Papers by Federico Prefumo
Umbilical cerebral ratio for detection of poor neonatal acid–base status in small-for-gestational age late preterm fetuses
Ultrasound in Obstetrics & Gynecology, Sep 30, 2019
Ultrasound in Obstetrics & Gynecology, Apr 1, 2020
This study introduces a new ultrasound sign, intracervical lakes (ICL), associated with placenta ... more This study introduces a new ultrasound sign, intracervical lakes (ICL), associated with placenta accreta spectrum disorder in women with placenta previa or low-lying placenta, which potentially represents a marker of deep villus invasion. Presence of ICL seems to be an independent predictor of placenta percreta and its incorporation into ultrasound examination may increase the diagnostic accuracy for Cesarean hysterectomy and major postpartum hemorrhage in women with placenta previa or low-lying placenta.
Ultrasound in Obstetrics & Gynecology, Oct 1, 2020
In this paper we exhibit smooth 2-manifolds F 2 in the 4-sphere S 4 having the property that the ... more In this paper we exhibit smooth 2-manifolds F 2 in the 4-sphere S 4 having the property that the second homology of the group π 1 (S i -F 2 ) is nontrivial. In particular, we obtain tori for which H 2 {π x )=Z 2 and, by forming connected sums, surfaces of genus n for which i^fe) is the direct sum of n copies of Z 2 . Corollaries include: (1) There are knotted surfaces in S 4 that cannot be constructed by forming connected sums of unknotted surfaces and knotted 2-spheres. (2) The class of groups that occur as knot groups of surfaces in S 4 is not contained in the class of high dimensional knot groups of S n in S n+2 .
OC02.05: Ductus venosus velocity ratios for prediction of neonatal cardiac dysfunction in early severe fetal growth restriction
Ultrasound in Obstetrics & Gynecology, Sep 8, 2016
Objectives To assess if fetal ductus venosus velocity ratios recorded within 24 h from birth are ... more Objectives To assess if fetal ductus venosus velocity ratios recorded within 24 h from birth are significantly different in severely growth restricted newborns with and without myocardial dysfunction. Methods Retrospective cohort study. From 2011 to 2015 we included singleton fetuses with estimated birthweight or fetal abdominal circumference ≤ 10th centile and umbilical artery pulsatility index (UA-PI) > 95th percentile, delivered between 26+0 and 34+0 weeks' gestation. Pregnancies complicated by fetal abnormalities or aneuploidy were excluded. Pulsatility index for veins (DV-PIV) and peak velocities of S-, D-, v- and a-waves were measured within 24 hours before delivery. Velocity ratios were converted into multiples of the median (MoM) adjusting for gestational age. DV-PIV was considered abnormal if ≥95th centile. Neonatal myocardial dysfunction was defined as need for inotropic support >24 hours after birth, within 3 days from delivery. Student's t-test was used for comparison of parametric continuous variables. Results The study population included 54 fetuses. There were 2/54 intrauterine deaths (IUD) and 10/52 neonatal deaths (NND). Inotropic support was needed in 12/52 cases. Abnormal DVPIV was not associated with an increased risk of neonatal myocardial dysfunction (relative risk =1.5; 95% Confidence Interval 0.75 to 3.3, p = 0.44). Newborns with myocardial dysfunction had lower mean v/D ratio [0.74 MoM, standard deviation (SD) 0.09 MoM vs 0.89MoM (0.04 SD); p = 0.04] and S/v ratio [0.58 MoM (SD 0.07 MoM) vs 0.78 MoM (0.04 SD); p = 0.02) when compared to newborns without myocardial dysfunction. Conclusions In severely growth restricted fetuses, ductus venosus velocity ratios correlate with neonatal myocardial dysfunction
OP11.04: Fetal cardiac parameters for the prediction of twin-twin transfusion syndrome
Ultrasound in Obstetrics & Gynecology, Sep 1, 2014
ABSTRACT Objectives To assess myocardial performance index measured by conventional Doppler (MPI)... more ABSTRACT Objectives To assess myocardial performance index measured by conventional Doppler (MPI) and by tissue Doppler imaging (MPI′) at 18 weeks' gestation in monochorionic diamniotic twins for the prediction of twin-to-twin transfusion syndrome (TTTS).Methods This was a single-center observational study of 100 uncomplicated monochorionic diamniotic twin pregnancies attending the twin pregnancy clinic at the University Hospital Spedali Civili of Brescia from 2009 to 2012. MPI and MPI′ were obtained from the left (LV) and right (RV) ventricles of each twin at around 18 weeks of gestation (range, 17 + 1 to 19 + 4 weeks) and fortnightly thereafter. Cases which later developed TTTS formed the study group, and the remaining controls were subdivided into those continuing as uncomplicated pregnancies and those which later developed selective intrauterine growth restriction (sIUGR). Data were analyzed by receiver-operating characteristics curve analysis and univariate and multivariable logistic regression.ResultsOf the 100 pregnancies, 88 were controls (84 uncomplicated and four developed sIUGR) and 12 developed TTTS. RV-MPI and LV-MPI, and LV-MPI′ were significantly higher in future TTTS recipients than in controls, while RV-MPI′ was significantly lower in donors. RV-MPI and LV-MPI and LV-MPI′ were found to be predictive indicators in pregnancies that had not yet developed TTTS. Their negative predictive values were > 90%, and their specificities > 80%. The best performing index was LV-MPI′, with a sensitivity of 91.7% and specificity of 88.6%.Conclusions Before diagnosis of TTTS, the cardiac function (as assessed by MPI and MPI′) of the future donor twin is not grossly abnormal, but that of the recipient is abnormal. We identified cardiac indices predictive of the subsequent development of TTTS, and suggest a possible role of these indices in planning the follow-up of monochorionic diamniotic twin pregnancies. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.
Effects of Epidural Analgesia on Uterine Artery Doppler in Labor
Obstetric Anesthesia Digest, Mar 1, 2012
processes using nonlinear mixed-effects models. A 2-compartment mamillary model was used to fit d... more processes using nonlinear mixed-effects models. A 2-compartment mamillary model was used to fit data for both processes, with parameter estimates standardized to a 70-kg person. Their analysis was based on 197 observations. Subjects had a mean gestational age of 35±4.5 weeks and mean weight of 2.5±0.9 kg. Mean thiopentone dose was 3±0.4mg/kg, given by rapid bolus dosing. Elimination was described adequately using both processes, and a combined process proved no better than either model alone. Controlling for PMA or sex did not improve the quality of fit. Clearance at 26 weeks was 0.015L/min/70 kg, increasing to 0.119L/min/70 kg by 42 weeks; Vmax at 26-weeks PMA was 0.22mg/min/70 kg, increasing to 4.13mg/min/70 kg by 42 weeks PMA. These results in neonates at term gestation were approximately 40% of adult values. The Michaelis constant (Km) was 28.3mg/L [between subject variability (BSV), 46.4%; 95% confidence interval (CI), 4.49–99.2mg/L]; intercompartment clearance was 0.44L/min/70 kg (BSV, 97.5%; 95% CI, 0.27–0.63 L/ min/70 kg); central volume of distribution was 46.4L/70 kg (BSV, 29.2%; 95% CI, 41.7–59.8L/70 kg); and peripheral volume of distribution was 95.7 L/70 kg (BSV, 70.3%; 95% CI, 61.3–128L/70 kg). The authors concluded that both first and mixedorder processes described elimination satisfactorily, and that first-order modeling adequately described the timeconcentration profile in the overdosed premature infant. Although clearance was low in preterm neonates, there was rapid maturation around 40 weeks PMA, irrespective of postnatal age. These results suggested that single-dose therapy should be based on the distribution volume, determined by using weight (mg/kg). As elimination curves are similar for premature and term neonates and adults for up to 60 minutes, reduced clearance in premature babies should have little impact on the duration of sedation after single-dose thiopentone therapy.
European Journal of Obstetrics & Gynecology and Reproductive Biology, May 1, 2020
Introduction: Fetal overgrowth is an acknowledged risk factor for abnormal labor course and mater... more Introduction: Fetal overgrowth is an acknowledged risk factor for abnormal labor course and maternal and perinatal complications. The objective of this study was to evaluate whether the use of antenatal ultrasound-based customized fetal growth charts in fetuses at risk for large-for-gestational age (LGA) allows a better identification of cases undergoing caesarean section due to intrapartum dystocia. Material and methods: An observational study involving four Italian tertiary centers was carried out. Women referred to a dedicated antenatal clinic between 35 and 38 weeks due to an increased risk of having an LGA fetus at birth were prospectively selected for the study purpose. The fetal measurements obtained and used for the estimation of the fetal size were biparietal diameter, head circumference, abdominal circumference and femur length, were prospectively collected. LGA fetuses were defined by estimated fetal weight (EFW) >95th centile either using the standard charts implemented by the World Health Organization (WHO) or the customized fetal growth charts previously published by our group. Patients scheduled for elective caesarean section (CS) or for elective induction for suspected fetal macrosomia or submitted to CS or vacuum extraction (VE) purely due to suspected intrapartum distress were excluded. The incidence of CS due to labor dystocia was compared between fetuses with EFW >95th centile according WHO or customized antenatal growth charts. Results: Overall, 814 women were eligible, however 562 were considered for the data analysis following the evaluation of the exclusion criteria. Vaginal delivery occurred in 466 (82.9 %) women (435 (77.4 %) spontaneous vaginal delivery and 31 (5.5 %) VE) while 96 had CS. The EFW was >95th centile in 194 (34.5 %) fetuses according to WHO growth charts and in 190 (33.8 %) by customized growth charts, respectively. CS due to dystocia occurred in 43 (22.2 %) women with LGA fetuses defined by WHO curves and in 39 (20.5 %) women with LGA defined by customized growth charts (p 0.70). WHO curves showed 57 % sensitivity, 72 % specificity, 24 % PPV and 91 % NPV, while customized curves showed 52 % sensitivity, 73 % specificity, 23 % PPV and 91 % NPV for CS due to labor dystocia. Conclusions: The use of antenatal ultrasound-based customized growth charts does not allow a better identification of fetuses at risk of CS due to intrapartum dystocia.
Corrigendum to “The Italian guidelines on ultrasound in obstetrics and gynecology: Executive summary of recommendations for practice” [Eur. J. Obstetrics Gynecol. 279 (2022) 176–182]
European Journal of Obstetrics & Gynecology and Reproductive Biology
Ultrasound in Obstetrics & Gynecology
ABSTRACTObjectiveTo describe the incidence, clinical features and perinatal outcome of late‐onset... more ABSTRACTObjectiveTo describe the incidence, clinical features and perinatal outcome of late‐onset fetal growth restriction (FGR) associated with genetic syndrome or aneuploidy, structural malformation or congenital infection.MethodsThis was a retrospective multicenter cohort study of patients who attended one of four tertiary maternity hospitals in Italy. We included consecutive singleton pregnancies between 32 + 0 and 36 + 6 weeks' gestation with either fetal abdominal circumference (AC) or estimated fetal weight < 10th percentile for gestational age or a reduction in AC of > 50 percentiles from the measurement at an ultrasound scan performed between 18 and 32 weeks. The study group consisted of pregnancies with late‐onset FGR and a genetic syndrome or aneuploidy, structural malformation or congenital infection (anomalous late‐onset FGR). The presence of congenital anomalies was ascertained postnatally in neonates with abnormal findings on antenatal investigation or detec...
International Journal of Gynecology & Obstetrics
ObjectiveTo estimate the neonatal survival rate after intra‐fetal laser (IFL) treatment for twin ... more ObjectiveTo estimate the neonatal survival rate after intra‐fetal laser (IFL) treatment for twin reversed arterial perfusion (TRAP) sequence, and to investigate the effect of gestational age at the time of procedure.MethodsRetrospective cohort study of TRAP sequences followed at our institution from 2013–2020. Systematic review and meta‐analysis of the neonatal survival rate after IFL was conducted. Both diamniotic and monoamniotic monochorionic pregnancies were included. A subgroup analysis to compare outcomes according to gestational age at procedure (<16+0 weeks or ≥16+0 weeks) was planned.ResultsThirteen pregnancies were followed at our center and seven were treated with IFL: the survival rate was 57%. Ten studies published between 2008 and 2020 for a total of 156 cases were included in the meta‐analysis. The overall neonatal survival after IFL was 79% (95% CI 0.72–0.86, I2 22%). A random‐effects model comparing neonatal survival for IFL performed <16+0 weeks versus ≥16+0 ...
BMJ Open
IntroductionFollowing the detection of fetal growth restriction, there is no consensus about the ... more IntroductionFollowing the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring invariably leading to delivery. Indices derived from fetal cerebral Doppler examination may guide such decisions although there are few studies in this area. We propose a randomised, controlled trial to establish the optimum method of timing delivery between 32 weeks and 36 weeks 6 days of gestation. We hypothesise that delivery on evidence of cerebral blood flow redistribution reduces a composite of perinatal poor outcome, death and short-term hypoxia-related morbidity, with no worsening of neurodevelopmental outcome at 2 years.Methods and analysisWomen with non-anomalous singleton pregnancies 32+0 to 36+6 weeks of gestation in whom the esti...
Ultrasound and magnetic resonance imaging in the diagnosis of clinically significant placenta accreta spectrum disorders
Journal of Perinatal Medicine, 2021
Objectives We aimed to assess the performance of ultrasound (US) and magnetic resonance imaging (... more Objectives We aimed to assess the performance of ultrasound (US) and magnetic resonance imaging (MRI) signs for antenatal detection of placenta accreta spectrum (PAS) disorders in women with placenta previa (placental edge ≤2 cm from the internal uterine orifice, ≥260/7 weeks’ gestation) with and without a history of previous Caesarean section. Methods Single center prospective observational study. US suspicion of PAS was raised in the presence of obliteration of the hypoechoic space between uterus and placenta, interruption of the hyperechoic uterine-bladder interface and/or turbulent placental lacunae on color Doppler. All MRI studies were blindly evaluated by a single operator. PAS was defined as clinically significant when histopathological diagnosis was associated with at least one of: intrauterine balloon placement, compressive uterine sutures, peripartum hysterectomy, uterine or hypogastric artery ligature, uterine artery embolization. Results A total of 39 women were include...
American Journal of Obstetrics and Gynecology, 2018
In the process of asphyxial fetal death due to placental insufficiency, fetal breathing movements... more In the process of asphyxial fetal death due to placental insufficiency, fetal breathing movements have been observed to cease prior to cessation of gross body movements or loss of fetal tone. We sought to examine the potential efficacy of a simplified biophysical profile (BPP) defined as reassuring by the presence of fetal breathing movements (FB) and adequate amniotic fluid volume (AFV) alone. STUDY DESIGN: We retrospectively examined fetal outcomes for all pregnancies between 2011 and 2016 undergoing an 8-point BPP in which a score of 4 or 6 was observed, with FB (30 seconds or more within 30 minutes) present and adequate AFV (single deepest vertical pocket > 2cm). RESULTS: During this time frame, 23,148 8 point BPPs without NST were performed in 5,939 singleton pregnancies at risk for fetal demise, at a mean gestational age of 33.6 AE 4.2 weeks. There were 575 women with a BPP 6. Good FB and adequate AFV were seen in 17.5% (n¼101, Group 1) and in 82.5% (n¼474, Group 2) one of these 2 features were absent. In Group 1 no neonatal deaths were seen prior to the next reassuring test, or delivery, in contrast to 6 neonatal deaths seen in Group 2. An adverse neonatal outcome (IVH, NEC, BPD, sepsis, perinatal death, and NICU admission) were seen in 29 (28.7%) cases in Group 1 vs. 328 (69.2%) cases in Group 2 (p < 0.001, OR 5.6; 95%CI: 3.4, 8.9). This difference persisted following logistic regression analysis controlling for gestational age at delivery and fetal anomalies (Table ). CONCLUSION: As expected from known physiologic principles, our data in over 23,000 biophysical profiles suggest that observation of fetal tone and movement may be irrelevant in the prediction of fetal demise in the presence of normal fetal breathing movements and adequate amniotic fluid volume. Our data also support the greater predictive value for normal outcomes of breathing and AFV evaluation over other features of the 8-point BPP. We suggest that a combination of FB and AFV evaluation or non-stress test and AFV evaluation may be the most appropriate and efficient initial approaches to antenatal testing.
Longitudinal reference ranges for serial measurements of myocardial performance index (MPI) by conventional and pulsed‐wave tissue Doppler in monochorionic diamniotic twins at 17 to 26 weeks of gestation
Prenatal Diagnosis, 2018
ObjectiveTo describe the longitudinal changes of fetal myocardial performance index (MPI) measure... more ObjectiveTo describe the longitudinal changes of fetal myocardial performance index (MPI) measured by conventional Doppler (MPI) and by pulsed‐wave tissue Doppler (MPI′) based on a prospective cohort of uncomplicated monochorionic diamniotic twin.MethodSingle‐center observational study. We measured MPI and MPI′ in the right and left ventricles 3 times between 17 and 26 weeks of gestation. Second‐degree fractional polynomials were built to obtain the best fitting curves in relation to gestational age (weeks) for each parameter. Gestational age‐specific reference values were estimated by using two‐level hierarchical models.ResultsEighty‐three uncomplicated monochorionic pregnancies were included in our study with a total of 249 observations. Fetal cardiac function was measured as MPI RV and LV, MPI′ RV and LV at a mean gestational age of 18+3 (range 17+1 to 19+2), 22+3 (21+1 to 23+5), and 24+3 (22+6 to 26+2) weeks. The reference ranges for MPI LV, MPI RV, MPI′ LV, and MPI′ RV at 17 to...
OC04.10: Incidence and perinatal outcome of late onset fetal growth restriction (FGR) identified within a population of fetuses with suspected FGR diagnosed beyond 32 weeks
Ultrasound in Obstetrics & Gynecology, 2021
Ultrasound in Obstetrics & Gynecology, 2020
The purpose of this paper is to establish some metrizability properties of normal Moore spaces an... more The purpose of this paper is to establish some metrizability properties of normal Moore spaces and normal, locally compact Moore spaces. Certain screenable subsets of complete normal Moore spaces are proved to be strongly screenable. Additional properties are related to screenability.
Acta Obstetricia et Gynecologica Scandinavica, 2019
IntroductionWe aimed to assess if maximum velocities of the ductus venosus flow velocity waveform... more IntroductionWe aimed to assess if maximum velocities of the ductus venosus flow velocity waveform are associated with adverse outcomes in early‐onset fetal growth restriction.Material and methodsRetrospective cohort study from two tertiary referral units, including singleton fetuses with estimated birthweight or fetal abdominal circumference ≤10th centile and absent or reversed end‐diastolic velocity in the umbilical artery delivered between 26+0 and 34+0 weeks of gestation. Pulsatility index for veins, and maximum velocities of S‐, D‐, v‐ and a‐waves, were measured in the ductus venosus within 24 hours of birth. Logistic regression was used to describe the relation between severe neonatal morbidity or neonatal death and clinical independent predictors.ResultsThe study population included 132 early‐onset fetal growth restriction fetuses. Newborns with neonatal morbidity or neonatal death had significantly lower values of v/D maximum velocity ratio multiples of the median (0.86 vs 09...
Ultrasound in Obstetrics & Gynecology, 2019
Objectives: To describe the outcome of growth-restricted fetuses with absent or reversed end-dias... more Objectives: To describe the outcome of growth-restricted fetuses with absent or reversed end-diastolic flow (ARED) in the umbilical artery delivered before 30 gestational weeks (GW). Methods: A retrospective study of all growth-restricted fetuses (singletons and twins with birth weight < mean -2SD) with ARED flow delivered in Lund during the time period of 1998-2015 (n=139). Control group: all AGA fetuses delivered < 30 GW during the corresponding time period (n=946). Perinatal mortality, neonatal morbidity, infant mortality and survival without neurodevelopmental impairment (NDI; cerebral palsy, cognitive delay, severe hearing impairment, blindness) after 2 years of age were compared between the two groups. Results: In the ARED group there were 7 cases of intrauterine death, all before 26 GW. The mean gestational age at birth was 26 GW in both groups, (range 23+3-29+6 and 22+0-29+6, respectively). There was no significant difference in perinatal mortality between the two groups (12% vs 15%). The incidence of chronic lung disease was higher in the ARED group than in control group (p < 0.001). There were no differences between the groups in the occurrence of necrotising enterocolitis, retinopathy of prematurity, intraventricular hemorrhage or cerebral palsy. The mean two-year survival was 83% in both group (ns). Significantly more children from the ARED group were in need of habilitation services (p < 0.01). Survival without NDI was 62% in the ARED group and 83% in the control group (p < 0.001); for children born after 26 GW the corresponding figures were 72% and 88% (p = 0.001). Conclusions: Very preterm growth-restricted fetuses with umbilical artery ARED flow delivered on fetal indication showed a high 2-year survival, similar rate of cerebral palsy and higher need for habilitation services compared to non-IUGR very preterm infants.
Ultraschall in der Medizin - European Journal of Ultrasound, 2019
Purpose To investigate the effects of the antenatal administration of betamethasone on fetal Dopp... more Purpose To investigate the effects of the antenatal administration of betamethasone on fetal Doppler and short term fetal heart rate variation (CTG-STV) in early growth restricted (FGR) fetuses. Materials and Methods Post hoc analysis of data derived from the TRUFFLE study, a prospective, multicenter, randomized management trial of severe early onset FGR. Repeat Doppler and CTG-STV measurements between the last recording within 48 hours before the first dose of betamethasone (baseline value) and for 10 days after were evaluated. Multilevel analysis was performed to analyze the longitudinal course of the umbilico-cerebral ratio (UC ratio), the ductus venosus pulsatility index (DVPIV) and CTG-STV. Results We included 115 fetuses. A significant increase from baseline in CTG-STV was found on day + 1 (p = 0.019) but no difference thereafter. The DVPIV was not significantly different from baseline in any of the 10 days following the first dose of betamethasone (p = 0.167). Multilevel anal...
Uploads
Papers by Federico Prefumo