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This study relates an incidence of maternal and feto-neonatal side effects at the Institute of Obstetrics and Gynecology of the University of Parma. Neonatal morbidity and mortality upon administration of corticosteroids and beta-mimetic drugs were observed. Remarkable was the low rate of maternal side effects and that their seriousness was quite inferior to that found by other authors. The fetal and neonatal side effects or symptoms were very few and it was impossible to ascertain whether they were due to the therapy, a consequence of maternal pathological events, the kind of delivery, gestational age or some other unknown factor. Finally, this study points out that the maternal, fetal and neonatal side effects can not be considered serious enough to judge the associated tocolytic and corticosteroid treatment unacceptable.

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A case of squamous cell carcinoma arising in a dermoid cyst of the ovary of a 38 year-old woman is reported. Its frequency is nearly 1%; nevertheless it is opinion that the real frequency could be higher if the hystological examination of the cyst would be made more accurately. Clinical and pathological findings of this case are presented in this brief note. The importance to always make an intraoperatively frozen-section examination is emphasized. The patient is alive and well after six months after surgery.

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In this study the authors compared cesarean section rate and post-operative maternal morbidity occurred during the period 1970-72 with the period 1980-82. The data showed an increased cesarean section rate from 8% to 24% but no difference about number of maternal post-operative complications and fever. Particularly post-operative maternal morbidity in emergency cesarean section fold down till to reach the already low morbidity found in elective cesarean section, besides febrile urinary tract infections are reduced in period 1980-82. No reduction was instead noted in post-cesarean endometrities and bronchopulmonary complications.

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This clinical trial was conducted to test the effectiveness of short-term prophylaxis (1 hour before, 8 and 16 hours after surgery) and long-term prophylaxis (8 hour a part 5 days long post-operatively) in preventing morbidity related to obstetrics and gynecological abdominal surgery. Short-term prophylaxis was always performed by cefuroxime meanwhile gynecological long-term prophylaxis was performed by ampicillin plus oxacillin and by cefuroxime in case of obstetrical surgery. The results showed that long-term prophylaxis is unnecessary and short-term prophylaxis is preferable because of decreased toxicity, a smaller hospital dispensary cost and a real prophylactic action because tha antibiotic is in the tissue before exposure to the infective agents.

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The Authors studied breech presentation rate occurred in the Institute of Obstetrics and Gynecology of University of Parma during 1983. Perinatal morbidity and mortality occurred after vaginal delivery was also compared with those occurred after both emergency and elective cesarean section. Breech presentation delivery vaginally in 12,91% and by cesarean section in 87,09%. Only one case of perinatal death occurred in 1983 and it was not related to breech presentation. Breech delivery showed the 31,18% of neonatal morbidity with an higher rate in case of vaginal delivery (66,66%). In conclusion the Author's opinion is that vaginal breech delivery should be explained in a few cases according to all possible hazards.

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The authors compared sequential HbA1 levels with the results obtained by oral glucose tolerance test (O.G.T.T.) with the purpose of detecting the confidence limit of each test regarding the glucose control in pregnant women. HbA1 detection showed more sensitivity than O.G.T.T. in detecting maternal impaired glucose control and in distinguishing between a metabolic or a genetic feto-neonatal macrosomia.

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The data collected from women who delivered in the Institute of Obstetrics and Gynecology of the University of Parma since 1/7/81 till 31/12/81 were compared to those of the Obstetric-Pediatric Policentric Study of the Subproject of Perinatal Medicine sponsored by N.R.C. (National Research Council) collected since 1973 to 1977. The maternal wish of pregnancy and the total number of obstetrical controls during pregnancy were higher in the data of Parma than in the data of N.R.C. No differences between the two groups were noted in the obstetrical pathological patterns. Spontaneous labor and elective cesarean section are more frequent in Parma meanwhile there is a minor incidence of low weight newborn and perinatal mortality. No difference was noted in the preterm labor incidence.

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The oral glucose tolerance test has been traditionally used to detect women with the gestational form of impaired glucose tolerance. We investigated whether the assessment of HbA1 levels could be a useful adjunct to these measurements. We found that HbA1 levels measured after the 35th week are not predictive of the percentile of each neonatal anthropometric parameter. Both metabolic and clinical maternal parameters as well as neonatal anthropometric parameters must also be evaluated.

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Postpartum HbA1 levels were studied in 114 mothers with a normal pregnancy. HbA1 levels were correlated with neonatal anthropometric parameters and with maternal metabolic parameters. A strong positive correlation was found between weight gain during pregnancy and postpartum HbA1 levels. There was also an increased frequency of infants with large thoracic circumference born to mothers with HbA1 levels above 8.6%. Thus, postpartum HbA1 levels in mothers in whom the serial HbA1 determination is not possible, may be a useful index of glucose control during the gestational period.

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A prospective randomized clinical trial was conducted to test the effectiveness of long-term and short-term prophylaxis with cefuroxime in preventing morbidity after cesarean section. Sixty patients who required emergency cesarean section were randomly assigned to one of three treatment groups: a control group of 20 patients receiving no prophylactic antibiotics; a group of 20 patients receiving 24 hours of cefuroxime prophylaxis (0.75 gm 30 to 60 minutes before surgery and at 8 hours and 16 hours after surgery); and a group of 20 patients receiving five days of cefuroxime prophylaxis (0.75 gm three times a day, the first dose being given postoperatively). The short-term and long-term prophylaxes were equally effective in reducing morbidity, assessed by postoperative temperatures, presence or absence of endometritis, and duration of postoperative hospital stay.

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In the present study the Authors considered some neonatal anthropometric parameters such as head and chest circumference besides the neonatal weight and placental weight that may be more expressive of the fetal growth. All these parameters were correlated separately and jointly with maternal HbA1 levels of the third day of the post partum period. All mothers spent a pregnancy without any clinical and metabolic disorder. The data show a significant higher HbA1 mean value, than the controls, in mothers whose newborn showed one or more parameters like/superior the 90th centile. This finding may suggest that the evaluation of all the parameters together, the maternal HbA1 value can give more informations about the fetal growth.

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A randomized, prospective study of 44 women undergoing total abdominal hysterectomy was conducted to compare cefuroxime short-term prophylaxis and ampicillin plus oxacillin long-term prophylaxis. Cefuroxime was given peri-operatively for 1 day only, whereas the penicillins were given post-operatively for 5 days. The results showed that both regimens were equally effective in providing prophylaxis. It is suggested, therefore, that the use of antibiotics after the first day of surgery is unnecessary and short-term prophylaxis is preferable because of fewer potential disadvantages.

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The authors have determined, by ionic resin exchange chromatographic method, HbA1 values in 16 chemical gestational diabetic pregnant, in 4 case with insulin dependent diabetes and 34 normal pregnant women. Statistical differences were found between normal's HbA1 mean values and clinical diabetics' but not with chemical gestational diabetics. HbA1 mean values in chemical gestational diabetics with diabetic familiarity were found statistically higher than normal subjects' values. Mothers with chemical gestational diabetic, who delivered newborn with less than 50th centile had HbA1 values significantly elevated.

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The Authors have studied 456 pregnancies on young women under the age of eighteen; this record was on 27.215 deliveries in ten years (1970-1979) at the Department of Obstetrics and Gynecology of the University of Parma. From 1970 to 1979 the number of adolescent in pregnancy has triplicated. It has been found that obstetric pathology was 45,25%: this was more in premature rupture of membranes, preeclampsia, premature delivery and urinary infections. The spontaneous delivery has been 90,35% of the total; premature delivery has ben 9,15%; low birthweight has been 9,19%. The incidence of malformations was 2,84%, while the perinatal mortality was 26,31%: the majority of this mortality was recorded after delivery.

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The Authors have studied 272 pregnancies in women above 40 years. This record was on 27.215 deliveries in ten years (1970-1979) at the Department of Obstetrics and Gynecology of the University of Parma. From 1970 to 1979 this phenomenon has decreased by 50%. The incidence of obstetric pathology has been elevated (38,87%): this percentage has been more in premature rupture of membranes, pre-eclampsia and uterine inertia. Of these 272 pregnancies, the 37,35% had pathologic cases before pregnancy: these cases were hypertension, heart troubles and diabetes. Cesarean section was elevated (38,98%), so also premature delivery (12,86%) and low birthweight (12,68%). The incidence of malformations was 10,50%. The perinatal mortality was elevated (49,05%0): the majority of this mortality was recorded before delivery.

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Maternal and feto-neonatal pathology in pregnant women with Hb values less than 10 gr./100 ml. in the last ten weeks of pregnancy was estimated. WHO considers HB values (gr./100 ml.) a valid and sufficient parameter for a clinical classification of the different degrees of anaemia in pregnancy: the authors agree with this suggestion.

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Serum cystine-animo-peptidase (CAP) is a valid test for placental function. We found it interesting following up the variations of CAP during induced labour and early puerperium; with this aim in view we determined the values of the enzyme in 33 pregnant nullipares. Six blood samples were taken from each woman. (174 determinations in all): 1) before labour; 2) at 5 cm. dilatation of the uterine neck; 3) immediately after the expulsion of fetus; 4) two hours after delivery; 5) first day of puerperium; 6) in the fourth day of puerperium. Statistical analysis -- Wilcoxon's test and rank bivalent variants analysis of Friedman (X2r) -- show that the variations of values in the first four groups are not statistically significant; values from 1th and 4th day of puerperium show a mean reduction in level of CAP which is remarkable and statistically significant.

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13 pathologic pregnancies with intrauterine fetal death, serially monitored by C.A.P. determination, were retrospectively examined. In 81,81% of the cases the last C.A.P. value determinated before fetal death is situated below the--1 of standard deviation. Furthermore 50 cases with the last C.A.P. value situated below the--1 of standard deviation were considered: in 26% of these cases subsequentely happened intrauterine fetal death.

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