Cervical cerclage in twin pregnancies

Purpose To evaluate the outcomes of cervical cerclage (CC) in twin pregnancies. Methods Retrospective analysis of twin pregnancies undergoing CC between January 2001 and December 2009 at our Institution. CC was offered in case of a cervical length measurement B20 mm (ultrasound-indicated CC) or in case of cervical dilatation with membranes at or beyond the external cervical os (physical examination-indicated CC). Cervicovaginal and rectal swabs were obtained preoperatively. Perioperative antibiotics and tocolysis were administered. Results There were 28 cases of ultrasound-indicated and 14 of physical examination-indicated CC. Positive swab cultures were observed in 21 % of cases. The incidence of preterm delivery\34 weeks was 32 % [95 % confidence interval (CI) 16–52 %] and 50 % (95 % CI 23–77 %) in the ultrasound-indicated and physical examination-indicated CC group, respectively. The incidence of premature rupture of membranes \34 weeks was 21 % (95 % CI 8–41 %) and 29 % (95 % CI 8–58 %) in the ultrasoundindicated and physical examination-indicated CC group, respectively. Perinatal survival was 96 % (95 % CI 88–100 %) in the ultrasound-indicated CC group, and 86 % (95 % CI 67–96 %) in the physical examinationindicated CC group.Conclusions We showed a high-risk of preterm delivery in both groups, but with a high overall perinatal survival. Our data stress the importance of re-evaluating the efficacy of CC in twin pregnancies by properly designed clinical trials, particularly if it is physical examination indicated

Monitoring fetal well-being in labor in late fetal growth restriction

Late-onset fetal growth restriction (FGr) accounts for approximately 70-80% of all cases of FGr secondary to uteroplacental insufficiency. It is associated with an increased incidence of adverse antepartum and perinatal events, which in most instances result from hypoxic insults either present at the onset of labor or supervening during labor as a result of uterine contractions. labor represents a stressful event for the fetoplacental unit being uterine contractions associated with an up-to 60% reduction of the uteroplacental perfusion. intrapartum fetal heart rate monitoring by means of cardiotocography (CTG) currently represents the mainstay for the identification of fetal hypoxia during labor and is recommended for the fetal surveillance during labor in the case of FGr or other conditions associated with an increased risk of intrapartum hypoxia. in this review we discuss the potential implications of an impaired placental function on the intrapartum adaptation to the hypoxic stress and the role of the ctG and alternative techniques for the intrapartum monitoring of the fetal wellbeing in the context of FGR secondary to uteroplacental insufficiency

First-trimester fetal neurosonography: technique and diagnostic potential

Most of the brain abnormalities are present in fact also at first trimester but only a few of these are detected at such early stage. According to the current recommendations for the first trimester ultrasound, the fetal head structures that should be visualized are limited to the cranial bones, the midline falx and the choroid-plexus-filled ventricles. Using this basic approach almost all cases of acrania, alobar holoprosencephaly and cephalocele are usually detected, however the majority of the other abnormalities of the fetal central nervous system remain undiagnosed until midtrimester. Such anomalies are potentially detectable if the sonographic study is extended to additional anatomic details which are not currently included in the existing guidelines. The aim of this review article is to describe how to assess the normal fetal brain at first trimester expert multiplanar neurosonography and to demonstrate the early sonographic findings which characterize some major fetal brain abnormalities. This article is protected by copyright. All rights reserved

Sars-CoV-2 in pregnancy: Why is it better than expected?

Since the outbreak of Coronavirus disease in December 2019, information specific to pregnancy remains limited and controversial. Based on data from previous reports, it has been noticed that contrary to prior pandemics such as SARS, MERS and H1N1 and although pregnancy is usually considered as a condition of high susceptibility to viral infections, new SARS-CoV2 infection seems to have a more benign clinical course when affecting pregnant women. We speculate that during pregnancy the physiological “silencing” of the Th1 pro-inflammatory response may blunt the cytokines storm which is thought to play a key-role in the pathogenesis of the severe complications of Covid-19

Persistent organochlorine compounds in fetal and maternal tissues: evaluation of their potential influence on several indicators of fetal growth and health

Some organochlorine compounds, such as polychlorinated biphenyls (PCBs), have a tendency to bioaccumulate in humans and predators at the top of the food chain. We have recently confirmed the transplacental transfer of these compounds and the present study has been designed on the same material with the aim of investigating their potential health effects on newborns from 70 pregnant women, resident in a Northern Italy industrial town. Organochlorine compounds [namely, p,p'-dichlorodiphenyltrichloroethane (p,p'-DDT), p,p'-dichlorodiphenyldichloroethene (p,p'-DDE), hexachlorobenzene (HCB), and PCBs] have been analyzed both in cord and maternal serum, placenta, and maternal subcutaneous adipose tissue by GC-MSD. p,p'-DDT levels in the adipose tissue resulted significantly (p<0.05) related to birth length. Mothers of neonates born by preterm programmed caesarean delivery showed significantly (p<0.005 for both) higher serum p,p'-DDE serum concentrations and p,p'-DDT levels in the adipose tissue, as compared to mothers delivering at term

OC09.04: Crown–rump length and abdominal circumference discrepancy as early predictors of late adverse pregnancy outcome in monochorionic diamniotic pregnancies

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Hyperechoic amniotic membranes in patients with preterm premature rupture of membranes (p-PROM) and pregnancy outcome

Objectives The early identification of women with preterm premature rupture of membranes (p-PROM) who are at higher risk of imminent delivery remains challenging. The aim of our study was to evaluate if an increased echogenicity of the amniotic membranes may represent a sonographic marker of impending delivery in women with p-PROM. Methods This was a prospective study including women with singleton pregnancies and diagnosis of p-PROM between 22 and 37 gestational weeks. A sonographic examination was performed within 24h from the hospital admission and the appearance of the amniotic membranes close to the internal os was specifically evaluated. The membranes were defined as hyperechoic when their echogenicity was similar to that of the fetal bones or normoechoic in the other cases. The primary aim of the study was to compare the admission to spontaneous onset of labor interval and the pregnancy outcome between the cases of p-PROM with and without hyperechoic membranes. Results Overall, 45 women fulfilled the inclusion criteria with similar characteristics at admission. In women with hyperechoic membranes, the admission to spontaneous onset of labor interval was significantly shorter (11.5 [5.3-25.0] vs. 3.0 [1.5-9.0] p=0.04) compared to women with normo-echoic membranes. At binomial logistic regression after adjustment for GA at hospital admission, the presence of hyperechoic membranes was found as the only independent predictor of spontaneous onset of labor≤72h (aOR: 6.1; 95% CI: 1.0-36.9) Conclusions The presence of hyperechoic membranes is associated with a 6-fold higher incidence of spontaneous onset of labor within 72h independently from the gestational age at p-PROM

VP24.05: First trimester evaluation of the fetal aqueduct of Sylvius by 3D ultrasound

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