Erika Ignacchiti

Transvaginal ultrasonography in women receiving emergency contraception

OBJECTIVE To determine whether transvaginal ultrasonography improves evaluation of conception time in women seeking emergency contraception. DESIGN Prospective study. SETTING Obstetrics and Gynecology Department, Siena University, Siena, Italy. PATIENT(S) One hundred sixty-three women seeking postcoital contraception. MAIN OUTCOME MEASURE(S) Data on menstrual history and time of unprotected intercourse were recorded. Ultrasonographic variables evaluated were ovarian follicle or corpus luteum diameter, endometrial echopattern and thickness, and peritoneal fluid volume. Expected pregnancy rates were calculated according to the probability of conception as estimated from Dixons table of data, based solely on anamnestic data, or from endometrial or ovarian findings on transvaginal ultrasonography. RESULT(S) According to the menstrual history (cut-off level < 0.03) we expected to find 7.6 pregnancies (7.9 in the high-risk group and 0.31 in the low-risk group). According to transvaginal ultrasonography (at the same cut-off), we expected 11.2 pregnancies (0.3 in the low-risk group and 10.9 in the high-risk group). No more than 7 pregnancies were observed, all of which occurred in the high-risk group as determined by transvaginal ultrasonography. In contrast, on the basis of anamnestic data, 4 of 7 pregnancies were in the high-risk group and 3 of 7 were in the low-risk group. CONCLUSION(S) Transvaginal ultrasonography allows timely definition of the fertile period and is a reliable method of computing the day of ovulation. It improves therapeutic options by allowing treatment of only women at high risk of conception.

Cervical ripening and induction of labor by prostaglandin E2: a comparison between intracervical gel and vaginal pessary

Objective: To compare the effectiveness and safety of two formulations of prostaglandin (PG) E2 (gel and pessary) for induction of labor. Primary outcomes were cervical ripening, initiation/ duration of labor, and type of delivery. Study design: A total of 115 women with singleton gestations were consecutively enrolled and assigned to receive intracervical PGE2 (dinoprostone 0.5 mg) by gel (n = 66) or PGE2 (dinoprostone 10 mg) by intravaginal pessary (n = 49). Results: Independently from parity, the vaginal pessary induced successful cervical ripening with a slightly higher but not statistically significant occurrence of vaginal delivery with respect to gel induction. The mean time interval from induction to vaginal delivery did not differ between groups, despite being shorter for the pessary group in inducation-delivery intervals > 12 h. No significant differences were found between the groups with respect to patients who required a second course of PGE2 (9% vs. 2%), as well as oxytocin (11% vs. 13%) induction. No significant difference was found in the incidence of uterine hyperstimulation and other adverse reactions in nulliparas, or in fetal and neonatal outcome. Conclusion: Independently from parity, both PGE2 administration routes appeared to be effective in achieving cervical ripening, initiation of labor and optimal type of delivery, and showed the same incidence of side-effects.

An ovarian mucinous adenocarcinoma arising from mature cystic teratoma associated with respiratory type tissue: a case report.

Mature cystic teratoma (dermoid cyst) is the most common benign germ cell tumor of the ovary, accounting for approximately 30% of all ovarian tumors. Malignant transformation is rare; the most frequent transformation reported is to squamous-cell carcinoma in 80% of cases, whereas transformation to adenocarcinoma is described in about 7% of cases. We report a case of malignant transformation to mucinous adenocarcinoma arising from respiratory-like epithelium in a mature teratoma of the ovary.

Inhibin A ,inhibin B and activin A concentrations in umbilical cord artery and vein

Activin A and inhibins (A and B) are growth factors expressed during pregnancy by the human placenta ,decidua and fetal membranes ,and by several fetal organs. They are secreted in both the maternal and the fetal circulations ,but the net contribution of the fetus to inhibins/activin A production is still unclear. In the present study we determined whether there was a difference in the serum concentration of activin A ,inhibin A and inhibin B between the artery and vein of the umbilical cord. Arterial and venous umbilical cord blood was obtained immediately before elective Cesarean section of 16 term infants from uncomplicated pregnancies. Inhibins and activin A levels were assayed by specific enzyme-linked immuno-sorbent assays. The paired t-test and linear regression analysis were used to calculate statistical significance. Inhibin A levels did not differ between the artery and vein of the umbilical cord. In contrast ,arterial inhibin B levels were significantly (p < 0.001) lower ,and activin A concentrations significantly (p < 0.05) higher than the respective venous concentrations. A significant correlation between arterial and venous levels of inhibin A (r = 0.591; p < 0.05) ,inhibin B (r = 0.749; p < 0.0001) and activin A (r = 0.571; p < 0.05) was found. The present findings suggest that the human placenta is the main source of inhibin B ,and the fetus of activin A ,in the umbilical cord. In light of the possible roles played by inhibin and activin in erythroid differentiation ,protection of neurons against brain injury and modulation of adrenal and pancreatic hormone release ,the present data may be of help in evaluating their changes in the umbilical cord when gestational diseases occur.

Pregnancy and delivery after right common carotid artery endarterectomy.

BACKGROUND: Carotid artery atherosclerosis and essential hypercholesterolemia can add a predisposing risk factor for coagulation in pregnancy. Careful management of anticoagulation during labor, delivery, and puerperium is called for in such a case. CASE: A 41-year-old woman, gravida 2, para 1, with a previous endarterectomy at the right common carotid artery because of atherosclerotic plaques, underwent anticoagulation studies and prophylactic antithrombotic therapy. Low-molecular-weight heparin was administrated during pregnancy and puerperium. She successfully delivered by cesarean at 36 weeks of gestation. CONCLUSION: Low-molecular-weight heparin treatment is an effective and safe therapy in pregnancy. The healthy course of therapy, delivery, and puerperium reported here is a reference that may support women with a similar history.

Abnormal Umbilical Artery Doppler Waveforms and Cord Blood Inhibin A and Inhibin B Levels

Inhibin A and inhibin B are glycoprotein hormones produced by human placenta and by several fetal organs during pregnancy. They are secreted in maternal circulation in increasing amounts from early until term pregnancy, and in umbilical cord blood levels are significantly lower than in maternal serum and do not differ from mid-pregnancy to term gestation. In the present study, we aimed to determine whether secretion of inhibin A and inhibin B into the fetal circulation is increased in pregnancies complicated by umbilical-placental vascular insufficiency. A group of women (n = 13) with abnormal Doppler umbilical artery flow velocimetry and a group of control women (n = 11) with uncomplicated term pregnancies and normal umbilical artery flow velocity waveforms were studied. In each woman, inhibin A and inhibin B concentrations were estimated in umbilical cord artery and vein. In the two groups of women, mean inhibin A levels did not differ between umbilical cord artery and vein. In addition, no difference was retrieved both in umbilical cord artery and vein values between healthy controls and patients with abnormal Doppler umbilical artery flow velocimetry. On the contrary, inhibin B levels were significantly higher in samples from umbilical cord vein than artery, in both groups of pregnant women (both p < 0.001). However, women with abnormal Doppler umbilical artery flow velocimetry had inhibin B levels significantly higher than healthy controls (p = 0.005) only in the umbilical cord artery, but not in the vein. In the presence of abnormal Doppler umbilical artery flow velocity, the concentrations of inhibin B are increased in the arterial umbilical circulation, suggesting that inhibin B is released from multiple fetal sources as a response to hypoxemic stress. As inhibins may affect the hypothalamus-pituitary-adrenal axis which plays an important role in the mechanisms of adaptations to the post-natal life, inhibin B in fetal circulation might then be beneficial to a fetus whose intrauterine survival is threatened by impaired umbilical-placental blood flow.

379 Maternal Plasma Urocortin I Levels in Preeclampsia and Fetal Growth Restriction Predict Neonatal Intraventricular Haemorrhage

Urocortin I levels were measured in maternal plasma collected from women with gestational hypertension (GH; n=70), preeclampsia (PE; n=19), PE with superimposed fetal growth restriction (PE+FGR; n=15), and controls (n=70), and also in umbilical cord plasma collected at delivery from a subset of patients (Controls: n=11; GH: n=10; PE: n= 11; PE+FGR: n=9). The correlation of maternal plasma urocortin measurement with the occurrence of perinatal intraventricular hemorrhage (IVH) was also evaluated. In all cases ultrasound scanning, Doppler velocimetry patterns of the uterine artery resistance index (UtA RI) and the umbilical cord artery vessels, and samples were collected before birth. Maternal levels were significantly higher in GH (P<0.05), PE (P<0.001) and PE+FGR (P<0.001) than in controls. PE+FGR had the highest urocortin levels, significantly (P<0.001) higher than PE and GH. In umbilical cord levels were significantly (P<0.0001) higher in GH, PE and PE+FGR than in controls; and significantly (P<0.001) higher in PE+FGR than in GH and PE. Concentrations were significantly (P<0.0001) higher than, and correlated to maternal levels. Eleven out of 140 patients developed IVH, giving an overall prevalence of the disease in our population of 7.14% (pretest probability). By using the cut-offs indicated by the ROC curve analysis, when mean UtA RI was used the probability of developing IVH (positive predictive value) was 28.6% (C.I.95%: 0.6–56.6%), and 0% if it was not altered, respectively. By using urocortin, the probability of IVH was 66.7%, and 0% if levels were unaltered. In conclusion, urocortin I levels are increased in maternal and fetal circulation in presence of hypertensive disorders of pregnancy, and their changes are correlated with neonatal IVH.