E. Gratacós

Hospital Sant Joan de Déu, Barcino, Catalonia, Spain

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Publications (614)1900.82 Total impact

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    ABSTRACT: To assess in vivo changes in lung and liver volume in fetuses with isolated congenital diaphragmatic hernia (CDH), either expectantly managed or treated in utero. This is a secondary analysis of prospectively collected data at 2 fetal therapy centers. We used archived magnetic resonance (MR) images of fetuses taken ≥7 days apart, creating paired observations in 20 expectantly managed cases, 41 with a second MR prior to balloon reversal and 64 after balloon removal. We measured observed to expected total fetal lung volume (O/E TFLV) and liver-to-thoracic volume ratio (LiTR). We calculated changes in volume as compared to the initial measurement and its rate as a function of gestational age (GA) at occlusion. The LiTR did not change in either group. In expectantly managed fetuses, O/E TFLV did not increase with gestation. In fetuses undergoing tracheal occlusion (TO) the measured increase in volume was 2.6-times larger with balloon in place as compared to after its removal. GA at TO was an independent predictor of the O/E TFLV. The net rate seems to initially increase and plateau at a maximum of 1.5%/week by 35-45 days after occlusion. TO induces a net increase in volume, its magnitude essentially dependent on the GA at occlusion. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Prenatal Diagnosis 07/2015; DOI:10.1002/pd.4642 · 3.27 Impact Factor
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    ABSTRACT: Among late-onset small fetuses, a combination of estimated fetal weight (EFW), cerebroplacental ratio (CPR) and uterine artery mean pulsatility index (UtA) discriminates a subgroup with poor perinatal outcome. The association of these criteria with fetal cardiac structure and function is unknown. A cohort of late-onset 209 small fetuses that were delivered > 34 weeks of gestation was divided in two categories: "small-for-gestational age" (SGA, n = 59) when EFW was 3-9th and CPR and UtA were normal, and "intrauterine growth restriction" (IUGR, n = 150), if EFW<3rd centile or EFW <10(th) centile together with CPR<5(th) centile and/or UtA>95(th) centile. These were compared with 150 normally grown fetuses. Fetal cardiac morphometry and function were assessed by echocardiography using 2D, M-mode, conventional and tissue Doppler. Both IUGR and SGA fetuses showed larger and more globular hearts (mean left sphericity index: controls 1.8(SD 0.3), SGA 1.5 (0.2) and IUGR 1.6(0.3), P < 0.01)) together with signs of systolic and diastolic dysfunction, including decreased tricuspid annular plane systolic excursion (controls 8.2 (1.1), SGA 7.4(1.2) and IUGR 6.9(1.1), P < 0.001) and increased myocardial performance index (controls 0.45 (0.14), SGA 0.51(0.08) and IUGR 0.57(0.1), P < 0.001). Despite near-normal perinatal outcome, the so-defined "SGA" fetuses are still associated with prenatal cardiac dysfunction. This supports that at least part of them are not "constitutionally small" and that further research is needed. This article is protected by copyright. All rights reserved.
    Ultrasound in Obstetrics and Gynecology 06/2015; DOI:10.1002/uog.14930 · 3.14 Impact Factor
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    ABSTRACT: To report on the accuracy of fetal echocardiography in the distinction between truncus arteriosus communis (CAT) and pulmonary atresia with ventricular septal defect (PA-VSD) and to describe the association with extracardiac and chromosomal anomalies. This was a retrospective study on 31 fetuses with a single arterial trunk overriding a VSD with a nonidentifiable right ventricle outflow tract with anterograde flow. Data on the type of cardiac defect, gestational age, characteristics of the arterial trunk valve, presence of additional vascular, chromosomal and extracardiac abnormalities and postnatal outcome were obtained. Misdiagnosed cases were reevaluated by four-dimensional spatiotemporal image correlation (4D-STIC) echocardiography. The overall diagnostic accuracy was 81% and increased to 93.5% with 4D-STIC. Chromosomal and extracardiac anomalies were detected in 40 and 27%, respectively. In the PA-VSD group, patent ductus arteriosus and major aortopulmonary collateral arteries (MAPCAs) were present in 70 and 50% of the cases, respectively, coexisting in 1 of 5 cases. MAPCAs were significantly associated with a right aortic arch and with a 22q11 microdeletion in 50% of cases. A prenatal distinction between CAT and PA-VSD can currently be achieved in most cases. MAPCAs should be actively searched for when PA-VSD is suspected, as they are associated with a higher risk of 22q11 microdeletion and potentially complicate postnatal treatment. © 2015 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 06/2015; DOI:10.1159/000433430 · 2.30 Impact Factor
  • American journal of obstetrics and gynecology 06/2015; DOI:10.1016/j.ajog.2015.06.033 · 3.97 Impact Factor
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    ABSTRACT: Objectives Fetuses with congenital heart disease have evidence of abnormal brain development before birth, which is thought to contribute to adverse neurodevelopment during childhood. We evaluated whether late pregnancy brain development can be predicted at the time of diagnosis by fetal brain Doppler, head biometry and the clinical form of congenital heart disease.Methods This prospective cohort study included 58 fetuses with congenital heart disease diagnosed at 19–24 weeks of gestation and 58 controls. At the time of diagnosis, we recorded fetal head circumference, biparietal diameter, middle cerebral artery pulsatility index, cerebroplacental ratio and brain perfusion by Fractional Moving Blood Volume. We classified cases in two clinical types, i.e. with expected high or low levels of placental (well-oxygenated) blood perfusion according to the anatomical defect. All fetuses underwent 3T magnetic resonance at 36–38 weeks’ gestation.ResultsAbnormal prenatal brain development was defined by a composite score including any of the following: total brain volume <10th centile, parietoccipital or cingulate fissure's depth <10th centile, and abnormal metabolic profile in the frontal lobe. Logistic regression analysis demonstrated that middle cerebral artery pulsatility index (p<0.01, OR 12.7), cerebroplacental ratio (p<0.01, OR 8.7) and cephalic circumference (p<0.01, OR 6.2) were independent predictors of abnormal brain neurodevelopment, while the clinical type of congenital heart disease was not.Conclusions Fetal brain Doppler and cephalic biometry at the time of congenital heart disease diagnosis are independent predictors of abnormal brain development at birth, and could be used in future algorithms to improve counseling and targeted interventions.
    Ultrasound in Obstetrics and Gynecology 06/2015; DOI:10.1002/uog.14919 · 3.14 Impact Factor
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    ABSTRACT: Objective To estimate the value of gestational age at birth and fetal Doppler in predicting the risk of neonatal cranial ultrasound abnormalities in intrauterine growth restricted fetuses born between 28 and 34 weeks.Study DesignFetal Doppler parameters, including umbilical artery, middle cerebral artery, aortic isthmus, ductus venous, and myocardial performance index, were evaluated in a cohort of 90 intrauterine growth restricted fetuses with abnormal umbilical artery Doppler delivered between 28 and 34 weeks and 90 control participants matched by gestational age. The value of gestational age and the fetal Doppler parameters to predict the risk of cranial ultrasound abnormalities, including interventricular haemorrhage, periventricular leucomalacia and basal ganglia lesions was analyzed.ResultsOverall, intrauterine growth restricted fetuses showed a significant higher incidence of cranial ultrasound abnormalities (40.0% vs. 12.2%, P < .001) than control participants. Within the group with intrauterine growth restriction, all predictive variables were individually associated with the risk of cranial ultrasound abnormalities, but fetal Doppler rather than gestational age at birth was identified as the best predictor. Middle cerebral artery Doppler distinguished two groups with different risks of cranial ultrasound abnormalities (48.5% compared with 13.6%, P < .01). In the subgroup of middle cerebral artery vasodilation, the presence of aortic isthmus retrograde net blood flow identified a subgroup of cases with the highest risk of cranial ultrasound abnormalities (66.7% compared with 38.6%, P < .05).Conclusion Evaluation of fetal Doppler parameters rather than gestational age at birth discriminates intrauterine growth restricted preterm fetuses at risk of abnormal neonatal brain scan.
    Ultrasound in Obstetrics and Gynecology 06/2015; DOI:10.1002/uog.14920 · 3.14 Impact Factor
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    ABSTRACT: We have assessed brain metabolite levels by magnetic resonance spectroscopy (MRS) in one year old infants born small at term, as compared with adequate for gestational age (AGA) born infants, and their association with neurodevelopment at two years of age. A total of 40 infants born small (birth weight <10(th) centile for GA) and 30 AGA infants underwent brain MRS at one year, on a 3 Tesla scanner. Small-born infants were subclassified as late-IUGR (intrauterine growth restriction) or as small for gestational age (SGA), based on the presence or absence of prenatal Doppler and birth weight predictors of an adverse perinatal outcome, respectively. Single-voxel PRESS (1)H-MRS data were acquired from the frontal lobe at short echo time. Neurodevelopment was evaluated at two years of age using the Bayley Scales 3rd Edition (BSID-III), assessing cognitive, language, motor, socio-emotional behavior and adaptative behavior. As compared with AGA controls, infants born small showed significantly higher levels of glutamate (Glu) and N-acetylaspartate (NAAt)/Creatine (Cr) at one year, and lower BSID-III scores at 2 years. The subgroup of late-IUGR infants further showed lower estimated glutathione (GSH) levels at one year. Significant correlations were observed for estimated GSH levels with adaptative scores, and for myo-inositol with language scores. Significant associations were also noticed for NAA/Cr with cognitive scores, and for Glu/Cr with motor scores. Infants born small show brain metabolite differences at one year of age, which are correlated with later neurodevelopment. These results support further research on MRS to develop imaging biomarkers of abnormal neurodevelopment. Copyright © 2015 Elsevier Inc. All rights reserved.
    American journal of obstetrics and gynecology 04/2015; DOI:10.1016/j.ajog.2015.04.011 · 3.97 Impact Factor
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    ABSTRACT: We report the successful use of fetoscopy to treat a case of prolapsed ureterocele in a female fetus. A diagnosis of a double renal system with an intravesical ureterocele was performed at 21 weeks' gestation. Follow-up exams showed that the ureterocele was obstructing the bladder outlet causing severe megacystis, bilateral hydronephrosis and progressive oligohydramnios. Those findings suggested a poor prognosis and therefore the patient was referred to our Fetal Therapy Unit to consider prenatal treatment. The ultrasound evaluation at admission confirmed severe bilateral hydronephrosis with pelvic and caliceal dilatation, but, surprisingly, the amniotic fluid was normal and no image of ureterocele could be identified into the bladder. Instead, a cystic image between the external genitalia could be observed, leading us to the diagnosis of a prolapsed ureterocele causing intermittently severe obstruction of the urethra. Due to the unpredictable course of the malformation, parents were counselled about the uncertain fetal prognosis and therefore fetal surgery to decompress the urinary system was proposed, with the agreement of the paediatric urologist. After extensive discussion and counselling, a fetoscopic operation was designed and indicated. The procedure consisted in opening the cystic mass by means of firing with contact diode laser until the opening of the ureterocele was achieved. After the surgery, resolution of the megacystis, with reduction of the hydronephrosis, and persistent normalization of the amniotic fluid volume were observed. The pregnancy continued uneventfully and a normal female infant was born at term at her local hospital. The child is developing normally with normal renal function at 4 years old. Our report demonstrates that fetoscopic decompression of a distal urethra obstruction is feasible in the rare event of congenital prolapsed ureterocele. This article is protected by copyright. All rights reserved.
    Ultrasound in Obstetrics and Gynecology 04/2015; DOI:10.1002/uog.14876 · 3.14 Impact Factor
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    ABSTRACT: To assess maternal vascular structure and function in fetal growth restriction (FGR) pregnancies with and without preeclampsia (PE) at the time of diagnosis. We evaluated 124 pregnant women with FGR subdivided in 60 FGR with and 64 FGR without PE, together with 110 controls. The group of FGR without PE was further subdivided according to the gestational age at diagnosis into early (<32 weeks) or late-onset (≥32 weeks). Maternal carotid intima-media thickness (IMT), blood pressure (BP), carotid artery distensibility (CD), circumferential wall stress (CWS), and inferior vena cava (IVC) collapsibility were assessed by ultrasound at the time of FGR diagnosis. FGR cases with PE showed increased maternal carotid IMT (controls: mean 0.409 mm (IQR 0.386-0.439); FGR with PE: 0.425 mm (0.381-0.486); P = 0.021), BP (controls: mean BP 82 mmHg (77-89); FGR with PE: 109 mmHg (101-117); P < 0.001) and CWS, together with reduced CD and IVC collapsibility (controls: IVC collapsibility index 0.10 (0.06-0.13); FGR with PE: 0.07 (0.06-1.11); P = 0.136). FGR without PE had increased maternal IMT (0.436 mm (0.392-0.476); P = 0.001) and BP (88mmHg (81-95); P < 0.001), but similar CD and IVC collapsibility to controls. When subclassified according to gestational age, only early-onset FGR had significantly increased IMT and CWS, but both groups had increased BP. FGR without PE shares some subclinical maternal vascular features with PE, which further reinforces the notion that, at least in a proportion of cases, there is a common placental disease that influences maternal cardiovascular features. This article is protected by copyright. All rights reserved.
    Ultrasound in Obstetrics and Gynecology 02/2015; DOI:10.1002/uog.14815 · 3.14 Impact Factor
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    ABSTRACT: Objective: To explore the value of circulating luteinizing human chorionic gonadotropin receptor (LHCGR) forms for the prediction of preeclampsia (PE) in the first trimester of pregnancy. Methods: Case-control study, based on a cohort of 5,759 pregnancies, including 20 early PE, 20 late PE, and 300 controls. We recorded/measured maternal characteristics, mean arterial pressure (MAP), uterine artery (UtA) Doppler, placental growth factor (PlGF), soluble Fms-like tyrosine kinase-1 (sFtl-1), and LHCGR forms (hCG-LHCGR and soluble LHCGR), and their independent predictive values were analyzed by logistic regression. Results: For early PE, the model included black ethnicity, chronic hypertension, previous PE, MAP, UtA Doppler, PlGF, sFlt-1, and LHCGR forms, achieving detection rates (DR) of 83% at 10% of false-positive rates (FPR) [AUC: 0.961 (95% CI: 0.921-1)]. For late PE, the model included body mass index, previous PE, UtA Doppler, PlGF, sFlt-1, and LHCGR forms, with DR of 75% at 10% of FPR [AUC: 0.923 (95% CI: 0.871-0.976)]. In both early and late PE, LHCGR forms improved DR by 6-15%. Conclusions: LHCGR forms improved the prediction for early and late PE. These results should be confirmed in larger prospective studies. © 2015 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 02/2015; DOI:10.1159/000371516 · 2.30 Impact Factor
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    ABSTRACT: To estimate the combined value of cerebral Doppler results and the Bishop score for predicting perinatal outcomes after labour induction for small for gestational age (SGA) foetuses in the presence of normal umbilical artery Doppler results. We conducted a cohort study in two tertiary centres of 164 women with normal umbilical artery Doppler recordings who underwent labour induction because of an estimated foetal weight below the 10(th) percentile. The middle cerebral artery pulsatility index and cerebroplacental ratio (CPR) were obtained in all cases within 24 hours before induction. The cervical condition was assessed at admission using the Bishop score. A predictive model for perinatal outcomes was constructed using the Decision Tree Analysis algorithm. Both a very unfavourable cervix (Bishop score < 2) (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.28-7.86) and an abnormal CPR (OR, 2.54; 95% CI, 1.18-5.61) were associated with an increased likelihood of emergent caesarean section for foetal distress, but only the latter was significantly associated with the need for neonatal admission (OR, 2.43; 95% CI, 1.28-4.59). In the decision tree analysis both criteria significantly predicted the likelihood of caesarean section for foetal distress. Combined use of the Bishop score and CPR improves the ability to predict caesarean section overall (for any indication), emergency caesarean section for foetal distress, and neonatal admission after labour induction for late-onset SGA in the presence of normal umbilical artery Doppler results. This article is protected by copyright. All rights reserved.
    Ultrasound in Obstetrics and Gynecology 02/2015; DOI:10.1002/uog.14807 · 3.14 Impact Factor
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    ABSTRACT: Objective: To explore corpus callosum (CC) developmental differences by ultrasound in late-onset small fetuses compared with adequate for gestational age (AGA) controls. Study Design: Ninety four small (estimated fetal weight <10th centile) and 71 AGA fetuses were included. Small fetuses were further subdivided into fetal growth restriction (IUGR, n = 64) and small for gestational age (SGA, n = 30) based on poor perinatal outcome factors, that is, birth weight <3rd centile and/or abnormal cerebroplacental ratio and/or uterine artery Doppler. The entire cohort was scanned to assess CC by transvaginal neurosonography obtaining axial, coronal and midsagittal images. CC length, thickness, total area and the areas after a subdivision in 7 portions were evaluated by semiautomatic software. Furthermore, the weekly average growth of the CC in each study group was calculated and compared. Results: Small fetuses showed significantly shorter (small fetuses: 0.49 vs. AGA: 0.52; p < 0.01) and smaller CC (1.83 vs. 2.03; p < 0.01) with smaller splenium (0.47 vs. 0.55; p < 0.01) compared to controls. The CC growth rate was also reduced when compared to controls. Changes were more prominent in small fetuses with abnormal cerebroplacental Doppler suggesting fetal growth restriction. Conclusions: Neurosonographic assessment of CC showed significantly altered callosal development, suggesting in-utero brain reorganization in small fetuses. This data support the potential value of CC assessment by US to monitor brain development in fetuses at risk. © 2015 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 02/2015; DOI:10.1159/000366160 · 2.30 Impact Factor
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    ABSTRACT: Objective To develop the best first trimester screening model for preeclampsia (PE) based on maternal characteristics, biophysical parameters, and angiogenic factors in a low-risk population.MethodsA prospective cohort of 9,462 pregnancies undergoing first-trimester screening. Logistic regression predictive models were developed for early and late PE (cut-off 34 weeks’ gestation at delivery). Data included the a priori risk (maternal characteristics), mean arterial pressure (MAP) and uterine artery (UtA) Doppler (11–13 weeks) in all cases. Plasma levels (8–11 weeks) of hCG, PAPP-A, placental growth factor (PlGF) and soluble Fms-like tyrosine kinase-1 (sFtl-1) was analyzed using a nested case-control study design.ResultsThe best model for early PE (n = 57, 0.6%) included a priori risk, MAP, UtA Doppler, PlGF and sFlt-1 achieving detection rates (DR) of 87.7% and 91.2% for 5% and 10% false-positive rates (FPR), respectively (AUC: 0.98 [95%CI: 0.97-0.99]). For late PE (n = 246, 2.6%), the best model included the a priori risk, MAP, UtA Doppler, PlGF and sFlt-1 achieving DR of 68.3% and 76.4% at 5% and 10% of FPR, respectively (AUC: 0.87 [95%CI: 0.84-0.90]).ConclusionPE can be predicted with high accuracy in general obstetric populations with a low-risk for PE, by combined algorithms. Angiogenic factors substantially improved the prediction. This article is protected by copyright. All rights reserved.
    Prenatal Diagnosis 02/2015; 35(2). DOI:10.1002/pd.4519 · 3.27 Impact Factor
  • American Journal of Obstetrics and Gynecology 01/2015; 212(1):S103. DOI:10.1016/j.ajog.2014.10.223 · 3.97 Impact Factor
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    ABSTRACT: To determine the relationship between fetal brain metabolism and microstructure expressed by brain sulcation, and corpus callosum (CC) development assessed by fetal brain MRI and proton MR spectroscopy ((1)H-MRS). A total of 119 fetuses, 64 that were small for gestational age (estimated fetal weight <10(th) centile and normal umbilical artery Doppler) and 55 controls underwent a 3T MRI/(1)H-MRS exam at 37 weeks. Anatomical T2-w images were obtained in the three orthogonal planes and long echo time (1)H-MRS acquired from the frontal lobe. Head biometrics, cortical fissure depths (insular, sylvian, parietoccipital, cingulate and calcarine) and CC area and biometries were blindly performed by manual and semi-automated delineation using Analyze® software and corrected creating ratios for biparietal diameter (BPD) and frontooccipital diameter (FOD) respectively for group comparison. Spectroscopic data were processed using LC Model® software and analyzed as metabolic ratios of N-Acetylaspartate (NAA) to choline (Cho), Cho to creatine (Cr) and Myo-inositol (Ino) to Cho. Differences between cases and controls were assessed. To test for the association between metabolic ratios and microstructural parameters, bivariate correlation analyses were performed. Spectroscopic findings showed decreased NAA/Cho and increased Cho/Cr ratios in small fetuses. They also presented smaller head biometrics, shorter and smaller CC and greater insular and cingulate depths. Frontal lobe NAA/Cho significantly correlated with BPD (r=0.268;p=0.021), ), head circumference (r=0.259;p=0.026), CC length(r=0.265;p=0.026),CC area (r=0.317;p=0.007), and the area of 6 from the 7 CC subdivisions. It did not correlate with any of the cortical sulcation parameters evaluated. None of the other metabolic ratios presented significant correlations with cortical development or CC parameters. Frontal lobe NAA/Cho levels -which is considered a surrogate marker of neuronal activity- show a strong association with CC development. These results suggest that both metabolic and callosal alterations may be part of the same process of impaired brain development associated with intrauterine growth restriction. Copyright © 2015 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 01/2015; 212(6). DOI:10.1016/j.ajog.2015.01.041 · 3.97 Impact Factor
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    ABSTRACT: Objective: To report the results of fetal cystoscopic laser ablation of posterior urethral valves (PUV) in a consecutive series in two referral centers. Methods: Twenty pregnant women with a presumptive isolated PUV were treated with fetal cystoscopy under local anesthesia. Identification and fulguration of the PUV by one or several firing-contacts with diode laser were attempted. Perinatal and long-term outcomes were prospectively recorded. Results: The median gestational age at procedure was 18.1 weeks (range 15.0-25.6), and median operation time was 24 min (range 15-40). Access to the urethra was achieved in 19/20 (95%) cases, and postoperative, normalization of bladder size and amniotic fluid was observed in 16/20 (80%). Overall, there were 9 (45%) terminations of pregnancy and 11 women (55%) delivered a liveborn baby at a mean gestational age of 37.3 (29.1-40.2) weeks. No infants developed pulmonary hypoplasia and all were alive at 15-110 months. Eight (40% of all fetuses, 72.7% of newborns) had normal renal function and 3 (27.3%) had renal failure awaiting renal transplantation. Conclusion: Fetoscopic laser ablation for PUV can achieve bladder decompression and amniotic fluid normalization with a single procedure in selected cases with anyhydramnios. There is still a significant risk of progression to renal failure pre or postnatally. © 2015 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 01/2015; DOI:10.1159/000367805 · 2.30 Impact Factor
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    ABSTRACT: We report the successful use of fetoscopy to treat a case of severe low urinary tract obstruction (LUTO) secondary to a congenital megalourethra. A second trimester male fetus presented at 21 weeks of gestation with massive dilatation of the penile urethra. In addition, bilateral hydronephrosis, an enlarged and hypertrophic bladder, with progressive oligohydramnios were found, suggesting poor prognosis. Extensive counselling was performed and, after the approval from the local ethics committee and informed consent, patients accepted fetal therapy by fetoscopy. The procedure consisted in fetoscopic identification of the tip of the penis and confirmation of the complete absence of the urethral meatus. Thereafter, under combined endoscopic and ultrasound guidance a perforation of the tip of the penis was performed with contact diode laser, until an opening into the urethra was achieved. After the operation, resolution of the cystic penile dilation, with reduction of the penile size, and normalization of the amniotic fluid volume were observed. The pregnancy continued uneventfully and a normal male infant was born at term at the local hospital. The baby was developing normally with normal renal function at 6 months of age. Our report demonstrates that fetoscopic decompression of a distal urethra obstruction can achieve neonatal survival in the rare event of congenital megalourethra. © 2015 S. Karger AG, Basel.
    Fetal Diagnosis and Therapy 01/2015; DOI:10.1159/000365988 · 2.30 Impact Factor
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    ABSTRACT: Objective To examine whether a first-trimester strategy of secondary prevention for preeclampsia increases anxiety in pregnant women.Methods The anxiety levels of a cohort of women screened for preeclampsia at first trimester were measured by the Spielberg State Anxiety Inventory [STAI-S] and compared between women screened as low and high risk. In a subgroup of women the anxiety levels were additionally measured at second and third trimester. A General Linear Model (GLM) model for repeated measurements was performed to adjust for potential confounders (age, nulliparity and socio-economic level).ResultsA total of 255 women (135 low-risk and 120 high-risk) were evaluated. No differences were found in the mean STAI-S scores between low and high risk women: 35 (SD 9.9) and 34.6 (SD 10.1) (p = 0.77). The proportion of women with high anxiety was not significantly different between groups (28/134[20.7%]vs.24/120 [20%]; p = 0.88). No differences were found in the subgroups (51 low-risk and 50 high-risk) in which the anxiety levels were also measured at second and third trimester: 35.8 (SD 8.8)vs.35.2 (SD9.7) [p = 0.74] and 37.2 (SD 9.4)vs.35.3 (SD 8.6) [p = 0.3]. These differences remained non-significant after adjustment for potential confounders.ConclusionA strategy of first-trimester screening for preeclampsia does not increase maternal anxiety. This article is protected by copyright. All rights reserved.
    Prenatal Diagnosis 01/2015; 35(1). DOI:10.1002/pd.4485 · 3.27 Impact Factor
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    ABSTRACT: Background Intrauterine growth restriction (IUGR) induces fetal cardiac remodelling and dysfunction, which persists postnatally and may explain the link between low birth weight and increased cardiovascular mortality in adulthood. However, the cellular and molecular bases for these changes are still not well understood. We tested the hypothesis that IUGR is associated with structural and functional gene expression changes in the fetal sarcomere cytoarchitecture, which remain present in adulthood. Methods and Results IUGR was induced in New Zealand pregnant rabbits by selective ligation of the utero-placental vessels. Fetal echocardiography demonstrated more globular hearts and signs of cardiac dysfunction in IUGR. Second harmonic generation microscopy (SHGM) showed shorter sarcomere length and shorter A-band and thick-thin filament interaction lengths, that were already present in utero and persisted at 70 postnatal days (adulthood). Sarcomeric M-band (GO: 0031430) functional term was over-represented in IUGR fetal hearts. Conclusion The results suggest that IUGR induces cardiac dysfunction and permanent changes on the sarcomere.
    PLoS ONE 11/2014; 9(11):e113067. DOI:10.1371/journal.pone.0113067 · 3.53 Impact Factor
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    ABSTRACT: Congenital diaphragmatic hernia (CDH) may be isolated or associated with other structural anomalies, the latter with poor prognosis. The defect allows viscera to herniate through the defect into the chest, competing for space with the developing lungs. At birth, pulmonary hypoplasia leads to respiratory insufficiency and persistent pulmonary hypertension that is lethal in up to 30% of patients. When isolated, survival chances can be predicted by antenatal measurement of lung size and liver herniation. Chromosomal microarrays and exome sequencing contribute to understanding genetic factors underlying isolated CDH. Prenatal intervention aims at stimulating lung development, clinically achieved by percutaneous fetal endoscopic tracheal occlusion (FETO) under local anesthesia. The Tracheal Occlusion To Accelerate Lung growth trial (www.totaltrial.eu) is an international randomized trial investigating the role of fetal therapy for severe and moderate pulmonary hypoplasia. Despite an apparent increase in survival following FETO, the search for lesser invasive and more potent prenatal interventions must continue. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Seminars in Fetal and Neonatal Medicine 11/2014; DOI:10.1016/j.siny.2014.09.006 · 3.13 Impact Factor

Publication Stats

6k Citations
1,900.82 Total Impact Points


  • 2014–2015
    • Hospital Sant Joan de Déu
      Barcino, Catalonia, Spain
  • 1993–2015
    • University of Barcelona
      • Department of Obstetrics and Gynecology, Pediatrics, Radiology and Anatomy
      Barcino, Catalonia, Spain
  • 2009–2014
    • Centro de Investigación Biomédica en Red de Enfermedades Raras
      Valenza, Valencia, Spain
  • 2006–2014
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 1994–2014
    • Hospital Clínic de Barcelona
      • Servicio de Medicina Materno Fetal
      Barcino, Catalonia, Spain
  • 2008–2012
    • Instituto de Salud Carlos III
      Madrid, Madrid, Spain
  • 2011
    • IDIBELL Bellvitge Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 2005–2010
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 2002–2009
    • Universitair Ziekenhuis Leuven
      • Department of Gynaecology and obstetrics
      Louvain, Flemish, Belgium
  • 2001–2009
    • University Hospital Vall d'Hebron
      • Department of Obstetrics
      Barcino, Catalonia, Spain
      Ayrivan, Yerevan, Armenia
  • 2002–2008
    • Autonomous University of Barcelona
      • Department of Biochemistry and Molecular Biology
      Cerdanyola del Vallès, Catalonia, Spain
  • 2006–2007
    • Southern Medical Clinic
      San Fernando, City of San Fernando, Trinidad and Tobago
  • 2004
    • University of Rochester
      Rochester, New York, United States
  • 1999–2001
    • KU Leuven
      • Faculty of Medicine
      Leuven, VLG, Belgium
  • 2000
    • University of Milan
      Milano, Lombardy, Italy