Annali di ostetricia, ginecologia, medicina perinatale最新文献

From July 1984 to September 1987, 981 women at third trimester of pregnancy were screened for HBsAg. 26 women were identified as being HBsAg carrier. The study of HBV markers and anti-HBV antibodies was conducted on these women and their offspring to evaluate the presence of intrauterine infection, and the newborns response to passive active immunization in relationship to their markers status during pregnancy. HBsAg, HBeAg, anti-HBe and anti-HBc were assayed on the plasma drawn form the mother, on the amniotic fluid drawn by transabdominal amniocentesis and on funicolar blood samples drawn immediately after delivery. IgM anti-HBc were assayed on amniotic and funicolar samples. HBsAg, anti-Hbc and anti-Hbe were present in 42.8%, 100% and 50% of amniotic samples; whereas the percentage of the same markers in funicolar samples were 50% for HBsAg and 100% for anti-HBc and anti-HBe. In no amniotic or funicolar samples were IgM anti-HBc antibodies present. Anti-HBs, anti-HBc and anti-HBe were assayed on the newborns at 2, 16, 12, 18 months to evaluate the response to immunization. Response to passive-active immunization was protective in all newborns independently from their antigenic status during intrauterine life. Anti-HBc antibodies were cleared within 18 months from delivery, while anti-HBs got a protective title within 6 months from delivery, persisting in 88.8% of cases at 18 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Intraerythrocyte potassium was determined on samples from 198 physiologic, 88 hypertensive and 92 diabetic pregnant women. An increasing trend was observed during puerperium after the day 3, but a significant difference among the groups was not detected. These results may be due to a wider involvement of other cations (sodium, calcium) in the pathophysiology of pregnancy.

106 term pregnant patients with unfavorable local condition (B.S. less than or equal to 5) and indication to induction of labour because of mother or fetus problems, were randomized for a controlled clinical trial. 52 patients (group A) received 0.5 mg. of PGE2 in 2 ml of tylose gel intracervically. 48 patients (group B) received 3.0 mg. of PGE2 in 5 ml of tylose gel intravaginally. 6 patients were excluded because of violation of protocol. The aim of our study was to evaluate the best method of cervical ripening before a classical induction with amniotomy and oxytocin. Our results show that intracervical PGE2 gel seems to have a better effect on the ripening of the cervix than the intravaginal one if we only consider the proposition of softening success (group A 14/52; group B 6/48). If the evaluation of the effect on the cervical ripening is made according to modification of Bishop's score after gel application, the situation seems inverted because the medians values of the modifications have obtained respectively for group A and B a variation of 2.0 and 3.0 points. Moreover the intravaginal way showed a significantly higher incidence of collateral effects.

Potassium is the most represented intracellular cation. Its concentration is regulated by active and passive mechanisms: cellular capacity, diffusion, channels and active transport. The relationships among Potassium and other cell cations may be involved in the pregnancy adaptation, and in the pathogenesis of some diseases, among which hypertension and diabetes.

A controlled clinical study has been conducted on the efficacy of a topic therapy. Kanamicine sulphate daily for 6 days and altered to polidesossiribonucleotide for the following 24 days were given after cervical cauterization for ectropion with or without AnTZ. Treated patients were 148 and untreated ones were 155. Subjective and objective parameters were evaluated. Among the former only bloody discharge (more frequent among the treated patients) and ill-smelling discharge (more frequent among the untreated patients) showed significant differences. Colposcopy instead showed better (or faster) healing of the treated group, with 83.6% vs 62% iodine dark cervices at Schiller test and 87.9% vs 59.7% SCJ at the external os or inside (P less than 0.01). Also disepitelized areas or areas with frail epithelium were less common among the treated patients.

This retrospective study concerns 537 adolescent pregnant patients followed at the 1st Dep. of Obst. and Gyn. during the time period 1984-87. Preeclampsia, preterm labor and neonatal mortality were more frequent than in the general population.

A review of more then 20,000 induced abortions led to recognize a series of about 1,500 late abortions induced upon medical indication during the second trimester of pregnancy, in accordance with the 1978 italian Law. About 20% of these abortions were performed in teen-agers. Only 3.5% of these 1.500 abortions corresponded to the classic "therapeutical" motivation due to danger to the physical health of the mother. Eugenic abortions induced by ascertained fetal malformation, chromosomal abnormality or other suspected prenatal pathology, could be identified in 36.9% of cases, even if legal motivation went correlated to the mental health of the mother. In 59.6% of cases motivation was a peculiar psycho-emotional condition of mother suffering, inducing fear for her mental health. Data were analysed and correlated to a series of relevant variables. Considerations of general value regarding the prevalence of the phenomenon of rejected pregnancies, the rate of spontaneous abortions, and the lack of birth control, are based on the comparison of the results with those of the first trimester induced abortions, spontaneous abortions and natality rate recorded in the same Hospital, in the population of Milan and in the italian largest region, Lombardy. Consistently with the recognition, based on biological, medical and ethical ground, of the presence of a new human life during pregnancy, the Author stresses the need for a realistic approach to the problem also from the legal and medical point of view. In particular, the urgent need for comprehensive and efficient programs of prevention of abortion, which still remains all over the world a major challenge for society, human dignity and modern gynaecological science is emphasized.

The performance of 465 sonographically guided percutaneous umbilical blood samplings and its use in the management of diagnostic problems in the second and third trimester of pregnancy are described. The method has been employed in the prenatal assessment of 423 patients (357 procedures in the second trimester and 108 in the third trimester). Pure fetal blood was obtained in all third trimester samplings whilst in the second trimester in 4 cases (1.1%) fetal blood could not be obtained at the first procedure and in 9 cases (2.6%) contamination with maternal blood or amniotic fluid was observed. Data analysis confirm how this simple and rapid procedure offers access to the fetal circulation for diagnostic and therapeutic purposes.

Fetal risk related to cordocentesis has been analyzed on a series of 222 ultrasound-guided fetal blood samplings for prenatal diagnosis of fetal diseases during the second trimester of pregnancy. Affected and malformed fetuses were excluded. Seven intrauterine deaths (3.2%) and 2 spontaneous abortions (0.9%) were observed. These figures proved higher than those observed in non-homogeneous series which consider the second and third trimester altogether. The fetal risk was significantly correlated with gestational age (less than 18 weeks 7.6% vs greater than 18 weeks 0.7% p = .02) and duration of the procedure (greater than 10'11.4% vs = less than 10'0.9% p = .0029). The number of abdominal insertions resulted in different death rates (greater than 1 ins. = 6.5% vs 1 ins. = 1.4%). It is likely that different developmental, anatomical and neurovegetative mechanism play a significant role in the risk rate found in the second trimester cordocentesis. These findings and the specific risk factors observed within the different technical conditions reported, must be taken into consideration for prenatal counseling.

The reproducibility degree in echographic biometry of uterus, studied by three diameters (longitudinal, transverse and antero-posterior), is mainly influenced by the anatomic characteristics of the structures. Starting from this observation a study about if and how much the understanding difficulties can influence differently the evaluation by four operators has been performed. Data, obtained from ten women, have been elaborated for appraising precision and accuracy of the four operators. Results show an almost univocal interpretation of the images and also that the data inhomogeneity in the less reproducible diameters valuation is caused by real difficulty in the interpretation of the pictures.