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Vitale S.G.,University of Catania | Padula F.,Fetal Maternal Medical Center | Gulino F.A.,University of Catania
Current Opinion in Obstetrics and Gynecology | Year: 2015

Purpose of review The review analyzes how fibroids may influence pregnancy and how myomas may be modified by pregnancy. The most important clinical aspect concerns the impact of myoma on pregnancy and the possibility of a well tolerated surgical treatment for the mother and her fetus, preserving maternal reproductive capacity. Recent findings Fibroids significantly increase in size during early pregnancy and then decrease in the third trimester. Although most women with uterine fibroids have a regular pregnancy, data from the literature suggest that they may have a higher risk of fertility problems and pregnancy complications. Summary Myomectomy can increase the rate of pregnancy in women with infertility, attempting to restore a normal anatomy and reduce uterine contractility and local inflammation associated with the presence of fibroids, improving the blood supply. Current evidence does not suggest routine myomectomy during pregnancy or at the cesarean birth, as fibroids-related complications are rare and may be overcome by the risks of surgery. However, in selected cases, myomectomy is a feasible and safe technique and associated to a good outcome. The diagnosis of myomas in pregnancy may require attention for the adequate management to preserve maternal and fetal well-being. © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Moos S.,Polytechnic University of Turin | Marcolin F.,Polytechnic University of Turin | Tornincasa S.,Polytechnic University of Turin | Vezzetti E.,Polytechnic University of Turin | And 4 more authors.
International Journal on Interactive Design and Manufacturing | Year: 2014

This work proposes a methodology to automatically diagnose and formalize prenatal cleft lip with representative key points and identify the type of defect (unilateral, bilateral, right, or left) in three-dimensional ultrasonography (3D US). Differential Geometry has been used as a framework for describing facial shapes and curvatures. Then, descriptors coming from this field are employed for identifying the typical key points of the defect and its dimensions. The descriptive accurateness of these descriptors has allowed us to automatically extract reference points, quantitative distances, labial profiles, and to provide information about facial asymmetry. Seventeen foetal faces, nine of healthy foetuses and eight with different types of cleft lips, have been obtained through a Voluson system and used for testing the algorithm. In case no defect is present, the algorithm detects thirteen standard facial soft-tissue landmarks. This would help ultrasonographists and future mothers in identifying the most salient points of the forthcoming baby. This algorithm has been designed to support practitioners in identifying and classifying cleft lips. The gained results have shown that differential geometry may be a valuable tool for describing faces and for diagnosis. © 2014 Springer-Verlag France

Padula F.,Fetal Maternal Medical Center | Gulino F.A.,University of Catania | Capriglione S.,Biomedical University of Rome | Giorlandino M.,Fetal Maternal Medical Center | And 4 more authors.
Journal of Ultrasound in Medicine | Year: 2015

Objectives-The purpose of this study was to estimate the rate of incomplete fetal anatomic surveys during a second-trimester scan due to an unfavorable fetal position in a nonobese population. Methods-All pregnant women who came to the Altamedica Fetal-Maternal Medical Center, a specialized center for prenatal diagnosis, for a routine second-trimester scan between January 2012 and April 2013 were retrospectively included in the analysis. Patients with a body mass index higher than 30.0 kg/m2 or anterior fibroids larger than 5 cm were not included in the study. Results-Of 4000 pregnant women admitted for a second-trimester scan, 169 (4.2%) came back within 2 weeks to complete the examination because of an unfavorable fetal position. In particular, 104 (2.6%) needed visualization of only 1 view, and 65 (1.6%) needed more than 1 view. The most difficult organ to visualize was the corpus callosum, in 73 cases (1.8%); the face was not visualized in 69 cases (1.7%); the cerebellar vermis was not seen in 47 fetuses (1.1%); and the heart could not be completely examined in 40 fetuses (1.0%). Of the 4000 women, 169 (4.2%) had a nonexhaustive scan; 149 (3.7%) needed a second scan to complete the second-trimester survey; 14 (0.35%) needed a third scan; and 2 (0.05%) remained with a not completely exhaustive scan. Conclusions-There is always a small percentage of incomplete fetal anatomic surveys during a second-trimester scan, which cannot be modified by the sonographer's skill or by technical sonographic innovations. ©2015 by the American Institute of Ultrasound in Medicine.

Cignini P.,Fetal Maternal Medical Center | Giorlandino M.,Fetal Maternal Medical Center | Brutti P.,University of Rome La Sapienza | Mangiafico L.,Fetal Maternal Medical Center | And 2 more authors.
PLoS ONE | Year: 2016

Objective To establish reference charts for fetal cerebellar vermis height in an unselected population. Methods A prospective cross-sectional study between September 2009 and December 2014 was carried out at ALTAMEDICA Fetalâ€"Maternal Medical Centre, Rome, Italy. Of 25203 fetal biometric measurements, 12167 (48%) measurements of the cerebellar vermis were available. After excluding 1562 (12.8%) measurements, a total of 10605 (87.2%) fetuses were considered and analyzed once only. Parametric and nonparametric quantile regression models were used for the statistical analysis. In order to evaluate the robustness of the proposed reference charts regarding various distributional assumptions on the ultrasound measurements at hand, we compared the gestational age-specific reference curves we produced through the statistical methods used. Normal mean height based on parametric and nonparametric methods were defined for each week of gestation and the regression equation expressing the height of the cerebellar vermis as a function of gestational age was calculated. Finally the correlation between dimension/gestation was measured. Results The mean height of the cerebellar vermis was 12.7mm (SD, 1.6mm; 95% confidence interval, 12.7â€"12.8mm). The regression equation expressing the height of the CV as a function of the gestational age was: height (mm) = -4.85+0.78 x gestational age. The correlation between dimension/gestation was expressed by the coefficient r = 0.87. Conclusion This is the first prospective cross-sectional study on fetal cerebellar vermis biometry with such a large sample size reported in literature. It is a detailed statistical survey and contains new centile-based reference charts for fetal height of cerebellar vermis measurements. © 2016 Cignini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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