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Bruno S, Nachira L, Arcaro P, Pattavina F, Campo E, Cadeddu C, Carducci B, Lanzone A, Damiani G, Laurenti P. Assessing Doubts, Knowledge, and Service Appreciation among Pregnant Women Who Received the COVID-19 Vaccination in an Italian Research Hospital: A Cross-Sectional Study. Vaccines (Basel) 2023; 11:vaccines11040812. [PMID: 37112724 PMCID: PMC10143795 DOI: 10.3390/vaccines11040812] [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: 03/10/2023] [Revised: 03/31/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
The COVID-19 pandemic is considered one of the deadliest pandemics in history. Pregnant women are more susceptible to developing serious diseases during COVID-19 than their non-pregnant peers. Pregnant women often express doubt about accepting the vaccination, especially in regard to their security and safety. This study aims to investigate the appreciation of the vaccination offer, and if there are any determinants impacting vaccine hesitancy. A questionnaire was administered to a sample of pregnant women who had just received their immunization against COVID-19 at the vaccination service of a teaching hospital in Rome, from October 2021 to March 2022. A high appreciation of the vaccination services was found, both for the logistic organization and the healthcare personnel, with mean scores above 4 out of 5. The degree of pre-vaccinal doubt was low (41%) or medium (48%) for the largest part of the sample, while the degree of COVID-19 vaccine knowledge was high for 91% of the participants. Physicians were the most decisive information source for the vaccination choice. Our results highlighted that a supportive approach could increase appreciation and improve the setting of vaccinations. Healthcare professionals should aim for a more comprehensive and integrated role of all figures.
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Affiliation(s)
- Stefania Bruno
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Lorenza Nachira
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Paola Arcaro
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Fabio Pattavina
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Enrica Campo
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Chiara Cadeddu
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Brigida Carducci
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Antonio Lanzone
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Gianfranco Damiani
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Patrizia Laurenti
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
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2
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Nachira L, Bruno S, Carducci B, Villani L, Pascucci D, Quaranta G, Damiani G, Federico B, Lanzone A, Laurenti P. Impact of COVID-19 on flu vaccination among pregnant women in a Teaching Hospital in Rome. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.413] [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
Background
According to WHO, UNICEF, GAVI and the Sabin Vaccine Institute data, the COVID-19 pandemic caused the disruption of routine vaccinations in at least 68 countries. In March ‘20, the WHO published a guide to help countries continuing their provision safely to prevent unnecessary visits and hospitalizations: especially flu vaccination is paramount to reduce respiratory illnesses and their burden on healthcare systems. For the flu season 2021-22, the Italian Ministry of Health recommended prioritizing flu vaccination for pregnant women. This study aims at comparing flu vaccination rates between pre-pandemic and pandemic periods in pregnant women attending a birthing preparation course at the Fondazione Policlinico Universitario A.Gemelli IRCCS (FPG) in Rome.
Methods
A repeated cross-sectional study was carried out in FPG during two flu epidemic seasons (October ‘19-January ‘20 and September ‘20-January ‘21), when two different cycles of birthing preparation courses were held (face-to-face and online, respectively). Pregnant women and their partners attending them were offered flu vaccination at FPG. A χ2 test was performed to compare vaccination rates, with statistical significance set at p = 0.05.
Results
In 2019-20, 48 out of 119 women and 39 men out of 119 attending the course accepted flu vaccination, while in 2020-21 they were respectively 88 out of 317 and 89 out of 317. Overall vaccination compliance among pregnant women was significantly higher in 2019-20 than in 2020-21 (40.3% and 27.8% respectively, p = 0.012), while the difference was not significant among their partners (32.8% and 28.1% respectively, p = 0.337).
Conclusions
The COVID-19 pandemic negatively affected flu vaccination adherence among the pregnant women involved. Fear of contagion and access to facilities closer to their home could be potential key drivers. These results represent an important warning on flu vaccination attitudes during the pandemic: more actions are needed to improve compliance.
Key messages
• COVID-19 might have hindered access to immunization services for at-risk populations, such as that of pregnant women.
• From a Public Health point of view, more actions are needed to harmonize interactions between hospitals and local national health services to improve vaccination compliance.
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Affiliation(s)
- L Nachira
- Hygiene, Life Sciences and Public Health, Catholic University of Sacred Heart , Rome, Italy
| | - S Bruno
- Hygiene, Life Sciences and Public Health, Catholic University of Sacred Heart , Rome, Italy
- Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
| | - B Carducci
- Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
| | - L Villani
- Hygiene, Life Sciences and Public Health, Catholic University of Sacred Heart , Rome, Italy
| | - D Pascucci
- Hygiene, Life Sciences and Public Health, Catholic University of Sacred Heart , Rome, Italy
- Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
| | - G Quaranta
- Hygiene, Life Sciences and Public Health, Catholic University of Sacred Heart , Rome, Italy
- Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
| | - G Damiani
- Hygiene, Life Sciences and Public Health, Catholic University of Sacred Heart , Rome, Italy
- Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
| | - B Federico
- Human Sciences, Society and Health, University of Cassino and Southern Lazio , Cassino, Italy
| | - A Lanzone
- Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
| | - P Laurenti
- Hygiene, Life Sciences and Public Health, Catholic University of Sacred Heart , Rome, Italy
- Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome, Italy
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3
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Zanfini BA, Catarci S, Vassalli F, Laurita Longo V, Biancone M, Carducci B, Frassanito L, Lanzone A, Draisci G. The Effect of Epidural Analgesia on Labour and Neonatal and Maternal Outcomes in 1, 2a, 3, and 4a Robson's Classes: A Propensity Score-Matched Analysis. J Clin Med 2022; 11:jcm11206124. [PMID: 36294447 PMCID: PMC9604843 DOI: 10.3390/jcm11206124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Lumbar epidural analgesia (EA) is the most commonly used method for reducing labour pain, but its impact on the duration of the second stage of labour and on neonatal and maternal outcomes remains a matter of debate. Our aim was to examine whether EA affected the course and the outcomes of labour among patients divided according to the Robson-10 group classification system. Methods: Patients of Robson’s classes 1, 2a, 3, and 4a were divided into either the EA group or the non-epidural analgesia (NEA) group. A propensity score-matching analysis was performed to balance the intergroup differences. The primary goal was to analyse the duration of the second stage of labour. The secondary goals were to evaluate neonatal and maternal outcomes. Results: In total, 21,808 cases were analysed. The second stage of labour for all groups was prolonged using EA (p < 0.05) without statistically significant differences in neonatal outcomes. EA resulted in a lower rate of episiotomies in nulliparous patients, with a higher rate of operative vaginal deliveries (OVD) (p < 0.05) and Caesarean sections (CS) (p < 0.05) in some classes. Conclusions: EA prolonged the duration of labour without affecting neonatal outcomes and reduced the rate of episiotomies, but also increased the rate of OVDs.
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Affiliation(s)
- Bruno Antonio Zanfini
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
- Correspondence:
| | - Stefano Catarci
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
| | - Francesco Vassalli
- Obstetric Anesthesia, Department of Critical Care and Perinatal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Valentina Laurita Longo
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
- Università Cattolica del Sacro Cuore Roma, Largo F. Vito 1, 00168 Roma, Italy
| | - Matteo Biancone
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
| | - Brigida Carducci
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
| | - Luciano Frassanito
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
| | - Antonio Lanzone
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
- Università Cattolica del Sacro Cuore Roma, Largo F. Vito 1, 00168 Roma, Italy
| | - Gaetano Draisci
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
- Obstetric Anesthesia, Department of Critical Care and Perinatal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Giannina Gaslini, 16147 Genova, Italy
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Largo A Gemelli 8, 00168 Roma, Italy
- Università Cattolica del Sacro Cuore Roma, Largo F. Vito 1, 00168 Roma, Italy
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Bruno S, Nachira L, Villani L, Beccia V, Di Pilla A, Pascucci D, Quaranta G, Carducci B, Spadea A, Damiani G, Lanzone A, Federico B, Laurenti P. Knowledge and beliefs about vaccination in pregnant women before and during the COVID-19 pandemic. Front Public Health 2022; 10:903557. [PMID: 35991061 PMCID: PMC9386522 DOI: 10.3389/fpubh.2022.903557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Vaccine hesitancy threatens the health of populations and challenges Public Health professionals. Strategies to reduce it aim to improve people's risk perception about vaccine-preventable diseases, fill knowledge gaps about vaccines and increase trust in healthcare providers. During pregnancy, educational interventions can provide a proper knowledge about safety and efficacy of maternal and childhood vaccinations. Fighting hesitancy and clarifying doubts is fundamental during the COVID-19 pandemic, which may have affected people's knowledge and beliefs toward vaccination. This study aimed at assessing if the advent of the pandemic was associated with changes in pregnant women's knowledge and beliefs toward vaccination, and trust in healthcare services. Methods A repeated cross-sectional study was conducted through self-reported questionnaires in a Roman teaching hospital, where educational classes about vaccinations are routinely held as part of a birthing preparation course. Data were collected on a sample of pregnant women before and during the pandemic. Free-of-charge flu vaccinations were offered to all course participants and adherence to flu vaccination was assessed. Results The proportion of pregnant women reporting that vaccines have mild side effects and that are sufficiently tested increased from 78.6 to 92.0% (p = 0.001) and from 79.4 to 93.2% (p = 0.001), respectively. There was a reduction from 33.0 to 23.3% (p = 0.065) in the proportion of those declaring that healthcare workers (HCWs) give information only on the benefits and not on the risks of vaccines, and a reduction from 27.3 to 12.1% (p = 0.001) in those reporting that vaccines are an imposition and not a free choice of mothers. Trust in National Health Service (NHS) operators slightly decreased. Among participants, the monthly flu vaccination adherence ranged from 50.0% in November to 29.2% January for 2019–20 flu season, and from 56.3% in September to 14.5% in January for 2020–21 flu season, showing a higher vaccination acceptance in the earlier months of 2020-21 flu season. Conclusions The pandemic may have positively affected pregnant women's knowledge and opinions about vaccinations and trust in HCWs, despite a possible negative impact on their perceptions about NHS operators. This should inspire Public Health professionals to rethink their role as health communicators.
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Affiliation(s)
- Stefania Bruno
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenza Nachira
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence: Lorenza Nachira
| | - Leonardo Villani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Viria Beccia
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Di Pilla
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Clinical Governance, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico Pascucci
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluigi Quaranta
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Brigida Carducci
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Gianfranco Damiani
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Lanzone
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Bruno Federico
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Frosinone, Italy
| | - Patrizia Laurenti
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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5
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Buonsenso D, Malorni W, Turriziani Colonna A, Morini S, Sbarbati M, Solipaca A, Di Mauro A, Carducci B, Lanzone A, Moscato U, Costa S, Vento G, Valentini P. Psychological Impact of the COVID-19 Pandemic on Pregnant Women. Front Pediatr 2022; 10:790518. [PMID: 35498808 PMCID: PMC9039297 DOI: 10.3389/fped.2022.790518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/24/2022] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The aim of this study is to assess the impact of the COVID-19 pandemic on mental health, type of delivery, and neonatal feeding of pregnant women with or without SARS-CoV-2 infection during gestation. STUDY DESIGN The study was conducted online, and anonymous survey was distributed to mothers that delivered during the COVID-19 pandemic. RESULTS The survey was completed by 286 women, and 64 women (22.4%) had COVID-19 during pregnancy. Women that had SARS-CoV-2 infection during pregnancy or at time of delivery had a significantly higher probability of being separated from the newborn (p < 0.0001) and a significantly lower probability of breastfeeding (p < 0.0001). The Edinburg Postnatal Depression Scale, to assess if mothers had symptoms of postnatal depression, showed that items suggestive of postnatal depression were relatively frequent in the whole cohort. However, women with SARS-CoV-2 infection during pregnancy reported higher probability of responses suggestive of postnatal depression in eight out of 10 items, with statistically significant differences in three items. CONCLUSION The COVID-19 pandemic affected the type of delivery and breastfeeding of pregnant women, particularly when they had SARS-CoV-2 infection. This, in turn, had an impact on the psychological status of the interviewed mothers, aspects that could benefit of special support.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Walter Malorni
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Arianna Turriziani Colonna
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sofia Morini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Martina Sbarbati
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Solipaca
- National Observatory on Health in the Italian Regions, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Di Mauro
- Pediatric Primary Care, National Pediatric Healthcare System, Margherita di Savoia, Italy
| | - Brigida Carducci
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Lanzone
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Umberto Moscato
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simonetta Costa
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
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6
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Teofili L, Papacci P, Bartolo M, Molisso A, Orlando N, Pane L, Giannantonio C, Serrao F, Bianchi M, Valentini CG, Pellegrino C, Baldascino A, Carducci B, Lepore D, Vento G. Transfusion-Free Survival Predicts Severe Retinopathy in Preterm Neonates. Front Pediatr 2022; 10:814194. [PMID: 35223696 PMCID: PMC8866869 DOI: 10.3389/fped.2022.814194] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/04/2022] [Indexed: 12/23/2022] Open
Abstract
Repeated red blood cell (RBC) transfusions are thought to increase the risk for retinopathy of prematurity (ROP), likely due to a critical fetal hemoglobin (HbF) reduction. In this study, we investigated if the postmenstrual age (PMA) of neonates at transfusion influences the risk for ROP. We estimated the cumulative transfusion-free survival (TFS) in a series of 100 preterm neonates receiving one or more RBC units. TFS was calculated by censoring patients at first transfusion and expressing the time between birth and transfusion as either PMA or postnatal day. Then, we investigated if TFS predicted the occurrence of severe ROP, defined as ROP stage 3 or higher. We found that neonates with severe ROP displayed a significantly shorter TFS expressed according to their PMA (p = 0.001), with similar TFS according to postnatal days. At receiver operating characteristic (ROC) curve analysis, receiving an RBC unit before week 28 of PMA predicted severe ROP with a sensitivity of 64% and a specificity of 78%. In addition, receiving a second RBC unit before the PMA of 29 weeks predicted severe ROP with a sensitivity of 75% and a specificity of 69%. At multivariate analysis, PMA at the second transfusion was even more informative than at first transfusion and outperformed all other variables in predicting severe ROP, with an odds ratio of 4.554 (95% CI 1.332-15.573, p = 0.016). Since HbF decrease is greater after multiple RBC transfusions, it is conceivable that neonates receiving more than one unit before the PMA of 29 weeks may be exposed to a greater disturbance of retinal vascularization. Any strategy aimed at preventing the critical HbF decrease at this low age might potentially reduce the risk for severe ROP.
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Affiliation(s)
- Luciana Teofili
- Divisione di Medicina Trasfusionale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica, ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy.,Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Patrizia Papacci
- Divisione di Neonatologia, Dipartimento per le Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy.,Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Bartolo
- Divisione di Medicina Trasfusionale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica, ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Anna Molisso
- Divisione di Neonatologia, Dipartimento per le Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Nicoletta Orlando
- Divisione di Medicina Trasfusionale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica, ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Lucia Pane
- Divisione di Neonatologia, Dipartimento per le Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Carmen Giannantonio
- Divisione di Neonatologia, Dipartimento per le Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Francesca Serrao
- Divisione di Neonatologia, Dipartimento per le Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Maria Bianchi
- Divisione di Medicina Trasfusionale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica, ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Caterina Giovanna Valentini
- Divisione di Medicina Trasfusionale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica, ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Claudio Pellegrino
- Divisione di Medicina Trasfusionale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica, ed Ematologia, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy.,Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Baldascino
- Divisione di Oculistica, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Brigida Carducci
- Divisione di Ostetricia e Patologia Ostetrica, Dipartimento per le Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy
| | - Domenico Lepore
- Divisione di Oculistica, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy.,Dipartimento Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Vento
- Divisione di Neonatologia, Dipartimento per le Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico, Rome, Italy.,Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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7
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Bruno S, Carducci B, Quaranta G, Beccia V, Di Pilla A, La Milia DI, Di Pumpo M, Carini E, Masini L, Tamburrini E, Spadea A, Damiani G, Lanzone A, Laurenti P. Enhancement of Vaccination Attitude and Flu Vaccination Coverage among Pregnant Women Attending Birthing Preparation Course. Vaccines (Basel) 2021; 9:183. [PMID: 33670085 PMCID: PMC7926478 DOI: 10.3390/vaccines9020183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 12/17/2022] Open
Abstract
Most vaccinations are recommended within the 15th month of life, in order to reduce risks and to protect children from the initial stages of their lives. A vaccination training session was carried out during the birthing preparation course, aimed at increasing the attitude toward vaccination in maternal-child age. A questionnaire on vaccination awareness was administered before and after the training session and on-site flu vaccination was offered to women and their companions. The percentage of participants who consider the preparatory course a useful tool to obtain information about vaccines increases significantly from 30.34% at pre-intervention to 64.56% at post-intervention (p < 0.001). There is a significant increase in the mean number of vaccinations that the participants want their children to get. The number of participants believing that there is no relationship between vaccination and autism rose from 41.05 to 72.97% (p < 0.001). In total, 48 out of 119 (40.34%) pregnant women participating in the course and 39 companions were vaccinated for influenza. Vaccination knowledge and attitude significantly increased after a training session dedicated to vaccination as a part of the pregnant pre-birth course, whose aim can be therefore extended to the management of the health of the child, well beyond the period of pregnancy, according to the life-course approach to health.
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Affiliation(s)
- Stefania Bruno
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.B.); (B.C.); (G.Q.); (D.I.L.M.); (L.M.); (E.T.); (G.D.); (A.L.); (P.L.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.B.); (M.D.P.); (E.C.)
| | - Brigida Carducci
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.B.); (B.C.); (G.Q.); (D.I.L.M.); (L.M.); (E.T.); (G.D.); (A.L.); (P.L.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.B.); (M.D.P.); (E.C.)
| | - Gianluigi Quaranta
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.B.); (B.C.); (G.Q.); (D.I.L.M.); (L.M.); (E.T.); (G.D.); (A.L.); (P.L.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.B.); (M.D.P.); (E.C.)
| | - Viria Beccia
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.B.); (M.D.P.); (E.C.)
| | - Andrea Di Pilla
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.B.); (M.D.P.); (E.C.)
| | - Daniele Ignazio La Milia
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.B.); (B.C.); (G.Q.); (D.I.L.M.); (L.M.); (E.T.); (G.D.); (A.L.); (P.L.)
| | - Marcello Di Pumpo
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.B.); (M.D.P.); (E.C.)
| | - Elettra Carini
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.B.); (M.D.P.); (E.C.)
| | - Lucia Masini
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.B.); (B.C.); (G.Q.); (D.I.L.M.); (L.M.); (E.T.); (G.D.); (A.L.); (P.L.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.B.); (M.D.P.); (E.C.)
| | - Enrica Tamburrini
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.B.); (B.C.); (G.Q.); (D.I.L.M.); (L.M.); (E.T.); (G.D.); (A.L.); (P.L.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.B.); (M.D.P.); (E.C.)
| | | | - Gianfranco Damiani
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.B.); (B.C.); (G.Q.); (D.I.L.M.); (L.M.); (E.T.); (G.D.); (A.L.); (P.L.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.B.); (M.D.P.); (E.C.)
| | - Antonio Lanzone
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.B.); (B.C.); (G.Q.); (D.I.L.M.); (L.M.); (E.T.); (G.D.); (A.L.); (P.L.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.B.); (M.D.P.); (E.C.)
| | - Patrizia Laurenti
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.B.); (B.C.); (G.Q.); (D.I.L.M.); (L.M.); (E.T.); (G.D.); (A.L.); (P.L.)
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (V.B.); (M.D.P.); (E.C.)
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8
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Carducci B, Keats EC, Ruel M, Haddad L, Osendarp SJM, Bhutta ZA. Food systems, diets and nutrition in the wake of COVID-19. ACTA ACUST UNITED AC 2021; 2:68-70. [PMID: 37117413 DOI: 10.1038/s43016-021-00233-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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9
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Carini E, Bruno S, Di Pilla A, Beccia V, Di Pumpo M, Damiani G, Carducci B, Masini L, Lanzone A, Laurenti P. Influenza vaccination among pregnant women: increasing awareness and coverage. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1426] [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: 11/13/2022] Open
Abstract
Abstract
Influenza is a serious public health issue and pregnant women are one of the categories at higher risk of complications. Vaccination represents a safe and effective tool for prevention but the importance is not well perceived and the coverage is low (ECDC: 25% median in 2016/17). A program of education and free vaccination has been proposed to pregnant women following birthing classes. The aim was to increase pregnant awareness and to increase vaccination coverage of both parents. Classes about vaccinations, their timing and efficacy were given and a dedicated ambulatory operating twice a month during the flu season was set up. After the classes, the women were addressed to the ambulatory to be vaccinated. Vaccination was offered to the partners of the pregnant as well. General data, anamnesis and data about previous vaccinations were asked and then entered into a database.
The number of women participating to the birthing classes from October 2019 to January 2020 was 119. Of those, from the beginning of the vaccination sessions on November 14th 2019 until January 16th 2020, 46 were vaccinated in the dedicated ambulatory (plus 2 in the resident ambulatory of the hospital). The compliance to vaccination was 40.34%. An additional number of 39 partners was also vaccinated. November was the month with the highest number of people vaccinated (20 women and 14 partners), while January had the lowest (7 women and 8 partners).
As expected a higher number of people got vaccinated at the beginning of the flu season. A considerable number of partners decided to vaccinate, showing the parents understanding of the importance of herd immunity. Sensitising the women towards vaccination and increasing their awareness is crucial to improve women and new-borns' health status. Even though the compliance was considerable, a lot of work has to be done to improve vaccination coverage and to make the importance of vaccination clear.
Key messages
Providing a programme of sensitisation could improve influenza vaccination coverage. The compliance, although satisfactory, can be further improved providing different and steady educational strategies.
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Affiliation(s)
- E Carini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Bruno
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Di Pilla
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Beccia
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Di Pumpo
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Damiani
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - B Carducci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Masini
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Lanzone
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - P Laurenti
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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10
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Di Pilla A, Bruno S, Carini E, Beccia V, Quaranta G, La Milia D, Masini L, Carducci B, Lanzone A, Laurenti P. Vaccination attitude assessment among attendees the birthing preparation course: a pre-post study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1416] [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: 11/13/2022] Open
Abstract
Abstract
Background
Vaccinations are among the most effective and safe ways to prevent the spreading and the complications of infectious diseases. In order to reduce risks and to protect children from the early beginning of their life, most vaccinations are recommended within the 15th month of life. In Italy, the law provides 10 compulsory vaccinations to the 0-16 age group. A training program was carried on by a Public Health specialist during the birthing preparation course, aimed at increasing the attitude to vaccination in maternal-child age.
Methods
A training session in the birthing preparation course was specifically carried out to raise awareness about vaccination during both pregnancy and puerperium and in early childhood; a questionnaire on vaccination awareness was administered before and after the training session.
Results
Out of 119 pregnant women attended the birthing preparation course from October 2019 to January 2020. As a result of the interventions, the percentage of the participants who consider the preparatory course a useful tool to obtain information about vaccines increases significantly from 30.34% pre-intervention to 64.56% post-intervention (p < 0.001). There is a significant increase in the mean number of vaccinations that the participants want their children to get, out of the 12 vaccinations proposed in the questionnaire: 9.68/12 pre-intervention versus 10.57/12 post-intervention (p = 0.021). Participants supporting the mandatory vaccinations are 96.04% pre-intervention and rise to 98.73% post-intervention.
Conclusions
Attitude and knowledge related to vaccination are crucial values for maternal-child health: they significantly increased after a training session dedicated to vaccination as a part of the pregnant pre-birth course, whose aim can be therefore extended to the management of the health of the child, well beyond the period of pregnancy, labor and childbirth, according the life-course approach to health, from the Public Health perspective.
Key messages
The childbirth preparation courses for pregnant should be valuable as a precious opportunity to raise parents’ awareness and their attitude to vaccinations, if dedicated sessions are included in them. The mandatory nature of vaccines is very well received by pregnant women.
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Affiliation(s)
- A Di Pilla
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Bruno
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario, Rome, Italy
| | - E Carini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - V Beccia
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Quaranta
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario, Rome, Italy
| | - D La Milia
- Fondazione Policlinico Universitario, Rome, Italy
| | - L Masini
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario, Rome, Italy
| | - B Carducci
- Fondazione Policlinico Universitario, Rome, Italy
| | - A Lanzone
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario, Rome, Italy
| | - P Laurenti
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario, Rome, Italy
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11
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Teofili L, Papacci P, Orlando N, Bianchi M, Molisso A, Purcaro V, Valentini CG, Giannantonio C, Serrao F, Chiusolo P, Nicolotti N, Pellegrino C, Carducci B, Vento G, De Stefano V. Allogeneic cord blood transfusions prevent fetal haemoglobin depletion in preterm neonates. Results of the CB-TrIP study. Br J Haematol 2020; 191:263-268. [PMID: 32510635 DOI: 10.1111/bjh.16851] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 12/25/2022]
Abstract
Repeated red blood cell (RBC) transfusions in preterm neonates are associated with poor outcome and increased risk for prematurity-associated diseases. RBC transfusions cause the progressive replacement of fetal haemoglobin (HbF) by adult haemoglobin (HbA). We monitored HbF levels in 25 preterm neonates until 36 weeks of post-menstrual age (PMA); patients received RBC units from allogeneic cord blood (cord-RBCs) or from adult donors (adult-RBCs), depending on whether cord-RBCs were available. Primary outcome was HbF level at PMA of 32 weeks. Twenty-three neonates survived until this age: 14 received no transfusions, two only cord-RBCs, three only adult-RBCs and four both RBC types. HbF levels in neonates transfused with cord-RBCs were significantly higher than in neonates receiving adult-RBCs (P < 0·0001) or both RBC types (P < 0·0001). Superimposable results were obtained at PMA of 36 weeks. Every adult-RBCs transfusion increased the risk for an HbF in the lowest quartile by about 10-fold, whereas this effect was not evident if combined adult- and cord-RBCs were evaluated. Overall, these data show that transfusing cord-RBCs can limit the HbF depletion caused by conventional RBC transfusions. Transfusing cord blood warrants investigation in randomised trials as a strategy to mitigate the severity of retinopathy of prematurity (NCT03764813).
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Affiliation(s)
- Luciana Teofili
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica, ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro, Cuore, Roma, Italy
| | - Patrizia Papacci
- Area Salute del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro, Cuore, Roma, Italy
| | - Nicoletta Orlando
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica, ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Maria Bianchi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica, ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Anna Molisso
- Area Salute del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Velia Purcaro
- Area Salute del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Caterina Giovanna Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica, ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Carmen Giannantonio
- Area Salute del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesca Serrao
- Area Salute del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica, ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro, Cuore, Roma, Italy
| | - Nicola Nicolotti
- Direzione Sanitaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Claudio Pellegrino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica, ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Brigida Carducci
- Area Salute del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giovanni Vento
- Area Salute del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro, Cuore, Roma, Italy
| | - Valerio De Stefano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica, ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.,Università Cattolica del Sacro, Cuore, Roma, Italy
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12
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Buonsenso D, Costa S, Sanguinetti M, Cattani P, Posteraro B, Marchetti S, Carducci B, Lanzone A, Tamburrini E, Vento G, Valentini P. Neonatal Late Onset Infection with Severe Acute Respiratory Syndrome Coronavirus 2. Am J Perinatol 2020; 37:869-872. [PMID: 32359227 PMCID: PMC7356068 DOI: 10.1055/s-0040-1710541] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To date, no information on late-onset infection in newborns to mother with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contracted in pregnancy are available. This study aimed to evaluate postdischarge SARS-CoV-2 status of newborns to mothers with COVID-19 in pregnancy that, at birth, were negative to SARS-CoV-2. STUDY DESIGN This is an observational study of neonates born to mothers with coronavirus disease 2019 (COVID-19). RESULTS Seven pregnant women with documented SARS-CoV-2 infection have been evaluated in our institution. One woman had a spontaneous abortion at 8 weeks of gestational age, four women recovered and are still in follow-up, and two women delivered. Two newborns were enrolled in the study. At birth and 3 days of life, newborns were negative to SARS-CoV-2. At 2-week follow-up, one newborn tested positive although asymptomatic. CONCLUSION Our findings highlight the importance of follow-up of newborns to mothers with COVID-19 in pregnancy, since they remain at risk of contracting the infection in the early period of life and long-term consequences are still unknown. KEY POINTS · Newborns to mothers with coronavirus disease 2019 (COVID-19) in pregnancy can acquire the infection later after birth.. · Newborns to mothers with COVID-19 in pregnancy need a long-term follow-up, even if they tested negative at birth.. · Specific guidelines for the long-term follow-up of newborns to mothers with COVID-19 in pregnancy are needed..
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Address for correspondence Danilo Buonsenso, MD Largo A. Gemelli 8, Rome 00168Italy
| | - Simonetta Costa
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento Scienze di laboratorio e infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Paola Cattani
- Dipartimento Scienze di laboratorio e infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Brunella Posteraro
- Dipartimento Scienze di laboratorio e infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Simona Marchetti
- Dipartimento Scienze di laboratorio e infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Brigida Carducci
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Lanzone
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrica Tamburrini
- Dipartimento Scienze di laboratorio e infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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13
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Gui B, Corvino M, Grimaldi PP, Russo L, Marco MD, Valentini AL, Carducci B, Lanzone A, Manfredi R. Multidetector CT appearance of the pelvis after vaginal delivery: normal appearances and abnormal acute findings. ACTA ACUST UNITED AC 2020; 25:210-218. [PMID: 31063140 DOI: 10.5152/dir.2019.18127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vaginal delivery is the most commonly performed delivery in the world and accounts for nearly two-thirds of all deliveries in the United States. It is a secure method but may be associated with some acute complications, especially in the immediate postpartum days, which can potentially be fatal for the mother. The most frequent acute complications are hemorrhages/hematomas, uterine rupture, endometritis, retained product of conception (RPOC), ovarian thrombosis and HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count). A first evaluation of the clinical status of the patients is executed by the clinicians who, depending on their experience, perform ultrasonography by themselves and eventually may request further radiologic exams in doubtful cases. Radiologists may play an important role recognizing early postpartum complications and differentiating them from physiologic postoperative findings. In this setting, the use of multidetector computed tomography (MDCT) is important for diagnosis of suspected postpartum complications. The aim of this article is to review the normal and abnormal post vaginal delivery MDCT aspects in order to help the clinical management by preventing misdiagnoses and tailoring the best medical treatments.
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Affiliation(s)
- Benedetta Gui
- Department of Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Miriam Corvino
- Department of Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Pier Paolo Grimaldi
- Department of Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Russo
- Department of Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Margo Di Marco
- Department of Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna Lia Valentini
- Department of Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Brigida Carducci
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Antonio Lanzone
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Riccardo Manfredi
- Department of Radiological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
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14
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Neri C, Familiari A, Preziosi F, Vassallo C, Botta A, Lanzone A, Carducci B, Caruso A. Oral misoprostol versus intravaginal dinoprostone for labor induction: a comparison study. Minerva Obstet Gynecol 2018; 70:378-384. [PMID: 29376620 DOI: 10.23736/s0026-4784.18.04184-9] [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: 11/08/2022]
Abstract
BACKGROUND Induction of labor (IOL) is one of the most common procedures performed in obstetrics, accounting for about the 20% of deliveries in the developed countries and it still represents a challenge to obstetricians. The aim of this study is the comparison between two techniques for IOL: oral misoprostol and Propess®. METHODS A retrospective study has been carried out in a single tertiary referral center. Clinical maternal, fetal and neonatal information was recorded. RESULTS A total of 863 women were included. the vaginal delivery (VD) rate was significantly higher in the misoprostol group. The cesarean section rate was comparable between groups. Adverse events and neonatal outcomes were comparable between groups. CONCLUSIONS Misoprostol shows a higher VD rate with fewer patients needing a second type of induction and a shorter time to the onset of active labor and to VD.
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Affiliation(s)
- Caterina Neri
- Department of Women's and Children's Health, Sacro Cuore Catholic University, Agostino Gemelli University Hospital Foundation, Rome, Italy -
| | - Alessandra Familiari
- Department of Women's and Children's Health, Sacro Cuore Catholic University, Agostino Gemelli University Hospital Foundation, Rome, Italy
| | - Francesco Preziosi
- Department of Women's and Children's Health, Sacro Cuore Catholic University, Agostino Gemelli University Hospital Foundation, Rome, Italy
| | - Chiara Vassallo
- Department of Women's and Children's Health, Sacro Cuore Catholic University, Agostino Gemelli University Hospital Foundation, Rome, Italy
| | - Angela Botta
- Department of Women's and Children's Health, Sacro Cuore Catholic University, Agostino Gemelli University Hospital Foundation, Rome, Italy
| | - Antonio Lanzone
- Department of Women's and Children's Health, Sacro Cuore Catholic University, Agostino Gemelli University Hospital Foundation, Rome, Italy
| | - Brigida Carducci
- Department of Women's and Children's Health, Sacro Cuore Catholic University, Agostino Gemelli University Hospital Foundation, Rome, Italy
| | - Alessandro Caruso
- Department of Women's and Children's Health, Sacro Cuore Catholic University, Agostino Gemelli University Hospital Foundation, Rome, Italy
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Gui B, Danza FM, Valentini AL, Laino ME, Caruso A, Carducci B, Rodolfino E, Devicienti E, Bonomo L. Multidetector CT appearance of the pelvis after cesarean delivery: normal and abnormal acute findings. Diagn Interv Radiol 2017; 22:534-541. [PMID: 27756714 DOI: 10.5152/dir.2016.15593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cesarean section (CS) may have several acute complications that can occur in the early postoperative period. The most common acute complications are hematomas and hemorrhage, infection, ovarian vein thrombosis, uterine dehiscence and rupture. Pelvic hematomas usually occur at specific sites and include bladder flap hematoma (between the lower uterine segment and the bladder) and subfascial or rectus sheath hematoma (rectus sheath or prevescical space). Puerperal hemorrhage can be associated with uterine dehiscence or rupture. Pelvic infections include endometritis, abscess, wound infection, and retained product of conception. Radiologists play an important role in the diagnosis and management of postoperative complications as a result of increasing use of multidetector CT in emergency room. The knowledge of normal and abnormal postsurgical anatomy and findings should facilitate the correct diagnosis so that the best management can be chosen for the patient, avoiding unnecessary surgical interventions and additional treatments. In this article we review the surgical cesarean technique and imaging CT technique followed by description of normal and abnormal post-CS CT findings.
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Affiliation(s)
- Benedetta Gui
- Department of Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli Hospital, Rome, Italy.
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16
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Bracaglia M, Ianniello F, Quagliozzi L, Donati L, Basile F, Cesare CD, Viggiano M, Carducci B, Caruso A, Paradisi G. 211 EFFECT OF PRAVASTATIN ON ENDOTHELIAL FUNCTION AND ENDOTHELIAL PROGENITOR CELLS IN HEALTY POSTMENOPAUSAL WOMEN. Maturitas 2012. [DOI: 10.1016/s0378-5122(12)70322-5] [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: 10/27/2022]
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17
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Paradisi G, Ianniello F, Tomei C, Bracaglia M, Carducci B, Gualano MR, La Torre G, Banci M, Caruso A. Longitudinal changes of adiponectin, carbohydrate and lipid metabolism in pregnant women at high risk for gestational diabetes. Gynecol Endocrinol 2010; 26:539-45. [PMID: 20170346 DOI: 10.3109/09513591003632084] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [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] [Indexed: 11/13/2022] Open
Abstract
To evaluate, in pregnant women at high risk for gestational diabetes (GDM), the longitudinal changes of adiponectin, carbohydrate and lipid metabolism, and to assess their independent value as risk factors for the development of GDM. Fifty women at beginning of pregnancy were studied. Adiponectin, insulin sensitivity (homeostasis model assessment, HOMA) and lipid panel were measured at 1st, 2nd and 3rd trimesters of pregnancy. Twelve patients developed GDM. In both groups, GDM and normal glucose tolerance (NGT), adiponectin decreased from 1st to 2nd and 3rd trimesters by about 5 and 20% (GDM, p < 0.05), and of about 17 and 25% in NGT (p < 0.05), respectively. Values observed in NGT were similar to those of GDM (F = 9.401; p = 0.238). The Cox regression model identified as the strongest independent risk factor for GDM HOMA over 1.24 (RR = 14.12) at 1st trimester, fasting glycaemia over 87 mg/dl (RR = 42.68) triglycerides over 158 mg/dl (RR = 5.87) and body mass index (BMI) over 27 kg/m(2) (RR = 4.38) at 2nd trimester. Adiponectin in high-risk women is characterised by a constant reduction throughout gestation, irrespective of the development of GDM. HOMA, fasting glycaemia, triglycerides and BMI, but not adiponectin are independent predictors of GDM.
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Affiliation(s)
- Giancarlo Paradisi
- Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy.
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Abstract
BACKGROUND Gadolinium derivatives are ionic paramagnetic contrast agents used to enhance magnetic resonance images, labeled as a pregnancy category C by the Food and Drug Administration because of a lack of epidemiological studies concerning first-trimester exposure. METHODS Prospective cohort study to determine whether gadolinium derivatives exposure in periconceptional period is a risk factor for pregnancy or fetal development. RESULTS We report the outcome of 26 pregnant women exposed to gadolinium derivatives in the first trimester without adverse effect on pregnancy and neonatal outcome. CONCLUSIONS Currently, this study represents the only prospective investigation of gadolinium derivatives in pregnancy, but more data are necessary to exclude a teratogenic risk.
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Affiliation(s)
- M De Santis
- Telefono Rosso - Teratology Information Service, Department of Obstetrics and Gynaecology, Catholic University of Sacred Heart, Rome, Italy
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De Carolis S, Grimolizzi F, Garofalo S, Fatigante G, Ferrazzani S, Carducci B, Caruso A. Cancer in pregnancy: results of a series of 32 patients. Anticancer Res 2006; 26:2413-8. [PMID: 16821625] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Cancer complicates approximately 1 in 1000 pregnancies. In pregnancy management, whether the benefits outweigh the risks derived from therapy must be carefully considered. MATERIALS AND METHODS Thirty-two pregnant patients with the diagnosis of malignancy were followed. The indications and timing for surgery, chemotherapy, radiotherapy or delayed treatment were decided according to the malignancy characteristics and gestational age. The patient's consent was obtained before every decision. RESULTS The rate of live births, premature deliveries, foetal abnormalities and neonatal deaths was 97%, 82%, 9% and 3%, respectively. Three women (9%) died during puerperium because of disease progression. CONCLUSION The cancer treatment took into full consideration the specific condition of each pregnant patient. A good rate of live births was observed, even if a high rate of preterm delivery occurred. The management of malignancy required a team of experts in order to optimise every available choice for maternal health and neonatal well-being.
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Affiliation(s)
- Sara De Carolis
- Department of Obstetrics and Gynaecology, Catholic University, Rome, Italy.
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De Santis M, Straface G, Cavaliere AF, Cinque B, Carducci B, Caruso A. Teratological risk evaluation and prevention of voluntary abortion. Minerva Ginecol 2006; 58:91-9. [PMID: 16582865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
AIM Many women exposed to completely innocuous agents during pregnancy have a high perception of adverse effects to such an extent that they may interrupt their pregnancy. The objective of our study is to evaluate the importance of the perception of the risk level in making the decision to end the pregnancy and the relevance that a teratology consultation can have in preventing unmotivated terminations of pregnancy METHODS We carried out a survey on 350 women in Rome who voluntarily interrupted their pregnancy to evaluate the prevalence due to presumed teratogen. Contemporarily we studied the pregnancy outcomes, the clinical, the psychological and the socio-economic factors of 142 women who contacted our Teratology Information Service (TIS) in the 1(st)trimester of pregnancy because suspected of teratogen exposure: 72 decided to terminate their pregnancy, whereas 70 were used as a control group. RESULTS On 350 women who voluntarily interrupted their pregnancy, 4 cases (1.4%) reported exposure to a suspected teratogen, but our evaluation determined only 1 case. On 72 women decided to terminate their pregnancy and who contacted our TIS, after counselling 73% continued their pregnancy with respect to 97% of the control group. Those women who interrupted their pregnancy did so because of personal reasons independently to or the type of exposure or the risk attributed by us. CONCLUSIONS From our data it appears that a percentage of voluntary abortions is related to suspected teratogen exposure and that TIS are effective in the prevention of this kind of voluntary abortions caused by groundless fears.
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Affiliation(s)
- M De Santis
- Telefono Rosso, Teratology Information Service, Department of Obstetrics and Gynecology, Sacro Cuore Catholic University, Rome, Italy.
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Abstract
BACKGROUND Sibutramine is a drug that is used in the treatment of obesity. There are currently no epidemiological studies relating to sibutramine exposure in pregnancy. The objective of our study was to determine whether sibutramine exposure during pregnancy constitutes a risk factor to the mother and developing fetus. METHODS Fifty-two pregnant women who were exposed to sibutramine in the first trimester of pregnancy, when they were unaware of being pregnant, contacted our Teratology Information Service. We recorded the prospective outcomes of this case series between May 2001 and September 2004 with a complete neonatal follow-up up to 1 month after delivery. RESULTS Seven cases of hypertensive complications were observed during pregnancies. No cases of congenital anomalies in neonates were observed. CONCLUSION Although many more cases are necessary to demonstrate that sibutramine is not teratogenic in pregnancy, our experience improves the counseling of pregnancies occurring involuntarily during sibutramine therapy.
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Affiliation(s)
- Marco De Santis
- Department of Obstetrics and Gynecology, Telefono Rosso - Teratology Information Service, Catholic University of the Sacred Heart, Rome, Italy.
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De Santis M, Cavaliere AF, Straface G, Carducci B, Caruso A. Failure of the emergency contraceptive levonorgestrel and the risk of adverse effects in pregnancy and on fetal development: an observational cohort study. Fertil Steril 2005; 84:296-9. [PMID: 16084867 DOI: 10.1016/j.fertnstert.2005.01.136] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [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: 07/26/2004] [Revised: 01/28/2005] [Accepted: 01/28/2005] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine pregnancy and neonatal outcome after the failure of levonorgestrel as an emergency contraceptive. DESIGN A retrospective observational cohort study. SETTING Telephone consultations concerning reproductive risk factors conducted by Telefono Rosso-Teratology Information Service, Catholic University of Sacred Heart, Rome, Italy. PATIENT(S) Women exposed to levonorgestrel (36 cases) compared with a control group (80 cases). INTERVENTION(S) Teratological counseling. MAIN OUTCOME MEASURE(S) The rate of congenital anomalies, the prepartum or peripartum complications, and the pregnancy outcomes. RESULT(S) Twenty-five exposed newborns with length and weight identical to that of the control group were shown to be without increased risk of congenital malformation. No statistical differences were observed in terms of spontaneous or legal abortion and pregnancy and neonatal complications, and there was no ectopic pregnancy in either group. CONCLUSION(S) Although the sample size was small, in our experience, the failure of levonorgestrel as an emergency contraceptive was not associated with an increased risk of major congenital malformations, prepartum or peripartum complications, or an adverse pregnancy outcome.
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Affiliation(s)
- Marco De Santis
- Telefono Rosso, Teratology Information Service, Department of Obstetrics and Gynaecology, Catholic University of Sacred Heart, Rome, Italy.
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De Santis M, Straface G, Cavaliere A, Carducci B, Caruso A. Paternal and maternal exposure to leflunomide: pregnancy and neonatal outcome. Ann Rheum Dis 2005; 64:1096-7. [PMID: 15958772 PMCID: PMC1755581 DOI: 10.1136/ard.2004.030254] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Guariglia L, Carducci B, Botta A, Ferrazzani S, Caruso A. Uterine prolapse in pregnancy. Gynecol Obstet Invest 2005; 60:192-4. [PMID: 16020934 DOI: 10.1159/000087069] [Citation(s) in RCA: 19] [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: 11/30/2004] [Accepted: 05/11/2005] [Indexed: 11/19/2022]
Abstract
We present a case of a patient developing uterine prolapse during pregnancy. The cervix reached the introitus at 10 weeks gestation and subsequently protruted progressively as the pregnancy advanced. The patient was conservatively treated with bed rest and the main maternal and fetal risks are avoided. At 4 months postpartum follow-up there was no evidence of uterine prolapse.
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Affiliation(s)
- Lorenzo Guariglia
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
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25
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De Santis M, Straface G, Carducci B, Cavaliere AF, De Santis L, Lucchese A, Merola AM, Caruso A. Risk of drug-induced congenital defects. Eur J Obstet Gynecol Reprod Biol 2005; 117:10-9. [PMID: 15474237 DOI: 10.1016/j.ejogrb.2004.04.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2004] [Indexed: 11/19/2022]
Abstract
Defects attributable to drug therapy represent about 1% of congenital defects of known aetiology. This means that a precautionary attitude and correct use of drugs in fertile, and especially pregnant, women is a feasible form of prevention. Drugs currently in use with proven teratogenic effect number approximately 25, but new pharmaceutical drugs are constantly in preparation. Recognition of a drug-induced teratogenic effect is a complex procedure taking into account not only experimental animal data but also experience in humans. Considering that 40% of pregnancies are not planned, it follows that any drug with known or suspected teratogenic potential must be used only under strict medical control. Also, adequate knowledge on potential teratogenicity of a drug permits modification of therapy before conception. It goes without saying that any drug should be used during pregnancy only if it is essential, and it would be prudent to use only those where adequate information is provided and prior clinical experience is available. Teratology Information Services can assist both physicians and patients when any doubt exists.
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Affiliation(s)
- Marco De Santis
- Telefono Rosso-Teratology Information Service, Institute of Obstetrics and Gynaecology, Catholic University Sacred Heart, Largo A. Gemelli 8, Rome 00168, Italy.
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De Santis M, Lucchese A, Carducci B, Cavaliere AF, De Santis L, Merola A, Straface G, Caruso A. Latanoprost exposure in pregnancy. Am J Ophthalmol 2004; 138:305-6. [PMID: 15289149 DOI: 10.1016/j.ajo.2004.03.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2004] [Indexed: 11/25/2022]
Abstract
PURPOSE To observe pregnancies exposed to latanoprost, a prostaglandin analog administered in the treatment of glaucoma. Its prescription is limited in pregnancy, because reproduction studies in animals report a high incidence of abortion and human investigations are not adequate. As a consequence it is classified as category C drug according to the United States Food and Drug Administration's use-in-pregnancy ratings. DESIGN Observational study. METHODS We collected data, referred to our Teratology Information Service, relative to latanoprost exposure in pregnancy. We followed by phone interviews women treated with latanoprost during the first trimester, and we evaluated whether there had been any adverse effects on the fetus. RESULTS Eleven cases of latanoprost exposure in pregnancy were referred to our Teratology Information Service. One case was lost to follow-up, and one case was complicated by miscarriage. Nine cases had a complete follow-up without congenital anomalies. CONCLUSIONS Our series is too small to perform statistical significance; however, we found no evidence of adverse effects of latanoprost on pregnancy or neonatal outcomes.
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Affiliation(s)
- Marco De Santis
- Telefono Rosso Teratology Information Service, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
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Abstract
PURPOSE To assess pregnancy and neonatal outcomes in a woman accidentally exposed to Verteporfin photodynamic therapy in the third week of pregnancy. METHODS Post-conception counselling and prospective follow-up by telephone interview at Telefono Rosso (Teratology Information Service) were carried out. The baby was examined at birth and at 26 months. RESULTS The outcome of the pregnancy was normal and a healthy female child with a normal birthweight was born. The baby's follow-up was normal at 26 months. CONCLUSIONS This is the first reported case of a childbearing woman being accidentally exposed to Verteporfin during pregnancy. No fetal or neonatal adverse effects were documented.
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Affiliation(s)
- Marco De Santis
- Telefono Rosso, Teratology Information Service, Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy.
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Di Simone N, Maggiano N, Caliandro D, Riccardi P, Evangelista A, Carducci B, Caruso A. Homocysteine induces trophoblast cell death with apoptotic features. Biol Reprod 2003; 69:1129-34. [PMID: 12773435 DOI: 10.1095/biolreprod.103.015800] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [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: 11/01/2022] Open
Abstract
Hyperhomocysteinemia has been suggested as a possible risk factor in women suffering from habitual abortions, placental abruption or infarcts, preeclampsia, and/or intrauterine growth retardation. However, little is known about the pathogenic mechanisms underlying the action of homocysteine. The present study investigated the in vitro ability of homocysteine to affect trophoblast gonadotropin secretion and to induce cell death. In primary human trophoblast cells, homocysteine treatment (20 micromol/L) resulted in cellular flattening and enlargement, extension of pseudopodia, and cellular vacuolization. Cellular detachment, apoptosis, and necrosis were favored. With in situ nick end labeling, we investigated DNA degradation, and we used M30 CytoDEATH to selectively stain the cytoplasm of apoptotic cells. Cytochrome c release from mitochondria to the cytosol and DNA cleavage in agarose gel have been investigated. Homocysteine, but not cysteine, induced trophoblast apoptosis and significantly reduced human chorionic gonadotropin secretion. These findings suggest that trophoblast cell death might represent a pathogenic mechanism by which homocysteine may cause pregnancy complications related to placental diseases.
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Affiliation(s)
- Nicoletta Di Simone
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, 00168 Rome, Italy
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Ferrazzani S, De Santis L, Carducci B, Caliandro D, De Carolis S, Di Simone N, Caruso A. Prostaglandin: cervical ripening in hypertensive pregnancies. Acta Obstet Gynecol Scand 2003; 82:510-5. [PMID: 12780421 DOI: 10.1034/j.1600-0412.2003.00143.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 11/23/2022]
Abstract
BACKGROUND To determine the outcome of cervical ripening with intracervical prostaglandin E2 (PEG2) in hypertensive and non-hypertensive high-risk pregnancies in terms of successful ripening, mode of delivery, time intercorring between ripening and the beginning of labor or parturition and, at least, duration of labor. METHODS A total of 63 women with a diagnosis of hypertensive disorders were included in the study protocol. These 63 women were compared with 71 consecutive high-risk pregnancies requiring induction of labor for maternal and/or fetal indications. Cervical ripening was performed with single or multiple doses of 0.5 mg of intracervical PGE2 gel. RESULTS The rate of successful ripening was 84% for non-hypertensive patients (60/71) and 69% (43/63) for hypertensive patients ( p < 0.03). Twenty-four out of 63 hypertensive patients (38%) and 21 out of 71 non-hypertensive patients (30%) ( p < 0.05) were delivered by cesarean section. After stratification of hypertensive patients, the time interval from the first PGE2 administration to the onset of labor or vaginal delivery was significantly longer for preeclamptic patients vs. non-hypertensive patients or non-preeclamptic hypertensive patients. There were no differences in the duration of labor. CONCLUSIONS Among hypertensive patients, only preeclamptic patients showed a lower rate of successful ripening and vaginal delivery if compared with non-preeclamptic or non-hypertensive patients; however, a vaginal delivery might be obtained in most preeclamptic patients when suitable cervical ripening was performed in the presence of clinician-perceived urgency to delivery.
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Affiliation(s)
- Sergio Ferrazzani
- Department of Obstetrics and Gynecology, Catholic University, School of Medicine, Rome, Italy.
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De Santis M, Carducci B, Cavaliere AF, De Santis L, Lucchese A, Straface G, Caruso A. Paternal exposure to ribavirin: pregnancy and neonatal outcome. Antivir Ther 2003; 8:73-5. [PMID: 12713067] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
We report seven cases of newborns conceived within 6 months from the end or during paternal ribavirin exposure.
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Affiliation(s)
- Marco De Santis
- Department of Obstetrics and Gynaecology, Telefono Rosso--Teratology Information Service, Catholic University of the Sacred Heart, Largo A Gemelli, 8. 00168 Rome, Italy.
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Abstract
We report seven cases of newborns conceived within 6 months from the end or during paternal ribavirin exposure.
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Affiliation(s)
- Marco De Santis
- Department of Obstetrics and Gynaecology, Telefono Rosso – Teratology Information Service, Catholic University of the Sacred Heart, Largo A Gemelli, 8. 00168 Rome, Italy
| | - Brigida Carducci
- Department of Obstetrics and Gynaecology, Telefono Rosso – Teratology Information Service, Catholic University of the Sacred Heart, Largo A Gemelli, 8. 00168 Rome, Italy
| | - Anna Franca Cavaliere
- Department of Obstetrics and Gynaecology, Telefono Rosso – Teratology Information Service, Catholic University of the Sacred Heart, Largo A Gemelli, 8. 00168 Rome, Italy
| | - Lidia De Santis
- Department of Obstetrics and Gynaecology, Telefono Rosso – Teratology Information Service, Catholic University of the Sacred Heart, Largo A Gemelli, 8. 00168 Rome, Italy
| | - Angela Lucchese
- Department of Obstetrics and Gynaecology, Telefono Rosso – Teratology Information Service, Catholic University of the Sacred Heart, Largo A Gemelli, 8. 00168 Rome, Italy
| | - Gianluca Straface
- Department of Obstetrics and Gynaecology, Telefono Rosso – Teratology Information Service, Catholic University of the Sacred Heart, Largo A Gemelli, 8. 00168 Rome, Italy
| | - Alessandro Caruso
- Department of Obstetrics and Gynaecology, Telefono Rosso – Teratology Information Service, Catholic University of the Sacred Heart, Largo A Gemelli, 8. 00168 Rome, Italy
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Abstract
Approximately 1% of congenital anomalies relate to pharmacological exposure and are. in theory, preventable. Prevention consists of controlled administration of drugs known to have teratogenic properties (e.g. retinoids, thalidomide). When possible, prevention could take the form of the use of alternative pharmacological therapies during the pre-conception period for certain specific pathologies, selecting the most appropriate agent for use during pregnancy [e.g. haloperidol or a tricyclic antidepressant instead of lithium; anticonvulsant drug monotherapy in place of multitherapy; propylthiouracil instead of thiamazole (methimazole)], and substitution with the most suitable therapy during pregnancy (e.g. insulin in place of oral antidiabetics; heparin in place of oral anticoagulants; alpha-methyldopa instead of ACE inhibitors). Another strategy is the administration of drugs during pregnancy taking into account the pharmacological effects in relation to the gestation period (e.g. avoidance of chemotherapy during the first trimester, avoidance of nonsteroidal anti-inflammatory drugs in the third trimester, and avoidance of high doses of benzodiazepines in the period imminent to prepartum).
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Affiliation(s)
- M De Santis
- Department of Obstetrics and Gynaecology, Catholic University of Sacred Heart, Rome, Italy.
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Affiliation(s)
- Marco De Santis
- Department of Obstetrics and Gynecology, Catholic University of Sacred Heart, Rome, Italy.
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Ferrazzani S, Merola A, De Carolis S, Carducci B, Paradisi G, Caruso A. Birth weight in pre-eclamptic and normotensive twin pregnancies: an analysis of discordance and growth restriction. Hum Reprod 2000; 15:210-7. [PMID: 10611214 DOI: 10.1093/humrep/15.1.210] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 11/14/2022] Open
Abstract
The aim of this study was to verify whether twin pregnancies complicated by pre-eclampsia were associated with a higher rate of inter-twin weight discordance or an increased prevalence of small for gestational age (SGA) neonates than in normotensive twin pregnancies. A 17 year retrospective study was undertaken by examining 76 twin pregnancies complicated by pre-eclampsia and comparing them with 400 normotensive twin pregnancies. The case notes were reviewed in reference to birth weight differences, birth order, pregnancy outcome and inter-twin birth weight discordance. Statistical analyses were performed with t-test, contingency tables, regression curves, rank sum test and non-parametric survival plots. Power analysis was also carried out. Pre-eclamptic twin pregnancies were delivered at similar weeks of gestation to normotensive. They resulted in a smaller size for the second twin the earlier the delivery week, while in normotensive twin pregnancies no significant difference occurred at any week. Twin pregnancies complicated by pre-eclampsia showed higher rates of SGA neonates among second twins than those with normal pressure. The >25% discordance was associated with lower gestational age at delivery in each group [mean (range) 33 weeks (27-38) versus 37 (29-41), P < 0.005 pre-eclampsia and 35 weeks (25-41) versus 38 (25-42), P < 0.001 normotensive]. In pre-eclampsia the concomitant occurrence of SGA second twin and the discordance >25% was associated with shorter gestation while the presence of SGA second twin alone was not.
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Affiliation(s)
- S Ferrazzani
- Department of Obstetrics and Gynaecology, Catholic University, School of Medicine, 00168 Rome, Italy
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Caforio L, Testa AC, Mastromarino C, Carducci B, Ciampelli M, Mansueto D, Caruso A. Predictive value of uterine artery velocimetry at midgestation in low- and high-risk populations: a new perspective. Fetal Diagn Ther 1999; 14:201-5. [PMID: 10420041 DOI: 10.1159/000020921] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to assess the value of uterine artery Doppler velocimetry performed at 18-20 and 22-24 weeks of gestation in predicting preeclampsia and adverse pregnancy outcome in low- and high-risk patients. METHODS 865 pregnant women were evaluated: 335 and 530 pregnant women represented the high- and low-risk groups, respectively. Doppler ultrasound examination of the uterine arteries was performed at 18-20 weeks of gestation in 385 patients and at 22-24 weeks of gestation in 659 patients. Pregnancy outcome was evaluated in terms of: onset of preeclampsia; birth weight <2,500 g; birth weight <1,750 g; delivery before 36 weeks, and delivery before 32 weeks. RESULTS At 18-20 weeks of gestation the sensitivity for the prediction of preeclampsia was 100 and 94% in low- and high-risk groups, respectively. Excellent negative predictive values towards birth weight <1,750 g (97% in low-risk and 93% in high-risk groups) and delivery prior to 32 weeks of gestation (99% in low-risk and 95% in high-risk groups) were obtained. At 22-24 weeks of gestation the sensitivity for the prediction of preeclampsia was 100 and 97% in low- and high-risk groups, respectively. Negative predictive values towards birth weight <1,750 g were 97% in low-risk and 94% in high-risk groups, whereas towards delivery prior to 32 weeks of gestation they were 98% in low-risk and 94% in high-risk groups. CONCLUSION Doppler evaluation of the uterine artery at 18-20 and 22-24 weeks of gestation represents a useful predictive test in high-risk pregnancy and can also be used in prenatal surveillance of a low-risk population.
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Affiliation(s)
- L Caforio
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
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De Carolis S, Carducci B, De Santis L, Ferrazzani S, Noia G, Merola A, Caruso A. Therapeutic amnioinfusions and fetal fibronectin pattern in a case with preterm ruptured membranes that resealed. Fetal Diagn Ther 1998; 13:66-8. [PMID: 9650648 DOI: 10.1159/000020807] [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: 11/19/2022]
Abstract
OBJECTIVE Determination of fetal fibronectin (fFN) levels in a patient at risk of preterm delivery and having premature rupture of the membranes. PATIENT AND METHODS The present case report concerns a pregnant woman with premature rupture of the membranes at 16 weeks of gestation who was submitted to repeated therapeutic transabdominal amnioinfusions and had a spontaneous resolution of the rupture at 32 weeks of gestation. RESULTS A good pregnancy outcome was observed. High cervicovaginal fFN levels were observed during the period of membrane rupture with following drop of fFN levels during this period and spontaneous reseal of the membranes. CONCLUSIONS Active expectant management, using repeated amnioinfusions, probably played a useful role in the therapeutic success of this pregnancy. Further, fFN was a reliable marker of the rupture of membranes. The possible role of fFN in the clinical management of high-risk pregnancies is confirmed.
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Affiliation(s)
- S De Carolis
- Department of Obstetrics and Gynecology, Catholic University of Rome, Italy
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Noia G, De Carolis S, De Stefano V, Ferrazzani S, De Santis L, Carducci B, De Santis M, Caruso A. Factor V deficiency in pregnancy complicated by Rh immunization and placenta previa. A case report and review of the literature. Acta Obstet Gynecol Scand 1997; 76:890-2. [PMID: 9351421 DOI: 10.3109/00016349709024374] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- G Noia
- Department of Obstetrics, Catholic University of Rome, Italy
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Caruso A, De Santis L, Carducci B, Ferrazzani S, De Carolis S, Mancuso S. The use of prostaglandin E2 for cervical ripening in patients requiring induction of labour. J Int Med Res 1997; 25:159-66. [PMID: 9178148 DOI: 10.1177/030006059702500306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A total of 290 women who required induction of labour for medical or obstetric reasons were given single or multiple doses of prostaglandin E2 gel (0.5 mg) to induce cervical ripening. Onset of labour occurred in 185 (63.8%) of the women treated with the gel, without any further treatment. The overall Caesarean section rate was 27.2% (79/290) and was significantly higher among those with an initially low Bishop score than in those with a higher initial score (34.7% versus 22.1%; P = 0.025). Prostaglandin E2 gel appears to be of considerable clinical benefit, especially where no other options are available except Caesarean section or a very long, difficult labour that may result in significant fetal distress.
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Affiliation(s)
- A Caruso
- Department of Obstetrics and Gynaecology, Catholic University of Rome, Italy
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Mancuso S, Ferrazzani S, De Carolis S, Carducci B, De Santis L, Caruso A. Term and postterm low-risk pregnancies: management schemes for the reduction of high rates of cesarean section. Minerva Ginecol 1996; 48:95-8. [PMID: 8684694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We compare trends and current levels of cesarean section delivery by indication in some industrialized countries to help us understand factors underlying national differences in obstetric delivery practice and identify pathways to lower cesarean rates. STUDY DESIGN In this report we describe the schemes employed at our Department for the management of low-risk at term and postterm pregnancies and list the most important motivations for increased cesarean section rate and remedies suggested to reduce high cesarean section rate. Moreover a randomized trial to assess the role of labor induction with PGE2 gel vs i.v. Oxytocin+Amniotomy in the management of prolonged pregnancy is being evaluated presently at our center. METHODS To date, 75 postterm pregnancies have been followed. Patients are enrolled at > or = 287 days (41 weeks). Intracervical PGE2 gel (0.5 mg) is used for cervical ripening. Induction of labor is randomly performed using intravaginal PGE2 gel (2 mg) or i.v. Oxytocin+Amniotomy. RESULTS Overall rates of 75% for spontaneous delivery, and 25% for cesarean section have been observed in our study group of prolonged pregnancies. CONCLUSIONS The accurate labelling of low- and high-risk pregnancy and the appropriate management of term and postterm pregnancy are two important steps for the reduction of a high rate of cesarean section.
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Affiliation(s)
- S Mancuso
- Catholic University of Rome, Department of Obstetrics and Gynecology
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Abstract
The present study reports for the first time on the presence of anticardiolipin antibodies (aCL) in a population of 259 women with a history of recurrent abortion, intrauterine death, and/or neonatal death associated with fetal growth restriction, preeclampsia and abruptio placentae. The overall incidence of aCL in this study group was 20.5%, a statistically significant increase in comparison with a control group. The highest positive rate was observed among women who presented both recurrent abortion and intrauterine death (33.3%), the lowest was observed among women with a history of neonatal death. Our findings confirm that aCL are strongly linked with fetal loss. Thus, before planning a subsequent pregnancy, the presence of aCL should be tested in all women with poor pregnancy outcome.
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Affiliation(s)
- S De Carolis
- Department of Obstetrics and Gynecology, Catholic University, Rome, Italy
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Abstract
INTRODUCTION A study was done with EMS personnel to determine the ease of use and acceptance of a saline lock (SL), intermittent infusion device in place of traditional intravenous tubing and fluid bags for prehospital intravenous (IV) maintenance. STUDY HYPOTHESES: Saline lock, intermittent infusion device use in specific clinical scenarios is easier, less expensive, and as effective as traditional IV tubing and fluid bags. The emergency medical technician-paramedic (EMT-P) would accept the implementation of saline locks in the emergency medical services (EMS) system. METHODS This was a prospective, non-blinded study with the EMS providers under the medical command of a suburban community hospital's emergency department. Patients were included if prophylactic IV access or medication administration was required by clinical protocols. Excluded from the study were those patients requiring IV access for fluid infusion, constant drug infusion, cardiac arrests, or transport to another hospital's emergency department (ED). Intravenous access was achieved with the usual catheter over needle cannulation techniques. The device (Interlink Injection Site SL) was attached to the hub of the IV cannula and flushed with 2 cc of 0.9% saline from prefilled carpujects. RESULTS There were completed questionnaires for 79 successful SL initiated in 98 attempts of IV access on 80 patients over a four-month period. When compared to traditional IV fluid bags, SL were judged by the paramedics to be less time-consuming to initiate and maintain (55 of 79 or 70%), easier to use (51 of 79 or 65%) and facilitated patient transportation (73 of 79 or 92%).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- B Carducci
- Department of Emergency Services, Suburban General Hospital, Pittsburgh, Pa 15202
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Pomini F, De Carolis S, Ferrazzani S, De Santis L, Carducci B, Caruso A. [Continuous subcutaneous administration of terbutaline in the therapy of threatening premature labour]. Minerva Ginecol 1993; 45:57-63. [PMID: 8469366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The purpose of this study was to evaluate the tocolytic efficacy of terbutaline, administered subcutaneously in a low-dose continuous infusion, and intermittent high-dose boluses. The population study consisted of 13 women admitted with the diagnosis of Threatened Preterm Labour. Before starting chronic infusion by terbutaline, patients received 48 hour of therapy with intravenous MgSO4 for acute tocolysis. Therapy with microinfusor was continued until the 37th week of gestation or until labor. The mean gestational age at the beginning of therapy was 25.6 +/- 3.5 and pregnancies were prolonged an average of 65.5 +/- 29 days. In any case uterine activity was diminished by terbutaline therapy in all patients. Patient tolerance was excellent and there were no significant complications due to the therapy.
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Affiliation(s)
- F Pomini
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Roma
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Abstract
Proper emergency evaluation and treatment of the victim of penetrating neck trauma requires a thorough knowledge of cervical anatomy and of the injuries that are likely to occur. Nonoperative studies supplement the physical examination in the evaluation of these patients, and may either assist in the operative approach or allow for safe observation of the patient. The debate concerning exploration and observation of penetrating neck wounds continues.
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Abstract
We evaluated the efficacy of constant intravenous (IV) phenytoin infusion. Thirty-eight patients were evaluated prospectively for complications of continuous-infusion phenytoin loading. A total dose of 18 mg/kg was administered as a solution of 500 mg phenytoin in 50 mL normal saline using a constant infusion pump. The initial delivery rate was 40 mg/min. Cardiac rhythm was monitored by telemetry, and rhythm strips and vital signs were obtained every 15 minutes during infusion. Therapeutic phenytoin blood levels (greater than 10 micrograms/mL) were achieved in 37 patients (97%). Infusion was discontinued in one patient because of IV site irritation shortly after initiation of the infusion. Phenytoin levels in the toxic range were seen immediately postinfusion in 22 patients and in the four-hour postinfusion samples of 16 patients. Thirteen of 18 levels drawn 12 to 24 hours after infusion were therapeutic. Phenytoin levels greater than 20 micrograms/mL were tolerated without significant change in rhythm, QRS interval, or QT interval. A small statistically significant (P less than .05) decrease in systolic and mean arterial pressure was noted during the infusion. Complications included burning at the IV infusion site in four patients; the discomfort was relieved in three cases by reducing the rate of infusion to 20 mg/min. Seizures occurred in two patients during the infusion, requiring the additional use of diazepam or phenobarbital. Administration of a loading phenytoin dose by constant IV infusion is an effective means for achieving therapeutic levels quickly.
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Matthews KA, Scheier MF, Brunson BI, Carducci B. Attention, unpredictability, and reports of physical symptoms: eliminating the benefits of predictability. J Pers Soc Psychol 1980. [PMID: 7373519 DOI: 10.1037//0022-3514.38.3.525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sometimes unpredictable aversive events have more adverse consequences than predictable aversive events and sometimes not. Three experiments were conducted to test an attentional explanation of the inconsistent effects of unpredictability. This explanation suggests that unpredictable events exert a deleterious influence because more attention is typically directed to them. If there were no difference in the amount of attention directed to unpredictable and predictable events, however, there should be no difference in their effects. The validity of these notions was assessed by applying them to one previously established finding from the unpredictability literature--the finding that exposure to unpredictable noise leads to reports of more severe physical symptoms than does exposure to predictable noise. In Experiment 1, subjects performed a reaction time task while they listened to loud bursts of either predictable or unpredictable noise. As expected, reaction times were slower when the noise was unpredictable than when it was not. This finding suggests that more attention had been directed to the unpredictable than the predictable noise. In Experiments 2 and 3, subjects were exposed to either predictable or unpredictable noise and were either instructed to attend to the noise or given no special instructions. In both cases, subjects not instructed to attend to the noise reported more severe symptoms when the noise was unpredictable than when it was not, thus replicating the previous finding. Of greater interest, however, was the fact that equating the amount of attention directed to the unpredictable and predictable noise (by asking subjects to attend to the noise) eliminated the apparent benefits of predictability. The discussion of the findings centers on their theoretical and practical significance.
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Matthews KA, Scheier MF, Brunson BI, Carducci B. Attention, unpredictability, and reports of physical symptoms: eliminating the benefits of predictability. J Pers Soc Psychol 1980; 38:525-37. [PMID: 7373519 DOI: 10.1037/0022-3514.38.3.525] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Sometimes unpredictable aversive events have more adverse consequences than predictable aversive events and sometimes not. Three experiments were conducted to test an attentional explanation of the inconsistent effects of unpredictability. This explanation suggests that unpredictable events exert a deleterious influence because more attention is typically directed to them. If there were no difference in the amount of attention directed to unpredictable and predictable events, however, there should be no difference in their effects. The validity of these notions was assessed by applying them to one previously established finding from the unpredictability literature--the finding that exposure to unpredictable noise leads to reports of more severe physical symptoms than does exposure to predictable noise. In Experiment 1, subjects performed a reaction time task while they listened to loud bursts of either predictable or unpredictable noise. As expected, reaction times were slower when the noise was unpredictable than when it was not. This finding suggests that more attention had been directed to the unpredictable than the predictable noise. In Experiments 2 and 3, subjects were exposed to either predictable or unpredictable noise and were either instructed to attend to the noise or given no special instructions. In both cases, subjects not instructed to attend to the noise reported more severe symptoms when the noise was unpredictable than when it was not, thus replicating the previous finding. Of greater interest, however, was the fact that equating the amount of attention directed to the unpredictable and predictable noise (by asking subjects to attend to the noise) eliminated the apparent benefits of predictability. The discussion of the findings centers on their theoretical and practical significance.
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