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Biomedical subjects

M M Anceschi

Publications and source records attributed to M M Anceschi.

At least 19 recordsLinked to original sources
PubMed2003

Ultrasonographic patterns of fetal breathing movements in normal pregnancy.

OBJECTIVE: To assess through pregnancy fetal breathing movements (FBMs) patterns detected by M-mode and Doppler velocimetry technology. METHODS: In this cross-sectional study FBMs were investigated in 1882 uncomplicated pregnancies over a 4-year period. Abdominal and thoracic wall movements of fetuses between 14 and 40 weeks of gestation were studied by M-Mode scan, and color Doppler velocimetry with spectral imaging analysis was used to investigate the presence of FBMs associated with nasal fluid flow velocity waveforms (NFFVWs). RESULTS: Abdominal movements were observed in 19% of cases when gestation was less than 20 weeks and in 61% of cases when it was between 21 and 25 weeks; chest movements were significant after 21 weeks; and NFFVWs were detected at 22 weeks and increased progressively to 93% of cases at term. CONCLUSIONS: Fetal breathing movements are a complex phenomenon with a composite, progressive pattern of development during gestation.

Abdominal Wall↗
PubMed2001

The prognostic significance of acetowhitening of the vulva and HPV-DNA test. A multicentre study.

Acetowhitening of the vulva has been related to a subclinical human papillomavirus (HPV) infection. No consense has been reached about undertaking -or not- any therapy for these acetowhite changes. We have observed from our clinical experience and in a 10 years observational follow-up, that acetowhitening of the vulva regarding high risk (16-18) and low risk (6-11) HPV groups (as assessed by PCR analysis) significantly decreased; and acetowhitening areas negative to polymerase chain reaction (PCR), significantly increased from 53% (202/382) to 85% (276/325) (P<0.001). Our findings suggest that independently from HPV type and in the absence of cofactors, there is a statistically significant spontaneous remission of these areas.

Adult↗
PubMed2001

Lamellar body counts: a consensus on protocol.

Lamellar bodies, concentrically layered "packages" of phospholipid that represent the storage form of surfactant, can be counted in the platelet channel of most electronic cell counters. The lamellar body count has been used for more than a decade and performs as well as traditional phospholipid analysis as an assay for evaluating fetal lung maturity. It is preferable to phospholipid analysis because it is rapid, objective, and inexpensive and can be performed in any hospital laboratory. The current methodologies for specimen preparation vary widely among laboratories, most notably with respect to centrifugation, resulting in differences in maturity cutoffs used. Our goal was to establish a consensus regarding a standardized methodology for the lamellar body count. Institutions that previously had published their results with lamellar body counts were invited to contribute. The consensus of the four participating institutions includes the following: centrifugation is not a necessary step and should be abandoned, maturity is suggested by a count of 50,000/microL or greater, and immaturity is suggested by a count of 15,000/microL or lower. As the lamellar body count gains wider acceptance as a primary assay for assessing fetal lung maturity, the test must be performed uniformly and accurately, given the implications of acting on a falsely negative test resulting from improper methodology.

Amniotic Fluid↗
PubMed2001

Effect of antenatal betamethasone therapy on maternal-fetal Doppler velocimetry.

BACKGROUND: The effect of antenatal betamethasone on fetal parameters includes a transient reduction of FHR variation and of fetal body movements. An effect on maternal-fetal blood flow has also been shown, with non-univocal results. AIMS: To evaluate the effect of antenatal betamethasone in third trimester singleton high-risk pregnancies by Doppler technology. SUBJECTS AND METHODS: Thirty-six pregnant women who received a full course of betamethasone (12 mg i.m. two times, 24 h apart) were studied. The Doppler examination included the assessment of the pulsatility index (PI) of the umbilical artery (UA PI), the middle cerebral artery (MCA PI) and of resistance index of uterine arteries (Ut RI) before treatment, and 48 and 96 h after second dose of betamethasone. RESULTS: No significant variation was noted in UA PI through betamethasone therapy. MCA PI decreased significantly 48 h from the last injection of betamethasone (P=0.002), and returned to basal values at 96 h. No difference was found for the other Doppler parameters examined. When serial Doppler studies were analyzed according to the gestational age, in the group <32 weeks' gestation, MCA PI decreased significantly after 48 h (P<0.006) and returned to pre-treatment values after 96 h from the last betamethasone dose. Conversely, no difference was found in Doppler serial measurements in any of the analyzed districts in the subgroup > or =32 weeks. CONCLUSION: Betamethasone treatment is associated with a significant, although transient, reduction of MCA PI, especially at gestational ages <32 weeks'.

Arteries↗
PubMed2001

The combination of computerized cardiotocography and amniotic fluid index for the prediction of neonatal acidemia at birth: a modified biophysical profile.

OBJECTIVE: To study the combination of computerized cardiotocography (cCTG) and the amniotic fluid index (AFI) in the prediction of neonatal acidemia at birth. METHODS: A total of 89 singleton third-trimester high-risk pregnancies delivered by Cesarean section, with an AFI evaluated within 24 h from birth, and an antepartum cCTG performed within 6 h from delivery, were studied. The score was the sum of values for AFI (oligo/anhydramnios = 1, normal = 0) and cCTG (Dawes-Redman criteria, not met = 1, met = 0). The endpoint was to predict an abnormal neonatal outcome as defined by an umbilical artery pH of < or = 7.2. RESULTS: Fifteen neonates had an umbilical artery pH of < 7.2. The combination of cCTG + AFI score was able to predict pH values (< or = 7.20) with an OR = 2.83 (p < 0.02). The diagnostic accuracy of the combination of cCTG + AFI was as follows: sensitivity 80%, specificity 58%, positive predictive value 28%, negative predictive value 83%. COMMENT: We suggest that the cCTG + AFI score may be of value in the prediction of neonatal acidemia and help in the management of third-trimester high-risk pregnancies.

Acidosis↗
PubMed2000

[Pulsatility index of the umbilical artery and fetal movements/hour in the prediction of neonatal acidemia in high risk pregnancy].

OBJECTIVE: The aim of this study was to correlate antepartum computerized cardiotocography (cCTG) and Doppler velocimetry parameters to umbilical blood gas analysis (UBGA) value and Apgar score 1-5 min as neonatal outcome endpoints. METHODS: Forty-eight third trimester single high risk pregnancies were considered for this study, with a cCTG performed within 24 hrs from delivery, a complete Doppler velocimetry study performed within 48 hrs from delivery and an UBGA evaluation at birth and before the first breath. RESULTS: When we analyzed the backward stepwise regression of each Doppler velocimetry and cCTG parameters versus UBGA parameters as dependent variables, we found that the linear combination of fetal heart rate (FHR) (p < 0.001), high variation episodes in min (HV) (p < 0.01) and low variation episodes in msec (LV) (p < 0.03) was able to predict pO2 values. When performing a logistic regression of data for every single parameter of FHR tracing and Doppler velocimetry against pH < 7.2 and Becf < -4 as endpoints, we found that only umbilical artery pulsatility index (UA PI) was able to predict umbilical artery pH (O.R.: 8.1 [1.07-61.8]) and only fetal movements (FM) from FHR tracing values was able to predict UA pH (O.R.: 0.94 [0.89-0.99]). Further analysis considers a cut-off for the prediction of UA pH < 7.2 at birth a value at > or = 1.35 for UA PI and at < or = 12 for FM/h. The combination of UA PI > 1.35 and FM/h < 12 did not improve the ability to predict acidemia at birth. CONCLUSION: The validity of our data from the clinical point of view suggests that in third trimester high risk pregnancies, an UA PI > or = 1.35 and/or FM/h < or = 12 (in a FHR tracing > or = 40 min) may represent a risk of 70% acidemia in neonates.

Blood Gas Analysis↗
PubMed1999

Hyperimmunoglobulin therapy for a twin fetus with cytomegalovirus infection and growth restriction.

OBJECTIVE: Cytomegalovirus immunoglobulin was administered to a pregnant woman with primary cytomegalovirus infection and placental involvement of 1 twin fetus, in whom growth restriction had developed. STUDY DESIGN: Inhibition of viral activity was attempted by administration of high-titer cytomegalovirus neutralizing antibodies for therapy of the involved fetoplacental unit and prevention of cytomegalovirus infection in the uninfected twin fetus. RESULTS: After cytomegalovirus immunoglobulin infusions the placental edema decreased and the infected fetus started to grow once again, showing at birth only hepatosplenomegaly associated with viruria and cytomegalovirus deoxyribonucleic acidemia. Moreover, cytomegalovirus immunoglobulin G avidity increased and cell-mediated immunity improved. The other twin, who had negative results of cytomegalovirus culture and deoxyribonucleic acid detection at birth, was found to have cytomegalovirus deoxyribonucleic acid in the urine after 1 week. From the age of 9 months, however, both twins had persistent negative results of cytomegalovirus deoxyribonucleic acid detection. CONCLUSION: Although large-scale studies are needed to establish the real efficacy and the best therapeutic regimen, cytomegalovirus immunoglobulin may be considered for treatment or prevention of fetal cytomegalovirus infection.

Adult↗
PubMed1999

Antepartum computerized CTG and neonatal acid-base status at birth.

OBJECTIVE: To assess the correlation between individual computerized cardiotocography (cCTG) variables and acid-base status at birth before the first breathing in uncomplicated term pregnancy delivered by cesarean section. STUDY DESIGN: A retrospective cohort study. SUBJECTS AND METHODS: Seventy singleton normal pregnancies delivered by elective cesarean section. The last antepartum cCTG performed within 4 h from delivery by the System 8002 (Oxford Sonicaid, UK) was correlated to umbilical blood gas analysis (UBGA) values (AVL compact 2 analyser). Considering blood gas analysis values as dependent and individual cCTG parameters as independent variables the best regression subsets followed by a backward stepwise linear regression was used. RESULTS: There was no significant correlation of cCTG parameters with any of the values of blood gas analysis. However, when neonatal conditions, as expressed by arterial pH > 7.20, Becf > - 4.0 mmol/l and Apgar score at 5 min > 7, were taken as an end-point, they could be predicted by Acc15 and FM/hour (sensitivity: 35%, positive predictive value: 92%, cut-off > 7 and 67%, 92%, > 21, respectively). CONCLUSION: In uncomplicated pregnancies, the prospect of a vigorous newborn seems particularly associated with the presence of Acc > 15 and FM/hour > 21.

Acid-Base Equilibrium↗
PubMed1999

Prenatal diagnosis of fetal cytomegalovirus infection after primary or recurrent maternal infection.

OBJECTIVE: To determine the reliability of prenatal diagnosis of cytomegalovirus infection in women with primary or recurrent infection. METHODS: Amniotic fluid (AF) samples from 117 pregnant women were evaluated for cytomegalovirus culture and cytomegalovirus-DNA detection. Neonatal and postnatal samples also were examined to confirm or exclude transmission of maternal-fetal cytomegalovirus infection. RESULTS: Of 25 women with primary cytomegalovirus infection, 13 (52%) had cytomegalovirus-positive AF samples by polymerase chain reaction (PCR), nine of which also were diagnosed by culture. All eight neonates born to mothers whose AF was cytomegalovirus-positive by PCR and culture were cytomegalovirus infected, and three were symptomatic. One aborted fetus had cytomegalovirus-DNAemia. Of four women with cytomegalovirus-positive AF samples by PCR only, two delivered asymptomatic cytomegalovirus-infected neonates and two aborted (one fetus had cytomegalovirus encephalopathy). Of 45 mothers with recurrent infection, two with AF cytomegalovirus-positive by PCR and culture, and another with cytomegalovirus-positive AF samples by PCR only, aborted cytomegalovirus-DNA-positive fetuses. Of the other seven women with cytomegalovirus-positive AF samples by PCR only, two delivered asymptomatic cytomegalovirus-infected neonates, two delivered neonates cytomegalovirus-positive by PCR only (one was symptomatic), and three delivered infants cytomegalovirus-negative by PCR and culture. All 47 mothers with nonactive cytomegalovirus infection and cytomegalovirus-negative AF samples had uninfected neonates. Polymerase chain reaction was superior to viral culture in sensitivity and negative predictive value (100% compared with 57% and 94%, respectively) but was lower in specificity and positive predictive value (97% and 83%, respectively, compared with 100%). CONCLUSION: Prenatal diagnosis of fetal cytomegalovirus infection should include PCR in addition to viral culture, particularly for congenital cytomegalovirus infections following maternal recurrence.

Adult↗
PubMed1999

Fetal lung maturity in pregnancies complicated by insulin-dependent and gestational diabetes: a matched cohort study.

OBJECTIVE: To study fetal lung maturity (FLM) as determined by amniotic fluid (AF) tests in diabetic pregnancies (DP) under euglycemic metabolic control, in comparison with matched controls (C). PATIENTS AND METHODS: From 514 consecutive pregnancies where amniocentesis was performed for FLM assessment, we selected 45 glycemic controlled DP. Nineteen DP were Type I (IDDM) and 26 pregnancies were diagnosed Type III (GDM). Cases were matched to C by therapy with corticosteroids, gestational age at amniocentesis, pregnancy complications other than diabetes and gender. FLM was determined by the shake test and lamellar bodies (LB) count, lecithin/sphingomyelin (L/S) ratio (planimetric and stechiometric) and phosphatidylglycerol presence (PG). DP were further sub-divided according to gestational age period at amniocentesis, type of diabetes, associated therapy and fetal malformations. RESULTS: RDS (n=2) and neonatal wet lung (n=5) were diagnosed in neonates from diabetic mothers. We found no statistical difference when comparing FLM indices between DP and C groups: shake test 3.1:1+/-1.2 vs. 2.7:1+/-1.2, P<0.40; planimetric L/S 3.4+/-1.4 vs. 3.1+/-2.0, P<0.27; stechiometric L/S 8.2+/-7.4 vs. 7.1+/-6.1, P<0.54; percentage of PG positivity 57% vs. 46%, P<0.13; lamellar bodies count (X10(3)/microl) 42.8+/-36.9 vs. 41.5+/-30.4, P<0.72. No differences were found between DP and controls for subgroups according to gestational age, type of Diabetes (IDDM or GDM), congenital lesions and associated therapy. CONCLUSIONS: In euglycemic, metabolically controlled diabetic patients FLM is not delayed, however an increased risk for neonatal wet lung should be considered.

Amniocentesis↗
PubMed1999

The effect of primary cytomegalovirus infection on fetal lung maturity indices.

The aim of this study was to evaluate the impact of primary cytomegalovirus (CMV) infection on fetal pulmonary surfactant production as assessed by different tests for the diagnosis of fetal lung maturity (FLM) on amniotic fluid (AF). A cross-sectional cohort study. AF samples from 11 pregnant women with primary CMV infection were examined for FLM between the 26th and 37th week of gestation. Normal pregnancies (n = 11) were matched for gestational age at amniocentesis and at delivery, birth weight, Apgar score and gender sex. FLM was assessed by planimetric and stoichiometric lecithin to sphingomyelin ratio (L/S), phosphatidylglycerol (PG) presence and lamellar bodies count (LB). Maternal immunological parameters (T-cells, natural killer [NK] activity) were also considered. Mean planimetric L/S ratio (4.2+/-2.1 vs 2.3+/-0.7, P < 0.01) and LB count (42.6 x 10(3)+/-19.0 x 10(3) vs 16.8 x 10(3)+/-11.5 x 10(3), P < 0.004) were higher in controls when compared to CMV infected patients. Moreover, planimetric L/S ratio was higher in five CMV non-infected babies compared to six CMV-infected babies (3.1+/-1.3 vs 1.9+/-0.8, P < 0.05). When FLM was related to maternal immunological results, planimetric and stoichiometric L/S and LBs count were negatively correlated with CD8+ T-cells (r = -0.8, P < 0.05; r = -0.9, P < 0.05; r = -0.9, P < 0.01, respectively); LBs was also negatively correlated with CD14+ T-cells (r = -0.8, P < 0.03). In contrast, a positive correlation was found between stoichiometric L/S and NK activity (r = 0.9, P > 0.01). Maternal primary CMV infection impairs FLM indices as a possible result of reduced surfactant release and/or production. Significant correlations were found between immunity status of CMV-infected mothers and FLM tests.

Amniotic Fluid↗
PubMed1999

The biophysical/biochemical test. A new marker of fetal lung maturity in borderline cases.

OBJECTIVE: To assess the diagnostic accuracy of the combination of a biophysical (lamellar body count [LB]) with a biochemical test lecithin/sphingomyelin ratio (L/S) for the evaluation of fetal lung maturity (FLM) in cases of intermediate-borderline pulmonary maturity. STUDY DESIGN: We studied 105 cases with one or both intermediate (2.1-2.4:1 for L/S and/or 15,000-19,000/microL for LB) or borderline (2.5:1 for L/S and/or 20,000/microL for LB count) FLM indices and no phosphatidylglycerol who delivered within 72 hours of amniocentesis, excluding multiple gestation and contaminated amniotic fluid samples. The biophysical x biochemical marker (B x B) was calculated by multiplying L/S by the corresponding LB, then dividing by 10(3). By using the ROC curve, a cutoff of 50 was found. RESULTS: B x B values were lower in respiratory distress syndrome (RDS) than in the non-RDS group (30 [23-41] vs. 52 [50-70], P < .001; median, 25-75%). All RDS cases had a B x B value < 50. Diagnostic accuracy for B x B was: sensitivity, 100%; specificity, 83%; positive predictive value, 61%; negative predictive value, 100%. Sensitivity and positive predictive values were higher for B x B than L/S. CONCLUSION: B x B may be a useful tool for cases with borderline FLM.

Amniocentesis↗
PubMed1998

The effect of glucocorticoid therapy on fetal lung maturity indices in hypertensive pregnancies.

OBJECTIVE: To assess fetal lung maturity tests in hypertensive pregnancies and to examine the effect of glucocorticoid therapy. METHODS: In a cohort study involving 68 pregnant women with hypertension, 34 received antenatal betamethasone before amniocentesis and 34 did not. Controls were 68 women with uncomplicated pregnancies, matched for gestational age at amniocentesis and fetal gender. Amniotic fluid (AF) samples were analyzed by lamellar body count, planimetric and stechiometric lecithin-sphingomyelin ratio (L/S), and presence of phosphatidylglycerol. RESULTS: Fetal lung maturity, as determined by lamellar body counts and by planimetric L/S, was lower in hypertensive pregnancies not treated with steroids than in controls (19,600 +/- 14,500 versus 39,800 +/- 22,700, P < .009, and 1.9 +/- 0.6 versus 3.9 +/- 1.8, P < .01, respectively). In the period of 24 to 33 weeks' gestation, the percentage of untreated pregnancies with mature lamellar body counts and mature L/S was significantly lower than that of controls (13% versus 33%, P < .001; 6% versus 40%, P < .002 and P < .003, respectively). In contrast, in patients treated with betamethasone, the percentage of cases with mature indices for both tests was not significantly different from that of controls, but was higher than that of untreated hypertensive patients (40% versus 13%, P < .001; 33% versus 6%, P < .001). Phosphatidylglycerol did not differ among groups. From 34 to 38 weeks, no difference was found in the percentage of mature cases for lamellar bodies in pregnant women with hypertension not treated with steroids in comparison with controls (68% versus 84%), nor between cases treated and controls (74% versus 84%). In the same period, no difference in L/S values was found among groups, and the percentage of cases positive for phosphatidylglycerol was lower in hypertensive pregnancies than in controls (47% versus 95%, P < .001) and was not affected by steroid treatment (37% versus 95%, P < .001). CONCLUSION: Fetal lung maturity, as reflected in AF tests, is delayed in hypertensive pregnant patients, and steroids increase all lung maturity indices except phosphatidylglycerol between 24 and 33 weeks' gestation.

Adult↗
PubMed1998

The effect of polyhydramnios and oligohydramnios on fetal lung maturity indexes.

The influence of amniotic fluid (AF) volume on common fetal lung maturity (FLM) indices was evaluated. Cases diagnosed with altered AF volume as estimated by ultrasound (n = 71; polyhydramnios = 33, oligohydramnios = 38) were matched to controls by: gestational age (GA) at amniocentesis, GA at delivery, neonatal weight, sex, and pregnancy complication. FLM was assessed on AF specimens obtained by transabdominal amniocentesis by planimetric and stechiometric L/S, phosphatidylglycerol (PG), and lamellar bodies counts (LB). In cases with polyhydramnios, L/S ratios (planimetric and stechiometric) were statistically lower in cases with respect to controls (2.1 +/- 0.9 vs. 2.8 +/- 1.0, p = 0.007, and 4.8 +/- 2.4 vs. 5.9 +/- 2.7, p < 0.04; respectively). Absence of PG was more frequent in (70.8% vs. 50%, p = 0.02). LB counts were lower in cases than in controls (15.5 +/- 12.1 x 10(3)/microL vs. 21.9 +/- 14.3 x 10(3)/microL, p < 0.05). In cases with oligohydramnios, no difference was found for planimetric and stechiometric L/S in comparison to controls (2.6 +/- 1.2 vs. 2.6 +/- 1.0, N.S. and 4.9 +/- 2.1 vs. 4.6 +/- 1.8, N.S.; respectively), absence of PG (62.5% vs. 50%, N.S.), and LB counts (27.2 x 10(3)/microL +/- 12.8 x 10(3)/microL vs. 28.6 x 10(3)/microL +/- 24.1 x 10(3)/microL, N.S.). In conclusion, oligohydramnios was not associated with altered FLM indices; in cases with polyhydramnios all FLM indices were significantly lower.

Adult↗
PubMed1997

Bone mass density in post-menopausal women.

OBJECTIVES: To evaluate the effect of age, years since menopause and body weight on bone mass density (BMD) in 283 patients. METHODS: Bone mass density was assessed by bone computerized mineralometry at two sites of the forearm. RESULTS: The mean distal BMD and ultra BMD in the postmenopausal group were negatively correlated with age (P < 0.001, r = -0.48 and P < 0.001, r = -0.50, respectively) and years since menopause (P < 0.001, r = -0.32 and P < 0.001, r = -0.33, respectively). When body-mass index was regressed against distal and ultra distal BMD, positive correlations were found (P = 0.008 and P = 0.007). CONCLUSIONS: From our data, forearm computerized mineralometry seems to be a reliable method for the evaluation of the effects of age and body-mass index on bone mass.

Adult↗
PubMed1997

Intraamniotic surfactant for prevention of neonatal respiratory distress syndrome (IRDS): rationale and personal experience.

OBJECTIVE: To evaluate the efficacy of intramniotic instillation of supplementary surfactant for the prophylaxis of neonatal IRDS in an emergency obstetric setting. STUDY DESIGN: Supplementary natural surfactant (SS) was administered intra-amniotically (80 mg in 1 ml) under ultrasound guidance in the proximity of the fetal nostrils and mouth in six pregnant women at 24-32 weeks gestation, with immature amniotic fluid indices of fetal lung maturity, and whose delivery was imminent because of severe fetal distress, deteriorating maternal conditions, or refractory vaginal bleeding. The administration of SS was preceded by IV aminophylline to the mother (a bolus of 240 mg over 10 min, and a maintenance dose of 0.02-0.1 mg kg-1 min-1) in order to elicit sustained fetal breathing movements. RESULTS: The clinical conditions of the six newborn infants were good with no respiratory problems in four cases, and with mild IRDS in the remaining two, which, however, resolved uneventfully. CONCLUSIONS: It is suggested that this prophylactic approach has a great potential for becoming a reliable option for the antenatal prevention of IRDS.

Amnion↗