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Objective: In Italy the percentage of repeated abortions is about 24%. Long-acting reversible contraceptive (LARC) methods are currently considered the most effective mode worldwide and are associated with the highest rate of 12-months continuation, with a potential reported reduction of recurrent abortions. The aim of this study was evaluating LARC continuation and the patients' satisfaction at two and twelve months in use. Materials and methods: A longitudinal observational study collected women who underwent surgical abortion and placed a LARC method at the time of abortion in our hospital. Results: Totally 828 women underwent surgical abortion during the study period from which 434 choose a LARC method. After two months the rate of continuation of 52mg LNG IUD was 100% in women presenting for follow-up. Continuation rate at one year was approximately 70% for all LARC methods. More than 70% of women declared themselves satisfied or very satisfied with all LARC methods. Conclusion: Despite a high rate of patient loss at follow-up, LARC methods showed a high rate of continuation at two and twelve months, with a high degree of patients' satisfaction. [ABSTRACT FROM AUTHOR]

Primary ovarian melanoma arising on a mature ovarian cystic teratoma is extremely rare. As best of our knowledge, to date, 49 cases have been reported in literature. Few information was reported about best management and therapy. We present a case occurred in a 69-year-old woman, without symptoms, who come to our unit for stress incontinence. A pelvic mass was detected and, after imaging evaluation, surgery was performed. The diagnosis was ovarian melanoma arose on a mature teratoma. No other adjuvant treatment was proposed after surgery. She died 9 months after the first diagnosis. Primary ovarian melanoma is a definite entity associated with a variable natural history and poor prognosis. Differential diagnosis is a challenge for the pathologist, because it must be differentiated by metastatic melanoma. The corner stone treatment of this disease is surgery; however, chemotherapy, immunotherapy, and target therapy seem to have a role.

We reported a case of secondary abdominal pregnancy with placental implantation into the fallopian tube, diagnosed at 16 weeks, in a woman admitted to the emergency room complaining of syncopal attacks. The best approach would be termination of the pregnancy, taking into consideration the high risk to the mother and the low possibility of alive and healthy birth. We had to perform an urgent surgical intervention due to the fact that the patient was in a clinically unstable condition, which was related to hemoperitoneum. If placental implantation is on abdominal organs or vessel the best approach would be to ligate the cord and to leave placenta in situ. Taking into consideration the place of placental implant, the removal of the fallopian tube with the placenta was the safest approach in this case. The best and most acceptable form of treatment would be individualized in case of rare form of ectopic pregnancy.

The percentage of repeat abortion in Italy is about 25%. It is therefore important to implement the strategies that can facilitate the adoption of the most effective contraceptive methods. Long-acting reversible contraceptive methods are currently considered the most effective and with the highest rates of 12-months continuation, with a reported reduction of recurrent abortion. Our study has the aim to evaluate the contraceptive choice of women requesting abortion, when an accurate and dedicate counselling is offered and the availability of a LARC method is given immediately after pregnancy termination, both in case of surgical and medical abortion. LARC methods were chosen both in case of surgical and medical abortion, by an high percentage of patients. We reported no differences between the surgical and pharmacological groups on the choice of LARC and SARC. Our observational study shows the feasibility to perform an accurate, dedicate, and personalised counselling on contraception at time of abortion. This approach has enabled a high number of women to have a LARC method inserted at the time of abortion, as a valid strategy to prevent the risk unplanned pregnancy. Repeated abortion is an international problem which could be reduced by LARCs methods use. Contraceptive counselling during hospitalisation for abortion could implement the use of LARC. [ABSTRACT FROM AUTHOR]

Placenta Accreta Spectrum disorders (PASd) refer to the range of pathologic adherence of placenta associated with high maternal morbidity and mortality due to severe and sometimes life-threatening hemorrhage at the time of delivery. The aim of this study is to describe the surgical technique of extraperitoneal retrograde hysterectomy, which has allowed a reduction of blood transfusions compared to patients who underwent classical post-partum hysterectomy. We collected data from twelve patients with antenatal diagnosis of PASd treated between 2018 and 2021 with an extra-peritoneal hysterectomy using a posterior retrograde approach and we compared them to patients who underwent classical hysterectomy for suspected PASd, treated between 2007 and 2017. The classical hysterectomy group presented a higher frequency of blood and plasma transfusion compared to the extraperitoneal hysterectomy group. In particular, classical hysterectomy resulted in an independent risk factor for transfusion, with an increment of 6.6 times of risk. Even if future studies are required, we think that extraperitoneal hysterectomy could be a safe option in case of PASd, considering that classical hysterectomy compared to this approach increases, in our population, the risk of blood and plasma transfusion. [ABSTRACT FROM AUTHOR]

Objective: In fertile women, hysterocele is a rare condition. Genital prolapse can be treated conservatively with laparoscopic hysterosacropexy. It is objected to present a successful case series of laparoscopic hysteropexy for patients with hysterocele after vaginal delivery. Case report: We presented a successful case series of three patients with III or IV degrees of hysterocele who were treated conservatively with an uncomplicated laparoscopic hysteropexy within a year of delivery. Given our patients' young ages and the fact that they all have infant children at home, we chose a conservative surgery performed laparoscopically due to the lower surgical impact and quicker return to normal life. All surgical procedures were successfully performed, without complications, with a prompt recovery of all women and with a regular subsequent follow-up, without recurrence nowadays. Conclusion: For young women who have not terminated their desire to bear children, laparoscopic hysterepexy may be a safe and effective surgical option. [ABSTRACT FROM AUTHOR]

Objective: In case of uterine prolapse, hyseroxacropexy, a conservative surgical approach, which allows the sparing of body image and sexuality, could be the choice in fertile women. Few information are reported on subsequent pregnancy after surgery. Case report: A 33 years-old women with symptomatic prolapse underwent a laparoscopic hysterosacropexy. Subsequently she expressed her pregnancy desire and she got pregnant. A scheduled caesarean section was performed without complication. The subsequent follow-up was regular: the patient was asymptomatic and presented no sign of prolapse recurrence. Conclusion: In motivate and well counselled patient, informed about the risk of prolapse recurrence, pregnancy could be considered after hysterosacropexy. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the clinical utility of placental growth factor (PlGF) for the prediction of preeclampsia (PE).Materials and Methods: This prospective cohort study included women divided into three groups: (1) pregnancies without preconceptional risk of developing PE; (2) pregnancies with a preconceptional and/or current risk of developing PE; (3) PE-complicated pregnancies (control group). Blood samples were collected every 4-5 weeks or during hospitalization from early second trimester until delivery in the group 1 and 2, at the diagnosis of PE in the group 3. Plasma levels of PlGF were measured using The Triage PlGF test (Alere) and considered pathological under the 5th centile for gestational age. Sensitivity (Sn), specificity (Sp), positive and negative predictive value (PPV, NPV) were calculated.Results: In group 1, 30% of women (3/10) had pathological test but none of them developed PE (Sp 70%, NPV 100%). In group 2 (n = 75), none of the patients with normal test developed PE (0/24), while 39% of women with PlGF < 5th centile (20/51) developed PE (Sn 100%, Sp 44%, PPV 39%, NPV 100%). In group 3 (n = 11) all women except one had a pathological PlGF test (Sn 90%, PPV 100%).Conclusions: Our data support recent studies which identify PlGF as a biochemical marker not only of PE, but also of placental dysfunction. In fact, it is useful for ruling out PE in women at risk because of the high Sn and high NPV: a normal PlGF is related with a positive pregnancy outcome. Therefore, the measurement of this biomarker would simplify PE clinical management and would reduce costs. [ABSTRACT FROM AUTHOR]

This letter to the editor discusses the management of scar pregnancy using a double cervical balloon. The authors share their experience with a case of scar pregnancy and highlight the use of Doppler evaluation to guide management decisions. They emphasize the possibility of a non-surgical and non-invasive approach using a double cervical ripening balloon, which was well tolerated by the patient. Despite difficulties in placing the balloon, they were able to achieve detachment of the pregnancy sac and a reduction in myometrial vascularization, leading to a successful hysterosuction procedure with minimal bleeding. The authors suggest that this approach may be a viable option for scar pregnancy management. [Extracted from the article]

Objective: Primary malignant urethral melanoma is a rare condition, concerning less than 1% of melanomas and 4% of all urethral cancers. The early treatment of urethral melanoma is extremely important due to the tendency to early metastasis. Case report: 88-year-old Caucasian lady presented vaginal bleeding. At first Gynaecological examination an urethral caruncle with otherwise normal trans-vaginal ultrasound was diagnosed. The patient not reassured asked for a second consultation opting to remove the reddish fleshy polypoid lesion protruding from the urethra. Histology revealed a urethral amelanotic melanoma. The patient underwent an excission of the urethral lesion. Urologist, oncologist and gynaecologist at tumor board meeting, considering patient's age and negative PET, decided for conservative management with close clinical and imaging follow-up.7 months after, vaginal bleeding recurred and a nodule on the anterior vaginal wall was detected and biopsied and resulted a pigmented melanoma. The patient underwent a wide margin excision. At 10 months follow-up there were no evidence of recurrence nor distant metastasis. She started a prophylactic immunotherapy with Nivolumab; at her third administration she presented only asthenia as side effect. Conclusion: It is importanto to keep in mind the urethral amelanotic melanoma to allow an early removal or biopsy, preventing diagnostic delay/misdiagnosis and aiding either in better patient management or outcome. [ABSTRACT FROM AUTHOR]

The aim was to demonstrate that the technique of near infrared range/indocyanine green (NIR/ICG) could aid the detection of inguinal sentinel lymph nodes in patients with vulvar cancer, in addition to technetium-99m (Tc-99m) scanning. We present a case report of sentinel lymph node detection in a patient with vulvar cancer with two methods: Tc-99m scan and NIR/ICG. The video showed that bilateral inguinal lymph nodes were detected both by Tc gamma probe and NIR/ICG. NIR/ICG may be a safe and effective alternative method for identifying sentinel lymph nodes in cases of early-stage vulvar cancer, although more evidence is required. [ABSTRACT FROM AUTHOR]

Objective: Syringoma is a benign adnexal neoplasm of sweat gland, usually presenting as extra-genital lesions, while vulvar localization is rare. Moreover, syringoma is an uncommon vulvar neoplasms. Case report: A 44-year-old woman with previous diagnosis of duodenal gastrointestinal stromal tumour, underwent a local surgical excision for an isolated, painful, vulvar lesion. The specimen was submitted for histological examination. A vulvar syringoma was diagnosed. Conclusion: We describe this case according on its rarity and atypical presentation as well; therefore, vulvar neoplasms encompass many differential diagnoses, among which the incidence rate of syringoma is very low. Although its rarity, syringoma should be included among the differential diagnosis for vulvar neoplasm. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has rapidly spread worldwide, with severe complications affecting particularly elderly and compromised subjects. Less information about COVID-19 in pregnancy has been reported so far in the literature.Methods: Case series on pregnancies complicated by COVID-19. All cases were diagnosed at Bolognini Hospital, Seriate, Italy. These cases are presented to clarify the features of COVID-19 occurring in pregnancy.Results: Four women had symptoms of COVID-19 during pregnancy or immediately after delivery. All cases were confirmed by oropharyngeal swab. All patients presented with fever and low saturation levels at the diagnosis. One case was transferred after diagnosis to a tertiary referral center and delivered the day after for worsening clinical conditions. In the other three cases, bilateral pneumonia was documented at the admission. Antithrombotic therapy was used in most cases. No cases of the infected neonate was reported. At 2 month follow-up, all patients were alive, three were asymptomatic while one presented neurological complication. One more case was described because suspicious for COVID-19, however, it was not confirmed by oropharyngeal swab.Conclusions: In pregnant women, the peripheral nervous system could be affected. No case of trans-placental passage was reported. The swab could be helpful in diagnosis. The antithrombotic therapy could play a role in the positive course of COVID-19 also in pregnant women. [ABSTRACT FROM AUTHOR]

Introduction: Autologous and heterologous assisted reproductive technology (ART) conceptions have been on the rise for the last few decades and alongside with that have the rate of multiple pregnancies. Multiple gestations are associated with high odds of gestational complications and, in turn, adverse delivery and feto-neonatal outcomes. Whether ART-conception further increases such elevated risk is still debated. ART is more commonly accessed by older women with chronic diseases, which relate to heightened likelihood of complications. We decided to investigate the influence of autologous and heterologous ART conception compared to spontaneous conception on delivery and feto-neonatal outcomes of diamniotic twin pregnancies in a cohort of healthy women with no chronic conditions or gestational complications.Materials and methods: Retrospective cohort study among diamniotic twin pregnancies in mothers without pregestational or gestational disease. Delivery and feto-neonatal outcomes were compared among three groups according to mode of conception: (1) spontaneous conception (SC, referent group, n = 251 pregnancies), (2) autologous ART-conception (A-ART, n = 87), and (3) heterologous ART-conception (H-ART, n = 22).Results: At adjusted analyses, twin pregnancies conceived by A-ART showed a twofold heightened risk of delivery by urgent/emergent cesarean section, as well as four and sevenfold increase in odds of blood loss >1000 and >1500 mL, respectively. H-ART pregnancies were at fivefold higher risk of undergoing prelabor cesarean section compared to SC, whereas no differences were identified for odds of severe post-partum hemorrhage. Also, A-ART and H-ART gestations displayed fetal and neonatal outcomes similar to SC pregnancies when analysis was adjusted for relevant confounding factors.Conclusion: Our results suggest that both A-ART and H-ART conception associate with increased odds of operative delivery among diamniotic twin pregnancies in healthy mothers with no chronic diseases or gestational complications. Also, a higher risk of severe postpartum hemorrhage appears to relate to A-ART independent of mode of delivery and maternal age. Further studies with larger series of uncomplicated twin pregnancies are warranted to improve our understanding of the relationship of ART to adverse delivery outcomes. [ABSTRACT FROM AUTHOR]

Objective: Optimal management of twin deliveries is controversial. We aimed to assess if intertwin delivery interval, after vaginal delivery of the first twin, may have an influence on adverse neonatal outcomes of the second twin Study design: This is a retrospective observational study including diamniotic twin pregnancies with vaginal delivery of the first twin, between January 2000 and July 2017. Inclusion criteria were diamniotic pregnancies and vaginal delivery of the first twin. We excluded higher twin order, monoamniotic pregnancies, cesarean delivery of the first twin and patients with missing data. Results: A number of 400 diamniotic twin pregnancies met the inclusion criteria and were divided, considering intertwin delivery interval into (1) ≤30 minutes (n = 365); and (2) >30 minutes (n = 35). Considering the two study groups, maternal and first twin characteristics and outcomes were similar. Second twin reported higher incidence of cesarean section and vacuum delivery, but similar incidence of neonatal adverse outcomes, in case of intertwin interval >30 minutes. At multivariate analysis, a difference between second and first twin weight ≥25% was correlated to neonatal adverse outcome, while we did not found this correlation with a cut-off of 30 minutes. Conclusions: In our study, growth discrepancy between twins was significantly correlated to adverse neonatal outcomes, while intertwin delivery time was not an influencing factor. So, in line with this result, in our clinical practice, we do not use a fixed time in which both twins should be delivered, neither in monochorionic nor in dichorionic pregnancies, when fetal wellbeing was demonstrated during labor. [ABSTRACT FROM AUTHOR]

Objective: Optimal management of twin deliveries is controversial. We aimed to assess potential risk factors correlated to the development of hypoxia in the second twin after vaginal delivery of the first twin. Study design: This is a retrospective observational study including diamniotic twin pregnancies delivering at our Institution at 35 weeks of gestational age or more, weighing ≥1800 g. Hypoxia was defined as at least one of the following: Apgar score <5 at 10 minute, neonatal resuscitation for >10 minutes, neonatal acidosis (pH ≤7 and/or BE ≥12 mmol/L). Results: A number of 275 diamniotic twin pregnancies met the inclusion criteria and were divided within the following groups: (1) second twin not developing neonatal hypoxia (n = 265); and (2) second twin developing neonatal hypoxia (n = 10). The rate of second twins with neonatal hypoxia during the study period was 3.6% (10/275). Abnormal cardiotocography during the intertwin delivery interval, defined as ACOG category III, was significantly correlated to second twin hypoxia. Of interest, there was no significant difference in the intertwin delivery interval between the study groups. In addition, breech presentation of the second twin did not show to be a risk factor for neonatal hypoxia. None of the second twins developing neonatal hypoxia was reported to have encephalopathy (follow up of at least 24 months). At multivariate analysis, only abnormal cardiotocography was an independent risk factor for second twin hypoxia (OR 17.8, 95% CI 4.1–77.2). Conclusions: In our study, neonatal hypoxia was significantly correlated to abnormal cardiotocography, while intertwin delivery interval was not correlated to the development of this adverse neonatal outcome. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to assess, in a population of dichorionic twin pregnancies with selective growth restriction, the effect of inter-twin differences by use of Doppler velocimetry and fetal growth discordancy on perinatal outcomes. Methods: This was a retrospective study including dichorionic twin pregnancies from January 2008 to December 2015 at the Department of Obstetrics and Gynecology of Fondazione MBBM. Only dichorionic twin pregnancies affected by selective intrauterine growth restriction (IUGR) delivering at ≥24 weeks were included in the study. Results: We found that twin pregnancies with inter-twin estimated fetal weight (EFW) discordance ≥15% were significantly associated with a higher risk of preterm delivery before 32 (P=0.004) and 34 weeks (P=0.04). Similarly, twin pregnancies with inter-twin abdominal circumference (AC) discordance ≥30° centiles were associated with a higher rate of neonatal intensive care unit (NICU) admission (P=0.02), neonatal resuscitation (P=0.02) and adverse neonatal composite outcome (P=0.04). Of interest, when comparing twin pregnancies according to Doppler study, growth restricted twins had a higher rate of composite neonatal outcome and in multivariate analysis, an abnormal Doppler was an independent risk factor for this outcome. Conclusions: Our study associated growth discrepancy with specific pregnancy outcomes, according to defined cut-offs. In addition, we demonstrated that an abnormal umbilical artery Doppler is independently associated with a composite neonatal adverse outcome in growth restricted fetuses. [ABSTRACT FROM AUTHOR]

Fetal malformations are more frequent in twins than in singletons. The aim of our study was to define the influence of a malformed twin on di-chorionic pregnancy outcomes. We performed a retrospective cohort study of di-chorionic pregnancies delivered between 2000 and 2015. Exclusion criteria were: both twins affected by fetal malformations, double intra-uterine fetal death in pregnancies without fetal malformation, selective feticide and therapeutic pregnancy termination. We compared maternal and fetal outcomes of di-chorionic pregnancies not complicated by fetal malformations with pregnancies affected by a single malformed fetus with conservative management. We included 642 di-chorionic pregnancies: 56 (case group, 8.7%) with one twin affected by a malformation (20 minor, 36 major ones), 586 (control group, 91.3%) without fetal malformation. No differences were found on maternal and not malformed co-twin outcomes when compared to pregnancies with no malformation; case vs control group presented similar rates of preeclampsia (8.9% vs. 10.8%, respectively), intrauterine growth restriction (7.1% vs. 9.4%) and composite adverse neonatal outcomes (19.6% vs. 15.1%). No case of fetal death in not malformed co-twin was reported. Expectant management could be a safe option for both mother and co-twin in case of di-chorionic twin pregnancy complicated by only one malformed fetus. [ABSTRACT FROM AUTHOR]

Objective: Optimal management of twin deliveries is controversial. We aimed to assess potential risk factors correlated to the development of hypoxia in the second twin after vaginal delivery of the first twin. Study design: This is a retrospective observational study including diamniotic twin pregnancies delivering at our Institution at 35 weeks of gestational age or more, weighing ≥1800 g. Hypoxia was defined as at least one of the following: Apgar score <5 at 10 minute, neonatal resuscitation for >10 minutes, neonatal acidosis (pH ≤7 and/or BE ≥12 mmol/L). Results: A number of 275 diamniotic twin pregnancies met the inclusion criteria and were divided within the following groups: (1) second twin not developing neonatal hypoxia (n = 265); and (2) second twin developing neonatal hypoxia (n = 10). The rate of second twins with neonatal hypoxia during the study period was 3.6% (10/275). Abnormal cardiotocography during the intertwin delivery interval, defined as ACOG category III, was significantly correlated to second twin hypoxia. Of interest, there was no significant difference in the intertwin delivery interval between the study groups. In addition, breech presentation of the second twin did not show to be a risk factor for neonatal hypoxia. None of the second twins developing neonatal hypoxia was reported to have encephalopathy (follow up of at least 24 months). At multivariate analysis, only abnormal cardiotocography was an independent risk factor for second twin hypoxia (OR 17.8, 95% CI 4.1-77.2). Conclusions: In our study, neonatal hypoxia was significantly correlated to abnormal cardiotocography, while intertwin delivery interval was not correlated to the development of this adverse neonatal outcome. [ABSTRACT FROM AUTHOR]

Objective: Optimal management of twin deliveries is controversial. We aimed to assess potential risk factors correlated to the development of hypoxia in the second twin after vaginal delivery of the first twin. Study design: This is a retrospective observational study including diamniotic twin pregnancies delivering at our Institution at 35 weeks of gestational age or more, weighing ≥1800 g. Hypoxia was defined as at least one of the following: Apgar score <5 at 10 minute, neonatal resuscitation for >10 minutes, neonatal acidosis (pH ≤7 and/or BE ≥12 mmol/L). Results: A number of 275 diamniotic twin pregnancies met the inclusion criteria and were divided within the following groups: (1) second twin not developing neonatal hypoxia (n = 265); and (2) second twin developing neonatal hypoxia (n = 10). The rate of second twins with neonatal hypoxia during the study period was 3.6% (10/275). Abnormal cardiotocography during the intertwin delivery interval, defined as ACOG category III, was significantly correlated to second twin hypoxia. Of interest, there was no significant difference in the intertwin delivery interval between the study groups. In addition, breech presentation of the second twin did not show to be a risk factor for neonatal hypoxia. None of the second twins developing neonatal hypoxia was reported to have encephalopathy (follow up of at least 24 months). At multivariate analysis, only abnormal cardiotocography was an independent risk factor for second twin hypoxia (OR 17.8, 95% CI 4.1-77.2). Conclusions: In our study, neonatal hypoxia was significantly correlated to abnormal cardiotocography, while intertwin delivery interval was not correlated to the development of this adverse neonatal outcome. [ABSTRACT FROM AUTHOR]

Uterus didelphys accounts for 13% of uterine anomalies and has been correlated with preterm delivery and fetal malpresentation at delivery. A 37-year-old pregnant woman reported a spontaneous pregnancy in the right horn of a uterus didelphys. The course of the pregnancy was complicated by gestational diabetes, but no miscarriage threat or preterm delivery threat was reported during this pregnancy. She arrived at our division, in labor, at 39.2 gestational weeks'. She delivered by cesarean section due to failure to progress at 5 cm. Her post-operative course was uneventful. Vaginal delivery could be a safe option and the induction of labor or the use of oxytocin could be helpful in such cases, but recommended doses and labor time should be evaluated, so cesarean section is to date the most frequent delivery route in uterus didelphys at term. [ABSTRACT FROM AUTHOR]

Backgrounds: Maternal total weight gain during pregnancy influences adverse obstetric outcomes in singleton pregnancies. However, its impact in twin gestation is less understood. Our objective was to estimate the influence of total maternal weight gain on preterm delivery in twin pregnancies.Methods: We conducted a retrospective cohort study including diamniotic twin pregnancies with spontaneous labor delivered at 28 + 0 weeks or later. We analyzed the influence of total weight gain according to Institute of Medicine (IOM) cut-offs on the development of preterm delivery (both less than 34 and 37 weeks). Outcome were compared between under and normal weight gain and between over and normal weight gain separately using Fisher's exact test with Holm-Bonferroni correction.Results: One hundred seventy five women were included in the study and divided into three groups: under (52.0%), normal (41.7%) and overweight gain (6.3%). Normal weight gain was associated with a reduction in the rate of preterm delivery compared to under and over weight gain [less than 34 weeks: under vs. normal OR 4.97 (1.76-14.02), over vs. normal OR 4.53 (0.89-23.08); less than 37 weeks: OR 3.16 (1.66-6.04) and 6.51 (1.30-32.49), respectively].Conclusions: Normal weight gain reduces spontaneous preterm delivery compared to over and underweight gain. [ABSTRACT FROM AUTHOR]

Placental growth factor (PlGF) is an angiogenic molecule produced by the placenta and implicated in the pathogenesis of preeclampsia (PE) and intrauterine growth restriction (IUGR). We have evaluated utility and applicability of the PlGF test in a clinical setting of pregnancies at risk of PE or complicated by IUGR in order to assess its relationship with pregnancy outcomes. Seventy-three pregnancies were enrolled between 19 and 35 weeks: 57 pregnancies at risk of PE and 16 at diagnosis of IUGR. Maternal circulating PlGF levels were measured by the Triage PlGF test (Alere, San Diego, CA). Pregnancy outcomes were evaluated in relation to three categories of plasma PlGF levels: very low (<12 pg/ml), low (12–100 pg/ml) and normal (≥100 pg/ml). Uterine artery Doppler velocimetry (UADV) pulsatility index (PI) was measured in the same patients on the day of maternal sampling. Pregnancies at risk with very low plasma PlGF levels had significantly lower gestational age at delivery than patients with low or normal PlGF. The rate of emergency C-section was significantly higher in the group with PlGF <12 pg/ml. IUGR pregnancies with very low and low PlGF delivered earlier than patients with normal PlGF. All IUGR with very low and low PlGF had UADV PI > 95th percentile. Our data indicate that PlGF may provide useful information to identify fetuses requiring increased surveillance and possibly urgent delivery in pregnancies at risk of adverse outcomes. Furthermore, in IUGR, PlGF can predict adverse pregnancy outcomes that may be secondary to placental insufficiency. [ABSTRACT FROM AUTHOR]

Objective: PTX3, sFlt-1 and PlGF levels in maternal blood are altered in some obstetric diseases, such as preeclampsia (PE). Nonetheless, only few data on their expression in the fetal compartment have been reported so far. Study Design: An observational study was performed by prospectively collecting maternal and fetal serum samples in 51 singleton pregnancies divided into two groups: 22 PE women and 29 healthy controls. The relationships between maternal and fetal marker serum levels were evaluated by Spearman correlation. Results: A feto-maternal correlation was neither identified for PTX3 in either PE or control groups (1.1 versus 3.8 ng/ml, p = 0.17 and 0.9 versus 1.3 ng/ml, p = 0.30, respectively), nor for sFlt-1 and PlGF in healthy pregnancies (158.2 versus 3326.0 pg/ml, p = 0.28 and 11.0 versus 230.9 pg/ml, p = 0.51). In contrast, PE patients showed a significant positive feto-maternal correlation for both sFlt-1 and PlGF (324.1 versus 10 825.0 pg/ml and 7.8 versus 31.6 pg/ml, respectively, p = 0.02 for both markers). Conclusion: According to our results, an independent fetal production of the analyzed soluble angiogenic markers can be hypothesized in pregnancies complicated by PE. [ABSTRACT FROM AUTHOR]

Objective: Different etiologies for early- (<34.0 weeks) and late (≥34.0 weeks)-onset preeclampsia (EO-LO PE) are reported. The aim of our study is to identify influencing factors for the LO form. Methods: Retrospective study of 284 consecutive women diagnosed as preeclamptic at 22.4-41.5 weeks, from 3/2005 to 10/2011, evaluated in relation to EO versus LO PE. Results: LO PE was identified in 151 cases. Gestational Diabetes Mellitus (11% versus 4%, p = 0.04), body mass index (BMI) ≥35 kg/m2 (9% versus 2%, p = 0.03), pathological weight gain for BMI class (30% versus 13%, p = 0.001), ≥5 (58% versus 23%, p < 0.001) and ≥7 kg/m2 BMI increase (19% versus 9%, p = 0.04) were more common in LO than in EO PE. At Estimation Regression analysis weighted for Gestational Age (GA) at delivery BMI ≥35 and ≥5 kg/m2 BMI increase resulted related to LO PE (OR = 3.76, CI(95%) = 1.97-17.04; OR = 4.28, CI(95%) = 2.44-7.54). Conclusions: BMI ≥35 and ≥5 kg/m2 increase appeared as influencing factors for LO PE, thus supporting the role of systemic inflammation in its pathogenesis. [ABSTRACT FROM AUTHOR]

Heterotopic pregnancy is a rare condition, and its recognition could be highly challenging. We decided to report our cases, in which the evaluation of beta Human Chorionic Gonadotropin (HCG) level coupled with an ultrasound assessment played a pivotal role in diagnosis and clinical management. G2P1, spontaneous conception, came to the clinic for a routinely visit at 6.1 weeks. Her first trimester HCG level was 23,027 mUI/mL (normal: 217–7138 mUI/mL).

Introduction To evaluate the clinical utility of placental growth factor (PlGF) in the management of pregnancies complicated by preeclampsia (PE). Methods This prospective cohort study included women with a risk of developing PE. Blood samples were collected every 4–5 weeks from second trimester until delivery. Plasma levels of PlGF were stratified in very low (<12 pg/mL) or low (PlGF >12 pg/mL but <5th centile) and analyzed according to pregnancy outcome. Statistical analysis: Fisher’s test and ANOVA One Way. Results A total of 75 women were included, 20 developed PE: the ones with very low plasma levels ( n = 12) had a significantly lower gestational age at delivery ( p = 0.0003), lower birthweight ( p = 0.0009), and higher rate of emergency C-section outside labour ( p < 0.001) and a time from dosage to delivery shorter than women with low plasma PlGF levels ( p = 0.005). Conclusion Our data suggest that the decreasing of PlGF levels is associated with worse outcomes. Therefore the PlGF may be useful for risk stratification of pregnancies that require an intensive monitoring or delivery. This single biomarker would simplify the clinical management and would reduce costs. [ABSTRACT FROM AUTHOR]