Seasonal onset of the menopause.

OBJECTIVES: A seasonal rhythm of reproduction is evident in humans. Herein it was investigated whether also the cessation of woman's fertile life follows a seasonal rhythm. METHODS: A retrospective study was performed on 2436 women in postmenopause for more than 12 months, in our menopause centres. Time of menopause was stratified for month and season. The variation was compared to the seasonal rhythm of 14,310 conceptions. RESULTS: The onset of menopause was more frequent (p<0.0001) in winter (32.5%) than in spring (20.8%), autumn (20.3%) and summer (26.2%), in which a minor peak was also observed (p<0.0001 vs. spring and autumn). The two peaks were temporally coincident with the transitions between the high to low and low to high rate of conceptions. CONCLUSIONS: The present data show that in women, like reproduction also the onset of menopause shows a seasonal modulation.

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.

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.

Abdominal or vaginal hysterectomy for enlarged uteri: a randomized clinical trial.

OBJECTIVE: The purpose of this study was to compare advantages, disadvantages, and outcomes in patients who undergo vaginal or abdominal hysterectomy for enlarged symptomatic uteri. STUDY DESIGN: In a prospective, randomized study, 60 vaginal hysterectomies (study group) were compared with 59 abdominal hysterectomies (control group); all of the hysterectomies were performed for symptomatic uterine fibroids from January 1997 through December 2000. We excluded from the study the other common causes of hysterectomy such as prolapse, bleeding, adenomyosis, and endometrial or cervical carcinoma. In both groups, uterine weights ranged from 200 g to 1300 g. For enlarged uteri, vaginal hysterectomies were performed with the use of volume reduction techniques: Intramyometrial coring, corporal bisection, and morcellation. The evaluated parameters included patient age, weight, parity, uterine weight, operative time, blood loss, demand for analgesics, eventual surgical complications, length of admission, and hospital charges. The Mann-Whitney U test and chi(2) tests were applied for statistical analysis. Probability values of <.05 were considered statistically significant. RESULTS: There were no major differences in patient age, weight, parity, and uterine weight between the two groups. Operative time was significantly lower for the vaginal route as compared with the abdominal route (86 minutes vs 102 minutes, P <.001). No intraoperative complications were noted both in the study and control groups or the control group. Surgical bleeding (expressed by hemoglobin loss) was not significantly different between the two groups. In the postoperative period, we found a higher incidence of fever (30.5% vs 16.6%, P <.05) and demand for analgesics (86% vs 66%, P <.05) in the abdominal group as compared with the vaginal group. Significant advantages of vaginal hysterectomy were a reduction in the hospital stay (3 days vs 4 days, P <.001) and cost. CONCLUSION: These results should lead to the choice of vaginal hysterectomy as a valid alternative to the abdominal hysterectomy, even for enlarged uteri.

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.

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.

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.

[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.

Chemically assisted dissection of tissues: an interesting support in abdominal myomectomy.

BACKGROUND: The aim of this study was to verify the efficacy of sodium-2-mercaptoethanesulfonate (mesna) in the chemical separation of tissues in abdominal myomectomies when used with the traditional mechanical separation techniques. STUDY DESIGN: In a prospective, randomized study, 58 women underwent abdominal myomectomy. In 29 of these, we used mesna for highlighting and separating tissues, and in the other 29 we used saline solution for the same purposes. The variables evaluated included the number of myomas removed, the volume of the biggest myoma, and the total volume of the myomas removed in every intervention. We also recorded operating time, the length of hospital stay, the degree of procedure difficulty, perioperative blood loss, operative complications, and cost. RESULTS: The operation was significantly shorter in the mesna group (p < 0.05) even though the volume and the number of myomas were larger. The degree of difficulty evaluated by the surgeon at the end of every operation was not significantly different in the two groups. The reduction in hemoglobin 24 hours after operation was significantly less in the patients treated with mesna (p = 0.006), but this difference was probably altered by the increase in hematocrit levels. CONCLUSIONS: Because of its ability as a chemical dissector, mesna may be a useful aid in this type of benign gynecologic operation. Larger studies to confirm this are needed.

[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.

[Pre-partum cardiotocography: comparison between the traditional and the computed systems]. / Cardiotocografia antepartum: confronto fra analisi tradizionale e computerizzata.

The objective of our study was to determine the usefulness of a computerized antepartum fetal heart rate (FHR) analysis instead of the common visual evaluation of cardiotocographic parameters. From a total of 4,000 antepartum FHR tracings performed in our institute in the years 1994-1996, and analyzed on-line by the software HP 2CTG, 100 were visually assessed by five physicians in three different moments. To each reader a qualitative and quantitative interpretation was required. With use of k coefficient, we have analyzed the differences in observer's qualitative interpretation, then, with use of the intraclass correlation coefficient (RINTRA) and the contingency table X2 we have compared the quantitative analysis with that of the computer. Our results show that variability is the most difficult parameter to interpret, so that the interobserver agreement isn't in anyway sufficient (k 0.43). The agreement between observers on the clinical judgment of the FHR traces proves to be low (k 0.54). The agreement between each of the observers and the computer readings is good for the estimation of the FHR (RINTRA between 0.96 e 0.98) and low for the mean term variability (RINTRA between 0.81 and 0.58). There is a valuable agreement with the computer for tracings with 0 or 1 large acceleration (94.7% and 97.5% respectively), but it is significantly poorer (p < 0.001) for tracings with 0 or 1 small acceleration (57.4% and 50.8% respectively). Decelerations are the most difficult pattern of interpretation. Usually observers do not identify 36% of the FHR traces having at least one deceleration according to computer analysis. Our study confirms the wide variability in fetal monitoring interpretation, a difficulty which can be overcome thanks to a computerized analysis.

[Childbirth preparation courses: obstetrical and neonatal evaluation]. / Corsi di preparazione al parto: valutazioni ostetriche e alla nascita.

From 1997, R.A.T. (Respiratory Autogenous Training) and "Stretching" training have been performed into the Department of Obstetrics and Gynecology University of Parma, for childbirth preparation. The aim of this study is to evaluate the obstetric characteristics of these women during labor and delivery. We compared the labour and delivery characteristics of 200 women who have completed antepartum R.A.T. and stretching training with 100 matched controls who have not. Preparation is significantly related to reduction in dystocic deliveries (operative vaginal delivery and cesarean section) and emergency cesarean section. Epidural analgesia (an obstetric procedure that is not routinely offered in the department of Parma) is more frequently performed in women prepared with ante-partum training. The neonatal outcome is good in all the three groups. "Prepared-childbirth" courses offer measurable clinical, obstetrical and neonatal advantages and psychological support, providing a useful link between prenatal ambulatory care and hospital labor and delivery care.

[Preliminary data on early discharge after delivery]. / Dati preliminari sulla dimissione precoce dopo il parto.

Puerpera and baby's early discharging falls within a bigger project that deals with the reduction of medical treatment and with the razionalization of economic resources. We can talk about early discharging when it occurs by 48 hours after a vaginal childbirth and by 96 hours after a cesarean section. When the mother and the baby have been discharged from hospital, their health will chiefly depend on the efficiency of the sanitary organization that works on the territory. If the nursing service at home is competent and specialized, the stay in hospital will get shorter and shorter. The most deepen studies about early discharging after vaginal childbirth agree upon the lack of any risk both for the mother and for the baby. Early discharging is possible without any risk for the mother's health after a cesarean section as well, but only if the woman is well-disposed, if she is at low risk, if she answers to predetermined criteria of eligibility, and if she has an adequate follow-up when she comes back home. On the basis of these evidences, we have traced a clinical outline that draws the early discharging in obstetrics that, in the last five years, has led to a progressive reduction of the stay in hospital both after vaginal childbirth and after cesarean section.

[Innovations of the Stark method for cesarean section. Comparison of techniques]. / Innovazione al metodo di stark per il taglio cesareo. Tecniche a confronto.

BACKGROUND: The evolution of surgical techniques for cesarean section have improved the neonatal outcome as well as maternal morbidity and mortality. Aim of this study is to compare the conventional technique with a personally modified Stark's technique, in order to evaluate its effectiveness. METHODS: A prospective study has been carried out on a group of patients submitted to cesarean section by two different teams. A conventional technique for cesarean section was performed by a team, while the other carried out a modified Stark's technique, at the Obstetrics and Gynecology Department of the University of Parma from May 1997 to February 1998. A total of 105 cases underwent a modified Stark's technique, while 99 were submitted to cesarean section with the conventional technique. In order to get a better reliability of results, homogeneous cases for epidemiological characteristics and indications have been enrolled in the study. Statistical analysis was performed by using Student "t"-test, chi 2 test and Wilcoxon test. The Stark's technique for cesarean section, modified by the Authors, is described. RESULTS: The parameters concerning surgical procedure, postoperative course and neonatal outcome showed statistically significant differences in favour of the modified Stark's technique. CONCLUSIONS: The conclusion is drawn that this technique leads to a remarkable reduction of blood loss and urine bacteria. Surgical drainage was never required.

Amnioinfusion in the management of oligohydramnios.

Oligohydramnios, with its extremely varied aetiology, is associated with unfavourable perinatal outcome, especially if detected during the second trimester. Amnioinfusion has recently become widely used for the diagnostic, prophylactic and therapeutic management of oligohydramnios, although as yet no incontrovertible proof exists of its advantages over conservative treatments. This study analyses our preliminary experience regarding antepartum amnioinfusion, aimed at clarifying its diagnostic and therapeutic role and its relative harmlessness. The outcomes of 80 pregnancies with oligohydramnios were analysed, comparing the 35 amnioinfused cases with the 45 conservatively treated ones; the cases were classed as second or third trimester, according to when a reduction in amniotic fluid was diagnosed. In the amnioinfused group, latency was longer; this was only significant in the third trimester (a median 14 days vs. 5 days; p < 0.05), no difference occurring in the incidence of spontaneous abortion, intrauterine death or preterm delivery. Analysis of neonatal outcomes at the second trimester shows a lesser incidence of neonatal deaths (5% vs. 33%; p < 0.05). The number of neonates discharged after amnioinfusion at the II trimester (3 out of 4) constitutes 75% of live births, compared with only 25% (2 out of 8) among those not undergoing amnioinfusion in the same period. Cumulative analysis of neonatal complications in the two treatment groups revealed no significant differences; cases of serious neurological damage at the third trimester were more frequent in the non-amnioinfused group (7 out of 27 vs. 0 out of 15; p < 0.05). There were no differences between the two groups (amnioinfused and not) with regard to maternal parameters of phlogosis analysed (leukocytosis, hyperpyrexia, CRP C-reacting Protein). In conclusion, our experience shows that within the limits of the small number of samples here used, amnioinfusion, involving few maternal or fetal risks, is advantageous as to perinatal mortality and morbidity. We thus confirm it as one of the few available methods in the active management of pregnancies affected by second-term and incipient third-term oligohydramnios.

Intravesicular prostaglandin E2 for the prophylaxis of urinary retention after colpohysterectomy.

The aim of this study was to assess the efficacy of PGE2 in enhancing bladder function after vaginal hysterectomy. A total of 110 women with or without urinary incontinence underwent vaginal hysterectomy and cystourethropexy surgery because of grade II or III genital prolapse. Preoperatively the patients were randomly assigned to two groups: group 1 (n = 50) received on the fourth post-operative day, before removal of the bladder catheter, an intravesicular solution of 1.50 mg PGE2 (2 x 0.75 mg); group 2 (n = 60) did not receive any prophylaxis for urinary retention. In the PGE2-treated group significantly fewer patients had urinary retention for 3 days or more (10%, P < 0.05) than in the control group (27%). The use of intravesicular PGE2 reduced the time taken to restore detrusor function.

Amniotic fluid index variations after amniocentesis, amnioinfusion and amnioreduction: preliminary data.

We studied the relationship between the ultrasonographically measurable variations in the amniotic fluid index (AFI) and actual changes in the amniotic fluid volume induced by three differing invasive procedures: genetic amniocentesis, amnioinfusion and amnioreduction. We examined 50 patients, all between the 15th and 34th weeks of pregnancy, subdivided into three groups. The first group consisted of 33 women who underwent genetic amniocentesis, the second was of 11 patients submitted to amnioinfusion for oligohydramnios (AFI < 5 cm), and the third was composed of 6 patients affected by hydramnios (AFI > 20 cm) and treated with amnioreduction. In all cases AFI was measured before and after the invasive procedures and their variations (delta AFI) were correlated to the actual quantities of liquid infused or extracted. All the procedures gave rise to statistically significant AFI changes. After genetic amniocentesis, the mean change was from 12.0 to 10.9 cm (p < 0.005), after amnioinfusion from 3.1 to 10.6 cm (p < 0.0001) and after amnioreduction from 33.1 to 22.0 cm. (p < 0.005). However, a significant linear correlation between delta AFI and the fluid volume variations actually induced was found for amnioinfusion (y = 0.236537 + 0.031465x; R2 = 44.4%; p < 0.05) and for amnioreduction (y = -0.0584294 + 0.012008x; R2 = 89.8%. p < 0.00001). Only for amnioreduction is it possible, as proved by a multiple regression analysis, to improve the predictability of delta AFI, taking into consideration together with the quantity of fluid aspirated, the value of the preprocedure AFI (R2 = 92%; p < 0.05).

First-trimester chromosome diagnosis by lavage of the uterine cavity.

Fetal karyotyping of trophoblast cells obtained by lavage of the uterine cavity was evaluated on 86 first-trimester irrigation fluid samples. Villus fragments were observed in 72 fluid samples indicating an 83.7 per cent sampling success rate. The amount of villi in these samples ranged from 1 to 32 mg. In most cases, villus fragments showed degeneration of the external syncytiotrophoblast layer and absence of blood vessels. In the first phase of this study (15 samples), a high degree of maternal cell contamination was observed after long-term cultures. In the following phase (71 samples), this obstacle was overcome by the application of a semi-direct method. Chromosome preparations were set up after 24 h incubation of villus fragments and QFQ-banded metaphase spreads were scored for chromosome number and sex. Sixty samples showed the presence of villus fragments and the fetal karyotype was established in 40. Male and female chromosome complements were observed in 16 and 24 cases, respectively. In four cases, an abnormal fetal karyotype was diagnosed. These included trisomy of chromosomes 13, 15, and 16, and one mosaic with trisomy 12. Our results indicate that first-trimester fetal karyotyping might be feasible by a semi-direct method using chorionic villus fragments obtained at intrauterine lavage.

[Term pregnancy: the review and development of fetal surveillance protocols]. / La gravidanza a termine: revisione ed evoluzione dei protocolli di sorveglianza fetale.

The authors have analyzed the reasons behind the changes in clinical and biophysical monitoring of term and post-term pregnancies. In particular, there is an assessment of the results of NST monitoring over a one-year period. Furthermore, the importance of the introduction of new methods of labour induction by means of intracervical PGE2 is also discussed and there is a reference to the results. It is clinically evident that these methods have contributed to modify the problem of term-pregnancy management. Finally, there is a presentation of the new version of up-to-date procedures based on more clinical experience and more recent statistics on the subject.

Spontaneous remission of double pulsatile umbilical venous flow in twin-twin transfusion syndrome: a case report.

Double umbilical pulsatile venous flow is a rare event generally associated with fetal right heart failure. We observed, at 21 weeks' gestation, this venous flow pattern in a case of twin-twin transfusion syndrome occurring in the recipient twin affected by severe hydrops. In spite of a spontaneous remission of fetal hydrops at 30 weeks, the fetus died suddenly in utero, 2 weeks later. We hypothesized that this unexpected event was related to reversed acute twin-twin transfusion, and concluded that fetal hydrops remission in twin-twin transfusion syndrome must not be considered as a reassuring prognostic index but as an indication of the need for continuing biophysical monitoring.