The nerve-sparing approach is effective in eradicating DIE of the posterior compartment, with satisfactory pain control, significant improvement of sexual function, and preservation of bladder and rectal function.

Aim: To compare the recurrence of benign endometrial polyps after office hysteroscopic polypectomy performed with a bipolar electrode (BE) or a small diameter hysteroscopic tissue removal system (HTRs). Methods: From July 2018 to December 2019 we evaluated the charts of 114 asymptomatic fertile women who underwent office hysteroscopic polypectomy, 1 year before, for a single large benign endometrial polyp (size between 10 and 20 mm) using a 4 mm continuous flow hysteroscope with a BE or a 5 mm HTRs. Patients, divided into two groups according to surgical procedure, each performed exclusively by one expert gynecologist, were scheduled for a 12-month postoperative transvaginal sonography to evaluate the recurrence of endometrial polyps. Results: Forty-eight women of the BE group and 42 of the HTRs group were considered for the 1-year transvaginal sonography follow-up. Five polyps were identified in the BE group and three in the HTRs group (5/48 vs 3/42, P = n.s.). All polyps were removed hysteroscopically (in three out of five and in two out of three cases, respectively, in the same places of the previous polypectomy) and evaluated as 'benign' by the pathologist. Conclusion: Office hysteroscopic endometrial polypectomy with small HTRs compared to BE revealed at a 1-year follow-up no difference in terms of complete removal and recurrence of polyps. HTRs polypectomy resulted in less pain and significantly quicker time of procedure compared to BE. This data should be kept in mind for patient comfort any time hysteroscopic polypectomy is planned in an office setting.

ObjectiveTo assess the efficacy and safety of vaginal misoprostol after a pretreatment with vaginal estradiol to facilitate the hysteroscopic surgery in postmenopausal women.MethodsIn this observational comparative study, 35 control women (group A) did not receive any pharmacological treatment,26 women (group B) received 25 µg of vaginal estradiol daily for 14 days and 400 µg of vaginal misoprostol 12 hours before hysteroscopic surgery, 32 women (group C) received 400 µg of vaginal misoprostol 12 hours before surgery.ResultsDemographic data were well balanced and all variables were not significantly different among the three groups. The study showed a significant difference in the preoperative cervical dilatation among the group B (7.09±1.87 mm), the group A (5.82±1.85 mm; B vs. A, P=0.040) and the group C (5.46±2.07 mm; B vs. C, P=0.007). The dilatation was very easy in 73% of women in group B. The pain scoring post surgery was lower in the group B (B vs. A, P=0.001; B vs. C, P=0.077). In a small subgroup of women with suspected cervical stenosis, there were no statistically significant differences among the three groups considered. No complications during and post hysteroscopy were observed.ConclusionIn postmenopausal women the pretreatment with oestrogen appears to have a crucial role in allowing the effect of misoprostol on cervical ripening. The combination of vaginal estradiol and vaginal misoprostol presents minor side effects and has proved to be effective in obtaining satisfying cervical dilatation thus significantly reducing discomfort for the patient.

Background. Anteversion of the uterus is essential for the abdominal pregnant uterus growth and for the uterine contraction during labor and post-partum period. The role of the round ligaments is not yet completely understood, but certainly do have a coherent synergistic role with that of the neo-myometrium. The uterine contraction depends not only by the uterine muscle fibers, but also by the integrated pelvic myofascial system, connecting the uterine body to the round ligaments, to the ileo-psoas muscles and to the abdominal wall. In view of these functional anatomy reflections, it is possible to understand the procedures used in our management of postpartum hemorrhage and in our study. Materials and methods. We have a retrospective observational study of a population of 5927 women who delivered by Cesarean Section or vaginal labor between 2014 and 2018, after the 34th gestational week. Of these, 173 women with risk factors for postpartum hemorrhage (PPH) or with mild PPH were treated with a non-invasive method consisting of an abdominal band for uterine compression/anteversion, in combination with standard drug or surgical therapy. Results. We had only one peripartum hysterectomy on 5927 birth 0.016/1000 (Italy-ItOSS 1.08/1000, Regno Unit UKOSS-NethOSS-Nord Europa NOSS 0.3-0.4/1000). Five women received 4 or more blood transfusions on 5927 delivers (0.85/1000). Conclusions. The non-invasive uterine compression technique reduced the incidence of PPH in high-risk women and prevented maternal morbidity and mortality. SOMMARIOBackground. L'antiversione uterina è essenziale per l'espansione dell'utero gravidico nell'addome e per le contrazioni durante il travaglio e nel post-partum. Il ruolo dei legamenti rotondi non è ancora del tutto compreso, ma sicuramente ha un ruolo coerente e sinergico con quello del neo-miometrio. La contrazione uterina dipende non solo dalle fibre muscolari uterine, ma dal sistema integrato miofasciale pelvico, che collega il corpo uterino ai legamenti rotondi, ai muscoli ileo-psoas e ai muscoli della parete addominale. In considerazione di queste riflessioni anatomico-funzionali, è possibile comprendere le procedure che abbiamo utilizzato nella gestione dell'emorragia postpartum e nel nostro studio. Materiali e metodi. Si tratta di uno studio retrospettivo osservazionale su una popolazione di 5927 donne che hanno partorito con taglio cesareo o per via vaginale in un periodo compreso tra il 2014 e il 2018, dopo la 34esima settimana gestazionale. Di queste, 173 donne con fattori di rischio per emorragia postpartum (EPP) o con lieve EPP sono state trattate con un metodo non invasivo costituito da una fascia addominale per la compressione/antiversione uterina, in combinazione con farmaci standard o terapia chirurgica. Risultati. Abbiamo avuto solo un'isterectomia peripartum su 5927 nascite. 0.016/1000 (Italia-ItOSS 1,08/1000, Unità Regno UKOSS-NethOSS-Nord Europa NOSS 0,3-0,4/1000). Cinque donne hanno ricevuto 4 o più trasfusioni di sangue su 5927 parti (0,85/1000). Conclusioni. La tecnica di...

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