227 results on '"di Pasquo, E."'
Search Results
52. OC25.05: Maternal hemodynamic findings in small‐for‐gestational‐age and growth‐restricted fetuses
- Author
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di Pasquo, E., primary, Ghi, T., additional, Dall'Asta, A., additional, Volpe, N., additional, Schera, G., additional, Ciavarella, S., additional, Armano, G., additional, Di Peri, A., additional, Sesenna, V., additional, and Frusca, T., additional
- Published
- 2019
- Full Text
- View/download PDF
53. OP19.09: Intracervical lakes as a sonographic marker of placenta accreta spectrum (PAS) in patients with placenta previa
- Author
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di Pasquo, E., primary, Ghi, T., additional, Calì, G., additional, D'Antonio, F., additional, Fratelli, N., additional, Forlani, F., additional, Prefumo, F., additional, Kaihura, C., additional, Volpe, N., additional, Dall'Asta, A., additional, and Frusca, T., additional
- Published
- 2019
- Full Text
- View/download PDF
54. Gestational weight gain as an independent risk factor for adverse pregnancy outcomes in women with gestational diabetes
- Author
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Macrì, F, Pitocco, Dario, di Pasquo, E, Salvi, Silvia, Rizzi, Alessandro, Di Leo, Mauro, Tartaglione, Linda, Di Stasio, Enrico, Lanzone, Antonio, De Carolis, Sara, Pitocco, D (ORCID:0000-0002-6220-686X), Salvi, S (ORCID:0000-0001-7793-9612), Rizzi, A, Di Leo, M, Tartaglione, L, Di Stasio, E (ORCID:0000-0003-1047-4261), Lanzone, A (ORCID:0000-0003-4119-414X), De Carolis, S (ORCID:0000-0002-5160-7609), Macrì, F, Pitocco, Dario, di Pasquo, E, Salvi, Silvia, Rizzi, Alessandro, Di Leo, Mauro, Tartaglione, Linda, Di Stasio, Enrico, Lanzone, Antonio, De Carolis, Sara, Pitocco, D (ORCID:0000-0002-6220-686X), Salvi, S (ORCID:0000-0001-7793-9612), Rizzi, A, Di Leo, M, Tartaglione, L, Di Stasio, E (ORCID:0000-0003-1047-4261), Lanzone, A (ORCID:0000-0003-4119-414X), and De Carolis, S (ORCID:0000-0002-5160-7609)
- Abstract
OBJECTIVE: Obesity and gestational diabetes mellitus (GDM) are rising worldwide. This study retrospectively evaluated the role of excessive gestational weight gain (eGWG) in women with GDM and different pre-pregnancy body mass indices (BMIs). PATIENTS AND METHODS: Optimal glycaemic control was defined as achieving glucose target thresholds in more than 80% of measurements. 283 women with GDM were categorized as underweight, normal weight, overweight or obese based on WHO's classification scheme. eGWG was defined as >18.0 kilograms for women who were underweight, >15.8 kilograms for those who were normal weight, >11.3 kilograms for those who were overweight and >9.0 kilograms for those who were obese. For the analysis, women were divided into two groups: normal and excessive GWG. The main outcomes measured were incidences of large/small for gestational age (LGA/SGA), macrosomia, preterm delivery, hypertensive disorders and caesarean sections (CS). RESULTS: Excessive GWG was associated with higher birth weight and percentile (p<0.001), and with a higher prevalence of LGA (p<0.001), macrosomia (p=0.002) and hypertensive disorders (p=0.036). No statistical differences were found for the week of delivery, or prevalence of CS and SGA. The multivariate analysis highlighted both pre-pregnant BMI and eGWG as independent risk factors for LGA and macrosomia. Women with a pre-pregnant BMI of at least 25 and eGWG have a 5.43-fold greater risk of developing LGA (p=0.005). CONCLUSIONS: When combined with an inadequate pre-pregnant BMI, eGWG acts as a "synergic risk factor" for a poor outcome. When obesity or GDM occur, an optimal GWG can guarantee a better pregnancy outcome.
- Published
- 2018
55. OP13.11: Transabdominal and transperineal intrapartum ultrasound and mode of delivery in prolonged second stage of labour
- Author
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Dall'Asta, A., primary, Volpe, N., additional, Schera, G., additional, Kiener, A., additional, Galli, L., additional, Commare, A., additional, Angeli, L., additional, di Pasquo, E., additional, and Ghi, T., additional
- Published
- 2018
- Full Text
- View/download PDF
56. P02.01: Glial peri-orbital heterotopia: a rare type of peri-orbital mass: a case report and a literature review
- Author
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di Pasquo, E., primary, Kuleva, M., additional, Sonigo, P., additional, Millischer, A., additional, Bremond-Gignac, D., additional, Ville, Y., additional, and Salomon, L.J., additional
- Published
- 2018
- Full Text
- View/download PDF
57. OC27.06: Non-visualisation of the fetal gallbladder (NVFGB) at prenatal ultrasound: cohort study and systematic review of the literature on postnatal outcome
- Author
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di Pasquo, E., primary, Kuleva, M., additional, Chardot, C., additional, Ville, Y., additional, and Salomon, L.J., additional
- Published
- 2018
- Full Text
- View/download PDF
58. Fetal intra-abdominal umbilical vein varix: retrospective cohort study and systematic review and meta-analysis
- Author
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di Pasquo, E., primary, Kuleva, M., additional, O'Gorman, N., additional, Ville, Y., additional, and Salomon, L. J., additional
- Published
- 2018
- Full Text
- View/download PDF
59. Maternal hemodynamic changes and intrapartum cardiotocographic (CTG) findings following epidural analgesia.
- Author
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di Pasquo, E., Valenti, A., Valentini, B., Compagnone, C., Trombi, G., Bignami, E.G., and Ghi, T.
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EPIDURAL analgesia , *HEMODYNAMICS - Published
- 2023
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- View/download PDF
60. P12.09: Fetal intra-abdominal umbilical vein varix: a retrospective cohort study, systematic review of the literature and meta-analysis
- Author
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di Pasquo, E., primary, Kuleva, M., additional, O'Gorman, N., additional, Ville, Y., additional, and Salomon, L.J., additional
- Published
- 2017
- Full Text
- View/download PDF
61. OP07.06: Role of prenatal MRI in the prediction of long-term outcome of fetuses with isolated agenesis of the septum pellucidum
- Author
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di Pasquo, E., primary, Kuleva, M., additional, Millischer, A., additional, Sonigo, P., additional, Bernard, J., additional, Salomon, L.J., additional, and Ville, Y., additional
- Published
- 2017
- Full Text
- View/download PDF
62. OC21.03: Relationship between the incidence of genomic microarray anomalies and first trimester nuchal translucency value
- Author
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di Pasquo, E., primary, Kuleva, M., additional, Malan, V., additional, Ville, Y., additional, and Salomon, L.J., additional
- Published
- 2017
- Full Text
- View/download PDF
63. Is there any role for the hydroxychloroquine (HCQ) in refractory obstetrical antiphospholipid syndrome (APS) treatment?
- Author
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De Carolis, Sara, Botta, Angela, Salvi, Silvia, di Pasquo, E., Del Sordo, G., Garufi, C., Lanzone, Antonio, De Carolis, M. P., De Carolis S. (ORCID:0000-0002-5160-7609), Botta A., Salvi S. (ORCID:0000-0001-7793-9612), Lanzone A. (ORCID:0000-0003-4119-414X), De Carolis, Sara, Botta, Angela, Salvi, Silvia, di Pasquo, E., Del Sordo, G., Garufi, C., Lanzone, Antonio, De Carolis, M. P., De Carolis S. (ORCID:0000-0002-5160-7609), Botta A., Salvi S. (ORCID:0000-0001-7793-9612), and Lanzone A. (ORCID:0000-0003-4119-414X)
- Abstract
The best therapy regimen for refractory obstetrical antiphospholipid syndrome remains to be determined. Additional treatments with steroids, plasma exchanges and immunoglobulins failed to show any beneficial effect. We present a case of a woman who had a better pregnancy outcome after the administration of hydroxychloroquine (HCQ) as additional treatment. Furthermore, we highlighted that HCQ was able to dramatically reduce the antiphospholipid antibodies levels.
- Published
- 2015
64. CONTINUOUS SUBCUTANEOUS INSULIN INFUSION (CSII) VS. MULTIPLE DAILY INJECTIONS (MDI) IN PREGNANT WOMEN WITH TYPE 1 DIABETES
- Author
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De Carolis, Sara, Degennaro, V. A., di Pasquo, E., Martino, C., Macri', F., Salvi, Silvia, Vitucci, A., and D. Pitocco.
- Subjects
Settore MED/40 - GINECOLOGIA E OSTETRICIA ,Pregnancy ,Diabetes ,Settore MED/13 - ENDOCRINOLOGIA - Published
- 2013
65. Gestational weight gain as an independent risk factor for adverse pregnancy outcomes in women with gestational diabetes.
- Author
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MACRÌ, F., DI PASQUO, E., RIZZI, S., LANZONE, A., DE CAROLIS, S., PITOCCO, D., DI LEO, M., TARTAGLIONE, L., and DI STASIO, E.
- Abstract
OBJECTIVE: Obesity and gestational diabetes mellitus (GDM) are rising worldwide. This study retrospectively evaluated the role of excessive gestational weight gain (eGWG) in women with GDM and different pre-pregnancy body mass indices (BMIs). PATIENTS AND METHODS: Optimal glycaemic control was defined as achieving glucose target thresholds in more than 80% of measurements. 283 women with GDM were categorized as underweight, normal weight, overweight or obese based on WHO's classification scheme. eGWG was defined as >18.0 kilograms for women who were underweight, >15.8 kilograms for those who were normal weight, >11.3 kilograms for those who were overweight and >9.0 kilograms for those who were obese. For the analysis, women were divided into two groups: normal and excessive GWG. The main outcomes measured were incidences of large/ small for gestational age (LGA/SGA), macrosomia, preterm delivery, hypertensive disorders and caesarean sections (CS). RESULTS: Excessive GWG was associated with higher birth weight and percentile (p<0.001), and with a higher prevalence of LGA (p<0.001), macrosomia (p=0.002) and hypertensive disorders (p=0.036). No statistical differences were found for the week of delivery, or prevalence of CS and SGA. The multivariate analysis highlighted both pre-pregnant BMI and eGWG as independent risk factors for LGA and macrosomia. Women with a pre-pregnant BMI of at least 25 and eGWG have a 5.43-fold greater risk of developing LGA (p=0.005). CONCLUSIONS: When combined with an inadequate pre-pregnant BMI, eGWG acts as a "synergic risk factor" for a poor outcome. When obesity or GDM occur, an optimal GWG can guarantee a better pregnancy outcome. [ABSTRACT FROM AUTHOR]
- Published
- 2018
66. BONE CHANGES EVALUATION DURING PREGNANCY BY MEANS OF RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS) TECHNOLOGY.
- Author
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Degennaro, V. A., Cagninelli, G., Casciaro, S., Conversano, F., Di Pasquo, E., Lombardi, F. A., Pisani, P., and Ghi, T.
- Published
- 2023
- Full Text
- View/download PDF
67. EP01.56: Maternal hemodynamic findings as a tool to predict the risk of left ventricular hypertrophy in pregnant women with chronic hypertension.
- Author
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di Pasquo, E., Alissa, V., Angeli, L., Valentini, B., Alfarè, C., Dall'Asta, A., and Ghi, T.
- Abstract
Cardiac Output and Systemic Vascular Resistance showed the highest accuracy in predicting the risk of LVH (AUC 94.4 95% CI 0.86-0.99 cut-off 5.8 and AUC 94.0% 95% CI 0.86-0.99 cut-off 1387, respectively). To evaluate the accuracy of hemodynamic parameters in predicting the risk of left ventricular hypertrophy (LVH) in women with chronic hypertension (CH). [Extracted from the article]
- Published
- 2022
- Full Text
- View/download PDF
68. Is there any role for the hydroxychloroquine (HCQ) in refractory obstetrical antiphospholipid syndrome (APS) treatment?
- Author
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De Carolis, S., primary, Botta, A., additional, Salvi, S., additional, di Pasquo, E., additional, Del Sordo, G., additional, Garufi, C., additional, Lanzone, A., additional, and De Carolis, M.P., additional
- Published
- 2015
- Full Text
- View/download PDF
69. Fondaparinux in pregnancy: Could it be a safe option? A review of the literature
- Author
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De Carolis, S., primary, di Pasquo, E., additional, Rossi, E., additional, Del Sordo, G., additional, Buonomo, A., additional, Schiavino, D., additional, Lanzone, A., additional, and De Stefano, V., additional
- Published
- 2015
- Full Text
- View/download PDF
70. Placental and infant metastasis of maternal melanoma: A new case
- Author
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De Carolis, S., primary, Garofalo, S., additional, Degennaro, V. A., additional, Zannoni, G. F., additional, Salvi, S., additional, Moresi, S., additional, Di Pasquo, E., additional, and Scambia, G., additional
- Published
- 2014
- Full Text
- View/download PDF
71. Complementemia and obstetric outcome in pregnancy with antiphospholipid syndrome.
- Author
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De Carolis, Sara, Botta, Angela, Santucci, Stefania, Salvi, Silvia, Moresi, S, Di Pasquo, E, Del Sordo, G, Martino, Carmelinda, De Carolis, Sara (ORCID:0000-0002-5160-7609), Salvi, Silvia (ORCID:0000-0001-7793-9612), De Carolis, Sara, Botta, Angela, Santucci, Stefania, Salvi, Silvia, Moresi, S, Di Pasquo, E, Del Sordo, G, Martino, Carmelinda, De Carolis, Sara (ORCID:0000-0002-5160-7609), and Salvi, Silvia (ORCID:0000-0001-7793-9612)
- Abstract
Objective: To investigate the predictive value of serum C3 and C4 complement component levels in relation to pregnancy outcome in patients with antiphospholipid syndrome (APS). Materials and methods: A prospective study of 47 pregnancies associated with APS was performed. Pregnancy outcome was analyzed in terms of: fetal loss, preterm delivery (≤34 gestational weeks), fetal intrauterine growth restriction (IUGR), birth weight <2500 g and preeclampsia. Week at delivery, neonatal birth weight and neonatal birth weight percentile were also investigated. Hypocomplementemia, positivity for anti-dsDNA and triple positivity for antiphospholipid antibodies (aPL) were related to pregnancy outcome. Results: Forty-three pregnancies ended in live births with a fetal loss rate of 8.5%. Fetal death, preterm delivery and birth weight <2500 g were associated with hypocomplementemia (p = 0.019, p = 0.0002, p < 0.0001 respectively). Lower neonatal birth weight, lower neonatal birth weight percentile and lower week at delivery were associated with hypocomplementemia (p < 0.0001, p = 0.0003, p < 0.0001 respectively) and with triple aPL positivity (p = 0.008, p = 0.014, p = 0.03 respectively). A poor pregnancy outcome was confirmed among primary APS (PAPS) pregnancies with hypocomplementemia. Multivariate analysis confirmed that hypocomplementemia was an independent predictor of lower neonatal birth weight (p = 0.0001) and lower week at delivery (p = 0.002). Conclusion: Hypocomplementemia could be considered a novel prognostic factor for pregnancy outcome in APS patients.
- Published
- 2012
72. W235 EFFECT OF GESTATIONAL HYPERTENSION ON BIRTH WEIGHT IN TWIN PREGNANCIES
- Author
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Ferrazzani, S., primary, Moresi, S., additional, Degennaro, V.A., additional, Martino, C., additional, Stifani, F., additional, De Luca, C., additional, Di Pasquo, E., additional, Del Sordo, G., additional, and De Carolis, S., additional
- Published
- 2012
- Full Text
- View/download PDF
73. PP158. Hypertensive disorders in pregnant women affected by type I diabetes
- Author
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Ferrazzani, S., primary, Di Pasquo, E., additional, Moresi, S., additional, Martino, C., additional, Salvi, S., additional, Degennaro, V.A., additional, Del Sordo, G., additional, and De Carolis, S., additional
- Published
- 2012
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74. PP029. Gestational hypertension and birth weight in twin pregnancies
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Ferrazzani, S., primary, Moresi, S., additional, Garofalo, S., additional, Degennaro, V.A., additional, Salvi, S., additional, Di Pasquo, E., additional, Del Sordo, G., additional, and De Carolis, S., additional
- Published
- 2012
- Full Text
- View/download PDF
75. Complementemia and obstetric outcome in pregnancy with antiphospholipid syndrome
- Author
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De Carolis, S, primary, Botta, A, additional, Santucci, S, additional, Salvi, S, additional, Moresi, S, additional, Di Pasquo, E, additional, Del Sordo, G, additional, and Martino, C, additional
- Published
- 2012
- Full Text
- View/download PDF
76. P35. Hypertensive disorders in pregnant women affected by type 1 diabetes
- Author
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De Carolis, S., primary, Martino, C., additional, di Pasquo, E., additional, Santucci, S., additional, Stifani, F., additional, Macri’, F., additional, Degennaro, V., additional, and Ferrazzani, S., additional
- Published
- 2011
- Full Text
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77. EP23.04: The renal position index: an anatomic landmark to define the normal position of fetal kidneys at first trimester.
- Author
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Volpe, N., Chiarelli, A., Melito, C., Dall'Asta, A., di Pasquo, E., Michela, T., Montrucchio, C., Melandri, E., and Ghi, T.
- Abstract
Conclusions The RPI seems a valuable anatomic landmark to define normal kidneys position on a coronal view in the first trimester (figure 1A). To define the normal position of fetal kidneys at 1st trimester. [Extracted from the article]
- Published
- 2022
- Full Text
- View/download PDF
78. EP19.17: Correlation between fetal Doppler parameters and fetal cardiac function in late‐onset fetal growth restriction: a prospective study.
- Author
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Dall'Asta, A., di Tonto, A., Minopoli, M., Sorrentino, S., Corno, E., Cagninelli, G., di Pasquo, E., and Ghi, T.
- Abstract
To evaluate the relationship between fetal Doppler parameters and functional echocardiography in fetuses at risk for late-onset fetal growth restriction (FGR). Conclusions Functional echocardiographic findings on a selected population of fetuses at risk for late-onset FGR and birthweight < 10th percentile demonstrate a relationship between the UA Doppler and left ventricular strain and EF. At sub-analysis performed according to the birthweight, fetuses with birthweight 3 SP rd sp -10 SP th sp percentile and abnormal UA Doppler showed lower LV global longitudinal strain (-18.6 versus -21.9, p = 0.01), LV global radial strain (-31.1 versus -47.5, p = 0.003), LV global circumferential strain (-24.4 versus -31.6, p = 0.03) and EF (52.5 versus 60.2, p = 0.004) compared to those with normal UA Doppler. [Extracted from the article]
- Published
- 2022
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79. EP07.01: The cortical bite sign: a novel marker of focal cortical abnormalities in fetuses with isolated callosal anomalies?
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Volpe, N., Grisolia, G., Chiarelli, A., Melito, C., Pisello, M., di Pasquo, E., Dall'Asta, A., and Ghi, T.
- Abstract
The primary outcome of this study was to evaluate the prevalence and the laterality of the CBS at antenatal ultrasound and MRI. Cases with additional central nervous system (CNS) anomalies not involving the cortex were excluded. To describe a specific marker of cortex anomaly in fetuses with complete callosal agenesis. [Extracted from the article]
- Published
- 2022
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80. EP04.04: Fetal ventriculomegaly at first trimester: ultrasound diagnosis and association with brain structural anomalies.
- Author
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Volpe, N., Chiarelli, A., Melito, C., Spinelli, M., Sorrentino, S., Valentini, B., Casciaro, A., di Pasquo, E., and Ghi, T.
- Abstract
CPVLr shows higher association with BSA, and the evidence of a reduced CPVLr at 11-13 weeks should prompt detailed evaluation of the fetal brain. To evaluate the association between ventriculomegaly and brain structural anomalies (BSA) at 11 + 0-13 + 6 weeks of gestation. We selected a non-consecutive series of fetuses with a BSA detected in the first trimester, excluding neural tube defects, and a group of normal fetuses as controls. [Extracted from the article]
- Published
- 2022
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81. The Italian guidelines on non-invasive and invasive prenatal diagnosis: Executive summary of recommendations for practice the Italian Society for Obstetrics and Gynecology (SIGO).
- Author
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Stampalija, T., Ghi, T., Barbieri, M., Morlando, M., Di Pasquo, E., Formigoni, C., and Ferrazzi, E.
- Subjects
- *
INVASIVE diagnosis , *PRENATAL diagnosis , *GYNECOLOGY , *OBSTETRICS - Published
- 2024
- Full Text
- View/download PDF
82. Can We Prevent Preeclampsia? Pharmacologic Prevention of Preeclampsia
- Author
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Carolis, S., Di Pasquo, E., Ferrazzani, S., Garofalo, S., Martino, C., Botta, A., Salvi, S., Moresi, S., Del Sordo, G., and Antonio LANZONE
83. Placental and infant metastasis of maternal melanoma: a new case.
- Author
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De Carolis, S, Garofalo, S, Degennaro, V A, Zannoni, G F, Salvi, S, Moresi, S, Di Pasquo, E, and Scambia, G
- Published
- 2015
- Full Text
- View/download PDF
84. Identification of large-for-gestational age fetuses using antenatal customized fetal growth charts: Can we improve the prediction of abnormal labor course?
- Author
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Giuseppe Maria Maruotti, Marta Papaccio, Anna Fichera, Chiara Ottaviani, Federico Prefumo, Nicola Volpe, Elvira Di Pasquo, Tamara Stampalija, Andrea Dall'Asta, Gabriele Saccone, A. Kiener, E. Roletti, Alexander Makatsariya, Laura Sarno, Tiziana Frusca, Giuseppe Rizzo, Ilenia Mappa, Tullio Ghi, Dall'Asta, A., Rizzo, G., Kiener, A., Volpe, N., Di Pasquo, E., Roletti, E., Mappa, I., Makatsariya, A., Maruotti, G. M., Saccone, G., Sarno, L., Papaccio, M., Fichera, A., Prefumo, F., Ottaviani, C., Stampalija, T., Frusca, T., and Ghi, T.
- Subjects
Adult ,Birth canal ,medicine.medical_specialty ,medicine.medical_treatment ,Caesarean section ,Fetal growth ,Macrosomia ,Prolonged labor ,Sensitivity and Specificity ,Ultrasonography, Prenatal ,Fetal Macrosomia ,Fetal Development ,Abnormal labor ,Pregnancy ,Risk Factors ,Medicine ,Humans ,Prospective Studies ,Risk factor ,Growth Charts ,reproductive and urinary physiology ,Fetus ,business.industry ,Vaginal delivery ,Obstetrics ,Incidence (epidemiology) ,Obstetrics and Gynecology ,Gestational age ,Dystocia ,Reproductive Medicine ,Fetal Weight ,Settore MED/40 ,Female ,business - Abstract
Introduction Fetal overgrowth is an acknowledged risk factor for abnormal labor course and maternal and perinatal complications. The objective of this study was to evaluate whether the use of antenatal ultrasound-based customized fetal growth charts in fetuses at risk for large-for-gestational age (LGA) allows a better identification of cases undergoing caesarean section due to intrapartum dystocia. Material and methods An observational study involving four Italian tertiary centers was carried out. Women referred to a dedicated antenatal clinic between 35 and 38 weeks due to an increased risk of having an LGA fetus at birth were prospectively selected for the study purpose. The fetal measurements obtained and used for the estimation of the fetal size were biparietal diameter, head circumference, abdominal circumference and femur length, were prospectively collected. LGA fetuses were defined by estimated fetal weight (EFW) >95th centile either using the standard charts implemented by the World Health Organization (WHO) or the customized fetal growth charts previously published by our group. Patients scheduled for elective caesarean section (CS) or for elective induction for suspected fetal macrosomia or submitted to CS or vacuum extraction (VE) purely due to suspected intrapartum distress were excluded. The incidence of CS due to labor dystocia was compared between fetuses with EFW >95th centile according WHO or customized antenatal growth charts. Results Overall, 814 women were eligible, however 562 were considered for the data analysis following the evaluation of the exclusion criteria. Vaginal delivery occurred in 466 (82.9 %) women (435 (77.4 %) spontaneous vaginal delivery and 31 (5.5 %) VE) while 96 had CS. The EFW was >95th centile in 194 (34.5 %) fetuses according to WHO growth charts and in 190 (33.8 %) by customized growth charts, respectively. CS due to dystocia occurred in 43 (22.2 %) women with LGA fetuses defined by WHO curves and in 39 (20.5 %) women with LGA defined by customized growth charts (p 0.70). WHO curves showed 57 % sensitivity, 72 % specificity, 24 % PPV and 91 % NPV, while customized curves showed 52 % sensitivity, 73 % specificity, 23 % PPV and 91 % NPV for CS due to labor dystocia. Conclusions The use of antenatal ultrasound-based customized growth charts does not allow a better identification of fetuses at risk of CS due to intrapartum dystocia.
- Published
- 2020
85. Determinants of neonatal hypoglycemia after antenatal administration of corticosteroids (ACS) for lung maturation: Data from two referral centers and review of the literature
- Author
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Vincenzo Berghella, Stefania Fieni, Elena Borghi, Elvira Di Pasquo, L. Angeli, Gabriele Saccone, Cinzia Magnani, Tiziana Frusca, Andrea Dall'Asta, Tullio Ghi, di Pasquo, E., Saccone, G., Angeli, L., Dall'Asta, A., Borghi, E., Fieni, S., Berghella, V., Magnani, C., Frusca, T., and Ghi, T.
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Hypoglycemia ,Infant, Newborn, Diseases ,03 medical and health sciences ,Neonate ,0302 clinical medicine ,Adrenal Cortex Hormones ,Pregnancy ,030225 pediatrics ,medicine ,Birth Weight ,Humans ,Corticosteroid ,Lung ,Glycemic ,Respiratory distress ,business.industry ,Incidence (epidemiology) ,Neonatal hypoglycemia ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,medicine.disease ,Prenatal Exposure Delayed Effects ,Pediatrics, Perinatology and Child Health ,Premature Birth ,Betamethasone ,Female ,business ,030217 neurology & neurosurgery ,Cohort study ,medicine.drug - Abstract
Background: A correlation between ACS and neonatal hypoglycemia has been recently demonstrated. Aims: The aim of the study was to evaluate the determinants of neonatal hypoglycemia in women exposed to ACS for respiratory distress syndrome prevention. Material and methods: Retrospective, multicenter, cohort study conducted in two Tertiary University Units. All fetuses delivered from 2016 to 2017 after ACS (two doses i.m. of Betamethasone 12 mg 24 h apart) were considered eligible for the study purpose. The primary outcome was the incidence of hypoglycemia, defined as a glycemic value ≤45 mg/dl within the first 48 h of neonatal life. The effect on neonatal glycaemia due to timing (interval from exposure to delivery) and type (single completed, single partial or repeated course) of ACS administration was also assessed. Results: Overall, 99 neonates met the inclusion criteria. Hypoglycemia occurred in 38/99 (38.4%) of the included newborns. Compared to normoglycemic neonates, those with hypoglycemia had lower gestational age at delivery (33.06 ± 3.37 vs. 35.94 ± 3.17 g; p < 0.0001). Lower birthweight (1747.28 ± 815.29 vs. 2499.24 ± 780.51 g; p < 0.0001), a shorter interval time from administration to delivery (1.85 ± 2.59 vs. 3.34 ± 3.39 weeks; p = 0.02) and a higher incidence of single partial course (23.7 vs. 8.72%; p = 0.03). Multivariate logistic regression found that only birthweight was significantly associated with neonatal hypoglycemia (OR 0.4 95% CI −1.16/−0.04; p < 0.038). Conclusion: Hypoglycemia occurs in a large proportion of fetuses exposed to ACS independently from the type of exposure (single partial/single completed) and from the time interval between ACS administration and delivery. Birthweight seems to be the strongest determinant for the occurrence neonatal hypoglycemia after antenatal administration of steroids for lung maturation.
- Published
- 2020
86. Maternal Hemodynamics from Preconception to Delivery: Research and Potential Diagnostic and Therapeutic Implications: Position Statement by Italian Association of Preeclampsia and Italian Society of Perinatal Medicine.
- Author
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Vasapollo B, Zullino S, Novelli GP, Farsetti D, Ottanelli S, Clemenza S, Micaglio M, Ferrazzi E, Di Martino DD, Ghi T, Di Pasquo E, Orabona R, Corbella P, Frigo MG, Prefumo F, Stampalija T, Giannubilo SR, Valensise H, and Mecacci F
- Subjects
- Humans, Female, Pregnancy, Italy, Fetal Growth Retardation, Societies, Medical, Hypertension, Pregnancy-Induced diagnosis, Hemodynamics, Pre-Eclampsia diagnosis
- Abstract
Objective: The Italian Association of Preeclampsia (AIPE) and the Italian Society of Perinatal Medicine (SIMP) developed clinical questions on maternal hemodynamics state of the art., Study Design: AIPE and SIMP experts were divided in small groups and were invited to propose an overview of the existing literature on specific topics related to the clinical questions proposed, developing, wherever possible, clinical and/or research recommendations based on available evidence, expert opinion, and clinical importance. Draft recommendations with a clinical rationale were submitted to 8th AIPE and SIMP Consensus Expert Panel for consideration and approval, with at least 75% agreement required for individual recommendations to be included in the final version., Results: More and more evidence in literature underlines the relationship between maternal and fetal hemodynamics, as well as the relationship between maternal cardiovascular profile and fetal-maternal adverse outcomes such as fetal growth restriction and hypertensive disorders of pregnancy. Experts agreed on proposing a classification of pregnancy hypertension, complications, and cardiovascular states based on three different hemodynamic profiles depending on total peripheral vascular resistance values: hypodynamic (>1,300 dynes·s·cm
-5 ), normo-dynamic, and hyperdynamic (<800 dynes·s·cm-5 ) circulation. This differentiation implies different therapeutical strategies, based drugs' characteristics, and maternal cardiovascular profile. Finally, the cardiovascular characteristics of the women may be useful for a rational approach to an appropriate follow-up, due to the increased cardiovascular risk later in life., Conclusion: Although the evidence might not be conclusive, given the lack of large randomized trials, maternal hemodynamics might have great importance in helping clinicians in understanding the pathophysiology and chose a rational treatment of patients with or at risk for pregnancy complications., Key Points: · Altered maternal hemodynamics is associated to fetal growth restriction.. · Altered maternal hemodynamics is associated to complicated hypertensive disorders of pregnancy.. · Maternal hemodynamics might help choosing a rational treatment during hypertensive disorders.., Competing Interests: None declared., (Thieme. All rights reserved.)- Published
- 2024
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87. First-trimester ultrasound of the cerebral lateral ventricles in fetuses with open spina bifida: a retrospective cohort study.
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Volpe N, Bovino A, Di Pasquo E, Corno E, Taverna M, Valentini B, Dall'Asta A, Brawura-Biskupsi-Samaha R, and Ghi T
- Subjects
- Humans, Female, Retrospective Studies, Pregnancy, Adult, Gestational Age, Cohort Studies, Case-Control Studies, Ultrasonography, Prenatal methods, Spina Bifida Cystica embryology, Spina Bifida Cystica diagnosis, Spina Bifida Cystica diagnostic imaging, Lateral Ventricles embryology, Lateral Ventricles diagnostic imaging, Pregnancy Trimester, First, Choroid Plexus embryology, Choroid Plexus diagnostic imaging
- Abstract
Background: Beyond 18 weeks of gestation, an increased size of the fetal lateral ventricles is reported in most fetuses with open spina bifida. In the first trimester of pregnancy, the definition of ventriculomegaly is based on the ratio of the size of the choroid plexus to the size of the ventricular space or the entire fetal head. However, contrary to what is observed from the midtrimester of pregnancy, in most fetuses with open spina bifida at 11 to 13 weeks of gestation, the amount of fluid in the ventricular system seems to be reduced rather than increased., Objective: This study aimed to compare the biometry of the lateral ventricles at 11 0/7 to 13 6/7 weeks of gestation between normal fetuses and those with confirmed open spina bifida., Study Design: This was a retrospective cohort study that included all cases of isolated open spina bifida detected at 11 0/7 to 13 6/7 weeks of gestation over a period of 5 years and a group of structurally normal fetuses attending at our center over a period of 1 year for the aneuploidy screening as controls. Transventricular axial views of the fetal brain obtained from cases and controls were extracted from the archive for post hoc measurement of cerebral ventricles. The choroid plexus-to-lateral ventricle length ratio, sum of the choroid plexus-to-lateral ventricle area ratio, choroid plexus area-to-fetal head area ratio, and mean choroid plexus length-to-occipitofrontal diameter ratio were calculated for both groups. The measurements obtained from the 2 groups were compared, and the association between each parameter and open spina bifida was investigated., Results: A total of 10 fetuses with open spina bifida were compared with 358 controls. Compared with controls, fetuses with open spina bifida showed a significantly smaller size of the cerebral ventricle measurements, as expressed by larger values of choroid plexus-to-lateral ventricle area ratio (0.49 vs 0.72, respectively; P<.001), choroid plexus-to-lateral ventricle length ratio (0.70 vs 0.79, respectively; P<.001), choroid plexus area-to-fetal head area ratio (0.28 vs 0.33, respectively; P=.006), and choroid plexus length-to-occipitofrontal diameter ratio (0.52 vs 0.60, respectively; P<.001). The choroid plexus-to-lateral ventricle area ratio was found to be the most accurate predictor of open spina bifida, with an area under the curve of 0.88, a sensitivity of 90%, and a specificity of 82%., Conclusion: At 11 0/7 to 13 6/7 weeks of gestation, open spina bifida is consistently associated with a reduced amount of fluid in the lateral cerebral ventricles of the fetus, as expressed by a significantly increased choroid plexus-to-lateral ventricle length ratio, choroid plexus-to-lateral ventricle area ratio, choroid plexus area-to-fetal head area ratio, and choroid plexus length-to-occipitofrontal diameter ratio., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
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88. Antenatal visualization of the caudo-thalamic groove at expert fetal neurosonography.
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di Pasquo E, Contro E, Labadini C, Dall'Asta A, Volpe N, Larcher L, Vettor L, Piemonti L, Ormitti F, and Ghi T
- Abstract
Objective: to describe the normal features of the caudo-thalamic groove at antenatal brain ultrasound in a group of structurally normal fetuses at third trimester and to report a small series of cases with abnormal appearance of the caudothalamic groove at antenatal brain ultrasound., Methods: This was an observational study conducted at two referral Fetal Medicine units. A non-consecutive cohort of pregnant women with a singleton non anomalous pregnancy were prospectively recruited and underwent 3D ultrasound of the fetal brain at 28-32 weeks. At offline analysis the ultrasound volumes were adjusted in the multiplanar mode according to a standardized methodology, until the caudothalamic groove was visible on the parasagittal plane. To evaluate the inter-observer agreement, two operators were independently asked to indicate if the caudothalamic groove was visible unilaterally or bilaterally on each volume. The digital archives of the two Centres were also retrospectively searched to retrieve cases with abnormal findings at the level of the caudothalamic groove at antenatal brain ultrasound which were postnatally confirmed., Results: 180 non-consecutive cases fulfilling the inclusion criteria were prospectively included. At offline analysis of the 3D US volumes the caudo-thalamic groove was identified on the parasagittal plane by both operators at least unilaterally in 176 cases (97.8%) and bilaterally in 174 cases (96.6%). The K-coefficient for the agreement between the two independent operators in recognizing the caudo-thalamic groove was 0.89 and 0.83 on one and both hemispheres respectively. At the retrospective search of our archives 5 cases with abnormal appearance of the groove at antenatal brain ultrasound (2 haemorrhage and 3 cyst) were found., Conclusion: Our study has demonstrated that the caudo-thalamic groove is consistently seen among normal fetuses at third trimester submitted to multiplanar neurosonography and that abnormal findings at this level may be antenatally detected. This article is protected by copyright. All rights reserved., (This article is protected by copyright. All rights reserved.)
- Published
- 2024
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89. Erratum: Maternal Hemodynamics from Preconception to Delivery: Research and Potential Diagnostic and Therapeutic Implications: Position Statement by Italian Association of Pre-Eclampsia and Italian Society of Perinatal Medicine.
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Vasapollo B, Zullino S, Novelli GP, Farsetti D, Ottanelli S, Clemenza S, Micaglio M, Ferrazzi E, Di Martino DD, Ghi T, Di Pasquo E, Orabona R, Corbella P, Frigo MG, Prefumo F, Stampalija T, Giannubilo SR, Valensise H, and Mecacci F
- Abstract
Competing Interests: Disclosure The authors report no conflicts of interest in this work.
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- 2024
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90. The "Preeclampsia and Hypertension Target Treatment" study: a multicenter prospective study to evaluate the effectiveness of the antihypertensive therapy based on maternal hemodynamic findings.
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di Pasquo E, Giannubilo SR, Valentini B, Salvi S, Rullo R, Fruci S, Filippi E, Ornaghi S, Zullino S, Rossi F, Farsetti D, Di Martino DD, Vasapollo B, Locatelli A, De Santis M, Ciavattini A, Lanzone A, Mecacci F, Ferrazzi E, Valensise H, and Ghi T
- Subjects
- Humans, Female, Pregnancy, Prospective Studies, Adult, Cardiac Output drug effects, Cardiac Output physiology, Nifedipine pharmacology, Nifedipine administration & dosage, Nifedipine therapeutic use, Vascular Resistance drug effects, Methyldopa administration & dosage, Methyldopa pharmacology, Methyldopa therapeutic use, Blood Pressure drug effects, Blood Pressure physiology, Hypertension, Pregnancy-Induced drug therapy, Hypertension, Pregnancy-Induced physiopathology, Hypertension, Pregnancy-Induced diagnosis, Treatment Outcome, Heart Rate drug effects, Heart Rate physiology, Stroke Volume drug effects, Stroke Volume physiology, Vasodilator Agents administration & dosage, Vasodilator Agents pharmacology, Vasodilator Agents therapeutic use, Antihypertensive Agents therapeutic use, Antihypertensive Agents pharmacology, Antihypertensive Agents administration & dosage, Hemodynamics drug effects, Hemodynamics physiology, Pre-Eclampsia physiopathology, Pre-Eclampsia drug therapy, Pre-Eclampsia diagnosis, Labetalol administration & dosage, Labetalol pharmacology
- Abstract
Background: Despite major advances in the pharmacologic treatment of hypertension in the nonpregnant population, treatments for hypertension in pregnancy have remained largely unchanged over the years. There is recent evidence that a more adequate control of maternal blood pressure is achieved when the first given antihypertensive drug is able to correct the underlying hemodynamic disorder of the mother besides normalizing the blood pressure values., Objective: This study aimed to compare the blood pressure control in women receiving an appropriate or inappropriate antihypertensive therapy following the baseline hemodynamic findings., Study Design: This was a prospective multicenter study that included a population of women with de novo diagnosis of hypertensive disorders of pregnancy. A noninvasive assessment of the following maternal parameters was performed on hospital admission via Ultrasound Cardiac Output Monitor before any antihypertensive therapy was given: cardiac output, heart rate, systemic vascular resistance, and stroke volume. The clinician who prescribed the antihypertensive therapy was blinded to the hemodynamic evaluation and used as first-line treatment a vasodilator (nifedipine or alpha methyldopa) or a beta-blocker (labetalol) based on his preferences or on the local protocols. The first-line pharmacologic treatment was retrospectively considered hemodynamically appropriate in either of the following circumstances: (1) women with a hypodynamic profile (defined as low cardiac output [≤5 L/min] and/or high systemic vascular resistance [≥1300 dynes/second/cm
2 ]) who were administered oral nifedipine or alpha methyldopa and (2) women with a hyperdynamic profile (defined as normal or high cardiac output [>5 L/min] and/or low systemic vascular resistances [<1300 dynes/second/cm2 ]) who were administered oral labetalol. The primary outcome of the study was to compare the occurrence of severe hypertension between women treated with a hemodynamically appropriate therapy and women treated with an inappropriate therapy., Results: A total of 152 women with hypertensive disorders of pregnancy were included in the final analysis. Most women displayed a hypodynamic profile (114 [75.0%]) and received a hemodynamically appropriate treatment (116 [76.3%]). The occurrence of severe hypertension before delivery was significantly lower in the group receiving an appropriate therapy than in the group receiving an inappropriately treated (6.0% vs 19.4%, respectively; P=.02). Moreover, the number of women who achieved target values of blood pressure within 48 to 72 hours from the treatment start was higher in the group who received an appropriate treatment than in the group who received an inappropriate treatment (70.7% vs 50.0%, respectively; P=.02)., Conclusion: In pregnant individuals with de novo hypertensive disorders of pregnancy, a lower occurrence of severe hypertension was observed when the first-line antihypertensive agent was tailored to the correct maternal hemodynamic profile., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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91. Correlation between intrapartum CTG findings and interleukin-6 levels in the umbilical cord arterial blood: A prospective cohort study.
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di Pasquo E, Fieni S, Chandraharan E, Dall'Asta A, Morganelli G, Spinelli M, Bettinelli ML, Aloe R, Russo A, Galli L, Perrone S, and Ghi T
- Subjects
- Pregnancy, Infant, Newborn, Humans, Female, Retrospective Studies, Prospective Studies, Resuscitation, Umbilical Arteries, Inflammation, Heart Rate, Fetal, Interleukin-6, Cardiotocography
- Abstract
Objective: to investigate the correlation between the intrapartum CardioTocoGraphic (CTG) findings "suggestive of fetal inflammation" ("SOFI") and the interleukin (IL)-6 level in the umbilical arterial blood., Study Design: prospective cohort study conducted at a tertiary maternity unit and including 447 neonates born at term., Methods: IL-6 levels were systematically measured at birth from a sample of blood taken from the umbilical artery. The intrapartum CTG traces were retrospectively reviewed by two experts who were blinded to the postnatal umbilical arterial IL-6 values as well as to the neonatal outcomes. The CTG traces were classified into "suggestive of fetal inflammation (SOFI)" and "no evidence of fetal inflammation (NEFI) according to the principles of physiologic interpretation the CTG traces. The CTG was classified as "SOFI" if there was a persistent fetal heart rate (FHR) increase > 10 % compared with the observed baseline FHR observed at the admission or at the onset of labor without any preceding repetitive decelerations. The occurrence of Composite Adverse Outcome (CAO) was defined as Neonatal Intensive Care Unit (NICU) or Special Care Baby Unit (SCBU) admission due to one or more of the following: metabolic acidaemia, Apgar score at 5 min ≤ 7, need of neonatal resuscitation, respiratory distress, tachypnoea/polypnea, jaundice requiring phototherapy, hypotension, body temperature instability, poor perinatal adaptation, suspected or confirmed early neonatal sepsis., Main Outcome Measures: To compare the umbilical IL-6 values between the cases with intrapartum CTG traces classified as "SOFI" and those classified as "NEFI"; to assess the correlation of umbilical IL-6 values with the neonatal outcome., Results: 43 (9.6 %) CTG traces were categorized as "SOFI"; IL-6 levels were significantly higher in this group compared with the "NEFI" group (82.0[43.4-325.0] pg/ml vs. 14.5[6.8-32.6] pg/mL; p <.001). The mean FHR baseline assessed 1 h before delivery and the total labor length showed an independent and direct association with the IL-6 levels in the umbilical arterial blood (p <.001 and p = 0.005, respectively). CAO occurred in 33(7.4 %) cases; IL-6 yielded a good prediction of the occurrence of the CAO with an AUC of 0.72 (95 % CI 0.61-0.81)., Conclusion: Intrapartum CTG findings classified as "SOFI" are associated with higher levels of IL-6 in the umbilical arterial blood., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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92. The "cortical invagination sign": a midtrimester sonographic marker of unilateral cortical focal dysgyria in fetuses with complete agenesis of the corpus callosum.
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Ramirez Zegarra R, Casati D, Volpe N, Lanna M, Dall'Asta A, Chiarelli A, Ormitti F, Percesepe A, Montaguti E, Labadini C, Salsi G, di Pasquo E, Bonasoni MP, Quarello E, Pilu G, Grisolia G, Righini A, and Ghi T
- Subjects
- Pregnancy, Humans, Male, Female, Pregnancy Trimester, Second, Prenatal Diagnosis, Retrospective Studies, Ultrasonography, Prenatal methods, Gestational Age, Fetus, Corpus Callosum diagnostic imaging, Corpus Callosum pathology, Agenesis of Corpus Callosum diagnostic imaging, Agenesis of Corpus Callosum pathology
- Abstract
Background: Agenesis of the corpus callosum is associated with several malformations of cortical development. Recently, features of focal cortical dysgyria have been described in fetuses with agenesis of the corpus callosum., Objective: This study aimed to describe the "cortical invagination sign," a specific sonographic feature of focal cortical dysgyria, which is consistently seen at midtrimester axial brain ultrasound in fetuses with complete agenesis of the corpus callosum., Study Design: This was a retrospective analysis of prospectively collected data from 2018 to 2021, including patients referred to 5 fetal medicine centers in the second trimester of pregnancy (19 0/7 to 22 0/7 weeks of gestation) with suspected complete agenesis of the corpus callosum. All cases with the diagnosis of complete agenesis of the corpus callosum were submitted to an axial sonographic assessment of the fetal brain on the transventricular plane. In this scanning section, the mesial profile of both cerebral hemispheres at the level of the frontal-parietal cortex was investigated. In this area, the operator looked for an abnormal invagination of the cortical surface along the widened interhemispheric fissure, which was referred to as the "cortical invagination sign." All fetuses were submitted to dedicated antenatal magnetic resonance imaging to reassess the ultrasound findings. Cases with additional brain anomalies, which did not involve the cortex, were excluded. The final diagnosis was confirmed at postnatal brain magnetic resonance imaging or postmortem examination, for cases undergoing termination of pregnancy. The primary outcome of this study was to evaluate the presence and laterality of the "cortical invagination sign" in fetuses with complete agenesis of the corpus callosum at antenatal ultrasound and magnetic resonance imaging., Results: During the study period, 64 cases of complete agenesis of the corpus callosum were included; of those cases, 50 (78.1%) resulted in termination of pregnancy, and 14 (21.9%) resulted in a live birth. The "cortical invagination sign" was detected at ultrasound in 13 of 64 cases (20.3%) and at targeted brain magnetic resonance imaging in 2 additional cases (23.4%), all of which were electively terminated. Moreover, the "cortical invagination sign" was found to be exclusively unilateral and on the left cerebral hemisphere in all the cases. There was a predominant number, although nonsignificant, of male fetuses (80.0% of cases; P=.06) in the group of complete agenesis of the corpus callosum with the "cortical invagination sign.", Conclusion: The "cortical invagination sign" is a specific marker of focal cortical dysgyria, which seems to characterize at midtrimester of pregnancy in a large group of fetuses with complete agenesis of the corpus callosum. The etiology, pathophysiology, and prognostic significance of this finding remain to be elucidated., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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93. Effect of the "shoulder-up" bundle on the incidence of spontaneous perineal injury after vaginal delivery: comparison of 2 historic cohorts after propensity score matching.
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Morganelli G, Fieni S, Dall'Asta A, di Pasquo E, Capozzi VA, Valenti A, Pezzani A, Kiener AJO, and Ghi T
- Subjects
- Pregnancy, Humans, Female, Infant, Retrospective Studies, Incidence, Propensity Score, Delivery, Obstetric adverse effects, Delivery, Obstetric methods, Shoulder, Perineum injuries
- Abstract
Background: Perineal injury following vaginal delivery represents a major cause of long-term maternal morbidity, and its prevention is among the priorities of modern obstetrical practice., Objective: This study aimed to investigate whether the systematic implementation of a bundle of maneuvers to prevent perineal injury (ie, the "shoulder-up" bundle) may reduce the rate of spontaneous perineal tears in women delivering at a single tertiary maternity unit., Study Design: This was a single-center retrospective intervention study including all vaginal deliveries between April 1, 2020 and March 31, 2022. On March 1, 2021, a bundle focused on perineal injury prevention in vaginal deliveries was implemented and introduced as a standard of care. The "shoulder-up" bundle includes the addition of a hands-on technique for the delivery of the posterior shoulder, which is slowly lifted up under the direct visualization of the perineal body, immediately after the disengagement of the anterior shoulder. The labor ward staff underwent dedicated training to acquire expertise on the "shoulder-up" bundle. Little changes in terms of medical and midwifery staffing were recorded during the study period. The incidence of spontaneous second-degree or higher perineal tears was compared between the patients who gave birth before the clinical implementation of the bundle (standard-care group) and those who were delivered following the implementation of the bundle (shoulder-up group). A 1:1 propensity score matching of the 2 groups was done for the variables that proved to be independently associated with the perineal outcome., Results: From April 1, 2020 to March 31, 2022, 3671 patients had a vaginal birth at our tertiary care unit (1786 in the standard-care group and 1885 in the "shoulder-up" group) and were enrolled in the study population. Of these, 1191 (32.4%) had a spontaneous second-degree or higher perineal tear. At univariate analysis, nulliparity (59.6% vs 39.1%; P<.001), higher gestational age at delivery (39.8±1.28 vs 39.4±1.97 weeks; P<.001), epidural analgesia (40.6% vs 31.2%; P<.001), vacuum-assisted delivery (9.6% vs 4.0%; P<.001), and birthweight >4 kg (11.0% vs 6.3%; P<.001) were independently associated with the perineal outcome. Following propensity score matching for the above cited factors, the 1703 patients of each group were compared. A significant increase in the rate of intact perineum (71.0% vs 64.1%; P=.014) and a reduction in the incidence of second- (27.2% vs 32.9%; P=.006) and third to fourth-degree perineal tears (1.3% vs 3.0%; P<.001) was demonstrated in the "shoulder-up" group. Among the subgroup of patients undergoing vacuum-assisted delivery, a borderline significant reduction in the rate of obstetrical anal sphincter injury (10.4% vs 2.9%; P=.052) was also observed., Conclusion: Our study showed that the clinical implementation of the "shoulder-up" bundle at vaginal delivery is associated with a significant reduction in the incidence of spontaneous second-degree or higher perineal tears., (Copyright © 2023 Elsevier Inc. All rights reserved.)
- Published
- 2023
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94. An update on maternal cardiac hemodynamics in fetal growth restriction and pre-eclampsia.
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Dall'Asta A, Minopoli M, Ramirez Zegarra R, Di Pasquo E, and Ghi T
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- Pregnancy, Female, Humans, Fetal Growth Retardation, Placenta, Hemodynamics, Pre-Eclampsia, Hypertension, Pregnancy-Induced
- Abstract
Pre-eclampsia and fetal growth restriction (FGR) have been long related to primary placental dysfunction, caused by abnormal trophoblast invasion. Nevertheless, emerging evidence has led to a new hypothesis for the origin of pre-eclampsia and FGR. Suboptimal maternal cardiovascular adaptation has been shown to result in uteroplacental hypoperfusion, ultimately leading to placental hypoxic damage with secondary dysfunction. In this review, we summarize current evidence on maternal cardiac hemodynamics in FGR and pre-eclampsia. We also discuss the different approaches for antihypertensive treatment according to the hemodynamic phenotype observed in pre-eclampsia and FGR., (© 2022 Wiley Periodicals LLC.)
- Published
- 2023
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95. Antepartum sonographic prediction of cephalopelvic disproportion: are we getting any closer?
- Author
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Ramirez Zegarra R, Dall'Asta A, di Pasquo E, and Ghi T
- Subjects
- Female, Humans, Pregnancy, Cesarean Section, Ultrasonography, Cephalopelvic Disproportion, Obstetric Labor Complications
- Published
- 2023
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96. The sonographic measurement of the ratio between the fetal head circumference and the obstetrical conjugate is accurate in predicting the risk of labor arrest: results from a multicenter prospective study.
- Author
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Di Pasquo E, Morganelli G, Volpe N, Labadini C, Ramirez Zegarra R, Abou-Dakn M, Mappa I, Rizzo G, Dall'Asta A, and Ghi T
- Subjects
- Female, Pregnancy, Humans, Infant, Prospective Studies, Ultrasonography, Prenatal methods, Risk Factors, Cephalopelvic Disproportion diagnosis, Cephalopelvic Disproportion epidemiology, Cephalopelvic Disproportion etiology, Labor, Obstetric
- Abstract
Background: Labor arrest is estimated to account for approximately one-third of all primary cesarean deliveries, and is associated with an increased risk of adverse maternal and perinatal outcomes. One of the main causes is the mismatch between the size of the birth canal and that of the fetus, a condition usually referred to as cephalopelvic disproportion., Objective: This study aimed to describe a new ultrasound predictor of labor arrest leading to cesarean delivery because of suspected cephalopelvic disproportion., Study Design: This was a multicenter prospective study conducted at 3 maternity units from January 2021 to January 2022. A nonconsecutive series of singleton pregnancies with cephalic-presenting fetuses, gestational age of 34 weeks+0 days or above, and no contraindication to vaginal delivery attending at the antenatal clinics of each institution were considered eligible. Between 34+0 and 38+0 weeks of gestation, all eligible patients were submitted to transabdominal 2D ultrasound measurement of the obstetrical conjugate. On admission to the labor ward, the fetal head circumference was measured on the standard transthalamic plane by transabdominal ultrasound. The primary outcome of the study was the accuracy of the ratio between the fetal head circumference and the obstetrical conjugate measurement (ie, head circumference/obstetrical conjugate ratio) in predicting the occurrence of cesarean delivery secondary to labor arrest. The secondary outcome was the relationship between the head circumference/obstetrical conjugate ratio and labor duration., Results: A total of 263 women were included. Cesarean delivery for labor arrest was performed in 7.6% (20/263) of the included cases and was associated with more frequent use of epidural analgesia (95.0% vs 45.7%; P<.001), longer second stage of labor (193 [120-240] vs 34.0 [13.8-66.5] minutes; P=.002), shorter obstetrical conjugate (111 [108-114] vs 121 [116-125] mm; P<.001), higher head circumference/obstetrical conjugate ratio (3.2 [3.2-3.35] vs 2.9 [2.8-3.0]; P<.001), and higher birthweight (3678 [3501-3916] vs 3352 [3095-3680] g; P=.003) compared with vaginal delivery. At logistic regression analysis, the head circumference/obstetrical conjugate ratio expressed as Z-score was the only parameter independently associated with risk of cesarean delivery for labor arrest (odds ratio, 8.8; 95% confidence interval, 3.6-21.7) and had higher accuracy in predicting cesarean delivery compared with the accuracy of fetal head circumference and obstetrical conjugate alone, with an area under the curve of 0.91 (95% confidence interval, 81.7-99.5; P<.001). A positive correlation between the head circumference/obstetrical conjugate ratio and length of the second stage of labor was found (Pearson coefficient, 0.16; P=.018)., Conclusion: Our study, conducted on an unselected low-risk population, demonstrated that the head circumference/obstetrical conjugate ratio is a reliable antenatal predictor of labor arrest leading to cesarean delivery., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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97. Association between the cervical sliding sign and successful induction of labor in women with an unfavorable cervix: A prospective observational study.
- Author
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Volpe N, Ramirez Zegarra R, Melandri E, Casciaro A, Chiarelli A, Di Pasquo E, Abou-Dakn M, Dall'Asta A, and Ghi T
- Subjects
- Humans, Female, Pregnancy, Prospective Studies, Predictive Value of Tests, Labor, Induced, Cervix Uteri diagnostic imaging, Ultrasonography, Prenatal
- Abstract
Objectives: To evaluate the role of the cervical sliding sign (CSS) in the prediction of the outcome of induction of labor (IOL)., Study Design: Two-center prospective observational cohort study involving a non-consecutive series of uncomplicated singleton term pregnancies, planned for IOL, with a fetus in cephalic presentation and unfavorable cervix as defined by a Bishop score ≤ 6. The Bishop score was evaluated by transvaginal digital examination and the cervical length and CSS by transvaginal ultrasound. The presence of CSS was defined as the sliding of the anterior cervical lip on the posterior one under gentle pressure of the transvaginal probe. The primary outcome of the study was successful vaginal delivery within 24 h. The secondary outcome was the induction-to-active-labor time. The interobserver agreement for the CSS was also evaluated., Results: Over a period of 12 months, 179 women were included. The CSS was found in 86 (48.0 %) patients and was associated with an increased likelihood of vaginal delivery within 24 h (60/86 or 69.8 % vs 27/93 or 29.0 %, P < 0.001) and a shorter induction-to-active-labor time (954 ± 618 min vs 1416 ± 660 min, P < 0.001). Multivariable regression analysis showed that the CSS was an independent predictor of vaginal delivery within 24 h (aOR 5.37, 95 % CI 2.26-12.75) and shorter induction-to-active-labor time interval (HR 1.81, 95 % CI 1.19-2.74). The interobserver variability based on intraclass correlation coefficient for the CSS was excellent (ICC = 0.90)., Conclusion: In women undergoing IOL with an unfavorable cervix, the CSS is associated with a higher frequency of vaginal delivery within 24 h and a shorter induction-to-active-labor time., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)
- Published
- 2022
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98. Short-term morbidity and types of intrapartum hypoxia in the newborn with metabolic acidaemia: a retrospective cohort study.
- Author
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di Pasquo E, Commare A, Masturzo B, Paolucci S, Cromi A, Montersino B, Germano CM, Attini R, Perrone S, Pisani F, Dall'Asta A, Fieni S, Frusca T, and Ghi T
- Subjects
- Cohort Studies, Female, Humans, Hypoxia epidemiology, Hypoxia etiology, Infant, Newborn, Morbidity, Pregnancy, Retrospective Studies, Acidosis diagnosis, Acidosis epidemiology
- Abstract
Objectives: To assess labour characteristics in relation to the occurrence of Composite Adverse neonatal Outcome (CAO) within a cohort of fetuses with metabolic acidaemia., Design: Retrospective cohort study., Setting: Three Italian tertiary maternity units., Population: 431 neonates born with acidaemia ≥36 weeks., Methods: Intrapartum CTG traces were assigned to one of these four types of labour hypoxia: acute, subacute, gradually evolving and chronic hypoxia. The presence of CAO was defined by the occurrence of at least one of the following: Sarnat Score grade ≥2, seizures, hypothermia and death <7 days from birth., Main Outcome Measures: To compare the type of hypoxia on the intrapartum CTG traces among the acidaemic neonates with and without CAO., Results: The occurrence of a CAO was recorded in 15.1% of neonates. At logistic regression analysis, the duration of the hypoxia was the only parameter associated with CAO in the case of an acute or subacute pattern (odds ratio [OR] 1.3; 95% CI 1.02-1.6 and OR 1.04; 95% CI 1.0-1.1, respectively), whereas both the duration of the hypoxic insult and the time from PROM to delivery were associated with CAO in those with a gradually evolving pattern (OR 1.13; 95% CI 1.01-1.3 and OR 1.04; 95% CI 1.0-1.7, respectively). The incidence of CAO was higher in fetuses with chronic antepartum hypoxia than in those showing CTG features of intrapartum hypoxia (64.7 vs. 13.0%; P < 0.001)., Conclusions: The frequency of CAO seems related to the duration and the type of the hypoxic injury, being higher in fetuses showing CTG features of antepartum chronic hypoxia., Tweetable Abstract: This study demonstrates that in a large population of neonates with metabolic acidaemia at birth, the overall incidence of short-term adverse outcome is around 15%. Such risk seems closely correlated to the duration and the type of hypoxic injury, being higher in fetuses admitted in labour with antepartum chronic hypoxia than those experiencing intrapartum hypoxia., (© 2022 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)
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- 2022
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99. Achieving an appropriate cesarean birth (CB) rate and analyzing the changes using the Robson Ten-Group Classification System (TGCS): Lessons from a Tertiary Care Hospital in Italy.
- Author
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di Pasquo E, Ricciardi P, Valenti A, Fieni S, Ghi T, and Frusca T
- Subjects
- Birth Rate, Female, Hospitals, University, Humans, Infant, Newborn, Pregnancy, Tertiary Care Centers, Cesarean Section, Obstetrics
- Abstract
Background: To describe the interventions that were implemented at a Tertiary University Hospital and how they affected the rate of cesarean birth (CB) and main obstetrics and neonatal outcomes., Study Design: An analysis of the contemporaneously collected data from all deliveries that occurred from 2014 to 2018. Major obstetric and neonatal outcomes were analyzed and grouped according to the Ten-Group Classification System (TGCS)., Results: A significant decrease in CB rates, from 28.4% to 23.0% (P < 0.001), was found over the study period. Although the relative sizes of both nulliparous (groups 1 + 2) and multiparous (groups 3 + 4) women remained stable over the study period, a significantly higher incidence of CB was reported in 2014 for both groups, compared with 2018 (2.6% vs. 13.0%, P < 0.001 for nulliparous women and 7.5% vs. 3.3%, P < 0.001 for multiparous women). In contrast, the relative size of Group 5 was significantly lower in 2014 than in 2018 (9.9% vs. 11.5%, P = 0.003), but a 13.3% reduction in CB was also reported for this group. No significant differences were noted in the occurrence of major obstetrics and neonatal outcomes that were reported., Conclusions: A reduction in CB rate may be safely achieved through implementing a multifaceted strategy., (© 2022 Wiley Periodicals LLC.)
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- 2022
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100. Third-trimester ultrasound for antenatal diagnosis of placenta accreta spectrum in women with placenta previa: results from the ADoPAD study.
- Author
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Fratelli N, Prefumo F, Maggi C, Cavalli C, Sciarrone A, Garofalo A, Viora E, Vergani P, Ornaghi S, Betti M, Vaglio Tessitore I, Cavaliere AF, Buongiorno S, Vidiri A, Fabbri E, Ferrazzi E, Maggi V, Cetin I, Frusca T, Ghi T, Kaihura C, Di Pasquo E, Stampalija T, Belcaro C, Quadrifoglio M, Veneziano M, Mecacci F, Simeone S, Locatelli A, Consonni S, Chianchiano N, Labate F, Cromi A, Bertucci E, Facchinetti F, Fichera A, Granata D, D'Antonio F, Foti F, Avagliano L, Bulfamante GP, and Calì G
- Subjects
- Cesarean Section, Female, Humans, Placenta diagnostic imaging, Placenta pathology, Pregnancy, Pregnancy Trimester, Third, Prenatal Diagnosis, Prospective Studies, Retrospective Studies, Ultrasonography, Prenatal methods, Placenta Accreta diagnostic imaging, Placenta Accreta pathology, Placenta Previa diagnostic imaging, Placenta Previa pathology
- Abstract
Objective: To evaluate the performance of third-trimester ultrasound for the diagnosis of clinically significant placenta accreta spectrum disorder (PAS) in women with low-lying placenta or placenta previa., Methods: This was a prospective multicenter study of pregnant women aged ≥ 18 years who were diagnosed with low-lying placenta (< 20 mm from the internal cervical os) or placenta previa (covering the internal cervical os) on ultrasound at ≥ 26 + 0 weeks' gestation, between October 2014 and January 2019. Ultrasound suspicion of PAS was raised in the presence of at least one of these signs on grayscale ultrasound: (1) obliteration of the hypoechogenic space between the uterus and the placenta; (2) interruption of the hyperechogenic interface between the uterine serosa and the bladder wall; (3) abnormal placental lacunae. Histopathological examinations were performed according to a predefined protocol, with pathologists blinded to the ultrasound findings. To assess the ability of ultrasound to detect clinically significant PAS, a composite outcome comprising the need for active management at delivery and histopathological confirmation of PAS was considered the reference standard. PAS was considered to be clinically significant if, in addition to histological confirmation, at least one of these procedures was carried out after delivery: use of hemostatic intrauterine balloon, compressive uterine suture, peripartum hysterectomy, uterine/hypogastric artery ligation or uterine artery embolization. The diagnostic performance of each ultrasound sign for clinically significant PAS was evaluated in all women and in the subgroup who had at least one previous Cesarean section and anterior placenta. Post-test probability was assessed using Fagan nomograms., Results: A total of 568 women underwent transabdominal and transvaginal ultrasound examinations during the study period. Of these, 95 delivered in local hospitals, and placental pathology according to the study protocol was therefore not available. Among the 473 women for whom placental pathology was available, clinically significant PAS was diagnosed in 99 (21%), comprising 36 cases of placenta accreta, 19 of placenta increta and 44 of placenta percreta. The median gestational age at the time of ultrasound assessment was 31.4 (interquartile range, 28.6-34.4) weeks. A normal hypoechogenic space between the uterus and the placenta reduced the post-test probability of clinically significant PAS from 21% to 5% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 9% in the subgroup with previous Cesarean section and anterior placenta. The absence of placental lacunae reduced the post-test probability of clinically significant PAS from 21% to 9% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 36% in the subgroup with previous Cesarean section and anterior placenta. When abnormal placental lacunae were seen on ultrasound, the post-test probability of clinically significant PAS increased from 21% to 59% in the whole cohort and from 62% to 78% in the subgroup with previous Cesarean section and anterior placenta. An interrupted hyperechogenic interface between the uterine serosa and bladder wall increased the post-test probability for clinically significant PAS from 21% to 85% in women with low-lying placenta or placenta previa and from 62% to 88% in the subgroup with previous Cesarean section and anterior placenta. When all three sonographic markers were present, the post-test probability for clinically significant PAS increased from 21% to 89% in the whole cohort and from 62% to 92% in the subgroup with previous Cesarean section and anterior placenta., Conclusions: Grayscale ultrasound has good diagnostic performance to identify pregnancies at low risk of PAS in a high-risk population of women with low-lying placenta or placenta previa. Ultrasound may be safely used to guide management decisions and concentrate resources on patients with higher risk of clinically significant PAS. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology., (© 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.)
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- 2022
- Full Text
- View/download PDF
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