Annarosa Chincoli

US-color Doppler early diagnosis of uterine rupture with protrusion of umbilical cord

OBJECTIVE to analyze a case of uterine rupture in a pregnant woman that had a previous laparoscopic myomectomy. METHODS pregnant woman at 34 weeks gestation came to our emergency room for abdominal pain. She had undergone a previous laparoscopic multiple myomectomy. Patient was evaluated in our Department, that is a tertiary center, by a team of experienced ultrasonographers. RESULTS at a first clinical examination, the findings were a deep abdominal pain, dysuria and a positive Giordanos sign on the right. 2D ultrasound showed an alive intrauterine foetus, normal anterior fundal placenta and mild reduction of amniotic fluid. It revealed also a maternal right pyelectasis. A further meticulous ultrasound evaluation plus color Doppler revealed on the left side of the uterus the presence of a small vascularised area with venous and arterial flow that seemed to be in continuity with umbilical cord and that had its ultrasound characteristics. Emergency laparotomy was performed and confirmed the hypothesis of uterine rupture. DISCUSSION uterine rupture seems to occur more frequently as a consequence of a laparoscopic myomectomy and the classic signs and symptoms are fetal distress, loss of uterine contractility, abdominal pain, hemorrhage and shock, so the early US suspect of uterine rupture was extremely important in the decision to perform an emergency caesarean section. CONCLUSION the correlation between clinical examination and ultrasound-Doppler findings has been essential to recognise an obstetrical emergency and to perform prompt surgery.

Clinical Management of Infections in Pregnancy: Update in Congenital Cytomegalovirus and Toxoplasmosis

The management of infections in pregnancy aims mainly at improving the diagnosis and prognosis of congenital infections. Investigation and management are often difficult and associated with potential ethical and medicolegal implications; when an infection is diagnosed during pregnancy, it is important to supply perinatal counselling about the risks of vertical transmission in utero and about all diagnostic, prognostic, and therapeutic approaches, emphasizing also the risks for possible fetal long-term sequelae of infection. Recently, the most investigated maternal infections that may affect fetal development or well-being are cytomegalovirus (CMV) and toxoplasmosis, as detectable by a MEDLINE search for congenital infection in the last 5 years of literature.

Uterine Rupture after Laparoscopic Myomectomy in Two Cases: Real Complication or Malpractice?

We describe two cases of uterine rupture in pregnancy after laparoscopic myomectomy and analyze all the aetiological factors involved in this circumstance according to the recent literature, focusing above all on the surgical procedures and the characteristics of the excised myomas. The two cases of uterine rupture in pregnancy following laparoscopic myomectomy occurred at 36 and 18 weeks of gestation, respectively. Both women had undergone laparoscopic multiple myomectomy and uterine rupture occurred along the isthmic myomectomy scars, despite the fact that compliance with all the recent technical surgical recommendations for the previous laparoscopic multiple myomectomy had been fully observed. In our cases we identified the isthmic localization, size of the excised myomas (≥4 cm), and individual characteristics of the healing process as possible risk factors for “a real complication.” Larger studies and robust case-control analyses are needed to draw reliable conclusions; special care should be paid when performing laparoscopic myomectomy in women planning a later pregnancy.

P28.14: Correlation between ultrasound diagnosis and autopsy findings of fetal malformations in second trimester terminations of pregnancy

Amniocentesis N/A Attempted – suboptimal access Yes – normal chromosomes Declined Yes – normal chromosomes Declined Yes – DiGeorge syndrome Outcome baby appeared normal transferred care to FMU TOP due to severe cardiac abnormalities baby appeared normal dysmorphic features at birth – duplication of long arm chromosome 2 and long arm chromosome 10 complete AVSD, neonatal cardiac failure, transferred to tertiary unit for baby’s condition TOP