"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.

[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.

[Functional evaluation of the perineum in pregnancy. Hypertonia of the levator ani muscles]. / Valutazione funzionale del perineo in gravidanza. L'ipertonia dei muscoli elevatori dell'ano.

In this study, the role of "levator ani muscles hypertonia" among pathogenetic factors of perineal obstetric injuries is analysed. For this purpose, clinical data of 142 pregnant women, who underwent functional evaluation of perineum during pregnancy and 30 days after delivery were examined. Data here reported are not sufficient to confirm the importance of this factor within the pathogenesis of postpartum perineal deficiency. Levator ani hypertonia on one hand seems to be able to obstruct fetal progression, on the other hand it presumably constitutes, as an expression of a good voluntary control of perineal muscles, a favourable prognostic factor.

[Functional evaluation of the perineum in pregnancy. Inversion of control]. / Valutazione funzionale del perineo in gravidanza. L'inversione del comando.

This study concerns clinical data of 142 women, who were subjected to functional evaluation of perineum during the last part of pregnancy. The 16 cases characterized by synergic activation, during the examination of perineal muscles ("perineal testing"), of antagonist muscles ("inverted control"), were examined taking into account data regarding evolution of labour and perineal outcome. "Inverted control" seems to influence, in this study, length of the second stage and frequency of operative deliveries whereas we can't confirm the importance of this disorder within pathogenesis of perineal obstetric complications.

[Monitoring of protracted pregnancy. Comparison of two methods]. / Monitoraggio della gravidanza protratta. Due metodiche a confronto.

Antepartum cardiotocographic patterns (NsT:Nonstress Test) and echographic assessments of amniotic fluid pockets were retrospectively analysed in 63 postdate pregnancies. The results of NsT (Fisher-score) and ecographic examinations were correlated with obstetric outcome (5 minutes Apgar-score). Ecographic assessments of amniotic volumes seem more effective than NsT for the lower frequency of false-positive results. Anyhow, considering the low sensibility of NsT and Echography separatedly considered, the Authors suggest a simultaneous valuation of the two tests.

[Oligoamnios in protracted pregnancy. Cardiotocographic aspects]. / L'oligoamnios nella gravidanza oltre il termine. Aspetti del cardiotocogramma.

Ecographic assessments of amniotic fluid volumes and their relationship to ante-partum cardiotocographic patterns were retrospectively analyzed in 59 postdate pregnancies. Sonographic evidence of oligoamnios is significantly related with absence of sporadic accelerations and rarity of fetal movements.

[Therapeutic proposals in vulvar dystrophy and burning vulva]. / Proposte terapeutiche nella distrofia vulvare e nella "burning vulva".

The paper reports the results of 80 cases of vulvar dystrophy and 11 cases of burning vulva. The Authors put forward a protocol for therapy which also aims to provide the basis for a comparative study of this pathology about which little is known from a clinical and research point of view.

Our experience with direct intraperitoneal insemination (DIPI) as a treatment for infertile couples.

The therapeutic value of Direct Intraperitoneal Insemination (DIPI) is of particular interest in cases of unexplained infertility and failed AID. The same technique is less likely to be successful where functional or morphological semen abnormalities or multifactorial infertility exist. The Authors report their own experience with DIPI as a treatment on 76 couples with a long-standing infertility.

[Static anomalies of the pelvis caused by labor. Maternal weight increase during pregnancy as a risk factor]. / Le anomalie della statica pelvica conseguenti al parto. L'incremento ponderale gravidico materno quale fattore di rischio.

In this retrospective study, the role of Gravidic Maternal Ponderal Increase (GMPI) within pathogenetic factors of perineal obstetric injuries, is analysed. TO this purpose, clinical data of 58 puerperae, who underwent a functional evaluation of perineum 30 days after delivery, were examined. The results of this study seem to indicate an autonomous pathogenetic role of GMPI, besides the indirect relation deriving from the association with other risk factors (age, parity, diabetes, fetal megalosomia, ecc).