Management of the second phase of labour: perineum protection techniques.

The obstetric experience alongside scientific evidences in literature indicate several management techniques during the expulsive period of labour to minimize obstetric complications. Among the various methods that can be used for the protection of the perineum during the expulsive phase, some are performed prepartum (perineum massage), while most are used during childbirth. Among the second group, progressively increasing importance is assumed by the manual techniques to protect the perineum (using the "hands-on" and "hands-off") and by episiotomy. These techniques, when used in accordance to the guidelines, may favour the reduction of adverse outcomes for both the mother and the newborn, both immediately after birth and after a longer time. The midwife should be aware of the evidences in literature so that a critical analysis of the available techniques can be made and put in action during the expulsive phase in order to protect the mother and the foetus from any unfavourable outcomes. Currently, clinical evidence in literature is directing obstetric and medical staff towards a careful analysis of the maternal-foetal parameters, in order to achieve a precise assessment of the risks factors of intrapartum and postpartum outcomes. Increasingly, there is the need for close collaboration between the midwife and medical staff to ensure proper personalized assistance based on the peculiar characteristics of the woman and the fetus.

Analysis of the Influence of Lunar Cycle on the Frequency of Spontaneous Deliveries: A Single-centre Retrospective Study.

BACKGROUND: Man, since ancient times, has been convinced of, and has researched scientific evidence that the barometric and gravitational forces play an important role in structural and biological variation of the planets, influencing the various forms of life. In particular, the synergistic relationships between variations in atmospheric pressure and gravitational forces on human gestation period have been the subject of rigorous observations and statistical calculations, which have not led to a universal conclusion in literature. OBJECTIVES: The aim of our work was to check whether there is a higher incidence of spontaneous deliveries, during the periods of full Moon than during the other phases of the Moon. METHODS: We performed a retrospective analysis of 327 non-induced vaginal deliveries in a year, divided by month. We subsequently analyzed the incidence of these deliveries during periods of full Moon Vs other lunar phases. RESULTS: We evidenced a statistically significant difference between the annual total spontaneous deliveries happened in full Moon periods Vs all other Moon phases (T= 2,3948; p=0,0256). However, we reported a discordant trend of deliveries in full Moon period, depending on each considered month. CONCLUSION: Since these differences were found both in increase and decrease, it is unacceptable the assumption of a linear correlation between periods of full Moon and increased frequency of spontaneous deliveries. For this reason, our data allow us to conclude that there is no need to increase the number of doctors and midwives in obstetric units during these periods.

Heterotopic pregnancy: case report.

Heterotopic pregnancy is the simultaneus development of an intrauterine pregnancy and ectopic pregnancy. It is a potentially fatal condition and rarely occurrs in natural conception cycles. A high incidence of heterotopic pregnancy is reported in pregnancies following an assisted reproduction technique (ART) with embryo transfer in utero. We report the case of heterotopic pregnancy via ART in a 42-year-old primigravida. She presented with pelvic pain and intraabdominal fluid collection. She was treated with laparoscopic surgery. At present the intrauterine pregnancy is in normal evolution.

Laparoscopic management of adnexal masses in postmenopause.

The study included 64 postmenopausal women with adnexal masses. The selection criteria included menopausal status, an ultrasound scan indicating a benign mass and serum levels of CA-125 below the cutoff (35 U/ml). The results of the study confirm that the removal of a cystic mass in postmenopausal patients with laparoscopic surgery is a more valid and acceptable alternative to traditional surgery.

Ovarian endometriotic cyst in a patient with Ellis-van Creveld's syndrome: case report.

Ellis-van Creveld (EvC) syndrome, or chondroectodermal dysplasia, is a rare genetic disorder associated with chondrodysplasia, ectodermal dysplasia, polydactyly, and congenital cardiac malformations. The disorder is due to an autosomal-recessive mutation mapped to chromosome 4p16. It may occur with different phenotypes. The case of an ovarian endometriotic cyst in a patient suffering from EvC syndrome is reported.

Early induction of labor with PGE2-intravaginal gel in premature rupture of membranes.

Results of induction of labor with PGE2-intravaginal gel in PROM, were evaluated considering the best management.

Voluminous ovarian cystoma in term pregnancy: case report.

Treatment of a large voluminous serous cystoadenofibroma during a cesarean section is described. The relative frequency of such pathology in pregnancy and the importance of early diagnosis are discussed.

Benefits of antibiotic prophylaxis in laparoscopic gynaecological surgery.

The prevention of infectious complications by antibiotic prophylaxis has made traditional or laparoscopic surgery much safer but at the same time has contributed to an uncontrolled and often irrational use of every kind of antibiotic. In this study we wanted to show that often mini-invasive surgery like laparoscopy can be practised without the use of antibiotics. Thus, postoperatively several patients undergoing laparoscopic, diagnostic and operative interventions were followed-up. The results showed that subjects without antibiotic therapy did not have any symptomatology that could be ascribed to bacterial infections. In conclusion this study has demonstrated that laparoscopic surgery, especially without any complications, should follow the elementary rules of surgical techniques and surgical asepsis and that antibiotic prophylaxis is not always necessary.