1
|
Cuenca-Gómez D, de Paco Matallana C, Rolle V, Valiño N, Revello R, Adiego B, Mendoza M, Molina FS, Carrillo MP, Delgado JL, Wright A, Santacruz B, Gil MM. Performance of first-trimester combined screening for preterm pre-eclampsia: findings from cohort of 10 110 pregnancies in Spain. Ultrasound Obstet Gynecol 2023; 62:522-530. [PMID: 37099759 DOI: 10.1002/uog.26233] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of the Fetal Medicine Foundation (FMF) competing-risks model, incorporating maternal characteristics, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and placental growth factor (PlGF) (the 'triple test'), for the prediction at 11-13 weeks' gestation of preterm pre-eclampsia (PE) in a Spanish population. METHODS This was a prospective cohort study performed in eight fetal medicine units in five different regions of Spain between September 2017 and December 2019. All pregnant women with a singleton pregnancy and a non-malformed live fetus attending a routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation were invited to participate. Maternal demographic characteristics and medical history were recorded and MAP, UtA-PI, serum PlGF and pregnancy-associated plasma protein-A (PAPP-A) were measured following standardized protocols. Treatment with aspirin during pregnancy was also recorded. Raw values of biomarkers were converted into multiples of the median (MoM), and audits were performed periodically to provide regular feedback to operators and laboratories. Patient-specific risks for term and preterm PE were calculated according to the FMF competing-risks model, blinded to pregnancy outcome. The performance of screening for PE, taking into account aspirin use, was assessed by calculating the area under the receiver-operating-characteristics curve (AUC) and detection rate (DR) at a 10% fixed screen-positive rate (SPR). Risk calibration of the model was assessed. RESULTS The study population comprised 10 110 singleton pregnancies, including 72 (0.7%) that developed preterm PE. In the preterm PE group, compared to those without PE, median MAP MoM and UtA-PI MoM were significantly higher, and median serum PlGF MoM and PAPP-A MoM were significantly lower. In women with PE, the deviation from normal in all biomarkers was inversely related to gestational age at delivery. Screening for preterm PE by a combination of maternal characteristics and medical history with MAP, UtA-PI and PlGF had a DR, at 10% SPR, of 72.7% (95% CI, 62.9-82.6%). An alternative strategy of replacing PlGF with PAPP-A in the triple test was associated with poorer screening performance for preterm PE, giving a DR of 66.5% (95% CI, 55.8-77.2%). The calibration plot showed good agreement between predicted risk and observed incidence of preterm PE, with a slope of 0.983 (95% CI, 0.846-1.120) and an intercept of 0.154 (95% CI, -0.091 to 0.397). CONCLUSIONS The FMF model is effective in predicting preterm PE in the Spanish population at 11-13 weeks' gestation. This method of screening is feasible to implement in routine clinical practice, but it should be accompanied by a robust audit and monitoring system, in order to maintain high-quality screening. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- D Cuenca-Gómez
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - C de Paco Matallana
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
- Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar, Murcia, Spain
| | - V Rolle
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- Biostatistics and Epidemiology Platform, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - N Valiño
- Department of Obstetrics and Gynecology, Complejo Hospitalario Universitario A Coruña, A Coruña, Galicia, Spain
| | - R Revello
- Department of Obstetrics and Gynecology, Hospital Universitario Quirón, Pozuelo de Alarcón, Madrid, Spain
| | - B Adiego
- Department of Obstetrics and Gynecology, Hospital Universitario Fundación de Alcorcón, Alcorcón, Madrid, Spain
| | - M Mendoza
- Department of Obstetrics and Gynecology, Hospital Universitario Vall d'Hebrón, Barcelona, Catalonia, Spain
| | - F S Molina
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario San Cecilio, Granada, Spain
- Instituto de Investigación Biosanitaria (Ibs.GRANADA), Granada, Spain
| | - M P Carrillo
- Department of Obstetrics and Gynecology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - J L Delgado
- Department of Obstetrics and Gynecology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - B Santacruz
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - M M Gil
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| |
Collapse
|
2
|
Gil MM, Molina FS, Rodríguez‐Fernández M, Delgado JL, Carrillo MP, Jani J, Plasencia W, Stratieva V, Maíz N, Carretero P, Lismonde A, Chaveeva P, Burgos J, Santacruz B, Zamora J, De Paco Matallana C. New approach for estimating risk of miscarriage after chorionic villus sampling. Ultrasound Obstet Gynecol 2020; 56:656-663. [PMID: 32281125 PMCID: PMC7984173 DOI: 10.1002/uog.22041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/07/2020] [Accepted: 03/22/2020] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To estimate the risk of miscarriage associated with chorionic villus sampling (CVS). METHODS This was a retrospective cohort study of women attending for routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation at one of eight fetal-medicine units in Spain, Belgium and Bulgaria, between July 2007 and June 2018. Two populations were included: (1) all singleton pregnancies undergoing first-trimester assessment at Hospital Clínico Universitario Virgen de la Arrixaca in Murcia, Spain, that did not have CVS (non-CVS group); and (2) all singleton pregnancies that underwent CVS following first-trimester assessment at one of the eight participating centers (CVS group). We excluded pregnancies diagnosed with genetic anomalies or major fetal defects before or after birth, those that resulted in termination and those that underwent amniocentesis later in pregnancy. We used propensity score (PS) matching analysis to estimate the association between CVS and miscarriage. We compared the risk of miscarriage of the CVS and non-CVS groups after PS matching (1:1 ratio). This procedure creates two comparable groups balancing the maternal and pregnancy characteristics that are associated with CVS, in a similar way to that in which randomization operates in a randomized clinical trial. RESULTS The study population consisted of 22 250 pregnancies in the non-CVS group and 3613 in the CVS group. The incidence of miscarriage in the CVS group (2.1%; 77/3613) was significantly higher than that in the non-CVS group (0.9% (207/22 250); P < 0.0001). The PS algorithm matched 2122 CVS with 2122 non-CVS cases, of which 40 (1.9%) and 55 (2.6%) pregnancies in the CVS and non-CVS groups, respectively, resulted in a miscarriage (odds ratio (OR), 0.72 (95% CI, 0.48-1.10); P = 0.146). We found a significant interaction between the risk of miscarriage following CVS and the risk of aneuploidy, suggesting that the effect of CVS on the risk of miscarriage differs depending on background characteristics. Specifically, when the risk of aneuploidy is low, the risk of miscarriage after CVS increases (OR, 2.87 (95% CI, 1.13-7.30)) and when the aneuploidy risk is high, the risk of miscarriage after CVS is paradoxically reduced (OR, 0.47 (95% CI, 0.28-0.76)), presumably owing to prenatal diagnosis and termination of pregnancies with major aneuploidies that would otherwise have resulted in spontaneous miscarriage. For example, in a patient in whom the risk of aneuploidy is 1 in 1000 (0.1%), the risk of miscarriage after CVS will increase to 0.3% (0.2 percentage points higher). CONCLUSIONS The risk of miscarriage in women undergoing CVS is about 1% higher than that in women who do not have CVS, although this excess risk is not solely attributed to the invasive procedure but, to some extent, to the demographic and pregnancy characteristics of the patients. After accounting for these risk factors and confining the analysis to low-risk pregnancies, CVS seems to increase the risk of miscarriage by about three times above the patient's background risk. Although this is a substantial increase in relative terms, in pregnancies without risk factors for miscarriage, the risk of miscarriage after CVS remains low and similar to, or slightly higher than, that in the general population. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- M. M. Gil
- Department of Obstetrics and GynecologyHospital Universitario de Torrejón, Torrejón de ArdozMadridSpain
- School of Health SciencesUniversidad Francisco de Vitoria, Pozuelo de AlarcónMadridSpain
| | - F. S. Molina
- Department of Obstetrics and GynecologyHospital Clínico San Cecilio, Instituto de Investigación Biosanitaria IBSGranadaSpain
| | - M. Rodríguez‐Fernández
- Department of Obstetrics and GynecologyHospital Universitario de Torrejón, Torrejón de ArdozMadridSpain
| | - J. L. Delgado
- Department of Obstetrics and GynecologyHospital Clínico Universitario ‘Virgen de la Arrixaca’, El PalmarMurciaSpain
- Institute for Biomedical Research of Murcia, IMIB‐Arrixaca, El PalmarMurciaSpain
| | - M. P. Carrillo
- Department of Obstetrics and GynecologyHospital Universitario ‘Virgen de las Nieves’GranadaSpain
| | - J. Jani
- Department of Obstetrics and Gynecology, University Hospital BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | | | - V. Stratieva
- Obs/Gyn Dr Shterev HospitalSofiaBulgaria
- OSCAR ClinicSofiaBulgaria
| | - N. Maíz
- Fetal Medicine Unit, Department of Obstetrics and GynecologyBioCruces Health Research Institute, Hospital Universitario Cruces, Universidad del País Vasco (UPV/EHU), BarakaldoPaís VascoSpain
| | - P. Carretero
- Department of Obstetrics and GynecologyHospital Clínico San Cecilio, Instituto de Investigación Biosanitaria IBSGranadaSpain
| | - A. Lismonde
- Department of Obstetrics and Gynecology, University Hospital BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | | | - J. Burgos
- Fetal Medicine Unit, Department of Obstetrics and GynecologyBioCruces Health Research Institute, Hospital Universitario Cruces, Universidad del País Vasco (UPV/EHU), BarakaldoPaís VascoSpain
| | - B. Santacruz
- Department of Obstetrics and GynecologyHospital Universitario de Torrejón, Torrejón de ArdozMadridSpain
- School of Health SciencesUniversidad Francisco de Vitoria, Pozuelo de AlarcónMadridSpain
| | - J. Zamora
- CIBER Epidemiology and Public HealthClinical Biostatistics Unit, Hospital Ramón y CajalMadridSpain
- Barts Research Centre for Women's Health, WHO Collaborating CentreQueen Mary University of LondonLondonUK
| | - C. De Paco Matallana
- Department of Obstetrics and GynecologyHospital Clínico Universitario ‘Virgen de la Arrixaca’, El PalmarMurciaSpain
- Institute for Biomedical Research of Murcia, IMIB‐Arrixaca, El PalmarMurciaSpain
| |
Collapse
|
3
|
Molina FS, Terra R, Carrillo MP, Puertas A, Nicolaides KH. What is the most reliable ultrasound parameter for assessment of fetal head descent? Ultrasound Obstet Gynecol 2010; 36:493-499. [PMID: 20533441 DOI: 10.1002/uog.7709] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The aims of this study were, first, to establish the agreement between digital and ultrasound assessment of occipital position and, second, to evaluate the repeatability of the measurements of head direction, angle of the middle line, progression distance and angle of progression in women in the second stage of labor. METHODS Digital examination and then transabdominal ultrasound examination was performed on 50 women in the second stage of labor to determine the fetal occipital position. We also obtained three-dimensional (3D) blocks of the fetal head by transperineal sonography, and two experts in 3D ultrasound measured head direction, angle of the middle line, progression distance and angle of progression. Intraclass correlation coefficients with 95% CIs, and Bland-Altman analysis, were used to evaluate intraobserver and interobserver repeatability of measurements. RESULTS The fetal head position, determined by ultrasound examination, was occiput anterior in 33 (66%) cases and occiput lateral in 17 (34%) cases. Vaginal digital examination failed to identify the correct fetal head position by more than 45° in 33 (66%) cases. All four 3D ultrasound measurements were reproducible but the progression angle had the highest intraclass correlation coefficient for the same observer (0.94; 95% CI, 0.90-0.97) and for two different operators (0.84; 95% CI, 0.73-0.91). The progression angle was also the measurement for which smaller limits of agreement (LOA) were found in the Bland-Altman test, performed to calculate the intraobserver (bias 0.9; LOA, - 9.2 to 11.1%) and interobserver (bias 1.5; LOA, - 15.4 to 18.3%) variability. CONCLUSIONS Digital pelvic examination for determining the fetal head position during labor is not accurate. The most reproducible of the 3D measurements for progression of the fetal head in labor is the progression angle.
Collapse
Affiliation(s)
- F S Molina
- Department of Obstetrics and Gynaecology, University Hospital Virgen de las Nieves, Granada, Spain.
| | | | | | | | | |
Collapse
|
4
|
Manzanares S, Carrillo MP, González-Perán E, Puertas A, Montoya F. Isolated oligohydramnios in term pregnancy as an indication for induction of labor. J Matern Fetal Neonatal Med 2009; 20:221-4. [PMID: 17437223 DOI: 10.1080/14767050601127391] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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: 10/23/2022]
Abstract
OBJECTIVE To evaluate the outcome of active induction of labor for isolated oligohydramnios in low-risk term gestation. METHODS This retrospective study analyzed the obstetric and perinatal outcome of 412 singleton term pregnancies with cephalic presentation and no maternal risk factors or fetal abnormalities. Two groups were compared: 206 deliveries after induced labor for isolated oligohydramnios, and 206 deliveries matched for gestational age following spontaneous labor with normal amniotic fluid index. RESULTS The overall rate of cesarean deliveries and cesarean deliveries for nonreassuring fetal status, and operative vaginal delivery rates and those for nonreassuring fetal status were higher in the oligohydramnios group than in the control group. There were no differences between groups in neonatal outcome or perinatal morbidity or mortality. CONCLUSION Active induction of labor in term low risk gestations with isolated oligohydramnios translated into higher labor induction, operative vaginal delivery and cesarean section rates. This led to increased maternal risk and an increase in costs with no differences in neonatal outcome.
Collapse
Affiliation(s)
- S Manzanares
- Obstetrics and Gynecology Department, Virgen de las Nieves University Hospital, Granada, 18014 Spain.
| | | | | | | | | |
Collapse
|
5
|
Bruno JG, Carrillo MP, Phillips T. In vitro antibacterial effects of antilipopolysaccharide DNA aptamer-C1qrs complexes. Folia Microbiol (Praha) 2008; 53:295-302. [PMID: 18759112 DOI: 10.1007/s12223-008-0046-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 02/21/2008] [Indexed: 12/01/2022]
Abstract
DNA aptamers were developed against lipopolysaccharide (LPS) from E. coli O111:B4 and shown to bind both LPS and E. coli by a colorimetric enzyme-based microplate assay. The polyclonal aptamers were coupled to human C1qrs protein either directly using a bifunctional linker or indirectly using biotinylated aptamers and a streptavidin-C1qrs complex. Both systems significantly reduced colony counts when applied to E. coli O111:B4 and K12 strains across a series of 10x dilutions of the bacteria in the presence of human serum; it was diluted 1: 10(3) in order to avoid significant bacterial lysis by the competing alternate pathway of complement activation. A number of candidate DNA aptamer sequences were cloned and sequenced from the anti-LPS aptamer library for future screening of antibacterial or "antibiotic" potential and to aid in eventual development of an alternative therapy for antibiotic-resistant bacterial infections.
Collapse
Affiliation(s)
- J G Bruno
- Operational Technologies Corporation, San Antonio, TX 78229, USA.
| | | | | |
Collapse
|
6
|
Puertas A, Carrillo MP, çlvarez M, Cañizares JM, Miño M, Malde J. Meconium concentration and amniotic fluid index influence the outcome of amnioinfusion. Minerva Ginecol 2001; 53:321-30. [PMID: 11549996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND To determine the usefulness of amnioinfusion as a function of meconium concentration and amniotic fluid index. METHODS This was a prospective study of 206 pregnant women in whom amniotic fluid was moderately or heavily stained with meconium, according to subjective evaluation. The women were assigned randomly to receive amnioinfusion (n=103) or no amnioinfusion (control group, n=103). The results were compared in women with =/<15 % or >15 % meconium in the amniotic fluid (measured by centrifugation), and in women in whom the amniotic fluid index calculated 60 min after insertion of the amnioinfusion catheter was <10 or =/>10. RESULTS In women with >15% meconium, amnioinfusion decreased the rate of cesarian sections motivated by fetal distress (2.5% vs 22.2%), and in women with =/<15% meconium, amnioinfusion decreased the presence of meconium below the vocal cords (6.4% vs 25.9%). Greater benefits after amnioinfusion were seen in women with an amniotic fluid index =/>10: the rate of cesarian sections was lower (1.3% vs 13.3%), as was the frequency of meconium below the vocal cords (10.1% vs 33.3%). CONCLUSIONS Beneficial effects of amnioinfusion were seen in women with high and low concentrations of meconium, and with high and low amniotic fluid indexes. These criteria should therefore not be used to decide whether amnioinfusion is indicated when the amniotic fluid is moderately or heavily stained with meconium.
Collapse
Affiliation(s)
- A Puertas
- Servicio de Obstetricia y Ginecología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | | | | | | | | | | |
Collapse
|
7
|
Cellona RV, Fajardo TT, Kim DI, Hah YM, Ramasoota T, Sampattavanich S, Carrillo MP, Abalos RM, dela Cruz EC, Ito T. Joint chemotherapy trials in lepromatous leprosy conducted in Thailand, the Philippines, and Korea. Int J Lepr Other Mycobact Dis 1990; 58:1-11. [PMID: 2181040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Chemotherapy trials in lepromatous leprosy using various combinations of existing antileprosy drugs were conducted jointly by Korea, The Philippines, and Thailand. The general objective of these trials was to determine the most effective and practicable regimen or regimens for field application. Lepromatous patients were divided into two groups: Group I was comprised of new, untreated patients infected with dapsone-sensitive Mycobacterium leprae and Group II consisted of relapsed patients with dapsone-resistant disease. Four different regimens were administered to each group for 5 years. Comparison among the regimens was based on antileprotic efficacy, drug safety, acceptability, field practicability, and economic feasibility. No significant differences were noted among the various regimens as judged by the reduction in the bacterial index (BI), clinical response, and change in biopsy index. Toxicity was seen only in the regimens containing prothionamide and rifampin. The regimens were acceptable to the patients and all were found practical for field use. Clofazimine, even in low doses, was found to suppress the frequency and severity of erythema nodosum leprosum. A multidrug regimen effective against both new and relapsed cases of lepromatous leprosy, whether dapsone sensitive or dapsone resistant, is recommended for field use. Given priority, the cost of the regimens is affordable in the three countries.
Collapse
Affiliation(s)
- R V Cellona
- Epidemiology Branch, Leonard Wood Memorial, Cebu, Philippines
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Olano VA, Carrillo MP, de la Vega P, Espinal CA. Vector competence of Cartagena strain of Anopheles albimanus for Plasmodium falciparum and P. vivax. Trans R Soc Trop Med Hyg 1985; 79:685-6. [PMID: 3913070 DOI: 10.1016/0035-9203(85)90192-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|