[Neonatal group B Streptococcus infection: an integrated approach (of clinical pathologists, gynecologists, midwives, pediatricians-neonatologists) of the functional area of Cuneo (Italy)]. / Infezione neonatale da Streptococco B: un approccio multidisciplinare integrato (di laboratoristi, ginecologi, ostetriche e pediatri-neonatologi) del Quadrante di Cuneo.

The frequency of early-onset neonatal sepsis without prophylaxis is 1-5/1.000 live births. Since year '70 the most frequent causative microorganism is the group B Streptococcus (S. agalactiae, GBS), followed by Escherichia coli. The mortality rate is now reduced to 4% due to the improvement of neonatal intensive care. In the USA, the incidence of GBS early-onset neonatal sepsis has been markedly reduced by the application of the guidelines released by the Centers for Disease Control (CDC). This strategy, however, is not effective on occurrence of late-onset neonatal group B streptococcal disease. In Italy, the application of CDC guidelines is not customary, and different, often complex, protocols of obstetrical-neonatological integrated approach are applied. The frequency of infectious risk has made the GBS a paramount problem for the neonatologist, even for the legal responsibility issues resulting from the multiplicity of possible options. To reach the best level of protection of the newborn against early-onset GBS infection, the working group of providers of prenatal, obstetric, and neonatal care of the functional area of Cuneo issued an integrated protocol, in order to perform the GBS screening with the optimal culture method suggested by CDC guidelines in the highest possible number of pregnant women, and to standardize the obstetrical and neonatal management.

[Diagnosis and treatment of intrauterine pregnancy associated with tubal pregnancy. Description of a clinical case]. / Diagnosi e trattamento di gravidanza intrauterina associata a gravidanza tubarica. Descrizione di un caso clinico.

Description of a clinical case. In the last decade we have witnessed an increase in both ectopic and twin pregnancies. These events have various causes, such as PID, tubal plastic surgery, the use of agents for the induction of ovulation and many others. The number of intra- and extra-associated pregnancies (phenomenon that was considered quite rare in the past) has also been increasing. A medical case that has come under our observation is being discussed. A woman patient arrived in our ward with typical symptomatology of threatened abortion at the 8th week of amenorrhea. The echographic test showed an intra-uterine pregnancy in regular progress associated with right latero uterine tumefaction. The Douglas cavum was full of liquid of probable hematic nature. The promptly performed laparoscopy confirmed the suspicion of intra and extra uterine associated pregnancy. The consequent right adnexectomy through laparotomy led to the solution of the case.

Early prenatal sonographic diagnosis of neuropathic arthrogryposis multiplex congenita with osseous heterotopia.

A prenatal diagnosis of arthrogryposis multiplex congenita (AMC) has been carried out on a 19-week-old fetus by means of echography. The ultrasonographic characteristics were unnatural position of the four limbs associated with articular anomalies together with absence of active fetal movements. A therapeutic interruption of pregnancy was performed and the diagnosis was confirmed. At autopsy, architectural disorder of the motor neurons of the anterior medullary horn revealed a neuropathic pathogenesis of the arthrogryposis. Moreover, at the lumbar level the spinal cord was progressively replaced by heterotopic bony tissue which caused a more severe deformity of the lower limbs compared with the upper. The aspects of anatomo-pathological, genetic, and differential diagnosis are discussed showing the precocity of the prenatal diagnosis and the peculiarity of the aetiology of our case.

[Echographic examinations in 246 cases of voluntary interruption of pregnancy]. / Indagine ecografica in 246 casi di I.V.G.

PIP: 246 women underwent legal induced abortion between June 1978 and December 1979 at the Hospital "SS. Annunziata" in Savigliano, Italy. Echography was used prior to the operation to determine exactly the duration of pregnancy and to gather indications on the intervention and on its possible difficulties. 4% of patients were 18 years of age, and 14% were 24 years of age. 67% came from other provinces, 53% were housewives, 77% were married, and 41% had elementary school education. Only 15.8% had been referred by private physicians. Reasons for requesting abortion were family reasons (56.5%), social reasons (16.6%) and economic reasons (11.3%); only 1.2% of requests were for fear of fetal malformations. 25.8% of abortions were done at the 10th week of gestation; 24.8% of women were nulliparous and, of these, 11.4% had had a previous abortion; 57.7% were multiparous, and, of these, 28.8% had had a previous abortion. 91% of operations were done through vacuum aspiration and 7.5% by aspiration and curettage. Echographic exploration prior to the operation revealed 2 phases of rapid growth of the fetus, up to the 8th week and from the 10th to the 13th week.^ieng