Claudia Nardelli

Estimation of fetal weight by measurement of fetal thigh soft-tissue thickness in the late third trimester

The accuracy of current formulae for the sonographic estimation of fetal weight (EFW) is compromised by significant intra‐ and interobserver variability of biometrical measurements, particularly circumferences. The aim of this study was to assess the reliability of the linear measurement of mid‐thigh soft‐tissue thickness (STT) and to derive a novel formula for EFW.

Ultrasonographic and hysteroscopic outcomes of uterine scar healing after cesarean section: Comparison of two types of single‐layer suture

Aim:  A common anatomical consequence of low‐segment cesarean section is the presence of a pouch on the anterior uterine wall that can be detected by sonography or hysteroscopy. Different suturing techniques have been compared (single vs double layer) and showed no substantial differences. This prospective longitudinal study was aimed at evaluating the outcome of the cesarean scar, comparing two different types of single‐layer sutures by transvaginal ultrasound and hysteroscopy.

Are active labour and mode of delivery still a challenge for extremely low birth weight infants? Experience at a tertiary care hospital.

OBJECTIVE This study was to evaluate the impact of mode of delivery and timing of caesarean section in extremely preterm births, below 28 weeks of gestation, on long-term survival and psychomotor outcomes. STUDY DESIGN This was a single-centre retrospective cohort study of 84 cases of extremely low birth weight infants with complete maternal, obstetrical and neonatological information. Mortality and survival with neurological disabilities at 18 months of life were considered outcome measures. RESULTS Forty percent of deliveries were at or less than 25 weeks of gestation and birth weight was <or=500 g in 14% of all infants. The overall survival rate was 54.8% with a prevalence of neuromotor impairment with disability among the survivors of 26.1%. After adjustment using multiple logistic regression, only extreme prematurity (<or=25 weeks) and birth weight below 500 g had significant effects on survival (p<0.05), regardless of mode and timing of delivery. CONCLUSIONS Mode of delivery and labour seem not to play a significant role in adverse neonatal outcomes, either mortality or neuro-developmental impairment, in extremely low birth weight infants.

The role of office hysteroscopy in menopause

We evaluated the efficacy of office hysteroscopic treatment of benign intrauterine pathologies using 5F mechanical instruments (scissors, grasping forceps). Subjects were 4863 women who underwent the procedure without analgesia or anesthesia. We treated cervical and endometrial polyps (0.2-3.7 cm), intrauterine adhesions, and anatomic impediments. At 3 months postoperatively, pathology persisted in 364 women (5.6%). Many operative procedures may be performed in the office setting with simple instruments, provided that correct indications are observed.

Non-Puerperal Uterine Inversion due to Uterine Sarcoma

Background: Uterine inversion is a very rare pathologi cal condition that usually occurs in puerperium. Non- puerperal uterine inversion is exceptional and to our knowledge only a few cases of uterine inversion due to a uterine sarcoma have been reported. Case Report: A 79-year-old woman, gravida 0, para 0, presented with vaginal bleeding. Pelvic examination under anesthesia revealed a huge mass coming from the cervix filling the vagina to the introitus, and rectal examination could not identify the uterus. Diagnosis of uterine inversion was made and the patient was submitted to total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node sampling. The postoperative course was uneventful and the patient was discharged on the 5th postoperative day. She underwent postoperative pelvic radiation, and no recurrence was found during the 19-month follow-up period. Conclusion: Chronic non-puerperal uterine inversion can be considered a rare complication of malignant mixed müllerian tumor of the uterus.

The Effects of Chronic Lifelong Activation of the AHR Pathway by Industrial Chemical Pollutants on Female Human Reproduction

Environmental chemicals, such as heavy metals, affect female reproductive function. A biological sensor of the signals of many toxic chemical compounds seems to be the aryl hydrocarbon receptor (AHR). Previous studies demonstrated the environmental of heavy metals in Taranto city (Italy), an area that has been influenced by anthropogenic factors such as industrial activities and waste treatments since 1986. However, the impact of these elements on female fertility in this geographic area has never been analyzed. Thus, in the present study, we evaluated the AHR pathway, sex steroid receptor pattern and apoptotic process in granulosa cells (GCs) retrieved from 30 women, born and living in Taranto, and 30 women who are living in non-contaminated areas (control group), who were undergoing in vitro fertilization (IVF) protocol. In follicular fluids (FFs) of both groups the toxic and essential heavy metals, such as chromiun (Cr), Manganese (Mn), iron (Fe), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), cadmium (Cd) and lead (Pb), were also analyzed. Higher levels of Cr, Fe, Zn and Pb were found in the FFs of the women from Taranto as compared to the control group, as were the levels of AHR and AHR-dependent cytochrome P450 1A1 and 1B1; while CYP19A1 expression was decreased. The anti-apoptotic process found in the GCs of women fromTaranto was associated with the highest levels of progesterone receptor membrane component 1 (PGRMC1), a novel progesterone receptor, the expression of which is subjected to AHR activated by its highest affinity ligands (e.g., dioxins) or indirectly by other environmental pollutants, such as heavy metals. In conclusion, decreased production of estradiol and decreased number of retrieved mature oocytes found in women from Taranto could be due to chronic exposure to heavy metals, in particular to Cr and Pb.

Fertility preservation in males with cancer: 16-year monocentric experience of sperm banking and post-thaw reproductive outcomes

Background: Anticancer treatments can impair male fertility. Cryopreservation of semen is an efficient procedure for fertility preservation. The aim of this study was to evaluate pre-freeze semen parameters among the various types of cancer, post-thaw sperm viability and reproductive outcome of samples used for assisted reproductive treatment (ART). Methods: This study included 721 men with cancer that had their semen cryopreserved in our bank in 1999–2015. Semen analysis and cryopreservation were performed before the start of antineoplastic treatment, according to the World Health Organization recommendations, European Commission and Italian law. Results: Among the 721 patient, 196 had seminoma of the testis, 173 Hodgkin’s lymphoma, 108 mixed testicular tumors, 89 germ cell tumors, 67 other tumors, 46 hematological tumors, and 42 non-Hodgkin’s lymphoma. The mean age of patients was significantly lower in Hodgkin’s lymphoma compared to other tumors. Statistically significant lower volume, sperm count and number of straws stored were observed respectively in Hodgkin’s lymphoma, mixed testicular tumor and hematological tumors. Nineteen patients used their frozen semen for 20 ART cycles. After thawing a significant reduction of motility and vitality was recorded. A lower fertilization rate was observed in patients affected by testicular tumor and lymphoma (35.42% and 50%) compared with other cancers (71.43%). No significant differences were observed in terms of cleavage and implantation rates. A total of five pregnancies and seven healthy newborns were achieved. Conclusions: Fertility preservation before gonadotoxic therapy is of great importance to patients with cancer and must be indicate before the start of treatment.

Perinatal Risk Factors and Mode of Delivery Correlated to Survival and Psychomotor Disability in Extremely Low Birth Weight Infants

Background/Aims: Extreme preterm birth, <28 weeks of gestation, represents a public health concern with major economic implications, being the leading cause of neonatal mortality and morbidity. Methods: A single-centre retrospective cohort study was carried out to assess the role of caesarean section and to identify perinatal factors affecting neonatal survival and psychomotor development in these infants. 57 cases with complete maternal, obstetrical and neonatological information were selected for this study and neurological development was assessed for at least 18 months of life. Results: Infant survival and neurological morbidity rates were directly and inversely correlated to birth weights and gestational age at birth, respectively. In multivariate analysis only extreme prematurity (≤25 weeks) and birth weight <500 g were significantly associated with mortality, whereas no factor correlated to neuromotor impairment. Conclusions: The management of preterm labour at the limit of viability is always challenging. Knowledge of risk factors associated with obstetrical situations may affect medical management and indeed offer useful information for parent counselling.

Ultrasound evaluation of the uterine scar after cesarean delivery: a randomized controlled trial of one- and two-layer closure.

To the Editor: We read with interest the manuscript by Hamar et al1 on the ultrasound evaluation of the uterine scar after primary caesarean deliveries. The authors describe a randomized controlled trial on myometrial remodelling according to the surgical procedure performed. Patients had a preoperative and 6-week postoperative sonographic evaluation of the lower uterine segment. Significant variation was seen over time in the scar thickness, but this was unrelated to uterine closure type. The methodological approach of this study seems debatable mainly for length of follow-up and sonographic assessment of scar remodelling. Previous studies used magnetic resonance imaging, suggesting that the remodelling of the scar may not be complete up to 6 months after surgery.2 Therefore, the 6-week follow-up scheduled by Hamar et al seems quite arbitrary and probably unable to provide definitive information about the myometrial remodeling and the characteristics of the scar after a long time (years). Moreover, the methodological approach was likely to be insufficient to draw any conclusion as to whether the ultrasound was reported as either transabdominal or transvaginal, whereas it is known that transvaginal ultrasound is far more precise for small uterine defects. We agree with the authors that it is unclear how long the uterus takes to complete its remodelling, but certainly it is longer than 6 weeks. This is also confirmed by the onset of some symptoms, namely intermenstrual brown bleeding,3 linked to the cesarean scar defect that become evident about 2 years after delivery. The correlation between surgical technique and uterine scar remodelling after caesarean delivery is not clarified yet. This may be of some relevance for understanding the pathophysiology of abnormal healing of the uterine scar and subsequent development of intermenstrual bleeding.

Dynamics of the development of multiple follicles by early versus late hCG administration in ART program

Abstract Objective: To evaluate, in patients stimulated with recombinant FSH and GnRH antagonists, whether triggering the final maturation of oocytes affects IVF outcomes. Study design: Five hundred and six IVF procedures were divided into three groups according to the timing of hCG administration: when at least 2 follicles reached the diameter of 17 mm, at least 2 follicles reached 18 mm and at least 2 follicles reached 20 mm. The main outcome was the number of mature oocyte that was the dependent variable of a multivariate model whose independents were, age, AFC, hCG timing, E2 levels at hCG day, number of follicles in different categories of dimension. Secondary endpoints were to compare fertilization, implantation and pregnancy rates in a multilevel multivariate model whose covariates were age, BMI, AFC, embryo quality and cause of infertility. Results: Timing did not result a statistically significant factor influencing the number of oocytes collected, which was influenced by age, AFC, number of follicles between 12.1 and 15.9 mm and E2 levels. Implantation rate and pregnancy rate appear to be affected only by embryo quality. Conclusion: The number of oocytes collected and the probability of pregnancy are not associated with the time of hCG administration.