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Objective: To investigate the association of agenesis of the ductus venosus (ADV) with genetic abnormalities using genetic studies—Chromosomal Microarray Analysis (CMA) and Exome Sequencing (ES). Design: Retrospective study of all fetuses diagnosed with ADV between January 2013 and December 2022 in a tertiary center. Results: ADV was diagnosed in 33 fetuses. The diagnosis was made at a mean gestational age of 21.2 ± 8.4 weeks. Conventional karyotype was applied in a single fetus (3.0%), CMA was applied in 21 fetuses (66.7%), and five fetuses (22.8%) were additionally tested with ES. ADV was isolated in eight fetuses (24%), whereas in 25 (76%) it was associated with abnormal ultrasound findings, including increased nuchal translucency (NT), intrauterine growth restriction (IUGR) and variable structural malformations, mostly cardiac (42%) followed by central nervous system (CNS) and skeletal malformations (24%). Genetic abnormalities were found in six fetuses out of 22 investigated (27%), of which 3 were detected by ES, 3 by CMA and 1 by conventional karyotype. A higher incidence of genetic aberrations was evident among ADVs associated with abnormal ultrasound findings. Genetic abnormalities were indicative of Prader Willi/Angelman syndrome, Noonan syndrome, CASK related disorder, 16q24.3 microdeletion syndrome and Trisomy 21. Conclusion: ADV associated with abnormal ultrasound findings is commonly correlated with genetic abnormalities and consequently unfavorable pregnancy outcomes. Our study emphasizes the value of genetic studies chiefly among cases associated with abnormal ultrasound findings, enabling early diagnosis of fetal pathologies associated with ADV, and providing better parental counseling. [ABSTRACT FROM AUTHOR]

Objective: To determine whether equivocal prelabor rupture of membranes (PROM) cases are associated with adverse outcomes. Methods: A retrospective study was conducted in a tertiary medical center between July 2012 and March 2022. The cohort comprised all women diagnosed with term PROM (≥37 gestational weeks), divided into two groups. (1) Certain PROM—suggestive history of a watery vaginal discharge confirmed by visualization of fluid leaking from the cervix or pooling in the vagina on speculum examination. (2) Uncertain PROM—suggestive history of a watery vaginal discharge not supported by speculum examination. All patients were hospitalized and gave birth spontaneously or following either expectant management for up to 24 h from PROM or induction. The primary outcome measure was cesarean delivery (CD) rate. Secondary outcome measures were adverse maternal/neonatal events. Results: Of the 2012 women included in the study, 1750 had certain PROM and 262 uncertain PROM. CD rate was 5.8% in the certain PROM group and 8.8% in the uncertain PROM group; the difference was not statistically significant (P = 0.074). There was a significant between‐group difference in the rate of CD due to failed induction on univariate analysis (0.69% vs 2.67%, respectively, P = 0.007), but it was not maintained on multivariate logistic regression (odds ratio 0.37, 95% confidence interval: 0.12–1.17). Other maternal and neonatal outcomes were similar in the two groups. Conclusion: Our findings indicate that following the same management guidelines for equivocal cases of ruptured membranes as for confirmed cases of term PROM did not compromise maternal or fetal outcomes. Synopsis: Managing questionable rupture of membrane at term as prelabor rupture of membranes (PROM) appears not to result in adverse maternal or neonatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: Uterine-sparing surgery for pelvic organ prolapse (POP) repair has shown good results, but the potential negative implications of leaving the uterus in place are yet to be fully defined. We aimed to assess the risk of unanticipated abnormal gynecological pathology at the time of reconstructive pelvic surgery. Methods: A retrospective consecutive case series including women who underwent vaginal hysterectomy for POP repair at a tertiary medical center in 2006–2020. All patients were offered a free Pap smear test at the age of 65 years as part of a national screening program. Transvaginal ultrasound was routinely performed preoperatively. Standard 3 pedicle hysterectomy was performed with/without bilateral salpingo-oophorectomy (BSO). Results: The study comprised 462 women of mean age 63 ± 9.3 years without previous known malignant or premalignant pathology. Benign pathology was observed in 286 patients (61.9%). Endometrial malignancy was found in three patients (0.7%) and significant premalignant pathology in 15 patients (3.2%), including cervical intraepithelial neoplasia stage 2–3 in seven patients (1.5%) and complex hyperplasia with atypia in eight patients (1.7%). All these pathologies were found in postmenopausal women. None had preoperative clinical symptoms or endometrial thickness of ≥5 mm on preoperative ultrasound. In the 35 patients after BSO, adnexal findings were normal (77.2%) or benign (22.8%). Conclusions: Premenopausal women with uterovaginal prolapse and normal preoperative evaluation have a minimal risk of significant abnormal uterine pathology. In postmenopausal women, the risk of unanticipated malignant uterine pathology is 0.7% and 3.2% for significant premalignancy. [ABSTRACT FROM AUTHOR]

This document provides abstracts from various studies on labor and childbirth. The studies examine different ultrasound parameters and their relationship to outcomes such as ECV effectiveness, fetal cardiac function, mode of delivery, cervical dilatation, CPD, and OASI. The findings suggest that ultrasound measurements can be useful in evaluating clinical conditions and predicting outcomes. However, more research is needed to establish specific parameters and improve diagnostic accuracy. Other studies explore the use of intrapartum ultrasound in labor management, including predicting vaginal delivery, diagnosing complications, evaluating the pelvic floor, and assessing fetal position. The studies indicate that intrapartum ultrasound is a valuable tool for decision-making and improving outcomes. Transperineal ultrasound has shown promise in assessing anal sphincter injuries, and both parents and healthcare providers have positive attitudes towards using ultrasound for predicting delivery mode. Additionally, fetal head molding during labor was found to be common and not associated with difficult deliveries, except for parieto-parietal molding which was linked to failed operative deliveries. [Extracted from the article]

Objective Methods Results Conclusions To identify and analyze risk factors associated with relaparotomy following cesarean delivery (CD), focusing on obstetric and surgical parameters.Retrospective case–control study conducted at a high‐volume tertiary obstetric center. We reviewed all women who underwent CD between 2013 and 2023. Patients who required a relaparotomy, defined as the reopening of the fascia, were included in the study group. Patient data were systematically reviewed to identify potential risk factors contributing to the need for post‐CD relaparotomy, compared with a control group that did not undergo a relaparotomy.Out of 11 465 women underwent CD, 59 (0.5%) required relaparotomy. Using a multivariate model for independent risk factors, we found the following to be associated with relaparotomy: emergency CD (adjusted odds ratio [aOR] 3.09, 95% confidence interval [CI] 1.78–5.38, P < 0.01), placenta previa (aOR 4.66, 95% CI 1.54–14.11, P < 0.01), and multiple gestation as indications for the CD (aOR 4.61, 95% CI 2.10–10.12, P < 0.01); estimated intraoperative blood loss of more than 1 L (aOR 5.98, 95% CI 2.79–12.80, P < 0.01); and intraoperative adhesions (aOR 7.12, 95% CI 4.06–12.48, P < 0.01).Our study underscores the multifactorial nature of relaparotomy after CD, emphasizing the significance of considering a broad array of risk factors. By identifying and understanding these factors, clinicians can optimize patient care and potentially reduce morbidity, particularly the need for subsequent surgical interventions. [ABSTRACT FROM AUTHOR]

Background: The extent of surgery for differentiated thyroid cancer (DTC) remains a controversial issue. Since a less aggressive approach is becoming more predominant, we aim here to study the short- and long-term outcomes of DTC patients after hemithyroidectomy. Methods: From a total of 1252 consecutive papillary thyroid cancer (PTC) patients, 109 treated with hemithyroidectomy and 50 with total thyroidectomy but no I131 were included. Persistent or recurrent disease was defined based on histopathology, imaging studies, and thyroglobulin levels. Results: Our hemithyroidectomy cohort included females (84.4%), microcarcinomas (81.9%), TNM stage I (95.4%), and a low American Thyroid Association (ATA) recurrence risk (94.5%). At one-year post-treatment, 3.7% had persistent disease (all female, median age 55 years, tumor size 7.5 mm). Recurrent disease was detected in 7.5% of those with excellent response at 1-year. With a follow-up of 8.6 years (1–48), all 109 patients were disease free at last visit, including the 11 patients (10.1%) who received additional treatment. Also, when comparing the hemi- and total thyroidectomy groups no significant differences were found in the rate of persistent and recurrent disease, overall mortality, and disease status at last visit. Conclusions: For properly selected low-risk PTC patients, hemithyroidectomy is a safe treatment option with a favorable long-term outcome. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the potential differences in the outcomes of neonates in whom FGR was diagnosed late in pregnancy as compared to those in whom growth restriction was diagnosed after birth. Methods: A retrospective study was conducted in a tertiary medical center between 2017 and 2019. The study included women carrying a single infant with an estimated fetal weight below the tenth percentile in whom FGR was diagnosed during late pregnancy, after 32 gestational weeks (known late-onset FGR; study group) or only after birth (unknown FGR; control group). Data were collected by review of the electronic health records. The primary outcome measure was the rate of composite adverse neonatal outcome. Results: A total of 328 women were included, 77 (23.47%) in the known-FGR group and 251 (75.53%) in the unknown-FGR group. In the known-FGR group, an etiology for the FGR was identified in 28.57% cases, most commonly placental insufficiency (21.74%). Compared to the unknown-FGR group, the known-FGR group was characterized by significantly higher rates of elective cesarean delivery (15.58% vs. 9.96%, p < 0.001), preterm birth (18.18% vs. 3.98%, p < 0.01), and labor induction (67.53% vs. 21.51%, p < 0.01). A significantly higher proportion of neonates in the known-FGR group had a positive composite adverse outcome (38.96% vs. 15.53%, p < 0.01). For multivariate regression analysis adjusted for maternal age, gestational age at delivery, and mode of delivery, there was no difference between groups in the primary outcome (aOR 1.73, CI 0.89-3.35, p = 0.1). Every additional gestational week at delivery was a protective factor (aOR = 0.7, 95% CI 0.56-0.86, p < 0.01). Conclusions: A prenatal diagnosis of late-onset FGR is associated with higher intervention and preterm birth rates as compared to a diagnosis made after birth. Fetuses diagnosed with late-onset FGR during pregnancy should undergo specific and personalized assessment to determine the cause and severity of the growth delay and the best management strategy. This study highlights the importance of careful decision-making regarding the induction of labor in late-onset FGR.