Fetal intracranial hemorrhage: is minor maternal trauma a possible pathogenetic factor?

OBJECTIVE: The occurrence of fetal intracranial hemorrhage before labor has been repeatedly observed. The aim of this study was to evaluate the sonographic appearance of fetal intracranial hemorrhage in relation to its location. Possible causative factors were also evaluated. DESIGN: Five consecutive cases of fetal intracranial hemorrhage were identified at a single ultrasound unit between 1996 and 1999. In utero magnetic resonance imaging was also performed in four of these cases. Autopsy was performed after pregnancy termination or intrauterine fetal death (one case of each), and neurological follow-up was initiated in the three surviving infants. RESULTS: Hydrocephaly was the predominant sonographic finding associated with intraventricular or subependymal hemorrhage; sonography provided the correct diagnosis in the former (two cases), whereas magnetic resonance imaging was necessary in the latter. Massive intraparenchymal hemorrhage was depicted as an irregular echoic mass, whereas extradural hemorrhage had a cystic appearance. History of minor maternal physical trauma without maternal or placental injury was elicited in all cases. Ultrasound examinations performed before or shortly after the trauma were available in all cases and showed normal fetal anatomy. CONCLUSIONS: The sonographic appearance of fetal intracranial hemorrhage is variable, depending on its location. Even though sonography detected an intracranial anomaly in all cases, magnetic resonance imaging was necessary to establish the hemorrhagic nature of isolated subependymal and extradural hemorrhage. The similarity of histories involving minor maternal physical trauma in all cases, together with the absence of any known factor predisposing to fetal hemorrhage, may suggest that trauma is at least a contributing factor to the pathogenesis of fetal intracranial hemorrhage.

The association of ultrasonography and CA-125 test in the preoperative evaluation of ovarian carcinoma.

The aim of this study was to verify the role of the association of pelvic ultrasonography and CA-125 assay in the preoperative evaluation of ovarian carcinoma. The Authors examined 119 patients undergoing laparotomy for adnexal masses. Thirty-six had an ovarian carcinoma, the other 83 patients were affected by benign ovarian pathologies. Before surgery every patient underwent a pelvic ultrasonography. The data resulting from ultrasonography were processed on the basis of a personal scoring morphologic echostructural evaluation system. Furthermore in every patient the preoperative serum levels of CA-125 were measured. In the group of patients with ovarian carcinoma the ultrasonography score was greater than or equal to 10 in 26, while serum CA-125 was greater than or equal to 65 U/ml in 30 and greater than or equal to 35 U/ml in 31. In the group of patients with benign ovarian pathology the ultrasonography score was found to be greater than or equal to 10 in 2, while serum CA-125 was greater than or equal to 65 U/ml in 4 and greater than or equal to 35 U/ml in 20. Fixing 10 as reference value of ultrasonography score for ovarian carcinoma diagnosis, pelvic ultrasonography and a sensitivity of 72.2%, a specificity of 97.9%, a diagnostic accuracy of 89.9%. With a reference value of 65 U/ml CA-125 had a sensitivity of 83.3%, a specificity of 95.2%, a diagnostic accuracy of 91.9%. With a reference value of 35 U/ml CA-125 had a sensitivity of 86.1%, a specificity of 75.9%, a diagnostic accuracy of 79.0%.(ABSTRACT TRUNCATED AT 250 WORDS)

Sjögren's syndrome: clinical, cytological, histological and colposcopic aspects in women.

Sjögren's syndrome, characterized by a progressive alteration of the exocrine glands which ultimately results in their atrophy, has the highest incidence among females. The main etiopathogenetic mechanism is autoimmunological. The symptomatology is made up of symptoms depending on an altered glandular secretion and mucosal dryness. Dyspareunia and pruritus, due to vaginal and vulvar dryness, are quite common symptoms. Few studies have considered the clinical and histological consequences of Sjögren's syndrome in the external female genitalia. In the present study 26 women (mean age 46 years) affected by Sjögren's syndrome were examined by means of a series of tests including gynecological examination exam, colposcopic inspection and cervical biopsy. All the patients showed a particular dryness a series of tests including gynecological examination failed to evidence malign cells and, in 15% of the subjects, showed an estrogenic insufficiency in various degrees. The colposcopic inspection revealed dystrophic processes resulting in the atrophy of the cervico-vaginal mucosa in 50% of the cases. The histological findings of the cervical biopsies evidenced the presence of a chronic cervicitis in 10% of the cases.

Aminophylline treatment of preterm labor.

Prevention of neonatal mortality linked to prematurity may be achieved by treating preterm labor, thus allowing fetal lungs to spontaneously develop, or by administering drugs able to enhance pulmonary maturation. The methylxantine derivative aminophylline has been reported to reduce uterine contractility and increase the concentrations of saturated phosphatidylcholine in fetal lungs. Its effectiveness in treating preterm labor and preventing respiratory distress syndrome (RDS) has been evaluated in comparison to the widely used drug ritodrine. In 39 pregnant women with preterm labor the efficacy of aminophylline and ritodrine in delaying the delivery seemed similar. However, while two of the babies born from ritodrine treated mothers died because of RDS, all babies born from aminophylline-treated mothers survived. These data might then confirm the effectiveness of aminophylline treatment to prevent RDS.