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The clinical utility of Doppler blood flow investigations of the fetal and fetoplacental vessels is still under debate as far as timing of the delivery is concerned. However, in cases of absent or reverse end-diastolic flow, fetal compromise is usually very severe. As a consequence, we have investigated the possibility of using this information as a guide to obstetrical management. Altogether, 32 fetuses with absent or reverse end-diastolic flow in the fetal descending aorta and/or umbilical artery were studied. Reverse flow was observed in 11 cases and absence of end-diastolic flow in 21 cases. The two groups are considered separately. No significant difference was found in the mean gestational age at delivery. However, a highly significant difference was found in the mean birth weight and perinatal mortality rate. All the cases of perinatal mortality were encountered in the group presenting with reverse flow (mortality rate, 63.6%). All the live fetuses were delivered by Cesarean section and no neonatal mortality was observed in this group. Two cases of handicap were observed, one in each group. In our experience, reverse flow indicates the necessity for immediate delivery if no other clinical contraindications are present. Absence of end-diastolic flow can be observed for longer periods without adverse outcome. Absence of end-diastolic flow always precedes the appearance of fetal distress. Therefore, we believe that, after exclusion of conditions such as fetal abnormalities or extreme prematurity, a planned delivery should be considered.

La porpora trombocitopenica autoimmune è una patologia rara e grave che può insorgere in gravidanza. La paziente è stata sottoposta a terapia cortisonica e con immunoglobuline sclavo in preparazione all'intervento di taglio cesareo elettivo.In mancanza di un recupero dei valori delle piastrine, sono state somministrate tre unità di piastrine da diaferesi, da unico donatore. Eseguito taglio cesareo elettivo alla XXXIV settimana, non si sono avute complicazioni del decorso post operatorio della paziente. La neonata del peso 2550gr. ha avuto un normale outcome neonatale.

The treatment of hypertension in pregnancy is justified by the need to reduce blood pressure in order to avoid the onset of preeclampsia, eclampsia, retarded intrauterine growth and even neonatal, perinatal and maternal death. The value of using drugs to treat slight-moderate hypertension in pregnancy is, however, not clearly defined in the literature. In fact, from an etiopathogenetic point of view, the significance of increased blood pressure in pregnancy has not yet been satisfactorily explained, and above all the positive significance of increased blood pressure not be forgotten since, up to diastolic levels of 90 mmHg, it is accompanied by an increase in birth weight. The aim of the present study was to verify the efficacy of pharmacological treatment in cases of slight-moderate hypertension during pregnancy in a population of 121 pregnant women attending the Obstetrics-Gynecological Clinic of the "Istituto per l'Infanzia" in Trieste during the period from 14-11-1984 to 24-4-1991. Data for this retrospective study were extrapolated from an analysis of medical records and then memorized in a data-base file. The degree of hypertension was classified as slight, moderate and severe according to blood pressure levels measured on hospitalisation. Clinical signs taken into account included: edema, proteinuria and hypoprotidemia. Anti-hypertensive therapy was selected between one or more associated drugs belonging to the following classes: central action and peripheral action anti-adrenergic drugs, beta-blockers, calcium channel blockers, vasodilators, diuretics, ACE-inhibitors and sedatives. Moreover, patients also received non-pharmacological treatment in the form of low sodium diets and bed-rest.(ABSTRACT TRUNCATED AT 250 WORDS)

A clinical report concerning a severe idiopathic thrombocytopenia during pregnancy (minimal platelet count 3000/mm3 is described). Corticosteroids and immunoglobulins were administered in preparation to elective cesarean delivery. Since the platelet count not improve significantly, 3 units of platelets from a single donor were adjunctively given using diapheresis. An elective cesarean delivery was performed at 34 weeks, without further complications. The newborn weighed 2550 g and the postnatal course was uneventful.

Background The aim of this study is to review all the cases of FCV diagnosed in the Obstetric and Gynecology Unit of our Institution from 1990 to 1999 and to evaluate the neonatal outcome. Method This is a retrospective study. The diagnosis of ventriculomegaly is according to Cardoza criteria and to atrial width ≥ 10 mm between 15 and 40 weeks gestational. For all cases we consider: progression and/or resolution; association with other fetal ultrasound signs of malformations and with chromosomal abnormalities; fetal infections (TORCH); pregnancy termination and follow-up by pediatric report. In cases of interruption of pregnancy we evaluate postmortem examination. Results Among 165 cases of FCV, n 84 (50.9%) are associated with malformation of SNC, n 59 (35.76%) are isolated, n 22 (13.33%) are associated with other fetal malformations. In the group of isolated: 32 case are borderline (≤ 15 mm), chromosomal abnormalities are 4 among 40 evaluated (10%), favourable neonatal outcome is present in 22 cases of 29 born (75.86%). Conclusions In this study the percentage of chromosomal abnormalities in the FCV isolated is higher than other series in the literature. The reproducibility of measurement of atria rather permits comparisons than other qualitative and quantitative signs.

The Authors examine the correlation between hypertensive disorders of pregnancy and fetal growth. The results of a study of 342 pregnancies, confirm a significant correlation between hypertension and fetal growth retardation. These findings, so evident in moderate and severe hypertension, have also been confirmed in cases of mild hypertension. The medical treatment also in the pregnancies with mild hypertension, and a larger utilisation of operative deliveries, determined a decrease in perinatal mortality and morbidity.

The clinical utility of Doppler blood flow investigations of the fetal and fetoplacental vessels is still under debate as far as timing of the delivery is concerned. However, in cases of absent or reverse end-diastolic flow, fetal compromise is usually very severe. As a consequence, we have investigated the possibility of using this information as a guide to obstetrical management. Altogether, 32 fetuses with absent or reverse end-diastolic flow in the fetal descending aorta and/or umbilical artery were studied. Reverse flow was observed in 11 cases and absence of end-diastolic flow in 21 cases. The two groups are considered separately. No significant difference was found in the mean gestational age at delivery. However, a highly significant difference was found in the mean birth weight and perinatal mortality rate. All the cases of perinatal mortality were encountered in the group presenting with reverse flow (mortality rate, 63.6%). All the live fetuses were delivered by Cesarean section and no neonatal mortality was observed in this group. Two cases of handicap were observed, one in each group. In our experience, reverse flow indicates the necessity for immediate delivery if no other clinical contraindications are present. Absence of end-diastolic flow can be observed for longer periods without adverse outcome. Absence of end-diastolic flow always precedes the appearance of fetal distress. Therefore, we believe that, after exclusion of conditions such as fetal abnormalities or extreme prematurity, a planned delivery should be considered.

1841 pregnant women without any risk factor for heart malformation of the fetus underwent an echocardiographic screening at an average gestational age of 23 weeks. Seven cases of heart diseases were diagnosed (0.38%), of which one died in utero at 28 weeks and another one was interrupted. In four cases the karyotype was carried out prenatally, while in the remaining three it was performed only after birth. There were 11 false-negative (0.59%), mainly concerning anomalies of minor clinical significance. Within this group, two newborns with interatrial defect of the ostium secundum type appeared to be affected by trisomy 21. Therefore, the rate of congenital heart diseases in live births not at risk (0.86%) was in line with the data reported in paediatric literature. On the other hand, the association with chromosomal anomalies was surprisingly frequent (4 out of the 9 karyotypes performed were anomalous). Such finding should be verified by studying a larger non-selected population. However, a fetal karyotype should be offered, for its practical consequences, also in those cases of cardiac anomalies of lesser clinical significance.

A computerized system for colpocytologic data collection and filing, is presented. A descriptive and easy to elaborate recording of anamnestical data and examination findings is achieved using two correlated files. Step by step filing is obtained by multichoice scheme which progressively appears on the screen.

69 singleton pregnancies, with a diagnosis of intra-uterine growth retardation (IUGR) at ultrasound, were followed until delivery by pulsed Doppler evaluations in fetal thoracic descending aorta (DA) and umbilical artery (UA). Three haemodynamic groups were described according to flow characteristics expressed as the pulsatility index (PI) of the vessel under study. In each group the relative incidence of fetal distress, diagnosed according to CTG monitoring, was evaluated. Fetal distress occurred in 75% of the cases with a raised PI both in DA and UA, in 40% of the cases with a raised PI only in DA and in 21% of the cases with 'normal' PI values in both vessels. It can be said that Doppler flow measurements can be useful in defining the actual haemodynamic situation of the fetus with possible clarifications concerning its 'stressed' or 'distressed' condition and residual capacities to substain hypoxia.

Sixty-two cases of intrauterine hematoma (IUH) with a live fetus have been described. This condition was found in 11% of cases that presented with bleeding in early pregnancy. The rate of spontaneous abortion in this series was 12.9%, similar to that observed in cases of threatened abortion without observable hematoma. Spontaneous abortion and delivery rate before 35 weeks of pregnancy were correlated with the calculated volume of the hematoma. Fetal growth retardation seemed to be increased after observation of IUH, especially when the placenta was located on the posterior uterine wall. Uterine malformations and myomas were likely to represent a predisposing factor for IUH.

A retrospective analysis of the ultrasonic charts of 150 pregnancies with a birth weight below the tenth percentile is presented. In all cases the first scan was carried out before the 20th week of gestation to assess gestational age measuring crown to rump length or biparietal diameter (BPD). Subsequent scans every 4 weeks measured BPD or abdominal circumference. Birth weight was below the fifth percentile in 70 cases and between the fifth and tenth percentiles in 80 cases. A risk condition was found in 32.26%. The first observation of an abnormal parameter was widely spread throughout the latter half of the pregnancy. The management of IUGR included close observation and often required planned delivery. Cesarean section was required in 30.75% of the cases. Acute fetal distress has been the indication in 17.6% of cases and chronic fetal distress in 41.3%. Perinatal mortality was 6.66%. The need for criteria that will accurately detect the fetus most at risk from complications of IUGR is stressed.

In 52 fetuses, in utero sonographic diagnosis of urinary tract malformations was correlated with their autoptic or surgical findings. 39 malformations were correctly diagnosed prenatally, although 5 other extrarenal-associated anomalies were not detected; 10 diagnoses were incomplete; in 3 cases the characteristics of malformations found at sonography turned out to be different at the post-mortem examination. The following factors impaired sonographic diagnoses: limited number of examinations, gestational age at the time of examination, nature of malformation and, above all, oligohydramnios (which is common in most urinary tract malformations). The correlations between renal malformations and karyotype anomalies are also discussed in relation to the higher incidence present in polymalformative syndromes.

The authors made a review of the last 100 cases who underwent a conization of the cervix during the period 1980-1986. Cyto-histological evaluation was compatible in 78% of the cases with a cervical intraepithelial neoplasia of third degree and in 22% with a CIN of first and second degree. Early post-operative complications consisted of a hemorrhage in 3% of the cases, easily stopped with a vaginal packing. In 2% of the cases a risuture under general anaesthesia was required. In 1 case the stitches loosened and in another a urinary infection was present. Twenty-six patients underwent total hysterectomy after conization for different indications; only one patient had a relapse after six months as there was a moderate dysplasia localized in the vaginal vault. During the follow-up, 14 patient became pregnant. Among these, 5 underwent legal termination during the first trimester and 9 delivered at term without any complication. During these follow-up of 7 years in the older cases and 6 months in the more recent ones, 6 cases displayed a persistence of the disease after 3 months, (CIN of variable degree) and 2 cases relapsed at the second colpocytological control. These patients, according to the age and the presence of clinical indications, underwent total hysterectomy or diathermic coagulation with resolution of the disease. A relapsing invasive tumor was never observed.)

With the aim of evaluating the correlation between dysplastic lesions of the uterine cervix associated or not with condylomatosis and Chlamydia T. infection, we carried out a serological study of anti-Chlamydia species-specific antibodies and a direct and/or a cultural investigation on a sample of 320 women who performed a Pap-test. The serological examination showed positivity (titer greater than or equal to 1:32) in 49 control subjects (with negative cytology) (23.7%); in 27 cases (43.5%) with actual diagnosis of condylomatosis/CIN associated or not with condylomatosis and in 28 cases (54.9%) with previous diagnosis of condylomatosis/CIN associated or not with condylomatosis. The cultural investigation did not show any significant difference among the groups above mentioned. Finally, the frequency of positive cases for anti-Chlamydia antibodies was estimated for each grade of actual or previous CIN: a greater frequency of positivity was noted in cases with CIN 3 (75%).