Ovarian function during hormonal contraception assessed by endocrine and sonographic markers: a systematic review.

This systematic review focuses on the literature evidence for residual ovarian function during treatment with hormonal contraceptives. We reviewed all papers which assessed residual ovarian activity during hormonal contraceptive use, using endocrine markers such as serum anti-Müllerian hormone (AMH) concentrations, FSH, LH, oestradiol, progesterone and sonographic markers such as antral follicle count (AFC), ovarian volume and vascular indices. We considered every type (oestroprogestin or only progestin) and dosage of hormonal contraceptive and every mode of administration (oral, vaginal ring, implant, transdermal patch). We performed an electronic database search for papers published from 1 January 1990 until 30 November 2015 using PubMed and MEDLINE. We pre-selected 113 studies and judged 48 studies suitable for the review. Most studies showed that follicular development continues during treatment with hormonal contraceptives, and that during treatment there is a reduction in serum concentrations of FSH, LH and oestradiol, and also a reduction in endometrial thickness, ovarian volume and the number and size of antral follicles. The ovarian reserve parameters, namely AFC and ovarian volume, are lower among users than among non-users of hormonal contraception; regarding the effect of hormonal contraception on AMH, there are still controversies in the literature.

Emergency peripartum hysterectomy in a tertiary teaching hospital: a 14-year review.

PURPOSE: To determine incidence, risk factors, indications, outcomes, and complications of emergency peripartum hysterectomy (EPH) performed in a tertiary teaching hospital and to compare the results with literature data. METHODS: Retrospective study of 51 patients who underwent EPH at the Department of Gynecology, Obstetrics and Urology of the University of Rome Sapienza, from January 2000 to December 2013. Maternal characteristics of the index pregnancy and delivery, indications for EPH, operative and postoperative complications, maternal and neonatal outcome were acquired by the hospital records. Fisher's and Chi-square tests were performed for statistical analysis. RESULTS: There were 51 EPH out of 23,384 deliveries, for an incidence of 2.2 per 1,000 deliveries during the study period. Forty-nine EPHs were performed after caesarean delivery (CS) and two after vaginal delivery (p < 0.0001). The most common indications were abnormal placentation (49.0%), followed by uterine atony (41.2%), and uterine rupture (9.8%). Eighty percent of patients who underwent EPH with abnormal placentation had at least one previous CS (p < 0.01). Twenty-three patients (45.1%) underwent total hysterectomy, the most frequent indication being abnormal placentation (76%, p < 0.01). The remaining 28 patients underwent subtotal hysterectomy (54.9%), the most frequent indication being uterine atony (85.7%, p < 0.01). Maternal morbidity was 25.5% and mortality was 5.9%. Perinatal mortality was 3.9%. CONCLUSIONS: Abnormal placentation was the most common indication for EPH, requiring in most of the cases a total hysterectomy. Previous CS was a risk factor for abnormal placentation and in particular for pathological adherence of the placenta. EPH remains associated with a high incidence of morbidity and mortality.