Retrospective study 2005-2015 of all cases of fetal death occurred at ≥23 gestational weeks, in Friuli Venezia Giulia, Italy

Background

Intrauterine fetal death (IUFD) is a tragic event and, despite efforts to reduce rates, its incidence remains difficult to reduce. The objective of the present study was to examine the etiological factors that contribute to the main causes and conditions associated with IUFD, over an 11-year period in a region of North-East Italy (Friuli Venezia Giulia) for which reliable data in available.

Methods

Retrospective analysis of all 278 IUFD cases occurred between 2005 and 2015 in pregnancies with gestational age ≥ 23 weeks.

Results

The incidence of IUFD was 2.8‰ live births. Of these, 30% were small for gestational age (SGA), with immigrant women being significantly over-represented. The share of SGA reached 35% in cases in which a maternal of fetal pathological condition was present, and dropped to 28% in the absence of associated pathology. In 78 pregnancies (28%) no pathology was recorded that could justify IUFD. Of all IUFDs, 11% occurred during labor, and 72% occurred at a gestational age above 30 weeks.

Conclusion

The percentage of IUFD cases for which no possible cause can be identified is quite high. Only the adoption of evidence-based diagnostic protocols, with integrated immunologic, genetic and pathologic examinations, can help reduce this diagnostic gap, contributing to the prevention of future IUFDs.

[Intrahepatic cholestasis of pregnancy: diagnosis and obstetric management]

AIM

The aim of this study was to suggest a possible obstetric management of patients with intrahepatic cholestasis of pregnancy (ICP).

METHODS

We performed a retrospective analysis enrolling 44 women with ICP deliveries at our Obstetrics and Gynaecology clinic of the University of Udine between January 2005 and July 2008. Data on patient age, body mass index, weight, gestational age, parity, symptoms, comorbidity, value of liver test, APGAR score and fetal weight were prospectively recorded in a computed database and clinical folder.

RESULTS

The intensification of maternal and fetal surveillance in patients with ICP (liver function tests, ultrasound and cardiotocography), can significantly reduce perinatal mortality (no case of stillbirth in ours study) but, inevitably, increases the cesarean delivery rate (65.1%), the induction of labor rate (38.4%) and the preterm delivery rate (58.13 %, median gestational age 35 sg+/-1.46).

CONCLUSION

Obstetric management of ICP consist of weighing the risk of premature delivery against the risk of sudden death in utero. To date, no ideal method of fetal surveillance has been determined for ICP; the intrauterine deaths are thought to occur suddenly and fetal cardiac monitoring cannot forecast an acute event. Nevertheless, we think that a management strategy, inclusive of induction of labor at 37 weeks, can reduces the risk of fetal death. In most severe cases, no responsive to ursodeoxycholic acid and S-adenosylmethionine treatment, delivery has been initiated even before the 37 weeks, as soon as lung maturity has been established.

Varicose symptoms without varicose veins: the hypotonic phlebopathy, epidemiology and pathophysiology. The Acireale project

Ever since 1982 the authors have been interested in varicose symptoms without varicose veins. Carrying out several pilot studies with infrared photoplethysmography (PPG) and strain gauge plethysmography they suggest that the pathophysiology of this behaviour could be caused by the reduction of the venous wall tone. They propose the name of Hypotonic Phlebopathy (HP). The diagnosis criteria are focused by symptoms (heavy legs in upright position, restless leg syndrome, sub-oedema and/or evening oedema) and signs detected by PPG, s.g plethysmography and duplex scanning (reduction of the muscle-venous calf pump and increase of the venous wall compliance). Epidemiology, assessed between 1989 and 1992 (Acireale Project), showed a 15.90% morbidity, with higher prevalence in females; the most important risk factors are pregnancy and family history. HP is not rare in males; the principal risk factor is work involving standing for long periods. These behaviours have been independently confirmed by two studies carried out in France in 1992, which showed a 15% prevalence in a similar group of subjects with functional venous insufficiency. The authors suggest the introduction of the term of Hypotonic Phlebopathy, the symptoms of which are significantly improved by phlebotonic drugs, especially when they are stronger. CEAP classification: C(0-S); E(P); A(0); P(unclassifiable); Clinical score (1-2); Anatomical score (0); Disability score (1).

Three-month therapy with calcium-heparin in comparison with ticlopidine in patients with peripheral arterial occlusive disease at Leriche-Fontaine IIb class

Forty patients with a mean age of 62.6 +/- 6 years, 36 men and 4 women, with peripheral arterial occlusive disease (PAOD) at Leriche-Fontaine IIb class, were randomly allocated to one of two treatment groups, receiving either 12,500 IU/day of subcutaneous (sc) calcium-heparin (CAE) or 250 mg/day of oral ticlopidine, each given for ninety days. The following parameters were evaluated before the start of the active treatment period and after thirty and ninety days of treatment: pain-free walking distance (PWD), maximum walking distance (WDmax), systolic and diastolic blood pressure (BP), posterior tibial arterial pressure and Winsor index at rest and after exercise (treadmill), transcutaneous oxygen and carbon dioxide pressures at rest (TcPO2 and TcPCO2 respectively), and time to 50% TcPO2 recovery after three-minute ischemia. Both treatments induced an improvement in PWD/WDmax, which, at the end of the study, were increased by 50.7/58.7% and 31.7/36.2%, respectively, for CAE and ticlopidine treatments, respectively.

False positive 131I total body scan due to an ectasia of the common carotidis

A cervical accumulation of radioiodine at Total Body Scan (TBS) in a patient who had been thyroidectomized for a follicular thyroid carcinoma led to unnecessary radioiodine treatment. Thyroglobulin measurements indicated constantly low levels. Following ultrasound scanning of the neck, echo-doppler examination of the cervical vessels and angiography with 99Tc, this area of increased activity at TBS imaging was shown to be due to an ectasia of the right common carotidis causing blood stasis and reverse flow.

Effects of mesoglycan sulfate on the arterial elastic module

Ten patients with peripheral obstructive arterial disease (POAD) in stages I and II according to Leriche-Fontaine, were subjected to therapy with mesoglycan sulfate (60 mg/day for twenty days), to evaluate the effect of the drug on the elastic module of the arterial wall. The wall elasticity was deduced from some Doppler velocitographic indices (arterial dynamics index, resistance index, perfusion pressure index, tibial distensibility index); from the analysis of systolic, protodiastolic, and end diastolic velocity variations; and from computerized analysis of the Doppler sound spectrum. The results show a significant improvement of arterial wall elasticity, which suggests a rational use for the drug in the initial stages of peripheral obstructive arterial disease.

Burn and stricture of the ostomy due to colostomy irrigation. Report of a case

A case of burn and stricture of the ostomy subsequent to colostomy irrigation is reported. Heretofore, perforation has been the only serious complication noted. In this case, it was necessary to reconstruct the ostomy because of the development of postburn stricture.