Elisenda Eixarch

Bio: Elisenda Eixarch is an academic researcher from University of Barcelona. The author has contributed to research in topics: Gestational age & Medicine. The author has an hindex of 32, co-authored 152 publications receiving 4297 citations. Previous affiliations of Elisenda Eixarch include Imperial College London & Hospital Sant Joan de Déu Barcelona.

OC07.05: Incidence and clinical implications of unintended septostomy after fetoscopic laser therapy for twin–twin transfusion syndrome

Abstract: Objectives: Fetoscopic SLP improves outcome in TTTS by promoting resolution of cardiovascular (CV) manifestations. The time course and pattern of disease regression is unknown. We sought to investigate the nature of CV disease regression after SLP by analysis of individual cardiovascular elements through application of the CHOP score for TTTS. Methods: The CHOP score is a fetal echo derived system for detailed CV characterization of TTTS. Elements of the Score include 4 domains in the recipient: 1) ventricular characteristics of dilation, hypertrophy, systolic dysfunction, 2) atrioventricular valve (AV) regurgitation, 3) diastolic properties of Doppler AV inflow (double or single peak), ductus venosus, and umbilical venous flow, 4) right ventricular outflow tract obstruction (RVOTO) as assessed by pulmonary artery measuring smaller than aorta or pulmonary stenosis/atresia; and in the donor, evaluation of umbilical artery diastolic flow. In 32 twin pairs individual elements of the Score as well as myocardial performance indices (MPI) were measured at 1 day and 1 week after SLP and compared to pre-op values using paired t-test. Results: Overall score was unchanged at 1 day (pre-op 6.6 + 4.0 vs. 6.0 + 3.8, P = NS) but significantly improved by 1 week (4.2 + 4.1, P < 0.001) after SLP. At 1 day, there was no improvement in systolic or diastolic parameters and AV regurgitation worsened, however there was slight improvement in RVOTO (P < 0.05) and recipient RV and LV MPI (P = 0.02). At 1 week, improvements in ventricular dilation (P = 0.01), hypertrophy (P = 0.01) and all of the diastolic parameters were noted, with further improvement in RVOTO (P = 0.002) and recipient RV and LV MPI (P < 0.01). Systolic performance and AV regurgitation did not improve. Conclusions: Minimal improvement is seen 1 day after SLP, however diastolic CV elements, but not systolic, improve substantially at 1 week. Acute diastolic relaxation of the recipient right ventricle after SLP may improve filling and result in an increase in pulmonary artery diameter.

Acute Coronary Artery Vasospasm Associated with Misoprostol for Termination of Pregnancy

Abstract: Prostaglandin E1 analogues, gemeprost and misoprostol, are the most widely used drugs for medical termination of pregnancy within the first two trimesters of pregnancy. Gemeprost has been r

Analysis of maturation features in fetal brain ultrasound via artificial intelligence for the estimation of gestational age.

Abstract: Background Optimal prenatal care relies on accurate gestational age dating. After the first trimester, the accuracy of current gestational age estimation methods diminishes with increasing gestational age. Considering that, in many countries, access to first trimester crown rump length is still difficult owing to late booking, infrequent access to prenatal care, and unavailability of early ultrasound examination, the development of accurate methods for gestational age estimation in the second and third trimester of pregnancy remains an unsolved challenge in fetal medicine. Objective This study aimed to evaluate the performance of an artificial intelligence method based on automated analysis of fetal brain morphology on standard cranial ultrasound sections to estimate the gestational age in second and third trimester fetuses compared with the current formulas using standard fetal biometry. Study Design Standard transthalamic axial plane images from a total of 1394 patients undergoing routine fetal ultrasound were used to develop an artificial intelligence method to automatically estimate gestational age from the analysis of fetal brain information. We compared its performance—as stand alone or in combination with fetal biometric parameters—against 4 currently used fetal biometry formulas on a series of 3065 scans from 1992 patients undergoing second (n=1761) or third trimester (n=1298) routine ultrasound, with known gestational age estimated from crown rump length in the first trimester. Results Overall, 95% confidence interval of the error in gestational age estimation was 14.2 days for the artificial intelligence method alone and 11.0 when used in combination with fetal biometric parameters, compared with 12.9 days of the best method using standard biometrics alone. In the third trimester, the lower 95% confidence interval errors were 14.3 days for artificial intelligence in combination with biometric parameters and 17 days for fetal biometrics, whereas in the second trimester, the 95% confidence interval error was 6.7 and 7, respectively. The performance differences were even larger in the small-for-gestational-age fetuses group (14.8 and 18.5, respectively). Conclusion An automated artificial intelligence method using standard sonographic fetal planes yielded similar or lower error in gestational age estimation compared with fetal biometric parameters, especially in the third trimester. These results support further research to improve the performance of these methods in larger studies.

Gender-Specific Antenatal Growth Reference Charts in Monochorionic Twins.

Abstract: Objective To create antenatal gender-specific reference growth charts in uncomplicated monochorionic diamniotic twins. Materials and methods This is a prospective longitudinal study in which uncomplicated monochorionic (MC) twin pregnancies were included from 23 + 4 weeks of gestation onwards. Estimated fetal weight (EFW) and biometric parameters (biparietal diameter, head circumference, abdominal circumference, and femur length) were evaluated in both fetuses every 2 weeks using standardized methodology. Maternal and fetal complications were excluded. Charts were fitted for each biometric parameter and EFW in relation to gestational age and fetal gender using multilevel mixed models. Results The final analysis included a total of 456 ultrasound examinations in 62 MC twins, with a mean of 7 scans per pregnancy (range 5-8). The mean as well as 5th and 95th percentiles of each biometric parameter and EFW were adjusted in relation to gender and gestational age between 24 and 37 weeks of gestation. Male fetuses have higher reference values than females, and the disparity is larger in the upper centiles of the distribution. Discussion We provide gender-specific reference growth charts for MC twins. We suggest that these charts will improve prenatal MC twin assessment and surveillance, with a more accurate classification of normal or growth-restricted fetuses adjusted per sex.

BrainNet Viewer: a network visualization tool for human brain connectomics.

Abstract: The human brain is a complex system whose topological organization can be represented using connectomics. Recent studies have shown that human connectomes can be constructed using various neuroimaging technologies and further characterized using sophisticated analytic strategies, such as graph theory. These methods reveal the intriguing topological architectures of human brain networks in healthy populations and explore the changes throughout normal development and aging and under various pathological conditions. However, given the huge complexity of this methodology, toolboxes for graph-based network visualization are still lacking. Here, using MATLAB with a graphical user interface (GUI), we developed a graph-theoretical network visualization toolbox, called BrainNet Viewer, to illustrate human connectomes as ball-and-stick models. Within this toolbox, several combinations of defined files with connectome information can be loaded to display different combinations of brain surface, nodes and edges. In addition, display properties, such as the color and size of network elements or the layout of the figure, can be adjusted within a comprehensive but easy-to-use settings panel. Moreover, BrainNet Viewer draws the brain surface, nodes and edges in sequence and displays brain networks in multiple views, as required by the user. The figure can be manipulated with certain interaction functions to display more detailed information. Furthermore, the figures can be exported as commonly used image file formats or demonstration video for further use. BrainNet Viewer helps researchers to visualize brain networks in an easy, flexible and quick manner, and this software is freely available on the NITRC website (www.nitrc.org/projects/bnv/).

A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants

Abstract: The aim of this study was to revise the 2003 Fenton Preterm Growth Chart, specifically to: a) harmonize the preterm growth chart with the new World Health Organization (WHO) Growth Standard, b) smooth the data between the preterm and WHO estimates, informed by the Preterm Multicentre Growth (PreM Growth) study while maintaining data integrity from 22 to 36 and at 50 weeks, and to c) re-scale the chart x-axis to actual age (rather than completed weeks) to support growth monitoring. Systematic review, meta-analysis, and growth chart development. We systematically searched published and unpublished literature to find population-based preterm size at birth measurement (weight, length, and/or head circumference) references, from developed countries with: Corrected gestational ages through infant assessment and/or statistical correction; Data percentiles as low as 24 weeks gestational age or lower; Sample with greater than 500 infants less than 30 weeks. Growth curves for males and females were produced using cubic splines to 50 weeks post menstrual age. LMS parameters (skew, median, and standard deviation) were calculated. Six large population-based surveys of size at preterm birth representing 3,986,456 births (34,639 births < 30 weeks) from countries Germany, United States, Italy, Australia, Scotland, and Canada were combined in meta-analyses. Smooth growth chart curves were developed, while ensuring close agreement with the data between 24 and 36 weeks and at 50 weeks. The revised sex-specific actual-age growth charts are based on the recommended growth goal for preterm infants, the fetus, followed by the term infant. These preterm growth charts, with the disjunction between these datasets smoothing informed by the international PreM Growth study, may support an improved transition of preterm infant growth monitoring to the WHO growth charts.

Consensus definition of fetal growth restriction: a Delphi procedure

Abstract: Objective To determine, by expert consensus, a definition for early and late fetal growth restriction (FGR) through a Delphi procedure. Method A Delphi survey was conducted among an international panel of experts on FGR. Panel members were provided with 18 literature-based parameters for defining FGR and were asked to rate the importance of these parameters for the diagnosis of both early and late FGR on a 5-point Likert scale. Parameters were described as solitary parameters (parameters that are sufficient to diagnose FGR, even if all other parameters are normal) and contributory parameters (parameters that require other abnormal parameter(s) to be present for the diagnosis of FGR). Consensus was sought to determine the cut-off values for accepted parameters. Results A total of 106 experts were approached, of whom 56 agreed to participate and entered the first round, and 45 (80%) completed all four rounds. For early FGR ( 95th centile in either the UA or uterine artery) were agreed upon. For late FGR (≥ 32 weeks), two solitary parameters (AC or EFW two quartiles on growth charts and cerebroplacental ratio 95th centile) were defined. Conclusion Consensus-based definitions for early and late FGR, as well as cut-off values for parameters involved, were agreed upon by a panel of experts. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.