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Electronic fetal monitoring (EFM) has been introduced in the obstetrics practice as a test to identify the first signs of fetal deterioration, allowing a prompt intervention to reduce neonatal morbidity and mortality. However, results from clinical trials fail to demonstrate a clear benefit with the use of EFM. No decrease in the incidence of cerebral palsy due to intrapartum asphyxia has been achieved and a significant increase in the rate of operative deliveries and in medico-legal litigations has been observed instead. Despite the lack of evidence supporting its safety and effectiveness, this method is routinely used in the clinical practice and periodical updated guidelines to standardize the method of interpretation and proper actions are proposed. However, limitations still exist and the unavoidable consequences are the increasing rate of caesarean delivery, partly due to a defensive attitude in medical choices, and medico-legal litigations for presumed inappropriate evaluation in case of perinatal adverse event. While Obstetrics Societies are trying to "fight" the rise in caesarean section rates, intrapartum EFM tracings are taken in the court proceedings as one of the main evidences in case of adverse event. The aim of this review is to discuss the limitations of guidelines dealing with intrapartum EFM and the pathophysiological basis to assess the suspicious tracings which represent the most observed and critical issue of EFM interpretation.

Aim: The aim of the study was to compare elective induction of labour at 38 weeks versus expectant management in A1 and A2 gestational diabetes (GDM) pregnancies with fetal growth acceleration. Primary outcome of the study was C-section (CS) rate, while secondary outcomes were macrosomia incidence and adverse perinatal outcomes., Methods: A retrospective cohort study was carried out. Data were collected between 1996 and 2006 and evaluated through patients' records analysis. Differences between the two study groups were investigated using non-parametric tests for continuous variables and χ2 test for categorical ones., Results: There was no significant difference between induction and expectant management in terms of caesarean section rate. A trend favoring women in the induction group in terms of incidence of macrosomia and neonatal outcomes was identified, but results were not statistically significant., Conclusion: Labour induction at 38 weeks in GDM patients with fetal growth acceleration does not seem to determine an increased incidence of C-section in comparison to expectant management, particularly in case of maternal obesity.

Aim: With this study, we wanted to evaluate HIV-positive pregnant mothers followed at the HIV Reference Center of Friuli Venezia Giulia and to describe obstetric treatment aimed at identifying vertical transmission factors and at undertaking a correct diagnostic-therapeutic approach to this patient group. The data include a large case series from the European Collaborative Study on HIV in Pregnancy, in which our facility is a collaborating center., Methods: The protocol includes the administration of personalized antiretroviral therapy to seropositive patients at the first visit. An elective caesarean section is performed at 38 weeks gestation. Antiretroviral therapy is continued in the neonate. Breastfeeding is prohibited., Results: From 1998 to 2002, 28 pregnant mothers with HIV infection were followed. Most patients came from out of region and had acquired the infection through heterosexual intercourse with a serodiscordant partner. In 1 in 3 patients, a diagnosis of seropositivity was made during pregnancy. One case of vertical transmission was observed., Conclusions: When appropriate prevention measures are instituted, the percentage of vertical transmission of infection can be reduced to less than 1% in Europe today. An important part of this effort is early screening for HIV infection in pregnancy. Other fundamental measures are the institution of antiretroviral therapy starting from the first weeks of pregnancy, monitoring of pregnancy at a tertiary reference center, intravenous administration of therapies before caesarean section, possibly not during labor and with the membrane intact. Equally important factors are neonatal therapy, adequate pediatric monitoring after the infant is born and discontinuation of breastfeeding.

Aim: Gravidic cholestasis is a syndrome that is usually manifested during the third trimester of pregnancy and regresses in puerperium. It is characterized by the onset of itch, with or without associated jaundice and alterations of hepatic functional parameters. Its incidence varies according to geographical area., Methods: A retrospective analysis was made regarding the frequency of this pathology in pregnant patients attending the Gynecology and Obstetrics Clinic of Trieste from 1-1-1980 to 31-7-1997. The epidemiological and clinical characteristics were studied relating to the course of pregnancy and neonatal outcome. Patients were identified on the basis of diagnosis on admittance and anamnestic and laboratory data, generalised itch and increased transaminase, biliary salts and alkaline phosphatase. Patients suffering form active-phase viral hepatitis were excluded, as were those in whom symptoms appeared after the start of alpha methyldopa administration., Results: The frequency of gravidic cholestasis in this series was 0.36%. No significant differences were recorded in terms of age, parity and weight increase in these patients compared to the general population of pregnant women. Birth was spontaneous in 66% and by cesarean section in 34%. The frequency of premature births was 12%. The Apgar score at 5 min was satisfactory in all neonates., Conclusions: Careful monitoring of pregnancy associated with suitable obstetric care enabled a zero rate neonatal and maternal mortality to be achieved.

Aim: Human papilloma virus (HPV) infection is one of the most frequently observed sexually-transmitted diseases (10-60% of the general population). In pregnant women, as well as accelerating the evolution of dysplasia to cervical cancer, the infection may be transmitted to the fetus during gestation or at the time of birth. Children who have been infected at birth may develop laryngeal papillomatosis during the first 5 years of life that may, in some cases, spread to the point of causing aphonia or severe respiratory obstruction. There is also the risk, although it is very low, of a carcinomatous degeneration of the larynx in these subjects during adulthood. The hypothesis of the present study was to verify the prevalence of HPV infection in a population of pregnant women and the prevalence of maternal-fetal transmission., Experimental Design: A prospective longitudinal design lasting 11 months was used for the study. It included the collection of an endocervical biopsy from population of pregnant women using a swab that was diluted in 3 cc of physiological solution, and the collection of oropharyngeal secretions from their respective neonates using a cottonwool bud., Participants and Methods: A total of 170 pregnant women attending the Obstetric Centre of the Obstetric and Gynecological Clinic of Trieste University were recruited in the study. An endocervical biopsy was taken during the 1st and/or 2nd trimester of gestation and/or at the start of labour. Of these subjects, 23 completed all the planned biopsies and a sample of oropharyngeal secretion was collected from their neonates., Tests: From the material obtained the presence of HPV-DNA was analysed using a PCR (protein chain reaction) technique consisting of the following steps: 1) culture of human cells expressing sequences of HPV 16 and 18 used as positive controls; 2) preservation of tissue material washed in watery 4% formalin solution; 3) amplification and viral characterization in types 6-11-16-18-31-33-52., Results: Positive HPV-DNA results in at least one of the three samples collected during the various periods of gestation was 31.2%, whilst in the population in which all the planned samples were performed the frequency of positive cases was 30.4%. Positive results for HPV-DNA in oropharyngeal secretions from neonates was 21.7%. The concordance of positivity for HPV-DNA in mothers at the time of labour and in their respective neonates was 57.14%., Conclusions: The trend of infection did not reveal substantial changes during the various gestational periods in which tests were performed. The possibility of HPV-DNA transmission from mother to fetus is high, above all when the maternal PCR test is positive at the time of birth, or in the presence of a high viral load. This justifies the need to monitor this infection in pregnancy in those affected by florid genital condylomatosis or with koilocytosis on cervical cytology. It is also appropriate to check all HPV-DNA positive neonates one year after birth.

The prediction of spontaneous abortion in the first trimester is made possible owing to the use of two diagnostic procedures: maternal assay of some biochemical parameters and ultrasonography. However, the diagnostic value of ultrasound is greater than the former procedure since it enables the embryo to be visualized directly, measuring crown-rump length (CRL), together with the gestational sac whose diameter can also be measured (DSG). The present study aimed to verify the prediction of abortion given by the ratio between DSG and CRL measured using ultrasound in the first trimester of pregnancy, namely with signs of embryonic vitality already present. A prospective longitudinal study was performed in a population of 59 pregnant women attending the Obstetric and Gynecology Clinic of Trieste University during the period between April 1990 and April 1991. On enrollment in the study all patients had a gestational age of 8 +/- 2 weeks of amenorrhea. A preliminary measurement of DSG and CRL (t0) was then obtained and these measurements were repeated after four weeks (t1). The data obtained were first compared to each other for the same time (DSG0/CRL0 and DSG1/CRL1) and the relationship between the two ratios was then calculated ((DSG1/CRL1)/(DSG0/CRL0)). This method provides a sensitive method of analysing variations in the ratio between the two measurements taken at different moments. Inferential statistical principles were then applied. At the end of the first trimester the evolution or otherwise of pregnancy was assessed by examining and separating two groups of women: those who had had spontaneous abortions and those who had continued their pregnancies.(ABSTRACT TRUNCATED AT 250 WORDS)

The KBB acid elution test is used to assess the presence and extent of transplacental passage of fetal cells into the maternal circulation both as a diagnostic aid in detecting hemorrhage before birth and in monitoring pregnancies at risk for hemolytic disease of the newborn. However the technique is ineffective when an hereditary Hb-pathy with associated increase in HbF is present in the mother, like the HPFH, delta-beta thalassemia and other hereditary abnormal hemoglobins. A mother with HPFH and another mother with delta-beta thalassemia with false positive result of the acid-elution test are described and the need for an extension of the clinical and laboratory study in families with hereditary HbF disorder is stressed.

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.

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 frequency of the Pap test and the incidence of dysplastic and neoplastic lesions of the uterine cervix in the province of Trieste from 1/7/85 to 30/6/88 have been analysed. Over this period, the annual frequency of screening was 11% of the resident female population, with considerable differences from one age class to another. In the age group between 15 and 29, in which CIN 1 incidence is at its maximum, the frequency of screening is much lower than it is among subjects of average age. It is considered that it would be more advisable to detect the cervical lesion in the earliest stage and so bring forward performance of the first Pap test to a younger age.

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.

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%).

1103 cases of endometrial hyperplasia were diagnosed between January 1, 1978 and December 31, 1987 at the Department of Anatomy and Pathological Histology of the University of Trieste. Of these, 58% were cases of cystic glandular hyperplasia, 38% of adenomatous hyperplasia and 4% of atypical hyperplasia. Subdividing the period examined into two five-year periods, it was found that the rate of incidence of endometrial hyperplasias was more than doubled, this increase having been caused above all by cases of cystic hyperplasia. Distribution by age classes of subjects suffering from different hyperplastic forms suggests that cystic glandular hyperplasia is not a precursor of the adenomatous form, whereas the latter and atypical hyperplasia might constitute a continuous spectrum of potentially precancerous lesions.