Paolo Rosati

Longitudinal evaluation of uterine myoma growth during pregnancy. A sonographic study.

Thirty‐six pregnant women with a single uterine myoma were examined by ultrasonography at 2 to 4 week intervals. The initial diagnosis was made in 12 patients before pregnancy and in the other 24 patients between 9 and 12 weeks of gestation. Thirty‐four women had a scan 4 weeks after delivery. A reduction in size was observed in puerperium, which may indicate a return to its initial volume. Myoma growth was analyzed in different periods of gestation. An increase in volume during pregnancy was observed in 31.6% of cases. A statistically significant change in volume was noted between the first and the third trimesters (P < 0.001). The greatest increase in volume of myomas occurred before the 10th week of gestation. The relationship between myoma volume and myoma growth in the different gestational periods considered was not statistically significant. On the other hand, when myoma volume was related to complications during pregnancy or at delivery, a statistically significant difference was observed. Myomas with volumes greater than 200 cm3 show a higher rate of complications than those with volumes equal to or less than 100 cm3.

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.

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.

Laparoscopic Myomectomy at 25 Weeks of Pregnancy: Case Report

We performed laparoscopic myomectomy for treatment of a large, twisted, subserous myoma at 25 weeks of pregnancy in a woman with acute abdominal pain that did not respond to analgesic therapy. There are few reports in literature about laparoscopic management of uterine leiomyoma during the first half of pregnancy that demonstrate its feasibility in selected cases. Laparoscopic myomectomy can be considered a minimally invasive alternative to the traditional laparotomy when myomectomy is necessary during the second half of pregnancy, resulting in less postoperative pain and shorter recovery time.

Immune response at birth, long-term immune memory and 2 years follow-up after in-utero anti-HBV DNA immunization

Infections occurring at the end of pregnancy, during birth or by breastfeeding are responsible for the high toll of death among first-week infants. In-utero DNA immunization has demonstrated the effectiveness in inducing specific immunity in newborns. A major contribution to infant immunization would be achieved if a vaccine proved able to be protective as early as at the birth, preventing the typical ‘first-week infections’. To establish its potential for use in humans, in-utero DNA vaccination efficiency has to be evaluated for short- and long-term safety, protection at delivery, efficacy of boosts in adults and effective window/s for modulation of immune response during pregnancy, in an animal model suitable with human development. Here we show that a single intramuscular in-utero anti-HBV DNA immunization at two-thirds of pig gestation produces, at birth, antibody titers considered protective in humans. The boost of antibody titers in every animal following recall at 4 and 10 months demonstrates the establishment of immune memory. The safety of in-utero fetus manipulation is guaranteed by short-term (no fetus loss, lack of local alterations, at-term spontaneous delivery, breastfeeding) and long-term (2 years) monitoring. Treatment of fetuses closer to delivery results in immune ignorance without induction of tolerance. This result highlights the repercussion of selecting the appropriate time point when this approach is used to deliver therapeutic genes. All these findings illustrate the relevance of naked DNA-based vaccination technology in therapeutic efforts aimed to prevent the high toll of death among first-week infants.

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.

Fetal cholelithiasis: a diagnostic update and a literature review

Fetal gallstones and cholelithiasis, detected by routine third trimester ultrasound, have been described in the literature with controversial clinical significance. We report a case of fetal cholelithiasis detected at 35 weeks gestation during a routine scan. The diagnosis was performed using an integrated 2-dimensional (2-D) and 3-dimensional (3-D) ultrasound approach in order to obtain a better definition of the fetal gallbladder and its content. A neonatal follow-up was achieved. The present study has a twofold purpose: firstly, to update the diagnostic approach using the innovative 3-D modalities and secondly, to review the management of this condition during fetal and postnatal life.

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.

Ultrasonographic weight estimation in large for gestational age fetuses: A comparison of 17 sonographic formulas and four models algorithms

Objective. To evaluate the accuracy of different formulas and role of fetal parameters (cephalic, abdominal, femur) used for estimation fetal weight (EFW) in large for gestational age (LGA) fetus in diabetic and non-diabetic mothers. Methods. Seventeen formulas were assessed individually and clustered in four algorithms (X, Y, Z, W) on the basis of fetal biometric parameters using the mean absolute % error, standard deviation (SD), prediction within ±5%, ±10%, ±15% of error and introducing new variable hypotenuse test (HPT) that can sum up precision and accuracy of formulas employed. For predicting fetal macrosomia (BW ≥ 4200 g) a receiver-operating characteristic curve was constructed. Results. Warsof2 formula showed the lowest mean % error, SD and HPT (p < 0.01) with overall prediction ±5, ±10%, ±15% of birth weight in 68, 94 and 98%. The formulas that were only based on abdominal measurement (Warsof2, Hadlock1, Campbell) showed the best ability to identify fetal macrosomia. The X algorithm confirming primary role of abdominal circumference for EFW in diabetic mothers. Conclusions. Accuracy of EFW in LGA fetuses is attributable to the biometric parameters used. Our findings show that the best formulas for EFW are those which only consider the abdominal measurements, especially in diabetic mothers. The new variable that we propose (HPT) confirms this result.