Papers by Cristina Zanardini
International Journal of Gynecology & Obstetrics
2011/2012Aim: To understand myocardial performance index (MPI)-conventional Doppler, MPI’-tissue ... more 2011/2012Aim: To understand myocardial performance index (MPI)-conventional Doppler, MPI’-tissue Doppler imaging (MPI’-TDI) and aorthic isthmus pulsatility index (AoI PI) normal trend in uncomplicated monochorionic diamniotic pregnancies, and to study the impact of fetal cardiac function on outcome of monochorionic (MC) twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) in order to improve identification of cases and indications for therapy. Materials and Methods: MC twin pregnancies examined between January 2009 and December 2012 at the University Hospital Spedali Civili of Brescia. 84 uncomplicated pregnancies (Group 1; controls) were studied and compared to 46 complicated pregnancies: 34 TTTS (Group 2), 10 selective intrauterine growth restriction (sIUGR; Group 3), 2 intrauterine deaths not for fetal anomaly or maternal condition (Group 4). Fetal heart Doppler studies assessing AoI PI, MPI-conventional Doppler and MPI’-TDI were performed three times between ...
Frontiers in Pharmacology
Objectives: Women with Rheumatoid Arthritis (RA) can experience flares during pregnancy that migh... more Objectives: Women with Rheumatoid Arthritis (RA) can experience flares during pregnancy that might influence pregnancy outcomes. We aimed at assessing the disease course during pregnancy and identifying risk factors for flares.Methods: Data about prospectively-followed pregnancies in RA were retrospectively collected before conception, during each trimester and in the post-partum period. Clinical characteristics, disease activity (DAS28-CRP3), medication use, and pregnancy outcomes were analysed with regard to disease flares.Results: Among 73 women who had a live birth, 64 (88%) were in remission/low disease activity before conception. During pregnancy, a flare occurred in 27 (37%) patients, mainly during first and second trimester. Flares during pregnancy were associated with the discontinuation of bDMARDs at positive pregnancy test (55% of patients with flare vs. 30% of patients with no flare, p 0.034, OR 2.857, 95% CI 1.112–8.323) and a previous use of >1 bDMARDs (33% of patie...
Gazzetta medica italiana. Archivio per le scienze mediche, Apr 1, 2022
BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in patho... more BackgroundTocilizumab blocks pro-inflammatory activity of interleukin-6 (IL-6), involved in pathogenesis of pneumonia the most frequent cause of death in COVID-19 patients.MethodsA multicentre, single-arm, hypothesis-driven phase 2 trial was planned to study the effect of Tocilizumab on lethality rates at 14 and 30 days (co-primary endpoints). A cohort of patients consecutively enrolled after phase 2 was used as a validation dataset. A multivariable logistic regression was performed to generate hypotheses, while controlling for possible confounders.Resultsout of 301 patients in phase 2 intention-to-treat (ITT) analysis, 180 (59.8%) received tocilizumab. With 67 death events, lethality rates were 18.4% (97.5%CI: 13.6-24.0, P=0.52) and 22.4% (97.5%CI: 17.2-28.3, P<0.001) at 14 and 30 days. Lethality rates were lower in the validation dataset, including 920 patients. No signal of specific drug toxicity was reported. The multivariable logistic regression suggests tocilizumab might be...
Clinical Reviews in Allergy & Immunology, 2022
Systemic sclerosis (SSc) is a rare systemic autoimmune disease that can influence reproductive he... more Systemic sclerosis (SSc) is a rare systemic autoimmune disease that can influence reproductive health. SSc has a strong female predominance, and the disease onset can occur during fertility age in almost 50% of patients. Preconception counseling, adjustment of treatment, and close surveillance during pregnancy by a multidisciplinary team, are key points to minimize fetal and maternal risks and favor successful pregnancy outcomes. The rates of spontaneous pregnancy losses are comparable to those of the general obstetric population, except for patients with diffuse cutaneous SSc and severe internal organ involvement who may carry a higher risk of abortion. Preterm birth can frequently occur in women with SSc, as it happens in other rheumatic diseases. Overall disease activity generally remains stable during pregnancy, but particular attention should be paid to women with major organ disease, such as renal and cardiopulmonary involvement. Women with such severe involvement should be thoroughly informed about the risks during pregnancy and possibly discouraged from getting pregnant. A high frequency of sexual dysfunction has been described among SSc patients, both in females and in males, and pathogenic mechanisms of SSc may play a fundamental role in determining this impairment. Fertility is overall normal in SSc women, while no studies in the literature have investigated fertility in SSc male patients. Nevertheless, some considerations regarding the impact of some immunosuppressive drugs should be done with male patients, referring to the knowledge gained in other rheumatic diseases.
The term placenta praevia defines a placenta that lies over the internal os, whereas the term low... more The term placenta praevia defines a placenta that lies over the internal os, whereas the term low-lying placenta identifies a placenta that is partially implanted in the lower uterine segment with the inferior placental edge located at 1-20 mm from the internal cervical os (internal-os-distance). The most appropriate mode of birth in women with low-lying placenta is still controversial, with the majority of them undergoing caesarean section. The current project aims to evaluate the rate of vaginal birth and caesarean section in labour due to bleeding by offering a trial of labour to all women with an internal-os-distance >5 mm as assessed by transvaginal sonography in the late third trimester. The MODEL-PLACENTA is a prospective, multicentre, 1:3 matched case-control study involving 17 Maternity Units across Lombardy and Emilia-Romagna regions, Italy. The study includes women with a placenta located in the lower uterine segment at the second trimester scan. Women with a normally located placenta will be enrolled as controls. A sample size of 30 women with an internal-os-distance >5 mm at the late third trimester scan is needed at each participating Unit. Since the incidence of low-lying placenta decreases from 2% in the second trimester to 0.4% at the end of pregnancy, 150 women should be recruited at each centre at the second trimester scan. A vaginal birth rate ≥60% in women with an internal-os-distance >5 mm will be considered appropriate to start routinely admitting to labour these women. Ethical approval for the study was given by the Brianza Ethics Committee (No 3157, 2019). Written informed consent will be obtained from study participants. Results will be disseminated by publication in peer-reviewed journals and presentation in international conferences. NCT04827433 (pre-results stage).
Fetal Growth Restriction, 2018
European Journal of Case Reports in Internal Medicine, 2020
Postpartum hypoglycemia in non-diabetic women is a rare condition. We report the case of a 34-yea... more Postpartum hypoglycemia in non-diabetic women is a rare condition. We report the case of a 34-year-old woman who experienced neuroglycopenia 2 days after delivery. Corresponding to severe hypoglycemia, we found inappropriately elevated insulin and C-peptide levels. Following magnetic resonance imaging a lesion of 10x8 mm was detected in the head of the pancreas. An ultrasound-guided fine needle aspiration of the mass confirmed the diagnostic suspicion of a pancreatic neuroendocrine tumor. Complete surgical enucleation of the insulinoma resulted in immediate and permanent resolution of the hypoglycemia. The postoperative course was uneventful. Histopathological and immunohistochemical analyses were consistent with insulinoma. The diagnostic approach to postpartum hypoglycemia represents a challenge for multidisciplinary teamwork.
All in-text references underlined in blue are linked to publications on ResearchGate, letting you... more All in-text references underlined in blue are linked to publications on ResearchGate, letting you access and read them immediately.
Prenatal Diagnosis
To describe the longitudinal changes of fetal myocardial performance index (MPI) measured by conv... more To describe the longitudinal changes of fetal myocardial performance index (MPI) measured by conventional Doppler (MPI) and by pulsed‐wave tissue Doppler (MPI′) based on a prospective cohort of uncomplicated monochorionic diamniotic twin.
Journal of Translational Medicine
Following publication of the original article [1] the authors identified that the collaborators o... more Following publication of the original article [1] the authors identified that the collaborators of the TOCIVID-19 investigators, Italy were only available in the supplementary file. The original article has been updated so that the collaborators are correctly acknowledged. For clarity, all collaborators are listed in this correction article.
Ultrasound in Obstetrics & Gynecology
Ultrasound in Obstetrics & Gynecology
Short oral presentation abstracts and PAS 3 accounted for 3, 4 and 5 cases, respectively. All wom... more Short oral presentation abstracts and PAS 3 accounted for 3, 4 and 5 cases, respectively. All women were submitted to Caesarean section and hysterectomy was required in 10. The comparison of the perinatal outcomes among the PAS categories yielded significantly greater operative time and estimated blood loss for the highest PAS categories (p 0.001 for both), which were also associated with a significantly higher rate of hysterectomy (p < 0.001), intraoperative or postoperative transfusion (p 0.002), post-surgical admission to ITU or HDU (p < 0.001) and also associated with longer postoperative admission (p 0.02). Conclusions: The PAS scoring system retains its performance on external validation in the hands of ultrasound examiners with expertise in the evaluation of women at risk of abnormally invasive placenta.
Ultrasound in Obstetrics & Gynecology
Objectives: To investigate textural analyses as the radiomics in magnetic resonance (MR) imaging ... more Objectives: To investigate textural analyses as the radiomics in magnetic resonance (MR) imaging of the placenta in predicting of placenta accreta spectrum disorders (PAS) requiring Caesarean hysterectomy in a high-risk population. Methods: We performed a retrospective review of 51 pregnancies with prior Caesarean delivery referred for MRI from 2014-2018 because of sonographic suspicion for PAS. Placental regions of interest (ROIs) were generated on T2-weighted, diffusion-weighted images (DWI) and the DWI-derived apparent diffusion coefficient (ADC), based on definitions of areas of placenta in proximity to and remote from previous surgical incision sites. T-tests and chi-square analyses between the primary outcome (hysterectomy vs. no hysterectomy) were performed. 13 Haralick texture features calculated from gray-level co-occurrence matrixes were extracted from manually drawn placental ROIs within each of three MR acquisitions. Univariate logistic regression models tested the association between the primary outcome and the texture features. Results: Of 51 pregnancies at risk for PAS, 38 required Caesarean hysterectomy (75%), with excellent correlation between need for hysterectomy determined surgically and pathological confirmation of PAS in the hysterectomy specimen [κ=0.81(0.62, 1)]. Of the 13 Haralick texture features within each of 3 acquisition groups, significant differences were seen in 21 of 39 parameters comparing placental ROIs in proximity to incision scar(s) to those ROI's remote from scar(s). Stepwise selection algorithm indicated that the combination of several texture features (T2WF cm.joint.entr , T2WF cm.info.corr.2 , T2WF cm.joint.var , ADCF cm.sum.avg and ADCF cm.info.corr.2) gave the highest leave-one-out-AUC of 0.87 (0.80,1). Conclusions: We identified textural features on MR images of the placenta in the region of the prior uterine scar that differentiated pregnancies with invasion severe enough to require Caesarean hysterectomy from those that did not, suggesting predictive capabilities of these radiomics features.
Ultrasound in Obstetrics & Gynecology
Electronic poster abstracts was also done personally at scientific meetings. Primary outcome was ... more Electronic poster abstracts was also done personally at scientific meetings. Primary outcome was to compare the proportion of GOs that consider the need of a third trimester ultrasound (estimation of fetal weight) for screening of FGR in low risk pregnancies and the best time to perform it with the corresponding proportion of GPs. Results: A total of 573 surveys were available for analysis, 298 corresponded to GOs and 275 to GPs. The vast majority of GOs and GPs (93%) considered that third trimester ultrasound is useful and needed for surveillance of low risk pregnancy. A higher proportion of GOs (38%) selected 35 th-37 th weeks as the best time to perform the ultrasound compared to GPs (10%) (p < 0.001). GOs (51%) consider that symphysis-fundus distance is a measurement with moderate accuracy for screening of FGR while GPs (61%) attribute a low accuracy (p < 0.001). Fifty percent (50%) of GOs consider that performing a third trimester ultrasound will have no impact on Caesarean delivery rate for fetal distress, while 41% of GPs consider that routine ultrasound will contribute to increase this rate (p < 0.001). The majority of GPs (52%) consider that routine ultrasound will contribute to diminish the admission rate to NICU while GOs revealed a dichotomy with 43% of respondents reporting that it will diminish the rate and 40% that it will have no impact. Conclusions: Varied opinions among the clinicians included in our sample reflect the controversy that remains on the best screening of FGR in low risk pregnancies. EP01.13 Importance of ultrasonographic cervical length around 20 weeks of gestation for predicting spontaneous preterm labour: an artificial neural network analysis
Ultrasound in Obstetrics & Gynecology
Electronic poster abstracts Objectives: Some fetus in second trimester with tricuspid valve malfo... more Electronic poster abstracts Objectives: Some fetus in second trimester with tricuspid valve malformation show moderate to severe tricuspid regurgitation. The ventricular function may affect by the reverse blood flow. The aim of the study is to evaluate the ventricular function of fetus with tricuspid valve malformation in second trimester by VVI. Methods: We collect 27 fetus with tricuspid valve malformation in second trimester, showing severe tricuspid regurgitation and 36 normal fetus matched with the gestation weeks. We obtain the left and right ventricular myocardial long axis integral peak velocity, strain and strain rate by VVI, then compare within and between groups. Results: The general data were no significant differences among each groups. There were significant differences in LV/RV parameters (peak velocity, strain and strain rate) between the case group and the control group. And there were also significant differences in RV parameters in the case groups, which grouped whether there is pulmonary valve regurgitation. Conclusions: The ventricular function is significantly different between the normal fetus and the fetus with tricuspid malformation, which cause severe tricuspid regurgitation. The left ventricular function has been affected by the regurgitation through the foramen oval, in the meantime the right ventricular function affected by the regurgitation induced deformation. The qualitative and quantitative measurements of prenatal fetal tricuspid regurgitation is beneficial to evaluate the effects of cardiac structure, activity and rhythm. EP09.19 The quantification of z-scores of the colour flow widths of atrioventricular valves in the fetuses with dilation of the coronary sinus
Ultrasound in Obstetrics & Gynecology
Uploads
Papers by Cristina Zanardini