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Montaguti E, Diglio J, Petrachi B, Arosio V, Fiorentini M, Cavalera M, Pellegrino A, Amodeo S, Lenzi J, Pilu G. Identification of Fetuses at Increased Risk of Trisomies in the First Trimester Using Axial Planes. Fetal Diagn Ther 2023; 51:1-6. [PMID: 37778343 DOI: 10.1159/000533879] [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: 02/28/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION The measurement of nuchal translucency (NT) is crucial for assessing risk of aneuploidies in the first trimester. We investigate the ability of NT assessed by a transverse view of the fetal head to detect fetuses at increased risk of common aneuploidies at 11-13 weeks of gestation. METHODS We enrolled a nonconsecutive series of women who attended our outpatient clinic from January 2020 to April 2021 for aneuploidy screening by means of a first trimester combined test. All women were examined by operators certified by the Fetal Medicine Foundation. In each patient, NT measurements were obtained both from the median sagittal view and transverse view. We calculated the risk of aneuploidy using NT measurements obtained both with sagittal and axial scans, and then we compared the results. RESULTS A total of 1,023 women were enrolled. An excellent correlation was found between sagittal and transverse NT measurements. The sensitivity and specificity of the axial scan to identify fetuses that were deemed at risk of trisomy 21 using standard sagittal scans were 40/40 = 100.0% (95% confidence interval [CI]: 91.2-100.0) and 977/983 = 99.4% (95% CI: 98.7-99.7), respectively. The sensitivity and specificity of the axial scan to identify fetuses at risk of trisomy 13 or 18 were 16/16 = 100.0% (95% CI: 80.6-100.0) and 1,005/1,007 = 99.8% (95% CI: 99.3-99.9). CONCLUSIONS When the sonogram, a part of combined test screening, is performed by an expert sonologist, axial views can reliably identify fetuses at increased risk of trisomies without an increase in false negative results.
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Affiliation(s)
- Elisa Montaguti
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Josefina Diglio
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Benedetta Petrachi
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Viola Arosio
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marta Fiorentini
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marta Cavalera
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Anita Pellegrino
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Amodeo
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Gianluigi Pilu
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Ornaghi S, Bellante N, Abbamondi A, Maini M, Cesana F, Trabucchi M, Corsi D, Arosio V, Mariani S, Scian A, Colciago E, Lettino M, Vergani P. Cardiac and obstetric outcomes in pregnant women with heart disease: appraisal of the 2018 mWHO classification. Open Heart 2022; 9:openhrt-2021-001947. [PMID: 35332050 PMCID: PMC8948382 DOI: 10.1136/openhrt-2021-001947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/07/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To appraise the application of the 2018 European Society of Cardiology-adapted modified WHO (mWHO) classification to pregnant women with heart disease managed at our maternal-fetal medicine referral centre and to assess whether the lack of a multidisciplinary Pregnancy Heart team has influenced their outcomes. METHODS A retrospective cohort study including all pregnancies with heart disease managed at our centre between June 2011 and December 2020. Cardiac conditions were categorised in five classes according to the mWHO classification. An additional class, named X, was created for conditions not included in this classification. Outcomes were compared among all classes and factors potentially associated to cardiac complications were assessed. RESULTS We identified 162 women with 197 pregnancies, for a prevalence of 0.7%. Thirty-eight (19.3%) gestations were included in class X. Caesarean section was performed in 64.9% pregnancies in class X, a rate similar to that of class II, II-III, and III/IV, and mostly for obstetric indications; in turn, it was more commonly performed for cardiology reasons in class II-III and III/IV. Cardiac complications occurred in 10.7%, with class X and II pregnancies showing the highest number of events (n=30.8% and 34.6%, respectively). Multiple gestation and urgent caesarean section associated with a 5-fold and 6.5-fold increase in complication rates. CONCLUSIONS Even in a maternal-fetal medicine referral centre, the lack of a multidisciplinary team approach to women with heart disease may negatively impact their outcomes.
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Affiliation(s)
- Sara Ornaghi
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy .,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Nicolo' Bellante
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Alessandra Abbamondi
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Marzia Maini
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | | | | | - Davide Corsi
- Department of Cardiology, San Gerardo Hospital, Monza, Italy
| | - Viola Arosio
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Silvana Mariani
- Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Antonietta Scian
- Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | | | | | - Patrizia Vergani
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
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Ornaghi S, Arosio V, Maini M, Corsi D, Achilli F, Vergani P. 603: Outcomes among pregnant women with heart diseases not included in the modified WHO classification. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Piperno A, Sampietro M, D'Alba R, Roffi L, Fargion S, Parma S, Nicoli C, Corbetta N, Pozzi M, Arosio V, Boari G, Fiorelli G. Iron stores, response to alpha-interferon therapy, and effects of iron depletion in chronic hepatitis C. Liver 1996; 16:248-54. [PMID: 8877995 DOI: 10.1111/j.1600-0676.1996.tb00737.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We studied 81 patients with chronic hepatitis C to investigate the relationship between iron and alpha-interferon response. Sixty-one patients (group A) were given alpha-interferon irrespective of iron status, whereas 20 (group B) with iron overload, were iron depleted before alpha-interferon therapy. In group A, 21 patients responded to alpha-interferon and 40 were non-responders. Increased iron indices were significantly more frequent in non-responders than responders. Multivariate analysis showed that among the independent variables evaluated, only gamma-GT and liver iron concentration predicted therapy outcome. After phlebotomy treatment, serum alanine aminotransferase fell significantly both in patients of group B (196 +/- 122 IU/l vs 82 +/- 37 IU/l, p < 10(-6)) and in 12 non-responders of group A (198 +/- 89 IU/l vs 107 +/- 81 IU/l, p < 10(-6)). In 16 iron depleted patients, eight from each group, subsequent treatment with alpha-interferon produced a response in only one patient. These results suggest that increased liver iron is a negative prognostic factor for alpha-interferon response in chronic hepatitis C. Iron depletion had a beneficial effect on serum alanine aminotransferase in all the patients treated, but did not improve the response to alpha-interferon.
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Affiliation(s)
- A Piperno
- Istituto di Scienze Biomediche, Cattedra di Medicina Interna, Ospedale S. Gerardo dei Tintori, Monza e Università degli Studi di Milano, Italy
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Piperno A, D'Alba R, Fargion S, Roffi L, Sampietro M, Parma S, Arosio V, Faré M, Fiorelli G. Liver iron concentration in chronic viral hepatitis: a study of 98 patients. Eur J Gastroenterol Hepatol 1995; 7:1203-8. [PMID: 8789313 DOI: 10.1097/00042737-199512000-00014] [Citation(s) in RCA: 45] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the liver iron concentration (LIC) of Italian patients with chronic hepatitis B and C with those of controls, to evaluate increased LIC frequency in patients and to investigate the influence of the haemochromatosis gene in the development of liver iron overload. DESIGN AND SETTING Prospective controlled trial in two northern Italian hospitals. PATIENTS Ninety-eight patients (61 men and 37 women), 85 with chronic hepatitis C and 13 with chronic hepatitis B, and 38 control individuals (20 men and 18 women). METHODS Atomic absorption spectrophotometry was used to determine LIC; standard lymphocytotoxicity test was used for HLA typing in patients with increased LIC; and family studies were performed for patients with major iron overload. RESULTS Mean LIC was significantly higher in both patient groups than in the controls. Thirty-five patients (36%) had an increased LIC. Twenty-six of these patients had a minor iron overload, whereas nine (9.2%) had a major overload. HLA-A3 antigen was present in five out of the 26 and in four out of the nine patients, respectively. Family studies revealed two siblings HLA-identical to their own proband without evidence of iron overload and chronic hepatitis. CONCLUSION Increased LIC is frequent in Italian patients with chronic hepatitis. The mechanism by which the hepatitis virus promotes liver iron accumulation is not known, but it can favour the development of major iron overload in some cases. HLA-A3 antigen prevalence and family studies suggest that in these cases a single haemochromatosis gene probably coexists with the viral infection. LIC should be determined as part of the screening evaluation in patients with suspected chronic hepatitis B or C.
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Affiliation(s)
- A Piperno
- Divisione di Medicina I, Istituto di Scienze Biomediche S. Gerardo, Monza, Italy
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