Anna Nunzia Della Gatta | Università di Bologna (original) (raw)

Papers by Anna Nunzia Della Gatta

Anaesthesia, 2021

SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...

American Journal of Obstetrics & Gynecology MFM

BACKGROUND Hypoxia caused by inadequate intracardiac mixing due to a restrictive foramen ovale (F... more BACKGROUND Hypoxia caused by inadequate intracardiac mixing due to a restrictive foramen ovale (FO) is a potentially life-threatening complication in neonates with transposition of the great arteries (dTGA). An urgent balloon atrial septostomy (BAS) is a procedure of choice in such cases, but dependent on the availability of a 24-hour interventional cardiology facility. The prenatal identification of predictors for an urgent BAS at birth would help in optimizing the management of these neonates, minimizing the risk of hypoxic damage. OBJECTIVE to predict with prenatal echocardiography the need of urgent BAS in neonates with dTGA. STUDY DESIGN this was a retrospective cohort study of patients with a prenatal diagnosis of TGA that were delivered in our center between 2010 and 2019, for whom fetal ultrasound echocardiograms obtained less than three weeks before delivery were available. The following parameters were systematically obtained at fetal echocardiography: size and appearance of FO, septum primum excursion (FO flap angle at the maximal excursion), diameters of the atria, size of the ductus arteriosus. BAS was defined as urgent if performed within 12 hours from birth in neonates with restrictive foramen ovale. Neonatal follow-up was obtained through medical records analysis. RESULTS From November 2007 to April 2019, 160 fetuses with complete TGA were referred to our echocardiography laboratory and 60 of these were included in the analysis; 27 underwent urgent BAS, 11 elective BAS and 22 no BAS. The size of the FO was the best predictor of a urgent BAS. A measurement > 6.5 mm had a sensitivity of 100% and a false positive rate of 45%. CONCLUSION Fetal echocardiography predicts the need of a urgent BAS in fetuses with dTGA although with a limited precision. In our experience a measurement of the FO within three weeks of delivery had the greatest accuracy.

Menopause is a natural phase in a woman’s aging process defined as the absence of menstrual perio... more Menopause is a natural phase in a woman’s aging process defined as the absence of menstrual periods for 12 consecutive months with no further pathological or physiological causes. With “Genitourinary syndrome of menopause (GSM)” we usually describe the collection of symptoms resulting from changes to the internal and external genitalia and lower urinary tract. The most common symptoms are vaginal dryness, itching, irritation, and dyspareunia. GSM may have a significant impact on quality of life and sexual function of women affected. The aim of this review is to make a brief reflection about the use of ultralow-concentration estriol vaginal gel in the treatment of GSM symptoms and its impact on sexuality and quality of life of the patients.

Polycystic ovary syndrome (PCOS) is a common metabolic disorder that typically affects women of c... more Polycystic ovary syndrome (PCOS) is a common metabolic disorder that typically affects women of childbearing age. Several factors are involved in the genesis of this disease but a common agreement on its etiology is still far to be reached. According to Rotterdam criteria, PCOS is characterized by oligo and/ or anovulation, biochemical hyperandrogenism and polycystic ovaries on ultrasound; following main clinical features and symptoms, women with PCOS are distinguished in four different phenotypes. The combination of different medical and, in specific cases, surgical treatments is necessary to properly reduce symptoms and restore fertility. This review points out the last evidences on medical and surgical treatments for PCOS, especially it focuses on the most common assisted reproductive techniques currently performed in case of infertility due to this syndrome. We put a special attention on the possible approaches useful for sterile women who do not respond to first line medical an...

Fetal Diagnosis and Therapy

Introduction: Intrapartum cardiotocography (CTG) was used for several decades to detect a stresse... more Introduction: Intrapartum cardiotocography (CTG) was used for several decades to detect a stressed fetus so that delivery can be expedited to prevent birth asphyxia. The main aim of the study was to calculate the risk of neonatal acidemia (pH ≤ 7.10) according to duration of the 2nd stage of labor and occurrence of the International Federation of Gynecology and Obstetrics (FIGO) 2015 CTG classification parameters. Materials and Methods: This was a retrospective case-control study on 552 pregnancies receiving continuous CTG monitoring in labor and immediate hemogasanalysis at birth. Cases with umbilical artery (UA) pH ≤ 7.10 and controls with UA pH ≥ 7.10 were matched for parity and gestational age at delivery, with ratio 1:5. Logistic regression analysis, adjusted for the expected risk in the general population, was used to calculate the baseline risk of UA pH ≤ 7.10 in the absence of any CTG pathological feature and those associated with pathological CTG patterns occurring in the 2...

British Journal of Surgery

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numb... more Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst ...

Obstetrical & Gynecological Survey

The presence of coronavirus disease 2019 (COVID-19) in pregnant patients raises concerns for adve... more The presence of coronavirus disease 2019 (COVID-19) in pregnant patients raises concerns for adverse outcomes. The goal of this study was to collect information on mothers and neonates with COVID-19 and shed light on delivery timing and mode Health, Inc. All rights reserved. 721 Medical Complications of Pregnancy of delivery. Information regarding each pregnancy was collected through PubMed, Scopus, and CINAHL. The terms “coronavirus and/or pregnancy,” “COVID and/or pregnancy,” “COVID disease and/or pregnancy,” and “COVID pneumonia and/ or pregnancy” were used to search through the databases. Reports discussing recommended management for pregnancies complicated by COVID-19 were included. A total of 205 articles published from 1969 to 2020 were identified and searched. Overall, 199 were excluded because of representing animal studies, abstract not available, contents not related to the topic, significant information not provided, and duplicate articles, leaving a total of 12 articles; 6 articles were then excluded because the data were not comparable. This left a total of 6 studies that were included. There was no restriction on language in order to obtain as many articles and as much information as possible. The researchers analyzed clinical features, symptoms, associated diseases, fetal characteristics, time of delivery, type of delivery, and follow-up for mothers 20 years or older. Overall, a total of 51 cases with pregnancies affected by COVID-19 were analyzed. Median maternal age was 30 years (interquartile range [IQR], 27.5–33 years), and median gestational age at diagnosis was 36 weeks (IQR, 35–37.5 weeks). Of the 48 pregnant women who were included and had delivered before publication, the median gestational age at delivery was 36.5 weeks (IQR, 35–33weeks). For 22 patients, the range of time between symptom onset and delivery was between 1 and 7 days (median, 2 days; IQR, 1–4 days). In 3 cases, symptoms of COVID-19 appeared after delivery. In all, 35 pregnant women had documented symptoms at the time of diagnosis of COVID-19, which were similar to nonpregnant patients. The symptoms included the following: 17 pregnant women (48%) with fever on hospital admission, 16 (46%) with dry cough, and 8 (23%) with fever in the postpartum period. Other less frequent symptoms included sore throat, dyspnea, fatigue, myalgia, malaise, diarrhea, and cholecystitis. No pregestational comorbidities were reported; however, there was 1 case of gestational hypertension and 1 case of preeclampsia reported after the diagnosis of COVID-19. Through this study, there were no cases identified during the first trimester of pregnancy, 2 cases in the second trimester, and 49 cases during the third trimester. Of the 48 women who delivered, 2 had a spontaneous vaginal delivery, whereas the remaining 46 had a cesarean delivery. The indications for cesarean were not clearly reported for most cases. Of note, premature rupture of membranes occurred in 26% of patients. Of the neonates, 48 (with 1 set of twins) were reported healthy at the time of birth, and 1 fetal death was reported in a critically ill patient. All of the neonates had a throat swab taken within 72 hours of delivery and tested negative for COVID-19, whereas 1 neonate tested positive 36 hours after birth. Overall, the majority of pregnant patients infected with COVID-19 delivered via cesarean and often preterm. This raises concern as the COVID-19 pandemic continues to spread around the world. Notably, there was no evidence of vertical transmission. Moving forward, the rationale behind obstetrical interventions, including cesarean delivery, should be provided in reports in order to better understand the implications of COVID-19 in pregnancy. Further research is necessary to determine the maternal and fetal consequences of a COVID-19 infection during pregnancy.

American Journal of Obstetrics & Gynecology MFM

Ultrasound in Obstetrics & Gynecology

Journal of Perinatal Medicine

Objectives To evaluate the strength of association between maternal and pregnancy characteristics... more Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate par...

Cancers

Women who have previously received radiotherapy (RT) for gynecologic cancer often suffer from vag... more Women who have previously received radiotherapy (RT) for gynecologic cancer often suffer from vaginal fibrosis and stenosis. The success of “non-ablative” laser therapy for postmenopausal vaginal atrophy has led to the idea of testing the laser in patients submitted to RT. In this prospective observational study, we selected patients who underwent pelvic RT followed by vaginal laser treatment. We scheduled three treatment sessions (at T0–T1–T2) and three controls (at T1–T2–T3) one month apart. The follow-up (at T4) was carried out six months after the last treatment. Vaginal Health Index (VHI) and vaginal length were evaluated. Sexual function was assessed through Female Sexual Function Index (FSFI). Overall, 43 patients with severe vaginal shortening, atrophy and stenosis was enrolled and treated with intravaginal non-ablative CO2 laser. We observed a progressive increase in vaginal length of 9% (p = 0.03) at T2 and 28% (p < 0.0001) at T3; effects were maintained at T4 (p < 0...

Journal of Obstetrics and Gynaecology Research

Current Women s Health Reviews

Background: The use of effective contraceptive methods must be encouraged among adolescents, not ... more Background: The use of effective contraceptive methods must be encouraged among adolescents, not only to prevent unintended pregnancies but also to promote the sexual health and well-being of these young people. In effect, hormonal contraceptives offer several benefits beyond prevention of pregnancy to every woman, in particular to adolescents (e.g., dysmenorrhea, irregular bleeding, hirsutism, acne); moreover, they can be a targeted therapy for some gynecological diseases (e.g., endometriosis, polycystic ovary syndrome), to ensure a better quality of life. Objective: The purpose of this article is to review the different formulations of COCs for adolescent and young adult women, and analyze their efficacy, safety, and benefits of specific pathological conditions. Methods: We screened published literature on PubMed/MEDLINE and Scopus, using as keywords “oral contraceptive” in adolescent and young adult women. We included only articles in English about the COCs, different regimens an...

Fertility and Sterility, 2015

To investigate immunologic parameters and endoplasmic reticulum (ER) stress associated with unexp... more To investigate immunologic parameters and endoplasmic reticulum (ER) stress associated with unexplained infertility. Case-control study. Academic center. Women with no fertility problems (FS) (n = 13), women with recurrent miscarriage (RM) (n = 15) and women with repeated in vitro fertilization failure (RIF) (n = 15). Endometrial biopsy and collection of peripheral blood during the midsecretory phase of menstrual cycle. Leptin, resistin, soluble tumor necrosis factor receptor (sTNF-R), myeloperoxidase (MPO), soluble intercellular adhesion molecule 1 (sICAM-1), and interleukin 22 (IL-22) concentration in peripheral blood, endometrial CD3(+), CD4(+), CD5(+), CD8(+), and FoxP3(+) T lymphocytes, and endometrial expression of HSPA5, a specific marker of ER stress. We found an increase of proinflammatory molecules such as resistin, leptin, and IL-22 in both RM and RIF patients; sTNF-R and MPO only in RIF patients when compared with the FS women. We also found in endometria of infertile women a statistically significant increase of CD3(+), CD4(+), CD8(+) in both RM and RIF patients and CD5(+) in RM patients when compared with FS women. This was paralleled by a statistically significant reduction of infiltrating FoxP3(+) regulatory T cells. Finally, endometrial HSPA5 expression levels were statistically significantly up-regulated in both RM and RIF patients. Women with RM and RIF showed an increase of circulating proinflammatory cytokines, altered endometrial T lymphocytes subsets, and signs of endometrial ER stress.

Fertility and Sterility, 2015

To investigate immunologic parameters and endoplasmic reticulum (ER) stress associated with unexp... more To investigate immunologic parameters and endoplasmic reticulum (ER) stress associated with unexplained infertility. Case-control study. Academic center. Women with no fertility problems (FS) (n = 13), women with recurrent miscarriage (RM) (n = 15) and women with repeated in vitro fertilization failure (RIF) (n = 15). Endometrial biopsy and collection of peripheral blood during the midsecretory phase of menstrual cycle. Leptin, resistin, soluble tumor necrosis factor receptor (sTNF-R), myeloperoxidase (MPO), soluble intercellular adhesion molecule 1 (sICAM-1), and interleukin 22 (IL-22) concentration in peripheral blood, endometrial CD3(+), CD4(+), CD5(+), CD8(+), and FoxP3(+) T lymphocytes, and endometrial expression of HSPA5, a specific marker of ER stress. We found an increase of proinflammatory molecules such as resistin, leptin, and IL-22 in both RM and RIF patients; sTNF-R and MPO only in RIF patients when compared with the FS women. We also found in endometria of infertile women a statistically significant increase of CD3(+), CD4(+), CD8(+) in both RM and RIF patients and CD5(+) in RM patients when compared with FS women. This was paralleled by a statistically significant reduction of infiltrating FoxP3(+) regulatory T cells. Finally, endometrial HSPA5 expression levels were statistically significantly up-regulated in both RM and RIF patients. Women with RM and RIF showed an increase of circulating proinflammatory cytokines, altered endometrial T lymphocytes subsets, and signs of endometrial ER stress.

Fertility and Sterility, 2015

To investigate immunologic parameters and endoplasmic reticulum (ER) stress associated with unexp... more To investigate immunologic parameters and endoplasmic reticulum (ER) stress associated with unexplained infertility. Case-control study. Academic center. Women with no fertility problems (FS) (n = 13), women with recurrent miscarriage (RM) (n = 15) and women with repeated in vitro fertilization failure (RIF) (n = 15). Endometrial biopsy and collection of peripheral blood during the midsecretory phase of menstrual cycle. Leptin, resistin, soluble tumor necrosis factor receptor (sTNF-R), myeloperoxidase (MPO), soluble intercellular adhesion molecule 1 (sICAM-1), and interleukin 22 (IL-22) concentration in peripheral blood, endometrial CD3(+), CD4(+), CD5(+), CD8(+), and FoxP3(+) T lymphocytes, and endometrial expression of HSPA5, a specific marker of ER stress. We found an increase of proinflammatory molecules such as resistin, leptin, and IL-22 in both RM and RIF patients; sTNF-R and MPO only in RIF patients when compared with the FS women. We also found in endometria of infertile women a statistically significant increase of CD3(+), CD4(+), CD8(+) in both RM and RIF patients and CD5(+) in RM patients when compared with FS women. This was paralleled by a statistically significant reduction of infiltrating FoxP3(+) regulatory T cells. Finally, endometrial HSPA5 expression levels were statistically significantly up-regulated in both RM and RIF patients. Women with RM and RIF showed an increase of circulating proinflammatory cytokines, altered endometrial T lymphocytes subsets, and signs of endometrial ER stress.

American Journal of Obstetrics and Gynecology

Anaesthesia, 2021

SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...

American Journal of Obstetrics & Gynecology MFM

BACKGROUND Hypoxia caused by inadequate intracardiac mixing due to a restrictive foramen ovale (F... more BACKGROUND Hypoxia caused by inadequate intracardiac mixing due to a restrictive foramen ovale (FO) is a potentially life-threatening complication in neonates with transposition of the great arteries (dTGA). An urgent balloon atrial septostomy (BAS) is a procedure of choice in such cases, but dependent on the availability of a 24-hour interventional cardiology facility. The prenatal identification of predictors for an urgent BAS at birth would help in optimizing the management of these neonates, minimizing the risk of hypoxic damage. OBJECTIVE to predict with prenatal echocardiography the need of urgent BAS in neonates with dTGA. STUDY DESIGN this was a retrospective cohort study of patients with a prenatal diagnosis of TGA that were delivered in our center between 2010 and 2019, for whom fetal ultrasound echocardiograms obtained less than three weeks before delivery were available. The following parameters were systematically obtained at fetal echocardiography: size and appearance of FO, septum primum excursion (FO flap angle at the maximal excursion), diameters of the atria, size of the ductus arteriosus. BAS was defined as urgent if performed within 12 hours from birth in neonates with restrictive foramen ovale. Neonatal follow-up was obtained through medical records analysis. RESULTS From November 2007 to April 2019, 160 fetuses with complete TGA were referred to our echocardiography laboratory and 60 of these were included in the analysis; 27 underwent urgent BAS, 11 elective BAS and 22 no BAS. The size of the FO was the best predictor of a urgent BAS. A measurement > 6.5 mm had a sensitivity of 100% and a false positive rate of 45%. CONCLUSION Fetal echocardiography predicts the need of a urgent BAS in fetuses with dTGA although with a limited precision. In our experience a measurement of the FO within three weeks of delivery had the greatest accuracy.

Menopause is a natural phase in a woman’s aging process defined as the absence of menstrual perio... more Menopause is a natural phase in a woman’s aging process defined as the absence of menstrual periods for 12 consecutive months with no further pathological or physiological causes. With “Genitourinary syndrome of menopause (GSM)” we usually describe the collection of symptoms resulting from changes to the internal and external genitalia and lower urinary tract. The most common symptoms are vaginal dryness, itching, irritation, and dyspareunia. GSM may have a significant impact on quality of life and sexual function of women affected. The aim of this review is to make a brief reflection about the use of ultralow-concentration estriol vaginal gel in the treatment of GSM symptoms and its impact on sexuality and quality of life of the patients.

Polycystic ovary syndrome (PCOS) is a common metabolic disorder that typically affects women of c... more Polycystic ovary syndrome (PCOS) is a common metabolic disorder that typically affects women of childbearing age. Several factors are involved in the genesis of this disease but a common agreement on its etiology is still far to be reached. According to Rotterdam criteria, PCOS is characterized by oligo and/ or anovulation, biochemical hyperandrogenism and polycystic ovaries on ultrasound; following main clinical features and symptoms, women with PCOS are distinguished in four different phenotypes. The combination of different medical and, in specific cases, surgical treatments is necessary to properly reduce symptoms and restore fertility. This review points out the last evidences on medical and surgical treatments for PCOS, especially it focuses on the most common assisted reproductive techniques currently performed in case of infertility due to this syndrome. We put a special attention on the possible approaches useful for sterile women who do not respond to first line medical an...

Fetal Diagnosis and Therapy

Introduction: Intrapartum cardiotocography (CTG) was used for several decades to detect a stresse... more Introduction: Intrapartum cardiotocography (CTG) was used for several decades to detect a stressed fetus so that delivery can be expedited to prevent birth asphyxia. The main aim of the study was to calculate the risk of neonatal acidemia (pH ≤ 7.10) according to duration of the 2nd stage of labor and occurrence of the International Federation of Gynecology and Obstetrics (FIGO) 2015 CTG classification parameters. Materials and Methods: This was a retrospective case-control study on 552 pregnancies receiving continuous CTG monitoring in labor and immediate hemogasanalysis at birth. Cases with umbilical artery (UA) pH ≤ 7.10 and controls with UA pH ≥ 7.10 were matched for parity and gestational age at delivery, with ratio 1:5. Logistic regression analysis, adjusted for the expected risk in the general population, was used to calculate the baseline risk of UA pH ≤ 7.10 in the absence of any CTG pathological feature and those associated with pathological CTG patterns occurring in the 2...

British Journal of Surgery

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numb... more Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst ...

Obstetrical & Gynecological Survey

The presence of coronavirus disease 2019 (COVID-19) in pregnant patients raises concerns for adve... more The presence of coronavirus disease 2019 (COVID-19) in pregnant patients raises concerns for adverse outcomes. The goal of this study was to collect information on mothers and neonates with COVID-19 and shed light on delivery timing and mode Health, Inc. All rights reserved. 721 Medical Complications of Pregnancy of delivery. Information regarding each pregnancy was collected through PubMed, Scopus, and CINAHL. The terms “coronavirus and/or pregnancy,” “COVID and/or pregnancy,” “COVID disease and/or pregnancy,” and “COVID pneumonia and/ or pregnancy” were used to search through the databases. Reports discussing recommended management for pregnancies complicated by COVID-19 were included. A total of 205 articles published from 1969 to 2020 were identified and searched. Overall, 199 were excluded because of representing animal studies, abstract not available, contents not related to the topic, significant information not provided, and duplicate articles, leaving a total of 12 articles; 6 articles were then excluded because the data were not comparable. This left a total of 6 studies that were included. There was no restriction on language in order to obtain as many articles and as much information as possible. The researchers analyzed clinical features, symptoms, associated diseases, fetal characteristics, time of delivery, type of delivery, and follow-up for mothers 20 years or older. Overall, a total of 51 cases with pregnancies affected by COVID-19 were analyzed. Median maternal age was 30 years (interquartile range [IQR], 27.5–33 years), and median gestational age at diagnosis was 36 weeks (IQR, 35–37.5 weeks). Of the 48 pregnant women who were included and had delivered before publication, the median gestational age at delivery was 36.5 weeks (IQR, 35–33weeks). For 22 patients, the range of time between symptom onset and delivery was between 1 and 7 days (median, 2 days; IQR, 1–4 days). In 3 cases, symptoms of COVID-19 appeared after delivery. In all, 35 pregnant women had documented symptoms at the time of diagnosis of COVID-19, which were similar to nonpregnant patients. The symptoms included the following: 17 pregnant women (48%) with fever on hospital admission, 16 (46%) with dry cough, and 8 (23%) with fever in the postpartum period. Other less frequent symptoms included sore throat, dyspnea, fatigue, myalgia, malaise, diarrhea, and cholecystitis. No pregestational comorbidities were reported; however, there was 1 case of gestational hypertension and 1 case of preeclampsia reported after the diagnosis of COVID-19. Through this study, there were no cases identified during the first trimester of pregnancy, 2 cases in the second trimester, and 49 cases during the third trimester. Of the 48 women who delivered, 2 had a spontaneous vaginal delivery, whereas the remaining 46 had a cesarean delivery. The indications for cesarean were not clearly reported for most cases. Of note, premature rupture of membranes occurred in 26% of patients. Of the neonates, 48 (with 1 set of twins) were reported healthy at the time of birth, and 1 fetal death was reported in a critically ill patient. All of the neonates had a throat swab taken within 72 hours of delivery and tested negative for COVID-19, whereas 1 neonate tested positive 36 hours after birth. Overall, the majority of pregnant patients infected with COVID-19 delivered via cesarean and often preterm. This raises concern as the COVID-19 pandemic continues to spread around the world. Notably, there was no evidence of vertical transmission. Moving forward, the rationale behind obstetrical interventions, including cesarean delivery, should be provided in reports in order to better understand the implications of COVID-19 in pregnancy. Further research is necessary to determine the maternal and fetal consequences of a COVID-19 infection during pregnancy.

American Journal of Obstetrics & Gynecology MFM

Ultrasound in Obstetrics & Gynecology

Journal of Perinatal Medicine

Objectives To evaluate the strength of association between maternal and pregnancy characteristics... more Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate par...

Cancers

Women who have previously received radiotherapy (RT) for gynecologic cancer often suffer from vag... more Women who have previously received radiotherapy (RT) for gynecologic cancer often suffer from vaginal fibrosis and stenosis. The success of “non-ablative” laser therapy for postmenopausal vaginal atrophy has led to the idea of testing the laser in patients submitted to RT. In this prospective observational study, we selected patients who underwent pelvic RT followed by vaginal laser treatment. We scheduled three treatment sessions (at T0–T1–T2) and three controls (at T1–T2–T3) one month apart. The follow-up (at T4) was carried out six months after the last treatment. Vaginal Health Index (VHI) and vaginal length were evaluated. Sexual function was assessed through Female Sexual Function Index (FSFI). Overall, 43 patients with severe vaginal shortening, atrophy and stenosis was enrolled and treated with intravaginal non-ablative CO2 laser. We observed a progressive increase in vaginal length of 9% (p = 0.03) at T2 and 28% (p < 0.0001) at T3; effects were maintained at T4 (p < 0...

Journal of Obstetrics and Gynaecology Research

Current Women s Health Reviews

Background: The use of effective contraceptive methods must be encouraged among adolescents, not ... more Background: The use of effective contraceptive methods must be encouraged among adolescents, not only to prevent unintended pregnancies but also to promote the sexual health and well-being of these young people. In effect, hormonal contraceptives offer several benefits beyond prevention of pregnancy to every woman, in particular to adolescents (e.g., dysmenorrhea, irregular bleeding, hirsutism, acne); moreover, they can be a targeted therapy for some gynecological diseases (e.g., endometriosis, polycystic ovary syndrome), to ensure a better quality of life. Objective: The purpose of this article is to review the different formulations of COCs for adolescent and young adult women, and analyze their efficacy, safety, and benefits of specific pathological conditions. Methods: We screened published literature on PubMed/MEDLINE and Scopus, using as keywords “oral contraceptive” in adolescent and young adult women. We included only articles in English about the COCs, different regimens an...

Fertility and Sterility, 2015

To investigate immunologic parameters and endoplasmic reticulum (ER) stress associated with unexp... more To investigate immunologic parameters and endoplasmic reticulum (ER) stress associated with unexplained infertility. Case-control study. Academic center. Women with no fertility problems (FS) (n = 13), women with recurrent miscarriage (RM) (n = 15) and women with repeated in vitro fertilization failure (RIF) (n = 15). Endometrial biopsy and collection of peripheral blood during the midsecretory phase of menstrual cycle. Leptin, resistin, soluble tumor necrosis factor receptor (sTNF-R), myeloperoxidase (MPO), soluble intercellular adhesion molecule 1 (sICAM-1), and interleukin 22 (IL-22) concentration in peripheral blood, endometrial CD3(+), CD4(+), CD5(+), CD8(+), and FoxP3(+) T lymphocytes, and endometrial expression of HSPA5, a specific marker of ER stress. We found an increase of proinflammatory molecules such as resistin, leptin, and IL-22 in both RM and RIF patients; sTNF-R and MPO only in RIF patients when compared with the FS women. We also found in endometria of infertile women a statistically significant increase of CD3(+), CD4(+), CD8(+) in both RM and RIF patients and CD5(+) in RM patients when compared with FS women. This was paralleled by a statistically significant reduction of infiltrating FoxP3(+) regulatory T cells. Finally, endometrial HSPA5 expression levels were statistically significantly up-regulated in both RM and RIF patients. Women with RM and RIF showed an increase of circulating proinflammatory cytokines, altered endometrial T lymphocytes subsets, and signs of endometrial ER stress.

Fertility and Sterility, 2015

To investigate immunologic parameters and endoplasmic reticulum (ER) stress associated with unexp... more To investigate immunologic parameters and endoplasmic reticulum (ER) stress associated with unexplained infertility. Case-control study. Academic center. Women with no fertility problems (FS) (n = 13), women with recurrent miscarriage (RM) (n = 15) and women with repeated in vitro fertilization failure (RIF) (n = 15). Endometrial biopsy and collection of peripheral blood during the midsecretory phase of menstrual cycle. Leptin, resistin, soluble tumor necrosis factor receptor (sTNF-R), myeloperoxidase (MPO), soluble intercellular adhesion molecule 1 (sICAM-1), and interleukin 22 (IL-22) concentration in peripheral blood, endometrial CD3(+), CD4(+), CD5(+), CD8(+), and FoxP3(+) T lymphocytes, and endometrial expression of HSPA5, a specific marker of ER stress. We found an increase of proinflammatory molecules such as resistin, leptin, and IL-22 in both RM and RIF patients; sTNF-R and MPO only in RIF patients when compared with the FS women. We also found in endometria of infertile women a statistically significant increase of CD3(+), CD4(+), CD8(+) in both RM and RIF patients and CD5(+) in RM patients when compared with FS women. This was paralleled by a statistically significant reduction of infiltrating FoxP3(+) regulatory T cells. Finally, endometrial HSPA5 expression levels were statistically significantly up-regulated in both RM and RIF patients. Women with RM and RIF showed an increase of circulating proinflammatory cytokines, altered endometrial T lymphocytes subsets, and signs of endometrial ER stress.

Fertility and Sterility, 2015

To investigate immunologic parameters and endoplasmic reticulum (ER) stress associated with unexp... more To investigate immunologic parameters and endoplasmic reticulum (ER) stress associated with unexplained infertility. Case-control study. Academic center. Women with no fertility problems (FS) (n = 13), women with recurrent miscarriage (RM) (n = 15) and women with repeated in vitro fertilization failure (RIF) (n = 15). Endometrial biopsy and collection of peripheral blood during the midsecretory phase of menstrual cycle. Leptin, resistin, soluble tumor necrosis factor receptor (sTNF-R), myeloperoxidase (MPO), soluble intercellular adhesion molecule 1 (sICAM-1), and interleukin 22 (IL-22) concentration in peripheral blood, endometrial CD3(+), CD4(+), CD5(+), CD8(+), and FoxP3(+) T lymphocytes, and endometrial expression of HSPA5, a specific marker of ER stress. We found an increase of proinflammatory molecules such as resistin, leptin, and IL-22 in both RM and RIF patients; sTNF-R and MPO only in RIF patients when compared with the FS women. We also found in endometria of infertile women a statistically significant increase of CD3(+), CD4(+), CD8(+) in both RM and RIF patients and CD5(+) in RM patients when compared with FS women. This was paralleled by a statistically significant reduction of infiltrating FoxP3(+) regulatory T cells. Finally, endometrial HSPA5 expression levels were statistically significantly up-regulated in both RM and RIF patients. Women with RM and RIF showed an increase of circulating proinflammatory cytokines, altered endometrial T lymphocytes subsets, and signs of endometrial ER stress.

American Journal of Obstetrics and Gynecology