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Introduction: Recent studies report that early integration of palliative care approach with standard oncologic care in cancer patients may have a beneficial effect on quality of life and mood disorders. In Brain Tumor patients, however, the provision of supportive and palliative care often occurs late and the timing and the role of palliative care in brain tumor patients remain to be better defined. Since October 2000 in the Regina Elena National Cancer Institute of Rome, we started a palliative home-care project for patients affected by malignant BTs, with financial support of Regional Health System. The aims of this model of assistance are to meet patient’s needs of care during the evolution of the disease, to provide palliative care, to support the families and to facilitate death at home. Methods: in the first fifteen years of our program 873 patients have been assisted at home and 618 died. Home assistance includes neurological visits, neuro-rehabilitation at home, psychological support for patients and families and nursing assistance. Results: among the 410 patients who were assisted at home until death (410/618, 66%), the most frequent symptoms in the last 4 weeks of life were: epilepsy 37%, headache 36%, drowsiness 85%, dysphagia 85%, death rattle 12%, agitation and delirium 15%. The large majority of BT patients die with a process that has been defined as “peaceful death”, with progressive neurological deterioration. In some case, however, patients may present bad symptom control with agitated death that requires pharmacological sedation (15,7%). The early provision of home palliative care enables family caregivers to continue caring at home until death and allow to discuss timely with patient and family the End of Life Advance Care Planning, avoiding hospitalisation or Emergency room access in case of acute symptoms. CONCLUSION: early integration of palliative care model in the trajectory of desease of Brain Tumor patients is critical to providing more effective support, to enhancing the likelihood of a desired home death and to support the psychological and spiritual needs of patients and families.

The aim of this study was to evaluate the role of Bishop score, sonographic measurements of uterine cervical length and maternal characteristics, as predictors of spontaneous onset of labor within 24 hours, as well as response to induction in prolonged pregnancies.Pregnancies with gestational age over 280 days were followed as outpatient. Patients were included in the study if spontaneous delivery occurred between 286 and 295 days of gestation, or in pregnancies with gestational age of 291-293 days who required labor induction. Data about Bishop score, ultrasonographic cervical characteristics (length, funneling, volume) and maternal features (parity, body mass index and age) registered at the last control immediately before the delivery were retrieved from clinical charts.Data from 195 patients were available. Bishop score and, in particular, ultrasonographic cervical length can predict the spontaneous onset of labor with a positive predictive value (PPV) of 22% and 44%, respectively in 24 hours. On the other hands, in patients requiring labor induction, parity and ultrasonographic cervical length remained the only predictive parameters with a PPV of 39% and 42%, respectively. In term of predictive performance, the value of 30 mm was identified as the best cut-off value for the ultrasonographic cervical length (specificity 59% and sensitivity 69%).In prolonged pregnancies, Bishop score and ultrasonographic cervical length were shown to be relevant in the prediction of spontaneous onset of labor, while in patients who required labor induction, ultrasonographic cervical length represented the only clinic parameter predicting the onset of labor.

The use of diagnostic ultrasound and the diffusion of the technique improved the obstetric treatment and the usefulness of ultrasound increases in the delivery room for maternal and fetal care and as method of diagnosis of some obstetric complications. The knowledge of intrapartum ultrasound imaging can be considered useful for the obstetric team, since there is evidence that ultrasound can improve the obstetric management. The mean indications are described: fetal biometry and estimated fetal weight, amniotic fluid volume, fetal situation and presentation, placental localization and anatomy, assessment of size and location of uterine leiomyomas, fetal cardiac activity, evaluation of umbilical cord and fetal cardinal movements intrapartum. Besides, the use of ultrasound is reported in obstetric and postpartum complications. Actually ultrasonography, as a non-invasive, safety and low-cost technique, offers a diagnostic method in particular conditions during labour, delivery and postpartum.