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D'Alberti E, Rizzo G, Khalil A, Mappa I, Pietrolucci ME, Capannolo G, Alameddine S, Sorrenti S, Zullo F, Giancotti A, Di Mascio D, D'Antonio F. Counseling in fetal medicine: Congenital cytomegalovirus infection. Eur J Obstet Gynecol Reprod Biol 2024; 295:8-17. [PMID: 38310675 DOI: 10.1016/j.ejogrb.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/02/2023] [Accepted: 01/29/2024] [Indexed: 02/06/2024]
Abstract
Although the clinical work-up of CMV in pregnancy has gradually become more accurate, counseling for CMV is still challenging. Despite the potential feasibility of universal prenatal serological screening, its introduction in prenatal diagnosis continues to raise concerns related to its real cost-effectiveness. Contextually, anticipating the confirmation of fetal infection earlier in pregnancy is one of the most pressing issues to reduce the parental psychological burden. Amniocentesis is still the gold standard and recent data have demonstrated that it could be performed before 20 weeks of gestation, provided that at least 8 weeks have elapsed from the presumed date of maternal seroconversion. New approaches, such as chorionic villus sampling (CVS) and virome DNA, even if not yet validated as confirmation of fetal infection, have been studied alternatively to amniocentesis to reduce the time-interval from maternal seroconversion and the amniocentesis results. Risk stratification for sensorineural hearing loss (SNHL) and long-term sequelae should be provided according to the prognostic predictors. Nevertheless, in the era of valacyclovir, maternal high-dose therapy, mainly for first trimester infections, can reduce the risk of vertical transmission and increase the likelihood of asymptomatic newborns, but it is still unclear whether valacyclovir continues to exert a beneficial effect on fetuses with positive amniocentesis. This review provides updated evidence-based key counseling points with GRADE recommendations.
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Affiliation(s)
- Elena D'Alberti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, University of Roma Tor Vergata, Rome, Italy
| | - Asma Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, the United Kingdom of Great Britain and Northern Ireland; Fetal Medicine Unit, St George's Hospital, London, the United Kingdom of Great Britain and Northern Ireland; Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, the United Kingdom of Great Britain and Northern Ireland
| | - Ilenia Mappa
- Division of Maternal Fetal Medicine Ospedale Cristo Re, University of Roma Tor Vergata, Rome, Italy
| | - Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, University of Roma Tor Vergata, Rome, Italy
| | - Giulia Capannolo
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Sara Alameddine
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Sara Sorrenti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Fabrizio Zullo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
| | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy.
| | - Francesco D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
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Marra MC, Mappa I, Pietrolucci ME, Lu JLA, D' Antonio F, Rizzo G. Fetal brain development in pregnancies complicated by gestational diabetes mellitus. J Perinat Med 2024; 52:310-316. [PMID: 38231478 DOI: 10.1515/jpm-2023-0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/23/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVES Gestational diabetes mellitus (GDM) carries an increased risk of neurocognitive impairment in offsprings. However, the contribution of maternal hyperglycemia in affecting fetal brain development is not fully elucidated yet. The aim of this study was to evaluate fetal brain and sulci development in pregnancies complicated by GDM. METHODS Prospective observational study including 100 singleton pregnancies complicated by GDM and 100 matched controls. All fetuses underwent neurosonography at 29-34 weeks of gestation, including the assessment of the length of the corpus callosum (CC), cerebellar vermis (CV), Sylvian (SF), parieto-occipital (POF) and calcarine fissures (CF). Sub-group analysis according to the specific treatment regimen adopted (n 67 diet vs. 33 insulin therapy) was also performed. RESULTS Fetuses from mothers with GDM under insulin therapy had a smaller CC (35.54 mm) compared to both controls (40 mm; p<0.001) and women with GDM under diet (39.26 mm; p=0.022) while there was no difference in the HC between the groups. Likewise, when corrected for HC, CV depth was smaller in fetuses with GDM both under insulin therapy (7.03 mm) and diet (7.05 mm,) compared to controls (7.36 mm; p=0.013). Finally, when assessing the sulci development of the brain SF (p≤0.0001), POF (p≤0.0001) and CF (p≤0.0001) were significantly smaller in fetuses with maternal GDM. Post-hoc analysis showed that fetuses of GDM mothers requiring insulin therapy had significantly lower values of SF (p=0.032), POF (p=0.016) and CF (p=0.001). CONCLUSIONS Pregnancies complicated by GDM showed a peculiar pattern of fetal brain growth and cortical development and these changes, which are more evident in those requiring insulin supplementation.
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Affiliation(s)
- Maria Chiara Marra
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | | | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
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Mappa I, Marra MC, Pietrolucci ME, Lu JLA, Di Mascio D, D'Antonio F, Rizzo G. Effects of gender on fetal cortical development: a secondary analysis of a prospective cross-sectional study. J Perinat Med 2024; 52:114-116. [PMID: 37851901 DOI: 10.1515/jpm-2023-0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES The primary objective was to evaluate the effects of fetal sex on fetal cortical development in low-risk pregnancies. Secondary objective was the evaluate the impact of gestational age. METHODS This was a secondary analysis of a prospective cross-sectional study on low-risk fetuses undergoing fetal neurosonography between 19 and 34 weeks of gestation. The depth of Sylvian Fissure (SF), Parieto Occipital Fissure (POF) and Calcarine Fissure (CF) were evaluated and related to fetal sex. Neurosonographic variables were normalized for fetal head circumference and expressed as multiple of the median (MoM). RESULTS A total of 344 fetuses were considered (173 male, 171 female). The baseline characteristic of the two groups were similar except a higher birthweight present in male fetuses (p=0.044). The depth SF (p=0.023) CF (p=0.014) and POF (p=0.046) showed significantly higher values in male fetuses when all the gestational age range was considered. However, when data were controlled for gestational age, these differences resulted significant only after 28 weeks. CONCLUSIONS Differences in cortical development related to gender occur after 28 weeks of gestation with an increase depth of SF, POF and CF in male fetuses.
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Affiliation(s)
- Ilenia Mappa
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Maria Chiara Marra
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Daniele Di Mascio
- Department of Obstetrics and Gynecology, Università Roma La Sapienza, Rome, Italy
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Università di Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
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Mappa I, Marra MC, Pietrolucci ME, Lu JLA, D'Antonio F, Rizzo G. Midline structures and cortical development in fetuses with late growth restriction according to Doppler status: prospective study. Ultrasound Obstet Gynecol 2024. [PMID: 38279964 DOI: 10.1002/uog.27598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE Fetuses with late growth restriction (FGR) have a higher risk of sub-optimal neurocognitive performance after birth. Previous studies have reported that impaired brain and cortical development can start in utero. The primary aim of this study was to report midline structures and cortical development in fetuses with late growth restriction according to its severity; the secondary aim was to elucidate whether the severity of FGR, as defined by the presence of abnormal Doppler findings, plays a role in affecting brain growth and maturation. METHODS Prospective cross-sectional study including fetuses with late FGR undergoing neurosonography between 32 and 34 weeks of gestation. Midline structures (corpus callosum (CC) and cerebellar vermis (CV) length) and cortical development, including the depth of Sylvian (SF), parieto-occipital (POF) and calcarine (CF) were compared between FGR, small (SGA) and appropriate for gestational age (AGA) fetuses, defined upon the Delphi criteria. Sub-group analysis according to the severity of FGR (normal vs abnormal fetal Dopplers) was also performed. Univariate analysis was used to analyze the data. RESULTS 52 FGR with normal, 60 with abnormal Dopplers, 64 SGA and 100 AGA fetuses were included in the analysis. SGA and FGR fetuses showed significant differences in absolute values of CC (median (interquartile range) control 43.47 (28.9-56.05), vs SGA 41.85 (27.82-51.79), vs FGR ND 38.54 (29.12-50.53), vs FGR AD 31.72 (23.8-40.19) K= 26.68; p<0.0001), CV (control 24.85 (17.55-29.21), SGA K=16.71; p=0.0008), SF (control 14.52 (10.65-16.76) vs SGA 12.71 (9.8-15.10) vs FGR ND 11.93 (9.12-13.43) VS FGR A 8.30 (6.72-10.33) K=75.82; p<0.0001), POF (control 8.56 (6.31-11.09) vs SGA 8.11 (5.58-10.43) vs FGR ND 7.81 (6.14-9.29) vs FGR AD 6.56 (4.22-7.99), K=45.06; p<0.0001) and CF ( control 9.27 (6.70-11.45) vs SGA 8.23 (5.67-10.65) vs FGR ND 7.68 (5.22-9.41) vs FGR AD 6.26 (4.48-7.19) K=46.14; p<0.0001) when compared to AGA controls with a progressive reduction across groups. When neurosonographic variables were corrected for fetal HC values, significant difference in the length of CC, SF, POF and CF but CV were observed only in FGR fetuses with abnormal Doppler when compared to AGA controls. CONCLUSIONS Late onset small fetuses showed shorter CC length and a delayed cortical development when compared to control. After controlling for HC size these differences remain significant only in FGR fetuses with abnormal Dopplers. These findings support the existence of a link between brain development and impaired placental function. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- I Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - M C Marra
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - M E Pietrolucci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - J L A Lu
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - F D'Antonio
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - G Rizzo
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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Marra MC, Pietrolucci ME, Mappa I, Lu JLA, Di Mascio D, D'Antonio F, Rizzo G. Modeling fetal cortical development by quantile regression for gestational age and head circumference: a prospective cross sectional study. J Perinat Med 2023; 51:1212-1219. [PMID: 37596832 DOI: 10.1515/jpm-2023-0176] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/03/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES To develop charts for fetal brain cortical structures following a proposed standardized methodology and using quantile regression. METHODS Prospective cross-sectional study including 344 low-risk singleton pregnancies between 19 and 34 weeks of gestation. The depth of Sylvian (SF), Parieto-occipital (POF) and Calcarine fissures (CF) were measured on ultrasound images using a standardized technique and their changes were evaluated by quantile regression as a function of gestational age (GA) interval or head circumference (HC). RESULTS The measurements of SF, POF and CF depth significantly increased with gestation. Linear models better described the changes of cortical variables with GA and HC. When the fit of sulci depth with GA and HC were compared, a close relationship was highlighted for the latter variable. CONCLUSIONS We provided prospective charts of fetal cortical development using quantile regression and following a strict standardized methodology These new charts may help in better identifying cases at higher risk of abnormal cortical neurodevelopment.
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Affiliation(s)
- Maria Chiara Marra
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Daniele Di Mascio
- Department of Obstetrics and Gynecology, Università Roma La Sapienza, Rome, Italy
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Università di Chieti, Chieti, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
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Orlandi G, Di Girolamo R, Carbone L, Sarno L, Maresca A, Fulgione C, Mazzarelli LL, D'antonio F, Mappa I, Pietrolucci ME, Rizzo G, Maruotti GM. Ectrodactyly-ectodermal dysplasia-clefting syndrome. Prenatal prospective ultrasound diagnosis. J Clin Ultrasound 2023; 51:1348-1355. [PMID: 37665243 DOI: 10.1002/jcu.23549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Prenatal diagnosis of the Ectrodactyly-Ectodermal dysplasia-clefting (EEC) syndrome has been based upon the detection of ectrodactyly, in association with facial clefting and/or positive family history. Our aim is to describe other ultrasonographic features indicating the presuntive diagnosis, regardless of genetic diagnosis, especially in cases of negative family history. MATERIALS AND METHODS A case report and a review of the literature was assessed. RESULTS Our case report showed a singleton foetus "lobster claw" deformities of hands and feet. Paternal history revealed bilateral agenesia of two fingers. Through literature, 15 case reports of prenatal diagnosis of EEC syndrome were found, 14 of which were eligible for our systematic review. The 33% of cases (5/15) had a familiar history of EEC, thus, we found one case of consanguinity of parents. Anomalies EEC-related were recognized in the 40% of cases (6/15). An association with genitourinary anomalies was found in 30% (5/15) of them. CONCLUSIONS A strong suspicion of final diagnosis of EEC may be done in the presence of ectrodactyly, facial clefting and urinary malformation especially in cases of negative family history. More attention should be given to a genetic counseling, especially to understand a possible relation to other genetic syndromes.
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Affiliation(s)
- Giuliana Orlandi
- Gynecology and Obstetrics Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Raffaella Di Girolamo
- Gynecology and Obstetrics Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Carbone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Laura Sarno
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonia Maresca
- Gynecology and Obstetrics Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Caterina Fulgione
- Gynecology and Obstetrics Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Laura Letizia Mazzarelli
- Gynecology and Obstetrics Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesco D'antonio
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome "Tor Vergata", Rome, Italy
| | - Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome "Tor Vergata", Rome, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome "Tor Vergata", Rome, Italy
| | - Giuseppe Maria Maruotti
- Gynecology and Obstetrics Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
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Pietrolucci ME, Maqina P, Mappa I, Marra MC, D' Antonio F, Rizzo G. Evaluation of an artificial intelligent algorithm (Heartassist™) to automatically assess the quality of second trimester cardiac views: a prospective study. J Perinat Med 2023; 51:920-924. [PMID: 37097825 DOI: 10.1515/jpm-2023-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/25/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the agreement between visual and automatic methods in assessing the adequacy of fetal cardiac views obtained during second trimester ultrasonographic examination. METHODS In a prospective observational study frames of the four-chamber view left and right outflow tracts, and three-vessel trachea view were obtained from 120 consecutive singleton low-risk women undergoing second trimester ultrasound at 19-23 weeks of gestation. For each frame, the quality assessment was performed by an expert sonographer and by an artificial intelligence software (Heartassist™). The Cohen's κ coefficient was used to evaluate the agreement rates between both techniques. RESULTS The number and percentage of images considered adequate visually by the expert or with Heartassist™ were similar with a percentage >87 % for all the cardiac views considered. The Cohen's κ coefficient values were for the four-chamber view 0.827 (95 % CI 0.662-0.992), 0.814 (95 % CI 0.638-0.990) for left ventricle outflow tract, 0.838 (95 % CI 0.683-0.992) and three vessel trachea view 0.866 (95 % CI 0.717-0.999), indicating a good agreement between the two techniques. CONCLUSIONS Heartassist™ allows to obtain the automatic evaluation of fetal cardiac views, reached the same accuracy of expert visual assessment and has the potential to be applied in the evaluation of fetal heart during second trimester ultrasonographic screening of fetal anomalies.
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Affiliation(s)
- Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Pavjola Maqina
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | - Maria Chiara Marra
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
| | | | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Roma, Italy
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Mappa I, Pietrolucci ME, Pavjola M, Maruotti G, D'Antonio F, Rizzo G. Fetal brain biometry and cortical development after maternal SARS-CoV-2 infection in pregnancy: A prospective case-control study. J Clin Ultrasound 2023; 51:639-643. [PMID: 36305509 PMCID: PMC9874750 DOI: 10.1002/jcu.23382] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES To assess cerebral growth and the development of fetal cortex using neurosonography in fetuses from pregnancies experiencing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) according to infection timing. METHODS Pregnancies with by SARS-CoV-2 during first and second trimesters were prospectively studied and matched with unaffected controls. Enclosed women underwent neurosonography at 30-34 weeks of gestation and corpus callosum (CC) and cerebellar vermis (CV) lengths measured. Further Sylvian fissure (SF), insula. Parieto-occipital fissure (POF), and calcarine sulci fissures (CSF) depths were obtained. The ultrasonographic variables considered were normalized with fetal head size. RESULTS One hundred and seventy four consecutive pregnancies experiencing SARS COV 2 infection (81 before 14 weeks and 93 later) and 131 not affected pregnancies were considered. General and pregnancy characteristics were similar between the three groups of women. No significant differences existed in CC and CV lengths across groups. Similarly, insula, SF, POF And CSF depth did not result changed in fetuses of affected mothers. CONCLUSIONS SARS-CoV-2 infection does nor resulted associate with differential fetal cortical development or brain growth in mildly symptomatic pregnant women. This information may be useful to reassure infected mothers on the health of their fetuses.
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Affiliation(s)
- Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor VergataUniversity of Rome Tor VergataRomeItaly
| | - Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor VergataUniversity of Rome Tor VergataRomeItaly
| | - Maqina Pavjola
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor VergataUniversity of Rome Tor VergataRomeItaly
| | - Giuseppe Maruotti
- Department of Obstetrics and GynecologyUniversity Federico IINaplesItaly
| | | | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor VergataUniversity of Rome Tor VergataRomeItaly
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Rizzo G, Pavjola M, Pietrolucci ME. Expert ultrasonographic evaluation in fetuses with spina bifida: An essential prerequisite to select candidate to fetal surgery. J Clin Ultrasound 2023; 51:415-416. [PMID: 36893036 DOI: 10.1002/jcu.23363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 06/18/2023]
Abstract
Suggested management flowchart in presence of a prenatal diagnosis of open spina bifida.
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Affiliation(s)
- Giuseppe Rizzo
- Departement of Obstetrics and Gynecology, Università di Roma Tor Vergata, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Maqina Pavjola
- Departement of Obstetrics and Gynecology, Università di Roma Tor Vergata, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Maria Elena Pietrolucci
- Departement of Obstetrics and Gynecology, Università di Roma Tor Vergata, Fondazione Policlinico Tor Vergata, Rome, Italy
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Rizzo G, Pietrolucci ME, De Vito M, Pavjola M, Capponi A, Mappa I. Fetal brain biometry and cortical development in congenital heart disease: A prospective cross sectional study. J Clin Ultrasound 2023; 51:84-90. [PMID: 36069371 DOI: 10.1002/jcu.23308] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate brain biometry and cortical development by neurosonography in fetuses with congenital heart defect (CHD) and evaluate differences among different type of CHD. METHODS In a prospective cross sectional study singleton fetus with CHD were matched with controls and grouped into two categories according to the predicted severity of cerebral arterial oxygen deficit induced by the CHD: Group A mildly reduced or normal and Group B moderately to severely reduced. Neurosonography was done at 30-33 weeks to obtain measurements of corpus callosum (CC), cerebellar vermis (CV), Sylvian fissure (SF) insula, parieto-occipital fissure (POF), and calcarine sulci fissures (CSF). All the neurosonographic parameters were adjusted by head circumference (HC). RESULTS A total of 78 fetuses with CHD (group A 30; group B 48) and 80 matched controls form uncomplicated pregnancies were considered. CHD fetuses have significantly smaller CC, CV, SF, and POF and bigger insula when compared to control fetuses. These differences are more marked in group B fetuses. These differences remained significant after correction for HC values. CONCLUSION Fetuses with CHD have an impaired cortical development and these variations are more evident in those with a predicted lower oxygen delivery to the brain.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Marika De Vito
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Maqina Pavjola
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Alessandra Capponi
- Department of Obstetrics and Gynecology, Ospedale San Giovanni Rome, Rome, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
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Rizzo G, Pietrolucci ME, Mappa I. Which is the best time to perform balloon valvuloplasty in critically fetal aortic stenosis: Prenatally or after birth? J Clin Ultrasound 2022; 50:1286-1287. [PMID: 36353906 DOI: 10.1002/jcu.23338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Abstract
Fetal aortic valvuloplasty may prevent the progression of severe fetal aortic stenosis to hypoplastic left heart syndrome at birth. Since it is an high risk procedure a careful selection of fetuses that can benefit from the prenatal treatment instead of waiting for postnatal intervention.
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Affiliation(s)
- Giuseppe Rizzo
- Università di Roma Tor Vergata Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata Roma, Italy
| | - Maria Elena Pietrolucci
- Università di Roma Tor Vergata Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata Roma, Italy
| | - Ilenia Mappa
- Università di Roma Tor Vergata Department of Obstetrics and Gynecology Fondazione Policlinico Tor Vergata Roma, Italy
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12
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Rizzo G, Pietrolucci ME, Mappa I, Maqina P, Makatsarya A, D'Antonio F. Modeling gestational age centiles for fetal umbilicocerebral ratio by quantile regression analysis: a secondary analysis of a prospective cross-sectional study. J Matern Fetal Neonatal Med 2022; 35:4381-4385. [PMID: 33228405 DOI: 10.1080/14767058.2020.1849123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE There is a lack of evidence on whether to favor cerebroplacental ratio (CPR) or umbilicocerebral ratio (UCR) when assessing pregnancies at risk of fetal growth restriction. The Recent evidences highlight a significant heterogeneity in the methodology of previously published studies reporting reference ranges for Doppler indices, which may affect the clinical applicability of these charts. The aim of this study was to develop charts of UCR based upon a recently proposed standardized methodology and using quantile regression. METHODS This was a secondary analysis of a prospective cross-sectional study including low-risk singleton pregnancies between 24 and 40 weeks of gestation undergoing Doppler recordings. The UCR centile values were established by quantile regression at different gestational age intervals. Quantile regression analysis was used to build the UCR chart. RESULT 2516 low- risk singleton pregnancies were included in the analysis. UCR decreased with advancing gestational age. The 3rd, 5th 10th, 50th, 90th, 95th, and 97th centiles according to gestational age are provided, as well as equations to allow calculation of any other percentile. CONCLUSIONS We have established gestational age-specific normative centiles reference limits for UCR.
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Affiliation(s)
- Giuseppe Rizzo
- Division of Maternal Fetal Medicine Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Roma, Italy
- Department of Obstetrics and Gynecology Moscow, The First I.M. Sechenov Moscow State Medical University, Moskva, Russia
| | - Maria Elena Pietrolucci
- Division of Maternal Fetal Medicine Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Roma, Italy
| | - Ilenia Mappa
- Division of Maternal Fetal Medicine Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Roma, Italy
| | - Pavjola Maqina
- Division of Maternal Fetal Medicine Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Roma, Italy
| | - Alexander Makatsarya
- Department of Obstetrics and Gynecology Moscow, The First I.M. Sechenov Moscow State Medical University, Moskva, Russia
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, University Hospital of Chieti, Roma, Italy
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13
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Rizzo G, Mappa I, Pietrolucci ME, Lu JLA, Makatsarya A, D'Antonio F. Effect of SARS-CoV-2 infection on fetal umbilical vein flow and cardiac function: a prospective study. J Perinat Med 2022; 50:398-403. [PMID: 35073616 DOI: 10.1515/jpm-2021-0657] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/08/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To explore whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect umbilical vein blood flow (UVBF) and fetal cardiac function. METHODS Prospective case-control study of consecutive pregnancies complicated by SARS-CoV-2 infection during the second half of pregnancy matched with unaffected women. Measurements of UVBF normalized for fetal abdominal circumference (UVBF/AC), atrial area (AA) and ventricular sphericity indices (SI) were compared between the two study groups. Chi-square and Mann-Whitney U tests were sued to analyze the data. RESULTS Fifty-four consecutive pregnancies complicated and 108 not complicated by SARS-CoV-2 infection were included. The median gestational age at infection was 30.2 (interquartile range [IQR] 26.2 34.1). General baseline and pregnancy characteristics were similar between pregnant women with compared to those without SARS-CoV-2 infection. There was no difference in UVBF/AC (study groups z value -0.11 vs. 0.14 control p 0.751) values between pregnancies complicated compared to those not complicated by SARS-CoV-2 infection. Likewise, there was no difference in the left and right AA (left 1.30 vs. 1.28 p=0.221 and right 1.33 vs. 1.31 p=0.324) and SI (left 1.75 vs. 1.77 p=0.208 and right 1.51 vs. 1.54 p=0.121) between the two groups. CONCLUSIONS SARS-CoV-2 infection does not affect UVBF and fetal cardiac function in uncomplicated pregnancies.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
- The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | | | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | | | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
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Rizzo G, Pietrolucci ME, Mappa I, Bitsadze V, Khizroeva J, Makatsariya A, D'Antonio F. Modeling Pulsatility Index nomograms from different maternal and fetal vessels by quantile regression at 24-40 weeks of gestation: a prospective cross-sectional study. J Matern Fetal Neonatal Med 2022; 35:1668-1676. [PMID: 35343350 DOI: 10.1080/14767058.2020.1767060] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Recent evidences highlight a considerable heterogeneity in the methodology of previously published studies reporting reference ranges for maternal and fetal Dopplers, which may have relevant implications in clinical practice. In view of these limitations, a standardized methodology to construct Doppler charts has been proposed. The aim of this study was to develop charts for pulsatility index (PI) of maternal and fetal Dopplers based upon the recently proposed standardized methodology and using quantile regression. METHODS Prospective cross-sectional study including 2516 low-risk singleton pregnancies between 24 and 40 weeks of gestation. The mean uterine, umbilical (UA), middle cerebral (MCA) and their ratio (cerebroplacental ratio, CPR) centile values were established by quantile regression in the considered gestational interval. Interclass correlation coefficient (ICC) of each maternal and fetal vessel was also computed to assess the intra- and inter-observer agreement of the results. RESULTS There was a good intra- and inter-observer agreement for each of the explored vessels (ICC >0.92 and >0.91 for a single and two observers, respectively). The 5th, 10th, 50th, 90th and 95th centiles of the reference range for gestation were constructed by quantile regression and compared to previously established reference charts. All the Doppler indices significantly changed with gestation. Second-degree polynomial regression models better described the changes with gestation in PCR and MCA PI values while a linear model better predicted the changes of other Doppler indices with advancing gestation. When compared to other studies reporting reference ranges for maternal and fetal Dopplers, the present charts showed similar median values but different distribution from the median. CONCLUSIONS We provided prospective charts of maternal and fetal Dopplers based upon a previously proposed standardized methodology and using quantile regression. When compared to previously published studies, these new charts showed similar median values but different deviations from the median which may help in better differentiating cases at higher risk of placental insufficiency and adverse perinatal outcome.
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Affiliation(s)
- Giuseppe Rizzo
- Division of Maternal Fetal Medicine Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Roma, Italy
- Department of Obstetrics and Gynecology Moscow, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Maria Elena Pietrolucci
- Division of Maternal Fetal Medicine Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Roma, Italy
| | - Ilenia Mappa
- Division of Maternal Fetal Medicine Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Roma, Italy
| | - Victoria Bitsadze
- Division of Maternal Fetal Medicine Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Roma, Italy
- Department of Obstetrics and Gynecology Moscow, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Jamilya Khizroeva
- Division of Maternal Fetal Medicine Ospedale Cristo Re Roma, Università di Roma Tor Vergata, Roma, Italy
- Department of Obstetrics and Gynecology Moscow, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology Moscow, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, University Hospital of Foggia, Foggia, Italy
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15
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Rizzo G, Pietrolucci ME, Capponi A, Mappa I. Exploring the role of artificial intelligence in the study of fetal heart. Int J Cardiovasc Imaging 2022; 38:10.1007/s10554-022-02588-x. [PMID: 35296945 DOI: 10.1007/s10554-022-02588-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università Di Roma Tor Vergata, Roma, Italy.
| | - Maria Elena Pietrolucci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università Di Roma Tor Vergata, Roma, Italy
| | - Alessandra Capponi
- Department of Obstetrics and Gynecology Roma, Azienda Ospedaliera S. Giovanni Addolorata, Roma, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, Università Di Roma Tor Vergata, Roma, Italy
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16
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Rizzo G, Pietrolucci ME, Lu JLA, Mappa I. Perinatal assessment of lung hemodynamics. A new tool for predicting of bronchopulmonary dysplasia. J Clin Ultrasound 2022; 50:393-394. [PMID: 35277983 DOI: 10.1002/jcu.23162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynaecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | | | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
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17
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Rizzo G, Mappa I, Pietrolucci ME, Lu JLA, Makatsarya A, D'Antonio F. Effect of SARS-CoV-2 infection on fetal umbilical vein flow and cardiac function: a prospective study. J Perinat Med 2022. [PMID: 35073616 DOI: 10.1515/jpm-2021-0657.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect umbilical vein blood flow (UVBF) and fetal cardiac function. METHODS Prospective case-control study of consecutive pregnancies complicated by SARS-CoV-2 infection during the second half of pregnancy matched with unaffected women. Measurements of UVBF normalized for fetal abdominal circumference (UVBF/AC), atrial area (AA) and ventricular sphericity indices (SI) were compared between the two study groups. Chi-square and Mann-Whitney U tests were sued to analyze the data. RESULTS Fifty-four consecutive pregnancies complicated and 108 not complicated by SARS-CoV-2 infection were included. The median gestational age at infection was 30.2 (interquartile range [IQR] 26.2 34.1). General baseline and pregnancy characteristics were similar between pregnant women with compared to those without SARS-CoV-2 infection. There was no difference in UVBF/AC (study groups z value -0.11 vs. 0.14 control p 0.751) values between pregnancies complicated compared to those not complicated by SARS-CoV-2 infection. Likewise, there was no difference in the left and right AA (left 1.30 vs. 1.28 p=0.221 and right 1.33 vs. 1.31 p=0.324) and SI (left 1.75 vs. 1.77 p=0.208 and right 1.51 vs. 1.54 p=0.121) between the two groups. CONCLUSIONS SARS-CoV-2 infection does not affect UVBF and fetal cardiac function in uncomplicated pregnancies.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy.,The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | | | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | | | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Center for Fetal Care and High-Risk Pregnancy, University of Chieti, Chieti, Italy
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18
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Rizzo G, Pietrolucci ME, Mappa I, Bitsadze V, Khizroeva J, Makatsariya A, D'Antonio F. Sonoelastographic Assessment of the Uterine Cervix in the Prediction of Imminent Delivery in Singleton Nulliparous Women Near Term: A Prospective Cohort Study. J Ultrasound Med 2021; 40:559-568. [PMID: 32840895 DOI: 10.1002/jum.15434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/09/2020] [Revised: 07/15/2020] [Accepted: 07/18/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To explore the role of newly developed software to assess cervical sonoelastography in predicting the onset of spontaneous delivery in singleton pregnancies at term and to compare its diagnostic performance with that provided by the cervical length (CL) and posterior cervical angle (PCA). METHODS This work was a prospective study including nulliparous singleton pregnancies at gestational ages of 37 weeks to 38 weeks 6 days. The CL, PCA, hardness ratio (HR), and mean strain from the internal os and external os were obtained by a transvaginal ultrasound approach using semiautomatic software (E-Cervix; Samsung Medison Co, Ltd, Seoul, Korea). Multivariate logistic regression and area under the curve analyses were used to test the strength of the association and the diagnostic performance of the variables considered in predicting delivery within 7 days. RESULTS A total of 398 women were included, and 24.6% delivered within 7 days. The CL was shorter (19.5 versus 2 7 mm; P = .0001), PCA narrower (99° versus 102°; P = .02) HR lower (35.3 versus 40.7; P = .0001), mean strain from the external os higher (0.41 versus 0.35; P = .0001), and mean strain from the internal os higher (0.38 versus 0.33; P = .0001) higher in women who delivered within 7 days from the assessment. At the multivariable logistic regression analysis, the CL (adjusted odds ratio, 1.307) and HR (adjusted odds ratio, 1.227) were the only variables independently associated with delivery within 1 week. A model combining the CL and HR showed an area under the curve of 0.873 in predicting delivery within 7 days, higher than that obtained by using the CL and HR singularly (P ≤ .0001). CONCLUSIONS The HR assessed by sonoelastography improves the efficacy of the CL in predicting imminent delivery in nulliparous women close to term.
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Affiliation(s)
- Giuseppe Rizzo
- Division of Maternal-Fetal Medicine, Università di Roma Tor Vergata, Ospedale Cristo Re, Rome, Italy
- Department of Obstetrics and Gynecology, First I. M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Maria Elena Pietrolucci
- Division of Maternal-Fetal Medicine, Università di Roma Tor Vergata, Ospedale Cristo Re, Rome, Italy
| | - Ilenia Mappa
- Division of Maternal-Fetal Medicine, Università di Roma Tor Vergata, Ospedale Cristo Re, Rome, Italy
| | - Victoria Bitsadze
- Division of Maternal-Fetal Medicine, Università di Roma Tor Vergata, Ospedale Cristo Re, Rome, Italy
- Department of Obstetrics and Gynecology, First I. M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Jamilya Khizroeva
- Division of Maternal-Fetal Medicine, Università di Roma Tor Vergata, Ospedale Cristo Re, Rome, Italy
- Department of Obstetrics and Gynecology, First I. M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology, First I. M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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Rizzo G, Pietrolucci ME, Mappa I, Bitsadze V, Khizroeva J, Makatsariya A, D'Antonio F. Fetal Cardiac Remodeling Is Affected by the Type of Embryo Transfer in Pregnancies Conceived by in vitro Fertilization: A Prospective Cohort Study. Fetal Diagn Ther 2020; 47:1-7. [PMID: 32659781 DOI: 10.1159/000508987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/26/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Pregnancies conceived via intracytoplasmic sperm injection (ICSI) are associated with a higher risk of fetal cardiac remodeling. The aim of this study was to evaluate whether the type of embryo transfer may affect the magnitude of fetal cardiac remodeling in pregnancies conceived via ICSI. METHODS Prospective cross-sectional study including 212 pregnancies conceived by ICSI (111 with frozen and 101 with fresh embryos) and 120 spontaneously conceived gestations. All women underwent ultrasound biometric evaluation, Doppler, and echocardiographic assessment, including evaluation of left and right atrial areas and sphericity index (SI), at 20-24 weeks of gestation. The χ2 and Kruskal-Wallis H tests were used to analyze the data. RESULTS There was no difference in maternal characteristics, gestational age at ultrasound, Doppler, and fetal weight among the study groups. In pregnancies conceived by ICSI, left and right atrial areas were higher (p < 0.0001) and SI was lower (p < 0.0001) compared to spontaneously conceived pregnancies. Left (p = 0.004) and right (p = 0.023) atrial areas and left (p = 0.036) and right (p = 0.002) SIs were more affected in ICSI pregnancies conceived by fresh embryos. CONCLUSION The risk of fetal cardiac remodeling is higher in pregnancies conceived by ICSI and independent from fetal size and Doppler. The magnitude of these changes is affected by the type of ICSI technique and is higher in pregnancies conceived by fresh embryos.
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Affiliation(s)
- Giuseppe Rizzo
- Division of Maternal Fetal Medicine Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy,
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation,
| | - Maria Elena Pietrolucci
- Division of Maternal Fetal Medicine Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
| | - Ilenia Mappa
- Division of Maternal Fetal Medicine Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
| | - Victoria Bitsadze
- Division of Maternal Fetal Medicine Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation
| | - Jamilya Khizroeva
- Division of Maternal Fetal Medicine Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, University Hospital of Chieti, Chieti, Italy
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20
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Rizzo G, Pietrolucci ME, Mappa I, Bitsadze V, Khizroeva J, Makatsariya A, D'Antonio F. Fetal Cardiac Remodeling Is Affected by the Type of Embryo Transfer in Pregnancies Conceived by in vitro Fertilization: A Prospective Cohort Study. Fetal Diagn Ther 2020. [PMID: 32659781 DOI: 10.1159/000508987.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Pregnancies conceived via intracytoplasmic sperm injection (ICSI) are associated with a higher risk of fetal cardiac remodeling. The aim of this study was to evaluate whether the type of embryo transfer may affect the magnitude of fetal cardiac remodeling in pregnancies conceived via ICSI. METHODS Prospective cross-sectional study including 212 pregnancies conceived by ICSI (111 with frozen and 101 with fresh embryos) and 120 spontaneously conceived gestations. All women underwent ultrasound biometric evaluation, Doppler, and echocardiographic assessment, including evaluation of left and right atrial areas and sphericity index (SI), at 20-24 weeks of gestation. The χ2 and Kruskal-Wallis H tests were used to analyze the data. RESULTS There was no difference in maternal characteristics, gestational age at ultrasound, Doppler, and fetal weight among the study groups. In pregnancies conceived by ICSI, left and right atrial areas were higher (p < 0.0001) and SI was lower (p < 0.0001) compared to spontaneously conceived pregnancies. Left (p = 0.004) and right (p = 0.023) atrial areas and left (p = 0.036) and right (p = 0.002) SIs were more affected in ICSI pregnancies conceived by fresh embryos. CONCLUSION The risk of fetal cardiac remodeling is higher in pregnancies conceived by ICSI and independent from fetal size and Doppler. The magnitude of these changes is affected by the type of ICSI technique and is higher in pregnancies conceived by fresh embryos.
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Affiliation(s)
- Giuseppe Rizzo
- Division of Maternal Fetal Medicine Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy, .,Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation,
| | - Maria Elena Pietrolucci
- Division of Maternal Fetal Medicine Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
| | - Ilenia Mappa
- Division of Maternal Fetal Medicine Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
| | - Victoria Bitsadze
- Division of Maternal Fetal Medicine Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy.,Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation
| | - Jamilya Khizroeva
- Division of Maternal Fetal Medicine Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy.,Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation
| | - Alexander Makatsariya
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russian Federation
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, University Hospital of Chieti, Chieti, Italy
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Rizzo G, Aiello E, Pietrolucci ME, Arduini D. Ultrasonographic assessment of cervical length in pregnancies scheduled for a cesarean delivery: prediction of early spontaneous onset of labor. J Perinat Med 2016; 44:807-811. [PMID: 26581062 DOI: 10.1515/jpm-2015-0238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/23/2015] [Indexed: 02/07/2023]
Abstract
AIM To investigate whether the cervical length measured by transvaginal ultrasound at 35 to 36 weeks of gestation is predictive of spontaneous early onset of labor in pregnancies scheduled for elective cesarean section (CS). STUDY DESIGN This was a prospective observational study on 167 women scheduled for elective CS at 39 weeks of gestation. The cervical length was measured ultrasonographycally at 35 to 36 weeks of gestation and the pregnancies characteristics were recorded. The presence or absence of spontaneous onset of labor before the time scheduled for elective CS was related to cervical length and pregnancies characteristics. RESULTS Of the 167 pregnancies enrolled, 25 (14.97%) underwent early spontaneous onset of labor before the time scheduled for the elective CS. The cervical length was significantly shorter in these women when compared with those delivering with an elective CS (21 vs. 30 mm z=5.49 P<0.0001). The presence of ≥2 previous CS as an indicator for elective CS resulted a significant predictor of early onset of labor in univariate analysis (P=0.01). Multivariate logistic regression analysis showed that cervical length (adjusted odds ratio 1.40; 95% confidence interval (CI) 1.22-1.61; P≤0.0001) was the only predictor for the early onset of labor. The area under the receiver-operating characteristics curve for the prediction of early onset of labor was 0.844 (95% CI 0.738-0.950) for cervical length as test variable. Kaplan-Meier analysis demonstrated that a cervical length <24 mm was significantly associated with a short time interval to delivery (log rank test χ2=99,98; P≤0.0001). CONCLUSION Cervical length at 35-36 weeks of gestation provides information about the likelihood of spontaneous early onset of labor in pregnancies scheduled for CS and may be useful in individualizing the gestational age for elective CS.
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Rizzo G, Capponi A, Persico N, Ghi T, Nazzaro G, Boito S, Pietrolucci ME, Arduini D. 5D CNS+ Software for Automatically Imaging Axial, Sagittal, and Coronal Planes of Normal and Abnormal Second-Trimester Fetal Brains. J Ultrasound Med 2016; 35:2263-72. [PMID: 27582530 DOI: 10.7863/ultra.15.11013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/25/2016] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to test new 5D CNS+ software (Samsung Medison Co, Ltd, Seoul, Korea), which is designed to image axial, sagittal, and coronal planes of the fetal brain from volumes obtained by 3-dimensional sonography. The study consisted of 2 different steps. First in a prospective study, 3-dimensional fetal brain volumes were acquired in 183 normal consecutive singleton pregnancies undergoing routine sonographic examinations at 18 to 24 weeks' gestation. The 5D CNS+ software was applied, and the percentage of adequate visualization of brain diagnostic planes was evaluated by 2 independent observers. In the second step, the software was also tested in 22 fetuses with cerebral anomalies. In 180 of 183 fetuses (98.4%), 5D CNS+ successfully reconstructed all of the diagnostic planes. Using the software on healthy fetuses, the observers acknowledged the presence of diagnostic images with visualization rates ranging from 97.7% to 99.4% for axial planes, 94.4% to 97.7% for sagittal planes, and 92.2% to 97.2% for coronal planes. The Cohen κ coefficient was analyzed to evaluate the agreement rates between the observers and resulted in values of 0.96 or greater for axial planes, 0.90 or greater for sagittal planes, and 0.89 or greater for coronal planes. All 22 fetuses with brain anomalies were identified among a series that also included healthy fetuses, and in 21 of the 22 cases, a correct diagnosis was made. 5D CNS+ was efficient in successfully imaging standard axial, sagittal, and coronal planes of the fetal brain. This approach may simplify the examination of the fetal central nervous system and reduce operator dependency.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy
| | - Alessandra Capponi
- Department of Obstetrics and Gynecology, G. B. Grassi Hospital, Rome, Italy
| | - Nicola Persico
- Department of Obstetrics and Gynecology, Fondazione Ca' Granda, Maggiore Policlinico Hospital, Milan, Italy
| | - Tullio Ghi
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Giovanni Nazzaro
- Department of Obstetrics and Gynecology, University of Napoli Federico II, Naples, Italy
| | - Simona Boito
- Department of Obstetrics and Gynecology, Fondazione Ca' Granda, Maggiore Policlinico Hospital, Milan, Italy
| | | | - Domenico Arduini
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy
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Rizzo G, Aiello E, Pietrolucci ME, Arduini D. Are There Differences in Placental Volume and Uterine Artery Doppler in Pregnancies Resulting From the Transfer of Fresh Versus Frozen-Thawed Embryos Through In Vitro Fertilization. Reprod Sci 2016; 23:1381-6. [PMID: 27071962 DOI: 10.1177/1933719116641765] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare uterine artery pulsatility index (PI) and 3-dimensional (3D) placental volume values in first-trimester pregnancies conceived naturally or through in vitro fertilization (IVF) technique using either fresh or cryopreserved embryo and to relate these measurements with preeclampsia (PE) development. METHODS Uterine artery PI and placental volume were measured at 11 + 0 to 13 + 6 weeks of gestation in 266 IVF pregnancies (139 women with fresh embryo and 127 women with frozen-thawed embryo transfer) and in 266 spontaneously conceived pregnancies matched for maternal age. Nulliparous women with singleton pregnancies were recruited. The mean, highest, and lowest uterine artery PI and placental volume values measured were converted to multiples of the expected normal median (MoM) adjusted for gestational age. The MoM values of IVF pregnancies were compared with those of the naturally conceived group and related to PE development. RESULTS No differences were found in uterine artery PI MoM between the 3 groups. Placental volume was significantly lower than in both IVF groups when compared to the controls (fresh embryo IVF Z = 9.33; P ≤ .0001; frozen-thawed embryos IVF Z = 3.1; P = .04). The IVF pregnancies with fresh embryos showed placental volume MoM values significantly lower than in the frozen-thawed embryo IVF pregnancies (U = 5.4; P ≤ .0001). In fresh embryo IVF pregnancies developing PE placental volume values resulted lower than in the normotensive ones (U = 2.11; P = .03), while no differences were found for uterine artery PI values. CONCLUSION First-trimester placental volume, as assessed by 3D ultrasound, is reduced in IVF pregnancies, and these differences are more marked in those obtained with fresh embryos than those obtained with cryopreservation. This may explain the better obstetrical and perinatal outcomes occurring with the former technique.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università di Roma "Tor Vergata," Roma, Italy
| | - Elisa Aiello
- Department of Obstetrics and Gynecology, Università di Roma "Tor Vergata," Roma, Italy
| | | | - Domenico Arduini
- Department of Obstetrics and Gynecology, Università di Roma "Tor Vergata," Roma, Italy
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Rizzo G, Aiello E, Pietrolucci ME, Arduini D. Placental volume and uterine artery Doppler evaluation at 11 + 0 to 13 + 6 weeks' gestation in pregnancies conceived with in-vitro fertilization: comparison between autologous and donor oocyte recipients. Ultrasound Obstet Gynecol 2016; 47:726-31. [PMID: 26053472 DOI: 10.1002/uog.14918] [Citation(s) in RCA: 12] [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: 03/12/2015] [Revised: 05/23/2015] [Accepted: 05/31/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare first-trimester uterine artery pulsatility index (UtA-PI) and three-dimensional (3D) placental volume in pregnancies conceived through in-vitro fertilization (IVF) using autologous or donor oocytes and pregnancies conceived naturally, and to relate these measurements to the development of pre-eclampsia (PE). METHODS UtA-PI and placental volume were measured at 11 + 0 to 13 + 6 weeks of gestation in 416 IVF pregnancies (307 with autologous and 109 with donor oocytes) and in 498 spontaneously conceived pregnancies. We recruited nulliparous women with singleton pregnancy. The measured mean UtA-PI and placental volume values were converted to multiples of the expected normal median (MoM), adjusted for gestational age. MoM values of IVF pregnancies were compared with MoM values of the naturally conceived pregnancies and related to PE development. RESULTS Placental volume was significantly reduced in IVF pregnancies (K = 169.3; P < 0.0001) compared with natural pregnancies. No difference was found in UtA-PI MoM between the two groups. Among IVF pregnancies, significantly lower placental volumes were seen in those that received donor oocytes when compared with those with autologous oocytes (z = 3.89; P < 0.001). In IVF pregnancies that developed PE, lower values of placental volume were demonstrated with respect to normotensive pregnancies (donor: U = 6.8; P = 0.009; autologous: U = 5.1; P = 0.023), whereas no difference was found in UtA-PI. Multivariate logistic regression analysis demonstrated that placental volume (odds ratio (OR), 1.97 (95% CI, 1.33-2.27)) and donor oocytes in IVF pregnancy (OR, 2.24 (95% CI, 1.5-2.83)) were independent predictors of PE, whereas autologous oocytes in IVF pregnancy were not found to be significant in the model. CONCLUSIONS First-trimester placental volume, as assessed by 3D ultrasound, is reduced in IVF pregnancies and this reduction is more marked in those involving donor oocyte recipients. The relative decrease in placental volume in IVF pregnancies that developed PE suggests an etiological mechanism different from uterine perfusion in such patients. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G Rizzo
- Department of Obstetrics and Gynecology, Università di Roma 'Tor Vergata', Rome, Italy
| | - E Aiello
- Department of Obstetrics and Gynecology, Università di Roma 'Tor Vergata', Rome, Italy
| | - M E Pietrolucci
- Department of Obstetrics and Gynecology, Università di Roma 'Tor Vergata', Rome, Italy
| | - D Arduini
- Department of Obstetrics and Gynecology, Università di Roma 'Tor Vergata', Rome, Italy
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Rizzo G, Aiello E, Pietrolucci ME, Arduini D. The feasibility of using 5D CNS software in obtaining standard fetal head measurements from volumes acquired by three-dimensional ultrasonography: comparison with two-dimensional ultrasound. J Matern Fetal Neonatal Med 2016; 29:2217-22. [PMID: 26364724 DOI: 10.3109/14767058.2015.1081891] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the performance of a new software (5D CNS) developed to automatically recognize the axial planes of the fetal brain from three-dimensional volumes and to obtain the basic standard biometric measurements. The accuracy, reproducibility, and time required for analysis of 5D CNS were compared with that of two-dimensional (2D) ultrasound. METHODS This was a prospective study of 120 uncomplicated singleton pregnancies undergoing routine second trimester examination. For every pregnancy standard biometric measurements including biparietal diameter, head circumference, distal lateral ventricle width, transverse cerebellar diameter and cisterna magna width were obtained using 2D ultrasound and three-dimensional (3D) ultrasound with 5D CNS software. Reliability and agreement of the two techniques were evaluated using intraclass correlation coefficients (ICCs) and proportionate Bland-Altman plots were constructed. The time necessary to complete the measurements with either technique was compared and intraobserver and interobserver agreements of measurements calculated. RESULTS In 118/120 (98.3%), 5D CNS successfully reconstructed the axial diagnostic planes and calculated all the basic biometric head and brain measurements. The agreement between the two techniques was high for all the measurements considered (all ICCS > 0.920). The time necessary to measure the biometric variables considered was significantly shorter with 5D CNS (54 versus 115 s, p < 0.0001) than with 2D ultrasonography. No significant differences were found in 5D CNS repeated measurements obtained either by the same observer or by two independent observers. CONCLUSION 5D CNS software allows us to obtain reliable biometric measurements of the fetal brain and to reduce the examination time. Its application may improve work-flow efficiency in ultrasonographic practices.
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Affiliation(s)
- Giuseppe Rizzo
- a Department of Obstetrics and Gynecology , Università Di Roma "Tor Vergata" , Roma , Italy
| | - Elisa Aiello
- a Department of Obstetrics and Gynecology , Università Di Roma "Tor Vergata" , Roma , Italy
| | | | - Domenico Arduini
- a Department of Obstetrics and Gynecology , Università Di Roma "Tor Vergata" , Roma , Italy
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Rolo LC, Pietrolucci ME, Araujo Júnior E, Barros FSB, Nardozza LMM, Martina WP, Moron AF, Arduin D, Rizzo G. Viewing rate and reproducibility of papillary muscle areas in foetal atrioventricular valves using spatio-temporal image correlation in the rendering mode in congenital heart disease. J Matern Fetal Neonatal Med 2015; 28:1375-80. [PMID: 25123513 DOI: 10.3109/14767058.2014.954540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To assess the viewing rate and reproducibility of areas of the papillary muscles (PMs) of foetal atrioventricular valves using spatio-temporal image correlation (STIC) in the rendering mode in congenital heart disease (CHD). METHODS We retrospectively reviewed 40 4D-STIC volume datasets from different foetal CHD cases at a gestational age of 18w6d–35w6d. The following papillary muscles (PMs) were assessed: antero-lateral (MPAL) and postero-medial (MPPM) to the mitral valve and antero-superior (MPAS), inferior (MPI) and septal (MPS) to the tricuspid valve. To assess the valve viewing rate, percentages (%) were used. The concordance correlation coefficient (CCC) was used to assess inter-observer reliability. RESULTS Two independent observers concluded that a complete examination of the PMs was impossible in 11 cases, yielding a viewing rate of 72.5%. The complete examination of the PMs of the tricuspid and mitral valves was possible by both examiners in 33/40 (82.5%) and 32/40 (80.0%) cases, respectively. We observed moderate to good inter-observer reliability with CCCs of 0.95, 0.92, 0.97, 0.96 and 0.97 for MPS, MPI, MPAS, MPAL and MPPM, respectively. CONCLUSION The viewing rate of PM areas in different CHDs using STIC in the rendering mode was moderate. The inter-observer reproducibility was moderate to good for all PM areas.
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Rizzo G, Pietrolucci ME, Mammarella S, Dijmeli E, Bosi C, Arduini D. Authors' response to Letter from A. Toi: cerebellar vermis area versus perimeter. J Matern Fetal Neonatal Med 2015; 28:1845. [PMID: 25260127 DOI: 10.3109/14767058.2014.969971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Rolo LC, Rizzo G, Pietrolucci ME, Barros FSB, Nardozza LMM, Martins WP, Arduini D, Moron AF, Araujo Júnior E. Viewing rate and reference ranges for papillary muscle areas of the fetal heart using four-dimensional ultrasound in the rendering mode. Prenat Diagn 2014; 34:1153-60. [PMID: 25042276 DOI: 10.1002/pd.4444] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/24/2014] [Accepted: 06/26/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aims of this study were to assess the viewing rate and determine reference ranges for the papillary muscle areas in the fetal atrio-ventricular valves using four-dimensional (4D) ultrasound and spatio-temporal image correlation (STIC) in the rendering mode. METHODS This cross-sectional prospective study included 310 4D STIC volume data sets of normal fetuses between 18 weeks 0 day and 34 weeks 0 day of gestation. The papillary muscles were antero-lateral (MPAL) and postero-medial (MPPM) to the mitral valve and antero-superior (MPAS), inferior (MPI) and septal (MPS) to the tricuspid valve. Polynomial regressions were built to determine the reference ranges, and adjustments were made using the determination coefficient (R(2) ). To assess inter-observer reproducibility, the intra-class correlation coefficient (ICC) was used. RESULTS Identification of the papillary muscles was possible in 89.3% patients. The best-fit regression equations between papillary muscle areas and gestational age were second degree. The inter-observer reproducibility was good (ICC: 0.98 to MPAS, 0.97 to MPI, 0.98 to MPS, 0.98 to MPAL and 0.97 to MPPM). CONCLUSIONS Identification of the papillary muscles of the fetal valves was possible in most of the 4D STIC volume data sets, enabling the determination of reference ranges using the rendering mode. The reference ranges for the papillary muscle areas were determined.
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Affiliation(s)
- Liliam Cristine Rolo
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, SP, Brazil
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Rizzo G, Pietrolucci ME, Aiello E, Capponi A, Arduini D. Uterine artery Doppler evaluation in twin pregnancies at 11 + 0 to 13 + 6 weeks of gestation. Ultrasound Obstet Gynecol 2014; 44:557-61. [PMID: 24585633 DOI: 10.1002/uog.13340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 02/08/2014] [Accepted: 02/11/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To compare uterine artery pulsatility index (PI) obtained at 11 + 0 to 13 + 6 weeks of gestation in singleton and twin pregnancies and to evaluate changes in PI values of twin pregnancies developing pre-eclampsia (PE) or small-for-gestational age (SGA) of either one or both fetuses. METHODS Uterine artery PI was measured in 421 twin pregnancies (384 dichorionic and 37 monochorionic) and in 500 singleton pregnancies. The measured mean and lowest uterine artery PI values were converted to multiples of the expected normal median (MoM) after correction for maternal body mass index, ethnicity and gestational age. The median PI-MoM values of twins were compared with those of singleton pregnancies. In twin pregnancies, PI-MoM values were analyzed according to chorionicity, development of early-onset (< 34 weeks) or late-onset (≥ 34 weeks) PE and SGA of one or both twins. RESULTS Uterine artery PI-MoM was significantly lower in twin compared with singleton pregnancies (mean K = 174.31, P < 0.0001, lowest K = 139.27, P < 0.0001). However, there were no significant differences in the uterine artery PI-MoM values between monochorionic and dichorionic twins. The uterine artery PI in twin pregnancies that developed early-onset PE (P < 0.001) and SGA of both twins (P < 0.05) was higher than the uterine artery PI in uncomplicated twin pregnancies, whereas no differences were found for late PE or SGA of one twin. CONCLUSIONS First-trimester placental impedance to flow, as assessed by uterine artery Doppler examination, is reduced in twin pregnancies, with no differences related to chorionicity. The relative increase of uterine artery PI found in twin pregnancies that developed early PE and SGA of both twins suggests that first-trimester uterine artery assessment may be useful in identifying such complications.
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Affiliation(s)
- G Rizzo
- Fetal Medicine Center, Rome, Italy; Department of Obstetrics and Gynecology, Università di Roma 'Tor Vergata', Rome, Italy
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Rizzo G, Pietrolucci ME, Aiello E, Dijmeli E, Bosi C, Arduini D. Are there any differences in three-dimensional placental vascular indices obtained using conventional power Doppler and high-definition flow imaging? J Matern Fetal Neonatal Med 2012; 25:1664-7. [PMID: 22272917 DOI: 10.3109/14767058.2012.657274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether there are differences in values and reproducibility of three-dimensional (3D) vascular indices obtained on placental volumes using power Doppler (PD) or high-definition flow imaging (HDFI) techniques. METHODS A prospective study was performed on 121 uncomplicated singleton pregnancies at 11 + 0 to 13 + 6 weeks of gestation. Two placental volumes were acquired from each pregnancy. Vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were then analyzed and compared. In order to assess the reproducibility of the measurements, two additional placental volumes obtained with both PD and HDFI were acquired in 31 pregnancies and the agreement assessed by intraclass correlation coefficients. Inter-observer variability was assessed by analyzing all the volumes by two observers blinded to each other's. RESULTS A significant relationship was observed between the vascular indices values obtained with the two techniques (VI Pearson's r=0.891 p<0.001; FI r=0.769 p<0.001; VFI r=0.847 p<0.001). The median values of VI, FI and VFI were significantly higher when obtained with HDFI imaging. In serial recordings, the ICCs resulted higher when volumes were acquired with HDFI rather than with PD techniques. Similarly, HDFI demonstrated a higher inter-observer reproducibility. CONCLUSIONS 3D vascular indices calculated using HDFI are higher than those calculated using conventional PD. Although the relationship between the two methods is high, HDFI shows a better reproducibility suggesting its potential clinical application.
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Affiliation(s)
- Giuseppe Rizzo
- Fetal Medicine Center Genoma, Università di Roma “Tor Vergata”, Rome, Italy.
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Rizzo G, Capponi A, Pietrolucci ME, Aiello E, Arduini D. First trimester placental volume and three dimensional power doppler ultrasonography in type I diabetic pregnancies. Prenat Diagn 2012; 32:480-4. [PMID: 22504827 DOI: 10.1002/pd.3848] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to investigate the placental volume and three dimensional (3D) power Doppler vascularization in type I diabetic pregnancies during the first trimester METHODS 3D-power Doppler ultrasonography of the placenta was performed at 11+0-13+6 weeks in 32 pregnancies complicated by type I diabetes. Placental volume, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were calculated using a standardized setting. RESULTS In nine pregnancies, a poor first trimester glycemic control was present as expressed by HbA1c levels ≥ 7%, whereas in the remaining 23 mothers, the HbA1c concentrations were <7%. No differences were found in the placental volumes of diabetic mothers when compared with reference limits. 3D Doppler placental vascular indices were significantly higher in diabetic mothers (VI delta value 0.99, p=0.0012; FI delta value 0.64, p=0.0008; VFI delta value 1.28, p=0.0039) when compared with reference limits. Pregnancies with HbA1c ≥ 7% exhibited higher placental vascular indices when compared with diabetic mothers with better glycemic control. CONCLUSIONS In type I diabetic mothers, placental vascular indices are increased and these modifications are more evident in pregnancies with poor first trimester glycemic control.
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Rizzo G, Pietrolucci ME, Mammarella S, Dijmeli E, Bosi C, Arduini D. Assessment of cerebellar vermis biometry at 18-32 weeks of gestation by three-dimensional ultrasound examination. J Matern Fetal Neonatal Med 2012; 25:519-22. [PMID: 21919549 DOI: 10.3109/14767058.2011.622006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to construct reference limits for cerebellar vermis (CV) dimensions measured on images reconstructed from three-dimensional (3D) ultrasonography and to evaluate these measurements reproducibility. METHODS 3D ultrasound volumes were acquired transabdominally from an axial view of the fetal head in 342 fetuses cross-sectionally studied between 18 to 32 weeks of gestation. Offline analysis of fetal brain midsagittal plane was used to evaluate length and area of CV. The agreement between two-dimensional (2D) and 3D measurements as well as the interobserver variability in 3D measurements were assessed by interclass correlation coefficients (ICC). RESULTS Adequate visualization of the midsagittal plane was obtained in 96.7% of the fetuses. CV length (r = 0.89, p < 0.0001) and CV area (r = 0.93, p < 0.0001) showed a significant linear growth with gestation. A good agreement was found between measurements from either 2D or 3D ultrasound views (CV length ICC 0.943, CV area ICC 0.940) as well as between measured obtained by different observers (CV length ICC 0.965, CV area ICC 0.905). CONCLUSIONS Measurements of the CV can be obtained from the midsagittal plane of fetal brain reconstructed from 3D volumes acquired transabdominally. The constructed nomograms may facilitate the diagnosis of cerebellar abnormalities.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università di Roma, Tor Vergata, Roma, Italy.
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Rizzo G, Capponi A, Pietrolucci ME, Capece A, Aiello E, Mammarella S, Arduini D. An algorithm based on OmniView technology to reconstruct sagittal and coronal planes of the fetal brain from volume datasets acquired by three-dimensional ultrasound. Ultrasound Obstet Gynecol 2011; 38:158-64. [PMID: 21305636 DOI: 10.1002/uog.8959] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2011] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe a novel algorithm, based on the new display technology 'OmniView', developed to visualize diagnostic sagittal and coronal planes of the fetal brain from volumes obtained by three-dimensional (3D) ultrasonography. METHODS We developed an algorithm to image standard neurosonographic planes by drawing dissecting lines through the axial transventricular view of 3D volume datasets acquired transabdominally. The algorithm was tested on 106 normal fetuses at 18-24 weeks of gestation and the visualization rates of brain diagnostic planes were evaluated by two independent reviewers. The algorithm was also applied to nine cases with proven brain defects. RESULTS The two reviewers, using the algorithm on normal fetuses, found satisfactory images with visualization rates ranging between 71.7% and 96.2% for sagittal planes and between 76.4% and 90.6% for coronal planes. The agreement rate between the two reviewers, as expressed by Cohen's kappa coefficient, was > 0.93 for sagittal planes and > 0.89 for coronal planes. All nine abnormal volumes were identified by a single observer from among a series including normal brains, and eight of these nine cases were diagnosed correctly. CONCLUSIONS This novel algorithm can be used to visualize standard sagittal and coronal planes in the fetal brain. This approach may simplify the examination of the fetal brain and reduce dependency of success on operator skill.
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Affiliation(s)
- G Rizzo
- Fetal Medicine Center Genoma, Rome, Italy.
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Rizzo G, Pietrolucci ME, Capece G, Cimmino E, Colosi E, Ferrentino S, Sica C, Di Meglio A, Arduini D. Satisfactory rate of post-processing visualization of fetal cerebral axial, sagittal, and coronal planes from three-dimensional volumes acquired in routine second trimester ultrasound practice by sonographers of peripheral centers. J Matern Fetal Neonatal Med 2011; 24:1071-6. [PMID: 21231836 DOI: 10.3109/14767058.2010.545922] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility to visualize central nervous system (CNS) diagnostic planes from three-dimensional (3D) brain volumes obtained in ultrasound facilities with no specific experience in fetal neurosonography. METHODS Five sonographers prospectively recorded transabdominal 3D CNS volumes starting from an axial approach on 500 consecutive pregnancies at 19-24 weeks of gestation undergoing routine ultrasound examination. Volumes were sent to the referral center (Department of Obstetrics and Gynecology, Università Roma Tor Vergata, Italy) and two independent reviewers with experience in 3D ultrasound assessed their quality in the display of axial, coronal, and sagittal planes. RESULTS CNS volumes were acquired in 491/500 pregnancies (98.2%). The two reviewers acknowledged the presence of satisfactory images with a visualization rate ranging respectively between 95.1% and 97.14% for axial planes, 73.72% and 87.16% for coronal planes, and 78.41% and 94.29% for sagittal planes. The agreement rate between the two reviewers as expressed by Cohen's kappa coefficient was >0.87 for axial planes, >0.89 for coronal planes, and >0.94 for sagittal planes. The presence of a maternal body mass index >30 alters the probability of achieving satisfactory CNS views, while existence of previous maternal lower abdomen surgery does not affect the quality of the reconstructed planes. CONCLUSIONS CNS volumes acquired by 3D ultrasonography in peripheral centers showed a quality high enough to allow a detailed fetal neurosonogram.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università di Roma "Tor Vergata", Roma, Italy
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Rizzo G, Abuhamad AZ, Benacerraf BR, Chaoui R, Corral E, Addario VD, Espinoza J, Lee W, Mercé Alberto LT, Pooh R, Sepulveda W, Sinkovskaya E, Viñals F, Volpe P, Pietrolucci ME, Arduini D. Collaborative study on 3-dimensional sonography for the prenatal diagnosis of central nervous system defects. J Ultrasound Med 2011; 30:1003-8. [PMID: 21705734 DOI: 10.7863/jum.2011.30.7.1003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Prenatal diagnosis of central nervous system (CNS) anomalies by 2-dimensional sonography is challenging because of difficulties in obtaining complete visualization of the fetal brain during routine examinations, which is necessary for identification of its axial, coronal, and sagittal planes. Three-dimensional (3D) sonography has been introduced as a tool for studying the fetal CNS because of its ability to facilitate examinations of the fetal brain. The objective of this study was to determine inter-center agreement in diagnosing CNS defects by review of 3D volume data sets. METHODS This study included 11 centers with expertise in 3D fetal neurosonography. A total of 217 fetuses with and without confirmed CNS defects were scanned after 18 weeks' gestation, and their volume data sets were uploaded onto a centralized file transfer protocol server and later analyzed by all of the centers. Intercenter agreement was determined using a κ statistic for multiple raters. RESULTS All volumes were made anonymous and sent to the centers for blinded analysis with the exception of the data sets they had themselves previously uploaded. For identification of fetuses with CNS defects, the sensitivity, specificity, positive and negative predictive values, and false-positive and -negative rates were 93.3%, 96.5%, 96.5%, 93.3%, 3.5%, and 6.7%, respectively. No differences were found in the efficacy of the diagnostic indices according to either the route of acquisition (transabdominal or trans-vaginal) or the gestational age at diagnosis (18-24 or >24 weeks). Intercenter agreement was excellent (κ = 0.92; 95% confidence interval, 0.88-0.97). CONCLUSIONS Among centers with technical expertise, remote review of 3D sonographic volumes of the fetal CNS resulted in an accurate and reliable method for diagnosis of fetal brain malformations.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Fatebenefratelli S. Giovanni Calabita Hospital, Isola Tiberina 89, 00186 Rome, Italy.
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Rizzo G, Silvestri E, Capponi A, Servadei F, Pietrolucci ME, Capece A, Pisa R, Arduini D. Histomorphometric characteristics of first trimester chorionic villi in pregnancies with low serum pregnancy-associated plasma protein-A levels: relationship with placental three-dimensional power doppler ultrasonographic vascularization. J Matern Fetal Neonatal Med 2011; 24:253-7. [PMID: 20459339 DOI: 10.3109/14767058.2010.482627] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate histomorphometric vascular characteristics from samples obtained by chorionic villus sampling (CVS) in pregnancies with low serum pregnancy-associated plasma protein-A (PAPP-A) levels and to relate these findings to three-dimensional (3D) placental volume and power Doppler vascularization. METHODS Immediately before CVS, placental 3D-power Doppler ultrasonography was performed at 11 + 0 to 13 + 6 weeks in 12 pregnancies with PAPP-A concentrations <0.3 multiples of median (MoM) as well as in 11 control women. Using a standardized setting placental volume, vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were measured. Histomorphometric parameters of villi were blindly evaluated with a video-computerized-image-analysis system. RESULTS Pregnancies with low PAPP-A showed a significantly reduced number of capillary vessels per villus cross-section (p = 0.005) and a smaller capillary diameter (p = 0.041). Placental vascular indices were significantly related to the number of fetal capillary vessels per villus (VI: r = 0.51, p = 0.03; FI: r = 0.48, p = 0.04; VFI: r = 0.56, p = 0.01). CONCLUSIONS Differences in placental vascularization are present in first trimester in pregnancies with low PAPP-A and they are associated to altered 3D placental Doppler indices.
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Rizzo G, Pietrolucci ME, Capponi A, Arduini D. Assessment of corpus callosum biometric measurements at 18 to 32 weeks' gestation by 3-dimensional sonography. J Ultrasound Med 2011; 30:47-53. [PMID: 21193704 DOI: 10.7863/jum.2011.30.1.47] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The purposes of this study were to construct reference limits for corpus callosum dimensions measured on images reconstructed from 3-dimensional (3D) sonography and to evaluate the reproducibility of these measurements. METHODS Three-dimensional sonographic volumes were acquired transabdominally from an axial view of the head in 361 fetuses cross-sectionally studied at 18 to 32 weeks' gestation. Offline analysis of the fetal brain midsagittal plane was used to evaluate the length and area of the corpus callosum and corpus callosum-cavum septi pellucidi complex. The agreement between 2-dimensional (2D) and 3D measurements as well as the interobserver variability in 3D measurements were assessed by interclass correlation coefficients (ICCs). RESULTS Adequate visualization of the midsagittal plane was obtained in 98.1% of the fetuses. A clear distinction between the corpus callosum and cavum septi pellucidi was obtained in 35.7% of the fetuses, whereas in the remaining cases, the corpus callosum-cavum septi pellucidi complex was visualized as a single echogenic structure. The corpus callosum-cavum septi pellucidi complex length (r = 0.806; P < .0001), corpus callosum-cavum septi pellucidi complex area (r = 0.920; P < .0001), and corpus callosum area (r = 0.713; P < .0001) showed a significant linear growth with gestation. A good agreement was found between measurements from both 2D and 3D sonographic views (corpus callosum length ICC, 0.916) as well as between measurements obtained by different observers (corpus callosum-cavum septi pellucidi complex length ICC, 0.936; corpus callosum-cavum septi pellucidi complex area ICC, 0.931). CONCLUSIONS Measurements of the corpus callosum and cavum septi pellucidi can be obtained from the midsagittal plane of the fetal brain reconstructed from 3D volumes acquired transabdominally. The constructed nomograms may facilitate the diagnosis of corpus callosum abnormalities.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Fatebenefratelli S. Giovanni Calabita Hospital, Isola Tiberina 89, 00186 Rome, Italy.
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Rizzo G, Capponi A, Pietrolucci ME, Capece G, Cimmino E, Colosi E, Ferrentino S, Sica C, Di Meglio A, Arduini D. Satisfactory rate of postprocessing visualization of standard fetal cardiac views from 4-dimensional cardiac volumes acquired during routine ultrasound practice by experienced sonographers in peripheral centers. J Ultrasound Med 2011; 30:93-9. [PMID: 21193709 DOI: 10.7863/jum.2011.30.1.93] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this study was to evaluate the feasibility of visualizing standard cardiac views from 4-dimensional (4D) cardiac volumes obtained at ultrasound facilities with no specific experience in fetal echocardiography. Five sonographers prospectively recorded 4D cardiac volumes starting from the 4-chamber view on 500 consecutive pregnancies at 19 to 24 weeks' gestation undergoing routine ultrasound examinations (100 pregnancies for each sonographer). Volumes were sent to the referral center, and 2 independent reviewers with experience in 4D fetal echocardiography assessed their quality in the display of the abdominal view, 4-chamber view, left and right ventricular outflow tracts, and 3-vessel and trachea view. Cardiac volumes were acquired in 474 of 500 pregnancies (94.8%). The 2 reviewers respectively acknowledged the presence of satisfactory images in 92.4% and 93.6% of abdominal views, 91.5% and 93.0% of 4-chamber views, in 85.0% and 86.2% of left ventricular outflow tracts, 83.9% and 84.5% of right ventricular outflow tracts, and 85.2% and 84.5% of 3-vessel and trachea views. The presence of a maternal body mass index of greater than 30 altered the probability of achieving satisfactory cardiac views, whereas previous maternal lower abdominal surgery did not affect the quality of reconstructed cardiac views. In conclusion, cardiac volumes acquired by 4D sonography in peripheral centers showed high enough quality to allow satisfactory diagnostic cardiac views.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Fatebenefratelli San Giovanni Calabita Hospital, Isola Tiberina 89, 00186 Rome, Italy.,
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Rizzo G, Capponi A, Pietrolucci ME, Capece A, Arduini D. First-trimester umbilical vein blood flow in pregnancies with low serum pregnancy-associated plasma protein-A levels: an early predictor of fetal growth restriction. Ultrasound Obstet Gynecol 2010; 36:433-8. [PMID: 20509137 DOI: 10.1002/uog.7699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate umbilical vein blood flow (UVBF) during the first trimester in pregnancies with low serum pregnancy-associated plasma protein-A (PAPP-A) levels and to relate umbilical vein (UV) diameter, time-averaged maximum velocity (TAMXV) and UVBF values to the subsequent development of fetal intrauterine growth restriction (IUGR). METHODS UVBF assessment was performed at 11 + 0 to 13 + 6 weeks' gestation in 102 singleton pregnancies with PAPP-A concentrations of < 0.3 multiples of the median. UV diameter, UV-TAMXV and UVBF were calculated and analyzed in relation to pregnancy outcome. RESULTS Pregnancy outcomes were: 51 pregnancies with birth weight ≥ 10(th) centile (Group A), 30 pregnancies with birth weight < 10(th) centile with normal Doppler in the umbilical artery throughout gestation (Group B) and 21 pregnancies with birth weight < 10(th) centile and abnormal umbilical artery Doppler later in gestation (Group C). No differences were found in PAPP-A levels between groups. Group C fetuses exhibited significantly lower values of UV-TAMXV (z-score - 1.99 SDs, t = 8.527, P ≤ 0.0001) and UVBF (z-score - 0.97 SDs, t = 7.420, P ≤ 0.0001) in comparison with normal reference ranges, while no differences were found in Groups A or B. CONCLUSIONS Decreased UV-TAMXV and UVBF at 11 + 0 to 13 + 6 weeks' gestation identify fetuses at risk of developing IUGR among pregnancies with low levels of PAPP-A.
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Affiliation(s)
- G Rizzo
- Fetal Medicine Center, Genoma, Italy.
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Abstract
OBJECTIVE To establish reference intervals for fetal umbilical vein (UV) diameter, UV time averaged maximum velocity (TAMXV) and UV flow (UVBF) at 11 + 0 to 13 plus; 6 weeks of gestation and to determine the intraobserver reliability of these measurements. METHODS We considered, in a cross-sectional study, 162 fetuses from uncomplicated singleton pregnancies at 11 + 0 to 13 + 6 weeks of gestation. UV diameter and TAMXV were measured in its intraabdominal portion by real-time and Doppler ultrasonography and UVBF calculated. Relationships between these parameters and fetal crown rump length were tested by regression analysis. In 25 cases UVBF was measured twice by the same investigator and the intraobserver agreement of these measurements was calculated. RESULTS A significant increase was evidenced in the gestational age period considered in UV diameter (r = 0.729, p < 0.0001), TAMXV (r = 0.691, p < 0.0001) and UVBF (r = 0.777, p < 0.0001). UVBF increased from 2.26 ml/min at 11 weeks to 15.62 ml/min at 13 + 6 weeks of gestation. The intraobserver ICCs were 0.96, 0.92 and 0.88, respectively, for UV diameter, TAMXV and UVBF. CONCLUSIONS In normal fetuses, UV diameter, TAMVX and flow increase between 11 + 0 and 13 + 6 weeks of gestation. In this gestational age interval, the calculation of UV blood flow and its components shows an intraobserver agreement reliable enough for clinical use.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università di Roma, Tor Vergata, Roma, Italy.
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Rizzo G, Capponi A, Pietrolucci ME, Arduini D. Role of sonographic automatic volume calculation in measuring fetal cardiac ventricular volumes using 4-dimensional sonography: comparison with virtual organ computer-aided analysis. J Ultrasound Med 2010; 29:261-70. [PMID: 20103798 DOI: 10.7863/jum.2010.29.2.261] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the agreement and reliability of virtual organ computer-aided analysis (VOCAL) and sonographic automatic volume calculation (sonoAVC) for measurements of ventricular volume from fetal heart data sets acquired by 4-dimensional sonography with spatiotemporal image correlation (STIC). METHODS We studied 45 volumes from fetuses with normal (n = 30) and abnormal (n = 15) hearts. Spatiotemporal image correlation data sets were frozen in end systole and end diastole, and ventricular volumes were measured with VOCAL and sonoAVC. The stroke volume was calculated from these measurements. Reliability and agreement of the two techniques were evaluated with intraclass correlation coefficients (ICCs), and proportionate Bland-Altman plots were constructed. The time necessary to complete the measurements with either technique was compared. Intraobserver and interobserver agreement of measurements was calculated. RESULTS All data sets could be measured with both techniques. A high degree of reliability was observed between VOCAL and sonoAVC (left ventricular stroke volume ICC, 0.978; 95% confidence interval [CI], 0.957-0.989; right ventricular stroke volume ICC, 0.985; 95% CI, 0.972-0.992). The time necessary to measure the stroke volume was significantly shorter with sonoAVC (2.8 versus 11.7 minutes; P < .0001) than with VOCAL. Bland-Altman tests showed no clinically significant mean percent differences between stroke volume measurements obtained from each ventricle by the same observer or by 2 independent observers using either VOCAL or sonoAVC. CONCLUSIONS There was good agreement between cardiac volumes measured with VOCAL and sonoAVC. Sonographic automatic volume calculation represents a rapid technique for estimating fetal stroke volume and promises to become the method of choice.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Fatebenefratelli S. Giovanni Calabita Hospital, Isola Tiberina 89, 00186 Rome, Italy.
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Rizzo G, Capponi A, Pietrolucci ME, Capece A, Arduini D. First-trimester placental volume and vascularization measured by 3-dimensional power Doppler sonography in pregnancies with low serum pregnancy-associated plasma protein a levels. J Ultrasound Med 2009; 28:1615-22. [PMID: 19933473 DOI: 10.7863/jum.2009.28.12.1615] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the first-trimester placental volume and 3-dimensional (3D) power Doppler vascularization of pregnancies with low serum pregnancy-associated plasma protein A (PAPP-A) levels and to relate these findings to pregnancy outcomes. METHODS Three-dimensional power Doppler sonography of the placenta was performed at gestational ages of 11 weeks to 13 weeks 6 days in 84 pregnancies with PAPP-A concentrations of less than 0.4 multiple of the median (MoM). With a standardized setting, the placental volume and vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) were calculated and related to pregnancy outcomes. RESULTS Pregnancy outcomes were as follows: 57 pregnancies with birth weights at or above the 10th percentile (group A), 16 pregnancies with birth weights below the 10th percentile and normal Doppler findings in the umbilical artery throughout gestation (group B), and 11 pregnancies with birth weights below the 10th percentile and abnormal umbilical Doppler findings later in gestation (group C). No differences were found in PAPP-A levels among groups. Placental volume values were significantly lower than reference limits, but no differences were found between groups. In groups A and B, there were no significant differences in 3D Doppler indices. However, these indices were significantly lower in group C (VI mean difference, -1.904; P < .001; FI mean difference, -1.939; P < .001; VFI mean difference, -1.944; P < .001). Placental vascular indices were significantly related to the severity of intrauterine growth restriction (IUGR; VI, r = 0.438; P < .001; FI, r = 0.482; P < .001; VFI, r = 0.497; P < .001) but not to the PAPP-A MoM and placental volume values. CONCLUSIONS Low serum maternal PAPP-A levels are associated with altered 3D placental Doppler indices, and these changes are related to subsequent development of IUGR and adverse pregnancy outcomes.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Fatebenefratelli S. Giovanni Calabita Hospital, Isola Tiberina 89, 00186 Rome, Italy.
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Rizzo G, Capponi A, Pietrolucci ME, Boccia C, Arduini D. The significance of visualising coronary blood flow in early onset severe growth restricted fetuses with reverse flow in the ductus venosus. J Matern Fetal Neonatal Med 2009; 22:547-51. [PMID: 19350447 DOI: 10.1080/14767050902801777] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the incidence and significance of coronary blood flow visualisation in early onset severe intrauterine growth restriction (IUGR) fetuses and to assess its relationship with the presence of reverse flow in ductus venosus (DV). METHODS The examination of coronary artery was performed at a gestational age <26 weeks in 19 IUGR fetuses from mothers without medical complications and characterised by the presence of reverse flow in DV. Visualisation or non-visualisation of coronary circulation were compared with fetal and neonatal outcome. RESULTS Coronary flow was seen in 7/19 (36.8%) of the IUGR fetuses and these fetuses showed a higher incidence of fetal death (71.4%vs. 16.6%, p = 0.044), delivery or fetal death at an earlier gestational age (23.71 vs. 26.57 weeks, p = 0.011) and a lower birthweight (310 vs. 586 g, p = 0.011). Kaplan-Meier survival analysis demonstrated that visualisation or non-visualisation of coronary flow in such fetuses provides an independent contribution in the prediction of the time interval between Doppler study and delivery or fetal death (chi square = 15.36, p < 0.001). CONCLUSIONS Visualisation of coronary flow in IUGR fetuses with reverse flow in the DV identifies a subgroup of fetuses with a poorer fetal and neonatal outcome.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Universita di Roma 'Tor Vergata', Italy.
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Rizzo G, Capponi A, Pietrolucci ME, Arduini D. Effects of maternal cigarette smoking on placental volume and vascularization measured by 3-dimensional power Doppler ultrasonography at 11+0 to 13+6 weeks of gestation. Am J Obstet Gynecol 2009; 200:415.e1-5. [PMID: 19070830 DOI: 10.1016/j.ajog.2008.10.041] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2008] [Revised: 08/24/2008] [Accepted: 10/07/2008] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We sought to establish the effect of maternal smoking on placental volume and vascularization in early gestation. STUDY DESIGN Three-dimensional power Doppler ultrasonography of the placenta was performed at 11+0 to 13+6 weeks in 80 pregnancies categorized according to cigarette consumption: group A never smoked, B smoking < 10 cigarettes/day, C smoking 10-20 cigarettes/day, and D smoking > 20 cigarettes/day. Using a standardized setting, placental volume and vascularization index (VI), flow index (FI), and vascularization flow index (VFI) were calculated. RESULTS No differences were found in placental volume among groups. In groups C and D lower values were found for VI (group C: t = 4.52, P = .0002; group D: t = 3.72, P = .0014), FI (group C: t = 5.06, P = .0001; group D: t = 4.59, P = .0002), and VFI (group C: t = 3.49, P = .0024; group D: t = 2.88, P = .0095). Placental vascular indices were significantly related to birthweight (VI r = 0.563, FI r = 0.580, VFI r = 0.601; P < .001). CONCLUSION Maternal smoking is associated with altered 3-dimensional placental Doppler indices and these changes are related to birth weight.
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Affiliation(s)
- Giuseppe Rizzo
- Fetal Medicine Center Genoma, Ospedale G. B. Grassi, Rome, Italy
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Rizzo G, Capponi A, Vendola M, Pietrolucci ME, Arduini D. Relationship between aortic isthmus and ductus venosus velocity waveforms in severe growth restricted fetuses. Prenat Diagn 2008; 28:1042-7. [PMID: 18973156 DOI: 10.1002/pd.2121] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the incidence of abnormalities in velocity waveforms from ductus venosus (DV) and aortic isthmus (AoI) in fetuses with intrauterine growth restriction (IUGR) and their reciprocal temporal relationship. METHODS DV and AoI velocity waveforms were recorded in 31 IUGR fetuses characterized either by absent end diastolic (20) or reverse flow (11) in umbilical artery. Abnormal velocity waveforms in DV and AoI were defined in presence of reverse diastolic flows. RESULTS Abnormal DV velocity waveforms were present in 10 fetuses and were always associated with abnormalities. Abnormal AoI flows were also present in 10 fetuses of the remaining 21 fetuses with normal DV velocity waveforms (47.6%). Longitudinal monitoring of fetuses with normal DV flows showed a significantly shorter time interval in the onset of reverse flow in DV when abnormalities in AoI were present (4 vs 14 days p=0.001) irrespectively of gestational age or other potential confounding variables. CONCLUSIONS Our data suggest that AoI velocity waveforms become abnormal at an earlier stage of fetal compromise than DV.
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Affiliation(s)
- Giuseppe Rizzo
- Department Obstetrics and Gynecology, Università di Roma Tor Vergata, Italy.
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Rizzo G, Capponi A, Vendola M, Pietrolucci ME, Arduini D. Use of the 3-vessel view to record Doppler velocity waveforms from the aortic isthmus in normally grown and growth-restricted fetuses: comparison with the long aortic arch view. J Ultrasound Med 2008; 27:1617-22. [PMID: 18946101 DOI: 10.7863/jum.2008.27.11.1617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Aortic isthmus (AoI) velocity waveforms are considered powerful indicators of hemodynamic deterioration in intrauterine growth-restricted (IUGR) fetuses. However, technical difficulties in sampling AoI velocity waveforms from the longitudinal aortic arch (LAA) have limited its clinical application thus far. In this study, we tested the possibility of recording AoI velocity waveforms from the 3-vessel (3V) view of the fetal mediastinum and comparing the agreement of these measurements with recordings from the LAA. METHODS Doppler measurements of the pulsatility index (PI) from the AoI were performed in 70 fetuses (20 IUGR and 50 normally grown) between 20 and 34 weeks' gestation. All measurements were sampled in both the LAA and 3V views by the same investigator. Reliability was evaluated with intraclass correlation coefficients (ICCs), and Bland-Altman plots were generated. The time required to complete the measurements was compared. RESULTS A high degree of reliability was observed between PI values obtained from LAA and 3V views in both IUGR and normally grown fetuses (all fetuses: ICC, 0.976; 95% confidence interval [CI], 0.961-0.985; normally grown: ICC, 0.839; 95% CI, 0.731-0.906; IUGR: ICC, 0.954; 95% CI, 0.886-0.982). However, recordings from the 3V view were significantly less time-consuming than those from the LLA view (mean +/- SD, 30.4 +/- 14.2 versus 52.8 +/- 29.4 seconds; P < .0001) and showed higher intraobserver reproducibility. CONCLUSIONS In IUGR and normally grown fetuses, AoI waveforms can be reliably obtained from the 3V view with higher reproducibility and a shorter recording time.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Fatebenefratelli San Giovanni Calabita Hospital, Rome, Italy.
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Rizzo G, Capponi A, Vendola M, Pietrolucci ME, Arduini D. Role of tomographic ultrasound imaging with spatiotemporal image correlation for identifying fetal ventricular septal defects. J Ultrasound Med 2008; 27:1071-5. [PMID: 18577671 DOI: 10.7863/jum.2008.27.7.1071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to test the possibility of diagnosing ventricular septal defects (VSDs) by using tomographic ultrasound imaging (TUI) on 4-dimensional volumes of the fetal chest obtained with spatiotemporal image correlation and the color Doppler function. METHODS We retrospectively evaluated the 4-dimensional spatiotemporal image correlation volumes of 8 fetuses with VSDs (single in 7 and double in 1) between 20 and 33 weeks' gestation. The data were analyzed to determine whether VSDs were correctly identified in at least 1 of 7 automatically generated TUI displays. RESULTS All of the included VSDs were correctly identified with the use of an interslice distance in the TUI function ranging from 0.8 to 2 mm without the need to further manipulate the volume. CONCLUSIONS This automatic approach shows good retrieval of diagnostic cardiac planes in fetuses with VSDs, which may improve the diagnostic accuracy for this disease.
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Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy.
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Rizzo G, Capponi A, Pietrolucci ME, Arduini D. Sonographic automated volume count (SonoAVC) in volume measurement of fetal fluid-filled structures: comparison with Virtual Organ Computer-aided AnaLysis (VOCAL). Ultrasound Obstet Gynecol 2008; 32:111-2. [PMID: 18536064 DOI: 10.1002/uog.5387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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