Alessandra Curti

Maternal plasma mRNA species in fetal heart defects: a potential for molecular screening

To verify the hypothesis that aberrant placental mRNA genes related to cardiogenesis can be detected in maternal plasma at the second trimester of pregnancy.

Higher circulating mRNA levels of placental specific genes in a patient with placenta accreta

Giuliana Simonazzi1*, Antonio Farina1, Alessandra Curti1, Gianluigi Pilu1, Donatella Santini2, Cinzia Zucchini1, Akihiko Sekizawa3 and Nicola Rizzo1 1Department of Obstetrics and Gynecology, St. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy 2Department of Pathology, St. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy 3Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan

Fetal cerebellar damage in fetuses with severe anemia undergoing intrauterine transfusions

Abstract Objective: To evaluate radiologic findings and outcomes of cerebellar injuries in fetuses with severe anemia due to RhD alloimmunization undergoing intrauterine transfusions. Methods: Imaging of multiplanar neurosonography and magnetic resonance imaging (MRI) were reviewed. Pregnancy outcomes were recorded. Results: Cerebellar injuries were identified after the first intravascular transfusion in four fetuses. Two of these cases were previously reported. The median hemoglobin concentration was 2.1 g/dL. Prenatal neurosonography identified an echogenic collection involving the cerebellum suggestive for hemorrhage in three cases. A progressive hypoplasia of a hemisphere was demonstrated at follow-up examination in one of these cases. Hypoplasia of a cerebellar hemisphere was seen in the fourth fetus. Ultrasound diagnosis was confirmed by prenatal MRI in two cases. In the third case, the postnatal MRI showed as additional finding vermian involvement. One pregnancy was terminated and autopsy confirmed the presence of infratentorial hemorrhage. The remaining infants were delivered alive. At time of writing, a truncal ataxia was diagnosed in the child with vermian hypoplasia, while the other children have met all age-appropriate milestones. Conclusions: A severe anemia seems to put the fetus at risk of cerebellar damage, despite successful intravascular transfusion.

Perinatal Outcomes of Non-Primary Maternal Cytomegalovirus Infection: A 15-Year Experience

Objective: To evaluate perinatal outcomes in case of non-primary maternal cytomegalovirus (CMV) infection. Methods: We performed a retrospective cohort study of pregnant women with active CMV infection referred to our unit over a 15-year period (January 2000 to December 2014). Non-primary infection was diagnosed on the basis of the results of confirmatory serological and virological tests (avidity test, immunoblotting, real-time PCR-DNA). The vertical transmission rate and the percentage of symptomatic congenital infection were determined in this group of patients. Results: A total of 205 pregnant women were enrolled. Congenital infection occurred in 7 (3.4%) fetuses/neonates. Symptomatic disease was present at birth in 3 of the 7 congenitally infected neonates (1.5%). Two out of 3 symptomatic newborns presented a pathologic second-trimester ultrasound scan. Conclusion: Maternal immunity offers substantial protection against intrauterine transmission of CMV infection, but not against disease once the fetus is infected.

Multivariable evaluation of term birth weight: a comparison between ultrasound biometry and symphysis-fundal height

Abstract Objective: To derive a birth weight predictive equation and to compare its diagnostic value with that of ultrasound. Methods: A longitudinal observational cohort study, including singleton pregnancies at term, was performed at St. Orsola-Malpighi Hospital, University of Bologna (Italy). A birth weight prediction formula, including symphysis-fundal height (SFH), BMI, maternal abdominal circumference (mAC) and parity was derived from a general linear model (GLM) (retrospective study). Moreover, on a new series of patients, the fetal weight was estimated by using both GLM and ultrasound using Hadlock formula (prospective study). The residual analysis and the intraclass correlation coefficient (ICC) were used to test the accuracy of methods in predicting birth weight. Results: Between January and November 2012, 1034 patients were included in the retrospective study and 44 in the prospective one. The following GLM was derived: estimated birth weight (g) = 1485.61 + (SFH (cm) × 23.37) + (11.62 (cm) × mAC) + [BMI × (−6.81)] + (parity (0 = nulliparous, 1 = multiparous) × 72.25). When prospectively applied, the GLM and ultrasound provided a percentage of prediction within ±10% of the actual weight of 73% and 84%, respectively. Ultrasound estimation, as opposite of GLM one, was significantly associated with neonatal weight (R2 = 0.388, F = 26.607, p value <0.001, ICC = 0.767). Conclusions: Although ultrasound biometry has provided the best values in fetal weight estimation, the predictive performance of both methods is limited.

Cervical length and risk of antepartum hemorrhage in presence of low-lying placenta

Objectives: To evaluate whether transvaginal ultrasound cervical length (TVU CL) can predict antepartum bleeding (APB) in women with low-lying placenta. Study design: A retrospective study was performed including pregnancies with low-lying placenta for which third trimester TVU CL was available. Multiple pregnancies were excluded. Short cervix was defined as TVU CL ≤25 mm. Outcomes of interest were compared with respect to the TVU CL. Results: Forty three cases of singleton pregnancies complicated by low-lying placenta in third trimester were identified. Short cervix was reported in 8 cases (19%). APB (75% vs. 31 %, p = 0.02), blood transfusions (25% vs. 3%, p = 0.02), lower birth weight (2246 vs. 2985 g, p = 0.02), and neonatal intensive care unit (NICU) admissions (50% vs. 17%, p = 0.04) were more frequent in the women with short cervix. Rate of unplanned cesarean delivery for APB was similar between both the groups (25% vs. 28%, p = 0.83). Conclusions: In women with low-lying placenta persisting into third trimester, short cervical length can be used as a predictor for APB.

Outcome of severe placental insufficiency with abnormal umbilical artery Doppler prior to fetal viability.

To evaluate the outcome of pregnancies complicated by placental insufficiency and abnormal umbilical artery Doppler prior to viability.

Cervical lacerations in planned versus labor cerclage removal: a systematic review

OBJECTIVE The aim of this study was to evaluate the incidence of cervical lacerations with cerclage removal planned before labor compared to after the onset of labor by a systematic review of published studies. STUDY DESIGN Searches were performed in electronic databases from inception of each database to November 2014. We identified all studies reporting the rate of cervical lacerations and the timing of cerclage removal (either before or after the onset of labor). The primary outcome was the incidence of spontaneous and clinically significant intrapartum cervical lacerations (i.e. lacerations requiring suturing). RESULTS Six studies, which met the inclusion criteria, were included in the analysis. The overall incidence of cervical lacerations was 8.9% (32/359). There were 23/280 (6.4%) cervical lacerations in the planned removal group, and 9/79 (11.4%) in the removal after labor group (odds ratio 0.70, 95% confidence interval 0.31-1.57). CONCLUSIONS In summary, planned removal of cerclage before labor was not shown to be associated with statistically significant reduction in the incidence of cervical lacerations. However, since that our data probably did not reach statistical significance because of a type II error, further studies are needed.

A novel p63 mutation in a fetus with ultrasound detection of split hand/foot malformation

U.O. Ostetricia e Medicina dell’Età Prenatale, Policlinico Sant’Orsola-Malpighi, Bologna, Italy U.O. Genetica Medica, Policlinico Sant’Orsola-Malpighi, Bologna, Italy U.O. Anatomia Patologica, Policlinico Sant’Orsola-Malpighi, Bologna, Italy U.O. Anatomia Patologica, Istituto Pediatrico Giannina Gaslini, Genova, Italy S.C. Genetica Molecolare e Citogenetica, Istituto Pediatrico Giannina Gaslini, Genova, Italy *Correspondence to: Giuliana Simonazzi. E-mail: giulianasimo@yahoo.it

Exam-indicated cerclage in patients with fetal membranes at or beyond external os: a retrospective evaluation.

Aim:  To evaluate pregnancy outcome in women with fetal membranes at or beyond external os who underwent exam‐indicated cerclage or conservative management.