Erich Cosmi

Sonovaginography is a new technique for assessing rectovaginal endometriosis

OBJECTIVEnTo evaluate the efficacy of a new technique, the sonovaginography, for the assessment of rectovaginal endometriosis.nnnDESIGNnProspective study.nnnSETTINGnUniversity hospital.nnnPATIENT(S)nForty-six women were scheduled for laparotomic or laparoscopic surgery because of rectovaginal endometriosis suspected on the basis of patient history and/or clinical examination.nnnINTERVENTION(S)nBefore surgery, all the women underwent transvaginal ultrasonography and then sonovaginography. The latter is based on transvaginal ultrasonography combined with the introduction of saline solution to the vagina that creates an acoustic window between the transvaginal probe and the surrounding structures of the vagina. Ultrasound findings were compared with the results of surgical exploration and histological examination.nnnMAIN OUTCOME MEASURE(S)nWe assessed the accuracy of transvaginal ultrasonography and of sonovaginography for the detection and the location and extension assessment of rectovaginal endometriotic lesions, as well as compared patient compliance between the procedures.nnnRESULT(S)nSonovaginography diagnosed rectovaginal endometriosis more accurately than did transvaginal ultrasonography, with a sensitivity and specificity of 90.6% and 85.7%, respectively, whereas the transvaginal ultrasonography has shown a sensitivity and specificity of 43.7% and 50%, respectively. Patient discomfort did not differ significantly between the procedures.nnnCONCLUSION(S)nSonovaginography is a reliable and simple method for the assessment of rectovaginal endometriosis and provides information on location, extension, and infiltration of the lesions, which are important factors in selecting the kind of surgery.

Side effects and complications of sonohysterosalpingography

OBJECTIVEnTo evaluate the side effects and complications of, difficulties with, and possible solutions to the problems associated with sonohysterosalpingography.nnnDESIGNnProspective study.nnnSETTINGnUniversity hospital.nnnPATIENT(S)nOne thousand, one hundred fifty-three patients who underwent sonohysterosalpingography to investigate abnormal uterine bleeding, infertility, thick endometrium at transvaginal ultrasonography, müllerian abnormalities, or the Asherman syndrome.nnnMAIN OUTCOME MEASURE(S)nSide effects and complications of and difficulties related to the procedure. Tolerance was assessed by using a pain-rating scale.nnnRESULT(S)nNinety-three percent (1,074 of 1,153) procedures were performed correctly. Investigation was not completed in 79 (7%) women; a second attempt was successful in 60 of these patients. Side effects, such as moderate or severe pelvic pain, vasovagal symptoms, nausea, and vomiting, occurred in 102 (8.8%) women. Such complications as fever and peritonitis occurred in 0.95% of patients.nnnCONCLUSION(S)nSonohysterosalpingography is a simple, safe, and well-tolerated technique that has a low rate of side effects and rare complications.

Is Delayed Childbearing Changing Gene Frequencies in Western Populations

Experimental data and clinical observations suggest that delaying childbearing influences the biology of the mother-fetus relationship, with a negative effect on fetal development and predisposition to severe diseases such as type 1 diabetes. We reason that advanced maternal age may influence intrauterine selection, favoring genotypes that are more adapted to the intrauterine environment of less young women. In the present study we have investigated the relationship of maternal age to HP genotype and PGM1-Rh area (chromosome 1) that have been previously found to be associated with fertility and developmental parameters. HP phenotype was determined in 679 consecutive puerperae from the population of central Italy. PGM1 phenotype and Rh C phenotype were determined in 222 puerperae and 200 newborns. The HP 1,1 phenotype decreases and the HP 2,2 phenotype increases with maternal age. The proportion of phenotypes carrying both the Rh C and PGM1*1 alleles is much higher in puerperae older than 36 years than in puerperae of age 22 years. The frequency of the PGM1*1–Rh C haplotype increases and the frequency of the PGM1*2–Rh C haplotype decreases with maternal age. The changes in these genetic systems with advancing maternal age are similar in mothers and newborns. The delay of childbearing age, associated in Western countries with the fertility transition in addition to detrimental effects on intrauterine development and increased susceptibility to severe disorders, could bring about changes in the genetic composition of a population.

Application of Intima Media Thickness Measurement and Omics in IntrauterineGrowth Restriction Disease

Intrauterine growth restriction is defined as a fetus with an estimated fetal weight less than 10th percentile for gestational age and cardiovascular changes, usually detected by means of Doppler ultrasonography. Noncommunicable diseases (such as cardiovascular diseases -CVD- and diabetes) still represent the main cause of mortality and morbidity in the industrialized world. Various studies support the hypothesis, formulated by Barker, that an adverse intrauterine environ-ment results in physiological adaptations of the fetus, maximizing its immediate chances for survival, but with detri-mental effects in adulthood. Low birth weight caused by IUGR was recently known to be associated with increased rates of CVD, non-insulin dependent diabetes in adult life, and neuromotor development alteration. The ultrasound-based measurement of fetal aorta intima media thickness (aIMT) represents an easy marker to investigate the pre-atherosclerotic changes. Omics research holds great promise for discoveries in nutrition research, including profiles and characteristics of dietary and body proteins; metabolism of nutrients; functions of nutrients and other dietary factors in growth, reproduction, and health. The proteome and metabolome analysis are expected to play an important role in understanding pathophysiological molecular mechanisms and in solving major nutrition-associated problems in humans, such as IUGR and cardiovascular disease. This review focuses the importance to identify a class of fetuses at risk of cardiovascular disease in utero, childhood and adult life, combining clinical and omics markers. It should be interesting to combine functional and structural information discovered to develop preventative and/or interventional therapeutic strategies.

Maternal cigarette smoking, metabolic enzyme polymorphism, and developmental events in the early stages of extrauterine life,

The recent observation that maternal ACP1 genotype has an interactive effect with smoking on intrauterine development prompted us to search for a possible interaction effect between smoking and ACP1 genotype on haptoglobin (Hp) development in the neonatal period. ACP1 is a highly polymorphic protein tyrosine phosphatase involved in signal transduction of several growth factor receptors. The enzyme is composed of two isoforms, F and S. We studied 299 infants born in the Department of Obstetrics of the University Hospital of Rome La Sapienza. We found that an interaction between ACP1 genotype and smoking has an effect on haptoglobin development: A significant delay of haptoglobin development in infants born to smoking mothers is observed only in infants with the ACP1*B/*B genotype, which shows the highest concentration of the ACP1 F isoform. The results indicate that the ACP1 genotype modifies the deleterious effects of smoking on development not only during intrauterine life but also during the early stage of extrauterine life.

The Use of New Technologies in the Study of Pregnancy Disorders: The OMICS Approach

The “omics” technologies represent a new model of approach in the study of human disease. Metabolomics is defined as the quantitative measurement of the dynamic metabolic response of living systems to genetic, physical, pathological or developmental factors.

Quantitative Assessment of Prenatal AorticWall Thickness in Gestational Diabetes

Intrauterine environment, and especially a mismatch between the early and later-life environments, is thought to induce epigenetic and morphological changes that may manifest in later life as an increased vulnerability to non communicable diseases as diabetes. Prenatal events, such as intrauterine growth restriction, as well as an increased risk of developing diabetes and cardiovascular alterations, have been shown to be associated with an increased intima-media thickness (aIMT) of the abdominal aorta in the fetus. To date its measure, has been performed manually on ultrasound fetal images by skilled practitioners.We present an automatic algorithm that identifies abdominal aorta and estimates its diameter and thickness from routine third trimester ultrasonographic fetal data, providing a correlation between end-diastole aIMT automatic and manual measures of 0.96, with a mean error of 0.02 mm, and a relative error of 3%.

Infants Born with Intrauterine Growth Restriction: Renal and Cardiovascular Follow-Up

Intrauterine growth restriction (IUGR) is a abnormal fetal growth pattern, occurrung in 8% of pregnancies (Mandruzzato & al., 2008), but its prevalence changes in different categories of pregnant women, with rates of 3-5% for healthy mothers and 25% or more in some highrisk groups such as hypertensive mothers. This condition is the leading cause of fetal mortality and perinatal morbidity and significantly increased short-and long-term mortality (Froen & al., 2004). The modern purpose of Obstetrics is “To ensure that every baby born with a potential psychological and physical development as much as possible unchanged compared to the one inherited by the two parental gametes at the time of their union” (JP Greenhill, 1976). The identification of intrauterine growth restriction is important not only to choose the timing of delivery, but also, in cooperation with neonatologists, an appropriate follow-up of cardiovascular complications, renal, neurological and endocrinological that may arise in these infants (McIntire & al., 1999). Several factors have contributed to the confusion in terminology associated to IUGR (Battaglia & al., 1967). By definition, 10% of infants in any population, has a birth weight less than or equal to 10 th percentile (Figure 1). Often the distinction between pathological and normal growth cannot be performed reliably in clinical practice, especially before the fetus is born. Furthermore, although define a condition based on the 10th percentile seems to have a statistical significance, may prove to be clinically relevant. Although fetal growth curves for specific ethnic origin and geographical are increasingly used to assess the weight at birth, remains unclear whether or not they are appropriate (Zhang & al., 1995 ). The correct use of the terms “small for gestational age” (SGA) and “intrauterine growth restriction “(IUGR) is still unclear and often the two words are switched. Given these difficulties, the American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin, in January 2000, advised to apply

P270: Preliminary reports on a noninvasive method for the assessment of fetal lung maturity

weeks. The fetal development was always below the third percentile on Hadlock curve. At the 25 weeks’ gestation fetal vital signs were not detectable at the US exam. Because of the hypothesis of partial mole could not be excluded and the four previous cesarean sections, total hysterectomy was performed. Histological exam showed a placental mesenchymal dysplasia and a normal very small fetus. There was an intense placental vascular change. Conclusion: The placental mesenchymal dysplasia could be included as a possible cause of fetal growth restriction and death. This placental dysplasia could be suspected by the karyotypic exam as recommended. 3 US scan can be considered as additional tool to identify features of placenta.

P108: Transvaginal sonohysterography for the assessment of postpartum residual trophoblastic tissue: is a safe procedure?

cases (16.2%). Resolution occurred in 94.5% of the cases with a primary success rate of 91.8%. Only one case required multiple doses (2.8%). The mean time of resolution was 21.03 ± 8.95 days. Surgical treatment (salpingectomy) was necessary in 2 cases (5.4%). As for the reproductive outcome, 27 cases were eligible for the analysis. The overall pregnancy rate was 44.4% (12/27) with a 3.7% rate of recurrent ectopic pregnancy. Tubal patency was assessed in 19 cases. It was preserved in 84.2% (16/19). Conclusion: According to the studies in literature, our results support the use single dose MTX for the treatment of unrupted tubal pregnancy in carefully selected cases.