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Background and aim of the work: The EXIT-to-airway procedure is aimed to provide the time required to secure airways when an extrinsic or intrinsic fetal mass raise concerns about airways control at delivery. Due to the rarity of the procedure, we aim to provide a summary of the appropriate prenatal planning by a multidisciplinary team. Methods: Report of a case of EXIT-to-airway procedure. Results: A 30 years-old woman, G2P1 with previous cesarean section, was referred to our Unit at 34 gestational weeks due to a fetal cervical mass of 7cm. An EXIT-to-airways procedure was performed by a multidisciplinary team after accurate preoperative planning and the practice simulations. The partial fetal extraction and the amnioinfusion of pre-heated saline were used to prevent fetal complications. The use of supplemental intravenous anesthesia with remifentanil and better control of uterine tone with nitroglycerin allowed reducing the exposure to volatile halogen for both the mother and the fetus. The accurate preoperative planning and the practice simulations allowed us to perform the treatment safely in urgency due to the onset of spontaneous labor at 37 weeks and 6 days. Conclusions: The strong cooperation among specialists, accurate prenatal planning, and adopting all the required procedures and precautions are of paramount importance to successfully perform the EXIT-to-airway procedure.

Objectives To evaluate the learning climate (LC) and quality of training in postgraduate training courses in gynecology and obstetrics in Italy, as essential element to improve the training quality of future medical specialists. Study Design Web-based anonymous survey sent to all Italian trainees in gynecology and obstetrics to assess LC and quality of postgraduate training courses. This included sociodemographic information, details regarding training positions, and a 50-item validated Dutch Residency Educational Climate Test (D-RECT) questionnaire with 11 subscales (1–5 Likert scale). At the same time, the 24-items Fifth Year Training Questionnaire (FYT-Q) was submitted to all trainees at the fifth year of training to assess quality of life (burnout and depression), quality of training and final achieved competency level. Descriptive statistics were used to describe the main characteristics of the study population and for the D-RECT and the FYT-Q results. Results One hundred seventy-eight trainees’ responses were included from 13 departments, yielding a department response rate of 33%. The mean composite score of the D-RECT was 3.185 (SD 0.305). The subscales “Formal education” and “Role of specialty tutor” scored a mean of 2.751 (SD 0.123) and 2.757 (SD 0.130), respectively. Sixty-four FYT-Q evaluations were completed. The 33% of trainees reported more than 56 weekly working hours. At least one burnout episode during the training was reported by 61% of the trainees, and the 45% of them reported one or more episode of depression. More than 50% of trainees reported adequate autonomy for gynecologic ultrasound, obstetrics first level ultrasound, hysteroscopy, and cesarean section. In FYT-Q adequacy of training, teaching, surgical teaching, and tutoring values resulted equal to or less than 3 in a 1–5 Likert scale. Conclusions D-RECT and FYT-Q questionnaires show a training that requires improvement, although the results do not seem to be completely consistent. D-RECT emphasizes the need for a better formal teaching and specialty tutors to ensure training with better LC. Interventions are needed to improve LC and quality of training in postgraduate training courses in gynecology and obstetrics in Italy.

A pregnancy related cancer is defined as a neoplasm diagnosed in a woman during gestation or within 12 months following childbirth or abortion. Breast, thyroidal, melanoma, cervical and hematological malignancies are those most commonly diagnosed during pregnancy, with a reported incidence considered lower than those estimated of 1 case on 1000 pregnancies. The clinical complexity is generated by the co-presence of mother and fetus, and the consequent conflict represented by the need to identify a therapeutic strategy that is effective for the maternal prognosis and, at the same time, safeguards the fetal well-being. Moreover, the counseling, diagnosis, staging and management of these cases are further complicated because most of the scientific literature consists in case reports or small retrospective studies and lacks in guidelines and prospective clinical trials. On that basis, the Study Group on Cancer in Pregnancy (members of S.I.G.O.-Italian Society of Gynecology and Obstetrics) presents the TIGRE Trial, an Italian multicenter observational study aimed at establishing a shared database for the collection of epidemiological and clinical data of the patients affected by pregnancy related cancer in Italy, with the final objective to improve the outcome of a mother and a child involved in a such pathology.

Introduction Antithrombin levels are often reduced in preeclampsia and infusion of antithrombin concentrates has been reported to prolong gestation in severe preeclampsia. We aimed to evaluate efficacy and safety of high-dose antithrombin (ATIII) supplementation in patients with single pregnancies and preeclampsia occurring before 30 weeks of gestation. Materials and methods In November 2004 a double-blind, placebo-controlled trial (code KB033) was started in 13 Italian centers. The planned sample size was of 240 patients (intention-to-treat, ITT population) to detect a 30% relative risk reduction of the primary endpoint, composite perinatal morbidity. Eligible patients were randomized to high dose AT (3000 IU/daily, ATIII Kedrion S.p.A., Italy), or placebo (1% glycine) for 7 days or less until delivery, whichever came first. The per-protocol (PP) population was restricted to patients receiving at least two days of treatment. Results The study was terminated by the sponsor in October 2007 after the enrolment of 38 evaluable patients – 20 randomized to high dose AT and 18 to placebo, 27 treated for 2 days or more – out of 164 screened patients. Enrolment failures were mainly represented by requirement for immediate delivery and consent refusal (91 patients). The primary endpoint occurred in 15 of 38 patients (39.5%), with a relative risk in the AT arm of 0.85 (95% CI 0.42–1.75) and 0.79 (95% CI 0.30-2.11) in the ITT and PP populations, respectively. Living neonates in the two arms had similar weight at birth, Apgar scores, and duration of hospitalization in neonatal ICU. In mothers, AT supplementation was associated with reduced blood loss at delivery and with surrogate laboratory markers (LDH, d -dimer). Conclusions The results of this markedly underpowered trial, albeit suggestive of a potential maternal benefit, cannot support high-dose AT supplementation to improve fetal/neonatal outcomes in early preeclampsia.

To assess the predictive value of sonographic cervical-length (CL) measurement in mid-gestation for spontaneous preterm birth (PTB) in asymptomatic triplet pregnancy.This was a retrospective study of asymptomatic triplet pregnancies followed at five Italian tertiary referral centers, between 2002 and 2015. CL was measured transvaginally between 18 and 24 weeks' gestation. Pregnancies with medically indicated PTB were excluded. Demographic and pregnancy characteristics of pregnancies complicated by PTB were analyzed and the distributions of CL measurements in these patients were calculated. Logistic regression analysis was performed to assess the association between CL and PTB, adjusted for confounders. Performance of CL measurement in prediction of PTB 28, 30 and 32 weeks of gestation was assessed.A total of 120 triplet pregnancies were included in the final analysis. Median CL was 35 (interquartile range (IQR), 29-40) mm measured at a median gestational age of 20 + 2 (IQR, 20 + 0 to 23 + 4) weeks. Overall, 23 (19.2%), 17 (14.2%) and eight (6.7%) patients had a CL 25, 20 and 15 mm, respectively. Spontaneous PTB 32 weeks occurred in 41 (34.2%) cases, 30 weeks in 23 (19.2%) and 28 weeks in 12 (10%) cases. CL 15 mm was significantly more frequent in the group of patients who delivered 28 (P = 0.03) and 30 (P = 0.01) weeks' gestation, compared with those who delivered after 28 and after 30 weeks, respectively, while CL 20 mm was more common in triplet pregnancies with delivery 32 weeks compared with those delivered ≥ 32 weeks (P = 0.03). Logistic regression analysis was possible only for PTB 32 weeks due to the small number of cases that delivered 30 and 28 weeks. After adjustment for confounders, CL was not significantly associated with PTB 32 weeks (adjusted odds ratio, 0.97; 95% CI, 0.94-1.01). CL measurement had an area under the receiver-operating characteristics curve of 0.41 (95% CI, 0.20-0.62), 0.41 (95% CI, 0.26-0.56) and 0.42 (95% CI, 0.31-0.54) for the prediction of spontaneous PTB 28, 30 and 32 weeks, respectively.CL assessed in mid-gestation is a poor predictor of PTB 28, 30 and 32 weeks' gestation in asymptomatic triplet pregnancy. Copyright © 2017 ISUOG. Published by John WileySons Ltd.

Indirect questioning (IQ), i.e., asking respondents to predict the behavior of others, has been employed in stated preference studies as WTP elicitation technique. This technique, also referred to as Inferred Valuation, represents a promising approach for reducing hypothetical bias when it is not possible to sell actual goods to participants and when the social desirability bias is a potential problem (e.g., preferences for sustainable food attributes). To date, several issues associated to the use of IQ have not been adequately investigated. We carried out a Discrete Choice Experiment on field to verify the effects on estimated WTPs of: i) different IQ framing; ii) monetary incentives associated to predictions; and iii) the order of presentation. First, by employing two different question formats (e.g. asking to predict others’ behavior in a real market situation or in hypothetical situations) we uncover how respondents are able to anticipate the tendency of others to provide socially desirable answers. Second, monetary incentives create a rewarding environment that indirectly affects WTPs obtained from direct questions. Third, we uncover a potential ‘debiasing’ effect on WTPs of asking respondents to make predictions about others’ before stating their own preferences, which could have interesting implications for practitioners.