Is an episiotomy always necessary during an operative vaginal delivery with vacuum? A longitudinal study.

Objective: The use of episiotomy during operative vaginal birth (OVB) is rather debated among operators and in literature. It is also important to evaluate the indications for which episiotomy is performed. In fact, the consequences of an episiotomy can be invalidating for patients with long-lasting results. The aim of this study is the evaluation of the role of episiotomy during OVB with the vacuum extractor and its correlation with Obstetric Anal Sphincter Injuries (OASIs).Methods: On of 9165 vaginal births, a total of 498 OVB (5.4%) were enrolled in a longitudinal prospective observational study. The incidence of OASIs was evaluated in our population after OVB performed with the vacuum extractor, during which the execution of episiotomy was performed indicated by clinician in charge.Results: OASIs occurred in 4% of the patients (n = 20). Episiotomy was performed in 39% of them (n = 181). OASIs incidence was 6% (n = 17) in the No Episiotomy and 1.8% (n = 3) in Episiotomy group (p<.001). Performance of episiotomy during OVB determined a protective effect against OASIs (p = 0.025 in full cohort and p = 0.013 in the primiparous group). An expulsive phase under one hour was an almost significant protective factor (p = 0.052).Conclusions: The use of episiotomy during OVB was associated with much lower OASIs rates in nulliparous women with a vacuum extraction; OR 0.23 (CI 95% 0.07-0.81) p = 0.037 in nulliparous women and the number necessary to treat was 18 among nulliparous women to prevent 1 OASIs. A further risk factor that emerged from the analysis is a prolonged expulsive period, whereas fundal pressure does not seem to have a statistically significant influence.

Efficacy of Two Common Methods of Application of Residual Insecticide for Controlling the Asian Tiger Mosquito, Aedes albopictus (Skuse), in Urban Areas.

After its first introduction in the 1980's the Asian tiger mosquito, Aedes albopictus (Skuse), has spread throughout Southern Europe. Ae. albopictus is considered an epidemiologically important vector for the transmission of many viral pathogens such as the yellow fever virus, dengue fever and Chikungunya fever, as well as several filarial nematodes such as Dirofilaria immitis or D. repens. It is therefore crucial to develop measures to reduce the risks of disease transmission by controlling the vector populations. The aim of the study was to compare the efficacy of two application techniques (mist vs. stretcher sprayer) and two insecticides (Etox based on the nonester pyrethroid Etofenprox vs. Microsin based on the pyrethroid type II Cypermetrin) in controlling adult tiger mosquito populations in highly populated areas. To test the effect of the two treatments pre- and post-treatment human landing rate counts were conducted for two years. After one day from the treatment we observed a 100% population decrease in mosquito abundance with both application methods and both insecticides. However, seven and 14 days after the application the stretcher sprayer showed larger population reductions than the mist sprayer. No effect of insecticide type after one day and 14 days was found, while Etox caused slightly higher population reduction than Microsin after seven days. Emergency measures to locally reduce the vector populations should adopt adulticide treatments using stretcher sprayers. However, more research is still needed to evaluate the potential negative effects of adulticide applications on non-target organisms.