Gynecological Cancers and Microbiota Dynamics: Insights into Pathogenesis and Therapy.

In recent years, the relationship between the microbiota and various aspects of health has become a focal point of scientific investigation. Although the most studied microbiota concern the gastrointestinal tract, recently, the interest has also been extended to other body districts. Female genital tract dysbiosis and its possible impact on pathologies such as endometriosis, polycystic ovary syndrome (PCOS), pelvic inflammatory disease (PID), and gynecological cancers have been unveiled. The incursion of pathogenic microbes alters the ecological equilibrium of the vagina, triggering inflammation and compromising immune defense, potentially fostering an environment conducive to cancer development. The most common types of gynecological cancer include cervical, endometrial, and ovarian cancer, which occur in women of any age but especially in postmenopausal women. Several studies highlighted that a low presence of lactobacilli at the vaginal level, and consequently, in related areas (such as the endometrium and ovary), correlates with a higher risk of gynecological pathology and likely contributes to increased incidence and worse prognosis of gynecological cancers. The complex interplay between microbial communities and the development, progression, and treatment of gynecologic malignancies is a burgeoning field not yet fully understood. The intricate crosstalk between the gut microbiota and systemic inflammation introduces a new dimension to our understanding of gynecologic cancers. The objective of this review is to focus attention on the association between vaginal microbiota and gynecological malignancies and provide detailed knowledge for future diagnostic and therapeutic strategies.

Impact of cancer in the management of delivery: 10 years of variations.

Importance: The active-during-pregnancy-cancer (ADPC) is a condition that complicates the 0.1% of pregnancies. Abortion, preterm delivery and cesarean section (CS) are common attitudes for these patients, because of scarcity of evidence-based studies. Not-active-during-pregnancy-cancer (NADPC) is an increasing medical problem. The fertility of young girls survived to neoplasia is significantly lower compared to general population and there are increased rates of low birth weight and preterm birth.Objective: To analyze the impact that the pregnancy-related neoplastic disease has on management of deliveries in the decade 2006-2015.Material and methods: In this observational study, we collected obstetric and oncological data about 205 patients bearing a history of cancer related to pregnancy between January 2006 and September 2016 from Sant'Anna Hospital database archive in Turin. The entire population was divided in 59 patients with ADPC and 146 patients with NADPC because it was cured before starting the gestation. Three ADPC and three NADPC patients who completed their pregnancy in the year 2016 were excluded from the 10 years 2006-2015 trends realization. All in situ and invasive cancers were considered.Results: In ADPC patients, we registered 3.4% miscarriage and 15.3% iatrogenic abortion. The type of delivery was vaginal (22%) and CS (59.3%). Induction of labor was 14.6%, elective CS was 68.8%: the indication for these procedures was 78.6% oncological. The average gestational age was 35.5 weeks. In NADPC patients, we registered 9.6% miscarriage and 8.2% iatrogenic abortion. The type of delivery was vaginal (43.2%) and CS (39%). Induction of labor was 11.7%, elective CS was 36.7%: the indication for these procedures was 77.5% obstetrical. The average gestational age was 38.3 weeks.Conclusions: Ten-year trends in ADPC and NADPC patients showed an increase of induced deliveries and a decrease in elective CS. We observed not significant reduction of gestational age and birth weight. A contemporary decrease of oncological indications for CS in the two populations was reported.

Ultrasound imaging in prolonged second stage of labor: does it reduce the operative delivery rate?

OBJECTIVE: To reduce the operative delivery rate in the prolonged second stage of labor (PSSL) through intrapartum sonography. METHODS: Sixty-two women - with uncomplicated pregnancies at term, fetus in cephalic presentation and occipitoanterior position, in PSSL - had already undergone epidural anesthesia and oxytocin infusion. Transperineal ultrasound was performed to define fetal head direction (downward, horizontal, and upward) and patients were divided into three groups (D, H, and U). PROPOSED PROTOCOL: Cessation of oxytocin infusion, addition of a dose of anesthesia, invitation to assume a hand-and-knee position, and to relax. After one hour, oxytocin infusion was started again and women were invited to push. Fetal well-being ensured by cardiotocography (CTG). Chi-square test was used to compare the mode of delivery: cesarean section (CS), vacuum extraction (VE), and spontaneous delivery (SD). RESULTS: Group D (n = 20): 4 SD (20%), 4 VE, 12 CS; group H (n = 22): 9 SD (41%), 9 VE, 4 CS; group U (n20): 16 SD (80%), 4 VE. The risk of not having a SD in group D versus U is quadrupled (RR 4; 95% CI 1.6-9.9). CONCLUSIONS: Ultrasound diagnosis of fetal head upward direction is highly predictive of SD in case of PSSL. Further studies are needed to assess this hypothesis.