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Late-onset fetal growth restriction (FGR) accounts for approximately 70-80% of all cases of FGR secondary to uteroplacental insufficiency. It is associated with an increased incidence of adverse antepartum and perinatal events, which in most instances result from hypoxic insults either present at the onset of labor or supervening during labor as a result of uterine contractions. Labor represents a stressful event for the fetoplacental unit being uterine contractions associated with an up-to 60% reduction of the uteroplacental perfusion. Intrapartum fetal heart rate monitoring by means of cardiotocography (CTG) currently represents the mainstay for the identification of fetal hypoxia during labor and is recommended for the fetal surveillance during labor in the case of FGR or other conditions associated with an increased risk of intrapartum hypoxia. In this review we discuss the potential implications of an impaired placental function on the intrapartum adaptation to the hypoxic stress and the role of the CTG and alternative techniques for the intrapartum monitoring of the fetal wellbeing in the context of FGR secondary to uteroplacental insufficiency.

Objectives:The primary objective was to quantify the risk of perinatal mortality in non‐anomalous monochorionic monoamniotic (MCMA) twin pregnancies complicated by birth‐weight (BW) discordance. The secondary objectives were to investigate the effect of inpatientvsoutpatient fetal monitoring on the risk of mortality in weight‐discordant MCMA twin pregnancies, and to explore the predictive accuracy of BW discordance for perinatal mortality. Methods:This analysis included data on 242 MCMA twin pregnancies (484 fetuses) from three major research collaboratives on twin pregnancy (MONOMONO, STORK and NorSTAMP). The primary outcomes were the risks of intrauterine (IUD), neonatal (NND) and perinatal (PND) death, according to weight discordance at birth from ≥ 10% to ≥ 30%. The secondary outcomes were the association of inpatientvsoutpatient fetal monitoring with the risk of mortality in weight‐discordant pregnancies, and the accuracy of BW discordance in predicting mortality. Logistic regression and receiver‐operating‐characteristics‐curve analyses were used to analyze the data. Results:The risk of IUD was significantly increased in MCMA twin pregnancies with BW discordance ≥ 10% (odds ratio (OR), 2.2; 95% CI, 1.1–4.4;P= 0.022) and increased up to an OR of 4.4 (95% CI, 1.3–14.4;P= 0.001) in those with BW discordance ≥ 30%. This association remained significant on multivariate logistic regression analysis for BW‐discordance cut‐offs ≥ 20%. However, weight discordance had low predictive accuracy for mortality, with areas under the receiver‐operating‐characteristics curve of 0.60 (95% CI, 0.46–0.73), 0.52 (95% CI, 0.33–0.72) and 0.57 (95% CI, 0.45–0.68) for IUD, NND and PND, respectively. There was no difference in the risk of overall IUD, single IUD, double IUD, NND or PND between pregnancies managed as an inpatient compared with those managed as an outpatient, for any BW‐discordance cut‐off. Conclusions:MCMA twin pregnancies with BW discordance are at increased risk of fetal death, signaling a need for increased levels of monitoring. Despite this, the predictive accuracy for mortality is low; thus, detection of BW discordance alone should not trigger intervention, such as iatrogenic delivery. The current data do not demonstrate an advantage of inpatient over outpatient management in these cases. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

OBJECTIVES Outlet ventricular septal defects (VSDs) are usually suspected on the five-chamber view of the fetal heart; however, postnatal confirmation occurs only in a small number of cases. The aim of this study was to evaluate if the systematic assessment of the short axis view may improve the prediction of prenatally detected outlet VSDs. METHODS Cases where isolated outlet VSD was suspected on the five-chamber view were assessed by using the short axis scanning plane for confirmation of the defect. Postnatal assessment was performed within 2 weeks from birth at our Paediatric Cardiology Unit. RESULTS An outlet VSD was suspected at five-chamber view in 23 fetuses. Postnatal confirmation of the VSD occurred in 14 cases where the defect was prenatally detected both on the five chamber and the short axis views. VSDs were not confirmed at postnatal assessment only in two cases where outlet VSD was suspected on both views, whereas all the seven cases with a suspected VSD on the five-chamber view only turned out to be false positives. CONCLUSION The short axis view of the fetal heart seems useful in confirming the presence of outlet VSDs. © 2016 John Wiley & Sons, Ltd.

AIM: To evaluate the cardiotocography (CTG) features observed in suspected intrapartum chorioamnionitis in term fetuses according to the recently suggested criteria for the pathophysiological interpretation of the fetal heart rate and their correlation with perinatal outcomes. METHODS: Retrospective analysis of nonconsecutive CTG traces. 'CTG chorioamnionitis' was diagnosed either based on a persistent rise in the baseline for the given gestation or on a persistent increase in the baseline fetal heart rate during labor >10% without preceding CTG signs of hypoxia and in the absence of maternal pyrexia. Perinatal outcomes were compared among cases with no sign of chorioamnionitis, in those with only CTG features suspicious for chorioamnionitis and in those who developed clinical chorioamnionitis. RESULTS: Two thousand one hundred and five CTG traces were analyzed. Of these, 356 fulfilled the criteria for "CTG chorioamnionitis". Higher rates of Apgar

Soft wearable robots promise to be the new frontier for assistance and augmentation of human motor abilities. In this work, we present the design, controller and a preliminary assessment of a soft, textile based glove for assisting hand movements. The device is shown to reduce the muscular effort required for grasping an object in healthy subjects, for forces up to 25 N but slows hand movements in free space.

Interstitial pregnancy (IP) occurs within the intramural portion of the tube and accounts for 2% of ectopic pregnancies. Surgery is considered the most definitive treatment for IPs, although there is no clear consensus regarding the optimal approach. In this paper we describe the advantages of cornual resection performed using the Endoloop technique and present three patients who were successfully treated using this approach. IP diagnosis was confirmed at two and three-dimensional ultrasound and laparoscopy in all cases. Fertility sparing surgery with cornuectomy by Endoloop ligature technique demonstrated low mean operating time and blood loss, and allowed the quick recovery and discharge of all patients. Laparoscopy has become the gold standard surgical approach for IP. Cornual resection or excision is the most commonly performed procedure. In our case series, the Endoloop technique showed excellent treatment outcomes in terms of effectiveness, blood loss, operative time, recovery and post-procedure fertility. Because of these features, Endoloop appears to be a suitable option for the laparoscopic management of IPs, both in elective and emergency settings.

We sought to assess the causes and outcomes of severe VM diagnosed de novo after 24 weeks of gestation where a mid-trimester anomaly scan was described as normal. Multicenter retrospective study of five European fetal medicine centers. The inclusion criteria were normal anatomy at the mid-trimester scan, uni/bilateral finding of posterior ventricle measuring ≥ 15 mm after 24 weeks with neonatal and postnatal pediatric and/or neurological assessment data. Of 74 potentially eligible cases, 10 underwent termination, the outcome was missing in 19 cases and there was 1 neonatal death. Therefore, 44 formed the study cohort with a median gestation at diagnosis of 32 + 0 weeks (25 + 6 - 40 + 5). VM was unilateral in five cases. Agenesis of the corpus callosum (ACC) and grade III/IV intraventricular hemorrhage (IVH) accounted for 14 cases each. ACC was isolated in 9 fetuses. Obstructive abnormalities included 5 arachnoid and 1 cavum velum interpositum cyst. Four fetuses had an associated suspected or confirmed genetic condition, 2 congenital infections, 1 abnormal cortical development and the etiology was unknown in 3/44. Postnatal assessment at median 20 months (3 - 96) showed 22/44 (50 %) normal, 7 (16 %) mildly abnormal and 15 (34 %) severely abnormal neurodevelopmental outcomes. One half of babies with severe VM diagnosed after 24 weeks have normal infant outcome with ACC and IVH representing the most common causes. Etiology is the most important factor affecting the prognosis of fetuses with severe VM diagnosed at late gestation.ZIEL: Bestimmung der Ursachen und Folgen einer schweren Ventrikulomegalie (VM) mit de-novo Diagnose nach 24 Schwangerschaftswochen (SSW) bei unauffälligem Basisultraschall im 2. Trimenon. Multizentrische retrospektive Studie in 5 europäischen Pränatalzentren. Die Einschlusskriterien waren eine normale Fetoanatomie beim Screening im 2. Trimenon, ein nach der 24. SSW auftretender uni-/bilateraler Befund im Hinterhorn von 15 mm sowie neonatale und postnatale pädiatrische und / oder neurologische Befunde. Von 74 potentiell geeigneten Fällen wurde bei 10 die Schwangerschaft beendet, in 19 Fällen fehlte der Ausgang und in einem Fall verstarb das Neugeborene. Folglich bildeten 44 Fälle die Studienkohorte, die bei Diagnosestellung eine mediane SSW von 32 + 0 (25 + 6 bis 40 + 5) aufwies. In 5 Fällen war die VM einseitig. Eine Agenesie des Corpus Callosum (ACC) sowie eine intraventrikuläre Hämorrhagie (IVH) Grad III / IV bestand bei jeweils 14 Fällen. Eine isolierte ACC wurde bei 9 Feten festgestellt. Zu den obstruktiven Anomalien gehörten 5 arachnoidale Zysten und 1 Zyste des Cavum velum interpositum. Bei vier Feten war dies mit einer vermuteten oder bestätigten Erbkrankheit assoziiert, zwei hatten kongenitale Infektionen, bei einem lag eine abnormale Entwicklung des Cortex vor und in 3/44 Fällen war die Ätiologie nicht bekannt. Die postnatale Bewertung nach median 20 Monaten (3 – 96) ergab bei 22/44 (50 %) eine normale, in 7 (16 %) eine leicht auffällige und in 15 (34 %) schwer auffällige neurologische Entwicklung. Die Hälfte der Babys mit einer nach 24 SSW diagnostizierten schweren VM hatte ein normales pädiatrisches Outcome, wobei ACC und IVH die häufigsten Ursachen waren. Die Ätiologie ist der wichtigste Einflussfaktor auf die Prognose von Feten mit Diagnose einer schweren VM in der Spätschwangerschaft.

Introduction: Umbilical artery blood analysis is assumed to give a picture of the acid–base balance of the infant at birth and is considered the gold standard to diagnose neonatal acidemia at birth. The evaluation of umbilical vein pH has been suggested as an adjunct in order to optimize the understanding of the pathophysiology of the hypoxic events in labor. The objective of this study was to assess the correlation between the Delta pH (vein-to-artery) on the umbilical cord and the intrapartum cardiotocography (CTG) patterns in a selected cohort of acidemic neonates. Methods: Retrospective analysis of all CTG traces from non-anomalous term neonates consecutively born with acidemia (pH < 7.05 on the arterial cord) at four European tertiary Maternity Units. Intrapartum CTG traces were collected and their characteristics were reviewed in consensus by three senior Obstetricians. Each case was assigned to one of these four types of intrapartum hypoxia according to the CTG features: acute hypoxia, subacute hypoxia, slowly evolving hypoxia, and chronic hypoxia. The relationship between the different categories of intrapartum hypoxia and the Delta pH on the umbilical cord were evaluated. Results: Overall, 83 acidemic neonates were included. Acute hypoxia, subacute hypoxia, slowly evolving hypoxia, and chronic hypoxia accounted for 19 (22.9%), 24 (28.9%), 24 (28.9%) and 16 (19.3%) cases, respectively. No difference of the Delta pH (p 0.61) was noted across the CTG subclasses, while significantly lower birthweight among cases with chronic hypoxia was found (p 0.03). The mean Delta pH did not vary at comparison between the cases with rapid onset hypoxia (acute + subacute hypoxia) and those with long lasting hypoxia (chronic + slowly evolving) (p 0.59). Conclusions: Within a selected cohort of acidemic neonates, our data do not demonstrate an association between the different CTG patterns of intrapartum hypoxia and the artery-to-vein Delta pH on the umbilical cord.

Outlet ventricular septal defects (VSDs) are usually suspected on the five-chamber view of the fetal heart; however, postnatal confirmation occurs only in a small number of cases. The aim of this study was to evaluate if the systematic assessment of the short axis view may improve the prediction of prenatally detected outlet VSDs.Cases where isolated outlet VSD was suspected on the five-chamber view were assessed by using the short axis scanning plane for confirmation of the defect. Postnatal assessment was performed within 2 weeks from birth at our Paediatric Cardiology Unit.An outlet VSD was suspected at five-chamber view in 23 fetuses. Postnatal confirmation of the VSD occurred in 14 cases where the defect was prenatally detected both on the five chamber and the short axis views. VSDs were not confirmed at postnatal assessment only in two cases where outlet VSD was suspected on both views, whereas all the seven cases with a suspected VSD on the five-chamber view only turned out to be false positives.The short axis view of the fetal heart seems useful in confirming the presence of outlet VSDs. © 2016 John WileySons, Ltd.

Port-site metastases (PSMs) are well-known potential complications of laparoscopic surgery for gynaecologic malignancies. The present case study reports PSM following laparoscopic surgery for Stage IA Grade 1 endometrioid endometrial cancer (EEC). The recurrence developed within 7 months following primary surgery and required surgical excision followed by adjuvant chemo-radio therapy. After 9 months, the patient remains disease-free. PSMs are rare complications following laparoscopic surgery. Amongst the 23 cases of endometrial cancer PSMs reported so far, only 4 followed EEC Stage IA Grade 1-2. The present study reports a rare case of PSM after Stage IA Grade 1 EEC. The clinical and prognostic relevance of PSMs has not been identified so far; and it is not known whether PSMs represent a local recurrence or a systemic recurrence. Surgeons should be aware that even low-risk EEC may be followed by PSMs and should take steps to prevent these rare recurrences.

Although first trimester combined screening test (CST) has been originally implemented for the screening of chromosomal anomalies, more recent evidences have shown its role in the estimation of the risk of preeclampsia (PET). Pathophysiological basis of PET are related to impaired trophoblastic invasion of the maternal spiral arteries occurring during the process of placentation as early as 9 weeks of gestation, which in normal conditions leads to the conversion of uterine vessels into low resistance reservoirs allowing feto/maternal blood exchange. Uterine artery pulsatility index (PI) is inversely related to the extent of trophoblastic invasion of the spiral arteries. Impaired placentation is featured by an abnormal functional and biochemical environment which consists in increase in uterine artery PI, increase in antiangiogenetic and proinflammatory factors – i.e. sEng, sFLT1, AFP, Inhibin-A, AFP – and reduction in angiogenetic and mitogenic factors - i.e. PlGF, PAPP-A, PP13. These biomarkers are responsible for a subclinical syncitiotrophoblastic injury in the first trimester and PET arising before 34 weeks of gestation. Combined assessment of maternal history and characteristics together with the above mentioned biomarkers and uterine artery Doppler in the first trimester has shown high specificity in the detection of women at risk to develop early onset PET. Even though the administration of Cardio Aspirin (ASA) seems efficient in decreasing the PET rate in high risk patients, it is uncertain whether the same prophylaxis is effective in “low risk” patients identified at “high risk” of early onset PET at first trimester CST. ASPRE (ASpirin for evidence-based PREeclampsia prevention – ASPRE – study) is the acronym of an ongoing Randomized Controlled Trial investigating the effectiveness of low-dose Aspirin in the prevention of early onset PET in high risk patients identified at first trimester CST. Results from this study are warranted in order to provide further insights in prevention strategies for PET.

In this paper we summarize our experience in diagnosis and treatment of 402 retrospectively collected tubal EP and review the most recent topics from the literature. Systemic Methotrexate (MTX) was effective in 56 out of 65 patients (failure rate 13.8%), in whom hCG level was significantly lower when compared to the failure group (plt;0,05); we performed 299 salpingectomies, 297 of whom through laparoscopic approach. MTX single-dose is safe and effective in eligible patients; surgery represents the treatment of most of the EPs, mainly through laparoscopic approach.

The 5HT transporter complex in platelets is similar to that in the brain and thus widely used in biological psychiatry as a peripheral marker of the 5HT system. Our study aim was to measure 14C-5HT uptake parameters (Vmax and Km) in platelets from 12 patients affected by bipolar disorder, as compared with 12 healthy controls. The uptake assay was performed according to the method of Arora and Meltzer (1981). The results showed that the Vmax was significantly lower in bipolar patients than in healthy controls, with no modification of the Km. These preliminary data would indicate therefore that the mechanism of 5HT transport is altered in platelets of bipolar patients.

We compared 40 outpatients with "pure" generalized anxiety disorder (GAD) with 152 panic disordered patients with varying degrees of phobic avoidance, and 241 primary major depressives with single and recurrent episodic patterns. Despite sociodemographic and symptomatologic overlaps with these comparison groups, GAD emerged as a relatively distinct disorder, characterized by chronic low-grade symptomatology with observed anxiety at interview, as well as nausea, headache, tension, and insomnia. These anxious "traits," which appear to be part of the habitual self of the patient, are subject to fluctuation over time, and may form the temperamental substrate or precursor of panic and other anxiety and depressive disorders.

Biographical note on the activity of the superintendent architect Giuseppe Giaccone