Preterm delivery and premature rupture of membranes after conization in 80 women. Preliminary data.

AIM: Cervical intraepithelial neoplasia is most frequently in young women in reproductive age. Cold knife conization, laser ablation, laser conization and large loop excision are conservative methods of treatment to remove the transformation zone and preserve the cervical function. Previous studies have shown conflicting results on the outcomes of pregnancy following these therapies that might increase the risk of preterm delivery. The purpose of this study was to evaluate the outcome of pregnancy after conization and its role as predictive risk factor. METHODS: A retrospective study was performed. The study group comprised 80 women who had a conization and that had a subsequent singleton pregnancy. Variables considered includes maternal excision date, surgery procedure, previous surgery treatments, time interval between excisional procedure and subsequent pregnancy; duration and week of pregnancy, mode of delivery, histological grading (no cervical intraepithelial neoplasia [CIN], CIN 1, CIN 2-3) and cone excised depth. RESULTS: In group study 45 women underwent loop electrosurgical excision procedure (LEEP) conization, 32 cold knife conization and 3 laser CO2. The authors found 11 cases of cone tissue depth<1 cm, and remaining one>1 cm. Eight preterm delivery have been reported to data: 5 between 28 and 34 weeks, 2 lower than 28 weeks and 1 between 34 and 37 weeks. CONCLUSION: In these preliminary data the percentage of preterm birth appears as 10% and in range 6-15% evaluated for women not submitted to excisional procedures.

[Intraepithelial cervical carcinoma and HIV. Prevalence, risk factors and prevention strategies]. / Carcinoma cervicale intraepiteliale ed HIV. Prevalenza, fattori di rischio e strategie di prevenzione.

BACKGROUND: The present study analyses cervical dysplastic lesions associated with HIV infection by means of cytological, colposcopic and histologic examinations, and the diagnostic accuracy of the Pap test. METHODS: Cross-sectional study. We have studied colposcopic and histologic findings of 115 HIV-positive women. In 86 patients a cytological examination was also carried out. The results were compared with those of a control group consisting of 127 HIV-negative women in pre-menopause age. RESULTS: The prevalence of cervical dysplastic lesions present at colposcopic/bioptic examination was 3.2 times greater in HIV+ women than in HIV- women (38% vs 12%, p<0.001) and that of lesions of a higher degree 7 times greater. Compared to non-HIV+ women, patients who were positive presented more severe dysplastic lesions, a higher frequency of HPV-derived lesions and inflammatory pictures. There was also a correlation between high incidence of dysplastic cervical lesions and advanced stage of immunodepression. The negative predictive value of the Pap test was higher in the seronegatives (95%) than in the seropositives (83%, p<0.01). The overall agreement between cytology and colposcopy/histology was greater in the seronegati-ves than in the seropositives (87% vs 74%, p<0.05). CONCLUSIONS: Cervical dysplastic lesions in seropositive patients are more frequent and aggressive than in HIV negatives and are related both to the degree of immunodepression and to the HPV infection. Further, the diagnostic value of the Pap test in association with HIV is reduced. These results suggest that in HIV+ patients careful combined cytological-colposcopic screening should be adopted, together with an attentive cyto-colposcopic follow-up in treated patients.

[Labor in patients previously subjected to cesarean section: maternal and fetal aspects. Review of the literature]. / Il parto nella paziente precesarizzata: aspetti materni e fetali. Rassegna bibliografica.

In the present study the authors, on the basis of the existing literature, analyse the delivery problem in previous cesarean section patient, especially about maternal mortality and morbidity. After cesarean section vaginal delivery may occur only in selected patients, with precautionary measures and continuous monitoring in labor. The maternal mortality is lower in vaginal delivery patients after cesarean section than in iterative cesarean section patients; also the post operating complications are more frequent after iterative cesarean section. Perinatal mortality is in relation to uterine rupture, perinatal morbidity to iatrogenic prematurity and neonatal respiratory adaptation.

[Current trends in the therapy of C.I.N. (cervical intraepithelial neoplasia)]. / Attuali orientamenti nella terapia delle C.I.N. (cervical intraepitelial neoplasia).

The Authors examine the epidemiological data on cervical intraepithelial neoplasia (C.I.N.) and review the various therapeutic methods available for it's treatment, paying special attention to the outpatient treatment of these precancerous portio lesions.

[Short- or long-term antibiotic prophylaxis in obstetric and gynecologic laparotomy?]. / Profilassi antibiotica a breve o a lungo termine nella laparochirurgia ostetrica e ginecologica?

This clinical trial was conducted to test the effectiveness of short-term prophylaxis (1 hour before, 8 and 16 hours after surgery) and long-term prophylaxis (8 hour a part 5 days long post-operatively) in preventing morbidity related to obstetrics and gynecological abdominal surgery. Short-term prophylaxis was always performed by cefuroxime meanwhile gynecological long-term prophylaxis was performed by ampicillin plus oxacillin and by cefuroxime in case of obstetrical surgery. The results showed that long-term prophylaxis is unnecessary and short-term prophylaxis is preferable because of decreased toxicity, a smaller hospital dispensary cost and a real prophylactic action because tha antibiotic is in the tissue before exposure to the infective agents.

Short-term versus long-term cefuroxime prophylaxis in patients undergoing emergency cesarean section.

A prospective randomized clinical trial was conducted to test the effectiveness of long-term and short-term prophylaxis with cefuroxime in preventing morbidity after cesarean section. Sixty patients who required emergency cesarean section were randomly assigned to one of three treatment groups: a control group of 20 patients receiving no prophylactic antibiotics; a group of 20 patients receiving 24 hours of cefuroxime prophylaxis (0.75 gm 30 to 60 minutes before surgery and at 8 hours and 16 hours after surgery); and a group of 20 patients receiving five days of cefuroxime prophylaxis (0.75 gm three times a day, the first dose being given postoperatively). The short-term and long-term prophylaxes were equally effective in reducing morbidity, assessed by postoperative temperatures, presence or absence of endometritis, and duration of postoperative hospital stay.

Comparative efficacy of two different regimens of antibiotic prophylaxis in total abdominal hysterectomy.

A randomized, prospective study of 44 women undergoing total abdominal hysterectomy was conducted to compare cefuroxime short-term prophylaxis and ampicillin plus oxacillin long-term prophylaxis. Cefuroxime was given peri-operatively for 1 day only, whereas the penicillins were given post-operatively for 5 days. The results showed that both regimens were equally effective in providing prophylaxis. It is suggested, therefore, that the use of antibiotics after the first day of surgery is unnecessary and short-term prophylaxis is preferable because of fewer potential disadvantages.

[Cystine aminopeptidase (CAP) in induced labour and puerperium (author's transl)]. / Comportamento della cistino-amino-peptidasi sierica nel travaglio di parto indotto ed in puerperio.

Serum cystine-animo-peptidase (CAP) is a valid test for placental function. We found it interesting following up the variations of CAP during induced labour and early puerperium; with this aim in view we determined the values of the enzyme in 33 pregnant nullipares. Six blood samples were taken from each woman. (174 determinations in all): 1) before labour; 2) at 5 cm. dilatation of the uterine neck; 3) immediately after the expulsion of fetus; 4) two hours after delivery; 5) first day of puerperium; 6) in the fourth day of puerperium. Statistical analysis -- Wilcoxon's test and rank bivalent variants analysis of Friedman (X2r) -- show that the variations of values in the first four groups are not statistically significant; values from 1th and 4th day of puerperium show a mean reduction in level of CAP which is remarkable and statistically significant.

[Cystine aminopeptidase (CAP) and intrauterine death of the fetus]. / Cistina-amino-peptidasi (C.A.P.) e morte endouterina del feto.

13 pathologic pregnancies with intrauterine fetal death, serially monitored by C.A.P. determination, were retrospectively examined. In 81,81% of the cases the last C.A.P. value determinated before fetal death is situated below the--1 of standard deviation. Furthermore 50 cases with the last C.A.P. value situated below the--1 of standard deviation were considered: in 26% of these cases subsequentely happened intrauterine fetal death.

[Cystine-amino-peptidase (C.A.P.) and D.B.P. in "at risk" pregnancy with "poor intrauterine fetale growth" (P.I.F.G.) (author's transl)]. / Cistino-amino-pepsidasi serica ed ecografia fetale ultrasonica nella gravidanza a rischio con "poor intrauterine fetal growth" (P.I.F.G.)

The normal range of serum cystine-amino-peptidase (C.A.P.) in 54 cases of uncomplicated pregnancies was established. 21 patients whose pregnancies were though to be "at risk" were serially monitored by sonar biparietal cephalometry and serum cystine-amino-peptidase determination. The results show that exists a correlation between C.A.P. and biparietal cephalometry values. Furthermore the "predictive power" towards neonatal conditions (by birth weight and Apgar score determination) was of 77,55% for the biparietal cephalometry and 76,10% for C.A.P.

[Serial determinations of serum oxytocinase and ultrasonic biparietal cephalometry in normal and high-risk pregnancies]. / Determinazioni seriate della oxitocinasi serica e della cefalometria biparietale ultrasonica nella gravidanza normale e "a rischio"

The value of sonor biparietal cephalometry and serum oxytocinase that we have obtained with weekly simultaneous determinations in 14 females with normal pregnancy and in 5 with pathological pregnancy, from 24th to 39th week, show a statical positive relation. Serum oxitocinase determination against hormonal tests of the phetoplancental function (urinary oestriol, pregnandiol, serum HCS, ecc.) give advantages: it is the easyer, faster and less espandove determination. Therefore we think that it is helpful to determin togheter serial values of sonar biparietal cephalometry and serum oxytocinase to anticipate the endouterine fetal growth retardation.