Alessandra Kustermann

Transvaginal sonography for fetal measurement in early pregnancy

Objective To establish reference ranges for fetal size by gestation in the first trimester as indicated by cephalic, abdominal and limb measurements using trans‐vaginal sonography.

Diffusion-weighted magnetic resonance imaging of acute hypoxic-ischemic cerebral lesions in the survivor of a monochorionic twin pregnancy : case report

Monochorionic twin pregnancies complicated by the death of one twin are associated with substantial morbidity in the survivor, with a high risk of developing hypoxic‐ischemic brain damage. In this report, we demonstrate how prenatal diffusion‐weighted magnetic resonance imaging detected focal ischemic lesions in the survivor of a monochorionic twin pregnancy within 1–2 days of cotwin death. A very early diagnosis of cerebral ischemic lesions might influence the management of the pregnancy. Copyright

Prenatal magnetic resonance imaging evaluation of ischemic brain lesions in the survivors of monochorionic twin pregnancies: report of 3 cases.

The death of 1 twin of monochorionic pairs is associated with a significant risk of brain hypoxic-ischemic damage in the survivor. Ultrasound may diagnose cerebral anomalies only a few weeks after the event. We report 3 cases of single survivors of monochorionic-twin pregnancies in which prenatal magnetic resonance imaging detected brain changes earlier and with better definition of the brain abnormalities than ultrasound.

Patterns of evoked behaviour in twin pregnancies during the first 22 weeks of gestation

The objective of this work was to investigate the emergence of intrapair stimulation between twin fetuses and the presence of possible changes in types and percentage of evoked patterns with advancing gestational age. The existence of intrapair stimulation would indicate the functioning of fetal tactile and proprioceptive sensibility. This was studied from video recordings of 30 min ultrasonographic observations of 8 twin pregnancies at 8, 9 and 10 weeks gestational age, of 20 twin pregnancies at 11, 12 and 13 weeks and of 20 twin pregnancies studied with 60 min observations at 15-16, 18-19 and 21-22 weeks. All age groups were subdivided in Monochorionic (Mc) and Dichorionic (Dc) pregnancies. Intrapair stimulation before 11 weeks gestational age is an exceptional event. Due to greater spatial contiguity and thinness of the membrane dividing the two amniotic sacs in Mc pregnancies, it was noted only in these. From 12 weeks onwards, evoked movements began to be observed in Dc pregnancies as well. After the 15th week, intrapair stimulation is a constant and increasing feature of all twin gestations. Movements vary from generalized bodily activity to being progressively localized. No specific evoked movement patterns were observed.

Perinatal management of fetal hydronephrosis with normal bladder

This report covers 30 cases of prenatal diagnosis of uni- or bilateral hydronephrosis not associated with an overdistended bladder. Oligohydramnios was observed only in four cases while polyhydramnios occurred in three affected fetuses. In no case was fetal urine aspirated or drained prenatally. Early delivery was performed in four cases with oligohydramnios. Sixteen newborns required surgical correction of the lesion as it was confirmed by urography, following at least two sonographic examinations which confirmed a moderate to severe hydronephrosis after birth. The most frequent lesion was pyelo-ureteric junction obstruction (12 cases). Thirteen cases were normal at follow-up, and in two of these the dilation cleared up during intrauterine life. One case of severe hydronephrosis proved to be a multicystic kidney. In this series isolated hydronephrosis, both uni- or bilateral did not result in fetuses being at high risk for survival (only one infant died after surgery) nor as regards to associated malformations and perinatal morbidity. Provided a properly timed surgical correction was performed, renal function resulted to be good at follow-up.

Thrombophilia and fetal germinal matrix‐intraventricular hemorrhage: does it matter?

Germinal matrix‐intraventricular hemorrhage (GMH‐IVH) in the fetus is very rare and the role of thrombophilia in its pathogenesis is unclear. We report on the prenatal diagnosis by magnetic resonance imaging of GMH‐IVH in a 24‐week fetus. The newborn presented posthemorrhagic ventriculomegaly and was found to be heterozygous for two thrombophilic patterns, factor V Leiden and methylenetetrahydrofolate reductase mutation. The combination of this hypercoagulable state and prenatal GMH‐IVH is discussed together with the opportunity of testing these infants for thrombophilia. Copyright

What Is Known and Unknown About the Association Between Endometriosis and Sexual Functioning: A Systematic Review of the Literature:

It is well known that endometriosis is associated with an increase in the risk of deep dyspareunia, with potential negative effects on global female sexual functioning and couple relationship. The aims of this study were to review the literature on the impact of endometriosis on female sexual functioning and to suggest new avenues for future research and treatment strategies. An electronic database research was performed to identify all the studies on the relation between endometriosis and sexual functioning published in the period 2000 to 2016. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After the screening process, a total of 9 studies investigating the relation between endometriosis and female sexual functioning were considered. Overall, these studies indicated that around two thirds of women with endometriosis have some form of sexual dysfunction not limited to deep dyspareunia. These findings suggest that the global sexual impact of endometriosis requires further investigation, focusing not only on pain during intercourse but also on psychological and relational dimensions, including partner’s sexual functioning. Because sexual functioning is a complex, multidimensional phenomenon, the ideal treatment for endometriosis-related sexual dysfunctions should be conducted by a multidisciplinary team composed of gynecologists, sexologists, and psychologists/psychotherapists.

Vaginal rejuvenation: current perspectives

Female genital cosmetic surgery includes several procedures aimed at reaching better female genital appearance and/or improved sexual functioning. Among these procedures, vaginal rejuvenation is considered as one of the most controversial genital cosmetic surgical interventions and involves a range of surgical procedures performed by gynecologists or plastic surgeons to decrease the average diameter of the vagina, mainly for sexual reasons. In this narrative review, vaginal rejuvenation outcomes are examined in order to clarify the current scenario of the different vaginal rejuvenation techniques, as well as their effectiveness and associated complications. Psychological and ethical issues linked to these procedures are also addressed.

Fetal Behavioral States

Main points: historical survey, sleep in children and premature infants, fetal micro-awakenings are not wakefulness, fetal ocular motions building blocks of the visual system, development of behavioral states, and differences and similarities with neonatal states

Changes in Blood Flow Velocity Waveforms following Fetal Blood Sampling

The umbilical artery, aorta, and middle cerebral artery pulsatility indices were investigated by pulsed Doppler ultrasound in 73 fetuses at 18-37 weeks of gestation, before and after fetal blood sampling performed either at the placental cord insertion (n = 46) or at the intrahepatic vein (n = 27). At the end of the procedure, after randomization, 35 fetuses were infused amounts of normal saline equal to the blood volume withdrawn, and 38 fetuses served as controls. Following blood sampling, the umbilical artery pulsatility indices decreased both in controls (p = 0.004) and in the saline group (p = 0.006). The middle cerebral artery velocity waveforms exhibited similar changes only in controls (p = 0.01), and no changes in fetal heart rate and aortic pulsatility indices were recorded in either group. The changes in blood flow velocity waveforms did not correlate with gestational age and the blood volume sampled, and were similar whether the site of sampling was the placental cord insertion or the intrahepatic vein. In 10 acidemic and/or hypoxemic fetuses, pulsatility indices in the umbilical and middle cerebral arteries were not modified by the blood sampling procedure. The release of vasoactive substances is most likely the cause of diminished vascular resistances following fetal blood sampling. Hypoxemic/acidemic fetuses may fail to mount a normal vasodilative response to needle puncture.