The primary study objective was to investigate three decades from 1985 to 2014 of changes in pregnancies among HIV-infected women. The secondary objective was to assess risk factors associated with preterm delivery and severe small-for-gestational-age (SGA) infants in HIV-infected women. A retrospective review of deliveries among pregnant HIV-infected women at the University of Genoa and IRCCS San Martino-IST in Genoa between 1985 and 2014 was performed. Univariate and multivariable analyses were used to study the variables associated with neonatal outcomes. Overall, 262 deliveries were included in the study. An increase in median age (26 years in 1985-1994 vs. 34 years in 2005-2014), in the proportion of foreigners (none in 1985-1994 vs. 27/70 (38·6%) in 2005-2014), and a decrease in intravenous drug use (75·2% (91/121) in 1985-1994 vs. 12·9% (9/70) in 2005-2014) among pregnant HIV-infected women was observed. Progressively, HIV infections were diagnosed sooner (prior to pregnancy in 80% (56/70) of women in the last decade). An increase in combined antiretroviral therapy (cART) prescription during pregnancy (50% (27/54) in 1995-2004 vs. 92·2% (59/64) in 2005-2014) and in HIV-RNA <50 copies/ml at delivery (19·2% (5/26) in 1995-2004 vs. 82·3% (53/64) in 2005-2014) was observed. The rate of elective caesarean section from 1985 to 1994 was 9·1%, which increased to 92·3% from 2004 to 2015. Twelve (10·1%) mother-to-child transmissions (MTCT) occurred in the first decade, and six (8·3%) cases occurred in the second decade, the last of which was in 2000. Preterm delivery (<37 weeks gestation) was 5% (6/121) from 1985 to 1994 and increased to 17·1% (12/70) from 2005 to 2014. In univariate and multivariable logistic regression analyses, advancing maternal age and previous pregnancies were associated with preterm delivery (odds ratio (OR) 2·7; 95% confidence intervals (CI) 1-7·8 and OR 2·6; 95% CI 1·1-6·7, respectively). In the logistic regression analysis, use of heroin or methadone was found to be the only risk factor for severe SGA (OR 3·1; 95% CI 1·4-6·8). In conclusion, significant changes in demographic, clinical and therapeutic characteristics of HIV-infected pregnant women have occurred over the last 30 years. Since 2000, MTCT has decreased to zero. An increased risk of preterm delivery was found to be associated with advancing maternal age and previous pregnancies but not with cART. The use of heroin or methadone has been confirmed as a risk factor associated with severe SGA.

Perinatal infections are a serious and delicate problem for which great diagnostic care and accurate therapies are required. In some cases they are characterized by a dramatic onset, easy to diagnose at delivery, whereas in many other cases they are poorly symptomatic with medium and long term sequelae. In these other cases, further laboratory, mlcrobiological and instrumental investigations äs well äs blood tests are needed. With all these investigations, a correct diagnosis takes rather long with obvious disadvantages for the patient. Therefpre, more efforts should be made to reduce the time interval between diagnosis and beginning of therapy, for example through a rapid histological examination of the cord and membranes on frozen sections. However, with this method, by which a correct diagnosis can be obtained in a very short time, the cases to be examined must first be selected. After a long period of study and planning, during which the advantages and limits of this diagnostic tool have been examined, the following guidelines have been identified: 1) positive vaginal tampon during pregnancy for pathogenic agents infecting the phoetus; 2) untreated genital-urinary infection during pregnancy or for which no subsequent negative control is available after treatment; 3) any other infection risk factor present in individual cases; 4) prolonged rupture of the membranes (for morethan 24 hours) ; 5) pre-term delivery (before week 37) without any other known risk factors; 6) muddy and/or malodorous amniotic fluid; 7) skin rash at birth (pustules or macules/papules); 8) fever at birth; 9) mother's fever during labour and/or in the days preceding birth. From a practical point of view, because of the focal nature of funisitis and chorion amnionitis, the pathologist should be provided with a relatively long segment of the umbilical cord from which sections shall be cut at three different levels, äs well äs a fold of placental membrane to be examined throughout its length according to the 'Swiss roll' technique. The füll placenta will be sentlaterforthorough examination according tothe Standard protocol (see Pathologica 84,563-566,1992). The above protocol was rigorously applied with no interruptions to a case series from April to September 1993. In this period, 46 urgent examinations were conducted on a total of 680 newborns (i.e. 6.8%). 9 cases of chorion amnionitis were detected (19.6%), 5 of which with associated funisitis. These cases were referred to us based pn the following findings: -muddy or malodorous amniotic fluid (criterio n° 6): 4 cases -pre-term delivery (criterio n°5): 3 cases -prolonged rupture of the membranes (criterio n° 4): 1 case -fever at birth (criterio n°8): 1 case. All diagnoses made on frozen sections were later confirmed on embedded material specimens and on additional placenta specimens. Negative cases were also confirmed accordingly. The reliability of this technique is thus confirmed by these data. The 9 positive cases were confirmed by bacteriological examinations on the newborn and on the...