Iosifina Stergiotou

Patterns of maternal vascular remodeling and responsiveness in early- versus late-onset preeclampsia.

OBJECTIVE We sought to assess vascular structure and function in early- and late-onset preeclampsia (PE) at the time of diagnosis. STUDY DESIGN We evaluated 100 PE cases subdivided into 50 early- and 50 late-onset cases according to gestational age at onset (34 weeks), and 100 controls paired by maternal age and gestational age at scan with cases. Carotid intima-media thickness (IMT), distensibility, and circumferential wall stress together with inferior vena cava (IVC) collapsibility were assessed by ultrasound. RESULTS Early PE was characterized by increased carotid IMT diameters, and arterial stiffness with no significant changes in IVC parameters as compared to normotensive pregnancies. Late PE was characterized by significantly increased carotid IMT and lumen diameters as compared to controls while arterial stiffness, as expressed by distensibility, did not provide pronounced changes. A significant decrease of IVC collapsibility index was also observed in late PE as compared to controls. CONCLUSION The current data suggest that distinct vascular adaptations in early and late PE could reflect different pathophysiologic mechanisms. Future studies are warranted to further assess the complex etiologies and clinical expressions of the 2 entities.

First‐trimester detection of major cardiac defects with the use of ductus venosus blood flow

To assess the best method of combining fetal nuchal translucency (NT) and ductus venosus (DV) blood flow measurements in the detection of major cardiac defects in chromosomally normal fetuses during the first‐trimester scan.

Aortic and carotid intima–media thickness in term small‐for‐gestational‐age newborns and relationship with prenatal signs of severity

To assess carotid and aortic intima–media thickness (IMT) in term small‐for‐gestational‐age (SGA) newborns with and without prenatal signs of severity.

Transcervical chorionic villus sampling: a practical guide.

Abstract First trimester screening for fetal aneuploidies has made the implementation of diagnostic techniques essential. Chorionic villus sampling (CVS) is the method of choice for obtaining chorionic villi for molecular and cytogenetic analysis in the first trimester. Two techniques have been developed, a transcervical and a transabdominal. The selection criteria have been based historically on factors, such as placental location, parity, maternal weight and preference of the operator. In our institution, we developed an elevated level of expertise in the field of transcervical approach, resulting in good quality of samples and comparable fetal loss rate to other approaches. Despite three decades of transcervical CVS performance, little consensus in terms of its technique and clinical guidelines exists. Considering the expertise and the volume of procedures performed at our center, we suggest a practical clinical guideline for transcervical CVS.

Maternal subclinical vascular changes in fetal growth restriction with and without pre-eclampsia.

To assess maternal vascular structure and function in pregnancies complicated by fetal growth restriction (FGR), in women with and without pre‐eclampsia (PE) at the time of FGR diagnosis.

Heterotrisomy recurrence risk: a practical maternal age-dependent approach for excess trisomy 21 risk calculation after a previous autosomal trisomy.

Abstract A new maternal age-dependent method to estimate absolute excess risks of trisomy 21, either after a previous trisomy 21 (homotrisomy) or after another trisomy (heterotrisomy), is proposed to be added to the estimated risk by conventional screening methods. Excess risk at term for a subsequent trisomy 21 was calculated from midtrimester risks reported by Morris et al., decreasing from 0.49% at 20 years to 0.01% at 46 years at the index pregnancy. Excess risk after a previous uncommon trisomy was derived from data reported by Warburton et al., decreasing from 0.37% at 20 years to 0.01% at 50 years.

Parental Origin of the Retained X Chromosome in Monosomy X Miscarriages and Ongoing Pregnancies

Objective: To assess the distribution of the parental origin of the retained X chromosome in monosomy X, either in miscarriages or in ongoing pregnancies. Method: The parental origin of the X chromosome was determined in monosomy X pregnancies, either miscarriages or ongoing pregnancies. Microsatellite marker patterns were compared between maternal and fetal samples by quantitative fluorescence polymerase chain reaction. Distributions of maternally and paternally derived X chromosome were assessed in miscarriages and in ongoing pregnancies using two-tailed Fisher exact test. Results: Forty monosomy X pregnancies were included in the study: 26 miscarried at 5-16 weeks, and 14 ongoing pregnancies were diagnosed at 11-20 weeks. The retained X chromosome was maternally derived in 67% of the cases. In miscarriages, maternal and paternal X chromosome were retained in a similar proportion (54% [95% CI: 35-73%] vs. 46% [95% CI: 27-65%]), while in ongoing pregnancies, the maternal rate was 13 times higher (93% [95% CI: 79-100%)] vs. 7% [95% CI: 0-20%]). Conclusions: The retained X chromosome in individuals with monosomy X should theoretically be maternally derived in 2/3 of the cases. Our study suggests a preferential early miscarriage in pregnancies with a retained paternally derived X chromosome. This may explain the observation that 75-90% of individuals with monosomy X retain the maternal X chromosome.

Intertwin crown-rump length discordance in the prediction of fetal anomalies, fetal loss and adverse perinatal outcome

Abstract Objective: To assess the risks of fetal anomalies, fetal loss and adverse perinatal outcome in a cohort of first-trimester intertwin crown-rump length (CRL) discordant twins, stratified by chorionicity and the degree of CRL discordance. Method: Four-hundred-and-seventy-one twin pregnancies were scanned during an 8-year period at 11–14 weeks, and those with an intertwin CRL discordance ≥10% were compared with concordant twins. Outcomes were also compared between monochorionic and dichorionic twins and between moderate (10–16%) and severe (>16%) discordance. Results: Four-hundred-and-five twin pregnancies, 65 discordant and 340 concordant, were follow-up. Discordant twin pregnancies were at significant higher risk of chromosomal (OR = 11.42; 95% CI: 2.78–46.94) and structural anomalies (OR = 5.91; 95% CI: 2.25–15.54), spontaneous fetal loss (OR = 4.23; 95% CI: 1.79–10.01), birthweight discordance (OR = 2.8; 95% CI: 1.48–5.65) and small-for-gestational age (OR = 3.48; 95% CI: 1.78–6.79). Similar differences (except for birthweight discordance) were observed among dichorionic twins. Among monochorionic, increased frequencies were only seen for structural anomalies, birthweight discordance and small newborns. Severe CRL discordance presented with higher rates of structural anomalies, stillbirth, birthweight discordance and small newborns. Conclusion: Intertwin CRL discordance (≥10%) results in an increased risk of fetal anomalies and growth restriction that increases in severe CRL discordance (≥16%).

OC12.06: Aortic and carotid wall thickness in term small‐for‐gestational age newborns with normal and abnormal fetal cerebroplacental Doppler ratio

cardiac function, carotid artery diameter, IMT and stiffness nor in endothelial function. Conclusions: ARED flow seems to contribute to an irreversible restriction of aortic growth persisting into adulthood, while the carotid artery, an adjacent elastic artery, has unchanged geometry and mechanical properties. Even if no altered left ventricular geometry or function were revealed at present, the smaller diameter and higher systolic pressure reflection in the central aorta might have negative consequences for left ventricular performance in the future by increasing aortic impedance.

OC12.04: Cardiovascular characteristics at 6 months of life in infants suffering intrauterine growth restriction

cardiac function, carotid artery diameter, IMT and stiffness nor in endothelial function. Conclusions: ARED flow seems to contribute to an irreversible restriction of aortic growth persisting into adulthood, while the carotid artery, an adjacent elastic artery, has unchanged geometry and mechanical properties. Even if no altered left ventricular geometry or function were revealed at present, the smaller diameter and higher systolic pressure reflection in the central aorta might have negative consequences for left ventricular performance in the future by increasing aortic impedance.