PREGNANCY OUTCOMES IN WOMEN WITH EXTREMELY HIGH SFLT-1/PIGF RATIO: CASE SERIES.

Preeclampsia (PE) is a multisystem disorder, usually defined as the development of hypertension and proteinuria after 20 weeks of pregnancy. The sFlt-1/PlGF ratio has been widely studied as a diagnostic and prognostic marker of preeclampsia and other manifestations of placental dysfunction. A sFlt-1/PlGF ratio greater than 85 for early PE, <34 weeks of gestation suggests a high risk of PE requiring close clinical monitoring. Our main aim was to evaluate the maternal and perinatal outcomes of pregnancies with an extremely high sFlt-1/PlGF ratio. The analysis included data on placental growth factor and soluble fms-like tyrosine kinase serum levels, measured during 2017-2020 in 128 pregnant women. Here we present 8 cases of women with a numerical ratio greater than 850. In all 100% of cases, the signs of obstetric angiogenic catastrophe requiring imminent delivery developed soon. We observed a trend for worsening perinatal outcomes in women with an extremely high sFlt-1/PlGF of ≥850.

A rare case of spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema in the II stage of labour.

BACKGROUND: Pneumomediastinum associated with pneumothorax and subcutaneous emphysema also known as Hamman's syndrome is a rare obstetric complication that usually happens during the second stage of labor. The causal mechanism of Hamman's syndrome is thought to be due to excessive intrathoracic pressure associated with Valsalva maneuver which leads to distal alveolar rupture. The released alveolar air from alveolar rupture dissects along the vascular sheets down a pressure gradient toward the pulmonary hila and into the mediastinum. Prognosis is generally favorable. CASE PRESENTATION: We report the case of physiologic pregnancy in a multipara parturient, which was complicated in the late second stage of labor with subcutaneous emphysema, pneumomediastinum, and severe pneumothorax. Recovery occurred after seven days of active management and a chest tube insertion. No complications were seen afterwards. CONCLUSION: Pneumomediastinum associated with pneumothorax and subcutaneous emphysema in the absence of an obvious precipitating cause is a rare obstetric complication and is called "Hamman's syndrome". The incidence of relapse is unknown, due to the number of reported cases. It could be reasonable to develop a delivery plan at 37 weeks of gestation for women with the history of Hamman syndrome. In case of tendency for a large fetus it might be wise to consider earlier induction of childbirth. Non-aggressive management of the second period of childbirth is recommended. In case of prolonged labour surgical delivery by caesarean section could be considered.

Three years' experience of using a 29-gauge atraumatic needle for amniocentesis.

AIMS: To quantify the procedure-related complication rate after using modified technique of amniocentesis with a 29-gauge (29-G) pencil-point needle. METHODS: This is a prospective, descriptive study of 316 amniocenteses that were performed by means of atraumatic 29-G pencil-point needle under ultrasound control. RESULTS: A total of 316 amniocenteses were observed through the postprocedural period. The median time needed to retrieve 15 mL of amniotic fluid was 4 min. A total of 19 pregnancies were terminated after genetic testing. No case was regarded as procedure-related fetal loss. No other complications were observed. Seventeen children were born before 37 completed weeks of gestation and five children had a birth weight <2000 g. CONCLUSIONS: Amniocentesis with the 29-G atraumatic pencil-point needle seems to be a safe procedure with extremely low risk of complications and is a good alternative to the traditional 22-G Quincke needle.

Neonatal outcome following long-distance air travel for fetoscopic laser coagulation treatment of twin-to-twin transfusion syndrome.

OBJECTIVE: To investigate the impact of undertaking long-distance air travel to a specialized medical center while pregnant in order to undergo fetoscopic laser coagulation (FLC) for twin-to-twin transfusion syndrome (TTTS). METHODS: A retrospective cohort study was conducted of women with TTTS who travelled by air (n=16) or land (n=61) to the Centre of Perinatal Diagnosis and Microinvasive Fetal Surgery, Mainz, Germany, between January 1, 2006, and December 31, 2010. All women underwent FLC on arrival at the study center. Neonatal outcome, postoperative neonatal survival rates, and rates of adverse effects were recorded. RESULTS: The postoperative survival rate for a single twin was 100.0% (n=16) in the flight group and 98.3% in the land transportation group (n=60). The postoperative survival rate for both twins was 81.3% in the flight group (n=13) and 75.4% (n=46) in the land transportation group. No differences in neonatal outcome or the rate of adverse effects were observed between the 2 groups. No flight-related pregnancy complications were recorded. CONCLUSION: Long-distance air travel to a specialized tertiary care medical center is sufficiently safe to warrant recommendation to pregnant women with TTTS who require FLC.

Neonatal outcome using ultrathin fetoscope for laser coagulation in twin-to-twin-transfusion syndrome.

OBJECTIVE: To improve neonatal outcome using ultrathin fetoscope for laser treatment of twin-to-twin transfusion syndrome. METHODS: Retrospective cohort study of a series of 80 cases of twin-to-twin-transfusion syndrome prior to 26-weeks' gestation subjected to laser coagulation by means of a 1.0/1.2 mm fiber fetoscope with a sheath sectional area 2.65 mm(2)/3.34 mm(2) (n=27) and a 2.0 mm classic lens fetoscope with a sheath sectional area: 6.63 mm(2)/11.27 mm(2) (n=53). RESULTS: The survival rates of at least one twin in the compared groups were 94.4% (classic optic) and 100% (ultrathin optic), for both twins: 75.5% and 83.3%, respectively. By decreasing sheath diameter a pregnancy was prolonged by an average of 21.3 days (P=0.0045), with a resulting increase in the recipient's weight of 389 g (P=0.0049) and an increase in the donor's Apgar score. However, the intervention with ultrathin optic took 11 min longer (P=0.031). CONCLUSION: The reduction of the iatrogenic damage of the amniotic membrane using ultrathin fetoscope with a small sheath, significantly improves the neonatal outcome after laser treatment of twin-to-twin-transfusion syndrome. The operator should only commence working with the 1 mm fetoscope after the learning curve has been accomplished.