Atrial reservoir function by strain rate imaging in asymptomatic mitral stenosis: prognostic value at 3 year follow-up.

AIMS: Assessment of left and right systolic atrial reservoir function in asymptomatic mitral stenosis (MS) by strain and strain rate imaging (SRI) and their prognostic power at 3 year follow-up was the purpose of this study. There is clear indication to treat (by surgery or percutaneous valvotomy) symptomatic patients with MS, whereas for the asymptomatic ones, the question is much debated. So, we need new echocardiographic parameters helpful for the management of asymtomatic patients. Atrial reservoir function by SRI could help in evaluation of these patients. METHODS AND RESULTS: Fifty-three asymptomatic patients with MS and 53 healthy controls were evaluated by the standard echo-Doppler study [mitral valve (MV) area, mean gradient, systolic pulmonary pressure, left atrial (LA) width, LA volumes, LA compliance index] and by Doppler myocardial imaging (velocity, strain, and SR of both atria). The endpoint at 3 year follow-up was symptoms, hospitalization for cardiac cause, atrial fibrillation, thrombo-embolic events, valvular surgery, or percutaneous commissurotomy. LA width, volumes, and systolic pulmonary pressure were significantly increased in MS patients (P < 0.001). Atrial myocardial velocities and deformation indices were significantly compromised in MS patients (P < 0.0001). Significant correlation was found between atrial myocardial velocity and MV area (by pressure half-time method: P = 0.019, R = 0.41; by planimetric method: P = 0.016, R = 0.43). Peak systolic LA myocardial strain and SR were significantly correlated with atrial volumes (strain: P = 0.03, R = -0.28; SR: P = 0.0008, R = -0.42), with atrial compliance index (strain: P = 0.04, R = 0.26; SR: P = 0.04, R = 0.16), with atrial ejection fraction (strain: P < 0.0001, R = 0.56; SR: P = 0.03, R = 0.43). At 3 year follow-up, 22 (41%) patients had events. Comparing the MS patients who had events during the 3 year follow-up with those who did not, the former had bigger LA volumes, although these parameters did not reached a significant value, whereas atrial myocardial systolic SR was significantly impaired in patients with events. In multivariate analysis, the best predictor of adverse events was LA peak systolic SR average (P = 0.04; coefficient: 0.113; SE: 0.055; cut-off value of 1.69 s(-1) for LA peak systolic SR average) with a sensitivity of 88%, specificity of 80.6%, area under the receiver operating characteristic curve of 0.852 (SE: 0.048; 95% CI: 0.74-0.93, P = 0.0001). CONCLUSION: Atrial myocardial deformation properties, assessed by SRI, are abnormal in asymptomatic patients with rheumatic MS. The degree of this impairment is predictor of events in a 3 year follow-up. SRI could be helpful in decision-making of asymtomatic patients with MS.

[The role of natriuretic peptides in heart failure]. / Ruolo dei peptidi natriuretici nello scompenso cardiaco.

Over the last decades, there has been a significant increase in incidence and prevalence of heart failure, a major cause of cardiac morbidity and mortality. Measurements of neurohormones, in particular B-type natriuretic peptide (BNP), can significantly improve diagnostic accuracy, and also correlate with long-term morbidity and mortality in patients with chronic heart failure presenting to the emergency department. BNP is secreted by cardiac ventricles mainly in response to wall stress and neurohormonal factors like the sympathetic nervous system, endothelins, and the rennin-angiotensin-aldosterone system. BNP increases myocardial relaxation and oppose the vasoconstrictive, sodium retaining, and natriuretic effects caused by vasoconstrictive factors. BNP is the first biomarker to prove its clinical value for the diagnosis of left ventricular systolic and diastolic dysfunction but also for the right ventricular dysfunction, guiding prognosis and therapy management. Emerging clinical data will help further refine biomarker-guided therapeutic and monitoring strategies involving BNP.

[Perinatal results in patients with chronic hypertension at the National Institute of Perinatology]. / Resultados perinatales en pacientes con hipertensión arterial sistémica crónica en el Instituto Nacional de Perinatología.

There are many causes of Chronic Hypertension, and all can be present in pregnant women. The literature reports an incidence between 1-3%. The prognosis usually is favorable, if we have an excellent control of blood pressure along pregnancy. But the risks like abruptio placentae, fetal demise or fetal growth restriction have a greater incidence than in the health population, furthermore the superimposed preeclampsia increase notably the perinatal morbidity. The objective of this study is to determine the perinatal outcomes in women with chronic hypertension in the Instituto Nacional de Perinatología. In the study we included 66 patients with chronic hypertension with age between 21-45 years old, and 54.4% had an age between 30-40 years. The evolution time of hypertensive disease was 5 years or less principally (71.2% of the patients).

[Pulmonary vascular reactivity and the development of edema in the presence of prostaglandin inhibitors in the isolated canine lobe]. / Reactividad vascular pulmonar y formación de edema en presencia de inhibidores de prostaglandinas en el lóbulo canino aislado.

UNLABELLED: Alveolar hypoxia is the most powerful pulmonary vasoconstrictor. In a previous work, we did not demonstrate significant changes in vascular reactivity and edema formation in an isolated canine lobe model during alveolar hypoxia. The purpose of this study is to define vascular pulmonary reactivity and edema formation after induction of pulmonary vasoconstriction using a prostaglandin inhibitor like tiaprofenic acid and alveolar hypoxia. Six isolated canine pulmonary lobules were instrumented and studied, all of them under two conditions (normoxia FIO2 21% and hypoxia FIO2 5%) four starting in normoxia condition and 2 starting in hypoxia condition. RESULTS: No significant changes in filtration rate were found, normoxia 0.42 +/- 0.41, hypoxia 0.37 +/- 0.51 ml/min/100 g pulmonary tissue P = NS. The arterial pressure in basal conditions was 25.1 +/- 6.21, and during hypoxia increased to 37 +/- 7.19 cm H2O (Delta 12.0 +/- 1.2 cm H2O). P < 0.001. CONCLUSION: Hypoxia vascular reactivity was significantly increased in tiaprofenic acid pretreated isolated canine lobes, no changes in pulmonary permeability was found nor increased rate in edema formation.

"Pseudo" twin-to-twin transfusion syndrome and fetal outcome.

OBJECTIVE: To assess the fetal outcome, in a tertiary center, in pregnancies with suspected twin-to-twin transfusion syndrome (TTTS) not confirmed using ultrasonographic examination, diagnosis of pathology, or both. STUDY DESIGN: Forty-four pregnancies with suspected TTTS were followed longitudinally using ultrasonographic examination until delivery. The minimal criteria for the diagnosis of TTTS were: (1) suspicion of monochorionicity gleaned from ultrasound examination (to be confirmed at birth); (2) presence of polyhydramnios in one gestational sac (either assessed subjectively--or, finding that the largest vertical pocket of amniotic fluid was >8 cm in diameter before 20 weeks' gestation and >10 cm in diameter thereafter); and (3) presence of oligohydramnios in the other gestational sac (finding either that there was a "stuck" twin complication or that the largest vertical pocket of amniotic fluid was <1 cm in diameter). When one of the above criteria was not present, the pregnancy was defined as "pseudo" TTTS. Fetal outcome in "pseudo" TTTS was analyzed according to the relative size of the neonate (large or small) and whether the cord insertion was normal or velamentous. RESULTS: There were 18 cases of "pseudo" TTTS. No treatment in utero was necessary in any of the 18 pregnancies. The mean gestational age was 21.9 +/- 3.7 (1 SD) weeks at diagnosis and 33.0 +/- 3.0 weeks at delivery. The average weight discrepancy between the twins at birth was 34.3 +/- 14.8%. There were three fetal demises of the small twin and one neonatal demise of the large twin (p > 0.05). Large twins developed respiratory distress syndrome (RDS) more often than small twins (p < 0.05). Five percent of the large twins and 50% of the small twins had a velamentous insertion of the cord (p < 0.05). CONCLUSION: In pregnancies complicated by "pseudo" TTTS our data indicate that: (1) small twins have abnormal cord insertion more frequently than large twins, (2) large twins develop RDS more frequently than small twins. Our data suggest that the perinatal mortality in these pregnancies appears to be lower than that reported for the classical TTTS.

[Abdominal pregnancy, institutional experience]. / Embarazo abdominal experiencia institucional.

Abdominal pregnancy is a rare entity, which has been classified as primary or secondary by Studiford criteria. A retrospective study, between January 1989 and December 1994, realized at Instituto Nacional de Perinatología, found 35,080 pregnancies, from which 149 happened to be ectopic, and 6 of them were abdominal. All patients belonged to a low income society class, age between 24 and 35 years, and average of gestations in 2.6. Gestational age varied from 15 weeks to 32.2 weeks having only one delivery at term with satisfactory postnatal evolution. One patient had a recurrent abdominal pregnancy, with genital Tb as a conditional factor. Time of hospitalization varied from 4 to 5 days, and no further patient complications were reported. Fetal loss was estimated in 83.4%. Abdominal pregnancy is often the sequence of a tubarian ectopic pregnancy an when present, it has a very high maternal mortality reported in world literature, not found in this study. The stated frequency of abdominal pregnancy is from 1 of each 3372, up to 1 in every 10,200 deliveries, reporting in the study 1 abdominal pregnancy in 5846 deliveries. The study had two characteristic entities one, the recurrence and two, the delivery at term of one newborn. Abdominal pregnancy accounts for 4% of all ectopic pregnancies. Clinical findings in abdominal pregnancies are pain, transvaginal bleeding and amenorrea, being the cardinal signs of ectopic pregnancy.

Arterial and venous Doppler velocimetry in the severely growth-restricted fetus and associations with adverse perinatal outcome.

OBJECTIVE: To evaluate the association between arterial and venous Doppler waveforms and adverse perinatal outcome in severe intrauterine growth restriction. DESIGN: Fetuses between 26 and 32 weeks' gestation with ultrasonographically estimated fetal weight below the 5th centile were included in this prospective study. The last Doppler measurements of the umbilical artery, ductus venosus, umbilical vein and middle cerebral artery before delivery and adverse outcome parameters without gestational age independence were used for statistical analysis. Adverse outcome parameters were defined as the following: fetal demise or neonatal death in the first 30 days of life; 5-min Apgar score of < 7; intubation at birth; retinopathy of prematurity; respiratory distress syndrome; necrotizing enterocolitis; stay in neonatal intensive care unit of more than 60 days; intraventricular hemorrhage; periventricular leukomalacia. RESULTS: Nineteen fetuses fulfilled the inclusion criteria. Perinatal death, low 5-min Apgar values and necrotizing enterocolitis were gestational age-independent adverse outcome parameters. Abnormal Doppler velocimetry of the ductus venosus was the only significant parameter associated with perinatal death and low 5-min Apgar scores. None of the Doppler parameters predicted necrotizing enterocolitis. CONCLUSION: Our data suggest that management of severely growth-restricted fetuses may be aided by the study of ductus venosus Doppler velocimetry.

[Cholecystectomy during pregnancy]. / Colecistectomía durante el embarazo.

UNLABELLED: Cholecystectomy during pregnancy happens to be the second most common cause of laparotomy. The reported incidence of the procedure is I of every 1250 to 12,500 pregnancies. We have done a retrospective study from january 1989 to december 1994, at Instituto Nacional de Perinatología, having 35,080 deliveries registered, four of them with reported cholecystectomy during pregnancy. The average of maternal age resulted in 20.2 years, varying from 16 to 23 years. Three patients were multigravidas, and just one primigravida. Gestational age at the time of diagnosis and surgery was reported in 17 to 23.4 weeks. We found one twin pregnancy, and that two patients had history of chronic colecistitis. In the 100% of cases laparotomy and cholecystectomy was done, with preterm labor as the most frequent complication. There were 3 fetal loss in study and only 2 pregnancies were delivered at term. DISCUSSION: In this review the estimated frequency of cholecystectomy was 1 of 8780 deliveries, being the second cause of quirurgical treatment during pregnancy, after appendicectomy. There were reported 50% fetal deaths, and no severe maternal complications.

[Appendicitis during pregnancy]. / Apendicitis durante el embarazo.

Acute appendicitis es the most common cause of lapparotomy during pregnancy. The differential diagnosis in the pregnant woman becomes a challenge due to the anatomic changes that take place during the maternal adjustment to pregnancy. We have done a retrospective study between january 1989 and december 1994, at Instituto Nacional de Perinatologia. We found in that period of time 35,080 deliveries reported and 4 cases of acute appendicitis during pregnancy. The maternal age was between 16 and 42 years old, 26 years in average. Three patients were in the 3 trimester at the time of diagnosis, and the most important clinical sign was found to be diffuse abdominal pain. In 3 cases diagnosis was attributed to obstetric pathology rather than appendicitis in first place. Laparotomy and appendicectomy was done to all patients, with on block hysterectomy in only one case, having this particular patient an abscess as a postquirurgical complication. Just one case reported a healthy newborn delivered at term. It is obvious that early diagnosis and quirurgical treatment are important factors for the mother and the fetus prognosis. Appendicectomy as well as cholecystectomy are the two most common causes of laparotomy during pregnancy.

[Cornual pregnancy]. / Embarazo cornual.

Cornual ectopic pregnancy is a rare entity, found in 2-4% of all ectopic pregnancies, with an estimates incidence of one in every 2500 to 5000 deliveries. It represents a high rate of maternal mortality because of the growth and secondary rupture of the zone of implantation in advanced gestational ages, resulting in severe hemodynamic decompensation. We realizes a retrospective study from January 1989 to December 1994 at Instituto Nacional de Perinatologia. Only 6 cases of ectopic cornual pregnancies were found out of 35,080 deliveries reported, and of 149 ectopic pregnancies in general. Maternal age, gestational age at time of diagnosis, signs and symptoms, surgical treatment complications, and histopathologic report were some of the data collected. Maternal age in average was found to be 31.5, gestational age at time of diagnosis between 7.1 to 24 weeks. All patients referred diffuse abdominal pain and amenorrhea, with 2 cases of transvaginal bleeding. The 100% of cases required total abdominal hysterectomy as surgical treatment, and the most important complication found was shock, hence no maternal deaths were reported. We found this pathology to have an incidence of 1 of 5846 deliveries at our Institution, representing the 0.01% Of all ectopic pregnancies, we found to have an incidence of 4.02% that agrees with world literature.

[En block hysterectomy. Institutional experience of 6 years]. / Histerectomía en bloque. Experiencia institucional de seis años.

On block hysterectomy is defined as the removal of the gravid uterus with its gestational content in situ. The described indications for the realization of this procedure are neoplastic process as the most frequent cause; septic process, persistent trophoblastic diseases, and hemorrhage due to anomalous placentation. This is a retrospective, descriptive study of twelve cases of on block hysterectomy collected from January 1989 to December 1994 at Instituto Nacional de Perinatología. An average age of 33.4 years was found. The number of pregnancies for this patients in average was found to be 4.1. The gestational age was established between 9 to 29 weeks. Four patients with a 4 or more previous miscarriage background. There were two reported cases having a multiple gestation. Among the complications found, there were three cases of hipovolemic shock and one with abcess of vaginal cupula. The average days of hospitalization was 5.3 days. We found no mortality at all in this study, and the histopathologic correlation accorded in 100% of the cases. In this five year review, 12 cases of on block hysterectomy were found, being the most frequent reason for it's realization the persistent trophoblastic diseases; severe hemorrhage in second place, and serious infection process in third. The observed complications were derived from the hemodynamic compromise of each patient. Even though on block hysterectomy is one rarely seen procedure, it most be in mind as an alternative therapeutical instance it most be carried out in third level institutions, with technology and human resources capable of solving any complication derived from this kind of surgery.

[Shock in obstetrics. Institutional experience]. / Choque en obstetricia. Experiencia institucional.

Shock is one of the most difficult problems an obstetrician can face. Hemorrhage is the main reason of shock. A descriptive and retrospective research was conducted at Instituto Nacional de Perinatología, from January 1992 to May 1996, including all patients admitted to the intensive care unit with diagnosis of shock. There were found 90 cases with diagnosis of shock, 82 were hipovolemic, and 8 cases had the septic kind of shock. The average of age was 32.2 years, with a gestational age between 6.2 to 41.4 weeks . There were 71 healthy patients, hypertension was associated to pregnancy in 9 cases, infertility in two, myomatosis in 2, and diabetes in 2 more patients. Other 5 cases reported different pathologies. The most frequent cause for hipovolemic shock resulted to be placenta acreta (40 cases), followed by uterine tone alterations in 37 patients, ectopic pregnancy in 7, uterine rupture or perforation in 4, and vaginal or cervical lacerations in 2. The estimated blood loss varied from 2200 cc to 6500 cc, and the minimal arterial pressure registered during shock was between 40/20 mmHg to 90/60 mmHg. Medical initial assistance consisted in volume reposition with crystalloids, globular packages, and plasma expansors in 73 patients (81.1%). The rest of the patients received in addition coloids, platelets and cryoprecipitates. A total of 76 patients required surgical intervention consisting in total abdominal hysterectomy. In 5 cases the previous surgical procedure was done and ligation of hypogastric vessels was needed. Salpingectomy was performed in 5 patients, and rupture or perforation repair in 3. The average surgery time was 2 hours and 33 minutes. The observed complications were 7 cases with abscess of the cupula, consumption coagulopathy in 2, 1 vesical quirurgical injury, 1 intestinal occlusion, and 11 vesico-vaginal fistula. The average days of hospitalization resulted to be 5. The most frequent kind of shock seen by obstetricians is the hipovolemic type, followed by septic shock, Volume reposition and restoration of adequate tissue oxygenation is the main goal in treatment, and so the rapid and opportune decision for surgery shall prevent the patients decriment and maternal mortality.

The effect of intravascular blood transfusion on the flow velocity waveform of the portal venous system of the anemic fetus.

Our objective was to assess flow velocity waveforms of the portal venous system of the anemic fetus prior to and immediately following intravascular transfusion. Color-guided pulsed Doppler was used to obtain flow velocity waveforms from the fetal portal vein in 14 anemic fetuses that were transfused in utero for rhesus alloimmunization The portal vein velocity pattern was defined as continuous when no change in velocity during the cardiac cycle was noted. It was defined as pulsatile when a deflection of the wave was present. The flow velocity waveforms were quantified by using the ratio between the peak (highest, H) and the nadir (lowest, L) velocities (H/L ratio). Fourteen intravascular transfusions were performed. Gestational age ranged from 19.5 to 35 weeks (mean +/- SD, 26.7 +/- 5.3 weeks). The hematocrit ranged from 5.9 to 31.2% (mean +/- SD, 20.3 +/- 9%) prior to transfusion; after transfusion it was between 24.8 and 56.7% (mean +/- SD, 42 +/- 10.4%). In six cases (43%) the waveforms were pulsatile prior to transfusion; in the other eight (57%) they were continuous. The pulsatile pattern was present following transfusion in 13 cases (93%, p < 0.05). The mean of the H/L ratio was 1.3 +/- 0.38 prior to transfusion and 2.0 +/- 0.86 after transfusion (p < 0.05). Because the portal vein has continuous non-pulsatile flow in the normal fetus, the presence of pulsatility in the waves of six anemic fetuses (43%) may suggest portal hypertension. Compared to normal fetuses, there was an increased number of cases with pulsation, and even more so after transfusion. The pattern corresponds to findings in children with portal hypertension.

Ultrasonographically adjusted midtrimester risk of trisomy 21 and significant chromosomal defects in advanced maternal age.

OBJECTIVE: Our purpose was to determine whether normal midtrimester ultrasonography results reduces the risk of fetal Down syndrome and any clinically significant chromosomal defects in pregnancies with advanced maternal age and to develop risk tables on the basis of age and ultrasonographic results. STUDY DESIGN: Biometry data were obtained in 4079 women between 15 and 24 weeks undergoing amniocentesis for maternal age. Expected values of humerus, femur, both combined, and abdominal circumference based on biparietal diameter were generated from a normal group. Observed/expected values of each parameter and nuchal thickness > or = 6 mm was used to screen for Down syndrome and any clinically significant chromosome defects. Receiver-operator characteristic curves were used to determine threshold screening values for each parameter. By use of stepwise logistic regression the optimal measurements for detection of chromosome anomalies were established. An abnormal ultrasonography result was defined as either abnormal biometry choroid plexus cysts or a structural defect. RESULTS: The finding of shortened humerus (observed/expected < 0.90), abnormal nuchal thickness, or an anatomic defect had the highest sensitivity for Down syndrome detection, 70.6%, p < 0.0001, whereas a short humerus, small abdominal circumference, (observed/expected < 0.92), or an anatomic defect had a sensitivity of 46.7%, p < 0.0001, for any significant chromosome defect. With a normal ultrasonography the risk of Down syndrome in a 39-year-old woman falls from 1:100 to < 1:292. CONCLUSION: A normal ultrasonography substantially reduces the risk of Down syndrome and any chromosome abnormality. This information is useful in counseling women who decline amniocentesis on the basis of maternal age.

[The use of ultrasonography in the prediction of first-trimester abortion]. / Utilizzo dell'ultrasonografia nella predittività abortiva del primo trimestre.

The prediction of spontaneous abortion in the first trimester is made possible owing to the use of two diagnostic procedures: maternal assay of some biochemical parameters and ultrasonography. However, the diagnostic value of ultrasound is greater than the former procedure since it enables the embryo to be visualized directly, measuring crown-rump length (CRL), together with the gestational sac whose diameter can also be measured (DSG). The present study aimed to verify the prediction of abortion given by the ratio between DSG and CRL measured using ultrasound in the first trimester of pregnancy, namely with signs of embryonic vitality already present. A prospective longitudinal study was performed in a population of 59 pregnant women attending the Obstetric and Gynecology Clinic of Trieste University during the period between April 1990 and April 1991. On enrollment in the study all patients had a gestational age of 8 +/- 2 weeks of amenorrhea. A preliminary measurement of DSG and CRL (t0) was then obtained and these measurements were repeated after four weeks (t1). The data obtained were first compared to each other for the same time (DSG0/CRL0 and DSG1/CRL1) and the relationship between the two ratios was then calculated ((DSG1/CRL1)/(DSG0/CRL0)). This method provides a sensitive method of analysing variations in the ratio between the two measurements taken at different moments. Inferential statistical principles were then applied. At the end of the first trimester the evolution or otherwise of pregnancy was assessed by examining and separating two groups of women: those who had had spontaneous abortions and those who had continued their pregnancies.(ABSTRACT TRUNCATED AT 250 WORDS)

[The donation of autologous blood in pregnancy. Observations on its safety and the cost-benefit relationship]. / Riserva di sangue autologo in gravidanza. Considerazioni sull'innocuità e sul rapporto costi-benefici.

Experience with the collection of autologous blood during the last part of pregnancy in 57 women is reported. The authors confirm the safety of the autologous transfusion program but come to the conclusion that, with current entrance criteria, the cost-benefit ratio seems unfavourable. Therefore they suggest: a) the sole involvement of women with real potential hemorrhagic complications (placenta previa, multiple pregnancy); b) the collection, when possible, of at least 2 units of autologous blood.

[The importance and limits of laboratory tests for evaluating the transplacental passage of fetal erythrocytes into the maternal circulation]. / Importanza e limiti dei test di laboratorio per valutare il passaggio transplacentare di emazie fetali nel circolo materno.

The KBB acid elution test is used to assess the presence and extent of transplacental passage of fetal cells into the maternal circulation both as a diagnostic aid in detecting hemorrhage before birth and in monitoring pregnancies at risk for hemolytic disease of the newborn. However the technique is ineffective when an hereditary Hb-pathy with associated increase in HbF is present in the mother, like the HPFH, delta-beta thalassemia and other hereditary abnormal hemoglobins. A mother with HPFH and another mother with delta-beta thalassemia with false positive result of the acid-elution test are described and the need for an extension of the clinical and laboratory study in families with hereditary HbF disorder is stressed.

[Fetal bradycardia during the second stage of labor. Study of 72 cases]. / Bradicardia fetale durante il secondo stadio del travaglio. Studio condotto su 72 casi.

The Authors analyse cardiotocographic patterns characterized by a constant frequency level below 120 beats/minute during the second stage of labour. Some aspects of "terminal bradycardia" (length, amplitude of oscillations, fetal heart rate in the 30 minutes preceding the onset of bradycardia) are related with the condition of the newborn (1st and 5th minute Apgar-score). Terminal bradycardia (Fischer 3, Melchior 2, 3 and 4, 2nd and 4th of Thiery) seems to have an unfavourable prognostic value especially when prolonged (more than 20 minutes), associated with low base-line variability and when cardiotocographic pattern previous to the fall of frequency is characterized by variable and late decelerations.

[Prediction of EPH gestosis by means of the roll-over test. Clinical contribution]. / Predizione della gestosi EPH mediante roll-over test. Contributo clinico.

Roll-over test (ROT) was performed on 128 selected nulliparous women between 28 and 32 weeks of gestation. Considering the high frequency of true-positive (81.5%) and true-negative results (88.1%), ROT seems to show, in clinical practice, a good sensitivity (64.7%) and an excellent specificity (94.7%). The and an excellent specificity (94.7%). The results of this study confirm that ROT is a true predictor of pregnant women at risk for future development of EPH gestosis.