Eduard Gratacós

Fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia : evolution of a technique and preliminary results

Congenital diaphragmatic hernia (CDH) with liver herniation and a lung area to head circumference ratio (LHR) > 1 is associated with a high rate of neonatal death due to pulmonary hypoplasia.

Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion

To examine operative and perinatal aspects of fetal endoscopic tracheal occlusion (FETO) in congenital diaphragmatic hernia (CDH).

Prenatal prediction of survival in isolated left-sided diaphragmatic hernia

To investigate the potential value of antenatally determined intrathoracic herniation of the liver and the ratio of fetal lung area to head circumference (LHR) in the prediction of postnatal survival in isolated, left‐sided congenital diaphragmatic hernia (CDH).

Fetal Growth Restriction Results in Remodeled and Less Efficient Hearts in Children

Background— Fetal growth restriction (FGR) affects 5% to 10% of newborns and is associated with increased cardiovascular mortality in adulthood. The most commonly accepted hypothesis is that fetal metabolic programming leads secondarily to diseases associated with cardiovascular disease, such as obesity, diabetes mellitus, and hypertension. Our main objective was to evaluate the alternative hypothesis that FGR induces primary cardiac changes that persist into childhood. Methods and Results— Within a cohort of fetuses with growth restriction identified in fetal life and followed up into childhood, we randomly selected 80 subjects with FGR and compared them with 120 normally grown fetuses, matched for gender, birth date, and gestational age at birth. Cardiovascular assessment was performed in childhood (mean age of 5 years). Compared with control subjects, children with FGR had a different cardiac shape, with increased transversal diameters and more globular cardiac ventricles. Although left ejection fraction was similar among the study groups, stroke volume was reduced significantly, which was compensated for by an increased heart rate to maintain output in severe FGR. This was associated with subclinical longitudinal systolic dysfunction (decreased myocardial peak velocities) and diastolic changes (increased E/E′ ratio and E deceleration time). Children with FGR also had higher blood pressure and increased intima-media thickness. For all parameters evaluated, there was a linear increase with the severity of growth restriction. Conclusions— These findings suggest that FGR induces primary cardiac and vascular changes that could explain the increased predisposition to cardiovascular disease in adult life. If these results are confirmed, the impact of strategies with beneficial effects on cardiac remodeling should be explored in children with FGR.

Reference ranges for uterine artery mean pulsatility index at 11–41 weeks of gestation

To construct gestational age (GA)‐based reference ranges for the uterine artery (UtA) mean pulsatility index (PI) at 11–41 weeks of pregnancy.

Predictive value of angiogenic factors and uterine artery Doppler for early- versus late-onset pre-eclampsia and intrauterine growth restriction

To investigate potential differences in the prediction of early‐ vs. late‐onset pre‐eclampsia and/or intrauterine growth restriction (PE/IUGR) by second‐trimester uterine artery Doppler examination, and measurement of maternal serum placental growth factor (PlGF) and soluble fms‐like tyrosine kinase 1 (sFlt1).

Cardiac dysfunction and cell damage across clinical stages of severity in growth-restricted fetuses

OBJECTIVE The purpose of this study was to assess cardiac function and cell damage in intrauterine growth-restricted (IUGR) fetuses across clinical Doppler stages of deterioration. STUDY DESIGN One hundred twenty appropriate-for-gestational-age and 81 IUGR fetuses were classified in stages 1/2/3 according umbilical artery present/absent/reversed end-diastolic blood flow, respectively. Cardiac function was assessed by modified-myocardial performance index, early-to-late diastolic filling ratios, cardiac output, and cord blood B-type natriuretic peptide; myocardial cell damage was assessed by heart fatty acid-binding protein, troponin-I, and high-sensitivity C-reactive protein. RESULTS Modified-myocardial performance index, blood B-type natriuretic peptide, and early-to-late diastolic filling ratios were increased in a stage-dependent manner in IUGR fetuses, compared with appropriate-for-gestational-age fetuses. Heart fatty acid-binding protein levels were higher in IUGR fetuses at stage 3, compared with control fetuses. Cardiac output, troponin-I, and high-sensitivity C-reactive protein did not increase in IUGR fetuses at any stage. CONCLUSION IUGR fetuses showed signs of cardiac dysfunction from early stages. Cardiac dysfunction deteriorates further with the progression of fetal compromise, together with the appearance of biochemical signs of cell damage.

A classification system for selective intrauterine growth restriction in monochorionic pregnancies according to umbilical artery Doppler flow in the smaller twin

To evaluate a classification of selective intrauterine growth restriction (sIUGR) in monochorionic (MC) twins based on the characteristics of umbilical artery (UA) Doppler flow in the smaller twin, in terms of association with clinical outcome and with the pattern of placental anastomoses.

Neurodevelopmental outcome in 2‐year‐old infants who were small‐for‐gestational age term fetuses with cerebral blood flow redistribution

To assess the neurodevelopmental outcome at 2 years of age of children who had been small‐for‐gestational‐age (SGA) term babies with cerebral blood flow redistribution.

Twin chorionicity and the risk of adverse perinatal outcome

Objective: To evaluate the impact of chorionicity on the perinatal outcomes of twin pregnancies complicated by twin–twin transfusion syndrome (TTS) or selective intrauterine growth restriction (sIUGR). Method: Pregnancies with 127 monochorionic (MC) and 109 dichorionic (DC) twins were followed up, and TTS and sIUGR incidence as well as morbidity and mortality were evaluated. Results: The incidence of intrauterine fetal death was higher in MC than in DC pregnancies (6.5% vs. 1%), and higher in MC pregnancies complicated by TTS (5 deaths in 10 pregnancies [50%]) or sIUGR (2 in 9 [22%]). The incidence of sIUGR was similar in MC and DC pregnancies (7% vs. 5%), and the incidence of TTS was 8% in MC pregnancies (95% confidence interval, 3.2–12.8). Neonatal neurological and respiratory morbidity was higher among MC twins, and the increase in neonatal complications was linked to TTS and sIUGR. Uncomplicated MC and DC pregnancies had similar perinatal outcomes.Conclusion: The incidence of neonatal complications was higher in MC twins born of pregnancies complicated by TTS or sIUGR. Although the incidence of sIUGR was similar in MC and DC pregnancies, there was a trend towards worse outcomes in MC pregnancies affected by sIUGR.