Screening models using multiple markers for early detection of late-onset preeclampsia in low-risk pregnancy

BACKGROUND: Our primary objective was to establish a cutoff value for the soluble fms-like tyrosine kinase 1(sFlt-1)/placental growth factor (PlGF) ratio measured using the Elecsys assay to predict late-onset preeclampsia in low-risk pregnancies. Our secondary objective was to evaluate the ability of combination models using Elecsys data, second trimester uterine artery (UtA) Doppler ultrasonography measurements, and the serum fetoplacental protein levels used for Down’s syndrome screening, to predict preeclampsia. METHODS: This prospective cohort study included 262 pregnant women with a low risk of preeclampsia. Plasma levels of pregnancy-associated plasma protein-A (PAPP-A) and serum levels of alpha-fetoprotein, unconjugated estriol, human chorionic gonadotropin, and inhibin-A were measured, and sFlt-1/PlGF ratios were calculated. All women underwent UtA Doppler ultrasonography at 20 to 24 weeks of gestation. RESULTS: Eight of the 262 women (3.0%) developed late-onset preeclampsia. Receiver operating characteristic curve analysis showed that the third trimester sFlt-1/PlGF ratio yielded the best detection rate (DR) for preeclampsia at a fixed false-positive rate (FPR) of 10%, followed by the second trimester sFlt-1/PlGF ratio, sFlt-1 level, and PlGF level. Binary logistic regression analysis was used to determine the five best combination models for early detection of late-onset preeclampsia. The combination of the PAPP-A level and the second trimester sFlt-1/PlGF ratio yielded a DR of 87.5% at a fixed FPR of 5%, the combination of second and third trimester sFlt-1/PlGF ratios yielded a DR of 87.5% at a fixed FPR of 10%, the combination of body mass index and the second trimester sFlt-1 level yielded a DR of 87.5% at a fixed FPR of 10%, the combination of the PAPP-A and inhibin-A levels yielded a DR of 50% at a fixed FPR of 10%, and the combination of the PAPP-A level and the third trimester sFlt-1/PlGF ratio yielded a DR of 62.5% at a fixed FPR of 10%. CONCLUSIONS: The combination of the PAPP-A level and the second trimester sFlt-1/PlGF ratio, and the combination of the second trimester sFlt-1 level with body mass index, were better predictors of late-onset preeclampsia than any individual marker

Uterine peristalsis in adenomyosis: a prospective study

Obiettivi dello studio: valutare con l’ecografia transvaginale la peristalsi uterina in fase periovulatoria in donne con adenomiosi isolata, confrontandola con un gruppo di controllo e, secondariamente, valutare il grado di accordo tra gli sperimentatori nella descrizione dei pattern di contrattilità. Disegno dello studio: studio osservazione prospettico condotto presso il Policlinico S. Orsola- Malpighi di Bologna, Italia. Materiali e Metodi: sono state reclutate pazienti afferenti al Centro per valutazione ambulatoriale, suddivise sulla base dei criteri di inclusione ed esclusione nei gruppi A (adenomiosi) e B (controlli) e sono state sottoposte da un unico ecografista esperto a ecografia transvaginale con registrazione di un video della durata di 180 secondi della scansione sagittale dell’utero. La registrazione è stata rivalutata off line da due sperimentatori esperti ecografisti, non a conoscenza della storia clinica delle pazienti e in cieco l’uno rispetto all’altro, che hanno descritto il pattern contrattile. È stata stimata una numerosità campionaria di 18 pazienti per gruppo per ottenere una differenza del 20% nell’obiettivo primario con una significatività del 5% (power 80%). Risultati: di 51 pazienti reclutate nello studio, a seguito di drop out 36 sono state sottoposte alla videoregistrazione ecografica (18 per gruppo). Il pattern peristaltico nel gruppo A è risultato alterato in maniera statisticamente significativa rispetto al gruppo B con un p value= 0,02. Sono stati osservati un pattern retrogrado nel 27,8% vs 72,2%, anterogrado del 11,1% vs 16,7%, opposto 38,9% vs 5,6% e random nel 22,2% vs 5,6%, rispettivamente nel gruppo A e B. Il calcolo dell’accordo interosservatore ha portato a un κ value di 0,92. Conclusioni: l’adenomiosi isolata è associata a disperistalsi uterina, che concorrerebbe nello sviluppo dei sintomi tipici dell’adenomiosi. L’ecografia transvaginale rappresenta uno strumento accessibile e utile nella valutazione della contrattilità uterina in quanto il grado di accordo tra gli sperimentatori è ottimo.Objectives: To evaluate uterine peristalsis assessed by transvaginal ultrasound in periovulatory phase in women with adenomyosis compared with a control group and to assess the inter-observer agreement of transvaginal ultrasound in the evaluation of endometrial waves (EW) pattern. Study design: Observational prospective study conducted in S. Orsola- Malpighi University Hospital, Bologna, Italy. Materials and Methods: Patients referred to the Centre for an outpatient evaluation were enrolled and subsequently divided in 2 groups according to inclusion and exclusion criteria: patients in group A had a clinical and ultrasonographic diagnosis of adenomyosis, patients in group B had no pathological findings. Three-minute recording of transvaginal ultrasound scanning on sagittal uterine plane at periovulatory phase was performed by a single experienced sonographer gynecologist. Analysis of the EW patterns was performed offline by two different experienced sonographer gynecologists not aware of patients’ clinical history and blinded each other. A sample size of 18 patients per group was calculated to obtain a difference of 20% in the primary objective with a significance of 5% (power 80%). Results: 51 women were enrolled into this study and 36 patients met the inclusion criteria, 18 per group. The EW pattern was significantly altered when comparing the women with adenomyosis and control (p value= 0,02). Retrograde contractions were observed in 27,8% vs 72,2%, anterograde contractions in 11,1% vs 16,7%, opposing in 38,9% vs 5,6%, random in 22,2% vs 5,6%, respectively, in adenomyosis group versus the control group. EW evaluation showed a perfect inter-observer agreement (κ value= 0,92). Conclusions: Adenomyosis is associated with altered uterine contractility, which may aid in explaining the symptoms related with. Ultrasound imaging is an easy to access and useful method to evaluate uterine peristalsis, with a perfect inter-observer agreement

Clinical use of endovenous indocyanine green during rectosigmoid segmental resection for endometriosis

To describe a new use of endovenous indocyanine green (ICG) to allow real-time visualization of bowel perfusion in women with recto-sigmoid endometriosis who may be candidates for segmental resection