[Congenital factor XIII deficiency in pregnancy. A case report]. / Deficit congenito del fattore XIII in gravidanza. Esposizione di un caso clinico.

Congenital factor XIII deficiency is a rare hemorrhagic syndrome with an altered fibrin stability, hemorrhagic diathesis and habitual abortions. After a short introduction, a case report is described and the clinical differences between plasmatic and platelet deficiency pointed out.

[Clinical-diagnostic considerations of a case of endometrial ossification as a cause of secondary infertility]. / Considerazioni clinico-diagnostiche su un caso di ossificazione endometriale quale causa di sterilità secondaria.

Endometrial ossification is a rare finding. Its aetiology and pathogenesis are controversial. However a history of previous abortion is usually present. It has variable clinical presentations. We report a case in which the patient presented with secondary infertility.

[Current orientation about congenital Cytomegalovirus infection]. / Attuali orientamenti in tema di infezione congenita da Cytomegalovirus.

The CMV infection in pregnancy make serious problems about the diagnosis and the fetal prognosis. Infact primary infection by CMV is loaded by an high risk of congenital infection and the presence of antibodies IgG do not prevent a possible reinfection. Furthermore, the latent presence in the host of CMV induces his reactivation when the immunosorveillance decreases during pregnancy. The consequences of primary infection are well shown during pregnancy and they are very grave, but also the reactivations induce especially neurological consequences, that however are shown only after some months from delivery. Therefore in consideration of the prognosis and the poor therapeutics, the management in these cases is essentially to give minute details to the mother about all the consequences for the fetus without to exclude, because of serious sequels, so that just she can to decide the future of her pregnancy.

[Contraception and voluntary termination of pregnancy. Survey of a sample of 500 women]. / Contraccezione e interruzione volontaria della gravidanza. Indagine conoscitiva su di un campione di 500 donne.

In order to better evaluate the link between contraceptive attitudes and induced abortion, 500 women who underwent voluntary termination of pregnancy (VTP) at the First Institute of Obstetrics and Gynaecology of the University of Rome "La Sapienza" were interviewed. They were young (median age 28 years), medium to high educated (61%), non married (52.4%), nulliparous (59.2%) women. Forty-two percent of them had the first sexual intercourse before 18 years of age and 72.6% at least five years before. Ninety-five women (19%) admitted a previous voluntary termination of pregnancy. Withdrawal (305 women), oral contraceptives (246 women) and condom (223 women) were the most widely used methods of fertility regulation, but the pill had been taken only for short periods of time, never exceeding one year. Withdrawal resulted to be the most utilized method during the cycle in which conception occurred (49.4%); no method had been employed by 34.8% of the women. The diffusion of modern methods of fertility regulation greatly influences the number of induced abortions in Italy, as clearly indicated by the progressive reduction of VIP starting from 1982 paralleled by a constant increase in OCs diffusion. Our data, although limited in number, confirm that induced abortion is the consequence of an insufficient use of modern methods of fertility regulation.

[Pharmacological preparation of the endometrium in surgical hysteroscopy]. / La preparazione farmacologica dell'endometrio nell'isteroscopia operativa.

Danazol, GnRH analogues (GnRH-A), progestins and gestrinone have been indicated for medical pre-treatment of surgical hysteroscopy, although only danazol and GnRH-A had some clinical evaluation. Pre-hysteroscopic pharmacological preparation is, in general, intended to reduce endometrial thickness, intraoperative bleeding and the need for endouterine distension with fluid media. In addition, in case of endometrial ablation, medical pre-treatment should facilitate the complete removal of endometrium, thus allowing better long-term results. The mechanism of action of progestins, danazol and gestrinone is partly indirect, through inhibition of ovulation and mild reduction in the synthesis of gonadotropins, and partly direct, through, first, decidualization of the endometrium, and then complete inactivation. On the other hand, GnRH-A have only an indirect, central mechanism of action of inhibition, through pituitary desensitization, of the synthesis of gonadotropins, thus inducing a profound hypoestrogenism. GnRH analogues appear to be more effective and rapid than danazol at the endometrial level and better tolerated. However, the effectiveness of pre-treatment versus no treatment needs to be clearly demonstrated in well-designed controlled studies. No significant difference, so far, has been found between danazol and GnRH analogues in terms of both surgical safety and long-term results.

[Human papillomavirus infections in pregnancy]. / Infezioni da Human Papilloma Virus in gravidanza.

After an overview on the diffusion and transmission of the Human Papilloma Virus infection, the authors' attention is focused on clinical and therapeutic aspects of the disease. Following the most recent findings on congenital transmission, problems related to prophylaxis and therapy are discussed.

[The indications and need for diuretics in pregnancy]. / Indicazione e necessità dei diuretici in gravidanza.

The authors take into consideration specific cases of pregnancy with remarkable oedema caused by cardiac insufficiency, gestosis, pre-eclampsia and eclampsia. They emphasize that in these conditions and in other similar ones use of diuretics cannot be precluded. They report the case of a pregnant woman with severe cardiac insufficiency and considerable oedema observed at the Obstetric Clinical of Rome University. Thanks to diuretic therapy, the pregnancy could be followed through to full term.

[Use of anticoagulants in pregnant women carrying heart valve prosthesis]. / L'uso degli anticoagulanti in portatrici di protesi valvolari cardiache in gravidanza.

Prosthetic heart valves require permanent anticoagulant treatment. In the case of pregnancy, serious problems arise in that coumarin drugs lead to increased incidence of fetal death and malformation. On the other hand, the omission of anticoagulant treatment implies considerable risks of systemic embolism and even of maternal death. Review of the literature and the few cases published so far do not prove that antiplatelet agents are effective and safe and offer sufficient protection against thromboembolism. The use of heparin may reduce the incidence of complications. The authors come to the conclusion that women with prosthetic heart valves should be advised to avoid pregnancy. Biovalves should be applied in those who wish to bear children.