Despite advances in fetal monitoring during labor, one of the most critical causes of neonatal death and neurologic injuries remains intrapartum asphyxia. Umbilical cord gases can be used to detect acidosis and fetal distress. We conducted a retrospective, multicenter study to evaluate umbilical cord blood pH and lactate as a mean of evaluating the degree of intrapartum hypoxia and also to establish which of the two is more reliable in predicting morbidity in term neonates. The present study utilized a total of 124 cases that met the criteria for intrapartum asphyxia and 150 normal term newborns that were randomly selected as case control. Both umbilical cord lactate and pH proved to be accurate predictors of neonatal morbidity caused by intrapartum hypoxia. Lactate proved to be superior to pH in predicting adverse neonatal outcome. The greatest sensibility and specificity in predicting intrapartum asphyxia were achieved in our study by using a cutoff value of 3.75 mmol/l for lactate and 7.24 for pH.

Premature birth is considered to be the consequence of independent alterations in the cervix and in the uterus. During labor, for full-term birth, as well as for premature birth, the cervix changes, from firm, long and closed, to soft and pliable, through a biochemical process characterized by the reshaping of the extracellular matrix and a growth of the tissue concentration of inflammatory mediators; the uterus proves an increase in contractility and sensitivity to endogenic hormones, such as oxytocin. Premature labor is associated with the premature activation of the release of cytokines in the decidua (mucosa lining uterus walls) and cervix. Interleukins IL-1 beta, IL-6, IL-8 and the alpha tumoral necrosis factor increase the production and activation of matrix metalloproteinases (MMP-1, MMP-3 and MMP-9) and of cathepsin S, which digests the collagen from the extracellular matrix of the cervix, causing the wiping and softening of the cervix. These cytokines are released by leukocytes in the myometer, leading to the production of prostaglandins and oxytocin, which stimulate uterine contractions. Therefore, the cervical shortening represented by ultrasound is believed to represent premature cervical softening. The obstetrical approach of aspects related to premature birth are based, considerably, on the prognosis expected by the obstetrician regarding the survival of the premature new-born baby, as well as the therapeutic variants to be followed. And not only survival is important, of equal importance is also the quality of life of underweight, immature new-born babies, who are considerably affected both physically, and intellectually.

Ectopic pregnancy is a polymorphic disorder, with difficult early diagnosis, and in late stages it determines serious complications, targeting obstetrical and vital prognosis of the patient. A precise and early diagnosis is supported on ultrasound and dosage of the b-hCG dynamics. The presence of b-hCG, the empty uterine cavity on ultrasound tests, the detection of a periuterine tumor mass leads to the diagnosis of ectopic pregnancy. The treatment of ectopic pregnancy is a medical and surgical one. The medical treatment is preferred by most clinicians when it is possible. Our study aims to diagnose and monitor the tubal ectopic pregnancy under methotrexate treatment through biochemical marker hormone b-hCG and progesterone dosing in dynamics. Success or failure rate of the conservatively treatment with methotrexate depends on the initial b-hCG value. The purpose to spare fertility of the young women who want to procreate has led us to avoid surgery and give more weight to curative therapeutic behavior.

Sj�gren�s syndrome (SS) is a multisystemic disease mainly characterized by the hypofunction of the lachrymal and salivary glands and can be either primary or secondary, when related to other autoimmune pathologies. We present the case of a 35-year-old female admitted in the Department of Obstetrics and Gynecology for pregnancy monitoring. The patient had a personal history of a spontaneous abortion one year prior to admission at 5 months of gestation and a maternal history of SS. A multidisciplinary approach with solid obstetrical, rheumatological and neonatal monitoring is essential for best outcomes of the mother and fetus. An early detection of maternal and fetal immune-mediated threats and judicious use of medication is essential in women with autoimmune diseases who plan conceiving.

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