Role of D-dimer testing in severe pelvic inflammatory disease: a new usable marker to assess the need for fertility-impairing surgery?

Pelvic inflammatory disease (PID), like many other inflammatory diseases, can be characterized by an inflammation-induced activation of the coagulation cascade, resulting in the production of D-dimers. In this study it is demonstrated how high levels of D-dimers, assayed at the time of hospitalization, are encountered in patients diagnosed with PID and how the levels of this parameter are significantly higher in patients, which due to the severity of the disease, needed surgical treatment. Therefore the d-dimer is shown to be an important parameter to be considered in the therapeutic counseling of severe forms of PID.

Effect of physical training on age-related reduction of GH secretion during exercise in normally cycling women.

Objective: To evaluate whether prolonged physical activity (25 km/week running for 8 years) modifies GH decline.

Design: The GH response to maximal exercise on bicycle-ergometer was tested in younger (26-30 years) and older (42-46 years) healthy women. Each age group included 2 subgroups of 10 sedentary and 10 runners, which were compared.

Uterine tumors resembling ovarian sex cord tumors: a case report of conservative management in young women.

Uterine tumors resembling ovarian sex cord tumors (UTROSCT) are distinguished into two separate groups: endometrial stromal tumors with sex cord-like elements (Group I), which have an unfavorable prognosis; and UTROSCT proper (group II), with more than 40% sex cord-like differentiation and less endometrial component, which are biologically less aggressive than the tumors of the other group. We report the case of a young woman with UTROSCT treated by minimally invasive hysteroscopic surgery. This is one of the few cases reported in the literature that have been managed conservatively.

Association between fetal Doppler velocimetry abnormalities and confined placental trisomy 22: A case report.

The occurrence of trisomy 22 confined to the placenta is rare. We report on a patient who presented with fetal abnormal Doppler velocimetry (elevated umbilical artery pulsatility index), but serial ultrasound examinations revealed a spontaneous recovery throughout pregnancy. A healthy baby was normally delivered at 40 weeks.

Intrapancreatic rupture of a splenic artery aneurysm during pregnancy - a rare case report with fetal and maternal survival.

Rupture of a splenic artery aneurysm (SAA) during pregnancy is a rare and severe condition. A 35-year-old woman at 34 weeks' gestation came to our observation for acute abdominal pain. After being diagnosed with intra-pancreatic SAA rupture, she was delivered of a live fetus by cesarean section.

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.

Methods: One hundred and five patients undergoing elective surgical treatment for single adnexal masses at the University of Parma were enrolled. After the final diagnosis, we had the ultrasound recordings reviewed retrospectively by a group of three residents, and the features of each adnexal mass were evaluated according to the morphological score reported by the IOTA Group.

Ultrasound screening in second and third trimester of pregnancy: an update.

Ultrasound screening of structural fetal malformations is mainly based on the use of ultrasounds during the second trimester of pregnancy. The diagnostic sensibility of ultrasounds varies in the different multicentric studies reported in literature and is correlated to different factors: gestation period, type of malformation, number of ultrasounds performed, operator experience, etc. Third trimester ultrasounds may identify late-onset malformations and offer adequate information for postnatal assistance.

Cervical length as a predictor of preterm delivery: gestational age-related percentiles vs fixed cut-offs.

Background: To determine whether preterm delivery is more effectively predicted by sonographic cervical length measurement using fixed cut-off or gestational age-specific percentiles.

Methods: One hundred and eight patients hospitalized for suspected preterm labor (PTL) were studied prospectively between the 20th and the 33rd week of gestation.

Results: Cervical length below 15 mm, 25 mm and the 2.

Second-trimester maternal serum alpha-fetoprotein elevation and its association with adverse maternal/fetal outcome: ten years experience.

Background: Alpha-fetoprotein (AFP) is the major serum protein in the embryonic stage and in the early fetal stage. The aim of this study was to determine any possible association between an "unexplained" elevation of maternal serum alpha-fetoprotein (MSAFP) levels in the second trimester of pregnancy and adverse maternal/fetal outcome.

Methods: A retrospective cohort study, was carried out in the University of Parma, by reviewing all triple tests that had been found positive for neural tube defect screening, showing an "unexplained" MSAFP elevation (> or =2.

Mid-trimester amniocentesis and antibiotic prophylaxis.

Objectives And Methods: Assuming that the rate of fetal loss after amniocentesis may be reduced in patients receiving antibiotic prophylaxis, we conducted a retrospective study on untreated versus treated patients receiving prophylactic antibiotics (amoxicillin/clavulanic-acid or azithromycin) and evaluated the fetal loss rate within the 22nd week of gestation, also with respect to the risk of spontaneous abortion, both preexisting and related to mid-trimester amniocentesis.

Results: Spontaneous abortion occurred in 22 cases out of 1744 (1.26%).

Changes in interleukin-6 and IGF system and their relationships in placenta and cord blood in newborns with fetal growth restriction compared with controls.

Objectives: The IGF system is central to fetal growth. Recently, the relationships between cytokines and the IGF system have been shown in specific tissues. It is unknown whether these occur in the placenta.

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

Unlabelled: 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.

Prenatal diagnosis of agenesis of corpus callosum: what is the neurodevelopmental outcome?

Background: Corpus callosum is the largest cerebral commissure that connects neocortical areas. Agenesis of corpus callosum (ACC) can be partial or complete, isolated or associated with other malformations. Its prenatal diagnosis creates problems within parental counselling due to its uncertain prognosis.

Retzius' space haematoma after spontaneous delivery: a case report.

We report a case of a haematoma of the Retzius space after spontaneous uncomplicated delivery. In the postpartum period, the patient complained of urinary retention and pain in the hypogastric region radiating to her left hip and leg. The ultrasound examination showed the presence of 160 x 100 x 80 mm confluent solid and liquid areas with peripheral vascularization.

Diagnostic accuracy of fetal renal pelvis anteroposterior diameter as a predictor of significant postnatal nephrouropathy: second versus third trimester of pregnancy.

Objective: The objective of the study was to determine the most effective fetal renal pelvis anteroposterior diameter thresholds and the best gestational age in predicting significant neonatal nephrouropathy and neonatal nephrouropathy requiring surgery.

Study Design: Eighty-three newborns with prenatal ultrasound evidence of unilateral or bilateral fetal renal pelvis dilatation (anteroposterior diameter 4 mm or more) before the 26th week of gestation were systematically and prospectively investigated prenatally and postnatally.

Results: Receiver operating characteristic curve analysis showed that third-trimester anteroposterior diameter cut-offs were more reliable than second-trimester cut-offs in predicting significant neonatal nephrouropathy, the best threshold being 8 mm.

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.

Alteration of the amniotic fluid and neonatal outcome.

Quantitative and qualitative alterations of the amniotic fluid complicate 7% of the pregnancies. Polyhydramnios complicates 1-3% while oligohydramnios involves 3-5% of the pregnancies. The most common causes of polyhydramnios are fetal abnormalities, maternal diabetes and twin pregnancies, but are idiopathic in the 60%.

Amniotic fluid index versus largest vertical pocket in the prediction of perinatal outcome in post-term pregnancies.

We studied a cohort of 41 singleton pregnancies induced at term with prostaglandins and, when necessary, oxytocin. We evaluated with ultrasound the amniotic fluid index (AFI) and the largest vertical pocket (LVP), at least 2 days before the delivery, to compare the sonographic measurement of amniotic fluid with fetal distress and perinatal outcome. We analysed the incidence of fetal distress using intrapartum monitoring of fetal heart rate, considering the absence of variability, the presence of persistent severe variable and/or late decelerations.

Amnioreduction for treatment of severe polyhydramnios.

Between January 2000 and March 2003 we studied the pregnancies complicated by polyhydramnios in 10 patients. The objective was that of evaluating the efficacy of amnioreduction in improving the principal complications given by polyhydramnios such as maternal dyspnea and uterine activity. Our results showed that this procedure resolve maternal symptoms in all the cases but there is no significant reduction in uterine activity.

Ultrasound evaluation of amniotic fluid volume: methods and clinical accuracy.

Ultrasound evaluation of amniotic fluid volume (AFV) is frequently used to detect fetuses at high risk for an adverse outcome - an event that is often correlated with AFV abnormalities. As is well known, ultrasound is a non invasive procedure, which makes it ideal for application on a very large scale: in practice, it can be used for routine monitoring of all pregnancies and, not infrequently, for repeat AFV determination in those cases where there is the suspect of amniotic fluid abnormalities. Sonographic quantification of AFV, whether it is performed through a simple visual estimation or through biometric measurement of one or more amniotic fluid pockets, can never represent a true "quantitative" method and its actual reliability has not consistently been proved by scientific evidence.

Twin-twin transfusion syndrome: a review of treatment option.

Objective: The twin-twin transfusion syndrome (TTTS) is a complication of monozygotic-monochorionic twinning and is a direct result of transplacental communication between the circulations of twins. When acute TTTS occurs in the second trimester, the perinatal mortality can be as high as 95% in the absence of treatment. For this reason, several aggressive, even desperate treatment modalities have been attempted including selective fetocide, umbilical cord ligation, maternal digoxin therapy.

Early complications of prenatal invasive diagnostics: perspective analysis.

In this retrospective analysis we studied 1489 women who underwent prenatal invasive diagnostic procedures between January 2000 and December 2002. We examine the influence of risk factors and the incidence of early complications following amniocentesis and chorion villus sampling, in particular the incidence of fetal loss. The study group included 438 women who underwent CVS and 1051 underwent amniocentesis.

Transvaginal sonographic cervical length changes during normal pregnancy.

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

Methods: We studied a cross-sectional sample of 321 pregnant women, including 185 nulliparous and 136 multiparous women. The inclusion criteria were sonographic confirmation of gestational age within the 12th week, the absence of any risk factors for preterm birth, and uncomplicated pregnancy with expected delivery during the 38th to 42nd weeks.