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9. Intrapartum ultrasound and mother acceptance: A study with informed consent and questionnaire

Author

Antonio Malvasi, Gianluca Raffaello Damiani, DI Naro Edoardo, Amerigo Vitagliano, Miriam Dellino, Reuven Achiron, Kosmas Ioannis, Antonella Vimercati, Maria Gaetani, Ettore Cicinelli, Marina Vinciguerra, Ilaria Ricci, Andrea Tinelli, Giorgio Maria Baldini, Silvestris Erica, and Giuseppe Trojano

Subjects
Visual biofeedback, Intrapartum ultrasonography, Informed consent, Labour, Obstetric violence, Discomfort, Gynecology and obstetrics, RG1-991
Abstract

Introduction: Intrapartum ultrasound (IU) is used in the delivery ward; even if IU monitors the labouring women, it could be perceived as a discomfort and even as an“ obstetric violence”, because it is a young technique, not often well ''accepted''. A group of clinicians aimed at obtain an informed consent from patients, prior to perform a translabial ultrasound (TU). The aim of this study was to evaluate the acceptance of both translabial and transabdominal IU. Methods: In this study, performed at the University Hospital of Bari (Unit of Obstetrics and Gynecology), were enrolled 103 patients in the first or second stage of labor in singleton cephalic presentation. A statistical frequency and an association analysis were performed. As a significant result, we consider the peace of mind/satisfaction and the” obstetric violence”. IU was performed both transabdominal and translabial to determine the presentation, head positions, angle of progression and head perineum distance. During the first and second stage of labor, the ASIUG questionnaires (Apulia study intrapartum ultrasonography group) were administered. Results: 74 (71, 84%) patients underwent IU and 29 had a vaginal examination (28, 15%). Significant less “violence” has been experienced with a IU (73 out 74/98, 65%) and only one person (1 /1, 35%) recorded that. On the contrary, 10 patients (10/29) perceived that “violence” (34, 48%) while 19 (65, 52%) did not respond on a similar way, after a vaginal examination (VE). More patients felt satisfaction (71 out 74/95, 95%) with the use of IU and only 3 (3/4, 05%) felt unease. A different picture was evident in the vaginal examination group. Only 17 patients (17 out 29/58, 62%) felt comfort while 12 (41, 38%) felt unease. Conclusions: In our study, IU use is well accepted by most of patients, because it could reassure women about their fetal condition. Moreover, they can see the fetus on the screen, while the obstetrician is performing the US and this is important for a visual feedback, in comparison with the classical VE.

Published
2023
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13. Unilateral twin tubal pregnancy: A case report and review of the literature

Author

Betti, M, Vergani, P, Raffaello Damiani, G, Pellegrino, A, Di Naro, E, Trojano, G, Betti, Marta, Vergani, Patrizia, Raffaello Damiani, Gianluca, Pellegrino, Antonio, Di Naro, Edoardo, Trojano, Giuseppe, Betti, M, Vergani, P, Raffaello Damiani, G, Pellegrino, A, Di Naro, E, Trojano, G, Betti, Marta, Vergani, Patrizia, Raffaello Damiani, Gianluca, Pellegrino, Antonio, Di Naro, Edoardo, and Trojano, Giuseppe

Abstract

Background: Unilateral twin tubal pregnancy is an extremely rare condition, occurring in 1/20.000- 250.000 pregnancies and represents a major health risk for reproductive-aged women, leading to even lifethreatening complications. Aim: We present a case of a 31-year-old woman with unilateral twin tubal pregnancy, treated with methotrexate and then surgically because of failure, followed by review of the literature. Methods: Researches for relevant data were conducted utilizing multiple databases, including PubMed and Ovid. Results: The most common type of twin ectopic pregnancy is the heterotopic (1/7000 pregnancies) in which in which both ectopic and intrauterine pregnancy occur simultaneously. Expectant, medical and surgical therapy have similar success rates in correctly selected patients. Two prospective randomized trials did not identify any statistically significant differences between groups receiving MTX as a single dose or in multiple doses. Among the 106 cases reported in literature, methotrexate was tried just in 4 patients (3 unilateral and 1 bilateral) before ours. Details are reported in the table 1. Conclusion: The recent shift in the treatment of singleton ectopic pregnancies to the less invasive medical therapy might apply even in the case of twin implants.

Published
2018

15. Predictors of postoperative morbidity after laparoscopic versus open radical hysterectomy plus external beam radiotherapy: a propensity-matched comparison

Author

Bogani, G, Cromi, A, Serati, M, Di Naro, E, Uccella, S, Donadello, N, and Ghezzi, F.

Subjects
cervical cancer, Uterine Cervical Neoplasms, Hysterectomy, Postoperative Complications, late complications, Humans, Prospective Studies, Propensity Score, Neoplasm Staging, Radiotherapy, Carcinoma, Length of Stay, Middle Aged, Prognosis, Combined Modality Therapy, Neoplasm Recurrence, Squamous Cell, Local, radical hysterectomy, Carcinoma, Squamous Cell, Lymph Node Excision, Female, Laparoscopy, Morbidity, Neoplasm Recurrence, Local, morbidity, radiotherapy, Follow-Up Studies
Abstract

Identification of peri-operative variables predicting postoperative morbidity may improve postoperative patients' care. We aimed to identify patients' characteristics and operative factors predictive of early (≤ 30-day) and late (≤ 6-month) morbidity in cervical cancer patients undergoing surgery plus external beam radiotherapy (EBRT).We studied 45 propensity-matched patient pairs (90 patients) undergoing laparoscopic radical hysterectomy (LRH) plus EBRT vs. abdominal radical hysterectomy (RAH) plus EBRT. Basic descriptive, multivariable and artificial neuronal network analyses (ANN) were used to design predicting models influencing outcomes.Baseline characteristics of the study populations were similar. Patients undergoing LRH experienced lower blood loss (200 (range, 10-700) vs. 400 (range, 100-2000) ml; P0.001), shorter length of hospital stay (4 (range, 1-10) vs. 8 (range, 5-52) days; P0.001) and similar operative time (235 (± 67.3) vs. 258 (± 70.2) min; P = 0.14) than patients undergoing RAH. We observed that, at multivariate analysis, open approach correlated with overall (OR: 1.2; 95%CI: 1.03-1.46), early (OR: 1.14; 95%CI:0.99-1.3) and late (OR: 1.13; 95%CI: 1.001-1.28) postoperative complications.Open approach is the main predictor for developing morbidity among cervical cancer patients undergoing radical hysterectomy followed by adjuvant radiotherapy. Laparoscopic surgery enhances peri-operative surgical results and minimizes the occurrence of late complications.

Published
2014

35. Nomogram of Wharton's jelly as depicted in the sonographic cross section of the umbilical cord

Author

Ghezzi, Fabio, Raio, L, DI NARO, E, Franchi, M, Balestreri, D, and D'Addario, V.

Subjects
Adult, Embryonic and Fetal Development, Biometry, Cross-Sectional Studies, Fetus, Anthropometry, Pregnancy, Humans, Female, Prospective Studies, Ultrasonography, Prenatal, Umbilical Cord
Abstract

To generate a nomogram for the sonographic measurement of Wharton's jelly area (WJA) during gestation and to investigate whether WJA is related to fetal biometric parameters.The sonographic cross-sectional area of the umbilical cord and of its vessels was measured in 659 fetuses between 15 and 42 weeks of gestation. The WJA was calculated by subtracting the vascular area from the umbilical cord area. The conventional biometric parameters were measured and correlated with the WJA. Polynomial regression analysis was utilized for statistical purposes.The WJA increased as a function of gestational age (r = 0.63, P0.001). The regression equation for the mean WJA (y) according to gestational age (x) was y = -114.7 + 4.142x - 0.01x2 and for the standard deviation (y') was y' = -7.567 + 1.319x. There was a strong correlation between the WJA and the umbilical cord area (r = 0.97, P0.001). A significant correlation was also found between the WJA and fetal biometric parameters before 32 weeks of gestation (WJA and biparietal diameter: r = 0.82, P0.001; WJA and abdominal circumference: r = 0.79, P0.001; WJA and femur length: r = 0.81, P0.001) while after 32 weeks of gestation no correlations were found between WJA and fetal anthropometric parameters.A nomogram for the WJA has been generated. The WJA increases as a function of gestational age and it is correlated with fetal size up to 32 weeks of gestation.

Published
2001

41. Hormonal contraception in adolescents

Author

Fabio Ghezzi, Buttarelli M, Cromi A, Di Naro E, and Franchi M

Subjects
Time Factors, Adolescent, Adolescent Behavior, Pregnancy, Risk Factors, Contraindications, Pregnancy in Adolescence, Age Factors, Humans, Female, Contraceptives, Oral, Hormonal
Abstract

The proper use of hormonal contraceptives represents an effective and safe prevention of unintended pregnancies which are still associated with morbidity and mortality. The side effects of the hormonal method are of concern to many young women even if a lot of adolescents are unaware of health benefits associated with their use except for those regarding menstrual disorders. Effective contraception improves health and may gives non contraceptives benefits such as a decreased risk of developing pelvic inflammatory diseases and improvement of endometriosis. However, incorrect or inconsistent use and discontinuation rate are higher in young girls than in older women determining a higher incidence of voluntary abortion. The use of hormonal contraception in adolescents is still a topic of discussion among medical practitioners. Adolescents require an accurate screening and a more frequent follow-up to reduce side effects and improve compliance and use.

Published
2001

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