Background Childbirth brings many changes to women’s life and sexual health. The influence of operative vaginal delivery on sexual function has produced inconsistent results. Aim To evaluate the effects of mode of vaginal delivery (spontaneous or operative) in postpartum sexual function. Methods Descriptive prospective study (MOODS- Maternal-neonatal Outcomes in Operative Vaginal Delivery) including 304 women who had a singleton term vaginal delivery (operative or spontaneous in a relation 2:1). Women were invited to answer a questionnaire at 3, 6 months and 1 year postpartum. Outcomes Measurement A validated questionnaire was applied, the Female Sexual Function Index (FSFI) Score, to evaluate effects of operative delivery on sexual health. Sexual dysfunction was defined by FSFI score <26.55. RESULTS 211 women answered at least one questionnaire. Overall rate of sexual dysfunction was 62%, 43% and 48% at 3, 6 and 12 months respectively. At 3 months, total FSFI score was significantly lower in operative vaginal delivery group (mean±SD, 21.3±8.6 vs 24.9±7.9, P = 0.015). Arousal (P = 0.028), orgasm (P = 0.029), satisfaction (P = 0.015) and pain (P = 0.007) FSFI domains were also significantly inferior. At this time, 44% women in spontaneous delivery group and 70% in operative delivery group had sexual dysfunction (P = 0.0002). At 6 months, there were no differences in FSFI scores according the type of delivery. At 12 months, total FSFI score was similar in both groups, but pain domain was significantly lower in operative delivery (P = 0.004). Considering type of instrument (Thierry’s Spatulas or Kiwi Vacuum), no differences were found regarding episiotomy, perineal trauma, obstetric anal sphincter injury or postpartum complications. FSFI scores did not differ between the two instruments at any time point. A logistic regression showed that, when controlled for perineal trauma, mode of delivery was independently associated with sexual dysfunction at 3 months (P = 0.02). Clinical Implications Clinicians should assess women’s sexual health during pregnancy and postpartum period in order to enhance their wellbeing. Strengths/Limitations Strengths include its prospective design, standardized questionnaire and the new perspectives about a different obstetrical instrument (Thierry’s spatulas). Limitations include the absence of pre-pregnancy sexual function data and considerable drop-out rate. CONCLUSION Sexual dysfunction affects a great proportion of newly mothers and in postpartum period mode of delivery and perineal trauma seem to play an important role. Although there was a progressive reduction over time, prevalence of sexual dysfunction at 6 months and 1 year postpartum was still considerable. The type of obstetrical instrument does not seem to influence short or long-term sexual function.

Background: Women carrying twin pregnancies receive extensive antenatal counselling on fetal risks, but less is known about whether the presence of two placentas confers dissimilar maternal risks. We pretend to determine the impact of chorionicity on the maternal and fetal outcome, evaluating the possibility of finding the association between complications and the presence of two placental masses.Methods: We conducted a retrospective observational cohort study of 550 twin pregnancies monitored at a level-3 hospital, between January 2004 and December 2018.Results: Of the 550 pregnancies, 419 (76.2%) were bichorionic and 131 (23.8%) were monochorionic. Caesarean delivery was more frequent in monochorionic group (70.2% vs. 61.8%, p=0.05). There were no statistically significant differences in the proportion of adverse maternal outcomes between bichorionic and monochorionic pregnancies, despite a trend towards higher proportions in bichorionic group. Regarding fetal outcomes, monochorionic twins were delivered earlier (mean gestational age of 34+4 weeks vs. 35+1 weeks, p=0.04) and the proportion of preterm delivery cases between 32+0 and 36+6 weeks was higher in monochorionic pregnancies (72.5% vs. 54.9%, p=0.002). Stillbirth of one or both twins was more frequent in monochorionic group (3.1% vs. 0.5%, p=0.03).Conclusions: The presence of two placental masses does not seems to confer an increase in maternal risks, despite a trend towards higher proportions of adverse outcomes in bichorionic pregnancies. However, monochorionicity is associated with an increase in fetal risks, particularly prematurity. Counselling and monitoring of bichorionic or monochorionic pregnancies may be identical with respect to maternal risks, but chorionicity should be considered when evaluating fetal risks.

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Torsion of the fallopian tube without ovarian involvement is an extremely rare event and often difficult to diagnose, but noteworthy, cause of lower abdominal pain. The authors describe a case related to a 14- year-old adolescent with acute lower abdominal pain and vomiting presented to the gynaecological emergency department. Blood tests exhibited modest biochemical parameters of inflammation and a transvaginal ultrasound showed a left adnexal tubular cystic mass with normal ovarian appearance. A diagnostic laparoscopy revealed an isolated fallopian tube torsion. The tube was able to be untwisted with restoration of pelvic anatomy and the follow-up was uneventful. The authors describe a challenging diagnosis in an adolescent in which delayed intervention could compromise her reproductive future. Tubal torsion should however be kept in mind in the differential diagnosis of lower abdominal pain in women of all ages.