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Maiorana A, Maranto M, Restivo V, Gerfo DL, Minneci G, Mercurio A, Incandela D. Evaluation of long-term efficacy and safety of dienogest in patients with chronic cyclic pelvic pain associated with endometriosis. Arch Gynecol Obstet 2024; 309:589-597. [PMID: 38019280 PMCID: PMC10808538 DOI: 10.1007/s00404-023-07271-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/15/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE To evaluate the efficacy and long-term safety (up to 108 months) of treatment with Dienogest in patients with endometriosis. METHODS Patients with chronic pelvic pain endometriosis-related were enrolled in this observational study from June 2012 to July 2021. The patients enrolled took Dienogest 2 mg as a single daily administration. Group B of long-term therapy patients (over 15 months) were compared with group A of short-term therapy patients (0-15 months). The effects of the drug on pain variation were assessed using the VAS scale and endometriomas dimensions through ultrasonographic evaluation. Furthermore, has been valuated the appearance of side effects and the effect of the drug on bone metabolism by performing MOC every 24 months in group B. RESULTS 157 patients were enrolled. The mean size of the major endometrioma progressively decreased from 33.2 mm (29.4-36.9) at T0 to 7 mm (0-15.8) after 108 months of treatment. We found a significant improvement in dysmenorrhea, dyspareunia, dyschezia and non-cyclic pelvic pain. As for the side effects, both groups complained menstrual alterations present in 22.9%. In 27.6% of group B, osteopenia was found. Group B had a higher percentage statistically significant of side effects such as headaches, weight gain and libido reduction compared to group A. 2 CONCLUSION: Long-term therapy with Dienogest has proven effective in controlling the symptoms of the disease and reducing the size of endometriomas, with an increase in the positive effects related to the duration of the intake and in the absence of serious adverse events. Study approved by the "Palermo 2" Ethics Committee on July 2, 2012 No. 16.
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Affiliation(s)
- Antonio Maiorana
- HCU Obstetrics and Gynecology, ARNAS Civico Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Marianna Maranto
- HCU Obstetrics and Gynecology, ARNAS Civico Di Cristina-Benfratelli Hospital, Palermo, Italy
| | | | | | - Gabriella Minneci
- HCU Obstetrics and Gynecology, ARNAS Civico Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Antonella Mercurio
- HCU Obstetrics and Gynecology, ARNAS Civico Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Domenico Incandela
- HCU Obstetrics and Gynecology, ARNAS Civico Di Cristina-Benfratelli Hospital, Palermo, Italy
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2
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Berlanda N, Alio W, Angioni S, Bergamini V, Bonin C, Boracchi P, Candiani M, Centini G, D'Alterio MN, Del Forno S, Donati A, Dridi D, Incandela D, Lazzeri L, Maiorana A, Mattei A, Ottolina J, Orenti A, Perandini A, Perelli F, Piacenti I, Pino I, Porpora MG, Scaramuzzino S, Seracchioli R, Solima E, Somigliana E, Venturella R, Vercellini P, Viganò P, Vignali M, Zullo F, Zupi E. Impact of endometriosis on obstetric outcome after natural conception: a multicenter Italian study. Arch Gynecol Obstet 2021; 305:149-157. [PMID: 34623489 PMCID: PMC8782812 DOI: 10.1007/s00404-021-06243-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
Purpose To evaluate obstetric outcome in women with endometriosis who conceive naturally and receive standard obstetric care in Italy. Methods Cases were consecutive women with endometriosis managed in eleven Italian referral centers. Controls were women in whom endometriosis was excluded. All women filled in a questionnaire addressing previous natural pregnancies. Marginal logistic regression models were fitted to evaluate the impact of endometriosis on obstetric outcome. A post hoc analysis was performed within the endometriosis group comparing women with severe adenomyosis versus women with absent or mild adenomyosis. Results Three hundred and fifty-five pregnancies in endometriosis group and 741 pregnancies in control group were included. Women with endometriosis had a higher risk of preterm delivery < 34 weeks (6.4% vs 2.8%, OR 2.42, 95% CI 1.22–4.82), preterm delivery < 37 weeks (17.8% vs 9.7%, OR 1.98, 95% CI 1.23–3.19), and neonatal admission to Intensive Care Unit (14.1% vs 7.0%, OR 2.04, 95% CI 1.23–3.36). At post hoc analysis, women with endometriosis and severe adenomyosis had an increased risk of placenta previa (23.1% vs 1.8%, OR 16.68, 95% CI 3.49–79.71), cesarean delivery (84.6% vs 38.9%, OR 8.03, 95% CI 1.69–38.25) and preterm delivery < 34 weeks (23.1% vs 5.7%, OR 5.52, 95% CI 1.38–22.09). Conclusion Women with endometriosis who conceive naturally have increased risk of preterm delivery and neonatal admission to intensive care unit. When severe adenomyosis is coexistent with endometriosis, women may be at increased risk of placenta previa and cesarean delivery. Trial registration Clinical trial registration number: NCT03354793.
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Affiliation(s)
- N Berlanda
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy
| | - W Alio
- Department of Obstetrics and Gynecology, Ospedale Civico, Piazza Nicola Leotta 4, 90127, Palermo, Italy
| | - S Angioni
- Department of Surgical Sciences, Università di Cagliari, Cittadella Universitaria, 09042, Cagliari, Italy
| | - V Bergamini
- Azienda Ospedaliera Universitaria Integrata, Università di Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - C Bonin
- Azienda Ospedaliera Universitaria Integrata, Università di Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - P Boracchi
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry "G. A. Maccacaro", Università di Milano, Via Vanzetti 5, 20133, Milan, Italy
| | - M Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - G Centini
- Department of Gynecology, Università di Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, Università di Siena, Strada delle Scotte 4, 53100, Siena, Italy
| | - M N D'Alterio
- Department of Surgical Sciences, Università di Cagliari, Cittadella Universitaria, 09042, Cagliari, Italy
| | - S Del Forno
- Gynaecology and Human Reproduction Physiopathology Unit, Department of Medical and Surgical Sciences, DIMEC, Sant'Orsola Hospital, Università di Bologna, Via Massarenti 13, 40138, Bologna, Italy
| | - A Donati
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy
| | - D Dridi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy
| | - D Incandela
- Department of Obstetrics and Gynecology, Ospedale Civico, Piazza Nicola Leotta 4, 90127, Palermo, Italy
| | - L Lazzeri
- Department of Gynecology, Università di Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, Università di Siena, Strada delle Scotte 4, 53100, Siena, Italy
| | - A Maiorana
- Department of Obstetrics and Gynecology, Ospedale Civico, Piazza Nicola Leotta 4, 90127, Palermo, Italy
| | - A Mattei
- Division of Gynaecology and Obstetrics, Santa Maria Annunziata Hospital, USL Toscana Centro, Via Antella 58, 50012, Florence, Italy
| | - J Ottolina
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - A Orenti
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry "G. A. Maccacaro", Università di Milano, Via Vanzetti 5, 20133, Milan, Italy
| | - A Perandini
- Azienda Ospedaliera Universitaria Integrata, Università di Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - F Perelli
- Division of Gynaecology and Obstetrics, Santa Maria Annunziata Hospital, USL Toscana Centro, Via Antella 58, 50012, Florence, Italy
| | - I Piacenti
- Department of Maternal and Child Health and Urology, Università di Roma La Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - I Pino
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - M G Porpora
- Department of Maternal and Child Health and Urology, Università di Roma La Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - S Scaramuzzino
- Department of Maternal and Child Health and Urology, Università di Roma La Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - R Seracchioli
- Gynaecology and Human Reproduction Physiopathology Unit, Department of Medical and Surgical Sciences, DIMEC, Sant'Orsola Hospital, Università di Bologna, Via Massarenti 13, 40138, Bologna, Italy
| | - E Solima
- Department of Obstetrics and Gynecology, Macedonio Melloni Hospital, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Melloni 52, 20129, Milan, Italy
| | - E Somigliana
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy.
| | - R Venturella
- Department of Clinical and Experimental Medicine, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - P Vercellini
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy
| | - P Viganò
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - M Vignali
- Department of Obstetrics and Gynecology, Macedonio Melloni Hospital, Milan, Italy
| | - F Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Università di Napoli Federico II, Via Pansini 5, 80131, Naples, Italy
| | - E Zupi
- Department of Gynecology, Università di Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, Università di Siena, Strada delle Scotte 4, 53100, Siena, Italy
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3
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Buscemi S, Maiorana A, Fazzotta S, Incandela D, Palumbo VD, Damiano G, Maffongelli A, Messina M, Bisso C, Anzelmo G, Curione F, Cantavenera V, Bellomo E, Raia VE, Scimeca R, Geraci G, Cudia BM, Lo Monte AI. Scar endometriosis: not a rare cause for a painful scar. Clin Ter 2021; 172:129-133. [PMID: 33763680 DOI: 10.7417/ct.2021.2299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Conclusion High suspicion of scar endometriosis are painful no-dule in the abdominal scar. Wide surgical excision is the treatment of choice. Introduction Endometriosis has been described as the presence of endometrial tissue outside uterine cavity. Scar endometriosis (SE) is a rare disease reported in 0.03-1.08% of women following gynaecologic surgery. In our retrospective observational cohort study we studied anamnesis, symptoms, surgical procedures and outcomes linked to scar endometriosis in our medical experience from 2004 to 2018. Methods We reviewed the medical records of 46 patients with a histopathological diagnosis of SE. All patients had a history of at least one previous caesarean section (n=46, 100%). Forty-two patients (91,3%) complained gradually growing nodular abdominal mass near or adjacent to caesarean incision scar, while only 4 patients (8,6%) complained aspecific abdominal pain. Ultrasound scan was performed in all patients (n=46, 100%) and mean size of the nodules at US was 26,8 ± 13,8 mm. Results All patients underwent surgery. Seven patients (15,2%) needed mesh implantation, while 39 patients (84,8%) underwent local resection with reconstruction of muscle fascia. Mean follow-up was 31,6 ± 14 months and no patients reported local recurrence of disease.
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Affiliation(s)
- S Buscemi
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - A Maiorana
- Department of Obstetrics and Gynaecology, ARNAS Civico Hospital, Palermo
| | - S Fazzotta
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - D Incandela
- Department of Obstetrics and Gynaecology, ARNAS Civico Hospital, Palermo
| | - V D Palumbo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - G Damiano
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - A Maffongelli
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - M Messina
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - C Bisso
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - G Anzelmo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - F Curione
- Department of Molecular Medicine, Legal Medicine, University of Padua, Padua
| | - V Cantavenera
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - E Bellomo
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - V E Raia
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - R Scimeca
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - G Geraci
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - B M Cudia
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
| | - A I Lo Monte
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo
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4
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Alio L, Angioni S, Arena S, Bartiromo L, Bergamini V, Berlanda N, Bonin C, Busacca M, Candiani M, Centini G, D’Alterio MN, Di Cello A, Exacoustos C, Fedele L, Frattaruolo MP, Incandela D, Lazzeri L, Luisi S, Maiorana A, Maneschi F, Martire F, Massarotti C, Mattei A, Muzii L, Ottolina J, Perandini A, Perelli F, Pino I, Porpora MG, Raimondo D, Remorgida V, Seracchioli R, Solima E, Somigliana E, Sorrenti G, Venturella R, Vercellini P, Viganó P, Vignali M, Zullo F, Zupi E. When more is not better: 10 'don'ts' in endometriosis management. An ETIC * position statement. Hum Reprod Open 2019; 2019:hoz009. [PMID: 31206037 PMCID: PMC6560357 DOI: 10.1093/hropen/hoz009] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/09/2018] [Indexed: 02/07/2023] Open
Abstract
A network of endometriosis experts from 16 Italian academic departments and teaching hospitals distributed all over the country made a critical appraisal of the available evidence and definition of 10 suggestions regarding measures to be de-implemented. Strong suggestions were made only when high-quality evidence was available. The aim was to select 10 low-value medical interventions, characterized by an unfavorable balance between potential benefits, potential harms, and costs, which should be discouraged in women with endometriosis. The following suggestions were agreed by all experts: do not suggest laparoscopy to detect and treat superficial peritoneal endometriosis in infertile women without pelvic pain symptoms; do not recommend controlled ovarian stimulation and IUI in infertile women with endometriosis at any stage; do not remove small ovarian endometriomas (diameter <4 cm) with the sole objective of improving the likelihood of conception in infertile patients scheduled for IVF; do not remove uncomplicated deep endometriotic lesions in asymptomatic women, and also in symptomatic women not seeking conception when medical treatment is effective and well tolerated; do not systematically request second-level diagnostic investigations in women with known or suspected non-subocclusive colorectal endometriosis or with symptoms responding to medical treatment; do not recommend repeated follow-up serum CA-125 (or other currently available biomarkers) measurements in women successfully using medical treatments for uncomplicated endometriosis in the absence of suspicious ovarian cysts; do not leave women undergoing surgery for ovarian endometriomas and not seeking immediate conception without post-operative long-term treatment with estrogen-progestins or progestins; do not perform laparoscopy in adolescent women (<20 years) with moderate-severe dysmenorrhea and clinically suspected early endometriosis without prior attempting to relieve symptoms with estrogen-progestins or progestins; do not prescribe drugs that cannot be used for prolonged periods of time because of safety or cost issues as first-line medical treatment, unless estrogen-progestins or progestins have been proven ineffective, not tolerated, or contraindicated; do not use robotic-assisted laparoscopic surgery for endometriosis outside research settings. Our proposal is to better address medical and surgical approaches to endometriosis de-implementing low-value interventions, with the aim to prevent unnecessary morbidity, limit psychological distress, and reduce the burden of treatment avoiding medical overuse and allowing a more equitable distribution of healthcare resources.
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5
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Maiorana A, Incandela D, Parazzini F, Alio W, Mercurio A, Giambanco L, Alio L. Efficacy of dienogest in improving pain in women with endometriosis: a 12-month single-center experience. Arch Gynecol Obstet 2017; 296:429-433. [DOI: 10.1007/s00404-017-4442-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 06/22/2017] [Indexed: 11/29/2022]
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6
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Alabiso G, Alio L, Arena S, Barbasetti di Prun A, Bergamini V, Berlanda N, Busacca M, Candiani M, Centini G, Di Cello A, Exacoustos C, Fedele L, Fuggetta E, Gabbi L, Geraci E, Imperiale L, Lavarini E, Incandela D, Lazzeri L, Luisi S, Maiorana A, Maneschi F, Mannini L, Mattei A, Muzii L, Pagliardini L, Perandini A, Perelli F, Pinzauti S, Porpora MG, Remorgida V, Leone Roberti Maggiore U, Seracchioli R, Solima E, Somigliana E, Tosti C, Venturella R, Vercellini P, Viganò P, Vignali M, Zannoni L, Zullo F, Zupi E. Adenomyosis: What the Patient Needs. J Minim Invasive Gynecol 2016; 23:476-88. [DOI: 10.1016/j.jmig.2015.12.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 01/19/2023]
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7
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Alabiso G, Alio L, Arena S, di Prun AB, Bergamini V, Berlanda N, Busacca M, Candiani M, Centini G, Di Cello A, Exacoustos C, Fedele L, Gabbi L, Geraci E, Lavarini E, Incandela D, Lazzeri L, Luisi S, Maiorana A, Maneschi F, Mattei A, Muzii L, Pagliardini L, Perandini A, Perelli F, Pinzauti S, Remorgida V, Sanchez AM, Seracchioli R, Somigliana E, Tosti C, Venturella R, Vercellini P, Viganò P, Vignali M, Zullo F, Zupi E. How to Manage Bowel Endometriosis: The ETIC Approach. J Minim Invasive Gynecol 2015; 22:517-29. [PMID: 25678420 DOI: 10.1016/j.jmig.2015.01.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 12/11/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 01/07/2023]
Abstract
A panel of experts in the field of endometriosis expressed their opinions on management options in a 35-year-old patient desiring pregnancy with a history of previous surgery for endometrioma and bowel obstruction symptoms. Many questions that this paradigmatic patient may pose to the clinician are addressed, and various clinical scenarios are discussed. A decision algorithm derived from this discussion is proposed as well.
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Affiliation(s)
- Giulia Alabiso
- Department of Obstetrics and Gynecology, Macedonio Melloni Hospital, University of Milan, Milan, Italy
| | - Luigi Alio
- Department of Obstetrics and Gynecology, Civico Hospital, Palermo, Italy
| | - Saverio Arena
- Department of Obstetrics and Gynecology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | | | - Valentino Bergamini
- Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
| | - Nicola Berlanda
- Department of Obstetrics and Gynecology, Isituto Luigi Mangiagalli, University of Milan, Milan, Italy
| | - Mauro Busacca
- Department of Obstetrics and Gynecology, Macedonio Melloni Hospital, University of Milan, Milan, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, San Raffaele Hospital, University of Milan, Milan, Italy
| | - Gabriele Centini
- Department of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Annalisa Di Cello
- Department of Obstetrics and Gynecology, University of Magna Graecia, Catanzaro, Italy
| | | | - Luigi Fedele
- Department of Obstetrics and Gynecology, Isituto Luigi Mangiagalli, University of Milan, Milan, Italy
| | - Laura Gabbi
- Department of Obstetrics and Gynecology, University of Genova, Genova, Italy
| | - Elisa Geraci
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - Elena Lavarini
- Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
| | - Domenico Incandela
- Department of Obstetrics and Gynecology, Civico Hospital, Palermo, Italy
| | - Lucia Lazzeri
- Department of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Stefano Luisi
- Department of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Antonio Maiorana
- Department of Obstetrics and Gynecology, Civico Hospital, Palermo, Italy
| | - Francesco Maneschi
- Department of Obstetrics and Gynecology, Santa Maria Goretti Hospital, Latina, Italy
| | - Alberto Mattei
- Department of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Ludovico Muzii
- Department of Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Luca Pagliardini
- Department of Obstetrics and Gynecology, San Raffaele Hospital, University of Milan, Milan, Italy
| | - Alessio Perandini
- Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
| | - Federica Perelli
- Department of Obstetrics and Gynecology, University of Florence, Florence, Italy
| | - Serena Pinzauti
- Department of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Valentino Remorgida
- Department of Obstetrics and Gynecology, University of Genova, Genova, Italy
| | - Ana Maria Sanchez
- Department of Obstetrics and Gynecology, San Raffaele Hospital, University of Milan, Milan, Italy
| | - Renato Seracchioli
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Tosti
- Department of Obstetrics and Gynecology, University of Siena, Siena, Italy
| | - Roberta Venturella
- Department of Obstetrics and Gynecology, University of Magna Graecia, Catanzaro, Italy
| | - Paolo Vercellini
- Department of Obstetrics and Gynecology, Isituto Luigi Mangiagalli, University of Milan, Milan, Italy
| | - Paola Viganò
- Department of Obstetrics and Gynecology, San Raffaele Hospital, University of Milan, Milan, Italy
| | - Michele Vignali
- Department of Obstetrics and Gynecology, Macedonio Melloni Hospital, University of Milan, Milan, Italy
| | - Fulvio Zullo
- Department of Obstetrics and Gynecology, University of Magna Graecia, Catanzaro, Italy
| | - Errico Zupi
- Department of Obstetrics and Gynecology, University of Siena, Siena, Italy.
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8
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Abstract
Pregnancy, the implantation of a fertilized ovum outside the endometrial cavity, occurs in 1.5%-2% of pregnancies. It is one of the major causes (about 6%) of maternal death during the first trimester of pregnancy. The remaining 5% implant in the ovary, peritoneal cavity, within the cervix, and the omental pregnancy is the least common form of abdominal pregnancies. A review of the literature on Medline for the period 1958-2012 reported only 16 cases of omental pregnancy. Here we report a case of primary omental pregnancy in a nulliparous woman. A 24 year-old woman gravid 1, para 0, with lower abdominal pain. Her last menstrual period occurred 8 weeks before the visit. The physical examination revealed abdominal tenderness in the lower quadrants, she was not bleeding. Transvaginal ultrasound showed: a free anechoic/hypoechoic area of 30 x 57 mm in the pouch of Douglas and the endometrium was homogeneus with a thickness of 12 mm and no evidence of gestational sac in the uterine cavity. Laboratory data revealed a normal cell blood count and beta hcg levels of 8047 IU / L. Because of continuing abdominal pain and a diagnosis of ectopic pregnancy a diagnostic laparoscopy was performed, which showed hemoperitoneum. Further inspection of abdominal cavity revealed a bloody lesion that was tenaciously adherent to the omentum, using non traumatic laparoscopic forceps and bipolar scissors we carefully removed a friable mass of about 30 mm from the omental attachments. Histological examination showed the presence of blood clot material mixed with trophoblastic tissue. Ultrasound evaluation and and hCG assessment are important to determine the extrauterine location of the ectopic pregnancy but the early diagnosis of abdominal pregnancy requires also a laparoscopic evaluation and, as our case has highlighted, thorough abdominal exploration especially in the absence of adnexal findings when ectopic pregnancy is highly suspected. Early diagnosis of omental pregnancy is difficult but essential to reduce the high mortality risk for the mother.
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Affiliation(s)
- Antonio Maiorana
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
| | - Domenico Incandela
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
| | - Laura Giambanco
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
| | - Walter Alio
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
| | - Luigi Alio
- Gynecology and Obstetrics Unit, Palermo Civic Hospital and National Center of Clinical Excellence (ARNAS Di Cristina-Benfratelli), Palermo, Italy
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Alio L, Giambanco L, Alio W, Doveri T, Incandela D, Cali’ G. O040 CERVICAL PREGNANCY IN A NULLIPAROUS WOMAN: CASE REPORT. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)60470-6] [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: 11/27/2022]
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Perino A, Mangione D, Svelato A, Forlani F, Gargano F, Incandela D, Coppola MA, Venezia R. Chronic renal failure and endometrial osseous metaplasia: a hypothetical pathway. Acta Obstet Gynecol Scand 2012; 92:118-9. [PMID: 22709353 DOI: 10.1111/j.1600-0412.2012.01487.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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