OBJECTIVEWe present a simple 2D big ultrasound measurement of the fetal adrenal glands and their biometrical growth analysis highlighted as a potential preterm birth marker. METHODSThis was a ...prospective observational case-control study. Sixty-four patients were included in the study (32 with the diagnosis of imminent preterm birth before 37 and 32 controls) from January 2018 to May 2020. Anteroposterior dimensions and circumferences of the whole adrenal glands and their central zones were measured by simple B-mode ultrasound imaging. For the statistical analysis, StatsDirect 3.0 and ROC curves were used. As a studied descriptor, routine standard ultrasound cervical measurements were added (cervical length, funneling, sludge, cervical dilatation, and cervical glandular area). RESULTSIn biometrics of gestational age-related changes, a significant analysis of the overall growth of the adrenal gland was observed (circumference p < 0.001, anteroposterior diameter p = 0.02). The growth of the central zone was observed independently of gestational age. The growth of the central zone of the fetal adrenal glands revealed significant changes between the group of patients who delivered prematurely and control groups (p < 0.01). The ideal cut-off value of the proportion of enlargement of the fetal zone as a predictor of preterm delivery before week 37 was 45.1 %, with the sensitivity of 87.5 % and specificity of 85.4 %. CONCLUSIONSA simple 2D B-mode measurement of the fetal adrenal glands´ central zone growth can be applied as an additional marker in the prediction of true preterm delivery. The natural biometrical overall growth of the adrenal glands seems to be dependent on gestational age, whereas that of the central adrenal gland zone seems to be independent on gestational age (Tab. 3, Fig. 5, Ref. 26).
Analyzing the clinical group to evaluate current indications for cordocenteses, their complications and data obtained in further pregnancy management.
Retrospective analysis evaluated 92 ...cordocenteses (diagnostic and therapeutic) performed during the period of 2007‒2018. These were performed between 17 and 36 weeks of gestation under ultrasound guidance by a specialist at 2nd Department of Gynecology and Obstetrics, Faculty of Medicine, Comenius University.
Out of 92 procedures, 78 were diagnostic and 14 were therapeutic. The diagnostic cordocentesis was successful in 97.4 % and intrauterine therapy was successful in 85.7 %. There were 2 (2.56 %) diagnostic cordocenteses complicated by fetal demise and 2 (14 %) intrauterine demises in therapeutic cordocentesis. The pathological karyotype was detected in 14.5 %. Aneuploidia was present in 4 cases (44.4 %), mosaicism in 4 cases (44.4 %) and triploidia in one case (11.1 %).
Despite of novel molecular genetic technique cordocentesis still plays unreplaceable role in current prenatal diagnosis and treatment. The risk of complications of cordocentesis increases depending on the severity of fetal pathology in pathologic pregnancies. In some situations it can be used as a useful tool for original fetal diagnosis and therapy (Tab. 3, Ref. 20).
To analyze a rare triad of intracranial fetal pathologies and clinical study of the novel defined sequence pathogenesis based on prenatal and postmortem findings.
Complex multidisciplinary clinical ...analysis and review of up-to-date literature.
In an 18-gestational-week fetus the screening ultrasound scan resembled the semilobar type of holoprosencephaly and oral tumor. After the indicated termination of pregnancy, the histopathology results confirmed another pathologies - oral meningoencephalocele, teratoma of the sellar area and large arachnoidal cyst of the anterior cerebral fossa. The surprising final results were evaluated by specialists in prenatal diagnosis, histopathology, genetics, neurology, and radiology.
We defined the final diagnosed triad oral meningoencephalocele - intracranial sellar teratoma- arachnoidal cyst as a novel sequence defect malformation. In the detailed sequence pathogenesis, the intracranial sellar teratoma created an aperture for meningoencephalocele in the cranial base and the arachnoidal cyst facilitated, by its growth and pressure, the protrusion of the brain tissues (Fig. 4, Ref. 10). Text in PDF www.elis.sk.
To perform a review of Tuberous sclerosis complex and its complications during the pregnancy from up to date scientific literature.
Complex systematic review of the literature.
2nd Department of ...Obstetrics and Gynaecology, University Hospital Bratislava, Comenius University, Bratislava, Slovak Republic.
Complex analysis of the syndrome, systematic search of MEDLINE and Slovak Medical Library. The reason to create a complex review of this syndrome was our clinical experience with one of the most acute lifethreatening condition of this syndrome - acute retroperitoneal haemorrhage in the pregnancy.
Tuberous sclerosis can cause a rare, but potentially lifethreatening complications, especially during the pregnancy. These should be carefully dispesarized and in complicated cases acute radical management should be considered.
Transvaginal polypropylene mesh implantation is one of the techniques used for pelvic organ prolapse (POP) repair. The surgery outcomes depend on the indication criteria used. The aim of our study ...was to evaluate the outcomes of the mesh implantation using the strict indication criteria.
In 47 women aged 61.7±8.3 years with pelvic organ prolapse (POP-Q≥2) and a history of other surgery in the pelvic region outcomes of the mesh implantation were evaluated for up to 7 years (range 1-7 years).
Forty six of 47 patients (97.8%) had a successful mesh implantation (10 anterior, 22 posterior, 14 combined). Peroperative complications occurred in 3 of 47 patients (6.4%). The anatomic cure (POP-Q≤1) was achieved in 93.5% patients with mesh at 6 months after surgery. Any of the postoperative complications occurred in 16 of 46 women (34.8%). Significantly lower risk of complications was found in the group aged over 65 years compared to the younger patients (p=0.005).
This is the first study on the mesh implantation including women only with the history or other surgery in the pelvic region, achieving high anatomic success rate and low risk of complications. Thus, our data support the use of the strict indication criteria for this procedure (Tab. 2, Fig. 2, Ref. 14).
The authors present their first experience with a new operative method (within two years' period in 18 patients) solving pelvic prolapse in women by means of installation of polypropylene (Prolene) ...mesh implant.
The authors corrected various forms and stages of POP, particularly prolapse of the vaginal stump after hysterectomy, through the installation of Prolene mesh implants or the systems Prolift Anterior, Prolift Posterior and Prolift Total.
Short-term results (follow-up 24 months) are promising. The patients present no significant subjective complaints and the objective findings are considerably improved. The authors report one particular case of point perforation of the urinary bladder with no side effects and they have not noticed any serious postoperative complications so far.
Nowadays, considering a new methodology the following factors are required: multicentre data collection, determination of rational indicating criteria (together with contraindications), analysis of per- and postoperative complications and publishing continuous clinical outcomes. This is the way how to find an adequate place for implants in a wide spectrum of operations regarding pelvic floor repair (Tab. 4, Fig. 5, Ref. 13). Full Text (Free, PDF) www.bmj.sk.
Uterine artery embolization (UAE) has become a standard therapy in the treatment of symptomatic uterine myomas. The procedure is associated with a few complications. One of them is myoma expulsion. A ...32-year-old woman was sent to our hospital with diagnosed intramural myoma with dysmenorrhea and pressure symptoms. UAE was performed since the patient preferred conservative treatment. The procedure was without any complications. Three weeks after embolization, she was readmitted because of vaginal discharge and minor bleeding. We diagnosed expulsion of necrotic myoma and performed transvaginal resection. Four months later, the patient is symptom free. Expulsion of intramural myoma can be thus considered as definite treatment and not a complication of embolization therapy.
Clinical case of extremely elevated levels of alkaline phosphatase (ALP) enzyme detected in the 3rd trimester of gestation, the diagnostic and therapeutic procedures, delivery and puerperium are ...presented. The paper also offers a review of the currently available bibliographical data of the issue.
The case presents a 23-year-old secundipara with clinical problems in her 3rd trimester, namely a generalized pruritus. The gestation had signs of asymmetrical fetal hypotrophy induced by placental insufficiency. Laboratory tests showed elevated (as much as a 10.5-fold increase) values of alkaline phosphatase enzyme, 94.05% of which was placental isoenzyme. The patient also had clinical symptoms of a preterm delivery. The spontaneous delivery occurred in 36 week of gestation. The postpuerperium values of alkaline phosphatase returned to normal.
The authors point out the potential relationship between elevated placental isoenzyme of alkaline phosphatase levels and placental insufficiency and the onset of a preterm delivery.
PDF
