An update on maternal hydration strategies for amniotic fluid improvement in isolated oligohydramnios and normohydramnios: Evidence from a systematic review of literature and meta-analysis

open8Objective Several trials aimed at evaluating the efficacy of maternal hydration (MH) in increasing amniotic-fluid-volume (AFV) in pregnancies with isolated oligohydramnios or normohydramnos have been conducted. Unfortunately, no evidences support this intervention in routineclinical- practice. The aim of this systematic-literature-review and meta-analysis was to collect all data regarding proposed strategies and their efficacy in relation to each clinical condition for which MH-therapy was performed with the aim of increasing amniotic-fluid (AF) and improving perinatal outcomes. Materials and Methods A systematic literature search was conducted in electronic-database MEDLINE, EMBASE, ScienceDirect and the Cochrane-Library in the time interval between 1991 and 2014. Following the identification of eligible trials, we estimated the methodological quality of each study (using QADAS-2) and clustered patients according to the following outcome measures: route of administration (oral versus intravenous versus combined), total daily dose of fluids administered (2000), duration of hydration therapy: (1 day, >1 day but 1 week), type of fluid administered (isotonic versus hypotonic versus combination). Results In isolated-oligohydramnios (IO), maternal oral hydration is more effective than intravenous hydration and hypotonic solutions superior to isotonic solutions. The improvement in AFV appears to be time-dependent rather than daily-dose dependent. Regarding normohydramnios pregnancies, all strategies seem equivalent though the administration of hypotonicfluid appears to have a slightly greater effect than isotonic-fluid. Regarding perinatal outcomes, data is fragmentary and heterogeneous and does not allow us to define the real clinical utility of MH. Conclusions Available data suggests that MH may be a safe, well-tolerated and useful strategy to improve AFV especially in cases of IO. In view of the numerous obstetric situations in which a reduced AFV may pose a threat, particularly to the fetus, the possibility of increasing AFV with a simple and inexpensive practice like MH-therapy may have potential clinical applications. Considering the various strategies of maternal hydration implemented in the treatment of IO, better results were observed when treatment was based on a combination of intravenous (for a period of 1 day) and oral (for a period of at least 14 days) hypotonic fluids (≥2000ml).openGizzo, Salvatore; Noventa, Marco; Vitagliano, Amerigo; Dall'Asta, Andrea; D'Antona, Donato; Aldrich, Clive J.; Quaranta, Michela; Frusca, Tiziana; Patrelli, Tito SilvioGizzo, Salvatore; Noventa, Marco; Vitagliano, Amerigo; Dall'Asta, Andrea; D'Antona, Donato; Aldrich, Clive J.; Quaranta, Michela; Frusca, Tiziana; Patrelli, Tito Silvi

Extragenital Müllerian adenosarcoma with pouch of Douglas location

Background: Of all female genital tract tumors, 1-3% are stromal malignancies. In 8-10% of cases, these are represented by Mullerian adenosarcoma an extremely rare tumor characterized by a stromal component of usually low-grade malignancy and by a benign glandular epithelial component. Variant that arises in the pouch of Douglas is scarcely mentioned in the medical literature.Case Presentation: A 49-year-old para-0 woman, was seen at our OB/GYN-UNIT because she complained vaguely of pelvic pain. She had a mass of undefined nature in the pouch of Douglas. A simple excision of the mass showed low-grade Mullerian adenosarcoma with areas of stromal overgrowth. One and a half year after surgery, at another hospital, a mass was detected in the patient's posterior vaginal fornix and removed surgically. Six months later she came back to our observation with vaginal bleeding and mass in the vaginal fornix. We performed radical surgery. The pathological examination showed recurrent adenosarcoma. Surgical treatment was supplemented by radiation therapy.Conclusions: The case of Mullerian adenosarcoma reported here is the third known so far in the literature that was located in the pouch of Douglas. To date, only two other such cases have been reported, including one resulting from neoplastic degeneration of an endometriotic cyst

Frozen section in borderline ovarian tumours: a multicentric study

Background e obiettivo dello studio I tumori borderline dell’ovaio (BOT) rappresentano il 10-20% dei tumori ovarici, il picco di incidenza è fra i 40 e i 50 anni; sono diagnosticati solitamente in uno stadio FIGO I-II e hanno, per ogni stadio, una prognosi nettamente migliore rispetto ai tumori maligni. L'obiettivo primario è stato quello di confrontare i gruppi in termini di accuratezza diagnostica dell’estemporaneo rispetto alla istologia definitiva. L'obiettivo secondario è stato quello di eseguire valutazione clinico - patologica (pre -operatoria e intra -operatoria ) dei cofattori di rischio strettamente legati alla “under-diagnosis” e “over- diagnosis” in entrambi i gruppi . Metodi Studio multicentrico, retrospettivo, caso-controllo su donne che operate per tumescenza ovarica monolaterale avessero ricevuto diagnosi estemporanea o definitiva di BOT. Il Gruppo di studio aveva eseguito oltre alle indagini preoperatorie di routine anche il dosaggio di HE4 ed il ROMA SCORE, e questi dati erano stati comunicati al patologo responsabile della diagnosi estemporanea, il gruppo di controllo aveva eseguito gli esami routinari compreso il CA125. Risultati I due gruppi, complessivamente 113 Pazienti, risultavano omogenei per quanto riguardava le caratteristiche clinico-laboratoristico e strumentali. L’accuratezza diagnostica dell’esame istologico estemporaneo con l’istotipo tumorale, risultava che questa era maggiore per le neoplasie sierose. HE4 e ROMA score sono buoni ausili nella diagnosi intraoperatoria, tuttavia anche se nel gruppo in cui erano dosati aumentavano le “over-diagnosis”. Conclusioni L’esame istologico estemporaneo risulta affidabile per escludere la presenza di lesioni maligne nelle masse sospette. In accordo con quanto presente in letteratura, è stato evidenziato che le dimensioni e l’istotipo tumorale influenzano l’accuratezza diagnostica. Secondo i nostri dati e in attesa di ulteriori studi, si consiglia di indagare i valori pre –operatori di He4 e ROMA score quando la massa ovarica viene diagnosticata e la malignità non può essere esclusa con certezza. Dare informazioni sui markers sierici in combinazione con le caratteristiche ecografiche della massa può potenzialmente ridurre il tasso di “under-diagnosis” aumentando il tasso di “over-diagnosis” quando l’istologia estemporanea sospetta un BOT. L'accuratezza della FS globale in caso di BOT (specialmente quando si trovano i fattori di rischio riportati) rimane bassa e una chirurgia conservativa è fortemente consigliata in caso di futuro desiderio di prole. Nelle donne in postmenopausa, la stadiazione chirurgica per i BOT è accettabile anche in caso di sotto-diagnosi, rimandando ad una seconda valutazione successiva all’istologia definitiva ulteriori eventuali procedure di debulking

Cervical Mullerian Adenosarcoma with heterologous sarcomatous overgrowth: a fourth case and review of literature

Abstract Background Uterine sarcomas are relatively rare tumors that account for approximately 1-3% of female genital tract malignancies and between 4-9% of uterine cancers. Less than 8% of all cases are Mullerian adenosarcoma, a distinctive uterine neoplasm characterized by a benign, but occasionally atypical, epithelial and a malignant, usually low-grade, stromal component, both of which should be integral and neoplastic constituents of the tumor. Mullerian adenosarcoma with sarcomatous overgrowth (MASO) is a very aggressive variant, associated with post-operative recurrence, metastases, even when diagnosed in early stage. Case Presentation We present a fourth MASO case derived from uterine cervix in a 72-year-old woman with metrorrhagia and a polypoid mass protruding through the cervical ostium. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, systematic pelvic lymph node dissection, omental biopsy and appendectomy were performed. Surgery treatment was associated with adjuvant whole-pelvis radiation (45 Gy) and adjuvant chemotherapy (cisplatin/ifosfamide). After nine months of follow up, the patient was free of tumor. Conclusions The rarity of MASO of the cervix involves a management difficult. Most authors recommend total abdominal hysterectomy, usually accompanied by bilateral salpingo-oophorectomy. There is no common agreement on staging by lymphadenectomy during primary surgery and adjuvant chemo-radio therapy.</p

Uterine tumors resembling ovarian sex cord tumors: a case report of conservative management in young women

Uterine tumors resembling ovarian sex cord tumors (UTROSCT) are distinguished into two separate groups: endometrial stromal tumors with sex cord-like elements (Group I), which have an unfavorable prognosis; and UTROSCT proper (group II), with more than 40% sex cord-like differentiation and less endometrial component, which are biologically less aggressive than the tumors of the other group. We report the case of a young woman with UTROSCT treated by minimally invasive hysteroscopic surgery. This is one of the few cases reported in the literature that have been managed conservatively

Total laparoscopic hysterectomy: our experience from 2008 to 2012

Nowadays total laparoscopic hysterectomy (TLH) is a surgical procedure increasingly adopted for the treatment of benign and malign uterine disease. The aim of our study is to revise our recent experience of TLH

Anti-Müllerian hormone serum values and ovarian reserve: can it predict a decrease in fertility after ovarian stimulation by ART cycles?

BACKGROUND: A variety of indicators of potentially successful ovarian stimulation cycles are available, including biomarkers such as anti-Mullerian hormone. The aim of our study was to confirm the usefulness of serum anti-Mullerian hormone assay in predicting ovarian response and reproductive outcome in women eligible for ART cycles. MATERIALS: Forty-six women undergoing ART cycles at the Centre for Reproductive Medicine in Parma were recruited from March-to-June 2010. INCLUSION CRITERIA: age<42 years; body-mass-index = 20-25; regular menstrual cycles; basal serum FSH concentration <12 IU/L and basal serum estradiol concentration <70 pg/mL. The couples included in our study reported a variety of primary infertility causes. All women underwent FSH stimulation and pituitary suppression (GnRH-agonist/GnRH-antagonist protocols). Women were considered poor-responders if they had ≤ 3 oocytes; normal-responders 4-9 oocytes and high-responders ≥ 10 oocytes. Serum samples for the AMH assays were obtained on the first and last days of stimulation. A P value ≤ 0.05 was considered statistically significant. RESULT: FSH levels increased significantly when AMH levels decreased. The total dose of r-FSH administered to induce ovulation was not correlated to AMH. The number of follicles on the hCG, serum estradiol levels on the hCG-day, and the number of retrieved oocytes were significantly correlated to AMH. The number of fertilized oocytes was significantly correlated to the AMH levels. No significant correlation was found between obtained embryos or transferred embryos and AMH. Basal serum AMH levels were significantly higher than those measured on the hCG-day, which appeared significantly reduced. There was a significant correlation between AMH in normal responders and AMH in both high and poor responders. CONCLUSIONS: Our data confirm the clinical usefulness of AMH in ART-cycles to customize treatment protocols and suggest the necessity of verifying an eventual permanent decrease in AMH levels after IVF