Publications by authors named "Leonardo Gucciardo"

49 Publications

Enhancing the value of the sFlt-1/PlGF ratio for the prediction of preeclampsia: Cost analysis from the Belgian healthcare payers' perspective.

Pregnancy Hypertens 2021 Dec 18;26:31-37. Epub 2021 Aug 18.

Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium. Electronic address:

Objective: To evaluate the economic impact of introducing the soluble fms-like tyrosine kinase (sFlt-1) to placental growth factor (PlGF) ratio test into clinical practice in Belgium for the prediction of preeclampsia (PE).

Study Design: We developed a one-year time-horizon decision tree model to evaluate the short-term costs associated with the introduction of the sFlt-1/PlGF test for guiding the management of women with suspected PE from the Belgian public healthcare payers' perspective. The model estimated the costs associated with the diagnosis and management of PE in pregnant women managed in either a test scenario, in which the sFlt-1/PlGF test is used in addition to current clinical practice, or a no test scenario, in which clinical decisions are based on current practice alone. Test characteristics were derived from PROGNOSIS, a non-interventional study in women presenting with clinical suspicion of PE. Unit costs were obtained from Belgian-specific sources. The main model outcome was the total cost per patient.

Results: Introduction of the sFlt-1/PlGF ratio test is expected to result in a cost saving of €712 per patient compared with the no test scenario. These savings are generated mainly due to a reduction in unnecessary hospitalizations.

Conclusions: The sFlt-1/PlGF test is projected to result in substantial cost savings for the Belgian public healthcare payers through reduction of unnecessary hospitalization of women with clinical suspicion of PE that ultimately do not develop the condition. The test also has the potential to ensure that women at high risk of developing PE are identified and appropriately managed.
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http://dx.doi.org/10.1016/j.preghy.2021.08.113DOI Listing
December 2021

Effect of air temperature on human births, preterm births and births associated with maternal hypertension.

J Matern Fetal Neonatal Med 2021 May 4:1-7. Epub 2021 May 4.

Department of Obstetrics and Prenatal Medicine, UZ Brussels University Hospital, Brussels, Belgium.

Objective: We studied potential effects of outdoor air temperatures or barometric pressure on births, preterm births and births associated with maternal hypertension.

Methods: 12,269 births were retrospectively reviewed in Brussel and 25,880 in South Reunion Island. National Belgium and French weather reference centers provided outdoor air temperatures and barometric pressures from the nearest weather stations on the corresponding birthdays. Poisson regression models were used to assess if outdoor air temperatures or barometric pressure could be correlated, immediately and several days later, with the number of daily births, preterm births and births associated with hypertension.

Results: Outdoor air temperature was significantly correlated to the number of daily births in Brussels. For each additional degree Celsius, overall births increased by 0.4% during the same day. Four days later, overall births increased by 1.8%, preterm births by 2.6% and births associated with hypertension by 5.7%. Similar observations on numbers of daily births were reported in South Reunion Island, without reaching statistical significance ( = .08).

Conclusion: As previously demonstrated in recent studies, increased air temperature leads progressively to higher rates of births and preterm births. An even stronger delayed effect of air temperature was observed on births associated with hypertension. This would be worth further investigating.
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http://dx.doi.org/10.1080/14767058.2021.1919075DOI Listing
May 2021

Optimal timing to screen for asymptomatic bacteriuria during pregnancy: first vs. second trimester.

J Perinat Med 2021 Jun 13;49(5):539-545. Epub 2021 Jan 13.

University Hospital of Brussels, Brussels, Belgium.

Objectives: Although current guidelines advice to screen for asymptomatic bacteriuria during pregnancy, little is known about the best moment of testing. The goal of this study is to analyze the optimal timing (first vs. second trimester) to screen for asymptomatic bacteriuria during pregnancy.

Methods: A retrospective cohort analysis, comparing patients that were screened for asymptomatic bacteriuria in the first vs. second trimester was performed. The main question was to compare the rate of positive urinary culture in both trimesters. Study included patients all followed a prenatal consultation at the University Hospital of Brussels between 2012 and 2017. Other outcomes considered were the nature of identified germs, treatments, possible risk and confounding factors (age, BMI, gravidity-parity-abortus [GPA], type of conception, ethnicity, education, prior urinary tract infection (UTI), diabetes, hypertension, prior preterm delivery and sickle cell disease) and complications (UTI, preterm delivery, preterm rupture of the membranes and chorio-amnionitis).

Results: A total of 2,005 consecutive files were reviewed, 655 concerned patients screened during the first trimester group and 1,350 in the second trimester group. Asymptomatic bacteriuria was present in only 71 cases (3.54%), 23 in the first trimester group (3.50%) and 48 in the second trimester group (3.55%). was the most frequently identified germ (37 cases (1.8%), 14 in the first trimester group and 23 in the second trimester group). Our logistic regression analysis shows no statistical difference according to the moment the urinary culture was done for the presence of asymptomatic bacteriuria ( or others), for its association with hospitalization for pyelonephritis, preterm contractions, preterm pre-labor rupture of the membranes (PPROM) and/or preterm delivery.

Conclusions: If recommendations remain to screen for asymptomatic bacteriuria at least once during pregnancy, this study indicates that the moment of testing (first vs. second trimester) has no clinical impact on obstetrical outcomes.
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http://dx.doi.org/10.1515/jpm-2020-0322DOI Listing
June 2021

Corpus luteum score, a simple Doppler examination to prognose early pregnancies.

Eur J Obstet Gynecol Reprod Biol 2021 Mar 6;258:324-331. Epub 2021 Jan 6.

Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium.

Objectives: In early pregnancies, miscarriages and inconclusive ultrasound scans considering location and viability are very common. In several previous studies, serum progesterone levels predicted viability of pregnancy and, in recent ones, failed Pregnancies of Unknown Location (PUL), completion of miscarriage and complications. Corpus luteum, secreting progesterone in early pregnancy, was less studied. Some publications showed correlations between corpus luteum aspects and diagnosis of miscarriage but it was not evaluated for other outcomes in early pregnancy, such as failed PUL, completion of miscarriage or complications. We aimed to assess if Doppler examination of corpus luteum could also predict all these outcomes: failed PUL, diagnosis and completion of miscarriages and complications.

Study Design: A single operator prospectively described and/or collected pictures of Doppler signal in the wall of the corpus luteum at most consultations in our early pregnancy unit and established a three-level score. All suspected or confirmed non-viable pregnancies with this score or/and serum progesterone levels were registered retrospectively. With logistic regressions, AIC/BIC, likelihood ratios, ROC curves, Mann-Whitney and Fisher exact tests, we evaluated the ability of the score, alone, to predict failed PUL, diagnosis and completion of miscarriages and the complications, and, combined, to improve previously published predictions.

Results: From 277 included pregnancies, 186 (67.1 %) miscarried. Of these, 159/186 (85.5 %) fully evacuated without surgery: 114/186 (61.3 %) within 20 days after the first diagnosis and 45/186 (24.2 %) after more than 20 days. Twenty-seven patients (14.5 %) underwent surgical evacuation, including ten complications, five haemorrhages and five suspected infections. Logistic regression correlated strongly the corpus luteum score with failed PUL (p < 0.0001) and miscarriages (p < 0.0001). Moreover, rates of complications and swift non-surgical completions of miscarriage were respectively 0 % and 92 % with scores of 0, versus 6 % and 44 % with scores of 1, versus 16 % and 0 % with scores of 2. Combined with serum progesterone levels, this score improved most predictions. Adding parity or history of miscarriage in predictive models even increased these performances.

Conclusions: Corpus luteum score, alone, can predict failed PUL, diagnosis and completion of miscarriages and their complications. Combining this score with other factors (mainly serum progesterone levels) improves most predictions.
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http://dx.doi.org/10.1016/j.ejogrb.2021.01.001DOI Listing
March 2021

Midwifery students' satisfaction with perinatal simulation-based training.

Women Birth 2021 Nov 29;34(6):554-562. Epub 2020 Dec 29.

Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus Brussels University of Applied Sciences and Arts, Laarbeeklaan 121, 1090 Brussels, Belgium; Faculty of Medicine and Pharmacy, Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium.

Background: Simulation-based training has proved to be an effective teaching and learning approach in healthcare. Nevertheless, any assessment of its effectiveness should also take the students' perspective into account.

Aim: To validate the Satisfaction with Simulation Experience Scale (SSES) for use with midwifery students and evaluate midwifery students' satisfaction with perinatal simulation-based training.

Methods: Satisfaction with simulation was assessed using the SSES, a measurement tool translated from English to Dutch. Data was collected in four consecutive years (2016-19). A mixed methods design was used to capture both qualitative and quantitative data. Using the quantitative data, factor analysis was performed to assess the construct validity, while Cronbach's alpha was used to assess internal consistency. Qualitative data was assessed using thematic content analysis.

Findings: 367 SSES questionnaires were completed by 251 students. The exploratory factor analysis resulted in a three-factor model covering debriefing and reflection, clinical reasoning and clinical learning. Cronbach's alpha showed good internal consistency. Students were very satisfied with perinatal simulation-based training for all three factors: 4.30 (SD=0.47) for debriefing and reflection, 3.97 (SD=0.55) for clinical reasoning and 4.10 (SD=0.46) for clinical learning. Satisfaction scores remained high and stable over the years investigated. Thematic content analysis identified 6 categories: simulation-based training is valuable, the need for more simulation-based training, fidelity, students, negative feelings, and preparation is vital.

Conclusion: Students were satisfied with the simulation-based training, experiencing it as providing added value to their education. Simulations gave them the opportunity to make and learn from mistakes in a safe learning environment.
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http://dx.doi.org/10.1016/j.wombi.2020.12.006DOI Listing
November 2021

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

J Perinat Med 2020 11;48(9):950-958

Department of Obstetrics and Gynaecology, Ospedale di San Leonardo, Castellammare di Stabia, Italy.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.
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http://dx.doi.org/10.1515/jpm-2020-0355DOI Listing
November 2020

Serum progesterone levels could predict diagnosis, completion and complications of miscarriage.

J Gynecol Obstet Hum Reprod 2020 May 26;49(5):101721. Epub 2020 Feb 26.

Department of Obstetrics and Prenatal Medicine, UZ Brussel University Hospital, VUB, Brussels, Belgium.

Background: Low serum progesterone levels were strongly correlated with miscarriages in several publications and with completion of miscarriage in one paper. This study evaluated several parameters, predominantly serum progesterone, as predictors for miscarriages, their swift non-surgical completion and their complications.

Basic Procedures: Suspected or confirmed non-viable pregnancies with available concomitant serum progesterone measurements were retrospectively reviewed. The performance of serum progesterone, either alone or combined with other parameters, to predict viability, surgical removal and delay of non-surgical evacuation of non-viable pregnancy and complications, was analysed by logistic regression combined with Akaike and Bayesian information criteria, likelihood, receiver operated characteristic (ROC) curves, Mann-Whitney test and Fisher's exact test.

Main Findings: From 151 included pregnancies, 104 (68.9 %) were non-viable with 91 completions of miscarriage without surgery. The probability of viability was correlated linearly and curvilinearly with serum progesterone (p < 0.001). The probability of surgical removal, and the delay before non-surgical evacuation, showed a linear relationship with progesterone. No complication occurred when progesterone levels remained below 10 μg/L, while its rates were 9.5 % of non-viable pregnancies with progesterone levels between 10 and 20 μg/L and 26.7 % of cases with progesterone levels above 20 μg/L. Combined with progesterone, either "parity" or "history of miscarriage" improved the prediction of viability, "history of supra-isthmic uterine surgery" improved the prediction of surgery and "history of miscarriage" improved the prediction of delayed non-surgical evacuations.

Conclusion: Serum progesterone can probably predict the odds of miscarriages, surgical removal, delayed non-surgical evacuation and complications, with potential improvements when different predictors are combined.
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http://dx.doi.org/10.1016/j.jogoh.2020.101721DOI Listing
May 2020

Learning experiences of final-year student midwives in labor wards: A qualitative exploratory study.

Eur J Midwifery 2019 29;3:15. Epub 2019 Aug 29.

Department Health Care, Knowledge Centre Brussels Integrated Care, Erasmus University College Brussels, Brussels, Belgium.

Introduction: Clinical placements are an integral part of midwifery education and are crucial for achieving professional competencies. Although students' experiences on placements have been shown to play a meaningful role in their learning, they have received scant attention in the literature. The aim of this paper is to describe the learning experiences of final-year student midwives in labor wards within the Brussels metropolitan region, Belgium.

Methods: A qualitative exploratory study was conducted using two focus groups (N=20). Data analysis included: transcription of audio recordings, thematic content analysis with coding into recurrent and common themes, and broader categories. Discussions among researchers were incorporated in all phases of the analysis for integrity and data fit.

Results: Data analysis identified the following categories as determining student learning experiences in labor wards: 1) managing opportunities, 2) being supported, and 3) dealing with the environment. Overall, respondents were positive and enthusiastic about their learning experiences, although some felt tense and unprepared. Students expressed concerns about differences in learning opportunities between placements and found it challenging to achieve all competencies. Student learning experiences were enhanced when they had placements for longer periods with the same supportive mentors.

Conclusions: Factors related to students' functioning, the healthcare professional, midwifery education and hospital environment affected their learning in labor wards. The combination of a more persevered preparation of students and mentors, together with a student-centered organization of placements, is crucial to create a positive learning experience for midwifery students in labor wards.
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http://dx.doi.org/10.18332/ejm/111802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839143PMC
August 2019

Hearing Loss With Congenital Cytomegalovirus Infection.

Pediatrics 2019 08 2;144(2). Epub 2019 Jul 2.

Departments of Otolaryngology, Head and Neck Surgery.

Objective: In this study, we determined the prevalence of hearing loss in 157 children with proven congenital cytomegalovirus (cCMV) infection. We looked at possible risk determinants for developing hearing loss and proposed recommendations for screening and follow-up in the newborn.

Methods: In a prospective 22-year study, 157 children with proven cCMV infection were evaluated for sensorineural hearing loss (SNHL). The development of SNHL was correlated with the type of maternal infection (primary versus nonprimary), the gestational age of maternal primary infection, imaging findings at birth, and the presence of symptomatic or asymptomatic infection in the newborn.

Results: Of all children, 12.7% had SNHL, and 5.7% needed hearing amplification because of SNHL. Improvement, progression, and fluctuations of hearing thresholds were seen in 45%, 53.8%, and 5.7% of the children, respectively. Hearing loss was more common in the case of a symptomatic infection at birth ( = .017), after a maternal primary infection in the first trimester of pregnancy ( = .029), and in the presence of abnormalities on a neonatal brain ultrasound and/or MRI ( < .001).

Conclusion: SNHL is a common sequela in children with cCMV infection. Risk factors for SNHL were primary maternal infections before the 14th week of pregnancy, the presence of a disseminated infection at birth, and imaging abnormalities in the newborn. These children may benefit from a more thorough investigation for SNHL than children who do not present with those risk factors.
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http://dx.doi.org/10.1542/peds.2018-3095DOI Listing
August 2019

Body weight, body composition and energy balance related behaviour during the transition to parenthood: study protocol of a multi-centre observational follow-up study (TRANSPARENTS).

BMC Public Health 2019 May 6;19(1):516. Epub 2019 May 6.

Faculty of Physical Education and Physiotherapy, Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.

Background: The transition to parenthood is a cornerstone event for both parents, potentially leading to relevant changes in lifestyle and behaviour. In women, the metabolic changes during and after pregnancy and the deleterious effects of excessive gestational weight gain and postpartum weight retention have been extensively described. However, there is no full understanding about which specific energy balance related behaviours (EBRB) contribute to unfavourable weight gain and weight retention. Furthermore, information on how transition to parenthood affects men is lacking. Therefore, this study aims to investigate changes in body weight, body composition and EBRB in couples transitioning to parenthood.

Methods: TRANSPARENTS is a multi-centre observational follow-up study that focuses on body weight, body composition and EBRB during the transition to parenthood. Couples (women and men) will be recruited during the first trimester of their first pregnancy. Study visits will occur at four occasions (12 weeks of pregnancy, 6 weeks postpartum, 6 months postpartum and 12 months postpartum). Anthropometrics of the parents and new-borns will be assessed including body weight, height/length, body composition (using bio-electrical impedance analysis and measurement of four skinfold thicknesses (biceps, triceps, subscapular and supraspinal/suprailiac)) and waist and hip circumference. Dietary intake, physical activity, sedentary behaviour, smoking habits, sleeping pattern, fatigue, diet and exercise related partner support, mental health, breastfeeding, contraception use, and socio-demographics will be assessed using a questionnaire. In addition, accelerometry will be used to assess physical activity and sedentary behaviour objectively. Also data from women's medical record, such as pre-pregnancy weight and pregnancy outcomes, will be included. Multilevel modelling will be used to evaluate maternal and paternal changes in body weight, body composition and EBRB during and after pregnancy (primary outcomes). Multiple linear regression analyses will be performed to identify predictors of changes in body weight, body composition and EBRB. All analyses will be adjusted for possible confounders.

Discussion: TRANSPARENTS is a unique project identifying vulnerable parents and (un)favourable changes in EBRB throughout this potentially critical life period. Provided insights will facilitate the development of effective intervention strategies to help couples towards a healthy transition to parenthood.

Trial Registration: Clinicaltrials.gov Identifier: NCT03454958. Registered March 2018.
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http://dx.doi.org/10.1186/s12889-019-6884-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501312PMC
May 2019

Perception and knowledge of early pregnancy assessment units among perinatal practitioners in Europe.

Int J Gynaecol Obstet 2018 Dec 21;143(3):289-299. Epub 2018 Sep 21.

Department of Obstetrics and Prenatal Medicine, Univeritair Ziekenhuis Brussel, Vrij Universiteit Brussel, Brussels, Belgium.

Objective: To investigate perceptions of early pregnancy assessment units (EPAUs) among perinatal practitioners working in Belgium, France, and Switzerland.

Methods: A prospective multinational survey was conducted between September 1, 2015, and May 21, 2016. Obstetricians, gynecologists, medical doctors, radiologists, and midwives were recruited during meetings, via e-mail invitations, or through the websites of regional obstetrics and gynecology scientific societies. The survey comprised 17 questions that assessed the participants' knowledge, interest, and management of early pregnancy.

Results: Of the 871 individuals invited to participate in the survey, 306 (35.1%) responded. Most of the participants were gynecologists and/or obstetricians (225 [73.5%]). A total of 258 (84.3%) participants had no or limited knowledge about EPAUs. Furthermore, 211 (69.0%) participants reported incorrect management when they visualized a gestational sac without embryo and 265 (86.6%) misinterpreted changes in serum levels of chorionic gonadotropin during early pregnancy. In all, 201 (65.7%) participants were interested in collaboration with an EPAU; however, only 125 (40.8%) had sufficient time and resources available to support a patient's psychological distress after early pregnancy loss or salpingectomy.

Conclusion: Knowledge about early management of pregnancy was limited among the perinatal practitioners surveyed; however, the concept of EPAUs was welcomed by many.
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http://dx.doi.org/10.1002/ijgo.12661DOI Listing
December 2018

The fetal fibronectin test: 25 years after its development, what is the evidence regarding its clinical utility? A systematic review and meta-analysis.

J Matern Fetal Neonatal Med 2020 Feb 9;33(3):493-523. Epub 2018 Sep 9.

Department of Obstetrics and Prenatal Medicine, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.

The identification of women at risk for preterm birth should allow interventions which could improve neonatal outcome. Fetal fibronectin, a glycoprotein which acts normally as glue between decidua and amniotic membranes could be a good marker of impending labour when its concentration in cervicovaginal secretions between 22 and 36 weeks of gestation is ≥50 ng/mL. Many authors worldwide have tested this marker with many different methodologies and clinical settings, but conclusions about its clinical use are mixed. It is time for a comprehensive update through a systematic review and meta-analysis. We searched PubMed, Cochrane Library, and Embase, supplemented by manual search of bibliographies of known primary and review articles, international conference papers, and contact with experts from 1-1990 to 2-2018. We have selected all type of studies involving fetal fibronectin test accuracy for preterm delivery. Two authors independently extracted data about study characteristics and quality from identified publications. Contingency tables were constructed. Reference standards were preterm delivery before 37, 36, 35, 34, and 32 weeks, within 28, 21, 14, or 7 d and within 48 h. Data were pooled to produce summary likelihood ratios for positive and negative tests results. One hundred and ninety-three primary studies were identified allowing analysis of 53 subgroups. In all settings, none of the summary likelihood ratios were >10 or <0.1, thus indicating moderate prediction, particularly in asymptomatic women and in multiple gestations. The fetal fibronectin test should not be used as a screening test for asymptomatic women. For high-risk asymptomatic women, and especially for women with multiple pregnancies, the performance of the fetal fibronectin test was also too low to be clinically relevant. Consensual use as a diagnostic tool for women with suspected preterm labor, the best use policy probably still depends on local contingencies, future cost-effectiveness analysis, and comparison with other more recent available biochemical markers.
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http://dx.doi.org/10.1080/14767058.2018.1491031DOI Listing
February 2020

Clinically relevant discordances identified after tertiary reassessment of fetuses with isolated congenital diaphragmatic hernia.

Prenat Diagn 2017 Sep 25;37(9):883-888. Epub 2017 Jul 25.

Division of Woman and Child, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.

Objective: Fetoscopic endoluminal tracheal occlusion (FETO) may improve outcome of severe isolated congenital diaphragmatic hernia (iCDH). We aimed to identify any discrepancy between initial assessment at the referring hospital and the evaluation at the fetal surgery center, and to document parental decisions following counseling for fetal surgery.

Design: Single center retrospective study on patients with presumed iCDH either referred for assessment and counseling or referred for fetal surgery. Discordant findings were defined as either a >10% difference in lung size, discordant liver position or associated anomalies.

Results: Outcomes from 129 consecutive assessments over 24 months were analyzed. Among fetal surgery referrals, 2% did not have CDH, and 10% had undiagnosed associated anomalies. Liver position was discordant in 7%. Thirty-three per cent had discordant lung size. Ninety-four per cent of patients eligible for surgery underwent FETO. In patients referred because of suspicion of CDH, associated anomalies were found in 14%. Fetal liver and lung assessments were discordant in 50% resp. 38%. Of those patients eligible for FETO, 26% requested termination. For three patients, the postnatal course was marked by a genetic or syndromic additional diagnosis.

Conclusion: Discordances between initial assessment before referral and evaluation in our institution were frequent, some of them clinically relevant. © 2017 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/pd.5060DOI Listing
September 2017

The experiences of last-year student midwives with High-Fidelity Perinatal Simulation training: A qualitative descriptive study.

Women Birth 2017 Jun 22;30(3):253-261. Epub 2017 Mar 22.

Department Health Care, Midwifery Department, Knowledge Centre Brussels Integrated Care, Erasmus University College Brussels, Brussels, Belgium; Department Rehabilitation Research, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.

Background: Simulation training is a powerful and evidence-based teaching method in healthcare. It allows students to develop essential competences that are often difficult to achieve during internships. High-Fidelity Perinatal Simulation exposes them to real-life scenarios in a safe environment. Although student midwives' experiences need to be considered to make the simulation training work, these have been overlooked so far.

Aim: To explore the experiences of last-year student midwives with High-Fidelity Perinatal Simulation training.

Methods: A qualitative descriptive study, using three focus group conversations with last-year student midwives (n=24). Audio tapes were transcribed and a thematic content analysis was performed. The entire data set was coded according to recurrent or common themes. To achieve investigator triangulation and confirm themes, discussions among the researchers was incorporated in the analysis.

Findings: Students found High-Fidelity Perinatal Simulation training to be a positive learning method that increased both their competence and confidence. Their experiences varied over the different phases of the High-Fidelity Perinatal Simulation training. Although uncertainty, tension, confusion and disappointment were experienced throughout the simulation trajectory, they reported that this did not affect their learning and confidence-building.

Conclusion: As High-Fidelity Perinatal Simulation training constitutes a helpful learning experience in midwifery education, it could have a positive influence on maternal and neonatal outcomes. In the long term, it could therefore enhance the midwifery profession in several ways. The present study is an important first step in opening up the debate about the pedagogical use of High-Fidelity Perinatal Simulation training within midwifery education.
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http://dx.doi.org/10.1016/j.wombi.2017.02.014DOI Listing
June 2017

Effect of Genital Sampling Site on the Detection and Quantification of Species with Quantitative Polymerase Chain Reaction during Pregnancy.

Infect Dis Obstet Gynecol 2017 5;2017:6725168. Epub 2017 Feb 5.

Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, Jette, 1090 Brussels, Belgium.

. This study aimed to compare the qualitative and quantitative reproducibility of quantitative PCR (qPCR) for species spp.) throughout pregnancy and according to the genital sampling site. . Between 5 and 14 weeks of gestation (T1), vaginal, fornix, and two cervical samples were taken. Sampling was repeated during the 2nd (T2) and 3rd (T3) trimester in randomly selected T1 positive and negative women. Qualitative and quantitative reproducibility were evaluated using, respectively, Cohen's kappa () and interclass correlation coefficients (ICC) and repeated measures ANOVA on the log-transformed mean number of DNA copies for each sampling site. . During T1, 51/127 women were positive for and 8 for (4 patients for both). Sampling was repeated for 44/55 women at T2 and/or T3; 43 (97.7%) remained positive at the three timepoints. ranged between 0.83 and 0.95 and the ICC for cervical samples was 0.86. . Colonization by spp. seems to be very constant during pregnancy and vaginal samples have the highest detection rate.
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http://dx.doi.org/10.1155/2017/6725168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5316449PMC
August 2017

Primary maternal cytomegalovirus infections: accuracy of fetal ultrasound for predicting sequelae in offspring.

Am J Obstet Gynecol 2016 Nov 8;215(5):638.e1-638.e8. Epub 2016 Jun 8.

Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. Electronic address:

Background: Cytomegalovirus infection is the most common perinatal viral infection that can lead to severe long-term medical conditions. Antenatal identification of maternal cytomegalovirus infections with proven fetal transmission and potential postnatal clinical sequelae remains a major challenge in perinatology. There is a need to improve the prenatal counseling offered to patients and guide future clinical management decisions in cases of proven primary cytomegalovirus infection.

Objective: We sought to evaluate the accuracy of fetal ultrasound for predicting sequelae in fetuses infected with congenital cytomegalovirus after maternal primary infection.

Study Design: We conducted a prospective observational study from 1996 through 2012 in pregnant women with serological evidence of primary cytomegalovirus infection and proven vertical transmission to the fetus, based on viral load in the amniotic fluid. Fetal ultrasound was performed in all patients. Pregnancy termination was presented as an option for infected fetuses. Hearing and neurological clinical assessments were performed for all neonates with cytomegalovirus-positive urine samples.

Results: A total of 67 patients (69 fetuses) with proven vertical transmission were included in this study, including 64 singleton and 3 twin pregnancies. Eight fetuses were lost to follow-up. Of the remaining 61 fetuses, termination of the pregnancy was performed for 26, including 11 with fetal ultrasound anomalies. Autopsy provided histological evidence of fetal cytomegalovirus infection in all cases. In the 15 terminated fetuses without ultrasound anomalies, histological evidence of damage caused by fetal infection was detected in 13 cases. Among the 35 live-born infants, 12 had fetal ultrasound anomalies suggestive of congenital infection. Of these 12 infants, 6 had normal clinical evaluations, whereas 6 presented with either hearing and/or neurological anomalies, classified as severe in 4 cases. Among the 23 live-born infants with normal prenatal ultrasound, 5 developed hearing impairments and 1 showed mild neurological developmental delay.

Conclusion: Fetal ultrasound anomalies were detected in 37.7% of pregnant women with primary cytomegalovirus infection acquired in early pregnancy and proven fetal infection, and were confirmed by autopsy or postnatal clinical evaluation in 73.9%. Autopsy or postnatal clinical evaluation also detected cytomegalovirus-related anomalies in 55% of infants with normal fetal ultrasound evaluations.
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http://dx.doi.org/10.1016/j.ajog.2016.06.003DOI Listing
November 2016

Reply.

Am J Obstet Gynecol 2017 03 22;216(3):330. Epub 2016 Oct 22.

Department of Obstetrics and Prenatal Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. Electronic address:

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http://dx.doi.org/10.1016/j.ajog.2016.10.026DOI Listing
March 2017

Inter-professional Perinatal Simulation training: A valuable educational model to improve competencies amongst student midwives in Brussels, Belgium.

Midwifery 2016 Feb 10;33:49-51. Epub 2015 Dec 10.

Erasmus University College Brussels, Department Health Care, Knowledge Centre Brussels Integrated Care, Midwifery Section, Belgium; Vrije Universiteit Brussel (VUB), Faculty of Physical Education and Physiotherapy, Rehabilitation Research, Belgium.

Simulation training is a powerful and evidence-based teaching method for students and healthcare professionals. The described educational model of Inter-professional Perinatal Simulation training is the result of a collaborative project with the Erasmus University College Brussels, the Medical School of the Vrije Universiteit Brussel (VUB) and the University Hospital Brussels. This model enhances student midwives to acquire competencies in all fields of midwifery according to national and European legislation and to the International Confederation of Midwives Global Standards for Midwifery Education. In our educational program, simulation training enhanced the achievement of decision-making and inter-professional communication competences.
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http://dx.doi.org/10.1016/j.midw.2015.11.020DOI Listing
February 2016

Prophylactic use of the Arabin cervical pessary in fetuses with severe congenital diaphragmatic hernia treated by fetoscopic endoluminal tracheal occlusion (FETO): preliminary experience.

Prenat Diagn 2016 Jan 1;36(1):81-7. Epub 2015 Dec 1.

Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium.

Objective: The aim of this study was to describe whether the prophylactic use of a cervical pessary decreases the rate of premature birth in congenital diaphragmatic hernia (CDH) fetuses treated with fetoscopic tracheal occlusion (FETO).

Methods: The study concerns a consecutive series of cases with CDH and FETO and a group of CDH without FETO. In a subgroup of the FETO group, a prophylactic cervical pessary was inserted the day following the procedure. Gestational age (GA) at birth was the primary outcome.

Results: Fifty-nine fetuses with FETO and 47 expectantly managed were included. The last 15 FETO had a cervical pessary inserted. The median GA at delivery in the FETO group with pessary was 35.1 weeks and was not different from that in the FETO group without a pessary (34.3 weeks; p = 0.28) but was below that in the expectantly managed group (38.3 weeks; p < 0.001).

Conclusion: Early results suggest that prophylactic use of an Arabin cervical pessary does not prolong gestation of CDH fetuses treated with FETO. © 2015 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/pd.4716DOI Listing
January 2016

Safe and effective cryopreservation methods for long-term storage of human-amniotic-fluid-derived stem cells.

Prenat Diagn 2015 May;35(5):456-62

Department of Development and Regeneration, Organ System Cluster, Group Biomedical Sciences, KU, Leuven, Belgium.

Objectives: Stem cells (SCs) can be isolated from amniotic fluid (AF) for a variety of perinatal applications. In view of this, we compared different cryopreservation protocols for these AFSCs.

Methods: We screened seven freezing and thawing protocols using two well-established human AFSC lines: freezing protocol 1 (FP1), 10% dimethyl sulfoxide (DMSO); FP2, 2.5% DMSO, caspase inhibitor, and catalase; FP3, 5% glycerol, caspase inhibitor, and catalase; FP4, sperm freezing medium; FP5, slow-freezing solution; FP6, ethylene glycol, sucrose, and Ficoll 70; and FP7, vitrification solution. Outcome measures were post-thawing cell viability, recovery, doubling time and mesenchymal SC markers. The three best performing protocols were subsequently tested on cells isolated from clinical consecutive freshly harvested AF samples from two fetal medicine units.

Results: Protocols 1, 5, and 6 performed significantly better on well-characterized cell lines. They performed equally well on cell pellets from freshly harvested AF (n = 28).

Conclusions: We identified three suitable cryopreservation protocols because of high cell recovery and unchanged SC characteristics. Given one of these, the slow-freezing solution, is compatible with current good manufacturing practice legislation, it may be ultimately clinically used.
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http://dx.doi.org/10.1002/pd.4556DOI Listing
May 2015

Prediction of neonatal respiratory function and pulmonary hypertension in fetuses with isolated congenital diaphragmatic hernia in the fetal endoscopic tracleal occlusion era: a single-center study.

Fetal Diagn Ther 2015 8;37(1):24-32. Epub 2014 Nov 8.

Department of Obstetrics and Gynaecology, Division of Woman and Child, University Hospitals Leuven, Leuven, Belgium.

Objective: To correlate prenatal indicators of pulmonary hypoplasia with neonatal lung function and pulmonary hypertension (PHT) in isolated congenital diaphragmatic hernia (iCDH).

Materials And Methods: Prospective single-center study on 40 fetuses with iCDH either expectantly managed (n = 13) or undergoing tracheal occlusion (n = 27). Prenatal predictors included observed/expected lung-head ratio (O/E LHR), observed/expected total fetal lung volume, fetal pulmonary reactivity to maternal O2 administration (Δpulsatility index, ΔPI) and liver-to-thorax ratio (LiTR) as measured in the second and third trimesters. Postnatal outcome measures included survival until discharge, best oxygenation index (OI) and alveolar-arterial oxygen gradient [D(A-a)O2] in the first 24 h of life and the occurrence of PHT in the first 28 days of life.

Results: Median gestational age (GA) at evaluations was 27.2 and 34.3 weeks. GA at delivery was 36.0 weeks, and overall survival was 55%. In the second trimester, measurement of lung size, LiTR and pulmonary reactivity were significantly related to survival and the best OI and D(A-a)O2.The occurrence of PHT was better predicted by ΔPI and LiTR.

Conclusions: O/E LHR, LiTR and vascular reactivity correlate with ventilatory parameters in the first 24 h of life. Occurrence of PHT at ≥28 days was best predicted by LiTR and ΔPI, but not by lung size.
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http://dx.doi.org/10.1159/000364805DOI Listing
November 2015

Full thickness abdominal wall defect in growing rats as a model for congenital diaphragmatic hernia prosthetic repair.

J Pediatr Surg 2014 Oct 10;49(10):1458-65. Epub 2014 Feb 10.

Department of Development and Regeneration, Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology and Engineering Research Center, University Hospital Leuven, Leuven, Belgium. Electronic address:

Background: Large congenital diaphragmatic hernia may require prosthetic correction. Acellular collagen matrices were introduced to avoid complications owing to the use of synthetic patches. We tested 3 different ACM for reconstruction of an abdominal wall defect in an animal model that mimics the fast growth during infancy.

Methods: Pelvisoft® (CR Bard, Covington, GA) and 2 investigational ACM were used for primary reconstruction of a full thickness abdominal wall defect. 3months-old rats (n=26) were allowed to survive for 90days after implantation. Anatomical, tensiometric and histological analyses were performed. Based on good outcomes, we did the same with 1month-old rats (n=54). Unoperated rats were used for obtaining reference tensiometric values of selected native tissues.

Results: Major wound complications were exclusively observed in 1month-old rats. All explants in both groups thinned significantly (p<0.03) and had an elastic modulus increasing over time, far above that from native tissues at 90days of life. Both investigational ACM induced a more vigorous foreign body reaction than Pelvisoft(®).

Conclusions: The shift from 3 to 1month-old rats was associated with wound complications. Pelvisoft® showed a better biocompatibility than the 2 investigational ACM. Passive biomechanical properties of all explants were still not comparable to that of native tissues.
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http://dx.doi.org/10.1016/j.jpedsurg.2014.01.058DOI Listing
October 2014

Medical and regenerative solutions for congenital diaphragmatic hernia: a perinatal perspective.

Eur J Pediatr Surg 2014 Jun 17;24(3):270-7. Epub 2014 Jun 17.

Department of Development and Regeneration, KU Leuven, Leuven, Belgium.

In the EU-27, 2,100 babies with congenital diaphragmatic hernia (CDH) are born annually. CDH is fatal in 30% of them. Experimental fetal surgery in severe cases results in a survival rate of 50 to 60% at its best. Failure is due to insufficient lung growth, persistent pulmonary hypertension or prematurity induced by the procedure. For nonsurvivors alternative strategies are required. Survivors undergo anatomical repair, but large diaphragmatic defects are closed using a patch. At present the used materials are less than ideal, mainly because of recurrence and chest deformation. To overcome the above limitations, alternative medical therapies (pharmacologic or cell therapy) that are more potent and less invasive are needed. Also a more functional postnatal repair may be possible when using novel scaffolds or engineered constructs. We see a prominent place for autologous amniotic fluid-derived stem cells for these novel strategies, which could be prenatally harvested following appropriate patient selection by noninvasive imaging.
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http://dx.doi.org/10.1055/s-0034-1382262DOI Listing
June 2014

Perception and knowledge about stem cell and tissue engineering research: a survey amongst researchers and medical practitioners in perinatology.

Stem Cell Rev Rep 2014 Aug;10(4):447-54

Department of Development and Regeneration, Cluster Organ Systems, University Hospitals Leuven, Leuven, Belgium.

Introduction: Stem cell and tissue engineering (SC&TE) research remain controversial. Polemics are potential hurdles for raising public funds for research and clinical implementation. In view of future applications of SC&TE in perinatal conditions, we aimed to measure the background knowledge, perceptions or beliefs on SC&TE research among clinicians and academic researchers with perinatal applications on the department's research agenda.

Material And Methods: We polled three professional categories: general obstetrician gynecologists, perinatologists and basic or translational researchers in development and regeneration. The survey included questions on demographics, work environment, educational background, general knowledge, expectations, opinions and ethical reflections of the respondent about SC&TE.

Results: The response rate was 39 %. Respondents were mainly female (54 %) and under 40 years (63 %). The general background knowledge about SC&TE is low. Respondents confirm that remaining controversies still arise from the confusion that stem cell research coincides with embryo manipulation. Clinicians assume that stem cell research has reached the level of clinical implementation, and accept the risks associated of purposely harvesting fetal amniotic cells. Researchers in contrast are more cautious about both implementation and risks.

Conclusion: Professionals in the field of perinatology may benefit of a better background knowledge and information on current SC & TE research. Though clinicians may be less aware of the current state of knowledge, they are open to clinical implementation, whereas dedicated researchers remain cautious. In view of the clinical introduction of SC & TE, purposed designed informative action should be taken and safety studies executed, hence avoid sustaining needless polemics.
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http://dx.doi.org/10.1007/s12015-014-9506-3DOI Listing
August 2014

Psychosocial aspects of invasive fetal therapy as compared to prenatal diagnosis and risk assessment.

Prenat Diagn 2013 Apr 11;33(4):334-40. Epub 2013 Mar 11.

Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.

Objective: To explore the psychosocial impact of invasive fetal therapy (FT).

Methods: We studied 100 consecutive patients scheduled for invasive FT. Contemporary controls were women undergoing (1) invasive prenatal diagnosis (AC/CVS) and (2) first trimester risk assessment of aneuploidy (NT), and (3) women who declined the latter (CTR). Prior to the procedure, participants completed the Beck Depression Inventory II, the State-Trait Anxiety Inventory, the Dyadic Adjustment Scale and a questionnaire specifically designed to evaluate the process preceding the intervention.

Results: Thirty-five percent of women in the FT group had mild to severe depressive symptoms, and 30% showed high levels of state anxiety. Mean state anxiety was significantly higher in women facing invasive as compared to non-invasive procedures. Trait anxiety levels and relationship scores were comparable across all groups. FT patients were more satisfied with the information and support given, whereas women in the NT group felt a greater degree of self-determination and contentedness with the choices they made.

Conclusion: Pregnant women awaiting invasive prenatal diagnosis and FT face higher levels of state anxiety than women undergoing non-invasive procedures. Traits of depression and high state anxiety are found in at least one third of women undergoing FT.
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http://dx.doi.org/10.1002/pd.4073DOI Listing
April 2013

Fetal weight estimation: comparison of two-dimensional US and MR imaging assessments.

Radiology 2013 Jun 17;267(3):902-10. Epub 2013 Jan 17.

Department of Obstetrics and Gynecology, Fetal Medicine Unit and Department of Radiology, University Hospital Brugmann, Place A. Van Gehuchten 4, 1020 Brussels, Belgium.

Purpose: To prospectively define fetal density in the second half of pregnancy by using magnetic resonance (MR) imaging and to compare estimates of fetal weight based on ultrasonography (US) and MR imaging with actual birth weight.

Materials And Methods: Written informed consent was obtained for this ethics committee-approved study. In this cross-sectional study between March 2011 and May 2012, fetal density was calculated as actual birth weight at delivery divided by fetal body volume at MR imaging in 188 fetuses between 20 weeks and 2 days and 42 weeks and 1 day of gestational age. Regression analysis was used to investigate the effect of variables, including sex, on fetal density. The US estimate of fetal weight was performed according to Hadlock et al, and the MR estimate of fetal weight was calculated based on the equation developed by Baker et al. US and MR estimates of fetal weight were compared with actual birth weights by using regression analysis.

Results: Median fetal density was equal to 1.04 (range, 0.95-1.18). Fetal density was significantly associated with gestational age at delivery but not with fetal sex. In 26.6% of fetuses, the US estimate of fetal weight had a relative error of more than 10%, while a similar relative error for the MR estimate of fetal weight occurred in only 1.1% of fetuses. The limits of agreement were narrower with the MR estimate of fetal weight compared with the US estimate of fetal weight.

Conclusion: In the second half of pregnancy, fetal density varies with gestational age. Fetal weight estimates by using fetal MR imaging are better than those by using prenatal US.
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http://dx.doi.org/10.1148/radiol.12121374DOI Listing
June 2013

Sonographic evaluation of vascular pulmonary reactivity following oxygen administration in fetuses with normal lung development.

Prenat Diagn 2012 Dec 7;32(13):1300-4. Epub 2012 Nov 7.

Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.

Objective: This study aimed to establish nomograms for sonographic assessment of fetal pulmonary vascular reactivity following maternal hyperoxygenation.

Study Design: Sixty-two healthy fetuses were assessed at four weekly intervals from 26 weeks onwards. Pulmonary reactivity was evaluated using Doppler ultrasound in the main pulmonary artery and in the first branch of this main pulmonary artery. The difference in pulsatility index (∆PI) during maternal inhalation of a mixture of room air and oxygen (9 L/min) for at least 10 min was expressed as a percentage. Nomograms were constructed, and Kaplan-Meier curves were used to express the occurrence of a reactive test (∆PI ≥ 20%) with advancing gestation.

Results: In the first branch, linear regression analysis revealed a significant correlation of ∆PI (%) with gestational age (r(2) = 0.04, p = 0.0057). Large inter-individual and intra-individual variability was noted. The ∆PI (%) in the main pulmonary artery remained constant throughout gestation (6.62 ± 17.83%).

Conclusion: Vascular reactivity in the pulmonary circulation increases in the first branch of the pulmonary artery. Large individual variability is limiting its use as a management tool.
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http://dx.doi.org/10.1002/pd.4000DOI Listing
December 2012

Preterm prelabor rupture of membranes and fetal survival after minimally invasive fetal surgery: a systematic review of the literature.

Fetal Diagn Ther 2012 19;31(1):1-9. Epub 2011 Nov 19.

Katholieke Universiteit Leuven, Leuven, Leuven, Belgium.

Objective: Iatrogenic preterm prelabor rupture of membranes (iPPROM; <37 weeks of gestation) is a major complication of fetal surgery. Little information is available about risk factors and incidence.

Methods: We systematically reviewed reported iPPROM rates, gestational age at delivery and fetal survival after representative minimally invasive antenatal procedures.

Results: A total of 1,146, 36 and 194 cases with mean iPPROM rates of 27, 31 and 26% were included for placental laser in twin-twin transfusion syndrome, shunting in lower urinary tract obstruction and interventions for twin-reversed arterial perfusion, respectively. In the statistical analysis, the maximum diameter of the instrument predicted iPPROM rate and was significantly related to gestational age at birth as well as fetal survival. Information on duration of the respective procedures was scarce and did not allow for meaningful analysis.

Conclusions: iPPROM occurs in about 30% of cases treated by minimally invasive fetal surgery. The maximum diameter of the instrument explains iPPROM rate, gestational age at birth and fetal survival. Great variations in the reporting of iPPROM make data analysis difficult.
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http://dx.doi.org/10.1159/000331165DOI Listing
November 2012

Prenatal assessment and management of sacrococcygeal teratoma.

Prenat Diagn 2011 Jul 8;31(7):678-88. Epub 2011 Jun 8.

Department of Woman and Child, Division Woman, Fetal Medicine Unit, University Hospital Gasthuisberg Leuven, Leuven, Belgium.

Sacrococcygeal teratoma (SCT) is one of the most common tumors in newborns with a birth prevalence of up to 1 in 21,700 births. Routine fetal anomaly screening programs allow for prenatal diagnosis in many cases. Fetal ultrasound with Doppler evaluation and more recently magnetic resonance imaging may be used to document the extent of the tumor as well as identifying the population at risk for serious fetal complications. Rapidly growing SCT and highly vascularized tumors are more likely to have hemodynamic repercussions. Fetal hydrops is usually considered as a poor prognostic marker and a potential indicator for fetal intervention. Newborns with SCT require stabilization prior to early surgical resection. In case of malignancy additional chemotherapy may be required. SCT may result in significant morbidity, either directly or as a consequence of surgical therapy. Careful postnatal follow-up is required for timely identification and treatment of complications as well as recurrence. This paper aims to review the perinatal management of this condition.
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http://dx.doi.org/10.1002/pd.2781DOI Listing
July 2011
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