Post-partum evaluation of maternal cardiac function after severe preeclampsia.

OBJECTIVE: To evaluate the post-partum maternal cardiac function in patients with history of severe preeclampsia. METHODS: A series of women with previous singleton pregnancy complicated by severe preeclampsia underwent transthoracic echocardiography at 6-12 months from delivery. A group of women with previous uncomplicated pregnancy was selected as controls. RESULTS: Sixteen women with history of severe preeclampsia were enrolled in the study group whereas 18 patients were selected as controls. In the study group systolic (p=0.002) and diastolic blood pressure (p=0.044) were significantly higher. Significant differences were observed in systolic left ventricular (LV) parameters, such as cardiac output (p=0.034), LV mass indexed to BSA (p=0.024) and longitudinal contraction, expressed by tissue Doppler (TD) S1 wave, which resulted relatively impaired in former preeclamptic women (p=0.049). As regards as diastolic parameters, pulsed Doppler A-wave velocity was increased (p=0.036). TD E-wave velocity was significantly lower in study group (p<0.001) and E/E1 ratio (E=peak early diastole transmitral wave velocity/E1=peak early diastolic velocity at mitral valve annulus at TD) was higher respect to controls (p<0.001). CONCLUSIONS: LV contractility and diastolic function, although within normal reference ranges, show slight but significant impairment among women who experienced a severe preeclampsia. TD seems to be a sensible tool to identify these precocious signs of potential LV dysfunction.

Significance of uteroplacental Doppler at midtrimester in patients with favourable obstetric history.

OBJECTIVE: To reassess the usefulness of midtrimester uterine Doppler in low-risk multiparous women. METHODS: We prospectively recruited low-risk pregnant women at 20-22 weeks attending our clinic. Among those, women with a favourable obstetric history (group A) were distinguished from nulliparous (group B) and of each group we measured uterine artery Doppler (pulsatility index (PI)). We evaluated the accuracy of uterine artery Doppler in the prediction of preeclampsia and small for gestational age (SGA) neonates. RESULTS: Between January 2009 and October 2010, 382 women were included in the study of which 147 in group A and 235 in group B. Overall, 26/382 (6.8%) women presented preeclampsia and SGA occurred in 59/382 (15.4%) cases. In our population, at a 10% false positive rate (FPR) uterine artery Doppler showed a detection rate (DR) of 19.2% for preeclampsia and of 37.3% for SGA, with a higher sensitivity for SGA neonates delivered ≤ vs. >34 weeks (87% vs. 29.4%). The univariable receiver operating characteristics (ROC) curve by uterine artery PI yielded a significant prediction only for SGA in nulliparous women (areas under the curve (AUC) of 0.70; 95% CI 0.60-0.79). CONCLUSIONS: Our data confirmed that midtrimester uterine artery Doppler is not an efficient strategy in anticipating the risk of pregnancy complications among low-risk multiparous women.

The pregnancy outcome in women with incidental diagnosis of septate uterus at first trimester scan.

BACKGROUND: Septate uterus seems to be strongly associated with an adverse pregnancy outcome. However, the possible relationship between septate uterus and miscarriage has only been retrospectively ascertained. The aim of our study was to describe the reproductive outcome in women with incidental diagnosis of malformed uterus at first trimester scan. METHODS: Women at their first pregnancy attending our centre for a routine viability scan with an incidental suspicion of uterine anomaly at standard sonography were submitted to transvaginal volume ultrasound. All the cases with a 3D diagnosis of septate uterus were prospectively recruited and followed up. RESULTS: Overall 24 patients with a single intrauterine pregnancy were included at a median gestational age of 8.2 weeks. The cumulative pregnancy progression rate, as quoted by Kaplan-Meier algorithm, was 33.3% due to the occurrence of early (≤ 13 weeks) or late miscarriages (14-22 weeks) in 13 and 3 cases, respectively. CONCLUSION: The pregnancy outcome is poor if a septate uterus is incidentally diagnosed in the early stage of a viable intrauterine pregnancy.

Normal morphometry of fetal posterior fossa at midtrimester: brainstem-tentorium angle and brainstem-vermis angle.

OBJECTIVE: To standardize the evaluation of normal tentorium insertion and normal rotation of the cerebellar vermis over the brainstem, using two novel measurements: the brainstem-tentorium angle (BT angle) and the brainstem-vermis angle (BV angle). We also aimed to test the reproducibility of these measurements. METHODS: Prospective observational study including normal fetuses at routine anomaly scan with confirmed normal follow-up. Three-dimensional volumes of the fetal head were acquired starting from standard trans-cerebellar views. In the sagittal plane, obtained by multiplanar reconstruction, the angle between the brainstem and the tentorium insertion in the fetal skull, and between the brainstem and the lower edge of the vermis were measured twice by two independent operators. Intraobserver and interobserver variations were calculated. RESULTS: Eighty cases were included. The estimated BT and BV angles lie in a wide interval among normal midtrimester fetuses with a median value (min-max) of 25.65 (20.13-47.39) and 9.29 (3.87-19.36) respectively. Intraobserver and interobserver variation were good for both measurements. CONCLUSION: The BT and BV angle may be of help in assessing the fetal posterior fossa at midgestation and gives a standardized and reproducible measurement of normal tentorium insertion and normal rotation of the cerebellar vermis over the brainstem.

The impairment of sexual function is less distressing for menopausal than for premenopausal women.

INTRODUCTION: Menopause requires psychological and physical adjustments because of the occurring significant hormonal changes. Sexuality is one of the aspects that undergoes the most profound modifications. Preliminary data suggest that sometimes women do not regard sexual changes as problematic and often readjust their life and relationship according to their new physical status. AIM: The aim of our study was to evaluate sexual function and the way women feel by comparing healthy postmenopausal and premenopausal women. METHODS: One hundred menopausal (M) and 100 premenopausal (pM) healthy women were asked to complete anonymous questionnaires to assess sexual function and stress related to sexual activity. MAIN OUTCOME MEASURES: Female Sexual Function Index (FSFI), Female Sexual Distress Scale (FSDS) were completed by M and pM women. Results. Medium FSFI score was 20.5 +/- 9.6 and 26.4 +/- 7.7 (P < 0.0005) and medium FSDS score was 12.1 +/- 11.7 (95% CI 9.7-14.4) and 11.3 +/- 10.2 (P = 0.917) for M and pM women, respectively. Twenty-five of the 69 M women and 20 of the 31 pM women with a pathological score in the FSFI questionnaire scored higher than 15 in the FSDS (P < 0.0005). The overall prevalence of sexual dysfunction was 20% and 25% (P = 0.5) in the M and pM women. CONCLUSIONS: Our data confirm that menopause is associated with changes in sexual function that may be compatible with sexual dysfunction. However, personal distress caused by these changes in sexual life appears to be lower among menopausal women (36.2%) as compared with premenopausal women (64.5%). These data suggest that medical treatment for sexual health in menopause must be highly personalized and carefully prescribed.