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Ovarian stimulation is an important step in the success rate of in vitro fertilization (IVF) allowing multiple follicular growth, several oocytes and consequently more embryos. The combination of GnRH-antagonists (GnRH-ant) and gonadotrophins is now available for clinical use and represent a valid alternative to classical protocol with GnRH agonist. GnRH-antagonists induce a direct block of GnRH receptor with a rapid decrease in LH and FSH, preventing LH surge. Two protocols has been designed for assisted reproduction technology (ART) treatment: multiple-dose protocol and a single-dose. Both protocols are simply, efficacious, started in the late follicular phase and do not have side effects. A review of GnRH-antagonist applications in ART cycles are presented. Smaller doses of gonadotrophins, shorter stimulation period and lower ovarian hyperstimulation syndrome (OHSS) incidence are reported in literature using GnRH-antagonist compared to agonist. Triggering of ovulation, the use in polycystic ovarian syndrome (PCOS) and poor reponders patients are other interesting indication. Regarding to pregnancy rate and potentially adverse effects of drugs on endometrium or implantation needed more data.

Analysis of the fetus should start with the assessment of lactates and acid-base balance. The method which revolutionized the techniques of foetal monitoring is undoubtedly represented by cardiotocography. However, likely most of neurological outcomes are not correlated with a perinatal event or with peripartum asphyxia. Approximately 10% of cases of CP would actually be due to perinatal asphyxia, and this percentage approaches approximately to 15% if we consider only newborns at term. This again confirms the weak association of a causal relationship between asphyxia and CP. In addition, available foetal suffering markers are vague and allow to identify only less than half of the effective cases of newborns which will develop CP.

With the term "oncological screening", we define the overall performances made to detect early onset of tumors. These tests are conducted on a population that does not have any signs or symptoms related to a neoplasm. The whole population above a certain age, only one sex, only subjects with a high risk of developing cancer due to genetic, professional, discretionary reasons may be involved. Screening campaigns should be associated, when risk factors that can be avoided are known, with campaigns for the prevention of cancer by means of suitable behavior. The goal of cancer screening cannot however be limited to the diagnosis of a greater number of neoplasms. Screening will be useful only if it leads to a reduction in overall mortality or at least in mortality related to the tumor. Screening should then allow the diagnosis of the disease at a stage when there is a possibility of healing, possibility that is instead difficult when the disease is diagnosed at the appearance of signs or symptoms. This is the reason why not all campaigns of cancer screening have the same effectiveness. In Italy, every year there are about 150000 deaths due to cancer. Some of these tumors can be cured with a very high percentage of success if diagnosed in time. Cervical cancer can be diagnosed with non-invasive tests. The screening test used all over the world is Papanicolaou (Pap) test. This test may be carried out over the entire healthy population potentially exposed to the risk of contracting cancer. Public health has begun the screening campaigns in the hope of saving many of the approximately 270000 new cases of cancer reported each year. Screening is done following protocols that guarantee quality at the national level: these protocols are subject to change over time to reflect new realities or to correct any errors in the system. A simplified sketch of a possible route of cancer screening is as follows: (1) after selecting the target population, for example all women between 25 and 64 years (in the case of monitoring of cervical cancer), an invitation letter with the date and time of the appointment, planned according to the acceptance capacity of the hospital, is sent to all individuals; (2) an examination, which depending on the individual and the type of cancer to be monitored, for example, can be a Pap smear, is performed and the patient can go home; (3) once available the results of examinations, if negative, they shall be communicated to the person concerned that will be notified by mail and will be recalled for a second test at a few years of distance, in the case of non-negativity, instead, the patient is contacted by telephone and informed of the need to carry out further examinations: it is said that the patient is in the "phase two" of the screening pathway; (4) in phase two, reached by only a small portion of the interested parties (usually less than 3%-5%), more in-depth tests are carried out, which, depending on the individual and the type of cancer, can be: cytological and colposcopic examinations, the removal of...

The migrant population of Prato Province has decreased adherence with cervical cancer screening.

Oligohydramnios occurs in about 2.3% of pregnancies and is threatening to fetal health. Hydration has been hypothesized to be an effective way of decreasing the occurrence of the condition because the likelihood for oligohydramnios increases with maternal dehydration. Several studies have shown that both serum and oral hydration therapies are effective treatments for oligohydramnios. The amniotic fluid index (AFI) is the most commonly used quantitative indicator of amniotic fluid volume. This randomized controlled clinical trial evaluated the efficacy of acute maternal hydration on increasing AFI in 44 pregnant Iranian women who were diagnosed by sonography to have oligohydramnios (defined as 2.1 Ͻ AFI Ͻ 6 cm). The participants were randomly divided into 2 groups: an intervention group (n ϭ 22) receiving oral hydration (2 liters of water within 2 hours) and a control group (n ϭ 22) receiving routine amounts of water. AFI and urinary specific gravity were measured in both groups at baseline and following intervention.Before treatment, the mean AFI was 50.8 in the intervention group and 52.1 in the control group. After treatment, the mean AFI increased to 67.2 in the intervention group whereas the AFI in the control group (52.5) remained close to the baseline value (P Ͻ 0.001, t test ϭ 3.827). There was a marked increase in the mean urinary specific gravity after treatment (intervention: 13.4 vs. control: 1.68) (P Ͻ 0.001, t test ϭ 3.956).These findings are consistent with previous studies showing that acute oral hydration is an effective, noninvasive, easily accessible and inexpensive treatment to increase AFI. OBSTETRICS Volume 65, Number 3 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTActive management of the third stage of labor (AMTSL) is more effective in reducing postpartum hemorrhage than expectant management. Widespread implementation of AMTSL in remote and rural areas, however, is hampered by the lack of availability of an efficacious, easily administered, safe, and storable oxytocic. Two parenterally administered oxytocics, methyl ergometrine, and oxytocin, have a number of drawbacks in addition to their routes of administration. Methylergometrine is associated with the occurrence of life-threatening complications, and oxytocin requires careful handling and storage due to thermal-and photolability. In previous studies, a synthetic prostaglandin E1 analog, misoprostol has shown promise as an effective oxytocic agent. This agent is affordable, stable at room temperature, has a long-shelf, and can be administered orally or by other routes.This double-blind randomized trial compared the effectiveness of sublingual misoprostol with that of intravenous oxytocin, and intravenous methylergometrine in reducing blood loss during the third and fourth stages of labor. A total ABSTRACTThe major cause of immune hemolytic disease of the newborn (HDN) in developed countries is ABO incompatibility. HDN due to ABO incompatibility is considered a high risk condition because it leads to early onset hyperbilirubinemia, due to...

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SummaryBetween January 1996 and December 2001, at the Department of Gynecology, Perinatology and Human Reproduction of the University of Florence, 49 ectopic pregnancies were submitted to medical treatment. The treatment schedule consisted of the administration of 100 mg of intravenous methotrexate (MTX). The patients included in this study fulfilled the following requisites: gestational period <8 weeks; diameter of the ectopic gestational sac <4 cm; serum level of human chorionic beta-gonadotropin (β-hCG)<5000 IU/ml; absence of clinical and ultrasound signs of tube rupture with initial hemoperitoneum; hematochemical tests compatible with chemotherapic treatment.All patients were followed with a dosage of serum β-hCG repeated every 2-3 days after chemotherapy and with an ultrasound every 3-4 days. In case of documented success of treatment the patient was hospitalized for no more than 3 days after administration of the drug. In 1 case therapy took place in a day-hospital regimen.Medical treatment was effective in 35 patients out of 49 (71.4%) and led to negative β-hCG in a median time of 11 days, with a range between 2 and 48 days. In the 14 non-responsive cases (28.6%), after a mean time of 6 days we proceeded to a traditional surgical approach or laparoscopy. In none of the cases did we find significant pharmacological toxicity, while in 9 patients (18.3%), severe painful symptoms appeared immediately after treatment, but resolved within 24 hours.Our results are interesting and in agreement with other experiences found in the literature. In our opinion, the advisability of a second administration in case of slow response, the comparison with an analogous intramuscular treatment, a more precise definition of the eligibility criteria, long-term follow-up of the patients, especially in case of subsequent pregnancies should all be further considered.