Is an episiotomy always necessary during an operative vaginal delivery with vacuum? A longitudinal study

Objective: The use of episiotomy during operative vaginal birth (OVB) is rather debated among operators and in literature. It is also important to evaluate the indications for which episiotomy is performed. In fact, the consequences of an episiotomy can be invalidating for patients with long-lasting results. The aim of this study is the evaluation of the role of episiotomy during OVB with the vacuum extractor and its correlation with Obstetric Anal Sphincter Injuries (OASIs).Methods: On of 9165 vaginal births, a total of 498 OVB (5.4%) were enrolled in a longitudinal prospective observational study. The incidence of OASIs was evaluated in our population after OVB performed with the vacuum extractor, during which the execution of episiotomy was performed indicated by clinician in charge.Results: OASIs occurred in 4% of the patients (n = 20). Episiotomy was performed in 39% of them (n = 181). OASIs incidence was 6% (n = 17) in the No Episiotomy and 1.8% (n = 3) in Episiotomy group (p<.001). Performance of episiotomy during OVB determined a protective effect against OASIs (p = 0.025 in full cohort and p = 0.013 in the primiparous group). An expulsive phase under one hour was an almost significant protective factor (p = 0.052).Conclusions: The use of episiotomy during OVB was associated with much lower OASIs rates in nulliparous women with a vacuum extraction; OR 0.23 (CI 95% 0.07-0.81) p = 0.037 in nulliparous women and the number necessary to treat was 18 among nulliparous women to prevent 1 OASIs. A further risk factor that emerged from the analysis is a prolonged expulsive period, whereas fundal pressure does not seem to have a statistically significant influence.

Impact of COVID-19 Pandemic on the Diagnostic and Therapeutic Management of Endometrial Cancer: A Monocentric Retrospective Comparative Study

Endometrial cancer represents an ideal target to evaluate the impact of COVID-19 being the most frequent gynecological malignancy in Italy, generally detected at early stages and correlated with favorable oncological outcomes. The present comparative retrospective study carried out at Campus Bio-medico University Foundation in Rome aims to evaluate the impact of the COVID-19 pandemic on the presentation, diagnosis and treatment of EC. All women with a histological diagnosis of non-endometrioid and endometrioid endometrial cancer between 1 March 2018 and 31 October 2022 were included. The number of cases was higher in period 2 (95 vs. 64 cases). Time to diagnosis did not show statistically significant differences but in period 2, 92.06% of the diagnoses were made following abnormal uterine bleeding, while in period 1, only 67.02% were. The waiting time for the intervention was significantly shorter in period 2. Definitive histology, FIGO staging, surgical technique and adjuvant therapy did not show significant differences between the two periods. The study demonstrates that the impact of the COVID-19 pandemic did not have a direct effect on the diagnostic delay, tumor staging and type of therapy but rather on the presentation pattern of endometrial cancer.

Role of Protopine and Nuciferine in the management of nocturia, urgency and dysuria in pre- and post-menopausal women: a prospective pilot study

Abstract Objectives: Nocturia was commonly treated with drugs burdened with high costs and numerous side effects; in fact, more than 70% of patients drop out of long-term treatment. Protopine and Nuciferine are two alkaloids that have different effects on the neurotransmitter receptors involved in the regulation mechanism of the onset of urinary stimuli. The aim of the study is to evaluate the efficacy in controlling primarily nocturia and secondarily urgency and dysuria after three months of treatment with combination therapy of protopine and nuciferine syrup. Design: This is a prospective cohort study in which all patients were diagnosed with overactive bladder syndrome (OAB) and the presence of symptoms: nocturia, urgency, and dysuria. 30 patients are administered 10 ml/die (16.6 mg of Nuciferine – 0.09 mg of Protopine) of syrup for 3 months. Patients are evaluated at baseline (T0) with the ICIQ questionnaire (International Consultation on Incontinence), VAS (Visual Analogue Scale) for the evaluation of dysuria, PPIUS (Patient Perception of Intensity of Urgency Scale) and at 3 months (T1) with the PGI-C Scale (Patients' Global Impression of Change), PPIUS, VAS and ICIQ. Participants: Women with diagnosis of OAB; presence of nocturia, urgency, and dysuria symptoms agreeing to undergo treatment and compiling informed consent; absence of contraindications to the use of active ingredients. Setting: Patients were recruited at (T0) during the visit to the Uro-Gynecology clinic of the University of 'Campus Bio-Medico' and visited again 3 months (T1) after the initiation of therapy. Methods: We explored survey data by descriptive statistics: in particular, continuous values (i.e., ICIQ) have been summarized by mean and standard deviation, discrete ordinal values (i.e., VAS, PPIUS, and bladder diary parameters at T0 and T1) by median, minimum, and maximum reported scores. Where we could assume normality in distribution, assessed by the Shapiro-Wilk test and the evaluation of the QQ plot, we compared the observation T0 and T1 with the paired Student's t test, otherwise we tested differences in distribution with the paired Mann–Whitney U test. Results: Thirty patients completed a three-month therapy. The ICIQ, VAS questionnaires for the assessment of dysuria, both, reported an improvement in dysuria at T1 (p< 0.001). The PPIUS questionnaire reported an improvement in urinary urgency in T1 (p<0.001). The PGI-C scale in T1 indicated an improvement in symptoms: 93% for nocturia, 70% for urinary urgency, and 63% for dysuria. Limitations: The weaknesses are the small number of patients, as a pilot study, the study design is not randomized with placebo and without blinding and the short follow-up. Conclusions: Protopine and Nuciferine can be an interesting alternative to primarily treat and reduce nocturia episodes, in addition to improving OAB-related urgency and dysuria. (Prot. N. Proto-Gyn-Uro 007/06.02.2019)