Serial cervical-length measurements after first episode of threatened preterm labor improve prediction of spontaneous delivery prior to 37 weeks' gestation.

OBJECTIVE: To assess whether repeat cervical-length (CL) measurement in women discharged from hospital after their first episode of threatened preterm labor can predict their risk of spontaneous preterm birth. METHODS: This was a secondary analysis of a randomized controlled trial of maintenance tocolysis, in which CL was measured on transvaginal ultrasound at the time of hospital discharge and after 2, 4, 8 and 12 weeks, in women who remained undelivered after their first episode of threatened preterm labor. After univariate analysis, multivariate logistic regression analysis was used to assess whether CL < 10 mm at the time of hospital discharge or at any follow-up evaluation could predict spontaneous delivery prior to 37 weeks of gestation. RESULTS: Of 226 women discharged after a diagnosis of threatened preterm labor, 57 (25.2%) delivered spontaneously prior to 37 weeks' gestation. The risk of spontaneous preterm birth was higher among women with CL < 10 mm at hospital discharge compared to those with CL ≥ 10 mm (adjusted odds ratio (aOR), 3.3; 95% CI, 1.2-9.2). Moreover, spontaneous preterm delivery was more common when CL < 10 mm was detected up to 2 weeks (aOR, 2.9; 95% CI, 1.1-7.3) or up to 4 weeks (aOR, 7.3; 95% CI, 2.3-22.8) post discharge, as compared with when CL was persistently ≥ 10 mm. The association was not significant when considering CL measurements at 8 weeks, and there was insufficient information to assess the effect of measurements obtained at 12 weeks. CONCLUSIONS: Women who remain undelivered after their first episode of threatened preterm labor continue to be at high risk of spontaneous preterm birth if their CL is below 10 mm at the time of hospital discharge or at any follow-up visit up to 4 weeks later. CL measurement could be included in the antenatal care of these women in order to stratify their risk of preterm birth, rationalize resource utilization and help clinicians improve pregnancy outcome. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Consumption of Moringa oleifera Lam Leaves Lowers Postprandial Blood Pressure.

Objective: This clinical study monitored the effect of eating cooked Moringa oleifera leaves on the blood pressure (BP) of healthy participants in view of the perception that consumption of Moringa is associated with an increase in blood pressure, which is contradictory to the findings from the literature.Methods: A random sample of 41 healthy participants were enrolled in this prospective, placebo-controlled clinical study. Participants in the case study consumed 120 g of cooked M. oleifera leaves while the control group did not eat Moringa leaves. BP was measured at baseline before the meal and followed up at regular intervals over 24 hours for both groups. Baseline (T0) mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and postprandial follow-up (T2-T24) were measured for both groups. Participants recorded their diet for a week and this led to an estimation of the total salt consumption per day.Results: A significant difference was observed between DBP at baseline and two hours postprandial (T2) for the case group (p = 0.013). Moreover, in the case group, despite high consumption of salt (7 g/d) during the week preceding the clinical study, there was a significant decrease in both the SBP and DBP. In the control group, participants with prior high consumption of salt (7 g/d) during the week had elevated SBP and DBP.Conclusions: These findings in human subjects indicated the lowering effect of Moringa oleifera leaves consumption on the 2 hours postprandial BP and showed a potential lowering effect on both SBP and DBP despite prior high consumption of salt (7 g/d).

[Congenital heart disease: contraception and management of pregnancy]. / Cardiopatie congenite: contraccezione e management della gravidanza.

The number of women with congenital heart disease reaching childbearing age is constantly increasing due to the advances achieved in cardiac surgery during the past decades. The significant physiological haemodynamic changes and adaptations of the cardiovascular system associated with pregnancy, birth and puerperium increases the cardiovascular risk to pregnant women with congenital heart disease. It is therefore necessary not only the awareness of these haemodynamic changes and risks, but also a multidisciplinary approach that involves preconception counseling, choosing the best contraceptive method, close surveillance during pregnancy, delivery and puerperium. The purpose of this article is to review the major risks associated with pregnancy in women with CHD and to provide an indication on the best contraceptive method and cares during pregnancy in these patients.

Randomized comparison of vaporizing electrode and cutting loop for endometrial ablation.

OBJECTIVE: To compare endometrial ablation using a vaporizing electrode with resection using a standard cutting loop, evaluating distension fluid absorption, operating time, and ease of procedure. METHODS: Premenopausal menorrhagic women with normal hysteroscopic and endometrial biopsy findings were allocated randomly to endometrial vaporization (n = 47) or resection (n = 44). Distension medium deficit, operating time, and degree of difficulty of the procedure were determined at surgery. Menstrual pattern of women in both groups was also assessed after 1-year follow-up. RESULTS: Mean +/- standard deviation (SD) distension fluid deficit was 109+/-126 mL in the vaporization and 367+/-257 mL in the resection group (mean difference 258 mL; 95% confidence interval 175, 341 mL; P < .001, unpaired t test). Mean +/- SD operating time was, respectively, 9.2+/-3.1 minutes versus 10.7+/-2.5 minutes. The surgeon classified intraoperative difficulties as none in 32, minimal in 11, moderate in four, and severe in none in the vaporization group, and 17, 14, seven, and six in the resection group. Menstrual pattern at 1 year in the former group was amenorrhea in 17 (36%) cases, hypomenorrhea or spotting in 20 (43%), normal flows in 10 (21%), and menorrhagia in none compared with, respectively, 21 (48%), 14 (32%), seven (16%), and two (5%) in the latter group. CONCLUSION: Endometrial ablation with the vaporizing electrode limited fluid absorption compared with resection by the standard cutting loop. Long-term effects on uterine bleeding were similar.

Hysteroscopic myomectomy: long-term effects on menstrual pattern and fertility.

OBJECTIVE: To determine the effects of hysteroscopic myomectomy on menorrhagia and infertility and the influence of intramural extension on surgical feasibility and long-term outcomes. METHODS: We studied 108 women who had first-line hysteroscopic resection of submucous pedunculated (n = 54), sessile (n = 30), or intramural (n = 24) leiomyomas over 7 years at an academic department specializing in endoscopic surgery. RESULTS: The mean (+/- standard deviation) operating time and distension medium deficit were 18+/-7 minutes and 204+/-276 mL in the pedunculated lesion group, 23+/-9 minutes and 278+/-269 mL in the sessile lesion group, and 32+/-8 minutes and 335+/-272 mL in the intramural lesion group, respectively. More than one procedure was required to complete myoma removal in 14 (26%) of 54, eight (26%) of 30, and 12 (50%) of 24 subjects in the pedunculated, sessile, and intramural lesion groups, respectively. After a mean follow-up of 41 months, myomas recurred in 27 subjects, with a 3-year cumulative rate of 34%. Twenty women had recurrent menorrhagia, with a 3-year cumulative probability of 30%. The 3-year cumulative probability of conception was 49% in women with pedunculated lesions, 36% in those with sessile lesions, and 33% in those with intramural lesions. The study had 80% power to detect five- and three-fold increases in menorrhagia recurrence and conception rates, respectively, in the mainly intramural myoma group compared with the completely or mainly intracavitary myoma group. CONCLUSION: Hysteroscopic resection of submucous myomas gives satisfactory menorrhagia control and limited recurrence, but the benefit for infertility was less impressive. Myoma intramural extension did not have a substantial influence on any of the long-term outcomes but affected operating time and the number of procedures needed for complete removal.