Screening efficacy of the subcutaneous tissue width/femur length ratio for fetal macrosomia in the non-diabetic pregnancy.

BACKGROUND: Antenatal weight estimations have limited sensitivity and specificity for the detection of macrosomia. The objective of our study was to examine the screening efficacy of the subcutaneous tissue width/femur length ratio for the intrapartum detection of fetal macrosomia in a non-diabetic population at term. STUDY DESIGN: Intrapartum sonographic measurements were performed in 178 well-dated gravidas at 37-41 weeks' gestation with negative glucose tolerance screens. The biparietal diameter, femur length (FL), abdominal circumference and subcutaneous tissue width of the thigh (SCT) were determined. Subsequently, predictions for macrosomia (actual birth weights above the 90th centile) were made using varying cut-off points of the examined parameters or estimated fetal weights. RESULTS: Macrosomia occurred in 27 newborns (15.1%). The SCT/FL ratio was independent of gestational age (r = -0.017). Maternal age, gravidity, parity, gestational age and the ratio of male-to-female infants were similar in pregnancies resulting in appropriate-for-gestational-age and macrosomic infants (NS). There was no difference in the SCT/FL ratio between these groups (p = 0.067; 99% power to detect 2 standard deviation differences). Comparison of screening efficacy by the univariate z score for the area under receiver operating characteristic (ROC) curves (theta) revealed that the abdominal circumference had the best sensitivity-specificity trade-off (theta = 0.8843; p < 0.0001 for comparison with SCT/FL ROC curve), followed by weight estimations based on the Hadlock formula (theta = 0.8773; p < 0.0005), the Shepard formula (theta = 0.8606; p < 0.0001), subcutaneous tissue thickness alone (theta = 0.6872; p < 0.01) and the SCT/FL ratio (theta = 0.6303). CONCLUSIONS: We conclude that the SCT/FL ratio is a poor sonographic predictor of fetal macrosomia in the non-diabetic pregnancy and does not improve fetal weight estimations by conventional sonographic parameters.

Spatial distribution of glutathione, glutathione-related and antioxidant enzymes in cultured mouse embryos.

The present study was undertaken to evaluate the detoxifying capacity of organogenesis-stage murine concepti cultured in vitro. Investigative attention was particularly focused on the embryonic tissue distribution of cytoprotective pathways. Glutathione (GSH) status, GSH-related and antioxidant enzymes were assayed in the embryo proper (EP), visceral yolk sac (VYS) and ectoplacental cone (EC) of 29.44 +/- 1.56 (mean +/- SD) somite pairs concepti. All the tissues displayed significant and comparable concentrations of GSH, further supporting this tripeptide as critical in protection against embryotoxicants. The totality of enzymatic activities was detectable in the selected embryonic compartments. In terms of spatial distribution analysis, maximal activities were found in EC (glutathione peroxidase, glutathione reductase, superoxide dismutase and glyoxalase I and II), and VYS (glutathione transferase and catalase). These results indicate: (1) the organogenesis-stage conceptus, in addition to significant amounts of GSH, expresses constitutive activities of GSH-related and antioxidant enzymes; (2) maximal activity levels are detectable in the embryonic sites which, at the developmental stage selected for assay, serve (VYS) or are evolving to serve (EC) embryo/maternal exchange, and thus represent the primary sites of interaction with foreign compounds.

Doppler velocimetry of the uterine and fetal circulations during prostaglandin E2 cervical ripening.

The objective of the study was to investigate flow characteristics of the maternal uterine and fetal umbilical and middle cerebral arteries following intracervical administration of prostaglandin E2 (PGE2). Doppler velocimetry of uterine, umbilical and middle cerebral arteries was performed immediately before and 2 h after PGE2 administration in 28 women with uncomplicated post-term pregnancy and an unfavorable cervix. Placental position was determined in all cases. When all patients were considered jointly, regardless of placental position, the mean uterine artery resistance index (RI) values were 0.41 +/- 0.07 before and 0.48 +/- 0.13 2 h after PGE2 administration (p < 0.05). When patients with lateral placentas (n = 20) were analyzed separately, only the non-placental uterine artery showed a significant increase 2 h after PGE2 administration, whereas no significant differences were found in the placental uterine artery. No changes were observed in uterine RI values of patients with central placentas. No significant differences were observed for umbilical artery and middle cerebral artery before and after PGE2 administration. It is concluded that intracervical PGE2 administration increases uteroplacental resistance but probably does not substantially affect placental perfusion; that the umbilical circulation is not affected; and that there were no signs of redistribution of fetal blood flow.

[Efficacy of estrogen-progestin replacement therapy after bone marrow transplantation]. / Efficacia del trattamento sostitutivo con estro-progestinici in pazienti sottoposte a trapianto di midollo osseo.

Ovarian failure is a common consequence of chemotherapy and radiotherapy in women undergoing bone marrow transplantation. The longer survival in these women has raised, during the past years, the need for a better quality of life. The objective of the present study has been to evaluate perspectively the potential benefit of hormonal replacement therapy in 24 women who underwent bone marrow transplantation. The data obtained indicated that hormonal replacement therapy results effective in preventing and/or relieving the multiple manifestations of gonadal failure, including amenorrhea, hot flashes, atrophy of genital apparatus, osteoporosis and cardiovascular disease.

[Alcoholism and pregnancy]. / Alcolismo e gravidanza.

The T-ACE test, introduced by Sokol, is currently used in the screening of the pregnant women at risk for alcohol abuse. In this study, this test has been applied to a group of 150 pregnant women to verify the congruity of the methodology used, sensitivity and specificity of the test. According to the answers given by the patients in the preliminary interview, 9 patients (6%) proved at risk for alcohol abuse. At the subsequent, control, interview, the answers given were all in agreement with the data obtained with the T-ACE test. The results obtained confirmed the high sensitivity and specificity of this method. Even though the comprehension of the utilized verbalization was excellent, nevertheless the test, applied to patients of a different culture in comparison with that studied by Sokol, cannot be applied in its original form, but must be diluted within a group of questions.

Uterine myoma in pregnancy: ultrasound study.

In many cases the presence of a myomatous formation in pregnancy begins its effect in a symptomless way and is revealed only by a regular sonographic control or at the time of delivery. In other cases, however, it could represent the cause of several complications, such as increased incidence of abortion extrauterine pregnancy premature breaking of the membranes, premature delivery distocia during delivery or it could itself be the site of necrotic processes. The attitude towards this type of pathology during pregnancy has often varied. The authors report their experiences regarding 408 cases of pregnancies complicated by myoma that were followed with accurate sonographic monitoring and they evaluate the incidence of the principal complications during pregnancy at the time of delivery and the eventual influence on the fetal weight at the time of birth.

[Natural history of fetal uropathies. Experience in 40 cases]. / L'evoluzione naturale delle uropatie fetali. Esperienza su 40 casi.

Appropriate management of fetal uropathies depends on accuracy in assessing the severity of urinary tract obstruction and renal damage, and in predicting the potential for recovery after surgical correction. A review of 40 fetuses aged between 20 an 39 weeks referred to us for prenatal counseling for a suspected anomaly of the urinary tract, has been made. Reliability of our diagnostic resources has been retrospectively evaluated on the basis of clinical, ultrasonographic and radiological postnatal data. Conservative approach has been adopted in all our cases. None intrauterine surgery was attempted; pre term delivery was advised only in two cases. Our results confirm poor prognosis of fetuses with marked decrease of amniotic fluid within the 24th week of gestational age. After this date the amount of amniotic fluid alone may not be a completely reliable prognostic factor. Ultrasonographic aspect of fetal kidneys and, in some occasions, chemical analysis of fetal urines may accomplish our prenatal study and help to predict the degree of neonatal renal function and potential of survival.

Non-invasive radioisotopic evaluation of placental blood flow.

The authors have evaluated placental blood flow using a non-invasive radioisotopic approach. The procedure involves the intravenous administration of 113mIn and the technique is a modified version of a previously reported method for a non-diffusive tracer kinetics analysis. The method is presented in detail and its performance is evaluated in 17 normal and 32 pathologic pregnancies (19 intrauterine growth retarded patients; 7 patients with iso-Rh immunization; 5 patients with gestational diabetes, and 1 pregnancy with extensive fetal malformation which was not included in any group). The normal pregnancies showed a flow index of 5.34 +/- 1.64 (1 SD) units compared to the pathological pregnancies value of 2.73 +/- 0.73 (1 SD) units (p less than 0.001). The conclusions drawn are: (1) the method is very well suited to clinical evaluation of placental blood flow; (2) the evaluation of placental blood flow cannot be directly equated with fetal development as it is not its only determinant, and (3) no other independent test to evaluate the radioisotopic study in terms of accuracy exists.

[Amenorrhea in drug dependence]. / L'amenorrea nella farmacodipendenza.

Irregular menstrual cycles are fairly common in drug-addicted patients. The purpose of this research is to stablish the connection between the administration of a narcotic and the onset of amenorrhoea. After a review of the literature and aetiopathogenetic hypotheses regarding ovulatory block, 39 heroin- or morphine-addicted patients personally observed during pregnancy are studied. Even relatively low doses of narcotics can impair normal ovarian function and ovulation so there is a risk that menstrual irregularities can arise even when doses are reduced.