We read the article by Carlos et al titled “Antenatal corticosteroid therapy: Historical and scientifific basis to improve preterm birth management” with the greatest interest [1]. The authors suggested whatever clinical conditions, antenatal corticosteroids could be recommended as administration routine for women with preterm birth <34 weeks. However, the results of Packer et al have showed that treatment of corticosteroids caused the more ICU admissions and maternal deaths for the women with COVID-19 infection [2].

Surgical excision of the groin and vulva is a painful procedure. Traditionally following general or regional anaesthesia, local anaesthetic was infiltrated around the wound. Thedistribution varied and the somatic pain control was not reliable. Inspired by the success of the application of peripheral nerve blocks for postoperative pain control with open abdominal procedures, we introduced blockade of the ilioinguinal nerve (IIN) and pudendal nerve (PN) into our vulval surgery to assess the requirement for parenteral and oral analgesia in the postoperative period. This is an observational study of all patients undergoing major vulval and/or related groin surgery. Sampling biopsies were excluded. Levobipuvicaine 0.25% (2.5mg/ml) or 0.5% (5mg/ml) was used for and dosage was calculated based on the patient's weight with no more than 2mg/kg. For example, using 0.25% of levobupivacaine (2.5mg/ml) for a 70kg patient, 56ml is administered divided into 4, giving 14mls at each site (2 sites abdominally for IIN block and 2 sites for pudendal block). Eighteen women were included in the analysis. Median age was 67 (range 34-81) years and thirteen (72%) were >60years. Visual analogue scores (VAS) ranged from 0 to 3 for seventeen patients from day 0 to day 1 and fifteen patients from day 2 to day 5. Two patients had pain scores >4 on one or more postoperative days: one had chronic arthralgia and one had received a lower volume of bupivacaine. This observational study demonstrates that ilioinguinal and pudendal nerve LA blocks may be a valuable addition to the multimodal postoperative analgesic pathway for women undergoing major surgical excision in the vulva and groin.

Obstetric investigators have used predictive models to assist with the complex decision regarding delivery mode in women with a history of prior cesarean birth [1]. One model, which has become part of the standard of care in counseling women with a history of prior cesarean birth in the US, provides a woman’s likelihood of achieving a vaginal birth after cesarean (VBAC) based on characteristics that can be identified when she enters prenatal care [1]. In this analysis, our aim was to apply the Grobman model to the WHO Global Survey on Maternal and Perinatal Health (WHOGS) dataset, which is a large, cross-sectional study that assessed mode of delivery and its association with maternal and perinatal outcomes [2,3].

Since its recent outbreak Sars-CoV-2 infection has emerged as a potential threat to feto-maternal wellbeing. Literature data supporting possibility of vertical transmission haven’t been reported yet, but insufficient data so far cannot rule this possibility out [1,2].

To study the temporal trends in cytologic detection of cervical epithelial cell abnormalities (ECA) and to evaluate the impact of introduction of endocervical brush sampling on detection of ECA. This was a cross-sectional study of conventional cervical smears collected over a 13 year period (2006-2018). The study was divided into two time periods (TP)-TP1 (2006-2014, 67,437 smears) using only extended tip Ayre's spatula and TP2 (2015-2018; 36,746 smears) when Cytobrush Papsmear kit (Ayre's spatula + endocervical brush) was used. The unsatisfactory rate and detection rate of ECA was compared between the two TPs. The unsatisfactory rate reduced from 4.7 % in TP 1-1.5% in TP2 (P < 0.001). The frequency of ECA was 1.5 % in TP1 and 1.9 % in TP2 (P < 0.001). A significantly higher number of ASC-H and HSIL were detected in TP2. There was a substantial improvement (3.7 times) in detection of glandular abnormalities overall (P < 0.001), as also for both the qualifiers AGC- NOS (4.4 times) and AGC- FN (3.3 times) in TP2. Cervical sampling using combined spatula and endocervical brush reduces the unsatisfactory rate and improves the detection of both squamous and glandular precancerous lesions. Hence, this sampling procedure should be recommended for all laboratories practicing conventional cervical cytology.