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Ross C, Deruelle P, Pontvianne M, Lecointre L, Wieder S, Kuhn P, Lodi M. Prediction of adverse neonatal adaptation in fetuses with severe fetal growth restriction after 34 weeks of gestation. Eur J Obstet Gynecol Reprod Biol 2024; 296:258-264. [PMID: 38490046 DOI: 10.1016/j.ejogrb.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE To establish a predictive model for adverse immediate neonatal adaptation (INA) in fetuses with suspected severe fetal growth restriction (FGR) after 34 gestational weeks (GW). METHODS We conducted a retrospective observational study at the University Hospitals of Strasbourg between 2000 and 2020, including 1,220 women with a singleton pregnancy and suspicion of severe FGR who delivered from 34 GW. The primary outcome (composite) was INA defined as Apgar 5-minute score <7, arterial pH <7.10, immediate transfer to pediatrics, or the need for resuscitation at birth. We developed and tested a logistic regression predictive model. RESULTS Adverse INA occurred in 316 deliveries. The model included six features available before labor: parity, gestational age, diabetes, middle cerebral artery Doppler, cerebral-placental inversion, onset of labor. The model could predict individual risk of adverse INA with confidence interval at 95 %. Taking an optimal cutoff threshold of 32 %, performances were: sensitivity 66 %; specificity 83 %; positive and negative predictive values 60 % and 87 % respectively, and area under the curve 78 %. DISCUSSION The predictive model showed good performances and a proof of concept that INA could be predicted with pre-labor characteristics, and needs to be investigated further.
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Affiliation(s)
- Célia Ross
- Obstetrics and Gynecology Department, Strasbourg University Hospitals, 1 Avenue Molière, Strasbourg 67200, France
| | - Philippe Deruelle
- Obstetrics and Gynecology Department, Strasbourg University Hospitals, 1 Avenue Molière, Strasbourg 67200, France
| | - Mary Pontvianne
- Obstetrics and Gynecology Department, Strasbourg University Hospitals, 1 Avenue Molière, Strasbourg 67200, France
| | - Lise Lecointre
- Obstetrics and Gynecology Department, Strasbourg University Hospitals, 1 Avenue Molière, Strasbourg 67200, France
| | - Samuel Wieder
- Independent Researcher and Software Architect, France
| | - Pierre Kuhn
- Pediatrics Department, Strasbourg University Hospitals, 1 Avenue Molière, Strasbourg 67200, France
| | - Massimo Lodi
- Obstetrics and Gynecology Department, Strasbourg University Hospitals, 1 Avenue Molière, Strasbourg 67200, France; Institute of Genetics and Molecular and Cellular Biology (IGBMC), CNRS, UMR7104 INSERM U964, Strasbourg University, 1 rue Laurent Fries, Illkirch-Graffenstaden 67400, France; Louis Pasteur Hospital, 39 Avenue de la Liberté, Colmar 68024, France.
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Shahbazi A, Mueller AA, Mezey S, Gschwindt S, Kiss T, Baksa G, Kisnisci RS. Is the collateral circulation pattern in the hard palate affected by cleft deformity? Clin Oral Investig 2024; 28:277. [PMID: 38668852 PMCID: PMC11052802 DOI: 10.1007/s00784-024-05627-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/20/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES To evaluate the influence of collateral vascularization on surgical cleft palate closure and deformities. MATERIALS AND METHODS Corrosion casting was performed using red-colored acrylic resin in twelve fresh adult cadavers with a normal hard palate. Additionally, white-colored barium sulfate was injected into a fetus with a unilateral complete cleft palate, and layer-by-layer tissue dissection was performed. Both substances were injected into the external carotid arteries. Corrosion casting involved dissolving the soft and hard tissues of the orofacial area utilizing an enzymatic solution. RESULTS In normal palates, bilateral intraosseous infraorbital arteries formed a network in the premaxilla with the intraosseous nasopalatine- and greater palatine arteries (GPAs). The perforating GPAs anastomosed with the sphenopalatine artery sub-branches. Bilateral extraosseous GPA anastomoses penetrated the median palatine suture. Complex vascularization in the retrotuberal area was detected. In the cleft zone, anastomoses were omitted, whereas in the non-cleft zone, enlarged GPAs were distributed along the cleft edges and followed the anatomical course anteriorly to initiate the network with facial artery sub-branches. CONCLUSIONS The anatomical subunits of the palate exhibited distinct anastomosis patterns. Despite omitted anastomoses with collateral circulation in the cleft zone, arteries maintained their anatomical pattern as seen in the normal specimen in the non-cleft zone. CLINICAL RELEVANCE Based on the findings in normal- and cleft palates, surgeons may expect developed anastomosis patterns in the non-cleft zone. Due to the lack of microcirculation in the cleft zone, the existent anastomoses should be maintained as much as possible by the surgical technique. This applies anteriorly in the incisive canal territory, alveolar ridges, and posteriorly in the retrotuberal area.
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Affiliation(s)
- Arvin Shahbazi
- Department of Anatomy, Histology and Embryology (Oral Morphology Group), Semmelweis University, Budapest, Hungary.
- Department of Restorative Dentistry and Endodontics, Semmelweis University, Budapest, Hungary.
- Department of Periodontology, Semmelweis University, Budapest, Hungary.
| | - Andreas A Mueller
- Department of Oral and Craniomaxillofacial Surgery, University Hospital Basel and University Children's Hospital Basel, Basel, Switzerland
- Facial and Cranial Anomalies Research Group, Department of Biomedical Engineering and Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Szilvia Mezey
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Sebastian Gschwindt
- Department of Anatomy, Histology and Embryology (Oral Morphology Group), Semmelweis University, Budapest, Hungary
| | - Tamás Kiss
- Pont32 Dental and Oral Surgery Clinic, Budapest, Hungary
| | - Gábor Baksa
- Department of Anatomy, Histology and Embryology (Oral Morphology Group), Semmelweis University, Budapest, Hungary
| | - Reha S Kisnisci
- Department of Oral and Maxillofacial Surgery, Lokman Hekim University, Ankara, Türkiye
- Cleft Lip & Palate and Related Anomalies Research and Treatment Center, Ankara, Türkiye
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Rouzer SK, Sreeram A, Miranda RC. Reduced fetal cerebral blood flow predicts perinatal mortality in a mouse model of prenatal alcohol and cannabinoid exposure. BMC Pregnancy Childbirth 2024; 24:263. [PMID: 38605299 PMCID: PMC11007973 DOI: 10.1186/s12884-024-06436-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Children exposed prenatally to alcohol or cannabinoids individually can exhibit growth deficits and increased risk for adverse birth outcomes. However, these drugs are often co-consumed and their combined effects on early brain development are virtually unknown. The blood vessels of the fetal brain emerge and mature during the neurogenic period to support nutritional needs of the rapidly growing brain, and teratogenic exposure during this gestational window may therefore impair fetal cerebrovascular development. STUDY DESIGN To determine whether prenatal polysubstance exposure confers additional risk for impaired fetal-directed blood flow, we performed high resolution in vivo ultrasound imaging in C57Bl/6J pregnant mice. After pregnancy confirmation, dams were randomly assigned to one of four groups: drug-free control, alcohol-exposed, cannabinoid-exposed or alcohol-and-cannabinoid-exposed. Drug exposure occurred daily between Gestational Days 12-15, equivalent to the transition between the first and second trimesters in humans. Dams first received an intraperitoneal injection of either cannabinoid agonist CP-55,940 (750 µg/kg) or volume-equivalent vehicle. Then, dams were placed in vapor chambers for 30 min of inhalation of either ethanol or room air. Dams underwent ultrasound imaging on three days of pregnancy: Gestational Day 11 (pre-exposure), Gestational Day 13.5 (peri-exposure) and Gestational Day 16 (post-exposure). RESULTS All drug exposures decreased fetal cranial blood flow 24-hours after the final exposure episode, though combined alcohol and cannabinoid co-exposure reduced internal carotid artery blood flow relative to all other exposures. Umbilical artery metrics were not affected by drug exposure, indicating a specific vulnerability of fetal cranial circulation. Cannabinoid exposure significantly reduced cerebroplacental ratios, mirroring prior findings in cannabis-exposed human fetuses. Post-exposure cerebroplacental ratios significantly predicted subsequent perinatal mortality (p = 0.019, area under the curve, 0.772; sensitivity, 81%; specificity, 85.70%) and retroactively diagnosed prior drug exposure (p = 0.005; AUC, 0.861; sensitivity, 86.40%; specificity, 66.7%). CONCLUSIONS Fetal cerebrovasculature is significantly impaired by exposure to alcohol or cannabinoids, and co-exposure confers additional risk for adverse birth outcomes. Considering the rising potency and global availability of cannabis products, there is an imperative for research to explore translational models of prenatal drug exposure, including polysubstance models, to inform appropriate strategies for treatment and care in pregnancies affected by drug exposure.
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Affiliation(s)
- Siara Kate Rouzer
- Department of Neuroscience and Experimental Therapeutics, Texas A&M School of Medicine, 8447 Riverside Parkway, Bryan, TX, 77807, USA
| | - Anirudh Sreeram
- Department of Neuroscience and Experimental Therapeutics, Texas A&M School of Medicine, 8447 Riverside Parkway, Bryan, TX, 77807, USA
| | - Rajesh C Miranda
- Department of Neuroscience and Experimental Therapeutics, Texas A&M School of Medicine, 8447 Riverside Parkway, Bryan, TX, 77807, USA.
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Souka AP, Chatziioannou MI, Pegkou A, Antsaklis P, Daskalakis G. The role of the PLGF in the management of pregnancies complicated with fetal microsomia. Arch Gynecol Obstet 2024; 309:1369-1376. [PMID: 36977917 DOI: 10.1007/s00404-023-07012-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE To explore the contribution of maternal and fetal parameters in predicting the time interval between diagnosis and development of adverse events leading to delivery in singleton pregnancies complicated with fetal microsomia. METHODS Prospective study on singleton pregnancies referred to a tertiary center because of suspicion of fetal smallness in the third trimester. The study cohort included cases with fetal abdominal circumference (AC) ≤ 10th centile or estimated fetal weight ≤ 10th centile or umbilical artery pulsatitlity index ≥ 90th centile. Development of pre-eclampsia, fetal demise, and fetal deterioration diagnosed by fetal Doppler studies or fetal heart rate monitoring and leading to delivery were considered as adverse events. Maternal demographics, obstetric history, blood pressure, serum PLGF, and fetal Doppler studies were explored as predictors of the time interval between the first visit to the clinic and the diagnosis of complications. RESULTS In 59 women, the median incubation period from presentation to the clinic to an adverse event was 6, 2 weeks, whereas half of the pregnancies (52.5%) did not develop any adverse event. PLGF was the strongest predictor of adverse events. Both PLGF in raw values and PLGF MOM had equally good predictive ability (AUC 0.82 and 0.78 respectively). Optimal cut-off points were 177.7 pg/ml for PLGF raw values (sensitivity 83% and specificity 66.7%) and 0.277 MoM (sensitivity 76% and specificity 86.7%). On multiple Cox regression analysis, maternal systolic blood pressure, PLGF, fetal increased umbilical artery PI, and reduced CP ratio were independently associated with adverse events. Half of the pregnancies with low PLGF and only one in ten with high PLGF were delivered within two weeks after the initial visit. CONCLUSION Half of the pregnancies carrying a small fetus in the third trimester will not develop maternal or fetal complications. PLGF is a strong predictor of adverse events that can be used to customize antenatal care.
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Affiliation(s)
- Athena P Souka
- Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens-Faculty of Medicine,, Emvryomitriki Fetal Medicine Unit, 41 D.Soutsou Str, 11521, Athens, Greece.
| | - M I Chatziioannou
- Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens-Faculty of Medicine,, Emvryomitriki Fetal Medicine Unit, 41 D.Soutsou Str, 11521, Athens, Greece
| | - A Pegkou
- Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens-Faculty of Medicine,, Emvryomitriki Fetal Medicine Unit, 41 D.Soutsou Str, 11521, Athens, Greece
| | - P Antsaklis
- Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens-Faculty of Medicine,, Emvryomitriki Fetal Medicine Unit, 41 D.Soutsou Str, 11521, Athens, Greece
| | - G Daskalakis
- Department of Obstetrics and Gynecology, Alexandra Hospital, National and Kapodistrian University of Athens-Faculty of Medicine,, Emvryomitriki Fetal Medicine Unit, 41 D.Soutsou Str, 11521, Athens, Greece
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Vellvé K, Garcia-Canadilla P, Nogueira M, Youssef L, Arranz A, Nakaki A, Boada D, Blanco I, Faner R, Figueras F, Agustí À, Gratacós E, Crovetto F, Bijnens B, Crispi F. Pulmonary vascular reactivity in growth restricted fetuses using computational modelling and machine learning analysis of fetal Doppler waveforms. Sci Rep 2024; 14:5919. [PMID: 38467666 PMCID: PMC10928161 DOI: 10.1038/s41598-024-54603-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
The aim of this study was to investigate the pulmonary vasculature in baseline conditions and after maternal hyperoxygenation in growth restricted fetuses (FGR). A prospective cohort study of singleton pregnancies including 97 FGR and 111 normally grown fetuses was carried out. Ultrasound Doppler of the pulmonary vessels was obtained at 24-37 weeks of gestation and data were acquired before and after oxygen administration. After, Machine Learning (ML) and a computational model were used on the Doppler waveforms to classify individuals and estimate pulmonary vascular resistance (PVR). Our results showed lower mean velocity time integral (VTI) in the main pulmonary and intrapulmonary arteries in baseline conditions in FGR individuals. Delta changes of the main pulmonary artery VTI and intrapulmonary artery pulsatility index before and after hyperoxygenation were significantly greater in FGR when compared with controls. Also, ML identified two clusters: A (including 66% controls and 34% FGR) with similar Doppler traces over time and B (including 33% controls and 67% FGR) with changes after hyperoxygenation. The computational model estimated the ratio of PVR before and after maternal hyperoxygenation which was closer to 1 in cluster A (cluster A 0.98 ± 0.33 vs cluster B 0.78 ± 0.28, p = 0.0156). Doppler ultrasound allows the detection of significant changes in pulmonary vasculature in most FGR at baseline, and distinct responses to hyperoxygenation. Future studies are warranted to assess its potential applicability in the clinical management of FGR.
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Affiliation(s)
- Kilian Vellvé
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Sabino Arana 1, 08028, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Patricia Garcia-Canadilla
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Sabino Arana 1, 08028, Barcelona, Spain
- Interdisciplinary Cardiovascular Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Mariana Nogueira
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Lina Youssef
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Sabino Arana 1, 08028, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Angela Arranz
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Sabino Arana 1, 08028, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ayako Nakaki
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Sabino Arana 1, 08028, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Boada
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Sabino Arana 1, 08028, Barcelona, Spain
| | - Isabel Blanco
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Pneumology Department, Respiratory Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Respiratory Diseases (CIBER-ES), Madrid, Spain
| | - Rosa Faner
- Centre for Biomedical Research on Respiratory Diseases (CIBER-ES), Madrid, Spain
| | - Francesc Figueras
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Sabino Arana 1, 08028, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Àlvar Agustí
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Pneumology Department, Respiratory Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Centre for Biomedical Research on Respiratory Diseases (CIBER-ES), Madrid, Spain
- Cathedra Salud Respiratoria, University of Barcelona, Barcelona, Spain
| | - Eduard Gratacós
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Sabino Arana 1, 08028, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | - Francesca Crovetto
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Sabino Arana 1, 08028, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain
| | | | - Fàtima Crispi
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), University of Barcelona, Sabino Arana 1, 08028, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
- Centre for Biomedical Research on Rare Diseases (CIBER-ER), Madrid, Spain.
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Chan ES, Suchet I, Yu W, Somerset D, Soliman N, Kuret V, Chadha R. Absence of Ductus Venosus: A Comparison of 2 Distinctive Fetal Autopsy Cases and Embryologic Perspectives. Pediatr Dev Pathol 2024; 27:139-147. [PMID: 38098271 PMCID: PMC11015709 DOI: 10.1177/10935266231211760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
In fetal circulation, oxygenated blood from the placenta flows through the umbilical vein into the ductus venosus (DV), then enters the inferior vena cava, and subsequently reaches the right atrium of the heart. The DV serves as a shunt, allowing this oxygen-rich blood to bypass the liver. The absence of the DV (ADV), also known as agenesis of the DV, is a rare congenital anomaly. Without a DV, blood from the umbilical vein must follow alternative routes to the heart. In ADV cases, blood from the umbilical vein must follow 1 of 2 primary drainage patterns: either an extrahepatic shunt or an intrahepatic shunt. This report details the antenatal ultrasound and postmortem findings of 2 fetuses diagnosed with ADV by prenatal imaging studies. The first case involved a fetus with a persistent right umbilical vein connected directly to the suprahepatic IVC, accompanied by early obliteration of the left umbilical vein and true agenesis of the DV. This fetus also had additional congenital anomalies. In contrast, the second case involved a fetus with a normal left umbilical vein that entered the liver. However, despite an ultrasound diagnosis of "absence" of the DV, a DV was present, though markedly hypoplastic and probably minimally functional or non-functional. In this case, blood from the umbilical vein likely followed an alternate intrahepatic route through the portal and hepatic veins, before reaching the heart (intrahepatic shunt). These contrasting cases emphasize the heterogeneity of vascular anomalies and embryologic origins captured by the term "ADV." Additionally, the terminology of "absence" or "agenesis" may be misleading in some purported ADV cases. Specifically, in the second case, the DV was not absent; it was markedly hypoplastic instead. This also appears to be the first reported case of a hypoplastic DV in a fetus. Both cases underscore the importance of effective collaboration and clear communication between maternal-fetal medicine specialists and pathologists.
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Affiliation(s)
- Elaine S. Chan
- Department of Pathology and Laboratory Medicine, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Alberta Precision Laboratories, Calgary, AB, Canada
- Alberta Children’s Hospital, Calgary, AB, Canada
| | - Ian Suchet
- Department of Obstetrics and Gynaecology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Weiming Yu
- Department of Pathology and Laboratory Medicine, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Alberta Precision Laboratories, Calgary, AB, Canada
- Alberta Children’s Hospital, Calgary, AB, Canada
| | - David Somerset
- Department of Obstetrics and Gynaecology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- EFW Radiology, Calgary, AB, Canada
| | - Nancy Soliman
- Department of Obstetrics and Gynaecology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- EFW Radiology, Calgary, AB, Canada
| | - Verena Kuret
- Department of Obstetrics and Gynaecology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- EFW Radiology, Calgary, AB, Canada
| | - Rati Chadha
- Department of Obstetrics and Gynaecology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- EFW Radiology, Calgary, AB, Canada
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Marsosi V, Haghighi L, Nasimi PH, Ghaemi M, Navaee S. Effects of sildenafil on Doppler parameters, maternal and neonatal outcomes in the active labor phase of low-risk pregnancies: a randomized clinical trial. J Perinat Med 2024; 52:210-214. [PMID: 37931599 DOI: 10.1515/jpm-2023-0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/12/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES The benefits of sildenafil by increasing blood flow in the improvement of Doppler parameters of umbilical (UA), uterine (UtA), and fetal middle cerebral arteries (MCA) remain uncertain. On the other hand, insufficient blood flow during uterine contractions in labor can lead to decrease blood supply and fetal distress. Therefore, we aimed to assess the changes in fetal Doppler indices and maternal and neonatal outcomes following the use of sildenafil in the active phase of labor in low-risk pregnancies with healthy fetuses. METHODS This randomized double-blinded controlled trial was conducted on 70 pregnant single low-risk, pregnant women. The patients were randomly assigned into two groups receiving sildenafil (n=35) or placebo (n=35) when the active phase of labor was initiated. Doppler parameters were assessed at baseline as well as 3 h after that. Indeed, the maternal and neonatal outcomes were compared between groups. RESULTS The Doppler parameters including the pulsatility index of MCA, UA, and left and right UtA remained unchanged after the administration of sildenafil. Neonatal outcomes including birth weight, PH of the umbilical artery, Apgar score, respiratory distress syndrome, and neonatal intensive care unit admission as well as maternal outcomes such as cesarean section rate and the occurrence of intrapartum/postpartum hemorrhage had no difference between groups. CONCLUSIONS The use of sildenafil in the active phase of labor in low-risk pregnancies may not be beneficial in improving Doppler parameters in MCA, umbilical, and uterine arteries and thus may not improve pregnancy outcomes.
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Affiliation(s)
- Vajiheh Marsosi
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ladan Haghighi
- Shahid Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Marjan Ghaemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saimaz Navaee
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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8
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Choi ES, Lee H, Lee SJ, Jung YM, Kim HY, Lee SM, Lee KA, Seol HJ, Ko HS, Na SH, Kwak DW, Hwang HS, Choi S, Hong SC, Won HS, Kim SY, Kim HJ, Ahn KH. Ultrasonographic assessment of abnormal fetal growth related to uteroplacental-fetal biometrics and Doppler (U-AID) indices: Protocol for multicenter retrospective cohort study trial. PLoS One 2024; 19:e0298060. [PMID: 38359058 PMCID: PMC10868764 DOI: 10.1371/journal.pone.0298060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Fetal growth restriction (FGR) is one of the leading causes of perinatal morbidity and mortality. Many studies have reported an association between FGR and fetal Doppler indices focusing on umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV). The uteroplacental-fetal circulation which affects the fetal growth consists of not only UA, MCA, and DV, but also umbilical vein (UV), placenta and uterus itself. Nevertheless, there is a paucity of large-scale cohort studies that have assessed the association between UV, uterine wall, and placental thickness with perinatal outcomes in FGR, in conjunction with all components of the uteroplacental-fetal circulation. Therefore, this multicenter study will evaluate the association among UV absolute flow, placental thickness, and uterine wall thickness and adverse perinatal outcome in FGR fetuses. This multicenter retrospective cohort study will include singleton pregnant women who undergo at least one routine fetal ultrasound scan during routine antepartum care. Pregnant women with fetuses having structural or chromosomal abnormalities will be excluded. The U-AID indices (UtA, UA, MCA, and UV flow, placental and uterine wall thickness, and estimated fetal body weight) will be measured during each trimester of pregnancy. The study population will be divided into two groups: (1) FGR group (pregnant women with FGR fetuses) and (2) control group (those with normal growth fetus). We will assess the association between U-AID indices and adverse perinatal outcomes in the FGR group and the difference in U-AID indices between the two groups.
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Affiliation(s)
- Eun-Saem Choi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Hwasun Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Se Jin Lee
- Department of Obstetrics and Gynecology, School of Medicine Kangwon National University, Chuncheon-si, Gangwon-Do, Korea
| | - Young Mi Jung
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Yeon Kim
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seung Mi Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung A. Lee
- Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyun-Joo Seol
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun Sun Ko
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hun Na
- Department of Obstetrics and Gynecology, School of Medicine Kangwon National University, Chuncheon-si, Gangwon-Do, Korea
| | - Dong Wook Kwak
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Han-Sung Hwang
- Department of Obstetrics and Gynecology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Sooran Choi
- Department of Obstetrics and Gynecology, College of Medicine, Inha University, Incheon, Korea
| | - Soon-Cheol Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Hye-Sung Won
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Young Kim
- Department of Obstetrics and Gynecology, Gachon University Gil Hospital, Incheon, South Korea
| | - Hai-Joong Kim
- Department of Obstetrics and Gynecology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Korea
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9
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Thornton J, Alfirevic Z, Berghella V, Ganzevoort W, Kenny L, Mol B, Muriithi F, Rouse D, Shennan A, Strandell A, Post JAMVD, Wely MV. Comment: The Effect of Antenatal Vaginal Progesterone Administration on Uterine, Umbilical, and Fetal Middle Cerebral Artery Doppler Flow: A Cohort Study. Am J Perinatol 2024; 41:373-374. [PMID: 35240696 DOI: 10.1055/a-1787-7744] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Jim Thornton
- University of Nottingham, Nottingham, United Kingdom
| | | | | | | | - Louise Kenny
- University of Liverpool, Merseyside, United Kingdom
| | - Ben Mol
- Monash University, Clayton, Victoria, Australia
| | | | | | | | | | | | - Madelon van Wely
- University of Amsterdam, Duivendrecht, Noord-Holland, The Netherlands
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10
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La Verde M, Savoia F, Riemma G, Schiattarella A, Conte A, Hidar S, Torella M, Colacurci N, De Franciscis P, Morlando M. Fetal aortic isthmus Doppler assessment to predict the adverse perinatal outcomes associated with fetal growth restriction: systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:79-92. [PMID: 37072584 PMCID: PMC10769912 DOI: 10.1007/s00404-023-06963-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/01/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE Fetal growth restriction (FGR) management and delivery planning is based on a multimodal approach. This meta-analysis aimed to evaluate the prognostic accuracies of the aortic isthmus Doppler to predict adverse perinatal outcomes in singleton pregnancies with FGR. METHODS PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov and Google scholar were searched from inception to May 2021, for studies on the prognostic accuracy of anterograde aortic isthmus flow compared with retrograde aortic isthmus flow in singleton pregnancy with FGR. The meta-analysis was registered on PROSPERO and was assessed according to PRISMA and Newcastle-Ottawa Scale. DerSimonian and Laird's random-effect model was used for relative risks, Freeman-Tukey Double Arcsine for pooled estimates and exact method to stabilize variances and CIs. Heterogeneity was quantified using I2 statistics. RESULTS A total of 2933 articles were identified through the electronic search, of which 6 studies (involving 240 women) were included. The quality evaluation of studies revealed an overall acceptable score for study group selection and comparability and substantial heterogeneity. The risk of perinatal death was significantly greater in fetuses with retrograde Aortic Isthmus blood flow, with a RR of 5.17 (p value 0.00001). Similarly, the stillbirth rate was found to have a RR of 5.39 (p value 0.00001). Respiratory distress syndrome had a RR of 2.64 (p value = 0.03) in the group of fetuses with retrograde Aortic Isthmus blood flow. CONCLUSION Aortic Isthmus Doppler study may add information for FGR management. However, additional clinical trial are required to assess its applicability in clinical practice.
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Affiliation(s)
- M La Verde
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138, Naples, Italy.
| | - F Savoia
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - G Riemma
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - A Schiattarella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - A Conte
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - S Hidar
- Obstetrics and Gynecology Department, F. Hached University Teaching Hospital, 4000, Sousse, Tunisia
| | - M Torella
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - N Colacurci
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - P De Franciscis
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138, Naples, Italy
| | - M Morlando
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie 1, 80138, Naples, Italy
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11
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Morales-Roselló J, Martínez-Varea A. Fetal activity modifies middle cerebral artery pulsatility index: physiology of frequent pitfall in evaluation of fetal cerebral flow. Ultrasound Obstet Gynecol 2024; 63:117-118. [PMID: 37670590 DOI: 10.1002/uog.27468] [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: 06/14/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/07/2023]
Affiliation(s)
- J Morales-Roselló
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, Valencia, Spain
| | - A Martínez-Varea
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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12
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Saini BS, Ducas R, Darby JRT, Marini D, Sun L, Macgowan CK, Windrim R, Kingdom JC, Wald RM, Morrison JL, Seed M. Feasibility of MRI assessment of maternal-fetal oxygen transport and consumption relative to maternal position in healthy late gestational pregnancies. J Physiol 2023; 601:5413-5436. [PMID: 37906114 DOI: 10.1113/jp285097] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
Late gestational supine positioning reduces maternal cardiac output due to inferior vena caval (IVC) compression, despite increased collateral venous return. However, little is known about the impact of maternal position on oxygen (O2 ) delivery and consumption of the gravid uterus, fetus, placenta and lower limbs. We studied the effects of maternal positioning on these parameters in 20 healthy pregnant subjects at 36 ± 2 weeks using magnetic resonance imaging (MRI); a follow-up MRI was performed 6-months postpartum (n = 16/20). MRI techniques included phase-contrast and T1/T2 relaxometry for blood flow and oximetry imaging, respectively. O2 transport was measured in the following vessels (bilateral where appropriate): maternal abdominal descending aorta (DAoabdo ), IVC, ovarian, paraspinal veins (PSV), uterine artery (UtA) and external iliacs, and umbilical. Maternal cardiac output was measured by summing DAothoracic and superior vena cava flows. Supine mothers (n = 6) had lower cardiac output and O2 delivery in the DAoabdo , UtA and external iliac arteries, and higher PSV flow than those in either the left (n = 8) or right (n = 6) lateral positions during MRI. However, O2 consumption in the gravid uterus, fetus, placenta and lower limbs was unaffected by maternal positioning. The ratio of IVC/PSV flow decreased in supine mothers while ovarian venous flow and O2 saturation were unaltered, suggesting a major route of pelvic venous return unaffected by maternal position. Placental-fetal O2 transport and consumption were similar between left and right lateral maternal positions. In comparison to non-pregnant findings, DAoabdo and UtA O2 delivery and pelvic O2 consumption increased, while lower-limb consumption remained constant , despite reduced external iliac artery O2 delivery in late gestation. KEY POINTS: Though sleeping supine during the third trimester is associated with an increased risk of antepartum stillbirth, the underlying biological mechanisms are not fully understood. Maternal cardiac output and uteroplacental flow are reduced in supine mothers due to inferior vena caval compression from the weight of the gravid uterus. This MRI study provides a comprehensive circulatory assessment, demonstrating reduced maternal cardiac output and O2 delivery (uteroplacental, lower body) in supine compared to lateral positioning; however, O2 consumption (gravid uterus, fetus, placenta, lower limbs) was preserved. Unlike other mammalian species, the ovarian veins conduct substantial venous return from the human pregnant uterus that is unaffected by maternal positioning. Lumbar paraspinal venous flow increased in supine mothers. These observations may have important considerations during major pelvic surgery in pregnancy (i.e. placenta percreta). Future studies should address the importance of maternal positioning as a potential tool to deliver improved perinatal outcomes in pregnancies with compromised uteroplacental O2 delivery.
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Affiliation(s)
- Brahmdeep S Saini
- Heart Centre, Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robin Ducas
- Department of Internal Medicine, Section of Cardiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jack R T Darby
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Davide Marini
- Heart Centre, Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Liqun Sun
- Heart Centre, Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christopher K Macgowan
- Translational Medicine, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Biophysics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rory Windrim
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John C Kingdom
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Division, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rachel M Wald
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Janna L Morrison
- Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike Seed
- Heart Centre, Division of Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Inatomi A, Nishinaka T, Umeki A, Tsukiya T, Katagiri N, Fujii M, Kobayashi F, Imaoka S, Tanaka S, Mizuno T, Murakami T. Feasibility study of an artificial placenta system consisting of a loop circuit configuration extracorporeal membrane oxygenation with a bridge circuit in the form of the umbilical arterial-venous connection. J Artif Organs 2023; 26:287-296. [PMID: 36227380 DOI: 10.1007/s10047-022-01370-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 10/02/2022] [Indexed: 11/25/2022]
Abstract
We developed a new artificial placenta (AP) system consisting of a loop circuit configuration extracorporeal membrane oxygenation (ECMO) with a bridge circuit designed to be applied to the fetus in the form of an umbilical arterial-venous connection. We aimed to evaluate the feasibility of the AP system by performing a hydrodynamic simulation using a mechanical mock circulation system and fetal animal experiment. The effect of the working condition of the AP system on the fetal hemodynamics was evaluated by hydrodynamic simulation using a mechanical mock circulation system, assuming the weight of the fetus to be 2 kg. The AP system was introduced to two fetal goats at a gestational age of 135 days. The general conditions of the experimental animals were evaluated. The mock simulation showed that in an AP system with ECMO in the form of an umbilical arterial-venous connection in series, it could be difficult to maintain fetal hemodynamics when high ECMO flow was applied. The developed AP system could have high ECMO flow with less umbilical blood flow; however, the possibility of excessive load on the fetal right-sided heart should be noted. In the animal experiment, kid 1 (1.9 kg) was maintained on the AP system for 12 days and allowed to grow to term. In kid 2 (1.6 kg), the AP system could not be established because of the occlusion of the system by a thrombus. The developed AP system was feasible under both in vitro and in vivo conditions. Improvements in the AP system and management of the general fetal conditions are essential.
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Affiliation(s)
- Ayako Inatomi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan.
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan.
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan.
| | - Akihide Umeki
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Nobumasa Katagiri
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Masahiko Fujii
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Futoshi Kobayashi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Syusuke Imaoka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Shun Tanaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Toshihide Mizuno
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
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Kovo M, Berman E, Odeh H, Luria O, Beloosesky R, Bar J. The effects of inflammation and acidosis on placental blood vessels reactivity. Placenta 2023; 144:8-12. [PMID: 37949032 DOI: 10.1016/j.placenta.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/04/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Inflammation and acidosis are two stress stimuli that correspond to pathophysiological processes occurring in placental-mediated vascular disorders. We aimed to investigate the effects of these stimuli on placental chorionic blood vessels reactivity using the ex-vivo placental perfusion model. METHODS Term placentas were obtained immediately after cesarean deliveries, and selected cotyledons were cannulated and dually perfused ex-vivo. Placentas were perfused with three different protocols: culture medium (M199-controls, n = 5), culture medium with lipopolysaccharide (inflammatory stimuli) (LPS,1 μg/ml, n = 7), and acidotic culture medium (M - 199, pH: 6.9-7, n = 6). Each perfusion experiment was maintained for 180 min. Fetal perfusion pressure was continuously measured. Measurements in response to angiotensin II (AT II) at the end of the perfusion were compared between the treatment groups, including amplitude of the contraction response, relaxation factor, time to maximal constriction and the area under the pressure curve (AUC). RESULTS In response to ATII there was a significant difference in the amplitude of the contraction and the AUC between the treatment groups, (p = 0.049, p = 0.015, respectively). As compared with control perfused cotyledon, the inflammatory stimuli significantly increased the vasoconstriction response to ATII in fetal placental blood vessels, as expressed by increased AUC - median (IQR): 555 (235-1184) vs. 133 (118-207), respectively, p = 0.017. The time to maximal constriction and the relaxation factor did not differ between the groups. DISCUSSION Inflammatory stimuli but not acidosis impact fetal-placental vasculature in response to ATII, suggesting that inflammation can compromise vascular function.
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Affiliation(s)
- Michal Kovo
- Meir Medical Center, Kfar Saba, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
| | - Erez Berman
- Wolfson Medical Center, Holon, Israel; Institute for Drug Research, School of Pharmacy, The Hebrew University of Jerusalem, Israel
| | - Hind Odeh
- Wolfson Medical Center, Holon, Israel
| | - Oded Luria
- Faculty of Biomedical Engineering, Tel Aviv University, Tel-Aviv, Israel
| | | | - Jacob Bar
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Wolfson Medical Center, Holon, Israel
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15
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Souza A, Carvalho C, Souza G, Moraes R. Characterization of the normal fetal circulatory system of the ductus venosus using sound complexity parameters. Braz J Med Biol Res 2023; 56:e13018. [PMID: 37970925 PMCID: PMC10644967 DOI: 10.1590/1414-431x2023e13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/21/2023] [Indexed: 11/19/2023] Open
Abstract
The aim of this study was to characterize the normality of the fetal circulatory system through the time between ventricular systoles of the ductus venosus in the three gestational trimesters in healthy fetuses using nonlinear methods of the complexity of the signal. A prospective cohort study was conducted at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) from December 2019 to May 2020. Pregnant women between 11 and 14 weeks, with intrauterine pregnancy and healthy fetus were included. Patients with multiple gestation, positive screening for congenital malformation, including heart disease, and under 18 years of age were excluded. Doppler velocimetry ultrasonography of the ductus venosus was performed between the 11th and 14th weeks, 20th and 24th weeks, and 28th and 32nd weeks of gestation, and then the sound signal was extracted and segmented from the videos. To compare the means between the gestational trimesters of the approximate entropy (ApEn) and Lempel-Ziv complexity (CLZ) of the time between ventricular systoles, the Friedman test was used, with a significance level of 5%. No statistically significant difference was found between the 1st, 2nd, and 3rd trimesters regarding the mean ApEn (P=0.281) and CLZ (P=0.595) of the time between ventricular systoles of the ductus venosus. Ductus venosus systolic time was not sensitive to differentiate fetal cardiovascular dynamics between gestational trimesters. This study pioneered the characterization of cardiovascular normality by nonlinear parameters of the fetal ductus venosus in all three trimesters.
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Affiliation(s)
- A.S.R. Souza
- Centro de Atenção à Mulher, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, PE, Brasil
- Escola de Saúde e Ciências da Vida, Universidade Católica de Pernambuco, Recife, PE, Brasil
- Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife, PE, Brasil
| | - C.F. Carvalho
- Centro de Atenção à Mulher, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, PE, Brasil
- Escola de Saúde e Ciências da Vida, Universidade Católica de Pernambuco, Recife, PE, Brasil
| | - G.F.A. Souza
- Escola de Saúde e Ciências da Vida, Universidade Católica de Pernambuco, Recife, PE, Brasil
| | - R.B. Moraes
- Escola de Saúde e Ciências da Vida, Universidade Católica de Pernambuco, Recife, PE, Brasil
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Rubin JM, Pinter SZ, Halloran KM, Pallas BD, Fowlkes JB, Vyas AK, Padmanabhan V, Kripfgans OD. Placental assessment using spectral analysis of the envelope of umbilical venous waveforms in sheep. Placenta 2023; 142:119-127. [PMID: 37699274 PMCID: PMC10954287 DOI: 10.1016/j.placenta.2023.08.072] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION This study was designed to test the efficacy of an ultrasound flow measurement method to evaluate placental function in a hyperandrogenic sheep model that produces placental morphologic changes and an intrauterine growth restriction (IUGR) phenotype. MATERIALS AND METHODS Pregnant ewes were assigned randomly between control (n = 12) and testosterone-treatment (T-treated, n = 22) groups. The T-treated group was injected twice weekly intramuscularly (IM) with 100 mg testosterone propionate. Control sheep were injected with corn oil vehicle. Lambs were delivered at 119.5 ± 0.48 days gestation. At the time of delivery of each lamb, flow spectra were generated from one fetal artery and two fetal veins, and the spectral envelopes examined using fast Fourier transform analysis. Base 10 logarithms of the ratio of the amplitudes of the maternal and fetal spectral peaks (LRSP) in the venous power spectrum were compared in the T-treated and control populations. In addition, we calculated the resistive index (RI) for the artery defined as ((peak systole - min diastole)/peak systole). Two-tailed T-tests were used for comparisons. RESULTS LRSPs, after removal of significant outliers, were -0.158 ± 0.238 for T-treated and 0.057 ± 0.213 for control (p = 0.015) animals. RIs for the T-treated sheep fetuses were 0.506 ± 0.137 and 0.497 ± 0.086 for controls (p = 0.792) DISCUSSION: LRSP analysis distinguishes between T-treated and control sheep, whereas RIs do not. LRSP has the potential to identify compromised pregnancies.
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Affiliation(s)
- Jonathan M Rubin
- University of Michigan Department of Radiology, Medical Sciences Building 1, 1301 Catherine St, Ann Arbor, MI, 48109-2026, USA.
| | - Stephen Z Pinter
- University of Michigan Department of Radiology, Medical Sciences Building 1, 1301 Catherine St, Ann Arbor, MI, 48109-2026, USA.
| | - Katherine M Halloran
- University of Michigan Department of Pediatrics, 7510 MSRB1, 1150 W. Medical Center Dr, Ann Arbor, MI, 48109-5718, USA.
| | - Brooke D Pallas
- University of Michigan Address Unit Lab Animal Medicine, 2800 Plymouth Rd. NCRC-G090, Ann Arbor, MI, 48109-2800, USA.
| | - J Brian Fowlkes
- University of Michigan Department of Radiology, Medical Sciences Building 1, 1301 Catherine St, Ann Arbor, MI, 48109-2026, USA.
| | - Arpita K Vyas
- Washington University in St. Louis Department of Pediatrics, St. Louis Children's Hospital, 1 Children's Place, St. Louis, MO, 63110, USA.
| | - Vasantha Padmanabhan
- University of Michigan Department of Pediatrics, 7510 MSRB1, 1150 W. Medical Center Dr, Ann Arbor, MI, 48109-5718, USA.
| | - Oliver D Kripfgans
- University of Michigan Department of Radiology, Medical Sciences Building 1, 1301 Catherine St, Ann Arbor, MI, 48109-2026, USA.
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Sanchez-Martinez S, Randanne PC, Hawkins-Villarreal A, Rezaei K, Fucho R, Bobillo-Perez S, Bonet-Carne E, Illa M, Eixarch E, Bijnens B, Crispi F, Gratacós E. Acute fetal cardiovascular adaptation to artificial placenta in sheep model. Ultrasound Obstet Gynecol 2023; 62:255-265. [PMID: 37021764 DOI: 10.1002/uog.26215] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/21/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To describe the acute cardiovascular adaptation of the fetus after connection to an artificial placenta (AP) in a sheep model, using ultrasound and invasive and non-invasive hemodynamic assessment. METHODS This was an experimental study of 12 fetal sheep that were transferred to an AP system, consisting of a pumpless circuit with umbilical cord connection, at 109-117 days' gestation. The study was designed to collect in-utero and postcannulation measurements in all the animals. The first six consecutive fetuses were fitted with intravascular catheters and perivascular probes to obtain invasive physiological data, including arterial and venous intravascular pressures and perivascular blood flows, with measurements taken in utero and at 5 and 30 min after cannulation. These experiments were designed with a survival goal of 1-3 h. The second set of six fetuses were not fitted with catheters, and experiments were aimed at 3-24 h of survival. Echocardiographic assessment of cardiac anatomy and function, as well as measurements of blood flow and pre- and postmembrane pressures recorded by circuit sensors in the AP system, were available for most of the fetuses. These data were acquired in utero and at 30 and 180 min after cannulation. RESULTS Compared with in-utero conditions, the pulsatility index at 30 and 180 min after connection to the AP system was reduced in the umbilical artery (median, 1.36 (interquartile range (IQR), 1.06-1.50) vs 0.38 (IQR, 0.31-0.50) vs 0.36 (IQR, 0.29-0.41); P < 0.001 for extreme timepoints) and the ductus venosus (median, 0.50 (IQR, 0.41-0.67) vs 0.29 (IQR, 0.22-0.33) vs 0.36 (IQR, 0.22-0.41); P = 0.011 for extreme timepoints), whereas umbilical venous peak velocity increased (median, 20 cm/s (IQR, 18-22 cm/s) vs 39 cm/s (IQR, 31-43 cm/s) vs 43 cm/s (IQR, 34-54 cm/s); P < 0.001 for extreme timepoints) and flow became more pulsatile. Intravascular monitoring showed that arterial and venous pressures increased transiently after connection, with median values for mean arterial pressure at baseline, 5 min and 30 min of 43 mmHg (IQR, 35-54 mmHg), 72 mmHg (IQR, 61-77 mmHg) and 58 mmHg (IQR, 50-64 mmHg), respectively (P = 0.02 for baseline vs 5 min). Echocardiography showed a similar transient elevation of fetal heart rate at 30 and 180 min after connection compared with in utero (median, 145 bpm (IQR, 142-156 bpm) vs 188 bpm (IQR, 171-209 bpm) vs 175 bpm (IQR, 165-190 bpm); P = 0.001 for extreme timepoints). Fetal cardiac structure and function were mainly preserved; median values for right fractional area change were 36% (IQR, 34-41%) in utero, 38% (IQR, 30-40%) at 30 min and 37% (IQR, 33-40%) at 180 min (P = 0.807 for extreme timepoints). CONCLUSIONS Connection to an AP system resulted in a transient fetal hemodynamic response that tended to normalize over hours. In this short-term evaluation, cardiac structure and function were preserved. However, the system resulted in non-physiologically elevated venous pressure and pulsatile flow, which should be corrected to avoid later impairment of cardiac function. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S Sanchez-Martinez
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - P C Randanne
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Pediatric Cardiology Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - A Hawkins-Villarreal
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Fetal Medicine Service, Obstetrics Department, Santo Tomás Hospital, University of Panama, Panama City, Panama (on behalf of the Iberoamerican Research Network in Obstetrics, Gynecology and Translational Medicine)
| | - K Rezaei
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Cardiovascular Surgery Unit, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - R Fucho
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
| | - S Bobillo-Perez
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - E Bonet-Carne
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Barcelona Tech, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - M Illa
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - E Eixarch
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - B Bijnens
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- ICREA, Barcelona, Spain
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - F Crispi
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
| | - E Gratacós
- BCNatal Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain
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Leal CRV, Rezende KP, Macedo EDCPD, Rezende GDC, Corrêa Júnior MD. Comparison between Protocols for Management of Fetal Growth Restriction. Rev Bras Ginecol Obstet 2023; 45:96-103. [PMID: 36977407 PMCID: PMC10078887 DOI: 10.1055/s-0043-1764493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/17/2022] [Indexed: 03/30/2023] Open
Abstract
This comprehensive review compares clinical protocols of important entities regarding the management of fetal growth restriction (FGR), published since 2015. Five protocols were chosen for data extraction. There were no relevant differences regarding the diagnosis and classification of FGR between the protocols. In general, all protocols suggest that the assessment of fetal vitality must be performed in a multimodally, associating biophysical parameters (such as cardiotocography and fetal biophysical profile) with the Doppler velocimetry parameters of the umbilical artery, middle cerebral artery, and ductus venosus. All protocols reinforce that the more severe the fetal condition, the more frequent this assessment should be made. The timely gestational age and mode of delivery to terminate the pregnancy in these cases can vary much between the protocols. Therefore, this paper presents, in a didactic way, the particularities of different protocols for monitoring FGR, in order to help obstetricians to better manage the cases.
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Zalinska A, Respondek-Liberska M, Slodki M. Maternal hyperoxygenation during pregnancy as a tool in fetal disease diagnosis and treatment. J Clin Ultrasound 2023; 51:273-282. [PMID: 36785501 DOI: 10.1002/jcu.23347] [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: 06/30/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 06/18/2023]
Abstract
Maternal hyperoxygenation (MHO) consists of giving pregnant women (60% to 100%) oxygen through a facemask and using ultrasound assess or monitor the influence on fetal cardiovascular circulation. This review discusses the findings and the utility of acute and chronic MHO in various fetal diseases.
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Affiliation(s)
- Agnieszka Zalinska
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Department of Obstetrics and Perinatology, Chair of Obstetrics, Gynecology and Oncological Gynecology, Medical University of Lodz, Lodz, Poland
| | - Maria Respondek-Liberska
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Department of Diagnosis and Prevention of Fetal Malformations, Medical University of Lodz, Lodz, Poland
| | - Maciej Slodki
- Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Faculty of Health Sciences, The Mazovian State University, Plock, Poland
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20
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Kaur K, Acharya G, Chen H, Shannon CN, Lipscomb BE, Newman R, Zuckerwise LC. Impact of fetal trisomy 21 on umbilical artery Doppler indices. J Matern Fetal Neonatal Med 2022; 35:8364-8371. [PMID: 34570672 PMCID: PMC10346994 DOI: 10.1080/14767058.2021.1974388] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/16/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Umbilical artery (UA) Doppler indices are surrogate measures of placental function, most commonly used to assess fetal wellbeing in pregnancies with fetal growth restriction. Fetuses with trisomy 21 (t21) are reported to have elevated UA Doppler indices, but reference percentiles are currently lacking for this population. We hypothesized that gestational age-specific values of UA Doppler indices in pregnancies complicated by t21 will be elevated compared to established percentiles based on euploid pregnancies. We aimed to assess UA Doppler indices longitudinally in fetuses with t21 in order to demonstrate Doppler patterns across gestation in this population, compare them with euploid fetuses, and investigate their association with pregnancy outcomes. METHODS We conducted a retrospective cohort study of singleton pregnancies with confirmed fetal t21 who underwent UA Doppler surveillance antenatally from January 2012 to August 2019. UA Doppler indices, including systolic/diastolic (S/D) ratio, pulsatility index (PI), and resistance index (RI) were extracted from ultrasound reports or directly from ultrasound images. UA S/D, PI, and RI percentiles by gestational week were created from available observations from our cohort via a data-driven approach using a generalized additive model. A secondary analysis was run to statistically compare t21 values to established percentiles based on observations from a historical population of euploid fetuses. RESULTS UA Doppler measurements from 86 t21 fetuses and 130 euploid fetuses were included in our analysis. Median (IQR) maternal age in t21 pregnancies and euploid pregnancies were 35 years (29-38) and 30 years (27-33), respectively. As in euploid fetuses, we found a negative association between Doppler indices and gestational age in the t21 fetuses. Maternal tobacco use, obesity, or chronic hypertension had no significant effect on UA Doppler indices. As hypothesized, values for UA S/D ratio, PI, and RI at the 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 97.5th percentiles by gestational week were significantly higher in t21 fetuses compared to euploid fetuses (p<.001). Overall, 55.8% (48/86) of the t21 fetuses demonstrated at least one Doppler value above the 95th percentile for gestational age based on euploid reference standard. At birth, eight (9.3%) of the t21 fetuses were small for gestational age. When these pregnancies were removed from analysis, UA Doppler indices remained significantly higher than established percentiles at each week of gestation (p < .001). Only three pregnancies ended in fetal demise in the t21 population, two of which had persistently elevated Dopplers above the 95th percentile per established reference percentiles. CONCLUSIONS At each week of gestation, UA Doppler indices in t21 fetuses were significantly higher than established percentiles from a euploid population. Reference intervals based on euploid fetuses may therefore not be appropriate for antenatal surveillance of fetuses with t21. Prospective studies are needed to investigate the role and impact of serial UA Doppler velocimetry in the surveillance of pregnancies complicated by fetal t21.
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Affiliation(s)
- Karampreet Kaur
- Vanderbilt University School of Medicine, Vanderbilt Surgical Outcomes Center for Kids, Nashville, TN, USA
| | - Ganesh Acharya
- Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Vanderbilt Surgical Outcomes Center for Kids, Nashville, TN, USA
| | - Chevis N Shannon
- Department of Neurosurgery, Vanderbilt University Medical Center, Vanderbilt Surgical Outcomes Center for Kids, Nashville, TN, USA
| | | | - Randa Newman
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lisa C Zuckerwise
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Vanderbilt University Medical Center, Vanderbilt Surgical Outcomes Center for Kids, Nashville, TN, USA
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21
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Feucht U, Hlongwane T, Vannevel V, Mulol H, Botha T, Pattinson R. Identifying the High-Risk Fetus in the Low-Risk Mother Using Fetal Doppler Screening. Glob Health Sci Pract 2022; 10:GHSP-D-21-00692. [PMID: 36332066 PMCID: PMC9242613 DOI: 10.9745/ghsp-d-21-00692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/26/2022] [Indexed: 11/15/2022]
Abstract
Continuous-wave Doppler ultrasound of the umbilical artery offers an inexpensive and scalable method of detecting undiagnosed fetal growth restriction. Using Doppler to screen low-risk pregnancies in low- and middle-income countries identifies fetuses at risk of stillbirth and, when managed appropriately, results in a step change reduction in the stillbirth rate. Identifying the high-risk fetus in the low-risk pregnant mother (LRM) is a neglected area of research. Fetal growth restriction (FGR) is a major cause of stillbirths, especially in low- and middle-income countries (LMICs). FGR is very poorly detected particularly in healthy pregnant women classified as low risk. Umbiflow is an inexpensive continuous-wave Doppler ultrasound (CWDU) apparatus that is suitable for use by low-level health care providers for screening low-risk pregnant populations. It can easily detect umbilical artery blood flow in the cord, which correlates well with placental function, and poor placental function correlates well with FGR. Use of CWDU to screen an LMIC population of more than 7,000 LRMs has demonstrated a high prevalence of abnormal umbilical artery flow of 13%, and absent end-diastolic flow, which is associated with end-stage placental disease, was found in 1.2%. This is 10 times higher than previously reported in high-income countries. Screening with CWDU together with a standard protocol managing those pregnancies with abnormal placental blood flow resulted in a 43% reduction in stillbirths (risk ratio: 0.57; 95% confidence interval=0.29, 0.85) in this LRM population. Further, follow-up of infants who had abnormal umbilical artery blood flow showed that these infants had significantly less fat-free mass at ages 6 weeks, 10 weeks, 14 weeks, and 6 months, than those with normal umbilical artery blood flow (P<.015), confirming that CWDU was able to detect true FGR. Thus, screening with CWDU can detect the fetus at risk of stillbirth, and infants likely to have suboptimal growth and development postnatally. Screening with CWDU in LRMs opens the door to a step change in preventing stillbirths in LMICs.
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Affiliation(s)
- Ute Feucht
- University of Pretoria, Pretoria, South Africa.
- South African Medical Research Council, Pretoria, South Africa
| | - Tsakane Hlongwane
- University of Pretoria, Pretoria, South Africa
- South African Medical Research Council, Pretoria, South Africa
| | - Valerie Vannevel
- University of Pretoria, Pretoria, South Africa
- South African Medical Research Council, Pretoria, South Africa
| | - Helen Mulol
- University of Pretoria, Pretoria, South Africa
- South African Medical Research Council, Pretoria, South Africa
| | - Tanita Botha
- University of Pretoria, Pretoria, South Africa
- South African Medical Research Council, Pretoria, South Africa
| | - Robert Pattinson
- University of Pretoria, Pretoria, South Africa
- South African Medical Research Council, Pretoria, South Africa
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Luna-García J, Martínez-Rodríguez M, López-Saiz L, Villalobos-Gómez R, Cruz-Martínez R. Reversed blood flow in the superior sagittal sinus in hydrops fetalis. Ultrasound Obstet Gynecol 2021; 58:949-950. [PMID: 34131986 DOI: 10.1002/uog.23710] [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: 03/18/2021] [Accepted: 06/01/2021] [Indexed: 06/12/2023]
Affiliation(s)
- J Luna-García
- Fetal Medicine and Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Querétaro, Mexico
| | - M Martínez-Rodríguez
- Fetal Medicine and Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Querétaro, Mexico
- Universidad Autónoma del Estado de Hidalgo, Hidalgo, Mexico
| | - L López-Saiz
- Fetal Medicine and Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Querétaro, Mexico
| | - R Villalobos-Gómez
- Fetal Medicine and Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Querétaro, Mexico
| | - R Cruz-Martínez
- Fetal Medicine and Surgery Center, Medicina Fetal México and Fetal Medicine Foundation of Mexico, Querétaro, Mexico
- Universidad Autónoma del Estado de Hidalgo, Hidalgo, Mexico
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23
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Vedel C, Rode L, Bundgaard H, Iversen K, Jørgensen FS, Petersen OB, Sillesen AS, Sundberg K, Vejlstrup N, Zingenberg H, Tabor A, Ekelund CK. Prenatal cardiac biometry and flow assessment in fetuses with bicuspid aortic valve at 20 weeks' gestation: multicenter cohort study. Ultrasound Obstet Gynecol 2021; 58:846-852. [PMID: 33998082 DOI: 10.1002/uog.23670] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/14/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate prenatal changes in cardiac biometric and flow parameters in fetuses with bicuspid aortic valve (BAV) diagnosed neonatally compared with controls with normal cardiac anatomy. METHODS This analysis was conducted as part of the Copenhagen Baby Heart Study, a multicenter cohort study of 25 556 neonates that underwent second-trimester anomaly scan at 18 + 0 to 22 + 6 weeks' gestation and neonatal echocardiography within 4 weeks after birth, in Copenhagen University Hospital Herlev, Hvidovre Hospital and Rigshospitalet in greater Copenhagen, between April 2016 and October 2018. From February 2017 (Rigshospitalet) and September 2017 (Herlev and Hvidovre hospitals), the protocol for second-trimester screening of the heart was extended to include evaluation of the four-chamber view, with assessment of flow across the atrioventricular valves, sagittal view of the aortic arch and midumbilical artery and ductus venosus pulsatility indices. All images were evaluated by two investigators, and cardiac biometric and flow parameters were measured and compared between cases with BAV and controls. All cases with neonatal BAV were assessed by a specialist. Maternal characteristics and first- and second-trimester biomarkers were also compared between the two groups. RESULTS Fifty-five infants with BAV and 8316 controls with normal cardiac anatomy were identified during the study period and assessed using the extended prenatal cardiac imaging protocol. There were three times as many mothers who smoked before pregnancy in the group with BAV as in the control group (9.1% vs 2.7%; P = 0.003). All other baseline characteristics were similar between the two groups. Fetuses with BAV, compared with controls, had a significantly larger diameter of the aorta at the level of the aortic valve (3.1 mm vs 3.0 mm (mean difference, 0.12 mm (95% CI, 0.03-0.21 mm))) and the pulmonary artery at the level of the pulmonary valve (4.1 mm vs 3.9 mm (mean difference, 0.15 mm (95% CI, 0.03-0.28 mm))). Following conversion of the diameter measurements of the aorta and pulmonary artery to Z-scores and Bonferroni correction, the differences between the two groups were no longer statistically significant. Pregnancy-associated plasma protein-A (PAPP-A) multiples of the median (MoM) was significantly lower in the BAV group than in the control group (0.85 vs 1.03; P = 0.04). CONCLUSIONS Our findings suggest that fetuses with BAV may have a larger aortic diameter at the level of the aortic valve, measured in the left-ventricular-outflow-tract view, and a larger pulmonary artery diameter at the level of the pulmonary valve, measured in the three-vessel view, at 20 weeks' gestation. Moreover, we found an association of maternal smoking and low PAPP-A MoM with BAV. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Vedel
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - L Rode
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - H Bundgaard
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - K Iversen
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - F S Jørgensen
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - O B Petersen
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - A-S Sillesen
- Department of Cardiology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - K Sundberg
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - N Vejlstrup
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - H Zingenberg
- Department of Obstetrics and Gynecology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - A Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - C K Ekelund
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
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Sun L, van Amerom JFP, Marini D, Portnoy S, Lee FT, Saini BS, Lim JM, Aguet J, Jaeggi E, Kingdom JC, Macgowan CK, Miller SP, Huang G, Seed M. MRI characterization of hemodynamic patterns of human fetuses with cyanotic congenital heart disease. Ultrasound Obstet Gynecol 2021; 58:824-836. [PMID: 34097323 DOI: 10.1002/uog.23707] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/22/2020] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To characterize, using magnetic resonance imaging (MRI), the distribution of blood flow and oxygen transport in human fetuses with subtypes of congenital heart disease (CHD) that present with neonatal cyanosis. METHODS Blood flow was measured in the major vessels of 152 late-gestation human fetuses with CHD and 40 gestational-age-matched normal fetuses, using cine phase-contrast MRI. Oxygen saturation (SaO2 ) was measured in the major vessels of 57 fetuses with CHD and 40 controls. RESULTS Compared with controls, we found lower combined ventricular output in fetuses with single-ventricle physiology, with the lowest being observed in fetuses with severe forms of Ebstein's anomaly. Obstructive lesions of the left or right heart were associated with increased flow across the contralateral side. Pulmonary blood flow was reduced in fetuses with Ebstein's anomaly, while those with Ebstein's anomaly and tricuspid atresia had reduced umbilical flow. Flow in the superior vena cava was elevated in fetuses with transposition of the great arteries, normal in fetuses with hypoplastic left heart, tetralogy of Fallot or tricuspid atresia and reduced in fetuses with Ebstein's anomaly. Umbilical vein SaO2 was reduced in fetuses with hypoplastic left heart or tetralogy of Fallot. Ascending aorta and superior vena cava SaO2 were reduced in nearly all CHD subtypes. CONCLUSIONS Fetuses with cyanotic CHD exhibit profound changes in the distribution of blood flow and oxygen transport, which result in changes in cerebral, pulmonary and placental blood flow and oxygenation. These alterations of fetal circulatory physiology may influence the neonatal course and help account for abnormalities of prenatal growth and development that have been described in newborns with cyanotic CHD. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L Sun
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
- Division of Paediatric Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - J F P van Amerom
- Division of Paediatric Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - D Marini
- Division of Paediatric Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - S Portnoy
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - F-T Lee
- Division of Paediatric Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - B S Saini
- Division of Paediatric Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - J M Lim
- Division of Paediatric Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - J Aguet
- Division of Paediatric Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - E Jaeggi
- Division of Paediatric Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - J C Kingdom
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - C K Macgowan
- Department of Medical Biophysics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - S P Miller
- Division of Neurology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - G Huang
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - M Seed
- Division of Paediatric Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
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Wolf H, Stampalija T, Lees CC. Fetal cerebral blood-flow redistribution: analysis of Doppler reference charts and association of different thresholds with adverse perinatal outcome. Ultrasound Obstet Gynecol 2021; 58:705-715. [PMID: 33599336 PMCID: PMC8597586 DOI: 10.1002/uog.23615] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 05/27/2023]
Abstract
OBJECTIVES First, to compare published Doppler reference charts of the ratios of flow in the fetal middle cerebral and umbilical arteries (i.e. the cerebroplacental ratio (CPR) and umbilicocerebral ratio (UCR)). Second, to assess the association of thresholds of CPR and UCR based on these charts with short-term composite adverse perinatal outcome in a cohort of pregnancies considered to be at risk of late preterm fetal growth restriction. METHODS Studies presenting reference charts for CPR or UCR were searched for in PubMed. Formulae for plotting the median and the 10th percentile (for CPR) or the 90th percentile (for UCR) against gestational age were extracted from the publication or calculated from the published tables. Data from a prospective European multicenter observational cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks' gestation, in which fetal arterial Doppler measurements were collected longitudinally, were used to compare the different charts. Specifically, the association of UCR and CPR thresholds (CPR < 10th percentile or UCR ≥ 90th percentile and multiples of the median (MoM) values) with composite adverse perinatal outcome was analyzed. The association was also compared between chart-based thresholds and absolute thresholds. Composite adverse perinatal outcome comprised both abnormal condition at birth and major neonatal morbidity. RESULTS Ten studies presenting reference charts for CPR or UCR were retrieved. There were large differences between the charts in the 10th and 90th percentile values of CPR and UCR, respectively, while median values were more similar. In the gestational-age range of 28-36 weeks, there was no relationship between UCR or CPR and gestational age. From the prospective observational study, 856 pregnancies at risk of late-onset preterm fetal growth restriction were included in the analysis. The association of abnormal UCR or CPR with composite adverse perinatal outcome was similar for percentile thresholds or MoM values, as calculated from the charts, and for absolute thresholds, both on univariable analysis and after adjustment for gestational age at measurement, estimated fetal weight MoM and pre-eclampsia. The adjusted odds ratio for composite adverse perinatal outcome was 3.3 (95% CI, 1.7-6.4) for an absolute UCR threshold of ≥ 0.9 or an absolute CPR threshold of < 1.11 (corresponding to ≥ 1.75 MoM), and 1.6 (95% CI, 0.9-2.9) for an absolute UCR threshold of ≥ 0.7 to < 0.9 or an absolute CPR threshold of ≥ 1.11 to < 1.43 (corresponding to ≥ 1.25 to < 1.75 MoM). CONCLUSIONS In the gestational-age range of 32 to 36 weeks, adjustment of CPR or UCR for gestational age is not necessary when assessing the risk of adverse outcome in pregnancies at risk of fetal growth restriction. The adoption of absolute CPR or UCR thresholds, independent of reference charts, is feasible and makes clinical assessment simpler than if using percentiles or other gestational-age normalized units. The high variability in percentile threshold values among the commonly used UCR and CPR reference charts hinders reliable diagnosis and clinical management of late preterm fetal growth restriction. © 2021 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)
- H. Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC)University of AmsterdamAmsterdamThe Netherlands
| | - T. Stampalija
- Unit of Fetal Medicine and Prenatal DiagnosisInstitute for Maternal and Child Health, IRCCS Burlo GarofoloTriesteItaly
- Department of Medicine, Surgery and Health SciencesUniversity of TriesteTriesteItaly
| | - C. C. Lees
- Department of Metabolism, Digestion and Reproduction, Imperial College LondonLondonUK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College NHS TrustLondonUK
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Donepudi R, Espinoza J, Nassr AA, Belfort MA, Shamshirsaz AA, Sanz Cortes M. Prediction of post-laser fetal death in selective growth restriction complicating twin-twin transfusion syndrome using standardized definitions. Ultrasound Obstet Gynecol 2021; 58:738-743. [PMID: 33073885 DOI: 10.1002/uog.23519] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/24/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Selective fetal growth restriction (sFGR) complicating twin-twin transfusion syndrome (TTTS) is associated with a 3-6-fold increased risk of fetal demise after fetoscopic laser surgery (FLS). Identifying these patients is challenging due to varying definitions of sFGR used in the literature. The objective of this study was to determine the association of three currently used definitions for sFGR with demise of the smaller twin, typically the donor, following FLS for TTTS. METHODS This was a retrospective cohort study of monochorionic diamniotic twin pregnancies undergoing FLS for TTTS between January 2015 and December 2018. Classification of the cohort as sFGR or non-sFGR was performed using three different definitions: (1) estimated fetal weight (EFW) of one twin < 10th centile and intertwin EFW discordance > 25%, according to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) (Definition A); (2) EFW of one twin < 3rd centile, according to the solitary criterion for sFGR reported in a Delphi consensus (Definition B); and (3) presence of at least two of four of the following criteria: EFW of one twin < 10th centile, abdominal circumference of one twin < 10th centile, intertwin EFW discordance of ≥ 25% and umbilical artery pulsatility index of the smaller twin > 95th centile, according to the contributory criteria for sFGR in monochorionic diamniotic twin pregnancies reported in the Delphi consensus (Definition C). Pearson's χ2 and univariate and multivariate logistic regression analyses were performed to assess the association of classification as sFGR according to the different definitions with fetal demise within 48 h after FLS. RESULTS A total of 124 pregnancies underwent FLS for TTTS during the study period. Of these, 46/124 (37.1%) were identified as having sFGR according to the ISUOG criteria (Definition A), 57/124 (46.0%) based on EFW < 3rd centile (Definition B) and 70/124 (56.5%) according to the Delphi contributory criteria (Definition C). There were no differences in maternal body mass index, recipient twin amniotic fluid volume, gestational age (GA) at intervention or GA at delivery between sFGR and non-sFGR cases for any of the three definitions. There were also no differences in the rates of postprocedure recipient demise or Doppler abnormalities in the recipient. Regardless of the definition used, sFGR cases showed a significantly higher rate of postprocedure donor twin demise compared with that in non-sFGR cases (Definition A: 28.3% vs 3.8%, P < 0.01; Definition B: 22.8% vs 4.5%, P = 0.02; Definition C: 22.9% vs 0%, P < 0.01). For all of the sFGR definitions, the rate of Stage-III TTTS was increased in sFGR compared to non-sFGR cases (Definition A: 65.2% vs 35.9%, P ≤ 0.01; Definition B: 59.6% vs 35.8%, P = 0.04; Definition C: 62.9% vs 25.9%, P < 0.01). All cases of donor demise met the criteria for sFGR according to Definition C. Classification as sFGR according to Definition C was associated with a significantly higher rate of post-FLS donor demise compared to Definitions A and B (χ2 , 15.32; P < 0.01). Logistic regression analysis demonstrated that sFGR cases had an increased risk of donor demise (Definition A: odds ratio (OR), 4.97 (95% CI, 1.77-13.94), P < 0.01; Definition B: OR, 4.39 (95% CI, 1.36-14.15), P = 0.01) and that staging of TTTS was also predictive of demise (OR, 2.26 (95% CI, 1.14-4.47), P = 0.02). After adjusting for GA at intervention and stage of TTTS, the results were similar (Definition A: OR, 6.48 (95% CI, 2.11-24.56), P = 0.002; Definition B: OR, 4.16 (95% CI, 1.35-15.74), P = 0.02). CONCLUSIONS The rate of fetal demise following FLS for TTTS is increased in the presence of sFGR. Improving diagnosis of sFGR should improve counseling and may affect management. The Delphi method of defining sFGR based on the presence of at least two of four contributory criteria had the highest predictive value for donor demise following FLS for TTTS. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Donepudi
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - J Espinoza
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - A A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - M A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - A A Shamshirsaz
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
| | - M Sanz Cortes
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, TX, USA
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Zielinsky P, MagalhÃes GA, Zurita-Peralta J, Sosa-OlavarrÍa A, Marinho G, Van Der Sand L, Sulis NM, Nicoloso LH, Piccoli A, Vian I. Improvement in fetal pulmonary hypertension and maturity after reversal of ductal constriction: prospective cohort study. Ultrasound Obstet Gynecol 2021; 58:420-427. [PMID: 33502049 DOI: 10.1002/uog.23599] [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: 09/03/2020] [Revised: 12/20/2020] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To test the hypotheses that estimated mean pulmonary arterial pressure (MPAP) decreases and pulmonary vascular maturation, assessed by the ratio of pulmonary arterial flow acceleration time to ejection time (AT/ET ratio), increases after reversal of fetal ductus arteriosus constriction by reducing maternal intake of the causal agent (prostaglandin inhibitors, such as polyphenol-rich foods or non-steroidal anti-inflammatory drugs), and that these effects are independent of gestational age, which are inferences not yet demonstrated in the clinical setting. METHODS This was a prospective cohort study comparing Doppler echocardiographic ductal flow dynamics, MPAP and pulmonary arterial flow AT/ET ratio in third-trimester fetuses (≥ 28 weeks' gestation) with ductus arteriosus constriction, at the time of diagnosis and after 2 weeks of reduced maternal intake of prostaglandin inhibitors either by suspending the use of pharmacological agents with potential for prostaglandin inhibition or by restricting the consumption of polyphenol-rich foods. MPAP was estimated using the Dabestani equation (MPAP = 90 - (0.62 × AT)), and pulmonary vascular maturity was assessed using the AT/ET ratio, according to reported validation studies. Student's t-test was used for comparison of variables at diagnosis with those after reversal of ductal constriction. Change in MPAP and pulmonary AT/ET ratio between the two assessments was compared with the expected change in the same gestational period in normal fetuses based on reference curves of MPAP and pulmonary AT/ET ratio constructed in normal fetuses from healthy pregnant women at 19-37 weeks' gestation, encompassing the same gestational age range as the study group (28-37 weeks). RESULTS Seventy pregnancies with fetal ductus arteriosus constriction were included in the study. After 2 weeks of reduced maternal intake of prostaglandin inhibitors, normalization of mean systolic (change from 1.86 ± 0.34 m/s at diagnosis to 1.38 ± 0.41 m/s; P < 0.001) and diastolic (change from 0.41 ± 0.11 m/s to 0.21 ± 0.065 m/s; P < 0.001) ductal velocities and of mean pulsatility index (change from 1.99 ± 0.20 to 2.55 ± 0.42; P < 0.001) was demonstrated. MPAP decreased between the assessments (change from 66.7 ± 6.90 mmHg at diagnosis to 54.5 ± 6.70 mmHg after 2 weeks; P < 0.001) and mean pulmonary AT/ET ratio increased (change from 0.20 ± 0.06 to 0.33 ± 0.07; P < 0.001). Change in MPAP between diagnosis and after 2 weeks of reduced maternal intake of prostaglandin inhibitors was -12.2 ± 0.30 mmHg, which was 5.3-times higher than that in 305 normal fetuses over 2 weeks during the same gestational period (-2.3 ± 0.19 mmHg) (P < 0.001), and change in pulmonary AT/ET ratio between the two assessments was 0.13 ± 0.08, which was 8.7-times higher than that in normal fetuses in the same gestational period (0.015 ± 0.08) (P < 0.001). CONCLUSIONS Resolution of fetal ductal constriction is followed by a fall in MPAP and by an increase in pulmonary vascular maturity, to a significantly greater degree than is observed in normal fetuses in the same gestational-age period. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- P Zielinsky
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
- Department of Pediatrics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - G A MagalhÃes
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - J Zurita-Peralta
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | | | - G Marinho
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - L Van Der Sand
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - N M Sulis
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - L H Nicoloso
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - A Piccoli
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
| | - I Vian
- Fetal Cardiology Unit, Institute of Cardiology, Porto Alegre, Brazil
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Ochiai D, Endo T, Oishi M, Kasuga Y, Ikenoue S, Tanaka M. Vasa previa with fetal vessels running transversely across the cervix: a diagnostic pitfall. Ultrasound Obstet Gynecol 2021; 58:485-486. [PMID: 32991754 DOI: 10.1002/uog.23133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Affiliation(s)
- D Ochiai
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - T Endo
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - M Oishi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Y Kasuga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - S Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - M Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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James JL, Tongpob Y, Srinivasan V, Crew RC, Bappoo N, Doyle B, Gerneke D, Clark AR, Wyrwoll CS. Three-dimensional visualisation of the feto-placental vasculature in humans and rodents. Placenta 2021; 114:8-13. [PMID: 34418753 DOI: 10.1016/j.placenta.2021.08.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/19/2022]
Abstract
Adequate development of the feto-placental circulation is critical for placental exchange function and healthy fetal growth. Understanding the structure of this circulation and how it informs fetal outcomes is important both in the human placenta, and the rodent, a purported comparative experimental model. Vascular casting and micro-CT imaging approaches enable detailed quantification of the complex vascular relationships in the feto-circulation, and provide detailed data to parameterise in silico models. Here, to assist researchers to apply these technically challenging methods we provide detailed approaches to cast and image; 1) human placentas at the cotyledon-level, and 2) whole rodent placentas.
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Affiliation(s)
- J L James
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Y Tongpob
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia; Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | - V Srinivasan
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - R C Crew
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia
| | - N Bappoo
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia; Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre and the UWA Centre for Medical Research, The University of Western Australia, WA, Australia; School of Engineering, The University of Western Australia, Perth, WA, 6009, Australia
| | - B Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre and the UWA Centre for Medical Research, The University of Western Australia, WA, Australia; School of Engineering, The University of Western Australia, Perth, WA, 6009, Australia; Australian Research Council Centre for Personalised Therapeutics Technologies, Australia; Centre for Cardiovascular Science, The University of Edinburgh, UK
| | - D Gerneke
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - A R Clark
- Auckland Bioengineering Institute, University of Auckland, New Zealand
| | - C S Wyrwoll
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia.
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Sammallahti S, Tiemeier H, Louwen S, Steegers E, Hillegers M, Jaddoe VWV, White T. Fetal-placental blood flow and neurodevelopment in childhood: population-based neuroimaging study. Ultrasound Obstet Gynecol 2021; 58:245-253. [PMID: 32851732 PMCID: PMC8457176 DOI: 10.1002/uog.22185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/13/2020] [Accepted: 08/18/2020] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Antenatal Doppler measurements of the fetal umbilical and cerebral circulations can predict perinatal complications; however, it is unclear if subtle variations in antenatal Doppler measurements are associated with long-term neurodevelopmental outcome. In this study, we examined whether antenatal Doppler measurements of the fetal-placental circulation are associated with cognitive and motor abilities and brain morphology in childhood. METHODS To evaluate differences in long-term sequelae across the continuum of the umbilical and cerebral artery circulations in the general population, we utilized a population-based longitudinal cohort study approach. In women from the Generation R study, we measured second- and third-trimester umbilical artery pulsatility index (UA-PI). Children underwent non-verbal intelligence testing at 4-8 years of age, and at 8-12 years they underwent finger-tapping tests to measure fine motor skills, balance beam tests to measure gross motor skills and brain magnetic resonance imaging. We assessed the relationships between prenatal UA-PI and neurodevelopmental outcome using linear regression. We adjusted for child age and sex, maternal age, education, parity and smoking status. RESULTS The study sample included 2803 pregnancies. Higher third-trimester UA-PI was associated with poorer fine motor performance (0.41 (95% CI, 0.11-0.70) fewer taps on the finger-tapping test per 1 SD higher UA-PI) and gross motor performance (0.64 (95% CI, 0.20-1.08) fewer steps on the balance beam test per 1 SD higher UA-PI). One SD higher third-trimester UA-PI was also associated with 0.65 (95% CI, 0.04-1.25) points lower intelligence quotient; however, unlike the associations with motor abilities, this finding did not persist after correction for multiple testing. Higher second-trimester UA-PI was associated with smaller brain volume (6.1 (95% CI, 1.0-11.3) cm3 reduction per 1 SD higher UA-PI), but the association did not persist after correction for multiple testing. CONCLUSION Higher placental vascular resistance may have mild adverse effects on neurodevelopmental outcome at school age. While these effects are subtle at population level, we encourage future research into the role of early circulation in brain development. This information could be used to develop targeted interventions. © 2020 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)
- S. Sammallahti
- Department of Child and Adolescent Psychiatry and PsychologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of Social and Behavioral SciencesHarvard School of Public HealthBostonMAUSA
| | - H. Tiemeier
- Department of Child and Adolescent Psychiatry and PsychologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of Social and Behavioral SciencesHarvard School of Public HealthBostonMAUSA
| | - S. Louwen
- Department of Child and Adolescent Psychiatry and PsychologyErasmus University Medical CenterRotterdamThe Netherlands
- Department of NeuroscienceErasmus University Medical CenterRotterdamThe Netherlands
| | - E. Steegers
- Department of Obstetrics and GynecologyErasmus University Medical CenterRotterdamThe Netherlands
| | - M. Hillegers
- Department of Child and Adolescent Psychiatry and PsychologyErasmus University Medical CenterRotterdamThe Netherlands
| | - V. W. V. Jaddoe
- Department of PediatricsErasmus University Medical CenterRotterdamThe Netherlands
| | - T. White
- Department of Child and Adolescent Psychiatry and PsychologyErasmus University Medical CenterRotterdamThe Netherlands
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Wilson RL, Troja W, Sumser EK, Maupin A, Lampe K, Jones HN. Insulin-like growth factor 1 signaling in the placenta requires endothelial nitric oxide synthase to support trophoblast function and normal fetal growth. Am J Physiol Regul Integr Comp Physiol 2021; 320:R653-R662. [PMID: 33621475 PMCID: PMC8163607 DOI: 10.1152/ajpregu.00250.2020] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/22/2022]
Abstract
Currently, there is no effective treatment for placental dysfunction in utero. In a ligated mouse model of fetal growth restriction (FGR), nanoparticle-mediated human insulin-like 1 growth factor (hIGF1) gene delivery (NP-Plac1-hIGF1) increased hIGF1 expression and maintained fetal growth. However, whether it can restore fetal growth remains to be determined. Using the endothelial nitric oxide synthase knockout (eNOS-/-) mouse model, a genetic model of FGR, we found that despite inducing expression of hIGF1 in the placentas treated with NP-Plac1-hIGF1 (P = 0.0425), FGR did not resolve. This was associated with no change to the number of fetal capillaries in the placental labyrinth; an outcome which was increased with NP-Plac1-hIGF1 treatment in the ligated mouse model, despite increased expression of angiopoietin 1 (P = 0.05), and suggested IGF1 signaling in the placenta requires eNOS to modulate placenta angiogenesis. To further assess this hypothesis, BeWo choriocarcinoma cell line and human placental explant cultures were treated with NP-Plac1-hIGF1, oxidative stress was induced with hydrogen peroxide (H2O2), and NOS activity was inhibited using the inhibitor NG-monomethyl-l-arginine (l-NMMA). In both BeWo cells and explants, the protective effect of NP-Plac1-hIGF1 treatment against H2O2-induced cell death/lactate dehydrogenase release was prevented by eNOS inhibition (P = 0.003 and P < 0.0001, respectively). This was associated with an increase in mRNA expression of oxidative stress markers hypoxia inducing factor 1α (HIF1α; P < 0.0001) and ADAM10 (P = 0.0002) in the NP-Plac1-hIGF1 + H2O2 + l-NMMA-treated BeWo cells. These findings show for the first time the requirement of eNOS/NOS in IGF1 signaling in placenta cells that may have implications for placental angiogenesis and fetal growth.
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Affiliation(s)
- Rebecca L Wilson
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
| | - Weston Troja
- Center for Fetal and Placental Research, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio
| | - Emily K Sumser
- Center for Fetal and Placental Research, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio
| | - Alec Maupin
- Center for Fetal and Placental Research, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio
| | - Kristin Lampe
- Center for Fetal and Placental Research, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio
| | - Helen N Jones
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida
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Semmler J, Garcia-Gonzalez C, Sanchez Sierra A, Gallardo Arozena M, Nicolaides KH, Charakida M. Fetal cardiac function at 35-37 weeks' gestation in pregnancies that subsequently develop pre-eclampsia. Ultrasound Obstet Gynecol 2021; 57:417-422. [PMID: 33098138 DOI: 10.1002/uog.23521] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 09/14/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To compare fetal cardiac morphology and function between pregnancies that subsequently developed pre-eclampsia (PE) and those that remained normotensive. METHODS This was a prospective observational study in 1574 pregnancies at 35-37 weeks' gestation, including 76 that subsequently developed PE. We carried out comprehensive assessment of fetal cardiac morphology and function including novel imaging modalities, such as speckle-tracking echocardiography, and measured uterine artery pulsatility index, mean arterial pressure (MAP), serum placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and cerebroplacental ratio (CPR). The findings in the group that subsequently developed PE were compared to those in pregnancies that remained normotensive. RESULTS In fetuses of mothers who subsequently developed PE, compared to those from normotensive pregnancies, there was a more globular right ventricle, as shown by reduced right ventricular sphericity index, reduced right ventricular systolic contractility, as shown by reduced global longitudinal strain, and reduced left ventricular diastolic function, as shown by increased E/A ratio. On multivariable regression analysis, these indices demonstrated an association with PE, independent of maternal characteristics and fetal size. In pregnancies that subsequently developed PE, compared to those that remained normotensive, MAP, sFlt-1 and the incidence of low birth weight were higher, whereas serum PlGF, CPR and the interval between assessment and delivery were lower. These findings demonstrate that, in pregnancies that develop PE, there is evidence of impaired placentation, reflected in low PlGF and reduced birth weight, placental ischemia, evidenced by increased sFlt-1 which becomes apparent in the interval of 2-4 weeks preceding the clinical onset of PE, and consequent fetal hypoxia-induced redistribution in the fetal circulation, reflected in the low CPR. CONCLUSION Although the etiology of the observed fetal cardiac changes in pregnancies that subsequently develop PE remains unclear, it is possible that the reduction in right-heart systolic function is the consequence of high afterload due to increased placental resistance, whilst the early left ventricular diastolic changes could be due to fetal hypoxia-induced redistribution in the fetal circulation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- J Semmler
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - C Garcia-Gonzalez
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - A Sanchez Sierra
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Gallardo Arozena
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, Fetal Medicine Research Institute, King's College Hospital, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Rosati P, Buongiorno S, Salvi S, Lanzone A, Familiari A. Reference values for pulsatility index of fetal anterior and posterior cerebral arteries in prolonged pregnancy. J Clin Ultrasound 2021; 49:199-204. [PMID: 33501682 DOI: 10.1002/jcu.22979] [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: 04/07/2020] [Revised: 12/10/2020] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To establish consistent normal reference values for fetal anterior cerebral artery (ACA) and posterior cerebral artery (PCA) pulsatility index (PI) in prolonged pregnancy. METHODS This prospective cross-sectional observational study included singleton normal prolonged pregnancies into two study groups according to the gestational age: from 40 + 0 to 40 + 6 and from 41 + 0 to 41 + 6 weeks. The PI was assessed in both anatomical segments of ACA (ACA-S1 and ACA-S2) and of PCA (PCA-S1 and PCA-S2) with color Doppler imaging and pulsed Doppler examination, and reference centiles charts were generated. PI values from the two investigated segments of each vessel were also compared. RESULTS Data were obtained in 771 patients: n = 448 in the 40 + 0 and 40 + 6 weeks group, and n = 323 in the 41 + 0 and 41 + 6 weeks group. A moderate decrease in PI was observed as pregnancy progressed. No differences in PI values were found between the two anatomical segments of ACA and PCA. CONCLUSION This study provides Doppler reference values for the fetal ACA and PCA PI. It also shows that Doppler examination could be performed indifferently in one of the two anatomical segments of these arteries.
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Affiliation(s)
- Paolo Rosati
- Department of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" della, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Silvia Buongiorno
- Department of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" della, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Silvia Salvi
- Department of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" della, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Antonio Lanzone
- Department of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" della, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Alessandra Familiari
- Department of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" della, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
- Department of Obstetrics and Gynecology, "L. Mangiagalli," Fondazione IRCCS "Ca' Granda" - Ospedale Maggiore Policlinico, Milan, Italy
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De Luca A, Küster A, Tea I, Darmaun D, Rozé JC, Robins R, Hankard R. Plasma amino acid pools in the umbilical cord artery show lower 15N natural isotope abundance relative to the maternal venous pools. Isotopes Environ Health Stud 2021; 57:3-10. [PMID: 32972258 DOI: 10.1080/10256016.2020.1817914] [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: 03/17/2020] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
15N natural isotope abundance (NIA) is systematically higher in infants' hair than in that of their mothers at birth. This study aimed to investigate this difference in plasma pools. We compared 15N NIA values for plasma amino acid (AA) pools (free + protein-bound) in the umbilical cord artery (UCA) and vein (UCV) and in the maternal vein (MV) at birth. This preliminary study included 7 mother-infant dyads. Whole plasma was treated (HCl) to hydrolyze protein. Following derivatization, AAs were separated using gas chromatography and compound-specific 15N NIA values were measured on-line using an isotope ratio monitoring mass spectrometer. 15N NIA plasma AA pools in the UCA and UCV were highly correlated to the MV, r 2 > 0.89 and r 2 > 0.88 (both P < 10-4) respectively. The full model found a significant effect of sampling compartment (P = 0.02) and AA type (P < 0.0001) on 15N NIA plasma AA values. 15N NIA plasma AA was 0.74 ‰ higher (P = 0.01) in the MV than in the UCA. This study indicates that a decrease in 15N NIA for plasma AA pools occurs in the fetal-placental unit. Trial registration: ClinicalTrials.gov identifier: NCT00607061.
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Affiliation(s)
- Arnaud De Luca
- Inserm UMR 1069, Nutrition, Croissance et Cancer, Tours, France
- Nutrition Unit, Regional University Hospital Centre, Tours, France
| | - Alice Küster
- Neonatal and Pediatric Intensive Care Units, University Hospital Centre, Nantes, France
- INRAE UMR PhAN, University of Nantes, CRNH-Ouest, Nantes, France
| | - Illa Tea
- University of Nantes, CNRS, CEISAM UMR 6230, Nantes, France
| | | | - Jean-Christophe Rozé
- Neonatal and Pediatric Intensive Care Units, University Hospital Centre, Nantes, France
- INRAE UMR PhAN, University of Nantes, CRNH-Ouest, Nantes, France
| | - Richard Robins
- University of Nantes, CNRS, CEISAM UMR 6230, Nantes, France
| | - Régis Hankard
- Inserm UMR 1069, Nutrition, Croissance et Cancer, Tours, France
- Nutrition Unit, Regional University Hospital Centre, Tours, France
- University F Rabelais, Tours, France
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Kosiv KA, Moon-Grady A, Hogan W, Keller R, Rapoport R, Rogers E, Feldstein VA, Lee H, Peyvandi S. Fetal cerebrovascular impedance is reduced in left congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 2021; 57:386-391. [PMID: 32068925 PMCID: PMC7431368 DOI: 10.1002/uog.21992] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/31/2020] [Accepted: 02/09/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Congenital diaphragmatic hernia (CDH) can cause a significant mass effect in the fetal thorax, displacing the heart into the opposite hemithorax. In left-sided CDH (L-CDH), this is associated with smaller left-sided cardiac structures and reduced left-ventricular cardiac output (LVCO). The effect of these physiologic changes on cerebral blood flow is not well understood. We sought to describe the middle cerebral artery (MCA) pulsatility index (PI), a measure of cerebrovascular impedance, in fetuses with L-CDH and those with right-sided CDH (R-CDH) compared with unaffected fetuses, and the relationship between MCA-PI and LVCO. We hypothesized that MCA-PI would be lower in fetuses with L-CDH and similar in those with R-CDH compared to controls, and that MCA-PI would be correlated with LVCO. METHODS We identified all fetuses with CDH evaluated at The University of California San Francisco, San Francisco, CA, USA from 2011 to 2018. Fetal echocardiograms and ultrasound scans were reviewed. Umbilical artery and MCA Doppler examinations were assessed to calculate pulsatility indices. Ventricular outputs were calculated using Doppler-derived stroke volume and fetal heart rate. Lung-to-head ratio (LHR), estimated fetal weight, biparietal diameter (BPD) and head circumference (HC) were obtained from fetal sonograms. Measurements in fetuses with CDH, according to the side of the defect, were compared with those in unaffected, gestational age-matched controls. A subset of CDH survivors had available data on neurodevelopmental outcome, as assessed using the Bayley Scales of Infant Development, 3rd edition. RESULTS A total of 64 fetuses with CDH (L-CDH, n = 53; R-CDH, n = 11) comprised the study groups, with 27 unaffected fetuses serving as controls. Mean gestational age at evaluation was similar between the three groups. Compared to controls, fetuses with L-CDH had significantly lower LVCO expressed as a percentage of combined cardiac output (CCO) (32%; 95% CI, 29-35% vs 38%; 95% CI, 33-42%; P = 0.04) and lower MCA-PI Z-score (-1.3; 95% CI, -1.7 to -1.0 vs 0.08; 95% CI, -0.5 to 0.6; P < 0.001), while they did not differ between the R-CDH group and controls. There was a strong positive association between LVCO as a percentage of CCO and MCA-PI Z-score in the overall cohort of CDH and control fetuses (P = 0.01). BPD and HC were similar between the three groups. At neurodevelopmental follow-up, mean cognitive, motor and language scores in the CDH group were within 1 SD of those in the general population. CONCLUSION MCA-PI values are significantly lower in fetuses with L-CDH as compared to controls, and lower LVCO was correlated with lower MCA vascular impedance. The neurodevelopmental effect of changes in MCA-PI in response to decreased LVCO is unknown, although, on average, CDH survivors had neurodevelopmental scores in the normal range. This may reflect a fetal compensatory mechanism in response to diminished antegrade cerebral blood flow. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- Katherine A. Kosiv
- The University of California, San Francisco Department of Pediatrics, Division of Pediatric Cardiology, San Francisco, CA
| | - Anita Moon-Grady
- The University of California, San Francisco Department of Pediatrics, Division of Pediatric Cardiology, San Francisco, CA
| | - Whitnee Hogan
- The University of California, San Francisco Department of Pediatrics, Division of Pediatric Cardiology, San Francisco, CA
| | - Roberta Keller
- The University of California, San Francisco Department of Pediatrics, Division of Neonatology, San Francisco, CA
| | - Rebecca Rapoport
- The University of California, San Francisco Department of Pediatrics, Division of Neonatology, San Francisco, CA
| | - Elizabeth Rogers
- The University of California, San Francisco Department of Pediatrics, Division of Neonatology, San Francisco, CA
| | - Vickie A. Feldstein
- The University of California, San Francisco Department of Pediatrics, Department of Radiology & Biomedical Imaging, San Francisco, CA
| | - Hanmin Lee
- The University of California, San Francisco Department of Pediatrics, Department of Surgery, San Francisco, CA
| | - Shabnam Peyvandi
- The University of California, San Francisco Department of Pediatrics, Division of Pediatric Cardiology, San Francisco, CA
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Sorensen DW, Carreon D, Williams JM, Pearce WJ. Hypoxic modulation of fetal vascular MLCK abundance, localization, and function. Am J Physiol Regul Integr Comp Physiol 2021; 320:R1-R18. [PMID: 33112654 PMCID: PMC7847055 DOI: 10.1152/ajpregu.00212.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022]
Abstract
Changes in vascular contractility are among the most important physiological effects of acute and chronic fetal hypoxia. Given the essential role of myosin light-chain kinase (MLCK) in smooth muscle contractility and its heterogeneous distribution, this study explores the hypothesis that subcellular changes in MLCK distribution contribute to hypoxic modulation of fetal carotid artery contractility. Relative to common carotid arteries from normoxic term fetal lambs (FN), carotids from fetal lambs gestated at high altitude (3,802 m) (FH) exhibited depressed contractility without changes in MLCK mRNA or protein abundance. Patterns of confocal colocalization of MLCK with α-actin and 20-kDa regulatory myosin light chain (MLC20) enabled calculation of subcellular MLCK fractions: 1) colocalized with the contractile apparatus, 2) colocalized with α-actin distant from the contractile apparatus, and 3) not colocalized with α-actin. Chronic hypoxia did not affect MLCK abundance in the contractile fraction, despite a concurrent decrease in contractility. Organ culture for 72 h under 1% O2 decreased total MLCK abundance in FN and FH carotid arteries, but decreased the contractile MLCK abundance only in FH carotid arteries. Correspondingly, culture under 1% O2 depressed contractility more in FH than FN carotid arteries. In addition, hypoxia appeared to attenuate ubiquitin-independent proteasomal degradation of MLCK, as reported for other proteins. In aggregate, these results demonstrate that the combination of chronic hypoxia followed by hypoxic culture can induce MLCK translocation among at least three subcellular fractions with possible influences on contractility, indicating that changes in MLCK distribution are a significant component of fetal vascular responses to hypoxia.
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Affiliation(s)
- Dane W Sorensen
- Divisions of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California
| | - Desirelys Carreon
- Divisions of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California
| | - James M Williams
- Divisions of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California
| | - William J Pearce
- Divisions of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California
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Xu R, Zhu Z, Tang W, Zhou Q, Zeng S. Inferior Adrenal Artery PI in Fetuses with IUGR: Value Indicating Early Blood Redistribution and Steroidogenic Response. J Clin Endocrinol Metab 2020; 105:5908703. [PMID: 32946562 DOI: 10.1210/clinem/dgaa610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/16/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To characterize the inferior adrenal artery (IAA) pulsatility index (PI) in intrauterine growth-restricted (IUGR) fetuses without brain sparing. METHODS Twenty-three IUGR fetuses with a normal Doppler cerebroplacental ratio (CPR) and 23 normal controls were included in this prospective cross-sectional study. The PI of the IAA was recorded using routine transabdominal Doppler ultrasound. The differences in Doppler characteristics, perinatal outcomes, and steroidogenesis in the umbilical vein at birth (adrenocorticotropic hormone [ACTH] and cortisol [F] levels) were compared between the 2 groups. The correlations between IAA-PI and steroidogenesis were assessed in the IUGR group. RESULTS IAA-PI was significantly lower in IUGR fetuses than in normal controls (0.85 vs 1.18 at first scan, 0.78 vs 0.92 at last scan; both P < 0.001). The plasma F and ACTH levels in IUGR cases were significantly higher than those of the normal controls (18.2 vs 12.4 µg/dL and 280.5 vs 125.6 pg/mL for F and ACTH, respectively; both P < 0.001). There were negative correlations between IAA-PI and plasma F values and between IAA-PI and ACTH values in the IUGR group (r = -0.774 and -0.82 at first scan, r = -0.525 and -0.45 at last scan, respectively; P < 0.001). CONCLUSION Increased adrenal gland blood flow with concomitant increases in ACTH and F levels were observed in IUGR fetuses. IAA-PI is useful to assess early blood redistribution and may be beneficial for evaluating the steroidogenic response in high-risk pregnancies.
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Affiliation(s)
- Ran Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ziling Zhu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenjuan Tang
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qichang Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shi Zeng
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Hata T, Koyanagi A, Yamanishi T, Bouno S, Takayoshi R, Miyake T. Fetal abdominal blood vessels and organ microvasculature detected by Slowflow HD. Ultrasound Obstet Gynecol 2020; 56:955-957. [PMID: 32291852 DOI: 10.1002/uog.22043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Affiliation(s)
- T Hata
- Department of Obstetrics and Gynecology, Miyake Clinic, Ohfuku, Minami-ku, Okayama, Japan
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Ikenobe, Miki, Kagawa, Japan
| | - A Koyanagi
- Department of Obstetrics and Gynecology, Miyake Clinic, Ohfuku, Minami-ku, Okayama, Japan
| | - T Yamanishi
- Department of Obstetrics and Gynecology, Miyake Clinic, Ohfuku, Minami-ku, Okayama, Japan
| | - S Bouno
- Department of Obstetrics and Gynecology, Miyake Clinic, Ohfuku, Minami-ku, Okayama, Japan
| | - R Takayoshi
- Department of Obstetrics and Gynecology, Miyake Clinic, Ohfuku, Minami-ku, Okayama, Japan
| | - T Miyake
- Department of Obstetrics and Gynecology, Miyake Clinic, Ohfuku, Minami-ku, Okayama, Japan
- Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Ikenobe, Miki, Kagawa, Japan
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Terstappen F, Calis JJA, Paauw ND, Joles JA, van Rijn BB, Mokry M, Plösch T, Lely AT. Developmental programming in human umbilical cord vein endothelial cells following fetal growth restriction. Clin Epigenetics 2020; 12:185. [PMID: 33256815 PMCID: PMC7708922 DOI: 10.1186/s13148-020-00980-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Fetal growth restriction (FGR) is associated with an increased susceptibility for various noncommunicable diseases in adulthood, including cardiovascular and renal disease. During FGR, reduced uteroplacental blood flow, oxygen and nutrient supply to the fetus are hypothesized to detrimentally influence cardiovascular and renal programming. This study examined whether developmental programming profiles, especially related to the cardiovascular and renal system, differ in human umbilical vein endothelial cells (HUVECs) collected from pregnancies complicated by placental insufficiency-induced FGR compared to normal growth pregnancies. Our approach, involving transcriptomic profiling by RNA-sequencing and gene set enrichment analysis focused on cardiovascular and renal gene sets and targeted DNA methylation assays, contributes to the identification of targets underlying long-term cardiovascular and renal diseases. RESULTS Gene set enrichment analysis showed several downregulated gene sets, most of them involved in immune or inflammatory pathways or cell cycle pathways. seven of the 22 significantly upregulated gene sets related to kidney development and four gene sets involved with cardiovascular health and function were downregulated in FGR (n = 11) versus control (n = 8). Transcriptomic profiling by RNA-sequencing revealed downregulated expression of LGALS1, FPR3 and NRM and upregulation of lincRNA RP5-855F14.1 in FGR compared to controls. DNA methylation was similar for LGALS1 between study groups, but relative hypomethylation of FPR3 and hypermethylation of NRM were present in FGR, especially in male offspring. Absolute differences in methylation were, however, small. CONCLUSION This study showed upregulation of gene sets related to renal development in HUVECs collected from pregnancies complicated by FGR compared to control donors. The differentially expressed gene sets related to cardiovascular function and health might be in line with the downregulated expression of NRM and upregulated expression of lincRNA RP5-855F14.1 in FGR samples; NRM is involved in cardiac remodeling, and lincRNAs are correlated with cardiovascular diseases. Future studies should elucidate whether the downregulated LGALS1 and FPR3 expressions in FGR are angiogenesis-modulating regulators leading to placental insufficiency-induced FGR or whether the expression of these genes can be used as a biomarker for increased cardiovascular risk. Altered DNA methylation might partly underlie FPR3 and NRM differential gene expression differences in a sex-dependent manner.
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Affiliation(s)
- Fieke Terstappen
- Division Woman and Baby, Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Postbus 85090, 3508 AB, Utrecht, The Netherlands.
- Department for Developmental Origins of Disease, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Jorg J A Calis
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Nina D Paauw
- Division Woman and Baby, Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Postbus 85090, 3508 AB, Utrecht, The Netherlands
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bas B van Rijn
- Department of Obstetrics and Fetal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michal Mokry
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Torsten Plösch
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Titia Lely
- Division Woman and Baby, Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Postbus 85090, 3508 AB, Utrecht, The Netherlands
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Dimova I, Rizov M, Giragosyan S, Koprinarova M, Tzoneva D, Belemezova K, Hristova-Savova M, Milachich T, Djonov V, Shterev A. Molecular pathogenesis of spontaneous abortions - Whole genome copy number analysis and expression of angiogenic factors. Taiwan J Obstet Gynecol 2020; 59:99-104. [PMID: 32039809 DOI: 10.1016/j.tjog.2019.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To study two major molecular alterations in spontaneous abortions (SA) with unexplained etiology - fetal genomic anomalies and the endometrial expression of main angiogenic factors VEGFA/VEGFR2 and chemokines SDF-1/CXCR4. MATERIALS AND METHODS Whole genome copy number analysis by arrayCGH or Next Generation Sequencing (NGS) was applied for detection of fetal genomic imbalances. The abortive decidua of SA without fetal aneuploidies was further investigated for expression levels of the abovementioned factors using real time PCR analysis. A total of 30 abortive materials were collected from spontaneous abortions after exclusion of known predisposing factors. RESULTS In 21 of 30 spontaneous abortions (70%), genomic anomalies were discovered by whole genome copy number analysis. Numerical anomalies were detected in 90% of aberrant cases, and in 10% - structural aberrations were revealed. An increased expression for essential factors of angiogenesis was identified in spontaneous abortions' tissues - 3.44 times for VEGFA and 10.29 times for VEGFR2. We found an average of 14 times increase in the expression levels of SDF-1 and 3.21 times for its receptor CXCR4. CONCLUSION We could suggest the occurrence of increased angiogenesis in SA without fetal aneuploidies, compared to the control tissues, which could lead to increased oxidative stress and fetal loss.
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Affiliation(s)
- Ivanka Dimova
- Center of Molecular Medicine, Medical University Sofia, Zdrave Str.2, 1431 Sofia, Bulgaria; Genetics Department, SAGBAL "Dr Shterev", Hristo Blagoev Str. 25, 1330 Sofia, Bulgaria.
| | - Momchil Rizov
- Genetics Department, SAGBAL "Dr Shterev", Hristo Blagoev Str. 25, 1330 Sofia, Bulgaria
| | - Silva Giragosyan
- Center of Molecular Medicine, Medical University Sofia, Zdrave Str.2, 1431 Sofia, Bulgaria
| | - Miglena Koprinarova
- Institute of Molecular Biology, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - Dochka Tzoneva
- UMBAL "Aleksandrovska", Medical University Sofia, Bulgaria
| | - Kalina Belemezova
- Genetics Department, SAGBAL "Dr Shterev", Hristo Blagoev Str. 25, 1330 Sofia, Bulgaria
| | | | - Tanya Milachich
- Genetics Department, SAGBAL "Dr Shterev", Hristo Blagoev Str. 25, 1330 Sofia, Bulgaria
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, CH-3000, Berne-9, Switzerland
| | - Atanas Shterev
- Genetics Department, SAGBAL "Dr Shterev", Hristo Blagoev Str. 25, 1330 Sofia, Bulgaria
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Wohlmuth C, Agarwal A, Stevens B, Johnson A, Moise KJ, Papanna R, Donepudi R, Bell CS, Averiss IE, Gardiner HM. Fetal ventricular strain in uncomplicated and selective growth-restricted monochorionic diamniotic twin pregnancies and cardiovascular response in pre-twin-twin transfusion syndrome. Ultrasound Obstet Gynecol 2020; 56:694-704. [PMID: 31682302 PMCID: PMC7702120 DOI: 10.1002/uog.21911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/21/2019] [Revised: 10/19/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Our primary aim was to confirm whether intertwin discordance in ventricular strain and ductus venosus (DV) time intervals predicts twin-twin transfusion syndrome (TTTS). Secondary aims were to create gestational-age ranges for ventricular strain in uncomplicated monochorionic diamniotic (MCDA) twin pregnancies without selective intrauterine growth restriction (sIUGR) and to characterize the relationship of ventricular strain with gestational age in MCDA twin pregnancies with sIUGR that did not develop TTTS. METHODS In the period 2015-2018, we enrolled 150 MCDA twin pregnancies consecutively into this prospective, blinded study of global longitudinal left and right ventricular strain. With the observer blinded to twin pairing and pregnancy outcome, videoclips of the four-chamber view, which had been recorded during ultrasound surveillance in the usual window for development of TTTS (16-26 completed gestational weeks), underwent offline measurement of strain. Uncomplicated MCDA twin pregnancies, without sIUGR, were used to test the association between strain, gestational age and estimated fetal weight using mixed-effects multilevel regression. Inter-rater reliability was tested in 208 strain measurements in 31 fetuses from pregnancies which did not develop TTTS and within-fetus variation was assessed in 16 such fetuses, in which multiple four-chamber views were taken on the same day. The effect of sIUGR on strain in otherwise uncomplicated MCDA twin pregnancy was analyzed. MCDA twin pregnancies were defined as 'pre-TTTS' when, having been referred for TTTS evaluation, they did not satisfy Quintero staging criteria, but subsequently developed TTTS requiring laser treatment. MCDA pregnancies which did not develop TTTS comprised the 'non-TTTS' group. Cardiovascular parameters measured in these cases included tissue Doppler parameters and DV early filling time as a percentage of the cardiac cycle (DVeT%). Intertwin strain and DVeT% discordance was compared between non-TTTS and pre-TTTS cases, matched for gestational age. RESULTS Paired strain data were available for intertwin comparison in 127/150 MCDA twin pregnancies, comprising 14 pre-TTTS and 113 non-TTTS pregnancies, after exclusions. Scans were collected at a median frame rate of 97 (range, 28-220) Hz. Laser therapy was performed at a median gestational age of 20.6 (range, 17.2-26.6) weeks. There were no group differences in right (RV) or left (LV) ventricular strain discordance between 68/113 non-TTTS and 13/14 pre-TTTS MCDA twin pregnancies < 20 completed gestational weeks (RV, P = 0.338; LV, P = 0.932). DVeT% discordance > 3.6% was found in eight of 13 pre-TTTS pregnancies. In non-TTTS pregnancies, the estimated variability in ventricular strain within each twin during the day was high (RV, 19.7; LV, 12.9). However, within each pair (intertwin variation), variability was low (RV, 5.5; LV, 2.9). Interclass correlation reflecting the proportion of total variability represented by the variability between twin pairs was low (RV, 0.22; LV, 0.18). Both RV (P < 0.001) and LV (P = 0.025) strain showed a negative association with gestational age. Among non-TTTS MCDA twin pregnancies, LV strain was, on average, higher by 1.83 in sIUGR compared with normally grown fetuses (P = 0.023), with no statistically significant difference in RV strain (P = 0.271). CONCLUSIONS Although ventricular strain has been reported previously as a possible predictor of developing TTTS, in this blinded, prospective study, we found no significant intergroup differences in ventricular strain in pre-TTTS compared with age-matched non-TTTS MCDA twin pregnancies. We recommend using DVeT% discordance as a more practical screening tool in MCDA twin pregnancies. This study also provides new information on the changes with gestational age, and the biological and technical variation, of global longitudinal ventricular strain in uncomplicated MCDA twin pregnancies and those with isolated sIUGR. © 2019 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. Wohlmuth
- The Fetal CenterUTHealth McGovern Medical SchoolHoustonTXUSA
- Department of Obstetrics and GynecologyParacelsus Medical UniversitySalzburgAustria
| | - A. Agarwal
- The Fetal CenterUTHealth McGovern Medical SchoolHoustonTXUSA
| | - B. Stevens
- The Fetal CenterUTHealth McGovern Medical SchoolHoustonTXUSA
| | - A. Johnson
- The Fetal CenterUTHealth McGovern Medical SchoolHoustonTXUSA
| | - K. J. Moise
- The Fetal CenterUTHealth McGovern Medical SchoolHoustonTXUSA
| | - R. Papanna
- The Fetal CenterUTHealth McGovern Medical SchoolHoustonTXUSA
| | - R. Donepudi
- The Fetal CenterUTHealth McGovern Medical SchoolHoustonTXUSA
| | - C. S. Bell
- Center for Clinical Research & Evidence‐Based MedicineUTHealth McGovern Medical SchoolHoustonTXUSA
| | - I. E. Averiss
- The Fetal CenterUTHealth McGovern Medical SchoolHoustonTXUSA
| | - H. M. Gardiner
- The Fetal CenterUTHealth McGovern Medical SchoolHoustonTXUSA
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Abstract
Pre-eclampsia and fetal growth restriction arise from disorders of placental development and have some shared mechanistic features. Initiation is often rooted in the maldevelopment of a maternal-placental blood supply capable of providing for the growth requirements of the fetus in later pregnancy, without exerting undue stress on maternal body systems. Here, we review normal development of a placental bed with a safe and adequate blood supply and a villous placenta-blood interface from which nutrients and oxygen can be extracted for the growing fetus. We consider disease mechanisms that are intrinsic to the maternal environment, the placenta or the interaction between the two. Systemic signalling from the endocrine placenta targets the maternal endothelium and multiple organs to adjust metabolism for an optimal pregnancy and later lactation. This signalling capacity is skewed when placental damage occurs and can deliver a dangerous pathogenic stimulus. We discuss the placental secretome including glycoproteins, microRNAs and extracellular vesicles as potential biomarkers of disease. Angiomodulatory mediators, currently the only effective biomarkers, are discussed alongside non-invasive imaging approaches to the prediction of disease risk. Identifying the signs of impending pathology early enough to intervene and ameliorate disease in later pregnancy remains a complex and challenging objective.
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Affiliation(s)
- John D Aplin
- Maternal and Fetal Health Group, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester, UK.
| | - Jenny E Myers
- Maternal and Fetal Health Group, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester, UK
| | - Kate Timms
- Lydia Becker Institute of Inflammation and Immunology, The University of Manchester, Manchester, UK
| | - Melissa Westwood
- Maternal and Fetal Health Group, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester, UK
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Ruiz-Martinez S, Papageorghiou AT, Staines-Urias E, Villar J, Gonzalez De Agüero R, Oros D. Clinical impact of Doppler reference charts on management of small-for-gestational-age fetuses: need for standardization. Ultrasound Obstet Gynecol 2020; 56:166-172. [PMID: 31237023 DOI: 10.1002/uog.20380] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/09/2019] [Accepted: 06/17/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess clinical variability in the management of small-for-gestational-age (SGA) fetuses according to different published Doppler reference charts for umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler indices and cerebroplacental ratio (CPR). METHODS We performed a systematic search of MEDLINE, EMBASE, CINAHL and the Web of Science databases from 1954 to 2018 for studies with the sole aim of creating fetal Doppler reference values for UA, MCA and CPR. The top cited articles for each Doppler parameter were included. Variability in Doppler values at the following clinically relevant cut-offs was assessed: UA-pulsatility index (PI) > 95th percentile; MCA-PI < 5th percentile; and CPR < 5th percentile. Variability was calculated for each week of gestation and expressed as the percentage difference between the highest and lowest Doppler value at the clinically relevant cut-offs. Simulation analysis was performed in a cohort of SGA fetuses (n = 617) to evaluate the impact of this variability on clinical management. RESULTS From a total of 40 studies that met the inclusion criteria, 19 were analyzed (13 for UA-PI, 10 for MCA-PI and five for CPR). Wide discrepancies in reported Doppler reference values at clinically relevant cut-offs were found. MCA-PI showed the greatest variability, with differences of up to 51% in the 5th percentile value at term. Variability in the 95th percentile of UA-PI and the 5th percentile of CPR at each gestational week ranged from 21% to 41% and 15% to 33%, respectively. As expected, on simulation analysis, these differences in Doppler cut-off values were associated with significant variation in the clinical management of SGA fetuses, despite using the same protocol. CONCLUSIONS The choice of Doppler reference chart can result in significant variation in the clinical management of SGA fetuses, which may lead to suboptimal outcomes and inaccurate research conclusions. Therefore, an attempt to standardize fetal Doppler reference ranges is needed. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Ruiz-Martinez
- Aragon Institute of Health Research (IIS Aragón), Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - A T Papageorghiou
- Nuffield Department of Obstetrics and Gynaecology, Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - E Staines-Urias
- Nuffield Department of Obstetrics and Gynaecology, Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - J Villar
- Nuffield Department of Obstetrics and Gynaecology, Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - R Gonzalez De Agüero
- Aragon Institute of Health Research (IIS Aragón), Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Red de Salud Materno Infantil y del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII), Subdirección General de Evaluación y Fomento de la Investigación y Fondo Europeo de Desarrollo Regional (FEDER), Spain
| | - D Oros
- Aragon Institute of Health Research (IIS Aragón), Obstetrics Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Nuffield Department of Obstetrics and Gynaecology, Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
- Red de Salud Materno Infantil y del Desarrollo (SAMID), RETICS, Instituto de Salud Carlos III (ISCIII), Subdirección General de Evaluación y Fomento de la Investigación y Fondo Europeo de Desarrollo Regional (FEDER), Spain
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Acharya G, Ebbing C, Karlsen HO, Kiserud T, Rasmussen S. Sex-specific reference ranges of cerebroplacental and umbilicocerebral ratios: longitudinal study. Ultrasound Obstet Gynecol 2020; 56:187-195. [PMID: 31503378 DOI: 10.1002/uog.21870] [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] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Observational studies have shown that low cerebroplacental ratio (CPR) values predict an increased risk of adverse perinatal outcome. The inverse ratio, i.e. the umbilicocerebral ratio (UCR), has been suggested to be a better predictor as it rises with increasing degree of fetal compromise. However, longitudinal reference ranges for UCR have not been established, and whether gestational-age-dependent changes in CPR or UCR differ between male and female fetuses has not been studied. Thus, the aims of this study were to investigate sex-specific, gestational-age-associated serial changes in CPR and UCR during the second half of pregnancy and to establish longitudinal reference ranges. METHODS This was a secondary analysis of prospectively collected data from a dual-center longitudinal observational cohort study of low-risk singleton pregnancies. Doppler blood-flow velocity waveforms were obtained serially from the umbilical artery (UA) and fetal middle cerebral artery (MCA) from 19-41 weeks' gestation, and pulsatility indices (PIs) were determined. CPR and UCR were calculated as the ratios MCA-PI/UA-PI and UA-PI/MCA-PI, respectively. The course and outcome of pregnancies were recorded, and the sex of the fetus was determined after delivery. Reference intervals for CPR and UCR were constructed using multilevel modeling, and gestational-age-specific Z-scores in male and female fetuses were compared. RESULTS Of a total of 299 pregnancies enrolled, 284 (148 male and 136 female fetuses) were included in the final analysis, and 979 paired measurements of UA-PI and MCA-PI were used to construct sex-specific longitudinal reference intervals. The relationship of both CPR and UCR with gestational age was U-shaped, but in opposite directions. There was a small but significant difference in Z-scores of CPR and UCR between male and female fetuses throughout the second half of pregnancy (P = 0.007). CONCLUSIONS We have established longitudinal reference ranges for CPR and UCR suitable for serial monitoring, with the possibility of refining assessment by using fetal sex-specific ranges and conditioning by a previous measurement. The clinical significance of such refinements needs further evaluation. © 2019 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)
- G Acharya
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø and Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Science, Intervention & Technology, Karolinska Institutet and Center for Fetal Medicine Karolinska, University Hospital, Stockholm, Sweden
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - H O Karlsen
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - T Kiserud
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - S Rasmussen
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Rial-Crestelo M, Morales-Roselló J, Hernández-Andrade E, Prefumo F, Oros D, Caffici D, Sotiriadis A, Zohav E, Cruz-Martinez R, Parra-Cordero M, Lubusky M, Kacerovsky M, Figueras F. Quality assessment of fetal middle cerebral and umbilical artery Doppler images using an objective scale within an international randomized controlled trial. Ultrasound Obstet Gynecol 2020; 56:182-186. [PMID: 31180608 DOI: 10.1002/uog.20370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/05/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine the quality of Doppler images of the fetal middle cerebral artery (MCA) and umbilical artery (UA) using an objective scale, and to determine the reliability of this scale, within a multicenter randomized controlled trial (Revealed versus concealed criteria for placental insufficiency in unselected obstetric population in late pregnancy (Ratio37)). METHODS The Ratio37 trial is an ongoing randomized, open-label, multicenter controlled study of women with a low-risk pregnancy recruited at 20 weeks. Doppler measurements of the fetal MCA and UA were performed at 37 weeks. Twenty patients from each of the six participating centers were selected randomly, with two images evaluated per patient (one each for the MCA and UA). The quality of a total of 240 images was evaluated by six experts, scored on an objective scale of six items. Inter- and intrarater reliability was assessed using the Fleiss-modified kappa statistic for ordinal scales. RESULTS On average, 89.2% of MCA images and 85.0% of UA images were rated as being of perfect (score of 6) or almost perfect (score of 5) quality. Kappa values for intrarater reliability of quality assessment were 0.90 (95% CI, 0.88-0.92) and 0.90 (95% CI, 0.88-0.93) for the MCA and UA, respectively. The corresponding inter-rater reliability values were 0.85 (95% CI, 0.81-0.89) and 0.84 (95% CI, 0.80-0.89), respectively. CONCLUSION The quality of MCA and UA Doppler ultrasound images can be evaluated reliably using an objective scale. Over 85% of images, which were obtained by operators from a broad range of clinical practices within a multicenter study, were rated as being of perfect or almost perfect quality. Intra- and inter-rater reliability of quality assessment was very good. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Rial-Crestelo
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia y Neonatología, IDIBAPS, Obstetrics and Gynecology, University of Barcelona, Barcelona, Spain
| | - J Morales-Roselló
- Department of Obstetrics and Gynecology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - E Hernández-Andrade
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Hutzel Women's Hospital, Perinatology Research Branch, NICHD/NIH/DHHS, Detroit, MI, USA
| | - F Prefumo
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - D Oros
- Aragon Institute for Health Research (IIS Aragón), Obstetrics Department, Hospital Clínico Univeristario Zaragoza, Zaragoza, Spain
| | - D Caffici
- Sociedad Argentina de Ultrasonografía en Medicina y Biología, Buenos Aires, Argentina
| | - A Sotiriadis
- 2nd Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Zohav
- Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Lis Maternity and Women's Hospital University, Tel Aviv University, Tel Aviv, Israel
| | - R Cruz-Martinez
- Department of Fetal Medicine and Surgery, Children's and Women's Specialty Hospital of Querétaro, Querétaro, Mexico
| | - M Parra-Cordero
- Fetal Medicine Unit, Obstetrics and Gynecology, University of Chile Hospital, Santiago de Chile, Chile
| | - M Lubusky
- Department of Obstetrics and Gynecology, Palacky University Olomouc, Faculty of Medicine and Dentistry, University Hospital Olomouc, Olomouc, Czech Republic
| | - M Kacerovsky
- Charles University in Prague, Faculty of Medicine Hradec Kralove, Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Prague, Czech Republic
| | - F Figueras
- Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic and Hospital Sant Joan de Déu), Institut Clínic de Ginecología, Obstetricia y Neonatología, IDIBAPS, Obstetrics and Gynecology, University of Barcelona, Barcelona, Spain
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Bouchghoul H, Adamsbaum C, Maurey H, Ozanne A, Senat MV. Pseudofeeders: sonographic sign of poor prognosis in fetus with vein of Galen malformation. Ultrasound Obstet Gynecol 2020; 56:296-297. [PMID: 32449243 DOI: 10.1002/uog.22097] [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: 03/30/2020] [Revised: 05/01/2020] [Accepted: 05/17/2020] [Indexed: 06/11/2023]
Affiliation(s)
- H Bouchghoul
- Department of Obstetrics and Gynecology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
- Rare Disease Reference Center 'AVANCE': Anomalies Vasculaires Neurologiques et Craniofaciales de L'Enfant et de L'adulte
| | - C Adamsbaum
- Rare Disease Reference Center 'AVANCE': Anomalies Vasculaires Neurologiques et Craniofaciales de L'Enfant et de L'adulte
- Department of Pediatric Radiology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - H Maurey
- Rare Disease Reference Center 'AVANCE': Anomalies Vasculaires Neurologiques et Craniofaciales de L'Enfant et de L'adulte
- Department of Neuropediatrics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - A Ozanne
- Rare Disease Reference Center 'AVANCE': Anomalies Vasculaires Neurologiques et Craniofaciales de L'Enfant et de L'adulte
- Department of Interventional Neuroradiology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - M V Senat
- Department of Obstetrics and Gynecology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
- Rare Disease Reference Center 'AVANCE': Anomalies Vasculaires Neurologiques et Craniofaciales de L'Enfant et de L'adulte
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Stampalija T, Thornton J, Marlow N, Napolitano R, Bhide A, Pickles T, Bilardo CM, Gordijn SJ, Gyselaers W, Valensise H, Hecher K, Sande RK, Lindgren P, Bergman E, Arabin B, Breeze AC, Wee L, Ganzevoort W, Richter J, Berger A, Brodszki J, Derks J, Mecacci F, Maruotti GM, Myklestad K, Lobmaier SM, Prefumo F, Klaritsch P, Calda P, Ebbing C, Frusca T, Raio L, Visser GHA, Krofta L, Cetin I, Ferrazzi E, Cesari E, Wolf H, Lees CC. Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study. Ultrasound Obstet Gynecol 2020; 56:173-181. [PMID: 32557921 DOI: 10.1002/uog.22125] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. METHODS This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored. RESULTS The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33 weeks and 1.0 at 34-36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association. CONCLUSION In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 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)
- T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - T Pickles
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk and Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - H Valensise
- Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - R K Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - P Lindgren
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - E Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - B Arabin
- Department of Obstetrics Charite, Humboldt University Berlin and Clara Angela Foundation, Berlin, Germany
| | - A C Breeze
- Fetal Medicine Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - L Wee
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - J Richter
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - A Berger
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Brodszki
- Department of Pediatric Surgery and Neonatology, Lund University, Skane University Hospital, Lund, Sweden
| | - J Derks
- Department of Perinatal Medicine, University of Utrecht, Utrecht, The Netherlands
| | - F Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - G M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples 'Federico II', Naples, Italy
| | | | - S M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - F Prefumo
- Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - P Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - L Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - G H A Visser
- Department of Obstetrics, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Krofta
- Institute for the Care of Mother and Child, Prague, Czech Republic and Third Medical Faculty, Charles University, Prague, Czech Republic
| | - I Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - E Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - H Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - C C Lees
- Imperial College School of Medicine, Imperial College London and Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS trust, London, UK
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Goldsher YW, Salem Y, Weisz B, Achiron R, Jacobson JM, Gindes L. Bovine aortic arch: Prevalence in human fetuses. J Clin Ultrasound 2020; 48:198-203. [PMID: 31777971 DOI: 10.1002/jcu.22800] [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: 10/10/2019] [Revised: 11/03/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE "Bovine aortic arch" is the second most common variant of aortic arch branching, in which only two branches originate directly from the aorta. The prevalence of this condition has been reported in different studies to be around 6% in human fetuses and 11-27% in the adult population. In this study, we describe the prevalence of bovine aortic arch in fetuses, and assess the prevalence of concomitant fetal anomalies. METHODS A retrospective analysis of 417 fetuses between 15-40 weeks of gestation. Data regarding branching of the fetal aortic arch and other fetal anomalies were collected by fetal echocardiography and/or fetal ultrasonography. RESULTS A bovine arch was found in 20/413 fetuses (4.8%, 95CI 3.1-7.3%), of whom 14/310 (4.5%) had no fetal anomalies, and 6/77 (7.8%) exhibited minor changes (P = .241). None of the 26 fetuses with major anomalies had a bovine arch. CONCLUSION Fetuses in this study had a lower prevalence of bovine aortic arch than that previously reported in adults, most probably due to differences in the population examined. This study was underpowered to determine that bovine arch is a common anatomic variant, and is not associated with fetal anomalies.
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Affiliation(s)
- Yulia W Goldsher
- Department of Obstetrics and Gynecology, Ultrasound Unit, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Yishai Salem
- Department of Pediatric Cardiology, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Ultrasound Unit, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler school of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reuven Achiron
- Department of Obstetrics and Gynecology, Ultrasound Unit, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler school of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Jacobson
- Department of Pediatric Radiology, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Liat Gindes
- Department of Obstetrics and Gynecology, Ultrasound Unit, Wolfson Medical Center, Holon, Israel
- Sackler school of medicine, Tel Aviv University, Tel Aviv, Israel
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Ražem K, Kocijan J, Podbregar M, Lučovnik M. Near-infrared spectroscopy of the placenta for monitoring fetal oxygenation during labour. PLoS One 2020; 15:e0231461. [PMID: 32298307 PMCID: PMC7162483 DOI: 10.1371/journal.pone.0231461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/24/2020] [Indexed: 11/18/2022] Open
Abstract
Although being the golden standard for intrapartum fetal surveillance, cardiotocography (CTG) has been shown to have poor specificity for detecting fetal acidosis. Non-invasive near-infrared-spectroscopy (NIRS) monitoring of placental oxygenation during labour has not been studied yet. The objective of the study was to determine whether changes in placental NIRS values during labour could identify intrapartum fetal hypoxia and resulting acidosis. We included 43 healthy women in active stage of labour at term. CTG and NIRS parameters in groups with vs. without neonatal umbilical artery pH ≤ 7.20 were compared using Mann-Whitney-U. Receiver-operating-characteristics (ROC) curves were used to estimate predictive value of CTG and NIRS parameters for neonatal pH ≤ 7.20. A computer-based statistical classification was also performed to further evaluate predictive values of CTG and NIRS for neonatal acidosis. Ten (23%) neonates were born with umbilical artery pH ≤ 7.20. Compared to group with pH > 7.20, fetal acidosis was associated with more episodes of placental NIRS deoxygenation (9 (range 2-37) vs. 2 (range 0-65); p<0.001), higher velocity of placental NIRS deoxygenation (2.31 (range 0-22) vs. 1 (range 0-49) %/s; p = 0.03), more decelerations on CTG (25 (range 3-91) vs. 10 (range 10-60); p = 0.02), and more prolonged decelerations on CTG (2 (range 0-4) vs. 1 (range 0-3); p = 0.04). Number of placental deoxygenations had the highest prognostic value for fetal/neonatal acidosis (area under the ROC curve 0.85 (95% confidence interval 0.70-0.99). Computer-based classification also identified number of placental deoxygenations as the most accurate classifier, with 25% false positive and 93% true positive rate in the training dataset, with 100% accuracy when applied to the testing dataset. Placental deoxygenations during labour measured by NIRS are associated with fetal/neonatal acidosis. Predictive value of placental NIRS for neonatal acidosis was superior to that of CTG.
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Affiliation(s)
- Katja Ražem
- Division of Obstetrics and Gynecology, Department of Perinatology, UniversityMedical Centre Ljubljana, Ljubljana, Slovenia
- * E-mail:
| | - Juš Kocijan
- Department of Systems and Control, Jožef Štefan Institute, Ljubljana, Slovenia
- School of Engineering and Management, University of Nova Gorica, Nova Gorica, Slovenia
| | - Matej Podbregar
- Department of Intensive Internal Medicine, General Hospital Celje, Celje, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miha Lučovnik
- Division of Obstetrics and Gynecology, Department of Perinatology, UniversityMedical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Hernandez-Andrade E, Romero R. Visualization of fetal tongue circulation using Doppler ultrasound. Ultrasound Obstet Gynecol 2020; 55:559-560. [PMID: 31294506 PMCID: PMC7062294 DOI: 10.1002/uog.20393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/01/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Edgar Hernandez-Andrade
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
- Detroit Medical Center, Detroit, Michigan, USA
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