Pregnancy after heart transplant: update and case report.

A literature review of 22 cases of pregnancy following cardiac transplantation up to 1995 and a case report are presented here. A 30 year old woman, gravida 3, para 1, contacted us for obstetric care at 8 weeks gestation, about 55 months after orthotopic cardiac transplantation. The transplant had been performed for a familial dilative cardiomyopathy, which had become manifest during her previous pregnancy. The course of the current gestation was uneventful. The patient's cardiovascular function was good throughout the pregnancy. Immunosuppressive therapy, the dose of which was increased during pregnancy, included cyclosporine and azathioprine. Because of an increase in the patient's plasma uric acid concentration and an initial rise in her blood pressure, despite therapy, a repeat Caesarean section was performed at 37 weeks gestation. A female baby weighing 2330 g, Apgar scores 7/9, was delivered. Mother and infant were discharged on postoperative day 15 and are doing well 14 months postpartum. Through a review of literature and our case, the issues and problems related to pregnancy after a heart transplant are discussed, in particular the maternal-fetal risks, management, therapy, delivery, neonatal problems and follow-up postpartum of mother and baby.

[The emotive and cognitive reactions in temporary pharmacological menopause]. / Reazioni emotivo-cognitive in menopausa farmacologica temporanea.

The authors have attempted to evaluate the extent to which menopausal crisis is linked to hypoestrogenism and the extent to which it is linked to the socioenvironmental context in which it takes place. The study analyses emotional and cognitive aspects in a group of women in temporary menopause which was pharmacologically induced for therapeutic purposes. The study was carried out in 30 patients suffering from benign gynecological pathologies receiving ovarian steroidogenesis-blocking treatment. Treatment consisted of a subcutaneous administration of a Gn-Rh analog every 28 days for 6 months. After having collected information regarding the symptoms that appeared following the administration of therapy, the authors evaluated the emotive (anxiety and depression) and cognitive (short-term memory and concentration) conditions of patients using psychometric reactives performed during the first check-up, and then repeated at the 3rd, 5th and 7th control visit: the State-Trait-Anxiety-Inventory to assess trait anxiety and state anxiety; scale D of the Minnesota Multiphasic Personality Inventory to assess depression; the sub-test for memory of figures from Wechsler-Bellevue Intelligence Scale to evaluate short-term memory; the Toulouse-Pieron reactive to evaluate attention and concentration. The results obtained were analysed statistically using Student's t-test and Pearson's coefficient. An analysis of the data shows that, after the first doses of the drug stress trends to diminish from the high levels recorded at the first visit, stabilising at normal values throughout treatment. Like anxiety and depression, concentration and memory do not show marked variations.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pregnancy in HIV positive women: psycho-emotional aspects. Study of 16 cases]. / Gravidanza in donne HIV positive: aspetti psicoemotivi. Studio su sedici casi.

The aim of this study was to analyse the day-to-day life of HIV-positive women during pregnancy and to assess the emotions deriving from their relations with the baby during the first few months of life. The study was carried out on a group of 16 HIV-positive women aged between 19 and 37 years old (mean age 27.3 years) who underwent a guided interview using a questionnaire. The questionnaire, which was mainly based on questions requiring a free answer, focused on four main areas: 1) the woman's reaction to HIV-positive status; 2) the influence of HIV-positive status on relations with her partner and surroundings; 3) the interaction between pregnancy and the HIV-positive status; 4) the relation between mother and children after birth and during the first few months of life. 56.25% of the women interviewed had become infected by intravenous drug injection, 25% through heterosexual relationships and 12.5% through blood transfusions. The cause was unspecified in 6.25%. The women had been aware of their HIV-positive status for between one and four years. Their reactions to HIV-positive status were predominantly denial, condemnation, and depression accompanied by a sense of death, anxiety and of being different. Relations between couples were influenced in a variety of ways by the new situation: 4 women reported a diminished frequency of sexual relations, one women reported reduced libido, 10 women did not notice changes in sexual relations and one woman did not reply.(ABSTRACT TRUNCATED AT 250 WORDS)