Effect of regular exercise on prevention of excessive weight gain in pregnancy: A randomised controlled trial

Objectives?To assess whether a 12-week supervised exercise-programme with an additional 30?min of moderate self-imposed physical activity on the non-supervised weekdays prevents excessive weight gain in pregnancy, as well as postpartum weight retention.

Methods?One hundred and five sedentary, nulliparous pregnant women with a mean age of 30.7?±?4.0 years and a pre-pregnancy body mass index of 23.8?±?4.3?kg/m² were randomised to either an exercise group (EG, n?=?52) or a control group (CG, n?=?53). The exercise programme consisted of 60?min supervised aerobic dance and strength training for 60?min, at least twice per week for a minimum of 12 weeks.

Results?Drop-out rates were 19% and 21% in the EG and CG, respectively. Fewer women in the EG than in the CG exceeded the Institute of Medicine recommendations; however, only EG participants who attended 24 exercise sessions (n?=?14) differed significantly from controls (p?=?0.006) with regard to weight gain during pregnancy (11.0?±?2.3 vs. 13.8?±?3.8?kg, p?<?0.01) and postpartum weight retention (0.8?±?1.7 vs. 3.3?±?4.1?kg, p?<?0.01).

Conclusions?Regular participation in aerobic dance exercise can contribute to significantly reduce weight gain during pregnancy.     

Efectos de un programa de ejercicio físico supervisado sobre la estructura cardiaca durante la gestación. Ensayo clínico aleatorizado

Objective

To analyze the safety of aerobic exercise for the cardiovascular system in pregnant women, and to assess improvement in the cardiovascular system.

Subjects and methods

A randomized clinical trial was designed. Data collection was performed at weeks 20 and 34 of gestation. At week 20, 45 women were studied in the exercise (EG), of which 35 completed the study. There were 14 pregnant women in the control group (CG) in week 20, of which nine completed the study.

Results

At week 20 there were improvements in body mass index (EG: 25.1.±.4.3/CG: 27.9 ± 4.5) (P=.04), and in systolic blood pressure (EG: 104.7 ± 10.9/CG: 112 .5 ± 11.3) (P=.02). In the CG there was concentric hypertrophy (N = 2; 14.3%). At week 34, the EG had a higher stroke volume (EG: 52.33 ± 10.42/GC: 43.69 ± 9.48) (P=.03).

Conclusion

Aerobic exercise during pregnancy is safe for the cardiovascular system and even improves some parameters.     

Comparison of prenatal and postnatal treatments of spina bifida in Poland – a non-randomized,single-center study

Abstract

Objective: The aim of this study was a comparison of the outcomes of intrauterine myelomeningocele (MMC) repairs (IUMR) in type II Chiari malformation (II CM) fetuses with clinical data of newborns and infants operated on postnatally.

Methods: The study group (SG) comprised 46 pregnant women whose type II CM children underwent IUMR, while 47 pregnant women whose type II CM children were operated on postnatally constituted the control group (CG). A total of 24 SG and 20 CG patients reached the endpoint of the study.

Results: High incidence of prelabor rupture of membranes (24 (52.2%), CI: 3.74 (1.69–8.26) (p?<?0.001) was noted in the group of prenatal surgeries as compared to controls. The need for ventriculoperitoneal shunt implantation was statistically significantly lower (p?<?0.008) in the group of children after IUMR as compared to controls (5 (27.8%) and 16 (80%), respectively, CI: 0.35 (0.16–0.75). None of the postnatally treated CG children can walk without adaptive equipment. In contrast, two children from the SG (2 (11.1%) CI: 1.86 (1.00–3.48) p?<?0.05) are able to walk independently.

Conclusions: Prenatal MMC closure significantly lowers further adverse evolution of the II CM. Further studies are needed, especially on preventive measures for preterm labor and iatrogenic preterm prelabor rupture of membranes (iPPRM) in the postoperative course of IUMR.     

Cadmium-induced testicular damage in a rat model of subchronic intoxication

Background: Cadmium (Cd)-induced testicular damage in relation to spermatogenesis has not been well studied. We studied the mechanism of Cd-induced testicular damage in a rat model of subchronic intoxication.
Methods:  Male Sprague–Dawley rats were subcutaneously injected with 0.6 mg Cd/kg per day for 6 weeks. The concentration of Cd in urine, serum and testes was measured by using atomic absorption spectrophotometry. Testicular damage was evaluated by counting the spermatogonia (SG) and spermatocytes (SC) on one cut-surface of five seminiferous tubules in stages VII or VIII of spermatogenesis every week. The location of intratesticular cadmium was determined by using oxine-fluorescent cytochemistry.
Results: There were no differences in the testes/bodyweight ratio between the study and control groups. The concentration of Cd in the testes increased more than 100-fold that in serum after week 2, suggesting active testicular Cd accumulation (1–3 mg/g tissue). Cadmium accumulation was detected in SG and SC. The number of SG and SC diminished significantly in the study group (week 2: SG 74%, SC 90%; week 4: SG 47%, SC 75%; week 6: SG 30%, SC 54% of the control, respectively).
Conclusions: Cadmium accumulated in SG and SC, consequently reduced the number of these cells, and disturbed the spermatogenesis in this rat model of subchronic Cd intoxication. Therefore, the number of SG decreased in this rat model of subchronic Cd intoxication. (Reprod Med Biol 2002; 1 : 59–63).     

Effect of specific exercise training on bone mineral density in women with postmenopausal osteopenia or osteoporosis

Aim.?To analyse the effect of a specific program of weight training exercise with closed kinetic chain in bone mineral density in postmenopausal women with osteopenia or osteoporosis.

Methods.?A total of 59 postmenopausal women with osteoporosis or osteopenia were included in this prospective study. Subjects were divided into two groups: the study group (SG, n = 30; 57.5 ± 5.1 years) and the control group (CG, n = 29; 56.6 ± 4.6 years). In the study group was applied a weight exercise protocol (longitudinal forces in closed kinetic chain) during 12 months, whereas in the control group no weight exercise protocol was applied. Bone mineral density at the lumbar spine and hip was assessed at baseline and at the end of follow-up by dual energy X-ray absorptiometry.

Results.?Although no significant intragroup differences were found, patients in SG showed a 1.17% increase in the lumbar spine whereas in CG a 2.26% decrease in bone density was detected.

Conclusion.?This protocol of weight training exercise did not significantly improve bone mineral density in postmenopausal women with osteopenia or osteoporosis, but in comparison to the control group, the results showed the importance of practising the specific exercise program for maintenance of bone health in postmenopausal women.     

Comprehensive assessment of the effect of Sphenocentrum jollyanum root extract on male reproductive activity in albino rats

Aim  To evaluate the effect of methanol extract from the Sphenocentrum jollyanum root on male reproductive activity. Methods  Male albino rats were treated orally with distilled water (vehicle for the extract; control) and 50, 100 and 150 mg kg^-1 body weight of Sphenocentrum jollyanum root extract for 8 weeks. Each group had its own recovery. Rats were killed 24 h after the last treatment. Caudal epididymal sperm count, motility, viability, morphology and organ weights were determined. Hematological indices, serum proteins, enzymes, testicular Superoxide dismutase (SOD) activity, and testicular and epididymal histology were determined. Results  Compared with the control, the extract caused a dose dependent significant (P< 0.05) reduction in progressive motility of spermatozoa, viability and total sperm counts. The number of abnormal spermatozoa and epididymal volume were not statistically significant. There was a significant increase (P< 0.05) in serum testosterone levels in rats treated with 50 (P< 0.01) and l00 mg kg⁻¹ (P< 0.05) of Sphenocentrum jollyanum. There was a significant (P< 0.05) increase in red blood cell count, packed cell volume and hemoglobin concentration, whereas there was no change in white blood cell count, mean total serum protein, albumin and globulin in the sera of Sphenocentrum jollyanum treated rats when compared with the control. The extract caused a significant decrease (P< 0.05) in serum aspartate and alanine aminotransferase activities with a significant increase (P < 0.05) in testicular SOD activity at a dose of 50 mg kg⁻¹ bodyweight. Testicular cytoarchitecture of the extract treated rats showed degeneration of seminiferous tubules, whereas regeneration of germinal epithelium and restructuring of the germinal interstitium occurred in the recovery rats. No lesions were observed in the epididymis of the rats. Conclusion  The results suggest that methanol extract of the Sphenocentrum jollyanum root could produce harmful effects on reproductive functions in male albino rats which can be attributed to poor sperm quantity (epididymal sperm count), quality (sperm motility, viability and morphology) and testicular degeneration. The steroidogenic potential of the plant could explain its use as an aphrodisiac agent.     

Effects of low-power laser auriculotherapy on chronic spinal pain: Randomized clinical trial

Aims and objectivesTo evaluate the effect of laser auriculotherapy on chronic spinal pain. It is a randomized controlled clinical trial. Methods: Volunteers with chronic spinal pain underwent three evaluations: an initial evaluation, a final evaluation immediately after the last intervention session, and a 15-day follow-up. Pain intensity, nociceptive threshold in relation to mechanical stimulus, and degree of pain (the greatest and least pain) in the last seven days were the assessed variables. The experimental group (EG, n = 24) underwent 10 sessions of laser auriculotherapy twice a week, while the control group (CG, n = 23) did not receive any intervention.ResultsThe EG showed great clinical improvement in relation to the variable pain intensity between pre- and post-interventions (65.2%) and pre-intervention and follow-up (58.62%) compared to the CG. There was a significant increase in the nociceptive threshold for the EG. In contrast, the CG showed a significant reduction in the nociceptive threshold. The intergroup analysis indicated an improvement in pain intensity for the EG (0.006). This result remained at the follow-up (0.012). The nociceptive threshold increased over time for the EG (0.016). In contrast, the CG showed a reduction in this variable with a significant difference over time (<0.001).ConclusionThe results of this clinical trial suggest that the proposed intervention may be effective in reducing pain intensity and increasing the nociceptive threshold. The effect of the intervention remained 15 days after the end of the treatment, when the volunteers were re-evaluated.     

Surfactant administration without intubation in preterm infants with respiratory distress syndrome – our experiences

Background: Surfactant replacement therapy is crucial in the management of respiratory distress syndrome (RDS) in preterm infants. Classic strategies of surfactant administration required intubation. To reduce the need of intubation and mechanical ventilation (MV), we applied surfactant via a thin endotracheal catheter without intubation.

Patients and methods: We compared 26 preterm infants threatened by RDS treated with surfactant via a thin endotracheal catheter without intubation (studied group – SG) with a retrospective group of preterm infants managed on MV with early surfactant treatment using INtubation SURfactant Extubation (INSURE) method (control group – CG). Study had an approval from the ethics committee (RNN/6/14/KE).

Results: In the SG, 26 preterm infants were treated with one dose of surfactant (Curosurf®) administered via endotracheal catheter without intubation while receiving nasal continuous positive airway pressure (nCPAP)/SiPAP (Infant Flow). After surfactant administration, significantly less patients in SG required intubation and MV (19.2%) versus 65% necessity of second intubation in the CG. The median of time of MV in SG was 5?d versus 3.5?d in CG. Median time spent on nCPAP was 5.5?d versus 4.0?d in CG. The incidence of intraventricular hemorrhage (IVH) in the SG was 53.9%, including 50% with ≥IVH II versus 36.7% (30% ≥IVH II) in CG. The incidence of other complications of prematurity in the SG, such as necrotizing enterocolitis was 11.5% versus 23.3% in CG, the hemodynamically important patent ductus arteriosus was observed in 53.9% in SG versus 45% in CG. Bronchopulmonary dysplasia level in SG was significantly lower (15.4%) than in CG (40%), and the incidence of retinopathy of prematurity in SG was also lower (3.9%) versus 11.7% in MV group.

Conclusion: Surfactant application via a thin endotracheal catheter without intubation seems to be a beneficial therapy for preterm infants with slight and mild degree of RDS. This new method of surfactant application was associated with a lower prevalence of intubation and MV and better pulmonary outcome than implementation of traditional surfactant therapy (INSURE) and MV. Prospective randomized controlled trial is required.     

Closed-system solid surface vitrification versus slow programmable freezing of mouse 2-cell embryos

Purpose  To compare closed-system solid surface vitrification with slow freezing. Methods  Mouse 2-cell embryos (n = 348) were divided into vitrification, slow freezing and non-frozen groups. For vitrification, embryos were exposed to 10% ethylene glycol (EG), 10% dimethylsulfoxide (DMSO) and 10% fetal bovine serum (FBS) in phosphate-buffered saline (PBS) for 10 min, then transferred into 17.5% EG, 17.5% DMSO, 0.25 M trehalose and 10% FBS in PBS. They were placed on hemi-straws and inserted into 0.5 ml straws inside a previously cooled aluminum cylinder. Slow freezing was done in straws by the conventional method. Results  Vitrified embryos had significantly higher survival, further cleavage and blastocyst formation rates than those in the slow freezing group (p < 0.001) and were comparable to controls. Blastocysts in the vitrification and control groups had significantly more cells than those in the slow freezing group (p < 0.05). Conclusions  Closed-system vitrification was more effective than conventional slow freezing. Capsule   Closed system solid surface vitrification was more effective than conventional slow freezing in the cryopreservation of mouse 2-cell embryos.     

A distribution of two SNPs in exon 10 of the FSHR gene among the women with a diminished ovarian reserve in Ukraine

Purpose  To evaluate the association between phenotype and follicle stimulating hormone receptor (FSHR) genotype in women with ovarian dysfunction and patients with “poor response” to gonadotropin stimulation of ovulation. Methods  FSHR gene SNPs were analyzed by PCR and RFLP. “Poor responders” (ovarian dysfunction) group and “good responders” group constituted the study group. Normo-ovulatory women who gave birth to naturally conceived children formed control groups: under 35 years of age (control I) and over 35 years of age (control II). Results  The frequency of Ala307-Ser680/Ala307-Ser680 genotype was significantly more prevalent in the ovarian dysfunction group (26%) compared to the control I (7.7%) (P < 0.001) and a “good responders” group (12.5%) (P < 0.05); and in a “poor responders” group (33.3%) compared to a “good responders” group (P < 0.05), control I (P < 0.001) and control II (17.5%) (P < 0.05). Conclusions  Our data shows the prevalence of the Ala307-Ser680/ Ala307-Ser680 genotype in the both groups of patients. The finding should have impact on the delineation of stimulation protocols. FSHR receptor gene polymorphisms and diminished ovarian reserve. Capsule The association between phenotype and Asn680Ser and Thr307Ala FSHR gene polymorphisms was found in women with ovarian dysfunction and poor response to FSH ovarian stimulation.     

Epidemiological characteristics in women with and without endometriosis in the Yale series

Objective The association between demographic factors, menstrual and reproductive characteristics, and clinical profile for women with endometriosis was analyzed in a retrospective case-control study. Methods Over a 6-year period, 535 women with endometriosis and 200 infertile women without endometriosis, studied by laparoscopy or laparotomy, were evaluated. Information was then collected in a uniform manner from the patients’ medical records. Statistical methods included χ ² and Mann–Whitney U test. Results The factors associated with an increased risk for endometriosis include lower body weight, alcohol use (χ ² = 8.8; P < 0.003), early menarche (χ ² = 5.08; P < 0.024), shorter cycle length (χ ² = 13.06; P < 0.001), and heavier menstrual cycles. Pelvic pain was present in 79.1% of women with endometriosis, dysmenorrhea in 70.2%, and dyspareunia in 49.5%. These symptoms were statistically significantly higher in comparison with the infertile women without endometriosis (P < 0.001). Moreover, we found that women with endometriosis had fewer prior pregnancies, elective abortions and ectopic pregnancies compared to women seeking care for infertility, who did not have endometriosis. Interestingly, women with endometriosis were significantly more likely to report a family history of cancer compared to women in control group (χ ² = 78.2; P < 0.001). Conclusions Body habitus, personal habits and menstrual characteristics are all strongly associated with the development of endometriosis. There may also be an association between family history of cancer and the development of endometriosis.     

Effects of raloxifene and hormone replacement therapy on serum Th2 and Th3 type cytokine concentrations in healthy postmenopausal women: a randomised controlled trial

Background Since sex hormones are reported to have important roles in the regulation of immune function, this study was designed to investigate the effects hormone replacement therapy (HRT) and raloxifene (RAL) on serum cytokine concentrations in healthy postmenopausal women. Methods Fifty-three healthy postmenopausal women were randomly assigned and treated by RAL (Group I, [RAL 60 mg daily and continuously], n = 16), HRT (Group II, [2 mg estradiol valerat + 2 mg dienogest, continuously] n = 18) or placebo (Group III, n = 19). Two fasting morning blood samples were obtained from each participant before and 3 months after the treatments. Serum concentration of interleukin (IL)-4 (as a Th2 cytokine) and transforming growth factor-beta (TGF-β)1 (as a Th3 cytokine), were measured by using commercially available enzyme-linked immunosorbent assay kits. Kruskal–Wallis analysis of variance, Mann–Whitney U, and Wilcoxon Signed-Ranks Tests were used as necessary. Results At the beginning of the study, the chronological ages, menopausal ages, years of amenorrhea, weights, body mass indexes, and blood pressures were not significantly different between groups (P < 0.05). RAL treatment caused a significant decrease on serum IL-4 concentration (P < 0.001). Although HRT caused a 14% decrease in serum IL-4 concentration, this decrease was not statistically significant (P > 0.05). Serum TGF-β1 concentrations were significantly decreased by HRT when compared to basal value (P < 0.001), and to control (P < 0.05). RAL treatment has no significant effect on serum TGF-β1 concentration (P > 0.05). Conclusion It seems that RAL treatment might cause a decrease in serum IL-4 concentration while valerate plus dienogest treatment as HRT seems to cause a Th3 tendency in healthy postmenopausal women. The results of this study were presented at first International Congress on Reproductive Medicine (22–25 September 2004 Antalya, Turkey), and 24th Joint Meeting of The British Endocrine Societies (4–6 April 2005 Harrogate, UK).     

Determination of tumor necrosis factor alpha (TNFα) and Interleukin 2 (IL2) in women with idiopathic recurrent miscarriage

Summary Some recurrent miscarriages may be due to a host versus graft reaction. Elevated Interleukin 2 (IL2) levels have been found during pregnancy and elevated TNFα levels during acute rejection crises of allotransplantats and so we determined IL2- and TNFα levels in women with recurrent miscarriages. Samples were taken for serum TNFα and IL2 radioimmunoassays (IRE Medgenix, Belgium) from 28 healthy non-pregnant women and in 49 women with at least 3 miscarriages between the 6th and 14th week of pregnancy, 38 women having their first or second miscarriage and 42 pregnant women with no complications. In women with recurrent miscarriage an increase in TNFα (P<0.05) and a decrease in IL2 serum levels (P<0.05) was found compared to women with normal pregnancies. These results support the concept that disturbances of immune tolerance of the fetus may account for some cases of recurrent miscarriage.     

Plasma sFlt-1-to-PlGF ratio is correlated with inflammatory but not with oxidative stress in Chinese preeclamptic women

Purpose  Considerable interest has been focused on angiogenic factors and angiogenic imbalance in the field of pre-eclampsia (PE), owing to its gaining role in the development of PE. This study was addressed to investigate the associations of sFlt-1-to-PlGF plasma ratios with oxidative stress assessed by the level of 8-isoprostane, and inflammation measured by the level of high-sensitive C-reactive protein (hs-CRP), and adipocytokines. Methods  A total of 83 patients with PE including 47 mild PE (MPE) and 36 severe PE (SPE) and 50 age-matched normotensive subjects in the third trimester of pregnancy were examined. Measurements included body mass index (BMI), systolic and diastolic blood pressure (BP) levels, plasma concentrations of hs-CRP, 8-isoprostane, adiponectin, and leptin. Results  Subjects with PE had higher levels of sFlt-1/PlGF (P < 0.01), hs-CRP (P < 0.01), 8-isoprostane and leptin (both P < 0.01) and lower adiponectin (P < 0.01) than did normotensive control subjects. Significant positive correlations were found between plasma sFlt-1/PlGF and hs-CRP (r = 0.437, P < 0.01) or leptin (r = 0.656, P < 0.01). A weak inverse correlation emerged between sFlt-1/PlGF and adiponectin (r = −0.306, P < 0.01). When a multiple regression analysis was performed, with sFlt-1/PlGF as a dependent variable and all the other parameters as independent variables, sFlt-1/PlGF maintain a significant relationship with leptin (β = 0.219, P < 0.05) and with hs-CRP (β = 0.295, P < 0.01) as well as with systolic BP(β = 0.446, P < 0.05). Conclusions  In Chinese preeclamptic women, plasma sFlt-1-to-PlGF ratio is correlated with inflammatory and adipocytokines but not with oxidative stress.     

Comparison of total laparoscopic, vaginal and abdominal hysterectomy

Introduction Due to technical improvements and growing experience, hysterectomies are performed laparoscopically more and more frequently. We analyzed 43 total laparoscopic hysterectomies (TLH) of the years 2005 and 2006 and compared them with 87 vaginal (VH) and 103 abdominal hysterectomies (AH). Methods Patients’ original files and surgery reports of the TLHs, VHs and AHs were analyzed retrospectively for the indication of surgery, patients’ age, weight, parity, time for surgery, uterus weight, blood loss, post-operative need of analgetics, hospital stay, complications and so on. Data were compared with Student’s t test and χ² test. Results Indications for TLH were fibroids (n = 21), endometrial cancer (n = 10), bleeding anomalies (n = 7), dysplasia of the cervix uteri (n = 3) and others. In 23/43 cases salpingo-ovarectomy was added, in six cases laparoscopic pelvic or paraaortic lymphadenectomy (LNE) was performed. Looking at cases without LNE, patients’ median age was 46 years (32–72), median weight 68 kg (53–115), median time for TLH 130 min (75–270), median uterus weight 150 g (44–954), median blood loss 200 ml (50–600), post-operative analgetica were given for 1.5 days (0–12), and post-operative hospital stay was 6 days (2–15). Indications for VH were genital prolapse (n = 53, 61%), often combined with fixative procedures (n = 50). In this group, median age was significantly higher (median 56 years, P < 0.001). VH was the fastest (median 90 min, P < 0.001), but blood loss was highest (median 300 ml, P = 0.07). In cases with AH, uterus weight was significantly higher (median 290 g, P < 0.001), as well as the need for analgetics (median 4 days, P = 0.001), and the hospital stay was longest (median 8 days, P < 0.001). Major complications of TLH were bladder injury (3×), of VH rectum lesion (2×, both at pelvic repair measures), of AH post-operative ileus (2×) and vesico-vaginal fistula (1×). Conclusion For many patients TLH is a safe and less invasive alternative, especially towards AH, and shows significantly better post-operative reconstitution. Although VH is faster and shows comparable post-operative results, TLH offers the advantage to view the intra-abdominal situs and perform additional steps in case of pathologies.     

First trimester three-dimensional ultrasound volumetry of the gestational sac

Summary. First trimester amniotic fluid is an ultrafiltrate of maternal plasma and constitutes the major component of gestational sac volume (GSV). We hypothesized that GSV, assessed by 3-dimensional (3-D) ultrasound volumetry, would reflect function of the early uteroplacental unit and therefore provide a basis for predicting pregnancy outcome. We tested this hypothesis in 38 pregnancies which had first trimester GSV measurements by two investigators thus allowing determination of interobserver variation. Gestational age (GA) was based on a careful history and conventional 2-dimensional ultrasound measurements. Serum for β-hCG, estradiol (E2) and progesterone (P) was obtained at the time of ultrasound examinations. ``Normal' outcome was defined as confirmation of a viable fetus. ``Abnormal outcome' was defined as either a ``blighted ovum' or embryonic demise. Statistical analysis was performed by Independent t-test and regression analysis. There were 31 ``normal' and 7 ``abnormal' pregnancies studied between 5 and 11 weeks gestation (mean ± SD 8.3 ± 1.3 weeks). GSV was significantly correlated to GA (r = 0.74, P < 0.001), higher than to β-hCG (r = 0.40, P = 0.034), E2 (r = 0.70, P < 0.001) and P (r = 0.21, P = 0.334), respectively. In the abnormal group 2/2 pregnancies with a twin sac had a GSV within 1 SD of the mean. 3/5 cases of missed abortions or blighted ovum had a GSV < 2 SD of the mean. The interobserver correlation was high (r = 0.99, P < 0.001). This is the first clinical study investigating the diagnostic use of 3-D ultrasound volumetry in first trimester pregnancy. Our results suggest that GSV volumetry has the potential to predict pregnancy survival into the mid to late trimester. Received: 26 February 1994 / Accepted: 27 April 1994     

The prevalence of sexual dysfunction and associated risk factors in women with chronic pelvic pain: a cross-sectional study

The aims of the study were to determine the prevalence of sexual dysfunction, its subtypes and associated risk factors in women with chronic pelvic pain (CPP) as compared to a general female population. We evaluated 112 women (mean age 34.73 ± 8.07; age range 18–50) complaining of CPP with a comprehensive history including female sexual function index (FSFI) and several general assessment questions (GAQs), a complete physical examination and routine laboratory tests. A group of 108 healthy women (mean age 33.28 ± 7.95; age range 19–52) without CPP were enrolled as cross-sectional controls. According to the general population, the incidence of female sexual dysfunction (FSD) was 67.8% in women with CPP and 32.2% in women without CPP (P < 0.0001). Among 112 CPP patients, 78 (69.6%) of them had FSD and 34 (30.4%) patients did not have FSD in the study (P < 0.0001). In that 78 patients, 42 patients (53.8%) had hypoactive sexual desire disorder, 26 patients (33.3%) had sexual arousal disorder, 17 patients (21.7%) had orgasmic disorder and finally 58 patients (74.3%) had sexual pain disorder. The FSFI scores in both groups were as follows: (patients vs. controls; median value; P value, respectively): desire: 3.31 versus 3.98 (P < 0.0001); arousal: 3.58 versus 4.35 (P < 0.0001); lubrication: 4.20 versus 4.88 (P < 0.0001); orgasm: 3.70 versus 4.48 (P < 0.0001); sexual satisfaction: 3.80 versus 4.64 (P < 0.0001); sexual pain: 2.75 versus 4.98 (P < 0.0001) and total FSFI score: 21.35 versus 27.29 (P < 0.0001). The prevalence of FSD was higher in women with CPP than in a general healthy population not complaining of CPP. Investigation of female sexuality was essential for these patients.     

Weight Loss by Multidisciplinary Intervention Improves Endothelial and Sexual Function in Obese Fertile Women

IntroductionWeight loss in sexually active women improves their quality of life. At present, no studies have investigated whether weight loss may affect female sexual function in severe obese women.AimThe aim of this study was to investigate the effects of different programs of weight loss on female sexual dysfunction complaints and on endothelial function in premenopausal obese females.MethodsForty‐four out of overall 80 obese fertile women (age 18–49 years; mean 36 years) were enrolled because of sexual complaints at Female Sexual Function Index‐6 (FSFI‐6 score ≤19). Patients were then allocated to different treatments of 8 weeks duration each: an intensive residential program with hypocaloric diet plus controlled physical exercise along with lifestyle modifications at a specialized clinic (Group A, N = 23) and a non‐intensive outpatient clinic program consisting of hypocaloric diet and physical exercise at home (Group B, N = 21). Afterward, overall patients were allocated to an extended 8‐week follow‐up period consisting of outpatient clinic controlled diet plus physical exercise at home.Main Outcome MeasuresPrimary end points were modifications of FSFI‐6 scores and endothelial function as measured by reactive hyperemia (RHI) with EndoPat‐2000. Secondary end points were modifications in body composition as measured by dual‐energy X‐ray absorptiometry (DEXA).ResultsAfter 16 weeks, FSFI‐6 score and the frequency of sexual activity were significantly higher in Group A compared with Group B (P < 0.01), and significant improvements in arousal, lubrication, and satisfaction sub‐domain scores were also found (P < 0.01). Group A showed improvements in RHI (P < 0.01) and marked improvement in homeostasis model assessment of insulin resistance (P < 0.001), anthropometric parameters as weight (P < 0.01), body mass index (P < 0.01), fat mass (P < 0.0001), and percentage of fat mass (P < 0.005) compared with Group B. A relationship between peak insulin (P < 0.0001) and RHI (P < 0.001) vs. FSFI‐6 scores was found, respectively.ConclusionsA multidisciplinary approach to female obesity appears to be superior to conventional outpatient clinic to produce weight loss and to improve several aspects of sexual dysfunction in obese women. Such changes might be related to persistent improvements in endothelial function and in insulin resistance.     

Fetal heart rate variability responsiveness to maternal stress,non-invasively detected from maternal transabdominal ECG

Prenatal stress (PS) during pregnancy affects in utero- and postnatal child brain-development. Key systems affected are the hypothalamic–pituitary–adrenal axis and the autonomic nervous system (ANS). Maternal- and fetal ANS activity can be gauged non-invasively from transabdominal electrocardiogram (taECG). We propose a novel approach to assess couplings between maternal (mHR) and fetal heart rate (fHR) as a new biomarker for PS based on bivariate phase-rectified signal averaging (BPRSA). We hypothesized that PS exerts lasting impact on fHR. Prospective case–control study matched for maternal age, parity, and gestational age during the third trimester using the Cohen Perceived Stress Scale (PSS-10) questionnaire with PSS-10 over or equal 19 classified as stress group (SG). Women with PSS-10 < 19 served as control group (CG). Fetal electrocardiograms were recorded by a taECG. Coupling between mHR and fHR was analyzed by BPRSA resulting in fetal stress index (FSI). Maternal hair cortisol, a memory of chronic stress exposure for 2–3 months, was measured at birth. 538/1500 pregnant women returned the questionnaire, 55/538 (10.2%) mother–child pairs formed SG and were matched with 55/449 (12.2%) consecutive patients as CG. Maternal hair cortisol was 86.6 (48.0–169.2) versus 53.0 (34.4–105.9) pg/mg (p = 0.029). At 36 + 5 weeks, FSI was significantly higher in fetuses of stressed mothers when compared to controls [0.43 (0.18–0.85) versus 0.00 (− 0.49–0.18), p < 0.001]. Prenatal maternal stress affects the coupling between maternal and fetal heart rate detectable non-invasively a month prior to birth. Lasting effects on neurodevelopment of affected offspring should be studied. Clinical trial registration: NCT03389178.     

Relation between vaginal and endocervical pH in pre- and post-menopausal women

We aimed to verify whether vaginal fornix pH is related to endocervical pH and whether or not acid pH could contribute to the prophylactic treatment of vaginal infections. Four groups of healthy women with or without uterus were selected: pre-menopausal (>39 years) and post-menopausal (<61 years). Pre-menopausal non-hysterectomized women were further analysed in proliferative (8–12 days) and secretory phase (18–22 days) of the menstrual cycle. Endocervical and vaginal pH was determined by a digitally pH metro during the gynaecological examination. Vaginal pH is more acid than endocervical pH in pre- and post-menopausal women, 5.1 versus 6 and 5.4 versus 6.4 (P<0.001), respectively. Vaginal pH is related to endocervical pH in proliferative phase of menstrual cycle and post-menopausal women (P=0.009). Pre- and post-menopausal hysterectomized women presented more acid vaginal pH than non-hysterectomized women, 4.35 versus 5.1 and 4.9 versus 5.4 (P<0.05), respectively. Endocervical pH has not presented change during menstrual cycle and menopause, 6 and 6.4, respectively. Vaginal pH is related to endocervical pH in proliferative phase of menstrual cycle phase and post-menopausal women.