72 results on '"Gian Paolo Novelli"'
Search Results
2. Distinction between SGA and FGR by means of fetal umbilical vein flow and maternal hemodynamics
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I. Pisani, D. Farsetti, Giulia Gagliardi, Herbert Valensise, Francesca Pometti, Damiano Lo Presti, Gian Paolo Novelli, Barbara Vasapollo, and G. M. Tiralongo
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Umbilical Veins ,Cardiac output ,medicine.medical_specialty ,systemic vascular resistance ,Gestational Age ,030204 cardiovascular system & hematology ,Venous flow ,Ultrasonography, Prenatal ,Umbilical vein ,small for gestational age ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Internal medicine ,medicine ,Fetal growth ,Humans ,maternal hemodynamics ,Fetal Growth Retardation ,030219 obstetrics & reproductive medicine ,business.industry ,Fetal growth restriction ,Infant, Newborn ,Hemodynamics ,cardiac output ,Obstetrics and Gynecology ,medicine.disease ,umbilical vein blood flow ,medicine.anatomical_structure ,Fetal Weight ,Settore MED/40 ,Infant, Small for Gestational Age ,Pediatrics, Perinatology and Child Health ,Maternal hemodynamics ,Vascular resistance ,Cardiology ,Small for gestational age ,Female ,business - Abstract
To improve identification of fetal growth restriction (FGR) by means of umbilical venous flow (QUV) and maternal hemodynamics, including systemic vascular resistance (SVR) and cardiac output (CO), in order to distinguish between FGR and SGA.We enrolled 68 pregnancies (36 SGA, 8 early FGR and 24 late FGR) who underwent a complete fetal hemodynamic examination including QUV and a noninvasive maternal hemodynamics assessment by means of USCOM.In comparison with SGA, QUV and corrected for estimated fetal weight QUV (cQUV) were significantly lower in early and late-FGR. In addition, maternal CO was lower in early and late-FGR, while SVR was lower only in early-onset FGR. According to ROC analysis, cQUV centile (AUC 0.92, 0.72) was the best parameter for the prediction of SGA before and after 32 weeks, followed by SVR and CO. For all parameters, the prediction was always better in the case of early-onset FGR32 weeks.UV flow and maternal hemodynamics examination are useful tools to accurately discern between SGA and FGR.
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- 2021
3. Maternal hemodynamics for the identification of early fetal growth restriction in normotensive pregnancies
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Daniele Farsetti, Barbara Vasapollo, Francesca Pometti, Roberta Frantellizzi, Gian Paolo Novelli, and Herbert Valensise
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Adult ,Fetal Growth Retardation ,Infant, Newborn ,Hemodynamics ,Obstetrics and Gynecology ,Gestational Age ,Ultrasonography, Doppler ,Umbilical Arteries ,Ultrasonography, Prenatal ,Reproductive Medicine ,Pregnancy ,Infant, Small for Gestational Age ,Humans ,Female ,Developmental Biology - Abstract
We aimed at testing systemic vascular resistance (SVR) for the correct identification of early fetal growth restriction (FGR). 61 normotensive patients, gestational age 29 + 0-32 + 0, with suspected diagnosis of early FGR, were submitted to USCOM and to an ultrasound evaluation. 24 patients met the criteria of FGR, and 9 patients developed umbilical artery Doppler alterations. SVR1006 dyn s·cm
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- 2022
4. Systemic vascular resistance may influence the outcome of in vitro fertilization
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Francesco Galanti, Ilaria Pisani, Serena Riccio, Daniele Farsetti, Barbara Vasapollo, Gian Paolo Novelli, Donatella Miriello, Rocco Rago, and Herbert Valensise
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hemodynamic assessment ,Adult ,Male ,胚胎植入全身血管阻力 ,Pregnancy Rate ,Systemic vascular resistance ,Endocrinology, Diabetes and Metabolism ,DEET ,Obstetrics and Gynecology ,Fertilization in Vitro ,血流动力学评估 ,Luteal Phase ,Embryo Transfer ,Endocrinology ,体外受精技术 ,Settore MED/40 ,Pregnancy ,Humans ,embryo implantation ,Female ,Vascular Resistance ,In vitro fertilization techniques - Published
- 2022
5. The cardiac-fetal-placental unit: fetal umbilical vein flow rate is linked to the maternal cardiac profile in fetal growth restriction
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Herbert Valensise, Daniele Farsetti, Francesca Pometti, Barbara Vasapollo, Gian Paolo Novelli, and Christoph Lees
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Obstetrics and Gynecology - Abstract
The functional maternal-fetal hemodynamic unit includes fetal umbilical vein flow and maternal peripheral vascular resistance.This study investigated the relationships between maternal and fetal hemodynamics in a population with suspected fetal growth restriction.This was a prospective study of normotensive pregnancies referred to our outpatient clinic for a suspected fetal growth restriction. Maternal hemodynamics measurement was performed, using a noninvasive device (USCOM-1A) and a fetal ultrasound evaluation to assess fetal biometry and velocimetry Doppler parameters. Comparisons among groups were performed with 1-way analysis of variance with Student-Newman-Keuls correction for multiple comparisons and with Kruskal-Wallis test where appropriate. The Spearman rank coefficient was used to assess the correlation between maternal and fetal hemodynamics. Pregnancies were observed until delivery.A total of 182 normotensive pregnancies were included. After the evaluation, 54 fetuses were classified as growth restricted, 42 as small for gestational age, and 86 as adequate for gestational age. The fetus with fetal growth restriction had significantly lower umbilical vein diameter (P.0001), umbilical vein velocity (P=.02), umbilical vein flow (P.0001), and umbilical vein flow corrected for fetal weight (P.01) than adequate-for-gestational-age and small-for-gestational-age fetuses. The maternal hemodynamic profile in fetal growth restriction was characterized by elevated systemic vascular resistance and reduced cardiac output. The umbilical vein diameter was positively correlated to maternal cardiac output (rMaternal and fetal hemodynamic parameters were different in the 3 groups of fetuses: fetal growth restriction, small for gestational age, and adequate for gestational age. Maternal hemodynamic parameters were closely and continuously correlated with fetal hemodynamic features. In particular, a maternal hemodynamic profile with high systemic vascular resistance, low cardiac output, reduced inotropism, and hypodynamic circulation was correlated with a reduced umbilical vein flow and increased umbilical artery pulsatility index. The mother, placenta, and fetus should be considered as a single cardiac-fetal-placental unit. The correlations of systemic vascular resistance, cardiac output, and inotropy index with umbilical artery impedance indicate the key role of these 3 parameters in placental vascular tree development. The umbilical vein flow rate and, therefore, the placental perfusion seems to be influenced not only by these three parameters but also by the maternal cardiovascular kinetic energy.
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- 2023
6. Hemodynamic maladaptation and left ventricular dysfunction in chronic hypertensive patients at the beginning of gestation and pregnancy complications: a case control study
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Herbert Valensise, Gian Paolo Novelli, I. Pisani, Giulia Gagliardi, G. M. Tiralongo, D. Farsetti, Barbara Vasapollo, and Damiano Lo Presti
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medicine.medical_specialty ,Hemodynamics ,Early pregnancy factor ,left ventricular function ,Ventricular Dysfunction, Left ,Pregnancy ,Internal medicine ,medicine ,Humans ,Maladaptation ,Cardiac geometry ,biology ,business.industry ,Case-control study ,Obstetrics and Gynecology ,medicine.disease ,Chronic hypertension ,left ventricular geometry ,Settore MED/40 ,Echocardiography ,Case-Control Studies ,Hypertension ,Pediatrics, Perinatology and Child Health ,Maternal hemodynamics ,biology.protein ,Cardiology ,Gestation ,Female ,business - Abstract
The aim of this study was to evaluate early pregnancy differences in maternal hemodynamics, cardiac geometry and function, between chronic hypertensive (CH) patients with and without the development of feto-maternal complications later in pregnancy.We performed a case-control study on nulliparous CH treated patients. From a group of CH patients referred to our outpatient clinic at 4-6 weeks for a clinical evaluation the first consecutive 30 patients with subsequent complications (superimposed PE, abruptio placentae, uncontrolled severe hypertension with delivery34 weeks, HELLP syndrome, FGR, perinatal death) were enrolled; the first 2 CH women with uneventful pregnancy referred after the case were enrolled as controls for a total of 60 patients. All patients were shifted to alpha-methyl dopa at the beginning of pregnancy and were submitted to an echocardiographic evaluation to assess the maternal hemodynamics, cardiac geometry, diastolic and systolic function.Patients developing complications had a lower early pregnancy heart rate (73 ± 11 vs. 82 ± 11 bpm), cardiac output (5.23 ± 1.2 vs. 6.5 ± 1.3 L/min,CH treated patients developing maternal and/or fetal complications show early pregnancy altered cardiac geometry, diastolic and systolic dysfunction, and impaired hemodynamics with a high resistance circulation.
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- 2020
7. Hemodynamic assessment in patients with preterm premature rupture of the membranes (pPROM)
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Herbert Valensise, Francesca Pometti, Daniele Farsetti, Gian Paolo Novelli, and Barbara Vasapollo
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Cardiac output ,Fetal Membranes, Premature Rupture ,Systemic vascular resistance ,Hemodynamics ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational Age ,Leukocyte Count ,Reproductive Medicine ,Pregnancy ,Settore MED/40 ,Case-Control Studies ,Humans ,pPROM ,Female ,Maternal hemodynamics - Abstract
The aim of this study was to assess the hemodynamic differences in women with pPROM versus physiological pregnancies.This was a prospective case control study of 15 patients with pPROM and 45 controls. Patients and controls were submitted at enrollment to a non-invasive hemodynamic evaluation with UltraSonic Cardiac Output Monitor (USCOM), and to blood tests to check white blood cells count and C-reactive protein (CRP) levels. We followed pPROM patients until delivery noting fetal/neonatal and maternal unfavorable outcomes (maternal fever, APGAR 1' and 5'7, stillbirth).Patients with pPROM showed higher values of cardiac output (9.1 ± 2.3 vs 7.1 ± 0.85, p 0.01), lower systemic vascular resistances (792.1 ± 162 vs 1006.2 ± 110.7, p 0.01), higher minute distance (32.3 ± 7.8 vs 25 ± 2.8, p 0.01), lower Potential to Kinetic Energy Ratio (16.5 ± 5.3 vs 22.4 ± 6.8, p 0.01), higher heart rate (97.5 ± 15.4 vs 82.4 ± 12, p 0.01) and higher oxygen delivery (1313.2 ± 325.8 vs 1080.7 ± 151.8, p 0.01) vs. controls. Six out of 15 pPROM patients had an unfavorable outcome. There were no significant differences in CRP levels and WBC count at admission in the two pPROM subgroups, whereas maternal hemodynamics was characterized by lower SVR (718 ± 72 vs 863 ± 123, p = 0.02) in subsequently complicated patients.Maternal hemodynamics is altered in pPROM patients, with a lower Systemic Vascular Resistance and higher Cardiac Output vs. controls. This hyperdynamic circulation appears to anticipates the changes of serum markers of inflammation (CRP, WBC count) and seems to be more pronounced at admission in pPROM patients developing unfavorable outcomes.
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- 2022
8. Maternal peripheral vascular resistance at mid gestation in chronic hypertension as a predictor of fetal growth restriction
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Gian Paolo NOVELLI, Herbert Valensise, Daniele Farsetti, and Barbara VASAPOLLO
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Fetal Growth Retardation ,Fetal growth restriction ,Obstetrics and Gynecology ,Gestational Age ,hemodynamics ,Settore MED/40 ,Pediatrics, Perinatology and Child Health ,Hypertension ,peripheral vascular resistance ,Humans ,Birth Weight ,Female ,Vascular Resistance ,pregnancy ,chronic hypertension - Abstract
We aimed at analyzing the relationship between maternal hemodynamics as expressed by Peripheral Vascular Resistance (PVR) at mid gestation and fetal growth at delivery in chronic hypertension. 152 chronic hypertensive patients were submitted to echocardiography noting PVR at 22-24 weeks' gestation and were followed until delivery noting birthweight centile and the diagnosis of fetal growth restriction (FGR). The logarithmic correlation analysis showed that PVR at mid gestation was strongly related to birthweight at delivery (
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- 2022
9. Fetal Umbilical Vein Flow in the Classification of Fetuses with Growth Restriction
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Gian Paolo Novelli, Giulia Gagliardi, G. M. Tiralongo, D. Farsetti, Francesca Pometti, Herbert Valensise, Barbara Vasapollo, Damiano Lo Presti, and I. Pisani
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medicine.medical_specialty ,Ocean Engineering ,030204 cardiovascular system & hematology ,early-FGR ,Umbilical vein ,fetal growth restriction ,late-FGR ,03 medical and health sciences ,small for gestational age ,0302 clinical medicine ,Growth restriction ,medicine ,reproductive and urinary physiology ,Water Science and Technology ,Fetus ,Pregnancy ,030219 obstetrics & reproductive medicine ,Receiver operating characteristic ,Obstetrics ,business.industry ,Fetal doppler ,Geology ,Blood flow ,medicine.disease ,umbilical vein blood flow ,female genital diseases and pregnancy complications ,Settore MED/40 ,Small for gestational age ,business - Abstract
Objectives: To assess umbilical vein (UV) blood flow in fetal growth restriction (FGR) and in pregnancy with small for gestational age (SGA) fetus. To evaluate the predictive capacity of UV blood flow (QUV) in the discrimination of SGA fetuses from FGR before and after 32 weeks of pregnancy. Methods: Sixty-five women with a recent diagnosis of FGR or SGA fetuses were enrolled and underwent a complete fetal Doppler examination comprehending QUV. We collected SGA (n = 34), early-FGR (n = 9), and late-FGR (n = 22) fetuses. Results: UV diameter was lower in early and late-FGR compared to SGA, while time-averaged maximum velocity (TAMXV) was lower only in early-FGR. UV blood flow (QUV) and QUV corrected for estimated fetal weight (cQUV) were significantly lower in early-FGR and late-FGR compared to SGA. The receiver operating characteristic (ROC) curves analysis of cQUV showed a significant predictive capacity for SGA diagnosis before and after 32 weeks. Conclusions: The evaluation of UV blood flow allows distinguishing SGA fetuses from FGR. The assessment of UV flow should be taken into consideration in future research of new parameters to differentiate SGA from FGR.
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- 2021
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10. The relevance of maternal cardiovascular situation before labor in the outcome of birth: an observational study
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Daniele Farsetti, Grazia Tiralongo, Ilaria Pisani, Damiano Lo Presti, Giulia Gagliardi, Barbara Vasapollo, Gian Paolo Novelli, and Herbert Valensise
- Published
- 2020
11. Hemodynamic guided treatment of hypertensive disorders in pregnancy: is it time to change our mind?
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Herbert Valensise, Barbara Vasapollo, and Gian Paolo Novelli
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Fetus ,Pregnancy ,Pediatrics ,medicine.medical_specialty ,Relative efficacy ,business.industry ,Hemodynamics ,Obstetrics and Gynecology ,Hypertension, Pregnancy-Induced ,medicine.disease ,Settore MED/40 ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Female ,business - Abstract
Hypertensive disorders of pregnancy remain a leading cause of maternal and fetal morbidity and mortality [1].There is no consensus on the relative efficacy and safety of the medications to treat se...
- Published
- 2019
12. Pregnancy complications in chronic hypertensive patients are linked to pre-pregnancy maternal cardiac function and structure
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Gian Paolo Novelli, D. Farsetti, Giulia Gagliardi, Barbara Vasapollo, and Herbert Valensise
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Cardiac function curve ,Adult ,medicine.medical_specialty ,Mean arterial pressure ,Cardiac output ,Complications of pregnancy ,Heart Ventricles ,Diastole ,Cohort Studies ,Ventricular Dysfunction, Left ,Pregnancy ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Univariate analysis ,business.industry ,Obstetrics and Gynecology ,Prenatal Care ,Hypertension, Pregnancy-Induced ,medicine.disease ,medicine.anatomical_structure ,ROC Curve ,Settore MED/40 ,Echocardiography ,Hypertension ,Vascular resistance ,Cardiology ,Female ,business - Abstract
Chronic hypertension complicates around 3% of all pregnancies and is associated with an increased risk for pregnancy complications such as superimposed preeclampsia, fetal growth restriction, preterm delivery, and stillbirth, reaching a rate of complications of up to 25-28%.We performed an echocardiographic study to evaluate pre-pregnancy cardiac geometry and function, along with the hemodynamic features of treated chronic hypertension patients, searching for a possible correlation with the development of feto-maternal complications and with pre-pregnancy therapy.This was a prospective observational cohort study of 192 consecutive patients receiving treatment for chronic hypertension (calcium channel blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, α1-adrenoceptor antagonists, and/or diuretics). Patients underwent echocardiography before pregnancy, assessing left ventricular morphology and function, cardiac output, and total vascular resistance. Pre-pregnancy therapy was noted, patients were shifted to α-methyldopa right before pregnancy, and were followed until delivery, noting major early (34weeks' gestation) and late (≥34 weeks' gestation) complications. Comparisons among the 3 groups (ie, those with no complications, early complications, and late complications) were performed with 1-way analysis of variance with Student-Newman-Keuls correction for multiple comparisons. The Mann-Whitney U test was used for non-normally distributed data. Comparison of proportions was used as appropriate. Receiver operating characteristic curve analysis was used to identify cutoff values of diastolic dysfunction in this population using the E/e' ratio, and separate cutoff of values for total vascular resistance for the prediction of early and late complications of pregnancy. Binary univariate and multivariate logistic regression as well as Cox proportional hazards regression were used to evaluate the possible correlation among angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and/or calcium channel blocker pre-pregnancy therapy, cardiovascular features, and the risk for subsequent early and late complications of pregnancy.Of 192 patients, 141 had no complications, and 51 had a complicated pregnancy (24 had early complications and 27 had late complications). Concentric geometry was more frequent in those women with early versus late and no complications (50% vs 13.5% and 11.1%, respectively; P.05), whereas eccentric hypertrophy was more represented in women with late versus early and no complications (32% versus 12.5% and 1.4%, respectively; P.05). The receiver operating characteristic curve showed an E/e' ratio value7.65 (sensitivity, 59.6%; specificity, 68.6%) as a predictor of subsequent complications of pregnancy, whereas total vascular resistance1048 (sensitivity, 83.7%; specificity, 55.6%) was predictive for late complications and total vascular resistance1498 (sensitivity, 87.5%; specificity, 78.0%) for the early complications of pregnancy. Univariate analysis showed that the following parameters were predictive for complications of pregnancy: altered geometry of the left ventricle (odds ratio, 5.94; 95% confidence interval, 2.90-12.19), diastolic dysfunction (odds ratio, 3.22; 95% confidence interval, 1.63-6.37), altered total vascular resistance (odds ratio, 3.52; 95% confidence interval, 1.78-6.97), and pre-pregnancy therapy without calcium channel blockers/angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (odds ratio, 2.73; 95% confidence interval, 1.37-5.42). These parameters, except for altered total vascular resistance, were independent predictors in the multivariate analysis corrected for body mass index, heart rate, parity, and mean arterial pressure.Chronic hypertension patients with pre-pregnancy cardiac remodeling and dysfunction more often develop early and late complications of pregnancy. Pre-pregnancy therapy for chronic hypertension patients with calcium channel blockers and/or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers may positively influence cardiac profiles and the outcome of a future pregnancy with a reduced rate of complications.
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- 2019
13. Assessment of venous hemodynamics and volume homeostasis during pregnancy: recommendations of the International Working Group on Maternal Hemodynamics
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Gian Paolo NOVELLI, Wilfried Gyselaers, Victoria Meah, and Ian Wilkinson
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medicine.medical_specialty ,Cardiac output ,Pregnancy ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics and Gynecology ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Inferior vena cava ,Cardiovascular physiology ,03 medical and health sciences ,0302 clinical medicine ,Reproductive Medicine ,Venous hemodynamics ,medicine.vein ,Maternal hemodynamics ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Intensive care medicine ,Homeostasis ,Venous return curve - Abstract
Venous hemodynamics and volume homeostasis are important aspects of cardiovascular physiology. However, today their relevance is still very much underappreciated. Their most important role is maintenance and control of venous return and, as such, cardiac output. A high-flow/low-resistance circulation, remaining constant under physiological circumstances, is mandatory for an uncomplicated course of pregnancy. In this article, characteristics of normal and abnormal venous and volume regulating functions are discussed with respect to normal and pathologic outcomes of pregnancy, and current (non-invasive) methods to assess these functions are summarized. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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- 2018
14. Restricted physical activity in pregnancy reduces maternal vascular resistance and improves fetal growth
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D. Farsetti, D. Lo Presti, Barbara Vasapollo, Herbert Valensise, Gian Paolo Novelli, Giulia Gagliardi, I. Pisani, and G. M. Tiralongo
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medicine.medical_specialty ,Pregnancy ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,Obstetrics ,business.industry ,Restricted physical activity ,medicine.medical_treatment ,Abdominal circumference ,Obstetrics and Gynecology ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Bed rest ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Blood pressure ,Reproductive Medicine ,medicine ,Fetal growth ,Vascular resistance ,Gestation ,Radiology, Nuclear Medicine and imaging ,business - Abstract
OBJECTIVES To test the efficacy of maternal activity restriction for reducing peripheral vascular resistance in normotensive pregnant women with raised total vascular resistance (TVR) and to evaluate its effect on fetal growth. METHODS This was a prospective case-control study of 30 women enrolled between 27 and 29 weeks' gestation. All patients met the following criteria: normal blood pressure before and during pregnancy, TVR between 1300 and 1400 dynes × s/cm5 at enrolment, normal fetal Doppler parameters at enrolment and abdominal circumference between the 10th and 25th centiles. Patients were assigned to activity restriction (activity-restriction group; n = 15) or no treatment (control group; n = 15) and were assessed after 4 weeks for TVR and fetal growth. RESULTS TVR at enrolment and estimated fetal weight centile were similar in the activity-restriction group vs controls (1358 ± 26 vs 1353 ± 30 dynes × s/cm5 ; 18th ± 4 vs 19th ± 4 centile; P = NS). After 4 weeks, the activity-restriction group compared with controls showed significantly lower TVR (1165 ± 159 vs 1314 ± 190 dynes × s/cm5 ; P
- Published
- 2018
15. Maternal hemodynamics early in labor: a possible link with obstetric risk?
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Herbert Valensise, D. Lo Presti, Gian Paolo Novelli, I. Pisani, G. M. Tiralongo, M. R. Basile, Giulia Gagliardi, Barbara Vasapollo, and D. Farsetti
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medicine.medical_specialty ,Pregnancy ,Cardiac output ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Cardiac index ,Obstetrics and Gynecology ,Hemodynamics ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Labor Complication ,Uterine atony ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Reproductive Medicine ,Vascular resistance ,Fetal distress ,Medicine ,Radiology, Nuclear Medicine and imaging ,business - Abstract
Objective To determine if hemodynamic assessment in 'low-risk' pregnant women at term with an appropriate-for-gestational age (AGA) fetus can improve the identification of patients who will suffer maternal or fetal/neonatal complications during labor. Methods This was a prospective observational study of 77 women with low-risk term pregnancy and AGA fetus, in the early stages of labor. Hemodynamic indices were obtained using the UltraSonic Cardiac Output Monitor (USCOM® ) system. Patients were followed until the end of labor to identify fetal/neonatal and maternal outcomes, and those which developed complications of labor were compared with those delivering without complications. Results Eleven (14.3%) patients had a complication during labor: in seven there was fetal distress and in four there were maternal complications (postpartum hemorrhage and/or uterine atony). Patients who developed complications during labor had lower cardiac output (5.6 ± 1.0 vs 6.7 ± 1.3 L/min, P = 0.01) and cardiac index (3.1 ± 0.6 vs 3.5 ± 0.7 L/min/m2 , P = 0.04), and higher total vascular resistance (1195.3 ± 205.3 vs 1017.8 ± 225.6 dynes × s/cm5 , P = 0.017) early in labor, compared with those who did not develop complications. Receiver-operating characteristics curve analysis to determine cut-offs showed cardiac output ≤ 5.8 L/min (sensitivity, 81.8%; specificity, 69.7%), cardiac index ≤ 2.9 L/min/m2 (sensitivity, 63.6%; specificity, 76.9%) and total vascular resistance > 1069 dynes × s/cm5 (sensitivity, 81.8%; specificity, 63.6%) to best predict maternal or fetal/neonatal complications. Conclusions The study of maternal cardiovascular adaptation at the end of pregnancy could help to identify low-risk patients who may develop complications during labor. In particular, low cardiac output and high total vascular resistance are apparently associated with higher risk of fetal distress or maternal complications. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
- Published
- 2018
16. Correlation between maternal body composition and haemodynamic changes in pregnancy: different profiles for different hypertensive disorders
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D. Lo Presti, D. Farsetti, I. Pisani, Barbara Vasapollo, Gian Paolo Novelli, Angela Andreoli, G. M. Tiralongo, Giulia Gagliardi, and Herbert Valensise
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Adult ,Gestational hypertension ,Cardiac function curve ,medicine.medical_specialty ,Cardiac output ,Body water ,Population ,030204 cardiovascular system & hematology ,Pregnancy-Induced ,Maternal body composition ,Preeclampsia ,03 medical and health sciences ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,Settore MED/30 ,Prenatal Diagnosis ,Electric Impedance ,Internal Medicine ,medicine ,Hypertensive pregnancy disorders ,Humans ,Cardiac Output ,education ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Haemodynamics in pregnancy ,Total vascular resistance ,Female ,Hypertension, Pregnancy-Induced ,Body Composition ,Pregnancy Trimesters ,Vascular Resistance ,Obstetrics and Gynecology ,medicine.disease ,medicine.anatomical_structure ,Settore MED/40 ,Hypertension ,Vascular resistance ,business - Abstract
Objectives To assess and correlate changes in body composition and haemodynamic function during pregnancy. To identify different haemodynamic profiles based on the onset of hypertensive diseases such as gestational hypertension and preeclampsia. Methods We enrolled 265 healthy, normotensive pregnant women throughout pregnancy (from 6 + 0 to 36 + 0 weeks). They were subjected to assessment of body composition and haemodynamic function using non-invasive methods. We divided our population in three groups: group A with physiological pregnancy, group B with gestational hypertension and group C with preeclamptic patients. Results In patients who developed gestational hypertension we found lower total body water (TBW) percentage, higher Fat Mass (FM), associated with lower Cardiac Output (CO) and higher Total Vascular Resistance (TVR) during the second trimester. In the third trimester we didn’t find haemodynamic differences, but a significative increase in extracellular water (ECW) percentage. In patients who developed preeclampsia we found since the first trimester significative higher TVR and hypodynamic circulation, associated with lower FM percentage. Conclusions Assessment of body composition and maternal cardiac function may help to identify earlier in pregnancy, patients with different (mal) adaptations to pregnancy. Women with high TVR, hypodynamic circulation and low fat mass during the first trimester, might be at higher risk to develop preeclampsia. Patients with higher BMI and FM percentage, and increased TVR in the second trimester, might be at risk of gestational hypertension and excessive fluid retention at the end of pregnancy.
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- 2017
17. Assessment of arterial function in pregnancy: recommendations of the International Working Group on Maternal Hemodynamics
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Asma Khalil, Victoria Meah, Gian Paolo NOVELLI, Lin Foo, Christoph Lees, and Ian Wilkinson
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medicine.medical_specialty ,Pregnancy ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics and Gynecology ,Intrauterine growth restriction ,General Medicine ,030204 cardiovascular system & hematology ,International working group ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Reproductive Medicine ,Maternal hemodynamics ,medicine ,Arterial stiffness ,Radiology, Nuclear Medicine and imaging ,Maternal health ,Intensive care medicine ,business ,Arterial function - Abstract
There is strong evidence supporting the role of maternal arterial dysfunction in pregnancy-specific disorders such as pre-eclampsia and intrauterine growth restriction. As more work is focused towards this field, it is important that methods and interpretation of arterial function assessment are applied appropriately. Here, we summarize techniques and devices commonly used in maternal health studies, with consideration of their technical application in pregnant cohorts. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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- 2017
18. Friendly help for clinical use of maternal hemodynamics
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D. Farsetti, I. Pisani, Barbara Vasapollo, Giulia Gagliardi, Herbert Valensise, Damiano Lo Presti, G. M. Tiralongo, and Gian Paolo Novelli
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medicine.medical_specialty ,Cardiac output ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Heart Rate ,Pregnancy ,medicine ,Humans ,Cardiac Output ,Intensive care medicine ,business.industry ,Hemodynamics ,Obstetrics and Gynecology ,medicine.disease ,Pregnancy Trimester, First ,medicine.anatomical_structure ,Settore MED/40 ,Pediatrics, Perinatology and Child Health ,Maternal hemodynamics ,Vascular resistance ,Female ,Vascular Resistance ,business - Abstract
Maternal hemodynamics plays a major role during pregnancy and its evaluation is fundamental to understand obstetric conditions. The modern opinion about maternal hemodynamics assessment is to shift focus from single hemodynamic parameters to the whole hemodynamic profile. Our aim is to create a simple, intuitive, and easily understandable graphing technique to evaluate the main hemodynamic parameters.We enrolled 531 pregnant women without maternal or fetal disease. One hundred and forty five in the first trimester of pregnancy, 258 in the second one and 128 in the third one. We performed hemodynamic assessment with ultrasonic cardiac output monitor method. We selected the six main parameters: cardiac output, systemic vascular resistance, heart rate, potential-to-kinetic energy ratio, inotropy index, and stroke volume variation. We chose the radar chart to display the multivariate data of the hemodynamic measurement of the patient in evaluation.We have obtained mean and deviation standard values for the six main hemodynamic parameters in every trimester. They deeply change during the pregnancy, so it is correct to compare a new hemodynamic measurement with the mean values for the specific trimester in order to evaluate any possible alterations. In fact, once a new hemodynamic assessment is performed, we calculate theAt the end of a hemodynamic exam, the physician can input the data in the program obtaining a graphic representation. Using this technique, which simultaneously evaluates six hemodynamic parameters, it is possible to easily understand the patient's hemodynamic status. By converting the parameters values in
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- 2019
19. Methods and considerations concerning cardiac output measurement in pregnant women: recommendations of the International Working Group on Maternal Hemodynamics
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Ian B. Wilkinson, Jérôme Cornette, R C Bijl, Baskaran Thilaganathan, Herbert Valensise, Gian Paolo Novelli, Christoph Lees, Eric J. Stöhr, C. D. van der Marel, Barbara Vasapollo, Obstetrics & Gynecology, and Anesthesiology
- Subjects
Technology ,IMPEDANCE CARDIOGRAPHY ,Cardiac output ,pulse contour analysis ,inert-gas rebreathing technique ,medicine.medical_treatment ,inert gas rebreathing technique ,Hemodynamics ,Blood Pressure ,TOTAL VASCULAR-RESISTANCE ,0302 clinical medicine ,Pregnancy ,THORACIC ELECTRICAL BIOIMPEDANCE ,030212 general & internal medicine ,Cardiac Output ,pulmonary artery catheter ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,Radiology, Nuclear Medicine & Medical Imaging ,Obstetrics & Gynecology ,Obstetrics and Gynecology ,Heart ,General Medicine ,Stroke volume ,Middle Aged ,Magnetic Resonance Imaging ,DIASTOLIC FUNCTION ,Impedance cardiography ,medicine.anatomical_structure ,Echocardiography ,Settore MED/40 ,CARDIOVASCULAR MAGNETIC-RESONANCE ,Female ,Life Sciences & Biomedicine ,CESAREAN-SECTION ,Adult ,medicine.medical_specialty ,Pulse Wave Analysis ,transthoracic echocardiography ,03 medical and health sciences ,LEFT-VENTRICULAR MASS ,International Working Group on Maternal Hemodynamics ,cardiac MRI ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Obstetrics & Reproductive Medicine ,Intensive care medicine ,MEAN ARTERIAL-PRESSURE ,Science & Technology ,business.industry ,Pulmonary artery catheter ,STROKE VOLUME ,Ultrasonography, Doppler ,Acoustics ,Hypertension, Pregnancy-Induced ,medicine.disease ,pulse-contour analysis ,Blood pressure ,Reproductive Medicine ,CONCENTRIC GEOMETRY ,Catheterization, Swan-Ganz ,Vascular resistance ,1114 Paediatrics and Reproductive Medicine ,Vascular Resistance ,Pregnant Women ,business - Abstract
Cardiac output (CO), along with blood pressure and vascular resistance, is one of the most important parameters of maternal hemodynamic function. Substantial changes in CO occur in normal pregnancy and in most obstetric complications. With the development of several non-invasive techniques for the measurement of CO, there is a growing interest in the determination of this parameter in pregnancy. These techniques were initially developed for use in critical-care settings and were subsequently adopted in obstetrics, often without appropriate validation for use in pregnancy. In this article, methods and devices for the measurement of CO are described and compared, and recommendations are formulated for their use in pregnancy, with the aim of standardizing the assessment of CO and peripheral vascular resistance in clinical practice and research studies on maternal hemodynamics. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
- Published
- 2019
20. Preterm delivery and elevated maternal total vascular resistance: signs of suboptimal cardiovascular adaptation to pregnancy?
- Author
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Giulia Gagliardi, D. Lo Presti, Gian Paolo Novelli, Barbara Vasapollo, Herbert Valensise, I. Pisani, D. Farsetti, and G. M. Tiralongo
- Subjects
Cardiac output ,medicine.medical_specialty ,Population ,Cardiac index ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Radiology, Nuclear Medicine and imaging ,education ,education.field_of_study ,Pregnancy ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,Stroke volume ,medicine.disease ,medicine.anatomical_structure ,Reproductive Medicine ,Premature birth ,Anesthesia ,Vascular resistance ,Cardiology ,business - Abstract
Objective To evaluate the maternal hemodynamic profile in women with a diagnosis of threatened preterm delivery (TPD) in order to understand the possible pathophysiologic mechanism leading to an increased lifetime risk for future cardiovascular disease. Methods Patients with a diagnosis of TPD were enrolled and assessed using a non-invasive method (USCOM®) for the determination of hemodynamic parameters. Vaginal and rectal swabs were taken, cervical length, blood inflammatory indices, fetal blood-vessel Doppler velocimetry were measured and gestational age at the time of delivery and neonatal outcomes were noted. Results A total of 68 patients were enrolled and included in the analysis. The population was divided into two groups according to total vascular resistance (TVR): Group A with a TVR of ≤ 1000 dynes × s/cm5 (n = 48) and Group B with a TVR of > 1000 dynes × s/cm5 (n = 20). C-reactive protein (CRP) was higher in Group B than in Group A, suggesting a systemic inflammation status. Group B delivered earlier (32 + 4 weeks vs 38 + 2 weeks; P 1000 dynes × s/cm5 and elevated levels of CRP are at high risk of preterm delivery. An impaired maternal cardiovascular adaptation during pregnancy in these patients might suggest a possible higher risk for subsequent future cardiovascular disease. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
- Published
- 2016
21. Prevention and Treatment of Fetal Growth Restriction by Influencing Maternal Hemodynamics and Blood Volume
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Barbara Vasapollo, Gian Paolo Novelli, and Herbert Valensise
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business.industry ,Maternal hemodynamics ,Fetal growth ,Medicine ,Physiology ,Blood volume ,business - Published
- 2018
22. Hemodynamic Prediction and Stratification of Hypertensive Disorders of Pregnancy: A Dream That Is Coming True?
- Author
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Barbara Vasapollo, Gian Paolo Novelli, and Herbert Valensise
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medicine.medical_specialty ,Pregnancy ,030219 obstetrics & reproductive medicine ,business.industry ,Hemodynamics ,030204 cardiovascular system & hematology ,medicine.disease ,Stratification (mathematics) ,03 medical and health sciences ,0302 clinical medicine ,Settore MED/40 ,Internal medicine ,Cardiology ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment - Abstract
Hypertensive disorders of pregnancy (HDP) are a major cause of maternal and fetal morbidity and death.[1][1] To date, the prediction of these disorders and their complications has been based on many clinical characteristics, hemodynamics, and placental indicators (either with Doppler evaluation of
- Published
- 2018
23. Cardiac Dysfunction in Hypertensive Pregnancy
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Herbert Valensise, Gian Paolo Novelli, and Barbara Vasapollo
- Published
- 2018
24. Cardiac Function
- Author
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Herbert Valensise, Gian Paolo Novelli, Daniele Farsetti, and Barbara Vasapollo
- Subjects
Settore MED/40 - Published
- 2018
25. PRE-ECLAMPSIA: ONE NAME, TWO CONDITIONS – THE CASE FOR EARLY AND LATE DISEASE BEING DIFFERENT
- Author
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Herbert Valensise, Barbara Vasapollo, and Gian Paolo Novelli
- Subjects
medicine.medical_specialty ,Eclampsia ,business.industry ,Obstetrics ,Pediatrics, Perinatology and Child Health ,Obstetrics and Gynecology ,Medicine ,Disease ,business ,medicine.disease - Published
- 2013
26. Screening for pre-eclampsia in the first trimester: role of maternal hemodynamics and bioimpedance in non-obese patients
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Herbert Valensise, Angela Andreoli, D. LoPresti, Giulia Gagliardi, Gian Paolo Novelli, I. Pisani, Barbara Vasapollo, G. M. Tiralongo, and D. Farsetti
- Subjects
Adult ,medicine.medical_specialty ,Body water ,Hemodynamics ,Intrauterine growth restriction ,Blood Pressure ,030204 cardiovascular system & hematology ,Ultrasonography, Prenatal ,Preeclampsia ,preeclampsia ,03 medical and health sciences ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,bioimpedance ,Electric Impedance ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,bioimpedence ,Cardiac Output ,combined screening ,030219 obstetrics & reproductive medicine ,Eclampsia ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Pregnancy Trimester, First ,Reproductive Medicine ,Settore MED/40 ,Case-Control Studies ,cardiac function ,first trimester ,hemodynamics ,Body Composition ,Gestation ,Settore MED/40 - Ginecologia e Ostetricia ,Female ,Vascular Resistance ,business ,Body mass index ,Biomarkers - Abstract
Objective To test if maternal hemodynamics and bioimpedance, assessed at the time of combined screening for PE, are able to identify in the first trimester of gestation normotensive non-obese patients at risk for pre-eclampsia (PE) and/or intrauterine growth restriction (IUGR). Methods One hundred and fifty healthy nulliparous non-obese women (body mass index
- Published
- 2016
27. Persistent maternal cardiac dysfunction after preeclampsia identifies patients at risk for recurrent preeclampsia
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Giulia Gagliardi, Damiano Lo Presti, Herbert Valensise, I. Pisani, Barbara Vasapollo, G. M. Tiralongo, and Gian Paolo Novelli
- Subjects
Cardiac output ,Left ,030204 cardiovascular system & hematology ,hemodynamics ,Ventricular Dysfunction, Left ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,Recurrence ,Ventricular Dysfunction ,echocardiography ,left ventricular remodeling ,030219 obstetrics & reproductive medicine ,Ventricular Remodeling ,Incidence ,Stroke volume ,medicine.anatomical_structure ,Settore MED/40 ,Cardiology ,Female ,Maternal Age ,Cardiac function curve ,Adult ,medicine.medical_specialty ,hypertension ,diastolic dysfunction ,preeclampsia ,pregnancy ,Blood Pressure Determination ,Case-Control Studies ,Echocardiography ,Follow-Up Studies ,Gravidity ,Hemodynamics ,Humans ,Hypertension, Pregnancy-Induced ,Retrospective Studies ,Risk Assessment ,Stroke Volume ,Vascular Resistance ,Diastole ,Pregnancy-Induced ,Preeclampsia ,03 medical and health sciences ,Internal medicine ,Internal Medicine ,medicine ,Ventricular remodeling ,Gynecology ,business.industry ,medicine.disease ,Vascular resistance ,business - Abstract
The purpose of our study was to assess cardiac function in nonpregnant women with previous early preeclampsia before a second pregnancy to highlight the cardiovascular pattern, which may take a risk for recurrent preeclampsia. Seventy-five normotensive patients with previous preeclampsia and 147 controls with a previous uneventful pregnancy were enrolled in a case-control study and submitted to echocardiographic examination in the nonpregnant state 12 to 18 months after the first delivery. All patients included in the study had pregnancy within 24 months from the echocardiographic examination and were followed until term. Twenty-two (29%) of the 75 patients developed recurrent preeclampsia. In the nonpregnant state, patients with recurrent preeclampsia compared with controls and nonrecurrent preeclampsia had lower stroke volume (63±14 mL versus 73±12 mL and 70±11 mL, P P P −1 ·cm −5 versus 1341±270 dyne·s −1 ·cm −5 and 1383±261 dyne·s −1 ·cm −5 , P 2.7 and 30.4±6.8 g/m 2.7 versus 24.8±5.0 g/m 2.7 , P
- Published
- 2016
28. Medical treatment of early-onset mild gestational hypertension reduces total peripheral vascular resistance and influences maternal and fetal complications
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Herbert Valensise, Dario Manfellotto, Giulia Gagliardi, G. M. Tiralongo, Barbara Vasapollo, L. Giannini, I. Pisani, and Gian Paolo Novelli
- Subjects
Gestational hypertension ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics and Gynecology ,Hemodynamics ,General Medicine ,Odds ratio ,medicine.disease ,Group B ,medicine.anatomical_structure ,Blood pressure ,Reproductive Medicine ,Nifedipine ,Anesthesia ,medicine ,Vascular resistance ,Gestation ,Radiology, Nuclear Medicine and imaging ,business ,medicine.drug - Abstract
Objective Complications in early-onset mild gestational hypertension (GH) are better predicted by total peripheral vascular resistance (TPVR) > 1350 dyne than by blood pressure. We therefore aimed to assess the possible reduction of severe complications by lowering TPVR with nitric oxide (NO) donors, oral fluids and standard antihypertensive therapy in women with early-onset mild GH. Methods A group of 400 patients with early-onset (20–27 weeks' gestation) mild GH (systolic and diastolic blood pressure 1350 dyne were enrolled in a prospective non-randomized trial with sequential allocation: 100 patients were treated with nifedipine (Group A); 100 with nifedipine and NO donors (Group B); 100 with nifedipine and oral fluids (Group C); and 100 with nifedipine, NO donors and oral fluids (Group D). TPVR was checked 1 month after initiation of therapy, and the number of patients with severe maternal and fetal complications was recorded in each group. The relationship between reduction in TPVR and the frequency of severe complications was assessed. Results Severe complications developed in 51% of patients in Group A, 48% in Group B, 53% in Group C and 35% in Group D, the frequency in Group D being significantly lower than that in the other treatment groups (P < 0.05). A reduction in TPVR of < 15% predicted the occurrence of severe complications with sensitivity 95.2% and specificity 88.3%. In Group D a reduction in TPVR of ≥ 15% was more probable (odds ratio (OR) = 2.03; 95% CI, 1.15–3.60; P < 0.015) and severe complications were less probable (OR = 0.52; 95% CI, 0.29–0.91; P < 0.023). Conclusion In women with early-onset mild GH, combined treatment with NO donors, oral fluids and nifedipine optimally reduces TPVR and seems to reduce maternal and fetal complications. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
- Published
- 2012
29. Left ventricular midwall mechanics at 24 weeks' gestation in high-risk normotensive pregnant women: relationship to placenta-related complications of pregnancy
- Author
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L. Giannini, Dario Manfellotto, G. M. Tiralongo, Gian Paolo Novelli, Herbert Valensise, Barbara Vasapollo, Giulia Gagliardi, and I. Pisani
- Subjects
Gynecology ,Pregnancy ,medicine.medical_specialty ,Complications of pregnancy ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Obstetrics and Gynecology ,Gestational age ,Hemodynamics ,General Medicine ,medicine.disease ,Blood pressure ,Reproductive Medicine ,Obstetrics and gynaecology ,medicine.artery ,medicine ,Gestation ,Radiology, Nuclear Medicine and imaging ,Uterine artery ,business - Abstract
Objectives Most studies during pregnancy have assessed maternal left ventricular (LV) function by load-dependent indices, assessing only chamber function. The aim of this study was to assess afterload-adjusted LV myocardial and chamber systolic function at 24 weeks' gestation and 6 months postpartum in high-risk normotensive pregnant women. Methods A group of 118 high-risk women with bilateral notching of the uterine arteries underwent an echocardiographic examination to evaluate midwall mechanics (midwall shortening (mFS%) and stress-corrected midwall shortening (SCmFS%)) of the LV at 24 weeks' gestation and 6 months postpartum. Patients were followed until delivery and pregnancies were classified retrospectively as uneventful (uncomplicated outcome) or complicated. A control group of 54 low-risk women with uneventful pregnancies without bilateral notching was also enrolled. Results The pregnancy was uneventful in 74 (62.7%) women, whereas 44 (37.3%) developed complications. At 24 weeks' gestation, mFS% and SCmFS% were greater in the uncomplicated-outcome compared with the complicated-outcome group (25.9 ± 4.8 vs 18.8 ± 5.0%, P < 0.001 and 107.9 ± 18.4 vs 77.9 ± 20.7%, P < 0.001, respectively). At 6 months postpartum, SCmFS% remained greater in the uncomplicated-outcome compared with the complicated-outcome group (100.4 ± 21.6 vs 87.8 ± 19.1, P < 0.05). In the uncomplicated-outcome group, SCmFS% was higher during pregnancy than it was postpartum, whereas in the complicated-outcome group, it was lower during pregnancy than it was postpartum (P < 0.05). Conclusions Maternal cardiac midwall mechanics appear to be enhanced (SCmFS% increased compared with controls) during pregnancy compared with postpartum in high-risk patients with uncomplicated pregnancy, whereas midwall mechanics are depressed both during pregnancy and postpartum in patients with pregnancy complications. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
- Published
- 2012
30. Total Vascular Resistance and Left Ventricular Morphology as Screening Tools for Complications in Pregnancy
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Gian Paolo Novelli, Herbert Valensise, and Barbara Vasapollo
- Subjects
Adult ,Gestational hypertension ,medicine.medical_specialty ,Pregnancy Complications, Cardiovascular ,Preeclampsia ,Pre-Eclampsia ,Predictive Value of Tests ,Pregnancy ,Internal medicine ,medicine.artery ,Internal Medicine ,medicine ,Humans ,Mass Screening ,Outpatient clinic ,Uterine artery ,Abruptio Placentae ,Observer Variation ,Fetus ,Fetal Growth Retardation ,business.industry ,Uterus ,Infant, Newborn ,Hypertension, Pregnancy-Induced ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Echocardiography ,Cardiology ,Vascular resistance ,Gestation ,Female ,Hypertrophy, Left Ventricular ,Vascular Resistance ,business - Abstract
We evaluated the predictive value of elevated total vascular resistance on the outcome of pregnancy in normotensive high-risk primigravidas with bilateral notching of the uterine artery Doppler. A total of 526 high-risk primigravidas referred to the obstetrics outpatient clinic of Tor Vergata University with bilateral notching of the uterine artery at 20 to 22 weeks’ gestation were submitted to a maternal echocardiographic examination and uterine artery Doppler evaluation at 24 weeks’ gestation. Blood pressure was recorded at the time of the examination, total vascular resistance was calculated, and the geometric pattern of the left ventricle was assessed. Patients were followed until the end of pregnancy to detect fetal/maternal adverse outcomes (gestational hypertension, preeclampsia, abruptio placentae, fetal growth restriction, perinatal death, etc). A total of 111 of the 526 pregnancies showed a bilateral notch at 24 weeks’ gestation, and 97 had an adverse outcome (18.44%). The best independent predictor for maternal and fetal complications was total vascular resistance (odds ratio: 91.25; 95% CI: 39.64 to 210.05; P −5 , with a sensitivity and a specificity of 89% and 94%, respectively. A high relative wall thickness of the left ventricle (>0.37; odds ratio: 2.47; 95% CI: 1.12 to 5.44) and a hypertrophized ventricle (left ventricular mass >130 g; odds ratio: 2.52; 95% CI: 1.12 to 5.64) were also independent predictors ( P
- Published
- 2008
31. Fetal growth restriction and maternal cardiac function
- Author
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Herbert Valensise, Barbara Vasapollo, and Gian Paolo Novelli
- Subjects
Cardiac function curve ,medicine.medical_specialty ,Cardiac output ,Pregnancy ,Mean arterial pressure ,business.industry ,Obstetrics and Gynecology ,Intrauterine growth restriction ,Stroke volume ,medicine.disease ,Preload ,Endocrinology ,Reproductive Medicine ,Internal medicine ,Maternity and Midwifery ,Pediatrics, Perinatology and Child Health ,Heart rate ,medicine ,Cardiology ,business - Abstract
Cardiac output rises in pregnancy, and most of this increase occurs in the first trimester. Both heart rate and stroke volume contribute to this increase, which, coupled with a decrease in mean arterial pressure, determines a reduction of maternal total vascular resistance (TVR) in physiological pregnancy. The absence of a ‚correct’ maternal cardiovascular compensatory response (absence of increase in cardiac output, heart rate, stroke volume, left ventricular mass and decrease in maternal TVR), in addition to abnormal trophoblastic invasion, might be one of the factors that could determine a reduced placental perfusion and, eventually, the development of fetal intrauterine growth restriction (IUGR). In fact, pregnancies complicated by IUGR appear to lack the stimulus to induce the hemodynamic changes typically present in physiological pregnancy such as the increase in preload, maternal heart rate, stroke volume, the enlargement of the left atrium and, above all, the reduction of TVR. It is difficult to e...
- Published
- 2008
32. Anti-Shock Action of Phenyl-t-Butyl-Nitrone, a Spin Trapper
- Author
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Patrizia Angiolini, Guglielmo Consales, Gian Paolo Novelli, Riccardo Tani, and Roberto Lippi
- Subjects
chemistry.chemical_classification ,Chemistry ,Shock (circulatory) ,medicine ,medicine.symptom ,Photochemistry ,Spin-½ ,Nitrone - Published
- 2015
33. Superoxide Generation by Granulocytes during Superior Mesenteric Artery Occlusion Shock in Rabbits
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Gian Paolo Novelli, Sandra Brunelleschi, Maria Luisa Ghinassi, Paola Livi, Roberto Fantozzi, and Loris Lisi
- Subjects
chemistry.chemical_compound ,chemistry ,business.industry ,Superoxide ,Anesthesia ,Shock (circulatory) ,medicine.artery ,Occlusion ,Medicine ,Superior mesenteric artery ,medicine.symptom ,business - Published
- 2015
34. Fluidity of Mitochondrial and Microsomal Membranes in Traumatic Shock as Studied by ESR
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Lorenzo Bordi, Gian Paolo Novelli, Giacomo Martini, Aldo Becciolini, Guglielmo Consales, and S. Porciani
- Subjects
Traumatic Shock ,Membrane ,Biochemistry ,Chemistry ,Microsome - Published
- 2015
35. Maternal total vascular resistance and concentric geometry: a key to identify uncomplicated gestational hypertension
- Author
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Barbara Vasapollo, Gian Paolo Novelli, Patrizio Pasqualetti, Alberto Galante, Domenico Arduini, and Herbert Valensise
- Subjects
Adult ,Gestational hypertension ,medicine.medical_specialty ,Pregnancy Complications, Cardiovascular ,Geometry ,Pregnancy-Induced ,Cardiovascular ,Ultrasonography, Prenatal ,Obstetric Labor ,Obstetric Labor, Premature ,Pregnancy ,Fetal distress ,medicine ,Humans ,Prenatal ,Outpatient clinic ,Prospective Studies ,Prospective cohort study ,Abruptio Placentae ,Premature ,Ultrasonography ,Observer Variation ,Fetal Growth Retardation ,Placental abruption ,Obstetrics ,business.industry ,Doppler ,Pregnancy Outcome ,Obstetrics and Gynecology ,Hypertension, Pregnancy-Induced ,Cardiomyopathies ,Case-Control Studies ,Echocardiography, Doppler ,Female ,Vascular Resistance ,medicine.disease ,Pregnancy Complications ,Blood pressure ,medicine.anatomical_structure ,Echocardiography ,Hypertension ,Vascular resistance ,Settore MED/40 - Ginecologia e Ostetricia ,business - Abstract
Objective To evaluate the prognostic impact of elevated total vascular resistance (TVR) on the outcome of pregnancy in early mild gestational hypertension (EMGH). Design Prospective observational study. Setting Data collected from women with EMGH referred to the obstetrics outpatient clinic of Tor Vergata University from June 2003 to June 2005. Population A total of 268 women with EMGH (systolic and diastolic blood pressure [BP] 140–150 mmHg and 90–99 mmHg, respectively, without significant proteinuria). Methods Women had a maternal echocardiographic examination and BP examination within 24 hours of diagnosis. From this, the TVR was calculated and the geometric pattern of the left ventricle assessed. Main outcome measures Fetal/maternal adverse outcomes (pre-eclampsia, preterm delivery, placental abruption, other maternal medical problems, fetal distress, neonatal low birthweight, admittance to neonatal intensive care unit and perinatal death). Results Ninety-two out of the 268 pregnancies showed adverse outcomes (34.3%). The best independent predictor for the composite of maternal and fetal complications was TVR (OR 64.4, 95% CI 25.9–160.1). The cutoff value was 1340 dyn seconds/cm5 with a sensitivity and a specificity of 90 and 91%, respectively. Concentric geometry of the left ventricle was also an independent predictor (OR 4.72, 95% CI 1.85–12.04). Conclusions Echocardiography could help in identifying women with EMGH who subsequently develop maternal and fetal complications, allowing a classification in high-risk (TVR > 1340 dyn seconds/cm5, concentric geometry of the left ventricle) and low-risk women (TVR < 1340 dyn seconds/cm5, nonconcentric geometry of the left ventricle) for adverse outcomes of pregnancy.
- Published
- 2006
36. Abnormal maternal cardiac function precedes the clinical manifestation of fetal growth restriction
- Author
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Fp Altomare, Alberto Galante, Gian Paolo Novelli, Barbara Vasapollo, Hcc Valensise, and Domenico Arduini
- Subjects
Cardiac function curve ,Pregnancy ,medicine.medical_specialty ,Cardiac output ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics and Gynecology ,Hemodynamics ,Umbilical artery ,General Medicine ,Stroke volume ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Reproductive Medicine ,Internal medicine ,medicine.artery ,medicine ,Vascular resistance ,Cardiology ,Small for gestational age ,Radiology, Nuclear Medicine and imaging ,business ,reproductive and urinary physiology - Abstract
Objective To compare maternal hemodynamics in women whose fetuses are small-for-gestational age (SGA) with those in women with fetal growth restriction (FGR) before manifestation of the clinical disease. Methods Thirty-five normotensive pregnant women with fetal abdominal circumference < 10th centile, normal fetal anatomy and normal umbilical artery pulsatility index (PI) underwent maternal echocardiographic examinations between 27 and 30 weeks of gestation. Pregnancies were followed until delivery and fetuses were retrospectively classified as either SGA or FGR and the maternal hemodynamic data were compared. Results Nineteen SGA and 16 FGR patients were retrospectively identified after delivery. Heart rate, stroke volume, cardiac output, left atrial function and left ventricular mass index were higher, while mean blood pressure and total vascular resistance were lower in the SGA group compared with the FGR group. A significant inverse linear correlation was found between total vascular resistance and weight centile (r = 0.83; P < 0.0001). Conclusions Mothers of SGA fetuses show hemodynamic features similar to those with physiological pregnancies suggesting that their fetuses are likely to be constitutionally small and not pathologically growth-restricted. Copyright © 2004 ISUOG. Published by John Wiley & Sons, Ltd.
- Published
- 2004
37. Fetal subcutaneous tissue thickness (SCTT) in healthy and gestational diabetic pregnancies
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Domenico Arduini, Herbert Valensise, Gian Paolo Novelli, Simona Menghini, G. Di Pierro, Giovanni Larciprete, Giorgio Mello, Elena Parretti, F. Altomare, Barbara Vasapollo, and Giulia Barbati
- Subjects
Pregnancy ,education.field_of_study ,medicine.medical_specialty ,Fetus ,Glucose tolerance test ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,Obstetrics ,business.industry ,Population ,Obstetrics and Gynecology ,Gestational age ,General Medicine ,medicine.disease ,Gestational diabetes ,Reproductive Medicine ,medicine ,Lean body mass ,Gestation ,Radiology, Nuclear Medicine and imaging ,education ,business - Abstract
Objective To determine reference values of fetal subcutaneous tissue thickness (SCTT) throughout gestation in a healthy population and to compare them with those from a population of pregnant women with gestational diabetes under standard therapy. Methods Three hundred and three women recruited from a high-risk pregnancy clinic were classified as being healthy (n = 218) or as having gestational diabetes (n = 85) on the basis of a negative or positive oral glucose tolerance test, respectively. They were enrolled into the cross-sectional study at 20 weeks' gestation. Ultrasound examinations were performed approximately every 3 weeks until delivery at term. The mid-arm fat mass and lean mass (MAFM, MALM), the mid-thigh fat mass and lean mass (MTFM, MTLM), the abdominal fat mass (AFM) and the subscapular fat mass (SSFM) were evaluated. Time-specific reference ranges were constructed from the 218 healthy women and a conventional Student's t-test was performed to compare SCTT values between the two study groups throughout gestation. Results Normal ranges, including 5th, 50th and 95th centiles of the distribution, were generated for each SCTT parameter obtained in each of the two groups of women. Significant differences were found between the two study groups at 37–40 weeks' gestation for MTFM, at 20–22 and 26–28 weeks for MTLM, at 31–34 and 35–37 weeks for MAFM, at 26–28 and 38–40 weeks for SSFM, and at 39–40 weeks for AFM, the mean residual values always being greater in gestational diabetic women than they were in the group of healthy pregnant women. Conclusions We provide gestational age-specific reference values for fetal SCTT. Fetal fat mass values, particularly in late gestation, are greater in women with gestational diabetes compared with healthy women. The reference values may have a role in assessing the influence of maternal metabolic control on fetal state. Copyright © 2003 ISUOG. Published by John Wiley & Sons, Ltd.
- Published
- 2003
38. MATERNAL CARDIOVASCULAR HAEMODYNAMICS IN NORMAL AND COMPLICATED PREGNANCIES
- Author
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Gian Paolo Novelli, Herbert Valensise, and Barbara Vasapollo
- Subjects
Cardiac function curve ,medicine.medical_specialty ,Pregnancy ,Obstetrics ,business.industry ,Obstetrics and Gynecology ,Hemodynamics ,Blood volume ,Disease ,medicine.disease ,Preeclampsia ,medicine.anatomical_structure ,Diabetes mellitus ,Placenta ,Pediatrics, Perinatology and Child Health ,medicine ,business - Abstract
Why should obstetricians study maternal cardiac function in normal and complicated pregnancies? Despite our understanding of the importance of disease processes, such as autoimmunity, impaired renal function and long-standing diabetes, on the placenta and thus pregnancy outcome, new data is emerging to suggest that early central cardiovascular adaptions are central to pregnancy success. Furthermore, successful maternal cardiovascular adaptions are a diagnostic test of longer-term cardiovascular health for the mother. The importance of the maternal ‘cardiac pump’ as the “core” of adaptation to pregnancy has increased in the last years. Studies identifying high risk patients by uterine artery Doppler waveforms in the 2nd trimester indicate that high uterine vascular impedance affects a proportion of women (resulting in severe preeclampsia) while the majority remain well. This dichotomy in maternal response is one explanation for the poor screening characteristics of uterine artery Doppler in unselected women. Women destined to develop preeclampsia with abnormal uterine artery Doppler have a latent period before the disease develops. During this phase, the heart adapts to alterations in circulating blood volume, placental implantation, and maternal peripheral vascular impedance. We believe that disordered heart function is an unavoidable part of the disease spectrum of preeclampsia, since it makes many adaptions even in the face of normal pregnancy. In this article we summarise the experience of our group and the published literature concerning maternal cardiac performance in normal and complicated pregnancies. These findings are relevant to modern day clinical practice.
- Published
- 2003
39. Are Gestational and Essential Hypertension Similar? Left Ventricular Geometry and Diastolic Function
- Author
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Alberto Galante, F. Altomare, Giovanni Larciprete, Giuseppe Di Pierro, Gian Paolo Novelli, Barbara Vasapollo, Domenico Arduini, and Herbert Valensise
- Subjects
Adult ,medicine.medical_specialty ,Left ,Diastole ,Essential hypertension ,Ventricular Function, Left ,Muscle hypertrophy ,Pre-Eclampsia ,Pregnancy ,Internal medicine ,Echocardiography ,Female ,Humans ,Hypertension ,Internal Medicine ,Ventricular Function ,Medicine ,Diastolic function ,Left ventricular geometry ,Isovolumetric contraction ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,Cardiology ,Gestation ,Settore MED/40 - Ginecologia e Ostetricia ,business - Abstract
To evaluate the differences and similarities in diastolic function and left ventricular geometry in gestational and essential hypertension.Thirty-nine consecutive gestational hypertensive pregnant women in the third trimester of gestation (GH), 40 nonpregnant essential hypertensive women (EH), and 38 normotensive nonpregnant women (N) matched for age were enrolled into the study and underwent echocardiographic and Doppler evaluations. The GH and EH patients were evaluated prior to the administration of any drug treatment.Left atrial function was similar in GH and N subjects and lower than that in EH patients. Both GH and EH patients had early left ventricular diastolic filling pattern significantly different as compared to N subjects (longer isovolumetric relaxation time, deceleration time of the E wave, and lower E wave velocity in GH and EH vs. N), whereas the late filling properties were similar in GH and N subjects with a lower A velocity, and velocity-time integral vs. EH (p0.05). Systolic fraction of the pulmonary vein flow was similar in GH and EH patients and lower in N subjects. Altered left ventricular geometry was more common in GH than in EH, whereas normotensive subjects did not show any alteration of the geometric pattern.Gestational and essential hypertension induce similar early altered diastolic filling of the left ventricle. Essential hypertension is characterized by a compensatory late filling mechanism due to an enhancement of left atrial function. Gestational hypertension is characterized by altered left ventricular geometry, which is far less common during essential hypertension.
- Published
- 2003
40. Abnormal maternal cardiac function and morphology in pregnancies complicated by intrauterine fetal growth restriction
- Author
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B. Casalino, Gian Paolo Novelli, F. Altomare, Alberto Galante, Giovanni Larciprete, Barbara Vasapollo, G. Di Pierro, Herbert Valensise, and Domenico Arduini
- Subjects
Cardiac function curve ,Cardiac output ,medicine.medical_specialty ,Fetus ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics ,Diastole ,Obstetrics and Gynecology ,Intrauterine growth restriction ,General Medicine ,Stroke volume ,medicine.disease ,Blood pressure ,medicine.anatomical_structure ,Reproductive Medicine ,embryonic structures ,Vascular resistance ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,reproductive and urinary physiology - Abstract
Objective To explore maternal cardiac function through an echocardiographic evaluation, in a group of nulliparous patients with intrauterine fetal growth restriction during the third trimester of pregnancy. Methods Twenty-one consecutive nulliparous pregnant women who had fetuses with intrauterine growth restriction (IUGR) and abnormal umbilical artery Doppler pulsatility index (PI) underwent maternal echocardiographic examination during the third trimester of gestation. The data were then compared with those obtained from 21 normal nulliparous women who had fetuses with an estimated fetal weight > 10th percentile and a normal umbilical artery Doppler PI who were considered as the control group. Results Heart rate was slightly lower in the IUGR group, whereas blood pressure and total vascular resistance were higher compared with the control subjects. End-diastolic volume, stroke volume and cardiac output were lower in the IUGR patients compared with normal patients. The IUGR group had smaller left atrial maximal dimensions and greater left atrial minimal areas compared with the control subjects. Left atrial function was depressed in the IUGR group. A smaller left ventricular mass was present in the IUGR patients compared with the control subjects. Isovolumetric relaxation time (IVRT) was prolonged in the IUGR patients compared with the controls. Conclusions The absence of a ‘correct’ maternal cardiovascular compensatory response to abnormal trophoblastic invasion, might be one of the factors that slowly determine the conditions of reduced placental perfusion and eventually of the development of fetal growth restriction.
- Published
- 2002
41. Sevoflurane low-flow anaesthesia: best strategy to reduce Compound A concentration
- Author
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M. Pacenti, F. Marini, Gian Paolo Novelli, A Di Filippo, L. Focardi, and Stefano Dugheri
- Subjects
Compound a ,Potassium hydroxide ,business.industry ,Sodium ,chemistry.chemical_element ,General Medicine ,Sevoflurane ,chemistry.chemical_compound ,Anesthesiology and Pain Medicine ,Soda lime ,chemistry ,Sodium hydroxide ,Anesthesia ,Low flow anaesthesia ,Carbon dioxide ,Medicine ,business ,Nuclear chemistry ,medicine.drug - Abstract
Background: To define the best strategy to reduce Compound A production in Sevoflurane low-flow anaesthesia by experiments in vitro and in vivo of different absorbers and different anaesthesia machines. Methods:In vitro Compound A has been measured at 45°C in vitro following Sevoflurane interactions with potassium hydroxide, sodium hydroxide, soda lime, Dragersorb 800 Plus and Amsorb, a new absorber that does not contain sodium or potassium hydroxide. In vivo Compound A concentration in the anaesthesia circuit (inspiratory branch) has been measured using an indirect sampling method through absorber vials (SKC) with active coal granules, during low flows (500 ml/min) general anaesthesia using soda lime, Dragersorb 800 Plus or Amsorb as absorber. Compound A was also measured during low flows (500 ml/min) general anaesthesia using as carbon dioxide absorber soda lime with different anaesthesia machines. Results:In vitro at 45°C Compound A concentration with soda lime and Dragersorb 800 Plus was about 10 times higher than with Amsorb. In vivo the Compound A concentrations in the inspiratory branch of the circuit were lower in the group with Amsorb. Conclusion: The Compound A production is minimal with Amsorb as carbon dioxide absorber.
- Published
- 2002
42. Maternal diastolic function in asymptomatic pregnant women with bilateral notching of the uterine artery waveform at 24 weeks' gestation: a pilot study
- Author
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Barbara Vasapollo, Carlo Romanini, Domenico Arduini, Gian Paolo Novelli, Alberto Galante, Maria Elisabetta Romanini, Giovanni Larciprete, and Herbert Valensise
- Subjects
Gestational hypertension ,medicine.medical_specialty ,Pregnancy ,Fetus ,Radiological and Ultrasound Technology ,Obstetrics ,business.industry ,Diastole ,Obstetrics and Gynecology ,General Medicine ,medicine.disease ,Asymptomatic ,Reproductive Medicine ,medicine.artery ,medicine ,Gestation ,Ventricular outflow tract ,Radiology, Nuclear Medicine and imaging ,medicine.symptom ,business ,Uterine artery - Abstract
Objective To study second-trimester maternal cardiac adaptation in asymptomatic patients at risk, on the basis of abnormal uterine artery Doppler, for the development of gestational hypertension or having a small-for-gestational age fetus. Fetal and maternal outcomes were verified at the end of pregnancy. Methods Thirty-six normotensive women with abnormal uterine artery waveforms underwent maternal echocardiographic examination at 24 weeks' gestation. Results Twenty-one women (58.3%) subsequently showed normal outcome; 12 patients developed gestational hypertension (33.3%) and three (8.3%) had small-for-gestational age newborns. Left ventricular outflow tract, left ventricular diastolic dimensions and atrial and ventricular function were significantly lower in the pathological outcome group. Diastolic function parameters were significantly different between the two groups: peak mitral E-wave and A-wave and A-wave duration showed lower values in the pathological outcome group. Isovolumetric relaxation time of the left ventricle was significantly longer in the pathological outcome group. The prevalence of an altered geometric pattern was 14.3% (3/21) in the normal and 80% (12/15) in the pathological outcome groups (P < 0.001). Conclusions Women who subsequently develop a complication of pregnancy tend to display abnormal cardiac adaptation. An abnormal placentation process, expressed by an elevated resistance index and the presence of notches in the uterine artery waveform, are likely to cause an adaptative mechanism involving the whole cardiovascular system. A pathological outcome of pregnancy is associated with the failure of this process. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
- Published
- 2001
43. Maternal cardiac systolic and diastolic function: relationship with uteroplacental resistances. A Doppler and echocardiographic longitudinal study
- Author
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Alberto Galante, M. Borzi, Herbert Valensise, Carlo Romanini, Domenico Arduini, Barbara Vasapollo, and Gian Paolo Novelli
- Subjects
Cardiac function curve ,Cardiac output ,medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,Diastole ,Obstetrics and Gynecology ,General Medicine ,Stroke volume ,medicine.disease ,Preload ,Reproductive Medicine ,Afterload ,Internal medicine ,medicine ,Cardiology ,Left atrial enlargement ,Radiology, Nuclear Medicine and imaging ,Systole ,business - Abstract
Objective To test the hypothesis of the existence of a relationship between central and peripheral hemodynamic parameters by the longitudinal evaluation of maternal echocardiographic and uteroplacental resistance modifications during normal pregnancy. Methods Forty-three healthy normotensive primigravidae were evaluated at 12 ± 1, 21 ± 1, and 33 ± 1 weeks of gestation with uterine artery color Doppler and maternal echocardiographic examinations to identify morphologic, systolic, and diastolic variables. Results Cardiac output and stroke volume significantly increased during pregnancy. Uterine resistance index (RI) decreased from the first to the second trimesters (0.72 ± 0.10 versus 0.54 ± 0.09, P < 0.001). Left atrial dimensions increased during pregnancy (33.8 ± 1.9 cm, 38.1 ± 1.8 cm, 39.3 ± 2.1 cm, P < 0.001). Left atrial function also increased. Left ventricular mass increased (132 ± 18 g, 162 ± 16 g, 174 ± 27 g, P < 0.001). Diastolic function parameters showed significant modifications: E wave velocity and E/A ratio decreased; A wave velocity and deceleration time of the E wave (DtE) increased; the left ventricular isovolumetric relaxation time (IVRT) decreased significantly (88.7 ± 6.7 ms, 75.6 ± 7.7 ms, 71.1 ± 5.0 ms, P < 0.001) showing a correlation with left atrial dimensions and RI (r = −0.38, r = 0.47, respectively; P < 0.001). Conclusions Diastolic cardiac function varies during pregnancy. A relationship between preload (left atrial enlargement), afterload (RI reduction), morphologic, and diastolic function modifications (IVRT reduction, DtE prolongation) appears to exist as a consequence of the hemodynamic modifications which occur during physiologic pregnancy. Diastolic function analysis maybe useful to identify women who fully adapt to pregnancy, and to understand the mechanisms that might be involved in women who show abnormal uterine artery Doppler waveforms. Copyright © 2000 International Society of Ultrasound in Obstetrics and Gynecology
- Published
- 2000
44. P51. Screening for preeclampsia in the first trimester: A reduced fat mass increases the risk in normo BMI patients
- Author
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Giulia Gagliardi, Damiano Lo Presti, I. Pisani, Gian Paolo Novelli, Herbert Valensise, Angela Andreoli, G. M. Tiralongo, R.L. Scala, and Barbara Vasapollo
- Subjects
Cardiac output ,medicine.medical_specialty ,Pregnancy ,Complications of pregnancy ,business.industry ,Obstetrics and Gynecology ,medicine.disease ,Preeclampsia ,Blood pressure ,medicine.anatomical_structure ,Endocrinology ,Internal medicine ,Internal Medicine ,Vascular resistance ,medicine ,Cardiology ,Population study ,Gestation ,business - Abstract
Introduction Maternal cardiovascular system adapts to pregnancy thanks to complex physiological mechanisms that involve cardiac output, total vascular resistance (TVR) and water body distribution. Abnormalities of this adaptive mechanism are connected with hypertensive disorders and foetal growth restriction. Moreover, maternal serum PAPP-A is considered a biochemical marker extensively used for the first trimester screening of PE. Objective To identify patients at high risk of developing hypertensive complications of pregnancy during the first trimester through the use of non-invasive methods such as USCOM (Ultrasonic Cardiac Output Monitor), bioimpedance and biochemical marker. Materials and Methods We enrolled 96 healthy normotensive women with normal Body Mass Index during the first trimester of pregnancy (from 11+0 to 13+6weeks of gestation) obtaining all measurements with the USCOM system, Bioimpedance and collecting MoM values of PAPP-A Results Patients were divided into two groups: Group A ( n =54) with TVR n =42) with TVR >1200dynesseccm −5 . 10% ( n =10) of our study population developed pregnancy complications as IUGR and hypertensive disorders. In this group 81% of patients presented high TVR values and 37% PAPP-A p Conclusions High TVR and lower Fat Mass during the first weeks of gestation may be an early marker of cardiovascular maladaptation more than the evaluation of PAPP-A values and blood pressure assessment.
- Published
- 2015
45. Vitamin E protects human skeletal muscle from damage during surgical ischemia-reperfusion
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Gian Paolo Novelli, Lucia Formigli, Alessandro Quattrone, Laura Papucci, Sergio Capaccioli, Elena Gandini, Chiara Adembri, Sandra Zecchi Orlandini, Carlo Pratesi, and Lidia Ibba Manneschi
- Subjects
Male ,medicine.medical_specialty ,Neutrophils ,Premedication ,medicine.medical_treatment ,Ischemia ,Aortic aneurysm ,chemistry.chemical_compound ,Malondialdehyde ,Internal medicine ,Edema ,medicine.artery ,medicine ,Humans ,Vitamin E ,Muscle, Skeletal ,Aged ,Leg ,Aorta ,business.industry ,Skeletal muscle ,General Medicine ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Endocrinology ,chemistry ,Reperfusion Injury ,medicine.symptom ,business ,Infiltration (medical) ,Aortic Aneurysm, Abdominal - Abstract
Purpose The biochemical and morphological alterations induced in lower limb skeletal muscle by ischemia-reperfusion (I–R) during aortic surgery and the effect of vitamin E pretreatment were investigated. Methods Two groups of patients undergoing aortic aneurysm resection, one untreated and one treated with vitamin E, were examined. Quadricep muscle biopsies were taken after induction of anesthesia, at the end of ischemia, and after reperfusion. The malondialdehyde (MDA) content and morphology of biopsies were examined to assess peroxidative processes. Results Ischemia did not induce an increase in MDA content but did increase neutrophil infiltration in muscle fibers of untreated patients. Reperfusion led to a significant increase in MDA content and to intermyofibrillar edema and mitochondrial swelling. The MDA content was not increased during ischemia and neutrophil infiltration was minimal in vitamin E treated patients. At reperfusion, the MDA content, the ultrastructural injuries and neutrophil infiltration were significantly reduced by the treatment. Conclusions Vitamin E is effective in reducing the oxidative muscle damage occurring after a period of I–R.
- Published
- 1997
46. Postpartum cerebellar infarction and haemolysis, elevated liver enzymes, low platelet (HELLP) syndrome
- Author
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Herbert Valensise, P.M. Rossini, Barbara Vasapollo, Francesco Tibuzzi, Fabrizio Vernieri, Gian Paolo Novelli, and Claudia Altamura
- Subjects
Adult ,Brain Infarction ,HELLP Syndrome ,medicine.medical_specialty ,Brain Stem Infarctions ,Ataxia ,HELLP syndrome ,Infarction ,Dermatology ,Pre-Eclampsia ,Cerebellar Diseases ,Pregnancy ,Risk Factors ,Cerebellum ,Internal medicine ,Dysmetria ,Vertebrobasilar Insufficiency ,Humans ,Medicine ,Genetic Predisposition to Disease ,Stroke ,Methylenetetrahydrofolate Reductase (NADPH2) ,biology ,business.industry ,General Medicine ,medicine.disease ,Haemolysis ,Magnetic Resonance Imaging ,Psychiatry and Mental health ,Anesthesia ,Methylenetetrahydrofolate reductase ,Cardiology ,biology.protein ,Female ,Prothrombin ,Neurology (clinical) ,medicine.symptom ,business - Abstract
Pregnancy is considered to be a hypercoagulable state per se with an increased risk for cerebrovascular events, however cerebellar infarction has been rarely described in pregnant women. A nulliparous pre-eclamptic woman at 25 weeks' gestation was submitted to an echocardiographic exam that showed an impaired cardiac structure and function. After 2 h, the patient underwent caesarean section for diagnosis of haemolysis, elevated liver enzymes, low platelet (HELLP) syndrome. Afterwards her platelet count raised, and eight days later she developed nystagmus, ataxia, dysmetria and motor deficit in the right limbs and sensory impairment in the right side of the face and in the left limbs. Cerebral magnetic resonance imaging (MRI) demonstrated a right cerebellar and median posterior bulbar infarction. Colour-coded sonography of cerebral vessels showed an occlusion of the right vertebral artery. Coagulation pattern analysis evidenced double heterozygosis of the methylenetetrahydrofolate reductase (MTHFR) gene and single mutation of the prothrombin gene. This case report gives evidence of the importance of considering the different risk factors involved in stroke occurrence during pregnancy.
- Published
- 2005
47. Oxygen radicals in experimental shock
- Author
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Gian Paolo Novelli
- Subjects
Male ,Pathology ,medicine.medical_specialty ,Free Radicals ,Membrane Fluidity ,Radical ,chemistry.chemical_element ,Pharmacology ,Critical Care and Intensive Care Medicine ,Oxygen ,Animals ,Medicine ,Chi-Square Distribution ,Spin trapping ,business.industry ,Microcirculation ,Rats, Inbred Strains ,Shock ,Survival Analysis ,Pathophysiology ,Rats ,Membrane ,chemistry ,Shock (circulatory) ,Circulatory system ,Microsome ,Nitrogen Oxides ,Lipid Peroxidation ,medicine.symptom ,business - Abstract
Circulatory shock is accepted as a consequence of an acute oxygen radical overgeneration. Spin-trapping nitrones inactivate free radicals by forming relatively stable adducts.Three spin-trapping nitrones (N-tert-phenyl-butyl-nitrone; alpha-4-pyridyl-oxide-N-tert-butyl-nitrone; 5-5,dimethyl,1,pyrroline-N-oxide) were tested regarding their role in the pathophysiology and evolution of circulatory shock in rats.Prospective, randomized, controlled trial of spin-trapping nitrones in rats experiencing three different models of circulatory shock.In the first group, endotoxic, traumatic, and mesenteric artery occlusion shock (all 100% lethal in control experiments) was prevented by the ip administration of N-tert-phenyl-butyl-nitrone (150 mg/kg); alpha-4-pyridyl-oxide-N-tert-butyl-nitrone (100 mg/kg); or 5-5,dimethyl,1,pyrroline-N-oxide (100 mg/kg). However, the evolution of shock was unaffected by the same compounds when all three nitrones had been previously inactivated by exposure to light and air. In the second group, microcirculatory derangements that were provoked by endotoxin and were observed in the mesocecum of rats were completely prevented by pretreatment with either peritoneal administration of each of the three nitrones or by their topical application to the microscopic field. While the rats survived after systemic treatment, those rats receiving topical nitrones died from endotoxic shock. In the third group, cell-membrane stiffness (a sign of peroxidative damage) was measured by spin-probes and electron-spin resonance in mitochondrial and microsomal membranes. Cell membranes obtained from shocked rats were more rigid than those membranes of controls. However, the membranes obtained from rats that were submitted to trauma or endotoxin after pretreatment with N-tert-phenyl-butyl-nitrone had normal stiffness. The fourth group of experiments was carried out to quantify ethane (one of the final products of lipid peroxidation) in the exhaled air of shocked rats. Ethane concentrations increased in direct proportion to the worsening of the condition. Pretreatment of the rats with N-tert-phenyl-butyl-nitrone prevented such an increase.Since nitrones are effective inactivators of oxygen-radicals, or of their secondary radicals, these data confirm the relationship between oxygen-radicals and experimental shock. The therapeutic use of spin-trapping nitrones should possibly be considered for future use in shock.
- Published
- 1992
48. Exogenous glutathione increases endurance to muscle effort in mice
- Author
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Gian Paolo Novelli, Silvia Falsini, and G. Bracciotti
- Subjects
Male ,Pharmacology ,medicine.medical_specialty ,Antioxidant ,Free Radicals ,Muscle fatigue ,Ratón ,Muscles ,medicine.medical_treatment ,Physical Exertion ,Physical exercise ,Biological activity ,Free Radical Scavengers ,Glutathione ,Oxygen ,Mice ,chemistry.chemical_compound ,Endocrinology ,chemistry ,Repeated doses ,Internal medicine ,medicine ,Animals ,Intracellular - Abstract
Many data suggest an involvement of toxic oxygen radicals in the termination of endurance to muscle fatigue. Being reduced glutathione (GSH), an efficient intracellular physiological antioxidant, experiments have been performed to discover whether exogenous GSH modifies endurance to exhaustive swimming in mice. GSH was administered to mice as a single dose (250, 500, 750 or 1000 mg/kg i.p.) or as repeated doses (250 mg/kg i.p. once a day during 7 days) 10 min before a swimming test to exhaustion. GSH 500, 750 and 1000 mg/kg, increased endurance to swimming by respectively 102.4%, 120.0% and 140.7%. GSH 250 mg/kg did not affect endurance when injected in a single dose but increased it by 103.7% when injected once a day for 7 days.
- Published
- 1991
49. Early and late preeclampsia: two different maternal hemodynamic states in the latent phase of the disease
- Author
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Giulia Gagliardi, Herbert Valensise, Gian Paolo Novelli, and Barbara Vasapollo
- Subjects
Cardiac function curve ,Adult ,medicine.medical_specialty ,Pregnancy Trimester, Third ,Hemodynamics ,Blood Pressure ,Disease ,Asymptomatic ,Preeclampsia ,Body Mass Index ,Pre-Eclampsia ,Pregnancy ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Placental Circulation ,Cardiac Output ,business.industry ,Uterus ,Case-control study ,medicine.disease ,Prognosis ,Endocrinology ,Echocardiography ,Case-Control Studies ,Pregnancy Trimester, Second ,Cardiology ,Gestation ,Female ,Hypertrophy, Left Ventricular ,Vascular Resistance ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Because early and late preeclampsia (PE) are thought to be different disease entities, we compared maternal cardiac function at 24 weeks gestation in a group of normotensive asymptomatic patients with subsequent development of early (140/90+proteinuria >300 mg/dL) to detect possible early differences in the hemodynamic state. A group of 1345 nulliparous normotensive asymptomatic women underwent at 24 weeks gestation uterine artery Doppler evaluation and maternal echocardiography calculating total vascular resistance. In the subsequent follow-up 107 patients showed PE: 32 patients had late and 75 had early PE. Five of 32 patients with late PE and 45 of 75 patients with early PE had bilateral notching of the uterine artery at 24 weeks (15.6% versus 60.0%; P −5 , and cardiac output was 4.49±1.09 versus 8.96±1.83 L in early versus late PE ( P 2 ; P
- Published
- 2008
50. PP065. Assessment of total vascular resistance and total body water in normotensive women during the first trimester of pregnancy in order to predict hypertensive complications
- Author
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R.L. Scala, Herbert Valensise, Giulia Gagliardi, I. Pisani, Damiano Lo Presti, Barbara Vasapollo, G. M. Tiralongo, Gian Paolo Novelli, and Angela Andreoli
- Subjects
medicine.medical_specialty ,Pregnancy ,Cardiac output ,Complications of pregnancy ,business.industry ,Body water ,Obstetrics and Gynecology ,Hemodynamics ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Internal medicine ,Internal Medicine ,medicine ,Cardiology ,Vascular resistance ,Settore MED/40 - Ginecologia e Ostetricia ,Observational study ,business ,Lead (electronics) - Abstract
In pregnancy there is an increase in maternal cardiac output (CO) and a reduction in total vascular resistance (TVR). Abnormalities of this adaptive mechanisms lead to numerous disorders of pregnancy. Moreover the mother's body water composition undergoes important modifications in total body water (TBW), extracellular and intracellular body water (EBW, IBW).Aim of the study is to identify a group of patients at high risk of developing hypertensive complications of pregnancy in frist trimester.To investigate hemodynamic changes and distribution of body water during the frist trimester of pregnancy, we conducted an observational study. We evaluated CO, TVR and Time Flow Corrected (TFc) with the USCOM system, a non invasive method. Patients were, also, subjected to BIA (Body Impedance Assessment).We enrolled 120 healthy pregnant women. 20 patients, were excluded for bad signal. Absolute values of haemodynamic and body impedance measures are shown in Fig. 1. Patients were divided in two groups:Group A with TVR1200 dyne and Group B with TVR1200 dyne. CO values were higher in group B. There wasn't significant differences in TBW, haematocrit, TFc and WBI (water balance index: TBW/Hct) between the two groups.Our results show that at costant values of TBW, Hct and WBI,we can find difference in term of TVR and CO in the first trimester of pregnancy. These parameters may improve the accuracy of screening in clinical practice.
- Published
- 2013
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