[Amniotic fluid analysis as a screening test in term and post-term pregnancy]. / La valutazione del liquido amniotico come test di screening nella gravidanza a termine ed oltre il termine.

BACKGROUND: To verify the hypothesis that isolated oligohydramnios in low-risk term or post-term pregnancy does not increase the risk of trauma to the fetus compared with a control group. METHODS: This prospective study compared a group of patients with low-risk pregnancy and oligohydramnios (AFI = or <50) and a control group which on ultrasonography performed 24 hours before delivery had an AFI volume >50 and = or <250 mm. The evaluation criteria included incidence of induction, modality of delivery and neonatal outcome. Statistical analysis was carried out using Student's "t"-test and the data set of categories was compared using the chi square test. RESULTS: From January 1997 to April 1999, 105 cases of oligohydramnios were compared with a control group (105 patients) matched for maternal age, gestation period and parity. The incidence of induction, fetal distress and variable deceleration was significantly higher in the group with AFI = or <50. The incidence of vacuum extractor, cesarean section, duration of labor and late deceleration did not differ between the two groups. No significant differences in neonatal outcome were found between the two groups. CONCLUSIONS: In patients with oligohydramnios without risk factors, the modality of delivery and neonatal outcome do not differ compared with those with normal amniotic fluid volume.

[Influence of the environment on perineal tears in physiological delivery]. / L'influenza dell'ambiente sulle lesioni perineali nel parto fisiologico.

INTRODUCTION: In the last decades there was a growing interest in new methods of delivery-assistance and in the literature appeared many new studies. This study shows an analysis of all physiological deliveries (581 women) at the Burresi Hospital of Poggibonsi (SI), Italy, in 1993. From 1984, in this hospital an experimental delivery-room (SPN), where new methods of delivery-assistance are tested (151 women in the period of study), has been used in parallel with a conventional delivery-room (SP)(430 women). RESULTS: The most important difference between the two environments is that in SPN the woman is free to choose her positions during all the phases of delivery. We have evaluated the effect of the different environments on the perineal outcome-intact perineum (41% SPN vs 32% SP), first-degree tears (32% SPN vs 21% SP), second-degree tears (23% SPN vs 21% SP) and mediolateral episiotomy (3% SPN vs 26% SP). Age of the woman, weight of the infant and parity appeared to be most important factors for perineal tears. The SPN reduces significantly the number of perineal tears, when allowing for the other factors. CONCLUSION: It was commonly felt that a reduction in the episiotomy-rate increases the number of perineal tears. Our study shows a protective effect for all levels of perineal outcomes associated with the natural delivery-room. However, for primiparous women a higher risk for first-degree tears is documented in the SPN and should be further evaluated. A selection bias cannot be excluded, due to the observational nature of the present investigation.