Lorenzo Guariglia

Ultrasound-guided fine needle aspiration of ovarian cysts during pregnancy

OBJECTIVE To evaluate the safety and efficacy of ultrasound-guided fine needle aspiration in the treatment of ovarian cysts during pregnancy. STUDY DESIGN Nine out of twenty-nine patients between the 6th and the 16th week of gestation with unilateral ovarian cysts ranging between 65 and 540 cm3 in volume were selected for sonographically-guided fine needle aspiration. RESULTS No complications were observed at either short or long-term follow-up; all patients delivered healthy infants at term. Clinical and sonographic post-partum follow-up was uneventful in all cases. In three cases it was necessary to repeat the procedure once and in one case twice during pregnancy. In one case a recurrent serous cyst was excised at operative laparoscopy performed 3 months after delivery. CONCLUSIONS Ultrasound-guided fine needle aspiration was safely performed in nine patients as an alternative treatment to surgery when persistent monolateral and unilocular ovarian cysts with regular borders and completely anechoic structure are detected during pregnancy.

Cerebral blood flow autoregulation and congenital heart disease: possible causes of abnormal prenatal neurologic development.

Objective. To determine whether the major congenital heart diseases (CHDs) can modify the cerebrovascular flow dynamics and the biometrical parameters in fetuses at third trimester of pregnancy. Methods. We studied 60 fetuses with CHD. Data included prenatal versus postnatal cardiac diagnosis, cerebral and umbilical artery doppler, fetal biometrical parameters, fetal weight, and gestational age. The pulsatility index (PI) was used to determine blood flow velocities in the umbilical artery (UA) and middle cerebral artery (MCA), while the cerebro/placental ratio (CPR) was assessed as a measure of cerebral autoregulation. Fetuses with CHD were compared to normal controls and then analyzed after being divided into groups based on specific defects. Results. Compared with control fetuses, those with CHD showed a decrease of resistance blood flow in the middle cerebral artery (1.76 vs 1.92 PI) especially considering the CPR (1.66 vs 2.03 PI) (p  <  0.01). Furthermore, fetuses with CHD also had smaller head circumferences (30.6 cm vs 31.5 cm p  <  0.01) and head/abdominal (HC/AC) ratio (1 vs 1.05 p  <  0.01). When stratified for single cardiac diseases, fetuses with hypoplasic left heart syndrome showed a lower CPR and HC/AC ratio. Conclusions. Cerebrovascular resistance is significantly lower in fetuses with CHD, especially in cases of left side obstruction. The cerebro/placental hemodynamic changes are similar to that described in fetuses with placental insufficiency and may contribute to their abnormal neurologic development.

Conservative Management of Placenta Previa-Accreta by Prophylactic Uterine Arteries Ligation and Uterine Tamponade

Background: Placenta previa-accreta is associated with severe hemorrhage occurring while separating the placenta during cesarean delivery and hysterectomy is considered the treatment of choice. Conservative management has recently been proposed. Case: A 26-year-old woman had pregnancy complicated by placenta previa with suspected accreta. During elective cesarean section a prophylactic double bilateral ligation of uterine arteries was performed before removal of the placenta; subsequently, the continuous small bleeding from the placental bed was stopped by tamponade with a balloon catheter filled with saline solution. The patient was discharged 5 days later. An ultrasonographic color Doppler follow-up demonstrated a renewed uterine vascularization. Conclusion: Double bilateral ligation of uterine arteries can be used as a prophylactic surgical treatment when a severe bleeding because of placenta previa-accreta is expected, in order to avoid hysterectomy.

Uterine prolapse in pregnancy

We present a case of a patient developing uterine prolapse during pregnancy. The cervix reached the introitus at 10 weeks gestation and subsequentely protruted progressively as the pregnancy advanced. The patient was conservatively treated with bed rest and the main maternal and fetal risks are avoided. At 4 months postpartum follow-up there was no evidence of uterine prolapse.

Acceptability of early transvaginal or abdominal sonography in the first half of pregnancy

Abstract Objective: To evaluate the acceptability of early transvaginal sonography by pregnant patients. Methods: A questionnaire was completed by 246 patients and the resulting data were analysed. Results: The incidence of discomfort was higher for the transabdominal than for the transvaginal route. Moreover, the transvaginal approach in early pregnancy, when compared with other transvaginal sonographic examinations was described as more satisfactory in 95% of cases. Conclusions: Transvaginal sonography in early pregnancy is better tolerated than transabdominal sonography.

Transvaginal Ultrasound Evaluation of Myometrial Invasion in Endometrial Carcinoma

In 20 cases of histologically proved endometrial cancer the depth of myometrial invasion was ascertained by means of transvaginal ultrasound, using a high-frequency endocavitary probe. The sonographic findings were confirmed by histologic examination in 18 of the 20 patients evaluated (90.0%). Transvaginal ultrasound provides a fuller preoperative clinical picture and supplies additional diagnostic information which is invaluable in the choice of therapeutic approach.

Intra‐ and interobserver repeatability of femur length measurement in early pregnancy

To assess the intra‐ and interobserver reproducibility of songographic measurement of fetal femur length between 10 and 16 weeks of gestation.

Ovarian Fibrothecoma: Sonographic and Histologic Findings

The sonographic and histologic findings observed in 11 cases of ovarian fibrothecoma were compared, and an attempt was made to find a correlation between each histologic type of the tumor (pure thecoma, predominantly fibrous fibrothecoma, mixed fibrothecoma) and its sonographic appearance. The presence of a homogeneous echogenic pattern, with marked posterior acoustic shadowing, in the absence of any calcification, was highly suggestive of a predominantly fibrous ovarian fibrothecoma; the presence of a diffusely hypoechoic ovarian mass, with no posterior echo enhancement, was strikingly correlated with pure thecomas; mixed fibrothecomas were characterized by the presence of an echogenic pattern with no posterior acoustic shadowing. Sonographic findings, even though nonspecific, can provide the clinician with useful information which permits to detect these rare neoplasms preoperatively.

Successful treatment of post-cesarean hemorrhage related to placenta praevia using an intrauterine balloon. Two case reports.

The authors report a positive experience in controlling severe postpartum hemorrhage after cesarean section performed for placenta praevia by using an inflated intrauterine balloon and avoiding any further invasive surgery.

Transvaginal Ultrasound Detection of Septated and Non-Septated Cystic Hygroma in Early Pregnancy

OBJECTIVE To evaluate the correlation of sonographic transvaginal signs of cystic hygroma and fetal outcome. METHOD Diagnosis was made in 11 cases at 9.1-13.4 weeks of gestation. Fetal karyotype, presence of septations and other associated malformations were considered. The volume of septated and non-septated cystic hygromas was compared by a t test with a statistical significance of p < 0.01. RESULTS Septation of the hygroma was found in 4 cases and fetal death occurred in 3 of these with an abnormal karyotype. Five fetuses demonstrated regression of the hygroma within the 19th week. The volume of septated and non-septated cystic hygromas are statistically different (p < 0.01). CONCLUSIONS Diagnosis of cystic hygromas is possible in early pregnancy by transvaginal scan. Prognosis varies depending on fetal karyotype, volume, presence of septations and other associated malformations. The volume of the hygroma and the presence of septa are associated with a higher incidence of chromosomopathies and a poorer fetal prognosis.