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1.
Int J Mol Sci ; 25(9)2024 Apr 29.
Article in English | MEDLINE | ID: mdl-38732088

ABSTRACT

Pregnancy at advanced maternal age (AMA) is a condition of potential risk for the development of maternal-fetal complications with possible repercussions even in the long term. Here, we analyzed the changes in plasma redox balance and the effects of plasma on human umbilical cord mesenchymal cells (hUMSCs) in AMA pregnant women (patients) at various timings of pregnancy. One hundred patients and twenty pregnant women younger than 40 years (controls) were recruited and evaluated at various timings during pregnancy until after delivery. Plasma samples were used to measure the thiobarbituric acid reactive substances (TBARS), glutathione and nitric oxide (NO). In addition, plasma was used to stimulate the hUMSCs, which were tested for cell viability, reactive oxygen species (ROS) and NO release. The obtained results showed that, throughout pregnancy until after delivery in patients, the levels of plasma glutathione and NO were lower than those of controls, while those of TBARS were higher. Moreover, plasma of patients reduced cell viability and NO release, and increased ROS release in hUMSCs. Our results highlighted alterations in the redox balance and the presence of potentially harmful circulating factors in plasma of patients. They could have clinical relevance for the prevention of complications related to AMA pregnancy.


Subject(s)
Maternal Age , Mesenchymal Stem Cells , Nitric Oxide , Oxidation-Reduction , Reactive Oxygen Species , Thiobarbituric Acid Reactive Substances , Umbilical Cord , Humans , Female , Pregnancy , Adult , Mesenchymal Stem Cells/metabolism , Reactive Oxygen Species/metabolism , Nitric Oxide/metabolism , Nitric Oxide/blood , Thiobarbituric Acid Reactive Substances/metabolism , Umbilical Cord/cytology , Umbilical Cord/metabolism , Glutathione/metabolism , Glutathione/blood , Cell Survival , Oxidative Stress , Plasma/metabolism
2.
J Med Virol ; 96(2): e29474, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38373185

ABSTRACT

This study aimed to analyze the human papillomavirus (HPV) genotype distribution in a large cohort of high-grade vaginal intraepithelial neoplasia (VaIN) (vaginal HSIL, VaIN2/3) patients from two Italian referral centers. We included all patients with histologically confirmed VaIN2/3 from the Department of Surgical Sciences, Sant'Anna Hospital, University of Torino, Torino, Italy, and Ospedale Maggiore della Carità, Novara, Italy, between 2003 and 2022. After the histological evaluation of formalin-fixed paraffin-embedded samples, we performed HPV genotyping with VisionArray HPV Chip 1.0. We detected HPV DNA in 94.4% of VaIN2/3 (168/178), with HPV 16 as the most prevalent genotype, accounting for 51.8% of all infections, 41.2% of VaIN2 and 77.6% of VaIN3 cases. Other frequent genotypes were HPV 58 (8.3%, 10.9% of VaIN2 and 2.0% of VaIN3), HPV 73 (5.4%, 5.0% of VaIN2 and 6.1% of VaIN3), and HPV 31 (5.4%, 6.7% of VaIN2 and 2.0% of VaIN3). 73.2% of VaIN2/3 had a single HPV genotype infection and 26.8% a multiple infection (20.8% a double infection, 4.8% a triple infection, and 1.2% a quadruple infection). Single infection was more frequently present in VaIN3 than VaIN2 (81.6% vs. 69.8%). 69.1% of single infections and 73.3% of multiple infections had one or more genotypes covered by nine-valent HPV vaccine. HPV vaccination is expected to have a large impact on reducing the incidence of vaginal intraepithelial neoplasia.


Subject(s)
Carcinoma in Situ , Papillomavirus Infections , Uterine Cervical Dysplasia , Uterine Cervical Neoplasms , Vaginal Neoplasms , Female , Humans , Papillomavirus Infections/epidemiology , Genotype , Retrospective Studies , Carcinoma in Situ/epidemiology , Papillomaviridae/genetics , Human papillomavirus 16
3.
J Perinat Med ; 52(2): 215-221, 2024 Feb 26.
Article in English | MEDLINE | ID: mdl-37846639

ABSTRACT

OBJECTIVES: Although the knowledge on SARS-CoV-2 infection in pregnancy has greatly improved, there is still a lack of information on its role in the later stages of gestation. The aim of this study is to investigate whether SARS-CoV-2 discovered at delivery is associated with any obstetric or neonatal complications. METHODS: A retrospective case-control study was conducted at Department of Obstetrics, University Hospital Maggiore della Carità, Novara, Italy, from March 2020 to March 2023. Pregnant women admitted were tested for SARS-CoV-2. 168 women resulted positive at the time of delivery; the women were asymptomatic or paucisymptomatic. 170 negative women were selected as controls, selecting, for each SARS-CoV-2 positive patient, the patient who gave birth right before, if negative. Demographic and anamnestic characteristics, pregnancy, labor, and neonatal outcomes were evaluated. RESULTS: SARS-CoV-2 positive patients were more likely to have gestational diabetes (13.7 vs. 5.3 %) and required less frequently intrapartum analgesia (11.3 vs. 27 %) and labor augmentation (7.3 vs. 16.5 %). Post-partum hemorrhage rate was lower (13.7 vs. 22.9 %) and a shorter length of first and second stage of labor occurred. There were no statistically significant differences between the two groups regarding the mode of delivery and neonatal outcomes. CONCLUSIONS: SARS-CoV-2 positive patients have shorter labor length and a lower incidence of postpartum hemorrhage. Fewer obstetric interventions, as well as less use of intrapartum analgesia and oxytocin, could explain these findings. Moreover, gestational diabetes could increase susceptibility to infection. SARS-CoV-2 infection discovered at the time of delivery in asymptomatic or paucisymptomatic patients does not appear to increase the rate of cesarean delivery or other obstetric complications, and neonatal outcomes have not worsened.


Subject(s)
COVID-19 , Diabetes, Gestational , Labor, Obstetric , Postpartum Hemorrhage , Pregnancy Complications, Infectious , Humans , Infant, Newborn , Pregnancy , Female , COVID-19/epidemiology , Retrospective Studies , SARS-CoV-2 , Case-Control Studies , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Postpartum Hemorrhage/epidemiology , Pregnancy Outcome/epidemiology
4.
Case Rep Womens Health ; 39: e00536, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37663888

ABSTRACT

Lung adenosquamous carcinoma (ASC) is a rare biphasic malignant tumor with squamous cell carcinoma (SCC) and adenocarcinoma (AC) components. ASC is reported to be aggressive; the most common metastatic sites are the regional lymph nodes and surrounding areas. A 46-year-old woman was referred to the emergency department with a persistent dry cough. She underwent fibro-bronchoscopy and was diagnosed with an adenosquamous lung carcinoma. Other than pulmonary and lymphatic findings, a total-body computed tomography (CT) examination highlighted a hypodense formation, of about 9 mm, with a cystic appearance, at the level of the vaginal region. A biopsy performed in the posterior vaginal wall highlighted a vaginal wall flap with subepithelial localization of neoplasia, compatible with the pulmonary ASC. Oncologists took charge of the case and the patient commenced medical therapy with entrectinib. Four months later, she developed dyspnea, and high-resolution CT highlighted an increase in the pathological tissue causing bronchial occlusion. The patient underwent endobronchial stent placement and thereafter restarted therapy with entrectinib, previously stopped because of the new symptoms, and was closely monitored. Apparently only one case of vaginal metastasis from pulmonary tumor has been previously reported, and this is the first report of vaginal metastasis from ASC. Although extremely rare, the presence of such metastasis should be considered in women with suspected vaginal neoformations.

5.
Case Rep Womens Health ; 39: e00544, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37753223

ABSTRACT

Hydatiform mole occurs in 1/1000 singleton and 1/20000-100,000 twin pregnancies. Although the pregnancy often ends in a miscarriage or presents with many obstetric complications such as preeclampsia, vaginal bleeding, hyperthyroidism, prematurity, or fetal malformations, in some cases of twin pregnancy, one of the fetuses can develop normally. Coexistence of a viable fetus in a twin molar pregnancy is more commonly described for cases of complete hydatiform moles than partial hydatiform moles. A partial hydatiform mole coexisting with a normal fetus was suspected in a 40-year-old woman, G2P1, at twelve weeks of gestation of a twin dichorionic diamniotic pregnancy. Serial antenatal ultrasound scans and serial evaluations of human chorionic gonadotropin were performed, and a healthy baby was delivered at term without any obstetric or neonatal complications. A twin pregnancy with partial hydatidiform mole and a coexisting normal fetus is a rare obstetric condition that can result, under proper management, in the delivery of a healthy baby without any sequelae for the mother or child.

6.
Arch Gynecol Obstet ; 308(5): 1515-1524, 2023 11.
Article in English | MEDLINE | ID: mdl-37568070

ABSTRACT

BACKGROUND: Hysteroscopy plays a crucial role in diagnosing and managing various intrauterine pathologies. However, its execution can be influenced by patients' perception and understanding, which are often shaped by digital resources such as YouTubeTM. Given its popularity and accessibility, YouTubeTM has the potential to greatly influence patients' knowledge and expectations about this procedure, highlighting the need for accurate and reliable information. PURPOSE: This study aims to assess the reliability and quality of hysteroscopy information available to patients on YouTubeTM. Understanding the nature of information patients' access can help address their fears and potential misunderstandings about the procedure, consequently reducing the likelihood of suspension or postponement due to anxiety. METHODS: A comprehensive analysis of YouTubeTM was conducted, simulating the search process of a patient seeking information about hysteroscopy. The study evaluated the reliability and quality of 90 out of the first 100 hysteroscopy-related videos on YouTubeTM, scored by four gynecologists-two experienced hysteroscopists and two trainees. The videos were assessed for reliability and quality using the mDISCERN and Global Quality Scale (GQS) scores. RESULTS: The average mDISCERN and GQS scores for the evaluated videos were below the optimal three points, highlighting the lack of fluency, comprehensiveness, and reliability of the available information. Notably, while videos produced by experts, including doctors and professional channels, had higher scores, they still fell short of the minimum score of 3. These videos also were not considered more suitable for either patients or trainees. Videos that were assessed as reliable (mDISCERN ≥ 3) were observed to be longer and were more frequently produced by doctors. These videos were suggested more to trainees rather than patients. Similarly, videos deemed as fluent and comprehensive (GQS ≥ 3) were longer and were more often recommended to patients. CONCLUSIONS: While YouTubeTM is a widely used source of medical information, the quality and reliability of hysteroscopy videos on the platform are poor. The strategic use of selected, high-quality hysteroscopy videos can enhance procedure success and alleviate patient fears. However, the unsupervised discovery of information by patients could potentially lead to procedure failure or an elevated level of stress due to misleading or incorrect information.


Subject(s)
Information Dissemination , Social Media , Female , Pregnancy , Humans , Information Dissemination/methods , Video Recording , Reproducibility of Results , Hysteroscopy
7.
Article in English | MEDLINE | ID: mdl-37539674

ABSTRACT

Female genital mutilation/cutting (FGM/C or FGM) are injuries to the female genital organs for non-medical reasons. Every year, over 4 million girls are at risk of FGM. Complications of this practice are very common and some of them are still under investigation. The purpose of this short narrative review is to highlight and summarize the main ones. Psychologic and psychiatric sequelae, chronic vulvar pain, urogenital symptoms, pelvic organs prolapse, sexual disfunction, cervical dysplasia and infections resulted as chronic sequalae of FGM. Severe pain, excessive bleeding, and tissues swelling are acute consequences of FGM. Rates of caesarean section, time of second stage of delivery, post-partum blood loss (but not major hemorrhage), peri-clitoral and perineal injuries and episiotomy rates are higher in pregnant women with FGM, when compared with those non victims of mutilation. The female genital mutilation practice is often cause of severe urogynecologic, psychologic and obstetrics sequelae. Although several studies have been carried out on FMG complications and treatments, long term sequelae are still very common and deserve major attention and further research.

9.
Medicina (Kaunas) ; 59(8)2023 Aug 03.
Article in English | MEDLINE | ID: mdl-37629707

ABSTRACT

(1) Background: Aggressive angiomyxoma is a mesenchymal cancer that is rare during pregnancy. It is a neoplasm that relapses and infiltrates the nearest structures. Our aim is to evaluate the management and outcomes of an observed case, in light of the current literature. (2) Methods: We observed this condition at the "Maggiore della Carità" Hospital in Novara (Italy) in a patient with an initial twin pregnancy and a suspected pelvic mass. The words "angiomyxoma" and "pregnancy" were searched on the main online scientific search sources (PubMed, Google Scholar, Scopus, WES, and Embase, etc.). (3) Results: The patient underwent surgery with a complicated follow-up, but recent negative controls. We analyzed the literature about the topic and found only 24 similar clinical cases. (4) Conclusions: Considering the current literature, it is useful to assess an aggressive angiomyxoma in the differential diagnosis of soft masses in pregnant women. The treatment of choice is surgical excision, and vaginal delivery is feasible. The therapeutic decision depends on each case.


Subject(s)
Patients , Pregnancy, Twin , Pregnancy , Female , Humans , Diagnosis, Differential , Gravidity , Hospitals
11.
Cureus ; 15(2): e35182, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36960249

ABSTRACT

BACKGROUND AND AIM: Breech presentation is a condition that occurs in rare cases in pregnancy. Although guidelines recommend a cesarian section or an external cephalic version in case of breech, alternative procedures like acupuncture, are also available. Information on this approach is mostly found by patients through social media; we aimed to study content quality and the reliability of information present on YouTube™ (Google LLC, Mountain View, California, United States), one of the most popular. METHODS: Two gynecologists and an anesthesiologist, who was qualified as an acupuncturist, rated the reliability and the content quality of 23 of the first 100 results from YouTube. Normal data distribution was tested with the Shapiro-Wilk test. General features of videos, reliability, and content quality were compared with the Wilcoxon-Mann-Whitney test (continuous variables) and the Chi-square test (categorical variables). All tests were two-sided, and the statistical significance level was determined at p<0.05. RESULTS: Concerning reliability, all videos were rated poorly while only one was judged as sufficiently high in quality content. Lower scores in terms of reliability and content quality resulted from the reviewers' evaluation with no videos reported as suggestable to patients. Two videos were considered fit to be suggested to patients by the gynecologist reviewers. CONCLUSIONS: Information about the role and the success rate of acupuncture for converting breech presentation found on YouTube are poorly reliable, low-quality, and not valid for patients. It should be a physician's duty to provide correct information to patients.

12.
J Minim Invasive Gynecol ; 30(8): 616-626, 2023 08.
Article in English | MEDLINE | ID: mdl-37001691

ABSTRACT

The evaluation of endometriosis in an adolescent girl is a challenging topic. The initial stage of the disease and the limited diagnostic instrument appropriate for the youth age and for its typical features can reduce the ability of the gynecologist. At the same time, missing a prompt diagnosis can delay the beginning of specific and punctual management of endometriosis, which could avoid a postponed diagnosis from 6 to 12 years, typical of adolescent girls complaining of dysmenorrhea. This article aimed to answer all the potential questions around the diagnosis and management of endometriosis in adolescents starting from a clinical case looking at the possible solution that is easily reproducible in the clinical practice.


Subject(s)
Endometriosis , Female , Adolescent , Humans , Endometriosis/complications , Endometriosis/diagnosis , Endometriosis/surgery , Dysmenorrhea/etiology , Dysmenorrhea/therapy , Dysmenorrhea/diagnosis
13.
Acta Biomed ; 94(S1): e2023054, 2023 02 13.
Article in English | MEDLINE | ID: mdl-36779935

ABSTRACT

Fetal well-being in labor could be assessed trough cardiotocography (CTG). Some doubts have been raised about its unequivocal applicability. Pathological CTG is in most cases connected to fetal acidosis at birth, but other potential causes must be considered in the differential diagnosis. A 31-years-old G2P1 patient referred to our Department of Obstetrics and Gynecology for her scheduled post-term CTG at 40 weeks and 3 days of gestation. The pregnancy was uneventful. CTG was classified as suspicious, and after pharmacological induction, it switched as pathological: an emergency cesarean section was performed. Venous and arterial blood sample taken from the umbilical cord were normal. The next assessments revealed that Atrial Flutter (AFL) occurred at birth. Suspicious CTG is not always associated to neonatal asphyxia. Cardiotocography can help not only in the evaluation of fetal distress, but also in the assessment of global fetal cardiac activity. The presence of a fetal heart defect should be considered when CTG is suspicious.


Subject(s)
Acidosis , Cardiotocography , Humans , Infant, Newborn , Pregnancy , Female , Adult , Cesarean Section , Friends , Pregnancy Outcome , Acidosis/diagnosis
15.
Arch Gynecol Obstet ; 308(4): 1067-1074, 2023 10.
Article in English | MEDLINE | ID: mdl-36703012

ABSTRACT

PURPOSE OF REVIEW: Female genital mutilation/cutting (FGM/C or FGM) are procedures that involve partial or total removal of external female genitalia and other injuries to the female genital organs for non-medical reasons. Over 4 million girls are at risk of FGM annually. Since urogynecologic and obstetric complications of FGM have been extensively described and characterized, the aim of this review is to shift the focus on other aspects like perception of women, awareness of community, and knowledge of health workers. Our purpose is to highlight those aspects and understand how their grasp might help to eradicate this practice. RECENT FINDINGS: Self-perception of women with FGM changes when they emigrate to western countries; awareness of complications and awareness of their rights are factors that make women reject the practice. Women from rural areas, already circumcised, or without a secondary level education are more likely to have a circumcised daughter. Women with at least a secondary education are more likely to agree with the eradication of the practice. Lack of education and poor wealth index are factors associated with men's support of FGM. Although aware of FGM, healthcare professionals need to be trained on this topic. General practitioners play a central role in addressing patients with FGM to the right path of diagnosis and treatment and psychologists in helping them with psychological sequelae. CONCLUSION: These findings point out the future area of intervention, stressing the need of higher standard of care and global effort to eradicate this practice.


Subject(s)
Circumcision, Female , Male , Female , Humans , Circumcision, Female/adverse effects , Circumcision, Female/psychology , Genitalia, Female , Educational Status , Health Personnel
16.
Eur J Contracept Reprod Health Care ; 28(1): 10-16, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36287190

ABSTRACT

PURPOSE: The aim of the study was to assess the length of diagnostic delay of symptomatic endometriosis in Italy and analyse the presence of correlations between the socio-demographic status of patients and the clinical characteristics/type of diagnosis. MATERIALS AND METHODS: This multicenter cross-sectional questionnaire-based study was conducted in 10 tertiary Italian referral centres for diagnosis and treatment endometriosis. A total of 689 respondents with histologically proven endometriosis and onset of the disease with pain symptoms completed an on-line self-reported questionnaire written in their own language (World Endometriosis Research Foundation-Endometriosis Phenome and Biobanking Harmonisation Project-Endometriosis Patient Questionnaire-Minimum) evaluating endometriosis related symptoms, family history of endometriosis and chronic pelvic pain, demographic data, as well as medical, reproductive, and obstetric history. RESULTS: The mean diagnostic delay found was of 11.4 years. The mean time (14.8 years) from symptoms onset to diagnosis was significantly longer among patients aged 9-19 vs patients aged 20-30 (mean 6.9 years, p < 0.001) and patients aged 31-45 (mean 2.9, p < 0.001). No significant association were found between a delayed diagnosis and any of the clinically relevant factors such as the number or severity of the reported symptoms, familiarity, hormonal therapy intake or methodology of diagnosis. CONCLUSIONS: The mean diagnostic delay of endometriosis in Italy is about 11 years. The delay can be up to 4 years longer in patients with pain symptoms onset under 20 years. Educating clinicians and patients on pathologic nature of endometriosis related pelvic pain is advisable to reduce waiting time to diagnosis, especially for young women.


Subject(s)
Delayed Diagnosis , Endometriosis , Adolescent , Adult , Child , Female , Humans , Middle Aged , Young Adult , Cross-Sectional Studies , Delayed Diagnosis/prevention & control , Delayed Diagnosis/statistics & numerical data , Endometriosis/complications , Endometriosis/diagnosis , Italy , Pelvic Pain/etiology , Surveys and Questionnaires , Tertiary Care Centers
17.
J Obstet Gynaecol ; 42(7): 2753-2757, 2022 Oct.
Article in English | MEDLINE | ID: mdl-35950331

ABSTRACT

Our aim was to evaluate the intra- and inter-operator agreement in cardiotocography (CTG) traces analysis using the 2015 FIGO classification guidelines, and whether the educational background and the knowledge of anamnestic data can influence the interpretation of CTG traces. A retrospective interpretation of 73 intrapartum CTGs at time 0 (T0) for a first blind interpretation and at time 1 (T1) two months later with additional anamnestic pregnancy information was made by eight different operators (four obstetricians and four midwives with different years of work experience). The intra-observer agreement demonstrates that midwifes are more concordant than obstetricians with a mean of 77.05% versus a mean of 65.75%. There is moderate inter-observer agreement in classifying a CTG trace as 'normal'; on the contrary, there is no consensus on the 'suspect' and 'pathological' classification category.IMPACT STATEMENTWhat is already known on this subject? Interpretation of intrapartum CTG is affected by significant subjective variables with relevant intra- and inter-observer lack of optimal agreement, especially in case of abnormal o pathologic findings.What do the results of this study add? Clinical data seem to play a role in interpretation of suspicious and pathological traces while they do not affect the rate of agreement for normal traces. Midwives tend to be less influenced by anamnestic data in visual CTG interpretation. Instead, obstetricians tend to be more focussed on clinical data and clinical setting that, as a consequence, tend to have great impact on CTG trace interpretation.What are the implications of these findings for clinical practice and/or further research? Cooperation among obstetricians and between obstetricians and midwives should be encouraged in order to optimise CTG reading and improve maternal and neonatal outcomes. Regarding the influence of clinical parameters in classification of intrapartum CTG traces, especially in case of abnormal CTG traces, it should be conceivable to improve medical skills in CTG blind interpretation and further investigate which clinical parameters are mainly related with an augmented risk of foetal asphyxia and adverse neonatal outcomes.


Subject(s)
Cardiotocography , Midwifery , Pregnancy , Female , Infant, Newborn , Humans , Cardiotocography/methods , Retrospective Studies , Parturition , Fetal Hypoxia , Heart Rate, Fetal , Observer Variation
18.
Ital J Pediatr ; 48(1): 100, 2022 Jun 16.
Article in English | MEDLINE | ID: mdl-35710390

ABSTRACT

In our third-level Neonatal Unit in Northern Italy, we recorded a high rate of neonatal hyperbilirubinemia requiring phototherapy in March-November 2020, during the first phase of COVID-19 pandemic, compared to the previous year (198/1348, 14.2%, vs 141/1432, 9.8%, p = 0.0004). Supposing it could be the result of neonatal polycythemia, we evaluated capillary hematocrit (Hct) and the rate of hyperbilirubinemia in all newborns ≥36 weeks gestational age born in December 2020. Out of 73 neonates, 37 had Hct ≥65% (50.7%). However, as capillary blood samples may overestimate Hct by 5-15%, even downsizing all values by 15%, Hct was still ≥65% in 9/73 neonates (12.3%), much higher than 0.4-5% prevalence of polycythemia reported in healthy newborns. All those newborns were singleton and healthy, with no clinical signs of hyperviscosity and no underlying factors predisposing to polycythemia. Out of 73 newborns, 13 (17.8%) developed hyperbilirubinemia requiring phototherapy. Their mean Hct value was 66.3 ± 8.2%. Since hyperbilirubinemia is common in the offspring of women with SARS-CoV-2 infection and we recorded increased rates of neonatal hyperbilirubinemia in the first phase of COVID-19 pandemic, it could be hypothesized that even asymptomatic Sars-CoV2 infection during pregnancy might cause placental vascular malperfusion, eliciting polycythemia in the fetus as a compensatory response, that could be the link between COVID-19 in the mothers and hyperbilirubinemia in the newborns.


Subject(s)
COVID-19 , Hematologic Diseases , Hyperbilirubinemia, Neonatal , Infant, Newborn, Diseases , Polycythemia , COVID-19/epidemiology , Female , Humans , Hyperbilirubinemia, Neonatal/epidemiology , Hyperbilirubinemia, Neonatal/therapy , Infant, Newborn , Infant, Newborn, Diseases/diagnosis , Pandemics , Placenta , Polycythemia/epidemiology , Pregnancy , RNA, Viral , SARS-CoV-2
19.
Midwifery ; 107: 103279, 2022 Apr.
Article in English | MEDLINE | ID: mdl-35182821

ABSTRACT

BACKGROUND: In case of suspicious CTG in labor a conservative attitude is recommended, when possible, through intrauterine resuscitation maneuvers. AIMS: This study aims to evaluate the use of intrauterine resuscitation maneuvers (IRM) at two Italian hospitals; the secondary outcome is the assessment of the agreement in their application. MATERIALS AND METHODS: Retrospective analysis was performed on the data of 80 deliveries (40 vs 40) from two different Italian hospitals, located in Novara (group 1) and in Borgomanero (group 2). In order to evaluate a varied series of CTG traces (normal and pathological), we randomly extracted 13 cases of neonatal asphyxia (2015-2020). The normal CTG traces were identified among the deliveries of the same day of these cases, in a ratio of 1: 4. One gynecologist and one midwife for the group 1 and one other gynecologist and one midwife for the group 2 were given a file with anonymous patient's clinical data, and the CTG registered during labor. Then, they classified the CTG trace, and they stated what they would have done if they had been present. RESULTS: Maternal position was changed for 58 patients, especially in group 2 (25/40 vs 33/40) (p = 0.046). Intravenous fluid administration was performed for 35 patients, more in group 2 (8/40 vs 27/40) (p < 0.001). Oxytocin was used for 21/80 patients: in 7/21 cases were discontinued (p = 0.241). Clark's test was used only in 2 cases, in group 2. No one used tocolysis, oxygen, or amnioinfusion. The concordance rate among operators showed poor agreement regarding the use of IRM, group 2 showed increased general concordance rates. CONCLUSIONS: The use of IRM in labor is recommended but underused and with poor concordance rate in the application, based on our results.


Subject(s)
Asphyxia Neonatorum , Cardiotocography , Asphyxia Neonatorum/complications , Asphyxia Neonatorum/therapy , Cardiotocography/methods , Delivery Rooms , Female , Heart Rate, Fetal , Humans , Infant, Newborn , Pregnancy , Retrospective Studies
20.
Minerva Obstet Gynecol ; 74(4): 319-324, 2022 Aug.
Article in English | MEDLINE | ID: mdl-34137568

ABSTRACT

BACKGROUND: One of the provisions implemented to contain the spread of COVID-19 infections in Italy was the lockdown. Effects of the lockdown on childbirth outcomes and on the well-being of both the mother and the child have not yet been defined. An inadequate diet during pregnancy and a reduced physical activity can predispose women to become overweight or obese and trigger the development of various complications and maternal-fetal adverse outcomes. METHODS: This is a retrospective study including all consecutive patients who delivered at the Maggiore della Carità Hospital in Novara, Italy, in April-May 2017 (group 1, N.=294), a period prior to the pandemic, and during the same months in 2020 (group 2, N.=256) during and immediately after lockdown. Clinical data were extracted from the report "Childbirth Assistance Certificate (CedAP) - Birth Event Analysis." RESULTS: Demographic characteristics were similar between the two study groups, except for a decreased number of married couples in group 2 (P=0.018) and an increased percentage of patients with clinical checkups at family planning facilities in 2020 (P=0.04). The number of hospitalizations during pregnancy was 26 (8.9%) vs. 10 (3.9%) with a significative reduction during 2020 (P=0.004). Regarding obstetric outcomes, we observed a significant increase in induction of labour in 2020 (23.9% vs. 35.9%; P=0. 002), a reduction of amniorrhexis (11.3% vs. 5.5% P=0.015), a reduction of supine positions with an increase of vertical and all four positions in 2020 (49.3% vs. 61.9% and 9.5% vs. 12.4% respectively, P=0.023), and a reduction of left occipito-anterior presented part (63.2% vs. 55.4%) in favor of right occipito-anterior (34.7% vs. 41.2%, P=0.019). CONCLUSIONS: There were no significant differences either for antepartum or intrapartum complications. Long-term studies are needed to evaluate psychological, behavioral, and epigenetic effects of maternal physical inactivity on obstetric outcomes.


Subject(s)
COVID-19 , COVID-19/epidemiology , Child , Communicable Disease Control , Delivery, Obstetric , Female , Humans , Peripartum Period , Pregnancy , Retrospective Studies
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