Folic acid use in planned pregnancy: an Italian survey.

It is well known that periconceptional folic acid supplementation decreases the risk of neural tube defects. The aim of this study was to evaluate the attitudes and practices of women with planned pregnancies regarding periconceptional folic acid intake and to identify factors associated with the use of this supplement. During 2 years of observation, we surveyed women with planned pregnancies who called our Teratology Information Service. A total of 500 women were surveyed: 217 (43.4%) took folic acid before becoming pregnant, and 283 (56.6%) did not take it. The women who took folic acid before becoming pregnant had a high education level and received preconception counselling. Our results suggest that less than half of Italian women took folic acid before they became pregnant although they were trying to conceive. Knowledge about the benefits of this vitamin is inadequate also among women who planned the pregnancy and the level of information received from their physicians.

Laparoscopic management of a large, twisted, ovarian dermoid cyst during pregnancy: a case report.

BACKGROUND: Mature cystic teratomas, commonly known as dermoid cysts, are the most frequent ovarian tumors discovered during pregnancy. They are present in 0.3% of pregnancies from weeks 16-20 of gestation. The diagnosis of mature cystic teratomas during pregnancy presents the vexing problem of weighing the risks of surgery under general anesthetic against the risks of an untreated persistent adnexal mass. CASE: We present the case of an 18-year-old woman, gravida 1, in her 18th week of pregnancy who was referred to our center with severe abdominal pain and nausea. The diagnosis of torsion of a dermoid cyst 15 cm in diameter was made. The patient underwent laparoscopy under general anesthesia and the cyst was successfully removed intact. This was enabled by the endobag technique, thus preventing spillage of the cyst content into the peritoneal cavity. The fetus tolerated surgery well with no complications. CONCLUSION: In the case of an adnexal mass in pregnancy, surgery should be taken into consideration if the mass is > 5-6 cm. The data suggest that, given the availability of an experienced laparoscopic surgeon, laparoscopy should be considered, and in cases in which there is no emergency, elective surgery should be scheduled in the late first or, preferably, early second trimester if possible.

Syphilis Infection during pregnancy: fetal risks and clinical management.

Congenital syphilis is still a cause of perinatal morbidity and mortality. Untreated maternal infection leads to adverse pregnancy outcomes, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death, and congenital disease among newborns. Clinical manifestations of congenital syphilis are influenced by gestational age, stage of maternal syphilis, maternal treatment, and immunological response of the fetus. It has been traditionally classified in early congenital syphilis and late congenital syphilis. Diagnosis of maternal infection is based on clinical findings, serological tests, and direct identification of treponemes in clinical specimens. Adequate treatment of maternal infection is effective for preventing maternal transmission to the fetus and for treating fetal infection. Prenatal diagnosis of congenital syphilis includes noninvasive and invasive diagnosis. Serological screening during pregnancy and during preconception period should be performed to reduce the incidence of congenital syphilis.

Chronic exposure to high doses of selenium in the first trimester of pregnancy: Case report and brief literature review.

BACKGROUND: Obstetricians usually prescribe supplements during pregnancy without actual indication. The use of selenium during pregnancy has increased, due to its function in several antioxidant mechanisms. CASE: A pregnant woman received 200,000 micrograms (µg) per day of a selenium galenic formulation, since gestational week (g.w.) 7 to 12, due to a prescription error. The patient experienced nausea, vomiting, hand and foot paresthesia, followed by fatigue, loss of fingernails and hair. The woman was referred to our Fetal and Maternal Medicine Unit for surveillance. The mother's blood selenium levels went back to normal 13 weeks after arrest and the baby was born at term, without complications. Clinical evaluation and imaging studies were normal at one month of age. CONCLUSION: This is the first case of severe chronic selenium intoxication during the first trimester of pregnancy. In the present case, no consequences of congenital defects or pregnancy complications occurred. However, since vitamins, minerals, and food supplements may be harmful and prescription errors occur, obstetricians should avoid prescribing supplements in the absence of maternal deficiency.

Managing fertile women under lithium treatment: the challenge of a Teratology Information Service.

BACKGROUND: The objective of the present study is to review the literature regarding the management of fertile patients under lithium treatment for bipolar disorder and to report the experience of our Teratology Information Service over the past thirteen years in managing women treated with lithium during preconception, pregnancy and breastfeeding. METHODS: This research focuses on a selective review of the literature and a retrospective survey has been carried out on fertile women under lithium treatment who called our service at A. Gemelli University Hospital in Rome from May 2002 to December 2015. RESULTS: A total of 140 women under lithium treatment called our TIS. A complete follow-up has been performed on 34 patients: 29 called during pregnancy and 5 called during preconception. None of the patients called during breastfeeding, while half of the patients were taking concomitant drugs during pregnancy. One major cardiac malformation (hypoplastic left heart syndrome) has been reported. No minor malformations have been detected. Twenty-one patients delivered a living child, with one premature neonate. Two patients underwent voluntary interruption of pregnancy and six patients had early spontaneous abortion. In one patient, intrauterine growth retardation occurred, but with no adverse neonatal outcomes. Four neonates experienced transient respiratory distress at birth. Two children developed mild to severe language delay, but normal motor development. CONCLUSIONS: Lithium treatment in fertile women is a very delicate topic, where risks and benefits of discontinuing therapy when women plan to become pregnant should be accurately evaluated. Thorough peri-conceptional counselling is crucial for the outcome of pregnancy and for maternal health status during preconception, gestation and breastfeeding.

Glaucoma Drug Therapy in Pregnancy: Literature Review and Teratology Information Service (TIS) Case Series.

BACKGROUND: There are many contradictions about pregnancy and fetal/neonatal outcomes after topical use of timolol alone or timolol in combination with other antiglaucoma medications. METHODS: Seventy-five pregnant women exposed to antiglaucoma medications were followed prospectively by phone interviews. 27 women used timolol as monotherapy, 48 women used timolol as a part of multidrug therapy. We selected a control group of 187 healthy pregnant women. RESULTS: Topical use of timolol alone or timolol in combination with other antiglaucoma medications does not influence pregnancy or fetal/neonatal outcomes. CONCLUSION: Beta-blocker is the first choice treatment for glaucoma in pregnancy but, when necessary, multidrug therapy should not to be excluded.

Screening and management of maternal colonization with Streptococcus agalactiae: an Italian cohort study.

INTRODUCTION: Streptococcus agalactiae (Group B streptococcus [GBS]) is the most common cause of sepsis and meningitis in infants <3 months of age. Intrapartum antibiotic prophylaxis (IAP) is effective in preventing the transmission of GBS to newborns. The Centers for Disease Control and Prevention (CDC) guidelines suggest vaginal and rectal cultures to assess GBS colonization between 35 and 37 weeks' gestation. METHODS: Between July and December 2013, we identified 535 women admitted to the Obstetric and Gynecology Unit of Cardarelli Hospital (Campobasso, Italy) for delivery. We evaluated the indications for IAP, complete execution of IAP, and neonatal outcomes. RESULTS: Our sample included 468 women and 475 live births. Correct screening for GBS was executed in 241 cases (51.5%), the number of women colonized was 96 (30.2%), and 136 women had indications to receive IAP, but only 68 (50%) received adequate treatment. CONCLUSIONS: GBS colonization status should be determined by collecting both vaginal and rectal specimens at 35-37 weeks' gestation. Inadequate screening for GBS and incorrect IAP led to an increased incidence of early-onset disease in newborns. Local public health agencies should promote surveillance and educational programs to prevent neonatal GBS infections.

Pegylated liposomal doxorubicin in the management of ovarian cancer.

Among the pharmaceutical options available for treatment of ovarian cancer, much attention has been progressively focused on pegylated liposomal doxorubicin (PLD), whose unique formulation, which entraps conventional doxorubicin in a bilayer lipidic sphere surrounded by a polyethylene glycol layer, prolongs the persistence of the drug in the circulation and potentiates intratumor drug accumulation. These properties enable this drug to sustain its very favorable toxicity profile and to be used safely in combination with other drugs. PLD has been already approved for treatment of advanced ovarian cancer patients failing first-line platinum-based treatment. Moreover, phase III trials have been already completed, and results are eagerly awaited, which hopefully will expand the range of PLD clinical application in this neoplasia both in front-line treatment, and in the salvage setting in combination with other drugs. Moreover, attempts are continuing to enable this drug to be combined with novel cytotoxic drugs and target-based agents. This review aims at summarizing the available evidence and the new perspectives for the clinical role of PLD in the management of patients with epithelial ovarian cancer.

Treatment of cervical cancer in Italy: strategies and their impact on the women.

Treatment of cervical cancer greatly varies according to the stage of the disease. Laparoscopic surgical staging is emerging as a valid approach, compared to clinical and imaging staging, to better identify the treatment plan. Minimally invasive surgery plays the greatest role in the treatment of early cervical carcinoma (ECC). Laparoscopically assisted radical vaginal hysterectomy (LARVH) is an alternative surgical strategy in this subset of patients. Interest has been increasing in using conservative fertility-sparing surgery such as laparoscopic vaginal radical trachelectomy (LVRT) or chemo-conization, options to be preferred in selected patients, with early-stage disease and asking for future fertility. Chemoradiotherapy currently represents the gold standard in the treatment of patient with locally advanced cervical cancer (LACC). In Italy, neoadjuvant chemotherapy (NACT) followed by radical surgery is today emerging as a valid alternative to the standard chemoradiation and the paclitaxel, ifosfamide and cisplatin (TIP) regimen is one of the most active neoadjuvant chemotherapeutic treatments. Moreover, the combination of different strategies to maximize local control should be considered. Among different approaches to this issue the use of a three-modality treatment, including radiotherapy, chemotherapy and surgery has been investigated. Our data on a large single-institutional series of LACC patients treated with chemoradiation followed by radical surgery confirm that this three-modality treatment can achieve overall survival (OS) and Disease Free Survival (DFS) rates at least comparable to chemoradiation alone, with an acceptable rate of complications. Tailoring of radical surgery, on the basis of intraoperative findings, such as lympho-nodes status, might play an important role in diminishing the overall rate of complications and eventually improve quality of life (QoL) of these patients. Cervical cancer generally has an aggressive impact on relatively young women and, as we experienced, the relevance of psychosocial aspects in gynaecologic oncology has become a main issue.