[Assisted labor among non European community pregnant women at the Gynecology and Obstetrics Clinic of the Verona University]. / L'assistenza al parto per le gestanti extracomunitarie presso la Clinica Ginecologica e Ostetrica dell'Università di Verona (1992-1998).

BACKGROUND: The aim of this paper is to evaluate the role and the prevalence of the non-European Community pregnant women in our Institute during the period 1992-1998. The peculiarity of the female immigration in the world and particularly in Italy is stressed from the point of view of the different cultural, ethnic and religious problems of these women. METHODS: During the observed period 8972 women delivered; 434 of them came from non-European Community countries and their individual (age, country) and obstetric (parity, physiological or pathological evaluation of pregnancy, mode of delivery) data were observed. On the basis of the different countries of provenance these women have been subdivided into five groups (East Europe, North Africa and Middle East, Central Africa, Far East and Latin America). RESULTS: The percentages of preterm births (24.2% vs 23.1%), of < or = 1500 g newborns (6.9% vs 5.3%) and of caesarean sections (34.3% vs 27.7%) are higher in the non-European Community women that delivered in our Institute. In 222 (51.1%) cases the women delivered without induction of labour; while in 14.5% of cases it was induced. The length of labour and the genital conditions (episiotomy, tearing) were considered in all ethnic groups of women. CONCLUSIONS: On the basis of the literature and of the analysis of our data, some suggestions about the management of labour and delivery of non-European Community women in Italy are proposed. In particular, the problems of linguistic communication and of the hospital staff preparation in the assistance to labour and delivery are stressed.

[Fatty acid composition of the cervical mucus obtained during ovulation and at the term of pregnancy]. / Composizione in acidi grassi del muco cervicale prelevato in periodo ovulatorio e al termine della gravidanza.

BACKGROUND: Aim of this work is to evaluate the different fatty acid composition of cervical mucus obtained during ovulation and at the term of pregnancy. METHODS: The fatty acid composition in cervical mucus was determined in 14 non pregnant women during expected ovulation (cervical score > 10) and in 12 at term pregnant women. Following extraction, (acidification and transesterification), the identification and quantification of fatty acids was performed by gas-chromatographic analysis, with the aid of a specific software. RESULTS: In both groups of samples, palmitic acid, stearic acid and oleic acid were the prevalent acids comprising more than half of the total amounts. Compared to non pregnant samples, in pregnant cervical mucus, elevated levels of oleic acid were pointed out, while mean levels of miristic acid and stearic acid were lower. In the samples of cervical mucus drew at the term of pregnancy, arachidonic acid levels mean values were higher when the first period of labour was started. CONCLUSIONS: The pregnancy-induced biochemical changes in fatty acid pattern could likely be correlate to the variations of the physiochemical properties and to the physical appearance that cervical mucus undergoes during pregnancy. The elevated levels of arachidonic acid, during the first period of labour, may be correlated with prostaglandin production by intrauterine tissues (amniotic fluid, amnion, chorion, decidua, myometrium) and probably by cervical mucus.

Fetal macrosomia and management of delivery.

During the period 1988-1966, 737 pregnancies, in which the infant birth weight was > or = 4000 grams were studied. During the same period there were 11,631 newborns, and 6.3% of them were infants with a birth weight > or = 4000 grams. Normal vaginal delivery occurred in 583 cases (79.1%), vacuum extraction in 24 cases (3.3%) and caesarean section in 130 cases (17.6%). Regarding the caesarean section, 38 (29.2%) of them were elective and 92 (70.8%) were done in different periods of the labour. In these macrosomic babies perinatal death never occurred, but different pathological neonatal outcomes were observed and the majority of these were clavicle abruptions (39 cases: 5.3%). Maternal morbidity observed in the 607 (82.4%) cases with vaginal delivery is characterized by: 60 cases (9.8%) of vaginal and perineal tears, 4 cases (0.6%) of cervical tears, and 2 cases (0.3%) of pubic symphysis traumatic diastasis. Shoulder dystocia is the most likely outcome in fetal macrosomic delivery; for this reason we considered the diagnostic and therapeutic management of this obstetrical complication. Because the normal outcome of neonatal births actually encourages the preference for normal vaginal delivery, we concluded that mothers with macrosomic fetuses can safely be managed expectantly unless there is a high maternal and fetal risk.

[Obstetric prevention of neonatal infections caused by group B beta-hemolytic Streptococcus]. / La profilassi ostetrica delle infezioni neonatali da streptococco beta-emolitico di gruppo B.

While our understanding of Group B Streptococcal infections has progressed with impressive measure, their prevention has not been accompanied by an effective means. Chemoprophylaxis for selected colonized women at rupture of membranes or at onset of labour, enhances benefit and minimizes adverse effects. Two or more maternal risk factors are special circumstances for routine use of chemoprophylaxis in asymptomatic neonates. Immunoprophylaxis by IgG antibodies directed against the type-specific polysaccharide antigen of GBS may be provided by passive or active immunization. Hyperimmune i.v. globulins or vaccination of adult women with low levels of antibodies in their sera have been demonstrate to be protective in vivo.

[Fetal macrosomia and mode of delivery]. / Megalosomia fetale e modalità del parto.

During the period 1988-1993 the route of delivery in 482 infants with birth weight > or = 4000 grams was studied. Normal vaginal delivery occurred in 396 (82.1%) cases, vacuum extractor in 8 (1.6%) cases and caesarean section in 78 (16.1) cases. Elective induction of labor with oxytocin and/or amniotomy was carried out in 25 cases of macrosomia. Perinatal death and shoulder dystocia never occurred in these macrosomic babies, but clavicles abruption (27 cases), cephalohaematoma (2 cases), shoulder-bladehaematoma (1 case) and birth brachial palsy (1 case) were observed. Because, in our experience, elective induction of labor increased the operative delivery rate (caesarean section, vacuum extractor), we conclude that mothers with macrosomic fetuses can safely be managed expectantly unless there is a indication for induction or caesarean section.

[Determination of fetal pulmonary maturity using gas chromatographic analysis of fatty acids in the amniotic fluid. Statistic reliability of the method]. / Determinazione della maturità polmonare fetal mediante analisi gascromatografica degli acidi grassi nel liquido amniotico. Affidabilità statistica della metodica.

Assessment of foetal lung maturity by gas chromatographic analysis of the fatty acids in the amniotic fluid. Statistical reliability of the technique. Gas-chromatographic analysis of the fatty acids (Palmitis acid/Steric acid ratio: P/S ratio) was carried out in 432 samples of amniotic fluid obtained between the 28th and 42th weeks of gestational age. The present results from a series of normal (257) and various pathological (175) cases support the conclusions of other investigations that an amniotic fluid P/S ratio equal to or greater than 5 is a reliable indicator of attained fetal lung maturity. When correlated with gestational age the P/S ratios show regression lines that define the range of lung maturity in normal pregnancies between 32 and 33 weeks and in pathological cases around and over 36 weeks. Statistical studies stress that centrifugation in standard sample conditions before its gas chromatographic analysis is an essential step in order to avoid the serious consequences of an erroneous prediction. Finally Lecithin/Sphingomyelin (L/S) and P/S ratios were assessed in the same 100 samples of amniotic fluid: statistical analysis shows a very good correlation between the two methods and their reliability in the prediction of fetal lung maturity.

[Radioimmunoassay of SP1 in obstetrics and gynecological oncology]. / Dosaggio radioimmunologico della SP1 nella pratica ostetrica e nella oncologia ginecologica.

The authors by means of radioimmunoassay analyze SP1 values in selected obstetric and oncological samples. Seven amniotic fluid samples showed various degrees of positivity, but not strictly correlated to the gestational age (previous analysis by immunodiffusion were always negative). SP1 concentrations in ectopic pregnancy confermed similar investigations by other authors. In the oncological field only one serum was highly positive (440 ng/ml); negativity of others could be due to the long time of storage. The SP1 was assayed using a sperimental kit supplied by Boehringwerke A.G. (Marburg, W.G..). Assay procedure: preparation of a standard curve (7 - 440 ng/ml) from which the unknown SP1 content was determinated. Reaction time: 16 - 24 h/20 degrees C (first incubation) and 0.5 - 4 h/20 degrees C (second incubation).

[Radioimmunological determination of insulin in the amniotic fluid]. / Dosaggio radioimmunologico dell'insulina nel liquido amniotico.

Small amounts of immunoreactive insulin, at about one-eighth the concentrations found in maternal serum, have been detected in human amniotic fluid. A positive correlation between term amniotic fluid insulin levels and newborn birth weight was found. Insulin was studied in 42 samples of amniotic fluid obtained from normal and pathological pregnancies by radioimmunoassay. In only one sample of amniotic fluid of diabetic mother with insulin dependence we found high values of insulin and condition of insufficient fetal lung maturity. We believe that radioimmunoassay of insulin in amniotic fluid may be a parameter of evaluation of fetal maturity.

[Creatinine in the amniotic fluid]. / Creatinina nel liquido amniotico.

Creatinine concentration in the amniotic fluid during the latter half of pregnancy was investigated by single determinations in 39 patients and serial determinations in 2 patients. Concentrations of creatinine remained constant or increased very gradually up to approximately 34 weeks, at which point a more abrupt increase apparently took place so that after 37 weeks the level was 1,5 mg. Physiologically, these data lend support to the commonly held theory of fetal urine as an additive source of amniotic fluid. Clinically, they suggest that assay of creatinine might prove useful in estimation of fetal maturity.

[Placental lactogen (HPL) in amniotic fluid]. / Ormone lattogeno placentare (HPL) nel liquido amniotico.

Human placental lactogen (HPL) was analyzed in 52 samples of amniotic fluid. Assays of liquor HPL appear to aid in the evaluation of the degree of fetal involvement with erythroblastosys. The measurement of HPL in amniotic fluid may yet be proved also in the management of mothers with diabetes.