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Biomedical subjects

L Guariglia

Publications and source records attributed to L Guariglia.

At least 19 recordsLinked to original sources
PubMed2005

[Postpartum hemorrhage].

Postpartum hemorrhage, frequently due to uterine atony, is an important cause of maternal death and morbidity. The knowledge of causes, of antenatal and intrapartum risk factors and of physiopathological changes in hemodynamics and coagulation during pregnancy are essential for the management of the condition. At the present time, many efforts are made to organize a multidisciplinary approach to this complication of delivery involving clinical and laboratory staffs, since the rapid correction of hypovolemia, the diagnosis and treatment of defective coagulation, the surgical and pharmacological control of bleeding are mandatory. Several medical options have been developed and the surgical management includes traditional and newer conservative procedures with variable success rates. The developments in the treatment of postpartum hemorrhage may reduce hysterectomy that is to be considered the last resort to resolve the hemorrhage in some cases. In the modern management of postpartum hemorrhage protocols and guidelines should be available in every delivery room.

Embolization, Therapeutic↗
PubMed2004

Intra- and interobserver repeatability of femur length measurement in early pregnancy.

OBJECTIVE: To assess the intra- and interobserver reproducibility of songographic measurement of fetal femur length between 10 and 16 weeks of gestation. METHODS: Femur length was measured three times by the same trained observer in each fetus of 136 pregnant women. A second trained observer then repeated the measurements. The coefficient of variation, intraclass correlation coefficient and repeatability coefficient with 95% CIs were calculated for each observer and between the two observers. RESULTS: The inter- and intraobserver repeatabilities of femur length were good. For interobserver correlation, the coefficient of variation was 4.6% (95% CI, 3.0-6.2), the intraclass correlation coefficient was 0.82 (95% CI, 0.69-0.95) and the repeatability coefficient was 2.1 (95% CI, 1.8-2.7). For intraobserver correlation, the coefficient of variation was 4.2% (95% CI, 3.2-5.6), the intraclass correlation coefficient was 0.91 (95% CI, 0.75-0.97) and the repeatability coefficient was 3.23 (95% CI, 2.33-3.86) for Observer 2. Similar results were obtained for the other observer. CONCLUSION: Transvaginal femur length measurement is technically feasible and easy to perform between 10 and 16 weeks of gestation. The high degree of intra- and interobserver repeatability indicates it to be a reproducible method.

Adult↗
PubMed2004

[Therapy and prevention of obstetric hemorrhage by tamponade using a balloon catheter].

The aim of this study was to verify the possibility to use a balloon catheter as hemostatic method in pregnancies at high risk for hemorrhage as an alternative to less conservative surgical procedures. In 4 pregnancies at risk for hemorrhage, a compressive endouterine or endocervical method, consisting of a balloon catheter filled of warm saline solution, was used in order to stop or to prevent otherwise uncontrollable bleeding. In the cases treated the use of the balloon catheter was safe and effective both in the treatment of hemorrhage due to abnormal placentation and in the prevention of hemorrhagic complications due to abnormal implantation of pregnancy. Among novel medical and surgical approaches developed to control obstetric hemorrhage, tamponade using a balloon catheter could be considered a valid option. Moreover, this procedure, by avoiding radical surgical treatments, such as hysterectomy, which are frequently performed in unstable patients, could offer the advantage of preserving fertility.

Balloon Occlusion↗
PubMed2002

A new mathematical formula for predicting long bone length in early pregnancy.

OBJECTIVE: To propose new mathematical formulae to estimate fetal long bone biometry in early pregnancy and to establish their efficacy in comparison to previously constructed mathematical formulae. METHODS: A study population of 1960 singleton euploid fetuses was referred for transvaginal ultrasound examinations between 71 and 112 days of gestation prior to genetic amniocentesis. To determine the relationship between the biparietal diameter and long bone length, a sample group of 400 randomly chosen normal fetuses was evaluated. Regression equations were derived, then tested in the remaining 1560 control fetuses and compared with previously reported mathematical formulae by other authors. Mean absolute error, mean absolute percentage error and mean systematic error with their standard deviations were calculated. RESULTS: The relationships between femur or humerus length vs. biparietal diameter (BPD) and gestational age (GA) were, respectively: expected femur length = -16.92108 + 0.4569402 x BPD + 0.171617 x GA (P < 0.001) and expected humerus length = -16.28531 + 0.4283019 x BPD + 0.1696017 x GA (P < 0.001). The confidence intervals of the predicted values for different values of biparietal diameter and gestational age and confidence intervals for the regression coefficients, such as the distribution of the residuals, are given. All previous formulae obtained by transabdominal ultrasound demonstrated an overestimation of expected long bones measurements; this was reduced using different formulae obtained in early pregnancy. Using our mathematical formulae, the mean absolute percentage error and the mean systematic error in estimating femur and humerus length were very low (11.15% and -2.02%; 10.59% and -1.74%, respectively). CONCLUSIONS: The new ultrasonographic morphometric models derived from transvaginal measurements in early pregnancy show a good reliability in estimating fetal long bone length.

Female↗
PubMed2002

[Early transvaginal measurement of cephalic index for the detection of fetuses at risk for Down syndrome].

BACKGROUND: The aim of this study was to evaluate the utility of cephalic index screening in early pregnancy for the identification of fetuses at risk for trisomy 21. METHODS: Measurements of cephalic index, calculated as the ratio between biparietal diameter/occipito-frontal diameter, were obtained in 36 Down syndrome fetuses and the values were compared with normal data in the same gestational periods considered. RESULTS: Cephalic index was found to show fairly constant values throughout the period evaluated. The measurements obtained in Down syndrome fetuses were similar to those obtained in euploid fetuses. CONCLUSIONS: The data obtained show that in early pregnancy cephalic index cannot be considered a useful tool in the detection of fetuses at risk for Down syndrome.

Cephalometry↗
PubMed2002

[Early transvaginal sonographic measurement of cephalic index].

BACKGROUND: The aim of this study is to obtain normal values of cephalic index by transvaginal scan early in pregnancy. METHODS: In this prospective cross-sectional study, transvaginal high-resolution sonography was performed between 57 and 112 days' gestation in 1087 euploid fetuses. Measurements of cephalic index with standard deviations, calculated as the ratio biparietal diameter/occipito-frontal diameter, were obtained in the single gestational periods considered. RESULTS: Cephalic index was found to show fairly constant values throughout the period evaluated with smaller values of standard deviation. The best correlation with gestational age was described by a linear correlation. CONCLUSIONS: The data obtained by transvaginal scan can be used as parameters of normal values in early pregnancy.

Cephalometry↗
PubMed2001

Endovaginal sonographic diagnosis of the fetal urinary tract anomalies in early pregnancy.

Transvaginal sonography has enhanced the ability to follow fetal development and detect pathologies in early gestation. Examination of the fetal urinary tract is an integral part of routine sonographic examinations in the second trimester of pregnancy and one of the major benefits of prenatal sonography is to allow early diagnosis of relatively common urinary tract malformations. Detailed evaluation of the fetal urinary tract and identification of anomalies were considered to be difficult before the 18th week of gestation prior to the use of transvaginal sonography. Using the transvaginal route, a detailed evaluation of the kidneys is possible around 12 weeks and structural anomalies of the urinary tract are being detected at an ever-increasing rate. Transvaginal sonography, owing to its proximity to the maternal pelvic organs, allows an earlier determination of the normal fetal urinary system and more accurate diagnosis and identification of fetal urinary anomalies as compared with transabdominal ultrasound.

Female↗
PubMed2000

Acceptability of early transvaginal or abdominal sonography in the first half of pregnancy.

OBJECTIVE: To evaluate the acceptability of early transvaginal sonography by pregnant patients. METHODS: A questionnaire was completed by 246 patients and the resulting data were analysed. RESULTS: The incidence of discomfort was higher for the transabdominal than for the transvaginal route. Moreover, the transvaginal approach in early pregnancy, when compared with other transvaginal sonographic examinations was described as more satisfactory in 95% of cases. CONCLUSIONS: Transvaginal sonography in early pregnancy is better tolerated than transabdominal sonography.

Female↗
PubMed2000

Transvaginal sonographic detection of embryonic-fetal abnormalities in early pregnancy.

OBJECTIVE: To estimate the detection rate of abnormalities by transvaginal ultrasound in early pregnancy. METHODS: We prospectively analyzed records of 3592 sequential pregnant women at 10-16 weeks' (singleton) gestation (mean 13 weeks and 2 days). After exclusion of 114 women, there were 3478 women in the study. Each woman underwent a transvaginal sonographic survey for fetal anomalies as well as biometric measurements. Fetuses diagnosed with malformations were followed to delivery, and those without underwent transabdominal sonography at 18-24 weeks' gestation. RESULTS: The anomaly detection rate by transvaginal ultrasound was 51.6% (33 of 64; 95% confidence interval [CI] 38.7, 64.2) in early pregnancy, and the detection rate by transvaginal ultrasound combined with second-trimester transabdominal ultrasound was 84.4% (54 of 64; 95% CI 73.1, 92.2). Cystic hygroma and fetal hydrops were the anomalies detected most frequently by transvaginal ultrasound. Low detection rates for abnormalities of the face and of the cardiac, skeletal, and urinary systems were found even when both methods were used. CONCLUSION: Transvaginal sonography appears to be an effective way to identify many congenital fetal anomalies in early pregnancy. There is a good probability of diagnosing cystic hygroma and fetal hydrops, although other abnormalities, particularly heart defects, are associated with lower detection rates.

Adolescent↗
PubMed2000

Prognostic value of ultrasound findings of fetal cystic hygroma detected in early pregnancy by transvaginal sonography.

OBJECTIVE: To assess the prognostic value of first and early second trimester transvaginal ultrasound findings of fetal cystic hygroma such as volume, presence of septa and associated fetal anomalies or malformations. DESIGN: A prospective study of fetal cystic hygroma volume detected at 10-15 weeks of gestation by transvaginal scan. SUBJECTS: The study comprised a series of 33 cystic hygromas detected throughout the period March 1994 to March 1998 in 1918 pregnant women. METHODS: The volume of the hygroma and the presence of septa and other associated fetal anomalies or malformations were evaluated and correlated with fetal karyotype, persistence of the hygroma and pregnancy outcome. RESULTS: A volume equal to or greater than 75 mm3 revealed a sensitivity of 66.7% [eight of 12 cases; 95% confidence interval (CI), 34.9-90.1%] for the identification of abnormal fetal karyotype, 72.7% (eight of 11 cases; 95% CI, 39.0-90.4%) for the identification of persistence of the hygroma and 90% (nine of 10 cases; 95% CI, 55.5-99.7%) for identification of an unfavorable outcome of pregnancy. Furthermore, the prognostic value of ultrasound in determining pregnancy and fetal outcome were improved by combining data on the volume of the hygroma and the presence of associated anomalies or malformations. CONCLUSIONS: Measuring the volume of a cystic hygroma proves to be a useful ultrasound prognostic indicator in determining the risk of an associated karyotypic abnormality and adverse fetal and pregnancy outcome. However, due to limited sample size, caution is required in interpretation of the data and further studies are needed.

Female↗
PubMed2000

Clinical significance of placenta previa detected at early routine transvaginal scan.

Transvaginal ultrasonography in early pregnancy was used to determine the prevalence of placenta previa and the rate of persistence until delivery. The location of the placenta was registered systematically in 2342 pregnant women who underwent transvaginal ultrasonography at 10 to 16 weeks' gestation as a primary examination. The outcome of pregnancy as well as the presence or absence of placenta previa at delivery was noted in a total of 2158 cases. A receiver operating characteristic curve was generated for the different measurements from the edge of the placenta to the internal cervical os versus placenta previa at delivery. In 105 of the 2158 women screened in the early stages of pregnancy (4.9%) the placenta extended to or over the internal cervical os, and in 34 of 2158 patients (1.6%) the distance to the placental edge beyond the internal cervical os was equal to or greater than 14 mm. Of the eight cases of placenta previa at delivery, six (75%) were identified in our study, and two cases were missed. When a cutoff value of greater than 14 mm is used for the receiver operating characteristic curve the likelihood is 17.6% (95% confidence interval = 6.8 to 34.5) for placenta previa at delivery. Although a high percentage of false-positive results occur owing to the low prevalence at delivery, this screening procedure can identify high-risk patients who should be rescanned later in pregnancy.

Adolescent↗
PubMed2000

[Estimate of fetal long bone length in early pregnancy: comparison between mathematical formulae].

BACKGROUND: The aim of this study was to determine the efficacy of different mathematical formulae described in the literature and to propose new mathematical formulae to estimate fetal long bones biometry in early pregnancy. METHODS: In 1481 singleton euploid fetuses a transvaginal ultrasound examination was performed between 9 and 16 week's gestation. To determine the relationship between the biparietal diameter and long bone lengths, a sample group of 100 randomly chosen normal fetuses was evaluated by regression equations. The equations derived were then tested in the remaining 1381 control fetuses and the mean absolute percentage error and the mean systematic error with their standard deviations were compared with previously reported mathematical formulae by other authors. RESULTS: All previous formulae described in literature when applied to our population revealed an overestimation of expected long bones measurements. Using our mathematical formulae, the mean absolute percentage error and the mean systematic error were 11.5% and 1% in estimating femur and 10.9% and 0.8% in estimating humerus length, respectively. CONCLUSIONS: These newly derived ultrasound morphometric formulae could be proposed as reliable models in estimating fetal long bone lengths in early pregnancy.

Anthropometry↗
PubMed1999

Ultrasound-guided fine needle aspiration of ovarian cysts during pregnancy.

OBJECTIVE: To evaluate the safety and efficacy of ultrasound-guided fine needle aspiration in the treatment of ovarian cysts during pregnancy. STUDY DESIGN: Nine out of twenty-nine patients between the 6th and the 16th week of gestation with unilateral ovarian cysts ranging between 65 and 540 cm3 in volume were selected for sonographically-guided fine needle aspiration. RESULTS: No complications were observed at either short or long-term follow-up; all patients delivered healthy infants at term. Clinical and sonographic post-partum follow-up was uneventful in all cases. In three cases it was necessary to repeat the procedure once and in one case twice during pregnancy. In one case a recurrent serous cyst was excised at operative laparoscopy performed 3 months after delivery. CONCLUSIONS: Ultrasound-guided fine needle aspiration was safely performed in nine patients as an alternative treatment to surgery when persistent monolateral and unilocular ovarian cysts with regular borders and completely anechoic structure are detected during pregnancy.

Adult↗
PubMed1999

Prevalence and significance of isolated fetal choroid plexus cysts detected in early pregnancy by transvaginal sonography in women of advanced maternal age.

This study examines the prevalence of isolated fetal choroid plexus cysts (CPCs) detected in early pregnancy by transvaginal sonography in an increased genetic risk population and their association with abnormal fetal karyotype. A prospective study was performed on 1692 pregnant women (>37 years) who underwent transvaginal scan at 11-16 weeks' gestation before genetic amniocentesis. The prevalence of isolated CPCs in our population was 1.48 per cent. An abnormal fetal karyotype was found in one case (4 per cent). It was concluded that if fetal CPCs are apparently isolated, genetic amniocentesis is not mandatory and additional risk factors such as advanced maternal age should be the main indication for fetal karyotyping.

Adult↗
PubMed1998

Isolated mild fetal pyelectasis detected by transvaginal sonography in advanced maternal age.

OBJECTIVE: To evaluate the importance and evolution of isolated, mild fetal pyelectasis, detected in early pregnancy by high-resolution transvaginal sonography, and to determine its association with abnormal fetal karyotypes. METHODS: Transvaginal scan at 11-16 weeks' gestation and transabdominal ultrasound examinations at the time of amniocentesis (16-18 weeks) were performed in 1093 pregnant women undergoing genetic amniocentesis because of advanced maternal age. In 795 cases, transabdominal scans were repeated at 22-24 weeks. Women were excluded if they had a spontaneous abortion, chose to terminate their pregnancy, or declined amniocentesis. Each patient was screened for fetal pyelectasis, defined as an increase in anteroposterior renal pelvic diameter, using cutoff values related to various stages of pregnancy. RESULTS: Isolated fetal pyelectasis was detected at the first ultrasound examination in 56 women (5.1%) in early pregnancy, in 32 (2.9%) at the time of amniocentesis, and in 23 (2.9%) at 22-24 weeks' gestation. Two fetuses with diagnoses of mild pyelectasis at the first transvaginal ultrasound demonstrated abnormal karyotypes at amniocentesis. In one case, the pyelectasis disappeared at 22-24 weeks' gestation. CONCLUSION: This retrospective study shows that pyelectasis is more frequently detectable by high-resolution transvaginal sonography in the first half of pregnancy than in the second half. When detected in early pregnancy, the finding is frequently transient and not associated with an increased risk of abnormal fetal karyotypes.

Adult↗
PubMed1997

Transvaginal fetal biometry in early pregnancy.

OBJECTIVE: To produce reference charts for fetal size with transvaginal sonography that are potentially helpful in evaluating normal and abnormal early pregnancies. DESIGN: A prospective cross-sectional study. SUBJECTS: 1081 normal singleton pregnancies with a normal fetal karyotype or normal healthy baby at delivery, at 9-16 weeks' gestation. Measurements included crown rump length, biparietal diameter, transverse cerebellar diameter, head and abdominal circumference, mean abdominal diameter, thoracic circumference, femur length, humerus length and foot length. RESULTS: The best description of the relationship between single ultrasonographic parameters and gestational age was achieved by polynomial regression analysis. All fetal biometric parameters correlated closely with gestational age. Biparietal diameter maintained the closest correlation with gestational age (r2 = 97.15, p < 0.001; y = -0.545 - 0.06x + 0.15x2); transverse cerebellar diameter showed the poorest correlation with gestational age (r2 = 88.17, p < 0.001). Reference ranges (5 degrees and 95 degrees percentile intervals) were constructed for all biometric parameters in relation to gestational age. Mean residuals are similar for all parameters with a very low range. CONCLUSIONS: These data provide normograms for first and early second trimester fetal measurements which may be of aid in the dating of pregnancies and can be useful in the early detection of genetic disorders affecting the growth of fetal structures.

Anthropometry↗