The primary objective of this randomized, double-blind, controlled study was the assessment of the pH-lowering effect of three different formulations of a vaginal device each containing 250 mg vitamin C. Overall, 39 women with vaginal pH >or=5, without evidence of vaginal infections, were randomly assigned to receive one of the three formulations for 6 days. The primary parameter assessed was vaginal pH, performed by the physician at the baseline and final visits and by the subjects each day during the application period; secondary parameters included the acceptability and safety profile of the tested devices. A decrease in pH to the normal range in all groups was observed following the first application, with stable low values during the whole study period. No statistically significant differences were seen among the three groups, while statistically significant within-group differences were observed. Acceptability and tolerability were rated as very good/good in most cases. The study results confirm that the vaginal application of vitamin C has an effective and long-lasting vaginal pH-lowering effect.

A 36-year-old gravida 3, para 2, a medical doctor herself (G. P.) had two previous full term deliveries by Cesarean section. In her third pregnancy, she presented with vaginal bleeding in 7 weeks and an early vaginal ultrasound scan, revealed an early marginal placental abruption, with an alive fetus. After following conservative management at home, she was then hospitalized, continuing the same therapy. Although the bleeding was milder and in 3-4 days stopped, and had scans every other day, the last scan showed negative FHR, so she underwent a dilatation and curettage (D&C) under anesthesia. It should be noted that during the procedure she had unusually heavy bleeding, that was difficult to control. After staying for the next 24 hours in the hospital, she was discharged in good condition, with directions and administration of uterine-contraction agents (methergine and oxytocine), plus antibiotics (doxycycline bpd) for a week. Ten days later, she reported that the vaginal bleeding although milder continued and did not stop at all, so she came for a new scan, that showed a mass of 10 cm in diameter, between the anterior uterine wall and the bladder, with mixed echogenicity and regular flows in the color Dopplers. Twenty days later an MRI was performed, that confirmed the same findings with the ultrasound scans, without helping us further with the origin of the presenting problem. In exactly 30 days after the D&C, the above mentioned patient, presented urgently, with heavy vaginal bleeding, which could not be controlled with an attempted new D&C, so an urgent abdominal hysterectomy followed and simultaneously the patient was transfused with 3 blood units. Her post surgery follow-up was stable and in 5 days she was discharged in good condition. The pathology report, to our surprise, revealed a remaining, necrotic and well organized placenta accreta. Objectives: To evaluate the marginal sinus of the placenta with two and three dimensional imaging, and to correlate diameter and flow with abnormal pregnancy outcomes. Methods: Dimensions of the marginal sinus were determined with Doppler, multiplanar, and volume acquisitions in 280 gestations at 16 to 34 weeks. Mean diameter and area of the axial venous sinus was determined for each gestational week. A separate cohort of 88 patients with sonographic impression of ''prominent'' marginal sinus was evaluated for antepartal complications and delivery management. Results: The boundary of the marginal sinus at the chorionic and basal plates was indistinct in 8% of patients. When visible, the typical venous ring increased 10-30% from second to third trimester. Patients with 'prominent' marginal sinus had significantly larger mean diameter at each gestational week compared to controls. The etiology of the prominence appears to be extension into the intervillous space, most likely due to peripheral villous agenesis. Patients in the prominent sinus cohort had no difference in mean gestational age at delivery (38.2 weeks), or C-section rate of 30.8%. However, second or third trim...

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