Annali di ostetricia, ginecologia, medicina perinatale最新文献

Fifty consecutive cases of cervical cancer from the Afagnan Hospital in Togo have been reviewed in their clinical features, and in ten out of these and five additional ones from the year 1979 the histological specimens were reexamined. The high rate of late diagnosis was the most striking clinical data observed, while the histopathological study revealed a high quota of undifferentiated or rare patterns, very different from the types commonly observed in Europe. In spite of the very poor public health level of the population, an almost complete absence of histological signs of HPV infection in the neoplastic tissue should be remarked.

Sixty-five couples with male infertility or unexplained infertility or infertility due to cervical factor underwent 156 cycles of homologue intrauterine insemination. The overall pregnancy rate was 16.5% with 2.4 mean value of insemination cycles for each couple. The highest pregnancy rate was observed in cases of cervical factor infertility. The mean age of patients who had pregnancy was 30 years (overall mean value 34 years) and the mean time of sterility was 3 years (overall mean value 4.4 years).

Neoplastic myometrial invasion is an important prognostic factor in local advanced endometrial carcinoma, conditioning therapeutic choice. In 34 patients with stage I and II endometrial carcinoma, the depth of myometrial invasion was evaluated by transvaginal sonography (TVS). In comparison with pathological findings, TVS showed an overall accuracy of 82.3% with a sensitivity of 82.6% and a specificity of 81.8%. The principal error was related to the underestimation of the lesion: negative predictive value of 49.2% vs positive predictive value of 90.4%. In conclusion, TVS is an accurate imaging method for staging of local advanced endometrial carcinoma.

Although endometrial carcinoma is characterized by a precocious symptomatology, in 28.4-22.6% of cases at the time of diagnosis it is found to be at clinical stage higher than I. In the present study the diagnostic delay is related to the stage of disease. Our data suggest that diagnostic delay can cause a higher risk of advanced-stage disease; all the cases of stage III and IV disease, in fact, were diagnosed after more than 7 months. Diagnostic delay was also directly related to depth of myometrial invasion; the mean diagnostic delay was significantly shorter in patients with stage I disease and superficial myometrial invasion (3.92 vs 8.76 months) (p < 0.001). Therefore, diagnostic delay is directly related to well-established prognostic variables as well as to clinical stage and depth of myometrial invasion.

The data of three years of activity (1985-1987) at the 4th Obstetrics and Gynecology Department of the University of Milan, S. Gerardo Hospital in Monza, for a total of 5595 deliveries and 5672 new-borns are reviewed. Each case of perinatal death has been evaluated for gestational age, weight, way of delivery and preexisting or pregnancy-induced maternal diseases, trying to single out the primary causes of death. In order to compare these data with the ones of the previous three years the results have been divided, following the gestational age, in two groups (less or more and equal than 28 weeks). Late perinatal death rate (including all the babies older than 24 weeks of gestational age, still-born or live-born and dead within the 28th day of life) has been 1.8%, compared to the 2.1% in the previous 3 years. Obstetrical procedures and neonatal outcomes are analyzed in depth. Puerperium was pathological in 8.9% of patients. Only 4.2% of women decided not to breast-fed their babies.

The authors evaluated the efficacy of Goserelin, a synthetic GnRh analogue, in 15 patients affected by symptomatic uterine leiomyomata. The answer to treatment has been evaluated on clinical signs, echographically and by serial determinations of FSH, LH, 17 beta estradiol, Cortisol, total Cholesterol, HDL Cholesterol, Triglycerides, Calcemia, Hb, blood iron, MCHC. Clinical answer showed to be satisfactory, with complete subsiding of menometrorrhagia starting from the 3rd month of treatment, and not reappearing during the six months of follow-up. Ultrasound evaluation showed fibroid volume reduction of 70% at the end of the 6 months treatment, but volumes had increased up to only 22% lower than the starting ones at the end of follow-up. A better volume reduction and lesser growth during follow-up were shown for small fibroids. 17-Beta estradiol, total and HDL cholesterol shifted toward menopausal values, with a trend towards starting values during follow-up. Haemocromocytometric values showed to better even in the absence of target anti-anemic treatment, and the result showed to be kept during follow-up. The Authors conclude that such treatment can be useful in premenopausal women affected by symptomatic fibroids, when the need for treatment is likely to be limited in time.

The association between oral contraceptives (o.c.) and disease risk was reviewed on the basis of data from a network of a case-control studies conducted in northern Italy since the early 1980's on about 150 cases below age 55 with acute myocardial infarction, 150 with gallstone disease, 350 with uterine fibromyoma, 170 with endometrial cancer, 700 with benign or malignant ovarian tumours, 2000 with breast cancer, 360 with intraepithelial and 370 with invasive cervical cancer, 20 with liver cancer plus over 2000 control women admitted to hospital for acute, non hormone-related non neoplastic diseases. The relative risk (RR) of myocardial infarction was 2.1 (95% confidence interval from 0.7 to 7.1) among current o.c. users, but only 4% of women were current users. There was no association between gallstone disease, uterine fibromyoma and o.c. use. Significant protections were observed with reference to endometrial cancer and benign, borderline and malignant ovarian tumours, while the RR was above unity (RR = 1.9) for invasive cervical cancer, but not for intraepithelial cervical neoplasia. A significantly increased risk was observed for primary liver cancer, which is however extremely rare in young women. With reference to breast cancer, there was no consistent duration-risk relationship, and the RR was 0.8 for use for 5 or more years. Thus, these data provide reassuring information on the relationship between o.c. use and the risk of several important diseases in a Southern European population.

Maternal mortality attributed to anaesthesia, decreased in the last twenty years, has in inhalation of gastric contents one of its principal causes. Pregnant women are considered "high risk". In this retrospective investigation we studied 12,380 patients undergoing caesarean section in general anaesthesia between January 1977 and December 1991. During this period of obstetric activity the frequency of aspiration syndrome is 1:1,547 general anaesthesias (0.064%), being the 61.5% of all anaesthetic complications. In the 8 patients we had no maternal and neonatal mortality. Aspiration pneumonitis occurred in three patients. All patients were admitted at our recovery room for less than 5 days. The emergency procedure (8 cases) and a difficult tracheal intubation (4 cases) are the more important risk factors. In our clinical practice we used prevention in few cases (3.1%). Our results suggest the utility in obstetric anaesthesia of high doses of thiopental (5-6 mg/kg); these doses didn't change the principal neonatal parameters, while give in pregnant woman a light anaesthesia.

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.