L-Arginina e ipertensione in gravidanza

Il ruolo svolto dal sistema L-Arginina-ossido d’azoto (L-Arg-NO) nella genesi dell’ipertensione gestazionale è consolidato da numerosi studi in vitro ed in vivo. Infatti è stato dimostrato che l’inibizione della produzione di NO determina nell’animale da esperimento i medesimi segni e sintomi che si verificano in corso di preeclampsia (1-4). Recentemente la nostra attenzione si è focalizzata sulla capacità della L-Arginina di modificare la storia ostetrica delle donne affette da ipertensione cronica, che come è noto rappresenta un importante fattore di rischio per lo sviluppo di preeclampsia. A questo proposito sono state prese in esame 62 gravide affette da ipertensione preesistente alla gravidanza afferenti all’Ambulatorio di Patologia Ostetrica del Dipartimento Integrato Materno-Infantile dell’Università di Modena. Scopo dello studio è la valutazione della percentuale di conversione in preeclampsia, la quantità complessiva di farmaco antipertensivo utilizzato durante la gravidanza ed inoltre la valutazione dell’effetto della L-Arginina sulla pressione arteriosa misurato tramite Holter-24 ore. Considerando l’outcome materno-fetale, è stato osservato come il gruppo trattato con L-Arginina presenti rispetto al gruppo osservazione un’epoca gestazionale al parto più avanzata (38.1±2.8 vs 36.9±3.7), peso fetale maggiore (3048±741 vs 2933±950) e minor ricorso al taglio cesareo (20.6% vs 27.6%). Inoltre, il gruppo trattato con L-Arginina presenta una minor percentuale di parti al di sotto della 37ª settimana (26.5% vs 34.5%) e minor percentuale di neonati con peso inferiore a 2500 grammi (20.6% vs 24.1%

Contraception after pregnancy

Whatever the outcome, pregnancy provides the opportunity to offer effective contraception to couples motivated to avoid another pregnancy. This narrative review summarizes the evidence for health providers, drawing attention to current guidelines on which contraceptive methods can be used, and when they should be started after pregnancy, whatever its outcome. Fertility returns within 1 month of the end of pregnancy unless breastfeeding occurs. Breastfeeding, which itself suppresses fertility after childbirth, influences both when contraception should start and what methods can be used. Without breastfeeding, effective contraception should be started as soon as possible if another pregnancy is to be avoided. Interpregnancy intervals of at least 6 months after miscarriage and 1-2 years after childbirth have long been recommended by the World Health Organization in order to reduce the chance of adverse pregnancy outcome. Recent research suggests that this may not be necessary, at least for healthy womenPeer reviewe

Adnexal Torsion during Pregnancy after Oocyte In Vitro Maturation and Intracytoplasmic Sperm Injection Cycle

We report a case of right adnexal torsion during pregnancy after an oocyte in vitro maturation and intracitoplasmic sperm injection cycle in patient with polycystic ovary syndrome. A 31-year-old woman with a typical clinical disorder of polycystic ovarian syndrome was included in an oocyte in vitro maturation program. Right adnexal torsion occurred two days after embryo transfer, and laparoscopy detorsion was successfully performed with preservation of adnexa. The patient had a full-term pregnancy and delivered a healthy infant at 40 weeks of gestation. To our knowledge this is the first report of adnexal torsion after an oocyte in vitro maturation and intracitoplasmic sperm injection program

Prediction of age at menopause from assessment of ovarian reserve may be improved by using body mass index and smoking status.

OBJECTIVE: Menopause is the consequence of exhaustion of the ovarian follicular pool. AMH, an indirect hormonal marker of ovarian reserve, has been recently proposed as a predictor for age at menopause. Since BMI and smoking status are relevant independent factors associated with age at menopause we evaluated whether a model including all three of these variables could improve AMH-based prediction of age at menopause. METHODS: In the present cohort study, participants were 375 eumenorrheic women aged 19-44 years and a sample of 2,635 Italian menopausal women. AMH values were obtained from the eumenorrheic women. RESULTS: Regression analysis of the AMH data showed that a quadratic function of age provided a good description of these data plotted on a logarithmic scale, with a distribution of residual deviates that was not normal but showed significant left-skewness. Under the hypothesis that menopause can be predicted by AMH dropping below a critical threshold, a model predicting menopausal age was constructed from the AMH regression model and applied to the data on menopause. With the AMH threshold dependent on the covariates BMI and smoking status, the effects of these covariates were shown to be highly significant. CONCLUSIONS: In the present study we confirmed the good level of conformity between the distributions of observed and AMH-predicted ages at menopause, and showed that using BMI and smoking status as additional variables improves AMH-based prediction of age at menopause

Second Trimester Amniocentesis Is Not a Risk Factor for Very Low Birth Weight and Extremely Low Birth Weight

Objectives. To assess the risk of very low birth weight (VLBW) and extremely low birth weight (ELBW) attributable to second trimester amniocentesis. Methods. Records of 4,877 consecutive amniocentesis, performed between 1997 and 2003, were analyzed. Only VLBW and ELBW in the study population (exposed) and in the control group (unexposed) were evaluated. Comparisons were made between the amniocentesis group versus nonexposed. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for VLBW and ELBW classes. Results. In the study population, the VLBW were 35 (0.71%) and the ELBW were 20 (0.41%). In the control group, the VLBW were 220 (0.67%) and the ELBW were 112 (0.34%). The Odds ratios of the VLBW between the study and the control group did not show any statistical significant risk (OR = 1.07, 95% CI = 0.72–1.54). Also in ELBW odds ratios between study and control group were not statistically significant (OR = 1.20, 95% CI = 0.7–1.95). Conclusions. No effect of the second trimester amniocentesis was noted on VLBW and ELBW

Unexpectedly Low Mutation Rates in Beta-Myosin Heavy Chain and Cardiac Myosin Binding Protein Genes in Italian Patients With Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease. Fourteen sarcomeric and sarcomere-related genes have been implicated in HCM etiology, those encoding β-myosin heavy chain (MYH7) and cardiac myosin binding protein C (MYBPC3) reported as the most frequently mutated: in fact, these account for around 50% of all cases related to sarcomeric gene mutations, which are collectively responsible for approximately 70% of all HCM cases. Here, we used denaturing high-performance liquid chromatography followed by bidirectional sequencing to screen the coding regions of MYH7 and MYBPC3 in a cohort (n = 125) of Italian patients presenting with HCM. We found 6 MHY7 mutations in 9/125 patients and 18 MYBPC3 mutations in 19/125 patients. Of the three novel MYH7 mutations found, two were missense, and one was a silent mutation; of the eight novel MYBPC3 mutations, one was a substitution, three were stop codons, and four were missense mutations. Thus, our cohort of Italian HCM patients did not harbor the high frequency of mutations usually found in MYH7 and MYBPC3. This finding, coupled to the clinical diversity of our cohort, emphasizes the complexity of HCM and the need for more inclusive investigative approaches in order to fully understand the pathogenesis of this disease. J. Cell. Physiol. 226: 2894–2900, 2011. © 2011 Wiley-Liss, Inc

Contraception after pregnancy

Whatever the outcome, pregnancy provides the opportunity to offer effective contraception to couples motivated to avoid another pregnancy. This narrative review summarizes the evidence for health providers, drawing attention to current guidelines on which contraceptive methods can be used, and when they should be started after pregnancy, whatever its outcome. Fertility returns within 1 month of the end of pregnancy unless breastfeeding occurs. Breastfeeding, which itself suppresses fertility after childbirth, influences both when contraception should start and what methods can be used. Without breastfeeding, effective contraception should be started as soon as possible if another pregnancy is to be avoided. Interpregnancy intervals of at least 6 months after miscarriage and 1‐2 years after childbirth have long been recommended by the World Health Organization in order to reduce the chance of adverse pregnancy outcome. Recent research suggests that this may not be necessary, at least for healthy women <35 years old. Most contraceptive methods can be used after pregnancy regardless of the outcome. Because of an increased risk of venous thromboembolism associated with estrogen‐containing contraceptives, initiation of these methods should be delayed until 6 weeks after childbirth. More research is required to settle the questions over the use of combined hormonal contraception during breastfeeding, the use of injectable progestin‐only contraceptives before 6 weeks after childbirth, and the use of both hormonal and intrauterine contraception after gestational trophoblastic disease. The potential impact on the risk of ectopic pregnancy of certain contraceptive methods often confuses healthcare providers. The challenges involved in providing effective, seamless service provision of contraception after pregnancy are numerous, even in industrialized countries. Nevertheless, the clear benefits demonstrate that it is worth the effort

Analysis of river bed dynamic evolution following a landslide dam

Landslides and debris flows can strongly interact with the river network and its mass transport processes, determining modifications of the river pattern with consequent effects on the hydrodynamic phenomena, alterations of the existing morphologies and possible interferences with anthropic works. Modifications of the cross section geometry and channel slope may produce changes in the sediment budget, with consequent repercussions on the stream evolutionary dynamics and its equilibrium configuration, leading to a new river branch arrangement. In this paper, investigations were carried out on a gravel-bed reach in the middle valley of the Noce River in Basilicata (Italy), which in 2007 suffered a progressive morpho-hydrodynamic change caused by a landslide. Because of the phenomenon complexity, mainly due to the mutual interaction between the landslide and the river transport dynamics, an integrated approach that combines field observations and numerical modelling in a spatial scale and natural environment, rarely available in literature, is suggested. The results highlight a satisfying correspondence between the altimetric profiles obtained through the numerical models and those deriving from the field surveys.Peer ReviewedPostprint (published version

[Correlation between hematic acid-base equilibrium of the mother and newborn infant].

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[Obstetrical organizational problems in perinatal medicine in the Province of Messina].

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