paracetamol (14% to 18%) and newer coxib compounds (4% to 6%), with the use of opioids limited to a minority of cases (range 0 to 8% of cases). When asked about side effects, specialists seemed to be well aware of their incidence. The potential for side effects of NSAIDs at the gastrointestinal level was well-recognized by the majority of the specialists interviewed (61%), while the potential side effects of opioids (somnolence, etc) at the central nervous system level was indicated only by a minority of physicians (21%). Finally, and most interestingly, only a minority of specialists indicated that they had even a fair knowledge of law 38/2010 (16%), while more than one third of the specialists interviewed (34%) candidly declared their lack of knowledge of the law.
Abortion has been legal in Italy since June 1978. At the Obstetrical and Gynecological Clinic of the University of Siena a doctor is assisted by a psychologist and by a social worker, who deal mostly with adolescents; all patients are given a brochure with information on the procedure and with detailed instructions for the postabortum period. Abortion is commonly carried out by vacuum aspiration and under total anesthesia in 98% of cases. 2171 abortions were done from June 1978 to June 1980; the 1st year there were 1138 abortions and 1107 live births; the second year there were 1133 abortions and 1190 live births. 30% of patients came from districts outside of the Siena region, 32.2% of patients were housewives and 15.29% students. Most abortions were done between the 9-10th gestational week because of the shortage of medical personnel at the clinic. All ages were more or less equally represented, with a slight majority of patients in the age group 25-35; minors were only 2.67% of all patients in the 1st year, but the percentage doubled in the 2nd year. In 86.87% of cases hospitalization was only 1 day. 10.78% of patients had had previous abortions; 68.17% of patients were married. 65.45% of women did not use any type of contraception, and 23.44% used coitus interruptus, or 88.89% of women without effective contraception. There were 35 cases of complications, or a rate of 1.61%, 2 requiring laparotomy and 1 requiring hysterectomy. From these data it seems obvious to conclude that many women use abortion as a fertility control method and information on birth control methods and family planning education are sorely lacking.
Orofacial clefts are the most common congenital craniofacial anomalies and can occur as an isolated defect or be associated with other anomalies such as posterior fossa anomalies as a part of several genetic syndromes. We report two consecutive voluntary pregnancy interruptions in a nonconsanguineous couple following the fetal ultrasound finding of cleft lip and palate and posterior fossa anomalies confirmed by means of post-termination examination on the second fetus. The quantitative fluorescent PCR, the karyotype, and the comparative genomic hybridization-array analysis after amniocentesis were normal. Exome sequencing on abortive material from both fetuses detected a missense mutation in MID1, resulting in a clinical diagnosis of Opitz G/BBB syndrome. The same mutation was found in the mother and in her brother, who both revealed cerebellar anomalies at an MRI examination. Our study supports the efficacy of exome sequencing in the presence of both a family history suggestive of an inherited disorder and well-documented ultrasound findings. It reveals the importance of a synergistic effort between gynecologists and geneticists aimed at the integration of the most sophisticated ultrasound techniques with the next-generation sequencing tools to provide a definite diagnosis essential to orient the final decision and to estimate a proper recurrence risk.
To evaluate the diagnostic capacity of first trimester ultrasound scan analysis in detection of fetal anomalies. We enrolled in the study patients between May 2001 and December 2009 to undergo obstetric ultrasonography. Ultrasound equipment used were: HDI 3000 ATL, Voluson 730 Expert and Voluson E8. A total of 13.913 obstetric ultrasound scans analysis performed 199 fetal defects identified. Among the 3728 ultrasound scans were performed in first trimester 47 fetal anomalies were correctly diagnosed, thus displaying a detection rate (DR) of 1.26%. Among those: cystic hygroma (n = 8), nuchal edema (n = 8), omphalocele (n = 5), hydrops (n = 2), holoprosencephaly (n = 1), anasarca (n = 1), anencephaly (n = 2), omphalomesenteric duct remnant (n = 1), umbilical cord cyst (n = 3), heart defects (n = 2 ventricular septal defects, n = 1 crux cordis defect), megacystis (n = 5), bilateral corneal opacity (n = 1), spina bifida (n = 1), ectopia cordis (n = 1), multiple defects (n = 5), amniotic band syndrome associated to omphalocele and leg amputation, pentalogy of Cantrell, oloprosencephaly associated to central cleft lip and heart defect, oloprosencepahaly with omphalocele, cystic hygroma associated to bowel loops erniation and increased placenta thickness (n = 1). Following diagnosis of fetal structural anomalies, 27 women underwent invasive diagnostic procedure thus allowing identification of 6 trisomy 21, 2 trisomy 18 and 19 euploid fetuses. Among the 10185 ultrasound scans performed in second and third trimester, 152 between major and minor fetal defects were diagnosed (DR = 1.49%). A total of 23.6% of fetal defects were diagnosed during the first trimester. During first trimester of pregnancy major fetal structural defects and multiple anomalies are easier to diagnose compared to minor and single defects. As suggested by our data, ultrasound scan analysis performed in first trimester shows a similar DR compared to second and third trimester scans (DR = 1.26% vs. DR = 1.49%). Our data corroborates the possibility to consider in the future a reliable first trimester ‘anatomic’ ultrasound examination.
Umbilical cord cysts are common, occurring at a frequency from 8% at 7 weeks to 29% at 8 weeks, represented by single, multiple cysts and pseudocysts. Nevertheless the ultrasound detection rate is less than about 3% in the first-trimester. We investigated the ability of trained ultrasound operators to detect umbilical cord masses in the first-trimester and their clinical significance. A specific morphological and morphometric ultrasound evaluation of the umbilical cord was performed by operators with 10 years' experience in 2982 women with a singleton pregnancy at 11–13 + 6 weeks' gestation during a scan for nuchal translucency. All women had routine ultrasound examinations at 20 and 32 weeks, or more if indicated, and completed follow-up. The prevalence of cysts was 1.8% (52/2892); there were 40 simple cysts, eight multiple cysts and four pseudocysts. The range of dimensions (2.1–6.3 mm) was similar for all kinds of cyst. The maximum detection rate was 51.9% (27/52) at 11 weeks, 38.4% (20/52) at 12 weeks and 9.6% (5/52) at 13 weeks. In the second trimester the simple cysts reverted spontaneously in about 90% (37/40), and the babies did not have structural and chromosomal anomalies. Among women with multiple cysts, two (2/8, 25%) delivered a fetus with chromosomal anormalities (trisomy 18 and 13) and two (2/8, 25%) a fetus with severe growth restriction (FGR); among those with pseudocysts there was a fetus with trisomy 18 (1/4, 25%). Umbilical cord single cysts decrease dramatically during pregnancy (over 90%) and have no clinical significance. The presence of multiple cysts and pseudocysts of the umbilical cord increases the risk of chromosomal abnormalities (3/12, 25%) and poor outcome (2/12, 16%). The difference between multiple cysts and pseudocysts is in their position in the umbilical cord: the former are found inside the cord and between the vessels (23% FGR because of vessel compression), whereas pseudocysts are lateral.
The aim of the study was to assess the length of diagnostic delay of symptomatic endometriosis in Italy and analyse the presence of correlations between the socio-demographic status of patients and the clinical characteristics/type of diagnosis.This multicenter cross-sectional questionnaire-based study was conducted in 10 tertiary Italian referral centres for diagnosis and treatment endometriosis. A total of 689 respondents with histologically proven endometriosis and onset of the disease with pain symptoms completed an on-line self-reported questionnaire written in their own language (World Endometriosis Research Foundation-Endometriosis Phenome and Biobanking Harmonisation Project-Endometriosis Patient Questionnaire-Minimum) evaluating endometriosis related symptoms, family history of endometriosis and chronic pelvic pain, demographic data, as well as medical, reproductive, and obstetric history.The mean diagnostic delay found was of 11.4 years. The mean time (14.8 years) from symptoms onset to diagnosis was significantly longer among patients aged 9-19 vs patients aged 20-30 (mean 6.9 years, p < 0.001) and patients aged 31-45 (mean 2.9, p < 0.001). No significant association were found between a delayed diagnosis and any of the clinically relevant factors such as the number or severity of the reported symptoms, familiarity, hormonal therapy intake or methodology of diagnosis.The mean diagnostic delay of endometriosis in Italy is about 11 years. The delay can be up to 4 years longer in patients with pain symptoms onset under 20 years. Educating clinicians and patients on pathologic nature of endometriosis related pelvic pain is advisable to reduce waiting time to diagnosis, especially for young women.
Abstract Objective To investigate the relationship between the position of the anterior mesh, measured by ultrasound through the Bladder neck - Mesh Distance technique and the surgical outcomes after laparoscopic sacrocolpopexy (SCP) for apical prolapse. Study design: Retrospective analysis of prospectively collected data in a tertiary care hospital. Between January 2019 and September 2019, 63 women who underwent laparoscopic SCP due to apical prolapse were included. Bladder neck - Mesh Distance was measured immediately after surgery. The pelvic floor was evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) System before, one month, and 2.7 years (mid-term) after the surgery. Postoperative stress urinary incontinence (SUI) and Patient Global Impression of Improvement (PGI-I) scores were also assessed. The correlation between Bladder neck - Mesh Distance and the postoperative outcomes was investigated using the Spearman rank correlation coefficient. Results At mid-term follow-up visit, Bladder neck - Mesh Distance was inversely correlated with the correction of apical prolapse and postoperative SUI. No correlation was detected with the anterior compartment prolapse correction. PGI-I scores were high in all patients at mid-term follow-up, irrespective of Bladder neck - Mesh Distance values. Conclusion The shorter the Bladder neck - Mesh Distance, the better the outcome for apical compartment repair. Bladder neck - Mesh Distance had no correlation with the anterior anatomical correction. Shorter Bladder neck - Mesh Distance values were positively correlated to better PGI-I scores and a higher risk of SUI.
