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Vasarri MV, Fernicola F, Arienti F, Carli A, Colciago E, Locatelli A, Trotta M, Procopio A, Zammarchi L, Ornaghi S. Indirect impact of SARS-CoV-2 pandemic on incidence of maternal primary cytomegalovirus and Toxoplasma gondii infection in pregnancy. Int J Gynaecol Obstet 2024. [PMID: 38619337 DOI: 10.1002/ijgo.15534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 03/21/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Public health interventions promoted during the SARS-CoV-2 pandemic to control viral spread have impacted the occurrence of other communicable disease. Yet no studies have focused on perinatal infections with the potential for neonatal sequelae, including cytomegalovirus (CMV) and Toxoplasma gondii (TG). Here we investigate whether incidence rates of maternal primary CMV and TG infection in pregnancy were affected by the implementation of pandemic-related public health measures. METHODS A retrospective study including all pregnant women with confirmed primary CMV or TG infection in pregnancy, managed between 2018 and 2021 at two university centers. The incidence rate was calculated as the number of CMV and TG infections per 100 consultations with a 95% confidence interval (CI). Data were compared between pre-pandemic (2018-2019) and pandemic (2020 and 2021) years. The Newcombe Wilson with Continuity Correction method was employed to compare incidence rates. RESULTS The study population included 215 maternal primary CMV and 192 TG infections. Rate of maternal primary CMV infection decreased in 2021 compared with 2018-2019 (4.49% vs 6.40%, attributable risk [AR] 1.92, P = 0.019). By contrast, the rate of TG infection substantially increased in 2020 (6.95% vs 4.61%, AR 2.34, P = 0.006). Close contact with cats was more common among patients with TG infection in 2020 and 2021 than among pre-pandemic TG-infected women (26.3% and 24.4% vs 13.3%, P = 0.013). CONCLUSION Pandemic-related public health interventions and associated behavioral and lifestyle changes exerted a divergent effect on the incidence of primary CMV and TG infection in pregnancy, likely due to modulation of exposure to risk factors for these infections.
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Affiliation(s)
- Maria Viola Vasarri
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Federica Fernicola
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Francesca Arienti
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Anna Carli
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Anna Locatelli
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Michele Trotta
- Tuscany Referral Centre for Infectious Diseases in Pregnancy, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Angelica Procopio
- School of Human Health Sciences, Degree Course in Medicine and Surgery, University of Florence, Florence, Italy
| | - Lorenzo Zammarchi
- Tuscany Referral Centre for Infectious Diseases in Pregnancy, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sara Ornaghi
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
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Ornaghi S, Fernicola F, Marelli E, Perotti M, Di Gennaro F, Cameroni I, Mariani EM, Pincelli AI, Colciago E, Cetin I, Vergani P. Acute spontaneous non-hemorrhagic adrenal infarction in pregnancy: case-report and literature review. Gynecol Endocrinol 2023; 39:2234492. [PMID: 37486308 DOI: 10.1080/09513590.2023.2234492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023] Open
Abstract
Unilateral non-hemorrhagic adrenal infarction (NHAI) is a very uncommon cause of acute abdomen in pregnancy. Diagnosis is highly challenging due to its rarity, heterogeneity of clinical presentation, and inconclusiveness of the initial workup. Timely recognition is pivotal to ensuring optimal outcomes. Here we describe a case of spontaneous unilateral NHAI diagnosed in a singleton pregnant woman at 32 weeks' gestation at our centre and provide the findings of an extensive literature review on the topic. We identified 22 articles describing 31 NHAI cases in 30 obstetric patients: NHAI occurs more frequently on the right side and in the third trimester, and diagnosis is formulated more than 24 h after clinical presentation in 50% of cases; second-level imaging is always necessary to reach a definitive diagnosis and start appropriate treatment. A high degree of clinical suspicion is needed to promptly recognize NHAI in pregnancy, thus allowing appropriate multidisciplinary management and timely treatment initiation. Promotion of knowledge and awareness of NHAI as a potential cause of acute abdomen in pregnancy is mandatory to improve clinical practice and, ultimately, perinatal outcomes.
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Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Federica Fernicola
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Elisabetta Marelli
- Department of Clinical and Biological Sciences, University of Milan, Milan, Italy
- Department of Woman, Mother, and Neonate, Buzzi Children's Hospital-ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mario Perotti
- Department of Internal Medicine, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Irene Cameroni
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Eloisa M Mariani
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Angela I Pincelli
- Department of Internal Medicine, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Irene Cetin
- Department of Clinical and Biological Sciences, University of Milan, Milan, Italy
- Department of Woman, Mother, and Neonate, Buzzi Children's Hospital-ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Patrizia Vergani
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
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Borrelli S, Fumagalli S, Colciago E, Downey J, Spiby H, Nespoli A. How should a video-call service for early labour be provided? A qualitative study of midwives' perspectives in the United Kingdom and Italy. Women Birth 2023; 36:504-510. [PMID: 37365096 DOI: 10.1016/j.wombi.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/23/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
PROBLEM Women in early labour are typically encouraged to delay admission to the maternity unit, but they may find this challenging without appropriate professional support. BACKGROUND Prior to the pandemic, research conducted with midwives and women showed positivity towards using video-technology for early labour, with concerns raised about privacy. AIM To explore midwives' perspectives on potential use of video-calls during early labour METHODS: A multi-centre descriptive qualitative study was undertaken in UK and Italy. Ethical approval was gained prior to commencing the study and ethical processes were followed. Seven virtual focus groups were conducted with 36 participants, 17 midwives working in the UK and 19 midwives working in Italy. Line-by-line thematic analysis was performed and themes agreed by the research team. FINDINGS The findings include three main themes: 1) who, where, when and how: key aspects to consider for an effective video-call service in early labour; 2) video-call content and expected contribution; 3) potential barriers to address. DISCUSSION Midwives responded positively to the concept of video-calling in early labour and provided detailed suggestions on how an ideal video-call service for early labour should be provided to maximise effectiveness, safety and quality of care. CONCLUSION Guidance, support and training should be provided to midwives and healthcare professionals, with dedicated resources for an early labour video-call service that is accessible, acceptable, safe, individualised and respectful for mothers and families. Further research should systematically explore clinical, psychosocial and service feasibility and acceptability.
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Affiliation(s)
- Sara Borrelli
- University of Nottingham, School of Health Sciences, Queen's Medical School, B Floor, Nottingham NG7 2UH, United Kingdom.
| | - Simona Fumagalli
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy
| | - Elisabetta Colciago
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy
| | - Joshua Downey
- Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Hucknall Rd, Nottingham NG5 1PB, United Kingdom
| | - Helen Spiby
- University of Nottingham, School of Health Sciences, Queen's Medical School, B Floor, Nottingham NG7 2UH, United Kingdom
| | - Antonella Nespoli
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy
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4
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Bazzurini L, Ornaghi S, Colciago E, Penati C, di Gennaro F, Passoni P, Buda A, Locatelli A, Landoni F, Vergani P. Endometriosis-related spontaneous hemoperitoneum in pregnancy: A case series. J Obstet Gynaecol Res 2023; 49:744-752. [PMID: 36366961 DOI: 10.1111/jog.15498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/03/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
Endometriosis can be associated with adverse pregnancy outcomes. We report six cases of endometriosis-related spontaneous hemoperitoneum diagnosed in pregnant and postpartum women over 13 years. Spontaneous hemoperitoneum in pregnancy mainly occurred in the second half of gestation. All women presented with acute abdominal pain; four of them needed an emergent surgery, two were managed expectantly. The median estimated blood loss was 4250 ml, four women required massive transfusion. Three out of six women had a known history of endometriosis, all of them had histologically confirmed endometriosis after surgery. No maternal or perinatal deaths occurred. In one case, reticence to perform a computed tomography scan led to delayed diagnosis. Since delay can lead to lethal consequences, high levels of suspicion for spontaneous hemoperitoneum should be maintained in cases of severe abdominal pain, even with a woman's negative history of endometriosis. Improved knowledge and regular interdisciplinary meetings are pivotal to ameliorate outcomes.
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Affiliation(s)
- Luca Bazzurini
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy
| | - Sara Ornaghi
- Department of Obstetrics and Gynecology, Division of Obstetrics, Foundation MBBM Onlus at San Gerardo Hospital, University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
| | - Elisabetta Colciago
- University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
| | - Cristina Penati
- Department of Obstetrics and Gynecology, Carate Brianza Hospital, Monza e Brianza, Italy
| | | | - Paolo Passoni
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy
| | - Anna Locatelli
- University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy.,Department of Obstetrics and Gynecology, Carate Brianza Hospital, Monza e Brianza, Italy
| | - Fabio Landoni
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy.,University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, Division of Obstetrics, Foundation MBBM Onlus at San Gerardo Hospital, University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
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5
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Borrelli S, Downey J, Colciago E, Fumagalli S, Nespoli A, Spiby PH. Mothers' perspectives on the potential use of video-calling during early labour in the United Kingdom and Italy: A qualitative study. Women Birth 2023:S1871-5192(23)00017-3. [PMID: 36682951 DOI: 10.1016/j.wombi.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
PROBLEM Women in early labour are typically encouraged to delay maternity unit admission, but they may find this challenging without appropriate professional support. BACKGROUND Despite pre-pandemic research which identified potential advantages of video-calling in early labour, implementation of such service has not been reported. AIM To explore mothers' perspectives on potential use of video-calls during early labour. METHODS A multi-centre descriptive qualitative study was undertaken in UK and Italy. Ethical approval was gained and ethical processes were followed. Six virtual focus groups were conducted with 37 participants, 24 mothers who gave birth in the UK and 13 who gave birth in Italy. Line-by-line thematic analysis was performed and themes agreed. FINDINGS Two themes emerged: 1) women's expectations of video-calls' content and features; 2) technological challenges and solutions. Mothers responded positively to the concept of video-calling in early labour. Receiving guidance, information on coping with pain and advice on timely access in early labour was perceived as key. Women highlighted the importance of accessible, reliable and user-friendly technology. Equitable access, technological literacy, acceptability and privacy were considered as challenges to implementation, with solutions proposed to overcome disparities. DISCUSSION AND CONCLUSION Guidance and training should be provided to midwives, with designated resources to build a service that is accessible, acceptable, safe, individualised and respectful for mothers and birth companions. Further research should explore feasibility, acceptability, clinical and cost-effectiveness.
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Affiliation(s)
- Sara Borrelli
- University of Nottingham, School of Health Sciences, Queen's Medical School, B Floor, Nottingham NG7 2UH, United Kingdom.
| | - Joshua Downey
- Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Hucknall Rd, Nottingham NG5 1PB, United Kingdom.
| | - Elisabetta Colciago
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy.
| | - Simona Fumagalli
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy.
| | - Antonella Nespoli
- University of Milano Bicocca, School of Medicine and Surgery, Via Cadore 48, 20900 Monza, MB, Italy.
| | - Prof Helen Spiby
- University of Nottingham, School of Health Sciences, Queen's Medical School, B Floor, Nottingham NG7 2UH, United Kingdom.
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6
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Maraschini A, Salvi S, Colciago E, Corsi E, Cetin I, Lovotti M, Donati S. Eclampsia in Italy: A prospective population-based study (2017–2020). Pregnancy Hypertens 2022; 30:204-209. [DOI: 10.1016/j.preghy.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
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7
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Fumagalli S, Borrelli S, Bulgarelli M, Zanoni A, Serafini M, Colciago E, Nespoli A. Coping strategies for labor pain, related outcomes and influencing factors: A systematic review. Eur J Midwifery 2022. [DOI: 10.18332/ejm/156440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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8
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Colciago E, Capitoli G, Vergani P, Ornaghi S. Women's attitude towards COVID-19 vaccination in pregnancy: A survey study in northern Italy. Int J Gynaecol Obstet 2022:10.1002/ijgo.14506. [PMID: 36227124 PMCID: PMC9874513 DOI: 10.1002/ijgo.14506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/15/2022] [Accepted: 10/12/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To investigate attitudes and risk perceptions towards the coronavirus disease 2019 (COVID-19) vaccine and reasons for hesitancy among pregnant women. METHODS A prospective survey study was conducted at a University Maternity Department. Participants included any pregnant woman aged 18 years or older, able to understand the Italian language, who accessed the antenatal clinic for a prenatal appointment. The survey comprised questions about sociodemographic characteristics, pregnancy vaccination history, and perception of risk related to the immunization for the woman herself and her infant. RESULTS A total of 538 women completed the questionnaire, 445 (82.7%) accepted COVID-19 vaccination. Women vaccinated against pertussis were three times more likely to take up the COVID-19 vaccine (odds ratio [OR] 3.19; 95% confidence interval [CI] 1.78-5.72). Having had COVID-19 during pregnancy (OR 0.24; 95% CI 0.11-0.54), and having a high-risk perception towards the immunization for the fetus (OR 0.18; 95% CI 0.09-0.34) were factors associated with vaccine hesitancy. Lack of safety data in pregnancy and the possibility of harm to the fetus were the main concerns. CONCLUSION A trusting and supportive relationship with the healthcare professional to address fears, and the transmission of evidence-based information, are pivotal to guide women through an informed choice. Understanding the determinants implicated in women's decision making might guide towards effective public health strategies to boost vaccine acceptance.
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Affiliation(s)
| | - Giulia Capitoli
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 CenterSchool of Medicine and Surgery, University of Milano—BicoccaMonzaItaly
| | - Patrizia Vergani
- School of Medicine and SurgeryUniversity of Milano—BicoccaMonzaItaly,Department of Obstetrics and Gynecology—MBBM Foundation OnlusMonzaItaly
| | - Sara Ornaghi
- School of Medicine and SurgeryUniversity of Milano—BicoccaMonzaItaly,Department of Obstetrics and Gynecology—MBBM Foundation OnlusMonzaItaly
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9
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Zobbi VF, Alberti S, Fumagalli S, Colciago E, Nespoli A. Intimate partner violence screening during pregnancy: midwives' perspective. Women Health 2022; 62:827-838. [PMID: 36397268 DOI: 10.1080/03630242.2022.2148804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Violence during pregnancy has serious health consequences. Several scientific societies recommend introducing domestic violence screening in clinical practice, but it is poorly employed. This study aimed to explore midwives' perspective regarding how, where, and when to conduct intimate partner violence screening during pregnancy to increase its clinical application. We performed a qualitative study using a hermeneutic phenomenological approach. Eleven midwives were recruited, and semi-structured interviews were conducted. The interviews were audio recorded and transcribed verbatim. Content analysis was conducted. Six main themes emerged: "the healthcare providers involved," "the best place to investigate," "the best time to ask," "how to investigate," "what facilitates investigations and women's disclosure," and "what hinders investigations and women's disclosure." Most interviewees believed that midwives are the most suitable healthcare providers to investigate violent situations during pregnancy because the continuity of midwifery care can facilitate women's disclosure. Midwives emphasized the importance of an environment where women's privacy is respected. Midwives did not consider it appropriate to ask about domestic violence at the first antenatal appointment. Most believed that the best way to investigate domestic violence depends on the context and the woman's personal history.
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Affiliation(s)
- Virna Franca Zobbi
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Silvia Alberti
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Simona Fumagalli
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Elisabetta Colciago
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Antonella Nespoli
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
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10
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Mazzocco MI, Donati S, Maraschini A, Corsi E, Colciago E, Guelfi F, Cetin I. Spontaneous hemoperitoneum in pregnancy: Italian prospective population-based cohort study. Acta Obstet Gynecol Scand 2022; 101:1220-1226. [PMID: 36047477 PMCID: PMC9812087 DOI: 10.1111/aogs.14431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/17/2022] [Accepted: 07/16/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Spontaneous hemoperitoneum in pregnancy is defined as a sudden non-traumatic intraperitoneal bleeding in pregnancy and up to 42 days postpartum. In the present study we aim to estimate the incidence and investigate the risk factors, the management and the outcomes of spontaneous hemoperitoneum in pregnancy in order to improve its clinical identification and reduce avoidable maternal deaths. MATERIAL AND METHODS This is a prospective population-based cohort study, set in maternity units from nine Italian regions covering 75% of the national births. The study population comprises all women admitted for spontaneous intraperitoneal hemorrhage during pregnancy and up to 42 days postpartum between November 2017 and March 2020. Incident cases were reported by trained clinicians through electronic data collection forms. Descriptive statistics were performed. The main outcome measures included incidence rate of spontaneous hemoperitoneum in pregnancy, association with potential risk factors, clinical management and maternal and perinatal outcomes. RESULTS Twenty-nine cases met the adopted definition of spontaneous hemoperitoneum in pregnancy with an estimated incidence rate of 0.04 per 1000 births. An increased risk ratio (RR) of this condition was observed in pregnancies conceived by assisted reproductive technology (RR = 6.60, 95% CI 2.52-17.29), in the case of multiple pregnancies (RR = 6.57, 95% CI 1.99-21.69) and maternal age ≥35 years (RR 2.10, 95% CI 1.01-4.35). In 17/29 cases the bleeding site was intra-pelvic (23.5% in the posterior uterine wall and 35.2% in the left hemipelvis). Laparotomy represented the surgical treatment in 27 cases (93%), and most women underwent a cesarean delivery (92.6%). Median blood loss was 1900 mL, one hysterectomy was necessary, and two women died. Twenty-two preterm births were recorded. CONCLUSIONS Spontaneous hemoperitoneum in pregnancy is a rare, life-threatening condition associated with high perinatal morbidity and mortality. Maternal age ≥35 years, multiple pregnancies and assisted reproductive technology were associated to a higher risk of the condition. Two women of 29 died and 70% of births occurred preterm.
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Affiliation(s)
- Martina Ilaria Mazzocco
- Obstetrics and Gynecology, Hospital Vittore BuzziDepartment of Biomedical and Clinical Sciences, University of MilanMilanItaly
| | - Serena Donati
- National Center for Disease Prevention and Health PromotionIstituto Superiore di Sanità ‐ Italian National Institute of HealthRomeItaly
| | - Alice Maraschini
- Technical‐scientific statistical serviceItalian National Institute of HealthRomeItaly
| | - Edoardo Corsi
- National Center for Disease Prevention and Health PromotionIstituto Superiore di Sanità ‐ Italian National Institute of HealthRomeItaly,Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly
| | | | - Fabiola Guelfi
- Obstetrics and Gynecology, Hospital Vittore BuzziDepartment of Biomedical and Clinical Sciences, University of MilanMilanItaly
| | - Irene Cetin
- Obstetrics and Gynecology, Hospital Vittore BuzziDepartment of Biomedical and Clinical Sciences, University of MilanMilanItaly
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11
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Fumagalli S, Antolini L, Cosmai G, Gramegna T, Nespoli A, Pedranzini A, Colciago E, Valsecchi MG, Vergani P, Locatelli A. Development and validation of a predictive model to identify the active phase of labor. BMC Pregnancy Childbirth 2022; 22:641. [PMID: 35971093 PMCID: PMC9377074 DOI: 10.1186/s12884-022-04946-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background The diagnosis of the active phase of labor is a crucial clinical decision, thus requiring an accurate assessment. This study aimed to build and to validate a predictive model, based on maternal signs and symptoms to identify a cervical dilatation ≥4 cm. Methods A prospective study was conducted from May to September 2018 in a II Level Maternity Unit (development data), and from May to September 2019 in a I Level Maternity Unit (validation data). Women with singleton, term pregnancy, cephalic presentation and presence of contractions were consecutively enrolled during the initial assessment to diagnose the stage of labor. Women < 18 years old, with language barrier or induction of labor were excluded. A nomogram for the calculation of the predictions of cervical dilatation ≥4 cm on the ground of 11 maternal signs and symptoms was obtained from a multivariate logistic model. The predictive performance of the model was investigated by internal and external validation. Results A total of 288 assessments were analyzed. All maternal signs and symptoms showed a significant impact on increasing the probability of cervical dilatation ≥4 cm. In the final logistic model, “Rhythm” (OR 6.26), “Duration” (OR 8.15) of contractions and “Show” (OR 4.29) confirmed their significance while, unexpectedly, “Frequency” of contractions had no impact. The area under the ROC curve in the model of the uterine activity was 0.865 (development data) and 0.927 (validation data), with an increment to 0.905 and 0.956, respectively, when adding maternal signs. The Brier Score error in the model of the uterine activity was 0.140 (development data) and 0.097 (validation data), with a decrement to 0.121 and 0.092, respectively, when adding maternal signs. Conclusion Our predictive model showed a good performance. The introduction of a non-invasive tool might assist midwives in the decision-making process, avoiding interventions and thus offering an evidenced-base care.
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Affiliation(s)
- Simona Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
| | - Laura Antolini
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Greta Cosmai
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Teresa Gramegna
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Antonella Nespoli
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Astrid Pedranzini
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Elisabetta Colciago
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Maria Grazia Valsecchi
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Anna Locatelli
- Department of Obstetrics and Gynecology, Carate Brianza Hospital, ASST Brianza, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Ornaghi S, Bellante N, Abbamondi A, Maini M, Cesana F, Trabucchi M, Corsi D, Arosio V, Mariani S, Scian A, Colciago E, Lettino M, Vergani P. Cardiac and obstetric outcomes in pregnant women with heart disease: appraisal of the 2018 mWHO classification. Open Heart 2022; 9:openhrt-2021-001947. [PMID: 35332050 PMCID: PMC8948382 DOI: 10.1136/openhrt-2021-001947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/07/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To appraise the application of the 2018 European Society of Cardiology-adapted modified WHO (mWHO) classification to pregnant women with heart disease managed at our maternal-fetal medicine referral centre and to assess whether the lack of a multidisciplinary Pregnancy Heart team has influenced their outcomes. METHODS A retrospective cohort study including all pregnancies with heart disease managed at our centre between June 2011 and December 2020. Cardiac conditions were categorised in five classes according to the mWHO classification. An additional class, named X, was created for conditions not included in this classification. Outcomes were compared among all classes and factors potentially associated to cardiac complications were assessed. RESULTS We identified 162 women with 197 pregnancies, for a prevalence of 0.7%. Thirty-eight (19.3%) gestations were included in class X. Caesarean section was performed in 64.9% pregnancies in class X, a rate similar to that of class II, II-III, and III/IV, and mostly for obstetric indications; in turn, it was more commonly performed for cardiology reasons in class II-III and III/IV. Cardiac complications occurred in 10.7%, with class X and II pregnancies showing the highest number of events (n=30.8% and 34.6%, respectively). Multiple gestation and urgent caesarean section associated with a 5-fold and 6.5-fold increase in complication rates. CONCLUSIONS Even in a maternal-fetal medicine referral centre, the lack of a multidisciplinary team approach to women with heart disease may negatively impact their outcomes.
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Affiliation(s)
- Sara Ornaghi
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy .,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Nicolo' Bellante
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Alessandra Abbamondi
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Marzia Maini
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | | | | | - Davide Corsi
- Department of Cardiology, San Gerardo Hospital, Monza, Italy
| | - Viola Arosio
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Silvana Mariani
- Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Antonietta Scian
- Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | | | | | - Patrizia Vergani
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
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Colciago E, Brown AM, Ornaghi S, Antolini L, Nespoli A, Fumagalli S, Robinson A. The unpredictable nature of labour and birth: a qualitative investigation regarding expectations of Italian parents to-be. Midwifery 2022; 108:103286. [DOI: 10.1016/j.midw.2022.103286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/10/2022] [Accepted: 02/10/2022] [Indexed: 12/01/2022]
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14
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Ornaghi S, Colciago E, Vaglio Tessitore I, Abbamondi A, Antolini L, Locatelli A, Inversetti A, Pintucci A, Cetin I, Bracco B, Fabbri E, Sala V, Meroni M, Volpe G, Benedetti S, Bulfoni C, Marconi A, Lagrasta F, Paolini CL, Mazza E, Candiani M, Valsecchi L, Smid M, Pasi F, Pozzoni M, Castoldi M, Vignali M, Dal Molin G, Guarano A, Pellegrino A, Callegari C, Betti M, Lazzarin S, Prefumo F, Zanardini C, Parolin V, Catalano A, Barbolini E, Antonazzo P, Pignatti L, Tintoni M, Spelzini F, Martinelli A, Facchinetti F, Chiossi G, Vergani P. Mode of birth in women with low-lying placenta: protocol for a prospective multicentre 1:3 matched case-control study in Italy (the MODEL-PLACENTA study). BMJ Open 2021; 11:e052510. [PMID: 34873004 PMCID: PMC8650481 DOI: 10.1136/bmjopen-2021-052510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The term placenta praevia defines a placenta that lies over the internal os, whereas the term low-lying placenta identifies a placenta that is partially implanted in the lower uterine segment with the inferior placental edge located at 1-20 mm from the internal cervical os (internal-os-distance). The most appropriate mode of birth in women with low-lying placenta is still controversial, with the majority of them undergoing caesarean section. The current project aims to evaluate the rate of vaginal birth and caesarean section in labour due to bleeding by offering a trial of labour to all women with an internal-os-distance >5 mm as assessed by transvaginal sonography in the late third trimester. METHODS AND ANALYSIS The MODEL-PLACENTA is a prospective, multicentre, 1:3 matched case-control study involving 17 Maternity Units across Lombardy and Emilia-Romagna regions, Italy. The study includes women with a placenta located in the lower uterine segment at the second trimester scan. Women with a normally located placenta will be enrolled as controls. A sample size of 30 women with an internal-os-distance >5 mm at the late third trimester scan is needed at each participating Unit. Since the incidence of low-lying placenta decreases from 2% in the second trimester to 0.4% at the end of pregnancy, 150 women should be recruited at each centre at the second trimester scan. A vaginal birth rate ≥60% in women with an internal-os-distance >5 mm will be considered appropriate to start routinely admitting to labour these women. ETHICS AND DISSEMINATION Ethical approval for the study was given by the Brianza Ethics Committee (No 3157, 2019). Written informed consent will be obtained from study participants. Results will be disseminated by publication in peer-reviewed journals and presentation in international conferences. TRIAL REGISTRATION NUMBER NCT04827433 (pre-results stage).
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Affiliation(s)
- Sara Ornaghi
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Obstetrics and Gynaecology, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
| | | | | | | | - Laura Antolini
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Anna Locatelli
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Obstetrics and Gynaecology, ASST di Vimercate, Carate Brianza, Italy
| | - Annalisa Inversetti
- Department of Obstetrics and Gynaecology, ASST di Vimercate, Carate Brianza, Italy
| | - Armando Pintucci
- Department of Obstetrics and Gynaecology, ASST di Monza, Desio, Italy
| | - I Cetin
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Benedetta Bracco
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Elisa Fabbri
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Valentina Sala
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Mario Meroni
- Department of Obstetrics and Gynaecology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Grazia Volpe
- Department of Obstetrics and Gynaecology, Ca' Grande Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Sara Benedetti
- Department of Obstetrics and Gynaecology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Camilla Bulfoni
- Department of Obstetrics and Gynaecology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Annamaria Marconi
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Federica Lagrasta
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Cinzia Lucia Paolini
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Elisabetta Mazza
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Massimo Candiani
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Luca Valsecchi
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Maddalena Smid
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Federica Pasi
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Mirko Pozzoni
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Maria Castoldi
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Michele Vignali
- Department of Biomedical Sciences for Health, Università degli Studi di Milano Facoltà di Medicina e Chirurgia, Milano, Italy
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Giulia Dal Molin
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Alice Guarano
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Clelia Callegari
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Marta Betti
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Sara Lazzarin
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
- School of Medicine and Surgery, University of Brescia, Brescia, Lombardia, Italy
| | - Cristina Zanardini
- Department of Obstetrics and Gynaecology, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
- School of Medicine and Surgery, University of Brescia, Brescia, Lombardia, Italy
| | - Valentina Parolin
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Anna Catalano
- Department of Obstetrics and Gynaecology, Poliambulanza Foundation Hospitals, Brescia, Italy
| | - Edoardo Barbolini
- Department of Obstetrics and Gynaecology, Poliambulanza Foundation Hospitals, Brescia, Italy
| | - Patrizio Antonazzo
- Department of Obstetrics and Gynaecology, Maurizio Bufalini Hospital, Cesena, Italy
| | - Lucrezia Pignatti
- Department of Obstetrics and Gynaecology, Maurizio Bufalini Hospital, Cesena, Italy
| | - Mauro Tintoni
- Department of Obstetrics and Gynaecology, Maurizio Bufalini Hospital, Cesena, Italy
| | - Federico Spelzini
- Department of Obstetrics and Gynaecology, Infermi Hospital Rimini, Rimini, Italy
| | - Anna Martinelli
- Department of Obstetrics and Gynaecology, Infermi Hospital Rimini, Rimini, Italy
| | - Fabio Facchinetti
- Obstetric Unit, Mother Infant Department, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy
- Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - G Chiossi
- Obstetric Unit, Mother Infant Department, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy
- Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynaecology, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
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Zobbi VF, Fumagalli S, Antolini L, Bianco A, Mornatta M, Colciago E, Nespoli A. Women's knowledge and attitude towards human milk donation: a survey within the Italian context. Minerva Pediatr (Torino) 2021:S2724-5276.21.06339-4. [PMID: 34515443 DOI: 10.23736/s2724-5276.21.06339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Human milk is the best nutrition for all infants. When this is not available, the use of donor human milk through human milk banks (HMBs), is recommended. The aim of the study is to explore Italian women's knowledge and attitude towards human milk donation and HMB. METHODS A web-based self-administered 20-item questionnaire was developed based on the literature review and distributed via the social networking site Facebook. RESULTS 3290 women completed the survey. Of those 76.57% knew about the opportunity to donate human milk and 72.37% were aware of the existence of HMBs, most of them breastfed for more than 6 months. Altruism towards other mothers and having an abundant milk supply, were found to be the most important facilitators that should lead women to donate their own milk. The most important barrier was lack of information (91.25%). A high rate of women who breastfed longer than 6 months expressed issues related to collection and transportation; concerns regarding the time needed to express was reported mainly by women currently breastfeeding. CONCLUSIONS This is the first Italian study to investigate this topic. Advertising to inform the general public should be used to increase awareness, short sessions within the school programme might sensitize women from a very young age. Healthcare professionals should strive to divulgate appropriate information.
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Affiliation(s)
- Virna F Zobbi
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Monza Brianza, Italy
| | - Simona Fumagalli
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Monza Brianza, Italy
- ASST Vimercate, Desio, Monza Brianza, Italy
| | - Laura Antolini
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Monza Brianza, Italy
| | | | | | - Elisabetta Colciago
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Monza Brianza, Italy -
| | - Antonella Nespoli
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Monza Brianza, Italy
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Colciago E, Fumagalli S, Ciarmoli E, Antolini L, Nespoli A, Mastrolia SA, Tagliabue PE, Furlan C, Manganini C, Vergani P. The effect of clamped and unclamped umbilical cord samples on blood gas analysis. Arch Gynecol Obstet 2021; 304:1493-1499. [PMID: 34021806 PMCID: PMC8553729 DOI: 10.1007/s00404-021-06076-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/16/2021] [Indexed: 12/02/2022]
Abstract
Purpose Delayed cord clamping for at least 60 s is recommended to improve neonatal outcomes. The aim of this study is to evaluate whether there are differences in cord BGA between samples collected after double clamping the cord or without clamping the cord, when blood collection occurs within 60 s from birth in both groups. Methods A cross-sectional study was carried out, collecting data from 6884 high-risk women who were divided into two groups based on the method of cord sampling (clamped vs unclamped). Results There were significant decrease in pH and BE values into unclamped group compared with the clamped group. This difference remained significant when considering pathological blood gas analysis parameters, with a higher percentage of pathological pH or BE values in the unclamped group. Conclusion Samples from the unclamped cord alter the acid–base parameters compared to collection from the clamped cord; however, this difference does not appear to be of clinical relevance. Findings could be due to the large sample size, which allowed to achieve a high power and to investigate very small numerical changes between groups, leading to a statistically significant difference in pH and BE between samples even when we could not appreciate any clinical relevant difference of pH or BE between groups. When blood gas analysis is indicated, the priority should be given to the timing of blood collection to allow reliable results, to assess newborns status at birth and intervene when needed.
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Affiliation(s)
- Elisabetta Colciago
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Simona Fumagalli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. .,San gerardo Hospital, Monza, Italy.
| | - Elena Ciarmoli
- Neonatal Intensive Care Unit, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Laura Antolini
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonella Nespoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Ospedale dei Bambini "Vittore Buzzi", University of Milano, Milan, Italy
| | | | - Chiara Furlan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Fondazione MBBM, Monza, Italy
| | - Cristina Manganini
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Patrizia Vergani
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Fondazione MBBM, Monza, Italy
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Nespoli A, Colciago E, Fumagalli S, Locatelli A, Hollins Martin CJ, Martin CR. Validation and factor structure of the Italian version of the Birth Satisfaction Scale-Revised (BSS-R). J Reprod Infant Psychol 2020; 39:516-531. [PMID: 33084372 DOI: 10.1080/02646838.2020.1836333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To validate the Italian-language version of the Birth Satisfaction Scale-Revised (BSS-R) and report key measurement properties of the tool. To evaluate the impact of antenatal class attendance on BSS-R assessed birth satisfaction. BACKGROUND Maternal satisfaction is one of the standards of care defined by the World Health Organisation (WHO) to improve the quality of services. The BSS-R is a multi-dimensional self-report measure of the experience of labour and birth. METHODS Cross-sectional instrument evaluation design examining factor structure and key aspects of validity and reliability. Embedded between-subjects design to examine known-group discriminant validity and the impact of antenatal class attendance on BSS-R sub-scale and total scores as dependent variables. After giving birth, 297 women provided data for analysis. RESULTS The Italian version of the BSS-R (I-BSS-R) was the key study measure. The established three-factor and bi-factor models of the BSS-R were found to offer an excellent fit to the data. Comparison of the tri-dimensional measurement model and the bi-factor model of the BSS-R found no significant differences between models. Women who attended antenatal classes had significantly lower stress experienced during childbearing sub-scale scores (I-BSS-R SE), compared to those who did not. Good convergent, divergent validity and known-groups discriminant validity were established for the I-BSS-R. Internal consistency observations were found to be sub-optimal in this population. CONCLUSIONS On all key psychometric indices, with the exception of internal consistency that requires further investigation, the I-BSS-R was found to be a valid translation of the original BSS-R. The impact of antenatal classes on birth satisfaction warrants further research.
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Affiliation(s)
- Antonella Nespoli
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Elisabetta Colciago
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Simona Fumagalli
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Anna Locatelli
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Unit of Mother and Child, ASST Vimercate
| | | | - Colin R Martin
- Institute of Clinical and Applied Health Research (ICAHR), Faculty of Health Sciences, University of Hull, UK
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Colciago E, Merazzi B, Panzeri M, Fumagalli S, Nespoli A. Women's vulnerability within the childbearing continuum: A scoping review. Eur J Midwifery 2020; 4:18. [PMID: 33537620 PMCID: PMC7839125 DOI: 10.18332/ejm/120003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The aim of this scoping review is to explore the concept of ‘vulnerability’ affecting pregnant women and to identify an appropriate definition of this term. METHODS Five stages were adopted for conducting the scoping review. A literature search was undertaken between 1 October 2017 and 5 January 2018, using three databases. Relevant publications were appraised, and semantic content analysis was performed to identify emergent themes and four determinants of the vulnerability concept. This involved combining items that seem to address the same issue. RESULTS Eleven publications were considered, and eight definitions of vulnerability were identified, and from these four themes emerged: poor health outcome or status; exposure to risk; complex social needs; and lack of resources. Further analysis of evidence found examples of groups of people considered to be vulnerable; they were reported into six matrices, mainly with social and psychological difficulties. From these, eleven themes arose. Following a semantic and content analysis of all themes, thirteen final themes were identified. They represent the characteristics associated with women considered to be vulnerable and are called indices of vulnerability. Semantic and content analysis allowed addressing the thirteen indices of vulnerability into four categories called determinants of the vulnerability concept: deficiency, need, risk exposure, and barriers. CONCLUSIONS The vulnerability could be defined as a lack of health, related to the presence of at least one of the four determinants. Midwives are the key to identify vulnerable women, offering appropriate care.
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Affiliation(s)
| | - Beatrice Merazzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Simona Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Antonella Nespoli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Colciago E, Fumagalli S, Inzis I, Borrelli SE, Nespoli A. Management of the second stage of labour in women with epidural analgesia: A qualitative study exploring Midwives’ experiences in Northern Italy. Midwifery 2019; 78:8-15. [DOI: 10.1016/j.midw.2019.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/14/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
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Nespoli A, Colciago E, Pedroni S, Perego S, Fumagalli S. The Birth Satisfaction Scale-Revised (BSS-R): process of translation and adaptation in an Italian context. Ann Ist Super Sanita 2019; 54:340-347. [PMID: 30575571 DOI: 10.4415/ann_18_04_11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The Birth Satisfaction Scale-Revised (BSS-R) is a tool to assess women's childbirth satisfaction. The aim of this research was to achieve the cross-cultural and conceptual equivalence of the BSS-R tool in Italian. METHOD The World Health Organization (WHO) method was adopted to achieve the BSS-R in Italian. This is a well-established method using forward-translations and back-translations. This process has been refined in the course of several WHO studies to result in five steps: forward translation, expert panel translation, back-translation, pre-testing and cognitive interviewing, final version. RESULTS The forward translation step developed an Italian version of the BSS-R, this was revised by an expert panel. During the pretesting and cognitive interviewing step, 100 women were involved to check if the instrument was understandable and they did not report any difficulties to comprehend the questionnaire. Women repeated with different expressions and words items 1, 7 and 9. After a conceptual analysis of the sentences used by women during the debriefing stage, items 1 and 9 have been changed. At the end of the process, we had a final version of the questionnaire in Italian. DISCUSSION The BSS-R should be a reliable instrument to be adopted by healthcare professionals, researches and managers in order to improve Italian maternity services with the aim to offer a positive experience of childbirth.
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Affiliation(s)
- Antonella Nespoli
- Dipartimento di Medicina e Chirurgia,Università degli Studi Milano-Bicocca, Milan, Italy
| | - Elisabetta Colciago
- Dipartimento di Medicina e Chirurgia,Università degli Studi Milano-Bicocca, Milan, Italy
| | - Silvia Pedroni
- Dipartimento di Medicina e Chirurgia,Università degli Studi Milano-Bicocca, Milan, Italy
| | - Sofia Perego
- Dipartimento di Medicina e Chirurgia,Università degli Studi Milano-Bicocca, Milan, Italy
| | - Simona Fumagalli
- Dipartimento di Medicina e Chirurgia,Università degli Studi Milano-Bicocca, Milan, Italy
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Abstract
INTRODUCTION Quality of care is increasingly recognized as a critical aspect of the maternal and newborn health, mainly with respect to care around labor and delivery and in the immediate postnatal period. The aim of this review was to identify the recommended intrapartum care indicators in order to measure the quality of midwifery care. EVIDENCE ACQUISITION A structured literature search was conducted in August 2017 incorporating English and Italian language studies from 1993 and onwards to identify published articles on quality standards of intrapartum care. Research was performed into the area of enquiry in electronic database (Medline, Cochrane Library, CINAHL, Trip) and in relevant midwifery websites. EVIDENCE SYNTHESIS We identified 369 quality indicators to measure the intrapartum care. Following a systematic process that allows to classify all indicators in domains and categories, we analyzed 268 outcome and process indicators specifically designated to monitor the intrapartum care in a low risk population. Through the identification of further exclusion criteria and semantic analogies we obtained 80 final quality indicators (39 outcome indicators and 41 process indicators). CONCLUSIONS We identified 80 indicators that should be used to measure the quality of low risk intrapartum care. Although the majority of indicators we could monitor through hospital databases and the Italian Birth Register-CeDAP are outcome indicators, it is important to give attention also to process indicators that measure the activities performed and whether or not they are evidence-based. For a low risk population they could measure adherence with guidelines that promote and support the normality of the process.
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Affiliation(s)
- Elisa Lazzaretto
- Department of Maternity, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonella Nespoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Simona Fumagalli
- FBBM Monza, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Elisabetta Colciago
- Center of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy -
| | - Sofia Perego
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anna Locatelli
- Unit of Mother and Child, ASST Vimercate, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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22
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Rota A, Antolini L, Colciago E, Nespoli A, Borrelli SE, Fumagalli S. Timing of hospital admission in labour: latent versus active phase, mode of birth and intrapartum interventions. A correlational study. Women Birth 2017; 31:313-318. [PMID: 29054342 DOI: 10.1016/j.wombi.2017.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/18/2017] [Accepted: 10/03/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hospitalization of women in latent labour often leads to a cascade of unnecessary intrapartum interventions, to avoid potential disadvantages the recommendation should be to stay at home to improve women's experience and perinatal outcomes. AIM The primary aim of this study was to investigate the association between hospital admission diagnosis (latent vs active phase) and mode of birth. The secondary aim was to explore the relationship between hospital admission diagnosis, intrapartum intervention rates and maternal/neonatal outcomes. METHODS A correlational study was conducted in a large Italian maternity hospital. Data from January 2013 to December 2014 were collected from the hospital electronic records. 1.446 records of low risk women were selected. These were dichotomized into two groups based on admission diagnosis: 'latent phase' or 'active phase' of labour. FINDINGS 52.7% of women were admitted in active labour and 47.3% in the latent phase. Women in the latent phase group were more likely to experience a caesarean section or an instrumental birth, artificial rupture of membranes, oxytocin augmentation and epidural analgesia. Admission in the latent phase was associated with higher intrapartum interventions, which were statistically correlated to the mode of birth. CONCLUSIONS Women admitted in the latent phase were more likely to experience intrapartum interventions, which increase the probability of caesarean section. Maternity services should be organized around women and families needs, providing early labour support, to enable women to feel reassured facilitating their admission in labour to avoid the cascade of intrapartum interventions which increases the risk of caesarean section.
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Affiliation(s)
- A Rota
- San Raffaele Hospital, Maternity Department, Via Olgettina 60, 20132 Milan, Italy
| | - L Antolini
- Department of Health Science, Center of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Via Cadore, 48, 20900 Monza, Milan, Italy
| | - E Colciago
- Department of Health Science, Center of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Via Cadore, 48, 20900 Monza, Milan, Italy
| | - A Nespoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, 20900 Monza, Italy
| | - S E Borrelli
- Division of Midwifery, School of Health Sciences, The University of Nottingham, Nottingham UK
| | - S Fumagalli
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, 20900 Monza, Italy.
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23
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Affiliation(s)
- Camilla Svanera
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy -
| | | | - Elisabetta Colciago
- Unit of Innovation and Development, Welfare Department, Lombardy Region, Milan, Italy
| | - Simona Fumagalli
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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