Selenium supplementation in the management of thyroid autoimmunity during pregnancy: results of the "SERENA study", a randomized, double-blind, placebo-controlled trial.

PURPOSE: Selenium is frequently in nutraceuticals for pregnancy, given its role on fertility and thyroid metabolism. However, most evidence rise from non-controlled studies. We aimed to evaluate the protective effect of selenium against thyroid autoimmunity during and after pregnancy. METHODS: A multicenter, randomized, double-blind, placebo-controlled trial was performed and promoted by the Young Italian Endocrinologists Group (EnGioI)-Italian Society of Endocrinology. Forty-five women with thyroiditis in pregnancy were enrolled and randomly assigned to L-selenomethionine (L-Se-Met) 83 mcg/day or placebo (PLB) and evaluated at 10 ± 2 (T1), 36 ± 2 weeks of gestation (T2) and 6 months after delivery (postpartum, PP). RESULTS: We measured a significant reduction of autoantibodies after pregnancy in L-Se-Met group [at PP: TgAb 19.86 (11.59-52.60), p < 0.01; TPOAb 255.00 (79.00-292.00), p < 0.01], and an antibodies titer's rebound in PLB group (TgAb 151.03 ± 182.9, p < 0.01; TPOAb 441.28 ± 512.18, p < 0.01). A significant increase in selenemia was measured in L-Se-Met group at T2 (91.33 ± 25.49; p < 0.01) and PP (93.55 ± 23.53; p = 0.02). Two miscarriage occurred in PLB. No differences were found in thyroid volume, echogenicity, quality of life, maternal/fetal complications. CONCLUSIONS: SERENA study demonstrated a beneficial effect of L-Se-Met supplementation on autoantibody titer during pregnancy and on postpartum thyroiditis recurrence.

Laser vaporization in the management of CIN.

AIMS: To evaluate the effectiveness of laser CO2 vaporization in high-grade cervical intraepithelial neoplasias and to assess the diagnostic reliability of cytology, colposcopy, microbiology and HPV tests in predicting recurrence in a long-term outcome. METHODS: Forty-four patients affectd by high-grade cervical intraepithelial neoplasia (HG-CIN) were submitted to laser CO2 vaporization and followed-up a minimum of five years. Vaginal smears for microbiological examination were detected. HPV testing was performed by polymerase chain reaction (PCR). RESULTS: The average age of the patients was 19.5 years (range 15-24). The cure rate after a single treatment was 95%. Two cases (5%) revealed HG-CIN persistence after three months. The five year follow-up of all cases submitted to a second laser procedure revealed negative cytologic and colposcopic findings. CONCLUSIONS: A higher degree of expertise and experience from the colposcopist and long-term follow-up proves the effectiveness of laser vaporization in the management of CIN in young women. It has been suggested that HPV infection alone may not be sufficient to promote carcinogenesis and that other cofactors could be involved. Microbiological tests are important to identify and treat any inflammation which might represent a cofactor of HPV infection in the pathogenesis of cervical dysplasia. Cytocolposcopic long-term follow-up, microbiological and HPV tests can improve regression of disease.

[Contraception in teenagers. Medico legal implication]. / Gli estroprogestinici nelle teen agers. Quali Risvoli medico-legali?

Contraception in adolescence is an issue which, due to its clinical and medico-legal implications, requires an in depth and clear knowledge of the general principles that govern contraception in minors, as stated in a broad body of laws. The position of the physician is complex, since he/she must comply with the law whilst protecting the minor. The physician has to provide answers to many questions: Can health care facilities and guidance centers administer to the minor, by medical prescription, the means necessary for her to make free choices in the area of responsible procreation without parental authorization? How must the gynecologist go about prescribing the morning after pill ? Emergency contraception, that is the morning after pill , has proven to be extremely helpful for adolescents whose physical and psychic health could be undermined by an unwanted pregnancy, so that it is the physicians duty to protect it. In our legislation there are principles that guarantee the right of minors to conscious and responsible motherhood; however, there are no provisions that allow for such principles to be easily enforced. Consequently, only the health worker can actually interpret the law provisions and translate them into concrete action. Laws are therefore the only point of reference for the physician, who is then responsible for enforcing them in clinical practice, always fully respecting the rights of the minor. The aim of paper is to provide experts with a correct legislative framework on contraception in adolescents, in order to facilitate his/her work in prescribing treatment while at the same time protecting the health of the minor.

[Perineal modification in pregnancy and puerperium, risk of urinary incontinence]. / Modificazioni del piano perineale in gravidanza e nel puerperio e rischio di incontinenza urinaria.

UNLABELLED: Pregnancy and delivery are important etiopathological factors in the alteration of pelvic equilibrium; in particular and the first delivery is the decisive factor in terms of perineal sequelae affecting pelvic equilibrium and urinary continence. Epidemiological studies have identified a number of pathogenic risk factors related to pregnancy (abnormal increase in maternal weight, diabetes in pregnancy and macrosoma) and the newborn (cranial circumference, newborn weight). Mechanical stress caused by the passage of the fetus may lead to the overstretching of the pelvic floor and the failure to recognise muscular damage even in the absence of macroscopic lesions. In the immediate postpartum or after a number of years these may damage the function of the musculo-aponeurotic structures of the perineum and foster the onset of alterations to pelvic equilibrium and urinary incontinence. In this study the authors have evaluated the modifications to the perineum and continence during pregnancy and puerperium. METHODS: Clinical data were analysed for 40 puerperae all of whom underwent a through perineal examination to assess the function of perineal muscles, both on discharge and 6 months after delivery. RESULTS: The authors tried to identify the main risk factors which predisposed the onset of changes to pelvic equilibrium and urinary continence. On the basis of the contemporary outcome of the Q-TIP test and TP, all women were divided into 4 groups: Group A (TP < 3 and positive Q-TIP test) (22.5%). CONCLUSIONS: In the light of these results, the authors affirm that during gestation it is important to concentrate preventive action on these risk factors.

[Hypertension in pregnancy. Retrospective epidemiologic study]. / La malattia ipertensiva in gravidanza. Studio epidemiologico retrospettivo.

BACKGROUND: Pregnancy hypertension today has not a valid etiological explanation. It's possible however that the association of more factors could determine the symptoms. The pregnancy hypertensive disorders are not uncommon, with an incidence estimated from 6 to 8%. Epidemiological studies have shown hypertension in pregnancy increases fetal and maternal mortality and morbidity. Preterm delivery is more common in women with hypertension in pregnancy. The aim of this retrospective study was to verify some epidemiological aspects of pregnancy hypertension at the IV Divisions of I Institute of Obstetrics and Gynaecology of the "La Sapienza" University of Rome. METHODS: 1926 pregnant women have been hospitalised at the IV Division from January 1993 to December 1997. Of these 101 had hypertension. Age, hypertension degree, type of job, smoking, parity, previous hypertension developed by patients and their relatives, birthweight, stage of development of hypertension and delivery procedures have been evaluated in this group. RESULTS: The main data obtained from this study are: strong correlation of primiparity and hypertension (55, 45% of observations); increased risk to have hypertension induced by pregnancy in women that have just incurred in hypertension in previous pregnancy; the high incidence of caesarean section in the group considered with respect to the general population (70.9%). CONCLUSIONS: Hypertension is still a frequent disorder in pregnancy which may lead to serious complications.

[The role of antenatal courses in preventing the onset of altered pelvic statics and urinary incontinence]. / Quale ruolo dei corsi di preparazione al parto nella prevenzione dell'insorgenza delle alterazioni della statica pelvica e dei disturbi della continenza urinaria.

BACKGROUND AND AIMS: This study was prompted by the frequent finding of urinary incontinence in peri- and postmenopausal women. In an attempt to reduce this incidence, the authors evaluated the role of antenatal courses as an important preventive and operative means of providing information aimed at preventing the onset of alterations to pelvic statics and urinary incontinence. The clinical data of 40 puerperae, of whom 45% had followed our antenatal course, were examined for this purpose. METHODS: A functional examination of the perineum was made in all subjects on discharge after birth and 6 months later. RESULTS: These findings appear to indicate that antenatal courses play an important role in preventing obstetric perineal complications. CONCLUSIONS: During the courses all women were given useful advice on hygiene and diet, including guidelines for suitable regular exercise, the need to drink about 1 litre of unsweetened liquid daily, a balanced diet and advice regardingf perineal relaxation. Subsequently, all subjects were advised to continue exercising after birth to ensure the correct rehabilitation of the perineal floor and they were also given a sheet containing the different learnt during the antenatal courses. In this way these subjects increased their awareness of the need not to underestimate the early symptoms of urinary incontinence should they occur after birth.

[Maternal attitude and psychophysical adaptation of women undergoing primary and secondary cesarean section]. / Studio sull'atteggiamento e adattamento psicofisico materno nel primo cesareo e nel ripetuto.

BACKGROUND: The increase of cesarean sections, which is typical of the most industrialised countries, resulted in a higher rate of repeat cesarean sections. The previous CS is the main indication for cesarean delivery. The purpose of this study is to compare women who had a primary cesarean with women who had a repeat cesarean section in order to assess their different emotional reactions as well as their psychophysical consequences. METHODS: A questionnaire was administered to 36 patients who had a primary cesarean section and to 34 patients who had a repeat cesarean section, 6-12 months after birth. All these women were similar for age and gestational age of the birth. RESULTS: Results underline that patients are more disposed to accept the operation in repeat cesarean rather than in primary cesarean. Women who have a repeat cesarean section are more likely to accept this kind of delivery since the beginning, with positive effects on their postoperative course. Women who have a repeat cesarean section face more serenely not only prenatal but also post-natal period and show less serious psychophysical sequelae with respect to primary cesarean section because of their previous experience. CONCLUSIONS: As a result, an appropriate psychological support coupled with adequate information can reduce discomfort in cesarean patients.

[Clinical use of leuprolide acetate depot in a group of gynecologic patients in the preoperative period]. / Impiego clinico del leuprolide acetato depot in un gruppo di pazienti ginecologiche in attesa di intervento chirurgico.

BACKGROUND: The authors examined 33 patients with symptomatic uterine leiomyomas due to undergo total hysterectomy in order to evaluate the effects of treatment with GnRH analogues on leiomyoma and estrogen and progesterone receptors. METHODS: The patients were divided into two groups: one group was treated with leuprolide acetate (Group A) and the other did not receive treatment (Group B). RESULTS: A significant reduction in the volume of leiomyomas and estrogen and progesterone receptors was noted in patients in Group A. CONCLUSIONS: Treatment with GnRH analogues therefore represents a valid aid for patients with uterine leiomyomas and sideropenic anemia awaiting surgery.

[Episiotomy: can its habitual use be defended? A study of 100 puerperae and a group of gynecologists and midwives]. / Episiotomia: l'utilizzazione abituale va difesa? Un'indagine su 100 puerpere, su un gruppo di ginecologi e di ostetriche.

METHODS: The authors studied vaginal delivery with and without episiotomy, during the period 1993-1994. The aim of this study was to examine 100 puerperal women and a group of gynecologists and midwives, to evaluate the benefits and risks of routinely used medical procedures, and to understand the rational of the procedure and put in evidence the indications on which decisions were based. RESULTS: This study does not indicate that episiotomy offers a clear benefit to primipara in terms of decreased numbers of risk factors, while it is indicated in laborious vaginal delivery. The opinion of sanitary operators about this procedure is favourable especially for primiparas, but however this does not necessarily mean that more routine episiotomy can be justified.

[The clinical experiences of abortions on demand in a group of 221 adolescents]. / Esperienze cliniche sulle interruzioni volontarie di gravidanza in un gruppo di 221 adolescenti.

The authors studied about planned abortion performed by girls under 19 years of age, during the period 1991-1994. The aim of this study was to evaluate the entity of planned abortion also concerning the number of adolescent pregnancy. Our study show the percentage of pregnancy was progressively diminished, while regarding the planned abortion even if reduced along the time, the percentage remain steady in the course of years examined.

[Cesarean section and spontaneous birth: clinical aspects and maternal psychodynamic impact]. / Taglio cesareo e parto spontaneo: aspetti clinici ed impatto psicodinamico materno.

Cesarean delivery was considered a medical saving-operation for a very long time. Few editorials focus on psychological results of cesarean deliver in respect of the mother, the relationship mother-newborn, the Hospital, and family environment. The authors examined psychodynamic effects of cesarean and vaginally deliver puerperas, comparing different experiences of attainment of maternity. An interview was administered to 39 cesarean and 41 vaginally delivered mothers, 4-6 days after birth. All these women were primiparas and similar for social abd educational level, marital status, employment rate, age and gestational age of the birth. Women with malformed babies and obstetric pathologies were excluded. After elaborating these data we can understand that there are many factors interfering with maternal gratification in the era of cesarean delivery. Results underline the main consequences of surgical delivery, focus on the privation of creative onnipotence of vaginally birth. This is reflected on quality of the first contact with the newborn. Therefore, for the medical staff, it is important to reduce the troubles caused by the anaesthesia, the lack of "the first contact" mother-newborn, taking care about puerperas" psychosomatic problems.

The Valsalva maneuver in vasodepressor syncope.

In this work the authors propose the Valsalva maneuver as a diagnostic test in a group of patients shown, by anamnestic, physical, and instrumental criteria, to be affected by vasodepressor syncope. They studied the response of heart rate and baseline arterial pressure to the maneuver performed in passive orthostasis in 7 healthy volunteers and 24 patients. These patients showed a hypotensive response and a time of recovery to the initial values that was significantly longer than in the control group (p less than 0.01). The authors conclude that studying the response to the Valsalva maneuver can be useful in the diagnosis of vasodepressor syncope.