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di Pasquo E, Giannubilo SR, Valentini B, Salvi S, Rullo R, Fruci S, Filippi E, Ornaghi S, Zullino S, Rossi F, Farsetti D, Di Martino DD, Vasapollo B, Locatelli A, De Santis M, Ciavattini A, Lanzone A, Mecacci F, Ferrazzi E, Valensise H, Ghi T. The "Preeclampsia and Hypertension Target Treatment" study: a multicenter prospective study to evaluate the effectiveness of the antihypertensive therapy based on maternal hemodynamic findings. Am J Obstet Gynecol MFM 2024; 6:101368. [PMID: 38574856 DOI: 10.1016/j.ajogmf.2024.101368] [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: 12/31/2023] [Revised: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Despite major advances in the pharmacologic treatment of hypertension in the nonpregnant population, treatments for hypertension in pregnancy have remained largely unchanged over the years. There is recent evidence that a more adequate control of maternal blood pressure is achieved when the first given antihypertensive drug is able to correct the underlying hemodynamic disorder of the mother besides normalizing the blood pressure values. OBJECTIVE This study aimed to compare the blood pressure control in women receiving an appropriate or inappropriate antihypertensive therapy following the baseline hemodynamic findings. STUDY DESIGN This was a prospective multicenter study that included a population of women with de novo diagnosis of hypertensive disorders of pregnancy. A noninvasive assessment of the following maternal parameters was performed on hospital admission via Ultrasound Cardiac Output Monitor before any antihypertensive therapy was given: cardiac output, heart rate, systemic vascular resistance, and stroke volume. The clinician who prescribed the antihypertensive therapy was blinded to the hemodynamic evaluation and used as first-line treatment a vasodilator (nifedipine or alpha methyldopa) or a beta-blocker (labetalol) based on his preferences or on the local protocols. The first-line pharmacologic treatment was retrospectively considered hemodynamically appropriate in either of the following circumstances: (1) women with a hypodynamic profile (defined as low cardiac output [≤5 L/min] and/or high systemic vascular resistance [≥1300 dynes/second/cm2]) who were administered oral nifedipine or alpha methyldopa and (2) women with a hyperdynamic profile (defined as normal or high cardiac output [>5 L/min] and/or low systemic vascular resistances [<1300 dynes/second/cm2]) who were administered oral labetalol. The primary outcome of the study was to compare the occurrence of severe hypertension between women treated with a hemodynamically appropriate therapy and women treated with an inappropriate therapy. RESULTS A total of 152 women with hypertensive disorders of pregnancy were included in the final analysis. Most women displayed a hypodynamic profile (114 [75.0%]) and received a hemodynamically appropriate treatment (116 [76.3%]). The occurrence of severe hypertension before delivery was significantly lower in the group receiving an appropriate therapy than in the group receiving an inappropriately treated (6.0% vs 19.4%, respectively; P=.02). Moreover, the number of women who achieved target values of blood pressure within 48 to 72 hours from the treatment start was higher in the group who received an appropriate treatment than in the group who received an inappropriate treatment (70.7% vs 50.0%, respectively; P=.02). CONCLUSION In pregnant individuals with de novo hypertensive disorders of pregnancy, a lower occurrence of severe hypertension was observed when the first-line antihypertensive agent was tailored to the correct maternal hemodynamic profile.
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Affiliation(s)
- Elvira di Pasquo
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy (Drs di Pasquo, Valentini, and Ghi)
| | - Stefano Raffaele Giannubilo
- Department of Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy (Drs Giannubilo and Ciavattini)
| | - Beatrice Valentini
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy (Drs di Pasquo, Valentini, and Ghi)
| | - Silvia Salvi
- High-Risk Pregnancy Unit, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Largo Agostino Gemelli, Rome, Italy (Drs Salvi, Rullo, Fruci, and Lanzone)
| | - Roberta Rullo
- High-Risk Pregnancy Unit, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Largo Agostino Gemelli, Rome, Italy (Drs Salvi, Rullo, Fruci, and Lanzone)
| | - Stefano Fruci
- High-Risk Pregnancy Unit, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Largo Agostino Gemelli, Rome, Italy (Drs Salvi, Rullo, Fruci, and Lanzone)
| | - Elisa Filippi
- Department of Obstetrics and Gynecology, Ospedale Ca Foncello, Treviso, Italy (Drs Filippi and Santis)
| | - Sara Ornaghi
- Department of Obstetrics, University of Milan-Bicocca, Foundation Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Milan, Italy (Drs Ornaghi, Rossi, and Locatelli)
| | - Sara Zullino
- High-Risk Pregnancy Unit, Department of Women's and Children's Health, Azienda Ospedaliera Careggi, Florence, Italy (Drs Zullino and Dr Mecacci)
| | - Francesca Rossi
- Department of Obstetrics, University of Milan-Bicocca, Foundation Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Milan, Italy (Drs Ornaghi, Rossi, and Locatelli)
| | - Daniele Farsetti
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, Policlinico Casilino, Tor Vergata University of Rome, Rome, Italy (Drs Farsetti, Vasapollo, and Valensise)
| | - Daniela Denis Di Martino
- Unit of Obstetrics, Division of Obstetrics and Gynecology, Department of Woman, Child, and Newborn, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Drs Di Martino and Ferrazzi)
| | - Barbara Vasapollo
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, Policlinico Casilino, Tor Vergata University of Rome, Rome, Italy (Drs Farsetti, Vasapollo, and Valensise)
| | - Anna Locatelli
- Department of Obstetrics, University of Milan-Bicocca, Foundation Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Milan, Italy (Drs Ornaghi, Rossi, and Locatelli)
| | - Michela De Santis
- Department of Obstetrics and Gynecology, Ospedale Ca Foncello, Treviso, Italy (Drs Filippi and Santis)
| | - Andrea Ciavattini
- Department of Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy (Drs Giannubilo and Ciavattini)
| | - Antonio Lanzone
- High-Risk Pregnancy Unit, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Largo Agostino Gemelli, Rome, Italy (Drs Salvi, Rullo, Fruci, and Lanzone)
| | - Federico Mecacci
- High-Risk Pregnancy Unit, Department of Women's and Children's Health, Azienda Ospedaliera Careggi, Florence, Italy (Drs Zullino and Dr Mecacci)
| | - Enrico Ferrazzi
- Unit of Obstetrics, Division of Obstetrics and Gynecology, Department of Woman, Child, and Newborn, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Drs Di Martino and Ferrazzi)
| | - Hebert Valensise
- Division of Obstetrics and Gynecology, Department of Surgical Sciences, Policlinico Casilino, Tor Vergata University of Rome, Rome, Italy (Drs Farsetti, Vasapollo, and Valensise)
| | - Tullio Ghi
- Department of Obstetrics and Gynecology, University Hospital of Parma, Parma, Italy (Drs di Pasquo, Valentini, and Ghi); Obstetrics and Gynaecology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy (Dr Ghi).
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Vasapollo B, Zullino S, Novelli GP, Farsetti D, Ottanelli S, Clemenza S, Micaglio M, Ferrazzi E, Martino DDD, Ghi T, Pasquo ED, Orabona R, Corbella P, Frigo MG, Prefumo F, Stampalija T, Giannubilo SR, Valensise H, Mecacci F. Maternal Hemodynamics from Preconception to Delivery: Research and Potential Diagnostic and Therapeutic Implications: Position Statement by Italian Association of Pre-Eclampsia and Italian Society of Perinatal Medicine. Am J Perinatol 2024. [PMID: 38350640 DOI: 10.1055/a-2267-3994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
OBJECTIVE The Italian Association of Preeclampsia (AIPE) and the Italian Society of Perinatal Medicine (SIMP) developed clinical questions on maternal hemodynamics state of the art. STUDY DESIGN AIPE and SIMP experts were divided in small groups and were invited to propose an overview of the existing literature on specific topics related to the clinical questions proposed, developing, wherever possible, clinical and/or research recommendations based on available evidence, expert opinion, and clinical importance. Draft recommendations with a clinical rationale were submitted to 8th AIPE and SIMP Consensus Expert Panel for consideration and approval, with at least 75% agreement required for individual recommendations to be included in the final version. RESULTS More and more evidence in literature underlines the relationship between maternal and fetal hemodynamics, as well as the relationship between maternal cardiovascular profile and fetal-maternal adverse outcomes such as fetal growth restriction and hypertensive disorders of pregnancy. Experts agreed on proposing a classification of pregnancy hypertension, complications, and cardiovascular states based on three different hemodynamic profiles depending on total peripheral vascular resistance values: hypodynamic (>1,300 dynes·s·cm-5), normo-dynamic, and hyperdynamic (<800 dynes·s·cm-5) circulation. This differentiation implies different therapeutical strategies, based drugs' characteristics, and maternal cardiovascular profile. Finally, the cardiovascular characteristics of the women may be useful for a rational approach to an appropriate follow-up, due to the increased cardiovascular risk later in life. CONCLUSION Although the evidence might not be conclusive, given the lack of large randomized trials, maternal hemodynamics might have great importance in helping clinicians in understanding the pathophysiology and chose a rational treatment of patients with or at risk for pregnancy complications. KEY POINTS · Altered maternal hemodynamics is associated to fetal growth restriction.. · Altered maternal hemodynamics is associated to complicated hypertensive disorders of pregnancy.. · Maternal hemodynamics might help choosing a rational treatment during hypertensive disorders..
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Affiliation(s)
- Barbara Vasapollo
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
- Division of Obstetrics and Gynecology, Policlinico Casilino, Rome, Italy
| | - Sara Zullino
- Department of Obstetrics and Gynecology, Biomedical, Experimental and Clinical Sciences, University Hospital Careggi, Florence, Italy
| | - Gian Paolo Novelli
- Department of Integrated Care Services, Prehospitalization Unit, Policlinico di Tor Vergata, Rome, Italy
| | - Daniele Farsetti
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
- Division of Obstetrics and Gynecology, Policlinico Casilino, Rome, Italy
| | - Serena Ottanelli
- Department of Obstetrics and Gynecology, Biomedical, Experimental and Clinical Sciences, University Hospital Careggi, Florence, Italy
| | - Sara Clemenza
- Department of Obstetrics and Gynecology, Biomedical, Experimental and Clinical Sciences, University Hospital Careggi, Florence, Italy
| | - Massimo Micaglio
- Department of Anesthesia and Intensive Care, Unit of Obstetric and Gynecologic Anesthesia, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Enrico Ferrazzi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Department of Woman, Child, and Newborn, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Daniela Denis Di Martino
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Department of Woman, Child, and Newborn, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Tullio Ghi
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elvira Di Pasquo
- Obstetrics and Gynecology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rossana Orabona
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paola Corbella
- Maternal Infant Department SC, Obstetrics and Gynecology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Maria Grazia Frigo
- Department of Anesthesia and Resuscitation in Obstetrics, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Federico Prefumo
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Stefano Raffaele Giannubilo
- Department of Obstetrics and Gynecology, Marche Polytechnic University, Ancona, Italy
- Department of Clinical Sciences, Polytechnic University of Marche Salesi Hospital, Ancona, Italy
| | - Herbert Valensise
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
- Division of Obstetrics and Gynecology, Policlinico Casilino, Rome, Italy
| | - Federico Mecacci
- Department of Obstetrics and Gynecology, Biomedical, Experimental and Clinical Sciences, University Hospital Careggi, Florence, Italy
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Orsi M, Motta F, Fedele F, Ossola MW, Ferrazzi E. Heterotopic cervical and isthmic pregnancy. Ultrasound Obstet Gynecol 2024. [PMID: 38315714 DOI: 10.1002/uog.27603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/02/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024]
Affiliation(s)
- M Orsi
- Unit of Obstetrics, Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Motta
- Unit of Obstetrics, Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Fedele
- Unit of Obstetrics, Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - M W Ossola
- Unit of Obstetrics, Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - E Ferrazzi
- Unit of Obstetrics, Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Saltini P, Tassis B, Ronchi A, Tagliabue C, Di Pietro G, Dellepiane RM, Muscatello A, Giacomelli A, Pugni L, Ferrazzi E, Bandera A, Bozzi G. Preventing HIV mother-to-child transmission in a vertically infected pregnant woman with multiclass drug resistance, role of bis-in-die dolutegravir and neonatal AZT prophylaxis: A case report. Heliyon 2024; 10:e23072. [PMID: 38163123 PMCID: PMC10754893 DOI: 10.1016/j.heliyon.2023.e23072] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/18/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024] Open
Abstract
A suppressive antiretroviral therapy (ART) is necessary to prevent mother-to-child transmission (MTCT) of HIV during pregnancy. During this period, it is recommended to continue an ongoing safe and suppressive regimen, but history of multiclass drug-resistance (MDR) might need tailored, uncommon approaches posing tolerability and toxicity issues. This is the case of a 33 years of age, vertically infected woman with MDR HIV infection suppressed on a darunavir/cobicistat + atazanavir regimen switched during pregnancy to lamivudine + darunavir/ritonavir + dolutegravir 50 mg bis-in-die, maintaining complete viral suppression and delivering via caesarian section and without zidovudine (AZT) intrapartum prophylaxis a healthy HIV-negative newborn who received AZT post-exposure prophylaxis and showed regular growth patterns up to 2 years. Our case shows how archived MDR might complicate the preservation of HIV RNA suppression and highlights the importance of a tailored, multidisciplinary approach for pregnant women with MDR HIV and their newborns.
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Affiliation(s)
- Paola Saltini
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Università Degli Studi di Milano, Milan, Italy
| | - Beatrice Tassis
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Alice Ronchi
- Università Degli Studi di Milano, Milan, Italy
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Claudia Tagliabue
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giada Di Pietro
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Maria Dellepiane
- Pediatric Intermediate Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Giacomelli
- III Infectious Diseases Unit, Azienda Socio-Sanitaria Territoriale-Fatebenefratelli-Sacco, Milan, Italy
| | - Lorenza Pugni
- Neonatology and Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Università Degli Studi di Milano, Milan, Italy
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Università Degli Studi di Milano, Milan, Italy
| | - Giorgio Bozzi
- Infectious Diseases Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Orsi M, Cappuccio G, Kurihara H, Rossi G, Perugino G, Ferrazzi E, Coppola C. Three-Dimensional Transperineal Ultrasound Guiding Early Secondary Repair of Obstetric Anal Sphincter Injury in an Incontinent Patient without Suture Dehiscence. Diagnostics (Basel) 2023; 14:68. [PMID: 38201377 PMCID: PMC10804317 DOI: 10.3390/diagnostics14010068] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/24/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
We present the case of a 36-year-old primigravida who gave birth to a 3200 g baby by vacuum-assisted (Kiwi OmniCup™) operative vaginal delivery with mediolateral episiotomy. A "y"-shaped perineal tear with a grade IIIC obstetric anal sphincter injury (OASI) was diagnosed and repaired. Two days after delivery, in the absence of suture dehiscence, she started experiencing complete anal incontinence. A decision was made in association with a proctologic surgeon for an early secondary repair. Before surgery, a Three-dimensional transperineal ultrasound (TPUS) was performed. The exam revealed a major defect of the external anal sphincter at the 11 o'clock position. This allowed for the reopening of only a circumscribed area of the perineal suture and repair of the sphincters using the end-to-end technique. The symptoms regressed completely, and follow-up TPUS demonstrated the gradual wound healing process. Anal incontinence, secondary to obstetric anal sphincter injury (OASI), has a severe negative impact on women's quality of life. TPUS is an effective method to detect sphincter defects and monitor the healing process. This report investigates the feasibility of identifying the sphincter tear in an incontinent puerperal patient without suture dehiscence in order to target early secondary repair while minimizing its extent. TPUS has proven a safe and effective tool to guide early secondary repair of symptomatic OASI complications while minimizing the invasiveness of the procedure. Multidisciplinary management is crucial to ensure the adequate standard of care.
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Affiliation(s)
- Michele Orsi
- Unit of Obstetrics, Department of Woman, Newborn and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giuseppe Cappuccio
- Unit of Obstetrics, Department of Woman, Newborn and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Hayato Kurihara
- Unit of Emergency Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Gabriele Rossi
- Unit of Obstetrics, Department of Woman, Newborn and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giuseppe Perugino
- Unit of Obstetrics, Department of Woman, Newborn and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Enrico Ferrazzi
- Unit of Obstetrics, Department of Woman, Newborn and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Carmela Coppola
- Unit of Obstetrics, Department of Woman, Newborn and Child, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Giovannini N, Lattuada D, Danusso R, Ferrazzi E. From pandemic to syndemic: microbiota, pregnancy, and environment at a crossroad. J Matern Fetal Neonatal Med 2023; 36:2183738. [PMID: 36977591 DOI: 10.1080/14767058.2023.2183738] [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: 03/30/2023]
Abstract
Aim: SARS-CoV2 is the latest pandemic that have plagued the socio-health system as an epiphenomenon resulting from planetary resources abuse, crucial for biodiversity. The Anthropocene best defines the present epoch in which human activity irreversibly manipulates intricate and delicate geological and biological balances established over eons. The devastating ecological and socio-economic implications of COVID-19, underline the importance of updating the present pandemic framework to a syndemic. This paper stems from the need to suggest to scientists, doctors, and patients a mission that integrates responsibility from individual to collective health, from present to trans-generational, from human to the entire biotic network. Today's choices are crucial for the perspective on all levels: political, economic, and health as well as cultural.Methods: Research on PubMed and other specific web-sites journal was performed on the topic "Microbiota", "Covid-19", "Pandemic", "Zoonosis", "SARS-CoV-2", "Environmental Pollutants", "Epigenetics", "Fetal Programming", "Human Extinction". Data collected were analysed for an integrative model of interconnection between environment, pregnancy, SARS-CoV-2 infection, and microbiota. Moreover, systematic literature review allowed to summarise in a table information about the worst pandemics that afflicted the human species recently.Results: This paper offers a broad view of the current pandemic starting with pregnancy, the moment when a new life begins and the health trajectories of the unborn child are defined, which will inevitably have repercussions on his well-being. The fundamental role of the biodiversity-rich microbiota in avoiding the development of severe infectious diseases, is therefore highlighted. It is imperative to adjust the current reductionist paradigm based on mostly immediate symptom management towards a broader understanding of the spatial interconnection of ecological niches with human health and the impacts of today's choices on the future. Health and healthcare are elitist rather than egalitarian, therefore focusing on environmental health forces us to make a concerted and systemic effort that challenges political and economic barriers, which are biologically senseless. A healthy microbiota is essential to well-being, both by preventing chronic degenerative conditions, the infectiousness and pathogenicity of bacterial and viral diseases. SARS-CoV-2 should not be an exception. The human microbiota, forged by the first 1,000 days of life, is fundamental in shaping the health-disease trajectories, and by the everlasting exposome that is dramatically affected by the ecological disaster. Individual health is one world health whereas single and global well-being are interdependent in a space-time perspective.Conclusions: Is it not a convenient reductionism not to consider the COVID-19 emergency as a bio-social epiphenomenon of a far more devastating and multi-faceted crisis whose common denominator is the global biotic network loss of which humans are still part?
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Affiliation(s)
- Niccolò Giovannini
- Department of women-child-newborn Obstetrics and Gynaecology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Debora Lattuada
- Department of women-child-newborn Obstetrics and Gynaecology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Roberta Danusso
- Department of women-child-newborn Obstetrics and Gynaecology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Enrico Ferrazzi
- Department of women-child-newborn Obstetrics and Gynaecology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Ramirez Zegarra R, Carbone IF, Angeli L, Gigli F, Di Ilio C, Barba O, Cassardo O, Valentini B, Ferrazzi E, Ghi T. Association of umbilical vein flow with abnormal fetal growth and adverse perinatal outcome in low-risk population: multicenter prospective study. Ultrasound Obstet Gynecol 2023. [PMID: 37963279 DOI: 10.1002/uog.27534] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/09/2023] [Accepted: 11/08/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES To investigate the relationship of umbilical vein flow (UVF) measured close to term with abnormal fetal growth and adverse perinatal outcome in a cohort of pregnancies at low risk of placental insufficiency. METHODS This was a prospective multicenter observational study conducted across two tertiary maternity units. Patients with a singleton appropriate-for-gestational-age fetus between 35 and 38 weeks' gestation were included. Pregnancies at higher risk of placental insufficiency or with fetal anomalies were excluded. At ultrasound examination, the abdominal circumference (AC), umbilical vein diameter and peak velocity of the umbilical vein were measured, and, using these variables, a new variable, UVF/AC, was calculated. The primary outcome was the occurrence of severely stunted fetal growth, defined as a greater than 40-percentile drop between estimated fetal weight at the third-trimester ultrasound and birth weight between the third-trimester ultrasound and delivery. The occurrence of adverse perinatal outcome, defined as one of the following: neonatal acidosis (umbilical artery pH < 7.15 and/or base excess > 12 mmol/L) at birth, 5-min Apgar score < 7, neonatal resuscitation or neonatal intensive care unit admission, was analyzed as a secondary outcome. RESULTS Between April 2021 and March 2023, 365 women were included in the study. The mean UVF/AC at enrolment was 6.4 ± 2.6 mL/min/cm, and 35 (9.6%) cases were affected by severely stunted fetal growth. Severely stunted fetal growth was associated with a lower mean UVF/AC (5.4 ± 2.6 vs 6.5 ± 2.6 mL/min/cm; P = 0.02) and a higher frequency of UVF/AC < 10th percentile (8/35 (22.9%) vs 28/330 (8.5%); P = 0.01). Moreover, UVF/AC showed an area under the receiver-operating-characteristics curve (AUC) of 0.65 (95% CI, 0.55-0.75; P = 0.004) in predicting the occurrence of severely stunted fetal growth, and the optimal cut-off value of UVF/AC for discriminating between normal and severely stunted fetal growth was 7.2 mL/min/cm. This value was associated with a sensitivity and specificity of 0.77 (95% CI, 0.60-0.90) and 0.33 (95% CI, 0.28-0.39), and positive and negative predictive values of 0.11 (95% CI, 0.07-0.15) and 0.93 (95% CI, 0.87-0.97), respectively. Regarding the occurrence of adverse perinatal outcome, this was associated independently with maternal age (adjusted odds ratio (aOR), 0.93 (95% CI, 0.87-0.99); P = 0.04), UVF/AC Z-score (aOR, 0.53 (95% CI, 0.30-0.87); P = 0.01) and augmentation of labor (aOR, 2.69 (95% CI, 1.28-5.69); P = 0.009). UVF/AC showed an AUC of 0.65 (95% CI, 0.56-0.73; P = 0.005) in predicting the occurrence of adverse perinatal outcome, and the optimal cut-off value of UVF/AC for discriminating between normal and adverse perinatal outcome was 6.7 mL/min/cm. This value was associated with a sensitivity and specificity of 0.70 (95% CI, 0.54-0.83) and 0.40 (95% CI, 0.34-0.45), and positive and negative predictive values of 0.14 (95% CI, 0.09-0.19) and 0.91 (95% CI, 0.85-0.95), respectively. CONCLUSIONS Our data demonstrate an association between reduced UVF close to term, severely stunted fetal growth and adverse perinatal outcome in a cohort of low-risk pregnant women, with a moderate ability to rule out and a poor ability to rule in either outcome. Further studies are needed to establish whether the assessment of UVF can improve the identification of fetuses at risk of subclinical placental insufficiency and adverse perinatal outcome. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Ramirez Zegarra
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - I F Carbone
- Unit of Obstetrics, Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - L Angeli
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - F Gigli
- Unit of Obstetrics, Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Di Ilio
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
- Department Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - O Barba
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - O Cassardo
- Unit of Obstetrics, Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - B Valentini
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - E Ferrazzi
- Unit of Obstetrics, Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - T Ghi
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
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Comelli A, Genovese C, Gobbi F, Brindicci G, Capone S, Corpolongo A, Crosato V, Mangano VD, Marrone R, Merelli M, Prato M, Santoro CR, Scarso S, Vanino E, Marchese V, Antinori S, Mastroianni C, Raglio A, Bruschi F, Minervini A, Donà D, Garazzino S, Galli L, Lo Vecchio A, Galli A, Dragoni G, Cricelli C, Colacurci N, Ferrazzi E, Pieralli A, Montresor A, Richter J, Calleri G, Bartoloni A, Zammarchi L. Schistosomiasis in non-endemic areas: Italian consensus recommendations for screening, diagnosis and management by the Italian Society of Tropical Medicine and Global Health (SIMET), endorsed by the Committee for the Study of Parasitology of the Italian Association of Clinical Microbiologists (CoSP-AMCLI), the Italian Society of Parasitology (SoIPa), the Italian Society of Gastroenterology and Digestive Endoscopy (SIGE), the Italian Society of Gynaecology and Obstetrics (SIGO), the Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV), the Italian Society of General Medicine and Primary Care (SIMG), the Italian Society of Infectious and Tropical Diseases (SIMIT), the Italian Society of Pediatrics (SIP), the Italian Society of Paediatric Infectious Diseases (SITIP), the Italian Society of Urology (SIU). Infection 2023; 51:1249-1271. [PMID: 37420083 PMCID: PMC10545632 DOI: 10.1007/s15010-023-02050-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/08/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Agnese Comelli
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Genovese
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- II Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Federico Gobbi
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
- University of Brescia, Brescia, Italy
| | - Gaetano Brindicci
- AOU Consorziale Policlinico di Bari, Infectious Diseases Unit, Bari, Italy
| | - Susanna Capone
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Angela Corpolongo
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' (IRCCS), Rome, Italy
| | - Verena Crosato
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Valentina Dianora Mangano
- Department of Translational Research, N.T.M.S, Università di Pisa, Pisa, Italy
- Programma Di Monitoraggio Delle Parassitosi e f.a.d, AOU Pisana, Pisa, Italy
| | - Rosalia Marrone
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Maria Merelli
- Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Marco Prato
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | - Salvatore Scarso
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Elisa Vanino
- Unit of Infectious Diseases, Ospedale "Santa Maria delle Croci", AUSL Romagna, Ravenna, Italy
| | - Valentina Marchese
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Infectious Diseases Epidemiology, Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg, Germany
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Annibale Raglio
- Committee for the Study of Parasitology of the Italian Association of Clinical Microbiologists (CoSP-AMCLI), Milan, Italy
| | - Fabrizio Bruschi
- Department of Translational Research, N.T.M.S, Università di Pisa, Pisa, Italy
- Programma Di Monitoraggio Delle Parassitosi e f.a.d, AOU Pisana, Pisa, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Urology, University of Florence, Florence, Italy
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Silvia Garazzino
- Paediatric Infectious Disease Unit, Regina Margherita Children's Hospital, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Lo Vecchio
- Department of Translational Medical Sciences, Paediatric Infectious Disease Unit, University of Naples Federico II, Naples, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Claudio Cricelli
- Health Search-Istituto di Ricerca della SIMG (Italian Society of General Medicine and Primary Care), Florence, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Enrico Ferrazzi
- Department of Woman, New-Born and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Annalisa Pieralli
- Ginecologia Chirurgica Oncologica, Careggi University and Hospital, Florence, Italy
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Joachim Richter
- Institute of International Health, Charité Universitätsmedizin, Corporate Member of Freie und Humboldt Universität Berlin and Berlin Institute of Health, Berlin, Germany
| | - Guido Calleri
- Amedeo Di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
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Cassardo O, Perugino G, Nesa F, Ossola MW, Ferrazzi E, D´Ambrosi F. Giant leiomyoma management during elective cesarean section: a case report. Pan Afr Med J 2023; 45:73. [PMID: 37663633 PMCID: PMC10474799 DOI: 10.11604/pamj.2023.45.73.39357] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/04/2023] [Indexed: 09/05/2023] Open
Abstract
We present the unique case of a 44-year-old gravida 3 para 2 woman with complaints of monolateral perception of fetal movements who underwent elective cesarean section and hysterectomy for the presence of an exceptionally voluminous infralegamentary leiomyoma. Cesarean section required in-depth preoperative planning and was possible only after gravid uterus exteriorization. Myomectomy and hysterectomy were then necessary to reestablish the physio-anatomical pelvic environment. The patient was discharged after regular and uncomplicated postoperative time. In recent years, the paradigma of avoiding cesarean myomectomy due to fear of hemorrhage has been questioned by many authors and in certain cases cesarean myomectomy may even be undeferrable. We describe an innovative surgical technique which could be useful to obstetricians approaching similar uterine masses during cesarean sections.
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Affiliation(s)
- Ottavio Cassardo
- Unit of Obstetrics, Department of Woman, Child and Neonate, Mangiagalli Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Perugino
- Unit of Obstetrics, Department of Woman, Child and Neonate, Mangiagalli Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Nesa
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Manuela Wally Ossola
- Unit of Obstetrics, Department of Woman, Child and Neonate, Mangiagalli Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Unit of Obstetrics, Department of Woman, Child and Neonate, Mangiagalli Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco D´Ambrosi
- Unit of Obstetrics, Department of Woman, Child and Neonate, Mangiagalli Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Danusso R, Rosati R, Possenti L, Lombardini E, Gigli F, Costantino ML, Ferrazzi E, Casagrande G, Lattuada D. Human umbilical cord blood cells suffer major modification by fixatives and anticoagulants. Front Physiol 2023; 14:1070474. [PMID: 37008002 PMCID: PMC10050555 DOI: 10.3389/fphys.2023.1070474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/28/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction: Developing techniques for the tagless isolation of homogeneous cell populations in physiological-like conditions is of great interest in medical research. A particular case is Gravitational Field-Flow Fractionation (GrFFF), which can be run avoiding cell fixation, and that was already used to separate viable cells. Cell dimensions have a key role in this process. However, their dimensions under physiological-like conditions are not easily known since the most diffused measurement techniques are performed on fixed cells, and the fixation used to preserve tissues can alter the cell size. This work aims to obtain and compare cell size data under physiological-like conditions and in the presence of a fixative.Methods: We developed a new protocol that allows the analysis of blood cells in different conditions. Then, we applied it to obtain a dataset of human cord blood cell dimensions from 32 subjects, comparing two tubes with anticoagulants (EDTA and Citrate) and two tubes with different preservatives (CellRescue and CellSave). We analyzed a total of 2071 cells by using confocal microscopy via bio-imaging to assess dimensions (cellular and nuclear) and morphology.Results: Cell diameter measured does not differ when using the different anticoagulants, except for the increase reported for monocyte in the presence of citrate. Instead, cell dimensions differ when comparing anticoagulants and cell preservative tubes, with a few exceptions. Cells characterized by high cytoplasm content show a reduction in their size, while morphology appears always preserved. In a subgroup of cells, 3D reconstruction was performed. Cell and nucleus volumes were estimated using different methods (specific 3D tool or reconstruction from 2D projection).Discussion: We found that some cell types benefit from a complete 3D analysis because they contain non-spherical structures (mainly for cells characterized by poly-lobated nucleus). Overall, we showed the effect of the preservatives mixture on cell dimensions. Such an effect must be considered when dealing with problems highly dependent on cell size, such as GrFFF. Additionally, such information is crucial in computational models increasingly being employed to simulate biological events.
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Affiliation(s)
- Roberta Danusso
- Department of Women-Child-Newborn, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Riccardo Rosati
- Department of Women-Child-Newborn, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Luca Possenti
- LaBS, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Elena Lombardini
- Department of Women-Child-Newborn, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Francesca Gigli
- Department of Women-Child-Newborn, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Maria Laura Costantino
- LaBS, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Enrico Ferrazzi
- Department of Women-Child-Newborn, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giustina Casagrande
- Department of Women-Child-Newborn, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- LaBS, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Debora Lattuada
- Department of Women-Child-Newborn, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- *Correspondence: Debora Lattuada,
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Di Martino DD, Stampalija T, Zullino S, Fusè F, Garbin M, Parasiliti M, Sterpi V, Farina A, Ferrazzi E. Maternal hemodynamic profile during pregnancy and in the post-partum in hypertensive disorders of pregnancy and fetal growth restriction. Am J Obstet Gynecol MFM 2023; 5:100841. [PMID: 36563878 DOI: 10.1016/j.ajogmf.2022.100841] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Maternal cardiovascular changes, occurring since the beginning of pregnancy, are necessary for normal placentation and regular evolution of pregnancy. OBJECTIVE This study aimed to compare the hemodynamic profiles and cardiac remodeling of women with hypertensive disorders of pregnancy and either appropriate for gestational age fetuses or growth-restricted fetuses, women with normotensive pregnancies complicated by fetal growth restriction, and women with uncomplicated pregnancies, during pregnancy and the postpartum period. STUDY DESIGN A prospective longitudinal case-control design was used for this study. Over the study period, 220 eligible women with singleton pregnancies were selected for the analysis and divided into 4 groups: (1) hypertensive disorders of pregnancy with appropriate for gestational age fetuses; (2) hypertensive disorders of pregnancy with fetal growth restriction; (3) normotensive fetal growth restriction; and (4) controls. Ultrasound fetal biometry and fetoplacental Doppler velocimetry were performed at recruitment. Maternal hemodynamic assessment using transthoracic echocardiography was performed at the time of recruitment by a dedicated cardiologist blinded to maternal clinical data. The same assessments were performed in 104 patients at 32 weeks (interquartile range, 24-40) after delivery by the same cardiologist. RESULTS During pregnancy, women in the hypertensive-disorders-of-pregnancy-fetal-growth-restriction group showed significantly lower cardiac output and increased compared with those in the control group. These values were associated with concentric remodeling of the left ventricle owing to relatively increased wall thickness, which was not accompanied by an increase in left ventricular mass. Isolated fetal growth restriction presented similar but less important hemodynamic changes; however, there was no change in relative wall thickness. At postpartum follow-up, the hemodynamic parameters of women in the hypertensive-disorders-of-pregnancy-fetal-growth-restriction and isolated-fetal-growth-restriction groups reverted to values similar to those of the control group. Only 8.3% of women in these groups experienced hypertension even in the postpartum period, and asymptomatic stage-B cardiac failure was observed for 17% at echocardiography. In the group of women with hypertensive disorders of pregnancy and appropriate for gestational age fetuses, cardiac output increased as in normal pregnancies, but total vascular resistance was significantly higher; hypertension then occurred, along with ventricular concentric hypertrophy and diastolic dysfunction. At postpartum follow-up, women in the hypertensive-disorders-of-pregnancy-appropriate-for-gestational-age-fetus group showed significantly higher mean arterial pressure, total vascular resistance, and left ventricular mass compared with those in the control group. Persistent hypertension and asymptomatic stage-B cardiac failure were observed in 39.1% and 13% of women in the former group, respectively. CONCLUSION Pregnancies with hypertensive disorders of pregnancy and fetal growth restriction and normotensive pregnancies with fetal growth restriction were associated with the hemodynamic profile of lower heart rate and cardiac output, most likely because of abnormal adaptation to pregnancy, as confirmed by abnormal changes from pregnancy to the postpartum period. The heart rates and cardiac output of women in the hypertensive-disorders-of-pregnancy-appropriate-for-gestational-age-fetus group showed changes opposite to those observed in the hypertensive-disorders-of-pregnancy-fetal-growth-restriction and fetal-growth-restriction groups. Obesity and other metabolic risk factors, significantly prevalent in women in the hypertensive-disorders-of-pregnancy-appropriate-for-gestational-age-fetus group, predispose to hypertension and cardiovascular diseases during pregnancy and the postpartum period, potentially offering a window for personalized prevention. Such preventive strategies could differ in women with hypertensive disorders of pregnancy and fetal growth restriction characterized by poor early placental development.
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Affiliation(s)
- Daniela Denis Di Martino
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy (Drs Di Martino, Parasiliti, Sterpi, and Ferrazzi)
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy (Dr Stampalija); Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy (Dr Stampalija)
| | - Sara Zullino
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Azienda Ospedaliero Universitaria Careggi, Florence, Italy (Dr Zullino).
| | - Federica Fusè
- Department of Obstetrics and Gynecology, University of Milan, Hospital Luigi Sacco, Milan, Italy (Dr Fusè)
| | - Massimo Garbin
- Unit of Cardiology, Vittore Buzzi Children's Hospital, Milan, Italy (Dr Garbin)
| | - Marco Parasiliti
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy (Drs Di Martino, Parasiliti, Sterpi, and Ferrazzi)
| | - Vittoria Sterpi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy (Drs Di Martino, Parasiliti, Sterpi, and Ferrazzi)
| | - Antonio Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery, IRCCS Sant'Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy (Dr Farina)
| | - Enrico Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy (Drs Di Martino, Parasiliti, Sterpi, and Ferrazzi); Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy (Dr Ferrazzi)
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D’Ambrosi F, Ruggiero M, Cesano N, Di Maso M, Cetera GE, Tassis B, Carbone IF, Ferrazzi E. Risk of stillbirth in singleton fetuses with advancing gestational age at term: A 10-year experience of late third trimester prenatal screenings of 50,000 deliveries in a referral center in northern Italy. PLoS One 2023; 18:e0277262. [PMID: 36812250 PMCID: PMC9946230 DOI: 10.1371/journal.pone.0277262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/23/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The risk of intrauterine death (IUD) at term varies from less than one to up to three cases per 1,000 ongoing pregnancies. The cause of death is often largely undefined. Protocols and criteria to prevent and define the rates and causes of stillbirth are the subjects of important scientific and clinical debates. We examined the gestational age and rate of stillbirth at term in a 10-year period at our maternity hub to evaluate the possible favorable impact of a surveillance protocol on maternal and fetal well-being and growth. METHODS AND FINDINGS Our cohort included all women with singleton pregnancies resulting in early term to late term birth at our maternity hub between 2010 and 2020, with the exclusion of fetal anomalies. As per our protocol for monitoring term pregnancies, all women underwent near term to early term maternal and fetal well-being and growth surveillance. If risk factors were identified, outpatient monitoring was initiated and early- or full-term induction was indicated. Labor was induced at late term (41+0-41+4 weeks of gestation), if it did not occur spontaneously. We retrospectively collected, verified, and analyzed all cases of stillbirth at term. The incidence of stillbirth at each week of gestation, was calculated by dividing the number of stillbirths observed that week by the number of women with ongoing pregnancies in that same week. The overall rate of stillbirth per 1000 was also calculated for the entire cohort. Fetal and maternal variables were analyzed to assess the possible causes of death. RESULTS A total of 57,561 women were included in our study, of which 28 cases of stillbirth (overall rate, 0.48 per 1000 ongoing pregnancies; 95% CI: 0.30-0.70) were identified. The incidence of stillbirth in the ongoing pregnancies measured at 37, 38, 39, 40, and 41 weeks of gestation was 0.16, 0.30, 0.11, 0.29, and 0.0 per 1000, respectively. Only three cases occurred after 40+0 weeks of gestation. Six patients had an undetected small for gestational age fetus. The identified causes included placental conditions (n = 8), umbilical cord conditions (n = 7), and chorioamnionitis (n = 4). Furthermore, the cases of stillbirth included one undetected fetal abnormality (n = 1). The cause of fetal death remained unknown in eight cases. CONCLUSIONS In a referral center with an active universal screening protocol for maternal and fetal prenatal surveillance at near and early term, the rate of stillbirth was 0.48 per 1000 in singleton pregnancies at term in a large, unselected population. The highest incidence of stillbirth was observed at 38 weeks of gestation. The vast majority of stillbirth cases occurred before 39 weeks of gestation and 6 of 28 cases were SGA, and the median percentile of the remaining case was the 35th.
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Affiliation(s)
- Francesco D’Ambrosi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- * E-mail:
| | - Marta Ruggiero
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Cesano
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Di Maso
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, University of Milan, Milan, Italy
| | - Giulia Emily Cetera
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Beatrice Tassis
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilma Floriana Carbone
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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13
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Aprile A, Calì G, Chianchiano N, Chiappa V, Corbella P, D'Addario V, Dall'Asta A, De Robertis V, Exacustos C, Familiari A, Fichera A, Formigoni C, Frusca T, Ghi T, Guerriero S, Iuculano A, Labate F, Martinelli P, Monni G, Morlano M, Nonino F, Olivieri C, Paladini D, Peddes C, Prefumo F, Rizzo G, Rustico M, Sarno L, Sciacovelli I, Sciarrone A, Stampalija T, Taddei F, Todros T, Valensise H, Vergani P, Volpe N, Volpe P, Votino C, Bettoncelli G, Bracalente G, Collini Ceccatelli M, Costantini M, D'Aloia A, Ferrazzi E, Giorlandino C, Locci M, Verrotti di Pianella C, Viora E, Zoia R, Bilardo K, Vicar M. Corrigendum to "The Italian guidelines on ultrasound in obstetrics and gynecology: Executive summary of recommendations for practice" [Eur. J. Obstetrics Gynecol. 279 (2022) 176-182]. Eur J Obstet Gynecol Reprod Biol 2023; 281:85-86. [PMID: 36584523 DOI: 10.1016/j.ejogrb.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Anna Aprile
- Complex Operative Unit of Legal Medicine and Toxicology AOP, D.M.M. University of Padua, Italy
| | - Giuseppe Calì
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Unit, AO Villa Sofia/Cervello, Palermo, Italy
| | - Nicola Chianchiano
- Fetal Medicine Unit, Bucchieri La Ferla-Fatebenefratelli Hospital, Palermo, Italy
| | - Valentina Chiappa
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Paola Corbella
- Maternal Infant Department SC, Obstetrics and Gynecology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Andrea Dall'Asta
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | | | - Caterina Exacustos
- Academic Department of Surgical Sciences, University of Rome "Tor Vergata", Italy
| | - Alessandra Familiari
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Anna Fichera
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | | | - Tiziana Frusca
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Tullio Ghi
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Stefano Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Cagliari, Italy
| | - Ambra Iuculano
- Pathophysiology of Human Reproduction and Prenatal Diagnosis, Microcythemia Hospital Unit "A. CaO", ARNAS Brotzu, Cagliari, Italy
| | - Francesco Labate
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine Unit, AO Villa Sofia/Cervello, Palermo, Italy
| | | | - Giovanni Monni
- Pathophysiology of Human Reproduction and Prenatal Diagnosis, Microcythemia Hospital Unit "A. CaO", ARNAS Brotzu, Cagliari, Italy
| | - Maddalena Morlano
- Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Nonino
- Operative Unit of Epidemiology and Statistics, IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Claudiana Olivieri
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy
| | - Dario Paladini
- Complex Operative Unit of Maternal-Fetal Risk Pregnancy, G. Gaslini Institute, Genova, Italy
| | - Cristina Peddes
- Pathophysiology of Human Reproduction and Prenatal Diagnosis, Microcythemia Hospital Unit "A. CaO", ARNAS Brotzu, Cagliari, Italy
| | - Federico Prefumo
- Obstetrics and Gynecology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Giuseppe Rizzo
- Unità Operativa Complessa di Ginecologia ed Ostetricia Fondazione Policlinico Tor Vergata, Italy
| | - Mariangela Rustico
- Prenatal Diagnosis and Fetal Therapy "Umberto Nicolini", Hospital "V. Buzzi", Milan, Italy
| | - Laura Sarno
- Gynaecology and Obstetrics, University of Naples Federico II, Italy
| | - Irene Sciacovelli
- Gynecology and Obstetrics, Rovereto and Trento Hospitals, ASST, Trento, Italy
| | - Andrea Sciarrone
- Obstetrics and Gynecological Ultrasound and Prenatal Diagnosis Center, Citta' della Salute e della Scienza, Torino, Italy
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, University of Trieste, Italy
| | - Fabrizio Taddei
- Gynecology and Obstetrics, Rovereto and Trento Hospitals, ASST, Trento, Italy
| | - Tullia Todros
- Professor of Gynaecology and Obstetrics, University of Torino, Italy
| | - Herbert Valensise
- Operative Unit of Gynaecology and Obstetrics, Casilino Polyclinic, University of Rome "Tor Vergata", Italy
| | | | - Nicola Volpe
- Department of Medicine and Surgery, Unit of Surgical Sciences, Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Paolo Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy
| | - Carmela Votino
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, ASL BA, Bari, Italy
| | - Germano Bettoncelli
- Councillor of the Medical Association and Head of the Culture Commission of the Board of Physicians of Brescia, Italy
| | | | | | | | | | - Enrico Ferrazzi
- Obstetrics and Gynaecological Clinic, IRCCS Foundation, Ca' Granda Hospital Maggiore Policlinico of Milan, University of Milan, SIGO Delegate, Italy
| | | | | | | | - Elsa Viora
- Gynaecology and Obstetrics, Turin, President of AOGOI, Italy
| | - Riccardo Zoia
- Legal Medicine and Insurance, University of Milan, President of the Italian Society of Legal Medicine, Italy
| | | | - Maria Vicar
- Midwife, Department of Obstetrics of the University Consortium Universalus, Naples, past President of FNOPO, Italy
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14
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Mylrea-Foley B, Wolf H, Stampalija T, Lees C, Arabin B, Berger A, Bergman E, Bhide A, Bilardo CM, Breeze AC, Brodszki J, Calda P, Cetin I, Cesari E, Derks J, Ebbing C, Ferrazzi E, Ganzevoort W, Frusca T, Gordijn SJ, Gyselaers W, Hecher K, Klaritsch P, Krofta L, Lindgren P, Lobmaier SM, Marlow N, Maruotti GM, Mecacci F, Myklestad K, Napolitano R, Prefumo F, Raio L, Richter J, Sande RK, Thornton J, Valensise H, Visser GHA, Wee L. Longitudinal Doppler Assessments in Late Preterm Fetal Growth Restriction. Ultraschall Med 2023; 44:56-67. [PMID: 34768305 DOI: 10.1055/a-1511-8293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE To assess the longitudinal variation of the ratio of umbilical and cerebral artery pulsatility index (UCR) in late preterm fetal growth restriction (FGR). MATERIALS AND METHODS A prospective European multicenter observational study included women with a singleton pregnancy, 32+ 0-36+ 6, at risk of FGR (estimated fetal weight [EFW] or abdominal circumference [AC] < 10th percentile, abnormal arterial Doppler or fall in AC from 20-week scan of > 40 percentile points). The primary outcome was a composite of abnormal condition at birth or major neonatal morbidity. UCR was categorized as normal (< 0.9) or abnormal (≥ 0.9). UCR was assessed by gestational age at measurement interval to delivery, and by individual linear regression coefficient in women with two or more measurements. RESULTS 856 women had 2770 measurements; 696 (81 %) had more than one measurement (median 3 (IQR 2-4). At inclusion, 63 (7 %) a UCR ≥ 0.9. These delivered earlier and had a lower birth weight and higher incidence of adverse outcome (30 % vs. 9 %, relative risk 3.2; 95 %CI 2.1-5.0) than women with a normal UCR at inclusion. Repeated measurements after an abnormal UCR at inclusion were abnormal again in 67 % (95 %CI 55-80), but after a normal UCR the chance of finding an abnormal UCR was 6 % (95 %CI 5-7 %). The risk of composite adverse outcome was similar using the first or subsequent UCR values. CONCLUSION An abnormal UCR is likely to be abnormal again at a later measurement, while after a normal UCR the chance of an abnormal UCR is 5-7 % when repeated weekly. Repeated measurements do not predict outcome better than the first measurement, most likely due to the most compromised fetuses being delivered after an abnormal UCR.
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Affiliation(s)
- Bronacha Mylrea-Foley
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London W12 0HS
| | - Hans Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Christoph Lees
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London W12 0HS
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - B Arabin
- Department of Obstetrics Charite, Humboldt University Berlin and Clara Angela Foundation, Berlin, Germany
| | - A Berger
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - E Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, location VUMC, Amsterdam, The Netherlands
| | - A C Breeze
- Fetal Medicine Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Brodszki
- Department of Pediatric Surgery and Neonatology, Lund University, Skane University Hospital, Lund, Sweden
| | - P Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - I Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - J Derks
- Department of Perinatal Medicine, University of Utrecht, Utrecht, The Netherlands
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - E Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium, Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk and Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - L Krofta
- Institute for the Care of Mother and Child, Prague, Czech Republic and Third Medical Faculty, Charles University, Prague, Czech Republic
| | - P Lindgren
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - S M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - G M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples 'Federico II', Naples, Italy
| | - F Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | | | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - F Prefumo
- Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - L Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - J Richter
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - R K Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - H Valensise
- Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata, University, Policlinico Casilino Hospital, Rome, Italy
| | - G H A Visser
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - L Wee
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
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15
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Doffini A, Forcato C, Mangano C, Lattuada D, Aversa R, Maranta C, Giovannone ED, Buson G, Bolognesi C, Maiocchi R, Dori M, Jamal L, Ahmad RB, Yeo GSH, Yeo TW, Saragozza S, Silipigni R, Serafini M, Biondi A, Perego S, Vergani P, Ferrazzi E, Ricciardi-Castagnoli P, Musci TJ, Grati FR. Isolation of single circulating trophoblasts from maternal circulation for noninvasive fetal copy number variant profiling. Prenat Diagn 2023; 43:14-27. [PMID: 36443901 PMCID: PMC10107339 DOI: 10.1002/pd.6275] [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] [Received: 10/26/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop a multi-step workflow for the isolation of circulating extravillous trophoblasts (cEVTs) by describing the key steps enabling a semi-automated process, including a proprietary algorithm for fetal cell origin genetic confirmation and copy number variant (CNV) detection. METHODS Determination of the limit of detection (LoD) for submicroscopic CNV was performed by serial experiments with genomic DNA and single cells from Coriell cell line biobank with known imbalances of different sizes. A pregnancy population of 372 women was prospectively enrolled and blindly analyzed to evaluate the current workflow. RESULTS An LoD of 800 Kb was demonstrated with Coriell cell lines. This level of resolution was confirmed in the clinical cohort with the identification of a pathogenic CNV of 800 Kb, also detected by chromosomal microarray. The mean number of recovered cEVTs was 3.5 cells per sample with a significant reverse linear trend between gestational age and cEVT recovery rate and number of recovered cEVTs. In twin pregnanices, evaluation of zygosity, fetal sex and copy number profiling was performed in each individual cell. CONCLUSION Our semi-automated methodology for the isolation and single-cell analysis of cEVTS supports the feasibility of a cell-based noninvasive prenatal test for fetal genomic profiling.
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Affiliation(s)
- Anna Doffini
- A. Menarini Biomarkers Singapore Pte Ltd, R&D department, Singapore, Singapore
| | - Claudio Forcato
- A. Menarini Biomarkers Singapore Pte Ltd, R&D department, Singapore, Singapore
| | - Chiara Mangano
- A. Menarini Biomarkers Singapore Pte Ltd, R&D department, Singapore, Singapore
| | - Debora Lattuada
- Department of Woman Child and Neonate, Obstetrics Unit, Fondazione IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberta Aversa
- A. Menarini Biomarkers Singapore Pte Ltd, R&D department, Singapore, Singapore
| | - Chiara Maranta
- A. Menarini Biomarkers Singapore Pte Ltd, R&D department, Singapore, Singapore
| | - Emilia D Giovannone
- A. Menarini Biomarkers Singapore Pte Ltd, R&D department, Singapore, Singapore
| | - Genny Buson
- A. Menarini Biomarkers Singapore Pte Ltd, R&D department, Singapore, Singapore
| | - Chiara Bolognesi
- A. Menarini Biomarkers Singapore Pte Ltd, R&D department, Singapore, Singapore
| | - Rebecca Maiocchi
- A. Menarini Biomarkers Singapore Pte Ltd, R&D department, Singapore, Singapore
| | - Martina Dori
- A. Menarini Biomarkers Singapore Pte Ltd, R&D department, Singapore, Singapore
| | - Liyana Jamal
- A. Menarini Biomarkers Singapore Pte Ltd, R&D department, Singapore, Singapore
| | - Raidah B Ahmad
- A. Menarini Biomarkers Singapore Pte Ltd, R&D department, Singapore, Singapore
| | - George S H Yeo
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Tai Wai Yeo
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Silvia Saragozza
- Research and Development, Cytogenetics and Molecular Genetics, TOMA Advanced Biomedical Assays S.p.A., Impact Lab, Busto Arsizio, Italy
| | - Rosamaria Silipigni
- Laboratory of Medical Genetics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Serafini
- Centro Ricerca M. Tettamanti, Department of Pediatrics, University of Milano-Bicocca, Monza, Italy
| | - Andrea Biondi
- Centro Ricerca M. Tettamanti, Department of Pediatrics, University of Milano-Bicocca, Monza, Italy
| | - Sofia Perego
- Department of Obstetrics and Gynecology, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Enrico Ferrazzi
- Department of Woman Child and Neonate, Obstetrics Unit, Fondazione IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Thomas J Musci
- A. Menarini Biomarkers Singapore Pte Ltd, R&D department, Singapore, Singapore
| | - Francesca Romana Grati
- A. Menarini Biomarkers Singapore Pte Ltd, R&D department, Singapore, Singapore.,Research and Development, Cytogenetics and Molecular Genetics, TOMA Advanced Biomedical Assays S.p.A., Impact Lab, Busto Arsizio, Italy
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16
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Di Martino DD, Soldavini CM, Rossi G, Lonardoni MC, Tinè G, Caneschi A, D’Ambrosi F, Ferrazzi E. The sFlt-1/PlGF Ratio in Patients Affected by Gestational Diabetes and SARS-CoV-2 Infection. Metabolites 2022; 13:metabo13010054. [PMID: 36676978 PMCID: PMC9866868 DOI: 10.3390/metabo13010054] [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: 11/29/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Low values of the ratio of plasmatic soluble blocking factor FMS-like tyrosine Kinase 1 and placental growth factor (sFlt-1/PlGF) are required for an adequate placental angiogenesis and function. It has been shown that patients affected by gestational diabetes (GD) and patients with pneumonia from SARS-CoV-2 are characterized by an increased sFlt-1/PlGF ratio. The aim of the present study was to evaluate the sFlt-1-PlGF ratio in pregnancies complicated by COVID-19 and GD. We compared the plasmatic sFlt-1/PlGF ratio among the following groups of pregnant women: COVID-19, GD patients; COVID-19, non-GD patients; non-COVID-19, GD patients; and non-COVID-19, non-GD controls. We enrolled 62 women in the present study, who were divided as follows: 14 COVID-19, GD patients; 12 COVID-19, non-GD patients; 11 non-COVID-19, GD patients; and 25 non-COVID-19, non-GD controls. The COVID-19, GD patients presented a higher pre-pregnancy BMI, a higher prevalence of hypertensive disorders of pregnancy as a co-morbidity, and an increased need for medication for their diabetes. Neonatal data were similar between the groups. The controls showed a significantly lower sFlt-1/PlGF ratio compared to pregnancies complicated by GD and SARS-CoV-2 infection. The sFlt-1/PlGF ratio was higher in patients affected by both GD and SARS-CoV-2 infection; these subjects were characterized by a greater incidence of obesity and hypertensive disorders of pregnancy.
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Affiliation(s)
- Daniela Denis Di Martino
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence:
| | - Chiara Maria Soldavini
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Gabriele Rossi
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maria Chiara Lonardoni
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Gabriele Tinè
- Department of Economics and Quantitative Methods, University of Milano Bicocca, 20900 Monza, Italy
| | - Agnese Caneschi
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesco D’Ambrosi
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Enrico Ferrazzi
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, 20122 Milan, Italy
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17
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Molgora S, Campo E, Carones MB, Ferrazzi E, Saita E, Facchin F. Predictors of Women’s Childbirth Experience: A Prospective Longitudinal Study on Italian New Mothers. Int J Childbirth 2022. [DOI: 10.1891/ijc-2021-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDWomen’s memories of their childbirth experience tend to remain unchanged over time. This experience can be influenced by obstetric factors as well as by sociodemographic and psychological variables.OBJECTIVETo examine whether women’s perceived childbirth experience changes over time; to identify the predictors (obstetric, sociodemographic, and psychological variables) of this experience immediately after delivery and after 3 months.METHODSThis prospective longitudinal study comprised two hundred and twenty-one Italian women who completed a self-report questionnaire at two assessment points: immediately (1–3 days) after birth (Time 1) and 3 months postpartum (Time 2). At Time 1, the questionnaire included some questions on sociodemographic, psychological, and obstetric information, and the Wijma Delivery Experience Questionnaire (WDEQ(B); at Time 2 women compiled again the WDEQ(B).RESULTSRepeated measures ANOVA revealed that the childbirth experience did not change from Time 1 to Time 2. However, predictors of this experience were different between Time 1 and Time 2: at Time 1, the childbirth experience (WDEQ(B)_t1) was significantly predicted nly by type of cesarean section; at Time 2, the childbirth experience (WDEQ(B)_t2) was significantly predicted by WDEQ(B)_t1, history of psychological disorders, and type of conception.DISCUSSIONSOur findings enhance the understanding of the main predictors of a woman’s childbirth experience. Identifying areas of vulnerability is important for clinical practice, as well as for developing maternal health policies to improve women’s birth experiences, postpartum well-being, and the baby’s development.
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18
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Fratelli N, Prefumo F, Maggi C, Cavalli C, Sciarrone A, Garofalo A, Viora E, Vergani P, Ornaghi S, Betti M, Vaglio Tessitore I, Cavaliere AF, Buongiorno S, Vidiri A, Fabbri E, Ferrazzi E, Maggi V, Cetin I, Frusca T, Ghi T, Kaihura C, Di Pasquo E, Stampalija T, Belcaro C, Quadrifoglio M, Veneziano M, Mecacci F, Simeone S, Locatelli A, Consonni S, Chianchiano N, Labate F, Cromi A, Bertucci E, Facchinetti F, Fichera A, Granata D, D'Antonio F, Foti F, Avagliano L, Bulfamante G, Calì G. Third-trimester ultrasound for antenatal diagnosis of placenta accreta spectrum in women with placenta previa: results from the ADoPAD study. Ultrasound Obstet Gynecol 2022; 60:381-389. [PMID: 35247287 PMCID: PMC9544821 DOI: 10.1002/uog.24889] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/27/2022] [Accepted: 03/05/2022] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the performance of third-trimester ultrasound for the diagnosis of clinically significant placenta accreta spectrum disorder (PAS) in women with low-lying placenta or placenta previa. METHODS This was a prospective multicenter study of pregnant women aged ≥ 18 years who were diagnosed with low-lying placenta (< 20 mm from the internal cervical os) or placenta previa (covering the internal cervical os) on ultrasound at ≥ 26 + 0 weeks' gestation, between October 2014 and January 2019. Ultrasound suspicion of PAS was raised in the presence of at least one of these signs on grayscale ultrasound: (1) obliteration of the hypoechogenic space between the uterus and the placenta; (2) interruption of the hyperechogenic interface between the uterine serosa and the bladder wall; (3) abnormal placental lacunae. Histopathological examinations were performed according to a predefined protocol, with pathologists blinded to the ultrasound findings. To assess the ability of ultrasound to detect clinically significant PAS, a composite outcome comprising the need for active management at delivery and histopathological confirmation of PAS was considered the reference standard. PAS was considered to be clinically significant if, in addition to histological confirmation, at least one of these procedures was carried out after delivery: use of hemostatic intrauterine balloon, compressive uterine suture, peripartum hysterectomy, uterine/hypogastric artery ligation or uterine artery embolization. The diagnostic performance of each ultrasound sign for clinically significant PAS was evaluated in all women and in the subgroup who had at least one previous Cesarean section and anterior placenta. Post-test probability was assessed using Fagan nomograms. RESULTS A total of 568 women underwent transabdominal and transvaginal ultrasound examinations during the study period. Of these, 95 delivered in local hospitals, and placental pathology according to the study protocol was therefore not available. Among the 473 women for whom placental pathology was available, clinically significant PAS was diagnosed in 99 (21%), comprising 36 cases of placenta accreta, 19 of placenta increta and 44 of placenta percreta. The median gestational age at the time of ultrasound assessment was 31.4 (interquartile range, 28.6-34.4) weeks. A normal hypoechogenic space between the uterus and the placenta reduced the post-test probability of clinically significant PAS from 21% to 5% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 9% in the subgroup with previous Cesarean section and anterior placenta. The absence of placental lacunae reduced the post-test probability of clinically significant PAS from 21% to 9% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 36% in the subgroup with previous Cesarean section and anterior placenta. When abnormal placental lacunae were seen on ultrasound, the post-test probability of clinically significant PAS increased from 21% to 59% in the whole cohort and from 62% to 78% in the subgroup with previous Cesarean section and anterior placenta. An interrupted hyperechogenic interface between the uterine serosa and bladder wall increased the post-test probability for clinically significant PAS from 21% to 85% in women with low-lying placenta or placenta previa and from 62% to 88% in the subgroup with previous Cesarean section and anterior placenta. When all three sonographic markers were present, the post-test probability for clinically significant PAS increased from 21% to 89% in the whole cohort and from 62% to 92% in the subgroup with previous Cesarean section and anterior placenta. CONCLUSIONS Grayscale ultrasound has good diagnostic performance to identify pregnancies at low risk of PAS in a high-risk population of women with low-lying placenta or placenta previa. Ultrasound may be safely used to guide management decisions and concentrate resources on patients with higher risk of clinically significant PAS. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N. Fratelli
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - F. Prefumo
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - C. Maggi
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - C. Cavalli
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - A. Sciarrone
- Obstetrics–Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and GynecologyCittà della Salute e della ScienzaTurinItaly
| | - A. Garofalo
- Obstetrics–Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and GynecologyCittà della Salute e della ScienzaTurinItaly
| | - E. Viora
- Obstetrics–Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and GynecologyCittà della Salute e della ScienzaTurinItaly
| | - P. Vergani
- University of Milan‐Bicocca, School of Medicine and Surgery, Department of Obstetrics and GynecologyFondazione MBBM Onlus, San Gerardo HospitalMonzaItaly
| | - S. Ornaghi
- University of Milan‐Bicocca, School of Medicine and Surgery, Department of Obstetrics and GynecologyFondazione MBBM Onlus, San Gerardo HospitalMonzaItaly
| | - M. Betti
- Obstetrics and Gynaecology Unit, A. Manzoni Hospital, ASST LeccoLeccoItaly
| | - I. Vaglio Tessitore
- University of Milan‐Bicocca, School of Medicine and Surgery, Department of Obstetrics and GynecologyFondazione MBBM Onlus, San Gerardo HospitalMonzaItaly
| | - A. F. Cavaliere
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità PubblicaFondazione Policlinico Universitario ‘A. Gemelli’ IRCCS‐Università Cattolica del Sacro CuoreRomeItaly
| | - S. Buongiorno
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità PubblicaFondazione Policlinico Universitario ‘A. Gemelli’ IRCCS‐Università Cattolica del Sacro CuoreRomeItaly
| | - A. Vidiri
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità PubblicaFondazione Policlinico Universitario ‘A. Gemelli’ IRCCS‐Università Cattolica del Sacro CuoreRomeItaly
| | - E. Fabbri
- Obstetrics and Gynecology UnitBuzzi Children's Hospital, University of MilanMilanItaly
| | - E. Ferrazzi
- Fondazione IRCCS Ca Granda Ospedale Maggiore PoliclinicoMilano, Unit of ObstetricsMilanItaly
- Department of Clinical and Community SciencesUniversity of MilanMilanItaly
| | - V. Maggi
- Fondazione IRCCS Ca Granda Ospedale Maggiore PoliclinicoMilano, Unit of ObstetricsMilanItaly
| | - I. Cetin
- Obstetrics and Gynecology UnitBuzzi Children's Hospital, University of MilanMilanItaly
| | - T. Frusca
- Department of Medicine and Surgery, Obstetrics and Gynaecology UnitUniversity of ParmaParmaItaly
| | - T. Ghi
- Department of Medicine and SurgeryUniversity of ParmaParmaItaly
| | - C. Kaihura
- Department of Medicine and Surgery, Obstetrics and Gynaecology UnitUniversity of ParmaParmaItaly
| | - E. Di Pasquo
- Department of Medicine and Surgery, Obstetrics and Gynaecology UnitUniversity of ParmaParmaItaly
| | - T. Stampalija
- Unit of Fetal Medicine and Prenatal DiagnosisInstitute for Maternal and Child Health, IRCCS Burlo GarofoloTriesteItaly
- Department of Medical, Surgical and Health ScienceUniversity of TriesteTriesteItaly
| | - C. Belcaro
- Unit of Fetal Medicine and Prenatal DiagnosisInstitute for Maternal and Child Health, IRCCS Burlo GarofoloTriesteItaly
| | - M. Quadrifoglio
- Unit of Fetal Medicine and Prenatal DiagnosisInstitute for Maternal and Child Health, IRCCS Burlo GarofoloTriesteItaly
| | - M. Veneziano
- Obstetrics and Gynecology UnitBolzano HospitalBolzanoItaly
| | - F. Mecacci
- Department of Woman and Child's HealthCareggi University HospitalFlorenceItaly
| | - S. Simeone
- Department of Woman and Child's HealthCareggi University HospitalFlorenceItaly
| | - A. Locatelli
- University of Milan‐Bicocca, School of Medicine and Surgery, Obstetrics and Gynecology Unit, Carate Brianza Hospital, ASST BrianzaCarate BrianzaItaly
| | - S. Consonni
- Obstetrics and Gynecology Unit, Carate Brianza Hospital, ASST BrianzaCarate BrianzaItaly
| | - N. Chianchiano
- Fetal Medicine Unit, Bucchieri La Ferla–Fatebenefratelli HospitalPalermoItaly
| | - F. Labate
- Department of Obstetrics and GynaecologyAzienda Ospedaliera Villa Sofia CervelloPalermoItaly
| | - A. Cromi
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | - E. Bertucci
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Children and AdultsUniversity of Modena and Reggio Emilia School of MedicineModenaItaly
| | - F. Facchinetti
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Children and AdultsUniversity of Modena and Reggio Emilia School of MedicineModenaItaly
| | - A. Fichera
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - D. Granata
- Obstetrics and Gynecology UnitBolognini HospitalSeriateItaly
| | - F. D'Antonio
- Center for Fetal Care and High‐Risk Pregnancy, Department of Obstetrics and GynecologyUniversity of ChietiChietiItaly
| | - F. Foti
- Obstetrics and Gynecology Unit, Civico Hospital of PartinicoPalermoItaly
| | - L. Avagliano
- Department of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - G. P. Bulfamante
- Department of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - G. Calì
- Department of Obstetrics and GynaecologyArnas Civico HospitalPalermoItaly
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19
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Orsi M, Somigliana E, Cribiù FM, Lopez G, Buggio L, Ossola MW, Ferrazzi E. The Prevalence and Clinical Impact of Adenomyosis in Pregnancy-Related Hysterectomy. J Clin Med 2022; 11:jcm11164814. [PMID: 36013049 PMCID: PMC9410253 DOI: 10.3390/jcm11164814] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/06/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The epidemiology of adenomyosis has been traditionally based on patients undergoing hysterectomy for gynecological indications, while its prevalence among hysterectomies performed for obstetric complications is unknown. The aim of this study was to assess the prevalence and clinical impact of adenomyosis diagnosed through histology among women undergoing pregnancy-related hysterectomy (PH). Methods: This was a retrospective cohort study. Women who delivered at a tertiary care regional obstetric hub in Milan between 2009 and 2020 were reviewed to identify cases of PH. Histopathological reports of surgical specimens were examined. Cases with adenomyosis were compared to those without adenomyosis for baseline characteristics, obstetric history and outcomes. Results: During the study period there were 71,061 births and a total of 130 PH, giving a PH incidence of 1.83 per 1000 deliveries. Adenomyosis cases were 18, giving a prevalence of 13.8%. Adenomyosis was associated with placenta previa (77.8 vs. 45.5%, p = 0.01), chorionamnionitis (27.8 vs. 5.4%, p = 0.008), lower gestational age at birth (32 ± 4.6 vs. 35.5 ± 3.6 weeks’ gestation, p = 0.0004), and intrauterine fetal demise among twin pregnancies (50 vs. 4.5%, p = 0.048). Conclusion: Adenomyosis entails a relevant impact on obstetric and perinatal outcomes related to PH. More evidence is needed on the clinical relevance of an ultrasonographic diagnosis of adenomyosis before conception.
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Affiliation(s)
- Michele Orsi
- Department of Woman, New-Born and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda, 12, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
- Maternal-Infant Department, Azienda Socio Sanitaria Territoriale Rhodense, Garbagnate Hospital, Via Carlo Forlanini, 95, 20024 Milan, Italy
- Correspondence:
| | - Edgardo Somigliana
- Department of Woman, New-Born and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda, 12, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Fulvia Milena Cribiù
- Pathology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy
- Pathology Unit, Azienda Socio Sanitaria Territoriale Bergamo Ovest, Treviglio-Caravaggio Hospital, Piazzale Ospedale Luigi Meneguzzo, 1, 24047 Treviglio, Italy
| | - Gianluca Lopez
- Pathology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy
| | - Laura Buggio
- Gynecology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda, 12, 20122 Milan, Italy
| | - Manuela Wally Ossola
- Department of Woman, New-Born and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda, 12, 20122 Milan, Italy
| | - Enrico Ferrazzi
- Department of Woman, New-Born and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Via della Commenda, 12, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
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20
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Di Martino DD, Avagliano L, Ferrazzi E, Fusè F, Sterpi V, Parasiliti M, Stampalija T, Zullino S, Farina A, Bulfamante GP, Di Maso M, D’Ambrosi F. Hypertensive Disorders of Pregnancy and Fetal Growth Restriction: Clinical Characteristics and Placental Lesions and Possible Preventive Nutritional Targets. Nutrients 2022; 14:nu14163276. [PMID: 36014782 PMCID: PMC9414322 DOI: 10.3390/nu14163276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The purpose of this study was to describe the placental lesions in pregnancies complicated by hypertensive disorders (HDP) and/or fetal growth restriction (FGR) and in uneventful control pregnancies. Methods: This is a case control study that included singleton pregnancies with HDP and normally grown fetus (HDP-AGA fetus), with HDP and FGR, early FGR, late FGR, and uneventful pregnancies. Feto-placental Doppler velocimetry and sFlt-1/PlGF ratio were performed. Placental histology was evaluated blinded according to the Amsterdam Consensus criteria. Results: Placental lesions with maternal vascular malperfusion (MVM) were significantly more frequent in HDP-FGR and early FGR (92% and 83%). MVM were significantly associated with abnormal feto-placental Doppler parameters, especially in early FGR. Delayed villous maturation (DVM) was associated with late FGR (83%). HDP-AGA fetus cases presented a heterogeneous pattern of placental lesions, including 60% of cases with MVM, but were not associated with abnormal Doppler feto-placental velocimetry. Conclusions: We found a prevalence of placental maternal vascular malperfusion in HDP-FGR and early FGR groups. These lesions were also associated with abnormal, anti-, and angiogenic markers. Conversely HDP-AGA fetus and late FGR presented more heterogeneous placental lesions not severe enough to cause feto-placental Doppler anomalies. These conditions are likely associated with different etiologies, such as maternal pre-pregnancy risk factors for metabolic syndrome. These findings suggest a possible preventive nutritional approach in addition to low-dose aspirin in pregnant women with predisposing factors for HDP-AGA fetuses and late FGR.
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Affiliation(s)
- Daniela Denis Di Martino
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Laura Avagliano
- Department of Health Sciences, San Paolo Hospital, ASST Santi Paolo e Carlo, 20142 Milano, Italy
| | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Clinical and Community Health Sciences, University of Milan, 20122 Milan, Italy
- Correspondence:
| | - Federica Fusè
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Vittoria Sterpi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Marco Parasiliti
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Sara Zullino
- Department of Obstetrics and Gynaecology, Pisan University Hospital, 56124 Pisa, Italy
| | - Antonio Farina
- Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC), Sant’Orsola-Malpighi Hospital, University of Bologna, 40126 Bologna, Italy
| | - Gaetano Pietro Bulfamante
- Department of Health Sciences, San Paolo Hospital, ASST Santi Paolo e Carlo, 20142 Milano, Italy
- Unit of Human Pathology, San Paolo Hospital, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Matteo Di Maso
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology “G.A. Maccacaro”, University of Milan, 20122 Milan, Italy
| | - Francesco D’Ambrosi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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21
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D'Ambrosi F, Di Maso M, Viscardi A, Ossola MW, Soldavini CM, Cetera GE, Erra R, Ferrazzi E. Serum hepatic biomarkers in women with obstetric cholestasis and a concurrent SARS-CoV-2 infection. J Obstet Gynaecol Res 2022; 48:2713-2720. [PMID: 35915565 PMCID: PMC9538249 DOI: 10.1111/jog.15383] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 01/08/2023]
Abstract
Aim The aim of the study was to evaluate the association between SARS‐CoV‐2 infection and serum hepatic biomarker levels among women with obstetric cholestasis. Methods In this prospective study, we recruited all pregnant women admitted in our hospital with obstetric cholestasis. Among those with a concurrent SARS‐CoV‐2 infection, we evaluated the following serum hepatic biomarkers: aspartate aminotransferase (AST), alanine aminotransferase (ALT), and biliar acids (BA). Results Among the 88 women enrolled in the study, 20 presented with a SARS‐CoV‐2 infection while 68 were negative. SARS‐CoV‐2 infected women were younger (mean age 30.5 ± 5.7 vs. 34.3 ± 5.4; p < 0.01) and in a greater percentage of non‐Caucasian ethnicity when compared to noninfected women (60.0% vs. 17.6%; p < 0.01). Regarding levels of hepatic biomarkers, they showed higher levels of AST (111.5 ± 134.1 vs. 37.3 ± 43.4 UI/L; p = 0.02), ALT (132.2 ± 115.7 vs. 50.5 ± 73.173.1 UI/L; p < 0.01), and BA (41.4 ± 46.8 vs. 18.4 ± 13.4 μmol/L; p = 0.04) compared to noninfected patients. No significant differences in maternal or fetal outcomes were found between infected and noninfected women. Conclusion SARS‐CoV‐2 infection was associated with higher levels of liver enzymes in patients with obstetric cholestasis. This could be the result of a possible hepatic involvement in patients with SARS‐CoV‐2 infection.
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Affiliation(s)
- Francesco D'Ambrosi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Matteo Di Maso
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Anna Viscardi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Manuela W Ossola
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Chiara M Soldavini
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Giulia E Cetera
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Roberta Erra
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Rondinone O, Murgia A, Costanza J, Tabano S, Camanni M, Corsaro L, Fontana L, Colapietro P, Calzari L, Motta S, Santaniello C, Radaelli T, Ferrazzi E, Bosari S, Gentilini D, Sirchia SM, Miozzo M. Correction: Rondinone et al. Extensive Placental Methylation Profiling in Normal Pregnancies. Int. J. Mol. Sci. 2021, 22, 2136. Int J Mol Sci 2022; 23:ijms23105298. [PMID: 35628670 PMCID: PMC9140439 DOI: 10.3390/ijms23105298] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
In the original publication [...].
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Affiliation(s)
- Ornella Rondinone
- Research Laboratories Coordination Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (O.R.); (A.M.); (J.C.); (M.C.); (L.F.); (S.M.); (C.S.); (M.M.)
| | - Alessio Murgia
- Research Laboratories Coordination Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (O.R.); (A.M.); (J.C.); (M.C.); (L.F.); (S.M.); (C.S.); (M.M.)
| | - Jole Costanza
- Research Laboratories Coordination Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (O.R.); (A.M.); (J.C.); (M.C.); (L.F.); (S.M.); (C.S.); (M.M.)
| | - Silvia Tabano
- Medical Genetics, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy; (S.T.); (P.C.)
- Laboratory of Medical Genetics, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Margherita Camanni
- Research Laboratories Coordination Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (O.R.); (A.M.); (J.C.); (M.C.); (L.F.); (S.M.); (C.S.); (M.M.)
| | - Luigi Corsaro
- Department of Brain and Behavioral Sciences, Università di Pavia, 27100 Pavia, Italy;
| | - Laura Fontana
- Research Laboratories Coordination Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (O.R.); (A.M.); (J.C.); (M.C.); (L.F.); (S.M.); (C.S.); (M.M.)
- Medical Genetics, Department of Health Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
| | - Patrizia Colapietro
- Medical Genetics, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy; (S.T.); (P.C.)
| | - Luciano Calzari
- Bioinformatics and Statistical Genomics Unit, Istituto Auxologico Italiano IRCCS, 20095 Cusano Milanino, Italy;
| | - Silvia Motta
- Research Laboratories Coordination Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (O.R.); (A.M.); (J.C.); (M.C.); (L.F.); (S.M.); (C.S.); (M.M.)
| | - Carlo Santaniello
- Research Laboratories Coordination Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (O.R.); (A.M.); (J.C.); (M.C.); (L.F.); (S.M.); (C.S.); (M.M.)
| | - Tatjana Radaelli
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (T.R.); (E.F.)
| | - Enrico Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (T.R.); (E.F.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Silvano Bosari
- Scientific Direction, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Davide Gentilini
- Department of Brain and Behavioral Sciences, Università di Pavia, 27100 Pavia, Italy;
- Bioinformatics and Statistical Genomics Unit, Istituto Auxologico Italiano IRCCS, 20095 Cusano Milanino, Italy;
- Correspondence: ; Tel.: +39-038-298-7541
| | - Silvia Maria Sirchia
- Medical Genetics, Department of Health Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
| | - Monica Miozzo
- Research Laboratories Coordination Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (O.R.); (A.M.); (J.C.); (M.C.); (L.F.); (S.M.); (C.S.); (M.M.)
- Medical Genetics, Department of Health Sciences, Università degli Studi di Milano, 20122 Milano, Italy;
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Ornaghi S, Caricati A, Di Martino DD, Mossa M, Di Nicola S, Invernizzi F, Zullino S, Clemenza S, Barbati V, Tinè G, Mecacci F, Ferrazzi E, Vergani P. Non-invasive Maternal Hemodynamic Assessment to Classify High-Risk Pregnancies Complicated by Fetal Growth Restriction. Front Clin Diabetes Healthc 2022; 3:851971. [PMID: 36992751 PMCID: PMC10012115 DOI: 10.3389/fcdhc.2022.851971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022]
Abstract
ObjectivesTo verify whether the use of the temporal criterion of 32 weeks’ gestation is effective in identifying maternal hemodynamic differences between early- and late-onset fetal growth restriction (FGR), and to test the statistical performance of a classificatory algorithm for FGR.Materials and methodsA prospective multicenter study conducted at three centers over 17 months. Singleton pregnant women with a diagnosis of FGR based on the international Delphi survey consensus at ≥ 20 weeks of gestation were included. FGR was classified as early-onset if diagnosed <32 weeks’ gestation and as late-onset if ≥32 weeks. Hemodynamic assessment was performed by USCOM-1A at the time of FGR diagnosis. Comparisons between early- and late-onset FGR among the entire study cohort, FGR associated with hypertensive disorders of pregnancy (HDP-FGR), and isolated FGR (i-FGR) were performed. In addition, HDP-FGR cases were compared to i-FGR, regardless of the temporal cut-off of 32 weeks’ gestation. Finally, a classificatory analysis based on the Random Forest model was performed to identify significant variables with the ability to differentiate FGR phenotypes.ResultsDuring the study period, 146 pregnant women fulfilled the inclusion criteria. In 44 cases, FGR was not confirmed at birth, thus limiting the final study population to 102 patients. In 49 (48.1%) women, FGR was associated to HDP. Fifty-nine (57.8%) cases were classified as early-onset. Comparison of the maternal hemodynamics between early- and late-onset FGR did not show any difference. Similarly, non-significant findings were observed in sensitivity analyses performed for HDP-FGR and for i-FGR. In turn, comparison between pregnant women with FGR and hypertension and women with i-FGR, independently of the gestational age at FGR diagnosis, revealed substantial differences, with the former showing higher vascular peripheral resistances and lower cardiac output, among other significant parameters. The classificatory analysis identified both phenotypic and hemodynamic variables as relevant in distinguishing HDP-FGR from i-FGR (p=0.009).ConclusionsOur data show that HDP, rather than gestational age at FGR diagnosis, allows to appreciate specific maternal hemodynamic patterns and to accurately distinguish two different FGR phenotypes. In addition, maternal hemodynamics, alongside phenotypic characteristics, play a central role in classifying these high-risk pregnancies.
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Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Monza e Brianza per il Bambino e la sua Mamma Foundation Onlus at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
- *Correspondence: Sara Ornaghi,
| | - Andrea Caricati
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Department of Woman, Child, and Newborn, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Denis Di Martino
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Department of Woman, Child, and Newborn, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Mossa
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Sara Di Nicola
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Monza e Brianza per il Bambino e la sua Mamma Foundation Onlus at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Francesca Invernizzi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Monza e Brianza per il Bambino e la sua Mamma Foundation Onlus at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Sara Zullino
- Department of Obstetrics and Gynecology, Biomedical, Experimental and Clinical Sciences, University Hospital Careggi, Florence, Italy
| | - Sara Clemenza
- Department of Obstetrics and Gynecology, Biomedical, Experimental and Clinical Sciences, University Hospital Careggi, Florence, Italy
| | - Valentina Barbati
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Department of Woman, Child, and Newborn, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriele Tinè
- Department of Economics and Quantitative Methods, University of Milan-Bicocca, Monza, Italy
| | - Federico Mecacci
- Department of Obstetrics and Gynecology, Biomedical, Experimental and Clinical Sciences, University Hospital Careggi, Florence, Italy
| | - Enrico Ferrazzi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Department of Woman, Child, and Newborn, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Monza e Brianza per il Bambino e la sua Mamma Foundation Onlus at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
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24
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Mylrea-Foley B, Thornton JG, Mullins E, Marlow N, Hecher K, Ammari C, Arabin B, Berger A, Bergman E, Bhide A, Bilardo C, Binder J, Breeze A, Brodszki J, Calda P, Cannings-John R, Černý A, Cesari E, Cetin I, Dall'Asta A, Diemert A, Ebbing C, Eggebø T, Fantasia I, Ferrazzi E, Frusca T, Ghi T, Goodier J, Greimel P, Gyselaers W, Hassan W, Von Kaisenberg C, Kholin A, Klaritsch P, Krofta L, Lindgren P, Lobmaier S, Marsal K, Maruotti GM, Mecacci F, Myklestad K, Napolitano R, Ostermayer E, Papageorghiou A, Potter C, Prefumo F, Raio L, Richter J, Sande RK, Schlembach D, Schleußner E, Stampalija T, Thilaganathan B, Townson J, Valensise H, Visser GHA, Wee L, Wolf H, Lees CC. Perinatal and 2-year neurodevelopmental outcome in late preterm fetal compromise: the TRUFFLE 2 randomised trial protocol. BMJ Open 2022; 12:e055543. [PMID: 35428631 PMCID: PMC9014041 DOI: 10.1136/bmjopen-2021-055543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Following the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring invariably leading to delivery. Indices derived from fetal cerebral Doppler examination may guide such decisions although there are few studies in this area. We propose a randomised, controlled trial to establish the optimum method of timing delivery between 32 weeks and 36 weeks 6 days of gestation. We hypothesise that delivery on evidence of cerebral blood flow redistribution reduces a composite of perinatal poor outcome, death and short-term hypoxia-related morbidity, with no worsening of neurodevelopmental outcome at 2 years. METHODS AND ANALYSIS Women with non-anomalous singleton pregnancies 32+0 to 36+6 weeks of gestation in whom the estimated fetal weight or abdominal circumference is <10th percentile or has decreased by 50 percentiles since 18-32 weeks will be included for observational data collection. Participants will be randomised if cerebral blood flow redistribution is identified, based on umbilical to middle cerebral artery pulsatility index ratio values. Computerised cardiotocography (cCTG) must show normal fetal heart rate short term variation (≥4.5 msec) and absence of decelerations at randomisation. Randomisation will be 1:1 to immediate delivery or delayed delivery (based on cCTG abnormalities or other worsening fetal condition). The primary outcome is poor condition at birth and/or fetal or neonatal death and/or major neonatal morbidity, the secondary non-inferiority outcome is 2-year infant general health and neurodevelopmental outcome based on the Parent Report of Children's Abilities-Revised questionnaire. ETHICS AND DISSEMINATION The Study Coordination Centre has obtained approval from London-Riverside Research Ethics Committee (REC) and Health Regulatory Authority (HRA). Publication will be in line with NIHR Open Access policy. TRIAL REGISTRATION NUMBER Main sponsor: Imperial College London, Reference: 19QC5491. Funders: NIHR HTA, Reference: 127 976. Study coordination centre: Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS with Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University. IRAS Project ID: 266 400. REC reference: 20/LO/0031. ISRCTN registry: 76 016 200.
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Affiliation(s)
- Bronacha Mylrea-Foley
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Jim G Thornton
- Department of Obstetrics and Gynaecology, University of Nottingham, City hospital, Nottingham, UK
| | - Edward Mullins
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Neil Marlow
- Elizabeth Garrett Anderson Institute for Women's Health University College London, London, UK
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Ammari
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Birgit Arabin
- Department of Obstetrics Charite, Humboldt University of Berlin, Berlin, Germany
| | - Astrid Berger
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Bergman
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Amarnath Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Caterina Bilardo
- Department of Obstetrics Amsterdam, Vrije Universiteit Amsterdam, Noord-Holland, The Netherlands
| | - Julia Binder
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Andrew Breeze
- Fetal medicine Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jana Brodszki
- Department of Obstetrics and Gynecology, Lund Skanes universitetssjukhus Lund, Skåne, Sweden
| | - Pavel Calda
- Department of Obstetrics and Gynaecology, Charles University, Praha, Czech Republic
| | | | - Andrej Černý
- Department of Obstetrics & Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Elena Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Hospital, University of Milan, Milan, Italy
| | - Irene Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Hospital, University of Milan, Milan, Italy
| | | | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Ilaria Fantasia
- Unit of Fetal Medicine and Prenatal Diagnosis, RCCS materno infantile Burlo Garofolo Dipartimento di Pediatria, Trieste, Italy
| | - Enrico Ferrazzi
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, ltaly
| | | | - Tullio Ghi
- Department of Obstetrics & Gynecology, University of Parma, Parma, Italy
| | - Jenny Goodier
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Patrick Greimel
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Wilfried Gyselaers
- Department of Obstetrics and Gynecology, Hospital Oost-Limburg, Genk, Belgium
| | - Wassim Hassan
- Obstetrics & Gynaecology, East Suffolk and North Essex NHS Foundation Trust, Colchester Hospital, Colchester, UK
| | | | - Alexey Kholin
- National Medical Research Center for Obstetrics, Gynecology & Perinatology, Moscow, Russia
| | - Philipp Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Medical University of Graz, Graz, Austria
| | - Ladislav Krofta
- Institute for Care of Mother and Child, Prague, Czech Republic
| | - Peter Lindgren
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention & Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Silvia Lobmaier
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Karel Marsal
- Obstetrics and Gynaecology, Faculty of Medicine, Lunds Universitet, Lund, Sweden
| | - Giuseppe M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, Federico II University Hospital, Napoli, Italy
| | - Federico Mecacci
- High Risk Pregnancy Unit, University Hospital Careggi, Firenze, Italy
| | - Kirsti Myklestad
- Department of Obstetrics, Children's and Women's Health, St Olavs Hospital University Hospital, Trondheim, Norway
| | - Raffaele Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health University College London, London, UK
| | - Eva Ostermayer
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Aris Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK,Molecular & Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Claire Potter
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, Università degli Studi di Brescia, Brescia, Italy
| | - Luigi Raio
- Department of Obstetrics and Gynaecology, University of Bern, Bern, Switzerland
| | - Jute Richter
- Department of Gynecology and Obstetrics, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ragnar Kvie Sande
- Department of Obstetrics and Gynaecology, Stavanger University Hospital, Stavanger, Norway
| | - Dietmar Schlembach
- Vivantes Network for Health, Clinicum Neukoelln, Clinic for Obstetric Medicine, Berlin, Germany
| | | | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, RCCS materno infantile Burlo Garofolo Dipartimento di Pediatria, Trieste, Italy
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK,Molecular & Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Herbert Valensise
- Division of Obstetrics and Gynaecology Policlinico Casilino, Roma, Italy
| | - Gerard HA Visser
- Department of Obstetrics, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Ling Wee
- Obstetrics And Gynaecology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Hans Wolf
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Christoph C Lees
- Imperial College London, Obstetrics and Gynaecology, Queen Charlotte's & Chelsea Hospital London, London, UK
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25
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Lees CC, Romero R, Stampalija T, Dall'Asta A, DeVore GA, Prefumo F, Frusca T, Visser GHA, Hobbins JC, Baschat AA, Bilardo CM, Galan HL, Campbell S, Maulik D, Figueras F, Lee W, Unterscheider J, Valensise H, Da Silva Costa F, Salomon LJ, Poon LC, Ferrazzi E, Mari G, Rizzo G, Kingdom JC, Kiserud T, Hecher K. Clinical Opinion: The diagnosis and management of suspected fetal growth restriction: an evidence-based approach. Am J Obstet Gynecol 2022; 226:366-378. [PMID: 35026129 PMCID: PMC9125563 DOI: 10.1016/j.ajog.2021.11.1357] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 11/01/2022]
Abstract
This study reviewed the literature about the diagnosis, antepartum surveillance, and time of delivery of fetuses suspected to be small for gestational age or growth restricted. Several guidelines have been issued by major professional organizations, including the International Society of Ultrasound in Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine. The differences in recommendations, in particular about Doppler velocimetry of the ductus venosus and middle cerebral artery, have created confusion among clinicians, and this review has intended to clarify and highlight the available evidence that is pertinent to clinical management. A fetus who is small for gestational age is frequently defined as one with an estimated fetal weight of <10th percentile. This condition has been considered syndromic and has been frequently attributed to fetal growth restriction, a constitutionally small fetus, congenital infections, chromosomal abnormalities, or genetic conditions. Small for gestational age is not synonymous with fetal growth restriction, which is defined by deceleration of fetal growth determined by a change in fetal growth velocity. An abnormal umbilical artery Doppler pulsatility index reflects an increased impedance to flow in the umbilical circulation and is considered to be an indicator of placental disease. The combined finding of an estimated fetal weight of <10th percentile and abnormal umbilical artery Doppler velocimetry has been widely accepted as indicative of fetal growth restriction. Clinical studies have shown that the gestational age at diagnosis can be used to subclassify suspected fetal growth restriction into early and late, depending on whether the condition is diagnosed before or after 32 weeks of gestation. The early type is associated with umbilical artery Doppler abnormalities, whereas the late type is often associated with a low pulsatility index in the middle cerebral artery. A large randomized clinical trial indicated that in the context of early suspected fetal growth restriction, the combination of computerized cardiotocography and fetal ductus venosus Doppler improves outcomes, such that 95% of surviving infants have a normal neurodevelopmental outcome at 2 years of age. A low middle cerebral artery pulsatility index is associated with an adverse perinatal outcome in late fetal growth restriction; however, there is no evidence supporting its use to determine the time of delivery. Nonetheless, an abnormality in middle cerebral artery Doppler could be valuable to increase the surveillance of the fetus at risk. We propose that fetal size, growth rate, uteroplacental Doppler indices, cardiotocography, and maternal conditions (ie, hypertension) according to gestational age are important factors in optimizing the outcome of suspected fetal growth restriction.
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Affiliation(s)
- Christoph C Lees
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI
| | - Tamara Stampalija
- Department of Obstetrics and Gynecology, Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, Scientific Institute for Research, Hospitalization and Healthcare Burlo Garofolo, Trieste, Italy; Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Andrea Dall'Asta
- Department of Metabolism, Digestion and Reproduction, Institute of Reproductive and Developmental Biology, Imperial College London, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Greggory A DeVore
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Tiziana Frusca
- Department of Medicine and Surgery, Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - Gerard H A Visser
- Department of Obstetrics, University Medical Center, Utrecht, The Netherlands
| | - John C Hobbins
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
| | - Ahmet A Baschat
- Department of Gynecology and Obstetrics, John Hopkins Center for Fetal Therapy, Johns Hopkins University, Baltimore, MD
| | - Caterina M Bilardo
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands
| | - Henry L Galan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO; Colorado Fetal Care Center, Children's Hospital of Colorado, Aurora, CO
| | | | - Dev Maulik
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Francesc Figueras
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Wesley Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX
| | - Julia Unterscheider
- Department of Maternal-Fetal Medicine, Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, The University of Melbourne, Australia
| | - Herbert Valensise
- University of Rome Tor Vergata, Rome, Italy; Department of Surgery, Policlinico Casilino, Rome, Italy
| | - Fabricio Da Silva Costa
- Maternal-Fetal Medicine Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia; School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Laurent J Salomon
- Obstétrique et Plateforme LUMIERE, Hôpital Necker-Enfants Malades (AP-HP) et Université de Paris, Paris, France
| | - Liona C Poon
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Special Administrative Region of China
| | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Mari
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Giuseppe Rizzo
- Università di Roma Tor Vergata, Department of Obstetrics and Gynecology, Fondazione Policinico Tor Vergata, Rome, Italy; The First I.M. Sechenov Moscow State Medical University, Department of Obstetrics and Gynaecology, Moscow, Russian Federation
| | - John C Kingdom
- Placenta Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Torvid Kiserud
- Department of Obstetrics and Gynecology, Haukeland University Hospital, and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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26
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Forcato C, Mangano C, Lattuada D, Aversa R, Maranta C, Giovannone E, Buson G, Bolognesi C, Maiocchi R, Dori M, Jamal L, Ahmad R, Yeo GS, Yeo TW, Saragozza S, Serafini M, Biondi A, Perego S, Vergani P, Ferrazzi E, Grati FR, Ricciardi-Castagnoli P. OP049: Automated isolation and genetic characterization of single circulating fetal trophoblasts in pregnant women. Genet Med 2022. [DOI: 10.1016/j.gim.2022.01.595] [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: 11/16/2022] Open
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27
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Fredi M, Argolini LM, Angeli F, Trespidi L, Ramoni V, Zatti S, Vojinovic T, Donzelli D, Gazzola FG, Xoxi B, Andreoli L, Lojacono A, Ferrazzi E, Montecucco C, Chighizola CB, Meroni PL, Franceschini F, Cimaz R, Caporali R, Tincani A, Gerosa M. Anti-SSA/Ro positivity and congenital heart block: obstetric and foetal outcome in a cohort of anti-SSA/Ro positive pregnant patients with and without autoimmune diseases. Clin Exp Rheumatol 2022; 41:685-693. [PMID: 36377571 DOI: 10.55563/clinexprheumatol/2ju0yv] [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] [Received: 02/22/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Neonatal lupus (NL) is an acquired disease caused by the transplacental passage of anti-SSA/Ro antibodies. The rate of congenital heart block (CHB), its most serious manifestation, ranges from 1 to 5%. The aim of this study was to retrospectively assess the prevalence of CHB in anti-SSA/Ro positive pregnant women with or without systemic autoimmune diseases from 2010 to 2020. METHODS Patients underwent monthly visit and a shared follow-up programme of weekly (16th-24th week) foetal heart rate assessment by obstetric ultrasound. RESULTS 322 pregnancies in 258 anti-SSA/Ro patients were included; 314 were followed from the beginning of pregnancy because of the known presence of anti-SSA/Ro autoantibodies and 1 case of CHB occurred in an anti-SSA/Ro+ asymptomatic subject (0.3%). In the same period, 8 additional patients were referred to our clinics after in utero CHB diagnosis and subsequent discovery of anti-SSA/Ro without a disease diagnosis. Globally, 9 cases of congenital CHB (2.8%) occurred: 7 complete, 1 II-III degree and 1 rst degree CHB. Anti-SSB/La positivity was associated with a higher risk of CHB (7.8% vs. 1.2%; p=0.0071). No differences in maternal or foetal outcomes were found in comparison with a large cohort of unselected pregnancies except for caesarian section. Hydroxychloroquine (HCQ) was used in 58.3% pregnancies, with a different prevalence according with maternal diagnosis. CONCLUSIONS Our data suggest that anti-SSA/Ro positive patents with a de ned systemic autoimmune disease undergoing a strict follow-up since positive pregnancy test display a low risk of pregnancy complications, including but not limited to NL.
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Affiliation(s)
- Micaela Fredi
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Clinical and Experimental Science Department, University of Brescia, Italy
| | | | - Fabrizio Angeli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Clinical and Experimental Science Department, University of Brescia, Italy
| | - Laura Trespidi
- Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronique Ramoni
- Division of Rheumatology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sonia Zatti
- Obstetrics and Gynecology Unit, ASST Spedali Civili of Brescia, Italy
| | - Tamara Vojinovic
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Clinical and Experimental Science Department, University of Brescia, Italy
| | - Davide Donzelli
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO, Research Center for Adult and Paediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Federica Giulia Gazzola
- Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Blerina Xoxi
- Division of Rheumatology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Clinical and Experimental Science Department, University of Brescia, Italy
| | - Andrea Lojacono
- Obstetrics and Gynecology Unit, ASST Garda, Desenzano Hospital, Italy
| | - Enrico Ferrazzi
- Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlomaurizio Montecucco
- Division of Rheumatology, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cecilia Beatrice Chighizola
- Paediatric Rheumatology Unit, ASST G. Pini-CTO, Research Center for Adult and Paediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Pier Luigi Meroni
- Experimental Laboratory of ImmunoRheumatological Researches, IRCCS Istituto Auxologico Italiano, Cusano Milanino, Italy
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Clinical and Experimental Science Department, University of Brescia, Italy
| | - Rolando Cimaz
- Paediatric Rheumatology Unit, ASST G. Pini-CTO, Research Center for Adult and Paediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO, Research Center for Adult and Paediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili and Clinical and Experimental Science Department, University of Brescia, Italy, and I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Maria Gerosa
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO, Research Centre for Adult and Paediatric Rheumatic Diseases, Department of Clinical Sciences and Community Health, University of Milan, Italy.
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Amodeo S, Cavoretto PI, Seidenari A, Paci G, Germano C, Monari F, Donno V, Giambanco L, Avagliano L, Di Martino D, Fusé F, Masturzo B, Chiantera V, Facchinetti F, Ferrazzi E, Candiani M, Bulfamante G, Farina A. Second trimester uterine arteries pulsatility index is a function of placental pathology and provides insights on stillbirth aetiology: A multicenter matched case-control study. Placenta 2022; 121:7-13. [DOI: 10.1016/j.placenta.2022.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/21/2022] [Accepted: 02/24/2022] [Indexed: 12/21/2022]
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D'Ambrosi F, Rossi G, Di Maso M, Marino C, Soldavini CM, Caneschi A, Cetera GE, Erra R, Ferrazzi E. Altered Doppler velocimetry of fetal middle cerebral artery in singleton pregnancies complicated by mild well-controlled gestational diabetes. Fetal Diagn Ther 2022; 49:77-84. [PMID: 35104818 DOI: 10.1159/000522203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
Abstract
Introduction The aim the present study is to evaluate fetal umbilical artery (UA) and middle cerebral artery (MCA) blood flow in patients with gestational diabetes (GD), in order to determine whether minimal anomalies of glucose metabolism may influence fetal placental function. Methods UA and MCA flow were prospectively measured by transabdominal ultrasound in singleton pregnancies between 34 and 37 weeks of gestation. Results The study included 35 women with GD and 217 non-diabetic patients. Middle cerebral pusatility index (PI) was significantly higher in the GD group (mean MCA - PI =1.82±0.27 vs 1.71 ±0.26; p< 0.02). Likewise, MCA peak systolic velocity (MCA-PSV) was higher in the GD group compared to the non-GD group, though the difference was not significant (mean of MCA-PSV =47.14 ±8.45 vs 47.09 ± 11.21; p = 0.98). UA-PI resulted higher in the non-GD group without significant differences (mean of UA-PI =0.88 ±0.14 vs 0.86 ± 0.15; p = 0.32) Conclusions Our study shows that even in cases of minimal metabolic derangements, GD is characterised by a significant variation in fetal Doppler velocimetry, particularly in the brain.
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Affiliation(s)
- Francesco D'Ambrosi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriele Rossi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Di Maso
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro," Università degli Studi di Milano, Milan, Italy
| | - Cecilia Marino
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Chiara M Soldavini
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Agnese Caneschi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia E Cetera
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberta Erra
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Molgora S, Saita E, Barbieri Carones M, Ferrazzi E, Facchin F. Predictors of Postpartum Depression among Italian Women: A Longitudinal Study. IJERPH 2022; 19:ijerph19031553. [PMID: 35162574 PMCID: PMC8835615 DOI: 10.3390/ijerph19031553] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023]
Abstract
Introduction: Postpartum depression is commonly experienced by mothers worldwide and is associated with anxiety disorders, parenting stress, and other forms of distress, which may lead to a complex illness condition. Several studies have investigated the risk factors for this disorder, including biological and socio-demographic variables, medical and obstetric factors, and psychological and relational dimensions. The present study aimed to describe the psychological status of mothers up to 12 months postpartum, and to investigate the predictors of depressive symptoms at 12 months postpartum, considering obstetric factors along with psychological and relational variables. Methods: A sample of 137 women completed a questionnaire composed of a sheet on anamnestic and obstetric information and the following scales: Wijma Delivery Experience Questionnaire; State-Trait Anxiety Inventory; Edinburgh Postnatal Depression Scale; Parenting Stress Index (Short Form); Dyadic Adjustment Scale; and Multidimensional Scale of Perceived Social Support. Data were collected at four assessment times: 2–3 days, 3 months, 6 months, and 12 months postpartum. Results: Findings showed that the highest percentage of women with clinically significant symptoms of anxiety (state and trait) and depression was found at 12 months postpartum, which indicated that this was the most critical time. The quality of childbirth experience and trait anxiety at three months postpartum emerged as significant predictors of postpartum depression at 12 months. Conclusion: Our findings highlight the importance of providing stable programs (such as educational programs) to mothers in the first year postpartum. Furthermore, because the quality of the childbirth experience is one of the most important predictors of PPD at 12 months postpartum, effort should be made by healthcare professionals to guarantee a positive experience to all women to reduce possible negative long-term consequences of this experience.
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Affiliation(s)
- Sara Molgora
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (E.S.); (F.F.)
- Correspondence: ; Tel.: +39-0272342347; Fax: +39-0272345962
| | - Emanuela Saita
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (E.S.); (F.F.)
| | | | - Enrico Ferrazzi
- Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.B.C.); (E.F.)
- Department of Clinical Science and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Federica Facchin
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (E.S.); (F.F.)
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Soldavini CM, Di Martino D, Sabattini E, Ornaghi S, Sterpi V, Erra R, Invernizzi F, Tine' G, Giardini V, Vergani P, Ossola MW, Ferrazzi E. sFlt-1/PlGF ratio in hypertensive disorders of pregnancy in patients affected by COVID-19. Pregnancy Hypertens 2021; 27:103-109. [PMID: 34998223 PMCID: PMC8653398 DOI: 10.1016/j.preghy.2021.12.001] [Citation(s) in RCA: 3] [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: 09/09/2021] [Revised: 11/22/2021] [Accepted: 12/03/2021] [Indexed: 01/21/2023]
Abstract
Objectives To analyze soluble Fms-like tyrosine Kinase 1 (sFlt-1) and Placental Growth Factor (PlGF) ratio concentrations in COVID-19 pregnant patients with and without Hypertensive Disorders of Pregnancy (HDP), compared with non COVID-19 pregnant patients with HDP and a control group. Study design We recruited and obtained a complete follow-up of 19 COVID-19 pregnant patients with HDP and of 24 COVID-19 normotensive pregnant patients. Demographic, clinical and sFlt-1/PlGF ratio findings were compared with a group of 185 non COVID-19 pregnant patients with HDP and 41 non COVID normotensive patients. Findings were based on univariate analysis and on a multivariate adjusted model, and a case by case analysis of COVID-19 pregnant patients with an abnormal sFlt-1/PlGF ratio > 38 at recruitment. Main outcome measures sFlt-1/PlGF ratio. Results We confirmed a significant higher prevalence of HDP in women affected by COVID-19 compared to control population. sFlt-1/PlGF ratio was found high in HDP patients, with and without of Sars-Cov2 infection. COVID-19 patients with worse evolution of the disease showed greater rates of obesity and other comorbidities. sFlt/PlGF ratio proved not to be helpful in the differential diagnosis of the severity of this infection. Conclusions COVID-19 pregnant patients showed a higher prevalence of HDP compared to non COVID-19 controls, as well as higher comorbidity rates. In spite of the possible common endothelial target and damage, between Sars-Cov-2 infection and HDP, the sFlt1/PlGF ratio did not correlate with the severity of this syndrome.
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Affiliation(s)
- Chiara Maria Soldavini
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Di Martino
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Sabattini
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Ornaghi
- Obstetrics Unit, Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy
| | - Vittoria Sterpi
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberta Erra
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Invernizzi
- Obstetrics Unit, Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy
| | - Gabriele Tine'
- Department of Economics and Quantitative Methods, University of Milano Bicocca, Monza, Italy
| | - Valentina Giardini
- Obstetrics Unit, Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy
| | - Patrizia Vergani
- Obstetrics Unit, Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy; University of Milano Bicocca, Monza, Italy
| | - Manuela Wally Ossola
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Obstetrics Unit, Department of Woman Child and Newborn, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical and Community Sciences, University of Milan, Italy.
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Seidenari A, Carbone F, Cavoretto PI, Ferrazzi E, Pilu G, Farina A. Fetal Biometry: A Method for Comparing Local Curve Populations with Those from Major Reference Standards. Fetal Diagn Ther 2021; 48:757-764. [PMID: 34818227 DOI: 10.1159/000519058] [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: 04/15/2021] [Accepted: 08/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study aimed to present a statistical method for assessing potential differences between fetal growth standard curves and local curve population. METHODS This was an observational repeated measures longitudinal study. We used a simulation model to generate random distribution of the international population from the IG-21st for fetal AC using the original equations of means and standard deviations (SD) obtained by the fractional polynomial method. A general linear model (GLM) allowed us to calculate new equations originating from simulated intergrowth-21st data (SIM_IG21st) and to compare them, by visual inspection of the estimated coefficients and their 95% CI, with the original published. We used further GLMs for evaluating the goodness of fitting of our local curve and comparing the relative equations of means and SD with those of SIM_IG21st. Finally, the impact of percentile differences between the 2 curves was quantified. RESULTS SIM_IG21st data yielded very similar coefficients than those of IG-21st reference to such an extent that means and SD and percentiles of interest were identical to the original. The comparison between SIM_IG21st curve and local curves showed a nonsignificant intercept and a slight difference of the 2 slopes (GA and GA3) for the equations of the mean. As a result, the local curve resulted in greater AC values. A difference in the intercept but not in the slopes (GA2, GA3, and GA3 * lnGA) was instead reported for the equations of the SD. In the percentile comparison, the local curve resulted in an overestimation of the 3rd and the 10th percentile that corresponded to the 4th and 12th percentiles of SIM_IG21st, respectively. CONCLUSION This statistical method allows sonographers to assess potential differences between standard curves and local curve population, enabling a more proper identification of abnormal growth trajectories.
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Affiliation(s)
- Anna Seidenari
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria Sant' Orsola-Malpighi, Bologna, Italy,
| | - Floriana Carbone
- Department of Obstetrics and Gynecology, 'L. Mangiagalli' Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Ivo Cavoretto
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, University Vita-Salute, Milan, Italy
| | - Enrico Ferrazzi
- Department of Obstetrics and Gynecology, 'L. Mangiagalli' Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluigi Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria Sant' Orsola-Malpighi, Bologna, Italy
| | - Antonio Farina
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria Sant' Orsola-Malpighi, Bologna, Italy
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Cetera GE, D'Ambrosi F, Iurlaro E, Cesano N, Carbone IF, De Marinis S, Ferrazzi E. COVID-19-associated coagulopathy and unfavorable obstetric outcomes in the third trimester of pregnancy. Int J Gynaecol Obstet 2021; 157:206-207. [PMID: 34778970 PMCID: PMC9087497 DOI: 10.1002/ijgo.14026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Giulia E Cetera
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Francesco D'Ambrosi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Enrico Iurlaro
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Nicola Cesano
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Ilma F Carbone
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Stefano De Marinis
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Papageorghiou AT, Deruelle P, Gunier RB, Rauch S, García-May PK, Mhatre M, Usman MA, Abd-Elsalam S, Etuk S, Simmons LE, Napolitano R, Deantoni S, Liu B, Prefumo F, Savasi V, do Vale MS, Baafi E, Zainab G, Nieto R, Maiz N, Aminu MB, Cardona-Perez JA, Craik R, Winsey A, Tavchioska G, Bako B, Oros D, Rego A, Benski AC, Hassan-Hanga F, Savorani M, Giuliani F, Sentilhes L, Risso M, Takahashi K, Vecchiarelli C, Ikenoue S, Thiruvengadam R, Soto Conti CP, Ferrazzi E, Cetin I, Nachinab VB, Ernawati E, Duro EA, Kholin A, Firlit ML, Easter SR, Sichitiu J, Bowale A, Casale R, Cerbo RM, Cavoretto PI, Eskenazi B, Thornton JG, Bhutta ZA, Kennedy SH, Villar J. Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study. Am J Obstet Gynecol 2021; 225:289.e1-289.e17. [PMID: 34187688 PMCID: PMC8233533 DOI: 10.1016/j.ajog.2021.05.014] [Citation(s) in RCA: 149] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022]
Abstract
Background It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors. Objective This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. Study Design This was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions. Results We enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32–2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25–2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17–3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99–2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99–5.49) and 6.26 (95% confidence interval, 4.35–9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63–2.86; risk ratio, 2.53; 95% confidence interval, 1.44–4.45; and risk ratio, 2.84; 95% confidence interval, 1.67–4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32–2.35), 2.07 (95% confidence interval, 1.20–3.57), and 2.77 (95% confidence interval, 1.66–4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios. Conclusion COVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19.
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Affiliation(s)
- Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom; Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Robert B Gunier
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Stephen Rauch
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | | | | | - Mustapha Ado Usman
- Department of Obstetrics and Gynaecology, Muhammad Abdullahi Wase Teaching Hospital, Kano State, Nigeria
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Saturday Etuk
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Lavone E Simmons
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Raffaele Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom; Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sonia Deantoni
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom; Neonatal Care Unit, Department of Public Health and Pediatrics, School of Medicine, University of Turin, Italy
| | - Becky Liu
- Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Federico Prefumo
- Division of Obstetrics and Gynecology, zienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Valeria Savasi
- Department of BioMedical and Clinical Sciences, Ospedale Luigi Sacco University Hospital, University of Milan, Milan, Italy
| | | | | | - Ghulam Zainab
- Department of Obstetrics and Gynaecology, the Aga Khan University, Karachi, Pakistan
| | - Ricardo Nieto
- Division Neonatología, Hospital Materno Infantil Ramón Sarda, Buenos Aires Argentina
| | - Nerea Maiz
- Obstetrics Department, Hospital Universitari Vall d'Hebron, Barcelona Hospital Campus, Barcelona, Spain
| | - Muhammad Baffah Aminu
- Department of Obstetrics and Gynaecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | | | - Rachel Craik
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Adele Winsey
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Gabriela Tavchioska
- Department of Pediatrics, General Hospital Borka Taleski, Prilep, Republic of North Macedonia
| | - Babagana Bako
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medical Sciences, Gombe State University, Gombe, Nigeria
| | - Daniel Oros
- Obstetrics Department, Aragon Institute of Health Research, Hospital Clínico Universitario Lozano Blesa Zaragoza, Zaragoza, Spain
| | - Albertina Rego
- Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Anne Caroline Benski
- Département de la Femme, de l'Enfant et de l'Adolescent, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Fatimah Hassan-Hanga
- Bayero University Kano, Nigeria; Aminu Kano Teaching Hospital, Kano State, Nigeria
| | - Mónica Savorani
- Hospital de Moron, Moron, Provincia de Buenos Aires, Argentina
| | - Francesca Giuliani
- Neonatal Special Care Unit, Regina Margherita Children Hospital, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Loïc Sentilhes
- Department of Obstetrics and Gynecology Bordeaux University Hospital, Bordeaux, France
| | - Milagros Risso
- Servicio de Neonatologia del Departamento Materno Infantil del Hospital Universitario Austral, Pilar, Provincia de Buenos Aires, Argentina
| | - Ken Takahashi
- Department of Obstetrics and Gynecology, the Jikei University School of Medicine, Tokyo, Japan
| | | | - Satoru Ikenoue
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Cetin
- Department of BioMedical and Clinical Sciences, Ospedale Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | | | - Ernawati Ernawati
- Department of Obstetrics and Gynecology, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia; Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Eduardo A Duro
- Universidad de Buenos Aires, Buenos Aires, Argentina; Universidad de Moron, Moron, Argentina
| | - Alexey Kholin
- National Medical Research Center for Obstetrics, Gynecology & Perinatology, Moscow, Russia
| | - Michelle L Firlit
- Department of Obstetrics and Gynecology, University of Illinois Hospital and Health Science System, Chicago, IL
| | - Sarah Rae Easter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA; Division of Critical Care Medicine, Department of Anesthesia, Perioperative, and Pain Medicine, Harvard Medical School, Boston, MA
| | - Joanna Sichitiu
- Hôpital Universitaire Necker-Enfants Malades, AP-HP, Université de Paris, France
| | | | - Roberto Casale
- Maternal and Child Department, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Rosa Maria Cerbo
- Neonatal Unit and Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Ivo Cavoretto
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - Brenda Eskenazi
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA
| | - Jim G Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Pakistana
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - José Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, United Kingdom
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Cesano N, D'Ambrosi F, Cetera GE, Carbone IF, Di Maso M, Ossola MW, Iurlaro E, Ferrazzi E. Maternity ward management and COVID-19 pandemic: Experience of a single center in Northern Italy during lockdown. Eur J Midwifery 2021; 5:29. [PMID: 34316547 PMCID: PMC8288518 DOI: 10.18332/ejm/137605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The aim of our study is to describe the management of a maternity ward in a referral center during the COVID-19 pandemic and 2020 lockdown. METHODS This is a retrospective single-center study. We analyzed the records of all women consecutively admitted to our delivery ward during lockdown and compared them with those of women admitted in the same period in 2019. RESULTS The number of patients (1260) admitted to our department in 2020 was similar (1215) to that in 2019. Among patients admitted during lockdown, 50 presented with a Sars-CoV-2 infection (3.9%). In 2020, the number of antenatal check-ups was lower than in 2019 [7.9 (1.5) vs 8.2 (1.3), p<0.001] and the rate of labor inductions was higher [436 (34.6) vs 378 (31.1), p=0.008] although no difference in delivery mode was found. Moreover, women admitted during lockdown were more likely to give birth alone [140 (11.1) vs 50 (4.1), p<0.001]. However, during 2020, the rate of mother and newborn skinto-skin contact [1036 (82.2) vs 897 (73.8), p<0.001] and that of breastfeeding within 2 hours from birth [1003 (79.6) vs 830 (68.3), p<0.001] was higher. We found no significant differences in maternal or neonatal outcomes. CONCLUSIONS Despite the COVID-19 pandemic, we were able to guarantee a safe birth assistance to all pregnant women, both for those infected and those not infected by Sars-CoV-2.
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Affiliation(s)
- Nicola Cesano
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Co-first authors
| | - Francesco D'Ambrosi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Co-first authors
| | - Giulia E Cetera
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilma F Carbone
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Di Maso
- Branch of Medical Statistics, Biometry and Epidemiology 'G.A. Maccacaro', Department of Clinical Sciences and Community Health, Faculty of Medicine, University of Milan, Milan, Italy
| | - Manuela W Ossola
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Iurlaro
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Faculty of Medicine, University of Milan, Milan, Italy
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Ruggiero M, Somigliana E, Tassis B, Li Piani L, Uceda Renteria S, Barbara G, Lunghi G, Pietrasanta C, Ferrazzi E. Clinical relevance of SARS-CoV-2 infection in late pregnancy. BMC Pregnancy Childbirth 2021; 21:505. [PMID: 34253173 PMCID: PMC8273567 DOI: 10.1186/s12884-021-03985-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Evidence on the outcome of SARS-CoV-2 infection in pregnancy is generally reassuring but yet not definitive. METHODS To specifically assess the impact of SARS-CoV-2 infection in late pregnancy, we prospectively recruited 315 consecutive women delivering in a referral hospital located in Lombardy, Italy in the early phase of the epidemic. Restriction of the recruitment to this peculiar historical time period allowed to exclude infections occurring early in pregnancy and to limit the recall bias. All recruited subjects underwent a nasopharyngeal swab to assess the presence of Sars-Cov-2 using Real-time PCR. In addition, two different types of antibodies for the virus were evaluated in peripheral blood, those against the spike proteins S1 and S2 of the envelope and those against the nucleoprotein of the nucleocapsid. Women were considered to have had SARS-CoV-2 infection in pregnancy if at least one of the three assessments was positive. RESULTS Overall, 28 women had a diagnosis of SARS-CoV-2 infection in pregnancy (8.9%). Women diagnosed with the infection were more likely to report one or more episodes of symptoms suggestive for Covid-19 (n = 11, 39.3%) compared to unaffected women (n = 39, 13.6%). The corresponding OR was 4.11 (95%CI: 1.79-9.44). Symptoms significantly associated with Covid-19 in pregnancy included fever, cough, dyspnea and anosmia. Only one woman necessitated intensive care. Pregnancy outcome in women with and without SARS-CoV-2 infection did not also differ. CONCLUSIONS SARS-CoV-2 infection is asymptomatic in three out of five women in late pregnancy and is rarely severe. In addition, pregnancy outcome may not be markedly affected.
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Affiliation(s)
- Marta Ruggiero
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Via M. Fanti, 6, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Edgardo Somigliana
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Via M. Fanti, 6, 20122, Milan, Italy.
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy.
| | - Beatrice Tassis
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Via M. Fanti, 6, 20122, Milan, Italy
| | - Letizia Li Piani
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Via M. Fanti, 6, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Sara Uceda Renteria
- Virology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Giussy Barbara
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Via M. Fanti, 6, 20122, Milan, Italy
| | - Giovanna Lunghi
- Virology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Carlo Pietrasanta
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
- Neonatal Intensive Care Unit (NICU), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Milan, Italy
| | - Enrico Ferrazzi
- Department of Woman, New-Born and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mangiagalli Centre, Via M. Fanti, 6, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
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Pregnolato F, Gerosa M, Raimondo MG, Comerio C, Bartoli F, Lonati PA, Borghi MO, Acaia B, Ossola MW, Ferrazzi E, Trespidi L, Meroni PL, Chighizola CB. EUREKA algorithm predicts obstetric risk and response to treatment in women with different subsets of anti-phospholipid antibodies. Rheumatology (Oxford) 2021; 60:1114-1124. [PMID: 32441742 DOI: 10.1093/rheumatology/keaa203] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 02/03/2020] [Revised: 03/30/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES aPL, the serum biomarkers of APS, are the most common acquired causes of pregnancy morbidity (PM). This study investigates the impact of aPL positivity fulfilling classification criteria ('criteria aPL') and at titres lower than thresholds considered by classification criteria ('low-titre aPL') on PM and assesses the effectiveness of low-dose aspirin (LDASA), low molecular weight heparin (LMWH) and HCQ in reducing the probability of PM (PPM). METHODS Longitudinal data on 847 pregnancies in 155 women with persistent aPL at any titre and 226 women with autoimmune diseases and negative aPL were retrospectively collected. A generalized estimating equations model for repeated measures was applied to quantify PPM under different clinical situations. RESULTS EUREKA is a novel algorithm that accurately predicts the risk of aPL-associated PM by considering aPL titres and profiles. aPL significantly impact PPM when at low titres and when fulfilling classification criteria. PPM was further stratified upon the aPL tests: aCL IgG/IgM and anti-β2-glycoprotein I (β2GPI) IgM, alone or combined, do not affect the basal risks of PPM, an increase occurs in case of positive LA or anti-β2GPI IgG. LDASA significantly affects PPM exclusively in women with low-titre aPL without anti-β2GPI IgG. The LDASA + LMWH combination significantly reduces PPM in all women with low-titre aPL and women with criteria aPL, except those carrying LA and anti-β2GPI IgG. In this group, the addition of HCQ further reduces PPM, although not significantly. CONCLUSION EUREKA allows a tailored therapeutic approach, impacting everyday clinical management of aPL-positive pregnant women.
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Affiliation(s)
- Francesca Pregnolato
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Division of Rheumatology, ASST G. Pini & CTO, Milan, Italy
| | - Maria Gabriella Raimondo
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Division of Rheumatology, ASST G. Pini & CTO, Milan, Italy
| | - Chiara Comerio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Bartoli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Division of Rheumatology, ASST G. Pini & CTO, Milan, Italy
| | - Paola A Lonati
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy
| | - Maria Orietta Borghi
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Barbara Acaia
- Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Manuela Wally Ossola
- Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Trespidi
- Department of Obstetrics and Gynaecology, Fondazione Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Pier Luigi Meroni
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy.,Immunology and Rheumatology Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Cecilia B Chighizola
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy.,Immunology and Rheumatology Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
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Donati S, Corsi E, Salvatore MA, Maraschini A, Bonassisa S, Casucci P, Cataneo I, Cetin I, D’Aloja P, Dardanoni G, De Ambrosi E, Ferrazzi E, Fieni S, Franchi MP, Gargantini G, Iurlaro E, Leo L, Liberati M, Livio S, Locci M, Marozio L, Martini C, Maso G, Mecacci F, Meloni A, Mignuoli AD, Patanè L, Pellegrini E, Perotti F, Perrone E, Prefumo F, Ramenghi L, Rusciani R, Savasi V, Schettini SCA, Simeone D, Simeone S, Spinillo A, Steinkasserer M, Tateo S, Ternelli G, Tironi R, Trojano V, Vergani P, Zullino S. Childbirth Care among SARS-CoV-2 Positive Women in Italy. Int J Environ Res Public Health 2021; 18:ijerph18084244. [PMID: 33923642 PMCID: PMC8074190 DOI: 10.3390/ijerph18084244] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022]
Abstract
The new coronavirus emergency spread to Italy when little was known about the infection’s impact on mothers and newborns. This study aims to describe the extent to which clinical practice has protected childbirth physiology and preserved the mother–child bond during the first wave of the pandemic in Italy. A national population-based prospective cohort study was performed enrolling women with confirmed SARS-CoV-2 infection admitted for childbirth to any Italian hospital from 25 February to 31 July 2020. All cases were prospectively notified, and information on peripartum care (mother–newborn separation, skin-to-skin contact, breastfeeding, and rooming-in) and maternal and perinatal outcomes were collected in a structured form and entered in a web-based secure system. The paper describes a cohort of 525 SARS-CoV-2 positive women who gave birth. At hospital admission, 44.8% of the cohort was asymptomatic. At delivery, 51.9% of the mothers had a birth support person in the delivery room; the average caesarean section rate of 33.7% remained stable compared to the national figure. On average, 39.0% of mothers were separated from their newborns at birth, 26.6% practised skin-to-skin, 72.1% roomed in with their babies, and 79.6% of the infants received their mother’s milk. The infants separated and not separated from their SARS-CoV-2 positive mothers both had good outcomes. At the beginning of the pandemic, childbirth raised awareness and concern due to limited available evidence and led to “better safe than sorry” care choices. An improvement of the peripartum care indicators was observed over time.
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Affiliation(s)
- Serena Donati
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (A.M.); (P.D.)
- Correspondence: ; Tel.: +39-0649904318
| | - Edoardo Corsi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Montpellier 1, 00133 Rome, Italy;
| | - Michele Antonio Salvatore
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (A.M.); (P.D.)
| | - Alice Maraschini
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (A.M.); (P.D.)
| | - Silvia Bonassisa
- Department of Obstetrics and Gynecology, University Hospital Maggiore della Carità, 28100 Novara, Italy;
| | - Paola Casucci
- Sistema Informativo e Mobilità Sanitaria, Umbria Region, 06121 Perugia, Italy;
| | - Ilaria Cataneo
- Department of Obstetrics and Gynecology, Ospedale Maggiore, 40133 Bologna, Italy;
| | - Irene Cetin
- Unit of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20154 Milan, Italy; (I.C.); (S.L.)
| | - Paola D’Aloja
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità-Viale Regina Elena 299, 00161 Rome, Italy; (M.A.S.); (A.M.); (P.D.)
| | - Gabriella Dardanoni
- Osservatorio Epidemiologico Assessorato Salute Regione Siciliana, Sicily Region, 90145 Palermo, Italy;
| | | | - Enrico Ferrazzi
- Unit of Obstetrics, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 55031 Milan, Italy; (E.F.); (E.I.)
| | - Stefania Fieni
- Department of Obstetrics and Gynecology, University Hospital of Parma, 43126 Parma, Italy;
| | | | - Gianluigi Gargantini
- Maternal and Child Committee—Lombardy Region, 20124 Milan, Italy; (G.G.); (E.P.)
| | - Enrico Iurlaro
- Unit of Obstetrics, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 55031 Milan, Italy; (E.F.); (E.I.)
| | - Livio Leo
- Hospital “Beauregard” Valle D’Aosta, 11100 Aosta, Italy;
| | - Marco Liberati
- D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Stefania Livio
- Unit of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Department of Biomedical and Clinical Sciences, University of Milan, 20154 Milan, Italy; (I.C.); (S.L.)
| | | | - Luca Marozio
- Department of Obstetrics and Gynecology, University of Turin, 10124 Turin, Italy;
| | - Claudio Martini
- Territorio e Integrazione Ospedale Territorio, Marche Region, 60122 Ancona, Italy;
| | - Gianpaolo Maso
- Obstetrics and Gynecology, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy;
| | - Federico Mecacci
- Department of Biomedical, Division of Obstetrics and Gynecology, Experimental and Clinical Sciences, University of Florence, 50134 Florence, Italy;
| | - Alessandra Meloni
- Maternal and Neonatal Department, Azienda Ospedaliero Universitaria, 09042 Cagliari, Italy;
| | - Anna Domenica Mignuoli
- Dipartimento Regionale Tutela della Salute, Calabria Region, 88100 Reggio Calabria, Italy;
| | - Luisa Patanè
- Department of Obstetrics and Gynecology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy;
| | - Edda Pellegrini
- Maternal and Child Committee—Lombardy Region, 20124 Milan, Italy; (G.G.); (E.P.)
| | - Francesca Perotti
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo Foundation, University of Pavia, 27100 Pavia, Italy; (F.P.); (A.S.)
| | - Enrica Perrone
- Servizio Assistenza Territoriale, Direzione Generale Cura Della Persona, Salute e Welfare, Emilia-Romagna Region, 40127 Bologna, Italy;
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, ASST Spedali Civili, University of Brescia, 25123 Brescia, Italy;
| | - Luca Ramenghi
- Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Raffaella Rusciani
- Department of Epidemiology, ASL TO3 Piedmont Region, 10095 Turin, Italy;
| | - Valeria Savasi
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, University of Milan, 20157 Milan, Italy;
| | | | - Daniela Simeone
- Ospedale Civile Antonio Cardarelli, 86100 Campobasso, Italy;
| | - Serena Simeone
- Department of Woman and Child’s Health, Careggi University Hospital, 50141 Florence, Italy;
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Policlinico San Matteo Foundation, University of Pavia, 27100 Pavia, Italy; (F.P.); (A.S.)
| | - Martin Steinkasserer
- Central Teaching Hospital of Bozen, Division of Gynecology and Obstetrics, 39100 Bozen, Italy;
| | | | - Giliana Ternelli
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | | | | | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation/San Gerardo Hospital, University of Milan–Bicocca, 20900 Monza, Italy;
| | - Sara Zullino
- Department of Experimental and Clinical Medicine, Division of Obstetrics and Gynecology, University of Pisa, 56126 Pisa, Italy;
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Stampalija T, Quadrifoglio M, Casati D, Zullino S, Maggi V, Di Martino D, Rosti E, Mastroianni C, Signorelli V, Ferrazzi E. First trimester placental volume is reduced in hypertensive disorders of pregnancy associated with small for gestational age fetus. J Matern Fetal Neonatal Med 2021; 34:1304-1311. [PMID: 31232131 DOI: 10.1080/14767058.2019.1636026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Trophoblastic invasion and placental growth are critical for pregnancy outcome. The placental volume can be assessed by 3 D ultrasound using Virtual Organ Computer-aided Analysis (VOCAL). Epidemiological and clinical data suggest that there are two different clinical phenotypes of hypertensive disorders of pregnancy (HDP) that coexist at any gestational age: HDP associated to fetal growth impairment and HDP associated to appropriate for gestational age fetal growth. The aim of this study was to determine whether placental volume in the first trimester of pregnancy differs between women with HDP associated or not to fetal growth impairment and uncomplicated pregnancies. METHODS This is a retrospective cross-sectional study of prospectively recruited data in which maternal characteristics, Doppler velocimetry of uterine arteries, and three-dimensional (3 D) volume of the placenta were collected at 11 + 1 - 13 + 6 gestational weeks. The placental quotient (PQ) was calculated as placental volume/crown rump length. RESULTS In a 2-year period, we prospectively collected first trimester data of 1322 women. For the purposes of this cross-sectional study, 57 women that delivered a SGA fetus, 34 that developed HDP-AGA, and six that developed HDP-SGA, respectively, were included in the study as cases. The control group was made of 117 uncomplicated pregnancies. The PQ was higher in women with uncomplicated pregnancies (PQ median 16.36 cm3/cm) than in all other study groups (PQ in SGA: 13.02 cm3/cm, p < .001; PQ in HDP-AGA: 12.65 cm3/cm, p = .002; and PQ in women with HDP-SGA: 8.33 cm3/cm [IQR 6.50-10.13], p < .001). The lowest PQ was observed in women with HDP-SGA and was significantly lower than PQ in either women with SGA or those with HDP-AGA (p = .02 and p = .04, respectively). The mean uterine artery pulsatility index was the highest in women with HDP-SGA (median 2.30) compared to all other groups (uncomplicated pregnancies 1.48, p < .0001; women with SGA 1.59, p = .001; and women with HDP-AGA 1.75, p = .009). DISCUSSION Our findings suggest that HDP associated with SGA is characterized by impaired placental growth and perfusion as soon as in the first trimester of pregnancy. The role of PQ, isolated or in association with other biophysical parameters, to predict HDP with fetal growth impairment remains to be evaluated.
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Affiliation(s)
- Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Mariachiara Quadrifoglio
- Unit of Fetal Medicine and Prenatal Diagnosis, IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Daniela Casati
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Sara Zullino
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Valeria Maggi
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Daniela Di Martino
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Eleonora Rosti
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Cristina Mastroianni
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Valentina Signorelli
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Enrico Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Cribiù FM, Erra R, Pugni L, Rubio-Perez C, Alonso L, Simonetti S, Croci GA, Serna G, Ronchi A, Pietrasanta C, Lunghi G, Fagnani AM, Piñana M, Matter M, Tzankov A, Terracciano L, Anton A, Ferrazzi E, Ferrero S, Iurlaro E, Seoane J, Nuciforo P. Severe SARS-CoV-2 placenta infection can impact neonatal outcome in the absence of vertical transmission. J Clin Invest 2021; 131:145427. [PMID: 33497369 DOI: 10.1172/jci145427] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 10/23/2020] [Accepted: 01/20/2021] [Indexed: 12/18/2022] Open
Abstract
The effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the pathophysiology of the placenta and its impact on pregnancy outcome has not yet been fully elucidated. Here, we present a comprehensive clinical, morphological, and molecular analysis of placental tissues from pregnant women with and without SARS-CoV-2 infection. SARS-CoV-2 could be detected in half of placental tissues from SARS-CoV-2-positive women. The presence of the virus was not associated with any distinctive pathological, maternal, or neonatal outcome features. SARS-CoV-2 tissue load was low in all but one patient who exhibited severe placental damage leading to neonatal neurological manifestations. The placental transcriptional response induced by high viral load of SARS-CoV-2 showed an immunopathology phenotype similar to autopsy lung tissues from patients with severe coronavirus disease 2019. This finding contrasted with the lack of inflammatory response in placental tissues from SARS-CoV-2-positive women with low viral tissue load and from SARS-CoV-2-negative women. Importantly, no evidence of vertical transmission of SARS-CoV-2 was found in any newborns, suggesting that the placenta may be an effective maternal-neonatal barrier against the virus even in the presence of severe infection. Our observations suggest that severe placental damage induced by the virus may be detrimental for the neonate independently of vertical transmission.
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Affiliation(s)
| | - Roberta Erra
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenza Pugni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Lidia Alonso
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | - Garazi Serna
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Andrea Ronchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Pietrasanta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Lunghi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Maria Piñana
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain
| | | | | | | | - Andres Anton
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Enrico Ferrazzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Ferrero
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Iurlaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Joan Seoane
- Vall d'Hebron Institute of Oncology, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Universitat Autonoma de Barcelona (UAB), CIBERONC, Barcelona, Spain
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Fratelli N, Prefumo F, Wolf H, Hecher K, Visser GHA, Giussani D, Derks JB, Shaw CJ, Frusca T, Ghi T, Ferrazzi E, Lees CC. Effects of Antenatal Betamethasone on Fetal Doppler Indices and Short Term Fetal Heart Rate Variation in Early Growth Restricted Fetuses. Ultraschall Med 2021; 42:56-64. [PMID: 31476786 DOI: 10.1055/a-0972-1098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To investigate the effects of the antenatal administration of betamethasone on fetal Doppler and short term fetal heart rate variation (CTG-STV) in early growth restricted (FGR) fetuses. MATERIALS AND METHODS Post hoc analysis of data derived from the TRUFFLE study, a prospective, multicenter, randomized management trial of severe early onset FGR. Repeat Doppler and CTG-STV measurements between the last recording within 48 hours before the first dose of betamethasone (baseline value) and for 10 days after were evaluated. Multilevel analysis was performed to analyze the longitudinal course of the umbilico-cerebral ratio (UC ratio), the ductus venosus pulsatility index (DVPIV) and CTG-STV. RESULTS We included 115 fetuses. A significant increase from baseline in CTG-STV was found on day + 1 (p = 0.019) but no difference thereafter. The DVPIV was not significantly different from baseline in any of the 10 days following the first dose of betamethasone (p = 0.167). Multilevel analysis revealed that, over 10 days, the time elapsed from antenatal administration of betamethasone was significantly associated with a decrease in CTG-STV (p = 0.045) and an increase in the DVPIV (p = 0.001) and UC ratio (p < 0.001). CONCLUSION Although steroid administration in early FGR has a minimal effect on increasing CTG-STV one day afterwards, the effects on Doppler parameters were extremely slight with regression coefficients of small magnitude suggesting no clinical significance, and were most likely related to the deterioration with time in FGR. Hence, arterial and venous Doppler assessment of fetal health remains informative following antenatal steroid administration to accelerate fetal lung maturation.
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Affiliation(s)
- Nicola Fratelli
- Department of Obstetrics and Gynaecology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Hans Wolf
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, Netherlands
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center, Hamburg-Eppendorf, Germany
| | - Gerard H A Visser
- Department of Perinatal Medicine, University of Utrecht, Netherlands
| | - Dino Giussani
- Department of Physiology Development & Neuroscience, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Jan B Derks
- Department of Perinatal Medicine, University of Utrecht, Netherlands
| | - Caroline J Shaw
- Department of Surgery and Cancer, Imperial College London, United Kingdom of Great Britain and Northern Ireland
| | - Tiziana Frusca
- Department of Surgical Sciences, Obstetrics and Gynecology Unit, University of Parma, Italy
| | - Tullio Ghi
- Department of Surgical Sciences, Obstetrics and Gynecology Unit, University of Parma, Italy
| | - E Ferrazzi
- Children's Hospital Buzzi, University of Milan, Italy
| | - Christoph C Lees
- Department of Surgery and Cancer, Imperial College London, United Kingdom of Great Britain and Northern Ireland
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Di Martino D, Chiaffarino F, Patanè L, Prefumo F, Vergani P, Ornaghi S, Savasi V, Spinillo A, Cromi A, D’Ambrosi F, Tassis B, Iurlaro E, Parazzini F, Ferrazzi E. Assessing risk factors for severe forms of COVID-19 in a pregnant population: A clinical series from Lombardy, Italy. Int J Gynaecol Obstet 2021; 152:275-277. [PMID: 33098568 PMCID: PMC9087617 DOI: 10.1002/ijgo.13435] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/21/2020] [Indexed: 01/16/2023]
Abstract
In 250 pregnant women with either asymptomatic, non‐severe, or severe SARS‐CoV‐2 infection, obesity turned out to be the main determinant of severe COVID‐19 illness.
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Affiliation(s)
- Daniela Di Martino
- Department of Mother, Child and NeonateFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Francesca Chiaffarino
- Department of Mother, Child and NeonateFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Luisa Patanè
- Department of Obstetrics and GynecologyPapa Giovanni XXIII HospitalBergamoItaly
| | - Federico Prefumo
- Division of Obstetrics and GynaecologyASST Spedali CiviliBresciaItaly
- Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - Patrizia Vergani
- Department of Maternal Fetal MedicineFondazione MBBMSan Gerardo HospitalMonzaItaly
- University of Milano BicoccaMonzaItaly
| | - Sara Ornaghi
- Department of Maternal Fetal MedicineFondazione MBBMSan Gerardo HospitalMonzaItaly
- University of Milano BicoccaMonzaItaly
| | - Valeria Savasi
- Department of Woman, Mother and NeonateSacco Hospital‐ASST‐Fatebenefratelli‐SaccoMilanItaly
- Department of Clinical and Biological SciencesUniversity of MilanMilanItaly
| | - Arsenio Spinillo
- Department of Obstetrics and GynecologyIRCCS Foundation Policlinico San MatteoUniversity of PaviaPaviaItaly
| | - Antonella Cromi
- Department of Obstetrics and GynecologyUniversity of InsubriaVareseItaly
| | - Francesco D’Ambrosi
- Department of Mother, Child and NeonateFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Beatrice Tassis
- Department of Mother, Child and NeonateFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Enrico Iurlaro
- Department of Mother, Child and NeonateFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Fabio Parazzini
- Department of Mother, Child and NeonateFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
| | - Enrico Ferrazzi
- Department of Mother, Child and NeonateFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
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43
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D'Ambrosi F, Rossi G, Soldavini CM, Maggi V, Cetera GE, Carbone IF, Di Martino D, Di Maso M, Ferrazzi E. Management of gestational diabetes in women with a concurrent severe acute respiratory syndrome coronavirus 2 infection, experience of a single center in Northern Italy. Int J Gynaecol Obstet 2020; 152:335-338. [PMID: 33099770 PMCID: PMC9087777 DOI: 10.1002/ijgo.13434] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/12/2020] [Accepted: 10/22/2020] [Indexed: 01/10/2023]
Abstract
Objective In this study we describe the management of women with gestational diabetes (GD) and an ongoing severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. The aim of the study is to evaluate whether coronavirus disease 2019 (COVID‐19) can further complicate pregnancies, and if the protocol we usually use for GD pregnancies is also applicable to patients who have contracted a SARS‐CoV‐2 infection. Methods This is a retrospective study analyzing all pregnant women with GD and concomitant COVID‐19 admitted to our institution for antenatal care between March 1 and April 30, 2020. Results Among pregnant women with GD and a concomitant SARS‐CoV‐2 infection, the mean age was 32.9 (SD 5.6) years. Two patients (33%) were of white racial origin and four (67%) were of non‐white racial origin. All patients were diagnosed with COVID‐19 during the third trimester of pregnancy. Two women were asymptomatic and four were symptomatic. Only two (33.3%) women received treatment with insulin. None of the patients required intensive care or mechanical ventilation. No complications were found among the neonates. Conclusion COVID‐19 was not found to worsen the prognosis of patients with GD or of their offspring. Glycemic monitoring, diet therapy, and insulin, when needed, are sufficient for good metabolic control and favorable maternal and fetal outcomes.
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Affiliation(s)
- Francesco D'Ambrosi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriele Rossi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Maria Soldavini
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Maggi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Emily Cetera
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilma Floriana Carbone
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Di Martino
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Di Maso
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Enrico Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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44
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Ciavarella A, Erra R, Abbattista M, Iurlaro E, Boscolo-Anzoletti M, Ossola MW, Mosca F, Ferrazzi E, Peyvandi F, Martinelli I. Hemostasis in pregnant women with COVID-19. Int J Gynaecol Obstet 2020; 152:268-269. [PMID: 33245783 PMCID: PMC9087779 DOI: 10.1002/ijgo.13499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 12/04/2022]
Abstract
Coagulation parameters investigated in this pilot study were similar in pregnant women with COVID‐19 who were asymptomatic or had mild symptoms, and in pregnant women without COVID‐19 infection.
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Affiliation(s)
- Alessandro Ciavarella
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberta Erra
- Unit of Obstetrics, Department of Mother Neonate and Child, Mangiagalli Centre, Fondazione IRCCS Ca, Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Abbattista
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Iurlaro
- Unit of Obstetrics, Department of Mother Neonate and Child, Mangiagalli Centre, Fondazione IRCCS Ca, Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Boscolo-Anzoletti
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Manuela Wally Ossola
- Unit of Obstetrics, Department of Mother Neonate and Child, Mangiagalli Centre, Fondazione IRCCS Ca, Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca, Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Unit of Obstetrics, Department of Mother Neonate and Child, Mangiagalli Centre, Fondazione IRCCS Ca, Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Flora Peyvandi
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Ida Martinelli
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
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45
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Pietrasanta C, Pugni L, Ronchi A, Schena F, Davanzo R, Gargantini G, Ferrazzi E, Mosca F. Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context. J Neonatal Perinatal Med 2020; 13:307-311. [PMID: 32444569 PMCID: PMC7592681 DOI: 10.3233/npm-200478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the context of SARS-CoV-2 pandemic, the hospital management of mother-infant pairs poses to obstetricians and neonatologists previously unmet challenges. In Lombardy, Northern Italy, 59 maternity wards networked to organise the medical assistance of mothers and neonates with suspected or confirmed SARS-CoV-2 infection. Six “COVID-19 maternity centres” were identified, the architecture and activity of obstetric and neonatal wards of each centre was reorganised, and common assistance protocols for the management of suspected and proven cases were formulated. Here, we present the key features of this reorganization effort, and our current management of the mother-infant dyad before and after birth, including our approach to rooming-in practice, breastfeeding and neonatal follow-up, based on the currently available scientific evidence. Considered the rapid diffusion of COVID-19 all over the world, we believe that preparedness is fundamental to assist mother-infant dyads, minimising the risk of propagation of the infection through maternity and neonatal wards.
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Affiliation(s)
- C Pietrasanta
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - L Pugni
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Ronchi
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Schena
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - R Davanzo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.,Technical Panel on Breastfeeding, Ministry of Health, Rome, Italy
| | - G Gargantini
- Direzione Generale Welfare, Regione Lombardia, Milan, Italy
| | - E Ferrazzi
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy.,Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Obstetrical Unit - Mangiagalli Center. Via della Commenda, Milan, Italy (EU)
| | - F Mosca
- NICU, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
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46
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Lees CC, Stampalija T, Baschat A, da Silva Costa F, Ferrazzi E, Figueras F, Hecher K, Kingdom J, Poon LC, Salomon LJ, Unterscheider J. ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol 2020; 56:298-312. [PMID: 32738107 DOI: 10.1002/uog.22134] [Citation(s) in RCA: 299] [Impact Index Per Article: 74.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Affiliation(s)
- C C Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | - T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - A Baschat
- The Johns Hopkins Center for Fetal Therapy, Baltimore, MD, USA
| | - F da Silva Costa
- Ritchie Centre, Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Victoria, Australia
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - E Ferrazzi
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - F Figueras
- Fetal Medicine Research Center, BCNatal Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetricia i Neonatologia, University of Barcelona, Barcelona, Spain
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- J. Kingdom, Placenta Program, Maternal-Fetal Medicine Division, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - L C Poon
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong SAR
| | - L J Salomon
- Obstétrique et Plateforme LUMIERE, Hôpital Necker-Enfants Malades (AP-HP) et Université de Paris, Paris, France
| | - J Unterscheider
- Department of Maternal Fetal Medicine, Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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47
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Stampalija T, Thornton J, Marlow N, Napolitano R, Bhide A, Pickles T, Bilardo CM, Gordijn SJ, Gyselaers W, Valensise H, Hecher K, Sande RK, Lindgren P, Bergman E, Arabin B, Breeze AC, Wee L, Ganzevoort W, Richter J, Berger A, Brodszki J, Derks J, Mecacci F, Maruotti GM, Myklestad K, Lobmaier SM, Prefumo F, Klaritsch P, Calda P, Ebbing C, Frusca T, Raio L, Visser GHA, Krofta L, Cetin I, Ferrazzi E, Cesari E, Wolf H, Lees CC. Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study. Ultrasound Obstet Gynecol 2020; 56:173-181. [PMID: 32557921 DOI: 10.1002/uog.22125] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. METHODS This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored. RESULTS The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33 weeks and 1.0 at 34-36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association. CONCLUSION In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - T Pickles
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk and Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - H Valensise
- Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - R K Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - P Lindgren
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - E Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - B Arabin
- Department of Obstetrics Charite, Humboldt University Berlin and Clara Angela Foundation, Berlin, Germany
| | - A C Breeze
- Fetal Medicine Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - L Wee
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - J Richter
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - A Berger
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Brodszki
- Department of Pediatric Surgery and Neonatology, Lund University, Skane University Hospital, Lund, Sweden
| | - J Derks
- Department of Perinatal Medicine, University of Utrecht, Utrecht, The Netherlands
| | - F Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - G M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples 'Federico II', Naples, Italy
| | | | - S M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - F Prefumo
- Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - P Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - L Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - G H A Visser
- Department of Obstetrics, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Krofta
- Institute for the Care of Mother and Child, Prague, Czech Republic and Third Medical Faculty, Charles University, Prague, Czech Republic
| | - I Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - E Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - H Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - C C Lees
- Imperial College School of Medicine, Imperial College London and Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS trust, London, UK
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48
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Ferrazzi E, Beretta P, Bianchi S, Cetin I, Guarnerio P, Locatelli A, Marconi AM, Meroni MG, Pavone G, Pintucci A, Prefumo F, Savasi V, Spinillo A, Tassis B, Vergani P, Vignali M, Parazzini F, La Vecchia C. SARS-CoV-2 infection testing at delivery: a clinical and epidemiological priority. J Matern Fetal Neonatal Med 2020; 35:2417-2419. [PMID: 32660281 DOI: 10.1080/14767058.2020.1788532] [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: 12/28/2022]
Abstract
BACKGROUND Universal testing has been suggested as a useful strategy for a safe exit from the total lockdown, without recurrence of COVID-19 epidemic, delivering women being considered a sentinel population. Further universal testing for pregnant women may be useful in order to define appropriate access to COVID19 areas, dedicated neonatal care, and personal protective equipment. METHODS During the period 10-26 April, all consecutive women admitted for delivery at the Maternity Hospitals of the city of Milan and in six provinces of Lombardy: Brescia, Como, Lecco Monza, Pavia, and Sondrio. areas were tested with nasopharyngeal swabs. Results and conclusion: Out of 1566 women, 49 were tested positive for SARS-Cov-2 (3.1%, 95% Confidence Interval (CI) 2.3-4.0). This value is largely higher than Heath Authorities estimate. Of tested positive women, 22 (44.9%) had symptoms or reported close contacts with positive patients, that is were found at risk by the itemized questionnaire. In conclusion, routine estimate of frequency of positivity among delivering women can be consider a useful methods to monitor positivity at least in females in their fertile ages.
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Affiliation(s)
- Enrico Ferrazzi
- Department of Mother, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Beretta
- Department of Obstetrics and Gynecology, Sant'Anna Hospital-ASST Lariana, Como, Italy
| | - Stefano Bianchi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Irene Cetin
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital-ASST Fatebenefratelli-Sacco Milan, Milan, Italy.,Department of Clinical and Biological Sciences, University of Milan, Milan, Italy
| | - Paolo Guarnerio
- Obstetrics and Gynecology Unit, San Carlo Hospital-ASST Santi Paolo and Carlo, Milan, Italy
| | - Anna Locatelli
- Department of Mother and Child, ASST Vimercate, Vimercate, Italy.,School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Anna Maria Marconi
- Department of Obstetrics and Gynecology, San Paolo Hospital- ASST Santi Paolo and Carlo, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Giulia Pavone
- Department of Obstetrics and Gynecology, Lecco Hospital, Lecco, Italy
| | - Armando Pintucci
- Obstetrics and Gynecology Unit, Desio Hospital-ASST San Gerardo, Monza, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynecology, Spedali Civili di Brescia, Brescia, Italy.,Department of Clinical and Experimental Science, University of Brescia, Italy
| | - Valeria Savasi
- Department of Clinical and Biological Sciences, University of Milan, Milan, Italy.,Department of Woman, Mother and Neonate, Sacco Hospital-ASST Fatebenefratelli-Sacco Milan, Milan, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, University of Pavia, Pavia, Italy.,Department of Woman and Child Health, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Beatrice Tassis
- Department of Mother, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Patrizia Vergani
- School of Medicine and Surgery, University of Milano Bicocca, Monza, Italy.,Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Michele Vignali
- Obstetrics and Gynecology Unit, P.O. Macedonio Melloni-ASST Fatebenefratelli-Sacco, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Fabio Parazzini
- Department of Mother, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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49
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D'Ambrosi F, Ronzoni L, Villa R, De Marinis S, Cetera GE, Soldavini CM, Ferrazzi E. Ultrasound 2-D and 3-D diagnosis of Rubinstein-Taybi syndrome in a 21-week-old fetus. J Ultrasound 2020; 25:301-304. [PMID: 32557407 DOI: 10.1007/s40477-020-00491-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/01/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022] Open
Abstract
Rubinstein-Taybi syndrome is a rare genetic multisystem disorder with an estimated prevalence between 1 per 100,000-125,000 live births. Diagnosis is usually clinical and subsequent to birth. In fact, the rarity of the syndrome and the presence of aspecific morphologic anomalies make prenatal diagnosis challenging. The aim of our work is to analyze ultrasonographic findings, detectable with a combination of 2D and 3D techniques, which may increase the sensitivity of in utero diagnosis of this condition. We report a case of a sonographic prenatal diagnosis of broad and angulated thumbs and halluces and of an abnormal ductus venosus at 21 weeks of gestational age. These findings allowed us to suspect Rubinstein-Taybi syndrome. An accurate ultrasonographic examination may allow a prenatal diagnosis of those syndromes which are usually diagnosed after birth.
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Affiliation(s)
- Francesco D'Ambrosi
- Department of Obstetrics and Gynecology "L. Mangiagalli", Fondazione IRCCS "Ca' Granda"- Ospedale Maggiore Policlinico, Milan, Italy.
| | - Luisa Ronzoni
- Department of Medical Genetic Unit "L. Mangiagalli", Fondazione IRCCS "Ca' Granda"- Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberta Villa
- Department of Medical Genetic Unit "L. Mangiagalli", Fondazione IRCCS "Ca' Granda"- Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano De Marinis
- Department of Obstetrics and Gynecology "L. Mangiagalli", Fondazione IRCCS "Ca' Granda"- Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Emily Cetera
- Department of Obstetrics and Gynecology "L. Mangiagalli", Fondazione IRCCS "Ca' Granda"- Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Maria Soldavini
- Department of Obstetrics and Gynecology "L. Mangiagalli", Fondazione IRCCS "Ca' Granda"- Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Ferrazzi
- Department of Obstetrics and Gynecology "L. Mangiagalli", Fondazione IRCCS "Ca' Granda"- Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, EU, Italy
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50
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Ferrazzi E, Tiso G, Di Martino D. Folic acid versus 5- methyl tetrahydrofolate supplementation in pregnancy. Eur J Obstet Gynecol Reprod Biol 2020; 253:312-319. [PMID: 32868164 DOI: 10.1016/j.ejogrb.2020.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Abstract
Folate (vitamin B9) is widely accepted to protect against fetal neural tube defects. The main sources of dietary folate are folic acid-fortified foods and folic acid-containing dietary supplements. However, folic acid is inactive in the human body and must be converted by the liver into the active molecule 5-methyltetrahydrofolate (5-MTHF). 5-MTHF functions as a methyl donor in many metabolic reactions, including the conversion of homocysteine into methionine, the biosynthesis of glycine from serine, and the biosynthesis of DNA precursor molecules. Therefore, folate is fundamental for growth, especially in the embryonic and fetal stages. Prescription of folic acid to women in the preconception period and during pregnancy is a consolidated practice. However, it can pose health risks in certain conditions, such as megaloblastic anemia, where it will conceal megaloblastic anemia due to vitamin B12 deficiency and in cases of reduced hepatic transformation of folic acid (e.g. due to genetic variants or during some pharmacotherapies). Some of these risks can be avoided by supplementation with 5-MTHF rather than folic acid. Because 5-MTHF does not require activation, it is immediately available to mother and fetus and does not accumulate in blood like folic acid does in cases of reduced hepatic transformation. This paper reviews the advantages and disadvantages of folate supplementation with folic acid versus 5-MTHF, with a focus on maternal and fetal health.
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Affiliation(s)
- Enrico Ferrazzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Obstertics Unit, Dept of Woman Child and Neonate, Milan, Italy.
| | - Giulia Tiso
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Obstertics Unit, Dept of Woman Child and Neonate, Milan, Italy
| | - Daniela Di Martino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Obstertics Unit, Dept of Woman Child and Neonate, Milan, Italy
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