Treatment continuation and satisfaction in women using combined oral contraception with nomegestrol acetate and oestradiol: a multicentre, prospective cohort study (BOLERO).

OBJECTIVE: The aim of the study was to examine treatment continuation and satisfaction over 1 year among women receiving nomegestrol acetate (NOMAC)/oestradiol (E2) combined oral contraception (COC) in real-world clinical practice. METHODS: The 17ß-Estradiol and Nomegestrol Acetate (BOLERO) Study is an observational, non-interventional, prospective, multicentre cohort study of premenopausal women (aged 18-50 years) who received prescription NOMAC/E2 (2.5 mg/1.5 mg) for contraception during routine clinical practice. Assessments were carried out at enrolment and at 3, 6 and 12 months. Probability of treatment continuation through 12 months (primary outcome) was examined using Kaplan-Meier survival analysis. Secondary outcomes included treatment satisfaction, menstrual cycle-related symptoms, libido and adverse events (AEs). RESULTS: Of 298 enrolled women, 292 were evaluable. The probability of NOMAC/E2 continuation through 12 months was 73.7% (95% confidence interval [CI] 68.0%, 78.5%). Satisfaction with NOMAC/E2 increased from 56.9% (37/65) of women at initial evaluation to 89.2% (58/65) of women at 12 months. Physician ratings at 12 months showed satisfactory to very satisfactory in 84.0% (168/200) of women. Libido was not affected. Menstrual cycle-related symptoms significantly declined from enrolment (6.04 ± 4.32) to 3 months (3.25 ± 3.05) and 12 months (2.62 ± 2.74; p < .0001). Treatment-related AEs were reported by 38.7% (113/292) of women. CONCLUSION: The real-world experience of women receiving NOMAC/E2 indicated very good treatment continuation, high satisfaction and significantly improved menstrual cycle-related symptoms.

Does dienogest influence the inflammatory response of endometriotic cells? A systematic review.

OBJECTIVE AND DESIGN: A systematic review of all literature was done to assess the ability of the progestin dienogest (DNG) to influence the inflammatory response of endometriotic cells. MAIN OUTCOME MEASURES: In vitro and in vivo studies report an influence of DNG on the inflammatory response in eutopic or ectopic endometrial tissue (animal or human). RESULTS: After strict inclusion criteria were satisfied, 15 studies were identified that reported a DNG influence on the inflammatory response in endometrial tissue. These studies identified a modulation of prostaglandin (PG) production and metabolism (PGE2, PGE2 synthase, cyclo-oxygenase-2 and microsomal PGE synthase-1), pro-inflammatory cytokine and chemokine production [interleukin (IL)-1ß, IL-6, IL-8, tumor necrosis factor-α, monocyte chemoattractant protein-1 and stromal cell-derived factor-1], growth factor biosynthesis (vascular endothelial growth factor and nerve growth factor) and signaling kinases, responsible for the control of inflammation. Evidence supports a progesterone receptor-mediated inhibition of the inflammatory response in PR-expressing epithelial cells. It also indicated that DNG inhibited the inflammatory response in stromal cells, however, whether this was via a PR-mediated mechanism is not clear. CONCLUSIONS: DNG has a significant effect on the inflammatory microenvironment of endometriotic lesions that may contribute to its clinical efficacy. A better understanding of the specific anti-inflammatory activity of DNG and whether this contributes to its clinical efficacy can help develop treatments that focus on the inhibition of inflammation while minimizing hormonal modulation.

Intensity of menstrual pain and estimated angle of uterine flexion.

OBJECTIVE: To assess the impact of ultrasound-estimated uterus position on the intensity of pelvic pain. DESIGN: Descriptive analytical study. SETTING: Tertiary university gynecology unit. POPULATION: 181 consecutive patients with pelvic pain. METHODS: Each woman underwent physical examination, transvaginal sonography and filled self-administered questionnaires on pain using a 10-cm visual analog scale (VAS). MAIN OUTCOME MEASURES: Visual analog scale score of menstrual pain, intermenstrual pain and dyspareunia was related to uterine version (ante- or retroversion) and the angle of uterine flexion (actual angle between cervix and uterine body) evaluated by transvaginal sonography. RESULTS: Estimated uterine version was not associated with the intensity of any type of pain. The estimated angle of flexion was higher in retroverted than in anteverted uteri (182.3° ± 50.3° vs. 142.3° ± 24.2°, p < 0.0001). Intensity of menstrual pain was lowest with flexion between 150° and 210° (4.9 ± 3.1) (p = 0.002), intermediate with flexion <150° (6.3 ± 2.8) and highest with flexion ≥210° (7.9 ± 2.3). Severe menstrual pain was more prevalent with flexion ≥210° (77.7%) than between 150° and 210° (31.4%; p = 0.0008) or <150° (45.2%; p = 0.005). The intensity of intermenstrual pain and dyspareunia were not associated with the angle of flexion. In multiple regression analysis, the angle of flexion was independently related only to the intensity of menstrual pain (r = 0.272; p = 0.002). CONCLUSIONS: In women with pelvic pain, ultrasound-estimated uterine flexion represents an independent risk for intense menstrual pain.

Modification of body composition and metabolism during oral contraceptives containing non-androgenic progestins in association with estradiol or ethinyl estradiol.

AIM: To observe the influence on metabolism and body composition of two oral contraceptives containing non-androgenic progestins in association with estradiol or ethinyl estradiol (EE). STUDY DESIGN: Women on hormonal contraception with estradiol valerate (E2V)/dienogest (DNG) in a quadriphasic regimen (n = 16) or 30 µg EE/2 mg chlormadinone acetate (CMA) (n = 16) in a monophasic regimen were evaluated at the third cycle for modifications in lipoproteins, apoproteins and homeostatic model assessment for insulin resistance (HOMA-IR), and at the sixth cycle for body composition and the markers of bone turnover osteocalcin and C-telopeptide X. RESULTS: During E2V/DNG lipoprotein, apoproteins and HOMA-IR remained stable. During EE/CMA, total-cholesterol (p = 0.003), high-density lipoprotein (HDL)-cholesterol (p = 0.001), triglycerides (p = 0.003) Apoprotein-A1 (Apo-A1; p = 0.001) and Apo B (p = 0.04) increased, low-density lipoprotein/HDL (p = 0.039) decreased and total-cholesterol/HDL and Apoprotein-B/Apo-A1 ratio did not vary. HOMA-IR slightly increased from 1.33 ± 0.87 to 1.95 ± 0.88 (p = 0.005). There was a reduction of markers of bone metabolism in both groups with no modification of body composition. CONCLUSIONS: Administration of E2V/DNG does not influence lipid and glucose metabolism, while mixed effect are exerted by EE/CMA. Both preparations reduce bone metabolism without influencing short-term effect on body composition.

Reference values in ovarian response to controlled ovarian stimulation throughout the reproductive period.

Abstract The age-related decline in ovarian response to gonadotropins has been well known since the beginning of ovarian stimulation in IVF cycles and has been considered secondary to the age-related decline in ovarian reserve. The objective of this study was to establish reference values and to construct nomograms of ovarian response for any specific age to gonadotropins in IVF/ICSI cycles. We analyzed our database containing information on IVF cycles. According to inclusion and exclusion criteria, a total of 703 patients were selected. Among inclusion criteria, there were regular menstrual cycle, treatment with a long GnRH agonist protocol and starting follicle-stimulating hormone (FSH) dose of at least 200 IU per day. To estimate the reference values of ovarian response, the CG-LMS method was used. A linear decline in the parameters of ovarian response with age was observed: the median number of oocytes decreases approximately by one every three years, and the median number of follicles >16 mm by one every eight years. The number of oocytes and growing follicles corresponding to the 5th, 25th, 50th, 75th and 95th centiles has been calculated. This study confirmed the well known negative relationship between ovarian response to FSH and female ageing and permitted the construction of nomograms of ovarian response.

Age-specific reference values for serum FSH and estradiol levels throughout the reproductive period.

High serum day 3 FSH levels are associated with poor ovarian reserve and reduced fertility, but the interpretation of FSH values according to age is still not univocal. The purpose of this study was to determine age-dependent reference values in women with regular menstrual cycles and FSH as a guide for specialists. The study was performed at the Department of Mother-Infant of a University-based tertiary care centre. One-hundred ninety-two healthy normal menstruating women were recruited for the study. All patients attended the department on menstrual cycle day 3 for a blood sample for FSH and estradiol determination. A linear relationship between FSH or estradiol serum levels and age was observed. The FSH level increased by 0.11 IU for every year of age (1 IU for every 9 years of age). The values of FSH and estradiol corresponding to the 5th, 25th, 50th, 75th, 95th centiles for any specific age have been calculated. Serum FSH levels need to be interpreted according to age-dependent reference values. Serum FSH levels on 95th centile for any age may represent a warning sign for reduced ovarian reserve.

Multinational, multicentre, randomised, open-label study evaluating the impact of a 91-day extended regimen combined oral contraceptive, compared with two 28-day traditional combined oral contraceptives, on haemostatic parameters in healthy women.

OBJECTIVES: To evaluate the impact of a 91-day extended regimen combined oral contraceptive (150 µg levonorgestrel [LNG]/30 µg ethinylestradiol [EE] for 84 days, followed by 10 µg EE for seven days [Treatment 1]) compared with two traditional 21/7 regimens (21 days 150 µg LNG/30 µg EE [Treatment 2] or 150 µg desogestrel [DSG]/30 µg EE [Treatment 3], both with seven days' hormone free), on several coagulation factors and thrombin formation markers. METHODS: Randomised, open-label, parallel-group comparative study involving healthy women (18-40 years). The primary endpoint was change from baseline in prothrombin fragment 1 + 2 (F1 + 2) levels over six months. RESULTS: A total of 187 subjects were included in the primary analysis. In all groups, mean F1 + 2 values were elevated after six months of treatment. Changes were comparable between Treatments 1 and 2 (least squares mean change: 170 pmol/L and 158 pmol/L, respectively) but noticeably larger after Treatment 3 (least squares mean change: 592 pmol/L). The haemostatic effects of Treatment 1 were comparable to those of Treatment 2 and noninferior to those of Treatment 3 (lower limit of 95% confidence interval [- 18.3 pmol/L] > - 130 pmol/L). CONCLUSIONS: The LNG/EE regimens had similar effects on F1 + 2. Noninferiority was demonstrated between extended regimen LNG/EE and DSG/EE.

Intermenstrual pelvic pain, quality of life and mood.

BACKGROUND/AIMS: To investigate the independent importance of different types of pelvic pain on quality of life and depressive symptoms. METHODS: A cross-sectional study was performed on patients with pelvic pain. A 10-cm visual-analogue scale (VAS) was used to investigate intensity of intermenstrual pelvic pain, dysmenorrhea or deep dyspareunia. The SF-36 form and the Zung Self-Rating Scale for Depression (SDS) were used to investigate quality of life and depressive symptoms, respectively. RESULTS: The final study group consisted of 248 patients, 175/248 (70.6%) with intermenstrual pelvic pain, 46/248 (18.5%) with dysmenorrhea and 27/248 (10.9%) with deep dyspareunia associated or not with dysmenorrhea. Mean VAS score for dysmenorrhea was higher than that for deep dyspareunia (p < 0.003) and intermenstrual pelvic pain (p < 0.0001). Women with intermenstrual pelvic pain had the worst SF-36 (p < 0.0001) and SDS (p < 0.002) scores. SF-36 was independently and inversely related to intermenstrual pelvic pain (CR -1.522; 95% CI -2.188 to -0.856; p < 0.0001), and less strongly to dysmenorrhea (CR -0.729; 95% CI -1.487 to 0.030; p = 0.06). Indeed, only the physical component summary of SF-36 was independently related to dysmenorrhea (CR -0.956; 95% CI -1.783 to -0.129; p = 0.024). The SDS score was independently related only to intermenstrual pelvic pain (CR 0.573; 95% CI 0.241-0.904; p = 0.0008). CONCLUSIONS: Patients with intermenstrual pelvic pain have the worst SF-36 and SDS scores. Intermenstrual pelvic pain seems to be more strongly associated with a reduced quality of life and depressive mood.

Nitric Oxide concentration in endometrial washing throughout the menstrual cycle.

PURPOSE: Nitric oxide (NO) intrauterine production has been shown to have an important role in the reproductive system in females. The objective of the present study was to evaluate NO concentration in endometrial washing throughout the menstrual cycle. METHODS: Observational study at Institute of Obstetrics and Gynecology, Mother-Infant Department, University Hospital. The study included 40 healthy fertile women, aged 21-40, with regular menstrual cycle, undergoing endometrial washing by hydrosonography for the assessment of NO concentration. RESULTS: Nitric oxide concentration in endometrial washing were low in early to mid proliferative phase (4.73 ± 1.57 mcM/L), but significantly higher (p < 0.05) in late proliferative phase (7.30 ± 3.37 mcM/L) early secretory phase (8.05 ± 1.97 mcM/L) and late secretory phase (8.69 ± 4.12 mcM/L) of menstrual cycle. CONCLUSIONS: Endometrial washing by hydrosonography is a simple, minimally invasive, and effective tool to use in the evaluation of cyclical NO intrauterine production. Nitric oxide concentrations increased during the late proliferative and secretory phase of menstrual cycle.

Primary ovarian insufficiency: autoimmune causes.

PURPOSE OF REVIEW: To review the pathogenesis of premature ovarian insufficiency due to steroid cell autoimmunity (SCA-POI). RECENT FINDINGS: Autoimmune oophoritis is characterized by a selective mononuclear cell infiltration into the theca layer of large, antral follicles, with earlier stage follicles consistently free of lymphocytic infiltration. SCA-POI is caused by the selective autoimmune destruction of theca cells with preservation of granulosa cells that produce low amounts of estradiol because of lack of substrates. Typically, serum concentrations of inhibins are increased in women with SCA-POI, as compared to both healthy fertile women and women with other forms of ovarian insufficiency. Normal serum antimüllerian hormone (AMH) concentrations were detected in two-thirds of women with recently diagnosed SCA-POI, which demonstrates that this form of ovarian insufficiency is associated with a preserved pool of functioning follicles. SUMMARY: The combined measurement of autoantibodies and markers of ovarian reserve (as inhibin B and AMH) may permit to identify women with POI due to steroid cell autoimmunity with a preserved proportion of primordial and primary follicles. In the future the development of techniques of in-vitro folliculogenesis may permit new treatment strategies for women with SCA-POI-related infertility.

Hemoperitoneum in pregnancy from a ruptured varix of broad ligament.

We present a case of a 31-year-old woman, gravida 4 para 1, pregnant at 33 + 2 weeks of gestational age with acute abdomen due to hemoperitoneum. Hemoperitoneum was suspected for non-specific symptoms such as acute abdominal pain, vomit, cardiotocography alterations and maternal acute anaemia. An emergency caesarean section was performed; 3 L of blood was present in abdomen. Careful exploration of the uterus, placenta, abdominal organs and vessels was negative; only a bleeding from a rupture in a varix of the left broad ligament was observed. Hemoperitoneum due to a ruptured uterine varix in pregnancy is a rare condition. The solution to prevent the development of maternal hypovolemic shock is an immediate surgical intervention. A good foetal prognosis principally depends from gestational age and from good hemodynamic maternal conditions.

Vitrification versus controlled-rate freezing in cryopreservation of human ovarian tissue.

BACKGROUND: Controlled-rate freezing of ovarian cortical tissue for preservation of fertility among young women facing chemo- or radio-therapy is a widely accepted procedure. To improve the method for cryopreservation of ovarian tissue, particularly the stroma, we carried out a systematic comparison of vitrification versus slow programmed freezing. METHODS: Ovarian tissue from 20 women, donated during Caesarean section, was used for parallel comparison of survival and detailed light and electron microscopic (EM) morphology of oocytes, granulosa cells and ovarian stroma after freezing (slow freezing and vitrification), thawing and 24-h culture. Using tissue obtained from the same patient, we compared four cryopreservation protocols and fresh tissue. The cryoprotectants used in slow freezing were 1,2-propanediol (PrOH)-sucrose and ethylene glycol (EG)-sucrose. For vitrification, tissues were incubated for 5 or 10 min in three solutions containing a combination of dimethyl sulphoxide (DMSO), PrOH, EG and polyvinylpyrrolidone (PVP). RESULTS: Cryopreservation using controlled-rate freezing and vitrification preserved the morphological characteristics of ovarian tissue generally well. As revealed by morphological analysis, particularly EM, the ovarian stroma was significantly better preserved after vitrification than after slow freezing (P < 0.001). The follicles were similarly preserved after all freezing methods. CONCLUSIONS: Vitrification using a combination of PrOH, EG, DMSO and PVP was comparable to slow freezing in terms of preserving follicles in human ovarian tissue. Ovarian stroma had significantly better morphological integrity after vitrification than after controlled-rate freezing.

Seminal plasma total antioxidant capacity and semen parameters in patients with varicocele.

Total antioxidant capacity (TAC) was evaluated in the seminal plasma of infertile patients with varicocele in relation to their semen parameters. The study recruited 60 patients affected by varicocele and 10 fertile non-varicocele subjects as controls. Controls had normal semen parameters and proven fertility. On the basis of semen parameters, patients with varicocele were grouped into normozoospermic (n = 12), asthenozoospermic (n = 8), oligoasthenozoospermic (n = 40). The group with oligosthenozoospermia was divided into mild (<20 x 10(6)/ml; > or =15 x 10(6)/ml), moderate (<15 x 10(6)/ml; > or =5 x 10(6)/ml), and severe (<5 x 10(6)/ml), based on sperm count. Antioxidant activity was measured in seminal plasma and peripheral blood using the free oxygen radicals defence test. No significant differences were observed in peripheral blood TAC concentrations between controls and groups. In patients with varicocele and moderate oligoasthenozoospermia or severe oligoasthenozoospermia, seminal plasma TAC concentrations were significantly lower (P < 0.05) than in controls and normozoospermic patients with varicocele. Moreover, in patients with severe oligosthenozoospermia, seminal plasma TAC concentrations were also significantly lower (P < 0.05) than in asthenozoozpermic patients with varicocele. In all subjects, concentrations of TAC showed a positive correlation with sperm concentration (r = 0.93, P < 0.05) and motility (r = 0.92, P < 0.05).

Computerized evaluation of fetal heart rate during tocolytic treatment: comparison between atosiban and ritodrine.

We compared the effects of ritodrine and atosiban treatments on fetal cardiovascular behavior by computerized nonstress test (c-NST) analysis. Women diagnosed with preterm labor were randomized to receive either atosiban or ritodrine. A c-NST was performed at least 12 hours after the last corticosteroid administration. Differences in fetal cardiovascular behavior were evident when treatment was given before 30 weeks' gestation. Ritodrine induced higher fetal heart rates, lower long-term variation values, and lower low:high-frequency ratios compared with atosiban. Atosiban induced higher gestational ages at delivery and higher birth weights than ritodrine. The mean Apgar scores were similar for atosiban and ritodrine groups at 1 and 5 minutes. No 5-minute Apgar score was < 7. With respect with atosiban, ritodrine treatment induces tachycardia and a lower variability of fetal heart rate. Such changes could be erroneously interpreted as signal of fetal distress, namely at lower gestational age.

Relation of folates, vitamin B12 and homocysteine to vertebral bone mineral density change in postmenopausal women. A five-year longitudinal evaluation.

Elevation of homocysteine is associated with an increased risk for bone fractures. Whether the risk is due to homocysteine or to the reduced levels of cofactors necessary for its metabolisation, such as folates or vitamin B12, is not completely clear. In this study we wanted to determine whether in postmenopausal women, levels of folates, homocysteine or vitamin B12 are predictive of the rate of vertebral bone mineral density (BMD) change. The study was conducted at the centre for the menopause of our university hospital. Between September 2001 and March 2002, 161 healthy postmenopausal women volunteered for a cross-sectional evaluation of BMD and levels of serum folates, homocysteine and vitamin B12. Women were recalled for a second evaluation of vertebral BMD after about 5 years. Women having used anti-resorptive therapies for more than 1 year were excluded. The analysis was possible in 117 postmenopausal women. The annual rate of vertebral BMD change was independently related to levels of folates (coefficient of regression (CR): 2.040; 95%CI: 0.483, 3.596; p=0.011), and initial BMD values (CR: -0.060; 95%CI: -0.117, -0.003; p=0.040). No significant relation was found between the change of vertebral BMD and homocysteine or vitamin B12. BMD values at the first (r=0.225; p=0.016) and the second (r=0.206; p=0.027) evaluation were related to levels of folates, but not of homocysteine or of vitamin B12. These data suggest an important role for folates deficiency in the vertebral BMD decline of postmenopausal women.

Levonorgestrel administration in emergency contraception: bleeding pattern and pituitary-ovarian function.

BACKGROUND: This study was conducted to evaluate the effects of levonorgestrel administration for emergency contraception (EC) on bleeding pattern and pituitary-ovarian function. STUDY DESIGN: In 69 women with a reported stable menstrual cycle length of 24-34 days, we investigated bleeding patterns following EC administration in the follicular (n=26), periovulatory (n=14) and luteal (n=29) phase. In a subgroup of 8 women, hormonal evaluation and ultrasonography were performed. RESULTS: EC taken in the follicular, but not in the periovulatory or luteal phase, significantly shortened cycle length by 10.9+/-1 days. The subsequent cycle was not affected. EC taken in the late preovulatory phase, prior to the gonadotrophin surge, suppressed ovulation (n=7), while ovulation was not blocked when EC was given during an ongoing luteinizing hormone (LH) pulse (n=1). CONCLUSIONS: Our data indicate that EC given before the onset of the luteinizing hormone (LH) surge inhibits ovulation and hastens the end of the current menstrual cycle. Subsequently, the length of the following menstrual cycle returned as prior to treatment. By contrast, levonorgestrel administered after the expected ovulation has no effect on menstrual cycle length.

17alpha-hydroxy-progesterone effects on cervical proinflammatory agents in women at risk for preterm delivery.

We evaluated if the inhibitory effect of 17alpha-hydroxyprogesterone caproate (17P) on cervical ripening is mediated by cervical proinflammatory agents. Women with singleton pregnancy and intact membranes, between 25 and 33 weeks + 6 days, were randomly allocated either to observation (22 cases, controls) or to receive 341 mg of intramuscular 17P (23 cases, 17P group), twice a week, until 36 weeks. Just before randomization, 7 and 21 days later, a cervical swab for interleukin (IL)-1beta, IL-6, IL-8, tumor necrosis factor alpha (TNF-alpha), and nitrates/nitrites (NOx) assays was collected. Moreover, an ultrasound measure of cervical length (CL) was performed at the same time. At randomization, both groups of women showed similar levels of cervical ILs and NOx. In the 17P group, cervical IL-1beta levels were significantly decreased at day 21 ( P = 0.036); in controls, they remained stable throughout the observation period. There was no significant change in IL-6, IL-8, TNF-alpha, and NOx in either group. Women in the control group had a progressive CL shortening until day 21 (median shortening of 4 mm), and this shortening was significantly less in the 17P group (median shortening of 2 mm; P = 0.017). In patients at risk of preterm labor, high-dose 17P simultaneously inhibits both cervical proinflammatory IL-1beta secretion and the progressive shortening of the cervix.

Menopause and hormone replacement therapy: the 2017 Recommendations of the Italian Menopause Society.

Over the last decade, the risk benefits ratio of hormone replacement therapy (HRT) has been reevaluated mainly in tens of cardiovascular risk. Present Consensus Statement is largely inspired by the Global Consensus on Menopausal Hormone Therapy in 2013 and 2016 by leading global menopause societies (The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society). The aim of these recommendations is to provide a simple and updated reference on postmenopausal HRT. The term HRT typically includes estrogen replacement therapy (ERT) and estrogen-progestogen therapy (EPT). EPT can be sequential, when progestogen is added to ERT for 10-14 days a month, or continuous combined when progestogen is administered continuously every day along with a fixed amount of estrogen, In the everyday language, HRT includes also tibolone and the tissue-selective estrogen complex.

Cervical length changes during preterm cervical ripening: effects of 17-alpha-hydroxyprogesterone caproate.

OBJECTIVE: The purpose of this study was to evaluate whether 17-alpha-hydroxyprogesterone caproate (17P) treatment affect changes in cervical length. STUDY DESIGN: Women with singleton pregnancy, between 25 and 33 + 6 weeks of gestation, who were hospitalized for preterm labor were included. Patients with rupture of membranes and/or signs of chorioamnionitis were excluded. Sixty undelivered patients were allocated randomly to either observation or to receive 341 mg of 17P intramuscularly, twice each week until gestational week 36. Cervical length was measured by transvaginal ultrasound scanning at discharge and at day 7 and 21 after discharge. Statistical comparisons were done with analysis of variance and chi-square test. RESULTS: Shortening of the cervix in the observation group (30 cases) was higher than in the 17P group (30 cases) both at day 7 (2.37 +/- 2.0 mm vs 0.83 +/- 1.74 mm; P = .002) and day 21 (4.60 +/- 2.73 mm vs 2.40 +/- 2.46 mm; P = .002). Treatment with 17P was associated with both a reduction in the risk of cervical shortening of > or = 4 mm (odds ratio, 0.18; 95% CI, 0.04-0.66) and in the risk of preterm delivery (odds ratio, 0.15; 95% CI, 0.04-0.58). CONCLUSION: Undelivered patients after preterm labor undergo progressive shortening of the cervix, which is attenuated by 17P treatment.

Psychosocial factors associated with preterm uterine contractions.

BACKGROUND: The aim of our study was to evaluate how sociodemographic factors, psychosocial adaptation to pregnancy and well-being levels are associated with the onset of preterm uterine contractions allowing symptomatic preterm labor. METHODS: In a prospective case-control design, 51 consecutive women admitted for threatened preterm labor were enrolled. The patients received standard care. The day before discharge, once contractions had been stopped, the patients were administered 2 questionnaires: the Prenatal Self-Evaluation Questionnaire of Lederman and the Psychological Well-Being Scales. Controls were enrolled among asymptomatic, healthy women attending routine prenatal care. They were matched for parity and gestational age. RESULTS: Gestational age at inclusion ranged from 25 to 34 weeks. Fourteen cases and 4 controls delivered preterm. Cases were less educated than controls, showed a lower acceptance of pregnancy and worse relationship with others, namely with the husband, compared to controls. They also displayed a reduced environmental mastery. CONCLUSION: Having a low education, poor relationship with others, including the husband, and impaired coping skills appeared to be independent risk factors for the development of symptomatic preterm labor in urbanized women.