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Papers by nicola rizzo

Research paper thumbnail of Neonatal respiratory morbidity in twins versus singletons after elective prelabor caesarean section

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2013

To compare the rate of neonatal respiratory morbidity in singletons versus twins delivered by pre... more To compare the rate of neonatal respiratory morbidity in singletons versus twins delivered by pre-labour caesarean section. Study design: Uncomplicated pregnancies delivered by prelabor caesarean section at 34 + 0 to 37 + 6 weeks' gestation were retrospectively selected. For both singletons and twins caesarean delivery was undertaken electively only after amniocentesis and if the lecithin/sphingomyelin ratio was !2. Neonatal respiratory morbidity was compared in twins versus singletons. Results: 241 singletons and 100 twin neonates were included. Overall neonatal respiratory morbidity was comparable between the two groups (25/241 (11.7%) versus 7/100 (7%), p = .331). Between 34 + 0 and 36 + 6 weeks, however, the risk was higher among singleton than twins (15/46 (32.6%) versus 6/72 (8.3%), p < .001). At multiple regression, dichorionicity, gestational age at delivery !37 weeks and female sex independently decreased the risk of neonatal respiratory morbidity. Conclusion: The risk of neonatal respiratory morbidity after elective caesarean section seems lower among twins, especially prior to 37 + 0 weeks.

Research paper thumbnail of Atosiban versus usual care for the management of preterm labor

Journal of Perinatal Medicine, 2007

Research paper thumbnail of OP18.03: The longitudinal changes of the angle of progression and the midline angle in the active second stage according to the mode of delivery

Research paper thumbnail of Fundal pressure in second stage of labor (Kristeller maneuver) is associated with higher risk of levator ani muscle avulsion

Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, Jan 10, 2018

to investigate the association between fundal pressure in the second stage (Kristeller maneuver) ... more to investigate the association between fundal pressure in the second stage (Kristeller maneuver) and the risk of levator ani muscle (LAM) injury. This was a prospective case-control study conducted in our university hospital. We recruited women immediately following their first vaginal delivery. Women who underwent Kristeller maneuver were recruited as cases. For each case, a control (no Kristeller) was recruited matched by BMI, epidural analgesia, second stage duration and birthweight. All women were invited to undergo a postpartum 4D transperineal ultrasound (TPUS). The main outcome measure was the presence of LAM avulsion at 4D TPUS. TPUS results were compared between cases and controls. A multivariate logistic regression was performed to identify independent risk factors of LAM avulsion. During the study period, 134 women in the Kristeller group and 128 women in the control group underwent TPUS. Women in the Kristeller group had a higher prevalence of LAM avulsion in comparison ...

Research paper thumbnail of Emilia-Romagna Study on Pregnancy and Exposure to Antiepileptic drugs (ESPEA): a population-based study on prescription patterns, pregnancy outcomes and fetal health

Journal of neurology, neurosurgery, and psychiatry, Jan 16, 2018

To assess the prevalence of antiepileptic drug (AED) exposure in pregnant women and the comparati... more 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). 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. 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...

Research paper thumbnail of Correction to: Management of pregnancy-related issues in multiple sclerosis patients: the need for an interdisciplinary approach

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, Jan 26, 2017

The original version contained a mistake. The authors have specified only in a few paragraphs tha... more The original version contained a mistake. The authors have specified only in a few paragraphs that all the contents of the paper are meant for Copaxone but not for unbranded glatiramer acetate, Authors ask to add the specification of Copaxone or branded glatiramer acetate everytime.

Research paper thumbnail of P18.08: Haematometra and “floppy” uterus: powerful sonographic markers of severe post-Caesarean endometritis

Ultrasound in Obstetrics & Gynecology

Research paper thumbnail of Circulating mRNA in Maternal Plasma at the Second Trimester of Pregnancy: A Possible Screening Tool for Cardiac Conotruncal and Left Ventricular Outflow Tract Abnormalities

Molecular diagnosis & therapy, Dec 25, 2017

Maternal plasma is a source of circulating placental nucleic acids. This study was designed to de... more Maternal plasma is a source of circulating placental nucleic acids. This study was designed to detect aberrantly expressed placental mRNA genes circulating in the maternal plasma of pregnancies affected with fetal conotruncal anomalies (CNTRA) and left-ventricular outflow tract (LVOT) obstruction in the second trimester of pregnancy. This was a retrospective monocentric study conducted from 1 Jan 2016 to 31 Dec 2016. NanoString technology was used to identify aberrantly expressed genes, comparing 36 women carrying a fetus with CNTRA or LVOT obstruction to 42 controls at 19-24 weeks of gestation. The genes with differential expression were subsequently tested using real-time polymerase chain reaction. Linear discriminant analysis was used to combine all the mRNA species with discriminant ability for CNTRA and LVOT obstruction. A multivariable receiver operating characteristic (ROC) curve having the estimated discriminant score as an explanatory variable was generated for the two affe...

Research paper thumbnail of Obstetric implications of fetal inherited thrombophilia in thrombophilic women

Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health

Objectives: The relationship between fetal thrombophilic polymorphism and adverse pregnancy outco... more Objectives: The relationship between fetal thrombophilic polymorphism and adverse pregnancy outcomes is still unclear. The aim of this study is to evaluate if fetal thrombophilia may affect obstetric and perinatal outcomes in thrombophilic women. Study design: From 2007 to 2011 all patients with a known inherited thrombophilic mutation consecutively admitted to our labor ward at P25 weeks of gestation with a singleton viable pregnancy were considered eligible for the purpose of the study. At the age of 1 year, the infants were tested for inherited thrombophilic mutations. Patients were then divided into two groups according to the presence or absence of any neonatal mutation. Main outcome measures: The following outcome variables were then compared between the two groups: gestational age at delivery, birth weight, incidence of hypertensive disorders of pregnancy and SGA neonates. Results: Overall, 67 pregnancies of 49 women were studied. Among them, the G20210A Prothrombin (32/67 or 47.7%) mutation and the Factor V Leiden mutation (31/67 or 46.3%) were the commonest findings, with a single patient presenting both. A thrombophilic mutation was found in 38 mother-infant pairs. The risk of all maternal and perinatal events including the incidence of hypertensive disorders disorders (5/29 or 17.2% vs 6/ 38 or 15.7% p = 1.00) and of SGA neonates (3/29 or 10.3% vs 7/38 or 18.4%, p = 0.49) was comparable between the two groups irrespective of the associated fetal thrombophilia. Conclusions: Our data suggest that women with inherited thrombophilia carrying a thrombophilic fetus are not at increased risk of adverse pregnancy outcomes.

Research paper thumbnail of OP28.06: Objective assessment of fetal micrognathia: a new role for the prefrontal space ratio

Ultrasound in Obstetrics & Gynecology

Research paper thumbnail of P17.10: The subpubic angle measured by a novel three-dimensional ultrasound technique in nulliparous and parous women: a pilot study

Ultrasound in Obstetrics & Gynecology

The role of sonographic myometrial thickness measurement in the prediction of successful vaginal ... more The role of sonographic myometrial thickness measurement in the prediction of successful vaginal delivery after induction of labour with a balloon catheter device. Methods: A prospective study was conducted on term singleton pregnancies with a cephalic presentation designated for balloon induction at 38-42 week's gestation. Prior to induction, abdominal sonographic myometrial thickness was assessed at five locations-lower uterine segment (above and below the reflection of the urinary bladder), mid-anterior wall, fundus and posterior uterine wall. Induction of labour was then carried out with a trans-cervical Foley catheter that was substituted with intravenous oxytocin after balloon expulsion. The primary outcome was a successful vaginal delivery. Results: Indications for labour induction were: postdate pregnancy (48.1%), GDM (19.2%), oligohydramnios (11.5%), hypertension (5.8%), and others (15.4%). In the 52 women recruited, vaginal delivery occurred in 46 patients (88.5%) and Caesarean section was performed in 6 patients (11.5%). In a multi-variate regression model, a statistically significant correlation was found between fundal and posterior uterine wall myometrial thickness and time from induction to balloon expulsion (r = 0.36, p = 0.03; r =-0.35, p = 0.05, respectively). A correlation between myometrial thickness and time from labour induction to delivery was not statistically significant. Conclusions: Myometrial fundal and posterior uterine wall thickness in women undergoing induction of labour with a balloon catheter is associated with the time to balloon expulsion.

Research paper thumbnail of P27.02: Reproductive outcome in women with incidental diagnosis of septate uterus at viability scan

Ultrasound in Obstetrics & Gynecology

Research paper thumbnail of Three-dimensional/four-dimensional transperineal ultrasound: clinical utility and future prospects

International Journal of Women's Health

During the last decade, there has been a huge advancement in the use of transperineal ultrasound ... more During the last decade, there has been a huge advancement in the use of transperineal ultrasound (TPU) in the field of obstetrics and gynecology. Its main applications in obstetrics include the monitoring of fetal progression in labor and recently the assessment of maternal pelvic dimensions, whereas in gynecology, TPU is at present widely used for the evaluation of the female pelvic floor, opening new boundaries for the assessment of pelvic floor disorders. The association of volumetric three-dimensional techniques has largely contributed to the remarkable progress that has occurred in the use of TPU. The aim of this paper is to offer an overview of the advantages, challenges and future perspectives of the use of TPU for women's imaging.

Research paper thumbnail of Reduced short-term variation following antenatal administration of betamethasone: Is reduced fetal size a predisposing factor?

European Journal of Obstetrics & Gynecology and Reproductive Biology

To assess the association between fetal size and the incidence of reduced short-term variability ... more To assess the association between fetal size and the incidence of reduced short-term variability (STV) following bethametasone administration for fetal lung maturity. Study design: This was a retrospective, multicenter, cohort study conducted in two Tertiary University Units. Only uncomplicated singleton pregnancies admitted for threatened preterm labor between 26 and 34 weeks and submitted to betamethasone for fetal lung maturity were included. Delivery occurring within 72 h from betamethasone administration represented criteria for exclusion. Computerized cardiotocography was carried out on a daily basis. Cases were identified by persistently reduced STV, defined as <5th percentile for gestational age and lasting for at least 72 h after the first dose of betamethasone. The primary outcome was estimated fetal weight (EFW) at ultrasound in fetuses with normal and in those with persistently reduced STV. Pregnancy outcomes were also evaluated. Results: Persistently reduced STV occurred in 33/405 of the included patients (8.1%). Compared to women with normal STV, those with persistently reduced STV had significantly lower EFW (1472 AE 435 vs 1812 AE 532 g, p 0.04), lower birthweight (2353 AE 635 vs 2857 AE 796 g, p < 0.01) and earlier gestational age at delivery (35.1 AE 4.2 vs 37.3 AE 2.4 weeks, p < 0.01), whereas all the other variables including gestational age on admission were comparable. Conclusions: Reduced STV following maternal betamethasone administration among appropriately grown fetuses seems to correlate with lower fetal size. Furthermore, fetuses with such abnormal response to steroids seem to carry a higher risk of perinatal complications, including lower birthweight and earlier gestational age at delivery.

Research paper thumbnail of Management of pregnancy-related issues in multiple sclerosis patients: the need for an interdisciplinary approach

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, Jan 2, 2017

Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous s... more Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous system (CNS), most probably autoimmune in origin, usually occurring in young adults with a female/male prevalence of approximately 3:1. Women with MS in the reproductive age may face challenging issues in reconciling the desire for parenthood with their condition, owing to the possible influence both on the ongoing or planned treatment with the possible consequences on the disease course and on the potential negative effects of treatments on foetal and pregnancy outcomes. At MS diagnosis, timely counselling should promote informed parenthood, while disease evolution should be assessed before making therapeutic decisions. Current guidelines advise the discontinuation of any treatment during pregnancy, with possible exceptions for some treatments in patients with very active disease. Relapses decline during pregnancy but are more frequent during puerperium, when MS therapy should be promptl...

Research paper thumbnail of Elevated maternal placental protein 13 serum levels at term of pregnancy in postpartum major hemorrhage (>1000 mLs). A prospective cohort study

American journal of reproductive immunology (New York, N.Y. : 1989), Jan 15, 2017

To compare placental protein 13 (PP13) levels in the serum of women with primary postpartum hemor... more To compare placental protein 13 (PP13) levels in the serum of women with primary postpartum hemorrhage (PPH) with a control population. A prospective cohort study was conducted between May 2014 and May 2016 and included 435 pregnant women at term (38 weeks gestation) without any known risk factor and with normal labor. Multiples of median (MoM) were used to evaluate differences of the PP13 values between cases and controls. PP13 concentrations were adjusted for maternal and neonatal weight. Multivariable analysis was used to detect independent contribution of predictors of PPH. Fifteen had a major PPH >1000 mLs and represented the cases of the study. They were matched with 399 controls. Twenty-one patients who had a minor PPH (500-1000 mLs) were excluded. The mean observed rank in the PPH group was higher than that of controls (28.5 vs 13.5, P-value=.01). PP13 MoM values adjusted for maternal weight were higher than expected being 1.44±0.45 in PPH cases and 1.00±0.59 in controls ...

Research paper thumbnail of Antiphospholipid antibody profile based obstetric outcomes of primary antiphospholipid syndrome. The PREGNANTS study

American Journal of Obstetrics and Gynecology, 2017

Antiphospholipid syndrome (APS) is an autoimmune, hypercoagulable state caused by antiphospholipi... more Antiphospholipid syndrome (APS) is an autoimmune, hypercoagulable state caused by antiphospholipid antibodies. Anticardiolipin antibodies (aCL), anti-β2 glycoprotein-I (ab2GPI) and lupus anticoagulant (LA) are the main autoantibodies found in APS. Despite the amassed body of clinical knowledge, the risk of obstetric complications associated with specific antibody profile has not been well established. To assess the risk of obstetric complications in women with primary APS associated with specific antibody profile STUDY DESIGN: The PREGNANTS study is a multicenter, retrospective, cohort study. Diagnosis and classification of APS were based on the 2006 International revised criteria. All women included in the study had at least one clinical criteria for APS, were positive for at least one antiphospholipid antibodies (aCL, ab2GPI and/or LA), and were treated with low-dose aspirin and prophylactic low molecular weight heparin (LMWH) starting from the first trimester. Only singleton pregnancies with primary APS were included. The primary outcome was livebirth, defined as any delivery of a live infant after 22 weeks. The secondary outcomes were preeclampsia with and without severe features, intrauterine growth restriction (IUGR) and stillbirth. We planned to assess the outcomes associated with the various antibody profile (test result for LA, aCL and ab2GPI). There were 750 singleton pregnancies with primary APS in the study cohort. 54 (7.2%) were positive for LA only, 458 (61.0%) for aCL only, 128 (17.1%) for ab2GPI only; while 90 (12.0%) were double positive and LA negative and 20 (2.7%) were triple positive. The incidence of livebirth in each of these categories was 79.6%, 56.3%, 47.7%, 43.3%, and 30.0%, respectively. Compared to women with only one antibody positive test results, women with multiple antibody positive results had a significantly lower livebirth (40.9% vs 56.6%; aOR 0.71, 95% CI 0.51 to 0.90). Also, they were at increased risk of preeclampsia without (54.5% vs 34.8%; aOR 1.56, 95% CI 1.22 to 1.95) and with severe features (22.7% vs 13.8%, aOR 1.66, 95% CI 1.19 to 2.49), IUGR (53.6% vs 40.8%; aOR 2.31, 95% CI 1.17 to 2.61) and stillbirth (36.4% vs 21.7%; aOR 2.67, 95% CI 1.22 to 2.94). In women with only one positive test result, women with ab2GPI positivity present alone had a significantly lower livebirth (47.7% vs 56.3% vs 79.6%; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), and a significantly higher incidence of preeclampsia without (47.7% vs 34.1% vs 11.1%; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) and with severe features (17.2% vs 14.4% vs 0%; p=0.02), IUGR (48.4% vs 40.1% vs 25.9%; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) and stillbirth (29.7% vs 21.2% vs 7.4%; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) compared to women with aCL and to women with LA present alone, respectively. In the group of women with more than one antibody positivity, triple-positive women had lower livebirth (30% vs 43.3%; aOR 0.69, 95% CI 0.22 to 0.91), and higher incidence of IUGR (70.0% vs 50.0%; aOR 2.40, 95% CI 1.15 to 2.99) compared to double positive and LA negative women. In singleton pregnancies with primary APS, aCL is the most common sole antiphospholipid antibody present, but ab2GPI is the one associated with the lowest livebirth rate and highest incidence of preeclampsia, IUGR, and stillbirth, compared to presence of aCL or LA alone. Primary APS women have an increased risk of obstetric complications and lower livebirth when more than one antiphospholipid antibody is present. Despite therapy with low-dose aspirin and prophylactic LMWH, chance of a live-birth neonate is only 30% for triple-positive women.

Research paper thumbnail of An innovative test for non-invasive Kell genotyping on circulating fetal DNA by means of the allelic discrimination of K1 and K2 antigens

American journal of reproductive immunology (New York, N.Y. : 1989), Dec 1, 2016

The aim of this study was to present a new method for fetal Kell genotyping by means of the allel... more The aim of this study was to present a new method for fetal Kell genotyping by means of the allelic discrimination of K1 and K2 in real-time polymerase chain reaction (PCR). Real-time quantitative polymerase chain reaction incorporating an allele-specific primer was developed for detecting the K allele of KEL. By means of this method, the K1/K2 genotype was able to be determined in all blood samples analyzed. Results using cell-free fetal DNA (cffDNA) from two Kell-negative pregnant women confirmed the Kell-positive genotype of fetuses. The real-time PCR analysis also allowed the determination of the fetal fraction using the quantification of Kell-positive DNA. An efficient and reliable strategy for Kell genotyping is herein presented. The method was optimized on cffDNA to create a non-invasive prenatal test which could be routinely used for the prevention of hemolytic disease of the fetus and the newborn (HDFN).

Research paper thumbnail of Congenital Cytomegalovirus Infection: Prognostic Value of Maternal DNAemia at Amniocentesis

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 15, 2017

Human Cytomegalovirus (HCMV) is the most common cause of childhood hearing loss and can lead to n... more 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. 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...

Research paper thumbnail of Automated 3D ultrasound measurement of the angle of progression in labor

The Journal of Maternal-Fetal & Neonatal Medicine, 2017

To assess the feasibility and reliability of an automated technique for the assessment of the ang... more To assess the feasibility and reliability of an automated technique for the assessment of the angle of progression (AoP) in labor using three-dimensional (3D) ultrasound. AoP was assessed using 3D transperineal ultrasound by two operators in 52 women in active labor to evaluate intra- and interobserver reproducibility. Furthermore, intermethod agreement between automated and manual techniques on 3D images, and between automated technique on 3D vs 2D images were evaluated. Automated measurements were feasible in all cases. Automated measurements were considered acceptable in 141 (90.4%) out of 156 on the first assessments and in all 156 after repeating measurements for unacceptable evaluations. The automated technique on 3D images demonstrated good intra- and interobserver reproducibility. 3D-automated technique showed a very good agreement with the 3D manual technique. Notably, AoP calculated with the 3D automated technique were significantly wider in comparison with those measured manually on 3D images (133±17° vs 118±21°, P = 0.013). the assessment of the angle of progression through 3D ultrasound is highly reproducible. However, automated software leads to a systematic overestimation of AoP in comparison with the standard manual technique thus hindering its use in clinical practice in its present form.

Research paper thumbnail of Neonatal respiratory morbidity in twins versus singletons after elective prelabor caesarean section

European Journal of Obstetrics & Gynecology and Reproductive Biology, 2013

To compare the rate of neonatal respiratory morbidity in singletons versus twins delivered by pre... more To compare the rate of neonatal respiratory morbidity in singletons versus twins delivered by pre-labour caesarean section. Study design: Uncomplicated pregnancies delivered by prelabor caesarean section at 34 + 0 to 37 + 6 weeks' gestation were retrospectively selected. For both singletons and twins caesarean delivery was undertaken electively only after amniocentesis and if the lecithin/sphingomyelin ratio was !2. Neonatal respiratory morbidity was compared in twins versus singletons. Results: 241 singletons and 100 twin neonates were included. Overall neonatal respiratory morbidity was comparable between the two groups (25/241 (11.7%) versus 7/100 (7%), p = .331). Between 34 + 0 and 36 + 6 weeks, however, the risk was higher among singleton than twins (15/46 (32.6%) versus 6/72 (8.3%), p < .001). At multiple regression, dichorionicity, gestational age at delivery !37 weeks and female sex independently decreased the risk of neonatal respiratory morbidity. Conclusion: The risk of neonatal respiratory morbidity after elective caesarean section seems lower among twins, especially prior to 37 + 0 weeks.

Research paper thumbnail of Atosiban versus usual care for the management of preterm labor

Journal of Perinatal Medicine, 2007

Research paper thumbnail of OP18.03: The longitudinal changes of the angle of progression and the midline angle in the active second stage according to the mode of delivery

Research paper thumbnail of Fundal pressure in second stage of labor (Kristeller maneuver) is associated with higher risk of levator ani muscle avulsion

Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, Jan 10, 2018

to investigate the association between fundal pressure in the second stage (Kristeller maneuver) ... more to investigate the association between fundal pressure in the second stage (Kristeller maneuver) and the risk of levator ani muscle (LAM) injury. This was a prospective case-control study conducted in our university hospital. We recruited women immediately following their first vaginal delivery. Women who underwent Kristeller maneuver were recruited as cases. For each case, a control (no Kristeller) was recruited matched by BMI, epidural analgesia, second stage duration and birthweight. All women were invited to undergo a postpartum 4D transperineal ultrasound (TPUS). The main outcome measure was the presence of LAM avulsion at 4D TPUS. TPUS results were compared between cases and controls. A multivariate logistic regression was performed to identify independent risk factors of LAM avulsion. During the study period, 134 women in the Kristeller group and 128 women in the control group underwent TPUS. Women in the Kristeller group had a higher prevalence of LAM avulsion in comparison ...

Research paper thumbnail of Emilia-Romagna Study on Pregnancy and Exposure to Antiepileptic drugs (ESPEA): a population-based study on prescription patterns, pregnancy outcomes and fetal health

Journal of neurology, neurosurgery, and psychiatry, Jan 16, 2018

To assess the prevalence of antiepileptic drug (AED) exposure in pregnant women and the comparati... more 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). 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. 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...

Research paper thumbnail of Correction to: Management of pregnancy-related issues in multiple sclerosis patients: the need for an interdisciplinary approach

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, Jan 26, 2017

The original version contained a mistake. The authors have specified only in a few paragraphs tha... more The original version contained a mistake. The authors have specified only in a few paragraphs that all the contents of the paper are meant for Copaxone but not for unbranded glatiramer acetate, Authors ask to add the specification of Copaxone or branded glatiramer acetate everytime.

Research paper thumbnail of P18.08: Haematometra and “floppy” uterus: powerful sonographic markers of severe post-Caesarean endometritis

Ultrasound in Obstetrics & Gynecology

Research paper thumbnail of Circulating mRNA in Maternal Plasma at the Second Trimester of Pregnancy: A Possible Screening Tool for Cardiac Conotruncal and Left Ventricular Outflow Tract Abnormalities

Molecular diagnosis & therapy, Dec 25, 2017

Maternal plasma is a source of circulating placental nucleic acids. This study was designed to de... more Maternal plasma is a source of circulating placental nucleic acids. This study was designed to detect aberrantly expressed placental mRNA genes circulating in the maternal plasma of pregnancies affected with fetal conotruncal anomalies (CNTRA) and left-ventricular outflow tract (LVOT) obstruction in the second trimester of pregnancy. This was a retrospective monocentric study conducted from 1 Jan 2016 to 31 Dec 2016. NanoString technology was used to identify aberrantly expressed genes, comparing 36 women carrying a fetus with CNTRA or LVOT obstruction to 42 controls at 19-24 weeks of gestation. The genes with differential expression were subsequently tested using real-time polymerase chain reaction. Linear discriminant analysis was used to combine all the mRNA species with discriminant ability for CNTRA and LVOT obstruction. A multivariable receiver operating characteristic (ROC) curve having the estimated discriminant score as an explanatory variable was generated for the two affe...

Research paper thumbnail of Obstetric implications of fetal inherited thrombophilia in thrombophilic women

Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health

Objectives: The relationship between fetal thrombophilic polymorphism and adverse pregnancy outco... more Objectives: The relationship between fetal thrombophilic polymorphism and adverse pregnancy outcomes is still unclear. The aim of this study is to evaluate if fetal thrombophilia may affect obstetric and perinatal outcomes in thrombophilic women. Study design: From 2007 to 2011 all patients with a known inherited thrombophilic mutation consecutively admitted to our labor ward at P25 weeks of gestation with a singleton viable pregnancy were considered eligible for the purpose of the study. At the age of 1 year, the infants were tested for inherited thrombophilic mutations. Patients were then divided into two groups according to the presence or absence of any neonatal mutation. Main outcome measures: The following outcome variables were then compared between the two groups: gestational age at delivery, birth weight, incidence of hypertensive disorders of pregnancy and SGA neonates. Results: Overall, 67 pregnancies of 49 women were studied. Among them, the G20210A Prothrombin (32/67 or 47.7%) mutation and the Factor V Leiden mutation (31/67 or 46.3%) were the commonest findings, with a single patient presenting both. A thrombophilic mutation was found in 38 mother-infant pairs. The risk of all maternal and perinatal events including the incidence of hypertensive disorders disorders (5/29 or 17.2% vs 6/ 38 or 15.7% p = 1.00) and of SGA neonates (3/29 or 10.3% vs 7/38 or 18.4%, p = 0.49) was comparable between the two groups irrespective of the associated fetal thrombophilia. Conclusions: Our data suggest that women with inherited thrombophilia carrying a thrombophilic fetus are not at increased risk of adverse pregnancy outcomes.

Research paper thumbnail of OP28.06: Objective assessment of fetal micrognathia: a new role for the prefrontal space ratio

Ultrasound in Obstetrics & Gynecology

Research paper thumbnail of P17.10: The subpubic angle measured by a novel three-dimensional ultrasound technique in nulliparous and parous women: a pilot study

Ultrasound in Obstetrics & Gynecology

The role of sonographic myometrial thickness measurement in the prediction of successful vaginal ... more The role of sonographic myometrial thickness measurement in the prediction of successful vaginal delivery after induction of labour with a balloon catheter device. Methods: A prospective study was conducted on term singleton pregnancies with a cephalic presentation designated for balloon induction at 38-42 week's gestation. Prior to induction, abdominal sonographic myometrial thickness was assessed at five locations-lower uterine segment (above and below the reflection of the urinary bladder), mid-anterior wall, fundus and posterior uterine wall. Induction of labour was then carried out with a trans-cervical Foley catheter that was substituted with intravenous oxytocin after balloon expulsion. The primary outcome was a successful vaginal delivery. Results: Indications for labour induction were: postdate pregnancy (48.1%), GDM (19.2%), oligohydramnios (11.5%), hypertension (5.8%), and others (15.4%). In the 52 women recruited, vaginal delivery occurred in 46 patients (88.5%) and Caesarean section was performed in 6 patients (11.5%). In a multi-variate regression model, a statistically significant correlation was found between fundal and posterior uterine wall myometrial thickness and time from induction to balloon expulsion (r = 0.36, p = 0.03; r =-0.35, p = 0.05, respectively). A correlation between myometrial thickness and time from labour induction to delivery was not statistically significant. Conclusions: Myometrial fundal and posterior uterine wall thickness in women undergoing induction of labour with a balloon catheter is associated with the time to balloon expulsion.

Research paper thumbnail of P27.02: Reproductive outcome in women with incidental diagnosis of septate uterus at viability scan

Ultrasound in Obstetrics & Gynecology

Research paper thumbnail of Three-dimensional/four-dimensional transperineal ultrasound: clinical utility and future prospects

International Journal of Women's Health

During the last decade, there has been a huge advancement in the use of transperineal ultrasound ... more During the last decade, there has been a huge advancement in the use of transperineal ultrasound (TPU) in the field of obstetrics and gynecology. Its main applications in obstetrics include the monitoring of fetal progression in labor and recently the assessment of maternal pelvic dimensions, whereas in gynecology, TPU is at present widely used for the evaluation of the female pelvic floor, opening new boundaries for the assessment of pelvic floor disorders. The association of volumetric three-dimensional techniques has largely contributed to the remarkable progress that has occurred in the use of TPU. The aim of this paper is to offer an overview of the advantages, challenges and future perspectives of the use of TPU for women's imaging.

Research paper thumbnail of Reduced short-term variation following antenatal administration of betamethasone: Is reduced fetal size a predisposing factor?

European Journal of Obstetrics & Gynecology and Reproductive Biology

To assess the association between fetal size and the incidence of reduced short-term variability ... more To assess the association between fetal size and the incidence of reduced short-term variability (STV) following bethametasone administration for fetal lung maturity. Study design: This was a retrospective, multicenter, cohort study conducted in two Tertiary University Units. Only uncomplicated singleton pregnancies admitted for threatened preterm labor between 26 and 34 weeks and submitted to betamethasone for fetal lung maturity were included. Delivery occurring within 72 h from betamethasone administration represented criteria for exclusion. Computerized cardiotocography was carried out on a daily basis. Cases were identified by persistently reduced STV, defined as <5th percentile for gestational age and lasting for at least 72 h after the first dose of betamethasone. The primary outcome was estimated fetal weight (EFW) at ultrasound in fetuses with normal and in those with persistently reduced STV. Pregnancy outcomes were also evaluated. Results: Persistently reduced STV occurred in 33/405 of the included patients (8.1%). Compared to women with normal STV, those with persistently reduced STV had significantly lower EFW (1472 AE 435 vs 1812 AE 532 g, p 0.04), lower birthweight (2353 AE 635 vs 2857 AE 796 g, p < 0.01) and earlier gestational age at delivery (35.1 AE 4.2 vs 37.3 AE 2.4 weeks, p < 0.01), whereas all the other variables including gestational age on admission were comparable. Conclusions: Reduced STV following maternal betamethasone administration among appropriately grown fetuses seems to correlate with lower fetal size. Furthermore, fetuses with such abnormal response to steroids seem to carry a higher risk of perinatal complications, including lower birthweight and earlier gestational age at delivery.

Research paper thumbnail of Management of pregnancy-related issues in multiple sclerosis patients: the need for an interdisciplinary approach

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, Jan 2, 2017

Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous s... more Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous system (CNS), most probably autoimmune in origin, usually occurring in young adults with a female/male prevalence of approximately 3:1. Women with MS in the reproductive age may face challenging issues in reconciling the desire for parenthood with their condition, owing to the possible influence both on the ongoing or planned treatment with the possible consequences on the disease course and on the potential negative effects of treatments on foetal and pregnancy outcomes. At MS diagnosis, timely counselling should promote informed parenthood, while disease evolution should be assessed before making therapeutic decisions. Current guidelines advise the discontinuation of any treatment during pregnancy, with possible exceptions for some treatments in patients with very active disease. Relapses decline during pregnancy but are more frequent during puerperium, when MS therapy should be promptl...

Research paper thumbnail of Elevated maternal placental protein 13 serum levels at term of pregnancy in postpartum major hemorrhage (>1000 mLs). A prospective cohort study

American journal of reproductive immunology (New York, N.Y. : 1989), Jan 15, 2017

To compare placental protein 13 (PP13) levels in the serum of women with primary postpartum hemor... more To compare placental protein 13 (PP13) levels in the serum of women with primary postpartum hemorrhage (PPH) with a control population. A prospective cohort study was conducted between May 2014 and May 2016 and included 435 pregnant women at term (38 weeks gestation) without any known risk factor and with normal labor. Multiples of median (MoM) were used to evaluate differences of the PP13 values between cases and controls. PP13 concentrations were adjusted for maternal and neonatal weight. Multivariable analysis was used to detect independent contribution of predictors of PPH. Fifteen had a major PPH >1000 mLs and represented the cases of the study. They were matched with 399 controls. Twenty-one patients who had a minor PPH (500-1000 mLs) were excluded. The mean observed rank in the PPH group was higher than that of controls (28.5 vs 13.5, P-value=.01). PP13 MoM values adjusted for maternal weight were higher than expected being 1.44±0.45 in PPH cases and 1.00±0.59 in controls ...

Research paper thumbnail of Antiphospholipid antibody profile based obstetric outcomes of primary antiphospholipid syndrome. The PREGNANTS study

American Journal of Obstetrics and Gynecology, 2017

Antiphospholipid syndrome (APS) is an autoimmune, hypercoagulable state caused by antiphospholipi... more Antiphospholipid syndrome (APS) is an autoimmune, hypercoagulable state caused by antiphospholipid antibodies. Anticardiolipin antibodies (aCL), anti-β2 glycoprotein-I (ab2GPI) and lupus anticoagulant (LA) are the main autoantibodies found in APS. Despite the amassed body of clinical knowledge, the risk of obstetric complications associated with specific antibody profile has not been well established. To assess the risk of obstetric complications in women with primary APS associated with specific antibody profile STUDY DESIGN: The PREGNANTS study is a multicenter, retrospective, cohort study. Diagnosis and classification of APS were based on the 2006 International revised criteria. All women included in the study had at least one clinical criteria for APS, were positive for at least one antiphospholipid antibodies (aCL, ab2GPI and/or LA), and were treated with low-dose aspirin and prophylactic low molecular weight heparin (LMWH) starting from the first trimester. Only singleton pregnancies with primary APS were included. The primary outcome was livebirth, defined as any delivery of a live infant after 22 weeks. The secondary outcomes were preeclampsia with and without severe features, intrauterine growth restriction (IUGR) and stillbirth. We planned to assess the outcomes associated with the various antibody profile (test result for LA, aCL and ab2GPI). There were 750 singleton pregnancies with primary APS in the study cohort. 54 (7.2%) were positive for LA only, 458 (61.0%) for aCL only, 128 (17.1%) for ab2GPI only; while 90 (12.0%) were double positive and LA negative and 20 (2.7%) were triple positive. The incidence of livebirth in each of these categories was 79.6%, 56.3%, 47.7%, 43.3%, and 30.0%, respectively. Compared to women with only one antibody positive test results, women with multiple antibody positive results had a significantly lower livebirth (40.9% vs 56.6%; aOR 0.71, 95% CI 0.51 to 0.90). Also, they were at increased risk of preeclampsia without (54.5% vs 34.8%; aOR 1.56, 95% CI 1.22 to 1.95) and with severe features (22.7% vs 13.8%, aOR 1.66, 95% CI 1.19 to 2.49), IUGR (53.6% vs 40.8%; aOR 2.31, 95% CI 1.17 to 2.61) and stillbirth (36.4% vs 21.7%; aOR 2.67, 95% CI 1.22 to 2.94). In women with only one positive test result, women with ab2GPI positivity present alone had a significantly lower livebirth (47.7% vs 56.3% vs 79.6%; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01), and a significantly higher incidence of preeclampsia without (47.7% vs 34.1% vs 11.1%; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) and with severe features (17.2% vs 14.4% vs 0%; p=0.02), IUGR (48.4% vs 40.1% vs 25.9%; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) and stillbirth (29.7% vs 21.2% vs 7.4%; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) compared to women with aCL and to women with LA present alone, respectively. In the group of women with more than one antibody positivity, triple-positive women had lower livebirth (30% vs 43.3%; aOR 0.69, 95% CI 0.22 to 0.91), and higher incidence of IUGR (70.0% vs 50.0%; aOR 2.40, 95% CI 1.15 to 2.99) compared to double positive and LA negative women. In singleton pregnancies with primary APS, aCL is the most common sole antiphospholipid antibody present, but ab2GPI is the one associated with the lowest livebirth rate and highest incidence of preeclampsia, IUGR, and stillbirth, compared to presence of aCL or LA alone. Primary APS women have an increased risk of obstetric complications and lower livebirth when more than one antiphospholipid antibody is present. Despite therapy with low-dose aspirin and prophylactic LMWH, chance of a live-birth neonate is only 30% for triple-positive women.

Research paper thumbnail of An innovative test for non-invasive Kell genotyping on circulating fetal DNA by means of the allelic discrimination of K1 and K2 antigens

American journal of reproductive immunology (New York, N.Y. : 1989), Dec 1, 2016

The aim of this study was to present a new method for fetal Kell genotyping by means of the allel... more The aim of this study was to present a new method for fetal Kell genotyping by means of the allelic discrimination of K1 and K2 in real-time polymerase chain reaction (PCR). Real-time quantitative polymerase chain reaction incorporating an allele-specific primer was developed for detecting the K allele of KEL. By means of this method, the K1/K2 genotype was able to be determined in all blood samples analyzed. Results using cell-free fetal DNA (cffDNA) from two Kell-negative pregnant women confirmed the Kell-positive genotype of fetuses. The real-time PCR analysis also allowed the determination of the fetal fraction using the quantification of Kell-positive DNA. An efficient and reliable strategy for Kell genotyping is herein presented. The method was optimized on cffDNA to create a non-invasive prenatal test which could be routinely used for the prevention of hemolytic disease of the fetus and the newborn (HDFN).

Research paper thumbnail of Congenital Cytomegalovirus Infection: Prognostic Value of Maternal DNAemia at Amniocentesis

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 15, 2017

Human Cytomegalovirus (HCMV) is the most common cause of childhood hearing loss and can lead to n... more 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. 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...

Research paper thumbnail of Automated 3D ultrasound measurement of the angle of progression in labor

The Journal of Maternal-Fetal & Neonatal Medicine, 2017

To assess the feasibility and reliability of an automated technique for the assessment of the ang... more To assess the feasibility and reliability of an automated technique for the assessment of the angle of progression (AoP) in labor using three-dimensional (3D) ultrasound. AoP was assessed using 3D transperineal ultrasound by two operators in 52 women in active labor to evaluate intra- and interobserver reproducibility. Furthermore, intermethod agreement between automated and manual techniques on 3D images, and between automated technique on 3D vs 2D images were evaluated. Automated measurements were feasible in all cases. Automated measurements were considered acceptable in 141 (90.4%) out of 156 on the first assessments and in all 156 after repeating measurements for unacceptable evaluations. The automated technique on 3D images demonstrated good intra- and interobserver reproducibility. 3D-automated technique showed a very good agreement with the 3D manual technique. Notably, AoP calculated with the 3D automated technique were significantly wider in comparison with those measured manually on 3D images (133±17° vs 118±21°, P = 0.013). the assessment of the angle of progression through 3D ultrasound is highly reproducible. However, automated software leads to a systematic overestimation of AoP in comparison with the standard manual technique thus hindering its use in clinical practice in its present form.