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Vinit N, Heidet L, Taghavi K, Salomon LJ, Ville Y, Blanc T. Long-term urological and nephrological outcome after in-utero incision of obstructive duplex-system ureterocele. Ultrasound Obstet Gynecol 2024. [PMID: 38700062 DOI: 10.1002/uog.27673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024]
Affiliation(s)
- N Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants malades Hospital, APHP, Paris, France
- UFR de Médecine Paris Centre, Université Paris Cité, Paris, France
- EA FETUS 7328- PACT, Imagine Institute, Université Paris Cité, Paris, France
| | - L Heidet
- Department of Pediatric Nephrology, Reference Center for Inherited Renal Disease (MARHEA), Necker-Enfants malades Hospital, APHP, Paris, France
- INSERM UMR 1163, Laboratory of Inherited Kidney Diseases, Imagine Institute, Université Paris Cité, Paris, France
| | - K Taghavi
- Department of Pediatrics, Monasch University, Melbourne, Victoria, Australia
- Department of Pediatric Urology, Monash Children's Hospital, Monash University, Melbourne, Victoria, Australia
| | - L J Salomon
- UFR de Médecine Paris Centre, Université Paris Cité, Paris, France
- EA FETUS 7328- PACT, Imagine Institute, Université Paris Cité, Paris, France
- Department of Obstetrics, Fetal Medicine, Surgery and Imaging, Necker-Enfants malades Hospital, APHP, Paris, France
| | - Y Ville
- UFR de Médecine Paris Centre, Université Paris Cité, Paris, France
- EA FETUS 7328- PACT, Imagine Institute, Université Paris Cité, Paris, France
- Department of Obstetrics, Fetal Medicine, Surgery and Imaging, Necker-Enfants malades Hospital, APHP, Paris, France
| | - T Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants malades Hospital, APHP, Paris, France
- UFR de Médecine Paris Centre, Université Paris Cité, Paris, France
- INSERM U1151-CNRS UMR 8253, Université Paris Cité, Paris, France
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Corroenne R, Grevent D, Mahallati H, Millischer AE, Gauchard G, Bussieres L, Kasprian G, Ville Y, Salomon LJ. Quantitative fetal MRI with diffusion tensor imaging in cases with 'short' corpus callosum. Ultrasound Obstet Gynecol 2024; 63:385-391. [PMID: 37676105 DOI: 10.1002/uog.27473] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/11/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES It has been suggested previously that the presence of Probst bundles (PB) in cases with a short corpus callosum (SCC) on diffusion tensor imaging (DTI) may help to differentiate between corpus callosal (CC) dysplasia and a variant of normal CC development. The objectives of this study were to compare DTI parameters between cases of SCC vs normal CC and between cases of SCC with PB (SCC-PB+) vs SCC without PB (SCC-PB-). METHODS This was a retrospective study of patients referred to the Necker Hospital in Paris, France, for magnetic resonance imaging (MRI) evaluation of an apparently isolated SCC detected by sonography between November 2016 and December 2022 (IRB: 00011928). MRI was performed using a 1.5-Tesla Signa system. T2-weighted axial and sagittal sequences of the fetal brain were used to measure the length and thickness of the CC. 16-direction DTI axial brain sequences were performed to identify the presence of PB and to generate quantitative imaging parameters (fractional anisotropy (FA) and apparent diffusion coefficient (ADC)) of the entire CC, genu, body and splenium. Cases in which other associated brain abnormalities were detected on MRI were excluded. Cases were matched for fetal gender and gestational age with controls in a 1:3 ratio. Control cases were normal fetuses included in the LUMIERE on the FETUS trial (NCT04142606) that underwent the same DTI evaluation of the brain. Comparisons between SCC and normal CC cases, and between SCC-PB+ and SCC-PB- cases were performed using ANOVA and adjusted for potential confounders using ANCOVA. RESULTS Twenty-two SCC cases were included and compared with 66 fetuses with a normal CC. In 10/22 (45.5%) cases of SCC, PB were identified. As expected, dimensions of the CC were significantly smaller in SCC compared with normal CC cases (all P < 0.01). In SCC-PB+ vs SCC-PB- cases, FA values were significantly lower in the entire CC (median, 0.21 (range, 0.19-0.24) vs 0.24 (range, 0.22-0.28); P < 0.01), genu (median, 0.21 (range, 0.15-0.29) vs 0.24 (range, 0.17-0.29); P = 0.04), body (median, 0.21 (range, 0.18-0.23) vs 0.23 (range, 0.21-0.27); P = 0.04) and splenium (median, 0.22 (range, 0.16-0.30) vs 0.25 (range, 0.20-0.29); P = 0.03). ADC values were significantly higher in the entire CC, genu and body in SCC-PB+ vs SCC-PB- cases (all P < 0.05). In SCC-PB+ cases, all FA values were significantly lower, and ADC values in the CC body were significantly higher compared with normal CC cases (all P < 0.05). In SCC-PB- cases, there was no significant difference in FA and ADC compared with normal CC cases (all P > 0.05). CONCLUSIONS Fetal DTI evaluation of the CC showed that FA values were significantly lower and ADC values tended to be significantly higher in SCC-PB+ compared with normal CC cases. This may highlight alterations of the white matter microstructure in SCC-PB+. In contrast, isolated SCC-PB- did not demonstrate significant changes in DTI parameters, strengthening the possibility that this is a normal CC variant. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Corroenne
- URP FETUS 7328 and LUMIERE Platform, University of Paris, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - D Grevent
- URP FETUS 7328 and LUMIERE Platform, University of Paris, Paris, France
- Department of Radiology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - H Mahallati
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - A-E Millischer
- Department of Radiology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - G Gauchard
- URP FETUS 7328 and LUMIERE Platform, University of Paris, Paris, France
| | - L Bussieres
- URP FETUS 7328 and LUMIERE Platform, University of Paris, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - G Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Y Ville
- URP FETUS 7328 and LUMIERE Platform, University of Paris, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - L J Salomon
- URP FETUS 7328 and LUMIERE Platform, University of Paris, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
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Corroenne R, Jacquier M, Stirnemann J, Salomon LJ, Ville Y, Chalouhi G. Evaluation of optical positioning ultrasound simulator for assessment of trainee ability in obstetric ultrasound. Ultrasound Obstet Gynecol 2024; 63:115-116. [PMID: 37329498 DOI: 10.1002/uog.26295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Affiliation(s)
- R Corroenne
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Paris, France
| | - M Jacquier
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Paris, France
| | - J Stirnemann
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Paris, France
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Paris, France
| | - Y Ville
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Paris, France
| | - G Chalouhi
- Department of Obstetrics and Fetal Medicine, Necker-Enfants Malades Hospital, Paris, France
- Centre SFFERe, Boulogne-Billancourt, France
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Nkobetchou M, Leruez-Ville M, Guilleminot T, Roux N, Petrilli G, Guimiot F, Saint-Frison MH, Deryabin I, Ville Y, Faure-Bardon V. SARS-CoV-2 infection as cause of in-utero fetal death: regional multicenter cohort study. Ultrasound Obstet Gynecol 2023; 62:867-874. [PMID: 37519281 DOI: 10.1002/uog.27439] [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: 05/02/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Placental infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to placental insufficiency and in-utero fetal death (IUFD). The objective of this study was to confirm and quantify the extent to which fetoplacental infection with SARS-CoV-2 is a cause of fetal death. METHODS This was a multicenter retrospective cohort study of fetal deaths that underwent postmortem examination between January 2020 and January 2022 in three fetal pathology units in Paris, France. All cases of IUFD and termination of pregnancy (TOP) occurring in 31 maternity hospitals in the Paris region undergo detailed placental pathological examination in these units. Databases were searched for cases of IUFD and TOP. Cases with fetal malformation or cytogenetic abnormality were excluded to avoid bias. We included cases of IUFD with a placental or undetermined cause and cases of TOP in the context of severe intrauterine growth restriction (IUGR). Placentas were sent to a single virology unit for reverse-transcription polymerase chain reaction (RT-PCR) testing by a single laboratory technician blinded to the initial postmortem examination report. Our primary endpoint was the proportion of positive placental SARS-CoV-2 RT-PCR tests in the cohort. RESULTS Among 147 722 deliveries occurring over 2 years, 788 postmortem examinations for IUFD and TOP for severe IUGR were recorded, of which 462 (58.6%) were included. A total of 13/462 (2.8%) placentas tested positive for SARS-CoV-2 by RT-PCR. Wild-type virus and alpha and delta variants were identified. All positive cases had histological lesions consistent with placental dysfunction. There was a strong correlation between SARS-CoV-2 placentitis and the presence of chronic intervillositis and/or massive fibrin deposits in the placenta. When both lesion types were present, the specificity and negative predictive value for the diagnosis of placental SARS-CoV-2 infection were 0.99 (95% CI, 0.98-1.00) and 0.96 (95% CI, 0.94-0.98), respectively. CONCLUSIONS At the height of the SARS-CoV-2 pandemic, the cause of more than half of fetal deaths in the Paris area was determined by postmortem analysis to be of placental or undetermined origin. Of these cases, 2.8% were due to placental SARS-CoV-2 infection with a specific pattern of histological involvement. This study highlights the need for SARS-CoV-2 screening in stillbirth assessment. The impact of vaccination coverage remains to be established. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Nkobetchou
- EA 73-28, Paris Cité University, Necker University Hospital, Paris, France
- Maternity Department, Necker University Hospital, Paris, France
| | - M Leruez-Ville
- EA 73-28, Paris Cité University, Necker University Hospital, Paris, France
- Virology Department, Necker University Hospital, Paris, France
| | - T Guilleminot
- EA 73-28, Paris Cité University, Necker University Hospital, Paris, France
- Virology Department, Necker University Hospital, Paris, France
| | - N Roux
- Histopathology Department, Necker University Hospital, Paris, France
| | - G Petrilli
- Histopathology Department, Necker University Hospital, Paris, France
| | - F Guimiot
- Histopathology Department, Robert Debré Hospital, Paris, France
| | | | - I Deryabin
- Histopathology Department, Trousseau Hospital, Paris, France
| | - Y Ville
- EA 73-28, Paris Cité University, Necker University Hospital, Paris, France
- Maternity Department, Necker University Hospital, Paris, France
| | - V Faure-Bardon
- EA 73-28, Paris Cité University, Necker University Hospital, Paris, France
- Maternity Department, Necker University Hospital, Paris, France
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Stirnemann J, Besson R, Debavelaere V, Loge F, Amabile C, Migeon P, Curran MA, Fries N, Smith E, Ostermayer E, Bradley KE, Armstrong L, Trychon K, Sheehan K, Flinn M, Rodriguez DA, Spiliopoulos M, Romero V, Jones DA, Allbert JR, Ghulmiyyah L, Spaggiari E, Ville Y. Abstracts of the 33rd World Congress on Ultrasound in Obstetrics and Gynecology, 16-19 October 2023, Seoul, South Korea. Ultrasound Obstet Gynecol 2023; 62 Suppl 1:1-316. [PMID: 37779444 DOI: 10.1002/uog.26321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 10/03/2023]
Affiliation(s)
- J Stirnemann
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
| | | | | | | | | | | | - M A Curran
- Division of Maternal-Fetal Medicine, Pomona Valley Hospital Medical Center, Pomona, CA, USA
| | - N Fries
- Collège Français d'Echographie Fetale, Paris, France
| | - E Smith
- BovenMaas, Rotterdam, Netherlands
| | - E Ostermayer
- Pränatalmedizin 5-Seen-Land, Seefeld-Hechendorf, Germany
| | - K E Bradley
- Private Practice, Westlake, Village, CA, USA
| | - L Armstrong
- UNC Southeastern Maternal-Fetal Medicine, Lumberton, NC, USA
| | - K Trychon
- Center for Fetal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - K Sheehan
- Obstetrics and Gynecology, Private Practice, Ridgewood, NJ, USA
| | - M Flinn
- Diagnostic Center of Arizona, Chandler, AZ, USA
| | | | - M Spiliopoulos
- Prenatal Diagnostic and Ultrasound Center, Pediatrix Medical Group, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - V Romero
- Maternal-Fetal Medicine, Corewell Health-West, Grand Rapids, MI, USA
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - D A Jones
- Perinatal Specialists of the Palm Beaches, West Palm Beach, FL, USA
| | - J R Allbert
- Maternal-Fetal Medicine Associates, Charlotte, NC, USA
| | - L Ghulmiyyah
- Prenatal Diagnostic and Ultrasound Center, Pediatrix Medical Group, Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - E Spaggiari
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
| | - Y Ville
- Obstetrics, Paris Descartes University, Necker-Enfants Malades Hospital, Paris, France
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Stirnemann JJ, Besson R, Spaggiari E, Rojo S, Loge F, Peyro-Saint-Paul H, Allassonniere S, Le Pennec E, Hutchinson C, Sebire N, Ville Y. Development and clinical validation of real-time artificial intelligence diagnostic companion for fetal ultrasound examination. Ultrasound Obstet Gynecol 2023; 62:353-360. [PMID: 37161503 DOI: 10.1002/uog.26242] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/13/2023] [Accepted: 03/20/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Prenatal diagnosis of a rare disease on ultrasound relies on a physician's ability to remember an intractable amount of knowledge. We developed a real-time decision support system (DSS) that suggests, at each step of the examination, the next phenotypic feature to assess, optimizing the diagnostic pathway to the smallest number of possible diagnoses. The objective of this study was to evaluate the performance of this real-time DSS using clinical data. METHODS This validation study was conducted on a database of 549 perinatal phenotypes collected from two referral centers (one in France and one in the UK). Inclusion criteria were: at least one anomaly was visible on fetal ultrasound after 11 weeks' gestation; the anomaly was confirmed postnatally; an associated rare disease was confirmed or ruled out based on postnatal/postmortem investigation, including physical examination, genetic testing and imaging; and, when confirmed, the syndrome was known by the DSS software. The cases were assessed retrospectively by the software, using either the full phenotype as a single input, or a stepwise input of phenotypic features, as prompted by the software, mimicking its use in a real-life clinical setting. Adjudication of discordant cases, in which there was disagreement between the DSS output and the postnatally confirmed ('ascertained') diagnosis, was performed by a panel of external experts. The proportion of ascertained diagnoses within the software's top-10 differential diagnoses output was evaluated, as well as the sensitivity and specificity of the software to select correctly as its best guess a syndromic or isolated condition. RESULTS The dataset covered 110/408 (27%) diagnoses within the software's database, yielding a cumulative prevalence of 83%. For syndromic cases, the ascertained diagnosis was within the top-10 list in 93% and 83% of cases using the full-phenotype and stepwise input, respectively, after adjudication. The full-phenotype and stepwise approaches were associated, respectively, with a specificity of 94% and 96% and a sensitivity of 99% and 84%. The stepwise approach required an average of 13 queries to reach the final set of diagnoses. CONCLUSIONS The DSS showed high performance when applied to real-world data. This validation study suggests that such software can improve perinatal care, efficiently providing complex and otherwise overlooked knowledge to care-providers involved in ultrasound-based prenatal diagnosis. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J J Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- EA7328 Université de Paris, IMAGINE Institute, Paris, France
| | | | - E Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- EA7328 Université de Paris, IMAGINE Institute, Paris, France
- Department of Histology-Embryology and Cytogenetics, Unit of Embryo and Fetal Pathology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | | | | | | | - S Allassonniere
- School of Medicine, Université de Paris, INRIA EPI HEKA, INSERM UMR 1138, Sorbonne Université, Paris, France
- Center for Applied Mathematics, Ecole Polytechnique, Institut Polytechnique de Paris, Paris, France
| | - E Le Pennec
- Center for Applied Mathematics, Ecole Polytechnique, Institut Polytechnique de Paris, Paris, France
- Xpop, INRIA Saclay Center, Paris, France
| | - C Hutchinson
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - N Sebire
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Y Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- EA7328 Université de Paris, IMAGINE Institute, Paris, France
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Corroenne R, Grevent D, Mahallati H, Gauchard G, Bussieres L, Ville Y, Salomon LJ. Diffusion tensor imaging of fetal spinal cord: feasibility and gestational-age-related changes. Ultrasound Obstet Gynecol 2023; 62:241-247. [PMID: 36971038 DOI: 10.1002/uog.26208] [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: 11/16/2022] [Revised: 02/27/2023] [Accepted: 03/16/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Diffusion tensor imaging (DTI) of the fetal brain is a relatively new technique that allows evaluation of white matter tracts of the central nervous system throughout pregnancy, as well as in certain pathological conditions. The objectives of this study were to evaluate the feasibility of DTI of the spinal cord in utero and to examine gestational-age (GA)-related changes in DTI parameters during pregnancy. METHODS This was a prospective study conducted between December 2021 and June 2022 in the LUMIERE Platform, Necker-Enfants Malades Hospital, Paris, France, as part of the LUMIERE SUR LE FETUS trial. Women with a pregnancy between 18 and 36 weeks of gestation without fetal or maternal abnormality were eligible for inclusion. Sagittal diffusion-weighted scans of the fetal spine were acquired, without sedation, using a 1.5-Tesla magnetic resonance imaging scanner. The imaging parameters were as follows: 15 non-collinear direction diffusion-weighted magnetic-pulsed gradients with a b-value 700 s/mm2 and one B0 image without diffusion-weighting; slice thickness, 3 mm; field of view (FOV), 36 mm; phase FOV, 1.00; voxel size, 4.5 × 2.8 × 3 mm3 ; number of slices, 7-10; repetition time, 2800 ms; echo time, minimum; and total acquisition time, 2.3 min. DTI parameters, including fractional anisotropy (FA) and apparent diffusion coefficient (ADC), were extracted at the cervical, upper thoracic, lower thoracic and lumbar levels of the spinal cord. Cases with motion degradation and those with aberrant reconstruction of the spinal cord on tractography were excluded. Pearson's correlation analysis was performed to evaluate GA-related changes of DTI parameters during pregnancy. RESULTS During the study period, 42 pregnant women were included at a median GA of 29.3 (range, 22.0-35.7) weeks. Five (11.9%) patients were not included in the analysis because of fetal movement. Two (4.8%) patients with aberrant tractography reconstruction were also excluded from analysis. Acquisition of DTI parameters was feasible in all remaining cases (35/35). Increasing GA correlated with increasing FA averaged over the entire fetal spinal cord (r, 0.37; P < 0.01), as well as at the individual cervical (r, 0.519; P < 0.01), upper thoracic (r, 0.468; P < 0.01), lower thoracic (r, 0.425; P = 0.02) and lumbar (r, 0.427; P = 0.02) levels. There was no correlation between GA and ADC averaged over the entire spinal cord (r, 0.01; P = 0.99) or at the individual cervical (r, -0.109; P = 0.56), upper thoracic (r, -0.226; P = 0.22), lower thoracic (r, -0.052; P = 0.78) or lumbar (r, -0.11; P = 0.95) levels. CONCLUSIONS This study shows that DTI of the spinal cord is feasible in normal fetuses in typical clinical practice and allows extraction of DTI parameters of the spinal cord. There is a significant GA-related change in FA in the fetal spinal cord during pregnancy, which may result from decreasing water content as observed during myelination of fiber tracts occurring in utero. This study may serve as a basis for further investigation of DTI in the fetus, including research into its potential in pathological conditions that impact spinal cord development. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Corroenne
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - D Grevent
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
- Department of Radiology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - H Mahallati
- Department of Radiology, University of Calgary, Alberta, Canada
| | - G Gauchard
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
| | - L Bussieres
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Y Ville
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - L J Salomon
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, AP-HP, Paris, France
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Corroenne R, Grevent D, Kasprian G, Stirnemann J, Ville Y, Mahallati H, Salomon LJ. Corpus callosal reference ranges: systematic review of methodology of biometric chart construction and measurements obtained. Ultrasound Obstet Gynecol 2023; 62:175-184. [PMID: 36864530 DOI: 10.1002/uog.26187] [Citation(s) in RCA: 2] [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: 12/21/2022] [Revised: 01/28/2023] [Accepted: 02/10/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Adequate reference ranges of size of the corpus callosum (CC) are necessary to improve characterization of CC abnormalities and parental counseling. The objective of this study was to evaluate the methodology used in studies developing references charts for CC biometry. METHODS We conducted a systematic review of studies on fetal CC biometry using a set of predefined quality criteria of study design, statistical analysis and reporting methods. We included observational studies whose primary aim was to create ultrasound or magnetic resonance imaging charts for CC size in a normal population of fetuses. Studies were scored against a predefined set of independently agreed methodological criteria, and an overall quality score was given for each study. RESULTS Twelve studies met the inclusion criteria. Quality scores ranged between 17.4% and 95.7%. The greatest potential for bias was noted for the following items: sample selection and sample-size calculation, as only 17% of the studies were population-based and had consecutive or random recruitment of patients and with a justification of the sample size; number of measurements obtained for CC biometry, as only 17% of the studies performed more than one measurement per fetus and per scan; and description of characteristics of the study population, as only 8% of the studies clearly reported a minimum dataset of demographic characteristics. CONCLUSIONS Our review demonstrates substantial heterogeneity in methods and final biometric values of the fetal CC across the evaluated studies. The use of uniform methodology of the highest quality is essential in order to define a 'short' CC and provide appropriate parental counseling. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Corroenne
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
| | - D Grevent
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
- Department of Radiology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - G Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - J Stirnemann
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
| | - Y Ville
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
| | - H Mahallati
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - L J Salomon
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA Fetus 7328 and LUMIERE Platform, University of Paris, Paris, France
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Codaccioni C, Arthuis C, Deloison B, Bault JP, Henry C, Mahallati H, Bussières L, Ville Y, Grévent D, Salomon LJ. Offline ultrasound-ultrasound fusion imaging for assessment of normal fetal brain development: the way forward? Ultrasound Obstet Gynecol 2023; 61:549-551. [PMID: 36565442 DOI: 10.1002/uog.26149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/27/2022] [Accepted: 12/16/2022] [Indexed: 05/04/2023]
Affiliation(s)
- C Codaccioni
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
| | - C Arthuis
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, CHU Nantes, Nantes, France
| | - B Deloison
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
| | - J-P Bault
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
| | - C Henry
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
| | - H Mahallati
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - L Bussières
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Y Ville
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - D Grévent
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
- Service de Radiologie, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - L J Salomon
- EA Fetus 7328 and LUMIERE Platform, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
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Chatzakis C, Sotiriadis A, Dinas K, Ville Y. Neonatal and long-term outcomes of infants with congenital cytomegalovirus infection and negative amniocentesis: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2023; 61:158-167. [PMID: 36412976 PMCID: PMC10107880 DOI: 10.1002/uog.26128] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Cytomegalovirus (CMV) DNA is detectable in the amniotic fluid collected by amniocentesis in cases in which the fetus has been infected. However, cases of congenital neonatal CMV infection with a negative amniocentesis result have also been reported in the literature. The aim of the present study was to compare pregnancies with a negative amniocentesis result to those with a positive amniocentesis result in terms of incidence of fetal insult and long-term sequelae. METHODS Observational studies that included pregnant women with CMV infection who underwent amniocentesis and that reported their results together with neonatal and/or long-term outcomes of the offspring were included. The risk of bias in included studies was assessed using the Newcastle-Ottawa Scale. The rate of severe symptoms at birth, defined as neurological symptoms or multiorgan involvement at birth, and the rate of severe sensorineural hearing loss (SNHL) and/or neurodevelopmental impairment at follow-up were the main outcomes of the study. The secondary outcome was the rate of pregnancy termination due to the presence of CMV-associated central nervous system (CNS) findings or multiorgan involvement on ultrasound/magnetic resonance imaging (MRI). RESULTS Seven studies were included in the systematic review and meta-analysis. The pooled false-negative rate of amniocentesis was 8.0% (95% CI, 5.0-13.0%). The pooled rate of severe symptoms at birth was 0.0% (95% CI, 0.0-1.0%; I2 = 0%) in fetuses with a negative amniocentesis result and 22.0% (95% CI, 11.0-38.0%; I2 = 75%) in those with a positive amniocentesis result. The pooled odds ratio (OR) was 0.03 (95% CI, 0.01-0.10; I2 = 0%). The pooled rate of severe SNHL and/or neurodevelopmental impairment at follow-up in fetuses with a negative amniocentesis result was 0.0% (95% CI, 0.0-1.0%; I2 = 0%) and, in those with a positive amniocentesis result, it was 14.0% (95% CI, 7.0-26.0%; I2 = 64%). The pooled OR was 0.04 (95% CI, 0.01-0.14; I2 = 0%). The pooled rate of pregnancy termination due to the presence of CMV-associated CNS findings or multiorgan involvement on ultrasound/MRI was 0.0% (95% CI, 0.0-2.0%; I2 = 0%) in fetuses with a negative amniocentesis result and 20.0% (95% CI, 10.0-36.0%; I2 = 82%) in those with a positive amniocentesis result. The pooled OR was 0.03 (95% CI, 0.01-0.08; I2 = 0%). A subgroup analysis including only pregnancies with primary CMV infection and a sensitivity analysis including only prospective studies were carried out, showing very similar results to those of the main analysis. CONCLUSION A negative amniocentesis result in pregnant women with CMV infection ensures lack of fetal insult and long-term sequelae to the child, even if transmission has occurred. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C. Chatzakis
- Second Department of Obstetrics and Gynaecology, Faculty of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - A. Sotiriadis
- Second Department of Obstetrics and Gynaecology, Faculty of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - K. Dinas
- Second Department of Obstetrics and Gynaecology, Faculty of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Y. Ville
- EA Fetus, Paris Descartes UniversityUniversity of ParisParisFrance
- Department of Obstetrics, Fetal Medicine and SurgeryNecker–Enfants Malades Hospital, AP–HPParisFrance
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11
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Corroenne R, Arthuis C, Kasprian G, Mahallati H, Ville Y, Millischer Bellaiche AE, Henry C, Grevent D, Salomon LJ. Diffusion tensor imaging of fetal brain: principles, potential and limitations of promising technique. Ultrasound Obstet Gynecol 2022; 60:470-476. [PMID: 35561129 DOI: 10.1002/uog.24935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/24/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Human brain development is a complex process that begins in the third week of gestation. During early development, the fetal brain undergoes dynamic morphological changes. These changes result from events such as neurogenesis, neuronal migration, synapse formation, axonal growth and myelination. Disruption of any of these processes is thought to be responsible for a wide array of different pathologies. Recent advances in magnetic resonance imaging, especially diffusion-weighted imaging and diffusion tensor imaging (DTI), have enabled characterization and evaluation of brain development in utero. In this review, aimed at practitioners involved in fetal medicine and high-risk pregnancies, we provide a comprehensive overview of fetal DTI studies focusing on characterization of early normal brain development as well as evaluation of brain pathology in utero. We also discuss the reliability and limitations of fetal brain DTI. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Corroenne
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA FETUS 7328 and LUMIERE Platform, University of Paris, Paris, France
| | - C Arthuis
- EA FETUS 7328 and LUMIERE Platform, University of Paris, Paris, France
- Department of Obstetrics, University Hospital of Nantes, Nantes, France
| | - G Kasprian
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - H Mahallati
- Department of Radiology, University of Calgary, Calgary, Canada
| | - Y Ville
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
| | | | - C Henry
- EA FETUS 7328 and LUMIERE Platform, University of Paris, Paris, France
| | - D Grevent
- EA FETUS 7328 and LUMIERE Platform, University of Paris, Paris, France
- Department of Radiology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - L J Salomon
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA FETUS 7328 and LUMIERE Platform, University of Paris, Paris, France
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12
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Gottardi E, Renaudin B, Ville Y. [Interruption of pregnancy between 12 and 16 weeks of gestation: Complications depending on term and method]. Gynecol Obstet Fertil Senol 2022; 50:519-526. [PMID: 35595063 DOI: 10.1016/j.gofs.2022.05.001] [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: 12/19/2021] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Analyze the complication rate of pregnancy termination between 12 and 16 weeks of gestation, depending on the method and the exact term. MATERIAL AND METHODS Retrospective study focuses on patients who were going through a pregnancy termination between January 2015 and December 2020 at the Necker Universitary hospital in Paris. Two methods were applied: surgical abortion or medical evacuation. We compared 4 groups of patients depending on methods and term (12-14 or 14-16 weeks of gestation). The main complications such as hemorrhage, infection, need for surgery were collected. RESULTS 414 patients were included. Blood loss and hemorrhage rate>500cc were higher for surgical abortion (3.5 vs 55% P<0.001), but the medical evacuation lead to an important rate of secondary aspiration for trophoblastic retention (14.7% vs 1.5% P<0.001). We didn't observe any difference regarding the complication rate for medical evacuation depending on the term. However, in case of surgical abortion the increase of term from 12-14 to 14-16 weeks of gestation leads to a tiny increment of the transfusion rate (0.6% vs 4.4% P=0.04), even if the hemorrhage rate >500cc didn't significantly differ (50,3 vs 57,9% P=0,2). CONCLUSION Surgical abortion between 12 and 16 weeks of gestation exposed the patients to an increased hemorrhagic risk, while the medical evacuation required more secondary aspiration for trophoblastic retention. The term of the abortion didn't affect the complication rate, beside a tiny increase in transfusion rate for surgical abortion.
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Affiliation(s)
- E Gottardi
- Service de Gynécologie Obstétrique de l'hôpital Necker, 149, rue de Sèvre, 75015 Paris, France.
| | - B Renaudin
- Service de Gynécologie Obstétrique de l'hôpital Necker, 149, rue de Sèvre, 75015 Paris, France
| | - Y Ville
- Service de Gynécologie Obstétrique de l'hôpital Necker, 149, rue de Sèvre, 75015 Paris, France
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13
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Duy Anh N, Duy An N, Huyen Thuong PT, Thu Ha NT, Sim NT, Sy Hung H, Manh Tri N, Duc Lam N, Tuan Dat D, Ville Y, Manh Ha N, Minh Duc N. The Efficacy of Fetoscopic Laser Surgery in Twin-Twin Transfusion Syndrome: A Preliminary Vietnamese Study. Clin Ter 2022; 173:265-273. [PMID: 35612342 DOI: 10.7417/ct.2022.2430] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Twin-twin transfusion syndrome (TTTS) is a severe prenatal complication of monochorionic diamniotic twins (MCDA). If left untreated, TTTS is associated with a high risk of neonatal death and neurological complications. Various treatment methods for TTTS have been proposed, but fetoscopic laser surgery (FLS) is currently the primary treatment for TTTS in global fetal medicine centers. The objective of this study was to evaluate the outcome of TTTS following FLS treatment at Hanoi Obstetrics and Gynecology Hospital (HOGH), a new fetal medicine center in Vietnam. METHODS A prospective study of a series of 33 consecutive TTTS cases prior to 26 weeks of gestation subjected to FLS at HOGH in Vie-tnam between September 2019 to July 2021. Neonates were monitored for at least six months after birth. RESULTS The survival rate of at least one fetus reached 84.85%. No short-term neurological complications have been reported upon follow-up of the newborn up to six months after birth. There were three stillbirth cases (9.09%), one case of preterm ruptured membra-nes (PROM) (3.03%) after seven days of surgery and three cases of recurrent TTTS after surgery using the Solomon technique (25%). No maternal complications were observed. The mean gestational age at birth was 33.76 ± 4.52 weeks, with a mean interval of 12.24 ± 6.67 weeks between intervention and delivery. Nine cases (30%) were born prematurely before 32 weeks. Additionally, 60% of recipients and nearly 90% of donors weighed less than 2500 grams. CONCLUSIONS FLS leads to high survival rates for fetuses with TTTS. FLS seems to be an effective therapeutic option for TTTS before 26 weeks of gestation.
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Affiliation(s)
- N Duy Anh
- Department of Fetal Intervention, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - N Duy An
- Department of Obstetrics and Gynecology, Hanoi Medical University, Hanoi, Vietnam
| | - P T Huyen Thuong
- Department of Fetal Intervention, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - N T Thu Ha
- Department of Assisted Reproduction, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - N T Sim
- Department of Fetal Intervention, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - H Sy Hung
- Department of Obstetrics and Gynecology, Hanoi Medical University, Hanoi, Vietnam
| | - N Manh Tri
- Department of Prenatal diagnostic and Newborn screening, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - N Duc Lam
- Department of Obstetrics and Gynecology, Hanoi Medical University, Hanoi, Vietnam
| | - D Tuan Dat
- Department of Obstetrics and Gynecology, Hanoi Medical University, Hanoi, Vietnam
| | - Y Ville
- Department of Obstetrics and Fetal Medicine at Necker-Enfants-Malades Hospital at the Paris Descartes Universi-ty, Paris, French
| | - N Manh Ha
- Department of Histology and Embryology, Hanoi Medical University, Hanoi, Vietnam
| | - N Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Vinit N, Bessières B, Spaggiari E, Heidet L, Gubler MC, Dreux S, Attie-Bitach T, Blanc T, Ville Y. Pathological and sonographic review of early isolated severe lower urinary tract obstruction and implications for prenatal treatment. Ultrasound Obstet Gynecol 2022; 59:513-521. [PMID: 34182598 DOI: 10.1002/uog.23718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/05/2021] [Accepted: 06/14/2021] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To identify favorable renal histology in fetuses with early severe lower urinary tract obstruction (LUTO) and determine the best timing and selection criteria for prenatal surgery. METHODS This multicenter, retrospective study included male fetuses with severe LUTO which died before 24 weeks of gestation during the period January 2000 to December 2018. Age-matched controls were used as reference standard for renal histology. Prenatal ultrasound features and fetal serum and/or urine β2microglobulin level were retrieved and kidney histology slides (hematein-eosin-safran and α-smooth-muscle-actin (αSMA) immunostaining) were prepared and reviewed. αSMA-positive staining of the blastema is due to its aberrant differentiation into myofibroblastic cells. Cases were sorted into histopathologic groups (favorable or unfavorable) according to the blastema's morphology and αSMA labeling and the data of these groups were compared. RESULTS Included in the study were 74 fetuses with a median gestational age at outcome of 17 + 6 (range, 13 + 0 to 23 + 5) weeks. Parenchymal organization was preserved in 48% of the kidneys. A blastema was present in 90% of the kidneys, but it was morphologically normal in only 9% and αSMA-negative in only 1% of them. Most (82%) fetuses had an unfavorable prognosis, and 36% of fetuses died ≤ 18 weeks and had severe renal lesions detected on histology (early unfavorable prognosis). A favorable renal prognosis was associated with an earlier gestational age (P = 0.001). Fetuses with LUTO had a significantly lower number of mature glomeruli (P < 0.001) compared with controls. However, there was no significant difference in the number of glomeruli generations between the early-unfavorable-prognosis group (≤ 18 weeks) and the group with a favorable prognosis (P = 0.19). A comparison of prenatal ultrasound features and biochemical markers between groups could not identify any prenatal selection criteria. CONCLUSIONS Before 18 weeks, around 30% of fetuses with severe LUTO still have potential for kidney development. Identification of these cases would enable them to be targeted for prenatal therapy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
| | - B Bessières
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
- Department of Histology, Embryology and Cytogenetics, Fetal Pathology Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - E Spaggiari
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
- Department of Histology, Embryology and Cytogenetics, Fetal Pathology Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - L Heidet
- Department of Pediatric Nephrology, Reference Center for Inherited Renal Disease (MARHEA), Necker-Enfants Malades Hospital, APHP, Paris, France
- INSERM UMR 1163, Laboratory of Inherited Kidney Diseases, Imagine Institute, University of Paris, Paris, France
| | - M-C Gubler
- INSERM UMR 1163, Laboratory of Inherited Kidney Diseases, Imagine Institute, University of Paris, Paris, France
| | - S Dreux
- Department of Biochemistry-Hormonology, Robert Debré Hospital, APHP, Paris, France
| | - T Attie-Bitach
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
- Department of Histology, Embryology and Cytogenetics, Fetal Pathology Unit, Necker-Enfants Malades Hospital, APHP, Paris, France
- Université Paris Cité, Paris, France
| | - T Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Université Paris Cité, Paris, France
- INSERM U1151-CNRS UMR 8253, Paris University, Paris, France
| | - Y Ville
- EA FETUS 7328-PACT, Imagine Institute, Paris University, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- Université Paris Cité, Paris, France
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15
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Di Pasquo E, Kuleva M, Arthuis C, Morganelli G, Ormitti F, Millischer AE, Grevent D, Ville Y, Ghi T, Salomon LJ. Prenatal diagnosis and outcome of fetuses with isolated agenesis of septum pellucidum: cohort study and meta-analysis. Ultrasound Obstet Gynecol 2022; 59:153-161. [PMID: 34396620 DOI: 10.1002/uog.23759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/21/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the postnatal outcome of children with a prenatal diagnosis of apparently isolated agenesis of the septum pellucidum (ASP). METHODS A retrospective cohort study of cases of prenatally diagnosed ASP followed in two tertiary centers and a meta-analysis combining data from the cohort study with data from published studies identified in a systematic review were carried out. Only cases with apparently isolated ASP on antenatal ultrasound and/or magnetic resonance imaging and with available postnatal follow-up data were considered eligible for inclusion. The following outcomes were analyzed: incidence of chromosomal anomalies, agreement between antenatal and postnatal findings, overall incidence of septo-optic dysplasia (SOD) and incidence of major neurological disability (motor, language, coordination or behavioral disorder or epilepsy) in non-SOD children. The incidence of SOD in infants with apparently normal optic pathways on antenatal imaging was also evaluated. RESULTS Fifteen cases of isolated ASP, with median postnatal follow-up of 36 months (range, 12-60 months), were selected from the two centers. Six previously published studies met the inclusion criteria for the systematic review and a total of 78 cases were eligible for the analysis, including the 15 cases from our series. Genetic tests were carried out antenatally in 30 fetuses, of which two had an abnormal result (pooled proportion, 9.0% (95% CI, 1.8-20.7%); I2 = 0%). Additional or discordant imaging findings were noted postnatally in 9/70 (pooled proportion, 13.7% (95% CI, 3.5-29.0%); I2 = 63.9%) cases. Of all 78 neonates with available follow-up, SOD was diagnosed postnatally in 14 (pooled proportion, 19.4% (95% CI, 8.6-33.2%); I2 = 51.2%). In 60 cases, the optic pathways were considered to be normal on antenatal imaging, and six of these (pooled proportion, 9.1% (95% CI, 1.1-24.0%); I2 = 62.0%) were diagnosed postnatally with SOD. Of the 46 infants with available neurological follow-up who were not affected by SOD, a major neurological disability was diagnosed in three (pooled proportion, 6.5% (95% CI, 0.5-18.6%); I2 = 40.1%). CONCLUSIONS In the vast majority of cases with a prenatal diagnosis of apparently isolated ASP, the prognosis is favorable. However, an additional anomaly is detected after birth in about 14% of cases and has a negative impact on clinical outcome. Detailed antenatal assessment of the brain and optic pathways is strongly recommended in order to identify the presence of associated anomalies. Antenatal visualization of apparently normal optic pathways does not rule out SOD. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Di Pasquo
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
| | - M Kuleva
- Department of Obstetrics, Hôpital Intercommunal de Montreuil, Montreuil, France
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - C Arthuis
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - G Morganelli
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - F Ormitti
- Department of Radiology, University Hospital of Parma, Parma, Italy
| | - A-E Millischer
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, APHP, Université Paris Descartes, Paris, France
| | - D Grevent
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, APHP, Université Paris Descartes, Paris, France
| | - Y Ville
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - T Ghi
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
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16
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Ville Y. Long-term indomethacin therapy after laser surgery for TTTS. Worth the effort? BJOG 2021; 129:607. [PMID: 34780088 DOI: 10.1111/1471-0528.17015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Y Ville
- Fetal Medicine, Université Paris Descartes, Paris, France
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17
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de Barbeyrac C, Roth P, Noël C, Anselem O, Gaudin A, Roumegoux C, Azcona B, Castel C, Noret M, Letamendia E, Stirnemann J, Ville Y, Lapillonne A, Viallard ML, Kermorvant-Duchemin E. The role of perinatal palliative care following prenatal diagnosis of major, incurable fetal anomalies: a multicentre prospective cohort study. BJOG 2021; 129:752-759. [PMID: 34665920 DOI: 10.1111/1471-0528.16976] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe prenatal decision-making processes and birth plans in pregnancies amenable to planning perinatal palliative care. DESIGN Multicentre prospective observational study. SETTING Nine Multidisciplinary Centres for Prenatal Diagnosis of the Paris-Ile-de-France region. POPULATION All cases of major and incurable fetal anomaly eligible for TOP where limitation of life-sustaining treatments for the neonate was discussed in the prenatal period between 2015 and 2016. METHODS Cases of congenital defects amenable to perinatal palliative care were prospectively included in each centre. Prenatal diagnosis, decision-making process, type of birth plan, birth characteristics, pregnancy and neonatal outcome were collected prospectively and anonymously. MAIN OUTCOME MEASURE Final decision reached following discussions in the antenatal period. RESULTS We identified 736 continuing pregnancies with a diagnosis of a severe fetal condition eligible for TOP. Perinatal palliative care was considered in 102/736 (13.9%) pregnancies (106 infants); discussions were multidisciplinary in 99/106 (93.4%) cases. Prenatal birth plans involved life-sustaining treatment limitation and comfort care in 73/736 (9.9%) of the pregnancies. The main reason for planning palliative care at birth was short-term inevitable death in 39 cases (53.4%). In all, 76/106 (71.7%) infants were born alive, and 18/106 (17%) infants were alive at last follow-up, including four with a perinatal palliative care birth plan. CONCLUSIONS Only a small proportion of severe and incurable fetal disorders were potentially amenable to limitation of life-sustaining interventions. Perinatal palliative care may not be considered a universal alternative to termination of pregnancy. TWEETABLE ABSTRACT Perinatal palliative care is planned in 10% of continuing pregnancies with a major and incurable fetal condition eligible for TOP.
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Affiliation(s)
- C de Barbeyrac
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - P Roth
- Department Obstetrics and Fetal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, EA7328, Paris, France
| | - C Noël
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - O Anselem
- Department of Department Obstetrics and Fetal Medicine, AP-HP, Hôpital Cochin - Port-Royal, Paris, France
| | - A Gaudin
- Department of Neonatal Medicine, AP-HP, Hôpital Robert-Debré, Paris, France
| | - C Roumegoux
- Department of Neonatal Medicine, AP-HP, Hôpital Jean-Verdier, Bondy, France
| | - B Azcona
- Department of Neonatal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - C Castel
- Department of Neonatal Medicine, Centre Hospitalier Intercommunal de Poissy-Saint-Quentin, Poissy, France
| | - M Noret
- Department of Obstetrics, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - E Letamendia
- Maternity Unit, AP-HP, Hôpital Antoine Béclère, Clamart, France
| | - J Stirnemann
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - Y Ville
- Department Obstetrics and Fetal Medicine, Centre Hospitalier René Dubos, Pontoise, France
| | - A Lapillonne
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - M-L Viallard
- Palliative Medicine Unit, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - E Kermorvant-Duchemin
- Department of Neonatal Medicine, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
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18
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Seror V, Leruez-Ville M, Ӧzek A, Ville Y. Leaning towards Cytomegalovirus serological screening in pregnancy to prevent congenital infection: a cost-effectiveness perspective. BJOG 2021; 129:301-312. [PMID: 34651405 DOI: 10.1111/1471-0528.16966] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/27/2021] [Revised: 09/24/2021] [Accepted: 10/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the cost-effectiveness of prenatal detection of congenital cytomegalovirus (cCMV) following maternal primary infection in the first trimester within standard pregnancy follow-up or involving population-based screening (serological testing at 7 and 12 weeks of gestation), with or without secondary prevention (valaciclovir) in maternal CMV primary infection. DESIGN Cost-effectiveness study from the perspective of the French national health insurance system. SETTING Cost-effectiveness based on previously published probability estimates and associated plausible ranges hypothetical population of 1,000,000 pregnant women. POPULATION Hypothetical population of 1,000,000 pregnant women. METHODS Cost-effectiveness of detecting fetal cCMV in terms of the total direct medical costs involved and associated expected outcomes. MAIN OUTCOME MEASURES Detection rates and clinical outcomes at birth. RESULTS Moving to a population-based approach for targeting fetal CMV infections would generate high monetary and organizational costs while increasing detection rates from 15% to 94%. This resource allocation would help implementing horizontal equity according to which individuals with similar medical needs should be treated equally. Secondary prevention with valaciclovir had a significant effect on maternal-fetal CMV transmission and clinical outcomes in newborns, with a 58% decrease of severely infected newborns for a 3.5% additional total costs. Accounting for women decision-making (amniocentesis uptake and termination of pregnancy in severe cases) did not impact the cost-effectiveness results. CONCLUSIONS These findings could fuel thinking on the opportunity of developing clinical guidelines to rule identification of cCMV infection and administration of in-utero treatment. These findings could fuel the development of clinical guidelines on the identification of congenital CMV infection and the administration of treatment in utero. TWEETABLE ABSTRACT CMV serological screening followed by valaciclovir prevention may prevent 58% to 71% of severe cCMV cases for 38 € per pregnancy.
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Affiliation(s)
- V Seror
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,Institut Hospitalier Universitaire (IHU) - Méditerranée Infection, Marseille, France
| | - M Leruez-Ville
- Virology Laboratory, Hôpital Necker-Enfants Malades, AP-HP, National Reference Centre for Herpesviridae, Paris, France.,EA7328, Institut Imagine, Université de Paris, Paris, France
| | - A Ӧzek
- EA7328, Institut Imagine, Université de Paris, Paris, France.,Maternity, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Y Ville
- EA7328, Institut Imagine, Université de Paris, Paris, France.,Maternity, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
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19
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Faure-Bardon V, Fourgeaud J, Stirnemann J, Leruez-Ville M, Ville Y. Secondary prevention of congenital cytomegalovirus infection with valacyclovir following maternal primary infection in early pregnancy. Ultrasound Obstet Gynecol 2021; 58:576-581. [PMID: 33998084 DOI: 10.1002/uog.23685] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 03/01/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Cytomegalovirus (CMV) maternal primary infection (MPI) in early pregnancy is the main risk factor for congenital CMV (cCMV) infection with long-term sequelae. Our aim was to evaluate, in a single center offering CMV serology screening at 11-14 gestational weeks, secondary prevention of cCMV by administration of high-dosage maternal oral valacyclovir (VACV) in the first trimester of pregnancy. METHODS This was a case-control study in a longitudinal cohort of pregnancies with CMV-MPI diagnosed prior to 14 weeks of gestation by serology screening (immunoglobulin (Ig) M and IgG measurement and IgG avidity) between 2009 and 2020. From October 2019 onwards, all women presenting at our center with MPI before 14 weeks' gestation were offered treatment with high-dosage oral VACV (8 g/day, 4 g twice/day). We used propensity score matching to compare fetal infection rates in cases treated with maternal oral VACV (8 g/day) with those in untreated controls. Fetal infection was assessed following amniocentesis at 17-22 weeks of gestation, by polymerase chain reaction (PCR) analysis of amniotic fluid for viral DNA. RESULTS Of 310 cases of CMV-MPI identified, 269 underwent amniocentesis for PCR. Of these, 66 were offered, and 65 accepted, treatment with VACV. From the remaining untreated cases, we selected 65 controls, matched for proportion of periconceptional infections and gestational age at amniocentesis. VACV was initiated at a median gestational age of 12.71 (interquartile range (IQR), 10.00-13.86) weeks and the median duration of treatment was 35 (IQR, 26-54) days. On multivariate logistic regression, fetal infection was lower in the treated group (odds ratio, 0.318 (95% CI, 0.120-0.841); P = 0.021). One treated patient developed acute renal failure 4 weeks after initiation of VACV therapy, but this resolved within 5 days after treatment was stopped. CONCLUSION This study confirms the acceptability, tolerance and benefit of secondary prevention by VACV of cCMV infection in a clinical setting with a well-established routine maternal serum screening policy in the first trimester of pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- V Faure-Bardon
- Obstetrics and Fetal Medicine Department, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
- EA7328, Institut Hospitalo-Universitaire Imagine, Paris, France
| | - J Fourgeaud
- Université de Paris, Paris, France
- EA7328, Institut Hospitalo-Universitaire Imagine, Paris, France
- Virology Laboratory, Associated with the National Herpes Viridae Reference Laboratory, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - J Stirnemann
- Obstetrics and Fetal Medicine Department, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
- EA7328, Institut Hospitalo-Universitaire Imagine, Paris, France
| | - M Leruez-Ville
- Université de Paris, Paris, France
- EA7328, Institut Hospitalo-Universitaire Imagine, Paris, France
- Virology Laboratory, Associated with the National Herpes Viridae Reference Laboratory, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Y Ville
- Obstetrics and Fetal Medicine Department, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
- Université de Paris, Paris, France
- EA7328, Institut Hospitalo-Universitaire Imagine, Paris, France
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20
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Ville Y, Leruez-Ville M. Renal toxicity of high-dosage valacyclovir for secondary prevention of congenital cytomegalovirus infection: a dose regimen-related issue. Ultrasound Obstet Gynecol 2021; 58:637-638. [PMID: 34468055 DOI: 10.1002/uog.24753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Y Ville
- EA7328, Université de Paris & Institut IMAGINE, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery and Fetal Imaging, Hôpital Necker Enfants-Malades, Paris, France
| | - M Leruez-Ville
- EA7328, Université de Paris & Institut IMAGINE, Paris, France
- Microbiology Department, Virology Unit, National Reference Centre for Herpes Virus and Congenital CMV Infection, Paris, France
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21
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Mahallati H, Sotiriadis A, Celestin C, Millischer AE, Sonigo P, Grevent D, O'Gorman N, Bahi-Buisson N, Attié-Bitach T, Ville Y, Salomon LJ. Heterogeneity in defining fetal corpus callosal pathology: systematic review. Ultrasound Obstet Gynecol 2021; 58:11-18. [PMID: 32798278 DOI: 10.1002/uog.22179] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 06/08/2020] [Revised: 07/22/2020] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Fetal anomalies of the corpus callosum (CC) have been reported in the prenatal imaging literature since 1985, and, especially when isolated, pose challenges for both the patient and fetal medicine specialist. The purpose of this study was to review systematically the literature on prenatally diagnosed abnormalities of the CC, focusing on the terminology used to describe abnormalities other than complete agenesis of the CC, and to assess the heterogeneity of the nomenclature and definitions used. METHODS This study was conducted in accordance with the PRISMA statement for reporting systematic reviews. A literature search was performed to identify prospective or retrospective case series or cohort studies, published in English, French, Italian, German or Spanish, reporting fetal imaging findings and describing anomalies of the CC. Quality and risk of bias of the studies were evaluated using the Newcastle-Ottawa scale and a modification of the scale developed by Conde-Agudelo et al. for other fetal imaging studies. The data extracted included the number of patients, the number of different anomalies identified, the descriptive names of the anomalies, and, where applicable, the definitions of the anomalies, the number of cases of each type of anomaly and the biometric charts used. Secondary tests used to confirm the diagnosis, as well as the postnatal or post-termination tests used to ascertain the diagnosis, were also recorded. RESULTS The search identified 998 records, and, after review of titles and abstracts and full review of 45 papers, 27 studies were included initially in the review, of which 24 were included in the final analysis. These 24 studies had a broad range of quality and risk of bias and represented 1135 cases of CC anomalies, of which 49% were complete agenesis and the remainder were described using the term partial agenesis or nine other terms, of which five had more than one definition. CONCLUSIONS In comparison to the postnatal literature, in the prenatal literature there is much greater heterogeneity in the nomenclature and definition of CC anomalies other than complete agenesis. This heterogeneity and lack of standard definitions in the prenatal literature make it difficult to develop large multicenter pooled cohorts of patients who can be followed in order to develop a better understanding of the genetic associations and neurodevelopmental and psychological outcomes of patients with CC anomalies. As this information is important to improve counseling of these patients, a good first step towards this goal would be to develop a simpler categorization of prenatal CC anomalies that matches better the postnatal literature. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- H Mahallati
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Fetus & LUMIERE team, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C Celestin
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - A E Millischer
- Fetus & LUMIERE team, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
- Service de Radiologie Pédiatrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - P Sonigo
- Fetus & LUMIERE team, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
- Service de Radiologie Pédiatrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - D Grevent
- Fetus & LUMIERE team, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
- Service de Radiologie Pédiatrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - N O'Gorman
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - N Bahi-Buisson
- Fetus & LUMIERE team, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
- Pediatric Neurology Department, University Hospital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - T Attié-Bitach
- Fetus & LUMIERE team, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
- Service de Neurologie Pédiatrique, Université Paris Descartes et Inserm U781, Imagine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Y Ville
- Fetus & LUMIERE team, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - L J Salomon
- Fetus & LUMIERE team, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
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22
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Macé P, Ville Y, Bessière B, Quarello E. Early diagnosis of rhombencephalosynapsis: the limits of intracranial translucency at first-trimester screening and a plea for assessment of aqueduct of Sylvius. Ultrasound Obstet Gynecol 2021; 57:846-848. [PMID: 32349173 DOI: 10.1002/uog.22064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 06/11/2023]
Affiliation(s)
- P Macé
- Institut Méditerranéen d'Imagerie Médicale Appliquée à la Gynécologie, la Grossesse et l'Enfance IMAGE2, Marseille, France
- Unité de Dépistage et de Diagnostic Prénatal, Hôpital Privé Marseille Beauregard, Marseille, France
| | - Y Ville
- Maternité, Hôpital Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - B Bessière
- Unité d'Embryofœtopathologie, Service d'Histologie-Embryologie-Cytogénétique, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - E Quarello
- Institut Méditerranéen d'Imagerie Médicale Appliquée à la Gynécologie, la Grossesse et l'Enfance IMAGE2, Marseille, France
- Unité de Dépistage et de Diagnostic Prénatal, Hôpital Saint-Joseph, Marseille, France
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23
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Tebeka S, Le Strat Y, Mandelbrot L, Benachi A, Dommergues M, Kayem G, Lepercq J, Luton D, Ville Y, Ramoz N, Mullaert J, Dubertret C. Early- and late-onset postpartum depression exhibit distinct associated factors: the IGEDEPP prospective cohort study. BJOG 2021; 128:1683-1693. [PMID: 33656796 DOI: 10.1111/1471-0528.16688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify risk factors for early- and late-onset postpartum depression (PPD) among a wide range of variables, including sociodemographic characteristics, childhood trauma, stressful life events during pregnancy and history of personal and family psychiatric disorders, and to assess the contribution of each risk factor. DESIGN Nested case-control study in a prospective longitudinal cohort study. SETTING Eight maternity departments in the Paris metropolitan area, France. SAMPLE A cohort of 3310 women with deliveries between November 2011 and June 2016. METHODS Cases were women with early- or late-onset PPD. Controls were women without depression during pregnancy or the postpartum period. Logistic regression adjusted on sociodemographic variables was performed for each outcome and a multivariable model was proposed based on a stepwise selection procedure. MAIN OUTCOME MEASURES Early- and late-onset PPD assessed at 2 months and 1 year postpartum, respectively. RESULTS Stressful life events during pregnancy have a dose-response relationship with both early- and late-onset PPD. CONCLUSIONS Early- and late-onset PPD presented distinct patterns of determinants. These results have important consequences in terms of prevention and specific care. TWEETABLE ABSTRACT Early- and late-onset postpartum depression are associated with stressful life events and psychiatric history.
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Affiliation(s)
- S Tebeka
- INSERM U1266, Université de Paris, Paris, France.,Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
| | - Y Le Strat
- INSERM U1266, Université de Paris, Paris, France.,Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
| | - L Mandelbrot
- Departement Hospitalier Universitaire Risks in Pregnancy, Université de Paris, Paris, France.,Department of Obstetrics and Gynecology, AP-HP, Louis Mourier Hospital, Colombes, France
| | - A Benachi
- Université Paris Saclay, Clamart, France.,Department of Obstetrics and Gynecology, AP-HP, Antoine Beclere Hospital, Clamart, France
| | - M Dommergues
- Sorbonne University, Paris, France.,Department of Obstetrics and Gynecology, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
| | - G Kayem
- Sorbonne University, Paris, France.,Department of Obstetrics and Gynecology, AP-HP, Trousseau Hospital, Paris, France
| | - J Lepercq
- Departement Hospitalier Universitaire Risks in Pregnancy, Université de Paris, Paris, France.,Port-Royal Maternity Unit, AP-HP, Cochin Hospital, Paris, France
| | - D Luton
- Departement Hospitalier Universitaire Risks in Pregnancy, Université de Paris, Paris, France.,Department of Obstetrics and Gynecology, AP-HP, Bichat Hospital, Paris, France
| | - Y Ville
- Sorbonne University, Paris, France.,Department of Obstetrics and Gynecology, AP-HP, Necker Enfant Malade Hospital, Paris, France
| | - N Ramoz
- INSERM U1266, Université de Paris, Paris, France
| | - J Mullaert
- Department of Epidemiology, Biostatistics and Clinical Research, AP-HP, Hôpital Bichat, Paris, France.,IAME, INSERM, Université de Paris, Paris, France
| | - C Dubertret
- INSERM U1266, Université de Paris, Paris, France.,Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
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24
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Faure-Bardon V, Fourgeaud J, Guilleminot T, Magny JF, Salomon LJ, Bernard JP, Leruez-Ville M, Ville Y. First-trimester diagnosis of congenital cytomegalovirus infection after maternal primary infection in early pregnancy: feasibility study of viral genome amplification by PCR on chorionic villi obtained by CVS. Ultrasound Obstet Gynecol 2021; 57:568-572. [PMID: 33533526 DOI: 10.1002/uog.23608] [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: 01/15/2021] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the feasibility of amplification of the viral genome by polymerase chain reaction (PCR) analysis of trophoblast samples obtained by chorionic villus sampling (CVS) in cases of maternal primary infection (MPI) with cytomegalovirus (CMV) in early pregnancy. METHODS This was a prospective study carried out at the Department of Obstetrics and Fetal Medicine, Hopital Necker-E.M., between October 2019 and October 2020. Following CMV serology screening in early pregnancy, CVS was offered to women at 11-14 weeks' gestation after CMV-MPI ≤ 10 weeks. Array-comparative genomic hybridization and amplification of the viral genome by PCR were performed on the trophoblasts obtained by CVS. All cases also underwent amniocentesis from 17 weeks onwards and PCR was performed on the amniotic fluid. Secondary prevention with valacyclovir was initiated as soon as MPI was diagnosed, to decrease the risk of vertical transmission. We evaluated the diagnostic performance of CMV-PCR of trophoblast obtained by CVS, using as the reference standard PCR of amniotic fluid obtained by amniocentesis. RESULTS CVS was performed in 37 pregnancies, at a median (range) gestational age of 12.7 (11.3-14.4) weeks. CMV-PCR in chorionic villi was positive in three and negative in 34 cases. CMV-PCR following amniocentesis, performed at a median (range) gestational age of 17.6 (16.7-29.9) weeks, was positive for the three cases which were positive following CVS and, of the 34 patients with a negative finding following CVS, amniocentesis was negative in 31 and positive in three. The sensitivity of CMV-PCR analysis of trophoblast obtained by CVS for the diagnosis of CMV, using as the reference standard PCR analysis of amniotic fluid obtained by amniocentesis, was 50% (95% CI, 19-81%), specificity was 100% (95% CI, 89-100%), positive predictive value was 100% (95% CI, 44-100%) and negative predictive value was 91% (95% CI, 77-97%). CONCLUSIONS Diagnosis of placental infection following MPI in early pregnancy can be achieved by PCR amplification of the CMV genome in chorionic villi. We propose that negative CMV-PCR in the trophoblast after 12 weeks could be used to exclude CMV-related embryopathy leading to sequelae. However, this needs to be confirmed through long-term follow-up evaluation. These findings could help to establish CVS as the diagnostic test of choice following maternal serology screening in early pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- V Faure-Bardon
- EA 73-28, Université de Paris, Paris, France
- AP-HP, Department of Obstetrics and Fetal Medicine, Hopital Necker-E.M., Paris, France
| | - J Fourgeaud
- EA 73-28, Université de Paris, Paris, France
- AP-HP, Virology Laboratory, Hopital Necker-E.M., Paris, France
| | - T Guilleminot
- EA 73-28, Université de Paris, Paris, France
- AP-HP, Virology Laboratory, Hopital Necker-E.M., Paris, France
| | - J-F Magny
- EA 73-28, Université de Paris, Paris, France
- AP-HP, Neonatal Intensive Care Unit, Hopital Necker-E.M, Paris, France
| | - L J Salomon
- EA 73-28, Université de Paris, Paris, France
- AP-HP, Department of Obstetrics and Fetal Medicine, Hopital Necker-E.M., Paris, France
| | - J-P Bernard
- EA 73-28, Université de Paris, Paris, France
- AP-HP, Department of Obstetrics and Fetal Medicine, Hopital Necker-E.M., Paris, France
| | - M Leruez-Ville
- EA 73-28, Université de Paris, Paris, France
- AP-HP, Virology Laboratory, Hopital Necker-E.M., Paris, France
| | - Y Ville
- EA 73-28, Université de Paris, Paris, France
- AP-HP, Department of Obstetrics and Fetal Medicine, Hopital Necker-E.M., Paris, France
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25
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Faure-Bardon V, Ville Y. Maternal infections: revisiting the need for screening in pregnancy. BJOG 2021; 128:304-315. [PMID: 32937015 DOI: 10.1111/1471-0528.16509] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 12/09/2022]
Abstract
The decision to implement screening for infections during pregnancy depends upon epidemiological, economic, therapeutic and test performance criteria. It therefore varies with public health priorities from country to country. When screening is implemented, the first trimester has become the best time slot to build individual care pathways in this field. This is most relevant for evaluating the risk of embryonic consequences, planning diagnostic testing, initiating primary or secondary prevention and optimising the accuracy of ultrasound follow-up. This article is a critical appraisal of epidemiological data and current international screening recommendations for infections in pregnancy. TWEETABLE ABSTRACT: Screening for infections in pregnancy: a critical review of current epidemiological evidence and international guidelines.
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Affiliation(s)
- V Faure-Bardon
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Y Ville
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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26
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Faure‐Bardon V, Isnard P, Roux N, Leruez‐Ville M, Molina T, Bessieres B, Ville Y. Protein expression of angiotensin-converting enzyme 2, a SARS-CoV-2-specific receptor, in fetal and placental tissues throughout gestation: new insight for perinatal counseling. Ultrasound Obstet Gynecol 2021; 57:242-247. [PMID: 32798244 PMCID: PMC7461228 DOI: 10.1002/uog.22178] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 06/10/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Pregnant women can be infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), yet the incidence of perinatal infection is low. We hypothesized that this could be related to low expression of the membrane receptor for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2), in the fetoplacental unit. We evaluated protein expression of ACE2 at various gestational ages in both placentae and fetal organs from pregnancies not infected with SARS-CoV-2. METHODS In May 2020, using samples from a registered biobank, we performed immunohistochemical analysis for ACE2 in tissue samples from fetal organs and placentae from five cases of second- or third-trimester medical termination of pregnancy in healthy women (performed between 15 and 38 weeks' gestation), as well as a further two placentae, one from a 7-week spontaneous miscarriage in a non-infected woman and one from a symptomatic pregnant woman positive for SARS-CoV-2 delivered by Cesarean section at 34 weeks. Samples were paraffin-embedded and organ tissues included kidney, brain, lung, intestinal tract, heart and testis. Matching tissues (kidney, intestinal tract, lung and testis) from autopsies of four 8-year-old children were tested as controls. Tissue sections were incubated with rabbit monoclonal anti-ACE2, and protein expression of ACE2 was detected by immunohistochemistry. RESULTS ACE2 expression was detected in fetal kidney, rectum and ileum samples from 15 weeks onwards and in the pediatric controls. It was barely detectable in fetal lung samples at 15 + 5 weeks' gestation and not detectable thereafter, and, in the pediatric controls, ACE2 was detectable only in type-2 pneumocytes. No ACE2 expression was found in the cerebral ependymal or parenchymal tissues or in cardiac tissues. ACE2 was expressed in placental syncytiotrophoblast and cytotrophoblast samples, but not in the amnion, from 7 weeks onwards. The intensity and distribution of ACE2 staining in the placenta from the symptomatic SARS-CoV-2 woman was similar to that in the non-infected placentae. CONCLUSIONS Marked placental expression of ACE2 provides a rationale for vertical transmission at the cellular level. Absence of ACE2 expression in the fetal brain and heart is reassuring regarding the risk of congenital malformation. Clinical follow-up of infected pregnant women and their children is needed to validate these observations. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- V. Faure‐Bardon
- EA 73‐28Université de ParisParisFrance
- AP‐HP, Department of Obstetrics and Fetal MedicineHôpital Necker‐Enfants MaladesParisFrance
| | - P. Isnard
- AP‐HP, Department of Histology, Embryology and CytogeneticsHôpital Necker‐Enfants MaladesParisFrance
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1151, CNRS UMR 8253, Hôpital Necker‐Enfants Malades, Department of Growth and SignalingUniversité de ParisParisFrance
| | - N. Roux
- AP‐HP, Department of Histology, Embryology and CytogeneticsHôpital Necker‐Enfants MaladesParisFrance
| | - M. Leruez‐Ville
- EA 73‐28Université de ParisParisFrance
- AP‐HP, Virology LaboratoryHôpital Necker‐Enfants MaladesParisFrance
| | - T. Molina
- AP‐HP, Department of Histology, Embryology and CytogeneticsHôpital Necker‐Enfants MaladesParisFrance
| | - B. Bessieres
- AP‐HP, Department of Histology, Embryology and CytogeneticsHôpital Necker‐Enfants MaladesParisFrance
| | - Y. Ville
- EA 73‐28Université de ParisParisFrance
- AP‐HP, Department of Obstetrics and Fetal MedicineHôpital Necker‐Enfants MaladesParisFrance
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Fries N, Le Garrec S, Egloff M, Sault C, Dreux S, Mangione R, Salomon LJ, Ville Y. Non-invasive prenatal testing: what are we missing? Ultrasound Obstet Gynecol 2021; 57:345-346. [PMID: 32119166 DOI: 10.1002/uog.22005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/23/2020] [Accepted: 02/26/2020] [Indexed: 06/10/2023]
Affiliation(s)
- N Fries
- Collège Français d'Échographie Fœtale (CFEF), Paris, France
| | - S Le Garrec
- Maternité Centre, Hospitalier Nord Deux Sèvres, Faye-l'Abbesse, France
| | - M Egloff
- Laboratoire de Génétique Biologique, CHU de Poitiers, Poitiers, France
- Université de Poitiers, INSERM, Laboratoire de Neurosciences Expérimentales et Cliniques, Poitiers, France
| | - C Sault
- Eurofins, Lyon, France
- Association des Biologistes Agrées, Laboratoire de Biochimie Hormonologie, Hôpital Robert Debré, AP-HP, Paris, France
| | - S Dreux
- Association des Biologistes Agrées, Laboratoire de Biochimie Hormonologie, Hôpital Robert Debré, AP-HP, Paris, France
| | - R Mangione
- Collège Français d'Échographie Fœtale (CFEF), Paris, France
| | - L J Salomon
- Collège Français d'Échographie Fœtale (CFEF), Paris, France
- Maternité Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Descartes, Paris, France
| | - Y Ville
- Maternité Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Descartes, Paris, France
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Faure-Bardon V, Isnard P, Roux N, Leruez-Ville M, Molina T, Bessieres B, Ville Y. Reply. Ultrasound Obstet Gynecol 2021; 57:352-353. [PMID: 33524233 DOI: 10.1002/uog.23583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- V Faure-Bardon
- EA 73-28, Université de Paris, Paris, France
- AP-HP, Department of Obstetrics and Fetal Medicine, Hospital Necker-E.M., Paris, France
| | - P Isnard
- AP-HP, Department of Histology, Embryology and Cytogenetics, Hospital Necker-E.M, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1151, CNRS UMR 8253, Hospital Necker-E.M., Department of Growth and Signaling, Université de Paris, Paris, France
| | - N Roux
- AP-HP, Department of Histology, Embryology and Cytogenetics, Hospital Necker-E.M, Paris, France
| | - M Leruez-Ville
- EA 73-28, Université de Paris, Paris, France
- AP-HP, Virology Laboratory, Hospital Necker-E.M, Paris, France
| | - T Molina
- AP-HP, Department of Histology, Embryology and Cytogenetics, Hospital Necker-E.M, Paris, France
| | - B Bessieres
- AP-HP, Department of Histology, Embryology and Cytogenetics, Hospital Necker-E.M, Paris, France
| | - Y Ville
- EA 73-28, Université de Paris, Paris, France
- AP-HP, Department of Obstetrics and Fetal Medicine, Hospital Necker-E.M., Paris, France
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Leruez-Ville M, Ren S, Magny JF, Jacquemard F, Couderc S, Garcia P, Maillotte AM, Benard M, Pinquier D, Minodier P, Astruc D, Patural H, Ugolin M, Parat S, Guillois B, Garenne A, Parodi M, Bussières L, Stirnemann J, Sonigo P, Millischer AE, Ville Y. Accuracy of prenatal ultrasound screening to identify fetuses infected by cytomegalovirus which will develop severe long-term sequelae. Ultrasound Obstet Gynecol 2021; 57:97-104. [PMID: 32339337 DOI: 10.1002/uog.22056] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To compare the ability of detailed routine ultrasound examination, performed without knowledge of maternal serology and fetal status, with that of targeted prenatal imaging performed in prenatal diagnostic units in cases of known fetal infection to identify cytomegalovirus (CMV)-infected fetuses that will develop long-term sequelae. METHODS All prenatal imaging reports were collected for 255 children with congenital CMV in a registered cohort between 2013 and 2017 (NCT01923636). All women had undergone detailed routine fetal ultrasound examination at 20-24 and 30-34 weeks as part of routine antenatal care. All cases of known fetal CMV infection had also undergone targeted prenatal ultrasound examination. Postnatal structured follow-up for up to 48 months of age involved clinical, audiological and neurological assessment, including Brunet-Lezine scoring. Long-term sequelae (> 12 months) were considered to be mild in cases with isolated unilateral hearing loss and/or vestibular disorders, and severe in cases with bilateral hearing loss and/or neurological sequelae. All imaging reports were analyzed retrospectively with the knowledge of congenital CMV infection, searching for reference to findings that were, or could have been, related to fetal infection. Findings were analyzed in relation to whether the cases were diagnosed with CMV in utero or only postnatally. RESULTS There were 237 children with complete follow-up data (> 12 months), for a median of 24 (range, 12-48) months. Of these, 30% (71/237) were diagnosed with CMV prenatally and 70% (166/237) were diagnosed within 3 weeks after birth. 72.5% (29/40) of children with long-term sequelae, including 74% (14/19) with severe long-term sequelae, were not identified in the prenatal period. Among those diagnosed prenatally, the sensitivity of prenatal imaging for predicting long-term sequelae and severe long-term sequelae was 91% and 100%, respectively, while, in the group diagnosed only postnatally, non-specific infection-related ultrasound findings had been reported without raising suspicion in 48% of cases with long-term sequelae and 64% of those with severe long-term sequelae. CONCLUSIONS Routine detailed ultrasound examination in pregnancy is not an appropriate screening tool for congenital CMV infection that leads to long-term sequelae, in contrast with the high performance of targeted prenatal imaging in known cases of fetal infection. The non-specific nature of ultrasound features of CMV and their evolution, and a lack of awareness of caregivers about congenital CMV, are likely explanations. Awareness of the sonologist regarding congenital CMV and knowledge of the maternal serological status in the first trimester seem key to the performance of prenatal ultrasound. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Leruez-Ville
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, Paris, France
| | - S Ren
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - J-F Magny
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Neonatal Intensive Care Unit, Paris, France
| | - F Jacquemard
- American Hospital of Paris, Prenatal Diagnostic Unit, Neuilly, France
| | - S Couderc
- Hospital Intercommunal Poissy-Saint Germain, Maternity, Poissy, France
| | - P Garcia
- AP-HM, Hospital La Conception, Neonatology and Intensive Care Department, Marseille, France
| | - A-M Maillotte
- CHU Nice, Hospital L'Archet, Neonatal Intensive Care Unit, Nice, France
| | - M Benard
- Toulouse University Hospital, Department of Neonatology, Toulouse, France
| | - D Pinquier
- Rouen University Hospital, Department of Neonatology, Rouen, France
| | - P Minodier
- AP-HM, Hospital Nord, Emergency Care Department, Marseille, France
| | - D Astruc
- Strasbourg University Hospital, Department of Neonatology, Strasbourg, France
| | - H Patural
- University Hospital, Neonatal Intensive Care Unit, Saint-Etienne, France
| | - M Ugolin
- CHU Rennes and CIC1414, Pediatric Department, Neonatology, Rennes, France
| | - S Parat
- AP-HP, Hospital Cochin, Maternity, Paris, France
| | - B Guillois
- CHU de Caen, Department of Neonatology, Caen, France
- Université Caen Normandie, Medical School, Caen, France
| | - A Garenne
- CHRU Brest, Neonatal and Pediatric Intensive Care Unit, Brest, France
| | - M Parodi
- AP-HP, Hospital Necker-E.M., Otology Department, Paris, France
| | - L Bussières
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Clinical Research Unit, Paris, France
| | - J Stirnemann
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Maternity, Paris, France
| | - P Sonigo
- AP-HP, Hospital Necker-E.M., Radiology Department, Paris, France
| | - A E Millischer
- AP-HP, Hospital Necker-E.M., Radiology Department, Paris, France
| | - Y Ville
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- AP-HP, Hospital Necker-E.M., Maternity, Paris, France
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Hautier S, Kermorvant E, Khen-Dunlop N, de Wailly D, Beauquier B, Corroenne R, Milani G, Bonnet D, James S, Vinit N, Blanc T, Aigrain Y, Colmant C, Salomon L, Ville Y, Stirnemann J. [Prenatal path of care following the diagnosis of a malformation for which a novel prenatal therapy is available]. ACTA ACUST UNITED AC 2020; 49:172-179. [PMID: 33166705 DOI: 10.1016/j.gofs.2020.11.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Fetal therapy is part of the available care offer for several severe malformations. The place of these emergent prenatal interventions in the prenatal path of care is poorly known. The objective of this study is to describe the decision-making process of patients facing the option of an emergent in utero intervention. METHODS We have conducted a retrospective monocentric descriptive study in the department of maternal-fetal medicine of Necker Hospital. We collected data regarding eligibility or not for fetal surgery and the pregnancy outcomes of patients referred for myelomeningocele, diaphragmatic hernia, aortic stenosis and low obstructive uropathies. RESULTS All indications combined, 70% of patients opted for fetal surgery. This rate was lower in the case of myelomeningocele with 21% consent, than in the other pathologies: 69% for diaphragmatic hernias, 90% for aortic stenoses and 76% for uropathy. When fetal intervention was declined, the vast majority of patients opted for termination of pregnancy: 86%. In 14% of the considering fetal surgery, the patient was referred too far. CONCLUSION The acceptance rate for fetal surgeries depends on condition. It offers an additional option and is an alternative for couples for which termination of pregnancy (TOP) is not an option. Timely referral to an expert center allows to discuss the place of a fetal intervention and not to deprive couples of this possibility.
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Affiliation(s)
- S Hautier
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - E Kermorvant
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - N Khen-Dunlop
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - D de Wailly
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - B Beauquier
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - R Corroenne
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - G Milani
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - D Bonnet
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - S James
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - N Vinit
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - T Blanc
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - Y Aigrain
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - C Colmant
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - L Salomon
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - Y Ville
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - J Stirnemann
- Maternité et médecine fœtale, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.
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Badaoui S, Grevent D, Salomon LJ, Ville Y, Stirnemann J. Magnetic resonance imaging-based three-dimensional modeling of pregnant pelvis for fetoscopic surgical planning. Ultrasound Obstet Gynecol 2020; 56:793-795. [PMID: 32365244 DOI: 10.1002/uog.22067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/14/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Affiliation(s)
- S Badaoui
- Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- EA7328, Université de Paris, Fondation LUMIERE and Institut IMAGINE, Paris, France
| | - D Grevent
- EA7328, Université de Paris, Fondation LUMIERE and Institut IMAGINE, Paris, France
- Pediatric Radiology, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - L J Salomon
- Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- EA7328, Université de Paris, Fondation LUMIERE and Institut IMAGINE, Paris, France
| | - Y Ville
- Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- EA7328, Université de Paris, Fondation LUMIERE and Institut IMAGINE, Paris, France
| | - J Stirnemann
- Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
- EA7328, Université de Paris, Fondation LUMIERE and Institut IMAGINE, Paris, France
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Ville Y. Should we offer fetal surgery for severe congenital diaphragmatic hernia or bring these cases to trial? Difference between chance and hazard. Ultrasound Obstet Gynecol 2020; 56:491-492. [PMID: 33001494 DOI: 10.1002/uog.22103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/17/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Y Ville
- Fetal Medicine and Surgery Centre, MICADO Consortium (Multidisciplinary Initiative for Congenital and Developmental Anomalies), Université de Paris, Hôpital Necker-Enfants Malades, Paris, France
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Tollenaar LSA, Slaghekke F, Lewi L, Ville Y, Lanna M, Weingertner A, Ryan G, Arévalo S, Khalil A, Brock CO, Klaritsch P, Hecher K, Gardener G, Bevilacqua E, Kostyukov KV, Bahtiyar M, Kilby M, Tiblad E, Oepkes D, Lopriore E. Treatment and outcome of 370 cases with spontaneous or post-laser twin anemia-polycythemia sequence managed in 17 fetal therapy centers. Ultrasound Obstet Gynecol 2020; 56:378-387. [PMID: 32291846 PMCID: PMC7497010 DOI: 10.1002/uog.22042] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To investigate the antenatal management and outcome in a large international cohort of monochorionic twin pregnancies with spontaneous or post-laser twin anemia-polycythemia sequence (TAPS). METHODS This study analyzed data of monochorionic twin pregnancies diagnosed antenatally with spontaneous or post-laser TAPS in 17 fetal therapy centers, recorded in the TAPS Registry between 2014 and 2019. Antenatal diagnosis of TAPS was based on fetal middle cerebral artery peak systolic velocity > 1.5 multiples of the median (MoM) in the TAPS donor and < 1.0 MoM in the TAPS recipient. The following antenatal management groups were defined: expectant management, delivery within 7 days after diagnosis, intrauterine transfusion (IUT) (with or without partial exchange transfusion (PET)), laser surgery and selective feticide. Cases were assigned to the management groups based on the first treatment that was received after diagnosis of TAPS. The primary outcomes were perinatal mortality and severe neonatal morbidity. The secondary outcome was diagnosis-to-birth interval. RESULTS In total, 370 monochorionic twin pregnancies were diagnosed antenatally with TAPS during the study period and included in the study. Of these, 31% (n = 113) were managed expectantly, 30% (n = 110) with laser surgery, 19% (n = 70) with IUT (± PET), 12% (n = 43) with delivery, 8% (n = 30) with selective feticide and 1% (n = 4) underwent termination of pregnancy. Perinatal mortality occurred in 17% (39/225) of pregnancies in the expectant-management group, 18% (38/215) in the laser group, 18% (25/140) in the IUT (± PET) group, 10% (9/86) in the delivery group and in 7% (2/30) of the cotwins in the selective-feticide group. The incidence of severe neonatal morbidity was 49% (41/84) in the delivery group, 46% (56/122) in the IUT (± PET) group, 31% (60/193) in the expectant-management group, 31% (57/182) in the laser-surgery group and 25% (7/28) in the selective-feticide group. Median diagnosis-to-birth interval was longest after selective feticide (10.5 (interquartile range (IQR), 4.2-14.9) weeks), followed by laser surgery (9.7 (IQR, 6.6-12.7) weeks), expectant management (7.8 (IQR, 3.8-14.4) weeks), IUT (± PET) (4.0 (IQR, 2.0-6.9) weeks) and delivery (0.3 (IQR, 0.0-0.5) weeks). Treatment choice for TAPS varied greatly within and between the 17 fetal therapy centers. CONCLUSIONS Antenatal treatment for TAPS differs considerably amongst fetal therapy centers. Perinatal mortality and morbidity were high in all management groups. Prolongation of pregnancy was best achieved by expectant management, treatment by laser surgery or selective feticide. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L. S. A. Tollenaar
- Department of Obstetrics, Division of Fetal therapyLeiden University Medical CenterLeidenThe Netherlands
| | - F. Slaghekke
- Department of Obstetrics, Division of Fetal therapyLeiden University Medical CenterLeidenThe Netherlands
| | - L. Lewi
- Department of Obstetrics and GynecologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Y. Ville
- Department of Obstetrics and Maternal‐Fetal MedicineHôpital Necker‐Enfants Malades, AP‐HPParisFrance
| | - M. Lanna
- Fetal Therapy Unit ‘U. Nicolini’, Vittore Buzzi Children's HospitalUniversity of MilanMilanItaly
| | - A. Weingertner
- Department of Obstetrics and GynecologyStrasbourg University HospitalStrasbourg CedexFrance
| | - G. Ryan
- Fetal Medicine Unit, Ontario Fetal Centre, Mount Sinai HospitalUniversity of TorontoTorontoCanada
| | - S. Arévalo
- Maternal Fetal Medicine Unit, Department of ObstetricsVall d'Hebron University HospitalBarcelonaSpain
| | - A. Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation TrustUniversity of LondonLondonUK
- Vascular Biology Research CentreMolecular and Clinical Sciences Research Institute, St George's University of LondonLondonUK
| | - C. O. Brock
- The Fetal Center, Department of Obstetrics, Children's Memorial Hermann Hospital, Gynecology and Reproductive Sciences, UT Health, McGovern Medical SchoolUniversity of TexasHoustonTXUSA
| | - P. Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and GynecologyMedical University of Graz, GrazAustria
| | - K. Hecher
- Department of Obstetrics and Fetal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - G. Gardener
- Department of Maternal Fetal MedicineMater Mothers' HospitalSouth BrisbaneQueenslandAustralia
| | - E. Bevilacqua
- Department of Obstetrics and Gynecology, University Hospital BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - K. V. Kostyukov
- Acad. V. I. Kulakov Research Center of ObstetricsGynecology, and Perinatology, Ministry of Health of the Russian FederationMoscowRussia
| | - M. O. Bahtiyar
- Department of Obstetrics, Gynecology and Reproductive SciencesYale School of MedicineNew HavenCTUSA
| | - M. D. Kilby
- Fetal Medicine Centre, Birmingham Women's and Children's Foundation TrustUniversity of BirminghamBirminghamUK
| | - E. Tiblad
- Center for Fetal MedicineKarolinska University HospitalStockholmSweden
| | - D. Oepkes
- Department of Obstetrics, Division of Fetal therapyLeiden University Medical CenterLeidenThe Netherlands
| | - E. Lopriore
- Department of Pediatrics, Division of NeonatologyLeiden University Medical CenterLeidenThe Netherlands
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Khalil A, Sotiriadis A, Chaoui R, da Silva Costa F, D'Antonio F, Heath PT, Jones C, Malinger G, Odibo A, Prefumo F, Salomon LJ, Wood S, Ville Y. ISUOG Practice Guidelines: role of ultrasound in congenital infection. Ultrasound Obstet Gynecol 2020; 56:128-151. [PMID: 32400006 DOI: 10.1002/uog.21991] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 06/11/2023]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - F da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - F D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway
| | - P T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, St George's University of London and St George's University Hospitals NHS Trust, London, UK
| | - C Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Malinger
- Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Odibo
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - F Prefumo
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | | | - Y Ville
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
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Vinit N, Grevent D, Millischer-Bellaiche AE, Pandya VM, Sonigo P, Delmonte A, Sarnacki S, Aigrain Y, Boddaert N, Bessières B, Benchimol G, Salomon LJ, Stirnemann JJ, Blanc T, Ville Y. Biometric and morphological features on magnetic resonance imaging of fetal bladder in lower urinary tract obstruction: new perspectives for fetal cystoscopy. Ultrasound Obstet Gynecol 2020; 56:86-95. [PMID: 31006924 DOI: 10.1002/uog.20297] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/03/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Incompatibility between currently available fetoscopes and the anatomical constraints of the distended fetal bladder, with the resulting curvature around the bladder neck, account for most technical difficulties during fetal cystoscopy in lower urinary tract obstruction (LUTO). The aim of this anatomical study was to assess by magnetic resonance imaging (MRI) the variation in three bladder angles (bladder-neck angle (BNA), vesicourethral angle (VUA) and angle between bladder dome and posterior urethra (DUA)), according to gestational age (GA), bladder volume and the presence of LUTO. METHODS From our fetal medicine database, we retrieved for review 46 MRI examinations of male fetuses between 2015 and 2019, including 17 with LUTO, examined at a mean GA of 28.1 (range, 17.3-35.0) weeks and 29 age-matched controls, examined at 29.9 (range, 21.9-35.0) weeks. We measured bladder volume, bladder-wall thickness and the three bladder angles, and used the Mann-Whitney U-test to compare values between groups. Variations according to GA and bladder volume were determined using analysis of variance (ANOVA). A reliability study was performed using the Bland-Altman method and Lin's correlation coefficient was calculated. RESULTS Both bladder volume and bladder-wall thickness were significantly greater in the LUTO group (P < 0.01). BNA was significantly larger in LUTO compared with control fetuses: the mean (range) was 127.1° (101.6-161.6°) vs 111.2° (88.5-157.3°) (P < 0.01). DUA averaged 117° and showed no difference between the groups (P = 0.92). No statistical comparison was performed on VUA since this was not measurable in most control fetuses. ANOVA showed no variation of any angle with bladder volume in both LUTO fetuses and control fetuses. BNA in LUTO fetuses was the only angle to vary with GA, being larger after, compared with at or before, 25 weeks (P = 0.04). The reliability study showed an acceptable bias for both intra- and interobserver reproducibility for all three angles. CONCLUSION The findings that BNA is increased by approximately 15° in fetuses with LUTO and DUA averages 117° could aid in development of a customized fetal cystoscope and help to overcome the current technical challenges of fetal cystoscopy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- N Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
| | - D Grevent
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, APHP, Paris, France
- INSERM U1000 and UMR1163, Imagine Institute, Paris, France
| | - A-E Millischer-Bellaiche
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - V M Pandya
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - P Sonigo
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - A Delmonte
- IMAG2 Laboratory, Imagine Institute, Paris, France
| | - S Sarnacki
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- IMAG2 Laboratory, Imagine Institute, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Y Aigrain
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - N Boddaert
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, APHP, Paris, France
- INSERM U1000 and UMR1163, Imagine Institute, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - B Bessières
- Department of Histology, Embryology and Cytogenetics, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - G Benchimol
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - L J Salomon
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - J J Stirnemann
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - T Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Y Ville
- EA 7328-PACT, Paris Descartes University, Sorbonne Paris Cité, Imagine Institue, Paris, France
- Department of Obstetrics, Fetal Medicine and Surgery, Necker-Enfants Malades Hospital, APHP, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
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Colmant C, Lapillonne A, Stirnemann J, Belaroussi I, Leroy-Terquem E, Kermovant-Duchemin E, Bussieres L, Ville Y. Impact of different prenatal management strategies in short- and long-term outcomes in monochorionic twin pregnancies with selective intrauterine growth restriction and abnormal flow velocity waveforms in the umbilical artery Doppler: a retrospective observational study of 108 cases. BJOG 2020; 128:401-409. [PMID: 32416618 DOI: 10.1111/1471-0528.16318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To review perinatal and neurodevelopmental outcome (NDO) following selective fetoscopic laser coagulation (SFLC), cord coagulation (CC) or expectant management of monochorionic diamniotic twin pregnancies complicated with selective intrauterine growth restriction (sIUGR) and absent or reverse end-diastolic flow (AREDF) in the umbilical arteries (UA). DESIGN AND SETTING Single-centre retrospective observational study. POPULATION 108 cases of sIUGR diagnosed before 26+6 weeks' gestation with AREDF in the UA. METHODS Survival rate and potential risk factors were analysed. NDO was assessed using parental questionnaires. MAIN OUTCOMES MEASURES Survival, gestational age at delivery and NDO. RESULTS SFLC, CC and EM were performed in 13, 50 and 45 cases, respectively, with an overall survival of 23.1, 40 and 77.8% and intrauterine demise of the co-twin of 30.8, 10 and 6.7% respectively. Intrauterine demise of the sIUGR twin occurred in 76.9 and 17.8% following SFLC and EM, respectively. The discordance in EFW at diagnosis was higher and absent/negative a-wave in the ductus venosus (DV) was more prevalent in the surgical groups. NDO in survivors at follow up was abnormal in 0 and 18% in the smaller twin following SFLC and EM, respectively, and in 25, 24 and 21% in the larger twin following SFLC, CC and EM, respectively. CONCLUSION SFLC yielded a poor result. EM seems a valid option when EFW discordance is <30% and a-wave in DV is positive. Otherwise, CC should be considered to protect the AGA co-twin. The long-term outcome of both small and large twins seems unaffected by the choice in primary prenatal management strategy. TWEETABLE ABSTRACT In type II sIUGR in MC twins, long-term neurodevelopment is normal in over 80% of the survivors.
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Affiliation(s)
- C Colmant
- Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - A Lapillonne
- EA7328 and PACT, Université Paris Descartes, Paris, France.,Neonatology and Intensive Care Unit, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - J Stirnemann
- Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, Paris, France.,EA7328 and PACT, Université Paris Descartes, Paris, France
| | - I Belaroussi
- Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | | | - E Kermovant-Duchemin
- EA7328 and PACT, Université Paris Descartes, Paris, France.,Neonatology and Intensive Care Unit, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - L Bussieres
- Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, Paris, France.,EA7328 and PACT, Université Paris Descartes, Paris, France
| | - Y Ville
- Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, Paris, France.,EA7328 and PACT, Université Paris Descartes, Paris, France
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Affiliation(s)
- V Faure-Bardon
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, AP-HP, Hospital Necker-E.M., Paris, France
| | - L J Salomon
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, AP-HP, Hospital Necker-E.M., Paris, France
| | - M Leruez-Ville
- Maternity, AP-HP, Hospital Necker-E.M., Paris, France.,Virology Laboratory, AP-HP, Hospital Necker-E.M., Paris, France
| | - Y Ville
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, AP-HP, Hospital Necker-E.M., Paris, France
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38
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Le Bras A, Salomon LJ, Bussières L, Malan V, Elie C, Mahallati H, Ville Y, Vekemans M, Durand-Zaleski I. Cost-effectiveness of five prenatal screening strategies for trisomies and other unbalanced chromosomal abnormalities: model-based analysis. Ultrasound Obstet Gynecol 2019; 54:596-603. [PMID: 31006923 DOI: 10.1002/uog.20301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/15/2019] [Revised: 04/08/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of five prenatal screening strategies for trisomies (13/18/21) and other unbalanced chromosomal abnormalities (UBCA), following the introduction of cell-free DNA (cfDNA) analysis. METHODS A model-based cost-effectiveness analysis was performed to estimate prevalence, safety, screening-program costs and healthcare costs of five different prenatal screening strategies, using a virtual cohort of 652 653 pregnant women in France. Data were derived from the French Biomedicine Agency and published articles. Uncertainty was addressed using one-way sensitivity analysis. The five strategies compared were: (i) cfDNA testing for women with a risk following first-trimester screening of ≥ 1/250; (ii) cfDNA testing for women with a risk of ≥ 1/1000 (currently recommended); (iii) cfDNA testing in the general population (regardless of risk); (iv) invasive testing for women with a risk of ≥ 1/250 (historical strategy); and (v) invasive testing for women with a risk of ≥ 1/1000. RESULTS In our virtual population, at similar risk thresholds, cfDNA testing compared with invasive testing was cheaper but less effective. Compared with the historical strategy, cfDNA testing at the ≥ 1/1000 risk threshold was a more expensive strategy that detected 158 additional trisomies, but also 175 fewer other UBCA. Implementation of cfDNA testing in the general population would give an incremental cost-effectiveness ratio of €9 166 689 per additional anomaly detected compared with the historical strategy. CONCLUSION Extending cfDNA to lower risk thresholds or even to all pregnancies would detect more trisomies, but at greater expense and with lower detection rate of other UBCA, compared with the historical strategy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Le Bras
- AP-HP, DRCI-URC Eco Ile-de-France, Paris, France
| | - L J Salomon
- AP-HP, Hôpital Necker-Enfants Malades, Department of Obstetrics and Gynecology, Paris, France
- Collège Français d'Echographie Foetale (CFEF), France
| | - L Bussières
- AP-HP, Hôpital Necker-Enfants Malades, Department of Obstetrics and Gynecology, Paris, France
- AP-HP, Hôpital Necker-Enfants Malades, Clinical Unit Research/Clinic Investigation Center, Paris, France
| | - V Malan
- INSERM U1163, Hôpital Necker-Enfants Malades, Paris, France
- AP-HP, Hôpital Necker-Enfants Malades, Department of Histology, Embryology and Cytogenetics, Paris, France
| | - C Elie
- AP-HP, Hôpital Necker-Enfants Malades, Clinical Unit Research/Clinic Investigation Center, Paris, France
| | - H Mahallati
- AP-HP, Hôpital Necker-Enfants Malades, Department of Obstetrics and Gynecology, Paris, France
| | - Y Ville
- AP-HP, Hôpital Necker-Enfants Malades, Department of Obstetrics and Gynecology, Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - M Vekemans
- AP-HP, Hôpital Necker-Enfants Malades, Department of Histology, Embryology and Cytogenetics, Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - I Durand-Zaleski
- AP-HP, DRCI-URC Eco Ile-de-France, Paris, France
- Assistance Publique-Hôpitaux de Paris, Service de Santé Publique, Henri Mondor-Albert-Chenevier, Créteil, France
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Di Pasquo E, Kuleva M, Rousseau A, Vitucci A, Sonigo P, Chardot C, Salomon LJ, Ville Y. Outcome of non-visualization of fetal gallbladder on second-trimester ultrasound: cohort study and systematic review of literature. Ultrasound Obstet Gynecol 2019; 54:582-588. [PMID: 30809885 DOI: 10.1002/uog.20252] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/20/2019] [Accepted: 02/07/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate the ultrasound characteristics and outcome of fetuses with non-visualization of the fetal gallbladder (NVFGB) followed in our tertiary university hospital, and to provide a comprehensive review of the literature on prenatal findings and outcome of NVFGB. METHODS NVFGB was defined as non-visualization of the gallbladder on two targeted ultrasound examinations performed within a 1-week period. First, we reviewed the medical records of NVFGB cases managed in our center over a 9-year period. Then, we performed a systematic review of the literature to identify studies on NVFGB. The incidence of chromosomal anomalies, later visualization of the gallbladder, gallbladder agenesis, cystic fibrosis and biliary atresia was assessed in fetuses with isolated and non-isolated NVFGB. The role of hepatic enzyme measurements in the diagnosis of cystic fibrosis and biliary atresia in fetuses with NVFGB was also reviewed. RESULTS Sixteen cases of NVFGB were followed in our center, in 10 (62.5%) of which it was an isolated finding. The incidence of biliary atresia was 12.5% and that of gallbladder agenesis was 12.5%, while no case of cystic fibrosis was reported. The gallbladder was visualized later in pregnancy or postnatally in 43.8% and 25.0% of cases, respectively. A total of seven studies, including our cohort, involving a total of 280 NVFGB cases, met the inclusion criteria for the systematic review. Overall, 20.5% of fetuses had an associated ultrasound anomaly, and the incidence of chromosomal anomaly in this group was 20.4%. In cases with isolated NVFGB, the incidence of chromosomal anomaly was 1.9%. In fetuses with normal karyotype and isolated NVFGB, the gallbladder was later visualized in 70.4% of cases, while the incidence of gallbladder agenesis, cystic fibrosis and biliary atresia was 25.2%, 3.1% and 4.8%, respectively. In fetuses with non-isolated NVFGB, the incidence of cystic fibrosis and biliary atresia was 23.1% and 18.2%, respectively. The negative predictive value of amniotic fluid enzyme levels for the prediction of severe disease (including biliary atresia or cystic fibrosis) ranged between 94% and 100% when evaluated before 22 weeks' gestation, and dropped to 88% after 22 weeks. CONCLUSIONS In cases with persistent NVFGB, the risk of a severe postnatal condition should be considered. A detailed ultrasound scan should be offered and parents tested for cystic fibrosis gene mutation. An invasive procedure for karyotyping and measurement of liver enzyme concentrations before 22 weeks constitutes a reasonable work-up. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E Di Pasquo
- Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - M Kuleva
- Maternité, Hôpital Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - A Rousseau
- Maternité, Hôpital Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - A Vitucci
- Maternité, Hôpital Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - P Sonigo
- Radiologie Pédiatrique, Hôpital Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - C Chardot
- Chirurgie Pédiatrique, Hôpital Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - L J Salomon
- Maternité, Hôpital Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
- Société Française pour l'Amélioration des Pratiques Echographiques, Paris, France
| | - Y Ville
- Maternité, Hôpital Necker-Enfants Malades, Assistance Publique, Hôpitaux de Paris, Université Paris Descartes, Paris, France
- Société Française pour l'Amélioration des Pratiques Echographiques, Paris, France
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Faure-Bardon V, Millischer AE, Deloison B, Sonigo P, Grévent D, Salomon L, Stirnemann J, Nicloux M, Magny JF, Leruez-Ville M, Ville Y. Refining the prognosis of fetuses infected with Cytomegalovirus in the first trimester of pregnancy by serial prenatal assessment: a single-centre retrospective study. BJOG 2019; 127:355-362. [PMID: 31505103 DOI: 10.1111/1471-0528.15935] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To define the predictive value (PV) of known prognostic factors of fetal infection with Cytomegalovirus following maternal primary infection <14 weeks of gestation, at different time points of pregnancy: the end of the second trimester; following prenatal magnetic resonance imaging (MRI) at 32 weeks of gestation; and using all ultrasound scans performed in the third trimester (US3rdT). DESIGN A retrospective study. SETTING Reference fetal medicine unit. POPULATION Sixty-two fetuses infected <14 weeks of gestation. METHODS We defined second-trimester assessment (STA) as the combination of ultrasound findings <28 weeks of gestation and fetal platelet count at cordocentesis. Three groups were defined: normal, extracerebral, and cerebral STA. MAIN OUTCOME MEASURES For each group, the PV of STA alone, STA + MRI, and STA + US3rdT were assessed retrospectively. Outcome at birth and at follow-up were reported. RESULTS The STA was normal, and with extracerebral and cerebral features, in 43.5, 42.0, and 14.5%, respectively. The negative PV of normal STA and MRI for moderate to severe sequelae was 100%. The residual risk was unilateral hearing loss in 16.7% of cases. Of pregnancies with cerebral STA, 44% were terminated. Following extracerebral STA, 48% of neonates were symptomatic and 30% had moderate to severe sequelae. In those cases, the positive and negative PV of MRI for sequelae were 33 and 73%, respectively. STA + US3rdT had a lower negative PV than MRI for symptoms at birth and for moderate to severe sequelae. Any false-positive findings at MRI were mostly the result of hypersignals of white matter. CONCLUSIONS Serial assessment in the second and third trimesters by ultrasound and MRI is necessary to predict the risk of sequelae occurring in 35% of pregnancies following fetal infection in the first trimester of pregnancy. TWEETABLE ABSTRACT Serial ultrasound prognostic assessment following fetal CMV infection in the 1st trimester is improved by MRI at 32 weeks.
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Affiliation(s)
- V Faure-Bardon
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - A-E Millischer
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Radiology, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - B Deloison
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - P Sonigo
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Radiology, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - D Grévent
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Radiology, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - L Salomon
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - J Stirnemann
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - M Nicloux
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Neonatal Intensive Care Unit, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - J-F Magny
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Neonatal Intensive Care Unit, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - M Leruez-Ville
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Y Ville
- EA 73-28, Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Maternity, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
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Bitumba I, Lévy M, Bernard JP, Ville Y, Salomon LJ. [Isolated right aortic arch: prenatal diagnosis characteristics, pregnancy outcomes and systematic review]. ACTA ACUST UNITED AC 2019; 47:726-731. [PMID: 31494313 DOI: 10.1016/j.gofs.2019.09.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate prenatal diagnosis characteristics and pregnancy outcomes associated with isolated right aortic arch (RAA). METHODS A retrospective study including fetuses with isolated RAA, managed between January 2010 and February 2018. Cases were identified from the ultrasound databases of the expert pediatric cardiologists, who made the aforementioned diagnosis. All fetuses were examined by a fetal medicine imaging expert to exclude any extracardiac abnormality. A systematic review was performed to assess the prenatal diagnosis and outcomes of fetuses with isolated RAA. RESULTS Fifty-six fetuses were diagnosed with an isolated RAA. An isolated double aortic arch (DAA) was diagnosed in one fetus. Mean gestational age at diagnosis was 24 weeks. The sex ratio (boy/girl) was 0.89. No significant abnormality was detected in invasive tests (karyotype and FISH or microarray). Only one fetus was misdiagnosed with isolated RAA. He was the only symptomatic (stridor) newborn baby and was later diagnosed with DAA. Four studies were included in our systematic review representing 115 cases of isolated RAA. One significant chromosomal abnormality was detected: a 22q11 deletion in a newborn baby who had a postnatal finding of a soft palate cleft. There was one major obstetric complication: an intrauterine fetal demise at 41 gestational weeks. CONCLUSION Diagnosis of isolated RAA can be challenging. Invasive tests are to be discussed. The diagnosis of isolated RAA should not change obstetric monitoring. Nevertheless, an echocardiography should be performed systematically in these new newborn babies within their first month of life.
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Affiliation(s)
- I Bitumba
- Service de gynécologie obstétrique, hôpital Necker-Enfants malades, 149, rue de Sèvres, 75015 Paris, France.
| | - M Lévy
- Service de cardiologie pédiatrique, hôpital Necker-Enfants malades, 149, rue de Sèvres, 75015 Paris, France
| | - J-P Bernard
- Service de gynécologie obstétrique, hôpital Necker-Enfants malades, 149, rue de Sèvres, 75015 Paris, France
| | - Y Ville
- Service de gynécologie obstétrique, hôpital Necker-Enfants malades, 149, rue de Sèvres, 75015 Paris, France
| | - L-J Salomon
- Service de gynécologie obstétrique, hôpital Necker-Enfants malades, 149, rue de Sèvres, 75015 Paris, France
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42
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Gueneuc A, Spaggiari E, Millischer AE, Michot C, O'Gorman N, Ville Y. Contribution of three-dimensional ultrasound and three-dimensional helical computed tomography to prenatal diagnosis of Stickler syndrome. Ultrasound Obstet Gynecol 2019; 54:279-280. [PMID: 30251283 DOI: 10.1002/uog.20127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/12/2018] [Accepted: 09/20/2018] [Indexed: 06/08/2023]
Affiliation(s)
- A Gueneuc
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - E Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - A E Millischer
- Department of Pediatrics Radiology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - C Michot
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
- Department of Medical Genetics, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - N O'Gorman
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Y Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- University Paris Descartes, Sorbonne Paris-Cité, Paris, France
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43
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Gueneuc A, De Garnier J, Dommergues M, Rivière M, Ville Y, Chalouhi GE. [Impact of sonography simulation in the training of midwifery students]. ACTA ACUST UNITED AC 2019; 47:776-782. [PMID: 31288093 DOI: 10.1016/j.gofs.2019.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE During their studies, French midwives need to acquire basic ultrasound skills to measure the amniotic fluid index, fetal biometry and identify fetal lie and placental positions. They have a clinical ultrasound training during their curriculum to acquire these skills. Assess the contribution that a training on an obstetrical ultrasound simulator (OUS) could make to the competence of midwives and to evaluate the best time to integrate it into their curriculum. METHODS Forty students in their 4th and final year in midwifery were randomized into 2 groups. Group A learned with the traditional academic course, with a clinical ultrasound training which was followed by an evaluation on an OUS (E1A). Group B was evaluated on a simulator before the clinical ultrasound training (E1B). After these initial assessments, both groups were provided with learning and training sessions on OUS, and re-evaluated in the same exercise (E2A and E2B). Group B then completed its clinical ultrasound training and was evaluated one month later on the simulator (E3B). The evaluation consisted of scoring the biometry images according to previously published quality criteria, and of assessing their competence based on a published objective and structured assessment score of ultrasound skills (OSAUS). RESULTS Evaluation 1 found comparable OSAUS scores (2.375/5 vs. 2.24/5 P=0.52) between the two groups (E1A vs. E1B) but a significantly higher image quality score for Group A (P=0.02). In Evaluation 2, an improvement was noted for both groups with comparable OSAUS averages between the two groups (P=0.76). After the clinical training of Group B, their OSAUS score (E3B) was significantly better than that of Group A (E1A) after their clinical training (3.45/5 vs. 2.375/5 [P=0.00017]). The same was true for the quality of their images (12.67/16 vs. 9.95/16 [P=0.003]). CONCLUSION Ultrasound simulation-based training, as an adjunct to ultrasound clinical training, significantly improves obstetrical ultrasound skills. The best time to train on simulators seems to be prior to clinical training on real patients.
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Affiliation(s)
- A Gueneuc
- École de simulation pour l'enseignement et le perfectionnement en échographie gynécologique et obstétricale (SimECHOle), 75006 Paris, France; Service d'obstétrique et de médecine fœtale, université Paris Descartes, Sorbonne Paris cité, hôpital Necker-enfants-malades, AP-HP, 75015 Paris, France
| | - J De Garnier
- Service d'obstétrique et de médecine fœtale, université Paris Descartes, Sorbonne Paris cité, hôpital Necker-enfants-malades, AP-HP, 75015 Paris, France
| | - M Dommergues
- Service de gynécologie et d'obstétrique, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - M Rivière
- École de sages-femmes, hôpital Saint-Antoine, AP-HP, 75012 Paris, France
| | - Y Ville
- École de simulation pour l'enseignement et le perfectionnement en échographie gynécologique et obstétricale (SimECHOle), 75006 Paris, France; Service d'obstétrique et de médecine fœtale, université Paris Descartes, Sorbonne Paris cité, hôpital Necker-enfants-malades, AP-HP, 75015 Paris, France
| | - G E Chalouhi
- École de simulation pour l'enseignement et le perfectionnement en échographie gynécologique et obstétricale (SimECHOle), 75006 Paris, France; Service d'obstétrique et de médecine fœtale, université Paris Descartes, Sorbonne Paris cité, hôpital Necker-enfants-malades, AP-HP, 75015 Paris, France; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Faculty of Medicine and Medical Center, 1107 Beyrouth, Liban.
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44
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Sanz Cortes M, Lapa DA, Acacio GL, Belfort M, Carreras E, Maiz N, Peiro JL, Lim FY, Miller J, Baschat A, Sepulveda G, Davila I, Gielchinsky Y, Benifla M, Stirnemann J, Ville Y, Yamamoto M, Figueroa H, Simpson L, Nicolaides KH. Proceedings of the First Annual Meeting of the International Fetoscopic Myelomeningocele Repair Consortium. Ultrasound Obstet Gynecol 2019; 53:855-863. [PMID: 31169957 DOI: 10.1002/uog.20308] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- M Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - D A Lapa
- Fetal Therapy Program, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - G L Acacio
- Department of Obstetrics, Universidade de Taubate, São Paulo, Brazil
| | - M Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - E Carreras
- Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - N Maiz
- Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - J L Peiro
- Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - F Y Lim
- Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - J Miller
- Department of Gynecology and Obstetrics, Johns Hopkins Center for Fetal Therapy, Baltimore, MD, USA
| | - A Baschat
- Department of Gynecology and Obstetrics, Johns Hopkins Center for Fetal Therapy, Baltimore, MD, USA
| | - G Sepulveda
- Medicine Perinatal Alta Especialidad, Hospital Christus Muguerza Alta Especialidad, Monterrey, NL, Mexico
| | - I Davila
- Medicine Perinatal Alta Especialidad, Hospital Christus Muguerza Alta Especialidad, Monterrey, NL, Mexico
| | - Y Gielchinsky
- Department of Obstetrics & Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Obstetrics & Gynecology, Rabin Medical Center, Petach Tikva, Israel
| | - M Benifla
- Pediatric Neurosurgery Unit, Rambam Health Care Campus, Haifa, Israel
| | - J Stirnemann
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, Paris, France
| | - Y Ville
- Department of Obstetrics and Gynecology, Necker-Enfants Malades Hospital, Paris, France
| | - M Yamamoto
- Universidad Los Andes, Santiago de Chile, Chile
| | - H Figueroa
- Universidad Los Andes, Santiago de Chile, Chile
| | - L Simpson
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York Presbyterian Hospital, New York City, NY, USA
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45
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Luton D, Mitanchez D, Winer N, Muller F, Gallot D, Perrotin F, Jouannic JM, Bretelle F, de Lagausie P, Ville Y, Guibourdenche J, Oury JF, Alberti C, Benachi A. A randomised controlled trial of amnioexchange for fetal gastroschisis. BJOG 2019; 126:1233-1241. [PMID: 31033140 DOI: 10.1111/1471-0528.15804] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Morbidity in fetuses affected by gastroschisis is mainly the result of bowel ischaemic and inflammatory processes. Experimental studies on animal models show that clearing amniotic fluid from the digestive secretions by amnioexchange procedures reduces the inflammatory process. We evaluated the benefit of the amnioexchange procedure for fetal gastroschisis in humans. DESIGN Prospective, interventional, randomised study. SETTING Eight referral centres for fetal medicine. POPULATION Pregnant women carrying a fetus with gastroschisis. METHODS We compared, in utero, amnioexchange with a sham procedure. The protocol included, in both arms, steroid injections at 30 weeks of gestation and the use of postnatal minimal enteral feeding. MAIN OUTCOME MEASURES The primary outcome was a composite variable based on the duration of ventilation and parenteral nutrition. Secondary outcomes were the effectiveness and safety of the amnioexchange procedure, including the rate of perinatal death, time to full enteral feeding, primary closure, and late feeding disorders. RESULTS Sixty-four patients were randomised. There was no difference in the composite criteria between the amnioexchange and control groups. Based on an intention-to-treat analysis, there were no significant between-group differences in pregnancy outcome or complications. When studying the relationship between digestive compounds and amniotic fluid inflammatory markers, a clear correlation was found between bile acid and both ferritin and interleukin 1β (IL1β). CONCLUSIONS In humans, amnioexchange, as described in our protocol, is not an option for fetal care; however, we provide supplementary proof of the involvement of inflammation in the pathogenicity of gastroschisis and suggest that future research should aim at reducing inflammation. ClinicalTrials.gov: NCT00127946. TWEETABLE ABSTRACT A prospective, interventional, randomised study shows no benefit of amnioexchange for fetal gastroschisis in humans.
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Affiliation(s)
- D Luton
- Department of Obstetrics and Gynaecology, AP-HP, Bichat Hospital, Paris, France.,DHU Risks in Pregnancy, Paris, France.,Department of Obstetrics and Gynaecology, AP-HP, Bichat-Claude Bernard Hospital, Paris, France.,Université Paris VII, Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1141, Robert-Debré Hospital, Paris, France
| | - D Mitanchez
- Department of Neonatal Pediatrics, AP-HP, GHUEP, Armand Trousseau Hospital, Paris, France.,Faculty of Medicine, Sorbonne University, Paris, France
| | - N Winer
- Department of Obstetrics and Gynaecology, University Hospital of Nantes, CIC Mère enfant Nantes, UMR 1280 INRA Physiologie des Adaptations Nutritionnelles, Nantes, France
| | - F Muller
- INSERM U1141, Robert-Debré Hospital, Paris, France.,Department of Biochemistry and Hormonology, AP-HP, Robert Debré Hospital, Paris, France
| | - D Gallot
- Department of Obstetrics and Gynaecology, CHU de Clermont-Ferrand - Hôpital d'Estaing, Auvergne University, Clermont-Ferrand, France
| | - F Perrotin
- Department of Obstetrics and Gynaecology, CHRU de Tours, François Rabelais University, Tours, France
| | - J-M Jouannic
- Department of Obstetrics and Gynaecology, Faculty of Medicine, AP-HP, Armand Trousseau Hospital, Sorbonne University, Paris, France
| | - F Bretelle
- Department of Obstetrics and Gynaecology, CHU de Marseille, APHM, Aix Marseille University, Marseille, France
| | - P de Lagausie
- INSERM U1141, Robert-Debré Hospital, Paris, France.,Department of Paediatrics Surgery, AP-HP, Robert Debré Hospital, Paris, France
| | - Y Ville
- Department of Obstetrics and Gynaecology, AP-HP, Necker-Enfants Malades, Paris Descartes University, Paris, France
| | - J Guibourdenche
- Department of Biochemistry and Hormonology, AP-HP, Robert Debré Hospital, Paris, France
| | - J-F Oury
- Department of Obstetrics and Gynaecology, AP-HP, Robert Debré Hospital, Paris, France
| | - C Alberti
- INSERM U1141, Robert-Debré Hospital, Paris, France.,AP-HP, Inserm, Univ. Paris Diderot, Univ. Sorbonne Paris Cité, Robert Debré Hospital, CIC 1426, UMR-S 1123, Paris, France
| | - A Benachi
- Department of Obstetrics and Gynaecology, AP-HP, Antoine Béclère Hospital, Paris-Sud University, Clamart, France
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Di Renzo GC, Cabero Roura L, Facchinetti F, Helmer H, Hubinont C, Jacobsson B, Jørgensen JS, Lamont RF, Mikhailov A, Papantoniou N, Radzinsky V, Shennan A, Ville Y, Wielgos M, Visser GHA. Preterm Labor and Birth Management: Recommendations from the European Association of Perinatal Medicine. J Matern Fetal Neonatal Med 2018; 30:2011-2030. [PMID: 28482713 DOI: 10.1080/14767058.2017.1323860] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- G C Di Renzo
- a Department of Obstetrics and Gynecology , University of Perugia , Perugia , Italy
| | - L Cabero Roura
- b Department of Obstetrics and Gynecology , Hospital Vall D'Hebron , Barcelona , Spain
| | - F Facchinetti
- c Mother-Infant Department, School of Midwifery , University of Modena and Reggio Emilia , Italy
| | - H Helmer
- d Department of Obstetrics and Gynaecology , General Hospital, University of Vienna , Vienna , Austria
| | - C Hubinont
- e Department of Obstetrics , Saint Luc University Hospital, Université de Louvain , Brussels , Belgium
| | - B Jacobsson
- f Department of Obstetrics and Gynecology , Institute of Clinical Sciences, University of Gothenburg , Gothenburg , Sweden
| | - J S Jørgensen
- g Department of Obstetrics and Gynaecology , Odense University Hospital , Odense , Denmark
| | - R F Lamont
- h Department of Gynaecology and Obstetrics , University of Southern Denmark, Odense University Hospital , Odense , Denmark.,i Division of Surgery , University College London, Northwick Park Institute of Medical Research Campus , London , UK
| | - A Mikhailov
- j Department of Obstetrics and Gynecology , 1st Maternity Hospital, State University of St. Petersburg , Russia
| | - N Papantoniou
- k Department of Obstetrics and Gynaecology , Athens University School of Medicine , Athens , Greece
| | - V Radzinsky
- l Department of Medicine , Peoples' Friendship University of Russia , Moscow , Russia
| | - A Shennan
- m St. Thomas Hospital, Kings College London , UK
| | - Y Ville
- n Service d'Obstétrique et de Médecine Foetale , Hôpital Necker Enfants Malades , Paris , France
| | - M Wielgos
- p Department of Obstetrics and Gynecology , Medical University of Warsaw , Warsaw , Poland
| | - G H A Visser
- o Department of Obstetrics , University Medical Center , Utrecht , The Netherlands
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Abstract
In June 2018, Mothers and Babies Reducing Risks through Audits and Confidential Enquiries across the UK (MBRRACE-UK) published a Perinatal Surveillance report of an audit between 2013-2016. This noted that the stillbirth rate for twins nearly halved between 2014-2016; whereas the stillbirth rate for singletons remained static. There was a statistically significant reduction in the rate of stillbirth in twins over this period from 11.07 (95% CI, 9.78-12.47) to 6.16 (95% CI, 5.20-7.24) per 1000 total births. This commentary discusses these observations, the effects of twin chorionicity, and the potential obstetric and neonatal interventions, as well as public health improvements, that may have influenced these findings.
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Affiliation(s)
- M D Kilby
- Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J L Gibson
- Maternal and Fetal Medicine, Ian Donald Fetal Medicine Centre, Queen Elizabeth University Hospital, Glasgow, UK
| | - Y Ville
- Department of Obstetrics and Gynaecology, Paris Descartes University, Paris, France.,Department of Obstetrics and Fetal Medicine, Necker-Enfants-Malades Hospital, Paris, France
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48
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Kuleva M, Ben Miled S, Steffann J, Bonnefont JP, Rondeau S, Ville Y, Munnich A, Salomon LJ. Increased incidence of obstetric complications in women carrying mitochondrial DNA mutations: a retrospective cohort study in a single tertiary centre. BJOG 2018. [PMID: 30461153 DOI: 10.1111/1471‐0528.15515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the obstetric outcome of women carriers of the oxidative phosphorylation (OXPHOS) disorder mutation. DESIGN A retrospective cohort study in a single tertiary centre. SETTING A review of the obstetric history of women referred for prenatal screening of a mitochondrial disorder was performed. POPULATION Women were divided into three groups: (1) women carrying mitochondrial DNA (mtDNA) mutations; (2) healthy women with a family history of mtDNA-related OXPHOS disorder; and (3) healthy women carrying heterozygote nuclear DNA mutations. METHODS Obstetric history and pregnancy complications were evaluated separately in the three groups and compared with the control group. MAIN OUTCOME MEASURES PREGNANCY COMPLICATIONS. RESULTS Seventy-five women were included with 287 cumulative pregnancies. Groups 1 and 3 had a significantly greater proportion of terminations of pregnancy (20 and 13% versus 0.8%, P < 0.001), and a lower percentage of live births (52 and 72% versus 87%, P = 0.001), compared with controls. Apart from this, the rate of obstetric complications in group 3 did not differ from the controls. The obstetric history of women in group 1 was marked by higher rates of early miscarriages (26 versus 11%, P = 0.004), gestational diabetes (14 versus 3%, P = 0.02), intrauterine growth restriction (IUGR, 10 versus 1%, P = 0.008), and postpartum haemorrhage than were reported for controls (12 versus 2%, P = 0.01). CONCLUSION Women who are heteroplasmic for OXPHOS mutations have a higher incidence of pregnancy losses, gestational diabetes, IUGR, and post postpartum haemorrhage. TWEETABLE ABSTRACT Women heteroplasmic for mitochondrial DNA mutations have a higher incidence of obstetric complications, compared with the control group.
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Affiliation(s)
- M Kuleva
- Department of Obstetrics, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - S Ben Miled
- Department of Obstetrics, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - J Steffann
- Imagine Institute, UMR 1163, Hôpital Necker - Enfants Malades, Paris Descartes University, Paris, France
| | - J P Bonnefont
- Imagine Institute, UMR 1163, Hôpital Necker - Enfants Malades, Paris Descartes University, Paris, France
| | - S Rondeau
- Imagine Institute, UMR 1163, Hôpital Necker - Enfants Malades, Paris Descartes University, Paris, France
| | - Y Ville
- Department of Obstetrics, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - A Munnich
- Imagine Institute, UMR 1163, Hôpital Necker - Enfants Malades, Paris Descartes University, Paris, France
| | - L J Salomon
- Department of Obstetrics, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
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49
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Kuleva M, Ben Miled S, Steffann J, Bonnefont JP, Rondeau S, Ville Y, Munnich A, Salomon LJ. Increased incidence of obstetric complications in women carrying mitochondrial DNA mutations: a retrospective cohort study in a single tertiary centre. BJOG 2018; 126:1372-1379. [PMID: 30461153 DOI: 10.1111/1471-0528.15515] [Citation(s) in RCA: 9] [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] [Accepted: 09/20/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the obstetric outcome of women carriers of the oxidative phosphorylation (OXPHOS) disorder mutation. DESIGN A retrospective cohort study in a single tertiary centre. SETTING A review of the obstetric history of women referred for prenatal screening of a mitochondrial disorder was performed. POPULATION Women were divided into three groups: (1) women carrying mitochondrial DNA (mtDNA) mutations; (2) healthy women with a family history of mtDNA-related OXPHOS disorder; and (3) healthy women carrying heterozygote nuclear DNA mutations. METHODS Obstetric history and pregnancy complications were evaluated separately in the three groups and compared with the control group. MAIN OUTCOME MEASURES PREGNANCY COMPLICATIONS. RESULTS Seventy-five women were included with 287 cumulative pregnancies. Groups 1 and 3 had a significantly greater proportion of terminations of pregnancy (20 and 13% versus 0.8%, P < 0.001), and a lower percentage of live births (52 and 72% versus 87%, P = 0.001), compared with controls. Apart from this, the rate of obstetric complications in group 3 did not differ from the controls. The obstetric history of women in group 1 was marked by higher rates of early miscarriages (26 versus 11%, P = 0.004), gestational diabetes (14 versus 3%, P = 0.02), intrauterine growth restriction (IUGR, 10 versus 1%, P = 0.008), and postpartum haemorrhage than were reported for controls (12 versus 2%, P = 0.01). CONCLUSION Women who are heteroplasmic for OXPHOS mutations have a higher incidence of pregnancy losses, gestational diabetes, IUGR, and post postpartum haemorrhage. TWEETABLE ABSTRACT Women heteroplasmic for mitochondrial DNA mutations have a higher incidence of obstetric complications, compared with the control group.
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Affiliation(s)
- M Kuleva
- Department of Obstetrics, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - S Ben Miled
- Department of Obstetrics, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - J Steffann
- Imagine Institute, UMR 1163, Hôpital Necker - Enfants Malades, Paris Descartes University, Paris, France
| | - J P Bonnefont
- Imagine Institute, UMR 1163, Hôpital Necker - Enfants Malades, Paris Descartes University, Paris, France
| | - S Rondeau
- Imagine Institute, UMR 1163, Hôpital Necker - Enfants Malades, Paris Descartes University, Paris, France
| | - Y Ville
- Department of Obstetrics, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - A Munnich
- Imagine Institute, UMR 1163, Hôpital Necker - Enfants Malades, Paris Descartes University, Paris, France
| | - L J Salomon
- Department of Obstetrics, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
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50
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Deloison B, Sonigo P, Millischer-Bellaiche AE, Quibel T, Cavallin M, Benoist G, Quelin C, Jouk PS, Lev D, Alison M, Baumann C, Beldjord C, Razavi F, Bessières B, Boddaert N, Ville Y, Salomon LJ, Bahi-Buisson N. Prenatally diagnosed periventricular nodular heterotopia: Further delineation of the imaging phenotype and outcome. Eur J Med Genet 2018; 61:773-782. [PMID: 30391507 DOI: 10.1016/j.ejmg.2018.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/17/2017] [Revised: 10/24/2018] [Accepted: 10/28/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Periventricular nodular heterotopia (PNH) is a malformation of cortical development which presents with heterogeneous imaging, neurological phenotype and outcome. There is a paucity of comprehensive description detailing the prenatal diagnosis of PNH. The aim of this study is to report neuroimaging features and correlated outcomes in order to delineate the spectrum of prenatally diagnosed PNH. METHODS It was a retrospective study over 15 years in five tertiary centers. All fetuses with prenatally diagnosed PNH were collected. Fetal ultrasound and MRI were reviewed and genetic screening collected. Prenatal findings were analyzed in correlation to fetopathological analyses and post-natal follow up. RESULTS Thirty fetuses (22 females and 8 males) with PNH were identified. The two major ultrasound signs were ventriculomegaly associated with dysmorphic frontal horns (60%) and posterior fossa anomalies (73.3%). On MRI, two groups of PNH were identified: the contiguous and diffuse PNH (n = 15, 50%), often associated with megacisterna magna, and the non-diffuse, either anterior, posterior or unilateral PNH. FLNA mutations were found in 6/11 cases with diffuse PNH. Additional cortical malformations were exclusively observed in non diffuse PNH (9/15; 60%). Twenty-four pregnancies (80%) were terminated. Six children aged 6 months to 5 years are alive. Five have normal neurodevelopment (all had diffuse PNH) whereas one case with non diffuse PNH has developmental delay and epilepsy. CONCLUSION PNH is heterogeneous but patients with diffuse PNH are a common subgroup with specific findings on prenatal imaging and implications for prenatal counseling.
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Affiliation(s)
- B Deloison
- Department of Obstetrics and Gynecology and SFAPE Société Française pour l'Amélioration des Pratiques Echographiques, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Descartes - Sorbonne Paris Cités, France; EA 7328 FETUS, Université Paris Descartes, France
| | - P Sonigo
- Pediatric Radiology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - A E Millischer-Bellaiche
- Pediatric Radiology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T Quibel
- Department of Obstetrics and Gynecology, Poissy Saint-Germain Hospital, Poissy, France
| | - M Cavallin
- Université Paris Descartes - Sorbonne Paris Cités, France; Institut Imagine-INSERM UMR-1163, Embryology and genetics of congenital malformations, France; Pediatric Neurology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - G Benoist
- Department of Obstetrics and Gynecology, Caen Hospital, Caen Basse Normandie University, France
| | - C Quelin
- Clinical Genetic Department, Rennes Hospital, France
| | - P S Jouk
- Clinical Genetic Department, Grenoble Hospital, France
| | - D Lev
- Institute of Medical Genetics, Wolfson Medical Center, Holon, Israel
| | - M Alison
- Pediatric Radiology, Robert Debre Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Baumann
- Clinical Genetics Department, Robert Debre Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Beldjord
- Department of Molecular Genetics, Cochin-Port-Royal Université Paris Descartes - Sorbonne Paris Cités, Paris, France
| | - F Razavi
- Fetopathology Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - B Bessières
- Fetopathology Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - N Boddaert
- Université Paris Descartes - Sorbonne Paris Cités, France; Pediatric Radiology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Y Ville
- Department of Obstetrics and Gynecology and SFAPE Société Française pour l'Amélioration des Pratiques Echographiques, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Descartes - Sorbonne Paris Cités, France; EA 7328 FETUS, Université Paris Descartes, France
| | - L J Salomon
- Department of Obstetrics and Gynecology and SFAPE Société Française pour l'Amélioration des Pratiques Echographiques, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Descartes - Sorbonne Paris Cités, France; EA 7328 FETUS, Université Paris Descartes, France
| | - N Bahi-Buisson
- Université Paris Descartes - Sorbonne Paris Cités, France; Institut Imagine-INSERM UMR-1163, Embryology and genetics of congenital malformations, France; Pediatric Neurology, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
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