[The incidence of cesarean section and the means of delivery in women who have already had a cesarean]. / Incidenza del parto cesareo e modalità di parto di gravide già cesareizzate.

BACKGROUND: This study has taken into account the modalities of delivery during years 1983-1996 in the Department of Obstetrics and Gynecology of the "Spirito Santo" Hospital in Pescara. METHODS: Delivery methods of gravidae already subjected to a caesarean in the last seven years (1990-1996) have been examined and the single and multiple indications of a repeated caesarean have been analyzed considering also the modalities in dealing with the labour after a previous caesarean. RESULTS: The data obtained underline a minimum variability in the incidence of vaginal delivery, while among the operative deliveries, a marked reduction in the application of forceps and a more substantial rise of the caesarean in the last three years have been observed. CONCLUSIONS: The conclusion is drawn that the wide variability in the incidence of caesarean section among the several populations, as well as among the several Centres of the same population, is not justified and that in order to reverse this trend it is necessary to analyze the reasons for the use of a caesarean section, limiting such practice to particular indications. Moreover, it should always be taken into account the natural labour in women already subjected to one or more caesarean sections, in order to limit the operative delivery to necessary cases.

[Simultaneous intrauterine and tubal pregnancy. A clinical case]. / Simultanea gravidanza intrauterina e tubarica. Caso clinico.

The presence at the same time of intrauterine and ectopic (heterotopic) pregnancy is unusual. A case of acute abdomen by tubaric haemorrage in a patient with ectopic pregnancy and evolutive intrauterine pregnancy during first trimester is reported. After surgical therapy, the intrauterine pregnancy had a good evolution.