Laura Letizia Mazzarelli

Preeclampsia in women with chronic kidney disease.

Objective: Women with chronic kidney disease have an increased risk of developing preeclampsia and its severe complications. Currently, there are no assessments available in order to quantify such risk. The aim of the study is to establish the incidence of superimposed preeclampsia in women with chronic kidney disease according to Serum creatinine (SCr) level. Methods: Pregnant women with chronic kidney disease were retrospectively identified from January 2000 to July 2010. We defined two groups according to SCr: Group 1: SCr ≤ 125 µmol/l; Group 2: SCr > 125 µmol/l. Incidence of preeclampsia, early preeclampsia (delivery <34 weeks), gestational age (GA) at diagnosis and delivery outcome were assessed. Results: Ninety-three nephropatic women were considered for the analysis. Group 2 (n = 14) compared with Group 1 (n = 79) had an increased incidence of preeclampsia (78.6% vs. 25.3%; p < 0.0001), an increased rate of pregnancy complications as early preeclampsia (82% vs. 38%; p < 0.03), a lower GA at diagnosis (29 ± 2 vs. 33 ± 1 weeks; p < 0.04) and a lower GA at delivery (30 ± 2 weeks vs. 34 ± 1; p < 0.04). Conclusion: Women with chronic kidney disease and an increased creatinine threshold have a high risk of developing preeclampsia and delivering preterm.

Pregnancy outcome in proteinuria-onset and hypertension-onset preeclampsia

Objective: To evaluate pregnancy outcome in preeclampsia (PE), according to the timing of onset of proteinuria and hypertension. Methods: Preeclamptic women were retrospectively divided into proteinuria-onset and hypertension-onset PE according to the first symptom. Maternal and perinatal outcome were assessed in both the groups. Results: One hundred and ninety five single pregnancies complicated by PE were included. According to the first symptom, they were divided into two groups: proteinuria-onset PE (n = 49, 25.1%) and hypertension-onset PE (n = 146, 74.9%). Pregnancy and neonatal outcome was significantly worse in proteinuria-onset PE. Conclusion: Proteinuria-onset PE is associated with an increased risk of adverse pregnancy outcome than hypertension-onset PE.

Anesthetic management of a parturient with spinal muscular atrophy type II

In the past, pregnancy was contraindicated in patients with spinal muscular atrophy. Recently, more cases are occurring because of improvement in survival and functional status. The goals for anesthetic management of these patients include satisfactory anesthesia during surgery and excellent postoperative analgesia with minimal compromise of respiratory function. Spinal anesthesia may be considered contraindicated due to spinal deformities, but successful spinal anesthesia was performed in a 37 year old parturient following magnetic resonance imaging of the spine.

Trisomy 18 caused by isochromosome 18p and 18q formation: Is there a milder phenotype?†

Trisomy 18 Caused by Isochromosome 18p and 18q Formation: Is There a Milder Phenotype? Giuseppe Maria Maruotti, Floriana Fabbrini, Raffaele Napolitano, Rita Genesio, Anna Conti, Giovanna Mallia Milanes, Laura Letizia Mazzarelli, and Pasquale Martinelli* Department of Gynecology and Obstetrics, University Federico II of Naples, Naples, Italy Prenatal Diagnosis Unit, University Federico II of Naples, Naples, Italy

Prevalence and characteristics of symptomatic and asymptomatic tuboovarian masses in women with HIV: an ultrasonographic study

HIV-positive women with pelvic inflammatory disease have been reported to have an increased prevalence of tuboovarian masses (TOMs). The aim of this study was to assess the prevalence of asymptomatic ultrasonographic TOMs in women with HIV and to identify associated factors in order to formulate a selective ultrasonographic screening strategy. Two-hundred and four HIV outpatients underwent transvaginal ultrasonography. Eight (3.9%) had a diagnosis of TOM (5 were asymptomatic). Two profiles of patients at risk for TOM were identified who could be considered for selective screening strategies: the ‘long-term infected’ (age>35 years, diagnosis of HIV infection more than 5 years ago, HIV clinical category C, CD4 counts below 200/mm3, >5 lifetime partners and on antiretroviral therapy) and the ‘recently diagnosed with HIV’ (African ethnicity, age 25–35, HIV diagnosis in the previous year, >5 lifetime partners, HIV clinical category C and not on antiretroviral therapy).

P15.04: Congenital syphilis

examination showed no further anomalies, especially no craniofacial, urogenital, heart or lung malformations. Therefore, our case concerned a Tetra-amelia, and not a tetra-Amelia syndrome. Tetra-Amelia syndrome is described to be caused by a homozygous WNT3-gene mutation in only one consanguineous family. DNAanalysis of this gene was therefore not performed. The autosomal recessive Roberts syndrome is characterized by tetraphocomelia and is clinically variable. DNA-analysis of the ESCO2-gene was performed. No pathological mutations were found in this gene. In this case the couple was counselled for a low recurrence rate. Meanwhile, a new pregnancy occurred and the prenatal scan at 16 weeks showed normal limbs.

P18.19: Prenatal invasive diagnosis and counseling: what changes in the years? A south Italian referral centre's experience

Objectives: Our aim is to describe the technique of fetal intracranial pressure (FIP) assessment developed by using a safe and accurate system of invasive pressure monitoring and registering. Methods: By performing a fetal ultrasound-guided cephalocentesis in the fetal parieto-occipital fissure we may reach the posterior horn of the ventricular cavity. The procedure requires local anesthesia, little or no maternal sedation and no fetal curarization. The technique relies on the use of a sterile disposable pressure transducer that relays pressure information from the intraventricular catheter to a digital monitor in real time. It requires less than 5 seconds for the system to read and plot the pressure values into a graphic describing a straight line with low amplitude oscillations. The pressure transducer has a test port that allows one to verify the accuracy of the system before the fetal punction, minimizing the procedure time. The sensitivity is 5.0 μ V/V/mmHg ±1%, adequate to low pressure ranges. Fetal heart beats should be monitored for bradycardia may occur. Patient should be given uterolythics and has low risk of preterm rupture of membranes after procedure. Discussion: Congenital hydrocephaly has a wide spectrum of presentations and is related to multiple factors. Prognosis depends on the underlying cause, presence of associated malformations, the gestacional age of onset and progression of the ventricle enlargement with brain injury by intracranial hypertension. The FIP assessment may select those who could benefit from intrauterine ventricular derivations, in advanced and progressive cases. The FIP is estimated to be 2mmHg or less in normal fetuses and should be much higher in obstructive hydrocephaly, leading to parenchymal compression and neuronal migration impairment. Conclusions: The technique of FIP measurement is described. Fast, accurate and low-risk assessment may add important information and greatly improve outcome of fetuses with hydrocephaly.

P15.12: Prenatal diagnosis of severe combined immunodeficiency (SCID): ultrasonographic detection of the absence of cavum septi pellucidi may be predictive?

Objective: To analyze the methods of prenatal sonographic diagnosis of all kinds of aortic arch anomalies and to improve prenatal sonographic detection rate of aortic arch anomalies. Methods: 73 fetuses with congenital aortic arch anomalies were studied. The results from prenatal ultrasound examination, postnatal examination were compared. Results: 73 cases were with congenital aortic arch anomalies, 33 cases with malposition of aortic arch, 9 cases with normal left aortic arch with aberrant left subclavian artery, 5 cases with interruption of aortic arch, 26 cases with coarctation of aortic arch. The accuracy rate of prenatal sonographic diagnosis was 87.7%. Conclusions: Aortic arch anomalies have typical sonographic image. If we grasp typical sonographic images, we could make accurate diagnosis.

Prenatal Diagnosis of Ulbright-Hodes Syndrome

lbright-Hodes syndrome, or limb reduction defects and renal dysplasia, is an unusual lethal congenital malformation that consists of mesomelia, radiohumeral fusion, and renal dysplasia. We report the successful prenatal diagnosis of the condition at 21 weeks’ gestation in a family with a negative history, which to our knowledge has not been reported previously. Sonographic findings, new and atypical features, the differential diagnosis, and counseling of the couple are reported.

P33.05: Prenatal diagnosis of trisomy 18 in fetus with only bilateral choroids plexus cysts

Results: Ultrasound examination of a 30-year-old Caucasian female, pregnant for the first time, showed a monozygotic pregnancy with: scalp cystic hygromata, polycystic kidney, bilateral clubhand, varusequin foot and polyhydramnios. These anomalies indicated possibility of chromosomal abnormality and suggested to perform the amniocentesis; fetal chromosomal analysis showed abnormal karyotype 47, XY, +21. The parents opted for termination of this pregnancy. Conclusions: The necessity of routine ultrasound examination for the prenatal detection of chromosomal abnormalities to all pregnancies.