Prenatal diagnosis of intra-abdominal cystic lesions by fetal ultrasonography: diagnostic agreement between prenatal and postnatal diagnosis.

OBJECTIVE: The aim of this study was to assess the diagnostic agreement between the prenatal diagnosis of intra-abdominal cystic lesions made by ultrasound examination and the postnatal diagnosis. METHODS: We reviewed all consecutive cases referred for an anechoic abdominal cyst from 2009 to 2013. Prenatal ultrasound diagnosis was compared with postnatal diagnosis. Prenatal diagnosis was defined as 'correct' if a specific prenatal diagnosis or one of the possible diagnoses was confirmed postnatally, as 'not confirmed' if the postnatal examination revealed no abnormalities and as 'incorrect' if the postnatal diagnosis was different from those suggested prenatally. RESULTS: Seventy-three cases were included, and prenatal diagnoses were made at a median gestational age of 27 weeks (range: 13-36). Correct diagnoses were made in 66 cases (90.4%), including four in which the lesion resolved spontaneously in utero; two diagnoses were 'not confirmed' postnatally, and one was incorrect (a prenatal diagnosis of intestinal duplication was in fact an anorectal malformation). Postnatal diagnosis was not achieved in four cases: None of them required surgery, and clinical follow-up was favorable. The abdominal cysts were isolated in 52 cases (71%) and associated with other anomalies in 21 cases (29%). Aneuploidies were diagnosed in three cases (all trisomy 21). Eight cases underwent termination of pregnancy; there were no fetal deaths and one neonatal death. Postnatal surgery was performed in 30 out of 65 liveborn infants (46.1%). CONCLUSION: Overall diagnostic agreement between prenatal and postnatal diagnosis of fetal intra-abdominal cystic lesions is high.

Single indication of labor induction with prostaglandins: is advanced maternal age a risk factor for cesarean section? A matched retrospective cohort study.

OBJECTIVE: The aim of this study is to investigate if advance maternal age is an independent risk factor for cesarean section in women induced with prostaglandins. Only patients with a single indication for induction of labor were considered. METHODS: A matched retrospective cohort study was conducted. A study group of 112 women aged 35 or older was enrolled. The control group included 216 women aged 34 or younger. Multivariate logistical regression models were fitted for the prediction of the cesarean section. RESULTS: There were no statistically significant differences in characteristics of the patients in the study and control groups. However, a higher prevalence of nulliparous women was found in control group (p = 0.002). The indications of labor induction were homogeneous in the two groups. No significant differences were found in the route of delivery. The median time of labor was significantly shorter in the study group (p = 0.002), and the birth weight and the placental weight were significantly lower in the study group. Advanced maternal age and newborn weight were directly related, whereas time of labor, Bishop score and parity were inversely related to a higher cesarean rate. CONCLUSIONS: When single indication of induction of labor with prostaglandins is considered, advanced maternal age represents a significant independent risk factor for cesarean delivery.

Vaginal myomectomy is a safe and feasible procedure: a retrospective study of 46 cases.

AIM: The aim of this study was to establish the feasibility and safety of vaginal myomectomy via posterior colpotomy in a series of consecutive procedures performed by one surgeon. MATERIAL AND METHODS: We conducted a retrospective study in a tertiary care university hospital, involving 46 patients with symptomatic myomas and uteruses smaller than 16 gestational weeks and with no signs of pelvic disease. After a presurgical study, the patients underwent vaginal myomectomy. Characteristics of patients, position and size of myomas, operative data, intraoperative and postoperative complications, and length of hospital stay were recorded. RESULTS: Forty-four women underwent vaginal myomectomy and conversion to laparotomy was required in two cases (4.3%). Two patients suffered from infertility and one of these achieved pregnancy after the procedure. The median size of myomas was 50 mm (range 16-81). In two cases a culdoscopy was performed with a flexible fiberoptic gastroscope to better evaluate size and localization of myomas. Thirty-two patients underwent vaginal myomectomy under general anesthesia and 12 under locoregional anesthesia. The median vaginal operating time was 70 min (range 30-120). The estimated hemoglobin loss was 0.70 g/dL (range 0.40-3.35 g/dL). No severe intraoperative complications occurred. The median duration of hospital stay was 1 day (range 1-6). CONCLUSIONS: Vaginal myomectomy is a safe and feasible surgical procedure if performed by a well-trained, experienced surgeon.

Pregnancy outcome in women aged 40 years or more.

OBJECTIVE: The study aimed to analyze the pregnancy outcome of women aged 40 years or more. METHODS: A matched retrospective cohort study comparing women aged 40 years or more with a control group aged 20 to 30 years is described. Multivariate logistic regression models were fitted for the prediction of preterm birth and cesarean delivery. RESULTS: Pregnancy-induced hypertension, preeclampsia and placenta previa were similar in both groups, but a higher rate of gestational diabetes was found in elderly patients (odds ratio [OR] 3.820, 95% confidence interval [CI] = 1.400-10.400; p < 0.0001). Preterm delivery was significantly more frequent in elderly women (OR 1.847, 95% CI = 1.123-3.037; p = 0.020). Gestational diabetes and pregnancy-induced hypertension were strongly associated with preterm delivery and advanced maternal age was not an independent risk factor for preterm delivery. The cesarean delivery rate was significantly higher in the study group (OR 3.234, 95% CI = 2.266-4.617; p < 0.0001). The variables most influencing the cesarean delivery rate were maternal age, analgesia, parity, premature rupture of the membranes and gestational hypertension. No significant differences were detected in neonatal birth weight and Apgar score. CONCLUSIONS: Patients aged 40 years or more have been demonstrated to carry a favorable pregnancy and neonatal outcome, similar to younger patients. The risk of cesarean delivery was higher in patients with advanced maternal age, in nulliparous and in women with a previous cesarean section. The risk of preterm delivery was not related to age but it was strongly associated with gestational diabetes and pregnancy-induced hypertension.