Josep Maria Martinez

IDIBAPS August Pi i Sunyer Biomedical Research Institute, Barcino, Catalonia, Spain

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Publications (12)18.68 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Congenital diaphragmatic hernia (CDH) is a severe congenital birth defect, which is commonly associated with genetic abnormalities and malformations in other systems. Once the diagnosis is made, there should be a thorough evaluation to confirm that the malformation is isolated, as well as an assessment of prognostic factors, essentially lung size and liver herniation. With these parameters an individualized and relatively accurate prognosis can be offered to parents. Management options include termination of pregnancy, conservative prenatal management and post-natal treatment, or fetal therapy. Fetal therapy consists of fetal endoscopic tracheal occlusion (FETO) and is offered in a small number of centers worldwide. Available evidence suggests that prenatal treatment might increase the chances of survival by 35-40% compared with baseline survival. Several randomized trials are now underway to assess the impact of therapy on very severe and moderate cases of CDH.
    Diagnóstico Prenatal. 01/2012; 23(3):126–133.
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    ABSTRACT: Objective To evaluate the perinatal outcome in the 500 consecutive cases of severe twin-twin transfusion syndrome (TTTS) treated in a single centre with fetoscopic laser coagulation.Material and methodsA prospective study including 500 cases of severe TTS treated with laser therapy as a first option. Main outcome measures were survival, perinatal outcome, obstetrical complications and rate of neurological damage at 6-12 months of life.ResultsMean gestational age at therapy was 19.4 weeks (range 15.0-31.4). The placenta was anterior in 48% (n = 240) of the cases. The rate of conversion to cord occlusion was 1.2% (6/500). Overall neonatal survival was 74.8% (748/1,000), with at least one survivor in 91.6% (458/500). Mean duration of surgery was 29.4 min (range 9-64). There were no cases of intra- or post-operative abruptio placenta or chorioamnionitis. TTTS persisted in 2 cases (0.4%) and TAPS occurred in 8 (1.6%). Premature rupture of membranes (PROM) at < 32 weeks occurred in 32 cases (6.4%). Mean gestational age at delivery was 33.6 weeks (26.4-38.5), with 92% beyond 28 weeks. Mean birth-weight was 1,920 g (range 680-3,660) in recipients and 1,615 g (range 440-2,530) in donors. Severe neurological damage was observed in 6.4%.Conclusions In this large consecutive series of TTTS treated by fetoscopy in the same centre, results lie in the high range of those previously reported. Fetoscopic laser coagulation of the placental anastomosis is a safe therapy and offers consistent results in centres with experience.
    Diagnóstico Prenatal. 01/2012; 23(3):102–108.
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    ABSTRACT: Monochorionic twin pregnancy (MC) occurs in one in 250 pregnancies and represents a significant proportion of perinatal morbidity and mortality in twin pregnancies, and in general. The optimal management of MC is based on two fundamental aspects: early classification of chorionicity and close monitoring. The differential diagnosis of the complications of MC is still a challenge to the fetal medicine specialist. This is due to the frequent overlap of clinical signs and the complex relationships between the potential complications. However, the differential diagnosis and subsequent decisions are based on relatively simple rules. While some cases can be really complicated, clinical experience shows that in most cases proper classification and management can be achieved through the consistent use of simple concepts. This review provides an overview that allows a comprehensive understanding of MC twin pregnancies, the typical complications and the key concepts that allow an appropriate differential diagnosis and specific management.
    Diagnóstico Prenatal. 01/2012; 23(3):93–101.
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    ABSTRACT: Selective intrauterine growth restriction (sIUGR) in monochorionic twins is associated with a substantial increase in perinatal mortality and morbidity for both twins. Clinical evolution depends on the combination of the effects of placental insufficiency in the IUGR twin with inter-twin blood transfer through placental anastomoses. Classification of sIUGR into types according to the characteristics of umbilical artery diastolic flow in the IUGR twin permits the differentiation of clinical and prognostic groups. sIUGR type I has normal diastolic flow and relatively good outcome. Type II is defined by persistently absent/reverse end-diastolic flow and is associated with a high risk of intrauterine demise of the IUGR twin and/or very preterm delivery. Type III is defined by the presence of intermittent absent/reverse end-diastolic flow (iAREDF), and is associated with 10-20% risk of unexpected fetal demise of the smaller twin and 10-20% risk of neurological injury in the larger twin. The management strategy for sIUGR with abnormal umbilical artery Doppler (types II and III) remains a challenge, and may include elective fetal therapy or close surveillance with fetal therapy or elective delivery in the presence of severe fetal deterioration. Small clinical series reporting the use of cord occlusion or laser therapy in severe cases suggest that the outcome of the larger twin might be improved. There is probably no single optimal strategy, since decisions will ultimately be influenced by the severity of IUGR, gestational age, parents' wishes and technical issues.
    Seminars in Fetal and Neonatal Medicine 12/2010; 15(6):342-8. · 3.51 Impact Factor
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    ABSTRACT: Selective intrauterine growth restriction (sIUGR) occurs in 10 to 15% of monochorionic (MC) twins, and it is associated with a substantial increase in perinatal mortality and morbidity. Clinical evolution is largely influenced by the existence of intertwin placental anastomoses: pregnancies with similar degrees of fetal weight discordance are associated with remarkable differences in clinical behavior and outcome. We have proposed a classification of sIUGR into three types according to umbilical artery (UA) Doppler findings (I-normal, II-absent/reverse end-diastolic flow, III-intermittent absent/reverse end-diastolic flow), which correlates with distinct clinical behavior, placental features and may assist in counseling and management. In terms of prognosis, sIUGR can roughly be divided in two groups: type I cases, with a fairly good outcome, and types II and III, with a substantial risk for a poor outcome. Management of types II and III may consist in expectant management until deterioration of the IUGR fetus is observed, with the option of cord occlusion if this occurs before viability. Alternatively, active management can be considered electively, including cord occlusion or laser coagulation. Both therapies seem to increase the chances of intact survival of the larger fetus, while they entail, or increase the chances of, intrauterine demise of the IUGR fetus.
    Prenatal Diagnosis 08/2010; 30(8):719-26. · 2.68 Impact Factor
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    ABSTRACT: To evaluate cardiac function by tissue Doppler imaging vs conventional echocardiography in intrauterine growth restriction. A prospective study in 25 intrauterine growth restriction, and in 50 normally grown fetuses between 24 and 34 weeks. Conventional echocardiography (E/A ratios, outflow tract velocities and myocardial performance index), and tissue Doppler (myocardial peak velocities, E'/A' ratios and myocardial performance index') measurements were performed. With conventional echocardiography, intrauterine growth restriction fetuses showed an increase in left myocardial performance index but similar values of E/A ratios, outflow tract velocities and right myocardial performance index as compared with controls. Tissue Doppler imaging demonstrated that intrauterine growth restriction fetuses had significantly lower systolic and diastolic myocardial velocities in mitral and tricuspid annulus, higher mitral E'/A' ratio and higher mitral, tricuspid and septal myocardial performance index' values. Tissue Doppler imaging demonstrated the presence of both systolic and diastolic cardiac dysfunction in intrauterine growth restriction. Tissue Doppler imaging may constitute a more sensitive tool than conventional echocardiography to evaluate cardiac dysfunction in intrauterine growth restriction.
    American journal of obstetrics and gynecology 05/2010; 203(1):45.e1-7. · 3.28 Impact Factor
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    ABSTRACT: To assess the impact of lung perfusion by fractional moving blood volume (FMBV) for the prediction of survival in fetuses with congenital diaphragmatic hernia (CDH) treated with fetal endoscopic tracheal occlusion (FETO). Lung perfusion by FMBV (%) and the observed/expected lung-to-head ratio (o/e LHR) were evaluated 1 day before and 7-14 days after FETO in a cohort of 62 CDH fetuses, and their isolated and combined values to predict survival was assessed. Preoperative lung perfusion did not show association with survival. However, after FETO, an increase in 30% of the preoperative lung FMBV and an increase in 50% of the LHR was significantly associated with the probability of survival. A model combining the changes in FMBV and o/e LHR after therapy allowed discrimination of cases with poor (10% survival), moderate (40-70% survival) and very good prognosis (100% survival). Changes in lung tissue perfusion, evaluated by FMBV after FETO, improved the prediction of survival in fetuses with CDH.
    Fetal Diagnosis and Therapy 03/2010; 29(1):101-7. · 1.90 Impact Factor
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    ABSTRACT: To assess the intra- and interobserver reliability of the umbilical vein (UV) diameter, time-averaged maximum velocity (TAMX) and umbilical vein blood flow (BF). Sixty-three consecutive singleton pregnancies between 24 and 42 weeks were evaluated by two independent operators. UV diameter and TAMX were measured. UV flow was calculated as UV area x 60 x TAMX x 0.5. Reliability analyses were performed by means of the intraclass correlation coefficient (ICC) for agreement. Differences between and within observers were explored and agreement limits calculated by means of the Bland-Altman test. Satisfactory Doppler parameters were successfully obtained from all fetuses. The intraobserver ICCs for UV diameter, TAMX, and BF were 0.7, 0.59, and 0.55, respectively, whereas the interobserver ICCs were 0.65, 0.46, and 0.60, respectively. The 95% confidence intervals of the intraobserver differences were (+0.15, -0.14), (+8.0, -7.9), and (+150, -138.7), respectively. The 95% confidence intervals of the interobserver differences were (+0.16, -0.16), (+8.5, -8.2), and (+138.8, -141.9), respectively. Noninvasive Doppler calculation of umbilical vein blood flow and its components are reliable enough for clinical use.
    Prenatal Diagnosis 10/2008; 28(11):999-1003. · 2.68 Impact Factor
  • American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/2007; 197(6).
  • American Journal of Obstetrics and Gynecology - AMER J OBSTET GYNECOL. 01/2007; 197(6).
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    ABSTRACT: To analyse the inter-observer and inter-artery reliability of the umbilical artery (UA) pulsatility index (PI) at different sampling sites. One hundred consecutive singleton pregnancies between 24 and 40 weeks were included. The PI was calculated by two independent operators from both umbilical arteries at the placental end, at a free-floating loop and at the perivesical segment. Reliability analyses were performed between observers and between arteries at each sampling site. The mean percentage of PI difference between arteries was 15.2, 14.5 and 22% at the placental end, free-loop and perivesical site, respectively. The Intraclass correlation coefficients at each site were 0.51, 0.59 and 0.67, respectively. Whereas about 20% of cases showed a percentage of PI difference between arteries greater than 20% at free-loop and placental end sites, and at the perivesical site this figure was 45%. The perivesical sampling site for UA PI calculation is more reliable than at a free-floating loop, albeit without significance, and is significantly more reliable than at the placental end of the umbilical cord. Since discordances in PI between both arteries are more pronounced at the perivesical site, it seems mandatory to evaluate both arteries in this segment.
    Journal of Perinatal Medicine 02/2006; 34(5):409-13. · 1.95 Impact Factor
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    ABSTRACT: To report a successful selective feticide in a complicated monochorionic monoamniotic (MCMA) pregnancy. A case of MCMA pregnancy with severe twin-twin transfusion syndrome and discordant for hypoplastic left heart syndrome was diagnosed at 16 weeks' gestation. A complete ultrasound and fetoscopic surveillance was performed, ruling out cord entanglement and, thus, precluding the necessity of transecting the cord. The selective feticide was successfully performed by bipolar coagulation of the umbilical cord of the abnormal fetus under ultrasound guidance. The survivor twin developed normally during the rest of the pregnancy and was born at term. At 6 months of age, the infant was healthy. Selective feticide in complicated monoamniotic pregnancies can be safely performed. Cord entanglement can be confidently excluded by both ultrasound and fetoscopy, thus making the systematic transection of the umbilical cord unnecessary.
    Prenatal Diagnosis 01/2006; 25(13):1223-5. · 2.68 Impact Factor

Publication Stats

42 Citations
18.68 Total Impact Points

Institutions

  • 2012
    • IDIBAPS August Pi i Sunyer Biomedical Research Institute
      Barcino, Catalonia, Spain
  • 2010–2012
    • Centro de Investigación Biomédica en Red de Enfermedades Raras
      Valenza, Valencia, Spain
    • University of Barcelona
      • Department of Obstetrics and Gynecology, Pediatrics, Radiology and Anatomy
      Barcino, Catalonia, Spain