Normal fetal cardiac deformation values in pregnancy; a prospective cohort study protocol

Abstract Background Myocardial deformation imaging offers the potential to measure myocardial function. Remodelling, the change in size, shape and function, appears as a result of pressure or volume changes and is thought to be the first sign of fetal adaptation to placental dysfunction. Deformation can be measured using speckle tracking echocardiography (STE). STE in the fetus might be useful for detection and follow up of the fetus endangered by placental dysfunction. Reference values for fetal myocardial deformation during gestation have not been comprehensively described and need further investigation before STE can be introduced in daily clinical practice. The aim of this study is to determine reference values for fetal myocardial deformation throughout gestation in uncomplicated pregnancies. Methods A longitudinal cohort will be performed. 150 Women, pregnant from a non-anomalous singleton, will be included from 19 to 21 + 6 weeks gestational age. Thereafter, fetal heart ultrasounds will be performed 4 weekly, until 41 weeks gestational age or delivery. Ultrasound data will be analysed using STE software to determine reference values for fetal cardiac deformation during gestation. Discussion Measuring cardiac deformation changes in pregnancy can be a promising tool to detect preclinical cardiac adaptation to placental dysfunction. However, previous studies used different ultrasound scans and STE software resulting in incomparable and contradictory results on deformation values. In this prospective study reference values during pregnancy, cardiac deformation values will be assessed with the same ultrasound and software package in 150 uncomplicated pregnancies. Trial registration National Trial Register number: NTR7132. Date of inclusion: 2018/04/06.

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Postsystolic Shortening by Myocardial Deformation Imaging as a Sign of Cardiac Adaptation to Pressure Overload in Fetal Growth Restriction

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.113.001490 ◽

2014 ◽

Vol 7 (5) ◽

pp. 781-787 ◽

Cited By ~ 42

Author(s):

Fàtima Crispi ◽

Bart Bijnens ◽

Eduardo Sepulveda-Swatson ◽

Monica Cruz-Lemini ◽

Juan Rojas-Benavente ◽

...

Keyword(s):

Fetal Growth ◽

Fetal Growth Restriction ◽

Pressure Overload ◽

Growth Restriction ◽

Myocardial Deformation ◽

Deformation Imaging ◽

Cardiac Adaptation ◽

Myocardial Deformation Imaging

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Abnormal Left Ventricular Structure and Function in Pregnancy Complicated by Pre-Eclampsia

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)85349-1 ◽

1998 ◽

Vol 31 (2) ◽

pp. 377A

Author(s):

D Esposti

Keyword(s):

Left Ventricular ◽

Structure And Function ◽

Left Ventricular Structure ◽

Ventricular Structure ◽

And Function ◽

In Pregnancy

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Reference Values for Cord Blood Neutrophils: Neutrophil Count Is Strongly Influenced By Gestational Age, Sex and Caesarian Section

PEDIATRICS ◽

10.1542/peds.137.supplement_3.455a ◽

2016 ◽

Vol 137 (Supplement 3) ◽

pp. 455A-455A

Author(s):

Emilie Beaulieu ◽

Edith Massé ◽

Frederic Dallaire

Keyword(s):

Cord Blood ◽

Reference Values ◽

Neutrophil Count ◽

Gestational Age ◽

Caesarian Section ◽

Blood Neutrophils

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Ovarian Dysgerminoma in Pregnant Women with Viable Fetus: A Rare Case Report

Case Reports in Oncology ◽

10.1159/000513622 ◽

2021 ◽

pp. 141-146

Author(s):

Reda Youssef ◽

Gamal Sayed Ahmed ◽

Samir Alhyassat ◽

Sanaa Badr ◽

Ahmed Sabry ◽

...

Keyword(s):

Gestational Age ◽

Ovarian Neoplasms ◽

Imaging Modality ◽

Reproductive Age ◽

Diagnostic Challenge ◽

Short Period ◽

Ovarian Dysgerminoma ◽

The Impact ◽

In Pregnancy

Dysgerminoma is an uncommon malignant tumor arising from the germ cells of the ovary. Its association with pregnancy is extremely rare, with a reported incidence of about 0.2–1 per 100,000 pregnancies. Women in the reproductive age group are more commonly affected. It can be extremely rare to conceive naturally, without assisted reproductive interventions, in cases with ovarian dysgerminoma. If a pregnancy does occur with a concurrent dysgerminoma, it is even more unusual to carry the pregnancy to viability or childbirth without fetal or maternal compromise. We report a case of right ovarian dysgerminoma in a young female with a viable intrauterine pregnancy at 10 weeks, which is rarely diagnosed and managed at this gestational age. Numerous factors played a role in her favorable outcome, including early suspicion by ultrasound and presenting history, surgery, histopathological assessment, imaging, and involvement of the multidisciplinary oncology team. Ovarian neoplasms may rapidly increase in size within a short period with little or no symptoms. This poses a diagnostic challenge for obstetricians and oncologists. Hence, we aimed to evaluate the role of imaging in pregnancy using ultrasound as an imaging modality for both early detection of ovarian neoplasms and for follow-up. In conclusion, patients with ovarian dysgerminoma in pregnancy can have favorable outcomes. Treatment should be individualized on a case-to-case basis, depending on many factors; cancer stage, previous reproductive history, the impact of imaging in staging or follow-up of tumor on the fetus, fetal gestational age, and whether termination of the pregnancy can improve survival or morbidity for the mother.

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424 Advanced gestational age is a predictor of non-completion of sleep apnea testing in pregnancy

SLEEP ◽

10.1093/sleep/zsab072.423 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A168-A168

Author(s):

Mihaela Bazalakova ◽

Abigail Wiedmer ◽

Lauren Rice ◽

Sakshi Bajaj ◽

Natalie Jacobson ◽

...

Keyword(s):

Sleep Apnea ◽

Gestational Age ◽

Retrospective Chart Review ◽

Pregnant Patient ◽

Clinic Visit ◽

Early Screening ◽

Home Sleep Apnea Testing ◽

Living Children ◽

Apnea Testing ◽

In Pregnancy

Abstract Introduction Sleep apnea is emerging as an important and underdiagnosed comorbidity in pregnancy. Screening, diagnosis, and initiation of therapy are all time-sensitive processes during the dynamic progression of gestation. Completion of referral and testing for sleep apnea during pregnancy requires a significant commitment of time and effort on the part of the pregnant patient. We evaluated for predictors of non-completion of sleep apnea testing within our obstetric-sleep referral pipeline, in an effort to inform and optimize future referrals. Methods We performed a retrospective chart-review of 405 pregnant patient referrals for sleep apnea evaluation at the University of Wisconsin-Madison/UnityPoint sleep apnea pregnancy clinic. We used logistic regression analysis to determine predictors of lack of completion of sleep apnea testing. Results The vast majority of referrals (>95%) were triaged directly to home sleep apnea testing with the Alice PDX portable device, rather than a sleep clinic visit. The overall rate of referral non-completion was 59%. Predictors of non-completion of sleep apnea evaluation in our pregnant population included higher gestational age (GA) at referral (1–12 wks GA: 30%, 13–26 wks GA: 31%, and 27–40 wks GA: 57% non-completers, p=0.006) and multiparity with 1 or more living children (65% non-completers if any living children, compared to 45% non-completers if no living children, p=0.002). Age, race, and transportation were not predictors of failure to complete sleep apnea testing. Conclusion We have identified several predictors of pregnant patients’ failure to complete sleep apnea evaluation with objective home sleep apnea testing after referral from obstetrics. Not surprisingly, higher gestational age emerged as a strong negative predictor of referral completion, with >50% of patients referred in the third trimester not completing sleep apnea testing. Early screening and referral for sleep apnea evaluation in pregnancy should be prioritized, given the time-sensitive nature of diagnosis and therapy initiation, and demonstrated reduced completion of referrals in advanced pregnancy. Support (if any) None

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Evaluation of prenatal changes in fetal cardiac morphology and function in maternal diabetes mellitus using a novel fetal speckle-tracking analysis: a prospective cohort study

Cardiovascular Ultrasound ◽

10.1186/s12947-021-00256-z ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Dong Wang ◽

Caixia Liu ◽

Xinyu Liu ◽

Ying Zhang ◽

Yu Wang

Keyword(s):

Diabetes Mellitus ◽

Cohort Study ◽

Pregnant Women ◽

Gestational Age ◽

Speckle Tracking ◽

Control Group ◽

Second Trimester ◽

Cardiac Morphology ◽

Sphericity Index ◽

And Function

Abstract Background Due to metabolic changes in the second trimester and the increasing number of pregnant women with obesity and advanced maternal age, the incidence of gestational diabetes mellitus (GDM) remains high. This study aimed to evaluate the effects of GDM on fetal cardiac morphology and function, and to determine whether these changes increase with increasing estimated fetal weight (EFW). Methods Fifty-eight women with GDM (GDM group) and 58 women with a healthy pregnancy (control group) were included in this prospective observational cohort study. Each group included subgroups of 31 pregnant women with a gestational age between 24+0 weeks and 27+6 weeks as well as 27 pregnant women with a gestational age between 28+0 weeks and 40+0 weeks. For all fetuses, a cine of 2–3 s in the four-chamber view was obtained, and online speckle-tracking analysis was performed using the GE Automatic Fetal Heart Assessment Tool (fetal HQ; General Electric Healthcare Ultrasound, Zipf, Austria) to measure the global sphericity index (GSI), global longitudinal strain (GLS), fractional area change (FAC), 24-segment sphericity index (SI), and 24-segment end-diastolic diameter of the left ventricle (LV) and right ventricle (RV). Data were analyzed using the independent t-test and Wilcoxon rank-sum test, as applicable. Results The GDM group (mean HbA1c value was 5.3 ± 0.57 mmol/L) showed a lower GSI value than the control group (1.21 vs. 1.27, P = 0.000), which indicated a rounder shape of the heart. In addition, fetuses in the GDM group demonstrated significant impairment in cardiac function compared to those in the control group (LV-GLS: -18.26% vs. -22.70%, RV-GLS: -18.52% vs. -22.74%, LV-FAC: 35.30% vs. 42.36%, RV-FAC: 30.89% vs. 36.80%; P = 0.000 for all). Subgroup analyses according to gestational age (24+0–27+6 weeks and 28+0–40+0 weeks) showed that the statistical differences were retained between the GDM and control groups in each subgroup. Conclusions Fetuses of women with GDM present with signs of biventricular systolic dysfunction according to deformation analysis using fetal HQ. Additionally, the heart had a rounder shape in the GDM group than in the control group. This study showed that fetal HQ can be used to assess fetal cardiac morphology and function easily and quickly, and the effects of GDM on fetal cardiac morphology and function appeared from the second trimester. Thus, whether earlier and stricter clinical intervention was necessary remained to be further studied. Furthermore, future studies will need to supplement the effects of blood glucose levels on GLS, FAC, GSI, and 24-segment SI. Additionally, the long-term follow-up after birth should also be improved to observe the influence of changes in the indicators on the prognosis.

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Reference Values for Transverse Cerebellar Diameter Throughout Gestation

Pediatric and Developmental Pathology ◽

10.1007/s10024-001-0262-4 ◽

2002 ◽

Vol 5 (5) ◽

pp. 489-494 ◽

Cited By ~ 7

Author(s):

Halit Pinar ◽

Sarah H. Burke ◽

Carol W. Huang ◽

Don B. Singer ◽

C. James Sung

Keyword(s):

Reference Values ◽

Growth Curve ◽

Gestational Age ◽

Normal Values ◽

Growth Restriction ◽

Reliable Indicator ◽

Transverse Diameter ◽

Reliable Parameter ◽

Gestational Week ◽

Duration Of Gestation

The transverse cerebellar diameter (TCD) is well established in the ultrasound literature as a reliable parameter for estimating the duration of gestation. In cases of growth restriction the cerebellum is usually spared, making TCD a reliable indicator of gestational age even when other parameters fall off the appropriate growth curve. The purpose of this study is to establish normal values for the transverse diameter of the cerebellum in pathology specimens, and to determine if these values correlate with those obtained by ultrasound. We examined 96 specimens ranging from 14 to 42 weeks gestational age and found that our values correlate well with those published in the ultrasound literature. Mean TCD with 2 standard deviations for each gestational week were determined as reference values.

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