L’incidenza del parto pretermine nel Centro Ospedaliero Princesse Grace del Principato di Monaco

Il parto pretermine rappresenta tuttora una patologia della gravidanza di estrema rilevanza, essendo gravato da un’elevata morbosità e mortalità neonatale. È caratterizzato da un’eziopatogenesi di tipo multifattoriale: differenti fattori, di origine sia materna che fetale, fra loro variamente combinati, contribuiscono in diversa misura nel determinare la sua insorgenza. Uno dei principali obiettivi del management dei feti prematuri è pertanto quello di evitare l’asfissia fetale e, conseguentemente, le sequele più gravi: la mortalità peri-partale e le sequele a distanza, soprattutto neurologiche, tra cui l’infermità motoria-cerebrale. Al fine di verificare i fattori di rischio, l’incidenza ed il management del parto pretermine in una popolazione di livello medio-alto, sia pure multietnica, è stata studiata la percentuale di parti pretermine presso il CHPG del Principato di Monaco nel periodo compreso da gennaio 2002 a febbraio 200

Prenatal Diagnosis, Where and How: No Way Out?

ABSTRACTPrenatal diagnosis is the branch of medicine and in particular of obstetrics, that studies and applies the techniques that reveal the normality or the presence of diseases of various kinds, in the fetus. All the techniques of prenatal diagnosis are performed during pregnancy and may be invasive or less. Among the best known, amniocentesis is the most exploited technique nowadays to highlight the possible presence of chromosomal disorders in the fetus, but also infections and genetic diseases such as thalassemia, cystic fibrosis, hemophilia, spina bifida, albinism. Amniocentesis consists of taking an amniotic fluid sample which is then analyzed. Fetal cells suspended in the withdrawn liquid allow us to reconstruct the chromosome map of the fetus and then to confirm or not its normality. Genetic testing, however, are not able to recognize the physical or mental characteristics of the unborn child which are the result of the interaction between multiple genes and the environment. Amniotic fluid makes possible to perform other types of analysis, more or less complex, and it is also possible to store the amniotic stem cells. Similar to amniocentesis as a principle but different as a technique, is chorionic villus sampling (CVS), in which the cells can be put in culture to show their normality, but they are cells taken outside from the gestational chamber (chorionic villi). These are invasive techniques (the fluid is taken by puncture in both cases), but there are also noninvasive techniques. The development of ultrasound, for example, has made it possible to develop some highly sensitive diagnostic techniques, such as the first trimester combined test [bitest and nuchal translucency (NT)], the 'quadruple' test, and lately the SCA test in the second trimester, all based on the ultrasound measurement of anatomical and functional parameters of the fetus and on the results of blood tests. These are all screening tests, then they do not give a definite answer but they have a statistical value (very accurate) that can direct toward diagnostic tests. Recently, an extremely sensitive test for the most common aneuploidies and in particular Down syndrome has been proposed to be performed on maternal blood. This test (called fetal DNA testing) is based on the count of fragments of specific chromosomes (21 in the case of Down syndrome) in maternal blood. Although not belonging to diagnostic tests but to probabilistic ones, this test is absolutely the most accurate so far available, with values around 99.99% sensitivity and 0.2% false positives. Also ultrasound in the second trimester of pregnancy (also called morphological ultrasound) that can detect any malformation or fetal abnormality and fetal echocardiography, which analyzes sonographically the fetal heart not only anatomically but also from the dynamic-functional point of view, may be considered methods of prenatal diagnosis. This technique cannot identify genetic diseases.How to cite this articleBorruto F, Treisser A, Comparetto C. Prenatal Diagnosis, Where and How: No Way Out? Donald School J Ultrasound Obstet Gynecol 2014;8(3):293-310

Feasibility and safety study of a new device (Odón device) for assisted vaginal deliveries: study protocol

Background Intrapartum complications are responsible for approximately half of all maternal deaths, and two million stillbirth and neonatal deaths per year. Prolonged second stage of labour is associated with potentially fatal maternal complications such as haemorrhage and infection and it is a major cause of stillbirth and newborn morbidity and mortality. Currently, the three main options for managing prolonged second stage of labour are forceps, vacuum extractor and caesarean section. All three clinical practices require relatively expensive equipment (e.g., a surgical theatre for caesarean section) and/or highly trained staff which are often not available in low resource settings. The specific aim of the proposed study is to test the safety and feasibility of a new device (Odón device) to effectively deliver the fetus during prolonged second stage of labour. The Odón device is a low-cost technological innovation to facilitate operative vaginal delivery and designed to minimize trauma to the mother and baby. These features combined make it a potentially revolutionary development in obstetrics, particularly for improving intrapartum care and reducing maternal and perinatal morbidity and mortality in low resource settings. Methods/design This will be a hospital-based, multicenter prospective phase 1 cohort study with no control group. Delivery with the Odón device will be attempted under normal labour and non-emergency conditions on all the women enrolled in the study. One-hundred and thirty pregnant women will be recruited in tertiary care facilities in Argentina. Safety will be assessed by examining maternal and infant outcomes until discharge. Feasibility will be evaluated by observing successful expulsion of the fetal head after one-time application of the device under standardized conditions (full cervical dilation, anterior presentation, +2 station, normal fetal heart rate).Fil: Schvartzman, Javier A.. Centro de Educaciones Médicas e Investigación Clínica "Norberto Quirno"; ArgentinaFil: Krupitzki, Hugo Bernardo. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; ArgentinaFil: Betran, Ana Pilar. Department of Reproductive Health and Research. Ginebra; SuizaFil: Requejo, Jennifer. Department of Reproductive Health and Research. Ginebra; SuizaFil: Bergel, Eduardo. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Fiorillo, Angel Eduardo. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; ArgentinaFil: Gadow, Enrique Curt. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; ArgentinaFil: Vizcaino, Francisco M.. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; ArgentinaFil: Von Petery, Felicitas. Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”; ArgentinaFil: Althabe, Fernando. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Borruto, Franco. Centre Hospitalier Princesse Grace; MónacoFil: Boulvain, Michel. Hopitaux Universitaires de Ginebra. Ginebra; SuizaFil: Di Renzo, Gian Carlo. Santa Maria Della Misericordia University Hospital; ItaliaFil: Gülmezoglu , Metin. World Health Organization. Ginebra; SuizaFil: Hofmeyr, Justus. University of the Witwatersrand; SudáfricaFil: Judge, Kevin. Becton Dr. Franklin Lakes. New York; Estados UnidosFil: Leung, Tak Yeung. The Chinese University of Hong Kong; Hong KongFil: Nguyen, My Huong. Department of Reproductive Health and Research. Ginebra; SuizaFil: Saugstad, Ola Didrik. University of Oslo; NoruegaFil: Temmerman, Marleen. Department of Reproductive Health and Research. Ginebra; SuizaFil: Treisser, Alain. Centre Hospitalier Princesse Grace; MónacoFil: Vayena, Effy. Universitat Zurich; SuizaFil: Merialdi, Mario. Department of Reproductive Health and Research. Ginebra; Suiz