Dr. med. Ivonne Bedei

@article{pmid38363396,

title = {Two-dimensional speckle tracking echocardiography in fetuses with critical aortic stenosis before and after fetal aortic valvuloplasty},

author = {Justus G Reitz and Johanna M Meier and Christoph Berg and Eva C Weber and Ulrich Gembruch and Aline Wolter and Vanessa Sterzbecher and Ivonne Bedei and Roland Axt-Fliedner},

doi = {10.1007/s00404-024-07376-7},

issn = {1432-0711},

year  = {2024},

date = {2024-02-01},

journal = {Arch Gynecol Obstet},

abstract = {BACKGROUND: Critical aortic stenosis (AS) in fetuses may progress to hypoplastic left heart syndrome (HLHS) with need for postnatal single ventricular (SV) palliation. Fetal aortic valvuloplasty (FAV) is performed to achieve postnatal biventricular (BV) circulation. However, the impact of FAV on fetal myocardial function is difficult to measure. Prediction of postnatal circulatory status and, therefore, counseling is challenging.nnMETHODS: Retrospective study of fetuses with critical AS who underwent FAV. Global Longitudinal Peak Systolic Strain (GLPSS) of the left ventricle (LV) and right ventricle (RV) were retrospectively analyzed before and after intervention. Fisher's Exact Test and Mann-Whitney-U Test were used for univariant statistical analysis.nnRESULTS: 23 fetuses with critical AS were included. After intervention fetuses demonstrated more negative LV-GLPSS mean values post- vs. pre-intervention (- 5.36% vs. - 1.57%; p < 0.05). RV-GLPSS was decreased in all fetuses, there was no peri-interventional change. 20 fetuses were born alive. Postnatally, 10 had BV and 10 SV circulation. Improved post-interventional LV-GLPSS strain values correlated with BV outcome (p < 0.05). Pre-interventional continuous LV-GLPSS values correlated with postnatal SV vs. BV outcome (p < 0.05).nnCONCLUSION: In some fetuses, LV myocardial function assessed by speckle tracking echocardiography (STE) improves after FAV. Improved post-interventional LV-GLPSS correlates with biventricular postnatal outcome. Furthermore, pre-interventional LV- and RV-GLPSS correlate with postnatal outcome. Further studies are needed to asses, if pre-interventional STE parameters might predict which fetuses will benefit from FAV with postnatal BV circulation.},

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}

@article{pmid37698345,

title = {Perforation of cavum septi pellucidi in open spina bifida and need for hydrocephalus treatment by 1 year of age},

author = {M Sanz Cortes and R M Johnson and H Sangi-Haghpeykar and I Bedei and L Greenwood and A A Nassr and R Donepudi and W Whitehead and M Belfort and A R Mehollin-Ray},

doi = {10.1002/uog.27480},

issn = {1469-0705},

year  = {2024},

date = {2024-01-01},

journal = {Ultrasound Obstet Gynecol},

volume = {63},

number = {1},

pages = {60--67},

abstract = {OBJECTIVE: In-utero repair of an open neural tube defect (ONTD) reduces the risk of developing severe hydrocephalus postnatally. Perforation of the cavum septi pellucidi (CSP) may reflect increased intraventricular pressure in the fetal brain. We sought to evaluate the association of perforated CSP visualized on fetal imaging before and/or after in-utero ONTD repair with the eventual need for hydrocephalus treatment by 1 year of age.nnMETHODS: This was a retrospective cohort study of consecutive patients who underwent laparotomy-assisted fetoscopic ONTD repair between 2014 and 2021 at a single center. Eligibility criteria for surgery were based on those of the Management of Myelomeningocele Study (MOMS), although a maternal prepregnancy body mass index of up to 40 kg/m was allowed. Fetal brain imaging was performed with ultrasound and magnetic resonance imaging (MRI) at referral and 6 weeks postoperatively. Stored ultrasound and MRI scans were reviewed retrospectively to assess CSP integrity. Medical records were reviewed to determine whether hydrocephalus treatment was needed within 1 year of age. Parametric and non-parametric tests were used as appropriate to compare outcomes between cases with perforated CSP and those with intact CSP as determined on ultrasound at referral. Logistic regression analysis was performed to assess the predictive performance of various imaging markers for the need for hydrocephalus treatment.nnRESULTS: A total of 110 patients were included. Perforated CSP was identified in 20.6% and 22.6% of cases on preoperative ultrasound and MRI, respectively, and in 26.6% and 24.2% on postoperative ultrasound and MRI, respectively. Ventricular size increased between referral and after surgery (median, 11.00 (range, 5.89-21.45) mm vs 16.00 (range, 7.00-43.5) mm; P < 0.01), as did the proportion of cases with severe ventriculomegaly (ventricular width ≥ 15 mm) (12.7% vs 57.8%; P < 0.01). Complete CSP evaluation was achieved on preoperative ultrasound in 107 cases, of which 22 had a perforated CSP and 85 had an intact CSP. The perforated-CSP group presented with larger ventricles (mean, 14.32 ± 3.45 mm vs 10.37 ± 2.37 mm; P < 0.01) and a higher rate of severe ventriculomegaly (40.9% vs 5.9%; P < 0.01) compared to those with an intact CSP. The same trends were observed at 6 weeks postoperatively for mean ventricular size (median, 21.0 (range, 13.0-43.5) mm vs 14.3 (range, 7.0-29.0) mm; P < 0.01) and severe ventriculomegaly (95.0% vs 46.8%; P < 0.01). Cases with a perforated CSP at referral had a lower rate of hindbrain herniation (HBH) reversal postoperatively (65.0% vs 88.6%; P = 0.01) and were more likely to require treatment for hydrocephalus (89.5% vs 22.7%; P < 0.01). The strongest predictor of the need for hydrocephalus treatment within 1 year of age was lack of HBH reversal on MRI (odds ratio (OR), 36.20 (95% CI, 5.96-219.12); P < 0.01) followed by perforated CSP on ultrasound at referral (OR, 23.40 (95% CI, 5.42-100.98); P < 0.01) and by perforated CSP at 6-week postoperative ultrasound (OR, 19.48 (95% CI, 5.68-66.68); P < 0.01).nnCONCLUSIONS: The detection of a perforated CSP in fetuses with ONTD can reliably identify those cases at highest risk for needing hydrocephalus treatment by 1 year of age. Evaluation of this brain structure can improve counseling of families considering fetal surgery for ONTD, in order to set appropriate expectations about postnatal outcome. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.},

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pubstate = {published},

tppubtype = {article}

}

@article{pmid38337754,

title = {Associated Anomalies and Outcome in Patients with Prenatal Diagnosis of Aortic Arch Anomalies as Aberrant Right Subclavian Artery, Right Aortic Arch and Double Aortic Arch},

author = {Roland Axt-Fliedner and Asia Nazar and Ivonne Bedei and Johanna Schenk and Maleen Reitz and Stefan Rupp and Christian Jux and Aline Wolter},

doi = {10.3390/diagnostics14030238},

issn = {2075-4418},

year  = {2024},

date = {2024-01-01},

journal = {Diagnostics (Basel)},

volume = {14},

number = {3},

abstract = {We aimed to evaluate retrospectively associated anomalies and outcome in prenatal aortic arch anomalies (AAAs). We included ninety patients with aberrant right subclavian artery (ARSA), right aortic arch (RAA) with mirror image branching (RAA-mirror) or aberrant left subclavian artery (RAA-ALSA) and double aortic arch (DAA) between 2011 and 2020. In total, 19/90 (21.1%) had chromosomal anomalies, the highest rate being within the ARSA subgroup (17/46, 37%). All (13/13) of the RAA-mirror subgroup, 10/27 (37.0%) of RAA-ALSA, 13/46 (28.3%) of ARSA and 0/4 within the DAA subgroup had additional intracardiac anomaly. The rate of extracardiac anomalies was 30.7% in RAA-mirror, 28.3% in ARSA, 25.0% in DAA and 22.2% in the RAA-ALSA subgroup. A total of 42/90 (46.7%) had isolated AAAs: three (7.1%) with chromosomal anomalies, all trisomy 21 (3/26, 11.5%) within the ARSA subgroup. Out of 90, 19 (21.1%) were lost to follow-up (FU). Two (2.2%) intrauterine deaths occurred, and six (6.7%) with chromosomal anomalies terminated their pregnancy. In total, 63 (70.0%) were liveborn, 3/63 (4.8%) with severe comorbidity had compassionate care and 3/60 (5.0%) were lost to FU. The survival rate in the intention-to-treat cohort was 53/57 (93%). Forty-one (77.4%) presented with vascular ring/sling, two (4.9%) with RAA-ALSA developed symptoms and one (2.4%) needed an operation. We conclude that intervention due to vascular ring is rarely necessary. NIPT could be useful in isolated ARSA cases without higher a priori risk for trisomy 21 and after exclusion of other anomalies.},

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pubstate = {published},

tppubtype = {article}

}

@article{pmid38013494,

title = {Prenatal diagnosis and postnatal outcome of closed spinal dysraphism},

author = {Ivonne Bedei and Eyal Krispin and Magdalena Sanz Cortes and Hennie Lombaard and Roni Zemet and William E Whitehead and Michael A Belfort and Thierry A G M Huisman},

doi = {10.1002/pd.6454},

issn = {1097-0223},

year  = {2023},

date = {2023-11-01},

journal = {Prenat Diagn},

abstract = {OBJECTIVE: To evaluate the prenatal diagnosis of closed dysraphism (CD) and its correlation with postnatal findings and neonatal adverse outcomes.nnMETHODS: A retrospective cohort study including pregnancies diagsnosed with fetal CD by prenatal ultrasound (US) and magnetic resonance imaging (MRI) at a single tertiary center between September 2011 and July 2021.nnRESULTS: CD was diagnosed prenatally and confirmed postnatally in 12 fetuses. The mean gestational age of prenatal imaging was 24.2 weeks, in 17% the head circumference was ≤fifth percentile and in 25% the cerebellar diameter was ≤fifth percentile. US findings included banana sign in 17%, and lemon sign in 33%. On MRI, posterior fossa anomalies were seen in 33% of cases, with hindbrain herniation below the foramen magnum in two cases. Mean clivus-supraocciput angle (CSA) was 74°. Additional anomalies outside the CNS were observed in 50%. Abnormal foot position was demonstrated prenatally in 17%. Neurogenic bladder was present in 90% of patients after birth.nnCONCLUSION: Arnold Chiari II malformation and impaired motor function can be present on prenatal imaging of fetuses with CD and may be associated with a specific type of CD. Prenatal distinction of CD can be challenging. Associated extra CNS anomalies are frequent and the rate of neurogenic urinary tract dysfunction is high.},

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pubstate = {published},

tppubtype = {article}

}

@article{pmid35304733b,

title = {Analysis of the Results of Sonographic Screening Examinations According to the Maternity Guidelines Before and After the Introduction of the Extended Basic Screening (IIb Screening) in Hesse},

author = {Christine Schmand and Björn Misselwitz and Helge Hudel and Ivonne Bedei and Aline Wolter and Johanna Schenk and Corinna Keil and Siegmund Köhler and Roland Axt-Fliedner},

doi = {10.1055/a-1778-3585},

issn = {1438-8782},

year  = {2023},

date = {2023-08-01},

journal = {Ultraschall Med},

volume = {44},

number = {4},

pages = {e175--e183},

abstract = {AIM OF THE STUDY: The aim of the study is to examine the detection rates of malformations before and after the introduction of extended basic screening in Hesse by the Federal Joint Committee (Gemeinsamer Bundesausschuss, GQH) on July 1, 2013.nnMETHOD: This is a retrospective, mainly exploratory data analysis of quality assurance data from the Office for Quality Assurance in Hesse (GQH). The data was collected in the period from January 1, 2010 to December 31, 2016 in the obstetric departments of the Hessian hospitals using documentation forms. The classification and evaluation of the diagnoses is based on ICD-10-GM-2019.nnRESULTS: At least one malformation is present in 0.7% of the cases. With a share of 30.0%, most of the congenital malformations are from the musculoskeletal system. 12.2% of the malformations come from the facial cleft, closely followed by malformations of the circulatory system with 11.3%. The highest prenatal detection rate (PDR) is found in congenital malformations of the nervous system at 56.8%. The lowest PDR is found in those of the genital organs with 2.1%. The PDR of cardiovascular malformations is 32.9%. Overall, a PDR of 25.2% is achieved. There was no change in the number of prenatal malformation diagnoses after the introduction of extended basic ultrasound. The distribution of malformation diagnoses not detected prenatally to the organ systems also has not changed after the introduction.nnCONCLUSION: The introduction of extended basic ultrasound did not bring the desired improvement with regard to the PDR in Hesse. Alternative approaches should be considered.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37568553,

title = {Implementation and Assessment of a Laparotomy-Assisted Three-Port Fetoscopic Spina Bifida Repair Program},

author = {Corinna Keil and Siegmund Köhler and Benjamin Sass and Maximilian Schulze and Gerald Kalmus and Michael Belfort and Nicolas Schmitt and Daniele Diehl and Alice King and Stefanie Groß and Caitlin D Sutton and Luc Joyeux and Mirjam Wege and Christopher Nimsky and Wiliam E Whitehead and Eberhard Uhl and Thierry A G M Huisman and Bernd A Neubauer and Stefanie Weber and Helmut Hummler and Roland Axt-Fliedner and Ivonne Bedei},

doi = {10.3390/jcm12155151},

issn = {2077-0383},

year  = {2023},

date = {2023-08-01},

journal = {J Clin Med},

volume = {12},

number = {15},

abstract = {Open spina bifida (OSB) is a congenital, non-lethal malformation with multifactorial etiology. Fetal therapy can be offered under certain conditions to parents after accurate prenatal diagnostic and interdisciplinary counseling. Since the advent of prenatal OSB surgery, various modifications of the original surgical techniques have evolved, including laparotomy-assisted fetoscopic repair. After a two-year preparation time, the team at the University of Giessen and Marburg (UKGM) became the first center to provide a three-port, three-layer fetoscopic repair of OSB via a laparotomy-assisted approach in the German-speaking area. We point out that under the guidance of experienced centers and by intensive multidisciplinary preparation and training, a previously described and applied technique could be transferred to a different setting.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid37240614,

title = {Comparison of the Results of Prenatal and Postnatal Echocardiography and Postnatal Cardiac MRI in Children with a Congenital Heart Defect},

author = {Marios Mamalis and Tamara Koehler and Ivonne Bedei and Aline Wolter and Johanna Schenk and Ellyda Widriani and Roland Axt-Fliedner},

doi = {10.3390/jcm12103508},

issn = {2077-0383},

year  = {2023},

date = {2023-05-01},

journal = {J Clin Med},

volume = {12},

number = {10},

abstract = {OBJECTIVE: In fetuses with suspicion of congenital heart disease (CHD), assessment by segmental fetal echocardiography is of great importance. This study sought to examine the concordance of expert fetal echocardiography and postnatal MRI of the heart at a high-volume paediatric heart centre.nnMETHODS: The data of two hundred forty-two fetuses have been gathered under the condition of full pre- and postnatal and the presence of a pre- and postnatal diagnosis of CHD. The haemodynamically leading diagnosis was determined for each test person and was then sorted into diagnostic groups. The diagnoses and diagnostic groups were used for the comparison of diagnostic accuracy in fetal echocardiography.nnRESULTS: All comparisons between the diagnostic methods for detection of congenital heart disease showed an "almost perfect" (Cohen's Kappa > 0.9) strength of agreement for the diagnostic groups. The diagnosis made by prenatal echocardiography showed a sensitivity of 90-100%, a specificity and a negative predictive value of 97-100%, and a positive predictive value of 85-100%. The diagnostic congruence resulted in an "almost perfect" strength of agreement for all evaluated diagnoses (transposition of great arteries, double outlet right ventricle, hypoplastic left heart, tetralogy of Fallot, atrioventricular septal defect). An agreement of Cohen's Kappa > 0.9 was achieved for all groups, with exception of the diagnosis of double outlet right ventricle (0.8) in prenatal echocardiography compared to postnatal echocardiography. This study came to the result of a sensitivity of 88-100%, a specificity and negative predictive value of 97-100%, and a positive predictive value of 84-100%. The performance of cardiac magnetic resonance imaging (MRI) as an additional measure to echocardiography had an added value in the description of the malposition of the great arteries when diagnosed with double outlet right ventricle and in the detailed description of the anatomy of the lung circulation.nnCONCLUSIONS: Prenatal echocardiography could be shown to be a reliable method for detection of congenital heart disease when regarding the slightly lower accuracy of diagnosis for double outlet right ventricle and right heart anomalies. Furthermore, the impact of examiner experience and the consideration of follow-up examinations for further improvement of diagnosis accuracy may not be underestimated. The main advantage of an additional MRI is the possibility to obtain a detailed anatomic description of the blood vessels of the lung and the outflow tract. The conduction of further studies that include false-negative and false-positive cases, and studies that are not set within the high-risk-group, as well as studies in a less specialized setting, would allow the completion and investigation of possible differences and discrepancies when comparing the results that have been obtained in this study.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36726284,

title = {Multicenter clinical experience with non-invasive cell-free DNA screening for monosomy X and related X-chromosome variants},

author = {Ivonne Bedei and Tascha Gehrke and Karl-Philipp Gloning and Matthias Meyer-Wittkopf and Daria Willner and Martin Krapp and Alexander Scharf and Jan Degenhardt and Kai-Sven Heling and Peter Kozlowski and Kathrin Trautmann and Kai M Jahns and Annegret Geipel and Jan-Erik Baumüller and Lucas Wilhelm and Ingo Gottschalk and Andreas Schröer and Alexander Graf and Aline Wolter and Johanna Schenk and Axel Weber and Ignatia B Van den Veyver and Roland Axt-Fliedner},

doi = {10.1002/pd.6320},

issn = {1097-0223},

year  = {2023},

date = {2023-02-01},

journal = {Prenat Diagn},

volume = {43},

number = {2},

pages = {192--206},

abstract = {OBJECTIVE: We aimed to investigate how the presence of fetal anomalies and different X chromosome variants influences Cell-free DNA (cfDNA) screening results for monosomy X.nnMETHODS: From a multicenter retrospective survey on 673 pregnancies with prenatally suspected or confirmed Turner syndrome, we analyzed the subgroup for which prenatal cfDNA screening and karyotype results were available. A cfDNA screening result was defined as true positive (TP) when confirmatory testing showed 45,X or an X-chromosome variant.nnRESULTS: We had cfDNA results, karyotype, and phenotype data for 55 pregnancies. cfDNA results were high risk for monosomy X in 48/55, of which 23 were TP and 25 were false positive (FP). 32/48 high-risk cfDNA cases did not show fetal anomalies. Of these, 7 were TP. All were X-chromosome variants. All 16 fetuses with high-risk cfDNA result and ultrasound anomalies were TP. Of fetuses with abnormalities, those with 45,X more often had fetal hydrops/cystic hygroma, whereas those with "variant" karyotypes had different anomalies.nnCONCLUSION: Both, 45,X or X-chromosome variants can be detected after a high-risk cfDNA result for monosomy X. When there are fetal anomalies, the result is more likely a TP. In the absence of fetal anomalies, it is most often an FP or X-chromosome variant.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36600414,

title = {Turner syndrome-omphalocele association: Incidence, karyotype, phenotype and fetal outcome},

author = {Ivonne Bedei and Karl-Philipp Gloning and Luc Joyeux and Matthias Meyer-Wittkopf and Daria Willner and Martin Krapp and Alexander Scharf and Jan Degenhardt and Kai-Sven Heling and Peter Kozlowski and Kathrin Trautmann and Kai M Jahns and Annegret Geipel and Ismail Tekesin and Michael Elsässer and Lucas Wilhelm and Ingo Gottschalk and Jan-Erik Baumüller and Cahit Birdir and Andreas Schröer and Felix Zöllner and Aline Wolter and Johanna Schenk and Tascha Gehrke and Alicia Spaeth and Roland Axt-Fliedner},

doi = {10.1002/pd.6302},

issn = {1097-0223},

year  = {2023},

date = {2023-02-01},

journal = {Prenat Diagn},

volume = {43},

number = {2},

pages = {183--191},

abstract = {OBJECTIVE: Omphalocele is known to be associated with genetic anomalies like trisomy 13, 18 and Beckwith-Wiedemann syndrome, but not with Turner syndrome (TS). Our aim was to assess the incidence of omphalocele in fetuses with TS, the phenotype of this association with other anomalies, their karyotype, and the fetal outcomes.nnMETHOD: Retrospective multicenter study of fetuses with confirmed diagnosis of TS. Data were extracted from a detailed questionnaire sent to specialists in prenatal ultrasound.nnRESULTS: 680 fetuses with TS were included in this analysis. Incidence of small omphalocele in fetuses diagnosed ≥12 weeks was 3.1%. Including fetuses diagnosed before 12 weeks, it was 5.1%. 97.1% (34/35) of the affected fetuses had one or more associated anomalies including increased nuchal translucency (≥3 mm) and/or cystic hygroma (94.3%), hydrops/skin edema (71.1%), and cardiac anomalies (40%). The karyotype was 45,X in all fetuses. Fetal outcomes were poor with only 1 fetus born alive.nnCONCLUSION: TS with 45,X karyotype but not with X chromosome variants is associated with small omphalocele. Most of these fetuses have associated anomalies and a poor prognosis. Our data suggest an association of TS with omphalocele, which is evident from the first trimester.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34652254b,

title = {Fetal therapy of LUTO (lower urinary tract obstruction) - a follow-up observational study},

author = {Corinna Keil and Ivonne Bedei and Lara Sommer and Martin Koemhoff and Roland Axt-Fliedner and Siegmund Köhler and Stefanie Weber},

doi = {10.1080/14767058.2021.1988562},

issn = {1476-4954},

year  = {2022},

date = {2022-12-01},

journal = {J Matern Fetal Neonatal Med},

volume = {35},

number = {25},

pages = {8536--8543},

abstract = {PURPOSE: Fetal megacystis (MC) can be severe and is mainly caused by fetal lower urinary tract obstruction (LUTO). Mortality of fetal LUTO can be high as a result of pulmonary hypoplasia and/or (chronic) renal insufficiency. Several technical procedures for vesicoamniotic shunting (VAS) were developed to improve fetal MC outcomes.



MATERIAL AND METHODS: We present the outcome of nine fetuses with MC who received VAS in the prenatal period (14 + 6 to 27 + 6 weeks GA) using the Somatex intrauterine shunt system. MC was defined as an increased longitudinal measurement of the bladder >15 mm. The median follow-up time after birth was 18 months.



RESULTS: Eight Fetuses had uncomplicated VAS intervention. One case developed PPROM 24 h after VAS leading to abortion. Pregnancy was later terminated in further two cases. All six live-born infants received intensive care treatment. Invasive-mechanical ventilation was necessary in one case who died 24 h post-partum of severe cardiac depression. Five infants who survived the follow-up time developed chronic renal insufficiency (CRI), with one infant developing end-stage renal failure requiring peritoneal dialysis.



CONCLUSION: Overall, 5 of 9 LUTO fetuses (55%) undergoing VAS with the Somatex intrauterine shunt system showed long-term survival beyond the neonatal period of 28 d (5/9; 55%) with varying morbidity.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36556157,

title = {The Value of Delta Middle Cerebral Artery Peak Systolic Velocity for the Prediction of Twin Anemia-Polycythemia Sequence-Analysis of a Heterogenous Cohort of Monochorionic Twins},

author = {Anthea de Sainte Fare and Ivonne Bedei and Aline Wolter and Johanna Schenk and Ellydda Widriani and Corinna Keil and Siegmund Koehler and Franz Bahlmann and Brigitte Strizek and Ulrich Gembruch and Christoph Berg and Roland Axt-Fliedner},

doi = {10.3390/jcm11247541},

issn = {2077-0383},

year  = {2022},

date = {2022-12-01},

journal = {J Clin Med},

volume = {11},

number = {24},

abstract = {Introduction: Twin anemia-polycythemia sequence (TAPS) is a complication in monochorionic-diamniotic (MCDA) twin pregnancies. This study analyzes whether the prenatal diagnosis using delta middle cerebral artery-peak systolic velocity (MCA-PSV) > 0.5 multiples of the median (MoM) (delta group) detects more TAPS cases than the guideline-based diagnosis using the MCA-PSV cut off levels of >1.5 and <1.0 MoM (cut-off group), in a heterogenous group of MCDA twins. Methods: A retrospective analysis of 348 live-born MCDA twin pregnancies from 2010 to 2021 with available information on MCA-PSV within one week before delivery and hemoglobin-values within 24 h postnatally were considered eligible. Results: Among postnatal confirmed twin pairs with TAPS, the cut-off group showed lower sensitivity than the delta group (33% vs. 82%). Specificity proved higher in the cut-off group with 97% than in the delta group at 86%. The risk that a TAPS is mistakenly not recognized prenatally is higher in the cut-off group than in the delta group (52% vs. 18%). Conclusions: Our data shows that delta MCA-PSV > 0.5 MoM detects more cases of TAPS, which would not have been diagnosed prenatally according to the current guidelines. In the collective examined in the present study, TAPS diagnostics using delta MCA-PSV proved to be a more robust method.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid36498602,

title = {The Evolution and Developing Importance of Fetal Magnetic Resonance Imaging in the Diagnosis of Congenital Cardiac Anomalies: A Systematic Review},

author = {Marios Mamalis and Ivonne Bedei and Bjoern Schoennagel and Fabian Kording and Justus G Reitz and Aline Wolter and Johanna Schenk and Roland Axt-Fliedner},

doi = {10.3390/jcm11237027},

issn = {2077-0383},

year  = {2022},

date = {2022-11-01},

journal = {J Clin Med},

volume = {11},

number = {23},

abstract = {Magnetic Resonance Imaging (MRI) is a reliable method, with a complementary role to Ultrasound (US) Echocardiography, that can be used to fully comprehend and precisely diagnose congenital cardiac malformations. Besides the anatomical study of the fetal cardiovascular system, it allows us to study the function of the fetal heart, remaining, at the same time, a safe adjunct to the classic fetal echocardiography. MRI also allows for the investigation of cardiac and placental diseases by providing information about hematocrit, oxygen saturation, and blood flow in fetal vessels. It is crucial for fetal medicine specialists and pediatric cardiologists to closely follow the advances of fetal cardiac MRI in order to provide the best possible care. In this review, we summarize the advance in techniques and their practical utility to date.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35956203,

title = {Is Fetal Hydrops in Turner Syndrome a Risk Factor for the Development of Maternal Mirror Syndrome?},

author = {Ivonne Alexandra Bedei and Alexander Graf and Karl-Philipp Gloning and Matthias Meyer-Wittkopf and Daria Willner and Martin Krapp and Sabine Hentze and Alexander Scharf and Jan Degenhardt and Kai-Sven Heling and Peter Kozlowski and Kathrin Trautmann and Kai Jahns and Anne Geipel and Ismail Tekesin and Michael Elsässer and Lucas Wilhelm and Ingo Gottschalk and Jan-Erik Baumüller and Cahit Birdir and Felix Zöllner and Aline Wolter and Johanna Schenk and Tascha Gehrke and Corinna Keil and Jimmy Espinosa and Roland Axt-Fliedner},

doi = {10.3390/jcm11154588},

issn = {2077-0383},

year  = {2022},

date = {2022-08-01},

journal = {J Clin Med},

volume = {11},

number = {15},

abstract = {Mirror syndrome is a rare and serious maternal condition associated with immune and non-immune fetal hydrops after 16 weeks of gestational age. Subjacent conditions associated with fetal hydrops may carry different risks for Mirror syndrome. Fetuses with Turner syndrome are frequently found to be hydropic on ultrasound. We designed a retrospective multicenter study to evaluate the risk for Mirror syndrome among pregnancies complicated with Turner syndrome and fetal hydrops. Data were extracted from a questionnaire sent to specialists in maternal fetal medicine in Germany. Out of 758 cases, 138 fulfilled our inclusion criteria and were included in the analysis. Of the included 138, 66 presented with persisting hydrops at or after 16 weeks. The frequency of placental hydrops/placentomegaly was rather low (8.1%). Of note, no Mirror syndrome was observed in our study cohort. We propose that the risk of this pregnancy complication varies according to the subjacent cause of fetal hydrops. In Turner syndrome, the risk for Mirror syndrome is lower than that reported in the literature. Our observations are relevant for clinical management and parental counseling.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35304733,

title = {Analysis of the Results of Sonographic Screening Examinations According to the Maternity Guidelines Before and After the Introduction of the Extended Basic Screening (IIb Screening) in Hesse},

author = {Christine Schmand and Björn Misselwitz and Helge Hudel and Ivonne Bedei and Aline Wolter and Johanna Schenk and Corinna Keil and Siegmund Köhler and Roland Axt-Fliedner},

doi = {10.1055/a-1778-3585},

issn = {1438-8782},

year  = {2022},

date = {2022-03-01},

journal = {Ultraschall Med},

abstract = {AIM OF THE STUDY: The aim of the study is to examine the detection rates of malformations before and after the introduction of extended basic screening in Hesse by the Federal Joint Committee (Gemeinsamer Bundesausschuss, GQH) on July 1, 2013.



METHOD: This is a retrospective, mainly exploratory data analysis of quality assurance data from the Office for Quality Assurance in Hesse (GQH). The data was collected in the period from January 1, 2010 to December 31, 2016 in the obstetric departments of the Hessian hospitals using documentation forms. The classification and evaluation of the diagnoses is based on ICD-10-GM-2019.



RESULTS: At least one malformation is present in 0.7% of the cases. With a share of 30.0%, most of the congenital malformations are from the musculoskeletal system. 12.2% of the malformations come from the facial cleft, closely followed by malformations of the circulatory system with 11.3%. The highest prenatal detection rate (PDR) is found in congenital malformations of the nervous system at 56.8%. The lowest PDR is found in those of the genital organs with 2.1%. The PDR of cardiovascular malformations is 32.9%. Overall, a PDR of 25.2% is achieved. There was no change in the number of prenatal malformation diagnoses after the introduction of extended basic ultrasound. The distribution of malformation diagnoses not detected prenatally to the organ systems also has not changed after the introduction.



CONCLUSION: The introduction of extended basic ultrasound did not bring the desired improvement with regard to the PDR in Hesse. Alternative approaches should be considered.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35204956,

title = {New Challenges with Treatment Advances in Newborn Infants with Genetic Disorders and Severe Congenital Malformations},

author = {Rahel Schuler and Ivonne Bedei and Frank Oehmke and Klaus-Peter Zimmer and Harald Ehrhardt},

doi = {10.3390/children9020236},

issn = {2227-9067},

year  = {2022},

date = {2022-02-01},

journal = {Children (Basel)},

volume = {9},

number = {2},

abstract = {Advances in the prognosis of relevant syndromes and severe congenital malformations in infants during the last few decades have enabled the treatment and survival of an ever-increasing number of infants, whose prospects were previously judged futile by professional health care teams. This required detailed counselling for families, which frequently started before birth when a diagnosis was made using genetic testing or ultrasound. Predictions of the estimated prognosis, and frequently the more-or-less broad range of prospects, needed to include the chances of survival and data on acute and long-term morbidities. However, in the interest of a having an informed basis for parental decision-making with a professional interdisciplinary team, this process needs to acknowledge the rights of the parents for a comprehensive presentation of the expected quality of life of their child, the potential consequences for family life, and the couple's own relationship. Besides expert advice, professional psychological and familial support is needed as a basis for a well-founded decision regarding the best treatment options for the child. It needs to be acknowledged by the professional team that the parental estimate of a "good outcome" or quality of life does not necessarily reflect the attitudes and recommendations of the professional team. Building a mutually trusting relationship is essential to avoid decision conflicts.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid35327684,

title = {Neonatal Outcome and Treatment Perspectives of Preterm Infants at the Border of Viability},

author = {Rahel Schuler and Ivonne Bedei and Frank Oehmke and Klaus-Peter Zimmer and Harald Ehrhardt},

doi = {10.3390/children9030313},

issn = {2227-9067},

year  = {2022},

date = {2022-02-01},

journal = {Children (Basel)},

volume = {9},

number = {3},

abstract = {Decision-making at the border of viability remains challenging for the expectant parents and the medical team. The preterm infant is dependent on others making the decision that will impact them for a lifetime in hopefully their best interest. Besides survival and survival without neurodevelopmental impairment, other relevant outcome measures, such as the quality of life of former preterm infants and the impact on family life, need to be integrated into prenatal counselling. Recommendations and national guidelines continue to rely on arbitrarily set gestational age limits at which treatment is not recommended, can be considered and it is recommended. These guidelines neglect other individual prognostic outcome factors like antenatal steroids, birth weight and gender. Besides individual factors, centre-specific factors like perinatal treatment intensity and the attitude of healthcare professionals significantly determine the futures of these infants at the border of viability. A more comprehensive approach regarding treatment recommendations and relevant outcome measures is necessary.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid34652254,

title = {Fetal therapy of LUTO (lower urinary tract obstruction) - a follow-up observational study},

author = {Corinna Keil and Ivonne Bedei and Lara Sommer and Martin Koemhoff and Roland Axt-Fliedner and Siegmund Köhler and Stefanie Weber},

doi = {10.1080/14767058.2021.1988562},

issn = {1476-4954},

year  = {2021},

date = {2021-10-01},

journal = {J Matern Fetal Neonatal Med},

pages = {1--8},

abstract = {PURPOSE: Fetal megacystis (MC) can be severe and is mainly caused by fetal lower urinary tract obstruction (LUTO). Mortality of fetal LUTO can be high as a result of pulmonary hypoplasia and/or (chronic) renal insufficiency. Several technical procedures for vesicoamniotic shunting (VAS) were developed to improve fetal MC outcomes.



MATERIAL AND METHODS: We present the outcome of nine fetuses with MC who received VAS in the prenatal period (14 + 6 to 27 + 6 weeks GA) using the Somatex intrauterine shunt system. MC was defined as an increased longitudinal measurement of the bladder >15 mm. The median follow-up time after birth was 18 months.



RESULTS: Eight Fetuses had uncomplicated VAS intervention. One case developed PPROM 24 h after VAS leading to abortion. Pregnancy was later terminated in further two cases. All six live-born infants received intensive care treatment. Invasive-mechanical ventilation was necessary in one case who died 24 h post-partum of severe cardiac depression. Five infants who survived the follow-up time developed chronic renal insufficiency (CRI), with one infant developing end-stage renal failure requiring peritoneal dialysis.



CONCLUSION: Overall, 5 of 9 LUTO fetuses (55%) undergoing VAS with the Somatex intrauterine shunt system showed long-term survival beyond the neonatal period of 28 d (5/9; 55%) with varying morbidity.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33805390,

title = {Chances and Challenges of New Genetic Screening Technologies (NIPT) in Prenatal Medicine from a Clinical Perspective: A Narrative Review},

author = {Ivonne Bedei and Aline Wolter and Axel Weber and Fabrizio Signore and Roland Axt-Fliedner},

doi = {10.3390/genes12040501},

issn = {2073-4425},

year  = {2021},

date = {2021-01-01},

journal = {Genes (Basel)},

volume = {12},

number = {4},

abstract = {In 1959, 63 years after the death of John Langdon Down, Jérôme Lejeune discovered trisomy 21 as the genetic reason for Down syndrome. Screening for Down syndrome has been applied since the 1960s by using maternal age as the risk parameter. Since then, several advances have been made. First trimester screening, combining maternal age, maternal serum parameters and ultrasound findings, emerged in the 1990s with a detection rate (DR) of around 90-95% and a false positive rate (FPR) of around 5%, also looking for trisomy 13 and 18. With the development of high-resolution ultrasound, around 50% of fetal anomalies are now detected in the first trimester. Non-invasive prenatal testing (NIPT) for trisomy 21, 13 and 18 is a highly efficient screening method and has been applied as a first-line or a contingent screening approach all over the world since 2012, in some countries without a systematic screening program. Concomitant with the rise in technology, the possibility of screening for other genetic conditions by analysis of cfDNA, such as sex chromosome anomalies (SCAs), rare autosomal anomalies (RATs) and microdeletions and duplications, is offered by different providers to an often not preselected population of pregnant women. Most of the research in the field is done by commercial providers, and some of the tests are on the market without validated data on test performance. This raises difficulties in the counseling process and makes it nearly impossible to obtain informed consent. In parallel with the advent of new screening technologies, an expansion of diagnostic methods has begun to be applied after invasive procedures. The karyotype has been the gold standard for decades. Chromosomal microarrays (CMAs) able to detect deletions and duplications on a submicroscopic level have replaced the conventional karyotyping in many countries. Sequencing methods such as whole exome sequencing (WES) and whole genome sequencing (WGS) tremendously amplify the diagnostic yield in fetuses with ultrasound anomalies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid33585987,

title = {Natural history of pulmonary atresia with intact ventricular septum (PAIVS) and critical pulmonary stenosis (CPS) and prediction of outcome},

author = {Aline Wolter and Natalia Markert and Jan Sebastian Wolter and Andrii Kurkevych and Jan Degenhardt and Jochen Ritgen and Rüdiger Stressig and Christian Enzensberger and Ivonne Bedei and Carina Vorisek and Johanna Schenk and Oliver Graupner and Markus Khalil and Josef Thul and Christian Jux and Roland Axt-Fliedner},

doi = {10.1007/s00404-020-05929-0},

issn = {1432-0711},

year  = {2021},

date = {2021-01-01},

journal = {Arch Gynecol Obstet},

volume = {304},

number = {1},

pages = {81--90},

abstract = {OBJECTIVES: To analyse prenatal parameters predicting biventricular (BV) outcome in pulmonary atresia with intact ventricular septum/critical pulmonary stenosis (PAIVS/CPS).



METHODS: We evaluated 82 foetuses from 01/08 to 10/18 in 3 centres in intervals 1 (< 24 weeks), 2 (24-30 weeks) and 3 (> 30 weeks).



RESULTS: 61/82 (74.4%) were livebirths, 5 (8.2%) lost for follow-up, 3 (4.9%) had compassionate care leaving 53 (64.6% of the whole cohort and 86.9% of livebirths) with intention to treat. 9 died, 44/53 (83.0%) survived. 24/38 (63.2%) with information on postnatal outcome had BV outcome, 14 (36.8%) non-BV outcome (2 × 1.5 circulation). One with BV outcome had prenatal valvuloplasty. Best single parameter for BV outcome was tricuspid/mitral valve (TV/MV) ratio (AUC 0.93) in intervals 2 and 3 (AUC 0.92). Ventriculo-coronary-arterial communications (VCAC) were present in 11 (78.6%) in non-BV outcome group vs. 2 (8.3%) in BV outcome group (p < 0.001). Tricuspid insufficiency (TI)-Vmax > 2.5 m/s was present in BV outcome group in75.0% (18/24) vs. 14.3% (2/14) in non-BV outcome group. Including the most predictive markers (VCAC presence, TI- Vmax  < 2.5 m/s, TV/MV ratio < cutoff) to a score, non-BV outcome was correctly predicted when > 1 criterion was fulfilled in all cases. After recently published criteria for foetal intervention, only 4/9 (44.4%) and 5/14 (35.7%) in our interval 2 + 3 with predicted non-BV outcome would have been candidates for intervention. Two (1 × intrauterine intervention) in interval 2, two in interval 3 reached BV outcome and one 1.5 circulation without intervention.



CONCLUSION: TV/MV ratio as simple parameter has high predictive value. After our score, non-BV outcome was correctly predicted in all cases. Criteria for foetal intervention must further be evaluated.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31801169,

title = {[Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/025, February 2019) - Part 2 with Recommendations on the Tertiary Prevention of Preterm Birth and the Management of Preterm Premature Rupture of Membranes]},

author = {Richard Berger and Harald Abele and Franz Bahlmann and Ivonne Bedei and Klaus Doubek and Ursula Felderhoff-Müser and Herbert Fluhr and Yves Garnier and Susanne Grylka-Baeschlin and Hanns Helmer and Egbert Herting and Markus Hoopmann and Irene Hösli and Udo Hoyme and Alexandra Jendreizeck and Harald Krentel and Ruben Kuon and Wolf Lütje and Silke Mader and Holger Maul and Werner Mendling and Barbara Mitschdörfer and Tatjana Nicin and Monika Nothacker and Dirk Olbertz and Werner Rath and Claudia Roll and Dietmar Schlembach and Ekkehard Schleußner and Florian Schütz and Vanadin Seifert-Klauss and Susanne Steppat and Daniel Surbek},

doi = {10.1055/a-1008-8730},

issn = {1439-1651},

year  = {2019},

date = {2019-12-01},

journal = {Z Geburtshilfe Neonatol},

volume = {223},

number = {6},

pages = {373--394},

abstract = {AIMS: This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recently published scientific literature, the experience of the members of the guideline commission and the views of self-help groups.



METHODS: The members of the participating medical societies and organizations developed Recommendations and Statements based on the international literature. The Recommendations and Statements were adopted following a formal consensus process (structured consensus conference with neutral moderation, voting done in writing using the Delphi method to achieve consensus).



RECOMMENDATIONS: Part 2 of this short version of the guideline presents Statements and Recommendations on the tertiary prevention of preterm birth and the management of preterm premature rupture of membranes.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31623006,

title = {[Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/025, February 2019) - Part 1 with Recommendations on the Epidemiology, Etiology, Prediction, Primary and Secondary Prevention of Preterm Birth]},

author = {Richard Berger and Harald Abele and Franz Bahlmann and Ivonne Bedei and Klaus Doubek and Ursula Felderhoff-Müser and Herbert Fluhr and Yves Garnier and Susanne Grylka-Baeschlin and Hanns Helmer and Egbert Herting and Markus Hoopmann and Irene Hösli and Udo Hoyme and Alexandra Jendreizeck and Harald Krentel and Ruben Kuon and Wolf Lütje and Silke Mader and Holger Maul and Werner Mendling and Barbara Mitschdörfer and Tatjana Nicin and Monika Nothacker and Dirk Olbertz and Werner Rath and Claudia Roll and Dietmar Schlembach and Ekkehard Schleußner and Florian Schütz and Vanadin Seifert-Klauss and Susanne Steppat and Daniel Surbek},

doi = {10.1055/a-0979-1028},

issn = {1439-1651},

year  = {2019},

date = {2019-10-01},

journal = {Z Geburtshilfe Neonatol},

volume = {223},

number = {5},

pages = {304--316},

abstract = {AIMS: This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent scientific literature, the experience of the members of the guideline commission and the views of self-help groups.



METHODS: Based on the international literature, the members of the participating medical societies and organizations developed Recommendations and Statements. These were adopted following a formal process (structured consensus conference with neutral moderation, voting was done in writing using the Delphi method to achieve consensus).



RECOMMENDATIONS: Part I of this short version of the guideline lists Statements and Recommendations on the epidemiology, etiology, prediction and primary and secondary prevention of preterm birth.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31423017,

title = {Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/025, February 2019) - Part 2 with Recommendations on the Tertiary Prevention of Preterm Birth and the Management of Preterm Premature Rupture of Membranes},

author = {Richard Berger and Harald Abele and Franz Bahlmann and Ivonne Bedei and Klaus Doubek and Ursula Felderhoff-Müser and Herbert Fluhr and Yves Garnier and Susanne Grylka-Baeschlin and Hanns Helmer and Egbert Herting and Markus Hoopmann and Irene Hösli and Udo Hoyme and Alexandra Jendreizeck and Harald Krentel and Ruben Kuon and Wolf Lütje and Silke Mader and Holger Maul and Werner Mendling and Barbara Mitschdörfer and Tatjana Nicin and Monika Nothacker and Dirk Olbertz and Werner Rath and Claudia Roll and Dietmar Schlembach and Ekkehard Schleußner and Florian Schütz and Vanadin Seifert-Klauss and Susanne Steppat and Daniel Surbek},

doi = {10.1055/a-0903-2735},

issn = {0016-5751},

year  = {2019},

date = {2019-08-01},

journal = {Geburtshilfe Frauenheilkd},

volume = {79},

number = {8},

pages = {813--833},

abstract = { This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recently published scientific literature, the experience of the members of the guideline commission and the views of self-help groups.  The members of the participating medical societies and organizations developed Recommendations and Statements based on the international literature. The Recommendations and Statements were adopted following a formal consensus process (structured consensus conference with neutral moderation, voting done in writing using the Delphi method to achieve consensus).  Part 2 of this short version of the guideline presents Statements and Recommendations on the tertiary prevention of preterm birth and the management of preterm premature rupture of membranes.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid31423016,

title = {Prevention and Therapy of Preterm Birth. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/025, February 2019) - Part 1 with Recommendations on the Epidemiology, Etiology, Prediction, Primary and Secondary Prevention of Preterm Birth},

author = {Richard Berger and Harald Abele and Franz Bahlmann and Ivonne Bedei and Klaus Doubek and Ursula Felderhoff-Müser and Herbert Fluhr and Yves Garnier and Susanne Grylka-Baeschlin and Hanns Helmer and Egbert Herting and Markus Hoopmann and Irene Hösli and Udo Hoyme and Alexandra Jendreizeck and Harald Krentel and Ruben Kuon and Wolf Lütje and Silke Mader and Holger Maul and Werner Mendling and Barbara Mitschdörfer and Tatjana Nicin and Monika Nothacker and Dirk Olbertz and Werner Rath and Claudia Roll and Dietmar Schlembach and Ekkehard Schleußner and Florian Schütz and Vanadin Seifert-Klauss and Susanne Steppat and Daniel Surbek},

doi = {10.1055/a-0903-2671},

issn = {0016-5751},

year  = {2019},

date = {2019-08-01},

journal = {Geburtshilfe Frauenheilkd},

volume = {79},

number = {8},

pages = {800--812},

abstract = { This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent scientific literature, the experience of the members of the guideline commission and the views of self-help groups.  Based on the international literature, the members of the participating medical societies and organizations developed Recommendations and Statements. These were adopted following a formal process (structured consensus conference with neutral moderation, voting was done in writing using the Delphi method to achieve consensus).  Part I of this short version of the guideline lists Statements and Recommendations on the epidemiology, etiology, prediction and primary and secondary prevention of preterm birth.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid30826159,

title = {Provision of paediatric and adolescent gynaecology in Europe today: A joint review by the European Association of Paediatric and Adolescent Gynaecology (EURAPAG) and European Board and College of Obstetrics and Gynaecology (EBCOG)},

author = {Ivonne Bedei and Zana Bumbuliene and Milko Sirakov and Tahir Mahmood and Paul L Wood and },

doi = {10.1016/j.ejogrb.2018.08.023},

issn = {1872-7654},

year  = {2019},

date = {2019-04-01},

journal = {Eur J Obstet Gynecol Reprod Biol},

volume = {235},

pages = {116--120},

abstract = {Paediatric and Adolescent Gynaecology (PAG) is a multidisciplinary field combining aspects of gynaecology but also includes paediatrics, endocrinology, genetics, radiology, psychology and urology. Specialist knowledge is warranted for the care of these youngsters, and it is important that doctors attending to the gynaecological needs of children must understand that they are not just "little women". Their needs and accompanying clinical approaches required are very different from those of adults in this sensitive area, as is the spectrum of diseases and problems. A multidisciplinary collaboration is as important as the establishment and adoption of standards in education, training and management. The situation in Europe in PAG is varied, reflecting the relative youth of this area of special interest and thereby allowing for earlier consolidation of standards and services across Europe. This article summarises the background to PAG in Europe, inequitable current provision of care and issues relating to education and training all of which are relevant in providing a common approach to PAG problems and endeavouring to obtain the best outcomes. There remains huge diversity how the services for "young women" are currently delivered across different countries within Europe. A concerted European approach is urgently required to streamline standards of training and clinical care, to ensure high quality care by using agreed national and European pathways.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{pmid21709403,

title = {First-trimester screening for trisomy 21 with adjustment for biochemical results of previous pregnancies},

author = {David Wright and Argyro Syngelaki and Cahit Birdir and Ivonne Bedei and Kypros H Nicolaides},

doi = {10.1159/000328710},

issn = {1421-9964},

year  = {2011},

date = {2011-01-01},

journal = {Fetal Diagn Ther},

volume = {30},

number = {3},

pages = {194--202},

abstract = {OBJECTIVE: To investigate the effect of associations in serum free β-hCG and PAPP-A between successive pregnancies on the performance of screening for trisomy 21 at 11-13 weeks' gestation.



METHODS: In 8,499 women with two consecutive pregnancies, including 49 women with fetal trisomy 21 in the second pregnancy, the correlation in serum free β-hCG multiples of the median (MoM) and PAPP-A MoM between pregnancies was determined, and the effects of correcting for the correlation on the performance of screening was estimated.



RESULTS: There were significant associations between pregnancies in free β-hCG MoM (r = 0.4435) and PAPP-A MoM (r = 0.4796). In screening by maternal age and biochemistry at a risk cutoff of 1 in 100, in the second pregnancies the false-positive rate was 35.5% for those with screen-positive results in the first pregnancy, and this was reduced to 17.1% after adjustment for the results of the first pregnancy. Similarly, in women with screen-negative results in the first pregnancy, adjustment for the results improved the detection rate in the second pregnancy from 66.7 to 81.2%.



CONCLUSIONS: In screening for trisomy 21, adjustment for the biochemical findings in a previous pregnancy has major effects on individual patient-specific risks, increases the detection rate and reduces the false-positive rate.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}