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The physiological function of fetal hiccup and its correlation with fetal well-being is a debated topic. We conducted a prospective observational study in a Tertiary care University Hospital to correlate the fetal hiccups with the antepartum computerized cardiotocography parameters. Fifty-one nonlaboring women with a term pregnancy were en-rolled. We collected data regarding maternal perception of fetal hiccups and the computerized cardiotocographic examination. The pregnant were divided into three groups depending on fetal hiccups perception. There was a statistical difference for the number of fetal movements in an hour between the group of daily perception and the group of no perception. Changes in fetal movements frequency are essential to recognize pregnancies at increased risk for adverse fetal outcomes. No one studies in the medical literature utilized the computerized cardiotocographic machine to explore fetal hiccups. Then our study showed that a mother with daily fetal hiccups could be considered a low risk considering the significant numbers of fetal movements revealed by computerized cardiotocography. Nevertheless, randomized controlled trials are required to evaluate the fetal hiccups evaluation and its influence on fetal outcomes.

Aim: To assess the efficacy and safety of tension-free vaginal tape-obturator (TVT-O) 13 years after implantation for the treatment of female pure stress urinary incontinence (SUI). This is the longest-term evaluation available of TVT-O outcomes. Methods: A multicenter, prospective study was conducted in five tertiary referral centers in three countries. All consecutive women with urodynamically proven pure SUI treated by TVT-O were included. Data regarding subjective outcomes (International Consultation on Incontinence Questionnaire-Short Form, Patient Global Impression of Improvement, and patient satisfaction scores), objective cure (stress test) rates, and adverse events were collected during follow-up. Univariable and multivariate analyses was performed to investigate outcomes. Results: One hundred sixty-eight women had TVT-O implantation. At 13 year after surgery, 150 of 157 patients (95%) declared themselves cured (P =.8). Similarly, at 10-year evaluation, 148 of 160 patients (92%) were objectively cured. No significant deterioration of objective cure rates was observed over time (P =.1). The multivariate analysis showed that previous anti-incontinence procedures and obesity independently predicted the subjective (odd ratio [OR]: 6.2 [95% confidence interval [CI], 1.8-13.6]; P =.02 and OR, 1.8 [95% CI, 1.3-3.0]; P =.03, respectively) and objective failure of TVT-O (OR, 5.8 [95% CI, 1.6-13.2]; P =.02 and OR, 1.6 [95% CI, 1.2-3.2]; P =.03, respectively). We found four cases of sling exposure; all of them occurred after the 10-year follow-up. Conclusions: The 13-year results of this study showed that TVT-O is a highly effective and safe option for the treatment of SUI. We found that there is a significantly higher risk of having a sling exposure over 10 years after the procedure; however, the incidence is very low. © 2020 Wiley Periodicals, Inc.

Human papilloma virus (HPV) infection persistence is responsible for modifications that will lead to progression to a pre-neoplastic cervical lesion. This study examined persistence or clearance of HPV infection related to genotypes and to risk factors, like patients' age, smoking habit, and use of oral contraceptives. The data of 90 patients, who had a positive high risk-HPV (HR-HPV) test for more than 18 months irrespective of the genotype, were taken from the pathology database of the Colposcopy Clinic and the presence of HPV was assessed by the linear array test which utilized amplification of target DNA by polymerase chain reaction (PCR) and nucleic acid hybridization. During the first visit a careful anamnesis was taken, with information about lifestyle. Clearance was observed in 25% of infections by low risk genotypes and in 43% of which by high risk and, among high oncogenic risk genotypes, HPV 16, 31, 33, 35, 39, 45, 51, and 59 were mostly associated to persistence of infection. Among persistent HPV infections, progression occurred with HPV16 in 50% of cases, with HPV18 in 44.4% of cases, with HPV31 and HPV35 in 33.3% of cases, with HPV33 in 28.5% of cases, with HPV45 in 41.7% of cases, with HPV51 in 25% of cases, and with HPV59 in 20%. There was no statistically significant difference between persistence of high risk and low risk genotypes and a significant association with the cited risk factors. A long period of follow- up, HPV-DNA detection by PCR, and the study of risk factors could lead to improve the diagnosis of persistent HPV infections.

Background Inside-out transobturator tape (tension-free vaginal tape–obturator [TVT-O]) is currently one of the most effective and popular procedures for the surgical treatment of female stress urinary incontinence (SUI). However, data reporting long-term outcomes are lacking. Objective To assess the efficacy and safety of TVT-O 10 yr after implantation for the treatment of female pure SUI. Design, setting, and participants A multicenter, prospective study was conducted in five tertiary referral centers in three countries. All consecutive women with urodynamically proven pure SUI treated by TVT-O were included. Patients with mixed incontinence and/or anatomic evidence of pelvic organ prolapse were excluded. Intervention TVT-O implantation. Outcome measurements and statistical analysis Data regarding subjective outcomes (International Consultation on Incontinence Questionnaire–Short Form, Patient Global Impression of Improvement, and patient satisfaction scores), objective cure (stress test) rates, and adverse events were collected during follow-up. Univariable analysis was performed to investigate outcomes. Results and limitations One hundred sixty-eight women had TVT-O implantation. At 10-yr follow-up, 160 patients (95%) were available for the evaluation. We did not find any significant change of the surgical outcomes during this time. At 10 yr after surgery, 155 of 160 patients (97%) declared themselves cured (p = 0.7). Similarly, at 10-yr evaluation, 148 of 160 patients (92%) were objectively cured. No significant deterioration of objective cure rates was observed over time (p = 0.4). The history of failure of previous anti-incontinence procedures (hazard ratio: 5.34; 95% CI, 2.61–11.9; p = 0.009) was the only predictor of recurrence of SUI. The onset of de novo overactive bladder was reported by 23 of 160 patients (14%) at 10-yr follow-up. No other late complications were reported. Conclusions The 10-yr results of this study showed that TVT-O is a highly effective and safe option for the treatment of SUI. Patient summary At long-term follow up, tension-free vaginal tape-obturator is highly effective and safe for the treatment of stress urinary incontinence. © 2016 European Association of Urology

Aim: Pelvic floor muscle training (PFMT) is classified with a level 1 evidence and a grade A recommendation, but long term effects have not been studied thoroughly. This study aims at assessing the long-term effectiveness of perineal rehabilitation on patients with mild prolapse and pure stress urinary incontinence (IUS) symptoms. Methods: Retrospective observational study on 49 patients examined at the beginning of the observation and 60 months after receiving biofeedback assisted PFMT. We created two groups. Group A: 27 women with mild symptoms of prolapse and pure mild IUS; Group B: 22 symptomatic patients postsurgery. We considered as therapeutic success a 50% general reduction of the symptoms experienced by the patients in terms of reduction of leakage episodes, number of pads used, strength and endurance of the pubococcygeus muscle and initial prolapse signs/symptoms. Results: Group A (follow-up 60 months): Reduction of prolapse symptoms: cured/much improved: 65% (17 patients); worse: 22.4%(6 patients); unchanged: 18.5% (5 patients); reduction of urinary symptoms: cured/much improved: 59.3% (16 patients); surgery: 40.7% (11 patients); group B (follow-up 60 months); cured: 55.5% (12 patients); much improved: 44% (10 patients) Conclusion: In conclusion, as for the treatment of menopausal patients with symptoms of mild disorders of the urinary/genital system, excellent results were reported in women underwent rehabilitation, as a first approach or after failed TVT-O.

Object: Apelin is an endogenous ligand of the human orphan receptor APJ. Apelin is involved in the regulation of blood pressure, blood flow and central control of body fluid homeostasis in different organs. In placenta vasculogenesis, blood pressure and flow are dramatically important to allow a normal embryonic and fetal growth and development, the aim of the present study was to investigate the immunohistochemical distribution of apelin and APJ in normal placentae throughout pregnancy and in preeclamptic placentae. Methods: Samples from first trimester were obtained from uterine evacuations (n=15) with a gestational age from 5 to 14 weeks, samples from third trimester were obtained from cesarean sections (n=15) with a gestational age from 28 to 40 weeks. Samples of pregnant patients with pre-eclampsia were obtained from cesarean delivery (n=15) and gestational age ranged from 35 to 40 weeks. All the collected specimens were immediately fixed in formalin for immunohistochemistry. Results: We observed a decrease of apelin expression from first to third trimester of gestation in placental cells and stroma of placental villi, in contrast with an increased expression of APJ expression in the cytoplasm of cytotrophoblast cells and in the cytoplasm of endothelial cells. In contrast, in preeclampsia-complicated placentae we observed an intense expression of both apelin and APJ receptor in all placental compartments. Conclusions: Our data seem to confirm that apelin and APJ might play a role in the regulation of fetal development regulating a correct formation of human placenta during gestation. Moreover, their strong expression in preeclampsia-complicated placentae probably suggest their involvement in the onset of this pathology. © Copyright 2006, CIC Edizioni Internazionali, Roma.

The development of thrombotic disorders is a major threat for young women during pregnancy. It is one of the main causes of pregnancy-related disorders, which may also result in harm for the conceptus. Successful pregnancies require an even balance of coagulation and fibrinolysis, in order to secure stabilization of the basal plate as well as adequate placental perfusion. Broad spectrum assays which measure a range of thrombin/fibrin formation in serum have become an established means of identifying activation of blood coagulation and/or fibrinolysis. There is considerable interest in the application of these assays to the diagnosis of other hypercoagulable states, such as thrombophilia during pregnancy. We investigated coagulation/fibrinolysis parameters for significant differences between pregnant women during their gestation (first, second and third trimester) with or without pregnancy loss and healthy nonpregnant women.Thirty-nine pregnant women, aged 24-39 years, were studied. They were subdivided according to pregnancy trimester: 15 patients in the first trimester; 13 in the second and 11 in the third. The selection of patients was carried out in cooperation with the Transfusion Center of the Second University of Naples in order to obtain a homogeneous sample group. The control group included 400 healthy patients. Biochemical and blood coagulation tests were performed for each patient and the results obtained were compared with the control group.A decrease in free protein S (PS) and fibrinolysis (t-PA/PAI-1) activities and an increase in Factor VII, Factor VIII, prothrombin fragment 1+2 (F1+2), D-dimer (D-dimer) were observed in pregnant women during the follow-up of gestation. However, there were statistical differences between the groups of women with one or more pregnancy loss where it was found the lowest values in t-PA and PAI and the highest values in FVII and F1+2. Among subjects with more than one abortion, coagulation/fibrinolysis derangements before the partum were more prominent. A significant association exists between consecutive recurrent abortions and pregnancy complications such as placental abruption, hypertensive disorders and CS. This association persists after controlling for variables considered to coexist with recurrent abortions.These findings suggest that an excessive hypercoagulable state is associated with the termination of pregnancy resulting into a moderate risk for thrombosis during the different trimesters of pregnancy. The follow-up of fibrinolytic markers could represent a useful diagnostic tool for termination of pregnancy.

Single-incision mini-slings (SIMS) are new minimally invasive devices used for female stress urinary incontinence (SUI). To date, several SIMS are available, but few and uncontrolled comparative data have assessed their safety and feasibility. The aim of the present clinical study was to compare three different SIMS in an ambulatory setting.One hundred and twenty patients with SUI were randomized to receive three SIMS: Ajust, MiniArc, and TVT Secur System. Surgical data were compared.Significantly (P0.05) lower surgical difficulty and higher patient satisfaction were detected in the MiniArc group when compared to the Ajust and TVT Secur System groups. A significantly (P0.05) higher feasibility under local anesthesia and in ambulatory setting was also detected for the MiniArc group. The overall complication rate was significantly (P0.05) lower in the MiniArc group than in the TVT Secur System group.MiniArc is simpler to insert under local anesthesia and in an ambulatory setting. It is safer than the TVT Secur System, and is related to higher patient satisfaction.