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  • 1
    In: Fetal Diagnosis and Therapy, S. Karger AG, Vol. 33, No. 4 ( 2013), p. 268-271
    Abstract: Maternal listeriosis is often associated with mild symptoms for the patient, but fetal infection can lead to severe adverse perinatal outcome. The most described antenatal symptoms are reduced fetal movements and an abnormal fetal heart rate trace. We present a case of fetal listeriosis suspected by ultrasound findings of fetal gastrointestinal compromise, neonatal diagnosis and outcome.
    Type of Medium: Online Resource
    ISSN: 1015-3837 , 1421-9964
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
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  • 2
    In: Fetal Diagnosis and Therapy, S. Karger AG, Vol. 39, No. 3 ( 2016), p. 186-191
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To describe perinatal outcomes achieved with cord occlusion (CO) in monochorionic twins with severe selective intrauterine growth restriction (sIUGR) and abnormal umbilical artery Doppler in the IUGR twin (types II and III). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We studied a consecutive series of 90 cases of sIUGR with abnormal Doppler treated with CO of the IUGR fetus. Abnormal Doppler was defined as continuous (type II, n = 41) or intermittent (type III, n = 49) absent/reversed end-diastolic flow. All cases presented at least one of the following severity criteria: gestational age (GA) 〈 22 weeks, inter-twin estimated weight discordance 〉 35%, reversed end-diastolic umbilical artery flow or ductus venosus pulsatility index 〉 95th centile. We prospectively recorded pregnancy course and perinatal outcome. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Median GA at surgery was 20.6 weeks and mean duration 22.4 min. Miscarriage ( 〈 24 weeks) occurred in 3.3% (3/90) and preterm delivery 〈 32 weeks in 7.1% (6/84) of continuing pregnancies. GA at delivery was 36.4 weeks and neonatal survival of the larger twin was achieved in 93.3%. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 In a consecutive series studied by an experienced team, CO in monochorionic twins with severe sIUGR type II or III was associated with delivery 〉 32 weeks in 92.9% and neonatal survival of the normal twin in 93.3% of pregnancies.
    Type of Medium: Online Resource
    ISSN: 1015-3837 , 1421-9964
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
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  • 3
    In: Fetal Diagnosis and Therapy, S. Karger AG, Vol. 41, No. 3 ( 2017), p. 202-208
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 The aim of this study was to determine the role of nerve growth factor (NGF) in the first-trimester screening for preeclampsia (PE). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Uterine artery Doppler (UtAD) was determined transvaginally. Maternal concentrations of NGF were assessed in 42 patients who subsequently developed PE and in 95 controls. Quantile and multivariate regression analyses were performed for the NGF and UtAD adjustment and expressed as the multiple of the median (MoM) of the unaffected group. Logistic regression analysis was conducted to identify the best model for the prediction of PE. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The maternal plasma concentration of NGF exhibited a trend towards lower values in patients who subsequently developed early-onset PE (e-PE) compared to controls (10.7 vs. 38.2 pg/ml, respectively; p = not significant). The median MoM NGF in the all-PE, e-PE and control groups was 0.97 (95% CI 0.13-3.36), 0.62 (95% CI 0.16-2.19) and 1.00 (95% CI 0.20-2.94), respectively (p = not significant). The best predictors of PE were previous PE, chronic hypertension and UtAD. With a false-positive rate of 10%, the detection rates (DRs) of all-PE and e-PE were 38 and 50%, respectively. The addition of MoM NGF did not improve the DR of PE. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 First-trimester NGF tends to be lower in patients who subsequently develop e-PE.
    Type of Medium: Online Resource
    ISSN: 1015-3837 , 1421-9964
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
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  • 4
    In: Fetal Diagnosis and Therapy, S. Karger AG, Vol. 48, No. 8 ( 2021), p. 596-602
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 This study aimed to determine the effect and clinical impact of physiological characteristics on the 95th/5th centile of the umbilical artery (UA) Doppler and the cerebroplacental ratio (CPR), at 36+ weeks. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 From the multicenter randomized trial “Ratio37,” we selected 4,505 low-risk pregnant women between June 2016 and January 2020. We registered physiological characteristics and the pulsatility indexes (PI) of the UA and middle cerebral artery (36–39 weeks). The 95th/5th centile of the UA PI and CPR was modeled by quantile regression. To evaluate the clinical impact of adjusting Doppler, we retrospectively applied gestational age (GA) and fully adjusted standards to 682 small for gestational age (SGA)-suspected fetuses (37 weeks) from a cohort of consecutive patients obtained between January 2010 and January 2020. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Several physiological characteristics significantly influenced the 95th/5th centile of the UA and CPR PI. The fully adjusted 95th centile of the UA was higher, and the 5th centile of the CPR was lower than GA-only-adjusted standards. Of the 682 SGA fetuses, 150 (22%) were classified as late fetal growth restricted only by GA and 112 (16.4%) when we adjusted Doppler. These 38 fetuses had similar perinatal outcome than the SGA group. 〈 b 〉 〈 i 〉 Discussion: 〈 /i 〉 〈 /b 〉 The 95th/5th centile of the UA and CPR PI is significantly influenced by physiological characteristics. Adjusting Doppler standards could differentiate better between FGR and SGA.
    Type of Medium: Online Resource
    ISSN: 1015-3837 , 1421-9964
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
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  • 5
    Online Resource
    Online Resource
    S. Karger AG ; 2019
    In:  Gynecologic and Obstetric Investigation Vol. 84, No. 3 ( 2019), p. 237-241
    In: Gynecologic and Obstetric Investigation, S. Karger AG, Vol. 84, No. 3 ( 2019), p. 237-241
    Abstract: 〈 b 〉 〈 i 〉 Backgrounds/Aims: 〈 /i 〉 〈 /b 〉 To assess the perinatal outcome of pregnancies with chorionic bump detected at the first trimester of pregnancy. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 This was a nested case-control study of pregnancies with chorionic bump identified at the first trimester ultrasound that was performed from October 2014 and October 2016. The control group consisted of the following 5 unaffected pregnancies after each case. From the first trimester ultrasound, maternal and perinatal characteristics were obtained and stored in a dedicated database. The primary outcome was defined as the presence of an alive new-born. Secondary outcome was defined as the presence of a composite adverse obstetric outcome. 〈 b 〉 〈 i 〉 Results 〈 /i 〉 〈 /b 〉 : Eleven first trimester pregnancies affected by a chorionic bump and 55 controls were identified. The primary outcome was observed in 72.7 and 89.1% of chorionic bump and controls respectively ( 〈 i 〉 p 〈 /i 〉 = 0.2). The secondary outcome was observed in 45.5% of pregnancies with a chorionic bump versus 12.7% in the unaffected group ( 〈 i 〉 p 〈 /i 〉 = 0.01). First trimester uterine artery Doppler demonstrated a non-significant trend to be higher in the chorionic bump group. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The presence of a chorionic bump is associated with a significant higher risk of adverse perinatal outcome.
    Type of Medium: Online Resource
    ISSN: 0378-7346 , 1423-002X
    RVK:
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2019
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  • 6
    Online Resource
    Online Resource
    S. Karger AG ; 2014
    In:  Gynecologic and Obstetric Investigation Vol. 77, No. 2 ( 2014), p. 111-116
    In: Gynecologic and Obstetric Investigation, S. Karger AG, Vol. 77, No. 2 ( 2014), p. 111-116
    Abstract: 〈 b 〉 〈 i 〉 Aim: 〈 /i 〉 〈 /b 〉 To assess the impact that pregestational insulin resistance (PIR) has as a risk factor for preeclampsia (PE). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Nested case-control study that included patients with PIR and a control group that was randomly selected from pregnancies admitted to the Fetal Medicine Unit between January 2005 and May 2011. Clinical and hemodynamic variables were analyzed by a multiple logistic regression analysis. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Of the 13,124 patients admitted during the study period, 119 had a diagnosis of PIR (0.9%). Patients with PIR were older and had a higher body mass index (BMI). PIR was also related to a significantly higher frequency of chronic hypertension (CrHT; 10.1 vs. 2.2%, p 〈 0.05) and hypothyroidism (5.0 vs. 1.6%, p 〈 0.05) than in the control group. Moreover, women with PIR were more likely to develop PE (8.4 vs. 4.2%, p 〈 0.05) and gestational diabetes mellitus (9.2 vs. 2.9%) than the control group. Multivariate analysis showed that maternal age, CrHT and altered uterine artery Doppler sonography during the first and second trimesters were good predictors of PE and that PIR was not. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Although PIR correlates with PE, conditions related to the latter (CrHT, higher maternal age and increased BMI) may be predominant as risk factors for PE.
    Type of Medium: Online Resource
    ISSN: 0378-7346 , 1423-002X
    RVK:
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
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  • 7
    In: Fetal Diagnosis and Therapy, S. Karger AG, Vol. 32, No. 1-2 ( 2012), p. 116-122
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To assess the value of gestational age and cardiovascular Doppler indices in predicting perinatal mortality in a multicenter cohort of early-onset intrauterine growth-restricted (IUGR) fetuses. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 A multicenter prospective cohort study including 157 early-onset ( 〈 34 weeks) IUGR cases with abnormal umbilical artery (UA) Doppler was conducted. Cardiovascular assessment included the ductus venosus (DV), the aortic isthmus flow index (IFI), and the myocardial performance index (MPI). Isolated and combined values to predict the risk of perinatal death were evaluated by logistic regression and by decision tree analysis, where the gestational age at delivery, UA, and middle cerebral artery (MCA) were also included as covariates. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Perinatal mortality was 17% (27/157). All parameters were significantly associated with perinatal death, with individual odds ratios (OR) of 25.2 for gestational age below 28 weeks, 12.1 for absent/reversed DV atrial flow, 5.3 for MCA pulsatility index 〈 5th centile, 4.6 for UA absent/reversed diastolic end-flow, 1.8 for IFI 〈 5th centile, and 1.6 for MPI 〉 95th centile. Decision tree analysis identified gestational age at birth as the best predictor of death ( 〈 26 weeks, 93% mortality; 26–28 weeks, 29% mortality, and 〉 28 weeks, 3% mortality). Between 26 and 28 weeks, DV atrial flow allowed further stratification between high (60%) and low risk (18%) of mortality. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Gestational age largely determines the risk of perinatal mortality in early-onset IUGR before 26 weeks and later than 28 weeks of gestation. The DV may improve clinical management by stratifying the probability of death between 26 and 28 weeks of gestation.
    Type of Medium: Online Resource
    ISSN: 1015-3837 , 1421-9964
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2012
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  • 8
    In: Fetal Diagnosis and Therapy, S. Karger AG, Vol. 48, No. 2 ( 2021), p. 81-87
    Abstract: The alteration of the uterocervical angle (UCA) has been proposed to play an important role in spontaneous preterm birth (sPTB). The aim of this systematic review and meta-analysis was to evaluate the evidence on the UCA predictive role in sPTB. In this study, PubMed, Web of Science, Scopus, and Google scholar were systematically searched from inception up to June 2020. Inter-study heterogeneity was also assessed using Cochrane’s 〈 i 〉 Q 〈 /i 〉 test and the 〈 i 〉 I 〈 /i 〉 〈 sup 〉 2 〈 /sup 〉 statistic. Afterward, the random-effects model was used to pool the weighted mean differences (WMDs) and the corresponding 95% confidence intervals (CIs). Eleven articles that reported second-trimester UCA of 5,061 pregnancies were included in this study. Our meta-analysis results indicate that a wider UCA significantly increases the risk of sPTB in following cases: all pregnancies (WMD = 15.25, 95% CI: 11.78–18.72, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001; 〈 i 〉 I 〈 /i 〉 〈 sup 〉 2 〈 /sup 〉 = 75.9%, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), singleton (WMD = 14.43, 95% CI: 8.79–20.06, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001; 〈 i 〉 I 〈 /i 〉 〈 sup 〉 2 〈 /sup 〉 = 82.4%, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001), and twin pregnancies (WMD = 15.14, 95% CI: 13.42–16.87, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001; 〈 i 〉 I 〈 /i 〉 〈 sup 〉 2 〈 /sup 〉 = 0.0%, 〈 i 〉 p 〈 /i 〉 = 0.464). A wider ultrasound-measured UCA in the second trimester seems to be associated with the increased risk of sPTB in both singleton and twin pregnancies, which reinforces the clinical evidence that UCA has the potential to be used as a predictive marker of sPTB.
    Type of Medium: Online Resource
    ISSN: 1015-3837 , 1421-9964
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
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  • 9
    In: Fetal Diagnosis and Therapy, S. Karger AG, Vol. 47, No. 10 ( 2020), p. 757-764
    Abstract: Objective: To construct valid reference standards reflecting optimal cerebroplacental ratio and to explore its physiological determinants. Methods: A cohort of 391 low-risk pregnancies of singleton pregnancies of nonmalformed fetuses without maternal medical conditions and with normal perinatal outcomes was created. Doppler measurements of the middle cerebral artery and umbilical artery were performed at 24–42 weeks. Reference standards were produced, and the influence of physiological determinants was explored by nonparametric quantile regression. The derived standards were validated in a cohort of 200 low-risk pregnancies. Results: Maternal body mass index was significantly associated with the 5th centile of the cerebroplacental ratio. For each additional unit of body mass index, the 5th centile was on average 0.014 lower. The derived 5th, 10th, and 50th centiles selected in the validation cohort were 5, 9.5, and 51% of the measurements. Conclusions: This study provides methodologically sound prescriptive standards and suggests that maternal body mass index is a determinant of a cutoff commonly used for decision-making.
    Type of Medium: Online Resource
    ISSN: 1015-3837 , 1421-9964
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
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  • 10
    In: Fetal Diagnosis and Therapy, S. Karger AG, Vol. 40, No. 4 ( 2016), p. 298-302
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To evaluate the fetal mechanical PR interval in fetuses from pregnancies with intrahepatic cholestasis of pregnancy (ICP). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 A case-control study was conducted in the Maternal-Fetal Medicine Unit at Hospital Carlos Van Buren between 2011 and 2013. Fetal echocardiography was performed in patients with ICP and normal pregnancies. Demographic and clinical characteristics were compared using the Mann-Whitney U test for continuous variables. A p value 〈 0.05 was considered significant. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 51 patients with ICP were compared with 51 unaffected pregnancies. There were no significant differences in neither demographic nor clinical characteristics between the two groups. The fetal PR interval was significantly longer in the ICP group when compared to the control group (134.6 ± 12 vs. 121.4 ± 10 ms, p 〈 0.001). Moreover, four fetuses from the ICP group had a mechanical PR interval 〉 150 ms, which is compatible with a first-degree atrioventricular block. Two fetuses were identified in the neonatal period and were transferred to pediatric cardiology for follow-up, with a normal mechanical PR after the first month of life. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 We demonstrated that the fetal cardiac conduction system is altered in fetuses of patients with ICP. Further research is necessary to determine whether this alteration is related to stillbirths seen in ICP.
    Type of Medium: Online Resource
    ISSN: 1015-3837 , 1421-9964
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
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