Uterine myomas are the most common benign growths affecting female reproductive system, occurring in 20–40% of women, whereas the incidence rate in pregnancy is estimated from 0.1 to 3.9%. The lower incidence in pregnancy is due to the association with infertility and low pregnancy rates and implantation rates after in vitro fertilization treatment. Uterine myomas, usually, are asymptomatic during pregnancy. However, occasionally, pedunculated fibroids torsion or other superimposed complications may cause acute abdominal pain. There are many controversies in performing myomectomy during cesarean section because of the risk of hemorrhage. Nevertheless, the majority of indication arises before labor and delivery due to acute symptoms leading to a discussion regarding the need for intervention during pregnancy. Therefore, we present a case of successful multiple laparotomic myomectomy at 17 + 2 weeks of gestational age and a systematic review of the literature in order to clarify the approach to this pathologic condition and its effect on pregnancy outcome.

What are the novel findings of this work?This is the first study to demonstrate that pre-eclampsia with a normally grown fetus is associated with an altered pattern of fetal cortical development compared with normally grown fetuses from normotensive mothers, manifested mainly by reduced Sylvian fissure depth and increased insula depth, which is similar to the pattern observed in small-for-gestational-age fetuses. What are the clinical implications of this work?Pre-eclampsia seems to be associated with differences in the pattern of fetal brain cortical development compared to fetuses from uncomplicated pregnancies, regardless of the association with small-for-gestational age.

Objective: To assess the added value of Doppler parameters, maternal history, and intrapartum clinical characteristics for the prediction of emergency delivery due to non-reassuring fetal status in low-risk pregnancies.Methods: This was a prospective cohort of low-risk pregnancies undergoing ultrasound assessment at 40 weeks' gestation within 7 days of delivery. The main outcome was emergency cesarean section due to non-reassuring fetal status. The association between Doppler parameters, intrapartum clinical characteristics, and maternal history was performed by logistic regression. The predictive performance of the constructed models was assessed by receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC).Results: From 403 included pregnancies, 18.6% (n= 75) underwent an emergency delivery due to non-reassuring fetal status. The mean gestational age at birth was 40.5 (SD 5) days. Middle cerebral artery pulsatility index (MCA) and cerebroplacental ratio (CPR) were lower in the emergency cesarean section group (1.16 vs. 1.30; p<0.001, and 1.61 vs. 1.78; p=0.001, respectively). There was a higher incidence of small-for-gestational-age neonates (20% vs. 10.1%; p=0.017), lower Apgar scores at the 5 th minute (9.7 vs. 9.9; p=0.006), and NICU admissions (9% vs. 3%; p=0.016) in the emergency cesarean section group. The base model comprised nulliparity, and the finding of meconium-stained amniotic fluid during labor, achieving an AUC of 66%, while the addition of the MCA Z-score significantly improved the previous model (AUC: 73%; DeLong: p=0.008). Conclusions:In low-risk pregnant woman at term, the addition of MCA Z-score to a previous model comprising maternal history and intrapartum clinical findings, significantly improves the prediction of emergency delivery due to non-reassuring fetal status.

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Eight pregnant women and three pregnant sheep received 400 mg of para-amino-hippurate (PAH) intraaminotically. Serial samples of amniotic fluid and maternal blood were obtained. In sheep samples of fetal blood were also withdrawn. PAH appeared in maternal plasma in all the cases. In all pregnant women PAH disappeared slowly from amniotic fluid (50% in 4 hours). In one ewe the study was performed as in humans and showed the same pattern of disappearance. In the other two, fetal urine was drained outside the amniotic fluid and PAH disappeared from it at a much faster rate (90% in 4 hours). PAH concentration in fetal urine was 100 times higher than in fetal plasma. Our findings in pregnant women seem to suggest that PAH disappears from the amniotic sac by a diffusion mechanism. On the other hand the results found in sheep also suggest that the fetus may have an active role in PAH concentration in amniotic fluid, eliminating part of the substance into maternal blood across the placenta but returning a major portion to the amniotic fluid with fetal urine.

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To our knowledge there are few studies which analyze the time course of the concentration in amniotic fluid of alien substances administered to women during pregnancy. This is particularly true for those substances mainly cleared by the kidney into the urine. HANON et al. [7] gave orally para-amino-hippurate (PAH) to mothers during labor and found that about two hours later, the concentration of PAH in amniotic fluid was higher than that of maternal plasma. BRANDES et al. [4] showed that inulin passed from the mother to the fetus during late pregnancy but ROSA [9] administering this substance to the mother, could not find it in serial samples of amniotic fluid. Recently BASSO et al. [2] demonstrated that mannitol administered to the mother appears in amniotic fluid atincreasingconcentrationsreaching values higher than those found in simultaneous samples of maternal plasma. This type of studies may contribute to the knowledge of fetal renal function and its role in the formation of amniotic fluid, äs well äs the transference of substances through the mother-fetusamniotic fluid complex. l Material and methods Thirteen pregnant women were studied. In two of them fetuses had died at 36 weeks of gestation between 36 and 72 hours before the study was Curriculum vitae OMAR ALTHABE studied in Buenos Aires andgraduated from the National University in 1955. During 1963-1965 he was a research fellow at the Servicio deFisiologia Obste trica'in Montevideo, Uruguay. Since then his work is dedicated to clinical research in Perinatology.