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Gravett MG, Menon R, Tribe RM, Hezelgrave NL, Kacerovsky M, Soma-Pillay P, Jacobsson B, McElrath TF. Assessment of current biomarkers and interventions to identify and treat women at risk of preterm birth. Front Med (Lausanne) 2024; 11:1414428. [PMID: 39131090 PMCID: PMC11312378 DOI: 10.3389/fmed.2024.1414428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024] Open
Abstract
Preterm birth remains an important global problem, and an important contributor to under-5 mortality. Reducing spontaneous preterm birth rates at the global level will require the early identification of patients at risk of preterm delivery in order to allow the initiation of appropriate prophylactic management strategies. Ideally these strategies target the underlying pathophysiologic causes of preterm labor. Prevention, however, becomes problematic as the causes of preterm birth are multifactorial and vary by gestational age, ethnicity, and social context. Unfortunately, current screening and diagnostic tests are non-specific, with only moderate clinical risk prediction, relying on the detection of downstream markers of the common end-stage pathway rather than identifying upstream pathway-specific pathophysiology that would help the provider initiate targeted interventions. As a result, the available management options (including cervical cerclage and vaginal progesterone) are used empirically with, at best, ambiguous results in clinical trials. Furthermore, the available screening tests have only modest clinical risk prediction, and fail to identify most patients who will have a preterm birth. Clearly defining preterm birth phenotypes and the biologic pathways leading to preterm birth is key to providing targeted, biomolecular pathway-specific interventions, ideally initiated in early pregnancy Pathway specific biomarker discovery, together with management strategies based on early, mid-, and-late trimester specific markers is integral to this process, which must be addressed in a systematic way through rigorously planned biomarker trials.
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Affiliation(s)
- Michael G. Gravett
- Department of Obstetrics and Gynecology and of Global Health, University of Washington, Seattle, WA, United States
| | - Ramkumar Menon
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Rachel M. Tribe
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, St Thomas' Hospital Campus, King's College London, London, United Kingdom
| | - Natasha L. Hezelgrave
- Department of Women and Children’s Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Marian Kacerovsky
- Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czechia
- Department of Obstetrics and Gynecology, Faculty of Medicine Hradec Kralove, Charles University in Prague, Hradec Kralove, Czechia
| | - Priya Soma-Pillay
- Department of Obstetrics and Gynaecology, The University of Pretoria School of Medicine, Pretoria, South Africa
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | - Thomas F. McElrath
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
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Oh KJ, Romero R, Kim HJ, Lee J, Hong JS, Yoon BH. Preterm labor with intact membranes: a simple noninvasive method to identify patients at risk for intra-amniotic infection and/or inflammation. J Matern Fetal Neonatal Med 2022; 35:10514-10529. [PMID: 36229038 PMCID: PMC10544756 DOI: 10.1080/14767058.2022.2131388] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/29/2022] [Accepted: 09/28/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To develop a noninvasive scoring system to identify patients at high risk for intra-amniotic infection and/or inflammation, which would reduce the need for amniocentesis. METHODS This prospective cohort study comprised patients admitted with preterm labor and intact membranes (20-34 weeks of gestation) who underwent a transabdominal amniocentesis and for whom concentrations of quantitative cervical fetal fibronectin and of maternal serum C-reactive protein (CRP) were determined. Intra-amniotic infection was defined as a positive amniotic fluid culture for microorganisms. Intra-amniotic inflammation was defined as an amniotic fluid matrix metalloproteinase-8 concentration >23 ng/mL. Multivariate logistic regression analysis was performed to identify intra-amniotic infection/inflammtion with noninvasive parameters that had a significant relationship with univariate analysis. With four parameters identified by multivariate analysis, we generated a noninvasive risk scoring system. RESULTS Of the study population consisting of 138 singleton pregnant women, (1) the overall rate of intra-amniotic infection/inflammation was 28.3% (39/138); (2) four parameters were used to develop a noninvasive risk scoring system [i.e. cervical fetal fibronectin concentration (score 0-2), maternal serum CRP concentration (score 0-2), cervical dilatation (score 0-2), and gestational age at presentation (score 0-1)]; the total score ranges from 0 to 7; 3) the area under the curve of the risk score was 0.96 (95% confidence interval (CI), 0.92-0.99), significantly higher than that of each predictor in the identification of intra-amniotic infection/inflammation (p < .001, for all); 4) the risk score with a cutoff of 4 had a sensitivity of 94.9% (37/39), a specificity of 90.9% (90/99), a positive predictive value of 80.4% (37/46), a negative predictive value of 97.8% (90/92), a positive likelihood ratio of 10.4 (95% CI, 5.6-19.5), and a negative likelihood ratio of 0.06 (95% CI, 0.15-0.22) in the identification of intra-amniotic infection/inflammation. CONCLUSIONS (1) The combination of four parameters (concentrations of cervical fetal fibronectin and maternal serum CRP, cervical dilatation, and gestational age) was independently associated with intra-amniotic infection and/or inflammation; and (2) the risk scoring system comprised of the combination of 4 noninvasive parameters was sensitive and specific to identify the patients at risk for intra-amniotic infection and/or inflammation.
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Affiliation(s)
- Kyung Joon Oh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, USA, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
- Detroit Medical Center, Detroit, Michigan, USA
| | - Hyeon Ji Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - JoonHo Lee
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Joon-Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Bo Hyun Yoon
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Chen J, Gong G, Zheng W, Xu J, Luo X, Zhang Y. Diagnostic accuracy of quantitative fetal fibronectin to predict spontaneous preterm birth: A meta-analysis. Int J Gynaecol Obstet 2021; 153:220-227. [PMID: 33336362 DOI: 10.1002/ijgo.13550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/14/2020] [Accepted: 12/16/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Use of quantitative fetal fibronectin (fFN) testing to predict spontaneous preterm birth (sPTB) is gaining attention owing to its absolute measurement of fFN concentration and increased positive predictive value compared with qualitative testing. OBJECTIVE To assess the predictive values of quantitative fFN for sPTB in different predefined thresholds using systematic review and meta-analysis. SEARCH STRATEGY Five major databases (PubMed, ScienceDirect, Web of Science, Embase, Cochrane library) were searched for eligible studies. SELECTION CRITERIA Observational studies of the diagnostic accuracy of different quantitative fFN thresholds on delivery outcomes were included. DATA COLLECTION AND EXTRACTION Articles were reviewed independently by two authors and data were extracted. Sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curves were extracted and calculated. MAIN RESULTS Fifteen studies were included. To detect sPTB at less than 34 weeks of gestation, pooled sensitivities for thresholds of 10, 50, 200, and 500 ng/ml were 0.78, 0.56, 0.33, and 0.11, respectively. Pooled specificities were 0.63, 0.84, 0.96, and 0.99, respectively. CONCLUSIONS Based on the results of the meta-analysis, the threshold of 10 ng/ml fFN may be a new choice for the prediction of sPTB. The improved diagnostic accuracy of quantitative testing over qualitative testing can provide additional discriminatory information for clinical practice.
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Affiliation(s)
- Jingning Chen
- Department of Gynecology and Obstetrics, Shantou Jinping Women and Children's Hospital, Shantou, Guangdong, China
| | - Guoliang Gong
- Department of Pathology, Chaonan Minsheng Hospital of Shantou, Shantou, Guangdong, China
| | - Wenhua Zheng
- Department of Gynecology and Obstetrics, Shantou Jinping Women and Children's Hospital, Shantou, Guangdong, China
| | - Jingyun Xu
- Department of Pathology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaowei Luo
- Department of Pathology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Yuanxin Zhang
- Department of Pathology, Chaonan Minsheng Hospital of Shantou, Shantou, Guangdong, China
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Oh KJ, Romero R, Park JY, Kang J, Hong JS, Yoon BH. A high concentration of fetal fibronectin in cervical secretions increases the risk of intra-amniotic infection and inflammation in patients with preterm labor and intact membranes. J Perinat Med 2019; 47:288-303. [PMID: 30763270 PMCID: PMC6497400 DOI: 10.1515/jpm-2018-0351] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/08/2019] [Indexed: 01/07/2023]
Abstract
Objective To determine whether the risk of intra-amniotic infection/inflammation and spontaneous preterm delivery (SPTD) varies as a function of the concentration of cervical fetal fibronectin (fFN) in patients with preterm labor and intact membranes. Methods This prospective study included 180 patients with preterm labor and intact membranes who had a sample collected for quantitative fFN measurement and underwent amniocentesis. Amniotic fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas. Intra-amniotic inflammation was defined as an amniotic fluid matrix metalloproteinase-8 concentration >23 ng/mL. Results (1) The prevalence of intra-amniotic infection/inflammation and SPTD within 7 days was 32.2% (58/180) and 33.9% (61/178), respectively; (2) The higher the fFN concentration, the greater the risk of intra-amniotic infection/inflammation and SPTD within 7 days (P<0.001, respectively); (3) An fFN concentration 150 ng/mL had a better diagnostic performance than an fFN 50 ng/mL in the identification of intra-amniotic infection/inflammation and SPTD within 7 days; (4) Among the patients with an fFN <50 ng/mL, intra-amniotic infection/inflammation was identified in 7.6% (6/79) of patients and 66.7% (4/6) delivered within 7 days. Conclusion The higher the concentration of fFN, the greater the risk of intra-amniotic infection/inflammation and SPTD in patients with preterm labor and intact membranes.
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Affiliation(s)
- Kyung Joon Oh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, USA, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Jihyun Kang
- Department of Obstetrics and Gynecology, Veterans Health Service Medical Center, Seoul, Korea
| | - Joon-Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Bo Hyun Yoon
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Chon AH, Chan Y, Korst LM, Llanes A, Abdel-Sattar M, Chmait RH. Quantitative fetal fibronectin to predict spontaneous preterm delivery after laser surgery for twin-twin transfusion syndrome. Sci Rep 2019; 9:4438. [PMID: 30872799 PMCID: PMC6418228 DOI: 10.1038/s41598-019-41163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 03/01/2019] [Indexed: 11/09/2022] Open
Abstract
Our goal was to assess whether quantitative fetal fibronectin (qfFN) is associated with spontaneous preterm birth (sPTB) after laser surgery for twin-twin transfusion syndrome (TTTS). qfFN was collected within 24 hours before and after laser surgery. Aims were: (1) To determine if qfFN changed with operative fetoscopy; and (2) To estimate the number of patients needed to study the predictive value of qfFN for sPTB <28 and <32 weeks. Results are reported as median (range). Among 49 patients, there was no net difference in qfFN levels after laser surgery [0.0 ng/mL (-37 to +400), p = 0.6041]. However, patients with a qfFN increase >10 ng/mL were 19 times more likely to undergo sPTB at <28 weeks (OR = 19.5). We determined that 383 and 160 patients would be needed to achieve adequate statistical power for qfFN to be predictive of sPTB at a GA <28 weeks and <32 weeks, respectively. In conclusion, laser surgery did not alter the qfFN level within the entire cohort, but qfFN may be useful in identifying a subset of patients at increased risk of preterm delivery.
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MESH Headings
- Female
- Fetofetal Transfusion/surgery
- Fibronectins/metabolism
- Gestational Age
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/etiology
- Infant, Newborn, Diseases/metabolism
- Infant, Newborn, Diseases/pathology
- Laser Therapy/adverse effects
- Pregnancy
- Pregnancy, Twin
- Premature Birth/diagnosis
- Premature Birth/etiology
- Premature Birth/metabolism
- Premature Birth/pathology
- Prospective Studies
- Twin Studies as Topic
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Affiliation(s)
- Andrew H Chon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Yen Chan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lisa M Korst
- Childbirth Research Associates, North Hollywood, Los Angeles, California, USA
| | - Arlyn Llanes
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Mira Abdel-Sattar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ramen H Chmait
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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Nguyen AD, Liu CZ, Lehner C, Amoako AA, Sekar R. The efficacy of quantitative fetal fibronectin in predicting spontaneous preterm birth in symptomatic women: A retrospective cohort study. Aust N Z J Obstet Gynaecol 2019; 59:656-661. [PMID: 30724331 DOI: 10.1111/ajo.12947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/09/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent data suggest that quantitative measurements of fetal fibronectin can be used accurately to predict increased risk of preterm birth. AIM The purpose of this study was to demonstrate that the quantification of fetal fibronectin improves diagnostic accuracy in women who present with symptoms suggestive of threatened preterm labour (TPL) using a quantitative fetal fibronectin (qfFN) bedside analyser. STUDY DESIGN This was a retrospective cohort study of pregnant women who presented between 22+6 and 32+6 weeks gestation with symptoms of TPL who had qfFN measured using the Rapid fFN Q10 system. The ability to predict spontaneous preterm birth (sPTB) within 48 h, 14 days and <34 weeks gestation at qfFN thresholds of 10, 50 and 200 ng/mL was assessed. RESULTS The overall rate of sPTB <34 weeks was 4.1% (n = 373). For deliveries within 48 h, within 14 days and <34 weeks, a qfFN threshold of 200 ng/mL had positive predictive values of 26.7%, 42.9% and 46.7%, respectively, when compared to patients with qfFN values of 0-9 ng/mL. The corresponding relative risks were 68.5, 53.8 and 38.0, respectively CONCLUSION: Quantitative fetal fibronectin testing with thresholds of 10, 50 and 200 ng/mL allows for more accurate prediction of preterm birth in symptomatic women. This higher degree of discrimination allows for more directed interventions for high-risk patients and reduces the cost and burden of unnecessary treatment for low-risk patients.
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Affiliation(s)
- Anh Duy Nguyen
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Cathy Zhenao Liu
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Christoph Lehner
- Centre for Advanced Prenatal Care, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Akwasi Atakora Amoako
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Obstetrics and Gynaecology, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Renuka Sekar
- Centre for Advanced Prenatal Care, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Di Fabrizio L, Giardina I, Cetin I, Di Tommaso M, Ciavattini A, Locci M, Facchinetti F, Zonca M, Di Renzo GC. [New methods for preterm birth prediction: the PAMG-1 test]. ACTA ACUST UNITED AC 2018; 70:635-640. [PMID: 29856188 DOI: 10.23736/s0026-4784.18.04243-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to assess the efficacy of PAMG-1 test (placental alpha microglobulin-1) in cervicovaginal secretions collected immediately following transvaginal ultrasound (TVUS) of women with signs and symptoms of preterm labor (PTL), clinically intact membranes and cervical length between 15 and 30 mm for the prediction of imminent spontaneous delivery (within 7 days of testing), as well as delivery <34 weeks of gestation. METHODS Performing PAMG-1 test in 79 women with singleton pregnancy (240/7 -336/7 weeks' gestation) reporting signs and symptoms indicative of PTL and cervical length <30 mm. RESULTS For PTB prediction risk within 7 days of testing in pregnant women with cervicale length between 15-30 mm sensitivity is 100% and specificity is 94%. Positive predictive value (PPV) is 77% and negative predictive value (NPV) is 100%. For delivery prediction <34 weeks of gestation sensitivity decreased from 100% to 67% and specificity from 94% to 89%, PPV is 55% and NPV 93%. CONCLUSIONS The inaccuracy of traditional methods, including biophysical tests, biochemical markers, or the combination of both, for assessing the risk of spontaneous preterm birth in patients presenting with symptoms of PTL often leads to unnecessary admission and administration of corticosteroids and tocolytics. The PAMG-1 test demonstrated high efficacy in identifying women at risk of imminent PTL within 7 days of testing, despite being performed immediately after TVUS. High NPV can prevent improper admission and unnecessary therapies for mother and fetus.
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Affiliation(s)
- Laura Di Fabrizio
- Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
| | - Irene Giardina
- Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
| | - Irene Cetin
- Department of Mother and Child Health, Luigi Sacco Hospital, Giorgio Pardi Center for Fetal Research, Milan, Italy
| | | | - Andrea Ciavattini
- Division of Gynecology, Department of Women's Health Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Mariavittoria Locci
- Department of Obstetrics and Gynecology, Federico II University, Naples, Italy
| | - Fabio Facchinetti
- Department of Mother and Child Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Marina Zonca
- Department of Surgical Sciences, Obstetrics, and Gynecology, University of Turin, Sant'Anna University Hospital, Turin, Italy
| | - Gian Carlo Di Renzo
- Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy -
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