F. Guasina

The prognostic role of uterine artery Doppler studies in patients with late-onset preeclampsia

OBJECTIVE To evaluate the usefulness of uterine artery Doppler in the prediction of outcome in patients with late-onset preeclampsia. STUDY DESIGN Patients with late-onset preeclampsia underwent Doppler interrogation of the uterine arteries. Patients with abnormal uterine artery Doppler were compared with those who had a normal uterine artery Doppler. RESULTS Ninety-nine patients were included in the study group. Abnormal uterine artery Doppler group presented significantly lower gestational age at admission (36.1 +/- 2.1 weeks vs 37.2 +/- 1.9 weeks; P < .005), lower gestational age at delivery (36.5 +/- 1.9 weeks vs 37.7 +/- 1.7 weeks; P < .005), lower birthweight (2429 +/- 590 g vs 3013 +/- 597 g; P < .0001), and a higher admission rate to neonatal intensive care unit (17/51 vs 6/48; odds ratio, 3.5; 95% confidence interval, 1.2-9.5). No significant difference in the occurrence of maternal complications (10/51 vs 6/48; odds ratio, 1.7; 95% confidence interval, 0.5-4.9) was registered. CONCLUSION Women with late-onset preeclampsia show a higher risk of perinatal complications if uterine resistance is increased although maternal outcome does not seem to be related to Doppler findings.

Accuracy of fetal gender determination in the first trimester using three-dimensional ultrasound

To evaluate the accuracy of three‐dimensional (3D) ultrasound in fetal gender assignment in the first trimester.

Electronic spatiotemporal image correlation improves four‐dimensional fetal echocardiography

To compare the efficiency of electronic spatiotemporal image correlation (eSTIC) with that of conventional STIC to acquire four‐dimensional (4D) fetal cardiac volumes of diagnostic quality.

Fertility‐Sparing Treatment of Endometrial Cancer with Initial Infiltration of Myometrium by Resectoscopic Surgery: A Pilot Study

Three women with a well-differentiated grade 1 endometrioid adenocarcinoma of the endometrium with minimal myometrial infiltration were treated with hysteroscopic resection and hormone therapy. The presence of myometrial infiltration has often been mentioned as an exclusion criterion for conservative management in young patients because of worsening cancer prognosis. The subsequent 5-year follow-up and the pregnancies achieved may confirm the choice of this temporary treatment and indicate a new option for fertility-sparing treatment in highly motivated patients.

Is the Distance Between Myoma and Serosa a Limiting Factor

Even if uterine myomas are often asymptomatic, they have been associated with a number of clinical issues such as abnormal uterine bleeding (AUB), heavy menstrual bleeding (HMB), infertility, and recurrent pregnancy loss, especially when these masses are submucous. Gold standard treatment for symptomatic submucous fibroids has long been considered their laparotomic removal or a total hysterectomy. The development of endoscopy has made these fibroids accessible and removable from the inner surface of uterus. The development of different and new techniques allows to overcome the initial limitations of the traditional resectoscopic myomectomy. For a long time several authors have considered the myometrial free margin as a limiting factor when it is lower than 5–10 mm. The onset of the “cold loop technique” has made possible to treat safely G2 submucous myomas even when the thickness of the myometrium is considerably thin. It is feasible because the myometrial free margin can undergo dynamic changes after the various phases of hysteroscopic resection performed with cold handles. It decreases after the distension of the uterine cavity and then increases progressively after the various phases of resection reaching the maximum value at the end of the procedure. Not applying electric energy the cold loop technique does not damage muscle fibers allowing the myometrium separating the myoma from serosa to be a dynamic factor. Thus the myometrial free margin should not longer be considered a selection criteria for the resectoscopic myomectomy.

Early Stages: Is There a Place for Hysteroscopic Treatment?

Endometrial cancer is the most common gynecological malignancy; approximately 20% is diagnosed in premenopausal women and 5% in women up to 40 years old and its incidence is rising among young women, reaching 1% for year. Stated the increasing rate of pregnancy achieved by women in advanced age, thanks to assisted reproductive technologies, endometrial cancer is often diagnosed in patients who have not fulfilled their reproductive plan, highlighting the importance of fertility preservation in this population.

Weight gain, body image and sexual function in young patients treated with contraceptive vaginal ring. A prospective pilot study

Abstract Introduction: Oral contraceptives could induce mood changes. As far as our knowledge, there are no studies in literature that have examined the role of vaginal contraception in self-perceived body image. Aim: To evaluate the effects of intravaginal contraception on weight gain and perceived body image in relation with the Beck’s Depression Inventory questionnaire (BDI) and the McCoy Female Sexuality Questionnaire (MFSQ). Methods: Twenty-one adult (18–35 years old) eumenorrheic (menstrual cycle of 25–35 days), lean (body mass index – BMI – of 19–25 kg/m2) women who were referred for hormonal contraception were administered the Stunkard Figure Rating Scale (FRS), BDI and MFSQ. Subjects were studied in basal condition and after 6 months of therapy with vaginal contraception (NuvaRing®; Organon-Schering-Plough Italia, Milan, Italy). Main outcome measures: BMI, FRS, MFSQ and BDI. Results: After 6 months of therapy with NuvaRing®, both body weight (60.0 ± 8.3; p = 0.050) and BMI (22.1 ± 3.1; p = 0.028) slightly, but statistically, increased. FRS and BDI showed no differences after the vaginal contraception. Hormonal contraception was associated with a significant decrease in the two-factor Italian MFSQ score. Conclusions: Vaginal ring seems a good alternative to other hormonal contraceptive not significantly altering the female sexuality and not influencing the FRS and BDI.

Real-Time Volume Contrast Imaging in the A Plane with a Four-Dimensional Electronic Probe Facilitates the Evaluation of Fetal Extremities in Midtrimester Sonograms

Objective: To evaluate the efficiency of real-time volume contrast imaging in the A plane (VCI-A) of fetal extremities, compared with conventional two-dimensional ultrasound (2D). Methods: This was a randomized controlled trial of 100 patients undergoing midtrimester sonography. The fetal limbs were imaged with either 2D or VCI-A with a four-dimensional (4D) electronic probe. Time required for the examination, number of images stored, and quality of the documentation were compared. During the study, 6 fetuses with abnormal extremities were scanned with both 2D and VCI-A, and the diagnostic accuracy and quality of the images were also compared. Results: In the VCI-A group, the fetal extremities were imaged more rapidly (2.3 ± 1.1 vs. 3.3 ± 0.9 min, p < 0.0001), less images were required to document the examination (5.6 ± 1.4 vs. 7.3 ± 1.6), and an optimal documentation was more frequently obtained (84 vs. 54%, p < 0.0001) compared with the 2D group. In malformed fetuses, a precise diagnosis was achieved with both techniques, although images obtained with VCI-A were found to be of superior quality. Conclusions: Real-time VCI-A with a 4D electronic probe is an effective tool for imaging the fetal extremities in midtrimester examinations and carries some advantages over conventional 2D sonography.

P19.09: Cervical length changes in twin and triplet pregnancies

Results: In our population of 50 triplet gestations, 24 (48.0%) had CS and 11 of these (45.8%) underwent CC. On average, patients with CS delivered 24 days earlier (P = 0.001), had babies that weighed 451 grams less (P < 0.0001) and had lower 1(P < 0.0001) and 5-minute APGARs (P = 0.006), compared to patients without CS. When comparing patients with CS that had CC to those managed expectantly, there were no differences in gestational age (GA) at delivery, birth weight, or APGARs (Table 1). Conclusions: Biweekly transvaginal ultrasound of triplets can identify those with CS and thus at risk for poorer neonatal outcomes. However, CC in triplets with CS offers no additional advantage to expectant management.

OC10.02: Common transvaginal sonographic features of adnexal/ovarian torsion

Objectives: Pulsed tissue Doppler is a technique to record fetal myocardial wall movements with extremely high temporal resolution. Applicable measurements of cardiac performance indexes as TD-Tei Index or mechanical atrioventricular conduction times require knowledge of the exact length of cardiac time intervals as short as 30–50 ms. This requires meticulously fine tuning of the ultrasound parameters and high performance ultrasound equipment.The effect of two different ultrasound machines used to record fetal cardiac tissue Doppler traces on the results was analysed. Methods: Fetal cardiac tissue Doppler traces where obtained on 176 patients, who attended our institute for routine ultrasound scanning for fetal abnormalities or routine assessment of fetal growth. Ultrasound equipment used was either: Philips IU22, vision 2009 (P) or General Electrics E8, BT08 (G). Td-Tei index, the corresponding z-scores, medians and variance where compared. Results: Mean TD-Tei Index was 0.597 (P) and 0.587 (G) variance of TD-Tei Index was 0.009 and 0.008 mean Z-score of TD-Tei Index was 0.167 and −0.115 variance of Z-score of TD-Tei Index was 0.984 and 0.826 mean isovolaemic contraction time was 50.54 and 51.17 variance of isovolaemic contraction time was 116.4 and 109.3 mean isovolaemic relaxation time was 48.28 and 52.12 variance of isovolaemic relaxation time was 70.68 and 93.54 Conclusions: There where only minor differences in the means for fetal cardiac time intervals and their corresponding indices. In the variance of parameters measured with the two different ultrasound systems there were also no significant differences. The used equipment in our setup did not influence the results.