1,721,061 research outputs found
Trial of Labor after Three or More Previous Cesarean Sections: Systematic Review and Meta-Analysis of Observational Studies
No full textAims To assess the success rate and prevalence of maternal or neonatal complications in women undergoing a trial of labor after three or more (≥3) previous cesarean sections (CSs). Methods A systematic literature review and meta-analysis was conducted from inception to May 2022 in Medline, Scopus, ENBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials and Reviews. Items detailing success rate and complications in women with a history of≥3 previous CSs were considered. Selected articles were evaluated for quality, heterogeneity, and publication bias. A pooled prevalence or odds ratio was calculated. Findings Twelve articles were included for a total of 540 women with a history of≥3 CSs, accounting for the 2% (CI 95% 1-4%) of the whole cohort of trial of labor. Our findings show a 0.67 (CI 95% 0.53-0.78) rate of successful vaginal delivery. A higher success rate was observed in women having a history of a prior vaginal delivery (0.90, CI 95% 0.77-0.96) and when prostaglandins, peridural anesthesia or oxytocin were allowed (respectively 0.73, CI 95% 0.62-0.83, 0,73, CI 95% 0.57-0.85 and 0.73, CI 95% 0.64-0.81). Uterine rupture rate was 0.01 (CI 95% 0.00-0.01). No cases of fetal asphyxia or maternal or neonatal death were registered. Conclusions The success rate and low frequency of severe complications observed seem to support a trial of labor in selected patients desiring a natural birth. However, a potential underestimation of serious maternal and neonatal complications should be considered in the decision-making process
Quantitative cervical elastography during pregnancy: influence of setting features on strain calculation
No full textAim: To evaluate the influence on feasibility and reliability of quantitative tissue Doppler imaging (TDI)-based cervical elastography of the cycle phase and of the derivative pitch (DP) selected during tissue strain (TS) calculation across all three trimesters of pregnancy. Materials and methods: The pilot study included 17 patients collected between the 12th and the 42nd week of gestation. The TS was measured by a single operator by quantitative elastography. The influence of DP values (5, 10, 15, and 20 mm) and phase (compression versus relaxation) was tested after a cycle of freehand compression and relaxation of the cervix through the vaginal probe. Feasibility and intra-operator intraclass correlation coefficient (ICC) agreement for strain measurement were also evaluated for every setting used. Results: TS values were inversely correlated with DP and were slightly higher if measured during a compression phase. TDI-based cervical elastography was feasible in all cases. Reliability for the process of strain calculation of different raw datasets was very good (ICC agreement ranging between 0.79 and 0.87), while excellent considering the same raw dataset (ICC agreement ranging between 0.93 and 0.95). Conclusions: The DP and cycle phase influenced the strain values calculated. Nonetheless, TDI-based cervical elastography was feasible and reliable for all the settings considered
Prevalence and risk factors for dyspareunia and unsatisfying sexual relationships in a cohort of primiparous and secondiparous women after 12 months postpartum
No full textEditorial: Precision Medicine in Obstetrics: Pregnancy Complication
No full text: Millions of women give birth every year worldwide [...]
COMBINED INTRAUTERINE AND CERVICAL PREGNANCY DIAGNOSED IN THE 13TH GESTATIONAL WEEK: WHICH TYPE OF MANAGEMENT IS MORE FEASIBLE AND SUCCESSFUL?
No full textComposite non-clinical interventions for a safe cesarean section rate reduction: results of a pre-post interventional study
No full textObjective: To evaluate the impact on cesarean section (CS) rate with of a program of multiple non-clinical interventions targeted at health-care professional within a hospital maternity ward. Materials and methods: Retrospective quasi-experimental pre-post intervention study with an historical control group conducted in a second-level teaching hospital. All women who gave birth in the period 2014 to 2018 were included. A series of multiple non-clinical interventions including a dedicated team of obstetricians for delivery room and antenatal counseling, monthly internal audits and physician education by local opinion leader were prospectively introduced from September 2016. The primary outcome of the study was the CS rate. The incidences of operative vaginal delivery, 3rd−/4th-degree perineal tears and further maternal and neonatal complications were considered as secondary outcomes. Results: The CS rate dropped from 33.05 to 26.06% after starting the interventions (p < 0.01); in particular, the cumulative rate of CS performed during labor decreased significantly from 19.46 to 14.11% (p < 0.01). CS reduction was still statistically significant after multivariate correction (OR = 0.66, CI.95 = 0.57–0.76, p < 0.01). Results further showed an increased prevalence of 3rd-degree perineal tears (0.97% versus 2.24%, p < 0.01), present also after correcting for possible confounding factors (OR = 2.36, CI.95 = 1.48–3.76, p < 0.01). No differences were found in the rate of vaginal-operative births and further maternal complications, while the composite neonatal outcome was found to be improved (OR = 0.73, CI.95 = 0.57–0.93, p = 0.010). Conclusions: The introduction of multiple non-clinical interventions can significantly reduce the CS rate. However, beside an improvement in neonatal composite outcome, a potential increase in high-degree perineal tears should be taken in account
First generation prophylactic HPV vaccines: The state of the art
No full textA chronic infection with "high risk" human papillomavirus (HPV) is as an obligated step in the development of cervical dysplasia and cancer and, less frequently, other types of cancers. It has been suggested to be responsible for an estimated 100% of cases of cervical cancer, 90% of anal cancers, 40% of vulvar, vaginal and penile cancers and very likely about 18% of oropharyngeal cancers. Furthermore, infection with "low risk" HPV types is responsible for some benign conditions such as genital warts and recurrent respiratory papillomatosis. Even if it is only very rarely a causative factor leading to cancer, these benign diseases have a high socioeconomic impact. HPV vaccination has been shown to be viable method in the prevention of HPV-related pathologies. Currently, there are two vaccine formulas belonging to the very low particles (VLPs) first generation vaccines. The first is the bivalent vaccine Cervarix®, which is active against high risk HPV 16 and 18. The second is the quadrivalent vaccine Gardasil®, which is active against high risk HPV 16 and 18, as well as against the low risk HPV types 6, 11. In this paper, we will discuss typical HPV-related pathologies, the effectiveness of these two first generation vaccines, existing advices, potential side effects and limits as well as new directions for HPV-vaccines implementation
Erratum: Low Back Pain during Pregnancy and Delivery Outcomes (Zeitschrift für Geburtshilfe und Neonatologie DOI: 10.1055/a-1553-4856)
No full textSecond-generation prophylactic HPV vaccines: Current options and future strategies for vaccines development
No full textTwo vaccines focused on the prevention of HPV-related diseases have been introduced in the last decade, the quadrivalent vaccine Gardasil® and the bivalent vaccine Cervarix® . They are targeted to prevent precancerous and cancerous lesions not only of the cervix, but also of the vulva, vagina, anal and head-neck region. Furthermore, the protection of the quadrivalent vaccine Gardasil includes also genital warts and recurrent respiratory Papillomatosis, two benign conditions with high socio-economic impact. Although their efficacy in reducing the burden of HPV-related pathologies has been already documented, second-generation HPV vaccines are being developed in order to overcome major limitations, above all the cost of production, distribution and acceptance, thus promoting an easier access to vaccination, especially in developing countries. Recently a new multivalent VLP vaccine active against nine HPV subtypes, called Gardasil 9® (Merck & Co., Inc., Whitehouse Station, NJ, USA), has been approved, showing promising preliminary results. In this article, we outline the strategies adopted for second-generation HPV vaccine engineering, the latest HPV vaccines available at this time, as well as those currently in development
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