Minerva obstetrics and gynecology最新文献

Background: Female urinary incontinence is a significant public health problem. Conservative treatments require high patient compliance, while surgery often leads to more complications and recovery time. Our aim is to evaluate the efficacy of microablative fractional CO2 laser (CO2-laser) therapy in women with urinary incontinence (UI).

Methods: This is a retrospective analysis of prospectively collected data on women with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) with predominant SUI subjected to four sessions of CO2-laser therapy performed once a month, between February 2017 and October 2017, with a 12-month follow-up. The subjective Visual Analogue Scale (VAS) 0-10 was used to score and variables were evaluated at baseline and at one, six and 12 months after initiation of therapy. Finally, results were compared to a control group.

Results: The cohort consisted of 42 women. The proportion of patients with vaginal atrophy among those younger than 55 years was substantially lower (3/23; 13%) than among those older than 55 years (15/19; 78.9%). CO2 laser treatment was associated with a significant improvement in VAS scores recorded one-month, six-months, and one-year, after conclusion of therapy (P<0.001). VAS scores improved significantly in patients with either SUI (26/42; 61.9%) or mixed UI (16/42; 38.1%). No major post treatment complications were registered. Women with vaginal atrophy demonstrated significantly better results (P<0.001).

Conclusions: Results confirm the efficacy and a good safety profile, for CO2 laser treatment in SUI, mostly in women with postmenopausal vaginal atrophy and should be considered as a treatment option for female patients with concomitant SUI and vaginal atrophy.

Background: The aim of this study was to retrospectively evaluate the therapeutic efficacy of the Knutson's paste, a solution composed of saccharose and povidone-iodine, in the management of perineal dehiscence following repair of post-partum laceration or episiotomy.

Methods: Thirty-seven women with post-partum perineal dehiscence were included in the study, conducted between September 2020 and December 2022. Patients self-applied the Knutson's paste three times per day for 14-21 days. Clinical evaluation was performed weekly; healing was defined as the closure of the wound margins. Recovery of sexual function was investigated with Female Sexual Function Index (FSFI) questionnaires at 6 months.

Results: All women achieved complete healing, and no one required resuturing. Full healing was achieved in 16.9±2.6 days. Second-degree dehiscence required significantly more days (24±2.64) to achieve healing compared to first-degree dehiscence (15.8±2.08). A mean of 3.4 outpatient visits was necessary during follow-up. The healing process and time were not associated with age, Body Mass Index (BMI), or birth weight. Around 50% of patients reported satisfying figures on FSFI questionnaires.

Conclusions: The Knutson's paste is a valid medicament for conservative treatment of post-partum perineal dehiscence. Due to its low costs and non-invasiveness, it could represent an alternative to the resuturing approach, especially in low-income countries and for women who refuse surgical revisions.

Colposcopy has traditionally played a crucial role in the assessment and management of abnormal cervical cytology and human papillomavirus (HPV) -related lesions. However, with the reduction in high-risk (HR) HPV types due to vaccination, the role of colposcopy in the HPV vaccination era is being questioned. The aim of this narrative review was to highlight the latest evidence from the world of HPV vaccination and the future role of colposcopy in the HPV vaccination era. PubMed, MEDLINE, Scopus, Web of Science were searched for relevant articles up to June 2024. HPV vaccination may influence colposcopic practice by reducing HR-HPV vaccine type, colposcopy referrals, colposcopic positive predictive value for CIN 2+, and by changing referral patterns, colposcopic performance, and procedures. The relative incidence of HPV-negative adenocarcinoma and its precursors may be increasing, presenting a new challenge that may increase the difficulty of colposcopic assessment. The role of colposcopy in the management of cervical abnormalities will vary according to vaccination status, vaccine type and timing of vaccination. As this evolves, colposcopy will need to adapt to provide optimal care tailored to individual risk profiles and to maintain the key role in cervical cancer prevention that it has acquired over the past decades. There will certainly be a need to improve the quality and performance of colposcopy by reducing inter- and intra-observer variability in colposcopic practice, including more objective patient selection, greater knowledge, expertise and skill, with the aim of achieving reproducible, sensitive and less biased assessment of cervical appearance.

Background: In Italy, egg donation is being allowed again following the ruling by the Constitutional Court N. 162/2014. Nevertheless, the number of voluntary donors is insignificant, probably because no reimbursement is provided. Therefore, the great majority of egg donation cycles are performed by using imported cryopreserved oocytes from foreign countries. However, recent evidence has questioned the overall efficacy of this strategy in comparison with the shipment of frozen sperm and vitrified embryos.

Methods: Retrospective cohort study, conducted at ANDROS Day Surgery Clinic Palermo, Italy in the period 2016-2022, with the objective of evaluating the efficiency of each batch of vitrified oocytes, in terms of completed cycles. The cryopreserved donated oocytes came from a single Spanish clinic (Next Fertility, Valencia, Spain). The primary outcome was the cumulative live birth rate (CLBR). The secondary outcomes were the cumulative ongoing pregnancy rate (COPR), the cumulative clinical pregnancy rate (CCPR) and the miscarriage rate.

Results: The CLBR totaled 35.1%, the COPR 36.8%, the CCPR 49.2% and the miscarriage rate 24.7%. In the multivariate analysis, the probability of success was significantly higher in younger recipients, in fresh embryo transfer and in blastocyst-stage embryo transfer.

Conclusions: Our "transnational" donation program with vitrified oocytes has good success rates. The main focus of our analysis is the negative effect of advancing recipient age on success rates, outlining a possible, important role of age-related uterine factor on implantation mechanisms. This aspect should be emphasized during the counselling with couples much more than is routinely done.

Introduction: Uterocervical angle (UCA) is the angle between the anterior or posterior uterine wall and the cervical canal, and it has become an unique ultrasonographic marker in the recent years. The predictive role of the UCA in spontaneous preterm births (sPTB) has been examined by numerous authors, however few data are available on UCA as predictor of labor outcome at term of pregnancy. Therefore, the purpose of this review is to evaluate the effectiveness of transvaginal ultrasound measurement of UCA at term, and its clinical implications in obstetrics' practice.

Evidence acquisition: A literature search was conducted including all studies regarding the predictive role of ultrasonographic evaluation of the UCA on labor outcomes from 1990 to 2023.

Evidence synthesis: A narrative synthesis was subsequently performed dividing studies that considered posterior and anterior UCA. Five studies were included for the anterior UCA, and ten for the posterior UCA. UCA was then evaluated as predictor of prolonged latent phase and predictor of the onset and mode of delivery.

Conclusions: It is likely that the combination of multiple cervical parameters, rather than UCA assessment alone, together with clinical information, can achieve higher levels of accuracy in predicting delivery outcomes. Future prospective studies are needed to define with greater certainty the role of UCA as a useful screening tool before laboring, but, until then, the use of UCA as a screening test to predict labor outcome should remain investigational.

Introduction: The diminished ovarian reserve (DOR) relates to a condition in which the ovary experiences a decline in its typical reproductive capacity. Despite notable advancements in understanding the pathophysiology of reduced ovarian reserve in recent years, significant unresolved challenges remain, particularly concerning the optimal therapeutic approaches for this complex condition. The main aim of this study was to investigate the potential of platelet-rich plasma (PRP) in enhancing ovarian follicle numbers by assessing changes in ovarian reserve markers.

Evidence acquisition: A comprehensive literature search was conducted on the following databases: PubMed/MEDLINE, SCOPUS, The Cochrane Library, Science Direct and Web of Science. All the relevant studies published till October 2023 were screened. After removing duplicates, and full-text evaluation, 9 articles were eventually included in the present review.

Evidence synthesis: The pregnancy rate (PR) among patients with poor ovarian reserve (POR) ranged from 13% to 40%, indicating the potential effectiveness of PRP as a rejuvenating treatment. The live birth rate (LBR) ranged from 13% to 20%, comparable to or not lower than the LBR of a matched healthy population aged between 38 and 42 years. Furthermore, the data presented thus far support the notion that PRP may lead to an average clinical PR of 10% in women affected by premature ovarian insufficiency (POI) and perimenopause.

Conclusions: PRP can not be regarded as a gamete replacement therapy, but rather as an 'additional' therapeutic tool in the management of women with DOR or POR, as well as in peri-menopausal women. Additional qualitative studies are required to validate the existing evidence, as the literature currently lacks randomized controlled trials (RCTs) in this regard.

Background: The aim of the study is to perform an overview of intrapartum stillbirth (SB) at term, assessing risk factors, causes of death and quality of pregnancy care.

Methods: This is an area-based, prospective cohort study on pregnant women at ≥37 weeks from 2014 to 2021. We compared intrapartum SB' information to alive birth and to antepartum deaths of the same period. Results of logistic regression are reported as the Odds Ratio (OR) with 95% confidence interval (95% CI) and the P value. A descriptive analysis about the causes of death and quality of pregnancy care is performed.

Results: The overall rate of SB at term in Emilia-Romagna was 1.06 ‰ births. Among the 260 cases, 27 (10.4%) occurred during labor, with an intrapartum SB rate of 0.11‰. This SB rate was stable during years. SGA newborn (P=0.005, 95% CI 1.47-9.04, OR 3.63), low level of education (P<0.0001, 95% CI 2.98-16.11, OR 6.93), pre pregnancy BMI ≥ 25 kg/m² (P<0.0001, 95% CI 6.61-31.74, OR 14.50) are independent risk factors for intrapartum SB when compared to alive newborns. Compared with antepartum SB, excessive weight gain in pregnancy (RR 2.91, 1.43-3.98, P=0.001) represents a risk factor for intrapartum ones.

Conclusions: Preventing intrapartum SB at term in developed country should be based on both the appropriate antenatal management of fetal growth and the avoidance of maternal excessive weight gain. An effort toward pre conceptional intervention of improving maternal shape could be of value.

Background: Histological evaluation of ovarian tissue harvested as part of the attempt to preserve fertility might clarify the mechanism by which ovarian failure is caused. The purpose of this study was to compare the histologic appearance of ovarian tissue harvested for ovarian tissue cryopreservation (OTC) in chemotherapy naïve and chemotherapy exposed patients regarding the presence of follicles in different stages of development and to explore ovarian tissue histology in patients exposed to low- and high-cytotoxicity risk chemotherapy.

Methods: A cohort of post-pubertal cancer survivors who underwent OTC between 1997 and 2018 was evaluated. An expert pathologist reviewed the pathology slides taken during OTC. The assessment included counting number of primordial, primary, secondary, and antral follicles. A comparison was made between chemotherapy naïve and chemotherapy exposed women and further between women who previously received low- versus high-risk gonadotoxic regimens.

Results: Seventy post-pubertal patients were included in the study. Seventeen (24.3%) received chemotherapy prior to OTC, and 53 (75.7%) were chemotherapy naïve at the time of OTC. A significant difference was found only in the number of secondary follicles, which was increased in chemotherapy naïve patients (2.81±4.26 vs. 0.88±1.18, respectively; P=0.005). Similar results were observed in a subgroup analysis of hematologic malignancies separately. Comparison of patients with previous exposure to chemotherapy revealed similar follicular appearance, except for the number of secondary follicles, which was higher in patients receiving low-risk compared to high-risk chemotherapy (1.40±1.28 vs. 0.14±0.35, respectively; P=0.006).

Conclusions: The ovarian follicular pool at OTC appears comparable between chemotherapy naïve individuals and those post-exposure, as well as among patients receiving low versus high-risk gonadotoxic regimens, with the exception of secondary follicles, which are presented in increased numbers in chemotherapy naïve and those exposed to low-risk gonadotoxic chemotherapy.

Background: Controlled ovarian stimulation during in-vitro fertilization (IVF) is personalized based on anticipated hyper, normal, poor response. With respect to poor responders, who are often treated using higher gonadotropin dosing and combination of urinary and recombinant gonadotropins (rFSH) with marginal benefit, we report our experience with a newer, more potent rFSH (Follitropin-δ) undergoing IVF.

Methods: Retrospective analysis of all IVF cycles in which follitropin-δ was used alone or combined with urinary gonadotropins over a 3-year period. Patients were grouped according to the POSEIDON Classification as expected low responders (POSEIDON 3-4; AMH<1.2; N.=45), unexpected low responders (POSEIDON 1-2; retrieval of ≤9 oocytes; N.=67) and those with a normal response (N.=93). Demographic, stimulation (including target number of retrieved oocytes [8 to14]), embryology and clinical outcome parameters (clinical pregnancy rate [CPR], live birth rate [LBR], cumulative live birth rate [cLBR]) were compared.

Results: Those categorized as POSEIDON patients were older, had lower ovarian reserve, were more likely to use a mixed protocol, less likely to reach the target oocytes retrieved (35.7% vs. 51.6%, P<0.001), and had a lower cLBR per patient (29.5% vs. 38.7%, P=0.006) when compared to non-POSEIDON patients. Expected low responders (POSEIDON 3-4) were older and had lower AMH when compared to unexpected low responders (POSEIDON 1-2), but no differences in the target of oocytes retrieved (33.3% vs. 37.3%, P=0.66) and cLBR (28.9% vs. 37.3%, P=0.06) were noted.

Conclusions: In expected low responders, follitropin-δ can be used to optimize oocyte collection and clinical outcome though one may need to deviate from the algorithm-suggested dose. Future studies should explore stimulation modifications in unexpected low responders.