A. Padoan

University of Milan, Milano, Lombardy, Italy

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Publications (18)55.48 Total impact

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    ABSTRACT: The aim of this study was to assess and compare uterine artery (UtA) blood flow volume in pregnant patients with an abnormal uterine Doppler pulsatility index (PI) who delivered fetuses with an appropriate weight for gestational age (AGA) or with intrauterine growth restricted (IUGR). We prospectively recruited singleton pregnancies with abnormal uterine arteries P.I. between 18 and 38 weeks of gestation regardless of estimated fetal weight (EFW). Vessel diameter and blood flow velocity were measured along the UtA upstream to the vessel bifurcation in both the right and left UtAs. Uterine blood flow volumes measured in these pregnancies were compared to historical Control-pregnancies. Forty-three patients delivered at term a normal weight newborn (AGA-pregnancies). Thirty patients delivered growth restricted newborns at 32 weeks (i.r. 29-36w) with a median weight of 1160 gr (i.r. 1000-2065 gr) (IUGR-pregnancies). At mid-gestation (18 + 0 - 25 + 6 weeks + days of gestation) a significantly lower uterine blood flow volume per unit weight was observed between the two study groups and compared to controls: 142 ml/min/kg in IUGR-pregnancies, 217 ml/min/kg in AGA-pregnancies and 538 ml/min/kg in Control-pregnancies. These striking differences in blood flow volume were already present at mid-gestation, at a time when EFW was still normal. In late gestation (27 + 0 - 37 + 6 weeks + days of gestation), pregnancies with an abnormal uterine P.I. showed persistently low UtA flow (<50% of controls) even when corrected for fetal weight: 81 ml/min/kg in IUGR-pregnancies, 105 ml/min/kg in AGA-pregnancies, and 193 ml/min/kg in Control-pregnancies; p < 0.0001. Our findings are consistent with other recent studies regarding the association between reduced uterine blood flow volume and fetal growth restriction. However, the study brings new insight into the finding of abnormal uterine P.I. in normally grown fetuses typically dismissed as "falsely abnormal" or "false positive" findings. Our study suggests that blood flow volume measurement may serve as a new tool to assess this group of patients and possibly those with ischemic placental diseases that may provide some basis for therapeutic interventions.
    Placenta 07/2011; 32(7):487-92. · 3.12 Impact Factor
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    ABSTRACT: The primary aim of this pilot study was to study uterine artery (UtA) blood flow volume in uneventful human pregnancies delivered at term, at mid and late gestation by means of 3D and bi-dimensional ultrasound imaging with angio-Doppler combined with fluid-dynamic modeling. Secondary aims were to correlate flow volume to placental site and to UtA Pulsatility Index (PI). Women with singleton, low-risk pregnancies were examined at mid and late gestation. The structure and course of the uterine artery (UtA) was studied in each patient by means of 3D-angio-Doppler and included vessel diameter D, blood flow velocity and PI (measured along the UtA). Fetal weight estimation and placental insertion site were assessed by ultrasound. A robust fluid-dynamic modeling was applied to calculate absolute flow and flow per unit fetal weight. Mean UtA diameter and blood flow velocity increased significantly (p < 0.0001) from mid-gestation to late gestation from 2.6 mm and 67.5 cm/s, to 3.0 mm and 85.3 cm/s, respectively, yielding an increasing absolute flow troughout gestation. h coefficient, derived by fluid-dynamic modeling to calculate mean velocity, increased significantly from 0.52 at mid-gestation to 0.57 at late gestation. UtA blood flow volume ml/min/kg-fetal weight was significantly higher at mid-gestation than at late gestation (535 ml/min/kg vs 193 ml/min/kg; p < 0.0001). In cases with strictly lateral placentas the ipsilateral UtA accommodates at mid and late gestation 63% and 67% of the total UtA flow. In central placentas UtA flow was evenly distributed between the two vessels. An inverse correlation was observed between PI and blood flow volume ml/min/kg (Pearson's coefficient r = -0.54). Our work confirms the technological and methodological limitations in the measurement of uterine artery blood flow. However, Doppler measurements supported by three-dimensional angio imaging of the uterine vessel, high resolution imaging and diameter measurement, and a robust mathematical model of local circulation adds a genuine new area of investigation into human uterine circulation during pregnancy.
    Placenta 11/2009; 31(1):37-43. · 3.12 Impact Factor
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    ABSTRACT: To study changes in umbilical vein (UV) blood flow velocity, diameter and blood flow volume in intrauterine growth retardation (IUGR) fetuses who die in utero (IUD-IUGR). Twelve singleton IUGR fetuses who died in utero below 600 g were included. All cases had abnormal uterine and umbilical arteries PI. UV diameter and velocity were measured at the time of diagnosis, and at the last exam, within 24 hours prior to intrauterine death. UV flow was calculated per unit weight (mL/min/kg) and abdominal circumference (AC) (mL/min/cm). UV diameter and velocity were normalized per unit AC. Findings were compared to 14 severe viable-IUGR and 22 normal gestational age-matched fetuses. UV flow (mL/min/kg) was significantly lower in IUD-IUGR compared to viable-IUGR (87 +/- 30 mL/min/kg) and control fetuses (131 +/- 33 mL/min/kg) both at the first (79 +/- 40 mL/min/kg) (P < 0.0001), and at the last exam (54 +/- 29 mL/min/kg) (P < 0.0001). No significant longitudinal flow changes were observed. UV velocity/AC was significantly reduced both in IUD-IUGR and viable-IUGR compared to normal fetuses. UV diameter/AC, was significantly reduced only in IUD-IUGR and not in viable-IUGR compared to normal fetuses. UV flow (mL/min/kg) was significantly lower in IUD-IUGR fetuses both versus viable-IUGR and normal fetuses. A low flow was due to a decreased UV flow velocity, but also due to a reduced vessel size. This significantly smaller UV size observed in IUGR fetuses with the worst outcome could be considered a severe prognostic sign because of the diagnosis of severe growth restriction.
    Prenatal Diagnosis 11/2008; 28(10):908-13. · 2.68 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 09/2007; 30(4):506 - 506. · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 01/2007; 30(4):457-457. · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 08/2006; 28(4):481 - 481. · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 08/2006; 28(4):491 - 492. · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 08/2006; 28(4):569 - 569. · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 08/2006; 28(4):570 - 570. · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 09/2005; 26(4):353 - 353. · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 09/2005; 26(4):341 - 342. · 3.56 Impact Factor
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    ABSTRACT: The purpose of this study was to assess fetal subcutaneous fat and lean mass areas as predictors of fetal growth restriction. Seventeen severe fetal growth-restricted (abdominal circumference, < 2 SD) fetuses and 20 control fetuses underwent ultrasound measurements of subcutaneous fat, lean mass, and standard biometry. Thigh subcutaneous fat and lean mass were measured on enlarged ultrasound axial images (subcutaneous fat area = total cross sectional area - lean mass area [bone + muscle areas]). Subcutaneous fat and lean mass areas were expressed as a percentage of the total cross-sectional area and were normalized to femur length and head circumference. Measurements were modeled as a function of fetal growth-restriction status and week of gestation with multiple linear regression. Fetal growth-restriction fetuses showed reductions in fat and lean mass (in standard biometry) and showed a disproportionate reduction in fat mass compared with lean mass. These were all associated significantly with fetal growth restriction. Fetal growth-restricted fetuses have reduced subcutaneous fat and lean mass compared with control fetuses; a further reduction occurs in subcutaneous fat concentration compared with the reduction in lean mass when fat is normalized for body size, with either head circumference or femur length. Fat-to-bone proportions may be useful in distinguishing the small for gestational age fetus who is truly fetal growth restriction from the constitutionally small fetus.
    American Journal of Obstetrics and Gynecology 11/2004; 191(4):1459-64. · 3.88 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 08/2004; 24(3):311 - 311. · 3.56 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 08/2004; 24(3):320 - 320. · 3.56 Impact Factor
  • American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/2003; 189(6).
  • American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/2003; 189(6).
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    ABSTRACT: Purpose: To assess the diagnostic accuracy of sonohysterography in preoperative assessment of submucous myomas.Methods: Twenty premenopausal patients with submucous myomas and irregular uterine bleeding and/or infertility were consecutively collected in 12 months. Before surgery, all patients underwent transvaginal sonography (TVS) (Voluson, KRETZ, 5300), with color Doppler evaluation, and sonohysterography (SHG). Number and site of myomas and the myoma–perimetrium distance were considered at TVS. SHG was performed with a 4.7-mm (14F) intrauterine catheter. Patient compliance to SHG was evaluated by a subjective pain scale. Duration from TVS to completion of the procedure, and volume of saline solution instilled for SHG, were evaluated. Sonographic findings at TVS and SHG were classified as submucous myoma G0, G1 and G2 and compared to hysteroscopic finding. Depending on myoma grading and volume, selected patients underwent preoperative medical treatment with triptorelin (decapeptyl-ipsen). Hysteroscopic myomectomy was the standard surgical approach. Diagnostic accuracy of TVS and SHG was evaluated.Results: Mean age was 41 years (interquartile range 34–47). Mean BMI was 24 kg/m2 (interquartile range 21–28). Twelve patients reported irregular bleeding, eight infertility. Eleven patients had additional intramural and or subserous myomas. Mean duration time of SHG was 12 min (interquartile range 9–16). Mean volume of sterile solution instilled for SHG was 16 mL (interquartile range 8–24). In all cases, a successful SHG was performed, with no and mild discomfort in 16 (80%) and 3 (11%) patients, respectively. Hysteroscopic findings were compared to TVS and SHG considering the submucous myoma grading. SHG correctly classified all miomas (five cases of G0, 11 cases of G1, five cases of G2). TVS correctly classified all G0 cases, over classified two G1 cases as G2, correctly classified five cases of G2.Conclusions: Sonohysterography was a simple and well tolerated imaging technique, with a diagnostic accuracy comparable to hysteroscopy. We speculate that endometrial sampling performed during SHG could help to exclude coexisting endometrial abnormalities which are likely to occur in larger series.
    Ultrasound in Obstetrics and Gynecology 01/2001; 18. · 3.56 Impact Factor
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    ABSTRACT: Purpose: To compare demographic, sonographic, and outcome data of postmenopausal patients with asymptomatic endometrial polyp, surgically treated or not treated.Methods: Ninety postmenopausal women with sonographic/sonohysterographic diagnosis of asymptomatic endometrial polyp were prospectively enrolled in this study. All patients underwent transvaginal sonography with color Doppler evaluation (Voluson 5300, KRETZ), and sonohysterography in selected cases. Patients were counseled on the risk of malignancy (estimated risk < 1/200). Sonographic follow up at 3, 6 and 12 months was proposed as an option to standard hysteroscopic polipectomy. Surgery was considered in case of bleeding, polyp enlargement, or Doppler PI < 0.6. Demographic and sonographic data of both groups were recorded. Surgical complications in group B patients were considered as abnormal outcome.Results: Sonographic follow up was chosen by 42 women (group A) and surgical removal by 47 patients (group B). Forty-three patients underwent operative hysteroscopy, and four patients hysterectomy (group B). One major (uterine perforation not requiring surgery) and three minor complications (two cervical lacerations requiring hemostatic suturing, one false entry) (9%). Demographic (age, years of menopause, blood hypertension/diabetes, BMI, nulligravidity, hormonal replacement therapy assumption, tamoxifen assumption) and sonographic data) Endometrial thickness mean (interquartile range) = 8 (5–10) vs. 11 mm (7–13); volume (cc): 3 (1–4) vs. 4 (1–5); PI: 0.48 (0.44–0.51) vs. 0.49 (0.45–0.53) were not significantly different between group A and B. Pathologic findings were glandulocystic and hyperplastic polyp in 45 and in two patients, respectively. All group A patients remained asymptomatic in the follow up period (mean 10 months, interquartile range 5–16).Conclusions: Demographic and sonographic data were not significantly different in the two groups. No untreated patient became symptomatic during follow up period. Benign lesions only were found in treated patients, at the cost of one uterine perforation. A large multicentre study is needed to understand the exact prevalence of endometrial cancer in asymptomatic endometrial polyp, and verify the safety of conservative management.
    Ultrasound in Obstetrics and Gynecology 01/2001; 18. · 3.56 Impact Factor