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Objective  To systematically evaluate pregnancy and labor course, obstetrical complications, and maternal and neonatal outcomes in women with endometriosis, stratifying according to the specific location of the disease. Study Design  We retrospectively analyzed our prospectively maintained obstetrical database from January 2011 to August 2014 to identify all women with a previous histological diagnosis of endometriosis who delivered at our institution (cases). We divided the cases according to the specific location of the disease (deep infiltrating endometriosis, ovarian endometriosis, and peritoneal endometriosis). As controls, we identified all unaffected women who delivered in the year 2013. To avoid the confounding effect of parity, we limited our analysis to nulliparous women. Results  A total of 118 nulliparous women with endometriosis and 1,690 nulliparous controls were identified. Women with endometriosis were significantly older, had a lower body mass index, and had a higher incidence of assisted reproductive technology. The duration of pregnancy was significantly shorter among women with endometriosis. A higher incidence of placenta previa (3.4 vs. 0.5%; p  = 0.006), hypertension (11 vs. 5.9%; p  = 0.04), cesarean section (41.5 vs. 24.2%; p  < 0.0001), and vacuum delivery (10.1 vs. 2.9%; p  = 0.006) was found in women with endometriosis. Neonatal outcomes were similar between groups. The incidence of placenta previa in patients with deep endometriosis was 11.7 versus 0.5% among controls (p  < 0.0001), whereas in women with ovarian and peritoneal endometriosis, it was similar to the controls. Conclusion  Women with endometriosis have a higher incidence of vacuum delivery, cesarean section, and placenta previa compared with unaffected women. The higher risk of placenta previa is attributable exclusively to women with deep endometriosis. Neonatal outcomes are unaffected by the presence of the disease. [ABSTRACT FROM AUTHOR]

Objective  This study was aimed to investigate the effects of physical activity on perineal outcomes at delivery according to the different levels and types of maternal physical activity before and during pregnancy. Study Design  We prospectively evaluated the obstetrical and perineal outcomes of all consecutive women who delivered at the Del Ponte Hospital, in the period between July 2014 and September 2014. Women were divided into three groups according to the features of physical activity performed before pregnancy: group 1: "very sporty women," group 2: "moderately sporty women," and group 3: "inactive women." A subanalysis of our data was performed based on the specific type of sport activity, on the degree of involvement of perineal muscles during physical activity, and on the continuation/discontinuation of this activity during pregnancy. Results  A total of 135, 84, and 85 women were included in group 1, group 2, and group 3, respectively. The demographic characteristics were comparable among all the groups. Sport activity during pregnancy was more frequent in groups 1 and 2 (59.3 and 53.6%, respectively, vs. 29.4% in group 3; p  = 0.003). No differences among groups were detected in terms of perineal outcomes. A lower rate of episiotomy/lacerations ≥ 2nd degree was found among women who practiced sports that specifically involved the perineal muscles and who continued this practice during pregnancy. Conclusion  Perineal outcomes are not influenced by the intensity of sport activity performed before/during pregnancy. Continuous sports during pregnancy that specifically train the perineal muscles are associated with a lower rate of episiotomy and perineal lacerations ≥ 2nd degree. [ABSTRACT FROM AUTHOR]

The article discusses clinician perspectives on hysterectomy versus uterine preservation in pelvic organ prolapse surgery. It emphasizes the importance of proper counseling and shared decision-making to improve patient satisfaction and clinical outcomes. The authors agree with the proposed 4P model as a valuable tool for gynecologists in clinical practice. The study was conducted by researchers from the Department of Obstetrics and Gynecology at the University of Verona in Italy. [Extracted from the article]

Objectives: To report the first cases of surgical staging for apparently early-stage endometrial cancer performed using the Versius® next-generation robotic surgical system (Cambridge Medical Robots [CMR] Surgical, Cambridge, UK)., Design: Prospective case series. Participants/Materials: Women who underwent surgical staging, including total hysterectomy, bilateral adnexectomy, and sentinel lymph node (SLN) biopsy, for apparently early-stage endometrial cancer using the Versius® next-generation robotic surgical system (CMR Surgical, Cambridge, UK)., Setting: Gynecologic oncology referral center., Methods: We prospectively recorded data of all consecutive women who underwent the investigated surgical procedure., Results: Fourteen endometrial cancer patients were treated between March and August 2024 at the Azienda Ospedaliera Universitaria Integrata of Verona. The mean age was 69.4 ± 8.7 years, and the average body mass index was 27.2 ± 4.8. SLN biopsy was performed in all patients: 5 patients had unilateral and 9 bilateral successful SLN detection; 6 women underwent systematic pelvic lymphadenectomy in the unmapped areas. The median operative time was 122 (min-max, 77-185) minutes, and the median hysterectomy time was 34 (min-max, 18-68) minutes. None of the surgical procedures required conversion to conventional laparoscopic or open surgery for technical reasons, and no intraoperative complications were recorded. No readmissions, reoperations, or deaths were observed during the follow-up (median 102 days, min-max 39-249)., Limitations: First experience in a limited study population and use of methylene blue for SLN mapping., Conclusions: Our preliminary results with the Versius® platform appear encouraging regarding surgical time, blood loss, rate of completion of the robotic procedures, and complications risk. Further studies will confirm the indications, feasibility, and safety of the Versius® surgical robot system for treating apparently early-stage endometrial cancer., (S. Karger AG, Basel.)

Background: The optimal duration of second stage of labor has been largely discussed in literature, but there are no uniformly accepted contemporary criteria for defining normal or abnormal length. Available evidence suggests that longer duration of second stage of labor is associated with a lower rate of spontaneous vaginal delivery and increased maternal morbidity. On the neonatal side, it seems that longer second stage doesn't affect new-born morbidity, in a context of very rare neonatal complications., Objectives: To investigate the association between the second stage of labor management and maternal and neonatal outcomes., Study Design: This is a retrospective multicenter study involving all consecutive singleton term pregnancies who reached the second stage of labor between January and December 2022 at two third level maternity Hospitals. We compared an interventional management (considering operative vaginal delivery after 30 min of pushing) adopted at Robert Debre Hospital in France, and an expectant management (up to 1-2 h of pushing based on parity) adopted at AOUI Verona in Italy. Propensity score matched 1:1 analysis was implemented. The association between the second stage of labor management and maternal and neonatal outcomes was tested by conditional logistic regression, overall and stratified by parity., Results: The propensity score matching (1:1) identified 1,168 matched couples of women. The interventional management was associated with a higher use of operative vaginal delivery (OR 2.3, 95 %CI 1.8-2.9) and episiotomy (OR 1.4, 95 % CI1.1-1.8), and a lower risk of severe postpartum hemorrhage (OR 0.1, 95 %CI 0.05-0.3) and cesarean section among nulliparous (OR 0.4, 95 % CI 0.2-0.9). No association with perineal lacerations, neonatal outcomes, and major maternal morbidity was observed., Conclusions: The interventional management was associated with lower risk of postpartum hemorrhage in all patients and cesarean section among nulliparous women, but higher operative vaginal delivery and episiotomy use, without clinical advantages for the newborn. To support one approach over the other, additional factors should be considered, such as women's preferences and expectations, obstetricians' skills, and medicolegal context., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: The chemotherapy response score (CRS) has been developed for measuring response to neoadjuvant chemotherapy in tubo-ovarian high-grade serous carcinoma. This study aimed to validate the ability of this three-tier scoring system of pathologic response on omental specimens to determine prognosis in a subgroups of patients who had clinical complete response to neoadjuvant chemotherapy., Methods: This was a retrospective study, conducted in women receiving interval debulking surgery at the Division of Gynecologic Oncology, between December 2007 and April 2017. Inclusion criteria were: high-grade serous ovarian cancer, FIGO stage IIIC/IV, platinum-based neoadjuvant chemotherapy, and clinical complete response after neoadjuvant chemotherapy (normalization in CA125 levels, disappearance of all target and non-target lesions according to RECIST 1.1). CRS was defined by a single pathology review and classified as previously reported: CRS1, no or minimal tumor response with fibroinflammatory changes limited to a few foci ranging from multifocal or diffuse regression-associated fibroinflammatory changes with viable tumor in sheets, or nodules to extensive regression-associated fibroinflammatory changes with multifocal residual tumor; CRS2, appreciable tumor response with viable tumor readily identifiable; and CRS3, complete absence of tumor or nodules with maximum size of 2 mm. CRS was analyzed according to clinical variables and survival., Results: A total of 108 patients were eligible for analysis. The average age was 65 (range 36-85) years. A total of 91 (84.3%) patients had stage IIIC disease and 17 (15.7%) patients had stage IV disease. No statistically significant differences were observed in terms of age, FIGO stage, CA125 serum levels, type of chemotherapy schedules, and number of cycles between the three groups. Patients in the CRS3 group had a longer median progression-free survival (25.8 months) compared with CRS2 or CRS 1 (20.3 vs 17.4 months, respectively; p=0.001). Median overall survival was 68.9 months for CRS3, 35.0 months for CRS2, and 45.9 months for CRS1 (p=0.034)., Conclusion: Complete or near-complete pathologic response assessed in the omental specimens of advanced epithelial ovarian carcinoma patients after neoadjuvant chemotherapy (CRS3) is predictive of prolonged progression-free and overall survival. In particular, this is true in women with a clinical complete response., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2020. No commercial re-use. See rights and permissions. Published by BMJ.)