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Mylrea-Foley B, Wolf H, Stampalija T, Lees C, Arabin B, Berger A, Bergman E, Bhide A, Bilardo CM, Breeze AC, Brodszki J, Calda P, Cetin I, Cesari E, Derks J, Ebbing C, Ferrazzi E, Ganzevoort W, Frusca T, Gordijn SJ, Gyselaers W, Hecher K, Klaritsch P, Krofta L, Lindgren P, Lobmaier SM, Marlow N, Maruotti GM, Mecacci F, Myklestad K, Napolitano R, Prefumo F, Raio L, Richter J, Sande RK, Thornton J, Valensise H, Visser GHA, Wee L. Longitudinal Doppler Assessments in Late Preterm Fetal Growth Restriction. Ultraschall Med 2023; 44:56-67. [PMID: 34768305 DOI: 10.1055/a-1511-8293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To assess the longitudinal variation of the ratio of umbilical and cerebral artery pulsatility index (UCR) in late preterm fetal growth restriction (FGR). MATERIALS AND METHODS A prospective European multicenter observational study included women with a singleton pregnancy, 32+ 0-36+ 6, at risk of FGR (estimated fetal weight [EFW] or abdominal circumference [AC] < 10th percentile, abnormal arterial Doppler or fall in AC from 20-week scan of > 40 percentile points). The primary outcome was a composite of abnormal condition at birth or major neonatal morbidity. UCR was categorized as normal (< 0.9) or abnormal (≥ 0.9). UCR was assessed by gestational age at measurement interval to delivery, and by individual linear regression coefficient in women with two or more measurements. RESULTS 856 women had 2770 measurements; 696 (81 %) had more than one measurement (median 3 (IQR 2-4). At inclusion, 63 (7 %) a UCR ≥ 0.9. These delivered earlier and had a lower birth weight and higher incidence of adverse outcome (30 % vs. 9 %, relative risk 3.2; 95 %CI 2.1-5.0) than women with a normal UCR at inclusion. Repeated measurements after an abnormal UCR at inclusion were abnormal again in 67 % (95 %CI 55-80), but after a normal UCR the chance of finding an abnormal UCR was 6 % (95 %CI 5-7 %). The risk of composite adverse outcome was similar using the first or subsequent UCR values. CONCLUSION An abnormal UCR is likely to be abnormal again at a later measurement, while after a normal UCR the chance of an abnormal UCR is 5-7 % when repeated weekly. Repeated measurements do not predict outcome better than the first measurement, most likely due to the most compromised fetuses being delivered after an abnormal UCR.
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Affiliation(s)
- Bronacha Mylrea-Foley
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London W12 0HS
| | - Hans Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Christoph Lees
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London W12 0HS
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - B Arabin
- Department of Obstetrics Charite, Humboldt University Berlin and Clara Angela Foundation, Berlin, Germany
| | - A Berger
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - E Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, location VUMC, Amsterdam, The Netherlands
| | - A C Breeze
- Fetal Medicine Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Brodszki
- Department of Pediatric Surgery and Neonatology, Lund University, Skane University Hospital, Lund, Sweden
| | - P Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - I Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - J Derks
- Department of Perinatal Medicine, University of Utrecht, Utrecht, The Netherlands
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - E Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium, Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk and Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - L Krofta
- Institute for the Care of Mother and Child, Prague, Czech Republic and Third Medical Faculty, Charles University, Prague, Czech Republic
| | - P Lindgren
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - S M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - G M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples 'Federico II', Naples, Italy
| | - F Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | | | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - F Prefumo
- Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - L Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - J Richter
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - R K Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - H Valensise
- Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata, University, Policlinico Casilino Hospital, Rome, Italy
| | - G H A Visser
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - L Wee
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
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Van Mieghem T, Lewi L, Slaghekke F, Lopriore E, Yinon Y, Raio L, Baud D, Dekoninck P, Melamed N, Huszti E, Sun L, Shinar S. Prediction of fetal death in monochorionic twin pregnancies complicated by Type-III selective fetal growth restriction. Ultrasound Obstet Gynecol 2022; 59:756-762. [PMID: 35258125 DOI: 10.1002/uog.24896] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Monochorionic diamniotic twin pregnancies complicated by Type-III selective fetal growth restriction (sFGR) are at high risk of fetal death. The aim of this study was to identify predictors of fetal death in these pregnancies. METHODS This was an international multicenter retrospective cohort study. Type-III sFGR was defined as fetal estimated fetal weight (EFW) of one twin below the 10th percentile and intertwin EFW discordance of ≥ 25% in combination with intermittent absent or reversed end-diastolic flow in the umbilical artery of the smaller fetus. Predictors of fetal death were recorded longitudinally throughout gestation and assessed in univariable and multivariable logistic regression models. The classification and regression trees (CART) method was used to construct a prediction model of fetal death using significant predictors derived from the univariable analysis. RESULTS A total of 308 twin pregnancies (616 fetuses) were included in the analysis. In 273 (88.6%) pregnancies, both twins were liveborn, whereas 35 pregnancies had single (n = 19 (6.2%)) or double (n = 16 (5.2%)) fetal death. On univariable analysis, earlier gestational age at diagnosis of Type-III sFGR, oligohydramnios in the smaller twin and deterioration in umbilical artery Doppler flow were associated with an increased risk of fetal death, as was larger fetal EFW discordance, particularly between 24 and 32 weeks' gestation. None of the parameters identified on univariable analysis maintained statistical significance on multivariable analysis. The CART model allowed us to identify three risk groups: a low-risk group (6.8% risk of fetal death), in which umbilical artery Doppler did not deteriorate; an intermediate-risk group (16.3% risk of fetal death), in which umbilical artery Doppler deteriorated but the diagnosis of sFGR was made at or after 16 + 5 weeks' gestation; and a high-risk group (58.3% risk of fetal death), in which umbilical artery Doppler deteriorated and gestational age at diagnosis was < 16 + 5 weeks' gestation. CONCLUSIONS Type-III sFGR is associated with a high risk of fetal death. A prediction algorithm can help to identify the highest-risk group, which is characterized by Doppler deterioration and early referral. Further studies should investigate the potential benefit of fetal surveillance and intervention in this cohort. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Van Mieghem
- Ontario Fetal Centre, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - L Lewi
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - F Slaghekke
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - E Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Y Yinon
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - L Raio
- Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland
| | - D Baud
- Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - P Dekoninck
- Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Huszti
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - L Sun
- Fetal Medicine Unit & Prenatal Diagnosis Center, Shanghai First Maternity and Infant Hospital of Tongji University, Shanghai, China
| | - S Shinar
- Ontario Fetal Centre, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Brigger JS, Zbinden A, Raio L, Förger F. AB0547 PLACENTAL ANGIOGENESIS MARKERS IN THE SCREENING FOR ADVERSE PREGNANCY OUTCOMES IN SLE AND APS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPregnancies in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are at risk for adverse pregnancy outcomes such as preeclampsia or placental insufficiency and prematurity. In these high-risk pregnancies, maternal serum concentration of the anti-angiogenic factor soluble Fms-like tyrosine kinase-1 (sFlt-1) and the pro-angiogenic factor placental growth factor (PlGF) can predict fetal growth restriction and preeclampsia (1-3).ObjectivesTo evaluate the sFlt-1/PlGF ratio in routine assessment of singleton high-risk pregnancies in patients with SLE and APS.MethodsPatients with SLE and APS that followed in our outpatient clinic were retrospectively analysed for their pregnancy course and outcomes. In these high-risk pregnancies, the sFlt-1/PlGF ratio was measured in the context of screening for preeclampsia and a ratio below 38 was applied to exclude preeclampsia. We compared the sFlT-1/PlGF ratio between patients with and without adverse pregnancy outcome. Adverse pregnancy outcome (APO) was defined as preeclampsia, preterm delivery and small for gestational age newborns.ResultsWe analysed sFlt-1/PlGF ratios of 13 singleton pregnancies in 12 patients with SLE and/or APS (4 SLE, 6 SLE with APS or aPL, 2 obstetric APS). Low-dose aspirin was used in all but one pregnancy with de-novo obstetric APS. Low-molecular weight heparin was given in seven pregnancies. Adverse pregnancy outcome occurred in five pregnancies thereof two with preeclampsia. The median sFlt-1/PlGF ratio measured between gestational week 22 and 37 was higher in patients with APO (median 173, range 4 -1904) than in patients without APO (median 7.5, range 1-50) (P=0.03). The sFlt-1/PlGF ratio > 38 was found in 6 pregnancies including two with preeclampsia. Highest sFlt-1/PlGF ratios were found in a case with severe intrauterine growth restriction without signs of preeclampsia (sFlt-1/PlGF=1940) and in a case with early preeclampsia < week 34 (sFlt-1/PlGF=1187). In pregnancies with a sFlt-1/PlGF ratio < 38 there were no signs of preeclampsia or intrauterine growth restriction.ConclusionThe detection of a dysbalanced sFlt-1/PlGF ratio is clinically useful as it differentiates between pregnancies with adverse outcome and those without. More data are needed to further evaluate the predictive potential of these placental biomarkers in the first trimester and their usefulness for treatment adjustments in order to improve pregnancy outcome.References[1]Zeisler H, Llurba E, Chantraine F, Vatish M, Staff AC, Sennstrom M, et al. Predictive Value of the sFlt-1:PlGF Ratio in Women with Suspected Preeclampsia. The New England journal of medicine. 2016;374(1):13-22.[2]Umapathy A, Chamley LW, James JL. Reconciling the distinct roles of angiogenic/anti-angiogenic factors in the placenta and maternal circulation of normal and pathological pregnancies. Angiogenesis. 2020;23(2):105-17.[3]Kim MY, Buyon JP, Guerra MM, Rana S, Zhang D, Laskin CA, et al. Angiogenic factor imbalance early in pregnancy predicts adverse outcomes in patients with lupus and antiphospholipid antibodies: results of the PROMISSE study. American journal of obstetrics and gynecology. 2016;214(1):108 e1- e14.Disclosure of InterestsJasmin Simone Brigger: None declared, Astrid Zbinden: None declared, Luigi Raio Speakers bureau: Thermo Fischer, Frauke Förger Speakers bureau: UCB pharma, GSK, Consultant of: UCB pharma, GSK, Roche, Grant/research support from: UCB pharma, GSK
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Shinar S, Xing W, Lewi L, Slaghekke F, Yinon Y, Raio L, Baud D, DeKoninck P, Melamed N, Huszti E, Sun L, Van Mieghem T. Growth patterns of monochorionic twin pregnancy complicated by Type-III selective fetal growth restriction. Ultrasound Obstet Gynecol 2022; 59:371-376. [PMID: 34369619 DOI: 10.1002/uog.23752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/09/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Little is known regarding fetal growth patterns in monochorionic twin pregnancy complicated by Type-III selective fetal growth restriction (sFGR). We aimed to assess fetal growth and umbilical artery Doppler pattern in Type-III sFGR across gestation and evaluate the effect of changing Doppler flow pattern on growth and intertwin growth discordance. METHODS This was a retrospective cohort study of all Type-III sFGR pregnancies managed at nine fetal centers over a 12-year time period. Higher-order multiple pregnancy and cases with major fetal anomaly or other monochorionicity-related complications at presentation were excluded. Estimated fetal weight (EFW) was assessed on ultrasound for each twin pair at five timepoints (16-20, 21-24, 25-28, 29-32 and > 32 weeks' gestation) and compared with singleton and uncomplicated monochorionic twin EFW. EFW and intertwin EFW discordance were compared between pregnancies with normalization of umbilical artery Doppler of the smaller twin later in pregnancy and those with persistently abnormal Doppler. RESULTS Overall, 328 pregnancies (656 fetuses) met the study criteria. In Type-III sFGR, the smaller twin had a lower EFW than an average singleton fetus (EFW Z-score ranging from -1.52 at 16 weeks to -2.69 at 36 weeks) and an average monochorionic twin in uncomplicated pregnancy (Z-score ranging from -1.73 at 16 weeks to -1.49 at 36 weeks) throughout the entire gestation, while the larger twin had a higher EFW than an average singleton fetus until 22 weeks' gestation and was similar in EFW to an average uncomplicated monochorionic twin throughout gestation. As pregnancy advanced, growth velocity of both twins decreased, with the larger twin remaining appropriately grown and the smaller twin becoming more growth restricted. Intertwin EFW discordance remained stable throughout gestation. On multivariable longitudinal modeling, normalization of fetal umbilical artery Doppler was associated with better growth of the smaller twin (P = 0.002) but not the larger twin (P = 0.1), without affecting the intertwin growth discordance (P = 0.09). CONCLUSIONS Abnormal fetal growth of the smaller twin in Type-III sFGR was evident early in pregnancy, while EFW of the larger twin remained normal throughout gestation. Normalization of umbilical artery Doppler was associated with improved fetal growth of the smaller twin. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Shinar
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - W Xing
- Fetal Medicine Unit and Prenatal Diagnosis Center, Shanghai First Maternity and Infant Hospital of Tongji University, Shanghai, China
| | - L Lewi
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - F Slaghekke
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Y Yinon
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - L Raio
- Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland
| | - D Baud
- Department of Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - P DeKoninck
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - E Huszti
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - L Sun
- Fetal Medicine Unit and Prenatal Diagnosis Center, Shanghai First Maternity and Infant Hospital of Tongji University, Shanghai, China
| | - T Van Mieghem
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Amylidi-Mohr S, Karakitsiou M, Braun R, Förger F, Rexhaj E, Raio L. POS0794 INCIDENCE AND PHENOTYPE OF ANTIPHOSPHOLIPID SYNDROME (APS) AFTER PREECLAMPSIA. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Obstetric Antiphospholipid syndrom (oAPS) is induced by antiphospholipid antibodies (aPL) and associated with specific pregnancy complications. oAPS requires the combination of at least one obstetrical and one laboratory criteria (in 2 or more occasions at least 12 weeks apart). Multiple aPL positivity, lupus anticoagulant (LA) or persistently high aPL titers is defined as high risk aPL profile. “Non-criteria” oAPS are cases not fulfilling the clinical criteria.Objectives:To investigate the incidence of aPL after preeclampsia and the association of phenotypes of oAPS and pregnancy outcome.Methods:The present retrospective cohort analysis included women followed up after preeclampsia. Anti-PL (LA, aCL, anti-β2GBI of IgG and IgM isotype) are assessed 8 to 12 weeks after PE and if positive, again at least 12 weeks apart. According to the ISSHP PE is classified as severe if the blood pressure exceeds 160/110mmHg, or is associated with HELLP syndrome, or eclampsia. FGR is defined as estimated fetal weight <5th, and birth weight <10th percentile, and/or pathologic fetal Doppler.Results:Complete clinical and laboratory data were available for 99 women over a period of 6 years. 38.4% delivered <34 + 0 weeks. PE was severe in 63.6% of cases, and the incidence of FGR was 58.9%. HELLP syndrome was diagnosed in 34.3% and in 4 cases it was isolated. The prevalence of aPL was 35 (35.4%) at first evaluation, and 23 (23.2%) were still positive 12 weeks apart. 14/99 (14.1%) cases fulfilled the definition of classical oAPS, and 9/99 (9.1%) delivered >34 weeks (“non-criteria oAPS”). Of interest, the incidende og high risk aPL profiles was similar in both groups (64.3% vs. 77.8%; p=NS). The incidence of HELLP syndrome was higher in the presence of APS (APS: 9/23 [39.1%] vs. 21/76 [27.6%]; p=NS). 3 out of 4 cases with isolated HELLP syndrome were associated with high risk aPL profiles. Overall, aCL IgG was the dominant aPL. 32/35 (91.4%) and 22/23 (95.7%) had positive aCL at first and second investigation, respectively (p=NS). An aCL IgG titer >32.8CU at first assessment yield a LR of 10 for persistent aCL with a sensitivity and specificity of 91.3% and 90.9%, respectively.Conclusion:Classical and “non-criteria” obstetrical APS show a similar aPL pattern and distribution of aPL phenotypes regardless of gestational age at delivery. aCL IgG is the dominant aPL antibody and is highly predictive for aPL persistence at follow up. HELLP syndrome may be an additional feature of oAPS, in particular the isolated form. However, more studies are necessary to explore this possible association.References:[1]Tektonidou MG et al, EULAR recommendations for the management of antiphospholipid syndrome in adults Ann Rheum Dis. 2019 Oct;78(10):1296-1304. doi: 10.1136/annrheumdis-2019-215213. Epub 2019 May 15.Disclosure of Interests:None declared
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Shinar S, Xing W, Pruthi V, Jianping C, Slaghekke F, Groene S, Lopriore E, Lewi L, Couck I, Yinon Y, Batsry L, Raio L, Amylidi-Mohr S, Baud D, Kneuss F, Dekoninck P, Moscou J, Barrett J, Melamed N, Ryan G, Sun L, Van Mieghem T. Outcome of monochorionic twin pregnancy complicated by Type-III selective intrauterine growth restriction. Ultrasound Obstet Gynecol 2021; 57:126-133. [PMID: 33073883 DOI: 10.1002/uog.23515] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/03/2020] [Revised: 09/15/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Type-III selective intrauterine growth restriction (sIUGR) is associated with a high and unpredictable risk of fetal death and fetal brain injury. The objective of this study was to describe the prospective risk of fetal death and the risk of adverse neonatal outcome in a cohort of twin pregnancies complicated by Type-III sIUGR and treated according to up-to-date guidelines. METHODS We reviewed retrospectively all monochorionic diamniotic twin pregnancies complicated by Type-III sIUGR managed at nine fetal centers over a 12-year period. Higher-order multiple gestations and pregnancies with major fetal anomalies or other monochorionicity-related complications at initial presentation were excluded. Data on fetal and neonatal outcomes were collected and management strategies reviewed. Composite adverse neonatal outcome was defined as neonatal death, invasive ventilation beyond the resuscitation period, culture-proven sepsis, necrotizing enterocolitis requiring treatment, intraventricular hemorrhage Grade > I, retinopathy of prematurity Stage > II or cystic periventricular leukomalacia. The prospective risk of intrauterine death (IUD) and the risk of neonatal complications according to gestational age were evaluated. RESULTS We collected data on 328 pregnancies (656 fetuses). After exclusion of pregnancies that underwent selective reduction (n = 18 (5.5%)), there were 51/620 (8.2%) non-iatrogenic IUDs in 35/310 (11.3%) pregnancies. Single IUD occurred in 19/328 (5.8%) pregnancies and double IUD in 16/328 (4.9%). The prospective risk of non-iatrogenic IUD per fetus declined from 8.1% (95% CI, 5.95-10.26%) at 16 weeks, to less than 2% (95% CI, 0.59-2.79%) after 28.4 weeks and to less than 1% (95% CI, -0.30 to 1.89%) beyond 32.6 weeks. In otherwise uncomplicated pregnancies with Type-III sIUGR, delivery was generally planned at 32 weeks, at which time the risk of composite adverse neonatal outcome was 29.0% (31/107 neonates). In twin pregnancies that continued to 34 weeks, there was a very low risk of IUD (0.7%) and a low risk of composite adverse neonatal outcome (11%). CONCLUSIONS In this cohort of twin pregnancies complicated by Type-III sIUGR and treated at several tertiary fetal centers, the risk of fetal death was lower than that reported previously. Further efforts should be directed at identifying predictors of fetal death and optimal antenatal surveillance strategies to select a cohort of pregnancies that can continue safely beyond 33 weeks' gestation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Shinar
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - W Xing
- Fetal Medicine Unit &Prenatal Diagnosis Center, Shanghai 1st Maternity and Infant Hospital of Tongji University, Shanghai, China
| | - V Pruthi
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - C Jianping
- Fetal Medicine Unit &Prenatal Diagnosis Center, Shanghai 1st Maternity and Infant Hospital of Tongji University, Shanghai, China
| | - F Slaghekke
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - S Groene
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - E Lopriore
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - L Lewi
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - I Couck
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Y Yinon
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - L Batsry
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - L Raio
- Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland
| | - S Amylidi-Mohr
- Department of Obstetrics and Gynecology, Inselspital, University of Bern, Bern, Switzerland
| | - D Baud
- Department of Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - F Kneuss
- Department of Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - P Dekoninck
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J Moscou
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J Barrett
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - N Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - G Ryan
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - L Sun
- Fetal Medicine Unit &Prenatal Diagnosis Center, Shanghai 1st Maternity and Infant Hospital of Tongji University, Shanghai, China
| | - T Van Mieghem
- Ontario Fetal Centre, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Radan AP, Mosimann B, Trottmann F, Rieubland C, Surbek D, Raio L. Arthrogryposis multiplex congenita: fetal sonographic, clinical and genetic findings in seven cases from a tertiary care center in Switzerland. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717962] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | | | | | - C Rieubland
- Inselspital Bern, Abteilung für Humangenetik
| | - D Surbek
- Inselspital Bern, Pränatalmedizin
| | - L Raio
- Inselspital Bern, Pränatalmedizin
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Filippi V, Raio L, von Mueller T, Tschudi R, Schoening A, Bolla D. When to deliver “idiopathic” SGA infants between 37 to 42 weeks of gestation? The impact of the week of gestation on adverse perinatal outcome. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717161] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- V Filippi
- Department of Obstetrics and Gynaecology, Hospital of Langenthal
| | - L Raio
- Department of Obstetrics and Gynaecology, University Hospital of Bern
| | - T von Mueller
- Department of Obstetrics and Gynaecology, Hospital of Langenthal
| | | | - A Schoening
- Department of Obstetrics and Gynaecology, Hospital of Langenthal
| | - D Bolla
- Department of Obstetrics and Gynaecology, Hospital of Langenthal
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Amylidi-Mohr S, Mosimann B, Surbek D, Raio L. The Bernese Gestational Diabetes (GDM) Project: Third trimester fasting glucose or first trimester HbA1c to reduce oral glucose tolerance tests? Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717177] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- S Amylidi-Mohr
- Inselspital Bern, Universitätsklinik für Frauenheilkunde
| | - B Mosimann
- Inselspital Bern, Universitätsklinik für Frauenheilkunde
| | - D Surbek
- Inselspital Bern, Universitätsklinik für Frauenheilkunde
| | - L Raio
- Inselspital Bern, Universitätsklinik für Frauenheilkunde
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Filippi V, Raio L, von Mueller T, Hefti D, Tschudi R, Bolla D. The use of epidural analgesia during trial of labor after cesarean section (TOLAC). Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717913] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- V Filippi
- Department of Obstetrics and Gynaecology, Hospital of Langenthal
| | - L Raio
- Department of Obstetrics and Gynaecology, University Hospital of Bern
| | - T von Mueller
- Department of Obstetrics and Gynaecology, Hospital of Langenthal
| | - D Hefti
- Department of Obstetrics and Gynaecology, Hospital of Langenthal
| | | | - D Bolla
- Department of Obstetrics and Gynaecology, Hospital of Langenthal
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Gasparri M, Filippi V, Bolla D, Papadia A, Tschudi R, Raio L. Maternal height combined with neonatal weight as a new anthropometric predictor for adverse delivery outcomes. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717920] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | - V Filippi
- Hospital of Langenthal, Department of Obstetrics and Gynecology
| | - D Bolla
- Hospital of Langenthal, Department of Obstetrics and Gynecology
| | - A Papadia
- Department of Obstetrics and Gynecology, Università della Svizzera Italiana, Ente Ospedaliero Cantonale
| | | | - L Raio
- Department of Obstetrics and Gynecology, Inselspital Bern
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Zdanowicz J, Disler M, Gerull R, Raio L, Surbek D. Using estimated fetal weight and cerebroplacental ratio in predicting adverse neonatal outcome in late onset fetal growth restriction. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717994] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- J Zdanowicz
- Inselspital, Universitätsklinik für Frauenheilkunde
| | - M Disler
- Inselspital, Universitätsklinik für Frauenheilkunde
| | - R Gerull
- Universitätskinderspital beider Basel, Abteilung für Neonatologie
| | - L Raio
- Inselspital, Universitätsklinik für Frauenheilkunde
| | - D Surbek
- Inselspital, Universitätsklinik für Frauenheilkunde
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Stampalija T, Thornton J, Marlow N, Napolitano R, Bhide A, Pickles T, Bilardo CM, Gordijn SJ, Gyselaers W, Valensise H, Hecher K, Sande RK, Lindgren P, Bergman E, Arabin B, Breeze AC, Wee L, Ganzevoort W, Richter J, Berger A, Brodszki J, Derks J, Mecacci F, Maruotti GM, Myklestad K, Lobmaier SM, Prefumo F, Klaritsch P, Calda P, Ebbing C, Frusca T, Raio L, Visser GHA, Krofta L, Cetin I, Ferrazzi E, Cesari E, Wolf H, Lees CC. Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study. Ultrasound Obstet Gynecol 2020; 56:173-181. [PMID: 32557921 DOI: 10.1002/uog.22125] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. METHODS This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored. RESULTS The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33 weeks and 1.0 at 34-36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association. CONCLUSION In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - T Pickles
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk and Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - H Valensise
- Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - R K Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - P Lindgren
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - E Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - B Arabin
- Department of Obstetrics Charite, Humboldt University Berlin and Clara Angela Foundation, Berlin, Germany
| | - A C Breeze
- Fetal Medicine Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - L Wee
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - J Richter
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - A Berger
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Brodszki
- Department of Pediatric Surgery and Neonatology, Lund University, Skane University Hospital, Lund, Sweden
| | - J Derks
- Department of Perinatal Medicine, University of Utrecht, Utrecht, The Netherlands
| | - F Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - G M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples 'Federico II', Naples, Italy
| | | | - S M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - F Prefumo
- Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - P Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - L Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - G H A Visser
- Department of Obstetrics, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Krofta
- Institute for the Care of Mother and Child, Prague, Czech Republic and Third Medical Faculty, Charles University, Prague, Czech Republic
| | - I Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - E Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - H Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - C C Lees
- Imperial College School of Medicine, Imperial College London and Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS trust, London, UK
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Troester I, Kollert F, Zbinden A, Raio L, Foerger F. AB0372 PREGNANCY OUTCOME IN WOMEN WITH SJÖGREN SYNDROME IS OFTEN COMPLICATED BY PLACENTA INSUFFICIENCY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Chronic inflammatory rheumatic diseases are often associated with a negative effect on pregnancy outcome. Most obstetrical complications are placenta-mediated such as preterm delivery and growths restrictions. In women with Sjögren syndrome, data on placenta- mediated complications are scarce and conflicting (1,2).Objectives:To analyse neonatal outcome in women with Sjögren syndrome with focus on preterm delivery and growth restriction.Methods:We retrospectively analysed 23 pregnancies of 16 patients with Sjögren syndrome that were followed at our centre with regard to pregnancy outcome, medication and disease characteristics. Small for gestational age was defined as birthweight percentile <10th. Preterm delivery was defined as delivery before 37, early term as delivery between 37-39 and term as delivery between 39-42 weeks of gestation.Results:Of 23 pregnancies, one ended in a miscarriage and 22 resulted in live births including one set of twins. Treatment used during pregnancy was hydroxychloroquine (20 pregnancies), prednisone (8), azathioprine (5) and cyclosporine (2). Concomitant treatment with low-dose aspirin was used in 9 pregnancies.Of the 22 live births, 17 were born at early term and 5 at term. There were no preterm deliveries. Median birth weight was 2820g (range 2095-3845g). Nine newborns (40.9%) were small for gestational age (SGA). Maternal treatment during these pregnancies was hydroxychloroquine in all cases and additional low-dose aspirin in three cases. Elevated CRP levels during pregnancy were found in 57% of the cases with SGA outcome. Only one woman with an SGA infant had positive anti-phospholipid antibodies.Regarding delivery mode, most patients had caesarean sections.Conclusion:In our cohort of women with Sjögren syndrome the prevalence of small for gestational age infants was high despite maternal treatment with hydroxychloroquine. Inflammatory markers could help to identify the patients at risk for placental insufficiency, yet prospective studies of larger cohorts are needed.References:[1]Gupta S et al; Sjögren Syndrome and Pregnancy: A literature review. Perm J 2017; 21:16-047[2]De Carolis S et al; The impact of primary Sjögren’s syndrome on pregnancy outcome: Our series and review of the literature. Autoimmun Rev 2014; 13(2):103-7Disclosure of Interests:Isabella Troester: None declared, Florian Kollert Employee of: Novartis, Astrid Zbinden: None declared, Luigi Raio: None declared, Frauke Foerger Grant/research support from: unrestricted grant from UCB, Consultant of: UCB, GSK, Roche, Speakers bureau: UCB, GSK
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Buffle E, Neagoe A, Raio L, Rimoldi SF, Messerli FH, Scherrer U, Rexhaj E. P5359Pulmonary artery pressure is elevated three month after delivery in patients with preeclampsia and antiphospholipid syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Preeclampsia (PE) is a multisystem disease affecting 2–8% of all pregnancies. Recently we found that the prevalence of antiphospholipid syndrome (APS) in PE patients at 13.9%. APS can be the cause of thromboembolic pulmonary hypertension. However, data on heart function and pulmonary pressure in PE and in PE with APS are sparse.
Purpose
We sought to investigate cardiac hemodynamics in this population.
Method
Between July 2016 and December 2018, we performed echocardiography in patients who had suffered from PE alone (n=102, age=32.6±4.8 y) or PE with APS (n=21, age=32.1±4.2 y) 3 months after delivery. APS was diagnosed according to the Sapporo criteria.
Results
The overall prevalence of APS was 17%. Right ventricular to right atrial pressure (RV/RA) gradient was significantly higher in PE + APS patients than in patients who had PE only (21.1±3.8 vs. 17.9±4.6mmHg, p=0.04, PE+APS vs. PE). The indexed volume of the left atrium (LA: 20.3±4.4 vs 23.5±5.5ml/m2, p=0.01, PE+APS vs. PE) and the birthweight of the newborn (1379.8±759.1 vs 1848.1±879.6.1g, p=0.02, PE+APS vs. PE) were lower in APS patients.
Conclusion
In patients with preeclampsia and APS, three month after delivery, pulmonary artery pressure was higher and the left atrium size smaller than in patients who had PE only. Conceivably this may reflects multiple subclinical clots in the pulmonary vessels in APS patients and may put these patients at an elevated risk of pulmonary hypertension later in life.
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Affiliation(s)
- E Buffle
- Bern University Hospital, Cardiology and Biomedical Research, Bern, Switzerland
| | - A Neagoe
- Bern University Hospital, Cardiology and Biomedical Research, Bern, Switzerland
| | - L Raio
- Bern University Hospital, Obstetrics and Gynecology, Bern, Switzerland
| | - S F Rimoldi
- Bern University Hospital, Cardiology and Biomedical Research, Bern, Switzerland
| | - F H Messerli
- Bern University Hospital, Cardiology and Biomedical Research, Bern, Switzerland
| | - U Scherrer
- Bern University Hospital, Cardiology and Biomedical Research, Bern, Switzerland
| | - E Rexhaj
- Bern University Hospital, Cardiology and Biomedical Research, Bern, Switzerland
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Spinelli M, Wiest R, Di Meglio L, Baumann M, Raio L, Surbek D. The "vermian-crest angle": does it allow accurate categorisation of fetal upward rotation of cerebellar vermis on intrauterine MRI? A pilot study. Clin Radiol 2019; 74:489.e1-489.e7. [PMID: 30954236 DOI: 10.1016/j.crad.2019.02.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/21/2019] [Indexed: 12/23/2022]
Abstract
AIM To test a new parameter to assess the position of the fetal cerebellar vermis in the posterior fossa (PF) using intrauterine magnetic resonance imaging (MRI). MATERIALS AND METHODS The angle between the cerebellar vermis and the internal occipital crest (vermian-crest angle, VCA) was assessed retrospectively using MRI in fetuses with and without PF anomalies. Spearman's rank test was used to investigate correlation of the VCA with gestational age (GA). Groups were compared using Student's t-test and the one-way analysis of variance (ANOVA) with the Bonferroni adjustment. Box-and-whisker plots were also used. RESULTS One hundred and two normal cases were identified. Mean±SD GA at MRI was 26.5±2.8 weeks (range: 22-32 weeks). The VCA was 64.49±11.5° independently of GA (r=0.19; p=0.12). In addition, 30 fetuses at 19-28 weeks were identified with Blake's pouch cyst (BPC; n=5), Dandy-Walker malformation (DWM; n=12), mega cisterna magna (MCM; n=10), and vermian hypoplasia (VH; n=3). The VCA was significantly different in the DWM (p<0.001) and BPC (p<0.001) subgroups, but was not significantly different in cases of VH (p=0.84) and MCM (p=0.95) in comparison with controls. CONCLUSIONS A new method to assess vermian position within the PF using intrauterine MRI was assessed. In combination with the other existing parameters, it may be helpful for addressing the categorisation of upward rotation of the fetal cerebellar vermis; however, further studies are necessary to strengthen the present findings.
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Affiliation(s)
- M Spinelli
- Department of Clinical Research, University of Bern, Bern, Switzerland.
| | - R Wiest
- Department of Diagnostic and Interventional Neuroradiology, University of Bern, Bern, Switzerland
| | - L Di Meglio
- Private Centre "Diagnostica ecografica Aniello Di Meglio srl", Naples, Italy
| | - M Baumann
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - L Raio
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - D Surbek
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
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Hecht C, Baumann M, Spinelli M, Trippel M, Raio L. Umbilical cord in conjoined twins: prenatal imaging and anatomopathological aspects. Ultrasound Obstet Gynecol 2019; 53:269-270. [PMID: 30125413 DOI: 10.1002/uog.20095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 06/08/2023]
Affiliation(s)
- C Hecht
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - M Baumann
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - M Spinelli
- Department of Biomedical Research, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - M Trippel
- Department of Pathology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - L Raio
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Mosimann B, Raio L. Re: Simultaneous recording of pulsed-wave Doppler signals in innominate vein and transverse aortic arch: new technique to evaluate atrioventricular conduction and fetal heart rhythm. Ultrasound Obstet Gynecol 2019; 53:277. [PMID: 30741448 DOI: 10.1002/uog.20204] [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: 11/01/2018] [Accepted: 12/20/2018] [Indexed: 06/09/2023]
Affiliation(s)
- B Mosimann
- Inselpital Bern Universitatsklinik fur Frauenheilkunde, Department of Obstetrics and Gynecology, Eddingerstrasse 102, Bern, 3010, Switzerland
| | - L Raio
- University Hospital of Bern, Department of Obstetrics and Gynecology, Bern, Switzerland
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Raio N, Amylidi-Mohr S, Mosimann B, Surbek D, Fiedler M, Stettler C, Raio L. The Bernese Gestational Diabetes (GDM) Project: Postpartum Oral Glucose Tolerance Test (OGTT) in women after gestational diabetes. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671116] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- N Raio
- Universität Bern, Bern, Schweiz
| | - S Amylidi-Mohr
- Department of Obstetrics and Gynecology, University Hospital and University of Bern, Bern, Schweiz
| | - B Mosimann
- Department of Obstetrics and Gynecology, University Hospital and University of Bern, Bern, Schweiz
| | - D Surbek
- Department of Obstetrics and Gynecology, University Hospital and University of Bern, Bern, Schweiz
| | - M Fiedler
- Center of Laboratory Medicine, University Institute of Clinical Chemistry, Bern University Hospital, University of Bern, Bern, Schweiz
| | - C Stettler
- Department of Diabetology and Endocrinology, University Hospital and University of Bern, Bern, Schweiz
| | - L Raio
- Department of Obstetrics and Gynecology, University Hospital and University of Bern, Bern, Schweiz
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Amylidi-Mohr S, Mosimann B, Kaderli N, Stettler C, Surbek D, Raio L. The Bernese gestational diabetes (GDM) project: Does pre-pregnancy BMI and weight gain in the first half of the pregnancy influence the development of GDM? Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671114] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- S Amylidi-Mohr
- Universitäts-Frauenklinik, Inselspital Bern, Geburtshilfe, Bern, Schweiz
| | - B Mosimann
- Universitäts-Frauenklinik, Inselspital Bern, Geburtshilfe, Bern, Schweiz
| | - N Kaderli
- Universitäts-Frauenklinik, Inselspital Bern, Geburtshilfe, Bern, Schweiz
| | - C Stettler
- Inselspital Bern, Endokrinologie und Diabetologie, Bern, Schweiz
| | - D Surbek
- Universitäts-Frauenklinik, Inselspital Bern, Geburtshilfe, Bern, Schweiz
| | - L Raio
- Universitäts-Frauenklinik, Inselspital Bern, Geburtshilfe, Bern, Schweiz
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Trottmann F, Baumann M, Mosimann B, Amylidi S, Surbek D, Raio L. Should we include sFlt-1 in the Swansea criteria? Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671492] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- F Trottmann
- Inselspital, Bern University Hospital, Department of Obstetrics and Gynaecology, Bern, Schweiz
| | - M Baumann
- Inselspital, Bern University Hospital, Department of Obstetrics and Gynaecology, Bern, Schweiz
| | - B Mosimann
- Inselspital, Bern University Hospital, Department of Obstetrics and Gynaecology, Bern, Schweiz
| | - S Amylidi
- Inselspital, Bern University Hospital, Department of Obstetrics and Gynaecology, Bern, Schweiz
| | - D Surbek
- Inselspital, Bern University Hospital, Department of Obstetrics and Gynaecology, Bern, Schweiz
| | - L Raio
- Inselspital, Bern University Hospital, Department of Obstetrics and Gynaecology, Bern, Schweiz
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Hofstaetter C, Baumann M, Raio L. Angiogenetische Charakterisierung von jelly-like Plazenten. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671167] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- C Hofstaetter
- Frauenklinik, Inselspital, Universität Bern, Bern, Schweiz
| | - M Baumann
- Frauenklinik, Inselspital, Universität Bern, Bern, Schweiz
| | - L Raio
- Frauenklinik, Inselspital, Universität Bern, Bern, Schweiz
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Amylidi-Mohr S, Mosimann B, Kaderli N, Stettler C, Fiedler G, Surbek D, Raio L. The Bernese gestational diabetes (GDM) project: Early hemoglobin A1c (HbA1c) as a predictor of GDM. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671115] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- S Amylidi-Mohr
- Universitäts-Frauenklinik, Inselspital Bern, Geburtshilfe, Bern, Schweiz
| | - B Mosimann
- Universitäts-Frauenklinik, Inselspital Bern, Geburtshilfe, Bern, Schweiz
| | - N Kaderli
- Universitäts-Frauenklinik, Inselspital Bern, Geburtshilfe, Bern, Schweiz
| | - C Stettler
- Inselspital Bern, Endokrinologie und Diabetologie, Bern, Schweiz
| | - G Fiedler
- Inselspital Bern, Labor für klinische Chemie, Bern, Schweiz
| | - D Surbek
- Universitäts-Frauenklinik, Inselspital Bern, Geburtshilfe, Bern, Schweiz
| | - L Raio
- Universitäts-Frauenklinik, Inselspital Bern, Geburtshilfe, Bern, Schweiz
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Spinelli M, Sica C, Meglio LD, Bolla D, Raio L, Surbek D. Fetal Cerebellar Vermis Circumference Measured by 2-Dimensional Ultrasound Scan: Reference Range, Feasibility and Reproducibility. Ultrasound Int Open 2016; 2:E124-E128. [PMID: 27921094 DOI: 10.1055/s-0042-119952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Purpose: To provide 2-dimensional ultrasonographic (2D-US) normograms of cerebellar vermis biometry, as well as to evaluate the feasibility and the reproducibility of these measurements in clinical practice. Materials and Methods: A prospective cross-sectional study of 328 normal singleton pregnancies between 18 and 33 weeks of gestation. Measurements of the fetal cerebellar vermis circumference (VC) in the mid-sagittal plane were performed by both a senior and a junior operator using 2D-US. VC as a function of gestational age (GA) was expressed by regression equations. In 24 fetuses 3-dimensional (3D) reconstructed planes were obtained in order to allow comparisons with 2D-US measurements. The agreement between 2D and 3D measurements and the interobserver variability were assessed by interclass correlation coefficients (ICC). Results: Satisfactory vermis measurements could be obtained in 89.9% of cases. The VC (constant= - 12.21; slope=2.447; r=0.887, p<0.0001) correlated linearly with GA. A high degree of consistency was observed between 2D and 3D ultrasound measurements (ICC=0.846 95% CI 679-0.930) as well as between measurements obtained by different examiners (ICC=0.890 95% CI 989-0.945). Conclusion: 2-dimensional ultrasonographic measurements of cerebellar vermis throughout gestation in the mid-sagittal view seem to be feasible and reproducible enough to be potentially used in clinical practice. Such measurements may supply a tool for accurate identification of posterior fossa anomalies, providing the basis for proper counseling and management and of these conditions.
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Affiliation(s)
- M Spinelli
- Department of Clinical Research, Prenatal Medicine, Inselspital Bern Universitatsklinik fur Frauenheilkunde, Bern, Switzerland
| | - C Sica
- Obstetrics and Gynecology, Private Centre "Diagnostica ecografica e prenatale Aniello Di Meglio s.r.l.", Naples, Italy
| | - L D Meglio
- Obstetrics and Gynecology, Private Centre "Diagnostica ecografica e prenatale Aniello Di Meglio s.r.l.", Naples, Italy
| | - D Bolla
- OB/GYN, University of Bern, Bern, Switzerland
| | - L Raio
- OB/GYN, University of Bern, Bern, Switzerland
| | - D Surbek
- OB & GYN, Inselspital, Bern, Switzerland
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Mueller M, Polowy J, Heverhagen A, Schleussner E, Raio L, Surbek D. Placental alpha-microglobulin-1 in cervico-vaginal fluid predicts preterm birth in women with preterm labor and intact membranes. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592950] [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: 10/20/2022] Open
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Baumann M, Risch L, Raio L, Surbek D, Zbinden A, Wiedemann U, Förger F. Pro- and anti-angiogene Faktoren während der Schwangerschaft bei rheumatoider Arthritis. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592912] [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: 10/20/2022] Open
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Bolla D, Favre D, Spinelli M, Baud D, Baumann M, Raio L. Placental anastomoses in monochorionic diamniotic twin pregnancy: not always a source of complication. Ultrasound Obstet Gynecol 2016; 48:253-254. [PMID: 26586033 DOI: 10.1002/uog.15822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/26/2015] [Accepted: 11/13/2015] [Indexed: 06/05/2023]
Affiliation(s)
- D Bolla
- Department of Obstetrics and Gynaecology, University Hospital of Bern, Bern, Switzerland
| | - D Favre
- Department of Obstetrics and Gynaecology, University Hospital of Bern, Bern, Switzerland
| | - M Spinelli
- Department of Obstetrics and Gynaecology, University Hospital of Bern, Bern, Switzerland
| | - D Baud
- Department of Obstetrics and Gynecology, University Hospital of Lausanne CHUV, Lausanne, Switzerland
- Swiss Fetal Laser Group. University Hospital of Bern, Bern, University Hospital of Lausanne CHUV, Lausanne, Switzerland
| | - M Baumann
- Department of Obstetrics and Gynaecology, University Hospital of Bern, Bern, Switzerland
| | - L Raio
- Department of Obstetrics and Gynaecology, University Hospital of Bern, Bern, Switzerland
- Swiss Fetal Laser Group. University Hospital of Bern, Bern, University Hospital of Lausanne CHUV, Lausanne, Switzerland
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Andreoli L, Bertsias GK, Agmon-Levin N, Brown S, Cervera R, Costedoat-Chalumeau N, Doria A, Fischer-Betz R, Forger F, Moraes-Fontes MF, Khamashta M, King J, Lojacono A, Marchiori F, Meroni PL, Mosca M, Motta M, Ostensen M, Pamfil C, Raio L, Schneider M, Svenungsson E, Tektonidou M, Yavuz S, Boumpas D, Tincani A. EULAR recommendations for women's health and the management of family planning, assisted reproduction, pregnancy and menopause in patients with systemic lupus erythematosus and/or antiphospholipid syndrome. Ann Rheum Dis 2016; 76:476-485. [PMID: 27457513 PMCID: PMC5446003 DOI: 10.1136/annrheumdis-2016-209770] [Citation(s) in RCA: 434] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/13/2016] [Accepted: 06/25/2016] [Indexed: 12/26/2022]
Abstract
Objectives Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). Methods Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. Results Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes. Risk stratification includes disease activity, autoantibody profile, previous vascular and pregnancy morbidity, hypertension and the use of drugs (emphasis on benefits from hydroxychloroquine and antiplatelets/anticoagulants). Hormonal contraception and menopause replacement therapy can be used in patients with stable/inactive disease and low risk of thrombosis. Fertility preservation with gonadotropin-releasing hormone analogues should be considered prior to the use of alkylating agents. Assisted reproduction techniques can be safely used in patients with stable/inactive disease; patients with positive antiphospholipid antibodies/APS should receive anticoagulation and/or low-dose aspirin. Assessment of disease activity, renal function and serological markers is important for diagnosing disease flares and monitoring for obstetrical adverse outcomes. Fetal monitoring includes Doppler ultrasonography and fetal biometry, particularly in the third trimester, to screen for placental insufficiency and small for gestational age fetuses. Screening for gynaecological malignancies is similar to the general population, with increased vigilance for cervical premalignant lesions if exposed to immunosuppressive drugs. Human papillomavirus immunisation can be used in women with stable/inactive disease. Conclusions Recommendations for women's health issues in SLE and/or APS were developed using an evidence-based approach followed by expert consensus.
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Affiliation(s)
- L Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy
| | - G K Bertsias
- Department of Rheumatology, Clinical Immunology and Allergy, University of Crete Medical School, Heraklion, Greece
| | - N Agmon-Levin
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.,The Faculty of Medicine, Tel Aviv University, Israel
| | - S Brown
- Royal National Hospital For Rheumatic Diseases, Bath, UK
| | - R Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - N Costedoat-Chalumeau
- AP-HP, Hôpital Cochin, Centre de référence maladies auto-immunes et systémiques rares, Paris, France.,Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - A Doria
- Rheumatology Unit, Department of Medicine, University of Padua, Italy
| | - R Fischer-Betz
- Policlinic of Rheumatology, Hiller Research Unit, University Clinic Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - F Forger
- Department of Rheumatology, Immunology and Allergology, University Hospital of Bern, Bern, Switzerland
| | - M F Moraes-Fontes
- Unidade de Doenças Auto-imunes-Serviço Medicina Interna 7.2, Hospital Curry Cabral/Centro Hospitalar Lisboa Central, NEDAI/SPMI, Lisboa, Portugal
| | - M Khamashta
- Lupus Research Unit, The Rayne Institute, St. Thomas Hospital, London, UK.,Department of Rheumatology, Dubai Hospital, Dubai, United Arab Emirates
| | - J King
- EULAR PARE Patient Research Partner, London, UK
| | - A Lojacono
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Obstetrics and Gynaecology, Spedali Civili, Brescia, Italy
| | - F Marchiori
- EULAR PARE Patient Research Partner, Rome, Italy
| | - P L Meroni
- Department of Clinical Sciences and Community Health, University of Milan, Istituto Auxologico Italiano, Milan, Italy
| | - M Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Motta
- Neonatology and Neonatal Intensive Care Unit, Spedali Civili, Brescia, Italy
| | - M Ostensen
- Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - C Pamfil
- Department of Rheumatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - L Raio
- Department of Obstetrics and Gynaecology, University Hospital of Bern, Inselspital, Switzerland
| | - M Schneider
- Policlinic of Rheumatology, Hiller Research Unit, University Clinic Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - E Svenungsson
- Rheumatology Unit, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M Tektonidou
- Rheumatology Unit, Joint Academic Rheumatology Programme, 1st Department of Propaedeutic Internal Medicine Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - S Yavuz
- Department of Rheumatology, Istanbul Bilim University, Istanbul Florence Nightingale Hospital, Esentepe-Istanbul, Turkey
| | - D Boumpas
- 4th Department of Internal Medicine, 'Attikon' University Hospital, Medical School, University of Athens, Athens, Greece.,Joint Academic Rheumatology Program, National and Kapodestrian University of Athens, Athens, Greece
| | - A Tincani
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Unit of Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy
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Förger F, Baumann M, Risch L, Raio L, Surbek D, Wiedemann U, Zbinden A. FRI0127 Angiogenic Placental Factors during Pregnancy in Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Amylidi-Mohr S, Jakob A, Mosimann B, Stettler C, Fiedler G, Surbek D, Raio L. Glycosylated hemoglobin (HbA1c) in the first trimester of pregnancy. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566622] [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: 10/22/2022]
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31
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Baumann M, Bolla D, Surbek D, Raio L. Nabelschnurhämodynamik in der Frühschwangerschaft. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566454] [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: 10/22/2022]
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32
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Tan Z, Baumann M, Raio L, Surbek D. Angiogenic markers sFlt-1 and PIGF can be used to predict the course of early-onset preeclampsia. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566679] [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: 10/22/2022]
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Tan Z, Baumann M, Raio L, Surbek D. Angiogenic markers sFlt-1 and PIGF: a new diagnostic tool for patients with suspected preeclampsia. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566531] [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: 10/22/2022]
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34
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Sycha AM, Baumann M, Raio L, Surbek D. Plazentares Alpha-Microglobulin-1 in Kombination mit sonografischer Zervixlängenmessung zur Prädiktion einer Frühgeburt. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0034-1375725] [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: 10/19/2022]
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35
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Bertrang Warncke A, Baumann M, Raio L. Fetales Rhabdomyosarkom (RBS): Konsequenz für das Kind und Risiko für die Mutter. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0034-1375771] [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: 10/19/2022]
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Bolla D, Raio L, Imboden S, Mueller MD. Laparoscopic Cerclage as a Treatment Option for Cervical Insufficiency. Geburtshilfe Frauenheilkd 2015; 75:833-838. [PMID: 26366003 PMCID: PMC4554519 DOI: 10.1055/s-0035-1557762] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/02/2015] [Accepted: 05/10/2015] [Indexed: 10/23/2022] Open
Abstract
Background: The traditional surgical treatment for cervical insufficiency is vaginal placement of a cervical cerclage. However, in a small number of cases a vaginal approach is not possible. A transabdominal approach can become an option for these patients. Laparoscopic cervical cerclage is associated with good pregnancy outcomes but comes at the cost of a higher risk of serious surgical complications. The aim of the present study was to evaluate intraoperative and long-term pregnancy outcomes after laparoscopic cervical cerclage, performed either as an interval procedure or during early pregnancy, using a new device with a blunt grasper and a flexible tip. Methods: All women who underwent laparoscopic cervical cerclage for cervical insufficiency in our institution using the Goldfinger® device (Ethicon Endo Surgery, Somerville, NJ, USA) between January 2008 and March 2014 were included in the study. Data were collected from the patients' medical records and included complications during and after the above-described procedure. Results: Eighteen women were included in the study. Of these, six were pregnant at the time of laparoscopic cervical cerclage. Mean duration of surgery was 55 ± 10 minutes. No serious intraoperative or postoperative complications occurred. All patients were discharged at 2.6 ± 0.9 days after surgery. One pregnancy ended in a miscarriage at 12 weeks of gestation. All other pregnancies ended at term (> 37 weeks of gestation) with good perinatal and maternal outcomes. Summary: Performing a laparoscopic cervical cerclage using a blunt grasper device with a flexible tip does not increase intraoperative complications, particularly in early pregnancy. We believe that use of this device, which is characterized by increased maneuverability, could be an important option to avoid intraoperative complications if surgical access is limited due to the anatomical situation. However, because of the small sample size, further studies are needed to confirm our findings.
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Affiliation(s)
- D. Bolla
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland
| | - L. Raio
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland
| | - S. Imboden
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland
| | - M. D. Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern, Bern, Switzerland
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Andreoli L, Bertsias G, Agmon-Levin N, Brown S, Cervera R, Costedoat-Chalumeau N, Doria A, Fischer-Betz R, Forger F, Moraes-Fontes M, Khamashta M, King J, Lojacono A, Marchiori F, Meroni P, Mosca M, Motta M, Ostensen M, Pamfil C, Raio L, Schneider M, Svenungsson E, Tektonidou M, Yavuz S, Boumpas D, Tincani A. OP0086 Eular Recommendations for Women's Health and the Management of Family Planning, Assisted Reproduction, Pregnancy, and Menopause in Patients With Systemic Lupus Erythematosus and/or the Antiphospholipid Syndrome. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Imboden S, Müller M, Raio L, Mueller MD, Tutschek B. Clinical significance of 3D ultrasound compared to MRI in uterine malformations. Ultraschall Med 2014; 35:440-444. [PMID: 24557634 DOI: 10.1055/s-0033-1335664] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Congenital uterine anomalies often remain asymptomatic until they cause problems, for example during pregnancy. We studied the diagnostic aspects of two- and three-dimensional ultrasound and MRI. MATERIALS AND METHODS 63 women referred for suspected uterine anomalies were studied: In the first group (until July 2008) with 2 D-US and MRI, in the second group (from August 2008) additionally with 3 D-US; these women also had diagnostic or therapeutic operative confirmation. In the third group, only 3D-US was used. RESULTS In all women 3D-US was possible and successful. The most common anomaly was a subseptate uterus, while a septate uterus was less frequent, and uterus bicornis (unicollis) and uterus didelphys (bicornis bicollis) were rare. The women in the first two groups all underwent at least diagnostic hysteroscopy, and some (subseptate or septate uterus) underwent operative hysteroscopy. After preoperative volume imaging, laparoscopies were required less often. 3D-US diagnoses as judged by intraoperative findings were correct in 100 % of cases, while the MRI diagnoses in the same group were correct in only 7/13 cases. CONCLUSION Since the introduction of volume imaging (MRI, later 3 D-US), laparoscopy during hysteroscopic septum resection was not necessary in the majority of cases. 3D-US brings the diagnostics of uterine anomalies back into the hands of the gynecologist and can provide the gynecological surgeon with a higher subjective degree of certainty during operative hysteroscopy.
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Affiliation(s)
- S Imboden
- Universitäts-Frauenklinik, Inselspital, Bern
| | - M Müller
- Universitäts-Frauenklinik, Inselspital, Bern
| | - L Raio
- Universitäts-Frauenklinik, Inselspital, Bern
| | - M D Mueller
- Universitäts-Frauenklinik, Inselspital, Bern
| | - B Tutschek
- Pränatalmedizin und gyn. Ultraschall, Basel, und Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf
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Tan Z, Baumann M, Raio L, Surbek D. Angiogenesefaktoren: Neues adjuvantes diagnostisches Kriterium bei unklarer Präeklampsie/HELLP-Syndrom-Symptomatik. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388607] [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: 10/24/2022] Open
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40
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Amylidi SK, Tappeser P, Mosimann B, Zdanowicz J, Baumann M, Surbek D, Raio L. Umbilical artery time-averaged maximum velocity: First trimester reference range. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388031] [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: 10/24/2022] Open
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41
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Aulitzky A, Amylidi SK, Stettler C, Fiedler GM, Surbek D, Raio L. First trimester oral glucose tolerance test in a population at high risk for gestational diabetes. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388104] [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: 10/24/2022] Open
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Mosimann B, Amylidi S, Raio L, Surbek D. Blutflusseigenschaften der linken fetalen Vena brachiocephalica. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388158] [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: 10/24/2022] Open
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Christoph P, Baumann M, Raio L, Surbek D, Schöll W. Secondary life-threatening postpartum hemorrhage – Case report. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388217] [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: 10/24/2022] Open
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Zdanowicz JA, Huber C, Gerull R, Raio L, Surbek D. Accuracy of fetal weight estimation with regard to clinical decision making in preterm birth at the limit of viability. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388148] [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: 10/24/2022] Open
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Grosskopf AU, Brühwiler H, Eggimann T, Rautenberg W, Raio L. [Preconceptional use of folic acid in the region of the Kantonsspital Münsterlingen/Thurgau: has it changed over the past 10 years?]. Z Geburtshilfe Neonatol 2014; 218:149-52. [PMID: 25127346 DOI: 10.1055/s-0034-1382067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Numerous studies have shown that the preconceptional use of folic acid prevents neural tube defects. We created a study to find out whether the preconceptional use of folic acid has improved in the past 10 years, in the area of Münsterlingen, Switzerland. MATERIAL AND METHODS We interviewed 2 groups of patients who delivered at our Institution, namely between 2000 and 2002 (period A) involving 287 women and from 2009 to 2010 (period B) involving 305 pregnant women. We asked them whether they used folic acid by means of a standardised questionnaire. RESULTS In period B significantly more women have taken folic acid preconceptionally (period A: 27.5% vs. period B: 40.7%; p=0.001). A significant increase in folic acid intake was seen in the German speaking group from period A to B (30.3% vs. 52.7%; p=0.0005), while this was not the case in the non-German speaking group (21.4% in both periods). More multiparaé women were taking folic acid compared to nulliparae. A significant increase from period A to B was noted only in the German speaking group. Unexpectedly, in nulliparae non-German speaking women, folic acid supplementation decreased from 14% to 6.1%. DISCUSSION We have found a significant increase in preconceptional folic acid supplementation from 2001 to 2010. The percentage of women taking folic acid is disappointingly low in all groups, particularly in nulliparae women of non-German ethnicity.
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Affiliation(s)
- A U Grosskopf
- Gynäkologie und Geburtshilfe, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - H Brühwiler
- Gynäkologie und Geburtshilfe, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - T Eggimann
- Gynäkologie und Geburtshilfe, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - W Rautenberg
- Gynäkologie und Geburtshilfe, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - L Raio
- Universitätsklinik für Frauenheilkunde, Inselspital Universitätsspital Bern, Bern, Switzerland
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Xu H, Huang X, Riserus U, Cederholm T, Lindholm B, Arnlov J, Carrero JJ, Leiba A, Vivante A, Bulednikov Y, Golan E, Skorecki K, Shohat T, Mjoen G, Zannad F, Jardine A, Schmieder R, Fellstrom B, Holdaas H, Zager P, Miskulin D, Gassman J, Kendrick C, Ploth D, Jhamb M, Jankowski V, Schulz A, Mischak H, Zidek W, Jankowski J, Lee YK, Cho A, Kim JK, Choi MJ, Kim SJ, Yoon JW, Koo JR, Kim HJ, Noh JW, Itano S, Satoh M, Kidokoro K, Sasaki T, Kashihara N, Koutroumpas G, Sarafidis P, Georgianos P, Karpetas A, Protogerou A, Syrganis C, Malindretos P, Raptopoulou K, Panagoutsos S, Pasadakis P, Zager P, Miskulin D, Gassman J, Kendrick C, Jhamb M, Ploth D, Vink EE, De Boer A, Verloop WL, Spiering W, Voskuil M, Vonken EJ, Hoogduin JM, Leiner T, Bots ML, Blankestijn PJ, Sarafidis PA, Karpetas AV, Georgianos PI, Bikos A, Sklavenitis-Pistofidis R, Tzimou R, Raptis V, Vakianis P, Tersi M, Liakopoulos V, Lasaridis AN, Protogerou A, Ribeiro S, Fernandes J, Garrido P, Sereno J, Vala H, Bronze Da Rocha E, Belo L, Costa E, Reis F, Santos-Silva A, Kalaitzidis R, Skapinakis P, Karathanos V, Karasavvidou D, Katatsis G, Pappas K, Hatzidakis S, Siamopoulos K, Margulis F, Sabbatiello R, Castro C, Ramallo S, Martinez M, Schiavelli R, Ganem D, Nakhoul F, Roth A, Farber E, Kim CS, Kim HY, Kang YU, Choi JS, Bae EH, Ma SK, Kim SW, Koutroumpas G, Sarafidis P, Georgianos P, Karpetas A, Protogerou A, Malindretos P, Syrganis C, Tzanis G, Panagoutsos S, Pasadakis P, Jankowski M, Kasztan M, Kowalski R, Piwkowska A, Rogacka D, Szczepa Ska-Konkel M, Angielski S, Evangelou D, Naka K, Kalaitzidis R, Lakkas L, Bechlioulis A, Gkirdis I, Nakas G, Zarzoulas F, Kotsia A, Balafa O, Tzeltzes G, Pappas K, Katsouras C, Dounousi E, Michalis L, Siamopoulos K, Maciorkowska D, Zbroch E, Koc-Zorawska E, Malyszko J, Karabay Bayazit A, Yuksekkaya I, Aynaci S, Anarat A, Nakai K, Fujii H, Ishida R, Utaka C, Awata R, Goto S, Ito J, Nishi S, Elsurer R, Afsar B, Lepar Z, Radulescu D, David C, Peride I, Niculae A, Checherita IA, Ciocalteu A, Sungur CI, Kanbay M, Siriopol D, Nistor I, Elcioglu OC, Telci O, Johnson R, Covic A, Vettoretti S, Gallazzi E, Meazza R, Gagliardi V, Villarini A, Alfieri CM, Floreani R, Messa P, Vettoretti S, Alfieri CM, Gallazzi E, Gagliardi V, Villarini A, Meazza R, Floreani R, Messa P, Kotovskaya Y, Villevalde S, Kobalava Z, Circiumaru A, Rusu E, Zilisteanu D, Atasie T, Cirstea F, Ecobici M, Voiculescu M, Rosca M, Tanase C, Baoti I, Vidjak V, Prka in I, Bulum T, Arslan E, Sarlak H, Cakar M, Demirbas S, Akhan M, Kurt O, Balta S, Yesilkaya S, Bulucu F, Chan CK, Lin YH, Wu VC, Wu KD, De Beus E, Bots ML, Van Zuilen AD, Wetzels JF, Blankestijn PJ, Mohaupt M, Straessle K, Baumann M, Raio L, Sirbek D, Nascimento MA, Mouro MG, Punaro GR, Mello MT, Tufik S, Higa EMS. HYPERTENSION. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu142] [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: 11/12/2022] Open
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Amylidi SK, Stettler C, Fiedler GM, Surbek D, Raio L. HbA1c im ersten Trimenon als Marker für Schwangerschaftskomplikationen in der Risikogruppe. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361188] [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: 10/26/2022]
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Gabioud S, Baumann M, Raio L, Risch L, Wiedemann U, Hofstaetter C, Surbek D. Angiogenesemarker bei klinisch manifester Präeklampsie und deren Relevanz. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361251] [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: 10/26/2022]
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Raio L, Cappocia R, Hofstaetter C, Ahrens O, Vial L. Intrazerebrale Blutungen bei wachstumsretardierten Feten < 34 Wochen und mit Zentralisierung. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361286] [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: 10/26/2022]
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Hofstaetter C, Zdanowicz J, Tapesser P, Baumann M, Raio L. Nullfluss und Pulsatilität Index in der Nabelschnurarterie im 1. Trimenon: Vergleich zwischen Prä-eklampsie und einer normalen Kontrollgruppe. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361288] [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: 10/26/2022]
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