Narcís Masoller

Bio: Narcís Masoller is an academic researcher from University of Barcelona. The author has contributed to research in topics: Medicine & Fetus. The author has an hindex of 13, co-authored 31 publications receiving 553 citations. Previous affiliations of Narcís Masoller include Hospital Sant Joan de Déu Barcelona.

OP25.10: Ultrasound findings and perinatal outcomes in women admitted with advanced Bishop score

Abstract: Objective: To determine whether the sonographically measured cervical length at term predicted onset of spontaneous labor with intact membranes and premature rupture of membranes (PROM) within the subsequent 2 weeks. Methods: This prospective observational study enrolled 483 consecutive women with singleton gestations at 37 weeks. Transvaginal ultrasound for measurement of the cervical length and digital vaginal examinations were performed serially at 37 weeks and 39 weeks. Outcomes included the onset of spontaneous labor with intact membranes and the occurrence of PROM at term within the subsequent 2 weeks. Univariate, multivariate and receiver operating characteristic curve analysis were used for statistical analysis. Results: 1) The cervical length at both 37 and 39 weeks was significantly shorter in women who had onset of spontaneous labor with intact membranes within 2 weeks than in those who did not (p < 0.05 for each). 2) The difference in mean cervical length at both 37 and 39 weeks between these two groups remained significant after adjustment for parity, cervical dilatation, effacement and consistency by digital examination, and birth weight (p < 0.05 for each). 3) In the receiver operating characteristic curves, the best cut-off values of cervical length for the prediction of onset of spontaneous labor with intact membranes within 2 weeks were 27 mm at both 37 and 39 weeks. 4) At these cut-off values, sensitivity rates were 61% and 55%, and specificity rates were 62% and 63%, respectively. 5) However, the mean cervical length at either 37 or 39 weeks’ gestation was not significantly different between women whom PROM occurred within 2 weeks and those whom PROM did not. Conclusions: Transvaginal sonographic measurement of cervical length at term can predict onset of spontaneous labor with intact membranes, but not occurrence of PROM, within the subsequent 2 weeks. Cervical length may contribute to physiological process of term human parturition.

Segmentation of the placenta and its vascular tree in Doppler ultrasound for fetal surgery planning

Abstract: Twin-to-twin transfusion syndrome (TTTS) is a serious condition that occurs in about 10–15% of monochorionic twin pregnancies. In most instances, the blood flow is unevenly distributed throughout the placenta anastomoses leading to the death of both fetuses if no surgical procedure is performed. Fetoscopic laser coagulation is the optimal therapy to considerably improve co-twin prognosis by clogging the abnormal anastomoses. Notwithstanding progress in recent years, TTTS surgery is highly risky. Computer-assisted planning of the intervention can thus improve the outcome. In this work, we implement a GPU-accelerated random walker (RW) algorithm to detect the placenta, both umbilical cord insertions and the placental vasculature from Doppler ultrasound (US). Placenta and background seeds are manually initialized in 10–20 slices (out of 245). Vessels are automatically initialized in the same slices by means of Otsu thresholding. The RW finds the boundaries of the placenta and reconstructs the vasculature. We evaluate our semiautomatic method in 5 monochorionic and 24 singleton pregnancies. Although satisfactory performance is achieved on placenta segmentation (Dice ≥ 84.0%), some vascular connections are still neglected due to the presence of US reverberation artifacts (Dice ≥ 56.9%). We also compared inter-user variability and obtained Dice coefficients of ≥ 76.8% and ≥ 97.42% for placenta and vasculature, respectively. After a 3-min manual initialization, our GPU approach speeds the computation 10.6 times compared to the CPU. Our semiautomatic method provides a near real-time user experience and requires short training without compromising the segmentation accuracy. A powerful approach is thus presented to rapidly plan the fetoscope insertion point ahead of TTTS surgery.

OP14.01: Combination of uterine artery Doppler and mean arterial pressure at first trimester in the prediction of preeclampsia

Abstract: Objective: To assess whether ultrasound measurement of vaginal wall thickness demonstrates intra-observer and inter-observer reliability. Method: Twenty five women had a transvaginal ultrasound scan and measurement of the thickness of tissue between the ultrasound probe and the pelvic organ in relation to the vaginal compartment being assessed. On the anterior vaginal wall this was the bladder and on the posterior vaginal wall, the rectum. This distance was termed vaginal wall thickness (VWT) and represented the thickness of the vaginal wall as well as any fascia between the vaginal wall and the pelvic organ. Measurements were taken at three anatomical sites: the bladder neck, dome of the bladder and the anterior fornix on the anterior wall, and the anorectal junction, rectum and posterior fornix on the posterior wall. The scan was repeated by an independent second operator at the first visit. Women then returned 4 to 6 weeks later and the ultrasound measurements of VWT were repeated. The interobserver and intraobserver measurements were analysed at each of the anatomical sites. Results: The mean difference in measurements between the two observers for the bladder neck measurement was 0.3 (SD: 0.41), bladder dome 0.07 (SD: 0.5) and anterior fornix was 0.3 (SD: 0.3). The mean difference at the anorectal junction was −0.02 (SD: 0.4), rectum −0.02 (SD: 0.4) and posterior fornix 0.2 (SD: 0.2). When comparing interoperator difference between visits 1 and 2. Mean difference for the bladder neck measurement was −0.1 (SD: 0.4), bladder −0.1 (SD: 0.3) and anterior fornix 0.07 (SD: 0.3). The anorectal junction was −1.0 (SD: 0.3), rectum −0.14 (SD: 0.4) and posterior fornix −0.05 (SD: 0.4). Conclusions: VWT showed small differences between operators and between the same operators at different visits. It is therefore a reliable technique.

EP17.09: Carotid‐subclavian artery index to predict coarctaction of the aorta in the second trimester of gestation

Abstract: Objective Prenatal diagnosis of coarctation of the aorta (COA) is challenging due to the fetal circulation characteristics. Different gestational age-specific scoring systems based on the combination of cardiac size parameters have been proposed to improve its prenatal detection. Carotid-subclavian artery index (CSAI) is a novel promising parameter for prenatal diagnosis of COA. A cut off < 0.78 has shown a high sensitivity (92.3%) and specificity (96.8%) when applied in the third trimester of pregnancy. The objective of our study was to explore the feasibility of the CSAI in fetuses with a suspicion of COA before 28 weeks of gestation. Retrospective study including 11 fetuses with prenatal suspicion of COA before 28 weeks of gestation and postnatal confirmation. Prenatal COA suspicion was defined by the presence of a significant right dominance (right to left ratio higher than 1.3) with an aortic isthmus size <-2 z-score adjusted by gestational age. arch morphology and flow characteristics at the level of the aortic isthmus by color Doppler, were also evaluated in all arch the subclavian and subclavian measured

Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies

Abstract: Objective To develop a practical evidence based list of clinical risk factors that can be assessed by a clinician at ≤16 weeks’ gestation to estimate a woman’s risk of pre-eclampsia. Design Systematic review and meta-analysis of cohort studies. Data sources PubMed and Embase databases, 2000-15. Eligibility criteria for selecting studies Cohort studies with ≥1000 participants that evaluated the risk of pre-eclampsia in relation to a common and generally accepted clinical risk factor assessed at ≤16 weeks’ gestation. Data extraction Two independent reviewers extracted data from included studies. A pooled event rate and pooled relative risk for pre-eclampsia were calculated for each of 14 risk factors. Results There were 25 356 688 pregnancies among 92 studies. The pooled relative risk for each risk factor significantly exceeded 1.0, except for prior intrauterine growth restriction. Women with antiphospholipid antibody syndrome had the highest pooled rate of pre-eclampsia (17.3%, 95% confidence interval 6.8% to 31.4%). Those with prior pre-eclampsia had the greatest pooled relative risk (8.4, 7.1 to 9.9). Chronic hypertension ranked second, both in terms of its pooled rate (16.0%, 12.6% to 19.7%) and pooled relative risk (5.1, 4.0 to 6.5) of pre-eclampsia. Pregestational diabetes (pooled rate 11.0%, 8.4% to 13.8%; pooled relative risk 3.7, 3.1 to 4.3), prepregnancy body mass index (BMI) >30 (7.1%, 6.1% to 8.2%; 2.8, 2.6 to 3.1), and use of assisted reproductive technology (6.2%, 4.7% to 7.9%; 1.8, 1.6 to 2.1) were other prominent risk factors. Conclusions There are several practical clinical risk factors that, either alone or in combination, might identify women in early pregnancy who are at “high risk” of pre-eclampsia. These data can inform the generation of a clinical prediction model for pre-eclampsia and the use of aspirin prophylaxis in pregnancy.

Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy: Executive Summary

Abstract: Objective: This executive summary presents in brief the current evidence assessed in the clinical practice guideline prepared by the Canadian Hypertensive Disorders of Pregnancy Working Group and published by Pregnancy Hypertension (http://www.pregnancyhypertension.org/article/S22107789(14)00004-X/fulltext) to provide a reasonable approach to the diagnosis, evaluation, and treatment of the hypertensive disorders of pregnancy.

Fetal growth restriction: current knowledge.

Abstract: Fetal growth restriction (FGR) is a condition that affects 5–10% of pregnancies and is the second most common cause of perinatal mortality. This review presents the most recent knowledge on FGR and focuses on the etiology, classification, prediction, diagnosis, and management of the condition, as well as on its neurological complications. The Pubmed, SCOPUS, and Embase databases were searched using the term “fetal growth restriction”. Fetal growth restriction (FGR) may be classified as early or late depending on the time of diagnosis. Early FGR (<32 weeks) is associated with substantial alterations in placental implantation with elevated hypoxia, which requires cardiovascular adaptation. Perinatal morbidity and mortality rates are high. Late FGR (≥32 weeks) presents with slight deficiencies in placentation, which leads to mild hypoxia and requires little cardiovascular adaptation. Perinatal morbidity and mortality rates are lower. The diagnosis of FGR may be clinical; however, an arterial and venous Doppler ultrasound examination is essential for diagnosis and follow-up. There are currently no treatments to control FGR; the time at which pregnancy is interrupted is of vital importance for protecting both the mother and fetus. Early diagnosis of FGR is very important, because it enables the identification of the etiology of the condition and adequate monitoring of the fetal status, thereby minimizing risks of premature birth and intrauterine hypoxia.

Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age.

Abstract: Importance Despite lack of evidence of their utility, biomarkers of ovarian reserve are being promoted as potential markers of reproductive potential. Objective To determine the associations between biomarkers of ovarian reserve and reproductive potential among women of late reproductive age. Design, Setting, and Participants Prospective time-to-pregnancy cohort study (2008 to date of last follow-up in March 2016) of women (N = 981) aged 30 to 44 years without a history of infertility who had been trying to conceive for 3 months or less, recruited from the community in the Raleigh-Durham, North Carolina, area. Exposures Early-follicular-phase serum level of antimullerian hormone (AMH), follicle-stimulating hormone (FSH), and inhibin B and urinary level of FSH. Main Outcomes and Measures The primary outcomes were the cumulative probability of conception by 6 and 12 cycles of attempt and relative fecundability (probability of conception in a given menstrual cycle). Conception was defined as a positive pregnancy test result. Results A total of 750 women (mean age, 33.3 [SD, 3.2] years; 77% white; 36% overweight or obese) provided a blood and urine sample and were included in the analysis. After adjusting for age, body mass index, race, current smoking status, and recent hormonal contraceptive use, women with low AMH values ( 10 mIU/mL [n = 83]) did not have a significantly different predicted probability of conceiving after 6 cycles of attempt (63%; 95% CI, 50%-73%) compared with women (n = 654) with normal values (62%; 95% CI, 57%-66%) or after 12 cycles of attempt (82% [95% CI, 70%-89%] vs 75% [95% CI, 70%-78%], respectively). Women with high urinary FSH values (>11.5 mIU/mg creatinine [n = 69]) did not have a significantly different predicted probability of conceiving after 6 cycles of attempt (61%; 95% CI, 46%-74%) compared with women (n = 660) with normal values (62%; 95% CI, 58%-66%) or after 12 cycles of attempt (70% [95% CI, 54%-80%] vs 76% [95% CI, 72%-80%], respectively). Inhibin B levels (n = 737) were not associated with the probability of conceiving in a given cycle (hazard ratio per 1-pg/mL increase, 0.999; 95% CI, 0.997-1.001). Conclusions and Relevance Among women aged 30 to 44 years without a history of infertility who had been trying to conceive for 3 months or less, biomarkers indicating diminished ovarian reserve compared with normal ovarian reserve were not associated with reduced fertility. These findings do not support the use of urinary or blood follicle-stimulating hormone tests or antimullerian hormone levels to assess natural fertility for women with these characteristics.