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  1. Article ; Online: Magnetic resonance imaging of intracranial anomalies in pregnancies complicated by twin anemia-polycythemia sequence.

    Tricca, Stefano / Parazzini, Cecilia / Doneda, Chiara / Arrigoni, Filippo / Tortora, Mario / Lanna, Mariano / Casati, Daniela / Faiola, Stefano / Righini, Andrea / Izzo, Giana

    Neuroradiology

    2024  

    Abstract: Purpose: To describe fetal brain Magnetic Resonance Imaging (MRI) findings in a large series of monochorionic (MC) pregnancies complicated by Twin Anemia-Polycythemia Sequence (TAPS) prenatally diagnosed, so to characterize the potential intracranial ... ...

    Abstract Purpose: To describe fetal brain Magnetic Resonance Imaging (MRI) findings in a large series of monochorionic (MC) pregnancies complicated by Twin Anemia-Polycythemia Sequence (TAPS) prenatally diagnosed, so to characterize the potential intracranial complications associated with this condition, their frequency and potential treatment options.
    Methods: This is a retrospective study of MC twin pregnancies complicated by TAPS and undergone fetal MRI in a single institution from 2006 to 2023. MRI control was performed and post-natal ultrasound (US) or MRI were available.
    Results: 1250 MC pregnancies were evaluated in our institution. 50 pregnancies (4%) were diagnosed with TAPS, 29 underwent a fetal brain MRI. 13/29 pregnancies (44.8%) demonstrated brain findings at MRI in at least a twin. Neuroradiological findings were detected in 14/57 twins (24.6%). We detected four main categories of findings: hemorrhagic lesions, T2-weighted white-matter hyperintensities (WMH), brain edema-swelling and venous congestion. Nineteen findings were present in the anemic and three in the polycythemic twins, with a statistically significant ratio between the two groups (p-value = 0.01). Intrauterine MRI follow-up demonstrated the sequalae of hemorrhagic lesions. A complete regression of brain swelling, veins prominence and T2-WMHs was demonstrated after treatment. Postnatal imaging confirmed prenatal features.
    Conclusions: Our work demonstrates that TAPS-related MRI anomalies consisted in edematous/hemorrhagic lesions that occur mostly in anemic rather than in polycythemic twins. Fetoscopic laser surgery could have a potential decongestant role. Therefore, prenatal MRI may help in counselling and management in TAPS pregnancies, especially for the planning of therapy and the monitoring of its efficacy.
    Language English
    Publishing date 2024-05-08
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 123305-1
    ISSN 1432-1920 ; 0028-3940
    ISSN (online) 1432-1920
    ISSN 0028-3940
    DOI 10.1007/s00234-024-03373-4
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  2. Article: Amnioreduction for Polyhydramnios in a Consecutive Series at a Single Center: Indications, Risks and Perinatal Outcomes.

    Laoreti, Arianna / Sala, Valentina / Casati, Daniela / Faiola, Stefano / Spaccini, Luigina / Cetin, Irene / Lanna, Mariano M

    Children (Basel, Switzerland)

    2024  Volume 11, Issue 4

    Abstract: Pregnancies complicated by severe polyhydramnios are associated with a high rate of underlying fetal anomaly. Amnioreduction may be offered to alleviate maternal symptoms. This is a retrospective study of amnioreductions performed on singleton and twin ... ...

    Abstract Pregnancies complicated by severe polyhydramnios are associated with a high rate of underlying fetal anomaly. Amnioreduction may be offered to alleviate maternal symptoms. This is a retrospective study of amnioreductions performed on singleton and twin gestations complicated by symptomatic polyhydramnios between 2010 and 2023 at our tertiary referral center. The indications, procedural techniques and pregnancy and neonatal outcomes were retrieved from an archive database and reviewed with the use of the maternal and child medical record chart, the hospital electronic clinical discharge report and telephone recalls. Our study comprised 86 pregnancies, 65 singletons and 21 twin pregnancies. Fetal anomalies were identified in 79% of cases, mainly gastrointestinal obstructive anomalies; 9.3% of cases were idiopathic. The median gestational age at first amnioreduction was 32.5 weeks, and peri-procedural complications were rare (1 case of placental abruption and 2 cases of preterm delivery). The median gestational age at delivery was 36.5 weeks, with a median prolongation of the pregnancy from the time of first drain until birth of 30 days. Preterm labor < 37 weeks occurred in 48.8% of procedures, with 26.7% of patients delivering before 34 weeks and pPROM < 36 weeks recorded in 23.2% of cases. In conclusion, amnioreduction offered to alleviate maternal symptoms is a reasonably safe procedure with a low complication rate. These pregnancies necessitate management in a tertiary referral center because of their need for a multidisciplinary approach both prenatally and postnatally.
    Language English
    Publishing date 2024-04-22
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2732685-8
    ISSN 2227-9067
    ISSN 2227-9067
    DOI 10.3390/children11040502
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  3. Article: Long-Term Postnatal Follow-Up in Monochorionic TTTS Twin Pregnancies Treated with Fetoscopic Laser Surgery and Complicated by Right Ventricular Outflow Tract Anomalies.

    Faiola, Stefano / Mandalari, Maria / Coco, Chiara / Casati, Daniela / Laoreti, Arianna / Mannarino, Savina / Corti, Carla / Consonni, Dario / Cetin, Irene / Lanna, Mariano

    Journal of clinical medicine

    2023  Volume 12, Issue 14

    Abstract: Right ventricular outflow tract anomalies (RVOTAs), such as pulmonary stenosis (PS), pulmonary atresia (PA), and pulmonary insufficiency (PI), are typical cardiac anomalies in monochorionic twins, and they are complicated by twin-to-twin transfusion ... ...

    Abstract Right ventricular outflow tract anomalies (RVOTAs), such as pulmonary stenosis (PS), pulmonary atresia (PA), and pulmonary insufficiency (PI), are typical cardiac anomalies in monochorionic twins, and they are complicated by twin-to-twin transfusion syndrome (TTTS). The aim of this study was to conduct a long-term postnatal cardiological evaluation of prenatal RVOTAs in monochorionic diamniotic twin pregnancies complicated by TTTS and treated with fetoscopic laser surgery (FLS) and to analyze possible prenatal predictors of congenital heart disease (CHD). Prenatal RVOTAs were retrospectively retrieved from all TTTS cases treated with FLS in our unit between 2009 and 2019. Twenty-eight prenatal cases of RVOTAs (16 PI, 10 PS, 2 PA) were observed out of 335 cases of TTTS. Four cases did not reach the postnatal period. CHD was present in 17 of the remaining 24 cases (70.8%), with 10 being severe (58.8%; 10/17); nine cases of PS required balloon valvuloplasty, and one case required biventricular non-compaction cardiomyopathy. The risk of major CHD increased with prenatal evidence of PS and decreased with the gestational age at the time of TTTS and with the prenatal normalization of blood flow across the pulmonary valve. Despite treatment with FLS, the majority of monochorionic diamniotic twin pregnancies complicated by TTTS with prenatal RVOTAs had CHD at long-term follow-up.
    Language English
    Publishing date 2023-07-17
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662592-1
    ISSN 2077-0383
    ISSN 2077-0383
    DOI 10.3390/jcm12144734
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  4. Article ; Online: Maternal hemodynamic evaluation in monochorionic twin pregnancy complicated by twin-to-twin transfusion syndrome treated with fetoscopic laser surgery.

    Milazzo, Roberta / Garbin, Massimo / Consonni, Dario / Casati, Daniela / Faiola, Stefano / Laoreti, Arianna / Mannarino, Savina / Cetin, Irene / Lanna, Mariano M

    American journal of obstetrics & gynecology MFM

    2023  Volume 6, Issue 3, Page(s) 101270

    Abstract: Background: Maternal cardiovascular adaptations are amplified in twin pregnancies to support the metabolic request of the feto-placental unit. Few studies have evaluated the maternal hemodynamics changes after routine use of laser surgery in the ... ...

    Abstract Background: Maternal cardiovascular adaptations are amplified in twin pregnancies to support the metabolic request of the feto-placental unit. Few studies have evaluated the maternal hemodynamics changes after routine use of laser surgery in the treatment of twin-twin transfusion syndrome.
    Objective: The aim of our study was to evaluate hemodynamic changes in monochorionic twin pregnancies complicated by twin-twin transfusion syndrome before and after treatment with fetoscopic laser surgery.
    Study design: A prospective observational study from 2020 to 2022, included monochorionic twin pregnancies complicated with twin-twin transfusion syndrome undergoing laser surgery between 16 and 26 weeks of gestation. To assess placental function and perfusion, uterine artery pulsatility index, hemoglobin, hematocrit, and soluble fms-like tyrosine kinase-1/placental growth factor ratio sampling prelaser and 24 hours postlaser were measured. Echocardiography by a single cardiologist evaluated maternal hemodynamics at presurgery, 24 hours, and 1 week postlaser. Those data were crosswise compared with cardiovascular indices of uncomplicated monochorionic pregnancies recruited at the same gestational age using nonparametric tests. Moreover, we fitted random-intercept linear regression models to investigate maternal hemodynamic changes according to the amount of amniotic fluid drained during laser surgery.
    Results: Forty-two twin-twin transfusion syndrome pregnancies with a median gestational age of 19.1 (17.4-20.9) weeks and 15 uncomplicated monochorionic pregnancies at the same gestational age were enrolled. Overall survival rate after laser was 72% with delivery at a median gestational age of 31.5 (27-34) weeks. Significant changes in blood chemistry and placental function were observed in the twin-twin transfusion syndrome group, along with alterations in arterial pressure, heart rate, cardiac output, and ventricular strain, eventually aligning with the uncomplicated group's values by 1 week postlaser. The amount of amniodrainage, with a 1000 ml cut-off, did not significantly impact hemodynamic parameters. Lastly, we detected a percentage of laser surgery complications in agreement with international literature and we did not record any maternal procedure-related problems.
    Conclusion: Our analysis highlighted that maternal cardiovascular status in monochorionic twin pregnancy complicated by twin-twin transfusion syndrome was more dynamic and; 1 week after fetoscopic laser ablation of placental anastomosis completed by amniodrainage, maternal hemodynamic parameters restored to values similar to uncomplicated monochorionic twin pregnancies.
    MeSH term(s) Pregnancy ; Female ; Humans ; Infant ; Fetofetal Transfusion/diagnosis ; Fetofetal Transfusion/surgery ; Pregnancy, Twin ; Placenta ; Placenta Growth Factor ; Hemodynamics ; Lasers ; Laser Therapy/adverse effects
    Chemical Substances Placenta Growth Factor (144589-93-5)
    Language English
    Publishing date 2023-12-23
    Publishing country United States
    Document type Observational Study ; Journal Article
    ISSN 2589-9333
    ISSN (online) 2589-9333
    DOI 10.1016/j.ajogmf.2023.101270
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  5. Article ; Online: Fetal oxygen and glucose utilization of uncomplicated monochorionic twins: Adapting to the intrauterine environment.

    Casati, Daniela / Lanna, Mariano / Mando', Chiara / Zavatta, Alice / Nelva Stellio, Leonardo / Faiola, Stefano / Laoreti, Arianna / Anelli, Gaia Maria / Cetin, Irene

    Placenta

    2022  Volume 132, Page(s) 7–14

    Abstract: Introduction: Monochorionic twins (MC) develop under unique intrauterine conditions and show a high risk of compromise during fetal life. Here we describe umbilical vein blood flow (UVBF) and fetal oxygen and glucose utilization in uncomplicated MC ... ...

    Abstract Introduction: Monochorionic twins (MC) develop under unique intrauterine conditions and show a high risk of compromise during fetal life. Here we describe umbilical vein blood flow (UVBF) and fetal oxygen and glucose utilization in uncomplicated MC twins and investigate possible differences within twin-pairs according to birth-order.
    Methods: Prospective single-center study on 48 uncomplicated MC twins enrolled at the time of elective cesarean delivery. Ultrasound measurements of UVBF for Twin 1 and Twin 2 labelled according to birth-order were performed before spinal anesthesia. Umbilical arterial and venous blood samples were collected for each twin after fetal delivery, and fetal oxygen and glucose deliveries and uptakes were computed.
    Results: All twins were delivered within 2 min from one-another under steady-state conditions at 36.4 weeks of median gestational age (IQR 36.0-37.0). Birthweight and umbilical cord gas analyses were within physiological ranges for all twins. Second-born twins showed significantly lower UVBF, measured before delivery, and lower median birthweight compared to first-borns. Moreover, median values of estimated fetal oxygen and glucose consumption were lower in second compared to first MC twins.
    Discussion: Uncomplicated MC twins show different birthweight, oxygenation and metabolic rates based on their position in utero, hinting at pre-existing conditions possibly deriving by uneven vascular and metabolic distribution of the two placental territories. The innovative findings of this study emphasize the biological uniqueness of these pregnancies and prompt further physiological studies on MC twins and placenta metabolism.
    MeSH term(s) Pregnancy ; Female ; Humans ; Placenta/blood supply ; Birth Weight ; Pregnancy, Twin ; Prospective Studies ; Twins, Monozygotic ; Gestational Age
    Language English
    Publishing date 2022-12-26
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 603951-0
    ISSN 1532-3102 ; 0143-4004
    ISSN (online) 1532-3102
    ISSN 0143-4004
    DOI 10.1016/j.placenta.2022.12.004
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    Zs.A 1578: Show issues Location:
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  6. Article ; Online: Cerebro-placental and umbilico-cerebral ratios in uncomplicated monochorionic twins: Longitudinal references and comparison with singletons.

    Casati, Daniela / Zavatta, Alice / Cortinovis, Ivan / Spada, Elena / Faiola, Stefano / Laoreti, Arianna / Cetin, Irene / Lanna, Mariano

    Prenatal diagnosis

    2022  Volume 42, Issue 9, Page(s) 1111–1119

    Abstract: Objectives: Monochorionic twins (MC) are at high risk of adverse outcomes and Doppler investigation of umbilical and cerebral flows is mandatory for their surveillance. The cerebro-placental (CPR) and umbilico-cerebral (UCR) ratios are considered non- ... ...

    Abstract Objectives: Monochorionic twins (MC) are at high risk of adverse outcomes and Doppler investigation of umbilical and cerebral flows is mandatory for their surveillance. The cerebro-placental (CPR) and umbilico-cerebral (UCR) ratios are considered non-invasive measures of fetal adaptation to hypoxemia. We aimed to provide longitudinal references for CPR and UCR from 16 to 37 weeks of gestation that are specific for MC twins, and compare these with singleton charts.
    Methods: Longitudinal study of a cohort of consecutive uncomplicated MC twin pregnancies monitored at our unit from 2010 to 2018. The estimated centile curves were obtained estimating the median with fractional polynomials by a multilevel model and the external centiles through the residuals. The comparison with singletons references was made through graphic evaluation.
    Results: One-hundred-fifty-two MC pregnancies were included with a median of 10 longitudinal ultrasounds each. References for CPR and UCR in function of gestational age are presented. Compared to singletons, MC twins showed an earlier and greater circulatory redistribution with lower CPR and higher UCR median values.
    Conclusions: MC twin-specific references for CPR and UCR suitable for serial monitoring are presented. The comparison with singleton references demonstrates substantial differences in the hemodynamic balance that must be considered when interpreting findings in MC twins.
    MeSH term(s) Female ; Gestational Age ; Humans ; Longitudinal Studies ; Placenta/diagnostic imaging ; Pregnancy ; Pregnancy, Twin ; Twins ; Ultrasonography, Prenatal
    Language English
    Publishing date 2022-08-05
    Publishing country England
    Document type Journal Article
    ZDB-ID 82031-3
    ISSN 1097-0223 ; 0197-3851
    ISSN (online) 1097-0223
    ISSN 0197-3851
    DOI 10.1002/pd.6210
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  7. Article ; Online: Fetal Hydrothorax Treated with Pleuro-Amniotic Shunting: Fetal and Maternal Complications and Long-Term Outcomes.

    Lanna, Mariano / Consonni, Dario / Faiola, Stefano / Casati, Daniela / Laoreti, Arianna / Zavatta, Alice / Farolfi, Andrea / Spaccini, Luigina / Scelsa, Barbara / Lista, Gianluca / Cetin, Irene

    Fetal diagnosis and therapy

    2023  Volume 50, Issue 2, Page(s) 115–120

    Abstract: Introduction: We aimed to identify maternal and fetal complications and investigate postnatal and long-term outcomes of fetal hydrothorax (FHT) treated with pleuro-amniotic shunting (shunt).: Methods: Single-center retrospective observational cohort ... ...

    Abstract Introduction: We aimed to identify maternal and fetal complications and investigate postnatal and long-term outcomes of fetal hydrothorax (FHT) treated with pleuro-amniotic shunting (shunt).
    Methods: Single-center retrospective observational cohort of shunt cases performed from 2000 to 2021. Risk factors for maternal complications, fetal demise, neonatal death (NND), and postnatal outcomes were identified.
    Results: Out of 88 cases, 70 (79.5%) were complicated by hydrops, with an average gestational age (GA) at diagnosis of 27 weeks (range 16-34). In 16 cases, definitive etiology of FHT was identified; five cases of Noonan syndrome and three cases of monogenic disorders diagnosed by whole-exome sequencing (EPHB4, VEGFR3, RASA1). Shunt was performed at an average GA of 28 weeks (20-34), with a dislodgement in 10 cases (11.4%). Maternal: Complications occurred in three cases; survival rate was 76.1% (67/88). Follow-up data were available for 57/67 (85.1%) children. Incidence of severe neurodevelopmental impairment and pneumopathy (broncho dysplasia, persistent pulmonary hypertension of newborn, and asthma) was 5.3% and 8.8%, respectively. Post-treatment persistence of hydrops, FHT associated with genetic syndromes, and GA at birth were risk factors for fetal demise, NND, and postnatal complications.
    Conclusion: In truly isolated FHT, whenever indicated, pleuro-amniotic shunting is a safe procedure associated with good survival rate and long-term outcome.
    MeSH term(s) Pregnancy ; Female ; Infant, Newborn ; Child ; Humans ; Infant ; Hydrothorax/surgery ; Retrospective Studies ; Prenatal Care ; Fetal Death/etiology ; Edema ; p120 GTPase Activating Protein
    Chemical Substances RASA1 protein, human ; p120 GTPase Activating Protein
    Language English
    Publishing date 2023-01-27
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 1066460-9
    ISSN 1421-9964 ; 1015-3837
    ISSN (online) 1421-9964
    ISSN 1015-3837
    DOI 10.1159/000529334
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  8. Article ; Online: Analysis of fetal heart rate variability in frequency domain: methodical considerations.

    Casati, Daniela / Frasch, Martin G

    Experimental physiology

    2014  Volume 99, Issue 2, Page(s) 466–467

    MeSH term(s) Animals ; Female ; Fetus/physiology ; Heart Rate/physiology ; Pregnancy ; Sheep/physiology
    Language English
    Publishing date 2014-02-03
    Publishing country England
    Document type Letter ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 1016295-1
    ISSN 1469-445X ; 0958-0670
    ISSN (online) 1469-445X
    ISSN 0958-0670
    DOI 10.1113/expphysiol.2013.076539
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  9. Article: A closer look at discordant placental echogenicity: two cases under the microscope.

    Lanna, Mariano M / Toto, Valentina / Faiola, Stefano / Casati, Daniela / Bulfamante, Gaetano P / Cetin, Irene / Rustico, Maria Angela

    Clinical case reports

    2021  Volume 9, Issue 7, Page(s) e04506

    Abstract: Discordant placental echogenicity is observed in MC pregnancies complicated with twin anemia-polycythemia sequence, but could also belong to complicated singleton gestation. ...

    Abstract Discordant placental echogenicity is observed in MC pregnancies complicated with twin anemia-polycythemia sequence, but could also belong to complicated singleton gestation.
    Language English
    Publishing date 2021-07-21
    Publishing country England
    Document type Case Reports
    ZDB-ID 2740234-4
    ISSN 2050-0904
    ISSN 2050-0904
    DOI 10.1002/ccr3.4506
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  10. Article ; Online: Right ventricular outflow tract abnormalities in monochorionic twin pregnancies without twin-to-twin transfusion syndrome: Prenatal course and postnatal long-term outcomes.

    Faiola, Stefano / Casati, Daniela / Laoreti, Arianna / Amendolara, Mariella / Consonni, Dario / Corti, Carla / Mannarino, Savina / Lanna, Mariano / Rustico, Mariangela / Cetin, Irene

    Prenatal diagnosis

    2021  Volume 41, Issue 12, Page(s) 1510–1517

    Abstract: Objectives: Right ventricular outflow tract abnormalities (RVOTA) have been mostly reported in recipient twins (RT) of monochorionic/diamniotic (MC/DA) twin pregnancies with twin-to-twin transfusion syndrome (TTTS). Aim of the study was to describe ... ...

    Abstract Objectives: Right ventricular outflow tract abnormalities (RVOTA) have been mostly reported in recipient twins (RT) of monochorionic/diamniotic (MC/DA) twin pregnancies with twin-to-twin transfusion syndrome (TTTS). Aim of the study was to describe RVOTA detected in MC/DA pregnancies without TTTS.
    Methods: Cases of RVOTA were retrieved from our database among all MC/DA pregnancies without TTTS from 2009 to 2018.
    Results: Out of 891 MC/DA twin pregnancies without TTTS, 14 (1.6%) were associated with RVOTA: 10 pulmonary stenosis (PS), one steno-insufficiency, one insufficiency and two atresia (PA). In 93% of cases (13/14), pregnancy was complicated either by amniotic fluid discrepancy (AFD) or by TAPS or mostly by selective fetal growth restriction (sFGR) (11/13: 85%), involving predominantly (10/11: 91%) the large twin, with high incidence (9/11: 82%) of sFGR and AFD coexistence. Eight out of 14 (57%) survived after the perinatal period (7 PS, 1 PA). Five (62%) underwent pulmonary balloon valvuloplasty, whereas 3 children still showed persistent mild PS at cardiac follow up after 1 year of life.
    Conclusions: RVOTA can occur in MC/DA pregnancies without TTTS, particularly when other complications coexist. In complicated cases specialized fetal echocardiographic evaluation is recommended during pregnancy; RVOTA cases should be delivered in a tertiary level center, where cardiologists are available.
    MeSH term(s) Adult ; Female ; Fetal Growth Retardation ; Fetofetal Transfusion/diagnosis ; Fetofetal Transfusion/diagnostic imaging ; Humans ; Incidence ; Long Term Adverse Effects/etiology ; Pregnancy ; Pregnancy, Twin/physiology ; Retrospective Studies ; Ultrasonography, Prenatal/methods ; Ventricular Outflow Obstruction/diagnostic imaging ; Ventricular Outflow Obstruction/physiopathology
    Language English
    Publishing date 2021-10-05
    Publishing country England
    Document type Journal Article ; Observational Study
    ZDB-ID 82031-3
    ISSN 1097-0223 ; 0197-3851
    ISSN (online) 1097-0223
    ISSN 0197-3851
    DOI 10.1002/pd.6052
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