Stefania Fieni

Transvaginal sonographic cervical length changes during normal pregnancy

To examine the relationship between cervical length and gestational age in normal pregnancy in nulliparous versus parous women.

Clinical management of paroxysmal nocturnal hemoglobinuria in pregnancy : A case report and updated review

Because women with paroxysmal nocturnal hemoglobinuria (PNH) are especially vulnerable to thromboembolic phenomena, pregnancy is a time of increased risk for both mother and fetus. However, pregnancies in affected women are rare; only case reports and small studies have been reported so far. We present the case of a 20-year-old woman with PNH who, while undergoing medical tests in preparation for a bone marrow transplant, was discovered to be pregnant. We also review the obstetric literature on pregnancy complicated by PNH, which indicates that both maternal and fetal mortality is exceptionally high (11.6% and 7.2%) with the major cause of maternal mortality being thromboembolism. Major maternal complications are more frequent postpartum (30.2%) than antepartum or intrapartum (16.3%). Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to recall that paroxysmal nocturnal hemoglobinuria (PNH) during pregnancy increases adverse events for both the mother and the fetus, state that maternal and fetal mortality are both high, and explain that the major complications occur in the postpartum period.

Transabdominal antepartum amnioinfusion

Objectives: The purpose of our study was to evaluate whether transabdominal antepartum amnioinfusion is associated with maternal complications during pregnancy and at childbirth. Methods: Fifty‐three pregnant women, hospitalized for oligohydramnios and submitted to transabdominal antepartum amnioinfusion between 16 and 34 weeks’ gestational age, were compared with a historic group of 42 pregnant women treated conservatively. Results: The study population was divided into two groups of women with ruptured and unruptured membranes (Groups A and B, respectively). The latency period between time of admission and term of pregnancy was more favorable in amnioinfused patients (Group A: 22 vs. 11 days; Group B: 30 vs. 9 days), and none of the maternal adverse events under study was significantly more common in amnioinfused patients. By contrast, maternal temperature over 38 °C was more frequent among controls than among amnioinfused patients with ruptured membranes (23% vs. 4%); so was the number of cesarean sections for fetal distress in Group B (50 vs. 11%). Conclusions: Antepartum amnioinfusion does not appear to induce greater complications than conservative treatment for oligohydramnios, with or without premature rupture of membranes. On the contrary, this procedure seems to offer several benefits to pregnant women.

Diagnostic accuracy of IOTA ultrasound morphology in the hands of less experienced sonographers

Aim:   The purpose of our study was to evaluate the ability of the International Ovarian Tumor Analysis (IOTA) classification and its impact on the identification of benign and malignant adnexal masses by less experienced sonographers.

Prenatal Diagnosis of Isolated Limb Defects: An Updated Review

Abnormalities of bone segments, either isolated or in combination with others, may affect any single bone. Given the relatively low incidence of such defects and the relevance of the clinical issues involved, it could be useful to evaluate all the diagnostic and procedural aspects that should be considered at prenatal diagnosis, when obstetricians are confronted with an event that is certainly unfamiliar to most of them: a fetus with an isolated limb defect. In fact, with comparatively infrequent abnormalities investigators often tend to neglect some diagnostic aspects that could be useful both in terms of prenatal counseling and of optimum management of the affected fetus. Therefore, a multidisciplinary approach is required that supplements ultrasound diagnostics with additional tests and examinations, even of the invasive type, depending on the complexity of the condition. This updated review may represent a useful tool to reach the stated objectives.

Oligohydramnios and Fetal Renal Sonographic Appearances Related to Prostaglandin Synthetase Inhibitors

A case of acute neonatal renal failure in twins following tocolytic treatment with ketoprotene is described. The twins had visible signs in utero of developed anhydramniosis associated with morphological renal abnormalities on ultrasound. At birth both twins had acute renal failure with reduced creatinine and urea levels, which could only be normalized after 3 and 18 months, respectively.

Ultrasound Assessment of Biometric Trends in a Case of Thanatophoric Dysplasia

We present a case of thanatophoric dysplasia diagnosed at the 21st week of gestation. Serial ultrasound was performed throughout pregnancy. The scans showed a distinctive pattern of development of the fetal long bones. Up to week 25, the fetal long bones appeared to grow steadily but slower compared to normal measurements (4–5 SD below the mean); then, between weeks 26 and 30, long bone growth was further and more severely hampered, until it almost stopped altogether approaching term, with measurements 9–12 SD below the mean at week 38.

The Effect of Chorionicity on Maternal Cardiac Adaptation to Uncomplicated Twin Pregnancy: A Prospective Longitudinal Study

Objective: The objective of this study was to longitudinally evaluate maternal echocardiographic findings in uncomplicated twin gestations according to chorionicity. Methods: Healthy women with twin pregnancy were assessed with transthoracic echocardiography across the first, second, and third trimesters. Cardiac findings were compared within each group and between monochorionic (MC) and dichorionic (DC) pregnancies. Results: Overall, 19 MC and 48 DC uncomplicated twin pregnancies were included. In the MC group, no significant maternal haemodynamic changes were documented across gestation, with the exception of a decrease in ejection fraction. Compared to DC pregnancies, in the MC set lower cardiac output (second and third trimester, p = 0.001 and p = 0.006, respectively) and higher total vascular resistance (first trimester, p = 0.032) were observed. Regarding the diastolic function in MC twins, significantly higher values were observed for mitral E/A ratio (third trimester, p = 0.014), septal mitral E1/A1 ratio (third trimester, p = 0.030), lateral mitral E1 (second and third trimester, p = 0.014 and p = 0.029, respectively), and E1/A1 ratio (third trimester, p = 0.006). Conclusions: Maternal cardiac adaptation in twin pregnancy seems to differ significantly according to chorionicity. In particular, in MC pregnancies the impairment of diastolic function is less pronounced, presumably due to the lower circulating volume.

C4. Maternal cardiac changes during uncomplicated twin pregnancy: does the chorionicity matter?

Abstract Objectives: To assess longitudinally the echocardiographic findings in a cohort of women carrying an uncomplicated monochorionic (MC) twin pregnancy and compare them with those obtained from dichorionic (DC) twin gestations. Methods: Healthy women with MC twin pregnancies were submitted to serial transthoracic maternal echocardiography during the first, second and third trimester. Cases with severe obstetric complications after enrollment were eventually excluded. The cardiac findings obtained at different time frames within the MC group were compared. Moreover, these data were compared with those obtained longitudinally in a cohort of uncomplicated DC twin pregnancies. Results: From 2012 to 2016, 19 women with an uncomplicated MC twin pregnancy were included in this study group. Among this group no significant changes were documented from 1st to 3rd trimester with the exception of an ejection fraction decrease. In respect of 48 DC uneventful twin gestations in the MC set the following significant differences were observed: reduced cardiac output (midtrimester) and ejection fraction (1st and 2nd trimester), increased total vascular resistance (1st trimester). Regarding the diastolic function in the MC versus DC twins a significant increase of the following parameters was noted: mitral valve E/A (early diastolic – atrial contraction) ratio (3rd trimester); MSE1 (1st and 2nd trimester), MS E1/A1 (3rd trimester); ML E1 (2nd and 3rd trimester); ML E1/A1 (3rd trimester). The longitudinal trend of the following data showed a significant difference between the MC and the DC set: increase of ML E1 and MLE1/A1, decrease of ML A1. Conclusions: In uncomplicated MC twin pregnancies maternal cardiac changes seem to differ significantly from the DC set. In particular, in the former group the diastolic function impairment is less pronounced presumably due to the lower circulating volume.

P14.84: Fetal pyelectasis and prediction of post‐natal renal abnormalities

Objective: To examine the underlying pathology in male fetuses with sonographic evidence of severe and isolated LUTO. Methods: Detailed postmortem examination was carried out after termination of pregnancy in 24 male fetuses presenting before 25 weeks of gestation with ultrasound evidence of isolated severe low urinary tract obstruction. Results: Gender was male in all cases. There was megacystis and hyperechogenic kidneys in all cases. There was anhydramnios/oligohydramnios and pelvicalyceal dilatation in 20 and 15 cases respectively. Prenatal diagnosis of the underlying condition was erroneous in 2/3 of the cases. Urethral atresia was never suspected antenatally. Examination of the urethra demonstrated atresia in 6 cases, severe stenosis in 8 cases, posterior urethral valves in 9 cases and an apparently normal urethra in one. Renal dysplasia was found in all cases but one. Urethral atresia was the most common urethral anomaly at 12–17 weeks. Hydronephrosis was more frequent in cases with PUV (8/9) and urethral stenosis (6/8) than with urethral atresia (1/6). In LUTO presenting before 25 weeks hyperechogenic kidneys was predictive of renal dysplasia in 95% of the cases. The association of a bladder larger diameter of more than 40 mm and hydronephrosis in a male fetus before 25 weeks was predictive of PUV with a PPV and NPV of 44% and 100% respectively. Absence of hydronephrosis and a bladder larger diameter of less (or equal) than 40 mm were predictive of urethral atresia or stenosis with a PPV and NPV of 83% and 57% respectively. Conclusion: LUTO presenting with megacystis in a male fetus in the first and second trimester can correspond to urethral atresia or stenosis more often than posterior urethral valves. Since the formers carry a poor prognosis size of the bladder and the presence of hydronephrosis could be the most discriminant association to improve prenatal counselling.