25 research outputs found
Color-dye injection of monochorionic placentas and correlation with pregnancy complications
No full textIntroduction Vascular anastomoses in monochorionic (MC) twin placenta can be easily identified with color-dye injection. The aim of this study is to analyze the relationship between different type of anastomoses and twin pregnancy complications. Methods From January 2011 to October 2014, MC placentas were analyzed with color-dye injection and five group of pregnancies were identified: those that were not complicated (NC), those complicated with selective intrauterine growth restriction (sIUGR), twin-twin transfusion syndrome (TTTS), or twin anemia-polycitemia sequence (TAPS) and those with amniotic fluid discordance (AFD) between twins. Cases of TTTS treated with endoscopic laser coagulation of placenta anastomoses or cases with in utero death of one twin were excluded. Results A total of 118 MC placentas were observed, 58 (49%) NC, 35 (30%) sIUGR, 10 (8%) TTTS, 13 (11%) AFD and 2 (2%) TAPS. The median number of anastomoses was 7 (range 1-15), 8 (2-18), 4 (2-11), 7 (2-13) and 1 (1-1), respectively. At least one artero-venous anastomoses was found in the placenta observed, while the prevalence of artero-arterial anastomoses was 95% for NC, 91% for sIUGR, 60% for TTTS, and 77% for AFD; no TAPS placenta had this type of anastomoses. The diameter of arteroarterial anastomoses was greater in the AFD group (3.3 mm), compared to the NC, sIUGR and TTTS groups (2.3, 2.5 and 1.4 respectively, p 0.04). Discussion In this large serie of MC placenta analyzed with color-dye injection, a specific distribution of anastomoses emerged for twins with amniotic fluid discordance, which points to a need for intensive surveillance
Marche. Il battito della mia terra - Marche. The Heartbeat of My Land
No full textStorie di città, storie di uomini e di animali. Evocazioni letterarie e visionarie di una terra radicata nel cuore.
Un filo segreto che lega città e territori. Terra di mezzo e terra di confine. Paesaggi di elfi e fate, dove, di notte, comete, serpentine luminose e tappeti di stelle indicano la strada ai viaggiatori.
Le Marche hanno un volto di sirena. Qualcosa che si intuisce, affascina e scompare. Un canto suadente e sconosciuto. Nascosto e tenacemente vivo. Tenero e irraggiungibile.
Lo sguardo di un viso assorto e trepidante, all’inizio di ogni spartito, segna il ritmo del racconto: il volto della maternità prelude alla ricerca delle nostre radici. “Terra di Marche, Terra Madre” attraversa i tempi e i luoghi della nostra identità, cavalcando le ere di una civiltà antica, dal romanico asciutto e rustico del medioevo, al quattrocento che vola sui loggiati, al barocco dei campanili tempestosi, all’Ottocento sinuoso dalle armonie sconnesse, fino al Novecento, secco e tagliente. I sensi del partire, del risiedere e del resistere si sedimentato nell’anima marchigiana con la forza di una cicatrice, di una stigmate marchiata sulla pelle, il segno di un battesimo e di una rinascita.
Un viaggio alle origini dei luoghi costruiti, alla sorgente della nostra madre terra.
Il viso di una bambina spalanca gli occhi all’innocenza di una bellezza intangibile.
Così “Il battito della mia terra” fa vibrare il cuore pulsante di storia e arte delle nostre contrade e la possibilità che la bellezza salvi le nostre città. E il paesaggio marchigiano mostra i suoi transiti di luce, sulla terra e dal cielo.
Il ritratto di un ragazzo custodisce le tracce invisibili di una storia ancora chiusa nel suo enigma, sensibilmente affine ad un immaginario pittorico, giocato su affreschi e dipinti visionari, ombre di un segreto inconscio e delicato.
Il volto di un pescatore sussurra storie di uomini e di animali, con la voce smisurata di poeti e scrittori dimenticati.
Il genio dei luoghi, le architetture, l’urbanistica assumono il volto della maturità, che svela il mistero che abita ogni frammento di questa terra.
Il volto di un vecchio incarna la memoria dei luoghi, le testimonianze di pietra e di parola. Il “respiro luminoso delle Marche” abbraccia un passato radioso, racconta a bassa voce quelle città sparite per sempre.
E infine l’epilogo, la storia di un viaggio, e la “Sirena negli occhi”, da cui tutto ha avuto inizio, si allontana dalla sua terra nel sogno di una bellezza impossibile, nell’utopia che i saperi, il fascino di nuovi orizzonti, l’immortalità diano senso all’esistenza, e ritorna infine, gabbiano, nel suo mare. A ricongiungersi con le sue origini.
Abstract
Stories of cities, people and animals. Literary and visionary evocation of a land rooted deep in our hearts.
A secret thread that binds the city and territories. A middle land and borderland. A land of elves and fairies where, at night, comets, brilliant winding lights and a sea of stars, show the way to travellers.
The story is unexpectedly seductive. Marche has the face of a mermaid. Something that you sense, that fascinates you and disappears. A melodious unknown song. Hidden and tenaciously alive. Tender and unreachable.
The expression of a rapt and eager countenance, at the beginning of each and every musical score, marks the pace of the narrative: the face of maternity preludes the search for our roots. “Land of Marche, Mother Land” passes through the ages and places of our identity, riding the eras of an ancient civilisation.
A journey to the origins of built-up places, to the source of our mother land.
And finally in the epilogue, the “Mermaid in our eyes” from which everything originated, moves away from its land following a dream of impossible beauty, a Utopia where knowledge, the fascination of new horizons and immortality bring meaning to our existence, and then returns like a seagull to its sea. Returning to its origin
Longitudinal Doppler references for monochorionic twins and comparison with singletons
No full textOBJECTIVES:
To construct monochorionic (MC) twin-specific longitudinal Doppler references for umbilical artery pulsatility index (UA-PI), middle cerebral artery (MCA) PI and peak systolic velocity (PSV) and ductus venosus (DV) PI derived from a strictly selected cohort of uncomplicated MC twins. The secondary aim of the study was to compare our findings with singleton reference charts.
METHODS:
A retrospective evaluation was made of all consecutive uncomplicated MC twin pregnancies referred to our Unit from 2010 to 2018. Fortnightly serial examinations were performed of UA-PI, MCA-PI, MCA-PSV and DV-PI, according with the clinical protocol, from 20 to 37 weeks of gestation. We included cases with at least four ultrasound examinations, delivery at our hospital and complete neonatal follow up. A two-step method was used to trace the estimated centile curves: estimation of the median was performed with appropriate fractional polynomials by a multilevel model and estimation of the external centiles through the residuals (quantile regression). The comparison with singletons was made by plotting the references derived from the present study on the referred charts commonly used for singletons.
RESULTS:
The study group comprised 150 uncomplicated MC twin pairs. Estimated centiles (3rd, 5th, 10th, 50th, 90th, 95th, 97th) of UA-PI, MCA-PI, MCA-PSV and DV-PI in function of the gestational age are presented. The comparison with singletons showed substantial differences, with higher UA-PI and lower MCA-PI and PSV median values in MC twins. Median DV PI values were similar to the values for singletons, while the upper centiles were higher in MC twins.
CONCLUSIONS:
This study sets out MC twin-specific longitudinal references for UA-PI, MCA-PI, MCA-PSV and DV-PI derived from the largest series of uncomplicated MC twin pregnancies presently available. The comparison with singleton reference values underscores the deviation from physiology that is intrinsic to these unique pregnancies and supports the need for MC twin-specific charts
Fetal lung lesions diagnosis: the crucial role of ultrasonography
No full textFetal lung lesions may cause significant effects of mass and may evolve into a non-immune hydrops and lead to the death of the fetus or the child. Treatment options for these severely affected infants are constantly evolving. The widespread use of ultrasound in prenatal diagnosis, in tertiary center like ours, allows us to identify the fetus, including lung lesions more ‘small. Prenatal diagnosis and possible therapeutic intervention in the immediate prenatal or postnatal period has significantly changed the quality of life and the survival of fetuses and infants, especially those who were completely asymptomatic at birth.
Object of our interest is the pulmonary sequestration and congenital pulmonary malformation is the second in order of frequency, with an incidence between 0.15% and 6.4% of cases
Early diagnosis, follow‐up, and prenatal treatment of a case of TRAP sequence occurring in a dichorionic triamniotic triplet pregnancy
No full textIncidence of Cerebral Injury in Monochorionic Twin Survivors after Spontaneous Single Demise: Long-Term Outcome of a Large Cohort
No full text
