Irene Romanello

Ischemia-modified albumin in pregnancy.

OBJECTIVE In normal pregnancies, a hypoxic intrauterine environment seems necessary for early trophoblast development. In this context, maternal serum levels of ischemia-modified albumin (IMA) are elevated, reflecting the oxidative stress associated with placental development. The aim of this study was to evaluate IMA and pregnancy-associated plasma protein A (PAPP-A) in mothers bearing small-for-gestational-age (SGA) fetuses compared to normal pregnancies. STUDY DESIGN A prospective study was performed between June 2010 and June 2011. Serum total albumin, IMA and PAPP-A concentrations were determined in 81 pregnant women in three different periods: 1st trimester, 2nd trimester and postpartum. Two groups of subjects were retrospectively identified: Group (1) mothers bearing appropriate-for-gestational-age (AGA) fetuses, and Group (2) mothers bearing SGA fetuses. Serum total albumin and IMA concentrations were determined in 198 non-pregnant women as controls. RESULTS Serum IMA concentrations increase during gestation. IMA/albumin serum levels in the 1st trimester were significantly higher in subjects of Group (2) (p<0.05), whereas values of serum PAPP-A MoM were significantly lower (p<0.05). CONCLUSIONS Elevated IMA serum levels together with low levels of PAPP-A were detected in the 1st trimester in mothers bearing SGA fetuses, and this may reflect early placental changes occurring before clinical manifestation of SGA.

Assessment of endometrial volume and vascularization using transvaginal 3D power Doppler angiography in women with postmenopausal bleeding

To compare the usefulness of 3D power Doppler angiography (3D‐PDA) and endometrial thickness measurement by 2D Doppler ultrasound in the distinction of benign from malignant disease in postmenopausal women with abnormal uterine bleeding (AUB) and an endometrial thickness greater than 4.5 mm.

OP18.01: Assessment of fetal brain vascularisation in fetuses affected by late onset fetal growth restriction using three-dimensional power Doppler angiography

function in pregnancy. In this study, we made a comprehensive evaluation of in vivo vascular function (including flow-mediated dilatation (FMD), peripheral arterial tonometry (PAT), and arterial stiffness) in pre-eclamptic patients and compared them to normal pregnancies. In addition, we assessed the evolution of vascular function during normal pregnancy and the trend in vascular function after pre-eclamptic pregnancies. Methods: 14 patients with pre-eclampsia (PE) and 14 healthy pregnant controls were included. Endothelial function was determined by FMD and PAT, arterial stiffness by carotid-femoral pulse wave velocity (cfPWV) and augmentation index (AIx). Results: The reactive hyperemia index (RHI) assessed using PAT is decreased at the third trimester in comparison to the first trimester in an uncomplicated pregnancy (1.5±0.3 vs 2.3±0.6, p=0.001). Arterial stiffness is significantly higher in PE versus normal pregnancy (cfPWV 7.7±0.9 vs 6.0±0.8; AIx 23±8.8 vs 9±9.8; p<0.001). Endothelial function obtained by FMD is deteriorated in PE versus normal pregnancy (4.8±3.1 vs 8.5±4.1; p=0.015), while endothelial function assessment by PAT is improved in PE versus normal pregnancy (2.1±0.4 vs 1.5±0.3; p=0.001). Both arterial stiffness (cfPWV 7.0±0.6 vs 7.9±0.9; p=0.009, AIx 6.9±11.0 vs 26.3±7.8; p<0.0001) and endothelial function obtained by FMD (9.0±3.9 vs 5.2±3.7; p=0.02) are ameliorated six months after PE. Conclusions: Flow mediated dilation and peripheral arterial tonometry are disturbed in PE, yet are improved six months post-partum. Endothelial function assessed by FMD and PAT show distinct results. This may indicate that measurements with FMD and PAT reflect different aspects of endothelial function and that PAT should not be used as a substitute for FMD as a measure of endothelial function in pregnancy.

OP10.09: Ischemia‐modified albumin in pregnancy

AC was significantly associated with SGA neonates (21.3% vs 8.4%; OR, 2.94; 95% CI, 2.21-3.93; p<0.001), but not with PTB (7.3% vs 5.7%; OR, 1.31; 95% CI, 0.84-2.03; P=0.224). The fetuses with both small AC and short FL were significantly associated with increased risk of SGA neonates (39.4% vs 9.2%, OR 6.42; 95% CI 3.17-13.0; p<0.001), and PTB (21.2% vs 5.7%; OR, 4.48; 95% CI, 1.92-10.4; p<0.001). Conclusions: Small AC and short FL diagnosed at mid-trimester ultrasound can be used as a predictor of PTB and SGA neonates.

OP22.09: Assessment of placental vascularization using three-dimensional power Doppler ultrasound in normal fetuses and fetuses affected by fetal growth restriction (FGR)

examination slightly weakened the relationship between PI of the distal pulmonary branch and PE (P = 0.02). Conclusions: Among growth restricted fetuses, those whose mothers had PE exhibited higher vascular resistance of the distal pulmonary branch than fetuses of unaffected pregnancies. Further investigation of postnatal long-term respiratory outcomes may be warranted to improve the understanding of in utero pathogenesis of neonatal respiratory disorders.

OP33.06: Ductus venosus S‐wave/isovolumetric A‐wave (SIA) Index and A‐wave reversed flow in normal gestation

Objectives: We sought to evaluate the association of small abdominal circumference (AC < 10th percentile) at third trimester ultrasound with gestational age (GA) at delivery. Methods: All women seen at our institution from 2009 through 2011 for measurements from 28 to 34 weeks’ gestation with a singleton, non-anomalous pregnancy were included in this retrospective cohort. We compared GA at delivery, with preterm defined as <37 weeks, among three groups: fetuses with normal AC and normal estimated fetal weight (EFW; both ≥10th percentile; Group 1), small AC and normal EFW (AC < 10th percentile, EFW ≥ 10th percentile; Group 2), and small AC and small EFW (both <10th percentile; Group 3). Data are presented as medians (interquartile ranges (IQR)) and risk ratios (RR) with 95% confidence intervals (CI). Results: Of the 612 eligible pregnancies, 47.7% of the women were White, 17.2% Black, 15.4% Hispanic, 14.1% Asian and 5.7% other/unknown. The median GA at ultrasound was 32.0 weeks (IQR: 30.6–33.0) and median maternal age at delivery was 32.9 years (IQR: 28.8–36.7). A small AC was found in 10.6% of the fetuses. Compared to Group 1, fetuses with a small AC (Groups 2 and 3) had a lower GA at delivery and a higher incidence of preterm delivery. Fetuses in Group 2 were more than twice as likely to be delivered preterm than fetuses in Group 1, while the risk was more than six times higher in Group 3 compared to Group 1 (See Table). The RRs did not change appreciably after adjusting for maternal age and race/ethnicity. Conclusions: Small AC is associated with a higher incidence of preterm delivery. This effect was demonstrated even in fetuses with EFW ≥ 10th percentile. Further studies should examine factors that influence this association.

OP33.07: Three dimensional cerebroplacental ratio (CPR 3DPDA): a new parameter for the antenatal surveillance in IUGR fetuses

Objectives: We sought to evaluate the association of small abdominal circumference (AC < 10th percentile) at third trimester ultrasound with gestational age (GA) at delivery. Methods: All women seen at our institution from 2009 through 2011 for measurements from 28 to 34 weeks’ gestation with a singleton, non-anomalous pregnancy were included in this retrospective cohort. We compared GA at delivery, with preterm defined as < 37 weeks, among three groups: fetuses with normal AC and normal estimated fetal weight (EFW; both ≥ 10th percentile; Group 1), small AC and normal EFW (AC < 10th percentile, EFW ≥ 10th percentile; Group 2), and small AC and small EFW (both < 10th percentile; Group 3). Data are presented as medians (interquartile ranges (IQR)) and risk ratios (RR) with 95% confidence intervals (CI). Results: Of the 612 eligible pregnancies, 47.7% of the women were White, 17.2% Black, 15.4% Hispanic, 14.1% Asian and 5.7% other/unknown. The median GA at ultrasound was 32.0 weeks (IQR: 30.6–33.0) and median maternal age at delivery was 32.9 years (IQR: 28.8–36.7). A small AC was found in 10.6% of the fetuses. Compared to Group 1, fetuses with a small AC (Groups 2 and 3) had a lower GA at delivery and a higher incidence of preterm delivery. Fetuses in Group 2 were more than twice as likely to be delivered preterm than fetuses in Group 1, while the risk was more than six times higher in Group 3 compared to Group 1 (See Table). The RRs did not change appreciably after adjusting for maternal age and race/ethnicity. Conclusions: Small AC is associated with a higher incidence of preterm delivery. This effect was demonstrated even in fetuses with EFW ≥ 10th percentile. Further studies should examine factors that influence this association.

OP33.08: Evaluation of fetal cerebral blood perfusion using power Doppler ultrasound angiography (3D‐PDA) in normal and growth‐restricted fetuses (IUGR)

Objectives: The aim of the present study was to explore the possible use of 3D Power Doppler Angiography (3D PDA) using VOCALTM software (GE Healthcare, USA) assessing different fetal cerebral regions in normal and growth restricted fetuses (IUGR). Methods: 77 AGA and 55 IUGR (24–36 ws gestation). IUGR were divided in 3 groups: group 1 (n = 28): Late onset IUGR (> 34 ws) with normal bidimensional Doppler flow analysis, group 2 (n = 11): early onset IUGR (< 34 ws) with abnormal umbilical artery (UA) pulsatilty index (PI), normal middle cerebral artery (MCA) PI and normal ductus venosus (DV) PI, group 3 (n = 16): early onset IUGR (< 34 ws) with abnormal umbilical artery (UA) pulsatilty index (PI), abnormal MCA PI and pathological DV PI. Two regions of interest (ROI) were defined within the fetal brain. The first ROI (zone 1) is anterior respect the cavum septi pellucidi (CSP). The second ROI (zone 2) is obtained tracing a contour between the temporal bones as wide as the CSP. 3D-PDA vascular indexes (VI = vascularization, FI = flow, VFI = vascularization and flow) were determined in both areas for both AGA and IUGR fetuses by one operator. Results: VFI values demonstrated increased blood flow in frontal zone compared to control group (AGA) in ‘‘early onset IUGR’’ (in both groups 2–3 with and without abnormal 2D MCA findings). VI and VFI values demonstrated increased blood flow in frontal zone and decreased blood flow in temporal zone compared to control group (AGA) in ‘‘late onset IUGR’’ with preferential increment in bloody supply to the frontal region to protect general cognitive functions. Conclusions: 3DPDA analysis could be considered a valid method to identify earlier vascular redistribution in IUGR fetuses comparing to 2D velocimetry. 3DPDA could become an additional parameter to adjust the monitoring intervals in the evaluation of high risk fetuses.

OP36.10: Evaluation of fetal cerebral blood flow perfusion using power Doppler ultrasound angiography (3D-PDA) in normal and growth-restricted fetuses (IUGR): Oral poster abstracts

Objectives: The aim of this study is to evaluate three dimensional cerebroplacental ratio (CPR 3D) using 3D power Doppler angiography (3D PDA) in the intrauterine monitoring of the growth restricted fetuses (IUGR). Methods: Cerebroplacental ratio (CPR), the ratio between PI of MCA and PI of umbilical artery (UA), is a better predictor for adverse outcome than a single vessel considered alone. We defined CPR 3DPDA as the ratio between vascular indices of a region of fetal brain (ROI) and the vascular indices of the placenta using 3DPDA methodology. The ROI evaluated were a ‘frontal zone’, sprinkled mainly by anterior cerebral artery, obtained tracing a contour passing through the anterior side of cavum septum pellucido (CSP) surrounding part of temporal and frontal bone. Then a second ROI obtained tracing a contour from temporal bones of the width of CSP included (’temporal zone’) sprinkled by middle cerebral artery MCA. We considered 3DPDA vascular indexes (VI = vascularisation FI = flow, VFI = vascularisation and flow). We enrolled 33 IUGR fetuses and 81 adeguate for gestational age, as control cases (24–38 weeks). IUGR fetuses were divided into 2 groups: group 1, IUGR with normal flussimetry of umbilical artery (UA) and MCA; group 2, IUGR with abnormal UA-PI (mean > 2 SD) and abnormal MCA-PI (PI < 2 SD). We calculated the 2D CPR and the CPR 3D of the frontal and temporal cerebral zones for all vascular indexes. Results: Values of 2D CPR were in accordance with the expected ones. CPR 3D, applying VI and VFI, both in frontal and temporal zone demonstrated a statistically significant different values compared with control cases. Conclusions: CPR 3D can be considered a new parameter: it demonstrates the vascular redistribution in frontal and temporal zones during the ‘brain sparing effect’ in IUGR fetuses also in the group of IUGR fetuses without bidimensional pathological flussimetry.

OP36.08: Three dimensional cerebroplacental ratio (CPR 3DPDA): a proposal of a new parameter for the antenatal surveillance in IUGR fetuses

Objectives: The aim of this study is to evaluate three dimensional cerebroplacental ratio (CPR 3D) using 3D power Doppler angiography (3D PDA) in the intrauterine monitoring of the growth restricted fetuses (IUGR). Methods: Cerebroplacental ratio (CPR), the ratio between PI of MCA and PI of umbilical artery (UA), is a better predictor for adverse outcome than a single vessel considered alone. We defined CPR 3DPDA as the ratio between vascular indices of a region of fetal brain (ROI) and the vascular indices of the placenta using 3DPDA methodology. The ROI evaluated were a ‘frontal zone’, sprinkled mainly by anterior cerebral artery, obtained tracing a contour passing through the anterior side of cavum septum pellucido (CSP) surrounding part of temporal and frontal bone. Then a second ROI obtained tracing a contour from temporal bones of the width of CSP included (’temporal zone’) sprinkled by middle cerebral artery MCA. We considered 3DPDA vascular indexes (VI = vascularisation FI = flow, VFI = vascularisation and flow). We enrolled 33 IUGR fetuses and 81 adeguate for gestational age, as control cases (24–38 weeks). IUGR fetuses were divided into 2 groups: group 1, IUGR with normal flussimetry of umbilical artery (UA) and MCA; group 2, IUGR with abnormal UA-PI (mean > 2 SD) and abnormal MCA-PI (PI < 2 SD). We calculated the 2D CPR and the CPR 3D of the frontal and temporal cerebral zones for all vascular indexes. Results: Values of 2D CPR were in accordance with the expected ones. CPR 3D, applying VI and VFI, both in frontal and temporal zone demonstrated a statistically significant different values compared with control cases. Conclusions: CPR 3D can be considered a new parameter: it demonstrates the vascular redistribution in frontal and temporal zones during the ‘brain sparing effect’ in IUGR fetuses also in the group of IUGR fetuses without bidimensional pathological flussimetry.