Thrombosed Arteriovenous Malformation of Umbilical Cord.

Background: Arteriovenous malformation of umbilical cord is an extremely rare congenital malformation. Causes of this condition are unknown. AVM of umbilical cord can cause significant complications in the developing fetus. Methods: We report our management of the case with accurate ultrasound study that could improve and facilitate the approach to this pathology due to the lack of literature and with an overview of the available literature. Results: There are only two cases of umbilical AVM diagnosed in the prenatal period with associated pathology. The mainstay of prenatal detection is the accurate study of umbilical cord also even if it is not requested from the actual guide lines in a way to improve the perinatal morbidity and mortality.

Total laparoscopic hysterectomy four-handed ergonomic technique: description of an original surgical procedure for the reduction of learning curve.

The aim of this study was to propose the four-handed technique for total laparoscopic hysterectomy (TLH), with or without adnexectomy. From our point of view this is a more ergonomic, efficient, and effective technique that can contribute to the training of specialists in obstetrics/gynecology. In fact, teacher and learner have both an active role on the surgical field using two laparoscopic instruments each. They are alternately, mutually, and symmetrically first operator and assistant, reducing number of attempts needed for laparoscopic hysterectomy learning curve. The detailed description of all the surgical steps of TLH, "four-handed technique" (FHT), with or without adnexectomy, make sure that it can be effectively reproduced step by step safely, by transposing "FHT" surgical steps of laparotomic approach. This may allow easy access to anatomical spaces inserting trocars in different ways. By clearly knowing the steps of TLH, "FHT" it is possible to favor minimally invasive routes so that patients benefit from its multiple proven benefits. Operating this way, operative time, blood loss, use of analgesics and hospitalization can be significantly reduced. In conclusion benefits of TLH have already been widely demonstrated in literature. It is a real opportunity that young specialists become confident with this innovative "FHT," a procedure that allows them to be surgeon first assistant, and in which they can learn faster real intraoperative stereotaxis and surgical steps sequence, familiarizing with the anatomy of retroperitoneal space.

Five-vessel umbilical cord and fetal outcome: an obstetric overview.

PURPOSE: The birth of a child with an increased number of blood vessels in the umbilical cord (UC) is a rare event and has been previously reported to be associated with a higher incidence of congenital anomalies. METHODS: A case of a healthy female infant with an intra-uterine growth restriction (IUGR), born from a bicornuate uterus at 37 weeks of gestation and weighing 2500 g with a diagnosis of five-vessel UC made post-natally, on gross examination of the UC and confirmed by histopathological examination is documented. In particular, sections from the UC showed four umbilical arteries (UA) and one umbilical vein (UV). A review of literature was performed. RESULT: The physical examination of the baby after birth was normal. To the best of our knowledge, this is the first case to document the association of five-vessel UC with IUGR and the Mullerian anomaly of bicornuate uterus. CONCLUSION: The detection of supernumerary blood vessels in the UC mandates comprehensive workup for associated congenital anomalies but this case suggests that such finding might not always serve as an ominous sign for an adverse perinatal outcome.

The association between the regular use of early-term labor induction and improved birth outcomes: new evidence from an Italian hospital.

BACKGROUND: Associations have been recently reported between the frequent use of early-term preventive labor induction and improvements in multiple parameters of birth health. We sought to replicate these findings in an Italian hospital. METHODS: The outcomes of 120 consecutively delivered women who were exposed to the alternative method of care were compared to the outcomes of 159 women who received standard management. The primary and secondary outcomes were group cesarean delivery rate and group adverse outcome index score. RESULTS: Exposed women had a higher induction rate, a lower cesarean delivery rate (1.7% vs. 43.4%), and a lower group AOI Score (0.2 vs.5.8). CONCLUSIONS: Exposure to high levels of early term preventive labor induction was associated with a lower group cesarean delivery rate and improvement in several other major birth outcomes. An adequately powered randomized controlled trial is needed to further explore this alternative method of care.