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The aim of this study was to evaluate the diagnostic accuracy of endocervicoscopy as a preoperative examination to improve the outcome of the excisional treatment (LEEP) of high-grade cervical preneoplastic lesions.Patients with histologic diagnosis of CIN II-CIN III undergoing LEEP divided in two groups: in group A (85 women) a preoperative endocervicoscopy was performed, in group B (85 women) no additional examination was performed before LEEP. The size of the surgical specimen (H, D, W) and the margins of the lesion were evaluated.Seventy-four women in group A and 80 in group B completed the follow-up. group A showed significant correlation between colposcopic examination and endocervicoscopic examination (P=0.001, k=0.30) and between endocervicoscopic and definitive histological examination (P0.05, k=0.16). The depth of the operative sample was significantly lower (P0.0001) in group A (0.91±0.4) than in group B (1.58±0.2), group A showed fewer patients B with positive endocervical margins than group B (3 vs. 17, P002). Colposcopic, cytological and virological follow-up did not show significant differences between the two groups.Endocervicoscopy as preoperative tool for excisional treatment of cervical lesions showed high diagnostic effectiveness and allows to perform a conservative surgery.

Aim of the study was to assess by what percentage the use of transvaginal ultrasound (TV, curettage) following voluntary interruption of pregnancy (IVG) reduces the incidence of haemorrhagic events resulting from incomplete drainage of the cavity during the first trimester of gestation. The use of ultrasound examination, may considerably reduce the incidence both of post-IVG haemorrhages due to incomplete curettage and of the total number of complications.

Hormone replacement therapy (HRT) may reduce the risk of cardiovascular events in healthy postmenopausal women. However recent studies suggest a 2-4 fold increased risk of idiopathic venous thromboembolism (VTE) among users of HRT. Our aim was to evaluate the overall effect of HRT on hemostatic variables probably related to increased VTE risk reported in epidemiological studies.

The aim of this paper was to establish the physiologic changes in the coagulation and fibrinolytic systems during normal pregnancy.One-hundred and twenty normal pregnant women were investigated in a longitudinal study involving 3 measurements: blood samples were collected at 12, 24 and 36 weeks of gestation and were assayed for prothrombin time, antithrombin III (ATIII) activity, protein C activity, protein S (PS) activity, prothrombin fragments 1+2, type 1 plasminogen activator inhibitor activity, tissue plasminogen activator antigen, plasminogen, activated protein C resistance, factors VII and VIII levels and D dimer. Student t-test, one way analysis of variance (ANOVA) and Fisher test were used for statistical analysis.Factor VII and factor VIII were always increased with respect to controls. Variance analysis showed a statistically significant reduction for anticoagulants (PS) and a rise for F1+2 and D dimer. With regard to fibrinolysis, there was an increase both for t-PA and PA1-1 during pregnancy. Moreover, the increased activity of factors of haemostasis was accompanied by an increase of activity and concentration of ATIII and acquired activated protein C resistance.These findings suggest that normal pregnancy is associated with an hypercoagulable state, resulting into a moderate risk for thrombosis during the different trimesters of pregnancy. Also broad spectrum assays which measure a range of trombin/fibrin formation in serum have become an established mean to identify activation of blood coagulation and/or fibrinolysis. There is a considerable interest in the application of these assays to the diagnosis of other acquired hypercoagulable states; such as thrombophilia during pregnancy. From the viewpoint of coagulation/fibrinolysis changes, the follow-up of thrombophilia markers could be recommended when levels of coagulation parameters exceed the normal values during pregnancy.

The development of thrombotic disorders is a major threat for young women during pregnancy. It is one of the main causes of pregnancy-related disorders, which may also result in harm for the conceptus. Successful pregnancies require an even balance of coagulation and fibrinolysis, in order to secure stabilization of the basal plate as well as adequate placental perfusion. Broad spectrum assays which measure a range of thrombin/fibrin formation in serum have become an established means of identifying activation of blood coagulation and/or fibrinolysis. There is considerable interest in the application of these assays to the diagnosis of other hypercoagulable states, such as thrombophilia during pregnancy. We investigated coagulation/fibrinolysis parameters for significant differences between pregnant women during their gestation (first, second and third trimester) with or without pregnancy loss and healthy nonpregnant women.Thirty-nine pregnant women, aged 24-39 years, were studied. They were subdivided according to pregnancy trimester: 15 patients in the first trimester; 13 in the second and 11 in the third. The selection of patients was carried out in cooperation with the Transfusion Center of the Second University of Naples in order to obtain a homogeneous sample group. The control group included 400 healthy patients. Biochemical and blood coagulation tests were performed for each patient and the results obtained were compared with the control group.A decrease in free protein S (PS) and fibrinolysis (t-PA/PAI-1) activities and an increase in Factor VII, Factor VIII, prothrombin fragment 1+2 (F1+2), D-dimer (D-dimer) were observed in pregnant women during the follow-up of gestation. However, there were statistical differences between the groups of women with one or more pregnancy loss where it was found the lowest values in t-PA and PAI and the highest values in FVII and F1+2. Among subjects with more than one abortion, coagulation/fibrinolysis derangements before the partum were more prominent. A significant association exists between consecutive recurrent abortions and pregnancy complications such as placental abruption, hypertensive disorders and CS. This association persists after controlling for variables considered to coexist with recurrent abortions.These findings suggest that an excessive hypercoagulable state is associated with the termination of pregnancy resulting into a moderate risk for thrombosis during the different trimesters of pregnancy. The follow-up of fibrinolytic markers could represent a useful diagnostic tool for termination of pregnancy.

Obiettivo. Lo scopo di questo studio era verificare l’incidenza delle complicanze conseguenti alla diagnosi prenatale invasiva effettuata mediante amniocentesi presso il centro di Diagnosi Prenatale del Secondo Ateneo di Napoli. Metodi. Sono state intervistate telefonicamente 1.580 pazienti circa le complicanze conseguenti ad amniocentesi effettuate nel periodo compreso tra gennaio 2001 e dicembre 2003. Risultati. Delle intervistate hanno risposto correttamente al questionario soltanto 1.416 pazienti. Le complicanze verificatesi nelle prime 24 h dall’intervento (complicanze precoci) sono state costituite da lievi contrazioni e lipotimie da riflesso vagale rispettivamente nell’8,3% e nel 6,7% dei casi; perdite di liquido amniotico si sono avute nell’l,06% mentre sanguinamenti si sono avuti nello 0,85% dei casi. L’incidenza di aborti nella settimana successiva all’intervento è risultata essere pari allo 0,78%. Parti prematuri si sono verificati solo nel 6% delle pazienti sottoposte ad amniocentesi; parti spontanei a termine nel 43% e mediante taglio cesareo nel 51% dei casi. L’indice di Apgar è risultato normale nel 95,7% dei nati. Nel restante 4,3% si sono avute patologie quali ipoglicemia o distress respiratorio prontamente regrediti. Le complicanze precoci e l’incidenza di aborti sono risultati significativamente correlati con il traumatismo uterino conseguente alla seconda infissione dell’ago, ma non con l’età della paziente o con il prelievo transplacentare. Conclusioni. L’ortodossia della tecnica associata allo scrupoloso rispetto del protocollo e alla rigorosa selezione delle pazienti sono presupposti necessari per una riduzione sempre maggiore delle complicanze relative all’amniocentesi.