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ABSTRACT: The angle of progression (AOP), measured by transperineal ultrasound, has been used to assess fetal head descent during labor. Our aim was to assess whether, before onset of labor, parous women have a narrower AOP than do nulliparous women and if a narrow AOP is associated with a higher rate of Cesarean delivery.
In this prospective, observational study, we performed transperineal ultrasound in pregnant women not yet in labor at ≥ 39 weeks' gestation who delivered within 1 week of sonography. The AOP was compared as follows: in nulliparous women, between those who had a Cesarean section and those who delivered vaginally; and among women who delivered vaginally, between those who were nulliparous and those who were parous.
Included in the study were 100 nulliparous and 71 parous women. Among those who delivered vaginally (n = 161), the median AOP before onset of labor was narrower in parous than in nulliparous women (98° (interquartile range (IQR)), 90-107° vs 104° (IQR, 97-113°), P < 0.001). Among the 100 nulliparous women, (1) the median AOP before onset of labor was narrower in those who went on to deliver by Cesarean section (n = 9) than in those delivered vaginally (n = 91) (90° (IQR, 85.5-93.5°) vs 104° (IQR, 97-113°), P < 0.001); (2) an AOP ≥ 95° (derived from the receiver-operating characteristics curve) was associated with vaginal delivery in 99% of women; and (3) 89% (8/9) of women who delivered by Cesarean section had an AOP < 95°. Among the 71 parous women, only one delivered by Cesarean section and all of those with an AOP < 95° delivered vaginally.
A narrow AOP (< 95°) in non-laboring nulliparous women at term is associated with a high rate of Cesarean delivery. Parous women have a narrower AOP than do nulliparous women before the onset of labor; however, unlike in nulliparous women, a narrow AOP in parous women does not appear to be associated with Cesarean delivery and most parous women with such an angle go on to deliver vaginally.
Ultrasound in Obstetrics and Gynecology 05/2012; 40(3):332-7. · 3.01 Impact Factor
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ABSTRACT: The sonographic "onion skin" sign was initially described as concentric echogenic layers in mucinous tumors unrelated to the female reproductive system. Typically, the sonographic appearance of ovarian mucinous cystadenoma includes numerous septa and fine, gravity-dependent echoes. We present a case of the "onion skin" sign in a mucinous ovarian tumor. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2012.
Journal of Clinical Ultrasound 01/2012; · 0.81 Impact Factor
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ABSTRACT: Malignant ovarian carcinoma is the leading cause of death among gynecological cancers. Most of these cases are diagnosed at an advanced stage. Traditionally the treatment of advanced ovarian cancer is based on primary surgery, debulking the tumor to minimal volume, followed by chemotherapy. Numerous trials have proven that the residual tumor volume has the greatest impact on patient prognosis. The use of neoadjuvant chemotherapy was proposed in an effort to increase the number of patients who will benefit from optimal debulking, as well as minimize the mortality and morbidity associated with major surgery. This review will discuss whether, and in which cases, neoadjuvant chemotherapy is an appropriate equivalent to primary surgery.
Harefuah 06/2010; 149(6):377-81, 402.
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ABSTRACT: Breast cancer is the most common cancer among women in the western world. The dramatic change in mortality due to breast cancer in the last decade was associated with better screening for early detection of malignancy and improved hormonal anti-estrogenic adjuvant therapy, mainly Tamoxifen. However, in the endometrium, Tamoxifen has a proestrogenic effect. Among women treated with Tamoxifen, a wide range of endometrial pathologies was documented--from polyps and hyperplasia to malignant tumors. Hence, there is still a debate on the character of malignant tumors developing under the influence of Tamoxifen treatment. Moreover, there are no clear guidelines considering the evaluation of the endometrium in women treated by Tamoxifen. These issues are discussed in this review.
Harefuah 04/2006; 145(3):219-22, 244.
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ABSTRACT: Hydatidiform mole with co-existing live fetus is a rare entity. Two cases are reported. In the first, complete mole with a co-existing live fetus was suspected on ultrasound examination at 16 weeks of gestation. A termination of pregnancy was performed due to early onset of severe preeclampsia and thyrotoxicosis. In the second case, the patient was admitted at 26 weeks of gestation due to preeclampsia. Genetic amniocentesis at 19 weeks of gestation revealed a normal 46 XX karyotype. Ultrasound examination at 21 weeks of gestation demonstrated two cystic lesions in the fetal liver, wide multicystic placenta and polyhydramnious. Following deteriorating severe preeclampsia, a live female infant (730 g) along with a huge placenta (1350 g) was delivered by a cesarean section. Unfortunately, the newborn died after 35 days. Pathological examination in both cases was consistent with a complete mole co-existing with a viable fetus. During a 1 year follow up period, there was no evidence of persistent or metastatic disease in both cases. Review of literature discussing the diagnostic tools, clinical features, management and outcome of pregnancies with complete mole with a co-existing live fetus is presented.
Gynecologic Oncology 08/2005; 98(1):19-23. · 3.89 Impact Factor
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ABSTRACT: Cervical carcinoma is one of the most common malignancies diagnosed during pregnancy since about 30% of diagnosed women are in their fertile years. Diagnosis of cervical cancer during pregnancy superimposes ethical dilemmas on the clinical considerations. Both maternal and fetal outcome should be considered when managing such a case. Is it necessary to discontinue the pregnancy? What are the implications of delayed treatment? How does the treatment affect the fetus and newborn? This article reviews the practical aspects of these issues and suggests management proposals.
Harefuah 11/2003; 142(10):680-4, 718.
