Search

BACKGROUND: To analyze prenatal ultrasound (US) markers to predict treatment and adverse neonatal outcome in fetal gastroschisis. METHODS: It was conducted a retrospective single-center study considering all pregnancies with isolated gastroschisis that were treated in our department between 2008 and 2020. 17 US markers were analyzed. Moreover, the association between prenatal ultrasound signs and neonatal outcomes was analyzed: need of bowel resection, techniques of reduction, type of closure, adverse neonatal outcomes, time to full enteral feeding, length of total parenteral nutrition and length of hospitalization. RESULTS: The analysis included 21 cases. We found significant associations between intestinal dilation (≥10 mm) appeared before 30 weeks of gestation and the need of bowel resection (p = 0.001), the length of total parenteral nutrition (p = 0,0013) and the length of hospitalization (p = 0,0017). Intrauterine growth restriction (IUGR) is a risk factor for serial reduction (p = 0,035). There were no signs significantly associated with the type of closure. Hyperbilirubinemia is related with gestational age (GA) at the diagnosis of intra-abdominal bowel dilation (IABD) (p = 0.0376) and maximum IABD (p = 0.05). All newborns with sepsis had echogenic loops in uterus (p = 0.026). The relation between the GA at delivery and the GA at the extra-abdominal bowel dilation (EABD)≥10 mm was r = 0.70. CONCLUSION: We showed the significant role of the early presence of bowel dilation in predicting intestinal resection and adverse outcomes. All IUGR fetuses needed staged reduction through the silo-bag technique. The echogenic bowel was related to neonatal sepsis, while IABD was associated with hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Introduction: Misoprostol vaginal insert could lead to a significant reduction in the time to vaginal delivery, and an increase in the proportion of women achieving vaginal delivery, compared with dinoprostone vaginal insert. We compared the delivery outcomes of misoprostol 200 μg vaginal insert and dinoprostone 10 mg vaginal insert for induction of labor in women with an unfavorable cervix.Material and Methods: This is a retrospective observational study conducted on a cohort of 220 women with a Bishop score ≤4 admitted for induction of labor at a single institution. Of these, 109 (49.5%) received the misoprostol vaginal insert and 111 (50.5%) received the dinoprostone vaginal insert. The primary outcome was the vaginal delivery rate. Secondary outcomes were time from induction to vaginal delivery, time to any delivery mode, time from induction to the onset of active labor, oxytocin use, uterine tachysystole and need for tocolysis.Results: The vaginal delivery rate was 88% in the misoprostol insert group, compared with 74% in the dinoprostone insert group (P < 0.007). The average time from drug administration to the beginning of labor was shorter in the misoprostol compared with the dinoprostone group (855 min vs 1740 min, P < 0.0001). Also, the average time from administration to delivery was shorter for women receiving misoprostol compared with dinoprostone (1113 min vs 2150 min, P < 0.0001). The use of misoprostol reduced the need for oxytocin compared with dinoprostone (30.2% vs 43.2%, P = 0.046). Finally, compared with dinoprostone, the misoprostol insert was associated with more uterine tachysystole (38% vs 12%, P < 0.001), but the rate of tachysystole requiring tocolysis was not significantly different between the 2 groups (51.2% vs 46.1%, P = 0.1). Multivariate analysis showed that Bishop score and method of induction, but not maternal body mass index or gestational age at induction, were independently associated with mode of delivery.Conclusions: The cesarean section rate was significantly lower in the misoprostol insert group. The use of misoprostol was also associated with reduced time to vaginal delivery and time to onset of active labor and with decreased use of oxytocin. Tachysystole was a frequent complication during induction of labor with the misoprostol insert. [ABSTRACT FROM AUTHOR]

Bituminous mastic is a self-healing viscoelastic material. Recoverable phenomena, such as thixotropy and self-healing capability, are recognised as an important resource for the development of sound road pavements. The experimental investigation described in this paper and carried out through a Dynamic Shear Rheometer (DSR) provides a comparison among mastics blended with different percentages of aged polymer modified bitumen, new virgin polymer modified bitumen and filler in terms of fatigue, self-healing and thixotropy. Data analysis is based on a model adopted in previous studies for polymer modified bitumens in order to calculate the fatigue endurance limit. Results show that the presence of increasing percentages of filler causes detrimental effects on mastic fatigue performance which can be offset by the addition of a certain amount of aged polymer modified bitumen. In fact, regardless of the filler content considered, a percentage of aged polymer modified bitumen (up to 45%) added to mastics enhances the fatigue endurance limit suggesting significant benefits when dealing with sustainable recycled mixtures containing Reclaimed Asphalt (RA) aggregates. [ABSTRACT FROM AUTHOR]

Fatigue resistance of bituminous materials is related to time-dependent phenomena, such as damage accumulation, hardening, viscoelasticity, thixotropy and healing. In bituminous mixtures, damage related to fatigue processes mainly involves bitumen and its combination with filler (i.e. mastic). Currently, there is no consolidated method for the determination of the fatigue endurance limit of bitumens that takes into account also the above-mentioned phenomena, while limited work has been done on mastics. To bridge this gap, the experimental investigation described in this paper provides a comparison between bitumens and corresponding mastics in terms of fatigue, self-healing and thixotropy. Long term aged materials were also taken into consideration in order to identify potential detrimental effects on self-healing due to oxidation phenomena, evaluating the possible inclusion of Reclaimed Asphalt (RA) for the production of bituminous mixtures. The data analysis was based on an innovative test method which had previously been implemented for bitumens and was carried out using a Dynamic Shear Rheometer (DSR). Moreover, the influence of morphological properties of filler on filler-bitumen interactions was assessed by means of a Scanning Electron Microscope (SEM). Results show that the above-mentioned analysis method is also suitable for analysing bituminous mastics and is able to identify the role of filler as well as the influence of ageing on the self-healing process of bituminous materials. The investigation confirms that a certain amount of aged bitumen added to a virgin bitumen/mastic is able to considerably improve the overall fatigue performance suggesting significant benefits when dealing with recycled mixtures including RA aggregates. [ABSTRACT FROM AUTHOR]

Objective: To investigate pathological associations between sleep‐disordered breathing (SDB) and pregnancy outcomes. Methods: From May 2016 to September 2019, obese women during their uncomplicated singleton pregnancies underwent screening sleep questionnaires, oxygen saturation monitoring, and, in proper cases, complete overnight polysomnography. Their medical records were also recorded. Results: In all, 112 pregnant women were included in the study cohort; 44 showed an oxygen desaturation index ≥10, and their newborns had a significantly higher rate of congenital abnormalities and respiratory distress syndrome compared with the women with normal pulse oximetry. Stepwise multivariate regression analysis showed that basal oxygen saturation was independently associated with the occurrence of fetal growth restriction. Conclusion: Among obese pregnant women, the rate of congenital abnormalities is higher in the ones with altered pulse oximetry. Maternal basal oxygen saturation in the first trimester of pregnancy predicts fetal growth restriction independently of maternal age, ethnicity, body mass index, gravidity, and hypertensive disorders of pregnancy. Synopsis: The rate of congenital abnormalities is higher in patients with altered pulse oximetry. Maternal basal oxygen saturation in the first trimester predicts fetal growth restriction. [ABSTRACT FROM AUTHOR]

Introduction: Spontaneous preterm birth in women with a twin pregnancy is one of the main causes of perinatal mortality and morbidity. Our aim was to review the perinatal outcome of asymptomatic twin pregnancies with a sonographic short cervical length during the second trimester treated with an ultrasound-indicated cerclage or cervical pessary.Material and Methods: Retrospective study on asymptomatic twin pregnancies with a short cervix (≤ 25 mm) at transvaginal ultrasound examination during the second trimester treated with a cervical cerclage or pessary (2001-2017). The rate of preterm birth < 28, 32 and 34 weeks of gestation, neonatal mortality, neonatal morbidity and composite adverse neonatal outcome were compared in the groups of women treated with cerclage or pessary.Results: Seventy-four twin pregnancies underwent a cerclage while a cervical pessary was inserted in 34 women with twins at our Department: 36 women with an ultrasound-indicated cerclage and 20 with a pessary were included in the analysis. Median gestational age at delivery was higher in women treated with cerclage compared with those with pessary placement (P = .02) and the rate of preterm birth before 34 weeks of gestation was lower in the cerclage group (P = .03). Admissions to the Neonatal Intensive Care Unit were more frequent in pregnancies with pessary (P = .01), the length of admission was longer (P = .005) and composite adverse neonatal outcome occurred more often (P = .03) compared with the cerclage group.Conclusions: Ultrasound-indicated cerclage appears to reduce the rate of preterm birth before 34 weeks of gestation in asymptomatic twin pregnancies with a short cervix during the second trimester, and also the composite adverse neonatal outcome compared with pessary. [ABSTRACT FROM AUTHOR]