Pregnant women's knowledge and behaviour to prevent cytomegalovirus infection: an observational study

OBJECTIVES

Congenital cytomegalovirus (cCMV) infection can negatively affect pregnancy outcomes, but may be prevented by simple precautions. Literature suggests that gynaecologists do not always adequately inform about preventive behaviour and most pregnant women have a low-level knowledge regarding cCMV infection. The aim of this study is to evaluate knowledge and risk behaviours related to cCMV infection in an unselected group of pregnant women.

METHODS

An institutional based cross-sectional study was conducted in three Maternal and Fetal Divisions in Rome between November and February 2019 on 296 pregnant women, their knowledge on cCMV was measured using six cytomegalovirus (CMV) related questions.

RESULTS

Out of the 296 respondents, 59.1% had heard, read or seen information about cCMV infection. Regarding the way of transmission, 96/296 (32.4%) correctly recognize children as a potential source of the infection but only 25/296 (8.44%) knew all prevention practices, 28/296 (9.5%) of women reported that they have never performed cCMV test during pregnancy.

CONCLUSIONS

The results of this survey show that knowledge on cCMV infection among pregnant women is poor. This highlights the need to improve counselling on all preventive practices for cCMV infection during perinatal care consultation.

Spontaneous Pregnancy after 4D-Hysterosalpingo-Sonography (HyCoSy) in the Same Menstrual Cycle: A Case Report and an Updating Review of the Current Literature regarding the Positive Impact of Tubal Flushing Effect on Fertility

Infertility is increasing worldwide, as well as in Italy, and fallopian tube pathology represents one of the most impacting causes of infertility for multiple women. Indeed, tubal patency assessment is a crucial step in medical evaluation for women attending an in vitro fertilization (IVF) center. Currently, different methods for tubal investigation are available, such as chromosalpingoscopy, hysterosalpingography (HSG), and hysterosalpingo-contrast sonography (HyCoSy). This diagnostic exam is performed by ultrasonography and an air-water-based contrast agent represented by air-water, or foam solution (HyFoSy). An additional side benefit of these assessment tests is a fertility-enhancing effect, thanks to a positive effect defined as "tubal flushing," which in current literature is more strongly associated with HyFoSy with respect to HyCoSy. In this report, we present a case of a 34-year-old woman presented to our attention at the Reproductive and Physiopathology Unit of Sandro Pertini Hospital, Rome, in 2023, with unexplained infertility for 3.1 years of free sexual intercourse with a partner who did not report sperm abnormalities. Subsequently, in this exam, the woman spontaneously conceived in the same menstrual cycle that the 4D-HyCoSy was performed, without any additional fertility enhancement interventions. In this case report, we also include an updating review of the current literature regarding the insurgence of spontaneous pregnancy after this technique in order to explore the physiopathological and etiopathogenetic mechanisms underlying the achievement of spontaneous pregnancy and to confront our case with other recent works published. According to our clinical experience and the current literature, 4D-HyCoSy is the easiest, safest, and cheapest diagnostic exam for investigating tubal patency, which can lead to medical success in some cases of "unexplained infertility" as the achievement of a spontaneous pregnancy.

Ectopic pregnancy on the uterosacral ligament post-double frozen embryo transfer in an endometriosis patient: case report and review of management and treatment options

BACKGROUND

Ectopic pregnancy (EP) is a serious obstetric condition that can be life-threatening, with various risk factors contributing to its development. In particular, in vitro fertilization (IVF) techniques may lead to an increased rate EP. Additionally, also endometriosis seems to be related to this particular obstetrical condition.

CASE REPORT

We report a rare case of ectopic pregnancy on the uterosacral ligament (USL) along with a suspected coexisting tubal ectopic pregnancy following IVF. The patient is a 48-year-old woman in menopause, with a history of pelvic endometriosis, who experienced sudden abdominal pain and vomiting at eight weeks of amenorrhea after undergoing a double heterologous frozen embryo transfer. Thorough examination and pelvic ultrasound, we diagnosed a hemoperitoneum due to a suspected heterotopic EP on the left USL and contralateral tube. Due to the sudden worsening of the patient's condition, we opted for a surgical procedure. An urgent laparotomy revealed a severe hemoperitoneum caused by an EP implanted on the left USL and a malacic, bleeding contralateral tube, both of which were removed, and hemostasis was then guaranteed. The histopathologic exam confirmed the EP on the left USL and an edematous tube without product of conception (POC).

CONCLUSIONS

Comparing our case with others reported in the current literature, it appears that the etiopathogenetic mechanisms leading to this urgent obstetrical condition are various and not fully understood. Despite those circumstances, the present case highlights the importance of considering non-tubal ectopic pregnancies in the context of risk factors, including IVF techniques, endometriosis, and advanced age, in cases of abdominal pain and hemoperitoneum after a single or double embryo transfer. The treatment, which involves different professional figures, should be executed as soon as possible, with the aim of preserving the patient's life and any future desire for pregnancies.

Sexual function analysis and clitoral vascularization in postmenopausal women with genitourinary syndrome treated with Ospemifene

AIMS

To evaluate the efficacy of Ospemifene in the vaginal health index (VHI), in the vulvovaginal vascular perfusion and to assess its impact on quality of life and sexual function.

METHODS

Among 52 eligible patients, 43 consecutive postmenopausal patients affected by vulvo-vaginal atrophy (VVA) or Genitourinary Syndrome (GSM) were evaluated. VVA evaluation and ultrasound of the vulvo-vaginal vascularization by sampling the pulsatility index (PI) of clitoris dorsal artery were performed before and after 3 months-treatment with Ospemifene. The 36-Item Short Form Survey (SF-36) for the quality-of-life assessment before and after 3 months were available for all women; instead Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS) questionnaires for the sexual function evaluation were performed for sexually active women in the study. The Patient Impression of Global Improvement (PGI-I) after 3 months of treatment was also calculated.

RESULTS

The number of sexually active women significantly increased after 3 months [26 (60.46%) vs 35 (81.39%); p=0.01]. The mean number of intercourses during the treatment increased (12.87 ± 3.43 vs 15.79 ± 3.12, p=0.03). The PI of clitoris dorsal artery has significantly changed before and after treatment respectively [PI (1.69 ± 0.42 vs 1.28 ± 0.45, p=0.001) RI (0.74 ± 0.11 vs 0.54 ± 0.15, p=0.001)]. The FSFI, FSDS and SF-36 questionnaires scores showed a significant improvement after 3 months. VHI and PI were the independent factors of a lower FSFI after 3 months of treatment at multivariate analysis.

CONCLUSIONS

Ospemifene improve the VHI and vulvovaginal vascular perfusion demonstrating a positive impact on sexual function and quality of life.