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Cetera GE, Merli CEM, Facchin F, Barbara G, Caia C, Libutti G, Boero V. "Time is on my side". Disease trajectory of vulvodynia: a systematic review with a narrative synthesis. Arch Gynecol Obstet 2024; 309:1-8. [PMID: 36869940 DOI: 10.1007/s00404-023-06984-z] [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: 10/17/2022] [Accepted: 02/15/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE The aim of this systematic review was to shed light on the disease-trajectory of vulvodynia and identify potential risk factors which may affect such trajectory. METHODS We searched Pubmed to identify articles providing evidence on vulvodynia trajectory (i.e., remission, relapse or persistence rates) with a minimum follow-up of 2 years. A narrative approach was used for data synthesis. RESULTS Four articles were included (total participants: 741 women with vulvodynia; 634 controls). At a 2-year follow-up, 50.6% of women reported remission, remission with relapse was observed in 39.7% and persistence throughout time occurred in 9.6%. A decrease in pain was observed in 71.1% of patients at a 7-year follow-up. Mean pain scores and depressive symptoms resulted lower at 2-year follow-up, whereas sexual function and satisfaction were increased. Factors associated with remission of vulvodynia were greater couple cohesion, decreased reporting of pain after intercourse and lower levels of worst pain. Risk factors for symptom persistence included marriage, more severe pain ratings, depression, pain with partner touch, interstitial cystitis, pain with oral sex, fibromyalgia, older age and anxiety. Recurrence was associated with: longer duration of pain, more severe ratings of the worst pain ever and pain described as provoked. CONCLUSIONS Symptoms of vulvodynia seem to improve over time, regardless of treatment. This finding contains a key message for patients and their physicians, considering the deleterious consequences of vulvodynia on women's lives.
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Affiliation(s)
- G E Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - C E M Merli
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - G Barbara
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C Caia
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Libutti
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Boero
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Cetera GE, Merli CEM, Boero V, Caia C, Vercellini P. Topical estrogens for the treatment of superficial dyspareunia related to genitourinary syndrome of menopause in women with a history of endometriosis: A clinical dilemma. Eur J Obstet Gynecol Reprod Biol 2023; 288:12-17. [PMID: 37421742 DOI: 10.1016/j.ejogrb.2023.06.025] [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: 05/06/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
Estrogen withdrawal, which occurs with the cessation of ovulation, causes genitourinary syndrome of menopause in up to 50-85% of women. Symptoms may profoundly impact quality of life and sexual function, interfering with enjoyment of sex in up to three out of four individuals. Topical estrogens have been found to provide symptom relief with minimal systemic absorption and appear to be superior to systemic therapy as what regards genitourinary symptoms. However, conclusive data on their appropriateness in postmenopausal women with a history of endometriosis is not available and the hypothesis that exogenous estrogen stimulation may reactivate endometriotic foci or even promote their malignant transformation is still open. On the other hand, endometriosis affects around 10% of premenopausal women, many of which may be exposed to an acute hypoestrogenic depletion even before spontaneous menopause occurs. This considered, excluding on principle patients with a history of endometriosis from first-line treatment for vulvovaginal atrophy would mean excluding a considerable percentage of the population from adequate care. More robust evidence is urgently needed in these regards. Meanwhile, it would appear reasonable to tailor the prescription of topical hormones in these patients, taking into account the entity of symptoms and the impact such symptoms have on patients' quality of life, as well as the form of endometriosis and the possible risks hormonal may entail. Moreover, the application of estrogens on the vulva instead of the vagina could be efficacious, while outweighing the possible biological cost of hormonal treatment in women with a history of endometriosis.
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Affiliation(s)
- G E Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C E M Merli
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - V Boero
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Caia
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - P Vercellini
- Gynecology Unit, 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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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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Barbara G, Buggio L, Micci L, Spinelli G, Paiocchi C, Dridi D, Cetera GE, Facchin F, Donati A, Vercellini P, Kustermann A. Sexual violence in adult women and adolescents: a narrative review. Minerva Obstet Gynecol 2022; 74:261-269. [PMID: 35147019 DOI: 10.23736/s2724-606x.22.05071-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sexual violence is a widespread phenomenon, as it has been estimated that about 35.6% of women have experienced some forms of sexual abuse, with variable prevalence estimates worldwide. Sexual violence has remarkable negative consequences on women's health and quality of life, with a specific harmful impact on women's psychological well-being and sexuality. In this narrative review, we provide an overview on the phenomenon of sexual violence against adult women and adolescents, discussing its associated multiple negative consequences with a specific focus on clinical and sexological aspects. ''Women centered care'' and a multidisciplinary approach appear of pivotal importance when working with sexual violence survivors. Woman should be engaged in all the clinical activities as equal partners in the decision-making process, and should be supported by multiple and different professional figures (i.e. gynecologists, psychologists, sexologists, forensic medical doctors, lawyers) working within the framework of a cooperative integrated model.
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Affiliation(s)
- Giussy Barbara
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy - .,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy -
| | - Laura Buggio
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laila Micci
- Gynecological Emergency Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaia Spinelli
- Gynecological Emergency Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Paiocchi
- Gynecological Emergency Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dhouha Dridi
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia E Cetera
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Facchin
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Agnese Donati
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Vercellini
- Gynecological Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessandra Kustermann
- Gynecological Emergency Unit and SVSeD, Service for Sexual and Domestic Violence, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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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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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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Boero V, Liverani CA, Brambilla M, Monti E, Tozzi R, Murina F, Di Loreto E, Cipriani S, Libutti G, Cetera GE, Iorio M, Dell'Acqua A, Parazzini F. The "CIV Classification," a New Proposal for the Architectural Grading of Vulvar Lichen Sclerosus. J Low Genit Tract Dis 2021; 25:291-295. [PMID: 34542084 DOI: 10.1097/lgt.0000000000000627] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this cross-sectional study was to prepare a reliable and easy-to-use architectural classification for vulvar lichen sclerosus (VLS) aimed at defining the morphological patterns of this condition. MATERIALS AND METHODS An expert panel composed by 7 physicians with expertise in clinical care of vulvar conditions outlined the architectural criteria for the definition of VLS severity (phimosis of the clitoris, involvement of the interlabial sulci, narrowing of the vulvar introitus), identifying 5 grades to build up a classification. Thirteen physicians with 2-30 years expertise in vulvar diseases (nonexpert group) were asked to evaluate 3-5 pictures from 137 patients. Each physician individually assigned a grade to each case, according to the previously mentioned criteria. Interrater reliability was analyzed by means of intraclass correlation coefficient (ICC). The reliability concerning the 2 classifications of each rater was analyzed by means of κ statistic. Intraobserver and interobserver reliability in vivo was analyzed by means of κ index. RESULTS This study provides a new classification of VLS, based on defined anatomical criteria and graded into mutually exclusive progressive classes.The ICC analysis showed a substantial interrater reliability of the classification, ICC = 0.89 (0.87-0.91), both in the expert panel and in the nonexpert group (ICC = 0.92 and 0.87, respectively). An "almost perfect" intraobserver and interobserver reliability was achieved among physicians in vivo (κ = 0.93). CONCLUSIONS Our classification showed a high reliability. It is easy to use, and it can be applied in clinical practice and eventually, in the evaluation of regenerative and cosmetic surgery.
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Affiliation(s)
- Veronica Boero
- Gynecology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Massimiliano Brambilla
- Plastic Surgery Service, Gynecology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - Ermelinda Monti
- Gynecology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - Roberto Tozzi
- Department of Gynaecologic Oncology, Nuffield Department of Women's and Reproductive Health (WRH), University of Oxford, Oxford, United Kingdom
| | - Filippo Murina
- Lower Genital Tract Disease Unit, Obstetrics and Gynecology Department, Ospedale Vittore Buzzi, Milano, Italy
| | - Eugenia Di Loreto
- Gynecology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - Sonia Cipriani
- Gynecology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - Giada Libutti
- Gynecology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - Giulia E Cetera
- Gynecology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - Maria Iorio
- Gynecology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Dell'Acqua
- Gynecology Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milano, Italy
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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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D'Ambrosi F, Iurlaro E, Tassis B, Di Maso M, Erra R, Cetera GE, Cesano N, Di Martino D, Ossola MW, Ferrazzi EM. Sociodemographic characteristics of pregnant women tested positive for COVID-19 admitted to a referral center in Northern Italy during lockdown period. J Obstet Gynaecol Res 2021; 47:1751-1756. [PMID: 33650278 PMCID: PMC8013282 DOI: 10.1111/jog.14729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/21/2020] [Revised: 01/23/2021] [Accepted: 02/12/2021] [Indexed: 01/24/2023]
Abstract
INTRODUCTION We investigated association between sociodemographic characteristics and COVID-19 disease among pregnant women admitted to our unit, the largest high-risk maternity unit in the Milan metropolitan area. METHODS Between March 1, 2020 and April 30, 2020, 896 pregnant women were admitted to our Institution and tested for COVID-19. We collected information regarding their sociodemographic characteristics. Additional information on geographical area of residence, number of family members, number of family members tested positive for COVID-19, and clinical data was collected for women tested positive for COVID-19. Odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of developing COVID-19 according to sociodemographic characteristics were estimated by unconditional logistic regression models. RESULTS Among the 896 women enrolled, 50 resulted positive for COVID-19. Pregnant women aged ≥35 years had a significantly lower risk of developing the infection (crude OR = 0.29; 95% CI:0.16-0.55). Conversely, foreign women (crude OR = 3.32; 95% CI:1.89-5.81), unemployed women (crude OR = 3.09; 95% CI: 1.77-5.40), and women with an unemployed partner (crude OR = 3.16; 95% CI: 1.48-6.79) showed a significantly higher risk of infection. Ethnicity was positively associated with the risk of developing COVID-19 (mutually adjusted OR = 2.15; 95% CI:1.12-4.11) in the multivariate analysis. Foreign women with COVID-19 were more likely to have a lower education level (p < 0.01), to be unemployed (p < 0.01), and to live in larger families (p < 0.01) compared to Italian pregnant women. CONCLUSIONS The socioeconomic conditions described are characteristic of immigration patterns in our metropolitan area. These factors may increase the risk of viral transmission, reducing the effectiveness of lockdown and social distancing.
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Affiliation(s)
- Francesco D'Ambrosi
- 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
| | - Beatrice Tassis
- 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
| | - Roberta Erra
- 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
| | - Nicola Cesano
- 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
| | - Manuela W Ossola
- Department of Woman, Child and Neonate, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Maria 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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10
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D'Ambrosi F, Rossi G, Soldavini CM, Di Maso M, Carbone IF, Cetera GE, Colosi E, Ferrazzi E. Ultrasound assessment of maternal adipose tissue during 1st trimester screening for aneuploidies and risk of developing gestational diabetes. Acta Obstet Gynecol Scand 2020; 99:644-650. [PMID: 31898313 DOI: 10.1111/aogs.13800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/22/2019] [Accepted: 12/29/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The objective of the present study is to compare the sonographic measurement of subcutaneous adipose thickness and visceral adipose thickness during 1st trimester screening for aneuploidies between non-diabetic pregnant women and patients who develop 1st trimester or 2nd trimester gestational diabetes mellitus (GDM). MATERIAL AND METHODS Adipose thickness was measured by transabdominal ultrasound imaging in pregnant women attending our clinic for screening for fetal aneuploidies between 11 and 13 weeks of gestation. During the 1st trimester all patients were evaluated for fasting glycemia in accordance with the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations. Patients with confirmed fasting glycemia (FPG) ≥92 mg/dL were diagnosed as 1st trimester GDM. Patients with FPG <92 mg/dL underwent a 75-g oral glucose tolerance test between 24 and 28 weeks. RESULTS The study population included 238 non-diabetic women, 29 women with 1st trimester GDM and 28 women with 2nd trimester GDM. Mean subcutaneous adipose thickness and visceral adipose thickness values in non-diabetic women were 9.8 mm (standard deviation [SD = 4.9) and 7.2 mm (SD = 3.5), respectively. Values in women with 1st trimester GDM were 12.8 mm (SD = 6.5) and 9.9 mm (SD = 4.4). In the 2nd trimester GDM group, the mean subcutaneous adipose thickness was 11.1 mm (SD = 4.6) and the mean visceral adipose thickness 10.5 mm (SD = 5.3). Multiple logistic regression analysis showed that visceral adipose thickness, but not subcutaneous adipose thickness, was significantly and independently associated with both 1st trimester GDM (OR 1.15, 95% CI 1.02-1.29) and 2nd trimester GDM (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.05-1.34). CONCLUSIONS Sonographic thickness of maternal visceral adipose tissue was greater in women with GDM than in non-diabetic patients, independently of other known risk factors associated with GDM in the 1st and in the 2nd trimester of pregnancy. Thus, this measurement may be considered of clinical use in 1st trimester screening.
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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
| | - Gabriele Rossi
- Department of Obstetrics and Gynecology "L. Mangiagalli", Fondazione IRCCS "Ca' Granda" - Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara M Soldavini
- Department of Obstetrics and Gynecology "L. Mangiagalli", 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
| | - Ilma F Carbone
- Department of Obstetrics and Gynecology "L. Mangiagalli", Fondazione IRCCS "Ca' Granda" - Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia E Cetera
- Department of Obstetrics and Gynecology "L. Mangiagalli", Fondazione IRCCS "Ca' Granda" - Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Colosi
- Prenatal Care Unit, Grosseto Misericordia Hospital, Grosseto, 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, Università degli Studi di Milano, Milan, Italy
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11
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Giovannini N, Crippa BL, Denaro E, Raffaeli G, Cortesi V, Consonni D, Cetera GE, Parazzini F, Ferrazzi E, Mosca F, Ghirardello S. The effect of delayed umbilical cord clamping on cord blood gas analysis in vaginal and caesarean-delivered term newborns without fetal distress: a prospective observational study. BJOG 2019; 127:405-413. [PMID: 31762140 DOI: 10.1111/1471-0528.16026] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine variations in cord blood gas (CBG) parameters after 3-minute delayed cord clamping (DCC) in vaginal deliveries (VDs) and caesarean deliveries (CDs) at term without fetal distress. DESIGN Prospective observational study. SETTING University hospital. SAMPLE CBG from 97 VDs and 124 CDs without fetal distress. METHODS Comparison of paired arterial-venous CBG parameters drawn at birth from the unclamped cord and after 3-minutes DCC for VDs and CDs. MAIN OUTCOME MEASURES Base excess, bicarbonate, haematocrit and haemoglobin from both arterial and venous cord blood, lactate, neonatal outcomes, partial pressure of oxygen (pO2 ), partial pressure of carbon dioxide (pCO2 ), pH, and postpartum haemorrhage. RESULTS Arterial cord blood pH, bicarbonate ( HCO 3 - , mmol/l), and base excess (BE, mmol/l) decreased significantly after 3-minute DCC both in VDs (pH = 7.23 versus 7.27; P < 0.001; HCO 3 - = 23.3 versus 24.3; P = 0.004; BE = -5.1 versus -2.9; P < 0.001) and CDs (pH = 7.28 versus 7.34; P < 0.001; HCO 3 - = 26.2 versus 27.2; P < 0.001; BE = -1.5 versus 0.7; P < 0.001). After 3-minute DCC, pCO2 increased in CDs only (57 versus 51; P < 0.001), whereas lactate increased more in CDs compared with VDs (lactate, +1.1 [0.9, 1.45] versus +0.5 [-0.65, 2.35]; P = 0.01). Postpartum maternal haemorrhage, neonatal maximum bilirubin concentration, and need for phototherapy were similar between the two groups. Newborns born by CD more frequently required postnatal clinical monitoring or admission to a neonatal intensive care unit. CONCLUSIONS After 3-minute DCC, the acid-base status shifted towards mixed acidosis in CDs and prevalent metabolic acidosis in VDs. CDs were associated with a more pronounced increase in arterial lactate, compared with VDs. TWEETABLE ABSTRACT By 3-minute DCC, acid-base status shifts towards mixed and metabolic acidosis in caesarean and vaginal delivery, respectively.
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Affiliation(s)
- N Giovannini
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - B L Crippa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - E Denaro
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Raffaeli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - V Cortesi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - D Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G E Cetera
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Parazzini
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - E Ferrazzi
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - F Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - S Ghirardello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
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