Ultrasound Nomograms of the Fetal Optic Nerve Sheath Diameter.

OBJECTIVE: To construct prenatal age-specific reference intervals for sonographic measurements of the optic nerve sheath diameter (ONSD) during gestation in normal fetuses. MATERIALS AND METHODS: Prospective cross-sectional study of fetuses assessed in antenatal ultrasound units between 2010 and 2014. The examination was based on a technique for the sonographic assessment of ONSD previously published by our group. The mean values and SDs of the ONSD were modeled as a function of the gestational week by curve estimation analysis based on the highest adjusted R2 coefficient. Repeatability tests were performed to assess intraobserver variability and interobserver agreement. RESULTS: During the study period 364 healthy fetuses were enrolled. The mean values for the ONSD varied from 0.6 mm at 15-16 weeks to 2.8 mm at 37-38 weeks. The ONSD grows in a linear fashion throughout gestation, with a quadratic equation providing an optimal fit to the data (adjusted R2 = 0.957). CONCLUSION: Sonographic age-specific references for the fetal ONSD are presented. This data may assist in the decision-making process in fetuses with a suspected increase in intracranial pressure, or anomalies affecting the development of optic stalks, such as optic hypoplasia and septo-optic dysplasia.

Clinical and Sonographic Findings in Suspected Retained Trophoblast: Correlation with Histological Findings.

BACKGROUND: Different clinical and sonographic parameters have been suggested to identify patients with retained products of conception. In suspected cases, the main treatment is hysteroscopic removal. OBJECTIVES: To compare clinical, sonographic, and intraoperative findings in cases of hysteroscopy for retained products of conception, according to histology. METHODS: The results of operative hysteroscopies that were conducted between 2011 and 2016 for suspected retained products of conception were evaluated. Material was obtained and evaluated histologically. The positive histology group (n=178) included cases with confirmed trophoblastic material. The negative histology group (n=26) included cases with non-trophoblastic material. RESULTS: Patient demographics were similar in the groups, and both underwent operative hysteroscopy an average of 7 to 8 weeks after delivery/abortion. A history of vaginal delivery was more common among the positive histology group. The main presenting symptom in all study patients was vaginal bleeding, and the majority of cases were diagnosed at their routine postpartum/abortion follow-up visit. Sonographic parameters were similar in the groups. Intraoperatively, the performing surgeon was significantly more likely to identify true trophoblastic tissue as such than to correctly identify non-trophoblastic tissue (P < 0.001). CONCLUSIONS: Suspected retained trophoblastic material cannot be accurately differentiated from non-trophoblastic material according to clinical, sonographic, and intraprocedural criteria. Thus, hysteroscopy seems warranted in suspected cases.

Different Routes of Misoprostol for Same-Day Cervical Priming Prior to Operative Hysteroscopy: A Randomized Blinded Trial.

STUDY OBJECTIVE: To compare the effectiveness of and patient satisfaction with different routes of misoprostol administration for short-term cervical priming before operative hysteroscopy. DESIGN: Randomized blinded trial (Canadian Task Force classification I). SETTING: University hospital. PATIENTS: One hundred and twenty patients undergoing operative hysteroscopy. INTERVENTIONS: Patients were randomly assigned to receive 400 µg of misoprostol administered orally (n = 40), vaginally (n = 40), or sublingually (n = 40) for cervical priming at 1.5 to 4 hours before undergoing operative hysteroscopy. MEASUREMENTS AND MAIN RESULTS: The primary outcome was preoperative cervical dilatation. Secondary outcomes included cervical consistency, ease of dilation and time of dilation, patient discomfort, and side effects. No differences were noted among the 3 groups in terms of patient age, parity, previous vaginal delivery, menopausal status, and time interval from preparation to procedure. Patients in the 3 groups reported similar discomfort and side effects. Initial mean cervical dilatation was 6.1 ± 2.0 mm in the oral group, 6.4 ± 2.1 in the vaginal group, and 6.4 ± 1.8 mm in the sublingual group (p = .75). Cervical consistency and ease of dilation were similar among the groups. The mean time of dilation was 37.2 ± 30.6 seconds in the oral group, 31.7 ± 29.0 seconds in the vaginal group, and 31.5 ± 21.7 seconds in the sublingual group (p = .59). Additional subanalyses according to menopausal status and parity did not demonstrate any differences among the groups. CONCLUSION: Same-day cervical priming for operative hysteroscopy is achieved equally with all routes of misoprostol administration, with similar patient satisfaction and side effects.

Different routes of misoprostol for cervical priming in first trimester surgical abortions: a randomized blind trial.

PURPOSE: To compare effectiveness and patient satisfaction of different routes of misoprostol for short-term (same day) cervical priming in first trimester surgical abortions. METHODS: In a blind randomized trial, patients undergoing surgical abortion at a gestational age of 6 + 0-14 + 6 were administered oral, vaginal, or sub-lingual 400 mcg misoprostol, 1.5 to 4 h prior to procedure. Surgeons blinded to patient allocation evaluated cervical priming. The primary outcome was initial cervical dilatation. Secondary outcomes were cervical consistency, ease of dilation, patient discomfort, and side effects. RESULTS: From July 2015 through May 2016, 120 patients were randomized as follows: 40 to oral, 40 to vaginal, and 40 to sublingual misoprostol administration. No differences were noted in patient age, gestational age, curettage indication (termination/delayed miscarriage), past vaginal delivery, and administration to procedure interval. Initial cervical dilatation was similar between the groups, as were cervical consistency and ease of dilation. Patients noted the greatest discomfort and side effects with sublingual administration. The followings were found to be independently associated with cervical dilatation in a linear regression analysis: sublingual administration, gestational age, missed abortion, and previous vaginal delivery. Side effects and administration to procedure interval were found non-significant. CONCLUSION: The same day cervical priming for first trimester surgical abortion is similarly achieved with all routes of misoprostol administration. In cases of termination of pregnancy with no prior vaginal delivery, sublingual administration may be considered, but entails a higher rate of side effects and patient discomfort.

Ovarian Pregnancy Following in Vitro Fertilization in a Woman After Bilateral Salpingectomy: A Case Report and Review of the Literature.

We present a rare case of ovarian pregnancy that occurred in a woman who underwent in vitro fertilization (IVF) after bilateral salpingectomy. The patient presented with abdominal pain and a positive pregnancy test. Ovarian pregnancy was diagnosed owing to a suspicious mass detected on ultrasound. She underwent laparoscopy to confirm the diagnosis, which was subsequently verified by histopathological examination. The question that comes in mind is: How did the pregnancy get there? After a review of the literature, we have found a few possible explanations for the mechanism of this rare event. This case emphasizes the need for vigilance in suspecting ectopic pregnancy even in women who have undergone salpingectomy.

The effects of maternal smoking on pregnancy outcome and placental histopathology lesions.

OBJECTIVE: To study the effects of maternal smoking on pregnancy outcome and placental histopathology findings. MATERIALS & METHODS: Maternal and labor characteristics and pathological reports were compared between term placentas of complicated and uncomplicated pregnancies of: heavy smokers (>10 cigarettes per day, H-smokers), moderate smokers (<10 cigarettes per day, M-smokers) and non-smokers (controls, N-smokers). RESULTS: Birth-weights were lower in the H-smokers and M-smokers as compared to the N-smokers (p<0.001), with a higher rate of small for gestational age (SGA): 18.2%, 19.2% and 11.4%, respectively (p=0.01). Deliveries among smokers were characterized by higher rates of abnormal fetal heart rate tracings during labor as compared to non-smokers (p=0.01). Rates of placental maternal and fetal stromal-vascular supply lesions was similar between the groups. CONCLUSIONS: Maternal smoking is associated with higher rates of SGA. Tobacco's potential influence is probably through the disruption of normal placental epigenetic patterns, not expressed in placental histopathology lesions.

The optimal cutoff serum level of human chorionic gonadotropin for efficacy of methotrexate treatment in women with extrauterine pregnancy.

OBJECTIVE: To evaluate the efficacy of methotrexate treatment for extrauterine pregnancy and define criteria for prediction of success. METHODS: Of 829 patients with an ectopic pregnancy admitted to E. Wolfson Medical Center, Holon, Israel, from January 1997 through December 2009, 238 had asymptomatic tubal pregnancies and increasing serum ß-human chorionic gonadotropin (ßhCG) levels. These patients were treated with a single intramuscular injection of 50mg of methotrexate (MTX) per square meter of body surface. Success was defined as undetectable ßhCG levels without the need for a surgical intervention. RESULTS: The groups of patients successfully treated (n=167 [70%]) and unsuccessfully treated (n=71 [30%]) were compared. They were similar regarding age and gravidity. The initial serum ßhCG level was significantly higher in the latter group than in the former (3798 mIU/mL vs. 1601 mIU/mL, P<0.01). The success rate was 88% when initial ßhCG levels were less than 1000 mIU/mL, 71% when they were between 1000 and 2000 mIU/mL, and only 59% when they were between 2000 and 3000 mIU/mL. CONCLUSION: Methotrexate treatment is a safe and effective alternative to surgery. However, patients with initial ßhCG levels higher than 2000 mIU/mL should only be offered the surgical approach.