A. Dall'Asta

Calcium supplementation and prevention of preeclampsia: a meta-analysis

Background: Since the early 1980s, epidemiological evidence has suggested a connection between low calcium intake and preeclampsia The purpose of this meta-analysis is to summarize current evidence regarding calcium supplementation during pregnancy in predicting preeclampsia and associated maternal–fetal complications. Methods: Literature revision of all RCT (random allocation of calcium versus placebo) available in MEDLINE/PUBMED up to 2/29/2012 regarding calcium supplementation during pregnancy for preventing preeclampsia. We used the Mantel-Haenszel’s Method for four subgroup of patients: Adequate calcium intake; Low calcium intake; Low risk of preeclampsia; High risk of preeclampsia. We considered p < 0.05 as significant. Results: There is no consensus in Literature about: (1) the efficacy of calcium supplementation in the prevention of preeclampsia, (2) other/adverse/long-term effects of calcium supplementation in pregnancy. Conclusions: Preeclampsia is likely to be a multifactorial disease. However, inadequate calcium intake represents a factor associated with an increased incidence of hypertensive disease. The results of our meta-analysis demonstrate that the additional intake of calcium during pregnancy is an effective measure to reduce the incidence of preeclampsia, especially in populations at high risk of preeclampsia due to ethnicity, gender, age, high BMI and in those with low baseline calcium intake.

Crystal Vue technique for imaging fetal spine and ribs.

New ways of assessing the fetus are now possible owing to the introduction of three-dimensional (3D) ultrasound over a decade ago1. 3D ultrasound has been used as an easy-to-perform and accurate technique to image the fetal skeleton1–6. Garjian et al. demonstrated that 3D ultrasound can provide more information than does conventional two-dimensional (2D) imaging in the diagnosis of skeletal abnormalities, both in multiplanar and volume-rendered methods. This is particularly true when assessing short ribs and chest hypoplasias as the entire body region can be visualized and offline volume reconstruction can be performed3. Classical 2D ultrasound examination of long bones, ribs and vertebrae frequently gives insufficiently detailed images for assessment of bone contour, thickness and mineralization. Crystal Vue is a new technique based on image-contrast enhancement that can be used for processing and rendering of acquired 3D volumes. Our recent experience with Crystal Vue, specifically when imaging the bone/soft tissue interface, has led us to believe that it may offer new opportunities for prenatal imaging, particularly of the skeletal system but also of the face and brain. Here we present and compare images of the spine and ribs in a third-trimester normal fetus and those in a fetus with suspected skeletal dysplasia, examined using a Samsung WS80 Elite system (Samsung Medison Co. Ltd., Seoul, South Korea) with Crystal Vue and Realistic Vue software applications. A 39-year-old pregnant woman who had five previous healthy pregnancies was followed up at 20 weeks’ gestation after spontaneous resolution of pleural effusion and echogenic bowel. Amniotic fluid-polymerase chain reaction and array were negative as was TORCH and cystic fibrosis testing. Ultrasound examination was performed at 29 + 4 weeks’ gestation (Figure 1). On 2D imaging, the spine and ribs appeared normal with normal fetal movements and amniotic fluid. Using Crystal Vue postprocessing on a saved 3D volume, the rib/vertebral interface was seen clearly and rib mineralization appeared normal; we were able to identify 12 ribs.

Qualitative evaluation of Crystal Vue rendering technology in the assessment of fetal lip and palate

Facial clefts of the lip and alveolar ridge are usually evaluated with conventional ultrasound imaging. However, assessment of the extension of the defect into the palate and the detection of isolated clefts of the secondary palate is often not always possible due to poor acoustic windows. Nevertheless, knowledge of the extent of the cleft has significant prognostic implications in terms of pregnancy choices, surgical and functional outcome. Newly developed three-dimensional (3D) technologies offer the opportunity to develop novel imaging techniques for the evaluation of the secondary palate, although these have not been objectively compared. Crystal Vue (CV) is a recently developed ultrasound 3D post processing rendering technology based on image-contrast enhancement which is capable of preserving context and surface information. In this study we qualitatively describe its performance in the assessment of the fetal lip and palate and compare our findings to those reported using other 3D methods.

Intrapartum diagnosis of posterior asynclitism using two‐dimensional transperineal ultrasound

Fetal head malposition in labor is among the main causes of poor progression and dystocia. In affected cases, ultrasound has proven to be helpful in supporting the findings of digital examination and refining clinical management accordingly. We report here a case of posterior asynclitism identified on transperineal ultrasound. A 28-year-old nulliparous woman on epidural analgesia following slow progression of the first stage of labor

Intrapartum sonographic diagnosis of posterior asynclitism by two-dimensional transperineal ultrasound.

Fetal head malposition in labor is among the main causes of poor progression and dystocia. In affected cases, ultrasound has proven to be helpful in supporting the findings of digital examination and refining clinical management accordingly. We report here a case of posterior asynclitism identified on transperineal ultrasound. A 28-year-old nulliparous woman on epidural analgesia following slow progression of the first stage of labor

Short-term outcome of periviable small-for-gestational-age babies: is our counseling up to date?

There are limited data for counseling on and management of periviable small‐for‐gestational‐age (SGA) fetuses. We therefore aimed to investigate the short‐term outcome of periviable SGA fetuses in relation to the likely underlying cause.

Is the short axis view of the fetal heart useful in improving the diagnostic accuracy of outlet ventricular septal defects

Outlet ventricular septal defects (VSDs) are usually suspected on the five‐chamber view of the fetal heart; however, postnatal confirmation occurs only in a small number of cases. The aim of this study was to evaluate if the systematic assessment of the short axis view may improve the prediction of prenatally detected outlet VSDs.

Endoloop technique for laparoscopic cornuectomy: A safe and effective approach for the treatment of interstitial pregnancy

Interstitial pregnancy (IP) occurs within the intramural portion of the tube and accounts for 2% of ectopic pregnancies. Surgery is considered the most definitive treatment for IPs, although there is no clear consensus regarding the optimal approach. In this paper we describe the advantages of cornual resection performed using the Endoloop technique and present three patients who were successfully treated using this approach. IP diagnosis was confirmed at two and three‐dimensional ultrasound and laparoscopy in all cases. Fertility sparing surgery with cornuectomy by Endoloop ligature technique demonstrated low mean operating time and blood loss, and allowed the quick recovery and discharge of all patients. Laparoscopy has become the gold standard surgical approach for IP. Cornual resection or excision is the most commonly performed procedure. In our case series, the Endoloop technique showed excellent treatment outcomes in terms of effectiveness, blood loss, operative time, recovery and post‐procedure fertility. Because of these features, Endoloop appears to be a suitable option for the laparoscopic management of IPs, both in elective and emergency settings.

Three‐dimensional assessment of umbilical vein deviation angle for prediction of liver herniation in left‐sided congenital diaphragmatic hernia

To introduce a new sonographic marker of intrathoracic liver herniation in fetuses with left‐sided congenital diaphragmatic hernia (CDH).

Randomised Italian Sonography for Occiput POSition Trial Ante Vacuum (R.I.S.POS.T.A.)

To assess whether sonographic diagnosis of fetal head position before instrumental vaginal delivery can reduce the risk of failed vacuum extraction and improve delivery outcome.