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Journal: Minerva ginecologica

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COVID-19 was declared pandemic due to the rapid increase of cases around the world, including the number of pregnant women. Data about vertical transmission of Covid-19 are still limited and controversial: in most cases, although a positive mother, the virus could not be isolated in amniotic fluid, cord blood, breast milk or neonatal throat swab in these patients. No data have been published about possible intrauterine sonographic signs of infection.

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Cervical stenosis is defined as an adhesion process of variable degree, producing narrowing, distortion, or complete obliteration of the cervix. Several techniques have been defined to access to the uterine cavity and nowadays hysteroscopy seems to be the best option. In this manuscript, we review all the hysteroscopic modalities to overcome a cervical stenosis and access to the uterine cavity.

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The journey of human labour involves hypoxic and mechanical stresses as a result of progressively increasing frequency, duration and strength of uterine contractions and resultant compression of umbilical cord. In addition, occlusion of the spiral arteries during myometrial contractions also leads to repetitive interruptions in the utero-placental circulation, predisposing a fetus to progressively worsening hypoxic stress as the labour progresses. The vast majority of fetuses are equipped with compensatory mechanisms to withstand these hypoxic and mechanical stresses. They emerge unharmed at birth. However, some fetuses may sustain an antenatal injury or experience a chronic utero-placental insufficiency prior to the onset of labour. These may impair the fetus to compensate for the ongoing hypoxic stress secondary to ongoing uterine contractions. Non-hypoxic pathways of neurological damage such as chorioamnionitis, fetal anaemia or an acute fetal hypovolemia may potentiate fetal neurological injury, especially if in the presence of a superimposed, additional hypoxic stress. The use of utero-tonic agents to induce or augment labour may increase the risk of hypoxic-ischaemic injury. Clinicians need to move away from “pattern recognition” guidelines (“Normal”, “Suspicious”, “Pathological”), and apply the knowledge of fetal physiology to differentiate fetal compensation from decompensation. Individualization of care is essential to optimize outcomes.

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Intrapartum hypoxic events most commonly occur in low-risk pregnancies with appropriately grown fetuses. Continuous intrapartum monitoring by means of cardiotocography has not demonstrated a reduction in the frequency of adverse perinatal outcome but has been linked with an increase in the caesarean section rate, particularly among women considered at low risk. Available evidence from the literature suggests that abnormalities in the uterine artery Doppler and in the ratio between fetal cerebral and umbilical Doppler (i.e. cerebroplacental ratio, CPR) are associated with conditions of subclinical placental function occurring in fetuses who have failed to achieve their growth potential regardless of their actual size. In this review we summarize the available evidence on the use of intrapartum Doppler ultrasound for the fetal surveillance during labour and the identification of the fetuses at risk of intrapartum distress.

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Improving maternal and perinatal care is a global priority. Simulation training and novel applications of simulation for intrapartum care may help to reduce preventable deaths worldwide. Evaluation studies have published details of the effectiveness of simulation training for obstetric emergencies, exploring clinical and non-clinical factors as well as the impact on patient outcomes (both maternal and neonatal). This review summarises the many uses of simulation in obstetric emergencies from training to assessment. It also describes the adaption of training in low-resource settings and the evidence behind the equipment recommended to support simulation training. The review then discusses more novel applications for simulation such as its use in the development of a new device for assisted vaginal birth and its potential role in Caesarean section training. It further discusses the financial implications of simulation training and how this may impact the delivery of such training packages. It presents a concept that simulation should be developed and utilised as a key tool in the development of safe intrapartum care in both emergency and non-emergency settings, in innovation and product development.

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The aim of our systematic review is the assessment of effects of excisional treatments for the management of cervical intraepithelial neoplasia (CIN) on preterm delivery (PD), lower birth weight (LBW), preterm premature rupture of membrane (PPROM) and obstetrical outcomes.

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Lymph node involvement is an important prognostic factor in early and advanced epithelial ovarian cancer (eoc). However, to date there is no reliable method of detecting lymph node involvement, apart from surgical staging. Thus, pelvic and paraaortic lymphadenectomy (lNe) are still part of standard surgery of early ovarian cancer. There is conflicting evidence about the therapeutic value of systematic lNe in early eoc. Thus, the developmemt of a method to predict nodal status accurately, without extensive lNe, is the subject of ongoing research. Sentinel lymphadenectomy (SlN) has become a standard procedure in oncological surgery. However, SlN is not yet an established and widely accepted pro-cedure for eoc. This review aimed at summarizing available evidence on its feasibility and reliability in eoc. overall, evidence of SlN in early eoc is still scarce. So far, only small series of patients with a variety of tracers and injection sites were published. From the available literature, the most promising technique seems to be injection into the infundibu-lopelvic, as well as the proper ovarian ligament. indocyanine green seems to be an excellent tracer for successful SlN of ovarian tumors, which can be used during laparoscopic or robotic surgery. The detection rates and true positive rates of studies support further investigation of the technique. Results from prospective studies, e.g. the ongoing SellY trial, are necesssary to implement SlN into the standard treatment of early EOC.

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The current literature and guidelines are largely silent regarding the contribution of the fallopian tubes to the fluid deficit (FD) during hysteroscopy. We explored whether the FD could be in part due to transtubal passage.

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Urinary incontinence is a common condition that negatively impacts quality of life of millions women.It\'s a result of a synergy between the structures of pelvic floor in particular levator ani muscle and pelvic connective tissues. Urinary incontinence,increasing with age, is associated with considerable personal and societal expenditure.

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Urinary Incontinence significantly affects daily life of suffering women. Minimally invasive solutions to cope with urine leakage would be of great interest. A Survey to investigate efficacy and compliance of an innovative intravaginal device (DiveenĀ®) to reduce the risk of urine leakage was performed in 5 Urogynecological Centers across Italy. Women with Urodynamic diagnosis of Stress Incontinence, included Mixed conditions, underwent the survey. The device was effective (60%) independently from severity of Incontinence or the presence of concomitant detrusor overactivity (Mixed forms) with a positive impact on Quality of Life in more than half of the women. Also compliance with the device was satisfactory (up to 73%) Clinically symptomatic prolapse and age >65 years are the only limiting factors in terms of efficacy and compliance, while the menopausal status would not seem to affect these aspects. Despite global satisfactory outcomes 46% of the surveyed women declare their propensity to use the device. This data deserves further investigation.