Correlation between fetal movement revealed in actography and fetal-neonatal well-being: observational study on 3,805 pregnancies followed in a Northern Italy tertiary care hospital.

PURPOSE OF INVESTIGATION: To evaluate the correlation between fetal movement revealed in cardiotocography and fetal-neonatal well-being as well as to assess the value of cardiotocography in our clinical practice. METHODS: Retrospective analysis of 3,805 pregnancies followed at Parma General Hospital. Exclusion criteria were cesarean section, preterm delivery, and stillbirth. We analyzed the predictive power of actography during the dilating and expulsive phases of labor by establishing a correlation between number of fetal movements and our neonatal indexes of well being, i.e., cardiotocographic score, Apgar index and neonatal pH value. Statistical tests used were Fisher's test, chi-square test (X2), Pearson correlation and Spearman Rho; p value was considered significant if it was less than 0.05. RESULTS: We considered 2,389 vaginal deliveries. Analyzing the correlation between fetal movement and cardiotocographic score in the two different phases of labor, the comparison among subpopulations identified by different cardiotocograph scores revealed no statistical difference. CONCLUSION: Cardiotocography is reconfirmed as a good instrument to evaluate neonatal outcome, while actigraphy cannot be used alone to define fetal well-being, mainly due to the inability to standardize assessment of the actographic study.

Acrofacial dysostosis syndromes: a relevant prenatal dilemma. A case report and brief literature review.

The acrofacial dysostosis (AFD) syndromes are an heterogeneous group of disorders with undefined classification and inheritance. We report the sonographic and clinical features of an AFD fetus with predominantly pre-axial forms. We made a prenatal diagnosis of Nager syndrome but postnatal examination showed post-axial defects previously undetectable by ultrasound.

Follicular fluid levels of vascular endothelial growth factor and early corpus luteum function during assisted reproductive technology cycles.

BACKGROUND: The relation between vascular endothelial growth factor (VEGF) and early luteal function has rarely been proven in humans. The purpose of this study was to define the relation between follicular fluid concentrations of VEGF (FF VEGF) and early luteal function at the preimplantation stage during assisted reproductive technology (ART) cycles. METHODS: 71 women were divided into two groups, based on reproductive outcome: women who became pregnant after embryo transfer (ET) (n = 18, Group A) and non-pregnant women (n = 53, Group B). Serum progesterone (Se P) and inhibin A on ET day, and FF VEGF levels were measured in all women. Data were expressed as mean +/- standard deviation. Statistical analysis was performed using Excel Office 98 for Student's t-test, linear regression test and chi-square test. A p value of < 0.05 was considered statistically significant. RESULTS: The groups were comparable for age, ovarian reserve, number and quality of the oocytes retrieved and of the embryos obtained and transferred. FF VEGF levels were increased (4235 +/- 1433 vs 3432 +/- 1231 pg/ml), while Se P and inhibin A levels were significantly reduced (83.1 +/- 34.1 vs 112.0 +/- 58.8 ng/ml and 397.4 +/- 223 vs 533.5 +/- 283 pg/ml, respectively) in the non-pregnant group and were negatively correlated with FF VEGF (r = -0.482, p < 0.05; r = -0.468, p < 0.05) only in pregnant women. CONCLUSION: Much has to be learned about the regulation and role of VEGF during the early luteal phase. We advance the hypothesis that the existence of a negative correlation between FF VEGF/Se P and FF VEGF/inhibin A in pregnant women might indicate the existence of a normal VEGF-mediated paracrine response when Se P and inhibin A levels are decreased. Excess production of FF VEGF and the absence of a correlation between FF VEGF/Se P and FF VEGF/inhibin A in non-pregnant women may be a paracrine reaction to immature luteal vasculature, resulting in luteal dysfunction.

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.

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.

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.

[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.

[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.

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.

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).

[Bacterial vaginosis. Prevention of recurrence]. / Vaginosi batterica. Profilassi delle ricorrenze.

Bacterial vaginosis (BV) is the main cause of vaginitis. The condition is characterised by an abundant and odorous vaginal loss, but more than half the patients with demonstrable signs of BV do not report symptoms at all. Gardnerella vaginalis (Gv) is often associated with BV, but it is not the sole factor responsible, as is shown by the fact that it can be isolated in the vagina of women withBV. In 1992 and 1993, 2630 patients, 1460 of them gynaecological and 1170 obstetric, were admitted to the Obstetrics and Gynaecology Clinic of Parma University. Amsel criteria were adopted for diagnosing BV. Cases of BV were treated with 5 mg/die 2% clindamycin vaginal cream for 7 days. In the event of recurrences, 250 mg tablets of metronidazol were added: 8 tablets in 4 administrations in a single day, treatment also being extended to the partner. Patients admitted in 1993 received a protocol of hygienic and behavioural standards, stress being laid on prophylaxisa measures even after the end of therapy. BV proved to be present in 12.3% of cases, of whom only half were symptomatic. The situation was practically stationary if the 2 years are considered separately. Recurrences of symptomatic bacterial vaginosis were 15% in the absence of protocol application and 8.3% after the protocol. Recurrences were less frequent in the asymptomatic forms. Compared to the total number od cases of BV, recurrences were significantly low (12.1% p < 0.001).

Ultrasound dating-curve analysis in the assessment of gestational age.

The accurate assessment of gestational age is very important in everyday practice. By the use of multiple regression analysis, in a longitudinal study, ultrasound dating-curves were calculated for the crown-rump length, biparietal diameter, femur length, humerus length, binocular distance and transverse cerebellar diameter. All the examined parameters showed a good statistical correlation with gestational age; however, the earlier the estimation of the gestational age, the more accurate it is. The crown-rump length has been shown as the best parameter during the first trimester. Later on, the other biometric parameters become easier and more reliable. If determination of gestational age is required during the third trimester, the use of multiple parameters is recommended.

Methods of contraception and rates of genital infections.

Bacterial vaginosis, trichomoniasis and candidiasis are the most common genital infection. The aim of this study was to evaluate the various methods of contraception with regard to the prevalence of bacterial vaginosis and vulvo-vaginitis over a period of four years. We also evaluated in the same period the rates of trichomoniasis, candidiasis, bacterial vaginosis and vulvo-vaginitis between users and non users of contraceptional methods and the relationship between ages of patients and types of contraceptives. Finally we considered the change of contraceptive use with regard to age among two different periods. The IUD users showed a significant increase of B.V., T.v. and other bacteria and a decrease of the negatives compared to OC users. Barrier contraceptive users had a reduction (0.01 > p > 0.001) of B.V. and an increase (p < 0.001) of the negatives compared to IUD users. OC users had a significant (p < 0.05) increase in candidiasis, B.V. together with a reduction of the negatives compared to non users group. IUD users had a significant (p < 0.001) increase of B.V. and vulvo-vaginitis from other bacteria, and the reduction of the negatives. Teenagers use OC much more than adults, but less IUD (p < 0.001). The use of OC has increased and the use of IUD decreased among adults (p < 0.001). The barrier methods were seen to be statistically reduced.

PIP: During 1985-1986 and 1991-1992 in Italy, clinicians recruited 2387 patients attending the Centre for Sexually Transmitted Diseases (STDs) at the University of Parma with symptoms of genital infections. The study aimed to examine the various types of contraceptive methods in connection with the most common genital infections. Over the 4-year period, among patients with vulvo-vaginitis, IUD users had a higher rate than oral contraceptive (OC) users of bacterial vaginosis [BV] (24.9% vs. 15.7%; p 0.05), of trichomoniasis (1.7% vs. 1.3%), and of other infections (31.6% vs. 20%; p 0.05). They had a lower negative rate than OC users (23.9% vs. 43.4%; p 0.001). Patients using barrier methods (diaphragm and condom) had a lower rate of BV and a higher negative rate than IUD users (11.5% vs. 24.9%, p 0.01 and 49.6% vs. 23.9%, p 0.001, respectively). OC users had a higher rate of candidiasis and BV and a lower negative rate than the nonusers (19.6% vs. 14.8% and 15.7% vs. 11%; p 0.05 and 43.4% vs. 52.9%; p 0.001, respectively). IUD users had a higher rate of BV and vulvo-vaginitis from other bacteria and a lower negative rate than nonusers (24.9% vs. 11%, p 0.001; 31.6% vs. 20.4%, p 0.05; and 23.9% vs. 52.9%; p 0.001, respectively). Teenagers used OCs more often than did adults (29.3% vs. 15.6%) and were less likely to use the IUD (0.3% vs. 5.5) and no method (62.2% vs. 73.5%) (p 0.001). Between 1985-1986 and 1991-1992 among adults, OC use increased (9.9% vs. 17.9%; p 0.001) and IUD use and barrier method use decreased (8.9% vs. 4.1% and 9.3% vs. 3.9%, respectively; p 0.001).

[Vaginitis and vaginosis. Comparison of two periods]. / Vaginite e vaginosi. Due periodi a confronto.

Vaginitis is the most frequent gynecological disease. It is characterized by objective and subjective signs of inflammation and differs from bacterial vaginosis (BV) which is an abnormal condition of the vaginal ecosystem caused by the excessive growth of aerobic and anaerobic flora normally present in the vagina with an increased risk of pelvic inflammatory disease (PID). The authors report the results of a study carried out at the Centre for Gynecological Infections at the Clinic of Obstetrics and Gynecology of the University of Parma. 828 patients were enrolled in the study during the period 1985-86 and 1559 patients during the two-year period 1991-92. The aim of the study was to evaluate variations in epidemiological data for vaginitis and bacterial vaginosis in the two periods examined. No significant changes were observed (p > 0.05) with regard to the prevalence of Ca, Tv and BV forms. On the other hand, there was a significant reduction (p < 0.001) in the forms sustained by other microorganisms (above all, streptococcus and enterobacteria) between the first and second periods with a parallel increase in the number of negative cases. The analysis of the age distribution of vaginitis and BV showed a reduction of other microorganisms and an increase in negative vaginal swabs in adults (> 20 years old).

Color Doppler ultrasound in prenatal diagnosis of umbilical cord angiomyxoma. Case report.

A pregnant woman, at 28 weeks' gestation, has been observed ultrasonographically. A complex mass arising from the umbilical cord was detected. Color Doppler imaging demonstrated the vascular nature of the mass and the strictly connection with the three umbilical vessels. Color Doppler ultrasound provides useful informations for a correct assessment of the masses arising from the umbilical cord.