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Gabrielli L, Bonasoni MP, Piccirilli G, Petrisli E, Venturoli S, Cantiani A, Pavoni M, Marsico C, Capretti MG, Simonazzi G, Lazzarotto T. The Auditory Pathway in Congenitally Cytomegalovirus-Infected Human Fetuses. Int J Mol Sci 2024; 25:2636. [PMID: 38473883 DOI: 10.3390/ijms25052636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/02/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Congenital cytomegalovirus (CMV) infection is the main cause of non-hereditary sensorineural hearing loss (SNHL). In order to shed light on SNHL pathophysiology, we examined the auditory pathway in CMV-infected fetuses; the temporal lobe, in particular the auditory cortex, and the inner ear. We investigated both inner ears and temporal lobes of 20 human CMV-infected fetuses at 21 weeks of gestation. As a negative group, five fetuses from spontaneous miscarriages without CMV infection were studied. Inner ears and temporal lobes were histologically examined, immunohistochemistry for CMV and CMV-PCR were performed. On the auditory cortex, we evaluated the local microglial reaction to the infection. CMV-positive cells were found in 14/20 brains and the damage was classified as severe, moderate, or mild, according to histological features. Fetuses with severe brain damage had a statistically higher temporal lobe viral load and a higher number of activated microglial cells in the auditory cortex compared to fetuses with mild brain damage (p: 0.01; p: 0.01). In the inner ears, the marginal cells of the stria vascularis were the most CMV positive. In our study, CMV affected the auditory pathway, suggesting a tropism for this route. In addition, in the auditory cortex, microglial activation may favor further tissue damage contributing to hearing loss.
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Affiliation(s)
- Liliana Gabrielli
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Giulia Piccirilli
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Evangelia Petrisli
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Simona Venturoli
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessia Cantiani
- Section of Microbiology, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Matteo Pavoni
- Section of Microbiology, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Concetta Marsico
- Neonatal Intensive Care Unit, IRCCS AziendaOspedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Maria Grazia Capretti
- Neonatal Intensive Care Unit, IRCCS AziendaOspedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giuliana Simonazzi
- Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Section of Obstetrics, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Tiziana Lazzarotto
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Section of Microbiology, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
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Manconi M, van der Gaag LC, Mangili F, Garbazza C, Riccardi S, Cajochen C, Mondini S, Furia F, Zambrelli E, Baiardi S, Giordano A, Rizzo N, Fonti C, Viora E, D'Agostino A, Cicolin A, Cirignotta F, Aquilino D, Barassi A, Del Giudice R, Fior G, Gambini O, Giordano B, Martini A, Serrati C, Stefanelli R, Scarone S, Canevini M, Fanti V, Stein HC, Marconi AM, Raimondo E, Viglietta E, Santoro R, Simonazzi G, Bianconcini A, Meani F, Piazza N, Filippakos F, Gyr T. Sleep and sleep disorders during pregnancy and postpartum: The Life-ON study. Sleep Med 2024; 113:41-48. [PMID: 37984016 DOI: 10.1016/j.sleep.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE to prospectively assess sleep and sleep disorders during pregnancy and postpartum in a large cohort of women. METHODS multicenter prospective Life-ON study, recruiting consecutive pregnant women at a gestational age between 10 and 15 weeks, from the local gynecological departments. The study included home polysomnography performed between the 23rd and 25th week of pregnancy and sleep-related questionnaires at 9 points in time during pregnancy and 6 months postpartum. RESULTS 439 pregnant women (mean age 33.7 ± 4.2 yrs) were enrolled. Poor quality of sleep was reported by 34% of women in the first trimester of pregnancy, by 46% of women in the third trimester, and by as many as 71% of women in the first month after delivery. A similar trend was seen for insomnia. Excessive daytime sleepiness peaked in the first trimester (30% of women), and decreased in the third trimester, to 22% of women. Prevalence of restless legs syndrome was 25%, with a peak in the third trimester of pregnancy. Polysomnographic data, available for 353 women, revealed that 24% of women slept less than 6 h, and 30.6% of women had a sleep efficiency below 80%. Sleep-disordered breathing (RDI≥5) had a prevalence of 4.2% and correlated positively with BMI. CONCLUSIONS The Life-ON study provides the largest polysomnographic dataset coupled with longitudinal subjective assessments of sleep quality in pregnant women to date. Sleep disorders are highly frequent and distributed differently during pregnancy and postpartum. Routine assessment of sleep disturbances in the perinatal period is necessary to improve early detection and clinical management.
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Affiliation(s)
- Mauro Manconi
- Sleep Medicine Unit, Neurocenter of the Southern Switzerland, EOC, Regional Hospital of Lugano, Switzerland; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University of Bern, Bern, Switzerland.
| | - Linda C van der Gaag
- Istituto Dalle Molle di Studi Sull'Intelligenza Artificiale (IDSIA), USI-SUPSI, Lugano, Switzerland
| | - Francesca Mangili
- Istituto Dalle Molle di Studi Sull'Intelligenza Artificiale (IDSIA), USI-SUPSI, Lugano, Switzerland
| | - Corrado Garbazza
- Sleep Medicine Unit, Neurocenter of the Southern Switzerland, EOC, Regional Hospital of Lugano, Switzerland; Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002, Basel, Switzerland
| | - Silvia Riccardi
- Sleep Medicine Unit, Neurocenter of the Southern Switzerland, EOC, Regional Hospital of Lugano, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, 4002, Basel, Switzerland
| | - Susanna Mondini
- UOC NEUROMET IRCCS Institute of Neurological Sciences Bologna, Italy
| | - Francesca Furia
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Elena Zambrelli
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Simone Baiardi
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy; IRCCS - Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alessandra Giordano
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | - Nicola Rizzo
- Division of Obstetrics and Prenatal Medicine, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cristina Fonti
- IRCCS - Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Elsa Viora
- Prenatal Ecography Unit, AOU Città Della Salute e Della Scienza, Dipartimento di Ostetricia e Ginecologia, Torino, Italy
| | - Armando D'Agostino
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy; Department of Health Sciences, Università Degli Studi di Milano, Italy
| | - Alessandro Cicolin
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | | | - Daniele Aquilino
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alessandra Barassi
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Renata Del Giudice
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Giulia Fior
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Orsola Gambini
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Barbara Giordano
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alma Martini
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Chiara Serrati
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Rossana Stefanelli
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Silvio Scarone
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Mariapaola Canevini
- Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy; Department of Health Sciences, Università Degli Studi di Milano, Italy
| | - Valentina Fanti
- Department of Health Sciences, Università Degli Studi di Milano, Italy
| | | | - Anna Maria Marconi
- Department of Health Sciences, Università Degli Studi di Milano, Italy; Department of Obstetrics and Gynecology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Erica Raimondo
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | - Emanuela Viglietta
- Sleep Medicine Center, AOU Città Della Salute e Della Scienza, Dipartimento di Neuroscienze "Rita Levi Montalcini", Torino, Italy
| | - Rossella Santoro
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, UOC Clinical Neurologica NeuroMet, Ospedale S. Orsola-Malpighi, Via Albertoni 15, 40138, Bologna, Italy
| | - Giuliana Simonazzi
- Ostetricia e Medicina Dell'Età Prenatale, Ospedale S. Orsola-Malpighi, Via Massarenti 13, 40138, Bologna, Italy
| | - Alessandra Bianconcini
- Ostetricia e Medicina Dell'Età Prenatale, Ospedale S. Orsola-Malpighi, Via Massarenti 13, 40138, Bologna, Italy
| | - Francesco Meani
- Centro di Senologia Della Svizzera Italiana, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
| | - Nicoletta Piazza
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
| | - Filippos Filippakos
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
| | - Thomas Gyr
- Dipartimento di Ginecologia e Ostetricia, Ente Ospedaliero Cantonale, EOC, CH, Switzerland
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Angeli L, Fieni S, Dall'Asta A, Ghi T, De Carolis S, Sorrenti S, Rizzo F, Della Gatta AN, Simonazzi G, Pilu G, Benvenuti M, Luchi C, Simoncini T, Gaibazzi N, Niccoli G, Ardissino D, Frusca T. Mode of delivery and peripartum outcome in women with heart disease according to the ESC guidelines: an Italian multicenter study. J Matern Fetal Neonatal Med 2023; 36:2184221. [PMID: 36935360 DOI: 10.1080/14767058.2023.2184221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
INTRODUCTION The European Society of Cardiology (ESC) guidelines (GL) provide indications on the mode of delivery in women with heart disease. However available data suggests that the rate of Cesarean Delivery (CD) is high and widely variable among such patients. In this study, we aimed to investigate the degree of adherence to the ESC recommendations among women delivering in four tertiary maternity services in Italy and how this affects the maternal and neonatal outcomes. MATERIAL AND METHODS Retrospective multicenter cohort study including pregnant women with heart disease who gave birth between January 2014 and July 2020. Composite adverse maternal outcome (CAM) was defined by the occurrence of one or more of the following: major postpartum hemorrhage, thrombo-embolic or ischemic event, de novo arrhythmia, heart failure, endocarditis, aortic dissection, need for re-surgery, sepsis, maternal death. Composite Adverse Neonatal outcome (CAN) was defined as cord arterial pH <7.00, APGAR <7 at 5 min, admission to the intensive care unit, and neonatal death. We compared the incidence of CAM and CAN between the cases with planned delivery in accordance (group "ESC consistent") or in disagreement (group "ESC not consistent") with the ESC GL. RESULTS Overall, 175 women and 181 liveborn were included. A higher frequency of CAN was found when delivery was not planned accordingly to the ESC guidelines [("ESC consistent" 9/124 (7.2%) vs "ESC not consistent" 13/57 (22.8%) p = 0.002 OR 3.74 (CI 95% 1.49-9.74) , while the occurrence of CAM was comparable between the two groups. At logistic regression analysis, the gestational age at delivery was the only parameter independently associated with the occurrence of CAN (p = 0.006). CONCLUSION Among pregnant women with heart disease, deviating from the ESC guidelines scheduling cesarean delivery does not seem to improve maternal outcomes and it is associated with worse perinatal outcomes, mainly due to lower gestational age at birth.
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Affiliation(s)
- L Angeli
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - S Fieni
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - A Dall'Asta
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - T Ghi
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
| | - S De Carolis
- UOC of Obstetric Pathology, Departement of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - S Sorrenti
- UOC of Obstetric Pathology, Departement of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - F Rizzo
- UOC of Obstetric Pathology, Departement of "Scienze della Salute della Donna, del Bambino e di Sanità Pubblica" Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - A N Della Gatta
- Obstetric Unit, Department of Medical and Surgical Sciences (DIMEC) IRCSS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Simonazzi
- Obstetric Unit, Department of Medical and Surgical Sciences (DIMEC) IRCSS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences (DIMEC) IRCSS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - M Benvenuti
- Unità di Medicina Materno-Fetale, UOC Ginecologia ed Ostetricia University of Pisa, Pisa, Italy
| | - C Luchi
- Unità di Medicina Materno-Fetale, UOC Ginecologia ed Ostetricia University of Pisa, Pisa, Italy
| | - T Simoncini
- Unità di Medicina Materno-Fetale, UOC Ginecologia ed Ostetricia University of Pisa, Pisa, Italy
| | - N Gaibazzi
- Cardiology Department, University of Parma, Parma, Italy
| | - G Niccoli
- Cardiology Department, University of Parma, Parma, Italy
| | - D Ardissino
- Cardiology Department, University of Parma, Parma, Italy
| | - T Frusca
- Department of Maternal Neonatal Medicine, University of Parma, Parma, Italy
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Zammarchi L, Tomasoni LR, Liuzzi G, Simonazzi G, Dionisi C, Mazzarelli LL, Seidenari A, Maruotti GM, Ornaghi S, Castelli F, Abbate I, Bordi L, Mazzotta S, Fusco P, Torti C, Calò Carducci FI, Baccini M, Modi G, Galli L, Lilleri D, Furione M, Zavattoni M, Ricciardi A, Arossa A, Vimercati A, Lovatti S, Salomè S, Raimondi F, Sarno L, Sforza A, Fichera A, Caforio L, Trotta M, Lazzarotto T. Treatment with valacyclovir during pregnancy for prevention of congenital cytomegalovirus infection: a real-life multicenter Italian observational study. Am J Obstet Gynecol MFM 2023; 5:101101. [PMID: 37516151 DOI: 10.1016/j.ajogmf.2023.101101] [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: 04/20/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Valacyclovir is the only treatment demonstrated to be effective for the prevention of vertical transmission of cytomegalovirus within a clinical randomized, placebo-controlled trial and has been reimbursed by the Italian National Health System since December 2020. OBJECTIVE This study reported the results of a real-life Italian multicenter observational study on cytomegalovirus infection in pregnancy evaluating the effect of the introduction of valacyclovir in the clinical practice for the prevention of vertical transmission of cytomegalovirus. STUDY DESIGN The outcomes of women who received valacyclovir treatment and their fetuses or newborns were compared with those of a retrospective cohort observed between 2010 and 2020 who did not receive the antiviral treatment. The inclusion criterion was the diagnosis of cytomegalovirus primary infection occurring in the periconceptional period or up to 24 weeks of gestation. The primary outcome was the transmission by the time of amniocentesis. The secondary outcomes were termination of pregnancy, transmission at birth, symptomatic infection at birth, and a composite outcome (termination of pregnancy or transmission at birth). RESULTS A total of 447 pregnant women from 10 centers were enrolled, 205 women treated with valacyclovir (called the valacyclovir group, including 1 twin pregnancy) and 242 women not treated with valacyclovir (called the no-valacyclovir group, including 2 twin pregnancies). Valacyclovir treatment was significantly associated with a reduction of the diagnosis of congenital cytomegalovirus infection by the time of amniocentesis (weighted odds ratio, 0.39; 90% confidence interval, 0.22-0.68; P=.005; relative reduction of 61%), termination of pregnancy (weighted odds ratio, 0.36; 90% confidence interval, 0.17-0.75; P=.0021; relative reduction of 64%), symptomatic congenital cytomegalovirus infection at birth (weighted odds ratio, 0.17; 90% confidence interval, 0.06-0.49; P=.006; relative reduction of 83%). The treatment had no significant effect on the rate of diagnosis of congenital cytomegalovirus infection at birth (weighted odds ratio, 0.85; 90% confidence interval, 0.57-1.26; P=.500), but the composite outcome (termination of pregnancy or diagnosis of congenital cytomegalovirus infection at birth) occurred more frequently in the no-valacyclovir group (weighted odds ratio, 0.62; 90% confidence interval, 0.44-0.88; P=.024). Of note, the only symptomatic newborns with congenital cytomegalovirus infection in the valacyclovir group (n=3) were among those with positive amniocentesis. Moreover, 19 women (9.3%) reported an adverse reaction to valacyclovir treatment, classified as mild in 17 cases and moderate in 2 cases. Lastly, 4 women (1.9%) presented renal toxicity with a slight increase in creatinine level, which was reversible after treatment suspension. CONCLUSION Our real-life data confirm that valacyclovir significantly reduces the rate of congenital cytomegalovirus diagnosis at the time of amniocentesis with a good tolerability profile and show that the treatment is associated with a reduction of termination of pregnancy and symptomatic congenital cytomegalovirus infection at birth.
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Affiliation(s)
- Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (Dr Zammarchi and Dr Modi); Infectious and Tropical Disease Unit, Careggi University Hospital, Florence, Italy (Dr Zammarchi and Dr Trotta); Tuscany Regional Referral Center for Infectious Diseases in Pregnancy, Florence, Italy (Dr Zammarchi and Dr Trotta).
| | - Lina Rachele Tomasoni
- Department of Infectious and Tropical Diseases, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili, University of Brescia, Brescia, Italy (Dr Tomasoni, Dr Lovatti, and Dr Sforza)
| | - Giuseppina Liuzzi
- National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy (Dr Liuzzi, Dr Abbate, Dr Bordi, and Dr Mazzotta)
| | - Giuliana Simonazzi
- Obstetric Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Dr Simonazzi, Dr Dionisi, and Dr Seidenari); Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy (Dr Simonazzi, Dr Dionisi, Dr Seidenari, and Dr Lazzarotto)
| | - Camilla Dionisi
- Obstetric Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Dr Simonazzi, Dr Dionisi, and Dr Seidenari); Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy (Dr Simonazzi, Dr Dionisi, Dr Seidenari, and Dr Lazzarotto)
| | - Laura Letizia Mazzarelli
- Department of Public Health, University of Naples Federico II, Naples, Italy (Dr Mazzarelli and Dr Maruotti)
| | - Anna Seidenari
- Obstetric Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Dr Simonazzi, Dr Dionisi, and Dr Seidenari); Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy (Dr Simonazzi, Dr Dionisi, Dr Seidenari, and Dr Lazzarotto)
| | - Giuseppe Maria Maruotti
- Department of Public Health, University of Naples Federico II, Naples, Italy (Dr Mazzarelli and Dr Maruotti)
| | - Sara Ornaghi
- Department of Obstetrics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy (Dr Ornaghi); University of Milano-Bicocca School of Medicine and Surgery, Monza, Italy (Dr Ornaghi)
| | - Francesco Castelli
- Infectious and Tropical Diseases Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (Dr Castelli)
| | - Isabella Abbate
- National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy (Dr Liuzzi, Dr Abbate, Dr Bordi, and Dr Mazzotta)
| | - Licia Bordi
- National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy (Dr Liuzzi, Dr Abbate, Dr Bordi, and Dr Mazzotta)
| | - Stefania Mazzotta
- National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy (Dr Liuzzi, Dr Abbate, Dr Bordi, and Dr Mazzotta)
| | - Paolo Fusco
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy (Dr Fusco and Dr Torti)
| | - Carlo Torti
- Infectious and Tropical Diseases Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy (Dr Fusco and Dr Torti)
| | | | - Michela Baccini
- Department of Statistics, Computer Science, Applications "G. Parenti," University of Florence, Florence, Italy (Dr Baccini)
| | - Giulia Modi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (Dr Zammarchi and Dr Modi)
| | - Luisa Galli
- Infectious Diseases Unit, Meyer Children's Hospital IRCCS, Florence, Italy (Dr Galli); Department of Health Sciences, University of Florence, Florence, Italy (Dr Galli)
| | - Daniele Lilleri
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Dr Lilleri, Dr Furione, and Dr Zavattoni)
| | - Milena Furione
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Dr Lilleri, Dr Furione, and Dr Zavattoni)
| | - Maurizio Zavattoni
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Dr Lilleri, Dr Furione, and Dr Zavattoni)
| | - Alessandra Ricciardi
- Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Dr Ricciardi)
| | - Alessia Arossa
- Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (Dr Arossa)
| | - Antonella Vimercati
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy (Dr Vimercati)
| | - Sofia Lovatti
- Department of Infectious and Tropical Diseases, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili, University of Brescia, Brescia, Italy (Dr Tomasoni, Dr Lovatti, and Dr Sforza)
| | - Serena Salomè
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy (Dr Salomè and Dr Raimondi, and Dr Sarno)
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy (Dr Salomè and Dr Raimondi, and Dr Sarno)
| | - Laura Sarno
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy (Dr Salomè and Dr Raimondi, and Dr Sarno)
| | - Anita Sforza
- Department of Infectious and Tropical Diseases, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili, University of Brescia, Brescia, Italy (Dr Tomasoni, Dr Lovatti, and Dr Sforza)
| | - Anna Fichera
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Sciences, ASST Spedali Civili, University of Brescia, Brescia, Italy (Dr Fichera)
| | - Leonardo Caforio
- Fetal and Perinatal Medicine and Surgery Unit, Bambino Gesù Children's Hospital, Rome, Italy (Dr Caforio)
| | - Michele Trotta
- Infectious and Tropical Disease Unit, Careggi University Hospital, Florence, Italy (Dr Zammarchi and Dr Trotta); Tuscany Regional Referral Center for Infectious Diseases in Pregnancy, Florence, Italy (Dr Zammarchi and Dr Trotta)
| | - Tiziana Lazzarotto
- Department of Medical and Surgical Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy (Dr Simonazzi, Dr Dionisi, Dr Seidenari, and Dr Lazzarotto); Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (Dr Lazzarotto)
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Della Gatta AN, Aceti A, Spinedi SF, Martini S, Corvaglia L, Sansavini A, Zuccarini M, Lenzi J, Seidenari A, Dionisi C, Pilu G, Simonazzi G. Neurodevelopmental outcomes of very preterm infants born following early foetal growth restriction with absent end-diastolic umbilical flow. Eur J Pediatr 2023; 182:4467-4476. [PMID: 37490110 PMCID: PMC10587239 DOI: 10.1007/s00431-023-05104-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
This study aims to assess the impact of time of onset and features of early foetal growth restriction (FGR) with absent end-diastolic flow (AEDF) on pregnancy outcomes and on preterm infants' clinical and neurodevelopmental outcomes up to 2 years corrected age. This is a retrospective, cohort study led at a level IV Obstetric and Neonatal Unit in Bologna, Italy. Pregnant women were eligible if having singleton pregnancies, with no major foetal anomaly detected, and diagnosed with early FGR + AEDF (defined as FGR + AEDF detected before 32 weeks gestation). Early FGR + AEDF was further classified according to time of onset and specific features into very early and persistent (VEP, FGR + AEDF first detected at 20-24 weeks gestation and persistent at the following scans), very early but transient (VET, FGR + AEDF detected at 20-24 weeks gestation and progressively improving at the following scans) and later (LA, FGR + AEDF detected between 25 and 32 weeks gestation). Pregnancy and neonatal outcomes and infant follow-up data were collected and compared among groups. Neurodevelopment was assessed using the revised Griffiths Mental Developmental Scales (GMDS-R) 0-2 years. A regression analysis was performed to identify early predictors of preterm infants' neurodevelopmental impairment. Fifty-two pregnant women with an antenatal diagnosis of early FGR + AEDF were included in the study (16 VEP, 14 VET, 22 LA). Four intrauterine foetal deaths occurred, all in the VEP group (p = 0.010). Compared to LA infants, VEP infants were born with lower gestational age and lower birth weight, had lower arterial cord blood pH and were at higher risk for intraventricular haemorrhage and periventricular leukomalacia (p < 0.05 for all comparisons). At 12 months, VEP infants had worse GMDS-R scores, both in the general quotient (mean [SD] 91.8 [12.4] vs 104.6 [8.7] in LA) and in the performance domain (mean [SD] 93.3 [15.4] vs 108.8 [8.8] in LA). This latter difference persisted at 24 months (mean [SD] 68.3 [17.0] vs 92.9 [17.7] in LA). In multivariate analysis, at 12 months corrected age, PVL was found to be an independent predictor of impaired general quotient, while the features and timing of antenatal Doppler alterations predicted worse scores in the performance domain. Conclusion: Timing of onset and features of early FGR + AEDF might impact differently on neonatal clinical and neurodevelopmental outcomes. Shared awareness of the importance of FGR + AEDF features between obstetricians and neonatologists may offer valuable tools for antenatal counselling and for tailoring pregnancy management and neonatal follow-up in light of specific antenatal and neonatal risk factors. What is Known: • Foetal growth restriction (FGR), together with antenatal umbilical Doppler abnormalities, is known to affect maternal and neonatal outcomes. • Infants born preterm and growth-restricted face the highest risk for neurodevelopmental impairment, especially when FGR occurs early during pregnancy (early FGR, before 32 weeks gestation). What is New: • The timing of onset and features of FGR and antenatal umbilical Doppler abnormalities impact differently on maternal and neonatal outcomes; when FGR and Doppler abnormalities occur very early, at the limit of neonatal viability, and persist until delivery, infants face the highest risk for neurodevelopmental impairment. • Shared knowledge between obstetricians and neonatologists about timing of onset and features of FGR would provide a valuable tool for informed antenatal counselling in high-risk pregnancies.
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Affiliation(s)
- Anna Nunzia Della Gatta
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
| | - Arianna Aceti
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy.
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy.
| | - Sofia Fiore Spinedi
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy
| | - Silvia Martini
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy
| | - Luigi Corvaglia
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Neonatal Intensive Care Unit, IRCCS AOUBO, Bologna, Italy
| | - Alessandra Sansavini
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | | | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Anna Seidenari
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
| | - Camilla Dionisi
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
| | - Gianluigi Pilu
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
| | - Giuliana Simonazzi
- Department of Medical, Surgical Sciences, University of Bologna, Bologna, Italy
- Obstetric Unit, IRCCS AOUBO, Bologna, Italy
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6
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Piani F, Agnoletti D, Baracchi A, Scarduelli S, Verde C, Tossetta G, Montaguti E, Simonazzi G, Degli Esposti D, Borghi C. Serum uric acid to creatinine ratio and risk of preeclampsia and adverse pregnancy outcomes. J Hypertens 2023; 41:1333-1338. [PMID: 37260263 PMCID: PMC10328517 DOI: 10.1097/hjh.0000000000003472] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/07/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Preeclampsia is one of the most severe diseases among the hypertensive disorders of pregnancy (HDP) and the leading cause of maternal and fetal morbidity and mortality. It is of crucial importance to early identify women at a high risk for preeclampsia to implement appropriate preventive strategies. In our study, we aimed to test the hypothesis that serum uric acid to creatinine ratio (SUA/sCr) is related to the development of preeclampsia and maternal and neonatal complications. METHODS We searched for uric acid and creatine values in the medical records of 269 women who consecutively attended our HDP Clinic from December 2018 to December 2022. We compared the baseline characteristics of participants with normotensive pregnancy ( n = 57), to those with HDP without preeclampsia (HDP-non-PE) ( n = 100) and those with preeclampsia ( n = 112), and we performed adjusted logistic regression analysis to test the associations between SUA/sCr and the development of preeclampsia and maternal and neonatal complications. RESULTS SUA/sCr was consistently higher in women with preeclampsia in all trimesters of pregnancy. Higher SUA/sCr at the third trimester was associated with an increased odd of developing preeclampsia [odds ratio (OR) 1.29, confidence interval (CI) 1.15-1.50, P = 0.001], preterm birth (OR 1.23, CI 1.05-1.45, P = 0.011), and composite neonatal outcome (OR 1.33, CI 1.12-1.59, P = 0.001), after adjustment for age, BMI before pregnancy, nulliparity, antihypertensive therapy, and acetylsalicylic acid therapy during pregnancy. CONCLUSIONS Having higher SUA/sCr during pregnancy is associated with the development of PE and adverse pregnancy outcomes. Controlled prospective studies are warranted to clarify the predictive power of this novel marker during pregnancy.
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Affiliation(s)
- Federica Piani
- Cardiovascular Internal Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- University of Bologna, Department of Medical and Surgical Sciences
| | - Davide Agnoletti
- Cardiovascular Internal Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- University of Bologna, Department of Medical and Surgical Sciences
| | | | - Sara Scarduelli
- University of Bologna, Department of Medical and Surgical Sciences
| | - Carmine Verde
- University of Bologna, Department of Medical and Surgical Sciences
| | - Giovanni Tossetta
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Elisa Montaguti
- Obstetrics and Gynecology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Giuliana Simonazzi
- University of Bologna, Department of Medical and Surgical Sciences
- Obstetrics and Gynecology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Daniela Degli Esposti
- Cardiovascular Internal Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna
| | - Claudio Borghi
- Cardiovascular Internal Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna
- University of Bologna, Department of Medical and Surgical Sciences
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7
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Piccirilli G, Gabrielli L, Bonasoni MP, Chiereghin A, Turello G, Borgatti EC, Simonazzi G, Felici S, Leone M, Salfi NCM, Santini D, Lazzarotto T. Fetal Brain Damage in Human Fetuses with Congenital Cytomegalovirus Infection: Histological Features and Viral Tropism. Cell Mol Neurobiol 2023; 43:1385-1399. [PMID: 35933637 PMCID: PMC10006254 DOI: 10.1007/s10571-022-01258-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/08/2022] [Indexed: 11/24/2022]
Abstract
Human cytomegalovirus (HCMV) causes congenital neurological lifelong disabilities. To date, the neuropathogenesis of brain injury related to congenital HCMV (cCMV) infection is poorly understood. This study evaluates the characteristics and pathogenetic mechanisms of encephalic damage in cCMV infection. Ten HCMV-infected human fetuses at 21 weeks of gestation were examined. Specifically, tissues from different brain areas were analyzed by: (i) immunohistochemistry (IHC) to detect HCMV-infected cell distribution, (ii) hematoxylin-eosin staining to evaluate histological damage and (iii) real-time PCR to quantify tissue viral load (HCMV-DNA). The differentiation stage of HCMV-infected neural/neuronal cells was assessed by double IHC to detect simultaneously HCMV-antigens and neural/neuronal markers: nestin (a marker of neural stem/progenitor cells), doublecortin (DCX, marker of cells committed to the neuronal lineage) and neuronal nuclei (NeuN, identifying mature neurons). HCMV-positive cells and viral DNA were found in the brain of 8/10 (80%) fetuses. For these cases, brain damage was classified as mild (n = 4, 50%), moderate (n = 3, 37.5%) and severe (n = 1, 12.5%) based on presence and frequency of pathological findings (necrosis, microglial nodules, microglial activation, astrocytosis, and vascular changes). The highest median HCMV-DNA level was found in the hippocampus (212 copies/5 ng of human DNA [hDNA], range: 10-7,505) as well as the highest mean HCMV-infected cell value (2.9 cells, range: 0-23), followed by that detected in subventricular zone (1.7 cells, range: 0-19). These findings suggested a preferential viral tropism for both neural stem/progenitor cells and neuronal committed cells, residing in these regions, confirmed by the expression of DCX and nestin in 94% and 63.3% of HCMV-positive cells, respectively. NeuN was not found among HCMV-positive cells and was nearly absent in the brain with severe damage, suggesting HCMV does not infect mature neurons and immature neural/neuronal cells do not differentiate into neurons. This could lead to known structural and functional brain defects from cCMV infection.
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Affiliation(s)
- Giulia Piccirilli
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Liliana Gabrielli
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | | | - Angela Chiereghin
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gabriele Turello
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Eva Caterina Borgatti
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Giuliana Simonazzi
- Department of Obstetrics and Gynecology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Felici
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marta Leone
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Donatella Santini
- Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tiziana Lazzarotto
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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8
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Paris F, Marrazzo P, Pizzuti V, Marchionni C, Rossi M, Michelotti M, Petrovic B, Ciani E, Simonazzi G, Pession A, Bonsi L, Alviano F. Characterization of Perinatal Stem Cell Spheroids for the Development of Cell Therapy Strategy. Bioengineering (Basel) 2023; 10:bioengineering10020189. [PMID: 36829683 PMCID: PMC9952228 DOI: 10.3390/bioengineering10020189] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Type 1 diabetes mellitus (T1DM) is a complex metabolic disease characterized by a massive loss of insulin-producing cells due to an autoimmune reaction. Currently, daily subcutaneous administration of exogenous insulin is the only effective treatment. Therefore, in recent years considerable interest has been given to stem cell therapy and in particular to the use of three-dimensional (3D) cell cultures to better reproduce in vivo conditions. The goal of this study is to provide a reliable cellular model that could be investigated for regenerative medicine applications for the replacement of insulin-producing cells in T1DM. To pursue this aim we create a co-culture spheroid of amniotic epithelial cells (AECs) and Wharton's jelly mesenchymal stromal cells (WJ-MSCs) in a one-to-one ratio. The resulting co-culture spheroids were analyzed for viability, extracellular matrix production, and hypoxic state in both early- and long-term cultures. Our results suggest that co-culture spheroids are stable in long-term culture and are still viable with a consistent extracellular matrix production evaluated with immunofluorescence staining. These findings suggest that this co-culture may potentially be differentiated into endo-pancreatic cells for regenerative medicine applications in T1DM.
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Affiliation(s)
- Francesca Paris
- Unit of Histology, Embryology and Applied Biology, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Pasquale Marrazzo
- Unit of Histology, Embryology and Applied Biology, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
- Correspondence: (P.M.); (L.B.)
| | - Valeria Pizzuti
- Unit of Histology, Embryology and Applied Biology, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Cosetta Marchionni
- Unit of Histology, Embryology and Applied Biology, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Maura Rossi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Martina Michelotti
- Unit of Histology, Embryology and Applied Biology, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Biljana Petrovic
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Center for Applied Biomedical Research (CRBA), University of Bologna, 40138 Bologna, Italy
| | - Elisabetta Ciani
- Department of Biomedical and Neuromotor Science, University of Bologna, 40126 Bologna, Italy
| | - Giuliana Simonazzi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Obstetrics Unit, Department of Obstetrics and Gynecology, IRCCS Azienda Ospedaliero-Universitaria Sant’Orsola, 40138 Bologna, Italy
| | - Andrea Pession
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Laura Bonsi
- Unit of Histology, Embryology and Applied Biology, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
- Correspondence: (P.M.); (L.B.)
| | - Francesco Alviano
- Unit of Histology, Embryology and Applied Biology, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
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9
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Capretti MG, Marsico C, Gabrielli L, Vocale C, Arcuri S, Simonazzi G, Piccinini AR, Brandolini C, Lazzarotto T, Corvaglia LT. Infants Born Following SARS-CoV-2 Infection in Pregnancy. Pediatrics 2022; 150:189773. [PMID: 36285569 DOI: 10.1542/peds.2022-056206] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To evaluate outcomes of neonates born to mothers with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy, the dynamics of placental transfer of maternal antibodies, and its persistence during infancy. METHODS Cohort study enrolling neonates born to mothers with SARS-CoV-2 infection in pregnancy. All infants were evaluated at birth. Those born to women with infection onset within 2 weeks before delivery were excluded from further analyses. Remaining infants underwent cerebral and abdominal ultrasound, fundoscopy evaluation, and were enrolled in a 12 month follow-up. Qualitative immunoglobulin G (IgG)/immunoglobulin M and quantitative IgG to S1/S2 subunits of spike protein were assessed in mother-neonate dyads within 48 hours postdelivery and during follow-up. RESULTS Between April 2020 and April 2021, 130 of 2745 (4.7%) neonates were born to mothers with SARS-CoV-2 infection in pregnancy, with 106 of 130 infections diagnosed before 2 weeks before delivery. Rates of preterm and cesarean delivery were comparable between women with and without infection (6% vs 8%, P = .57; 22% vs 32%, P = .06). No clinical or instrumental abnormalities were detected at birth or during follow-up. There was a positive correlation between maternal and neonatal SARS-CoV-2 IgG levels (r = 0.81, P < .001). Transplacental transfer ratio was higher after second-trimester maternal infections as compared with first and third trimester (P = .03). SARS-CoV-2 IgG level progressively decreased in all infants, with 89 of 92 (97%) infants seronegative at 6 months of age. CONCLUSIONS Clinical outcomes were favorable in all infants. Matching peak IgG level after infection and higher IgG transplacental transfer might result in the most durable neonatal passive immunity.
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Affiliation(s)
| | - Concetta Marsico
- NICU.,Departments of Medical and Surgical Sciences.,Co-first authors
| | | | - Caterina Vocale
- Regional Reference Center for Microbiological Emergencies (CRREM)
| | - Santo Arcuri
- NICU.,Departments of Medical and Surgical Sciences
| | - Giuliana Simonazzi
- Microbiology Unit.,Obstetric Unit.,Departments of Medical and Surgical Sciences
| | | | - Cristina Brandolini
- Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tiziana Lazzarotto
- Microbiology Unit.,Specialized, Experimental, and Diagnostic Medicine, University of Bologna, Bologna, Italy.,Co-last authors
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10
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Pizzuti V, Abruzzo PM, Chatgilialoglu A, Zia S, Marrazzo P, Petrocelli G, Zannini C, Marchionni C, Poggi P, Simonazzi G, Canaider S, Alviano F, Facchin F, Bonsi L. A Tailored Lipid Supplement Restored Membrane Fatty Acid Composition and Ameliorates In Vitro Biological Features of Human Amniotic Epithelial Cells. J Clin Med 2022; 11:jcm11051236. [PMID: 35268327 PMCID: PMC8911266 DOI: 10.3390/jcm11051236] [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] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/11/2022] [Accepted: 02/22/2022] [Indexed: 02/07/2023] Open
Abstract
Cell culture conditions influence several biological and biochemical features of stem cells (SCs), including the membrane lipid profile, thus limiting the use of SCs for cell therapy approaches. The present study aims to investigate whether the in vitro culture may alter the membrane fatty acid signature of human Amniotic Epithelial Cells (hAECs). The analysis of the membrane fatty acid composition of hAECs cultured in basal medium showed a loss in polyunsaturated fatty acids (PUFA), in particular in omega-6 (ω-6) content, compared to freshly isolated hAECs. The addition to the basal culture medium of a chemically defined and animal-free tailored lipid supplement, namely Refeed®, partially restored the membrane fatty acid signature of hAECs. Although the amelioration of the membrane composition did not prolong hAECs culture lifespan, Refeed® influenced cell morphology, counteracted the onset of senescence, and increased the migratory capacity as well as the ability of hAECs to inhibit Peripheral Blood Mononuclear Cell (PBMC) proliferation. This study provides new information on hAEC features during culture passages and demonstrates that the maintenance of the membrane fatty acid signature preserved higher cell quality during in vitro expansion, suggesting the use of lipid supplementation for SC expansion in cell-based therapies.
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Affiliation(s)
- Valeria Pizzuti
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126 Bologna, Italy; (V.P.); (P.M.A.); (P.M.); (G.P.); (C.M.); (S.C.); (F.F.); (L.B.)
- Unit of Nephrology, Dialysis and Renal Transplant, Department of Experimental, Diagnostic and Specialty Medicine, St. Orsola-Malpighi University Hospital, 40138 Bologna, Italy
| | - Provvidenza Maria Abruzzo
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126 Bologna, Italy; (V.P.); (P.M.A.); (P.M.); (G.P.); (C.M.); (S.C.); (F.F.); (L.B.)
| | | | | | - Pasquale Marrazzo
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126 Bologna, Italy; (V.P.); (P.M.A.); (P.M.); (G.P.); (C.M.); (S.C.); (F.F.); (L.B.)
| | - Giovannamaria Petrocelli
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126 Bologna, Italy; (V.P.); (P.M.A.); (P.M.); (G.P.); (C.M.); (S.C.); (F.F.); (L.B.)
| | - Chiara Zannini
- National Laboratory of Molecular Biology and Stem Cell Bioengineering of the National Institute of Biostructures and Biosystems (NIBB)-ELDOR Lab, at the Innovation Accelerator, CNR, Via Piero Gobetti 101, 40129 Bologna, Italy;
| | - Cosetta Marchionni
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126 Bologna, Italy; (V.P.); (P.M.A.); (P.M.); (G.P.); (C.M.); (S.C.); (F.F.); (L.B.)
| | - Paola Poggi
- Remembrane S.r.l., 40026 Imola, Italy; (A.C.); (P.P.)
| | - Giuliana Simonazzi
- Obstetric Unit, Department of Medical and Surgical Sciences, Policlinico St. Orsola-Malpighi, University of Bologna, 40126 Bologna, Italy;
| | - Silvia Canaider
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126 Bologna, Italy; (V.P.); (P.M.A.); (P.M.); (G.P.); (C.M.); (S.C.); (F.F.); (L.B.)
| | - Francesco Alviano
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126 Bologna, Italy; (V.P.); (P.M.A.); (P.M.); (G.P.); (C.M.); (S.C.); (F.F.); (L.B.)
- Correspondence:
| | - Federica Facchin
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126 Bologna, Italy; (V.P.); (P.M.A.); (P.M.); (G.P.); (C.M.); (S.C.); (F.F.); (L.B.)
| | - Laura Bonsi
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40126 Bologna, Italy; (V.P.); (P.M.A.); (P.M.); (G.P.); (C.M.); (S.C.); (F.F.); (L.B.)
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11
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Zammarchi L, Lazzarotto T, Di Tommaso M, Tomasoni L, Pasquini L, Galli L, Simonazzi G, Castelli F, Borchi B, Campolmi I, Ornaghi S, Bartoloni A, Andreoni M, Pagano I, Petraglia S, Ramenghi L, Clerici P, Tavio M, Trotta M. Valacyclovir for prevention and treatment of fetal CMV infection: inclusion in the Law 648/96 list and launch of the Italian multicentre observational prospective study "MEGAL-ITALI". Infez Med 2021; 29:299-303. [PMID: 34061801] [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: 06/12/2023]
Abstract
Not available.
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Affiliation(s)
- Lorenzo Zammarchi
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Firenze, Italia; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italia; Centro di Riferimento per le Malattie Infettive in Gravidanza della Toscana, Firenze, Italia
| | - Tiziana Lazzarotto
- Laboratorio di Virologia, UO di Microbiologia, Dipartimento di Medicina Specialistica, Sperimentale e Diagnostica, IRCCS Policlinico Sant'Orsola, Università di Bologna, Bologna, Italia
| | - Mariarosaria Di Tommaso
- Dipartimento di Scienze della Salute, Sezione di Ostetricia e Ginecologia, Università degli Studi di Firenze, Firenze, Italia
| | - Lina Tomasoni
- Dipartimento Universitario di Malattie Infettive e Tropicali, Università degli Studi di Brescia e ASST Spedali Civili, Brescia, Italia
| | - Lucia Pasquini
- Unità di Medicina Fetale, Dipartimento per la Salute della Donna e del Bambino, Azienda Ospedaliero Universitaria Careggi, Firenze, Italia
| | - Luisa Galli
- Dipartimento di Scienze della Salute Università di Firenze, Divisione Malattie Infettive Pediatriche, Ospedale Universitario Pediatrico Anna Meyer, Firenze, Italia
| | - Giuliana Simonazzi
- Divisione di Ostetricia e Medicina Prenatale, Dipartimento di Scienze Medico Chirurgiche, Policlinico Sant'Orsola, Bologna, Italia
| | - Francesco Castelli
- Dipartimento Universitario di Malattie Infettive e Tropicali, Università degli Studi di Brescia e ASST Spedali Civili, Brescia, Italia
| | - Beatrice Borchi
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italia; Centro di Riferimento per le Malattie Infettive in Gravidanza della Toscana, Firenze, Italia
| | - Irene Campolmi
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italia; Centro di Riferimento per le Malattie Infettive in Gravidanza della Toscana, Firenze, Italia
| | - Sara Ornaghi
- Dipartimento di Ostetricia e Ginecologia, Scuola di Medicina e Chirurgia, Università di Milano-Bicocca - Fondazione MBBM, Monza, Italia
| | - Alessandro Bartoloni
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Firenze, Italia; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italia
| | - Massimo Andreoni
- Clinica di Malattie Infettive, Università Tor Vergata, Roma, Italia
| | | | | | - Luca Ramenghi
- UOC Patologia Neonatale, IRCCS Istituto Giannina Gaslini e Università di Genova, Genova
| | - Pierangelo Clerici
- Unità di Microbiologia, ASST Ovest Milanese, Ospedale di Legnano, Legnano, Italia
| | - Marcello Tavio
- Unità di Malattie Infettive Emergenti e Immunosoppresse, Dipartimento di Gastroenterologia e Trapianti, Università Politecnica delle Marche, Ancona, Italia
| | - Michele Trotta
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italia; Centro di Riferimento per le Malattie Infettive in Gravidanza della Toscana, Firenze, Italia
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12
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Cataneo I, Carapezzi A, Livi A, Lenzi J, Fantini MP, Lazzarotto T, Gabrielli L, Simonazzi G. Maternal perception of the risk of vertically transmitted infections: the impact of expert counseling. Am J Obstet Gynecol MFM 2021; 3:100341. [PMID: 33652157 DOI: 10.1016/j.ajogmf.2021.100341] [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: 01/29/2021] [Accepted: 02/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Insufficient and imprecise information during pregnancy can lead to an overestimation of maternal and fetal risk associated to various exposures during gestation. OBJECTIVE This study aimed to assess whether expert obstetrical counseling in cases of maternal infections at risk of vertical transmission could impact maternal perception of risk and the tendency to terminate pregnancy. STUDY DESIGN This is a monocentric prospective observational study of 185 consecutive pregnant women with confirmed diagnosis of infectious diseases at risk of vertical transmission during the first or second trimester of pregnancy. Patients were divided into 2 different groups, according to the type infectious disease: infections at high risk of fetal damages and infections at low risk. Every woman included in the study underwent medical counseling with a physician with experience of vertically transmitted infections. Moreover, each woman involved in the study was offered a detailed second trimester ultrasound scan. Maternal concern for their pregnancy and the disposition to interrupt the pregnancy were investigated by 2 questionnaires submitted to patients before and after medical expert counseling; a third questionnaire was completed only by those women who decided to undergo second trimester ultrasound scan at our hospital. RESULTS Of the 185 consecutive patients meeting the inclusion criteria, 171 (92.4%) filled out the visual analog scale for concern about the baby's health both before and after medical consultation. After medical consultation, there was a significant decrease in mean visual analog scale for concern: from 67.1±26.0 to 41.3±28.8 (change score, -25.8; 95% confidence interval, -29.9 to -21.7). Higher baseline levels of concern had more room for reduction, and infections at high fetal risk of damage were associated with lower decrease in concern. However, risk perception decreased in both low-risk and high-risk pregnancies. Notably, 82 patients (53.2%) underwent ultrasonography and filled out the visual analog scale after examination. The mean score after examination was 28.3±24.4 and significantly lower than the mean score registered after consultation (change score, -16.6; 95% confidence interval, -22.9 to -10.3). A total of 162 women (87.6%) declared their tendency to interrupt pregnancy both before and after the consultation. There was a significant decrease in mean tendency from 42.1±32.6 to 22.7±27.1 (change score, -19.4; 95% confidence interval, -23.6 to -15.2). Regression analysis revealed that both low- and high-risk patients significantly reduced their tendency. A total of 73 patients (45.1%) underwent ultrasonography and filled out the visual analog scale after examination. The mean score after examination was 9.9±20.6 and significantly lower than the mean score registered after consultation (change score, -13.4; 95% confidence interval, -19.1 to -7.7). CONCLUSION Our results confirm the importance of a comprehensive and sufficient expert medical counseling that, on one hand, can reduce maternal risk perception, improving quality of life for mothers, and, on the other hand, can lead to feasible results, reducing a woman's disposition to termination of pregnancy.
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Affiliation(s)
- Ilaria Cataneo
- Obstetric Unit, Department of Medical and Surgical Sciences (Drs Cataneo, Livi, and Simonazzi),; Department of Obstetrics and Gynecology, Ospedale Maggiore, Bologna, Italy (Dr Cataneo)
| | - Annalisa Carapezzi
- Department of Surgical Sciences, Ospedale Sant'Anna, University of Turin, Torino, Italy (Dr Carapezzi)
| | - Alessandra Livi
- Obstetric Unit, Department of Medical and Surgical Sciences (Drs Cataneo, Livi, and Simonazzi)
| | - Jacopo Lenzi
- Section of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (Drs Lenzi and Fantini)
| | - Maria Pia Fantini
- Section of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (Drs Lenzi and Fantini)
| | - Tiziana Lazzarotto
- Department of Specialized, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology (Dr Lazzarotto)
| | - Liliana Gabrielli
- Operative Unit of Clinical Microbiology (Dr Gabrielli), University of Bologna and IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Giuliana Simonazzi
- Obstetric Unit, Department of Medical and Surgical Sciences (Drs Cataneo, Livi, and Simonazzi),.
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13
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Razonable RR, Inoue N, Pinninti SG, Boppana SB, Lazzarotto T, Gabrielli L, Simonazzi G, Pellett PE, Schmid DS. Clinical Diagnostic Testing for Human Cytomegalovirus Infections. J Infect Dis 2021; 221:S74-S85. [PMID: 32134488 DOI: 10.1093/infdis/jiz601] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Human cytomegalovirus (HCMV) infections are among the most common complications arising in transplant patients, elevating the risk of various complications including loss of graft and death. HCMV infections are also responsible for more congenital infections worldwide than any other agent. Congenital HCMV (cCMV) infections are the leading nongenetic cause of sensorineural hearing loss and a source of significant neurological disabilities in children. While there is overlap in the clinical and laboratory approaches to diagnosis of HCMV infections in these settings, the management, follow-up, treatment, and diagnostic strategies differ considerably. As yet, no country has implemented a universal screening program for cCMV. Here, we summarize the issues, limitations, and application of diagnostic strategies for transplant recipients and congenital infection, including examples of screening programs for congenital HCMV that have been implemented at several centers in Japan, Italy, and the United States.
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Affiliation(s)
- Raymund R Razonable
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Swetha G Pinninti
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Suresh B Boppana
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tiziana Lazzarotto
- Operative Unit of Microbiology and Virology, Department of Specialized, Experimental, and Diagnostic Medicine, Polyclinic of St Orsola-Malpighi, University of Bologna, Italy
| | - Liliana Gabrielli
- Operative Unit of Microbiology and Virology, Department of Specialized, Experimental, and Diagnostic Medicine, Polyclinic of St Orsola-Malpighi, University of Bologna, Italy
| | - Giuliana Simonazzi
- Operative Unit of Obstetrics and Prenatal Medicine, Department of Medical Surgical Sciences, Polyclinic of St Orsola-Malpighi, University of Bologna, Italy
| | - Philip E Pellett
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - D Scott Schmid
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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14
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Di Mascio D, Sen C, Saccone G, Galindo A, Grünebaum A, Yoshimatsu J, Stanojevic M, Kurjak A, Chervenak F, Rodríguez Suárez MJ, Gambacorti-Passerini ZM, Baz MDLAA, Aguilar Galán EV, López YC, De León Luis JA, Hernández IC, Herraiz I, Villalain C, Venturella R, Rizzo G, Mappa I, Gerosolima G, Hellmeyer L, Königbauer J, Ameli G, Frusca T, Volpe N, Luca Schera GB, Fieni S, Esposito E, Simonazzi G, Di Donna G, Youssef A, Della Gatta AN, Di Donna MC, Chiantera V, Buono N, Sozzi G, Greco P, Morano D, Bianchi B, Lombana Marino MG, Laraud F, Ramone A, Cagnacci A, Barra F, Gustavino C, Ferrero S, Ghezzi F, Cromi A, Laganà AS, Laurita Longo V, Stollagli F, Sirico A, Lanzone A, Driul L, Cecchini D F, Xodo S, Rodriguez B, Mercado-Olivares F, Elkafrawi D, Sisti G, Esposito R, Coviello A, Cerbone M, Morlando M, Schiattarella A, Colacurci N, De Franciscis P, Cataneo I, Lenzi M, Sandri F, Buscemi R, Gattei G, Sala FD, Valori E, Rovellotti MC, Done E, Faron G, Gucciardo L, Esposito V, Vena F, Giancotti A, Brunelli R, Muzii L, Nappi L, Sorrentino F, Vasciaveo L, Liberati M, Buca D, Leombroni M, Di Sebastiano F, Di Tizio L, Gazzolo D, Franchi M, Ianniciello QC, Garzon S, Petriglia G, Borrello L, Nieto-Calvache AJ, Burgos-Luna JM, Kadji C, Carlin A, Bevilacqua E, Moucho M, Pinto PV, Figueiredo R, Morales Roselló J, Loscalzo G, Martinez-Varea A, Diago V, Jimenez Lopez JS, Aykanat AY, Cosma S, Carosso A, Benedetto C, Bermejo A, May Feuerschuette OH, Uyaniklar O, Ocakouglu SR, Atak Z, Gündüz R, Haberal ET, Froessler B, Parange A, Palm P, Samardjiski I, Taccaliti C, Okuyan E, Daskalakis G, Moreira de Sa RA, Pittaro A, Gonzalez-Duran ML, Guisan AC, Genç ŞÖ, Zlatohlávková B, Piqueras AL, Oliva DE, Cil AP, Api O, Antsaklis P, Ples L, Kyvernitakis I, Maul H, Malan M, Lila A, Granese R, Ercoli A, Zoccali G, Villasco A, Biglia N, Madalina C, Costa E, Daelemans C, Pintiaux A, Cueto E, Hadar E, Dollinger S, Brzezinski Sinai NA, Huertas E, Arango P, Sanchez A, Schvartzman JA, Cojocaru L, Turan S, Turan O, Di Dedda MC, Molpeceres RG, Zdjelar S, Premru-Srsen T, Cerar LK, Druškovič M, De Robertis V, Stefanovic V, Nupponen I, Nelskylä K, Khodjaeva Z, Gorina KA, Sukhikh GT, Maruotti GM, Visentin S, Cosmi E, Ferrari J, Gatti A, Luvero D, Angioli R, Puri L, Palumbo M, D'Urso G, Colaleo F, Chiara Rapisarda AM, Carbone IF, Mollo A, Nazzaro G, Locci M, Guida M, Di Spiezio Sardo A, Panici PB, Berghella V, Flacco ME, Manzoli L, Bifulco G, Scambia G, Zullo F, D'Antonio F. Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19. J Perinat Med 2020; 48:950-958. [PMID: 32975205 DOI: 10.1515/jpm-2020-0355] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
Abstract
Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.
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Affiliation(s)
- Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Cihat Sen
- Perinatal Medicine Foundation and Department of Perinatal Medicine, Memorial Hospital, Istanbul, Turkey
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Alberto Galindo
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of MadridDepartment of Obstetrics and Gynaecology, Madrid, Spain
| | - Amos Grünebaum
- Department of Obstetrics and Gynaecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jun Yoshimatsu
- Department of Perinatology and Gynaecology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Milan Stanojevic
- Department of Obstetrics and Gynaecology, Medical School University of Zagreb, Sveti Duh University Hospital, Zagreb, Croatia
| | - Asım Kurjak
- Department of Obstetrics and Gynaecology, Medical School University of Zagreb, Sveti Duh University Hospital, Zagreb, Croatia
| | - Frank Chervenak
- Department of Obstetrics and Gynaecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | | | - María de Los Angeles Anaya Baz
- Department of Obstetrics and Gynaecology, Ciudad Real University General Hospital, Ciudad Real, Spain
- University of Castilla-La Mancha, Ciudad Real, Spain
| | - Esther Vanessa Aguilar Galán
- Department of Obstetrics and Gynaecology, Ciudad Real University General Hospital, Ciudad Real, Spain
- University of Castilla-La Mancha, Ciudad Real, Spain
| | - Yolanda Cuñarro López
- Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Juan Antonio De León Luis
- Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Ignacio Cueto Hernández
- Fetal Medicine Unit, Maternal and Child Health anad Development Network, Gregorio Marañón Hospital, Complutense University of Madrid, Department of Obstetrics and Gynaecology, Madrid, Spain
| | - Ignacio Herraiz
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of MadridDepartment of Obstetrics and Gynaecology, Madrid, Spain
| | - Cecilia Villalain
- Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of MadridDepartment of Obstetrics and Gynaecology, Madrid, Spain
| | - Roberta Venturella
- Department of Obstetrics and Gynaecology, School of Medicin, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Rizzo
- University of Roma Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Rome, Italy
- Department of Obstetrics and Gynaecology The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Ilenia Mappa
- University of Roma Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Rome, Italy
| | - Giovanni Gerosolima
- Department of Obstetrics and Gynaecology, Ospedale AOSG Moscati, Avellino, Italy
| | - Lars Hellmeyer
- Department of Gynaecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Josefine Königbauer
- Department of Gynaecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Giada Ameli
- Department of Gynaecology and Obstetrics, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Tiziana Frusca
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - Nicola Volpe
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | | | - Stefania Fieni
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - Eutalia Esposito
- Department of Obstetrics and Gynaecology, Ospedale di San Leonardo, Castellammare di Stabia, Italy
| | - Giuliana Simonazzi
- Department of Obstetrics and Gynaecology, University of Bologna, Sant'Orsola- Malpighi University Hospital, Bologna, Italy
| | - Gaetana Di Donna
- Department of Obstetrics and Gynaecology, University of Bologna, Sant'Orsola- Malpighi University Hospital, Bologna, Italy
| | - Aly Youssef
- Department of Obstetrics and Gynaecology, University of Bologna, Sant'Orsola- Malpighi University Hospital, Bologna, Italy
| | - Anna Nunzia Della Gatta
- Department of Obstetrics and Gynaecology, University of Bologna, Sant'Orsola- Malpighi University Hospital, Bologna, Italy
| | | | - Vito Chiantera
- Department of Gynaecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
| | - Natalina Buono
- Department of Gynaecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
| | - Giulio Sozzi
- Department of Gynaecologic Oncology, University of Palermo, Palermo, Sicilia, Italy
| | - Pantaleo Greco
- Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Danila Morano
- Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Beatrice Bianchi
- Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Lombana Marino
- Department of Medical Sciences, Section of Obstetrics and Gynaecology, Azienda Ospedaliera-Universitaria Sant' Anna, University of Ferrara, Ferrara, Italy
| | - Federica Laraud
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Arianna Ramone
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Angelo Cagnacci
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Claudio Gustavino
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospita University of Insubria, Varese, Italy
| | - Antonella Cromi
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospita University of Insubria, Varese, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospita University of Insubria, Varese, Italy
| | - Valentina Laurita Longo
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
- Queen Margaret University,Institute for Global Health and Development, Edinburgh, UK
| | - Francesca Stollagli
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Sirico
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Lanzone
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenza Driul
- Clinic of Obstetrics and Gynaecology, University of Udine, Udine, Italy
| | | | - Serena Xodo
- Clinic of Obstetrics and Gynaecology, University of Udine, Udine, Italy
| | - Brian Rodriguez
- Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
| | - Felipe Mercado-Olivares
- Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
| | - Deena Elkafrawi
- Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
| | - Giovanni Sisti
- Department of Obstetrics and Gynaecology, New York Health and Hospitals/Lincoln Bronx, The Bronx, NY, USA
| | - Rosanna Esposito
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Coviello
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Marco Cerbone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maddalena Morlando
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ilaria Cataneo
- Unit of Obstetrics and Gynaecology, Ospedale Maggiore, Bologna, Italy
| | - Marinella Lenzi
- Unit of Obstetrics and Gynaecology, Ospedale Maggiore, Bologna, Italy
| | - Fabrizio Sandri
- Unit of Obstetrics and Gynaecology, Ospedale Maggiore, Bologna, Italy
| | - Riccardo Buscemi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Giorgia Gattei
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Francesca Della Sala
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Eleonora Valori
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
- Hospital Castelli, Verbania, Italy
| | | | - Elisa Done
- UZ Brussel, Universitair Ziekenhuis, Brussel, Belgium
| | - Gilles Faron
- UZ Brussel, Universitair Ziekenhuis, Brussel, Belgium
| | | | | | - Flaminia Vena
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Luigi Nappi
- Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Felice Sorrentino
- Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Lorenzo Vasciaveo
- Department of Obstetrics and Gynaecology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Marco Liberati
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Danilo Buca
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Martina Leombroni
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Francesca Di Sebastiano
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Luciano Di Tizio
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
| | - Diego Gazzolo
- Neonatal Intensive Care Unit, University of Chieti, ChietiItaly
| | - Massimo Franchi
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | | | - Simone Garzon
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, Verona, Italy
| | - Giuliano Petriglia
- Maternal and Child Health Department, Santa Maria Hospital, Terni, Italy
| | - Leonardo Borrello
- Maternal and Child Health Department, Santa Maria Hospital, Terni, Italy
| | - Albaro Josè Nieto-Calvache
- Fundación Valle del Lili,Tertiary Obstetric Unit, Cali, Colombia
- Postgraduate Department, Universidad Icesi, Cali, Colombia
| | - Juan Manuel Burgos-Luna
- Fundación Valle del Lili,Tertiary Obstetric Unit, Cali, Colombia
- Postgraduate Department, Universidad Icesi, Cali, Colombia
| | - Caroline Kadji
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew Carlin
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Elisa Bevilacqua
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Marina Moucho
- Department of Obstetrics and Gynaecology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Pedro Viana Pinto
- Department of Obstetrics and Gynaecology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Rita Figueiredo
- Department of Obstetrics and Gynaecology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - José Morales Roselló
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gabriela Loscalzo
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alicia Martinez-Varea
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Vincente Diago
- Servicio de Obstetricia y Ginecología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Alicia Yeliz Aykanat
- Department of Obstetrics and Gynaecology, Istanbul University-Cerrahpasa Medical School, Istanbul, Turkey
| | - Stefano Cosma
- Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Andrea Carosso
- Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Department of Obstetrics and Gynaecology, Sant'Anna Hospital, University of Turin, Turin, Italy
| | | | | | | | | | | | - Reyhan Gündüz
- Department of Obstetrics and Gynaecology, University of Dicle, Diyarbakır, Turkey
| | | | - Bernd Froessler
- Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, Australia
| | - Anupam Parange
- Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, Australia
| | - Peter Palm
- Department of Anaesthesia, Lyell McEwin Hospital, Adelaide, Australia
| | - Igor Samardjiski
- University Clinic of Obstetrics and Gynaecology, Skopje, North Macedonia
| | - Chiara Taccaliti
- Ospedale Generale Regionale "F. Miulli", Acquaviva delle Fonti, Italy
| | - Erhan Okuyan
- Batman Maternity and Child Health Hospital, Batman, Turkey
| | - George Daskalakis
- Alexandra Hospital - National and Kapodistrian, University of Athens, Athens, Greece
| | | | | | | | | | | | - Blanka Zlatohlávková
- Department of Obstetrics and Gynaecology, Division of Neonatology, General Hospital in Prague and First Faculty of Medicine,Charles University, Prague, Czech Republic
| | | | | | | | - Olus Api
- American Hospital, Istanbul, Turkey
| | - Panos Antsaklis
- Alexandra Hospital - National and Kapodistrian, University of Athens, Athens, Greece
| | - Liana Ples
- Department of Obstetrics and Gynaecology, Saint John Hospital, UMF Carol Davila, Bucharest, Romania
| | | | - Holger Maul
- Asklepios Hospital Barmbek, Hamburg, Germany
| | | | - Albert Lila
- Regional Hospital Gjakova, Kosovo, Republic of Kosovo
| | - Roberta Granese
- Department of Obstetrics and Gynaecology, University of Messina, Messina, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynaecology, University of Messina, Messina, Italy
| | - Giuseppe Zoccali
- Department of Obstetrics and Gynaecology, University of Messina, Messina, Italy
| | - Andrea Villasco
- Academic Division of Obstetrics and Gynaecolog, Mauriziano Umberto I Hospital, University of Turin, Turin, Italy
| | - Nicoletta Biglia
- Academic Division of Obstetrics and Gynaecolog, Mauriziano Umberto I Hospital, University of Turin, Turin, Italy
| | - Ciuhodaru Madalina
- Universitatea de Medicină și Farmacie Grigore T. Popa Iași, Iasi, Romania
| | - Elena Costa
- Department of Obstetrics and Gynaecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium
| | - Caroline Daelemans
- Department of Obstetrics and Gynaecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium
| | - Axelle Pintiaux
- Department of Obstetrics and Gynaecology, Hospital Erasme, Cliniques Universitaires de Bruxells, Brussels, Belgium
| | | | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sarah Dollinger
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Noa A Brzezinski Sinai
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Pedro Arango
- Instituto Nacional Materno Perinatal, Lima, Peru
| | | | | | - Liviu Cojocaru
- Department of Obstetrics, Gynaecology and Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | - Sifa Turan
- Department of Obstetrics, Gynaecology and Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | - Ozhan Turan
- Department of Obstetrics, Gynaecology and Reproductive Science, University of Maryland Medical Center, Baltimore, MD, USA
| | | | | | | | - Tanja Premru-Srsen
- Department of Perinatology, University Medical Center, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Lilijana Kornhauser Cerar
- Department of Perinatology, University Medical Center, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mirjam Druškovič
- Department of Perinatology, University Medical Center, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | | | - Vedran Stefanovic
- Department of Obstetrics and Gynaecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Irmeli Nupponen
- Department of Obstetrics and Gynaecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaisa Nelskylä
- Department of Obstetrics and Gynaecology, Neonatology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Zulfiya Khodjaeva
- National Medical Research Center for Obstetrics, Gynaecology and Perinatology, Moscow, Russia
| | - Ksenia A Gorina
- National Medical Research Center for Obstetrics, Gynaecology and Perinatology, Moscow, Russia
| | - Gennady T Sukhikh
- National Medical Research Center for Obstetrics, Gynaecology and Perinatology, Moscow, Russia
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Silvia Visentin
- Department of Woman' and Child's Health, University of Padova, Padova, Italy
| | - Erich Cosmi
- Department of Woman' and Child's Health, University of Padova, Padova, Italy
| | - Jacopo Ferrari
- Department of Woman' and Child's Health, University of Padova, Padova, Italy
| | | | | | | | - Ludovica Puri
- Istituto di Clinica Ostetrica e Ginecologica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Giusella D'Urso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Francesco Colaleo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | | | | | | | - Giovanni Nazzaro
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Mariavittoria Locci
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maurizio Guida
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Attilio Di Spiezio Sardo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Berghella
- Maternal Fetal Medicine Division, Sidney Kimmel Medical College at Thomas Jefferson University, Obstetrics and Gynaecology Department, Philadelphia, PA, USA
| | | | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario A Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesco D'Antonio
- Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy
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15
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Locatelli C, Corvaglia L, Simonazzi G, Bisulli M, Paolini L, Faldella G. "Percorso Giacomo": An Italian Innovative Service of Perinatal Palliative Care. Front Pediatr 2020; 8:589559. [PMID: 33330283 PMCID: PMC7710893 DOI: 10.3389/fped.2020.589559] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/20/2020] [Indexed: 11/21/2022] Open
Abstract
The perspective proposed by this article will focus on perinatal palliative care as a strategy for improving the quality of life of neonates with life-limiting conditions when extending the patient's life is no longer the goal of care. This manuscript reports the creation of an innovative program of perinatal palliative care called "Percorso Giacomo" (Giacomo's Pathway) at Sant'Orsola Hospital in Bologna, Italy in 2013. Key features include interdisciplinary collaboration between professionals from obstetrics, neonatology and other specialties aiming to reach the most detailed fetal and neonatal diagnosis and prognosis; communication and engagement with the family to discuss goals of care and prepare a birthing plan that follows the family's desires and expectations; and personalized care to achieve comfort for each newborn and support for families according to their social, cultural, and religious backgrounds.
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Affiliation(s)
- Chiara Locatelli
- Neonatal Intensive Care Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - Luigi Corvaglia
- Neonatal Intensive Care Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Giuliana Simonazzi
- Obstetric Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Maria Bisulli
- Obstetric Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | | | - Giacomo Faldella
- Neonatal Intensive Care Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
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16
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Zammarchi L, Lazzarotto T, Andreoni M, Giaché S, Campolmi I, Pasquini L, Di Tommaso M, Simonazzi G, Tomasoni LR, Castelli F, Galli L, Borchi B, Clerici P, Bartoloni A, Tavio M, Trotta M. Valacyclovir for cytomegalovirus infection in pregnancy: additional evidences, additional questions. Clin Microbiol Infect 2020; 27:644-645. [PMID: 32950710 DOI: 10.1016/j.cmi.2020.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy; Referral Centre for Infectious Diseases in Pregnancy of Tuscany, Florence, Italy.
| | - Tiziana Lazzarotto
- Virology Laboratory, Department of Specialized, Experimental, and Diagnostic Medicine, Polyclinic St. Orsola, University of Bologna, Bologna, Italy
| | - Massimo Andreoni
- Clinical Infectious Diseases, Tor Vergata University, Rome, Italy
| | - Susanna Giaché
- Referral Centre for Infectious Diseases in Pregnancy of Tuscany, Florence, Italy
| | - Irene Campolmi
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy
| | - Lucia Pasquini
- Fetal Medicine Unit, Department for Women and Children Health, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mariarosaria Di Tommaso
- Department of Health Sciences, Obstetrics and Gynaecology Branch, University of Florence, Florence, Italy
| | - Giuliana Simonazzi
- Division of Obstetrics and Prenatal Medicine, Department of Medical Surgical Sciences, Polyclinic St. Orsola, Bologna, Italy
| | - Lina Rachele Tomasoni
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy
| | - Francesco Castelli
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, Italy; UNESCO Chair "Training and Empowering Human Resources for Health Development in Resource-limited Countries, University of Brescia", Italy
| | - Luisa Galli
- Department of Health Sciences University of Florence, Paediatric Infectious Diseases Division, Anna Meyer Children's University Hospital, Florence, Italy
| | - Beatrice Borchi
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy; Referral Centre for Infectious Diseases in Pregnancy of Tuscany, Florence, Italy
| | - Pierangelo Clerici
- Microbiology Unit, ASST-Ovest Milanese, Legnano Hospital, Legnano, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy
| | - Marcello Tavio
- Unit of Emerging and Immunosuppressed Infectious Diseases, Department of Gastroenterology and Transplantation, Polytechnic University of Marche, Ancona, Italy
| | - Michele Trotta
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, Florence, Italy; Referral Centre for Infectious Diseases in Pregnancy of Tuscany, Florence, Italy
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17
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Della Gatta AN, Rizzo R, Pilu G, Simonazzi G. Coronavirus disease 2019 during pregnancy: a systematic review of reported cases. Am J Obstet Gynecol 2020; 223:36-41. [PMID: 32311350 PMCID: PMC7165087 DOI: 10.1016/j.ajog.2020.04.013] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 12/18/2022]
Abstract
Objective This study aimed to conduct a systematic review of the clinical outcomes reported for pregnant patients with coronavirus disease 2019. Data Sources The PubMed, CINAHL, and Scopus databases were searched using a combination of key words such as “Coronavirus and/or pregnancy,” “COVID and/or pregnancy,” “COVID disease and/or pregnancy,” and “COVID pneumonia and/or pregnancy.” There was no restriction of language to allow collection of as many cases as possible. Study Eligibility Criteria All studies of pregnant women who received a coronavirus disease 2019 diagnosis using acid nucleic test, with reported data about pregnancy, and, in case of delivery, reported outcomes, were included. Study Appraisal and Synthesis Methods All the studies included have been evaluated according to the tool for evaluating the methodological quality of case reports and case series described by Murad et al. Results Six studies that involved 51 pregnant women were eligible for the systematic review. At the time of the report, 3 pregnancies were ongoing; of the remaining 48 pregnant women, 46 gave birth by cesarean delivery, and 2 gave birth vaginally; in this study, 1 stillbirth and 1 neonatal death were reported. Conclusion Although vertical transmission of severe acute respiratory syndrome coronavirus 2 infection has been excluded thus far and the outcome for mothers and neonates has been generally good, the high rate of preterm delivery by cesarean delivery is a reason for concern. Cesarean delivery was typically an elective surgical intervention, and it is reasonable to question whether cesarean delivery for pregnant patients with coronavirus disease 2019 was warranted. Coronavirus disease 2019 associated with respiratory insufficiency in late pregnancies certainly creates a complex clinical scenario.
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Affiliation(s)
- Anna Nunzia Della Gatta
- Obstetric Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy.
| | - Roberta Rizzo
- Obstetric Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Gianluigi Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Giuliana Simonazzi
- Obstetric Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
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18
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Gabrielli L, Bonasoni MP, Chiereghin A, Piccirilli G, Borgatti EC, Simonazzi G, Salfi NCM, Tamagnini I, Lazzarotto T. Pathophysiology of Hyperechogenic Bowel in Congenitally Human Cytomegalovirus Infected Fetuses. Microorganisms 2020; 8:microorganisms8050779. [PMID: 32455864 PMCID: PMC7285288 DOI: 10.3390/microorganisms8050779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/24/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/19/2022] Open
Abstract
Hyperechogenic bowel (HB) is a nonspecific ultrasound finding that can be associated with human cytomegalovirus (CMV) congenital infection. In this study, we investigated HB pathophysiology in CMV-infected fetuses. We examined small and large intestine as well as pancreas in 8 fetuses at 22 weeks of gestation with congenital CMV infection. Ultrasound findings showed 4 fetuses with HB and 4 without. As negative group, 4 fetuses without CMV infection and without HB were studied. Immunohistochemistry for CMV, lymphocytic infiltrate, B-cell leukemia/lymphoma-2 (bcl-2), CD-117, cystic fibrosis transmembrane regulator (CFTR) were performed. HB fetuses showed multiple and sequential CMV-positive ganglion cells of Auerbach’s myenteric plexus. In the ganglia, bcl-2 was weakly expressed representing a reduced neuronal functionality. CD-117 revealed a regular distribution of Cajal cells, the pacemakers of intestinal contractility. Pancreas showed normal CFTR staining, indicating a preserved exocrine secretion, thus unlikely a contributory factor in HB. In CMV-infected fetuses without HB, CMV-positive cells were scatteredly found in ganglion cells and bcl-2 was strongly expressed. Intestinal CD-117 and pancreatic CFTR expression were similar to fetuses with HB. In conclusion, fetal CMV infection of the bowel may lead to peristalsis impairment (paralytic ileus) due to intestinal plexus involvement, which at ultrasound appeared as HB.
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Affiliation(s)
- Liliana Gabrielli
- Operative Unit of Clinical Microbiology, St. Orsola Polyclinic, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy;
- Correspondence: ; Tel.: +39-051-2144645
| | - Maria P. Bonasoni
- Pathology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (M.P.B.); (I.T.)
| | - Angela Chiereghin
- Department of Specialized, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology, St. Orsola Polyclinic, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; (A.C.); (E.C.B.); (T.L.)
| | - Giulia Piccirilli
- Operative Unit of Clinical Microbiology, St. Orsola Polyclinic, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy;
| | - Eva C. Borgatti
- Department of Specialized, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology, St. Orsola Polyclinic, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; (A.C.); (E.C.B.); (T.L.)
| | - Giuliana Simonazzi
- Department of Obstetrics and Gynecology, St. Orsola Polyclinic, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy;
| | - Nunzio C. M. Salfi
- Pathology Unit, St. Orsola Polyclinic, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy;
| | - Ione Tamagnini
- Pathology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS, Viale Risorgimento 80, 42123 Reggio Emilia, Italy; (M.P.B.); (I.T.)
| | - Tiziana Lazzarotto
- Department of Specialized, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology, St. Orsola Polyclinic, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy; (A.C.); (E.C.B.); (T.L.)
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19
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Floridia M, Ravizza M, Masuelli G, Tassis B, Savasi VM, Liuzzi G, Sansone M, Simonazzi G, Franceschetti L, Meloni A, Vimercati A, Guaraldi G, Pinnetti C, Dalzero S, Tamburrini E. Prevalence, Correlates and Outcomes of Smoking in Pregnant Women with HIV: A National Observational Study in Italy. Subst Use Misuse 2020; 55:1165-1172. [PMID: 32100603 DOI: 10.1080/10826084.2020.1729204] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Few studies have evaluated in pregnant women with HIV the prevalence of smoking and its associations with maternal and neonatal outcomes. Objectives: to assess the prevalence of smoking among women with HIV in early pregnancy and the association between smoking and pregnancy outcomes in this particular population. Methods: We used data from a multicenter observational study to define the prevalence of smoking in women with HIV in early pregnancy, and the role of smoking status and intensity as risk factors for adverse maternal and neonatal outcomes. Main outcome measures were fetal growth restriction [FGR], preterm delivery [PD] and low birthweight [LB], evaluated in univariate and multivariate analyses. Results: The overall (2001-2018) prevalence of reported smoking (at least one cigarette/day) was 25.6% (792/3097), with a significant decrease in recent years (19.0% in 2013-2018). Women who smoked were less commonly African, had lower body mass index, older age, a longer history of HIV infection and higher CD4 counts. In univariate analyses, smokers were significantly more likely to have PD, LB, FGR and detectable HIV viral load at third trimester. Multivariable analyses confirmed for smokers a significantly higher risk of LB (adjusted odds ratio [AOR]: 1.69, 95%CI 1.22-2.34) and FGR (AOR 1.88, 95%CI 1.27-2.80), while the associations with detectable HIV and PD were not maintained. Conclusions: The common prevalence of smoking among pregnant women with HIV and its association with adverse outcomes indicates that smoking cessation programs in this population may have a significant impact on neonatal and maternal health.
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Affiliation(s)
- Marco Floridia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marina Ravizza
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - Giulia Masuelli
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Beatrice Tassis
- Department of Obstetrics and Gynecology "L. Mangiagalli," Fondazione IRCCS "Ca' Granda" - Ospedale Maggiore Policlinico, Milan, Italy
| | - Valeria Maria Savasi
- Department of Obstetrics and Gynaecology, Luigi Sacco Hospital and University of Milan, Milan, Italy
| | - Giuseppina Liuzzi
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Matilde Sansone
- Department of Neurosciences, Reproductive and Dentistry Science, University Federico II, Naples, Italy
| | - Giuliana Simonazzi
- Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi and University of Bologna, Bologna, Italy
| | - Laura Franceschetti
- Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
| | - Alessandra Meloni
- Division of Gynaecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Antonella Vimercati
- Department of Biomedical and Human Oncological Science (DIMO), 2nd Unit of Obstetrics and Gynaecology, University of Bari, Bari, Italy
| | - Giovanni Guaraldi
- Department of Medical Specialties, Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Carmela Pinnetti
- National Institute for Infectious Diseases "Lazzaro Spallanzani", IRCCS, Rome, Italy
| | - Serena Dalzero
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - Enrica Tamburrini
- Department of Infectious Diseases, Catholic University and Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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20
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Floridia M, Masuelli G, Ravizza M, Tassis B, Cetin I, Sansone M, Degli Antoni A, Simonazzi G, Maccabruni A, Francisci D, Frisina V, Liuzzi G, Dalzero S, Tamburrini E. Atazanavir and darunavir in pregnant women with HIV: evaluation of laboratory and clinical outcomes from an observational national study. J Antimicrob Chemother 2019; 73:1025-1030. [PMID: 29244115 DOI: 10.1093/jac/dkx478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/18/2017] [Indexed: 11/13/2022] Open
Abstract
Background Atazanavir and darunavir represent the main HIV PIs recommended in pregnancy, but comparative data in pregnant women are limited. We assessed the safety and activity profile of these two drugs in pregnancy using data from a national observational study. Methods Women with atazanavir or darunavir exposure in pregnancy were evaluated for laboratory measures and main pregnancy outcomes (e.g. preterm delivery, low birthweight, non-elective caesarean section and neonatal gestational age-adjusted birthweight Z-score). Results Final analysis included 500 pregnancies with either atazanavir (n = 409) or darunavir (n = 91) exposure. No differences in pregnancy outcomes, weight gain in pregnancy, drug discontinuations, undetectable HIV-RNA, haemoglobin, ALT, total cholesterol, HDL cholesterol and LDL cholesterol were observed between the two groups. At third trimester, exposure to darunavir was associated with higher levels of plasma triglycerides (median 235.5 versus 179 mg/dL; P = 0.032) and a higher total cholesterol/HDL cholesterol ratio (median 4.03 versus 3.27; P = 0.028) and exposure to atazanavir was associated with higher levels of plasma bilirubin (1.54 versus 0.32 mg/dL; P < 0.001). Conclusions In this observational study, the two main HIV PIs currently recommended by perinatal guidelines showed similar safety and activity in pregnancy, with no evidence of differences between the two drugs in terms of main pregnancy outcomes. Based on the minor differences observed in laboratory measures, prescribing physicians might prefer either drug in some particular situations where the different impacts of treatment on lipid profile and bilirubin may have clinical relevance.
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Affiliation(s)
- M Floridia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - G Masuelli
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - M Ravizza
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - B Tassis
- Obstetric and Gynaecology Unit, Fondazione IRCCS Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - I Cetin
- Department of Obstetrics and Gynaecology, Luigi Sacco Hospital and University of Milan, Milan, Italy
| | - M Sansone
- Department of Neurosciences, Reproductive and Dentistry Science, University Federico II, Naples, Italy
| | - A Degli Antoni
- Department of Infectious Diseases and Hepatology, Azienda Ospedaliera di Parma, Parma, Italy
| | - G Simonazzi
- Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi and University of Bologna, Bologna, Italy
| | - A Maccabruni
- IRCCS S. Matteo and Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - D Francisci
- Clinic of Infectious Diseases, Azienda Ospedaliera 'Santa Maria', Terni and University of Perugia, Perugia, Italy
| | - V Frisina
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy
| | - G Liuzzi
- I.N.M.I. Lazzaro Spallanzani, Rome, Italy
| | - S Dalzero
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - E Tamburrini
- Department of Infectious Diseases, Catholic University, Rome, Italy
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21
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Bellussi F, Salsi G, Simonazzi G, Youssef A, Cataneo I, Cariello L, Ghi T, Pilu G. A simple sonographic finding is associated with a successful vacuum application: the fetal occiput or forehead sign. Am J Obstet Gynecol MFM 2019; 1:148-155. [PMID: 33345820 DOI: 10.1016/j.ajogmf.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/23/2019] [Accepted: 05/03/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intrapartum ultrasound scanning has been proposed as an ancillary tool in the decision-making process of instrumental vaginal delivery. OBJECTIVE The purpose of this study was to evaluate the correlation between the sonographic visualization with a transperineal scan of the fetal occiput or forehead distal to the pubic symphysis with anterior or posterior presentation, respectively (fetal occiput or forehead sign), and the outcome of a vacuum delivery. STUDY DESIGN We conducted a retrospective cohort study of patients who underwent a vacuum application in our hospital from 2011-2017, excluding outlet applications. In each case, a preliminary transperineal scan was performed to confirm fetal presentation and position and to demonstrate the presence or absence of the fetal occiput or forehead sign. The head direction, angle of progression, and the head perineum distance were also noted. The primary outcome measure was the success of the vacuum. The secondary outcome measures included fetal complications and perineal lacerations. RESULTS A total of 196 consecutive patients were enrolled in the study. The occiput or forehead sign was present in 150 and was associated with a successful vaginal extraction in all cases. Of the 46 cases without the sign, 5 babies (10.8%) were delivered by cesarean section after a failed vacuum (P=.0006). The occiput or forehead sign was also associated with fewer grade 3-4 perineal lacerations (10.7% vs 35.7%; P=.0005) and cephalohematomas, although the difference was not statistically significant (1.4% vs 4.3%). There was a good correlation between the occiput or forehead sign and the other sonographic methods that previously had been proposed to predict a successful vacuum extraction, such as head direction, angle of progression, and head perineum distance. CONCLUSION In our hands, the fetal occiput or forehead sign was associated strongly with successful vacuum application and with a very low rate of maternal and fetal complications.
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Affiliation(s)
- Federica Bellussi
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Ginevra Salsi
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giuliana Simonazzi
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Aly Youssef
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ilaria Cataneo
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luisa Cariello
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Tullio Ghi
- Department of Obstetrics and Gynecology of the University of Parma, Ospedale Maggiore, Italy
| | - Gianluigi Pilu
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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22
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Cavallini C, Zannini C, Olivi E, Tassinari R, Taglioli V, Rossi M, Poggi P, Chatgilialoglu A, Simonazzi G, Alviano F, Bonsi L, Ventura C. Restoring In Vivo-Like Membrane Lipidomics Promotes Exosome Trophic Behavior from Human Placental Mesenchymal Stromal/Stem Cells. Cell Transplant 2019; 27:55-69. [PMID: 29562775 PMCID: PMC6434476 DOI: 10.1177/0963689717723016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 12/20/2022] Open
Abstract
Human mesenchymal stem cells (hMSCs) are an effective tool in regenerative medicine notably for their intrinsic plentiful paracrine activity rather than differentiating properties. The hMSC secretome includes a wide spectrum of regulatory and trophic factors, encompassing several naked molecules as well as different kinds of extracellular vesicles (EVs). Among EVs, exosomes represent an intriguing population, able to shuttle proteins, transcription factors, and genetic materials, with a relevant role in cell-to-cell communication, modulating biological responses in recipient cells. In this context, the extracellular milieu can greatly impact the paracrine activity of stem cells, modifying their metabolism, and the dynamics of vesicle secretion. In the present study, we investigated the effects elicited on exosome patterning by tailored, ad hoc formulated lipid supplementation (Refeed®) in MSCs derived from human fetal membranes (hFM-MSCs). Wound healing experiments revealed that stem cell exposure to exosomes obtained from Refeed®-supplemented hFM-MSCs increased their migratory capability, although the amount of exosomes released after Refeed® supplementation was lower than that yielded from non-supplemented cells. We found that such a decrease was mainly due to a different rate of exosomal exocytosis rather than to an effect of the lipid supplement on the endocytic pathway. Endoplasmic reticulum homeostasis was modified by supplementation, through the upregulation of PKR-like ER kinase (PERK) and inositol-requiring enzyme 1α (IRE1α). Increased expression of these proteins did not lead to stress-induced, unfolded protein response (UPR)-mediated apoptosis, nor did it affect phosphorylation of p38 kinase, suggesting that PERK and IRE1α overexpression was due to augmented metabolic activities mediated by optimization of a cellular feeding network afforded through lipid supplementation. In summary, these results demonstrate how tailored lipid supplementation can successfully modify the paracrine features in hFM-MSCs, impacting both intracellular vesicle trafficking and secreted exosome number and function.
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Affiliation(s)
- Claudia Cavallini
- 1 GUNA - ATTRE (Advanced Therapies and Tissue Regeneration), Innovation Accelerator at CNR, Via Gobetti 101, 40129 Bologna, Italy.,2 National Institute of Biostructures and Biosystems (NIBB), Rome, Italy.,3 Ettore Sansavini Health Science Foundation ONLUS-Lab SWITH, Lugo, Italy
| | - Chiara Zannini
- 3 Ettore Sansavini Health Science Foundation ONLUS-Lab SWITH, Lugo, Italy.,4 Department of Experimental, Diagnostic and Specialty Medicine, Unit of Nephrology, Dialysis and Renal Transplant, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Elena Olivi
- 1 GUNA - ATTRE (Advanced Therapies and Tissue Regeneration), Innovation Accelerator at CNR, Via Gobetti 101, 40129 Bologna, Italy.,2 National Institute of Biostructures and Biosystems (NIBB), Rome, Italy.,3 Ettore Sansavini Health Science Foundation ONLUS-Lab SWITH, Lugo, Italy
| | - Riccardo Tassinari
- 1 GUNA - ATTRE (Advanced Therapies and Tissue Regeneration), Innovation Accelerator at CNR, Via Gobetti 101, 40129 Bologna, Italy.,2 National Institute of Biostructures and Biosystems (NIBB), Rome, Italy.,3 Ettore Sansavini Health Science Foundation ONLUS-Lab SWITH, Lugo, Italy
| | - Valentina Taglioli
- 2 National Institute of Biostructures and Biosystems (NIBB), Rome, Italy.,6 Department of Experimental, Diagnostic and Specialty Medicine, Laboratory of Experimental Cardiology, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Martina Rossi
- 5 Department of Experimental, Diagnostic and Specialty Medicine, Unit of Histology, Embryology and Applied Biology, University of Bologna, Bologna, Italy
| | | | | | - Giuliana Simonazzi
- 8 Division of Obstetrics and Prenatal Medicine, Department of Medical and Surgical Sciences, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesco Alviano
- 5 Department of Experimental, Diagnostic and Specialty Medicine, Unit of Histology, Embryology and Applied Biology, University of Bologna, Bologna, Italy
| | - Laura Bonsi
- 5 Department of Experimental, Diagnostic and Specialty Medicine, Unit of Histology, Embryology and Applied Biology, University of Bologna, Bologna, Italy
| | - Carlo Ventura
- 1 GUNA - ATTRE (Advanced Therapies and Tissue Regeneration), Innovation Accelerator at CNR, Via Gobetti 101, 40129 Bologna, Italy.,2 National Institute of Biostructures and Biosystems (NIBB), Rome, Italy.,9 CNR, Institute of Organic Synthesis and Photoreactivity (Istituto per la Sintesi Organica e la Fotoreattività ISOF), Via Gobetti 101, 40129 Bologna, Italy
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23
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Mostacci B, Bisulli F, Poluzzi E, Cocchi G, Piccinni C, Curti A, Simonazzi G, Astolfi G, Rizzo N, Zenesini C, D'Alessandro R, Tinuper P. Emilia-Romagna Study on Pregnancy and Exposure to Antiepileptic drugs (ESPEA): a population-based study on prescription patterns, pregnancy outcomes and fetal health. J Neurol Neurosurg Psychiatry 2018; 89:983-988. [PMID: 29549194 PMCID: PMC6109238 DOI: 10.1136/jnnp-2017-317833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/13/2017] [Revised: 01/23/2018] [Accepted: 02/21/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess the prevalence of antiepileptic drug (AED) exposure in pregnant women and the comparative risk of terminations of pregnancy (TOPs), spontaneous abortions, stillbirths, major birth defects (MBDs), neonatal distress and small for gestational age (SGA) infants following intrauterine AED exposure in the Emilia Romagna region, Italy (4 459 246 inhabitants on 31 December 2011). METHODS We identified all deliveries and hospitalised abortions in Emilia Romagna in the period 2009-2011 from the certificate of delivery assistance registry (Certificato di Assistenza al Parto- CedAP) and the hospital discharge card registry, exposure to AEDs from the reimbursed drug prescription registries, MBDs from the regional registry of congenital malformations, and Apgar scores and cases of SGA from the CedAP. Records from different registries were linked. RESULTS We identified 145 243 pregnancies: 111 284 deliveries, 16 408 spontaneous abortions and 17 551 TOPs. Six hundred and eleven pregnancies (0.42%; 95% Cl 0.39 to 0.46) were exposed to AEDs. In the AED-exposed group 21% of pregnancies ended in TOPs vs 12% in the non-exposed women (OR: 2.24; 95% CI 1.41 to 3.56). Rates of spontaneous abortions, stillbirths, neonatal distress and SGA were comparable. Three hundred and fifty-three babies (0.31%; 95% CI 0.28 to 0.35) were exposed to AEDs during the first trimester. MBD rates were 2.3% in the exposed vs 2.0% in the non-exposed pregnancies (OR: 1.12, 95% CI 0.55 to 2.55). CONCLUSION The Emilia Romagna prevalence of AED exposure in pregnancy was 0.42%, comparable with previous European studies. Rates of spontaneous abortions, stillbirths, neonatal distress, SGA and MBDs following AED exposure were not significantly increased. The rate of TOPs was significantly higher in the AED-exposed women.
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Affiliation(s)
| | - Francesca Bisulli
- Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Guido Cocchi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.,Division of Neonatology, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Carlo Piccinni
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Alessandra Curti
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.,Division of Prenatal Medicine, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Giuliana Simonazzi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.,Division of Prenatal Medicine, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Gianni Astolfi
- IMER Registry (Emila Romagna Registry of Birth Defects)- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Nicola Rizzo
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy.,Division of Prenatal Medicine, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | | | | | - Paolo Tinuper
- Institute of Neurological Sciences of Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
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24
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Gabrielli L, Bonasoni MP, Foschini MP, Silini EM, Spinillo A, Revello MG, Chiereghin A, Piccirilli G, Petrisli E, Turello G, Simonazzi G, Gibertoni D, Lazzarotto T. Histological Analysis of Term Placentas from Hyperimmune Globulin-Treated and Untreated Mothers with Primary Cytomegalovirus Infection. Fetal Diagn Ther 2018; 45:111-117. [PMID: 29684915 DOI: 10.1159/000487302] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 12/04/2017] [Accepted: 01/29/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Congenital Human Cytomegalovirus Infection Prevention (CHIP) study, a randomized, blinded, placebo-controlled trial, demonstrated that the efficacy of hyperimmune globulin (HIG) was not different from that of placebo regarding transmission of cytomegalovirus (CMV) from mothers to newborns. Our aim was to analyze histologically HIG effects on placentas collected for the CHIP study. MATERIALS AND METHODS Virological and histological analyses were performed on 40 placentas from transmitter and nontransmitter HIG-treated and untreated mothers by assessing the number of CMV-positive cells, tissue viral load, tissue damage, and compensatory mechanisms. RESULTS The HIG and placebo groups showed no significant differences in the number of CMV-positive cells (median number in 10 fields at 10 high-power fields: 2.5 vs. 2, p = 0.969) and viral load (median load: 5 copies/5 ng vs. 10.5 copies/5 ng, p = 0.874). Regarding histological examination, the scores of parameters related to tissue damage and hypoxic parenchymal compensation were higher in transmitters except for chorangiosis, with statistically significant differences observed for chronic villitis (p = 0.007), calcification (p = 0.011), and the total score of tissue damage (p < 0.001). The HIG and placebo groups showed no significant differences for all tissue damage and compensation parameters and overall scores. DISCUSSION HIGs are not able to reduce placental viral load and histological damage, which was significantly associated only with infection.
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Affiliation(s)
- Liliana Gabrielli
- Operative Unit of Clinical Microbiology, St Orsola-Malpighi University Hospital, Bologna,
| | - Maria Paola Bonasoni
- Operative Unit of Pathology, IRCCS "Santa Maria Hospital,", Reggio Emilia, Italy
| | - Maria Pia Foschini
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Enrico Maria Silini
- Unit of Surgical Pathology and Center for Molecular and Translational Oncology, University of Parma, Parma, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, IRCCS-Fondazione Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Maria Grazia Revello
- Department of Obstetrics and Gynecology, IRCCS-Fondazione Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Angela Chiereghin
- Department of Specialized, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giulia Piccirilli
- Department of Specialized, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Evangelia Petrisli
- Operative Unit of Clinical Microbiology, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Gabriele Turello
- Department of Specialized, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giuliana Simonazzi
- Department of Obstetrics and Gynecology, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene and Biostatistics, University of Bologna, Bologna, Italy
| | - Tiziana Lazzarotto
- Department of Specialized, Experimental, and Diagnostic Medicine, Operative Unit of Clinical Microbiology, St Orsola-Malpighi University Hospital, Bologna, Italy
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25
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Guasina F, Bellussi F, Morganelli G, Salsi G, Pilu G, Simonazzi G. Electronic spatiotemporal image correlation improves four-dimensional fetal echocardiography. Ultrasound Obstet Gynecol 2018; 51:357-360. [PMID: 28337810 DOI: 10.1002/uog.17474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/06/2017] [Accepted: 03/17/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To compare the efficiency of electronic spatiotemporal image correlation (eSTIC) with that of conventional STIC to acquire four-dimensional (4D) fetal cardiac volumes of diagnostic quality. METHODS This was a randomized controlled trial of 100 patients in mid-gestation with normal sonograms. In half of the cases, STIC volumes of the fetal heart were obtained with a conventional mechanical 4D probe and in the remaining cases eSTIC volumes were obtained with an electronic 4D probe. Examinations were kept within the timeframe allotted for a standard examination of fetal anatomy, and a maximum of two attempts were made at obtaining a 4D cardiac volume. Datasets were stored on a computer and subsequently analyzed and categorized as being of optimal, satisfactory or inadequate quality, depending on whether or not it was possible to perform an extended basic cardiac examination, including obtaining a three vessels and trachea view, as well as a clear reconstruction of both the aortic and ductal arches in the sagittal plane. RESULTS The eSTIC volume datasets were more frequently of optimal or satisfactory diagnostic quality compared with conventional STIC (94% vs 76%, P < 0.0001). Failure to obtain an eSTIC volume of adequate quality was in all cases the consequence of an unfavorable position of the fetus. CONCLUSIONS Compared with a standard mechanical probe, the electronic 4D probe facilitates acquisition of sonographic cardiac volumes in mid-trimester fetuses. In our hands, eSTIC volumes of optimal or satisfactory diagnostic quality, allowing a detailed offline evaluation of the fetal heart, were obtained in more than 90% of cases within the time frame of a standard examination of fetal anatomy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- F Guasina
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
- GynePro Medical Centers, Bologna, Italy
| | - F Bellussi
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
- GynePro Medical Centers, Bologna, Italy
| | - G Morganelli
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - G Salsi
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
| | - G Pilu
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
- GynePro Medical Centers, Bologna, Italy
| | - G Simonazzi
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
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26
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Capretti MG, Marsico C, Guidelli Guidi S, Ciardella A, Simonazzi G, Galletti S, Gabrielli L, Lazzarotto T, Faldella G. Neonatal and long-term ophthalmological findings in infants with symptomatic and asymptomatic congenital cytomegalovirus infection. J Clin Virol 2017; 97:59-63. [DOI: 10.1016/j.jcv.2017.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 11/01/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022]
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Chiereghin A, Pavia C, Gabrielli L, Piccirilli G, Squarzoni D, Turello G, Gibertoni D, Simonazzi G, Capretti MG, Lanari M, Lazzarotto T. Clinical evaluation of the new Roche platform of serological and molecular cytomegalovirus-specific assays in the diagnosis and prognosis of congenital cytomegalovirus infection. J Virol Methods 2017; 248:250-254. [DOI: 10.1016/j.jviromet.2017.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/03/2017] [Accepted: 08/06/2017] [Indexed: 10/19/2022]
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28
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Bellussi F, Simonazzi G, Salsi G, Guasina F, Pilu G. Real-Time Volume Contrast Imaging in the A Plane with a Four-Dimensional Electronic Probe Facilitates the Evaluation of Fetal Extremities in Midtrimester Sonograms. Fetal Diagn Ther 2017; 43:291-296. [PMID: 28715806 DOI: 10.1159/000477931] [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: 02/07/2017] [Accepted: 05/30/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the efficiency of real-time volume contrast imaging in the A plane (VCI-A) of fetal extremities, compared with conventional two-dimensional ultrasound (2D). METHODS This was a randomized controlled trial of 100 patients undergoing midtrimester sonography. The fetal limbs were imaged with either 2D or VCI-A with a four-dimensional (4D) electronic probe. Time required for the examination, number of images stored, and quality of the documentation were compared. During the study, 6 fetuses with abnormal extremities were scanned with both 2D and VCI-A, and the diagnostic accuracy and quality of the images were also compared. RESULTS In the VCI-A group, the fetal extremities were imaged more rapidly (2.3 ± 1.1 vs. 3.3 ± 0.9 min, p < 0.0001), less images were required to document the examination (5.6 ± 1.4 vs. 7.3 ± 1.6), and an optimal documentation was more frequently obtained (84 vs. 54%, p < 0.0001) compared with the 2D group. In malformed fetuses, a precise diagnosis was achieved with both techniques, although images obtained with VCI-A were found to be of superior quality. CONCLUSIONS Real-time VCI-A with a 4D electronic probe is an effective tool for imaging the fetal extremities in midtrimester examinations and carries some advantages over conventional 2D sonography.
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Affiliation(s)
- Federica Bellussi
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
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29
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Simonazzi G, Curti A, Cervi F, Gabrielli L, Contoli M, Capretti MG, Rizzo N, Guerra B, Farina A, Lazzarotto T. Perinatal Outcomes of Non-Primary Maternal Cytomegalovirus Infection: A 15-Year Experience. Fetal Diagn Ther 2017; 43:138-142. [PMID: 28697499 DOI: 10.1159/000477168] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 04/21/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate perinatal outcomes in case of non-primary maternal cytomegalovirus (CMV) infection. METHODS We performed a retrospective cohort study of pregnant women with active CMV infection referred to our unit over a 15-year period (January 2000 to December 2014). Non-primary infection was diagnosed on the basis of the results of confirmatory serological and virological tests (avidity test, immunoblotting, real-time PCR-DNA). The vertical transmission rate and the percentage of symptomatic congenital infection were determined in this group of patients. RESULTS A total of 205 pregnant women were enrolled. Congenital infection occurred in 7 (3.4%) fetuses/neonates. Symptomatic disease was present at birth in 3 of the 7 congenitally infected neonates (1.5%). Two out of 3 symptomatic newborns presented a pathologic second-trimester ultrasound scan. CONCLUSION Maternal immunity offers substantial protection against intrauterine transmission of CMV infection, but not against disease once the fetus is infected.
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Affiliation(s)
- Giuliana Simonazzi
- Division of Obstetrics and Prenatal Medicine, Department of Medical Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Saccone G, Berghella V, Maruotti GM, Ghi T, Rizzo G, Simonazzi G, Rizzo N, Facchinetti F, Dall'Asta A, Visentin S, Sarno L, Xodo S, Bernabini D, Monari F, Roman A, Eke AC, Hoxha A, Ruffatti A, Schuit E, Martinelli P. Antiphospholipid antibody profile based obstetric outcomes of primary antiphospholipid syndrome: the PREGNANTS study. Am J Obstet Gynecol 2017; 216:525.e1-525.e12. [PMID: 28153662 DOI: 10.1016/j.ajog.2017.01.026] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/02/2017] [Accepted: 01/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Antiphospholipid syndrome is an autoimmune, hypercoagulable state that is caused by antiphospholipid antibodies. Anticardiolipin antibodies, anti-β2 glycoprotein-I, and lupus anticoagulant are the main autoantibodies found in antiphospholipid syndrome. Despite the amassed body of clinical knowledge, the risk of obstetric complications that are associated with specific antibody profile has not been well-established. OBJECTIVE The purpose of this study was to assess the risk of obstetric complications in women with primary antiphospholipid syndrome that is associated with specific antibody profile. STUDY DESIGN The Pregnancy In Women With Antiphospholipid Syndrome study is a multicenter, retrospective, cohort study. Diagnosis and classification of antiphospholipid syndrome were based on the 2006 International revised criteria. All women included in the study had at least 1 clinical criteria for antiphospholipid syndrome, were positive for at least 1 antiphospholipid antibody (anticardiolipin antibodies, anti-β2 glycoprotein-I, and/or lupus anticoagulant), and were treated with low-dose aspirin and prophylactic low molecular weight heparin from the first trimester. Only singleton pregnancies with primary antiphospholipid syndrome were included. The primary outcome was live birth, defined as any delivery of a live infant after 22 weeks gestation. The secondary outcomes were preeclampsia with and without severe features, intrauterine growth restriction, and stillbirth. We planned to assess the outcomes that are associated with the various antibody profile (test result for lupus anticoagulant, anticardiolipin antibodies, and anti-β2 glycoprotein-I). RESULTS There were 750 singleton pregnancies with primary antiphospholipid syndrome in the study cohort: 54 (7.2%) were positive for lupus anticoagulant only; 458 (61.0%) were positive for anticardiolipin antibodies only; 128 (17.1%) were positive for anti-β2 glycoprotein-I only; 90 (12.0%) were double positive and lupus anticoagulant negative, and 20 (2.7%) were triple positive. The incidence of live birth in each of these categories was 79.6%, 56.3%, 47.7%, 43.3%, and 30.0%, respectively. Compared with women with only 1 antibody positive test results, women with multiple antibody positive results had a significantly lower live birth rate (40.9% vs 56.6%; adjusted odds ratio, 0.71; 95% confidence interval, 0.51-0.90). Also, they were at increased risk of preeclampsia without (54.5% vs 34.8%; adjusted odds ratio, 1.56; 95% confidence interval, 1.22-1.95) and with severe features (22.7% vs 13.8%, adjusted odds ratio, 1.66; 95% confidence interval, 1.19-2.49), of intrauterine growth restriction (53.6% vs 40.8%; adjusted odds ratio, 2.31; 95% confidence interval, 1.17-2.61) and of stillbirth (36.4% vs 21.7%; adjusted odds ratio, 2.67; 95% confidence interval, 1.22-2.94). In women with only 1 positive test result, women with anti-β2 glycoprotein-I positivity present alone had a significantly lower live birth rate (47.7% vs 56.3% vs 79.6%; P<.01) and a significantly higher incidence of preeclampsia without (47.7% vs 34.1% vs 11.1%; P<.01) and with severe features (17.2% vs 14.4% vs 0%; P=.02), intrauterine growth restriction (48.4% vs 40.1% vs 25.9%; P<.01), and stillbirth (29.7% vs 21.2% vs 7.4%; P<.01) compared with women with anticardiolipin antibodies and with women with lupus anticoagulant present alone, respectively. In the group of women with >1 antibody positivity, triple-positive women had a lower live birth rate (30% vs 43.3%; adjusted odds ratio,0.69; 95% confidence interval, 0.22-0.91) and a higher incidence of intrauterine growth restriction (70.0% vs 50.0%; adjusted odds ratio,2.40; 95% confidence interval, 1.15-2.99) compared with double positive and lupus anticoagulant negative women. CONCLUSION In singleton pregnancies with primary antiphospholipid syndrome, anticardiolipin antibody is the most common sole antiphospholipid antibody present, but anti-β2 glycoprotein-I is the one associated with the lowest live birth rate and highest incidence of preeclampsia, intrauterine growth restriction, and stillbirth, compared with the presence of anticardiolipin antibodies or lupus anticoagulant alone. Women with primary antiphospholipid syndrome have an increased risk of obstetric complications and lower live birth rate when <1 antiphospholipid antibody is present. Despite therapy with low-dose aspirin and prophylactic low molecular weight heparin, the chance of a liveborn neonate is only 30% for triple-positive women.
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Affiliation(s)
- Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy.
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy
| | - Tullio Ghi
- Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy; Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Giuseppe Rizzo
- Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy; Department of Obstetrics and Gynecology, Università Roma Tor Vergata, Rome, Italy
| | - Giuliana Simonazzi
- Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nicola Rizzo
- Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Fabio Facchinetti
- Department of Obstetrics & Gynecology, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Dall'Asta
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - Silvia Visentin
- Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy; Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Laura Sarno
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy
| | - Serena Xodo
- Department of Gynaecology and Obstetrics, School of Medicine, University of Udine, Udine, Italy
| | - Dalila Bernabini
- Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesca Monari
- Department of Obstetrics & Gynecology, University of Modena and Reggio Emilia, Modena, Italy
| | - Amanda Roman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Ahizechukwu Chigoziem Eke
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ariela Hoxha
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Amelia Ruffatti
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Ewoud Schuit
- Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA
| | - Pasquale Martinelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG), Rome, Italy
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Bellussi F, Ghi T, Youssef A, Cataneo I, Salsi G, Simonazzi G, Pilu G. Intrapartum Ultrasound to Differentiate Flexion and Deflexion in Occipitoposterior Rotation. Fetal Diagn Ther 2017; 42:249-256. [DOI: 10.1159/000457124] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/17/2017] [Indexed: 11/19/2022]
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Bellussi F, Cataneo I, Visentin S, Simonazzi G, Lenzi J, Fantini MP, Mimmi S, Cosmi E, Pilu G. Clinical Validation of the INTERGROWTH-21st Standards of Fetal Abdominal Circumference for the Prediction of Small-for-Gestational-Age Neonates in Italy. Fetal Diagn Ther 2017; 42:198-203. [PMID: 28237993 DOI: 10.1159/000457121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 09/26/2016] [Accepted: 01/03/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To compare the accuracy of the INTERGROWTH-21st (IG-21) with the Italian Society of Ultrasound in Obstetrics and Gynecology (SIEOG) abdominal circumference (AC) standards in the detection of small-for-gestational-age (SGA) fetuses in a high-risk population. MATERIAL AND METHODS Our study included all pregnant patients with an increased risk of placental insufficiency that were seen in two Italian university hospitals between 2014 and 2015. The accuracy of IG-21 and SIEOG AC standards in the detection of SGA neonates was analyzed by means of the area under the receiver operating characteristic curve (ROC-AUC) at 4 gestational age intervals (24-27, 28-31, 32-35, >35 weeks). RESULTS We enrolled 428 patients (278 Italians). There was no significant difference between the ROC-AUC of AC according to IG-21 and SIEOG standards for all birthweight thresholds and gestational intervals that were considered. The diagnostic performance was similar in Italian and non-Italian patients. The accuracy was, however, limited, with values of ROC-AUC ranging between 0.80 and 0.89. CONCLUSIONS The IG-21 and SIEOG AC standards are interchangeable for the diagnosis of SGA fetuses. The diagnostic accuracy is, however, limited. We provide figures that can be used to stratify the probability that an infant will be SGA in an obstetric population at increased risk of growth restriction.
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Affiliation(s)
- Federica Bellussi
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
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Floridia M, Masuelli G, Tamburrini E, Spinillo A, Simonazzi G, Guaraldi G, Degli Antoni AM, Martinelli P, Portelli V, Dalzero S, Ravizza M. HBV coinfection is associated with reduced CD4 response to antiretroviral treatment in pregnancy. HIV Clin Trials 2017; 18:54-59. [PMID: 28067163 DOI: 10.1080/15284336.2016.1276312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the impact of Hepatitis B virus (HBV) coinfection on response to antiretroviral treatment in pregnant women with HIV. METHODS Retrospective analysis of a large case series of pregnant women with HIV in Italy; outcome measures were CD4 changes, HIV viral load, and main pregnancy outcomes (preterm delivery, low birthweight, intrauterine growth restriction, mode of delivery, and major birth defects). RESULTS Rate of HBV coinfection among 1462 pregnancies was 12.0%. Compared to the HBV-uninfected, HBV-coinfected women had a significantly lower median CD4 cell gain between first and third trimester (26.5 vs. 60 cells/mm3, p = 0.034), with similar rate of undetectable (<50 copies/ml) HIV-RNA at third trimester (70.5% vs. 65.2%, p = 0.229), and no differences in all the main maternal and infant outcomes. A multivariable linear regression analysis identified four variables significantly and independently associated with a lower CD4 response in pregnancy: HBV coinfection (-35 cells/mm3), being on antiretroviral treatment at conception (-59.7 cells/mm3), AIDS status (-59.8 cells/mm3) and higher first CD4 levels in pregnancy (-0.24 cells per unitary CD4 increase). CONCLUSIONS HBV coinfection had no adverse influence on the main pregnancy outcomes or on HIV viral load suppression in late pregnancy but was associated with a significantly reduced CD4 response in pregnancy. This effect might have clinical relevance, particularly in women with advanced immune deterioration.
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Affiliation(s)
- Marco Floridia
- a Department of Therapeutic Research and Medicines Evaluation , Istituto Superiore di Sanità , Rome , Italy
| | - Giulia Masuelli
- b Department of Obstetrics and Neonatology , Città della Salute e della Scienza Hospital, and University of Turin , Turin , Italy
| | - Enrica Tamburrini
- c Department of Infectious Diseases , Catholic University , Rome , Italy
| | - Arsenio Spinillo
- d Department of Obstetrics and Gynaecology , IRCCS S. Matteo , Pavia , Italy
| | - Giuliana Simonazzi
- e Department of Medical and Surgical Sciences , Policlinico Sant'Orsola-Malpighi and University of Bologna , Bologna , Italy
| | - Giovanni Guaraldi
- f Department of Medical Specialties, Infectious Diseases Clinic , University of Modena and Reggio Emilia , Modena , Italy
| | - Anna Maria Degli Antoni
- g Department of Infectious Diseases and Hepatology , Azienda Ospedaliera di Parma , Parma , Italy
| | - Pasquale Martinelli
- h Department of Neurosciences, Reproductive and Dentistry Science , University Federico II Naples , Naples , Italy
| | - Vincenzo Portelli
- i Infectious Diseases Unit , S. Antonio Abate Hospital , Trapani , Italy
| | - Serena Dalzero
- j Department of Obstetrics and Gynaecology , DMSD San Paolo Hospital Medical School, University of Milan , Milan , Italy
| | - Marina Ravizza
- j Department of Obstetrics and Gynaecology , DMSD San Paolo Hospital Medical School, University of Milan , Milan , Italy
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Simonazzi G, Cervi F, Zavatta A, Pellizzoni L, Guerra B, Mastroroberto M, Morselli-Labate AM, Gabrielli L, Rizzo N, Lazzarotto T. Congenital Cytomegalovirus Infection: Prognostic Value of Maternal DNAemia at Amniocentesis. Clin Infect Dis 2016; 64:207-210. [PMID: 27986666 DOI: 10.1093/cid/ciw700] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 04/27/2016] [Accepted: 10/16/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human Cytomegalovirus (HCMV) is the most common cause of childhood hearing loss and can lead to neurodevelopmental delay. To date, few studies have examined the correlation between maternal viremia and congenital HCMV infection. The aim of our study was to ascertain if HCMV DNA in the peripheral blood of pregnant women with primary HCMV infection at the time of amniocentesis may have a prognostic value in terms of congenital infection and neonatal symptomatic disease. METHODS We performed a prospective observational study of pregnant women referred to our maternal-fetal medicine division with suspected HCMV infection. Primary infection was diagnosed based on seroconversion for HCMV and/or HCMV immunoglobulin M-positive and low or moderate HCMV immunoglobulin G avidity. At the time of amniocentesis, maternal blood samples were collected and analyzed by means of real-time polymerase chain reaction to determine the presence of viral DNAemia. Fetuses and newborns were evaluated for the presence of congenital infection and symptomatic disease. RESULTS A total of 239 pregnant women were enrolled; 32 blood samples (13.4%) were positive, and 207 (86.6%) were negative for HCMV DNA. The overall rate of transmission was 23.4%. Fifteen infected patients (26.8%) were symptomatic. Vertical transmission occurred in 14 women (43.8%) with positive and 42 (20.3%) with negative results for HCMV DNAemia (P = .006; odds ratio, 3.06; 95% confidence interval, 1.41-6.64). Symptomatic infection occurred in 6 (42.9%) infected fetuses or newborns from women with and in 9 (21.4%) from women without viral DNAemia (P = .16). CONCLUSION Maternal viremia at amniocentesis is associated with a 3-fold greater chance of congenital infection, but it is not correlated with symptomatic disease.
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Affiliation(s)
- Giuliana Simonazzi
- Department of Medical and Surgical Sciences, Division of Obstetrics and Prenatal Medicine, and
| | - Francesca Cervi
- Department of Medical and Surgical Sciences, Division of Obstetrics and Prenatal Medicine, and
| | - Alice Zavatta
- Department of Medical and Surgical Sciences, Division of Obstetrics and Prenatal Medicine, and
| | - Laura Pellizzoni
- Department of Medical and Surgical Sciences, Division of Obstetrics and Prenatal Medicine, and
| | - Brunella Guerra
- Department of Medical and Surgical Sciences, Division of Obstetrics and Prenatal Medicine, and
| | - Marianna Mastroroberto
- Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, and
| | | | - Liliana Gabrielli
- Department of Specialised, Experimental, and Diagnostic Medicine, Division of Microbiology and Virology, St Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Nicola Rizzo
- Department of Medical and Surgical Sciences, Division of Obstetrics and Prenatal Medicine, and
| | - Tiziana Lazzarotto
- Department of Specialised, Experimental, and Diagnostic Medicine, Division of Microbiology and Virology, St Orsola-Malpighi Hospital, University of Bologna, Italy
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Bellussi F, Perolo A, Ghi T, Youssef A, Pilu G, Simonazzi G. Diagnosis of Severe Fetomaternal Hemorrhage with Fetal Cerebral Doppler: Case Series and Systematic Review. Fetal Diagn Ther 2016; 41:1-7. [DOI: 10.1159/000446109] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/11/2016] [Indexed: 11/19/2022]
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Affiliation(s)
- Giuliana Simonazzi
- Department of Medical Surgical Sciences; Division of Obstetrics and Prenatal Medicine; St. Orsola Malpighi Hospital; University of Bologna; Bologna Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry; School of Medicine; University of Naples Federico II; Naples Italy
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology; Division of Maternal-Fetal Medicine; Thomas Jefferson University Hospital; Philadelphia PA USA
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Simonazzi G, Bisulli M, Saccone G, Moro E, Marshall A, Berghella V. Tranexamic acid for preventing postpartum blood loss after cesarean delivery: a systematic review and meta-analysis of randomized controlled trials. Acta Obstet Gynecol Scand 2015; 95:28-37. [DOI: 10.1111/aogs.12798] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/25/2015] [Indexed: 01/16/2023]
Affiliation(s)
- Giuliana Simonazzi
- Department of Medical Surgical Sciences; Division of Obstetrics and Prenatal Medicine; St Orsola Malpighi Hospital; University of Bologna; Bologna Italy
| | - Maria Bisulli
- Department of Medical Surgical Sciences; Division of Obstetrics and Prenatal Medicine; St Orsola Malpighi Hospital; University of Bologna; Bologna Italy
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry; School of Medicine; University of Naples Federico II; Naples Italy
| | - Elisa Moro
- Department of Medical Surgical Sciences; Division of Obstetrics and Prenatal Medicine; St Orsola Malpighi Hospital; University of Bologna; Bologna Italy
| | - Ariela Marshall
- Department of Hematology and Medical Oncology; Dana-Farber Cancer Institute; Boston Massachusetts USA
- Department of Hematology; Massachusetts General Hospital; Boston Massachusetts USA
| | - Vincenzo Berghella
- Department of Obstetrics and Gynecology; Division of Maternal-Fetal Medicine; Thomas Jefferson University Hospital; Philadelphia Pennsylvania USA
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Simonazzi G, Curti A, Bisulli M, Seravalli V, Saccone G, Berghella V. Cervical lacerations in planned versus labor cerclage removal: a systematic review. Eur J Obstet Gynecol Reprod Biol 2015. [PMID: 26209805 DOI: 10.1016/j.ejogrb.2015.06.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the incidence of cervical lacerations with cerclage removal planned before labor compared to after the onset of labor by a systematic review of published studies. STUDY DESIGN Searches were performed in electronic databases from inception of each database to November 2014. We identified all studies reporting the rate of cervical lacerations and the timing of cerclage removal (either before or after the onset of labor). The primary outcome was the incidence of spontaneous and clinically significant intrapartum cervical lacerations (i.e. lacerations requiring suturing). RESULTS Six studies, which met the inclusion criteria, were included in the analysis. The overall incidence of cervical lacerations was 8.9% (32/359). There were 23/280 (6.4%) cervical lacerations in the planned removal group, and 9/79 (11.4%) in the removal after labor group (odds ratio 0.70, 95% confidence interval 0.31-1.57). CONCLUSIONS In summary, planned removal of cerclage before labor was not shown to be associated with statistically significant reduction in the incidence of cervical lacerations. However, since that our data probably did not reach statistical significance because of a type II error, further studies are needed.
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Affiliation(s)
- Giuliana Simonazzi
- Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandra Curti
- Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Bisulli
- Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Viola Seravalli
- Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
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Lazzarotto T, Gabrielli L, Guerra B, Cervi F, Piccirilli G, Simonazzi G, Chiereghin A, Bellini F, Landini MP. Diagnosis and prognosis of congenital CMV infection: a case report and review of the literature. Scand J Clin Lab Invest Suppl 2015; 244:34-40; discussion 39. [PMID: 25083891 DOI: 10.3109/00365513.2014.936679] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Congenital cytomegalovirus (CMV) infection is the leading non-genetic cause of sensori-neural hearing loss and neurodevelopmental sequelae. Despite these alarming facts, the general public healthcare system is often not aware of CMV and not enough is done to prevent congenital CMV infection.We describe the clinical and laboratory monitoring of a case with primary CMV infection occurring before the first trimester of gestation. Specific literature review is included in order to point out major goals achieved in the diagnosis and prognosis of congenital CMV infection and the many questions still unanswered. Serological diagnosis of primary CMV infection was performed based on serum-CMV specific-IgM antibodies, combined with low avidity anti-CMV IgG antibodies. The maternal infection was asymptomatic, as it is for most infections in immunocompetent patients. Therefore, disclosing primary infection depended on specific serological tests during the initial period of pregnancy (before weeks 12-16 of gestation). The invasive (amniocentesis) and non-invasive (ultrasonographic examination) prenatal tests, carried out at 21 weeks gestation, revealed a severe CMV infection in a fetus small for gestational age with ventriculomegaly. The presence of overt ultrasound abnormalities combined with high viral load in the amniotic fluid sampled at the appropriate times was highly suggestive of an unfavourable prognosis. The autopsy performed on the fetus confirmed severe disseminated CMV infection with histological brain damage.
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Affiliation(s)
- Tiziana Lazzarotto
- DIMES, Operative Unit of Clinical Microbiology, Laboratory of Virology, St. Orsola-Malpighi General Hospital, University of Bologna , Bologna , Italy
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Simonazzi G, Bernabini D, Curti A, Bisulli M, Pilu G, Brill CB, Rizzo N, Berghella V. Fetal cerebellar damage in fetuses with severe anemia undergoing intrauterine transfusions. J Matern Fetal Neonatal Med 2015; 29:389-92. [DOI: 10.3109/14767058.2014.1001973] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Simonazzi G, Capelli I, Curti A, Comai G, Rizzo N, La Manna G. Serum and Urinary Neutrophil Gelatinase-associated Lipocalin Monitoring in Normal Pregnancy Versus Pregnancies Complicated by Pre-eclampsia. In Vivo 2015; 29:117-121. [PMID: 25600539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Pre-eclampsia is a syndrome characterized by endothelium dysfunction, systemic inflammation, and kidney injury that could be associated with increased levels of neutrophil gelatinase-associated lipocalin (NGAL). We investigated whether serum and urinary NGAL may have a clinical value in defining the severity of pre-eclampsia. PATIENTS AND METHODS This cross-sectional case-control study enrolled 18 women with pre-eclampsia matched for gestational age with 22 uncomplicated pregnancies. We evaluated the correlation between NGAL levels and blood pressure and 24-hour proteinuria values by linear regression. RESULTS Linear regression disclosed a positive and significant correlation between urinary NGAL and 24-hour proteinuria. Serum NGAL appeared to be higher, but not significantly different, in severe pre-eclampsia. CONCLUSION These preliminary data indicate that NGAL may correlate with an inflammatory renal involvement in severe pre-eclampsia. Further studies would be useful to better estimate the clinical value of an NGAL increase for evaluating the possibility of delivery induction.
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Affiliation(s)
- Giuliana Simonazzi
- Department of Obstetrics and Gynecology, Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Irene Capelli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Alessandra Curti
- Department of Obstetrics and Gynecology, Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Giorgia Comai
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Nicola Rizzo
- Department of Obstetrics and Gynecology, Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Gaetano La Manna
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
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Simonazzi G, Cervi F, Curti A, Puccetti C, Zagonari S, Contoli M, Lazzarotto T, Rizzo N, Guerra B. 86: Fetal and neonatal outcomes of non-primary cytomegalovirus maternal infection: a 13-year follow-up. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.132] [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: 10/24/2022]
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Simonazzi G, Curti A, Murano P, Cervi F, Contoli M, Lazzarotto T, Capretti MG, Rizzo N, Guerra B. Congenital cytomegalovirus infection and small for gestational age infants. Prenat Diagn 2014; 34:765-9. [DOI: 10.1002/pd.4362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/18/2014] [Accepted: 03/19/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Giuliana Simonazzi
- Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St. Orsola Malpighi Hospital; University of Bologna; Bologna Italy
| | - Alessandra Curti
- Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St. Orsola Malpighi Hospital; University of Bologna; Bologna Italy
| | - Paola Murano
- Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St. Orsola Malpighi Hospital; University of Bologna; Bologna Italy
| | - Francesca Cervi
- Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St. Orsola Malpighi Hospital; University of Bologna; Bologna Italy
| | - Margherita Contoli
- Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St. Orsola Malpighi Hospital; University of Bologna; Bologna Italy
| | - Tiziana Lazzarotto
- Department of Specialised, Experimental, and Diagnostic Medicine, Division of Microbiology and Virology, St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Maria Grazia Capretti
- Department of Medical Surgical Sciences, Division of Neonatology, St. Orsola-Malpighi Hospital; University of Bologna; Bologna Italy
| | - Nicola Rizzo
- Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St. Orsola Malpighi Hospital; University of Bologna; Bologna Italy
| | - Brunella Guerra
- Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St. Orsola Malpighi Hospital; University of Bologna; Bologna Italy
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Raone B, Raboni R, Rizzo N, Simonazzi G, Patrizi A. Transepidermal water loss in newborns within the first 24 hours of life: baseline values and comparison with adults. Pediatr Dermatol 2014; 31:191-5. [PMID: 24383609 DOI: 10.1111/pde.12274] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The measurement of transepidermal water loss (TEWL) is important for evaluating the integrity of the barrier function of the stratum corneum. Normal TEWL values in healthy adults and in children ages 2 and older are well known, but few studies have been performed in infants and neonates. TEWL in healthy neonates younger than 24 hours old was assessed and compared with that of an adult study population. We also studied possible correlations between this parameter, gestational age, and mode of delivery. A prospective study was conducted in healthy newborns. The areas tested were the volar forearm and the popliteal fossa. Ninety-nine healthy newborns were enrolled and 33 healthy adults were analyzed as controls. Statistically significant differences were noted between newborns and adults in TEWL (p < 0.01). Newborns had a much higher mean TEWL than adults. Differences in the morphology and physiology between newborn and mature skin can explain the higher TEWL in newborns. Higher TEWL could also be due to the sudden functional adaptation of the skin immediately after delivery, when the newborn transits from a liquid to the dry, gaseous extrauterine environment. Functional evaluation of the neonatal skin barrier is important mainly because maintaining skin integrity facilitates cutaneous adaptation.
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Affiliation(s)
- Beatrice Raone
- Department of Specialised, Experimental and Diagnostic Medicine, Dermatology, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
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Curti A, Zanello M, De Maggio I, Moro E, Simonazzi G, Rizzo N, Farina A. Multivariable evaluation of term birth weight: a comparison between ultrasound biometry and symphysis-fundal height. J Matern Fetal Neonatal Med 2013; 27:1328-32. [PMID: 24147792 DOI: 10.3109/14767058.2013.858241] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To derive a birth weight predictive equation and to compare its diagnostic value with that of ultrasound. METHODS A longitudinal observational cohort study, including singleton pregnancies at term, was performed at St. Orsola-Malpighi Hospital, University of Bologna (Italy). A birth weight prediction formula, including symphysis-fundal height (SFH), BMI, maternal abdominal circumference (mAC) and parity was derived from a general linear model (GLM) (retrospective study). Moreover, on a new series of patients, the fetal weight was estimated by using both GLM and ultrasound using Hadlock formula (prospective study). The residual analysis and the intraclass correlation coefficient (ICC) were used to test the accuracy of methods in predicting birth weight. RESULTS Between January and November 2012, 1034 patients were included in the retrospective study and 44 in the prospective one. The following GLM was derived: estimated birth weight (g) = 1485.61 + (SFH (cm) × 23.37) + (11.62 (cm) × mAC) + [BMI × (-6.81)] + (parity (0 = nulliparous, 1 = multiparous) × 72.25). When prospectively applied, the GLM and ultrasound provided a percentage of prediction within ±10% of the actual weight of 73% and 84%, respectively. Ultrasound estimation, as opposite of GLM one, was significantly associated with neonatal weight (R(2 )= 0.388, F = 26.607, p value <0.001, ICC = 0.767). CONCLUSIONS Although ultrasound biometry has provided the best values in fetal weight estimation, the predictive performance of both methods is limited.
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Affiliation(s)
- Alessandra Curti
- Department of Medicine and Surgery DIMEC, Division of Prenatal Medicine, St. Orsola Malpighi Hospital, University of Bologna , Bologna , Italy
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Sanlorenzo O, Farina A, Pula G, Zanello M, Pedrazzi A, Martina T, Gabrielli S, Simonazzi G, Rizzo N. Sonographic evaluation of the lower uterine segment thickness in women with a single previous Cesarean section. Minerva Ginecol 2013; 65:551-555. [PMID: 24096291] [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: 06/02/2023]
Abstract
AIM The aim of this paper was to evaluate the lower uterine segment (LUS) thickness through transvaginal sonography in late preterm and full term pregnancies with a single previous Cesarean section, to correlate the obtained LUS measurements with intraoperative observations, and to identify a predictive cut-off value in order to select the best candidates for a vaginal birth after Cesarean delivery (VBAC). METHODS Two hundred and fourteen women with a single previous Cesarean section who had an ultrasound measurement of the LUS thickness (stratified in S1, S2 and S3) in pregnancy were enrolled. The outcome of interest was the visual finding of a thin uterine scar at the time of the iterative Cesarean section. Linear regression was used to correlate the LUS thickness with gestational age (GA). A ROC curve has been used to determine the detection rate (DR) and the risk of each actual value of LUS thickness versus a thin uterine scar (outcome of interest). RESULTS The LUS thickness was correlated with the gestational age (R2=0.034, P-value =0.005). The DR as estimated by ROC curves to detect a translucent lower uterine segment (S3) was 94.1% at a false positive rate (FPR) of 20%. The correspondent cut-off value was 1.8 mm. Finally a likelihood ratio (LR) of observing S3 was estimated. At the quoted cut-off of 1.8 mm the LR was 3. As demonstrated, for a segment of 1 mm the LR was instead about 13. CONCLUSION The obtained values lead us to the conclusion that a thickness less than 1.8 mm can be reasonably considered a valid cut-off value to identify patients with a higher risk of thin uterine scar.
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Affiliation(s)
- O Sanlorenzo
- Department of Obstetrics and Prenatal Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy -
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Berghella V, Ludmir J, Simonazzi G, Owen J. Transvaginal cervical cerclage: evidence for perioperative management strategies. Am J Obstet Gynecol 2013; 209:181-92. [PMID: 23416155 DOI: 10.1016/j.ajog.2013.02.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/04/2013] [Accepted: 02/10/2013] [Indexed: 12/20/2022]
Abstract
The objective was to review the evidence supporting various perioperative technical and management strategies for transvaginal cervical cerclage. We performed MEDLINE, PubMed, EMBASE, and COCHRANE searches with the terms, cerclage, cervical cerclage, cervical insufficiency, and randomized trials, plus each technical aspect (eg, suture, amniocentesis, etc) considered. The search spanned 1966 through September 2012 and was not restricted by language. Each retrieved manuscript was carefully evaluated, and any pertinent references from the reports were also obtained and reviewed. All randomized trials covering surgical and selected perioperative, nonsurgical aspects of cerclage were included in the review. The evidence was assessed separately for history-, ultrasound-, and physical examination-indicated cerclage. Evidence levels according to the new method outlined by the US Preventive Services Task Force were assigned based on the evidence. There are no grade A high-certainty recommendations regarding technical aspects of transvaginal cervical cerclage. Grade B moderate-certainty recommendations include performing a fetal ultrasound before cerclage to ensure fetal viability, confirm gestational age, and assess fetal anatomy to rule out clinically significant structural abnormalities; administering spinal, and not general, anesthesia; performing a McDonald cerclage, with 1 stitch, placed as high as possible; and outpatient setting. Unfortunately, no other recommendations can be made regarding the other technical aspects of cerclage.
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Affiliation(s)
- Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
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Simonazzi G, Curti A, Rapacchia G, Gabrielli S, Pilu G, Rizzo N, Pozzati E. Symptomatic cerebral cavernomas in pregnancy: a series of 6 cases and review of the literature. J Matern Fetal Neonatal Med 2013; 27:261-4. [DOI: 10.3109/14767058.2013.809417] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Simonazzi G, Curti A, Cattani L, Rizzo N, Pilu G. Outcome of severe placental insufficiency with abnormal umbilical artery Doppler prior to fetal viability. BJOG 2013; 120:754-7. [DOI: 10.1111/1471-0528.12133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2012] [Indexed: 12/01/2022]
Affiliation(s)
- G Simonazzi
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
| | - A Curti
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
| | - L Cattani
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
| | - N Rizzo
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
| | - G Pilu
- Department of Obstetrics and Gynecology; St. Orsola Malpighi Hospital; University of Bologna; Bologna; Italy
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Simonazzi G, Curti A, Moro E, Pedrazzi A, Martina T, Farina A, Rizzo N. 89: Neonatal respiratory morbidity and mode of delivery between 34+0 and 36+6 weeks of gestation. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.254] [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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