RESUMO
PURPOSE: The objective of the present study was to analyze current indications and results of different methods for breast anomaly correction of Poland's syndrome. PATIENTS AND METHODS: Eight patients with this deformity were operated between 1997 and 2008: seven females and one male. The mean age was 22. According to Foucras et al. classification, four patients revealed Poland's syndrome grade II, three patients grade I and two patients grade III. Three patients received silicone implants (two with Poland's syndrome grade II, one with grade III). Autologous fat injection was used for a male adolescent who was very embarrassed by his deformity. Controlateral lipo-aspiration was carried out in three cases with moderate Poland's syndrome breast asymmetry. For one patient, correction was achieved by controlateral breast resection. RESULTS: No intraoperative or postoperative complications occurred for the eight patients. Aesthetic results were overall satisfactory. CONCLUSION: The simplest and the fastest breast deformity correction technique in Poland's syndrome patients, the one with the least complications and cosmetic sequella and the most practiced by the surgeon, remains the best method for breast anomaly correction of Poland's syndrome.
Assuntos
Mama/anormalidades , Mama/cirurgia , Síndrome de Poland/cirurgia , Feminino , Humanos , Masculino , Adulto JovemRESUMO
OBJECTIVES: To assess the benefit of sublingual misoprostol in addition to standard oxytocin in the prevention of post-partum hemorrhage at caesarean section. PATIENTS AND METHODS: This was a prospective randomized controlled clinical trial conducted from March to June 2007 at our department of obstetrics-Sousse-Tunisia, including 250 single low risk pregnant women undergoing caesarean section at gestational age>32 weeks gestation. Patients were randomly assigned to receive at cord clamping either sublingual 200microg misoprostol (Cytotec) with 20UI intravenous oxytocin (Oxytocin): bolus 10UI and infusion 10UI in 500ml Ringer Lactate): Group I, or only oxytocin at the same dose: Group II. The main outcome was total blood loss assessed by decrease in perioperative hematocrit. Secondary outcomes included measured collected blood loss, drop in hemoglobin level, additional oxytocin, side-effects and postoperative complications. RESULTS: The two groups were similar in demographic and obstetrical patient characteristics. Drop in hematocrit was more important in group II than in group I: 4.30%+/-3.14 versus. 1.10%+/-3.25; P=0.013. Drop in hemoglobin level was also more important in group II than in group I: 1.03g/dl+/-1.19 versus 0.54g/dl+/-1.17; P<0.01. Collected blood loss was less important in group I than in group II: 669.68cc+/-333.01 versus 852.52cc+/-295.08 ; P<0.01. Need for additional oxytocin and postoperative complications rate were more frequent in group II than in group I but the differences weren't significant. The rate of transient shivering, nausea and fever was significantly higher among women receiving misoprostol. CONCLUSIONS: Sublingual misoprostol (in addition to oxytocin) is effective in prevention of post-partum hemorrhage at caesarean sections when compared to oxytocin alone, without major side-effects. Larger studies are needed to confirm our results.
Assuntos
Cesárea , Misoprostol/uso terapêutico , Ocitócicos/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Administração Sublingual , Adulto , Feminino , Humanos , Gravidez , Estudos ProspectivosRESUMO
OBJECTIVES: To compare efficacy and safety of two regimens of intracervical dinoprostone (Prepidil) in cervical ripening before labor induction at term. PATIENTS AND METHODS: This was a prospective randomized clinical study including 148 patients with single pregnancy, viable fetus at gestational age greater than 36 weeks gestation and a Bishop score less than five, who required induction of labor. Patients were randomised to receive either repeated doses of dinoprostone gel 0.5mg (Prepidil) every 6 hours (group I) or every 12 hours (group II) for maximum three times before inducing labor with Oxytocin. The main outcome was the rate of caesarean sections. RESULTS: The two groups were similar in patient characteristics, indication for labor induction and preinduction Bishop scores. The caesarean rate was lower in group I (20.3%) than in group II (23%); though the difference did not reach statistical difference: p=0.69. Delivery rate in the first 24 hours was significantly higher in group I (62.2%) than in group II (40.5%); p=0.009. Prepidil secondary effects were experienced in 8.1% of patients in group I versus 1.4% in group II; p=0.11. Median umbilical artery pH at birth was 7.232+/-0.47 in group I and 7.294+/-0.58 in group II; p=0.30. Maternofetal infections rate was lower in group I (1.4%) than in group II (2.7%) without significant difference (p=0.56). CONCLUSIONS: Repeated intracervical doses of Prepidil every 6 hours, in cervical ripening before labor induction at term, enables higher delivery rate in the first 24 hours without inducing excess of caesarean sections or maternofetal morbidity when compared to its administration every 12 hours.
Assuntos
Dinoprostona/uso terapêutico , Trabalho de Parto Induzido/métodos , Adulto , Dinoprostona/administração & dosagem , Dinoprostona/efeitos adversos , Feminino , Febre/induzido quimicamente , Humanos , Concentração de Íons de Hidrogênio , Hipercinese/induzido quimicamente , Ocitócicos/administração & dosagem , Ocitócicos/efeitos adversos , Ocitócicos/uso terapêutico , Dor/induzido quimicamente , Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Segurança , Vagina/fisiologiaRESUMO
Placental mesenchymal dysplasia (PMD) is a distinct placental disorder that may coexist with a normal fetus. In one-third of cases, the fetus exhibits Beckwith-Wiedemann Syndrome (BWS). In the present study, we report a case of PMD changes associated with an unusual genetic constitution. Pathological examination showed an enlarged placenta with a mixture of normal but also numerous clusters of grape-like fluid-filled vesicles confined to the stem villi without trophoblast proliferation. Some stem villi contained many large vessels filled by partially organized thrombi consistent with PMD. The fetus presented an enlarged liver and cytomegaly in the adrenal glands, hyperplastic islets of Langerhans in the pancreas, and some microcysts with cuboidal epithelium in the kidneys. These findings suggest the Beckwith-Wiedemann syndrome phenotype. DNA genetic markers showed three alleles for three independent markers and two alleles for the 12 others. Fluorescent in situ hybridization (FISH) demonstrated that villous trophoblast and fetal tissues are diploid. The haploid paternal complement found in the androgenetic cells was different from that found in biparental cells, suggesting a double fertilization event. Preferential distribution of the androgenetic cells into the placenta explains the predominance of molar villi with an apparently normal fetus. This represents a well-documented case of androgenic and biparental mixture of cell types in both fetal and placental tissues.
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Síndrome de Beckwith-Wiedemann/complicações , Quimerismo , Feto/patologia , Mesoderma/patologia , Doenças Placentárias/patologia , Adulto , Androgênios/farmacologia , Síndrome de Beckwith-Wiedemann/genética , Linhagem Celular , Feminino , Humanos , Padrões de Herança , Modelos Biológicos , Gravidez , Primeiro Trimestre da GravidezRESUMO
OBJECTIVE: To determine the rate and risk factors for group B streptococcus (GBS) colonization in term pregnancies. PATIENTS AND METHODS: Vaginal and anal cultures were prospectively conducted in 294 parturient on admission for term vaginal delivery. RESULTS: Thirty-eight (12.92%) parturient had positive GBS cultures. None of the studied risk factors (age, education status, nulliparity, previous obstetric problem, twin pregnancy and diabetes) was statistically predictive of maternal colonization. All the isolated GBS were sensitive to the penicillin G. DISCUSSION AND CONCLUSION: Systematic screening strategy of GBS close to the delivery on all pregnant women is desirable.
Assuntos
Antibacterianos/uso terapêutico , Portador Sadio/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae , Adulto , Canal Anal/microbiologia , Portador Sadio/diagnóstico , Portador Sadio/tratamento farmacológico , Feminino , França , Humanos , Programas de Rastreamento , Penicilinas/uso terapêutico , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Estudos Prospectivos , Fatores de Risco , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Vagina/microbiologiaRESUMO
OBJECTIVE: To evaluate clinical reliability compared to intrapartum ultrasound as a tool to diagnose occiput posterior position and to investigate the proportion of rotations occurring during labour. PATIENTS AND METHODS: 350 women in labor with a singleton fetus in a vertex position were prospectively studied using ultrasound and obstetrical examination. Outcome of labor was also monitored. RESULTS: Reliability of clinical examination is 85,7%, initial occiput posterior position represented 40,2% and most rotated in an anterior position (84, 8%) while only 0,6% of initial anterior positions delivered in occiput posterior position. Logistic regression did not allow to find significant predictor of occiput posterior position rotation. DISCUSSION AND CONCLUSION: Clinical examination is relatively reliable for posterior position diagnosis and in most cases, initially occipitoposterior positions rotate anteriorly.
Assuntos
Parto Obstétrico , Apresentação no Trabalho de Parto , Ultrassonografia Pré-Natal , Adulto , Feminino , Movimento Fetal , Humanos , Trabalho de Parto , Modelos Logísticos , Estudos Longitudinais , Gravidez , Estudos Prospectivos , Versão FetalRESUMO
BACKGROUND: Little is known about the epidemiological characteristics of papillomavirus (HPV) infection among North African countries. Herein, we conducted a molecular epidemiological study to investigate prevalence of HPV type and HPV-16 variants among cervical-screened unvaccinated Tunisian women. METHODS: Cross-sectional study was performed on 494 Tunisian women visiting Women's Healthcare Centers. HPV-DNA detection was carried out on cervical samples using real-time polymerase chain reaction. HPV genotyping and HPV-16 variants were characterized by direct sequencing of L1 viral capsid gene. RESULTS: The overall HPV prevalence was 34% (95% CI: 30-38%) with significantly higher prevalence among women with squamous intraepithelial lesions (SIL) than those with no intraepithelial lesions (NIL) 84% (95% CI: 76-92%) and 24.5% (95% CI: 20-29%) respectively. The distribution of HPV prevalence according to women's age shows a U-shaped curve and the highest HPV prevalence rates were observed among the youngest (≤25 years; 51.2%, 95% CI: 37-67%) and the oldest women (>55 years; 41.7%, 95% The HPV-16 prevalence was 32.8% (95% CI: 22-45%) among women with SIL and 9.2% (95% CI: 6-12%) among women with NIL. Whereas, the HPV-18 prevalence was 1.3% (95% CI: 0-5%) among women with SIL and 0.3% (95% CI: 0-1%) among women with NIL. Among HPV-16 positive women, European lineage (E) was identified as the predominant HPV-16 variant (85.7%, 95% CI: 76-95%). The frequency of E variant was lower among SIL than among NIL women (81%, 95% CI: 64-99%, and 88%, 95% CI: 77-100%, respectively). Conversely, the African-2 variant frequency was higher among SIL than among NIL women (18%, 95% CI: 1-36% and 6%, 95% CI: 2-14%, respectively). In multivariate analysis, young age was the only risk factor that is independently associated with HPV infection. Moreover, HPV infection and menopause were both found to be independently associated with SIL and HSIL. CONCLUSION: HPV DNA testing should be proposed to young and menopausal Tunisian women. Considering HPV prevalence, only 13% of the Tunisian women could be protected by the bivalent HPV vaccine. These results may be helpful for designing an adapted HPV testing and vaccination program in Tunisia.
RESUMO
Cavernous hemangiomas of the breast are uncommon. Clinical diagnosis is rather difficult. Generally there are coincidental microscopic findings. We present a case of a 67-year-old woman which commenced as a 6 cm palpable mass of the right breast. The use of mammography, ultrasound and MRI facilitate diagnosis. Large surgical excision of the lesion was performed and histology allowed to find a cavernous hemangioma without cellular atypia.
Assuntos
Neoplasias da Mama/diagnóstico , Hemangioma Cavernoso/diagnóstico , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Hemangioma Cavernoso/patologia , Hemangioma Cavernoso/cirurgia , Humanos , Imageamento por Ressonância Magnética , Mamografia , UltrassonografiaRESUMO
We report a case of pregnancy in a rudimentary horn that ruptured at 18 weeks. An emergency laparotomy was taken for acute abdomen and ruptured right rudimentary horn pregnancy was diagnosed. Excision of the rudimentary horn and ipsilateral salpingectomy were carried out. The patient's postoperative course was uneventful, and she left the hospital 6 days later.
Assuntos
Gravidez Ectópica , Ruptura Uterina/etiologia , Útero/anormalidades , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Adulto , Feminino , Humanos , Histerossalpingografia , Laparotomia , Gravidez , Segundo Trimestre da Gravidez , Gravidez Ectópica/diagnóstico , Gravidez Ectópica/cirurgia , Resultado do Tratamento , Ruptura Uterina/cirurgia , Útero/cirurgiaRESUMO
OBJECTIVES: To assess the clinical efficacy of mifepristone 100 mg followed two days later by misoprostol 400 microg orally in women undergoing medical termination of pregnancy up to 56 days gestational age. MATERIALS AND METHODS: Retrospective study over 8.5 months of 762 cases early medical abortion. 100 mg mifepristone was used on day 1 after clinic visit and vaginal ultrasonography. Misoprostol 400 microg was administered orally on day 3. Following administration of prostaglandin, women were observed in the ward for 4 hours. A control visit on day 15 was systematic. Success was defined as a complete uterine evacuation without the need for surgical intervention. RESULTS: Medical terminations accounted for 42% of all abortions. 16% of women were pregnant for < 42 days, 76% for 43 to 49 days and 8% for 50 to 56 days. Termination occurred within 4 hours after administration of misoprostol in 80.2% of the women. Only one woman aborted within 48 hours of mifepristone administration only. The success rate in this study was 94.4% and the failure rate increased with the gestational age. Pain was the predominant side effect. Six cases of bleeding required a surgical intervention. No patient required transfusion. 96% of patients attended a control visit on day 15. The acceptability rate of the method has been 94%. CONCLUSION: Mifepristone 100 mg followed two days later by misoprostol 400 microg orally is safe and effective for early termination of pregnancy.
Assuntos
Abortivos Esteroides/administração & dosagem , Aborto Induzido/métodos , Mifepristona/administração & dosagem , Abortivos não Esteroides/administração & dosagem , Abortivos não Esteroides/efeitos adversos , Abortivos Esteroides/efeitos adversos , Adulto , Feminino , Humanos , Mifepristona/efeitos adversos , Misoprostol/administração & dosagem , Misoprostol/efeitos adversos , Paridade , Gravidez , Estudos Retrospectivos , Resultado do TratamentoRESUMO
We report a girl with juvenile primary hypothyroidism revealed by growth retardation and a syndrome of primary amenorrhea-galactorrhea with hyperprolactinemia and suprasellar pituitary enlargement. Resolution of the pituitary enlargement and the amenorrhea-galactorrhea syndrome occurred after thyroid hormone replacement. No similar observation has been reported earlier in juvenile hypothyroidism.
Assuntos
Amenorreia/etiologia , Galactorreia/etiologia , Transtornos do Crescimento/etiologia , Hiperprolactinemia/etiologia , Hipotireoidismo/complicações , Sela Túrcica/patologia , Adulto , Feminino , Humanos , Hipotireoidismo/patologia , SíndromeRESUMO
At present, the application of combined methods in molecular biology allows us to carry out the prenatal diagnosis in a more rapid and less onerous manner especially when the family presents an index case. In this study, we have analyzed a family with one case of intermediate beta-thalassemia. First, we have used the denaturing gradient gel electrophoresis (DGGE). Then, we have identified the mutations by the refractory mutation system technique (ARMS PCR) using specific primers for the most frequent mutations in the Tunisian population (codon 39 (C --> T) and IVS-I-2 (T--> G) for beta0 thalassemias and IVS-I-110 (G --> A) for beta+ thalassemias). The analyzed family has shown the IVS-I-110 (G --> A) mutation in the heterozygous state in the mother and the index case. Subsequently, sequencing in the gene revealed a frameshift 8 (-AA) mutation in the father and his daughter. This patient is thus a compound heterozygote Codon 8 (-AA)/IVS-I-110. DGGE and ARMS PCR analysis of foetal DNA extracted from trophoblast culture didn't show any of the two mutations found in the family.
Assuntos
Mutação , Diagnóstico Pré-Natal , Talassemia beta/diagnóstico , Talassemia beta/genética , Adulto , Sequência de Bases , Criança , Códon , Eletroforese em Gel de Poliacrilamida , Feminino , Genótipo , Heterozigoto , Humanos , Masculino , Linhagem , Fenótipo , Reação em Cadeia da Polimerase , Gravidez , TunísiaRESUMO
Beta-thalassemia, by its high frequency and its heterogeneity, constitutes a real problem of health in Tunisia. Prenatal diagnosis by DNA analysis represents the only reality for couples at risk. The denaturant gradient (urea and formamide) on polyacrylamide gel electrophoresis has been performed in our laboratory, using psoralen as chemical clamps. This method is simple, reliable, safe, rapid, without radioactivity and has a reasonable cost (chemical clamps). Even if it needs an informatic modelization in other laboratories, this method seems to be adapted to our economic and work conditions and to the molecular heterogeneity of the Tunisian beta-thalassemia. We present the results of an epidemiological molecular study on 75 patients with beta-thalassemia and the results of ten prenatal diagnosis. The molecular lesions codon 39 (C-T) and IVS1 nt2 (T-G) are the most frequent in our study. This technical approach provides genetic counselling for at risk families by offering prenatal diagnosis (reducing as possible the cost and the delay of the result) after prealable family study and identification of the mutation(s).
Assuntos
Globinas/genética , Mutação , Diagnóstico Pré-Natal , Talassemia beta/diagnóstico , Talassemia beta/embriologia , Códon , Feminino , Heterozigoto , Homozigoto , Humanos , Epidemiologia Molecular , Reação em Cadeia da Polimerase , Gravidez , Tunísia/epidemiologia , Talassemia beta/epidemiologia , Talassemia beta/genéticaRESUMO
Having seen a personal case and having reviewed the literature, we clarify the details when neurofibromatosis and pregnancy occur together. Few cases of this combination of conditions have been reported. The complications can be serious and have led some authors to suggest that the pregnancy should be terminated in every case and that the patient should be sterilised. Sometimes the only risk is hypertension of pregnancy, which is what occurred in our case. Its progress was benign and according to the literature this seems to be the most usual outcome. All the same, because it is possible that complications can occur in any case of neurofibromatosis in pregnancy, pregnant women with neurofibromatosis should be placed in a high-risk group which has to be watched very carefully.
Assuntos
Neurofibromatose 1/complicações , Complicações Neoplásicas na Gravidez , Adulto , Feminino , Humanos , Neurofibromatose 1/genética , Linhagem , GravidezRESUMO
Pelvic genital hydatid disease is rare. It accounts for only 0.9% of hydatidoses and 1.8% of operated adnexial masses. Its clinical signs are often misleading, making the preoperative diagnosis difficult. This diagnosis rests on questioning with particular attention to the socio-professional context and previous history of hydatid disease. Ultrasonography is the first choice examination. Treatment is purely surgical, the best technique being total cystectomy, but the best treatment is prevention.
Assuntos
Equinococose/epidemiologia , Doenças dos Genitais Femininos/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Diagnóstico Diferencial , Equinococose/diagnóstico , Equinococose/cirurgia , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/cirurgia , Hospitais Universitários , Humanos , Anamnese/normas , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Retrospectivos , Fatores de Risco , Tunísia/epidemiologiaRESUMO
OBJECTIVE: To compare one hour postprandial glucose measurements with the one hour 50gm plasma glucose test as predictors of gestational diabetes. SUBJECTS AND METHODS: One hundred women at 24-28 weeks' gestation were prospectively randomized for both screening methods: one hour postprandial and one hour 50gm plasma glucose test with a one-week-interval between tests. A week later a formal 2-hour 75gm glucose tolerance test was done in each case. RESULTS: Of the 95 patients who completed the study 13 had gestational diabetes (13.6%). For a threshold of 7.1mmol/l the sensitivity of 1-hour postprandial plasma glucose screening test was 84.6% with a specificity of 87.8%. These values were respectively 84.6% and 81.7% for 1-hour 50 gm plasma glucose test screening test. A threshold of 7.7mmol/l yielded a sensitivity of 60.5% with a specificity of 91.4% for the 1-hour postprandial plasma glucose screening test (69.2% and 86.5% for 1-hour 50gm plasma glucose test) CONCLUSION: In our study the 1-hour postprandial plasma glucose screening test was as effective as the 1-hour 50 gm plasma glucose test screening test for gestational diabetes.
Assuntos
Glicemia/análise , Diabetes Gestacional/diagnóstico , Alimentos , Adulto , Feminino , Idade Gestacional , Teste de Tolerância a Glucose , Humanos , Gravidez , Estudos Prospectivos , Curva ROC , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: To compare the effectiveness of misoprostol administrated intravaginally alone versus misoprostol with oxytocin infusion for termination of pregnancy at 13 to 29 weeks. Subjects and methods. Ninety women at 13-29 weeks requesting pregnancy termination were randomized to receive 200 microgram of misoprotol intravaginally every 12 hours either with oxytocin infusion or alone for up to 48 hours. RESULTS: The mean induction to abortion interval was significantly shorter in the misoprostol-oxytocin group than in the misoprostol alone group (22+/-10.8 hours versus 27+/-14.1 hours respectively p<0.05). The 48 hours successful abortion rates were 95% and 90% respectively. Abortion was complete in 79.1% and 62.5% respectively. Side effects were similar between groups. CONCLUSION: Vaginal misoprostol associated with oxytocin infusion is more effective than misoprostol alone in termination of second-trimester pregnancy.
Assuntos
Abortivos não Esteroides/administração & dosagem , Aborto Terapêutico/métodos , Misoprostol/administração & dosagem , Ocitocina/administração & dosagem , Administração Intravaginal , Adulto , Quimioterapia Combinada , Feminino , Humanos , Infusões Intravenosas , Paridade , Seleção de Pacientes , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Fatores de TempoRESUMO
OBJECTIVE: To compare the clinical effectiveness and safety of intracervical dinoprostone versus conservative management of term prelabor rupture of membranes. SUBJECTS AND METHODS: 88 women with term prelabor rupture of membranes were assigned randomly to one of two groups RESULTS: 44 women were allocated in each group. The means (+/- S. D) intervals from PROM to delivery and from inclusion to start of labour were significantly shorter in the dinoprostone group (19.5+/-6.2 vs 25.5+/-7.7 hours p<0.01 and 8.7+/-5.5 hours vs 14+/-6. 8; p=0.32 respectively). No significant differences were observed in the mean duration of labour (4.5+/-1.6 hours vs. 4.9+/-1.67 p=0.32). The rates of clinical amniotits were 15.9% in the dinoprostone group and 6.8% in the control group; difference is not statistically significant (p=0.17). The mode of delivery and Apgar score were similar in the two groups. Uterine tachysystole occurred more frequently in the dinoprostone group (6.8 vs 0%) but did not reach statistical significance. CONCLUSION: Intracervical administration of dinoprostone with prelabor rupture of membrane at term and unripened cervix shortens the interval to delivery without a significant increase of maternal or neonatal morbidity.
Assuntos
Colo do Útero/efeitos dos fármacos , Dinoprostona/administração & dosagem , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Idade Gestacional , Trabalho de Parto , Adulto , Índice de Apgar , Dinoprostona/uso terapêutico , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Prospectivos , Fatores de TempoRESUMO
OBJECTIVE: Our purpose was to determine whether the use of aortic isthmus Doppler waveform analysis in growth restricted fetuses delivered at 28 to 38 weeks predicts perinatal outcomes. MATERIAL AND METHODS: Prospective longitudinal study including singleton non-malformed euploid fetuses with accurate dating and diagnosed as growth restricted (abdominal circumference<10th percentile) and who were followed up at our institution and delivered<10 days after the last Doppler. Timing of delivery was collegial. Perinatal mortality and morbidity outcomes were compared in cases with anterograde blood flow versus retrograde net blood flow in aortic isthmus. Relative risk (RR) were calculated with 95% CI and P<0,05 was considered significant. RESULTS: Thirty-two cases were considered for analysis: growth-restricted foetuses with anterograde blood flow (n=26) versus retrograde net blood (n=6). Maternal demographic characteristics in the two groups were similar and exceptions made of femur length average values for fetal biometrics were not significantly different. Doppler velocimetry results at the uterine, umbilical and cerebral arteries were similar in the two groups. Gestational age at delivery and birth weight were similar in both groups (respectively (239.65 20.1 vs. 247.3 16.4 (days) (p=0.349) and 1748.8 gr 468.7 vs. 1933.3 gr 468.7 (p=0.408)). There was a statistically significant increase in perinatal mortality in retrograde net blood flow group: 8.66 [IC 95% 2.03 - 36.84]. An interesting finding was that neonates with aortic isthmus retrograde net blood flow were more frequently born by cesarean delivery because of a suspected fetal compromise RR=3.22 CI 95% [1.29-8]. CONCLUSION: In our study Doppler identification of aortic isthmus retrograde net blood flow in growth-restricted fetuses was associated with an increase of perinatal death.
Assuntos
Retardo do Crescimento Fetal/diagnóstico por imagem , Retardo do Crescimento Fetal/fisiopatologia , Feto/irrigação sanguínea , Resultado da Gravidez , Ultrassonografia Doppler/métodos , Ultrassonografia Pré-Natal/métodos , Adulto , Aorta/diagnóstico por imagem , Biometria , Velocidade do Fluxo Sanguíneo , Cesárea , Feminino , Idade Gestacional , Humanos , Mortalidade Infantil , Recém-Nascido , Estudos Longitudinais , Gravidez , Complicações na Gravidez , Prognóstico , Estudos Prospectivos , Sensibilidade e Especificidade , Útero/irrigação sanguíneaRESUMO
PURPOSE OF THE STUDY: To study the feasibility, advantages and risks of laparoscopic management of adnexal tumors in the course of the last two trimesters of the pregnancy. MATERIAL AND METHODS: Retrospective study of a series of 25 cases of adnexal tumors operated by laparoscopy in the course of the second and the third trimester of pregnancy, during a period of 49 Months from 1st January 1999 to 30 January 2003. RESULTS: Mean gestational age at surgery was 16 weeks 3 days (range 12-29 weeks). The adnexal tumor was an ovarian cyst in 24 cases and in a paratubal cyst in a single case. Conversion was necessary in only one case due to difficult hemostasis. One revision required for borderline malignancy cystadenoma was performed laparoscopically during the same pregnancy. No operative complication was noted. Average post-operative stay was 36 hours (range 24-72 hours). There was one situation of eminent abortion in early the postoperative period but no thromboembolic complications. The pregnancy progress was normal after laparoscopy. CONCLUSION: Laparoscopic treatment of adnexal tumors is feasible in the course of the last two trimesters of the pregnancy in the hands of an experienced surgeon using advanced techniques. The well-known advantages of laparoscopy are particularly important during the pregnancy.