Otilia Gonzalez

Introduction: Our objective was to compare the predictive performance of the Fetal Medicine Foundation (FMF) competing‐risk model for preterm preeclampsia (PE) screening using placental growth factor (PlGF) measurements obtained at 11–13⁺⁶ weeks versus before 11 weeks of gestation.Material and Methods: This multicenter prospective cohort study included women with singleton pregnancies attending their routine first‐trimester assessment (11⁺⁰ to 13⁺⁶ weeks) in four hospitals across Spain from 2021 to 2023. Maternal characteristics, biophysical parameters (mean arterial pressure and uterine artery pulsatility index), and biochemical markers (PlGF measured twice in each woman, before 11 weeks and between 11 and 13⁺⁶ weeks) were assessed. Risk assessment for preterm PE was estimated by the FMF algorithm. Predictive performance was evaluated by comparing detection rates (DR) at different fixed screen‐positive rates (SPR), area under the receiver‐operating characteristic curve (AUROC), and calibration plots. Statistical adjustments were made to account for prophylactic aspirin use.Results: The study population comprised 3448 women, including 19 (0.55%) who developed preterm preeclampsia and 47 (1.36%) who developed term preeclampsia. At 10% SPR, the detection rates (adjusted for aspirin use) were highest for the model incorporating PlGF between 11 and 13⁺⁶ weeks (72.9%; 95% CI, 42.2%–90.9%), compared to models with PlGF before 11 weeks (66.4%; 95% CI, 39.9%–85.4%) and without PlGF (66.0%; 95% CI, 39.3%–85.3%). Similar trends were observed at higher SPR thresholds. The best discrimination (AUROC: 0.863; 95% CI, 0.754–0.971) and calibration were also achieved by the model using PlGF between 11 and 13⁺⁶ weeks.Conclusions: PlGF measured before 11 weeks did not improve preterm PE screening performance. Due to the small number of cases, further validation is needed. Maternal and biophysical markers remain a viable alternative when PlGF is unavailable.

Objectives: To evaluate the reproducibility of measurements of breech progression angle (BPA) by transperineal ultrasound (US) before and after its standardization by applying an image-based checklist. Methods: Eighteen 3-dimensional (3D) volumes of transperineal US from women at 36–40 weeks of gestation with a singleton fetus in breech presentation were provided to eight operators from four maternity units in Spain and Italy. All operators measured the BPA using 3D US volume processing software, and interobserver reproducibility was evaluated using the intraclass correlation coefficient (ICC). Following an online live review of all measurements by the operators, and the identification of sources of disagreement, an image-based scoring system for BPA measurement was collaboratively developed. The checklist included the following: (1) acquisition in the midsagittal plane, avoiding the posterior shadow of the pubic ramus; (2) visualization of the complete “almond-shaped” pubic symphysis; (3) drawing a first line along the longitudinal axis of the symphysis, dividing it equally; (4) extending this line to the inferior edge of the bone; and (5) drawing a second line tangentially from the lower edge of the symphysis to the lowest recognizable fetal part. The BPA measurements were then repeated using this checklist, and reproducibility was reassessed. Results: Eighteen volumes were analyzed by the eight operators, achieving a moderate reproducibility (ICC: 0.70, 95% confidence interval (CI): 0.48 to 0.86). A score was developed to include a series of landmarks for the appropriate assessment of BPA. Subsequently, the same eighteen volumes were reassessed using the new score, resulting in improved reproducibility (ICC: 0.81, 95% CI: 0.66 to 0.92). Conclusions: The measurement of BPA is feasible and reproducible when using a standardized image-based score.

Pregnant women with SARS-CoV-2 infection have a significantly higher risk of maternal death, ICU admission, preterm delivery, and stillbirth compared to those without infection. Additionally, the risk of preeclampsia (PE) increases in pregnant women infected with SARS-CoV-2, particularly in severe cases. The association between COVID-19 and PE is likely attributed to various mechanisms, including direct effects of the virus on trophoblast function and the arterial wall, exaggerated inflammatory response in pregnant women, local inflammation leading to placental ischemia, SARS-CoV-2-related myocardial injury, cytokine storm, and thrombotic microangiopathy. This paper aims to explore the similarities between PE and SARS-CoV-2 infection, considering COVID-19 as a valuable study model. By examining these parallels, we can enhance our knowledge and comprehension of PE. We wish to emphasize the potential for COVID-19-induced myocardial injury in pregnant women and its connection to the increased maternal mortality rate.

In this review, we aimed to understand the relationship between SARS-CoV-2 infection and preeclampsia severity in infected pregnant women. Pregnant women with SARS- CoV-2 infection have been shown to have a significantly increased risk of maternal death, ICU admission, preterm delivery, and stillbirth compared with those without infection. The risk of preeclampsia also increases in pregnant women infected with SARS-CoV-2, particularly in those with severe symptoms. We emphasize the im-portance of specialized clinical management to prevent poor pregnancy outcomes in this situation. The association between COVID-19 and preeclampsia (PE) is likely due to multiple mechanisms, including the direct effects of the virus on trophoblast function and the arterial wall, acute atherosis, local inflammation leading to pla-cental ischemia, exaggerated inflammatory responses in pregnant women, SARS-CoV-2-related myocardial injury, cytokine storm, and thrombotic microan-giopathy. Emphasis has been placed on the potential impact of COVID-19 on pregnant women, specifically in relation to thrombotic complications, placental dysfunction, and cardiovascular dysfunction. Undoubtedly, one of the diagnostic tools to differentiate between COVID-19-induced preeclampsia-like syndrome and true preeclampsia is the use of biomarkers, such as the sFlt-1/PlGF ratio. We wish to highlight the potential for COVID-19-induced myocardial injury in pregnant women and the associated in-crease in maternal mortality rate. Vaccination against COVID-19 in the general population and in pregnant women in particular, drastically reduced the severity of the disease. There is an urgent need to continue the follow-up of these women and their children to detect the appearance of sequelae of the disease or peristent COVID 19

Objective: To investigate fetal‐survival rates following laser surgery for twin‐to‐twin transfusion syndrome (TTTS) and the impact of Doppler analysis.Methods: The present retrospective single‐center study included data from patients with pregnancies exhibiting TTTS treated with fetoscopic laser surgery between January 1, 2007, and December 31, 2016. Perinatal outcomes were examined and variables were compared between the donor and recipient fetuses that survived and died, respectively.Results: There were 86 pregnancies exhibiting TTTS treated with fetoscopic laser surgery included in the study. The median length of pregnancy at the time of surgery was 21.1 weeks. Both twin fetuses and at least one fetus survived in 61 (71%) and 73 (85%) pregnancies, respectively. Among recipient fetuses, ductus venosus a‐wave anomalies (P=0.026), shorter cervical length (P=0.044), and a greater than 25% discrepancy in the estimated weight of the twin fetuses (P=0.045) were associated with reduced survival.Conclusion: Among pregnancies exhibiting TTTS, laser surgery was associated with significant dual‐fetus survival. Preoperative ductus venosus anomalies were associated with lower survival among recipient fetuses, and 1‐week postsurgical ultrasonography data demonstrated lower survival among recipient fetuses with persistent anomalous ductus venosus compared with normalized ductus venosus.

A sensor based on torsional waves is proposed, designed and validated to quantify elastic constants of soft tissue. The proposed transducer design is able to deploy a shear wave elastography technique that accurately quantifies the shear viscoelastic moduli of the tissue, which, as opposed to compression waves, are strongly dependent on the stroma architecture, thus serving as a new biomarker.