1.
Dostopno za:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
2.
ASPRE trial: performance of screening for preterm pre‐eclampsia
Rolnik, D. L.; Wright, D.; Poon, L. C. Y. ...
Ultrasound in obstetrics & gynecology,
October 2017, Letnik:
50, Številka:
4
Journal Article
ABSTRACT
Objective
To examine the performance of screening for preterm and term pre‐eclampsia (PE) in the study population participating in the ASPRE (Combined Multimarker Screening and Randomized ...
Patient Treatment with Aspirin for Evidence‐Based Preeclampsia Prevention) trial.
Methods
This was a prospective first‐trimester multicenter study on screening for preterm PE in 26 941 singleton pregnancies by means of an algorithm that combines maternal factors, mean arterial pressure, uterine artery pulsatility index and maternal serum pregnancy‐associated plasma protein‐A and placental growth factor at 11–13 weeks' gestation. Eligible women with an estimated risk for preterm PE of > 1 in 100 were invited to participate in a double‐blind trial of aspirin (150 mg per day) vs placebo from 11–14 until 36 weeks' gestation, which showed that, in the aspirin group, the incidence of preterm PE was reduced by 62%. In the screened population, the detection rates (DRs) and false‐positive rates (FPRs) for delivery with PE < 37 and ≥ 37 weeks were estimated after adjustment for the effect of aspirin in those receiving this treatment. We excluded 1144 (4.2%) pregnancies because of loss to follow‐up or study withdrawal (n = 716), miscarriage (n = 243) or termination (n = 185).
Results
The study population of 25 797 pregnancies included 180 (0.7%) cases of preterm PE, 450 (1.7%) of term PE and 25 167 (97.6%) without PE. In combined first‐trimester screening for preterm PE with a risk cut‐off of 1 in 100, the DR was 76.7% (138/180) for preterm PE and 43.1% (194/450) for term PE, at screen‐positive rate of 10.5% (2707/25 797) and FPR of 9.2% (2375/25 797).
Conclusion
The performance of screening in the ASPRE study was comparable with that of a study of approximately 60 000 singleton pregnancies used for development of the algorithm; in that study, combined screening detected 76.6% of cases of preterm PE and 38.3% of term PE at a FPR of 10%. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Resumen
Ensayo ASPRE: el comportamiento del cribado de preeclampsia pretérmino
Objetivo
Estudiar el comportamiento del cribado de pre‐eclampsia pretérmino y a término (PE) en la población de estudio que participa en el ensayo ASPRE (Cribado combinado basado en evidencia mediante múltiples marcadores y tratamiento aleatorizado de la paciente con aspirina para la prevención de preeclampsia).
Métodos
Se trata de un estudio multicéntrico prospectivo de primer trimestre sobre el cribado de PE pretérmino en 26 941 embarazos con feto único, mediante un algoritmo que combina factores maternos como la presión arterial promedio, el índice de pulsatilidad de la arteria uterina y la proteína plasmática A del suero materno asociada al embarazo y el factor de crecimiento de la placenta a las 11‐13 semanas de gestación. Se invitó a las mujeres con posibilidades de ser elegidas por tener un riesgo estimado de PE pretérmino >1 entre 100 a participar en un ensayo doble ciego de aspirina (150 mg por día) versus un placebo, desde las semanas 11‐14 a las 36 semanas de gestación, que resultó en una reducción de la incidencia de PE prematura de un 62% en el grupo que tomó aspirina. En la población en la que se hizo el cribado, después del ajuste del efecto de la aspirina en las mujeres que recibieron este tratamiento, se estimaron las tasas de detección (TD) y las tasas de falsos positivos (TFP) para el parto con PE <37 y >37 semanas. Se excluyeron 1144 (4,2%) embarazos debido a falta de seguimiento o abandono del estudio (n = 716), aborto (n = 243) o terminación (n = 185).
Resultados
La población estudiada de 25 797 embarazos incluyó 180 (0,7%) casos de PE pretérmino, 450 (1,7%) de PE a término y 25 167 (97,6%) sin PE. En el cribado combinado del primer trimestre para PE pretérmino con un límite de riesgo de 1 entre 100, la TD fue del 76,7% (138/180) para PE pretérmino y 43,1% (194/450) para PE a término, con una tasa positiva del cribado del 10,5% (2707/25797) y una TFP del 9,2% (2375/25797).
Conclusión
El comportamiento del cribado en el estudio ASPRE fue comparable con el de un estudio de aproximadamente 60 000 embarazos con feto único utilizados para el desarrollo del algoritmo; en ese estudio, el cribado combinado detectó el 76,6% de los casos de PE pretérmino y el 38,3% de los de PE a término con una TFP del 10%.
摘要
ASPRE试验:对早产子痫前期的筛查能力
目的
检测在ASPRE(多种标志物联合筛查和随机患者阿斯匹林治疗,进行循证子痫前期预防)试验的研究人群中对早产和足月子痫前期(pre‐eclampsia,PE)的筛查能力。
方法
本研究为一项前瞻性孕早期多中心研究,通过一种在孕11~13周时联合母体因素、平均动脉压、子宫动脉搏动指数以及母体血清妊娠相关血浆蛋白A和胎盘生长因子的方法对26 941例单胎妊娠进行早产PE筛查。符合纳入标准的估计早产PE风险>1%的孕妇从孕11~14周起参加阿斯匹林(150 mg/day)和安慰剂双盲试验,直至孕36周,结果显示,阿斯匹林组早产PE发生率降低62%。筛查人群中,校正接受治疗的孕妇中阿斯匹林的作用后,估计PE<37周和≥37周分娩的检出率(detection rates,DRs)和假阳性率(false‐positive rates,FPRs)。由于失访或者退出研究(n=716)、流产(n=243)或终止妊娠(n=185),排除1144例(4.2%)孕妇。
结果
研究人群为25 797例孕妇,包括180例(0.7%)早产PE,450例(1.7%)足月PE,25 167例(97.6%)无PE孕妇。孕早期联合筛查早产PE在风险截断值为1%时,早产PE的DR为76.7%(138/180),足月PE的DR为43.1%(194/450),筛查阳性率为10.5%(2707/25 797),FPR为9.2%(2375/25 797)。
结论
ASPRE研究中筛查能力与用于开发这种方法的基于约60 000例单胎妊娠的研究相似;后者在FPR为10%时联合筛查检出76.6%的早产PE和38.3%的足月PE。
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več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
3.
Screening for pre‐eclampsia by maternal factors and biomarkers at 11–13 weeks' gestation
Tan, M. Y.; Syngelaki, A.; Poon, L. C. ...
Ultrasound in obstetrics & gynecology,
August 2018, Letnik:
52, Številka:
2
Journal Article
ABSTRACT
Objective
To examine the performance of screening for early, preterm and term pre‐eclampsia (PE) at 11–13 weeks' gestation by maternal factors and combinations of mean arterial pressure ...
(MAP), uterine artery (UtA) pulsatility index (PI), serum placental growth factor (PlGF) and serum pregnancy‐associated plasma protein‐A (PAPP‐A).
Methods
The data for this study were derived from three previously reported prospective non‐intervention screening studies at 11 + 0 to 13 + 6 weeks' gestation in a combined total of 61 174 singleton pregnancies, including 1770 (2.9%) that developed PE. Bayes' theorem was used to combine the prior distribution of gestational age at delivery with PE, obtained from maternal characteristics, with various combinations of biomarker multiples of the median (MoM) values to derive patient‐specific risks of delivery with PE at < 37 weeks' gestation. The performance of such screening was estimated.
Results
In pregnancies that developed PE, compared to those without PE, the MoM values of UtA‐PI and MAP were increased and those of PAPP‐A and PlGF were decreased, and the deviation from normal was greater for early than late PE for all four biomarkers. Combined screening by maternal factors, UtA‐PI, MAP and PlGF predicted 90% of early PE, 75% of preterm PE and 41% of term PE, at a screen‐positive rate of 10%; inclusion of PAPP‐A did not improve the performance of screening. The performance of screening depended on the racial origin of the women; on screening by a combination of maternal factors, MAP, UtA‐PI and PlGF and using a risk cut‐off of 1 in 100 for PE at < 37 weeks in Caucasian women, the screen‐positive rate was 10% and detection rates for early, preterm and term PE were 88%, 69% and 40%, respectively. With the same method of screening and risk cut‐off in women of Afro‐Caribbean racial origin, the screen‐positive rate was 34% and detection rates for early, preterm and term PE were 100%, 92% and 75%, respectively.
Conclusion
Screening by maternal factors and biomarkers at 11–13 weeks' gestation can identify a high proportion of pregnancies that develop early and preterm PE. © 2018 Crown copyright. Ultrasound in Obstetrics & Gynecology © 2018 ISUOG.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
4.
Accuracy of competing‐risks model in screening for pre‐eclampsia by maternal factors and biomarkers at 11–13 weeks' gestation
O'Gorman, N.; Wright, D.; Poon, L. C. ...
Ultrasound in obstetrics & gynecology,
June 2017, 2017-Jun, 2017-06-00, 20170601, Letnik:
49, Številka:
6
Journal Article
ABSTRACT
Objective
To examine the diagnostic accuracy of a previously developed model for prediction of pre‐eclampsia (PE) by a combination of maternal factors and biomarkers at 11–13 weeks' ...
gestation.
Methods
This was a prospective first‐trimester multicenter study of screening for PE in 8775 singleton pregnancies. A previously published algorithm was used for the calculation of patient‐specific risk of PE in each individual. The detection rates (DRs) and false‐positive rates (FPRs) for delivery with PE < 32, < 37 and ≥ 37 weeks were estimated and compared with those for the dataset used for development of the algorithm.
Results
In the study population, 239 (2.7%) cases developed PE, of which 17 (0.2%), 59 (0.7%) and 180 (2.1%) developed PE < 32, < 37 and ≥ 37 weeks, respectively. With combined screening by maternal factors, mean arterial pressure, uterine artery pulsatility index and serum placental growth factor, the DR was 100% (95% CI, 80–100%) for PE < 32 weeks, 75% (95% CI, 62–85%) for PE < 37 weeks and 43% (95% CI, 35–50%) for PE ≥ 37 weeks, at a 10% FPR. These DRs were similar to the estimated rates for the dataset used for development of the model: 89% (95% CI, 79–96%) for PE < 32 weeks, 75% (95% CI, 70–80%) for PE < 37 weeks and 47% (95% CI, 44–51%) for PE ≥ 37 weeks.
Conclusion
Assessment of a combination of maternal factors and biomarkers at 11–13 weeks provides effective first‐trimester screening for preterm PE. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
5.
Why did the Elites Extend the Suffrage? Democracy and the Scope of Government, with an Application to Britain's “Age of Reform”
Lizzeri, Alessandro; Persico, Nicola
The Quarterly journal of economics,
05/2004, Letnik:
119, Številka:
2
Journal Article
A new rationale is presented for why an elite may want to expand the franchise even in the absence of threats to the established order. Expanding the franchise can turn politicians away from ...
particularistic politics based on ad personam redistribution within the elite and foster competition based on programs with diffuse benefits. If these programs are valuable, a majority of the elite votes in favor of an extension of the franchise despite the absence of a threat from the disenfranchised. We argue that the evolution of public spending and of political competition in nineteenth century Britain is consistent with our model.
več
Dostopno za:
BFBNIB, INZLJ, IZUM, KILJ, NMLJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK, ZRSKP
6.
Role of magnetic resonance imaging in fetuses with mild or moderate ventriculomegaly in the era of fetal neurosonography: systematic review and meta‐analysis
Di Mascio, D.; Sileo, F. G.; Khalil, A. ...
Ultrasound in obstetrics & gynecology,
August 2019, Letnik:
54, Številka:
2
Journal Article
ABSTRACT
Objectives
To report the rate of additional central nervous system (CNS) anomalies detected exclusively on prenatal magnetic resonance imaging (MRI) in fetuses diagnosed with isolated mild ...
or moderate ventriculomegaly (VM) on ultrasound, according to the type of ultrasound protocol adopted (dedicated neurosonography vs standard assessment of the fetal brain), and to explore whether the diagnostic performance of fetal MRI in detecting such anomalies is affected by gestational age at examination and laterality and degree of ventricular dilatation.
Methods
MEDLINE, EMBASE, CINAHL and
Clinicaltrials.gov were searched for studies reporting on the prenatal MRI assessment of fetuses diagnosed with isolated mild or moderate VM (ventricular dilatation of 10–15 mm) on ultrasound. Additional anomalies detected only on MRI were classified as callosal, septal, posterior fossa, white matter, intraventricular hemorrhage, cortical, periventricular heterotopia, periventricular cysts or complex malformations. The rate of additional anomalies was compared between fetuses diagnosed on dedicated neurosonography, defined as a detailed assessment of the fetal brain, according to the International Society of Ultrasound in Obstetrics and Gynecology guidelines, and those diagnosed on standard fetal brain assessment. The rate of additional CNS anomalies missed on prenatal MRI and detected only at birth was calculated and compared between fetuses that had early (at or before 24 weeks' gestation) and those that had late (after 24 weeks) MRI. Subanalysis was performed according to the laterality (uni‐ vs bilateral) and degree (mild vs moderate, defined as ventricular dilatation of 10–12 and 13–15 mm, respectively) of ventricular dilatation. Whether MRI assessment led to a significant change in prenatal management was explored. Random‐effects meta‐analysis of proportions was used.
Results
Sixteen studies (1159 fetuses) were included in the systematic review. Overall, MRI detected an anomaly not identified on ultrasound in 10.0% (95% CI, 6.2–14.5%) of fetuses. However, when stratifying the analysis according to the type of ultrasound assessment, the rate of associated anomalies detected only on MRI was 5.0% (95% CI, 3.0–7.0%) when dedicated neurosonography was performed compared with 16.8% (95% CI, 8.3–27.6%) in cases that underwent a standard assessment of the fetal brain in the axial plane. The overall rate of an additional anomaly detected only at birth and missed on prenatal MRI was 0.9% (95% CI, 0.04–1.5%) (I2, 0%). There was no difference in the rate of an associated anomaly detected only after birth when fetal MRI was carried out before, compared with after, 24 weeks of gestation (P = 0.265). The risk of detecting an associated CNS abnormality on MRI was higher in fetuses with moderate than in those with mild VM (odds ratio, 8.1 (95% CI, 2.3–29.0); P = 0.001), while there was no difference in those presenting with bilateral, compared with unilateral, dilatation (P = 0.333). Finally, a significant change in perinatal management, mainly termination of pregnancy owing to parental request, following MRI detection of an associated anomaly, was observed in 2.9% (95% CI, 0.01–9.8%) of fetuses undergoing dedicated neurosonography compared with 5.1% (95% CI, 3.2–7.5%) of those having standard assessment.
Conclusions
In fetuses undergoing dedicated neurosonography, the rate of a CNS anomaly detected exclusively on MRI is lower than that reported previously. Early MRI has an excellent diagnostic performance in identifying additional CNS anomalies, although the findings from this review suggest that MRI performed in the third trimester may be associated with a better detection rate for some types of anomaly, such as cortical, white matter and intracranial hemorrhagic anomalies. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
7.
Position of the choroid plexus of the fourth ventricle in first‐ and second‐trimester fetuses: a novel approach to early diagnosis of cystic posterior fossa anomalies
Volpe, P.; De Robertis, V.; Volpe, G. ...
Ultrasound in obstetrics & gynecology,
October 2021, 2021-Oct, 2021-10-00, 20211001, Letnik:
58, Številka:
4
Journal Article
ABSTRACT
Objective
To describe the sonographic appearance and position of the choroid plexus of the fourth ventricle (4V‐CP) between 12 and 21 weeks' gestation in normal fetuses and in fetuses with ...
Dandy–Walker malformation (DWM) or Blake's pouch cyst (BPC).
Methods
The study population comprised 90 prospectively recruited normal singleton pregnancies and 41 pregnancies identified retrospectively from our institutional database that had a suspected posterior fossa anomaly at 12–13 weeks' gestation based on the ultrasound finding of abnormal hindbrain spaces. In all cases the final diagnosis was confirmed by prenatal and/or postnatal magnetic resonance imaging or postmortem examination. All pregnancies underwent a detailed ultrasound assessment, including a dedicated examination of the posterior fossa, at 12–13 weeks, 15–16 weeks and 20–21 weeks of gestation. Two‐dimensional ultrasound images of the midsagittal and coronal views of the brain through the posterior fontanelle and three‐dimensional volume datasets were obtained. Multiplanar orthogonal image correlation with volume contrast imaging was used as the reference visualization mode. Two independent operators, blinded to the fetal outcome, were asked to classify the 4V‐CP as visible or not visible in both normal and abnormal cases, and to assess if the 4V‐CP was positioned inside or outside the cyst in fetuses with DWM and BPC.
Results
Of the 41 fetuses with apparently isolated cystic posterior fossa anomaly in the first trimester, eight were diagnosed with DWM, 29 were diagnosed with BPC and four were found to be normal in the second trimester. The position of the 4V‐CP differed between DWM, BPC and normal cases in the first‐ and second‐trimester ultrasound examinations. In particular, in normal fetuses, no cyst was present and, in the midsagittal and coronal planes of the posterior fossa, the 4V‐CP appeared as an echogenic oval‐shaped structure located inside the 4V apparently attached to the cerebellar vermis. In fetuses with DWM, the 4V‐CP was not visible in the midsagittal view because it was displaced inferolaterally by the cyst. In contrast, in the coronal view of the posterior brain, the 4V‐CP was visualized in all cases with DWM at 12–13 weeks, with a moderate decrease in the visualization rate at 15–16 weeks (87.5%) and at 20–21 weeks (75%). In the coronal view, the 4V‐CP was classified as being outside the cyst in all DWM cases at 12–13 weeks and in 87.5% and 75% of cases at 15–16 and 20–21 weeks, respectively. In fetuses with BPC, the 4V‐CP was visualized in all cases in both the midsagittal and coronal views at 12–13 weeks and in 100% and 96.6% of cases, respectively, at 15–16 weeks. In the coronal view, the 4V‐CP was classified as being inside the cyst in 28 (96.6%), 27 (93.1%) and 25 (86.2%) cases at 12–13, 15–16 and 20–21 weeks, respectively. The medial segment of the 4V‐CP was visualized near the inferior part of the vermis.
Conclusions
Our study shows that longitudinal ultrasound assessment of the 4V‐CP and its temporal changes from 12 to 21 weeks is feasible. The 4V‐CP is located inside the cyst, just below the vermis, in BPC and outside the cyst, inferolaterally displaced and distant from the vermian margin, in DWM, consistent with the pathogenesis of the two conditions. The position of the 4V‐CP is a useful sonographic marker that can help differentiate between DWM and BPC as early as in the first trimester of pregnancy. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
8.
Maternal exposure to air pollutants, PCSK9 levels, fetal growth and gestational age – An Italian cohort
Macchi, C.; Iodice, S.; Persico, N. ...
Environment international,
April 2021, 2021-04-00, 2021-04-01, Letnik:
149
Journal Article
•In healthy pregnant women, circulating PCSK9 positively correlates with air pollutants.•PCSK9 levels are associated to the outcomes of pregnancy occurring at delivery.•A rise in PCSK9 levels ...
associates to decreased gestational age at delivery.•A rise in PCSK9 levels associates to an increased probability of urgent cesarean delivery.
Exposure to airborne pollutants during pregnancy appears to be associated with uterine growth restriction and adverse neonatal outcome. Proprotein convertase subtilisin/kexin type (PCSK9), the key modulator of low-density lipoprotein (LDL) metabolism, increases following particulate matter (PM10) exposure. Because maternal cholesterol is required for fetal growth, PCSK9 levels could be used to evaluate the potential impact of airborne pollutants on fetal growth.
A cohort of 134 healthy women during early pregnancy (11–12 weeks of gestational age) was studied.
A significant association between circulating PCSK9 levels and three tested air pollutants (PM10, PM2.5, nitric oxide (NO2)) was found. Of importance, gestational age at birth was reduced by approximately 1 week for each 100 ng/mL rise in circulating PCSK9 levels, an effect that became more significant at the highest quartile of PM2.5 (with a 1.8 week advance in delivery date for every 100 ng/mL rise in circulating PCSK9; p for interaction = 0.026). This finding was supported by an elevation of the odds ratio for urgent cesarean delivery for each 100 ng/mL rise in PCSK9 (2.99, 95% CI, 1.22–6.57), similar trends being obtained for PM10 and NO2.
The association between exposure to air pollutants during pregnancy and elevation in PCSK9 advances our understanding of the unforeseen influences of environmental exposure in terms of pregnancy associated disorders.
več
Dostopno za:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
9.
Prediction and prevention of small‐for‐gestational‐age neonates: evidence from SPREE and ASPRE
Tan, M. Y.; Poon, L. C.; Rolnik, D. L. ...
Ultrasound in obstetrics & gynecology,
July 2018, 2018-07-00, 20180701, Letnik:
52, Številka:
1
Journal Article
ABSTRACT
Objectives
To examine the effect of first‐trimester screening for pre‐eclampsia (PE) on the prediction of delivering a small‐for‐gestational‐age (SGA) neonate and the effect of prophylactic ...
use of aspirin on the prevention of SGA.
Methods
The data for this study were derived from two multicenter studies. In SPREE, we investigated the performance of screening for PE by a combination of maternal characteristics and biomarkers at 11–13 weeks' gestation. In ASPRE, women with a singleton pregnancy identified by combined screening as being at high risk for preterm PE (> 1 in 100) participated in a trial of aspirin (150 mg/day from 11–14 until 36 weeks' gestation) compared to placebo. In this study, we used the data from the ASPRE trial to estimate the effect of aspirin on the incidence of SGA with birth weight < 10th, < 5th and < 3rd percentile for gestational age. We also used the data from SPREE to estimate the proportion of SGA in the pregnancies with a risk for preterm PE of > 1 in 100.
Results
In SPREE, screening for preterm PE by a combination of maternal factors, mean arterial pressure, uterine artery pulsatility index and serum placental growth factor identified a high‐risk group that contained about 46% of SGA neonates < 10th percentile born at < 37 weeks' gestation (preterm) and 56% of those born at < 32 weeks (early); the overall screen‐positive rate was 12.2% (2014 of 16 451 pregnancies). In the ASPRE trial, use of aspirin reduced the overall incidence of SGA < 10th percentile by about 40% in babies born at < 37 weeks' gestation and by about 70% in babies born at < 32 weeks; in babies born at ≥ 37 weeks, aspirin did not have a significant effect on incidence of SGA. The aspirin‐related decrease in incidence of SGA was mainly due to its incidence decreasing in pregnancies with PE, for which the decrease was about 70% in babies born at < 37 weeks' gestation and about 90% in babies born at < 32 weeks. On the basis of these results, it was estimated that first‐trimester screening for preterm PE and use of aspirin in the high‐risk group would potentially reduce the incidence of preterm and early SGA by about 20% and 40%, respectively.
Conclusion
First‐trimester screening for PE by the combined test identifies a high proportion of cases of preterm SGA that can be prevented by the prophylactic use of aspirin. © 2018 Crown copyright. Ultrasound in Obstetrics & Gynecology © 2018 ISUOG.
Click here to see the Video of this article.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
10.
Impact of choroid plexus size in prenatal diagnosis of normal and abnormal closure of fourth ventricle
Volpe, P.; De Robertis, V.; Fanelli, T. ...
Ultrasound in obstetrics & gynecology,
December 2023, 2023-12-00, 20231201, Letnik:
62, Številka:
6
Journal Article
ABSTRACT
Objective
To assess the role of the choroid plexus (CP) of the fourth ventricle (4V) in fetuses with an open 4V and a normal cerebellar vermis.
Methods
Two groups of patients were recruited ...
in two fetal medicine referral centers. The prospectively collected control group included singleton pregnancies with a normal sonographic examination after first‐trimester combined screening for chromosomal abnormalities and normal outcome, recruited in the period between 2019 and 2022. The study group was selected retrospectively by searching our databases to identify all cases with an isolated open 4V and normal anatomy and size of the cerebellar vermis. The inclusion criteria of the study group were: (1) gestational age between 20 and 22 weeks; (2) a brainstem–vermis angle ≥ 18° in the midsagittal plane with an otherwise normal cerebellum and vermis; (3) 4V‐CP visible and seen separately from the vermis; (4) absence of other intra‐ and extracranial anomalies; and (5) available prenatal and/or postnatal magnetic resonance imaging (MRI) data.
Results
In 169 cases of the control group, the 4V‐CP was seen separately from the cerebellar vermis and was noticed to progressively fill the space caudal to the 4V, between the vermis and brainstem. From 12 to 22 weeks, the surface areas of the vermis and medial portion of the 4V‐CP increased progressively with advancing gestation (P < 0.0001). Intra‐ and interobserver correlation analysis showed good reproducibility for the measurements. Among the cases with an open 4V and a normal vermis, it was retrospectively feasible to visualize the 4V‐CP separately from the inferior part of the vermis in 41 fetuses. In five of these cases, the open 4V was due to a small CP. In all 41 fetuses, the diagnosis on MRI was isolated upward rotation of the cerebellar vermis, and no additional anomaly was found.
Conclusions
Closure of the 4V is dependent on the 4V‐CP and not only the cerebellar vermis. In fact, a small CP may represent another cause of an open 4V. Therefore, separate visualization of the 4V‐CP and cerebellar vermis is crucial to improve discrimination between the different causes of an open 4V at the anomaly scan and its clinical implications. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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