Boris M. Petrikovsky

Successful pregnancy outcome in Ehlers-Danlos syndrome, vascular type.

Background. Ehlers–Danlos syndrome (EDS) is a rare connective tissue disorder characterized by tissue fragility, translucent skin and joint hypermobility. Patients with the vascular type of EDS are prone to spontaneous arterial and visceral rupture. Pregnancy for women with vascular EDS can be life-threatening. Mortality rates are high due to the increased risk for uterine and arterial rupture in the peripartum period. Case. We describe the counseling, multidisciplinary management, protocol, and successful pregnancy outcome of a 32-year-old woman with vascular EDS. Conclusion. There is no consensus in the literature on the timing and mode of delivery for pregnant women with vascular EDS. The management undertaken in our patient may assist others in optimizing the perinatal outcome in other women who elect to continue their pregnancy despite the risks of this severe medical condition.

Fetal dacryocystocele: comparing 2D and 3D imaging

Received: 6 May 2002 Accepted: 24 September 2002 Published online: 26 April 2003 Springer-Verlag 2003 Sir, Three-dimensional ultrasound is slowly gaining in popularity. Many anomalies, including those of the fetal face and head [1, 2], originally seen in conventional two-dimensional sonography are being redescribed using 3D ultrasound. The usefulness of the 3D approach, beyond obtaining ‘‘pretty’’ pictures, has been questioned. We share our experience with a situation when 3D made a difference. A 31-week fetus had a bilateral cystic structure within the orbit and medial to the globe with no other abnormalities detected. Dacryocystocele was the most likely diagnosis (Fig. 1). The parents were informed that the lesion was likely benign and transient in nature. However, the idea of a facial deformity was severely distressing to the couple. At this point, a surface-rendering-type 3D ultrasound image of the lesion (Fig. 2) was shown to the parents. After reviewing a 3D image, the parents were able to obtain a better idea of the nature of the deformity and felt more comfortable. The baby was born at term. A slightly raised purple structure medial to and below the eyes was detected. The diagnosis of dacryocystocele was confirmed by

Jugular venous blood flow velocity waveforms in human fetuses between 20 and 42 weeks of pregnancy.

Background. The goal of the study was to measure the blood flow parameters of the fetal internal jugular vein during the second half of normal pregnancy using Doppler ultrasound.

In utero meconium suctioning may prevent meconium aspiration.

Objective: To assess usefulness of in utero meconium suctioning using endoscopic approach. Materials and Methods: In utero meconium suctioning under direct endoscopic visualization was successfully performed in 11 fetuses in whom thick meconium was detected upon rupture of the membranes. A gas-sterilized flexible fiberoptic scope with an operational channel was introduced via cervix, and meconium was aspirated from the fetal mouth. Definitive suction was performed in all neonates immediately after birth. Results: Endoscopic meconium suctioning was successfully performed in 11 out of 16 fetuses with retrieval of 3–12 ml of meconium. Only 1 neonate in this series of cases had meconium below the vocal cords and none developed meconium aspiration syndrome postnatally. Conclusion: Because fatal meconium aspiration syndrome is largely an intrauterine event, the concept of in utero prophylactic meconium suctioning may serve as an effective modality for its prevention.

Does viewing of Surgical specimen improve patient satisfaction? A cohort study

The purpose of this study was to assess a cohort of patients who underwent elective gynecologic surgery to determine whether viewing of intraoperative photographic images by patients played a role in patient satisfaction. Three hundred and eighteen patients participated in this study, out of which 159 patients were assigned to view the operative photographic pictures and 159 were not. According to the results obtained in this study, a greater number of women who viewed their operative photographic pictures, expressed satisfaction in comparison to those who did not. In addition, this difference was significantly greater in those who encountered intra- and/or postoperative complications.