Annali di ostetricia, ginecologia, medicina perinatale最新文献

The authors have examined 20 patients with genuine stress incontinence and urogenital prolapse and 20 control subjects searching a difference between static and dynamic condition of the pelvic floor. They used a simple device to study the mean position of the perineal plane both at rest and under switch. In incontinent patients the perineal plane is always below the bituberal plane (+1.17 cm at rest and +1.32 cm straining). These values are on a higher plane in the control subject (-0.64 cm at rest and +0.48 cm upon straining). These differences have an highly significant statistical value (P = 0.0002 and P = 0.001).

In order to increase our knowledge of the physiopathology of urinary stress incontinence related to pelvic relaxation, the Authors examined 20 women suffering from SUI (Stress Urinary Incontinence) almost always characterized by concomitant slight or moderate urethrocystocele and 20 women without urological problems. They analyzed and compared the measurement of perineal descent with radiological and electromyographic parameters in order to detect if a suffering of some fibers of the pudendal plexus can be related to the pathology of SUI. They pointed out that patients affected by SUI show a perineal position, either at rest and under switch, below the ischial tuberosities plane. Furthermore the anterior angle at rest is always more than 30 degrees and electromyographic records are pathological in 90% of cases.

The authors expose the problems to be solved preliminarily in order to obtain a perfect standardization of autoptic protocols concerning perinatal subjects. Therefore the propose a draft of detailed anamnestic clinical card that follows the woman and the conception product during and after the pregnancy, and suggest the ways for an adequate perinatal diagnostic autoptic protocol. They deem advisable to insert the anamnestic clinical summary, codified with the SNO-MED, in an autoptic data bank, an irreplaceable instrument of interdisciplinary study.

Complete or incomplete transverse vaginal septum is a rare malformation of the female genital tract. Usually the complete congenital type occurs at puberty because of the collection of menstrual blood above the septum with amenorrhea and cyclic lower abdominal pain as presenting symptoms. On the contrary, in the case shown by the authors, the subacute epilogue occurred in the perimenopausal phase: a very large colpohematometra is reported in a 49 years old woman, with an incomplete vaginal septum resulting in progressive obstruction. The association between this malformation and the presence of endometriotic localizations in the genital tract, as reported by other authors, is interesting. In this case, endometriosis can be secondary to the presence of the septum or could have determined the impairment of the obstruction in consequence of the associated status of chronic flogosis.

Myasthenia gravis is an autoimmune disorder characterized by a reduction of muscular strength. It is associated with production of anti-acetylcholine-receptor antibodies and with the consequent decrease of muscular acetylcholine receptors. The Authors have studied this pathology during the pregnancy and the puerperium in a myasthenic patient and in her newborn, evaluating seric AChRAbs title and seric alpha-fetoprotein levels, to investigate the possible correlation among these parameters and MG. The study shows that with low seric levels of AChRAbs the mother had a progressive symptomatological impairment of MG from 36th week of pregnancy to term and in puerperium too; the newborn didn't show any sign of pathology. The possible immuno-protective role of alpha-FP in maternal and fetal MG evolution is discussed.

In the present study the authors, on the basis of the existing literature, analyse the delivery problem in previous cesarean section patient, especially about maternal mortality and morbidity. After cesarean section vaginal delivery may occur only in selected patients, with precautionary measures and continuous monitoring in labor. The maternal mortality is lower in vaginal delivery patients after cesarean section than in iterative cesarean section patients; also the post operating complications are more frequent after iterative cesarean section. Perinatal mortality is in relation to uterine rupture, perinatal morbidity to iatrogenic prematurity and neonatal respiratory adaptation.