Annalisa Agangi

In vitro resistance to macrolides and clindamycin by Group B Streptococcus isolated from pregnant and nonpregnant women.

Background. Despite the introduction of screening bases intrapartum prophylaxis, Streptococcus agalactiae is still an important etiological agent of perinatal infections. The increasing rate of resistance and the differences in resistance pattern among countries suggest that a program of surveillance at the institutional level is important in determining optimal prophylaxis. In contrast, knowledge on GBS epidemiology in Italy is limited, and no data are available in the Southern region of the country. We sought to determine the occurrence of resistance to macrolides and clindamycin of GBS isolates in pregnant and nonpregnant women. Methods. Between 2005 and 2008, 1346 vaginal and 810 rectovaginal swabs were obtained from pregnant and not-pregnant women. Results. The occurrence of macrolides and clindamycin resistance was 16.5% in 2005 increasing up to 69.9% in 2008. A high percentage of isolates was resistant to tetracycline through all the study period with no statistically significant annual. Conclusions. In our cohort, an increase of in vitro resistance of GBS to macrolides and clindamycin is clearly evident. The discordance with reports from different countries emphasize the crucial role of microbiological methods in setting possible therapeutic strategies.

Epidemiological and clinical features of pregnant women with HIV: a 21-year perspective from a highly specialized regional center in southern Italy.

Abstract Purpose: To analyze the changes over two decades in HIV-infected pregnant women followed at a highly specialized regional center for antenatal care in southern Italy. Method: Since 1985, all HIV-infected pregnant women attending our center have been monitored using progressively updated protocols. Results: By December 2006, 230 deliveries in 159 women had been monitored. Deliveries in HIV-infected women increased from 0.16% (4/2,499) of all deliveries in 1985 to 0.73% (15/2,042) in 2006. The sociodemographic profile of the women changed greatly over the study period, and there was a shift from injecting drug use to heterosexual contact as the main transmission route and an increased proportion of foreign women. Subsequent to improvements in clinical care, the proportion of infected pregnant women receiving antiretroviral treatment increased from 27% (17/63) before 1996 to 81% (63/78) in 2006, with a corresponding decrease in the mother-to-child transmission rate from 36% (16/44) to 0.6% (1/157). Conclusion: The increasing number of HIV-infected pregnant women can be attributed to nonselective antenatal HIV screening, the spread of HIV infection through heterosexual contacts, and the desire of HIV-infected women to have children. In this context, highly specialized reference centers can play an important role in providing HIV-infected pregnant women with optimal care and in reducing mother-to-child transmission rates to very low levels.

Pregnancy in a woman with a history of Budd-Chiari syndrome treated by porto-systemic shunt, protein C deficiency and bicornuate uterus

Pregnancy in a woman with a history of Budd-Chiari syndrome treated by porto-systemic shunt, protein C deficiency and bicornuate uterus -

Ethic, medical and legal reflections about the fetal protection by a pregnant woman suffering, in comorbidity, from HIV infection

The trend to have children even if one or both parents suffer from chronic diseases is influenced by personal, psycho-organic and social factors. The Authors face the moral and professional dilemma of honouring a womans intentions, or persuading her to interrupt her pregnancy to prevent damage to her health.

Prevalence and characteristics of symptomatic and asymptomatic tuboovarian masses in women with HIV: an ultrasonographic study

HIV-positive women with pelvic inflammatory disease have been reported to have an increased prevalence of tuboovarian masses (TOMs). The aim of this study was to assess the prevalence of asymptomatic ultrasonographic TOMs in women with HIV and to identify associated factors in order to formulate a selective ultrasonographic screening strategy. Two-hundred and four HIV outpatients underwent transvaginal ultrasonography. Eight (3.9%) had a diagnosis of TOM (5 were asymptomatic). Two profiles of patients at risk for TOM were identified who could be considered for selective screening strategies: the ‘long-term infected’ (age>35 years, diagnosis of HIV infection more than 5 years ago, HIV clinical category C, CD4 counts below 200/mm3, >5 lifetime partners and on antiretroviral therapy) and the ‘recently diagnosed with HIV’ (African ethnicity, age 25–35, HIV diagnosis in the previous year, >5 lifetime partners, HIV clinical category C and not on antiretroviral therapy).

Prenatal Diagnosis of Ulbright-Hodes Syndrome

lbright-Hodes syndrome, or limb reduction defects and renal dysplasia, is an unusual lethal congenital malformation that consists of mesomelia, radiohumeral fusion, and renal dysplasia. We report the successful prenatal diagnosis of the condition at 21 weeks’ gestation in a family with a negative history, which to our knowledge has not been reported previously. Sonographic findings, new and atypical features, the differential diagnosis, and counseling of the couple are reported.

An important clinical lesson from a patient infected with HIV with diabetic nephropathy and retinopathy.

In resource-rich settings, advances in antiretroviral therapy have reduced the morbidity and increased the life expectancy of patients infected with HIV and consequently increased the likelihood of observing other non-HIV-related diseases in this group of patients. We report a high-risk pregnancy in a 26-year-old woman infected with HIV with complicated insulin-dependent diabetes mellitus. Because of maternal concomitant disease and concerns regarding potential antiretroviral toxicity on maternal disease, an abbreviated regimen of zidovudine prophylaxis was offered to prevent neonatal infection. After the iatrogenic preterm delivery of a healthy and uninfected baby, the patient experienced vulvar oedema and she is now waiting for renal transplantation. In conclusion, our case is one of a range of possible scenarios that may develop in pregnant women who are infected with HIV, reflecting the highly active antiretroviral therapy (HAART)-associated improvements in survival and health.

P33.05: Prenatal diagnosis of trisomy 18 in fetus with only bilateral choroids plexus cysts

Results: Ultrasound examination of a 30-year-old Caucasian female, pregnant for the first time, showed a monozygotic pregnancy with: scalp cystic hygromata, polycystic kidney, bilateral clubhand, varusequin foot and polyhydramnios. These anomalies indicated possibility of chromosomal abnormality and suggested to perform the amniocentesis; fetal chromosomal analysis showed abnormal karyotype 47, XY, +21. The parents opted for termination of this pregnancy. Conclusions: The necessity of routine ultrasound examination for the prenatal detection of chromosomal abnormalities to all pregnancies.