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The number of women undertaking a pregnancy in late reproductive age is increasing. It is unclear if age of 35 to 40 years constitutes a real biologic limit to reproduction or if unfounded social prejudices play a role. Many publications present advanced age as a significant risk factor for the mother and fetus. Only recent data can be considered because of constant advances in perinatal medicine. Furthermore, many studies are limited by the small sample size and by the lack of control groups and correct statistical analysis. Reproductive outcome is influenced by obstetric, maternal, social and psychological factors. The most recent data obtained on large series of women after control for confounding variables have demonstrated that advanced maternal age is a risk factor for fewer complications than generally believed, such as probability of conception, frequency of chromosomal anomalies, occurrence and consequences of hypertension and diabetes, type of delivery, and maternal and fetal mortality. In the absence of preexisting maternal disease and if correct care is provided by health personnel the prognosis for a pregnancy in an older woman is not greatly different from that of a younger one. By adopting an appropriate attitude the physician can reduce the mother's excessive preconceived concerns, thus allowing the delivery of correct prenatal care and a serene pregnancy.

A case of severe haemolytic disease of the fetus due to six rare alloantibodies is described. In a pregnant women at 23 weeks gestation after the finding of a positive indirect Coombs test maternal antibodies have been precisely identified and titrated: anti-I: 1/23, anti-c: 1/64, anti-S: 1/16, anti-Fya: 1/128, anti-M: 1/64, anti-Jka: 1/32000. Fetal blood group, free and red blood cell adherent antibodies have been investigated on fetal blood samples obtained by means of cord centesis. A compatible donor has been found. Severe fetal anemia has been corrected by ultrasound guided intrauterine transfusions (one abdominal and two intravascular transfusions) with positive outcome of the pregnancy.

Two cases are reported of acardiac-acephalic twin pregnancy, a rare malformation of multiple gestations with large placental vascular anastomosis. In both cases, respectively 25 and 30 weeks of gestation, ultrasound scan revealed a first normal fetus and a nonviable twin without cardiac activity and head, but increasing in size at serial scans. The authors describe the obstetric management, the Rx details and the anatomo-pathological findings emphasizing the analogies between the two acardiac fetuses.

This retrospective study concerns 537 adolescent pregnant patients followed at the 1st Dep. of Obst. and Gyn. during the time period 1984-87. Preeclampsia, preterm labor and neonatal mortality were more frequent than in the general population.

Fetal risk related to cordocentesis has been analyzed on a series of 222 ultrasound-guided fetal blood samplings for prenatal diagnosis of fetal diseases during the second trimester of pregnancy. Affected and malformed fetuses were excluded. Seven intrauterine deaths (3.2%) and 2 spontaneous abortions (0.9%) were observed. These figures proved higher than those observed in non-homogeneous series which consider the second and third trimester altogether. The fetal risk was significantly correlated with gestational age (less than 18 weeks 7.6% vs greater than 18 weeks 0.7% p = .02) and duration of the procedure (greater than 10'11.4% vs = less than 10'0.9% p = .0029). The number of abdominal insertions resulted in different death rates (greater than 1 ins. = 6.5% vs 1 ins. = 1.4%). It is likely that different developmental, anatomical and neurovegetative mechanism play a significant role in the risk rate found in the second trimester cordocentesis. These findings and the specific risk factors observed within the different technical conditions reported, must be taken into consideration for prenatal counseling.

The performance of 465 sonographically guided percutaneous umbilical blood samplings and its use in the management of diagnostic problems in the second and third trimester of pregnancy are described. The method has been employed in the prenatal assessment of 423 patients (357 procedures in the second trimester and 108 in the third trimester). Pure fetal blood was obtained in all third trimester samplings whilst in the second trimester in 4 cases (1.1%) fetal blood could not be obtained at the first procedure and in 9 cases (2.6%) contamination with maternal blood or amniotic fluid was observed. Data analysis confirm how this simple and rapid procedure offers access to the fetal circulation for diagnostic and therapeutic purposes.