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Okpaise OO, Ahn H, Tonni G, Ruano R. Prenatal diagnosis and in utero treatment of congenital adrenal hyperplasia: An up-to-date comprehensive review. Prenat Diagn 2024; 44:635-643. [PMID: 38448010 DOI: 10.1002/pd.6542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 03/08/2024]
Abstract
Congenital adrenal hyperplasia (CAH) is a term that encompasses a wide range of conditions that affect the adrenals. Diagnosis and treatment before birth are important as irreparable birth defects can be avoided, decreasing the need for surgical intervention later in life, especially regarding genitalia anomalies. Although early implementation of dexamethasone in the prenatal treatment of CAH has been controversial, there is recent evidence that this treatment can reduce long-term complications.
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Affiliation(s)
| | - Hyunyoung Ahn
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Prenatal Diagnostic Centre, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
- Women-Children Health Center of Excellence, Americas Group, United Health Care Brazil, São Paulo, Brazil
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Tonni G. Dear esteemed colleagues, Associate Editors (AEs), and Editorial Board Members (EBMs) of Journal of Clinical Ultrasound. J Clin Ultrasound 2024; 52:227. [PMID: 38497219 DOI: 10.1002/jcu.23668] [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: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology, and Researcher Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), ASL Reggio Emilia, Reggio Emilia, Italy
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Okpaise OO, Tonni G, Werner H, Araujo Júnior E, Lopes J, Ruano R. Three-dimensional real and virtual models in fetal surgery: a real vision. Ultrasound Obstet Gynecol 2024; 63:303-311. [PMID: 36565438 DOI: 10.1002/uog.26148] [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: 08/17/2022] [Revised: 11/30/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Affiliation(s)
- O O Okpaise
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - G Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - H Werner
- Biodesign Lab DASA/PUC-Rio, Rio de Janeiro, Brazil
| | - E Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- Medical School, Municipal University of São Caetano do Sul (USCS), Bela Vista Campus, São Paulo, Brazil
| | - J Lopes
- Biodesign Lab DASA/PUC-Rio, Rio de Janeiro, Brazil
- Institute for Pure and Applied Mathematics, Rio de Janeiro, Brazil
| | - R Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
- Maternal-Fetal-Children Service of Excellence, Americas Group, United Health Care Brazil, São Paulo, Brazil
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Tonni G, Lituania M, Carboni E, Cecchi A, Sepulveda W. Decollatio (decapitation): early catastrophic event detected by transvaginal three-dimensional ultrasound with pathological confirmation. Ultrasound Obstet Gynecol 2024; 63:276-277. [PMID: 37698521 DOI: 10.1002/uog.27467] [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: 05/12/2023] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 09/13/2023]
Affiliation(s)
- G Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - M Lituania
- Preconceptional and Prenatal Pathophysiology, Department of Obstetrics and Gynaecology, Ente Ospedaliero Ospedali Galliera, Genoa, Italy
| | - E Carboni
- Unified Regional Center of Prenatal Diagnosis, ASUR, S.O.D.S. Community Hospital, Loreto, Italy
| | - A Cecchi
- Unified Regional Center of Prenatal Diagnosis, ASUR, S.O.D.S. Community Hospital, Loreto, Italy
| | - W Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
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Peixoto AB, Bravo-Valenzuela NJ, Martins WP, Tonni G, Moron AF, Mattar R, Ruano R, Rolo LC, Araujo Júnior E. Impact of overweight and obesity in the fetal cardiac function parameters in the second and third trimesters of pregnancy. Cardiol Young 2024; 34:319-324. [PMID: 37408451 DOI: 10.1017/s1047951123001609] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE To assess the impact of overweight and obesity in the second and third trimesters of pregnancy on fetal cardiac function parameters. METHODS We performed a prospective cohort study of 374 singleton pregnant women between 20w0d and 36w6d divided into three groups: 154 controls (body mass index - BMI < 25 kg/m2), 140 overweight (BMI 25-30 kg/m2) and 80 obese (BMI ≥ 30 kg/m2). Fetal left ventricular (LV) modified myocardial performance index (Mod-MPI) was calculated according to the following formula: (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. Spectral tissue Doppler was used to determine LV and right ventricular (RV) myocardial performance index (MPI'), peak myocardial velocity during systole (S'), early diastole (E'), and late diastole (A'). RESULTS We found significant differences between the groups in maternal age (p < 0.001), maternal weight (p < 0.001), BMI (p < 0.001), number of pregnancies (p < 0.001), parity (p < 0.001), gestational age (p = 0.013), and estimated fetal weight (p = 0.003). Overweight pregnant women had higher LV Mod-MPI (0.046 versus 0.044 seconds, p = 0.009) and LV MPI' (0.50 versus 0.47 seconds, p < 0.001) than the control group. Obese pregnant women had higher RV E' than control (6.82 versus 6.33 cm/sec, p = 0.008) and overweight (6.82 versus 6.46 cm/sec, p = 0.047) groups. There were no differences in 5-min APGAR score < 7, neonatal intensive care unit admission, hypoglycemia and hyperglobulinemia between the groups. CONCLUSIONS We observed fetal myocardial dysfunction in overweight and obese pregnant women with higher LV Mod-MPI, LV MPI' and RV E' compared to fetuses from normal weight pregnant women.
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Affiliation(s)
- Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba-MG, Brazil
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Department of Pediatrics, Pediatric Cardiology, School of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil
| | | | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Prenatal Diagnostic Centre, Istituto di Cura e Ricovero a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Rosiane Mattar
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Rodrigo Ruano
- Department of Maternal and Fetal Medicine, Fetal Surgery Service, Obstetrics and GynecologyUniversity of Miami, Miller School of Medicine, Miami, Fl, USA
| | - Liliam Cristine Rolo
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
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Dittmer FP, Guimarães CDM, Peixoto AB, Pontes KFM, Bonasoni MP, Tonni G, Araujo Júnior E. Parvovirus B19 Infection and Pregnancy: Review of the Current Knowledge. J Pers Med 2024; 14:139. [PMID: 38392573 PMCID: PMC10890458 DOI: 10.3390/jpm14020139] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Parvovirus B19, a member of the Parvoviridae family, is a human pathogenic virus. It can be transmitted by respiratory secretions, hand-to-mouth contact, blood transfusion, or transplacental transmission. Most patients are asymptomatic or present with mild symptoms such as erythema infectiosum, especially in children. In rare cases, moderate-to-severe symptoms may occur, affecting blood cells and other systems, resulting in anemia, thrombocytopenia, and neutropenia. Non-immune pregnant women are at risk for fetal infection by parvovirus B19, with greater complications if transmission occurs in the first or second trimester. Infected fetuses may not show any abnormalities in most cases, but in more severe cases, there may be severe fetal anemia, hydrops, and even pregnancy loss. Maternal diagnosis of intrauterine parvovirus B19 infection includes IgG and IgM antibody testing. For fetal diagnosis, PCR is performed through amniocentesis. In addition to diagnosing the infection, it is important to monitor the peak of systolic velocity of the middle cerebral artery (PVS-MCA) Doppler to assess the presence of fetal anemia. There is no vaccine for parvovirus B19, and fetal management focuses on detecting moderate/severe anemia by fetal PVS-MCA Doppler, which, if diagnosed, should be treated with intrauterine transfusion by cordocentesis. Prevention focuses on reducing exposure in high-risk populations, particularly pregnant women.
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Affiliation(s)
- Fernanda Parciasepe Dittmer
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil
| | - Clara de Moura Guimarães
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil
| | - Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba 38050-501, MG, Brazil
- Department of Gynecology and Obstetrics, Federal University of Triângulo Mineiro (UFTM), Uberaba 38025-440, MG, Brazil
| | - Karina Felippe Monezi Pontes
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil
- Service of Gynecology and Obstetrics, Ipiranga Hospital, São Paulo 04262-000, SP, Brazil
| | - Maria Paola Bonasoni
- Department of Pathology, Santa Maria Nuova Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 50122 Reggio Emilia, Italy
| | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 42122 Reggio Emilia, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), São Caetano do Sul 09521-160, SP, Brazil
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Pontes KFM, Nardozza LMM, Peixoto AB, Werner H, Tonni G, Granese R, Araujo Júnior E. Cytomegalovirus and Pregnancy: A Narrative Review. J Clin Med 2024; 13:640. [PMID: 38276146 PMCID: PMC10816506 DOI: 10.3390/jcm13020640] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Cytomegalovirus (CMV) infection is the most common congenital infection worldwide, affecting between 0.7% and 1% of all live births. Approximately 11% of infected newborns are symptomatic at birth, and between 30% and 40% of these are at risk of developing long-term neurological sequelae. Until recently, the lack of an effective treatment did not justify universal testing of pregnant women. In recent years, however, valacyclovir at a dose of 8 g/day has been shown to be effective in preventing vertical transmission, and ganciclovir has been shown to be effective in preventing long-term sequelae in the treatment of symptomatic neonates. The aim of this article is to review congenital CMV infection, from its epidemiology to its treatment, using the most recent studies in the literature, and to help in the decision to modify protocols for universal testing of pregnant women according to the possibilities of each locality.
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Affiliation(s)
- Karina Felippe Monezi Pontes
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-900, SP, Brazil; (K.F.M.P.); (L.M.M.N.); (E.A.J.)
- Service of Gynecology and Obstetrics, Ipiranga Hospital, São Paulo 04262-000, SP, Brazil
| | - Luciano Marcondes Machado Nardozza
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-900, SP, Brazil; (K.F.M.P.); (L.M.M.N.); (E.A.J.)
| | - Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mário Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba 38050-501, MG, Brazil;
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba 38025-180, MG, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro 21941-901, SP, Brazil;
| | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 242100 Reggio Emilia, Italy
| | - Roberta Granese
- Obstetrics and Gynecology Unit, Department of Human Pathology of Adult and Childhood “G. Barresi”, University Hospital “G. Martino”, 98124 Messina, Italy;
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-900, SP, Brazil; (K.F.M.P.); (L.M.M.N.); (E.A.J.)
- Discipline of Woman Health, Municipal University of São Caetano do Sul (USCS), Campus Center, São Caetano do Sul 09521-160, SP, Brazil
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Meloni P, Simari T, Roberta L, Cassella I, Brizio R, Conturso R, Russo D, Araujo Júnior E, Tonni G. Occult invasive cervical cancer, FIGO stage III, with a negative Pap smear test - clinical presentation and brief review of the literature. Ceska Gynekol 2024; 89:34-39. [PMID: 38418251 DOI: 10.48095/cccg202434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Occult cervical cancer is rare and is diagnosed incidentally after a simple hysterectomy. The staging upon histological examination is usually International Federation of Gynecology and Obstetrics (FIGO) stage I, rarely higher with negative preoperative diagnostic tests such as a Pap smear. The clinical case in question is a rare case of cervical carcinoma diagnosed at the time of hysterectomy with a negative exo-endocervical Pap smear, diagnostic tests including transvaginal ultrasound, abdominal magnetic resonance imaging and abdominal computed tomography with a diagnosis of degenerating myoma or suspected sarcoma. In the operating theatre, the surgical radicality was modified and the operation was completed with removal of the parameters, vaginal collar and bilateral pelvic lymphadenectomy. The final histological examination indicated FIGO stage III, for which the patient underwent radiotherapy and chemotherapy.
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Tonni G, Sepulveda W. Cleft Lip and Cleft Palate: Time to Include Orofacial Ultrasound Markers Into the First-Trimester Anatomy Scan? J Ultrasound Med 2023; 42:2905-2909. [PMID: 37551869 DOI: 10.1002/jum.16310] [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: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 08/09/2023]
Abstract
Orofacial clefts are one of the most common congenital malformations. The prenatal diagnosis is often made in the second trimester of pregnancy as result of ultrasound examination of the midface on coronal and axial planes. However, the diagnosis in the first trimester is elusive due to the small size of the facial structures and technical limitations present at this early gestational age. In this Commentary, we suggest the routine systematic ultrasound identification of easy-to-obtain landmarks to improve the detection of cleft lip and cleft palate in the first trimester. These include, but are not limited to, visualization of the primary palate using the coronal plane of the face looking for disruption at the base of the retronasal triangle, and visualization of the palate using the sagittal plane looking for the maxillary gap and loss of the superimposed line. Early prenatal detection of orofacial clefts would allow a more detailed search for associated chromosomal anomalies or genetic syndromes.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
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Araujo Júnior E, Coutinho LG, Bravo-Valenzuela NJ, Aquino P, Rocha LAD, Rizzo G, Tonni G, Respondek-Liberska M, Slodki M, Wolter A, Axt-Fliedner R. Ectopia cordis: prenatal diagnosis, perinatal outcomes, and postnatal follow-up of an international multicenter cohort case series. J Matern Fetal Neonatal Med 2023; 36:2203791. [PMID: 37080921 DOI: 10.1080/14767058.2023.2203791] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
OBJECTIVE This study aimed to analyze prenatal diagnosis, perinatal outcomes, and postnatal follow-up in fetuses with ectopia cordis (EC). METHODS This retrospective analysis accessed 31 patients with EC who were either diagnosed or referred to a tertiary Fetal Medicine centers for EC diagnosis in Brazil, Germany, Italy, and Poland. We analyzed prenatal diagnosis, perinatal outcomes, and follow-up in these patients. RESULTS Our study included a cohort of 31 fetuses with EC, 4 and 27 of whom had partial and complete protrusion of the heart through a ventral defect in the thoracoabdominal wall, respectively. EC was diagnosed by fetal echocardiography at a mean gestational age of 20.3 ± 8.6 weeks (range, 8-35 weeks). Of the four cases, in which the karyotype was performed, all of them had a normal result (1 - 46,XX and 3 - 46,XY). Five patients showed conotruncal abnormalities and six ventricular septal defects. Termination of pregnancy (TOP) was performed in 15 cases (48%) and seven pregnant women had spontaneous fetal demise (22.5%). Of the seven fetuses that were born alive, four of them died, and three infants underwent surgery. Among these three infants, all of them survived, one was 5 months, 13 years old and 29 years old at the time of study completion. CONCLUSIONS Ectopia cordis is associated with high mortality rates and intracardiac/extra-cardiac defects. Ventricular septal defects and conotruncal anomalies were the more common intracardiac defects associated with EC. However, in this cohort of fetuses with EC the incidence of PC was lower than reported in the literature.
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Affiliation(s)
- Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
| | - Luiza Graça Coutinho
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Department of Pediatrics, Pediatric Cardiology, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Postgraduate Program in Health Sciences (Fetal Medicine), Itinerant Continuing Medical Education, Rio de Janeiro, Brazil
| | - Patrícia Aquino
- Postgraduate Program in Health Sciences (Fetal Medicine), Itinerant Continuing Medical Education, Rio de Janeiro, Brazil
| | - Luciane Alves da Rocha
- Postgraduate Program in Health Sciences, Medical School, Federal University of Amazonas (UFAM), Manaus, Brazil
| | - Giuseppe Rizzo
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Respondek-Liberska
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
- Prenatal Cardiology Department, Research Institute Polish Mother's Memorial Hospital, Lodz, Poland
| | - Maciej Slodki
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
- Prenatal Cardiology Department, Research Institute Polish Mother's Memorial Hospital, Lodz, Poland
- Faculty of Health Sciences, The Masovian State University, Plock, Poland
| | - Aline Wolter
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University-Hospitals Giessen and Marburg Campus, Giessen, Germany
| | - Roland Axt-Fliedner
- The International Prenatal Cardiology Collaboration Group, Lodz, Poland
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University-Hospitals Giessen and Marburg Campus, Giessen, Germany
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Tonni G, Pinto A, Bianchi A, Pisello M, Grisolia G. 3D ultrasound angioscan with MV-Flow™: Enhancing fetal brain low-flow microvascular neuroimaging. J Clin Ultrasound 2023; 51:1502-1504. [PMID: 37728339 DOI: 10.1002/jcu.23563] [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: 08/25/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
MVFlow™ is a 3D algorithm that enhances the study of the microvasculature, useful in the study of tumoral lesions or in assessing the slow-flow of the placenta vessels and the developing fetal brain. It may improve the study of the corpus callosum in normal fetuses and be applied in the characterization of brain pathologies.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology, and Researcher, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Unita' Sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy
| | - Alessia Pinto
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | - Annalisa Bianchi
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | - Marlene Pisello
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy
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Tonni G, Grisolia G. Should we introduce 3D ultrasound in the assessment of fetal cavum septum pellucidum? J Clin Ultrasound 2023; 51:1472-1474. [PMID: 37707417 DOI: 10.1002/jcu.23560] [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: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology, and Researcher, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, AST Mantova, Mantua, Italy
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Scappa JPC, Peixoto AB, Bravo-Valenzuela NJ, Tonni G, Mattar R, Araujo Júnior E. Area of the Fetal Ascending and Descending Aorta by Spatiotemporal Image Correlation in the Rendering Mode: Reproducibility and Comparison with Pregestational Diabetic Mothers. J Med Ultrasound 2023; 31:298-304. [PMID: 38264598 PMCID: PMC10802868 DOI: 10.4103/jmu.jmu_102_22] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/14/2022] [Accepted: 03/21/2023] [Indexed: 01/25/2024] Open
Abstract
Background The objective of this study was to assess the ascending and descending aorta area measurements by three-dimensional (3D) ultrasound using spatiotemporal image correlation (STIC) in the rendering mode comparing these measurements with pregestational diabetic mothers and assessing the reproducibility of the method. Methods We carried out a retrospective cross-sectional study with 58 normal and nine fetuses from pregestational diabetic mothers between 20 and 33 + 6 weeks of gestation. Fetal heart volumes were acquired at the level of four-chamber view to obtain the reconstructed planes for the ascending and descending aorta areas in the rendering mode. Linear regression was performed to assess the correlation between the fetal aorta areas and gestational age (GA). To assess the intra- and interobserver reproducibility, we used the concordance correlation coefficient (CCC). Results The mean ascending and descending aorta areas were 0.12 (0.02-0.48) and 0.11 (0.04-0.39) cm2 in normal fetuses, respectively. There was a moderate positive correlation between GA and ascending aorta area measurements (0.005676*GA - 0.01283; r = 0.53, P < 0.0001) and strong positive correlation between GA and descending aorta area (0.01095*GA - 0.1581; r = 0.68, P < 0.0001). We observed a weak intra- and interobserver reproducibility with CCC ranging from 0.05 to 0.91. The mean difference in the ascending and descending aorta area measurements of normal and fetuses of pregestational diabetic mothers was -0.03 cm2 (P = 0.276) and -0.03 cm2 (P = 0.231), respectively. Conclusion The fetal ascending and descending aorta area measurements obtained by 3D ultrasound using STIC in the rendering mode increased with GA in normal fetuses. The method showed weak intra- and interobserver reproducibility.
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Affiliation(s)
- João Pedro Cassin Scappa
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mario Palmério University Hospital – University of Uberaba (UNIUBE), Uberaba, Minas Gerais, Brazil
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Department of Pediatrics, Pediatric Cardiology, School of Medicine, Federal University of Rio De Janeiro, Rio De Janeiro, Brazil
| | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto Di Ricovero E Cura A Carattere Scientifico, Ausl Di Reggio Emilia, Reggio Emilia, Italy
| | - Rosiane Mattar
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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Tonni G, Lituania M, Cecchi A, Carboni E, Resta S, Bonasoni MP, Ruano R. Umbilical Cord Diseases Affecting Obstetric and Perinatal Outcomes. Healthcare (Basel) 2023; 11:2634. [PMID: 37830671 PMCID: PMC10572758 DOI: 10.3390/healthcare11192634] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND (1) The aim of this article is to describe the physiopathology underlying umbilical cord diseases and their relationship with obstetric and perinatal outcomes. (2) Methods: Multicenter case series of umbilical cord diseases with illustrations from contributing institutions are presented. (3) Results: Clinical presentations of prenatal ultrasound findings, clinical prenatal features and postnatal outcomes are described. (4) Conclusions: Analysis of our series presents and discusses how umbilical cord diseases are associated with a wide variety of obstetric complications leading to a higher risk of poor perinatal outcomes in pregnancies. Knowing the physiopathology, prenatal clinical presentations and outcomes related to umbilical diseases allow for better prenatal counseling and management to potentially avoid severe obstetric and perinatal complications.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 42100 Reggio Emilia, Italy
| | - Mario Lituania
- Preconceptional and Prenatal Pathophysiology, Department of Obstetrics and Gynecology, E.O. Ospedali Galliera, 16128 Genoa, Italy;
| | - Alessandro Cecchi
- Department of Obstetrics and Gynecology, Regional Prenatal Diagnostic 2 Level Center, ASUR Loreto Hospital, 60025 Loreto, Italy; (A.C.); (E.C.)
| | - Elisa Carboni
- Department of Obstetrics and Gynecology, Regional Prenatal Diagnostic 2 Level Center, ASUR Loreto Hospital, 60025 Loreto, Italy; (A.C.); (E.C.)
| | - Serena Resta
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Tor Vegata, 00133 Rome, Italy;
| | - Maria Paola Bonasoni
- Department of Pathology, Santa Maria Nuova Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 42100 Reggio Emilia, Italy;
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
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15
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Tonni G, Grisolia G. Simulator, machine learning, and artificial intelligence: Time has come to assist prenatal ultrasound diagnosis. J Clin Ultrasound 2023; 51:1164-1165. [PMID: 37354115 DOI: 10.1002/jcu.23512] [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: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023]
Abstract
In this Commentary authors investigated and extended the role of simulator in assisting obstetric sonographers in training program. The interconnection of different digitalized technologies such as digital data, artificial neuronal and convolutional networks, machine and deep learning, telemedicine, and output are discussed and contribute to the generation of artificial intelligence.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology, and Researcher, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, ASST Mantova, Mantua, Italy
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16
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Tonni G, Koçak Ç, Grisolia G, Rizzo G, Araujo Júnior E, Werner H, Ruano R, Sepulveda W, Bonasoni MP, Lituania M. Clinical Presentations and Diagnostic Imaging of VACTERL Association. Fetal Pediatr Pathol 2023; 42:651-674. [PMID: 37195727 DOI: 10.1080/15513815.2023.2206905] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/18/2023]
Abstract
Background: VACTERL association consists of Vertebral, Anorectal, Cardiac, Tracheo-Esophageal, Renal, and Limb defects. The diagnosis depends on the presence of at least three of these structural abnormalities. Methods: The clinical presentation and diagnostic prenatal imaging of VACTERL association are comprehensively reviewed. Results: The most common feature is a vertebral anomaly, found in 60-80% of cases. Tracheo-esophageal fistula is seen in 50-80% of cases and renal malformations in 30% of patients. Limb defects including thumb aplasia/hypoplasia, polydactyly, and radial agenesis/hypoplasia are present in 40-50% of cases. Anorectal defects, like imperforate anus/anal atresia, are challenging to detect prenatally. Conclusion: The diagnosis of VACTERL association mostly relies on imaging techniques such as ultrasound, computed tomography, and magnetic resonance. Differential diagnosis should exclude similar diseases such as CHARGE and Townes-Brocks syndromes and Fanconi anemia. New insights into genetic etiology have led to recommendations of chromosomal breakage investigation for optimal diagnosis and counseling.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology and Researcher, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Çağla Koçak
- Faculty of Medicine, Düzce Medical School, Duzce, Turkey
| | - Gianpaolo Grisolia
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Carlo Poma Hospital, Mantua, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Policlinic Hospital, University of Tor Vergata, Rome, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics and Gynecology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Heron Werner
- Laboratorio de Biodesign (Dasa/PUC-Rio), Alta Excelência Diagnostica, Rio de Janeiro, RJ, Brazil
| | - Rodrigo Ruano
- Fetal Surgery, Department of Maternal and Fetal Medicine, Obstetrics and Gynecology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Waldo Sepulveda
- FETALMED, Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Maria Paola Bonasoni
- Pathology Unit, Santa Maria Nuova Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Mario Lituania
- Preconceptional and Prenatal Physiopathology, Department of Maternal & Neonatology, E.O. Ospedali Galliera, Genoa, Italy
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17
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Tonni G. Reply. Ultrasound Obstet Gynecol 2023; 62:158. [PMID: 37391930 DOI: 10.1002/uog.26281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Affiliation(s)
- G Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
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18
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Castro PT, Werner H, Araujo Júnior E, Bonasoni MP, Tonni G. Prenatal and Postnatal Zika Intrauterine Infection: Diagnostic Imaging Techniques and Placental Pathology. Fetal Pediatr Pathol 2023; 42:207-215. [PMID: 36125260 DOI: 10.1080/15513815.2022.2118559] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction: Zika virus (ZIKV) is an arbovirus (arthropod-borne virus) in the genus Flavivirus and Flaviviridae family. In November 2015, several cases of microcephaly in Northeastern of Brazil suggested ZIKV involvement. Case Report: A 33-year-old primigravida developed fever and cutaneous rash at 7th week of gestation (WGA). The ultrasound and MRI examination showed head circumference < 5th centile and enlargement of lateral ventricles. The infant was delivered at 39th WGA with microcephaly. Microscopy of the placenta showed chronic villitis and intervillitis, nodular stromal fibrosis in the stem villi, and vascular thickening. Postnatal CT showed collapsed cranium due to growth impairment of the suprathalamic brain, multiple cerebral calcifications, parenchymal atrophy, and ventricular dilatation. Now, at 6 years old, the child suffers from severe neurologic symptoms, including seizures. Conclusion: This case gathers images of prenatal and postnatal period, and placental histopathology. The long-term follow-up highlights the dramatic neurological sequelae induced by ZIKV.
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Affiliation(s)
- Pedro Teixeira Castro
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | | | - Gabriele Tonni
- Department of Obstetrics and Neonatology and Researcher, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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19
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Pontes ALS, Chagas CC, Bravo-Valenzuela NJ, Peixoto AB, Mappa I, Rizzo G, Tonni G, Araujo Júnior E. Fetal heart foramen ovale area by three-dimensional ultrasound using stic in the rendering mode: reference range and applicability in congenital heart diseases. Int J Cardiovasc Imaging 2023; 39:531-539. [PMID: 36334212 DOI: 10.1007/s10554-022-02752-3] [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: 08/04/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
To determine reference values for the foramen ovale (FO) area of fetal hearts by three-dimensional (3D) ultrasound using spatio-temporal image correlation (STIC) method in the rendering mode, as well as applicability in fetuses with congenital heart disease (CHD). A retrospective and prospective study was performed of 242 normal fetuses and 36 fetuses with CHD between 20 and 33 + 6 weeks of gestation. The FO area was determined in the four-chamber view with manual delineation. To determine the reference curve of the FO area as a function of gestational age (GA), a linear regression model was utilized with an adjusted coefficient of determination (R2). For intra- and interobserver reproducibility calculations, the concordance correlation coefficient (CCC) was used. The mean ± standard deviation (SD) of the FO measurement area was 21.2 ± 1.8 and 48.1 ± 1.9 mm2 at 20 and 33 weeks' gestation, respectively. A linear correlation was observed between the FO area and GA (1.924*GA - 17.95; R2 = 0.91). Good intra- (CCC = 0.97) and interobserver (CCC = 0.94) agreement was observed for the FO area measurement. The mean difference in FO area between normal and CHD fetuses was - 14.4 mm2 (p < 0.001). Reference values for the FO area of fetal hearts were determined by 3D ultrasound using STIC in the rendering mode. This method showed good intra- and interobserver reproducibility and could be used to assess different CHD types.
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Affiliation(s)
- Ana Letícia Siqueira Pontes
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM- UNIFESP), São Paulo, SP, Brazil
| | - Caroline Cervantes Chagas
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM- UNIFESP), São Paulo, SP, Brazil
| | - Nathalie Jeanne Bravo-Valenzuela
- Department of Pediatrics, Pediatric Cardiology, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro-RJ, Brazil
| | - Alberto Borges Peixoto
- Gynecology and Obstetrics Service, Mario Palmério University Hospital - University of Uberaba (UNIUBE), Uberaba, MG, Brazil
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM- UNIFESP), São Paulo, SP, Brazil.
- , Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, Vila Leopoldina, Sao Paulo, SP, CEP 05089-030, Brazil.
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20
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Tonni G, Grisolia G, Rizzo G, Ruano R, Sepulveda W. 'Turkish turban' sign: rare phenotype of acrania-exencephaly-anencephaly sequence. Ultrasound Obstet Gynecol 2023; 61:417-418. [PMID: 36178772 DOI: 10.1002/uog.26086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Linked article: There is a comment on this article by Demir et al. Click here to view the Correspondence.
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Affiliation(s)
- G Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - G Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, ASST Mantova, Mantua, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - R Ruano
- Department of Obstetrics and Maternal-Fetal Medicine, UH Jackson Fetal Care, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - W Sepulveda
- FETALMED Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
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21
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Tonni G, Grisolia G, Bonasoni MP, Rizzo G, Werner H, Sepulveda W, Ruano R, Araujo Júnior E. Fetal Hands: A Comprehensive Review of Prenatal Assessment and Diagnosis Over the Past 40 Years. Ultrasound Med Biol 2023; 49:657-676. [PMID: 36526543 DOI: 10.1016/j.ultrasmedbio.2022.09.022] [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: 05/11/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 06/17/2023]
Abstract
Fetal skeletal dysplasias involving limbs and hands are rare congenital malformations. Prenatal two-dimensional ultrasound diagnosis of fetal limb defects has a sensitivity of about 30%; however, an increased detection rate may be obtained using three-dimensional (3-D) ultrasound in the rendering mode. 3-D ultrasound may be used as a complementary method providing additional information. Currently, magnetic resonance imaging (MRI), with the emergence of ultrafast imaging techniques and new sequences, allows for better diagnosis of several fetal skeletal dysplasias such as limb reduction defects and neuromuscular disorders. 3-D volumetric images from ultrasound or MRI scan data allow 3-D ultrasound reconstructions of virtual/physical models, and virtual reality can help researchers to improve our understanding of both normal and abnormal fetal limb/hand anatomy. In this article, we review the embryological development of fetal hands and their main anomalies including prenatal diagnostic methods, genetic counseling, the role of orthopedic and plastic surgery reconstruction, and new perspectives in fetal surgery.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy.
| | - Gianpaolo Grisolia
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Carlo Poma Hospital, Mantua, Italy
| | - Maria Paola Bonasoni
- Human Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI-DASA), Rio de Janeiro, Brazil
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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22
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Rizzo G, Tonni G. Advances in Maternal-Fetal Imaging. J Clin Ultrasound 2023; 51:213-214. [PMID: 36785502 DOI: 10.1002/jcu.23424] [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] [Accepted: 01/03/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Giuseppe Rizzo
- Chairman, Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome, Reggio Emilia, Italy
| | - Gabriele Tonni
- Department of Obstetrics and Gynecology, Istituto di Ricovero e Cura a Carettere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
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23
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Sepulveda W, Garcia-Rodriguez R, Martinez-Ten P, Tonni G, Grisolia G, Meagher S. Basic sonographic examination of the fetal brain at 11-13 weeks' gestation: Rationale for a simple and reliable four-step technique. J Clin Ultrasound 2023; 51:300-310. [PMID: 36785499 DOI: 10.1002/jcu.23337] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/17/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 06/18/2023]
Abstract
The widespread incorporation of first-trimester scanning between 11 and 13 weeks' gestation has shifted from the screening of chromosomal abnormalities, mainly by measuring nuchal translucency thickness and visualization of the nasal bone, to a more detailed study of the fetal anatomy leading to early detection of several structural congenital anomalies. This goal can be improved by the routine and focused sonographic assessment of specific anatomic planes and the identification of distinctive landmarks that can help disclosing a particular, non-evident condition. In this article we present the basis for a basic, early examination of the fetal brain during screening using a four-step technique, which can be readily incorporated during the first-trimester scan. The technique includes the focused visualization of the cranial contour, choroid plexuses of the lateral ventricles and midline, aqueduct of Sylvius, brainstem, fourth ventricle, and the choroid plexus of the fourth ventricle. The rationale for this approach is presented and discussed.
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Affiliation(s)
- Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Raquel Garcia-Rodriguez
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Pilar Martinez-Ten
- DELTA-Ultrasound Diagnostic Center for Obstetrics and Gynecology, Madrid, Spain
| | - Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Cura e Ricovero a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Mantua, Italy
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Tonni G, Peixoto AB, Werner H, Grisolia G, Ruano R, Sepulveda F, Sepulveda W, Araujo Júnior E. Ultrasound and fetal magnetic resonance imaging: Clinical performance in the prenatal diagnosis of orofacial clefts and mandibular abnormalities. J Clin Ultrasound 2023; 51:346-361. [PMID: 36785498 DOI: 10.1002/jcu.23403] [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: 09/28/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 06/18/2023]
Abstract
Cleft lip, with or without cleft palate, is the most common congenital craniofacial anomaly and the second most common birth defect worldwide. Micrognathia is a rare facial malformation characterized by small, underdeveloped mandible and frequently associated with retrognathia. Second- and third-trimester prenatal ultrasound is the standard modality for screening and identification of fetal orofacial abnormalities, with a detection rate in the low-risk population ranging from 0% to 73% for all types of cleft. The prenatal ultrasonography detection can also be performed during the first trimester of pregnancy. Given the potential limitations of obstetric ultrasound for examining the fetal face, such as suboptimal fetal position, shadowing from the surrounding bones, reduce amniotic fluid around the face, interposition of fetal limbs, umbilical cord and placenta, and maternal habitus/abdominal scars, the use of adjunct imaging modalities can enhance prenatal diagnosis of craniofacial anomalies in at-risk pregnancies. Fetal magnetic resonance imaging (MRI) is a potentially useful second-line investigation for the prenatal diagnosis of orofacial malformations with a pooled sensitivity of 97%. In this review, we discuss the role of ultrasound and fetal MRI in the prenatal assessment of abnormalities of the upper lip, palate, and mandible.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, Brazil
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, UH Jackson Fetal Care, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Francisco Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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25
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Tonni G, Rizzo G. Bronchopulmonary dysplasia: Can we provide a link between prenatal and postnatal lung ultrasound? J Clin Ultrasound 2022; 50:1328-1330. [PMID: 36353904 DOI: 10.1002/jcu.23221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 06/16/2023]
Abstract
The role of lung ultrasound in the prediction of bronchopulmonary dysplasia.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology, Prenatal Diagnosis Center & Researcher, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy, University of Tor Vergata, Rome, Italy
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Tonni G, Bonasoni MP, Grisolia G, Bellotti M, Araujo Júnior E. Heterotaxy Syndrome with Increased Nuchal Translucency and Normal Karyotype Associated with Complex Systemic Venous Return. Ultrasound Diagnosis with Autopsy Correlation. Fetal Pediatr Pathol 2022; 41:852-860. [PMID: 34629036 DOI: 10.1080/15513815.2021.1988011] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: Prenatal ultrasound (US) detection of heterotaxy syndrome can be challenging, especially in identifying cardiovascular and associated anomalies. We present a new case of heterotaxy syndrome with anomalous systemic venous return (ASVR) fully displayed at autopsy. Case report: Left heterotaxy syndrome was diagnosed in a 19 weeks' of gestation fetus with right-sided stomach. The heart showed both ventricles with left morphology, a large ventricular septal defect, persistent left superior vena cava draining into the coronary sinus, ASVR with interrupted inferior vena cava (IVC) and azygous continuation. Autopsy dissection further identified the azygous draining into the left lower pulmonary vein (LLPV). Prenatal a-CGH on villous sampling showed 22q13.1 microduplication inherited from the father, not contributory to the phenotype. Conclusion/discussion: Heterotaxy syndrome requires US accuracy for anomaly identification, as they allow legal termination of pregnancy. Our case is unusual as IVC drained into the azygous vein and then into the LLPV.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Paola Bonasoni
- Department of Pathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Mantua, Italy
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), Sao Paulo, Brazil
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Tonni G, Viviani D, Bellanca E. Present and Future Perspectives of Urogynecology. CLIN EXP OBSTET GYN 2022. [DOI: 10.31083/j.ceog4909210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tonni G, Grisolia G, Pisello M, Zampriolo P, Fasolato V, Sindico P, Araújo Junior E, Bonasoni MP. Congenital Syphilis Presenting with Brain Abnormalities at Neuroscan: A Case Report and a Brief Literature Review. Microorganisms 2022; 10:microorganisms10081497. [PMID: 35893555 PMCID: PMC9330733 DOI: 10.3390/microorganisms10081497] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/13/2022] [Accepted: 07/20/2022] [Indexed: 02/04/2023] Open
Abstract
A case of vertical transmission in a 35-year-old pregnant woman, gravida 4, para 2 with an unknown medical history of carrying primary syphilis is described. A routine 3rd trimester scan was performed at 30 + 5 weeks of pregnancy, which revealed fetal growth restriction (FGR) associated with absent fetal movement, a pathologic neuroscan characterized by cortical calcifications and ominous Doppler waveform analysis of the umbilical artery and ductus venosus. Computerized electronic fetal monitoring (EFM) showed a Class III tracing, according to the American College of Obstetricians and Gynecologists (ACOG) guidelines. An emergency C-section was performed and a female newborn weighing 1470 g was delivered. The Apgar scores were 5 and 8 at the first and fifth min, respectively. Besides the prompted obstetrical and neonatal interventions, the neonate died after 7 days. A histologic examination of the placenta revealed a chorioamnionitis at stage 1/2 and grade 2/3. The parenchyma showed diffuse delayed villous maturation, focal infarcts, and intraparenchymal hemorrhages. The decidua presented with chronic deciduitis with plasma cells. The parents declined the autopsy. Congenital syphilis is an emerging worldwide phenomenon and the multidisciplinary management of the mother and the fetus should be mandatory.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology and Researcher, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 42122 Reggio Emilia, Italy
- Correspondence:
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, ASST Mantova, 46100 Mantova, Italy; (G.G.); (M.P.); (P.Z.)
| | - Marlene Pisello
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, ASST Mantova, 46100 Mantova, Italy; (G.G.); (M.P.); (P.Z.)
| | - Paolo Zampriolo
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, ASST Mantova, 46100 Mantova, Italy; (G.G.); (M.P.); (P.Z.)
| | - Valeria Fasolato
- Neonatal Intensive Care Unit (NICU), Carlo Poma Hospital, ASST Mantova, 46100 Mantova, Italy; (V.F.); (P.S.)
| | - Paola Sindico
- Neonatal Intensive Care Unit (NICU), Carlo Poma Hospital, ASST Mantova, 46100 Mantova, Italy; (V.F.); (P.S.)
| | - Edward Araújo Junior
- Department of Obstetrics, Universitade Federal de Sao Paulo, Sao Paulo 04021-001, Brazil;
| | - Maria Paola Bonasoni
- Pathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, 42122 Reggio Emilia, Italy;
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Bonasoni MP, Comitini G, Tonni G, Asioli S, Barbieri V, Rinaldini M, Marinelli M. Prenatal Diagnosis of Fetal Trisomy 5 Mosaicism with Congenital Pulmonary Airway Malformation Type 3: A Case Report. Fetal Pediatr Pathol 2022; 41:516-522. [PMID: 33411590 DOI: 10.1080/15513815.2020.1831660] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Trisomy mosaicism of chromosome 5 is uncommon with few cases described. Case report: A 41-year-old woman underwent ultrasound (US) at 16 weeks, which showed oligohydramnios and intrauterine growth restriction (IUGR). Amniocentesis discovered a karyotype of 47,XX,+5/46,XX. US at 19 weeks disclosed IUGR, enlargement of right side of heart, main pulmonary artery dilatation, and a suspected congenital pulmonary airway malformation (CPAM) in the inferior lobe of the left lung. Due to poor fetal prognosis, the parents opted for legal termination of pregnancy. At postmortem, a wide ventricular septal defect and CPAM type 3 were found. Cytogenetic analyses on fetal tissues detected mosaic trisomy 5 in skin, thymus, kidneys and CPAM. Placenta and fetal peripheral blood revealed normal female karyotype. Discussion/conclusion: These results suggest that if a fetus presents normal phenotypic features, mosaicism may be confined to extraembryonic structures, otherwise, in case of malformations, it may be carried by affected organs.
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Affiliation(s)
- Maria Paola Bonasoni
- Pathology, Azienda Unita Sanitaria Locale-IRCCS Tecnologie Avanzate e Modelli Assistenziali in Oncologia di Reggio Emilia, Italy
| | | | - Gabriele Tonni
- Obstetrics and Gynecology, Azienda Unità Sanitaria Locale di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Asioli
- Pathology, Azienda Unita Sanitaria Locale della Romagna Forli, Italy
| | - Veronica Barbieri
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Monia Rinaldini
- Cytogenetics Laboratory, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Marinelli
- Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Tonni G, Aguzzoli L. Should we include sonographic adnexal torsion score in gynecologic practice? J Clin Ultrasound 2022; 50:532-534. [PMID: 35521924 DOI: 10.1002/jcu.23179] [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: 02/16/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology, Prenatal Diagnostic Center & Researcher, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Department of Obstetrics, Gynecology, Santa Maria Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL di Reggio Emilia, Reggio Emilia, Italy
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Duete ÚR, Brunetta DM, Araujo Júnior E, Tonni G, Carvalho FHC. Maternal-fetal alloimmunization: perinatal outcomes in a reference hospital in Northeastern Brazil. Rev Assoc Med Bras 2022; 68:670-674. [DOI: 10.1590/1806-9282.20220047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/01/2022] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Edward Araujo Júnior
- Universidade Federal de São Paulo, Brazil; Universidade Municipal de São Caetano do Sul, Brazil
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Tonni G, Grisolia G, Baldi M, Bonasoni M, Ginocchi V, Rolo LC, Araujo Júnior E. Early Prenatal Ultrasound and Molecular Diagnosis of Apert Syndrome: Case Report with Postmortem CT-Scan and Chondral Plate Histology. Fetal Pediatr Pathol 2022; 41:281-292. [PMID: 32538685 DOI: 10.1080/15513815.2020.1775732] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background Apert syndrome is characterized by craniosynostosis, midface hypoplasia and symmetric syndactyly. Case report: A 36-year-old mother, G2P1 underwent an ultrasound scan at 19 week's gestation. There was craniosynostosis, brachi-turricephaly and bilateral hand syndactyly. Genomic DNA from amniocentesis revealed the mutation C758C>Gp. (Pro to Arg substitution) at 252 of the exon 8 of the FGFR2 encoding for Apert syndrome. The pregnancy was terminated. Femoral chondral plate histology showed an increased interstitial matrix between bony trabeculae. Compared with normal, the trabeculae were thinner, more irregular with numerous osteoclasts suggesting abnormal bone remodeling. Hands and feet had an abrupt transition between resting and proliferating cartilage. Conclusion: Apert syndrome has increased intertrabecular matrix, thin trabeculae, increased remodeling, and irregular transition between the maturing and mineralization zones in the femur, and abnormal abrupt transition between the resting and proliferating cartilage in the fingers and toes.
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Affiliation(s)
- Gabriele Tonni
- Azienda Unità Sanitaria Locale di Reggio Emilia, Obstetrics and Gynecology, Istituto di Ricerca a Carattere Clinico Scientifico (IRCCS), Reggio Emilia, Italy
| | - Gianpaolo Grisolia
- Obstetrics and Gynecology, Azienda Ospedaliera Carlo Poma, Mantova, Italy
| | - Maurizia Baldi
- Human Genetic Laboratory, Istituto Giannina Gaslini, Genova, Italy
| | | | - Vladimiro Ginocchi
- Radiology, Guastalla Civil Hospital, Azienda Unità Sanitaria Locale di Reggio Emilia, Istituto di Ricerca a Carattere Clinico Scientifico (IRCCS), Reggio Emilia, Italy
| | - Liliam Cristine Rolo
- Obstetrics and Gynecology, Universidade Federal de Sao Paulo Hospital Sao Paulo, Sao Paulo, Brazil
| | - Edward Araujo Júnior
- Obstetrics, Federal University of Sao Paulo Paulista Medical School, Sao Paulo, Brazil
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Bonasoni P, Tonni G, Comitini G, Barbieri V, Rinaldini M, Marinelli M. Mosaic Trisomy 12: Prenatal Diagnosis at Amniocentesis and Molecular Genetic Analysis on Fetal Tissues. Fetal Pediatr Pathol 2022; 41:299-305. [PMID: 32609035 DOI: 10.1080/15513815.2020.1786199] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Mosaic trisomy 12 is a genetic condition with few cases diagnosed prenatally and postnatally. Phenotypic variability is wide ranging from normal patients to severe congenital anomalies. Case report: A 35-year-old woman underwent amniocentesis at 17 weeks of gestation because of advanced maternal age. Prenatal ultrasound was negative. Cultured amniocytes revealed a karyotype of 47,XX,+12/46,XX. Parents opted for termination of pregnancy at 22 weeks. Postmortem revealed dysmorphic face; hands with broad thumbs and incomplete transverse palmar creases; partial anomalous pulmonary venous return, intestinal malrotation, and bicornuate uterus. Histologically, no anomalies were identified. Cytogenetic analyses on fetal tissues detected mosaic trisomy 12 in thymus, lung, brain, kidney, placenta, and cord blood. Discussion/Conclusion: We report a new case of mosaic trisomy 12 with non-lethal morphological findings not previously described. Although prenatal ultrasound may be negative, genetic counseling should consider minor abnormalities and widespread presence of trisomic cell lines in various internal organs.
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Affiliation(s)
- Paola Bonasoni
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gabriele Tonni
- Department of Obstetrics & Gynaecology, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppina Comitini
- Department of Obstetrics & Gynaecology, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Veronica Barbieri
- Medical Genetics Laboratory, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Monia Rinaldini
- Medical Genetics Laboratory, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Marinelli
- Medical Genetics Laboratory, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Tonni G, Grisolia G. Can fetal ultrasound and MRI predict outcome after fetal endoscopic tracheal occlusion for isolated severe congenital diaphragmatic hernia? J Clin Ultrasound 2022; 50:191-192. [PMID: 35148005 DOI: 10.1002/jcu.23124] [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: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology, Prenatal Diagnostic Center & Researcher, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, Mantua, Italy
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Tonni G, Ruano R. Fetal cholelithiasis: What we know to counsel parents? J Clin Ultrasound 2022; 50:80-81. [PMID: 35043441 DOI: 10.1002/jcu.23109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology, Prenatal Diagnosis Center & Researcher, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL di Reggio Emilia, Reggio Emilia, Italy
| | - Rodrigo Ruano
- Division of Maternal-Fetal, Department of Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Peixoto AB, Bravo-Valenzuela NJ, Martins WP, Tonni G, Mattar R, Moron AF, Pares DB, Araujo Júnior E. Reference ranges for the fetal mitral, tricuspid, and interventricular septum annular plane systolic excursions (mitral annular plane systolic excursion, tricuspid annular plane systolic excursion, and septum annular plane systolic excursion) between 20 and 36 + 6 weeks of gestation. J Perinat Med 2020; 48:601-608. [PMID: 32609650 DOI: 10.1515/jpm-2020-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/24/2020] [Indexed: 02/07/2023]
Abstract
Objectives This study aimed to establish reference ranges for fetal mitral, tricuspid, and interventricular septum annular plane systolic excursions (MAPSE, TAPSE, and SAPSE) in normal pregnant women between 20 and 36 + 6 weeks of gestation. Methods This prospective and cross-sectional study included 360 low-risk singleton pregnancies between 20 and 36 + 6 weeks of gestation. MAPSE, TAPSE, and SAPSE were measured by M-mode in real time in an apical or basal four-chamber view through placing the cursor at the atrioventricular junction, marked by the valve rings at the tricuspid, mitral, and basal septum, respectively. A regression analysis was done to determine the appropriate polynomial equation model for both measurements and standard deviation (SD) values in relation to gestational age (GA). The intra- and inter-observer reproducibility was evaluated using the concordance correlation coefficient (CCC) and limits of agreement (LoA). Results There was a significant positive correlation between MAPSE (r=0.705, p<0.0001), TAPSE (r=0.804, p<0.0001), and SAPSE (r=0.690, p<0.0001) and GA. The mean of each parameter ranged as follows: 2.87-5.56 mm, MAPSE; 3.98-8.07 mm, TAPSE; and 2.34-4.21 mm, SAPSE. Poor/moderate intra- and inter-observer reliability (CCC between 0.70 and 0.90) and poor/moderate agreement of all the tested parameters were evaluated (LoA between 10 and 50%). Conclusions Reference values were established for the fetal MAPSE, TAPSE, and SAPSE between 20 and 36 + 6 weeks of gestation in low-risk pregnant women. These parameters showed poor/moderate reproducibility.
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Affiliation(s)
- Alberto Borges Peixoto
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.,Gynecology and Obstetrics Service, Mario Palmério University Hospital - University of Uberaba (UNIUBE), Uberaba-MG, Brazil.,Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
| | | | | | - Gabriele Tonni
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL Reggio Emilia, Guastalla, Italy
| | - Rosiane Mattar
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - David Baptista Pares
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
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Peixoto AB, Bravo-Valenzuela NJM, Martins WP, Mattar R, Moron AF, Pares DBDS, Tonni G, Araujo Júnior E. Reference ranges of filling time and systolic-to-diastolic time index of the left ventricle, right ventricle, and interventricular septum using both spectral and tissue Doppler of fetal heart between 20 and 36 + 6 weeks of gestation. Eur J Obstet Gynecol Reprod Biol 2020; 252:366-372. [PMID: 32682211 DOI: 10.1016/j.ejogrb.2020.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/02/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this study is to determine the reference ranges for filling time (FT) and systolic-to-diastolic time index (SDI) of the left ventricle (LV) by using spectral Doppler, and FT' and SDI' of the LV, right ventricle, and interventricular septum (IVS) by using tissue Doppler of the fetal heart. STUDY DESIGN This prospective and cross-sectional study included 360 low-risk singleton pregnancies between 20 and 36 + 6 weeks of gestation. The SDI/SDI' is the sum of the ejection time, isovolumic contraction time, and isovolumic relaxation time (IRT) divided by the FT. We measured FT/FT' from the beginning of the opening click of the E wave of the mitral valve to the closing click of the A wave of the mitral valve. We used regression analysis to obtain the best-fit model polynomial equation for the parameters. Additionally, we assessed intra- and inter-observer reproducibility by using concordance correlation coefficient (CCC). RESULTS There was a weak correlation among FT LV (r = 0.31, p < 0.0001), SDI LV (r = -0.23, p < 0.0001), and gestational age (GA). Additionally, there was a very weak positive correlation among FT' RV (r = 0.09, p = 0.0001), FT' LV (r = 0.07, p < 0.0001), FT' IVS (r = 0,08, p < 0.0001), and GA. In contrast, there was a very weak negative correlation among SDI' LV (r=-0.09, p < 0.0001), SDI' IVS (r=-0.05, p < 0.0021), and GA. There was no significative correlation between SDI' RV (r=-0.06, p < 0.081) and GA. Poor/very poor intra- and inter-observer reliability was observed for all the parameters (CCC = 0.19-0.79), whereas moderate intra- and inter-observer agreement was observed for all parameters (CCC = 0.37-0.72). CONCLUSIONS The reference ranges for FT and SDI were determined by using spectral and tissue Doppler of the fetal heart and showed a poor reproducibility.
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Affiliation(s)
- Alberto Borges Peixoto
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil; Mario Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba-MG, Brazil; Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba-MG, Brazil
| | - Nathalie Jeanne Magioli Bravo-Valenzuela
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil; Discipline of Pediatrics (Pediatric Cardiology), Department of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro-RJ, Brazil
| | | | - Rosiane Mattar
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Antonio Fernandes Moron
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - David Baptista da Silva Pares
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
| | - Gabriele Tonni
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL Reggio Emilia, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil.
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Abstract
Since the World Health Organization (WHO) declared coronavirus infection (COVID-19) a Public Health Emergency of International Concern in January 2020, there have been many concerns about pregnant women and the possible effects of this emergency with catastrophic outcomes in many countries. Information on COVID-19 and pregnancy are scarce and spread throughout a few case series, with no more than 50 cases in total. The present review provides a brief analysis of COVID-19, pregnancy in the COVID-19 era, and the effects of COVID-19 on pregnancy.
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Affiliation(s)
- Pedro Castro
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem, Rio de Janeiro, RJ, Brazil
- Department of Radiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Ana Paula Matos
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem, Rio de Janeiro, RJ, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem, Rio de Janeiro, RJ, Brazil
| | - Flávia Paiva Lopes
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem, Rio de Janeiro, RJ, Brazil
| | - Gabriele Tonni
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL Reggio Emilia, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Medical Course, Universidade Municipal de São Caetano do Sul, São Caetano do Sul, SP, Brazil
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Tonni G, Araujo Júnior E. Covid-19 in Italy: A Lesson to be Learned. Rev Bras Ginecol Obstet 2020; 42:369-370. [PMID: 32604441 PMCID: PMC10418249 DOI: 10.1055/s-0040-1713410] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL Reggio Emilia, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Medical course, Universidade Municipal São Caetano do Sul, Bela Vista Campus, São Paulo, SP, Brazil
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Teles Abrao Trad A, Ibirogba ER, Elrefaei A, Narang K, Tonni G, Picone O, Suy A, Carreras Moratonas E, Kilby MD, Ruano R. Complications and outcomes of SARS-CoV-2 in pregnancy: where and what is the evidence? Hypertens Pregnancy 2020; 39:361-369. [PMID: 32456489 DOI: 10.1080/10641955.2020.1769645] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To add to the growing evidence on SARS-CoV-2 infection during pregnancy, so as to better inform clinical decision making and optimize patient outcomes. METHODS A systematic search of relevant databases was perfomed on 25 March 2020 and a repeat search, on 10 April 2020. Reports of pregnant patients with SARS-CoV-2 infection at any time during their pregnancy were reviewed and summarized . RESULTS We summarized the outcomes of a total of 155 pregnant women and 118 neonates. The evidence suggests a similar rate of severe COVID-19 cases in pregnant women and the general population. The frequency of cesarean deliveries is high, against guidelines recommendations. CONCLUSION Limited data on COVID-19 during preganacy, associated with a wide variation in the methodology make accurate data interpretation difficult.
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Affiliation(s)
- Ayssa Teles Abrao Trad
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine , Rochester, MN, USA
| | - Eniola R Ibirogba
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine , Rochester, MN, USA
| | - Amro Elrefaei
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine , Rochester, MN, USA
| | - Kavita Narang
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine , Rochester, MN, USA
| | - Gabriele Tonni
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynaecology, AUSL Istituto Di Ricerca a Carattere Clinico Scientifico (IRCCS) Di Reggio Emilia , Reggio Emilia, Italy
| | - Olivier Picone
- Service de Gynécologie-obstétrique Colombes, Assistance publique-hôpitaux de Paris, hôpitaux Louis Mourier, Université de Paris , Colombes, France
| | - Anna Suy
- Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron , Barcelona, Spain
| | | | - Mark D Kilby
- Fetal Medicine Centre, Birmingham Women's and Children's Foundation NHS Trust , Birmingham, UK.,College of Medical & Dental Sciences, University of Birmingham , Birmingham, UK
| | - Rodrigo Ruano
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine , Rochester, MN, USA
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Narang K, Ibirogba ER, Elrefaei A, Trad ATA, Theiler R, Nomura R, Picone O, Kilby M, Escuriet R, Suy A, Carreras E, Tonni G, Ruano R. SARS-CoV-2 in Pregnancy: A Comprehensive Summary of Current Guidelines. J Clin Med 2020; 9:E1521. [PMID: 32443538 PMCID: PMC7291307 DOI: 10.3390/jcm9051521] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022] Open
Abstract
Since the declaration of the global pandemic of COVID-19 by the World Health Organization on 11 March 2020, we have continued to see a steady rise in the number of patients infected by SARS-CoV-2. However, there is still very limited data on the course and outcomes of this serious infection in a vulnerable population of pregnant patients and their fetuses. International perinatal societies and institutions including SMFM, ACOG, RCOG, ISUOG, CDC, CNGOF, ISS/SIEOG, and CatSalut have released guidelines for the care of these patients. We aim to summarize these current guidelines in a comprehensive review for patients, healthcare workers, and healthcare institutions. We included 15 papers from 10 societies through a literature search of direct review of society's websites and their journal publications up till 20 April 2020. Recommendations specific to antepartum, intrapartum, and postpartum were abstracted from the publications and summarized into Tables. The summary of guidelines for the management of COVID-19 in pregnancy across different perinatal societies is fairly consistent, with some variation in the strength of recommendations. It is important to recognize that these guidelines are frequently updated, as we continue to learn more about the course and impact of COVID-19 in pregnancy.
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Affiliation(s)
- Kavita Narang
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA; (K.N.); (E.R.I.); (A.E.); (A.T.A.T.)
| | - Eniola R. Ibirogba
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA; (K.N.); (E.R.I.); (A.E.); (A.T.A.T.)
| | - Amro Elrefaei
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA; (K.N.); (E.R.I.); (A.E.); (A.T.A.T.)
| | - Ayssa Teles Abrao Trad
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA; (K.N.); (E.R.I.); (A.E.); (A.T.A.T.)
| | - Regan Theiler
- Obstetrics Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA;
| | - Roseli Nomura
- Department of Obstetrics and Gynecology, Escola Paulista de Medicina—Universidade Federal de São Paulo, São Paulo 04021, Brazil;
| | - Olivier Picone
- Groupe de Recherche sur les Infections pendant la Grossesse (GRIG), CNGOF, Service de Gynécologie-Obstétrique Colombes, Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Université de Paris, Inserm IAME-U1137, 75000 Paris, France;
| | - Mark Kilby
- Fetal Medicine Centre, Birmingham Women’s and Children’s Foundation Trust, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
| | - Ramón Escuriet
- Catalan Health Service, Government of Catalonia, 080028 Barcelona, Spain;
| | - Anna Suy
- Department of Obstetrics and Gynecology, Hospital Universitari Vall d’Hebron, 080028 Barcelona, Spain; (A.S.); (E.C.)
| | - Elena Carreras
- Department of Obstetrics and Gynecology, Hospital Universitari Vall d’Hebron, 080028 Barcelona, Spain; (A.S.); (E.C.)
| | - Gabriele Tonni
- Prenatal Diagnostic Division, Department of Obstetrics and Gynecology, AUSL di Reggio Emilia Istituto di Ricerca a Carattere Clinico Scientifico, 42100 Reggio Emilia, Italy;
| | - Rodrigo Ruano
- Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA; (K.N.); (E.R.I.); (A.E.); (A.T.A.T.)
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Carrilho MC, Rolo LC, Tonni G, Araujo Júnior E. Assessment of the quality of fetal heart standard views using the FAST, STAR, and FINE four-dimensional ultrasound techniques in the screening of congenital heart diseases. Echocardiography 2019; 37:114-123. [PMID: 31872925 DOI: 10.1111/echo.14574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/05/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To compare the quality of standard fetal echocardiographic views obtained by four-dimensional ultrasound with those obtained by the simple targeted arterial rendering (STAR) technique, four-chamber view swing technique (FAST), and fetal intelligent navigation echocardiography (FINE/5D Heart® ) technique. METHODS This was a cross-sectional prospective study that included pregnant women between 22 and 34 weeks of gestation, with normal fetuses. Fetal heart volumes were acquired using spatio-temporal image correlation (STIC) with the fetal spine between 2 and 9 o'clock. The FAST/STAR techniques consist of the manipulation of STIC volumes by drawing OmniView™ lines to obtain echocardiographic views. The FINE/5D Heart® technique uses intelligent navigation to automatically generate echocardiographic views. The quality of the images was classified as excellent, good, acceptable, and unacceptable. The analysis was performed using the Bonferroni multiple comparisons test. RESULTS The study included 101 pregnant women aged between 16 and 44 years. There was no mean difference in image quality between the techniques regarding fetal spine position in all echocardiographic views (P > .05). However, in the five-chamber, left ventricular outflow tract, right ventricular outflow tract, ductal arch, superior vena cava/inferior vena cava, and abdomen/stomach views, there was a statistically significant mean difference quality between the techniques, regardless of the spine position (P < .05). The best mean image quality was obtained by the FINE technique (P ≤ .016 for all fetal echocardiographic views). CONCLUSION The quality of the echocardiographic views obtained using the FINE technique was superior to that of those generated by the FAST/STAR techniques in normal fetuses.
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Affiliation(s)
- Milene Carvalho Carrilho
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Liliam Cristine Rolo
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Gabriele Tonni
- Department of Obstetrics and Gynecology, Prenatal Diagnostic Service, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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Novoa V, Shazly S, Ibirogba ER, Sutton L, Tonni G, Prefumo F, Sepulveda W, Araujo Júnior E, Werner H, Trinidad MC, Ruano R. Perinatal outcomes of fetal intra-abdominal umbilical vein varix: a multicenter cohort study. J Matern Fetal Neonatal Med 2019; 34:3393-3396. [PMID: 31736416 DOI: 10.1080/14767058.2019.1685969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To investigate the perinatal outcomes of fetuses with antenatal diagnoses of intra-abdominal umbilical vein varix (UVV). METHODS A multicenter retrospective study was conducted in four countries on fetuses diagnosed with intra-abdominal UVV between 2012 and 2019. Collected data included gestational age (GA), UVV maximum diameter at diagnosis and delivery, associated anatomical and chromosomal anomalies, birth weight, and neonatal outcomes. RESULTS Twenty fetuses were identified, of which 20% had associated chromosomal and/or anatomical abnormalities, most resulting in poor outcomes (either intrauterine fetal death or pregnancy termination). Mean maternal age was 34.1 ± 7.0 years, UVV was diagnosed at 26.5 ± 4.5 weeks of GA on average with a maximum diameter of 12.0 ± 4.0 mm. Mean GA at delivery was 35.4 ± 5.6 weeks. Survival rate was 85%. CONCLUSION Our study shows a satisfactory outcome when intra-abdominal UVV is an isolated finding, with minimal obstetrical and perinatal consequences. The prognosis is worse when UVV is associated with other anomalies.
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Affiliation(s)
- Victoria Novoa
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sherif Shazly
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Eniola R Ibirogba
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Laura Sutton
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Gabriele Tonni
- Department of Obstetrics and Gynecology, Prenatal Diagnostic Center, Guastalla Civil Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, University of Brescia, Brescia, Italy
| | - Waldo Sepulveda
- Fetal Imaging Unit, FETALMED - Maternal-Fetal Diagnostic Center, Santiago, Chile
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Heron Werner
- Department of Radiology, Clínica de Diagnóstico Por Imagem, Rio De Janeiro, Brazil
| | - Mari Charisse Trinidad
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Rodrigo Ruano
- Maternal Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Melo Júnior JF, Bravo-Valenzuela NJ, Nardozza LMM, Peixoto AB, Mattar R, Martins WP, Tonni G, Araujo Júnior E. Reference range of fetal myocardial area by three-dimensional ultrasonography and its applicability in fetuses of pre-gestational diabetic women. J Perinat Med 2019; 47:422-428. [PMID: 30763269 DOI: 10.1515/jpm-2018-0342] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/14/2019] [Indexed: 11/15/2022]
Abstract
Objective To determine the reference range for the myocardial area in healthy fetuses using three-dimensional (3D) ultrasonography and validate these results in fetuses of pregnant women with pre-gestational diabetes mellitus (DM). Methods This cross-sectional retrospective study included 168 healthy pregnant women between gestational weeks 20 and 33+6 days. The myocardial area was measured using spatio-temporal image correlation (STIC) in the four-chamber view. Polynomial regression models were used, and the goodness of fit of the models were evaluated by the coefficient of determination (R2). Intra- and inter-observer reproducibility was determined using the concordance correlation coefficient (CCC). Validation was performed in 30 pregnant women with pre-gestational DM. Results There was a strong correlation (R2=0.71, P<0.0001) between myocardial area and gestational age. There was good intra- and inter-observer reproducibility, with a CCC of 0.86 and 0.83, respectively. However, there was no significant difference in the mean myocardial area between healthy fetuses and fetuses of women with pre-gestational DM (0.11 cm2, P=0.55). Conclusion The reference range was determined for the myocardial area in fetuses, and there was no significant difference in this variable between healthy fetuses and the fetuses of women with pre-gestational DM.
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Affiliation(s)
- José Francisco Melo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | | | | | - Alberto Borges Peixoto
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil.,Mario Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba-MG, Brazil
| | - Rosiane Mattar
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | | | - Gabriele Tonni
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL Reggio Emilia, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
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Tonni G, Palmisano M, Perez Zamarian AC, Rabachini Caetano AC, Santana EFM, Peixoto AB, Armbruster-Moraes E, Ruano R, Araujo Júnior E. Phenotype to genotype characterization by array-comparative genomic hydridization (a-CGH) in case of fetal malformations: A systematic review. Taiwan J Obstet Gynecol 2019; 58:15-28. [PMID: 30638470 DOI: 10.1016/j.tjog.2018.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2018] [Indexed: 11/16/2022] Open
Abstract
The aim of the current review is to report a-CGH abnormalities identified in fetuses with prenatally diagnosed fetal malformations in whom a normal karyotype was diagnosed with conventional cytogenetic analysis. A systematic electronic search of databases (PubMed/Medline, EMBASE/SCOPUS) has been conducted from inception to May, 2017. Bibliographic analysis has been performed according to PRISMA statement for review. The following keywords were used: 'array-CGH' and 'fetal malformations" and "prenatal diagnosis"; alternatively, "microarray", "oligonucleotide array", "molecular biology", "antenatal diagnostics", "fetal diagnostics", "congenital malformations" and "ultrasound" were used to capture both "a-CGH" and "prenatal". One-hundred and twelve fetuses with prenatally diagnosed fetal malformations with normal karyotyping and a-CGH abnormalities detected are described. Single or multiple microarray abnormalities diagnosed have been classified in relation to different organ/system affected. The most frequent a-CGH abnormalities were detected in cases of congenital heart diseases (CDHs), multiple malformations and central nervous system (CNS) malformations. Maternal or paternal carrier-state was seen in 19.64% (22/112), of cases while the number of reported de novo mutations accounted for 46.42% (52/112) of all CNVs microarray abnormalities. Array-comparative genomic hydridization (a-CGH) may become an integral and complemantary genetic testing when fetal malformations are detected prenatally in fetuses with normal cytogenetic karyotype. In addition, a-CGH enables the identification of CNVs and VOUS and improves the calculation of recurrent risk and the genetic counseling.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, Istituto di Ricerca a Carattere Clinico Scientifico (IRCCS) AUSL Reggio Emilia, Italy.
| | - Marcella Palmisano
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, Istituto di Ricerca a Carattere Clinico Scientifico (IRCCS) AUSL Reggio Emilia, Italy
| | - Ana Cristina Perez Zamarian
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Ana Carolina Rabachini Caetano
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Eduardo Félix Martins Santana
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Alberto Borges Peixoto
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Edecio Armbruster-Moraes
- Discipline of Genetics, Faculty of Medicine of ABC (FMABC), Santo André-SP, Brazil; Department of Gynecology and Obstetrics, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo-SP, Brazil
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
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Rocha LA, Rolo LC, Nardozza LMM, Tonni G, Araujo Júnior E. Z-Score Reference Ranges for Fetal Heart Functional Measurements in a Large Brazilian Pregnant Women Sample. Pediatr Cardiol 2019; 40:554-562. [PMID: 30415382 DOI: 10.1007/s00246-018-2026-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
Abstract
The objective of this study was to determine the reference values for fetal heart functional measurements at 24 and 34 weeks of gestation and to develop Z-score equations for all measurements. A single-center, prospective, cross-sectional study with normal fetuses between 24 and 34 weeks of gestation was performed. All pregnant women underwent a comprehensive fetal Doppler echocardiogram with anatomical and functional analysis. Measurements of left and right cardiac output, combined cardiac output, mitral and tricuspid valve flow, inferior vena cava flow, and pulmonary vein flow were performed. The Shapiro-Wilk test and histogram evaluation were performed on all variables. Linear regression was used to assess the relationships between measurements and gestational age. A total of 612 pregnant women with singleton and normal fetuses were included. We assessed the reference values and percentiles of cardiac function as a function of gestational age. The variables that were not normally distributed were subjected to logarithmic or square root transformation. Eleven Z-score equations were developed, with equations for left and right ventricle output and combined cardiac output that were dependent on gestational age and with other equations that were independent of gestational age. The present study produced a large database, allowing the demonstration of reference values and percentiles as well as the development of Z-score equations to facilitate the echocardiographic evaluation of fetal heart function.
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Affiliation(s)
- Luciane Alves Rocha
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | - Liliam Cristine Rolo
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | - Luciano Marcondes Machado Nardozza
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil
| | - Gabriele Tonni
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, Istituto di Ricerca a Carattere Clinico Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), Rua Belchior de Azevedo, 156 apto. 111 Torre Vitoria, São Paulo, SP, CEP 05089-030, Brazil.
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Bravo-Valenzuela NJ, Peixoto AB, Araujo Júnior E, Tonni G. Fetal supraventricular tachycardia at 12 weeks of gestation: diagnosis and follow up. A case report. Med Ultrason 2019; 21:93-95. [PMID: 30779838 DOI: 10.11152/mu-1617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This report describes a case of fetal supraventricular tachycardia (SVT) diagnosed at 12 weeks of gestation in a pregnant woman with diabetes mellitus. Transplacental digoxin therapy administered orally to the mother was unsuccessful. Subsequently, sotalol was added to digoxin to achieve fetal heart rate (HR) control and the conversion to sinus rhythm was achieved. The fetal HR remained stable until term, and a healthy male baby was born. The newborn electrocardiogram showed sinus rhythm with normal PR and QTc intervals. When the newborn was stable, he was discharged with propanolol. Sustained SVT is extremely rare during the first trimester. The goal of treatment in utero is the conversion to sinus rhythm or reduction of the ventricular rate to tolerable levels, preventing or even reversing fetal hydrops.
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Affiliation(s)
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo, São Paulo-SP, Brazil.
| | - Gabriele Tonni
- Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, AUSL Reggio Emilia.
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Novoa Y Novoa V, Shazly S, Araujo Júnior E, Tonni G, Ruano R. Tocolysis for open prenatal repair of myelomeningocele: systematic review. J Matern Fetal Neonatal Med 2018; 33:1786-1791. [PMID: 30526147 DOI: 10.1080/14767058.2018.1528222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: To summarize current evidence on the use of tocolytic medications perioperatively for open prenatal repair of fetal myelomeningocele including tocolytic agent options, regimens, efficiency, and potential risks.Methods: A search of Medline, Embase, and SCOPUS databases was conducted from inception to March 2017. Studies that described their tocolytic protocol, gestational age at delivery, perinatal outcomes were included. Studies that did not exclusively assessed fetal myelomeningocele or did not adequately endorse obstetric and neonatal outcomes were excluded. Neither sample size nor language was a basis for exclusion.Results: Out of 570 studies retrieved on initial search, 462 were excluded for irrelevance. Of the 61 remaining titles, 17 were animal studies, 17 were reviews, 12 studied a spectrum of anomalies, three specified fetoscopy, four did not report neonatal outcomes, and one article was retracted. Two studies were added to the pool when the literature search was updated. Nine articles were eventually included; three case reports, six cohort studies with a total of 205 cases. Fetuses were managed at gestational ages between 19 and 30 weeks. Although tocolytic regimens were variable, indomethacin was commonly utilized as a preoperative tocolytic. Magnesium sulfate was usually initiated intraoperatively and was resumed postoperatively for a variable duration (18-48 hours) with or without subcutaneous terbutaline. Gestational age at delivery ranged from 30-37 weeks with an average of 33-35 weeks. Pulmonary edema was reported in two studies to be 2.2-5.5%. Perinatal outcomes were overall favorable.Conclusion: Preoperative indomethacin and postoperative course of magnesium sulfate seem to be a favorable tocolytic option in women with open prenatal myelomeningocele repair. Risks are generally minimal. However, adequate information on the duration of postoperative tocolysis seems to be inadequate.
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Affiliation(s)
- Victoria Novoa Y Novoa
- Department of Obstetrics, Universidade Federal de Sao Paulo Escola Paulista de Medicina, São Paulo, Brazil
| | - Sherif Shazly
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Edward Araujo Júnior
- Department of Obstetrics, Universidade Federal de Sao Paulo Escola Paulista de Medicina, São Paulo, Brazil
| | - Gabriele Tonni
- Department of Obstetrics and Gynecology, AUSL Reggio Emilia, Guastalla Civil Hospital, Guastalla, Italy
| | - Rodrigo Ruano
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
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Tonni G, Grisolia G, Zampriolo P, Prefumo F, Fichera A, Bonasoni P, Lefebvre M, Khung-Savatovsky S, Guimiot F, Rosenblatt J, Araujo Júnior E. TRAP Sequence in Monochorionic/Monoamniotic (MC/MA) Discordant Twins: Two Cases Treated with Fetoscopic Laser Surgery. Fetal Pediatr Pathol 2018; 37:433-447. [PMID: 30636554 DOI: 10.1080/15513815.2018.1526240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Ablation of the acardiac twin umbilical cord in the TRAP protects the normal donor twin. MATERIALS AND METHODS Two case descriptions, one of interstitial laser photocoagulation and one of laser umbilical cord occlusion (L-UCO) of the acardiac twin in monochorionic monoamniotic pregnancies are reported. RESULTS L-UCO in two pregnancies with TRAP syndrome in the second trimester resulted in intrauterine fetal death in both cases after 1 month. Case 1 had no detectable cause of fetal death. Case 2 had rupture of the amniotic sac causing anhydramnios and acute chorioamnionitis. A groove on the umbilical cord of the normal twin indicated a cord stricture due to cord entanglement. CONCLUSION Our experience confirms that the best timing and optimal treatment of MC/MA twins complicated by TRAP sequence still remains a controversial clinical issue. Cord entanglement may continue be a potential clinical risk factor for adverse perinatal outcome even after ablation therapy.
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Affiliation(s)
- Gabriele Tonni
- a Department of Obstetric and Gynecology, Prenatal Diagnostic Service , Reggio Emilia , Italy
| | - Gianpaolo Grisolia
- b Azienda Socio Sanitaria Territoriale di Mantova, Department of Obstetrics and Gynecology , Carlo Poma Hospital , Mantova , Italy
| | - Paolo Zampriolo
- b Azienda Socio Sanitaria Territoriale di Mantova, Department of Obstetrics and Gynecology , Carlo Poma Hospital , Mantova , Italy
| | | | - Anna Fichera
- d Universita degli Studi di Brescia Sezione Materno Infantile, Obstetrics and Gynecology , Brescia , Italy
| | | | - Mathilde Lefebvre
- f Hopital Universitaire Robert-Debre, Unite de Foetopathologie , Paris , France
| | | | - Fabien Guimiot
- f Hopital Universitaire Robert-Debre, Unite de Foetopathologie , Paris , France
| | - Jonathan Rosenblatt
- g Hopital Universitaire Robert-Debre, Obstetrics and Gynecology , Paris , France
| | - Edward Araujo Júnior
- h Paulista School of Medicine - Federal University of São Paulo, Obstetrics , São Paulo , Brazil
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Martins Santana EF, Araujo Júnior E, Tonni G, Costa FDS, Meagher S. Acrania-exencephaly-anencephaly sequence phenotypic characterization using two- and three-dimensional ultrasound between 11 and 13 weeks and 6 days of gestation. J Ultrason 2018; 18:240-246. [PMID: 30451407 PMCID: PMC6442210 DOI: 10.15557/jou.2018.0035] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 12/14/2022] Open
Abstract
The study presents a pictorial essay of acrania-exencephaly-anencephaly sequence using two-(2D) and three-dimensional (3D) ultrasonography, documenting the different phenotypic characterization of this rare disease. Normal and abnormal fetuses were evaluated during the first trimester scan. The International Society of Ultrasound in Obstetrics and Gynecology practice guidelines were adopted to standardize first trimester anatomical ultrasound screening. The guidelines outline the importance of systematic fetal head and brain examination including the formation of cranial bones, choroid-plexus and ventricles. Acrania-exencephaly-anencephaly sequence and/or other neural tube defects, such as meningoencephalocele, may be identified during a routine 11–14 week scan. Early first trimester detection of acrania-exencephaly-anencephaly sequence with the characterization of different related phenotypes, 2D and 3D ultrasound imaging as well as differential diagnosis are also presented in this pictorial essay. The main diagnostic ultrasound features of the disease may be characterized by findings of acrania with increased amniotic fluid echogenicity; “Mickey-Mouse” bi-lobular face, cystic, elongated, irregular and overhanging head morphology. Lightening techniques have also been added to 3D ultrasound to enhance anatomical details. Moreover, discordant amniotic fluid echotexture in the setting of twin pregnancies may be the first sign of acrania-exencephaly-anencephaly sequence. Extracranial malformations, aneuploidy and genetic syndromes associated with acrania-exencephaly-anencephaly sequence are also reported and described. First trimester neuroscan by an expert sonographer with appropriate training together with the application of standardized protocol are essential for a high detection rate of this rare type of neural tube defect malformation during a scan performed at 11 and 13 weeks and 6 days.
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Affiliation(s)
- Eduardo Félix Martins Santana
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil ; Department of Perinatology, Albert Einstein Hospital, São Paulo-SP, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Gabriele Tonni
- Department of Obstetrics & Gynecology, Guastalla Civil Hospital, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Fabricio Da Silva Costa
- Monash Ultrasound for Women, Melbourne, Victoria, Australia ; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - Simon Meagher
- Monash Ultrasound for Women, Melbourne, Victoria, Australia
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