[The conservative treatment of placenta accreta. A clinical case report]. / Trattamento conservativo della placenta accreta. Descrizione di un caso clinico.

The following description is a clinical case of placenta accreta and its conservative treatment. According to some authors, abnormal adhesion of the placenta depends on the alteration of the equilibrium between the trophoblastic tissue invasion and the reaction of the decidua. Consequently we have various degrees of penetration of the myometrium by chorionic villi into areas of deficit, sparse or absent decidua. Whatever the pathogenetic mechanism, the final clinical picture is slight to deep penetration of the trophoblastic tissue into the uterine wall. That causes absence of the normal plane of cleavage between placenta and maternal decidua, no spontaneous placental detachment during the third stage of labour and no possible manual removal. The patient, primigravida, was admitted at the 36th Week of gestation with PROM and physiologically delivered a neonate weighing 1820 g, after she spontaneously began labour. The newborn was admitted in the neonatal-pathology ward because it was premature although the Apgar score at 1-5 minutes after birth was 5-9. Placental ejection was awaited for 1 hour, then manual exploration of the uterine cavity was undertaken. The normal plane of cleavage between placental tissue and decidua was absent and therefore manual extraction of the placenta was impossible. Surgery was stopped and, after informed consensus was obtained from the patient, a conservative treatment was tried. After cutting the umbilical cord as short as possible and checking for vaginal bleeding, the patient was moved to obstetrics ward.(ABSTRACT TRUNCATED AT 250 WORDS)

Miscarriage diagnosis and gestational age estimation in the early first trimester of pregnancy: transabdominal versus transvaginal sonography.

A comparison is made between 290 patients examined using transabdominal sonography and 308 patients examined using transvaginal sonography. Patients with suboptimal menstrual histories and threatened miscarriages were excluded from these two groups of patients. The transabdominal and transvaginal sonography examinations were carried out while the patient's bladder was empty, so that there was no delay between the clinical and sonographic examinations. In this way there was no patient discomfort from a full bladder. In normal pregnancies after 42 days of amenorrhea, the percentage visualization rates of the chorionic sac, of the embryo with heart activity and of the yolk sac were measured. There were no significant differences between the two groups. The two techniques were able to provide a reliable diagnosis of miscarriage on embryos >or= 4 mm or with chorionic sacs >or= 10 mm mean diameter. However, before 42 days of gestation, transvaginal sonography was better than transabdominal sonography at diagnosing miscarriage. The percentage of anembryonic pregnancies was higher in the transabdominal sonography group (21%) than in the transvaginal sonography group (7%), despite similar gestational ages at the time of a positive diagnosis. Thus, a transabdominal scan can be used after 42 days and borderline cases can be referred for transvaginal sonography for confirmation.

Effect of prednisone and heparin treatment in 14 patients with poor reproductive efficiency related to lupus anticoagulant.

In women with a previous intrauterine fetal death related to lupus anticoagulant (LAC), we studied the effect of prednisone and calcieparine treatment to enable longer intrauterine life, increased fetal growth and increased survival rate. LAC was determined by the kaolin clotting time and was associated with elevated levels of antinuclear and anticardiolipin antibody in 42% and 21% of the cases, respectively. 14 women entered the study; they had a past history of 27 pregnancies, with only 1 small-for-gestational age (SGA) liveborn. The mean gestational age at the time of fetal death was 30 +/- 4 weeks. During index pregnancies, we observed 2 miscarriage, 9 liveborns (6 of appropriated gestational weight, 3 SGA) and a mean gestational age of 35 +/- 3 weeks. The mean decrease in fetal weight from the 50th percentile in previous pregnancies was 44%, and with treatment this was reduced to 12%. All these differences were statistically significant. We conclude that prednisone and heparin treatment can improve reproductive prognosis in fertile patients with LAC.