Coagulation assessment in normal pregnancy: thrombelastography with citrated non activated samples.

BACKGROUND: Thrombelastography (TEG) provides an effective and convenient means of whole blood coagulation monitoring. TEG evaluates the elastic properties of whole blood and provides a global assessment of hemostatic function. Previous studies performed TEG on native blood sample, but no data are available with citrated samples in healthy pregnant women at term. The aim of this study was to investigate the effect of pregnancy on coagulation assessed by TEG and establish normal ranges of TEG values in pregnant women at term comparing them with healthy non pregnant young women. METHODS: We enrolled pregnant women at term undergoing elective cesarean section or labour induction (PREG group) and healthy non-pregnant women (CTRL group). Women with fever or inflammatory syndrome, defined as C-reactive protein (CRP) >5 mg/L and with a platelet count <150.000/mm(3) have been excluded. For each women hemochrome and standard coagulation test were assessed. At the same time we performed a thrombelastographic test with Hemoscope TEG(®) after sample recalcification without using any activator. RESULTS: One hundred thirty patients were studied, 65 for each group. There were no differences between groups regarding demographic data. Hemoglobin, platelet count, International Normalized Ratio and Activated Partial Thromboplastin Time Ratio were lower and fibrinogen was higher in PREG group. All TEG parameters resulted as being significantly different between the groups with a hypercoagulable pattern in PREG group compared to CTRL group. CONCLUSION: The main findings of this study confirm the hypercoagulability status of pregnant women at term. This coagulation pattern is well represented by thrombelastographic trace obtained by recalcified citrate blood sample.

Ultrasonographic assessment of cervix size and its correlation with female characteristics, pregnancy, BMI, and other anthropometric features.

PURPOSE: Cervical length during the first trimester of pregnancy has not been completely investigated yet. The objective of our study is to compare cervical size in the first ten gestational weeks with that of non-pregnant women, and to determine its correlation with maternal factors, including age, anthropometric features, and reproductive history. METHODS: We collected retrospective data about women who applied to the Obstetrics and Gynecology Outpatients Facility of Udine between February and June 2009, selecting both pregnant and non-pregnant women possessing a transvaginal ultrasonographic measurement of their cervix, and focusing on their age, parity, BMI, cervical, and uterine size. Data were analyzed by R (version.2.8.0), considering significant P < 0.05. RESULTS: 135 women were recruited. By multivariate linear regression, both cervical length and width result independently influenced by pregnancy status, and among non-pregnant nullipara, cervical length results to be significantly lower in women younger than 20 (P < 0.05). CONCLUSIONS: During the first ten gestational weeks, cervix results to be longer and wider than in non-pregnant women, suggesting the possible existence of early gestational, morphological, uterine, and cervical modifications. Women under the age of 20 have a significantly shorter cervix, suggesting an incomplete cervix maturity in this group of women, which may justify the higher prevalence of pre-term births in teenage pregnancies.

[The rationalization of the follow-up of hormonal replacement treatment in menopause]. / Razionalizzazione del follow-up del trattamento ormonale sostitutivo in menopausa.

BACKGROUND: Decision making about the opportunity of starting or continuing hormone replacement therapy (HRT) in menopause should rely on an overall evaluation of its risks and benefits for the women's health; the evaluation of HRT cost-benefit ratio, however, should include its possible outcomes from an economical point of view. In this view, and with the certainty that menopausal patients should be protected by proper treatments, our case series has been evaluated in order to improve the quality of our clinical schedules for both their access to HRT and the treatment follow-up. METHODS: Two groups of patients have been considered the first one consisted of 560 women observed during '97 for climacteric symptoms and candicated to begin HRT. The second one consisted of 100 women on HRT for 1 to 6 years. In the first group we considered which test and with which frequency were responsible for stopping or delay the beginning of therapy; while in the second group we evaluated the reasons for stopping treatment. RESULTS AND CONCLUSIONS: On the basis of our experience, the exams required before starting HRT seem to be the following: patient history, mammography, densitometry and endometrial sample as well as the parameters of glucose lipidic, coagulative and hepatic metabolism. Densitometry is useful in the annual follow-up only in patients with bone alterations from the beginning. The same exams seem required for the follow-up, with the exception of bone densitometry which should be performed yearly only in patients with bone demineralization.