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LA PORTATA EMATICA DELLE ARTERIE UTERINE E DELLA VENA OMBELICALE NELLE GRAVIDANZE COMPLICATE DA RESTRIZIONE DI CRESCITA FETALE (IUGR)
Full text linkABSTRACT
Intrauterine growth restriction (IUGR) indicates a condition in which the fetus fails to reach its growth potential genetically predetermined. This condition is associated with a higher risk of adverse perinatal outcome, especially if undetected. However, the definition of IUGR in clinical practice is challenging because some “small fetuses” might be simply constitutionally small (SGA), whether other might have suffered from growth restriction despite the fact that they present biometric parameters within normal ranges. There are some evidences to support the added value of the volume blood flow in the uterine arteries (QAUt) or in umbilical vein (QVOmb) in IUGR fetuses.
Aim of the study
The aim of the study is to evaluate QAUt and QVOmb in fetuses considered to be SGA or that have slowed down their growth. Particularly, we wanted to evaluate the relationship with other Doppler parameters commonly used, the possible association with adverse perinatal outcome, and the added value of blood flow volume in differentiating between SGA and IUGR.
Methods
This was a case-control study (1:2) in a single third referral centre. Patients were recruited during second and third trimester in the presence of abdominal circumference (AC)-12 or admission to neonatal special care unit. Logistic regression models, adjusted for gestational age, were adopted to evaluate differences between the groups of dependent variables.
Main findings of the study
We recruited 110 cases and 220 controls. Of those 4 cases and 42 controls had to be excluded for missing outcome data or onset of some complication in control group. Thus, the analysis was performed on 106 cases and 178 controls. The QAUt and QVOmb, total and normalized for EFW, were significantly lower in fetuses with CA<10°pc or growth retardation than in controls (total QAUt, total QVOmb and normalized QVOmb all p<0.0001; QAUt normalized for EFW p=0,0005 at diagnosis and p=0,04 before delivery). Cases that had also at least one Doppler alteration had significantly lower QAUt and QVOmb, total and normalized for EFW, than controls (total QAUT p<0.0001; normalized relative QAUt p=0,0002; total and normalized QVOmb both p<0,0001). However, also fetuses without Doppler abnormalities showed significantly lower total QAUt, total and normalized for EFW QVOmb than controls (total QAUt p<0.0001; relative QAUt p=0,6; total QVOmb p<0,0001 and normalized QVOmb p=0,003). In those fetuses QVOmb, total and normalized for EFW, were significantly lower in the presence of composite adverse outcome than in controls (respectively p <0.0001; p=0.004), while there were no significant differences between those fetuses with normal outcome and controls (total QVOmb p<0.0001; normalized QVOmb p=0.06), respectively.
Conclusion
Blood flow volume in uterine arteries and umbilical vein might be helpful in identifying small fetuses that suffered from growth restriction in the absence of other Doppler abnormalities. Further studies are needed to prove the clinical usefulness and performance
RCT of real versus placebo acupuncture in IVF
No full textThe efficacy of acupuncture in in vitro fertilization treatment is a very controversial issue. Four metaanalysis have been published over the last months (El-Toukhy et al., 2008; Manheimer et al., 2008; Ng et al., 2008; El-Toukhy and Khalaf, 2009) leading to opposite conclusions. Three metaanalysis conclude that there is no evidence of acupuncture efficacy (El-Toukhy et al., 2008; Manheimer et al., 2008; El-Toukhy and Khalaf, 2009), whereas another one concludes that acupuncture improves rates of pregnancy and live birth (Manheimer et al., 2008)
Indicazioni della IUI
No full textL’inseminazione intrauterina (IUI) ha come razionale il superamento della barriera mucosa cervicale e l’aumento della percentuale di spermatozoi mobili, con forme normali, a livello del sito di fertilizzazione. Le procedure di lavaggio riducono la concentrazione di prostaglandine, linfochine, citochine e radicali dell’ossigeno da parte di agenti infettivi, spermatozoi non mobili, leucociti, cellule immature, portando così ad un miglioramento della qualità del liquido seminale, con aumento della percentuale di fertilizzazione, in vitro ed in vivo.
Questa tecnica, semplice, non invasiva e poco costosa, offre numerosi vantaggi, quali la necessità di avere attrezzature minime, il ridotto disagio psicologico per la paziente, i rischi minimi di Sindrome da Iperstimolazione Ovarica (OHSS) e di gravidanze multiple (7), garantendo quindi una compliance per l’IUI maggiore rispetto alla fecondazione in vitro (IVF). Ciononostante tale procedura è ancora oggetto di discussione clinica (1,2).
Le principali indicazioni all’IUI, con o senza stimolazione ormonale, sono l’infertilità femminile da fattore cervicale, l’infertilità maschile e la sterilità sine causa
Finasteride and Fertility: Case Report and Review of the Literature
No full textAlthough millions of men have taken or are taking finasteride, there are no documented cases of successful pregnancy in the literature after discontinuation of the drug. Early studies did not show significant influence of finasteride on semen parameters, whereas some recent observations have suggested that in subfertile patients, the effects of the drug might be amplified. Therefore, counseling is particularly difficult for men taking finasteride and planning pregnancy. We report the case of a couple whose male partner had used finasteride for approximately 10 years and who presented for primary infertility. The first semen analysis, carried out 3 months after finasteride cessation, revealed severe oligospermia. One month later, sperm concentration increased, and the following month, the couple spontaneously conceived. A healthy baby was delivered at full term. To the best of our knowledge, this is the first case of successful full-term pregnancy and live birth after long-term use of finasteride, which suggests that treatment with finasteride, even after several years, does not prevent normal conception. However, caution should be advised with the use of finasteride in male partners of couples who are attempting to become pregnant
“Pregressa miomectomia: modalità e management del parto”
No full textIn considerazione della tendenza, indotta dai mutamenti sociali, a posporre l'età della prima gravidanza e del fatto che il riscontro dei fibromi aumenta nella quarta decade di vita, è probabile che la prevalenza dei miomi associati ad infertilità sia in aumento e quindi il clinico sia sempre più di frequente obbligato a scegliere condotta ed eventuali terapie in caso di donna gravida con pregressa miomectomia. In concreto, se è disponibile una buona documentazione dell’intervento (eventualmente videoregistrazione), che attesti una sua corretta esecuzione, e/o eventualmente il parere scritto di chi ha eseguito l’intervento, la paziente può essere assimilata a una paziente con pregresso taglio cesareo. Ogni sforzo deve esser fatto per reperire la documentazione. Il management dovrà essere ispirato alle linee guida disponibili in merito. In caso contrario, appare prudente, discussi con la donna i pro e i contro, programmare un taglio cesareo elettivo. Questo atteggiamento non è suffragato da alcuno studio clinico, ma solo dall’analisi dei case reports, che dimostra come il fattore determinante nelle donne con tale complicanza non sia la sede o il numero o le dimensioni del mioma, né l’intervallo fra l’intervento e la gravidanza, ma un difetto della tecnica chirurgica
Fecondazione assistita per tutte? Quando bisogna dire no!
No full textDi fatto, l’unico criterio riportato in documenti ufficiali (disposizioni di legge, linee-guida, raccomandazioni di organismi sanitari e scientifici, ecc.), che regoli l’accesso alla fecondazione in vitro è rappresentato dall’età, anche se come visto, la normativa italiana rimanda al singolo medico la decisione “di non procedere alla procreazione medicalmente assistita, esclusivamente per motivi di ordine medico-sanitario.” (art. 6, c. 4 L. 40/2004). Tuttavia, procedere o non procedere al trattamento rappresenta una difficile decisione in cui sono in gioco interessi che confliggono. Da una parte la coppia che ha l’interesse di provare tutto il possibile per avere un bambino. Dall’altra il medico che ha l’interesse di evitare danni ai pazienti e ai nascituri, e di evitare la frustrazione di fornire trattamenti virtualmente certi di fallimento, oltre l’interesse comune, nel caso di procedure in centri del sistema sanitario pubblico, di evitare speco di risorse (spese per personale, spazi, apparecchiature, farmaci, ecc.), che potrebbero essere più opportunamente allocate
Valutazione delle arterie uterine nei tre trimestri di gravidanza nei disordini ipertensivi di origine placentare e maternogenica
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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