D. Rinaldo

Interleukin-6 concentrations in cervical secretions identify microbial invasion of the amniotic cavity in patients with preterm labor and intact membranes

OBJECTIVE The objectives of this study were to determine whether cytokine levels in cervical secretions were increased in the presence of microbial invasion of the amniotic cavity in patients with preterm labor and intact membranes and to relate concentrations to cytokine levels in amniotic fluid, cervicovaginal microflora, and the presence of chorioamnionitis. STUDY DESIGN Cervical secretions were sampled immediately before amniocentesis in 92 patients admitted for preterm labor with singleton pregnancies and intact membranes. Amniotic fluid was cultured and the following cytokines were measured in amniotic fluid and cervical secretions: interleukin-1 beta, interleukin-1 receptor antagonist, tumor necrosis factor-alpha, and interleukin-6. The cervicovaginal microflora and placentas (n = 42) were also analyzed. RESULTS A total of 19.56% (18/92) of the amniotic fluid cultures had positive results. All the cytokines tested showed significantly higher levels in cervical secretions in the presence of intraamniotic infection. There were significant relationships between the concentrations of interleukin-6 and interleukin-1 receptor antagonist in amniotic fluid and cervical secretions. A concentration of interleukin-6 in cervical secretions > 410 pg/ml had a sensitivity of 66.8% and a specificity of 90.5% and a relative risk of 7.7 for intraamniotic infection, higher than the other cytokines tested. There were no relationships between the presence of bacterial vaginosis and cervicovaginal pathogens and cervical cytokine levels. In the presence of chorioamnionitis, cervical concentrations of interleukin-6 and interleukin-1 receptor antagonist were significantly increased in spite of negative amniotic fluid culture results. CONCLUSION The measurement of interleukin-6 in cervical secretions may help to noninvasively identify intraamniotic infection among pregnancies with preterm labor and intact membranes.

Preoperative sonographic features of borderline ovarian tumors

To determine the sonographic findings that distinguish borderline ovarian tumors (BOT) from both benign and invasive malignant tumors, thus allowing conservative treatment and laparoscopic management of these tumors.

Staging of Pelvic Endometriosis: Role of Sonographic Appearance in Determining Extension of Disease and Modulating Surgical Approach

Abstract Study Objective To estimate whether laparoscopic staging of endometriosis can be predicted by ultrasound findings. Design Prospective study (Canadian Task Force classification II-2). Setting Obstetrics and Gynecology Department, University of Rome Tor Vergata. Patients One hundred twenty-one women with histologically confirmed sonographic diagnosis of endometriomas. Intervention Ultrasonographic staging and laparoscopic assessment. Measurements and Main Results All patients underwent transvaginal and/or transrectal sonographic evaluation of ovarian endometriomas and other sonographic markers (anatomic sites and their relation to abdominovaginal palpation, adhesions, deep or infiltrating nodules) to stage the disease before surgery. These results were compared with laparoscopic staging. Concordance between methods was 83.5%. Specificity and sensitivity of ultrasonographic staging of stages 3 and 4 disease were 86% and 82% and 76% and 91%, respectively. Conclusion Ultrasonographic findings can predict pelvic extension and stage of endometriosis.

Fetal pH value determined by cordocentesis: an independent predictor of the development of antepartum fetal heart rate late decelerations in growth retarded fetuses with absent end-diastolic velocity in umbilical artery

Objective of this study was to establish the relationship in growth retarded fetuses between acid-base status in fetal blood obtained by cordocentesis and time interval between blood sampling and occurrence of antepartum heart rate late decelerations. Eighteen growth retarded fetuses scheduled for cordocentesis were considered for this study. All fetuses were free from structural and chromosomal abnormalities, characterized by absent end diastolic velocity waveforms in umbilical artery and later delivered for the development of antepartum heart rate late decelerations. Regression analysis showed that the time interval between cordocentesis and delivery was significantly related to pO2 (r = 0.46; p < or = 0.05) and pH (r = 0.57; p < or = 0.01) delta values but not with pCO2 values. Stepwise multiple regression analysis demonstrated that the severity of fetal acidosis significantly and independently predicted the length of this time interval even after controlling for confounding variables such as pO2 values, gestational age, presence of hypertension, or umbilical vein pulsations. The knowledge of this relationship may be useful in the clinical management of growth retarded fetuses.

Effects of Braxton-Hicks Contractions on Fetal Heart Rate Variations in Normal and Growth-Retarded Fetuses

The objective of this study was to evaluate whether Braxton-Hicks contractions induce changes in fetal heart rate variation in normal and growth-retarded fetuses. 110 uncomplicated singleton pregnancies were cross-sectionally studied as well as 16 pregnancies complicated by fetal growth retardation secondary to uteroplacental insufficiency. Fetal heart rate variability was analyzed by a commercially available computerized system (2CTG Hewlett Packard, Italy) 10 min before and 10 min after the Braxton-Hicks contraction. All the included fetal heart rate tracings fulfilled the following criteria: (1) presence of a single Braxton-Hicks contraction in the 20 min considered; (2) absence of fetal heart rate decelerations after the contraction, and (3) stable fetal heart rate behavioral pattern in the period analyzed. 82 tracings of normal fetuses were analyzed during an active fetal heart rate pattern (type B) and the remaining 28 during a quiet pattern (type A). In both patterns no significant differences in delta value, long-term irregularity, short-term variability and interval index were found before and after the contraction. All the tracings of growth-retarded fetuses were analyzed during the fetal heart rate pattern A. Short-term variation and interval index significantly decreased during the first 5 min after the contraction while no significant differences were found in the other indices investigated. The decrease in these indices was significantly more marked in those fetuses developing fetal distress within 7 days. In conclusion, Braxton-Hicks contractions induce a significant decrease of short-term variation and interval index only in growth-retarded fetuses. This can be useful in the early identification of fetal compromise in such fetuses.

Effects of cordocentesis on inferior vena cava velocity waveforms : Differences between normally grown and growth-retarded fetuses

The objective of this study was to analyze the effects of cordocentesis on velocity waveforms recorded from the inferior vena cava and to evaluate differences, if any, in the hemodynamic response between normally grown and growth-retarded fetuses. Twenty-five normally grown fetuses and 20 growth-retarded fetuses were considered for this study. This latter group was characterized by abnormal Doppler indices in the umbilical artery and the middle cerebral artery suggestive of uteroplacental insufficiency as the causative factor of the impaired growth. Flow velocity waveforms were measured from the inferior vena cava immediately before and after cordocentesis and the % reverse flow during atrial contraction calculated. In normally grown fetuses the % reverse flow values did not vary significantly after cordocentesis, while in growth-retarded fetuses this index increased significantly after the procedure (p < or = 0.001). Furthermore, the amplitude of this increase was inversely related to pH levels in umbilical vein (p = 0.004). In conclusion, in growth-retarded fetuses cordocentesis induces an increase of % reverse flow in the inferior vena cava, while no modifications occur in normally grown fetuses. This suggests the presence in growth-retarded fetuses of an impaired cardiac adaptive mechanism to cordocentesis that may explain the higher incidence of complications occurring in such fetuses.

OC259: Low malignant potential ovarian tumors: role of sonographic diagnostic criteria

removed – there were no cases of malignancy. In a study of 55,278 pregnancy terminations, there were 2 cases of malignancy. We have prospectively evaluated 3000 consecutive women who presented to the Early Pregnancy Unit. The prevalence of ovarian cysts was 5.3%. These women were managed expectantly and followed until resolution of the ovarian cyst occurred, intervention was required or the pregnancy concluded. 72.2% resolved spontaneously, 23.6% persisted and 4.2% required intervention – there were no cases of malignancy. Only 0.13% (1.3/1000) of all women in this longitudinal study required acute intervention. We concluded that examining the ovaries in the first trimester is of no value. Expectant management is advocated, at least until the pregnancy is beyond 14 weeks’ gestation. If symptomatic, simple ovarian cysts diagnosed during pregnancy can be successfully and safely treated with sonographic guided cyst aspiration. Adnexal masses can be accurately classified according to TVS. However in the few cases when the nature of the cyst is in question, one must balance the risks to the pregnancy from intervention versus the risk of malignancy.

WS09-05Sonographic appearance of borderline ovarian tumors

Background

OC181: Characterising borderline tumours of the ovary

Objective: To investigate the natural history and outcome of fetal cystic adenomatoid malformation (CCAM) of the lung diagnosed by routine ultrasound scanning at 18–23 weeks’ gestation. Patients and Methods: This was a retrospective study of all cases of fetal CCAM of the lung diagnosed at 18–23 weeks of gestation. All cases were referred to a tertiary centre for further management. A computer search was made to identify all referred cases, and the records of these patients were examined to determine the pregnancy outcome. Results: In a four year period, 32 cases of fetal CCAM were referred for further management. At presentation, all the cases were noted to be unilateral CCAMs and the majority (75%) were microcystic in nature. The CCAMs were complicated by varying degrees of mediastinal shift (81.2%), hydrops fetalis (12.5%) and polyhydramnios (12.5%). During the course of the pregnancy, the lung lesion was seen to reduce in size or resolve spontaneously in 75% of cases without any prenatal intervention (including resolution of hydrops in three cases). One pregnancy was terminated for persisting hydrops fetalis and another resulted in a late neonatal death from complications of neonatal cardiac surgery to an associated aortic coarctation. Conclusion: The outcome of antenatally detected CCAM is much better than previously reported even when complicated by hydrops fetalis at presentation. The latter seems to be related to the high spontaneous regression rate of this tumour. Despite the antenatal resolution of CCAMs on ultrasound, postnatal followup is recommended in view of the long-term complications of this malformation.

OC055: 2D and 3D transvaginal sonohysterography for the assessment of submucosal myomas grading

fetuses with chromosomal aneuploiy were detected using the nuchal translucency. At the scanning in week 18, additionally 12 major malformations were observed. Two had chromosomal aneuploidy. Of the 43 fetuses with prenatally detected major anomalies all but 2 were aborted. Diagnoses were in all 43 cases confirmed by clinical or pathological examination after abortion/delivery. 60 children with major anomalies not detected prenatally, were diagnosed shortly after delivery. Follow-up via national registries revealed that another 47 children from the cohort had major malformations. Conclusions: Our study shows that the majority of prenatally detectable major malformations can be diagnosed by early sonography in that 31 out of 43 major malformations were identified at this scanning. However, a major number of anomalies remain undetected pre-natally by current ultrasonographic approaches.