[Hemolytic uremic syndrome in twin pregnancy at 32 weeks gestation with HELLP syndrome. Case report]

Renal failure occurring in pregnancy or post partum is an unusual but well-described complication. Acute renal failure seems to be associated more often with HELLP syndrome rather than with pre-eclampsia or chronic hypertension. Probable overlapping of HELLP and hemolytic uremic syndrome in pregnancy or postpartum should be taken into consideration when treating pregnant women who show signs of proteinuria, hypertension, hematuria, increase of reticulocytes, decrease of haptoglobin with thrombocytopenia and microangiopathic hemolytic anemia. Our case refers to a 32 year old woman at 32 weeks gestation in twin pregnancy who presented with HELLP syndrome and renal failure. Immediately postpartum oliguria was noted and the laboratory analyses suggested the coexistence of HELLP and hemolytic uremic syndrome. In patients with gestosis and/or HELLP syndrome presenting oliguria combined with a decrease of hemoglobin level not due to intraoperative hematic leaks it is always necessary to ask for haptoglobin dosage. In treating hemolytic uremic syndrome it is very important to use a high dosage of plasma and sometimes plasmapheresis. HELLP syndrome contributes to various complications which are sometimes responsible for kidney or maternal mortality. In treating these patients early diagnosis combined with a specific treatment can considerably reduce kidney and maternal mortality.

[Premature membrane rupture. Comparison of diagnostic tests]

BACKGROUND

Objective of this study was to evaluate the accuracy of the vaginal pH-test, the Fern-test, the research of foetal cells and of foetal fibronectin in vaginal discharge, which are used to diagnose premature rupture of membranes.

METHODS

To this aim 40 pregnant patients between 24th and 37th weeks gestation have been examined, considered at risk for sub-clinic loss of aminiotic fluid: 23 were affected by preterm labour and 17 by suspected rupture of membranes.

RESULTS

Subsequently amniotic sac was confirmed to be ripped in 10 cases (25%): 2 (8.7%) in the 23 patients with preterm labour, and 8 (47%) in the 17 patients with suspected PROM. Sensibility, specificity and accuracy were respectively: 70, 97 and 90% for pH-test; 70, 100 and 93% for Fern-test; 50, 93 and 82% for foetal cells; 100, 90 and 93% for fibronectin test.

CONCLUSIONS

In personal experience fibronectin test appeared to be the most sensible and accurate marker. Fern-test was the most specific, while the research of foetal cells appeared to be the least reliable.

[Non-invasive instrumental method in uncontrollable post-partum hemorrhage (an alternative to hemostatic hysterectomy)]

A new non-invasive instrumental technique which is useful to stop the most severe post-partum haemorrhages is described. This technique is proposed as an alternative to more invasive methods such as the binding of uterine or hypogastric arteries, which is itself a trauma, not always effective and could promote the obstetric shock. The method proposed by the authors is not invasive, can be performed in a few minutes and performed without the help of anaesthesia. Very encouraging results were achieved and have allowed to avoid the use of the so-called "haemostatic" hysterectomy.

[beta-Interferon in the therapy of cervico-vaginal papilloma virus (HPV) infection associated with cervical intraepithelial neoplasia (CIN)]

58 patients suffering from HPV infection associated with CIN were treated using human fibroblast interferon, via an intramuscolar route, with positive results (87.9% of cases).

[Thymopentin and cervico-vaginal HPV infection associated with CIN]

46 patients affected by HPV+CIN were treated with Thymopentin i.m. HPV disappeared in all cases. We also observed complete disappearance or only a partial remission of CIN in 82.6% of cases.

[Emergency surgical indications in pregnancy (3 rarely encountered cases)]

The authors evaluated 3 cases of acute abdomen during pregnancy: Spontaneous rupture of splenic artery at 30th gestational week (gw). Torsion of left normal Fallopian tube at 33rd gw. Left adnexal torsion at 36th gw. The symptomatology, the etio-pathology and the anatomo-pathological characteristics of every case wore discussed. In women that are usually young, maternal and fetal exitus in the first case and salpingectomy or adnexectomy in the second and third case can be avoided only thanks to timely surgical intervention.

[Human fibroblast interferon therapy alone and human fibroblast interferon combined with thymostimulin in genital papillomavirus infection associated with cervical intraepithelial neoplasia]

Eighteen patients suffering for HPV infections associated with CIN were treated using human fibroblast interferon, via an intramuscular route, with positive results. Five cases of recurrent HPV within nine months of treatment received thymostimulin therapy, via an intramuscular route, with positive results.