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Objective: To ascertain the diagnostic ability of a computerized fetal heart rate (FHR) analysis system in the identification of patients at risk of fetal distress in labor. Study design: Five-hundred and seventy-seven healthy term pregnancies were enrolled in a prospective, cross-sectional study and subdivided into two groups, with (n = 90) or without (n = 487) fetal distress in labor. Computerized FHR recordings were performed periodically and regression analysis was performed in a univariate and multivariate way to assess the ability of the last FHR recording in the prediction of subsequent fetal distress. Results: The two groups showed a significant difference in almost all of the FHR parameters studied. The multivariate analysis showed that only the FHR baseline and the percentage of small accelerations were independently and significantly related to the labor outcome. The combination of these two parameters reaches a sensitivity of 45%, specificity of 91%, positive predictive value of 48% and negative predictive value of 90%, with an overall accuracy of 84%. Conclusions: The increase in FHR baseline and in small FHR accelerations can be major factors in the prediction of subsequent fetal distress in healthy term fetuses.

Pregnancy is considered to be a hypercoagulable state per se with an increased risk for cerebrovascular events, however cerebellar infarction has been rarely described in pregnant women. A nulliparous pre-eclamptic woman at 25 weeks' gestation was submitted to an echocardiographic exam that showed an impaired cardiac structure and function. After 2 h, the patient underwent caesarean section for diagnosis of haemolysis, elevated liver enzymes, low platelet (HELLP) syndrome. Afterwards her platelet count raised, and eight days later she developed nystagmus, ataxia, dysmetria and motor deficit in the right limbs and sensory impairment in the right side of the face and in the left limbs. Cerebral magnetic resonance imaging (MRI) demonstrated a right cerebellar and median posterior bulbar infarction. Colour-coded sonography of cerebral vessels showed an occlusion of the right vertebral artery. Coagulation pattern analysis evidenced double heterozygosis of the methylenetetrahydrofolate reductase (MTHFR) gene and single mutation of the prothrombin gene. This case report gives evidence of the importance of considering the different risk factors involved in stroke occurrence during pregnancy.

Introduction: Pregnancies complicated by fetal growth restriction (FGR) are known to be associated with a reduced expansion of maternal intravascular space and a lower cardiac output. Therapy with ...

Objective: The purpose of our study was to assess cardiac function in non-pregnant women with previous early preeclampsia before a second pregnancy to highlight the cardiovascular pattern, which may take a risk for recurrent preeclampsia.Methods: Seventy-five normotensive patients with previous preeclampsia and 147 controls with a previous uneventful pregnancy were enrolled in a case control study and submitted to echocardiographic examination in the non-pregnant state 12–18 months after the first delivery. All patients included in the study had pregnancy within 24 months from the echocardiographic examination and were followed until term.Results: Twenty-two (29%) of the 75 patients developed recurrent preeclampsia. In the non-pregnant state, patients with recurrent preeclampsia compared to controls and non-recurrent preeclampsia had lower stroke volume (63 ± 14 mL versus 73 ± 12 mL and 70 ± 11 mL, p

Objective: The objective of this study was to test the efficacy of bed rest in reducing total vascular resistance (TVR) in normotensive patients with TVR in the upper limits, evaluating the...

Introduction: During pregnancy, maternal body composition and haemodynamics undergo important changes that are of increasing interest for understanding the evolving maternal physiology.Targets: To ...

Introduction: The purpose of our study was to evaluate the maternal haemodynamic profile in women diagnosed with threatened preterm delivery (TPD) in order to understand the possible pathophysiologic mechanism leading to an increased lifetime risk for future cardiovascular disease.Methods: Sixty-eight patients diagnosed with TPD were enrolled and assessed using a non-invasive method (USCOM®) to determine the haemodynamic parameters. Cervix length assessment, vaginal and rectal swabs, blood inflammatory indexes, foetal vessel Doppler velocimetry, gestational age at the delivery and neonatal outcomes were considered.Results: The population was divided into two groups according to the total vascular resistance (TVR) in Group A ≤ 1000 dynes.s.cm−5, and Group B 41 000 dynes.s.cm−5. C-reactive protein was higher in Group B versus Group A, suggesting a systemic inflammation status. Group B delivered earlier (32 weeks + 4 days versus 38 weeks + 2 days, p

Introduction: Abnormalities of cardiac output, TVR and water body distribution are connected with PE and foetal growth restriction (FGR).Targets: To identify patients at risk of PE in the first trimester through USCOM system, bioimpedance and combined screening (maternal history, biophysical and biochemical markers). We enrolled 150 healthy nulliparous women with normal BMI.Results: The patients were divided into two groups: Group A (TVR

Objective: To improve the efficacy of screening patients at increased risk of hypertension or intrauterine growth retardation, we combined the assessment of increased uteroplacental resistance with a second-line screening using 24-h blood pressure monitoring.Methods: Doppler assessment of uterine artery flow (resistance index, diastolic notch) at 20 and at 24 weeks gestation and 24-h ambulatory blood pressure were determined in 48 consecutive patients. Mean 24-h diastolic blood pressure (M24-h DBP) was used as a measure to describe the overall pressure regimen for each patient. Based on a cutoff of 68 mm Hg, the series was divided into two groups: 18 high-risk patients with abnormal M24-h DBP (higher than 68 mm Hg). and 30 low-risk patients (equal to or lower than 68 mm Hg). The results were blinded to clinicians.Main Outcome Measures: The development of gestational hypertension, preeclampsia, and intrauterine growth retardation (IUGR).Results: None of the 18 pathological M24-h DBP as compared to 25/30 in...

Leiomyoma is the most common uterine tumor that occurs in more than 20% of women older than 30 years. This tumor presents different types of degenerations and a large variability in MRI imaging patterns. In literature ther is no case reported about leiomyomas spectroscopy. We report a case of 34 year-old woman who was admitted to the hospital for evaluation of an abdominal mass diagnosed at ultrasound. Physical examination revealed abdominal distension and abnormal uterine bleeding. Using abdominal MRI 3 Tesla we were able to determine the presence of a mass near uterine body very close to left ovarian. Laparotomy was performed and it showed a uterine peduncolated lesion. Histological examination proved smooth muscle cells and spindle-shaped cells separated by myxoid materials and ordinary myoma cells. This case report suggests that MR Spectroscopy may be able to allow distinction between benign and malignant lesions. It is important to differentiate leiomyomas from other diseases because of therapeutic treatment. In our case laparoscopic exeresis of the lesion permitted to preserve uterus and Patient’s fertility.

Objective There is emerging evidence suggesting that women who develop hypertensive disorders of pregnancy should be considered at risk for cardiovascular disease (CVD). Our objective was to determine whether persistent endothelial activation, which represents the earliest step in atherogenesis, is present after delivery in women with a history of hypertensive pregnancies compared to women with normal pregnancies. Study design Two matched case-control studies were conducted. In the first study, endothelial activation was assessed by the measurement of soluble intercellular adhesion molecules, namely, intercellular adhesion molecules-1 (ICAM-1), vascular cellular adhesion molecules-1 (V-CAM-1), E-selectin and P-selectin in 25 women with hypertensive pregnancies and in a matched control group with an uncomplicated pregnancy one month and three months after delivery. In the second study, adhesion molecules were measured in 20 patients with a history of HELLP syndrome several years after pregnancy and in 20 matched controls. Results Increased levels of soluble adhesion molecules were found in women with hypertensive complications compared to women with uncomplicated pregnancies shortly after delivery. Significant differences were still present, several years after delivery comparing levels of adhesion molecules in women with a history of HELLP syndrome with those found in control patients. Conclusions Patients with hypertensive pregnancies showed an abnormal activation of the endothelium which persists after pregnancy. This activation was particularly marked in patients experiencing HELLP syndrome. These observations may represent an explanation to the increased risk of CVD later in life in patients experiencing hypertensive pregnancies, especially in women with a history of HELLP syndrome.

The aim of our study was to evaluate the basal immune reactivity in patients with locally advanced endometrial carcinoma, and the immune modulating effect of adjuvant treatment in cancer population randomized to endocrine or radiation therapy.Forty-three patients with FIGO stage I and II endometrial carcinoma, treated with primary radical surgery, were randomly selected to receive endocrine (medroxy-progesterone acetate 30 mg weekly and Tamoxifen 300 mg weekly, given consecutively) or radiation adjuvant treatment (external beam photon treatment of the whole pelvis, with an average total dose of 3680 cGy rad). The immune assay included the evaluation of natural killer cell activity by target cell retention of the fluorescent dye carboxyfluoresceyn diacetate, using sensitive cell line K 562. The immunological monitoring was performed before surgery, and then before, during, and after adjuvant treatment. Nine patients, who refused any adjuvant treatment, were recruited as controls.Patients, matched for age and demographic characteristics, with locally advanced endometrial carcinoma had significantly lower mean values of natural killer activity than in healthy controls; the decrease of natural cytotoxicity was significantly related to the depth of myometrial invasion. The adjuvant treatment was associated with a significant immune modulation: patients in endocrine therapeutic regimen showed an increase of natural killer activity, while patients in radiation therapy had a reduction; in the control group there was no significant modification of natural cytotoxicity during negative follow up.Natural killer cell activity of peripheral blood is significantly reduced in local advanced endometrial carcinoma patients. The natural cytotoxicity evaluation, as a function of therapeutic modality, may be useful in establishing a relationship between adjuvant treatment and immune status in endometrial carcinoma.

Objectives: To report the antenatal pictures of a fetus with multiple intracranial lipomas. Methods: A 36-year-old primigravida, 33 weeks of gestation, was referred to our ultrasound laboratory due to sonographic suspicion of an intracranial hemorrhage. Results: At 2D and 3D ultrasound imaging, three separated round-shaped hyperechoic intracranial masses compatible with multiple lipomas were documented. Absence of corpus callosum was associated. Sonographic findings were confirmed by antenatal and postnatal MRI. Conclusions: Multiple intracranial lipomas in a fetus with absent corpus callosum have been infrequently described. Prognostic implications remain uncertain.

The absence of a rise in maternal serum glucose level during the course of a 3-h glucose tolerance test was noted in pregnancies that resulted in growth-retarded infants. It was postulated that this response to an oral glucose load, in association with increased impedence to uterine artery blood flow, as demonstrated by color flow Doppler waveforms, could select the pregnancies at greater risk of developing intrauterine growth retardation. One hundred and four uncomplicated primigravidae and 88 multigravid women considered to be at high risk of developing intrauterine growth retardation were monitored longitudinally from the 24th week of gestation. The right and left uterine artery resistance indices (RI) were measured at 24 weeks by means of pulsed Doppler with color flow imaging, and the results were averaged. The following week, an oral glucose tolerance test (OGTT) was performed. Serum glucose was measured immediately prior to the ingestion of 100 g glucose, and again after 60, 120 and 180 min. The OGTT results were classified as normal, impaired glucose tolerance, gestational diabetes mellitus, and flat. This last result was indicated by a less than 20% rise in serum glucose compared to the fasting value. A notch in the uterine artery waveform and/or an RI greater than 0.58 (> 2 SD above the mean) was found in 39 (20.3%) women. A flat response to the OGTT was seen in 31 (16.1%) cases. Of the 16 women in whom both a high RI and a flat OGTT response curve were demonstrated, 15 (93.7%) delivered low-birth-weight babies due to intrauterine growth retardation. Eight of these 16 women developed hypertension. In the group with a flat OGTT response curve but normal uterine artery RI, two of the 15 women (13.3%) had growth-retarded babies. The positive predictive value of an increased RI with a flat OGTT response curve was 94%, while the predictive values of each individual method were 62% and 55%, respectively, for development of intrauterine growth retardation. Increased resistance to blood flow in the uteroplacental circulation in conjunction with a flat response curve to an oral glucose load might identify a group of pregnant women at risk of having a growth-retarded infant with or without the development of hypertension. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology

Doppler ultrasound was used to study the main uterine artery flow velocity waveforms in an unselected population of 272 primiparous women at 22 weeks' gestation. The incidences of subsequent complications were as follows: gestational hypertension alone, 4.4%; intrauterine fetal growth retardation alone, 4%; and gestational hypertension with intrauterine growth retardation, 3.6%. The flow velocity waveform was considered abnormal when the resistance index in the uterine artery was greater than 0.58. This identified 9.5% of the population as ‘at risk’ and predicted either of the above outcomes with an overall sensitivity of 74% (kappa index, 0.72). The sensitivity of prediction for gestational hypertension alone was 50% while for proteinuric gestational hypertension it was 88%. The best result was obtained for the prediction of pregnancies affected by both gestational hypertension and intrauterine growth retardation, where the sensitivity was 100%. Copyright © 1993 International Society of Ultrasound in Obstetrics and Gynecology

Objective: The fundamental aim of the study was to verify if any longitudinal variations could be found in the measuring of variability of fetal heart rate through a computerized analysis in the period prior to the appearance of repetitive decelerations.Methods: A longitudinal study on 11 patients with gestational hypertension, fetal asymmetric intrauterine growth retardation, and with altered peripheral doppler pulsatility indexes (UA/ICA ratio > 2 SD) was conducted by using the computerized fetal heart rate software “System 8000.”Main Outcome Measures: The analysis of fetal heart rate variability indexes (long-term mean range and short term) was performed during the last 7 days preceding a cesarean section for fetal distress.Results: A progressive and significant decrease (ANOVA P

We compared the effects of ritodrine and atosiban treatments on fetal cardiovascular behavior by computerized nonstress test (c-NST) analysis. Women diagnosed with preterm labor were randomized to receive either atosiban or ritodrine. A c-NST was performed at least 12 hours after the last corticosteroid administration. Differences in fetal cardiovascular behavior were evident when treatment was given before 30 weeks' gestation. Ritodrine induced higher fetal heart rates, lower long-term variation values, and lower low:high-frequency ratios compared with atosiban. Atosiban induced higher gestational ages at delivery and higher birth weights than ritodrine. The mean Apgar scores were similar for atosiban and ritodrine groups at 1 and 5 minutes. No 5-minute Apgar score was < 7. With respect with atosiban, ritodrine treatment induces tachycardia and a lower variability of fetal heart rate. Such changes could be erroneously interpreted as signal of fetal distress, namely at lower gestational age.

Because early and late preeclampsia (PE) are thought to be different disease entities, we compared maternal cardiac function at 24 weeks gestation in a group of normotensive asymptomatic patients with subsequent development of early (140/90+proteinuria >300 mg/dL) to detect possible early differences in the hemodynamic state. A group of 1345 nulliparous normotensive asymptomatic women underwent at 24 weeks gestation uterine artery Doppler evaluation and maternal echocardiography calculating total vascular resistance. In the subsequent follow-up 107 patients showed PE: 32 patients had late and 75 had early PE. Five of 32 patients with late PE and 45 of 75 patients with early PE had bilateral notching of the uterine artery at 24 weeks (15.6% versus 60.0%; P −5 , and cardiac output was 4.49±1.09 versus 8.96±1.83 L in early versus late PE ( P 2 ; P

I disordini ipertensivi rappresentano una delle cause piu importanti di mortalita e morbilita materno-fetale (insieme con i disordini emorragici, infettivi e tromboembolici) e allo stesso tempo rimangono uno dei piu ampi e controversi capitoli della patologia ostetrica, richiedendo, sia a livello diagnostico che clinico, un’adeguata esperienza medica ed un approccio multidisciplinare.

AIM The aim of this study was to explore a birthweight prediction model using ultrasound determined tissue thickness (SCTT) parameters. METHODS We measured routine ultrasonographic biometric parameters and in addition, fetal SCTT in 201 healthy singleton pregnancies. Mid-arm fat and lean mass, mid-thigh fat and lean mass, subscapular fat mass and abdominal fat mass (AFM) were measured in order to calculate a birthweight prediction model. Ultrasound measurements were analyzed using an 'anovarepeated measures model'. The growth rate (beta-slope) of the selected parameters was computed and the correlation coefficient with the birthweight and the Kendall rank correlation tau, were calculated. RESULTS From the ultrasound determined SCTT parameters, only abdominal circumference (AC), AFM, and MTLM showed a statistically significant trend. The beta-slope of mid-thigh lean mass was excluded since it exhibited significant correlation with the beta-slope of AFM. The final regression model could be calculated as: birthweight (gr.) = intercept +alpha(1)(AFM beta-slope) + alpha(2)(AC beta-slope), where alpha(1), alpha(2) represent regression coefficients. CONCLUSIONS We provide a graphical birthweight prediction model for clinical practice using conventional and specific ultrasound measurements of fetal subcutaneous tissue thickness. This model is based upon an overall analysis of the ultrasound estimated body components.

Objective The aim of the study was to propose a set of tests to clarify the diagnosis of repeated implantation failure in patients undergoing in vitro fertilization (IVF). Study design Fifty-nine patients with at least two unsuccessful IVF attempts were included in the study. Blood samples were evaluated for the presence of underlying thyroid abnormalities, antiphospholipid antibodies (aPL), increased levels of natural killer cells (NK), inherited thrombophilia and mouse embryo assay factor (MEA-f). The same tests were performed on 20 normal fertile control patients. Results Seventy-six percent of IVF patients showed at least one abnormal result. This incidence was higher with respect to that found among control patients (45%). The prevalence of thyroid abnormalities, aPL and increased NK level was higher in IVF patients whereas no differences were observed in terms of prevalence of inherited thrombophilias and MEA-f. Conclusions A better understanding of reproductive failure mechanisms should allow an effective diagnostic flow chart and a focused therapeutic option for patients experiencing repeated IVF failure. With this objective in mind, our data provide two important results: thyroid abnormalities, aPL and increased NK levels are more prevalent in women experiencing IVF failure. No evidence was found for an association between inherited thrombophilia and MEA-f and failure to achieve pregnancy after IVF.

In pregnancy there is an increase in maternal cardiac output (CO) and a reduction in total vascular resistance (TVR). Abnormalities of this adaptive mechanisms lead to numerous disorders of pregnancy. Moreover the mother's body water composition undergoes important modifications in total body water (TBW), extracellular and intracellular body water (EBW, IBW).Aim of the study is to identify a group of patients at high risk of developing hypertensive complications of pregnancy in frist trimester.To investigate hemodynamic changes and distribution of body water during the frist trimester of pregnancy, we conducted an observational study. We evaluated CO, TVR and Time Flow Corrected (TFc) with the USCOM system, a non invasive method. Patients were, also, subjected to BIA (Body Impedance Assessment).We enrolled 120 healthy pregnant women. 20 patients, were excluded for bad signal. Absolute values of haemodynamic and body impedance measures are shown in Fig. 1. Patients were divided in two groups:Group A with TVR1200 dyne and Group B with TVR1200 dyne. CO values were higher in group B. There wasn't significant differences in TBW, haematocrit, TFc and WBI (water balance index: TBW/Hct) between the two groups.Our results show that at costant values of TBW, Hct and WBI,we can find difference in term of TVR and CO in the first trimester of pregnancy. These parameters may improve the accuracy of screening in clinical practice.

Objective To ascertain the diagnostic ability of a computerized fetal heart rate (FHR) analysis system in the identification of patients at risk of fetal distress in labour. Study design Three hundred and two healthy post-term pregnancies were enrolled in a retrospective, cross-sectional study and subdivided into two groups, with ( n = 42) or without ( n = 260) fetal distress in labour. The last computerized FHR recording before onset of labour was analyzed. Results The two groups showed a significant difference only in FHR baseline and in percentage of small accelerations on total. The multivariate analysis showed that only the percentage of small accelerations was significantly related to the labour outcome. A higher diagnostic accuracy was obtained with use of neural network analysis, which allowed a sensitivity of 56%, specificity 91%, positive predictive value 53% and negative predictive value 92% with an overall accuracy of 86%. Conclusions The increase in FHR baseline and in small FHR accelerations can be major factors in the prediction of subsequent fetal distress in healthy term fetuses. Use of neural networks seems to further improve the ability of computerized FHR analysis in the prediction of intrapartum distress.

Implantation is possible within a defined period of the menstrual cycle, referred to as the 'implantation window'. It is during this critical period that proper dialog can be established between the blastocyst and a receptive endometrium. If for any reason this dialog is not established or is altered, the embryo is aborted. The factors responsible for the interaction between the embryo and the mother at the moment of implantation remain poorly understood. Recent studies indicate that endocannabinoids may contribute to the development of an adequate milieu at the implantation site. Here we show that the levels of anandamide and of its degrading enzyme, the fatty acid amide hydrolase, in peripheral lymphocytes undergo specific variations during the various phases of the human ovulatory cycle. In particular, we found the highest levels of fatty acid amide hydrolase activity and protein content, paralleled by the lowest anandamide concentrations, in the period that temporally coincides with the putative window of implantation in humans. On the other hand, the anandamide-synthesizing phospholipase D, the anandamide membrane transporter and the anandamide-binding cannabinoid receptors of lymphocytes did not change during the menstrual cycle. This study indicates that high fatty acid amide hydrolase activity and low anandamide levels may be among the factors that co-operate in the success of implantation. This would add to our understanding of the pathophysiological and therapeutic implications of the endocannabinoid system in human fertility.

Maternal body composition undergoes a deep adaptative change during the course of pregnancy. Fat mass, fat-free mass, and total body water (TBW) increase in different ways and their effects on pregnancy outcome represent a field of major interest in perinatal medicine. The aim of this study was to evaluate the changes in maternal body composition [maternal weight, TBW, intracellular water (ICW) and extracellular water (ECW)] during healthy pregnancy by using bioimpedance analysis (BIA). A total of 170 healthy pregnant women, aged 22-44 years, volunteered to participate in our study. The BIA measurements were carried out with a Tefal BIA scale determining resistance and reactance. Lukaski's multiple-regression equation was used to estimate TBW and ICW and ECW were computed using the prediction formula of Segal. The evaluations were performed at 10-38 weeks' gestation, every 3-4 weeks, and hematocrit was determined at every time interval. Analysis of variance and multiple comparisons of Bonferroni were performed to compare variables among the different study intervals. Second-order polynomial interpolation was used to obtain percentile values for each bioimpedance parameter. Percentile bioimpedance values of the healthy population are provided at each study time, by showing the mean value and the 5th, 25th, 75th, 95th percentiles. Moreover, normal reference ranges for TBW are provided for each gestational age, in relation to maternal weight gain. Reactance, TBW, and ICW enhance slightly during the course of gestation. Tetrapolar BIA could be an easy and practical tool for evaluating changes of maternal body components during pregnancy. It could also provide indirect proof of the normal hemodilution occurring in normal pregnancies. Moreover, fat mass deposition, and not only fluid retention, seems to be responsible for the mother's gestational weight gain, since reactance is an indirect parameter in estimating fat mass amount.

To assess the relative influence of maternal body composition at late gestation on birth weight, we examined maternal body composition near term (36.50+/-2.67 weeks gestation) in a group of 29 women, aged 20-39 years. The women came to the laboratory after an overnight fast. After anthropometric measurements, bioelectrical impedance analysis (BIA) was performed, determining resistance (R) and reactance (Xc), with a Tefal scale at 50 kHz. Fat mass (FM, kg) and fat-free mass (FFM, kg) were determined with the total body water (TBW) equation of Siri. The correlation between BIA parameters and birth weights was examined by linear regression analysis. All subjects delivered between 37 and 41 weeks' gestation. The mean+/-SD values of the studied parameters were: Xc=490.00+/-77.34 ohm, R=55.71+/-8.71 ohm, FM=24.18+/-6.51 kg, FFM=45.82+/-2.65 kg, maternal weight gain=9.51+/-6.43 kg, birth weight=3.43+/-0.36 kg. A direct significant correlation was found between FFM, maternal weight gain, and birth weight. It is known that in late pregnancy, maternal weight gain over gestation is linked to birth weight. We observed that FFM was the most important maternal body component associated with the newborn weight at term gestation, and we believe that this finding might be elucidated by fluid retention. In fact, resistance seemed to be inversely related to birth weight and we do not overlook the link between resistance and TBW. The implementation of our study could shed more light on the influence of maternal body composition on birth weight.

Meconium staining of the fetus and placenta is associated with increased neonatal mortality and asphyxia. Very often it is unclear whether the discharge of meconium is a cause or an effect of fetal distress. In the available literature there are no large epidemiological studies of pregnancy outcome with meconium-related lesions, even though this could be useful to improve our state of knowledge on this topic.A case of umbilical cord vascular necrosis is described. A severely asphyxiated infant was delivered at 39 weeks' gestation by cesarean section due to alarming results of fetal heart rate monitoring and rupture of membranes with meconium-stained amniotic fluid. There was no meconium aspiration. We report a review of 15 similar cases. In the whole series, a linkage between umbilical cord vascular necrosis and evidence of remote meconium discharge always seems to be detectable. The pathophysiological mechanism is unknown.It is still not clear why only a tiny percentage of cases with meconium-stained amniotic fluid develops umbilical cord lesions and poor pregnancy outcome. Further investigations are needed to explain why some meconium-stained newborns suffer severe neurological and other damage even without meconium aspiration.

In the past, an adverse prognostic significance of an altered left ventricular geometry in essential hypertension has been demonstrated. There are no data on the prognostic significance of an altered cardiac structure during pregnancy. The present study was designed to evaluate the prognostic impact on the outcome of pregnancy of an altered geometry of the left ventricle in mild gestational hypertension. One hundred forty-eight consecutive, pregnant, mild gestational hypertensive women (systolic and diastolic blood pressure, 140 to 150 mm Hg and 90 to 99 mm Hg, respectively) were included in the study. Patients were monitored until term to detect subsequent fetal and/or maternal adverse outcomes (preeclampsia, preterm delivery, abruptio placentae, other maternal medical problems, fetal distress, neonatal low birth weight, admittance to neonatal intensive care unit). One hundred one gestational hypertensive patients (68.2%) had an uneventful pregnancy; 47 patients (31.8%) showed a subsequent development of maternal and/or fetal complications. Concentric geometry was prevalent among patients with the subsequent development of complicated gestational hypertension (37 out of 47 patients) compared with the uneventful gestational hypertensive patients (31 out of 101 patients; 78.7% versus 30.1%; P =0.0001). The multivariate analysis showed concentric geometry as an independent predictor of adverse outcomes (odds ratio, 3.65; 95% confidence interval, 1.30 to 10.27; P =0.014). In patients with gestational hypertension, blood pressure values alone appear to be insufficient to identify the effective risk of adverse events. Ventricular geometry gives additional prognostic information, possibly improving our clinical ability to follow and eventually treat these patients.

There are few studies on the effect of nifedipine on fluid homeostasis during pregnancy.To assess the variation of body composition at term in patients with normal pregnancy and patients with gestational hypertension (GH) treated with nifedipine.Seventeen healthy patients with singleton pregnancies and 12 non-proteinuric patients with gestational hypertension treated with nifedipine were enrolled consecutively from our University Hospital from January 2000 to January 2001. Two evaluations were performed (anthropometric measurements, bioelectric impedance analysis (BIA) at 5, 50 and 100kHz and hematocrit), the first at 36.4+/-3.2 weeks' gestation, the second at 2.1+/-1.6 days of puerperium. The BIA measurements included: fat mass (FM, kg), fat-free mass (FFM, kg), extra-cellular water (ECW, Lt), intra-cellular water (ICW, Lt), total body water (TBW, Lt). Values were analyzed as mean+/-S.D. and statistical analysis was performed by using the Student's t-test for unpaired data.Birthweights were significantly lower in the gestational hypertensive patients (3472.7+/-266.4g versus 2735.8+/-575.9g, P0.001). At the first study time, systolic and diastolic blood pressure were significantly higher in the hypertensive patients than in control group, notwithstanding the therapy. Interestingly we found pre-delivery and post-delivery TBW higher in gestational hypertensive patients versus the control patients (44.48+/-9.12Lt versus 36.60+/-5.07Lt, P0.001 and 40.69+/-4.31Lt versus 37.30+/-4.35Lt, P=0.016, respectively). TBW loss after delivery was greater among hypertensive patients (3.79+/-4.81Lt versus -0.70+/-0.72Lt, P0.001).Bioelectrical impedance analysis is a practical tool in the follow-up of anti-hypertensive therapy at term gestation. Moreover, nifedipine increases TBW in gestational hypertensive patients, reverting the pathophisiological pattern, yet described elsewhere.

We assessed total body water (TBW) content and cardiac function in 25 normotensive (N) and 22 gestational hypertensive (GH) women matched for age, gestational age, and prepregnancy body mass index (BMI) during the third trimester of gestation. Patients underwent maternal echocardiography, bioelectrical impedance analysis (BIA), and hematocrit (Hct %) evaluation. The TBW:Hct ratio (water balance index, WBI) was calculated. Hct was significantly lower in N vs. GH women (31.9+/-2.2% vs. 36.2+/-2.5; p

Gestational hypertension is associated with insulin-resistance; insulin and insulin-like growth factor-1 (IGF-1), acting through their receptors, play a role in the growth of the feto-placental unit. Since both receptors are exposed to the maternal circulation, it has been suggested that maternal metabolic abnormalities might affect placental insulin (HIR) and IGF-1 (IGF-1R) receptors. To clarify this issue, we characterized HIR and IGF-1R in placenta at term from normal women, normoinsulinaemic women with gestational hypertension (NGH), and hyperinsulinaemic women with gestational hypertension (HGH). Insulin binding was decreased in HGH women (B/T 0.12 +/- 0.03) compared to control and NGH women (B/T 0.18 +/- 0.07, p0.036; and 0.22 +/- 0.5, p0.009 respectively). Receptor affinity was lower in HGH women (ED50 0.95 +/- 0.32 nmol/l) than control and NGH women (ED50 0.42 +/- 0.19 nmol/l, p0.01; and 0.40 +/- 0.1 nmol/l, p0.007, respectively), whereas low-affinity Ex11+ isoform was higher in HGH women (Ex11+ 50 +/- 7, %) than in control and NGH women (Ex11+ 34 +/- 9%, p0.001; and 39 +/- 4%, p0.01, respectively). Increased expression of Ex11+ isoform was correlated with ED50 (r = 0.71; p0.002) and insulinaemia (r = 0.70, p0.002). IGF-I binding was increased in HGH women (B/T 0.17 +/- 0.03) compared to control and NGH women (B/T 0.09 +/- 0.05, p0.002; and 0.11 +/- 0.03, p0.002, respectively). IGF-IR affinity was similar in the three groups. The percentage of insulin/IGF-I hybrid receptors was increased in HGH women (85 +/- 3%) compared to control and NGH women (68 +/- 7%, p0.001; and 63 +/- 9%, p0.001, respectively), and was positively correlated with insulinaemia (r = 0.62, p0.018), ED50 of insulin binding (r = 0.62, p0.05), and maximal IGF-I binding (r = 0.69, p0.004); whereas it was inversely correlated with maximal insulin binding (r = -0.69, p0.004). Results provide the first evidence for altered expression of insulin/IGF-I hybrids found in insulin-resistance states.

Antiphospholipid antibodies are associated with fetal distress and fetal death. Although different therapeutic regimens have been used, the incidence of fetal growth retardation varies between 30 and 60 per cent of reported cases. We report the evolution of fetal growth in patients with antiphospholipid antibody syndrome treated with high-dose intravenous immunoglobulins (IVIG). Fourteen patients with a history of recurrent spontaneous abortion and immunological diagnosis of antiphospholipid syndrome were followed longitudinally. Intravenous immunoglobulin at a dose of 0.5 g/kg body weight for two consecutive days was started from the fifth week of pregnancy and repeated every 4 weeks until the 33rd week of gestation. Fetal biometry was evaluated longitudinally from the appearance of the gestational sac at 4 weekly intervals. In the period between 26 and 34 weeks, the frequency of evaluation was increased to every 14 days. Data obtained were compared with a control group of 70 fetuses with uneventful pregnancies matched for gestational age. Neonatal weight is shown in relation to the centiles for the normal population. One patient out of 14 (7.1 per cent) developed gestational hypertension and abruptio placentae. No other pregnancy complications were seen. No proteinuria was found. The mean maternal age was 31.2 +/- 3.8 years. Median birth weight was 3433 g +/- 287. The median centile of the birth weight was 65.3 +/- 18.6. Mean gestational age at delivery was 1.3 weeks. No fetal or neonatal growth retardation was seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Peripheral blood natural killer (NK) cell activity against K562 tumor line was monitored in 16 patients with locally advanced squamous cervical carcinoma (II and III FIGO stages) during neoadjuvant polychemotherapy (cisplatin at 80 mg/m2 and bleomycin at 30 mg/m2). There was a significant progressive decrease in NK activity during the three cycles of antiblastic treatment (P = 0.008) without significant depletion of NK cell (CD56 and CD16 monoclonal antibody positive cell percentage and absolute number). A significant relationship was shown between basal NK activity levels and response to polychemotherapy; in fact, nonresponder patients had a significantly lower mean value of NK activity before polychemotherapy than responders (P = 0.044). In conclusion, NK activity declines as a result of antiblastic therapy; although polychemotherapy reduces tumor spread, its antineoplastic action may be affected by this decreased immune reactivity.

sometimes it is necessary. It is indicated to deliver when some specific maternal or fetal conditions develop. Maternal indications for delivery include: platelet count under 100,000, progressive liver function deterioration, progressive renal function deterioration, suspected abruptio placentae, refractory severe hypertension (>160/110), persistent severe headache or visual changes, persistent severe epigastric pain or emesis. Fetal indications for delivery are: severe fetal intrauterine growth retardation, low umbilical artery systolic/diastolic ratio by doppler ultrasound, non-reassuring fetal testing, oligohydramnios. If the gestation is greater than 34 weeks, delivery after stabilization is recommended.

malformations were excluded. The accuracy of each model for prediction of macrosomia was calculated using several thresholds: 4000 g (or 360 mm for AC), the threshold obtained from the inflexion point in the ROC curve, and the threshold associated with the highest overall accuracy. The models were rank ordered from 1 (most accurate) to 22 (least accurate) using a composite score. Results: 1) There was a considerable variation in the accuracy of the different models (in Table 1 values are presented as mean (range) of all models), 2) The use of different types of threshold resulted in significant differences in the performance of the different models (table). 3) Models based on three or four biometric indices were significantly more accurate than those based on two indices. 4) AC as a single measure was of relatively low accuracy in predicting macrosomia (rank order = 15). Conclusions: When macrosomia is suspected, models based on three or four biometric indices appear to be superior over those based on two indices or AC as a single measure. Model-specific threshold may provide better accuracy than the uniform use of the 4000 g threshold.