Conservative treatment for placenta accreta can help women avoid hysterectomy and involves a low rate of severe maternal morbidity in centers with adequate equipment and resources.

P erinatal asphyxia, a major cause of neonatal and childhood death and morbidity (eg, hypoxic ischemic encephalopathy, seizures, intraventricular hemorrhage, cerebral palsy, and delayed development), is predicted by fetal acidosis measured by umbilical cord pH at birth. The cord pH (about <7.00) and base deficit (about Z12 mmol/L) levels commonly used to judge risk, were derived by consensus, and the longterm implications of a low arterial cord pH are uncertain. Despite this, cord pH values are commonly used as an outcome measure in obstetric clinical trials, are a benchmark for judging obstetricians' clinical performance, and are used to support medicolegal claims of harm due to intrapartum events that might lead to long-term child disability. The authors of this systematic review and meta-analysis evaluated more closely the association between umbilical cord pH readings at birth and short-term and long-term childhood outcomes.Data were obtained from Medline, Embase, the Cochrane Library (2008 issue 8), and Medion, without language restrictions. Reference lists of selected articles were recorded, follow-up contact with authors was performed and review articles, the SIGLE, Web of Science, the national research register, and medical conferences register were all examined. Eligible studies were those (cohort, case-controlled, review) in which cord pH at birth was compared with any neonatal or long-term outcome. Criteria for inclusion also included a study population of >5 subjects in whom cord blood was obtained at birth, performance of an index test (cord blood examined for arterial or venous pH or base excess); a recording of outcomes (any measure of compromise of neonatal or childhood well-being); and inclusion of a study design that allowed generation of a 2 Â 2 table to compute estimates of associations between test results and outcomes. The primary outcome measures were neonatal mortality, an author created composite of neonatal morbidity, and cerebral palsy.A total of 51 primary articles (with 481,753 infants) were found, with widely variable design, quality, outcome definition, and results. Meta-analyses carried out within predefined groups from 43 studies showed that low arterial cord pH was significantly associated with neonatal mortality [odds ratio (OR), 16.9; 95% confidence interval (CI), 9.7-29.5]; hypoxic ischemic encephalopathy (OR, 13.8; 95% CI, 6.6-28.9); intraventricular hemorrhage or periventricular leukomalacia (OR, 2.9; 95% CI, 2.1-4.1); and cerebral palsy (OR, 2.3; 95% CI, 1.3-4.2). Longterm (1 to 8 y) adverse outcomes found in 15 studies included cerebral palsy, unspecified neurologic abnormalities, intelligent quotient (IQ) deficits, and developmental problems.

Successful conservative treatment for placenta accreta does not appear to compromise the patients' subsequent fertility or obstetrical outcome. Nevertheless, patients should be advised of the high risk that placenta accreta may recur during future pregnancies.

Maternal CD4 count is significantly and specifically associated with the risk of serious infections with encapsulated bacteria in HEU infants.

Total n = 18 patients Age (median (min-max)) 36 (30-45) Gravidity (median (min-max)) 2 (1-7) Parity (median (min-max)) 2 (1-3) Number of caesarean (median (min-max)) 2 (1-3)

No abstract

UAE for UAVM is an effective and safe technique. It does not impair fertility, and obstetric prognosis is good.

Epithelial ovarian cancer (EOC) usually spreads into the peritoneal cavity, thereby providing an opportunity for intraperitoneal adoptive immunotherapy with Vc9Vd2 T lymphocytes, a T cell subpopulation endowed with high lytic properties against tumor cells. However, previous studies have reported that Vc9Vd2 T cells fail to expand from peripheral blood mononuclear cells in one-third of patients with cancer. Here, from a cohort of 37 patients with EOC, a multiple correspondence analysis identified three populations, one of which was not suitable for Vc9Vd2 T-cell adoptive therapy. Interestingly, the ineligible patients were identified based on the frequency of Vc9Vd2 T cells in their peripheral blood and the patients' age. The average time to tumor recurrence was also found to be significantly different between the three populations, suggesting that the innate immune response is involved in EOC prognosis. A dramatic decrease in the lytic properties of Vc9Vd2 T cells occurred following incubation with ascitic supernatant and was found to be associated with reduced perforin/granzyme degranulation. Prostaglandin E2, but not IL-6, IL-10, VEGF or TGF-b, showed immunosuppressive effects in Vc9Vd2 T cells. Interestingly, our results emphasize that pretreating ovarian tumor cells with zoledronate partially reverses the immunosuppressive effects of ovarian cancer-associated ascites and restores a high level of lytic activity. These data sustain that optimal Vc9Vd2 T-cell adoptive immunotherapy previously requires counteracting the tumor immunosuppressive microenvironment. Altogether, our findings provide a rationale for clinically evaluating Vc9Vd2 T-cell adoptive immunotherapy with intraperitoneal carcinomatosis presensitization by zoledronate in patients with EOC.Epithelial ovarian cancer (EOC) is the fifth most frequent cancer among women and the fourth most common cause of cancer-related deaths among women.1 More than 70% of patients are diagnosed when the cancer has spread beyond the ovaries, and these patients have low median survival rates.2 The prognosis is poor, with a 5-year survival rate of only 30%, and the rate is less than 10% for patients with bulky residual disease remaining after surgery and chemotherapy, which emphasizes the need for innovative treatments.3 The inflammatory microenvironment of ovarian carcinomas prevents the maturation of myeloid cells, favors regulatory T-cell development and restrains the cytotoxic activity of effector T lymphocytes, leading to the escape of the tumor from the immune system. 4 Thus, research is ongoing to develop innovative approaches aimed at stimulating the immune system. 5 The preferential spread pattern of EOC in the peritoneal cavity offers an excellent opportunity for the regional administration of adoptive T-cell therapy.2 Some pilot trials have shown the feasibility of and promising