Post-abortion long-acting reversible contraception in a sample of Italian women: intrauterine device versus subdermal implant.

Long-acting reversible contraceptives (LARC) represent an especially effective kind of post-abortion contraception. We aimed at assessing satisfaction, discontinuation, efficacy, and tolerability associated with either levonorgestrel intrauterine device (L-IUCD), the copper intrauterine device (C-IUCD) and implant (IMP) after termination of pregnancy (TOP). We recorded baseline data about the patients and performed phone surveys at 3, 6 and 12 months after insertion to assess the bleeding profile. Furthermore, women were inquired about possible adverse events, satisfaction, and discontinuation at 12 months after insertion. LARC continuers (>12 months after TOP) were divided into three groups: L-IUCD (n = 47), C-IUCD (n = 6) and IMP (n = 36). Satisfaction rates among L-IUCD users were higher than among IMP users (100% vs. 72.2%, p < .05). A higher, yet not significant, share of patients decided to withdraw contraception in IMP group (3.6% in IUCD group and 12.2% in IMP group). The bleeding profile was significantly more favorable among L-IUCD users than among IMP users. Finally, the reported rate of treatment-associated adverse events did not differ significantly among the groups. L-IUCD insertion after TOP is associated with higher satisfaction and lower discontinuation rates than IMP. Such pattern could be attributed to a more favorable bleeding profile.

Gynaecological and obstetric audit at a G&O emergency department.

The present study takes into account only the patients that are sent home because their conditions do not require emergency hospitalization in order to try to understand the reasons why a woman seeks emergency treatment at a G&O emergency service.

[Alleged sexual assault. The role of the emergency department gynecologist]. / Riferita violenza sessuale. Il ruolo del ginecologo nel pronto soccorso.

The objective of this paper is to better understand the role of the Emergency department gynecologist in cases of alleged sexual assault. The gynecologist should know that he is a justice collaborator and, as public officer, he has to report to authorities every indictable offense. He should also know that patient's informed consent is required during each step of medical investigation. The doctor should indeed know when, how and where to find and collect evidence of crime and perform, in conformity with the victim's statement, specimens of biologic samples, a pregnancy test and a prophylaxis of sexually transmitted diseases. The gynecologist should evaluate psychological and general state of the patient, take the tailored medical history including the modalities of violent act, perform a physical examination, a genital and rectal examination with accurate description of the lesions and collect evidence of rape. The role of the gynecologist is to document all injuries in order to afterwards establish the conformity with patient's history. He should treat acute physical injuries, offer the counseling for the prevention of sexually transmitted diseases, for the pregnancy prophylaxis and emergency contraception and for psychosocial consequences, report to authorities as required by law and, at last, arrange for follow-up medical care and counseling. Personal experience highlights the necessity of a standard protocol to be used in all Emergency departments. This would allow and facilitate an uniform medical approach to the sexual assault victim as well as an accurate and correct collection of data for legal requirements.

[Critical review of colpo-histological results in cervix pathology]. / Revisione critica dei risultati colpo-istologici nella patologia cervicale.

BACKGROUND: The objective of this paper was to evaluate the role of squamous metaplasia in the determination of certain colposcopic appearances. METHODS: One thousand four hundred and six infertile outpatients, attending assisted reproduction techniques, underwent a "first level" colposcopy. Two hundred fifty nine abnormal transformation zones were biopsied and the histologic diagnoses were subdivided as follows: squamous metaplasia, squamous metaplasia + koilocytosis, isolated koilocytosis, condyloma, CIN + HPV, cervicitis. RESULTS: Two hundred forty seven cases out of 259 biopsied colposcopic findings (95.4%) were colposcopically classified as grade 1 abnormal transformation zone (thin white epithelium, regular mosaic and punctuation). The correlation between 247 grade 1 abnormal transformation zone colposcopic patterns and histologic diagnosis revealed 105 (42.5%) histologic findings described as squamous metaplasia that resulted immature in 63% of these samples. Between 132 (53.4%) cases that presented a pattern of human papillomavirus infection (condyloma, squamous metaplasia + koilocytosis or isolated koylocitosis), quite two thirds (62%) were described as condylomas, one third (31%) as squamous metaplasia associated with koylocitosis and only 7% as isolated koylocitosis. In conclusion, 42.5% of target biopsies performed on low grade abnormal transformation of the cervix revealed squamous metaplasia, more than half of them revealed one of HPV infection forms, while only 2% represented cervical intraepithelial neoplasia. CONCLUSIONS: Among the low risk female population, one out of two cases of colposcopically low grade pattern should be considered indicative of squamous metaplasia. The results obtained confirm that colposcopic evaluation is unable to distinguish between immature metaplastic transformation of the epithelium and metaplastic epithelium with initial neoplastic transformation.