Interstitial pregnancy is an unusual and potentially life-threatening form of ectopic pregnancy, accounting for approximately 1–6% of all ectopic pregnancies, with a maternal mortality rate of 2–2.5%. Implantation happens in the proximal portion of the fallopian tube as it passes through the myometrium. The resolution of interstitial pregnancy after medical treatment should be assessed by a decline in serum β-hCG, which occurs in about 85–90% of cases. Nonetheless, its effectiveness and consequences have been presented through case reports and case series. However, few cases of interstitial pregnancies treated totally medically with the use of methotrexate and mifepristone have been presented in the literature. Complications of this medical treatments have also never been reviewed before. In the present manuscript, we present a case of interstitial pregnancy treated with methotrexate and mifepristone. The patient after treatment developed a uterine arteriovenous malformation, treated with uterine artery embolization. Furthermore, we performed a systematic review of the literature using Scopus, PubMed and Google Scholar. A total of 186 papers were found, and 7 papers which included 10 cases were assessed for eligibility. The systemic medical treatment with the use of methotrexate and mifepristone was effective in 7 of the 10 cases. Two cases of hemoperitoneum following combined methotrexate and mifepristone treatment were reported. The applicability of this medical conservative treatment should be tailored to the patient, taking into account their obstetric history, gestational age at diagnosis and desire for future pregnancies. Complete resolution after this treatment was achieved in most of the cases reported without major complications. The appearance of uterine arteriovenous malformation can be managed conservatively, and we propose uterine artery embolization as an effective treatment of this rare complication.

Mucosal malignant melanoma has a low incidence and only 2% are diagnosed in the gynecological tract. Diagnosis of primary cervical malignant melanoma is often challenging. The clinical presentation mimics other malignant cervical tumors, usually with abnormal bleeding or discharge. Cervical screening tests, such as cytology, often fail to detect malignant melanomas because of the rarity of the disorder, and histological evaluation of lesions is of paramount importance. The treatment is often based on regimens used for cutaneous malignant melanoma. We present the first case in the literature of primary malignant melanoma of the endocervix diagnosed by outpatient hysteroscopy and we have performed a narrative review of the literature on PubMed, Scopus and Web of Science from 1980 to December 2023, identifying 137 cases. The most common initial symptom was vaginal bleeding in 82.8% of cases, and 84.8% of patients were menopausal at the time of diagnosis. The first diagnostic modality was biopsy in 67.7%; 90% of patients underwent surgery and 64.5% of the deaths occurred within the first 12 months after diagnosis. Primary malignant melanoma of the cervix is extremely rare and difficult to diagnose at an early stage which is due to the aggressiveness of the disease and the non-specificity of the symptoms. To improve survival, early diagnosis is essential and hysteroscopy could be a useful tool in achieving it. It is crucial to increase the attention of gynecologists on primary malignant melanoma of the cervix to also perform a diagnostic hysteroscopy in case of doubtful symptoms.

Background/Objectives: Umbilical cord blood (UCB) is a valuable source of hematopoietic stem cells used in treating blood and immune disorders. Despite its potential and the availability of public banking systems in Italy, donation rates remain low due to patient misinformation, emotional barriers, and organizational inefficiencies. This study aimed to evaluate the impact of integrating Narrative Medicine (NM) and Lean Management (LM) on UCB donation rates and operational effectiveness at the University Hospital of Alessandria. Methods: This prospective, single-center pre-post study ran from July 2022 to December 2024. Two interventions were introduced: NM training for healthcare staff to enhance empathetic communication, and LM-based reorganization of workflows to improve process efficiency. Outcomes included changes in UCB donation and adherence rates, transplant-eligible unit percentages, and patient satisfaction, assessed through institutional and project-specific surveys (PERLA–SIMeN). Results: Post-intervention, donation rates increased from 0% in early 2022 to 30.8% (2022), 25.8% (2023), and 30.6% (2024), with adherence rates near 40%, far exceeding the national average of ~3%. Patient satisfaction improved, resulting in PERLA certification in February 2025. Conclusions: The integration of NM and LM significantly improved both patient engagement and organizational efficiency. Empathetic communication fostered trust and reduced emotional barriers, while LM optimized workflows and resource use. These results suggest the model is applicable in other hospitals to enhance UCB donation outcomes and overall quality of maternal care.

Background/Objectives: Umbilical cord blood (UCB) is a valuable source of hematopoietic stem cells used in treating blood and immune disorders. Despite its potential and the availability of public banking systems in Italy, donation rates remain low due to patient misinformation, emotional barriers, and organizational inefficiencies. This study aimed to evaluate the impact of integrating Narrative Medicine (NM) and Lean Management (LM) on UCB donation rates and operational effectiveness at the University Hospital of Alessandria. Methods: This prospective, single-center observational study ran from July 2022 to December 2024. Two interventions were introduced: NM training for healthcare staff to enhance empathetic communication, and LM-based reorganization of workflows to improve process efficiency. Outcomes included changes in UCB donation and adherence rates, transplant-eligible unit percentages, and patient satisfaction, assessed through institutional and project-specific surveys (PERLA–SIMeN). Results: Post-intervention, donation rates increased from 0% in early 2022 to 30.8% (2022), 25.8% (2023), and 30.6% (2024), with adherence rates near 40%, far exceeding the national average of ~3%. Transplant-eligible unit rates peaked at 5.5% in 2023, matching national figures. Patient satisfaction improved, resulting in PERLA certification in February 2025. Conclusions: The integration of NM and LM significantly improved both patient engagement and organizational efficiency. Empathetic communication fostered trust and reduced emotional barriers, while LM optimized workflows and resource use. These results suggest the model is replicable in other hospitals to enhance UCB donation outcomes and overall quality of maternal care.