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Background: Obstetric lesions of the anal sphincter (OASIS) are tears intersecting the structure of the anus after vaginal delivery. Our aim is to provide data on the incidence of OASIS and investigate potentially connected risk factors. Methods: This is a retrospective analysis of 464 parturient patients admitted to the AOU Maggiore della Carità, Novara (Italy), in the last ten years (2013–2023), comparing 116 cases (with OASIS) versus 348 controls (with no OASIS). Results: The incidence of OASIS was 1.1%. Among the significant risk factors associated with the risk of severe perineal laceration in our sample, we observed nulliparity, previous caesarean sections, assisted reproduction technology, kilos gained during pregnancy, induced delivery, the use of oxytocin for augmentation, epidural analgesia, delivery after 40 weeks of gestation, position at delivery, the duration of labor, the application of a vacuum cup, newborn weight and head circumference. Conclusions: It was a challenge to find data on OASIS and on more preventable and modifiable risk factors. Beyond the improvement of the corresponding diagnostic and therapeutic tools, a new aim could be to stratify women giving birth based on possible risk factors. [ABSTRACT FROM AUTHOR]

(1) Background: Microbiota could be related to tumorigenesis through the persistence of an inflammatory state, also at the endometrial level. Inflammation, in fact, is involved in the promotion of genetic instability and in a favorable microenvironment for tumor growth. One pathway could be the disruption of the epithelial/mucosal barrier, with the activation of cytokines. The microbiota also seem to favor other involved patterns, such as insulin resistance and increased adipose tissue. (2) Methods: The online search for this review was based on keywords such as "endometrial cancer" and "microbiota" on the main online scientific database. Our objective is a narrative up-to-date review of the current literature on gynecological microbiota; we analyze the possible correlations with known modifying and promoting oncological factors (i.e., Body Mass Index- BMI, menopause, pH), with particular attention to vaginal and uterine microorganisms respective to the development of endometrial cancer in comparison to healthy women. (3) Results: Various species and distributions of bacteria could be related to tumorigenesis and induce alterations in cell signaling and cycle pathways, including those in the gynecological field. (4) Conclusions: In the literature, the different composition of uterine and vaginal microbiota has been analyzed in the past years, and their diversity and actions seem to correlate with possible oncological effects. [ABSTRACT FROM AUTHOR]

Approximately one-third of the global population uses complementary medicine, as yoga and meditation, not endorsed by evidence-based conventional medicine and, with more difficulties in case of pregnancy. Our study investigates the prevalence of Complementary and Alternative Medicine (CAM) usage in Novara (Italy) and its province through a survey to pregnant women at 36 gestational weeks. The sample consisted of 70 women, average age of 33 years, most Caucasian, highly educated, mostly employed, under private gynecological care, with a prevalence of CAM use of 24.3 % [95 % CI 14.83; 36.01]. Six women (35.3 %) did not inform their healthcare provider of using these medicines, 15 women (88.2 %) express willingness to use complementary medicine in their next pregnancy, while 2 (11.8 %) are uncertain. The study found a significant association between higher education and CAM usage among pregnant women. Other factors, including nationality, occupation, choice of private practice, parity, physical activity, diet, smoking, pregnancy complications, and vaccination status, did not show significant relationships with CAM usage. Our objective is to delineate the characteristics of CAM users, explore the methodologies and motivations of their usage, and ascertain any correlations with the rejection of conventional vaccination practices. The analyzed population consists of 70 women aged 32.9 years in mean, mostly Caucasian, with a high level of education. Most women are under private gynecological care (84.3 %), half of the participants are experiencing their first pregnancy. Physical activity levels vary, with 34.3 % reporting high activity levels. Regarding diet, 77.1 % consider their eating habits moderately healthy, with a notable portion of smokers women (24.3 %); 20.0 % have experienced pregnancy complications. 17 participants utilized non-conventional or alternative medicine, with a prevalence of 24.3 [95 % CI 14.83; 36.01]. Six women (35.3 %) did not inform their healthcare provider about using CAM. Seven women (46.7 %) claim significant beneficial effects in most cases, while 8 (53.3 %) state this occasionally. Based on their experiences, 15 women (88.2 %) express willingness to use complementary alternative medicine in their subsequent pregnancy, while 2 (11.8 %) are uncertain. Only one person (11.1 %) used this type of therapy as a substitute for conventional treatment, but they informed their attending physician. The study seeks to enhance our understanding of CAM utilization in pregnancy, informing more comprehensive and evidence-based healthcare practices for expectant mothers. [ABSTRACT FROM AUTHOR]

Background and Objectives: Conscientious objection to voluntary abortion remains a hot debate topic. This could affect the accessibility to pregnancy termination. Our aim is to evaluate the possible aspects related to an operators' choice about objection for voluntary abortion, such as the following: the abolition of the time limit, the instruction of a multi-collegiate commission, the introduction of pharmacological rather than surgical procedures, the fetal/maternal illness and the case of sexual violence. Materials and Methods: This is an observational, descriptive study that involves a cohort of Italian healthcare workers who answered a web-survey. Results: Of the total 352 respondents, only 20.8% affirmed to be objectors versus 79.2% of non-objectors. For the objectors, 72.2% declared that they would not change status in case of pharmacological abortion; 79.7% would not suspend their choice for interruption in the second trimester; 63.3% would suspend the objection with a multi-collegiate commission, and 69.0% would discontinue their objection in the case of sexual violence. 72.0% of the total participants declared that the abolition of the time limit could have a resecuring impact on women's choice. Conclusions: Most operators declared that the abolition of the time limit could have beneficial effects. Among the objectors, the status would change especially with the introduction of a multi-collegiate commission, and in case of serious maternal/fetal illness and/or sexual violence. [ABSTRACT FROM AUTHOR]

Children, women, and older people suffer different types of violence, which appears to have been exacerbated during the COVID-19 pandemic and the relative lockdown. The aim of this study is to analyze the literature about gender violence and abuse in the different ages of life and during the COVID-19 lockdown. Data were obtained from an electronic literature search using various online sources such as PubMed, Google Scholar, Science Direct and Web of Science. The terms "child abuse" were the most frequently used, followed in frequency by "gender violence," "femicide," and, lastly, "elderly abuse." The first studies considered gender-based violence as a purely physical problem, then, progressively, the analysis focused on the psychological point of view of the issue. There was a greater number of studies in 2020 about violence in comparison with previous years. The social and scientific attention to gender-based violence appeared to be very poor, especially in the case of older people abuse. It is necessary to increase general attention to the topic to correctly identify each form of abuse and to be able to take care of the subjects most at risk. [ABSTRACT FROM AUTHOR]

Purpose: Different techniques have been studied to prevent the risk of perineal trauma during labor and post-partum pain. Limited information is available on the effect of Ritgen's maneuver. The aim of this review was to analyze whether Ritgen's maneuver during vaginal delivery has an effect on the risks of perineal trauma.Data sources: Electronic databases were searched from their inception until April 2018. No restrictions for language or geographic location were applied.Methods: We included all randomized controlled trials (RCTs) comparing the use of Ritgen's maneuver with a control group in women with singleton gestation and cephalic presentation at ≥37 weeks. Ritgen's maneuver was defined as an upward pressure from the coccygeal region to extend the head during vaginal delivery. Trials evaluating other technique (e.g. hands-on, perineal massage, warm compresses, etc.) were not included. All analyses were done using an intention-to-treat approach. The primary outcome was severe perineal laceration, defined as either third- or fourth-degree lacerations. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of either a relative risk (RR) with 95% confidence interval (CI).Results: Three trials including 1589 women were analyzed. Ritgen's maneuver was usually done by a midwife in the second stage during uterine contraction and/or during the crowning process. Pooled data showed no significant differences in the incidence of severe perineal lacerations (RR = 0.69, 95% CI = 0.10-4.61), and a higher risk of post-partum pain (RR = 1.95, 95% CI = 1.13-3.38).Conclusions: Ritgen's maneuver during labor is not protective for severe perineal lacerations and is associated with higher post-partum pain. [ABSTRACT FROM AUTHOR]

Background: Different techniques have been analyzed to reduce the risk of perineal trauma during labor.Objective: To evaluate whether perineal massage techniques during vaginal delivery decreases the risk of perineal trauma.Search strategy: Electronic databases (Medline, Prospero, Scopus, ClinicalTrials.gov, Embase, ScienceDirect, the Cochrane Library, SciELO) were searched from their inception until February 2018. No restrictions for language or geographic location were applied.Selection criteria: We included all randomized controlled trials (RCTs) comparing the use of perineal massage during labor (i.e. intervention group) with a control group (i.e. no perineal massage) in women with singleton gestation and cephalic presentation at ≥36 weeks. Perineal massage was defined as massage of the posterior perineum by the clinician's fingers (with or without lubricant). Trials on perineal massage during antenatal care, before the onset of labor, or only in the early part of the first stage, were not included.Data collection and analysis: All analyses were done using an intention-to-treat approach. The primary outcome was severe perineal trauma, defined as third and fourth degree perineal lacerations. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of either a relative risk (RR) with 95% confidence interval (CI).Main results: Nine trials including 3374 women were analyzed. All studies included women with singleton pregnancy in cephalic presentation at ≥36 weeks undergoing spontaneous vaginal delivery. Perineal massage was usually done by a midwife in the second stage, during or between and during pushing time, with the index and middle fingers, using a water-soluble lubricant. Women randomized to receive perineal massage during labor had a significantly lower incidence of severe perineal trauma, compared to those who did not (RR 0.49, 95% CI 0.25-0.94). All the secondary outcomes were not significant, except for the incidence of intact perineum, which was significantly higher in the perineal massage group (RR 1.40, 95% 1.01-1.93), and for the incidence of episiotomy, which was significantly lower in the perineal massage group (RR 0.56, 95% CI 0.38-0.82).Conclusions: Perineal massage during labor is associated with significant lower risk of severe perineal trauma, such as third and fourth degree lacerations. Perineal massage was usually done by a midwife in the second stage, during or between and during pushing time, with the index and middle fingers, using a water-soluble lubricant. [ABSTRACT FROM AUTHOR]

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Background: Vaginal application of lubricant during labor has been studied to shorten the length of the second stage of labor.Objective: To evaluate whether vaginal application of lubricant shortens the second stage of labor.Data sources: Electronic databases were searched from their inception until February 2018. No restrictions for language or geographic location were applied.Study eligibility criteria: Randomized controlled trials (RCTs) comparing the use of lubricant of the vaginal canal (i.e. intervention group) with a control group (i.e. no lubricant) in pregnant women with singleton gestation and cephalic presentation undergoing spontaneous vaginal delivery at term. Trials on other interventions that might impact second stage of labor (pushing methods, perineal massage, Ritgen's maneuver, etc.) were not included.Study appraisal and synthesis methods: All analyses were done using an intention-to-treat approach. The primary outcome was the length of the second stage of labor. Pooled analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of mean difference (MD) with 95% confidence interval (CI).Tabulation, integration, and results: Three RCTs including 512 women evaluating the effect of lubricant application during labor were included in the meta-analysis. All trials included pregnant women with singleton gestations in cephalic presentation at term undergoing spontaneous vaginal delivery. One trial included only nulliparous women, while the other two included both nulliparous and multiparous women. Lubricant application started in the first stage before the active phase of labor, and was done intermittently by the midwife or the physician. A sterile gel was applied into the vaginal canal manually or with an applicator. All trials used water-soluble gel. The quantity of gel used was about 2-5 ml for each vaginal examination. There were no statistically significant differences, comparing women who received lubricant gel during labor with those who did not, in the lengths of second stage of labor (MD -7.11 min, 95% CI -15.60 to 1.38), of the first stage of labor, or of the active phase of the first stage of labor. No between-group differences were noticed in the risk of perineal lacerations, mode of delivery, and in the neonatal outcomes.Conclusion: Vaginal application of lubricant during labor does not reduce the length of the second stage of labor in pregnant women with singleton gestations undergoing an attempt at spontaneous vaginal delivery at term. [ABSTRACT FROM AUTHOR]

Fetal well-being in labor could be assessed trough cardiotocography (CTG). Some doubts have been raised about its unequivocal applicability. Pathological CTG is in most cases connected to fetal acidosis at birth, but other potential causes must be considered in the differential diagnosis. A 31-years-old G2P1 patient referred to our Department of Obstetrics and Gynecology for her scheduled post-term CTG at 40 weeks and 3 days of gestation. The pregnancy was uneventful. CTG was classified as suspicious, and after pharmacological induction, it switched as pathological: an emergency cesarean section was performed. Venous and arterial blood sample taken from the umbilical cord were normal. The next assessments revealed that Atrial Flutter (AFL) occurred at birth. Suspicious CTG is not always associated to neonatal asphyxia. Cardiotocography can help not only in the evaluation of fetal distress, but also in the assessment of global fetal cardiac activity. The presence of a fetal heart defect should be considered when CTG is suspicious.