[Amniotic fluid embolism in trial of labor. A case report]. / Embolia amniotica in travaglio di parto. Descrizione di un caso.

Amniotic fluid embolism is a rare complication of pregnancy, which accounts for about 10% of all maternal deaths. A case of acute embolic episode occurred during labor in a 36-year-old patient with spontaneous rupture of membranes is described. Caesarean section was performed immediately, followed by hysterectomy; the baby survived but the mother died because of DIC and cardiorespiratory arrest.

[Implementation of the pediatric services in the region of Piedmont. A Piedmont pediatric team]. / Attuazione dell'area pediatrica nella regione Piemonte. Gruppo Collaborativo Pediatrico Piemontese.

A survey was carried out within the framework of the Association of Hospital Pediatricians (APO) on the implementation of the pediatric structure in Pediatric hospitals wards in Piedmont during 1990. There was a 100% adhesion rate. It was found that only in 7 out of 36 hospitals were children always admitted to the Pediatric Division irrespective of symptoms. In all remaining cases, hospitalisation was based on the pathology and therefore children were spread between pediatric and adult wards with a percentage of over 30% (it was only possible to verify this figure in a small number of hospitals). Children with surgical symptoms were admitted to adult wards for the entire duration of their hospital stay in 17 hospitals. Only in 7 hospitals were children with surgical problems given pre- and postoperative treatment in pediatric wards. In 18 out of 36 hospitals children undergoing surgery were not even examined before the operation by a pediatrician. The implementation of the pediatric structure mainly depended on the behaviour of the PS DEA and therefore the fact that when a child entered hospital he immediately came into contact with the pediatrician. It was also found that average hospital stay in pediatric wards was 4.4 days (range 2.1-7.4); the mean index of bed occupation was 50% (range 27.5-83.4). A pediatric doctor was on duty round the clock only in 10 out of 36 centres. In the majority of hospitals the number of beds destined for day-hospital activities was not specified. It is also worth pointing out that the number of neonatal cradles is never specified by the Regional Health Plan and there is no legal recognition of neonates admitted to the Nursery and, as a result, the number of neonatal medical staff is not quantified. A greater incisiveness of the current statutory requirements for the implementation of the pediatric structure might improve the level of assistance for children admitted to hospital.

Perioperative prophylaxis in abdominal and vaginal hysterectomy.

The aim of this study is to evaluate the clinical efficiency of perioperative short-term prophylaxis in gynecological surgery, in order to prevent both systemic and local infections, caused either by aerobic or by anaerobic bacteria. A group of 320 patients, undergoing abdominal or vaginal hysterectomy and treated with perioperative antibiotic prophylaxis is compared, with 320 women undergoing conventional wide-spectrum antibiotic treatment from the first post-operative day for 4-5 days.

[Cervix cerclage. A 20-year case load]. / II cerchiaggio cervicale. 20 anni di casistica.

Uterine cervical incompetence is the most common cause of habitual abortion in the second trimester of pregnancy and premature delivery; cervical cerclage still represents the only surgical treatment for cervical incompetence. In the last 20 years (1971-1990) we performed 272 Mac Donald cervical cerclages in patients between the 8th and the 34th week of pregnancy. In 16 cases the outcome of pregnancy is unknown; 198 women (73.3%) subsequentely delivered healthy infants later than 37 weeks' gestation or weighing more than 2500 g.

Pre-surgical treatment of uterine myomas with LH-RH agonists.

Twenty-five non-menopausal women with uterine myomas were treated with LHRH-analogues for 3-6 months. An average reduction of 40% in uterine volume was observed. One patient refused to complete her therapy, three had no more menses after the interruption of treatment, nine underwent myomectomy within four weeks of their final administration, while in 12 cases hysterectomy was performed. In all cases the decrease in uterine volume induced by the analogue allowed a more limited intervention and prevented excessive blood loss.

[Comparison of metroplasty by Strassman's method and by Tomkins' method. Retrospective study of 30 years]. / Confronto tra metroplastica sec. Strassman e sec. Tompkins. Studio retrospettivo di 30 anni.

The study aimed to evaluate the usefulness of metroplasty to improve gestational ability in the presence of uterine malformations. From the analysis of results, it is clear that this surgical operation is undoubtedly efficacious when performed in selected patients (earlier negative obstetric outcome). The comparison of the two techniques (Strassman vs Tompkins) confirms that the latter produced better results in this series of patients.

[Neuroendocrine factors in postpartum blues]. / Fattori endocrini nei postpartum blues.

A very considerable proportion of women, estimated from 50 to 80 per cent, experience a noticeable period of emotional distress, usually mild or transistor, between the third and the tenth day postpartum (postpartum blues: PPB). The onset of this syndrome conform to a practically immutable of timing-symptoms are almost never noted before the third day postpartum (latent period). After this period, in approximately 10 per cent of women, occurs a depression: postpartum depression (PPD), and last to 8 weeks. Neuro endocrine factors in the pathogenesis of postpartum depression is discussed: thyroid, pituitary and adrenal cortex are reviewed. Considerable evidence support that the late postpartum syndromes are associated to psychological stress of childbirth with postpartum decrease of placental steroids, estrogen and progesteron, with high levels of pituitary prolactin.