Gastric emptying and orocecal transit time in pregnancy.

PURPOSE: To evaluate the effects of pregnancy on gastrointestinal function, we determined gastric emptying time, orocecal transit time, and fasting gastrointestinal hormone levels (cholecystokinin, gastrin, pancreatic polypeptide, neurotensin) in 11 women with mild dyspeptic symptoms during the first and third trimesters of their pregnancies, and again 4-6 months after delivery. METHODS: After the women ingested a disaccharide solution, orocecal transit time was determined by monitoring breath hydrogen concentrations at 10-min intervals, and values were compared with the postpartum value. Ultrasound examinations of gastric emptying were performed during the same intervals. RESULTS: The half-emptying time and the final gastric emptying time did not differ in the first and third trimesters and postpartum, but gastrointestinal transit time was significantly longer in the third trimester of pregnancy than postpartum (100.0 min [range, 50.5-240.0 min] vs 70.0 min [range, 40.5-240.0 min; P < 0.05]), respectively. Mean plasma pancreatic polypeptide values were lower in the third trimester of pregnancy than postpartum. and a negative correlation was observed between pancreatic polypeptide levels and transit time in the third trimester (r = -0.65; P = 0.0261). The plasma levels of other gastrointestinal hormones did not differ in the various periods studied. CONCLUSIONS: Our study shows that, despite evident dyspeptic symptoms, there were no significant alterations in gastric emptying or orocecal transit time during the first trimester of pregnancy. Conversely, in the third trimester, orocecal transit time was significantly longer.

[Early ultrasonic amniocentesis. 147 cases]. / Amniocentesi precoce ecoguidata. 147 casi.

The results of 147 amniocenteses are analysed. The authors found chromosome abnormalities in 1.4% of the cases (two Down's syndromes were diagnosed) and no short and/or long-term materno-foetal complications were encountered.

[High resolution electrophoresis of serum aand amniotic fluid]. / Elettroforesi ad alta risoluzione del siero e del liquido amniotico.

In a sample group of 92 women undergoing prenatal echo-guided transabdominal amniocentesis between the 12th and 23rd week of pregnancy the Authors analysed amniotic fluid and maternal serum using the recently developed method of high resolution protein electrophoresis in order to identify the presence of particular proteins in the amniotic fluid which are pathognomonic for a number of maternofetal pathologies. The results obtained in normal and pathological pregnancies or in the case of twins showed a marked dispersion in amniotic fluid of total protein concentrations depending on the period of gestation; in addition, albumin, alpha 1-antitrypsin, alpha 2-glycoprotein acid, alpha 2-macroglobulin and beta 2-protein were also found. Plasma levels of prealbumin, albumin, alpha 1-glycoprotein acid and IgG were slightly reduced, whereas there was a marked increase in ceruloplasmin, transferrin and fibrinogen; C3 and haptoglobin levels were normal. It is therefore possible to ascertain that amniotic fluid proteins analysed by high-resolution 15-band electrophoresis did not vary qualitatively or quantitatively until the 23rd week of gestation and in those cases of twin or pathological pregnancies examined no anomalous band was found in the protein electrophoresis of maternal serum or amniotic fluid which might prove useful in prenatal diagnosis.

Proposal of new gradual dilation metal dilators.

The Authors suggest a new conceived line of metal cervical dilators, testing them on a group, made up of 69 patients, who will undergo Voluntary Pregnancy Interruption (VPI). Comparing the results with those obtained within a further test-group, made up of 69 women who have undergone a cervical dilation, performed by traditional Hegar dilators, it has been noticed that the new dilators are less traumatic on the cervical canal of the uterus; they can be used more easily and a wider employment is foreseen.

PIP: A set of 5 newly cervical dilators was tested on a group of 69 patients having abortion before the 3rd month of gestation, in comparison with 69 on which Hegar dilators were used. The new dilators are cone shaped, 190 mm in length, with a working length of 50 mm corresponding to the length of uterus from the os to the fundus. The minimum and maximum diameters were calculated as a function of the vertex angle, with each instrument's diameter larger than the preceding one. Calculations of design parameters, drawings and photographs are shown. cervical dilation of the subjects was assessed with Hegar dilators before the procedure began and at follow up 1 month later. Among both multiparas, and nulliparas and women with only cesarean deliveries, the cervical dilation as follow up was increased in a higher proportion of the group that had been dilated with Hegar dilators than in those dilated with the new dilators. There were no complications or fevers in these subjects. These new dilators caused less trauma as shown by cervical dilation at follow up, allowed less operative and anesthesia time, and fewer instruments, 5 instead of 20 Hegar dilators.

Electrical activity of the human uterus in vivo in the phases of the menstrual cycle.

The Authors established a method for detecting the electrical activity in the human uterus in vivo in order to observe possible variations in the two phases of the menstrual cycle. The results of surveys on six women, both in the follicular and in the luteal phase, as well as the spectral analysis, indicated an increase of frequency and intensity in the follicular phase.

[Uterine malformations and pregnancy: differential diagnosis (description of a case)]. / Malformazioni uterine e gravidanza: diagnostica differenziale (descrizione di un caso).

The authors describe a case of near-term pregnancy in a bicornuate uterus, discussing the differential diagnosis with the amniotic band syndrome and amnio-chorionic separation and discussing the distinctive characteristics of each of them.

Gastric myoelectrical activity in the first trimester of pregnancy: a cutaneous electrogastrographic study.

Recently, it has been shown that changes in gastric electrical rhythm can be connected with clinical syndromes characterized by nausea and vomiting, among these the nausea of pregnancy. We studied gastric electrical activity during the first trimester of pregnancy in nine women with nausea and vomiting (study group) by means of cutaneous electrogastrography. Recordings were made before and after a standardized meal in the 6th-8th wk of gestation, and 2 months after voluntary interruption of pregnancy (VIP). The control group consisted of eight pregnant women without a history of nausea and vomiting. In the women in the study group there was more unstable cutaneous electrogastrographic (EGGc) activity and a reduced increase in postprandial power during pregnancy than after VIP, when a normal pattern with regular 3-cpm EGGc waves was reestablished. The coefficient of variation of gastric frequency during pregnancy was significantly higher than after VIP (p less than 0.01), whereas the postprandial to preprandial power ratio was lower (p less than 0.01). During the recording sessions, none of the subjects had clear episodes of tachygastria or bradygastria, and none of them had nausea, vomiting, or epigastric discomfort. Comparison of the EGGc data for the pregnant women in the study and control groups revealed a similar pattern of gastric electrical activity in the two, the only exception being the power ratio, which was lower in the study group (p less than 0.01). We conclude that pregnant women without symptoms of nausea and vomiting at the time of EGG recordings have normal 3-cpm myoelectrical activity, and that EGGc activity is more unstable and less responsive to the ingestion of food during pregnancy than after VIP. Furthermore, in pregnant women with a history of nausea and vomiting, EGGc activity is less responsive to the ingestion of food than it is in symptom-free pregnant women.

Preliminary observation on human tubal electrical activity in vivo.

The authors have set up a new technique for recording the human tubal electrical activity in vivo. A polyethylene catheter was used with six couples of electrodes placed on the tube of 5 women during simple laparohysterectomy. The slow electrical activity was recorded by means of a 8-channel paper amplifying recorder for 3-5 days from surgery. The fimbria showed frequencies between 1.25 and 3.3 c/min, the ampulla showed higher frequencies (1-5 c/min), the isthmus showed little electrical activity. The propagation signal velocity ranges between 0.25 and 0.5 cm/sec. The amplitude ranges between 50 and 200 V. The propagation occurs mainly in the distal-proximal direction.