Martina Leombroni

Outcomes Associated With Isolated Agenesis of the Corpus Callosum: A Meta-analysis.

CONTEXT: Antenatal counseling in cases of agenesis of the corpus callosum (ACC) is challenging. OBJECTIVES: To ascertain the outcome in fetuses with isolated complete ACC and partial ACC. DATA SOURCES: Medline, Embase, CINAHL, and Cochrane databases. STUDY SELECTION: Studies reporting a prenatal diagnosis of ACC. The outcomes observed were: chromosomal abnormalities at standard karyotype and chromosomal microarray (CMA) analysis, additional anomalies detected only at prenatal MRI and at postnatal imaging or clinical evaluation, concordance between prenatal and postnatal diagnosis and neurodevelopmental outcome. DATA EXTRACTION: Meta-analyses of proportions were used to combine data. RESULTS: Twenty-seven studies were included. In cACC, chromosomal anomalies occurred in 4.81% (95% confidence interval [CI], 2.2–8.4) of the cases. Gross and fine motor control were abnormal in 4.40% (95% CI, 0.6–11.3) and 10.98% (95% CI, 4.1–20.6) of the cases, respectively, whereas 6.80% (95% CI, 1.7–14.9) presented with epilepsy. Abnormal cognitive status occurred in 15.16% (95% CI, 6.9–25.9) of cases. In partial ACC, the rate of chromosomal anomalies was 7.45% (95% CI, 2.0–15.9). Fine motor control was affected in 11.74% (95% CI, 0.9–32.1) of the cases, and 16.11% (95% CI, 2.5–38.2) presented with epilepsy. Cognitive status was affected in 17.25% (95% CI, 3.0–39.7) of cases. LIMITATIONS: Different neurodevelopmental tools and time of follow-up of the included studies. CONCLUSIONS: Children wih a prenatal diagnosis of isolated ACC show several degrees of impairment in motor control, coordination, language, and cognitive status. However, in view of the large heterogeneity in outcomes measures, time at follow-up, and neurodevelopmental tools used, large prospective studies are needed to ascertain the actual occurrence of neuropsychological morbidity of children with isolated ACC.

Systematic review and meta-analysis on persistent left superior vena cava on prenatal ultrasound: associated anomalies, diagnostic accuracy and post-natal outcome.

To quantify the prevalence of chromosomal anomalies in fetuses with persistent left superior vena cava (PLSVC), assess the strength of the association between PLSVC and coarctation of the aorta and ascertain the diagnostic accuracy of antenatal ultrasound in correctly identifying isolated cases of PLSVC.

Diagnostic accuracy of ultrasound in predicting birth‐weight discordance in twin pregnancy: systematic review and meta‐analysis

To investigate the diagnostic performance of ultrasound in predicting birth‐weight (BW) discordance in twin pregnancy.

Early diagnosis of heterotopic triplet pregnancy with an intrauterine and bilateral tubal pregnancy after IVF: A case report

Heterotopic pregnancy (HP) is a rare condition defined as the simultaneous presence of intrauterine pregnancy (IUP) and ectopic pregnancy (EP). It occurs in around 1/30000 of spontaneous pregnancie...

Outcome of fetal ovarian cysts diagnosed on prenatal ultrasound examination: systematic review and meta‐analysis

To explore the outcome of fetuses with a prenatal diagnosis of ovarian cyst.

Long-term outcome after surgical repair of pelvic organ prolapse with Elevate Prolapse Repair System

Abstract Female pelvic organ prolapse (POP) is a common condition and the correction of prolapse remains a major challenge for the surgical community. A retrospective study of women with POP undergoing pelvic reconstructive surgery with the Elevate System followed-up for 48 months. A total of 138 women with POP were included in the study. We observed an objective cure rate of 94.9% for the anterior wall after 4 years’ follow-up. The subjective cure rate was 97.1%. Improvement in the urinary symptoms was seen after the surgery: the number of asymptomatic patients increased from 14.5 to 77% after the 4 years of follow-up. We reported no cases of bleeding, haematoma, mesh infection and bowel injury, while we had four cases of bladder injury and one case of sepsis. The mesh extrusion rate was 7.3%, all cases interested the anterior compartment. Postoperative dyspareunia and pelvic pain were rare. In this cohort, the Elevate Prolapse Repair System was associated with excellent long-term results, for both anatomical corrections of prolapse, with a high objective and subjective cure rate and a functional urinary outcome. Impact statement What is already known on this subject? Female pelvic organ prolapse is a common condition and the correction of prolapse remains a major challenge for the surgical community. The optimal treatment of POP has still to be determined. What do the results of this study add? The findings from this study shows that the Elevate Prolapse Repair System had high anatomic results associated with a good durability, low morbidity and excellent subjective outcome. To the best of our knowledge, this is the first study that reports a follow-up up to 48 months. What are the implications of these findings for clinical practice and/or further research? The Elevate Prolapse Repair System was associated with excellent long terms results in terms of safety, durability and tolerability during the 4 years’ follow-up. Despite the fact that the Elevate kit produced by AMS was withdrawn from the market and it is no longer available, we believe that it is helpful to have data about the outcomes of a transvaginal mesh implant.

Risk factors for abnormally invasive placenta: a systematic review and meta-analysis

Abstract Purpose of the article. To explore the strength of association between different maternal and pregnancy characteristics and the occurrence of abnormally invasive placenta (AIP). Materials and methods: Pubmed, Embase, CINAHL databases were searched. The risk factors for AIP explored were: obesity, age >35 years, smoking before or during pregnancy, placenta previa, prior cesarean section (CS), placenta previa and prior CS, prior uterine surgery, abortion and uterine curettage, in vitro fertilization (IVF) pregnancy and interval between a previous CS, and a subsequent pregnancy. Random-effect head-to-head meta-analyses were used to analyze the data. Results: Forty-six were included in the systematic review. Maternal obesity (Odd ratio, OR: 1.4, 95% CI 1.0–1.8), advanced maternal age (OR: 3.1, 95% CI 1.4–7.0) and parity (OR: 2.5, 95% CI 1.7–3.6), but not smoking were associated with a higher risk of AIP. The presence of placenta previa in women with at least a prior CS was associated with a higher risk of AIP compared to controls, with an OR of 12.0, 95% CI 1.6–88.0. Furthermore, the risk of AIP increased with the number of prior CS (OR of 2.6, 95% CI 1.6–4.4 and 5.4, 95% CI 1.7–17.4 for two and three prior CS respectively). Finally, IVF pregnancies were associated with a high risk of AIP, with an OR of 2.8 (95% CI 1.2–6.8). Conclusion: A prior CS and placenta previa are among the strongest risk factors for the occurrence of AIP.

Outcomes associated with fetal hepatobiliary cysts: a systematic review and meta-analysis

To explore the outcomes associated with fetal hepatobiliary cysts.

Corticosteroid prophylaxis for fetal immaturity in a pregnant patient with atrial myxoma

We report a case of a woman at 32nd gestational week, admitted for resting dyspnea, showing left atrial (LA) myxoma. Cardiac myxomas are the most common primary benign tumors of the heart. The incidence of cardiac myxomas diagnosed in pregnancy is extremely low. In the present case, cesarean delivery and concomitant surgical resection of LA myxoma were both delayed after corticosteroid prophylaxis in order to reduce neonatal cerebral, intestinal, and pulmonary complications. <Learning objective: The rarity of these cases makes the management more related to anecdotal experiences. In our case, the gestational age was lower than 34th week, but the fetus was sufficiently large to be delivered before heart surgery with low risk of prematurity complications after an adequate corticosteroid prophylaxis. A waiting approach with several days of corticosteroid prophylaxis was successfully adopted. When the pregnant hemodynamics are stable with low risk of complications, heart surgery should be delayed after corticosteroid prophylaxis.>.

A 2-Year Evaluation of Quality of Life Outcomes of Patients With Pelvic Organ Prolapse Treated With an Elevate Prolapse Repair System.

Objectives To evaluate 2-year quality of life of women with pelvic organ prolapse submitted to prosthetic correction with Elevate. Methods We enrolled 116 consecutive patients with a stage ≥ to 2 prolapse. The Prolapse Quality of Life questionnaire was administered in the preoperative time and after 2 years of follow-up. The statistical results were obtained by using the SPSS Advanced Statistical™ 11.0 Software. Results Patients quality of life improved substantially following prosthetic vaginal surgery. In particular, a clear improvement in the “general state of patients health” (P < 0.05), and a reduction in the daily physical, social, and psychological quality of life (P < 0.05) connected to the prolapse of pelvic organ were observed. Furthermore, a significant reduction in the percentage of patients with urinal disturbances (86.2% preoperative vs 20.7% postoperative; P < 0.05), and an improvement in patients relations with their partners with 12 patients resuming sexual activity were found. Conclusions This study demonstrates that prosthetic vaginal correction represents a long-term efficient clinical instrument for women with symptomatic pelvic organ prolapse. It also achieves a resolution for urinary symptomatology and embarrassment, social limitation, physical and psychological difficulties of women, which, in great part, resulted in many overcoming surgical therapy, worried about fixed outcomes.