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Vitagliano A, Nicoli' P, Damiani GR, Dellino M, Cicinelli E, D' Amato A. Authors' reply. J Minim Invasive Gynecol 2024:S1553-4650(24)00170-5. [PMID: 38641051 DOI: 10.1016/j.jmig.2024.04.011] [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] [Received: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Amerigo Vitagliano
- University of Bari "Aldo Moro", Policlinico of Bari, Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, Bari, Italy.
| | - Pierpaolo Nicoli'
- University of Bari "Aldo Moro", Policlinico of Bari, Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, Bari, Italy
| | - Gianluca Raffaello Damiani
- University of Bari "Aldo Moro", Policlinico of Bari, Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, Bari, Italy
| | - Miriam Dellino
- University of Bari "Aldo Moro", Policlinico of Bari, Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, Bari, Italy
| | - Ettore Cicinelli
- University of Bari "Aldo Moro", Policlinico of Bari, Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, Bari, Italy
| | - Antonio D' Amato
- University of Bari "Aldo Moro", Policlinico of Bari, Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, Bari, Italy
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Dellino M, Pinto G, D’Amato A, Barbara F, Di Gennaro F, Saracino A, Laganà AS, Vimercati A, Malvasi A, Malvasi VM, Cicinelli E, Vitagliano A, Cascardi E, Pinto V. Analogies between HPV Behavior in Oral and Vaginal Cavity: Narrative Review on the Current Evidence in the Literature. J Clin Med 2024; 13:1429. [PMID: 38592283 PMCID: PMC10932293 DOI: 10.3390/jcm13051429] [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: 12/28/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Human genital papilloma virus infection is the most prevalent sexually transmitted infection in the world. It is estimated that more than 75% of sexually active women contract this infection in their lifetime. In 80% of young women, there is the clearance of the virus within 18-24 months. In developed countries, oral squamous cell carcinoma (OSCC) is now the most frequent human papilloma virus (HPV)-related cancer, having surpassed cervical cancer, and it is predicted that by 2030 most squamous cell carcinomas will be the HPV-related rather than non-HPV-related form. However, there are currently no screening programs for oral cavity infection. While the natural history of HPV infection in the cervix is well known, in the oropharynx, it is not entirely clear. Furthermore, the prevalence of HPV in the oropharynx is unknown. Published studies have found wide-ranging prevalence estimates of 2.6% to 50%. There are also conflicting results regarding the percentage of women presenting the same type of HPV at two mucosal sites, ranging from 0 to 60%. Additionally, the question arises as to whether oral infection can develop from genital HPV infection, through oral and genital contact or by self-inoculation, or whether it should be considered an independent event. However, there is still no consensus on these topics, nor on the relationship between genital and oral HPV infections. Therefore, this literature review aims to evaluate whether there is evidence of a connection between oral and cervical HPV, while also endorsing the usefulness of the screening of oral infection in patients with high-risk cervical HPV as a means of facilitating the diagnosis and early management of HPV-related oral lesions. Finally, this review emphasizes the recommendation for the use of the HPV vaccines in primary prevention in the male and female population as the most effective means of successfully counteracting the increasing incidence of OSCC to date.
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Affiliation(s)
- Miriam Dellino
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (M.D.); (A.V.); (A.M.); (E.C.); (A.V.); (V.P.)
| | - Grazia Pinto
- Dentistry Unit, Department of Interdisciplinary Medicine, University of Bari Medical School, 70124 Bari, Italy;
| | - Antonio D’Amato
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (M.D.); (A.V.); (A.M.); (E.C.); (A.V.); (V.P.)
| | - Francesco Barbara
- Unit of Otolaryngology, Department of Ophtalmology and Otolaryngology, University of Bari, 70124 Bari, Italy;
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of Bari, Piazza Giulio Cesare n. 11, 70124 Bari, Italy; (F.D.G.); (A.S.)
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of Bari, Piazza Giulio Cesare n. 11, 70124 Bari, Italy; (F.D.G.); (A.S.)
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Antonella Vimercati
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (M.D.); (A.V.); (A.M.); (E.C.); (A.V.); (V.P.)
| | - Antonio Malvasi
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (M.D.); (A.V.); (A.M.); (E.C.); (A.V.); (V.P.)
| | | | - Ettore Cicinelli
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (M.D.); (A.V.); (A.M.); (E.C.); (A.V.); (V.P.)
| | - Amerigo Vitagliano
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (M.D.); (A.V.); (A.M.); (E.C.); (A.V.); (V.P.)
| | - Eliano Cascardi
- Pathology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari, Piazza Giulio Cesare 11, 70121 Bari, Italy;
| | - Vincenzo Pinto
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (M.D.); (A.V.); (A.M.); (E.C.); (A.V.); (V.P.)
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Malvasi A, Ballini A, Tinelli A, Fioretti B, Vimercati A, Gliozheni E, Baldini GM, Cascardi E, Dellino M, Bonetti M, Cicinelli E, Vitagliano A, Damiani GR. Oxytocin augmentation and neurotransmitters in prolonged delivery: An experimental appraisal. Eur J Obstet Gynecol Reprod Biol X 2024; 21:100273. [PMID: 38274243 PMCID: PMC10809121 DOI: 10.1016/j.eurox.2023.100273] [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: 11/12/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
The uterus is a highly innervated organ, and during labor, this innervation is at its highest level. Oxytocinergic fibers play an important role in labor and delivery and, in particular, the Lower Uterine Segment, cervix, and fundus are all controlled by motor neurofibers. Oxytocin is a neurohormone that acts on receptors located on the membrane of the smooth cells of the myometrium. During the stages of labor and delivery, its binding causes myofibers to contract, which enables the fundus of the uterus to act as a mediator. The aim of this study was to investigate the presence of oxytocinergic fibers in prolonged and non-prolonged dystocic delivery in a cohort of 90 patients, evaluated during the first and second stages of labor. Myometrial tissue samples were collected and evaluated by electron microscopy, in order to quantify differences in neurofibers concentrations between the investigated and control cohorts of patients. The authors of this experiment showed that the concentration of oxytocinergic fibers differs between non-prolonged and prolonged dystocic delivery. In particular, in prolonged dystocic delivery, compared to non-prolonged dystocic delivery, there is a lower amount of oxytocin fiber. The increase in oxytocin appeared to be ineffective in patients who experienced prolonged dystocic delivery, since the dystocic labor ended as a result of the altered presence of oxytocinergic fibers detected in this group of patients.
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Affiliation(s)
- Antonio Malvasi
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Andrea Ballini
- Department of clinical and experimental medicine, University of Foggia, Foggia, 71122, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), Veris Delli Ponti Hospital, 73020 Scorrano, Italy
| | - Bernard Fioretti
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Via dell'Elce di Sotto 8, 06132 Perugia, Italy
| | - Antonella Vimercati
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Elko Gliozheni
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
- University of Medicine of Tirana, Department of Obstetrics and Gynecology, Tirana, Albania
| | - Giorgio Maria Baldini
- Momo Fertilife, IVF Clinic, Bisceglie, 76011, Italy
- University of Bari Aldo Moro, 70121, Bari, Italy
| | - Eliano Cascardi
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Miriam Dellino
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Monica Bonetti
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Ettore Cicinelli
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Amerigo Vitagliano
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Gianluca Raffaello Damiani
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy
- Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
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Vitagliano A, Cicinelli E, Laganà AS, Favilli A, Vitale SG, Noventa M, Damiani GR, Dellino M, Nicolì P, D'Amato A, Bettocchi S, Matteo M, Palomba S. Endometrial scratching: the light at the end of the tunnel. Hum Reprod Update 2024; 30:238-239. [PMID: 38281106 DOI: 10.1093/humupd/dmad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Indexed: 01/29/2024] Open
Affiliation(s)
- Amerigo Vitagliano
- Department of Interdisciplinary Medicine (DIM), 1st Unit of Obstetrics and Gynecology, University of Bari, Bari, BA, Italy
| | - Ettore Cicinelli
- Department of Interdisciplinary Medicine (DIM), 1st Unit of Obstetrics and Gynecology, University of Bari, Bari, BA, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", University of Palermo, Palermo, Italy
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Marco Noventa
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Gianluca Raffaello Damiani
- Department of Interdisciplinary Medicine (DIM), 1st Unit of Obstetrics and Gynecology, University of Bari, Bari, BA, Italy
| | - Miriam Dellino
- Department of Interdisciplinary Medicine (DIM), 1st Unit of Obstetrics and Gynecology, University of Bari, Bari, BA, Italy
| | - Pierpaolo Nicolì
- Department of Interdisciplinary Medicine (DIM), 1st Unit of Obstetrics and Gynecology, University of Bari, Bari, BA, Italy
| | - Antonio D'Amato
- Department of Interdisciplinary Medicine (DIM), 1st Unit of Obstetrics and Gynecology, University of Bari, Bari, BA, Italy
| | - Stefano Bettocchi
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Maria Matteo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Stefano Palomba
- Department of Medical and Surgical Sciences, Sapienza University of Rome, Rome, Italy
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Cicinelli E, de Ziegler D, Vitagliano A. In women with endometriosis, effective treatment of chronic endometritis with antibiotics lowers serum CA-125 levels. Fertil Steril 2024:S0015-0282(24)00130-4. [PMID: 38403102 DOI: 10.1016/j.fertnstert.2024.02.041] [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] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Ettore Cicinelli
- 1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), Bari, Italy
| | - Dominique de Ziegler
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Foch Hospital, 92150, Suresnes, France
| | - Amerigo Vitagliano
- 1st Unit of Gynecology and Obstetrics, Department of Interdisciplinary Medicine (DIM), University of Bari (BA), Bari, Italy.
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Etrusco A, Laganà AS, Chiantera V, Gerli S, Carugno J, Sorrentino F, Riemma G, Vitagliano A, Favilli A. Efficacy, safety, and feasibility of the treatment of intrauterine pathologies with the mini-resectoscope: A systematic review. Int J Gynaecol Obstet 2024. [PMID: 38317479 DOI: 10.1002/ijgo.15393] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 11/30/2023] [Accepted: 01/09/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Hysteroscopy represents the gold standard for the diagnosis and treatment of intrauterine pathologies. The advent of the mini-resectoscope heralded a new era in intrauterine surgery, both in inpatient and outpatient settings. OBJECTIVES To evaluate the effectiveness, safety, and feasibility of the mini-resectoscope for the treatment of intrauterine pathologies. SEARCH STRATEGY Electronic databases were searched for English-language trials describing surgical procedures for uterine pathologies performed with a mini-resectoscope until 30 April 2023. SELECTION CRITERIA Retrospective or prospective original studies reporting the treatment of uterine pathologies with mini-resectoscope were deemed eligible for the inclusion. DATA COLLECTION AND ANALYSIS Data about study features, characteristics of included populations, surgical procedures, complications, and results/outcomes were collected. RESULTS Seven papers that met the inclusion criteria were included in this systematic review. Quantitative analysis was not possible due to data heterogeneity. A descriptive synthesis of the results was provided accordingly to the pathology hysteroscopically removed/corrected: polyps and myomas, uterine septum, intrauterine synechiae, and isthmocele. CONCLUSIONS The mini-resectoscope is poised to play a leading role in hysteroscopic surgery for many pathologies, both in inpatient and outpatient settings. Since some applications of the mini-resectoscope have not yet been thoroughly investigated, future studies should address current knowledge gaps, designing high-quality comparative trials on specific applications.
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Affiliation(s)
- Andrea Etrusco
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Jose Carugno
- Department of Obstetrics, Gynecology and Reproductive Sciences, Minimally Invasive Gynecology Division, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Felice Sorrentino
- Department of Medical and Surgical Science, Institute of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Amerigo Vitagliano
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Etrusco A, Buzzaccarini G, Laganà AS, Chiantera V, Vitale SG, Angioni S, D’Alterio MN, Nappi L, Sorrentino F, Vitagliano A, Difonzo T, Riemma G, Mereu L, Favilli A, Peitsidis P, D’Amato A. Use of Diode Laser in Hysteroscopy for the Management of Intrauterine Pathology: A Systematic Review. Diagnostics (Basel) 2024; 14:327. [PMID: 38337843 PMCID: PMC10855490 DOI: 10.3390/diagnostics14030327] [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: 12/19/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Hysteroscopy currently represents the gold standard for the diagnosis and treatment of intrauterine pathologies. Recent technological progress has enabled the integration of diagnostic and operative time, leading to the "see and treat" approach. Diode laser technology is emerging as one of the most innovative and intriguing techniques in this context. Methods: A comprehensive search of the literature was carried out on the main databases. Only original studies reporting the treatment of intrauterine pathologies using diode laser were deemed eligible for inclusion in this systematic review (PROSPERO ID: CRD42023485452). Results: Eight studies were included in the qualitative analysis for a total of 474 patients undergoing laser hysteroscopic surgery. Eighty-three patients had female genital tract abnormalities, 63 had submucosal leiomyomas, 327 had endometrial polyps, and one patient had a scar pregnancy. Except for leiomyomas, whose technique already included two surgical times at the beginning, only seven patients required a second surgical step. Cumulative rates of intraoperative and postoperative complications of 2.7% and 0.6%, respectively, were reported. Conclusions: Diode laser through "see and treat" hysteroscopy appears to be a safe and effective method. However, additional studies with larger sample sizes and improved designs are needed to consolidate the evidence currently available in the literature.
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Affiliation(s)
- Andrea Etrusco
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Giovanni Buzzaccarini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy;
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy;
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
- Unit of Gynecologic Oncology, National Cancer Institute IRCCS Fondazione “G. Pascale”, 80131 Naples, Italy
| | - Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (S.G.V.); (S.A.); (M.N.D.)
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (S.G.V.); (S.A.); (M.N.D.)
| | - Maurizio Nicola D’Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (S.G.V.); (S.A.); (M.N.D.)
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy; (L.N.); (F.S.)
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy; (L.N.); (F.S.)
| | - Amerigo Vitagliano
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.V.); (T.D.); (A.D.)
| | - Tommaso Difonzo
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.V.); (T.D.); (A.D.)
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Liliana Mereu
- Unit of Obstetrics and Gynecology, Department of General Surgery and Medical-Surgical Specialism, University of Catania, P.O. “G. Rodolico”, Via Santa Sofia, 78, 95123 Catania, Italy;
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06135 Perugia, Italy;
| | - Panagiotis Peitsidis
- Department of Obstetrics and Gynecology, Helena Venizelou Hospital, 11521 Athens, Greece;
| | - Antonio D’Amato
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.V.); (T.D.); (A.D.)
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Vitagliano A, Cicinelli E, Viganò P, Sorgente G, Nicolì P, Busnelli A, Dellino M, Damiani GR, Gerli S, Favilli A. Isthmocele, not cesarean section per se, reduces in vitro fertilization success: a systematic review and meta-analysis of over 10,000 embryo transfer cycles. Fertil Steril 2024; 121:299-313. [PMID: 37952914 DOI: 10.1016/j.fertnstert.2023.11.007] [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: 08/01/2023] [Revised: 10/14/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
IMPORTANCE Previous reviews have shown that a history of cesarean section (CS) is associated with a worse in vitro fertilization (IVF) prognosis. To date, whether the decline in the IVF chances of success should be attributed to the CS procedure itself or to the presence of isthmocele remains to be clarified. OBJECTIVE To summarize the available evidence regarding the impact of isthmocele on IVF outcomes. DATA SOURCES Electronic databases and clinical registers were searched until May 30, 2023. STUDY SELECTION AND SYNTHESIS Observational studies were included if they assessed the effect of isthmocele on IVF outcomes. Comparators were women with isthmocele and women without isthmocele with a previous CS or vaginal delivery. Study quality was assessed using the modified Newcastle-Ottawa Scale. MAIN OUTCOMES The primary outcome was the live birth rate (LBR). The effect measures were expressed as adjusted odds ratios (aORs) and unadjusted odds ratios (uORs) with 95% confidence intervals (95% CIs). The body of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation working group methodology. RESULTS Eight studies (n = 10,873 patients) were included in the analysis. Women with isthmocele showed a lower LBR than both women with a previous CS without isthmocele (aOR, 0.62; 95% CI, 0.53-0.72) and those with a history of vaginal delivery (aOR, 0.55; 95% CI, 0.42-0.71). The LBRs in women with a previous CS without isthmocele and those with a history of vaginal delivery were similar (aOR, 0.74; 95% CI, 0.47-1.15). Subgroup analysis suggested a negative effect of the intracavitary fluid (ICF) in women with isthmocele on the LBR (uOR, 0.36; 95% CI, 0.18-0.75), whereas the LBRs in women without ICF and those without isthmocele were similar (uOR, 0.94; 95% CI, 0.61-1.45). CONCLUSION AND RELEVANCE We found moderate quality of evidence (Grading of Recommendations Assessment, Development and Evaluation grade 3/4) supporting a negative impact of isthmocele, but not of CS per se, on the LBR in women undergoing IVF. The adverse effect of isthmocele on IVF outcomes appears to be worsened by ICF accumulation before embryo transfer. CLINICAL TRIAL REGISTRATION NUMBER CRD42023418266.
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Affiliation(s)
- Amerigo Vitagliano
- 1(st) Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Ettore Cicinelli
- 1(st) Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Giuseppe Sorgente
- 1(st) Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Pierpaolo Nicolì
- 1(st) Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Andrea Busnelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Miriam Dellino
- 1(st) Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Gianluca Raffaello Damiani
- 1(st) Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
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9
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Dellino M, Cerbone M, Fortunato F, Capursi T, Lepera A, Mancini T, Laganà AS, Malvasi A, Trerotoli P, Cormio G, Cicinelli E, Cazzato G, Carriero C, Pinto V, Cascardi E, Vitagliano A. Incidence of pre-neoplastic and neoplastic lesions of the cervix before and after the COVID-19 pandemic. Int J Gynecol Cancer 2024:ijgc-2023-004743. [PMID: 38103892 DOI: 10.1136/ijgc-2023-004743] [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: 12/19/2023] Open
Abstract
OBJECTIVE The COVID-19 pandemic had significant effects on healthcare systems worldwide, including the disruption of routine screening programs for cervical cancer. This study aimed to compare the incidence of cervical intra-epithelial neoplasia (CIN)2 and CIN3 lesions, adenocarcinoma, and squamous carcinoma of the cervix before and after the COVID-19 pandemic. METHODS A retrospective analysis was performed using archive data from the Policlinico di Bari, Unit of Gynecology and Obstetrics. The study included patients who tested positive for high-risk human papillomavirus (HPV) at the level I screening test (HPV test) and were subsequently referred to level II screening, which involves the Papanicolaou (Pap) test and colposcopic examination. We excluded individuals who did not comply with the recommended follow-up, patients with low-risk HPV infection, those with autoimmune diseases, oncologic diseases, or those undergoing immunosuppressive therapies. The time period spanned from January 2020 to December 2022. The incidence of CIN2/CIN3 lesions, adenocarcinoma, and squamous carcinoma of the cervix was compared between the pre-screening period (2017-2019) and the post-screening period (2020-2022). RESULTS The study comprised a cohort of 1558 consecutive European sexually active women with a median age of 34 years (range 25-65) who underwent colposcopic evaluation of the uterine cervix as a level II screening program. The comparison between the pre-screening and post-screening periods showed an increase in the incidence of CIN2/CIN3 lesions, rising from 23.9 to 63.3 per 100 000 (HR 2.62, 95% CI 1.64 to 4.20; p<0.001). Additionally, although there was an absolute increase in the incidence of cervical carcinoma and adenocarcinoma, the comparison did not reach statistical significance (squamous carcinoma: 2017-2019, 2.5 per 100 000; 2020-2022 3.4 per 100 000, p=0.72; adenocarcinoma: 2017-2019, 3.5 per 100 000; 2020-2022 7.6 per 100 000, p=0.24). CONCLUSION This study showed a significant increase in the incidence rate of CIN2/CIN3 lesions after the COVID-19 pandemic. Our findings may be attributed to the temporary suspension of follow-up programs during the pandemic, although the study does not rule out direct effects of SARS-CoV-2 on the risk of pre-neoplastic and neoplastic conditions of the cervix.
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Affiliation(s)
- Miriam Dellino
- Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Marco Cerbone
- Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Francesca Fortunato
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Teresa Capursi
- Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Achiropita Lepera
- Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Tiziana Mancini
- Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Antonio Malvasi
- Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Paolo Trerotoli
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Gennaro Cormio
- Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Puglia, Italy
- Department of Gynecology, University of Bari, Bari, Puglia, Italy
| | - Ettore Cicinelli
- Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Gerardo Cazzato
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and IonianArea (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy, Bari, Puglia, Italy
| | - Carmine Carriero
- Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Vincenzo Pinto
- Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Eliano Cascardi
- Section of Molecular Pathology, Department of Precision and Regenerative Medicine and IonianArea (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy, Bari, Puglia, Italy
| | - Amerigo Vitagliano
- Department of Interdisciplinary Medicine (DIM), University of Bari Aldo Moro, Bari, Puglia, Italy
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Paffoni A, Casalechi M, De Ziegler D, Cicinelli E, Somigliana E, Viganò P, Vitagliano A. Live Birth After Oocyte Donation In Vitro Fertilization Cycles in Women With Endometriosis: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2354249. [PMID: 38294811 PMCID: PMC10831577 DOI: 10.1001/jamanetworkopen.2023.54249] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/05/2023] [Indexed: 02/01/2024] Open
Abstract
Importance Although multiple mechanisms have been proposed to explain the infertility related to endometriosis, there are no conclusive data on the association of endometriosis with endometrial receptivity. The oocyte donation model in assisted reproduction technology (ART) cycles can clarify this issue. Objective To explore the association of a history of endometriosis with ART outcomes in recipients of oocyte donation. Data Sources In this systematic review and meta-analysis, electronic databases were searched from inception until August 31, 2023, using combinations of relevant keywords. Moreover, we retrieved data from the databases of the Society for Assisted Reproductive Technology (SART) in the US and the Human Fertilization and Embryology Authority (HFEA) in the United Kingdom. Study Selection Observational studies were included if they investigated the impact of endometriosis on ART outcomes with donor oocytes. Data Extraction and Synthesis Publicly available data related to ART from various sources were gathered, and a retrospective aggregate and nonaggregate analysis using registries of in vitro fertilization cycles with oocyte or embryo donation was conducted. Main Outcomes and Measures The primary outcome was live birth rate (LBR) following oocyte donor cycles. The effect measures of comparisons between groups are presented as odds ratios (ORs) with a 95% CI. Results This study analyzed 7212 oocyte donation cycles from 4 studies for the meta-analysis, along with 162 082 cycles from 2 registries (137 182 from SART and 24 900 from HFEA). No significant differences between the groups were observed in the meta-analysis of published data after adjusting for confounding factors (OR, 0.54; 95% CI, 0.19-1.57). A statistically significant lower LBR was identified in women with endometriosis when analyzing the aggregate data from SART and HFEA databases (OR, 0.89; 95% CI, 0.81-0.97). Conclusions and Relevance This study found a modest decrease in LBR among women with a history of endometriosis, although only results from the pooled analysis of registry data and not those from the meta-analysis reached statistical significance. These findings suggest that a marginal impairment of uterine receptivity may contribute to infertility mechanisms in women affected by endometriosis.
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Affiliation(s)
| | - Maíra Casalechi
- Human Reproduction Unit of the Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Dominique De Ziegler
- Department of Obstetrics, Gynecology and Human Reproduction, Hospital Foch, Suresnes, France
| | - Ettore Cicinelli
- First Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Edgardo Somigliana
- Infertility Unit, Department of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Paola Viganò
- Infertility Unit, Department of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Amerigo Vitagliano
- First Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
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11
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Parenti M, Degliuomini RS, Cosmi E, Vitagliano A, Fasola E, Origoni M, Salvatore S, Buzzaccarini G. Botulinum toxin injection in vulva and vagina. Evidence from a literature systematic review. Eur J Obstet Gynecol Reprod Biol 2023; 291:178-189. [PMID: 38353087 DOI: 10.1016/j.ejogrb.2023.10.028] [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: 12/29/2022] [Revised: 08/20/2023] [Accepted: 10/18/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Botulinum toxin (BoNT) administration has been proposed in the gynecologic field for pelvic, vulvar and vaginal disorders. On this regard, we aimed assessing the therapeutic effectiveness and safety of BoNT usage in the treatment of vaginal, vulvar and pelvic pain disorders. METHODS We searched for all the original articles without date restriction until 31.12.2021. We included all the original articles which administered botulinum toxin in the vulva or vagina of women suffering from vaginismus, dyspareunia, and chronic pelvic pain. Only English language studies and those performed in humans were eligible. We excluded all case reports and pilot study from the qualitative analysis, although we accurately evaluated them. 22 original studies were finally included in the systematic review. RESULTS Botulinum toxin injection was found to be effective in improving vulvar and vaginal dyspareunia, vaginismus, and chronic pelvic pain. No irreversible side effects were detected. Major side effects reported were transient urinary or fecal incontinence, constipation and rectal pain. The risk of bias assessment proved original articles to be of medium quality. No metanalysis could have been performed since lack of congruency in the definition of pathology and methods of botulinum toxin administration. CONCLUSION Data extraction pointed out different endpoints and different methods of analysis. Studies focus on different types of participants and use various techniques and timing. According to the best evidence available, different techniques provide evidence about positive outcomes, with the need for a standardized protocol.
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Affiliation(s)
- Michele Parenti
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, 35128, Padua, Italy
| | - Rebecca Susanna Degliuomini
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy; Italian Association of Functional and Esthetic Gynecology (AIGEF), Milan, Italy
| | - Erich Cosmi
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, 35128, Padua, Italy
| | - Amerigo Vitagliano
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, 35128, Padua, Italy
| | - Elena Fasola
- Italian Association of Functional and Esthetic Gynecology (AIGEF), Milan, Italy
| | - Massimo Origoni
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - Stefano Salvatore
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy; Italian Association of Functional and Esthetic Gynecology (AIGEF), Milan, Italy
| | - Giovanni Buzzaccarini
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
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12
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Malvasi A, Damiani GR, DI Naro E, Vitagliano A, Dellino M, Achiron R, Ioannis K, Vimercati A, Gaetani M, Cicinelli E, Vinciguerra M, Ricci I, Tinelli A, Baldini GM, Silvestris E, Trojano G. Intrapartum ultrasound and mother acceptance: A study with informed consent and questionnaire. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100246. [PMID: 37876768 PMCID: PMC10590726 DOI: 10.1016/j.eurox.2023.100246] [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: 08/02/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Intrapartum ultrasound (IU) is used in the delivery ward; even if IU monitors the labouring women, it could be perceived as a discomfort and even as an" obstetric violence", because it is a young technique, not often well "accepted". A group of clinicians aimed at obtain an informed consent from patients, prior to perform a translabial ultrasound (TU). The aim of this study was to evaluate the acceptance of both translabial and transabdominal IU. Methods In this study, performed at the University Hospital of Bari (Unit of Obstetrics and Gynecology), were enrolled 103 patients in the first or second stage of labor in singleton cephalic presentation. A statistical frequency and an association analysis were performed. As a significant result, we consider the peace of mind/satisfaction and the" obstetric violence". IU was performed both transabdominal and translabial to determine the presentation, head positions, angle of progression and head perineum distance. During the first and second stage of labor, the ASIUG questionnaires (Apulia study intrapartum ultrasonography group) were administered. Results 74 (71, 84%) patients underwent IU and 29 had a vaginal examination (28, 15%). Significant less "violence" has been experienced with a IU (73 out 74/98, 65%) and only one person (1 /1, 35%) recorded that. On the contrary, 10 patients (10/29) perceived that "violence" (34, 48%) while 19 (65, 52%) did not respond on a similar way, after a vaginal examination (VE). More patients felt satisfaction (71 out 74/95, 95%) with the use of IU and only 3 (3/4, 05%) felt unease. A different picture was evident in the vaginal examination group. Only 17 patients (17 out 29/58, 62%) felt comfort while 12 (41, 38%) felt unease. Conclusions In our study, IU use is well accepted by most of patients, because it could reassure women about their fetal condition. Moreover, they can see the fetus on the screen, while the obstetrician is performing the US and this is important for a visual feedback, in comparison with the classical VE.
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Affiliation(s)
- Antonio Malvasi
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), 141701 Moscow, Russia
| | - Gianluca Raffaello Damiani
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Edoardo DI Naro
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Amerigo Vitagliano
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Miriam Dellino
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Reuven Achiron
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - Kosmas Ioannis
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Antonella Vimercati
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Maria Gaetani
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Ettore Cicinelli
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Marina Vinciguerra
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Ilaria Ricci
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Andrea Tinelli
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), 141701 Moscow, Russia
- Department of Obstetrics and Gynecology, "Veris delli Ponti" Hospital, Scorrano, 73020 Lecce, Italy
- Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, 73100 Lecce, Italy
| | | | - Erica Silvestris
- Gynecologic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | - Giuseppe Trojano
- Department of Maternal and Child Gynecologic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, ItalyHealth, "Madonna delle Grazie" Hospital ASM, 75100 Matera, Italy
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13
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Damiani GR, Di Gennaro D, Vimercati A, Cicinelli E, Perrone AM, De Iaco P, Malvasi A, Gaetani M, Cascardi E, Cazzato G, Dellino M, Pellegrino A, Vitagliano A. Office intrauterine morcellation for retained products of conception. MINIM INVASIV THER 2023; 32:323-328. [PMID: 37493491 DOI: 10.1080/13645706.2023.2227694] [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: 01/28/2023] [Accepted: 06/02/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Proposing hysteroscopic morcellation (HM) as a surgical-therapeutic approach in the treatment of retained products of conception (RPOC) to prevent intrauterine adhesions (IUAs). DESIGN Prospective analysis. SETTING A teaching and university hospital. PATIENTS Women with RPOC. INTERVENTIONS Office -HM with 'Truclear 5 C'. MATERIAL AND METHODS Twenty-two consecutive patients presenting with trophoblastic residue retention after miscarriage and interruption of pregnancy or placenta remnants after cesarean section or delivery were enrolled. These women underwent office-HM with 'Truclear 5 C'. Primary outcomes were median time and rate of hospitalization. The quality of the specimen was also analyzed. A hysteroscopic second look for IUAs was performed. RESULTS Mean procedure time was six minutes (SD ± 5). Tissue samples had a mean collection size 2.5 cm3+0.9. 38% of the samples had spotting or abnormal vaginal discharge. Dilatation of the cervical canal was not performed in any case. Second-look hysteroscopy did not show any de novo IUAs in any of the enrolled patients. CONCLUSIONS In the hysteroscopic treatment of RPOC, HM is a valid choice in an office setting without the use of cervical dilatation. Removal of RPOC was uneventful in all cases, simple and carried out faster without any adverse outcomes.
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Affiliation(s)
| | - Daniele Di Gennaro
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Antonella Vimercati
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Ettore Cicinelli
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Anna Myriam Perrone
- Department of Obstetrics and Gynecology, Unit of Oncologic Gynecology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pierandrea De Iaco
- Department of Obstetrics and Gynecology, Unit of Oncologic Gynecology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Maria Gaetani
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Eliano Cascardi
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Gerardo Cazzato
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | - Miriam Dellino
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
| | | | - Amerigo Vitagliano
- Department of Obstetrics and Gynecology, Policlinico of Bari, University of Bari, Bari, Italy
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Favilli A, Mazzon I, Etrusco A, Dellino M, Laganà AS, Tinelli A, Chiantera V, Cicinelli E, Gerli S, Vitagliano A. The challenge of FIGO type 3 leiomyomas and infertility: Exploring therapeutic alternatives amidst limited scientific certainties. Int J Gynaecol Obstet 2023. [PMID: 38009829 DOI: 10.1002/ijgo.15260] [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: 08/31/2023] [Revised: 10/28/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Abstract
Uterine leiomyomas (ULs) are non-cancerous tumors composed of smooth muscle cells that develop within the myometrium and represent the most prevalent pathological condition affecting the female genital tract. Despite the volume of available research, many aspects of ULs remain unresolved, making it a "paradoxical disease" where the increase in available scientific literature has not been matched by an increase in solid evidence for clinical management. Fertility stands at the top of the list of clinical issues where the role of ULs is still unclear. The leiomyoma subclassification system, released by the International Federaion of Gynecology and Obstetrics (FIGO) in 2008, introduced a new and more effective way of categorizing uterine fibroids. The aim was to go beyond the traditional classification "subserosal, intramural and submucosal", facilitating a detailed examination of individual ULs impact on the female reproductive system. The "type 3 UL" is a special type of myoma, characterized by its complete myometrial development while encroaching the endometrium. It is a unique "hybrid" between a submucous and an intramural UL, that may exert a detrimental "double hit" mechanism, which is of particular interest in patients wishing pregnancy. To date, no robust evidence is available regarding the management of type 3 ULs. The aim of this narrative review is to provide a comprehensive overview of the physiopathological mechanisms that type 3 UL may exert on fertility, and to present new perspectives that may help us to better understand both the need for and the methods of treating this unique type of fibroid.
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Affiliation(s)
- Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Center of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | | | - Andrea Etrusco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Miriam Dellino
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, CERICSAL (CEntro di RIcerca Clinico SALentino), Veris delli Ponti Hospital, Scorrano, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Ettore Cicinelli
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Center of Perinatal and Reproductive Medicine, University of Perugia, Perugia, Italy
| | - Amerigo Vitagliano
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, Bari, Italy
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Favilli A, Etrusco A, Chiantera V, Laganà AS, Cicinelli E, Gerli S, Vitagliano A. Impact of FIGO type 3 uterine fibroids on in vitro fertilization outcomes: A systematic review and meta-analysis. Int J Gynaecol Obstet 2023; 163:528-539. [PMID: 37183601 DOI: 10.1002/ijgo.14838] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 02/21/2023] [Revised: 04/08/2023] [Accepted: 04/16/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The effect of FIGO (the International Federation of Gynecology & Obstetrics) type 3 myomas on in vitro fertilization (IVF) is uncertain. OBJECTIVES To evaluate whether FIGO type 3 myomas affect IVF outcomes, through a systematic review and meta-analysis (CRD42022379700). SEARCH STRATEGY Electronic databases were searched until November 15, 2022. SELECTION CRITERIA Studies evaluating the effects of FIGO type 3 myomas on IVF outcome. DATA COLLECTION AND ANALYSIS Pooled results were expressed as odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using Higgins I2 . Sources of heterogeneity were explored with sensitivity and subgroup analyses. MAIN RESULTS In total, 1020 patients were included: 324 with FIGO type 3 myomas and 696 controls (without myomas). A pooled data analysis showed a significantly lower live birth rate (OR 2.16, 95% CI 1.55-3.01, I2 = 0%, P < 0.00001), clinical pregnancy rate (OR 2.06, 95% CI 1.52-2.81, I2 = 0%, P < 0.00001), and implantation rate (OR 1.77, 95% CI 1.35-2.32, I2 = 0%, P < 0.00001) in women with untreated myomas compared with controls. The number and size of fibroids correlated with a worsening of IVF outcomes. CONCLUSIONS FIGO type 3 myomas are significantly associated with a lower implantation rate, cumulative pregnancy rate, and live birth rate. Furthermore, their deleterious effect on the outcome of IVF increases further with increasing size and number. Nevertheless, no firm conclusions could be drawn about the potential benefits of surgery for FIGO type 3 uterine fibroids on IVF outcomes.
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Affiliation(s)
- Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Andrea Etrusco
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Ettore Cicinelli
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, University of Bari, Policlinico, Bari, Italy
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Amerigo Vitagliano
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, University of Bari, Policlinico, Bari, Italy
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Vitagliano A, Dellino M, Favilli A, D' Amato A, Nicolì P, Laganà AS, Noventa M, Bochicchio MA, Cicinelli E, Damiani GR. Patients' Use of Virtual Reality Technology for Pain Reduction during Outpatient Hysteroscopy: A Meta-analysis of Randomized Controlled Trials. J Minim Invasive Gynecol 2023; 30:866-876. [PMID: 37648150 DOI: 10.1016/j.jmig.2023.08.427] [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: 06/28/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To summarize evidence from randomized controlled trials (RCTs) on the effectiveness of virtual reality technology (VRT), as used by patients, for reducing pain during outpatient hysteroscopy. DATA SOURCES Electronic databases and clinical registers were searched until June 21, 2023. The review protocol was registered in PROSPERO before the data extraction (CRD42023434340). METHODS OF STUDY SELECTION We included RCTs of patients receiving VRT compared with controls receiving routine care during outpatient hysteroscopy. TABULATION, INTEGRATION, AND RESULTS The primary outcome was average pain during hysteroscopy. Pooled results were expressed as mean differences (MDs) with 95% confidence interval (CI). Sources of heterogeneity were investigated through sensitivity and subgroups analysis. Five RCTs were included (435 participants). The comparison between the intervention and control groups showed a borderline difference in perceived pain during hysteroscopy (MD -0.88, 95% CI -1.77 to 0.01). Subgroup analysis based on the type of VRT (active or passive) indicated that active VRT potentially reduced the perception of pain (MD -1.42, 95% CI -2.21 to -0.62), whereas passive VRT had no effect (MD -0.06, 95% CI -1.15 to 1.03). CONCLUSION Patients' use of active VRT may be associated with a reduction in pain during outpatient hysteroscopy (evidence Grading of Recommendations Assessment, Development, and Evaluation 2/4). Future research should focus on conducting methodologically robust studies with larger sample sizes and more homogeneous populations.
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Affiliation(s)
- Amerigo Vitagliano
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy.
| | - Miriam Dellino
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery (Drs. Favilli), University of Perugia, Perugia, Italy
| | - Antonio D' Amato
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Pierpaolo Nicolì
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) (Dr. Laganà), University of Palermo, Palermo, Italy
| | - Marco Noventa
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health (Dr. Noventa), University of Padua, Padua, Italy
| | | | - Ettore Cicinelli
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Gianluca Raffaello Damiani
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
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Spagnol G, Marchetti M, De Tommasi O, Vitagliano A, Cavallin F, Tozzi R, Saccardi C, Noventa M. Simple rules, O-RADS, ADNEX and SRR model: Single oncologic center validation of diagnostic predictive models alone and combined (two-step strategy) to estimate the risk of malignancy in adnexal masses and ovarian tumors. Gynecol Oncol 2023; 177:109-116. [PMID: 37660412 DOI: 10.1016/j.ygyno.2023.08.012] [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: 06/16/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To compare performance of Assessment of Different NEoplasias in the adneXa (ADNEX model), Ovarian-Adnexal Reporting and Data System (O-RADS), Simple Rules Risk (SRR) assessment and the two-step strategy based on the application of Simple Rules (SR) followed by SRR and SR followed by ADNEX in the pre-operative discrimination between benign and malignant adnexal masses (AMs). METHODS We conducted a retrospective study from January-2018 to December-2021 in which consecutive patients with at AMs were recruited. Accuracy metrics included sensitivity (SE) and specificity (SP) with their 95% confidence intervals (CI) were calculated for ADNEX, O-RADS and SRR. When SR was inconclusive a "two-step strategy" was adopted applying SR + ADNEX model and SR + SRR assessment. RESULTS A total of 514 women were included, 400 (77.8%) had a benign ovarian tumor and 114 (22.2%) had a malignant tumor. At a threshold malignancy risk of >10%, the SE and SP of ADNEX model, O-RADS and SRR were: 0.92 (95% CI, 0.86-0.96) and 0.88 (95% CI, 0.85-0.91); 0.93 (95% CI, 0.87-0.97) and 0.89 (95% CI, 0.96-0.92); 0.88 (95% CI, 0.80-0.93) and 0.84 (95% CI, 0.80-0.87), respectively. When we applied SR, 109 (21.2%) cases resulted inconclusive. The SE and SP of two-step strategy SR + SRR assessment and SR + ADNEX model were 0.88 (95% CI, 0.80-0.93) and 0.92 (95% CI, 0.89-0.94), SR + ADNEX model 0.90 (95% CI, 0.83-0.95) and 0.93 (95% CI, 0.90-0.96), respectively. CONCLUSIONS O-RADS presented the highest SE, similar to ADNEX model and SR + ADNEX model. However, the SR + ADNEX model presented the higher performance accuracy with the higher SP and PPV. This two-step strategy, SR and ADNEX model applicated to inconclusive SR, is convenient for clinical evaluation.
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Affiliation(s)
- Giulia Spagnol
- Department of Women and Children's Health, Unit of Gynecology and Obstetrics, University of Padua, Padua, Italy
| | - Matteo Marchetti
- Department of Women and Children's Health, Unit of Gynecology and Obstetrics, University of Padua, Padua, Italy
| | - Orazio De Tommasi
- Department of Women and Children's Health, Unit of Gynecology and Obstetrics, University of Padua, Padua, Italy
| | - Amerigo Vitagliano
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, University of Bari, Policlinico, Bari, Italy
| | - Francesco Cavallin
- Independent Statistician (collaboration with University of Padua), Solagna, Italy
| | - Roberto Tozzi
- Department of Women and Children's Health, Unit of Gynecology and Obstetrics, University of Padua, Padua, Italy
| | - Carlo Saccardi
- Department of Women and Children's Health, Unit of Gynecology and Obstetrics, University of Padua, Padua, Italy
| | - Marco Noventa
- Department of Women and Children's Health, Unit of Gynecology and Obstetrics, University of Padua, Padua, Italy.
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Nicolì P, Damiani GR, Gaetani M, Dellino M, Vitagliano A, Malvasi A, Cazzato G, Cascardi E, Marzullo A, Alfonso R, Cicinelli E, Vimercati A. "The Strange Case of Dr Pump and Mr Acardiac": The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies-Diagnosis, Prognosis and Management: Review of Literature. Diagnostics (Basel) 2023; 13:3109. [PMID: 37835852 PMCID: PMC10572342 DOI: 10.3390/diagnostics13193109] [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: 08/17/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
The Twin Reversed Arterial Perfusion (TRAP) Sequence is an extremely rare complication of monochorionic twin pregnancies, with one severely malformed twin (the "acardiac") lacking autonomous placental blood supply and being perfused by the co-twin (the "pump"), through arterio-arterial (and sometimes also veno-venous) vascular anastomoses located on the placental surface. The prognosis is poor: mortality is 100% in the acardiac twin because of its severe malformations and about 50-55% in the pump twin, mainly due to heart failure and prematurity. So, the goal of perinatal management of the TRAP twin pregnancy is to deliver a healthy and near-term pump twin without heart failure or fetal hydrops. Intuitively, the earlier the diagnosis, the better the outcome. Herein, we report two cases of monochorionic monoamniotic (MCMA) twin pregnancies complicated by the TRAP Sequence, which are of interest since the objective of early diagnosis was achieved by means of transvaginal and 3D ultrasound, two techniques which revealed themselves as being useful to this purpose but are underused in the literature. The second aim of this study is to provide an overview of literature data about the diagnosis, prognosis establishment, and management of this rare condition, which are still debated and unclear due to negligible poor-quality evidence.
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Affiliation(s)
- Pierpaolo Nicolì
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Gianluca Raffaello Damiani
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Maria Gaetani
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Miriam Dellino
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Amerigo Vitagliano
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | | | - Gerardo Cazzato
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Eliano Cascardi
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Andrea Marzullo
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Raffaello Alfonso
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Ettore Cicinelli
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Antonella Vimercati
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
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Stanziano A, Bianchi FP, Caringella AM, Cantatore C, D'Amato A, Vitti A, Cortone A, Vitagliano A, D'Amato G. The use of real time strain endometrial elastosonography plus endometrial thickness and vascularization flow index to predict endometrial receptivity in IVF treatments: a pilot study. BMC Med Imaging 2023; 23:130. [PMID: 37715124 PMCID: PMC10503140 DOI: 10.1186/s12880-023-01071-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/02/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The usefulness of endometrium strain elastosonography (SE) for the evaluation of endometrial receptivity in women undergoing in vitro fertilization (IVF) remains controversial. The objective of this prospective, observational study was to evaluate the correlation between endometrial thickness (EMT) and its related strain (ESR) on the day of ovulation triggering (hCG-d) and in vitro fertilization outcomes. Additionally, 3D Power Doppler vascular indices (3DPDVI) were also analysed. METHODS We included all the patients undergoing fresh IVF-single blastocyst transfer cycle from January 2021 to August 2021 at our center. On hCG-d, after B-mode scanning was completed to measure the EMT, the mode was changed to elastosonography to evaluate the ESR (ratio between endometrial tissue and the myometrium below). At the end of examination, the Endometrial Volume (EV) and 3DPDVI (vascularization index [VI], flow index [FI] and vascularization flow index [VFI]), were assessed. Statistical analysis was completed using STATA MP16 software. RESULTS A total number of 57 women were included. Based on the EMT on hCG-d, women were divided into two groups, Group 1: <7 mm and Group 2 ≥ 7 mm. Women with EMT < 7 mm had a significantly higher ESR (p = 0.004) and lower pregnancy rate (p = 0.04). Additionally, low ESR values were correlated with high VFI values (rho = -0.8; 95% CI = -0.9- -0.6; p < 0.0001) and EMT ≥ 7 mm could be predicted by low ESR (OR = 0.01; 95% CI = 0.01-0.30; p = 0.008, area under the ROC curve: 0.70). After all, in multiple logistic regression analysis, low values of ESR (p = 0.050) and high values of EMT (p = 0.051) on hCG-d had borderline statistical effects on pregnancy rate. CONCLUSIONS The ESR may be useful to improve the ultrasound evaluation of the endometrial quality in infertile women candidates to IVF/ICS. Given the small sample size of our study, the usefulness of strain elastosonography in this patients, needs further investigation.
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Affiliation(s)
- Antonio Stanziano
- Department of Advanced Reproductive Risk Management and High-Risk Pregnancies, ASL Bari, Reproductive and IVF Unit, PTA Conversano, Conversano, BA, Italy.
| | | | - Anna Maria Caringella
- Department of Advanced Reproductive Risk Management and High-Risk Pregnancies, ASL Bari, Reproductive and IVF Unit, PTA Conversano, Conversano, BA, Italy
| | - Clementina Cantatore
- Department of Advanced Reproductive Risk Management and High-Risk Pregnancies, ASL Bari, Reproductive and IVF Unit, PTA Conversano, Conversano, BA, Italy
| | - Antonio D'Amato
- Gynecology and Obstetrics Clinic, University of Bari, Aldo Moro, Bari, Italy
| | - Angela Vitti
- Department of Advanced Reproductive Risk Management and High-Risk Pregnancies, ASL Bari, Reproductive and IVF Unit, PTA Conversano, Conversano, BA, Italy
| | - Anna Cortone
- Department of Advanced Reproductive Risk Management and High-Risk Pregnancies, ASL Bari, Reproductive and IVF Unit, PTA Conversano, Conversano, BA, Italy
| | - Amerigo Vitagliano
- Gynecology and Obstetrics Clinic, University of Bari, Aldo Moro, Bari, Italy
| | - Giuseppe D'Amato
- Department of Advanced Reproductive Risk Management and High-Risk Pregnancies, ASL Bari, Reproductive and IVF Unit, PTA Conversano, Conversano, BA, Italy
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Damiani GR, Dellino M, Cascardi E, Xuamin H, Di Gennaro D, Vimercati A, Vitagliano A, Malvasi A, loizzi V, Paniga C, Lanteri L, Alfonso R, Cicinelli E, Pellegrino A. Uterine venous malformations in the puerperium: 2 Atypical cases and literature review. Eur J Obstet Gynecol Reprod Biol X 2023; 19:100220. [PMID: 37636521 PMCID: PMC10450833 DOI: 10.1016/j.eurox.2023.100220] [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: 05/13/2023] [Accepted: 07/29/2023] [Indexed: 08/29/2023] Open
Abstract
Uterine arteriovenous malformations (AVMs) is a rare but high-risk cause of uterine bleeding. The clinical management of this condition is challenging, as the ultrasound picture can sometimes be unambiguously interpreted. Moreover, in the puerperium in which acquired AVMs are most frequently formed, it is necessary to discuss the correct management in a multidisciplinary and personalized manner. We present two cases of AVMs developing in the puerperium, both with a vaginal delivery and spontaneous and complete secondment. The symptom of onset was an episode of bright red blood loss in the puerperium, on the 14th and 21st postpartum days, respectively. Transvaginal ultrasound showed a hypervascularized lesion in the myometrium with turbulent vascular flow, confirmed by transabdominal ultrasound and angiography. To date, there are no guidelines on the management of MAVs. In our cases we opted for a conservative approach, in order to preserve the fertility of the patient. These experiences reported have the purpose of enriching a literature still sparse on the subject and in the future to be able to represent a fulcrum for official recommendations.
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Affiliation(s)
- Gianluca Raffaello Damiani
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Miriam Dellino
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Eliano Cascardi
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - He Xuamin
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
- San Raffaele Hospital, Milan,Italy
| | - Daniele Di Gennaro
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Antonella Vimercati
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Amerigo Vitagliano
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Antonio Malvasi
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Vera loizzi
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", 70124 Bari, Italy
- Oncology Unit IRCSS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | - Cristiana Paniga
- University of Milan-Biccocca,Department of Medicine and Surgery, Milan, Italy
| | - Laura Lanteri
- University of Milan-Biccocca,Department of Medicine and Surgery, Milan, Italy
| | - Raffaello Alfonso
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Ettore Cicinelli
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of "Aldo Moro", 70124 Bari, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynecology, ASTT LECCO, Alessandro Manzoni Hospital, Dell'Eremo Street 11, Lecco, Italy
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Di Spiezio Sardo A, Vitagliano A. Hysteroscopic Metroplasty for Septate Uterus: A Technique Once Considered Dead, Now Thriving More Than Ever. J Minim Invasive Gynecol 2023; 30:681-682. [PMID: 37454726 DOI: 10.1016/j.jmig.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Attilio Di Spiezio Sardo
- Department of Public Health, School of Medicine (Dr. Sardo), University of Naples Federico II, Naples, Italy; Department of Interdisciplinary Medicine (Dr. Vitagliano), University of Bari Aldo Moro, Bari, Italy.
| | - Amerigo Vitagliano
- Department of Public Health, School of Medicine (Dr. Sardo), University of Naples Federico II, Naples, Italy; Department of Interdisciplinary Medicine (Dr. Vitagliano), University of Bari Aldo Moro, Bari, Italy
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Petre GC, Francini-Pesenti F, Vitagliano A, Grande G, Ferlin A, Garolla A. Dietary Supplements for Erectile Dysfunction: Analysis of Marketed Products, Systematic Review, Meta-Analysis and Rational Use. Nutrients 2023; 15:3677. [PMID: 37686709 PMCID: PMC10490034 DOI: 10.3390/nu15173677] [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: 06/28/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
The use of nutraceutical products to enhance male sexual performance has a long history, especially with regard to the treatment of erectile dysfunction (ED). Alternative treatments for ED are becoming increasingly popular, with growing interest from consumers, as well as increased revenue for manufacturers. Dietary supplements (DSs), which are a mixture of active ingredients, are mainly sold online. In randomized controlled trials, the molecules contained in DSs have demonstrated varying degrees of effectiveness, or even have no evidence to support their use. However, none of the studies carried out provided sufficient evidence to consider these products a first-line therapy. Therefore, the combination of the various active ingredients, especially in relation to the daily dose, leaves doubts about the real effectiveness. In order to evaluate the potential efficacy of DS formulations, we analyzed the products marketed in Italy using a scoring approach. A systematic review of the literature was performed to evaluate the effect of DS and to detect the active ingredients able to improve erectile function-called effective ingredients (EIs)-and their minimal effective daily dose (mED). A metanalysis identified some nutraceuticals, such as Panax ginseng, Tribulus terrestris and L-arginine, that are able to improve male sexual function. Based on the scoring system, 2 (8%) supplements matched with the cluster of higher expected efficacy, 3 (12%) with the lower efficacy cluster and 20 (80%) matched with the criterion of no expected efficacy. DSs marketed in Italy are usually blends of many substances that are frequently employed at a negligible dose or without any evidence.
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Affiliation(s)
- Gabriel Cosmin Petre
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, 35100 Padova, Italy; (G.C.P.); (G.G.); (A.F.)
| | | | - Amerigo Vitagliano
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70121 Bari, Italy;
| | - Giuseppe Grande
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, 35100 Padova, Italy; (G.C.P.); (G.G.); (A.F.)
| | - Alberto Ferlin
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, 35100 Padova, Italy; (G.C.P.); (G.G.); (A.F.)
| | - Andrea Garolla
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, 35100 Padova, Italy; (G.C.P.); (G.G.); (A.F.)
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Lamanna B, Dellino M, Cascardi E, Rooke-Ley M, Vinciguerra M, Cazzato G, Malvasi A, Vitagliano A, Nicolì P, Di Cosola M, Ballini A, Cicinelli E, Vimercati A. Efficacy of Systematic Early-Second-Trimester Ultrasound Screening for Facial Anomalies: A Comparison between Prenatal Ultrasound and Postmortem Findings. J Clin Med 2023; 12:5365. [PMID: 37629409 PMCID: PMC10455370 DOI: 10.3390/jcm12165365] [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: 07/05/2023] [Revised: 08/01/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Second-trimester 2D ultrasound (US) assessment of the fetal anatomy, as proposed by worldwide guidelines, allows detecting the majority of fetal malformation. However, the detection rates of fetal facial anomalies seem to still be low, mostly in cases of isolated facial malformation. The purpose of this research was to assess and analyze the concordance between the antenatal imaging findings from second-trimester US screening and the results of fetal postmortem autopsy. Between January 2010 and January 2020, there were 43 cases where fetuses with prenatal ultrasound diagnosis of a face abnormality, associated or not with a genetic syndrome or chromosomal disorder, following intrauterine death (IUD) or termination of pregnancy (TOP) after the 13 weeks of pregnancy, underwent autopsy in the Pathological Anatomy section of Bari Polyclinic specializing in feto-placental autopsies. The diagnosis of the fetal facial defects at ultrasound was compared with the findings at autopsy in all cases. A very high level of agreement between prenatal ultrasound and autopsy findings was found for facial abnormalities associated with genetic syndromes or numerical abnormality of chromosomes. A lower level of concordance was instead found in isolated facial defects or those associated with other organ anomalies, but not associated with genetic syndrome or numerical chromosome anomaly. A detailed examination of aborted fetuses led to successful quality control of early-second-trimester ultrasound detection of facial anomalies; however, it was less accurate for the isolated ones. It is, thus, reasonable to propose a systematic early-second-trimester prenatal ultrasound screening for facial anatomy by operators specialized in fetal medicine field, using 2D, 3D, and 4D techniques (two-, three-, and four-dimensional ultrasound).
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Affiliation(s)
- Bruno Lamanna
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70121 Bari, Italy
- Fetal Medicine Research Institute, King’s College Hospital, London SE5 9RS, UK
| | - Miriam Dellino
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Eliano Cascardi
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Mia Rooke-Ley
- Fetal Medicine Research Institute, King’s College Hospital, London SE5 9RS, UK
| | - Marina Vinciguerra
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Gerardo Cazzato
- Department of Precision and Regenerative Medicine and Jonic Area, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Antonio Malvasi
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Amerigo Vitagliano
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Pierpaolo Nicolì
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Michele Di Cosola
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy
| | - Andrea Ballini
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Ettore Cicinelli
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Antonella Vimercati
- Department of Precision and Regenerative Medicine and Jonic Area, University of Bari “Aldo Moro”, 70121 Bari, Italy
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24
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Baldari B, De Simone S, Cipolloni L, Frisoni P, Alfieri L, D’Errico S, Fineschi V, Turillazzi E, Greco P, Vitagliano A, Scutiero G, Neri M. Oxidative Stress Markers in Human Brain and Placenta May Reveal the Timing of Hypoxic-Ischemic Injury: Evidence from an Immunohistochemical Study. Int J Mol Sci 2023; 24:12221. [PMID: 37569597 PMCID: PMC10418753 DOI: 10.3390/ijms241512221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
During pregnancy, reactive oxygen species (ROS) serve as crucial signaling molecules for fetoplacental circulatory physiology. Oxidative stress is thought to sustain the pathogenesis and progression of hypoxic-ischemic encephalopathy (HIE). A retrospective study was performed on the brains and placentas of fetuses and newborns between 36-42 weeks of gestation (Group_1: Fetal intrauterine deaths, Group_2: Intrapartum deaths, Group_3: Post-partum deaths, Control group sudden neonatal death); all groups were further divided into two subgroups (Subgroup_B [brain] and Subgroup_P [placenta]), and the study was conducted through the immunohistochemical investigations of markers of oxidative stress (NOX2, 8-OHdG, NT, iNOS), IL-6, and only on the brain samples, AQP4. The results for the brain samples suggest that NOX2, 8-OHdG, NT, iNOS, and IL-6 were statistically significantly expressed above the controls. iNOS was more expressed in the fetal intrauterine death (Group_1) and less expressed in post-partum death (Group_3), while in intrapartum death (Group_2), the immunoreactivity was very low. IL-6 showed the highest expression in the brain cortex of the fetal intrauterine death (Group_1), while intrapartum death (Group_2) and post-partum death (Group_3) showed weak immunoreactivity. Post-partum death (Group_3) placentas showed the highest immunoreactivity to NOX2, which was almost double that of the fetal intrauterine death (Group_1) and intrapartum death (Group_2) placentas. Placental tissues of fetal intrauterine death (Group_1) and intrapartum death (Group_2) showed higher expression of iNOS than post-partum death (Group_3), while the IL-6 expression was higher in the fetal intrauterine death (Group_1) than the post-partum death (Group_3). The AQP4 was discarded as a possible marker because the immunohistochemical reaction in the three groups of cases and the control group was negative. The goal of this study, from the point of view of forensic pathology, is to provide scientific evidence in cases of medical liability in the Obstetric field to support the clinical data of the timing of HIE.
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Affiliation(s)
- Benedetta Baldari
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (B.B.); (V.F.)
| | - Stefania De Simone
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Viale Europa 12, 71122 Foggia, Italy; (S.D.S.); (L.C.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, Section of Legal Medicine, University of Foggia, Viale Europa 12, 71122 Foggia, Italy; (S.D.S.); (L.C.)
| | - Paolo Frisoni
- Unit of Legal Medicine, Azienda USL di Ferrara, Via Arturo Cassoli 30, 44121 Ferrara, Italy;
| | - Letizia Alfieri
- Department of Medical Sciences, Section of Legal Medicine University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy;
| | - Stefano D’Errico
- Department of Medicine, Surgery and Health, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy; (B.B.); (V.F.)
| | - Emanuela Turillazzi
- Department of Surgical Pathology, Medical, Molecular and Critical Area, Institute of Legal Medicine, University of Pisa, Via Roma, 55/57, 56126 Pisa, Italy;
| | - Pantaleo Greco
- Department of Medical Sciences, Section of Obstetrics and Gynecology, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (P.G.); (G.S.)
| | - Amerigo Vitagliano
- 1st Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, Policlinico, Piazza Giulio Cesare, 11, 70124 Bari, Italy;
| | - Gennaro Scutiero
- Department of Medical Sciences, Section of Obstetrics and Gynecology, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (P.G.); (G.S.)
| | - Margherita Neri
- Department of Medical Sciences, Section of Legal Medicine University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy;
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25
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Palomba S, Carone D, Vitagliano A, Costanzi F, Fracassi A, Russo T, Del Negro S, Biello A, Di Filippo A, Mangiacasale A, Monaco A, Ranieri A, Ermini B, Barba BF, Castello C, Di Guardo F, Pastorella F, Bernasconi E, Tricarico EM, Filippi F, Polsinelli F, Monte GL, Sosa Fernandez LM, Galletta M, Giardina P, Totaro P, Laganara R, Liguori R, Buccheri M, Montanino Oliva M, Piscopo R, Iuliano A, Innantuoni N, Romanello I, Sinatra F, Liprino A, Thiella R, Tiezzi A, Bartolotti T, Tomasi A, Finocchiaro V, Thiella M, Fuggetta G, Messineo S, Isabella F, Tripodi M, Iaccarino S, La Sala GB, Papaleo E, Caserta D, Marci R, Somigliana E, Guglielmino A. Fertility specialists' views, behavior, and attitudes towards the use of endometrial scratching in Italy. BMC Womens Health 2023; 23:397. [PMID: 37516869 PMCID: PMC10386779 DOI: 10.1186/s12905-023-02564-0] [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: 08/25/2022] [Accepted: 07/22/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Endometrial scratching (ES) or injury is intentional damage to the endometrium performed to improve reproductive outcomes for infertile women desiring pregnancy. Moreover, recent systematic reviews with meta-analyses and randomized controlled trials demonstrated that ES is not effective, data on the safety are limited, and it should not be recommended in clinical practice. The aim of the current study was to assess the view and behavior towards ES among fertility specialists throughout infertility centers in Italy, and the relationship between these views and the attitudes towards the use of ES as an add-on in their commercial setting. METHODS Online survey among infertility centers, affiliated to Italian Society of Human Reproduction (SIRU), was performed using a detailed questionnaire including 45 questions with the possibility to give "closed" multi-choice answers for 41 items and "open" answers for 4 items. Online data from the websites of the infertility centers resulting in affiliation with the specialists were also recorded and analyzed. The quality of information about ES given on infertility centers websites was assessed using a scoring matrix including 10 specific questions (scored from 0 to 2 points), and the possible scores ranged from 0 to 13 points ('excellent' if the score was 9 points or more, 'moderate' if the score was between 5 and 8, and 'poor' if it was 4 points or less). RESULTS The response rate was of 60.6% (43 questionnaires / 71 infertility SIRU-affiliated centers). All included questionnaires were completed in their entirety. Most physicians (~ 70%) reported to offer ES to less than 10% of their patients. The procedure is mainly performed in the secretory phase (69.2%) using pipelle (61.5%), and usually in medical ambulatory (56.4%) before IVF cycles to improve implantation (71.8%) without drugs administration (e.g., pain drugs, antibiotics, anti-hemorrhagics, or others) before (76.8%) or after (64.1%) the procedure. Only a little proportion of infertility centers included in the analysis proposes formally the ES as an add-on procedure (9.3%), even if, when proposed, the full description of the indications, efficacy, safety, and costs is never addressed. However, the overall information quality of the websites was generally "poor" ranging from 3 to 8 and having a low total score (4.7 ± 1.6; mean ± standard deviation). CONCLUSIONS In Italy, ES is a procedure still performed among fertility specialists for improving the implantation rate in IVF patients. Moreover, they have a poor attitude in proposing ES as an add-on in the commercial setting.
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Affiliation(s)
- Stefano Palomba
- Sant'Andrea Hospital, University "Sapienza" of Rome, Rome, Italy.
| | | | | | - Flavia Costanzi
- Sant'Andrea Hospital, University "Sapienza" of Rome, Rome, Italy
| | | | - Tiziana Russo
- Grande Ospedale Metropolitano, Reggio Calabria, Italy
- Gatjc Fertility Center, Gioia Tauro, Reggio Calabria, Italy
| | - Serena Del Negro
- Gatjc Fertility Center, Gioia Tauro, Reggio Calabria, Italy
- Presidio Ospedaliero Di Soverato "Basso Ionio", Soverato, Catanzaro, Italy
| | | | | | | | | | | | - Beatrice Ermini
- Centro Italiano Di Procreazione Assistita - CIPA, Rome, Italy
| | | | - Claudio Castello
- Centro FIVET Città Di Torino, Casa Della Salute Valdese, Turin, Italy
| | - Federica Di Guardo
- Azienda Ospedaliero Universitaria Policlinico "G. Rodolico - San Marco", Catania, Italy
| | | | | | | | - Francesca Filippi
- Fondazione IRCCS Ca' Grande - Ospedale Maggiore - University of Milan, Milan, Italy
| | | | - Giuseppe Lo Monte
- Centro Di Medicina Della Riproduzione E Crioconservazione Dei Gameti, Ospedale Di Brunico, Bolzano, Italy
| | | | - Marco Galletta
- Centro Di Procreazione Medicalmente Assistita, Azienda Ospedaliera "Papardo", Messina, Italy
| | | | - Pasquale Totaro
- Centro Di Procreazione Medicalmente Assistita, Ospedale Santa Maria, Bari, Italy
| | | | | | | | | | | | - Assunta Iuliano
- UOC Di Ostetricia E Ginecologia, Azienda Ospedaliera "San Carlo", Potenza, Italy
| | | | - Irene Romanello
- SSD Di Procreazione Medicalmente Assistita, Azienza Sanitaria Friuli Occidentale, Sacile, Pordenone, Italy
| | | | | | | | | | | | | | | | | | - Giuseppa Fuggetta
- SSD Di Procreazione Medicalmente Assistita, Azienza Sanitaria Friuli Occidentale, Sacile, Pordenone, Italy
| | | | | | | | | | | | | | | | | | - Edgardo Somigliana
- Fondazione IRCCS Ca' Grande - Ospedale Maggiore - University of Milan, Milan, Italy
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26
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Etrusco A, Laganà AS, Chiantera V, Vitagliano A, Cicinelli E, Mikuš M, Šprem Goldštajn M, Ferrari F, Uccella S, Garzon S, Gerli S, Favilli A. Feasibility and Surgical Outcomes of Hysteroscopic Myomectomy of FIGO Type 3 Myoma: A Systematic Review. J Clin Med 2023; 12:4953. [PMID: 37568356 PMCID: PMC10419844 DOI: 10.3390/jcm12154953] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 05/21/2023] [Revised: 07/16/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
The latest classification from the Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) has reclassified type 3 myomas, changing their classification from intramural to submucosal. While hysteroscopic myomectomy is considered the gold standard treatment for patients experiencing symptoms from submucosal myomas, there are currently no specific guidelines available for managing type 3 myomas, and the optimal surgical approach remains uncertain. Methods: The search for suitable articles published in English was carried out using the following databases (PROSPERO ID CRD42023418602): MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), Health Technology Assessment Database, Web of Science and search register. Only original studies reporting data on hysteroscopic myomectomy of type 3 myoma were considered eligible. The main outcomes investigated were the effectiveness and feasibility of hysteroscopic myomectomy and reproductive outcomes after surgical treatment. Results: Two hundred and sixty-one studies were screened and nineteen of these were read for eligibility. Three studies encompassing 56 patients in total were included. Among the overall population studied, three patients needed an additional procedure to completely remove the myoma and five cases of post-surgical synechiae were recorded. No complications were reported. Of 42 patients wishing for pregnancy, the cumulative live birth rates before and after the hysteroscopic myomectomy were 14.3% and 42.9%, respectively. Conclusions: Hysteroscopic myomectomy appears to be a safe and feasible approach. Nevertheless, data reported in the literature are extremely scarce and based on studies with few patients enrolled. New evidence is needed to assess the safety and effectiveness of hysteroscopic treatment for FIGO type 3 myomas.
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Affiliation(s)
- Andrea Etrusco
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy; (A.E.); (A.S.L.); (V.C.)
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy; (A.E.); (A.S.L.); (V.C.)
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy; (A.E.); (A.S.L.); (V.C.)
| | - Amerigo Vitagliano
- 1st Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, 70121 Bari, Italy; (A.V.); (E.C.)
| | - Ettore Cicinelli
- 1st Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, 70121 Bari, Italy; (A.V.); (E.C.)
| | - Mislav Mikuš
- Clinical Hospital Center Zagreb, Department of Obstetrics and Gynecology, 1000 Zagreb, Croatia;
| | - Marina Šprem Goldštajn
- Clinical Hospital Center Zagreb, Department of Obstetrics and Gynecology, 1000 Zagreb, Croatia;
| | - Federico Ferrari
- Department of Clinical and Experimental Sciences, University of Brescia, 25136 Brescia, Italy;
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37129 Verona, Italy; (S.U.); (S.G.)
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37129 Verona, Italy; (S.U.); (S.G.)
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (S.G.); (A.F.)
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy; (S.G.); (A.F.)
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27
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Fascilla FD, Piscitelli D, De Palma D, Mongelli M, Murgia F, Carugno J, Vitagliano A, Bettocchi S. Rapidly evolving pelvic lymphangioleiomyomatosis (LAM) mimicking bilateral hydrosalpinx: report of a rare case and literature review. Acta Chir Belg 2023:1-6. [PMID: 37395387 DOI: 10.1080/00015458.2023.2232687] [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: 03/16/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
Lymphangioleiomyomatosis (LAM) represents a rare neoplasm affecting almost exclusively women of reproductive age. This condition mainly affects the lungs, but extrapulmonary locations such as the pelvis and the retroperitoneum are possible. Clinical evaluation and ultrasound imaging are usually non-specific, and the diagnosis is obtained through surgical excision and histopathological examination. We report a very rare case of abdominal LAM in a young female patient. A thorough literature review of this rare condition with emphasis on gynecologic implications will be presented. The patient was referred for gynecologic consultation due to pelvic pain and infertility. Unfortunately, despite prompt diagnosis and treatment, the course of the disease was severe and led to patient's exitus in a short time. We encountered an extremely rare deadly pathology mimicking a very common gynecologic condition. The gynecologist must always be alert of possible unexpected conditions that will require prompt attention.
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Affiliation(s)
| | - Domenico Piscitelli
- Department of Anatomopathology, Policlinico of Bari, University of Bari "Aldo Moro", Bari, Italy
| | - Domenico De Palma
- Department of Emergency, "Di Venere" General Hospital, ASL BA, Bari, Italy
| | - Michele Mongelli
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Policlinico of Bari, Bari, Italy
| | - Ferdinando Murgia
- Department of Obstetrics and Gynecology, "Miulli" General Hospital, Acquaviva delle Fonti (Bari), Italy
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Science Department, Minimally Invasive Gynecology Division, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Amerigo Vitagliano
- Department of Interdisciplinary Medicine (DIM), Unit of Obstetrics and Gynecology, University of Bari "Aldo Moro", Policlinico of Bari, Bari, Italy
| | - Stefano Bettocchi
- Department of Obstetrics and Gynecology, University of Foggia, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Foggia, Italy
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28
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Gaetani M, Di Gennaro D, Vimercati A, Vitagliano A, Dellino M, Malvasi A, Loizzi V, Pinto V, Cicinelli E, Di Naro E, Lacalandra A, Damiani GR. Cornual Pregnancy. Gynecol Minim Invasive Ther 2023; 12:130-134. [PMID: 37807987 PMCID: PMC10553601 DOI: 10.4103/gmit.gmit_10_23] [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: 02/01/2023] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 10/10/2023] Open
Abstract
Cornual pregnancy (CP) is a subtype of ectopic pregnancy that is implanted in the interstitial segment of the fallopian tube which is defined as the tubal section crossing uterine muscular tissue. Widely recognized risk factors for CP are endometriosis, uterine leiomyomata, or pelvic inflammatory disease; all these diseases can cause tubal anatomic changes and consequently alter embryo physiological implant process. Many treatment options are available for this condition each one must be tailored according to patient and operating scenario. The incidence of uterine ruptures in the scarred uterus appears to be low, but the fear of it remains and therefore medical treatment might be favored over cornual wedge resection. The actual risk of uterine rupture after medical treatment is unknown. Multiple testing strategies exist to diagnose CP, but caution needs to be used to avoid a false diagnosis.
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Affiliation(s)
- Maria Gaetani
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Daniele Di Gennaro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Antonella Vimercati
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Amerigo Vitagliano
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Miriam Dellino
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Antonio Malvasi
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Vera Loizzi
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Vincenzo Pinto
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Ettore Cicinelli
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Edoardo Di Naro
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Angelo Lacalandra
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
| | - Gianluca Raffaello Damiani
- Department of Biomedical Sciences and Human Oncology, Gynaecologic and Obstetrics Clinic, University of Bari, Bari, Italy
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29
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Favilli A, Mattei Gentili M, De Paola F, Laganà AS, Vitagliano A, Bosco M, Cicinelli E, Chiantera V, Uccella S, Parazzini F, Gerli S, Garzon S. COVID-19 and Pregnancy: An Updated Review about Evidence-Based Therapeutic Strategies. J Pers Med 2023; 13:1035. [PMID: 37511648 PMCID: PMC10381390 DOI: 10.3390/jpm13071035] [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: 05/17/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic posed a significant challenge for clinicians in managing pregnant women, who were at high risk of virus transmission and severe illness. While the WHO declared in May 2023 that COVID-19 is no longer a public health emergency, it emphasized that it remains a global health threat. Despite the success of vaccines, the possibility of new pandemic waves due to viral mutations should be considered. Ongoing assessment of the safety and effectiveness of pharmacological therapies is crucial in clinical practice. This narrative review summarizes the evidence-based therapeutic strategies for pregnant women with COVID-19, considering over three years of pandemic experience. The review discusses the safety and effectiveness of various drug regimens (antivirals, anticoagulants, corticosteroids, immunoglobulins, monoclonal antibodies, and therapeutic gases) and procedures (prone positioning and extracorporeal membrane oxygenation). Drugs with contraindications, inefficacy during pregnancy, or unknown adverse effects were excluded from our evaluation. The aim is to provide healthcare professionals with a comprehensive guide for managing pregnant women with COVID-19 based on lessons learned from the pandemic outbreak.
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Affiliation(s)
- Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Marta Mattei Gentili
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Francesca De Paola
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Amerigo Vitagliano
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, University of Bari, 70121 Bari, Italy
| | - Mariachiara Bosco
- Unit of Obstetrics and Gynecology-Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona-University of Verona Piazzale A. Stefani 1, 37126 Verona, Italy
| | - Ettore Cicinelli
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, University of Bari, 70121 Bari, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Stefano Uccella
- Unit of Obstetrics and Gynecology-Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona-University of Verona Piazzale A. Stefani 1, 37126 Verona, Italy
| | - Fabio Parazzini
- Department of Clinic and Community Science, Mangiagalli Hospital, University of Milan, 20122 Milan, Italy
| | - Sandro Gerli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Simone Garzon
- Unit of Obstetrics and Gynecology-Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona-University of Verona Piazzale A. Stefani 1, 37126 Verona, Italy
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Damiani GR, Vimercati A, DI Gennaro D, Vitagliano A, Giampaolino P, Malvasi A, Perrone AM, Pellegrino A, Dellino M, Cicinelli E. Cesarean scar pregnancy: a practical overview and our series of combined double step procedure management. Minerva Obstet Gynecol 2023:S2724-606X.23.05291-0. [PMID: 37326353 DOI: 10.23736/s2724-606x.23.05291-0] [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] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cesarean scar pregnancy (CSP), a rare iatrogenic form of ectopic pregnancy (EP), cause of severe maternal morbidity. Each subtype of CSP needs different treatment and there is no consensus about this topic. Despite improvements, the lack of universally accepted therapeutic management and discordance present in literature indicates that treatment has been mainly based on experiences reported. METHODS A case series of our double combined approach with methotrexate (MTX) administration followed by vacuum aspiration or resectoscopic approach was reported, with an overview of literature. Eleven patients with CSP underwent a double-step treatment: systemic MTX therapy followed by vacuum aspiration or by resectoscopy, if the gestational sac was embedded deeply in myometrium. For CSP type 1, according to Delphi sonographic classification, with minor potentially risk of complications with a myometrial thickness >3.5 mm, we preferred to adopt vacuum aspiration, while type 2-3 of CSP and myometrial thickness ≤3.5mm were managed with resectoscopy. RESULTS The average gestational age was 59.1±7.22 days. On the seventh day after MTX administration, the serum β hCG levels decreased in 80% of all patients. After the MTX injection, the CSP mass did not disappear in any patient. MTX therapy was followed by vacuum aspiration in six and by resectoscopy in five cases. In one case bleeding was controlled by Foley balloon treated with vacuum. In type II-III, CSP was performed UAE (uterine artery embolization) followed by resectoscopy procedure. CONCLUSIONS Compared with the results in previous studies, MTX administration followed by suction curettage was more effective than dilatation and curettage and systemic MTX in treatment of CSP. We consider very useful this procedure in case of slow absorption and when the camera was embedded deeply in myometrium (CSP2-3), because that hysteroscopy evaluation of uterine cavity under direct vision is highly accurate in identifying the real cleavage of the gestational camera. We have only used vacuum aspiration in CSP type 1 for minor risk of bleeding.
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Affiliation(s)
- Gianluca R Damiani
- Department of Biomedical Sciences and Human Oncology, Clinic of Obstetrics and Gynecology, Polyclinic Hospital of Bari, University of Bari, Bari, Italy -
| | - Antonella Vimercati
- Department of Biomedical Sciences and Human Oncology, Clinic of Obstetrics and Gynecology, Polyclinic Hospital of Bari, University of Bari, Bari, Italy
| | - Daniele DI Gennaro
- Department of Biomedical Sciences and Human Oncology, Clinic of Obstetrics and Gynecology, Polyclinic Hospital of Bari, University of Bari, Bari, Italy
| | - Amerigo Vitagliano
- Department of Biomedical Sciences and Human Oncology, Clinic of Obstetrics and Gynecology, Polyclinic Hospital of Bari, University of Bari, Bari, Italy
| | | | - Antonio Malvasi
- Department of Biomedical Sciences and Human Oncology, Clinic of Obstetrics and Gynecology, Polyclinic Hospital of Bari, University of Bari, Bari, Italy
| | - Anna M Perrone
- Division of Oncologic Gynecology, Department of Medical and Surgical Sciences (DIMEC), Sant'Orsola-Malpighi Polyclinic Hospital, University of Bologna, Bologna, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynecology, ASTT Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Miriam Dellino
- Department of Biomedical Sciences and Human Oncology, Clinic of Obstetrics and Gynecology, Polyclinic Hospital of Bari, University of Bari, Bari, Italy
| | - Ettore Cicinelli
- Department of Biomedical Sciences and Human Oncology, Clinic of Obstetrics and Gynecology, Polyclinic Hospital of Bari, University of Bari, Bari, Italy
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Dellino M, Cerbone M, Laganà AS, Vitagliano A, Vimercati A, Marinaccio M, Baldini GM, Malvasi A, Cicinelli E, Damiani GR, Cazzato G, Cascardi E. Upgrading Treatment and Molecular Diagnosis in Endometrial Cancer-Driving New Tools for Endometrial Preservation? Int J Mol Sci 2023; 24:ijms24119780. [PMID: 37298731 DOI: 10.3390/ijms24119780] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
One emerging problem for onco-gynecologists is the incidence of premenopausal patients under 40 years of age diagnosed with stage I Endometrial Cancer (EC) who want to preserve their fertility. Our review aims to define a primary risk assessment that can help fertility experts and onco-gynecologists tailor personalized treatment and fertility-preserving strategies for fertile patients wishing to have children. We confirm that risk factors such as myometrial invasion and The International Federation of Gynecology and Obstetrics (FIGO) staging should be integrated into the novel molecular classification provided by The Cancer Genome Atlas (TCGA). We also corroborate the influence of classical risk factors such as obesity, Polycystic ovarian syndrome (PCOS), and diabetes mellitus to assess fertility outcomes. The fertility preservation options are inadequately discussed with women with a diagnosis of gynecological cancer. A multidisciplinary team of gynecologists, oncologists, and fertility specialists could increase patient satisfaction and improve fertility outcomes. The incidence and death rates of endometrial cancer are rising globally. International guidelines recommend radical hysterectomy and bilateral salpingo-oophorectomy as the standard of care for this cancer; however, fertility-sparing alternatives should be tailored to motivated women of reproductive age, establishing an appropriate cost-benefit balance between childbearing desire and cancer risk. New molecular classifications such as that of TCGA provide a robust supplementary risk assessment tool that can tailor the treatment options to the patient's needs, curtail over- and under-treatment, and contribute to the spread of fertility-preserving strategies.
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Affiliation(s)
- Miriam Dellino
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Marco Cerbone
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Amerigo Vitagliano
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Antonella Vimercati
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Marco Marinaccio
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | | | - Antonio Malvasi
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Ettore Cicinelli
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gianluca Raffaello Damiani
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Gerardo Cazzato
- Department of Emergency and Organ Transplantation, Pathology Section, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Eliano Cascardi
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060 Candiolo, Italy
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D'Amato A, Cascardi E, Etrusco A, Laganà AS, Schonauer LM, Cazzato G, Vimercati A, Malvasi A, Damiani GR, Di Naro E, Trojano G, Cicinelli E, Vitagliano A, Dellino M. "Lights and Shades" of Fertility Preservation in Transgender Men Patients: A Clinical and Pathological Review. Life (Basel) 2023; 13:1312. [PMID: 37374095 DOI: 10.3390/life13061312] [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: 05/11/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Fertility preservation (FP) is becoming a critical issue in transgender men who desire biological offspring in the future. The prevalence of transgender individuals in the United States is increasing, and as a result, the demand for gender-affirming surgeries (GAS) and associated FP techniques is rising. Despite the growing demand, there is currently no personalized approach to FP for transgender men, and the available techniques have limitations that require further investigation. In the present review we carefully examine the existing literature on this topic to highlight the shortcomings of current methods and areas where additional research is needed to advance the field. Hormonal therapy (HT), which is an integral part of gender transition in transgender men, can have a significant impact on fertility and may increase the risk of various diseases. Moreover, GAS usually leads to permanent sterility in these patients. Therefore, it is essential to provide patients with accurate information about the benefits and potential risks of different FP techniques, taking into account the patient's reproductive goals. This review underscores the complex and multifaceted nature of FP in transgender men and emphasizes the need for further research to develop more effective and personalized approaches to FP for this population.
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Affiliation(s)
- Antonio D'Amato
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Eliano Cascardi
- Department of Medical Sciences, University of Turin, 10124 Turin, Italy
- Pathology Unit, FPO-IRCCS Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Andrea Etrusco
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Luca Maria Schonauer
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Gerardo Cazzato
- Department of Emergency and Organ Transplantation, Pathology Section, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Antonella Vimercati
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Antonio Malvasi
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Gianluca Raffaello Damiani
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Edoardo Di Naro
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppe Trojano
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Ettore Cicinelli
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Amerigo Vitagliano
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Miriam Dellino
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
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Del Boca G, Damiani GR, Zagni R, Guglielmi D, Malvasi A, Vimercati A, Pellegri AM, Biffi A, Vitagliano A, Cicinelli E. Total laparoscopic hysterectomy four-handed ergonomic technique: description of an original surgical procedure for the reduction of learning curve. Minerva Obstet Gynecol 2023; 75:298-306. [PMID: 36255167 DOI: 10.23736/s2724-606x.22.05201-0] [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: 05/16/2023]
Abstract
The aim of this study was to propose the four-handed technique for total laparoscopic hysterectomy (TLH), with or without adnexectomy. From our point of view this is a more ergonomic, efficient, and effective technique that can contribute to the training of specialists in obstetrics/gynecology. In fact, teacher and learner have both an active role on the surgical field using two laparoscopic instruments each. They are alternately, mutually, and symmetrically first operator and assistant, reducing number of attempts needed for laparoscopic hysterectomy learning curve. The detailed description of all the surgical steps of TLH, "four-handed technique" (FHT), with or without adnexectomy, make sure that it can be effectively reproduced step by step safely, by transposing "FHT" surgical steps of laparotomic approach. This may allow easy access to anatomical spaces inserting trocars in different ways. By clearly knowing the steps of TLH, "FHT" it is possible to favor minimally invasive routes so that patients benefit from its multiple proven benefits. Operating this way, operative time, blood loss, use of analgesics and hospitalization can be significantly reduced. In conclusion benefits of TLH have already been widely demonstrated in literature. It is a real opportunity that young specialists become confident with this innovative "FHT," a procedure that allows them to be surgeon first assistant, and in which they can learn faster real intraoperative stereotaxis and surgical steps sequence, familiarizing with the anatomy of retroperitoneal space.
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Affiliation(s)
- Gregorio Del Boca
- Unit of Gynecology and Obstetrics, Hospital of Merate, ASST Lecco, Merate, Lecco, Italy
| | - Gianluca R Damiani
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy -
| | - Roberto Zagni
- Unit of Gynecology and Obstetrics, Hospital of Merate, ASST Lecco, Merate, Lecco, Italy
| | | | - Antonio Malvasi
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | | | - Antonio M Pellegri
- IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Biffi
- Unit of Gynecology and Obstetrics, Hospital of Merate, ASST Lecco, Merate, Lecco, Italy
| | - Amerigo Vitagliano
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Ettore Cicinelli
- Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
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D’Amato G, Caringella AM, Stanziano A, Cantatore C, D’Amato A, Cicinelli E, Vitagliano A. Corifolitropin-Alfa plus Five Days Letrozole Versus Daily Recombinant-FSH in Expected Normo-Responder Patients: A Retrospective Comparative Study. Diagnostics (Basel) 2023; 13:diagnostics13071249. [PMID: 37046467 PMCID: PMC10092944 DOI: 10.3390/diagnostics13071249] [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: 02/21/2023] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Background: In recent times, different novel GnRH-antagonist protocols with various combinations of gonadotropins and other molecules (e.g., aromatase inhibitors, selective estrogen receptor modulators) have been proposed for expected normal ovarian responders undergoing assisted reproductive treatments. The purpose of this study was to evaluate the effectiveness of a novel ovarian stimulation protocol based on the combination of corifollitropin-alfa plus five days of letrozole in E-NOR women undergoing IVF as compared with a daily recombinant-FSH regimen. Methods: We conducted a retrospective-controlled study on 182 couples undergoing their first IVF attempt. In Group A (experimental), letrozole (2.5 mg daily) was administered from day 2 (up to day 6 of the cycle), followed by corifollitropin-alfa on day 3 and daily recombinant FSH from day 10. In Group B, recombinant FSH from day 2 were administered (150 IU-225 IU daily). Statistical analysis was completed using SPSS Statistics. The primary outcome was the total number of MII oocytes retrieved. Results: Group A showed similar results compared to Group B in terms of MII oocytes, live birth, implantation, and clinical pregnancy rates (p = ns). Nevertheless, the experimental group was associated with a trend towards a higher number of developing follicles, total oocytes, and embryos (p < 0.05) with lower estradiol and progesterone values at ovulation induction compared to Group B, resulting in an increased chance of performing a fresh embryo transfer (p < 0.05). Conclusions: The combination of CFα plus five days of letrozole was associated with a trend towards a higher number of developing follicles, total oocytes, and obtained embryos. Moreover, the experimental protocol resulted in lower estradiol and progesterone values at ovulation induction compared to daily rFSH, with an increased chance of performing a fresh embryo transfer (with no OHSS occurrence). Given the observational design of our study, further well-conducted RCTs are needed.
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Affiliation(s)
- Giuseppe D’Amato
- Department of Advanced Reproductive Risk Management and High-Risk Pregnancies, ASL Bari, Reproductive and IVF Unit, PTA “F Jaia”, 70014 Conversano, BA, Italy
| | - Anna Maria Caringella
- Department of Advanced Reproductive Risk Management and High-Risk Pregnancies, ASL Bari, Reproductive and IVF Unit, PTA “F Jaia”, 70014 Conversano, BA, Italy
| | - Antonio Stanziano
- Department of Advanced Reproductive Risk Management and High-Risk Pregnancies, ASL Bari, Reproductive and IVF Unit, PTA “F Jaia”, 70014 Conversano, BA, Italy
| | - Clementina Cantatore
- Department of Advanced Reproductive Risk Management and High-Risk Pregnancies, ASL Bari, Reproductive and IVF Unit, PTA “F Jaia”, 70014 Conversano, BA, Italy
| | - Antonio D’Amato
- Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, 70100 Bari, BA, Italy
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, 70100 Bari, BA, Italy
| | - Amerigo Vitagliano
- Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari, 70100 Bari, BA, Italy
- Correspondence:
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Vitagliano A, Paffoni A, Viganò P. Does maternal age affect Assisted Reproduction Technology success rates after euploid embryo transfer? A systematic review and meta-analysis. Fertil Steril 2023:S0015-0282(23)00169-3. [PMID: 36878347 DOI: 10.1016/j.fertnstert.2023.02.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/04/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
IMPORTANCE Maternal age-related embryo aneuploidy is considered the most significant limiting factor for a favourable outcome following Assisted Reproduction Technology (ART) procedures. Thus, preimplantation genetic testing for aneuploidies (PGT-A) has been proposed as a strategy to genetically evaluate embryos before transfer to the uterus. However, whether embryo ploidy justifies all the aspects of age-related fertility decline remains controversial. OBJECTIVE To investigate the effect of different maternal ages on ART success rates following transfer of euploid embryos. DATA SOURCES Sciencedirect, Pubmed, Scopus, Embase, the Cochrane library, Clinicaltrials.gov, EU Clinical Trials Register and World Health Organization International Clinical Trials Registry were searched from inception until November 2021 using combinations of relevant keywords. STUDY SELECTION AND SYNTHESIS Observational and randomized controlled studies were included if they investigated the impact of maternal age on ART outcomes after the transfer of euploid embryos and reported frequencies of women achieving ongoing pregnancy or live birth (OPR/LBR). MAIN OUTCOMES The OPR/LBR after euploid embryo transfer comparing women <35 versus women ≥35 was the primary outcome. Secondary outcomes included implantation rate (IR) and miscarriage rate. Subgroup and sensitivity analyses were also planned in order to explore the sources of inconsistency among studies. The quality of studies was assessed using a modified version of the Newcastle-Ottawa Scale and body of evidence was evaluated using GRADE. RESULTS A total of 7 studies were included (n=11,335 ART embryo transfers of euploid embryos). A higher OPR/LBR (OR 1.29, 95% CI 1.07-1.54, I2=40%, p=0.006) in women aged <35 years compared to women ≥35 with a risk difference equal to 0.06 (95% CI 0.02-0.09) was found. In line, IR was higher in the youngest group (OR 1.22, 95% CI 1.12-1.32, I2=0%, p<0.00001). A statistically significant higher OPR/LBR was also found comparing women aged <35 to women 35-37, 38-40 or 41-42. A gradient relationship between age and OPR/LBR could be observed in proportion meta-analysis, especially if restricted to studies with low risk of bias. CONCLUSION AND RELEVANCE: Increasing maternal age is associated with a decline in ART success rates independently from embryo ploidy. This message contributes to an appropriate patient's counselling before starting PGT-A procedures.
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Affiliation(s)
- Amerigo Vitagliano
- Department of Women and Children's Health, Unit of Gynecology and Obstetrics, University of Padua, Padua, Italy
| | | | - Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Moufawad G, Laganà AS, Habib N, Chiantera V, Giannini A, Ferrari F, Vitagliano A, Della Corte L, Bifulco G, Sleiman Z. Learning Laparoscopic Radical Hysterectomy: Are We Facing an Emerging Situation? Int J Environ Res Public Health 2023; 20:ijerph20032053. [PMID: 36767419 PMCID: PMC9915887 DOI: 10.3390/ijerph20032053] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 05/29/2023]
Abstract
Despite wide screening campaigns and early detection, cervical cancer remains the fourth most common cancer among women. Radical hysterectomy, whether by open, laparoscopic or by robotic-assisted techniques, is the mainstay treatment. However, for adequate surgical results and good oncological prognosis, a gynecological surgeon should be trained to perform those procedures. The learning curve of radical hysterectomy, especially by laparoscopy, is influenced by several factors. The LACC trial, the decrease in cervical cancer incidence and radical hysterectomy procedures have widely reduced the learning curve for surgeons. This article mainly discusses the learning curve of laparoscopic radical hysterectomy for cervical cancers, and how several factors are influencing it negatively, with the need to have medical authorities reset specific surgical training programs and allocate them to special oncological centers.
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Affiliation(s)
- Graziella Moufawad
- Department of Obstetrics and Gynecology, Lebanese American University Medical Center-Rizk Hospital, Beirut 1100, Lebanon
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Nassir Habib
- Obstetrics and Gynecology Department, Francois Quesnay Hospital, 78200 Mantes-La-Jolie, France
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in “Translational Medicine and Oncology”, Sapienza University, 00185 Rome, Italy
| | - Federico Ferrari
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Amerigo Vitagliano
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80138 Naples, Italy
| | - Giuseppe Bifulco
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy
| | - Zaki Sleiman
- Department of Obstetrics and Gynecology, Lebanese American University Medical Center-Rizk Hospital, Beirut 1100, Lebanon
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Sabbadin C, Saccardi C, Andrisani A, Vitagliano A, Marin L, Ragazzi E, Bordin L, Ambrosini G, Armanini D. Role of Renin-Angiotensin-Aldosterone System and Cortisol in Endometriosis: A Preliminary Report. Int J Mol Sci 2022; 24:ijms24010310. [PMID: 36613755 PMCID: PMC9820500 DOI: 10.3390/ijms24010310] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Endometriosis is a chronic inflammatory disease associated with pelvic pain, infertility, and increased cardiovascular risk. Recent studies suggest a possible role of aldosterone as a pro-inflammatory hormone in the pathogenesis of the disease. Cortisol is also an important mediator of stress reaction, but its role is controversial in endometriosis. The aim of this study was to evaluate aldosterone and cortisol levels and blood pressure values in women with endometriosis. We measured blood pressure, plasma aldosterone, renin, cortisol, and dehydroepiandrosterone sulfate (DHEAS) in 20 women with untreated minimal or mild pelvic endometriosis compared with 20 healthy controls matched for age and body mass index. Aldosterone values were similar in the two groups, while renin was significantly lower and the aldosterone to renin ratio was significantly higher in patients with endometriosis than in controls. Systolic blood pressure was in the normal range, but significantly higher in patients with endometriosis. Morning plasma cortisol was normal, but significantly lower in patients with endometriosis compared with controls, while DHEAS to cortisol ratio was similar in the two groups. These preliminary results are evidence of increased biological aldosterone activity and dysregulation of the hypothalamic-pituitary-adrenal axis in early stages of endometriosis. These alterations could play a role in disease development, suggesting new therapeutic targets for aldosterone receptor blockers.
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Affiliation(s)
- Chiara Sabbadin
- Endocrinology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Carlo Saccardi
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
| | - Alessandra Andrisani
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
| | - Amerigo Vitagliano
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
| | - Loris Marin
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
| | - Eugenio Ragazzi
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35131 Padova, Italy
| | - Luciana Bordin
- Department of Molecular Medicine-Biological Chemistry, University of Padova, 35131 Padova, Italy
| | - Guido Ambrosini
- Department of Women’s and Children’s Health, University of Padova, 35128 Padova, Italy
| | - Decio Armanini
- Endocrinology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
- Correspondence:
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Spagnol G, Noventa M, Bonaldo G, Marchetti M, Vitagliano A, Laganà AS, Cavallin F, Scioscia M, Saccardi C, Tozzi R. Three-dimensional transvaginal ultrasound vs magnetic resonance imaging for preoperative staging of deep myometrial and cervical invasion in patients with endometrial cancer: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2022; 60:604-611. [PMID: 35656849 PMCID: PMC9828663 DOI: 10.1002/uog.24967] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/06/2022] [Revised: 05/02/2022] [Accepted: 05/25/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To evaluate and compare the diagnostic test accuracy (DTA) of three-dimensional transvaginal ultrasound (3D-TVS) and magnetic resonance imaging (MRI) for deep myometrial infiltration (DMI) and cervical invasion for preoperative staging and surgery planning in patients with endometrial cancer (EC). METHODS This systematic review and meta-analysis investigated the DTA of MRI and 3D-TVS for DMI and cervical invasion in patients with EC. A literature search was performed using MEDLINE, Scopus, EMBASE, ScienceDirect, The Cochrane library, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, EU Clinical Trials Register and World Health Organization International Clinical Trials Registry Platform to identify relevant studies published between January 2000 and December 2021. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. RESULTS Five studies, including a total of 450 patients, were included in the systematic review. All five studies compared the DTA of 3D-TVS vs MRI for DMI, and three studies compared the DTA of 3D-TVS vs MRI for cervical invasion. Pooled sensitivity, positive likelihood ratio and negative likelihood ratio for detecting DMI using 3D-TVS were 77% (95% CI, 66-85%), 4.57 and 0.31, respectively. The respective values for detecting DMI on MRI were 80% (95% CI, 73-86%), 4.22 and 0.24. Bivariate metaregression indicated a similar DTA of 3D-TVS and MRI (P = 0.80) for the correct identification of DMI. Pooled ln diagnostic odds ratio for detecting cervical invasion was 3.11 (95% CI, 2.09-4.14) for 3D-TVS and 2.36 (95% CI, 0.90-3.83) for MRI. The risk of bias was low for most of the four domains assessed in QUADAS-2. CONCLUSION 3D-TVS demonstrated good diagnostic accuracy in terms of sensitivity and specificity for the evaluation of DMI and cervical invasion, with results comparable with those of MRI. Thus, we confirmed the potential role of 3D-TVS in the preoperative staging and surgery planning in patients with EC. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- G. Spagnol
- Department of Women and Children's HealthUniversity of PaduaPaduaItaly
| | - M. Noventa
- Department of Women and Children's HealthUniversity of PaduaPaduaItaly
| | - G. Bonaldo
- Department of Women and Children's HealthUniversity of PaduaPaduaItaly
| | - M. Marchetti
- Department of Women and Children's HealthUniversity of PaduaPaduaItaly
| | - A. Vitagliano
- Department of Women and Children's HealthUniversity of PaduaPaduaItaly
| | - A. S. Laganà
- Department of Obstetrics and GynecologyFilippo Del Ponte Hospital, University of InsubriaVareseItaly
| | | | - M. Scioscia
- Unit of Gynaecological SurgeryMater Dei HospitalBariItaly
| | - C. Saccardi
- Department of Women and Children's HealthUniversity of PaduaPaduaItaly
| | - R. Tozzi
- Department of Women and Children's HealthUniversity of PaduaPaduaItaly
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Grande G, Petre GC, Pesenti FF, Toni LD, Vitagliano A, Nisio AD, Ferlin A, Foresta C, Garolla A. PMON262 Systematic review and critical analysis on dietary supplements for male infertility: from a blend of ingredients to a rationale strategy. J Endocr Soc 2022. [PMCID: PMC9627660 DOI: 10.1210/jendso/bvac150.1448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to evaluate the potential efficacy of each Dietary supplement (DS) proposed for male infertility and marketed in Italy, using an adapted version of the scoring system by the American Heart Association. In particular, the effect of any ingredients was evaluated according to semen alterations. On the website of Italian ministry of health we found 23 supplements marketed for male infertility. We considered as eligible only randomized clinical trials (RCTs) evaluating substances included in DS marketed for male infertility. A formula allowed us to classify the expected efficacy of each DS, based on composition. Each DS was scored and included into three classes of expected efficacy: high, low and none. Among 24 supplements,3 (12,5%) fall in high, 9 (37,5%) in lower and 12 (50,0%) in no expected efficacy class. DS composition showed 36 substances, 18 with no literature on male fertility and 18 showing positive effect on sperm parameters, thus considered potentially active ingredients (PAI). All DS were mixtures of ingredients, containing from 2 to 17 different substances. Fifteen supplements (65.2%) contained at least 1 ingredient without evidence of efficacy and 21 formulations had PAI dosed below mED. Some PAI were associated to the improvement of specific sperm parameters. DS were usually blends of many substances, that are frequently employed at negligible dose or without any evidence of efficacy on male reproduction. Some ingredients have been demonstrated to be effective on specific sperm parameters by RCTs. We report a list of ingredients with potential efficacy on specific sperm parameters, aimed to allow a tailored use of DS. In the light of our findings we rise three final considerations: i) the Italian market of DS for male infertility offers products with potential efficacy in the improvement of sperm parameters but also many with uncertain effect; ii) the actual literature is poor of well-designed studies on PAI investigating their mechanisms of action and effective dose in different pathological conditions; iii) based on current literature, our study can help in the choice of DS and PAI that are more likely to be effective on specific sperm alterations. Our critical analysis suggests a rational strategy for a tailored use of DS in male infertility. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
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Cicinelli E, McQueen DB, Huepfel B, Vitagliano A, Moreno I, Simon C, Pirtea P, Scott RT, Bellavia M, de Ziegler D. Should patients be screened for chronic endometritis before assisted reproductive technology? Fertil Steril 2022; 118:639-652. [PMID: 36182261 DOI: 10.1016/j.fertnstert.2022.08.846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Ettore Cicinelli
- Department of Biomedical and Human Oncological Science (DIMO), 1st Unit of Obstetrics and Gynecology, University of Bari, Policlinico, Bari, Italy
| | - Dana B McQueen
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Chicago, Chicago, Ilinois
| | - Bridget Huepfel
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, University of Chicago, Chicago, Ilinois
| | - Amerigo Vitagliano
- Department of Women and Children's Health, Unit of Gynecology and Obstetrics, University of Padua, Padua, Italy
| | - Inmaculada Moreno
- Carlos Simon Foundation, Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain
| | - Carlos Simon
- Carlos Simon Foundation, Instituto de Investigación Sanitaria (INCLIVA), Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, Universidad de Valencia, INCLIVA, Valencia, Spain; Department of Obstetrics and Gynecology BIDMC, Harvard University, Boston, Massachusetts
| | - Paul Pirtea
- Department of Obstetrics and Gynecology, Section of Reproductive Endocrinology and Infertility, Hospital Foch, Suresnes, France.
| | - Richard T Scott
- IVIRMA New Jersey, Basking Ridge, New Jersey; Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Marina Bellavia
- Direttore Sanitario FMH Ginecologia - Ostetricia ed Procreazione Medico Assistita
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Vieira MDC, Vitagliano A, Rossette MC, Neto LCDA, Gallo A, Sardo ADS. Endometrial Polyps: Update Overview on Etiology, Diagnosis, Natural History and Treatment. CLIN EXP OBSTET GYN 2022. [DOI: 10.31083/j.ceog4910232] [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: 11/06/2022]
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Vitagliano A, Laganà AS, De Ziegler D, Cicinelli R, Santarsiero CM, Buzzaccarini G, Chiantera V, Cicinelli E, Marinaccio M. Chronic Endometritis in Infertile Women: Impact of Untreated Disease, Plasma Cell Count and Antibiotic Therapy on IVF Outcome-A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12092250. [PMID: 36140651 PMCID: PMC9498271 DOI: 10.3390/diagnostics12092250] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 08/06/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 01/10/2023] Open
Abstract
This systematic review and meta-analysis aims to evaluate the impact of chronic endometritis (CE) and its therapy on in vitro fertilization (IVF) outcome. Additionally, we aim to investigate whether various degrees of CE severity may exert a different effect on IVF outcome. Ongoing-pregnancy rate/live-birth-rate (OPR/LBR), clinical-pregnancy rate (CPR), and miscarriage rate (MR) were calculated. A total number of 4145 patients (from ten studies) were included. Women with CE had lower OPR/LBR (OR 1.97, p = 0.02) and CPR (OR 2.28, p = 0.002) compared to those without CE. CE cure increased OPR/LBR (OR 5.33, p < 0.0001) and CPR (OR 3.64, p = 0.0001). IVF outcome was comparable between women with cured CE and those without CE (OPR/LBR, CPR and MR: p = ns). Women with severe CE had lower OPR/LBR (OR 0.43, p = 0.003) and CPR (OR 0.40, p = 0.0007) compared to those mild CE. Mild CE showed no influence on the IVF outcome as compared to women without CE (OPR/LBR, CPR and MR: p = ns). Based on this data analysis, CE significantly reduces OPR/LBR and CPR in women undergoing IVF. Importantly, CE resolution after antibiotic therapy may improves IVF outcome, leading to similar OPR/LBR and CPR as compared to unaffected patients. The negative effects of CE on IVF outcome may be restricted to severe disease, whereas mild CE may have no influence on IVF success.
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Affiliation(s)
- Amerigo Vitagliano
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
- Correspondence:
| | - Dominique De Ziegler
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Hospital Foch, Faculté de Médecine Paris Ouest (UVSQ), 92150 Suresnes, France
| | - Rossana Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Carla Mariaflavia Santarsiero
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Giovanni Buzzaccarini
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35128 Padua, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Marco Marinaccio
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
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Affiliation(s)
- Stefano Palomba
- Department of Experimental and Clinical Medicine, Gynecology and Obstetrics, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Amerigo Vitagliano
- Department of Experimental and Clinical Medicine, Gynecology and Obstetrics, University "Magna Graecia" of Catanzaro, Catanzaro, Italy; Department of Women's and Children's Health, University of Padua, Padua, Italy
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Laganà AS, Vitagliano A, Chiantera V, Cicinelli E. Diagnosis and Treatment of Endometriosis and Endometriosis-Associated Infertility: Novel Approaches to an Old Problem. J Clin Med 2022; 11:jcm11133914. [PMID: 35807199 PMCID: PMC9267304 DOI: 10.3390/jcm11133914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
- Correspondence:
| | - Amerigo Vitagliano
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy;
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico-Di Cristina-Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Ettore Cicinelli
- Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy;
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Marin L, Vitagliano A, Russo A, Esposito F, Della Vella M, Ambrosini G, Andrisani A. P-327 The impact of chronic endometritis disease on endometrial receptivity gene expression in women with repeated implantation failure. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.311] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Does chronic endometritis (CE) have an impact on the expression of the genes involved in the embryo implantation?
Summary answer
The mRNA expression of genes involved in embryo implantation (HOXA10, HOXA11, BTEB1 and LIF) does not change in patients with and without CE.
What is known already
CE is an inflammatory disorder of the endometrium with a detrimental effect on embryo implantation and its prevalence in women with repeated implantation failure (RIF) is up to 30%. During the implantation window, the expression of some genes plays a key role in determining the success of embryo implantation. The homeobox genes HOXA10, HOXA11 and the basic transcriptional element binding protein 1 (BTEB1) gene are essential for endometrial cells growth regulation and for embryonic development and the leukaemia inhibitory factor (LIF) has a role in the embryo–endometrium interaction.
Study design, size, duration
A single centre-prospective case-control study was conducted at the Women’s and Children’s Health Department at Padua University, on infertile women with RIF from June 2020 to November 2021. 29 women with RIF were prospectively enrolled.
Participants/materials, setting, methods
An endometrial biopsy using a Novak curette was performed for each patient and the obtained tissue samples were divided in two aliquots, one for immunohistochemistry for histological examination (endometrial dating and CE diagnosis) and one for RNA extraction and gene expression analysis that has been performed using RT-PCR. Sample of patients with and without CE were compared using non-parametric Mann–Whitney U-test. A p-value <.05 was considered as statistically significant.
Main results and the role of chance
Enrolled women were divided in two groups according to the histological diagnosis of CE: 13 patients with CE, 16 without CE. In all samples, appropriate histological dating (WOI) was evaluated according to Noyes criteria. After the comparison of all investigated genes (HOXA10, HOXA11, BTEB1 and LIF), no significant difference in mRNA expression was detected between women with and without CE (p value >.05). In the literature, defective endometrial expression of HOXA10, HOXA11 and LIF genes has been associated with abnormal implantation and the reduced expression of BTEB1 gene results in subfertility and progesterone resistance. Although the negative role of CE in altering embryo implantation is known, our results suggest that the CE has no effect on the expression of HOXA10, HOXA11, BTEB1 and LIF genes. Probably the detrimental effect of CE on embryo implantation does not act through HOXA10, HOXA11, BTEB1 and LIF gene expression.
Limitations, reasons for caution
This is a non-randomized observational study with a limited number of patients. Further studies are needed to confirm our data with immunohistochemistry evaluation to define the protein expression levels of the investigated genes.
Wider implications of the findings
Understanding the pathogenic mechanism of CE on endometrial receptivity is crucial for identifying markers that best correlate with possible implantation failure and for identifying the appropriate therapy to treat the disease and restore the embryo implantation capacity.
Trial registration number
not applicable
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Affiliation(s)
- L Marin
- University of Padua, Department of Women's and Children's Health , Padova, Italy
| | - A Vitagliano
- University of Padua, Department of Women's and Children's Health , Padova, Italy
| | - A Russo
- University of Padua, Department of Women's and Children's Health , Padova, Italy
| | - F Esposito
- Padua Hospital, Department of Women's and Children's Health , Padova, Italy
| | - M Della Vella
- University of Padua, Department of Women's and Children's Health , Padova, Italy
| | - G Ambrosini
- University of Padua, Department of Women's and Children's Health , Padova, Italy
| | - A Andrisani
- University of Padua, Department of Women's and Children's Health , Padova, Italy
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Laganà AS, Vitagliano A, Casarin J, Garzon S, Uccella S, Franchi M, Cromi A, Ghezzi F. Transvaginal versus port-site specimen retrieval after laparoscopic myomectomy: a systematic review and meta-analysis. Gynecol Obstet Invest 2022; 87:177-183. [PMID: 35728574 DOI: 10.1159/000525624] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/15/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To date, there is no robust evidence suggesting whether transvaginal (TVSR) or port-site specimen retrieval (PSSR) after laparoscopic myomectomy (LM) may lead to better surgical outcomes. Considering this element, we aimed to compare surgical outcomes of TVSR versus PSSR after LM. METHODS A search (PROSPERO ID: CRD42020176490) of international databases, from 1980 to 2020, in English language, was conducted. We selected studies that included women who underwent LM with TVSR compared with PSSR. RESULTS We did not find significant differences for operative time (MD=-8.90 [95% CI -30.00, 12.20]; I2=87%), myoma retrieval time (MD=-1.85 [95% CI -13.55, 9.85]; I2=98%), blood loss (MD=-27.62 [95% CI -178.68, 124.43]; I2=91%), intra-operative complication rate (OR 0.51, 95% CI 0.01-23.09; I2=69%) and hospital stay (MD=-0.14 [95% CI -0.43; 0.15]; I2=64%); we found a significant lower post-operative rescue analgesics utilization in the TVSR group compared with the PSSR group (OR 0.31, 95% CI 0.16-0.61, I2=0). CONCLUSION TVSR and PSSR after LM showed comparable results for operative time and surgery-related complications. However, the need of post-operative rescue analgesics was lower in women who underwent TVSR.
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Affiliation(s)
- Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Amerigo Vitagliano
- Unit of Gynecology and Obstetrics, Department of Women and Children's Health, University of Padua, Padua, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Massimo Franchi
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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Noventa M, Spagnol G, Marchetti M, Saccardi C, Bonaldo G, Laganà AS, Cavallin F, Andrisani A, Ambrosini G, Vitale SG, Pacheco LA, Haimovich S, Di Spiezio Sardo A, Carugno J, Scioscia M, Garzon S, Bettocchi S, Buzzaccarini G, Tozzi R, Vitagliano A. Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes-A Systematic Review and Meta-Analysis of Observational Research. J Clin Med 2022; 11:jcm11123290. [PMID: 35743362 PMCID: PMC9224595 DOI: 10.3390/jcm11123290] [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: 05/02/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 12/04/2022] Open
Abstract
Objective: we performed a systematic review/meta-analysis to evaluate the impact of septate uterus and hysteroscopic metroplasty on pregnancy rate-(PR), live birth rate-(LBR), spontaneous abortion-(SA) and preterm labor (PL) in infertile/recurrent miscarriage-(RM) patients. Data sources: a literature search of relevant papers was conducted using electronic bibliographic databases (Medline, Scopus, Embase, Science direct). Study eligibility criteria: we included in this meta-analysis all types of observational studies that evaluated the clinical impact of the uterine septum and its resection (hysteroscopic metroplasty) on reproductive and obstetrics outcomes. The population included were patients with a diagnosis of infertility or recurrent pregnancy loss. Study appraisal and synthesis methods: outcomes were evaluated according to three subgroups: (i) Women with untreated uterine septum versus women without septum (controls); (ii) Women with treated uterine septum versus women with untreated septum (controls); (iii) Women before and after septum removal. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for the outcome measures. A p-value < 0.05 was considered statistically significant. Subgroup analysis was performed according to the depth of the septum. Sources of heterogeneity were explored by meta-regression analysis according to specific features: assisted reproductive technology/spontaneous conception, study design and quality of papers included Results: data from 38 studies were extracted. (i) septum versus no septum: a lower PR and LBR were associated with septate uterus vs. controls (OR 0.45, 95% CI 0.27−0.76; p < 0.0001; and OR 0.21, 95% CI 0.12−0.39; p < 0.0001); a higher proportion of SA and PL was associated with septate uterus vs. controls (OR 4.29, 95% CI 2.90−6.36; p < 0.0001; OR 2.56, 95% CI 1.52−4.31; p = 0.0004). (ii) treated versus untreated septum: PR and PL were not different in removed vs. unremoved septum(OR 1.10, 95% CI 0.49−2.49; p = 0.82 and OR 0.81, 95% CI 0.35−1.86; p = 0.62); a lower proportion of SA was associated with removed vs. unremoved septum (OR 0.47, 95% CI 0.21−1.04; p = 0.001); (iii) before-after septum removal: the proportion of LBR was higher after the removal of septum (OR 49.58, 95% CI 29.93−82.13; p < 0.0001) and the proportion of SA and PL was lower after the removal of the septum (OR 0.02, 95% CI 0.02−0.04; p < 0.000 and OR 0.05, 95% CI 0.03−0.08; p < 0.0001) Conclusions: the results show the detrimental effect of the uterine septum on PR, LBR, SA and PL. Its treatment reduces the rate of SA.
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Affiliation(s)
- Marco Noventa
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
- Correspondence: ; Tel.: +39-347-6527255
| | - Giulia Spagnol
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Matteo Marchetti
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Carlo Saccardi
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Giulio Bonaldo
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Antonio Simone Laganà
- Unit of Gynecology Oncology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | | | - Alessandra Andrisani
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Guido Ambrosini
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy;
| | | | - Sergio Haimovich
- Hillel Yaffe Medical Center, Technion-Israel Technology Institute, Hadera 38100, Israel;
| | - Attilio Di Spiezio Sardo
- Department of Public Health, School of Medicine, University of Naples Federico II, 80138 Naples, Italy;
| | - Jose Carugno
- Minimally Invasive Gynecology Unit, Obstetrics, Gynecology and Reproductive Sciences Department, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Marco Scioscia
- Unit of Gynecology, Mater Dei Hospital, 70125 Bari, Italy;
| | - Simone Garzon
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, 37126 Verona, Italy;
| | - Stefano Bettocchi
- Inter-Departmental Project Unit of Minimal-Invasive Gynecological Surgery, Policlinico of Bari, University of Bari Aldo Moro, 70121 Bari, Italy;
| | - Giovanni Buzzaccarini
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Roberto Tozzi
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Amerigo Vitagliano
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
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Favilli A, Mattei Gentili M, Raspa F, Giardina I, Parazzini F, Vitagliano A, Borisova AV, Gerli S. Effectiveness and safety of available treatments for COVID-19 during pregnancy: a critical review. J Matern Fetal Neonatal Med 2022; 35:2174-2187. [PMID: 32508168 PMCID: PMC7284138 DOI: 10.1080/14767058.2020.1774875] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 05/20/2020] [Revised: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND COVID-19 is a pandemic disease caused by the SARS-CoV-2 and it spread globally in the last few months. The complete lack of specific treatment forced clinicians to use old drugs, chosen for their efficacy against similar viruses or their in vitro activity. Trials on patients are ongoing but the majority of information comes from small case series and single center reports. We aimed to provide a literature review on the putative effectiveness and safety of available treatments for COVID-19 in pregnant women. METHODS We reviewed all the available literature concerning the drugs that have been used in the treatment of COVID-19 during pregnancy and whose safe assumption during pregnancy had been demonstrated by clinical studies (i.e. including studies on other infectious diseases). Drugs contra-indicated during pregnancy or with unknown adverse effects were not included in our review. RESULTS AND CONCLUSIONS Clinical trials are not often conducted among pregnant patients for safety reasons and this means that drugs that may be effective in general population cannot be used for pregnant women due to the lack of knowledge of side effects in this category of people .The choice to use a specific drug for COVID-19 in pregnancy should take into account benefits and possible adverse events in each single case. In the current situation of uncertainty and poor knowledge about the management of COVID-19 during pregnancy, this present overview may provide useful information for physicians with practical implications.
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Affiliation(s)
| | - Marta Mattei Gentili
- Department of Surgical and Biochemical
Sciences, Centre of Perinatal and Reproductive Medicine, University of
Perugia, Perugia, Italy
| | - Francesca Raspa
- Department of Surgical and Biochemical
Sciences, Centre of Perinatal and Reproductive Medicine, University of
Perugia, Perugia, Italy
| | - Irene Giardina
- Department of Surgical and Biochemical
Sciences, Centre of Perinatal and Reproductive Medicine, University of
Perugia, Perugia, Italy
| | - Fabio Parazzini
- Fondazione IRCCS Cà Granda, Dipartimento
Materno-Infantile, Ospedale Maggiore Policlinico, Università degli Studi di Milano,
Dipartimento di Scienze Cliniche e di Comunità, Universita' di Milano,
Milan, Italy
| | - Amerigo Vitagliano
- Department of Women’s and Children’s Health,
University of Padua, Padova, Italy
| | - Anna V. Borisova
- Department of Obstetrics and Gynecology with
the Course of Perinatology, Peoples Friendship University of Russia (RUDN
University), Moscow, Russian Federation
| | - Sandro Gerli
- Department of Surgical and Biochemical
Sciences, Centre of Perinatal and Reproductive Medicine, University of
Perugia, Perugia, Italy
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Canovi L, Zanarelli L, Cardelli L, Dal Passo B, Frascaro F, Piscitelli L, De Carolis B, Gibiino F, Vitagliano A, Sciarra F, Zagnoni S, Pallotti M, Colletta M, Casella G. C52 THE BIG FOUR: RESPIRATORY FAILURE, RENAL INSUFFICIENCY, HAEMORRHAGE AND SEPSIS, HOW DO THEY IMPACT ON CICU PATIENT? Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.051] [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] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The current rise in life expectancy in the general population leads to changes in baseline characteristics of Cardiac Intensive Care Unit (CICU) patients, increasing the risk of non–cardiac complications during the hospitalization.
Objectives
Evaluate epidemiology and prognostic impact of major non–cardiac complications (respiratory failure, renal insufficiency, haemorrhage and sepsis) during CICU stay. Methods: Retrospective analysis of CICU patients at Ospedale Maggiore of Bologna between March and November 2021.
Results
Baseline characteristics, cardiovascular risk factors and comorbidities of the patients are reported in Table 1. During the CICU stay, 19.7% of patients suffered from acute respiratory failure, needing for ventilation; 15.0% had renal insufficiency (considered as need for haemodialysis, glomerular filtration rate according to Cockcroft–Gault < 60 ml/min, serum creatinine rise > 25% from baseline); 1.8% reported major haemorrhages (defined as serum haemoglobin < 8 g/dl or need for blood transfusion); 1.7% developed sepsis (positive blood cultures). Mean CICU stay for complicated patients was 6 days, intra–CICU mortality was 1.7% (8 deaths) and 30–days mortality was 7.0% (32 deaths). At univariate logistic regression analysis, acute respiratory failure was the only complication associated with a statistically relevant increase in 30–days mortality (OR 2.37, CI 95%, 1.05–5.34; p = 0.038), although, also the other complications had a negative prognostic effect: haemorrhage (OR 1.58, CI 95%, 1.77–14.16; p = 0.681), renal insufficiency (OR 1.47, CI 95%, 0.56–3.87; p = 0.432) and sepsis (OR 1.25, CI 95%, 0.33–5.87, p = 0.850).
Conclusions
Epidemiology and baseline characteristics of CICU patients are changing. Older age and frailty make non–cardiac complications more likely to happen. Acute respiratory failure has the worst prognostic effect on mortality. This fact suggests that CICU Cardiologists should improve their management of these major non–cardiac complications.
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Affiliation(s)
- L Canovi
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - L Zanarelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - L Cardelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - B Dal Passo
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - F Frascaro
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - L Piscitelli
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - B De Carolis
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - F Gibiino
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - A Vitagliano
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - F Sciarra
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - S Zagnoni
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - M Pallotti
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - M Colletta
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
| | - G Casella
- UNITÀ DI CARDIOLOGIA, AZIENDA OSPEDALIERA UNIVERSITARIA DI FERRARA, FERRARA; UNIVERSITÀ DEGLI STUDI DI BARI ALDO MORO, BARI; AZIENDA USL BOLOGNA, OSPEDALE MAGGIORE DI BOLOGNA, BOLOGNA
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D’Alcamo E, Gullo G, Cucinella G, Perino A, Burgio S, Etrusco A, Agrigento V, Sclafani S, Listi F, Maggio A, Vega I, Laganà AS, Vitagliano A, Noventa M, Buzzaccarini G. Cystic Fibrosis assessment in infertile couples: genetic analysis trough the Next Generation Sequencing technique. CLIN EXP OBSTET GYN 2022. [DOI: 10.31083/j.ceog4905105] [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: 11/06/2022]
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