Second trimester amniotic fluid retinol in patients developing preeclampsia.

BACKGROUND: Retinol (ROH) is an essential micronutrient required for normal fetal development and an essential molecule for antioxidant processes. OBJECTIVE: To investigate the putative role of ROH as a marker of preeclampsia in early second trimester amniotic fluid (AF). MATERIALS AND METHODS: Case-control study comparing the concentration of ROH and other antioxidants such as uric acid, vitamin E and malondialdehyde (MDA) in second trimester AF in patients that later developed preeclampsia with normal pregnancies. RESULTS: The concentration of ROH in amniotic fluids of women that later developed preeclampsia was significantly higher than those of uncomplicated pregnancies (66.72 µg/l (49.00-70.56) vs. 44.4 µg/l (31.9-51.17), p < 0.05). No statistical significant difference was found in uric acid, vitamin E and MDA concentration. In the multivariate logistic regression, concentrations of ROH in amniotic fluids directly correlate with the risk of developing preeclampsia (OR 1.13, IC 0.01-1.26, p < 0.05). CONCLUSIONS: Second trimester AF ROH concentration was significantly higher in pregnancies that developed preeclampsia compared to normal pregnancies.

Identification of patients with high osteoporosis risk: analysis of FRAX and phalangeal ultrasonography in a female population in North-East Italy.

AIM: Osteoporosis is a worldwide health problem and bone fractures from osteoporosis are among the major causes of disability, with a great impact on the national health budgets. The aim of our study was to analyze the efficacy of FRAX algorithm and phalanger ultrasound to predict the risk of osteoporotic fractures, in order to identify a high risk population to examine with a second level diagnostic analysis. METHODS: The study population was composed of 1208 premenopausal, perimenopausal, and postmenopausal women, between 40 and 81 years. For each woman phalangeal QUS was performed and FRAX index was calculated. The FRAX index was evaluated according to standard plots available on web (http://www.shed.ac.uk/FRAX/index.htm). RESULTS: Analysing the correlation between women age and phalanger bone ultrasound values we know that all parameter decrease with increasing of age. We found a significant difference between FRAX index and the ultrasound parameters (P<0.05) to predict a major osteoporotic fracture, we did not find differences between age and ultrasound parameters. Furthermore, we show that after correction per age of the women the ultrasound parameters lose their significant correlation with major osteoporotic fractures. Finally, FRAX index showed a good AUC and in our population and a 10-year probability over 9.4% of major osteoporotic fractures had a good specificity (88%) and sensitivity (83%) to predict osteoporotic fractures. CONCLUSION: Our data suggest that FRAX index alone could be used to address high risk women to more invasive tests but we need more data about ultrasound parameters.

Comparison of pelvic masses score (PMS) and Risk of Malignancy Index (RMI 3) in the evaluation of pelvic masses.

PURPOSE: Ovarian cancer is the fourth cause of death from cancer in women worldwide and the majority of its diagnoses is made in an advanced stage of the disease. Several sonographic scoring systems have been created for a better preoperative discrimination between benign and malignant pelvic masses. The aim of this study was to evaluate the performances of the Risk of the Malignancy Index 3 (RMI 3) and the Pelvic Masses Score (PMS). MATERIALS AND METHODS: This retrospective study was performed in 55 women admitted to the department of Obstetrics and Gynecology of University of Udine for surgical exploration of pelvic masses between 2009 and 2012. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for both the scores. RESULTS: PMS showed a sensitivity of 100%, a specificity of 93.8%, a PPV of 70%, and a NPV of 100%, while RMI 3 yielded a sensitivity of 85%, a specificity of 91%, a PPV of 60%, and a NPV of 97.8%. CONCLUSION: The authors found that, in discriminating between benign and malignant pelvic disease, the PMS method was more reliable than RMI3. PMS is a simple scoring system which can be used in clinical practice.

Therapy side-effects and predictive factors for preterm delivery in patients undergoing tocolysis with atosiban or ritodrine for threatened preterm labour.

The objective of this study was to compare the safety and efficacy of atosiban and ritodrine in the treatment of threatened preterm labour (TPL) and to analyse the predictive factors of preterm delivery. We retrospectively sampled data on 380 women hospitalised for TPL (24-35 weeks' gestation), in our clinic between 2004 and 2007. All were subjected to tocolysis with ritodrine and/or atosiban. Data were analysed using R (version 2.12.1), considering p < 0.05 as significant. We had 69 women treated with atosiban, 242 treated with ritodrine and 69 treated with ritodrine changed for atosiban, if adverse effects occurred. In the multivariate logistic regression, the use of atosiban vs ritodrine does not play any role in delaying delivery after 48 h or 7 days, whereas the cervical change at the digital examination, high contractions pre/post-therapy ratio, pPROM, cervical length and fibronectin result as predictive factors for both delivery before 48 h or 7 days. Maternal adverse drug effects were significantly more frequent in patients treated with ritodrine, and one single case of pulmonary oedema was observed. We found fewer side-effects in the atosiban than in the ritodrine group and no difference in efficacy. Moreover, the most predictive factors for preterm delivery were fibronectin test, pPROM, digital vaginal examination and uterine contraction persistence. We believe that predictive capacity of these tests could give the opportunity for targeting therapy and limiting drug side-effects and cost.

Prediction of large-for-gestation neonates with first-trimester maternal serum PAPP-A.

AIM: The aim of this paper was to identify maternal/pregnancy characteristics, first trimester ultrasound parameters and biochemical indices which are significant independent predictors of large-for-gestational age (LGA) neonates. METHODS: An Observational cross-sectional study was conducted at the Fetal Medicine Unit, Department of Obstetrics and Gynecology of the University of Udine (Italy). Seventy-two singleton pregnancies presenting for screening for chromosomal abnormalities by nuchal translucency and maternal serum biochemistry at 11-14 weeks. Linear regression was applied to develop first trimester prediction models for LGA. RESULTS: Maternal height, parity, smoking, assisted conception and pregnancy-associated plasma protein-A were significant independent predictors of LGA. PAPP-A cut-off value expressed in MoM of 1.25 used for the study was chosen to obtain good sensitivity and specificity values. CONCLUSION: Prediction for birthweight deviations (LGA) is feasible using data available at the routine 11-14 weeks' examination.

Coagulation assessment in normal pregnancy: thrombelastography with citrated non activated samples.

BACKGROUND: Thrombelastography (TEG) provides an effective and convenient means of whole blood coagulation monitoring. TEG evaluates the elastic properties of whole blood and provides a global assessment of hemostatic function. Previous studies performed TEG on native blood sample, but no data are available with citrated samples in healthy pregnant women at term. The aim of this study was to investigate the effect of pregnancy on coagulation assessed by TEG and establish normal ranges of TEG values in pregnant women at term comparing them with healthy non pregnant young women. METHODS: We enrolled pregnant women at term undergoing elective cesarean section or labour induction (PREG group) and healthy non-pregnant women (CTRL group). Women with fever or inflammatory syndrome, defined as C-reactive protein (CRP) >5 mg/L and with a platelet count <150.000/mm(3) have been excluded. For each women hemochrome and standard coagulation test were assessed. At the same time we performed a thrombelastographic test with Hemoscope TEG(®) after sample recalcification without using any activator. RESULTS: One hundred thirty patients were studied, 65 for each group. There were no differences between groups regarding demographic data. Hemoglobin, platelet count, International Normalized Ratio and Activated Partial Thromboplastin Time Ratio were lower and fibrinogen was higher in PREG group. All TEG parameters resulted as being significantly different between the groups with a hypercoagulable pattern in PREG group compared to CTRL group. CONCLUSION: The main findings of this study confirm the hypercoagulability status of pregnant women at term. This coagulation pattern is well represented by thrombelastographic trace obtained by recalcified citrate blood sample.

[Hormone replacement therapy and urogenital disease in postmenopausal women]. / La terapia ormonale sostitutiva e la patologia del pavimento pelvico nelle donne in postmenopausa.

Estrogen deficit in postmenopausal women causes urogenital atrophy, which is responsible for a wide range of urinary disorders (urinary incontinence, urge incontinence, recurrent urinary infections) and genital disorders (prolapse, dispareunya, vaginal dryness). The efficacy of estrogen therapy on urinary incontinence is not yet demonstrated, but it is widely recognized that the topical use of estrogens lowers the risk of recurrent urinary infections and improves urogenital atrophy.

Midwifery students' perceived independence within the core competencies expected of the midwifery community upon graduation: an Italian study.

AIM: The general aim of this article is to describe the independence perceived by midwifery students who are due to qualify with regard to core competencies that are considered essential by the community of professional midwives working in Italian healthcare hospitals. METHODS: A multi-method research project was undertaken. One hundred sixty-seven midwives working in 11 regional facilities were approached with the aim of selecting the core competencies expected by graduands. In the same region, all graduands (24) educated at two universities were involved in the study aiming to discover the level of the independence (from 0 none to 10 maximum) perceived in each core competence selected by the midwives. RESULTS: The average score obtained by graduands in the questionnaire containing 102 core competencies was 717.4 (standard deviation 130.3, median 743). The minimum score was 363 and the highest was 916. Assuming the minimum cut-off at 612 points, five students (20.8%) had a perceived level of independence below sufficiency. CONCLUSION: Italian midwifery education has been reformed five times since 1940. The reduction in the length of the direct entry midwifery programme as introduced in the latest Italian national reform, and the higher standard of education requested also by European Directives, cause an increasing number of students to prefer to extend their course duration and postpone graduation until they feel independent. Any change in curriculum should consider the impact in the short, medium and long terms. For this reason, each new policy should consider carefully the point of view of experts in the disciplines, such as midwifery, with the objective of protecting and developing their competence in taking care of women, newborns and their families.

[Maternal body mass index and breast feeding]. / Indice di massa corporeo materno e allattamento al seno.

AIM: The aim of this paper was to determine whether maternal BMI influences breast-feeding practice in quality and duration METHODS: A retrospective case-control study were included Fifty women with Body Max Index (BMI) ≥25 kg/m2 considered overweigh and obese and fifty controls with BMI<25 kg/m2 who delivered in our clinic between 2010 and 2011. RESULTS: The incidence of breast-feeding was significantly lower in overweight and obese women compared with normal weight. Breastfeeding length was negatively related to prepregnancy BMI but not to gestational weight gain, method of delivery or lactation integration. Obese women presented an elevated Body Max Index one year apart from childbirth and are correlated to maternal complications during breastfeeding. CONCLUSION: Maternal overweight and obesity is negatively correlated to duration and quality of lactation.

Fertility in women survivors of hematological malignancies: what is the real role of GnRH analogue treatment?

PURPOSE OF INVESTIGATION: The aim of this study was to evaluate the ovarian function in women who received or not gonadotropin-releasing hormone (GnRH) analogue co-treatment compared to the control group that did not receive it. MATERIALS AND METHODS: This study analyzed 124 patients affected by hematological diseases between 1998 and 2007. The data were analyzed using R (v 2.9.1). RESULTS: In the women treated with GnRH analogue, the authors found 33% post-treatment secondary amenorrhea and 6% had a pregnancy post-treatment, while in the other group the prevalence were respectively 49% and 4% (p n.s.). Moreover, in multivariate analysis the authors found bone marrow transplantation to be a risk factor for secondary amenorrhea, while the association of chemotherapy with radiotherapy was a protective factor (p < 0.05). Finally, none of the considered factors were predictive of pregnancy achievement post-treatment. CONCLUSIONS: The authors found no statistical evidence to support that Gn-RH analogue treatment preserves ovarian follicular reserve during hematologic cancer treatment, but more evidence must be obtained.

Breast-feeding and benign breast disease.

Benign breast disease (BBD) is very common among women in their fertile age, but its correlation with breast reproductive function remains unclear. Our study aimed to investigate the relation between BBD and breast-feeding. We collected data on 105 women with BBD and 98 controls, focusing on their reproductive history and breast-feeding. We analysed data by R (version 2.12.1) considering p < 0.05 as significant. The results showed that fibroadenoma represented the most frequent BBD (55%), followed by fibrocystic changes (19%), intraductal papilloma (6%) and inflammatory breast disorders (5%). The mean age was 31.5 years (± 6.1), BMI 21.2 kg/m² (± 3.4) and age at menarche 13.0 years (± 1.5). Duration of breast-feeding was not significantly different between controls and BBD types (p = NS). Selecting women with fibroadenoma breast-feeding duration directly correlated with the number of benign lesions (p < 0.05), which remains significant also by multivariate analysis. It was concluded that there seemed to be no difference in breast-feeding among BBDs types, but lactation may influence the number of fibroadenomas. Moreover, prospective studies would better define the correlation between lactation and BBDs.

Risk factors for chronic pelvic pain in a cohort of primipara and secondipara at one year after delivery: association of chronic pelvic pain with autoimmune pathologies.

AIM: Over genetic and obsteteric factors, also autoimmunity may be involved in female chronic pelvic pain (CPP) pathogenesis. Our study aims to determinate the prevalence of CPP after one year from delivery, and to investigate the possible influence on CPP of concomitant autoimmune conditions. Methods. We selected a cohort of caucasian primipara and secondipara who delivered in our clinic in 2006. We collected personal, clinical and obstetric data, and asked them about pelviperineal painful symptoms. Results. Mean maternal age is 35.52 years (±4.70), 27.65% of women delivered by cesarean section, 61.04% spontaneously and 11.32% by operative assistance, with partoanalgesia in 10.39% of cases, episiotomy in 41.19%, vaginoperineal tears in respectively 14.10% I degree, 11.13% II degree and 0.93% III-IV degree; 43.60% of women have ever undergone abdominopelvic surgery, 32.84% by laparotomy-laparoscopy, 7.05% by hysteroscopy, 5.01% limited to perineum. Chronic autoimmune diseases affect 78.48% of women, allergies 7.79%, rheumatic pathologies 1.3%, autoimmune endocrinopathies 71.8%; 26.53% of women report pelviperineal painful symptoms, being already present in 2.23% of cases, 12.43% generalised pelvic pain, 4.27% bladder pain, 2.60% vulvodynia, 17. 07% dyspareunia. By monovariate analysis CPP results influenced by III-IV degree vaginoperineal tears, operative assistance, preexisting CPP, previous and actual urinary incontinence, previous abdominopelvic surgical interventions and chronic rheumatic pathologies. Furthermore, rheumatic disease, operative assistance and previous CPP are predictive factors for CPP in the postpartum (AUC=58.10%). Conclusion. Delivery may highlight CPP symptoms in predisposed women affected by chronic autoimmune pathologies.

Ultrasonographic assessment of cervix size and its correlation with female characteristics, pregnancy, BMI, and other anthropometric features.

PURPOSE: Cervical length during the first trimester of pregnancy has not been completely investigated yet. The objective of our study is to compare cervical size in the first ten gestational weeks with that of non-pregnant women, and to determine its correlation with maternal factors, including age, anthropometric features, and reproductive history. METHODS: We collected retrospective data about women who applied to the Obstetrics and Gynecology Outpatients Facility of Udine between February and June 2009, selecting both pregnant and non-pregnant women possessing a transvaginal ultrasonographic measurement of their cervix, and focusing on their age, parity, BMI, cervical, and uterine size. Data were analyzed by R (version.2.8.0), considering significant P < 0.05. RESULTS: 135 women were recruited. By multivariate linear regression, both cervical length and width result independently influenced by pregnancy status, and among non-pregnant nullipara, cervical length results to be significantly lower in women younger than 20 (P < 0.05). CONCLUSIONS: During the first ten gestational weeks, cervix results to be longer and wider than in non-pregnant women, suggesting the possible existence of early gestational, morphological, uterine, and cervical modifications. Women under the age of 20 have a significantly shorter cervix, suggesting an incomplete cervix maturity in this group of women, which may justify the higher prevalence of pre-term births in teenage pregnancies.

Evaluation of fetal cerebral blood flow perfusion using power Doppler ultrasound angiography (3D-PDA) in growth-restricted fetuses.

OBJECTIVE: to explore the potential of 3D Power Doppler Angiography (3D PDA) to evaluate the cerebral circulation in normal and growth restricted fetuses (IUGR). STUDY DESIGN: in a pilot study, we enrolled 51 appropriate for gestational age (AGA) pregnancies and 17 singleton pregnancies presenting IUGR, all between 22 and 38 weeks of gestation. Using 3D power Doppler ultrasound, a -volume acquisition of the fetal brain was performed. Two regions of interest (ROI) were defined within the fetal brain. Zone 1 is anterior to the cavum septi pellucidi (CSP). Zone 2 is defined by a rectangle obtained tracing a contour -between the temporal bones as wide as the CSP, corresponding to the area of the middle cerebral artery. The Flow Index (FI), the Vascularization Index (VI), the Vascularization and Flow Index (VFI) were determined in both areas in both IUGR and AGA fetuses by a single operator. IUGR fetuses were divided into three groups: Group 1, with normal pulsatility index (PI) of umbilical artery (UA), middle cerebral artery (MCA) and ductus venosus (DV); Group 2, IUGR fetuses with abnormal UA PI, normal MCA PI, normal DV PI; in Group 3, IUGR fetuses with abnormal UA PI, MCA PI and DV PI. RESULTS: FI and VFI values of zone 1 were increased in Group 1.Values of VFI in zone 2 were increased in Group 2. CONCLUSIONS: Our findings are in line with recent studies in growth-restricted fetuses suggesting that the anterior -cerebral artery shows Doppler signs of vasodilatation before these are observed in the MCA, demonstrating the "frontal brain sparing effect".

[Retrospective analysis of one year of cesarean sections: indications and risk factors associated with intrapartum cesarean section]. / Analisi retrospettiva su un anno di tagli cesarei: indicazioni e fattori di rischio per taglio cesareo in travaglio di parto.

AIM: Cesarean section (CS) is currently the most commonly performed surgical intervention worldwide. Indications include previous CS, podalic presentation and fetal macrosomia in antepartum CS, fetal distress, and prolonged first or second phase of labor in intrapartum CS. Despite the marked reduction in fetal mortality and morbidity in selected circumstances, maternal complication rates associated with CS are far higher than with vaginal delivery. The aim of this study was to evaluate the indications and maternal and fetal outcomes in a population undergoing antepartum or intrapartum CS and to analyze the risk factors of intrapartum CS. METHODS: An analysis was conducted on data from 1748 deliveries performed at the Gynecology-Obstetrics Clinic of the University of Udine during 2006. A total of 603 medical records of the mothers who had delivered by CS and their infants were analyzed. The Indications and maternal and fetal outcomes were evaluated in mothers who had undergone elective CS, emergency antepartum or intrapartum CS; multivariate analysis was then performed to define the risk factors associated with intrapartum CS. RESULTS: Cesarean sections accounted for 34.5% of all deliveries performed during 2006, of which 42.1% were elective CS, 21.1% emergency antepartum CS, and 36.8% intrapartum CS. The principal reason for CS delivery was previous CS in elective CS, gestational hypertension in emergency antepartum CS, and cardiotocographic alterations in emergency intrapartum CS. Multivariate logistic regression analysis showed that the independent risk factors for intrapartum CS were excessive weight gain during pregnancy and medically induced labor. CONCLUSION: A more accurate evaluation of the mother's and neonate's needs could help to improve the current rates of CS. This could be achieved by selection of cases in which there is a real need for CS and by acting on modifiable risk factors of intrapartum CS such as excessive weight gain during pregnancy.

[Outcome of pregnancy for immigrant women: a retrospective study]. / L'outcome della gravidanza nella donna immigrata: studio retrospettivo.

AIM: Italy is experiencing a continuous increase in female immigration and, as a consequence, the number of births by immigrant mothers. The objective of our study was therefore to compare indices for maternal-foetal wellbeing as regards immigrant as opposed to autochthonous pregnant women. METHODS: An analysis was made of CEDAP data from 2001 to 2008 concerning parturients at Udine Obstetric and Gynaecological Clinic, DRG clinical data for 2008 and clinical records for 2008 of foreign parturients: the focus was on which geographical area they came from, hypertensive and metabolic symptoms during pregnancy, maternal serology, gestational period up to childbirth, weight at birth, Apgar index, duration of hospitalisation for the mother and infant. RESULTS: The study covered 13,352 women of whom 2,139 were foreigners, while 363 of the latter gave birth in 2008. In terms of geographical area the largest group of immigrants came from Eastern Europe, followed by sub-Saharan African and Arab countries. The worst outcome of pregnancy was found in African women, who showed the highest incidence of chronic hypertension, pregnancy-induced hypertension and pre-eclampsia and they also developed gestational diabetes more frequently, although a high incidence was also seen for Eastern European and Arab women. Furthermore, African women were found to be HIV-seropositive more frequently, showed a greater tendency to preterm or severely preterm birth, with a significantly lower weight and Apgar at birth compared to all other immigrant women. As a result, African women and infants remained in hospital for a longer period. CONCLUSION: Monitoring, both pre-conceptional and during pregnancy, needs to be intensified, especially among African mothers, in order to reduce the maternal-foetal disadvantage when compared to other women.

Pregnancy after kidney transplantation: two transplantation centers--Vicenza-Udine experience.

BACKGROUND: Pregnancy after kidney transplant has become possible thanks to the recent surgical and pharmacological breakthrough. MATERIALS AND METHODS: We performed a retrospective study including all childbearing women transplanted in our centers after 1997. The following variables were analyzed: type of nephropathy, patient age when dialysis started, age at transplantation, time between dialysis and transplantation and between transplantation and baby birth. We also considered immunosuppressive therapy, type of delivery, baby weight, Apgar score, and mother and baby follow-up. RESULTS: We followed up 13 pregnancies in 12 patients who were diagnosed with chronic pyelonephritis (n = 4), postpartum cortical necrosis (n = 1), immunoglobulin A GN (n = 4), diabetic nephropathy (n = 1), unknown nephropathy (n = 2). All patients received a cadaveric donor kidney. They were treated with calcium antagonists and alfamethyldopa for their high blood pressure. We observed 9 mother complications: nonnephrotic proteinuria (n = 1), urinary tract Infection (n = 1), pre-eclampsia (n = 4), internal placenta detachment (n = 1) and spontaneous abortions (n = 2); 4 fetal complications: IUGR (n = 2), acute distress respiratory syndrome (n = 1), Klinefelter syndrome (n = 1) and preterm births (n = 4). In 2 cases the child weight was lower when compared to the gestational age, and 5 babies were admitted to the neonatal intensive care unit. The mother's follow-up showed no acute rejection episodes. Breastfeeding was discouraged due to the transmission of immunosuppressive medications into breast milk. We did not observe significant disease upon child follow-up. CONCLUSION: Our data were in agreement with the literature confirming that pregnancy after kidney transplant though possible carries elevated risks. Patients therefore are referred to highly specialized centers where obstetricians, nephrologists, intensivists, and neonatologists provide surveillance and treatment.

[Intrahepatic cholestasis of pregnancy: diagnosis and obstetric management]. / Colestasi intraepatica della gravidanza: diagnosi e management ostetrico.

AIM: The aim of this study was to suggest a possible obstetric management of patients with intrahepatic cholestasis of pregnancy (ICP). METHODS: We performed a retrospective analysis enrolling 44 women with ICP deliveries at our Obstetrics and Gynaecology clinic of the University of Udine between January 2005 and July 2008. Data on patient age, body mass index, weight, gestational age, parity, symptoms, comorbidity, value of liver test, APGAR score and fetal weight were prospectively recorded in a computed database and clinical folder. RESULTS: The intensification of maternal and fetal surveillance in patients with ICP (liver function tests, ultrasound and cardiotocography), can significantly reduce perinatal mortality (no case of stillbirth in ours study) but, inevitably, increases the cesarean delivery rate (65.1%), the induction of labor rate (38.4%) and the preterm delivery rate (58.13 %, median gestational age 35 sg+/-1.46). CONCLUSION: Obstetric management of ICP consist of weighing the risk of premature delivery against the risk of sudden death in utero. To date, no ideal method of fetal surveillance has been determined for ICP; the intrauterine deaths are thought to occur suddenly and fetal cardiac monitoring cannot forecast an acute event. Nevertheless, we think that a management strategy, inclusive of induction of labor at 37 weeks, can reduces the risk of fetal death. In most severe cases, no responsive to ursodeoxycholic acid and S-adenosylmethionine treatment, delivery has been initiated even before the 37 weeks, as soon as lung maturity has been established.

[Knowledge of HPV-related genital lesions and of anti-HPV vaccination in a sample of women of north-eastern Italy]. / Conoscenza delle patologie genitali HPV-correlate e sul vaccino anti-HPV in una popolazione femminile del nord-est italiano.

AIM: Knowledge of human papilloma virus (HPV) infection and related genital lesions and vaccine is related to the success of the vaccination program. Authors have assessed knowledge, attitudes and beliefs on HPV and vaccination in a sample of women, in order to optimize any educational interventions. METHODS: This study enrolled 212 consecutive women with no history of HPV-related genital lesions by means of an anonymous questionnaire. The questionnaire included 21 questions (19 with a multiple choice and 2 with open answers) to check awareness of HPV infection and related lesions, HPV transmission, vaccine and vaccination program expectations, sexual/precautionary behaviours after vaccination and the need felt for more information. RESULTS: Forty-two percent of women in the study population know about HPV-related genital lesions, and 43% are aware of the right way of transmission; 75% have learned about the vaccine. In this last group 28% know that the vaccine efficiency is mainly limited to the HPV types included in the vaccine, 19.8% know that one of the vaccines can also prevent genital condylomata and 88% have heard about this vaccination program. CONCLUSIONS: There is still a lack of information or access to information about HPV and more needs to be done to raise awareness of HPV vaccination. A percentage of 74.4 of women wish to receive more information and thinks that schools and family planning clinics should play a central role in teenagers' health education. There is a need to further train healthcare workers involved in the vaccination program in order to optimize their counselling to teenagers and parents.