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1.
BMJ Open ; 11(12): e052510, 2021 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-34873004

RESUMO

INTRODUCTION: The term placenta praevia defines a placenta that lies over the internal os, whereas the term low-lying placenta identifies a placenta that is partially implanted in the lower uterine segment with the inferior placental edge located at 1-20 mm from the internal cervical os (internal-os-distance). The most appropriate mode of birth in women with low-lying placenta is still controversial, with the majority of them undergoing caesarean section. The current project aims to evaluate the rate of vaginal birth and caesarean section in labour due to bleeding by offering a trial of labour to all women with an internal-os-distance >5 mm as assessed by transvaginal sonography in the late third trimester. METHODS AND ANALYSIS: The MODEL-PLACENTA is a prospective, multicentre, 1:3 matched case-control study involving 17 Maternity Units across Lombardy and Emilia-Romagna regions, Italy. The study includes women with a placenta located in the lower uterine segment at the second trimester scan. Women with a normally located placenta will be enrolled as controls. A sample size of 30 women with an internal-os-distance >5 mm at the late third trimester scan is needed at each participating Unit. Since the incidence of low-lying placenta decreases from 2% in the second trimester to 0.4% at the end of pregnancy, 150 women should be recruited at each centre at the second trimester scan. A vaginal birth rate ≥60% in women with an internal-os-distance >5 mm will be considered appropriate to start routinely admitting to labour these women. ETHICS AND DISSEMINATION: Ethical approval for the study was given by the Brianza Ethics Committee (No 3157, 2019). Written informed consent will be obtained from study participants. Results will be disseminated by publication in peer-reviewed journals and presentation in international conferences. TRIAL REGISTRATION NUMBER: NCT04827433 (pre-results stage).


Assuntos
Cesárea , Placenta Prévia , Estudos de Casos e Controles , Feminino , Humanos , Estudos Multicêntricos como Assunto , Placenta/diagnóstico por imagem , Placenta Prévia/diagnóstico por imagem , Placenta Prévia/epidemiologia , Gravidez , Estudos Prospectivos , Ultrassonografia Pré-Natal/métodos
2.
Diagn Interv Radiol ; 23(3): 180-186, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28360021

RESUMO

PURPOSE: We aimed to verify whether combination of specific signs improves magnetic resonance imaging (MRI) accuracy in morbidly adherent placenta (MAP). METHODS: MRI findings for MAP were retrospectively evaluated in 27 women. Histopathology was the reference standard, showing MAP in eight of 27 cases. Specificity, sensitivity, positive predictive value, and negative predictive value were calculated for all MRI signs. Two skilled radiologists analyzed MRI findings, resolving discrepancies by consensus, using three alternative diagnostic criteria during three consecutive sections. First criterion: at least one of reported MRI signs indicates MAP and the absence of any sign is normal; second criterion: at least one statistically significant sign indicates MAP and no sign or nonsignificant sign is normal; third criterion: at least two statistically significant signs indicate MAP and no sign, nonsignificant sign, or only one significant sign is normal. RESULTS: Using the first criterion yielded an unacceptable rate of false positive results (78.9%). Using the second criterion there were less false positive results (31.5%), and diagnostic accuracy of the second criterion was significantly higher than the first; the third criterion correctly classified 100% of cases. CONCLUSION: Only specific MRI signs can correctly predict MAP at histopathology, particularly when multiple (at least two) specific signs are observed together.


Assuntos
Imageamento por Ressonância Magnética/métodos , Placenta Acreta/diagnóstico por imagem , Placenta/diagnóstico por imagem , Adulto , Cesárea/métodos , Feminino , Idade Gestacional , Humanos , Histerectomia/métodos , Pessoa de Meia-Idade , Placenta/patologia , Placenta Acreta/patologia , Placenta Acreta/cirurgia , Valor Preditivo dos Testes , Gravidez , Estudos Retrospectivos
4.
Clin Imaging ; 38(5): 747-50, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24674714

RESUMO

We report the case of a 33-year-old woman with antenatal ultrasound diagnosis of succenturiate placental lobe at 33 weeks confirmed by B-flow rendering, describing the advantages of the application of color Doppler to diagnosis and management of placental anomalies. We searched studies about antenatal diagnosis of succenturiate placental lobe, including only cases in which color Doppler was used. This case underlines the importance of color Doppler in increasing the accuracy of diagnosis and achieving an improved differential diagnosis.


Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Doenças Placentárias/diagnóstico por imagem , Placenta/anormalidades , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia Pré-Natal/métodos , Malformações Vasculares/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Placenta/diagnóstico por imagem , Gravidez
5.
J Matern Fetal Neonatal Med ; 25(3): 299-303, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21591972

RESUMO

OBJECTIVE: To show the validity of prenatal invasive surgical intervention when a fetal ovarian cyst is diagnosed, compared to a wait and see attitude, in order to avoid possible prenatal and postnatal complications. PATIENTS: Fourteen cases of intra-abdominal cysts monitored in our center between April 2005 and November 2010. All cases were first diagnosed in the third trimester, and were monitored for the remainder of the pregnancy and after delivery (2 months-3 years postnatally). SURGICAL INTERVENTION: Upon maternal and fetal cutaneous anesthesia performed trans-amniotically, the cystic fluid (mean contents 43.85 cc, DS 46.27) was extracted for cytological, biochemical, and hormonal examination. RESULTS: Thirteen cases of intra-abdominal cysts (92.8%) were fetal ovarian cysts. Ninety-two percent of pregnancies bearing such a condition were successfully concluded (n = 12). Sixty-nine percent concluded in vaginal delivery (n = 9). None experienced maternal and/or fetal complications. Every drained cyst had an estradiol concentration higher than 10,000 pg/ml. CONCLUSIONS: The aspiration of ovarian cysts exceeding a 40 mm diameter, performed as early as possible, allows a good longitudinal treatment of this fetal affection, thus avoiding torsion, tissue necrosis, and invasive postnatal surgery, as well as giving hope of future gestational capability to the fetus/newborn.


Assuntos
Terapias Fetais/métodos , Cistos Ovarianos/cirurgia , Doenças Ovarianas/cirurgia , Adulto , Feminino , Humanos , Cistos Ovarianos/diagnóstico por imagem , Doenças Ovarianas/diagnóstico por imagem , Gravidez , Reprodutibilidade dos Testes , Ultrassonografia Pré-Natal
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