Annali di ostetricia, ginecologia, medicina perinatale最新文献

The Authors report the results of a prospective clinical study by means of colposcopy, planimetric measurements of iodine-light areas, cytology and target biopsy on 140 women taking low-dosage oral contraceptives and 140 controls. A basal examination and a follow up control at a mean interval of 13 months (min. 6, max. 30 months) have been performed. Colposcopy has shown no qualitative changes during follow up, neither in cases nor in controls. Planimetric measurements have shown a significant reduction of Ectropion and AnTZ in cases in comparison to controls, and more NTZ both in cases and controls. Cytology has shown at follow up a higher and significant reduction of phlogosis and viral cytopathic effect in cases. The results related to CIN, although non significant because of the small case group and the relatively short follow up, appeared more favorable in cases. In conclusion, oral contraception appears not to negatively affect the uterine cervix as far as cervical cancer is concerned but possibly to be protective. Nevertheless a longer follow up and a wider case group are needed in order to reach definitive results.

Determinants of stillbirth, perinatal and infant mortality in Italy have been analyzed using information collected routinely by the Italian Central Institute of Statistics on more than 2,400,000 births and 33,000 infant deaths in the period 1980-1983. Individual records include data on maternal (for example age, education, obstetric history) and fetal (sex, birth weight, gestational week at birth) characteristics. The Italian stillbirth, perinatal and infant (1st-365th day of life) mortality rates were respectively 7.7/1000 births, 16.4/1000 births and 13.5/1000 livebirths for the considered period. Perinatal and infant mortality was impressive in very low birth weight. About 90% of livebirths weighing less than 1000g died within the first year of life, but this percentage decreased to about 45% in babies weighing 1000-1499g. As a whole, low birth weight explained more than 70% of deaths. Further, stillbirth, perinatal and infant mortality rates were higher in male babies, in older women and in higher birth rank. These findings persist, although less markedly, after adjustment for weight. Mortality rates were about 60-70% higher in less educated women. Stillbirth, perinatal and infant mortality rates were 20 to 30% higher in Southern Italy, as compared to the North of the country. This finding was not markedly changed after adjustment for birth weight and maternal age and education, suggesting that socio-economic factors are per se important determinants of perinatal and infant mortality in Italy, and explain in terms of population attributable risk, about 15% of stillbirths or deaths within the first year of life.

The Authors report the results of a controlled clinical study by means of colposcopy, cytology and target biopsy on 525 oral contraceptive (O.C.) users and 519 controls. Except for age class 31-35, more iodine dark cervices are found in cases, more iodine light (AnTZ and/or ectropion) in controls. The difference, although not statistically significant, suggests a protective role of O.C. on cervical epithelia. In 34 women (15 cases and 19 controls) CIN has been diagnosed. O.C. users show a more favorable situation, except for ages over 30 exposed to O.C. for less than 24 months. The Authors hypothesize a protective role of O.C. in younger women. While women aged 30 or more still appear protected when exposed to O.C. for more than two years (possibly from younger ages), these results suggest some caution in beginning oral contraception after the 30th year of age.

Preoperative serum CA 125 levels were measured in 61 patients with various FIGO stage endometrial adenocarcinoma and they were compared with stage of disease, grading and pelvic lymph nodes involvement. Serum CA 125 levels in excess of 35 U/ml were detected in 19 patients (31.1%): circulating levels exceeding 65 U/ml were also found in 15 patients (24.5). Rising concentrations were associated with increasing stages. Grading and lymph nodes involvement were correlated with the presence of elevated serum levels (more than 65% for grade two or three and more than 80% in patients with positive lymph nodes). Preoperative high concentrations of CA 125 suggest the presence and the probability of advanced endometrial cancer. The cases with elevated CA 125 serum levels seems to be a higher risk for extrauterine tumor progression and lymphatic space invasion: the preoperative presence of the antigen imposes an accurate intraoperative surgical staging and a careful follow-up for preventing recurrence or metastases.

The trend in frequency of multiple birth in Italy has been analyzed on the basis of the number of single and multiple births, according to age and regions, published annually by the Central Institute of Statistics. The rates and ratios of twin and triple or more pregnancy were computed for region, children sex and calendar period. Specific and standardized rates by maternal age are presented here too. Between 1955 and 1983 the frequency of multiple births declined from 12.6/1000 to 9.6/1000 deliveries. The downward trend was constant till the late 70's, when multiple pregnancy rates flattened out, being constant till the early 80's. This was largely attributable to decreasing trend in dizygotic multiple pregnancies, the monozygotic rates were generally constant over the considered period. Rates of triple births decreased slightly till the early 70's and increased in relative and absolute terms from late 70's on, thus if in the quinquennium 1955-1959 only 1 out of 99 multiple births was a triplet, this ratio increased to 1 out of 70 in 1980-1983. There was no noticeable variation in the North/South multiple birth frequency ratio, which was constantly about 0.7. Similarly the national trends were generally reproduced in various regions, the regional differences were largely attributable to differences in dizygotic multiple pregnancy rates.

87 patients treated for epithelial ovarian carcinoma between 1975 and 1986 were evaluated intensively. In all cases the original operation was followed by surgical reassessment to evaluate the result of adjuvant therapy and to study the cases without apparent disease. The actuarial survival rate after 3 years, by Kaplan-Meier calculation, demonstrated 73.5% survival in patients with negative second-look versus 32% in presence of positive reassessment (P less than 0.01). Surgical reexploration and histologic study were negative in 34 cases (39%). Original stage, histotype, histological grading, peritoneal washing and age of patients were considered for prognostic evaluation of the tumor. The absence of residual tumor (RT) at first surgery resulted in complete response after adjuvant therapy in 70.8% of women, versus 25.8% with RT greater than 2 cm (P less than 0.01). Negative second-look appears the most important prognostic factor for the evaluation of epithelial ovarian cancer (P less than 0.001).

Spontaneous abortion is the commonest complication of pregnancy. Its reported incidence appears to be constant in developed countries but the frequency of subclinical fetal loss is largely unknown. There is a well known relationship between fetal loss and advancing maternal age. Trisomic fetuses occur more commonly in older women and most are aborted but old women are also at greater risk of aborting a chromosomally normal fetus. Recent epidemiological data have demonstrated a significant association between maternal cigarette smoking and spontaneous abortion. A role of gravidity, early age at menarche, alcohol and methylxanthine consumption has been recently claimed, but epidemiological evidence is scanty and largely controversial. The present paper reviews the epidemiological data on spontaneous abortion.

A review of the history of the sexually transmitted diseases is outlined, emphasizing the pathways of their diffusion throughout the world, their impact on the sexual customs and the history of the attempts to know their etiopathogenesis before the scientific discoveries of the second half of the 19th century.

The present study describes the effects of lumbar epidural anaesthesia performed on a group of pregnant women (group A) during the period 1986-1988. The overall behavior of the women of group A is compared to that of another group of 990 women on whom no epidural anaesthesia was performed (group B). No serious hyperventilation was observed on any of the women of group A and no PO2 drop in the intervals between contractions of the uterus. Metabolic acid production of both mother and foetus was lower than that observed in group B. Comparisons of multiparas of group A to those of group B showed a higher percentage normal cardiotocographic records among the former. Newborns in group A showed better Apgar scores. No serious complications were observed among women of group A.

The prevalence of smoking in pregnancy has been analyzed in a surveillance of women delivering between February and March 1989 in a large maternity clinic in Milan, Northern Italy. Out of the 411 interviewed women, 133 (32%) were current smokers before and 71 quit smoking during pregnancy. The probability to quit smoking decreased with increasing age and was lower in less educated women; these findings were however not statistically significant. Considering persistent smokers only, the mean number of cigarettes per day decreased from 13 before pregnancy to 8 during gestation; this finding was generally consistent in various subgroups of age and education. These reduction, however, are probably overestimated, since they are based on women's report only. Thus, these findings indicate that there is still ample scope for intervention on smoking in pregnancy, particularly in older and less educated women.