A. Carmignani

Androgen therapy in women: for whom and when

Androgens play a primary role in female physiopathology. The age-related reduction in the production of ovarian and adrenal androgens may significantly affect women’s health. The decline of circulating androgens results from a combination of two events: reduced ovarian production and aged-related decline in adrenal androgen synthesis. The relative androgen deficiency in pre- and postmenopausal women may induce impairment of sexual function, libido, well-being, energy and may contribute to reduced cognitive functions. Whether androgen deficiency also affects cardiovascular or bone biology in women during reproductive aging is still controversial. Both in the central nervous system and peripheral tissues, there are multiple ways whereby androgens target their specific actions through a particular tropism of the brain areas that are involved in sexual function, behavior and cognition. Among circulating available androgens that are involved in several domains of sexual response, adrenal androgens seem to be related to some sexual symptoms as well as diminished cognitive function in postmenopausal women. The possibilities of treating low sexual desire/hypoactive sexual desire disorder are multifaceted and should include the combination of both pharmacological treatments able to maximize biological signals that drive the sexual response as well as individualized psychosocial therapies to overcome personal and relational difficulties. Transdermal testosterone has been proved to be effective but the use of additional treatment like oral or vaginal dehydroepiandrosterone is still controversial, despite many evidences support it. The decision to treat premenopausal or postmenopausal women with signs/symptoms of androgen insufficiency is mainly based on the clinical judgment, together with estrogens co-administration and following informed consent related to the unknown long-term risks.

Attitudes of Italian women concerning suppression of menstruation with oral contraceptives.

Objectives Perceptions of menstruation vary according to culture and religion. This study addresses attitudes of Italian women towards changes in menstrual frequency induced by oral contraceptives (OCs) administered in an extended regimen. Methods Three-hundred-and-fifty healthy women of reproductive age were enrolled in three test areas in Italy. Participants completed a standardized questionnaire. One-hundred-and-ten men, aged 21–54 years, accompanying their partners to the gynaecological consultation were also given a questionnaire to get to know their opinion about the extended use of OCs by their partner. Results Only 32% of Italian women prefer to bleed monthly. The preferred frequencies in all age groups were 3-monthly (23.7%) or never (26%). Of the OC-users, 57.2% preferred to bleed less than once a month: 26% wished to bleed every 3 months, and 21.2% once a year. Among men, 58.1% considered an extended OC regimen to be acceptable. Conclusions About 60% of Italian women with spontaneous or OC-driven cycles prefer to bleed less than monthly. This fact should be kept in mind by physicians when prescribing OCs.

Spontaneous Cornual Pregnancy after Homolateral Salpingectomy for an Earlier Tubal Pregnancy: A Case Report and Literature Review

Cornual pregnancy is an infrequent pathological condition with severe prognosis if not adequately recognized. Ipsilateral salpingectomy represents a unique risk factor for this clinical entity. This article reports a laparoscopically treated spontaneous cornual pregnancy after homolateral salpingectomy for an earlier tubal pregnancy in a condition of hemodynamic instability as a result of cornual rupture. We include a review of the literature, underlining the feasibility of a laparoscopic approach and new treatment options combining medical and surgical tools with specific attention to their impact on future fertility and on risk of uterine rupture in a future pregnancy.

Second trimester sonography and fetal spina bifida screening

After the ‘cranial signs’ (ventriculomegaly, ‘banana sign’, and ‘lemon sign’ ) were described, it was suggested that sonography might efficiently replace the alpha-fetoprotein (AFP) assay as a screening tool for fetal spina bifida. The aim of this study was to evaluate the respective contributions of AFP screening and routine sonographic examination to the overall prenatal diagnosis of fetal neural tube defects(NTD) compared with abdominal wall defects(AWD), when both tests are offered to the general obstetric population. Singleton pregnancies referred to our level 2 ultrasound unit during the years 1985–1999 were included in the study: (1) if the fetus was affected with NTD or AWD; and (2) if the indication for referral was raised maternal serum or amnioticfluid AFP, or a level 1 scan suspicious for NTD or AWD. The care provided by the regional health insurance included second-trimester sonographic examination during the entire study period and, beginning in 1992, maternal-serum AFP assay. In women undergoing amniocentesis for fetal karyo-

Erratum to: Androgen therapy in women: for whom and when

The online version of the original article can be found underdoi:10.1007/s00404-013-2969-7.N. Pluchino A. Carmignani A. Cubeddu (&) A. Santoro V. Cela T. ErrastiDepartment of Reproductive Medicine and Child Development,Division of Gynecology and Obstetrics, University of Pisa,Via Roma 35, 56100 Pisa, Italye-mail: cubeddissima@hotmail.comN. Pluchinoe-mail: nicola.pluchino@med.unipi.it

P26.08: Bilateral hemorrhagic fetal ovarian cyst: a case report

fetus was followed with successive ultrasounds and at its 31 week scan was noted to have superficial membranous formation on the back of its neck and throughout the amniotic cavity. The differential for this finding included fibrinous band formation from the anterior abdominal wall defect or possible amniotic bands. The infant was delivered at 35 weeks secondary to non-reasurring fetal well being. At delivery the fetus was noted to have strands of yellow fibrinous material on the intestinal wall as well as on the neonate’s back and arms. This was thought to be the fibrinous inflammatory peel found on the extracorporeal intestine associated with gastroschisis. Pathological diagnosis confirmed this finding. The neonate subsequently died on that night. This case illustrates the temporal evolution of the peel formation and detection by ultrasound. There is suggestion that this inflammatory peel formation is associated with meconium staining, premature delivery, and poorer outcome. In animal data the peel is associated with cytoskeletal changes which decrease intestinal mobility. More data with careful ultrasound documentation of this finding in cases of gastroschisis may help predict prognosis of these infants and help in understanding the intestinal pathophysiology that results.

P38.04: Indirect sonopraphic signs of fetal intracranial arteriovenous malformation

Objectives: The term macrocephaly signifies a head circumference (HC) that is more than 2 standard deviations above the mean or exceeds the 97th percentile. Benign familial macrocephaly is a dominantly or recessively inherited disorder in which the head size of otherwise normal newborn. In this study we report prenatal diagnosis of a benign familial macrocephaly case. Methods: The patient was a 20-year-old woman, gravida 1. She had an ultrasound examination at 11 weeks’ gestation. Ultrasound scanning at 18 weeks’ gestation showed a HC measurement above 97th percentile. Femoral length and abdomen circumference measurement were above 50th percentiles. Results: The serial scans demonstrated that HC had continued to growth above 97th percentile. Paternal HC was 62 cm (above 97th percentile) and family pedigree showed more than 14 other affected members with this disorder. At gestational age of 37+5 weeks, because of the large head size and premature rupture of membranes Cesarean section was performed and evaluation of the male infant at birth showed a HC 39 cm (above 98th percentile). No other physical abnormalities were detected. Follow-up evaluation by MRI and physical examination at 6 months of age showed a normal neurologic evaluation but persistent macrocephaly. Conclusion: In this disorder, serial measurement of HC demonstrates a proportional rather than an excessive rate of growth. In this condition, measurements of parental head size often reveal macrocephaly in one parent. This case report highlights the necessity of combining appropriate family history and serial measurement of HC for diagnosis of benign familial macrocephaly.

P26.12: Prenatal sonographic features of chloride diarrhea

Conclusions: This study defines GGT reference values for GW 16–22 in normal pregnancies. The amniotic fluid was analyzed by the Integra 800. This analyzer is commonly used in clinical laboratories and no reference values exist. An important value of the study was defining reference values until GW 22. This prolongation beyond 20 weeks is important in the workup of non-visualization of the gallbladder when anomaly scans are done in these later weeks. In conclusion, these reference values may be useful in differentiating between EHBA and other biliary pathologies.

Is reduction in size pathognomonic of functional ovarian cysts

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