PubMed · 14118992
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J LOVSET. 1964-02-27. [ABRUPTIO PLACENTAE].. https://pubmed.ncbi.nlm.nih.gov/14118992/
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OBJECTIVE: To establish the extent of maternal mortality in Italy in between 1980 and 1996 in order to compare it with the international data. STUDY DESIGN: We conducted a retrospective study on maternal deaths in Italy from 1980 to 1996. Data have been collected by Italian Statistic Institute (ISTAT). We calculated both the maternal mortality rates and the percentages of causes of death in the whole period, according to WHO definitions. RESULTS: The data confirmed the trends of the previous decade: maternal mortality rates have decreased from 13.25 (1980) to 3.78 (1996) for 100000 live births. Haemorrhage and hypertension have been the main causes of maternal death, while pulmonary embolism has had a minor affect on maternal mortality rates compared to other countries, particularly in Europe. CONCLUSION: Italian data appear reassuring and encourage further investigations on detailed welfare problems.
OBJECTIVE: To determine whether common inherited thrombophilias in the fetus influence the severity of severe preeclampsia, IUGR and placental abruption. DESIGN: A case-control study among patients with complicated pregnancies. Cases were defined as fetuses with thrombophilia. SETTING: A university hospital with 3700 deliveries per year. POPULATION: Seventy cases with severe preeclampsia, IUGR or placental abruption. METHODS: Mothers and neonates were tested for mutation of factor V Leiden, prothrombin gene and methylenetetrahydrofolate reductase. MAIN OUTCOME MEASURES: Gestational age at delivery, birth weight and early neonatal complications. RESULTS: Gestational age at delivery and birth weight were significantly lower in fetuses with factor V Leiden or prothrombin gene mutation compared to control fetuses. CONCLUSIONS: Fetal factor V Leiden mutation and prothrombin gene mutation may influence the course of severe preeclampsia, IUGR and placental abruption. These thrombophilic changes may cause an earlier appearance or lead to a late pregnancy complication of a greater severity.
OBJECTIVE: To determine the value of Doppler measurements obtained by a new multigate Doppler modality, the spectral Doppler index mapping (SDIM) technique, to predict adverse outcome among pregnant women with normal conventional umbilical artery (UA) Doppler indices. DESIGN: A cross-sectional prospective cohort study. SUBJECTS: 183 women with well-dated singleton pregnancies who underwent prenatal ultrasound examination between 18 and 40 weeks of gestation were included in the study. At the time of the initial Doppler examination, all patients had normal UA and uterine artery Doppler indices, size appropriate for gestational age, no evidence of fetal anomalies or fetal distress. METHODS: SDIM data included the distribution curves of the pulsatility indices (PI) as well as the mean of the PI detected in the placenta and in the umbilical cord. The mean PI values were also calculated using conventional spectral Doppler sonography. Logistic regression analysis was used to control for gestational age while assessing various Doppler variables in predicting outcome. RESULTS: Adverse outcomes occurred in 26.6% of the pregnancies. In pregnancies with adverse outcome, the umbilicoplacental PI gradient was significantly lower (0.10 vs. 0.28, p < 0.003), the maximum intraplacental PI value was higher (1.28 vs. 1.16, p = 0.031), and there was a greater proportion with skewed UA distribution curves. Using forward stepwise logistic regression to compare the predictive value of the conventional Doppler ultrasound with SDIM, we found that the most accurate predictors of adverse outcome were the maximum intraplacental PI value (p < 0.028), skewed distributions (p = 0.002) and the gradient between the umbilical and intraplacental PI distributions (p = 0.006). CONCLUSIONS: Our results suggest that the SDIM system may enhance the ability of Doppler technology to predict obstetrical outcomes in patients with normal UA Doppler indices.