Female sexuality after female cancer treatment: a clinical issue

PURPOSE OF INVESTIGATION

The aim of the present study was to record how the treatment of female cancer may affect sexuality and interpersonal relations in the couple.

MATERIAL AND METHODS

From September 2008 until February 2012, the authors prospectively studied 67 patients with breast cancer (Group A) and 43 with gynecological cancers (Group B). As control groups 33 patients with benign breast and 30 patients with benign gynecological lesions (group 0a and 0b respectively) were used. Sexuality and interpersonal relations were evaluated by a questionnaire. The authors also evaluated interpersonal relations focusing on sexual function at the time of diagnosis and a year after the initial treatment for cancer.

RESULTS

A significant reduction of the "sexual desire", "sexual Arousal", and "orgasm" dimension was found in both cancer groups, in contrast to the control group, revealing no significant change. The "sexual enjoyment" scale was significantly decreased in gynecological cancer group but not in breast cancer group. While the score on the "relationship quality" dimension significantly increased in both cancer groups. In all groups, there was a significantly positive correlation between sexual function and enjoyment; on the contrary, there was a significantly negative correlation between relationship quality and sexual function and enjoyment.

CONCLUSION

Sexual dysfunctions is a clinical problem which should be evidenced at the beginning of therapy, from the oncologists in order to provide integrated treatment to their patients.

Three cases of diabetes insipidus complicating pregnancy

Diabetes insipidus (DI) is a rare complication of pregnancy. In cases related to pregnancy, the condition is thought to result from enhanced placental clearance of arginine vasopressin secondary to placental vasopressinase production. In such cases careful monitoring of the patient's fluid balance during and after pregnancy is essential. If treatment is necessary, desmopressin is the drug of choice. In the present article, we present three cases of pregnancy complicated by DI.

Matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in plasma/serum and urine of women during term and threatened preterm labor: a clinical approach

OBJECTIVE

To explore the concentrations of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in plasma, serum and urine of women during term and threatened preterm labor.

METHODS

Plasma and urine proMMP-9 as well as serum and urine TIMP-1 were evaluated in 60 healthy pregnant women; 20 of them presented in term labor following an uncomplicated pregnancy, 20 of them presented with threatened preterm labor and intact membranes at 24-36 gestational weeks and 20 of them were at 24-40 gestational weeks with no evidence of uterine contractions or other pregnancy complications. Data were analyzed with non-parametric statistical tests and cut-off values were determined with receiver operator characteristic curves.

RESULTS

ProMMP-9 values were significantly higher and TIMP-1 values were significantly lower in cases with uterine term or preterm contractions compared to non-labor status; and in cases with preterm contractions that progressed to true preterm labor compared to those in which contractions were arrested.

CONCLUSIONS

Alterations in the concentrations of proMMP-9 and TIMP-1 can be detected in plasma or serum and urine of pregnant women experiencing term or preterm uterine contractions. The altered values of proMMP-9 and TIMP-1 could possibly identify the inevitable progress of preterm contractions to true preterm labor.

No association between insulin resistance and preeclampsia

OBJECTIVE

To investigate the possible link between insulin resistance and preeclampsia.

METHODS

The study included 30 primigravidas between 28 and 34 weeks of gestation. The study subjects were divided into two groups: Group A consisted of 15 normotensive women of a mean gestational age of 31.6 weeks and group B consisted of 15 preeclamptic women of a mean gestational age of 29.9 weeks. Glucose and insulin levels were measured at 0, 1 and 2 h of an OGTT (after 75 g oral glucose administration). Insulin resistance and sensitivity were evaluated with the use of IR HOMA, QUICKI and IS OGTT.

RESULTS

Glucose and insulin levels at 0, 1 and 2 h of the OGTT as well as IR HOMA, QUICKI and IS OGTT were comparable between preeclamptic and normotensive pregnant women.

CONCLUSIONS

Our results indicate that preeclampsia is not associated with hyperinsulinaemia and/or insulin resistance, in either the fasting or the postprandial state.

Umbilical cord blood gas analysis in augmented labour

Labour augmentation with oxytocin may produce an excessive increase in frequency, duration or strength in uterine contractions which may result in fetal stress. Umbilical cord acid-base assessment provides an objective parameter in evaluating the neonatal condition immediately after delivery. We evaluated the neonatal condition in 235 deliveries where oxytocin was used for labour augmentation. The umbilical cord blood acid-base status was correlated with intrapartum cardiotocographic findings and Apgar scores. In two cases we noted umbilical artery pH <7.05 but the BDecF was not higher than 11 mmol/l and the 5-minute Apgar score was 8 in all cases. Our results indicate that the use of oxytocin for labour augmentation had no adverse effects on neonatal condition.

Non classical congenital adrenal hyperplasia due to 21-hydroxylase deficiency in families from a Greek island with a closed society

In young members of a large family from a Greek island with a closed society, clinical and hormonal symptoms of 21-OH deficiency (CAH) were present. To discriminate those affected from those unaffected, we measured the basal and ACTH stimulated 30 values of 17-hydroxyprogesterone (17-0HP) progesterone (P) and cortisol (F) in combination with HLA-phenotypes in 25 out of 40 members of this family. The indices of the Gutai30-min assessment (17-0HP+P response to ACTH testing at 30 min), GF (F response at 30 min) and the ratio GF30/Guai30 named the Marina index were evaluated. The Marina index showed a very statistically significant difference among the three groups (p < 0.001). HLA phenotypes of the members of groups A and B showed a powerful association with B14, DR1, B7, and B35 phenotypes that were related with 21-OH/CAH. In conclusion, in our study population, a high incidence of a clinically asymptomatic form of 21-OHdef was found only after the ACTH stimulation test. The Marina index seems to be of high diagnostic value in classifying disease severity.

Computerized analysis of fetal heart rate variability using the matching pursuit technique as an indicator of fetal hypoxia during labor

OBJECTIVE

To determine whether the computerized analysis of fetal heart rate variability with the new matching pursuit technique can indicate fetal distress during labor.

STUDY DESIGN

Eighty women were studied during the intrapartum period with external cardiotocography. In all cases, cord arterial pH and 5-min Apgar Scores were evaluated. Six cases that presented large segments of missing data were excluded from the study. The remaining 74 women were divided into two groups; 32 women with normal (Group A) and 42 women with non-reassuring FHR tracings (group B). Group B was divided in subgroup BI, including 24 women with pH > 7.20, and BII, including 18 women with pH < 7.20. In order to evaluate the FHR fluctuations, in different frequency ranges, we applied an adaptive time-frequency method, called Matching Pursuit. We estimated the power of the FHR signal in four frequency ranges.

RESULTS

The 5-min Apgar Scores were significantly lower in both subgroup BI and subgroup BII (p = 0.003 and p = 0.003 respectively). The Low Low Frequency (LLF) parameter appears to recognize better the cases with lower pH (sensitivity 78.5%, specificity 52.3%) than the cases with non-reassuring FHR (66.6%, 56.2). The sensitivity and specificity of the Very Low Frequency (VLF) parameter were 72.2% and 59% respectively in recognizing the cases with lower pH and 64.2% and 53.1% in recognizing non-reassuring FHR.

CONCLUSION

Fetal hypoxia during labor can be recognized using the MP technique for the analysis of FHR signal power in the VLF and LLF frequency ranges. Since the analysis is feasible in real-time, it can be a useful tool for the intrapartum evaluation of fetal well-being.

Primary and metastatic ovarian cancer in patients with prior breast carcinoma. Pre-operative markers and treatment results

BACKGROUND

The pre-operative diagnosis of primary and metastatic malignant ovarian tumors in patients treated for breast cancer is difficult. The objective of this study was to analyze and compare the characteristics and outcome of women with a history of breast cancer in order to identify pre-operative markers useful in differential diagnosis and the role of surgery in their management.

MATERIALS AND METHODS

The medical records of 36 patients with a history of breast cancer, who had been operated on either for primary or metastatic cancer between 1987 and 2003, were reviewed retrospectively.

RESULTS

Twenty-seven patients had been diagnosed with primary epithelial ovarian cancer (POC) and nine had metastatic disease (MOC), resulting in a 3:1 ratio. The median age of breast and ovarian cancer diagnosis was 45 and 56 years, respectively, and the median interval was 8 years. The serum CA 125 level was elevated in the majority of cases, in 70% of the POC group and 56% of the MOC, but the median level was higher, though not statistically significant, in the former. Serum CA 15-3 levels were elevated >100 U/ml in 89% of patients with MOC (p = 0.0002). BrCA mutation risk, as calculated with the BRCAPRO software program, was 41.8% and 9% in primary and metastatic tumors, respectively (p=0.0477). Ovarian spread was not the only site of metastatic breast cancer in 55.5% of the MOC group, compared to 11% of the POC patients Disease was disseminated in the abdominal cavity at the time of diagnosis in both groups, however, 78% of patients had unilateral tumors in the POC group and bilateral disease in the MOC (p=0.0133). Cytoreduction to less than 2 cm tumor diameter was feasible in 67% of primary and 44% of metastatic neoplasms. In the follow-up period (12-204 months), the median survival was 10 months for patients with metastatic disease, compared to 33 months for those with primary tumors (p<0.05).

CONCLUSION

Small bilateral ovarian enlargements and minor serum elevation of CA 125 titers in patients with initial Stage IV breast cancer, suffering from multiple metastatic disease, are likely to illustrate MOC. Unilateral ovarian mass and high serum levels of CA 125 in apparently disease-free patients with a positive family history and high prevelance of BRCA mutations are suggestive of primary tumors. Optimal cytoreduction was feasible in both groups, but survival was longer in patients with primary tumors (p<0.05).

Advanced stage mucinous epithelial ovarian cancer: the Hellenic Cooperative Oncology Group experience

OBJECTIVE

Mucinous epithelial ovarian cancer (mEOC) representing about 10% of all EOC are known to be possibly resistant to platinum-based chemotherapy and bear a poorer prognosis with respect to other subtypes of EOC. This study was undertaken to compare response and survival to platinum-based chemotherapy between patients with advanced stages III and IV mEOC and serous EOC (sEOC).

METHODS

A retrospective analysis was performed in 47 patients with advanced stage of mEOC treated with first-line platinum-based chemotherapy in the context of several study protocols of the Hellenic Cooperative Oncology Group (HeCOG) between 6/7/1983 and 25/2/2003. The outcome was compared to that of 94 patients with sEOC treated with the same protocols during the same study period (ratio mucinous: serous 1:2).

RESULTS

One hundred forty-one patients (47 stages III and IV mEOC, 94 stages III and IV sEOC) treated with platinum-based chemotherapy were analyzed. The overall response rate for mEOC was 38.5% (complete remission 18%) (95% CI 23.4-55.4%) and 70% (complete remission 47%) (95% CI 58.5-80.3%) for sEOC (P = 0.001). After a median follow-up of 77.8 months, median survival and time to tumor progression (TTP) were not significantly different between the two groups (33.2 months [95% CI 23.3-43.1 months] vs. 38.0 months [95% CI 26.8-49.2 months], P = 0.46, 11.8 months [95% CI 7.2-16.4 months] vs. 20.0 months [95% CI 15.7-24.2 months], P = 0.18, respectively).

CONCLUSION

Patients with mEOC have significantly lower response to first-line platinum-based chemotherapy compared to patients with sEOC. This low response to platinum-based chemotherapy was not translated in inferior TTP or survival. Our data indicate that a new strategy for chemotherapy in mEOC should be adopted, one that focuses on new agents without cross-resistance to platinum agents.

Prevalence of hepatitis B and C in the maternity department of a Greek district hospital

OBJECTIVE

To define the prevalence of infection with hepatitis B virus (HBV) and hepatitis C virus (HBC), and the modifications observed during the last 8 years, amongst parturients who gave birth in our department.

DESIGN

This was a retrospective study.

PATIENTS

The 5497 parturients who gave birth in our department between October 1994 and September 2002.

RESULTS

On average, 3.87% (213) of the pregnant women tested positive for hepatitis B surface antigen; 2.90% amongst pregnant Greek women and 4.67% amongst pregnant immigrant women. Among all pregnant women, 0.80% (44) tested positive for antibodies against HCV; 0.16% amongst Greek women and 1.33% amongst immigrant women.

CONCLUSIONS

HBV prevalence in pregnant women did not seem to be affected by the increase of immigrants in our obstetric population over the course of time. HCV prevalence in the pregnant women, however, did seem to follow the increase of immigrants in our obstetric population. Economic and security issues unfortunately deprive some neonates, born to mothers with HBV infection, from the use of hepatitis B immunoglobulin.

21-Hydroxylase deficiency: from molecular genetics to clinical presentation

Congenital adrenal hyperplasia due to deficiency of the enzyme 21-hydroxylase (21-OH), a cytochrome P450 enzyme located in the endoplasmic reticulum and which catalyzes the conversion of 17-hydroxyprogesterone to 11-deoxycortisol and progestene to deoxycorticosterone, is distinguished in its classical and non-classical form and is also one of the most common autosomal recessive inherited diseases in humans. The classical form appears in a rate between 1:5000 and 1:15,000 among the live neonates of North America and Europe, while the non-classical form occurs in approximately 0.2% of the general white population. This rate is especially high between the Ahskenazi Jews and a part (ie Italians, Hispanics) of the Mediterranean populations. Three alleles are associated with the 21-OH locus and can be combined in several ways in individuals who are either unaffected, heterozygote carriers, or affected with classical or non-classical disease. Variable signs and symptoms of hyperandrogenism, such as hirsutism, acne, virilization of the external genitalia and/or the body, short stature, menstrual irregularities, are common to both types of the disorder. Among the genes responsible for the synthesis of the enzyme 21-OH and the antigens of HLA system, exist both a proven genetic linkage and a proven genetic linkage disequilibrium. HLA-Bw47, HLAB5 and HLA-B35 are the most common haplotypes usually met in the classical form, while the haplotype HLA-B14DR1 is the most recurrent in the non-classical form of the disease. The significant advances in molecular biology and gene analysis over the past two decades have led to the development of novel sensitive methods of DNA analysis and study, such as polymerase chain reaction and southern blot analysis. Thus, it has been revealed that the synthesis of enzyme 21-OH is controlled by two genes, the active CYP21B gene and the CYP21A pseudogene. All three forms of the disease have a known sequence of gene changes owing to mutations in isolated proteins or whole series of genes due to translocations or deletions of genetic material.

Tension-Free Vaginal Tape Efficacy in Relation to Collagen Quantity of Pubocervical Fascia

OBJECTIVE(S)

To investigate whether the quantity of collagen types I and III in the pubocervical fascia of women with genuine stress incontinence (GSI) affects the efficacy of the tension-free vaginal tape (TVT) procedure.

METHODS

Sixty-three patients participated in the study and were divided in 2 groups as follows: 37 patients with GSI and pelvic organ prolapse stage I (group 1), and 26 patients with pelvic organ prolapse stage I but not GSI (control group). Urodynamic studies confirmed the diagnosis of GSI. Biopsies were obtained during surgery from the pubocervical fascia.

RESULTS

The quantity of collagen types I and III was statistically significantly reduced in patients with GSI compared to the control group. The efficacy of the TVT procedure in patients with a significant reduction in collagen type I was an 82.1% cure. In patients with a significant reduction in collagen type III, the TVT efficacy was an 85.1% cure. The efficacy of the TVT procedure was not statistically significantly different between patients with GSI and a significant reduction in collagen types I and III, and patients with no reduction in collagen types I and III.

CONCLUSIONS

The significantly reduced quantity of collagen types I and III in the pubocervical fascia of women with GSI does not affect the efficacy of the TVT procedure at an average of 25 months of follow-up.

Outcome of patients with ovarian metastatic tumors. Report of 83 cases and review

The aim of the study was to review patients with metastatic ovarian tumors in relation to their outcome and clinical characteristics.

METHODS

It was a retrospective study including 83 patients with histopathological diagnosis of metastatic ovarian tumor. The examined parameters include age of the patients, origin of the tumor, consistency and appearance of the tumor, histological type and 5-year survival.

RESULTS

The 5-year survival time of patients with metastatic ovarian tumors originating from the genital tract was 14.8% and for metastatic ovarian tumors originating outside the genital tract 5.4%.

CONCLUSION

The presence of metastatic ovarian tumors should always be included in the differential diagnosis of a pelvic mass. Difficulties in identification of the primary tumor site are present mainly in cases of metastatic tumors from the colon, while metastasis to the ovary from the breast tends to form small nodules in the ovary.

Isolated torsion of the fallopian tube: a case report and review of the literature

INTRODUCTION

Isolated torsion of the fallopian tube is a very rare condition. It occurs without ipsilateral ovarian involvement associated with pregnancy, haemosalpinx, hydrosalpinx, ovarian or paraovarian cysts and other adnexal alterations or even with an otherwise normal fallopian tube. We document a case of isolated torsion of the right fallopian tube associated with hydrosalpinx.

CASE

The patient was a 39-year-old female, para 2, gravida 4, who was presented with acute pelvic pain, nausea and vomiting. Her medical history included an appendectomy and right hydrosalpinx diagnosed five months before admission by hysterosalpingography because of investigation for secondary infertility. The urinary pregnancy test was negative. Pelvic ultrasonography showed a dilated folded right tubular structure measuring 7.8 x 2.7 cm with thickened echogenic walls and mucosal folds protruding into the lumen; the ovaries and uterus were unremarkable. No free fluid in the cul-de-sac was noted. Preoperatively, a diagnosis of twisted right fallopian tube was suspected and an exploratory laparotomy confirmed the diagnosis of isolated torsion of the oviduct. The ipsilateral ovary appeared normal, but the fallopian tube was gangrenous and right salpingectomy was performed. The patient became pregnant three months after surgery.

CONCLUSION

Isolated torsion of the fallopian tube should be considered in the differential diagnosis of patients with acute abdomen and previous medical history of hydrosalpinx.

Multiple dermoid cysts within the same ovary: our experience of a rare case with review of the literature

OBJECTIVE

Ovarian dermoid cysts are relatively frequent ovarian lesions that can be easily diagnosed by transvaginal ultrasonography. However, the recognition of multiple dermoid cysts, separated by normal ovarian tissue, within a single ovary is rare.

CASE

We present a case with bilateral dermoid cysts, four dermoid cysts within the right ovary and one in the contralateral ovary. Transvaginal ultrasonography showed hyperechogenic areas in the right ovary with a hypoechogenic area in front of them; the hyperechogenic areas were separated by areas with the echogenicity of normal ovarian tissue and indentation, suggesting the presence of multiple dermoid cysts within the same ovary.

CONCLUSION

Preoperative ultrasonographic suspicion of multiple dermoid cysts within the same ovary might contribute to a better decision about the surgical approach.

Congenital bronchopulmonary sequestration presenting as a thoracic tumor: a case report

The accurate diagnosis of fetal thoracic tumors still remains unclear despite the progress in imaging technology. The differential diagnosis between tumors and congenital anomalies of the fetus respiratory system, largely depends on the diagnostic approaches involved. We report a case of a 25-year-old woman, gravida 3 para 0, who was seen at the 23rd gestational week for routine obstetric examination. The ultrasound scan detected a lung mass, occupying the whole left hemithorax with a significant shifting of the mediastinum exhibiting features compatible with cystic adenomatoid malformation (CAM). No other congenital anomalies were noted. Color Doppler ultrasound failed to detect any blood supply to the mass. Amniocentesis disclosed a normal male karyotype. Pregnancy termination was performed according to the parents' request, with the use of misoprostol and a 500 g dead fetus was delivered. The autopsy followed by detailed histological examination, disclosed the diagnosis of pulmonary sequestration. It is important to emphasize that the initial impression concerning the sonographic appearance and the size of the mass is not always in accordance with the diagnosis of the lesion and the outcome of the pregnancy. These data suggest that in cases of fetal pulmonary tumors, a thorough and comprehensive combination of imaging approaches should be employed followed by a pathologic examination of the congenital anomaly in order to establish a definitive diagnosis.

Primary ovarian carcinosarcoma: a case report and review of the literature

Primary ovarian carcinosarcoma is characterized by an admixture of malignant epithelial and stromal elements. This neoplasm is extremely rare with fewer than 400 cases reported in the English literature. Its histogenesis, clinical features and optimal treatment remain unclear because of the rarity of primary ovarian carcinosarcoma. This study focuses on the clinical, pathological, immunohistochemical features and survival of a 73-year-old patient with primary ovarian carcinocarcoma. The patient was treated with surgery followed by combined chemotherapy with carboplatin and taxol and assigned to FIGO Stage IIIc. She died from the disease 17 months after surgery. In conclusion, ovarian carcinosarcoma is a very aggressive tumor, especially when it is diagnosed at advanced stage.

Primary fallopian tube adenocarcinoma: preoperative diagnosis, treatment and follow-up

Preoperative diagnosis of fallopian tube carcinoma is difficult due to the rarity and silent course of this neoplasm. We present herein the case of a 58-year-old woman with primary fallopian tube carcinoma that was diagnosed preoperatively on the basis of a positive for adenocarcinoma Papanicolaou vaginal smear, repeated episodes of vaginal bleeding, negative endocervical and endometrial curettage, characteristic features on ultrasonography and elevated CA-125 levels. The patient was treated by total abdominal hysterectomy, bilateral salpigno-oophorectomy and omentectomy. Pathologic confirmation of primary serous papillary adenocarcinoma of the left fallopian tube was made. Peritoneal washings were positive for malignancy. FIGO stage was considered as IIIb and the patient received six courses of combined carboplatin-taxol chemotherapy. At two years from onset of therapy the patient underwent a modified radical mastectomy and lymphadenectomy because of primary carcinoma of the right breast. The patient was started on tamoxifen therapy, which she is still taking. At 60 months after initial surgery, the patient is alive and well. In conclusion, our study suggests an association between fallopian tube carcinoma and breast cancer and a good response of the patient to platinum-based chemotherapy.

The clinical significance of Doppler findings in fetal middle cerebral artery during labor

OBJECTIVES

(1) To investigate fetal intracranial circulation, relative to peripheral blood flow, during labor with abnormal cardiotocographic (CTG) patterns, using three non-invasive methods. (2) To determine the utility of monitoring middle cerebral artery (MCA) Doppler during labor.

INTERVENTIONS

Fetuses were assessed using simultaneous CTG, pulse oximetry, and Doppler ultrasonography of both the MCA and umbilical artery (UA) to measure the pulsatility index (PI), resistance index (RI), and flow velocity integral (FVI).

STUDY DESIGN

During labor 20 term fetuses with abnormal CTG patterns and oxygen saturation values >30%, and 24 term fetuses with abnormal CTG patterns and oxygen saturation values <30% were studied, and peripartum outcomes were compared. The groups were comparable with regard to maternal age and parity. Results were evaluated using the Student's t-test and Fisher exact test.

RESULTS

MCA Doppler showed significantly lower PI and RI, and higher FVI in the presence of reduced oxygen saturation. Differences in fetal outcomes between the two groups correlated with MCA Doppler findings.

CONCLUSIONS

In experienced hands, Doppler screening of fetal middle cerebral artery waveforms during labor can be useful in the evaluation of intrapartum hypoxia in complicated pregnancies.

Spinal and epidural versus general anesthesia for elective cesarean section at term: effect on the acid-base status of the mother and newborn

OBJECTIVE

To compare general, epidural and combined spinal-epidural anesthesia with respect to short-term outcome of newborns delivered by elective Cesarean section of healthy parturients with normal pregnancies.

STUDY DESIGN

A total of 238 eight pregnant women admitted to our institution between January 1998 and July 2002, for whom elective Cesarean section was planned after 38 weeks' gestation, were grouped according to the kind of anesthesia used for the procedure. Maternal characteristics, birth weight, Apgar scores, and maternal and umbilical artery (UA) acid-base parameters were analyzed.

RESULTS

Maternal pH was significantly lower and pCO2: and pO2 were significantly higher in the general anesthetic group, compared to the other two groups (7.38 +/- 0.03 vs. 7.43 +/- 0.02 and 7.43 +/- 0.05, respectively; 35.03 +/- 3.88 mmHg vs. 29.25 +/- 5.05 mmHg and 29.64 +/- 4.16 mmHg, respectively; and 224.56 +/- 86.77 mmHg vs. 151.28 +/- 38 mmHg and 157.36 +/- 53.51 mmHg, respectively, p < 0.05). The pH of the UA was higher in the general anesthetic group, compared to the spinal-epidural group (7.29 +/- 0.02 vs. 7.26 +/- 0.06, p < 0.05). The pO2 as well as O2 saturation of the UA were higher when general anesthetic was administered, compared to the two regional modalities (15.60 +/- 5.48 mmHg vs. 9.29 +/- 4.41 mmHg and 9.20 +/- 4.06 mmHg, respectively; and 17.37 +/- 9.79% vs. 7.87 +/- 4.98% and 6.90 +/- 5.22%, respectively, p < 0.05). UA O2 saturation fell to zero in some cases in the combined spinal-epidural group, without an evident effect on fetal well-being. No fetal acidemia was noted in any group. Neonatal outcomes were similar in the three groups studied.

CONCLUSIONS

Type of anesthesia does not influence short-term outcomes in infants born via elective Cesarean section, although differences in acid-base status of both the mother and especially the newborn recommend careful use of spinal anesthesia.

Evaluation of non-reassuring fetal heart rate patterns with fetal pulse oximetry combined with vibratory acoustic stimulation

OBJECTIVE

To determine the value of fetal pulse oximetry and vibratory acoustic stimulation in the presence of non-reassuring fetal heart rate patterns during labor.

DESIGN

Prospective study in women monitored by cardiotocography and fetal pulse oximetry during labor.

MATERIALS AND METHODS

During a period of 18 months, 907 consecutive parturients in labor were monitored by cardiotocography. Out of these women, 63 were selected on the basis of a non-reassuring fetal heart rate tracing during the first stage of labor. In these cases, fetal pulse oximetry was applied. Vibratory acoustic stimulation was applied in fetuses without spontaneous reactivity in order to evaluate the fetal status.

RESULTS

Our cases were classified into three groups, according to the lower fetal oxygen saturation levels, from the time of oximetry application until delivery. Group A consisted of 29 cases where fetal oxygen saturation levels were > or = 41%, group B (20 cases) with fetal oxygen saturation of 31-40% and group C (14 cases) with levels of < 30%. Spontaneous reactivity was observed in 15 fetuses of group A and seven of group B, while no case of reactivity was noted in group C. Vibratory acoustic-induced reactivity was associated with low fetal oxygen saturation levels. The mean umbilical artery pH levels were 7.29 +/- 0.051 in group A, 7.21 +/- 0.057 in group B and 7.04 +/- 0.05 in group C.

CONCLUSION

Fetal pulse oximetry should be indicated not only in fetuses without any reactivity but also in those with induced reactivity, after the application of vibratory acoustic stimulation.

The role of the mode of delivery in the alteration of intrapartum pathological cervical cytologic findings during the postpartum period

OBJECTIVE

The aim of the study was to determine whether abnormal antepartum cervical cytologic findings change in the postpartum period and the relation of this alteration to the mode of delivery.

STUDY DESIGN

Between 1991 and 2000, 192 pregnant women with antepartum abnormal cervical cytology were identified; complete demographic, clinical and cytologic reports were available for 90 of them. Papanicolaou smear tests were collected and separated in three groups using the Bethesda classification system (ASCUS, L-SIL and H-SIL).

RESULTS

Of the 90 women, 52 (61.1%) were delivered vaginally and 38 (38.9%) by cesarean section. No difference was found between women delivered vaginally and those delivered by cesarean section, regardin age, parity and smoking history. The overall postpartum regression rate for the 20 women with antepartum H-SIL cells was 45%. Of the 12 women with H-SIL cells who were delivered vaginally, eight (66.6%) showed regression in the postpartum period while this regression was achieved only in one (12.5%) woman, who was delivered by cesarean section (p < 0.002).

CONCLUSION

Postpartum spontaneous regression of suspicious Papanicolaou smears consistent with H-SIL occurs with increased frequency among women who are delivered vaginally compared to those delivered by cesarean section.

Computerised intrapartum diagnosis of fetal hypoxia based on fetal heart rate monitoring and fetal pulse oximetry recordings utilising wavelet analysis and neural networks

OBJECTIVE

To develop a computerised system that will assist the early diagnosis of fetal hypoxia and to investigate the relationship between the fetal heart rate variability and the fetal pulse oximetry recordings.

DESIGN

Retrospective off-line analysis of cardiotocogram and FSpO2 recordings.

SETTING

The Maternity Unit of the 2nd Department of Obstetrics and Gynaecology, Aretaieion Hospital, University of Athens.

POPULATION

Sixty-one women of more than 37 weeks of gestation were monitored throughout labour.

METHODS

Multiresolution wavelet analysis was applied in each 10-minute period of second stage of labour focussing on long term variability changes in different frequency ranges and statistical analysis was performed in the associated 10-minute FSpO2 recordings. Self-organising map neural network was used to categorise the different 10-minute fetal heart rate patterns and the associated 10-minute FSpO2 recordings.

MAIN OUTCOME MEASURES

Umbilical artery pH of < or = 7.20 and Apgar score at 5 minutes of < or = 7 formed the inclusion criteria of the risk group.

RESULTS

After using k-means clustering algorithm, the two-dimensional output layer of the self-organising map neural network was divided into three distinct clusters. All the cases that mapped in cluster 3 belonged in the risk group except one. The sensitivity of the system was 83.3% and the specificity 97.9% for the detection of risk group cases.

CONCLUSIONS

A relationship between the fetal heart rate variability in different frequency ranges and the time in which FSpO2 is less than 30% was noticed. Fetal pulse oximetry seems to be an important additional source of information. Computerised analysis of the fetal heart rate monitoring and pulse oximetry recordings is a promising technique in objective intrapartum diagnosis of fetal hypoxia. Further evaluation of this technique is mandatory to evaluate its efficacy and reliability in interpreting fetal heart rate recordings.

Uterine serous papillary carcinoma clinical and immunopathological study of 9 cases

From January 1993 to December 1998, nine patients with serous papillary endometrial carcinoma (SPEC) were diagnosed and treated at the 2nd Department of Obstetrics and Gynecology, Areteion University Hospital. The incidence of SPEC in our Clinic was 6.77%. The mean age of patients was 65.5 years (range 54-82 years). All patients underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and epiploectomy. Abdominal and para-aortic lymph node sampling was performed in all cases and peritoneal washings were examined cytologically. Histological sections of the specimens, stained with haematoxylin-eosin, were retrieved from the Laboratory of Pathology and re-evaluated by two pathologists. All cases conformed to the diagnostic criteria for SPEC. Immunohistochemical studies were performed in paraffin blocks retrieved from the files, by a streptavidin-viotin method for the detection of vimentin (ENZO monoclonal ab), secretory component (DAKO polyclonal ab), CEA (DAKO monoclonal ab), EMA (DAKO monoclonal ab). The hormonal receptor status, assessed by appropriate positive and negative controls, was studied as well. The presence of mucin and glycogen was studied by histochemical reaction, PAS, PAS diastase and mucicarmine. Serous papillary carcinoma is an unusual but distinct type of endometrical adenocarcinoma, a non-hormonal dependent tumor, with aggressive biologic behavior. Its recognition is mandatory for a correct therapeutic approach.

The value of transvaginal ultrasonography in diagnosis and management of cervical incompetence

To determine the value of transvaginal sonography in women with a previous history of second trimester miscarriage due to cervical incompetence, 55 patients were subjected to either elective cervical cerclage or follow-up (every second patient) with weekly evaluations of the cervix by transvaginal ultrasonography. Emergency cerclage was applied when significant cervical changes were noted. All patients were evaluated with cervical cultures and ultrasound. Women with infection, fibroids, uterine malformations and multiple pregnancies were excluded from the study. The study population was divided in two groups. In group I (n=27) elective cerclage was applied during the 14th week. Women in group II (n=28) were subjected to serial weekly evaluations of the cervix by transvaginal ultrasonograms. In 18 cases emergency cerclage was applied due to significant cervical changes. In group I, labor started before the 33rd week in two cases (7.4%), between 33 and 37 weeks in nine (33.3%) and after the 37th week in 16 cases (59.2%). Out of the 18 patients in group II who had cervical cerclage after ultrasonographic evaluation, four (22.2%) delivered before the 33rd week, three (16.6%) between 33 and 37 weeks and 11 (61.1%) after the 37th week. No statistical difference was noted between the two groups referring to pregnancy outcome (p<0.1). We concluded that ultrasound-guided management despite cervical shortening, does not result in unfavorable pregnancy outcome. A significant number of patients can avoid the operation.

Maternal homocysteine levels and plasma lipids in gestational diabetes: is there any relationship?

The aim of the study was to investigate the possible relationship between maternal homocysteine levels and plasma lipid parameters and whether gestational diabetes can alter the serum maternal concentration of this substance. The study included 36 primigravidas divided into two groups: group A consisted of 21 healthy pregnant women with a mean gestational age of 38.2 weeks, and group B consisted of 15 diabetic women with a mean gestational age of 38.4 weeks. No difference in maternal homocysteine levels was noted between the two groups (6.006 +/- 1.64 vs. 7.004 +/- 1.36 micromol/L). Serum cholesterol levels and serum triglyceride levels in normal pregnant women were not statistically significantly different compared to those seen in diabetic pregnant women. Similarly, no difference was found between the two groups regarding LDL levels and atheromatic index. In women with diabetes there was a weak positive relation between plasma concentrations of homocysteine and LDL levels as well as atheromatic index, but this relation was not statisticially significant. We conclude that serum homocysteine levels are not elevated in women with gestational-onset diabetes. There was also no relation between serum concentrations of homocysteine and lipid parameters in this complication of pregnancy.

Abnormal fetal heart rate patterns during the active phase of labor: the value of fetal oxygen saturation

OBJECTIVE

To determine the predictive value of intrapartum fetal oxygen saturation (SO2) for prediction of an umbilical artery pH less than 7.15 at birth in labors complicated by abnormal fetal heart rate traces.

STUDY DESIGN

Eighty-five primigravidas in spontaneous labor complicated by abnormal fetal heart rate traces underwent fetal SO2 monitoring using the fetal pulse oximetry technique. Cases with an SO2 of < 30% were delivered by Cesarean section. Umbilical artery pH was measured at birth in all women.

RESULTS

With the value set of 30% as the cut-off point of fetal oxygen saturation, the positive predictive value for umbilical artery pH of < 7.15 was 61.5% and the negative predictive value was 95.8%, with a sensitivity of 72% and a specificity of 93%.

CONCLUSIONS

Fetal pulse oximetry is a promising technique for assessment of fetal well-being during labor and may decrease the number of unnecessary Cesarean sections.

Fetoplacental leptin levels and their relation to birth weight and insulin in gestational diabetic pregnant women

To investigate the fetoplacental leptin circulation in gestational diabetes, we compared cord leptin and insulin levels in 17 healthy pregnant women and 17 women with gestational-onset diabetes. Leptin levels in the umbilical arteries (mean+/-SD 1.80+/-0.76 ng/ml) were significantly (P<0.006) lower than those in umbilical veins (2.67+/-0.98 ng/ml) in normal pregnancies. Similarly, leptin levels in umbilical veins (mean+/-4.59+/-1.60 ng/ml) were significantly (P<0.001) higher than those in umbilical arteries (mean+/-SD 2.08+/-0.90 ng/ml) in gestational diabetes. However, leptin levels in umbilical veins were significantly higher (P<0.002) in gestational diabetes than those in controls. Additionally, in women with diabetes but not in controls, the birth weight and the cord leptin concentrations were positively related to cord insulin levels. We conclude that there is a hyperleptinaemia in the fetoplacental circulation in pregnant women with carbohydrate intolerance and in these cases insulin and leptin may have antagonist roles regarding fetal development.

Alterations of maternal and fetal leptin concentrations in hypertensive disorders of pregnancy

OBJECTIVES

To investigate whether hypertensive disorders of pregnancy alter the maternal and fetal leptin levels.

METHODS

Fifty primigravidas between 28 and 34 weeks of gestation were divided into three groups: group A consisted of 17 normal pregnant women with a mean gestational age of 31 weeks, group B consisted of 15 women with gestational hypertension without proteinuria with a mean gestational age of 30 weeks and group C consisted of 18 pre-eclamptic women with a mean gestational age of 31 weeks.

RESULTS

The pre-eclamptics had significantly higher serum leptin levels than those in normal pregnancies (p<0.001) but no difference was noted between normal and gestational hypertensive pregnancies. Pre-eclamptic women had significantly higher umbilical vein leptin levels (4.68+/-1.66ng/ml) compared to normal pregnancies (1.92+/-0.71ng/ml) and those with gestational hypertension (2.47+/-0.81ng/ml).

CONCLUSIONS

Pre-eclampsia is associated with an increase in maternal plasma leptin levels and fetal of leptin production increases in gestational hypertension and even more in pre-eclampsia.

Changes of glucose tolerance after delivery in women with gestational diabetes

We investigated glucose tolerance after cesarean section in 24 women with gestational-onset diabetes (group A), in 18 women with an adverse pregnancy outcome (group B), and in 19 healthy pregnant women (group C). Glucose tolerance was performed within six days as well as six weeks after delivery. Eleven (45.8%) women in group A, five (27.8%) in group B and one (5.2%) in group C showed glucose intolerance immediately after delivery. Six weeks after delivery, 18 (75%) women in group. A showed normal glucose tolerance (NGT), four (16.6%) impaired glucose tolerance (IGT) and two (8.3%) diabetes according to WHO criteria. NGT showed 16 (88.8%) women in group B, and 19 (100%) in group C, while two (11.1%) women in group B presented with IGT. We conclude that a glucose tolerance test both immediately and six weeks after delivery is useful not only in women who have gestational diabetes but also in women with an adverse pregnancy outcome.

Maternal plasma leptin levels and their relationship to insulin and glucose in gestational-onset diabetes

To investigate the changes in leptin levels and the relationship between this substance and insulin and glucose in pregnant women with gestational-onset diabetes, we measured plasma leptin levels in the maternal peripheral vein of 17 healthy and 17 diabetic women at 29 and 33 weeks of gestation. We also correlated maternal plasma leptin levels in diabetic women with fasting plasma insulin levels and plasma glucose levels obtained 1 h after oral administration of 50 g of glucose. Maternal serum leptin levels in women with gestational diabetes (mean +/- SD 16.52 +/- 5.07 ng/ml, range 10.84-27.4 ng/ml) were significantly higher (p < 0.001) than those found in uncomplicated pregnancies (10.61 +/- 1.47 ng/ml, range 7.28-13.4 ng/ml). A positive correlation was found between maternal serum leptin levels and glycosylated haemoglobin values in diabetic pregnant women (r = 0.94, p < 0.001). A positive correlation was also found between maternal leptin concentrations and fasting serum insulin levels, as well as between leptin concentrations and plasma glucose levels obtained 1 h after the administration of 50 g of glucose in women with gestational diabetes (r = 0.84, p < 0.001, and r = 0.92, p < 0.001, respectively). We conclude that leptin levels are elevated in pregnant women with gestational diabetes, and its metabolism depends on insulin levels and the severity of diabetes.

Sweeping of the membranes versus uterine stimulation by oxytocin in nulliparous women. A randomized controlled trial

The aim of this study was to evaluate whether sweeping of the membranes at term could shorten the length of pregnancy and reduce the incidence of postterm pregnancies. We randomly selected 104 nulliparas with uncomplicated pregnancy and gestational age between 281 and 287 days. Our patients were divided into three groups. Group A consisted of 34 women who were subjected to sweeping of the membranes. Uterine stimulation with oxytocin was applied in 35 women (group B), and 35 women (group C) were used as a control group. We had no significant reduction of the time interval from sweeping of the membranes until delivery (1.9 +/- 1.2 days), compared to that of group B (2.1 +/- 0.8 days) as well as that of the control group (2.5 +/- 0.9 days). The incidence of spontaneous labor in patients after sweeping of the membranes was greater (67.6%) when compared with oxytocin-stimulated patients and the control group (p < 0.05). Furthermore, a better Bishop score was noted in patients of group A. No statistically significant difference was noted in the mode of delivery between the groups, but sweeping of the membranes significantly decreased the incidence of postterm pregnancies (p < 0. 05). We concluded that sweeping of the membranes is an effective method for initiating labor in women with a gestational age between 40 and 41 weeks, thus reducing the need for induction.

A randomized trial of pulsatile vs continuous oxytocin infusion for labor induction

In a prospective randomized study, 560 pregnant women were subjected to labor induction with continuous or pulsed intravenous oxytocin infusion. There were no significant differences with respect to maternal history, Bishop score and perinatal morbidity. The mean induction to delivery interval was shorter in the pulsed infusion group than in the continuous infusion group (325 +/- 63 vs 433 +/- 67 min in primiparous, p < 0.001 and 204 +/- 52 vs 236 +/- 87 min in multiparous women, p < 0.01). The mean amount of oxytocin administered in the pulsed infusion group was also significantly lower than in the continuous infusion group (4.7 +/- 0.6 mU/min versus 9.6 +/- 3.4 mU/min in primiparous, p < 0.001 and 2.1 +/- 0.4 mU/min versus 5.2 +/- 2.3 mU/min in multiparous women, p < 0.001). Our study demonstrates that pulsatile administration of oxytocin is as safe as continuous intravenous infusion, requires less oxytocin and is more effective as it reduces labor duration.

Renin-aldosterone system alterations during abdominal gynaecological operations under general or combined general and epidural anaesthesia

Alterations of plasma renin-activity and aldosterone levels were comparatively studied in 41 premenopausal patients who were subjected to total abdominal hysterectomy. Twenty-one women received general anaesthesia (group A) and 20 received a combination of general and epidural anaesthesia (group B). Five blood specimens were drawn from each patient in order to determine plasma aldosterone levels (PA) and plasma renin activity (PRA) by radioimmunoassay (RIA). The rise of PA levels in group A occurred 30 min after the initiation of surgery and at that time there was a statistically significant difference as compared with the epidural anaesthesia (EA) group (p < 0.001). PRA levels in both groups showed a rise of limited statistical significance at 30 minutes after the initiation of surgery (p < 0.05). During the remaining time intervals, group A did not show any significant changes, whereas group B showed a reduction of limited statistical significance (p < 0.05). General anaesthesia for gynecological abdominal surgery without the use of volatile agents significantly increases plasma aldosterone levels. Combined anaesthesia does not totally inhibit intraoperative hyperaldosteroism but it is much slower and is of great advantage for the patient.

A comparative study of serum soluble vascular cell adhesion molecule-1 and soluble intercellular adhesion molecule-1 in preeclampsia

OBJECTIVES

Maternal serum soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1) were evaluated in preeclampsia to investigate whether these molecules could be helpful with regard to this pregnancy complication.

STUDY DESIGN

The study population was composed of 30 preeclamptic patients with a mean gestational age of 35.5 +/- 4.6 weeks and 20 age-matched and gestational age-matched normotensive uncomplicated pregnancies (controls). Blood samples from 7 of the 30 preeclamptic patients and 15 of the 20 controls in the second trimester were also analyzed. Data were analyzed by parametric methods.

RESULTS

Significantly higher maternal serum sVCAM-1 levels were found in both groups of preeclamptic patients with and without fetal growth restriction (981 +/- 145 ng/ml; n = 13; p < 0.0005 and 846 +/- 84 ng/ml; p < 0.02, respectively) compared with controls (668 +/- 186 ng/ml). In contrast, no significant difference was found in maternal serum sICAM-1 levels between preeclamptic and normotensive pregnancies, or in both adhesion molecules (1) in the controls between second and third trimester samples and (2) in the second trimester between pregnant women who developed preeclampsia later and gestational age-matched controls.

CONCLUSION

These findings show a selective significant elevation of maternal serum sVCAM-1 in preeclampsia, with the highest values in cases complicated with fetal growth restriction, perhaps reflecting its angiogenic function. Hence, sVCAM-1 could be helpful in the diagnosis of this fetal complication in preeclampsia.

Evaluation of fetal heart rate patterns during the second stage of labor through fetal oximetry

The purpose of this study was to assess the feasibility and accuracy of fetal pulse oximetry during the second stage of labor in cases with abnormal fetal heart rate (FHR) patterns with reference to postpartum acid-base status and Apgar scores. Forty-eight parturients with normal and 20 parturients with abnormal FHR tracings during the second stage of labor were monitored by fetal pulse oximetry and postpartum umbilical artery pH, pO(2), pCO(2) values and 1- and 5-min Apgar scores. The mean SpO(2) value was 55. 47 +/- 9.95% in cases with normal and 52.55 +/- 16.42% in cases with abnormal FHR patterns. A significant correlation was noted between fetal SpO(2) and umbilical artery pH in cases with normal (r = 0.76, p < 0.05) as well as in cases with abnormal FHR patterns (r = 0.78, p < 0.05). No significant correlation was found between fetal SpO(2) and Apgar scores at 1 and 5 min in cases with normal FHR patterns. On the contrary a significant correlation was noted in cases with abnormal FHR patterns. A normal FHR pattern alone is reassuring. In cases with abnormal FHR, fetal pulse oximetry is an objective method for distinguishing a hypoxic fetus.

Defective antioxidant mechanisms via changes in serum ceruloplasmin and total iron binding capacity of serum in women with pre-eclampsia

OBJECTIVES

The aim of this study was to investigate the role of serum ceruloplasmin, its ferroxidase activity and total iron binding capacity in women with pre-eclampsia.

METHODS

Thirty primigravidas between 32 and 36 weeks of gestation were studied. The subjects were divided into two groups: group A consisted of 15 normal pregnancies with a mean gestational age of 33.9 weeks, and group B consisted of 15 pre-eclamptics with a mean gestational age of 32.8 weeks.

RESULTS

The pre-eclamptics presented significantly higher serum ceruloplasmin levels compared to those with normal pregnancies (P<0.01), while the mean ferroxidase activity levels of ceruloplasmin did not differ significantly between the two groups (450.13+/-110.88 and 467.26+/-135.35 micromol/l/min in groups A and B, respectively). The mean+/-S.D. serum iron level (104.48+/-39.81 microg/dl) was greater whereas the total iron binding capacity (55.59+/-8.47 micromol/l) was lower in women with preeclampsia when compared to normal pregnancies (P<0.01 and P<0.0001 respectively).

CONCLUSIONS

Our results indicate that the plasma of pre-eclamptic women shows a loss of ferroxidase activity of ceruloplasmin as well as a reduction of total iron binding capacity. Thus, it seems that the plasma of pre-eclamptic women lacks the protective anti-oxidative action of these substances.

Intrapartum vibratory acoustic stimulation after maternal meperidine administration

OBJECTIVE

To examine the effectiveness of the acoustic stimulation test in the interpretation of suspicious cardiotocograms obtained after meperidine administration to the mother during the first stage of labor.

SUBJECTS AND METHODS

We studied 45 unselected parturients who received 50 mg meperidine i.m. when cervical dilatation was 5 cm. In all cases a decreased beat-to-beat variability of the fetal heart rate and fetal movements was noted after the injection of meperidine. A vibratory acoustic stimulation was performed in 25 patients (group A) while the remaining 20 (group B) had no stimulation.

RESULTS

After the meperidine injection, the acoustic-induced reactivity returned immediately in group A, while the spontaneous reactivity returned 30 minutes later. The mean number of fetal movements in all parturients was 8.71 +/- 2.18 before meperidine administration. Sixty minutes after the meperidine injection the mean number was 8.52 +/- 2.48 in group A and 1.65 +/- 1.81 in group B (p < 0.0001).

CONCLUSION

The acoustic stimulation test is an effective method of interpreting suspicions CTG's obtained after meperidine administration to the mother during the first stage of labour.

Which is the threshold glycose value for further investigation in pregnancy?

The aim of this study was to investigate the lower threshold glycose value in a 50 gr-1 hour screening test for further testing in diagnosing gestational diabetes mellitus (GDM). Our study consisted of 602 pregnant women between 24-28 weeks of gestation, who received a 50 gr glycose load followed by glycose determination one hour later. After screening 273 out of 602 women showed test serum glycose values > 125 mg/dl. All 273 women received a 100 gr 3-hour glycose tolerance test (GTT). Thirty out of 273 women were found to have carbohydrate intolerance. The overall incidence of GDM was 4.98%. When the threshold glycose value was > or = 130 mg/dl the incidence of GDM was 17.8%, but lowering the threshold to 126 mg/dl a further 1.3% of the women showed carbohydrate intolerance. In the above threshold value the sensitivity was 100% but the specificity was only 54%. However, we recommend 126 mg/dl threshold for GTT since this threshold allows for the diagnosis of all women with carbohydrate intolerance during pregnancy.

Non-stress test: a fifteen-year clinical appraisal

During a 15-year period (Jan. 1981 to Dec. 1995) a total of 14,950 patients were delivered in our hospital. Throughout this period fetal heart rate monitoring during labor was increased from 10% up to 85%. The overall antepartum testing was also increased from 8 to 15%. In patients with significant complications in pregnancy the mean number of non-stress tests (NST's) per patient was 1.8 tests in 1981 to 4.8 tests in 1995. The average perinatal mortality was 15.2/1000, with a gradual decline. In patients who were subjected to antepartum testing the previous rate was only 3.7%/1000. Our conclusion is that the use of antepartum and intrapartum cardiotocography has increased during the last 15 years in our clinic. As a consequence a considerable decrease was noted in the overall perinatal mortality. The non-stress test is still today the first line of antepartum fetal assessment.

The effect of early second stage bradycardia on newborn status

In the present study 45 patients with intrapartum cardiotocograms showing prolonged fetal bradycardia during the early second stage of labor were included. Bradycardia persisted for 180 s or more with either rapid or prolonged return to baseline, without loss of variability and rise of baseline fetal heart rate (FHR). The mean duration of bradycardia was 5.0 +/- 1.3 min. In the group with normal FHR tracings the rate of normal delivery (73.3%) was significantly higher than that of the group with fetal bradycardia (26.7%, P < 0.0001). We also noted a significantly higher rate of cesarean section (44.4%) in patients with abnormal FHR tracings, compared to that (11.1%) of parturients with normal FHR tracings (P < 0.001). In all cases blood samples were obtained from the umbilical cord artery, immediately after delivery. Only in two cases with abnormal FHR tracing umbilical cord artery was the pH less than 7.20. We conclude that in most cases, prolonged fetal bradycardia in the early second stage with the characteristics described above is well tolerated by a mature fetus.

Hematological parameters of the mother and neonatal status during normal labor

This study reviews the relationship between hematological parameters of the mother and the newborns status. Our material consisted of 180 pregnant women with singleton pregnancies who had an uncomplicated vaginal delivery. A negative relationship was noted between the pH and the maternal hemoglobin values both in the umbilical artery and vein (r = -0.27, p < 0.001, for the umbilical vein and r = -0.32, p < 0.0001, for the umbilical artery). A negative relationship was also noted between the umbilical vein pH and the maternal hematocrit, which was statistically significant (r = -0.28, p = 0.001). A similar negative correlation was observed between the umbilical artery pH and the maternal hematocrit (r = -0.32, p < 0.0001). In conclusion, maternal hematological parameters (hemoglobin, hematocrit) can affect the fetal acid-base balance.

Platelet reactivity is increased in mild gestational diabetes compared with normal pregnancy

The purpose of this study was to measure blood platelet aggregation in pregnant women with gestational diabetes and its correlation with normal pregnancies. The study group included 10 women with diabetes of pregnancy and a group of 10 healthy pregnant women. We used the method of adenosine diphosphate (ADP) platelet stimulation with three different ADP solutions. The mean platelet aggregation and time in seconds was measured in each patient with the three different solutions. The analysis of our results showed that platelet activity was statistically increased (P < 0.001) in the group of diabetics compared with the group of normal pregnancies. Our conclusion is that platelet activity in patients with gestational diabetes appears to be enhanced, probably as a result of a disturbance in the equilibrium between prostacyclin and thromboxane.