Cervical cerclage has always been the main treatment option in cases of so-called cervical insufficiency, a condition that is notoriously associated with a high risk of second trimester abortion and/or preterm delivery. We can distinguish between a prophylactic cerclage, to be performed electively, usually at 13-16 weeks gestation, only when the woman has a history extremely suggestive for cervical incompetence (3 or more mid-trimester abortions or preterm deliveries) and a therapeutic cerclage. This last cerclage is recommended either for women who have ultrasonographic changes consistent with a short cervix or the presence of funneling after the 16-20 weeks gestation (urgent cerclage) and for women who present the asymptomatic dilation of the uterine cervix of at least 2 cm and/or a prolapse of the amniochorial membranes (emergent cerclage). So far there is still a lack of controlled and randomized trials that can unquestionably demonstrate the advantages of the cervical cerclage in comparison with a ''wait and see'' aptitude. The cerclage can be performed either transvaginally, usually according to the McDonald technique, or transabdominally. This last approach is recommended when a transvaginal cerclage has to be avoided because of technical difficulties depending on the conditions of the cervix or when the pregnant woman has a history of one or more failed transvaginal cerclages. Interesting perspectives are currently offered by the laparoscopic cerclage, a method that has been effective and unexpectedly safe till now.
The study examined the response to stress of a particular type of intrauterine device (MLCu 250) which had already been evaluated due to a supposed tendency to intracavity fragmentation. The study, which was carried out using original equipment specially designed for this experiment, highlights a reduced resistance to mechanical stress in both new IUDs and in those already subjected to several months' use.
The Adjusted Contraceptive Score (ACS), a new scoring method that was designed to help health providers and acceptors to select the most appropriate behavioral or barrier contraceptive method, was found to positively affect contraceptive performance. In this study, 100 women who applied to an Italian clinic for contraceptive counseling were administered the ACS and 100 controls also attending the clinic were given conventional contraception counseling. The following methods were available to cases and controls: diaphragm, condom, basal temperature, Billings method, Ogino method, and coitus interruptus. At a follow-up interview 12-15 months after the initial clinic visit, study participants were questioned about the number and type of contraceptive methods they had been using. Cases who were administered the ACS reported a significantly lower number of contraceptive choices at follow-up (150 choices total) compared with at the initial visit (224 choices) or the number reported by controls at follow-up (181 choices). Also recorded among those administered the ACS were reduced use of coitus interruptus and the Ogino method and increased reliance on the diaphragm and basal body temperature. Moreover, the occurrence of pregnancy in the follow-up period was markedly less among women administered the ACS (4.2%) than among controls (10.8%). Use of the ACS thus appears to represent a means of achieving effective fertility control among women who cannot use oral contraceptives or the IUD.
Chlamydia-positive genitourinary infections are common causes of male and female infertility. Semen abnormalities are often associated with Chlamydia infections. A large population of male patients, admitted to our clinic for genitourinary infection, were examined for genitourinary pathogens, including Chlamydia, and for semen abnormalities. There were higher abnormalities semen in Chlamydia-infected patients than either non-Chlamydia-infected or healthy controls. Chlamydia therapy by antimicrobial agents improved semen characteristics. Chlamydia infection contributes to seminal fluid abnormalities and probably to male infertility. A search for chlamydial infection is warranted whenever semen abnormalities are noted. An antimicrobial therapy improves semen quality when effective in eradicating Chlamydia.
Recently, within the wide subject on vaginal phlogosis a new pathology has been included. Owing to its peculiar characteristics, as it is not to be regarded as a vaginitis in the strict sense of the word, it has been identified as anaerobic bacterial vaginosis. The latter proves to be different from most common vaginitis related pathologies as a result of a series of microbiological and clinical patterns that are widely dealt with in this research. Moreover, the author place special emphasis on the diagnostic and therapeutic aspects of vaginosis.
