W. Klockenbusch

The conservative management of adnexal torsion—a case-report and review of the literature

In clinical routine adnexal torsion tends to be subject to adnexectomy to prevent embolism of thrombosed ovarian veins and its sequelae. This therapeutic intervention can be derogatory especially for young women during the reproductive years. As seen in animal models with adnexal torsion, restitution of the adnexa next to reperfusion is possible until 36 h after interruption of venous and arterial blood perfusion. We report about the successful management of a case of adnexal torsion, which was detorsed laparoscopically. We also reviewed 214 cases with conservative management of adnexal torsions reported in the literature.

Sonographic assessment of the extra-abdominal fetal small bowel in gastroschisis: a retrospective longitudinal study in relation to prenatal complications.

An explorative retrospective study following a case‐series of fetuses with isolated gastroschisis, to evaluate if small‐bowel dilatation may be indicative for emerging obstetric complications. The secondary aim was to establish preliminary normative curves for the external diameter and wall thickness of eventerated fetal small bowel in gastroschisis during the second and third trimester of pregnancy.

Recurrent leiomyomatosis peritonealis disseminata after hysterectomy and bilateral salpingo-oophorectomy during combined hormone replacement therapy.

Leiomyomatosis peritonealis disseminata is a rare disease characterised by the occurrence of multiple smooth muscle cells building up tumour nodules within the peritoneal cavity. Approximately 50 cases of this disease have been reported in the world literature. To our knowledge, this is the first case reporting the recurrence of leiomyomatosis peritonealis disseminata during combined hormone replacement therapy after hysterectomy and bilateral salpingo-oophorectomy and six laparotomies because of recurrence of the disease.

Reliability of Cervix Elastography in the Late First and Second Trimester of Pregnancy

PURPOSE To evaluate the reliability of cervical elastography as a new ultrasound tool for cervical stiffness assessment in pregnancy. MATERIALS AND METHODS Pilot prospective cohort study including 10 consecutive unselected pregnancies in the late first and second trimester. Ultrasound was performed by two blinded experienced operators using a 9-MHz vaginal probe. One raw dataset per patient was acquired by each operator after two cycles of gentle compression and relaxation of the cervix. Strain values were independently assessed by each operator using commercial offline analysis software (TDI-Q: Tissue Doppler Imaging - Quantification, Toshiba Medical Systems). The interobserver reliability of strain measurements was evaluated using the intraclass correlation coefficient (ICC). RESULTS The mean ± SD gestational week of the study population was 19 ± 4.1.  Raw data acquirement and strain evaluation were feasible in all ten patients. In total, 40 strain measurements were performed: 20 for each operator (10 for self-acquired raw data and 10 for raw data acquired by the other operator). The mean strain value was 0.33 ± 0.05, the mean of the differences among the measurements was 10.77 % ± 4.41 %. The obtained interobserver ICC agreement values comparing the different subsets of strain measurement ranged between 0.91 and 0.96. CONCLUSION Late first and second trimester cervical elastography was shown to be feasible and to have a high interobserver reliability. Its clinical value needs to be assessed in further studies on selected obstetric populations.

Prostacyclin Deficiency and Reduced Fetoplacental Blood Flow in Pregnancy-Induced Hypertension and Preeclampsia

Background: Low endothelial generation of prostacyclin (PGI2) is a typical feature of pregnancy-induced hypertensive disorders. The aim of the current study was to establish whether changes in PGI2 are accompanied by alterations in fetoplacental blood flow and to test the hypothesis that PGI2 deficiency contributes to reduced fetoplacental perfusion in pregnancy-induced hypertension (PIH) and preeclampsia. Methods: The study included 11 women with normal pregnancies, 12 with PIH/preeclampsia, and 7 with otherwise complicated pregnancies. Fetoplacental blood flow was assessed both by umbilical artery Doppler sonography measuring the resistance index (RI) and by means of neonatal birth weight. PGI2 formation was measured in umbilical arteries prepared immediately after birth. PGI2, RI and birth weight were correlated with and without correction for gestational age. Furthermore, data from patients with PIH/preeclampsia were compared with normal pregnancies as controls. Results: A significant inverse correlation was found between umbilical PGI2 formation and umbilical RI and between birth weight and RI, whereas PGI2 and birht weight were directly related. Patients with PIH/preeclampsia showed reduced PGI2 formation, markedly increased gestational age-corrected RI and significantly reduced percentile birth weight. Conclusions: These results provide evidence showing that PGI2 is a relevant mediator of fetoplacental blood flow and suggest an important role of PGI2 deficiency in PIH/preeclampsia.

Reliability of quantitative elastography of the uterine cervix in at - term pregnancies

Abstract Aims: To evaluate the intra-operator reliability of tissue Doppler imaging-based quantitative cervical elastography in at-term pregnancies. Methods: Three series of two cycles of manual gentle compression-relaxation of the cervix were performed by one gynecologist in 11 consecutive at-term pregnancies through the vaginal probe. The compression movements should be sufficient to obtain the maximal compression of the anterior portion of the cervical tissue, until the posterior portion begins to be dislocated. Strain values were assessed on the entire thickness of the anterior cervical lip. The influence of strain type (Lagrangian vs. natural) and the extent of compression exerted (difference among the two cycles of compression-relaxation) were evaluated. Results: Strain measurement was influenced by the extent of compression, as well as by the strain type. The strain measured during the cycle with larger cervical compression, using the natural strain preset, showed a superior reliability [mean strain among patients: 0.68±0.18; mean of differences among three measures: 0.07±0.06; intraclass correlation coefficient (ICC) consistency: 0.90]. The strain measured using the Lagrangian strain preset showed overall a low reliability (ICC consistency: 0.04). Conclusions: Quantitative cervical elastography performed in at-term pregnancies, under standardized conditions, has a high reliability.

Evaluation of placental syndecan-1 expression in early pregnancy as a predictive fetal factor for pregnancy outcome

Early expression of syndecan‐1, a regulator of growth factor and chemokine function, in animal and human abortuses or placenta at delivery suggests a potential role during embryonic development. The aim of this study was to examine the correlation between early placental syndecan expression and fetal outcome in ongoing pregnancies.

Occlusion of the ulnar artery in a patient with severe ovarian hyperstimulation syndrome

A patient with ovarian hyperstimulation syndrome, without additional predisposing risk factors for thrombosis suffered thrombotic occlusion of the distal left ulnar artery. Treatment with therapeutic heparinization was successful.

Excretion of prostacyclin and thromboxane metabolites before, during, and after pregnancy-induced hypertension

The aim of the present study was to assess whether changes in prostacyclin (PGI2) and thromboxane (TXA2) generation precede the manifestation of pregnancy-induced hypertension (PH). The metabolites 6-oxo-PGF1 alpha and TXB2 were measured in the urine of 69 randomly selected pregnant women from 16-20 weeks of gestation (wg) until delivery and more than 6 weeks postpartum. Between 16-20 and 21-24 wg 6-oxo-PGF1 alpha excretion did not change in patients who later developed PIH (n = 6) but increased significantly in the control group (n = 63). In contrast, a marked rise in TXB2 excretion was found in the PIH group but not in controls. Thereafter significant differences between both groups persisted from 25 wg until delivery. The 6-oxo-PGF1 alpha/TXB2 ratio was below the 10th percentile from 21-24 wg until delivery in patients with developing PIH. The excretion of both metabolites was substantially lower in the non-pregnant state without any difference between patient groups. These results show an altered urinary excretion of both 6-oxo-PGF1 alpha and TXB2 preceding the onset of the disease. A pathophysiological role of PGI2 deficiency and increased TXA2 formation in PIH appears substantiated.

Quantification of mechanical dyssynchrony in growth restricted fetuses and normal controls using speckle tracking echocardiography (STE).

Abstract Purpose: To evaluate longitudinal mechanical dyssynchrony in normally grown fetuses by speckle tracking echocardiography (STE) and to compare longitudinal mechanical dyssynchrony in fetal growth restriction (FGR) with normal controls. Materials and methods: A prospective study was performed on 30 FGR and 62 normally grown fetuses, including 30 controls matched by gestational age, using STE and a transversal four-chamber view. Data analysis was carried out with a high frame rate of about 175 frames/s. Dyssynchrony was analyzed offline with QLab 9 (Philips Medical Systems, Andover, MA, USA) as time differences between peaks in strain of both ventricles and the septum. Inter- and intraventricular and intraseptal dyssynchrony were obtained and inter- and intraobserver reliability was analyzed. Results: Longitudinal mechanical dyssynchrony was feasible in all cases, with high inter- and intraobserver reliability. Levels of inter- and intraventricular dyssynchrony were higher in the FGR than in the control group. Conclusion: Speckle tracking echocardiography (STE) is a reliable technique for cardiac function assessment in the fetal heart. Interventricular dyssynchrony could be a potential parameter for early detection of subclinical myocardial dysfunction before other parameters demand intervention. The future clinical role of longitudinal mechanical dyssynchrony needs to be verified in larger studies and with a technique customized for prenatal echocardiography.