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Resveratrol display's positive effects on follicle growth and development in preclinical studies while there is scantly information from clinical trials. The aim of this study was to evaluate the biological and clinical impact of a resveratrol-based multivitamin supplement on intracytoplasmatic sperm injection (ICSI) cycles.A randomized, single-center controlled trial conducted at the University Center of Assisted Reproductive Technologies involving 101 women infertile women undergoing ICSI cycles was conducted. A pretreatment with a daily resveratrol based nutraceutical was administered to the Study Group; Control Group received folic acid. The primary outcomes were the number of developed mature follicles (16 mm), total oocytes and MII oocytes recovered, the fertilization rate and the number of cleavage embryos/blastocysts obtained. Secondary endpoints were the duration and dosage of gonadotropins, the number of embryos for transfer, implantation, biochemical, clinical pregnancy rates, live birth and miscarriage rates.A significantly higher number of oocytes and MII oocytes were retrieved in the Study Group than in Control Group (A 3 months period of dietary supplementation with a resveratrol-based multivitamin nutraceutical leads to better biological effects on ICSI cycles.ClinicalTrials.gov registration identifier: NCT04386499.

Background: COVID-19 is a pandemic disease caused by the SARS-CoV-2 and it spread globally in the last few months. The complete lack of specific treatment forced clinicians to use old drugs, chosen for their efficacy against similar viruses or their in vitro activity. Trials on patients are ongoing but the majority of information comes from small case series and single center reports. We aimed to provide a literature review on the putative effectiveness and safety of available treatments for COVID-19 in pregnant women. Methods: We reviewed all the available literature concerning the drugs that have been used in the treatment of COVID-19 during pregnancy and whose safe assumption during pregnancy had been demonstrated by clinical studies (i.e. including studies on other infectious diseases). Drugs contra-indicated during pregnancy or with unknown adverse effects were not included in our review. Results and conclusions: Clinical trials are not often conducted among pregnant patients for safety reasons and this means that drugs that may be effective in general population cannot be used for pregnant women due to the lack of knowledge of side effects in this category of people .The choice to use a specific drug for COVID-19 in pregnancy should take into account benefits and possible adverse events in each single case. In the current situation of uncertainty and poor knowledge about the management of COVID-19 during pregnancy, this present overview may provide useful information for physicians with practical implications.

During the last decades, the age of pregnant women significantly increased. The incidence of maternal and labor complications is higher among older women, but conclusive data have not been delivered whether labor epidural analgesia (EA) may affect the duration of labor and delivery outcomes in this population of patients. The aim of this study is to evaluate the effect of EA among women aged over 35 years.We retrospectively reviewed medical records of all, singleton, at term deliveries, laboring with EA, between December 2011 and October 2017. Women aged ≥35 years (study group) were compared with women aged35 years (control group) to evaluate EA effects on the duration of labor and neonatal outcome.The study enrolled 459 women with EA: 122 women were included in the study group and 337 in the control group. The multiple regression analysis showed that parity was an independent variable for a shorter dilation period (Results of this study indicate that women aged ≥35 with EA may have labor duration and neonatal short-term outcomes similar to younger women with EA.

Objective To describe the characteristics and peripartum outcomes of patients diagnosed with uterine rupture (UR) by an observational cohort retrospective study on 270 patients. Methods Demographic information, surgical history, symptoms, and postoperative outcome of maternal and neonates after UR were collected in a large database. The statistical analysis searched for correlation between UR, previous uterine interventions, fibroids, and the successive perinatal outcomes in patients with previous UR. Results UR was significantly associated with previous uterine surgery, occurring, on average, at 36,81 weeks of gestation in patients also without previous uterine surgery. UR did not rise exponentially with an increasing number of uterine operations. Fibroids were related to URs. The earliest UR occurred at 159 days after hysteroscopic myomectomy, followed by laparoscopic myomectomy (251 days) and laparotomic myomectomy (253 days). Fertility preservation was feasible in several patients. Gestational age and birth weight seemed not to be affected in the subsequent pregnancy. Conclusion data analysis showed that previous laparoscopic and abdominal myomectomy were associated with UR in pregnancy, and hysteroscopic myomectomy was associated at earlier gestational ages. UR did not increase exponentially with an increasing number of previous scars. UR should not be considered a contra-indication to future pregnancies.

To identify whether COVID-19 vaccines should be administered in pregnant and breastfeeding women by reviewing the guidance and other evidence.We reviewed the COVID-19 vaccination guidance for pregnant and breastfeeding women published to date and evidence from preclinical experimental and observational clinical studies, and discuss their implications.Pregnant women were excluded from the initial phase 3 clinical trials of COVID-19 vaccines resulting in limited data on their efficacy and safety during pregnancy and postpartum. As a result, since December 2020, there has been conflicting advice from public health, governmental, and professional authorities on this matter. From the end of 2020 up to now, some consensus guidance has been published with a prevalent precautionary approach on the administration of vaccines in pregnant women, in breastfeeding ones, or for those who are planning a pregnancy (either spontaneously or with assisted technologies). After the first few months of vaccine administration in some countries, more permissiveness seems to prevail, although with inconsistencies. At the moment, the results obtained by preclinical experimental and observational clinical studies suggest that the risks of the maternal COVID-19 outweigh the undocumented and hypothetical risks of the COVID-19 vaccines in pregnancy. Also, until two viral vector COVID-19 vaccines were associated with very rare thromboembolic events, all guidance had agreed that all approved COVID-19 vaccines could be administered in pregnancy. Actually, some concern has been expressed.COVID-19 vaccines administered in pregnancy can reduce the risk of severe COVID-19 and their serious consequences for mothers and their offspring. However, many aspects remain to be clarified.

Periodontal disease (PD) has been shown to increase the risk of preterm birth, preeclampsia and low birth weight. These observations have suggested that PD may also affect the early phase of pregnancy, including conception. The present study aimed to evaluate whether an association exists between oral health status and the chance of clinical pregnancy, according to the currently published literature, by performing a systematic review. The PubMed and EMBASE databases were searched from their start dates to October 2021 using the following keywords: 'Infertility' OR 'conception' OR 'pre-pregnancy' OR 'time-to-pregnancy' AND 'periodontitis' OR 'periodontal disease' OR 'dental infection' OR 'gingivitis' OR 'odontogenic infection' (limits: Full article, English, Human). A total of 6 papers reporting observational information on PD and spontaneous (4 studies) or medically induced conception (2 studies) were retrieved. As such, there were limited studies with different designs (randomized controlled trials and observational studies) and different settings. Moreover, in the selected studies, the ethnicity of the women was heterogeneous. According to the limited published literature, oral health might affect fertility in women. However, only results from prospective randomized trials, comparing PD treatment vs. no treatment in women seeking pregnancy, may clarify the real effectiveness of treatment in improving the conception rate.

On December 2019, a new Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) was isolated and identified in Wuhan (China) [...]

The present study investigates the impact of the Coronavirus diseases 2019 (Covid-19) pandemic on the subjective experience of pregnant women, as well as the impact of the pandemic on this population in terms of psychopathological correlates.Pregnant women referring to the Section of Obstetrics and Gynecology of the General Hospital of Perugia, Italy, were recruited from 125 women were included in the study. Among these, 18 (72%) reported that the Covid-19 pandemic negatively impacted their experience of pregnancy. Were detected an average Pre-DM total score of 7.28±4.33 and an average state anxiety scale value of 35.56±9.21 and an average trait anxiety scale value of 34.04±7.44 at the STAI-Y. A global severity index1 at SCL-90 was detected in 8.3% of the sample.The identification of antepartum distress and the early treatment of perinatal psychopathology represent a priority during the Covid-19 pandemic era.

To identify risk factors for maternity blues (MB) and to evaluate the impact of obstetric factors on MB prevalence.194 mothers have completed the Edinburgh Postnatal Depression Scale (EPDS) 2 days after delivery. Bivariate and multivariate logistic regression models were used to identify the predictors of MB.57 women (29.4%) were positive at screening. Comparing the two groups, no statistically significant difference was found in age (This study showed that a lower education level and a previous PPD resulted to be important risk factors for MB development, while natural delivery was revealed as a protective factor. These results could be used to develop a better and more accurate prevention program after delivery.

Background Retained placenta represents a cause of maternal morbidity and mortality affecting 0.5–3% of all vaginal deliveries. The unpredictability of this condition makes difficult to develop predictive and preventive strategies to apply in clinical practice. This analysis collected and analyzed all known risk factors related to this obstetric complication. Methods A systematic literature review for all original research articles published between 1990 and 2020 was performed. Observational studies about retained placenta risk factors published in English language were considered eligible. Conference abstracts, untraceable articles and studies focused on morbidly adherent placenta were excluded. The included articles were screened to identify study design, number of enrolled patients and retained placenta risk factors investigated. All stages of the revision followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results Thirty-five studies met the inclusion criteria. The reported retained placenta prevalence ranged from 0.5 to 4.8%. Maternal age, previous cesarean sections, previous dilation and curettage, previous retained placenta, labor induction, resulted as the most recurrent, independent risk factors for retained placenta. Previous estro-progestins therapy, morphological placental features (weight, shape, insertion of umbilical cord, implantation site), endometriosis, Assisted Reproductive Technologies, Apgar score are fascinating new proposal risk factors. Conclusions Old and new data are not enough robust to draw firm conclusions. Prospective and well-designed studies, based on a well agreed internationally retained placenta definition, are needed in order to clarify this potential dramatic and life-threatening condition.

Pregnancy has been reported to be associated with an increased risk of ischemic stroke, and stroke occurring during pregnancy is one of the leading causes of maternal death.1 Kuklina et al2 reported that the rate of any stroke among antenatal hospitalizations increased by 47% (from 0.15 to 0.22 per 1000 deliveries) and among postpartum hospitalizations by 83% (from 0.12 to 0.22 per 1000 deliveries) when comparing the period 1994–1995 to 2006–2007. The American Heart Association Stroke Guidelines for Women have been published recently,3 which deal with risk factors unique to women, including reproductive factors, and those factors that are more common in women, including migraine, obesity, metabolic syndrome, and atrial fibrillation. However, the lifelong management of hormonal issues in women who have had stroke was not fully addressed regarding the following: future pregnancies, type of delivery, labor induction, and secondary prevention during future pregnancy and lactation. This consensus provides multidisciplinary approaches compiled by stroke neurologists, gynecologists, and endocrinologists, based on a thorough review of current literature through computerized searches up until July 26, 2016. Literature on pregnancy, secondary stroke prevention, labor induction, hormonal contraceptive therapy, ovarian stimulation, and hormone replacement therapy was reviewed. The panel collected relevant articles using computerized searches of medical literature up until July 26, 2016. The search strategy was designed to identify studies on pregnancy, delivery, labor induction, breast-feeding, ovarian stimulation, hormonal contraceptive therapy, hormone replacement therapy, and their stroke risks. The included studies were identified from the Medline/PubMed database, EMBASE, and the Cochrane Database. Additional papers were identified from reference lists of retrieved articles, abstract lists of recent scientific meetings, and Internet-based sources (http://www.tctmd.com, http://www.cxvascular.com; Figure). Figure. Flow chart of the research strategy. A list of treatment recommendations, including evaluations of evidence strength, is provided in Table 1. View this table: Table 1. Recommendations …

Study Objective To evaluate the outcomes of a new hysteroscopic technique for the treatment of a longitudinal vaginal septum. Design A retrospective study. Setting Arbor Vitae Center for Endoscopic Gynecology, Rome, Italy. Patients Thirty women who underwent hysteroscopic treatment for a vaginal septum. Intervention All enrolled patients underwent pelvic examination, hysteroscopy, and 2-dimensional ultrasound. In case of a diagnosis of a partial or complete uterine septum, magnetic resonance imaging or 3-dimensional ultrasound were performed, and surgical procedures were performed after diagnostic laparoscopy was used to better visualize the uterine fundus. All patients were treated with the technique using vaginal septum as uterine septum or the same methodology applied for a uterine septum. Measurements and Main Results The procedure was successfully accomplished in all patients, and longitudinal vaginal septa were totally resected. There were no perioperative complications, and in only 1 case, vaginal bleeding occurred because of an erroneous identification of the excision line that was easily remedied with coagulation by resectoscope. Dyspareunia has improved or completely disappeared in all patients. Conclusion The technique of vaginal septum as uterine septum for the resectoscope of a longitudinal vaginal septum appears to be safe and effective with good outcomes, even in terms of dyspareunia.

Endometriosis is a disease that has a profound impact on the quality of life of women, due to the associated chronic pelvic pain, dysmenorrhea, dyspareunia and infertility. However, even getting long-awaited pregnancy (often after assisted reproductive technologies), patients with endometriosis have a high risk of obstetric complications, such as miscarriage, preterm birth, preeclampsia, placental abnormalities, hemorrhage in labor, birth of small for gestational age infants, stillbirth and higher cesarean section rate. In addition, during pregnancy acute complications of endometriosis may occur, such as spontaneous hemoperitoneum, which is rare but life-threatening conditions that in most cases require surgical intervention. The mechanisms of the observed complications in pregnant women with endometriosis are not fully understood. This review presents literature data and personal considerations on the effect of endometriosis on pregnancy outcome and the occurrence of complications, as well as their possible underlined mechanisms. Based on this, we proposed ways to reduce the risk of obstetric complications in pregnant women with a history of endometriosis.

Fetal exposure to gestational diabetes mellitus (GDM) seems to stimulate a negative impact on the kidneys. Renal volumes and urinary biomarkers of renal function and tubular impairment and injury were evaluated in 30&ndash, 40-day old newborns of GDM mothers (n = 139) who needed insulin therapy during pregnancy. We found that neonates of mothers who maintained strict control over normoglycemia (n = 65) during pregnancy and fulfilled the other criteria of the GDM management program showed no differences compared to control (n = 55). Conversely, those (n&nbsp, =&nbsp, 74), whose mothers did not maintain glycemic control and were not compliant to the management program, exhibited significantly lower levels of renal volumes and higher activity of N-acetyl-&beta, D-glucosaminidase and cathepsin B. Differences due to maternal pre-gestational and gestational body mass index (BMI) as well as to maternal weight gain were demonstrated. Our findings indicate that a multidisciplinary approach, which involves an appropriate management of GDM, prevents the negative effects of GDM on the kidneys at 30&ndash, 40 days of postnatal age, indicating the fundamental role of glycemic control, as well as of an adequate range of maternal weight gain. Total renal volume, cortical volume, and urinary activity of N-acetyl-&beta, D-glucosaminidase and cathepsin B may be suggested as indicators for the early recognition of GDM neonates at long-term risk of hypertension and kidney disease.

Minimally invasive techniques for myomectomy are based on the rationale of preserving the myometrial integrity, in order to spare muscular and fibro-neurovascular myometrial fibers and ensure complete and bloodless myoma removal. Post-operative myometrial vascularization is crucial in injured muscle regeneration. The post-surgical myometrial healing is needful for uterine reproductive function. Neurotransmitters and neurofibers were analyzed in the myoma pseudocapsule surrounding fibroid. They activate signaling molecule synthesis and release which, in turn, promote cell activation and induce muscle regeneration and growth. Pseudocapsule damage during myomectomy may lead to a reduction of neuropeptides and neurofibers at the hysterotomic site, to a poor physiological myometrial healing, with more fibrosis due to hypoxia, ischemia and necrosis. These pathophysiological events cause deficit in myometrial neurotransmission, muscular impulse and contractility, with ultimately impaired uterine muscle function during pregnancy, labor and delivery. Hence, during myomectomy, all manipulations should be performed as precisely and bloodlessly as possible, avoiding extensive, high wattage diathermocoagulation or excessive tissue manipulation or muscular trauma. Any iatrogenic pseudocapsule damage may alter neurotransmitter function during successive myometrial healing, impacting negatively on uterine repair and on eventual pregnancies. Hence the reasoned myomectomy on a biological basis, the "intracapsular myomectomy", satisfied these surgical and physiological requirements. It was described precisely and firstly by the hysteroscopy, with the image magnification of the preservation of the myoma pseudocapsule. The "intracapsular hysteroscopic myomectomy" demonstrated the safe and effective removal of submucous myomas with intramural development. It allowed to completely remove the myoma in one or two surgical steps, saving the pseudocapsule and the surrounding healthy myometrium. The respect of the myometrium and the reduced thermal injury, a part the excellent outcomes in terms of surgical complications prevention, post-surgical fibrosis and intrauterine synechiae reduction, highlighted the physiological development of a successive pregnancy, without any myometrial complications during pregnancy, labor and delivery.

Dear Editor,We read with interest the Dr. Hartinaz’s article, endometrial myomectomy: a novel surgical Method during cesarean section (CS) [1]. The article is interesting and proposes an innovative...

Aim of this study is to analyze determinants of breech presentation using information from two regional databases of Lombardy (Italy) including data on consecutive singleton breech and vertex deliveries occurred in the Region, between January 2010 and December 2015. Breech presentation occurred in 3.8% of all single deliveries. Main determinants of breech presentation at birth were: gestational age and birth weight (the lower, the higher the incidence of breech presentation), maternal age (the older the mother, the higher the risk of breech presentation), parity (the frequency of breech decreased with increasing parity) and previous cesarean section. Breech presentation resulted more frequent after assisted reproduction procedures.

Uterine rupture is an uncommon but potentially life-threatening obstetrical emergency, occurring in 1 on 1200 to 1 on 5000 deliveries. It is more frequent in developing countries and in low-resource area. Rupture of the uterus in women without a history of cesarean section is rare, with a reported incidence of 0.02%. Incidence of uterine rupture is affected by the level of medical care and the presence of scar in the uterus. While asymptomatic uterine dehiscence rarely results in adverse fetal outcome, the complete uterine rupture with extrusion of the placenta or the fetus in the abdomen can be catastrophic. Generally, uterine rupture refers to a complete separation of all uterine layers, including the uterine serosa. It threatens the life of both the mother and fetus, with devastating maternal complications, including need for blood transfusion, intra-abdominal hemorrhage, and peripartum hysterectomy. Maternal mortality is 0.44%, and it resulted from hemorrhage, shock, sepsis, disseminated intravascular coagulation, pulmonary embolism, ileus paralyticus, peritonitis, and renal failure.

The aim of this study was to assess women preference about pain and duration of labour applying a standardized questionnaire.A prospective multicentre large cohort study was carried out in two different University Hospitals. A standardized questionnaire was proposed before active labour and the day after delivery in order to investigate whether women preferred low pain intensity for a longer labour duration or greater pain intensity for a shorter labour duration. The studied population was divided and analysed in two groups according to Epidural Analgesia (EA) administration. A multivariable linear regression analysis was performed to assess which variables were able to influence the opinion about the pain perception after birth.EA group showed an increased risk of episiotomy (p = 0.004), of longer duration of labour (Stage I, p 0.001; Stage II, p = 0.002) and of oxytocin augmentation (P = 0.030). No statistical differences were found about the route of delivery between the two groups. Rates of pre-labour scores significantly differed from rates of post labour scores (p 0.001). In the multivariable linear regression analysis, pre-labour score was directly related to post-labour score (p = 0.013). The EA was indirectly related to higher pain levels for a longer duration preference (p = 0.001), whereas oxytocic infusion in labour was directly related with preference for higher pain for a shorter duration (p = 0.011).Patients' preferences about labour are focused on both pain relief and labour duration. The standardized questionnaire could be a useful tool to screen patients eligible for EA.

Aims: To investigate sodium hyaluronate (SH) efficacy in the treatment of pregnancy rhinitis. Methods: A single-center, prospective, open-label, 2 parallel-group study was carried out. Pregnant women affected by pregnancy rhinitis were randomly assigned to 1 of 2 groups: Group A was treated with SH, while Group B did not receive any treatment. Pregnancy rhinitis symptoms and quality of life (QOL) during pregnancy were investigated by administering a questionnaire and carrying out an otorhinolaryngoiatric visit. Results: A significant reduction in the intensity of headache, snoring and insomnia in the Group A compared to the Group B were demonstrated. In the Group A, a significant lower presence of amount of secretions (Group A 0.88, 95% CI 0.57–1.18 vs. Group B 2.00, 95% CI 1.69–2.31, p < 0.001), turbinate hypertrophy (Group A 1.70, 95% CI 1.46–1.94 vs. Group B 2.53, 95% CI 2.29–2.77, p < 0.001), and mucosal congestion/hyperemia (Group A 1.41, 95% CI 1.14–1.68 vs. Group B 2.26, 95% CI 1.99–2.53, p < 0.001) was observed. No adverse events were reported in patients treated with SH. Conclusions: SH is a safe and effective therapeutic alternative for the treatment of pregnancy rhinitis symptoms, improving patients’ QOL.

Study Objective To assess the safety and efficacy of cold loop hysteroscopic myomectomy in a large series of cases. Design Retrospective study (Canadian Task Force Classification III). Setting Arbor Vitae Center for Endoscopic Gynecology, Rome, Italy. Patients A total of 1215 patients with 1 or more G1-G2 submucous myomas. Intervention Cold loop hysteroscopic myomectomy. Measurement and Main Results A total of 1690 myomas were removed. A minimum of 1 to a maximum of 5 fibroids for each surgical procedure were totally removed. Out of 1215 patients, 1017 (83.7%) were treated with a single surgical procedure. Twelve intraoperative complications occurred (0.84%). No cases of uterine perforation with the thermal loop or clinical intravasation syndrome were reported. Conclusion Cold loop hysteroscopic myomectomy seems to represent a safe and effective procedure for the removal of submucous myomas with intramural development, while at the same time respecting the anatomic and functional integrity of the myometrium. The use of a cold loop in resectoscopic myomectomy is associated with a low rate of minor intraoperative complications and an absence of major complications. This could be of primary relevance with a view to fertility and future pregnancies.

To assess if maternal risk profile and Hospital assistential levels were able to influence the inter-Hospitals comparison in the class 1 and 3 of the "The Ten Group Classification System" (TGCS).A population-based analysis using data from Institutional data-base of an Italian Region was carried out. The 11 maternity wards were divided into two categories: second-level hospitals (SLH), and first-level hospitals (FLH). The recorded deliveries were classified according to the TGCS. To analyze if different maternal characteristics and the hospitals assistential level could influence the cesarean section (CS) risk, a multivariate analysis was done considering separately women in the TGCS class 1 and 3.From January 2011 to December 2013 were recorded 19,987 deliveries. Of those 7,693 were in the TGCS class 1 and 4,919 in the class 3. The CS rates were 20.8% and 14.7% in class 1 (p 0.0001) and 6.9% and 5.3% (p 0.0230) in class 3, respectively in the FLH and SLH. The multivariate logistic regression showed that the FLH, older maternal age and gestational diabetes were independent risk factors for CS in groups 1 and 3. Obesity and gestational hypertension were also independent risk factors for group 1.TGCS is a useful tool to analyze the incidence of CS in a single center but in comparing different Hospitals, maternal characteristics and different assistential levels should be considered as potential bias.

Introduction. The aim of the study was to analyze which variables influenced the completion of a cold loop hysteroscopic myomectomy in a one-step procedure in a large cohort of patients. Materials and Methods. A retrospective cohort study of 1434 cold loop resectoscopic myomectomies consecutively performed. The study population was divided into two groups according to the number of procedures needed to accomplish the treatment. Variables influencing the completion of hysteroscopic myomectomy in a one-step procedure were investigated. Results. A total of 1434 resections were performed and 1690 myomas in total were removed. The procedure was accomplished in a one-step procedure in 1017 patients (83.7%), whereas 198 women (16.3%) needed a multiple-step procedure. The multivariate analysis showed that the size, the number of myomas, and the age of patients were significantly correlated with the risk of a multiple-step procedure. No correlation was revealed with the grading of myomas, parity, and the use of presurgical GnRH-agonist therapy. Conclusions. In case of multiple fibroids, the intramural development of submucous myomas did not influence the completion of cold loop hysteroscopic myomectomy in a one-step procedure. The size of myomas and the age of patients were significantly correlated with the need to complete the myomectomy in a multiple-step procedure.

Hydroxyl radical (.OH) is highly reactive, and therefore very short-lived. Finding new means to accurately detect .OH, and testing the ability of known .OH scavengers to neutralize them in human biological fluids would leverage our ability to more effectively counter oxidative (.OH) stress-mediated damage in human diseases. To achieve this, we pursued the evaluation of secondary products resulting from .OH attack, using a detection system based on Fenton reaction-mediated D-phenylalanine (D-Phe) hydroxylation. This reaction in turn generates o-tyrosine (o-tyr), m-tyrosine (m-tyr) and p-tyrosine (p-tyr). Here, these isomers were separated by HPLC, equipped with fluorescence detectors due to the natural fluorescence of these hydrotyrosines. By extension, we found that, adding radical scavengers competed with D-Phe on .OH attack, thus allowing to determine the .OH quenching capacity of a given compound expressed as inhibition ratio percent (IR%). Using a kinetic approach, we then tested the .OH scavenging capacity (OHSC) of well-known antioxidant molecules. In a test tube, N,N'-dimethylthiourea (DMTU) was the most efficient scavenger as compared to Trolox and N-Acethyl-L-cysteine, with NAC being the less effective. OHSC assay was then applied to biological fluid samples as seminal plasma, human serum from normal subjects and patients undergoing hemodialysis (HD), colostrum and human breast milk from mothers that received daily doses of 30g of chocolate (70% cocoa) during pregnancy. We found that a daily administration of dark chocolate during pregnancy almost doubled OHSC levels in breast milk (1.88 ± 0.12 times, p < 0.01). Furthermore, HD treatment determined a significant reduction of serum OHSC concentration (54.63 ± 2.82%, p < 0.001). Our results provide evidence that Fenton reaction-mediated D-Phe hydroxylation is a suitable method for routine and non-invasive evaluation of .OH detection and its scavenging in human biological fluids.

Study Objective To evaluate the intraoperative effects of gonadotropin-releasing hormone (GnRH) analogue pretreatment in patients undergoing cold loop hysteroscopic myomectomy. Design Randomized controlled trial (Canadian Task Force classification I). Setting Arbor Vitae Center for Endoscopic Gynecology, Rome, Italy. Patients A total of 99 patients were randomized and subsequently allocated to the GnRH analogue group or to the nonpharmacologic treatment control group. Fifteen patients were lost after allocation, and 42 patients per group underwent hysteroscopic myomectomy. Interventions Cold loop hysteroscopic myomectomy. Measurements and Main Results The control group accomplished the treatment in a 1-step procedure more frequently than the GnRH analogue group (92.85% and 73.8% of cases, respectively; p = .040). The completion of the treatment was more unlikely in case of G2 myomas (p = .006), whereas no differences were recorded for G1 and G0 myomas. The multivariate analysis showed a significant correlation between the multiple-step treatment and the use of GnRH analogue (odds ratio, 5.365; 95% confidence interval [CI], 1.018–28.284; p = .048), grading (odds ratio, 4.503; 95% CI, 1.049–19.329; p = .043), and size of myomas (odds ratio, 1.128; 95% CI, 1.026–1.239; p = .013). Conclusions Preoperative GnRH analogue administration did not facilitate the completion of cold loop hysteroscopic myomectomy in a single surgical procedure in G2 myomas and was correlated with a longer duration of the surgery. No significant benefits were found for G0 and G1 myomas. ( ClinicalTrials.gov : NCT01873378 .)

Foetal magnetic resonance imaging (MRI) plays an increasingly important role in the diagnosis of foetal abnormalities. Over the years, we have successfully applied bi-parametric MRI (bp-MRI) to the following obstetric conditions: (1) neurologic vascular diseases; (2) assessment of lung parenchyma maturation; (3) renal pathologies, such as polycystic kidney, suspected renal infarction, unilateral or bilateral renal agenesis; (4) placental pathologies, as twin-twin transfusion syndrome or placenta accreta; (5) benignant and malignant congenital tumours or cysts of the liver, such as haemangioendothelioma, hepatoblastoma or metastatic neuroblastoma, of the kidney (e.g. mesoblastic nephroma) and of the retroperitoneum, such as teratoma. The information derived from bp-MRI, and concerned with water motions in different tissues, improved the morphologic details provided by conventional foetal MRI. It has the potential to increase the value of MRI in the assessment of a wide range of foetal pathologies, particularly in renal diseases, allowing an adequate management decision and therapy.

Aim To determine the risk of cesarean delivery after induction of labor with prostaglandins and to establish if this is influenced by a single indication of induction of labor or any intrinsic characteristic of the woman or labor. Material and methods A retrospective cohort study was carried out. Three hundred and twenty-four pregnant women who underwent pharmacological induction of labor with prostaglandins were divided into nine groups through indication of labor induction. Statistical analysis was assessed with the Kolmogorov-Smirnov test to assess the normal distribution of variables, Kruskal-Wallis test for comparisons of non-parametric continuous variables, univariate analysis to compare cesarean delivery rates and multivariate logistic regression. Results The risk of cesarean section was significantly higher only in prolonged pregnancy (OR = 1.98; 95% CI: 1.18-3.34). Elective induction was associated with the lowest risk of cesarean section (OR = 0.46; 95% CI: 0.26-0.81). Maternal age and was directly related (OR = 1.087; 95% CI: 1.016-1.164), while parity (OR = 0.123; 95% CI: 0.051-0.332), Bishop score (OR = 0.703; 95% CI: 0.571-0.884), and duration of labor (OR = 0.995; 95% CI: 0.993-0.998) were inversely correlated with cesarean delivery. Conclusion Cesarean delivery rate is not significantly influenced by any indication of induction of labor with prostaglandins, except for prolonged pregnancy. Elective induction is associated with the lowest risk of cesarean section. Increasing maternal age, low parity, low Bishop score and low duration of labor are at higher risk of cesarean section.

Progesterone is an essential hormone in the process of reproduction. It is involved in the menstrual cycle, implantation and is essential for pregnancy maintenance. It has been proposed and extensively used in the treatment of different gynecological pathologies as well as in assisted reproductive technologies and in the maintenance of pregnancy. Called “the pregnancy hormone”, natural progesterone is essential before pregnancy and has a crucial role in its maintenance based on different mechanisms such as: modulation of maternal immune response and suppression of inflammatory response (the presence of progesterone and its interaction with progesterone receptors at the decidua level appears to play a major role in the maternal defense strategy), reduction of uterine contractility (adequate progesterone concentrations in myometrium are able to counteract prostaglandin stimulatory activity as well as oxytocin), improvement of utero-placental circulation and luteal phase support (it has been demonstrated that progesterone may promote the invasion of extravillous trophoblasts to the decidua by inhibiting apoptosis of extravillous trophoblasts). Once the therapeutic need of progesterone is established, the key factor is the decision of the best route to administer the hormone and the optimal dosage determination. Progesterone can be administered by many different routes, but the most utilized are oral, the vaginal and intramuscular administration. The main uses of progesterone are represented by: threatened miscarriage, recurrent miscarriage and preterm birth (in the prevention strategy, as a tocolytic agent and also in the maintenance of uterine quiescence).

The aim of this study is to investigate if advance maternal age is an independent risk factor for cesarean section in women induced with prostaglandins. Only patients with a single indication for induction of labor were considered.A matched retrospective cohort study was conducted. A study group of 112 women aged 35 or older was enrolled. The control group included 216 women aged 34 or younger. Multivariate logistical regression models were fitted for the prediction of the cesarean section.There were no statistically significant differences in characteristics of the patients in the study and control groups. However, a higher prevalence of nulliparous women was found in control group (p = 0.002). The indications of labor induction were homogeneous in the two groups. No significant differences were found in the route of delivery. The median time of labor was significantly shorter in the study group (p = 0.002), and the birth weight and the placental weight were significantly lower in the study group. Advanced maternal age and newborn weight were directly related, whereas time of labor, Bishop score and parity were inversely related to a higher cesarean rate.When single indication of induction of labor with prostaglandins is considered, advanced maternal age represents a significant independent risk factor for cesarean delivery.

The study aimed to analyze the pregnancy outcome of women aged 40 years or more.A matched retrospective cohort study comparing women aged 40 years or more with a control group aged 20 to 30 years is described. Multivariate logistic regression models were fitted for the prediction of preterm birth and cesarean delivery.Pregnancy-induced hypertension, preeclampsia and placenta previa were similar in both groups, but a higher rate of gestational diabetes was found in elderly patients (odds ratio [OR] 3.820, 95% confidence interval [CI] = 1.400-10.400; p0.0001). Preterm delivery was significantly more frequent in elderly women (OR 1.847, 95% CI = 1.123-3.037; p = 0.020). Gestational diabetes and pregnancy-induced hypertension were strongly associated with preterm delivery and advanced maternal age was not an independent risk factor for preterm delivery. The cesarean delivery rate was significantly higher in the study group (OR 3.234, 95% CI = 2.266-4.617; p0.0001). The variables most influencing the cesarean delivery rate were maternal age, analgesia, parity, premature rupture of the membranes and gestational hypertension. No significant differences were detected in neonatal birth weight and Apgar score.Patients aged 40 years or more have been demonstrated to carry a favorable pregnancy and neonatal outcome, similar to younger patients. The risk of cesarean delivery was higher in patients with advanced maternal age, in nulliparous and in women with a previous cesarean section. The risk of preterm delivery was not related to age but it was strongly associated with gestational diabetes and pregnancy-induced hypertension.

The diabetes epidemic is sweeping the globe. In 2011, 366 million people worldwide had diabetes; by 2030, that number is projected to almost double. More than eight million women in the United States have pregestational diabetes mellitus, and it is observed in 1 % of all pregnancies [1]. Studies suggest that the prevalence of diabetes among women of childbearing age is increasing in the United States [2]. Many of these women are undiagnosed until pregnancy.

The estimated prevalence of ectopic pregnancy (EP) is 1-2% worldwide. Bilateral tubal pregnancies represent the rarest form of heterotopic pregnancy, and spontaneously conceived are extremely unusual, as many cases are derived from assisted reproductive techniques. We describe a case of bilateral tubal pregnancy after clomiphene therapy and sexual intercourse in which the second EP was not contemporarily revealed.

Pre-eclampsia (PE) is a multisystemic disorder of human pregnancy, clinically characterized by hypertension, proteinuria, oedema and platelet aggregation; the syndrome includes vasoconstriction, resulting in maternal hypertension, reduced uterine blood flow, impairment of placenta-vascular endothelial integrity with increased permeability and activation of the coagulation cascade. The aetiopathogenesis of PE remains still unknown, although the central role played by the placenta seems to be crucial. To date, increasing efforts are trying to create an unique and robust biochemical pattern in serum to predict PE. Although the recent data, the definition of an early biochemical pattern in serum to predict PE is still far from reaching the final shape. This stalemate could be due, at least in part, to lack of robust and reproducible methodology (inclusion/exclusion criteria during enrolment, period and type of sample collection, type of sample analysis and interpretation of results) across the different studies. Considering these assumptions, the aim of the current paper is to review the available data about early serum markers of PE.

International audience; In recent years, interest has been focused to the study of the two major inositol stereoisomers: myo-inositol (MI) and d-chiro-inositol (DCI), because of their involvement, as second messengers of insulin, in several insulin-dependent processes, such as metabolic syndrome and polycystic ovary syndrome. Although these molecules have different functions, very often their roles have been confused, while the meaning of several observations still needs to be interpreted under a more rigorous physiological framework. With the aim of clarifying this issue, the 2013 International Consensus Conference on MI and DCI in Obstetrics and Gynecology identified opinion leaders in all fields related to this area of research. They examined seminal experimental papers and randomized clinical trials reporting the role and the use of inositol(s) in clinical practice. The main topics were the relation between inositol(s) and metabolic syndrome, polycystic ovary syndrome (with a focus on both metabolic and reproductive aspects), congenital anomalies, gestational diabetes. Clinical trials demonstrated that inositol(s) supplementation could fruitfully affect different pathophysiological aspects of disorders pertaining Obstetrics and Gynecology. The treatment of PCOS women as well as the prevention of GDM seem those clinical conditions which take more advantages from MI supplementation, when used at a dose of 2g twice/day. The clinical experience with MI is largely superior to the one with DCI. However, the existence of tissue-specific ratios, namely in the ovary, has prompted researchers to recently develop a treatment based on both molecules in the proportion of 40 (MI) to 1 (DCI).

A substantial body of research on mammalian gametogenesis and human reproduction has recently investigated the effect of myo-inositol (MyoIns) on oocyte and sperm cell quality, due to its possible application to medically assisted reproduction. With a growing number of both clinical and basic research papers, the meaning of several observations now needs to be interpreted under a solid and rigorous physiological framework. The 2013 Florence International Consensus Conference on Myo- and D-chiro-inositol in obstetrics and gynecology has answered a number of research questions concerning the use of the two stereoisomers in assisted reproductive technologies. Available clinical trials and studies on the physiological and pharmacological effects of these molecules have been surveyed. Specifically, the physiological involvement of MyoIns in oocyte maturation and sperm cell functions has been discussed, providing an answer to the following questions: (1) Are inositols physiologically involved in oocyte maturation? (2) Are inositols involved in the physiology of spermatozoa function? (3) Is treatment with inositols helpful within assisted reproduction technology cycles? (4) Are there any differences in clinical efficacy between MyoIns and D-chiro-inositol? The conclusions of this Conference, drawn depending on expert panel opinions and shared with all the participants, are summarized in this review paper.

Progesterone is an essential hormone in the process of reproduction. It is involved in the menstrual cycle, implantation and is essential for pregnancy maintenance. Although the pharmacokinetics and pharmacodynamics of progesterone have been well studied, and since 1935 it has been synthesised and is now available commercially, its use in the pathophysiology of pregnancy remains controversial. One of these concerns is the way in which the hormone is administered, with parenteral use proving the best way to obtain optimal plasma levels. Another concern is the paucity of randomised controlled trials and the different dosages and populations studied. As a result, the therapeutic application of progesterone in pregnancy is restricted to the prevention and treatment of threatened miscarriage, recurrent miscarriage and preterm birth. Progesterone is efficacious when continuation of pregnancy is hampered by immunological factors, luteinic and neuroendocrine deficiencies and myometrial hypercontractility. This may explain the reduction in the incidence of preterm birth in high risk pregnant women using high-dosage prophylactic progesterone.

Objective To compare the effectiveness of IM P and IM P plus oral phytoestrogens for luteal phase support in patients undergoing IVF-ET cycles. Design Prospective, controlled, randomized trial. Setting University Hospital, Perugia, Italy. Patient(s) Two hundred thirteen infertile patients undergoing IVF-ET were included in the study. The inclusion criteria were use of a GnRH agonist for pituitary down-regulation and age Intervention(s) Patients were assigned to receive either IM P (50 mg daily) plus placebo or P (50 mg daily) plus phytoestrogen supplementation (1,500 mg daily) for luteal phase support starting from the evening of oocyte retrieval until either a serum pregnancy test result was negative or embryonic heartbeat was sonographically confirmed. Main outcome measure(s) The outcomes of IVF-ET were evaluated in both study groups in terms of implantation rate, biochemical pregnancy rate (PR), clinical PR, spontaneous abortion rate, and ongoing pregnancy/delivered rate. Result(s) Statistically significant higher values for implantation rate, clinical PR, and ongoing pregnancy/delivered rate were recorded in the patients who received P plus phytoestrogens for luteal phase support in comparison with patients receiving P and placebo. Conclusion(s) Although the results of this study encourage the use of phytoestrogens for luteal phase support in patients undergoing IVF-ET program, more studies are necessary to support the hypothesis that phytoestrogens have a beneficial effect in IVF cycles.

To assess if anti-mullerian hormone (AMH) concentrations decrease during the third trimester of pregnancy and puerperium and whether this is correlated to gestational diabetes mellitus (GDM). AMH serum concentrations were determined by ELISA, with lowest detection limit of 0.08 ng/ml, during the third trimester of pregnancy and puerperium in 34 patients with GDM and in 32 healthy control pregnant women. Three blood samples were collected at 28–32, 34–36 weeks’ gestation and 40 days after delivery, respectively. No differences in AMH concentration between GDM and healthy pregnant women were found at any follow-up time. On the contrary, significant differences in delta AMH values between the first and the second sample (p < 0.0001), the second and the third sample (p < 0.0001), and the first and the third sample (p = 0.004) were found in both groups. The multivariate analysis showed that maternal age was not correlated to delta AMH variations. The analysis of AMH concentrations did not show a significant relationship with body mass index-variation, newborn and placental weight, and GDM, while only maternal age was significantly correlated with AMH concentrations in all blood samples. A significant decrease in AMH values was observed during the third trimester of pregnancy and this was independent on maternal age. GDM does not seem to influence the AMH concentrations during pregnancy and after delivery.

The high risk attributed to multiples calls for close observation during pregnancy. Based on adequate predictions in singletons, it was expected that the biophysical profile (reactive fetal heart rate pattern on non-stress test, presence of fetal breathing and body movements, documentation of normal fetal tone and adequate amount of amniotic fluid) could be used in multiples as well. However, the paucity of studies could not demonstrate an equivalent predictive capacity in multiple pregnancies.

An early, pre-operative, ultrasonographic diagnosis of an abdominal pregnancy was made and successfully treated by laparoscopy in an asymptomatic woman with a 8-weeks abdominal pregnancy. The early, ultrasonographic diagnosis allowed an easy, mini-invasive, endoscopic treatment of the potentially life threatening pregnancy.

Clinical efficacy of human-derived follicle-stimulating hormone (FSH) versus recombinant FSH (rFSH) in IVF-ICSI cycles has long been compared, but no clear evidence of the superiority of a preparation over the other has been found. Human gonadotropins have been often grouped together, but a different glycosylation may be present in each preparation, therefore influencing the specific bioactivity. To exclude confounding factors, a meta-analysis and a cost-effectiveness analysis were designed to compare effectiveness and cost-effectiveness of a specific highly purified human FSH (HP-hFSH) (Fostimon®) versus rFSH (Gonal-F®) in IVF/ICSI cycles. Research methodology filters were applied in MEDLINE, Current Contents and Web of Science from 1980 to February 2012. Eight randomized trials met selection criteria. The meta-analysis showed no significant differences between rFSH and HP-hFSH treatment in live-birth rate (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.63-1.11), clinical pregnancy rate (OR 0.85, 95% CI 0.68-1.07), number of oocytes retrieved, number of mature oocytes and days of stimulation. The cost-effectiveness ratio was € 7174 in the rFSH group and € 2056 in the HP-hFSH group. HP-hFSH is as effective as rFSH in ovarian stimulation for IVF-ICSI cycles, but the human preparation is more cost-effective.

This trial was undertaken to evaluate the effects of high-cocoa-content chocolate supplementation in pregnancy on several haematochemical and clinical parameters. The study had as reference population the pregnant women requesting an obstetric control at Outpatient Clinic of Obstetrics and Gynaecology of the S. Maria della Misericordia University Hospital, Perugia, Italy. Candidates who participated in this study were all Caucasian women aged 18-40 years, who had a single gestation pregnancy between 11th + 0 and 13th + 0 week gestational age.We conducted a single-center randomized controlled trial. The pregnant women selected were randomized into Group A, which received daily doses of 30 g of chocolate (70% cocoa), and Group B, which was free to increase their diet with other foods.Ninety women were randomized. Significant difference was found between the two groups for diastolic blood pressure (p = 0.05), systolic (p0.0001) and levels of liver enzymes, with values lower in Group A than in Group B. Total cholesterol levels and weight gain in Group A did not increase more than in Group B.A modest daily intake of high-cocoa-content chocolate contributes to reduce blood pressure, glycemic and liver pattern during pregnancy without affecting the weight gain.

To determine the risk of cesarean delivery after induction of labor with prostaglandins and to establish if this is influenced by a single indication of induction of labor or any intrinsic characteristic of the woman or labor.A retrospective cohort study was carried out. Three hundred and twenty-four pregnant women who underwent pharmacological induction of labor with prostaglandins were divided into nine groups through indication of labor induction. Statistical analysis was assessed with the Kolmogorov-Smirnov test to assess the normal distribution of variables, Kruskal-Wallis test for comparisons of non-parametric continuous variables, univariate analysis to compare cesarean delivery rates and multivariate logistic regression.The risk of cesarean section was significantly higher only in prolonged pregnancy (OR = 1.98; 95% CI: 1.18-3.34). Elective induction was associated with the lowest risk of cesarean section (OR = 0.46; 95% CI: 0.26-0.81). Maternal age and was directly related (OR = 1.087; 95% CI: 1.016-1.164), while parity (OR = 0.123; 95% CI: 0.051-0.332), Bishop score (OR = 0.703; 95% CI: 0.571-0.884), and duration of labor (OR = 0.995; 95% CI: 0.993-0.998) were inversely correlated with cesarean delivery.Cesarean delivery rate is not significantly influenced by any indication of induction of labor with prostaglandins, except for prolonged pregnancy. Elective induction is associated with the lowest risk of cesarean section. Increasing maternal age, low parity, low Bishop score and low duration of labor are at higher risk of cesarean section.

Progesterone is an essential hormone in the process of reproduction. It has been extensively studied in the treatment of different gynecological pathologies, as a contraceptive and in assisted reproductive technologies. However, the use of progesterone in the pathophysiology of pregnancy remains controversial. Progesterone, and its synthetic form 17 α-hydroxyprogesterone caproate (17 OHP-C), offer an effective intervention when the continuation of pregnancy is at risk from immunological factors, luteinic and neuroendocrine deficiencies, and myometrial hypercontractility. Progesterone has been successfully used as prophylaxis in the prevention of spontaneous miscarriage, with treatment beginning from the first trimester of pregnancy. There is substantial evidence, too, to indicate that women with idiopathic recurrent miscarriage may benefit from the immunomodulatory properties of progesterone in early pregnancy. The use of progesterone and 17 OHP-C has been extensively studied in the prevention of preterm birth in a variety of settings. Transvaginal ultrasound measurement of cervical length in singleton pregnancies between 19 and 24 weeks' gestation has been deemed the best way to identify women (approximately 2% of the pregnant population) who would benefit from prophylactic progesterone treatment for the prevention of spontaneous preterm birth. This paper reviews the evidence for the safety and efficacy of the use of progesterone in each of these indications.

Objective To report the successful treatment of a postmyomectomy, early uterine rupture with the use of a Bakri balloon. Design Case report. Setting University hospital, department of obstetrics and gynecology. Patient(s) A 32-year-old patient, gravida 1, at 19 weeks' gestation, with postmyomectomy spontaneous uterine rupture and concurrent uterine atony. Intervention(s) Laparotomy was done because of massive hemoperitoneum. A Bakri balloon was inserted, and a two-layer suture of the uterine defect was performed. Main Outcome Measure(s) Possibility of controlling hemorrhage and avoiding hysterectomy. Result(s) Contemporary surgical sutures and insertion of a Bakri balloon were effective at controlling hemorrhage. The uterus was preserved. Conclusion(s) The use of a Bakri balloon, combined with traditional surgical techniques, is described as a new method to successfully treat hemorrhage in the case of early spontaneous uterine rupture. In this case, hysterectomy was also avoided.