Born in Vetralla (Vt.) 23/12/1975. After getting in Viterbo scientific maturity in 1994, graduating in Medicine cum laude in 2000 at University La Sapienza of Rome, discussing the thesis entitled "Fetal Maternal endocrine responses after administration of betamethasone for fetal lung maturity in pregnancies with threating preterm birth. "
During the course of studies has won two awards in the University of Rome "La Sapienza" for the excellent curriculum and obtained a period of residency at the Laboratory of Perinatal Medicine in the same university. During this period conducted study of fetal lung maturity. Contribute to some international studies sponsored by the National Centre of Research (CNR) in Rome about intramniotic surfactant. Conducts numerous experiments in the field of fetal endocrinology with particular attention to fetal endocrine responses to the administration of cortisone for fetal lung maturity in high-risk pregnancies.
In 2001, conducted the Master of the University "La Sapienza" of Rome "Doppler and new technologies in Gynecology-Obstetrics and Reproductive Medicine.
During the first period of his specialization is dedicated actively to Gynecologic Oncology, carrying out a stage of two years at the National Institute of Cancer in Rome. In this period he had the opportunity to participate actively in the drafting of Clinical protocols for the study and treatment of both Endometrial Cancer and of the Cervix. He has participated in more than 800 interventions of gynaecologic oncology as assistant. He had the opportunity to learn and refine the laparoscopic technique. During its stay in this Institution he has also dedicated to the hysteroscopic surgery, especially as regards the study of endometrial lesions. He is the author of numerous publications in peer- reviewed scientific journals of Maternal-Fetal Medicine. He is a reviewer of: The British Journal of Obstetrics and Gynecology (BJOG), official organ of Royal College of Obstetrics and Gynecology, PloSOne He also is part of the commentators for the journal of Medicine-based Evidence Based Medicine (EBM . He is also "EXECUTIVE EDITOR" of the Journal of Prenatal Medicine, international scientific journal, reviewed the major search engine scientific literature of the National Center for Biotechnology Information (NCBI), official organ of the U.S. National Library of Medicine and the National Instiute of Halth (NIH) American. It is part of the most prestigious scientific societies such as AOGOI Italy (Association Obstetricians Gynecologists Hospital Italiana) and the SIDi.P. (Italian Society of prenatal diagnosis)
He has worked actively to the preparation and development of software "Computerized Screening of fetal Aneuploidies" (SCA-test). He has participated in numerous conferences as rapporteur on issues of maternal and fetal medicine with a focus on high-risk pregnancies and fetal diseases malconformative. Of particular importance is its active contribution to the study of displasie lung. It is recognized as one of the greatest experts in that fetal pathology, participating in numerous conferences and courses related to this issue.
Specialist in Gynecology and Obstetrics, today He is Consultant at ARTEMISIA Fetal Maternal Medical Centre in Roma, ITALY.
Abstract: Physiologic concentration in amniotic fluid (AF) of several metabolites has not been established with certainty. In this study, we initially assayed purines, pyrimidines, and amino compounds in 1,257 AF withdrawn between the 15th and the 20th week of gestation from actually normal pregnancies (normal gestations, normal offspring). Results allowed to determine physiologic reference intervals for 45 compounds. In these AF, not all purines and pyrimidines were detectable and uric acid (238.35±76.31 μmol/l) had the highest concentration. All amino compounds were measurable, with alanine having the highest concentration (401.10±88.47 μmol/l). In the second part of the study, we performed a blind metabolic screening of AF to evaluate the utility of this biochemical analysis as an additional test in amniocenteses. In 1,295 additional AF from normal pregnancies, all metabolites fell within the confidence intervals determined in the first part of the study. In 24 additional AF from women carrying Down's syndrome-affected fetuses, glutamate, glutamine, glycine, taurine, valine, isoleucine, leucine, ornithine, and lysine were different from physiologic reference values. One AF sample showed phenylalanine level of 375.54 μmol/l (mean value in normal AF=65.07 μmol/l) and was from a woman with unreported phenylketonuria with mild hyperphenylalaninemia (serum phenylalanine=360.88 μmol/l), carrying the IVS 4+5 G-T and D394A mutations. The fetus was heterozygote for the maternal D394A mutation. An appropriate diet maintained the mother phenylalanine in the range of normality during pregnancy, avoiding serious damage in fetal and neonatal development. These results suggest that the metabolic screening of AF might be considered as an additional biochemical test in amniocenteses useful to highlight anomalies potentially related to IEM.
Abstract: Amniotic band sequence (ABS) is the term applied to a wide range of congenital anomalies, most typically limb and digital amputations and constriction rings, that occur in association with fibrous bands (1). These alterations may be associated or not with cutaneous and visceral abnormalities.This work, which is a literature review, examines several studies that relate to cases of amniotic band syndrome (SBA). In particular, our attention was focused on the causes and pathogenesis of the SBA. These for the most part are still unknown, but from what we observe in different jobs, are due to a mechanism of vascular damage. Therefore in this paper we examine chemical risk factors, like smoking, drug use, maternal hyperglycemia, mechanical risk factors such as the puncture of the amniotic sac after amniocentesis. We also speak of the altitude as a risk factor related to blood pressure, of the increased incidence of disease in primigravid, in women with a low level of education, in which the pregnancy was not planned, and then we talk of a higher incidence in young fathers and of the role of familiarity.
Abstract: Thyroid diseases are common during pregnancy and an adequate treatment is important to prevent adverse maternal and fetal outcomes. Subclinical diseases are very frequent but not easily recognized without specific screening programs. In this article we try to summarize the knowledge on the physiologic change of the thyroid and pathological function during pregnancy; we also try to describe the best way of diagnosis and treatment of thyroid dysfunction.
Abstract: To compare the abortion rate and preterm premature rupture of membranes (PPROM) after amniocentesis in women who have undergone antibiotic prophylaxis with uterine fibroids and control.
Abstract: Gestational diabetes mellitus (GDM) is a metabolic alteration frequently found in pregnant women. In women with GDM, failure of pancreatic beta-cells to adapt the production of insulin at the increased metabolic demand in pregnancy, results in a inadequate insulin response, with consequent hyperglycemia. The criteria currently used for the diagnosis of GDM are too restrictive as some author suggested that different degrees of hyperglycemia, even though not diagnostic for diabetes, increase the risks of adverse perinatal outcomes (large for gestational age (LGA), higher rate of cesarean section, neonatal hypo-glycemia, respiratory distress, perinatal mortality). The objective of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study was to clarify the associations of levels of maternal glucose, lower than those diagnostic of diabetes, with perinatal outcome, defining a new overall strategy recommended for detection and diagnosis of hyperglycemic disorders in pregnancy.
Abstract: A fetus with de novo ring chromosome 16 is presented. At 20 weeksâ gestation,
ultrasound examination demonstrated bilateral clubfoot, bilateral renal pyelectasis, hypoplasia
of the corpus callosum, and transposition of the great vessel. Amniocentesis was
performed. Chromosome analysis identified a ring chromosome 16 [47,XY,r(16)] and array
comparative genomic hybridization (a-CGH) demonstrated that the ring included the
euchromatic portion 16p11.2. Postmortem examination confirmed prenatal findings. This
is the first case of de novo ring chromosome 16 diagnosed prenatally with a new phenotypic
pattern and also reinforces the importance of offering amniocentesis with a-CGH if fetal
anomalies are detected.
Abstract: To evaluate the role of a dedicated neurosonographer in prenatal diagnosis of isolated complete agenesis of the corpus callosum (iCACC) and to asses the postnatal outcome of these infants.
Abstract: Antepartum haemorrhage (APH) defined as bleeding from the genital tract in the second half of pregnancy, remains a major cause of perinatal mortality and maternal morbidity in the developed world.
Abstract: Shoulder Dystocia (SD) is the nightmare of obstetricians. Despite its low incidence, SD still represents a huge risk of morbidity for both the mother and fetus. Even though several studies showed the existence of both major and minor risk factors that may complicate a delivery, SD remains an unpreventable and unpredictable obstetric emergency. When it occurs, SD is difficult to manage due to the fact that there are not univocal algorithms for its management.Nevertheless, even if it is appropriately managed, SD is one of the most litigated cause in obstetrics, because it is frequently associated with permanent birth-related injuries and mother complications.All the physicians should be prepared to manage this obstetric emergency by attending periodic training, even if SD is difficult to teach for its rare occurrence and because in clinical practice it is often handled by experienced obstetricians.THE PURPOSE OF THIS STUDY IS TO REVIEW THE LITERATURE CONCERNING THE EVERLASTING PROBLEMS OF SD: identification of risk factors for the early detection of delivery at high risk of SD and a systematic management of this terrifying obstetric emergency in order to avoid the subsequent health, medico-legal and economic complications.
Abstract: OBJECTIVE: The aim of the study is to evaluate the role of Denaturing High Performance Liquid Chromatography (DHPLC) in the second level screening of the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene.METHODS: A 9-month prospective study, between June 2008 and March 2009 at Artemisia Fetal Medical Centre, included 3829 samples of amniotic fluid collected from women undergoing mid-trimester amniocentesis.The genetic diagnosis of CF was based on research of the main mutations of the CFTR gene on fetal DNA extracted from the amniocytes, (first level screening) using different commercial diagnostic systems. A second level screening using DHPLC, on the amniotic fluid and on a blood sample from the couple, was offered in case of fetuses heterozygous at first level screening.RESULTS: Of 3829 fetuses, 134 were found to be positive, 129 heterozygous and 5 affected. Of the 129 couples, following appropriate genetic counselling, 53 requested a second level screening. Through the use of DHPLC, 44 couples were found to be negative, and in nine couples, nine rare mutations were identified.CONCLUSIONS: The first level screening can be useful to evidence up to 75% of the CF mutations. The second level screening can identify a further 10% of mutant alleles. DHPLC was found to be a reliable and specific method for the rapid identification of the rare CFTR mutations which were not revealed in initial first level screening.
Abstract: Amniotic fluid (AF), routinely used for prenatal diagnosis, contains large amounts of proteins produced by the amnion epithelial cells, fetal tissues, fetal excretions and placental tissuesAlthough many amniotic fluid proteins have been identified and are currently used to detect potential fetal anomalies, little is known about the functions of these proteins and how they interact with one another. Identification of changes in the protein content of amniotic fluid, therefore, may be used to detect a particular type of pathology, or to ascertain a specific genetic disorder. In the present work we used a proteomic approach, combining 2DE and MS, in order to study the protein composition of AFS.
Abstract: To compare procedure-related pregnancy loss after second-trimester genetic amniocentesis in women given an antibiotic prophylaxis and controls.
Abstract: Cor triatriatum dexter is a rare cardiac malformation characterized by division of the right atrium into two compartments by a usually fenestrated membrane, whose degree of partitioning or septation is responsible for different clinical manifestations. Cor triatriatum dexter has been diagnosed incidentally in adults and children by echocardiography, surgery, or autopsy but has not previously been published in fetuses, apart from a report of two early-2nd-trimester fetuses aborted as a result of associated severe nuchal edema. To
our knowledge, this is the first report of an isolated fetal cor triatriatum dexter that was diagnosed during ultrasound screening at 22 weeks of gestation
Abstract: Congenital Heart Disease (CHD) is the most common severe congenital abnormality in the newborn and the cause of over half the deaths from congenital anomalies in childhood. Prenatal diagnosis, possible as early as 15 weeks of gestation, allows physicians and families the greatest number of therapeutic options, and can improve the postnatal outcome. There are several potential indications for performing such examination. Evaluation of the heart in the setting of restricted fetal growth or fetal distress is often recommended. Whenever extracardiac anomalies are detected during fetal ultrasound examination or in presence of chromosomal abnormalities detected with amniocentesis, cardiac assessment is mandatory. The test should also be performed as part of the assessment of fetal arrhythmias. Finally, whenever congenital heart disease is suspected for other reasons, such as maternal exposure to teratogenic substances or a parental history of previous children with congenital lesions, the examination should be considered.
The performance of a fetal echocardiogram requires experience and a systematic approach. Guidelines for training have been formulated, and only qualified individuals should perform this highly specialized examination.
A description of the techniques of heart examination is presented below.
Abstract: Objective
To compare procedure-related pregnancy loss after second-trimester genetic amniocentesis in women given an antibiotic prophylaxis and controls.
Methods
Prospective, open randomised controlled single-centre study between January 1999 and December 2005 at Artemisia Fetal Maternal Medical Centre. A follow-up within 4 weeks after the procedure was done.
Of 36 347 eligible women, 1424 refused to participate and 34 923 were enrolled and randomised with unequal chance of selection, 21 991 were assigned to treatment group and 12 932 were assigned to the control group, and did not receive any placebo. Oral azithromycin, 500 mg per day, was administered 3 days before amniocentesis. The primary endpoint was the procedure-related pregnancy loss. The secondary endpoint was the rate of preterm premature rupture of membranes.
Results
The rate of abortion related to the amniocentesis was 7/21 219 women (0.03%, 95% CI 0.009-0.057) in the intervention group, and 36/12 529 (0.28%, 0.28-0.30) in controls (p = 0.0019). The rate of preterm premature rupture of membranes was 14/21 219 (0.06%, 0.031-0.101) in the intervention group, and 140/12 529 (1.12%, 0.94-1.30) in the control group (p = 0.001).
Conclusions
Antibiotic prophylaxis before second-trimester amniocentesis reduced the risk of abortion and of rupture of the membranes
Abstract: Cor triatriatum dexter is a rare cardiac malformation characterized by division of the right atrium into two compartments by a usually fenestrated membrane, whose degree of partitioning or septation is responsible for different clinical manifestations.
Abstract: Congenital Heart Disease (CHD) is the most common severe congenital abnormality in the newborn and the cause of over half the deaths from congenital anomalies in childhood. Prenatal diagnosis, possible as early as 15 weeks of gestation, allows physicians and families the greatest number of therapeutic options, and can improve the postnatal outcome. There are several potential indications for performing such examination. Evaluation of the heart in the setting of restricted fetal growth or fetal distress is often recommended. Whenever extracardiac anomalies are detected during fetal ultrasound examination or in presence of chromosomal abnormalities detected with amniocentesis, cardiac assessment is mandatory. The test should also be performed as part of the assessment of fetal arrhythmias. Finally, whenever congenital heart disease is suspected for other reasons, such as maternal exposure to teratogenic substances or a parental history of previous children with congenital lesions, the examination should be considered. The performance of a fetal echocardiogram requires experience and a systematic approach. Guidelines for training have been formulated, and only qualified individuals should perform this highly specialized examination. A description of the techniques of heart examination is presented below.
Abstract: The SCA-TEST, Prenatal Aneuploidies Screening, is an innovating program with very articulated and differentiated calculation potentials. It is a software which allows executing a sequence-like rational screening involving the ultrasound study of the first and second trimester. The program enables to execute a complete and different- levels combined screening, through very sophisticated mathematic analysis methods. In particular, it enables to make: a first trimester screening combining it with nuchal translucency, and biochemical parameters of free beta-hCG and PAPP-A; a second trimester screening by the evaluation of up to 6 biometric parameters (biparietal diameter, cranial circumferentia, femur, humerus, pyelectasis and plica nucalis), and up to 7 associated morphologic parameters (hyperechogenic bowel, cardiac foci, interventricular defect, pericardial effusion, tricuspid valve regurgitation, right/left heart disproportion, and structural abnormalities). The purpose of the study was to present the performance of the SCA TEST in the second trimester of pregnancy through the evaluation of a prospective study performed in the period between April 2007 and December 2007 on 1000 women who underwent the SCA TEST followed by amniocentesis. Studying all the cardiovascular and non-cardiovascular markers, SCA TEST made it possible to identify 62.5% fetuses affected by Trisomy 21 with a specificity of 94.6%, and a 5.4% of false positive. Considering only women older than 35 years the detection rate reaches 80% with a 7.8% of false positive. The statistical analysis confirmed that the second trimester screening gives essential information regarding the aneuploidia risks in particular in high risk women, and in those who did not perform first trimester screening.
Abstract: Small supernumerary marker chromosomes (sSMCs) have been described from all human chromosomes with different sizes and shapes. However, it is difficult to know the clinical manifestations associated with them, because such knowledge depends on the size, presence of euchromatic material, degree of mosaicism and/or uniparental disomy (UPD).A case report of a familial small supernumerary marker chromosome (sSMC) through a structural and a segregation study is reported.
Abstract: The SCA-TEST, Prenatal Aneuploidies Screening, is an innovating program with very articulated and differentiated calculation potentials. It is a software which allows executing a sequence-like rational screening involving the ultrasound study of the first and second trimester. The program enables to execute a complete and different- levels combined screening, through very sophisticated mathematic analysis methods. In particular, it enables to make: a first trimester screening combining it with nuchal translucency, and biochemical parameters
of free beta-hCG and PAPP-A; a second trimester screening by the evaluation of up to 6 biometric parameters
(biparietal diameter, cranial circumferentia, femur, humerus, pyelectasis and plica nucalis), and up to 7 associated morphologic parameters (hyperechogenic bowel, cardiac foci, interventricular defect, pericardial
effusion, tricuspid valve regurgitation, right/left heart disproportion, and structural abnormalities).The purpose
of the study was to present the performance of the SCA TEST in the second trimester of pregnancy
through the evaluation of a prospective study performed in the period between April 2007 and December
2007 on 1000 women who underwent the SCA TEST followed by amniocentesis. Studying all the cardiovascular
and non-cardiovascular markers, SCA TEST made it possible to identify 62.5% fetuses affected by Trisomy
21 with a specificity of 94.6%, and a 5.4% of false positive. Considering only women older than 35 years the
detection rate reaches 80% with a 7.8% of false positive. The statistical analysis confirmed that the second
trimester screening gives essential information regarding the aneuploidia risks in particular in high risk
women, and in those who did not perform first trimester screening.
Abstract: AIMS: To assess the diagnostic accuracy of endometrial biopsy by means of the hysteroscopic resectoscope (EBHR) in evaluating tumor differentiation in patients with endometrial cancer. METHODS: Between January and December 2005, all the women with a diagnosis of endometrioid adenocarcinoma of the uterus, when admitted to hospital, were enrolled for this study. Patients eligible for surgical treatment underwent a preoperative work-up consisting in pelvic magnetic resonance imaging (MRI) and EBHR. In all patients submitted to a hysterectomy, a comparison between pre- and postoperative tumor grade was carried out. RESULTS: 42 women were enrolled in the study. Hysteroscopic biopsy was carried out in 39 patients (mean age 62.5 years, range 33-79; FIGO stage I: 34, stage II-IV: 5). No complication related to hysteroscopy was observed. The preoperative tumor grade by hysteroscopy correlated with the final grade in 97.1% of cases. No patient had positive peritoneal washing and after a median follow-up of ten months no intraperitoneal tumor relapse was observed. CONCLUSION: EBHR is a very accurate diagnostic procedure for assessing the preoperative tumor grade in patients with endometrial cancer.
Abstract: Small supernumerary marker chromosomes (sSMCs) have been described from all human chromosomes
with different sizes and shapes. However, it is difficult to know the clinical manifestations associated with
them, because such knowledge depends on the size, presence of euchromatic material, degree of mosaicism
and/or uniparental disomy (UPD). A case report of a familial small supernumerary marker chromosome (sSMC) through a structural and a segregation study is reported.
Abstract: OBJECTIVE: Primary squamous carcinoma of the vagina in young woman is extremely rare. Conservative management of both sexual and reproductive function poses challenging problems to gynecologic oncologists. METHODS: Between January 2001 and December 2004, four women under 40, nulliparous, with squamous cell carcinoma of the upper third of the vagina, at FIGO Stage I were submitted to conservative surgery of the reproductive/sexual function at our Institution. After written informed consent was obtained, conservative surgical treatment consisting of radical tumorectomy with pelvic lymphadenectomy, in three patients, and partial hemi-vaginectomy plus homolateral paracolpectomy/parametrectomy with pelvic lymphadenectomy, in the forth patient, was carried out. RESULTS: Mean operative time of conservative surgical treatment was 161 min. No intraoperative or postoperative complications were observed. In one patient, definitive pathologic examination revealed microscopic involvement of the paracolpium. Thus, after carrying out laparoscopic ovarian transposition, adjuvant radiotherapy (RT), consisting of pulsed-dose rate brachytherapy and external RT, was delivered in this woman. After a follow-up time of 51, 45, 21 and 9 months, respectively, all patients are regularly menstruating, sexually active and clinically free of disease. CONCLUSION: To our knowledge, this is the first report showing the feasibility and the efficacy of conservative surgery of reproductive and sexual function in young woman with vaginal carcinoma. A larger number of patients and a longer follow-up are needed to validate the safety of this approach.
Abstract: OBJECTIVE: To verify whether in high risk pregnancies, fetuses with altered Doppler flow velocimetry waveforms (FVW) are associated with both biochemical and/or biophysical changes in the amniotic fluid (AF) lung surfactant. MATERIALS AND METHODS: Hundred-eight high risk pregnancies were considered on the basis of a complete Doppler velocimetry study performed within 24 hrs before amniocentesis and delivery within 1 week from amniocentesis. From this group, 22 pregnancies were recruited as altered FVW cases on the basis of simultaneous alteration of Umbilical Artery Pulsatility Index (UA PI), and UA PI/MCA PI (Middle Cerebral Artery Pulsatility Index) ratio (UA/MCA); in all altered FVW group cases the Mean Uterine Artery Resistance Index (Ut RI) was also altered. Amniotic fluid samples obtained by ultrasound guided amniocentesis were analysed for FLM within 24 hours from collection. Pulmonary maturity was determined by planimetric lecithin/sphingomyelin ratio (L/S), phosphatidylglycerol (PG) and the lamellar bodies count (LBs). RESULTS: When FLM parameters were regressed versus FVW in the whole study group, we found a significant negative correlation between UA/MCA and L/S (r = -0.19, p < 0.05). No significant correlations were found between FVW indices and LBs. When we compared FLM parameters for gestational age subgroups (23-32 wks, > 33 wks), L/S values were significantly higher in patients with normal FVW indices in comparison to pathologic FVW pregnancies for gestational ages > 33 wks. This was reflected by a negativè correlation between FVW and FLM (UA/MCA vs. L/S r = -0.54, p < 0.02; UA/MCA vs. PG, r = -0.60, p < 0.01). COMMENT: Our data suggest that fetuses with an UA/MCA ratio > 95 degrees are not protected from neonatal RDS, as usually felt, but show a delay in FLM, particularly in pregnancies > 33 wks.
Abstract: We aimed to evaluate the effect of maternal glycemia on the parameters of CTG as assessed by a computerized fetal heart rate interpretation system (cCTG). We studied prospectively 22 single insuline dependent diabetic pregnancies (34-39 wks' gestation). A negative correlation was found between high variability epochs (HV) in msec, and maternal glycemia (r = -0.58, p < 0.01). HV epochs are known to be related with hypoxic episodes in the fetus. We suggest that the evaluation of maternal glycemia at the time of cCTG may increase the diagnostic accuracy of automated fetal heart rate interpretation.
Abstract: BACKGROUND: The effect of antenatal betamethasone on fetal parameters includes a transient reduction of fetal heart rate variation and of fetal body movements. An effect on maternal-fetal blood flow has also been shown, with non-univocal results. AIMS: To evaluate the effect of antenatal betamethasone in third trimester singleton high-risk pregnancies by Doppler technology. SUBJECTS AND METHODS: Thirty-six pregnant women who received a full course of betamethasone (12 mg i.m. two times, 24 hrs apart) were studied. The Doppler examination included the assessment of the pulsatility index (PI) of the umbilical artery (UA PI), the middle cerebral artery (MCA PI) and of resistance index of uterine arteries (Ut RI) before treatment, and 48 and 96 hrs after second dose of betamethasone. RESULTS: No significant variation was noted in UA PI through betamethasone therapy. MCA PI decreased significantly 48 hours from the last injection of betamethasone (p = 0.004), and returned to basal values at 96 hours. No difference was found for the other Doppler parameters examined. When serial Doppler studies were analyzed according to the gestational age, in the group < 32 wks' gestation, MCA PI decreased significantly after 48 hours (p < 0.006) and returned to pre-treatment values after 96 hours from the last betamethasone dose. Conversely, no difference was found in Doppler serial measurements in any of the analyzed districts in the subgroup > or = 32 wks' gestation. CONCLUSION: Betamethasone treatment is associated with an increase in end diastolic flow of the middle cerebral artery, as reflected by a significant, although transient, reduction of MCA PI, especially at gestational ages < 32 weeks.
Abstract: OBJECTIVE: To assess the need to perform amniocentesis for the evaluation of fetal lung maturity (FLM) in both amniotic sacs of twin pregnancies. STUDY DESIGN: A retrospective study. We considered 33 twin biamniotic pregnancies, delivering within 1 week from amniocentesis. FLM testing was performed by planimetric lecithin/sphingomyelin ratio (L/S), and lamellar bodies count (LB) according to our methodology. RESULTS: A strong correlation was found between L/S (p < 0.001, r = 0.59) and LB (p < 0.001, r = 0.69) values between smaller and larger twins. No significant regression was found between differences of L/S and LB among both amniotic sacs against gestational age. When stratifying FLM values < 34 and > 34 wks' gestation, again no difference was found in mean difference of L/S and LB before and after 34 wks. CONCLUSIONS: FLM should not be assessed in both amniotic sacs at any gestational age independent of weight and/or sex of the conceptus.
Abstract: OBJECTIVE: The aim of this study was to correlate antepartum computerized cardiotocography (cCTG) and Doppler velocimetry parameters to umbilical blood gas analysis (UBGA) value and Apgar score 1-5 min as neonatal outcome endpoints. METHODS: Forty-eight third trimester single high risk pregnancies were considered for this study, with a cCTG performed within 24 hrs from delivery, a complete Doppler velocimetry study performed within 48 hrs from delivery and an UBGA evaluation at birth and before the first breath. RESULTS: When we analyzed the backward stepwise regression of each Doppler velocimetry and cCTG parameters versus UBGA parameters as dependent variables, we found that the linear combination of fetal heart rate (FHR) (p < 0.001), high variation episodes in min (HV) (p < 0.01) and low variation episodes in msec (LV) (p < 0.03) was able to predict pO2 values. When performing a logistic regression of data for every single parameter of FHR tracing and Doppler velocimetry against pH < 7.2 and Becf < -4 as endpoints, we found that only umbilical artery pulsatility index (UA PI) was able to predict umbilical artery pH (O.R.: 8.1 [1.07-61.8]) and only fetal movements (FM) from FHR tracing values was able to predict UA pH (O.R.: 0.94 [0.89-0.99]). Further analysis considers a cut-off for the prediction of UA pH < 7.2 at birth a value at > or = 1.35 for UA PI and at < or = 12 for FM/h. The combination of UA PI > 1.35 and FM/h < 12 did not improve the ability to predict acidemia at birth. CONCLUSION: The validity of our data from the clinical point of view suggests that in third trimester high risk pregnancies, an UA PI > or = 1.35 and/or FM/h < or = 12 (in a FHR tracing > or = 40 min) may represent a risk of 70% acidemia in neonates.
Abstract: PURPOSE: Evaluate the most effective fetal treatment for male fetal obstructive uropathy. This study compares the different approaches of several authors for this pathology and presents our experience in cases of fetal obstructive uropathy to demonstrate which option is the easiest and the best for male obstructive uropathy.
ABSTRACT: Posterior urethral valves are the leading cause of antenatally dia-gnosed lower-urinary tract obstruction and are the structural genitourinary anomaly
amenable to fetal therapy. PUV are found only in the male population and have an incidence of 1 in 5000 births. The mortality rate in these patients has been reported to be as high as 63%, especially when it is associated with severe oligo-hydramnios due to pulmonary hypoplasia. This association is known as Prune Belly
Syndrome (PBS), an uncommon anomaly consisting of genito-urinary abnorm-alities and a partial or complete absence of the abdominal wall musculature.
Although many theories have been proposed to explain the pathogenesis of this anomaly (abnormal mesodermal development, genetic defect, and urethral obstruction
malformation complex), many authors suggest that the fetal prune belly is not a syndrome but a sequence when the âprimum movensâ is the obstruction of the outflow of the urine.
Urinary tract decompression in the early second trimester is recommended to reduce the potential for ongoing damage to the developing kidneys and pulmonary
hypoplasia due to the oligohydramnios. The percutaneous placement of an indwelling catheter for urinary diversion is a possible therapy.
Vesicoamniotic shunt for complete urinary tract obstruction is partially effective. Although the main purpose of VASP is to prevent pulmonary hypoplasia and dysfunctional
kidneys, Vesicoamniotic shunt has not always been effective, as the outcomes were poor in most patients.
According to a previous work (Zaccara, 2005), we use the amniotic fluid index to evaluate the bladder outlet obstruction and to decide whether to perform the bladder drainage or not. All cases of bilateral obstructive uropathy were seen prenatally at the Artemisia Medical Center. They were initially reviewed at 17 to 20 weeks of gestation, when a distended fetal bladder with thickened wall and enlarged kidneys were displayed. At the same time, ultrasonographic assessment of the amniotic fluid was performed by calculating the amniotic fluid index. An amniotic fluid index less than 25th percentile was considered below average and an index less than 5th percentile was considered oligohydramnios, whereas an index ranging between 50th and 75th percentiles was considered normal. In our simple technique, we empty the bladder with a percutaneous needle. Our result demonstrates that this easiest procedure is the most effective fetal treatment for male obstructive uropathy.
