The role of peritoneal lavage in benign gynecologic laparoscopic surgery

OBJECTIVE

Laparoscopic surgery offers many advantages compared to invasive surgery but one of the main problems is postoperative pain, partially resulting from the peritoneal inflammatory process mediated by inflammatory cytokines. The rationale of this study is that intraperitoneal washing could remove inflammatory mediators that are the cause of postoperative pain and could help in the removal of CO2 from the abdominal cavity. This article aims to analyze the effects of peritoneal lavage in the reduction of postoperative shoulder pain.

PATIENTS AND METHODS

277 patients enrolled to undergo laparoscopic gynecologic surgery were included in the study. Women are randomized into two groups, according to the use or non-use of peritoneal lavage with saline solution at the end of laparoscopic gynecological major procedures.

RESULTS

Data show that the peritoneal lavage can significantly reduce postoperative pain in the first 36 hours after surgery, as well as patients' requests for analgesics: during the first 3 postoperative days, requests for paracetamol were lower in the YW (Yes Washing) group than the NW (No Washing) group (77 vs. 101; p<0.05); similar results are obtained considering ketorolac administration (62 vs. 71; p<0.05).

CONCLUSIONS

Peritoneal lavage after gynecological laparoscopic procedures may be effective in the reduction of postoperative pain and use of analgesics.

Role of placental inflammatory mediators and growth factors in patients with rheumatic diseases with a focus on systemic sclerosis

Objectives

Pregnancy in SSc is burdened with an increased risk of obstetric complications. Little is known about the underlying placental alterations. This study aimed to better understand pathological changes and the role of inflammation in SSc placentas. Leucocyte infiltration, inflammatory mediators and atypical chemokine receptor 2 (ACKR2) expression in SSc placentas were compared with those in other rheumatic diseases (ORD) and healthy controls (HC).

Methods

A case–control study was conducted on eight pregnant SSc patients compared with 16 patients with ORD and 16 HC matched for gestational age. Clinical data were collected. Placentas were obtained for histopathological analysis and immunohistochemistry (CD3, CD20, CD11c, CD68, ACKR2). Samples from four SSc, eight ORD and eight HC were analysed by qPCR for ACKR2 expression and by multiplex assay for cytokines, chemokines and growth factors involved in angiogenesis and inflammation.

Results

The number of placental CD3, CD68 and CD11 cells was significantly higher in patients affected by rheumatic diseases (SSc+ORD) compared with HC. Hepatocyte growth factor was significantly increased in the group of rheumatic diseases patients (SSc+ORD) compared with HC, while chemokine (C-C motif) ligand 5 (CCL5) was significantly higher in SSc patients compared with ORD and HC. CCL5 levels directly correlated with the number of all local inflammatory cells and higher levels were associated with histological villitis.

Conclusions

Inflammatory alterations characterize placentas from rheumatic disease patients and could predispose to obstetric complications in these subjects.

Management of idiopathic recurrent pericarditis during pregnancy

BACKGROUND

Data concerning idiopathic recurrent pericarditis in pregnancy are scarce.

OBJECTIVES

To evaluate the management and outcome of idiopathic recurrent pericarditis during pregnancy.

METHODS AND RESULTS

Twenty-one pregnancies were evaluated in fourteen women with a history of recurrent idiopathic pericarditis (mean maternal age 31.5 years, mean gestational age 39.0 weeks), and subdivided in 2 cohorts: eight pregnancies were analyzed retrospectively (2002-2010), thirteen (2011-2017) prospectively and followed according a predefined management protocol. Ten pregnancies were uneventful, three ended in spontaneous early abortion, one fetal death occurred at 19 weeks. Recurrences of pericarditis occurred in eight and were treated by adding NSAIDs in two cases; in five cases the dose of corticosteroids was increased and in two cases aspirin was started/increased; paracetamol was always allowed. Colchicine was used in two cases in the prospective cohort. HELLP syndrome occurred in one patient, which resolved after delivery, and one patient experienced arterial hypertension and elevated transaminase. All infants had a good outcome (mean birth weight 3114 g, 10 males). Birth weight was significantly lower in the retrospective cohort (respectively 2806 g vs. 3320 g, p-value 0.017) in which higher doses of corticosteroids were used (median dose respectively 10.0 mg vs. 2.5 mg, p-value 0.048). Five recurrences of pericarditis occurred after delivery, easily treated with standard therapy.

CONCLUSION

General outcomes of pregnancy in patients with idiopathic recurrent pericarditis is good, especially when patients are carefully followed by multidisciplinary teams according to standardized protocols.

Congenital Chagas disease in a non-endemic area: Results from a control programme in Bergamo province, Northern Italy

INTRODUCTION

In non-endemic countries, one of the most important routes of transmission of Trypanosoma cruzi is vertical transmission. The objective of this work is to report the results of the screening activities for the control of congenital Chagas Disease (CD) implemented in Bergamo province between January 2014 and December 2016.

METHODS

The programme addressed Bolivian pregnant women settled in Bergamo province. All the eight hospitals offering antenatal and delivery care in that area were involved. We retrospectively calculated the coverage rate of the screening programme, the prevalence of CD in this population, as well as transmission rate to their offspring.

RESULTS

During the study period, 376 Bolivian women accounted for 387 deliveries. The coverage rate of serologic screening was 85.6%. Confirmed seropositive women were 28, accounting for a prevalence of CD of 8.7% (95% IC 5.9-11.5). Among 29 children born to positive mothers, one infected child was detected (transmission rate of 4.3%, 95% IC 0-12.6) and treated accordingly. Other 13 children previously born from the same mothers were retrieved and tested for CD: no additional congenital cases were diagnosed.

DISCUSSION

Our screening programme presented a high coverage, although widely variable in the different birthing facilities. National guidelines recommending CD testing in pregnant women would help to increase case detection countrywide.

Pregnancy in systemic sclerosis

This comprehensive review summarizes retrospective and prospective studies on pregnancy in systemic sclerosis in order to educate physicians on critical management issues. Fertility is normal in women with established systemic sclerosis. Their rates of spontaneous losses are comparable to the general population, except for patients with late diffuse systemic sclerosis and severe internal organ involvement who may have higher risks of abortion. Prematurity is clearly higher among systemic sclerosis women, similarly to other rheumatic diseases such as systemic lupus erythematosus and anti-phospholipid antibody syndrome. A placental vasculopathy has been observed in some women with systemic sclerosis. Overall, the disease generally remains stable in most pregnancies. Women with pulmonary hypertension should avoid pregnancy on account of the high maternal mortality risk. Management of systemic sclerosis patients before and during pregnancy includes evaluation of organ involvement and autoantibody analysis, preconceptional folic acid, and discontinuation of drugs with teratogenic potential (bosentan, mycophenolate mofetil, methotrexate, etc.). Management by high-risk pregnancy teams including neonatologists is very important to ensure the best outcomes.

Management of pericardial diseases during pregnancy

Relatively few data have been published on the management of pericardial diseases during pregnancy. Pericardial involvement is sporadic during pregnancy, and pregnant women do not show any specific predisposition to pericardial diseases. The more common form of pericardial involvement is hydropericardium, usually as a benign mild effusion recorded in about 40% of pregnant women by the third trimester, followed by pericarditis as the more common disease requiring medical therapy. The general management of these conditions is not different from those of nonpregnant women, although specific precautions should be followed for specific diagnostic and therapeutic issues during pregnancy. If possible, pregnancy should be planned in a phase of disease quiescence. Nonselective cyclooxygenase inhibitors and aspirin can be used safely during the first and second trimester, but should be withdrawn later and in any case at gestational week 32, because of the possible effects on ductus arteriosus and renal function. Low-medium doses of prednisone are allowed during all pregnancy and breastfeeding. Colchicine is generally contraindicated during pregnancy, except in women with familial Mediterranean fever. These pregnancies should be followed by a dedicated multidisciplinary teams.

Bacterial vaginosis: prevalence in an Italian population of asymptomatic pregnant women and diagnostic aspects

The present study has been carried out with the main objective of determining the prevalence rate of bacterial vaginosis (BV) in a population of asymptomatic pregnant women (8th to 9th month of pregnancy). Out of a total 1,441 patients examined BV was found to be present in 70 (4.9%). The diagnosis was made when an analysis of the vaginal discharge revealed the simultaneous presence of at least three out of four of the following laboratory indices: (1) direct Gram stain positive (bacterial flora mixed with Gram-negative coccobacilli and variable-gram predominant over the lactobacillus flora); (2) pH > 4.5; (3) positive odour test with KOH 10%; (4) presence of clue cells. After a discussion of the principal laboratory and clinical signs presently used for the diagnosis of BV, the authors suggest the exclusion of the evaluation of the appearance of the vaginal discharge from the standard diagnostic criteria. Further, three diagnostic methods are hypothesized for use in different settings.

The clinical relevance of the abdominal fetal electrocardiogram

We investigated the duration of fetal electrocardiographic events during normal pregnancies and during pregnancies with fetal abnormalities. The fetal abdominal signal was processed and enhanced by means of the averaging technique after removing the maternal complex. In normal pregnancies P wave and QRS complex duration increases progressively from the 17th week up to the term: this increase parallels the gain in weight of the fetal heart and particularly of the ventricular mass. These results indicated that the duration of fetal complexes could be used as an index of the size, development and maturity of the fetal heart. When fetal growth retardation (FGR) is present, the weight of the fetal heart is significantly reduced, and is reflected in a decrease in QRS duration. In a series of 107 cases the sensitivity of this parameter in detecting FGR was 81% and the specificity 93%. Moreover no perinatal death nor Apgar values below 7 occurred in growth retarded fetuses with normal QRS duration, while in the group with shortened QRS neonatal deaths were 11% and Apgar scores below 7 26%. Abdominal FECG do provide important auxiliary information for prenatal diagnosis of congenital heart defects (CHD). Anomalies with abnormal atrioventricular connection were reflected in longer PR interval. Ventricular hypertrophia and hypoplasia were associated with increased or decreased QRS duration, respectively. Furthermore, the three fetuses which developed congestive heart failure showed prolonged QRS duration. In severe RH disease, chronic fetal anemia can lead to myocardial hypertrophy and cardiac enlargement.(ABSTRACT TRUNCATED AT 250 WORDS)