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Berlanda N, Alio W, Angioni S, Bergamini V, Bonin C, Boracchi P, Candiani M, Centini G, D'Alterio MN, Del Forno S, Donati A, Dridi D, Incandela D, Lazzeri L, Maiorana A, Mattei A, Ottolina J, Orenti A, Perandini A, Perelli F, Piacenti I, Pino I, Porpora MG, Scaramuzzino S, Seracchioli R, Solima E, Somigliana E, Venturella R, Vercellini P, Viganò P, Vignali M, Zullo F, Zupi E. Impact of endometriosis on obstetric outcome after natural conception: a multicenter Italian study. Arch Gynecol Obstet 2021; 305:149-157. [PMID: 34623489 PMCID: PMC8782812 DOI: 10.1007/s00404-021-06243-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
Purpose To evaluate obstetric outcome in women with endometriosis who conceive naturally and receive standard obstetric care in Italy. Methods Cases were consecutive women with endometriosis managed in eleven Italian referral centers. Controls were women in whom endometriosis was excluded. All women filled in a questionnaire addressing previous natural pregnancies. Marginal logistic regression models were fitted to evaluate the impact of endometriosis on obstetric outcome. A post hoc analysis was performed within the endometriosis group comparing women with severe adenomyosis versus women with absent or mild adenomyosis. Results Three hundred and fifty-five pregnancies in endometriosis group and 741 pregnancies in control group were included. Women with endometriosis had a higher risk of preterm delivery < 34 weeks (6.4% vs 2.8%, OR 2.42, 95% CI 1.22–4.82), preterm delivery < 37 weeks (17.8% vs 9.7%, OR 1.98, 95% CI 1.23–3.19), and neonatal admission to Intensive Care Unit (14.1% vs 7.0%, OR 2.04, 95% CI 1.23–3.36). At post hoc analysis, women with endometriosis and severe adenomyosis had an increased risk of placenta previa (23.1% vs 1.8%, OR 16.68, 95% CI 3.49–79.71), cesarean delivery (84.6% vs 38.9%, OR 8.03, 95% CI 1.69–38.25) and preterm delivery < 34 weeks (23.1% vs 5.7%, OR 5.52, 95% CI 1.38–22.09). Conclusion Women with endometriosis who conceive naturally have increased risk of preterm delivery and neonatal admission to intensive care unit. When severe adenomyosis is coexistent with endometriosis, women may be at increased risk of placenta previa and cesarean delivery. Trial registration Clinical trial registration number: NCT03354793.
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Affiliation(s)
- N Berlanda
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy
| | - W Alio
- Department of Obstetrics and Gynecology, Ospedale Civico, Piazza Nicola Leotta 4, 90127, Palermo, Italy
| | - S Angioni
- Department of Surgical Sciences, Università di Cagliari, Cittadella Universitaria, 09042, Cagliari, Italy
| | - V Bergamini
- Azienda Ospedaliera Universitaria Integrata, Università di Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - C Bonin
- Azienda Ospedaliera Universitaria Integrata, Università di Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - P Boracchi
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry "G. A. Maccacaro", Università di Milano, Via Vanzetti 5, 20133, Milan, Italy
| | - M Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - G Centini
- Department of Gynecology, Università di Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, Università di Siena, Strada delle Scotte 4, 53100, Siena, Italy
| | - M N D'Alterio
- Department of Surgical Sciences, Università di Cagliari, Cittadella Universitaria, 09042, Cagliari, Italy
| | - S Del Forno
- Gynaecology and Human Reproduction Physiopathology Unit, Department of Medical and Surgical Sciences, DIMEC, Sant'Orsola Hospital, Università di Bologna, Via Massarenti 13, 40138, Bologna, Italy
| | - A Donati
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy
| | - D Dridi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy
| | - D Incandela
- Department of Obstetrics and Gynecology, Ospedale Civico, Piazza Nicola Leotta 4, 90127, Palermo, Italy
| | - L Lazzeri
- Department of Gynecology, Università di Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, Università di Siena, Strada delle Scotte 4, 53100, Siena, Italy
| | - A Maiorana
- Department of Obstetrics and Gynecology, Ospedale Civico, Piazza Nicola Leotta 4, 90127, Palermo, Italy
| | - A Mattei
- Division of Gynaecology and Obstetrics, Santa Maria Annunziata Hospital, USL Toscana Centro, Via Antella 58, 50012, Florence, Italy
| | - J Ottolina
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - A Orenti
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry "G. A. Maccacaro", Università di Milano, Via Vanzetti 5, 20133, Milan, Italy
| | - A Perandini
- Azienda Ospedaliera Universitaria Integrata, Università di Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - F Perelli
- Division of Gynaecology and Obstetrics, Santa Maria Annunziata Hospital, USL Toscana Centro, Via Antella 58, 50012, Florence, Italy
| | - I Piacenti
- Department of Maternal and Child Health and Urology, Università di Roma La Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - I Pino
- Preventive Gynecology Unit, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - M G Porpora
- Department of Maternal and Child Health and Urology, Università di Roma La Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - S Scaramuzzino
- Department of Maternal and Child Health and Urology, Università di Roma La Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy
| | - R Seracchioli
- Gynaecology and Human Reproduction Physiopathology Unit, Department of Medical and Surgical Sciences, DIMEC, Sant'Orsola Hospital, Università di Bologna, Via Massarenti 13, 40138, Bologna, Italy
| | - E Solima
- Department of Obstetrics and Gynecology, Macedonio Melloni Hospital, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Melloni 52, 20129, Milan, Italy
| | - E Somigliana
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy.
| | - R Venturella
- Department of Clinical and Experimental Medicine, Magna Graecia University of Catanzaro, Viale Europa, 88100, Catanzaro, Italy
| | - P Vercellini
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via della Commenda 12, 20122, Milan, Italy
| | - P Viganò
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - M Vignali
- Department of Obstetrics and Gynecology, Macedonio Melloni Hospital, Milan, Italy
| | - F Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Università di Napoli Federico II, Via Pansini 5, 80131, Naples, Italy
| | - E Zupi
- Department of Gynecology, Università di Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, Università di Siena, Strada delle Scotte 4, 53100, Siena, Italy
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Porpora MG, Scaramuzzino S, Sangiuliano C, Piacenti I, Bonanni V, Piccioni MG, Ostuni R, Masciullo L, Benedetti Panici PL. High prevalence of autoimmune diseases in women with endometriosis: a case-control study. Gynecol Endocrinol 2020; 36:356-359. [PMID: 31476950 DOI: 10.1080/09513590.2019.1655727] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The immune system seems to be involved in the pathogenesis of endometriosis. Peritoneal chronic inflammation is present and natural killer cells and macrophages abnormalities have been reported in women with the disease. Moreover, a higher production of serum autoantibodies has been found, which could be related to various factors; some still need to be clarified. The correlation between endometriosis and autoimmune diseases is still unclear with few and conflicting available data. The aim of this study was to evaluate the prevalence of autoimmune diseases, as conditions with a possible common pathogenetic factor, in women affected by endometriosis, in order to address future research on its pathogenesis. This retrospective case-control study includes one hundred and forty-eight women with endometriosis and 150 controls. All women were aged between 18 and 45. Informed consent was obtained from all participants of the study. Considered autoimmune diseases include systemic lupus erythematosus (SLE), celiac disease (CD), inflammatory bowel disease (IBD), and autoimmune thyroiditis. Statistical comparison of patients and control group was performed by means of chi-square test or Fisher's exact test as appropriate. Statistical comparison of parametric variable (age) among the groups was performed by t-test for unpaired data. Age was expressed as mean. A value of .05 or less was considered as significant. In the case group, five patients were affected by IBD, while the disease was not observed in the control group (p = .07). SLE was found in eight patients in the case group, while only one was found in the control group (p = .01). Fifteen women in the case group were affected by CD, while the disease was present only in one woman in the control group (p<.0001). A significant correlation was also found between endometriosis and autoimmune thyroiditis: 80 patients with endometriosis had thyroid diseases versus 14 patients in the control group (p<.0001). Our study reports an association between endometriosis and autoimmune disorders, showing a higher prevalence of autoimmune diseases in women affected by endometriosis. These results support a possible autoimmune pathogenesis of endometriosis.
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Affiliation(s)
- M G Porpora
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - S Scaramuzzino
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - C Sangiuliano
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - I Piacenti
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - V Bonanni
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - M G Piccioni
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - R Ostuni
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - L Masciullo
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - P L Benedetti Panici
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
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Imperiale L, Manganaro L, Ticino A, Piacenti I, Anastasi E, Resta S, Benedetti Panici P, Porpora MG. Endometriosis and Glanzmanns thrombasthenia. J BIOL REG HOMEOS AG 2016; 30:877-882. [PMID: 27655515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Glanzmanns thrombasthenia (GT) is a rare bleeding syndrome characterized by deficiency or defect of platelet aggregation complex. The pathogenesis of endometriosis is controversial but the strongest evidence leans towards retrograde menstruation. GT probably predisposes to endometriosis. The management of women affected by this disease can be difficult due to the risk of bleeding complications, especially during surgical treatment. We describe the cases of three sisters affected by endometriosis and GT, referred to our Department, who received different therapeutic management.
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Affiliation(s)
- L Imperiale
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Policlinico Umberto I, Rome, Italy
| | - L Manganaro
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - A Ticino
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Policlinico Umberto I, Rome, Italy
| | - I Piacenti
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Policlinico Umberto I, Rome, Italy
| | - E Anastasi
- Department of Molecular Medicine, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - S Resta
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Policlinico Umberto I, Rome, Italy
| | - P Benedetti Panici
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Policlinico Umberto I, Rome, Italy
| | - M G Porpora
- Department of Gynecology, Obstetrics and Urology, Sapienza, University of Rome, Policlinico Umberto I, Rome, Italy
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Marchetti C, Palaia I, De Felice F, Musella A, Donfracesco C, Vertechy L, Romito A, Piacenti I, Musio D, Muzii L, Tombolini V, Benedetti Panici P. Tyrosine-kinases inhibitors in recurrent platinum-resistant ovarian cancer patients. Cancer Treat Rev 2015; 42:41-6. [PMID: 26559739 DOI: 10.1016/j.ctrv.2015.10.011] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/29/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
For many decades, ovarian cancer (OC) has been one of the most common gynecological cancer. Despite advances in OC diagnosis and treatment, the risk of recurrence is ever present and approximately 85% of patients will experience relapse. Recurrent OC after first-line therapy is almost always incurable. Multiple novel therapies, including tyrosine-kinases inhibitors (TKI), have shown promising results, but their role needs to be clarified. In this review we describe the rationale and the clinical evidence regarding the use of TKI for the treatment of recurrent platinum-resistant OC patients.
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Affiliation(s)
- C Marchetti
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy.
| | - I Palaia
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy.
| | - F De Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
| | - A Musella
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy.
| | - C Donfracesco
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy.
| | - L Vertechy
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy.
| | - A Romito
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy.
| | - I Piacenti
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy.
| | - D Musio
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
| | - L Muzii
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy.
| | - V Tombolini
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
| | - P Benedetti Panici
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy.
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