S. Boito - Academia.edu (original) (raw)

Papers by S. Boito

Research paper thumbnail of Evalutation of Oxygen Uptake in Iugr Fetuses

Research paper thumbnail of Low torcular Herophili position and large brain stem: tentorium angle in two fetuses with open spinal dysraphism at 11-13 weeks of gestation

Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2021

OBJECTIVE The aim of this study was to evaluate whether in fetuses with open spina bifida the ten... more OBJECTIVE The aim of this study was to evaluate whether in fetuses with open spina bifida the tentorium is downward displaced and vertically oriented already at the 11-13 weeks scan and is reflected in an alteration of the Brainstem-Tentorium (BST) angle. PATIENTS AND METHODS Two groups of patients were recruited in three Fetal Medicine referral Centers: the prospectively collected control group included singleton pregnancies with a normal sonographic examination after first trimester combined screening for chromosomal abnormalities and normal outcome. The study group was selected retrospectively and enclosed all cases with open spina bifida. In all cases the position of the tentorium and the torcular Herophili (TH) were identified in the midsagittal view of the fetal brain at 11-13 weeks with the use of color Doppler; the BST angle was calculated in the same view. RESULTS In the period 2015-2020 sixty normal fetuses were included in the control group; in these fetuses the BST angle...

Research paper thumbnail of Trattamento con Doxorubicina per Ca della mammella in gravidanza: case report

Research paper thumbnail of OC11.04: Cell‐free DNA testing in prenatal screening of chromosomal microdeletions and microduplications: review of the literature

Ultrasound in Obstetrics & Gynecology

Research paper thumbnail of Development of Customized Fetal Growth Charts in Twins

American Journal of Obstetrics and Gynecology, 2017

Twin gestations are at significantly higher risk of fetal growth restriction in comparison with s... more Twin gestations are at significantly higher risk of fetal growth restriction in comparison with singletons. Using fetal biometric charts customized for obstetrical and parental characteristics may facilitate accurate assessment of fetal growth. To construct reference charts for gestation of fetal biometric parameters stratified by chorionicity and customized for obstetrical and parental characteristics. Fetal biometric measurements obtained from serial ultrasound examinations in uncomplicated twin pregnancies delivering after 36 weeks of gestation were collected by 19 Italian fetal medicine units under the auspices of the Società Italiana di Ecografia Ostetrica e Ginecologica. The measurements acquired in each fetus at each examination included biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). Multilevel linear regression models were used to adjust for the serial ultrasonographic measurements obtained and the clustering of each fetus in twin pregnancy. The impact of maternal and paternal characteristics (height, weight, ethnicity), parity, fetal sex and mode of conception were also considered. Models for each parameter were stratified by fetal chorionicity and compared to our previously constructed growth curves for singletons RESULTS: The dataset included 1781 twin pregnancies (dichorionic 1289; monochorionic diamniotic 492) with 8923 ultrasonographic examination with a median of 5 (range 2-8) observations per pregnancy in dichorionic and 6 in (range 2-11) monochorionic pregnancies. Growth curves of twin pregnancies differed from those of singletons, and differences were more marked in monochorionic twins and during the third trimester. A significant influence of parental characteristics was found. Curves of fetal biometric measurements in twins are influenced by parental characteristics. There is a reduction in growth rate during the third trimester. The reference limits for gestation constructed in this study may provide an useful tool for a more accurate assessment of fetal growth in twin pregnancies.

Research paper thumbnail of Prenatal ultrasound factors and genetic disorders in pregnancies complicated by polyhydramnios

Prenatal Diagnosis, 2016

The objective of the study is to examine the incidence of chromosomal or genetic abnormalities in... more The objective of the study is to examine the incidence of chromosomal or genetic abnormalities in pregnancies complicated by polyhydramnios and to assess the value of prenatal ultrasound findings in the prediction of cases associated with such disorders. We searched the prenatal records of all patients delivered in our hospital with a diagnosis of polyhydramnios during pregnancy. For each case, maternal characteristics, ultrasound findings, and genetic testing results were recorded. A postnatal follow-up program of at least 6 months, including a clinical assessment by a clinical geneticist, was carried out in all cases. On a total of 195 cases, genetic testing and clinical examination identified a chromosomal or genetic disease in 26 (13.3%) cases. Multivariate analysis demonstrated that significant predictors of a genetic disorder were a deepest vertical pocket of amniotic fluid of ≥13.0 cm (OR 4.306, 95%CI: 1.535-12.079) and reduced fetal movements (OR 25.084, 95%CI: 4.577-137.461), but not the presence of a structural defect. A postnatal clinical follow-up program can reveal chromosomal or genetic disorders in about 13% of neonates with a prenatal diagnosis of polyhydramnios. The severity of polyhydramnios and the reduction of fetal movements are independently associated with the presence of such diseases. © 2016 John Wiley & Sons, Ltd.

Research paper thumbnail of Spheno-frontal distance in euploid and trisomy 21 fetuses at 16-24 weeks' gestation by three-dimensional ultrasound

Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, Jan 29, 2016

To compare the distance between the sphenoid and frontal bones in trisomy 21 and euploid fetuses ... more To compare the distance between the sphenoid and frontal bones in trisomy 21 and euploid fetuses at 16-24 weeks' gestation by three-dimensional (3D) ultrasound. We acquired 3D volumes of the fetal profile from 80 normal and 30 trisomy 21 fetuses at 16-24 weeks. We used the multiplanar mode to obtain the mid-sagittal plane and measured the spheno-frontal distance as the shortest distance between the most anterior edge of the sphenoid bone and the lowest edge of the frontal bone. In the normal group, the spheno-frontal distance increased linearly with gestational age from 15.1 mm at 16 weeks to 18.2 mm at 24 weeks. In fetuses with trisomy 21, mean spheno-frontal distance delta value was significantly smaller than in normal cases (-3.447 mm; 95% CI -5.684 to -1.211 mm; p < 0.01). Spheno-frontal distance was below the 5th and the 1st percentile of the normal range in 29 (96.7%) and 27 (90.0%) fetuses, respectively. The spheno-frontal distance is shorter in fetuses with trisomy 21...

Research paper thumbnail of The Effect of Fetal Sex on Customised Fetal Growth Charts

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 2, 2016

Objective To evaluate the effect of fetal sex on singleton pregnancy growth charts customized for... more Objective To evaluate the effect of fetal sex on singleton pregnancy growth charts customized for parental characteristics, race and parity Methods In a multicentric cross-sectional study, 8070 ultrasonographic examinations from low risk singleton pregnancies between 16 and 40 weeks of gestation were considered. The fetal measurements obtained were biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). Quantile regression was used to examine the impact of fetal sex across the biometric percentiles of the fetal measurements considered together with parents' height, weight, parity and race. Results Fetal gender resulted to be a significant covariate for BDP, HC and AC with higher values for male fetuses (p≤0.0009). Minimal differences were found among sexes for FL. Parity, maternal race, paternal height and maternal height and weight resulted significantly related to the fetal biometric parameters considered independently from fetal...

Research paper thumbnail of Postnatal survival after endoscopic equatorial laser for the treatment of twin-to-twin transfusion syndrome

American Journal of Obstetrics and Gynecology, 2015

Background: Endoscopic laser coagulation of placental anastomoses is the first-line treatment for... more Background: Endoscopic laser coagulation of placental anastomoses is the first-line treatment for severe twin-to-twin transfusion syndrome (TTTS). A recent randomized controlled trial reported that laser coagulation along the entire vascular equator was associated with a similar dual survival and survival of at least one twin compared to the group treated with the selective technique. In addition, there was a significantly lower incidence of postoperative recurrence of TTTS and development of twin anemia-polycytemia sequence (TAPS) in the equatorial group. Objective: To report on neonatal survival in TTTS pregnancies treated with endoscopic laser using the equatorial technique and to examine the relationship between preoperative factors and twin loss. Study design: Endoscopic equatorial laser was carried out as the primary treatment for TTTS in all consecutive monochorionic diamniotic twin pregnancies referred at a single fetal surgery Centre over a 4 years' period. All visible placental anastomoses were coagulated and additional laser ablation of the placental tissue between the coagulated vessels was carried out. Pre-laser ultrasound data, peri-procedural complications, pregnancy outcome and postnatal survival at hospital discharge were recorded and analysed. Results: A total of 106 pregnancies were treated during the study period. Median gestational age at laser was 19.7 (range 15.1-27.6) weeks. There was postoperative recurrence of TTTS or development of TAPS in 2 (1.9%) and 2 (1.9%) cases, respectively. The survival rates of both and at least one twin were 56.6% and 83.0%, respectively. Donor survival was significantly lower compared to the recipient co-twin (64.2% vs 75.5%, respectively; p<0.05). The rate of fetal death, which was the most common cause of twin loss, was significantly higher in donors compared to recipient 4 fetuses (23.6% vs 10.4%, respectively; p<0.05). In cases with absent or reversed end-diastolic velocity in the donor umbilical artery, dual and donor survival rates were significantly lower compared to the remaining TTTS pregnancies (40.0% vs 64.8% and 40.0% vs 76.1%, respectively; p<0.05). There were no significant differences between the two groups in the survival of at least one twin and in the recipient survival. Conclusions: Endoscopic equatorial laser was associated with a survival of both and at least one twin of about 55% and 83%, respectively, and with a low rate of recurrent TTTS and TAPS. In addition, the preoperative finding of abnormal donor umbilical artery Doppler identified a subgroup of TTTS pregnancies with a lower dual survival rate due to increased intrauterine mortality of donor twins.

Research paper thumbnail of Prenatal Brain MR Imaging: Reference Linear Biometric Centiles between 20 and 24 Gestational Weeks

American Journal of Neuroradiology, Mar 8, 2018

BACKGROUND AND PURPOSE: Evaluation of biometry is a fundamental step in prenatal brain MR imaging... more BACKGROUND AND PURPOSE: Evaluation of biometry is a fundamental step in prenatal brain MR imaging. While different studies have reported reference centiles for MR imaging biometric data of fetuses in the late second and third trimesters of gestation, no one has reported them in fetuses in the early second trimester. We report centiles of normal MR imaging linear biometric data of a large cohort of fetal brains within 24 weeks of gestation. MATERIALS AND METHODS: From the data bases of 2 referral centers of fetal medicine, accounting for 3850 examinations, we retrospectively collected 169 prenatal brain MR imaging examinations of singleton pregnancies, between 20 and 24 weeks of gestational age, with normal brain anatomy at MR imaging and normal postnatal neurologic development. To trace the reference centiles, we used the CG-LMS method. RESULTS: Reference biometric centiles for the developing structures of the cerebrum, cerebellum, brain stem, and theca were obtained. The overall interassessor agreement was adequate for all measurements. CONCLUSIONS: Reference biometric centiles of the brain structures in fetuses between 20 and 24 weeks of gestational age may be a reliable tool in assessing fetal brain development. ABBREVIATIONS: BPD ϭ biparietal diameter; LLD ϭ latero-lateral diameter; CSA ϭ clivo-supraoccipital angle; FOD ϭ fronto-occipital diameter; GA ϭ gestational age; LCC ϭ length of the corpus callosum; APD ϭ antero-posterior diameter; CCD ϭ cranio-caudal diameter

Research paper thumbnail of OP15.01: Absolute uterine artery blood flow volume is increased in twin human pregnancies compared to singletons

Ultrasound in Obstetrics and Gynecology, 2007

To compare (1) absolute and (2) weight-specific blood flow volume of uterine arteries (UtA) in no... more To compare (1) absolute and (2) weight-specific blood flow volume of uterine arteries (UtA) in normal twin pregnancies to normal singleton pregnancies. Methods: Twelve twin pregnancies (10 dichorionic, two monochorionic) with normal UtA PI and normal weight at birth were included. UtA diameter and time-averaged maximum velocity were obtained to calculate flow (mL/min) and UtA flow/EFW (mL/min/kg) in each UtA. UtA flow was estimated by the formula Q = hV · πD 2 /4; a patient-specific coefficient, h, was obtained by an ad hoc mathematical model. Total UtA flow was calculated as a sum of right and left vessel flow volume. Twins' UtA flow was expressed per unit EFW considering the sum of the two EFWs. Twins were compared to 48 normal age-matched singletons. Results: Gestational age at exam was similar in twins and in singletons (25.9 ± 6.4 vs. 25.2 ± 6.2 weeks, NS). UtA flow (mL/min) was significantly increased in twins (509.3 ± 240.7 mL/min) compared to singletons (337.2 ± 257.0 mL/min) (P = 0.04). UtA flow (mL/min) exponentially increased along gestation in twins and in singletons. The twins' trend was above the third interquartile range of singletons' reference values. UtA diameter was significantly increased in twins (0.33 ± 0.07 cm) than in singletons (0.28 ± 0.05 cm), while no differences in UtA mean velocity were observed (77.5 ± 29.9 vs. 76.7 ± 29.1 cm/sec, respectively, NS). UtA flow per EFW did not differ between twins and singletons (384.4 ± 198.6 vs. 460.9 ± 302.9 mL/min/kg, respectively, NS). Conclusions: (1) UtA flow volume (mL/min) in twin pregnancies was significantly increased. This was determined by larger vessel diameter, compared to singletons. (2) Each twin proved to share an amount of UtA flow per unit estimated fetal weight not significantly different from singletons.

Research paper thumbnail of OP13.11: Uterine artery blood flow volume: ranges in uncomplicated human pregnancies

Ultrasound in Obstetrics and Gynecology, 2006

Oral poster abstracts towards term. The peak-systolic velocity increased from mean 59 to 71 cm/s ... more Oral poster abstracts towards term. The peak-systolic velocity increased from mean 59 to 71 cm/s during the weeks 21-31 and remained stable until term. The diastolic velocity showed a continuous increase from 31 cm/s at 21 weeks to 43 cm/s at 40 weeks. The pulsatility index for veins decreased from 0.57 at 21 weeks to 0.44 at 40 weeks. Terms for individually conditioned observations modify the reference ranges when used for serial measurements.

Research paper thumbnail of P07.05: Uterine artery blood flow volume growth rate in uncomplicated human pregnancies

Ultrasound in Obstetrics and Gynecology, 2006

Objective: 1) To study uterine artery (UtA) flow (ml/min) growth rate along gestation in normal h... more Objective: 1) To study uterine artery (UtA) flow (ml/min) growth rate along gestation in normal human pregnancies; 2) to evaluate longitudinal changes of UtA flow expressed per unit estimated fetal weight (EFW) (ml/min/kg). Methods: A cohort of twelve singleton uneventful human pregnancies, with a normal mean UtA PI, was included in this longitudinal study. UtA was evidenced by power-Doppler mode and sampled 10-15 mm prior to bifurcation. UtA diameter was measured on a perpendicular view after removing power-Doppler. UtA PI and velocity were measured with a Doppler beam angle < 30 • . The average of three consecutive diameters and velocities was considered. UtA flow was estimated by the formula Q = hV · πD2/4; h coefficient (0.5) was obtained by an ad hoc mathematical model. UtA total flow (ml/min) (right plus left UtA flow) was then expressed per EFW (ml/min/kg). Using linear interpolation, including random effects for the intercept and the slope of gestational age for each fetus, a linear mixed effects model was fitted. Results: Forty-seven ultrasound examinations were performed. Ultrasound exams were performed at 14.3,b1.2 weeks and every 4 weeks until delivery. Each case was definitively included in the study after recording normal perinatal and neonatal outcomes. UtA total flow (ml/min) showed a significant correlation to gestational age (133.6 ml/min at 15 weeks; 415.9 ml/min at 35 weeks) (p < 0.001), with a linear increase of 14.1 ml/min per week (right UtA 5.4 vs. left UtA 8.7 ml/min per week, p NS). UtA flow per unit EFW (ml/min/kg) showed a significant reduction from 780.3 ml/min/kg at 15 weeks to 144.1 ml/min/kg at 35 weeks (reduction rate 40.3 ml/min/kg per week). Conclusions: UtA flow (ml/min) significantly increased along gestation in this longitudinal cohort of normal pregnancies. UtA flow per unit EFW (ml/min/kg) significantly decreased longitudinally, since UtA flow (ml/min) growth rate was lower than fetal weight gain rate along gestation.

Research paper thumbnail of OP10.08: Is uterine artery blood flow volume correlated to placental site in normal human pregnancies?

Ultrasound in Obstetrics and Gynecology, 2006

Research paper thumbnail of P07.04: Uterine artery blood flow volume is reduced in human pregnancies with increase utero-placental downstream impedance

Ultrasound in Obstetrics and Gynecology, 2006

parous patients and in nulliparous women than in parous women after uncomplicated pregnancies.

Research paper thumbnail of OC27.05: Human uterine artery blood volume flow at mid-gestation: relationship to uterine artery Doppler velocimetry and placental site

Ultrasound in Obstetrics and Gynecology, 2005

intraventricular hemorrhagia and elevated nucleated red blood cell counts at delivery. Results: 8... more intraventricular hemorrhagia and elevated nucleated red blood cell counts at delivery. Results: 8 stillbirths (10.7%), 12 perinatal (16%) and 2 neonatal death (2%) occurred among 74 fetuses. Logistic regression analysis confirmed that abnormal Ductus venosus waveforms (R 2 = 0.57, p < 0.001) together with gestational age (R 2 = 0.57, p < 0.001) showed the strongest association with perinatal death, whereas gestational age only was significantly related with neonatal death (R 2 = 0.67, p < 0.05). Abnormal ductus venosus Doppler waveforms (R 2 = 0.86, p < 0.001) and gestation age (R 2 = 0.49, p < 0.05) were strongly associated with adverse outcome. Abnormal venous Doppler flow patterns performed better in the prediction of fetal or perinatal demise than died ARED flow or brain sparing. Conclusion: Abnormal Ductus venosus waveforms in preterm growth-related fetuses with ARED flow are strongly relates to adverse fetal and perinatal outcomes below 32 weeks of gestational age. The possible benefit of these pregnancies to be prolonged can only be evaluated in a prospective randomized study.

Research paper thumbnail of P07.15: Umbilical vein blood flow assessment in the human fetus: intra- and inter-observer comparison between two methodologies

Ultrasound in Obstetrics and Gynecology, 2004

29-32, 33-36 and 37-40 weeks of pregnancy, respectively. AFI in normal growth fetuses were 101.03... more 29-32, 33-36 and 37-40 weeks of pregnancy, respectively. AFI in normal growth fetuses were 101.03 ± 15.19, 82.28 ± 12.03 and 71.14 ± 14.37 mm at the same periods, respectively. Fetuses with oligohydroamnion revealed Vmax value more than mean − 1.5 S.D and showed normal renal function after birth. Conclusions: Even in fetuses with oligohydroamnion, good prognosis are expected, if Vmax for the renal artery is more than mean − 1.5 S.D of the normal fetus. To predict the prognosis, Vmax for the renal artery might be a better index than AFI.

Research paper thumbnail of P09.14: In search of a novel methodology to measure uterine arteries blood flow in pregnancy

Ultrasound in Obstetrics and Gynecology, 2004

Conclusion: Estimation of total fetal lung volume by 3DUS may be feasible and precise even in fet... more Conclusion: Estimation of total fetal lung volume by 3DUS may be feasible and precise even in fetuses with very small lungs as for example cases with isolated CDH, at least using the multiplanar imaging rotation approach with standardization of the method.

Research paper thumbnail of Uterine artery blood flow volume in pregnant women with an abnormal pulsatility index of the uterine arteries delivering normal or intrauterine growth restricted newborns

Placenta, 2011

The aim of this study was to assess and compare uterine artery (UtA) blood flow volume in pregnan... more The aim of this study was to assess and compare uterine artery (UtA) blood flow volume in pregnant patients with an abnormal uterine Doppler pulsatility index (PI) who delivered fetuses with an appropriate weight for gestational age (AGA) or with intrauterine growth restricted (IUGR).

Research paper thumbnail of Blood flow volume of uterine arteries in human pregnancies determined using 3D and bi-dimensional imaging, angio-Doppler, and fluid-dynamic modeling

Placenta, 2010

The primary aim of this pilot study was to study uterine artery (UtA) blood flow volume in uneven... more The primary aim of this pilot study was to study uterine artery (UtA) blood flow volume in uneventful human pregnancies delivered at term, at mid and late gestation by means of 3D and bi-dimensional ultrasound imaging with angio-Doppler combined with fluid-dynamic modeling. Secondary aims were to correlate flow volume to placental site and to UtA Pulsatility Index (PI).

Research paper thumbnail of Evalutation of Oxygen Uptake in Iugr Fetuses

Research paper thumbnail of Low torcular Herophili position and large brain stem: tentorium angle in two fetuses with open spinal dysraphism at 11-13 weeks of gestation

Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2021

OBJECTIVE The aim of this study was to evaluate whether in fetuses with open spina bifida the ten... more OBJECTIVE The aim of this study was to evaluate whether in fetuses with open spina bifida the tentorium is downward displaced and vertically oriented already at the 11-13 weeks scan and is reflected in an alteration of the Brainstem-Tentorium (BST) angle. PATIENTS AND METHODS Two groups of patients were recruited in three Fetal Medicine referral Centers: the prospectively collected control group included singleton pregnancies with a normal sonographic examination after first trimester combined screening for chromosomal abnormalities and normal outcome. The study group was selected retrospectively and enclosed all cases with open spina bifida. In all cases the position of the tentorium and the torcular Herophili (TH) were identified in the midsagittal view of the fetal brain at 11-13 weeks with the use of color Doppler; the BST angle was calculated in the same view. RESULTS In the period 2015-2020 sixty normal fetuses were included in the control group; in these fetuses the BST angle...

Research paper thumbnail of Trattamento con Doxorubicina per Ca della mammella in gravidanza: case report

Research paper thumbnail of OC11.04: Cell‐free DNA testing in prenatal screening of chromosomal microdeletions and microduplications: review of the literature

Ultrasound in Obstetrics & Gynecology

Research paper thumbnail of Development of Customized Fetal Growth Charts in Twins

American Journal of Obstetrics and Gynecology, 2017

Twin gestations are at significantly higher risk of fetal growth restriction in comparison with s... more Twin gestations are at significantly higher risk of fetal growth restriction in comparison with singletons. Using fetal biometric charts customized for obstetrical and parental characteristics may facilitate accurate assessment of fetal growth. To construct reference charts for gestation of fetal biometric parameters stratified by chorionicity and customized for obstetrical and parental characteristics. Fetal biometric measurements obtained from serial ultrasound examinations in uncomplicated twin pregnancies delivering after 36 weeks of gestation were collected by 19 Italian fetal medicine units under the auspices of the Società Italiana di Ecografia Ostetrica e Ginecologica. The measurements acquired in each fetus at each examination included biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). Multilevel linear regression models were used to adjust for the serial ultrasonographic measurements obtained and the clustering of each fetus in twin pregnancy. The impact of maternal and paternal characteristics (height, weight, ethnicity), parity, fetal sex and mode of conception were also considered. Models for each parameter were stratified by fetal chorionicity and compared to our previously constructed growth curves for singletons RESULTS: The dataset included 1781 twin pregnancies (dichorionic 1289; monochorionic diamniotic 492) with 8923 ultrasonographic examination with a median of 5 (range 2-8) observations per pregnancy in dichorionic and 6 in (range 2-11) monochorionic pregnancies. Growth curves of twin pregnancies differed from those of singletons, and differences were more marked in monochorionic twins and during the third trimester. A significant influence of parental characteristics was found. Curves of fetal biometric measurements in twins are influenced by parental characteristics. There is a reduction in growth rate during the third trimester. The reference limits for gestation constructed in this study may provide an useful tool for a more accurate assessment of fetal growth in twin pregnancies.

Research paper thumbnail of Prenatal ultrasound factors and genetic disorders in pregnancies complicated by polyhydramnios

Prenatal Diagnosis, 2016

The objective of the study is to examine the incidence of chromosomal or genetic abnormalities in... more The objective of the study is to examine the incidence of chromosomal or genetic abnormalities in pregnancies complicated by polyhydramnios and to assess the value of prenatal ultrasound findings in the prediction of cases associated with such disorders. We searched the prenatal records of all patients delivered in our hospital with a diagnosis of polyhydramnios during pregnancy. For each case, maternal characteristics, ultrasound findings, and genetic testing results were recorded. A postnatal follow-up program of at least 6 months, including a clinical assessment by a clinical geneticist, was carried out in all cases. On a total of 195 cases, genetic testing and clinical examination identified a chromosomal or genetic disease in 26 (13.3%) cases. Multivariate analysis demonstrated that significant predictors of a genetic disorder were a deepest vertical pocket of amniotic fluid of ≥13.0 cm (OR 4.306, 95%CI: 1.535-12.079) and reduced fetal movements (OR 25.084, 95%CI: 4.577-137.461), but not the presence of a structural defect. A postnatal clinical follow-up program can reveal chromosomal or genetic disorders in about 13% of neonates with a prenatal diagnosis of polyhydramnios. The severity of polyhydramnios and the reduction of fetal movements are independently associated with the presence of such diseases. © 2016 John Wiley &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Sons, Ltd.

Research paper thumbnail of Spheno-frontal distance in euploid and trisomy 21 fetuses at 16-24 weeks' gestation by three-dimensional ultrasound

Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, Jan 29, 2016

To compare the distance between the sphenoid and frontal bones in trisomy 21 and euploid fetuses ... more To compare the distance between the sphenoid and frontal bones in trisomy 21 and euploid fetuses at 16-24 weeks' gestation by three-dimensional (3D) ultrasound. We acquired 3D volumes of the fetal profile from 80 normal and 30 trisomy 21 fetuses at 16-24 weeks. We used the multiplanar mode to obtain the mid-sagittal plane and measured the spheno-frontal distance as the shortest distance between the most anterior edge of the sphenoid bone and the lowest edge of the frontal bone. In the normal group, the spheno-frontal distance increased linearly with gestational age from 15.1 mm at 16 weeks to 18.2 mm at 24 weeks. In fetuses with trisomy 21, mean spheno-frontal distance delta value was significantly smaller than in normal cases (-3.447 mm; 95% CI -5.684 to -1.211 mm; p < 0.01). Spheno-frontal distance was below the 5th and the 1st percentile of the normal range in 29 (96.7%) and 27 (90.0%) fetuses, respectively. The spheno-frontal distance is shorter in fetuses with trisomy 21...

Research paper thumbnail of The Effect of Fetal Sex on Customised Fetal Growth Charts

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, Jan 2, 2016

Objective To evaluate the effect of fetal sex on singleton pregnancy growth charts customized for... more Objective To evaluate the effect of fetal sex on singleton pregnancy growth charts customized for parental characteristics, race and parity Methods In a multicentric cross-sectional study, 8070 ultrasonographic examinations from low risk singleton pregnancies between 16 and 40 weeks of gestation were considered. The fetal measurements obtained were biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL). Quantile regression was used to examine the impact of fetal sex across the biometric percentiles of the fetal measurements considered together with parents' height, weight, parity and race. Results Fetal gender resulted to be a significant covariate for BDP, HC and AC with higher values for male fetuses (p≤0.0009). Minimal differences were found among sexes for FL. Parity, maternal race, paternal height and maternal height and weight resulted significantly related to the fetal biometric parameters considered independently from fetal...

Research paper thumbnail of Postnatal survival after endoscopic equatorial laser for the treatment of twin-to-twin transfusion syndrome

American Journal of Obstetrics and Gynecology, 2015

Background: Endoscopic laser coagulation of placental anastomoses is the first-line treatment for... more Background: Endoscopic laser coagulation of placental anastomoses is the first-line treatment for severe twin-to-twin transfusion syndrome (TTTS). A recent randomized controlled trial reported that laser coagulation along the entire vascular equator was associated with a similar dual survival and survival of at least one twin compared to the group treated with the selective technique. In addition, there was a significantly lower incidence of postoperative recurrence of TTTS and development of twin anemia-polycytemia sequence (TAPS) in the equatorial group. Objective: To report on neonatal survival in TTTS pregnancies treated with endoscopic laser using the equatorial technique and to examine the relationship between preoperative factors and twin loss. Study design: Endoscopic equatorial laser was carried out as the primary treatment for TTTS in all consecutive monochorionic diamniotic twin pregnancies referred at a single fetal surgery Centre over a 4 years' period. All visible placental anastomoses were coagulated and additional laser ablation of the placental tissue between the coagulated vessels was carried out. Pre-laser ultrasound data, peri-procedural complications, pregnancy outcome and postnatal survival at hospital discharge were recorded and analysed. Results: A total of 106 pregnancies were treated during the study period. Median gestational age at laser was 19.7 (range 15.1-27.6) weeks. There was postoperative recurrence of TTTS or development of TAPS in 2 (1.9%) and 2 (1.9%) cases, respectively. The survival rates of both and at least one twin were 56.6% and 83.0%, respectively. Donor survival was significantly lower compared to the recipient co-twin (64.2% vs 75.5%, respectively; p<0.05). The rate of fetal death, which was the most common cause of twin loss, was significantly higher in donors compared to recipient 4 fetuses (23.6% vs 10.4%, respectively; p<0.05). In cases with absent or reversed end-diastolic velocity in the donor umbilical artery, dual and donor survival rates were significantly lower compared to the remaining TTTS pregnancies (40.0% vs 64.8% and 40.0% vs 76.1%, respectively; p<0.05). There were no significant differences between the two groups in the survival of at least one twin and in the recipient survival. Conclusions: Endoscopic equatorial laser was associated with a survival of both and at least one twin of about 55% and 83%, respectively, and with a low rate of recurrent TTTS and TAPS. In addition, the preoperative finding of abnormal donor umbilical artery Doppler identified a subgroup of TTTS pregnancies with a lower dual survival rate due to increased intrauterine mortality of donor twins.

Research paper thumbnail of Prenatal Brain MR Imaging: Reference Linear Biometric Centiles between 20 and 24 Gestational Weeks

American Journal of Neuroradiology, Mar 8, 2018

BACKGROUND AND PURPOSE: Evaluation of biometry is a fundamental step in prenatal brain MR imaging... more BACKGROUND AND PURPOSE: Evaluation of biometry is a fundamental step in prenatal brain MR imaging. While different studies have reported reference centiles for MR imaging biometric data of fetuses in the late second and third trimesters of gestation, no one has reported them in fetuses in the early second trimester. We report centiles of normal MR imaging linear biometric data of a large cohort of fetal brains within 24 weeks of gestation. MATERIALS AND METHODS: From the data bases of 2 referral centers of fetal medicine, accounting for 3850 examinations, we retrospectively collected 169 prenatal brain MR imaging examinations of singleton pregnancies, between 20 and 24 weeks of gestational age, with normal brain anatomy at MR imaging and normal postnatal neurologic development. To trace the reference centiles, we used the CG-LMS method. RESULTS: Reference biometric centiles for the developing structures of the cerebrum, cerebellum, brain stem, and theca were obtained. The overall interassessor agreement was adequate for all measurements. CONCLUSIONS: Reference biometric centiles of the brain structures in fetuses between 20 and 24 weeks of gestational age may be a reliable tool in assessing fetal brain development. ABBREVIATIONS: BPD ϭ biparietal diameter; LLD ϭ latero-lateral diameter; CSA ϭ clivo-supraoccipital angle; FOD ϭ fronto-occipital diameter; GA ϭ gestational age; LCC ϭ length of the corpus callosum; APD ϭ antero-posterior diameter; CCD ϭ cranio-caudal diameter

Research paper thumbnail of OP15.01: Absolute uterine artery blood flow volume is increased in twin human pregnancies compared to singletons

Ultrasound in Obstetrics and Gynecology, 2007

To compare (1) absolute and (2) weight-specific blood flow volume of uterine arteries (UtA) in no... more To compare (1) absolute and (2) weight-specific blood flow volume of uterine arteries (UtA) in normal twin pregnancies to normal singleton pregnancies. Methods: Twelve twin pregnancies (10 dichorionic, two monochorionic) with normal UtA PI and normal weight at birth were included. UtA diameter and time-averaged maximum velocity were obtained to calculate flow (mL/min) and UtA flow/EFW (mL/min/kg) in each UtA. UtA flow was estimated by the formula Q = hV · πD 2 /4; a patient-specific coefficient, h, was obtained by an ad hoc mathematical model. Total UtA flow was calculated as a sum of right and left vessel flow volume. Twins' UtA flow was expressed per unit EFW considering the sum of the two EFWs. Twins were compared to 48 normal age-matched singletons. Results: Gestational age at exam was similar in twins and in singletons (25.9 ± 6.4 vs. 25.2 ± 6.2 weeks, NS). UtA flow (mL/min) was significantly increased in twins (509.3 ± 240.7 mL/min) compared to singletons (337.2 ± 257.0 mL/min) (P = 0.04). UtA flow (mL/min) exponentially increased along gestation in twins and in singletons. The twins' trend was above the third interquartile range of singletons' reference values. UtA diameter was significantly increased in twins (0.33 ± 0.07 cm) than in singletons (0.28 ± 0.05 cm), while no differences in UtA mean velocity were observed (77.5 ± 29.9 vs. 76.7 ± 29.1 cm/sec, respectively, NS). UtA flow per EFW did not differ between twins and singletons (384.4 ± 198.6 vs. 460.9 ± 302.9 mL/min/kg, respectively, NS). Conclusions: (1) UtA flow volume (mL/min) in twin pregnancies was significantly increased. This was determined by larger vessel diameter, compared to singletons. (2) Each twin proved to share an amount of UtA flow per unit estimated fetal weight not significantly different from singletons.

Research paper thumbnail of OP13.11: Uterine artery blood flow volume: ranges in uncomplicated human pregnancies

Ultrasound in Obstetrics and Gynecology, 2006

Oral poster abstracts towards term. The peak-systolic velocity increased from mean 59 to 71 cm/s ... more Oral poster abstracts towards term. The peak-systolic velocity increased from mean 59 to 71 cm/s during the weeks 21-31 and remained stable until term. The diastolic velocity showed a continuous increase from 31 cm/s at 21 weeks to 43 cm/s at 40 weeks. The pulsatility index for veins decreased from 0.57 at 21 weeks to 0.44 at 40 weeks. Terms for individually conditioned observations modify the reference ranges when used for serial measurements.

Research paper thumbnail of P07.05: Uterine artery blood flow volume growth rate in uncomplicated human pregnancies

Ultrasound in Obstetrics and Gynecology, 2006

Objective: 1) To study uterine artery (UtA) flow (ml/min) growth rate along gestation in normal h... more Objective: 1) To study uterine artery (UtA) flow (ml/min) growth rate along gestation in normal human pregnancies; 2) to evaluate longitudinal changes of UtA flow expressed per unit estimated fetal weight (EFW) (ml/min/kg). Methods: A cohort of twelve singleton uneventful human pregnancies, with a normal mean UtA PI, was included in this longitudinal study. UtA was evidenced by power-Doppler mode and sampled 10-15 mm prior to bifurcation. UtA diameter was measured on a perpendicular view after removing power-Doppler. UtA PI and velocity were measured with a Doppler beam angle < 30 • . The average of three consecutive diameters and velocities was considered. UtA flow was estimated by the formula Q = hV · πD2/4; h coefficient (0.5) was obtained by an ad hoc mathematical model. UtA total flow (ml/min) (right plus left UtA flow) was then expressed per EFW (ml/min/kg). Using linear interpolation, including random effects for the intercept and the slope of gestational age for each fetus, a linear mixed effects model was fitted. Results: Forty-seven ultrasound examinations were performed. Ultrasound exams were performed at 14.3,b1.2 weeks and every 4 weeks until delivery. Each case was definitively included in the study after recording normal perinatal and neonatal outcomes. UtA total flow (ml/min) showed a significant correlation to gestational age (133.6 ml/min at 15 weeks; 415.9 ml/min at 35 weeks) (p < 0.001), with a linear increase of 14.1 ml/min per week (right UtA 5.4 vs. left UtA 8.7 ml/min per week, p NS). UtA flow per unit EFW (ml/min/kg) showed a significant reduction from 780.3 ml/min/kg at 15 weeks to 144.1 ml/min/kg at 35 weeks (reduction rate 40.3 ml/min/kg per week). Conclusions: UtA flow (ml/min) significantly increased along gestation in this longitudinal cohort of normal pregnancies. UtA flow per unit EFW (ml/min/kg) significantly decreased longitudinally, since UtA flow (ml/min) growth rate was lower than fetal weight gain rate along gestation.

Research paper thumbnail of OP10.08: Is uterine artery blood flow volume correlated to placental site in normal human pregnancies?

Ultrasound in Obstetrics and Gynecology, 2006

Research paper thumbnail of P07.04: Uterine artery blood flow volume is reduced in human pregnancies with increase utero-placental downstream impedance

Ultrasound in Obstetrics and Gynecology, 2006

parous patients and in nulliparous women than in parous women after uncomplicated pregnancies.

Research paper thumbnail of OC27.05: Human uterine artery blood volume flow at mid-gestation: relationship to uterine artery Doppler velocimetry and placental site

Ultrasound in Obstetrics and Gynecology, 2005

intraventricular hemorrhagia and elevated nucleated red blood cell counts at delivery. Results: 8... more intraventricular hemorrhagia and elevated nucleated red blood cell counts at delivery. Results: 8 stillbirths (10.7%), 12 perinatal (16%) and 2 neonatal death (2%) occurred among 74 fetuses. Logistic regression analysis confirmed that abnormal Ductus venosus waveforms (R 2 = 0.57, p < 0.001) together with gestational age (R 2 = 0.57, p < 0.001) showed the strongest association with perinatal death, whereas gestational age only was significantly related with neonatal death (R 2 = 0.67, p < 0.05). Abnormal ductus venosus Doppler waveforms (R 2 = 0.86, p < 0.001) and gestation age (R 2 = 0.49, p < 0.05) were strongly associated with adverse outcome. Abnormal venous Doppler flow patterns performed better in the prediction of fetal or perinatal demise than died ARED flow or brain sparing. Conclusion: Abnormal Ductus venosus waveforms in preterm growth-related fetuses with ARED flow are strongly relates to adverse fetal and perinatal outcomes below 32 weeks of gestational age. The possible benefit of these pregnancies to be prolonged can only be evaluated in a prospective randomized study.

Research paper thumbnail of P07.15: Umbilical vein blood flow assessment in the human fetus: intra- and inter-observer comparison between two methodologies

Ultrasound in Obstetrics and Gynecology, 2004

29-32, 33-36 and 37-40 weeks of pregnancy, respectively. AFI in normal growth fetuses were 101.03... more 29-32, 33-36 and 37-40 weeks of pregnancy, respectively. AFI in normal growth fetuses were 101.03 ± 15.19, 82.28 ± 12.03 and 71.14 ± 14.37 mm at the same periods, respectively. Fetuses with oligohydroamnion revealed Vmax value more than mean − 1.5 S.D and showed normal renal function after birth. Conclusions: Even in fetuses with oligohydroamnion, good prognosis are expected, if Vmax for the renal artery is more than mean − 1.5 S.D of the normal fetus. To predict the prognosis, Vmax for the renal artery might be a better index than AFI.

Research paper thumbnail of P09.14: In search of a novel methodology to measure uterine arteries blood flow in pregnancy

Ultrasound in Obstetrics and Gynecology, 2004

Conclusion: Estimation of total fetal lung volume by 3DUS may be feasible and precise even in fet... more Conclusion: Estimation of total fetal lung volume by 3DUS may be feasible and precise even in fetuses with very small lungs as for example cases with isolated CDH, at least using the multiplanar imaging rotation approach with standardization of the method.

Research paper thumbnail of Uterine artery blood flow volume in pregnant women with an abnormal pulsatility index of the uterine arteries delivering normal or intrauterine growth restricted newborns

Placenta, 2011

The aim of this study was to assess and compare uterine artery (UtA) blood flow volume in pregnan... more The aim of this study was to assess and compare uterine artery (UtA) blood flow volume in pregnant patients with an abnormal uterine Doppler pulsatility index (PI) who delivered fetuses with an appropriate weight for gestational age (AGA) or with intrauterine growth restricted (IUGR).

Research paper thumbnail of Blood flow volume of uterine arteries in human pregnancies determined using 3D and bi-dimensional imaging, angio-Doppler, and fluid-dynamic modeling

Placenta, 2010

The primary aim of this pilot study was to study uterine artery (UtA) blood flow volume in uneven... more The primary aim of this pilot study was to study uterine artery (UtA) blood flow volume in uneventful human pregnancies delivered at term, at mid and late gestation by means of 3D and bi-dimensional ultrasound imaging with angio-Doppler combined with fluid-dynamic modeling. Secondary aims were to correlate flow volume to placental site and to UtA Pulsatility Index (PI).