14 research outputs found
Newly produced T and B lymphocytes and T-cell receptor repertoire diversity are reduced in peripheral blood of fingolimod-treated multiple sclerosis patients
No full textBackground: Fingolimod inhibits lymphocyte egress from lymphoid tissues, thus altering the composition of the peripheral lymphocyte pool of multiple sclerosis patients.
Objective: The objective of this paper is to evaluate whether fingolimod determines a decrease of newly produced T- and B-lymphocytes in the blood and a reduction in the T-cell receptor repertoire diversity that may affect immune surveillance.
Methods: Blood samples were obtained from multiple sclerosis patients before fingolimod therapy initiation and then after six and 12 months. Newly produced T and B lymphocytes were measured by quantifying T-cell receptor excision circles and K-deleting recombination excision circles by real-time PCR, while recent thymic emigrants, naive CD8+ lymphocytes, immature and naive B cells were determined by immune phenotyping. T-cell receptor repertoire was analyzed by complementarity determining region 3 spectratyping.
Results: Newly produced T and B lymphocytes were significantly reduced in peripheral blood of fingolimod-treated patients. The decrease was particularly evident in the T-cell compartment. T-cell repertoire restrictions, already present before therapy, significantly increased after 12 months of treatment.
Conclusions: These results do not have direct clinical implications but they may be useful for further understanding the mode of action of this immunotherapy for multiple sclerosis patients
Long-Lasting production of New T and B Cells and T-Cell Repertoire Diversity in Patients with Primary Immunodeficiency Who Had Undergone Stem Cell Transplantation : A Single-Centre Experience
No full textLevels of Kappa-deleting recombination excision circles (KRECs), T-cell receptor excision circles (TRECs), and T-cell repertoire diversity were evaluated in 1038 samples of 124 children with primary immunodeficiency, of whom 102 (54 with severe combined immunodeficiency and 48 with other types of immunodeficiency) underwent hematopoietic stem cell transplantation. Twenty-two not transplanted patients with primary immunodeficiency were used as controls. Only data of patients from whom at least five samples were sent to the clinical laboratory for routine monitoring of lymphocyte reconstitutions were included in the analysis. The mean time of the follow-up was 8 years. The long-lasting posttransplantation kinetics of KREC and TREC production occurred similarly in patients with severe combined immunodeficiency and with other types of immunodeficiency and, in both groups, the T-cell reconstitution was more efficient than in nontransplanted children. Although thymic output decreased in older transplanted patients, the degree of T-cell repertoire diversity, after an initial increase, remained stable during the observation period. However, the presence of graft-versus-host disease and ablative conditioning seemed to play a role in the time-related shaping of T-cell repertoire. Overall, our data suggest that long-term B- and T-cell reconstitution was equally achieved in children with severe combined immunodeficiency and with other types of primary immunodeficiency
Detection of newly produced T and B lymphocytes by digital PCR in blood stored dry on nylon flocked swabs
No full textAbstract Background A normal number of T-cell receptor excision circles (TRECs) and K-deleting recombination excision circles (KRECs) is considered a biomarker for adequate new T- and B-cell production. In newborns, detection of TRECs and KRECs by real time PCR from dried blood spotted on filter paper is used for the screening of severe immunodeficiency. In adults, elderly and during diseases, where the number of TRECs is lower than in newborns and children, a large amount of DNA and a sensitive method of amplification are necessary to identify newly produced lymphocytes. Methods DNA was prepared from blood of 203 healthy adults (range: 18–91 years old) absorbed for 10 s on flocked swabs and let to dry, or from peripheral blood mononuclear cells. DNA was subjected to digital PCR and to well established conventional real time PCR-based method using TREC- and KREC-specific primers and probes. The number of TRECs and KRECs was expressed per mL of blood. Statistical analysis was performed by nested ANOVA, Pearson coefficient of determination, and by linear regression tests. Results The novel method for the storage of dried blood on nylon flocked swabs and the use of digital PCR allow quantification of TRECs and KRECs with high degree of sensitivity, specificity, accuracy, and precision. TRECs and KRECs were amplified by digital PCR in all tested blood samples, including those obtained from elderly individuals (>70 years old) and that were negative by real time PCR. Furthermore, values of TRECs and KRECs obtained by digital PCR were in the range of those acquired by real time PCR. Conclusions Our findings demonstrate that DNA isolation from dried blood on flocked swabs followed by digital PCR-based analysis represents a useful tool for studying new lymphocyte production in adults and elderly individuals. This suggests the potential use of the methodology when monitoring of clinical variables is limited by the number of molecules that can be amplified and detected, such as in patients with immunodeficiency or under immunosuppressive therapies
Association of Resolved Low-Lying Placentation With Risk of Postpartum Hemorrhage
No full textOBJECTIVE: To evaluate whether individuals who have a
placenta previa or low-lying placenta that resolves
before delivery are at increased risk of postpartum
hemorrhage and postpartum hemorrhage–related mor-
bidity.
METHODS: This was a prospective, multicenter, 1:3
matched cohort study of pregnant individuals with single-
ton gestations diagnosed with low placentation by trans-
vaginal scan at 19 to 23 weeks of gestation between January
2021 and December 2023 at nine academic maternity
centers (exposed participants). Unexposed participants
were those with a normally located placenta, matched in
a 1:3 ratio according to parity. Resolution of low placenta-
tion was diagnosed when placenta was at 20 mm or more
from the internal os. Individuals with fetal anomalies,
hematologic disorders, therapeutic anticoagulation, pla-
centa accreta spectrum disorder, vasa previa, persistent
low placentation at birth, and delivery at a nonenrolling
enter were excluded. Primary outcome was postpartum
hemorrhage of 1,000 mL or more. Secondary outcomes
included postpartum hemorrhage of 1,500 mL or more, use
of second-line uterotonic drugs, blood transfusions, addi-
tional procedures to control bleeding, intensive care unit
admission, and hospital stay for more than 7 days.
Multivariable logistic regression adjusted for confounders
was used to estimate independent associations with out-
comes.
RESULTS: The study population included 182 exposed
and 589 unexposed participants. Individuals with
resolved low placentation had higher rates of smoking
(P5.024), prior dilation and curettage (P5.012), posterior
placenta (P,.001), and induction of labor (P5.038). Mul-
tivariate logistic regression analysis adjusted for con-
founders showed that exposed people had higher odds
of postpartum hemorrhage of 1,000 mL or more (13.2%
vs 4.1%, adjusted odds ratio [aOR] 3.1) compared with
unexposed people and of use of second-line uterotonic
drugs (28.0% vs 12.4%, aOR 2.69) and tranexamic acid
(16.5% vs 7.5%, aOR 2.19), as well as hospital stay longer
than 7 days (11.5% vs 3.4%, aOR 2.63).
CONCLUSION: Individuals with resolved low placenta-
tion are at increased risk of postpartum hemorrhage and
related complications compared with those who always
had a normally located placenta
Selected Abstracts of the 20th National Congress of the Italian Society of Perinatal Medicine (<em>Società Italiana di Medicina Perinatale</em>, SIMP); Catania (Italy); March 22-24, 2018; Session “Perinatal infections”
No full text20th National Congress of the Italian Society of Perinatal Medicine (Società Italiana di Medicina Perinatale, SIMP)
Catania (Italy) • March 22nd-24th, 2018
SIMP PRESIDENT
Irene Cetin
CONGRESS PRESIDENTS
Nicola Chianchiano, Angela Motta
SCIENTIFIC COMMITTEE
Mariarosaria Di Tommaso, Gianpaolo Donzelli, Luca Ramenghi
----------
Guest Editors: Irene Cetin, Nicola Chianchiano, Angela Motta
----------
Session “Perinatal infections”
ABS 1. ROLE OF ABNORMAL CTG FEATURES IN CLINICAL AND SUBCLINICAL CHORIOAMNIONITIS • L. Galli, V. Whelehan, A. Archer, A. Dall’Asta, T. Frusca, E. Chandraharan
ABS 2. HISTOLOGICAL CHORIOAMNIONITIS AT TERM: WHAT CLINICAL VALUE? • A. Pintucci, S. Consonni, L.E. Gioia, P. Colombo, P. Di Lorenzo, I. Vaglio Tessitore, F. Moltrasio, G. Bovo, A. Locatelli
ABS 3. VALNOCTAMIDE RESCUES CYTOMEGALOVIRUS-INDUCED ABNORMAL BRAIN ONTOGENY AND DEAFNESS • S. Ornaghi, J. Bai, W. Tan, J. Santos-Sacchi, D. Navaratnam, A.N. van den Pol, M.J. Paidas, P. Vergani
ABS 4. ZIKA TESTING IN PREGNANT AND PREGNANCY PLANNING WOMEN • G. Liuzzi, C. Castilletti E. Nicastri, F. Vairo, A. Corpolongo E. Lalle, M. Iannetta, L. Bordi, L. Scorzolini, F. Carletti, S. Quartu, F. Colavita, M.R. Capobianchi, G. Ippolito
ABS 5. MEASLES IS AGAIN A PROBLEM • C.I. Palermo, C.M. Costanzo, R. Russo, M. Di Franco, G. Scalia
ABS 6. OUTCOMES ASSOCIATED WITH FETAL PARVOVIRUS B19 INFECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS • D. Buca, F. Bascietto, M. Liberati, D. Murgano, A. Iacovelli, M.E. Flacco, L. Manzoli, A. Familiari, G. Scambia, F. D’Antonio
ABS 7. HIV INFECTION AMONG MIGRANT PEOPLE: A SINGLE CENTER EXPERIENCE • A. Giudicepietro, L. Sarno, G.M. Maruotti, L.L. Mazzarelli, M.C. De Angelis, A. Sirico, F. Zullo, P. Martinelli, M. Sansone
ABS 8. FETAL PARVOVIRUS B19 INFECTION • V. Giardini, S. Lazzarin, A. Martinelli, S. Cozzolino, M. Verderio, P. Vergani
ABS 9. MASTITIS AND BREAST ABSCESSES IN BREASTFEEDING: MILK CULTURE, ANTIBIOTIC TREATMENT AND FOLLOW UP • M.I. Mazzocco, P. Pileri, S.G. Rimoldi, A. Sartani, F. Romeri, S. Mancini, M.R. Gismondo, I. Cetin
ABS 10. ACTIVE TUBERCULOSIS CASE-FINDING AMONG PREGNANT WOMEN PRESENTING TO AN OBSTETRICS CLINIC IN NORTHERN ITALY • M. Lamanna, V. Giardini, F. Sabbatini, P. Faverio, S. Lazzarin, P. Vergani
ABS 11. LISTERIOSIS AND PREGNANCY: RESULTS FROM AN ITALIAN PILOT STUDY • L. Pucci, M. Massacesi, M. De Santi, G. Brandi
ABS 12. INCIDENCE OF TOXOPLASMOSIS IN PREGNANCY: A POPULATION-BASED STUDY • V. Donadono, L. Sarno, A. Giudicepietro, L.L. Mazzarelli, G. Saccone, S. Tagliaferri, A. Sirico, G. Esposito, G.M. Maruotti, F. Zullo, P. Martinelli
ABS 13. PARVOVIRUS B19 INFECTION IN PREGNANCY • V. Frisina, G. Masuelli, T. Todros
ABS 14. PRETERM PREMATURE RUPTURE OF MEMBRANES (PPROM): CAN WE OPTIMIZE OUR FIRST LINE TREATMENT BY STUDYING THE LOCAL MICROBIOTA? • A. Dall’Asta, L. Angeli, E. Roletti, T. Ghi, T. Frusca
ABS 15. PLACENTAL AND FETAL MEMBRANES INFECTION IN PREGNANCY WITH RUPTURE OF MEMBRANES. A PILOT STUDY • S. Cireddu, C. Gerosa, M. Anardu, F. Coghe, V. Fanos, G. Faa, S. Angion
Mode of birth in women with low-lying placenta: protocol for a prospective multicentre 1:3 matched case-control study in Italy (the MODEL-PLACENTA study)
No full textIntroduction The term placenta praevia defines a placenta that lies over the internal os, whereas the term low-lying placenta identifies a placenta that is partially implanted in the lower uterine segment with the inferior placental edge located at 1-20 mm from the internal cervical os (internal-os-distance). The most appropriate mode of birth in women with low-lying placenta is still controversial, with the majority of them undergoing caesarean section. The current project aims to evaluate the rate of vaginal birth and caesarean section in labour due to bleeding by offering a trial of labour to all women with an internal-os-distance >5 mm as assessed by transvaginal sonography in the late third trimester. Methods and analysis The MODEL-PLACENTA is a prospective, multicentre, 1:3 matched case-control study involving 17 Maternity Units across Lombardy and Emilia-Romagna regions, Italy. The study includes women with a placenta located in the lower uterine segment at the second trimester scan. Women with a normally located placenta will be enrolled as controls. A sample size of 30 women with an internal-os-distance >5 mm at the late third trimester scan is needed at each participating Unit. Since the incidence of low-lying placenta decreases from 2% in the second trimester to 0.4% at the end of pregnancy, 150 women should be recruited at each centre at the second trimester scan. A vaginal birth rate ≥60% in women with an internal-os-distance >5 mm will be considered appropriate to start routinely admitting to labour these women. Ethics and dissemination Ethical approval for the study was given by the Brianza Ethics Committee (No 3157, 2019). Written informed consent will be obtained from study participants. Results will be disseminated by publication in peer-reviewed journals and presentation in international conferences. Trial registration number NCT04827433 (pre-results stage
study
No full textObjectives: To evaluate the diagnostic performance of third trimester ultrasound for the diagnosis of clinically significant Placenta accreta spectrum disorder (PAS) in women with a low-lying placenta (less than 20 mm from the internal cervical os) or placenta praevia (covering the os) METHODS: Pregnant women with a low-lying placenta or placenta praevia, age ≥ 18 years and gestational age at ultrasound ≥ 26+0/7 weeks of gestation were prospectively included in the study. Ultrasound suspicion of PAS was raised in the presence of at least one of these signs: (1) obliteration of the hypoechoic space between the uterus and the placenta; (2) interruption of the hyperechoic interface between the uterine serosa and the bladder wall; (3) abnormal placental lacunae. In order to assess the ability of ultrasound to detect clinically significant PAS, a composite outcome comprehensive of both active management at delivery and histopathological confirmation of PAS was considered as the reference standard. PAS was considered of clinical significance if, in addition to histological confirmation, at least one of these procedures was carried out after delivery: use of hemostatic intrauterine balloon, compressive uterine suture, peripartum hysterectomy, uterine/hypogastric artery ligation, uterine artery embolization. Results: A total of 568 women underwent transabdominal and transvaginal ultrasound examinations. Of them, 95 delivered in local hospitals and placental pathology according to the study protocol was therefore not available. Among the 473 for whom placental pathology was available, clinically significant PAS was diagnosed in 99 (21%). A normal hypoechoic space between the uterus and the placenta reduces post-test probability of PAS from 21% to 5% in women with a low-lying placenta or placenta previa in the third trimester of pregnancy, and from 62% to 9% in the subgroup of women with previous cesarean section and anterior placenta. The absence of lacunae reduces post-test probability of PAS from 21% to 9% in women with low-lying placenta or placenta previa in the third trimester of pregnancy, and from 62% to 36% in the subgroup with previous cesarean section and anterior placenta. On the other side, when lacunae are seen the post-test probability increases from 21% to 59% in the whole study population and from 62% to 78% in women with placenta previa, previous cesarean section and anterior placenta. Conclusions: Grey-scale ultrasound is a good test to identify pregnancies at low risk of PAS in this high risk population. Ultrasound can be safely used to guide management decisions, concentrating greater resources in patients with the higher risk of clinically significant PAS This article is protected by copyright. All rights reserved
Determinants of emergency Cesarean delivery in pregnancies complicated by placenta previa with or without placenta accreta spectrum disorder: analysis of ADoPAD cohort
No full textObjectives: To investigate the rate and outcome of emergency Cesarean delivery (CD) in women with placenta previa with or without placenta accreta spectrum disorders (PAS) and to elucidate the diagnostic accuracy of ultrasound in predicting emergency CD. Methods: This was a secondary analysis of a multicenter prospective study involving 16 referral hospitals in Italy (ADoPAD study). Inclusion criteria were women with placenta previa minor (< 20 mm from the internal cervical os) or placenta previa major (covering the os), aged ≥ 18 years, who underwent transabdominal and transvaginal ultrasound assessment at ≥ 26 + 0 weeks of gestation. The primary outcome was the occurrence of emergency CD, defined as the need for immediate surgical intervention performed for emergency maternal or fetal indication, including active labor, cumulative maternal bleeding > 500 mL, severe and persistent vaginal bleeding such that maternal hemodynamic stability could not be achieved or maintained, or category-III fetal heart rate tracing unresponsive to resuscitative measures. The primary outcome was reported separately in the population of women with placenta previa and no PAS confirmed after birth and in those with PAS. The secondary aim was to report on the strength of association and to test the diagnostic accuracy of ultrasound in predicting emergency CD. Univariate, multivariate and diagnostic accuracy analyses were used to analyze the data. Results: A total of 450 women, including 97 women with placenta previa and PAS and 353 with placenta previa only, were analyzed. In women with placenta previa and PAS, emergency CD was required in 20.6% (95% CI, 14–30%), and 60.0% (12/20) delivered before 34 weeks of gestation. The mean gestational age at delivery was 32.3 ± 2.7 weeks in women undergoing emergency CD and 34.9 ± 1.8 weeks in those undergoing elective CD (P < 0.001). Women undergoing emergency CD had a higher median estimated blood loss (2500 (interquartile range (IQR), 1350–4500) vs 1100 (IQR, 625–2500) mL; P = 0.012), mean units of blood transfused (7.3 ± 8.8 vs 2.5 ± 3.4; P = 0.02) and more frequent placement of a mechanical balloon (50.0% vs 16.9%; P = 0.002) compared with those undergoing elective CD. On univariate analysis, the presence of interrupted retroplacental space, interrupted bladder line and placental lacunae was more common in women not experiencing emergency CD. No comprehensive multivariate analysis could be performed in this subgroup of women. Ultrasound signs of PAS, including presence of interrupted retroplacental space, interrupted bladder line and placental lacunae, were not predictive of emergency CD. In women with placenta previa but no PAS, emergency CD was required in 31.2% (95% CI, 26.6–36.2%), and 32.7% (36/110) delivered before 34 weeks of gestation. The mean gestational age at delivery was lower in women undergoing emergency CD compared with those undergoing elective CD (34.2 ± 2.9 vs 36.7 ± 1.6 weeks; P < 0.001). Pregnancies complicated by emergency CD were associated with a lower birth weight (2330 ± 620 vs 2800 ± 480 g; P < 0.001) and had a higher risk of need for blood transfusion (22.7% vs 10.7%; P = 0.003) compared with those who underwent elective CD. On multivariate analysis, only placental thickness (odds ratio (OR), 1.02 (95% CI, 1.00–1.03); P = 0.046) and cervical length < 25 mm (OR, 3.89 (95% CI, 1.33–11.33); P = 0.01) were associated with emergency CD. However, a short cervical length showed low diagnostic accuracy for predicting emergency CD in these women. Conclusion: Emergency CD occurred in about 20% of women with placenta previa and PAS and 30% of those with placenta previa only and was associated with worse maternal outcome compared with elective intervention. Prenatal ultrasound is not predictive of the risk of emergency CD in women with these disorders. © 2023 International Society of Ultrasound in Obstetrics and Gynecology
Selected Abstracts of the 20th National Congress of the Italian Society of Perinatal Medicine (<em>Società Italiana di Medicina Perinatale</em>, SIMP); Catania (Italy); March 22-24, 2018; Session “Prematurity”
No full text20th National Congress of the Italian Society of Perinatal Medicine (Società Italiana di Medicina Perinatale, SIMP)
Catania (Italy) • March 22nd-24th, 2018
SIMP PRESIDENT
Irene Cetin
CONGRESS PRESIDENTS
Nicola Chianchiano, Angela Motta
SCIENTIFIC COMMITTEE
Mariarosaria Di Tommaso, Gianpaolo Donzelli, Luca Ramenghi
----------
Guest Editors: Irene Cetin, Nicola Chianchiano, Angela Motta
----------
Session “Prematurity”
ABS 1. EARLY PAIN EXPERIENCES AND NEONATAL CEREBRAL CONNECTIVITY EVALUATED WITH rs-FMRI AT TERM CORRECTED AGE • D. Tortora, C. Di Biase, M. Severino, A. Parodi, M. Malova, G. Morana, A. Rossi, L.A. Ramenghi
ABS 2. PLACENTAL HISTOLOGY FINDINGS AS POSSIBLE RISK FACTORS FOR MRI-DETECTED BRAIN LESIONS IN VLBW INFANTS • A. Parodi, M. Re, L. De Angelis, D. Brignole, M.P. Brisigotti, M.G. Calevo, M. Malova, A. Sannia, M. Severino, G. Morana, D. Tortora, A. Rossi, E. Fulcheri, L.A. Ramenghi
ABS 3. PATTERN OF NEURODEVELOPMENTAL OUTCOME AT 2 YEARS OF CORRECTED AGE (CA) IN ISOLATED LOW-GRADE INTRAVENTRICULAR HEMORRHAGES VS LOW-GRADE CEREBELLAR HEMORRHAGES • A. Parodi, M. Malova, S. Uccella, L. Boeri, E. De Grandis, A. Sannia, M. Severino, G. Morana, D. Tortora, A. Rossi, E. Veneselli, L.A. Ramenghi
ABS 4. TWIN PREGNANCY AND PRETERM BIRTH: FOCUS ON “AUTOPHAGY BIOMARKERS” AS REGULATORS OF THE IMMUNE RESPONSE • G. Di Rienzo, S. Paccosi, A. Parenti, E. Magro-Malosso, G. Sisti, M. Di Tommaso, F. Petraglia
ABS 5. THE ROLE OF ELASTOGRAPHY IN PREDICTING PRETERM BIRTH • G. Nazzaro, E. Salzano, R. Iazzetta, M. Miranda, M. Locci
ABS 6. MRI-DIAGNOSED WHITE MATTER LESIONS IN THE BRAIN OF VLBW BABIES: RISK FACTOR ANALYSIS • A. Parodi, S. Raffa, V. Cardiello, M. Malova, A. Sannia, M. Severino, G. Morana, D. Tortora, M.G. Calevo, A. Rossi, L.A. Ramenghi
ABS 7. MATERNAL AND FETAL OUTCOMES IN TWIN OOCYTE DONATION PREGNANCIES: EXPERIENCE OF A TERTIARY REFERRAL OBSTETRIC ITALIAN CENTER • F. Fuse’, A. Turri, L. Primerano, O. Fornaciari, E. Bottazzoli, D. Di Martino
ABS 8. MATERNAL AND FETAL OUTCOMES IN SINGLETON OOCYTE DONATION PREGNANCIES: EXPERIENCE OF A TERTIARY REFERRAL OBSTETRIC ITALIAN CENTER • L. Primerano, F. Fuse’, A. Turri, E. Bottazzoli, O. Fornaciari, D. Di Martino
ABS 9. PREECLAMPSIA OR CHRONIC KIDNEY DISEASE? A CORRECT DIAGNOSIS CAN PREVENT PRETERM BIRTH. A CASE REPORT • F. Minelli, B. Montersino, F. Fassio, P. Gaglioti, L. Colla, S. Palagi, G.B. Piccoli, R. Attini, T. Todros
ABS 10. THE CERVICAL SLIDING SIGN: A NEW ULTRASOUND TOOL IN THE ASSESSMENT OF THREATENED PRETERM LABOR • N. Volpe, E. Roletti, A. Infranco, A. Dall’Asta, L. Galli, T. Ghi, T. Frusca
ABS 11. IS MATERNAL SERUM PREGNANCY ASSOCIATED PLASMA PROTEIN-A (PAPP-A) A PREDICTIVE MARKER OF SPONTANEOUS PRETERM BIRTH? • G. Fantappiè, S. Vannuccini, M.C. Cappellini, E.R. Magro Malosso, M. Di Tommaso, F. Petraglia
ABS 12. INSIGHTS ON THE USE OF EXTERNAL VENTRICULAR DEVICE IN THE TREATMENT OF POST-HAEMORRHAGIC VENTRICULAR DILATATION IN PRETERM INFANTS • M. Sebastiani, M. Severino, D. Tortora, G. Morana, M. Malova, A. Parodi, M. Ravegnani, A. Cama, A. Rossi, L. Ramenghi
ABS 13. ARE THE 2 YEAR GRIFFITHS SCORES OF BABIES WITH CEREBELLAR HAEMORRHAGE (CBH) AND INTRAVENTRICULAR HAEMORRHAGE (IVH) SIGNIFICANTLY DIFFERENT COMPARED TO THOSE OF BABIES SUFFERING FROM ISOLATED IVH? • S. Uccella, A. Parodi, M. Malova, L. Boeri, E. De Grandis, C. Traggiai, A. Sannia, M. Severino, G. Morana, D. Tortora, A. Rossi, E. Veneselli, L.A. Ramenghi
ABS 14. ARE PACKED RED BLOOD CELL TRANSFUSIONS (PRBCT) IN PRETERM INFANTS ASSOCIATED WITH IMPROVED GROWTH AND/OR FLUID RETENTION? • B. Bartolomei, A. Correani, F. De Angelis, C. Biagetti, P. Marchionni, V.P. Carnielli
ABS 15. LOOKING FOR NEUROLOGICAL BIOMARKERS IN VLBW BABIES: BLOOD ADENOSINE LEVELS AND NEUROLOGICAL OUTCOME • L. De Angelis, M. Colella, V. Cardiello, M. Malova, S. Uccella, L. Boeri, E. De Grandis, I. Panfoli, G. Candiano, M. Cassanello, A. Parodi, E. Veneselli, L. Ramenghi
ABS 16. PREDICTION OF PRETERM BIRTH IN MULTIPLE PREGNANCIES WITH SERIAL MEASUREMENTS OF CERVICAL LENGTH • G. Pavone, I. Faralli, A. Finelli, B. Matarrelli, D. Buca, M. Leombroni, C. Celentano
ABS 17. PREGNANCY COMPLICATED BY GESTATIONAL DIABETES MELLITUS: IS PRETERM DELIVERY CORRELATED TO METFORMIN TREATMENT? • C. Callegari, P. Algeri, S. Di Nicola, I. Crippa, E.M. Mariani, I. Cameroni, P. Vergani, N. Roncaglia
ABS 18. MATERNAL HYPERTENSION AND SURVIVAL IN VERY PRETERM SINGLETONS AND TWINS: NOT JUST ONE ANSWER… • L. Gagliardi, O. Basso
ABS 19. CARDIOVASCULAR AND METABOLIC EFFECTS OF HYDROCORTISONE THERAPY FOR BRONCHOPULMONARY DYSPLASIA IN PRETERM INFANTS • L. Antonini, A. Correani, L. Antognoli, I. Giretti, M. Maiorano, C. Rondina, V. Carnielli
ABS 20. DELIVERY AND NEONATAL OUTCOMES IN UNCOMPLICATED DICHORIONIC TWIN PREGNANCIES ACCORDING TO MODE OF CONCEPTION • P. Algeri, S. Ornaghi, I. Vaglio Tessitore, L. Brienza, S. Cozzolino, M. Incerti, P. Vergani
ABS 21. ROLE OF GROUP B STREPTOCOCCUS ON PERINATAL OUTCOME IN PREGNANCY COMPLICATED BY PRETERM DELIVERY < 34 WEEKS • F. Accordino, A. Griggio, S. Ornaghi, I. Cameroni, P. Vergan
Third-trimester ultrasound for antenatal diagnosis of placenta accreta spectrum in women with placenta previa: results from the ADoPAD study
No full textObjective To evaluate the performance of third-trimester ultrasound for the diagnosis of clinically significant placenta accreta spectrum disorder (PAS) in women with low-lying placenta or placenta previa. Methods This was a prospective multicenter study of pregnant women aged >= 18 years who were diagnosed with low-lying placenta (< 20 mm from the internal cervical os) or placenta previa (covering the internal cervical os) on ultrasound at >= 26 + 0 weeks' gestation, between October 2014 and January 2019. Ultrasound suspicion of PAS was raised in the presence of at least one of these signs on grayscale ultrasound: (1) obliteration of the hypoechogenic space between the uterus and the placenta; (2) interruption of the hyperechogenic interface between the uterine serosa and the bladder wall; (3) abnormal placental lacunae. Histopathological examinations were performed according to a predefined protocol, with pathologists blinded to the ultrasound findings. To assess the ability of ultrasound to detect clinically significant PAS, a composite outcome comprising the need for active management at delivery and histopathological confirmation of PAS was considered the reference standard. PAS was considered to be clinically significant if, in addition to histological confirmation, at least one of these procedures was carried out after delivery: use of hemostatic intrauterine balloon, compressive uterine suture, peripartum hysterectomy, uterine/hypogastric artery ligation or uterine artery embolization. The diagnostic performance of each ultrasound sign for clinically significant PAS was evaluated in all women and in the subgroup who had at least one previous Cesarean section and anterior placenta. Post-test probability was assessed using Fagan nomograms. Results A total of 568 women underwent transabdominal and transvaginal ultrasound examinations during the study period. Of these, 95 delivered in local hospitals, and placental pathology according to the study protocol was therefore not available. Among the 473 women for whom placental pathology was available, clinically significant PAS was diagnosed in 99 (21%), comprising 36 cases of placenta accreta, 19 of placenta increta and 44 of placenta percreta. The median gestational age at the time of ultrasound assessment was 31.4 (interquartile range, 28.6-34.4) weeks. A normal hypoechogenic space between the uterus and the placenta reduced the post-test probability of clinically significant PAS from 21% to 5% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 9% in the subgroup with previous Cesarean section and anterior placenta. The absence of placental lacunae reduced the post-test probability of clinically significant PAS from 21% to 9% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 36% in the subgroup with previous Cesarean section and anterior placenta. When abnormal placental lacunae were seen on ultrasound, the post-test probability of clinically significant PAS increased from 21% to 59% in the whole cohort and from 62% to 78% in the subgroup with previous Cesarean section and anterior placenta. An interrupted hyperechogenic interface between the uterine serosa and bladder wall increased the post-test probability for clinically significant PAS from 21% to 85% in women with low-lying placenta or placenta previa and from 62% to 88% in the subgroup with previous Cesarean section and anterior placenta.When all three sonographic markers were present, the post-test probability for clinically significant PAS increased from 21% to 89% in the whole cohort and from 62% to 92% in the subgroup with previous Cesarean section and anterior placenta. Conclusions Grayscale ultrasound has good diagnostic performance to identify pregnancies at low risk of PAS in a high-risk population of women with low-lying placenta or placenta previa. Ultrasound may be safely used to guide management decisions and concentrate resources on patients with higher risk of clinically significant PAS
