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A case of a pregnancy occurring in a woman with previously diagnosed Wegener's granulomatosis and the following neonatal follow-up are described. Complete clinical and laboratory disappearance of disease activity was achieved by steroid treatment before pregnancy. The newborn was followed up for 6 months; he always showed normal clinical and laboratory exams, except a mild and transient neutropenia.

Background: Cancer complicates approximately 1 in 1000 pregnancies. In pregnancy management, whether the benefits outweigh the risks derived from therapy must be carefully considered., Materials and Methods: Thirty-two pregnant patients with the diagnosis of malignancy were followed. The indications and timing for surgery, chemotherapy, radiotherapy or delayed treatment were decided according to the malignancy characteristics and gestational age. The patient's consent was obtained before every decision., Results: The rate of live births, premature deliveries, foetal abnormalities and neonatal deaths was 97%, 82%, 9% and 3%, respectively. Three women (9%) died during puerperium because of disease progression., Conclusion: The cancer treatment took into full consideration the specific condition of each pregnant patient. A good rate of live births was observed, even if a high rate of preterm delivery occurred. The management of malignancy required a team of experts in order to optimise every available choice for maternal health and neonatal well-being.

Objective: Inherited thrombophilia is associated with thromboembolic events and/or poor obstetric outcome. We evaluated the pregnancy outcome in women with inherited thrombophilia treated with low-molecular-weight heparin (LMWH)., Methods: 38 thrombophilic women with a history of thromboembolic events and/or poor obstetric outcome were treated during their 39 consecutive pregnancies with LMWH from pregnancy verification until 4-6 weeks in puerperium. A fixed dose of enoxaparin 4,000 IU/day (except 1 case who required nadroparin 0.3 ml/day) was administered in most cases, adopting a higher dose (6,000 IU/day to 6,000 IU twice a day) in those with previous thromboembolic events., Results: In the treated women, all had a good obstetric outcome, whereas in the previous untreated pregnancies (n = 78), the rate of fetal loss (early and late) was 76.9%, only 12 live infants survived (66.6%). Moreover, birth weight resulted significantly higher in live infants born to treated pregnancies in comparison to that of previous untreated pregnancies (p = 0.009). No maternal thrombosis or major bleeding complications were recorded., Conclusions: The treatment with LMWH improved pregnancy outcome resulting effective and safe in thrombophilic women with a history of thromboembolic events and/or poor obstetric outcome., (Copyright 2006 S. Karger AG, Basel.)

Rheumatic diseases in women of childbearing years may necessitate drug treatment during a pregnancy, to control maternal disease activity and to ensure a successful pregnancy outcome. This survey is based on a consensus workshop of international experts discussing effects of anti-inflammatory, immunosuppressive and biological drugs during pregnancy and lactation. In addition, effects of these drugs on male and female fertility and possible long-term effects on infants exposed to drugs antenatally are discussed where data were available. Recommendations for drug treatment during pregnancy and lactation are given.

Objective: To establish the extent of maternal mortality in Italy in between 1980 and 1996 in order to compare it with the international data., Study Design: We conducted a retrospective study on maternal deaths in Italy from 1980 to 1996. Data have been collected by Italian Statistic Institute (ISTAT). We calculated both the maternal mortality rates and the percentages of causes of death in the whole period, according to WHO definitions., Results: The data confirmed the trends of the previous decade: maternal mortality rates have decreased from 13.25 (1980) to 3.78 (1996) for 100000 live births. Haemorrhage and hypertension have been the main causes of maternal death, while pulmonary embolism has had a minor affect on maternal mortality rates compared to other countries, particularly in Europe., Conclusion: Italian data appear reassuring and encourage further investigations on detailed welfare problems.

Background: To determine the outcome of cervical ripening with intracervical prostaglandin E2 (PEG2) in hypertensive and non-hypertensive high-risk pregnancies in terms of successful ripening, mode of delivery, time intercorring between ripening and the beginning of labor or parturition and, at least, duration of labor., Methods: A total of 63 women with a diagnosis of hypertensive disorders were included in the study protocol. These 63 women were compared with 71 consecutive high-risk pregnancies requiring induction of labor for maternal and/or fetal indications. Cervical ripening was performed with single or multiple doses of 0.5 mg of intracervical PGE2 gel., Results: The rate of successful ripening was 84% for non-hypertensive patients (60/71) and 69% (43/63) for hypertensive patients ( p < 0.03). Twenty-four out of 63 hypertensive patients (38%) and 21 out of 71 non-hypertensive patients (30%) ( p < 0.05) were delivered by cesarean section. After stratification of hypertensive patients, the time interval from the first PGE2 administration to the onset of labor or vaginal delivery was significantly longer for preeclamptic patients vs. non-hypertensive patients or non-preeclamptic hypertensive patients. There were no differences in the duration of labor., Conclusions: Among hypertensive patients, only preeclamptic patients showed a lower rate of successful ripening and vaginal delivery if compared with non-preeclamptic or non-hypertensive patients; however, a vaginal delivery might be obtained in most preeclamptic patients when suitable cervical ripening was performed in the presence of clinician-perceived urgency to delivery.

Background: Pregnancy is uncommon in women with end-stage renal disease (ESRD) requiring chronic dialysis. An increasing number of successful pregnancies in women in hemodialytic treatment have been recently reported but few institutions experienced more than one or two cases of pregnancy., Methods: Between 1988-1998 five pregnancies in patients receiving hemodialysis were observed in our center. Medical records of these patients were reviewed., Results: At the conception the mean age was 27 years. One patient started dialysis after conception. All patients received bicarbonate dialysis. Three patients were dialyzed six times per week, the other two patients three-four times per week. The dry weight was increased progressively; on average of 1.2 +/- 0.5 kg in the first trimester and of 0.5 kg per week since the second trimester. The predialysis BUN was maintained between 50-100 mg/dL (17.85-35,70 mmol/L) during the pregnancy. Four patients were treated with erythropoietin to maintain hematocrit between 30-35%. Erythropoietin related-complications were not observed. Polyhydramnios was observed in all cases. All deliveries occurred before term. The mean gestational age of infants was 28.6 +/- 4 weeks. Four out of five pregnancies resulted in liveborn infants. Two infants had an Apgar score of zero. All neonates were of low birth weight (1,431 +/- 738 g) with percentile of birth weight in the normal range. No one was small for date., Conclusion: A successful pregnancy is possible in women on chronic dialysis. Prematurity occurs frequently as well as low weight birth leading to increased perinatal morbidity and mortality.

Objective: To evaluate whether abnormal endothelial function, a common finding in premenopausal women with type 2 diabetes, is present in early states of diabetes during pregnancy, such as impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM)., Research Design and Methods: Brachial artery flow-mediated dilatation (FMD) (endothelium-dependent) and nitrate-induced dilatation (NID) (endothelium-independent) were measured in 23 pregnant subjects with carbohydrate abnormalities (10 IGT, 13 GDM) and in 15 pregnant control subjects during the third trimester of gestation. High-resolution vascular ultrasonography was used to perform these investigations. A fasting lipid panel was obtained, and glucose and insulin values in response to a 100-g oral glucose load were also measured., Results: FMD was significantly reduced in both groups of women with abnormal carbohydrate metabolism compared with control subjects (7.6 +/- 1.1% in the IGT group and 4.1 +/- 0.9% in the GDM group vs. 10.9 +/- 1.1% in control subjects, P < 0.04 and P < 0.0001, respectively). Significant difference in FMD was also observed between IGT and GDM groups (P < 0.04). NID was comparable in the three groups. Among all subjects, FMD showed a strong independent negative correlation with glycemic area (r=-0.60, P < 0.0001)., Conclusions: Endothelial dysfunction, an early marker of macrovascular disease, is present in pregnancies complicated by IGT and GDM. This alteration, which seems to be directly related to glycemic levels, could explain, at least in part, the increased risk for concurrent hypertensive disorders during pregnancy in these women.

Objective: To assess the agreement between manual auscultatory arterial blood pressure values and the values obtained by an automated oscillometric device in normotensive pregnant patients., Methods: Arterial blood pressure was determined concomitantly by a Dinamap 1846 sx/p device and by one observer (I, IV, V Korotkoff sounds) blinded to the Dinamap values. Agreement between methods was tested and graded according to the protocol of the British Hypertension Society., Results: A total of 490 observations were performed. Differences were observed between the manual auscultatory method and the Dinamap method. In monitoring normotensive pregnant patients with a Dinamap device, an error was made of about 10 mmHg in 22% of the observations for systolic arterial blood pressure (BP); in 11% for diastolic arterial BP (IV sound); and in 15% for diastolic arterial BP (V sound). According to the British Hypertension Society protocol, the overall grade reached was 'C'., Conclusions: Although an underestimation of only 10 mmHg was shown, this can be of great importance in delaying a correct diagnosis of pre-eclampsia. The assessment of agreement of the Dinamap 1846 sx/p device in hypertensive pregnant patients should also be determined. A prospective study could be useful to determine the effectiveness of an automated device in detecting hypertensive disease in pregnancy.

Background: The aim of this retrospective study is to verify whether some maternal features are related to pregnancy outcome in cases of emergency mid-trimester cerclage when membranes are protruding through the dilated cervix., Methods: Between 1988 and 1996 twenty-three pregnant patients with dilated cervix and protruding membranes were treated with emergency cerclage. At the time of cerclage, gestational age ranged from 17 to 27 weeks (median 22)., Results: Pregnancy was prolonged from 0 to 20 weeks (median 4). Eleven living infants were born (46%); median gestational age at delivery was 25 weeks (range 21-39) and median birth weight 700 g (range 350-3980 g). Obstetric histories, white blood cell count, and vaginal-cervical and urine cultures obtained on admission were analyzed in the two following groups: data from patients with good pregnancy outcome (live births) versus those from patients with poor outcome (stillbirths and neonatal deaths). No significant difference was found between the groups for the above mentioned maternal features., Conclusions: The possibility of 46% live births is considered a good result for mid-trimester emergency cerclage when the membranes are protruding. Success of the procedure remains unpredictable on the basis of the maternal features investigated.

The aim of this study was to verify whether twin pregnancies complicated by pre-eclampsia were associated with a higher rate of inter-twin weight discordance or an increased prevalence of small for gestational age (SGA) neonates than in normotensive twin pregnancies. A 17 year retrospective study was undertaken by examining 76 twin pregnancies complicated by pre-eclampsia and comparing them with 400 normotensive twin pregnancies. The case notes were reviewed in reference to birth weight differences, birth order, pregnancy outcome and inter-twin birth weight discordance. Statistical analyses were performed with t-test, contingency tables, regression curves, rank sum test and non-parametric survival plots. Power analysis was also carried out. Pre-eclamptic twin pregnancies were delivered at similar weeks of gestation to normotensive. They resulted in a smaller size for the second twin the earlier the delivery week, while in normotensive twin pregnancies no significant difference occurred at any week. Twin pregnancies complicated by pre-eclampsia showed higher rates of SGA neonates among second twins than those with normal pressure. The >25% discordance was associated with lower gestational age at delivery in each group [mean (range) 33 weeks (27-38) versus 37 (29-41), P < 0.005 pre-eclampsia and 35 weeks (25-41) versus 38 (25-42), P < 0.001 normotensive]. In pre-eclampsia the concomitant occurrence of SGA second twin and the discordance >25% was associated with shorter gestation while the presence of SGA second twin alone was not.

In this paper we tried to define the capillaroscopic pattern of anti phospholipid syndrome able to differentiate between the primary (PAPS) and the systemic lupus erythematosus-associated form (SLE-APS) and to be a predictive marker of thrombotic manifestations. Eight PAPS and five SLE-APS patients were studied. In each patient the evaluation was based on anti cardiolipin antibody levels, nailfold capillaroscopy, retinal fluorangiography and transcranial doppler sonography. Statistical analysis has been performed using chi 2 analysis. Morphological alterations of capillary loops, venular visibility and sludging of blood were often observed in both groups. While we found in higher prevalence a variability of capillary loop length in PAPS patients, the SLE-APL group significantly differed for the presence of microhaemorrhages (p < 0.001). When we evaluated the clinical history, a marked microcirculatory damage was related with the occurrence of thrombotic manifestations in the PAPS patients. Anti cardiolipin antibody levels, retinal fluorangiography and transcranial doppler sonography did not correlate with clinical history in either group. In conclusion, nailfold capillaroscopy can be usefully employed in the differentiation between primary and SLE-associated anti phospholipid syndrome, and it can help to identify the patients at higher risk of thrombotic disease.

A total of 290 women who required induction of labour for medical or obstetric reasons were given single or multiple doses of prostaglandin E2 gel (0.5 mg) to induce cervical ripening. Onset of labour occurred in 185 (63.8%) of the women treated with the gel, without any further treatment. The overall Caesarean section rate was 27.2% (79/290) and was significantly higher among those with an initially low Bishop score than in those with a higher initial score (34.7% versus 22.1%; P = 0.025). Prostaglandin E2 gel appears to be of considerable clinical benefit, especially where no other options are available except Caesarean section or a very long, difficult labour that may result in significant fetal distress.

Background: We compare trends and current levels of cesarean section delivery by indication in some industrialized countries to help us understand factors underlying national differences in obstetric delivery practice and identify pathways to lower cesarean rates., Study Design: In this report we describe the schemes employed at our Department for the management of low-risk at term and postterm pregnancies and list the most important motivations for increased cesarean section rate and remedies suggested to reduce high cesarean section rate. Moreover a randomized trial to assess the role of labor induction with PGE2 gel vs i.v. Oxytocin+Amniotomy in the management of prolonged pregnancy is being evaluated presently at our center., Methods: To date, 75 postterm pregnancies have been followed. Patients are enrolled at > or = 287 days (41 weeks). Intracervical PGE2 gel (0.5 mg) is used for cervical ripening. Induction of labor is randomly performed using intravaginal PGE2 gel (2 mg) or i.v. Oxytocin+Amniotomy., Results: Overall rates of 75% for spontaneous delivery, and 25% for cesarean section have been observed in our study group of prolonged pregnancies., Conclusions: The accurate labelling of low- and high-risk pregnancy and the appropriate management of term and postterm pregnancy are two important steps for the reduction of a high rate of cesarean section.

We investigated the impact of pregestationally elevated insulin plasma levels on glycemic control in pregnant women with polycystic ovary disease (PCOD). Twelve patients with PCOD who became pregnant within six months following evaluation of their metabolic status were the study subjects. Four were obese and six (two obese) had a hyperinsulinemic response to the oral glucose tolerance test (OGTT). They were tested with the OGTT at 28-30 weeks of gestation. We also tested 12 normal patients and 10 consecutive patients with gestational diabetes; all were at the same gestational age. Plasma levels of insulin and glucose were determined in the samples collected for a period of four hours after glucose load (100 g). All PCOD patients significantly increased their insulin secretion in pregnancy. The hyperinsulinemic PCOD patients developed gestational diabetes (two patients) and impaired gestational glucose tolerance (three patients). The area under the insulin curve was greater in PCOD patients than in control and gestational diabetes patients (P < .01). In spite of their large increase in insulin secretion observed during pregnancy, patients with PCOD may develop a derangement of glycemic control, probably related to their pregestational insulinemic status.

Our objective was to evaluate whether antiphospholipid antibody-containing sera could play a regulatory role in signal transduction induced by gonadotrophin releasing hormone (GnRH) when incubated with normal human trophoblast cells. To test this hypothesis we established an in vitro placental culture system in which GnRH addition in the presence of normal human serum resulted in a significant increase in human chorionic gonadotrophin (hCG) secretion. When GnRH was added to the culture medium with antiphospholipid antibody-containing sera, the hCG increase was inhibited. These results suggest the possibility that antiphospholipid antibody-positive sera can exert their effect on GnRH-induced signal transduction. Further studies are needed to explain their exact site of action.

The present study reports for the first time on the presence of anticardiolipin antibodies (aCL) in a population of 259 women with a history of recurrent abortion, intrauterine death, and/or neonatal death associated with fetal growth restriction, preeclampsia and abruptio placentae. The overall incidence of aCL in this study group was 20.5%, a statistically significant increase in comparison with a control group. The highest positive rate was observed among women who presented both recurrent abortion and intrauterine death (33.3%), the lowest was observed among women with a history of neonatal death. Our findings confirm that aCL are strongly linked with fetal loss. Thus, before planning a subsequent pregnancy, the presence of aCL should be tested in all women with poor pregnancy outcome.

Objective: The purpose of the study was to determine whether the duration of hypertension in the puerperium of preeclamptic women was related to certain clinical features of disease severity., Study Design: We studied 269 singleton pregnancies divided into two groups: 159 with gestational hypertension and 110 with preeclampsia. The normalization time of blood pressure in puerperium was estimated as the interval between the delivery day and the first day when each of two to four self-measurements per day of diastolic blood pressure was observed to be < or = 80 mm Hg for at least 3 consecutive days., Results: Normalization time was shorter in gestational hypertension than in preeclampsia (6 +/- 5.5 [means +/- SD] vs 16 +/- 9.5, respectively, p < 0.0001). Normalization time of gestational hypertension showed a significant correlation with uric acid (r = 0.20, p < 0.025); normalization time of preeclampsia displayed significant correlations with the week of delivery (r = -0.34, p < 0.005), uric acid (r = 0.34, p < 0.025), and urea nitrogen (r = 0.29, p < 0.025), respectively. After stratification by parity, in both groups the correlations of normalization time with renal data were observed only among multiparous women, whereas in preeclampsia the link of normalization time with the week of delivery remained highly significant in both subgroups., Conclusions: The differences observed between gestational hypertension and preeclampsia suggest that distinct mechanisms or a different maternal answer to the same mechanism(s), in maintaining high blood pressure in puerperium, are present in the two groups. Normalization time might reflect the recovery time of the endothelial damage in preeclampsia.

Nifedipine was administered to 49 pregnant women with gestational hypertension as first-line therapy, and were longitudinally studied as paired observations for 3 or 10 day intervals of treatment with nifedipine until delivery. All the patients assumed a slow release formulation of nifedipine at the dose of 40-80 mg/24 hr in 2-3 administrations. Blood pressure was taken at least 4 times a day. The patients were divided in two groups: 32 women with non proteinuric gestational hypertension (NPGH) and 17 women with proteinuric preeclampsia (PP). No statistically significant modification of blood pressure was observed in both groups under treatment. However, NPGH showed a trend to reducing, while PP demonstrated a tendency to worsening both systolic and diastolic blood pressures. After treatment with nifedipine the platelet count of both groups was found unchanged. No adverse fetal or newborn effects imputable to the drug were observed. The present study demonstrates that nifedipine alone, at the doses used, is not effective in reducing blood pressure in long-term treatment. However the treatment could concur to avoid sharp and dangerous increases of blood pressure.

Twenty-one pregnancies in 16 women who conceived after cardiac valve replacement were reviewed. Oral anticoagulants were discontinued before conception or as soon as possible for subcutaneous heparin treatment (8000-14,000 IU every 8-12 h) and resumed in the second trimester until the last period of pregnancy when oral anticoagulants were replaced again by heparin. No therapeutic abortion was performed. The spontaneous abortion rate was found to be 14.3% (3/21). Preterm delivery (< or = 37 weeks) and low birth weight babies (< 2500 g) were 29.4% (5/17) and 35.3% (6/17), respectively, significantly more frequent than those of the control group (P < 0.02 and P < 0.0005). No significant statistical difference was found when the rate of spontaneous abortion [14.3% (3/21)] and the rate of fetal growth retardation [11.8% (2/17)] were compared with the control group. The majority of thromboembolic events (6/7) occurred during heparin regimen in three mothers; one of them subsequently died. No coumarin embryopathy was observed and the physical and mental development in the 16 surviving children was good. This study confirms: (1) the increased rate of preterm delivery and infants weighing < 2500 g; (2) the increased risk of maternal thrombosis related to heparin use; and (3) the good follow-up in the surviving children.

Objective: To determine whether uterine artery velocimetry is a useful tool for identifying pregnancies with antiphospholipid syndrome at risk for adverse outcome., Methods: Twenty-four women with antiphospholipid syndrome, who had experienced 56 fetal losses in 63 previous pregnancies (88.9%), were treated with prednisone (40 mg/day) and aspirin (100 mg/day) during 28 pregnancies. Color Doppler ultrasound was performed at 18-24 weeks' gestation to investigate the resistance index of the uterine arteries., Results: Treated women delivered 23 live infants in the 28 pregnancies (82.1%). Three infants weighed less than the tenth percentile (13%). Five pregnancies were complicated by preeclampsia and ten by nonproteinuric gestational hypertension. Positive results for all three assays for antiphospholipid antibodies (anticardiolipin antibodies, lupus anti-coagulant, VDRL) at conception identified pregnancies destined to have poor fetal outcome and a significantly lower birth weight compared to pregnancies not having all three assays positive. An abnormal resistance index of the uterine arteries predicted pregnancies with poor fetal outcome in terms of week of delivery, birth weight, and birth percentile, as well as four of five cases of preeclampsia., Conclusions: Three assays positive for antiphospholipid antibodies at conception and an abnormal resistance index of the uterine arteries at 18-24 weeks' gestation predicted pregnancies at major risk for obstetric complications. Future studies should determine whether treatment can be modulated based on the Doppler findings.

We performed a retrospective study of 26 pregnancies with chronic immune thrombocytopenic purpura (ITP) or incidental ITP. Thirteen pregnancies were followed without the use of percutaneous umbilical blood sampling (PUBS) and 13 were followed sampling PUBS at 36-40 weeks of gestation. The overall prevalence of neonatal thrombocytopenia was 27%: 50% in chronic ITP, 12.5% in incidental ITP. Symptomatic thrombocytopenia occurred only in infants born to mothers with chronic ITP. Without the use of PUBS, 2 symptomatic thrombocytopenic fetuses were vaginally delivered and there was a high rate of cesarean sections in normal fetuses. Owing to PUBS, a decrease of the cesarean section rate in normal fetuses was observed, but one fetal bradycardia (due to the technique) was encountered. PUBS resulted helpful to indicate the best route of delivery and reducing unnecessary cesarean sections in women with chronic ITP, but in presence of incidental ITP the use of PUBS remains an open question.

The purpose of this study was to evaluate the tocolytic efficacy of terbutaline, administered subcutaneously in a low-dose continuous infusion, and intermittent high-dose boluses. The population study consisted of 13 women admitted with the diagnosis of Threatened Preterm Labour. Before starting chronic infusion by terbutaline, patients received 48 hour of therapy with intravenous MgSO4 for acute tocolysis. Therapy with microinfusor was continued until the 37th week of gestation or until labor. The mean gestational age at the beginning of therapy was 25.6 +/- 3.5 and pregnancies were prolonged an average of 65.5 +/- 29 days. In any case uterine activity was diminished by terbutaline therapy in all patients. Patient tolerance was excellent and there were no significant complications due to the therapy.

The placental transfer of phenobarbital was investigated in 35 mother-infant pairs at birth. The drug was administered prenatally to the mothers for maternal epilepsy (group 1, n = 5), gestational hypertension and preeclampsia (group 2, n = 20) and prophylaxis of intraventricular hemorrhage in premature deliveries (group 3, n = 10). The phenobarbital levels in arterial cord blood were 100 +/- 2.8% in group 1, 89 +/- 21% in group 2 and 77 +/- 16% in group 3 with respect to the levels observed in the mothers. The most important factor influencing the transplacental passage was the duration of maternal treatment in the infant of group 1 (r = 0.80, p < 0.01), the gestational age in the infants of group 2 (r = 0.74, p < 0.01) and the arterial cord pH in the infants of group 3 (r = 0.89, p < 0.001).

The angiotensin sensitivity test was performed in 25 high risk pregnant women before and after administration of low-dose aspirin (100 mg/day for 7 days). After aspirin administration there was a significant decrease in AII sensitivity in sensitive patients with no change in nonsensitive patients. Low-dose aspirin favorably affects sensitivity to AII in sensitive patients, thus indicating a reduced vascular reactivity as a consequence of this regimen.

The purpose of this study was to determine the role of proteinuria on pregnancy outcome in 444 hypertensive women with singleton pregnancies. The patients were divided into three hypertensive groups: 98 with chronic hypertension, 199 with nonproteinuric gestational hypertension, and 147 with proteinuric preeclampsia and chronic hypertension with superimposed proteinuric preeclampsia. The presence of increased proteinuria (greater than 0.3 gm/L) predicted an adverse pregnancy outcome. Furthermore, the majority of small-for-gestational-age infants occurred in the group with proteinuric preeclampsia (52%), whereas the rate of small-for-gestational-age infants was 18% and 12% in the group with nonproteinuric gestational hypertension and chronic hypertension, respectively. The group with chronic hypertension did not show any increased risk for fetal outcome. Perinatal mortality rate was extremely poor in the group with proteinuric preeclampsia at 129 per 1000, four times higher than those of the other two groups.

In normal placentas during the first trimester of pregnancy, the syncytiotrophoblast appeared to be immunoreactive to alpha-antitrypsin (alpha 1-AT), alpha 1-antichymotrypsin, albumin, IgG, and transferrin. The underlying cytotrophoblast was negative for these same serum proteins. In the hydatidiform mole, these findings were profoundly different. The syncytiotrophoblast lost its immunoreactivity to albumin, IgG, transferrin, and, less frequently, to alpha 1-AT. Furthermore, the underlying cytotrophoblast became immunoreactive to albumin, alpha 1-AT, IgG, transferrin, ferritin, orosomucoid, and, sometimes, to alpha 1-antichymotrypsin. This altered immunohistochemical pattern suggested a notable change in the pinocytotic activity of the trophoblast in the placenta during molar degeneration. The absence of pinocytosis in the syncytiotrophoblast for several proteins can be explained by the partial loss of specific membrane receptors. The contemporaneous appearance of numerous serum proteins in the cytotrophoblast could indicate an activation, not only proliferative, but also functional, in the germinative cytotrophoblast. Diagnostically, this histochemical finding in the hydatidiform mole, which was quite different from that seen in normal placentas during the first trimester of pregnancy, could provide additional evidence concerning trophoblastic abnormalities in the chorionic villi during molar degeneration.

In a randomized prospective study, we investigated the effect of antenatal phenobarbital on neonatal intraventricular hemorrhage in 39 women destined to deliver babies of less than 32 weeks of gestation. The treatment group received an intravenous loading dose of 700 mg of phenobarbital, followed by a daily maintenance dose until delivery. The newborns were treated with phenobarbital for the first 96 h. Ultrasound examinations of the infants' heads were performed. Intraventricular hemorrhage was significantly less frequent in the treated group: 2 of 21 (9.5%) versus 9 of 18 (50%; p less than 0.006). Moreover no severe hemorrhage (grade 3-4) occurred in the treated babies: 0 of 21 versus 5 of 18 (27.7%; p less than 0.01).

Antithrombin III (AT III) plasma levels were investigated in 18 full term neonates and 14 healthy preterm neonates. A control group of 20 healthy adults was also studied. AT III was measured as antigen concentration (Ag) and antithrombin or anti-factor Xa heparin cofactor (H.C.) activities. Crossed immunoelectrophoresis on heparin-agarose (H-CIE) was carried out on plasma samples; moreover the distribution of isoantithrombins was investigated on whole plasma by a technique of crossed immunoelectrofocusing (CIEF). AT III plasma levels in full term infants were significantly lower as compared to the adult values. The preterm newborns group showed a further significant decrease in AT III levels as compared to the full term neonates. In all infants AT III H-CIE runs displayed a single fast moving anodal peak, so that a normal binding to heparin was demonstrated. The CIEF AT III plasma pattern of the adults as well as of all neonates displayed three major peaks at pH range 5.2-4.9, a small amount of AT III at pH 4.9-4.8 and a minor peak at pH 4.8-4.6, so that it was concluded that the isoantithrombins plasma distribution in neonatal age is identical to that of the adult subjects. Four neonates whose mothers were affected by AT III congenital defect were also investigated: diagnosis of congenital deficiency was established in three cases.

Four pregnant women with antithrombin III congenital deficiency underwent thrombosis prophylaxis including oral anticoagulants administered from the 16-18th week to the 36-37th week of pregnancy, subcutaneous heparin before the 16-18th week and after the 36-37th week, and a single infusion of AT III concentrate in the peripartum period in order to obtain a minimal level of 0.8 U/ml of AT III functional activity. The level of circulating AT III after the concentrate infusion needs to be evaluated by functional methods, because of a consistent amount in the concentrates of inactive AT III immunoreactive material. No thrombotic or haemorrhagic complication occurred after starting prophylaxis in any woman either in any newborn.