[Prenatal medicine: from the obstetric stethoscope to the computerized telecardiotocography]. / La medicina dell'età prenatale: dallo stetoscopio ostetrico alla telecardiotocografia computerizzata.

The aim of this article is to illustrate the history of fetal auscultation from the 19(th) century, when the fetus was considered as an object and the obstetrician as a ''mechanic of the birth'', to the present age, when the fetus is a subject and the obstetricians have at their disposal all the means they need to confirm his well-being and to early diagnose his pathologies, even using prenatal telemedicine.

Effects of gonadotropin-releasing hormone agonists on uterine volume and vasculature and on the immunohistochemical expression of basic fibroblast growth factor (bFGF) in uterine leiomyomas.

We investigated the effect of the GnRH agonist (GnRH-a) on the uterine volume and on the immunohistochemical expression of basic fibroblast growth factor (bFGF) and the vasculature of leiomyomas. Twenty-five women were treated with leuprorelin acetate for 3 months; 46 untreated patients were enrolled as a control group. The uterine volume was measured by ultrasonography. After myomectomy or hysterectomy, the immunoexpression of bFGF and the endothelial marker, CD34, was studied and compared in treated and untreated leiomyomas. Uterine volume decreased after therapy. The number of cells expressing bFGF and the vascularity were diminished in treated leiomyomas. Reduction in the blood supply might be responsible, in part, for uterine-volume shrinkage after GnRH-a therapy.

[Prenatal telemedicine and teledidactic networking. A report on the TOCOMAT project]. / Telemedicina prenatale e teledidattica. Esperienza nel progetto TOCOMAT.

Telemedicine originates with the combined use of electromedical equipment, information technologies and telecommunication systems designed to improve healthcare by overcoming the limitations of time and space. Moreover, telemedicine also possesses greater didactic potential than instruction by traditional means. Teledidactic networking, both as e-learning and e-teaching, represents a new integrated system of computer-aided education for the development and management of distance learning programs. Our study evaluated the effectiveness of teledidactic applications in the first Italian project in conventional and computerized telecardiotocography (TOCOMAT). Five cardiotocography outpatient monitoring facilities were linked telematically to a university central operating unit to obtain computerized analysis of telecardiotocographic (CTG) tracings and specialist consulting. The peripheral site operators received theoretical-practical training in the function and use of the system, the guidelines for CTG tracing interpretation and the diagnostic-therapeutic protocols. Improvement in learning progress was observed in the reduction of technical errors in CTG recording and in the increased ability of the outpatient clinic staff to select, analyze and interpret test RESULTS. Results from the feedback questionnaires on the didactic impact of the project indicated objective improvement in the specific skills acquired by the physicians at these facilities. The findings also show that a well-structured distance learning course can improve clinical, technical and managerial skills and behavior of healthcare operators by promoting the kind of professional continuing education a modern medical school should provide.

[Hydatidiform mole with coexistent fetus. Cytogenetic features, diagnosis, and management]. / Mola idatiforme con feto coesistente. Aspetti cito-genetici, diagnosi e management.

Hydatidiform mole with coexistent fetus is an unusual entity caused by two distinct types of pregnancy: the first one is a partial hydatidiform mole, while the second is a twin pregnancy in which a mole coexists with a normal fetus. In these two separate genetic entities, the counseling and the mother-fetus prognosis are different. Two cases of mole with coexistent fetus are reported: a partial hydatidiform mole typically tripliod and a partial mole with unusual diploid karyotype. Prenatal diagnosis is remarkable for the evaluation of fetus development related with his karyotype. Triplody excludes all hope of a non-malformed surviving child and termination of pregnancy is desirable, while normal karyotype the possibility of a continuation of pregnancy may be considered.

Homocysteinaemia during pregnancy and placental disease.

OBJECTIVE: Hyperhomocysteinaemia, due to enzymatic defects or to the lack of some vitamin cofactors (vit. B6, vit. B12, folic acid), could be associated with obstetric disease. The aim of this study was to investigate placental disease in women with mild-moderate hyperhomocysteinaemia. MATERIALS AND METHODS: Blood samples of seven pregnant women with severe early onset preeclampsia were assessed for hyperhomocysteinaemia. The obtained values were compared with those of a control group. In all cases, tissue samples obtained from the placenta, umbilical cord and membranes were studied. One of the patients was treated empirically with folic acid during a subsequent pregnancy. RESULTS: Patient homocysteine plasma levels were higher than in the control group. In all cases several placental abnormalities were found. The patient treated with folic acid had a good pregnancy outcome. CONCLUSION: Hyperhomocysteinaemia during pregnancy could be responsible for placental abnormalities. Treatment with folic acid could improve pregnancy outcome in women with homocysteine metabolism abnormalities.