First Trimester Neurosonogram-Our Experience.

Central nervous system (CNS) malformations represent 1% of all births. For this reason, efforts are being made to increase detection of such anomalies prenatally. Consequently, a detailed assessment of the fetal nervous system in the first trimester of pregnancy is no longer a utopia as this kind of evaluation can detect severe malformation such as acrania, neural tube defects, holoprosencephaly or can draw attention regarding to anomalies currently detected in the second trimester due to certain markers of diagnosis. MATERIAL AND METHODS: The study included 1376 pregnant women with gestational ages between 11 and 14 weeks, who were referred to our unit for sonographic evaluation. We analyzed in all patients the fetal brain in axial and mid-sagittal views, assessing markers like intracranial translucency, brainstem/brainstem-occipital bone (BS/BSOB) ratio, choroid plexus (CP/HA) ratio, the octopus sign in order to detect as many anomalies in the first trimester of pregnancy. RESULTS: We detected 6 CNS anomalies during our search. All markers assessed were abnormal in all pathological cases. CONCLUSION: A detailed assessment of the fetal brain is recommended at 11-14 weeks because the earlier the diagnosis is confirmed, the lower the chances of obstetrical, psychological complications to supervene.

The Importance of Ultrasound Monitoring of the Normal and Lesional Cervical Ectropion Treatment.

OBJECTIVE: to investigate the importance of various ultrasound prognosis features in the assessment of the cervical ectropion treatment monitoring. METHOD: The inclusion criteria was the presence of ectropion and the selection was based on clinical examination performed during routine consultations in specialized clinics, later confirmed by colposcopic evaluation of cervix. The evaluation protocol included: clinical evaluation completed with colposcopy, guided biopsy when lesions were suspected, serological assay of day 21 progesteronemy, presence of Chlamydia, Mycoplasma, Ureaplasma, HVS type II, HPV and bacterial infections, transvaginal ultrasound serial evaluation at the 7th, 14th and 21st day before and after tretment concerning: cervical volumetric calculations and velocimetric measurements of uterine arteries flows. Progestative treatment was prescribed, and antiinfectious specific treatment when needed. Patients were reevaluated after 3 months. RESULTS: The prospective study included 45 patients between 2013-2014. 28 presented serum progesterone levels below the reference range or borderline. We noted a moderate reduction of the ectropion area in 42 % and a marked reduction in 58% of the cases. No statistically significant differences were found between the size of the cervix before or after treatment, except certain evaluations (the 7th and the 14th day) in the presence of bacterial coinfections. Evaluation of pulsed Doppler velocimetric indices of uterine arteries flows showed generally minor variations with no constant positive or negative trend. CONCLUSION: Based on the data obtained in our study, we conclude that ultrasound monitoring of ectropion treatment do not provide reliable prognosis data regarding the evolution of cervical lesion.

The Estrogen-Induced Effects on Myometrium Are the Result of Activation of Two Different Receptor Types: GPER and ERα.

GPER (G protein coupled estrogen receptor 1), a particular estrogen binding site, is ubiquitously present in human tissues, but its precise physiological role is still very disputed. GPER is associated with normal and abnormal estrogen-dependent proliferations in female tissues and is involved in generation of rapid estrogenic answers. A very important fact is that GPER-induced genomic effects are additive to those mediated by "classic" estrogen receptors, but regarding the rapid effects, as we prove in this study, these can be significant different or even antagonistic.

Improved detection rate of structural abnormalities in the first trimester using an extended examination protocol.

OBJECTIVE: To assess the potential of first-trimester sonography in the detection of fetal abnormalities using an extended protocol that is achievable with reasonable resources of time, personnel and ultrasound equipment. METHODS: This was a prospective two-center 2-year study of 5472 consecutive unselected pregnant women examined at 12 to 13 + 6 gestational weeks. Women were examined using an extended morphogenetic ultrasound protocol that, in addition to the basic evaluation, involved a color Doppler cardiac sweep and identification of early contingent markers for major abnormalities. RESULTS: The prevalence of lethal and severe malformations was 1.39%. The first-trimester scan identified 40.6% of the cases detected overall and 76.3% of major structural defects. The first-trimester detection rate (DR) for major congenital heart disease (either isolated or associated with extracardiac abnormalities) was 90% and that for major central nervous system anomalies was 69.5%. In fetuses with increased nuchal translucency (NT), the first-trimester DR for major anomalies was 96%, and in fetuses with normal NT it was 66.7%. Most (67.1%) cases with major abnormalities presented with normal NT. CONCLUSIONS: A detailed first-trimester anomaly scan using an extended protocol is an efficient screening method to detect major fetal structural abnormalities in low-risk pregnancies. It is feasible at 12 to 13 + 6 weeks with ultrasound equipment and personnel already used for routine first-trimester screening. Rate of detection of severe malformations is greater in early- than in mid-pregnancy and on postnatal evaluation. Early heart investigation could be improved by an extended protocol involving use of color Doppler.

Neuroimaging parameters in early open spina bifida detection. Further benefit in first trimester screening?

OBJECTIVE: Morphological investigation of the central nervous system (CNS) in fetuses with positive markers for open spina bifida (OSB) detection, visualized by ultrasound during the first trimester of pregnancy. MATERIALS AND METHODS: Data from fetuses that underwent routine first trimester ultrasound scan in our center during September 2007-March 2011 and presented abnormal aspects of the fourth ventricle, also referred as intracranial translucency (IT), provided the morphological support to evaluate CNS features. A neuro-histological study of posterior cerebral fossa illustrated anatomical features of the structures involved in the sonographic first trimester detection of neural tube defects. RESULTS: Abnormal IT aspects were found in OSB cases examined in the first trimester, but also in other severe cerebral abnormalities. Brain stem antero-posterior diameter (BS) and brain stem to occipital bone (BSOB) ratio may be more specific for OSB detection. Correlations between histological aspects of posterior brain fossa and ultrasound standard assessment have been made; highlighting the anatomical features involved by the new techniques developed for OSB early detection. CONCLUSIONS: Preliminary results show that modern sonographic protocols are capable to detect abnormalities in the morphometry of the posterior brain. First trimester fourth ventricle abnormalities should be followed by careful CNS evaluation because are likely to appear in OSB affected fetuses, but also in other CNS severe anomalies; in such cases, normal BS and BSOB ratio may serve as indirect argument for spine integrity, if specificity is confirmed in large series of fetuses.

Cytological and histopathological aspects concerning preinvasive squamous cervical lesions.

Our study was carried out on a total number of 158 patients, with a mean age of 32, all tested and identified cytologically (Pap-test) as presenting minor cellular abnormalities, respectively ASCUS (10) and LSIL (119), and major cellular abnormalities, respectively SIL-borderline (8) and HSIL (21), and who, either voluntarily or upon cytopathologists' recommendation, were colposcopically examined. Subsequently, they were subjected to cervical biopsy or excision therapy. In patients with ASCUS cytology, 6 cases were morphologically diagnosed with benign cervical lesions, 3 were diagnosed with LSIL, and one patient was diagnosed as HSIL (CIN 2). Out of 119 LSIL smears 108 were confirmed by histopathology, while 11 were diagnosed as HSIL (CIN 2). In SIL-borderline patients, 5 cases were screened as LSIL and 3 as HSIL. In patients with HSIL cytology, 18 were diagnosed histopathologically as HSIL (CIN 2 and CIN 3/CIS), while 3 were diagnosed as invasive squamous carcinoma.

Colposcopic evaluation of neoplasic and preneoplasic lesions of the cervix - a retrospective study.

Based on observation sheets and the existing database in Obstetrics - Gynecology Department, we reviewed the outcome for patients diagnosed with neoplasic and preneoplasic lesions of the cervix that were examined in our clinic. Colposcopic diagnosis efficiency was analyzed retrospectively reported to the histopathologic diagnosis and to the results of other studies. Our results were similar to those presented in international literature, showing a carefull evaluation of cervical lesions in our colposcopy department.

Behaviour of fibrinolysis in the nephrotic syndrome.

When compared to 39 normal-weight normolipidemic control subjects, the dilute blood clot lysis time was found to be slightly (p less than 0.05) accelerated in the 49 investigated nephrotic patients, although their plasma fibrinogen, factor XIII as well as the inhibitors of fibrinolysis, are markedly increased. These findings indicate that the fibrinolytic system as a whole is not markedly depressed in the nephrotic syndrome. Although the fibrinolytic activity of euglobulins tested on agarose-fibrin plates was not significantly increased in nephrotic patients, one cannot definitely preclude an enhanced secretion of plasminogen activators in this pathological condition. A different quality of the inhibitors which may be less active in retarding dilute blood clot lysis time could also be considered.