Behaviour of lab parameters and neonatal weight loss in relation to neonatal breathing movements and cord clamping time.

BACKGROUND: To date, delaying cord clamping two to three minutes after birth is considered effective for newborn well-being. This time does not consider the newborn's breathing movements, which may also condition neonate well-being. AIM: To investigate the behaviour of neonatal weight loss and of some umbilical vein lab parameters, in relation to timing of newborn breathing and cord clamping. MATERIALS AND METHODS: Time from birth to cord clamping and time from birth to first cry of the newborn were collected in 87 full-term healthy women. First cry is a sign of effective breathing. Birth weight loss at the first, second, and third day from birth and lab parameters were assessed in relation to: time from birth to cord clamping, time from birth to first cry, and cord clamping before or after the first cry. RESULTS: Partial pressure of carbon dioxide (pCO2) decreased if cord clamping was performed after first cry and increased if first cry occurred after cord clamping, independently from the time elapsed from birth to first cry (p = 0.012). Calcium (Ca(2+)) concentration decreased if cord clamping was performed after the first cry and increased if first cry of the baby after birth was delayed (p = 0.021). Each second of delay from birth to cord clamping resulted in an increase in Cl- concentration (p <0.001). Each second of delay in cord clamping resulted in a reduction in the percentage of weight loss at the first day (p = 0.024), at the second day (p = 0.007), and at the third day (p = 0.028) after birth. CONCLUSIONS: Neonate breathing after birth should induce umbilical vein flow from placenta to lungs, conditioning the reduction of birth weight loss after birth and umbilical lab parameters modifications.

[Controlled release vaginal dinoprostone for the induction of labour]. / Induzione del travaglio di parto con dinoprostone vaginale a rilascio controllato.

AIM: To study the efficacy and safety of controlled release dinoprostone (PGE2) for the induction of labour. METHODS: From March 2001 to August 2002, a total of 173 patients hospitalized for postdate pregnancy, maternal hypertension, intrauterine delayed growth, reduction of amniotic fluid, were studied. In 33 of these patients, a hydrogel strip containing 10 mg dinoprostone, inserted into the posterior fornix of the vagina and release PGE2 at constant rate of 0.3-0.4 mg/h was used. RESULTS: Indications for induction, mode and time of delivery, maternal, fetal and neonatal parameters anomalies are evaluated. In 23 patients dinoprostone was used for postdate pregnancy, in 4 for maternal hypertension, in 4 for oligohydramnios and in 2 for intrauterine delayed growth. In 2 cases, the vaginal insert was removed for hyperstimulation in 1 case and for abnormal fetal heart rate in the other case. After vaginal delivery, Apgar scores and umbilical artery pH values were evaluated without anomalies. Vaginal delivery within 24 hours occurred in 51.6% of patients and medium time to delivery was 17.5 (nulliparous) and 12.3 (multiparous) hours. Only one case of uterine hyperstimulation to PGE2 was recorded, and the induction was suspended. The cesarean section rate was 12% and vaginal delivery after 24 hours was 38.7%. CONCLUSION: The continuous release of PGE2 from the vaginal insert permits a controlled and safe induction of labour, minimal risk of hyperstimulation, fast and easy removal of drugs in cases of fetal or maternal anomalies, easy accetability for patients, but high cost.

Endoscopic treatment of intrauterine adhesions.

PURPOSE OF INVESTIGATION: The authors investigated the validity of hysteroscopy as a diagnostic and operative technique in cases of intrauterine adhesions. METHODS: 6,680 hysteroscopies were carried out between June 1987 and December 2000 with 201 patients presenting intrauterine adhesions. Only 75 patients underwent resection of the adhesions by hysteroscopy with 94.6% of functional restoration and 93.3% of anatomic resolution. RESULTS: At 2-month follow-up the uterine cavity was completely regular in 70 cases, while in four cases a second surgical treatment was necessary. CONCLUSION: Good anatomic results are obtained after hysteroscopic treatment of intrauterine adhesions, and pregnancy rates vary from 28.7 to 53.6%.

Successful diagnostic and surgical hysteroscopy for endometrial ossification.

PURPOSE OF INVESTIGATION: Diagnostic-operative hysteroscopy was successful in two cases of endometrial ossification, and fertility was restored. METHODS: A 30-year-old and a 32-year-old woman presented at our Department with a history of secondary infertility, complaining of pelvic pain, dysmenorrhea and polymenorrhea which lasted for about one year before admission. Previous ultrasound studies revealed the presence of two bright hyperechogenic bands with posterior shadowing. RESULTS: In both cases diagnostic-operative hysteroscopies were performed, displaying osseous fragments which were removed with resectoscopy, mainly mechanically. CONCLUSION: Hysteroscopic resection should be the elective treatment for endometrial ossification because it allows complete removal of osseous fragments and reduces the chance of residual synechia. The mean objective of hysteroscopy in endometrial ossification is the restitution of conceivement capability.

Abdominal cystic lymphangioma in a woman at 14 weeks' gestation: case report.

Lymphangiomas are uncommon benign tumors that most commonly present early in life, and are even more exceptional in adults. We present a rare case of a 14-week pregnant woman who had a large septated cystic lesion adherent to the ileum. Despite analysis by ultrasound, the correct diagnosis was established only via laparotomy and she had surgical resection of an abdominal lymphangioma.

[Proposal for an informed consent form for hormonal replacement therapy in ambulatory care]. / Proposta di una scheda di consenso informato alla terapia ormonale sostitutiva nella pratica ambulatoriale.

Hormonal Replacement Therapy (HRT) represents a valid therapeutic approach for menopausal symptoms and for the prevention of cardiovascular disease and osteoporosis. Nevertheless, an informed consent, after a complete information, must be obtained from the patient. This procedure is generally adopted in any medical activity, but the modality of the consent in the HRT administration is not well established (verbal or written?, timing of administration?). The authors propose an informed written consent model to be utilized in menopausal centers; this model synthetically informs about HRT benefits and risks and must be red and signed by the patient. The written consent should be explained through a verbal detailed discussion about it, during which the patient's comprehension must be assured. The informed consent procedure should be renewed every year in long term-users. The influence of the HRT informed consent in menopausal centers must be analyzed in particular as far as women compliance is concerned.

Prevention of thromboembolic complications in women undergoing gynecologic surgery.

Our objective was to identify those patients particularly at risk of deep vein thrombosis (DVT) before they underwent extensive gynecologic surgery and to control if, a correct diagnostic analysis and a right pre-operative prophylaxis of patients with risk of developing DVT, was enough to improve post-operative prognosis. Of 2704 patients undergoing gynaecological surgery, 74 were pre-operatively considered at risk of developing DVT. Seventy percent of the patients received pre- and postoperative heparin, while 28% of the women received only postoperative heparin. Nonetheless, seven women receiving this prophylaxis developed DVT. The final results of our study demonstrate that there is a close correlation between incidence of DVT and the presence of risk factors. This incidence can be reduced by prophylactic measures such as elastic stockings for the lower legs, early post-operatory mobilization, hematocrit and volemy control, ending with pharmacological therapy with heparin.

Hysterectomy in women with cervical pregnancy complicated by life-threatening bleeding: a case report.

A 27-year-old women, gravida 2, para 1 presented with massive vaginal bleeding. After two days of bleeding from the external cervical ostium, intracervical tamponade was performed but the bleeding did not stop. At laparotomy, abdominal hysterectomy with adnexa preservation was done because of malacia tissue and life-threatening hemorrhage. Pathological examination revealed an isthmic pregnancy, gravidic decidua, and chorion villi.

Topic and systemic administration of natural alfa interferon in the treatment of female and male HPV genital infections.

The aim of the study was to evaluate the effectiveness and tolerance of topic and systemic administration of natural alfa-interferon from normal human leukocytes in the treatment of HPV lesions of the lower genital tract. From May 1991 through May 1992, 70 women (mean age = 29; range 16-42) and 51 men (mean age = 28; range 18-48) with histologically proven HPV genital lesions were studied. 43 patients and 32 male partners with subclinical infection underwent cream therapy (4 applications/day for 30 days) composed of natural alfa interferon and containing 1,000,000 IU/gr. 27 women and 19 men affected by florid infection underwent systemic i.m. therapy with natural alfa interferon in doses of 3,000,000 IU on alternate days for 30 days. The percentage of therapeutical success amounted to 55.8% for women and 78.1% for men subjected to topic therapy; for the 27 patients and 19 male partners treated with systemic therapy the final percentages of success were 70.3% respectively. Natural alfa interferon from normal human leucocytes seems to be a drug of good efficacy and tolerance in the treatment of HPV genital pathology.

Multiple primary neoplasms. Considerations on 42 cases.

During the years 1977-1993, 2,108 cases of gynecologic primary neoplasms were observed in the Department of Gynecology and Obstetrics of La Sapienza University in Rome. Forty-two cases were multiple primary cancers. Of these, 27 had multiple primary neoplasms involving only gynecologic sites, 15 had a neoplasm involving also another site; 3 patients had triple primary neoplasms. The most frequent neoplasm associations observed in our case series were: breast-ovary; endometrium-ovary; breast-cervix; endometrium-bowel (sigma-colon).

Cervical intraepithelial neoplasia: carbon dioxide laser vaporization and conization. Our experience.

Between 1984 and 1992, the CO2 laser was used to treat 341 patients affected by CIN of various degrees. On the basis of specific indications these patients underwent vaporization or conization. Two hundred and twenty eight patients underwent vaporization of intraepithelial lesions, 221 (96.92%) of whom were free of disease after one laser treatment, as observed during the subsequent years of follow-up. In 105 out of the 113 patients treated with conization the cone margin was free of disease. One hundred and one (96.19%) of the these 105 patients had no evidence of disease after one year of follow-up. In the remaining 8 (7.07%) cases examination of the cone revealed the presence of invasive carcinoma. The major complication was vaginal discharge observed in 115 (33.72%) patients. The CO2 laser is a very effective therapeutic procedure for the treatment of intraepithelial lesions of the cervix and permits to preserve reproductive function and anatomic integrity.

Pain evaluation during carbon dioxide laser vaporization for cervical intraepithelial neoplasia: a randomized trial.

63 pts affected by CIN of various degrees were randomly divided into 3 groups in order to evaluate the pain experienced during laser vaporization of the lesion. All pts were premenopausal and ages ranged between 19 and 39 years. 21 pts received Naproxene Sodium (550 mg) 30 minutes before surgery; 21 pts received placebo and 21 pts received no drug. Laser vaporization was performed with a Coherent System 451 CO2 laser with a power setting of 28 W/cm2 and a spot size of 1.8 mm. The severity of pain was assessed by means of a Visual Analogue Scale. The mean VAS value was 19 for the group treated with Naproxene Sodium; the mean VAS value was 20 for the placebo group and 23 for the group which received no pre-operative drug. Analysis of data from the 3 groups showed no statistically significant difference. Analgesia or anaesthesia before laser surgery for CIN is not a necessity.

Vulvar and penile HPV lesions: laser surgery and topic anaesthesia.

Treatment of genital warts (HPV lesions) by Laser-surgery was performed in 90 patients and 90 male partners under topical anaesthesia with 1-3 gr EMLA cream and in 45 patients and 45 males (control groups) under 1-2 ml 2% Carbocaine infiltration. EMLA cream was applied to warts 5-18 minutes (median = 7) before operation. Pain from application of anaesthetic and Laser surgery was significantly less (p < .001) in the groups treated by EMLA. Side effects were minimal in the EMLA groups. The results suggest that EMLA cream could be the anaesthetic of choice in Laser surgery of genital warts.

[Diagnosis and therapy of low-risk endometrial hyperplasia. Experience with LH-RH-A]. / Diagnosi e trattamento delle iperplasie endometriali a basso rischio. Esperienza con LH-RH-A.

Endometrial hyperplasia is a endometrial condition often found in perimenopausal age. AUB is the most frequent symptom of endometrial hyperplasia. The combination of hysteroscopy and endometrial biopsy is the most suitable approach for the diagnosis of endometrial hyperplasia in symptomatic patients. The Authors have studied endometrial modifications due to LH-RH analogue, a depot formula, in 60 perimenopausal patients with AUB and with hysteroscopic and histologic picture of low-risk endometrial hyperplasia. They report the result of treatment efficacy (disappearance of symptoms and tendency to hypoatrophy of the mucosa). The use of LH-RH A seems to have a good result in the management of oestrogen-dependent gynaecological benign diseases.

[Laser CO2: results of treatment of HPV lesions in male the partner]. / Laser CO2: risultati del trattamento delle lesioni virali da HPV nel partner maschile.

Hundred-fifty-seven male partners of patients affected by Human Papillomavirus (HPV) lesions, underwent CO2 Laser vaporization between January 1989 and January 1990. The age ranged between 18 and 45 (median 28.2). The vaporization was performed with a Coherent System 451 CO2 Laser equipment, at a power of 16 watt in continuous mode, depth of 2 mm and a free margin of 2 mm. First Laser treatment proved successful in 129 patients (82.1%); 17 out of 28 patients with persistent or relapsed pathology underwent a second CO2 Laser vaporization with a total cure percentage equal to 92.9%. Laser-surgery is the method of choice in the treatment of HPV genital lesions.

[Contraceptive methods, induced abortion, first sexual intercourse age, in a group of 1635 students of the University of Rome]. / Contraccezione, I.V.G., eta del primo rapporto in un gruppo di studentesse dell'Universita di Roma.

PIP: The authors report some data about contraceptive choice among young women examined in the Preventive Medicine Center of the University of Rome. Menarche age, menstrual cycle, age at 1st sexual intercourse, contraceptive method used, number of abortions, and pregnancies were examined. Moreover, the relationships between age at 1st sexual intercourse and contraceptive method and abortion were considered. Mean age at 1st intercourse was about 17.5 years. Pill and IUD were used by 11% and 5% respectively of the female students. Coitus interruptus was used among 83.3% of the cases. The prevalence of previous abortion was about 12.6%. The menstrual cycle characteristics did not influence the contraceptive choice of these students. Finally, previous abortion or pregnancy influenced contraceptive choice; in fact about 15% and 16.5% of the women with previous abortion performed or pregnancy experienced adopted the pill and IUD as contraceptive methods. (author's modified)^ieng