Introducción y objetivos: La fuga paravalvular (FPV) mitral se asocia con hemólisis e insuficiencia cardiaca, y con alteraciones del factor de von Willebrand que prolongan el tiempo de obturación con difosfato de adenosina (TO-DFA). Se evaluó si este puede servir como biomarcador para el diagnóstico, seguimiento y pronóstico tras la reparación de la FPV mitral.Métodos: Se incluyó prospectivamente a 89 pacientes (27 con FPV mitral moderada-grave remitidos para cierre, grupo 1; 31 con prótesis mitral sin FPV, grupo 2, y 31 controles sin enfermedad valvular, grupo 3). Se evaluaron marcadores de hemólisis y congestión, y el TO-DFA. Se sometió a los pacientes con FPV a reparación, y se les siguió durante 3 y 12 meses. Se utilizaron análisis ROC, regresión lineal y modelos de Cox para evaluar el valor diagnóstico y pronóstico del TO-DFA.Resultados: El TO-DFA se prolongó en pacientes con FPV mitral (mediana de 214 segundos) frente a los grupos control (86 segundos en el grupo 2 y 74 en el 3; p < 0,001). Un TO-DFA > 135 segundos mostró una excelente precisión diagnóstica (AUROC = 0,96; sensibilidad del 89% y especificidad del 97%). Tras una reparación exitosa, el TO-DFA posprocedimiento disminuyó significativamente (reducción mediana de 79 semanas) y permaneció sin cambios en presencia de fugas residuales. Valores posprocedimiento > 155 segundos identificaron FPV persistente y se asociaron con peores resultados al año (HR = 21,37; p = 0,004), incluyendo muerte, reingreso por insuficiencia cardiaca o hemólisis, o reintervención.Conclusiones: El TO-DFA podría ser un biomarcador prometedor para el diagnóstico y seguimiento de la FPV mitral, y aportar valor pronóstico tras su reparación.

Research question: Does trophectoderm biopsy for preimplantation genetic testing for aneuploidies (PGT-A) affect maternal serum first-trimester pregnancy biomarkers (pregnancy-associated plasma protein A [PAPP-A], free beta-HCG and placental growth factor [PIGF])? Design: Retrospective cohort study of all singleton pregnancies (n = 9794) after naturally conceived (n = 8005) IVF and fresh embryo transfers (n = 478), frozen embryo transfer of non PGT-A (FET) (n = 963) or PGT-A tested embryos (FET + PGT-A) (n = 348). Serum levels of free beta-HCG and PAPP-A were measured in all women with a viable pregnancy at 8-13.6 weeks of pregnancy; PIGF was measured in 3784 women. Biomarkers were converted to a multiple of the expected normal median (MOM) for a pregnancy of the same gestational day. The medians for the multiple of the median were calculated and compared. Results: Free beta-HCG did not differ according to mode of conception. The PAPP-A concentrations were significantly lower in IVF and fresh embryo transfers (-0.1 Log10 MOM raw PAPP-A) compared with FET + PGT-A (-0.04 Log 10 MOM raw PAPP-A, P = 0.009) and natural conceptions (-0.0187 Log 10 MOM raw PAPP-A) (P < 0.001). The PIGF levels were significantly lower in the FET + PGTA group versus natural conception (P = 0.001). Difference in means adjusted by crown rump length was 4.6 pg/ml (95% CI 2.7 to 6.6) for natural conceptions, 3.5 pg/ml (95% CI 0.34 to 6.6) for IVF and 2.2 pg/ml (95% CI 0.06 to 4.4) for FET. Conclusion: Trophectoderm biopsy for PGT-A has a significant effect on first-trimester maternal serum PAPP-A and PIGF. This needs to be further validated, as it may mislead the estimation of the first-trimester risk of aneuploidies and pre-eclampsia.

OBJECTIVES:To determine the prevalence of abnormalities of the corpus callosum (AbnCC) in a non-selected population, to propose a systematic screening protocol for AbnCC in all populations through direct assessment, and to describe the follow-up and prognosis of all AbnCC cases diagnosed in our clinical setting. METHODS:This was a retrospective review of the prevalence of AbnCC over 11 years. We included a sagittal assessment of the corpus callosum (CC) in the second-trimester scan. AbnCC was classified into complete agenesis of CC (ACC) and dysgenesis of CC (DCC; including small, partial agenesis, thick and with lipoma). RESULTS:Of the 38,586 second-trimester scans performed during our screening, 43 cases of AbnCC were detected (prevalence of 0.8/1000). Of the AbnCC cases, 10 cases were identified as ACC (29.40%) and 24 as DCC (70.59%). Follow-up investigations showed that in the 43 cases with AbnCC, 76.5% had other associated ultrasound abnormalities, 26.5% had genetic abnormalities, 11.8% had other MRI abnormalities, and 25% of the children had neurodevelopmental delays (8.8% of the total), which were severe in only one case. CONCLUSIONS:AbnCC is found in approximately 0.8/1000 of cases in an unselected population. The findings suggest that systematic and direct assessment of the CC as part of screening ultrasound in the second trimester of gestation should be recommended as a routine practice.

BACKGROUND: Fetal cardiology has shown a rapid development in the past decades. Fetal echocardiography is not only used for the detection of structural anomalies but also to assess fetal cardiac function. Assessment of the fetal cardiac function is performed mostly in the second and third trimesters. The study of fetal cardiac function at the end of first trimester has not been investigated properly, and there is a lack of reference values at early gestational weeks. OBJECTIVE: This study aimed to assess if the measurement of time-related parameters of cardiac function in the left ventricle of the fetal heart is feasible and reproducible at the end of the first trimester. If possible, we provide nomograms of these parameters from 11 to 13+6 gestational weeks. STUDY DESIGN: We conducted a prospective observational study from March to September 2022. The study was carried out in 2 hospitals (Hospital Universitari Dexeus, Barcelona, and Hospital VITAHS 9 Octubre, Valencia, Spain). The scans were performed by 3 specialists in fetal medicine. The exclusion criteria were fetal cardiac rhythm abnormalities, abnormal nuchal translucency, abnormal ductus venosus, fetal malformations, stillbirth, estimated fetal weight <10 percentile, diabetes, and gestational hypertensive disorders. The cardiac function parameters studied in the left ventricle were isovolumetric contraction time, isovolumetric relaxation time, ejection time, filling time, cycle time, myocardial performance index, ejection time fraction, and filling time fraction. We study the feasibility and intra- and interobserver reproducibility of these parameters using the interclass correlation coefficient. Nomograms were created and the percentiles of the values of the different parameters were calculated. RESULTS: A total of 409 cases were recruited but only 296 could be included in the statistical analysis once the exclusion criteria were applied. The intraobserver reproducibility study was excellent (interclass correlation coefficient >0.900), and the interobserver reproducibility study was good (interclass correlation coefficient >0.700). The data regression analysis showed that cycle time, filling time, isovolumetric contraction time, and filling time fraction increased with gestational age, whereas ejection time fraction decreased with gestational age and myocardial performance index (mean, 0.43±0.08), isovolumetric relaxation time (mean, 0.04±0.01), and ejection time (mean, 0.16±0.01) remained constant from 11 to 13 weeks. CONCLUSION: The study of fetal cardiac function is feasible and reproducible at 11 to 13+6 gestational weeks. Nomograms of the studied parameters are provided.

The authors aimed to compare cross‐sectional versus longitudinal models for prediction of small‐for‐gestational age (SGA) neonates among pregnancies with high risk of early pre‐eclampsia (PE).

Succinate is enhanced during initial reperfusion in blood from the coronary sinus in ST-segment elevation myocardial infarction (STEMI) patients and in pigs submitted to transient coronary occlusion. Succinate levels might have a prognostic value, as they may correlate with edema volume or myocardial infarct size. However, blood from the coronary sinus is not routinely obtained in the CathLab. As succinate might be also increased in peripheral blood, we aimed to investigate whether peripheral plasma concentrations of succinate and other metabolites obtained during coronary revascularization correlate with edema volume or infarct size in STEMI patients. Plasma samples were obtained from peripheral blood within the first 10 min of revascularization in 102 STEMI patients included in the COMBAT-MI trial (initial TIMI 1) and from 9 additional patients with restituted coronary blood flow (TIMI 2). Metabolite concentrations were analyzed by 1H-NMR. Succinate concentration averaged 0.069 ± 0.0073 mmol/L in patients with TIMI flow ≤ 1 and was significantly increased in those with TIMI 2 at admission (0.141 ± 0.058 mmol/L, p < 0.05). However, regression analysis did not detect any significant correlation between most metabolite concentrations and infarct size, extent of edema or other cardiac magnetic resonance (CMR) variables. In conclusion, spontaneous reperfusion in TIMI 2 patients associates with enhanced succinate levels in peripheral blood, suggesting that succinate release increases overtime following reperfusion. However, early plasma levels of succinate and other metabolites obtained from peripheral blood does not correlate with the degree of irreversible injury or area at risk in STEMI patients, and cannot be considered as predictors of CMR variables.Trial registration: Registered at www.clinicaltrials.gov (NCT02404376) on 31/03/2015. EudraCT number: 2015-001000-58.

Purpose: We evaluated the obstetrical outcomes, ultrasonographic characteristics, and final diagnosis in pregnancies with fetal megacystis (FM). Methods: We evaluated the obstetrical outcomes and associated structural abnormalities of fetuses with FM detected between FM between 2000 and 2021. Results: 17 FM were diagnosed, 16 had follow up. 16 were early megacystis. 14/16 (87.5%) of pregnancies were terminated, 1/16 (6.25%) resulted in intrauterine death, and 1/16 (6.25%) survived. FM was associated with 13 other abnormal sonographic findings in 12/16 (75%) pregnancies. The most common associated ultrasound abnormality was umbilical cord cyst in 3/16 (18.75%). Recognized etiologies included posterior urethral valves (2), trisomy 18 (2), trisomy 13 (1), Prune Belly syndrome (1), and Megacystis-Microcolon-Hypoperistalsis syndrome (1). Conclusion: Most FM are detected in the 2nd trimester, most are electively terminated, are associated with other ultrasonic abnormalities in 75%, most commonly umbilical cord cyst, and have an identifiable cause in 44%.

BACKGROUND:Percutaneous mitral paravalvular leak (PVL) closure techniques are an effective and safe alternative to surgical treatment, but data regarding long-term outcomes are scarce. We aim to describe the impact of successful percutaneous mitral PVL closure on long-term outcomes. METHODS:All consecutive patients in whom a first-attempt percutaneous mitral PVL closure was performed in a single tertiary centre between January 2010 and October 2021 were included. Clinical variables, procedural details, and procedural success were collected. Patients were classified based on procedural success, defined as no more than mild residual leak. All-cause mortality was the primary endpoint. Cardiovascular death and heart failure hospitalizations (HFHs) were key secondary endpoints. RESULTS:Ninety patients (median age 72.5 years [66.0-78.4]; median EuroSCORE-II 8.2 [5.3-12.46]) were included. Although reduction of at least 1 degree in PVL severity was achieved in 82 (91.1%), procedural success was achieved in 47 (52.2%). Chronic kidney disease, previous surgery for PVL, and the presence of multiple jets were independently associated with procedural failure. After a median follow-up of 3.2 (1.2-5.2) years, mortality rate was higher in the procedural failure group (27.3 per 100 patients-years) compared with the group with successful closure (8.2 per 100 patient-years). Procedural failure was associated with all-cause death (adjusted hazard ratio [aHR], 2.59; 95% confidence interval [CI], 1.41-4.78), cardiovascular death (aHR, 3.53; 95% CI, 1.67-7.49) and HFH (aHR, 3.27; 95% CI,1.72-6.20). CONCLUSIONS:A successful reduction in PVL to mild or absent is associated with improved rates of all-cause death, cardiovascular death, and HFHs.

Research question: How does first-trimester aneuploidy screening perform in pregnancies achieved through IVF with preimplantation genetic testing for aneuploidy (PGT-A) in a medical setting? Design: This retrospective cohort study was undertaken in a single tertiary care centre between January 2013 and June 2022. In total, 20,237 women had prenatal follow-up at the study centre and were included in the study. The women were divided into three groups: singleton pregnancies conceived through the transfer of a PGT-A-screened euploid embryo (n = 510); singleton pregnancies conceived through IVF without PGT-A (n = 3291); and singleton pregnancies conceived naturally (n = 16,436). Results: The conventional combined screening test for pregnancies conceived through IVF with PGT-A had specificity of 91%; sensitivity could not be calculated as there were no cases of fetal aneuploidy in this group. In 89.1% of pregnancies conceived through IVF with PGT-A with high risk for trisomy 21, 18 or 13, the result was related to advanced maternal age (>35 years at time of screening). Conclusions: The current screening strategy for trisomies 21, 18 and 13 can generate unnecessary tests in pregnancies achieved through IVF with PGT-A. A new protocol is needed for these patients, with greater weight given to ultrasound markers.

Prevalence of cannabis use disorder among pregnant people who

Backgroundincomplete strut coverage determines the risk of stent thrombosis in the first months after stent implantation.AimsTo evaluate the potential better early healing of a novel probucol coated polymer free ultra-thin strut sirolimus eluting stent (PF-SES). [Clinical trial unique identifier: NCT02785237].MethodsPatients with two (angiographically similar) lesions with clinical indication for PCI were enrolled. The investigated stent was compared to a thin strut, bioresorbable polymer, sirolimus eluting stent (BP-SES). Every patient received both stents, one in each lesion, assigned in a randomized sequence. OCT was systematically performed at 3 months.Primary end point was the difference in the proportion of covered struts at 3 months (defined as ≥20 μm of tissue coverage). Secondary end points included differences in percentage of uncovered struts (0 μm coverage), mean strut coverage thickness, and malapposed struts' coverage proportion. Major adverse cardiac events (cardiac death, myocardial infarction, target lesion revascularization, and definite or probable stent thrombosis) at 12 months were also evaluated.Results70 patients were included. At 3 months, a consistent and significantly higher strut coverage rate (≥20 μm) was observed in PF-SES as compared to BP-SES, both for well apposed (87.3% versus 79.1%, p < 0.001) and malapposed struts (50.4% vs 37.8%, p 0.00). Uncoverage rate (0 μm) was also significantly lower for the PF-SES (3.1% vs 5.3%, p < 0.001). There were no differences in clinical endpoints.ConclusionThe probucol coated non-polymeric ultra-thin strut sirolimus eluting stent showed a significantly better early strut coverage at 3 months.

BACKGROUND:TiNO-coated BAS have demonstrated competitive outcomes compared to drug-eluting stents (DES). These devices allow short antiplatelet regimens and may be a good option for the growing elderly population undergoing percutaneous coronary intervention (PCI). METHODS:Multicenter observational trial in routine clinical practice. A propensity-score matched analysis compared a prospective cohort of patients ≥ 75 years undergoing PCI with BAS, with a contemporary and retrospective cohort treated with last-generation DES. The co-primary endpoints of the study were the Target-Lesion-Failure (Cardiac death, non-fatal myocardial infarction, or target lesion revascularization) and Major Adverse Cardiovascular Events (total death, non-fatal myocardial infarction, stroke, or new revascularization) at 1 year. RESULTS:Whole population included 1000 patients, and 326 patients in each group were matched for analysis. No differences in primary endpoints were found: TLF 10.4% vs. 11% (HR 0.96 (Confidence Interval 95%, 0.36-1.7; p = 0.87)) and MACE 16.3% vs. 17.2% (HR 0.98 (Confidence Interval 95%; 0.3-1.5, p = 0.93)). Patients treated with BAS received shorter antiplatelets regimens (dual antiplatelet therapy at 1 year, 25.7% vs. 70.6%, p = 0.0001), and they presented lower incidence of bleeding (3.7% vs. 11.7%, HR 0.3 (IC 95% 0.16-0.6, p = 0.001)). CONCLUSION:In this real-life registry of patients ≥ 75 years, BAS were similar to the latest-generation DES in terms of efficacy and reduced the duration of the antithrombotic therapy, lowering bleeding events.

This practice guideline follows the mission of the World Association of Perinatal Medicine (WAPM) in collaboration with the Perinatal Medicine Foundation (PMF), bringing together groups and individuals throughout the world with the goal of improving the use of antenatal corticosteroids (ACS) for fetal maturation. In fact, this document provides further guidance for healthcare practitioners on the appropriate use of ACS with the aim to increase the timely administration and avoid unnecessary or excessive use. Therefore, it is not intended to establish a legal standard of care. This document is based on consensus among perinatal experts throughout the world and also serves as a guideline for use in clinical practice.

This statement follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation, bringing together groups and individuals throughout the world with the goal of improving the use of antenatal corticosteroids (ACS) for fetal maturation in Coronavirus Disease 2019 (COVID-19). Pregnant women with COVID-19 are at increased risk of hospitalization, admission to intensive care unit and mechanical ventilation compared to non-pregnant patients. Thus, obstetricians may face the dilemma of initiating maternal corticosteroid therapy for maternal indication while weighing its potential adverse effects on the fetus. As there is no evidence on the effect of betamethasone in pregnant women with COVID-19, dexamethasone should be preferably used for fetal maturation, if available. As a recommendation, for pregnant women with COVID-19 who are oxygen dependent or under mechanical ventilation and meet the criteria for ACS, the usual doses of dexamethasone should be administered, followed by oral prednisolone 40 mg OD or intravenous hydrocortisone 80 mg BD for up to 10 days.

BACKGROUND: The rate of twin pregnancies conceived via assisted reproductive technology has increased markedly in recent years. The elevated number of multiple pregnancies is the most serious and frequent complication of assisted reproductive technology. Twin pregnancies are associated with higher rates of obstetrical complications, preterm delivery, and perinatal morbidity and mortality than singleton pregnancies. OBJECTIVE: This study aimed to investigate the association between the mode of conception and obstetrical and perinatal outcomes in twin pregnancies, adjusting for parity, age, and chorionicity. STUDY DESIGN: This was a retrospective cohort study of 1135 twin pregnancies between May 2006 and April 2021. All spontaneous (n=369) and assisted reproductive technology-conceived (n=766) twin pregnancies with antenatal care and delivery in the Universitari QuironDexeus Hospital, Barcelona, Spain, a tertiary obstetrical care center, were studied according to chorionicity. RESULTS: The mean maternal age was higher among assisted reproductive technology twin pregnancies than among naturally conceived ones, and there were also less parous women in the assisted reproductive technology twin group. The global survival rates in both groups of twins were practically identical, namely 744 of 766 (97.1%) assisted reproductive technology twins and 357 of 369 (96.8%) spontaneously conceived twins. Patients with dichorionic assisted reproductive technology twins had a higher incidence of gestational diabetes (relative risk, 1.69; 95% confidence interval, 1.10-2.59) and gestational hypertension or preeclampsia (relative risk, 2.75; 95% confidence interval, 1.60-4.729). Monochorionic diamniotic assisted reproductive technology twins had a higher risk for gestational diabetes (relative risk, 4.12; 95% confidence interval, 1.35-12.56). We analyzed the gestational age at delivery, onset of labor, type of delivery, rate of preterm births, weight discordance, rate of small for gestational age neonates and intrauterine growth restriction, and admission to the neonatal intensive care unit. We could not find any statistical differences between monochorionic diamniotic assisted reproductive technology twins and spontaneously conceived twins. Among dichorionic twins, those conceived by assisted reproductive technology had an earlier gestational age at delivery (36.3 +/- 2.29 vs 36.6 +/- 2; P<.05) and we found statistical differences in the onset of labor with more cesarean deliveries (relative risk, 1.27; 95% confidence interval, 1.06 -1.51). When adjusting for cofounding factors (maternal age, parity, chorionicity), the type of conception remained an independent risk factor for gestational hypertension and preeclampsia but not for gestational diabetes or cesarean delivery. CONCLUSION: Pregnancy outcomes are comparable between assisted reproductive technology and spontaneously conceived twins, and when adjusted for confounding factors, only the risk for gestational hypertension and preeclampsia remained increased in the assisted reproductive technology group.

Twin pregnancies are at increased risk of growth restriction and their growth pattern is likely to be different when we compare with singletons. The aim of this study is to create a customised growth chart based on longitudinal data applied to singleton and twin pregnancies. All consecutive pregnancies enrolled before 12 weeks of pregnancy attending Hospital Universitario Dexeus during the period 2010-2018 were included. All pregnancies were dated by ultrasound (CRL). The standard biometric measurements were included: (DBP, HC, AC and FL). The Estimated Fetal weight was calculated using Hadlock formula. The scans were performed between 19 and 37 weeks. A mixed linear model was adjusted to analyse fetal growth according to the types of pregnancy, maternal age, gestational age, mother's weight at the beginning of pregnancy, fetal sex and the interaction between gestational age and the type of pregnancy as fixed effects. 20,262 pregnancies were included: 19,515 singletons, 663 dichorionic and 84 monochorionic. Total number of 21000 fetuses and 84,348 ultrasound exams. The significant variables included in the model were age, type of gestation, maternal weight, gestational age and gender. The slope of the curve (growth velocity) was lower in both twin groups and this drop started before 30 weeks (7% difference in median) and reached 10 % at term, regarding monochorionic the drop difference was even higher 10 and 12 % respectively. There is also a significant difference according to fetal gender, the male fetuses have a 2.5% more weight than the females. When we reach term the misclassification of growth restriction can be as high as 40 % of the twin cases if we use singleton growth charts. Twin pregnancies have a different growth pattern compared to singletons. The difference in growth velocity appears before 30 weeks and it becomes more pronounced reaching term. Maternal parameters such age, and weight and fetal parameters like gender have significant differences between the groups allowing to create customised growth charts.

Cesarean section (CS) is the most frequently performed surgical procedure around the world and during the last decades, the incidence of CSs has continuously risen in both, developed and developing countries.Consequently, women with a previous CS becoming pregnant again is constantly growing.This article aims to clarify how women who have had a previous CS should be counseled and managed, either before getting again pregnant or during pregnancy with regard to the different complications related to this previous surgical procedure.