Athanasios Pilalis

Screening for pre‐eclampsia and fetal growth restriction by uterine artery Doppler and PAPP‐A at 11–14 weeks' gestation

To assess the role of maternal demographic characteristics, uterine artery Doppler velocimetry, maternal serum pregnancy‐associated plasma protein‐A (PAPP‐A) and their combination in screening for pre‐eclampsia and small‐for‐gestational age (SGA) fetuses at 11–14 weeks.

Assessment of fetal anatomy at the 11–14‐week ultrasound examination

To assess the feasibility of examining cardiac and non‐cardiac fetal anatomy in a low‐risk population in the setting of the routine 11–14‐week ultrasound scan.

Screening for pre‐eclampsia and small for gestational age fetuses at the 11–14 weeks scan by uterine artery Dopplers

Objective. To assess the role of uterine artery Doppler studies at 11‐14 weeks in screening for pre‐eclampsia (PET), small for gestational age (SGA) fetuses, and placental abruption. Methods. Prospective study on 1,123 women presenting for routine ultrasound examination at 11–14 weeks for nuchal translucency measurement. Uterine artery blood flow was studied by transvaginal colour Doppler, the mean pulsatility index (PI) was calculated, and the presence of a diastolic notch was recorded. Results. The mean, median and 95th centile of uterine artery PI were 1.71, 1.64 and 2.54, respectively. Bilateral notches were observed in 63.4%, and a unilateral notch in 18.4% of cases. The sensitivity of mean uterine artery PI ≥95th centile for PET, early onset severe PET necessitating delivery before 34 weeks, SGA ≤5th centile, SGA necessitating delivery before 34 weeks, SGA ≤10th centile and placental abruption were 21.4, 33.3, 17.8, 100, 9.6 and 44.4%, respectively. One in 6 women with increased resistance in the uterine arteries at 11–14 weeks will develop a complication related to utero‐placental insufficiency. Conclusions. Abnormal uterine Dopplers at 11–14 weeks identified one‐third of women with severe early onset pre‐eclampsia, all fetuses with SGA ≤5th centile that were delivered at ≤34 weeks, and 40% of cases with placental abruption. Uterine artery Doppler examination at the 11–14 weeks scan can identify a high risk population in which preventive or therapeutic interventions might be effective.

Performance of third-trimester ultrasound for prediction of small-for-gestational-age neonates and evaluation of contingency screening policies

To assess the performance of third‐trimester fetal biometry and fetal Doppler studies for the prediction of small‐for‐gestational‐age (SGA) neonates, and to explore contingency strategies using a first‐trimester prediction model based on maternal and fetal parameters and third‐trimester ultrasound.

First trimester prediction of small- and large-for-gestation neonates by an integrated model incorporating ultrasound parameters, biochemical indices and maternal characteristics.

Objective. To identify maternal/pregnancy characteristics, first trimester ultrasound parameters and biochemical indices which are significant independent predictors of small‐for‐gestational age (SGA) and large‐for‐gestational age (LGA) neonates. Design. Retrospective cross‐sectional study. Setting. Two fetal Medicine Units. Population. 4 702 singleton pregnancies presenting for screening for chromosomal abnormalities by nuchal translucency and maternal serum biochemistry at 11–14 weeks. Methods. Reference ranges for birthweight applied to our population were constructed by the Royston and Wright method. Multiple logistic regression was applied to develop first trimester prediction models for SGA and LGA. Main outcome measures. Birth of SGA or LGA neonate. Results. Maternal height, parity, smoking, assisted conception, delta crown–rump length, delta nuchal translucency, free beta human chorionic gonadotrophin and pregnancy‐associated plasma protein‐A were significant independent predictors of SGA. Maternal weight and height, smoking, delta crown–rump length and delta nuchal translucency were significant independent predictors of LGA. Models for SGA (AUC=0.7296, CI: 0.69–0.76, p<0.0001) and LGA (AUC=0.6901, CI: 0.65–0.72, p<0.0001) were derived, applicable to routine obstetric population at low risk for these conditions. For 20% screen positive rate the modeling achieves sensitivities of about 55% for SGA and 48% for LGA neonates. Conclusion. Prediction for birthweight deviations is feasible using data available at the routine 11–14 weeks’ examination. Delta CRL and delta nuchal translucency were significant independent predictors for both SGA and LGA.

Performance of the ultrasound examination in the early and late third trimester for the prediction of birth weight deviations

This study aimed to define the optimal gestational age in the third trimester, early (30–33 weeks + 6 days) versus late (34–37 weeks), for performing an ultrasound examination for fetal biometry to predict birth weight deviations: small for gestational age (SGA ≤ 5th centile) and large for gestational age (LGA ≥ 95th centile) neonates.

Fetal intracranial translucency and cisterna magna at 11 to 14 weeks: reference ranges and correlation with chromosomal abnormalities

To measure the intracranial translucency (IT) and the cisterna magna (CM), to produce reference ranges and to examine the interobserver and intraobserver variability of those measurements. To examine the possible association of IT with chromosomal abnormalities.

First trimester diagnosis of dicephalus conjoined twins.

Dicephalus twinning is an extremely rare type of conjoined twins. Early prenatal diagnosis of this condition is important to provide an opportunity for pregnancy termination. We present such a case, which was diagnosed by ultrasound examination at 12 weeks of gestation. The ultrasonographic criteria are discussed together with implications for management.

Management of early viable cervical pregnancy

Objective  To evaluate conservative management of early viable cervical pregnancy.

Specific formulas improve the estimation of fetal weight by ultrasound scan

Abstract Objective: To develop and evaluate local, sex specific, small for gestational age (SGA) specific, large for gestational age (LGA) specific and combined (biometry, sex and Doppler indices) formulas for ultrasound estimated fetal weight (EFW). Method: Low-risk singleton pregnancies that delivered within 7 days from ultrasound examination were assessed. A formula-generating group (1407 pregnancies) and a validation group (469 pregnancies) were created. Fractional regression analysis was used to develop the formulas. Systematic error, random error, fraction within the 10% of actual birth weight and Bland–Altman analysis were used. Results: The local formula and the Hadlock formula with local co-efficients performed better than the Hadlock formula. The SGA-specific formula, the LGA-specific formula and the combined formula had the lower systematic error (MSE: +0.0022291, −0.4226888, +0.8386222, respectively) and the narrower 95% LOA (−292.8 to +292.23, −485.6 to +461.5, −425.7 to +450.46, respectively). The SGA- and the LGA-specific formulas had higher fraction within the 10% of actual birth weight (81.5% and 84%, respectively). Conclusions: Local formulas improve the EFW calculation. The combined formula can further optimize the accuracy and precision. Application of specific formulas for the small and the large fetus had the most pronounced effect in improving fetal weight estimation.