Association between endometrial senescent cells and immune cells in women with repeated implantation failure.

PURPOSE: The aim of this study was to compare women with recurrent implantation failure (RIF) and control group in terms of the associations between p16-positive senescent cells and certain types of immune cells in human endometrium during the mid-luteal phase METHODS: Immunohistochemical staining was performed in 116 endometrial biopsies taken from 57 women presenting RIF, and control group of 59 women who became pregnant after the first intracytoplasmic sperm injection. Endometrial tissue sections were stained immunohistochemically for p16 (Senescent cells), CD4 (T-helpers), CD8 (T-killers), CD14 (Monocytes), CD68 (Macrophages), CD56 (Natural killers), and CD79α (B-cells). The percentage of positively stained cells for each marker was calculated by HALO image analysis software. The quantity and the relationship between senescent cells and immune cells were assessed and compared between the two groups. RESULTS: The correlation coefficient was highest between senescent cells and CD4+ cells and was lowest between senescent cells and CD14+ cells in RIF women, similarly to the control group. However, most of the observed correlations among senescent and immune cells weaken notably or disappear in the RIF group. When comparing senescent cell-to-immune cell quantitative ratios, only p16+/CD4+ cell ratio was significantly higher in RIF women as compared with patients from the control group. CONCLUSION: Our study indicates that the quantity of senescent cells in human endometrium during the mid-luteal phase has the strongest association with the amount of T helpers. Moreover, the specificity of this association might have an important impact on the occurrence of RIF.

Interviewing children: the impact of the COVID-19 quarantine on children's perceived psychological distress and changes in routine.

BACKGROUND: The COVID-19 outbreak has resulted in governments implementing disease containment measures such as school closures, social distancing, and home quarantine. To date, only a few studies have drawn attention to the psychological impact of lockdown on Italian children's mental health. The present study aimed to investigate the psychological distress (anxiety and mood symptoms) and perceived changes in routine among Italian primary and middle school students during the COVID-19 quarantine. METHODS: This interview study was performed between the 18th of May and 7th of June 2020: it involved a sample of 82 children and adolescents living in Milan (Italy), attending primary and middle school (aged 6 to 14 years), and their parents. RESULTS: Almost 30 % of the subjects reported having struggled to adjust to home learning. 36 responders completely changed their dietary habits during the lockdown: they were not eating the same amount of food and were consuming more junk food. Sleep habits were also affected by the lockdown measures: 28 % of the sample had difficulties sleeping and wished to sleep in their parents' bed. Concerning psychological distress, 64 (78 %) children and adolescents had anxiety symptoms; 43.9 % of the students reported significant mood symptoms. CONCLUSIONS: Children are not indifferent to the dramatic impact of the COVID-19 epidemic: our data confirm their difficulties in adapting to the quarantine measures. The effects of stress exposure may not manifest later on during the children's development, and, for this reason, it would be interesting to follow up on these participants to improve our understanding of how long these outcomes may last.

Use of granulocyte colony-stimulating factor for the treatment of unexplained recurrent miscarriage: a randomised controlled trial.

BACKGROUND: Recurrent miscarriage (RM) is defined as the occurrence of three or more clinically detectable pregnancy losses in the first trimester. In most cases of RM, its aetiology remains unexplained. Granulocyte colony-stimulating factor (G-CSF), a cytokine, and its receptor are expressed in placental tissue. To investigate the effectiveness of G-CSF in preventing embryo demise, we administered G-CSF to women with RM. METHODS: A randomised controlled trial in women with RM treated with G-CSF or placebo was conducted in one private reproductive medicine clinic. Sixty-eight women with unexplained primary RM, all with at least four consecutive miscarriages and negative for all clinical investigations, were selected. Patients were randomized for s.c. treatment with G-CSF (n = 35) (1 microg/kg/day) starting on the sixth day after ovulation, or with placebo (n = 33). Patients were randomized using a computer-generated randomization number sequence. Pregnancy outcome (delivery of a healthy baby without major or minor malformations) was the primary outcome measure. RESULTS In the group treated with G-CSF, 29 out of 35 (82.8%) women delivered a healthy baby, whereas in the placebo group, this figure was only 16 out of 33 (48.5%) (P = 0.0061, odds ratio = 5.1; 95% confidence interval 1.5-18.4). Significantly higher beta-hCG levels were found in gestation weeks 5-9 in women treated with G-CSF versus placebo (P < 0.001). CONCLUSIONS: Our data show that G-CSF may be effective in the treatment of unexplained RM. However, further studies are needed to confirm the effectiveness of this treatment in women with unexplained RM, refractory to conventional treatment. The study was registered with a ICMJE recognized registry, the Clinical Trial.gov Protocol Registry System, with the number NCT00772122.

[Myoepithelial differentiation markers in salivary gland neoplasia]. / Marcatori di differenziazione mioepiteliale nelle neoplasie delle ghiandole salivari.

Salivary gland tumors frequently present myoepithelial cell differentiation that is not always easily identified on routinely stained sections. Recently novel markers of myoepithelium have been studied, such as calponin (CALP), caldesmon (CALD), and smooth muscle myosin heavy chain. These markers, together with smooth muscle actin may be useful tools for identifying myoepithelial cells. We immunohistochemically studied a series of 23 benign and malignant salivary gland tumors using antibodies to these four markers. The tumors were classified as follows: pleomorphic adenoma (n = 8), basal cell adenoma (n = 3), myoepithelioma with plasmacytoid cells (n = 2), epithelial-myoepithelial cell carcinoma (n = 6) and adenoid cystic carcinoma (n = 4). All tumors were positive for at least one of the four markers. CALP and smooth muscle actin were the markers more frequently expressed. Positivity was mostly located in the myoepithelial cells that constitute the external layer of the glandular or tubular neoplastic structures. In poorly differentiated epithelial myoepithelial carcinomas, composed of solid sheets of neoplastic cells and sometimes of clear cells, immunohistochemical staining for myoepithelial markers evidenced rudimentary glandular structures. CALP and smooth muscle actin were positive in the two cases of myoepithelioma with plasmacytoid cells. In conclusion, the combined staining with four markers helps to disclose myoepithelial cell differentiation and can be a useful tool for the correct histopathological diagnosis of salivary gland tumors. Among the four markers studied, CALP and smooth muscle actin were the most useful to identify myoepithelial cell differentiation.

Progesterone receptor expression in orbital cavernous hemangiomas.

Orbital cavernous hemangiomas (OCH) have thick and highly cellular vascular walls. Ultrastructural studies have demonstrated the smooth muscle nature of these cells. Vascular neoplasms can modify their morphological and clinical features under hormonal stimulation. The purpose of the present study was to investigate the presence of smooth muscle markers and sex steroid receptors in 12 cases of OCH. Orbital cases were compared with cutaneous hemangiomas and subcutaneous angioleiomyomas. Smooth muscle actin (SMA) and desmin were localized in spindle cells of the vascular walls of all 12 cases studied. OCH showed immunohistochemical positivity with progesterone receptor (PR) antibody both in smooth muscular and in endothelial cells. For comparison, sex steroid receptors were studied in 10 cases of cutaneous cavernous hemangioma and in 10 cases of subcutaneous angioleiomyoma. PR was found in smooth muscle and endothelial cells of 6 out of 10 cases of subcutaneous angioleiomyoma and in none of the cases of cutaneous cavernous hemangioma. No positivity was obtained with estrogen receptor (ER) antibody in any of the cases tested. The present data suggest that OCH share morphological and immunohistochemical features with subcutaneous angioleiomyomas. Furthermore, immunohistochemical positivity with PR antibody indicates that OCH have to be added to the list of mesenchymal lesions that express sex steroid receptors.

[Malignant myoepithelioma associated with in situ and invasive ductal carcinoma. Description of a case and review of the literature]. / Mioepitelioma maligno associato a carcinoma duttale in situ ed invasivo NAS. Descrizione di un caso e revisione della letteratura.

A case of malignant myoepithelioma of the breast, associated with in situ and invasive carcinoma NOS is described. Myoepithelial differentiation was demonstrated with immunohistochemistry and electron microscopy. The tumour affected the left breast of a 72 year old lady. The patient had been treated with quadrantectomy with axillary dissection, followed by radiotherapy. At the time of diagnosis no local or distant metastases were found. Bone, pulmonary and cerebral metastases appeared 28 months after treatment. Malignant myoepitheliomas share histological and immunohistochemical features with monophasic sarcomatoid carcinomas. Comparison and and possible relationship with monophasic sarcomatoid carcinomas is discussed.

Differential expression of IGF-I and IGF-II in eutopic and ectopic endometria of women with endometriosis and in women without endometriosis.

PROBLEM: Factors regulating the development, growth, and differentiation of endometrial cells of endometriotic lesions are poorly understood. To investigate the paracrine-autocrine regulation of ectopic endometrial cell growth, the expression of IGF-I and IGF-II were studied. METHOD: Tissue specimens of eutopic and ectopic endometria were obtained from eight patients with endometriosis at laparoscopy and from the endometria of 14 women without endometriosis as controls. They were tested for the expression of IGF-I and IGF-II by immunohistochemical analysis. RESULTS: Immunohistochemical study for IGF-I in controls showed a more intense staining during the proliferative phase both in stromal and epithelial cells. In eutopic endometria of women with endometriosis a reduction in the staining was observed, whereas in epithelial cells of fibrotic peritoneal adhesions an intense immunostaining for IGF-I was observed. Immunohistochemical study of IGF-II in controls showed a more intense staining during secretory phase both in stromal and epithelial cells. In eutopic endometria of women with endometriosis, a reduction in the staining was observed, whereas in epithelial cells of fibrotic peritoneal adhesions an intense immunostaining for IGF-I was observed. Immunohistochemical study of IGF-II in controls showed a more intense staining during secretory phase both in stromal and epithelial cells. In eutopic endometria of women with endometriosis, a reduction in the staining was observed, whereas in epithelial cells of ovarian lesions and fibrotic peritoneal adhesions, no immunostaining for IGF-II was observed. CONCLUSIONS: In endometriosis there is an alteration of mechanisms regulating cell proliferation and differentiation.

[Subcutaneous myolipoma with bizarre cells: morphological, immunohistochemical and ultrastructural study of a case and review of the literature]. / Miolipoma sottocutaneo con cellule bizzarre: studio morfologico, immunoistochimico e ultrastrutturale di un caso e revisione della letteratura.

A new case of subcutaneous myolipoma is reported. Grossly it appeared as a yellow-whitish nodule of 5.5 cm, in its major axis and showed well defined borders. Histologically the tumour was constituted by two components: areas of mature fat tissue were interminged with more cellular areas composed of bundles of spindle shaped eosinophilic cells, reminiscent of smooth muscle cells. In these latter component, cells showing multilobated, bizarre nuclei were also focally evident. No areas of necrosis, nor mitosis were found in both the components of the lesion. The immunohistochemical and ultrastructural findings revealed the myofibroblastic nature of the cellular myoid component of the lesion. The presence of myoid cells with bizarre, multilobated nuclei was considered expression of a regressive phenomenon, as observed in the so called "bizarre" leiomyoma of the uterus. Two years after the initial diagnosis the patient is well and free of disease. Soft tissue myolipoma is a benign lesion which has to be distinguished from lesions with malignant or uncertain biologic behaviour. The clinicopathologic features of the present case are discussed and compared to those of the previously reported cases of soft tissue myolipoma.

Systemic methotrexate treatment in early unruptured ectopic pregnancy.

Ectopic pregnancy is one of the most common and dangerous complications of the early pregnancy period. Until now diagnosis has been late because major symptoms occur after tubal rupture and so only demolitive surgery has been possible. At present, with the appearance of ultrasound in obstetrics an earlier diagnosis of this pathology can be made before tubal rupture so medical treatment has become possible. We treated a series of twelve patients with early ectopic pregnancy (9 tubal and 3 with no localized site of implantation) with intramuscular 0.5 mg/kg methotrexate and oral 0.1 mg/kg of folic acid (Citrovorum Factor) on alternate days, in the attempt to reduce hospitalization and obtain more effective and safer medical management. We observed a fall in serum beta-HCG levels after one cycle of treatment in 11 out of 12 patients and after two cycles of therapy in the remaining case. Minimal side-effects were observed in four cases. Three pregnancies occurred after treatment before the advised interval time and ended in blighted ovum. Methotrexate systemic therapy can be considered an elective treatment and a sufficiently safe management in early unruptured ectopic pregnancy when a good clinical selection of patients is performed.

[Sarcoid-like hepatic granulomas, associated with gastric neoplasia. Description of a case]. / Granulomi epatici sarcoido-simili, associati a neoplasia gastrica. Descrizione di un caso.

Giant cell granulomas in liver biopsies is a relative common finding. Among the many causes of granulomatous lesions of the liver primary biliary cirrhosis and sarcoidosis are the most frequently diagnosed. On the other hand sarcoid-like granulomatous reaction can be encountered associated to malignant tumours. Purpose of the present paper is to describe a case of a sarcoid-like reaction of the liver associated to gastric adenocarcinoma. The patient was a 66 yr old man who underwent gastrectomy for a signet-ring cell adenocarcinoma. Pathological anamnesis was unremarkable. Liver function tests were within normal limits. Chest x ray was normal. A liver biopsy was performed during surgery as the liver presented an irregular surface. On histology giant cell granulomas with sarcoid-like features were seen in the hepatic parenchyma. Same reaction was present in the perigastric lymph nodes. The patient died immediately after surgery due to massive pulmonary embolism. No autopsy was performed. Among the possible diagnoses primary biliary cirrhosis, sarcoidosis and paraneoplastic sarcoid-like granulomatous reaction were considered. Primary biliary cirrhosis and sarcoidosis were excluded on the basis of the past clinical history of the patient, that was unremarkable; furthermore liver function tests performed preoperatively were within normal ranges. Thus paraneoplastic sarcoid-like reaction involving the liver was regarded as the most likely diagnosis.

Breast cancer necrosis following fine needle aspiration biopsy.

Two cases of mammary carcinoma with nearly complete coagulative necrosis following fine needle aspiration biopsy (FNAB) are described. Although this occurrence rarely complicates a fine needle aspiration procedure, it seems to be a real possibility. Final diagnosis can be problematic and rests on the reassessment of the previous aspirate material, on the ghost architecture outlines of the infarct tumorous lesion and on any viable tissue left at the periphery of the lesion.

HLA antigen sharing in Italian couples in which women were affected by gestational trophoblastic tumors.

PROBLEM: The development of gestational trophoblastic tumors (GTT), in which genetic factors are strongly involved, is a rare event. To test the possibility that gene(s) linked to the Major histocompatibility Complex (MHC) may have a role in both embryo growth and tumor development, the HLA typing was performed on patients affected by GTT and on their partners. METHOD: The study group of sixteen couples, in which the women were affected by an invasive mole or choriocarcinoma, and the control group of thirty normal fertile couples without history of spontaneous abortion or GTT were typed for class I and class II HLA antigen. RESULTS: The results showed no differences in single HLA-A and B antigen frequency between GTT couples and controls. In HLA-DR, locus an increased frequency of DR-6 antigen was observed (p < 0.05). No differences were observed in the frequency of number of antigens shared. When considering the single locus no differences were found in the sharing of the antigens of the A and B locus, while the frequency of antigenic sharing for DR locus was significantly higher in GTT couples with respect to controls (p < 0.025). Furthermore a higher frequency of Bw35-DR5 antigenic combination was found in GTT partners than in controls (P < 0.02). CONCLUSIONS: These data represent a confirmation of the existence of a MHC linked gene(s) influencing the GTT development.

Influence of histocompatibility antigens in recurrent spontaneous abortion couples and on their reproductive performances.

PROBLEM: To determine if human leukocyte antigens (HLA) play any role in the aetiology of recurrent spontaneous abortion (RSA), a substantial group of RSA couples were studied, and their reproductive performances in a 3-year follow-up recorded. METHODS: HLA typing was performed for HLA-A, -B, and DR antigens in both partners of 75 couples with unexplained RSA, and compared with a control group of 30 fertile couples that never experienced abortion. A further 57 couples of this group were studied for their reproductive performance in a 3-year follow-up, and subdivided into three subgroups: 1) couples that achieved successful pregnancy during the follow-up, and subdivided into three subgroups: 1) couples that achieved successful pregnancy during the follow-up; 2) couples that experienced abortion and no livebirth during the follow-up; and 3) couples that experienced infertility during the follow-up. RESULTS: There were no significant differences for antigen frequency in all the different HLA loci, and HLA antigen sharing between all the RSA couples and controls. Significant increase of sharing for HLA-DR locus was observed in the couples that aborted during the follow-up with respect to the couples that achieved livebirth and controls (P < 0.03 and P < 0.02 respectively), and significantly increased frequency of B44, DR5 antigen combination in the same comparison (P < 0.03). No significant differences were observed in terms of the interval between conceptions in couples without antigen sharing with respect to couples with 1, 2 or more antigens shared, and antigen sharing in Locus A, B or DR. CONCLUSIONS: The results suggest that gene(s) disadvantageous for reproduction may exist between the HLA-B and -DR chromosomal region which influences the pregnancy outcome in RSA couples, and that HLA-antigen sharing itself does not influence the outcome.

Serum lipoperoxide level variations in normal and luteal phase defect cycles.

A luteal phase defect (LPD) is a clinical problem leading to infertility and is characterized by reduced progesterone levels during the luteal phase. Serum lipoperoxidation is an expression of cellular hypoxic damage occurring under all stress-oxidative conditions. Forty-eight consecutive infertility patients, according to the infertility class II of the WHO classification, underwent clinical observation. Twenty-five patients ovulated constantly with a normal luteal phase, while the other 23 had a LPD, hormonally and histologically assessed. The luteal phase was monitored biochemically by titration of progesterone, oestradiol, and serum lipid peroxides during the ovulatory period and 6-12 days after ovulation. The mean plasmatic concentration of oestradiol was not statistically different between the LPD and the normal-cycle groups, while a statistically significant difference was found for progesterone plasmatic concentrations between the LPD and the normal-cycle groups (p < 0.05); a greater statistical difference was also found in the mean serum lipoperoxide titration (p < 0.001). These findings suggest that serum lipoperoxidation titration may be a useful tool in the study of the interactions between hormonal milieu and sympathetic activity.

Semen parameters and sperm morphology in men in unexplained recurrent spontaneous abortion, before and during a 3 year follow-up period.

To investigate the role of the 'male factor' in the pathogenesis of recurrent spontaneous abortion (RSA), especially sperm morphology abnormalities, 120 previously selected couples with unexplained RSA were studied for sperm parameters retrospectively and prospectively. The patients were subdivided into three subgroups, depending on their reproductive outcome during the 3 years of follow-up study: (i) 48 RSA couples who achieved a successful pregnancy; (ii) 39 RSA couples who experienced further abortions, and (iii) 33 RSA couples who experienced infertility during the follow-up period. A semen analysis was performed twice at the time of inclusion in this study, and twice again during the 3 year follow-up period. No significant differences in semen parameters were observed between RSA males and fertile controls. Instead, significant differences were observed between the group of RSA couples who experienced infertility during the follow-up and the other two groups (RSA couples who achieved successful pregnancy and RSA couples who experienced miscarriages and no live birth during the follow-up) for sperm concentration (P < 0.01 and P < 0.01 respectively), sperm motility (P < 0.01 and P < 0.01 respectively) and sperm morphology abnormalities (P < 0.01 and P < 0.01 respectively). Sperm morphology abnormalities do not seem to be involved in determining RSA; instead, they are an aetiological factor in determining infertility in patients, along with the other semen parameters, in the RSA couple's subsequent reproductive life. Semen analysis is an important test in the clinical management of RSA couples.

Transvaginal ultrasonographic diagnosis of adenomyosis in female patients suffering from uterine fibromatosis.

Adenomyosis is an underestimated pathology frequently responsible of unknown origin pelvic pain and uterine enlargement. It is hyperestrinic condition with poor specific symptomatology and preoperative diagnostic tools are very few. The most important of them, ultrasound, has improved its diagnostic capacity with the introduction of transvaginal way of examination. However, for the ultrasound resemblance, the common etiopathogenetic origin and the symptomatologic likeness between adenomyosis and uterine leiomyomatosis, a problem still open is the differential diagnosis between these two pathologies especially when both are present in the same subject. In our study where the preoperative ultrasound was followed by surgical finding, we try to give some ultrasonographical guidelines to discern among these two pathologic conditions.

[Inflammatory pseudotumor of the urinary bladder. Study of 4 cases and review of the literature]. / Pseudotumore infiammatorio della vescica urinaria. Studio di 4 casi e revisione della letteratura.

INTRODUCTION: Inflammatory pseudotumour (IPT) of the urinary bladder is a benign proliferative lesion which can simulate clinically and histologically a sarcoma. Aim of this study is to report four new cases and to review the literature. CASES: Two patients were male, aged 2 and 4 years respectively (cases 1 and 2); cases 3 was a 26 year old woman and case 4 was a 40 year old man. Three patients presented with gross haematuria. One patient (case 4) presented with abdominal pain. On cystoscopy all the lesions presented as polypoid masses, ranging from 0.5 to 3 cm. in greatest axis. All patients were treated with conservative surgery. Case 1 died of unrelated causes 7 years later; at autopsy no evidence of residual bladder lesion was found. All the remaining three patients are alive and free of disease 8, 4, and 3 years respectively. RESULTS: On histology all the lesions had similar features. They were characterized by a submucosal growth of spindle cells with little pleomorphism, immersed in abundant myxoid stroma. In all cases immunoreactivity with vimentin was obtained; smooth muscle actin was focally positive in two cases and cytokeratin in one case. Bladder muscular wall was involved in three cases. CONCLUSION: The present four cases showed same histological and immunohistochemical feature of the IPTs previously described in the literature. IPT of the urinary bladder must be differentiated from malignant lesions such as rhabdomyosarcoma, leiomyosarcoma, inflammatory fibrosarcoma, sarcomatoid carcinoma. Differential diagnosis is based mainly on the characteristic histological picture of IPT. Immunohistochemistry can be misleading as IPT shares in common with those malignant conditions, positivity with some markers, such as desmin with rhabdomyosarcoma and cytokeratin with sarcomatoid carcinoma.

Use of new biologic markers in the ovulation induction.

Biological markers of ovulation, after a great in the past, have been fallen into disuse for the large diffusion of biochemical and biophysical ones. However, the real effect of hormones involved in ovulation is expressed by biological modifications on target tissues. To explore the modifications of not reproductive target tissues as ovulation markers we studied the behaviour of Albuminemia, Platelet Factor IV (as indicator of Platelet Aggregation), Type II estrogenic receptors in 42 ovulation induced women, undergoing our observation. 33 of them had ovulation and 9 developed a LUF syndrome, constituting two biological models of an opposite situation for the three markers observed. All the markers considered were sufficiently sensitive, but among them, Platelet Factor IV was the most reliable to the hormonal ovulatory situation.

Serum CA 125 and first trimester abortion.

OBJECTIVE: The study was carried out to assess the clinical value of serum CA 125 in association with serum beta-human chorionic gonadotropin (hCG) for predicting pregnancy outcome. METHODS: One hundred spontaneous pregnancies, 52 non-threatened pregnancies and 48 with threatened abortions, observed in the Department of Obstetrics and Gynecology at the University 'La Sapienza', Rome, Italy, were evaluated during the first trimester using ultrasound examination, CA 125 and beta-hCG titrations. RESULTS: Threatened pregnancies had statistically significantly higher CA 125 serum values than non-threatened pregnancies, especially those with a negative outcome (P < 0.01). The CA 125 levels in the threatened pregnancies were positively correlated with the tropho-decidual hematoma volume (r=0.839, P < 0.0001). The CA 125-beta-hCG association showed a higher prognostic value (sensitivity 78.9%, specificity 96.5%) in assessing pregnancy outcome than CA 125 or 0-hCG alone (sensitivity 78.9% and 57.9%, respectively; specificity 75.8% and 86.2%, respectively). CONCLUSIONS: Our findings are in accordance with the hypothesis of a tropho-decidual origin of this marker, suggesting its possible usefulness in the prognostic evaluation of first trimester threatened abortion.

Preterm labour and neonatal parameters.

OBJECTIVES: Our objective was to identify those neonatal factors associated with survival in preterm infants. MATERIAL AND METHODS: We examined a population of 457 preterm newborns delivered between 1 January-31 December 1990, with birthweight between < 1000 gr and > 2000 gr, in respect to umbilical pH values, plasmatic glucose values, 5-minute Apgar score and gestational age. Data were abstracted from the maternal intrapartum records and the neonatal records, with specific attention to neonatal parameters. RESULTS: A positive correlation between birthweight and 5-minute Apgar score, between birthweight, pH and glucose values was noted. No such relationship existed between pH values and 5-minute Apgar score. Within birthweight groups the distribution of neonatal mortality rate was 85.18% in ELBW (Extremely Low Birth Weight) and only 5.26% in LBW (Low Birth Weight). CONCLUSION: The importance of the echographic estimate of the fetal weight must be emphasized, since a birthweight of 1500 gr represents the cut-off for the neonatal morbidity and mortality, and also an accurate clinical evaluation of the risk of preterm labour or pathologies in order to improve the estimate of childbirth timing.