Elisa Faldini

The safety of veralipride

The perimenopausal period, from 1 to 4 years, is characterised by vasomotor symptoms, or hot flushes, and other effects due a deficit of estrogens. Approximately 85% of women have hot flushes for 1 year and 25 – 50% continue for up to 5 years. The cause of hot flushes has been linked to dysfunction of the thermoregulatory centre caused by estrogen withdrawal. One proposal for the aetiology of hot flushes is that the thermoregulatory zone is shifted downward in patients who experience hot flushes. Estrogen withdrawal creates a change of the central opioid system and a thermoregulatory instability. Estrogen and/or progestin replacement is the treatment of choice for this distressing symptom. However, steroid replacement may be associated with risks and complications, and is limited in some subjects by well-known contraindications. Veralipride, a synthetic benzamide derivative with antidopaminergic action, is effective in reducing the frequency and severity of hot flushes associated with menopausal hypoestrogenism, gaining interest as a non-hormonal treatment for climacteric flushing. In recent years, extrapyramidal disorders associated with veralipride therapy have been reported and are often due to drug misuse. Adverse effects include acute dyskinesia or Parkinsonism, which may occur after many months of treatment. An association between adverse effects and mistake of administration has been described. This article discusses available data on the benefits and risks of veralipride therapy for menopausal symptoms.

Listeriosis in pregnancy: a case report.

Listeria monocytogenes is an alimentary infection which can be extremely dangerous for pregnant women. A 34-year-old pregnant woman was hospitalized with fetal cardiac rate alterations and influenza-like symptoms. A caesarean section due to fetal distress was performed. A maternal-fetal listeriosis diagnosis was possible only after the birth through bacteriological and histological examination on both the placenta and the newborn.

P15.09: Correlation between transvaginal 2D and 3D first trimester neuroimaging and embryonic development according to Carnagie stadiation

Objective: Postnatal intracranial hemorrhage (ICH) is a rather common finding in preterm delivered neonates. However, prenatal diagnosis of ICH is rarely described in literature. We report on a series of cases that have been diagnosed during a 10 year period. Material and Methods: The archive of our ultrasound unit was searched for all cases of prenatally suspected ICH. Postnatal follow up from neonatology and pediatric registries was available for all cases. Results: During the study period, 8 fetuses were suspected to have ICH. All cases were confirmed by postnatal sonography and/or by magnetic resonance imaging (MRI). In 6 cases antenatal MRI confirmed the sonographic findings. Median (range) gestational age at diagnosis and delivery were 26.4 (28.3–36.5) and 34.6 (33.2–40.1) weeks, respectively. All cases were delivered by cesarean section. Prenatal sonographic findings included asymmetric ventriculomegaly with midline shift (n = 2), hyperechogenic parenchymal or intraventricular lesions (n = 4), and periventricular cystic lesions (n = 1). All cases were classified as severe ICH (Grade III in 5 cases, and grade 4 in 3 cases) as suggested in postnatal studies. Six cases were complicated by an aquaeduct stenosis requiring ventriculo-peritoneal shunting. Neurological deficits were found in all cases at follow up. Conclusions: All cases have been identified and accurately classified by antenatal ultrasound. However, antenatal MRI was often necessary for a conclusive diagnosis. In our cases with high grade ICH the outcome was invariably poor.

P11.08: Screening tests for chromosomal pathologies in the first trimester: combined test v/s nuchal translucency thickness

Conclusion: The policy of performing invasive procedures in all women aged ≥ 35yo did not detect any chromosomal abnormality, in our series, that would not be identified after 1st trimester screening. On the contrary, the much higher false positive rate of the age-alone screening adds just increased collateral damage, high cost/benefit ratio to the national health system, precious time consuming investigations for obstetrician/geneticists.

Utilizzo degli ormoni placentari e fetali in diagnosi prenatale

In medicina la possibilita di poter disporre d’indicatori o markers predittivi di patologia ha permesso di mettere a punto degli screening da applicare, naturalmente, alla popolazione generale o ha consentito di mettere a punto una strategia per il controllo dello stato di benessere del prodotto del concepimento. La medicina prenatale ha stressato questa possibilita-necessita in quanto si occupa di un soggetto, il feto, che puo controllare soltanto attraverso l’organismo di un intermediario rappresentato dalla futura madre. Le prime proteine che destarono l’attenzione dei ricercatori furono Formone della gravidanza (hCG) ed il lattogeno placentare umano (hPL) [1], poi successivamente a caduta sono arrivati l’alfa-fetoproteina l’unica proteina conosciuta di origine esclusivamente fetale [2, 3],un’alfa-2-macroglobulina legata alla gravidanza chiamata PAPP-A [4, 5], l’estriolo sia totale con dosaggio urinario che quello libero o non coniugato plasmatico, che rappresenta l’8-10% del totale [6]. Negli anni ’70-’80 il primo obbiettivo ehe ci si pose fu quello di monitorizzare il prodotto del concepimento nella sua crescita fisiologica, nel suo stato di benessere e nei deficit di accrescimento.

OC180: Comparison between three different methods of visualizing the secondary fetal palate by three-dimensional ultrasonography

period and to present data on ultrasound–anatomical correlates of the normal human palate between 12 and 24 weeks of gestation. Methods: Thirty fetuses from normal pregnancies underwent examination of the face and palate using 3D ultrasound imaging in both the axial and reverse face views. To establish ultrasound–anatomical correlates, high-resolution images of human embryos and fetuses of comparable gestational age to those examined by ultrasound were obtained from our collection of human embryology. Results: During the embryological period the palatal shelves grew towards the midline and fused during the 8th week (LMP) of gestation. The last component to reach full differentiation was the bilobular (bifid) uvula, which becomes monolobular during the 9th week of gestation. 3D ultrasound images using both maximum and surface rendered modes showed close anatomical correlation with the comparable anatomical specimens, with the exception of the soft palate and uvula. Axial views provided better visualization of the palate up to the 20th week but thereafter coronal sections were superior owing to the avoidance of acoustic shadowing. Discussion: Prenatal 3D ultrasound images from the 12th to the 24th week of gestation correlate well with the landmarks observed in anatomical specimens of comparable gestational ages. However, data from larger series of different ethnic groups are needed to establish reliable patterns of normal growth.

P15.05: The use of 3‐4D ultrasound improves the diagnosis of spinal dysraphism

Objectives: To assess the feasibility of prenatal diagnosis and the outcome of partial agenesis (PACC) and hypoplasia of corpus callosum (HCC). Methods: PACC/HCC were suspected on fetal multiplanar neurosonography when the corpus callosum appeared caudally shorter and thinner respectively. Follow-up was obtained in all cases. Results: Between 1990–2003, 8 cases of PACC and 3 cases of HCC were identified at a median gestational age of 22 weeks (21–33) (see table). The cavum septi pellucidum was present in 9 cases, in 7 there was mild to severe ventriculomegaly, usually in association with ‘teardrop’ lateral ventricles, and 4 had associated cerebral anomalies (Dandy-Walker complex, emimegalencephaly, microcephaly). Magnetic resonance (MR) was performed in 4/11 cases without adding significant information. Five fetuses were terminated, 7 had multiple anomalies, and 3 are developing normally. Conclusions: PACC can be reliably diagnosed since midgestation. However, multiplanar neurosonography is required. On standard axial planes sonographic findings are similar to complete agenesis but more subtle. In particular the cavum septi pellucidum is usually present. MR did not offer significant advantage over multiplanar neurosonography. HCC was an incidental finding usually in fetuses with multiple anomalies. The outcome of PACC/HCC is similar to complete agenesis of the corpus callosum.