Publications by authors named "Fabio Facchinetti"

220 Publications

BRCA mutation carriers' perception about benefits and risks associated with combined hormonal contraceptives use.

Eur J Contracept Reprod Health Care 2022 Aug 10:1-6. Epub 2022 Aug 10.

Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI), University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.

Objective: To evaluate the actual perceptions about combined hormonal contraceptives (CHCs) use in BRCA mutation carriers in comparison to women from the general population.

Methods: This was a cross-sectional, observational study involving two Italian referral centres for hereditary cancers. An identical questionnaire investigating how CHC use could affect the risk of developing some types of cancer, specific diseases, and symptoms was administered to 85 BRCA mutation carriers and 85 healthy women without this genetic mutation (control group). Women's perceptions were evaluated using specific questions and Likert scales (-5 to +5).

Results: Perceptions about the effects of CHC use on developing specific diseases and symptoms did not differ between BRCA mutation carriers and controls. Conversely, the protective effects of CHC use on colorectal ( = .02), uterine body ( = .01) and ovarian ( = .01) cancers were unknown by BRCA mutation carriers. Moreover, BRCA mutation carriers recognised the association between CHC use and a higher risk of breast ( = .0008) and uterine cervix cancer ( = .007).

Conclusions: Investing time and effort in transmitting the correct key messages about oncological risk related to CHC use could potentially increase their use in BRCA mutation carriers.
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http://dx.doi.org/10.1080/13625187.2022.2107199DOI Listing
August 2022

How adenomyosis changes throughout pregnancy: a retrospective cohort study.

Int J Gynaecol Obstet 2022 Aug 5. Epub 2022 Aug 5.

Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy.

Objective: To study how adenomyosis modifies during pregnancy and to possibly correlate these changes to maternal and fetal outcomes METHODS: Retrospective exploratory cohort study including 254 women with a pre-conceptional/1st trimester scan to document adenomyosis and known obstetric outcome. If visible, adenomyosis signs were documented in each trimester and post-partum. Mann Whitney U-tests or Chi-square tests were used for continuous/categorical variables respectively.

Results: A globular uterus was reported in 79% women with adenomyosis in the 1st trimester, in 38% and 2% women in the 2nd and 3rd trimester respectively and in the post-partum in 65% women. Asymmetrical thickening (30%) and cysts (23%) were only visible in 1st trimester. Adenomyosis was associated with miscarriage (OR 5.9, CI95% 2.4-14.9, p<0.001) also in normal conception only (OR 5.1 95%CI 1.8-14.2, p=0.002) or adjusting for maternal age (aOR 5.9, CI95% 2.3-15.2, p<0.001). Gestational age at delivery was lower in adenomyosis (p=0.004); the Caesarean Section (CS) rate was higher than in controls (OR 2.5, CI95% 1.3-4.8, p=0.007) also adjusting for age (aOR 2.07, CI95% 1.06-4.08, p=0.035).

Conclusions: Signs of adenomyosis were visible but progressively disappeared in pregnancy; adenomyosis was associated with an increased risk of early miscarriage. Prospective studies are needed to confirm our results.
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http://dx.doi.org/10.1002/ijgo.14383DOI Listing
August 2022

Chronic endometritis in recurrent implantation failure: Use of prednisone and IVF outcome.

J Reprod Immunol 2022 Jul 14;153:103673. Epub 2022 Jul 14.

Unit of Reproductive Medicine, Institute of Obstetrics and Gynecology, Mother Infant Department, University Hospital Policlinico of Modena, 41125 Modena, Italy.

In recurrent implantation failure patients (RIF), the main criteria for diagnosis of chronic endometritis, is the presence of plasma cells CD138 in endometrial biopsy. The aim of the present study was to evaluate if treatment with prednisone, in patients with RIF and chronic endometritis, improve IVF outcome. A retrospective study was performed between 2019 and 2020. A total of 27 patients with RIF and an endometrial biopsy positive for CD56 cells were enrolled. The treatment with prednisone 10 mg per day is began together with controlled ovarian stimulation (COS). Among endometrial biopsies, 13 (48.14%) were positive also for CD138 cells, and an antibiotic treatment was added. In all patients, after therapy, in the subsequent IVF cycle, the clinical pregnancy rate was 25.9% and the live birth rate was 22.2%. Analysing pregnancies according to the percentage of CD 56 cells on endometrial biopsy, the live birth rate in the subgroup of patients with marked endometritis (defined by the presence of >10% CD56cells) was 29.41%, while in the subgroup with mild endometritis (CD 56 >5% and <10%) was 10%. In the subgroup with mild endometritis with CD 138 positive the live birth was 25%, while in patients with CD 138 negative no live birth were observed. In patients with RIF the count of at least two cell types (CD 138 and CD 56 cells) on endometrial biopsies is advisable. Our study suggests a benefit of prednisone and antibiotic treatment on live birth rate in a subsequent IVF cycle.
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http://dx.doi.org/10.1016/j.jri.2022.103673DOI Listing
July 2022

Contraception During Perimenopause: Practical Guidance.

Int J Womens Health 2022 15;14:913-929. Epub 2022 Jul 15.

Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, 41124, Italy.

Climacteric is by no means in itself a contraindication to safe contraception. On the contrary, there are several conditions related to the perimenopause that could benefit from the use of modern contraceptives, mainly hormonal, with the goals of avoiding unintended pregnancies and giving further possible benefits beyond contraception (menstrual cycle control, a reduction of vasomotor symptoms and menstrual migraines, a protection against bone loss, a positive oncological risk/benefit balance). This narrative review aims to provide practical guidance on their possible use in this particular life stage, both short- and long-acting reversible contraceptives, and to assist clinicians for women transitioning from contraception to their menopausal years, including the possible initiation of postmenopausal hormone therapy. Comprehensive contraceptive counselling is an essential aspect of the overall health and wellbeing of women and should be addressed with each such patient irrespective of age.
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http://dx.doi.org/10.2147/IJWH.S288070DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9296102PMC
July 2022

Prelabour rupture of the membranes at term: antibiotic overuse in Italy.

Minerva Obstet Gynecol 2022 Jul 13. Epub 2022 Jul 13.

Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy -

Background: The proper management of women with premature rupture of membrane (PROM) and not spontaneously entering in labour remains controversial. The aim of this study was to identify the current management for women with PROM at term according to the Group B Streptococcus (GBS) status across different Italian hospitals.

Methods: Anonymous online survey evaluating: the current practice of women with PROM in terms of management (expectant management vs. induction of labour) and antibiotic prophylaxis according to GBS status.

Results: In case of negative GBS status, the 82.4% of respondents wait until 24 hours before labour induction. Antibiotics are administered for prophylaxis in 35.3%, 27.5% and 2% at 18, 12 and 24 hours respectively. The remaining 35.3% of respondents are divided between those using antibiotics only with signs of infections or according to different risk factors (i.e. meconium-stained amniotic fluid or suspected infection). Neonates born from a mother with negative GBS status almost never (90.2%) receive prophylactic antibiotics. In case of positive GBS status, induction is started as soon as possible by 49.1% of respondents; the remnants choose to wait 6 (15.7%), 12 (17.6%), 18 (3.9%) and 24 (13.7%) hours. Antibiotics are administered as soon as possible by 78.4% of clinicians. In the neonates, 51% of neonatologist administer antibiotics upon clinical indications (suspected sepsis); 15.7% use antibiotics routinely or with a short interval between maternal antibiotics and delivery (17.6%).

Conclusions: The management after PROM is highly heterogeneous with an inappropriate extension of antibiotic prophylaxis in cases with negative GBS status.
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http://dx.doi.org/10.23736/S2724-606X.22.05145-4DOI Listing
July 2022

Screening for low-tract genital infections in women with threatened preterm labour. Which role?

Gynecol Obstet Invest 2022 Jun 22. Epub 2022 Jun 22.

Objectives: to evaluate the possible relationship between cultural specimens and preterm birth in women admitted for threatened preterm labour. Preterm birth is the leading cause of neonatal mortality and antenatal hospitalization: several risk factors including intrauterine infections have been identified but its real causes remain poorly understood.

Design: retrospective, multicentre, cohort study including 250 women admitted for threatened preterm labour. Methods, Participants/Materials, Setting: all women admitted for threatened Preterm Labour, i.e. presenting with cervical changes and uterine activity before 37 weeks at the Obstetrics Unit of the hospitals of Modena, Monza, Carate and Vimercate were included in the study. We excluded twin pregnancies and cases with preterm premature rupture of membranes at admission. Data about maternal history, pregnancy complications, cervical length, vaginal swabs and urine culture at admission and gestational age at delivery were collected from clinical records in order to compare the incidence of preterm birth according to some known risk factors, cervical length and microbiological test at admission.

Results: 250 women were included in the study; preterm birth at less than 37 weeks occurred in 44.4% women admitted for threatened preterm labour. The incidence of preterm birth was not different between those with a positive or a negative vaginal swab (45.7% vs. 39%, p=0.38), or positive vs. negative urine culture (31.8% vs. 42.1%, p=0.23) at admission. A shorter cervical length at admission was found in women with subsequent preterm birth (17± vs 19.5± mm, p=0.03). Cervical length <15 mm (OR 1.82, CI95% 1.03-3.23, p=0.039) predicted the risk of PTB. Further, only the history of a previous preterm birth (p=0.02) and a previous uterine curettage (p=0.045) were associated with preterm birth.

Limitations: the observational and retrospective nature of the study and its small sample size are important limitations of the study. Moreover, women were not systematically or randomly assigned to the screening for vaginal or urinary infections.

Conclusions: there is no evidence that the search for vaginal or urinary infections in women admitted for threatened preterm labour is helpful to identify those at increased risk of preterm birth. Although several studies have explored the role of screening for bacterial vaginosis in asymptomatic women and some studies evaluated vaginal or urinary infections in women with PTB, none of them focused on the possible role of microbiological specimens as a predictive tool in women admitted for threatened PTL. No association was found in our study but prospective randomized controlled trials are required to confirm the results of this observation.
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http://dx.doi.org/10.1159/000525245DOI Listing
June 2022

Nutraceuticals and polycystic ovary syndrome: a systematic review of the literature.

Gynecol Endocrinol 2022 Jun 17:1-9. Epub 2022 Jun 17.

Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy.

Background: This study proposes a review of nutraceuticals used in the treatment of typical symptoms of Polycystic Ovary Syndrome (PCOS).The aim is to provide a classification of the most widely used nutraceutical supplements identifying the most effective nutraceuticals on glucose and insulin metabolism, the androgenic hormone profile, fertility, ovulatory capacity, inflammation, and oxidative stress.

Material And Methods: We included randomized controlled trials on PCOS patients undergoing administration of nutraceuticals, in particular vitamin D, vitamin E, probiotics, and inositols. These administrations are variable in terms of dosage, single supplementation, or combined with other compounds, dosage, and duration of the intervention.

Results: The supplementation of inositols, at the physiologic ratio of 40: 1 of myo- and D-chiro-inositols, resulted to be the most effective in improving the glucose homeostasis and fertility, with a restoration of ovulatory capacity and menstrual regularity. Other nutraceuticals are particularly effective in reducing hyperandrogenism, with promising results demonstrated by the combinations of vitamin D and probiotics, vitamin E and coenzyme Q10, and the enrichment of inositol therapy with group B vitamins. An improvement in the inflammatory status and antioxidant capacity is obtained with the co-supplementation of probiotics and selenium or with vitamin E combined with omega 3.

Conclusions: Inositol supplementation is effective in the treatment of insulin resistance and fertility. Probiotics reduced hyperandrogenism, inflammatory and oxidative conditions, and resulted more effective when combined with selenium. Although these results proved to be satisfactory, further studies are needed with larger samples and a more homogeneous analysis of the outcomes.
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http://dx.doi.org/10.1080/09513590.2022.2089106DOI Listing
June 2022

Perinatal outcomes in twin late preterm pregnancies: results from an Italian area-based, prospective cohort study.

Ital J Pediatr 2022 Jun 16;48(1):101. Epub 2022 Jun 16.

Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41125, Modena, Italy.

Background: Multiple gestations represent a considerable proportion of pregnancies delivering in the late preterm (LP) period. Only 30% of LP twins are due to spontaneous preterm labor and 70% are medically indicated; among this literature described that 16-50% of indicated LP twin deliveries are non-evidence based. As non-evidence-based delivery indications account for iatrogenic morbidity that could be prevented, the objective of our observational study is to investigate first neonatal outcomes of LP twin pregnancies according to gestational age at delivery, chorionicity and delivery indication, then non evidence-based delivery indications.

Methods: Prospective cohort study among twins infants born between 34 + 0 and 36 + 6 weeks, in Emilia Romagna, Italy, during 2013-2015. The primary outcome was a composite of adverse perinatal outcomes.

Results: Among 346 LP twins, 84 (23.4%) were monochorionic and 262 (75.7%) were dichorionic; spontaneous preterm labor accounted for 85 (24.6%) deliveries, preterm prelabor rupture of membranes for 66 (19.1%), evidence based indicated deliveries were 117 (33.8%), while non-evidence-based indications were 78 (22.5%). When compared to spontaneous preterm labor or preterm prelabor rupture of membranes, pregnancies delivered due to maternal and/or fetal indications were associated with higher maternal age (p <  0.01), higher gestational age at delivery (p <  0.01), Caucasian race (p 0.04), ART use (p <  0.01), gestational diabetes (p <  0.01), vaginal bleeding (p <  0.01), antenatal corticosteroids (p <  0.01), diagnosis of fetal growth restriction (FGR) (p <  0.01), and monochorionic (p <  0.01). Two hundred twenty-six pregnancies (65.3%) had at least one fetus experiencing one composite of adverse perinatal outcome. Multivariate analysis confirmed that delivery indication did not affect the composite of adverse perinatal outcomes; the only characteristic that affect the outcome after controlling for confounding was gestational age at delivery (p <  0.01). Moreover, there was at least one adverse neonatal outcome for 94% of babies born at 34 weeks, for 73% of those born at 35 weeks and for 46% of those born at 36 weeks (p <  0.01).

Conclusion: Our study suggests that the decision to deliver or not twins in LP period should consider gestational age at delivery as the main determinant infants' prognosis. Delivery indications should be accurately considered, to avoid iatrogenic early birth responsible of preventable complications.
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http://dx.doi.org/10.1186/s13052-022-01297-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9204959PMC
June 2022

Stillbirth occurrence during COVID-19 pandemic: a population-based prospective study.

J Perinat Med 2022 Jul 7;50(6):653-659. Epub 2022 Jun 7.

Obstetrics and Gynecology Unit, Mother-Infant and Adult Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.

Objectives: Data collected worldwide on stillbirth (SB) rates during the Covid-19 pandemic are contradictory. Variations may be due to methodological differences or population characteristics. The aim of the study is to assess the changes in SB rate, risk factors, causes of death and quality of antenatal care during the pandemic compared to the control periods.

Methods: This prospective study is based on the information collected by the Emilia-Romagna Surveillance system database. We conducted a descriptive analysis of SB rate, risk factors, causes of death and quality of cares, comparing data of the pandemic (March 2020-June 2021) with the 16 months before.

Results: During the pandemic, the SB rate was 3.45/1,000 births, a value in line with the rates of previous control periods. Neonatal weight >90th centile was the only risk factor for SB that significantly changed during the pandemic (2.2% vs. 8.0%; p-value: 0.024). No significant differences were found in the distribution of the causes of death groups. Concerning quality of antenatal cares, cases evaluated with suboptimal care (5.2%) did not change significantly compared to the control period (12.0%), as well as the cases with less than recommended obstetric (12.6% vs. 14%) and ultrasound evaluations (0% vs. 2.7%).

Conclusions: During the COVID-19 pandemic, no significant differences in SB rates were found in an area that maintained an adequate level of antenatal care. Thus, eventual associations between SB rate and the COVID-19 infection are explained by an indirect impact of the virus, rather than its direct effect.
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http://dx.doi.org/10.1515/jpm-2022-0129DOI Listing
July 2022

Complete hydatidiform mole in higher-order multiple pregnancies.

Minerva Obstet Gynecol 2022 Jun;74(3):308-313

Prenatal Medicine Unit, Service of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy -

Molar degeneration of the trophoblast is a rare, yet possible, complication of pregnancies. Complete hydatidiform mole is the most common histological type among all trophoblastic tumors and it is the result of the fertilization of an empty oocyte from two sperms or by one sperm that then duplicates. Complete mole is characterized by hydropic degeneration of abnormal chorionic villi, diffused trophoblast hyperplasia and the absence of identifiable embryonic or fetal tissue; the hyperplastic trophoblast justifies the common finding of high serum beta HCG levels. Twin molar pregnancy is an uncommon obstetric event, and even less frequent are triplet/quadruplet molar pregnancies. We hereby report a case of a complete hydatidiform mole with two coexistent fetuses in a triplet pregnancy after in vitro fertilization procedure; the pregnancy ended with a therapeutic abortion. During the follow-up, the serum beta human chorionic gonadotropin concentration started to rise, and the diagnosis of post-molar gestational trophoblastic neoplasia was made and consequently methotrexate treatment was started. Due to the rarity of this condition, there are no specific guidelines for the management of multiple pregnancies complicated by complete hydatidiform mole. We therefore performed a review of the literature including all reported cases of triplets/quadruplets pregnancies complicated by complete mole of a fetus focusing on ultrasound diagnosis, treatment and outcomes of this rare and life-threatening condition.
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http://dx.doi.org/10.23736/S2724-606X.21.05031-4DOI Listing
June 2022

It is time to talk about replacement of subdermal implants from the same cut, is it always feasible? The slow process of the "armpit approach".

Eur J Obstet Gynecol Reprod Biol 2022 07 18;274:253-254. Epub 2022 May 18.

Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Via del Pozzo 71, 41124 Modena, Italy.

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http://dx.doi.org/10.1016/j.ejogrb.2022.05.013DOI Listing
July 2022

Impact of endocrine disorders on stillbirth: a prospective cohort study.

Gynecol Endocrinol 2022 Jun 4;38(6):483-487. Epub 2022 May 4.

International Doctorate School in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy.

Objective: Among risk factors for SB, maternal endocrine diseases (ED), such as thyroids dysfunction and gestational diabetes mellitus (GDM), are the most frequent. This study aimed to investigate the rate of ED in a population of SB cases collected prospectively, and the relationship between these and causes of death.

Methods: This is an area-based, prospective cohort study conducted in Emilia-Romagna, Italy between January 2014 and December 2020. Data included all cases of SB (>22 weeks).

Results: From 2014 to 2020, 766 SB occurred out of a total of 232.506 births (SB rate:0.3/1000). The ED were present in 197/766 cases of SB (25.7%), respectively, 104 thyroid disease (52.8%), 74 GDM (37.5%), and 19 cases of concomitant GDM and thyroid disease (9.6%). Women who had SB associated with ED presented significantly higher mean maternal age ( < 0.001), BMI ( < 0.001), obesity ( < 0.001) and lower smoking habit ( = 0.02) respect with control group. Neonatal and placental weight of stillborn women with ED was significantly higher ( < 0.001) in respect to stillborn of the control group. Women with ED as associated condition (ReCODE classification), present significantly higher cases of SB caused by placenta pathologies ( = 0.009) namely abruptio placentae ( = 0.001) respect than control group.

Conclusions: ED was more frequent in older and obese women experiencing SB. The main cause of death was abruptio placentae. This information can be helpful when counseling mothers with ED and planning antenatal management to prevent SB.
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http://dx.doi.org/10.1080/09513590.2022.2069747DOI Listing
June 2022

Implementation of guidelines about women with previous cesarean section through educational/motivational interventions.

Int J Gynaecol Obstet 2022 Apr 9. Epub 2022 Apr 9.

Obstetrics Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia. University Hospital Policlinico of Modena, Italy, Modena, Italy.

Objective: To investigate the effect of a quality improvement project with an educational/motivational intervention in northern Italy on the implementation of the trial of labor after cesarean section (CS).

Method: A pre-post study design was used. Every birth center (n = 23) of the Emilia-Romagna region was included. Gynecologist opinion leaders were first trained about Italian CS recommendations. Barriers to implementation were discussed and shared. Educational/motivational interventions were implemented. Data of multipara with previous CS, with a single, cephalic pregnancy at term, were collected during two periods, before (2012-2014) and after (2017-2019) the intervention (2015-2016). The primary outcome was the rate of vaginal birth after CS (VBAC) and perinatal outcomes.

Results: A total of 20 496 women were included. The VBAC rate increased from 18.1% to 23.1% after intervention (P < 0.001). The likelihood of VBAC-adjusted for age 40 years or older, Caucasian, body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) at least 30, previous vaginal delivery, and labor induction-was increased by the intervention by 42% (odds ratio 1.42, 95% confidence interval 1.31-1.54). Neonatal well-being was improved by intervention; neonates requiring resuscitation decreased from 2.1% to 1.6% (P = 0.001).

Conclusion: Educating and motivating gynecologists toward the trial of labor after CS is worth pursuing. Health quality improvement is demonstrated by increased VBAC even improving neonatal well-being.
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http://dx.doi.org/10.1002/ijgo.14212DOI Listing
April 2022

Association of maternal body mass index and parity on induced labor stages.

Minerva Obstet Gynecol 2022 Apr 7. Epub 2022 Apr 7.

Obstetrics and Gynecology Unit, Mother-Infant Department, Policlinic Hospital, University of Modena and Reggio-Emilia, Modena, Italy.

Background: Obesity is a widespread pandemic and obstetric care must adapt to meet the needs of obese pregnant women. Little is known about the impact of body mass index (BMI) on the induction of labor (IOL). Therefore, our objective was to evaluate if the duration of the first and second stages of IOL is affected by maternal BMI in nulliparous and multiparous women.

Methods: We included singleton pregnancies at term with cephalic presentation whose labor was induced from June 2018 to December 2019. Women were divided into two groups according to pre-pregnancy BMI in Normal Weight and Obese Women.

Results: A total of 668 women with IOL were included in the study, among them, 349 had a normal weight and 321 were obese. The first stage of labor was longer in obese multiparous than normal-weight women (normal weight 81.98 ± 71.7 vs obese 134.3 ± 158.1 (min), p=0.000), while the second stage resulted significantly shorter (normal weight 22.2 ± 27.8 vs obese 14.3 ± 14.2 (min), p=0.000). The total time elapsed from IOL beginning and delivery was significantly higher in obese nulliparous (normal weight 10.4 ± 19.7 vs obese 22.0 ± 26.2 (h), p=0.000). Operative vaginal deliveries, emergency cesarean section, and failed IOL resulted to be similar between the groups.

Conclusions: Obese multiparous women have longer first stages of labor while shorter second stages. The total time for induced obese nulliparous to reach delivery is higher than the normal weight. It might be reasonable to reconsider the partographs according to maternal BMI in case of induced labor for future obstetric practice.
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http://dx.doi.org/10.23736/S2724-606X.22.05092-8DOI Listing
April 2022

Ultrasound-guided Needle Biopsy for Preoperative Assessment of Uterine Fibroids: Our Experience and a Review of the Literature.

Gynecol Minim Invasive Ther 2022 Jan-Mar;11(1):47-50. Epub 2022 Feb 14.

Cambridge Endometriosis and Endoscopic Surgery Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England.

Leiomyomas are the most common uterine benign tumor, and their malignant counterpart leiomyosarcomas are extremely rare. Despite this, a preoperative diagnosis could be useful for safe surgical minimally invasive management. At present, some clinical and ultrasound findings help recognizing lesions at risk of malignancy. We tried to implement a technique for the preoperative diagnosis for lesions at risk performing ultrasound-guided biopsies of suspected lesions in ten patients. Among them, one case was diagnosed as malignant by the needle biopsy. All patients underwent surgery for myomectomy or hysterectomy, and the histology was confirmed in all cases. No complications occurred. The review of the literature shows other similar experiences of preoperative biopsy of uterine lesions, showing good results for the differential diagnosis between uterine sarcoma and leiomyoma. In our experience, despite the small number of patients enrolled, this technique is safe and effective to plan minimally invasive surgery of uterine fibroids.
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http://dx.doi.org/10.4103/GMIT.GMIT_31_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8926054PMC
February 2022

Second trimester uterine arteries pulsatility index is a function of placental pathology and provides insights on stillbirth aetiology: A multicenter matched case-control study.

Placenta 2022 04 26;121:7-13. Epub 2022 Feb 26.

Department of Medicine and Surgery, Division of Obstetrics and Prenatal Medicine, IRCCS Sant'Orsola-Malpighi, University of Bologna, 40138, Bologna, Italy. Electronic address:

Introduction: The aim of this study was to investigate the relationships between maternal vascular malperfusions (MVM) and second trimester uterine arteries pulsatility index (UtA-PI) in cases of stillbirth (SB), compared to live-birth (LB) matched controls.

Methods: This was a multicentre, observational, matched case-control study performed at five referral maternity centres over a 4-year period including SB and LB control pregnancies at high-risk for preeclampsia (PE) and/or fetal growth restriction (FGR), matched and stratified for UtA-PI MoM quartiles values of the SB cases. Logistic regression was used to assess the rates of each MVM finding, within each increasing MoM quartile subcategory in SB and matched LB controls.

Results: 82 SB and 82 LB matched high-risk pregnancies were included. Placental hypoplasia, placental infarction, retroplacental hematoma, distal villous hypoplasia and accelerated villous maturation showed a significant correlation with UtA-PI. At univariable analysis, placental infarction and distal villous hypoplasia were more highly associated with the increasing quartile uterine Doppler measurements (odds ratio 2.24 and 2.23, respectively). Logistic regressions showed a significant positive and independent association between rates of retroplacental hematoma or distal villous hypoplasia and stillbirth within corresponding UtA-PI MoM quartiles (odds ratio 5.21 and 2.28, respectively).

Discussion: We are providing evidence for characterization of two major etiological stillbirth categories, characterized by a positive or absent association with UtA-PI impairment and specific histopathological placental MVM lesions. Our results support a strict third trimester follow-up of cases with increased second trimester UtA-PI, in order to improve the reproductive chances of these pregnant patients.
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http://dx.doi.org/10.1016/j.placenta.2022.02.021DOI Listing
April 2022

First-trimester prediction model for placental vascular disorders: An observational prospective study.

Pregnancy Hypertens 2022 Jun 11;28:35-40. Epub 2022 Feb 11.

Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy.

This study aims to develop a multivariable predictive model for the risk of placental vascular complications (PVC), by using biochemical, biophysical, anamnestic and clinical maternal features available at the first trimester. PVC include gestational hypertension, preeclampsia, placenta abruption, intrauterine growth restriction (IUGR), and stillbirth. Prospective study that included all singleton pregnancies attending the first-trimester aneuploidy screening (11 +0-12 +6 weeks) at Obstetrics Unit of the University Hospital of Modena, in Northern Italy, between June 2018 and December 2019. In a total of 503 women included in the analysis, 40 patients were in the PVC group. The final prediction model for PVC included the following independent variables: pre-pregnancy BMI ≥ 30 (OR = 2.65, 95% CI = 1.04; 6.75, p = 0.0415), increasing values of mean arterial pressure (OR = 1.06, 95% CI = 1.02; 1.10, p = 0.0008), PAPP-A < 2.40465 U/L (OR = 0.43, 95% CI = 0.19; 0.96, p = 0.0388) and decreasing values of PlGf (MoM) (OR = 0.28, 95% CI = 0.10; 0.79, p = 0.0153). The area under the ROC curve was 79.4% indicating a satisfactory predictive accuracy. The best predictive cut-off for this score was equal to -2.562, which corresponds to a 7.2 % probability of having PVC. By using such a cut-off, the risk of PVC can be predicted in our sample with sensitivity equal to 82,4 % and specificity equal to 69,9 %. This model for early prediction of PVC is a promising tool to early identify women at greater risk for placenta vascular complications.
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http://dx.doi.org/10.1016/j.preghy.2022.02.002DOI Listing
June 2022

Confirmation of the safety of combined oral contraceptives containing oestradiol on the risk of venous thromboembolism.

Eur J Contracept Reprod Health Care 2022 04 8;27(2):83-84. Epub 2022 Feb 8.

Department of Obstetrics and Gynaecology, University Hospital, University of Basel, Basel, Switzerland.

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http://dx.doi.org/10.1080/13625187.2022.2029397DOI Listing
April 2022

Delivery indication matters for perinatal outcomes in late preterm newborns.

J Matern Fetal Neonatal Med 2022 Jan 25:1-10. Epub 2022 Jan 25.

Mother-Infant Department, Modena Policlinico Hospital, University of Modena and Reggio Emilia, Modena, Italy.

Background: The late preterm (LP) rate in Western countries is 3-6% of all births, accounting for about two-thirds of the entire preterm population. However, all LP babies are not the same.

Aims: To identify pregnancies at risk for adverse outcomes in the LP period, we investigated how gestational age (GA) at delivery, delivery indication and prenatal risk factors may affect neonatal outcomes.

Study Design: Prospective cohort study among singleton infants born between 34 + 0 and 36 + 6 weeks, in Emilia Romagna, Italy, during 2013-2015.

Outcomes Measures: The primary outcome was a composite of adverse perinatal outcomes. Multivariate logistic regression models were used to, respectively, investigate the effects of GA at delivery, circumstances at parturition and prenatal risk factors, on study outcomes after controlling for confounding variable.

Results: Among 1867 births, 302, 504, and 1061 infants were born at 34, 35, and 36 weeks, respectively. There were no neonatal deaths. An increased risk of composite neonatal outcome was observed among 34 and 35 weeks deliveries compared with 36 weeks, and among indicated deliveries compared with spontaneous. When studying prenatal risk factors, neonatal morbidity was associated with pre gestational diabetes, preterm premature rupture of membranes (pPROM), maternal obesity, bleeding and polyhydramnios; instead, preeclampsia had a protective effect.

Conclusion: LP with indicated deliveries at 34 or 35 weeks, or with specific prenatal risk factors have worse neonatal outcome when compared to 36. Such differences should be considered when counseling patients and planning interventions such as timing of delivery in LP period.
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http://dx.doi.org/10.1080/14767058.2021.1969358DOI Listing
January 2022

Plasma and amniotic fluid concentrations of nitric oxide: Effects on uterine artery and placental vasculature in women who underwent voluntary pregnancy termination and in women with missed and threatened abortion. A pilot study.

Eur J Obstet Gynecol Reprod Biol 2022 Mar 6;270:105-110. Epub 2022 Jan 6.

Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Italy.

Objectives: First trimester miscarriage is a multifactorial event. Various angiogenic factors have been proposed as possible early markers of non-viable pregnancies. The aim of the present study was to evaluate the systemic nitric oxide (NO) production in healthy early pregnancy and its possible role in first trimester miscarriage.

Study Design: We prospectively enrolled women referred to our Unit for elective termination of pregnancy, threatened abortion or missed abortion. Blood samples were taken for testing circulating NO plasma levels. Subsequently, all patients underwent 2-D ultrasonographic analysis and Color Doppler imaging to assess the pulsatility index of the uterine arteries. 3-D ultrasonographic and power Doppler analysis allowed a volumetric and vascular reconstruction of the placenta. During dilatation and vacuum aspiration, amniotic fluid was collected.

Results: Seventy-two patients were enrolled: 25 with elective termination of pregnancy (Group I); 17 with threatened abortion (Group II); 30 with missed abortion (Group III). Group II showed greater placental volume and lower uterine arteries PI than others. The plasma NO concentration resulted statistically higher in women with threatened abortion, while amniotic fluid NO concentration were higher in the viable pregnancies (Group I) than in the aborted fetuses (Group III). Plasma NO was inversely correlated with both mean arterial pressure and uterine artery PI and was positively correlated with amniotic fluid NO and CRL; amniotic fluid NO was positively correlated with placental Vascularization Index and Vascularization-Flow Index.

Conclusion: Amniotic NO concentration was higher in viable pregnancies and positively related to Doppler 3D indices of vascularization and blood flow within the placenta. Further studies are needed to elucidate its role in first trimester miscarriage.
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http://dx.doi.org/10.1016/j.ejogrb.2022.01.001DOI Listing
March 2022

The appropriate counseling on prenatal screening test for foreign women in Emilia-Romagna.

Acta Biomed 2021 12 22;92(S2):e2021509. Epub 2021 Dec 22.

School of Midwifery Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, (Italy).

Objective: The increase in the migratory phenomenon entails the need to adapt obstetric care to the population which includes foreign pregnant women. In this context, it emerged a little adherence to the prenatal screening test among foreign women compared to Italian women, which is assumed to be attributable to an inadequate counseling. This study aims to evaluate midwife's perception of the  counseling effectiveness in foreign women for the combined test and subsequently assess its adequacy through an external evaluation.

Methods: this is a cross-sectional study conducted from September to November 2019. An ad hoc questionnaire was administered to midwives working in the territorial district of the Emilia-Romagna Region, investigating their counseling skills. Then an external evaluation of the counseling was conducted by observing the interview between the midwives and the patients (N = 10), to analyze its appropriateness.

Results: Seventy-five midwives completed the questionnaire with a positive response rate of 57.2%. In general, 69.3% of midwives are satisfied with the training received from the regional course, but 85% found many difficulties in counseling foreign women. The 14% of midwives state that they always have the cultural and linguistic mediator available and 44% of them state that they use brochures translated into several foreign languages. In the interviews observed, the counseling to foreign women was found to be shorter and more limited than that provided to Italian women.

Conclusions: Most of the consulting midwives declare that they feel prepared to perform a correct prenatal counseling also for foreign women, but the external evaluation of the interviews, and the regional data on adherence to the antenatal screening of foreign women, show many critical points. It becomes necessary to carry out further studies that investigate not only the counseling skills of midwives, but also the needs of assisted women about prenatal diagnosis.
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http://dx.doi.org/10.23750/abm.v92iS2.12607DOI Listing
December 2021

Ileocecal deep infiltrating endometriosis with intestinal mucinous metaplasia and high-grade dysplasia.

J Obstet Gynaecol 2022 Jan 6:1-4. Epub 2022 Jan 6.

Department of Pathology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.

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http://dx.doi.org/10.1080/01443615.2021.2006158DOI Listing
January 2022

Mode of birth in women with low-lying placenta: protocol for a prospective multicentre 1:3 matched case-control study in Italy (the MODEL-PLACENTA study).

BMJ Open 2021 12 6;11(12):e052510. Epub 2021 Dec 6.

Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, ASST di Lecco, Lecco, Italy.

Introduction: The term placenta praevia defines a placenta that lies over the internal os, whereas the term low-lying placenta identifies a placenta that is partially implanted in the lower uterine segment with the inferior placental edge located at 1-20 mm from the internal cervical os (internal-os-distance). The most appropriate mode of birth in women with low-lying placenta is still controversial, with the majority of them undergoing caesarean section. The current project aims to evaluate the rate of vaginal birth and caesarean section in labour due to bleeding by offering a trial of labour to all women with an internal-os-distance >5 mm as assessed by transvaginal sonography in the late third trimester.

Methods And Analysis: The MODEL-PLACENTA is a prospective, multicentre, 1:3 matched case-control study involving 17 Maternity Units across Lombardy and Emilia-Romagna regions, Italy. The study includes women with a placenta located in the lower uterine segment at the second trimester scan. Women with a normally located placenta will be enrolled as controls. A sample size of 30 women with an internal-os-distance >5 mm at the late third trimester scan is needed at each participating Unit. Since the incidence of low-lying placenta decreases from 2% in the second trimester to 0.4% at the end of pregnancy, 150 women should be recruited at each centre at the second trimester scan. A vaginal birth rate ≥60% in women with an internal-os-distance >5 mm will be considered appropriate to start routinely admitting to labour these women.

Ethics And Dissemination: Ethical approval for the study was given by the Brianza Ethics Committee (No 3157, 2019). Written informed consent will be obtained from study participants. Results will be disseminated by publication in peer-reviewed journals and presentation in international conferences.

Trial Registration Number: NCT04827433 (pre-results stage).
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http://dx.doi.org/10.1136/bmjopen-2021-052510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8650481PMC
December 2021

The challenging screen detection of ovarian cancer in BRCA mutation carriers adhering to a 6-month follow-up program: results from a 6-years surveillance.

Menopause 2021 11 1;29(1):63-72. Epub 2021 Nov 1.

Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Via del Pozzo 71, Modena, Italy.

Objective: Approximately 25% of ovarian cancer (OC) cases are related to an inherited predisposition. Genetic mutations for the oncosuppressor genes BRCA1 and 2 have the best-known linkage to a higher incidence of OC and breast cancer, in approximately 70% to 80% of hereditary OC cases. To provide the first comprehensive clinical description of screen-detected (SD) OCs during a 6-years surveillance of a cohort of young BRCA carriers and carriers who refuse risk-reducing salpingo-oophorectomy.

Methods: A prospective cohort study in a university hospital describing 191 women with BRCA1 and 2 mutations adhering continuously to our surveillance between 2015 and 2020, including a 6-monthly evaluation of cancer antigen 125 (CA 125) with concomitant transvaginal ultrasound (TVUS) performed by a dedicated specialist. Main outcomes were tumor's laterality, CA 125 at diagnosis, TVUS and computed tomography (CT) findings.

Results: Risk-reducing salpingo-oophorectomy was performed in 58/191 (30.4%) of mutation carriers during the study period (one OC case identified). Nine SD-OCs and no interval OCs were found in the remaining 133 women. OCs (FIGO stage I or II: 88.9%) occur mainly in BRCA 1 (77.8%), being bilateral in 85.7% BRCA 1 and unilateral in 100% BRCA 2. No lesions involved only the tubes: left ovaries/tubes were more frequently involved. We have described three new possible scenarios regarding imaging: 1) Evident cases (33.3%, TVUS and CT obvious for OC, CA 125 sensitivity: 100%), 2) Possible cases (55.6%, TVUS and CT are in general accordance, documenting new TVUS signs: increased solid pattern of the ovary with peripheral cortical small cysts, hypoechoic circular mass near the ovary, intraparenchymal small hyperechoic foci), and 3) Hidden cases (11.1%, the smallest lesion but the highest stage (IIIA2), with CA 125 44.2 U/mL and concomitant endometrial hyperplasia).

Conclusions: Different diagnostic tools must integrate to ensure early diagnosis of OC in BRCA mutation carriers adhering to a follow-up program.
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http://dx.doi.org/10.1097/GME.0000000000001883DOI Listing
November 2021

Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature.

J Med Case Rep 2021 Oct 20;15(1):530. Epub 2021 Oct 20.

Obstetrics and Gynecology Unit, Mother - Infant and Adult Department of Medical and Surgical Sciences, University Hospital Policlinico of Modena, Via del Pozzo 71, 41124, Modena, Italy.

Background: Vertebral artery dissection is an uncommon, but potentially fatal, vascular event. This case aimed to describe the pathogenesis and clinical presentation of vertebral artery dissection in a term pregnant patient. Moreover, we focused on the differential diagnosis, reviewing the available evidence.

Case Presentation: A 39-year-old Caucasian woman presented at 38 + 4 weeks of gestation with a short-term history of vertigo, nausea, and vomiting. Symptoms appeared a few days after cervical spine manipulation by an osteopathic specialist. Urgent magnetic resonance imaging of the head was obtained and revealed an ischemic lesion of the right posterolateral portion of the brain bulb. A subsequent computed tomography angiographic scan of the head and neck showed a right vertebral artery dissection. Based on the correlation of the neurological manifestations and imaging findings, a diagnosis of vertebral artery dissection was established. The patient started low-dose acetylsalicylic acid and prophylactic enoxaparin following an urgent cesarean section.

Conclusion: Vertebral artery dissection is a rare but potential cause of neurologic impairments in pregnancy and during the postpartum period. It should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women with a history of migraines, hypertension, or autoimmune disorders in pregnancy are at higher risk, as well as following cervical spine manipulations. Prompt diagnosis and management of vertebral artery dissection are essential to ensure favorable outcomes.
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http://dx.doi.org/10.1186/s13256-021-03090-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527659PMC
October 2021

Vitamin D and green tea extracts for the treatment of uterine fibroids in late reproductive life: a pilot, prospective, daily-diary based study.

Gynecol Endocrinol 2022 Jan 16;38(1):63-67. Epub 2021 Oct 16.

Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy.

Objective: The beneficial effects of Vitamin D (VD) and Epigallocatechin gallate (EGCG), a polyphenol of green tea, on the growth of uterine fibroids (UF) were previously described and . We have decided to investigate their simultaneous administration in women with UFs in late reproductive life.

Methods: >40 years old  = 16 premenopausal women with intramural (IM) or subserosal (SS) UF of ≥3 cm or several UFs of different sizes, even smaller but with a total diameter ≥3 cm but <10 cm, without further concomitant organic causes of abnormal uterine bleeding, treated with EGCG 300 mg, Vitamin B6 10 mg and VD 50 µg/day for 90 days. Women completed a diary on a daily basis to obtain information about bleeding and pelvic pain.

Results: We have observed a significant reduction in UF's mean size both at patient's (-17.8%,  = .03) and at single UF's level (-37.3%,  = .015). The effect was more evident in women with predominant IM ( = .016) in comparison to SS UFs. No significant changes were observed for uterine and ovarian volume and endometrial thickness during treatment. We reported a significant decrease in menstrual flow length of 0.9 day ( = .04) with no modification in cycle length, menstrual flow intensity and menstrual pain intensity. The satisfaction with treatment was in general very high, with no adverse effects reported.

Conclusion: The concomitant administration of VD and EGCG represents a promising treatment of UF in women of late reproductive life for which hormonal manipulation is not foreseen.
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http://dx.doi.org/10.1080/09513590.2021.1991909DOI Listing
January 2022

Inositols: From Established Knowledge to Novel Approaches.

Int J Mol Sci 2021 Sep 30;22(19). Epub 2021 Sep 30.

Department of Obstetrics and Gynecology, Santo Spirito Hospital, 00193 Rome, Italy.

Myo-inositol (myo-Ins) and D-chiro-inositol (D-chiro-Ins) are natural compounds involved in many biological pathways. Since the discovery of their involvement in endocrine signal transduction, myo-Ins and D-chiro-Ins supplementation has contributed to clinical approaches in ameliorating many gynecological and endocrinological diseases. Currently both myo-Ins and D-chiro-Ins are well-tolerated, effective alternative candidates to the classical insulin sensitizers, and are useful treatments in preventing and treating metabolic and reproductive disorders such as polycystic ovary syndrome (PCOS), gestational diabetes mellitus (GDM), and male fertility disturbances, like sperm abnormalities. Moreover, besides metabolic activity, myo-Ins and D-chiro-Ins deeply influence steroidogenesis, regulating the pools of androgens and estrogens, likely in opposite ways. Given the complexity of inositol-related mechanisms of action, many of their beneficial effects are still under scrutiny. Therefore, continuing research aims to discover new emerging roles and mechanisms that can allow clinicians to tailor inositol therapy and to use it in other medical areas, hitherto unexplored. The present paper outlines the established evidence on inositols and updates on recent research, namely concerning D-chiro-Ins involvement into steroidogenesis. In particular, D-chiro-Ins mediates insulin-induced testosterone biosynthesis from ovarian thecal cells and directly affects synthesis of estrogens by modulating the expression of the aromatase enzyme. Ovaries, as well as other organs and tissues, are characterized by a specific ratio of myo-Ins to D-chiro-Ins, which ensures their healthy state and proper functionality. Altered inositol ratios may account for pathological conditions, causing an imbalance in sex hormones. Such situations usually occur in association with medical conditions, such as PCOS, or as a consequence of some pharmacological treatments. Based on the physiological role of inositols and the pathological implications of altered myo-Ins to D-chiro-Ins ratios, inositol therapy may be designed with two different aims: (1) restoring the inositol physiological ratio; (2) altering the ratio in a controlled way to achieve specific effects.
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http://dx.doi.org/10.3390/ijms221910575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8508595PMC
September 2021

Treatment of menopausal symptoms: concomitant modification of cortisol.

Menopause 2021 10 11;29(1):23-27. Epub 2021 Oct 11.

Department of Obstetrics, Gynaecology and Paediatrics, University of Modena and Reggio Emilia, Modena, Italy.

Objectives: To evaluate whether change in menopausal symptoms is related to modification of 24-hour urinary cortisol.

Methods: Sixty-nine postmenopausal women were treated for their menopausal symptoms with either estrogen progestin therapy (0.3 mg conjugate equine estrogens and 1.5 mg medroxyprogesterone acetate; n = 25), phytoestrogens (75 mg isoflavones, twice daily; n = 21) or acupuncture (once a week; n = 23). Baseline and treatment-induced changes of total and subscale scores (vasomotor, depression, anxiety, somatization, sexuality) of the Greene's Climacteric Scale and of 24-hour urinary cortisol were evaluated.

Results: At baseline, 24-hour urinary cortisol was related to Greene's Climacteric Scale score (P < 0.0001). Independent determinants (R2 = 0.319) were the Greene's subscales scores of depression (with a mean difference of 24-h cortisol for score unit expressed as beta coefficient of regression (b) of 4.91, 95% CI 2.14-7.7; P = 0.0007), and of somatization (b 3.04 95% CI 0.69-5.4; P = 0.012). The Greene's Climacteric Scale score (-5.67 ± 6.8; P = 0.0001) and 24-hour cortisol (-23.6 ± 45.7 μg/24 h; P = 0.0001) declined after 3 months of treatment. Changes of 24-hour cortisol values were linearly related to changes of total Greene's Climacteric Scale score with a mean change for unit score (b) of 2.10, 95% CI 0.47-3.73; P = 0.012).

Conclusions: Present data indicate that greater reduction in menopausal symptoms is associated with a larger decrease in cortisol levels. Possible implication of this finding on the long-term consequences for women's health needs to be explored.
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http://dx.doi.org/10.1097/GME.0000000000001875DOI Listing
October 2021

A first trimester prediction model for large for gestational age infants: a preliminary study.

BMC Pregnancy Childbirth 2021 Sep 24;21(1):654. Epub 2021 Sep 24.

Obstetrics Unit, Mother Infant Department, University Hospital Policlinico of Modena, Modena, Italy.

Background: Large for gestational age infants (LGA) have increased risk of adverse short-term perinatal outcomes. This study aims to develop a multivariable prediction model for the risk of giving birth to a LGA baby, by using biochemical, biophysical, anamnestic, and clinical maternal characteristics available at first trimester.

Methods: Prospective study that included all singleton pregnancies attending the first trimester aneuploidy screening at the Obstetric Unit of the University Hospital of Modena, in Northern Italy, between June 2018 and December 2019.

Results: A total of 503 consecutive women were included in the analysis. The final prediction model for LGA, included multiparity (OR = 2.8, 95% CI: 1.6-4.9, p = 0.001), pre-pregnancy BMI (OR = 1.08, 95% CI: 1.03-1.14, p = 0.002) and PAPP-A MoM (OR = 1.43, 95% CI: 1.08-1.90, p = 0.013). The area under the ROC curve was 70.5%, indicating a satisfactory predictive accuracy. The best predictive cut-off for this score was equal to - 1.378, which corresponds to a 20.1% probability of having a LGA infant. By using such a cut-off, the risk of LGA can be predicted in our sample with sensitivity of 55.2% and specificity of 79.0%.

Conclusion: At first trimester, a model including multiparity, pre-pregnancy BMI and PAPP-A satisfactorily predicted the risk of giving birth to a LGA infant. This promising tool, once applied early in pregnancy, would identify women deserving targeted interventions.

Trial Registration: ClinicalTrials.gov NCT04838431 , 09/04/2021.
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http://dx.doi.org/10.1186/s12884-021-04127-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464112PMC
September 2021
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