1
|
Giardini V, Santagati AAF, Marelli E, Casati M, Cantarutti A, Vergani P. Predicting Time to Delivery in Hypertensive Disorders: Assessing PlGF and sFlt-1 with the Novel Parameter 'Mtp-Multiples of a Normal Term Placenta'. J Clin Med 2024; 13:1899. [PMID: 38610664 PMCID: PMC11012921 DOI: 10.3390/jcm13071899] [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: 03/03/2024] [Revised: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Imbalanced angiogenesis is characteristic of normal placental maturation but it also signals placental dysfunction, underlying hypertensive disorders during pregnancy. This study aimed to investigate the relationship between angiogenic placental aging, measured by markers placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) using the new index "Multiples of a normal term placenta" (Mtp) and the duration of pregnancy. Methods: A retrospective observational study was conducted, including singleton pregnancies diagnosed or suspected of hypertensive disorders after the 20th gestational week. Mtp measures how far a single dosage of angiogenic marker deviates from the expected value in an uncomplicated full-term pregnancy (Mpt = sFlt-1/sFlt-1 reference value or PIGF/PIGF reference value). We considered the 90th, 95th, and 97.5th centiles for sFlt-1 and the 2.5th, 5th, and 10th centiles for PlGF as references. Results: The categories with longer time to delivery, regardless of gestational age, were: Mtp PlGF 10th c ≥ 2, ≥3 and Mtp sFlt-1 90th c ≤ 0.5 (median days of 9, 11, 15 days, respectively). These two categories Mtp sFlt-1 90th c ≥ 3 and Mtp sFlt-1 97.5th c ≥ 2 allow the identification of women at risk for imminent delivery within 1 day. Women who were deemed at low/medium risk based on the sFlt-1/PIGF ratio appeared to be at high risk when considering the individual values of sFlt-1 and/or PIGF. Conclusions: This new Mtp index for sFlt-1 and PlGF could be employed to assess the degree of placental aging in women with hypertensive disorders. It represents a valid tool for evaluating the risk of imminent birth, irrespective of gestational age, surpassing the current stratification based on the sFlt-1/PIGF ratio.
Collapse
Affiliation(s)
- Valentina Giardini
- Department of Obstetrics, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, 20900 Monza, Italy
| | | | - Elisabetta Marelli
- Department of Obstetrics, MBBM Foundation Onlus, University of Milano-Bicocca, 20900 Monza, Italy
| | - Marco Casati
- Laboratory Medicine, IRCCS San Gerardo dei Tintori Foundation, 20900 Monza, Italy;
| | - Anna Cantarutti
- Division of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milano, Italy
| | - Patrizia Vergani
- Department of Obstetrics, MBBM Foundation Onlus, University of Milano-Bicocca, 20900 Monza, Italy
| |
Collapse
|
2
|
Sinelli M, Ornaghi S, Doni D, Paterlini G, Locatelli A, Bernasconi DP, Vergani P, Ventura ML. Prenatal use of indomethacin for preterm labor and renal function among very low birth weight infants. Minerva Obstet Gynecol 2024; 76:36-42. [PMID: 36786780 DOI: 10.23736/s2724-606x.22.05137-5] [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: 02/15/2023]
Abstract
BACKGROUND Indomethacin is administered as a tocolytic agent for threatening preterm labor <28weeks of gestation. Only a few, not conclusive, studies have investigated its nephrotoxicity in very low birth weight (VLBW) infants. We investigated whether indomethacin increases the incidence of acute kidney injury (AKI) among VLBW infants. METHODS This is a retrospective study including all VLBW infants born at our center between January 1, 2005, and December 31, 2013. Indomethacin was administered to women with preterm labor and intact membranes. Neonatal AKI was defined according to KDIGO classification. Univariate analyses were performed comparing VLBW infants exposed to and not exposed to indomethacin. In the multivariable model, the association of indomethacin and AKI was adjusted for patent ductus arteriosus, use of nephrotoxic medications, birth weight, and gestational age. RESULTS Five hundred seventy-five VLBW infants were included, 49 (8.5%) of whom were exposed to indomethacin in utero. The univariate analysis showed that infants exposed to indomethacin had lower birth weight, lower gestational age, and higher incidence of AKI than infants not exposed. The multivariable model adjusted for confounding factors confirmed an increased risk of AKI in relation to gestational age at birth <27 weeks, but not to indomethacin. CONCLUSIONS Our data suggest that extreme prematurity, but not the use of indomethacin, is associated with AKI.
Collapse
Affiliation(s)
- Mariateresa Sinelli
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy -
| | - Sara Ornaghi
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Daniela Doni
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Giuseppe Paterlini
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Anna Locatelli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| | - Davide P Bernasconi
- School of Medicine and Surgery, Bicocca Bioinformatics Biostatistics and Bioimaging Center - B4, University of Milano-Bicocca, Monza, Monza-Brianza, Italy
| | - Patrizia Vergani
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| | - Maria L Ventura
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Monza-Brianza, Italy
| |
Collapse
|
3
|
Frigerio M, Barba M, Palmieri S, Ruffolo AF, Gallo P, Magoga G, Manodoro S, Vergani P. Prevalence and severity of sexual disorders in the third trimester of pregnancy. Minerva Obstet Gynecol 2024; 76:21-26. [PMID: 35686638 DOI: 10.23736/s2724-606x.22.05118-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/15/2023]
Abstract
BACKGROUND Female sexual function in pregnancy is an under-investigated topic by care providers. This study aimed to investigate the sexual function and the impact of traditional risk factors for pelvic floor disorders (PFDs) during the third trimester of pregnancy. METHODS This is a secondary analysis of a multicenter cross-sectional study conducted in eight hospitals in Italy and Italian-speaking Switzerland. Women at the third trimester of pregnancy aged 18 years and over completed the Italian-PFQPP questionnaire anonymously. RESULTS Overall, 927 patients in the third trimester of pregnancy answered the questionnaire. About 29.5% of women reported reduced or absent sexual activity. The less reported symptom was coital incontinence (1.3%), while painful intercourses was the most frequent one (50.3%). Nicotine abuse was associated with traumatic sexual intercourses, impaired vaginal sensibility, and negative impact on sexual life and well-being. Familiarity for pelvic floor disorder resulted as a risk factor for coital incontinence (OR=3.61). CONCLUSIONS Sexual symptoms, with pain during intercourses being the most widely reported, are extremely common in the third trimester of pregnancy and can greatly affect quality of life. Familiarity for pelvic floor disorders and nicotine abuse resulted as significant risk factors for at least one sexual symptom.
Collapse
Affiliation(s)
- Matteo Frigerio
- ASST Monza, San Gerardo Hospital, Monza, Monza-Brianza, Italy
| | - Marta Barba
- Milano-Bicocca University, Monza, Monza-Brianza, Italy -
| | | | | | | | - Giulia Magoga
- ULSS2 Marca Trevigiana, Oderzo Hospital, Oderzo, Treviso, Italy
| | | | - Patrizia Vergani
- Obstetrics Division, Monza and Brianza Mother and Child Foundation, Monza, Monza-Brianza, Italy
| |
Collapse
|
4
|
Lazzarin S, Ornaghi S, Roncaglia N, Mariani S, Cameroni I, Vergani P. Fibroids-related complications in pregnancy: a twelve-year long experience at a maternal-fetal medicine referral center. Minerva Obstet Gynecol 2023; 75:520-525. [PMID: 36193831 DOI: 10.23736/s2724-606x.22.05146-6] [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: 06/16/2023]
Abstract
BACKGROUND Uterine fibroids are the most frequent female benign tumor, which can cause complications during pregnancy, mainly pain. Differential diagnosis may be challenging and a standardized management approach is lacking. We aim to propose an algorithm for the differential diagnosis of pain during pregnancy and for management of fibroid-related pain. METHODS A retrospective cohort study of all pregnant women admitted to our center for complications related to fibroids between 2008 and 2019. Data regarding clinical examination, laboratory results, imaging parameters, as well as perinatal outcomes, were collected and assessed (Fisher's Exact Test). RESULTS Twenty-four pregnant patients were admitted for fibroid-related complications. Six patients were admitted more than one times, for a total of 34 admissions. The main cause of hospital admission was pain (N.=33, 94.1%), which was successfully managed with acetaminophen and/or ketoprofen in 91.2%. In two cases, conservative management failed and a surgical approach was undertaken. Most women (N.=20, 90.9%) delivered at term, with a cesarean delivery and post-partum hemorrhage rate of 22.7%. All newborns had normal APGAR score, umbilical artery pH and birth weight. CONCLUSIONS Pain is the most common complication of fibroids during pregnancy. Accurate differential diagnosis and adequate management are pivotal to ensure good perinatal outcomes.
Collapse
Affiliation(s)
- Sara Lazzarin
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Monza-Brianza, Italy -
| | - Sara Ornaghi
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Monza-Brianza, Italy
- Department of Obstetrics, MBBM Foundation, Monza, Monza-Brianza, Italy
| | - Nadia Roncaglia
- Department of Obstetrics, MBBM Foundation, Monza, Monza-Brianza, Italy
| | - Silvana Mariani
- Department of Obstetrics, MBBM Foundation, Monza, Monza-Brianza, Italy
| | - Irene Cameroni
- Department of Obstetrics, MBBM Foundation, Monza, Monza-Brianza, Italy
| | - Patrizia Vergani
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Monza-Brianza, Italy
- Department of Obstetrics, MBBM Foundation, Monza, Monza-Brianza, Italy
| |
Collapse
|
5
|
Ornaghi S, Fernicola F, Marelli E, Perotti M, Di Gennaro F, Cameroni I, Mariani EM, Pincelli AI, Colciago E, Cetin I, Vergani P. Acute spontaneous non-hemorrhagic adrenal infarction in pregnancy: case-report and literature review. Gynecol Endocrinol 2023; 39:2234492. [PMID: 37486308 DOI: 10.1080/09513590.2023.2234492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023] Open
Abstract
Unilateral non-hemorrhagic adrenal infarction (NHAI) is a very uncommon cause of acute abdomen in pregnancy. Diagnosis is highly challenging due to its rarity, heterogeneity of clinical presentation, and inconclusiveness of the initial workup. Timely recognition is pivotal to ensuring optimal outcomes. Here we describe a case of spontaneous unilateral NHAI diagnosed in a singleton pregnant woman at 32 weeks' gestation at our centre and provide the findings of an extensive literature review on the topic. We identified 22 articles describing 31 NHAI cases in 30 obstetric patients: NHAI occurs more frequently on the right side and in the third trimester, and diagnosis is formulated more than 24 h after clinical presentation in 50% of cases; second-level imaging is always necessary to reach a definitive diagnosis and start appropriate treatment. A high degree of clinical suspicion is needed to promptly recognize NHAI in pregnancy, thus allowing appropriate multidisciplinary management and timely treatment initiation. Promotion of knowledge and awareness of NHAI as a potential cause of acute abdomen in pregnancy is mandatory to improve clinical practice and, ultimately, perinatal outcomes.
Collapse
Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Federica Fernicola
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Elisabetta Marelli
- Department of Clinical and Biological Sciences, University of Milan, Milan, Italy
- Department of Woman, Mother, and Neonate, Buzzi Children's Hospital-ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Mario Perotti
- Department of Internal Medicine, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Irene Cameroni
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Eloisa M Mariani
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Angela I Pincelli
- Department of Internal Medicine, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Irene Cetin
- Department of Clinical and Biological Sciences, University of Milan, Milan, Italy
- Department of Woman, Mother, and Neonate, Buzzi Children's Hospital-ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Patrizia Vergani
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| |
Collapse
|
6
|
Giardini V, Grilli L, Terzaghi A, Todyrenchuk L, Zavettieri C, Mazzoni G, Cozzolino S, Casati M, Vergani P, Locatelli A. sFlt-1 Levels as a Predicting Tool in Placental Dysfunction Complications in Multiple Pregnancies. Biomedicines 2023; 11:2917. [PMID: 38001918 PMCID: PMC10669317 DOI: 10.3390/biomedicines11112917] [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: 09/16/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND several studies have demonstrated that angiogenic markers can improve the clinical management of hypertensive disorders (HDs) and fetal growth restriction (FGR) in singleton pregnancies, but few studies have evaluated the performance of these tests in multiple pregnancies. Our aim was to investigate the role of soluble fms-like tyrosine kinase 1 (sFlt-1) in predicting adverse obstetric outcomes in hospitalized multiple pregnancies with HD (preeclampsia/gestational hypertension/uncontrolled chronic hypertension) and/or FGR in one or more fetuses. METHODS A retrospective analysis of multiple pregnancies with HD/FGR occurring after the 20th gestational week. Pregnant women were divided into two groups: women with high levels of sFlt-1 and those with low levels of sFlt-1. A value of sFlt-1 greater than or equal to 15,802 pg/mL was considered arbitrarily high, as it is equivalent to two times the 90th percentile expected in an uncomplicated full-term singleton pregnancy based on data from a prospective multicenter study (7901 pg/mL). RESULTS The cohort included 39 multiple pregnancies. There were no cases of birth <34 weeks, HELLP syndrome, ICU admission, and urgent cesarean sections for HD/FGR complications reported among women with low levels of sFlt-1. CONCLUSIONS A cut-off value of sFlt-1 ≥ 15,802 pg/mL could represent a valuable tool for predicting adverse obstetric outcomes in multiple pregnancies hospitalized for HD/FGR disorders, regardless of gestational age and chorionicity.
Collapse
Affiliation(s)
- Valentina Giardini
- Department of Obstetrics and Gynecology, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, 20900 Monza, Italy; (L.G.); (A.T.); (C.Z.); (A.L.)
| | - Leonora Grilli
- Department of Obstetrics and Gynecology, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, 20900 Monza, Italy; (L.G.); (A.T.); (C.Z.); (A.L.)
| | - Alessandra Terzaghi
- Department of Obstetrics and Gynecology, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, 20900 Monza, Italy; (L.G.); (A.T.); (C.Z.); (A.L.)
| | - Lyudmyla Todyrenchuk
- Department of Obstetrics and Gynecology, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, 20900 Monza, Italy; (L.G.); (A.T.); (C.Z.); (A.L.)
| | - Caterina Zavettieri
- Department of Obstetrics and Gynecology, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, 20900 Monza, Italy; (L.G.); (A.T.); (C.Z.); (A.L.)
| | - Giulia Mazzoni
- Department of Obstetrics and Gynecology, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, 20900 Monza, Italy; (L.G.); (A.T.); (C.Z.); (A.L.)
| | - Sabrina Cozzolino
- Department of Obstetrics and Gynecology, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, 20900 Monza, Italy; (L.G.); (A.T.); (C.Z.); (A.L.)
| | - Marco Casati
- Laboratory Medicine, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, 20900 Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, 20900 Monza, Italy; (L.G.); (A.T.); (C.Z.); (A.L.)
| | - Anna Locatelli
- Department of Obstetrics and Gynecology, IRCCS San Gerardo dei Tintori Foundation, University of Milano-Bicocca, 20900 Monza, Italy; (L.G.); (A.T.); (C.Z.); (A.L.)
| |
Collapse
|
7
|
Frigerio M, D'Alessandro G, Re I, Cola A, Vergani P, Barba M. Clinical, ultrasonographic, and functional outcomes after obstetric anal sphincter injury primary repair: A single-center experience. Int J Gynaecol Obstet 2023; 163:234-242. [PMID: 37128949 DOI: 10.1002/ijgo.14819] [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: 06/22/2022] [Revised: 12/14/2022] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To present clinical and instrumental sequelae after obstetric anal sphincter injuries (OASIS), evaluating correlations between intrapartum severity of lesions, postpartum symptoms, and sonographic and manometric findings; outcomes during subsequent deliveries were also evaluated. METHODS This retrospective study evaluated all consecutive women who sustained an OASIS between 2015 and 2020. Postpartum symptoms, anorectal manometry (ARM), and three-dimensional endoanal ultrasonography (3D-EAUS) were analyzed. RESULTS A total of 107 women underwent OASIS primary repair; 84 (78.5%) of them were asymptomatic after 1 month. The presence and severity of symptoms showed a great correlation with instrumental outcomes in terms of maximum resting pressure, squeeze pressure increment (SPI), circumferential extension of defect for both external anal sphincter (EAS) and internal anal sphincter (IAS), and EAS, IAS and total Starck scores. There was a significant correlation between ARM and 3D-EAUS findings, with the exception of SPI, for which the abnormalities were not predictable based on EAUS results. CONCLUSION Both ARM and EAUS findings after OASIS are directly related to each other, and associated with symptoms. These instrumental tools may be useful for OASIS assessment and counseling.
Collapse
Affiliation(s)
| | | | - Ilaria Re
- University of Milano-Bicocca, Monza, Italy
| | - Alice Cola
- ASST Monza, Ospedale San Gerardo, Monza, Italy
| | | | | |
Collapse
|
8
|
Sinelli M, Zannin E, Doni D, Ornaghi S, Acampora E, Roncaglia N, Vergani P, Ventura ML. Association of intrauterine growth restriction and low birth weight with acute kidney injury in preterm neonates. Pediatr Nephrol 2023; 38:3139-3144. [PMID: 36988690 DOI: 10.1007/s00467-023-05936-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Preterm birth alters nephrogenesis and reduces the total nephron number. Intrauterine growth restriction (IUGR) seems to worsen nephron loss, but only a few studies have investigated its role in neonatal kidney impairment. We investigated whether IUGR, defined as reduced estimated fetal growth and/or placental flow alterations and low birth weight z-score, increases the risk of developing acute kidney injury (AKI) in very preterm infants. METHODS We performed a retrospective study including infants born with a birth weight (BW) ≤ 1500 g and/or gestational age (GA) ≤ 32 weeks admitted to our center between January 2016 and December 2021. Neonatal AKI was defined according to the neonatal KDIGO classification based on the decline of urine output and/or creatinine elevation. We used multivariable linear regressions to verify the association between AKI and GA, BW z-score, IUGR definition, and hemodynamically significant patent ductus arteriosus (PDA). RESULTS We included 282 infants in the analysis, with a median (IQR) GA = 29.4 (27.4, 31.3) weeks, BW = 1150 (870, 1360) g, and BW z-score = - 0.57 (- 1.64, 0.25). AKI was diagnosed in 36 (13%) patients, and 58 (21%) had PDA. AKI was significantly associated with BW z-score (beta (std. error) = - 0.08 (0.03), p = 0.008) and severe IUGR (beta (std. error) = 0.21 (0.08), p = 0.009), after adjusting for GA and PDA. CONCLUSIONS Our data suggest that low BW z-score and IUGR could represent adjunctive risk factors for kidney impairment in preterm babies. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Mariateresa Sinelli
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900, Monza, Italy.
| | - Emanuela Zannin
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900, Monza, Italy
| | - Daniela Doni
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900, Monza, Italy
| | - Sara Ornaghi
- Unit of Obstetrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Bicocca School of Medicine and Surgery, University of Milan, Monza, Italy
| | - Eleonora Acampora
- Unit of Obstetrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Nadia Roncaglia
- Unit of Obstetrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
| | - Patrizia Vergani
- Unit of Obstetrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy
- Bicocca School of Medicine and Surgery, University of Milan, Monza, Italy
| | - Maria Luisa Ventura
- Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900, Monza, Italy
| |
Collapse
|
9
|
Frigerio M, Marino G, Barba M, Palmieri S, Ruffolo AF, Degliuomini R, Gallo P, Magoga G, Manodoro S, Vergani P. Prevalence and severity of bowel disorders in the third trimester of pregnancy. AJOG Glob Rep 2023; 3:100218. [PMID: 37645654 PMCID: PMC10461240 DOI: 10.1016/j.xagr.2023.100218] [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: 08/31/2023] Open
Abstract
BACKGROUND Bowel-related disorders are common conditions associated with pregnancy and are a cause of significant distress and healthcare burden. However, there is a lack of data in the literature about these disorders. OBJECTIVE This study aimed to investigate bowel dysfunctions during the third trimester of pregnancy in a large cohort of women using the validated bowel domain of the Italian version of the Pelvic Floor Questionnaire for Pregnant and Postpartum Women. STUDY DESIGN This was a secondary analysis of a multicenter cross-sectional study conducted in hospitals in Italy and Italian-speaking Switzerland. Women in the third trimester of pregnancy were asked to complete the Italian Pelvic Floor Questionnaire for Pregnant and Postpartum Women. RESULTS During the study period, 927 pregnant women in the third trimester of pregnancy responded to the questionnaire and were included in the analysis. Overall bowel dysfunctions were reported by 29.6% of patients. Constipation was reported by 66.6% of pregnant women, whereas symptoms of obstructed defecation were reported by 49.9% of patients. In contrast, urgency was reported by 41.1% of patients. Incontinence to flatus and incontinence to stool were reported by 45.1% and 2.8% of patients, respectively. Moreover, age >35 years, familiarity with pelvic floor disorders, nicotine abuse, and pelvic floor contraction inability were identified as independent risk factors for at least 1 bowel symptom. CONCLUSION Bowel symptoms are extremely common in the third trimester of pregnancy and can greatly affect a patient's quality of life; therefore, bowel symptoms deserve to be investigated and managed properly. The use of validated questionnaires represents a precious tool to investigate functional symptoms that could be very frequent and disabling in this particular period of life for women.
Collapse
Affiliation(s)
- Matteo Frigerio
- ASST Monza, San Gerardo Hospital, Monza, Italy (Dr Frigerio)
- Urogynecology-Pelvic Floor Working Group, Monza, Italy (Drs Frigerio, Gallo, and Manodoro)
| | - Giuseppe Marino
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milano, Italy (Drs Marino, Barba, and Palmieri)
| | - Marta Barba
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milano, Italy (Drs Marino, Barba, and Palmieri)
| | - Stefania Palmieri
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milano, Italy (Drs Marino, Barba, and Palmieri)
| | | | | | - Pasquale Gallo
- Urogynecology-Pelvic Floor Working Group, Monza, Italy (Drs Frigerio, Gallo, and Manodoro)
- San Giovanni di Dio Hospital, ASL Napoli 2 Nord, Frattamaggiore, Italy (Dr Gallo)
| | - Giulia Magoga
- ULSS2 Marca Trevigiana, Oderzo Hospital, Oderzo, Italy (Dr Magoga)
| | - Stefano Manodoro
- Urogynecology-Pelvic Floor Working Group, Monza, Italy (Drs Frigerio, Gallo, and Manodoro)
- ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy (Dr Manodoro)
| | - Patrizia Vergani
- Obstetric Division, Monza and Brianza Mother and Child Foundation, Monza, Italy (Dr Vergani)
| | - Urogynecology-Pelvic Floor Working Group
- ASST Monza, San Gerardo Hospital, Monza, Italy (Dr Frigerio)
- Urogynecology-Pelvic Floor Working Group, Monza, Italy (Drs Frigerio, Gallo, and Manodoro)
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, Milano, Italy (Drs Marino, Barba, and Palmieri)
- San Raffaele University, Milano, Italy (Drs Ruffolo and Degliuomini)
- San Giovanni di Dio Hospital, ASL Napoli 2 Nord, Frattamaggiore, Italy (Dr Gallo)
- ULSS2 Marca Trevigiana, Oderzo Hospital, Oderzo, Italy (Dr Magoga)
- ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy (Dr Manodoro)
- Obstetric Division, Monza and Brianza Mother and Child Foundation, Monza, Italy (Dr Vergani)
| |
Collapse
|
10
|
Ornaghi S, Fumagalli S, Galimberti S, Ornago AM, Brivio V, Lambicchi L, Nespoli A, Vergani P. Adverse Childbirth and Perinatal Outcomes Among Healthy, Low-Risk Pregnant Women with Abnormal Total Gestational Weight Gain. J Womens Health (Larchmt) 2023; 32:521-528. [PMID: 36735590 DOI: 10.1089/jwh.2022.0278] [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: 02/04/2023] Open
Abstract
Purpose: Little is known on the potential effects of abnormal gestational weight gain (GWG) among low-risk, healthy pregnant women with no comorbidities or gestational complications. We investigated perinatal outcomes of these pregnancies according to GWG as per the 2009 National Academy of Medicine (NAM) recommendations. Materials and Methods: A retrospective analysis of prospectively collected data of low-risk pregnant women giving birth at term between January 2016 and December 2020. Inclusion criteria were normal pregestational body mass index (pBMI) (18.5-24.9 kg/m2) and no pregestational or gestational complication. Self-reported prepregnancy weight was used to calculate pBMI; GWG was the difference between maternal weight at childbirth and prepregnancy weight. Women were classified according to the 2009 NAM guidelines for GWG: insufficient (iGWG, <11.5 kg), adequate (aGWG, 11.5-16 kg), and excessive (eGWG, >16 kg). Logistic regression analysis with aGWG as referent was performed to independently estimate dose-response associations. Results: During the study period, there were 4,127 (33.1%) births fulfilling the inclusion criteria. Fifty-two percent of women gained outside the recommended range: 33.5% had iGWG and 18.7% had eGWG. iGWG women were 40% more likely to have early-term births and small for gestational age neonates. In turn, eGWG women displayed increased odds of prolonged pregnancy (adjusted odds ratio [aOR] 1.32), cesarean section in labor (aOR 1.50), high-degree perineal tears (aOR 2.04), postpartum hemorrhage ≥1,000 mL (aOR 1.54), and large for gestational age newborns (aOR 1.83). Conclusion: Our data show that abnormal GWG independently associates with heightened risk of adverse outcomes among healthy, low-risk pregnant women with normal pBMI and no comorbidity or gestational complication.
Collapse
Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Simona Fumagalli
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Sofia Galimberti
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Alice Margherita Ornago
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Valentina Brivio
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Laura Lambicchi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Antonella Nespoli
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, Unit of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| |
Collapse
|
11
|
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
| |
Collapse
|
12
|
Bazzurini L, Ornaghi S, Colciago E, Penati C, di Gennaro F, Passoni P, Buda A, Locatelli A, Landoni F, Vergani P. Endometriosis-related spontaneous hemoperitoneum in pregnancy: A case series. J Obstet Gynaecol Res 2023; 49:744-752. [PMID: 36366961 DOI: 10.1111/jog.15498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/03/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
Endometriosis can be associated with adverse pregnancy outcomes. We report six cases of endometriosis-related spontaneous hemoperitoneum diagnosed in pregnant and postpartum women over 13 years. Spontaneous hemoperitoneum in pregnancy mainly occurred in the second half of gestation. All women presented with acute abdominal pain; four of them needed an emergent surgery, two were managed expectantly. The median estimated blood loss was 4250 ml, four women required massive transfusion. Three out of six women had a known history of endometriosis, all of them had histologically confirmed endometriosis after surgery. No maternal or perinatal deaths occurred. In one case, reticence to perform a computed tomography scan led to delayed diagnosis. Since delay can lead to lethal consequences, high levels of suspicion for spontaneous hemoperitoneum should be maintained in cases of severe abdominal pain, even with a woman's negative history of endometriosis. Improved knowledge and regular interdisciplinary meetings are pivotal to ameliorate outcomes.
Collapse
Affiliation(s)
- Luca Bazzurini
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy
| | - Sara Ornaghi
- Department of Obstetrics and Gynecology, Division of Obstetrics, Foundation MBBM Onlus at San Gerardo Hospital, University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
| | - Elisabetta Colciago
- University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
| | - Cristina Penati
- Department of Obstetrics and Gynecology, Carate Brianza Hospital, Monza e Brianza, Italy
| | | | - Paolo Passoni
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy
| | - Alessandro Buda
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy
| | - Anna Locatelli
- University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy.,Department of Obstetrics and Gynecology, Carate Brianza Hospital, Monza e Brianza, Italy
| | - Fabio Landoni
- Department of Obstetrics and Gynecology, Division of Gynecology, San Gerardo Hospital, Monza e Brianza, Italy.,University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, Division of Obstetrics, Foundation MBBM Onlus at San Gerardo Hospital, University of Milan-Bicocca, Department of Medicine and Surgery, Monza e Brianza, Italy
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Muacevic A, Adler JR, Delle Marchette M, Bonazzi CM, Gorla S, Moltrasio F, Fruscio R, Vergani P, Landoni F. Gestational Intraplacental Choriocarcinoma in a Term Pregnancy: A Case Report. Cureus 2022; 14:e31243. [PMID: 36505145 PMCID: PMC9731319 DOI: 10.7759/cureus.31243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 11/09/2022] Open
Abstract
Intraplacental choriocarcinoma (IC) is a rare type of gestational choriocarcinoma (GC) occurring within the placenta, and only a small number of cases have been reported so far. Intraplacental choriocarcinoma is usually asymptomatic or may present with aspecific symptoms, including unexplained vaginal bleeding during pregnancy. Early diagnosis and treatment are pivotal for ensuring optimal outcomes. However, intraplacental choriocarcinoma is rarely suspected due to limited knowledge and awareness of the condition. Here, we report the case of a 34-year-old woman diagnosed with intraplacental choriocarcinoma by placental histological examination performed after delivery due to unexplained vaginal bleeding at 29 gestational weeks, requiring hospital admission. Two lines of chemotherapy and surgery were necessary to achieve complete remission. Since unexplained vaginal bleeding during pregnancy can be a clinical manifestation of intraplacental choriocarcinoma, we propose to consider placental histological examination in all pregnancies with this complication.
Collapse
|
15
|
Colciago E, Capitoli G, Vergani P, Ornaghi S. Women's attitude towards COVID-19 vaccination in pregnancy: A survey study in northern Italy. Int J Gynaecol Obstet 2022:10.1002/ijgo.14506. [PMID: 36227124 PMCID: PMC9874513 DOI: 10.1002/ijgo.14506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/15/2022] [Accepted: 10/12/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To investigate attitudes and risk perceptions towards the coronavirus disease 2019 (COVID-19) vaccine and reasons for hesitancy among pregnant women. METHODS A prospective survey study was conducted at a University Maternity Department. Participants included any pregnant woman aged 18 years or older, able to understand the Italian language, who accessed the antenatal clinic for a prenatal appointment. The survey comprised questions about sociodemographic characteristics, pregnancy vaccination history, and perception of risk related to the immunization for the woman herself and her infant. RESULTS A total of 538 women completed the questionnaire, 445 (82.7%) accepted COVID-19 vaccination. Women vaccinated against pertussis were three times more likely to take up the COVID-19 vaccine (odds ratio [OR] 3.19; 95% confidence interval [CI] 1.78-5.72). Having had COVID-19 during pregnancy (OR 0.24; 95% CI 0.11-0.54), and having a high-risk perception towards the immunization for the fetus (OR 0.18; 95% CI 0.09-0.34) were factors associated with vaccine hesitancy. Lack of safety data in pregnancy and the possibility of harm to the fetus were the main concerns. CONCLUSION A trusting and supportive relationship with the healthcare professional to address fears, and the transmission of evidence-based information, are pivotal to guide women through an informed choice. Understanding the determinants implicated in women's decision making might guide towards effective public health strategies to boost vaccine acceptance.
Collapse
Affiliation(s)
| | - Giulia Capitoli
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 CenterSchool of Medicine and Surgery, University of Milano—BicoccaMonzaItaly
| | - Patrizia Vergani
- School of Medicine and SurgeryUniversity of Milano—BicoccaMonzaItaly,Department of Obstetrics and Gynecology—MBBM Foundation OnlusMonzaItaly
| | - Sara Ornaghi
- School of Medicine and SurgeryUniversity of Milano—BicoccaMonzaItaly,Department of Obstetrics and Gynecology—MBBM Foundation OnlusMonzaItaly
| |
Collapse
|
16
|
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.
Collapse
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
| | | |
Collapse
|
17
|
Fumagalli S, Antolini L, Cosmai G, Gramegna T, Nespoli A, Pedranzini A, Colciago E, Valsecchi MG, Vergani P, Locatelli A. Development and validation of a predictive model to identify the active phase of labor. BMC Pregnancy Childbirth 2022; 22:641. [PMID: 35971093 PMCID: PMC9377074 DOI: 10.1186/s12884-022-04946-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background The diagnosis of the active phase of labor is a crucial clinical decision, thus requiring an accurate assessment. This study aimed to build and to validate a predictive model, based on maternal signs and symptoms to identify a cervical dilatation ≥4 cm. Methods A prospective study was conducted from May to September 2018 in a II Level Maternity Unit (development data), and from May to September 2019 in a I Level Maternity Unit (validation data). Women with singleton, term pregnancy, cephalic presentation and presence of contractions were consecutively enrolled during the initial assessment to diagnose the stage of labor. Women < 18 years old, with language barrier or induction of labor were excluded. A nomogram for the calculation of the predictions of cervical dilatation ≥4 cm on the ground of 11 maternal signs and symptoms was obtained from a multivariate logistic model. The predictive performance of the model was investigated by internal and external validation. Results A total of 288 assessments were analyzed. All maternal signs and symptoms showed a significant impact on increasing the probability of cervical dilatation ≥4 cm. In the final logistic model, “Rhythm” (OR 6.26), “Duration” (OR 8.15) of contractions and “Show” (OR 4.29) confirmed their significance while, unexpectedly, “Frequency” of contractions had no impact. The area under the ROC curve in the model of the uterine activity was 0.865 (development data) and 0.927 (validation data), with an increment to 0.905 and 0.956, respectively, when adding maternal signs. The Brier Score error in the model of the uterine activity was 0.140 (development data) and 0.097 (validation data), with a decrement to 0.121 and 0.092, respectively, when adding maternal signs. Conclusion Our predictive model showed a good performance. The introduction of a non-invasive tool might assist midwives in the decision-making process, avoiding interventions and thus offering an evidenced-base care.
Collapse
Affiliation(s)
- Simona Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
| | - Laura Antolini
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Greta Cosmai
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Teresa Gramegna
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Antonella Nespoli
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Astrid Pedranzini
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Elisabetta Colciago
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Maria Grazia Valsecchi
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Anna Locatelli
- Department of Obstetrics and Gynecology, Carate Brianza Hospital, ASST Brianza, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
18
|
Lilleri D, Tassis B, Pugni L, Ronchi A, Pietrasanta C, Spinillo A, Arossa A, Achille C, Vergani P, Ornaghi S, Riboni S, Cavoretto P, Candiani M, Gaeta G, Prefumo F, Fratelli N, Fichera A, Vignali M, Barbasetti Di Prun A, Fabbri E, Cetin I, Locatelli A, Consonni S, Rutolo S, Miotto E, Savasi V, Di Giminiani M, Cromi A, Binda S, Fiorina L, Furione M, Cassinelli G, Klersy C. Prevalence, Outcome, and Prevention of Congenital Cytomegalovirus Infection in Neonates Born to Women With Preconception Immunity (CHILd Study). Clin Infect Dis 2022; 76:513-520. [PMID: 35717635 PMCID: PMC9907511 DOI: 10.1093/cid/ciac482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Human cytomegalovirus (HCMV) is the leading infectious cause of congenital disabilities. We designed a prospective study to investigate the rate, outcome, and risk factors of congenital CMV (cCMV) infection in neonates born to immune women, and the potential need and effectiveness of hygiene recommendations in this population. METHODS The study was composed of 2 sequential parts: an epidemiology (part 1) and a prevention (part 2) study. Performance of part 2 depended upon a cCMV rate >0.4%. Women enrolled in part 1 did not receive hygiene recommendations. Newborns were screened by HCMV DNA testing in saliva and cCMV was confirmed by urine testing. RESULTS Saliva swabs were positive for HCMV DNA in 45/9661 newborns and cCMV was confirmed in 18 cases. The rate of cCMV was .19% (95% confidence interval [CI]: .11-.29%), and 3 out of 18 infants with cCMV had symptoms of CMV at birth. Age, nationality, occupation, and contact with children were similar between mothers of infected and noninfected newborns. Twin pregnancy (odds ratio [OR]: 7.2; 95% CI: 1.7-32.2; P = .037) and maternal medical conditions (OR: 3.9; 95% CI: 1.5-10.1; P = .003) appeared associated with cCMV. Given the rate of cCMV was lower than expected, the prevention part of the study was cancelled. CONCLUSIONS Newborns from women with preconception immunity have a low rate of cCMV, which appears to be mostly due to reactivation of the latent virus. Therefore, serological screening in childbearing age would be pivotal to identify HCMV-seropositive women, whose newborns have a low risk of cCMV. CLINICAL TRIALS REGISTRATION www.clinicaltrials.gov (NCT03973359).
Collapse
Affiliation(s)
- Daniele Lilleri
- Correspondence: D. Lilleri, Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy ()
| | - Beatrice Tassis
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenza Pugni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Ronchi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Pietrasanta
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Arsenio Spinillo
- Ostetricia e Ginecologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessia Arossa
- Ostetricia e Ginecologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cristian Achille
- Neonatologia e Terapia intensiva neonatale, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Patrizia Vergani
- Fondazione Monza Brianza per il Bambino e la sua Mamma Onlus c/o Ospedale San Gerardo, Università Milano-Bicocca Scuola di Medicina e Chirurgia, Monza, Italy
| | - Sara Ornaghi
- Fondazione Monza Brianza per il Bambino e la sua Mamma Onlus c/o Ospedale San Gerardo, Università Milano-Bicocca Scuola di Medicina e Chirurgia, Monza, Italy
| | - Silvia Riboni
- Fondazione Monza Brianza per il Bambino e la sua Mamma Onlus c/o Ospedale San Gerardo, Università Milano-Bicocca Scuola di Medicina e Chirurgia, Monza, Italy
| | - Paolo Cavoretto
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - Massimo Candiani
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - Gerarda Gaeta
- Gynecology and Obstetrics Department, IRCCS San Raffaele Hospital and University, Milan, Italy
| | - Federico Prefumo
- ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Nicola Fratelli
- ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Anna Fichera
- ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Michele Vignali
- ASST Fatebenefratelli-Sacco, Ospedale Macedonio Melloni, Milan, Italy,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Allegra Barbasetti Di Prun
- ASST Fatebenefratelli-Sacco, Ospedale Macedonio Melloni, Milan, Italy,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Elisa Fabbri
- Dipartimento di Ostetricia e Ginecologia, Ospedale dei Bambini Vittore Buzzi, Università di Milano, Milan, Italy
| | - Irene Cetin
- Dipartimento di Ostetricia e Ginecologia, Ospedale dei Bambini Vittore Buzzi, Università di Milano, Milan, Italy
| | - Anna Locatelli
- ASST Brianza (Ospedali di Carate e Vimercate), Vimercate, Italy
| | - Sara Consonni
- ASST Brianza (Ospedali di Carate e Vimercate), Vimercate, Italy
| | | | | | - Valeria Savasi
- Unit of Obstetrics and Gynecology, ASST Fatebenefratelli-Sacco, Milan, Italy,Department of Biological and Clinical Sciences, University of Milan, Milan, Italy
| | - Maria Di Giminiani
- Unit of Obstetrics and Gynecology, ASST Fatebenefratelli-Sacco, Milan, Italy,Department of Biological and Clinical Sciences, University of Milan, Milan, Italy
| | | | - Sandro Binda
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Loretta Fiorina
- Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Milena Furione
- Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gabriela Cassinelli
- Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Epidemiologia clinica e Biostatistica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Ornaghi S, Bellante N, Abbamondi A, Maini M, Cesana F, Trabucchi M, Corsi D, Arosio V, Mariani S, Scian A, Colciago E, Lettino M, Vergani P. Cardiac and obstetric outcomes in pregnant women with heart disease: appraisal of the 2018 mWHO classification. Open Heart 2022; 9:openhrt-2021-001947. [PMID: 35332050 PMCID: PMC8948382 DOI: 10.1136/openhrt-2021-001947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/07/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To appraise the application of the 2018 European Society of Cardiology-adapted modified WHO (mWHO) classification to pregnant women with heart disease managed at our maternal-fetal medicine referral centre and to assess whether the lack of a multidisciplinary Pregnancy Heart team has influenced their outcomes. METHODS A retrospective cohort study including all pregnancies with heart disease managed at our centre between June 2011 and December 2020. Cardiac conditions were categorised in five classes according to the mWHO classification. An additional class, named X, was created for conditions not included in this classification. Outcomes were compared among all classes and factors potentially associated to cardiac complications were assessed. RESULTS We identified 162 women with 197 pregnancies, for a prevalence of 0.7%. Thirty-eight (19.3%) gestations were included in class X. Caesarean section was performed in 64.9% pregnancies in class X, a rate similar to that of class II, II-III, and III/IV, and mostly for obstetric indications; in turn, it was more commonly performed for cardiology reasons in class II-III and III/IV. Cardiac complications occurred in 10.7%, with class X and II pregnancies showing the highest number of events (n=30.8% and 34.6%, respectively). Multiple gestation and urgent caesarean section associated with a 5-fold and 6.5-fold increase in complication rates. CONCLUSIONS Even in a maternal-fetal medicine referral centre, the lack of a multidisciplinary team approach to women with heart disease may negatively impact their outcomes.
Collapse
Affiliation(s)
- Sara Ornaghi
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy .,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Nicolo' Bellante
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Alessandra Abbamondi
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Marzia Maini
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | | | | | - Davide Corsi
- Department of Cardiology, San Gerardo Hospital, Monza, Italy
| | - Viola Arosio
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Silvana Mariani
- Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Antonietta Scian
- Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | | | | | - Patrizia Vergani
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| |
Collapse
|
21
|
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
|
22
|
Ornaghi S, Crippa I, Di Nicola S, Giardini V, La Milia L, Locatelli L, Corso R, Roncaglia N, Vergani P. Splenic artery aneurysm in obstetric patients: a series of four cases with different clinical presentation and outcome. Int J Gynaecol Obstet 2022; 159:474-479. [PMID: 35122689 DOI: 10.1002/ijgo.14133] [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: 09/03/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe four consecutive cases of splenic artery aneurysm with different clinical patterns of presentation among obstetric patients. METHOD A series of four cases of splenic artery aneurysm diagnosed in pregnant or post-partum women at our University center between January 1998 and December 2020. Clinical and radiological data were retrospectively obtained by reviewing paper and electronic medical records after acquiring patient's consent. RESULTS One case was completely asymptomatic and incidentally identified at the beginning of pregnancy, thus allowing for multidisciplinary treatment. The other three cases were unknown: two manifested with maternal collapse due to aneurysm rupture in the third trimester of gestation, whereas one presented with acute abdominal pain during the post-partum period and was successfully managed before rupture occurred. CONCLUSION Although being extremely rare, SAA rupture in obstetric patients can be associated with dramatic consequences. Since early suspicion and prompt intervention are essential to avoid fatal outcomes, promotion of knowledge of all the potential clinical patterns of presentation of SAA rupture among obstetric patients is mandatory.
Collapse
Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Isabella Crippa
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Sara Di Nicola
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Valentina Giardini
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Laura La Milia
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Luca Locatelli
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Rocco Corso
- Department of Radiology, San Gerardo Hospital, Monza, Italy
| | - Nadia Roncaglia
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics, MBBM Foundation at San Gerardo Hospital, Monza, Italy
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| |
Collapse
|
23
|
Ornaghi S, Vaglio Tessitore I, Vergani P. Pregnancy and Delivery Outcomes in Women With Persistent Versus Resolved Low-Lying Placenta in the Late Third Trimester. J Ultrasound Med 2022; 41:123-133. [PMID: 33675045 DOI: 10.1002/jum.15687] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The safest mode of delivery in low-lying placenta is debatable. Little is known about outcomes in low-lying placenta resolved during the late third trimester. We compare outcomes of women with persistent versus resolved low-lying placenta. METHODS A retrospective analysis on a prospective cohort of women with low-lying placenta confirmed at 28-30 weeks sonography (01/2009 to 03/2018). Women were followed up serially every 2 to 3 weeks until delivery to assess the placental edge-to-internal os distance (IOD), and included if scan was performed within 28 days before delivery. RESULTS There were 86 women: in 21 the low-lying placenta resolved, whereas in 65 persisted (n = 15 IOD 1-10 mm, n = 50 IOD 11-20 mm). Antepartum bleeding associated with higher rates of urgent cesarean delivery in 1-10 mm (P = .041) but not in 11-20 mm (P = 1.000) and >20 mm (P = .333). Among women with IOD >10 mm allowed to labor, vaginal delivery occurred in 76.7% (11-20 mm) and 94.1% (>20 mm) (P = .155), with no difference according to parity (70% and 80% in multiparas, P = .696; 60% and 72.7% in nulliparas, P = .698). Severe PPH (P = .922) and hemoglobin drop (P = .109) were similar among groups. Women with IOD 11-20 mm and >20 mm and vaginal delivery bled less than women with similarly located placenta and cesarean delivery (P = .009 and P = .048). CONCLUSIONS Women with IOD >10 mm have high chances of deliver vaginally with no further increase of their hemorrhagic risk. Success of vaginal delivery is independent of parity and antepartum bleeding. Labor should be managed in an adequate hospital setting.
Collapse
Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Isadora Vaglio Tessitore
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| |
Collapse
|
24
|
Messina V, Dondossola D, Paleari MC, Fornoni G, Tubiolo D, Vergani P, Rona R, Rossi G. Liver Bleeding Due to HELLP Syndrome Treated With Embolization and Liver Transplantation: A Case Report and Review of the Literature. Front Surg 2021; 8:774702. [PMID: 34881288 PMCID: PMC8646087 DOI: 10.3389/fsurg.2021.774702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 10/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Liver bleeding secondary to haemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome is uncommon, but a life-threatening peripartum condition that needs a prompt multidisciplinary approach. Case Presentation: In this study, we presented a case of 28-year-old pregnant woman, who was presented to the obstetrics department with signs of preeclampsia and foetal growth restriction. An emergency caesarean section was performed, and the patient developed a HELLP syndrome complicated by spontaneous liver rupture. After radiological and surgical procedures, liver failure became evident and liver transplantation was successfully performed. The patient and her daughter are now alive. Conclusions: Despite the rarity of this disease, liver complications due to HELLP syndrome must be properly diagnosed and treated given the gravity of the possible evolution in young women. After diagnosis, the patients must be treated in specialised centres with gynaecological, liver surgery, and transplant skills.
Collapse
Affiliation(s)
- Valentina Messina
- Department of General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Dondossola
- Department of General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Maria Chiara Paleari
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca Fornoni
- Department of General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Tubiolo
- Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Patrizia Vergani
- Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Roberto Rona
- Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy
| | - Giorgio Rossi
- Department of General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| |
Collapse
|
25
|
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.
Collapse
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.
| |
Collapse
|
26
|
Ornaghi S, Colciago E, Vaglio Tessitore I, Abbamondi A, Antolini L, Locatelli A, Inversetti A, Pintucci A, Cetin I, Bracco B, Fabbri E, Sala V, Meroni M, Volpe G, Benedetti S, Bulfoni C, Marconi A, Lagrasta F, Paolini CL, Mazza E, Candiani M, Valsecchi L, Smid M, Pasi F, Pozzoni M, Castoldi M, Vignali M, Dal Molin G, Guarano A, Pellegrino A, Callegari C, Betti M, Lazzarin S, Prefumo F, Zanardini C, Parolin V, Catalano A, Barbolini E, Antonazzo P, Pignatti L, Tintoni M, Spelzini F, Martinelli A, Facchinetti F, Chiossi G, Vergani P. Mode of birth in women with low-lying placenta: protocol for a prospective multicentre 1:3 matched case-control study in Italy (the MODEL-PLACENTA study). BMJ Open 2021; 11:e052510. [PMID: 34873004 PMCID: PMC8650481 DOI: 10.1136/bmjopen-2021-052510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The term placenta praevia defines a placenta that lies over the internal os, whereas the term low-lying placenta identifies a placenta that is partially implanted in the lower uterine segment with the inferior placental edge located at 1-20 mm from the internal cervical os (internal-os-distance). The most appropriate mode of birth in women with low-lying placenta is still controversial, with the majority of them undergoing caesarean section. The current project aims to evaluate the rate of vaginal birth and caesarean section in labour due to bleeding by offering a trial of labour to all women with an internal-os-distance >5 mm as assessed by transvaginal sonography in the late third trimester. METHODS AND ANALYSIS The MODEL-PLACENTA is a prospective, multicentre, 1:3 matched case-control study involving 17 Maternity Units across Lombardy and Emilia-Romagna regions, Italy. The study includes women with a placenta located in the lower uterine segment at the second trimester scan. Women with a normally located placenta will be enrolled as controls. A sample size of 30 women with an internal-os-distance >5 mm at the late third trimester scan is needed at each participating Unit. Since the incidence of low-lying placenta decreases from 2% in the second trimester to 0.4% at the end of pregnancy, 150 women should be recruited at each centre at the second trimester scan. A vaginal birth rate ≥60% in women with an internal-os-distance >5 mm will be considered appropriate to start routinely admitting to labour these women. ETHICS AND DISSEMINATION Ethical approval for the study was given by the Brianza Ethics Committee (No 3157, 2019). Written informed consent will be obtained from study participants. Results will be disseminated by publication in peer-reviewed journals and presentation in international conferences. TRIAL REGISTRATION NUMBER NCT04827433 (pre-results stage).
Collapse
Affiliation(s)
- Sara Ornaghi
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Obstetrics and Gynaecology, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
| | | | | | | | - Laura Antolini
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Anna Locatelli
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Obstetrics and Gynaecology, ASST di Vimercate, Carate Brianza, Italy
| | - Annalisa Inversetti
- Department of Obstetrics and Gynaecology, ASST di Vimercate, Carate Brianza, Italy
| | - Armando Pintucci
- Department of Obstetrics and Gynaecology, ASST di Monza, Desio, Italy
| | - I Cetin
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Benedetta Bracco
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Elisa Fabbri
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Valentina Sala
- Department of BioMedical and Clinical Sciences, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Hospital V. Buzzi, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Mario Meroni
- Department of Obstetrics and Gynaecology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Grazia Volpe
- Department of Obstetrics and Gynaecology, Ca' Grande Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Sara Benedetti
- Department of Obstetrics and Gynaecology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Camilla Bulfoni
- Department of Obstetrics and Gynaecology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Annamaria Marconi
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Federica Lagrasta
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Cinzia Lucia Paolini
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Elisabetta Mazza
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynaecology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milano, Italy
| | - Massimo Candiani
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Luca Valsecchi
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Maddalena Smid
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Federica Pasi
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Mirko Pozzoni
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Maria Castoldi
- School of Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy
- Department of Obstetrics and Gynaecology, San Raffaele Hospital, Milano, Italy
| | - Michele Vignali
- Department of Biomedical Sciences for Health, Università degli Studi di Milano Facoltà di Medicina e Chirurgia, Milano, Italy
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Giulia Dal Molin
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Alice Guarano
- School of Medicine and Surgery, University of Milan, Milano, Italy
- Department of Obstetrics and Gynecology, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Clelia Callegari
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Marta Betti
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Sara Lazzarin
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
- School of Medicine and Surgery, University of Brescia, Brescia, Lombardia, Italy
| | - Cristina Zanardini
- Department of Obstetrics and Gynaecology, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
- School of Medicine and Surgery, University of Brescia, Brescia, Lombardia, Italy
| | - Valentina Parolin
- School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Anna Catalano
- Department of Obstetrics and Gynaecology, Poliambulanza Foundation Hospitals, Brescia, Italy
| | - Edoardo Barbolini
- Department of Obstetrics and Gynaecology, Poliambulanza Foundation Hospitals, Brescia, Italy
| | - Patrizio Antonazzo
- Department of Obstetrics and Gynaecology, Maurizio Bufalini Hospital, Cesena, Italy
| | - Lucrezia Pignatti
- Department of Obstetrics and Gynaecology, Maurizio Bufalini Hospital, Cesena, Italy
| | - Mauro Tintoni
- Department of Obstetrics and Gynaecology, Maurizio Bufalini Hospital, Cesena, Italy
| | - Federico Spelzini
- Department of Obstetrics and Gynaecology, Infermi Hospital Rimini, Rimini, Italy
| | - Anna Martinelli
- Department of Obstetrics and Gynaecology, Infermi Hospital Rimini, Rimini, Italy
| | - Fabio Facchinetti
- Obstetric Unit, Mother Infant Department, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy
- Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - G Chiossi
- Obstetric Unit, Mother Infant Department, Azienda Ospedaliera Universitaria Policlinico di Modena, Modena, Italy
- Department of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynaecology, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Milano, Italy
| |
Collapse
|
27
|
Giardini V, Ornaghi S, Acampora E, Vasarri MV, Arienti F, Gambacorti-Passerini C, Casati M, Carrer A, Vergani P. Letter to the Editor: SFlt-1 and PlGF Levels in Pregnancies Complicated by SARS-CoV-2 Infection. Viruses 2021; 13:v13122377. [PMID: 34960646 PMCID: PMC8705418 DOI: 10.3390/v13122377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 01/19/2023] Open
Affiliation(s)
- Valentina Giardini
- Department of Obstetrics and Gynecology, MBBM Foundation, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy; (S.O.); (E.A.); (M.V.V.); (F.A.); (P.V.)
- Correspondence:
| | - Sara Ornaghi
- Department of Obstetrics and Gynecology, MBBM Foundation, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy; (S.O.); (E.A.); (M.V.V.); (F.A.); (P.V.)
| | - Eleonora Acampora
- Department of Obstetrics and Gynecology, MBBM Foundation, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy; (S.O.); (E.A.); (M.V.V.); (F.A.); (P.V.)
| | - Maria Viola Vasarri
- Department of Obstetrics and Gynecology, MBBM Foundation, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy; (S.O.); (E.A.); (M.V.V.); (F.A.); (P.V.)
| | - Francesca Arienti
- Department of Obstetrics and Gynecology, MBBM Foundation, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy; (S.O.); (E.A.); (M.V.V.); (F.A.); (P.V.)
| | - Carlo Gambacorti-Passerini
- Hematology Division, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.-P.); (A.C.)
| | - Marco Casati
- Laboratory Medicine, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy;
| | - Andrea Carrer
- Hematology Division, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy; (C.G.-P.); (A.C.)
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy; (S.O.); (E.A.); (M.V.V.); (F.A.); (P.V.)
| |
Collapse
|
28
|
Lazzarin S, Ornaghi S, D'Andrea LMP, Pucci B, Vergani P. Comment on: "amniotic fluid embolism - implementation of international diagnosis criteria and subsequent pregnancy recurrence risk". J Perinat Med 2021; 49:1163-1164. [PMID: 34499825 DOI: 10.1515/jpm-2021-0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Sara Lazzarin
- Department of Obstetrics, School of Medicine, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Sara Ornaghi
- Department of Obstetrics, School of Medicine, Università degli Studi di Milano-Bicocca, Monza, Italy
| | | | - Barbara Pucci
- Fondazione Monza Brianza per il Bambino e la sua Mamma, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics, School of Medicine, Università degli Studi di Milano-Bicocca, Monza, Italy
| |
Collapse
|
29
|
Palmieri S, De Bastiani SS, Degliuomini R, Ruffolo AF, Casiraghi A, Vergani P, Gallo P, Magoga G, Cicuti M, Parma M, Frigerio M. Prevalence and severity of pelvic floor disorders in pregnant and postpartum women. Int J Gynaecol Obstet 2021; 158:346-351. [PMID: 34778951 DOI: 10.1002/ijgo.14019] [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: 09/21/2021] [Revised: 10/31/2021] [Accepted: 11/10/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This multicenter study aimed to evaluate risk factors, prevalence and severity of pelvic floor disorders (PFDs) as well as their consequences on women's emotional well-being, using a questionnaire validated specifically for pregnancy and postpartum. METHODS Prospective study conducted in eight teaching hospitals in Italy and Italian-speaking Switzerland. Pregnant and postpartum women completed the Italian Pelvic Floor Questionnaire for Pregnancy and Postpartum anonymously. Prevalence of, severity of, and risk factors for PFDs were evaluated for all the four domains considered: bladder, bowel, prolapse, and sexual function. RESULTS A total of 2007 women were included: 983 of the patients were bothered by at least one kind of PFD: bladder, bowel, and sexual dysfunction were more frequently reported. There were no significant differences in PFD prevalence between pregnancy and postpartum, except for bladder disorders, which were more prevalent in pregnancy. Familiarity for PFDs, pelvic floor contraction inability, cigarette smoking, body mass index more than 25 (calculated as weight in kilograms divided by the square of height in meters), and age more than 35 years were confirmed risk factors for the development of PFDs during pregnancy and postpartum. CONCLUSION Almost half of the women included in the study suffered from PFD-related symptoms with important consequences on quality of life. Validated questionnaires are fundamental in early diagnosis and treatment of PFDs.
Collapse
Affiliation(s)
| | | | | | | | - Arianna Casiraghi
- Gynecology Division, Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizia Vergani
- Gynaecology Division, Milano-Bicocca University, Milan, Italy
- Obstetric Division, Monza and Brianza Mother and Child Foundation, Monza, Italy
| | | | - Giulia Magoga
- ULSS2 Marca Trevigiana, Oderzo Hospital, Oderzo, Italy
| | - Marta Cicuti
- ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | | | | |
Collapse
|
30
|
Ornaghi S, Fumagalli S, Guinea Montalvo CK, Beretta G, Invernizzi F, Nespoli A, Vergani P. Indirect impact of SARS-CoV-2 pandemic on pregnancy and childbirth outcomes: A nine-month long experience from a university center in Lombardy. Int J Gynaecol Obstet 2021; 156:466-474. [PMID: 34669973 PMCID: PMC9087530 DOI: 10.1002/ijgo.13990] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/19/2021] [Indexed: 01/23/2023]
Abstract
Objective To determine the impact on perinatal health of changes in social policies and obstetric care implemented to curb SARS‐CoV‐2 transmission. However, robust data on the topic are lacking since most of the studies has examined only the first few months of the outbreak. Methods A retrospective analysis of prospectively collected data on uninfected and asymptomatically infected women giving birth between March and November 2020 and in the same time frame of 2019 at our tertiary care center in Lombardy, northern Italy. Perinatal outcomes were compared according to the year (2019 versus 2020) and to the trimester (March–May, June–August, September–November) of childbirth, corresponding to the three phases of the pandemic (first wave, deceleration, second wave) and covering a 9‐month period. Results We identified increased rates of gestational diabetes mellitus, spontaneous preterm birth, and neuraxial analgesia in 2020 versus 2019, with different temporal distributions: gestational diabetes mellitus and spontaneous preterm birth were more prevalent during the deceleration and the second wave phase, whereas epidural analgesia was more prevalent during the first wave. Conclusion By assessing a prolonged time frame of the pandemic, we show that pandemic‐related control measures, as applied in Lombardy, impacted relevant perinatal outcomes of women giving birth at our center.
Collapse
Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Simona Fumagalli
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | | | - Greta Beretta
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Francesca Invernizzi
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Antonella Nespoli
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, Unit of Obstetrics, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy.,University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| |
Collapse
|
31
|
Faverio P, Ornaghi S, Stainer A, Invernizzi F, Borelli M, Brunetti F, La Milia L, Paolini V, Rona R, Foti G, Luppi F, Vergani P, Pesci A. Feasibility of CPAP application and variables related to worsening of respiratory failure in pregnant women with SARS-CoV-2 pneumonia: Experience of a tertiary care centre. PLoS One 2021; 16:e0258754. [PMID: 34665818 PMCID: PMC8525751 DOI: 10.1371/journal.pone.0258754] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023] Open
Abstract
Continuous positive airway pressure (CPAP) has been successfully applied to patients with COVID-19 to prevent endotracheal intubation. However, experience of CPAP application in pregnant women with acute respiratory failure (ARF) due to SARS-CoV-2 pneumonia is scarce. This study aimed to describe the natural history and outcome of ARF in a cohort of pregnant women with SARS-CoV-2 pneumonia, focusing on the feasibility of helmet CPAP (h-CPAP) application and the variables related to ARF worsening. A retrospective, observational study enrolling 41 consecutive pregnant women hospitalised for SARS-CoV-2 pneumonia in a tertiary care center between March 2020 and March 2021. h-CPAP was applied if arterial partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2) was inferior to 200 and/or patients had respiratory distress despite adequate oxygen supplementation. Characteristics of patients requiring h-CPAP vs those in room air or oxygen only were compared. Twenty-seven (66%) patients showed hypoxemic ARF requiring oxygen supplementation and h-CPAP was needed in 10 cases (24%). PaO2/FiO2 was significantly improved during h-CPAP application. The device was well-tolerated in all cases with no adverse events. Higher serum C reactive protein and more extensive (≥3 lobes) involvement at chest X-ray upon admission were observed in the h-CPAP group. Assessment of temporal distribution of cases showed a substantially increased rate of CPAP requirement during the third pandemic wave (January-March 2021). In conclusion, h-CPAP was feasible, safe, well-tolerated and improved oxygenation in pregnant women with moderate-to-severe ARF due to SARS-CoV-2 pneumonia. Moderate-to-severe ARF was more frequently observed during the third pandemic wave.
Collapse
Affiliation(s)
- Paola Faverio
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
- * E-mail:
| | - Sara Ornaghi
- Obstetric Unit, School of Medicine and Surgery, University of Milano Bicocca, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Anna Stainer
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Francesca Invernizzi
- Obstetric Unit, School of Medicine and Surgery, University of Milano Bicocca, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Mara Borelli
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Federica Brunetti
- Department of Obstetrics and Gynaecology, Desio Hospital, ASST Monza, Desio, Italy
| | - Laura La Milia
- Obstetric Unit, School of Medicine and Surgery, University of Milano Bicocca, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Valentina Paolini
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Roberto Rona
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy
| | - Giuseppe Foti
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy
| | - Fabrizio Luppi
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Patrizia Vergani
- Obstetric Unit, School of Medicine and Surgery, University of Milano Bicocca, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Alberto Pesci
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
| |
Collapse
|
32
|
Nespoli A, Ornaghi S, Borrelli S, Vergani P, Fumagalli S. Lived experiences of the partners of COVID-19 positive childbearing women: A qualitative study. Women Birth 2021; 35:289-297. [PMID: 34353766 PMCID: PMC9051041 DOI: 10.1016/j.wombi.2021.07.006] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/26/2022]
Abstract
Problem Several maternity units worldwide have rapidly put in place changes to maternity care pathways and restrictive preventive measures in the attempt to limit the spread of COVID-19, resulting in birth companions often not being allowed to be present at birth and throughout hospital admission. Background The WHO strongly recommends that the emotional, practical, advocacy and health benefits of having a chosen birth companion are respected and accommodated, including women with suspected, likely or confirmed COVID-19. Aim To explore the lived experiences of the partners of COVID-19 positive childbearing women who gave birth during the first pandemic wave (March and April 2020) in a Northern Italy maternity hospital. Methods A qualitative study using an interpretive phenomenological approach was undertaken. Audio-recorded semi-structured interviews were conducted with 14 partners. Thematic data analysis was conducted using NVivo software. Ethical approval was obtained from the relevant Ethics Committee prior to commencing the study. Findings The findings include five main themes: (1) emotional impact of the pandemic; (2) partner and parent: a dual role; (3) not being present at birth: a ‘denied’ experience; (4) returning to ‘normality’; (5) feedback to ‘pandemic’ maternity services and policies. Discussion and conclusion Key elements of good practice to promote positive childbirth experiences in the context of a pandemic were identified: presence of a birth companion; COVID-19 screening tests for support persons; timely, proactive and comprehensive communication of information to support persons; staggered hospital visiting times; follow-up of socio-psychological wellbeing; antenatal and postnatal home visiting; family-centred policies and services.
Collapse
Affiliation(s)
- Antonella Nespoli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Sara Ornaghi
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Sara Borrelli
- Division of Midwifery, School of Health Sciences, The University of Nottingham, Nottingham, United Kingdom
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Simona Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| |
Collapse
|
33
|
Lambicchi L, Ornaghi S, Dal Molin G, Paterlini G, Bernasconi DP, Moltrasio F, Vergani P. Different antecedents and neonatal condition in neonatal arterial ischemic stroke and hypoxic-ischemic neonatal encephalopathy. Int J Gynaecol Obstet 2021; 157:333-339. [PMID: 34101180 PMCID: PMC9290624 DOI: 10.1002/ijgo.13781] [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: 01/29/2021] [Revised: 05/13/2021] [Accepted: 06/07/2021] [Indexed: 11/26/2022]
Abstract
Objective To define similarities and differences between neonatal arterial ischemic stroke (NAIS) and hypoxic‐ischemic neonatal encephalopathy (HINE). Methods A retrospective case‐control study was conducted of neonates born at 35 weeks or more and weighing 1800 g or more at a tertiary care university hospital, between 2005 and 2016, with NAIS (group A), perinatal asphyxia (PA) with Stage II–III HINE (group B), and PA with or without Stage I HINE (group C). Ante‐ and intrapartum data, neonatal characteristics, and placental histopathology were compared. Results Eleven neonates were identified in group A, 10 in group B, and 227 in group C. Sentinel events occurred exclusively in groups B (80%) and C (41.4%). Umbilical cord blood gas values and Apgar score were worse in groups B and C compared to group A. No group A neonates required resuscitation at birth, whereas all group B and one‐third of group C neonates did. Seizures developed only in neonates in groups A and B. One neonatal death occurred in group A. There were no significant differences in placental histopathology. Conclusion NAIS and PA/HINE cases have different intrapartum and neonatal features. PA does not seem necessary for the occurrence of NAIS. More research is needed regarding associated placental abnormalities. Birth asphyxia does not seem necessary for neonatal arterial ischemic stroke occurrence. The two conditions have different ante‐/intrapartum and neonatal features.
Collapse
Affiliation(s)
- Laura Lambicchi
- Department of Obstetrics and Gynecology, MBBM Foundation, San Gerardo Hospital, University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Sara Ornaghi
- Department of Obstetrics and Gynecology, MBBM Foundation, San Gerardo Hospital, University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Giulia Dal Molin
- University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy.,Department of Obstetrics and Gynecology, Macedonio Melloni Hospital, University of Milan School of Medicine and Surgery, Milan, Italy
| | - Giuseppe Paterlini
- Neonatal Intensive Care Unit, Department of Neonatology, MBBM Foundation, San Gerardo Hospital, Monza, Italy.,Neonatal Intensive Care Unit, Department of Mother and Child Health, Fondazione Poliambulanza, Brescia, Italy
| | - Davide P Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Francesca Moltrasio
- Department of Pathology, San Gerardo Hospital, University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation, San Gerardo Hospital, University of Milan-Bicocca School of Medicine and Surgery, Monza, Italy
| |
Collapse
|
34
|
Colciago E, Fumagalli S, Ciarmoli E, Antolini L, Nespoli A, Mastrolia SA, Tagliabue PE, Furlan C, Manganini C, Vergani P. The effect of clamped and unclamped umbilical cord samples on blood gas analysis. Arch Gynecol Obstet 2021; 304:1493-1499. [PMID: 34021806 PMCID: PMC8553729 DOI: 10.1007/s00404-021-06076-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/16/2021] [Indexed: 12/02/2022]
Abstract
Purpose Delayed cord clamping for at least 60 s is recommended to improve neonatal outcomes. The aim of this study is to evaluate whether there are differences in cord BGA between samples collected after double clamping the cord or without clamping the cord, when blood collection occurs within 60 s from birth in both groups. Methods A cross-sectional study was carried out, collecting data from 6884 high-risk women who were divided into two groups based on the method of cord sampling (clamped vs unclamped). Results There were significant decrease in pH and BE values into unclamped group compared with the clamped group. This difference remained significant when considering pathological blood gas analysis parameters, with a higher percentage of pathological pH or BE values in the unclamped group. Conclusion Samples from the unclamped cord alter the acid–base parameters compared to collection from the clamped cord; however, this difference does not appear to be of clinical relevance. Findings could be due to the large sample size, which allowed to achieve a high power and to investigate very small numerical changes between groups, leading to a statistically significant difference in pH and BE between samples even when we could not appreciate any clinical relevant difference of pH or BE between groups. When blood gas analysis is indicated, the priority should be given to the timing of blood collection to allow reliable results, to assess newborns status at birth and intervene when needed.
Collapse
Affiliation(s)
- Elisabetta Colciago
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Simona Fumagalli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. .,San gerardo Hospital, Monza, Italy.
| | - Elena Ciarmoli
- Neonatal Intensive Care Unit, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Laura Antolini
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Antonella Nespoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Salvatore Andrea Mastrolia
- Department of Obstetrics and Gynecology, Ospedale dei Bambini "Vittore Buzzi", University of Milano, Milan, Italy
| | | | - Chiara Furlan
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Fondazione MBBM, Monza, Italy
| | - Cristina Manganini
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Patrizia Vergani
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Fondazione MBBM, Monza, Italy
| |
Collapse
|
35
|
Tasca C, Rossi RS, Corti S, Anelli GM, Savasi V, Brunetti F, Cardellicchio M, Caselli E, Tonello C, Vergani P, Nebuloni M, Cetin I. Placental pathology in COVID-19 affected pregnant women: A prospective case-control study. Placenta 2021; 110:9-15. [PMID: 34058611 PMCID: PMC8096756 DOI: 10.1016/j.placenta.2021.04.002] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 01/23/2023]
Abstract
Introduction During pregnancy, SARS-CoV-2 infection may cause an abnormal development of the placenta, thus influencing maternal and fetal outcomes. Few studies have reported data on placental morphology and histology in infected pregnant patients, although not compared with carefully matched controls. The aim of this study is to compare placental morphology and histology of pregnant women affected by SARS-CoV-2 to non-infected controls. Methods This is a prospective multicenter case-control study on 64 pregnant women affected by SARS-CoV-2 who delivered at term or late-preterm. Data were collected about pregnancy course, maternal and fetal outcomes, placental biometry and macro- and microscopical morphology. 64 not-infected women were identified as controls, matched by age, body mass index and ethnicity. Results Cases and controls had similar fetal and maternal outcomes. No significant differences were observed in placental macro- or microscopical morphology between the two groups. In the cases treated with antivirals, chloroquine, LMWH or antibiotics, placentas were heavier but not more efficient than the non-treated, since the fetal/placental weight ratio did not differ. Moreover, delayed villous maturation was more frequent in treated women, although not significantly. The newborns whose mothers received oxygen therapy as treatment had higher levels of umbilical cord pO₂ at birth. Discussion In this prospective case-control study, SARS-CoV-2 infection during the third trimester did not influence placental histological pattern. Pharmacological and oxygen therapy administered to women affected by this viral infection could impact maternal and fetal outcomes and be associated to placental histological alterations.
Collapse
Affiliation(s)
- Chiara Tasca
- Department of Obstetrics and Gynecology, Vittore Buzzi Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milano, Italy
| | - Roberta Simona Rossi
- Pathology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milan, Italy
| | - Silvia Corti
- Department of Obstetrics and Gynecology, Vittore Buzzi Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milano, Italy
| | - Gaia Maria Anelli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milano, Italy
| | - Valeria Savasi
- Unit of Obstetrics and Gynecology, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milano, Italy
| | - Federica Brunetti
- Pathology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milan, Italy
| | - Manuela Cardellicchio
- Unit of Obstetrics and Gynecology, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milano, Italy
| | - Emilio Caselli
- Pathology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milan, Italy
| | - Cristina Tonello
- Pathology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milan, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Manuela Nebuloni
- Pathology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milan, Italy
| | - Irene Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences "Luigi Sacco", Università Degli Studi di Milano, Milano, Italy.
| |
Collapse
|
36
|
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.
Collapse
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;
| |
Collapse
|
37
|
Ornaghi S, Guinea Montalvo CK, Fumagalli S, Vasarri MV, Bracchi M, Nespoli A, Vergani P. Use of facemask during labor does not affect cord blood gas values at birth. Eur J Obstet Gynecol Reprod Biol 2021; 261:242-243. [PMID: 33863581 DOI: 10.1016/j.ejogrb.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics and Gynecology, MBBM Foundation Onlus at San Gerardo Hospital, Italy; University of Milan-Bicocca School of Medicine and Surgery, Italy.
| | | | - Simona Fumagalli
- Department of Obstetrics and Gynecology, MBBM Foundation Onlus at San Gerardo Hospital, Italy; University of Milan-Bicocca School of Medicine and Surgery, Italy
| | - Maria Viola Vasarri
- Department of Obstetrics and Gynecology, MBBM Foundation Onlus at San Gerardo Hospital, Italy; University of Milan-Bicocca School of Medicine and Surgery, Italy
| | - Michela Bracchi
- Department of Obstetrics and Gynecology, MBBM Foundation Onlus at San Gerardo Hospital, Italy
| | | | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation Onlus at San Gerardo Hospital, Italy; University of Milan-Bicocca School of Medicine and Surgery, Italy
| |
Collapse
|
38
|
Chiossi G, Di Tommaso M, Monari F, Consonni S, Strambi N, Zoccoli SG, Seravalli V, Comerio C, Betti M, Cappello A, Vergani P, Facchinetti F, Locatelli A. Neonatal outcomes and risk of neonatal sepsis in an expectantly managed cohort of late preterm prelabor rupture of membranes. Eur J Obstet Gynecol Reprod Biol 2021; 261:1-6. [PMID: 33857797 DOI: 10.1016/j.ejogrb.2021.03.036] [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: 12/29/2020] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Expectant management in patients with prelabor preterm rupture of membranes between between 340/7 and 36 6/7 weeks (late preterm pPROM or LpPROM) has been shown to decrease the burden of prematurity, when compared to immediate delivery. As the severity of prematurity depends on gestational age (GA) at PROM, and PROM to delivery interval, we first investigated how such variables affect neonatal outcomes (NO). Second, we assessed the risk of neonatal sepsis. STUDY DESIGN retrospective cohort study on neonatal morbidity among singleton infants born to expectantly managed mothers with LpPROM in five hospitals affiliated with three Italian academic institutions. The primary NO was a composite of neonatal death, non-invasive (cPAP) or invasive (mechanical ventilation) respiratory support, hypoglycemia (< 44 mg/dl needing therapy), newborn sepsis, confirmed seizures, stroke, intraventricular hemorrhage (IVH), basal nuclei anomalies, cardiopulmonary resuscitation, umbilical-cord-blood arterial pH < 7.0 or base excess < -12.5, and prolonged hospitalization (≥ 5 days). Univariate analysis described differences in the population according to GA at delivery. Multivariate logistic regression was then used to investigate the effects of GA at PROM, and PROM to delivery interval on the NO. RESULTS 258/606 (42.6 %) women with LpPROM were expectantly managed, as they did not deliver within the first 24 h. The median latency duration was 2 (95 %CI 1-3) days, having no effect on neonatal morbidity on multivariate analysis. Multivariate analysis also showed increased risks of adverse NO among PROM at 34 (OR 2.3 95 %CI 1.03-5.1) but not at 35 weeks when compared to 36 weeks, and among women receiving antenatal corticosteroids (OR 3.6 95 %CI 1.3-9.7), while antibiotic treatment showed a non-significant protective effect (OR 0.2 95 %CI 0.04-1.02). Prevalence of neonatal sepsis was 0.8 % (2/258) CONCLUSION: Expectant management of LpPROM should be encouraged especially between 34+0 and 34+6 weeks', when the burden of prematurity is the greatest. Antibiotics may have beneficial effects, while careful consideration should be given to antenatal corticosteroids until future studies specifically address LpPROM.
Collapse
Affiliation(s)
- Giuseppe Chiossi
- Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy
| | - Mariarosaria Di Tommaso
- Department of Health Science, University of Florence, Maternal Infant Department Careggi Hospital, Florence, Italy.
| | - Francesca Monari
- Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy
| | - Sara Consonni
- Obstetrics and Gynecology, University of Milano-Bicocca, FMBBM Monza, Carate Hospital, Lecco Hospital, Italy
| | - Noemi Strambi
- Department of Health Science, University of Florence, Maternal Infant Department Careggi Hospital, Florence, Italy
| | | | - Viola Seravalli
- Department of Health Science, University of Florence, Maternal Infant Department Careggi Hospital, Florence, Italy
| | - Chiara Comerio
- Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy
| | - Marta Betti
- Department of Obstetrics and Gynaecology, ASTT Lecco, Ospedale Alessandro Manzoni, Lecco, Italy
| | - Anna Cappello
- Obstetrics and Gynecology, University of Milano-Bicocca, FMBBM Monza, Carate Hospital, Lecco Hospital, Italy
| | - Patrizia Vergani
- Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, University of Milano Bicocca, Monza, Italy
| | - Fabio Facchinetti
- Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy
| | - Anna Locatelli
- Obstetrics and Gynecology, University of Milano-Bicocca, FMBBM Monza, Carate Hospital, Lecco Hospital, Italy
| |
Collapse
|
39
|
Chiossi G, Facchinetti F, Vergani P, Di Tommaso M, Marozio L, Acaia B, Pignatti L, Locatelli A, Spitaleri M, Benedetto C, Zaina B, D'Amico R. Serial cervical-length measurements after first episode of threatened preterm labor improve prediction of spontaneous delivery prior to 37 weeks' gestation. Ultrasound Obstet Gynecol 2021; 57:298-304. [PMID: 32851714 DOI: 10.1002/uog.22188] [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] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess whether repeat cervical-length (CL) measurement in women discharged from hospital after their first episode of threatened preterm labor can predict their risk of spontaneous preterm birth. METHODS This was a secondary analysis of a randomized controlled trial of maintenance tocolysis, in which CL was measured on transvaginal ultrasound at the time of hospital discharge and after 2, 4, 8 and 12 weeks, in women who remained undelivered after their first episode of threatened preterm labor. After univariate analysis, multivariate logistic regression analysis was used to assess whether CL < 10 mm at the time of hospital discharge or at any follow-up evaluation could predict spontaneous delivery prior to 37 weeks of gestation. RESULTS Of 226 women discharged after a diagnosis of threatened preterm labor, 57 (25.2%) delivered spontaneously prior to 37 weeks' gestation. The risk of spontaneous preterm birth was higher among women with CL < 10 mm at hospital discharge compared to those with CL ≥ 10 mm (adjusted odds ratio (aOR), 3.3; 95% CI, 1.2-9.2). Moreover, spontaneous preterm delivery was more common when CL < 10 mm was detected up to 2 weeks (aOR, 2.9; 95% CI, 1.1-7.3) or up to 4 weeks (aOR, 7.3; 95% CI, 2.3-22.8) post discharge, as compared with when CL was persistently ≥ 10 mm. The association was not significant when considering CL measurements at 8 weeks, and there was insufficient information to assess the effect of measurements obtained at 12 weeks. CONCLUSIONS Women who remain undelivered after their first episode of threatened preterm labor continue to be at high risk of spontaneous preterm birth if their CL is below 10 mm at the time of hospital discharge or at any follow-up visit up to 4 weeks later. CL measurement could be included in the antenatal care of these women in order to stratify their risk of preterm birth, rationalize resource utilization and help clinicians improve pregnancy outcome. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- G Chiossi
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - F Facchinetti
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - P Vergani
- Department of Medicine and Surgery, Obstetrics and Gynecology Branch, University of Milano-Bicocca Health Science, Milan, Italy
| | - M Di Tommaso
- Health Science Department, Obstetrics and Gynecology Branch, University of Florence, Florence, Italy
| | - L Marozio
- Department of Surgical Sciences, Gynecology and Obstetrics 1, University of Turin, Turin, Italy
| | - B Acaia
- Department of Medicine and Surgery, Obstetrics and Gynecology Branch, University of Milano-Bicocca Health Science, Milan, Italy
| | - L Pignatti
- Division of Obstetrics, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - A Locatelli
- Department of Medicine and Surgery, Obstetrics and Gynecology Branch, University of Milano-Bicocca Health Science, Milan, Italy
| | - M Spitaleri
- Health Science Department, Obstetrics and Gynecology Branch, University of Florence, Florence, Italy
| | - C Benedetto
- Department of Surgical Sciences, Gynecology and Obstetrics 1, University of Turin, Turin, Italy
| | - B Zaina
- Department of Medicine and Surgery, Obstetrics and Gynecology Branch, University of Milano-Bicocca Health Science, Milan, Italy
| | - R D'Amico
- Statistics Unit, Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
Fumagalli S, Ornaghi S, Borrelli S, Vergani P, Nespoli A. The experiences of childbearing women who tested positive to COVID-19 during the pandemic in northern Italy. Women Birth 2021; 35:242-253. [PMID: 33451929 PMCID: PMC7796658 DOI: 10.1016/j.wombi.2021.01.001] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/28/2020] [Accepted: 01/02/2021] [Indexed: 02/07/2023]
Abstract
Problem The COVID-19 pandemic has significantly challenged maternity provision internationally. COVID-19 positive women are one of the childbearing groups most impacted by the pandemic due to drastic changes to maternity care pathways put in place. Background Some quantitative research was conducted on clinical characteristics of pregnant women with COVID-19 and pregnant women’s concerns and birth expectations during the COVID-19 pandemic, but no qualitative findings on childbearing women’s experiences during the pandemic were published prior to our study. Aim To explore childbearing experiences of COVID-19 positive mothers who gave birth in the months of March and April 2020 in a Northern Italy maternity hospital. Methods A qualitative interpretive phenomenological approach was undertaken. Audio-recorded semi-structured interviews were conducted with 22 women. Thematic analysis was completed using NVivo software. Ethical approval was obtained from the research site’s Ethics Committee prior to commencing the study. Findings The findings include four main themes: 1) coping with unmet expectations; 2) reacting and adapting to the ‘new ordinary’; 3) ‘pandemic relationships’; 4) sharing a traumatic experience with long-lasting emotional impact. Discussion The most traumatic elements of women’s experiences were the sudden family separation, self-isolation, transfer to a referral centre, the partner not allowed to be present at birth and limited physical contact with the newborn. Conclusion Key elements of good practice including provision of compassionate care, presence of birth companions and transfer to referral centers only for the most severe COVID-19 cases should be considered when drafting maternity care pathways guidelines in view of future pandemic waves.
Collapse
Affiliation(s)
- Simona Fumagalli
- Department of Obstetrics and Gynecology, San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Sara Ornaghi
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Sara Borrelli
- Division of Midwifery, School of Health Sciences, The University of Nottingham, Nottingham, United Kingdom
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Antonella Nespoli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| |
Collapse
|
42
|
Ornaghi S, Fumagalli S, Nespoli A, Vergani P. Delivery table shield to assist suspected and confirmed severe acute respiratory syndrome coronavirus 2-positive women in labor. Am J Obstet Gynecol 2020; 223:777-778. [PMID: 32682857 PMCID: PMC7366076 DOI: 10.1016/j.ajog.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
|
43
|
Barba M, Frigerio M, Manodoro S, Bernasconi DP, Cola A, Palmieri S, Fumagalli S, Vergani P. Postpartum urinary retention: Absolute risk prediction model. Low Urin Tract Symptoms 2020; 13:257-263. [PMID: 33118328 DOI: 10.1111/luts.12362] [Citation(s) in RCA: 5] [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] [Received: 08/10/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the incidence and assess clinical factors that can predict the occurrence of postpartum urinary retention (PPUR). PPUR is a puerperal condition defined as the inability to void over 6 hours after birth or after catheter removal in case of cesarean section, requiring catheterization. Lack of prompt diagnosis of this condition may lead to severe sequelae, including infection, chronic voiding difficulties, and renal failure. METHODS This retrospective cohort study analyzed all deliveries from January 2011 to December 2017 in a single Italian university hospital. We used multivariate logistic regression to develop a predictive score for PPUR. RESULTS By multivariate logistic regression, our analysis shows as minor (odds ratio [OR] < 2) risk factors for PPUR: non-Caucasian ethnicity (OR = 1.46, CI = 1.05-2.03), nulliparity (OR = 1.47, CI = 1.01-2.14), body mass index (BMI) at the end of the pregnancy <30 kg/m2 (OR = 1.54, CI = 1.10-2.17). On the other hand, epidural analgesia (OR = 3.93, CI = 2.96-5.22), meconium-stained amniotic fluid (OR = 2.07, CI = 1.54-2.77), nonoperative vaginal birth vs cesarean section (OR = 6.25, CI = 2.16-18.13), vacuum extraction vs cesarean section (OR = 8.80, CI = 2.86-27.01), pushing stage ≥60 minutes (OR = 3.00,CI = 2.26-3.97), and perineal tear (OR = 2.87, CI = 1.86-4.43) proved to be major (OR > 2) risk factors for PPUR. Using our final model (area under curve = 0.84), we created a nomogram for PPUR absolute risk calculation. Specifically, a 116-point cutoff might be used to identify high-risk patients who deserve more intensive micturition monitoring. CONCLUSIONS Our study identified non-Caucasian ethnicity, nulliparity, and a BMI <30 kg/m2 at the end of the pregnancy as minor and epidural analgesia, meconium-stained amniotic fluid, vaginal nonoperative birth, vacuum extraction, pushing stage ≥60 minutes, and perineal tear as major independent risk factors for PPUR.
Collapse
Affiliation(s)
- Marta Barba
- University of Milano-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Matteo Frigerio
- University of Milano-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | | | | | - Alice Cola
- University of Milano-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Stefania Palmieri
- University of Milano-Bicocca, ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Simona Fumagalli
- University Milano-Bicocca, Monza and Brianza Mother and Child Foundation, San Gerardo Hospital, Monza, Italy
| | - Patrizia Vergani
- University Milano-Bicocca, Monza and Brianza Mother and Child Foundation, San Gerardo Hospital, Monza, Italy
| |
Collapse
|
44
|
Fenizia C, Biasin M, Cetin I, Vergani P, Mileto D, Spinillo A, Gismondo MR, Perotti F, Callegari C, Mancon A, Cammarata S, Beretta I, Nebuloni M, Trabattoni D, Clerici M, Savasi V. Analysis of SARS-CoV-2 vertical transmission during pregnancy. Nat Commun 2020; 11:5128. [PMID: 33046695 PMCID: PMC7552412 DOI: 10.1038/s41467-020-18933-4] [Citation(s) in RCA: 248] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/18/2020] [Indexed: 12/18/2022] Open
Abstract
The impact of SARS-CoV-2 infection during gestation remains unclear. Here, we analyse the viral genome on maternal and newborns nasopharyngeal swabs, vaginal swabs, maternal and umbilical cord plasma, placenta and umbilical cord biopsies, amniotic fluids and milk from 31 mothers with SARS-CoV-2 infection. In addition, we also test specific anti-SARS-CoV-2 antibodies and expression of genes involved in inflammatory responses in placentas, and in maternal and umbilical cord plasma. We detect SARS-CoV-2 genome in one umbilical cord blood and in two at-term placentas, in one vaginal mucosa and in one milk specimen. Furthermore, we report the presence of specific anti-SARS-CoV-2 IgM and IgG antibodies in one umbilical cord blood and in one milk specimen. Finally, in the three documented cases of vertical transmission, SARS-CoV-2 infection was accompanied by a strong inflammatory response. Together, these data support the hypothesis that in utero SARS-CoV-2 vertical transmission, while low, is possible. These results might help defining proper obstetric management of COVID-19 pregnant women, or putative indications for mode and timing of delivery.
Collapse
MESH Headings
- Adolescent
- Adult
- Antibodies, Viral/analysis
- Betacoronavirus/genetics
- Betacoronavirus/immunology
- Betacoronavirus/isolation & purification
- COVID-19
- Coronavirus Infections/diagnosis
- Coronavirus Infections/pathology
- Coronavirus Infections/transmission
- Coronavirus Infections/virology
- Female
- Genome, Viral
- Humans
- Infant, Newborn
- Infectious Disease Transmission, Vertical
- Inflammation
- Middle Aged
- Pandemics
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/pathology
- Pneumonia, Viral/transmission
- Pneumonia, Viral/virology
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/pathology
- Pregnancy Complications, Infectious/virology
- SARS-CoV-2
- Young Adult
Collapse
Affiliation(s)
- Claudio Fenizia
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Mara Biasin
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Irene Cetin
- Department of Woman, Mother and Neonate Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, Milan, Italy
| | - Patrizia Vergani
- Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy
| | - Davide Mileto
- Clinical Microbiology, Virology and Bio-emergence Diagnosis, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Maria Rita Gismondo
- Clinical Microbiology, Virology and Bio-emergence Diagnosis, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Francesca Perotti
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Clelia Callegari
- Department of Maternal Fetal Medicine, Fondazione MBBM, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy
| | - Alessandro Mancon
- Clinical Microbiology, Virology and Bio-emergence Diagnosis, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Selene Cammarata
- Unit of Obstetrics and Gynecology, ASST Fatebenefratelli-Sacco, Department of Biological and Clinical Sciences, University of Milan, Milan, Italy
| | - Ilaria Beretta
- Division of Infectious Diseases, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Manuela Nebuloni
- Pathology Unit, ASST Fatebenfretalli-Sacco, Department of Biological and Clinical Sciences, University of Milan, Milan, Italy
| | - Daria Trabattoni
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Mario Clerici
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- IRCCS Fondazione don Carlo Gnocchi, Milan, Italy
| | - Valeria Savasi
- Unit of Obstetrics and Gynecology, ASST Fatebenefratelli-Sacco, Department of Biological and Clinical Sciences, University of Milan, Milan, Italy.
| |
Collapse
|
45
|
Familiari A, Khalil A, Rizzo G, Odibo A, Vergani P, Buca D, Hidaka N, Di Mascio D, Nwabuobi C, Simeone S, Mecacci F, Visentin S, Cosmi E, Liberati M, D'Amico A, Flacco ME, Martellucci CA, Manzoli L, Nappi L, Iacovella C, Bahlmann F, Melchiorre K, Scambia G, Berghella V, D'Antonio F. Adverse intrapartum outcome in pregnancies complicated by small for gestational age and late fetal growth restriction undergoing induction of labor with Dinoprostone, Misoprostol or mechanical methods: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2020; 252:455-467. [PMID: 32738675 DOI: 10.1016/j.ejogrb.2020.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 04/01/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the outcome of pregnancies with small baby, including both small for gestational age (SGA) and late fetal growth restriction (FGR) fetuses, undergoing induction of labor (IOL) with Dinoprostone, Misoprostol or mechanical methods. STUDY DESIGN Medline, Embase and Cochrane databases were searched. Inclusion criteria were non-anomalous singleton pregnancies complicated by the presence of a small fetus, defined as a fetus with estimated fetal weight (EFW) or abdominal circumference (AC) <10th centile undergoing IOL from 34 weeks of gestation with vaginal Dinoprostone, vaginal misoprostol, or mechanical methods (including either Foley or Cook balloon catheters). The primary outcome was a composite measure of adverse intrapartum outcome. Secondary outcomes were the individual components of the primary outcome, perinatal mortality and morbidity. All the explored outcomes were reported in three different sub-groups of pregnancies complicated by a small fetus including: all small fetuses (defined as those with an EFW and/or AC <10th centile irrespective of fetal Doppler status), late FGR fetuses (defined as those with EFW and/or AC <3rd centile or AC/EFW <10th centile associated with abnormal cerebroplacental Dopplers) and SGA fetuses (defined as those with EFW and/or AC <10th but >3rd centile with normal cerebroplacental Dopplers). Quality assessment of each included study was performed using the Risk of Bias in Non-randomized Studies-of Interventions tool (ROBINS-I), while the GRADE methodology was used to assess the quality of the body of retrieved evidence. Meta-analyses of proportions and individual data random-effect logistic regression were used to analyze the data. RESULTS 12 studies (1711 pregnancies) were included. In the overall population of small fetuses, composite adverse intra-partum outcome occurred in 21.2 % (95 % CI 10.0-34.9) of pregnancies induced with Dinoprostone, 18.0 % (95 % CI 6.9-32.5) of those with Misoprostol and 11.6 % (95 % CI 5.5-19.3) of those undergoing IOL with mechanical methods. Cesarean section (CS) for non-reassuring fetal status (NRFS) was required in 18.1 % (95 % CI 9.9-28.3) of pregnancies induced with Dinoprostone, 9.4 % (95 % CI 1.4-22.0) of those with Misoprostol and 8.1 % (95 % CI 5.0-11.6) of those undergoing mechanical induction. Likewise, uterine tachysystole, was recorded on CTG in 13.8 % (95 % CI 6.9-22.3) of cases induced with Dinoprostone, 7.5 % (95 % CI 2.1-15.4) of those with Misoprostol and 3.8 % (95 % CI 0-4.4) of those induced with mechanical methods. Composite adverse perinatal outcome following delivery complicated 2.9 % (95 % CI 0.5-6.7) newborns after IOL with Dinoprostone, 0.6 % (95 % CI 0-2.5) with Misoprostol and 0.7 % (95 % CI 0-7.1) with mechanical methods. In pregnancies complicated by late FGR, adverse intrapartum outcome occurred in 25.3 % (95 % CI 18.8-32.5) of women undergoing IOL with Dinoprostone, compared to 7.4 % (95 % CI 3.9-11.7) of those with mechanical methods, while CS for NRFS was performed in 23.8 % (95 % CI 17.3-30.9) and 6.2 % (95 % CI 2.8-10.5) of the cases, respectively. Finally, in SGA fetuses, composite adverse intrapartum outcome complicated 8.4 % (95 % CI 4.6-13.0) of pregnancies induced with Dinoprostone, 18.6 % (95 % CI 13.1-25.2) of those with Misoprostol and 8.7 (95 % CI 2.5-17.5) of those undergoing mechanical IOL, while CS for NRF was performed in 8.4 % (95 % CI 4.6-13.0) of women induced with Dinoprostone, 18.6 % (95 % CI 13.1-25.2) of those with Misoprostol and 8.7 % (95 % CI 2.5-17.5) of those undergoing mechanical induction. Overall, the quality of the included studies was low and was downgraded due to considerable clinical and statistical heterogeneity. CONCLUSIONS There is limited evidence on the optimal type of IOL in pregnancies with small fetuses. Mechanical methods seem to be associated with a lower occurrence of adverse intrapartum outcomes, but a direct comparison between different techniques could not be performed.
Collapse
Affiliation(s)
- Alessandra Familiari
- Department of Clinical and Community Sciences, University of Milan, and Department of Woman Child and Neonate, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom
| | - Giuseppe Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy; Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Anthony Odibo
- Division of Maternal Fetal Medicine, University of South Florida, Tampa, FL, USA
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, FMBBM Foundation, University of Milano-Bicocca, Monza, Italy
| | - Danilo Buca
- Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Nobuhiro Hidaka
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, "Sapienza" University of Rome, Rome, Italy; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Chinedu Nwabuobi
- Division of Maternal Fetal Medicine, University of South Florida, Tampa, FL, USA
| | - Serena Simeone
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - Federico Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - Silvia Visentin
- Gynecology and Obstetrics Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Eric Cosmi
- Gynecology and Obstetrics Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Marco Liberati
- Department of Obstetrics and Gynecology, University of Chieti, Italy
| | - Alice D'Amico
- Department of Obstetrics and Gynecology, University of Chieti, Italy
| | | | - Cecilia Acuti Martellucci
- Section of Hygiene and Preventive Medicine, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Lamberto Manzoli
- Section of Hygiene and Preventive Medicine, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Luigi Nappi
- Department of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Carlotta Iacovella
- Department of Obstetrics and Gynecology, Bürgerhospital Frankfurt, Frankfurt, Germany
| | - Franz Bahlmann
- Department of Obstetrics and Gynecology, Bürgerhospital Frankfurt, Frankfurt, Germany
| | - Karen Melchiorre
- Department of Obstetrics and Gynecology, Santo Spirito Hospital, Pescara, Italy
| | - Giovanni Scambia
- Gynaecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University of Foggia, Italy.
| |
Collapse
|
46
|
Giardini V, Carrer A, Casati M, Contro E, Vergani P, Gambacorti‐Passerini C. Increased sFLT-1/PlGF ratio in COVID-19: A novel link to angiotensin II-mediated endothelial dysfunction. Am J Hematol 2020; 95:E188-E191. [PMID: 32472588 PMCID: PMC7300446 DOI: 10.1002/ajh.25882] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Valentina Giardini
- Department of Obstetrics and GynecologyMBBM Foundation Monza Italy
- University of Milano‐Bicocca Monza Italy
| | | | - Marco Casati
- Laboratory MedicineSan Gerardo Hospital, ASST Monza Monza Italy
| | - Ernesto Contro
- Department of Emergency MedicineSan Gerardo Hospital, ASST Monza Monza Italy
| | - Patrizia Vergani
- Department of Obstetrics and GynecologyMBBM Foundation Monza Italy
- University of Milano‐Bicocca Monza Italy
| | | |
Collapse
|
47
|
Giardini V, Rovelli R, Algeri P, Giunti L, Lazzarin S, Callegari C, Roncaglia N, Vergani P. Placental growth factor as a predictive marker of preeclampsia - PREBIO study - PREeclampsia BIOchemical study. J Matern Fetal Neonatal Med 2020; 35:3029-3035. [PMID: 32689860 DOI: 10.1080/14767058.2020.1792878] [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] [Indexed: 10/23/2022]
Abstract
INTRODUCTION To evaluate the clinical utility of placental growth factor (PlGF) for the prediction of preeclampsia (PE). MATERIALS AND METHODS This prospective cohort study included women divided into three groups: (1) pregnancies without preconceptional risk of developing PE; (2) pregnancies with a preconceptional and/or current risk of developing PE; (3) PE-complicated pregnancies (control group). Blood samples were collected every 4-5 weeks or during hospitalization from early second trimester until delivery in the group 1 and 2, at the diagnosis of PE in the group 3. Plasma levels of PlGF were measured using The Triage PlGF test (Alere) and considered pathological under the 5th centile for gestational age. Sensitivity (Sn), specificity (Sp), positive and negative predictive value (PPV, NPV) were calculated. RESULTS In group 1, 30% of women (3/10) had pathological test but none of them developed PE (Sp 70%, NPV 100%). In group 2 (n = 75), none of the patients with normal test developed PE (0/24), while 39% of women with PlGF < 5th centile (20/51) developed PE (Sn 100%, Sp 44%, PPV 39%, NPV 100%). In group 3 (n = 11) all women except one had a pathological PlGF test (Sn 90%, PPV 100%). CONCLUSIONS Our data support recent studies which identify PlGF as a biochemical marker not only of PE, but also of placental dysfunction. In fact, it is useful for ruling out PE in women at risk because of the high Sn and high NPV: a normal PlGF is related with a positive pregnancy outcome. Therefore, the measurement of this biomarker would simplify PE clinical management and would reduce costs.
Collapse
Affiliation(s)
- Valentina Giardini
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, MBBM Foundation, S. Gerardo Hospital, Monza, Italy
| | - Roberta Rovelli
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, MBBM Foundation, S. Gerardo Hospital, Monza, Italy
| | - Paola Algeri
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, MBBM Foundation, S. Gerardo Hospital, Monza, Italy
| | - Laura Giunti
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, MBBM Foundation, S. Gerardo Hospital, Monza, Italy
| | - Sara Lazzarin
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, MBBM Foundation, S. Gerardo Hospital, Monza, Italy
| | - Clelia Callegari
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, MBBM Foundation, S. Gerardo Hospital, Monza, Italy
| | - Nadia Roncaglia
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, MBBM Foundation, S. Gerardo Hospital, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, MBBM Foundation, S. Gerardo Hospital, Monza, Italy
| |
Collapse
|
48
|
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.
Collapse
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
| |
Collapse
|
49
|
Pignatti L, D'Amico R, Vergani P, Di Tommaso M, Acaia B, Benedetto C, Facchinetti F. Effectiveness of Progestogens as Maintenance Tocolysis and Urogenital Cultures: Secondary Analysis of the PROTECT Trial. AJP Rep 2020; 10:e198-e201. [PMID: 33094004 PMCID: PMC7571568 DOI: 10.1055/s-0040-1713788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 04/06/2020] [Indexed: 10/24/2022] Open
Abstract
Background In a recently published multicenter randomized controlled trial, we demonstrated that progestogens are not effective as maintenance tocolysis. Objective This study was aimed to evaluate if previous finding may be affected by positive urine culture and/or vaginal swab. Study Design We performed a secondary analysis of the PROTECT trial (NCT01178788). Women with singleton pregnancy between 22 and 31 6/7 weeks' gestation, admitted for threatened preterm labor were considered. At admission, we collected urine culture and vaginal swabs. At discharge, women with a cervical length ≤25 mm were randomized to vaginal progesterone or 17α-hydroxyprogesterone caproate or observation group. We used Chi-square statistics, considering 97.5% CI (confidence interval) and p -value less than 0.025 for significance. Results Urine culture and vaginal swabs were collected in 232 out of 235 patients included in the primary analysis. Overall, 31 out of 232 women (13.4%) had positive urine culture and 60 out of 232 (25.9%) had positive vaginal swab. In women with negative urine culture, a higher rate of preterm birth was found in vaginal progesterone group (27/69, 39.7%) respect with controls (14/68, 20.6%; relative risk [RR] = 1.90; 97.5% CI: 1.01-3.57; p = 0.018). Conclusion Among women with negative urine culture, the rate of preterm birth <37 weeks' gestation was significantly increased in those receiving vaginal progesterone, reinforcing our previous findings in symptomatic women.
Collapse
Affiliation(s)
- Lucrezia Pignatti
- Department of Mother Infant, Obstetrics and Gynecology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto D'Amico
- Department of Diagnostic, Clinical and Public Health Medicine, Statistics Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Vergani
- Department of Medicine and Surgery, Obstetrics Gynecology Branch, University of Milano-Bicocca Health Science, Milano, Lombardia, Italy
| | - Mariarosaria Di Tommaso
- Department of Health Science, Obstetrics and Gynecology Branch, University of Florence, Florence, Italy
| | - Barbara Acaia
- Obstetrics and Gynecology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico, Milan, Italy
| | - Chiara Benedetto
- Department of Surgical Sciences, Gynaecology and Obstetrics, University of Turin, Turin, Piemonte, Italy
| | - Fabio Facchinetti
- Department of Mother Infant, Obstetrics and Gynecology Unit, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
50
|
Moscheni M, Vergani P, Cetin I, Cromi A, Ghezzi F, Locatelli A, Iurlano E, Marconi A, Auxilia F, Bevilacqua L, Dell'Oro S, Picchetti CM, Scotti L, Trivelli M, Burato E. [The use of RCGO triggers in the obstetric - gynecological procedures: the impact on the reduction of adeverse events. The experience of the Lombardia Region]. Ig Sanita Pubbl 2020; 76:241-255. [PMID: 33161421] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The last few weeks of pregnancy are critical to a baby's health because important organs, including the brain and lungs, are not completely developed until the end of pregnancy. The adverse events during labor and childbirth can have very serious physical, psychological and financial consequences for the child, the family, health professionals and the whole community. These events can be reduced through interventions aimed at improving the safety and quality of care, based on evidence-based knowledge, guidelines and practices that must be widely and effectively applied. This work reports the experience of the Lombardy Region on improvement actions in the obstetric and gynecological procedures for the reduction of adverse events and sentinel events through the monitoring and management of the RCGS trigger tool.
Collapse
Affiliation(s)
- M Moscheni
- Coordinatore del Gruppo di Lavoro regionale Trigger in sala parto
| | - P Vergani
- Direttore della Scuola di Specialità di Ostetricia e Ginecologia Università degli Studi di Milano Bicocca
| | - I Cetin
- Professore Ordinario di Ostetricia e Ginecologia, Università degli Studi di Milano
| | - A Cromi
- Professore Associato Ostetricia e Ginecologia Università degli Studi dell'Insubria
| | - F Ghezzi
- Professore Ordinario di Ostetricia e Ginecologia, Università degli Studi dell'Insubria
| | - A Locatelli
- Direttore S.C. Ostetricia e Ginecologia ASST Vimercate
| | - E Iurlano
- Dirigente Medico. Responsabile Sala Parto IRCCS Policlinico Milano
| | - A Marconi
- Professore Ordinario di Ostetricia e Ginecologia, Università degli Studi di Milano
| | - F Auxilia
- Risk Manager, ASST Fatebenefratelli Sacco
| | | | - S Dell'Oro
- Scuola di Specializzazione in Ostetricia e Ginecologia Università degli studi Milano Biccocca
| | - C M Picchetti
- Centro Regionale gestione del rischio in sanità e sicurezza del paziente, DG Welfare - Regione Lombardia
| | - L Scotti
- Centro Regionale gestione del rischio in sanità e sicurezza del paziente, DG Welfare - Regione Lombardia
| | - M Trivelli
- Direttore DG Welfare - Regione Lombardia
| | - E Burato
- Coordinatore Centro Regionale gestione del rischio in sanità e sicurezza del paziente, DG Welfare - Regione Lombardia
| |
Collapse
|