandez @ servidor.inper.edu.mx
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Cruz-Martinez R, Figueras F, Jaramillo JJ, Meler E, Méndez A, Hernandez-Andrade E, Gratacos E. Learning curve for Doppler measurement of fetal modified myocardial performance index. Ultrasound Obstet Gynecol 2011; 37:158-162. [PMID: 20922780 DOI: 10.1002/uog.7765] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/06/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess the learning curve for measurement of the fetal modified myocardial performance index (MPI). METHODS Three trainees with the theoretical knowledge of but without prior experience in performing MPI measurement were selected. Each trainee and one experienced examiner measured MPI in a cohort of 90 consecutive fetuses. The average difference between the three trainees and the expert in the MPI measurements was calculated; a difference below 10% was considered to indicate an accurate measurement. Individual and averaged learning curves were delineated using cumulative sum analysis (CUSUM). RESULTS The gestational age at evaluation ranged from 20 + 4 to 41 + 4 (mean, 33 + 3) weeks. The CUSUM plots demonstrated that, on average, competence in performing fetal MPI measurement was achieved by 65 cases. The average number of attempts to achieve competence were 42, 77 and 83 for the ejection time, isovolumetric contraction time and isovolumetric relaxation time, respectively. CONCLUSIONS Evaluation of fetal MPI by an inexperienced trainee requires on average 65 measurements to achieve competence.
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Affiliation(s)
- R Cruz-Martinez
- Department of Maternal-Fetal Medicine, University of Barcelona, Barcelona, Spain
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Cruz-Martinez R, Figueras F, Hernandez-Andrade E, Benavides-Serralde A, Gratacos E. Normal reference ranges of fetal regional cerebral blood perfusion as measured by fractional moving blood volume. Ultrasound Obstet Gynecol 2011; 37:196-201. [PMID: 20549765 DOI: 10.1002/uog.7722] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To establish normal reference intervals of fetal regional brain blood perfusion using power Doppler ultrasound as measured by fractional moving blood volume (FMBV). METHODS A cohort of consecutive singleton normally grown fetuses was selected including at least 12 fetuses for each completed week of gestation between 24 and 41 weeks. Cerebral blood perfusion was estimated using conventional power Doppler ultrasound in the following brain regions: frontal area, basal ganglia and posterior brain. Five consecutive good-quality images were recorded in each area and the region of interest was delineated offline. The FMBV was quantified as the average of all images and expressed as a percentage. Normal reference ranges were constructed by means of the LMS (lambda-mu-sigma) method. RESULTS A total of 230 fetuses were included. The median gestational age at evaluation and at delivery was 33.1 (range, 24.0-41.0) and 39.7 (range, 34.9-42.3) weeks, respectively. From 24 to 41 weeks' gestation, the mean FMBV increased from 13.21 to 14.97% in the frontal area, 11.17 to 14.86% in the basal ganglia and 4.83 to 6.70% in the posterior brain. CONCLUSIONS Normal data of fetal cerebral blood perfusion in the frontal area, basal ganglia and posterior brain are provided, which could be of clinical use in the assessment of fetal brain circulation.
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Affiliation(s)
- R Cruz-Martinez
- Department of Maternal-Fetal Medicine Hospital Clinic, University of Barcelona, Barcelona, Spain
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Salomon LJ, Alfirevic Z, Berghella V, Bilardo C, Hernandez-Andrade E, Johnsen SL, Kalache K, Leung KY, Malinger G, Munoz H, Prefumo F, Toi A, Lee W. Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2011; 37:116-26. [PMID: 20842655 DOI: 10.1002/uog.8831] [Citation(s) in RCA: 602] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Cruz-Martinez R, Figueras F, Moreno-Alvarez O, Martinez JM, Gomez O, Hernandez-Andrade E, Gratacos E. Learning curve for lung area to head circumference ratio measurement in fetuses with congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2010; 36:32-36. [PMID: 20131334 DOI: 10.1002/uog.7577] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the learning curve for the fetal lung area to head circumference ratio (LHR) calculation in fetuses with congenital diaphragmatic hernia (CDH). METHODS Three trainees with the theoretical knowledge, but without prior experience in the LHR measurement, were selected. Each trainee and one experienced examiner measured the observed to expected (O/E)-LHR in the lung contralateral to the side of the hernia by two methods-manual tracing of lung borders and multiplication of the longest diameters-in a cohort of 95 consecutive CDH fetuses. The average difference between the three trainees and the expert in the O/E-LHR measurement was calculated. A difference below 10% was considered to indicate an accurate measurement. The average learning curve was delineated using cumulative sum analysis (CUSUM). RESULTS The CUSUM plots demonstrate that the learning curve was achieved by 77 and 72 tests performed for the area obtained by the manual-tracing and multiplication-of-the-longest-diameter methods, respectively. CONCLUSION The minimum number of scans required for an inexperienced trainee to become competent in examining the LHR is on average 70.
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Affiliation(s)
- R Cruz-Martinez
- Fetal and Perinatal Medicine Research Group, Department of Maternal-Fetal Medicine, Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Moreno-Alvarez O, Cruz-Martinez R, Hernandez-Andrade E, Done E, Gómez O, Deprest J, Gratacos E. Lung tissue perfusion in congenital diaphragmatic hernia and association with the lung-to-head ratio and intrapulmonary artery pulsed Doppler. Ultrasound Obstet Gynecol 2010; 35:578-582. [PMID: 20178113 DOI: 10.1002/uog.7592] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate lung tissue perfusion in fetuses with congenital diaphragmatic hernia (CDH) and to explore the association of lung tissue perfusion with the lung area to head circumference ratio (LHR) and intrapulmonary artery pulsed Doppler. METHODS Fetuses with isolated left CDH were evaluated and compared with a group of fetuses without CDH, which were sampled from our general population and matched by gestational age at inclusion. Lung tissue perfusion measured using fractional moving blood volume (FMBV), the observed to expected (O/E) LHR and pulsed Doppler of the proximal intrapulmonary artery were evaluated in the lung contralateral to the side of the hernia. Doppler waveform analysis included the pulsatility index (PI), the peak early diastolic reversed flow (PEDRF) and the peak systolic velocity (PSV). All Doppler parameters were converted into Z-scores for gestational age. The associations between FMBV and O/E-LHR and between FMBV and intrapulmonary arterial Doppler parameters were analyzed using multiple linear regression, adjusted by gestational age. RESULTS A total of 190 fetuses (95 with CDH and 95 controls) were evaluated. Fetuses with CDH showed significantly lower lung FMBV (26.8 (SD 8.4) vs. 37.9 (SD 8.1)%; P < 0.001) than controls. Lung tissue perfusion correlated positively with O/E-LHR (r = 0.37; P < 0.001) and negatively with intrapulmonary artery PI (r = - 0.31; P < 0.001), PEDRF (r = - 0.43; P < 0.001) and PSV (r = - 0.18; P = 0.03). CONCLUSIONS Fetuses with CDH have decreased lung tissue perfusion, which is associated with decreased lung growth and increased intrapulmonary artery impedance.
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Affiliation(s)
- O Moreno-Alvarez
- Fetal and Perinatal Medicine Research Group, Department of Maternal-Fetal Medicine Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Cruz-Martinez R, Moreno-Alvarez O, Hernandez-Andrade E, Castañon M, Done E, Martinez JM, Puerto B, Deprest J, Gratacos E. Contribution of intrapulmonary artery Doppler to improve prediction of survival in fetuses with congenital diaphragmatic hernia treated with fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol 2010; 35:572-577. [PMID: 20178111 DOI: 10.1002/uog.7593] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate the contribution of intrapulmonary artery Doppler in predicting the survival of fetuses with congenital diaphragmatic hernia (CDH) treated with fetoscopic tracheal occlusion (FETO). METHODS A cohort of 41 fetuses (between 24 and 28 weeks of gestation) with CDH was treated with FETO. The observed/expected lung-to-head ratio (O/E-LHR), pulmonary artery pulsatility index (PI), peak early diastolic reversed flow (PEDRF) and peak systolic velocity (PSV) were evaluated before FETO, and their isolated and combined value to predict survival using multiple logistic regression and decision-tree analysis was assessed. RESULTS O/E-LHR and intrapulmonary artery PI and PEDRF were significantly associated with the probability of survival (O/E-LHR > or = 26%, OR 14.2; PI < 1 Z-score, OR 8.4; and PEDRF < 3.5 Z-scores, OR 5.7). Decision-tree analysis showed that O/E-LHR was the best initial predictor of prognosis (O/E-LHR > or = 26%, 90% survival; O/E-LHR < 26%, 45% survival). For fetuses with an O/E-LHR of < 26%, Doppler parameters allowed discrimination of cases with moderate (66-71% survival) and very poor (0% survival) prognosis. CONCLUSION Intrapulmonary artery Doppler evaluation helps to refine the prediction of survival after FETO in fetuses with severe CDH.
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Affiliation(s)
- R Cruz-Martinez
- Department of Maternal-Fetal Medicine, Institute Clínic of Gynecology, Obstetrics and Neonatology, Hospital Clinic-IDIBAPS, University of Barcelona and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Oros D, Figueras F, Cruz-Martinez R, Padilla N, Meler E, Hernandez-Andrade E, Gratacos E. Middle versus anterior cerebral artery Doppler for the prediction of perinatal outcome and neonatal neurobehavior in term small-for-gestational-age fetuses with normal umbilical artery Doppler. Ultrasound Obstet Gynecol 2010; 35:456-461. [PMID: 20178115 DOI: 10.1002/uog.7588] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate whether anterior cerebral artery (ACA) Doppler ultrasonography is superior to middle cerebral artery (MCA) Doppler in the prediction of perinatal outcome and neonatal neurobehavior in term small-for-gestational-age (SGA) fetuses with normal umbilical artery (UA) Doppler. METHODS MCA and ACA Doppler ultrasonography was performed in a cohort of SGA term fetuses with normal UA Doppler. Perinatal outcome and neonatal neurobehavioral performance were compared with a group of term appropriate-for-gestational age (AGA) infants. Neurobehavior was evaluated at 40 ( +/- 1) weeks of corrected age with the Neonatal Behavioral Assessment Scale. Differences between the study groups were adjusted for potential confounding variables by multiple linear or logistic regression analyis. RESULTS A total of 199 newborns (98 SGA and 101 AGA) were included. Among the SGA fetuses, 28.6 and 17% had MCA and ACA redistribution, respectively. Cases with either type of redistribution had an increased risk for adverse outcome, with no differences in predictive performance between the two parameters. SGA fetuses with MCA redistribution compared with controls had an increased risk for abnormal neurobehavioral performance in motor (36 vs. 20%; adjusted P = 0.02) and state organization (25 vs. 17.5%; adjusted P = 0.03) areas. SGA fetuses with ACA redistribution had only an increased risk for abnormal neurobehavioral performance area in state organization compared with controls (30 vs. 17.5%; adjusted P = 0.021). CONCLUSION In term SGA newborns with no signs of brain-sparing, ACA Doppler investigation does not provide any benefit over MCA in terms of the prediction of adverse perinatal outcome.
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Affiliation(s)
- D Oros
- Department of Maternal-Fetal Medicine, Institute Clinic for Gynecology, Obstetrics and Neonatology, Hospital Clinic-IDIBAPS, University of Barcelona and Centro de Investigación Biomédica en Enfermedades Raras (CIBER-ER), Barcelona, Spain
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Hernandez-Andrade E, Crispi F, Benavides-Serralde JA, Plasencia W, Diesel HF, Eixarch E, Acosta-Rojas R, Figueras F, Nicolaides K, Gratacós E. Contribution of the myocardial performance index and aortic isthmus blood flow index to predicting mortality in preterm growth-restricted fetuses. Ultrasound Obstet Gynecol 2009; 34:430-436. [PMID: 19790100 DOI: 10.1002/uog.7347] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To evaluate the predictive value for perinatal death of the myocardial performance index (MPI) and aortic isthmus flow index (IFI), as isolated parameters and in a combined model including currently used Doppler indices, in preterm growth restricted (IUGR) fetuses. METHODS Umbilical artery, fetal middle cerebral artery (MCA) and ductus venosus (DV) pulsatility indices (PIs) were recorded, along with IFI and MPI, in a cohort of 97 preterm (delivered at between 24 and 34 weeks) IUGR fetuses. Logistic regression analysis was performed to identify those variables that were independently associated with perinatal mortality, and an algorithm to estimate probability of death was constructed including the best combination of parameters. RESULTS With the exception of MCA, all Doppler indices were significantly associated with perinatal death as isolated parameters, but only DV-PI and MPI were found to be independent predictors on multivariate analysis. An algorithm combining DV atrial flow (positive or absent/reversed) and MPI (normal or above 95(th) percentile) had a better predictive accuracy than did any single parameter. The risk for death in IUGR fetuses below 28 weeks' gestation with present atrial flow in the DV and normal MPI was 18%, with either characteristic abnormal it was 70-73%, and with both abnormal it was 97%. The risk for death in IUGR fetuses above 28 weeks with present atrial flow in the DV and normal MPI was 0.1%, with either abnormal it was 6-7%, and with both abnormal it was 45%. CONCLUSIONS MPI is an independent predictor of perinatal death in preterm IUGR fetuses with accuracy similar to that of DV flow. A combination of DV flow with MPI may better stratify the estimated probability of death. IFI does not add to the prediction of perinatal death when used in combination with DV flow.
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Affiliation(s)
- E Hernandez-Andrade
- Maternal-Fetal Medicine Department, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
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Figueras F, Benavides A, Del Rio M, Crispi F, Eixarch E, Martinez JM, Hernandez-Andrade E, Gratacós E. Monitoring of fetuses with intrauterine growth restriction: longitudinal changes in ductus venosus and aortic isthmus flow. Ultrasound Obstet Gynecol 2009; 33:39-43. [PMID: 19115231 DOI: 10.1002/uog.6278] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To explore in growth-restricted fetuses the sequence of changes in aortic isthmus and ductus venosus blood flow in relation to other arterial Doppler parameters commonly used to evaluate fetal wellbeing. METHODS Umbilical and middle cerebral arteries, ductus venosus and aortic isthmus were explored serially by means of pulsed Doppler in a cohort of singleton small-for-gestational age fetuses requiring delivery before 34 weeks. Longitudinal changes in the last 30 days before delivery were modeled by multilevel analysis. Individual regression lines for each variable were calculated for each fetus and from these the regression lines for the whole group were derived, in order to estimate the mean time point at which each Doppler parameter became abnormal (outside the 5th-95th centile range). A survival analysis was performed during the monitoring period, in which the endpoint was an abnormal Doppler pulsatility index. RESULTS A total of 162 observations were performed on 46 fetuses (median, 3; range, 2-10). The median gestational age at inclusion was 28.9 (range, 23.6-33.4) weeks and delivery occurred at a median gestational age of 30.5 (range, 25.9-33.9) weeks. Six (13%) cases of perinatal mortality occurred. Umbilical and middle cerebral artery Doppler showed an almost linear deterioration throughout monitoring, becoming abnormal on average 24 days and 20 days before delivery, respectively. Aortic isthmus Doppler became abnormal on average 13 days before delivery, while ductus venosus Doppler did so within the last week before delivery. CONCLUSIONS In preterm growth-restricted fetuses, aortic isthmus blood flow becomes abnormal on average 1 week earlier than does that in the ductus venosus. This could provide a sound basis to better define management protocols aimed to improve intact fetal survival.
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Affiliation(s)
- F Figueras
- Maternal-Fetal Medicine Department, Hospital Clinic, University of Barcelona, Barcelona, Spain.
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Eixarch E, Meler E, Iraola A, Illa M, Crispi F, Hernandez-Andrade E, Gratacos E, Figueras F. Neurodevelopmental outcome in 2-year-old infants who were small-for-gestational age term fetuses with cerebral blood flow redistribution. Ultrasound Obstet Gynecol 2008; 32:894-899. [PMID: 19035538 DOI: 10.1002/uog.6249] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To assess the neurodevelopmental outcome at 2 years of age of children who had been small-for-gestational-age (SGA) term babies with cerebral blood flow redistribution. METHODS Perinatal outcome was assessed in a cohort of 97 term singleton appropriate-for-gestational-age and 125 term singleton SGA fetuses with normal umbilical artery Doppler, stratified according to the presence of cerebral blood flow redistribution. Neurodevelopmental outcome was assessed prospectively at 2 years of age by means of the 24-month Age & Stage Questionnaire (ASQ). RESULTS Of the 125 SGA fetuses, 25 had redistribution of the cerebral blood flow, and 100 did not. There were no significant differences in perinatal outcome between these two SGA groups. At 2 years of age, children who had been SGA fetuses with middle cerebral artery (MCA) pulsatility index (PI) < 5(th) centile had a higher incidence of suboptimal neurodevelopmental outcome compared with those with normal MCA-PI (52% vs. 31%; P = 0.049) and a lower mean centile in communication (53.1 vs. 67.4; P = 0.006) and problem-solving (39.7 vs. 47.4; P = 0.04) areas. CONCLUSION SGA fetuses with cerebral blood flow redistribution have a higher risk of subtle neurodevelopmental deficits at 2 years of age. This challenges the concept that fetal cerebral redistribution is an entirely protective mechanism and suggests MCA-PI as a risk stratifying factor for adverse neurodevelopmental outcome.
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Affiliation(s)
- E Eixarch
- Maternal-Fetal Medicine Department, ICGON, Fetal and Perinatal Research Group, IDIBAPS, Hospital Clinic, University of Barcelona, Centre for Biomedical Research on Rare Diseases (CIBERER), Barcelona, Spain
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Hernandez-Andrade E, Figueroa-Diesel H, Jansson T, Rangel-Nava H, Gratacos E. Changes in regional fetal cerebral blood flow perfusion in relation to hemodynamic deterioration in severely growth-restricted fetuses. Ultrasound Obstet Gynecol 2008; 32:71-76. [PMID: 18570240 DOI: 10.1002/uog.5377] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To study regional cerebral blood perfusion with power Doppler ultrasound (PDU) imaging in appropriate-for-gestational age (AGA) fetuses and those with intrauterine growth restriction (IUGR) at different hemodynamic stages of fetal deterioration. METHODS Brain blood perfusion was studied with PDU imaging, and the fractional moving blood volume (FMBV) was estimated in 56 growth-restricted and 56 AGA matched fetuses at 26-32 weeks of gestation. Fetuses with IUGR were classified according to progression of hemodynamic deterioration as follows: Group 1, abnormal umbilical artery (UA) pulsatility index (PI) (mean > 2 SD, n = 13); Group 2, abnormal UA-PI and middle cerebral artery (MCA) PI (mean < 2 SD, n = 15); Group 3, abnormal UA-PI, MCA-PI and ductus venosus (DV) PI (mean > 2 SD) but atrial (a-wave) flow present (n = 16); and Group 4, absent or reversed DV atrial flow (n = 12). FMBV was calculated in the complete mid-sagittal, frontal, basal ganglia and cerebellar regions. RESULTS In all growth-restricted fetuses, FMBV was significantly increased in all regions. Fetuses in Group 1 showed considerable increments in FMBV values in the frontal, complete mid-sagittal and cerebellar regions, and a mild increase in the basal ganglia. From Groups 2 to 4, there was a steady reduction (compared with Group 1) in frontal FMBV values (F = 3.25, P = 0.027) together with a significant increment in the basal ganglia values (F = 11.61, P < 0.001). A trend for increasing FMBV values was also observed in the cerebellum, whereas a decreasing trend was noted in the complete mid-sagittal area. CONCLUSIONS Brain perfusion in growth-restricted fetuses shows clear regional variations, which change with progression of hemodynamic deterioration. After an initial and early increase in the frontal area, progression of fetal deterioration was rapidly associated with a pronounced decrease in frontal perfusion, together with an increase towards the basal ganglia.
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Affiliation(s)
- E Hernandez-Andrade
- Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
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Gratacós E, Antolin E, Lewi L, Martínez JM, Hernandez-Andrade E, Acosta-Rojas R, Enríquez G, Cabero L, Deprest J. Monochorionic twins with selective intrauterine growth restriction and intermittent absent or reversed end-diastolic flow (Type III): feasibility and perinatal outcome of fetoscopic placental laser coagulation. Ultrasound Obstet Gynecol 2008; 31:669-675. [PMID: 18504780 DOI: 10.1002/uog.5362] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To assess the feasibility and impact on perinatal outcome of fetoscopic laser coagulation of placental anastomoses in monochorionic twins with selective intrauterine growth restriction (sIUGR) and intermittent absent or reversed end-diastolic flow (iAREDF) in the umbilical artery (Type III), in comparison with expectant management. METHODS This is a descriptive study of the outcome of 18 cases of monochorionic twins with Type III sIUGR treated with laser, and 31 pregnancies managed expectantly over the same period. All newborns underwent neonatal brain ultrasound scans. Perinatal outcome and the incidence of neurological damage were compared between the two groups. RESULTS Laser coagulation could be performed in only 88.9% (16/18) of cases owing to technical difficulties, and in 12.5% (2/16) a second procedure was required to achieve complete coagulation of the large artery-to-artery anastomosis. Mean gestational age at delivery was 31.0 (range, 26-33) weeks in the expectant management group and 32.6 (range, 23-38) weeks in the laser group (P = 0.32). Overall perinatal survival was 85.5% (53/62) and 63.9% (23/36), respectively (P = 0.02). Intrauterine demise of the smaller twin occurred in 19.4% (6/31) and 66.7% (12/18), respectively (P = 0.001), and was associated with death of the cotwin in 50% (3/6) and 0% (0/12) of these cases, respectively (P = 0.02). The prevalence of periventricular leukomalacia in the larger fetus was 4/28 (14.3%) in the expectant management group and 1/17 (5.9%) in the laser group (P = 0.63). CONCLUSIONS Laser coagulation in sIUGR-iAREDF pregnancies is technically difficult and not always feasible. Placental dichorionization significantly increases the proportion of fetuses with intrauterine death of the growth-restricted twin, but it protects the normal twin from its cotwin's death in the event of demise of the growth-restricted twin.
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Affiliation(s)
- E Gratacós
- Department of Maternal-Fetal Medicine (ICGON) and Fetal and Perinatal Research Group (IDIBAPS), Hospital Clinic, University of Barcelona, Spain.
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Moreno-Alvarez O, Hernandez-Andrade E, Oros D, Jani J, Deprest J, Gratacos E. Association between intrapulmonary arterial Doppler parameters and degree of lung growth as measured by lung-to-head ratio in fetuses with congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2008; 31:164-170. [PMID: 18196498 DOI: 10.1002/uog.5201] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVES To describe the association between the intrapulmonary circulation and the degree of lung growth in fetuses with congenital diaphragmatic hernia (CDH). METHODS Thirty-six fetuses with isolated left CDH at 22-29 weeks of gestation were studied. Four groups were defined according to lung-to-head ratio (LHR), expressed as the ratio of observed to expected LHR for gestational age (O/E LHR). Pulsatility index (PI), peak systolic velocity (PSV), peak early-diastolic reversed flow (PEDRF), end-diastolic velocity (EDV), acceleration time (AT), time averaged velocity (TAV) and the ratio AT to ejection time (AT/ET) were measured in all fetuses in the proximal arterial branch of both lungs. For analysis, Doppler values were converted to Z-scores. RESULTS It was possible to record all Doppler parameters from the contralateral lung of all CDH fetuses, and from the ipsilateral lung in 28 (77.7%). PEDRF significantly increased in relation to the decrease in O/E LHR in both lungs (contralateral: r = - 0.65, P = 0.01; ipsilateral: r = - 0.43, P = 0.02). PI increased significantly with the reduction in O/E LHR but only on the side contralateral to the hernia (r = - 0.55, P = 0.02). In the ipsilateral pulmonary artery, PI values showed a significant overall increase but no differences were observed among the O/E LHR groups. PSV, EDV and TAV were reduced in both lungs with respect to normal values, but no association was found with the O/E LHR. No changes in AT or AT/ET were observed in either lung. CONCLUSIONS PEDRF is quick and easy to calculate, and showed the strongest and most consistent correlation with O/E LHR. The association between PEDRF and LHR might be an additional parameter that could help to establish prognosis in fetuses with CDH.
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Affiliation(s)
- O Moreno-Alvarez
- Fetal and Perinatal Medicine Research Group, Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
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Muñoz-Abellana B, Hernandez-Andrade E, Figueroa-Diesel H, Ferrer Q, Acosta-Rojas R, Cabero L, Gratacos E. Hypertrophic cardiomyopathy-like changes in monochorionic twin pregnancies with selective intrauterine growth restriction and intermittent absent/reversed end-diastolic flow in the umbilical artery. Ultrasound Obstet Gynecol 2007; 30:977-982. [PMID: 17975857 DOI: 10.1002/uog.5166] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To evaluate the prevalence of hypertrophic cardiomyopathy-like (HCL) changes in monochorionic twins with selective intrauterine growth restriction (sIUGR) and intermittent absent/reversed end-diastolic flow (iAREDF), also defined as Type III sIUGR, and the clinical relevance of this condition. METHODS A total of 80 pregnancies with sIUGR were studied, 40 with, and 40 without iAREDF. HCL changes were defined as an increased thickness of either left or right ventricular wall (mean > 2 SD) estimated with M-mode ultrasonography. Data were plotted on normal reference values constructed from 75 uncomplicated monochorionic twin pregnancies (150 fetuses) at 22-34 weeks' gestation. Perinatal outcomes in pregnancies with and without HCL changes were compared. RESULTS In the group with iAREDF, 8/40 of the larger twins (20%) had HCL changes (five bilaterally, two in the right, and one in the left ventricle) as compared with 1/40 (2.5%) in fetuses without iAREDF (P = 0.03). No differences were observed in the smaller twin (1/40 in both groups). HCL changes were not associated with a significant increment in perinatal mortality as only one large fetus from the group with iAREDF died in utero. In the remaining 10 cases, no differences in the intertwin weight discordance, placental surface discordance, or rate of neonatal neurological damage were observed. However, all 10 presented mildly abnormal neonatal cardiac findings that resolved over time with no apparent short-term impact on cardiac function. CONCLUSIONS HCL changes in the larger twin should be regarded as part of the spectrum of findings in Type III monochorionic-sIUGR (presenting iAREDF). This finding does not seem to be associated with an increased rate of short-term neurological or cardiac complications.
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Affiliation(s)
- B Muñoz-Abellana
- Department of Obstetrics, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
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Figueroa-Diesel H, Hernandez-Andrade E, Acosta-Rojas R, Cabero L, Gratacos E. Doppler changes in the main fetal brain arteries at different stages of hemodynamic adaptation in severe intrauterine growth restriction. Ultrasound Obstet Gynecol 2007; 30:297-302. [PMID: 17661428 DOI: 10.1002/uog.4084] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To evaluate changes in the temporal evolution and regional distribution of arterial brain Doppler parameters in relation to different stages of hemodynamic adaptation in fetuses with severe intrauterine growth restriction (IUGR). METHODS Thirty-six fetuses with severe IUGR (<or= 32 weeks of gestation) and abnormal umbilical artery (UA) pulsatility index (PI) (mean > 2 SD) were evaluated longitudinally with pulsed Doppler ultrasound at four different hemodynamic stages: Stage 1 (n = 36), mean UA-PI > 2 SD or absent UA end-diastolic flow; Stage 2 (n = 34), abnormal middle cerebral artery (MCA) PI (mean < 2 SD); Stage 3 (n = 30), reversed UA end-diastolic flow; Stage 4 (n = 12), absent or reversed atrial flow in the ductus venosus. In addition, 36 normally grown fetuses were studied for comparison. PI and time-averaged maximum velocity (TAMXV) in the MCA and the anterior cerebral (ACA), pericallosal (PER) and posterior cerebral (PCA) arteries were measured. RESULTS In IUGR fetuses, PI values from all arteries were significantly reduced at Stage 2. At Stages 3 and 4, ACA-PI and PCA-PI did not change further, whereas MCA-PI and PER-PI showed a slight increase. In the ACA, MCA and PER, TAMXV in Stage 2 increased significantly. In Stages 3 and 4, ACA and PER-TAMXV remained unchanged, whereas MCA-TAMXV showed a slight decrease, mirroring the PI values. PCA-TAMXV values were similar to controls at all stages. CONCLUSION In IUGR fetuses, the brain arteries differ in the magnitude and time sequence of Doppler parameters in relation to systemic hemodynamic adaptation, suggesting the existence of regional brain redistribution processes.
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Affiliation(s)
- H Figueroa-Diesel
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
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Gratacós E, Lewi L, Muñoz B, Acosta-Rojas R, Hernandez-Andrade E, Martinez JM, Carreras E, Deprest J. A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin. Ultrasound Obstet Gynecol 2007; 30:28-34. [PMID: 17542039 DOI: 10.1002/uog.4046] [Citation(s) in RCA: 261] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To evaluate a classification of selective intrauterine growth restriction (sIUGR) in monochorionic (MC) twins based on the characteristics of umbilical artery (UA) Doppler flow in the smaller twin, in terms of association with clinical outcome and with the pattern of placental anastomoses. METHODS One hundred and thirty-four MC twins diagnosed with sIUGR at 18-26 weeks were classified as Type I (UA Doppler with positive diastolic flow, n = 39), Type II (persistent absent or reversed end-diastolic flow, n = 30) and Type III (intermittent absent or reversed end-diastolic flow, n = 65). Perinatal outcome, placental sharing and the pattern of anastomoses were compared with those in 76 uncomplicated MC twins. RESULTS Mean gestational age at delivery was 35.5 (range, 30-38) weeks in controls, 35.4 (range, 16-38) weeks in Type I, 30.7 (range, 27-40) weeks in Type II (P < 0.0001) and 31.6 (range, 23-39) weeks in Type III (P < 0.0001) pregnancies. Fetal weight discordance was significantly higher in Type II (38%) and Type III (36%) than in Type I (29%) (P < 0.0001) pregnancies. Deterioration of the growth-restricted fetus occurred in 90% of Type II cases, compared with 0% and 10.8% of Types I and III, respectively (P < 0.001). Unexpected intrauterine fetal death of the smaller twin occurred in 15.4% of Type III cases, compared with 2.6% and 0% of Types I and II respectively (P < 0.05). Parenchymal brain lesions in the larger twin were observed in 19.7% of Type III cases and less than 5% in the other groups (P < 0.05). Placental discordance (larger/smaller) was 1.3 in controls, compared with 1.8, 2.6 and 4.4 in Types I, II and III, respectively (P < 0.01). The proportion of cases with arterioarterial anastomoses > 2 mm in diameter was 55% in controls, 70% in Type I, 18% in Type II (P < 0.01) and 98% in Type III (P < 0.01). CONCLUSION sIUGR can be classified on the basis of umbilical artery Doppler into three types that correlate with different clinical behavior and different patterns of placental anastomoses. This classification may be of help in clinical decision-making and when comparing clinical studies.
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Affiliation(s)
- E Gratacós
- Fetal Medicine Unit and Department of Obstetrics, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
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Hernandez-Andrade E, Jansson T, Figueroa-Diesel H, Rangel-Nava H, Acosta-Rojas R, Gratacós E. Evaluation of fetal regional cerebral blood perfusion using power Doppler ultrasound and the estimation of fractional moving blood volume. Ultrasound Obstet Gynecol 2007; 29:556-61. [PMID: 17444567 DOI: 10.1002/uog.4005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To standardize the evaluation of regional fetal brain blood perfusion, using power Doppler ultrasound (PDU) to estimate the fractional moving blood volume (FMBV) and to evaluate the reproducibility of this estimation. METHODS Brain blood perfusion was evaluated in 35 normally grown fetuses at 28-30 weeks of gestation, using PDU. The following cerebral regions were included in the PDU color box: anterior sagittal, complete sagittal, basal ganglia, and cerebellar. Ten consecutive good-quality images of each anatomical plane were recorded and the delimitation of the region of interest (ROI) was performed off-line. FMBV was quantified in the ROI of all images and the mean considered as the final value. Differences between regions, variability, reproducibility and agreement between observers were assessed. RESULTS Power Doppler images of the described anatomical planes were obtained in all cases, regardless of fetal position. The median time for the acquisition of the images was 7 (range 4-12) min. Mean (range) FMBV values were: anterior sagittal, 16.5 (10.7-22.8)%, inter-patient coefficient of variation (CV) 0.22; complete sagittal, 13.5 (8.8-16.1)%, CV 0.27; basal ganglia, 18.3 (10.7-27.6)%, CV 0.27; and cerebellar, 6.6 (3.0-11.0)%, CV 0.38. There were statistically significant differences in FMBV between cerebellar and complete sagittal ROIs with the frontal and basal ganglia regions. Reproducibility analyses showed an intraclass correlation coefficient of 0.91 (95% CI 0.67-0.97) and an interclass correlation coefficient of 0.87 (95% CI 0.70-0.94). Interobserver agreement showed a mean difference between observers of -0.2 (SD 2.7) with 95% limits of agreement -5.6 to 5.2. CONCLUSIONS When the regions of interest are well defined, the FMBV estimate offers a method to quantify blood flow perfusion in different fetal cerebral areas. There appear to be regional differences in FMBV within the fetal brain.
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Affiliation(s)
- E Hernandez-Andrade
- Department of Obstetrics, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Hospital Clínic and Fetal and Perinatal Medicine Group, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Spain.
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Hernandez-Andrade E, Figueroa-Diesel H, Kottman C, Illanes S, Arraztoa J, Acosta-Rojas R, Gratacós E. Gestational-age-adjusted reference values for the modified myocardial performance index for evaluation of fetal left cardiac function. Ultrasound Obstet Gynecol 2007; 29:321-5. [PMID: 17290412 DOI: 10.1002/uog.3947] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE It has been shown that the modified myocardial performance index (Mod-MPI) is associated with higher reproducibility than conventional MPI because it uses mitral and aortic valve 'clicks' to calculate each time period. We aimed to construct normal reference values for the Mod-MPI after 19 weeks' gestation. METHODS The Mod-MPI was calculated in the left ventricle of 557 normal fetuses at 19-39 weeks' gestation. The isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT) and ejection time (ET) were measured using the Doppler signals (clicks) of the opening and closing of the mitral and aortic valves as landmarks. Mod-MPI was calculated as (ICT + IRT)/ET. RESULTS Throughout gestation, there was a small increase in the Mod-MPI (at 19 weeks it was 0.35 +/- 0.027 (mean +/- SD); at 39 weeks, 0.37 +/- 0.029; Mod-MPI = 0.33 + 0.001x gestational age (GA) (weeks), r(2) = 0.017). Of the three components, ICT remained constant, IRT increased (IRT = 0.028 + 2.52 x GA (weeks)), and ET slightly decreased (ET = 0.184 - 3.65 x GA (weeks)). Fetal heart rate (FHR) had no effect on the Mod-MPI, but the duration of IRT, ICT and ET decreased by 13-15% when FHR increased from 130 to 160 beats per minute. CONCLUSION The GA-adjusted reference values for the Mod-MPI and the three time periods used for its calculation can be applied to fetal cardiac evaluation in the presence of pregnancy-associated complications.
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Affiliation(s)
- E Hernandez-Andrade
- Department of Obstetrics, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Hospital Clínic, Spain.
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Becker J, Hernandez-Andrade E, Muñoz-Abellana B, Acosta R, Cabero L, Gratacós E. Stage-dependent fetal umbilical blood flow changes induced by laser therapy and amniodrainage in twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol 2006; 28:674-80. [PMID: 16823767 DOI: 10.1002/uog.2734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To estimate changes in umbilical blood flow (UBF) and Doppler indices in pregnancies complicated by twin-to-twin transfusion syndrome (TTS) treated with either laser therapy or amniodrainage, and to evaluate the influence of the presence of hemodynamic deterioration prior to therapy, as determined by the Quintero stages of severity. METHODS Forty-eight cases of TTS were included, and further classified into severity Stages I or II (absence of critically abnormal Dopplers (CAD), n = 22) and Stages III or IV (presence of CAD or hydrops fetalis, n = 26). In Stages I-II, 14 cases were treated with laser and eight with amniodrainage, and in Stages III-IV, 17 were treated with laser and nine with amniodrainage. Differences in the UBF, umbilical artery pulstility index (UA-PI) and ductus venosus pulsatility index (DV-PI) were estimated for both groups of severity before and after both treatments. Eleven normal monochorionic pregnancies were evaluated as controls. RESULTS In recipients, UBF was significantly higher with respect to controls regardless of the stage, while donors had a significant decrease in UBF, but only in Stages III-IV. After laser treatment no changes were observed in fetuses in Stages I-II. In Stages III-IV, recipients showed a significant reduction in the DV-PI (mean DV-PI 1.31 +/- 0.18 vs. 1.05 +/- 0.22; P = 0.005) whereas donors showed a significant increase in the UBF (mean UBF 134 +/- 36 mL/min vs. 195 +/- 25 mL/min; P < 0.001) and in the DV-PI (mean DV-PI 0.99 +/- 0.26 vs. 1.36 +/- 0.42; P = 0.002), and a reduction in the UA-PI (mean UA-PI 1.86 +/- 0.41 vs. 1.58 +/- 0.30; P = 0.01). After amniodrainage only donor fetuses in Stages III-IV showed an increase in UA-PI (mean UA-PI 1.54 +/- 0.35 vs. 1.72 +/- 0.40; P = 0.015). No other changes were observed in any of the parameters studied. CONCLUSION Laser therapy induces consistent hemodynamic variations in TTS mainly manifested in Stages III-IV.
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Affiliation(s)
- J Becker
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
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Hansson SR, Chen Y, Brodszki J, Chen M, Hernandez-Andrade E, Inman JM, Kozhich OA, Larsson I, Marsál K, Medstrand P, Xiang CC, Brownstein MJ. Gene expression profiling of human placentas from preeclamptic and normotensive pregnancies. Mol Hum Reprod 2006; 12:169-79. [PMID: 16556680 DOI: 10.1093/molehr/gal011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to investigate patterns of gene expression in placental samples from patients with preeclampsia (PE), persistent bilateral uterine artery notching (without PE), and normal controls. This study included placental tissue from nine women with PE, seven with uncomplicated pregnancies and five with bilateral uterine artery notching in Doppler velocimetry tracings. Human cDNA microarrays with 6500 transcripts/genes were used and the results verified with real-time PCR and in-situ hybridization. Multidimensional scaling method and random permutation technique demonstrated significant differences among the three groups examined. Within the 6.5K arrays, 6198 elements were unique cDNA clones representing 5952 unique UniGenes and 5695 unique LocusLinks. Multidimensional scaling plots showed 5000 genes that met our quality criteria; among these, 366 genes were significantly different in at least one comparison. Differences in three genes of interest were confirmed with real-time PCR and in-situ hybridization; acid phosphatase 5 was shown to be overexpressed in PE samples and calmodulin 2 and v-rel reticuloendotheliosis viral oncogene homolog A (RELA) were downregulated in PE and uterine artery notch placentas. In conclusion downregulation of RELA and calmodulin 2 might represent an attempt by the placenta to compensate for elevations in intracellular calcium, possibly caused by hypoxia and/or apoptosis, in both pregnancies with uterine artery notching and preeclampsia.
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Affiliation(s)
- S R Hansson
- Department of Obstetrics and Gynecology, Lund University Hospital, Sweden
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Hernandez-Andrade E, López-Tenorio J, Figueroa-Diesel H, Sanin-Blair J, Carreras E, Cabero L, Gratacos E. A modified myocardial performance (Tei) index based on the use of valve clicks improves reproducibility of fetal left cardiac function assessment. Ultrasound Obstet Gynecol 2005; 26:227-32. [PMID: 16116562 DOI: 10.1002/uog.1959] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To determine whether a modified myocardial performance index (Mod-MPI) involving assessment of the movements (clicks) of the mitral valve (MV) and aortic valve (AV), improves intra- and interobserver agreement as compared to the previously reported method for MPI estimation. METHODS The Mod-MPI was recorded by two experienced operators in the left cardiac chambers of 25 normally grown fetuses using pulsed Doppler ultrasonography. The isovolumetric contraction time (ICT) was measured from the closure of the MV to the opening of the AV, the ejection time (ET) from the opening to the closure of the AV, and the isovolumetric relaxation time (IRT) from the closure of the AV to the opening of the MV. The Mod-MPI was calculated as (ICT + IRT)/ET. In addition, the MPI was estimated without using the valve clicks (F-MPI) as previously described. Intra- and interobserver agreement were then analyzed for both modalities. RESULTS There was a significantly lower intra- and inter-observer variability in the estimation of all time periods with the Mod-MPI than with the F-MPI (ICT: intra-observer, 9.9% vs. 13.9%; interobserver 9.9% vs. 15.6%; IRT: intraobserver, 9.9% vs. 14.8%; interobserver 10.4% vs. 18.3%; and ET: intraobserver, 4.5% vs. 6.1%; interobserver 2.8% vs. 5.2%, respectively). Intraclass correlation coefficient (IntraCC) for the Mod-MPI was 0.8 (95% confidence interval (95% CI), 0.56-0.9) and for the F-MPI, the IntraCC was 0.62 (95% CI, 0.26-0.84); P = 0.01. Agreement between observers using the Mod-MPI showed a mean difference of 0.0 with 95% limits of agreement (LA) -0.09 (95% CI, -0.1 to -0.075) to 0.09 (95% CI, 0.075-0.1) and for the F-MPI the mean difference was -0.01 with 95% LA -0.26 (95% CI, -0.3 to -0.22) to 0.25 (95% CI, 0.21-0.29). CONCLUSION Calculation of the Mod-MPI based on Doppler echoes of the MV and AV clicks is associated with a lower variation and better inter- and intraobserver agreement than the previously used method for fetal cardiac evaluation.
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Affiliation(s)
- E Hernandez-Andrade
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Vall D'Hebron University Hospital, Autonomous University of Barcelona, Spain.
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Bottalico B, Larsson I, Brodszki J, Hernandez-Andrade E, Casslén B, Marsál K, Hansson SR. Norepinephrine Transporter (NET), Serotonin Transporter (SERT), Vesicular Monoamine Transporter (VMAT2) and Organic Cation Transporters (OCT1, 2 and EMT) in Human Placenta from Pre-eclamptic and Normotensive Pregnancies. Placenta 2004; 25:518-29. [PMID: 15135235 DOI: 10.1016/j.placenta.2003.10.017] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2003] [Revised: 10/14/2003] [Accepted: 10/14/2003] [Indexed: 11/16/2022]
Abstract
Pre-eclampsia is one of the most common causes of perinatal and maternal morbidity and mortality. High blood pressure and proteinuria are important clinical signs of pre-eclampsia. Sympathetic overactivity and elevated level of circulating vaso active substances, such as monoamines has been shown. Extracellular concentrations of monoamines are normally kept low by specific transporter proteins of which many are expressed in the placenta. In this study we used in situ hybridization and real-time PCR to study the gene expression of monoamine transporters, such as NET, SERT, VMAT2, EMT and OCT1/2, in normal as well as in pre-eclamptic placentae. We demonstrated high expression of NET mRNA in the trophoblast cells of the anchoring villi and a lower expression intensity in the chorionic villi. SERT mRNA was mainly detected in chorionic villi. VMAT2 mRNA was not detected in the central part of the placenta but was present in the spiral arteries of placenta bed biopsies, in cytokeratin positive cells. EMT mRNA was mainly detected in the intra lobular septa and together with OCT1 and OCT2 mRNAs also expressed in scattered cells of placental vessel adventitias. Moreover, quantitative analysis showed a significant lower expression of NET and EMT mRNAs in pre-eclamptic placentae as compared to the control group. A defective gene expression or function of these monoamines transporters might explain the elevated concentrations of monoamines in pre-eclamptic patients. Monoamine transporters may serve as a protective mechanism preventing vasoconstriction in the placental vascular bed and thereby securing a stable blood flow to the fetus.
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Affiliation(s)
- B Bottalico
- Department of Obstetrics and Gynecology, Lund University Hospital, Klinikgatan, 221 85, Lund, Scania, Sweden
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Hernandez-Andrade E, Scheier M, Dezerega V, Carmo A, Nicolaides KH. Fetal middle cerebral artery peak systolic velocity in the investigation of non-immune hydrops. Ultrasound Obstet Gynecol 2004; 23:442-445. [PMID: 15133792 DOI: 10.1002/uog.1009] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE In some cases of non-immune hydrops there is congenital or acquired fetal anemia. The aim of this study was to investigate the potential value of fetal middle cerebral artery peak systolic velocity (MCA-PSV) in the assessment and management of non-immune hydrops due to anemia. METHODS Fetal MCA-PSV and fetal hemoglobin concentration, in blood obtained by cordocentesis, were measured in 16 singleton pregnancies referred to our unit for further investigations because of a diagnosis of non-immune hydrops fetalis. In all cases a detailed ultrasound examination demonstrated moderate or severe ascites, with or without skin edema, and pericardial or pleural effusions. Furthermore, there were no obvious malformations to account for the hydrops. In each fetus the measured MCA-PSV and hemoglobin concentration were expressed as delta values (the difference in SD from the normal mean for gestation). Regression analysis was used to determine the significance of the association between delta MCA-PSV and delta fetal hemoglobin concentration. In addition, we searched our database to identify the sonographic features and hemoglobin concentration of fetuses with congenital infection. RESULTS In the 16 cases of non-immune hydrops there were seven with parvovirus B19 infection, one each of alpha-thalassemia and primary cardiomyopathy and seven with no obvious explanation for the hydrops. There was a significant association between delta MCA-PSV and delta hemoglobin concentration (delta hemoglobin = (delta MCA-PSV + 0.1437)/-0.4154; R(2) = 0.7202; P < 0.0001). In 10 of the cases the fetal hemoglobin concentration was more than 4 SD below the normal mean for gestation and in all these cases the MCA-PSV was more than 2 SD above the normal mean for gestation. Our computer search identified an additional nine fetuses with parvovirus B19 infection and in all cases the predominant sonographic finding was ascites and the hemoglobin concentration was more than 4 SD below the normal mean. In contrast, only 3/14 fetuses with cytomegalovirus, toxoplasmosis, coxsackie B or Treponema infection had ascites and only 2/14 had a hemoglobin deficit of 4-6 SD. CONCLUSION In the management of non-immune hydrops, measurement of fetal MCA-PSV can help identify the subgroup with fetal anemia.
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Affiliation(s)
- E Hernandez-Andrade
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Scheier M, Hernandez-Andrade E, Carmo A, Dezerega V, Nicolaides KH. Prediction of fetal anemia in rhesus disease by measurement of fetal middle cerebral artery peak systolic velocity. Ultrasound Obstet Gynecol 2004; 23:432-436. [PMID: 15133790 DOI: 10.1002/uog.1010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE In red blood cell (RBC) isoimmunized pregnancies fetal anemia is associated with a hyperdynamic circulation. The aim of the present study was to examine further the possible value of fetal middle cerebral artery peak systolic velocity (MCA-PSV) in the management of affected pregnancies. METHODS A reference range of fetal MCA-PSV with gestation was constructed from the study of 813 normal singleton pregnancies at 20-40 weeks' gestation. Fetal MCA-PSV was also measured in 58 fetuses from RBC isoimmunized pregnancies, with maternal hemolytic antibody concentration of >15 IU/mL at 19-38 weeks' gestation and within 10 days of measurement of fetal hemoglobin concentration in blood obtained either by cordocentesis (n = 43) or at delivery (n = 15). In the RBC isoimmunized pregnancies each of the measured MCA-PSV and hemoglobin concentrations was expressed as a delta value (difference in SDs from the normal mean for gestation). Regression analysis was used to determine the significance of the association between delta MCA-PSV and delta fetal hemoglobin concentration. RESULTS In the normal pregnancies there was a significant increase in fetal MCA-PSV with gestation (mean MCA-PSV = 10(0.0223 x GA + 0.963)). In RBC isoimmunized pregnancies the fetal MCA-PSV was increased and there was a significant association between delta MCA-PSV and delta hemoglobin concentration (delta hemoglobin = (delta MCA-PSV + 0.093)/-0.356; R(2) = 0.638, P < 0.0001). An MCA-PSV of mean + 1.5 SDs detected 96% of severely anemic fetuses, with a hemoglobin deficit of at least 6 SDs, for a false-positive rate of 14%. CONCLUSION Measurement of fetal MCA-PSV is a useful method of assessing fetal anemia. In the clinical management of isoimmunized pregnancies a cut-off in MCA-PSV of mean + 1.5 SDs can identify nearly all severely anemic fetuses with a low false-positive rate.
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Affiliation(s)
- M Scheier
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Hernandez-Andrade E, Thuring-Jönsson A, Jansson T, Lingman G, Marsál K. Fractional moving blood volume estimation in the fetal lung using power Doppler ultrasound: a reproducibility study. Ultrasound Obstet Gynecol 2004; 23:369-373. [PMID: 15065187 DOI: 10.1002/uog.1003] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the reproducibility of fractional moving blood volume (FMBV) estimation in the fetal lung using power Doppler ultrasound (PDU). METHODS The lung blood perfusion of 20 normally grown singleton fetuses at 32-35 weeks of gestation was evaluated by two experienced observers using PDU. Each observer recorded two consecutive sequences of images from the posterior part of the fetal lung and calculated FMBV offline. FMBV expresses the percentage of blood movement within a defined region of interest (ROI). Repeatability and agreement were evaluated by means of the intraclass (intraCC) and interclass (interCC) correlation coefficients. RESULTS FMBV was successfully evaluated in 17/20 fetuses by both observers (kappa index 0.82; 95% CI 0.51-0.93). The intraCC for repeatability for Observer A was 0.92 (95% CI 0.78-0.96), and for Observer B 0.90 (95% CI 0.74-0.96). The mean difference between the first and the second measurement was 0.7% (SD 4.5%). The interCC for repeatability over time and between the operators was 0.70 (95% CI 0.56-0.76) and the mean difference between the observers was 0.6% (SD 4.65%). The interCC for agreement was 0.92 (95% CI 0.84-0.95) and the mean difference in FMBV results when both observers analyzed the same sequences offline was 0.6% (SD 3.85%). CONCLUSION In the hands of experienced operators, using a well-defined ROI and standard settings, FMBV estimation is a reproducible method of quantifying power Doppler signals recorded from fetal lung blood perfusion.
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