Brain cortical assessment by MRI in fetuses with left congenital diaphragmatic hernia Brain development in left congenital diaphragmatic hernia

OBJECTIVE

To evaluate fetal brain development using MRI (magnetic resonance imaging) in CDH (congenital diaphragmatic hernia).

METHODS

52 isolated left CDH and 104 control fetuses were imaged using MRI. Brain morphometry (Biparietal diameter - BPD, brain fronto-occipital diameter - BFOD, third ventricle, posterior ventricles, transcerebellar diameter - TCD, anteroposterior and craniocaudal cerebellar vermis diameter - AP and CC) and cortical structures (bilateral cingulate fissure - CF, insular fissure - IF, insular depth - ID) were compared with controls using Mann-Whitney test .

RESULTS

Median gestational age at MRI was comparable (p=0.95), as well as was the median biparietal diameter (p=0.737). Among morphometric parameters only the brain fronto-occipital diameter was significantly smaller in CDH (p= 0.001) and the third ventricle was significantly greater in CDH (<0.0001). Among cortical structures, the cingulate and insular fissure were significantly deeper in CDH fetuses (p<0.0001), as the insular depth ID was smaller in CDH (p< 0.03).

CONCLUSIONS

CDH fetuses have a smaller fronto-occipitaldiameter, reduced insular depth, and deeper cingulate and insular fissure, and greater third ventricle width as compared to controls. These findings suggest that left CDH may have an impact on fetal brain development with an overall reduction of brain volume. This article is protected by copyright. All rights reserved.

Intrafetal Laser Therapy Is a Feasible Treatment for Different Fetal Conditions: A Systematic Review

INTRODUCTION

Over the past years, intrafetal laser (IFL) therapy has been increasingly used in the management of various prenatal conditions. The aim of our research was to clarify the effectiveness and safety of this technique.

METHODS

A systematic review of the literature was carried out using MEDLINE/PubMed over a period of 20 years (2001-2021).

RESULTS

A total of forty-one articles were selected in the literature search, including 194 cases of twin reversed arterial perfusion (TRAP) sequence, 56 cases of bronchopulmonary sequestrations (BPSs), 5 cases of placental chorioangiomas (PCA), 11 cases of sacrococcygeal teratoma (SCT), and 103 cases of embryo reduction (ER) managed using IFL. In TRAP sequence, perfusion of the acardiac twin was successfully disrupted in all cases. However, preterm premature rupture of membranes (P-PROMs) occurred in 6 out of 79 pregnancies (7.5%), and preterm birth (PTB) occurred in 36 out of 122 pregnancies (29.5%). In BPS, IFL was successfully performed in all cases with no significant fetal-maternal complications. The rates of P-PROM and PTB were, respectively, 3.2% and 12.5%. All PCA IFL-treated cases resulted in successful pregnancy outcomes; no cases of P-PROM were reported, but the rate of PTB reached a peak of 60% due to complications such as severe fetal growth restriction and fetal Doppler abnormalities. In SCT cases, complete cessation of blood flow was achieved in 4 patients (36.4%); P-PROM occurred in 2 cases (18.2%), whereas the rate of PTB was 87.5%. In ER, no intraoperative or major maternal complications were described in the literature. Rates of miscarriage and PTB differed between initial trichorionic triamniotic and dichorionic triamniotic triplet pregnancies.

CONCLUSION

Our analysis suggests that IFL is a safe and feasible technique for the management of different fetal conditions. However, the overall risk of PTB, and its related morbidity and mortality, ranges from 12.5% in BPS to 87.5% in SCT IFL-treated cases. This information could aid in decision-making during prenatal counseling. However, final perinatal outcome depends on the severity of the disease itself.

The Obstetrician Gynecologist's role in the screening of infants at risk of severe plagiocephaly: Prevalence and risk factors

This study was conducted to determine the prevalence, maternal and/or neonatal risk factors for severe plagiocephaly in order to early detect and refer infants at risk. A prospective observational study was conducted, involving 4337 infants who visited the Perinatology Center at San Pietro Fatebenefratelli Hospital in Rome, evaluated following the Plagiocephaly Severity Scale of Atlanta. ©The plagiocephaly prevalence resulted 1.89%, considering moderate to severe forms. Maternal risk factors include primiparity, older age, gestational diabetes, and uterine fibromatosis. Neonatal risk factors are early term gestational age, low weight, twin pregnancy, and prolonged labor with an emergency cesarean section. Screening for severe plagiocephaly should begin antenatally. Although the low prevalence, identifying infants at risk can prevent potential permanent sequelae. We suggest a multidisciplinary approach for the management of plagiocephaly, involving the figure of the Obstetrician Gynecologist, who can highlight the risk factors ranging from obstetric and birth conditions.

Uterine leiomyoma in pediatric population: A case report and review of the literature

Uterine leiomyomas are rare in the pediatric population with less than 20 cases in adolescences reported in the literature. Furthermore, these masses represent a common presentation of gynecologic tumors with increasing age. We report a case of a 14-year-old female who presented with abdominal pain and increasing abdominal girth. Workup with ultrasound, CT and MRI demonstrated a large pelvic mass. Complete resection by median laparotomy was performed. The mass weighed 5,596 g and was 29.5 cm × 27 cm × 19 cm; the pathological examination confirmed the hypothesis of leiomyoma. The patient remained asymptomatic at 3 months follow up.

The Relevance of Insomnia in the Diagnosis of Perinatal Depression: Validation of the Italian Version of the Insomnia Symptom Questionnaire

BACKGROUND

Sleep disorders are common in perinatal women and may underlie or trigger anxiety and depression. We aimed to translate and validate and evaluate the psychometric properties of the Italian version of the Insomnia Symptom Questionnaire (ISQ), in a sample of women during late pregnancy and 6-months postpartum according to the DSM-5 criteria.

METHODS

The ISQ was administered to 292 women prenatally along with other measures of sleep quality, depression, and anxiety, to examine its construct and convergent validity. Women were readministered the ISQ six months postdelivery to assess test-retest reliability. Women were divided into DSM-5 No-Insomnia (N = 253) and Insomnia (N = 39) groups.

RESULTS

The insomnia group had received more psychopharmacotherapy, had more psychiatric family history, increased rates of medically assisted reproduction, of past perinatal psychiatric disorders, and scored higher on almost all TEMPS-A dimensions, on the EPDS, HCL-32, PSQI, and on ISQ prenatally and postnatally. ISQ scores correlated with all scales, indicating adequate convergent and discriminant validity; furthermore, it showed antenatal-postnatal test-retest reliability, 97.5% diagnostic accuracy, 79.5% sensitivity, 94.9% specificity, 70.5% positive predictive power, and 92.8% negative predictive power.

CONCLUSIONS

The ISQ is useful, valid, and reliable for assessing perinatal insomnia in Italian women. The Italian version showed equivalent properties to the original version.

Psychometric Properties of the Perinatal Anxiety Screening Scale Administered to Italian Women in the Perinatal Period

Literature stressed the importance of using valid, reliable measures to assess anxiety in the perinatal period, like the self-rated Perinatal Anxiety Screening Scale (PASS). We aimed to examine the psychometric properties of the Italian PASS version in a sample of Italian women undergoing mental health screening during their third trimester of pregnancy and its diagnostic accuracy in a control perinatal sample of psychiatric outpatients. Sample comprised 289 women aged 33.17 ± 5.08, range 19-46 years, undergoing fetal monitoring during their third trimester of pregnancy, with 49 of them retested 6 months postpartum. Controls were 60 antenatal or postnatal psychiatric outpatients aged 35.71 ± 5.02, range 22-50 years. Groups were assessed through identical self- and clinician-rating scales. Confirmatory Factor Analysis (CFA), Principal Component Analysis (PCA), Pearson's correlations and receiver operating characteristic were conducted for PASS. PCA and CPA confirmed four-factor structure with slight differences from the original version. Construct validity and test-retest reliability were supported. Cut-off was 26. The PASS correlated with principal anxiety scales. Despite small sample size, findings confirm reliability and validity of the Italian PASS version in assessing anxiety symptoms in the perinatal period. Its incorporation in perinatal care will improve future mother and child psychological health.

Ursodeoxycholic acid in the treatment of pregnancy cholestasis: a data-set available for Meta-analyses

BACKGROUND

The recent literature on intrahepatic cholestasis of pregnancy raises questions on the best management of such a disease. Improved evidence might be achieved by meta-analyses.

AIM

Providing data for allowing individual patients meta-analyses and aggregate data meta-analyses.

METHODS

Data were collected retrospectively at the Fabia Mater Hospital of Rome (Italy), between 2013 and 2018. Several variables were collected and analyzed according to low-level bile acid (less than 40 μmol/L) and high-level bile acid (at least 40 μmol/L). Eighty-three cases of pregnancy cholestasis, diagnosed according to itching symptoms and excluding bile diseases, were collected and analyzed, both descriptively and inferentially.

CONCLUSION

The analyzed data do not provide significant evidence supporting the use of ursodeoxycholic acid to prevent composite adverse fetal outcomes but they can be included in further meta-analyses.

Comparison of mediastinal shift angles obtained with ultrasound and magnetic resonance imaging in fetuses with isolated left sided congenital diaphragmatic hernia

Objectives: To compare ultrasound (US) and magnetic resonance imaging (MRI) in the assessment of mediastinal shift angles (MSAs) in fetuses affected by isolated left congenital diaphragmatic hernia (CDH). The use of MRI-MSA and US-MSA as prognostic factor for postnatal survival in fetal left CDH was also explored.Methods: This was an observational study of 29 fetuses with prenatally diagnosed isolated left CDH, assessed with both US and MRI examinations between January 2015 and December 2018. The US-MSA measurements performed within 2 weeks from the MRI assessment were considered for the analysis. The primary outcome was the postnatal survival rate.Results: No significant difference between US and MRI MSAs was detected (p = .419). Among the 29 cases, there were 21 alive infants, for an overall postnatal survival rate of 72.41%. After stratifying for postnatal survival, the best cutoffs with the highest discriminatory power in terms of sensibility and specificity were 42.1° for the US-MSA and 39.1° for the MRI-MSA. The performance of MRI-MSA in predicting postnatal survival was close to that of US-MSA in terms of sensitivity (62.5 versus 50.0%), specificity (80.9 versus 90.5%), positive predictive value (55.6 versus 66.7%), negative predictive value (85.0 versus 82.6%) and accuracy (75.9 versus 79.3%). There was no statistically significant difference between the two modalities (p > .05 for all).Conclusions: MRI and US can be interchangeably used for the assessment of MSA in prenatally diagnosed isolated left CDH. Moreover, MSA measured by both US and MRI was confirmed to be correlated with perinatal outcome in terms of survival.

The influence of ovulation induction and assisted conception on maternal and perinatal outcomes of twin pregnancies

OBJECTIVE

To compare obstetrical and neonatal outcomes of twin pregnancies conceived via assisted reproductive technology (ART) with those of naturally conceived ones and to investigate the influence of the ART procedure type on these parameters.

PATIENTS AND METHODS

This observational study included 450 ART and 647 spontaneous twin pregnancies delivered over 15 years at a single university-based hospital of Rome, Italy. Logistic and linear regression models adjusted for confounding factors were used to evaluate the effect of ART and the type of assisted conception (IVF/ICSI, ovulation induction ± intrauterine insemination, egg/embryo donation) on maternal and perinatal outcomes.

RESULTS

The mean gestational age was significantly lower in pregnancies conceived via ART. The occurrence rates of gestational diabetes, antenatal admission, prophylactic administration of corticosteroid, very preterm delivery and neonatal intensive care unit admission were higher in the ART group. Twin pregnancies achieved via egg/embryo donation had a lower risk of maternal thrombocytopenia and cervical incompetence and were at greater risk of receiving corticosteroid prophylaxis and patent ductus arteriosus than pregnancies obtained by IVF/ICSI. Conception by ovulation induction was associated with reduced risk of hyperemesis gravidarum and longer neonatal hospitalization compared to pregnancies obtained by IVF/ICSI.

CONCLUSIONS

Assisted conception was associated with adverse obstetrical outcomes and lower gestational age, but after adjustment for gestational age neonatal immediate outcomes were similar to those observed in the spontaneous group. There were no many important differences in the outcomes of twin pregnancies obtained by a different type of conception.

Symphysis-fundal height predicts difficult evolution of induced labours

BACKGROUND AND AIM

Symphysis-fundal-height (SFH) could be prove useful for the management of labour. This study aims to assess the behaviour of induced labours in relationship with SFH values.

METHODS

Prospective observational study in a sample of 158 women underwent induction with intravaginal dinoprostone for different indications. SFH, SFH corrected for station, gestational age and parity were considered independent variables in multivariable models. Vaginal delivery, operative vaginal delivery, Cesarean section, Cesarean section for dystocia, Cesarean section for cardiotochographyc abnormalities, oxytocin infusion (for potentiating labour), need of Kristeller's maneuvre, epidural anesthesia (on demand), episiotomy, time from the first dose of dinoprostone to delivery, and time of active phase of labour were considered dependent variables in multivariable models.

RESULTS

SFH >34 cm (both uncorrected and corrected for station) independently associates with an increase of odds ratio for operative vaginal birth, Kristeller's maneuver, oxytocin use, episiotomy. Additionally, SFH >34 cm (corrected for station) seems to correlate with increasing time of active phase of labour.

CONCLUSIONS

SFH >34 cm (both corrected and uncorrected for station) predicts difficult vaginal deliveries and operative vaginal deliveries in induced labours.

Myomectomy during the first and second trimester of pregnancy

Myomectomy was performed on five symptomatic women in the first and second trimester of pregnancy who were resistant to medical therapy. All the patients ended theirs pregnancies without complications. Three patients of five (60%) underwent spontaneous delivery while the other two patients (40%) had cesarean section. Myomectomy during pregnancy, when necessary, is proving highly effective today.

Thrombosis associated with a large uterine myoma: case report

A case of a 49-year-old woman who presented with a large uterine myoma weighing 5000 g and was affected by unilateral deep vein thrombosis of the left leg and pulmonary embolism is presented. After anticoagulant therapy she successfully underwent laparotomic hyterectomy.

[Primary microinvasive adenocarcinoma of the cervix. A clinical case]

In this case the authors describe a patient with primary microinvasive adenocarcinoma of the eso-cervix, with the cervical canal not involved by the pathology, diagnosed by colposcopy followed by biopsy. Before the diagnosis of microinvasive adenocarcinoma the patient was scheduled for electrocautery of the suspicious area due to the fact that previous Pap-smears had always been negative. The authors underline the important role of colposcopy as a diagnostic tool that should be mandatory before any surgical therapy on the cervix and that allowed to diagnose such a rare cervical tumor.