Giovanni Sisti

We present a case of a woman in her mid-30s at 21 weeks of gestation referred to our tertiary medical center by an outside clinic with an ultrasound finding of a cystic septated lesion on the left side of the fetal chest. The differential diagnosis included, among others, foetal nuchal oedema, cystic hygroma, meningocele, encephalocele, cervical teratoma, haemangioma and subchorionic placental cyst. The sonographic finding of lack of intralesional vascularity on Doppler, seemingly without communication with the spinal canal, pointed us towards a diagnosis of foetal cystic lymphangioma. Our diagnosis was confirmed postnatally. Foetal cystic lymphangiomas are rare benign congenital tumours of the vascular and lymphatic systems. The differential diagnosis is broad, and a timely diagnosis positively affects the prognosis. If a lymphangioma is suspected, we suggest referral to specialists in maternal–foetal medicine with expertise in the field.

Article: Immediate delivery versus expectant management in women with chronic hypertension: a meta-analysis of randomized controlled trials - Minerva Obstetrics and Gynecology 2023 May 04 - Minerva Medica - Journals

The abstract has a mispell (PRISMA). Please add info about previous similar studies on the topic. Add the results and conclusions in your manuscript: the whole full text is poorly written in scientific English, please have it...

* explain the meaning of abbreviations (ex NIPT) the first time you use them * clarify: what does it mean outcome of NIPT? you mean prevalence of genetic disease? * consanguineos? what level? first degree? explain * did you account for...

The diagnosis of previable preterm pre-labor rupture of membranes (PROM) is known to be associated with poor outcomes for both the mother and the fetus. Following previable preterm PROM, patients are generally offered either active management through the termination of the pregnancy or expectant management to increase the chances of fetal survival. It is difficult to counsel patients because there is a lack of data directly comparing maternal outcomes following active vs. expectant management. Using the data in the current literature, the goal of the present meta-analysis was to determine if there were any differences in terms of maternal risks when active versus elective management was chosen. PubMed, Google Scholar, EMBASE, and Scopus were searched. We found four studies accounting for a total of 506 patients. The risk ratio (RR) of chorioamnionitis in active vs. expectant management was 0.30 (with a 95% confidence interval, CI, of 0.09–1.02). The heterogeneity of the study results was 81% (I²). A sub–analysis of two included studies revealed an RR of postpartum hemorrhage in active vs. expectant management of 0.75 (95% CI 0.27–2.07) and an RR of maternal sepsis of 0.23 (95% CI 0.04–1.28). The heterogeneity of the study results for this sub-analysis was 68% (I²) for postpartum hemorrhage and 0% (I²) for maternal sepsis. Overall, there was no statistically significant difference in the risk of chorioamnionitis, postpartum hemorrhage, or maternal sepsis when active management was chosen over expectant management in previable preterm PROM at <24 weeks. The scarcity and the high heterogeneity of the available data likely contributed to the lack of statistical significance and calls for further work directly comparing maternal outcomes following active vs. expectant management.

Linked article: This is a mini commentary on Rusconi et al., pp.276–284 in this issue. To view this article visit https://doi.org/10.1111/1471‐0528.17315

There are limited studies on predisposing factors for COVID-19 positivity in asymptomatic pregnant women. The literature published to date on asymptomatic COVID-19 pregnant carriers does not focus on pregnancy or pre-pregnancy comorbidities. We wanted to identify risk factors for COVID-19 in asymptomatic pregnant women. We performed a retrospective chart review of 263 asymptomatic pregnant women admitted to labour and delivery at New York City Health + Hospitals/Lincoln. We analysed the association between race, body mass index (BMI), smoking, indication for admission, gravidity, parity, pre-pregnancy comorbidity, pregnancy comorbidity via uni- and multivariate statistical tests. Only Hispanic race was significant in the univariate analysis (p = .049). At the post-hoc analysis, Hispanics had a higher proportion of COVID-19 cases compared to non-Hispanic Blacks (p = .019). No variables were significantly associated with COVID-19 positivity in the multivariate analysis. Hispanic race appears to be a risk factor for asymptomatic COVID-19 infection during pregnancy. We speculate that the cultural and socioeconomic reality of Hispanic women living in our community leads to more exposure opportunities and therefore, a higher infection rate.

Objective Pregnant women with chronic hypertension are recommended to deliver at 36 to 39 weeks and 6 days. The ACC (American College of Cardiology) and AHA (American Heart Association) in 2017 lowered the blood pressure cut off for stage I hypertension to 130/80 mmHg. Methods We performed a literature review on studies comparing elective induction of labor versus expectant management in pregnant women with chronic hypertension. In addition, we reviewed fetal and maternal outcomes in pregnant women with blood pressure of 120-139/80-89 or 130-139/80-89 mmHg. Results We found 2 randomized clinical trials and 1 retrospective observational study comparing elective delivery of pregnant patients with chronic hypertension versus expectant management. The randomized trials favored expectant management and the observational study favored induction of labor. We found 15 retrospective cohort studies analyzing maternal and fetal outcomes in pregnant women with blood pressure cut off lower than 140/90 mmHg. There was a consistent finding of increased risk of any hypertensive disorder of pregnancy, gestational diabetes mellitus, and small for gestational age neonate. Conclusion Randomized clinical trials are needed to assess the appropriate timing of delivery for women with stage I hypertension with a blood pressure cut off of 130/80 mmHg.

To describe the distribution of abnormal uterine bleeding (AUB) type according to the PALM-COEIN (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified) International Federation of Gynecology and Obstetrics (FIGO) classification system in a medically underserved American inner-city population. Our secondary objective was to find an association between risk factors and type of AUB. We conducted a descriptive cross-sectional analysis at our outpatient women's health clinic located in The Bronx, New York City in the time frame from November 2016 to December 2019. In our study of 390 patients, the most common AUB type was AUB-L (n=185, 47.4%), followed AUB-P (n=100, 25.6%), AUB-A (n=55, 14.1%), AUB-O (n=19, 4.9%), AUB-M (n=15, 3.8%), AUB-E (n=14, 3.6%) and AUB-I (n=2, 0.5%). Race was distributed as follows: Hispanic (68.2%), Black (25.9%), Caucasian (3.3%), and Asian (2.1%). Comorbidities included hypertension (36.4%), diabetes (15.6%), and thyroid disease (6.9%). The median age of diagnosis was significantly higher in AUB-M (59 years old, p<0.001), AUB-P (52.5 years old, p<0.001), AUB-E (51.5 years old, p=0.001) compared to AUB-L (46 years old). The median BMI (body mass index) was significantly higher in AUB-E (34.2 kg/m2, p=0.048) and AUB-O (32.6 kg/m2, p=0.038) compared to AUB-L (30 kg/m2). Race was equally distributed among the AUB types. AUB-M (66.6%, p=0.002), AUB-E (57.1%, p=0.022), AUB-P (47%, p<0.001), AUB-A (30.8%, p<0.001), and had statistically significantly more cases of hypertension compared to AUB-L (28.1%). AUB-P (27%, p<0.001), AUB-M (26.6%, p=0.025), AUB-E (35.7%, p=0.001) and AUB-A (9%, p<0.001) had more higher patients with diabetes mellitus than AUB-L (3.3%). In an American population of medically underserved patients, the most common cause of AUB was leiomyoma and the most common race was Hispanic. Women with AUB-L were younger, with lower BMI, and with fewer cases of hypertension and diabetes mellitus when compared to other types of AUB.