Annali di ostetricia, ginecologia, medicina perinatale最新文献

During the last 20 years studies about sexual transmitted diseases have introduced decisive changes in the knowledge of both their pathogenesis and pathology and their clinical treatment. Only nowadays the psychological aspects of the diseases have been taken into consideration. Our research studied particularly the life style of women affected by florid condylomatosis. In this regard we developed a questionnaire with both open and closed answers and we handed it out to a group of women affected by HPV and to an unaffected control group. We took into account different parameters, in order to outline the profile of personality, the life style, in Adlerian terms, of the women affected by HPV. Looking at the result of our research we can state that the female group affected by flourishing condylomatosis does not show relevant differences with the controls as to the economical, social and cultural parameters, the sexual habits and behaviour. Whereas the results show a particular, conscious and unconscious conflict, which expresses itself by means of contradictory interrelational behaviour and reactions.

The construction of referral curves for the computerized ctg parameters may increase the clinical efficacy of the examinations in tracings of unfavourable interpretation. With the help of "System 8000" software, the longitudinal variation of computerized parameters fetal movements/hour, fetal movements in high and low variability, accelerations, length of high and low variability periods, mean range and value of short variability have been analyzed in a group of 12 low risk patients followed biweekly from the 24-26th week of gestation through term. While accelerations, minutes of low and high variability showed an absence of significative variation during pregnancy (F = 1.78; F = 9.3, F = 4.5 P = n.s.), significant (p less than 0.001) variation showed the other parameters. Number of movements/h and movements in high variability had an increase from 24-26 weeks to 32-34 weeks and a progressive further decrease till term; movements in low variability disappear after 32-34 weeks of gestation; mean range and short variability increase until 34 weeks and remained stable till end. Therefore the results obtained are in use for the high risk fetuses that perform a computerized ctg registration: nevertheless, the longitudinal evaluation reveals the maturation of fetal central nervous control on heart rate and fetal movements after the 34-36th weeks of gestation as a shown from behavioural states evaluation.

Platelet count and parameters (mean volume, MPV; volume distribution width, PDW; percent of large elements, PLCR) were examined at the third trimester, at delivery, at days 1 and 4 puerperium, in 9 primigravidae with idiopathic thrombocytopenia and 11 with pregnancy-induced hypertension (PIH) with associated thrombocytopenia, and compared with those from 27 PIH and 22 normotensive, normothrombocytemic primigravidae. All hypertensive women were treated with nifedipine alone or associated to methyldopa, clonidine or labetalol. Platelet count tends to a progressive fall during normal pregnancy, and to rough rise in puerperium, the remaining parameters being unchanged. In idiopathic thrombocytopenia the reduced count remains unchanged even in puerperium, and the increased MPV and PLCR are consistent with the presence of large, immature, circulating elements, in pregnancy as well as in puerperium. When thrombocytopenia is associated to PIH, puerperal recovery is maximum. In this case, the drop in MPV and PLCR is consistent with the resolution of microaggregates that may produce artifact in the evaluation of platelet parameters. The presence of platelet microaggregates may therefore cause overestimation of thrombocytopenia associated to PIH.

In 156 patients with gynecologic neoplasia the sieric levels of tumor markers (CA 125, CA 15-3, CA 72.4, SCC and 90 K) before the primary treatment and during the follow-up have been evaluated. In the patients with ovarian cancer elevated levels of CA 125 (80%), CA 72.4 (62%), 90 K (49%) and CA 15-3 (16.6) were found. The integrated evaluation of CA 125 and 90 K sieric levels was positive in the 86% of cases. The evaluation of CA 125 in combination with 90 K seems to facilitate the earlier detection of ovarian cancer recurrences. Elevated levels of SCC (89%) were found in the patients with cervical cancer. In the patients with endometrial or vulvar cancer the evaluation of these tumor markers was not significant.

The authors describe their experience in telephonic transmission of cardiographic recordings. With a Corometrics 116 and 410 unit installed in a remote facility, 61 CTG recordings were tele transmitted and received by a Toshiba personal computer. The comparison between original and transmitted CTG record was excellent and a very low percentage of signal loss during transmission (3.2%). The advantages of telephone transmission of CTG in peripheral areas are stressed.

Conization is frequently used as a diagnostic and curative method for the prevention of the cervical cancer on women of the fertile age. Conization was performed on 408 women up to 40 years in our Clinics during the years 1967 to 1989. The percentage of attested postoperative pregnancies among these women amounts to 13.51% and declines with age; it is high among women up to 25 years of age (29%) and low (3%) among women between 36 and 40 years. The percentage with premature births before the operation was 15.25%; after the operation the percentage declined to 13.31%. Preventive cerclage was used on one part (8.1%) of the latter percentage and no cerclage on the remaining 5.4%. It is concluded that there is not high danger of premature birth after conization and therefore performance of the operation does not seem to necessitate preventive cerclage.

The Italian standards of birth weight have been computed using information routinely collected by the Italian Central Institute of Statistics on about 1,200,000 births in the period 1984-1985. Individual records include data on birth weight and main fetal and maternal characteristics and delivery modalities. The crude and smoothed 5th, 10th, 50th, 90th and 95th centiles of weight at birth as function of gestational age according to sex, type of birth, maternal age and parity are presented. Centiles of weight at birth were higher (about 5%) in males than in females in all gestational ages: for example the 50th centile of weight at 40 weeks gestation was 3479 g in males and 3332 g in females. Between the 28th and the 32nd week the 50th centile of birth weight for multiple births grew at a rate similar to that of singletons; but beyond 32 weeks the weight growth in multiple birth was markedly lower than in singleton ones, the median multiple birth weight reaching the 10th centile of singleton at 38 weeks. The values of centiles increased with parity in both sexes and all gestational ages. The difference was however limited: for example with reference to the 50th centile the value for births in women reporting three or more births was about 5% higher than in those reporting no previous birth. Likewise, centiles of weight were higher in older women, but the difference tended to disappear after 36 weeks gestation. This analysis shows from a large national data-set standards of weight at birth from a Southern European population, providing to obstetrics and perinatologists curves of fetal growth more directly representative of the population under their care.

The problem of warts' therapy is of great interest for the diffusion of this pathology, for its high rate of recurrence and for its relation to CIN. So we evaluated the efficacy of different therapeutic methods for vulvar condylomata, used in 254 patients treated in our center from January '86 to July '90. 55 women underwent hot cautery, 31 laser-therapy, 42 excisional biopsy, 62 were treated with alpha interferon, 11 with beta interferon, 13 with thymopentin in association with electro-cautery or laser and in 40 cases no treatment was performed. The follow up, from 6 to 36 months, showed a remission of 88.1% in excisional biopsy, of 77.4% in laser-therapy, of 70.9% in electro-cautery, of 45.4% in beta interferon, of 45.2% in alpha interferon, of 76.9% in thymopentin and of 65% in the not treated group. No one therapy yielded optimal results, although surgical methods appeared to allow complete removal of the wart lesion with one application only, and to be better accepted by the patients because of the psychologic benefit of immediate remission notwithstanding the possibility of recurrencies. The results of the studied medical therapies appeared scanty. We conclude that, being the tissues around florid lesion purely affected by HPV, medical therapy needs further research in the hope of a more radical treatment.

From January 1st, 1984 to December 31st, 1988 67 cases of cholestasis during pregnancy (frequency rate 0.7%) have been reviewed. In the 79% of the cases cholestasis arose after the 32nd week. Preterm deliveries were 19.5% and cesarean sections were 19.4%. Perinatal mortality was 30%. Pregnancy complicated by cholestasis is a high risk problem in obstetrics. An attempt to show a clinical management is exposed.

The authors describe a case of near-term pregnancy in a bicornuate uterus, discussing the differential diagnosis with the amniotic band syndrome and amnio-chorionic separation and discussing the distinctive characteristics of each of them.