1.
Maternal psychosocial stress during pregnancy alters the epigenetic signature of the glucocorticoid receptor gene promoter in their offspring: a meta-analysis
Palma-Gudiel, H; Córdova-Palomera, A; Eixarch, E ...
Epigenetics,
10/2015, Letnik:
10, Številka:
10
Journal Article
Prenatal stress has been widely associated with a number of short- and long-term pathological outcomes. Epigenetic mechanisms are thought to partially mediate these environmental insults into the ...
fetal physiology. One of the main targets of developmental programming is the hypothalamic-pituitary-adrenal (HPA) axis as it is the main regulator of the stress response. Accordingly, an increasing number of researchers have recently focused on the putative association between DNA methylation at the glucocorticoid receptor gene (NR3C1) and prenatal stress, among other types of psychosocial stress. The current study aims to systematically review and meta-analyze the existing evidence linking several forms of prenatal stress with DNA methylation at the region 1
F
of the NR3C1 gene. The inclusion of relevant articles allowed combining empirical evidence from 977 individuals by meta-analytic techniques, whose methylation assessments showed overlap across 5 consecutive CpG sites (GRCh37/hg19 chr5:142,783,607-142,783,639). From this information, methylation levels at CpG site 36 displayed a significant correlation to prenatal stress (r = 0.14, 95% CI: 0.05-0.23, P = 0.002). This result supports the proposed association between a specific CpG site located at the NR3C1 promoter and prenatal stress. Several confounders, such as gender, methylation at other glucocorticoid-related genes, and adjustment for pharmacological treatments during pregnancy, should be taken into account in further studies.
več
2.
Customized birthweight standards for a Spanish population
Figueras, F; Meler, E; Iraola, A ...
European journal of obstetrics & gynecology and reproductive biology,
01/2008, Letnik:
136, Številka:
1
Journal Article
Abstract Objective To analyse the biological factors affecting birthweight and to derive customized birthweight standards for a Spanish population. Methods A retrospective cohort was created with all ...
the singleton pregnancies delivered at term and free of pathology in our Institution. Birthweight was modeled by multiple linear regression from maternal (ethnic origin, maternal height, booking weight, smoking, and parity), and fetal (gender, gestational age) characteristics. Results In addition to gestational age and sex, height, booking weight, ethnic origin, parity, and smoking all have significant and independent effects on birthweight. Women from East-Asia, Morocco and South-America had newborns on average 83 g, 74 g and 95 g heavier than White-European Spanish women. The effect of smoking was found to be dose-related. Conclusion We found the relative effect of the maternal and fetal characteristics to be very similar to that reported in previous studies. We report coefficients for ethnic groups that account for a sizeable proportion of the population composition of several European countries.
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3.
Second‐ to third‐trimester longitudinal growth assessment for prediction of small‐for‐gestational age and late fetal growth restriction
Caradeux, J.; Eixarch, E.; Mazarico, E. ...
Ultrasound in obstetrics & gynecology,
February 2018, 2018-Feb, 2018-02-00, 20180201, Letnik:
51, Številka:
2
Journal Article
ABSTRACT
Objective
Detection of fetal growth restriction (FGR) remains poor and most screening strategies rely on cross‐sectional evaluation of fetal size during the third trimester. A longitudinal ...
and individualized approach has been proposed as an alternative method of evaluation. The aim of this study was to compare second‐ to third‐trimester longitudinal growth assessment to cross‐sectional evaluation in the third trimester for the prediction of small‐for‐gestational age (SGA) and late FGR in low‐risk singleton pregnancy.
Methods
This was a prospective cohort study of 2696 unselected consecutive low‐risk singleton pregnancies scanned at 21 ± 2 and 32 ± 2 weeks. For cross‐sectional growth assessment, abdominal circumference (AC) measurements were transformed to z‐values according the 21st‐INTERGROWTH standards. Longitudinal growth assessment was performed by calculating the AC z‐velocity and the second‐ to third‐trimester AC conditional growth centile. Longitudinal assessment was compared with cross‐sectional assessment at 32 weeks. Association of cross‐sectional and longitudinal evaluations with SGA and late FGR was assessed by logistic regression analysis. Predictive performance was determined by receiver–operating characteristics curve analysis.
Result
In total, 210 (7.8%) newborns were classified as SGA and 103 (3.8%) as late FGR. Neither longitudinal measurement improved the association with SGA or late FGR provided by cross‐sectional evaluation of AC z‐score at 32 weeks. Areas under the curves of AC z‐velocity and conditional AC growth were significantly smaller than those of cross‐sectional AC z‐scores (P < 0.001), although AC z‐velocity performed significantly better than did conditional AC growth (P < 0.001).
Conclusion
Longitudinal assessment of fetal growth from the second to third trimester has a low predictive capacity for SGA and late FGR in low‐risk singleton pregnancy compared with cross‐sectional growth evaluation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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4.
Chorioamniotic membrane separation after fetoscopy in monochorionic twin pregnancy: incidence and impact on perinatal outcome
Ortiz, J. U.; Eixarch, E.; Peguero, A. ...
Ultrasound in obstetrics & gynecology,
March 2016, Letnik:
47, Številka:
3
Journal Article
ABSTRACT
Objective
To evaluate the incidence of chorioamniotic membrane separation (CMS) after fetoscopy in monochorionic diamniotic (MCDA) twins and its impact on pregnancy outcome.
Methods
The ...
study group comprised a consecutive series of 338 women with an MCDA pregnancy complicated by twin–twin transfusion syndrome (TTTS) or selective intrauterine growth restriction (sIUGR) treated with selective laser photocoagulation of communicating vessels (SLPCV) or cord occlusion (CO). Data obtained included cervical length, gestational age at procedure, type and duration of surgery and placental location. The incidence of CMS, the rates of miscarriage and preterm prelabor rupture of membranes (PPROM), gestational age at delivery and neonatal survival were recorded.
Results
Of the study population of MCDA pregnancies, 270 (79.9%) had TTTS and 68 (20.1%) had sIUGR. SLPCV was performed in 252 (74.6%) cases and CO in 86 (25.4%). Postoperative CMS was observed in 70 (20.7%) cases. Patients with CMS had higher rates of miscarriage (14.3% vs 7.1%; P = 0.049), PPROM before 32 weeks (43.3% vs 13.7%; P < 0.001) and preterm delivery before 32 weeks (53.3% vs 26.1%; P < 0.001) and a lower rate of neonatal survival of at least one twin (81.7% vs 93.6%; P = 0.003). Multivariate analysis showed that gestational age at surgery was the only independent predictor, with the highest proportion of CMS occurring in cases that underwent surgery before 18 weeks' gestation (odds ratio, 2.941 (95% CI, 1.640–5.275); P < 0.001). There was no influence of cervical length, placental location, duration of surgery or type of surgery on the risk of CMS.
Conclusions
CMS complicated one‐fifth of all MCDA pregnancies that underwent fetoscopy. It appeared to be more common in those who underwent surgery before 18 weeks' gestation and was associated with poorer outcomes. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
Linked Comment: Ultrasound Obstet Gynecol 2016; 47: 280–280
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5.
Premature placental aging in term small‐for‐gestational‐age and growth‐restricted fetuses
Paules, C.; Dantas, A. P.; Miranda, J. ...
Ultrasound in obstetrics & gynecology,
20/May , Letnik:
53, Številka:
5
Journal Article
ABSTRACT
Objective
To perform a comprehensive assessment of the placental aging process in small term fetuses classified as being small‐for‐gestational age (SGA) or having fetal growth restriction ...
(FGR) through analysis of senescence and apoptosis markers.
Methods
This was a prospective nested case–control study of singleton pregnancies delivered at term, including 21 control pregnancies with normally grown fetuses and 36 with a small fetus classified as SGA (birth weight between the 3rd and 9th percentiles and normal fetoplacental Doppler; n = 18) or FGR (birth weight < 3rd percentile and/or abnormal cerebroplacental ratio and/or uterine artery Doppler; n = 18). Telomerase activity, telomere length (quantified by comparing the amount of amplification product for the telomere sequence (T) to that of a single copy of the gene 36B4 (S)) and RNA expression of senescence (Sirtuins 1, 3 and 6) and apoptosis (p53, p21, BAX and Caspases 3 and 9) markers (analyzed using the 2–ΔΔCt method) were determined in placental samples collected at birth and compared between the three groups.
Results
Compared to pregnancies with a normally grown fetus, both SGA and FGR pregnancies presented signs of accelerated placental aging, including lower telomerase activity (mean ± SD, 12.8 ± 6.6% in controls vs 7.98 ± 4.2% in SGA vs 7.79 ± 4.6% in FGR; P = 0.008), shorter telomeres (mean ± SD T/S ratio, 1.20 ± 0.6 in controls vs 1.08 ± 0.9 in SGA vs 0.66 ± 0.5 in FGR; P = 0.047) and reduced Sirtuin‐1 RNA expression (mean ± SD 2–ΔΔCt, 1.55 ± 0.8 in controls vs 0.91 ± 0.8 in SGA vs 0.63 ± 0.5 in FGR; P = 0.001) together with increased p53 RNA expression (median (interquartile range) 2–ΔΔCt, 1.07 (0.3–3.3) in controls vs 5.39 (0.6–15) in SGA vs 3.75 (0.9–7.8) in FGR; P = 0.040). FGR cases presented signs of apoptosis, with increased Caspase‐3 RNA levels (median (interquartile range) 2–ΔΔCt, 0.94 (0.7–1.7) in controls vs 3.98 (0.9–31) in FGR; P = 0.031) and Caspase‐9 RNA levels (median (interquartile range) 2–ΔΔCt, 1.21 (0.6–4.0) in controls vs 3.87 (1.5–9.0) in FGR; P = 0.037) compared with controls. In addition, Sirtuin‐1 RNA expression, telomerase activity, telomere length and Caspase‐3 activity showed significant linear trends across groups as severity of the condition increased.
Conclusions
Accelerated placental aging was observed in both clinical forms of late‐onset fetal smallness (SGA and FGR), supporting a common pathophysiology and challenging the concept of SGA fetuses being constitutionally small. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
RESUMEN
Envejecimiento prematuro de la placenta en fetos pequeños para la edad gestacional y con restricción del crecimiento
Objetivo
Realizar una evaluación integral del proceso de envejecimiento de la placenta en fetos a término clasificados como pequeños para la edad gestacional (PEG) o con restricción del crecimiento fetal (RCF) mediante el análisis de los marcadores de senescencia y apoptosis.
Métodos
Este fue un estudio prospectivo de casos y controles anidados de embarazos únicos a término, que incluyó 21 embarazos de control con fetos de crecimiento normal y 36 con un feto clasificado como PEG (peso al nacer entre los percentiles 3o y 9o y Doppler fetoplacentario normal; n=18) o con RCF (peso al nacer menor del percentil 3o y/o relación cerebroplacentaria anómala y/o Doppler de la arteria uterina; n=18). La actividad de la telomerasa, la longitud de los telómeros (cuantificada comparando la cantidad de producto de amplificación para la secuencia de telómeros (T) con la de una sola copia del gen 36B4 (S)) y la expresión del ARN de la senescencia (Sirtuinas 1, 3 y 6) y los marcadores de apoptosis (p53, p21, BAX y Caspasas 3 y 9) (analizados usando el método 2–∆∆Ct) se determinaron en muestras de placenta obtenidas en el momento del nacimiento y se compararon entre los tres grupos.
Resultados
En comparación con los embarazos con un feto de crecimiento normal, tanto los embarazos PEG y con RCF presentaron signos de envejecimiento placentario acelerado, como una menor actividad de la telomerasa (media ± SD, 12,8 ± 6,6% en los controles frente a 7,98 ± 4,2% en PEG frente a 7,79 ± 4,6% en RCF; P=0,008), telómeros más cortos (media ± SD razón T/S, 1,20 ± 0,6 en los controles frente a 1,08 ± 0,9 en PEG frente a 0,66 ± 0,5 en RCF; P=0,047) y expresión reducida de la Sirtuina 1 en el ARN (media ± SD 2–∆∆Ct, 1,55 ± 0,8 en los controles frente a 0,91 ± 0,8 en PEG frente a 0,63 ± 0,5 en RCF; P=0,001), junto con una mayor expresión del p53 en el ARN (mediana (rango intercuartil) 2–∆∆Ct, 1,07 (0,3‐3,3) en los controles frente a 5,39 (0,6–15) en PEG frente a 3,75 (0,9–7,8) en RCF; P=0,040). Los casos de RCF presentaron signos de apoptosis, con un aumento de los niveles en ARN de la Caspasa 3 (mediana (rango intercuartil) 2–∆∆Ct, 0,94 (0,7–1,7) en los controles frente a 3,98 (0,9–31) en RCF; P=0,031) y Caspasa 9 (mediana (rango intercuartil) 2–∆∆Ct, 1,21 (0,6‐4,0) en los controles frente a 3,87 (1,5–9,0) en RCF; P=0,037) en comparación con los controles. Además, la expresión de la Sirtuina 1 en el ARN, la actividad de la telomerasa, la longitud de los telómeros y la actividad de la Caspasa 3 mostraron tendencias lineales significativas entre los grupos en función del aumento de la severidad de la anomalía.
Conclusiones
Se observó un envejecimiento acelerado de la placenta en ambas formas clínicas de tamaño pequeño del feto de inicio tardío (PEG y RCF), lo que apoya una fisiopatología común y pone en tela de juicio el concepto de que los fetos PEG son en pequeños por su propia condición.
摘要
足月小于胎龄儿和生长受限胎儿胎盘过早老化
目的
通过衰老和细胞凋亡标志物分析，对足月小于胎龄儿(SGA)或生长受限(FGR)胎儿的胎盘老化过程进行综合评估。
方法
这是一项对足月分娩的单胎妊娠进行的前瞻性巢式病例对照研究，研究纳入21例胎儿正常发育的对照组妊娠和36例小胎儿:SGA(出生体重介于3%和9%之间，胎儿胎盘多普勒正常；n=18)或FGR(出生体重<3%和/或脑胎盘比值异常和/或子宫动脉多普勒异常；n=18)。出生时采集胎盘标本，分别检测端粒酶活性、端粒长度(通过将端粒序列(T)的扩增产物数量与基因36B4(S)的单一拷贝扩增产物数量进行比较来量化)及衰老的RNA表达(Sirtuins 1、3、6)和细胞凋亡(p53、p21、BAX、Caspases 3、9)标志物(利用2–∆∆Ct法分析)，并在三组中进行比较。
结果
与正常发育的胎儿相比，SGA和FGR妊娠均表现出胎盘老化加速的迹象，包括降低的端粒酶活性(均数 ± 标准差，对照组12.8 ± 6.6% vs SGA组7.98 ± 4.2% vs FGR组7.79 ± 4.6%；P=0.008)、缩短的端粒(均数 ± 标准差 T/S 比值，对照组1.20 ± 0.6 vs SGA组1.08 ± 0.9 vs FGR组0.66 ± 0.5； P=0.047)及Sirtuin‐1 RNA表达减弱(均数 ± 标准差2–∆∆Ct；对照组1.55 ± 0.8 vs SGA组0.91 ± 0.8 vs FGR组0.63 ± 0.5；P=0.001)和P53 RNA表达增强(中位数(四分位数间距)2–∆∆Ct，对照组1.07(0.3–3.3) vs SGA组5.39(0.6–15)vs FGR组3.75(0.9–7.8)； P=0.040)。与对照相相比，FGR病例出现细胞凋亡迹象，并伴随caspase‐3 RNA水平升高(中位数(四分位数间距)2–∆∆Ct,，对照组0.94(0.7–1.7)vs FGR组3.98(0.9–31)；P=0.031)及caspase‐9 RNA水平升高(中位数(四分位数间距)2–∆∆Ct，对照组1.21(0.6–4.0)vs FGR组3.87(1.5–9.0)；P=0.037)。此外，随着病情的加重，Sirtuin‐1 RNA的表达、端粒酶活性、端粒长度和Caspase‐3活性在各组间呈明显的线性趋势。
结论
两种临床形式的迟发性胎小症(SGA和FGR)均出现胎盘加速老化的现象，支持共同的病理生理机制，并对SGA胎儿天生小的概念提出质疑。
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6.
Distinctive patterns of placental lesions in pre‐eclampsia vs small‐for‐gestational age and their association with fetoplacental Doppler
Paules, C.; Youssef, L.; Rovira, C. ...
Ultrasound in obstetrics & gynecology,
November 2019, 2019-Nov, 2019-11-00, 20191101, Letnik:
54, Številka:
5
Journal Article
ABSTRACT
Objectives
To describe placental histopathological findings in a large cohort of pregnancies complicated by pre‐eclampsia (PE) and/or small‐for‐gestational age (SGA), and to investigate ...
their association with fetoplacental Doppler parameters.
Methods
This was a prospective observational study of normotensive pregnancies with SGA (defined as birth weight < 10th centile) (n = 184), PE pregnancies with a normally grown fetus (n = 102), pregnancies with both PE and SGA (n = 120) and uncomplicated pregnancies (n = 202). Uterine (UtA), umbilical (UA) and fetal middle cerebral (MCA) artery pulsatility indices (PI) were assessed. The cerebroplacental ratio (CPR) was calculated by dividing MCA‐PI by UA‐PI. Doppler parameters were considered abnormal when UtA‐PI or UA‐PI was > 95th centile or MCA‐PI or CPR was < 5th centile. Placental lesions were categorized as vascular (maternal or fetal side), immunoinflammatory or other, according to the 2014 Amsterdam Placental Workshop Group Consensus Statement. Comparison between the study groups was performed using univariate and multiple regression analysis, and logistic regression was used to determine the relationship between abnormal Doppler parameters and placental lesions.
Results
Maternal‐side vascular lesions were significantly more common in PE pregnancies with SGA than in the other groups (PE + SGA, 73% vs PE, 46% vs SGA, 38% vs controls, 31%; P = 0.01) and included mainly two types of lesion: developmental (PE + SGA, 13% vs PE, 5% vs SGA, 3% vs controls, 1.5%; P < 0.001) and malperfusion (PE + SGA, 70% vs PE, 39% vs SGA, 32% vs controls, 25%; P = 0.001). In contrast, the incidence of fetal‐side developmental lesions was significantly higher in normotensive SGA pregnancies than in controls and PE pregnancies (PE + SGA, 0% vs PE, 3% vs SGA, 8% vs controls, 2%; P = 0.001). All cases displayed a lower prevalence of infectious lesions than did controls, with the highest prevalence of immune lesions observed in pregnancies with both PE and SGA (PE + SGA, 18% vs PE, 8% vs SGA, 10% vs controls, 9%; P = 0.001). All fetoplacental Doppler parameters evaluated were associated with maternal‐side vascular lesions, mainly malperfusion (mean UtA‐PI: odds ratio (OR), 2.45 (95% CI, 1.51–3.97); UA‐PI: OR, 2.05 (95% CI, 1.02–4.47); MCA‐PI: OR, 2.75 (95% CI, 1.40–5.42); CPR: OR, 1.75 (95% CI, 1.04–2.95)). This association was evident mainly in the normotensive SGA group, being
non‐significant in controls or PE pregnancies without SGA. No significant associations were observed between fetoplacental Doppler parameters and other placental lesions in any of the study groups.
Conclusions
PE and SGA are associated with different patterns of placental histopathological lesions in accordance with the clinical manifestation of the placental disorder (maternal vs fetal). Fetoplacental Doppler findings show an association with placental malperfusion lesions on the maternal side, supporting the use of abnormal Doppler as a surrogate for placental insufficiency. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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7.
Revisiting MOMS criteria for prenatal repair of spina bifida: upper gestational‐age limit should be raised and assessment of prenatal motor function rather than anatomical level improves prediction of postnatal function
Trigo, L.; Chmait, R. H.; Llanes, A. ...
Ultrasound in obstetrics & gynecology,
January 2024, 2024-01-00, 20240101, Letnik:
63, Številka:
1
Journal Article
ABSTRACT
ObjectivesTo determine if the lower‐extremity neurological motor function level in fetuses with open spina bifida deteriorates within the 4‐week interval between a first prenatal motor ...
assessment at around 22 weeks of gestation and a second evaluation, prior to ‘late’ prenatal surgery, defined as surgery at 26–28 weeks and, in certain situations, up to 30 weeks, and to assess the association between prenatal presurgical motor‐function level, anatomical level of the lesion and postnatal motor‐function level.
MethodsThis was a two‐center cohort study of 94 singleton fetuses with open spina bifida which underwent percutaneous repair using the skin‐over‐biocellulose for antenatal fetoscopic repair (SAFER) technique between December 2016 and January 2022. All women underwent two prenatal systematic ultrasound evaluations, approximately 4 weeks apart, with the second one being performed less than 1 week before surgery, and one postnatal evaluation via physical examination within 2 months of birth. Motor‐function classification was from spinal level T12 to S1, according to key muscle function. Each leg was analyzed separately; in case of discrepancy between the two legs, the worst motor‐function level was considered for analysis. Motor‐function‐level evaluations were compared with each other and with the anatomical level as observed on ultrasound. Independent predictors of a postnatal reduction in motor‐function level were assessed using a logistic regression model.
ResultsPrenatal motor‐function level was assessed at a median gestational age of 22.5 (interquartile range (IQR), 20.7–24.3) and 26.7 (IQR, 25.4–27.3) weeks, with a median interval of 4.0 (IQR, 2.4–6.0) weeks. The median gestational age at surgery was 27.0 (IQR, 25.9–27.6) weeks and the postnatal examination was at median age of 0.8 (IQR, 0.3–5.4) months. There was no significant difference in motor‐function level between the two prenatal evaluations (P = 0.861). We therefore decided to use the second prenatal evaluation for comparison with postnatal motor function and anatomical level. Overall, prenatal and postnatal motor function evaluations were significantly different from the anatomical level (preoperative assessment, P = 0.0015; postnatal assessment, P = 0.0333). Comparing prenatal with postnatal motor‐function level, we found that 87.2% of babies had similar or improved motor function compared with that prior to prenatal surgery. On logistic regression analysis, lower anatomical level of defect and greater difference between anatomical level and prenatal motor‐function level were identified as independent predictors of postnatal motor function (odds ratio, 0.237 (95% CI, 0.095–0.588) (P = 0.002) and 3.44 (95% CI, 1.738–6.813) (P < 0.001), respectively).
ConclusionsDuring a 4‐week interval between first ultrasound evaluation and late fetal surgical repair of open spina bifida, motor function does not change significantly, suggesting that late repair, ≥ 26 weeks, does not impact negatively on motor‐function outcome. Compared with the anatomical level of the lesion, preoperative neurological motor‐function assessment via ultrasound is more predictive of postnatal motor function, and should be included in preoperative counseling. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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8.
Fetal neurosonography detects differences in cortical development and corpus callosum in late‐onset small fetuses
Paules, C.; Miranda, J.; Policiano, C. ...
Ultrasound in obstetrics & gynecology,
July 2021, 2021-07-00, 20210701, Letnik:
58, Številka:
1
Journal Article
ABSTRACT
Objective
To explore whether neurosonography can detect differences in cortical development and corpus callosal length in late‐onset small fetuses subclassified into small‐for‐gestational ...
age (SGA) or growth restricted (FGR).
Methods
This was a prospective cohort study in singleton pregnancies, including normally grown fetuses (birth weight between the 10th and 90th centiles) and late‐onset small fetuses (estimated fetal weight < 10th centile, diagnosed after 32 weeks of gestation and confirmed by birth weight < 10th centile). Small fetuses were subclassified into SGA (birth weight between the 3rd and 9th centiles and normal fetoplacental Doppler) and FGR (birth weight < 3rd centile and/or abnormal cerebroplacental ratio and/or abnormal uterine artery Doppler). Neurosonography was performed at 33 ± 1 weeks of gestation to assess the depth of the insula, Sylvian fissure and parieto‐occipital sulcus in the axial views and corpus callosal length in the midsagittal plane. Measurements were performed offline using Alma Workstation software and were adjusted by biparietal diameter or cephalic index. Linear regression analysis was used to assess the association between the neurosonographic variables and study group, adjusting for confounding factors such as gender, gestational age at neurosonography, nulliparity and pre‐eclampsia.
Results
In total, 318 fetuses were included, of which 97 were normally grown and 221 were late‐onset small fetuses that were further subdivided into late‐onset SGA (n = 67) or late‐onset FGR (n = 154). Compared to controls, both SGA and FGR cases showed significantly increased insular depth adjusted for biparietal diameter (median (interquartile range), controls 0.329 (0.312–0.342) vs SGA 0.339 (0.321–0.347) vs FGR 0.336 (0.325–0.349); P = 0.006). A linear tendency to reduced Sylvian fissure depth adjusted for biparietal diameter was also observed across the study groups (mean ± SD, controls 0.148 ± 0.021 vs SGA 0.142 ± 0.025 vs FGR 0.139 ± 0.022; P = 0.003). However, differences were significant only between the FGR and control groups. Corpus callosal length adjusted for cephalic index was significantly reduced in FGR cases compared with both controls and SGA cases, while there was no difference between SGA cases and controls (median (interquartile range), controls 0.500 (0.478–0.531) vs SGA 0.502 (0.487–0.526) vs FGR 0.475 (0.447–0.508); P = 0.005). No differences were found in parieto‐occipital sulcus depth between the three study groups.
Conclusion
Neurosonography seems to be a sensitive tool to detect subtle structural differences in brain development in late‐onset small fetuses. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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9.
Prevalence of supratentorial anomalies assessed by magnetic resonance imaging in fetuses with open spina bifida
Trigo, L.; Eixarch, E.; Bottura, I. ...
Ultrasound in obstetrics & gynecology,
June 2022, 2022-Jun, 2022-06-00, 20220601, Letnik:
59, Številka:
6
Journal Article
ABSTRACT
Objectives
To determine the prevalence of brain anomalies at the time of preoperative magnetic resonance imaging (MRI) assessment in fetuses eligible for prenatal open spina bifida (OSB) ...
repair, and to explore the relationship between brain abnormalities and features of the spinal defect.
Methods
This was a retrospective cross‐sectional study, conducted in three fetal medicine centers, of fetuses eligible for OSB fetal surgery repair between January 2009 and December 2019. MRI images obtained as part of the presurgical assessment were re‐evaluated by two independent observers, blinded to perinatal results, to assess: (1) the type and area of the defect and its anatomical level; (2) the presence of any structural central nervous system (CNS) anomaly and abnormal ventricular wall; and (3) fetal head and brain biometry. Binary regression analyses were performed and data were adjusted for type of defect, upper level of the lesion (ULL), gestational age (GA) at MRI and fetal medicine center. Multiple logistic regression analysis was performed in order to identify lesion characteristics and brain anomalies associated with a higher risk of presence of abnormal corpus callosum (CC) and/or heterotopia.
Results
Of 115 fetuses included, 91 had myelomeningocele and 24 had myeloschisis. Anatomical level of the lesion was thoracic in seven fetuses, L1–L2 in 13, L3–L5 in 68 and sacral in 27. Median GA at MRI was 24.7 (interquartile range, 23.0–25.7) weeks. Overall, 52.7% of cases had at least one additional brain anomaly. Specifically, abnormal CC was observed in 50.4% of cases and abnormality of the ventricular wall in 19.1%, of which 4.3% had nodular heterotopia. Factors associated independently with higher risk of abnormal CC and/or heterotopia were non‐sacral ULL (odds ratio (OR), 0.51 (95% CI, 0.26–0.97); P = 0.043), larger ventricular width (per mm) (OR, 1.23 (95% CI, 1.07–1.43); P = 0.005) and presence of abnormal cavum septi pellucidi (OR, 3.76 (95% CI, 1.13–12.48); P = 0.031).
Conclusions
Half of the fetuses assessed for OSB repair had an abnormal CC and/or an abnormal ventricular wall prior to prenatal repair. The likelihood of brain abnormalities was increased in cases with a non‐sacral lesion and wider lateral ventricles. These findings highlight the importance of a detailed preoperative CNS evaluation of fetuses with OSB. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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10.
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