Biomedical subjects

Stefania Fieni

Publications and source records attributed to Stefania Fieni.

14 recordsLinked to original sources

PubMed2006

Diagnostic accuracy of fetal renal pelvis anteroposterior diameter as a predictor of significant postnatal nephrouropathy: second versus third trimester of pregnancy.

OBJECTIVE: The objective of the study was to determine the most effective fetal renal pelvis anteroposterior diameter thresholds and the best gestational age in predicting significant neonatal nephrouropathy and neonatal nephrouropathy requiring surgery. STUDY DESIGN: Eighty-three newborns with prenatal ultrasound evidence of unilateral or bilateral fetal renal pelvis dilatation (anteroposterior diameter 4 mm or more) before the 26th week of gestation were systematically and prospectively investigated prenatally and postnatally. RESULTS: Receiver operating characteristic curve analysis showed that third-trimester anteroposterior diameter cut-offs were more reliable than second-trimester cut-offs in predicting significant neonatal nephrouropathy, the best threshold being 8 mm. No significant differences were found between the 2 trimesters in the screening of fetuses at risk of neonatal nephrouropathy requiring surgery. CONCLUSION: Significant neonatal nephrouropathy is better predicted at the third trimester, the best threshold being 8 mm, but the screening of patients at greater risk of surgery is also possible during the second trimester. An anteroposterior diameter of 11 mm or more, with an odds ratio of 128.33 (95% confidence interval 11.68 to 1408.98), is a very effective cut-off and a reliable prognostic indicator of neonatal nephrouropathy requiring surgery, even before the 26th week.

Adult↗

PubMed2006

Clinical management of paroxysmal nocturnal hemoglobinuria in pregnancy: a case report and updated review.

UNLABELLED: Because women with paroxysmal nocturnal hemoglobinuria (PNH) are especially vulnerable to thromboembolic phenomena, pregnancy is a time of increased risk for both mother and fetus. However, pregnancies in affected women are rare; only case reports and small studies have been reported so far. We present the case of a 20-year-old woman with PNH who, while undergoing medical tests in preparation for a bone marrow transplant, was discovered to be pregnant. We also review the obstetric literature on pregnancy complicated by PNH, which indicates that both maternal and fetal mortality is exceptionally high (11.6% and 7.2%) with the major cause of maternal mortality being thromboembolism. Major maternal complications are more frequent postpartum (30.2%) than antepartum or intrapartum (16.3%). TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to recall that paroxysmal nocturnal hemoglobinuria (PNH) during pregnancy increases adverse events for both the mother and the fetus, state that maternal and fetal mortality are both high, and explain that the major complications occur in the postpartum period.

Adult↗

PubMed2006

Changes in interleukin-6 and IGF system and their relationships in placenta and cord blood in newborns with fetal growth restriction compared with controls.

OBJECTIVES: The IGF system is central to fetal growth. Recently, the relationships between cytokines and the IGF system have been shown in specific tissues. It is unknown whether these occur in the placenta. The aim of this study was to assess whether interleukin-6 (IL-6) modulated the IGF system. METHODS: Whole villous tissue and cord serum were collected from fetal growth restriction (FGR) neonates diagnosed before birth with altered Doppler velocimetry and controls. Sixteen FGR and 20 controls, born after week 32 of gestation from elective Caesarean sections, were compared. Total RNA was extracted from the placenta samples, reverse transcribed, and real-time quantitative reverse transcriptase (RT)-PCR was performed to quantify cDNA for IGF-I, IGF-II, IGF binding protein (IGFBP)-1, IGFBP-2, and IL-6. The same proteins were assayed in placenta lysates and cord serum using specific commercial kits and western immunoblotting. RESULTS: FGR subjects had significantly more IGFBPs-1 and -2, and IL-6 mRNA and corresponding proteins in the placenta. In particular, the less phosphorylated isoforms of IGFBP-1 were highly increased. IL-6 and IGFBPs-2 mRNA, and IL-6 and IGFBP-1 peptides were positively and significantly correlated in the placenta. The IGF-II peptide was also significantly increased in FGR placentas. In cord serum, IGFBPs-1 and -2 were significantly more elevated in the FGR neonates. Serum IL-6 was significantly and positively correlated with both IGFBP-1 and IGFBP-2. CONCLUSIONS: The placenta of FGR neonates has higher IGF-II, IGFBP-1, IGFBP-2, and IL-6 contents compared with controls. At birth, IGFBPs-1 and -2 are increased in the cord blood of FGR neonates. IL-6 and IGFBP-2 gene expressions are closely related in the placenta. We suggest that the increase in IL-6 and IGFBP-2 could be subsequent to hypoxia and nutrient deficiency. As IGFBP-2 has a strong affinity for IGF-II, which is crucial for fetal growth, it could be an important bioregulator of IGF-II in the placenta.

Control Groups↗

PubMed2005

Retzius' space haematoma after spontaneous delivery: a case report.

We report a case of a haematoma of the Retzius space after spontaneous uncomplicated delivery. In the postpartum period, the patient complained of urinary retention and pain in the hypogastric region radiating to her left hip and leg. The ultrasound examination showed the presence of 160 x 100 x 80 mm confluent solid and liquid areas with peripheral vascularization. At exploratory laparotomy a haemorrhagic infiltration was found in Retzius' space and the anterior wall of the bladder, which appeared thickened and swollen below the peritoneum. We tried to drain the haematoma, however, we failed to drain it completely because of the large blood infiltration in the bladder wall. Clinical and ultrasound follow-up examinations showed a progressive reduction of the haematoma which completely disappeared nine months later. The haemodynamic changes occurring during pregnancy and labour, associated with strong mechanical stress, seem to be among the major causative factors of haematoma formation. Moreover, the venous load in the pelvic vascular system is increased during pregnancy; a stress-induced increase in venous blood pressure might play a prominent role, especially in cases of venous ectasia, where the resistance of blood vessel walls is reduced. Intraoperative evidence seemed to suggest a haemorrhage secondary to the rupture of the venous vessels in the Santorini plexus. The rupture was probably caused by the thrust of the fetal head, associated with abnormality or fragility of the blood vessels, or by some pathologic changes occurring in the anatomical structures during pregnancy, which could not be accurately defined because of the severity and degree of the haematoma infiltration found intraoperatively.

Abdominal Cavity↗

PubMed2004

Prelabour rupture of the membranes: recent evidence.

Premature rupture of the membranes (PROM) complicates 10% of all gestations and 2-4% of preterm pregnancy. Our success in preventing preterm PROM and preterm birth is hampered by our limited knowledge of its etiology. PROM remains the single most identifiable cause of preterm delivery and the major contributor to perinatal morbidity and mortality. Its clinical management continues to be controversial. The management dilemma associated with preterm PROM (PPROM) involves a balance between expectant management and intervention, taking into consideration the risks of infection with the increased duration of membrane rupture. Recent evidence on the use of antibiotics and amnioinfusion, together with advances in the prediction, diagnosis and estimation of risk based upon occupational factors and genetics have provided additional therapeutic tools in our approach to the problem of PPROM. While PPROM at very early gestation is a serious complication and a major management dilemma often associated with poor outcome, the prognosis is not without hope.

Chorioamnionitis↗

PubMed2004

Amniotic fluid dynamics.

Amniotic fluid was once considered to be a stagnant pool, approximately circulating with a turnover time of one day. Adequate amniotic fluid volume is maintained by a balance of fetal fluid production (lung liquid and urine) and resorption (swallowing and intramembranous flow). Even though different hypotheses have been advanced on the mechanisms regulating this turnover, the inflow and outflow mechanism that keeps amniotic fluid volume within the normal range is not entirely clear. Regulatory mechanisms act at three levels: placental control of water and solute transfer; regulation of inflows and outflows from the fetus; and, maternal effect on fetal fluid balance. Amniotic fluid is 98-99% water. The chemical composition of its substances varies with gestational age. When fetal urine begins to enter the amniotic sac, amniotic osmolarity decreases slightly compared with fetal blood. After keratinization of the fetal skin, amniotic fluid osmolarity decreases further with advancing gestational age. The low amniotic fluid osmolarity, which is produced by the inflow of markedly hypotonic fetal urine, provides a large potential osmotic force for the outward flow of water across the intramembranous and transmembranous pathways. Within certain limits, amniotic fluid mirrors the metabolic status of the fetoplacental unit; for that reason, a study of its components and their respective variations in the different weeks of pregnancy provides useful indications, both for a correct assessment of fetal maturation and for an evaluation of kidney function parameters and placental insufficiency.

Amniotic Fluid↗

PubMed2004

Early complications of prenatal invasive diagnostics: perspective analysis.

In this retrospective analysis we studied 1489 women who underwent prenatal invasive diagnostic procedures between January 2000 and December 2002. We examine the influence of risk factors and the incidence of early complications following amniocentesis and chorion villus sampling, in particular the incidence of fetal loss. The study group included 438 women who underwent CVS and 1051 underwent amniocentesis. For each woman we studied anamnestic risk factors (recurrent pregnancy losses, fibroids, twin birth, uterine hematic loss), intraoperative risk factors (repetition of the insertion, transplacental sample, hematic liquid, early bleeding) and postoperative risk factors (pelvic pain, hematic losses, liquid losses, spastic pain, fever). In our data the miscarriage incidence was 1% for CVS and 1.7% for amniocentesis. Our results showed that in relation to CVS, the presence of fibroids gives an OR of miscarriage of 68 (95% C.I.=6.50-659.78; p=0.000). In relation to amniocentesis, the incidence of hematic losses gives an OR of miscarriage of 10 (95% C.I.=1.50-32.94; p=0.04). If these results were confirmed by other experiences, they could induce obstetricians to avoid CVS in these women with uterine fibroids and hence recommend amniocentesis to them. Particular attention has to be taken in those patients with vaginal bleeding following amniocentesis.

Abortion, Spontaneous↗

PubMed2004

Twin-twin transfusion syndrome: a review of treatment option.

OBJECTIVE: The twin-twin transfusion syndrome (TTTS) is a complication of monozygotic-monochorionic twinning and is a direct result of transplacental communication between the circulations of twins. When acute TTTS occurs in the second trimester, the perinatal mortality can be as high as 95% in the absence of treatment. For this reason, several aggressive, even desperate treatment modalities have been attempted including selective fetocide, umbilical cord ligation, maternal digoxin therapy. None have gained wide acceptance. Serial drainage amniocentesis or amnioreduction is actually the most widely used therapy. More recently, laser ablation under fetoscopic guidance of placental vessel has been reported in an attempt to improve survival. The objective of this review was to evaluate the impact of treatment modalities in TTTS. STUDY DESIGN: Reports of prospective and retrospective trials and other study designs in English identified from searches of MEDLINE, EMBASE, specialized databases, bibliographies of review articles. Study on twin pregnancies affected by TTTS between 1990 and 2003 that met our inclusion criteria were included. RESULTS AND CONCLUSIONS: No single therapy is associated with a uniformly improved outcome for the involved twins and success is primarily related to gestational age and severity at diagnosis. Standard therapy has commonly been serial amnioreduction, which appears to improve the overall outcome. Intertwin sepstostomy similary improves outcome but has no survival advantage over serial amnioreduction. Selective fetoscopic laser photocoagualtion has emerged as an alternative treatment strategy in TTTS with at least comparable if not superior survival to serial amnioreduction. TTTS diagnosed before 26 weeks' gestation has significantly better survival rates and fewer neurological sequelae after laser therapy than amnioreduction.

Amnion↗

PubMed2004

Ultrasound evaluation of amniotic fluid volume: methods and clinical accuracy.

Ultrasound evaluation of amniotic fluid volume (AFV) is frequently used to detect fetuses at high risk for an adverse outcome - an event that is often correlated with AFV abnormalities. As is well known, ultrasound is a non invasive procedure, which makes it ideal for application on a very large scale: in practice, it can be used for routine monitoring of all pregnancies and, not infrequently, for repeat AFV determination in those cases where there is the suspect of amniotic fluid abnormalities. Sonographic quantification of AFV, whether it is performed through a simple visual estimation or through biometric measurement of one or more amniotic fluid pockets, can never represent a true "quantitative" method and its actual reliability has not consistently been proved by scientific evidence. Moreover, even though ultrasound AFV evaluation is indispensable in the management of high-risk pregnancies, there is no consensus on which ultrasound index is the most accurate in predicting perinatal morbidity and mortality. The sonographer can evaluate AFV by directly observing amniotic fluid pockets and his experience is crucial for a high reliability of the procedure. When pathological AFV changes are present, especially if the examination is performed by a not so expert sonographer, biometric measurements (Single Deepest Pocket, Amniotic Fluid Index, Two-Diameter Pocket) with their respective reference ranges might be helpful in confirming the diagnosis of oligohydramnios or hydramnios. A complete review of all tests performances and confidences is made by the Authors.

Amniotic Fluid↗

PubMed2004

Amnioreduction for treatment of severe polyhydramnios.

Between January 2000 and March 2003 we studied the pregnancies complicated by polyhydramnios in 10 patients. The objective was that of evaluating the efficacy of amnioreduction in improving the principal complications given by polyhydramnios such as maternal dyspnea and uterine activity. Our results showed that this procedure resolve maternal symptoms in all the cases but there is no significant reduction in uterine activity.

Amniotic Fluid↗

PubMed2004

Amnioscopy: is it actual?

Amnioscopy is an invasive exam employed to visualise the forebag of the amnionic sac and to look out for meconium staining. Even though recognition of strongly stained fluid is easy, interpretation of those cases that are thinly stained is more difficult, since in these cases which are more common to find there could be an initial staining. On the other hand, visualisation of the forebag does not necessarily depict the condition of the rest of the amniotic fluid, especially in those cases where the fetal head is engaged. Moreover ascertainment that the amniotic fluid is limpid, only holds a temporary significance since it cannot predict successive release of meconium. The incidence of meconium stained fluid prior to labour has been found to range between 6-11%. Amnioscopy hence seems to hold a historical interest, and should only be employed in pregnancies at term where the cervix is sufficiently dilated to permit introduction of the amnioscope. Correlation between finding of meconium stained fluid during labour (1.5-18% reaching 44% in post-term pregnancies) with alterations at cardiotocography and above all to fetal acidosis or low Apgar scores at birth still remains controversial. Passage of meconium does not seem to express fetal compromise, at least until other parameters (CTG) do not support this suspicion. Finally it is important to remember that amnioscopy could in some cases lead to serious infections with chorioamnionites occasionally leading to fetal death. Accidental rupture of the membranes could also occur, reported in 1.4% of the cases, harmful especially when far from labour. From these considerations, and since majority of the cases especially with chronic fetal distress, release of meconium is preceded or accompanied by reduction in the amniotic fluid quantities, the last identifiable through ultrasound. We agree with those authors who advise its use only when adequate management through CTG and ultrasound is not possible, and anyhow only in pregnancies at term.

Female↗

PubMed2004

Amniotic fluid index versus largest vertical pocket in the prediction of perinatal outcome in post-term pregnancies.

We studied a cohort of 41 singleton pregnancies induced at term with prostaglandins and, when necessary, oxytocin. We evaluated with ultrasound the amniotic fluid index (AFI) and the largest vertical pocket (LVP), at least 2 days before the delivery, to compare the sonographic measurement of amniotic fluid with fetal distress and perinatal outcome. We analysed the incidence of fetal distress using intrapartum monitoring of fetal heart rate, considering the absence of variability, the presence of persistent severe variable and/or late decelerations. The oligohydramnios group, indipendently by ultrasound index, showed the same incidence of abnormal FHR, and rate of Cesarean section for fetal distress as the group with normal amniotic fluid. In conclusion there is no significant difference between the group of patients with oligohydramnios and the one with normal amniotic fluid regarding the perinatal outcome in induced labor.

Amniotic Fluid↗

PubMed2002

Transvaginal sonographic cervical length changes during normal pregnancy.

OBJECTIVE: To examine the relationship between cervical length and gestational age in normal pregnancy in nulliparous versus parous women. METHODS: We studied a cross-sectional sample of 321 pregnant women, including 185 nulliparous and 136 multiparous women. The inclusion criteria were sonographic confirmation of gestational age within the 12th week, the absence of any risk factors for preterm birth, and uncomplicated pregnancy with expected delivery during the 38th to 42nd weeks. Cervical length was measured in a straight line if the cervix did not show any curvature; in the presence of cervical curvature, the measurement was broken down into 2 or more segments. RESULTS: There was a relationship between gestational age and cervical length, which could be described with a linear function (R = 0.92; R2 = 0.85; P < .001). Moreover, there was no statistically significant difference between multiparous and nulliparous women. CONCLUSIONS: Our study shows that cervical length is comparable in nulliparous and multiparous women throughout pregnancy. In both groups, it actually shows a progressive, linear reduction between the 10th and 40th weeks. Reference ranges constructed for the whole gestational period might be more useful than a single cut-off value for more efficient prevention and management of preterm birth.

Cervix Uteri↗

PubMedDate not supplied

Prenatal diagnosis of isolated limb defects: an updated review.

Abnormalities of bone segments, either isolated or in combination with others, may affect any single bone. Given the relatively low incidence of such defects and the relevance of the clinical issues involved, it could be useful to evaluate all the diagnostic and procedural aspects that should be considered at prenatal diagnosis, when obstetricians are confronted with an event that is certainly unfamiliar to most of them: a fetus with an isolated limb defect. In fact, with comparatively infrequent abnormalities investigators often tend to neglect some diagnostic aspects that could be useful both in terms of prenatal counseling and of optimum management of the affected fetus. Therefore, a multidisciplinary approach is required that supplements ultrasound diagnostics with additional tests and examinations, even of the invasive type, depending on the complexity of the condition. This updated review may represent a useful tool to reach the stated objectives.

Counseling↗