Prediction of persistent occiput posterior position by sonographic assessment of fetal head attitude at start of second stage of labor: prospective study.

OBJECTIVES: To evaluate the relationship between the attitude of the fetal head quantified by means of the chin-to-chest angle (CCA) in fetuses in occiput posterior (OP) position at the beginning of the second stage of labor, and persistent OP position at birth. METHODS: This was a single-center, prospective observational study conducted at the University Hospital of Parma, Parma, Italy. We included singleton pregnancies at term with fetuses in the OP position at the beginning of the second stage of labor. The fetal head position, station by means of angle of progression and head-to-perineum distance, and attitude by means of CCA were assessed using transabdominal or transperineal ultrasound. The primary outcome was persistent OP position at birth. RESULTS: Between January and July 2022, 76 women were included in the study. There were 48 (63.2%) spontaneous rotations of the fetal head and spontaneous vaginal delivery occurred in all. Among the 28 (36.8%) fetuses that did not rotate spontaneously into an occiput anterior position, eight (28.6%) had a spontaneous vaginal delivery, while operative vaginal delivery and Cesarean delivery was performed in 11 (39.3%) and nine (32.1%) cases, respectively. Multivariable logistic regression analysis showed that the CCA (adjusted odds ratio (aOR), 2.15 (95% CI, 1.22-3.78); P = 0.008) and nulliparity (aOR, 0.20 (95% CI, 0.06-0.76); P = 0.02) were associated independently with persistent OP position at birth. Moreover, the CCA showed an area under the receiver-operating-characteristics curve of 0.69 (95% CI, 0.56-0.82); P = 0.005) for the prediction of persistent OP position. The optimal cut-off value of the CCA was 36.5°, and was associated with a sensitivity of 0.82 (95% CI, 0.63-0.94), specificity of 0.50 (95% CI, 0.35-0.65), positive predictive value of 0.49 (95% CI, 0.34-0.64), negative predictive value of 0.83 (95% CI, 0.64-0.94), positive likelihood ratio of 1.64 (95% CI, 1.18-2.29) and negative likelihood ratio of 0.36 (95% CI, 0.15-0.83). CONCLUSIONS: Our data show that, within a population of women with fetal OP position at the beginning of the second stage of labor, the sonographic fetal head attitude measured by means of the CCA might help in the identification of fetuses at risk of persistent OP position. Such findings can be useful for patient counseling when OP position is diagnosed at full cervical dilatation. Further studies should investigate if the CCA might select patients who may benefit from manual rotation of the fetal head. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Mode of delivery and peripartum outcome in women with heart disease according to the ESC guidelines: an Italian multicenter study.

INTRODUCTION: The European Society of Cardiology (ESC) guidelines (GL) provide indications on the mode of delivery in women with heart disease. However available data suggests that the rate of Cesarean Delivery (CD) is high and widely variable among such patients. In this study, we aimed to investigate the degree of adherence to the ESC recommendations among women delivering in four tertiary maternity services in Italy and how this affects the maternal and neonatal outcomes. MATERIAL AND METHODS: Retrospective multicenter cohort study including pregnant women with heart disease who gave birth between January 2014 and July 2020. Composite adverse maternal outcome (CAM) was defined by the occurrence of one or more of the following: major postpartum hemorrhage, thrombo-embolic or ischemic event, de novo arrhythmia, heart failure, endocarditis, aortic dissection, need for re-surgery, sepsis, maternal death. Composite Adverse Neonatal outcome (CAN) was defined as cord arterial pH <7.00, APGAR <7 at 5 min, admission to the intensive care unit, and neonatal death. We compared the incidence of CAM and CAN between the cases with planned delivery in accordance (group "ESC consistent") or in disagreement (group "ESC not consistent") with the ESC GL. RESULTS: Overall, 175 women and 181 liveborn were included. A higher frequency of CAN was found when delivery was not planned accordingly to the ESC guidelines [("ESC consistent" 9/124 (7.2%) vs "ESC not consistent" 13/57 (22.8%) p = 0.002 OR 3.74 (CI 95% 1.49-9.74) , while the occurrence of CAM was comparable between the two groups. At logistic regression analysis, the gestational age at delivery was the only parameter independently associated with the occurrence of CAN (p = 0.006). CONCLUSION: Among pregnant women with heart disease, deviating from the ESC guidelines scheduling cesarean delivery does not seem to improve maternal outcomes and it is associated with worse perinatal outcomes, mainly due to lower gestational age at birth.

Epidural analgesia and the risk of operative delivery among women at term: A propensity score matched study.

OBJECTIVE: To investigate the correlation between epidural analgesia (EA) administered during labour and the risk of requiring an operative delivery (caesarean section or operative vaginal delivery). METHODS: This was a retrospective, multicentric cohort study. All singleton births of viable foetuses in cephalic presentation with a gestational age ≥ 37 weeks delivered between 2016 and2019 were included. A propensity score (PS) matching analysis was used to obtain comparable groups, balancing the maternal and pregnancy characteristics that required epidural analgesia during labour. The risk of operative delivery in women with and without epidural analgesia was estimated following PS-matching analysis (1:1 ratio). RESULTS: As per the unmatched analysis, the occurrence of Caesarean section (CS) was significantly higher in women administered EA compared with the non-EA group (14.0 % vs 5.0 %; p < 0.001). The incidence of operative vaginal delivery (OVD) (9.1 % vs 4.0 %; p < 0.001) showed a similar pattern. The PS algorithm matched 16.301 cases who were administered EA with 16.301 cases not administered EA and found a significantly increased risk of CS (OR, 1.6; 95 %CI 1.5-1.7) and OVD (OR, 1.2; 95 % CI 1.1-1.2) in the former group. CONCLUSION: The risk of operative delivery almost halved in the EA group compared with the non-EA group, compared with the baseline risk of the unmatched subjects.

Interleukin-6 and insulin-like growth factor system relationships and differences in the human placenta and fetus from the 35th week of gestation.

The integrity of the insulin-like growth factor (IGF) system is essential for normal fetal growth. Cytokine and IGF-IGFBP relationships have been shown in specific tissues, but it is unknown whether these occur in the placenta. We aimed to assess possible differences in the IGF system depending on gestational age (GA) from week 35 to 40, and to study relationships of IL-6 with components of the IGF system in the placenta and newborn infant. We followed 32 normal births and collected whole villous tissue and cord serum. Total RNA was extracted from the placenta samples, reverse transcribed and then real-time quantitative (TaqMan) RT-PCR was performed to quantify cDNA for IGF-I, IGF-II, IGFBP-1, IGFBP-2 and IL-6. The corresponding proteins were assayed in placenta lysates and cord serum using specific commercial kits. Two groups of subjects (Group 1, 35-37 weeks GA, N=12 and Group 2, 38-40 weeks GA, N=20) were studied. In placenta, IGF-I mRNA was more abundant than IGF-II mRNA at all times and together with IGFBP-1mRNA were less expressed at term. IGFBP-2 and IL-6 mRNAs were higher after week 37 GA. IL-6 and IGFBP-2 gene expression were closely related. The corresponding proteins showed similar differences to the genes but IGF-I was undetectable in the lysates, whereas IGF-II was abundant. IGFBP-2 concentrations were very high and greater than those of IGFBP-1. In the newborn, no difference was seen in any cord serum protein after week 35 GA. IGFBP-1 was negatively correlated with parameters of neonatal size. In conclusion, this study reports new insights into IL-6, IGF-IGFBP relationships within the human placenta and shows the importance of comparing subjects with the same GA.

Very-early-onset discordant growth in monochorionic twin pregnancy.

BACKGROUND: The significance of growth restriction in the first trimester in karyotypically normal fetuses is uncertain. CASE: We report a case of diamniotic monochorionic twin pregnancy with marked growth discordance noted in the first trimester. No major congenital or karyotype abnormalities or ongoing evidence of twin-twin transfusion syndrome were found during gestation. Birth weight discordance in the twins was 49.5%. Histologic examination revealed immature villi, with a shortage of terminal villi and an abundance of intermediate mature villi, as well as hypoxic areas with altered villi in the part of the placenta supplying the smaller twin. CONCLUSION: The causes underlying discordant growth in karyotypically normal twin pregnancies without evidence of twin-twin transfusion syndrome are not entirely clear. There may be other conditions responsible for discordant growth that occur in the first or early second trimester of pregnancy.

Doppler velocimetry and thrombophilic screening at middle trimester of gestation: preliminary data.

OBJECTIVE: To establish whether asymptomatic normotensive pregnant women with an abnormal uterine Doppler velocimetry, have haematological changes characteristic of congenital or acquired thrombophilia, and whether this information improve predict in pregnancy complications. STUDY DESIGN: A prospective study involved the enrolment of 30 healthy normotensive pregnant women between the 23rd and 27th week of gestation, subdivided into group A (normal uterine Doppler velocimetry) and group B (abnormal uterine Doppler velocimetry). Besides uterine velocimetry (resistence index and presence/absence of notch), at enrolment in the study the PI of the umbilical artery and of the middle cerebral artery were measured, in addition to the usual foetal biometric parameters (biparietal diameter and abdominal circumference). Contemporaneously, a 20 ml blood sample was taken for the dosage of protein C, protein S, antithrombin III, activated protein C resistance, antiphospholipid antibodies and platelet functionality. Subsequently, for all the remaining period of the pregnancy, data were collected relating to the onset of any materno-foetal complications and modality of delivery, as well as neonatal data up to the first 20 days of life. RESULTS: The incidence of adverse perinatal outcomes (pre-eclampsia, gestational hypertension, abruptio placentae, endouterine foetal death, preterm birth, caesarean section because of maternal or foetal problems, APGAR score lower than 7 at the 5th minute of life, small for gestational age) resulted as being 75% in group B versus 11% in group A (P<0.001). The mean gestational age at delivery was 34 weeks (range 27-41) in group A versus 39 weeks (range 37-42) in group B (P<0.001). No difference emerged as to either the mean activity in the plasma levels of the coagulation protein studied in patients with normal and abnormal uterine velocimetry. The same consideration is also true if the population is analysed in relation to the lesser or greater seriousness of the Doppler velocimetry abnormalities. Subdividing the patients in relation to the absence and to the presence of unfavourable perinatal outcomes, the thrombophilic indices appear to be substantially comparable. CONCLUSION: Uterine Doppler velocimetry, carried out between the 24th and the 26th week of pregnancy, proves its validity by identifying a population at high risk of adverse perinatal outcomes. In contrast, the investigations carried out on the haematological abnormalities characteristic of thrombophilia do not reveal any significant differences, either between patients with normal and those with abnormal velocimetry, or between patients with adverse perinatal outcomes and those without. It is thus unlikely that these preliminary data will lead to an improvement in the clinical reliability of uterine velocimetry.

Antepartum amnioinfusion: a review.

OBJECTIVE: Antepartum amnioinfusion is a relatively recent procedure introduced with fetal medicine techniques. It is usually indicated for severe oligohydramnios in order to avoid the related complications such as pulmonary hypoplasia, the deforming effects of oligohydramnios, variable fetal heart rate decelerations and intraventricular hemorrhage. Antepartum amnioinfusion is also employed to improve ultrasound visualization in cases with oligohydramnios. Our objective was to evaluate the benefits and complications related to this procedure which is still less commonly used compared to intrapartum amnioinfusion, and whose risks are therefore not well established. STUDY DESIGN: Reports of study designs identified from searches of MEDLINE, PUBMED, the Cochrane Collaboration, specialized databases and bibliographies of review articles were identified. Studies in women who underwent amnioinfusion between 1987 and 2002 were included. RESULTS AND CONCLUSIONS: Amnioinfusion seems to offer several benefits, in terms of both prenatal diagnosis and favorable perinatal outcome. Most clinical experiences report that amnioinfusion is safe, both for the mother and for the fetus. However, randomized control-group studies subdivided on the basis of the cause of oligohydramnios (e.g. premature rupture of membranes, fetal growth restriction, obstructive uropathy and renal agenesis) could help to determine the advantages and risks linked to this procedure. Prospective randomized studies should therefore be encouraged, to clarify any possible doubts regarding the procedure, before it can be introduced into routine practice in the management of oligohydramnios.

Transabdominal antepartum amnioinfusion.

OBJECTIVES: The purpose of our study was to evaluate whether transabdominal antepartum amnioinfusion is associated with maternal complications during pregnancy and at childbirth. METHODS: Fifty-three pregnant women, hospitalized for oligohydramnios and submitted to transabdominal antepartum amnioinfusion between 16 and 34 weeks' gestational age, were compared with a historic group of 42 pregnant women treated conservatively. RESULTS: The study population was divided into two groups of women with ruptured and unruptured membranes (Groups A and B, respectively). The latency period between time of admission and term of pregnancy was more favorable in amnioinfused patients (Group A: 22 vs. 11 days; Group B: 30 vs. 9 days), and none of the maternal adverse events under study was significantly more common in amnioinfused patients. By contrast, maternal temperature over 38 degrees C was more frequent among controls than among amnioinfused patients with ruptured membranes (23% vs. 4%); so was the number of cesarean sections for fetal distress in Group B (50 vs. 11%). CONCLUSIONS: Antepartum amnioinfusion does not appear to induce greater complications than conservative treatment for oligohydramnios, with or without premature rupture of membranes. On the contrary, this procedure seems to offer several benefits to pregnant women.

[Sonographic characterization, Doppler ultrasonography and tumor markers in the diagnosis of malignancy of ovarian masses]. / Ecostructtura, eco Doppler e markers tumorali nella diagnosi di malignità delle masse ovariche.

BACKGROUND: The study analyses the diagnostic possibilities regarding ovarian neoplasms offered by different clinical approaches: B-mode morphological ultrasonographic examination, colour Doppler and Doppler pulsed ultrasonography, and lastly the assay of a number of tumour markers. METHODS: A prospective study was carried out in 125 selected patients attending the Ultrasonography unit of the Obstetrics and Gynecology Clinic at Parma University between June 1997 and June 1999 who presented an adnexal mass . All patients underwent transvaginal ultrasonography (multifrequency vaginal probe 5.0-6.5 MHz, Esaote Idea, Genova) to characterise the mass, applying 5 different ultrasonographic scores: Granberg, Sassone, Di Priest, Lerner, Ferrazzi. Colour Doppler imaging was then performed to analyse the vascularisation of the mass, also using pulsed Doppler to study a number of velocimetric parameters: pulsatility index, index of resistance, systolic and diastolic peak velocity, mean velocity. All the patients underwent surgery using laparotomy or video laparoscopy, accompanied by histological analysis. A number of different tumour markers were assayed prior to surgery: Cal25, CA19-9, CEA, beta-HCG, alpha-fetoprotein. RESULTS: Out of 127 pelvic masses examined, histological analysis showed that 19 were malignant and 108 benign. The diagnostic accuracy of malignancy was comparable for the 5 scores studied, with a minimum of 57.48% for Lerner and a maximum of 77.16% for Di Priest. The central importance of vascularisation was the only significant parameter among those analysed using colour Doppler which was useful for the diagnosis of a malignant neoplasm, with a diagnostic accuracy of 82.95%. No indicator obtained using pulsed Doppler was useful for diagnostic purposes. CA125 was the only tumour marker that revealed a statistically significant difference emerged between the benign (21.6 U/ml) and malignant (220.8 U/ml) masses. Its diagnostic accuracy was 75.58%. CONCLUSIONS: This study confirmed that the three methods analysed do not differentiate substantially in their overall diagnostic capacity of malignant ovarian neoplasms. The best performances for ecographic scores (Di Priest) did not exceed a sensitivity of 89.47% with a 21.25% incidence of false positives; this was comparable to CA125 with a sensitivity of 85.71% and false positives in 22.09%. In relation to the central importance of vascularisation, colour Doppler achieved a lower sensitivity (55.55%), but this was confirmed by a low incidence of false positives (7.95%). This revealed its importance as a useful method, especially for excluding the presence of malignant tumours.

Doppler velocimetry and non stress test in severe fetal growth restriction.

OBJECTIVE: The aim of our study was to evaluate the efficacy of Doppler velocimetry and cardiotocography in surveillance of the fetus affected by severe fetal growth retardation (FGR) and hence their capacity in predicting adverse perinatal outcome. This could therefore permit the timing of delivery thus reducing perinatal morbidity and mortality. METHODS: 53 women with high risk pregnancies, all suffering from various pathologies such as gestational hypertension, preeclampsia, HELLP syndrome, Antithrombin III deficit, and in whom FGR (fetal abdominal circumference < 2.5th percentile for gestational age) diagnosed between the 24th and 35th week of gestational age, were retrospectively enrolled in the study. Doppler velocimetry was carried out on the main vascular districts - both arterial [umbilical artery (UA), middle cerebral artery (MCA), aorta (Ao) and uterine artery] and venous [umbilical vein (UV), ductus venosus (DV), inferior vena cava (IVC)]. Also evaluated was the amniotic fluid index (AFI). Daily non stress tests (NST) were conducted at least thrice a day for an overall period of not shorter than 60 min. Also considered were the methods of delivery and the perinatal outcome, e.g. gestational age at birth, perinatal mortality, incidence resuscitation, etc. RESULTS: The 53 patients studied were subdivided into three groups on the basis of the initial velocimetric exam of the umbilical and uterine arteries. Group A was comprised of those with altered waveforms of the UA, Group B those with altered waveforms on the uterine artery while Group C contained those with altered waveforms both of the UA and uterine artery. The period of study for group C was on average six days (p < 0.05) while for groups A and B they were on average 10 and 22 days, respectively. Group C also presented higher incidences of altered waveforms in the venous compartment, i.e. absent or reversed end diastole (ARDEF) was observed in 89% of the cases versus 0% and 7.6% observed in Group A and B, respectively. Altered waveforms in the DV and pulsations in the UV were both observed in Group C while the same was not observed in either group A or B. The NST did not show any substantial difference between the groups - only as the appearance of decelerations present in over half the cases in all groups at the end of the study. Group C also presented higher incidences in adverse perinatal outcome as compared to groups A and B such as as low birth weight (868 g vs 1,324 g & 1,397 g, p < 0.001), neonatal resuscitation (52.6% vs 0% & 7.6% p = 0.001), longer periods of admission to neonatal intensive care unit (67 days vs 32 & 33 p < 0.001) and perinatal mortality (36% vs 0 & 0, p < 0.05). The velocimetric indices which appear to better predict perinatal mortality are those related to the venous compartment giving a diagnostic accuracy of 92.8% (KI > 0.75) in case of pulsations in the UV, 86.6% (KI > 0.75) with alterations on the DV, and of 78.5% (KI > 0.40) for those on the IVC. Cardiotocography revealed to be less capable in predicting perinatal mortality giving a diagnostic accuracy of 66.6% (KI > 0.40) with a non reactive, non variable NST. CONCLUSION: The data presented show that velocimetric modifications in the fetal venous compartment constitute a relevant prognostic sign in the prediction of perinatal mortality and neonatal resuscitation. The further the vessels compromised are from the heart, the higher is the relative risk for perinatal mortality, equal to 5.0 (95% C.I. = 0.61-40.9) with alterations on the IVC, of 8.2 (95% CI = 1.04-61.5) when they involve the DV, and of 18.0 (95% = 2.44-133) when pulsations are obtained on the UV.

Ultrasound assessment of biometric trends in a case of thanatophoric dysplasia.

We present a case of thanatophoric dysplasia diagnosed at the 21st week of gestation. Serial ultrasound was performed throughout pregnancy. The scans showed a distinctive pattern of development of the fetal long bones. Up to week 25, the fetal long bones appeared to grow steadily but slower compared to normal measurements (4-5 SD below the mean); then, between weeks 26 and 30, long bone growth was further and more severely hampered, until it almost stopped altogether approaching term, with measurements 9-12 SD below the mean at week 38.

Oligohydramnios and fetal renal sonographic appearances related to prostaglandin synthetase inhibitors. A case report.

A case of acute neonatal renal failure in twins following tocolytic treatment with ketoprotene is described. The twins had visible signs in utero of developed anhydramniosis associated with morphological renal abnormalities on ultrasound. At birth both twins had acute renal failure with reduced creatinine and urea levels, which could only be normalized after 3 and 18 months, respectively.

[Prevention of preeclampsia with low-dose acetyl salicylic acid: critical assessment]. / Prevenzione della preeclampsia con acido acetil salicilico a basse dosi: valutazione critica.

The Authors present a critical review of the published literature about the effect of low dose of acido acetilsalicilico on prevention and treatment of preeclampic. Beginning from the effects of low daily dose of acido acetilsalicilico on the pregnancy, the Authors present the published datas from 1970 until today, and suggest the present directions for use of acido acetilsalicilico in pregnancy.

Sonographic assessment of amniotic fluid volume between 11 and 24 weeks of gestation: construction of reference intervals related to gestational age.

OBJECTIVE: At present, most of the methods for sonographic assessment of amniotic fluid volume are unreliable in the second trimester of pregnancy, or else they do not present nomograms related to gestational age. DESIGN: The aim of this prospective cross-sectional study was to construct normal reference ranges of four ultrasound parameters for the evaluation of amniotic fluid volume which could be applied in the second trimester. For these parameters we calculated normal curve limits suitable for use in clinical practice. SUBJECTS: From a population of normal pregnant women between the 12th and the 24th weeks of gestation undergoing a routine ultrasound examination during 1997 at our institute, 273 were found to be suitable for the study, after the exclusion of all cases which presented any feto-maternal pathology or complications up to the 24th week. METHODS: The largest 'amniotic pocket' in a vertical direction, free of small fetal parts and umbilical cord, was measured: the maximum vertical and transverse diameters were measured on the same scan; the mean diameter and the product of the two diameters were calculated. The 'mean amniotic fluid diameter', the 'two-diameter pocket', the 'largest vertical pocket' and the 'largest transverse pocket' were the four sonographic parameters considered. RESULTS: The four parameters correlated well with gestational week and with the biparietal diameter; the normal reference intervals and normal curve were then calculated. All these parameters were found to have good intra- and interoperative reproducibility. CONCLUSIONS: We conclude that the use of an ultrasound semiquantitative method based on the measurement of a single amniotic fluid pocket and involving normal reference intervals according to gestational age could improve the early diagnosis of amniotic fluid variations during the second trimester, although this has yet to be confirmed by extensive clinical trials.

[Vertical transmission of HIV infection: risk factors and prevention strategies]. / Trasmissione verticale dell'infezione da HIV: fattori di rischio e strategie di prevenzione.

In this study it has been evaluated the connection between the maternal immune status and the obstetrical factors on the one hand end the perinatal transmission of HIV in the other as well as, the effects of zidovudine prophylaxis and elective caesarean section on vertical HIV transmission. From January 1987 to September 1999, 60 HIV infected pregnant women were followed with their 64 infants. From July 1995 15 women and their respective children were treated with zidovudine prophylaxis (protocol ACTG 076); from June 1997, in 8 of these patients a systematic caesarean section was performed (7 electively and 1 on an emergent basis). The transmission rare was 20.5% among the 44 children in the group without zidovudine prophylaxis, compared with 7.1% among the 14 children in the group receiving Zidovudine. As for as the mother-child pairs receiving Zidovudine therapy, the rate of vertical transmission was 0% for the 7 mothers who underwent elective cesarean section and 14.3% for the 7 mothers with other ways of delivery. The interaction between zidovudine prophylaxis and elective caesarean section was associated with the lowest rate of vertical HIV transmission.

[Amnioinfusion: techniques, indications, and controlled retrospective study of 55 cases]. / Amnioinfusione: tecniche, indicazioni e studio retrospettivo controllato di 55 casi.

Amnioinfusion is a relatively recent procedure introduced among fetal medicine techniques. Its applications focus on two different methods: transcervical and transabdominal. The first procedure usually is carried out during "intrapartum amnioinfusion" to prevent or treat fetal heart rate (FHR) decelerations related to oligohydramnios or to dilute thick meconium staining of the amniotic fluid. The latter method used during "antepartum amnioinfusion" is usually indicated for severe oligohydramnios in order to avoid the complications related such as pulmonary hypoplasia, deforming effects of oligohydramnios, variable FHR decelerations and intraventricular hemorrhages. Antepartum amnioinfusion, also used to improve ultrasound visualisation in presence of oligohydramnios, is less employed as compared to intrapartum amnioinfusion, therefore its risks are not well established. In order to study possible adverse effects on the mother or foetus, fifty five patients affected by oligohydramnios at 17th-34th week of gestational age were submitted to antepartum amnioinfusion (1-5 procedures) and were matched retrospectively with forty seven women with the same characteristics treated with the conservative and expectant management. The trend of pregnancy was the same for both groups in relation to maternal fever > 38 degrees (10.9% in the amnioinfused group vs 17.0% in control group ns), leukocyte count > 18,000/mm3 (25.5% vs 21.3%, ns), C-reactive protein > 10 ng/ml (10.9% vs 6.4%, ns). The latency period between admission and delivery was significantly longer in the amnioinfused group than in the control one [21 (range 1-98) vs 9 days (range 0-72); p < 0.001] and the frequency of Apgar score < 7 at the 5th min was less represented in the amnioinfused group than in the control group (32.3% vs 66.6%; p < 0.001). In conclusion, it was interesting to note that antepartum amnioinfusion seems to increase the latency period between premature rupture of membranes and delivery, but it remains to clarify if this procedure is as much safe for the fetus as for the mother.

[Evaluation of the peripartum effects of 2 analgesics: meperidine and tramadol, used in labor]. / Valutazione degli effetti peripartum di due analgesici, meperidina e tramadolo, utilizzati in travaglio di parto.

The need for analgesia to overcome pain in labour is highly requested by women today. Various ways either non pharmachologic e.g. Emotional sustain, psycho-prophylactic preparation, yoga and hypnosis or pharmachologic such as epidural blockade or parenteral are used. Therefore in our study we evaluated the efficacy and tolerability of the two opioids usually used today in parenteral analgesia to reduce pain during labour: Tramadol and Meperidine. We studied two groups of patients each made up of 20 women in labour, all at term and with a physiologic course of pregnancy. 75 mg i.m. of Meperidine chloryhydrate were somministered in the first group while in the second group 100 mg i.m. of tramadol chloryhydrate were somministered. Various maternal, fetal and neonatal parameters were then monitored demonstrating--A moderate maternal analgesic effect in both drugs (evaluated through the analogic grading of pain). In the group to whom Meperidine was given, sedative effects on the mother were observed associated with respiratory depression in the newborn (the latter evaluated through the Apgar index at 1st and 5th minute of life and pH of the blood obtained at the umbilical cord. The data obtained permitted us to conclude that Tramadol in accordance to the obtained in literature gives an analogous analgesic effect, with better tolerability for the absence of collateral effects on the mother, fetus and newborn.