Congenital heart disease in pregnancy.

The clinical cases of three patients affected respectively by Eisenmerger's syndrome, Marfan syndrome, coarctation of the aorta are described. All patients belonged to NYHA class I or II. During pregnancy contact with cardiologists, anaesthetists, neonatologists was maintained and this allowed accurate management. Both pregnancy and delivery evolved without any complication and with a positive outcome for mother and newborn.

Persistent foetal tachycardia as an early marker of chorion-amnionitis. Description of a clinical case.

Intra-amniotic infection (IAI) is uncommon in pregnancy (0.5-1%) and is rarely responsible for maternal mortality, but it does lead to a high rate of maternal and foetal morbidity, e.g. sepsis, septic shock, post-partum endometritis and neonatal sepsis. The diagnosis of IAI is immediate in the case of premature rupture of the membranes, whereas it is far more difficult to reach a correct and timely diagnosis when the amniotic sac is intact, as the mother's clinical symptoms are often scarce and non-specific. Foetal and maternal prognosis in IAI depends on the timely implementation of antibiotic treatment and induction of delivery in order to drain off the infected amniotic fluid. The clinical case described here not only illustrates the difficulty in diagnosing IAI, but also confirms that timely antibiotic therapy can prevent the onset of severe maternal and foetal complications.

Portal hypertension in a pregnant woman.

We report a case of a patient with long-standing prehepatic portal hypertension. The patient (a 43-year-old parous 2012 female with a history of 2 full-term pregnancies and normal deliveries, plus a spontaneous abortion) incurred spontaneous abortion at the 7th week of gestation. An early, spontaneous abortion avoided this patient running severe risks in late pregnancy. The overall estimated risk of bleeding in patients with portal hypertension, reported in the literature, is 400 times greater than in normal pregnancy. The association with aneurysm of splenic artery increases the likelihood of bleeding because intra-abdominal pressure adds to the risk of rupture of the aneurysms. In our opinion, a patient of fertile age, with pre-hepatic hypertension and associated chronic liver disease, should be treated with contraceptives to avoid any pregnancy-induced risk of complications.

[Diabetic nephropathy and pregnancy]. / Nefropatia diabetica e gravidanza.

Diabetes mellitus (or type 1) is a long-lasting disease (even twenty years or more) which causes kidney disease and, in the event of pregnancy, it can make differential diagnostic difficult even fort the most expert clinician. Metabolic changes caused by this type of diabetes (e.g., hypoglycemia, hyperglycemia, ketoacidosis) and their difficult compensation can often lead to the onset of eclampsia or convulsion. The diagnostic suspicion of diabetes is supported by the finding of proteinuria, edema and hypertension that are strictly correlated with the evolution of diabetic disease and sometimes exist prior to pregnancy. This cas report focuses on the diagnostic importance of clotting tests, especially in clarifying diagnostic doubts.

[Maternal anemia and fetal outcome. Authors's experience]. / Anemia materna ed outcome fetale. Nostra esperienza.

A physiological pregnancy in which the only pathological datum proved to be a computerised NST at the 40th week of pregnancy is reported. The NST trace showed evidence of fetal distress: absence of acceleration, short term reduced variability and deceleration of the fetal beat. On the basis of further traces, constantly pathological, and of the echographic evaluation of the fetal "outcome", with a biophysical profile which revealed oligohydramnios and absence of active fetal movement, Cesarean Section was undertaken, resulting in the birth of a baby girl of 3180 g, 50 cms, with Apgar 8/10. The clinical interest in this case arises from the total lack of pathological anamnestic data in the pregnancy, except, at a more accurate evaluation, anemia due to martial shortcoming of modest entity in the 1st and in the 2nd trimesters, worsening in the course of the 3rd after an episode of cystopyelitis. The message of the clinical case described is that immediate and careful evaluation of NST must be integrated in every case with obstetric anamneses, echographic and hormonal parameters, without a careful interpretation of routine hematochemical parameters.

[Collagenase IV and laminin receptors in cultured trophoblast cells]. / Collagenasi IV e recettori della laminina in cellule di trofoblasto in coltura.

Human trophoblast cells were obtained from a term placenta and cultured through several stages. Using specific antibodies marked using an avidin biotin system and given the characteristic "invasiveness" of placental tissue, the Authors investigated the possible presence of those markers which have been found to be correlated with invasive and metastatic tumour cells. The positivity shown by cultured trophoblast cells towards laminin receptors and collagenase IV may have important implications which might explain the strange formation and maintenance of the human uteroplacental circulation in which embryonal tissue is in direct contact with maternal blood.

[Diagnosis and treatment of cervical pregnancy. A clinical case]. / Diagnosi e trattamento della gravidanza cervicale. Caso clinico.

A personally observed case of cervical pregnancy is reported. The opportunity is taken to discuss the most recent views on the aetiopathogenesis and treatment of this rare but threatening pathology.

[Intrauterine death of one fetus in twin pregnancy]. / Morte endouterina di un feto nel corso di gravidanza gemellare.

A case of twin pregnancy complicated by intrauterine death of a foetus is reported. The most recent literature data on incidence, aetiology, diagnostic and monitoring difficulties (improved over the past few years thanks to echography) are discussed. Finally, prevention problems and the choice of therapy are examined, it being stressed that it is by now a widespread habit to close these pregnancies with Caesarean section as soon as the maturity of the surviving twin so permits.

Rapid method for cultured trophoblast cells identification.

The addition of human foetal cord serum to the culture medium improves the in vitro growth of human chorionic villi cells. The expression of HCG, laminin, laminin receptor, and type IV collagen has been studied on first passage (4-7 weeks) cultured villi cells by the immunoperoxidase method. No cells were positive for HCG, while various patterns of basement membrane markers were always detectable. The presence of laminin and collagen type IV excludes fibroblast contamination and can be used for a rapid trophoblast cells identification.