Diagnostics

Research

15 pages, 1231 KiB

Open AccessArticle

MRI Assessed Placental Location as a Diagnostic Tool of Placental Invasiveness and Maternal Peripartum Morbidity

by Charis Bourgioti, Marianna Konidari, Makarios Eleftheriades, Marianna Theodora, Maria Evangelia Nikolaidou, Konstantina Zafeiropoulou, Chara Tzavara, Stavros Fotopoulos, George Daskalakis and Lia Angela Moulopoulos

Diagnostics 2024, 14(9), 925; https://doi.org/10.3390/diagnostics14090925 - 29 Apr 2024

Cited by 1 | Viewed by 1165

Abstract

Placenta accreta spectrum (PAS) disorder is one of the leading causes of peripartum maternal morbidity and mortality; its early identification during pregnancy is of utmost importance to ensure the optimal clinical outcome. The aim of the present study is to investigate the possible [...] Read more.

Placenta accreta spectrum (PAS) disorder is one of the leading causes of peripartum maternal morbidity and mortality; its early identification during pregnancy is of utmost importance to ensure the optimal clinical outcome. The aim of the present study is to investigate the possible association of the presence and type/location of placenta previa on MRI with PAS and maternal peripartum outcome. One hundred eighty-nine pregnant women (mean age: 35 years; mean gestational age: 32 weeks) at high risk for PAS underwent a dedicated placental MRI. All women underwent a C-section within 6 weeks from the MRI. All MRIs were evaluated by two experienced genitourinary radiologists for presence, type (complete/partial vs. marginal/low lying), and location (anterior vs. anterior-posterior vs. posterior) of placenta previa. Statistical analysis was performed for possible association of type/location of previa with placental invasiveness and peripartum outcomes. Intraoperative information was used as a reference standard. Complete/partial previa was detected in 143/189 (75.6%) and marginal/low lying previa in 33/189 (17.5%) women; in 88/189 (46.6%) women, the placenta had anterior–posterior, in 54/189 (28.6%) anterior and in 41/189 (21.7%) posterior. Complete/partial previa had an at least 3-fold probability of invasiveness and was more frequently associated with unfavorable peripartum events, including massive intraoperative blood loss or hysterectomy, compared to low-lying/marginal placenta. Posterior placental location was significantly associated with lower rates of PAS and better clinical outcomes. In conclusion, the type and location of placenta previa shown with MRI seems to be associated with severity of complications during delivery and should be carefully studied. Full article

(This article belongs to the Special Issue Imaging of Fetal and Maternal Diseases in Pregnancy 2.0)

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11 pages, 589 KiB

Open AccessArticle

Relationship between the Central and Peripheral Thyroid Sensitivity Indices and Fetal Macrosomia: A Cohort Study of Euthyroid Pregnant Women in China

by Xin Zhao, Jianbin Sun, Ning Yuan and Xiaomei Zhang

Diagnostics 2023, 13(12), 2013; https://doi.org/10.3390/diagnostics13122013 - 9 Jun 2023

Cited by 3 | Viewed by 1706

Abstract

(1) Background: To explore the correlation between central and peripheral thyroid sensitivity indices and macrosomia in euthyroid pregnant women and to provide clinical basis for the prevention and treatment of macrosomia. (2) Methods: This study is a prospective study. A total of 1176 [...] Read more.

(1) Background: To explore the correlation between central and peripheral thyroid sensitivity indices and macrosomia in euthyroid pregnant women and to provide clinical basis for the prevention and treatment of macrosomia. (2) Methods: This study is a prospective study. A total of 1176 euthyroid women in early pregnancy in the obstetrics department of Peking University International Hospital from December 2017 to March 2019 were enrolled. The women were divided into two groups, namely the macrosomia and non-macrosomia groups, according to birth weight. (3) Results: The level of free triiodothyronine (FT3), thyroid-stimulating hormone (TSH), thyroid feedback quantile-based index (TFQI), thyrotropin-T4 resistance index (TT4RI), thyroid-stimulating hormone index (TSHI), and free triiodothyronine/free thyroxine (FT3/FT4) in the macrosomia group was higher than that in the non-macrosomia group (p < 0.05). The multivariate logistic regression model showed that FT3, TFQI, TT4RI, TSHI, and FT3/FT4 were independent risk factors for macrosomia in early pregnancy after adjusting for age, body mass index, parity, blood pressure, blood glucose, and blood lipid levels (p < 0.05, respectively). (4) Conclusions: TFQI, TT4RI, TSHI, and FT3/FT4 are independent risk factors for fetal macrosomia in early pregnancy in euthyroid women. Full article

(This article belongs to the Special Issue Imaging of Fetal and Maternal Diseases in Pregnancy 2.0)

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10 pages, 789 KiB

Open AccessArticle

Maternal and Offspring Cardiovascular Function following Pregnancy with Hypertensive Disorder

by Coral Garcia-Gonzalez, Elena Nunez, Huijing Zhang, Kypros H. Nicolaides and Marietta Charakida

Diagnostics 2023, 13(12), 2007; https://doi.org/10.3390/diagnostics13122007 - 8 Jun 2023

Cited by 4 | Viewed by 1455

Abstract

Background: Hypertensive disorders of pregnancy (HDP) have been associated with increased cardiovascular risk for the mother and her offspring. However, it remains unknown whether cardiovascular changes are present in the postpartum period. Methods: This was a cross-sectional study of women with singleton pregnancies. [...] Read more.

Background: Hypertensive disorders of pregnancy (HDP) have been associated with increased cardiovascular risk for the mother and her offspring. However, it remains unknown whether cardiovascular changes are present in the postpartum period. Methods: This was a cross-sectional study of women with singleton pregnancies. We recruited 33 women (20 following preeclampsia and 13 following gestational hypertension) and an equal number of women with uncomplicated pregnancy. Conventional and more advanced echocardiographic modalities such as speckle tracking were used to assess maternal and offspring cardiac function at 3–9 months postpartum. Results: In women with HDP compared to those without, there was higher mean arterial pressure (mean 92.3 (SD 7.3) vs. 86.8 (8.3) mmHg, p = 0.007), left-ventricular mass indexed for body-surface area (64.5 (10.5) vs. 56.8 (10.03), p < 0.003), and E/e′ (3.6 (0.8) vs. 3.1 (0.9), p = 0.022). There were no significant differences between groups in maternal left-ventricular systolic-functional indices and in offspring cardiac function between groups. Conclusions: At 3–9 months postpartum, mothers with HDP had higher blood pressure, higher left-ventricular mass, and reduced left-ventricular diastolic function. However, in their offspring, cardiac function was preserved. These findings suggest that mothers who experienced an HDP would benefit from cardio-obstetric follow-up in the postpartum period. Full article

(This article belongs to the Special Issue Imaging of Fetal and Maternal Diseases in Pregnancy 2.0)

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9 pages, 433 KiB

Open AccessArticle

Placenta Accreta Spectrum (PAS) Disorder: Ultrasound versus Magnetic Resonance Imaging

by Ida Faralli, Valentina Del Negro, Alessandra Chinè, Natalia Aleksa, Enrico Ciminello and Maria Grazia Piccioni

Diagnostics 2022, 12(11), 2769; https://doi.org/10.3390/diagnostics12112769 - 12 Nov 2022

Cited by 12 | Viewed by 4914

Abstract

Objective: PAS is one of the most dangerous conditions associated with pregnancy and remains undiagnosed before delivery in from half to two-thirds of cases. Correct prenatal diagnosis is essential to reduce the burden of maternal and fetal morbidity. The purpose of our study [...] Read more.

Objective: PAS is one of the most dangerous conditions associated with pregnancy and remains undiagnosed before delivery in from half to two-thirds of cases. Correct prenatal diagnosis is essential to reduce the burden of maternal and fetal morbidity. The purpose of our study is to evaluate the accuracy of US and MRI in the diagnosis of PAS. Study design: In this retrospective study, 104 patients with suspected placenta accreta were enrolled and had been investigated with US and MRI. They were divided into four groups: no PAS, accreta, increta, and percreta. Results: Compared to MRI, US results were higher in the diagnosis and in the identification of PAS severity (85% US vs. 80% MRI). For both methods, in the case of posterior placenta, there is greater difficulty in identifying the presence/absence of the disease (67% in both methods) and the severity level (61% US vs. 55% MRI). Conclusion: US, properly implemented with the application of defined and standardized scores, can be superior to MRI and absolutely sufficient for the diagnosis of PAS, limiting the use of MRI to a few doubtful cases and to cases in which surgical planning is necessary. Full article

(This article belongs to the Special Issue Imaging of Fetal and Maternal Diseases in Pregnancy 2.0)

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Review

Jump to: Research, Other

21 pages, 15733 KiB

Open AccessReview

Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium—Part II: Non-Obstetric Complications

by Gabriele Masselli, Giacomo Bonito, Silvia Gigli and Paolo Ricci

Diagnostics 2023, 13(18), 2909; https://doi.org/10.3390/diagnostics13182909 - 11 Sep 2023

Viewed by 1565

Abstract

Emergency imaging in pregnancy and puerperium poses unique challenges both for clinicians and radiologists, requiring timely and accurate diagnosis. Delay in treatment may result in poor outcomes for both the patient and the foetus. Pregnant and puerperal patients may present in the emergency [...] Read more.

Emergency imaging in pregnancy and puerperium poses unique challenges both for clinicians and radiologists, requiring timely and accurate diagnosis. Delay in treatment may result in poor outcomes for both the patient and the foetus. Pregnant and puerperal patients may present in the emergency setting with acute abdominopelvic pain for various complications that can be broadly classified into obstetric and non-obstetric related diseases. Ultrasonography (US) is the primary diagnostic imaging test; however, it may be limited due to the patient’s body habitus and the overlapping of bowel loops. Computed tomography (CT) carries exposure to ionising radiation to the foetus, but may be necessary in selected cases. Magnetic resonance imaging (MRI) is a valuable complement to US in the determination of the etiology of acute abdominal pain and can be used in most settings, allowing for the identification of a broad spectrum of pathologies with a limited protocol of sequences. In this second section, we review the common non-obstetric causes for acute abdominopelvic pain in pregnancy and post partum, offering a practical approach for diagnosis and pointing out the role of imaging methods (US, MRI, CT) with the respective imaging findings. Full article

(This article belongs to the Special Issue Imaging of Fetal and Maternal Diseases in Pregnancy 2.0)

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22 pages, 3568 KiB

Open AccessReview

Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium—Part I: Obstetric (Non-Fetal) Complications

by Giacomo Bonito, Gabriele Masselli, Silvia Gigli and Paolo Ricci

Diagnostics 2023, 13(18), 2890; https://doi.org/10.3390/diagnostics13182890 - 9 Sep 2023

Viewed by 1726

Abstract

Acute abdominopelvic pain in pregnant and postpartum patients presents clinical and therapeutic challenges, often requiring quick and accurate imaging diagnosis. Ultrasound remains the primary imaging investigation. Magnetic resonance imaging (MRI) has been shown to be a powerful diagnostic tool in the setting of [...] Read more.

Acute abdominopelvic pain in pregnant and postpartum patients presents clinical and therapeutic challenges, often requiring quick and accurate imaging diagnosis. Ultrasound remains the primary imaging investigation. Magnetic resonance imaging (MRI) has been shown to be a powerful diagnostic tool in the setting of acute abdominal pain during pregnancy and puerperium. MRI overcomes some drawbacks of US, avoiding the ionizing radiation exposure of a computed tomography (CT) scan. Although CT is not usually appropriate in pregnant patients, it is crucial in the emergency evaluation of postpartum complications. The aim of this article is to provide radiologists with a thorough familiarity with the common and uncommon pregnancy and puerperium abdominal emergencies by illustrating their imaging appearances. The present first section will review and discuss the imaging findings for acute abdominopelvic pain of obstetric (non-fetal) etiology. Full article

(This article belongs to the Special Issue Imaging of Fetal and Maternal Diseases in Pregnancy 2.0)

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20 pages, 680 KiB

Open AccessReview

A Narrative Review Discussing the Efficiency of Personalized Dosing Algorithm of Follitropin Delta for Ovarian Stimulation and the Reproductive and Clinical Outcomes

by Bogdan Doroftei, Ovidiu-Dumitru Ilie, Nicoleta Anton, Olivia-Andreea Marcu, Ioana-Sadyie Scripcariu and Ciprian Ilea

Diagnostics 2023, 13(2), 177; https://doi.org/10.3390/diagnostics13020177 - 4 Jan 2023

Cited by 4 | Viewed by 3734

Abstract

Background: Follitropin delta is the third recombinant human follicle-stimulating hormone (r-hFSH) expressed in a host cell line of human fetal retinal origin that currently emphasizes that the actual tendency of administration is a personalized dosing algorithm based on the anti-Müllerian hormone (AMH) and [...] Read more.

Background: Follitropin delta is the third recombinant human follicle-stimulating hormone (r-hFSH) expressed in a host cell line of human fetal retinal origin that currently emphasizes that the actual tendency of administration is a personalized dosing algorithm based on the anti-Müllerian hormone (AMH) and body mass index (BMI) for ovarian stimulation. Methods: In this context, we aimed, in the present manuscript, to gather all available data published between 2018–2022 regarding the co-administration and administration of follitropin delta and the clinical outcomes reported following an in vitro fertilization (IVF). Results: Follitropin delta is non-inferior in contrast to its previously launched agents for ovarian stimulation, enhancing a similar-to-superior response reflected by both the reproductive and pregnancy outcomes in parallel with a low risk of ovarian hyperstimulation syndrome (OHSS), being well tolerated. The body weight and AMH level are factors that may influence the outcome in a patient. Despite controversy and results that refute these arguments on several occasions, follitropin delta exceeds the benefits of conventional dosing with either follitropin alfa or follitropin beta. Thus, all post hoc, derived analyses and subsets of patients that participated in subsequent studies support this statement. Conclusions: Despite the relatively limited spectrum of data in the current literature, most authors brought potent proof, supporting the subsequent use of this drug depending on the patient’s profile and overcoming ethnic-related limitations. Although others contradict these observations, this topic and drug possess substantial potential, which is why additional studies are mandatory to fill the existing gaps in our knowledge and expand these experiences at a larger scale supported by the obtained reproductive and clinical outcomes that clearly indicate an overcoming of all limitations. Full article

(This article belongs to the Special Issue Imaging of Fetal and Maternal Diseases in Pregnancy 2.0)

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15 pages, 2049 KiB

Open AccessReview

Prenatal Course and Sonographic Features of Congenital Mesoblastic Nephroma

by Theera Tongsong, Watchareepohn Palangmonthip, Wisit Chankhunaphas and Suchaya Luewan

Diagnostics 2022, 12(8), 1951; https://doi.org/10.3390/diagnostics12081951 - 12 Aug 2022

Cited by 3 | Viewed by 2643

Abstract

Background: Congenital mesoblastic nephroma (CMN) is the most common renal tumor among fetuses and infants before the age of 6 months. It usually behaves as a benign tumor. The prenatal features and outcomes of pregnancies with fetal CMN have never been systematically reviewed [...] Read more.

Background: Congenital mesoblastic nephroma (CMN) is the most common renal tumor among fetuses and infants before the age of 6 months. It usually behaves as a benign tumor. The prenatal features and outcomes of pregnancies with fetal CMN have never been systematically reviewed and analyzed, whereas neonatal or pediatric series have been published several times. The aims of this study are to (1) describe the prenatal natural course and prenatal sonographic char-acteristics of CMN; (2) determine the outcomes of pregnancies with fetal CMN; and (3) demonstrate typical sonographic images together with video clips of prenatal CMN, as an educational example based on our index case presented here. Methods: Studies focused on fetal CMN, including those consecutively published on PubMed from 1980 to June 2022 as well as the index case presented here, were identified and validated to perform a systematic review. The data of fetal imaging and the prenatal course of pregnancies were extracted for analysis. Results: The findings derived from 41 cases of review are as follows: (1) No single case has been diagnosed in the first half of pregnancy. No cases were detected during routine anomaly screening at mid-pregnancy. All cases were de-tected in the third trimester or late second trimester. (2) Polyhydramnios is very common and is the first clinical manifestation in most cases, leading to detailed ultrasound in the second half of pregnancy. (3) Preterm birth and low birth weight are the most common adverse pregnancy out-comes, resulting in neonatal morbidity. (4) Hydrops fetalis, though relatively rare, can be associated with CMN and is a grave sign. (5) Prenatal diagnosis is essential since it is critical for the antenatal plan, comprising either referral to a tertiary care center or proper surveillance to prevent serious obstetric complications, especially preterm birth. (6) Ultrasound is the primary tool for prenatal diagnosis of CMN, whereas MRI can be used as an adjunct if some other tumors are suspicious or sonographic features are not typical for CMN. Conclusion: In contrast to CMN in neonates, fetal CMN is much more serious since it significantly impacts adverse pregnancy outcomes and perinatal morbidity and mortality. The typical prenatal course and the sonographic features of CMN are described. Full article

(This article belongs to the Special Issue Imaging of Fetal and Maternal Diseases in Pregnancy 2.0)

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16 pages, 1157 KiB

Open AccessReview

A Mini-Review Regarding the Clinical Outcomes of In Vitro Fertilization (IVF) Following Pre-Implantation Genetic Testing (PGT)-Next Generation Sequencing (NGS) Approach

by Bogdan Doroftei, Ovidiu-Dumitru Ilie, Nicoleta Anton, Theodora Armeanu and Ciprian Ilea

Diagnostics 2022, 12(8), 1911; https://doi.org/10.3390/diagnostics12081911 - 7 Aug 2022

Cited by 6 | Viewed by 3615

Abstract

Background: PGT-based NGS revolutionized the field of reproductive medicine, becoming an integrated component within current assisted reproductive technology (ART) protocols. Methods: We searched the literature published in the last half a decade in four databases (PubMed/Medline, ISI Web of Knowledge, ScienceDirect, and Scopus) [...] Read more.

Background: PGT-based NGS revolutionized the field of reproductive medicine, becoming an integrated component within current assisted reproductive technology (ART) protocols. Methods: We searched the literature published in the last half a decade in four databases (PubMed/Medline, ISI Web of Knowledge, ScienceDirect, and Scopus) between 2018 and 2022. Results: A total of 1388 articles were filtered, from which 60 met, initially, the eligibility criteria, but only 42 were included (≥100 patients/couples—62,465 patients and 6628 couples in total) in the present mini-review. In total, forty-two (70.0%) reported reproductive outcomes, while eighteen (30.0%) had distinct objectives. Furthermore, n = 1, 1.66% of the studies focused on PGT, n = 1, 1.66% on pre-implantation genetic testing for monogenic disorders (PGT-M), n = 3, 5.0% on pre-implantation genetic testing for structural rearrangements (PGT-SR) and n = 55, 91.66% on pre-implantation genetic testing for aneuploidies (PGT-A). Conclusions: PGT using NGS proved to be an excellent companion that folds within the current ascending tendency among couples that require specialty care. We strongly encourage future studies to provide a systematic overview expanded at a larger scale on the role of the PGT-NGS. Full article

(This article belongs to the Special Issue Imaging of Fetal and Maternal Diseases in Pregnancy 2.0)

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Other

Jump to: Research, Review

9 pages, 3151 KiB

Open AccessCase Report

An Unusual Case of Urachal Cyst Misdiagnosed as a Paraovarian Cyst: Ultrasound Assessment and Differential Diagnosis

by Ciprian Ilea, Ovidiu-Dumitru Ilie, Irina-Liviana Stoian, Ioana-Sadyie Scripcariu and Bogdan Doroftei

Diagnostics 2022, 12(12), 3166; https://doi.org/10.3390/diagnostics12123166 - 14 Dec 2022

Viewed by 2293

Abstract

The urachus is an embryologic remnant of the cloaca that usually degenerates after birth, resulting from the obliteration of the allantois, whose role is to connect the bladder to the umbilicus. Incomplete removal of the lumen may give rise to different malformations of [...] Read more.

The urachus is an embryologic remnant of the cloaca that usually degenerates after birth, resulting from the obliteration of the allantois, whose role is to connect the bladder to the umbilicus. Incomplete removal of the lumen may give rise to different malformations of the median umbilical ligament after birth. Although in the pediatric population urachus are common, most cases are asymptomatic and may go unrecognized until adulthood and give rise to cysts, rarely reported in the literature. Thus, in this manuscript we present the circumstances of a 43-year-old Romanian woman showing hypogastric pain of moderate intensity for three weeks, radiation in the left lower limb, menstrual cycle abnormalities, and dysmenorrhea. Based on the initial examinations, a paraovarian cyst measuring 80 mm was noted. Through the subsequent magnetic resonance imaging (MRI) conducted, a hypoechoic mass was detected, and the patient underwent a tumorectomy and partial cystectomy. A 9.7/7.5-cm tumor was excised, and the anatomopathological result was urachal mucinous cystadenoma. It came to our attention that relatively scarce data were found in the literature, with only seven studies with the diagnosis of the urachal cyst. Full article

(This article belongs to the Special Issue Imaging of Fetal and Maternal Diseases in Pregnancy 2.0)

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