Minerva obstetrics and gynecology最新文献

Background: Although misoprostol has been used as a potential option for cervical priming prior to hysteroscopy, the available scientific evidence regarding its use is not always conclusive. The purpose of this article is to assess the different practices and criteria applied for the use of misoprostol use for cervical preparation in outpatient hysteroscopy without anesthesia among gynecologists across Spain, exploring the need for the corresponding evidence-based guidelines.

Methods: We carried out a cross-sectional study in which a two-step approach survey was conducted. Firstly, an online pilot survey was conducted with a limited sample of 10 professionals from 10 centers to identify initial patterns and gather feedback. Subsequently, a comprehensive online survey was carried out over a larger sample of respondents. The comprehensive survey covered aspects of misoprostol usage, including dosage, timing, indications, safety concerns, and overall perception. The survey design allowed for a thorough examination of existing practices and provided valuable insights to help address the disparities noted in misoprostol use for cervical preparation in outpatient hysteroscopies.

Results: Through the comprehensive online survey, we received response of 102 gynecologists from 54 centers across Spain. The overall results show a considerable variation in misoprostol use prior to hysteroscopy, with 21.57% of respondents not using misoprostol in any case, while a substantial majority (78.43%) use it selectively (68.83%) or consistently (9.8%). When asked about the type of patients, the vast majority (72.55%) use it in postmenopausal nulliparous patients, while its was used considerably less in premenopausal nulliparous patients (35.29%), postmenopausal multiparous patients (22.55%), and premenopausal multiparous patients (3.92%), whereas some choose not to use it in any patients (26.47%). Furthermore, 89.22% of respondents felt that there is a lack of clear criteria on misoprostol use, while 79.41% believed that it is necessary to establish such criteria.

Conclusions: There was a diverse landscape of misoprostol use which underscores the complexity and individual approach to cervical preparation for an outpatient hysteroscopy. Indeed, the findings regarding its application, notably more prevalent among postmenopausal patients, contravene the prevailing body of published evidence. Moreover, a considerable proportion of respondents expressed the need for clear criteria, which emphasizes the importance of evidence-based protocols to guide the optimal use of misoprostol.

Background: Breastfeeding can be challenging in neonates born between 34 ^0/7 and 36 ^6/7 weeks gestation (late preterm).

Methods: This prospective cohort study aims to evaluate exclusive breastfeeding at discharge, at three and six months of life in late preterm infants, and to identify facilitators and challenges to it. We included late preterm neonates eligible for the rooming-in. Data about breastfeeding at discharge, at three and six months of life were collected.

Results: Two hundred and fourteen late preterm infants were included in the study. At discharge 70 infants (32.7%) were fed with human milk and 144 (67.2%) were not. Non-exclusive breastfeeding was more common in women who were primiparous, had hypertension, and who underwent cesarean sections. Non-exclusive breastfeeding was associated with a low birthweight (<2500 g), ≥2 blood glucose controls, weight loss >10%, and longer hospital stay. Early first latch-on and skin-to-skin contact were more frequently associated with exclusive human milk feeding (P<0.001). Late preterm neonates born at 35 weeks showed a significant increase in exclusive human milk feeding at 3 months compared to the rate at discharge (P=0.004).

Conclusions: In this cohort, early first latch-on and immediate skin-to-skin contact resulted associated with exclusive human milk feeding. Despite formula-fed during hospitalization, infants born at ≥35 weeks gestation who were exclusively breastfed at follow-up increased.

Background: Identifying and reducing inequities in the delivery of care is crucial to improving health disparities in obstetric outcomes. This study sought to evaluate the effect of race and ethnicity on time from decision for cesarean delivery to incision following implementation of a case classification system.

Methods: A retrospective cohort study was performed to identify women who had cesarean deliveries from October 1, 2020, to March 31, 2021, at a single, tertiary care institution. Medical records were reviewed for demographics and cesarean delivery case classification. Case classification was divided into STAT cesarean delivery (within 10 minutes), level A (within 30 minutes), level B (within 60 minutes), or scheduled/unscheduled other. The "decision to incision time" was determined from the time the case surgical order was placed to the case start time.

Results: There were 565 eligible individuals who had a cesarean delivery during the study period, with 13.6% identifying as Black/African American, 29.0% as Hispanic/Latina, and 57.3% as White. Hispanic women were more likely to need interpreter services than other race/ethnicity groups. There was no statistically significant difference in "decision to incision time" by race/ethnicity. Within the total cohort, 51.8% of cesarean delivery cases went within the goal time according to case classification, which also did not differ by race/ethnicity.

Conclusions: Race and ethnicity do not impact cesarean delivery "decision to incision time" or case classification. Only half of cesarean deliveries went within the goal time, so further evaluation to improve workflow and improve this metric for all patients is needed.

Background: P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP) are multidrug resistance (MDR) transporters that function as placental gatekeepers, lowering the fetal levels of diverse xenobiotics and toxins that may be circulating in the maternal blood throughout pregnancy. Placenta accreta spectrum (PAS) and the placenta previa (PP) disorders are obstetric pathologies encompassed by an abnormal invasion of chorionic villous tissue in the uterine wall or at the endocervical os, respectively. Given the fact that MDR transporters are involved in placentation and are highly responsive to inflammation, we hypothesized that immunostaining of P-gp and BCRP would be altered in PAS and in PP specimens.

Methods: A total of 32 placental histological specimens, sorted in control (N.=8; physiological pregnancies), PAS (N.=14), and PP (N.=10), were subjected to immunohistochemistry for P-gp and BCRP transporters. Semi-quantitative scoring of the resulting immunostained area and intensity was undertaken.

Results: Decreased P-gp staining intensity in the syncytiotrophoblast of the PAS compared to the control group (P<0.05) and in the PP compared to the PAS group was detected (P<0.05). Fetal blood vessel P-gp immunostaining was decreased in PAS and PP groups (P<0.001).

Conclusions: We conclude that PAS and PP histological specimens exhibit decreased immunostaning of the drug transporter P-gp, and that fetuses born from these pregnancies may be exposed to greater levels of drugs and toxins present at the maternal circulation. Futures studies should attempt to investigate the mechanisms underlying P-gp down-regulation in these obstetric pathologies.

Background: The aim of this study was to analyze how antepartum pelvic floor muscle training (PFMT) plus perineal massage associated with postpartum PFMT have a significant impact on pelvic floor health during pregnancy and after delivery.

Methods: One thousand two hundred thirty-three women were enrolled from January 2019 to December 2021. They were divided into two groups: 786 women underwent postpartum PFMT only, 447 women experienced both prepartum perineal massage and PFMT and postpartum PFMT. The primary endpoint was to evaluate prepartum perineal massage and PFMT's impact on delivery. The second endpoint was the evaluation of Quality of Life and sexual function at 3- and 12-months follow-up after delivery.

Results: Women who underwent prepartum PFMT experienced significantly lower percentage of episiotomy, high-grade obstetric tear or instrumental delivery and higher percentage of intact perineum. Furthermore, prepartum PFMT appeared to improve sexual function at 3 months follow-up, and it was associated with an earlier first sexual intercourse after childbirth. The incidence of stress urinary incontinence was significantly higher in women who experienced PFMT only in postpartum, both at 3- and 12-months follow-up, while the other examined clinical parameters did not show a significant difference.

Conclusions: Prepartum PFMT has a role in preventing obstetric traumas and on improving Sexual Function and Quality of Live in the immediate postpartum. Moreover, prepartum PFMT in association with postpartum PFMT reduces the incidence of stress urinary incontinence in a higher percentage than postpartum PFMT only.

Background: Inducing labor by ensuring a good maternal-fetal outcome is a challenge. The aim of the study was to evaluate the success rate, safeness, and time to delivery after the induction of labor (IOL), with the alternately first use of dinoprostone or Foley balloon, in high-risk pregnancy nulliparous women with unfavorable Bishop Score (BS).

Methods: This is a retrospective study of high-risk nulliparous women who underwent the IOL, either with dinoprostone or the Foley balloon method. In the former case, if the labor has not started after dinoprostone removal, oxytocin infusion started. In Foley group, the BS was re-evaluated after Foley removal, and IOL continued with the use of dinoprostone (if BS<6) or oxytocin (if BS>6). Here, too, if no labor occurred after dinoprostone removal, Oxytocin was administered. Delivery mode, fetal and maternal complications were recorded. The time to delivery was tracked.

Results: A total of 261 women were enrolled in the study. The CS rate was similar between groups (37.56% vs. 35.93%; P=0.81). Time to delivery was statistically lower in dinoprostone group (26.82h), as opposed to Foley (47.4h) (P<0.0001). Body Mass Index (BMI) of women who underwent Cesarean section (CS) was significantly higher than women who gave birth by vaginal delivery (VD), 26.80 vs. 27.40, P=0.012.

Conclusions: IOL in high-risk pregnancy nulliparous women resulted in equal rate of CS between the two groups. Dinoprostone first use resulted in a shorter time to delivery, with no maternal-fetal side effects. There is then no need to prolong IOL and raise maternal stress, as this will not yield better outcomes.

Today, the rate of cesarean sections is increasing worldwide. An underlying important phenomenon is cesarean section on maternal request (CSMR). CSMR is an elective cesarean section without medical and/or obstetric indications. The CSMR rate is often unknown but increasing. Women claim their right to choose how to give birth. Forcing a woman to undergo a vaginal delivery can affect not only her physical well-being but also her psychological well-being, and therefore her health. Over the last 20 years, various countries have developed national and international guidelines for the recognition of the woman's right to choose childbirth, although clear guidelines in this direction have not been established. In Italy, the rate of CSMR is about 9% of all cesarean sections, but it is underestimate. In Italy, CSMR is currently contrary to good care practice, so the doctor has no professional obligations and is entitled to refuse the request for a cesarean section. However, the legislation does not explicitly state that the doctor must refuse such a request. As a result, choice is not available to all the women. In a perspective where women claim their right to health, not only physical but also psychological, the need to develop informed consent for childbirth in general and a guideline on CSMR are unavoidable. This is important both to ensure equal opportunities for all women and to clarify the medical responsibilities and the legal consequences of this choice.

Background: Vulvodynia is a chronic painful entity that poses diagnostic and therapeutic challenges. The aim of this work was to describe the characteristics of women affected by vulvodynia and to estimate the effectiveness of currently available therapeutic options.

Methods: A retrospective observational study has been carried out with a sample of 50 women who presented vulvodynia at a chronic pelvic pain unit between 2019 and 2021.

Results: The mean age at diagnosis was 38.44 years. Mean delay to diagnosis was 29.82 months. According to the classification currently used, vulvodynia was mainly localized, provoked, intermittent, and immediate. Most of the women also reported dyspareunia with mean baseline pain and dyspareunia according to the Visual Analog Scale (VAS) of 4 and 8, respectively. Among the therapeutic options used, neuromodulatory drugs have shown to be effective in symptom control and improving quality of life both at 6 and 12 months. At 24 months improvement in dyspareunia was not statistically significant, probably due to the small sample size due to losses in the follow-up. Non-pharmacological treatments such as physical therapy and cognitive behavioral therapy may also play a role in symptom improvement.

Conclusions: Most of the available evidence is based on retrospective studies. Quality randomized clinical trials are necessary to better test the efficacy of treatments, especially neuromodulatory drugs.