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Maranto M, Zaami S, Restivo V, Termini D, Gangemi A, Tumminello M, Culmone S, Billone V, Cucinella G, Gullo G. Symptomatic COVID-19 in Pregnancy: Hospital Cohort Data between May 2020 and April 2021, Risk Factors and Medicolegal Implications. Diagnostics (Basel) 2023; 13:diagnostics13061009. [PMID: 36980317 PMCID: PMC10047111 DOI: 10.3390/diagnostics13061009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
Pregnancy does not appear to increase susceptibility to SARS-CoV-2 infection, but some physiological changes, such as the reduction of residual functional volumes, elevation of the diaphragm, and impaired cellular immunity, may increase the risk of severe disease and result in a higher risk of complications. The article’s primary objective is to evaluate the factors associated with symptomatic COVID-19 disease in pregnancy. The secondary objective is to describe maternal and neonatal outcomes and cases of vertical transmission of the infection. All pregnant women hospitalized with SARS-CoV2 infection were included in a prospective study in the UOC of Obstetrics and Gynecology, AOOR Villa Sofia—Cervello, Palermo, between May 2020 and April 2021. The patients who requested the termination of the pregnancy according to Law 194/78 were excluded. We included 165 pregnancies with a total number of 134 deliveries. Overall, 88.5% of the patients were asymptomatic at the time of admission and 11.5% were symptomatic. Of them, 1.8% of the patients required hospital admission in the intensive care unit. Symptoms occurrences were positively associated with the increase in maternal BMI (OR 1.17; p = 0.002), the prematurity (OR 4.71; p = 0.022), and at a lower birth weight (OR 0.99; p = 0.007). One infant tested positive for SARS-CoV2 nasopharyngeal swab; 11.4% of newborns had IgG anti SARS-CoV2 at birth; IgM was positive in 2.4% of newborns. There was no difference statistically significant difference in the vertical transmission of the infection among the group of symptomatic pregnant women and that of asymptomatic pregnant women.
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Affiliation(s)
- Marianna Maranto
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
| | - Vincenzo Restivo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Donatella Termini
- Neonatal Intensive Care Unit, Villa Sofia Cervello Hospital, 90146 Palermo, Italy
| | - Antonella Gangemi
- Neonatal Intensive Care Unit, Villa Sofia Cervello Hospital, 90146 Palermo, Italy
| | - Mario Tumminello
- Neonatal Intensive Care Unit, Villa Sofia Cervello Hospital, 90146 Palermo, Italy
| | - Silvia Culmone
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Valentina Billone
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
| | - Giuseppe Gullo
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy
- Correspondence:
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Shemer O, Shemer A, Ganor Paz Y, Rosen H, Tovbin J, Barzilay E. Association between level of training and reliability of intrapartum transperineal ultrasound measurement of angle of progression. J Matern Fetal Neonatal Med 2021; 35:9093-9097. [PMID: 34882060 DOI: 10.1080/14767058.2021.2014811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Intrapartum transperineal ultrasound (ITU) is an accepted tool for assessing fetal head position and station prior to operative vaginal delivery attempt. However, the validity of intrapartum ultrasound in real-life obstetrics with operators at different proficiency level is yet to be established. We aimed to investigate the association between operator level of training and reliability of angle of progression (AOP) measurements in real-life obstetrics. METHODS This was a retrospective study in one university medical center. We included women who underwent ITU for the measurement of AOP, before vacuum assisted delivery from November 2017 to September 2020. AOP measurements performed by residents and their correlation to head station were compared to those performed by specialists. RESULTS A total of 320 cases met the inclusion criteria. In 234 of them, AOP measurements were performed by specialists and in 86 by residents. Average AOP for each station was similar between the specialists and the residents groups, indicating similar accuracy. However, measurements in the residents group were more scattered (median deviation 11.4° vs. 8.9°, respectively, p = .021), indicating poorer precision. CONCLUSIONS AOP measurements performed by obstetrics and gynecology (OBGYN) specialists are more precise than those performed by residents. Efforts should be taken to improve ITU training and to implement assessment of performance programs.
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Affiliation(s)
- Ofer Shemer
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Asaf Shemer
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Ganor Paz
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Hadar Rosen
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Josef Tovbin
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Eran Barzilay
- Department of Obstetrics and Gynecology, Samson Assuta Ashdod University Hospital, Ashdod, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Twin-to-Twin Transfusion Syndrome: Diagnostic Imaging and Its Role in Staving Off Malpractice Charges and Litigation. Diagnostics (Basel) 2021; 11:diagnostics11030445. [PMID: 33806678 PMCID: PMC8002196 DOI: 10.3390/diagnostics11030445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
The study aims to expound upon the imaging-based diagnostic methodologies aimed at identifying twin-to-twin transfusion syndrome (TTTS), a serious, somewhat rare prenatal condition that takes place in pregnancies where identical twins, or other multiples, share a placenta (monochorionic placenta), highlighting how medico-legal outcomes can be affected by provable compliance with consolidated diagnostic guidelines or best practices. It is of utmost importance to produce a prompt identification of TTTS instances; an early diagnosis is in fact critical in order to effectively treat and manage TTTS. By virtue of TTTS being a highly progressive condition, a delay in diagnosis can result in disastrous outcomes; just a few weeks delay in the diagnosis of TTTS can turn out fatal for one or both twins. Hence, most TTTS malpractice claims involve allegations of medical negligence, namely the failure to recognize the condition in a timely fashion, or to proceed with adequate diagnostic and therapeutic pathways. In that regard, case law databases have been pored over (Justia, Lexis, Leagle), and five significant court cases have been examined and discussed in an attempt to identify objective medico-legal standards and bring to the forefront relevant forensic dynamics. In fact, when health professionals are capable of proving adherence to guidelines or best practices, this can shield them from malpractice allegations and ensuing litigation.
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Zaami S, Zupi E, Lazzeri L, Centini G, Stark M, Malvasi A, Signore F, Marinelli E. Episiotomy: a medicolegal vicious cycle. Panminerva Med 2020; 63:224-231. [PMID: 32414232 DOI: 10.23736/s0031-0808.20.03946-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present study aimed to analyze the litigation trends and ensuing compensatory damages brought about by the use of episiotomy, in order to outline a set of cautionary rules meant to limit the scope of legreal aftermath for both doctors and health care facilities. The authors have set out to gain an insight into the controversial practice of episiotomy, in light of available research data and official positions of various scientific and medical associations, with a close focus on the legal and medical viability of the procedure itself. Court data and trial records have been taken into account as well, via searches into legal databases and search engines (Justia, Lexis, Jurist.org, Venice Courthouse, etc.). This review showed that most episiotomy-related lawsuits stemmed from a routine use of that procedure, which is almost universally advised against, and without valid informed consent having been gained. Ultimately, authors have seen fit to underscore the need for patients potentially eligible for an episiotomy (selective episiotomy) to receive thorough and understandable information in a timely fashion including the necessity and the effectiveness of the procedure as well as the risks involved, so that a well-informed decision can be made based on factual data.
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Affiliation(s)
- Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, Rome, Italy -
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Michael Stark
- The New European Surgical Academy (NESA), Berlin, Germany.,ELSAN Group Hospitals, Paris, France
| | - Antonio Malvasi
- Department of Applied Mathematics, Institute of Physics and Technology, State University, Moscow, Russia.,Department of Obstetrics and Gynecology, GVM Care and Research, Santa Maria Hospital, Bari, Italy
| | - Fabrizio Signore
- Department of Obstetrics and Gynecology, Misericordia Hospital, Grosseto, Italy
| | - Enrico Marinelli
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, Rome, Italy
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