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Aim: The aim of this study was to compare the effects of a dietary supplementation with oral probiotic, and the treatment with vaginal clindamycin in pregnant women with bacterial vaginosis., Methods: Fourty pregnant women, with a diagnosis of bacterial vaginosis according to the Amsel criteria, were enrolled between the 10th and the 34th week of gestation. The patients were randomized in two groups. Patients in the group A were treated with probiotic orally (VSL3® Ferring), 2 tablets a day for 5 days, followed by 1 tablet daily for 10 days. Patients in group B were treated with vaginal clindamycin 100 mg daily for 15 days. After 5-10 days from the end of the treatment the patients returned for the follow-up., Results: After treatment the vaginal discharge was completely absent in group A, and reduced in group B. The itching occurred only in 10% of patients in each of the two groups. The improvement of constipation occurs only in the group A (P=0.002). Vaginal swabs resulted negative in both groups in particular for Gardnerella V., Conclusion: The oral treatment with VSL#3® is effective in the treatment of VB in pregnant women as a topical treatment with clindamycin. In particular for the resolution of leukorrhea, itching and in particular in the bacterial vaginosis caused by Gardnerella V.

Aim: Aim of this study is to report our preliminary experience with a minimally invasive surgical procedure using transobturator approach., Methods: We enrolled in our study 19 patients with stress urinary incontinence and urethral hypermobility without genital prolapse. All patients underwent suburethral transobturator tape (TOT) procedure. Four patients underwent previous surgical procedure for incontinence (3 Kelly and 1 Burch). No patients reported previous major gynaecological surgery. Mean age was 58.68 years (range 36-75). The sling was placed according to the technique described by Delorme., Results: Mean operating time was 21 min (range 14-48). No bladder lesions or intraoperative complications occurred. Fifteen patients were dismissed the same day of surgery. Mean hospital staying was 1.4 days (range 1-5). No infections, erosions or sieromas have been observed., Conclusions: Our experience shows as TOT technique is extremely rapid, reproducible and with a very short learning curve. The transobturator approach avoids the risk of bladder, bowel or vascular injuries. Compliance and patient satisfaction have been very encouraging, restoring a real functional well-being. However, the small number of patients in our study and the short follow up do not actually allow us to draw definitive results and further studies are needed to confirm the technique success.

Background: In this study we report our experience about hysterosonography and its use for the diagnosis of benign uterine pathology in premenopausal women referred to our Hospital., Methods: From May to October 2000, 58 patients underwent transvaginal sonohysterography. They referred to our Ultrasonography Center because of sterility, intermenstrual bleedings, menometrorrhagias or anomalous endometrial echopatterns which had been found by basal transvaginal ultrasound examination. All patients were in fertile age and were examined during the follicular phase of the ovarian cycle. The hysterosonographic examination consisted in introducing 20 cc of a physiological solution by catheter with inflating balloon for hysterosalpingography and assessment of the uterine cavity was possible thanks to the acoustic window created by the fluid which gradually distended the cavity itself. We considered as failures of the techniques those cases in which the profile of endometrial cavity was not clearly visualized., Results: Sonohysterography was performable in 52 of the 58 patients. The failure of examination in 3 cases was due to inadequate distention of the uterine cavity, in 2 cases to cervical stenosis and in 1 case to the reflux of the contrast medium. Diagnosis effected with sonohysterography revealed 3 uterus bicornis, 16 endometrial polyps and 9 submucosal myomas. No ultrasound anomalies were found in 23 patients. All the women underwent a subsequent hysteroscopy which confirmed our ultrasound diagnosis., Conclusions: Our study shows that sonohysterography allows to obtain a precise diagnosis of benign uterine pathology, which generally basal transvaginal ultrasonography can only suspect. The applicability of positive and negative predictive values, of the sensitivity and specificity is limited by the small number of cases included in the study. The role of sonohysterography is more difficult to define when compared to hysteroscopy. The conclusion is drawn that this new method offers an important aid for gynecological diagnosis of benign pathology.

Vesicouterine fistula is rare, accounting nearly 4% of all urogenital fistulas. Cesarean delivery through uterine lower segment is the main predisposing event but in the last years other possible predisposing factors have been pointed out. Clinically, it can occur in different forms and the diagnosis is often delayed although it is not difficult. In this study personal experience in a case of postcesarean vesicouterine fistula arisen on a focus of bladder endometriosis is reported and an eventual hypothetical pathogenetic correlation between bladder endometriosis and vesicouterine fistula is discussed.

The criteria, which a modern obstetric department is based on, are to deliver serenely and naturally according to the mother's personal exigencies and preserving the child's right to his/her own safety. The attempt to offer the woman a natural place with respect for these principles has improved the knowledge about the physiologic changes of the female organism during labour and water birth. Our experience about water birth began on 1st of July 2000, the day of the inauguration of the new birth room of the maternal-infantile department of the hospital of Lavagna. We nursed 15 women during labour and water birth, 11 were multiparas, 4 were primiparas, the average age was 31-year-old. We used the existing criteria of maternal and fetal selection for the care of physiologic water birth with a low risk. Particularly, the fetal heart rate was monitored at least for 30 minutes before the immersion into water and then at scheduled intervals during labour. To this purpose we used a cardiotocograph provided with an ultrasound probe (with high density of crystals) and with a toco (with high sensitivity), both waterproof and wireless. In our sample the episiotomy was not performed and 3rd degree lacerations did not happen. The neonatal average weight was 3100 gr for the primiparas and 3040 gr for the multiparas, respectively. The Apgar measurement was never lower than 8. The average time of labour was 6 hours for the group of the primiparas and 4.25 hours for the multiparas, respectively. In conclusion the monitoring of fetal welfare during water labour does not substantially differ from the monitoring of traditional labour, but it requires specific equipments.

We report making the prenatal diagnosis of thanatophoric dysplasia without "cloverleaf" skull at 21 weeks gestation. The ultrasound examination showed short and bowed limbs, narrow thorax, and large head. Radiological and histological studies confirmed the aborted fetus to be affected with thanatophoric dysplasia. The differential prenatal diagnosis with other skeletal dysplasias is discussed.