Central placenta praevia accreta with focal bladder percretism. Conservative management.

Placenta praevia is a condition when placenta is inserted in an abnormal position near or over the internal cervical orifice (ICO). Abnormal placental attachment (placenta accreta, increta, percreta) is a wide spectrum disorder ranging from abnormal adherence to deeply invasive placental tissue. We report a very rare case of central placenta praevia accreta and focal bladder percretism in a 29 years old pregnant woman with an obstetrical history of one previous vaginal delivery and four curettages following miscarriage. She was taken in charge by Catania S. Marco' university-hospital at 20 weeks with diagnosis of Central Placenta Praevia and Accreta (CPPA) detected by means of ultrasounds (US). At 31 weeks Magnetic Resonance Imaging (MRI) confirmed CPPA with focal bladder percretism. After alerting multidisciplinary team and obtaining blood units available, a Caesarean Section (CS) at 34 weeks was planned, when by means of US a detachment area with bleeding was observed. An adequate informed consent was completed, where the pregnant woman and her husband accepted the risk of possible hysterectomy and blood transfusions. A Pfannestiel's laparotomy with transversal corporal uterine incision, bilateral uterine ligation, packed tamponage, removal of placental tissue separated during fetal extraction and leaving a portion of placenta only in the place of percretism, allowed conservative intervention (uterus preservation) ending in good results for both mother and fetus. KEY WORDS: Caesarean section, Curettage, Placenta praevia, Placenta accreta, Preterm birth.

Congenital toxoplasmotic chorioretinitis following reinfection.

Toxoplasmosis does not usually give any symptoms to a pregnant woman and in most cases she does not realize to be infected. On the contrary, in the newborn, congenital toxoplasmosis can be responsible of hydrocephalus, microcephaly, intracranial calcifications, strabismus, blindness, epilepsy, mental retardation, thrombocytopenia, anemia and chorioretinitis. All these pathologies have been reported in the primary infection, while they are unusual in either reinfections or recurrences. We report two rare cases of reinfection of the mother during pregnancy where the neonates showed chorioretinitis.

Renal and Hepatic Functions after A Week of Controlled Ovarian Hyperstimulation during In Vitro Fertilization Cycles.

BACKGROUND: One the main aspects of in vitro fertilization (IVF) cycle is to avoid any possible systemic damage on women undergoing a controlled ovarian hyperstimulation (COH). The aim of this work is to evaluate renal and hepatic function blood tests in patients undergoing controlled ovarian hyperstimulation during IVF cycles. MATERIALS AND METHODS: We performed a prospective cohort analysis. All patients re- ceived a long stimulation protocol with gonadotropin-releasing hormone (GnRH) analogues by daily administration, since the twenty-first day of the previous ovarian cycle followed by COH with recombinant follicle-stimulating hormone (FSH). The daily dose of exogenous gonadotropins for every single patient was modified according to her follicular growth. The oocytes were retrieved during the oocyte pick up and fertilized by standard procedures of intracytoplasmic sperm injection (ICSI). The blood samples to evaluate renal and hepatic functions were taken at the 7th day of ovarian stimulation. RESULTS: We enrolled 426 women aged between 19 and 44 years, with a mean body mass index (BMI) of 24.68 Kg/m2. The mean value of blood urea nitrogen was 14 ± 3.16 mg/ dl, creatinine: 1 ± 0.45 mg/dl, uric acid: 4 ± 1.95 mg/dl, total proteins: 7 ± 3.93 mg/dl, aspartate aminotransferase: 18 ± 6.29 mU/ml, alanine aminotransferase: 19 ± 10.41 mU/ ml, alkaline phosphatase: 81 ± 45.25 mU/ml, total bilirubin 1 ± 0.35 mg/dL. All of the results were considered as a normal range following the Medical Council of Canada. CONCLUSION: Our data suggest that, unlike ovarian hyperstimulation syndrome (OHSS), COH patients did not show any alteration to renal and hepatic functions.

Retroperitoneal sarcoma involving unilateral double ureter: management, treatment and psychological implications.

The case of a 45-year-old woman who was admitted to our university hospital for polymenorrhea, weight gain and pain in the left iliac region is reported. An abdominal ultrasound revealed a 9.5 × 5.2-cm, hypoechoic and inhomogeneous mass located on the left side of the pelvis and behind the ovary. The patient underwent surgery. The pelvic mass was firmly anchored to the small intestine, colon, sigma and uterine fundus. After removing the adhesions, double ureters, which had been incorporated in the mass, were observed on the left side. Resection of the unilateral double ureters was necessary in order to remove the entire mass, and thereafter, a left salpingoophorectomy was performed. A histological examination showed a malignant retroperitoneal mass. Termino-terminal ureteral anastomosis with two double-J stents was carried out. Total hysterectomy with preservation of the right adenexum and regional lymphadenectomy was performed. The purpose of this case report is to discuss the physical and psychological implications related to the combination of two rare entities: leiomyosarcoma and a double ureter located within the mass. A literature review on the clinical management and psychological aspects from a female cancer patient's perspective undergoing surgery with the aforementioned disorders will be discussed.

Case Report: Atypical Cornelia de Lange Syndrome.

Cornelia de Lange Syndrome (CdLS) (also called Bushy Syndrome or Amsterdam dwarfism), is a genetic disorder that can lead to several alterations. This disease affects both physical and neuropsychiatric development. The various abnormalities include facial dysmorphia (arched eyebrows, synophrys, depressed nasal bridge, long philtrum, down-turned angles of the mouth), upper-extremity malformations, hirsutism, cardiac defects, and gastrointestinal alterations. The prevalence of this syndrome is approximately one per 15,000. Ultrasound is not the perfect means to diagnose CdLS, however, many abnormalities can be detected prenatally by scrupulous image observation. We report an atypical CdLS case characterized by increased nuchal translucency in the first trimester, normal karyotype, saddle nose, micrognathia with receding jaw, low set ears, facies senilis, arthrogryposis of the hands, absence of the Aranzio ductus venous, dilatation of gallbladder and bowel, a unique umbilical artery, increased volume of amniotic fluid, and intrauterine growth retardation ending with the interruption of pregnancy.

Physical and psychological implications in a multiple and preterm caesarean section. A case report.

Cesarean section (CS) in Italy has continuously increasing rates. Due to the primary CS, the repeated CS have shown a superimposable trend. Consequently, a number of pathologies are related to such surgery among which placenta previa, dehiscence of previous scar, placenta accreta and preterm delivery. The purpose of this case report is to discuss the physical and psychological implications correlated with a very unusual case of a consecutive seventh CS in the same pregnant woman associated with several diseases: preterm delivery, fetal distress, intrauterine growth retardation (IUGR) (-4 weeks), central placenta previa with metrorrhagia, dehiscence of hysterectomic scar. In spite of the therapy (antifibrinolytic, tocolytic drugs, iron, folates, betamethasone) a preterm CS could not be avoided. Surgery was challenging; hysterectomy was avoided and the mother followed a normal post-operative course, whereas fetal distress and IUGR did not allow the survival of the newborn. A review of the literature regarding the clinical management and psychological aspects of a pregnant woman undergoing multiple complicated CS with the aforementioned disorders will be undertaken.

The reproduction in women affected by cooley disease.

The health background management and outcomes of 5 pregnancies in 4 women affected by Cooley Disease, from Paediatric Institute of Catania University, are described, considering the preconceptual guidances and cares for such patients. These patients were selected among a group of 100 thalassemic women divided into three subgroups, according to their first and successive menstruation characteristics: i) patients with primitive amenorrhoea, ii) patients with secondary amenorrhoea and iii) patients with normal menstruation. Only one woman, affected by primitive amenorrhoea, needed the induction of ovulation. A precise and detailed pre-pregnancy assessment was effected before each conception. This was constituted by a series of essays, including checks for diabetes and hypothyroidism, for B and C hepatitis and for blood group antibodies. Moreover were evaluated: cardiac function, rubella immunity and transaminases. Other pregnancy monitoring, and cares during labour and delivery were effected according to usual obstetrics practice.All the women were in labour when she were 38 week pregnant, and the outcome were five healthy babies born at term, weighting between 2600 and 3200gs. The only complication was the Caesarean section. The improvements of current treatments, especially in the management of iron deposits, the prolongation of survival rate, will result in a continuous increase of pregnancies in thalassemic women. Pregnancy is now a real possibility for women affected by such disease. We are furthermore studying the possibility to collect the fetus' umbilical cord blood, after the delivery, to attempt eterologus transplantation to his mother trying to get a complete marrow reconstitution.

Huge fibroid (g. 3.000) removed during cesarean section with uterus preservation. A case report.

Removal of a giant fibroid during a caesarean section is very rare. We report a case of multiple myomectomy among which a huge myomas (cm 22, weight 3.000 g) in a 44 years old nullipara at 38 weeks. A 10 cm long suprapubic transversal incision according to Pfannenstiel on spinal anaesthesia was done; a female baby weighing 2.285 g, with Apgar score 9/10 was born. Owing to the uterine hypotonia following foetal extraction, myomectomy with womb preservation was carried out. Postoperative course was regular for mother and newborn too.

CD34(+) stem cells from umbilical cord blood.

We describe the relation between umbilical cord clamping time and two different enrichment system of CD34(+) stem cells from umbilical cord blood with the proliferative ability and bone marrow reconstitution of the stem cells obtained. After an obstetrician performed the cord blood collection, the purification of stem cells was performed either with a combination of monoclonal antibodies (negative selections) using the Stem Sep method, or with a positive cells selection based on their surface CD34 antigens using the Mini Macs system. An excellent recovery of haematopoietic progenitors [Burst Forming Unit Erythroids (BFUE); Colony Forming Unit Granulocytes and Macrophages (CFU-GM); and Colony Forming Unit Granulocytes, Erythroids, Monocytes and Macrophages (CFU-GME)], inversely related to the increase in clamping time, was performed with the Mini Macs system (54% of colonies, with 90% purity). With Stem Sep method, haematopoietic progenitor's recovery was 35% (with 80% purity). By applying early clamping of umbilical cord blood we obtained a greater number of CD34(+) cells and their clonogenic activity was increased with enrichment. This is a useful technique considering that the number of CD34(+) stem cells usually contained from a unit of placental blood is enough for the transplant to a child, but not for an adult. Thus, using these methods, we can get a larger number of CD34(+) stem cells which reduces the risk of Graft versus Host Disease also in adult patients, producing survival rates similar to those obtained with transplantation of bone marrow from unrelated donors.