Objective To investigate women’s experience with the cervical pessary for prevention of preterm birth. Design: Retrospecitve questionnaire study. Setting: Tertiary care hospital in Italy. Population: 166 pregnant women treated with Arabin cervical pessary within one center. Methods: A questionnaire was administered to all women after delivery. Main outcome measures: Data about patient’s experience before the insertion (adequacy of the information received), during treatment (follow-up, impact on daily life, perceived discomfort, side effects) and at the time of removal (pain, patient’s expectation met regarding the treatment) were analysed. Results: Information received before the insertion of Arabin pessary was considered adequate in 163/166 (98.2%). An increase of vaginal discharge was experienced by 70/166 (42.2%) women. Discomfort or other side effects were reported in 13.8% and 16.3% of cases, respectively. Overall, 77% of women reported an improved quality of life and 94% considered the follow-up during pregnancy adequate. Removal was moderately painful for 58/166 (35%) of women. Patient’s expectations regarding the treatment were exceeded in the majority of cases (75.3%). In a final step, we compared our results to previous studies suggesting that clinical experience of the health care specialists in charge may explain why the discrepancy of results. Conclusion: Although some trials report high rates of non-compliant patients, this could not be confirmed by our study. In contrast, most women reported a positive experience and were motivated to continue the treatment when they were continuously followed by experienced clinicians.

Running title: Timing of total serum bile acids measurement

Objective To establish pregnancy-specific reference ranges for fasting and postprandial total serum bile acids (TSBA) levels. Design Cross-sectional study. Setting Tertiary care university hospital. Population Healthy pregnant women at term admitted to the Obstetrics Department over one year. Exclusion criteria were an established diagnosis of intrahepatic cholestasis of pregnancy (ICP) or any co-existing condition of increased risk for ICP. Methods and Main Outcome Measures Both fasting and postprandial TSBA levels were measured in 612 women (528 fasting and 377 postprandial samples). Results Reference intervals of 4.4-14.1 µmol/L for fasting TSBA, and 4.7-20.2 µmol/L for postprandial TSBA were established. The postprandial values were significantly higher than the fasting measurements, with a mean increase of 1.77 µmol/L (22%). A correlation between fasting TSBA levels and postprandial levels was found, as well as with fetal gender, parity, and the use of assisted reproductive technologies. A seasonal pattern was noticed for both fasting and postprandial TSBA, with the highest values in the winter season (p < 0.01 and 0.02, respectively). Conclusions Normal pregnancy is a sub-cholestatic state and is associated with a physiological elevation of TSBA levels, therefore a higher threshold should be considered for the diagnosis of ICP. We suggest using the upper reference limit observed in our healthy pregnant population (fasting ≥14 µmol/L and postprandial ≥20 µmol/L). As the fasting measurement is more specific for the diagnosis, and the postprandial is essential for severity assessment, it is recommended to measure both values, rather than use random samplings. Funding No funding to declare.

Due to migration and travels, obstetricians are increasingly faced with a globalized setting and should adapt their daily clinical approach to the modifications of tropical infections epidemiology. This paper is focused on five emerging infectious diseases, namely Chagas disease, HTLV-1 infection, malaria, schistosomiasis and Zika virus infection, having a high prevalence in migrant populations and which can affect international travelers. These diseases frequently pass unrecognized since they are characterized by few symptoms during pregnancy, however they may cause a relevant maternal, fetal and neonatal impact. Specific diagnostic and treatment options are available but are rarely used during routine obstetrical practice.