Danila Morano

Prospective evaluation of ultrasound and biochemical‐based multivariable models for the prediction of late pre‐eclampsia

Prospective assignment at 11 + 0 to 13 + 6 weeks of risk for late pre‐eclampsia (PE) using eight logistic regression‐based statistical models.

Umbilical Cord Hematoma: A Case Report and Review of the Literature

Objectives To deepen the knowledge in obstetrics on a very rare pregnancy complication: umbilical cord hematoma. Methods A review of the case reports described in the last ten years in the literature was conducted in order to evaluate epidemiology, predisposing factors, potential outcomes, prenatal diagnosis, and clinical management. Results Spontaneous umbilical cord hematoma is a rare complication of pregnancy which represents a serious cause of fetal morbidity and mortality. There are many risk factors such as morphologic anomalies, infections, vessel wall abnormalities, iatrogenic causes, and traction or torsion of the cord, but the exact etiology is still unknown. Conclusions Due to the rarity of this condition, every new case of umbilical cord hematoma should be reported in order to improve the knowledge of predisposing factors, prenatal diagnosis, and clinical management.

Comment on "Longitudinal transvaginal ultrasound evaluation of cesarean scar niche incidence and depth in the first two years after single- or double-layer uterotomy closure: A randomized controlled trial"

Sir, We read with interest a recent article published by Bamberg et al. (1) that takes up an interesting issue previously published in the same journal by Kataoka et al. (2) on uterine niche after a cesarean section (CS). These two prospective studies assessed the risk of developing a uterine wall defect at the site of cesarean scar with relation to the surgical closure technique. Both studies assessed the residual myometrium thickness and the depth of the niche as it appears immediately after CS (Kataoka et al.) and on long-term outcomes (24 months in Bamberg et al.) using saline contrast sonohysterography and a classical sonographic midsagittal view, respectively. These studies are very well conducted and presented but we would share with you some doubts about the method we currently use to evaluate the characteristics of the niche. In fact, the uterine wall defect is known to be associated to gynecological symptoms such as abnormal uterine bleeding, dysmenorrhea and infertility that sometimes requires surgical correction (3). A few years ago, we conducted a prospective longitudinal study comparing two different methods for uterine closure at CS and the long-term risk (24 months) of uterine wall defect that was assessed by ultrasonography and hysteroscopy (4). Before starting, we carried out a brief pivotal assessment of which sonographic parameter should be used and we realized that the internal defect (niche) is not even at hysteroscopy. In fact, in many cases the depth was not the main cause of clinical symptoms but rather the overall “absent” volume in the internal uterine wall. Statistical analyses demonstrated that a bell-shaped pouch area under the scar could best represent the association between ultrasonography, hysteroscopic assessment, symptoms, and need for surgical correction. In fact, in some cases the defect is shallow but wide, whereas in others it is deep but narrow, as in figure 2 in Bamberg et al. (1). Certainly, CS is one of the most common surgical operations performed worldwide and its rate has dramatically increased in most developed countries, thus becoming a big concern (5). Yet, the question of which closure technique best avoids symptomatic uterine niche remains unanswered, but it seems even more important to find a non-invasive technique to assess the uterine wall defect. The two papers used different sonographic approaches, but we are still wondering if they accurately represent the uterine wall defect. Marco Scioscia, Piergiorgio Iannone* , Danila Morano, Giovanni Pontrelli and Pantaleo Greco Department of Obstetrics and Gynecology, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy, and Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Cona, Ferrara, Italy

Corrigendum to “Umbilical Cord Hematoma: A Case Report and Review of the Literature”

[This corrects the article DOI: 10.1155/2018/2610980.].

Untimely diagnosis of fetomaternal hemorrhage: what went wrong?

Abstract Fetomaternal hemorrhage (FMH) is an obstetrical challenge. It is defined as a passage of fetal blood into the maternal circulation or vice versa, which might complicate pregnancy or delivery. Most cases of acute and chronic FMH are idiopathic in origin and involve uncomplicated near-term pregnancies. Yet, due to the lack of universal screening, heterogeneous clinical presentation and insufficient clinicians awareness, in some cases FMH may present as immediate fetal compromise or even stillbirth as the most devastating consequence. We made a review of the literature of the FMH clinical cases of fetal/neonatal death in order to focus on the available diagnostic tools and their limitations. Cardiotocography, biophysical profile, middle cerebral artery peak systolic volume and current laboratory tests were studied and evaluated as diagnostic tools for FMH. International guidelines are needed to help clinicians make a prompt identification of FMH. Moreover, a standardized management protocol is essential in order to improve fetal-neonatal outcomes.

Correlation between umbilical arterial pH values and fetal vertebral artery Doppler waveforms at the beginning of the second stage of labor: a pilot prospective study

Abstract Objective: The aim of this study was to evaluate the association between umbilical arterial pH and fetal vertebral artery Doppler velocimetry waveforms measured at the beginning of the second stage of labor in physiological term pregnancies. Methods: This was a prospective cohort study of 250 pregnancies. The resistance index, pulsatility index, and peak systolic velocity were measured. The relationship between the fetal Doppler and the umbilical arterial pH was evaluated. A simple linear regression and a general linear model were used to explore possible correlations of Doppler parameters with fetal and neonatal outcome adjusted for confundents. Results: Umbilical arterial pH values were directly associated with vertebral artery pulsatility index. Fetuses with lower pulsatility index values were at increased risk of a subsequent diagnosis of pathological fetal heart rate tracing patterns (presence of decelerations or reduced variability according to FIGO criteria during the second stage of labor). We estimated a decrease in pulsatility index of 10% in those fetuses destined to show a pathological fetal heart rate tracing. Conclusion: Vertebral artery Doppler waveforms correlates with umbilical pH in normal pregnancies and is also a function of fetal heart rate patterns. If this proportional association would be demonstrated also for abnormal pH values, vertebral artery pulsatility index might be useful to evaluate fetal wellbeing in those cases of suspected hypoxia/academia.