It has been 27 years since the Human Fertilisation and Embryology Act 1990 was passed in the United Kingdom in response to advances in fertility treatment. Preimplantation genetic diagnosis - the screening of embryos for genetic diseases - has led to lengthy ethical debates on sex selection, eugenics, disabilities, saviour siblings, surplus embryos and most recently, adult-onset diseases (the BRCA cancer gene). This article provides an overview of how the law and practice of PGD in the United Kingdom and United States over the last quarter of a century has developed into new ‘branches’ of PGD, and predicts where they may be heading in the future. It concludes that many of the adverse views on PGD are unfounded and that some of these unique branches may develop to accommodate the screening of additional social traits. An underlying conflict between reproductive autonomy and a right to an open future is also rising under the surface to be noted for the future.

Giuseppe Luzi*, Elisa Iazzetta, Lorenzo Cecconi, Silvia Famiani , Saverio Arena , Gian carlo Di Renzo and Giorgio Epicoco

Objectives: Very Preterm Premature Rupture of Membranes (PPROM) complicates about 2% - 5% of pregnancies and leads to an exponential increase in perinatal mortality and morbidity. A lot of Bacteria have been associated with PPROM. The aim of the following study was to evaluate the impact of Lactobacillus BMX 54 vaginal application added to standard of care therapy on pregnancy and neonatal outcome.

Material and Methods: This observational study includes 38 consecutive women with PPROM hospitalized in the Department of Obstetric and Gynecology of Perugia Hospital. All the women presented PPROM before of 30 week of pregnancy and have been treated with antibiotics, tocolitics therapy and bed rest: 58% of the pregnancies (22 women) added to standard of care once day vaginal Lactobacillus rhamnosus BMX 54 application while the others (42% of the pregnancies: 16 women) have been treated only with standard therapy without probiotic vaginal application

Results: The women who added to standard therapy Lactobacillus rhamnosus BMX 54 daily vaginal application from the beginning of PPROM up to the delivery shown a statistical significant increase (p = 0.04) of delivery gestational age when compared with the women treated only with standard therapy. The time course between PPROM and delivery was 26.5 +/- 27.4 days in the Lactobacillus treated group and 11.6 +/- 14.2 days in the other group (p = 0.03). CRP (C-Reactive Protein) value at delivery time was 2.37 +/- 2.2 in the lactobacillus treated group and 3.87 +/- 2.5 in the control group (p = 0.0003). 5th minute Neonatal APGAR Score was 8.8 +/-0.8 in treated group and 6.6 +/-3.7 in control group (p= 0.006) while the Hospitalization time of the newborn in Neonatal Intensive Unit Care (NICU) was 43.4 +/- 24 days in the treated group versus 61 +/- 33 days in control group (p = 0.01)

Conclusions: Lactobacillus rhamnosus BMX 54 vaginal application used as adjuvant therapy to standard treatment seems to be an useful approach to reduce PPROM complications improving neonatal and maternal outcomes