Association between progesterone treatment and neonatal outcome in preterm births: a retrospective analysis.

This retrospective study was conducted to determine if infants born prematurely despite prophylactic maternal progesterone treatment during pregnancy may still benefit from its adjunct properties and have decreased neonatal complications. 248 women treated with vaginal/intramuscular progesterone during pregnancy and 2519 controls who gave birth to a preterm newborn (24 + 0-36 + 6 gestational weeks) at a tertiary medical centre in 2012-2019. The primary outcome measure was neonatal infectious composite outcome. Secondary outcome measures were other maternal and neonatal complications. Compared to controls, the study group was characterised by lower gestational age at birth (35.0 ± 2.66 vs. 36.0 ± 2.23 weeks, p < .001), lower birth weight (2294 vs. 2485 g, p < .001), higher rates of neonatal infectious composite outcome (27.82 vs. 21.36%, p = 0.024), NICU admission, periventricular leukomalacia, and mechanical ventilation. The higher neonatal infectious composite outcome is likely associated with the lower gestational age at birth in this high-risk group and not the progesterone treatment per se.IMPACT STATEMENTWhat is already known on this subject? Several randomised controlled trials have shown that progesterone administration in pregnancy significantly reduced the rate and complications of preterm birth. A recent study reported that vaginal administration of progesterone during pregnancy was more effective than intramuscular administration in decreasing vaginal group B Streptococcus (GBS) colonisation. This finding raises the question of whether progesterone treatment may have additional benefits besides preventing preterm birth and may reduce neonatal complication rate in preterm infants.What do the results of this study add? This is the first study examining the impact of gestational progesterone exposure on outcomes of preterm infants. The primary objective was a composite measure of infectious neonatal outcomes. Newborns who had progesterone exposure on average had lower gestational age, lower birth weight and higher neonatal infectious composite outcome. The significant difference is explained by lower gestational age.What are the implications of these findings for clinical practice and/or further research? Progesterone is widely used to prevent preterm birth, and may have important additive effects even when prematurity is not avoided. Although the findings did not support our initial hypothesis, they warrant further examination with larger cohorts.

DIEP Flap Breast Reconstruction Complication Rate in Previously Irradiated Internal Mammary Nodes.

BACKGROUND: Postmastectomy radiation therapy (PMRT) is a widely accepted treatment for locally advanced breast cancer. Some patients require additional boost radiation to the internal mammary nodes as the part of regional nodal irradiation (RNI). Delayed breast reconstruction with an autologous free flap using the internal mammary vessels for microvascular flap anastomosis is a common practice for these patients. The aim of our study was to evaluate the effect of RNI on autologous microvascular breast reconstruction. PATIENTS AND METHODS: A retrospective study was performed on 57 patients (69 flaps) undergoing deep inferior epigastric perforator (DIEP) flap for delayed breast reconstruction after radiation therapy. The study group included 37 patients (65%) who received PMRT and RNI to the internal mammary nodes. The control group included 20 patients (35%) who received PMRT alone. Early and delayed surgical complications, including wound complications, fat necrosis, and flap loss, were compared between the groups. RESULTS: The patient demographics in both groups were similar. Complication rate showed a higher trend in the study group for flap loss (8.3% versus 0%) and vascular anastomosis failure (5.6% versus 0%), but with no statistical difference (p = 0.54, 0.53, respectively). The control group showed a higher trend in fat necrosis (25% versus 8.3%, p = 0.11). CONCLUSIONS: DIEP flap breast reconstructions with internal mammary vessels anastomosis should be performed with cautious in patients who had received RNI to internal mammary nodes because of potential added risk for surgical complications.

Oncoplastic partial breast reconstruction improves patient satisfaction and aesthetic outcome for central breast tumours.

BACKGROUND: Patients with centrally located tumours involving the nipple-areolar complex (NAC) who undergo breast-conserving treatment (BCT) are at high risk for breast deformity and asymmetry. Immediate oncoplastic breast reconstruction (OBR) can have a favourable impact on surgical outcome. METHODS: We retrospectively compared aesthetic outcomes and patient satisfaction among women treated with NAC lumpectomy and immediate OBR with patients treated with BCT alone. Aesthetic outcome was evaluated by independent observers, and patient satisfaction was assessed by the BREAST-Q questionnaire. RESULTS: A total of 24 patients were studied, 12 in each group. Demographics and oncological staging were similar in both groups, apart from mean age, hypertension and tumour size/lumpectomy weight. Patients in the OBR group had higher scores for aesthetic outcome and a higher degree of patient satisfaction from the surgical outcome compared to the patients in the BCT-alone group. CONCLUSIONS: The immediate OBR approach in the treatment of centrally located tumours with NAC resection has clear advantages over BCT alone. This approach should be considered for and offered to suitable patients.