[STRIAE GRAVIDARUM - ETIOLOGY, PREVALENCE AND TREATMENT].

INTRODUCTION: Striae gravidarum is the second most prevalent skin manifestation after skin pigmentation during pregnancy. Its etiology is uncertain, but it is assumed that changes in the structure of collagen, mediated by hormonal changes during pregnancy, are the causative factor. These marks normally appear during the third trimester of pregnancy and disappear several months after delivery. Striae gravidarum have no adverse health implications though they have negative psychological effects on the affected gravid women. Several treatments for this coetaneous affliction have been tested but only skin rubbing of almond oil as well as extracts from the Centella tree have proved to be of limited therapeutic value. Nevertheless, it has been proven that the mere application of various creams for this coetaneous problem during pregnancy is effective in improving the feeling of the users.

[THE RIDDLE OF FEMALE ORGASM].

INTRODUCTION: Female orgasm is not necessary for coitus and reproduction from an evolutionary point of view. Furthermore, many women have difficulties in achieving an orgasm. In the present review, the authors discuss the possible benefits of female orgasm, the ability to have an orgasm in different times of the woman's life cycle and in various states of health. We further explore the effect of hormones on orgasm and evaluate different types of treatments for the improvement of female orgasm. Based on the current literature, so far there is no well-established information regarding the precise physiologic causes of female orgasm, hence the bulk of research on this theme comes from psychology or sociology sources. This, of course, does not promote the physiologic, as well as the hormonal knowledge of female orgasm. Therefore, to date, female orgasm still remains a riddle to medicine.

[HYPNOSIS IN OBSTETRICS AND GYNECOLOGY].

Hypnosis is an ancient method of treatment, in which an enhanced state of mind and elevated susceptibility for suggestion of the patient, are increased. Hypnosis is executed, either by a caregiver or by the person himself (after brief training). The use of hypnosis in alleviating labor pain has been studied as of the second half of the 20th century. In early studies, the use of hypnosis for this purpose has been proven quite effective. However, later studies, performed in randomized controlled trial terms, have shown controversial results. Other studies, in which the effect of hypnosis was tested in various aspects of both obstetrics and gynecology and with different levels of success, are elaborated on in this review.

The effect of labor and delivery on white blood cell count.

OBJECTIVE: To explore post-partum white blood cell (WBC) count, and possible factors affecting it. STUDY DESIGN: Retrospective cohort analysis of 12 079 healthy women, delivering a singleton term fetus with an uncomplicated course of labor, delivery and puerperium. All women delivered in a single tertiary, university-affiliated medical center from 2009 to 2014. Student's t-test, Mann-Whitney's U-test, χ(2) test and ANOVA were used to compare between variables. Multiple variable analyses was performed to allow adjustment for potential covariates and confounders. The main outcome measures included post-partum WBC count and the difference in the post-partum versus ante-partum WBC count, in association to mode of delivery, type of analgesia, timing of cesarean delivery and perineal trauma. RESULTS: The mean post-partum WBC count was 13.39 ± .24 × 10(9)/L (range 1.20-37.30 × 10(9)/L). There is a significant increase in the WBC after delivery (2.1 9 ± 3.33 × 10(9)/L) with significant differences according to mode of delivery (2.34 ± 3.48, 3.32 ± 3.69 and 1.6 0 ± 2.87 × 10(9)/L for spontaneous, assisted and cesarean deliveries. Multiple variables can affect post-partum leukocytosis, including: age, parity, gestational age, mode of delivery, type of anesthesia, timing of cesarean delivery in relation to labor onset and the extent of perineal trauma. CONCLUSIONS: Post-partum leukocytosis is a physiological phenomenon with a wide normal variation and multiple contributing factors. As a single parameter, post-partum leukocytosis should not prompt further work up.

Congenital cytomegalovirus infection following antenatal negative diagnostic amniotic fluid analysis - a single center experience.

OBJECTIVE: To determine the perinatal outcome of confirmed congenital cytomegalovirus (CMV) infection despite a negative prenatal amniotic-fluid analysis. METHODS: A retrospective cohort study of all neonates diagnosed with congenital CMV infection from January 2006 to December 2011 despite negative results on polymerase chain reaction and shell's vial assays of amniotic fluid. Data were collected on all neonates by physical examination, blood work-up (complete blood count, bilirubin, liver enzymes), fundoscopy, brainstem evoked response (BSER), and brain ultrasound, at birth and during follow-up in the neonatal period. RESULTS: The study group included 10 patients with primary congenital CMV infection during pregnancy. Follow-up time ranged from 1 to 62 months (median, 17 months). Four patients had consistently normal findings throughout follow-up, and three developed mild hepatosplenomegaly (1-32 months). In the remaining four offspring, brain ultrasound preformed after birth revealed lenticular striated vasculopathy (LSV) and in three of them the BSER test showed decreased hearing ability. Treatment with ganciclovir/valganciclovir was administered at age of 2 weeks, 2, 18, and 32 months. The BSER normalized after 9 and 12 months of treatment in two patients for whom follow-up data were available. CONCLUSION: Negative findings on amniotic-fluid tests for CMV do not rule out neonatal infection with clinical morbidity.