TY - JOUR T1 - Intrapartum fetal heart rate monitoring interpretation in labour: a critical appraisal. JF - Minerva Ginecol Y1 - 2015 A1 - Maso, G A1 - Piccoli, M A1 - De Seta, F A1 - Parolin, S A1 - Banco, R A1 - Camacho Mattos, L A1 - Bogatti, P A1 - Alberico, S AB -

Electronic fetal monitoring (EFM) has been introduced in the obstetrics practice as a test to identify the first signs of fetal deterioration, allowing a prompt intervention to reduce neonatal morbidity and mortality. However, results from clinical trials fail to demonstrate a clear benefit with the use of EFM. No decrease in the incidence of cerebral palsy due to intrapartum asphyxia has been achieved and a significant increase in the rate of operative deliveries and in medico-legal litigations has been observed instead. Despite the lack of evidence supporting its safety and effectiveness, this method is routinely used in the clinical practice and periodical updated guidelines to standardize the method of interpretation and proper actions are proposed. However, limitations still exist and the unavoidable consequences are the increasing rate of caesarean delivery, partly due to a defensive attitude in medical choices, and medico-legal litigations for presumed inappropriate evaluation in case of perinatal adverse event. While Obstetrics Societies are trying to "fight" the rise in caesarean section rates, intrapartum EFM tracings are taken in the court proceedings as one of the main evidences in case of adverse event. The aim of this review is to discuss the limitations of guidelines dealing with intrapartum EFM and the pathophysiological basis to assess the suspicious tracings which represent the most observed and critical issue of EFM interpretation.

VL - 67 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25411863?dopt=Abstract ER - TY - JOUR T1 - Lactobacillus plantarum P17630 for preventing Candida vaginitis recurrence: a retrospective comparative study. JF - Eur J Obstet Gynecol Reprod Biol Y1 - 2014 A1 - De Seta, F A1 - Parazzini, F A1 - De Leo, R A1 - Banco, R A1 - Maso, G P A1 - De Santo, D A1 - Sartore, A A1 - Stabile, G A1 - Inglese, S A1 - Tonon, M A1 - Restaino, S KW - Administration, Intravaginal KW - Adolescent KW - Adult KW - Antifungal Agents KW - Candidiasis, Vulvovaginal KW - Clotrimazole KW - Female KW - Humans KW - Lactobacillus plantarum KW - Microbiota KW - Middle Aged KW - Probiotics KW - Recurrence KW - Retrospective Studies KW - Secondary Prevention KW - Vagina KW - Vaginal Creams, Foams, and Jellies KW - Young Adult AB -

BACKGROUND: Recurrence is a frequent complaint of patients with vulvovaginal candidiasis (VVC). Although the pathogenesis of VVC remains a controversial issue, disruption of the balance between the vaginal microbiota may facilitate overgrowth by Candida. Some probiotic bacterial strains can suppress Candida albicans; Lactobacillus plantarum P17630 is able to attach to vaginal epithelial cells and significantly reduce the adhesion of C. albicans.

OBJECTIVE: To evaluate the effect of the application of Lactobacillus plantarum P17630 in restoring the vaginal microbiota and prevention of relapses among women with acute VVC undergoing conventional (azole) local and main therapy.

METHODS: Retrospective comparative study. We recruited 89 women with a diagnosis of VVC, who were placed into two groups on the basis of reported treatment. The control group was treated with a daily dose of 2% clotrimazole vaginal cream at bedtime for 3 days, followed by vaginal application of a capsule containing lubricant once a day for 6 days and then once a week for another 4 weeks. The probiotic group was treated with the same azole-based protocol but followed by vaginal application of a capsule containing Lactobacillus plantarum P17630 (>10₈ CFU) once a day for 6 days and then once a week for another 4 weeks beginning the day following clotrimazole discontinuation. Clinical and diagnostic patterns were monitored for three months of follow-up.

RESULTS: At the end of study the probiotic-treated women showed a statistically significant increase in Lactobacillus values "+++" (80% versus 40%, p<0.001) and a better subjective resolution of symptoms such as vaginal discomfort described as burning or itching (90% versus 67.5%, p<0.03). Among controls there was a non-significant increase at 3 months of recurrence of infection, but a significant increase of women with value of pH=5 or >5.

CONCLUSION: Although the results of different studies are controversial, most have suggested use of probiotics in the prevention or treatment of VVC, and no adverse effects have been reported. Our data with L. plantarum P17630 (Gyno-Canesflor - Bayer) confirm the role of this specific strain as a potential empirical preventive agent for reducing vaginal discomfort after conventional treatment of acute VVC and shifting the vaginal milieu toward a predominance of lactobacilli with an improvement of the vaginal pH value.

VL - 182 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25305660?dopt=Abstract ER - TY - JOUR T1 - Pelvic inflammatory disease (PID) from Chlamydia trachomatis versus PID from Neisseria gonorrhea: from clinical suspicion to therapy. JF - G Ital Dermatol Venereol Y1 - 2012 A1 - De Seta, F A1 - Banco, R A1 - Turrisi, A A1 - Airoud, M A1 - De Leo, R A1 - Stabile, G A1 - Ceccarello, M A1 - Restaino, S A1 - De Santo, D KW - Chlamydia Infections KW - Chlamydia trachomatis KW - Female KW - Gonorrhea KW - Humans KW - Neisseria gonorrhoeae KW - Pelvic Inflammatory Disease AB -

Pelvic inflammatory disease (PID) is the most significant complication of sexually transmitted infections in childbearing-age women and it represents an important public health problem because of its long-term sequelae (chronic pelvic pain, tubal infertility, ectopic pregnancy). Prior to the mid 1970s PID was considered a monoetiologic infection, due primarily to Neisseria gonorrhea. Now it is well documented as a polymicrobial process, with a great number of microrganisms involved. In addition to Neisseria gonorrhea and Chlamydia trachomatis, other vaginal microrganisms (anaerobes, Gardnerella vaginalis, Haemophilus influenzae, enteric Gram negative rods, Streptococco agalactie, Mycoplasma genitalium) also have been associated with PID. There is a wide variation in PID clinical features; the type and severity of symptoms vary by microbiologic etiology. Women who have chlamydial PID seem more likely than women who have gonococcal PID to be asymptomatic. Since clinical diagnosis is imprecise, the suspicion of PID should be confirmed by genital assessment for signs of inflammation or infection, blood test and imaging evaluation. Laparoscopic approach is considered the gold standard. According to the polymicrobial etiology of PID, antibiotic treatment must provide broad spectrum coverage of likely pathogens. Early administration of antibiotics is necessary to reduce the risk of long-term sequelae.

VL - 147 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23007248?dopt=Abstract ER - TY - JOUR T1 - [Proteomic applications in gynecology-obstetrics]. JF - Minerva Ginecol Y1 - 2011 A1 - De Seta, F A1 - Banco, R A1 - Guaschino, S A1 - De Santo, D A1 - Turrisi, A A1 - Piva, C KW - Endometriosis KW - Female KW - Genital Diseases, Female KW - Genital Neoplasms, Female KW - Humans KW - Polycystic Ovary Syndrome KW - Pregnancy KW - Pregnancy Complications KW - Proteomics AB -

Proteomics has recently emerged as a powerful approach both for discovering biomarkers as well as for understanding the physiopathology of unclear gynecological-obstetrical disorders. Currently, several biological fluids and fetal tissues were successfully tested, including maternal plasma, amniotic fluid, cervical-vaginal fluid, urine, saliva, placental trophoblast, amnio-chorionic membranes and cord blood. The potential of proteomics on the polycystic ovary syndrome (PCOS) involves biomarkers discovery for a more accurate diagnosis of the syndrome and identification, within the patients with PCOS, those who respond more easily to treatment and those who will be at increased risk for future metabolic complications. The proteomic approach applied to patients with endometriosis would allow not only a non-invasive early diagnosis, but also a staging of the disease and a prediction of infertility risk. Proteomics also involves oncological field, in order to discover biomarkers that allow early diagnosis and prognosis of female genital malignancies. In addition to this, proteomics could be used to understand and predict obstetrical complications such as recurrent spontaneous abortion, preterm birth and preeclampsia. However, further studies are needed on a larger cohort of patients to introduce these biomarkers in clinical practice.

VL - 63 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21311419?dopt=Abstract ER -