Shoulder dystocia and range of head-body delivery interval (HBDI); the association between prolonged HBDI and neonatal outcomes: protocol for a systematic review Shoulder dystocia (SD) is an obstetric emergency which if not carefully diagnosed and managed, can contribute to lifelong neonatal morbidities. Despite current guidelines on the definition of SD (impaction of the fetal shoulder behind the maternal symphysis pubis and need for ancillary manoeuvres or head-body delivery interval (HBDI)> 60 seconds) its accurate diagnosis requires clinical expertise as well as overall consideration of feto-maternal condition. Based on the literature available, our study aims to determine (1) the range of HBDI as an indicator of SD and (2) the neonatal complications occurring following prolonged HBDI in normal or SD-complicated births.
Can manual lymph drainage be improved or not: That’s the question! A response letter We have read the comments on the recently published protocol of the EFforT-BCRL trial  with great interest. The aim of this multi-centre randomized controlled trial (RCT) was to determine the effectiveness of fluoroscopy-guided manual lymph drainage (MLD) in addition to the other components of decongestive lymphatic therapy and compared to traditional or placebo MLD, in the treatment of breast cancer-related lymphoedema. The protocol of this trial adheres to the recommended CONSORT guidelines and the work received substantial contributions from all stakeholders in order to meet the required quality standards.
Twin pregnancy in non-communicating rudimentary horn Rudimentary horn pregnancy (RHP) is rare with incidence estimated of 1:76,000-1:160,000 pregnancies . It has also been reported that 75–83% of cases are in non-communicating rudimentary horn suggesting transmigration of peritoneal sperm or fertilized ovum . Usually the natural history is rupture during the second or third trimester, resulting in life-threatening heavy bleeding . A 20-year-old G2P1 who was 10 weeks pregnant was admitted to our medical center at due to mild vaginal bleeding.
The predictive value of sentinel node biopsy in early breast cancer after neo-adjuvant chemotherapy: A prospective study A sentinel Node (SN) has replaced axillary lymph node dissection (ALND) in patients with clinically node negative axilla (cN0). SN after Neo-adjuvant chemotherapy (NACT) is feasible but not accurate in clinically node positive (cN1-3) patients. The goal of this study is to determine the negative predictive value (NPV) of SN in cN0 breast cancer after NACT. A secondary endpoint is to determine if ALND can be avoided after NACT regardless of the pre-treatment clinical staging of the axilla, in case of a normalization of the 18F-fluoro-2-deoxy-glucose positron emission tomography scan (PET-CT scan).
Autosomal recessive polycystic kidney disease prenatally diagnosed in a fetus with unreported paternal inherited PKHD1 mutation Autosomal recessive polycystic kidney disease is caused by mutations in PKHD1, a large 500 Kb gene  with a complex splicing pattern located on chromosome 6p21.1-p12. The product of PKHD1, fibrocystin/polyductin (FPC), is a single-membrane spanning protein with multiple isoforms . It is expressed predominantly in the kidney, liver and pancreas. The exact function of FPC remains unclear. To date, >300 pathogenic mutations have been cataloged in the ARPKD mutation database (http://humgen.rwth-aachen.de) .
An unusual case of pregnancy in a patient with Caroli’s syndrome Caroli´s syndrome is a rare congenital disease with an incidence of 1:1,000,000 characterized by a non-obstructive segmental cystic dilation of large intrahepatic bile ducts . There are two distinguishable forms: Caroli’s syndrome, which is associated with congenital hepatic fibrosis and cirrhosis and Caroli’s disease, a much more rare condition which is linked with autosomal recessive polycystic kidney disease . Caroli’s syndrome can affect young women in their childbearing age, however, due its rare incidence there is paucity of data in the literature [2–4].
Guillain–Barré syndrome in pregnancy: Successful multidisciplinary approach A 30 year old primigravida presented to our emergency department at 20 weeks gestation with rapid onset distal paraesthesia, generalised weakness and motor difficulty. Two weeks prior to the onset, she reported having had the influenza vaccination as recommended in pregnancy. She had no other medical history of note and reported no recent travel. The patient underwent various investigations including lumbar puncture, MRI brain and spine, blood tests including electrolytes, thyroid function, autoimmune antibody screen, HIV, hepatitis and Epstein Barr virus (EBV); all of which were normal.
“Obstetric violence”: Between misunderstanding and mystification as Presidents of the Scientific Societies SIGO (Italian Society of Gynecology and Obstetrics), AOGOI (Association of Italian Hospital Gynecologists Obstetrics), AGUI (Association of Italian University Gynecologists) and FNPO (National Federation of Midwife Profession Orders) we would bring to your attention the following considerations after reading in your publication the letter written by Dr. Claudia Ravaldi and other authors: "Abuse and disrespect in childbirth assistance in Italy: a community-based survey".
A novel approach to ex-utero intrapartum treatment (EXIT) in a case with complete anterior placenta Developments in fetal therapy have included not only fetoscopic or open fetal surgical procedures but also intrapartum treatments, both of which contributed to lowering perinatal morbidity and mortality. Ex utero intrapartum treatment (EXIT) is an established management option for preventing catastrophic consequences of unsuccessful or delayed establishment of secured neonatal airway for fetuses with suspected airway compromise [1–4].
Joint position statement on universal screening for GDM in Europe by FIGO, EBCOG and EAPM Hyperglycaemia in Pregnancy (HIP) is a global issue as it increases risks for both the mother and child. There remains considerable disparity in clinical practice and national policies for HIP screening. FIGO, EBCOG and EAPM have joined forces to address this disparity in clinical care and reduce the burden of inter-generational Non-Communicable disease.
Conversion to IUI versus continuance with IVF in low responder patients: A systematic review Poor response to ovarian hyper-stimulation can be difficult to predict prior to stimulation even when factoring in patient age and ovarian reserve testing. When faced with the situation of poor response, patients and providers have the difficult decision to proceed with oocyte retrieval, convert to intrauterine insemination (IUI), or cancel the cycle. Although this is not an uncommon scenario, there is little data available to assist with the counseling of these patients.We performed a systematic review of published studies comparing clinical pregnancy and live births between those patients continuing with in-vitro fertilization (IVF) and those converting to IUI.
Cerebroplacental ratio before induction of labour in normally grown fetuses at term and intrapartum fetal compromise Recent literature suggests that the fetal cerebroplacental ratio (CPR) assessed before labour might be useful for the prediction of operative delivery for intrapartum fetal compromise (IFC) and for the detection of adverse neonatal outcomes in appropriately grown (AGA) fetuses . We are not aware of any study specifically addressing this issue in the setting of induction of labour. Therefore, we conducted a prospective observational cohort study in 151 consecutive singleton pregnancies with scheduled induction of labour above 37+0 weeks’ gestation.
Influence of tumour suppressor gene (TP53, BRCA1 and BRCA2) polymorphisms on polycystic ovary syndrome in South Indian women Polycystic Ovary Syndrome (PCOS) is a heterogeneous multifactorial endocrine metabolic disorder. In addition to hyperandrogenism, acne, hirsutism, obesity, oligoanovulation and infertility, insulin resistance is also a common feature in women of PCOS. Tumor suppressor genes (TSGs) perform essential function in the maintenance of genomic stability and regulatory pathways influencing the activity of several replication and transcription factors. The main aim of this study was to investigate the association of Single Nucleotide Polymorphisms of TP53, BRCA1and BRCA2 genes with the susceptibility to PCOS in South Indian women.
The effects of hydrocortisone on tight junction genes in an in vitro model of the human fallopian epithelial cells The tight junction between epithelial cells helps making connections in the fallopian tube and contributes to successful fertilization. Breaking the tight junction complex induces various diseases such as the EP. Previous studies have shown that glucocorticoids are effective in repairing and maintaining intercellular tight junctions in epithelial cells of the fallopian tube, although their mechanism is still unknown. This research is a genomic study of hydrocortisone’s effect on epithelial cells of the fallopian tube.
Risk of pre-eclampsia after fresh or frozen embryo transfer in patients undergoing oocyte donation Different perinatal and neonatal adverse outcomes have been reported to be increased in frozen embryo transfer pregnancies compared with fresh embryo transfer with patient’s own oocytes. Concerning preeclampsia, it has also been reported to be increased after frozen embryo transfer.The objective of this study is to asses if there is an increased risk of preeclampsia and gestational hypertension in pregnancies achieved with oocyte donation after frozen embryo transfer compared to fresh embryo transfer.
Breast cancer screening in young women Breast cancer is the leading cause of death by cancer in women aged less than 40. However, organized screening of young healthy women has been recognized as inefficient and even deleterious by most experts , and should not been offered. Individualized screening, targeting only some young high-risk women, may be beneficial although no randomized trial has proven an impact on breast cancer mortality. All recommendations are based on expert’s opinions. This review offers a toned overview of these recommendations and underlines the need of careful information and shared decision with each patient.
Severe pain in women undergoing first-trimester surgical abortion under local anaesthesia: A closer look at the predictive factors I read with great interest the article of Duros and colleagues  in a recent issue of the Journal. The authors performed an observational study of one hundred and ninety-four patients who underwent an elective first-trimester surgical abortion under local anesthetics and concluded that nearly half of the women experienced severe postoperative pain with gestation period of more than 10 weeks and parity the main predictive factors influencing the outcome. The authors should be commended for performing a well-designed study in patients undergoing obstetric procedures [2,3].
Paris Consensus on Gestational Diabetes Mellitus screening 2018 Released by the European Board and College of Obstetrics and Gynaecology (EBCOG) and the European Diabetes in Pregnancy Study Group (DPSG), supported by FIGO, at the 26th European Congress of EBCOG, held on 8th–10th March 2018 in Paris, following a whole day symposium on the challenging issue of Gestational Diabetes Mellitus (GDM) screening.
Breast cancer in pregnant patients: A review of the literature Breast cancer diagnosed during pregnancy is a rare occurrence at present; however, in recent years a trend towards delayed childbirth is generating an increase in its incidence. This situation requires a multidisciplinary approach involving obstetricians, oncologists and surgeons.In this review we analyse diagnostic methods, different possible treatments and long-term patient prognosis. We conducted a search for articles published in PubMed, or in abstract form from the San Antonio Breast Cancer Symposium (SABCS), the European Society for Medical Oncology (ESMO), and the American Society of Clinical Oncology (ASCO) annual meeting, using the search terms:“Breast cancer and pregnancy”.
Breast reconstruction after mastectomy Reconstructive surgery aims to improve quality of life by recreating a natural-looking breast that is warm to the touch. To obtain symmetry and body contour alignment, restoration of volume within the skin envelope is mandatory. The chosen reconstruction technique depends on the characteristics of the diseased breast, the shape and volume of the contralateral breast, and the technical skills of the surgical team. Timing, type and different possibilities of breast reconstruction are discussed.
Hormonal contraceptives and breast cancer: Clinical data The endocrine background of breast cancer has raised questions about the increase in risk that might bear the use of hormonal contraceptives. This has been a particular issue in the case of young women, who constitute the population of contraceptive consumers. Observational studies have been the main source of evidence, which has mainly limited to the combined estrogen-progestogen preparations, the popular pill. Studies in the 80′s and 90′s of the past century found a small, around a 20%, increase in risk.
The action of estrogens and progestogens in the young female breast Evidence from different sources sustains a pro-oncogenic role of hormones, estrogens and progestogens, on the breast. The issue is of interest for young women, who are exposed to the hormonal changes imposed by the ovarian cycle and, often, take hormones with contraceptive purposes.Experimental and clinical studies show that both estrogens and progesterone are involved in mammary development during puberty and lactation, the changes being observed across mammalian species, including humans. Estrogen receptors, and more particularly the alpha isoform, participate in molecular processes of stem cells differentiation and epithelial proliferation through paracrine actions implicating growth factors.
Obesity and breast cancer in premenopausal women: Current evidence and future perspectives There is raising evidence reporting an increased incidence of breast cancer over the past decades. Every year approximately 1.4 million new cases of breast cancer are diagnosed worldwide, with a mortality rate of approximately 450,000/year. Out of these cases, 6.6% are diagnosed in premenopausal women with a median age at diagnosis of 40 years: in premenopausal women breast cancer seems to be more aggressive than in post-menopausal women. Obesity has been reported to increase the risk of developing breast cancer and to worsen the prognosis.
Breast reconstruction after breast conservation therapy for breast cancer Conservative breast surgery followed by irradiation, often referred to as Breast conserving therapy (BCT), has replaced modified radical mastectomy for the treatment of early stage invasive breast cancer and ductal carcinoma in situ (DCIS). About 10% to 40% of the patients treated with BCT have poor cosmetic outcome results. Small tumours in large breasts can be successfully treated by lumpectomy and radiotherapy, with good cosmetic outcome. However when the tumour breast ratio is higher, the cosmetic outcome can be very disappointing.
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