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Background and Purpose— Quantification of early ischemic changes (EIC) may predict functional outcome in patients with basilar artery occlusion (BAO). We tested the validity of a novel CT score, the posterior circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS). Methods— Pc-ASPECTS allots the posterior circulation 10 points. Two points each are subtracted for EIC in midbrain or pons and 1 point each for EIC in left or right thalamus, cerebellum or PCA-territory, respectively. We studied 2 different populations: (1) patients with suspected vertebrobasilar ischemia and (2) patients with BAO. We applied pc-ASPECTS to noncontrast CT (NCCT), CT angiography source images (CTASI), and follow-up image by 3-reader consensus. We calculated sensitivity for ischemic changes and analyzed the predictivity of pc-ASPECTS for independent (modified Rankin Scale [mRS] score ≤2) and favorable (mRS score ≤3) outcome. Results— Of 130 patients with suspected vertebrobasilar ischemia, 72% (94) had posterior circulation stroke, 8% (10) transient ischemic attack, and 20% (26) nonischemic etiology. Sensitivity for ischemic changes was improved with CTASI compared to NCCT (65% [95% CI, 57% to 73%] versus 46% [95% CI, 37% to 55%], respectively). Pc-ASPECTS score on CTASI but not NCCT predicted functional independence (OR 1.58; P =0.005 versus 1.22; P =0.42, respectively). Of 46 patients with BAO, 52% (12/23) with CTASI pc-ASPECTS score ≥8 but only 4% (1/23) with a score Conclusion— The CTASI pc-ASPECTS score may identify BAO patients unlikely to have a favorable outcome despite recanalization.

Objective: PTX3, sFlt-1 and PlGF levels in maternal blood are altered in some obstetric diseases, such as preeclampsia (PE). Nonetheless, only few data on their expression in the fetal compartment have been reported so far. Study Design: An observational study was performed by prospectively collecting maternal and fetal serum samples in 51 singleton pregnancies divided into two groups: 22 PE women and 29 healthy controls. The relationships between maternal and fetal marker serum levels were evaluated by Spearman correlation. Results: A feto-maternal correlation was neither identified for PTX3 in either PE or control groups (1.1 versus 3.8 ng/ml, p = 0.17 and 0.9 versus 1.3 ng/ml, p = 0.30, respectively), nor for sFlt-1 and PlGF in healthy pregnancies (158.2 versus 3326.0 pg/ml, p = 0.28 and 11.0 versus 230.9 pg/ml, p = 0.51). In contrast, PE patients showed a significant positive feto-maternal correlation for both sFlt-1 and PlGF (324.1 versus 10 825.0 pg/ml and 7.8 versus 31.6 pg/ml, respectively, p = 0.02 for both markers). Conclusion: According to our results, an independent fetal production of the analyzed soluble angiogenic markers can be hypothesized in pregnancies complicated by PE. © 2014 Informa Healthcare USA, Inc.

Objective To study the expression of Annexin A5 (A5) in relation to preeclampsia using immunohistochemical Tissue Microarray (TMA) technique. Study design Case-control study of 66 singleton preeclamptic (PE) patients matched for gestational age (GA) at delivery with 63 normotensive controls with normally grown fetuses. Immunohistochemical expression of A5 and other population characteristics were compared between the two groups using Chi-square, One-way ANOVA, Spearman’s Correlation, and Linear Regression. Results The two groups were similar for maternal age and rate of corticosteroid administration, but differed for nulliparity, Body Mass Index (BMI), blood pressure, presence of placental histological lesions, and placental weight. Expression of A5 was similar in PE and controls (p = 0.10); however it was found to be lower in PE cases complicated by fetal growth restriction (FGR, n = 34) compared with matched controls (n = 55) (p = 0.04). An inverse correlation was found between A5 and GA in cases but not in controls (p = 0.04 vs p = 0.71). The association was even more significant in the subgroup of PE complicated by FGR (p = 0.02). A5 expression was not influenced by blood pressure, proteinuria, or placental weight. Conclusions Annexin A5 expression seems to be related only to FGR and not to PE or its clinical severity.

Inherited and acquired thrombophilic conditions are associated with maternal thromboembolic events and a variety of adverse perinatal outcomes, including, preeclampsia, intrauterine growth restriction (

The assessment of the hemodynamics in the maternal and fetal blood circulation currently relies on the color doppler and spectral doppler US techniques. Although several studies have proven the reliability of such methods, the complex morphology of the investigated vessels still causes several limitations. An alternative, high resolution technique, named MSDA, has been recently introduced for the investigation of fetal-maternal circulation. This work reports several examples selected among the data collected on more than 150 healthy and pathological pregnancies over 1 year of multi-centre screening. The presented results suggest that MSDA represents a method suitable to improve the accuracy in predicting pregnancy complications and in detecting pathological events. Prospective studies are needed to determine the utility of this technique in predicting placenta mediated complications.

Impaired trophoblastic invasion of the maternal spiral arteries is associated with increased risk for subsequent development of intrauterine growth restriction, preeclampsia, and placental abruption. A series of screening studies involving assessment of impedance to flow in the uterine arteries have examined the potential value of Doppler in identifying pregnancies at risk of the complications of impaired placentation. Currently we are able to characterize uteroplacental perfusion with quantitative and qualitative methodologies. This review will examine both methodologies and seek to highlight conclusive and inconclusive findings. © 2007 Elsevier Inc. All rights reserved.

Objective To study the relationship between prenatal ultrasound features and postnatal course of meconium peritonitis. Study Design We reviewed our cohort of cases of meconium peritonitis (MP) (n = 13/37, 225 pregnancies or 0.3/1000) as well as those published in the English literature with prenatal ultrasonographic findings and postnatal follow-up (n = 56). The total number of cases (n = 69) was divided into 4 grades of progressive severity based on the number of pertinent sonographic findings: grade 0, isolated intra-abdominal calcifications (n = 18); grade 1, intra-abdominal calcifications and ascites (n = 17) or pseudocyst (n = 2) or bowel dilatation (n = 6); grade 2, two associated findings (n = 20); and grade 3, all sonographic features (n = 6). Presence of polyhydramnios was also recorded. Prenatal predictors of need for neonatal surgery and risk of neonatal death were identified using Chi-square and Fisher exact test, with P < 0.05 considered significant. Results Neonatal surgical intervention was required in 0% (0/18) of newborns with grade 0 MP; in 52% (13/25) of those with grade 1; in 80% (16/20) with grade 2; and in 100% (6/6) with grade 3 MP (P < 0.001, Chi-square for trend). Moreover, neonatal surgery was more frequent in the presence than absence of polyhydramnios [69% (18/26) vs 37% (16/43); P = 0.007]. Neonatal mortality was 6% (4/69; 3 after surgery and 1 for premature delivery) and it was confined to the subgroup with polyhydramnios (4/26, 15%). Conclusions Prenatal sonographic features are related to postnatal outcome. Persistently isolated intra-abdominal calcifications have an excellent outcome. Delivery in a tertiary care center is recommended when calcifications are associated with other sonographic findings. Copyright © 2007 John Wiley & Sons, Ltd.

We assessed soluble fibrin polymer longitudinally in normal pregnancy, thrombophilic pregnancy and twin gestation Thirty-three thrombophilic pregnancies, 34 uncomplicated multiple gestations and 23 singleton normal pregnancies were studied. Maternal plasma samples were collected in the first (6-12 weeks), 2nd (13-25 weeks) and 3rd trimesters of pregnancy (26-40 weeks) and were stored at -70 degrees C until assay. Soluble fibrin polymer was assayed by enzyme-linked immunosorbent assay (ABS, Copiague, New York, USA). Statistical analysis were made by Spearman test and Levine's test for equality of variance (P < 0.05). First soluble fibrin polymer maternal levels in twin gestation were significantly higher than in normal pregnancy and thrombophilic pregnancy, (23.8 +/- 4.5 mug/ml versus 9.2 +/- 3.1 and 10.0 +/- 2.0 mug/ml respectively, P < 0.005). Second and third trimester maternal levels of SFP in twins were also significantly higher than in normal pregnancy. First trimester soluble fibrin polymer was highly correlated with birthweight in twin gestation (r = -1, P < 0.01). In the third trimester, maternal soluble fibrin polymer correlated with placental weight in twin gestation (r = 0.639, P < 0.01). Overall, soluble fibrin polymer was correlated with placental weight and birthweight in the three groups but this did not reach statistical significance. Elevated maternal plasma levels of soluble fibrin polymer in twin gestation may derive from an accelerated coagulation process due to extensive vascular remodelling. Current studies are underway to determine the utility of soluble fibrin polymer in assessing fetal growth abnormalities.

Doppler ultrasound (US) techniques are widely used in diagnostics to evaluate the maternal and fetal hemodynamics. Most of these studies involve the assessment of the blood flow in the fetal aorta, umbilical artery, and the uteroplacental circulation. The analysis is typically limited to the echoes originated from a sample volume (SV) covering the whole section of the vessel. Both the shape of the resulting sonogram and the corresponding quantitative indexes (e.g. PI, S/D and RI), have been proven to be relevant for diagnostic purposes and, in particular, to predict possible pregnancy complications. In this paper we propose the application of a method named multigate Spectral doppler analysis (MSDA), to improve the hemodynamic assessment in maternal and fetal circulation. In MSDA, the Doppler data from 128 SVs, aligned along an US scan line that intercepts the vessel, are independently analysed to produce high resolution velocity profiles. In the present study, the MSDA approach has been applied to 36 volunteers. Some example of flow profile extracted from maternal and fetal circulation is presented and the potentiality of the MSDA method to characterize the blood flow configurations is discussed

Objectives: In this study multigate spectral Doppler analysis, a novel ultrasound technology that overcomes the limitations related to the use of a single sample volume, has been applied to the evaluation of hypogastric (Ha) and uterine (Ut) artery flow during IVF treatment, specifically egg donor and recipient cycles. Methods: MSDA using MyLab (Esaote, Florence) was carried out at baseline, during ovulation induction and at egg retrieval in the egg donors, and at baseline and embryo transfer time in the recipients. The analysis in real time included velocity profile (VP), relative wall distension rate (rWDR) and wall shear rate (WSR) of Ha and Ut in the donors and only in Ut for the recipients. Results: A total of 10 egg donors (mean age 24.3 ± 1.8 years) and six recipients (mean age 42.6 ± 3.4 years) were found eligible for the study and successfully evaluated. Compared to conventional spectral Doppler, MSDA revealed different shapes of velocity profiles. There were no significant differences in VP, rWDR and WSR between egg donors at the time of egg retrieval and recipients at the time of embryo transfer in Ut. The rWDR was inversely related to gravity, parity and hematocrit (Hct) (P < 0.05). The WSR of both Ha and Ut were correlated with Hct and the FSH at day 3 (rs = 0.9, P < 0.05). Recipients who conceived had a lower mean WSR (R = 338.3, L = 326.6) than those who did not (R = 512.9, L = 766.3; P < 0.05). WSR of recipients was inversely correlated with positive pregnancy test (rs = −0.878, P < 0.05) bilaterally, while WSR of egg donors was not. Conclusions: This is the first study to provide basic physiological values of VP, rWDR and WSR in patients undergoing ovulation induction for IVF. The measurements in egg donors are to be considered as reference values for patients undergoing IVF since they are young and their ovarian response optimal. Likewise, given the high pregnancy rate in the recipients, the results should be considered promising but not definitive.

WITH NEONATAL AND PLACENTAL WEIGHT FRANCESCA SALA, GABRIELE URBAN, PATRIZIA VERGANI, FRANCESCA MOLTRASIO, BIAGIO EUGENIO LEONE, Universita di Milano-Bicocca, Obstetrics and Gynecology, Monza, Milan, Italy, University of Milano-Bicocca, Pathology Unit, Monza, Milan, Italy OBJECTIVE: Recently increased Annexin V (A5) levels in amniotic fluid have been shown to predict subsequent FGR. We investigated the placental expression of A5 in singleton growth restricted fetuses. STUDY DESIGN: Twenty nine small for gestational age (SGA) newborns were matched with 30 appropriate for gestational age (AGA) controls based on gestational age at delivery. Placental samples were obtained at three different sites: marginal, central and close to the insertion of the umbilical cord. Samples were stored at 80 C and in paraffin. Immuno-hystochemical analysis was performed blinded to the clinical condition. The localization of A5 in placenta was determined by immunoperoxidase staining with ABC peroxidase system using monoclonal antibodies anti-Human A5. The mean reactivity among 10 fields for sample was calculated. Maternal and neonatal blood and clotting markers were evaluated in cases and controls. Statistical analysis was performed with Spearman correlation and chi square (p!0.05). RESULTS: There were no significant differences in gestational age, parity, gravity, maternal age between SGA and AGA. In SGA but not AGA placentas, A5 was inversely correlated with birth weight (r=-0.4, p=0.04) and placental weight (r= 0.3, p=0.04), but not with gestational age (p=0.2). None of coagulation or blood markers were related with A5 expression except for the maternal LDH (r=0.4, p=0.04). CONCLUSION: Our results show that placental expression of A5 is increased in SGA neonates, and it is related to the severity of the condition regardless of the gestational age. The present results in the context of similar previous amniotic fluid findings suggest a role for A5 in the homeostatic placental regulation to vascular or hypoxic insults.

BIRTHWEIGHT IN TWIN GESTATION GABRIELE URBAN, MICHAEL PAIDAS, DEHUI KU, YALE ARKEL, CHARLES LOCKWOOD, Universita di Milano, Obstetrics and Gynecology, Monza, Italy, Italy, Yale University, Obstetrics, Gynecology and Reproductive Sciences, New Haven, Connecticut, New York University, Obstetric and Gyencology, New York City, New York OBJECTIVE: We assessed soluble fibrin polymer, Thrombus precursor Protein (TpP) longitudinally in normal pregnancy (NP) , thrombophilic pregnancy (TP) and twin gestation(TG). STUDY DESIGN: Thirty-three TP, 27 uncomplicated TG and 23 singleton NP were studied.Maternal plasma samples were collected in the first (6-12 weeks), second (13-25 weeks), and third trimester of pregnancy (26-40 weeks), stored at 70(C until assay.TpP was assayed by ELISA (ABS,Copiague, NY).Statistical analysis were made by Spearman test and Levene’s test for equality of variance (P ! .05). RESULTS: First TpP maternal levels in TG were significantly higher than in NP and TP, (23.8 G 4.5 mg/mL vs 9.2 G 3.1 and 10.0 G 2.0 mg/mL respectively, P ! .005). Second and third trimester maternal levels of TpP in twins were also significantly higher than in NP. First trimester TpP was highly correlated with birthweight in TG r = 1, P ! .01). In the third trimester, maternal TpP with placental weight in TG (r = .639, P ! .01). Overall, TpP was correlated with placental weight and birthweight in the three groups but this did not not reach statistical significance.

Objective: To assess the accuracy of prenatal ultrasonography (US) for congenital heart defects (CHD) in the entire pregnant population undergoing US examination over a 10-year period. Study design: From 1/1990 to 12/2002, 30746 pregnant women underwent prenatal US examination inclusive of four-chambers view in all cases and ventricular outflow tracts in about 50% of cases. The operators were obstetricians with a different degree of experience in US (2 months–20 years). The prenatal detection rate (DR) of US in the detection of CHD was related to the type of anomaly and indications for the US exam (screening vs other indications/referral). All patients were followed until delivery or pregnancy termination. Clinical or autopsy confirmation of abnormal antenatal finding was obtained in all cases. Neonatal echocardiogram was performed in all babies admitted to NICU, in those with heart murmurs detected within 24 hours of birth, and in those with dysmorphic features. Obstetricians and neonatologists met weekly to discuss cases of cardiac anomaly diagnosed preor post-natally. Statistical analysis included Chi-square. Results: 313 cases of CHD occurred (1%), of which 228 (73%) were detected prenatally. The DR for the different subgroups of cardiac malformation were: 1) isolated septal defects: 44% (48/108); 2) atrio-ventricular canals: 95% (52/55); 3) isolated conotruncal defects: 88% (49/56); 4) malformations affecting the size of ventricles: 97% (55/57); 5) other malformations: 62% (23/37). The DR was 40% in screening scans (low-risk pregnancies) and 82% among referrals (p < 0001). Conclusion: In this largest cohort of prenatal screening for CHD, the DR was 73%. Septal defects contributed heavily to the false-positive results. The indication for the US scan significantly influences the sensitivity of the test.