Annamaria Giacobbe

Thyroid Function in Women Found to Have Early Pregnancy Loss

BACKGROUND Pregnancy influences thyroid function and may bring to light mild and latent disorders. Thyroid dysfunction has been related to obstetrical complications such as premature delivery, gestational hypertension, preeclampsia, and placental abruption. The aim of our study was to evaluate whether the occurrence and timing of pregnancy loss could be related to thyroid autoimmunity or subclinical hypothyroidism (SH) per se. METHODS Two hundred sixteen apparently healthy pregnant women with no previous history of thyroid disease and with diagnosis of early miscarriage (before the 12th week of gestation) were enrolled. Miscarriages were classified as very early pregnancy loss (EPL) or embryo loss (crown rump length < or =10 mm) and EPL or fetal loss (crown rump length > 10 mm). Women were subdivided into four groups: euthyroid (ET), SH, overt hypothyroidism, and thyroid autoimmunity group. RESULTS One hundred seventy-six women had a normal thyroid function (84.6%), 24 patients were found to have positive thyroid antibodies (11.5%), 8 women (3.8%) an SH, and 8 cases were excluded. Thyroid-stimulating hormone levels were found to be higher in the very early (1.4 +/- 1.0 mU/L) than in the EPL group (1.1 +/- 0.7 mU/L) (p = 0.04), and in patients affected by SH (3.9 +/- 0.1 mU/L) compared to ET (1.0 +/- 0.5 mU/L) (p < 0.001) and autoimmune women (1.0 +/- 0.4 mU/L) (p < 0.001). Although the multivariate logistic regression analysis revealed that both autoimmunity and SH were independently correlated with the onset of very EPL, abortion was more precocious in the SH group (6.5 +/- 0.9 weeks), followed by the autoimmune (8.2 +/- 2.1 weeks) and ET groups (8.2 +/- 1.6 weeks) (p = 0.02). CONCLUSIONS Both thyroid diseases SH and autoimmune disorder are independently associated with very early embryo loss, but women suffering from SH have a lower gestational age at abortion.

Uterine myomas during pregnancy: a longitudinal sonographic study

To evaluate volumetric changes of uterine myomas (fibroids) during pregnancy.

Women's preference on mode of delivery in Southern Italy

Background. Rates of cesarean section are rising worldwide and maternal requests for this kind of delivery contribute to the increase in this trend. The purpose of this study was to analyze the factors influencing maternal demand in our region and the profile of women preferring this mode of delivery. Methods. Six obstetricians (3 male and 3 female) were asked to give out a questionnaire to their patients with an uncomplicated pregnancy. Demographic data, obstetrical history, lifestyle, and physician–patient relationship were analyzed. Patients who would have preferred abdominal delivery were asked to report the motivations for their choice. A psychiatric evaluation, using the Hamilton Anxiety Scale and the Montgomery–Åsberg Depression Rating Scale, was conducted. Results. 16.9% of 390 patients enrolled preferred cesarean section. This wish was correlated with patients’ age ≥ 35 years (OR 2.43; p=0.0065), high level of education (OR 4.28, p=0.019), previous infertility (OR 3.91, p=0.0045), smoking (OR 4.25, p=0.0008), quality of information (OR 29.08, p=0.0013), and desire for more comprehension (OR 8.25, p=0.00001). The most frequent motivation for this choice was a safer childbirth (90.9%). No difference was found for the Hamilton scales score, while the Montgomery‐Asberg Scale showed a lower mean score for the cesarean section group (7.2±3.3 versus 9.4±7.3, p=0.0002). Conclusions. A high rate of women wish to give birth by cesarean section. This is probably an expression of the changes in societys attitudes. However, more careful attention to the psychological aspects and more personalized information about pregnancy and delivery could reduce this maternal demand.

General versus spinal anaesthesia for elective caesarean sections: effects on neonatal short-term outcome. A prospective randomised study

Objective. To compare neonatal short-term outcome in patients who underwent spinal, general anaesthesia and conversion from spinal to general anaesthesia. Methods. One hundred seventy-nine pregnant women undergoing elective caesarean section were allocated randomly to general (n = 89) or spinal anaesthesia (n = 90) and compared with 63 patients who required conversion to general anaesthesia. Umbilical cord artery pH, Apgar score as well as its individual parameter and need for assisted ventilation were evaluated. Results. No differences were found in pH values (p = 0.35), while the need for assisted ventilation differed significantly (p = 0.001). The rate of depressed newborns was 1.1% in the spinal group, 25.9% in the general group and 12.7% in the conversion group with a significant difference for all comparisons. At 5-min, all newborns were vigorous. At 1 min, a higher score for each parameter was found in spinal group with respect to general group, while ‘activity’, ‘grimace’ and ‘respiration’ showed a higher score in conversion group than in general group. At 5 min, a difference was found only for ‘activity’. Conclusions. All kinds of anaesthesia seem to be safe, but loco-regional blockade shows more advantages on the neonatal outcome also when a conversion is necessary.

Wound length and corticosteroid administration as risk factors for surgical-site complications following cesarean section

Objective. To evaluate the effect of some specific gestational factors and other known variables associated with poor wound healing in women who delivered by cesarean section. Design. Observational, prospective study. Setting. University Hospital of Messina. Population. A total of 212 consecutive pregnant women at term delivering by elective cesarean section. Methods. All data regarding demographic and gestational characteristics were collected at admission. The subcutaneous tissue depth was intra‐operatively measured from the fascia to the skin surface, while the incision length was measured after skin closure. Main outcome measures. Onset of wound complications such as infection, seroma, hematoma, abscess or dehiscence > 1 cm. Results. Body mass index (BMI) at term [odd ratio (OR) 1.2, 95%CI 1.03–1.38; p = 0.01], wound length (OR 1.03, 95%CI 1.01–1.05; p < 0.001) and corticosteroid administration (OR 3.4, 95%CI 1.5–7.9; p = 0.004) were found to be correlated with wound complications. The receiver operating characteristics curve analysis suggested a cut‐off of 31.1 for the BMI at term and 166 mm for the wound length with an OR of 2.28 (95%CI 1.18–4.39; p = 0.013) and 4.3 (95%CI 2.2–8.6; p < 0.001), respectively. The multivariate logistic regression model, applied to these variables and to corticosteroid administration, showed an independent correlation (at term BMI > 31.1: OR 2.04, 1.01–4.13, p = 0.047; wound length > 166 mm: OR 4.89, 2.36–10.14, p < 0.001; corticosteroid administration: OR 3.11, 1.38–6.95, p = 0.006). Conclusions. To avoid wound complications obstetricians should be careful in the administration of steroids before surgery, in the skin incision length that should be kept as short as possible and in carefully observing gestational BMI.

High mobility group protein B1: a new biomarker of obesity in pregnant women?

Abstract Obesity is associated with an increased risk of an adverse pregnancy outcome. The aim of this study was to analyze the serum levels of high mobility group protein B1 (HMGB1) in obese pregnant women, to assess the role of this protein in the pathogenesis of this disease and to evaluate its possible function as a diagnostic marker for obesity-related complications in obese women. Study participants were randomly selected, from a cohort of pregnant women afferent to our department. A total of 120 women were enrolled in this study: 60 pregnant women had normal body mass index (BMI) and 60 women resulted obese. Pre-pregnancy BMI, weight increase and HMGB1 levels were evaluated for each pregnant woman enrolled. Matching serum HMGB1 levels in two groups, our data evidenced higher levels in the obese women, with a statistically significant difference (p = 0.0023). A significant positive univariate correlation was observed between serum HMGB1 levels and BMI in obese women. HMGB1 serum levels may therefore represent a predictive marker of disease in pregnant women (r = 20.9 and p = 0.0001). Further studies are needed in order to validate the role of this cytokine, with the aim of making it possible to use in clinical practice not only for diagnostic purposes, but especially for the early recognition of complications related to it.

An unusual form of mirror syndrome: a case report

Aim: Mirror syndrome is a triad consisting of fetal hydrops, maternal edema and placentomegaly. Its pathogenesis is unclear and it is frequently mistaken for preeclampsia, even though distinguishing features can be identified. It is associated with an increase in fetal mortality and maternal morbility. Methods: We report an uncommon case of mirror syndrome, which appeared late in pregnancy (38 weeks) in a young nulliparous and characterized by sudden and massive vulvar edema, with placentomegaly and hydramnios but without fetal hydrops. Results: Our report is an interesting example of an unusual form of Mirror syndrome for several reasons. First of all, the gestational age in which the disorder appeared differs remarkably from the data of literature; in our case, clinical signs and symptoms appeared only at 37 weeks. Another difference consists in the lack of hypertension that represents the second most common symptom associated and explains the difficulty to differentiate this syndrome from preeclampsia. Conclusions: Although mirror syndrome is associated with an increase in perinatal mortality, in the case we reported the late onset of the disorder associated with the medical treatment and the timely decision to perform a caesarean section allowed the birth of a healthy baby.

The influence of planned kinds of delivery on pregnant women's emotional state

Objective: To evaluate if labour induction and elective caesarean section could influence anxiety and depression in pregnant women. Methods: One hundred and sixteen consecutive pregnant women with uncomplicated singleton pregnancy at term, scheduled for these two obstetric procedures were enrolled. An anonymous questionnaire with two self-rating instruments STAI and HAM-A for anxiety and HAM-D for depression was administered. Results: Anxiety levels did not show significant differences while a light depressive mood was evidenced among pregnant women waiting for labour induction (p = 0.01). Conclusions: An adequate psychological support could be considered a helpful tool for pregnant women scheduled for labour induction.

Endovascular Treatment of Cerebral Arteriovenous Malformation Bleeding during Pregnancy: A Case Report

Cerebral arteriovenous malformations (AVMs) represent congenital anomalies of blood vessels composed of a nidus of anomalous arterial and venous vessels without a capillary network. We describe a case of bleeding cerebral AVM in a pregnant women at the second quarter of gestation and diagnosed by digital subtraction angiography showing a large principal arterial nidus supply. The AVM was treated by endovascular embolization at the 27th week of gestation. The post-operative course was uneventful and a caesarean section was performed at the 37th week of gestation. The endovascular approach may represent a safe method in the treatment of this cerebral condition during pregnancy.

Antenatal identification of isolated anophthalmia

Introduction Anophthalmia is a rare anomaly of the developing eye characterised by the absence of the globe, despite the presence of ocular adnexa (eyelids, conjunctiva and lacrimal apparatus) (Bardakjin et al. 2004). Its prevalence is estimated at 0.6 per 10,000 births and it is not infl uenced by race or gender of the newborn (Clementi et al. 1992; Kouassi et al. 2006). It oft en may be diffi cult to diff erentiate this anomaly, both clinically and by imaging, from severe microphthalmia (Albernaz et al. 1997). As a matter of fact, the term ‘ anophthalmia ’ has been used as a synonym for ‘ extreme microphthalmia ’ (Wong et al. 2008). Th is anomaly can be unilateral or, rarely, bilateral and it can be diff erentiated into two types, the ‘ true ’ and the ‘ clinical form ’. In particular, the former is due to the lack of development of the optic vesicle during the fi rst 8 weeks ’ gestation and it refl ects in the absence of eye and optic canal. It is oft en associated with other cerebral abnormalities (anencephaly and mid-line anomalies). Th e latter, instead, indicates the regression of the optic vesicle yet formed. In this case, an ocular remnant with optic nerve could be detected (Romero et al. 2002; Lodge et al. 2008). Th e exact pathogenesis is still unknown: chromosomal aberrations, genetic mutations, toxic agents and infections are found. Although the aetiology could be diff erent, treatment is similar for all forms. We describe the fi nding of isolated anophthalmia, diagnosed at 24 weeks ’ gestation.