Pietro Gaglioti

Fetal cerebral ventriculomegaly: outcome in 176 cases

To evaluate the outcome of fetuses affected by different degrees of ventriculomegaly.

Is three-dimensional power Doppler ultrasound useful in the assessment of placental perfusion in normal and growth-restricted pregnancies?

To investigate three‐dimensional (3D) power Doppler ultrasound indices in the assessment of placental perfusion and their relationship to gestational age (GA), placental position and umbilical artery Doppler flow velocity waveform (FVW) patterns in normal and intrauterine growth‐restricted (IUGR) pregnancies.

Accuracy of routine ultrasonography in screening heart disease prenatally

The aim of the present study was to assess the accuracy of the four‐chamber view as a screening test for detection of congenital heart disease (CHD) prenatally in a low‐risk population. A prospective observational study was conducted in 17 ultrasound units of the Piemonte Region, Italy, in pregnancies with no risk factors for CHD. At each routine scan, from 18 weeks of gestational age, the four‐chamber view of the heart was looked for. When an anomaly was suspected, the patients were referred to a specialized unit. Follow‐up of the babies until discharge from the hospital was obtained. 11 232 sonograms were performed on 8299 pregnancies. Cardiac malformations were diagnosed in 40 newborns (4·8/1000). Six of them (15 per cent) had been recognized in utero. The sensitivity, specificity, and positive and negative predictive values were 15, 99·9, 50, and 99·6 per cent, respectively. When malformations that are not associated with an abnormal four‐chamber view were excluded from the analysis, the sensitivity increased to 35·3 per cent. The sensitivity found in this study is low, but it is probably realistic since it is comparable to that reported in other multicentric studies. This type of study should reflect the state of the art of the method applied in the field. Although the sensitivity is low, it would be nil if the test were not performed. Moreover, it will probably increase with better training of the operators and by extending the examination to the ventriculo‐arterial connections.

Prenatal screening for congenital heart disease with four-chamber and outflow-tract views: a multicenter study

Congenital heart diseases (CHD) are the most common congenital anomalies, and most cases occur in the low‐risk population. Prenatal ultrasound screening based on visualization of the four‐chamber view has had disappointing results in detecting these anomalies thus far. The aim of this study was to evaluate the diagnostic accuracy of ultrasound screening based on the combination of the four‐chamber and outflow‐tract views.

The significance of fetal ventriculomegaly: etiology, short- and long-term outcomes

Fetal cerebral ventriculomegaly (VM) is diagnosed when the width of one or both ventricles, measured at the level of the glomus of the choroid plexus (atrium), is ≥ 10 mm. VM can result from different processes: abnormal turnover of the cerebrospinal fluid (CSF), neuronal migration disorders, and destructive processes. In a high percentage of cases, it is associated with structural malformations of the central nervous system (CNS), but also of other organs and systems. The rate of associated malformations is higher (≥60%) in severe VM (>15 mm) and lower (10–50%) in cases of borderline VM (10–15 mm). When malformations are not present, aneuploidies are found in 3–15% of borderline VM; the percentage is lower in severe VM. The neurodevelopmental outcome of isolated VM is normal in > 90% of cases if the measurement of ventricular width is between 10 and 12 mm; it is less favorable when the measurement is > 12 mm. Copyright

Pulmonary stenosis and atresia with intact ventricular septum during prenatal life

To identify fetal echocardiographic characteristics predictive of perinatal outcome in cases with a prenatal diagnosis of pulmonary stenosis or pulmonary atresia.

Pulmonary stenosis with intact ventricular septum: documentation of development of the lesion echocardiographically during fetal life

We describe a case of severe pulmonary stenosis with intact interventricular septum diagnosed during fetal life at 34 weeks gestational age. An echocardiographic examination had been performed on the same fetus at 20 weeks, when no cardiac anomalies were observed. It is concluded that this form of pulmonary stenosis might be a lesion either acquired during fetal life or becoming progressively more severe in the prenatal period.

Management of a fetus with intrapericardial teratoma diagnosed in utero

lntrapericardial teratoma is a rare condition. Fyler1 reports three cases of intrapericardial teratoma among 3626 infants with critical congenital heart disease. It is more frequent in infants than in adults. In infants it is symptomatic in most instances, with signs of cardiac tamponade, while in adults it may be an incidental finding at x· ray film of the chest or at autopsy.i In the recent literature we have found three cases diagnosed in utero (Table 1). Another case suspected to be a teratoma in utero was found to be a cavernous hemangioma at operation. We report one case in which the prenatal diagnosis of intrapericardial teratoma allowed a timely and successful treatment at birth.

Thymic volume in healthy, small for gestational age and growth restricted fetuses

The aim of this study was to verify the hypothesis that a difference in thymic size exists between small for gestational age (SGA) fetuses, likely constitutional, and intrauterine growth restricted (IUGR) fetuses because of placental causes.

Review: Feto-placental vascularization: A multifaceted approach

Doppler Ultrasound allows the in vivo study of feto-placental hemodynamics. Doppler flow velocity waveforms (FVWs) obtained from the umbilical arteries reflect downstream blood flow impedance, thus giving indirect evidence of vascular villous tree characteristics. Pulsatility Index, which quantifies FVWs, decreases throughout normal pregnancy, indicating decreasing impedance and is often higher in cases of fetal growth restriction (FGR). Different approaches (morphometrical, morphological, mathematical, immunohistochemical and molecular) have contributed to elucidation of which anomalies of the vascular villous tree underlie Doppler findings. 3D ultrasound may be useful in the study of feto-placental perfusion. However, the unsolved question is why developmental villous tree anomalies occur. Crucial to the success of future research is definition of the population studied based on the uniform and correct definition of FGR.