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Postpartum hemorrhage (PPH) is to this day one of the leading causes of maternal death and its diagnosis is still highly subjective, as it relies on unprecise estimates of the amount of blood loss. There are three areas in which PPH outcomes can be improved: prevention, treatment and rescue. PPH can escalate to a graver clinical picture of Severe Acute Maternal Morbidity (SAMM) due to an inaccurate estimate of the blood loss, inability to identify an at-risk patient, delays in testing and availability of hemoderivatives, and lack of clear guidelines and interdisciplinary communication. Many factors can predispose to PPH and in clinical practice the many causes of its insurgence are summarized with the 4T formula: Tone (uterine atony), Trauma (laceration/hematoma), Tissue (retained tissue/invasive placenta), Thrombin (coagulation). Some precautions can be taken in preventing PPH such as the use of uterotonics, the administration of oxytocin, the timing of umbilical cord clamping, and the monitoring of anemia and the platelet to fibrinogen concentration ratio. In recent years studies have been published with the goal of leading PPH diagnosis and management through universal guidelines, point-of-care testing and interdisciplinary approaches. The proposed algorithms, albeit not yet validated, are useful in the clinical practice; similarly beneficial is the use of reliable predictive panels such as the Modified Early Obstetric Warning System.

Hippocrates observed that in women, during childbirth, the iliac bones because of the failure of the joints disconnet and move away from their anchorage. In the 17th and 18thcentury, doctors plagued with severe and frequent mechanical dystocies, often fatal, devoted themselves to resolve these problem through measures aimed at obtaining a more modest growth of the fetus (thanks to an appropriate maternal nutrition, or induction of preterm birth) and both encouraging artificially and strengthening the natural pelvic collapse descripted by Hippocrates. they realized, but with little success, prophylactic measures (fumigation of the pelvis, local applications of emollients, fracture of the del coccyx in the female newborns, antepartum coitus), and absurd pharmacological remedies or resorted to intrapartum obstetric maneuvers, but they did non forget even to suggest the voluntary sterility to stunted or kyphotic women. The symphysiotomy on living women, officially performed for the first time by Dr. Sigault in 1777, in Paris (but certainly in 1774 by Prof. Ferrara in Naples) modified the obstetrical assistance. [ABSTRACT FROM AUTHOR]

The article discusses the view of abnormal pregnancies in Greek and Roman medicine. Among other topics addressed are the ancient Greek approach to understanding women's physiology, sources including the collection of medical treatises "Corpus Hippocraticum", and the ancient Greek attitude to birth defects.

Periodontitis is a condition of suffering of gingival and periodontal tissues. To the light of the available knowledges till now on the pathogenetic mechanisms of such affection is possible to affirm that the different risk factors can influence onset of it, evolution and therapeutic possibility. In the examination of the risk factors in the development of the periodontal pathology the effects of the systemic conditions on the health of the oral cavity has been considered, as well as the influence of the periodontal pathology on the onset and on the evolution of several systemic pathologies and related to some physiological conditions (e.g. the pregnancy).

Objective: To study the incidence and the features of congenital heart block (CHB) in patients with undifferentiated connective tissue disease (UCTD) and primary Sjögren's syndrome (pSS)., Methods: We studied 81 pregnancies of 41 women attending the Outpatients' Clinic of the Rheumatology Unit of University Hospital of Padova from July 1989 to March 2004. Twenty five of these (61%) were affected with UCTD and 16 (39%) with pSS. Serologic inclusion criteria was anti-Ro/La positivity, assessed by counterimmunoelectrophoresis and ELISA., Results: CHB was found in 2 out of the 46 (4.3%) pregnancies followed by our Staff and in 2 out of the 35 (5.7%) included in the retrospective part of the study. In 3 cases CHB was a 3rd degree block, causing pregnancy termination in 2. The only 2nd degree block was identified in one patient at the 22nd week of gestation and treated with dexamethasone and plasma-exchange. All of the women were positive to 52 kd and 60 kd Ro autoantibodies. CHB mothers had higher titer antibodies to 52 kd Ro protein than did the mothers with healthy infants (P = 0.026). Electrocardiographic abnormalities at birth were found in 3 out of 29 asymptomatic infants. One presented sinus bradycardia, the second abnormalities of ventricular repolarization, both regressed spontaneously, while the third ventricular extrasystoles which continue even now at 5 months., Conclusions: These results showed that in UCTD and pSS there is a higher incidence of CHB than that reported in Systemic Lupus Erythematosus. Electrocardiographic screening in all infants born to mothers with anti-Ro/La antibodies would seem an important measure to identify those with irreversible heart conduction abnormalities.

Spontaneous hepatic haemorrhage in pregnancy (SHHP) is a rare event (1 woman out of 15,000). It is generally considered as an advanced state of the microangiopathic hemolytic anemia (HELLP, Hemolysis, Elevated Liver enzyme levels, Low Platelet count). Furthermore, the HELLP is considered as a different form of preeclampsia. The patient, a 33-year-old-woman at 30 weeks' gestation, was admitted to hospital for preeclampsia, underwent an emergency Stark caesarean section with the extraction of an alive foetus and evidence of massive intraperitonal haemorrhage from a large hepatic haematoma. A haemostasis with gauzes of Surgicel was performed, with consequent arrest of the haemorrhage. After approximately 6 hours, a recurrence of the intraperitonal haemorrhage led to a new surgical intervention with hepatic packing with gauzes. After 4 days the patient died. The etiopathogenesis of disease is uncertain, both foetal and maternal mortality are high, and the slight number of reported cases (27) of SPPH from HELLP in international literature offer elements for debate. The following points have been put forward: 1. the monitoring of the counts of the platelets represent the only valid predictive test of HELLP. These concerned women in the third trimester of pregnancy, especially those with a history of preeclampsia; 2. the treatment must be immediate, intensive and multidisciplinary, the plasmapheresis has remarkably improved the prognosis; 3. surgical treatment performed in order to control the SPPH makes use of packing, embolization and/or fastening of the common hepatic artery and, in extreme cases, total hepatectomy with transplantation. The Authors believe it is useful to suggest a national epidemiological research in order to estimate the real incidence of the syndrome in Italy and to establish the guidelines for the medico-surgical treatment.

The objective of this article is to review the aetiology, epidemiology, diagnosis, clinical course, treatment and prognosis of peripartum cardiomyopathy (PPCM). The medical literature from 1966 to March 2002 was reviewed through MEDLINE. PPCM is a rare complication in pregnancy. It is seen in late pregnancy or in the early puerperium. The aetiology of this disease remains uncertain. Many possible causes have been proposed, including myocarditis, abnormal immune response to pregnancy, maladaptive response to the hemodynamic stresses of pregnancy and prolonged tocolysis. Risk factors for PPCM include advanced maternal age, multiparity, African descent, twinning and long-term tocolysis. Patients with systolic dysfunction during pregnancy are treated the same as patients who are not pregnant. The mainstays of medical therapy are digoxin, loop diuretics, sodium restriction and afterload reducing agents (hydralazine and nitrates). Due to a high risk for venous and arterial thrombosis, anticoagulation with heparin should be instituted. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be avoided during pregnancy because of severe adverse neonatal effects. The utility of immunosuppressive therapy remains ambiguous. Advances in medical therapy for dilated cardiomyopathy and cardiac transplantation have significantly improved the quality of life and survival for patients.

For about three decades glomerular diseases have been the most intensively investigated research area in nephrology. The increasing proportion of patients with end-stage renal disease (ESRD) secondary to hypertension has now revived interest in hypertension. Prospective studies have firmly established that high blood pressure is associated with an increased risk of renal failure independent of other risk factors. Hypertension-related renal injury might be interpreted in a general context taking into account genes, intrauterine growth and environmental factors. Disturbed intrauterine growth (due to malnutrition or other factors) has a negative influence on the development of the cardiovascular system and favours the occurrence of hypertension, insulin resistance, hypercholesterolaemia and hyperuricaemia in adult life (Barker's hypothesis). Altered intrauterine growth has also been associated with a reduced number of nephrons at birth. Damage attributable to glomerular hyperperfusion in kidneys with a reduced number of nephrons is aggravated by vascular lesions in middle and small arterial vessels (secondary to hypertension, hyperlipidaemia and environmental risk factors such as smoking). The observation that subjects homozygous for the D allele of the ACE gene are predisposed to both cardiovascular complications and nephrosclerosis, suggests that genetic factors may interact with altered intrauterine growth in determining the risk of cardiovascular and renal diseases.

Background: Recent literature shows conflicting results regarding this subject. Using a prospective study, we analysed the possible effects of pregnancy and delivery upon the pelvic floor support., Methods: In a group of 344 patients who received our phone-call 3 months after delivery, only 58 accepted the investigation, and came for an exam. We looked out for pathologies such as genital prolapse and stress urinary incontinence (IUS). During the exam we analysed: vagino-perineal scars; descensus of the vaginal walls and of the uterus; dyspareunia; urinary frequency and urgency; urge Incontinence and IUS; weakening of pelvic floor muscles., Results: We objectively identified in cystocele the prevalent "anatomic" damage, and in IUS, the most frequent "functional" damage. We then tried to find a statistical correlation between these pathologies and the most important risk factors cited in the literature., Conclusions: Through the systematic analysis of the obtained data, we thus identified the most important risk factors that lead to the development of these pathologies: operative delivery, pluriparity, heavy work, high BMI in mothers and newborns. The results that emerged from our study lead to some remarks of interest and discussion.

The most important metabolic changes in pregnancy are facilitated anabolism when food is available and accelerated catabolism during fasting. In combination with the acquisition of haemochorial placenta, bipedalism and obligatory prematurity at birth these evolutionary choices have been the prerequisite conditions for the rapid growth of the fetal brain and its further postnatal development.

The authors draw attention to the important role played by menopause in the onset of arterial hypertension, enhanced coronary risk and dyslipidemia, for which a particularly useful association has been found to be estrogens, only if administered by mouth (alone or with progestins), and statins. The authors review numerous studies for or against the use of estrogens as a means of reducing arterial hypertension and the incidence of myocardial ischemia in menopausal women. In order to ensure therapeutic efficacy, replacement estrogen therapy should not be started at not too late an age, but instead as young as possible (the first 5 years after the start of menopause are optimal), namely before levels of endothelial estrogen receptors start to fall. Moreover, therapy should not be continued for more than 5 years in order to avoid the risk of breast cancer and endometrial carcinoma. With regard to myocardial infarction, it is worth noting that women show a higher frequency of silent and atypical infarction leading to a late diagnosis and therefore the arrival in the coronary unit half an hour or an hour later than men. Together with the onset of myocardial infarction at an older age in women compared to men (5-10 years), and the fact that diagnosis is less accurate in women and treatment less sophisticated, this accounts for the higher immediate and medium-term mortality figures in women following myocardial infarction. However, at least in America studies have shown that the less aggressive diagnostic and therapeutic management of myocardial infarction in women compared to men is not sufficient to cause a significant difference in mortality between men and women 30 days after the event. Turning to arrhythmia, it is worth recalling that supraventricular tachycardia with close rapid complexes, caused by return in the atrioventricular node is more frequent in females and in the second lutein or progestin phase of the menstrual cycle, thus demonstrating the protective role of estrogens against the onset of arrhythmia. The authors also point out the frequent association between ischemic ictus and chronic non-valvular atrial fibrillation in women aged over 75 since they present a very high risk (94%) of death by ischemic ictus. On the one hand, the guidelines recommend the use of anticoagulating therapy in these patients, but on the other there is a very high risk of hemorrhage which acts as a major constraint. Lastly, pregnancy is mentioned as a condition that facilitates the onset of arrhythmia; for example, orthodromic supraventricular tachycardia in Wolf Parkinson White and ventricular tachycardia which usually regresses post-partum.

We described the case of a newborn, whose mother was affected by anti-phospholipids antibodies syndrome and had previously had several abortions. The newborn presented emispondilitis. (We suppose it is important to notice that cases like this have never been signalled in literature so far).

A case of premature rupture of membranes occurred at 19 weeks of pregnancy is reported. The patient underwent a genetic amniocentesis at 16 weeks of gestational age. During the hospitalization period, she presented amniotic fluid leakage responsible of olygohidramnios. She was treated with antibiotic, spasmolytic, tocolytic and cortisone therapy. All subsequent parameters were evaluated: blood cell count, heart rate frequency, body temperature. Ultrasound examinations were performed every two weeks. Cervical smears to detect infections were normal. Labour started at 28 weeks and the patient delivered spontaneously a 1010 g male baby, Apgar 4/8. The heaviest complication was a cerebral hemorrhage and the subsequent frontoparietal hematoma which progressively reduced. To date the neurological prognosis is good.

Marked stimulation of the chorionic gonadotropins underlies the frequent finding in the mole of larger ovaries with multiple luteal cysts, identifiable using ultrasound imaging, resembling ovarian hyperstimulation syndrome. The authors report a case of hyadatid pregnancy which presented serious non-neoplastic complications. Laboratory tests showed high values of beta-hCG and GOT/GPT, electrolytic alterations, hypoproteinemia, hypoalbuminemia, associated with conditions of severe dyspnea and tachycardia following hydrothorax diagnosed by X-ray. USG showed hypertrophic placenta containing anechoid lacunar areas and swollen ovaries with multiple luteal cysts. Positive results were achieved by using intensive therapy leading to the restitutio ad integrum of damaged functions. Endocrine hyperactivity of the molar trophoblast, with high levels of beta-hCG was responsible for ovarian hyperstimulation. Important findings for the early diagnosis of hyadatid pregnancy are: beta-hCG assay and ultrasound scan; moreover, an adequate follow-up lasting about 6 months is necessary to evaluate the serial trend of beta-hCG and the disappearance of ovarian luteal cysts.

The aim of this study was to evaluate the extent to which the presence of a transplanted kidney conditions the physiological renal and maternal cardiocirculatory adaptation to pregnancy. For this purpose, we compared the trend of cardiocirculatory and renal hematochemical parameters in a kidney-transplant patient to a group of 100 physiological pregnant women followed longitudinally. M. G., aged 36, primigravida, who underwent renal transplantation ten years before, was carefully monitored throughout gestation. Pregnancy was free of complications and ended at 38 weeks with an elective caesarian section. The trend of the parameters mirrored the physiological pattern, even if the values for some renal parameters were completely different. This type of comparison enabled us to evaluate the adaptation of the transplanted organ and the body to pregnancy and to formulate a prognostic judgement halfway through pregnancy regarding the outcome.

The principal aspects of the hyperplastic pathology which frequently appears during pregnancy and its epidemiological and clinical aspects are discussed. The existence of a particular kind of gingivitis, typical in pregnancy, not different from that appearing in not-pregnant women, let to hypothesize the existence of a relationship between the gingival lesion and the particular hormonal condition observed in pregnancy. Sometimes pregnancy gingivitis can show a tendency towards localized hyperplasia, this condition is defined pregnancy granuloma. Clinically a mass of variable size is observed; generally it appears in the 2 degrees-3 degrees month of pregnancy, with a tendency to bleeding and a possible interference with mastication. From a histological point of view, the pregnancy granuloma presents an inflammatory component characterized by lynphocytes, plasmacells and neutrophiles, an abundant vascular component with newly formed capillars and a great proliferation of fibroblasts. The differential diagnosis of pregnancy granuloma must be done with some forms of gingival hyperplasia, with pyogenic granuloma and with fibrous epulis (or hyperplasia). As to therapy, it is better to perform the surgical removal after delivery, considering that sometimes the lesions can spontaneously disappear. These lesions can reappear in a subsequent pregnancy.

Authors reports a rare case of association between two pathologies that, even if apparently very different, are both immunologically determined: celiac disease (CD) and transient erythroblastopenia of childhood (TEC). Such an association may be less rare commonly thought and this may be true for other autoimmune diseases, too. Clinical and pathological observations, together with etio-pathogenetic hypotheses, are discussed.

Background: To evaluate the triple screen serum test as a noninvasive screening test for expectant mothers > 35 years old, who are not usually considered for invasive screening for trisomy 21., Methods: 1784 tri-tests (triple serum screening tests) were performed on expectant mothers between their 15th and 18th week of pregnancy, using the radioimmunological Ria-Kodak with an Alpha program (Logical Medical System LTD) with a cut-off value of 1:350., Results: 244 positive equal to 13.60%. The percentage of false positives was respectively 12.9% (age < 35) and 28% (age > 35). Only in two of these cases did we have a positive response in amniocentesis for a fetus affected with Down syndrome. Of the 1540 patients with a negative tri-test, one woman gave birth to a fetus with Down syndrome., Conclusions: Our study revealed a sensitivity of 66%. The elevated number of false positives has led us to decide on a variation on the cut off in the future: from 1:350 to 1:300.

Non-immune hydrops fetalis (NHF) has become, with the decrease in frequency of rhesus-isoimmunization during the last years, an important aspect of modern obstetrics in consideration of the increased diagnostic and therapeutic means now available. Some cases of NHF with particular etiology (viral twin-twin transfusion syndrome, malformations) are reported and the necessity of a multidisciplinary specialistic approach for the resolution of diagnostic and prognostic problems of this serious complication of pregnancy is underlined.

A case of a pregnant woman suffering from centronuclear myopathy is described. The patient has successfully carried out the pregnancy and delivery.

A retrospective study of women who are delivered at the Dept. of Obstetrics and Gynecology at the University of Bari, in the period 1991-1994, was performed to evaluate if over 20 week pregnancies in women aged 35 years and over were at higher risk for maternal and neonatal complications than pregnancy in women aged 20 to 29 years. The results of these 4 years show that pregnancy in women aged 35 and over is burdened with a greater incidence of maternal complications and cesarean sections, but age is not a risk for neonatal outcomes. Moreover, most working women were obliged to delay the first birth child, but work does not increase the number of complications.

Background: An increasing number of women in childbearing age are submitted to surgical treatment of obesity; for this reason pregnancy represents a frequent event in operated patients., Methods: In this study pregnancy in patients with morbid obesity submitted to jejunoileal bypass (JIB) and gastric bypass (GB) are reviewed from the literature and the analysis of our experience with biliopancreatic diversion (BPD) is reported., Results: In 113 pregnancies after JIB reviewed from the literature, the results seem to be debated either about the course of pregnancy or about maternal and neonatal status. The data of literature concerning the pregnancies following GB are less debated but rather slight. One hundred and fifty-two pregnancies after BPD have a complete documentation concerning maternal conditions, modality of outcome and neonatal situation., Conclusions: Pregnancy occurred in the obese women represents an increased maternal-fetal risk. The excess weight loss, the weight maintenance and the reduced weight changes during pregnancy are an advantage in the operate women who, in any case, need accurate controls of the nutritional status during the whole gestational period. Keeping these cautions pregnancy following surgical treatment of obesity represents an event not only possible but even with less problems than in pregnancy in obese women.

The authors describe a case of pregnancy in a patient previously affected by Arnold-Chiari malformation associated with syringomyelia; from clinical experience and a review of the literature, the possibility is deduced of carrying out the pregnancy physiologically, although by observing close precaution while performing delivery which, by our experience, should be accomplished by partus caesarius in general anaesthesia, taking great care to the evaluation of neurologic parameters.

The case refers to a term-fetus, small-for-date, with polydramnios, idiopathic hypereosinophilic syndrome and eosinophilic vasculitis of large, medium and small-size pulmonary arteries. The pulmonary arteritis was the only lesion observed in the fetus.

Objective: To evaluate the efficacy and tolerability of treatment with goserelin + HMG vs bromocriptine + FSH + HMG in the induction of ovulation in patients with ovarian polycystosis., Experimental Design: A randomized prospective study., Patients: Sterile women with ovarian polycystosis of the first type not responding to clomiphene citrate., Treatment: Group A: bomocriptine + FSH + HMG (10 patients); Group B: goserelin depot (Zoladex) + HMG (18 patients)., Results: A greater percentage of ovulations, pregnancies and a higher success rate were obtained in Group B. The percentage of hyperstimulation was similar in both groups; there was a higher percentage of abortion in Group A. Cycle duration and the number of phials of gonadotropin were greater in Group B., Conclusions: Treatment with bromocriptine + gonadotropin remains the simplest; the treatment protocol based on geserelin depot + gonadotropin proved to be more efficacious.

A case of Aarskog syndrome in a 10-year-old boy born to an epileptic woman is reported. Clinical features and genetics of the condition are reviewed. An underestimated incidence of the syndrome related to its mild phenotypical appearance is suggested. Finally the association between Aarskog syndrome and maternal epilepsy is discussed.

The case of a patient with postpartum pituitary failure associated with primitive adrenal failure, jaundice and sepsis is described. Radiologic findings, which initially suggested a pituitary necrosis, were normal two months after the admission. Diagnostic and therapeutic approaches are reviewed and discussed.

We describe a case of Crohn's disease which came up before pregnancy and which is responsible of an acute abdomen picture caused by intestinal reacutation and perforation to the 38th week of amenorrhea. The relations between the disease and the pregnancy state are analyzed from the clinical, diagnostic and therapeutical aspect.

The aim of this paper is to synthetically focus on current views on the use of radioiodine for the treatment of hyperthyroidism in single autonomously functioning thyroid nodules (AFN). Radioiodine administration represents a simple and effective alternative to surgical ablation of AFN, especially in elderly patients with small nodules (< 3 cm diameter). Radioiodine is very selectively accumulated in the thyroid, where it can deliver its energy without virtually affecting any other organ. Since its first use in 1942, 131I is (as Na131I) still the radioisotope of choice, due to easy availability and to its peculiar physical characteristics. These include a short half-life (8 days) and a spectrum of radiation (mainly of the beta type) with an optimal energy delivery in the nodule and with low penetration in the surrounding tissue. The effectiveness of radioiodine administration in permanently correcting hyperthyroidism in AFN has been demonstrated in many studies and may reach 80% with a single dose administration. The optimal dose has not been completely defined, but may be empirically calculated taking into account the weight of the nodule (evaluated by scintiscan or ultrasound) and the radioiodine uptake after 24 hours. In our and in many other institutions, indications to radioiodine treatment are currently the following: age > 35-40 years, diameter of the nodule < 3 cm and/or serious general diseases contraindicating surgical treatment. The only absolute contraindication to radioiodine treatment is pregnancy, due to the possible mutagenic effects on the foetus and to the extreme sensitivity of the foetal thyroid to radioiodine after the 10th week of gestation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aetiologic factors (gallstones, hyperlipidemia I-IV, hypertriglyceridaemia) make their occurrence, mainly, in the third trimester of gestation. Two cases of acute pancreatitis in pregnancy are described; in both cases patients referred healthy diet, no habit to smoke and no previous episode of pancreatitis. An obstructive pathology of biliary tract was the aetiologic factor. Vomiting, upper abdominal pain are aspecific symptoms that impose a differential diagnosis with acute appendicitis, cholecystitis and obstructive intestinal pathology. Laboratory data (elevated serum amylase and lipase levels) and ultrasonography carry out an accurate diagnosis. The management of acute pancreatitis is based on the use of symptomatic drugs, a low fat diet alternated to the parenteral nutrition when triglycerides levels are more than 28 mmol/L. Surgical therapy, used only in case of obstructive pathology of biliary tract, is optimally collected in the third trimester or immediately after postpartum. Our patients, treated only medically, delivered respectively at 38th and 40th week of gestation. Tempestivity of diagnosis and appropriate therapy permit to improve prognosis of a pathology that, although really associated with pregnancy, presents high maternal mortality (37%) cause of complications (shock, coagulopathy, acute respiratory insufficiency) and fetal (37.9%) by occurrence of preterm delivery.

The authors review the published data on thyroid pathology and pregnancy. Attention is focused in particular on alterations in thyroid function and the iodine metabolism during pregnancy, thyroid interactions between the fetus, the placenta and the maternal organism, the control of fetal thyroid hormonal production, thyroid hormones and fetal development, endemic goitre and pregnancy, endemic cretinism, hypothyroidism in pregnancy, mixematous coma, hyperthyroidism in pregnancy, thyroid cancer in pregnancy and perinatal thyroid disease (hypothyroidism and hyperthyroidism).

Ninety-six cases of fetal macrosomia have been tested to focus on the factors necessary to select women running the risk of delivering macrosomic fetuses. The results of these studies are the following ones: a) pregnant women with pathology are multiparas; b) they are usually characterized by peculiar weight increase in pregnancy; c) they have gone beyond pregnancy term; d) they have previously delivered macrosomic fetuses. The Authors focus on the necessity to anticipate diagnosis and to plan caesarean section in order to avoid the traumatic lesions this kind of babies are frequently affected by.

This paper describes a case of acute pancreatitis occurring in a patient immediately after delivery and in primigravida. The patient had a family case history of dyslipidemia (Type IV). The pregnancy had been complicated by preeclampsia treated at home with nifedipine tablets (one tablet three times a day) with good results on pressure values; lipidic values were high despite dietary measures taken. The baby at birth weighed 3830 g after physiologic labour and a natural delivery. Acute pancreatitis was diagnosed after observation of epigastralgia with irradiation on the left shoulder, vomiting, symptoms of acute abdomen such as sweating, increased pulse rate, hypotension, abdominal pain on palpation, and absence of peristalsis. An analysis of the blood showed high levels of amylase and hyperglycemia, an increase in XDP, and leucocytosis. Instrumental tests such as pancreatic echography revealed an increase in pancreatic volume, uneven structure of the parenchyma and higher levels of liquid in the peritoneum. The patient was moved to intensive-care, a nasal gastric probe inserted, hydroelectrolytic treatment was begun, vital functions monitored, pain kept under control by medical therapy, and antibiotics administered. Subsequent tests showed an improvement in the parameters of pancreatic functions (amylase, lipase, calcium hematic) and their gradual return to normal values. The computerized tomography of abdomen additionally revealed the presence of pancreatic pseudo-cysts and effusion of peritoneal liquid near the right kidney. The patient was discharged after two weeks in the surgical ward. There are many caused of acute abdomen during and immediately after pregnancy, and one of these is acute pancreatitis, though rare (occurring between 1:3800 and 11.467 according to Rabkin).(ABSTRACT TRUNCATED AT 250 WORDS)

Anaesthesia for caesarean section in patients with cerebral artero-venous malformations (CAVM) is a controversial matter. We describe a case of a primiparus woman with an inoperable CAVM delivered by CS under epidural anaesthesia. Epidural anaesthesia can be a valid alternative to general anaesthesia as it provides excellent analgesia allowing an accurate assessment of the neurological conditions of the mother and avoiding opioids and/or hypotensive drugs, potentially dangerous to the foetus, to blunt the hypertensive response to intubation. The accidental dural puncture is to be avoided with extra-careful technique. The epidural injection must be made either very slowly or with an incremental technique to avoid any increase in intracranial pressure. Hypotension must be corrected promptly to maintain cerebral perfusion pressure.