Papers by Cristina Trilla
Clinical Infectious Diseases, Feb 8, 2021
Background. We performed a population-based study to describe the impact of severe acute respirat... more Background. We performed a population-based study to describe the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on pregnancy outcomes. Methods. This prospective, population-based study included pregnant women who consecutively presented at first/second trimester visits or at delivery at 3 hospitals in Barcelona, Spain. SARS-CoV-2 antibodies (immunoglobulin [Ig] G and IgM/IgA) were measured in all participants, and nasopharyngeal real-time polymerase chain reaction (RT-PCR) was performed at delivery. The primary outcome was a composite of pregnancy complications in SARS-CoV-2-positive vs negative women that included miscarriage, preeclampsia, preterm delivery, perinatal death, small-for-gestational-age newborn, or neonatal admission. Secondary outcomes were components of the primary outcome plus abnormal fetal growth, malformation, or intrapartum fetal distress. Outcomes were also compared between positive symptomatic and positive asymptomatic SARS-CoV-2 women. Results. Of 2225 pregnant women, 317 (14.2%) were positive for SARS-CoV-2 antibodies (n = 314, 99.1%) and/or RT-PCR (n = 36, 11.4%). Among positive women, 217 (68.5%) were asymptomatic, 93 (29.3%) had mild coronavirus disease 2019 (COVID-19), and 7 (2.2%) had pneumonia, of whom 3 required intensive care unit admission. In women with and without SARS-CoV-2 infection, the primary outcome occurred in 43 (13.6%) and 268 (14%), respectively (risk difference,-0.4%; 95% confidence interval,-4.1% to 4.1). Compared with noninfected women, those with symptomatic COVID-19 had increased rates of preterm delivery (7.2% vs 16.9%, P = .003) and intrapartum fetal distress (9.1% vs 19.2%, P = .004), while asymptomatic women had rates that were similar to those of noninfected cases. Among 143 fetuses from infected mothers, none had anti-SARS-CoV-2 IgM/IgA in cord blood. Conclusions. The overall rate of pregnancy complications in women with SARS-CoV-2 infection was similar to that of noninfected women. However, symptomatic COVID-19 was associated with modest increases in preterm delivery and intrapartum fetal distress.
Ultrasound in Obstetrics & Gynecology, Oct 1, 2020
Visual categorization is important to manage large collections of digital images and video, where... more Visual categorization is important to manage large collections of digital images and video, where textual meta-data is often incomplete or simply unavailable. The bag-of-words model has become the most powerful method for visual categorization of images and video. Despite its high accuracy, a severe drawback of this model is its high computational cost. As the trend to increase computational power in newer CPU and GPU architectures is to increase their level of parallelism, exploiting this parallelism becomes an important direction to handle the computational cost of the bag-of-words approach. In this paper, we analyze the bag-of-words model for visual categorization in terms of computational cost and identify two major bottlenecks: the quantization step and the classification step. We address these two bottlenecks by proposing two efficient algorithms for quantization and classification by exploiting the GPU hardware and the CUDA parallel programming model. The algorithms are designed to keep categorization accuracy intact and give the same numerical results. In the experiments on large scale datasets it is shown that, by using a parallel implementation on the GPU, quantization is 28 times faster and classification is 35 faster than a single-threaded CPU version, while giving the exact same numerical results. The GPU accelerations are applicable to both the learning phase and the testing phase of visual categorization systems.
Obstetrics & Gynecology International Journal, Aug 5, 2022
Background: Vasa previa consists in the presence of extraplacental fetal vessels overlying the ce... more Background: Vasa previa consists in the presence of extraplacental fetal vessels overlying the cervix. This condition is commonly associated with fatal outcome if prenatally undiagnosed. Two types of vasa previa have been classically described, associated with well-established risk factors. However, a rare third type of vasa previa has also been reported. Case: We present a case of type 3 vasa previa diagnosed in the second trimester, with two fetal vessels overlying the cervix. The placenta was unilobed, not previa, and the cord insertion was marginal. Placental examination after delivery confirmed the prenatal findings. Conclusion: This case suggests that vasa previa can occur in the absence of cord or placental anomalies. A review of vasa previa classification and screening strategies for this condition is needed.
Ultrasound in Obstetrics & Gynecology, Oct 1, 2021
Fetal Diagnosis and Therapy, Aug 12, 2020
Objective: The aim of this study was to assess the clinical applicability of a new analytical sof... more Objective: The aim of this study was to assess the clinical applicability of a new analytical software program by determining the inter- and intraobserver agreement for 2D placental biometry and three-dimensional (3D) placental volume (PV) in the first trimester. Methods: A prospective study of 25 singleton pregnancies between 11 and 14 weeks was conducted. 3D datasets were captured, and PV was estimated using the Phillips QLAB GI3DQ ultrasound quantification software. The basal plate (BP), chorionic plate (CP), placental thickness (PT), and the free uterine surface (FUS) area not occupied by placenta were considered for 2D biometry evaluation. Each variable was measured in 2 orthogonal planes with mean values used for the analysis. Intra- and interobserver agreement was evaluated. Results: Intraobserver agreement for both 2D and 3D measurements was high, particularly for the PV and PT (interclass correlation coefficient [ICC] 0.989 [95% confidence interval (CI) 0.97–0.99] and ICC 0.936 [95% CI 0.86–0.97], respectively). Interobserver agreement was good for the PV (ICC 0.963 [95% CI 0.91–0.98]), PT (ICC 0.822 [95% CI 0.63–0.91]), and CP (ICC 0.708 [95% CI 0.44–0.86]), but moderate for BP and FUS. Conclusions: PV, PT, and CP are reproducible measurements to evaluate first trimester placental biometry. Further research is needed to assess the clinical utility of these variables as predictors of poor obstetric outcomes.
Ultrasound in Obstetrics & Gynecology, Oct 1, 2021
Journal of Clinical Medicine, Apr 15, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
European Journal of Obstetrics & Gynecology and Reproductive Biology, Aug 1, 2014
Late preterm prematurity has been related to poorer neonatal outcomes. However, research has focu... more Late preterm prematurity has been related to poorer neonatal outcomes. However, research has focused on the neonatal outcomes of late preterm infants, maternal characteristics of these births have been less evaluated. The aim of the study was to compare maternal risk factors and obstetric complications in late preterm births (LPTB) and term births. These factors were also assessed comparing spontaneous LPTB with medically-indicated LPTB. Study design: We conducted a retrospective cohort study with two groups. All singleton LPTB occurred at our University Hospital between January 1, 2009 and December 31, 2010 were included in the first cohort (n = 171). A comparison cohort of term births was configured in a ratio 2:1 (n = 342). Well-dated pregnancies without congenital malformations, congenital infections or chromosome abnormalities were eligible. LPTB were classified into two groups, spontaneous LPTB and medically-indicated LPTB following delivery indications. Statistical analysis of categorical variables was performed using either x 2 or Fisher's exact. Continuous variables were compared using the Student's t-test. Results: Women with LPTB had more medical conditions than women with term births (29% vs 15.7%; P = 0.002). Prior preterm births (9.7% vs 2%; P < 0.001), prior adverse obstetric outcomes (6.9% vs 2.3%; P < 0.001), and obstetric complications were also more frequent in LPTB than in term births. However, no differences were found in maternal medical conditions when spontaneous LPTB and medically-indicated LPTB were compared. Women with medically-indicated LPTB were older (33.69 vs 31.07; P = 0.003) and mainly nulliparous (75.8% vs 49.4%; P = 0.002). Obstetric complications were more frequent in medicallyindicated LPTB than in spontaneous LPTB. Conclusions: Maternal risk factors and obstetric complications are significantly higher in LPTB than in term births. These factors should be considered to identify women at risk for either spontaneous or medically-indicated LPTB. 2014 Published by Elsevier Ireland Ltd.
Ultrasound in Obstetrics & Gynecology, Oct 1, 2020
Extracellular guidance cues steer axons towards their targets by eliciting morphological changes ... more Extracellular guidance cues steer axons towards their targets by eliciting morphological changes in the growth cone. A key part of this process is the asymmetric recruitment of the cytoplasmic scaffolding protein MIG-10 (lamellipodin). MIG-10 is thought to asymmetrically promote outgrowth by inducing actin polymerization. However, the mechanism that links MIG-10 to actin polymerization is not known. We have identified the actin regulatory protein ABI-1 as a partner for MIG-10 that can mediate its outgrowth-promoting activity. The SH3 domain of ABI-1 binds to MIG-10, and loss of function of either of these proteins causes similar axon guidance defects. Like MIG-10, ABI-1 functions in both the attractive UNC-6 (netrin) pathway and the repulsive SLT-1 (slit) pathway. Dosage sensitive genetic interactions indicate that MIG-10 functions with ABI-1 and WVE-1 to mediate axon guidance. Epistasis analysis reveals that ABI-1 and WVE-1 function downstream of MIG-10 to mediate its outgrowth-promoting activity. Moreover, experiments with cultured mammalian cells suggest that the interaction between MIG-10 and ABI-1 mediates a conserved mechanism that promotes formation of lamellipodia. Together, these observations suggest that MIG-10 interacts with ABI-1 and WVE-1 to mediate the UNC-6 and SLT-1 guidance pathways.
Biomedicines
Algorithms for first-trimester prediction of pre-eclampsia usually include maternal risk factors,... more Algorithms for first-trimester prediction of pre-eclampsia usually include maternal risk factors, blood pressure, placental growth factor (PlGF), and uterine artery Doppler pulsatility index. However, these models lack sensitivity for the prediction of late-onset pre-eclampsia and other placental complications of pregnancy, such as small for gestational age infants or preterm birth. The aim of this study was to assess the screening performance of PlGF, soluble fms-like tyrosine kinase-1 (sFlt-1), N-terminal pro-brain natriuretic peptide (NT-proBNP), uric acid, and high-sensitivity cardiac troponin T (hs-TnT) in the prediction of adverse obstetric outcomes related to placental insufficiency. This retrospective case–control study was based on a cohort of 1390 pregnant women, among which 210 presented pre-eclampsia, small for gestational age infants, or preterm birth. Two hundred and eight women with healthy pregnancies were selected as controls. Serum samples were collected between we...
Ultrasound in Obstetrics & Gynecology, 2021
P. Garcia-Canadilla1,2, A. Nadal3, A. Bonnin4, F. Crovetto1, M. Lopez3, E. Gratacos1,2, F. Loncar... more P. Garcia-Canadilla1,2, A. Nadal3, A. Bonnin4, F. Crovetto1, M. Lopez3, E. Gratacos1,2, F. Loncaric3, H. Dejea4, B. Bijnens2,5, F. Crispi1,2 1Maternal Fetal Medicine, Barcelona Center for Maternal Fetal and Neonatal Medicine (Hospital Clı́nic and Hospital Sant Joan de Déu), Barcelona, Spain; 2Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain; 3Hospital Clinic of Barcelona, Barcelona, Spain; 4Paul Scherrer Institute, Villigen, Switzerland; 5Catalan Institute for Research and Advanced Studies, Barcelona, Spain
Frontiers in Cardiovascular Medicine, Jul 26, 2022
Obstetrics & Gynecology International Journal
Background: Vasa previa consists in the presence of extraplacental fetal vessels overlying the ce... more Background: Vasa previa consists in the presence of extraplacental fetal vessels overlying the cervix. This condition is commonly associated with fatal outcome if prenatally undiagnosed. Two types of vasa previa have been classically described, associated with well-established risk factors. However, a rare third type of vasa previa has also been reported. Case: We present a case of type 3 vasa previa diagnosed in the second trimester, with two fetal vessels overlying the cervix. The placenta was unilobed, not previa, and the cord insertion was marginal. Placental examination after delivery confirmed the prenatal findings. Conclusion: This case suggests that vasa previa can occur in the absence of cord or placental anomalies. A review of vasa previa classification and screening strategies for this condition is needed.
Fetal Diagnosis and Therapy
Introduction: The objective of this study was to construct gestational age (GA) based reference v... more Introduction: The objective of this study was to construct gestational age (GA) based reference values for left ventricle (LV) longitudinal strain in normal fetuses, between 24-37 weeks’ gestation, assessing its feasibility and reproducibility, with automated cardiac motion quantification software (aCMQ-QLab) widely used in postnatal echocardiography. Methods: Prospective study including healthy gravid women with singleton pregnancies and no evidence of fetal structural cardiovascular disease. Fetal echocardiographies were performed between 24 and 37 GA. 2D four-chamber view clips were recorded and LV longitudinal strain was analyzed offline. Intra and interobserver reproducibility between 2 independent observers was evaluated by intraclass correlation coefficients (ICC) and Bland-Altman scatter plots. Regression analysis was used to determine GA adjusted reference ranges and construct nomograms. Results: LV longitudinal strain measurements were feasible in 95.4% of acquisitions. 43...
Diagnostics
Objectives: Several multivariate algorithms for preeclampsia (PE) screening in the first trimeste... more Objectives: Several multivariate algorithms for preeclampsia (PE) screening in the first trimester have been developed over the past few years. These models include maternal factors, mean arterial pressure (MAP), uterine artery Doppler (UtA-PI), and biochemical markers (pregnancy-associated plasma protein-A (PAPP-A) or placental growth factor (PlGF)). Treatment with low-dose aspirin (LDA) has shown a reduction in the incidence of preterm PE in women with a high-risk assessment in the first trimester. An important barrier to the implementation of first-trimester screening is the cost of performing tests for biochemical markers in the whole population. Theoretical contingent strategies suggest that two-stage screening models could also achieve high detection rates for preterm PE with lower costs. However, no data derived from routine care settings are currently available. This study was conducted to validate and assess the performance of a first-trimester contingent screening process ...
Frontiers in Cardiovascular Medicine
IntroductionThe incidence of preeclampsia (PE) is about 2–8%, making it one of the leading causes... more IntroductionThe incidence of preeclampsia (PE) is about 2–8%, making it one of the leading causes of perinatal morbidity and maternal mortality in the world. Early prophylactic low dose administration (150 mg) of acetylsalicylic acid is associated with a significant reduction in the incidence of early-onset PE, intrauterine growth restriction (IUGR), and neonatal mean stay in the intensive care unit (ICU). Universal implementation of a first-trimester screening system including angiogenic and antiangiogenic markers [the Placental Growth Factor (PlGF) and/or soluble fms-like Tyrosine Kinase-1 (sFlt-1)] has shown a prediction rate of 90% for early-onset PE but entails a high financial cost. The aim of this study is to determine the predictive and preventive capacity of a universal PE first-trimester two-step sequential screening model, determining the PlGF only in patients previously classified as intermediate risk by means of a multivariate model based on resources already used in th...
Journal of Clinical Medicine
The outbreak of a pandemic has negative psychological effects. We aimed to determine the impact o... more The outbreak of a pandemic has negative psychological effects. We aimed to determine the impact of the SARS-CoV-2 pandemic during pregnancy and identify the risk factors for maternal well-being. A multicenter, prospective, population-based study was carried out that included women (n = 1320) who were pregnant during the SARS-CoV-2 pandemic in Barcelona (Spain) compared against a pre-pandemic cohort (n = 345). Maternal well-being was assessed using the validated World Health Organization Well-Being Index Questionnaire (WHO-5 Index). Pregnant women attended during the COVID-19 pandemic showed worst WHO-5 well-being scores (median (IQR) of 56 (36–72) for the pandemic cohort vs. 64 (52–76) for the pre-pandemic cohort p < 0.001), with 42.8% of women presenting a poor well-being score vs. 28% for the pre-pandemic cohort (p < 0.001). Presence of a previous psychiatric disorder (OR 7.1; 95% CI 2.6–19, p < 0.001), being in the third trimester of pregnancy (OR 1.7; 95% CI 1.5–2, p &l...
BMC Pregnancy and Childbirth, 2021
Background Cardiovascular diseases (CVD) are cause of increased morbidity and mortality in spite ... more Background Cardiovascular diseases (CVD) are cause of increased morbidity and mortality in spite of advances for diagnosis and treatment. Changes during pregnancy affect importantly the maternal CV system. Pregnant women that develop preeclampsia (PE) have higher risk (up to 4 times) of clinical CVD in the short- and long-term. Predominance of an anti-angiogenic environment during pregnancy is known as main cause of PE, but its relationship with CV complications is still under research. We hypothesize that angiogenic factors are associated to maternal cardiac dysfunction/remodeling and that these may be detected by new cardiac biomarkers and maternal echocardiography. Methods Prospective cohort study of pregnant women with high-risk of PE in first trimester screening, established diagnosis of PE during gestation, and healthy pregnant women (total intended sample size n = 440). Placental biochemical and biophysical cardiovascular markers will be assessed in the first and third trime...
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Papers by Cristina Trilla