Eugenio Vadora

Transvaginal sonographic cervical length changes during normal pregnancy

To examine the relationship between cervical length and gestational age in normal pregnancy in nulliparous versus parous women.

Chemically assisted dissection of tissues: an interesting support in abdominal myomectomy

BACKGROUND The aim of this study was to verify the efficacy of sodium-2-mercaptoethanesulfonate (mesna) in the chemical separation of tissues in abdominal myomectomies when used with the traditional mechanical separation techniques. STUDY DESIGN In a prospective, randomized study, 58 women underwent abdominal myomectomy. In 29 of these, we used mesna for highlighting and separating tissues, and in the other 29 we used saline solution for the same purposes. The variables evaluated included the number of myomas removed, the volume of the biggest myoma, and the total volume of the myomas removed in every intervention. We also recorded operating time, the length of hospital stay, the degree of procedure difficulty, perioperative blood loss, operative complications, and cost. RESULTS The operation was significantly shorter in the mesna group (p < 0.05) even though the volume and the number of myomas were larger. The degree of difficulty evaluated by the surgeon at the end of every operation was not significantly different in the two groups. The reduction in hemoglobin 24 hours after operation was significantly less in the patients treated with mesna (p = 0.006), but this difference was probably altered by the increase in hematocrit levels. CONCLUSIONS Because of its ability as a chemical dissector, mesna may be a useful aid in this type of benign gynecologic operation. Larger studies to confirm this are needed.

Transabdominal antepartum amnioinfusion

Objectives: The purpose of our study was to evaluate whether transabdominal antepartum amnioinfusion is associated with maternal complications during pregnancy and at childbirth. Methods: Fifty‐three pregnant women, hospitalized for oligohydramnios and submitted to transabdominal antepartum amnioinfusion between 16 and 34 weeks’ gestational age, were compared with a historic group of 42 pregnant women treated conservatively. Results: The study population was divided into two groups of women with ruptured and unruptured membranes (Groups A and B, respectively). The latency period between time of admission and term of pregnancy was more favorable in amnioinfused patients (Group A: 22 vs. 11 days; Group B: 30 vs. 9 days), and none of the maternal adverse events under study was significantly more common in amnioinfused patients. By contrast, maternal temperature over 38 °C was more frequent among controls than among amnioinfused patients with ruptured membranes (23% vs. 4%); so was the number of cesarean sections for fetal distress in Group B (50 vs. 11%). Conclusions: Antepartum amnioinfusion does not appear to induce greater complications than conservative treatment for oligohydramnios, with or without premature rupture of membranes. On the contrary, this procedure seems to offer several benefits to pregnant women.

Chemically Assisted Dissection of Tissues in Laparoscopic Excision of Endometriotic Cysts

STUDY OBJECTIVE To evaluate the capacity of chemical dissection of tissues using a mucolytic substance, Mesna, in improving laparoscopic excision of endometriotic cysts. DESIGN Randomized, double-blind, controlled trial (Canadian Task Force classification I). SETTING University-affiliated training hospital. PATIENTS Forty-four women with symptomatic ovarian endometriotic cysts. Intervention. Laparoscopic excision of endometriotic cysts in 22 women with the aid of Mesna solution and in 22 with the aid of saline solution. MEASUREMENTS AND MAIN RESULTS In comparison with saline solution, Mesna as a chemical dissector resulted in significant reductions in operating time, in difficulty encountered by the surgeon to enucleate the cysts, and in less bleeding. No differences were found in length of hospital stay, costs of surgeries, analgesic requirement, and fever. Postoperatively, patients treated with Mesna achieved more pregnancies than those treated with saline. CONCLUSION Chemical dissection of tissues with Mesna proved to be a safe and suitable support in laparoscopic surgery for ovarian endometriotic cysts.

Prenatal Diagnosis of Isolated Limb Defects: An Updated Review

Abnormalities of bone segments, either isolated or in combination with others, may affect any single bone. Given the relatively low incidence of such defects and the relevance of the clinical issues involved, it could be useful to evaluate all the diagnostic and procedural aspects that should be considered at prenatal diagnosis, when obstetricians are confronted with an event that is certainly unfamiliar to most of them: a fetus with an isolated limb defect. In fact, with comparatively infrequent abnormalities investigators often tend to neglect some diagnostic aspects that could be useful both in terms of prenatal counseling and of optimum management of the affected fetus. Therefore, a multidisciplinary approach is required that supplements ultrasound diagnostics with additional tests and examinations, even of the invasive type, depending on the complexity of the condition. This updated review may represent a useful tool to reach the stated objectives.

Oligohydramnios and Fetal Renal Sonographic Appearances Related to Prostaglandin Synthetase Inhibitors

A case of acute neonatal renal failure in twins following tocolytic treatment with ketoprotene is described. The twins had visible signs in utero of developed anhydramniosis associated with morphological renal abnormalities on ultrasound. At birth both twins had acute renal failure with reduced creatinine and urea levels, which could only be normalized after 3 and 18 months, respectively.

Ultrasound Assessment of Biometric Trends in a Case of Thanatophoric Dysplasia

We present a case of thanatophoric dysplasia diagnosed at the 21st week of gestation. Serial ultrasound was performed throughout pregnancy. The scans showed a distinctive pattern of development of the fetal long bones. Up to week 25, the fetal long bones appeared to grow steadily but slower compared to normal measurements (4–5 SD below the mean); then, between weeks 26 and 30, long bone growth was further and more severely hampered, until it almost stopped altogether approaching term, with measurements 9–12 SD below the mean at week 38.