Placental site trophoblastic tumour (PSTT) is a very rare form of gestational trophoblastic disease that grows slowly, secretes low levels of beta-subunit of human chorionic gonadotropin (β-hCG), presents late-onset metastatic potential and is resistant to several chemotherapy regimens. Here, we report a case of PSTT in a 36-year-old woman who presented with amenorrhea and persistently elevated serum level of β-hCG after a miscarriage. Transvaginal ultrasound revealed a hypovascular ill-defined solid lesion of the uterine fundus and MRI showed a tumour infiltrating the external myometrium with discrete early enhancement and signal restriction on diffusion-weighted imaging. PSTT was suspected, and after endometrial biopsy by hysteroscopy and posterior hysterectomy, microscopic examination allowed the final diagnosis. The level of β-hCG dropped significantly in about a month after surgical treatment. Due to the rarity of PSTT, reporting new cases is crucial to improve the diagnosis and managing of these patients.

Imperforate hymen is the most frequent cause of haematocolpos, although it is a rare malformation (1:2000). We present two cases of young girls with cyclic abdominal pain and urinary symptoms. At gynaecological examination, they all presented imperforate hymen and ultrasound revealed significant vaginal distension. X-shaped hymenectomy was performed in all patients. The later the diagnosis of imperforate hymen, the higher the risk of complications like haematometra, haematosalpinx, haemoperitoneum and infections such as tubo-ovarian abscesses, peritonitis and endometriosis (retrograde menstruation theory).

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Turin. We considered 8 criteria of good practice from the review of national and international guidelines and we elaborated one or more indicators for each criterion, to evaluate caesarean delivery rate in the light of these criteria. Criteria and indicators are: Twin pregnancy with both cephalic presentation (dichorionic diamniotic, monochorionic diamniotic); preterm deliveries (≤32, ≤34 and ≤36 weeks of gestational age); maternal request; maternal age ≥45 years; previous caesarean delivery; BMI ≥50; HCV and HIV maternal infection. The rate of caesarean sections found in each criterion was compared with the respective standard in literature. The value obtained for each indicator has been tested for statistical significance (CI 95%). We considered performing indicators whose final rate was found to be better or equal to the reference standard.Results: Performing indicators: dichorionic diamniotic (≤59% vs. 44%); monochorionic diamniotic (≤77% vs. 71%); preterm deliveries ≤36 weeks (≤18.9 vs. 13%); maternal request for CS (≤40% vs. 12%). Non performing indicators: previous caesarean delivery (≤30% vs. 84%); preterm deliveries ≤34 weeks (≤27% vs. 29%); preterm deliveries ≤32 weeks (≤45.5% vs. 77%).Conclusions: The majority of the analysed indicators resulted to be performant and we suggest to consolidate the clinical practice that relates to such indicators. The rate of repeated caesarean sections was significantly higher than the standard value (84% vs. ≤30%). To reduce inappropriate repeated surgical intervention, our clinical audit provides a plan of improvement based on internal protocols, written informations and dedicated counselling for women with previous caesarean sections. Currently, we are re-auditing the impact of the implemented measures on repeated caesarean sections. Even if there analysis is still not completed, the general trend appears to be decreasing. In conclusion we support the use of Audit as a mean to improve health practice and we encourage comparison of the results and diffusion of the model in other clinical settings.http://dx.(S. Pedrosa).Protein S (PS) deficiency is associated with venous thromboembolism (VTE) and adverse pregnancy outcome and its prevalence is 0.03-0.13% in the European population. Many studies have focused on establishing the references curves for the gestational age for free PS (FPS) and total PS (TPS), in order to differentiate normal and abnormal PS deficiency in pregnancy. In 2006, Maternidade Bissaya Barreto laboratory construct reference ranges derived from normal gestations in caucasian women. The aim of this retrospective study is to evaluate the PS deficiency in women with adverse obstetric outcome or family/personal history of VTE and assess the impact of treatment in subsequent pregnancy.Methods: This study (since 2012-2015) included 297 women who have previously experienced adverse pregnancy outcomes or personal/family history of thrombosis. These women were submitted to FPS and TPS tests in preconceptional period after cessation of estrogen or vitamin K-a...