Browsing by Author "Arcangeli, T."

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First-trimester ultrasound determination of chorionicity in twin pregnancy
(Wiley, 2011) Dias, T.; Arcangeli, T.; Bhide, A.; Napolitano, R.; Mahsud-Dornan, S.; Thilaganathan, B.
OBJECTIVE: To determine the accuracy of ultrasound at 11-14 weeks' gestation in the diagnosis of chorionicity in twin pregnancy. METHODS:This was a retrospective observational study of data obtained between 1999 and 2010. At the first-trimester routine ultrasound scan,chorionicity was assigned according to the number of placental masses and T or λ-signs for a single placental mass. Chorionicity was confirmed by histology or discordant sex at birth. RESULTS: A total of 648 pregnancies were assigned chorionicity by first-trimester ultrasound during the study period. Chorionicity was ascertained in 613 cases, either by histology (n = 340) or discordant sex (n = 273). Chorionicity was correctly assigned by ultrasound at 11-14 weeks in 612 of 613 pregnancies (accuracy 99.8%). Sensitivity and specificity for determining monochorionicity were 100% and 99.8%, respectively.CONCLUSIONS:First-trimester ultrasound can be used to determine chorionicity reliably by noting the number of placental masses and T or λ-signs.Determination of twin chorionicity is important and should be completed in the first trimester.
Screening for pre-eclampsia by using changes in uterine artery Doppler indices with advancing gestation
(Wiley, 2012) Napolitano, R.; Melchiorre, K.; Arcangeli, T.; Dias, T.; Bhide, A.; Thilaganathan, B.
OBJECTIVE: The aim of the study was to assess the relationship of changes in uterine artery (UtA) Doppler pulsatility indices (PI) between first and second trimesters and the subsequent development of pre-eclampsia. METHODS: A retrospective study of singleton pregnancies undergoing both first and second trimesters UtA Doppler screening between 2002 and 2009 was conducted. Multiples of median of UtA Doppler PI were used for developing indices describing UtA changes between the two trimesters. Receiver-operating characteristics curves (ROC) were calculated for multiple comparisons. RESULTS:Three thousand five hundred sixty women had UtA Doppler screening in the first and second trimesters. Eleven women were excluded because of termination of pregnancy before 24 weeks. Out of the 3549 women recruited, 126 developed Pre-eclampsia (PE; 22 early PE delivered <34 weeks and 41 preterm PE delivered <37 weeks). The best index for predicting pre-eclampsia was the difference between the mean second trimester and mean first trimester UtA PI (areas under the ROC for early PE and preterm PE of 0.851 and 0.786, respectively). CONCLUSION:Changes of UtA resistance between the first and second trimesters can be calculated as the difference between UtA PI at these gestations. The data of this study demonstrate that the difference in mean PI is the best index in predicting early PE and preterm PE.
Second-trimester assessment of gestational age in twins: validation of singleton biometry charts
(Wiley, 2011) Dias, T.; Arcangeli, T.; Bhide, A.; Mahsud-Dornan, S.; Papageorghiou, A.; Thilaganathan, B.
OBJECTIVE: To determine the accuracy of dating twin pregnancies, of between 16 and 26 weeks' gestation, using singleton head circumference (HC) formulae. METHODS: This was a retrospective study of 269 singleton and 119 twin non-anomalous pregnancies conceived by in-vitro fertilization (IVF) with a known embryo transfer date. Fetal ultrasound biometry data for HC, obtained using different formulae, were compared with expected fetal HC size for gestation calculated from the date of conception. Similar comparisons were undertaken for femur length (FL) and for transverse cerebellar diameter. RESULTS: The mean differences in HC between observed ultrasound measurements and those expected from the IVF history were small (1-4 mm) and within the measurement error for both singletons and twins for all formulae. All measurements from the larger and the smaller twins straddled those of singletons, regardless of biometry and formula used. Negative skewing of FL measurements in the smaller twin suggests that fetal growth restriction may occur at this gestation and supports the practice of dating using the HC of the larger twin. CONCLUSIONS: Singleton pregnancy HC charts can be used to date reliably twin pregnancies. The data of the study also suggest that the HC of the larger twin is the most reliable measurement for use in dating