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28.2 Patologia degli annessi fetali
No full textVengono trattate le principali patologie degli annessi fetali suddivise in sottocapitoli:
1) Patologia del liquido amniotico
2) Patologie della placenta
3) Patologie delle membrane
4) Patologia del cordone ombelicale
5) Patologia infiammatoria degli annessi fetal
Capitolo 6-Assistenza prenatale
No full textVengono presi in esame gli obiettivi dell'assistenza prenatale, i disturbi tipici della gravidanza, gli screening delle possibili complicanze materne e gli screening delle complicanze fetali. Viene infine prospettata l'organizzazione dell'assistenza prenatale(chi deve fornire l'assistenza , la documentazione dell'assistenza, la frequenza e cadenza delle visite prenatali)
Placental Chorioangioma
No full textChorioangioma is a primary benign tumour with predominantly vascular involvement. It is found in 1% of all placentas undergoing careful and systematic histopathological examination. A rarer form is the clinically relevant chorioangioma which is likely to be associated with complications like polyhydramnios, pre-term birth, IUGR, anemia, fetal congested heart decompensation, non-immune fetal hydrops, perinatal mortality. Chorioangioma generally presents an increased consistency compared to adjacent tissues; it tends to be single, rounded and reddish-brown in colour. The preferred localisation is on the fetal side of the placental disk and it may protrude into the amniochorial cavity; the volume is variable (but rarely exceeds a maximum diameter of 4-5 cm). Of the known 3 histotypes of chorioangioma (angiomatous, cellular, degenerative), the first is the most insidious: the intratumoral vascular bed represents an arteriovenous shunt in the systematic circulation of the fetus #150; sometimes causing dramatic hemodynamic consequences #150; as well as a functional empty space (blood short-circuited through the neoplasm circulation would be deprived of the possibility of adequate gaseous and metabolic exchanges at the level of the terminal villi). Having been identified as early as 1798, chorioangioma has recently been the subject of renewed interest for the following reasons: 1) the possibility of prenatal diagnosis, prohibited to earlier generations of authors, following the development of instrumental techniques like ultrasonography and flowmetry; 2) the acquisition of new knowledge regarding the physiopathology of the tumour and the etiopathogenesis of its main complications; 3) improved prognostic capacity accompanied by better prospects for correct management; 4) wider awareness of the range of therapeutic options available
Il consultorio familiare. Centralità dell'area medica. Atti del XI Congresso Nazionale AGICO, Roma, 5-7 dicembre 2005
No full textRelazioni vari autor
L'incompetenza cervicale quale fattore di rischio di parto pretermine: ruolo del cerchiaggio cervicale nell'attuale pratica ostetrica.
No full textPreterm delivery is still the leading cause of neonatal mortality and morbidity. Among the risk factors of preterm delivery, there is also the so called cervical incompetence, that is the inhability of the uterine cervix to support a pregnancy to term, because of a structural or functional defect, either congenital or acquired. The diagnosis of cervical incompetence is mainly made during pregnancy and it is based on the ultrasonographic finding of uterine cervix morphometric changes (shortening and/or funneling, that is funnel-shaped dilatation of the upper portion of the cervical canal). In the light of the current scientific evidences, pregnant women who are at risk for second trimester abortion and/or early preterm delivery should undergo serial trans-vaginal ultrasound examination of the uterine cervix, starting from 16 - 20 week of gestation. In presence of significant cervical morphometric changes, the cerclage should be recommended when: 1) the gestational age is less than 24 weeks; 2) the woman history shows a high a priori risk of preterm delivery; 3) the residual cervical length is less than 20 mm; 4) fetal abnormalities, lower genital tract infections and uterine contractions have been previously ruled out. Up to date, it has not been carried out any clinical trial that demonstrates the efficacy and/or safety of emergency cerclage, performed in response to advanced cervical dilatation. For selected cases (previous failed trans-vaginal cerclage), it is possible to perform trans-abdominal cerclage. In particular, laparoscopic cerclage seems to be an unexpectedly effective and safe treatment. Key words: cervical cerclage, cervical incompetence; cervical insufficienc
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