A randomised placebo-controlled trial of ursodeoxycholic acid and S-adenosylmethionine in the treatment of intrahepatic cholestasis of pregnancy.

A randomised placebo controlled study was performed in 32 women with intrahepatic cholestasis of pregnancy. The population was divided into four groups: for 20 days each group was treated only with ursodeoxycholic acid, or S-adenosylmethionine, or a combination of both drugs, or a placebo (vitamin). Itching, standard liver function tests and serum total bile acids were measured before, during, and after treatment. Itching improved in all the women as well as the biochemical abnormalities. No side-effects in the mother or in the infant were recorded during and after therapy. A combination of ursodeoxycholic acid and S-adenosylmethionine is more effective than placebo and than either drug alone.

Ursodeoxycholic acid therapy in pregnant women with cholestasis.

OBJECTIVE: To test the efficacy and safety of ursodeoxycholic acid (UDCA) in the treatment of intrahepatic cholestasis of pregnancy (ICP) by a randomized, double-blind, placebo-controlled trial. METHOD: Eight patients with pruritus and abnormal liver function tests received 600 mg/day of UDCA in two doses for 20 days, compared with a control group of eight patients who received placebo for 20 days. RESULTS: No adverse reactions were detected in any patient. During UDCA therapy a statistically significant improvement in pruritus, serum bile salt levels, serum glutamic pyruvic transaminase, alkaline phosphatase, gamma-glutamyl transpeptidase and total and direct bilirubin was observed. Only two patients treated with UDCA underwent cesarean sections due to reasons unrelated to the therapeutic trial. All newborns had an Apgar score >7 and normal postnatal growth. CONCLUSION: Although the number of patients in this study was very small, we suggest that UDCA treatment has a role in improving clinical and biochemical results in ICP.

Development of melanoma throughout two close pregnancies. Case report.

Primary melanoma is the most malignant and the least frequent of all cutaneous tumors. Its incidence in pregnancy varies from 0.1 to 2.8/1000. Up to today, impact of pregnancy on melanoma's course is still a much debated question in the literature. Some earlier reports suggested a particularly serious prognosis for melanoma associated with pregnancy, while more recent studies show that pregnancy may influence relapses without significantly altering survival. This paper reports the case of a woman affected by melanoma, whose clinical conditions became more and more serious during her second pregnancy and the following puerperal period. The progressive impairment of her clinical condition has suggested a correlation between the two close pregnancies and the unfavourable course of her disease.

Long-term follow-up of women with amenorrhea-galactorrhea treated with bromocriptine.

The present study is aimed at investigating whether long-term use of bromocriptine on patients affected by amenorrhea and galactorrhea may improve the clinical picture after discontinuation of treatment. For this reason 26 patients with amenorrhea and galactorrhea have been studied. Sixteen had high PRL values and 10 were normoprolactinemic. The normoprolactinemic patients underwent a TRH test. All the patients underwent computed skull axial tomography (CT scan) and were treated with bromocriptine, at a daily dosage variable from 2.5 to 10 mg for an average period of 26 months. After discontinuation of treatment, follow-up was carried-out for 20 months. Eighty-seven percent of the patients affected by amenorrhea, galactorrhea and hyperprolactinemia had regular menses, in 75 of the patients galactorrhea completely disappeared. Of the ten patients with normoprolactinemic amenorrhea and galactorrhea, only those who positively responded to the TRH test had regular menstruation and showed disappearance of galactorrhea. Upon discontinuation of treatment amenorrhea recurred in 68% of the cases whereas galactorrhea recurred in 80%. CT scans revealed disappearance of 3 microadenomas and reduction in size of the macroadenoma. Long-term use of bromocriptine represents the first choice treatment for the syndrome of galactorrhea-amenorrhea. In case of relapse, treatment must be continued for an undefined period of time.

Induction of multifollicular growth in patients non responding to clomiphene citrate and gonadotropins or gonadotropins only.

OBJECTIVE: We aimed at inducing multifollicular recruitment in patients with chronic anovulation-resistant to Clomiphene Citrate (CC) and/or exogenous gonadotropins. DESIGN: At the II Department of Obstetrics and Gynecology we treated our patients with exogenous gonadotropins and concomitant endogenous gonadotropin suppression obtained by the use of a GnRH analog (Buserelin). PATIENTS: We studied 14 patients with chronic anovulation due to either hypothalamic dysfunction or polycystic ovarian syndrome. MEASUREMENTS: We monitored the follicular growth ultrasonographically from the eighth day of the menstrual cycle, and assessed E2 and LH daily dosage from the tenth day. RESULTS: With this protocol we obtained 2 or 3 mature follicles, and reached an ovulatory rate of 80.7% and a pregnancy rate of 71.4%. Premature luteinization never occurred, and progesterone increase took place only after human chorionic gonadotropins administration.

Relationship between some maternal haemato-clinical parameters and low neonatal weight. Preliminary study.

In a selected group of pregnant women we studied the influence of specific haematoclinical maternal factors (age, pre-pregnancy weight, pregnancy weight gain, blood pressure, haematocrit (HTC), haemoglobinaemia (Hb), platelets (PTL), uricaemia) on neonatal weight. The results show an association among pre-pregnancy low maternal weight, hypertension and low neonatal weight. The uricaemia behaviour and the role of PTL, Hb, HCT are uncertain.

Bari district birthweight study: comparison with the Bristol perinatal growth chart.

We studied the neonatal weight distribution of 15,298 newborns from the Bari District at various gestational ages by the 10th, 50th, and 90th percentiles. After analysis, we constructed a growth chart following the method of Dunn. By comparing our results with those of Dunn's Bristol Perinatal Growth Chart, we found a weight difference of +4.5% in our population. This difference may be related to ethnic as well as socioeconomic factors.

Hyperparathyroidism in a pregnant woman with previous thyroid carcinoma. Case report and review of the literature.

A 29 year old woman, primipara, at 26 weeks' gestation had been undergone, five years before, a total thyroidectomy owing to a mixed papillary-follicular carcinoma of thyroid. After thyroidectomy the patient was placed on suppressive thyroxine treatment. Since she was 22 years old she suffered from recurrent renal colics and cholelithiasis. For these reasons she underwent, at the age of 27, an operation to remove bilateral renal calculi and a cholecystectomy owing to gall-stones. During her pregnancy biochemical determinations revealed slight and persistent hypercalcemia, hypophosphatemia, elevated urine calcium besides elevated serum parathyroid hormone (PTH) levels. Thus a diagnosis of primary hyperparathyroidism was taken into consideration. It was considered, but temporarily delayed, the surgical exploration of the neck. A strict clinic overseeing of the patient, which allowed her to carry out the pregnancy happily, was undertaken. Any thyroid carcinoma repercussion on pregnancy was not noted. A left inferior parathyroid adenoma was removed five months after the woman's delivery. The child psychosomatic development, at one year of age, was absolutely normal. A review of the literature indicates that when a pregnancy is complicated by hyperparathyroidism its prognosis is improved by parathyroidectomy, if possible during the second trimester. In patients with asymptomatic hypercalcemia and/or in late pregnancy surgical treatment may be postponed until after delivery. It is also demonstrated that thyroid carcinoma is not aggravated by pregnancy and that the latter can develop without any worry for mother and fetus.

Detailed ultrasound as a screening method for craniospinal abnormalities.

High resolution diagnostic ultrasound was assessed as a screening method for craniospinal anomalies during the second trimester of pregnancy in a population at low risk for neural tube defects (83,403 mothers). The effectiveness of the test was about 60% and the failure rate mainly due to late attendance. In a subgroup (9325) where the screening purposes were satisfactorily fulfilled, the detection rate (87%) was substantially greater. The significance of the results and the cost/benefit ratio, especially compared with serum alpha-feto protein screening services, are then discussed.

[Effect of maternal anxiety (unrest) on the health status of the fetus]. / Untersuchungen über den Einfluss der mütterlichen Angst (Unruhe) auf den Gesundheitszustand des Fetus.

The aim of our study was to clarify the question, to what extent the anxiety of the gravida during gestation is capable to influence the fetal condition.--For that reason, besides of a statistical analysis of a standardized interview the basal heart frequency and the reaction in a non-stress CTG over 20 min has been examined. The data of 101 women between the 36th and 42nd week of gestation were included. The age of our patients ranged from 20 to 30 years.--For assessment of the degree of anxiety we used the STAI X-1 test (questionnaire for self-assessment of anxiety as condition and characteristically personal property, resp.). Cases of pathologic gestation were excluded by history and a carefully clinical examination. No significant correlations between the level of anxiety and fetal condition could be demonstrated. We detected only a slight tendency of decreasing heart-rate variability and increasing frequency of accelerations in the CTG, as well as an increase of active fetal movements with a raising maternal level of anxiety.