Postmaturity: how far is it a clinical entity in its own right?

In 1990 we adopted a protocol of antepartum testing for all booked pregnant patients, permitting healthy pregnancies to go beyond 42 completed weeks of gestation. This retrospective study regards 84 patients delivering after 42 completed weeks of pregnancy and a control group of 1351 patients delivering after 37 completed and before 41 completed weeks of pregnancy. Records were revised for maternal age and parity, previous obstetric history, managing and complications of the actual pregnancy, labour and mode of delivery, neonatal biometric data and outcome. Only 4 patients delivered after 43 completed weeks of gestation, while none in the series delivered later than 44 completed weeks after the beginning of the last menstrual period. The overall frequency of caesarean birth was higher, but not significantly, in study group. Average neonatal birthweight and length were significantly greater in the study group. No significant difference in neonatal outcome was observed between study and control groups in terms of perinatal mortality. Low 1' Apgar score was significantly more frequent in the study group, but a similar frequency of 5' Apgar score and need for intensive care was observed in the two groups.

An immunohistochemical study of leucocytes in human endometrium, first and third trimester basal decidua.

An immunohistochemical quantitative study of leucocyte subpopulations on fresh human endometrium and on biopsy specimens of first and third trimester basal decidua in normal (uncomplicated) pregnancies was performed. The most prominent population in endometrial and decidual stroma of basal decidua are macrophages. B cells as well as gamma/delta T cell receptor positive cells were found occasionally, scattered throughout the endometrial/decidual stroma. CD3+ cells were present in a relatively small number in the endometrium as well as in the first trimester basal decidua, but their number was elevated (doubled) in the third trimester of pregnancy. CD2+ cells showed a slight increase in first trimester basal decidua when compared with both endometrium and third trimester basal decidua. Cells with positive NKH-1 marker (CD56+) showed a significant increase in the first trimester, while in the third trimester their number diminished drastically. CD56:CD3 cell ratio increased to more than five times in first trimester basal decidua, while in the third trimester basal decidua decreased drastically. The mentioned increase of CD56+ cells in the first trimester and that of CD3+ cells at term suggests that these cells could have some specific function(s). However, it still has to be established whether the described quantitative changes of decidual leucocytes in basal decidua during pregnancy are of any importance for the mechanism(s) for the fetal allograft protection.

[Conservative treatment of tubal pregnancy with parenteral administration of methotrexate. Case contribution]. / Il trattamento conservativo della gravidanza tubarica mediante somministrazione parenterale di metotressato. Contributo casistico.

Three subjects with tubal ectopic pregnancy were treated with intravenous administration of methotrexate followed by oral administration of folinic acid. The treatment was effective in obtaining the resolution of ectopic pregnancies in all cases. Tubal patency was also preserved.

Immunohistochemical detection of terminal complement complex and S protein in normal and pre-eclamptic placentae.

Terminal complement complex and S protein were searched for in term placentae obtained from 13 women with normal pregnancy and 15 patients with moderate or severe form of pre-eclampsia. Terminal complement complex was found to localize in the fibrinoid material of the decidua of the basal plate, in the stroma of the chorionic villi and in the vessel walls, as subendothelial deposits. S protein had a quite different distribution, being detected in the syncytiotrophoblast located both in the chorionic villi and in the decidua of the basal plate (DBP) and also on the endothelial cells of fetal stem vessels. Mild deposits of C3 were found in the decidua of the basal plate and also in the stroma and on the basal membranes of the villi. Reactivity for C9 neoantigen was also observed in the cytoplasm of some cells, which were recognized to be macrophages by the presence in their cytoplasm of acid phosphatase and by their reaction with a monoclonal antibody specific for macrophages. Differences in complement deposition in normal and pre-eclamptic placentae were essentially quantitative. Possible mechanisms of complement activation are discussed.

[Subpopulations of immunocompetent cells in the placenta in normal pregnancy and in EPH gestosis]. / Subpopulacija imunokompetentnih stanica u placenti u fizioloskim trudnocama i kod EPH gestoza.

An effort of cellular element investigations in placentas of 8 physiological pregnancies and 7 EPH gestoses is performed with the aid of specific monoclonal antibodies by the indirect immunohistochemical method. The average mean of parturient ages (primiparae and pluriparae) was 24 years in EPH gestoses. By the aid of monoclonal antibodies OKT4, OKT8, OKT11, OKT6 and OKDR, Dako-macrophage, 2H4 (Coulter) murine type, immunocompetent cells were identified in the decidua, in the stroma of chorionic villi, in the intervillous space, and in the fibrinoid masses. The semiquantitative indirect method of the immunohistochemical cellular investigation was performed by the aid of optic microscopy in 20 fields per every cutting (section) of the placental tissue. The immunocompetent active cell distribution did not reveal any special difference in the frequency of placental tissues of physiogical pregnancies and EPH gestoses, but OKT11+ cells were present in the major number in gestoses (in decidua). OKT8+ and OKDR+ cells were found in a similar number in both populations, while OKT6+ were not found at all in any investigated tissue.

[Administration of uterotonic drugs at the end of the expulsion stage. Comparison of the use of oxytocin and ergometrine maleate]. / La somministrazione di farmaci uterotonici alla fine del periodo espulsivo. Confronto fra l'uso di ossitocina e quello di ergometrina maleato.

In spite of the large diffusion of uterotonic drugs some doubts persist about which preparation and which dosage are the most suitable. For such a reason a group of pregnant women, to whom ergometrine maleate was administered at the delivery of the anterior shoulder of the fetus, was compared by the authors to an analogous group formed by pregnant women to whom oxytocin was administered under the same conditions. Pregnant women not submitted to a pharmacologic control of the third stage of labour served as a control group. Each study group was thereafter divided into 2 subgroups: the former is composed by patients submitted to episiotomy and the latter by patients not submitted to this procedure. Our results have shown the usefulness of both drugs in the active management of the third stage of labour, whereas different side effects may occur.

Lyme Borrelia positive serology associated with spontaneous abortion in an endemic Italian area.

Lyme borreliosis acquired during pregnancy may be associated with stillbirth and fetal malformations. This paper reports preliminary results of a study intended to evaluate the frequency of Borrelia burgdorferi infection associated with spontaneous abortion in an endemic Italian area.

A simple local database for audit and epidemiologic studies.

The Authors, after having outlined the importance of clinical audit in order to improve the perinatal care provided and reduce management-dishomogeneity between obstetrical staff members, present a simple off-line system of computerized perinatal data collection that has proved to be the useful for audit applications and statistical epidemiological evaluations.

Objective diagnostic information and labour-delivery management homogeneity: our experience.

Since intrapartum cardiotocography was adopted as an objective diagnostic tool, we tried to evaluate if its routine use has induced more homogeneity in management between our staff members. The analysis of some simple parameters outlines how management variability between different staff members, still outweighs the supposed objectivity of the information coming from intrapartum cardiotocography.