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The last few weeks of pregnancy are critical to a baby's health because important organs, including the brain and lungs, are not completely developed until the end of pregnancy. The adverse events during labor and childbirth can have very serious physical, psychological and financial consequences for the child, the family, health professionals and the whole community. These events can be reduced through interventions aimed at improving the safety and quality of care, based on evidence-based knowledge, guidelines and practices that must be widely and effectively applied. This work reports the experience of the Lombardy Region on improvement actions in the obstetric and gynecological procedures for the reduction of adverse events and sentinel events through the monitoring and management of the RCGS trigger tool.

The need for contraception in a period of life characterized by irregular menstrual cycles as the perimenopause represents a social and biological event for each woman and a challenge for the gynecologist. The use of oral contraceptives in perimenopause has been vastly discussed in the last decade. Several investigators have focused their attention on the risks related to hormonal administration to older women neglecting all the advantages. The introduction of new lower-dose formulations and progestin-only preparations as implants or intra-uterine system has deeply changed the indications for hormonal contraception allowing their use in patients in whom it was previously contraindicated. Cumulative evidence has demonstrated that the use of hormonal contraception during the perimenopausal period does not offer only advantages in term of cycle control but also gives an important protection against the development of gynecological malignancies. However, in clinical practice the use of hormonal contraceptives in older women has not been accepted by a large number of physicians who continue to consider hormonal contraception in women over forties a tabù. The aim of this review is to discuss lights and shadows of the use of hormonal contraception in perimenopause.

The proper use of hormonal contraceptives represents an effective and safe prevention of unintended pregnancies which are still associated with morbidity and mortality. The side effects of the hormonal method are of concern to many young women even if a lot of adolescents are unaware of health benefits associated with their use except for those regarding menstrual disorders. Effective contraception improves health and may gives non contraceptives benefits such as a decreased risk of developing pelvic inflammatory diseases and improvement of endometriosis. However, incorrect or inconsistent use and discontinuation rate are higher in young girls than in older women determining a higher incidence of voluntary abortion. The use of hormonal contraception in adolescents is still a topic of discussion among medical practitioners. Adolescents require an accurate screening and a more frequent follow-up to reduce side effects and improve compliance and use.