The impact of chorionicity and type of conception on maternal-neonatal outcome in twin pregnancies.

PURPOSE OF INVESTIGATION: To evaluate the maternal and neonatal outcomes in twin pregnancies according to chorionicity (monochorionic (MC) versus dichorionic (DC) and type of conception [spontaneously conceived (SC) versus assisted reproduction technology (ART)]. MATERIALS AND METHODS: A retrospective study of 196 twin pregnancies admitted to the Department of Gynecology, Obstetrics and Urology of the University of Rome Sapienza, from January 2008 to April 2013. RESULTS: There were 55 MC and 141 DC twin pregnancies (82 SC and 59 ART). MC twin pregnancies had a higher incidence of preterm birth (p < 0.008), twin-twin transfusion syndrome (TTTS) (p < 0.021), and intrauterine growth restriction (IUGR) (p < 0.05). MC pregnancies had lower neonatal birth weight (p < 0.05), and lower Apgar score. ART DC pregnancies had a higher incidence of preterm delivery (p < 0.05). CONCLUSIONS: MC twin pregnancy is associated with higher risk of adverse maternal and perinatal outcomes. In the DC subgroup, ART is associated to a higher incidence of preterm delivery.

Management of hydrosalpinx before IVF: a literature review.

Hydrosalpinx has a detrimental effect on the outcome of in vitro fertilization (IVF). Surgical intervention such as salpingectomy or tubal occlusion before IVF improves the outcome of IVF, but these procedures are often contraindicated in women with dense pelvic adhesions. Thus, it is worthwhile to search minimally invasive alternative therapies. The main objective of this review is to assess and compare the value of all the therapeutic options for hydrosalpinx before IVF. The results of the following procedures were compared: the laparoscopic treatments (salpingectomy/proximal tubal occlusion), the hysteroscopic insertion of device achieving tubal occlusion, the tuberous sclerosis and the aspiration of hydrosalpingeal fluid at the time of IVF procedure. Laparoscopic surgical treatment should be considered for all women with hydrosalpinx before IVF. Whenever laparoscopy is not recommended, hysteroscopic insertion of device seems the most effective option for management of hydrosalpinx before IVF.

First trimester termination of pregnancy: methods in comparison between two European university hospitals.

PURPOSE OF INVESTIGATION: To compare methods, epidemiological features, and legislations of first trimester termination of pregnancy in two European Union University Hospital: Szeged, Hungary, (UHS) and Rome, Italy (UHR). MATERIALS AND METHODS: The study included 195 women in UHS and 197 women in UHR undergoing a termination of pregnancy, The method used in UHR was electric vacuum aspiration, while in UHS it is chosen according to the patients' features. RESULTS: Mean gestational week at the time of interruption was 8.21 ± 0.12 SD for UHS and 9.00 ± 0.08 SD for UHR (p = 0.000 1). Previous artificial termination of pregnancy was 0.40 ± 0.05 SD for UHR, and 0.77 ± 0.07 SD for UHS (p = 0.0001). Foreign women were 32.5% in UHR and 0.5% in UHS. Incidence of side effects was 1% for UHS and 0.5% for UHR. Parity was 2.54 ± 0.12 SD for UHR and 3.00 ± 0.14 SD for UHS (p = 0.01). CONCLUSIONS: The methods for interruption resulted safe and effective. Antibiotic prophylaxis, routinely provided in UHR, turned out to be effective to pre- vent post-operative infections. Cervical priming with Laminaria is safe, but patient's hospitalization is required. Different legislations may account for some epidemiological differences between the two hospitals.