E. Assimakopoulos

Maternal indomethacin therapy in the treatmentof polyhydramnios

Fifteen patients with polyhydramnios and clinical symptoms related to excess amniotic fluid volume were treated with indomethacin therapy that was started at a mean gestational age of 27.4 +/- 2.79 weeks and discontinued at a mean gestational age of 32.9 +/- 1.83 weeks. Patients were treated with 2.0 to 2.2 mg of indomethacin per kilogram of body weight per day, either orally or by rectal suppositories. No therapy was administered after 35 weeks, and the duration of therapy was no longer than 4 weeks. The majority of fluid reduction occurred within the first week of treatment. Subsequently, a smaller but steady reduction of fluid was observed. All patients were delivered after 38 weeks with a mean birth weight of 3543 +/- 586.3 gm. Examinations of newborns at birth and follow-up at 3 months, 6 months, and 1 year revealed no adverse effects of indomethacin administration.

Endometriotic Uterocutaneous Fistula after Cesarean Section

Endometriosis outside the pelvis is rare and most cases occur in surgical scars after operations involving the female genital tract. Fistulae involving the uterus are also very rare, usually being the result of postpartum and postoperative complications. In the present report, a case of a 44-year-old patient with an endometriotic uterocutaneous fistula is described. The patient presented 6 years after her fourth cesarean section with a painful nodule on the cesarean scar, which was bleeding during menstruation. The lesion extended to the uterine fundus, connecting the endometrial cavity with the skin. This is merely the second case of a uterocutaneous fistula to be reported in the literature and the first case developed on grounds of endometriosis.

Diabetes mellitus in pregnancy and the assessment of umbilical artery waveforms using pulsed Doppler ultrasonography.

The utility of Doppler ultrasonography as a means of assessing potential alterations of vascular resistance prior to fetal or maternal compromise is very attractive. We investigated this relationship by prospectively performing Doppler studies of the fetal umbilical artery in 56 diabetic patients, 14 of whom had varying degrees of vascular complications. When regression curves were established for the S/D ratio, the Pourcelot index, and the resistance index of the fetal umbilical artery, the mean Doppler values were higher in diabetic patients with vasculopathy than in nondiabetic control patients or in diabetic patients without vasculopathy. The third trimester S/D ratio was greater than 3.0 in almost 50% of patients with vasculopathy. A tendency toward adverse outcomes was observed at S/D ratios approaching 4.0. Statistically significant correlations were found between elevated Doppler indices and maternal vasculopathy associated with hypertension and worsening renal insufficiency. Intrauterine growth retardation and neonatal metabolic complications were also significantly correlated with elevated Doppler indices. There was, however, no correlation between Doppler indices and glucose values, although most were within a euglycemic range. The aforementioned data indicate an increased resistance circuit among diabetics with vasculopathy, which may reflect a relative reduction in basal uteroplacental blood flow and the need for cautious interpretation of Doppler indices in these patients.

Surgical treatment for hydrosalpinx prior to in‐vitro fertilization embryo transfer: a network meta‐analysis

The presence of hydrosalpinx impairs the outcome of in‐vitro fertilization embryo transfer (IVF‐ET). Surgical methods to either aspirate the fluid or isolate the affected Fallopian tubes have been attempted as a means of improving outcome. The aim of this network meta‐analysis was to compare the effectiveness of surgical treatments for hydrosalpinx before IVF‐ET.

Pelvic echinococcus mimicking multicystic ovary

An unusual case of pelvic echinococcus cyst is presented, appearing initially on transvaginal ultrasound as a pelvic mass mimicking a multicystic ovary. A similar mass in the liver raised preoperatively the suspicion of echinococcosis, making an open surgical procedure preferable to laparoscopy. Diagnosis was confirmed pathologically after removal of the cyst. Though their location in the pelvis is rare, echinococcal cysts should be considered in the differential diagnosis of pelvic masses, especially in patients from endemic areas. Evaluation of previous medical history and current symptoms, together with the ultrasonographic findings, is important for correct diagnosis and appropriate management. Copyright

Surgical treatment for hydrosalpinx prior to IVF‐ET: a network meta‐analysis

The presence of hydrosalpinx impairs the outcome of in‐vitro fertilization embryo transfer (IVF‐ET). Surgical methods to either aspirate the fluid or isolate the affected Fallopian tubes have been attempted as a means of improving outcome. The aim of this network meta‐analysis was to compare the effectiveness of surgical treatments for hydrosalpinx before IVF‐ET.

Neurodevelopmental fetal assessment using KANET scoring system in low and high risk pregnancies.

Objective: To assess and compare fetal behavior and neurodevelopment (KANET) between low and high risk pregnancies. Methods: Prospective, comparative, cohort study. One hundred and fifty-two consecutive pregnant women presenting for routine 2nd trimester and 3rd trimester scan had four dimensional ultrasound examinations (4D US) in order to assess fetal behavior and neurodevelopment. This was achieved by the study of: (1) isolated head movements, (2) isolated hand movements, (3) isolated leg movements, (4) cranial sutures, (5) hand to face/head movements, (6) finger movements, (7) yawning – mouthing, (8) facial expressions, (9) isolated eye blinking, (10) “Gestalt” perception. According to the maternal background risk, the population of the study was classified in low risk pregnancies (n = 78) and high risk pregnancies (n = 74) with IUGR fetuses (n = 12), diabetes mellitus (n = 24), and pre-eclampsia (n = 38). Results: The neurodevelopmental score was statistically significant higher in the low risk group compared to the high risk group (p < 0.0004). The diabetes subgroup score was statistically significantly higher compared to the IUGR and the pre-eclampsia subgroup (p = 0.0001). Conclusions: The neurodevelopment fetal assessment by 4D ultrasound appears to be a feasible technique in the evaluation of high risk pregnancies. Further studies where any association between KANET score and neurological outcome of the childhood are warranted.

Mucocele of the Vermiform Appendix with Sonographic Appearance of an Adnexal Mass

Mucocele of the vermiform appendix is caused by mucus retention in its lumen, due to obstruction or hyperproduction. Appendiceal malignancy can be the underlying cause, making accurate preoperative diagnosis imperative. In women, it can sometimes present as an adnexal mass. A rare case of an appendiceal mucocele is presented, mimicking a cystic tumor of the right adnexum, both clinically and ultrasonographically. In addition, serum levels of CA-125 were increased. This is the first case of a mucocele of the appendix simulating an adnexal mass on ultrasound with increased levels of CA-125 to be reported. This clinical entity should be considered in patients presenting on ultrasound with a right-sided adnexal mass as a rare potential diagnosis.

Comparison between 20G and 22G needle for second trimester amniocentesis in terms of technical aspects and short‐term complications

To compare short‐term complications of amniocentesis using 20G versus 22G needle.

Aggressive angiomyxoma of the vulva extending into the pelvis: Report of two cases

Aggressive angiomyxoma is a rare soft‐tissue neoplasm found mainly in the female pelvis. Approximately 130 cases have been reported in the literature to date. In most cases treatment consists of surgical resection, but local recurrence rates remain high (36–72%). Therefore, long‐term follow up is necessary and magnetic resonance imaging seems to be the preferred method for detecting recurrence. We report our experience of a primary and a recurrent aggressive angiomyxoma.