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Mappa I, Masturzo B, Carbone IF, Kiener A, Maruotti GM, Pintucci A, Suprani A, Visentin S, Ghi T, Rizzo G. A national survey on current practice of ultrasound in labor ward. J Perinat Med 2024; 0:jpm-2024-0057. [PMID: 38651816 DOI: 10.1515/jpm-2024-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/10/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Use of ultrasonography has been suggested as an accurate adjunct to clinical evaluation of fetal position and station during labor. There are no available reports concerning its actual use in delivery wards. The aim of this survey was to evaluate the current practice regarding the use of ultrasonography during labor. METHODS A questionnaire was sent to members of the Italian Society of Ultrasound in Obstetrics and Gynecology employed in delivery wards. The qFeuestionnaire was made up of 22 questions evaluating participant characteristics and the current use of ultrasound in labor in their hospital of employment. The answers were grouped according to participant characteristics. RESULTS A total of 200 participants replied. Ultrasound was considered useful before an operative vaginal delivery by 59.6 % of respondents, while 51.8 and 52.5 % considered it useful in the management of prolonged first and second stages of labor, respectively. The major indication for ultrasound use during labor was the assessment of fetal occiput position. The major difficulties in its application were the perceived lack of training and the complexity of the ultrasound equipment use. Participants that reported fewer difficulties were those employed in hospitals with a higher number of deliveries or having delivery units with more years of experience using ultrasound in labor, or those who had attended specific training courses. CONCLUSIONS The results indicate that, despite the reported evidence of a higher accuracy of ultrasound compared to clinical evaluation in assessing fetal position and station, its use is still limited, even amongst maternal-fetal medicine practitioners specialized in ultrasonography.
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Affiliation(s)
- Ilenia Mappa
- Department of Obstetrics and Gynecology, 9318 Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata , Rome, Italy
| | - Bianca Masturzo
- Department of Obstetrics and Gynecology, Ospedale di Biella, Biella, Italy
| | - Ilma Floriana Carbone
- Unit of Obstetrics, Department of Woman, Child and Neonate, 9339 Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan, Italy
| | - Ariane Kiener
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, 9370 University of Parma , Parma, Italy
| | | | - Armando Pintucci
- Department of Obstetrics and Gynaecology, ASST di Monza, Desio, Italy
| | - Alice Suprani
- Department of Women's and Children's Health, Forlì-Cesena, Cesena, Italy
| | - Silvia Visentin
- Department of Women's and Children's Health, 9308 University of Padua , Padova, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, 9370 University of Parma , Parma, Italy
| | - Giuseppe Rizzo
- Department of Obstetrics and Gynecology, 9318 Fondazione Policlinico di Tor Vergata, University of Rome Tor Vergata , Rome, Italy
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Bertoni M, Pintucci A, Locatelli A, Miranda A. Diffuse peritonitis secondary to urachal cyst abscess in a postpartum patient. Int J Surg Case Rep 2024; 118:109584. [PMID: 38579600 PMCID: PMC11004866 DOI: 10.1016/j.ijscr.2024.109584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Urachal cyst infections during pregnancy are exceptionally rare, posing diagnostic challenges. This case report contributes to the limited literature, emphasizing the rarity, diagnostic difficulties, and the need for heightened healthcare provider awareness for timely intervention. PRESENTATION OF CASE A 32-year-old pregnant woman with persistent pelvic pain, fever, and urinary symptoms sought care with inconclusive initial diagnoses despite multiple ER visits. Labor revealed a palpable mass, and postpartum, a CT scan identified a urachal cyst abscess. Urgent laparoscopy confirmed peritonitis, leading to cyst removal, antibiotics, and a subsequent laparotomy. Histology confirmed an abscessed urachal cyst. DISCUSSION Urachal cyst infections in pregnancy, exceptionally rare and diagnostically challenging, highlight the importance of considering them in abdominal pain differentials. Diagnostic tools, such as ultrasound and CT scans, can be misleading, emphasizing the necessity for a multidisciplinary approach. CONCLUSION This case report underscores the challenges in diagnosing and managing an infected urachal cyst during pregnancy, stressing the need for awareness and a comprehensive diagnostic approach for optimal outcomes. The rarity of such cases warrants increased attention within the medical community.
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Affiliation(s)
- Martina Bertoni
- School of Medicine and Surgery, University of Milano Bicocca, Italy.
| | - Armando Pintucci
- Obstetrics and Gynecology, Pio XI Hospital, Desio, ASST Brianza, Italy.
| | - Anna Locatelli
- Obstetrics Unit, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy.
| | - Angelo Miranda
- General Surgery, Pio XI Hospital, Desio, ASST Brianza, Italy.
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Consonni S, Salmoiraghi E, Vaglio Tessitore I, Pintucci A, Vitale V, Calzi P, Moltrasio F, Locatelli A. Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of "Triple I" at Term. Children (Basel) 2023; 10:1110. [PMID: 37508607 PMCID: PMC10378617 DOI: 10.3390/children10071110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023]
Abstract
Chorioamnionitis (CA) at term of pregnancy can have an infectious and/or inflammatory origin and is associated with adverse outcomes. Triple I (intrauterine inflammation, infection, or both, TI) has been proposed to reduce the overdiagnosis of infection and neonatal overtreatment. The aim of this study is to identify clinical and histological variables that could predict adverse outcomes when TI is suspected and/or confirmed. This retrospective cohort study included 404 pregnancies (gestational age ≥ 37 weeks) that were divided into 5 all-inclusive and mutually exclusive groups. TI was defined according to the NICHD definition of 2015, and it could be confirmed (TI+) or not confirmed (TI-) via histological examination. Signs of infection/inflammation that did not conform to the definition of TI were classified as "clinical suspicion" and could be supported (CS+) or not supported (CS-) by histology. Cases of histological chorioamnionitis (HCA) without clinical manifestation represented a fifth group. Whole placental involvement (WPLI) was defined as a histological inflammation involving the maternal and fetal sides. There were 113 TI+, 30 TI-, 186 CS+, 35 CS-, and 40 isolated HCA cases. WPLI was diagnosed in 133 cases (39.2%). Composite neonatal outcome (CNO) occurred in 114 cases (28.2%) while composite maternal outcome (CMO) occurred in 192 cases (47.5%). Compared with CS+, TI+ was more predictive of CNO (p = 0.001), CMO (p < 0.001), and WPLI (p = 0.005). WPLI was related both to CNO (p < 0.001) and to CMO (p = 0.046). TI+ and WPLI showed similar sensitivity but different specificity in predicting CNO. At logistic regression, CNO was independently predicted by TI+ (OR 2.21; p = 0.001) and by WPLI (OR 2.23; p = 0.001). Compared with CS, TI is a better predictor of CNO and can be useful for the identification of newborns at risk.
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Affiliation(s)
- Sara Consonni
- Department of Obstetrics and Gynecology, Carate Hospital, ASST Brianza, 20871 Vimercate, Italy
| | - Elettra Salmoiraghi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | | | - Armando Pintucci
- Department of Obstetrics and Gynecology, Desio Hospital, ASST Brianza, 20871 Vimercate, Italy
| | - Valentina Vitale
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Patrizia Calzi
- Department of Pediatrics, Carate Hospital, ASST Brianza, 20871 Vimercate, Italy
| | - Francesca Moltrasio
- Department of Pathology, Desio Hospital, ASST Brianza, 20871 Vimercate, Italy
| | - Anna Locatelli
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
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4
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Ornaghi S, Colciago E, Vaglio Tessitore I, Abbamondi A, Antolini L, Locatelli A, Inversetti A, Pintucci A, Cetin I, Bracco B, Fabbri E, Sala V, Meroni M, Volpe G, Benedetti S, Bulfoni C, Marconi A, Lagrasta F, Paolini CL, Mazza E, Candiani M, Valsecchi L, Smid M, Pasi F, Pozzoni M, Castoldi M, Vignali M, Dal Molin G, Guarano A, Pellegrino A, Callegari C, Betti M, Lazzarin S, Prefumo F, Zanardini C, Parolin V, Catalano A, Barbolini E, Antonazzo P, Pignatti L, Tintoni M, Spelzini F, Martinelli A, Facchinetti F, Chiossi G, Vergani P. Mode of birth in women with low-lying placenta: protocol for a prospective multicentre 1:3 matched case-control study in Italy (the MODEL-PLACENTA study). BMJ Open 2021; 11:e052510. [PMID: 34873004 PMCID: PMC8650481 DOI: 10.1136/bmjopen-2021-052510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
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).
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Affiliation(s)
- Sara Ornaghi
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Obstetrics and Gynaecology, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
| | | | | | | | - Laura Antolini
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Anna Locatelli
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Obstetrics and Gynaecology, ASST di Vimercate, Carate Brianza, Italy
| | - Annalisa Inversetti
- Department of Obstetrics and Gynaecology, ASST di Vimercate, Carate Brianza, Italy
| | - Armando Pintucci
- Department of Obstetrics and Gynaecology, ASST di Monza, Desio, Italy
| | - I Cetin
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Benedetta Bracco
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Elisa Fabbri
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Valentina Sala
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Mario Meroni
- Department of Obstetrics and Gynaecology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Grazia Volpe
- Department of Obstetrics and Gynaecology, Ca' Grande Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Sara Benedetti
- Department of Obstetrics and Gynaecology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Camilla Bulfoni
- Department of Obstetrics and Gynaecology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Annamaria Marconi
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Federica Lagrasta
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Cinzia Lucia Paolini
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Elisabetta Mazza
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Massimo Candiani
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Luca Valsecchi
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Maddalena Smid
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Federica Pasi
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Mirko Pozzoni
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Maria Castoldi
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Michele Vignali
- Department of Biomedical Sciences for Health, Università degli Studi di Milano Facoltà di Medicina e Chirurgia, Milano, Italy
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Giulia Dal Molin
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Alice Guarano
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Clelia Callegari
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Marta Betti
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Sara Lazzarin
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
- School of Medicine and Surgery, University of Brescia, Brescia, Lombardia, Italy
| | - Cristina Zanardini
- Department of Obstetrics and Gynaecology, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
- School of Medicine and Surgery, University of Brescia, Brescia, Lombardia, Italy
| | - Valentina Parolin
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Anna Catalano
- Department of Obstetrics and Gynaecology, Poliambulanza Foundation Hospitals, Brescia, Italy
| | - Edoardo Barbolini
- Department of Obstetrics and Gynaecology, Poliambulanza Foundation Hospitals, Brescia, Italy
| | - Patrizio Antonazzo
- Department of Obstetrics and Gynaecology, Maurizio Bufalini Hospital, Cesena, Italy
| | - Lucrezia Pignatti
- Department of Obstetrics and Gynaecology, Maurizio Bufalini Hospital, Cesena, Italy
| | - Mauro Tintoni
- Department of Obstetrics and Gynaecology, Maurizio Bufalini Hospital, Cesena, Italy
| | - Federico Spelzini
- Department of Obstetrics and Gynaecology, Infermi Hospital Rimini, Rimini, Italy
| | - Anna Martinelli
- Department of Obstetrics and Gynaecology, Infermi Hospital Rimini, Rimini, Italy
| | - Fabio Facchinetti
- Obstetric Unit, Mother Infant Department, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy
- Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - G Chiossi
- Obstetric Unit, Mother Infant Department, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy
- Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynaecology, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
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Consonni S, Vaglio Tessitore I, Conti C, Plevani C, Condo' M, Torcasio F, Pintucci A, Locatelli A. Umbilical cord management strategies at cesarean section. J Obstet Gynaecol Res 2020; 46:2590-2597. [PMID: 32961613 DOI: 10.1111/jog.14501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022]
Abstract
AIM To evaluate the effect of different strategies to improve placental transfusion in cesarean section (CS). METHODS Retrospective analysis of all singleton term pregnancies that underwent CS over 6 months. Delayed umbilical cord clamping (dUCC) was defined as one done at least 60 s after birth. Umbilical cord milking (UCM) was an option when waiting 60 s was deemed unsafe. The two strategies were compared against early (<60 s) umbilical cord clamping (eUCC) without milking. Neonatal hematocrit (Hct) at 48 h was the main outcome variable. RESULTS Of the 223 CS in the cohort, 100 were performed in labor and 123 were elective. dUCC was performed in 137, eUCC without milking in 53 and UCM in 33 cases. Neonatal Hct was higher in CS carried out in labor versus in elective CS (59.76% ± 6.17 vs 56.91% ± 5.95, P = 0.001). At multivariate analysis, CS performed in labor (coefficient [coeff.] 3.44, confidence interval [CI] 1.75-5.13, P < 0.001), UCM (coeff. 3.88, CI 1.61-6.14, P = 0.001) and birth weight (coeff. -0.003, CI -0.005 to -0.001, P = 0.001) were the only variables independently associated with neonatal Hct. In elective CS, UCM led to higher neonatal Hct (61.5% ± 5.5) compared to eUCC without milking (55.1% ± 5.5) and dUCC (56.4% ± 5.7, P = 0.001), while in CS performed in labor there were no significant differences among the placental transfusion strategies. CONCLUSION In term CS, neonatal Hct is significantly higher when the CS is performed in labor or with UCM. In elective CS, UCM could be a valid option to favor placental transfusion.
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Affiliation(s)
- Sara Consonni
- Department of Obstetrics and Pediatrics, Azienda Socio Sanitaria Territoriale Vimercate, Vittorio Emanuele III Hospital, Carate Brianza, University of Milano-Bicocca, Monza, Italy
| | - Isadora Vaglio Tessitore
- Department of Obstetrics and Pediatrics, Azienda Socio Sanitaria Territoriale Vimercate, Vittorio Emanuele III Hospital, Carate Brianza, University of Milano-Bicocca, Monza, Italy
| | - Claudia Conti
- Department of Obstetrics and Pediatrics, Azienda Socio Sanitaria Territoriale Vimercate, Vittorio Emanuele III Hospital, Carate Brianza, University of Milano-Bicocca, Monza, Italy
| | - Cristina Plevani
- Department of Obstetrics and Pediatrics, ASST Lecco, Azienda Socio Sanitaria Territoriale, A. Manzoni Hospital, Lecco, Lecco, Italy
| | - Manuela Condo'
- Department of Obstetrics and Pediatrics, ASST Lecco, Azienda Socio Sanitaria Territoriale, A. Manzoni Hospital, Lecco, Lecco, Italy
| | - Ferruccio Torcasio
- Department of Obstetrics and Pediatrics, Azienda Socio Sanitaria Territoriale Vimercate, Vittorio Emanuele III Hospital, Carate Brianza, University of Milano-Bicocca, Monza, Italy
| | - Armando Pintucci
- Department of Obstetrics and Pediatrics, Azienda Socio Sanitaria Territoriale Vimercate, Vittorio Emanuele III Hospital, Carate Brianza, University of Milano-Bicocca, Monza, Italy
| | - Anna Locatelli
- Department of Obstetrics and Pediatrics, Azienda Socio Sanitaria Territoriale Vimercate, Vittorio Emanuele III Hospital, Carate Brianza, University of Milano-Bicocca, Monza, Italy
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6
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Ferrazzi E, Beretta P, Bianchi S, Cetin I, Guarnerio P, Locatelli A, Marconi AM, Meroni MG, Pavone G, Pintucci A, Prefumo F, Savasi V, Spinillo A, Tassis B, Vergani P, Vignali M, Parazzini F, La Vecchia C. SARS-CoV-2 infection testing at delivery: a clinical and epidemiological priority. J Matern Fetal Neonatal Med 2020; 35:2417-2419. [PMID: 32660281 DOI: 10.1080/14767058.2020.1788532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Universal testing has been suggested as a useful strategy for a safe exit from the total lockdown, without recurrence of COVID-19 epidemic, delivering women being considered a sentinel population. Further universal testing for pregnant women may be useful in order to define appropriate access to COVID19 areas, dedicated neonatal care, and personal protective equipment. METHODS During the period 10-26 April, all consecutive women admitted for delivery at the Maternity Hospitals of the city of Milan and in six provinces of Lombardy: Brescia, Como, Lecco Monza, Pavia, and Sondrio. areas were tested with nasopharyngeal swabs. Results and conclusion: Out of 1566 women, 49 were tested positive for SARS-Cov-2 (3.1%, 95% Confidence Interval (CI) 2.3-4.0). This value is largely higher than Heath Authorities estimate. Of tested positive women, 22 (44.9%) had symptoms or reported close contacts with positive patients, that is were found at risk by the itemized questionnaire. In conclusion, routine estimate of frequency of positivity among delivering women can be consider a useful methods to monitor positivity at least in females in their fertile ages.
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Affiliation(s)
- Enrico Ferrazzi
- Department of Mother, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Beretta
- Department of Obstetrics and Gynecology, Sant'Anna Hospital-ASST Lariana, Como, Italy
| | - Stefano Bianchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Irene Cetin
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital-ASST Fatebenefratelli-Sacco Milan, Milan, Italy.,Department of Clinical and Biological Sciences, University of Milan, Milan, Italy
| | - Paolo Guarnerio
- Obstetrics and Gynecology Unit, San Carlo Hospital-ASST Santi Paolo and Carlo, Milan, Italy
| | - Anna Locatelli
- Department of Mother and Child, ASST Vimercate, Vimercate, Italy.,School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Anna Maria Marconi
- Department of Obstetrics and Gynecology, San Paolo Hospital- ASST Santi Paolo and Carlo, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Giulia Pavone
- Department of Obstetrics and Gynecology, Lecco Hospital, Lecco, Italy
| | - Armando Pintucci
- Obstetrics and Gynecology Unit, Desio Hospital-ASST San Gerardo, Monza, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Brescia, Italy.,Department of Clinical and Experimental Science, University of Brescia, Italy
| | - Valeria Savasi
- Department of Clinical and Biological Sciences, University of Milan, Milan, Italy.,Department of Woman, Mother and Neonate, Sacco Hospital-ASST Fatebenefratelli-Sacco Milan, Milan, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, University of Pavia, Pavia, Italy.,Department of Woman and Child Health, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Beatrice Tassis
- Department of Mother, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Patrizia Vergani
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.,Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Michele Vignali
- Obstetrics and Gynecology Unit, P.O. Macedonio Melloni-ASST Fatebenefratelli-Sacco, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Fabio Parazzini
- Department of Mother, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Consonni S, Incerti M, Bernasconi DP, Vergani P, Pintucci A, Ornaghi S, Fumagalli S, Locatelli A. Which factors make the difference in the progression of cervical dilation in vaginal birth after cesarean section? Minerva Ginecol 2019; 71:385-387. [PMID: 31560181 DOI: 10.23736/s0026-4784.19.04400-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sara Consonni
- Department of Obstetrics and Gynecology, ASST Vimercate, Vittorio Emanuele III Hospital, University of Milano-Bicocca, Monza, Monza-Brianza, Italy -
| | - Maddalena Incerti
- Department of Obstetrics and Gynecology, MBBM Foundation, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| | | | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| | - Armando Pintucci
- Department of Obstetrics and Gynecology, ASST Vimercate, Vittorio Emanuele III Hospital, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| | - Sara Ornaghi
- Department of Obstetrics and Gynecology, MBBM Foundation, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| | - Simona Fumagalli
- Department of Obstetrics and Gynecology, MBBM Foundation, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| | - Anna Locatelli
- Department of Obstetrics and Gynecology, ASST Vimercate, Vittorio Emanuele III Hospital, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
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Pintucci A, Consonni S, Lambicchi L, Vergani P, Incerti M, Bonati F, Locatelli A. Operative vacuum vaginal delivery: effect of compliance with recommended checklist. J Matern Fetal Neonatal Med 2019; 34:1627-1633. [PMID: 31390914 DOI: 10.1080/14767058.2019.1643312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE Even if the prerequisites and the technique of vacuum extraction are largely established, the role of a checklist in this field has not been tested. To evaluate the role of a checklist implementation on the compliance with the recommended rules in operative vacuum vaginal delivery (OVD) and on maternal and perinatal outcomes. MATERIALS AND METHODS Retrospective cohort study on OVD between January 2012 and December 2015 at two hospitals with a tradition of teaching of OVD. A checklist for OVD was introduced in 2014. Three rules had to be recorded: fetal head station and position determination, no more than four tractions, and no more than three cup applications. Adverse maternal outcomes included third- and fourth-degree perineal tears. Adverse neonatal outcome included asphyxia, need for neonatal resuscitation, NICU admission, major head injuries, scalp injuries, and bone or brachial plexus injuries. RESULTS Introduction of a checklist for OVD resulted in an increase in the compliance with the rules (83.3 versus 62.8%, p < .001). Cases in which the rules were respected had lower incidence of third- and fourth-degree perineal lacerations after controlling for episiotomy, nulliparity, and indication for OVD (OR = 0.4, 95% CI 0.18-0.89), but similar rates of failure of OVD (2.1 versus 2.2%, p = 1) and adverse neonatal outcome (10.8 versus 11.7%, p=.71). CONCLUSION Knowledge and documented compliance with a checklist of recommended rules in OVD may assist in achieving a lower rate of severe perineal and anal sphincter injury but does not alter the success of the procedure or neonatal outcome.
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Affiliation(s)
- Armando Pintucci
- Department of Obstetrics and Gynecology, ASST Vimercate, Carate, Italy
| | - Sara Consonni
- Department of Obstetrics and Gynecology, ASST Vimercate, Carate, Italy
| | - Laura Lambicchi
- Department of Obstetrics and Gynecology, FMBBM Foundation, University of Milano-Bicocca, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, FMBBM Foundation, University of Milano-Bicocca, Monza, Italy
| | - Maddalena Incerti
- Department of Obstetrics and Gynecology, FMBBM Foundation, University of Milano-Bicocca, Monza, Italy
| | - Francesca Bonati
- Department of Obstetrics and Gynecology, ASST Vimercate, Carate, Italy
| | - Anna Locatelli
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, ASST Vimercate, Carate, Italy
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Pintucci A, Consonni S, Locatelli A, Eloisa Gioia L, Colombo P, Vaglio Tessitore I, Moltrasio F. 780: The progressive involvement of placenta in case of chorionamnionitis according to Triple I classification. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Accordino F, Pintucci A, Manni MU, Meregalli V, Locatelli A. Re to: Tale of rudimentary horn pregnancy and literature review. J Matern Fetal Neonatal Med 2018; 32:2778-2779. [PMID: 29504438 DOI: 10.1080/14767058.2018.1448775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- F Accordino
- a Department of Obstetrics and Gynecology , San Gerardo Hospital, MBBM Foundatuibm University of Milano - Bicocca , Monza , Italy
| | - A Pintucci
- b Mother and Child Department , ASST Vimercate, Carate Brianza Hospital, Università degli Studi di Milano - Bicocca , Milan , Italy
| | - M U Manni
- b Mother and Child Department , ASST Vimercate, Carate Brianza Hospital, Università degli Studi di Milano - Bicocca , Milan , Italy
| | - V Meregalli
- b Mother and Child Department , ASST Vimercate, Carate Brianza Hospital, Università degli Studi di Milano - Bicocca , Milan , Italy
| | - Anna Locatelli
- c Mother and Child Department , ASST Vimercate, Carate Brianza Hospital, Università degli Studi di Milano - Bicocca , Milan , Italy.,d Department of Medicine and Surgery , Università degli Studi di Milano - Bicocca , Monza , Italy
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Plevani C, Incerti M, Del Sorbo D, Pintucci A, Vergani P, Merlino L, Locatelli A. Cesarean delivery rates and obstetric culture - an Italian register-based study. Acta Obstet Gynecol Scand 2017; 96:359-365. [DOI: 10.1111/aogs.13063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/09/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Cristina Plevani
- Department of Obstetrics and Gynecology; ASST Vimercate; Carate Brianza Hospital; University of Milano-Bicocca; Milan Italy
| | - Maddalena Incerti
- Department of Obstetrics and Gynecology; Fondazione MBBM; ASST Monza; University of Milano-Bicocca; Milan Italy
| | - Davide Del Sorbo
- Department of Informatics; ASST Vimercate; Vimercate Hospital; Vimercate Italy
| | - Armando Pintucci
- Department of Obstetrics and Gynecology; ASST Vimercate; Carate Brianza Hospital; University of Milano-Bicocca; Milan Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology; Fondazione MBBM; ASST Monza; University of Milano-Bicocca; Milan Italy
| | - Luca Merlino
- General Management for Health; Lombardy Region; Milan Italy
| | - Anna Locatelli
- Department of Obstetrics and Gynecology; ASST Vimercate; Carate Brianza Hospital; University of Milano-Bicocca; Milan Italy
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Pintucci A, Meregalli V, Colombo P, Fiorilli A. Premature rupture of membranes at term in low risk women: how long should we wait in the "latent phase"? J Perinat Med 2014; 42:189-96. [PMID: 24259235 DOI: 10.1515/jpm-2013-0017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 09/19/2013] [Indexed: 11/15/2022]
Abstract
AIM How long the waiting time may be for the onset of spontaneous labor after prelabor rupture of fetal membranes at term (tPROM) remains controversial. METHODS The study is an observational cohort study of 6032 women. All obstetric patients with no obstetric risk factors, other than tPROM, were included. The analysis focused on the onset of labor (spontaneous vs. induction), maternal morbidity [cesarean section (CS) and chorioamnionitis] and neonatal morbidity (suspected infection) related to a policy of waiting for the onset of spontaneous labor within 48 h of tPROM. RESULTS tPROM was experienced by 1439 women. A careful clinical management shows a very low rate of clinical chorioamnionitis (2.3%) and neonatal infection rate (2.8%), even after 24 h from tPROM. The overall incidence of CS was 4.5%. Furthermore, a policy of waiting for the onset of spontaneous labor within 48 h of tPROM is associated with a low rate of CS, less than induced labor (OR=1.76; 95% confidence interval 1.03-3.02; P<0.004). CONCLUSIONS Fetal and/or maternal morbidity in tPROM women may not increase if there is a strict analysis of maternal and or fetal risk factors added to a careful clinical management. Moreover, it may be useful to wait for spontaneous labor in order to enhance the patient's chance of vaginal delivery.
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Abstract
Dilatation of the fetal cerebral ventricles (ventriculomegaly) is a generic sonographic sign that is common to several pathological entities carrying different prognoses. The main causes of fetal ventriculomegaly are aqueductal stenosis, Chiari II malformation, Dandy-Walker complex, and agenesis of the corpus callosum. Ventriculomegaly is easily recognized by ultrasound by measuring the atrial width. This simple measure allows the recognition of mild forms of ventricular dilatation and is used in screening for ventriculomegaly. However, although the diagnosis of ventriculomegaly is easy, the prenatal identification of the cause of ventricular dilatation is a more difficult task. For this purpose the evaluation of the posterior fossa in association with the visualization of the corpus callosum is useful. Research into the causes of ventriculomegaly is clinically useful, since the prognosis mainly depends on the etiology and on the presence of associated abnormalities. In this article the role of prenatal sonography in determining the cause of the ventriculomegaly is reviewed, as well as the prognostic value of the prenatal sonographic findings.
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Affiliation(s)
- Vincenzo D'Addario
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Medical School, Bari, Italy.
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D'Addario V, Pinto V, Rossi AC, Pintucci A, Di Cagno L. Cavum veli interpositi cyst: prenatal diagnosis and postnatal outcome. Ultrasound Obstet Gynecol 2009; 34:52-54. [PMID: 19565533 DOI: 10.1002/uog.6419] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The cavum veli interpositi (CVI) is a space within the double-layered tela choroidea of the third ventricle. Occasionally, this space is fluid-filled and sonographically visible as an interhemispheric anechoic cyst. Because of its rarity, the incidence of CVI cyst is undetermined and the outcome of affected individuals has been found to be variable. The aim of this study was to report our experience of the sonographic findings and outcome of fetuses affected by CVI cysts. METHODS In five fetuses with a CVI cyst, we performed targeted prenatal ultrasound scans of intracranial structures and a detailed anatomical survey to rule out associated malformations. Follow-up consisted of neurological examination and neurosonography. RESULTS The CVI cyst appeared as a well-defined anechoic lesion without adjacent mass effect. In all fetuses the cyst was single and in two cases it enlarged slightly during pregnancy. The cyst was isolated in three fetuses and associated with borderline ventriculomegaly in two. A single umbilical artery was the only associated extracranial anomaly and this was detected in only one fetus. Neurosonography confirmed the presence of CVI cysts in all cases after delivery. During postnatal follow-up (range 10-48 months), the cyst regressed in one case within 1 month after delivery while the size of the others remained stable. No infant developed psychomotor disorders. CONCLUSIONS Prenatal sonographic diagnosis of CVI cysts is feasible. Its finding in isolation is consistent with favorable postnatal outcome.
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Affiliation(s)
- V D'Addario
- Department of Gynaecology, Obstetrics and Neonatology, University Medical School, Bari, Italy.
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Abstract
AIMS To compare the diagnostic accuracy of sonographic signs that may be looked for in fetuses with spina bifida. METHODS Forty-nine fetuses affected by spina bifida were enrolled, at a gestational age of 18-28 weeks. The following sonographic signs were looked for: "lemon" sign, small cerebellum, effaced cisterna magna, small posterior fossa, ventriculomegaly and direct visualization of a spinal defect. RESULTS The "lemon" sign was present in 53%, a small cerebellum in 96%, an effaced cisterna magna in 93%, a small posterior fossa in 96%. Ventriculomegaly was present in 40/49 (81%) cases and was severe in 20 fetuses and borderline in the remaining 20. The spinal defect was missed in one fetus presenting the cerebellar and posterior fossa signs. In two fetuses, the myelomeningocele was present without cranial signs of Chiari II malformation and in both cases the defect was covered by intact skin. CONCLUSIONS Our results confirm the usefulness of evaluation of the posterior fossa in the diagnosis of spina bifida, particularly in cases of small spinal defects that may be missed at ultrasound. Conversely, myelomeningocele covered by intact skin was not associated with the cranial signs of Chiari II malformation.
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Affiliation(s)
- Vincenzo D'Addario
- Department of Obstetrics, Gynecology and Neonatology, University of Bari, Bari, Italy.
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Pinto V, Ingravallo G, Cicinelli E, Pintucci A, Sambati GS, Marinaccio M, D'Addario V. Gastrointestinal stromal tumors mimicking gynecological masses on ultrasound: a report of two cases. Ultrasound Obstet Gynecol 2007; 30:359-61. [PMID: 17721899 DOI: 10.1002/uog.4097] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Gastrointestinal stromal tumors (GISTs) are among the most common mesenchymal tumors of the gastrointestinal tract. Diagnosis of GIST on ultrasound examination can be difficult because of their similarity in appearance to gynecological neoplasms. We present two cases of GIST originating from the small bowel and the stomach, which were preoperatively misdiagnosed as a uterine leiomyoma and an ovarian tumor, respectively. The ultrasonographic differential diagnosis of these pelvic masses is discussed.
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Affiliation(s)
- V Pinto
- Department of Gynecology and Obstetrics, Bari University Medical School, Bari, Italy.
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D'Addario V, Pinto V, Di Cagno L, Pintucci A. The midsagittal view of the fetal brain: a useful landmark in recognizing the cause of fetal cerebral ventriculomegaly. J Perinat Med 2005; 33:423-7. [PMID: 16238537 DOI: 10.1515/jpm.2005.075] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To evaluate the positive predictive value of the midsagittal view of the fetal brain in recognizing the cause of ventriculomegaly diagnosed with traditional axial scan. METHODS Fifty-eight pregnant women, referred to our Center following a generic diagnosis of ventriculomegaly have been evaluated: 38 had marked and 20 had borderline ventriculomegaly. The fetal brain was scanned by the midsagittal view using a transabdominal probe in fetuses in breech presentation or transverse lie and a transvaginal probe in fetuses in cephalic presentation. The possible cause of ventriculomegaly was postulated by combining the findings of the corpus callosum/cavum septi pellucidi complex with those of the posterior fossa. The prenatal diagnoses were compared with the anatomical specimens of aborted fetuses or with postnatal neuroimaging. RESULTS The prenatal diagnoses were confirmed in 54/58 cases (PPV 93.1%). In the marked ventriculomegaly group, one case of partial agenesis of the corpus callosum was mistaken for a complete agenesis. In the group of borderline ventriculomegaly, two cases of partial agenesis of the corpus callosum were confused with a complete agenesis, while one case of suspected isolated ventriculomegaly was diagnosed after birth as partial agenesis of the corpus callosum. CONCLUSIONS The sagittal scan of the fetal brain is a useful source of information and allows the contemporary view of both corpus callosum and posterior fossa, where various typical sonographic findings are present in ventriculomegaly.
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Affiliation(s)
- Vincenzo D'Addario
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, University Medical School, Bari, Italy.
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