Raquel Mula

Performance of a first-trimester screening of preeclampsia in a routine care low-risk setting

OBJECTIVE We sought to evaluate the effectiveness of an integrated first-trimester screening test to predict preeclampsia (PE). STUDY DESIGN A prospective cohort of singleton pregnancies underwent routine first-trimester screening from 2009 through 2011 (n = 5759). A logistic regression-based predictive model for early- and late-onset PE was constructed based on: maternal characteristics; levels of pregnancy-associated plasma protein-A and free β-human chorionic gonadotropin at 8-12 weeks; and blood pressure and uterine artery Doppler at 11.0-13.6 weeks. RESULTS Of the 5170 enrolled participants, 136 (2.6%) developed PE (early PE: 26 [0.5%]; late PE: 110 [2.1%]). At 5% and 10% false-positive rates, detection rates were 69.2% and 80.8% for early PE (area under the curve, 0.95; 95% confidence interval, 0.94-0.98) and 29.4% and 39.6% for late PE (area under the curve, 0.71; 95% confidence interval, 0.66-0.76), respectively. CONCLUSION First-trimester screening combining maternal factors with uterine artery Doppler, blood pressure, and pregnancy-associated plasma protein-A is useful to predict PE in a routine care setting.

Increased nuchal translucency and normal karyotype: perinatal and pediatric outcomes at 2 years of age

To assess the perinatal and pediatric outcomes up to 2 years of age in singleton karyotypically normal fetuses with increased nuchal translucency (NT) above the 99th percentile.

Prognostic Role of Uterine Artery Doppler in Patients with Preeclampsia

Objectives: To evaluate the predictive capacity of umbilical, cerebral and uterine artery Doppler in women admitted for preeclampsia (PE). Methods: 190 consecutive singleton pregnancies admitted with PE were included. Umbilical, cerebral and uterine artery Dopplers were performed. The association with adverse perinatal outcome was evaluated from 2 × 2 tables and multivariately by logistic regression. Results: A total of 82 (43%) women had an abnormal uterine artery Doppler on admission, being more prevalent in early-onset (<32 weeks) than in the late-onset PE (62 vs. 27%, p < 0.05). In both early- and late-onset forms, uterine artery Doppler showed a greater capacity than umbilical and middle cerebral artery Doppler for predicting adverse perinatal outcome. Conclusion: Uterine artery Doppler was the best predictive parameter for perinatal outcome in pregnancies with PE and may be included as a primary surveillance test.

Increased Fetal Brain Perfusion and Neonatal Neurobehavioral Performance in Normally Grown Fetuses

Objective: To explore the association between fetal cerebroplacental ratio (CPR) and frontal brain perfusion at third trimester with neonatal neurobehavioral performance in normally grown fetuses. Methods: CPR and frontal brain perfusion measured by fractional moving blood volume (FMBV) were assessed in 258 consecutive healthy fetuses at routine third trimester scan (32-35.6 weeks). Neonates were evaluated with the Neonatal Behavioral Assessment Scale. The association between Doppler parameters and neurobehavior was analyzed by MANCOVA (multiple analysis of covariance) and logistic regression, with adjustment for smoking, socioeconomic class, mode of delivery, gestational age at birth, postnatal days at examination and gender. Results: Fetuses with increased FMBV (in the upper quartile) had lower neurobehavioral scores in all areas, reaching significance in motor (5.6 vs. 5.8; p = 0.049), social (6 vs. 6.4; p = 0.006) and attention (5.3 vs. 5.9; p = 0.032). Fetuses with increased FMBV had higher risk of abnormal (<10th centile) motor (OR 3.3; 95% CI 1.36-8.1), social (OR 2.9; 95 CI% 1.33-6.5) and attention (OR 2.5; 95% CI 1.1-5.8) scores. Fetuses with lower CPR (in the lower quartile) did not differ in their neurobehavioral scores from those with normal values. Conclusions: Normally grown fetuses with increased frontal brain perfusion have poorer neurobehavioral competences, suggesting a disrupted neurological maturation. The results support the existence of forms of placental insufficiency not detected by current definitions of growth restriction.

Colposcopy Prediction of Progression in Human Papillomavirus Infections With Minor Cervical Lesions

OBJECTIVES: To evaluate the risk of progression to cervical intraepithelial neoplasia (CIN) grade 2 or 3 in women with positive human papillomavirus (HPV) testing and low-grade (low-grade squamous intraepithelial lesions), borderline (atypical squamous cells of undetermined significance), or no cervical lesions, and to determine the accuracy of initial colposcopy to predict progression. METHODS: Women with HPV infection and low-grade squamous intraepithelial lesions, atypical squamous cells, or normal cytology were recruited and grouped according to cytologic or histologic diagnosis. Exclusion criteria were histologic CIN 2 or 3, previous cervical cancer and HPV infection, cervical disease, or treatment for CIN 2 or 3 in the past 3 years. Four-hundred sixty-five women were included and monitored by cytology, Hybrid Capture-2 test, and colposcopy every 6 months. Colposcopy results were described as normal, with minor or major changes, and lesion size was recorded in quadrants. RESULTS: Forty-three women (9.3%) had progression to CIN 2 or 3. No significant differences were found in rate of progression between women with low-grade squamous intraepithelial lesions, atypical squamous cells, or negative results (8.2%, 13.4%, and 9.8%, respectively; P=.679). Neither colposcopy pattern (P=.284) nor lesion size (P=.170) at recruitment provided any information on the risk of progression. History of cervical lesion and worsening of the colposcopy pattern during follow-up were associated with progression (P<.001). CONCLUSION: Initial colposcopy findings do not provide relevant information on the risk of progression in HPV-positive women with minor or no cervical lesions. These women have a similar risk of progression and should benefit from the same follow-up strategies. LEVEL OF EVIDENCE: II

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.

Nuchal translucency thickness in the prediction of unbalanced translocations

The aim of this study was to assess the role of nuchal translucency (NT) in the prediction of unbalanced translocation in offspring of couples in which one of the parents is a balanced translocation carrier.

Further insights into diastolic dysfunction in first‐trimester trisomy‐21 fetuses

To assess fetal cardiac function in first‐trimester trisomy‐21 fetuses as compared with fetuses with other aneuploidies, euploid fetuses with cardiac defects or isolated increased nuchal translucency (NT) and controls.

Use of fetal nuchal translucency in the first trimester to predict single‐gene disorders

To assess the predictive value of fetal nuchal translucency (NT) measurement in the prenatal diagnosis of single‐gene disorders.

OC20.02: First‐trimester maternal haemodynamic evaluation in women with abnormal uterine Doppler for the prediction of preeclampsia

months and 70 had not received any hormonal treatment. All the patients underwent transvaginal pelvic ultrasonography followed by hysteroscopy and biopsies. Endometrial histopathologic findings were examined. The two groups were similar in age, parity, age at menopause, and body mass index. Results: Compared with the control subjects, the tamoxifen patients had a thicker endometrium (12.4 +/− 4.5 mm versus 4.3 +/− 3.0 mm) and larger uterine volume (68 +/− 28 versus 38 +/− 12 cm3), as determined by transvaginal sonography. Endometrial polyps were more frequent in the tamoxifen group (36 versus 10%; P =. 004), which included two patient with atypical hyperplasia, one with adenomatous hyperplasia, and two with endometrial adenocarcinoma; one case control had endometrial adenocarcinoma. Conclusion: The results provide evidence for an estrogenic effect of long-term tamoxifen treatment on the postmenopausal uterus and show it to be associated with an increased occurrence of polyps. The isolated use of transvaginal ultrasonography is insufficient for screening the endometrium of these women. Women receiving tamoxifen, especially those who are asymptomatic, should be closely monitored by transvaginal sonography and hysteroscopy to detect endometrial pathologies. In asymptomatic postmenopausal women receiving tamoxifen, 5 mm is the optimal endometrial thickness cutoff for diagnosing endometrial abnormalities with transvaginal ultrasonography.