Sonoelastography as method for preliminary evaluation of uterine cervix to predict success of induction of labor.

INTRODUCTION: Induction of labor is a useful practice to solve many obstetric situations but has a large impact on the health of women and their babies and therefore needs to be clearly justified clinically. AIM: To determine the sensitivity of sonoelastography in the evaluation of the cervix to predict the success of induction. MATERIALS AND METHODS: We enrolled 53 subjects preparing for induction of labor. Transvaginal evaluation of cervical length and a sonoelastogram were performed. We preliminarily classified the sonoelastograms into five elastography index (EI) categories and examined the different distribution of cesarean or spontaneous deliveries in various subgroups of EI by χ(2) test and multivariate analysis by logistic regression. RESULTS: Statistical analysis revealed a significant difference of prevalence of spontaneous delivery (EI1-3 82.75%, EI4-5 45.8%) versus cesarean section (EI1-3 17.25%, EI4-5 54.16%) (p = 0.0072). The diagnostic validity of EI was evaluated using the receiver operating characteristic curve and cut-off of the predictive value was EI3. DISCUSSION: The results of our study indicate that sonoelastography is an innovative technique that could allow a more objective preliminary evaluation of the cervix before inducing labor, however further studies with a larger number of subjects and a standardization of image acquisition are necessary.

Impact of surgery and radiotherapy in women with uterine malignancies.

According to the National Health and Social Life Survey, sexual dysfunction affects about 43% of perimenopausal women. A diagnosis of cancer has a profound physical, emotional, and social impact, influencing the relationship with the body, the perception of illness and death, family, social and professional relationships, and the relationship with the partner and, consequently, sexuality. Loss of desire, dyspareunia, orgasmic disorder, difficulties in emotional and physical closeness to the partner, feelings of shame, and inadequacy commonly occur after treatment for uterine cancer; however, if these problems are associated with surgery or with radiotherapy, still remains unclear. According to this study, the authors may conclude that the experience of cancer could lead patients to a rediscovery of. their own sexuality and to an improvement in the relationship with their partner, showing that, sometimes, the relational and psychological factors assume greater importance than physical effects on sexuality, and they can somewhere compensate the morphofunctional failure.

Correlation between 3D ultrasound appearance and postnatal findings in bilateral malformations of the fetal hands.

Malformations of the hand have an incidence of 1 in about 1,500 births. Ultrasound diagnosis and classification of the anomaly is not always easy because of the various positions taken by the hand. We describe the case of a 23-year-old patient with a fetus affected by a symmetrical and bilateral hand oligodactyly associated with deformities of the other fingers. 3D ultrasound evaluation allowed an exact prediction of the malformation and showed perfect correspondence with postnatal findings. The case illustrates the contribution of 3D ultrasound to the evaluation of fetal limb anomalies.

The optical trocar in gynecological surgery: clinical and technical outcomes.

Optical trocars have been introduced as an alternative technique for obtaining access to the peritoneal cavity. The advantage is that each layer of the abdominal wall can be identified avoiding inadvertent injuries due to a lack of vision. From March 2010 to March 2011, 138 women underwent laparoscopy for benign diseases. They were submitted to gynecological laparoscopy for direct optical access. There was no evidence of vascular injuries. This study confirms that the optical trocar is a safe, rapid, and effective method, that offers a real perception of the safety of the entrance into the abdomen.

Uterine tumors resembling ovarian sex cord tumors. A case report.

Uterine tumors resembling ovarian sex cord tumors (UTROSCT) are rare, usually benign, polypoid or nodular neoplasms which generally arise in the fourth to sixth decade of life. We report a case of a 74-year-old woman who presented with vaginal bleeding and remarkable uterine enlargement. Abdominal hysterectomy with bilateral salpingo-oophorectomy was performed and a diagnosis of UTROSCT was made. Immunohistochemistry is mandatory for a correct diagnosis and a panel of at least two markers of sex cord differentiation is recommended. Differential diagnoses include leiomyosarcoma, UTROSCT and ESTSCLE, mixed müllerian tumor and metastatic ovarian sex cord tumor.

Endometriosis: rare localizations in two cases.

Endometriosis is a disease in continuous evolution due to its various aspects and atypical localizations. Every year many women all over the world are affected by it. In typical localizations the diagnosis is simple; the symptoms include pelvic pain and in most of cases sterility. In rare localizations the symptoms are non-specific and the diagnosis is difficult. In particular an intestinal isolated localization is often asymptomatic or can cause non-specific pelvic pain, irregular intestinal activity and in such case, a subocclusive condition often with a diagnosis of inflammatory bowel disease. Two cases of rare localizations of endometriosis are described in the intestinal wall and a cesarean section scar. An analysis of the etiopathogenesis and diagnostic approach in these rare localizations is presented.