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Introduction Preterm delivery (gestational age Materials and Methods A retrospective cohort of 3377 singleton pregnancies delivered by vacuum extraction from 2014 to 2019. All were gestational age ≥ 34 w. We compared 206 (6.1%) neonates with low birthweights Results The lowest rates of subgaleal hematoma occurred in neonates Conclusions Vacuum extraction of neonates weighing

To analyse prenatal work-up, associated anomalies and postnatal outcomes of foetuses with cerebral lateral ventricular width 9-9.9 mm.This retrospective, observational, case-control study included 121 foetuses with initial presentation of isolated cerebral lateral ventricular width 9-9.9 mm detected during routine ultrasound scans, 21-24 weeks' gestation, in a tertiary referral centre, January 2001-December 2018. Controls included 123 foetuses with lateral ventricular width9 mm measured under the same parameters. Clinical characteristics, obstetrical history, ultrasound findings, prenatal work-up and pregnancy outcomes were collected from medical records. Information about postnatal functional and neurodevelopmental sequelae were obtained from telephone-based questionnaires.The study group had more males (82/116 (70.6%) versus 65/123 (52.8%), p = 0.004), more prenatal testing, including brain magnetic resonance imaging (28/116 (24.1%) versus 0/123 (0%), p 0.001), echocardiography (46/116 (39.7%) versus 15/123 (12.2%), p 0.001) and targeted anomaly scans (102/116 (87.9%) versus 1/123 (0.008%), p 0.001). Long-term follow-up did not reveal more neurodevelopmental sequelae compared to controls. Gender-based analysis found more males with ventricular dilatation 9-9.9 mm treated for developmental delay compared to females with similar findings (15/82 (18.2%) versus 1/34 (2.9%), p = 0.010).Foetuses with 9-9.9 mm cerebral lateral ventricular width versus9 mm underwent more prenatal testing but had similar rates of neurodevelopmental sequelae.

This retrospective cohort study assessed the association between nuchal cord and adverse outcomes during vacuum-assisted delivery (VAD). Women with singleton pregnancies, 34–41-weeks gestation, who underwent VAD, from 2014 to 2020 were included. The primary outcome was umbilical cord pH ≤ 7.1. Secondary outcomes were neonatal intensive care unit admission, Apgar scores, pH < 7.15, subgaleal hematoma, shoulder dystocia and third/fourth-degree perineal tear. Outcomes were compared between neonates with (1059/3754, 28.2%) or without (71.8%) nuchal cord after VAD. No difference in cord pH ≤ 7.1 was found between groups. The nuchal cord group had a lower rate of nulliparity (729 (68.8%) vs. 2004 (74.4%), p = 0.001) and higher maternal BMI (23.6 ± 4.3 vs. 23.1 ± 5, p = 0.017). Nuchal cord was associated with higher rates of induction (207 (19.5%) vs. 431 (16%), p = 0.009) and lower birthweights (3185 ± 413 vs. 3223 ± 436 g, p = 0.013). The main indication for VAD in 830 (80.7%) of the nuchal cord group was non-reassuring fetal heart rate (NRFHR) vs. 1989 (75.6%) controls (p = 0.004). The second stage was shorter in the nuchal cord group (128 ± 81 vs. 141 ± 80 min, p < 0.001). Multivariate regression found nulliparity, induction and birthweight as independent risk factors for nuchal cord VAD. Although induction and NRFHR rates were higher in VAD with nuchal cord, the rate of umbilical cord acidemia was not.

Estimated fetal weight (EFW) is crucial for clinical decision-making during pregnancy and labor. Maternal habitus impacts its accuracy. This study compared the accuracy of clinical versus ultrasound EFW in tall pregnant women (height ≥ 172 cm, 90th percentile). In this prospective study, tall pregnant women at term, who arrived for a prenatal visit and delivered within a week, underwent clinical and ultrasound assessments of estimated fetal weight. Each woman served as her own control. After delivery, birth weight was compared to the clinical and ultrasound EFW. The primary outcome was the accuracy of each method in predicting the actual birth weight. All 100 women included in this trial underwent clinical and ultrasound estimations of fetal weight. Mean maternal height was 175.7 ± 3.3 (172–185) cm. More clinical EFW swere inaccurate compared to ultrasound (25 (25%) vs. 6 (6%), respectively, p

To evaluate the effect of changes in sonographic cervical length (CL) measured at 14–16 and 21–24 weeks of gestation, on cervical ripening in term pregnancies. This retrospective, cohort study included term pregnancies with CL measured with transvaginal sonography (CL1 at 14–16 weeks gestation and CL2 at 21–24 weeks). History of preterm labor, multiple gestations, planned caesarean section, fetal anomalies and stillbirths were excluded. Participants were grouped based on ≥ 10% vs. 10% between 14–16 and 21–24-weeks’ gestation is associated with lower use of cervical ripening at term.

To evaluate the association between fetal head position during prevacuum assessment and adverse outcomes.This retrospective cohort study included all vacuum-assisted deliveries using the Kiwi Omnicup over 5 years. Primary outcomes were third- or fourth-degree perineal tear, pH 7.1, and subgaleal hematoma (SGH). AGAR, neonatal intensive care unit admission, cephalohematoma, Erb's palsy, third-stage duration, and postpartum hemorrhage were secondary. Outcomes were compared between the occiput posterior (OP) and occiput anterior (OA) positions.The study included 1960 patients. OP position was more likely to involve epidural analgesia (311 [82.5%] vs. 1216 [77%], P = 0.020), higher fetal head station (P = 0.001), higher percentage of cup detachments (121 cases [32.1%] vs. 307 [19.4%], P = 0.001), and longer procedure (5.5 ± 3.7 min vs. 4.7 ± 2.8 min, P = 0.001). OP was associated with umbilical cord pH 7.1 (21 [5.5%] vs. 52 [3.9%], P = 0.032), NICU admissions (16 [4.2%] vs. 38 [2.4%], P = 0.049), SGH (18 [4.8%] vs. 38 [2.4%], P = 0.013), and high-degree perineal tears (12 [3.2%] vs. 26 [1.7%], with borderline significance, P = 0.051). SGH and high-grade tears remained significantly associated with OP position (P = 0.008 and P = 0.016, respectively) after adjusting for maternal age, nulliparity, diabetes, epidural anesthesia, preprocedure head station, and birth weight.OP position is an independent risk-factor for anal sphincter injury and SGH during vacuum-assisted delivery.

This retrospective cohort study investigated the association between ultrasonographic estimated fetal weight (EFW) and adverse maternal and neonatal outcomes after vacuum-assisted delivery (VAD). It included women with singleton pregnancies at 34–41 weeks gestation, who underwent ultrasonographic pre-labor EFW and VAD in an academic institution, over 6 years. Adverse neonatal and maternal outcomes included shoulder dystocia, clavicular fracture, or third- and fourth-degree perineal tears. A receiver–operator characteristic curve was used to identify the optimal weight cut-off value to predict adverse outcomes. Fetuses above and below this point were compared. Multivariate analysis was used to control for factors that could lead to adverse outcomes. Eight-hundred and fifty women met the inclusion criteria and had sonographic EFW within two-weeks before delivery. Receiver–operator characteristic curve analysis found that ultrasonographic EFW 3666 g is the optimal threshold for adverse outcomes. Based on these results, outcomes were compared using EFW 3700 g. The average EFW in the ≥3700 g group (n = 220, 25.9%) was 3898 ± 154 g (average birthweight 3710 ± 324 g). In the group

Objective: Prematurity [gestational age (GA)Design: A retrospective cohort. Population: 3,335 singleton pregnancies, delivered by VE from 2014 to 2019. All were >34w GA. Methods: We compared 207 (6.2%) neonates with LBW 3,500g). Main outcome measures: HI and other neonatal complications. Results: The lowest rates of subgaleal hematoma occurred in neonates 3,500g groups, respectively; p=0.001). Fewer cephalohematomas occurred among LBW neonates (0.5% in 3,500g groups, respectively, p=0.026). Logistic regression found increasing birthweight as a significant risk-factor for head injuries during VE, with adjusted odds ratios of 8.874, 10.624, 13.980 for 2,500-2,999g, 3,000-3,499g, and >3,500g, respectively (p=0.015). NICU hospitalization rates were highest among neonates weighing 3,500g respectively, p=0.000). Conclusions: VE of neonates weighing Funding: none.

To identify whether older primiparas have more complications than do women who continue to deliver children into their late reproductive age. Patients of at least 35 years of age at delivery were included. Within this cohort, data from primiparous and multiparous women were compared. This retrospective study was based on electronic medical records from a single academic center, with more than 7000 deliveries annually. The impact of parity on maternal complications was assessed using a multivariate logistic regression model that adjusted for baseline maternal characteristics and medical history. During the study period, there were 54 283 deliveries in our medical center. A total of 13,982 (25.7%) patients were at least 35 years old at delivery. The rate of twin pregnancy was higher in the primiparous group (1.9%) as compared to the multiparous group (0.8%, 95% CI 0.30–0.64, P

Estimated fetal weight (EFW) is crucial for clinical decision-making during pregnancy and labor. Maternal habitus impacts its accuracy. This study compared the accuracy of clinical versus ultrasound EFW in tall pregnant women (height ≥ 172 cm, 90th percentile).In this prospective study, tall pregnant women at term, who arrived for a prenatal visit and delivered within a week, underwent clinical and ultrasound assessments of estimated fetal weight. Each woman served as her own control. After delivery, birth weight was compared to the clinical and ultrasound EFW. The primary outcome was the accuracy of each method in predicting the actual birth weight.All 100 women included in this trial underwent clinical and ultrasound estimations of fetal weight. Mean maternal height was 175.7 ± 3.3 (172-185) cm. More clinical EFW swere inaccurate compared to ultrasound (25 (25%) vs. 6 (6%), respectively, p 0.001). Both clinical (3583 g) and ultrasound (3490 g) evaluations underestimated the fetal weights compared to the birth weights (3664 g, p 0.001). In the macrosomic fetal group, both the clinical (3983 g) and ultrasound (3767 g) estimates were significantly inaccurate compared to the birth weights (4237 g, p 0.001).Among tall women, ultrasound EFW is more accurate than clinical EFW.IRB-0016-17-MMC, Clinical-Trials.gov identifier NCT03206281.

To evaluate the effect of changes in sonographic cervical length (CL) measured at 14-16 and 21-24 weeks of gestation, on cervical ripening in term pregnancies.This retrospective, cohort study included term pregnancies with CL measured with transvaginal sonography (CLAmong 267 women who met the inclusion criteria, CL decreased ≥ 10% between scans in 70 (26.3%) and 10% in 197 (73.7%). Baseline characteristics were similar between groups. Fewer women with ≥ 10% shortening between scans, underwent cervical ripening (7.1% vs. 16.8%, p 0.05). In addition, in the ≥ 10% group, although CLDecrease in cervical length 10% between 14-16 and 21-24-weeks' gestation is associated with lower use of cervical ripening at term.

This study measured cervical length (CL) at 14-16 and 21-24 weeks of gestation and assessed whether the difference between measurements is predictive of preterm birth (PTB) among asymptomatic women with twin gestations.This retrospective, cohort study included patients with two consecutive CL measurements with transvaginal sonography at 14-16 weeks of gestation (CL1) and 21-24 weeks (CL2). PTB was defined as delivery prior to 37 + 0 weeks of gestation. Electronic medical records were reviewed for demographic, medical and delivery data. CL1, CL2 and the change between scans were evaluated and correlated with the prediction of PTB.Among 103 women with twin gestations, 76 (73.7%) delivered at term and 27 (26.3%) had PTB. CL1 and CL2 were not good predictors of PTB (The delta between routine cervical length measurements at 14-16 and 21-24 weeks of twin gestations cannot be used as a reliable predictor of PTB.

This study evaluated the association of fetal lateral neck cysts (FLNC) with adverse pregnancy outcomes, in relation to specific sonographic characteristics and co-existing findings. Pregnancies in which FLNC were detected by a single examiner in early anatomical scans (14–16 weeks) were included. Data regarding the pregnancy and its outcome were retrieved from telephone-based questionnaires, patient charts and from the examiner’s reports. 654 cases of FLNC were detected among 9446 early anatomical scans (6.9%). Complete data regarding 219 pregnancies were available. FLNC were significantly more prevalent in males (65.2%). The prevalence of heart malformations was 3.2% [all were non-isolated cases or with abnormal nuchal translucency (NT) and/or nuchal fold (NF)]. Amniocentesis performed in 165 pregnancies was abnormal in 1.2%. Among 206 children born from this cohort, adverse medical outcomes were reported in 5.3%. The likelihood of adverse pregnancy outcomes was significantly higher in non-isolated cases and in cases with abnormal NT or NF. Sonographic characteristics such as cyst size and bilateral findings were not linked to adverse pregnancy outcomes. Isolated FLNC are benign findings which do not require additional work up. FLNC with additional sonographic abnormalities are associated with a significantly increased risk for adverse pregnancy outcomes.

This study measured cervical length (CL) at 14-16 and 21-24 weeks of gestation and assessed whether the difference between the measurements is predictive of preterm delivery (PTD).This retrospective, cohort study included patients with two consecutive CL measured with transvaginal sonography at 14-16 weeks of gestation (CLAmong the 216 patients, 196 (90.7%) delivered at term (≥37 weeks) and 20 (9.3%) preterm (37 weeks). CLSonographic measurement of CL at 14- to 16-week gestation and the difference between CL in the first and second scans are not reliable predictors of PTD. However, cervical length at 21-24 weeks in low-risk women is predictive of this complication.

Placenta percreta (PP) is an abnormal condition of trophoblast maturation and terminal differentiation through the uterine wall. We opted to study telomere homeostasis and senescence expression in trophoblasts from PP, the most severe subgroup of placenta accreta.Paraffin-embedded placental biopsies from pregnancies with percreta and normal placentation, matched by gestational age at delivery, were assessed for telomere length, aggregates, and senescence-associated heterochromatin foci using quantitative fluorescence in situ hybridization. Cyclin-dependent kinase inhibitors p21, p15, p16, and the tumor suppressor protein p53, known senescence-related markers, were assessed using immunohistochemical staining.Short telomeres were found more often in trophoblasts from the samples of PP (n = 9) compared to controls (n = 8; 54% ± 20% vs 2.3% ± 1.16%, respectively; P.05). More cells with telomere aggregates (18.3% ± 6.9%) were observed in the PP than in the control group (4.8% ± 5.4%; P = .0005). The percentage of nucleic senescence-associated heterochromatin foci in the PP and control samples was similar (10.9% ± 10.4% vs 10.7% ± 15%, respectively; P = .97). Immunohistochemistry of senescence markers was expressed differently in PP compared to the controls: higher p15 expression (46.42% ± 15.2% vs 36.63% ± 12.2%, P = .004), higher p21 expression (59.8% ± 22.1% vs 47.5% ± 21.9%, P = .011), lower p16 expression (54.8% ± 26.3% vs 73.4% ± 18.9%, P = .000), and lower p53 expression (24.4% ± 33.8% vs 34% ± 14.4%, P = .000).Placenta percreta exhibits telomere alterations and changes in expression of several senescence markers. These might be related to altered trophoblast invasion maturation and placental detachment postpartum.

Objective To assess diagnostic accuracy, related findings, and outcomes of fetuses with clubfoot. Methods Sonographic characteristics, pregnancy work-up, and postnatal outcomes were evaluated in 109 fetuses with clubfoot. Results Among 40 320 prenatal ultrasound anomaly scans, clubfoot was diagnosed in 150 (0.37%). Analysis included 108 pregnancies (72%) with 109 fetuses. Bilateral clubfoot was diagnosed in 51/109 (46.7%) fetuses and unilateral in 58/109 (53.2%). Clubfoot was diagnosed as an isolated anomaly in 76/109 (69.7%) and complex in 33/109 (30.2%). Amniocentesis or chorionic villus sampling in 48/109 (44%) yielded 6 (12.5%) with abnormalities (5.5% of the entire cohort). Diagnosis was confirmed in 65/91 (71.4%) liveborn infants. In singletons, 7/63 (11.1%) cases considered isolated on ultrasound had additional anomalies postpartum and 8/14 (57.1%) complex cases were verified after birth. Sonographic diagnosis of clubfoot was verified postpartum in more singletons than twins (p = 0.05). Bilateral clubfoot was verified postpartum more often than unilateral [29/33 (87.9%) vs. 29/44 (65.9%), respectively; p = 0.03]. Bilateral clubfoot resulted in additional prenatal testing without increased likelihood of finding additional anomalies and was associated with more surgical interventions postnatally. Conclusions Prenatal ultrasound diagnosis of clubfoot is more accurate in singletons with bilateral findings. Bilateral findings do not increase the likelihood of additional anomalies. Karyotyping should be considered even with isolated clubfoot. © 2017 John Wiley & Sons, Ltd.

To identify whether older primiparas have more complications than do women who continue to deliver children into their late reproductive age. Patients of at least 35 years of age at delivery were included. Within this cohort, data from primiparous and multiparous women were compared.This retrospective study was based on electronic medical records from a single academic center, with more than 7000 deliveries annually. The impact of parity on maternal complications was assessed using a multivariate logistic regression model that adjusted for baseline maternal characteristics and medical history.During the study period, there were 54 283 deliveries in our medical center. A total of 13,982 (25.7%) patients were at least 35 years old at delivery. The rate of twin pregnancy was higher in the primiparous group (1.9%) as compared to the multiparous group (0.8%, 95% CI 0.30-0.64, P 0.001), as was the incidence of delivery prior to 34 weeks (6.1% of the primiparas versus 2.9% of the multiparas, P 0.001, OR 2.16, 95% CI 1.75-2.68); hypertensive disorders (3.9% versus 1.7%, P 0.001, 95% CI 0.33-0.57); diabetes (4.6% versus 3.2%, P = 0.003, 95% CI 0.55-0.88); and IUGR (10.5% versus 4.7%, P 0.001, 95% CI 0.35-049), respectively. The increased risk for pre-term delivery, hypertensive disorders, diabetes, and IUGR was maintained after logistic regression analysis.We found that pregnancy complications typical to older parous women are significantly more common among primiparas, indicating that not only older age, but also having a first child relatively late in the reproductive period contributes to adverse pregnancy outcomes.

To compare maternal and neonatal outcomes in induced vs. expectant management of term PROM. This retrospective study included patients with term PROM. A total of 325 were enrolled: 213 managed expectantly and 112 induced at admission and matched according to gestational age. Expectant management group patients were allowed to defer labour induction up to 48 h. Primary outcome measures were maternal or foetal signs of infection (chorioamnionitis, early neonatal sepsis or postpartum endometritis) and prolonged maternal hospitalization. Secondary outcome was caesarean delivery rate. All group characteristics were comparable except that expectant management included more nulliparous women. Women managed expectantly had a higher rate of prolonged hospitalization [15 (7 %) vs. 2 (1.8 %); P = 0.043] as an indication of maternal complications, compared to induction management. They also had a higher rate of caesarean delivery [34 (16.4 %) vs. 8 (7.1 %), respectively; P = 0.024]. Adjustment for parity did not change the results. Early neonatal outcomes were similar between groups. Expectant management increases the likelihood of caesarean delivery and prolonged maternal hospitalization. This should be considered when advising patients with term PROM regarding labour induction.

To evaluate the yield of work-up in intrauterine growth restriction (IUGR) pregnancies and their outcomes.Retrospective data regarding prenatal work-up (serology, genetic testing and imaging), and neonatal outcomes of 198 IUGR pregnancies (estimated fetal weight10th percentile) were analyzed.IUGR was isolated in 72 cases. Work-up performed in 158 (80%) cases was positive in 4 (2.5%). No abnormalities were detected in prenatal genetic testing. Echocardiogram performed in 27 cases was abnormal in 3 (11.1%). Serological testing performed in 150 pregnancies (75.8%) detected 1 case (0.7%) of cytomegalovirus (CMV) infection. Thirteen neonates (6.5%) were diagnosed with significant health problems. A positive work-up and significant postnatal health problems were not correlated with IUGR severity, symmetry or additional concurrent findings.The yield of IUGR work-up is not clear and is probably highest for fetal echocardiography. The rate of significant adverse outcomes after birth is increased in IUGR pregnancies.

The purpose of this study was to evaluate telomere homeostasis in sub-fertile compared to fertile human sperm. This observational, comparative study included 16 sub-fertile men who required intracytoplasmic sperm injection and 10 fertile men. At least 100 sperm cells from each participant were assessed. Main outcome measures were telomere length and telomere aggregates. Telomerase RNA component (TERC) copy number and telomere capture were assessed using fluorescence in situ hybridization technique and human telomerase reverse transcriptase (hTERT) using immunohistochemistry. Clinical backgrounds were similar. The percentage of sperm cells with shorter telomeres was higher among the sub-fertile compared to the fertile participants (3.3 ± 3.1 vs. 0.6 ± 1.2%, respectively; P

This study assessed our hospital protocol of vaginal delivery for twins and evaluated whether trial of vaginal delivery (unless contraindicated) was as safe as elective cesarean. Risk factors leading to failed trial of labor (TOL) were characterized to improve our ability to advise patients and select cases for TOL.This retrospective, cohort study included women32 weeks gestation, with twin A in cephalic presentation and no contraindications for vaginal delivery. Controls were women with twin pregnancy and planned cesarean delivery (PCD). Maternal and neonatal morbidity between TOL and PCD were compared. TOL group was subcategorized by vaginal or cesarean delivery to characterize pre-labor risk factors for failed TOL.Of the 411 twins, 215 had TOL and 196 had PCD. Among TOL, 196/215 (91%) delivered vaginally. TOL was more likely to have spontaneous pregnancy, pregnancy complications and tended to deliver earlier. More TOL had postpartum hemorrhage (p .05), although transfusion rates in each group were similar. Neonatal outcomes between groups did not differ. Induction and gestational age at delivery were risk factors for failed TOL.The results support the contemporary practice of TOL for twins at term when the first is in cephalic presentation with no other contraindications.

Study Objective Extrauterine pregnancy (EUP) is a complication of assisted reproductive technology (ART). Data regarding specific clinical characteristics and treatment success rate of ART-related EUP are scant. This study assessed differences in clinical presentation, management and treatment success rate between spontaneous and ART-related EUP. Design A retrospective cohort study that included EUP diagnosed between 2007-2017. Setting Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel Patients or Participants 412 EUP diagnosed between 2007-2017. Interventions Electronic medical record data of 278 spontaneous EUP were compared to 125 ART-related EUP (36 after ovulation induction and 89 after in vitro fertilization (IVF)). Symptoms, laboratory tests, ultrasound findings and treatment modalities were compared between groups. Measurements and Main Results Women with spontaneous EUP were more likely to be symptomatic than those who conceived after IVF (81.8% vs. 68.5%, p=0.022). Surgery was used as first-line treatment in 21.9% of spontaneous pregnancies, as compared to 37.1% of IVF pregnancies (p=0.004). IVF cases required additional methotrexate following conservative treatment failure less often than did those with spontaneous EUP (33.3% vs. 55.2%, p=0.019). Conclusion Women with IVF-related EUP were less symptomatic upon presentation and underwent surgery for first-line treatment more often than those with spontaneous EUP did. The type of conception was not a prognostic factor for success of first-line conservative treatment. Observation alone was more successful among IVF pregnancies.

Purpose: To evaluate different ovarian volume cut-off values to distinguish between normal ovaries, benign lesions, and malignant lesions in menopausal women. Methods: Transvaginal sonographic ovarian volume measurements were performed in 362 menopausal patients prior to gynecologic surgery. Based on the histopathologic results, a total of 466 ovaries were divided into 3 groups: normal ovary, benign lesion, and malignant tumor. Different ovarian volume cut-off values were analyzed via receiver operating characteristic curves to determine the optimal cut-off value. Results: The mean ovarian volumes in the normal ovary, benign lesion, and malignant tumor groups were 3.4 ± 2.2 cm3 (range, 0.6–9.6 cm3), 102 ± 308 cm3 (range, 0.3–3543 cm3), and 368 ± 1176 cm3 (range, 8.1–9908) cm3, respectively. Cut-off values of 8 cm3 and 10 cm3 to distinguish between malignant and nonmalignant lesions had a sensitivity of 100% and 97% and a specificity of 39% and 45%, respectively. Conclusion: In menopausal patients, any ovary with a volume >8 cm3 can potentially harbor a cancer. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008

Purpose The aim of the study was to evaluate the contribution of gray-scale sonography and Doppler flow studies in differentiating between uterine sarcomas of different histologic types and leiomyomas. Patients and Methods The study included 111 patients, divided retrospectively into 2 groups: 98 patients with leiomyomas and 13 with postoperative diagnosis of uterine sarcoma. This latter group was further divided into a group of 6 patients with uterine leiomyosarcoma and 7 with malignant mixed mesodermal tumor. The gray-scale sonograms and Doppler parameters in the 3 groups were compared. Results The patients with leiomyomas were younger than those with sarcomas (52 years ± 11 versus 65 years ± 15, p < 0.05). No differences were noted between the 3 groups regarding gravidity, parity, symptoms upon admission, or findings during physical examination. The sonographic appearances of the leiomyomas were similar to those of the leiomyosarcomas, but in 6/7 cases, they were different from those of the malignant mixed mesodermal tumors. There was a significant difference between the mean resistance index in arterioles of the leiomyomas (0.59 ± 0.01) and that of the malignant mixed mesodermal tumors (0.41 ± 0.06) (P < 0.001) but not between those of the leiomyomas and the leiomyosarcomas (0.49 ± 0.18). Conclusions Doppler flow studies may assist in differentiating between leiomyomas and malignant mixed mesodermal tumors but not between leiomyomas and leiomyosarcomas. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 33:10–13, 2005

This study was designed to examine whether cytokeratin 20 (CK20) is expressed in molar pregnancies and may therefore be used in the diagnosis of gestational trophoblastic disease (GTD). The potential of CK20 expression in predicting the evolution and the prognosis of the different subtypes of GTD was also assessed.A total of 48 samples were studied for CK20 expression by RT-PCR methodology. Among these, 24 samples were obtained by curettage of the uterine cavity of patients diagnosed with hydatidiform mole (14 complete moles and 10 partial moles), 4 samples were obtained from choriocarcinoma cell lines (2 JAR and 2 JEG), and 20 samples were of normal trophoblast (control group) obtained from patients that underwent elective termination of pregnancy.Expression of CK20 was identified in all the samples of complete mole (CM), all choriocarcinoma cell lines, and 50% of the patients with partial mole (PM). None of the preparations of normal trophoblastic tissue from the control group expressed the CK20. A significant difference (P0.00001) was found in CK20 expression between samples of patients with GTD and control samples. Comparison between CK20 expression in CMs and PMs revealed a significantly more frequent expression of CK20 in CMs (P = 0.006). More than 50% of the patients with PMs that were positive for CK20 had an invasive evolution.In our opinion, CK20 may assist in distinguishing between molar and normal trophoblastic tissue and may be considered a marker of GTD. In cases in which pathological classification of different subtypes of GTD is in doubt, CK20-positive expression is suggestive for a CM whereas CK20-negative is more indicative for PM.

Background The optimal choice of skin closure at cesarean delivery has not yet been determined. Objective This study compared wound complications and scar healing following cesarean delivery between 2 methods of skin closure: glue (Dermabond; Ethicon, Somerville, NJ) and monofilament (Monocryl; Ethicon) epidermal sutures. Study Design We conducted a randomized controlled trial in which pregnant women undergoing a scheduled cesarean delivery were randomly assigned to skin (epidermis) closure with glue or with a monofilament synthetic suture. The subcutaneous tissue was sutured for all patients. Outcome assessors were blinded to group allocation. Scars were evaluated >8 weeks. Primary outcome measures were Patient and Observer Scar Assessment Scale scores. Secondary outcome measures were surgeon satisfaction, duration of surgery, duration of hospitalization after the cesarean delivery, and complications of surgical site infection or wound disruption (hematoma or seroma). A sample of 104 women was needed to achieve a clinically significant effect with a power of 80%. Results Demographic characteristics, patients' clinical background, prepregnancy body mass index, and subcutaneous thickness were similar in both groups. Length of surgery between the groups (37 ± 10 minutes for glue vs 39 ± 13 minutes for sutures, P = .515) was similar. Scores immediately after the wound closure were similar for both groups regarding surgeons' time estimate of closure ( P = .181) and closure appearance ( P = .082). Surgeons' satisfaction with the technique was significantly higher in the suture group ( P = .003). No significant differences were found between the groups in blood loss, surgical site infection, length of postpartum hospitalization, or wound disruption. Glue and suture skin closure scores using Patient and Observer Scar Assessment Scale were similar 8 weeks after surgery, at P = .710 for patients and P = .568 for a physician observer. Conclusion Skin closure using glue or a monofilament synthetic suture had similar results. Both methods were shown to be safe and successful for skin closure after a scheduled cesarean delivery and, therefore, can be used based on surgeon and patient preferences.

To detect location of uterine cesarean scar in relation to cervix in pregnancies with previous cesarean section (CS) and to compare location between elective and emergent previous CS.Prospective study, 91 pregnant women with previous low transverse CS. Two groups: previous elective [36 (39.6%)] and emergent CS [55 (60.4%)]. Transvaginal ultrasound was performed between 14 and 16 weeks. Cervical length (CL) and distance between external oss to hypoechogenic line (EO-HL distance), which describes location of cesarean scar, were measured. Surgical incision was considered cervical when EO-HL distance was smaller than CL.Mean CL and EO-HL distance: 45.4 + 7. 0 and 39.0 + 9.4 mm, respectively for all patients. No significant differences were observed in CL (45.9 + 6.2 vs. 45.1 + 8.5 mm; p = not significant [NS]) and EO-HL distance (40.7 + 9.7 vs. 37.9 + 9.1 mm; p = NS) between both groups. Sixty-four cases (70.3%) had cervical scar, eight (8.8%) at the level of the internal oss and 19 (20.9) in the lower uterine segment. No significant difference was observed between both groups regarding location of scar (cervix -72 vs. 67% emergent vs. elective, respectively; p = NS).CS incisions are mostly performed in cervix, in elective as well as in emergent operations.

Background There is a need to evaluate the extent of endometrial pathologies that might develop in postmenopausal breast cancer patients following discontinuation of tamoxifen (TAM) therapy. Methods The medical records of 153 postmenopausal breast cancer patients who remained untreated following discontinuation of tamoxifen therapy were evaluated for various clinical features, for endometrial thickness measurements, as detected by transvaginal ultrasonography, and for various endometrial pathologies detected. The last endometrial thickness measurement performed before discontinuation of tamoxifen was compared with endometrial thickness measured following discontinuation of tamoxifen. Results Patients were followed for 37.5 ± 31.3 months. There was a gradual and significant decrement of endometrial thickness measured at the last ultrasonographic study performed before cessation of tamoxifen, compared to that observed in all four ultrasonographic studies performed following discontinuation of tamoxifen ( P = 0.001). Endometrial thickness gradually and significantly decreased in correlation with the time intervals of the four ultrasonographic studies performed following discontinuation of tamoxifen ( P = 0.001). Overall, 40 hysteroscopies were performed in 38 (24.8%) patients. No tissue was obtained in 18 (11.8%) patients. Overall endometrial pathologies were diagnosed in 22 (14.4%) patients. Benign endometrial polyps were the most frequent endometrial pathology recovered: 17 (11.1%) patients. No endometrial malignancy was diagnosed. The rate of endometrial pathologies considerably decreased with the extension of time following discontinuation of tamoxifen therapy. Conclusions Long-term follow-up of postmenopausal breast cancer patients who remained untreated following discontinuation of TAM therapy did not reveal any malignant endometrial pathology. Only few benign endometrial pathologies were diagnosed, which became fewer in time.

Purpose. To describe the sonographic appearance of the uterine cavity in women after administration of mifepristone and misoprostol for termination of pregnancy. Methods. Thirty-six women treated with mifepristone 600 mg followed by misoprostol 400 μg 2 days later for termination of pregnancy were the subjects of the study. Gestational age as calculated from the last menstrual period was ≤49 days. Pretreatment sonographic parameters, including gestational sac size and crown–rump length, were measured. The sonographic appearance of the uterine cavity was recorded and documented 6 hours (T-1) and 14 days (T-2) after administration of misoprostol. Results. The mean menstrual age of the patients was 42 days (range 31–49 days). The mean gestational age according to crown–rump length was 43 days (range 40–48 days). Sonographic examination performed atT-1 revealed 23 patients (62.9%) with a well-defined echogenic mass located in the uterine cavity, 2 patients (5.5%) with an intrauterine sac containing a nonviable embryo, and 11 patients (30.5%) with an endometrium thickness of 7–14 mm with no evidence of intrauterine contents. Doppler flow signals were detected in 15 of the 23 patients (65.2%) with an echogenic intrauterine mass. Sonographic examination performed at T-2 revealed 19 patients (52.8%) with a persistent echogenic intrauterine mass; Doppler flow could be detected in 15 of these patients (78.9%). Dilatation and curettage was required in 2 patients (5.6%) due to failure of treatment; all others regained normal menses. Conclusions. An intrauterine echogenic mass with well-defined borders, with or without Doppler flow signals, can be detected 2 weeks after administration of mifepristone and misoprostol for termination of pregnancy. Because most of the women in our study regained normal menses without further surgical intervention, this finding could indicate remnants of trophoblastic tissue evacuated spontaneously from the uterine cavity. Therefore, dilatation and curettage should be avoided in these cases, unless clinical symptoms or signs necessitate surgical intervention. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:278–282, 2006

Aromatase inhibitors may decrease endometrial thickness in breast cancer patients previously having short-term tamoxifen treatment. There is a necessity to find out if aromatase inhibitors can also decrease endometrial thickness in patients previously treated with long-term tamoxifen treatment.Prospective comparison of the last ultrasonographic endometrial thickness measurement taken before discontinuation of long-term tamoxifen treatment in 36 postmenopausal breast cancer patients, with further measurements, performed following aromatase inhibitors administration.There was a significant decrement of endometrial thickness, following 36.2 +/- 16.8 months of tamoxifen treatment, from a mean value of 9.1 +/- 5.8 mm, measured at the last ultrasonographic measurement performed before discontinuation of tamoxifen treatment, down to a mean value of 6.0 +/- 5.0 mm, measured following 5.8 +/- 5.8 months of aromatase inhibitors therapy (P = 0.001). A second ultrasonographic measurement performed in 8 patients following of additional 7.5 +/- 4.0 months of aromatase inhibitors treatment revealed further decrement of mean endometrial thickness to 4.8 +/- 2.1 mm (P = 0.002 compared to baseline). In 28 patients (77.8%), endometrial thickness was reduced following the administration of aromatase inhibitors, in four patients (11.1%) there was no change in endometrial thickness and four (11.1%) patients demonstrated an increase of endometrial thickness.Aromatase inhibitors may reverse endometrial thickening induced by long-term tamoxifen treatment in postmenopausal breast cancer patients.