The Journal of Maternal-Fetal & Neonatal Medicine

Krukenberg tumor in pregnancy: a rare case and review of the literature

Krukenberg's tumor diagnosed in pregnancy is an uncommon situation that raises both diagnosis and medical management issues. We performed a review of the existing literature regarding this pathology, diagnostic means and therapeutic approaches, motivated by a case in our own practice. A 35-year-old primigravida was diagnosed with an adnexal mass during the first trimester prenatal ultrasound. Ultrasound revealed a 10 cm right adnexal mass with multiple septae, richly vascularized, whose presence and characteristics were confirmed by magnetic resonance imaging. Due to the progressively increasing tumor size, laparoscopy was performed with right adnexectomy and peritoneal biopsies. Histopathology diagnosed a metastatic ovarian tumor from a mucinous colorectal adenocarcinoma. After delivery the patient was further investigated and diagnosed with sigmoid cancer. Even though ovarian cancer in pregnancy is rare, adnexal ultrasound is mandatory when scanning during the first trimester to rule out the presence of associated fallopian or ovarian masses.

Hydatidiform mole incidence in Lombardy, northern Italy, 2009–2022: continued decline or plateau?

Hydatidiform mole (HM) incidence has shown contrasting temporal trends across different regions. We analyzed HM incidence in Lombardy, Italy, from 2009 to 2022. HM cases were identified through regional registry data. A total of 1,131 HM cases occurred among 1,471,567 pregnancies, averaging 77 cases per 100,000 pregnancies. A significant decline was observed between 2009 and 2015 ( The study suggests that diagnostic practices and demographic shifts may have influenced HM trends, while also confirming persistent ethnic and age-related risk patterns.

Unusual thrombosis or pregnancy complications associated to ovarian cancers: two clinical cases

Using illustrative cases of two patients with ovarian cancer who developed unusual thrombosis in pregnancy, to describe the difficulties in diagnosing and managing such patients. We present the analysis of two cases of thrombosis of unusual localization (central artery of the retina and transverse and sigmoid sinus thrombosis) during pregnancy in women with hidden ovarian cancer. In both cases, the symptomatic of unususal thrombosis was interpreted as a manifestation of eclampsia, leading to a choice of non-optimal obstetric tactics on a background of hidden ovarian cancer, which in both cases were diagnosed only postpartum. Pregnancy itself is a risk factor for thrombotic complications and in case malignancy develops in parallel with pregnancy, this risk is multiplied. In patients with ovarian cancer, difficulties arise both in detecting the tumor itself due to the enlarged uterus and in interpreting some of the symptoms, which can be regarded as a manifestation of pregnancy complications.

The risk of preterm delivery and pregnancy outcomes in women with asymptomatic short cervix: a retrospective cohort study

Routine cervical length measurement in asymptomatic pregnant women to prevent preterm birth has not been universally adopted due to poor predictive accuracy. The purpose of our study was to evaluate the risk of preterm delivery and pregnancy outcomes in women with asymptomatic short cervix and examine the implications of gestational age at presentation on these outcomes. This was a retrospective cohort study of women with singleton pregnancies who presented prior to or at 32 + 0 weeks with an asymptomatic short cervix (≤25 mm) between April 2014 to March 2018 at a single tertiary maternity center. Women with cervical length ≤25 mm were grouped into four cohorts according to gestational age at presentation: Obstetric outcomes were compared between the cohorts and the general cohort of women delivering during the same period. Outcomes were compared using Mann-Whitney The rate of spontaneous preterm birth <37 weeks was highest in the cohort presenting at 25 + 0-27 + 6 weeks, and lowest in the first cohort presenting at <22 + 0 (60.0 versus 22.2%, In asymptomatic women, cervical shortening showed significant increase in the risk of preterm birth. Our study findings suggest that routine cervical screening may be helpful in predicting risk of preterm birth even in women who are considered low-risk for preterm birth.

Adenocarcinoma in situ or early-stage cervical cancer is a risk factor for preterm delivery after cervical conization: a multicenter observational study

Pregnancy after conization is associated with a high risk of preterm delivery. However, because risk factors for preterm delivery after conization remain unknown, we conducted a multicenter observational study to investigate risk factors associated with preterm delivery. We selected patients who had previously undergone conization and reviewed medical records from 18 hospitals in cooperation with Keio University School of Medicine between January 2013 and December 2019. Women were classified as nulliparous and primiparous, and a multiple logistic regression analysis was performed to evaluate the relative contributions of the various maternal risk factors for preterm delivery (i.e. delivery before 37 gestational weeks). Among 409 pregnant women after conization, 68 women delivered preterm (17%). The incidence of nulliparity ( Pregnant women who previously underwent conization are at risk for preterm delivery. The histological type of AIS and cervical cancer was evaluated as a risk factor for preterm delivery. KEY MESSAGESPrior preterm delivery, presence of a short cervix, and cervical cancer or AIS were predictors of preterm delivery after conization.The depth of conization in cervical cancer or AIS group was significantly larger than that in the CIN group.

Quantitative strain elastography of the uterine cervix assessed by the GE Voluson E10 system in combination with a force-measuring device

During pregnancy, the stiffness of the cervical tissue decreases long before the cervical length decreases. Therefore, several approaches have been proposed in order to ensure a more objective assessment of cervical stiffness than that achieved by digital evaluation. Strain elastography has shown promising results. This technique is based on an ultrasound assessment of the tissue deformation that occurs when the examiner applies pressure on the tissue with the ultrasound probe. However, the results are only semi-quantitative as they depend on the unmeasured force used by the examiner. We, therefore, hypothesized that a force-measuring device applied to the handle of the ultrasound probe may render the technique quantitative. With this approach, the stiffness is the force (measured by the device) divided by the compression (measured by the elastography platform). One perspective is the early identification of women at risk of preterm birth in whom cervical stiffness may decrease long before cervical shortening. Another perspective is cervical evaluation when planning labor induction. In this feasibility study, we aimed to evaluate how quantitative strain elastography performs when a commercially available strain elastography platform (by which the algorithm is unavailable) is combined with a custom-made, force-measuring device. We studied how the assessments were associated with the gestational age in women with uncomplicated pregnancies and how they were associated with cervical dilatation time from 4 to 10 cm in women undergoing labor induction. In the analysis, we included quantitative strain elastography assessments from 47 women with uncomplicated singleton pregnancies, with gestational age between 12 The average Quantitative strain elastography may constitute a tool for the evaluation of a uterine cervix with normal length in women at risk of preterm birth and in women undergoing labor induction. The performance of this tool deserves evaluation in larger clinical trials.

Effects of transumbilical single-port laparoscopy versus multi-port laparoscopy for adnexal mass during pregnancy: a retrospective cohort study

To compare the effects of transumbilical single-port laparoscopic surgery (TSPLS) and multi-port laparoscopic surgery (MPLS) for adnexal mass during pregnancy. A retrospective analysis was performed on patients with adnexal mass during pregnancy admitted to our hospital between January 2015 and June 2023. The patients were divided into a TPLS group and a MPLS group according to surgical methods. Demographic characteristics, operative outcomes, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and Childbirth attitudes questionnaire (CAQ) were compared between the two groups. A total of 55 patients were included (TSPLS = 25; and MPLS = 30). The demographic characteristics of the patients between the two groups were not significantly different. The operation time in the TSPLS group was shorter than that in the MPLS group, but operative blood loss, length of hospital stay, and postoperative complications were comparable between the two groups. There were no significant difference observed in the preoperative SAS, SDS or CAS scores between the two groups, however, lower postoperative SAS (TSPLS 42.48 ± 4.57 vs. MPLS 45.90 ± 4.89), SDS (TSPLS 38.93 ± 3.70 vs. MPLS 42.12 ± 4.35) or CAS (TSPLS 34.04 ± 4.64 vs. MPLS 37.67 ± 4.79) scores were observed in the TSPLS group ( Compared with MPLS, TSPLS has shorter surgical time, reduces pregnancy and delivery pressure for pregnant women with adnexal mass.

Outcomes of cesarean myomectomy using novel and safe uterine isthmic circumferential technique

To evaluate the feasibility and safety of performing myomectomy during cesarean delivery using a novel bleeding-reducing suture technique. This retrospective cohort study included pregnant women with intramural uterine fibroids. A total of 120 patients were divided into two groups: Group A consisted of women who underwent myomectomy during cesarean section between January 2020 and June 2024, and Group B included women who underwent cesarean section alone without myomectomy. The following data were obtained from hospital records and compared between the groups: maternal age, gravidity, parity, myoma size, gestational age at time, preoperative and postoperative hemoglobin (Hb) levels, need for blood transfusion, hospital stay, and duration of surgery. The primary outcome of the study was the change in Hb levels before and after the operation. The demographic and laboratory characteristics of 120 pregnant women with intramural leiomyomas who underwent either cesarean myomectomy or cesarean section alone were analyzed. Of these, 60 underwent cesarean section alone, while 60 underwent cesarean section with myomectomy. No statistically significant difference was found between the two groups in terms of preoperative Hb, postoperative 24-hour Hb, or Hb decrease ( Cesarean myomectomy appears to be a feasible and safe option when performed using the bleeding-reducing uterine isthmic circumferential suture technique. However, further multicenter studies with larger sample sizes are required to confirm these findings before recommending cesarean myomectomy as a routine approach.