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  1. Article: Antenatal and Postnatal Sequelae of Oxidative Stress in Preterm Infants: A Narrative Review Targeting Pathophysiological Mechanisms.

    Martini, Silvia / Aceti, Arianna / Della Gatta, Anna Nunzia / Beghetti, Isadora / Marsico, Concetta / Pilu, Gianluigi / Corvaglia, Luigi

    Antioxidants (Basel, Switzerland)

    2023  Volume 12, Issue 2

    Abstract: The detrimental effects of oxidative stress (OS) can start as early as after conception. A growing body of evidence has shown the pivotal role of OS in the development of several pathological conditions during the neonatal period, which have been ... ...

    Abstract The detrimental effects of oxidative stress (OS) can start as early as after conception. A growing body of evidence has shown the pivotal role of OS in the development of several pathological conditions during the neonatal period, which have been therefore defined as OS-related neonatal diseases. Due to the physiological immaturity of their antioxidant defenses and to the enhanced antenatal and postnatal exposure to free radicals, preterm infants are particularly susceptible to oxidative damage, and several pathophysiological cascades involved in the development of prematurity-related complications are tightly related to OS. This narrative review aims to provide a detailed overview of the OS-related pathophysiological mechanisms that contribute to the main OS-related diseases during pregnancy and in the early postnatal period in the preterm population. Particularly, focus has been placed on pregnancy disorders typically associated with iatrogenic or spontaneous preterm birth, such as intrauterine growth restriction, pre-eclampsia, gestational diabetes, chorioamnionitis, and on specific postnatal complications for which the role of OS has been largely ascertained (e.g., respiratory distress, bronchopulmonary dysplasia, retinopathy of prematurity, periventricular leukomalacia, necrotizing enterocolitis, neonatal sepsis). Knowledge of the underlying pathophysiological mechanisms may increase awareness on potential strategies aimed at preventing the development of these conditions or at reducing the ensuing clinical burden.
    Language English
    Publishing date 2023-02-09
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2704216-9
    ISSN 2076-3921
    ISSN 2076-3921
    DOI 10.3390/antiox12020422
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Antenatal and Postnatal Sequelae of Oxidative Stress in Preterm Infants: A Narrative Review Targeting Pathophysiological Mechanisms

    Martini, Silvia / Aceti, Arianna / Della Gatta, Anna Nunzia / Beghetti, Isadora / Marsico, Concetta / Pilu, Gianluigi / Corvaglia, Luigi

    Antioxidants. 2023 Feb. 09, v. 12, no. 2

    2023  

    Abstract: The detrimental effects of oxidative stress (OS) can start as early as after conception. A growing body of evidence has shown the pivotal role of OS in the development of several pathological conditions during the neonatal period, which have been ... ...

    Abstract The detrimental effects of oxidative stress (OS) can start as early as after conception. A growing body of evidence has shown the pivotal role of OS in the development of several pathological conditions during the neonatal period, which have been therefore defined as OS-related neonatal diseases. Due to the physiological immaturity of their antioxidant defenses and to the enhanced antenatal and postnatal exposure to free radicals, preterm infants are particularly susceptible to oxidative damage, and several pathophysiological cascades involved in the development of prematurity-related complications are tightly related to OS. This narrative review aims to provide a detailed overview of the OS-related pathophysiological mechanisms that contribute to the main OS-related diseases during pregnancy and in the early postnatal period in the preterm population. Particularly, focus has been placed on pregnancy disorders typically associated with iatrogenic or spontaneous preterm birth, such as intrauterine growth restriction, pre-eclampsia, gestational diabetes, chorioamnionitis, and on specific postnatal complications for which the role of OS has been largely ascertained (e.g., respiratory distress, bronchopulmonary dysplasia, retinopathy of prematurity, periventricular leukomalacia, necrotizing enterocolitis, neonatal sepsis). Knowledge of the underlying pathophysiological mechanisms may increase awareness on potential strategies aimed at preventing the development of these conditions or at reducing the ensuing clinical burden.
    Keywords antioxidants ; bronchopulmonary dysplasia ; complications (disease) ; conception ; distress ; enterocolitis ; gestational diabetes ; oxidative stress ; postpartum period ; pre-eclampsia ; pregnancy ; premature birth ; retinal diseases
    Language English
    Dates of publication 2023-0209
    Publishing place Multidisciplinary Digital Publishing Institute
    Document type Article ; Online
    ZDB-ID 2704216-9
    ISSN 2076-3921
    ISSN 2076-3921
    DOI 10.3390/antiox12020422
    Database NAL-Catalogue (AGRICOLA)

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  3. Article ; Online: Coronavirus disease 2019 during pregnancy: a systematic review of reported cases.

    Della Gatta, Anna Nunzia / Rizzo, Roberta / Pilu, Gianluigi / Simonazzi, Giuliana

    American journal of obstetrics and gynecology

    2020  Volume 223, Issue 1, Page(s) 36–41

    Abstract: Objective: This study aimed to conduct a systematic review of the clinical outcomes reported for pregnant patients with coronavirus disease 2019.: Data sources: The PubMed, CINAHL, and Scopus databases were searched using a combination of key words ... ...

    Abstract Objective: This study aimed to conduct a systematic review of the clinical outcomes reported for pregnant patients with coronavirus disease 2019.
    Data sources: The PubMed, CINAHL, and Scopus databases were searched using a combination of key words such as "Coronavirus and/or pregnancy," "COVID and/or pregnancy," "COVID disease and/or pregnancy," and "COVID pneumonia and/or pregnancy." There was no restriction of language to allow collection of as many cases as possible.
    Study eligibility criteria: All studies of pregnant women who received a coronavirus disease 2019 diagnosis using acid nucleic test, with reported data about pregnancy, and, in case of delivery, reported outcomes, were included.
    Study appraisal and synthesis methods: All the studies included have been evaluated according to the tool for evaluating the methodological quality of case reports and case series described by Murad et al.
    Results: Six studies that involved 51 pregnant women were eligible for the systematic review. At the time of the report, 3 pregnancies were ongoing; of the remaining 48 pregnant women, 46 gave birth by cesarean delivery, and 2 gave birth vaginally; in this study, 1 stillbirth and 1 neonatal death were reported.
    Conclusion: Although vertical transmission of severe acute respiratory syndrome coronavirus 2 infection has been excluded thus far and the outcome for mothers and neonates has been generally good, the high rate of preterm delivery by cesarean delivery is a reason for concern. Cesarean delivery was typically an elective surgical intervention, and it is reasonable to question whether cesarean delivery for pregnant patients with coronavirus disease 2019 was warranted. Coronavirus disease 2019 associated with respiratory insufficiency in late pregnancies certainly creates a complex clinical scenario.
    MeSH term(s) Adult ; Betacoronavirus ; COVID-19 ; Cesarean Section ; Coronavirus Infections/complications ; Coronavirus Infections/diagnosis ; Female ; Humans ; Infant, Newborn ; Infectious Disease Transmission, Vertical ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/diagnosis ; Pregnancy ; Pregnancy Complications, Infectious/virology ; Pregnancy Outcome ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-04-18
    Publishing country United States
    Document type Journal Article ; Systematic Review ; Video-Audio Media
    ZDB-ID 80016-8
    ISSN 1097-6868 ; 0002-9378
    ISSN (online) 1097-6868
    ISSN 0002-9378
    DOI 10.1016/j.ajog.2020.04.013
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Association between Abnormal Antenatal Doppler Characteristics and Gastrointestinal Outcomes in Preterm Infants.

    Martini, Silvia / Annunziata, Mariarosaria / Della Gatta, Anna Nunzia / Aceti, Arianna / Brunetti, Marica / Pilu, Gianluigi / Simonazzi, Giuliana / Corvaglia, Luigi

    Nutrients

    2022  Volume 14, Issue 23

    Abstract: Antenatal Doppler disturbances are associated with fetal hypoxia and may induce a brain-sparing vascular redistribution at the expense of splanchnic circulation, possibly predisposing to gut complications. We aimed to compare several gastrointestinal ... ...

    Abstract Antenatal Doppler disturbances are associated with fetal hypoxia and may induce a brain-sparing vascular redistribution at the expense of splanchnic circulation, possibly predisposing to gut complications. We aimed to compare several gastrointestinal outcomes among very-low-birthweight (VLBW) preterm infants with different antenatal Doppler features. VLBW infants born between 2010-2022 were retrospectively included and stratified into the following clusters based on antenatal Doppler characteristics: normal Doppler (controls); absent or reversed end-diastolic flow in the umbilical artery (UA-AREDF) alone or also in the ductus venosus (UA+DV-AREDF); and abnormal Doppler with or without brain-sparing redistribution. The following outcomes were evaluated: time to reach full enteral feeds (FEF), feeding intolerance (FI), necrotizing enterocolitis (NEC), and spontaneous intestinal perforation (SIP). Overall, 570 infants were included. Infants born following UA+DV-AREDF had significantly higher FI, NEC, and SIP rates and achieved FEF later compared to controls. Increased FI prevalence and a longer time to FEF compared to controls were also observed among UA-AREDF infants and in the presence of brain-sparing redistribution, which also increased NEC rates. Antenatal Doppler abnormalities exacerbate the gastrointestinal risks of preterm infants. Detailed knowledge of Doppler features can aid in identifying those at highest risk of intestinal complications who may benefit from tailored enteral feeding management.
    Language English
    Publishing date 2022-12-02
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2518386-2
    ISSN 2072-6643 ; 2072-6643
    ISSN (online) 2072-6643
    ISSN 2072-6643
    DOI 10.3390/nu14235121
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Neurodevelopmental outcomes of very preterm infants born following early foetal growth restriction with absent end-diastolic umbilical flow.

    Della Gatta, Anna Nunzia / Aceti, Arianna / Spinedi, Sofia Fiore / Martini, Silvia / Corvaglia, Luigi / Sansavini, Alessandra / Zuccarini, Mariagrazia / Lenzi, Jacopo / Seidenari, Anna / Dionisi, Camilla / Pilu, Gianluigi / Simonazzi, Giuliana

    European journal of pediatrics

    2023  Volume 182, Issue 10, Page(s) 4467–4476

    Abstract: This study aims to assess the impact of time of onset and features of early foetal growth restriction (FGR) with absent end-diastolic flow (AEDF) on pregnancy outcomes and on preterm infants' clinical and neurodevelopmental outcomes up to 2 years ... ...

    Abstract This study aims to assess the impact of time of onset and features of early foetal growth restriction (FGR) with absent end-diastolic flow (AEDF) on pregnancy outcomes and on preterm infants' clinical and neurodevelopmental outcomes up to 2 years corrected age. This is a retrospective, cohort study led at a level IV Obstetric and Neonatal Unit in Bologna, Italy. Pregnant women were eligible if having singleton pregnancies, with no major foetal anomaly detected, and diagnosed with early FGR + AEDF (defined as FGR + AEDF detected before 32 weeks gestation). Early FGR + AEDF was further classified according to time of onset and specific features into very early and persistent (VEP, FGR + AEDF first detected at 20-24 weeks gestation and persistent at the following scans), very early but transient (VET, FGR + AEDF detected at 20-24 weeks gestation and progressively improving at the following scans) and later (LA, FGR + AEDF detected between 25 and 32 weeks gestation). Pregnancy and neonatal outcomes and infant follow-up data were collected and compared among groups. Neurodevelopment was assessed using the revised Griffiths Mental Developmental Scales (GMDS-R) 0-2 years. A regression analysis was performed to identify early predictors of preterm infants' neurodevelopmental impairment. Fifty-two pregnant women with an antenatal diagnosis of early FGR + AEDF were included in the study (16 VEP, 14 VET, 22 LA). Four intrauterine foetal deaths occurred, all in the VEP group (p = 0.010). Compared to LA infants, VEP infants were born with lower gestational age and lower birth weight, had lower arterial cord blood pH and were at higher risk for intraventricular haemorrhage and periventricular leukomalacia (p < 0.05 for all comparisons). At 12 months, VEP infants had worse GMDS-R scores, both in the general quotient (mean [SD] 91.8 [12.4] vs 104.6 [8.7] in LA) and in the performance domain (mean [SD] 93.3 [15.4] vs 108.8 [8.8] in LA). This latter difference persisted at 24 months (mean [SD] 68.3 [17.0] vs 92.9 [17.7] in LA). In multivariate analysis, at 12 months corrected age, PVL was found to be an independent predictor of impaired general quotient, while the features and timing of antenatal Doppler alterations predicted worse scores in the performance domain.   Conclusion: Timing of onset and features of early FGR + AEDF might impact differently on neonatal clinical and neurodevelopmental outcomes. Shared awareness of the importance of FGR + AEDF features between obstetricians and neonatologists may offer valuable tools for antenatal counselling and for tailoring pregnancy management and neonatal follow-up in light of specific antenatal and neonatal risk factors. What is Known: • Foetal growth restriction (FGR), together with antenatal umbilical Doppler abnormalities, is known to affect maternal and neonatal outcomes. • Infants born preterm and growth-restricted face the highest risk for neurodevelopmental impairment, especially when FGR occurs early during pregnancy (early FGR, before 32 weeks gestation). What is New: • The timing of onset and features of FGR and antenatal umbilical Doppler abnormalities impact differently on maternal and neonatal outcomes; when FGR and Doppler abnormalities occur very early, at the limit of neonatal viability, and persist until delivery, infants face the highest risk for neurodevelopmental impairment. • Shared knowledge between obstetricians and neonatologists about timing of onset and features of FGR would provide a valuable tool for informed antenatal counselling in high-risk pregnancies.
    MeSH term(s) Infant ; Pregnancy ; Female ; Infant, Newborn ; Humans ; Fetal Growth Retardation/diagnosis ; Infant, Premature ; Cohort Studies ; Retrospective Studies ; Umbilical Arteries/diagnostic imaging ; Gestational Age ; Ultrasonography, Prenatal
    Language English
    Publishing date 2023-07-25
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 194196-3
    ISSN 1432-1076 ; 0340-6199 ; 0943-9676
    ISSN (online) 1432-1076
    ISSN 0340-6199 ; 0943-9676
    DOI 10.1007/s00431-023-05104-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Pregnancy in a woman with sacral agenesis from prenatal counseling to delivery: A case report.

    Salsi, Ginevra / Bellussi, Federica / Pilu, Gianluigi / Della Gatta, Anna Nunzia / Youssef, Aly

    The journal of obstetrics and gynaecology research

    2020  Volume 46, Issue 5, Page(s) 784–786

    Abstract: Sacral agenesis or CRS (caudal regression syndrome) is a rare congenital condition involving approximately 1 in 25 000 live births (Sharma et al., 2015) and leading to the absence of lower sacral vertebral bodies and severe malformations of the pelvis. ... ...

    Abstract Sacral agenesis or CRS (caudal regression syndrome) is a rare congenital condition involving approximately 1 in 25 000 live births (Sharma et al., 2015) and leading to the absence of lower sacral vertebral bodies and severe malformations of the pelvis. This condition is associated with an extreme reduction of the xipho-pubic distance and of the pelvic dimensions. It is reasonable to think that this might lead to an increased difficulty in obtaining a spontaneous pregnancy and to a consistently increased risk of maternal and perinatal complications. In literature, very little is known about pregnancy in patients with sacral agenesis and therefore on the appropriate way to counsel a patient with this condition who is trying to get pregnant (Greenwell et al., 2013). Although a case of pregnancy in a woman with sacral agenesis is mentioned in a book (J. Rogers, 2006) no cases of women with CRS carrying a pregnancy until a viable age for the fetus are reported in medical literature: as far as we know this is the first case reported in literature of a woman with this condition followed before and throughout the pregnancy with reported pre- and perinatal management, leading to a near-term pregnancy. This case could be useful for clinicians who are requested to counsel female patients with the same condition on the possibility of a pregnancy and possible outcomes.
    MeSH term(s) Abnormalities, Multiple/diagnostic imaging ; Abnormalities, Multiple/physiopathology ; Adult ; Cesarean Section/methods ; Female ; Humans ; Meningocele/diagnostic imaging ; Meningocele/physiopathology ; Pregnancy ; Pregnancy Complications/diagnostic imaging ; Pregnancy Complications/physiopathology ; Pregnancy, High-Risk ; Prenatal Care/methods ; Sacrococcygeal Region/abnormalities ; Sacrococcygeal Region/diagnostic imaging ; Sacrococcygeal Region/physiopathology ; Ultrasonography, Prenatal
    Language English
    Publishing date 2020-03-05
    Publishing country Australia
    Document type Case Reports
    ZDB-ID 1327307-3
    ISSN 1447-0756 ; 1341-8076
    ISSN (online) 1447-0756
    ISSN 1341-8076
    DOI 10.1111/jog.14240
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Quantification of Posterior Risk Related to Intrapartum FIGO 2015 Criteria for Cardiotocography in the Second Stage of Labor.

    Cavoretto, Paolo Ivo / Seidenari, Anna / Amodeo, Silvia / Della Gatta, Anna Nunzia / Nale, Roberta / Ismail, Yasmin Sara / Candiani, Massimo / Farina, Antonio

    Fetal diagnosis and therapy

    2021  Volume 48, Issue 2, Page(s) 149–157

    Abstract: 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) ... ...

    Abstract 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 2nd stage according to FIGO 2015.
    Results: Seventy-three cases and 387 controls reached 2nd stage and were included in the analysis. For those reaching 2nd stage, the mean adjusted risk of acidemia associated with nonpathological CTG was 1.6%. Stratification of risk according to duration of the 2nd stage yielded risks of neonatal acidemia of 1.23, 2.08, 5.81, and 15.22% at 30, 60, 120, and 180 min, respectively. Bradycardia >10 min was associated with risk of neonatal acidemia of 9.9 and 15.8% for 2nd-stage durations of 30 and 60 min, respectively. Risks associated with 1 prolonged deceleration >5 min were 6.80, 11.08, 27.0, and 51.0% at 30, 60, 120, and 180 min, respectively. Repetitive late or prolonged decelerations >30 min were associated with risk of neonatal acidemia of 2.43, 4.14, 11.17, and 26.45% at 30, 60, 120, and 180 min, respectively.
    Conclusion: The risk of neonatal acidemia is directly proportional to duration of the 2nd stage, irrespective of the presence of CTG abnormalities, increasing 12-fold (1.2-15.3%) from 30 to 180 min. Occurrence of FIGO 2015 pathological CTG patterns showed a decreasing impact from bradycardia >10 min to decelerations >5 min, recurrent later or prolonged decelerations >30 min, and nonpathological CTG.
    MeSH term(s) Cardiotocography ; Case-Control Studies ; Female ; Heart Rate, Fetal ; Humans ; Labor Stage, Second ; Parturition ; Pregnancy ; Retrospective Studies
    Language English
    Publishing date 2021-01-28
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 1066460-9
    ISSN 1421-9964 ; 1015-3837
    ISSN (online) 1421-9964
    ISSN 1015-3837
    DOI 10.1159/000512658
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Coronavirus disease 2019 during pregnancy: a systematic review of reported cases

    Della Gatta, Anna Nunzia / Rizzo, Roberta / Pilu, Gianluigi / Simonazzi, Giuliana

    Am J Obstet Gynecol

    Abstract: OBJECTIVE: This study aimed to conduct a systematic review of the clinical outcomes reported for pregnant patients with coronavirus disease 2019. DATA SOURCES: The PubMed, CINAHL, and Scopus databases were searched using a combination of key words such ... ...

    Abstract OBJECTIVE: This study aimed to conduct a systematic review of the clinical outcomes reported for pregnant patients with coronavirus disease 2019. DATA SOURCES: The PubMed, CINAHL, and Scopus databases were searched using a combination of key words such as "Coronavirus and/or pregnancy," "COVID and/or pregnancy," "COVID disease and/or pregnancy," and "COVID pneumonia and/or pregnancy." There was no restriction of language to allow collection of as many cases as possible. STUDY ELIGIBILITY CRITERIA: All studies of pregnant women who received a coronavirus disease 2019 diagnosis using acid nucleic test, with reported data about pregnancy, and, in case of delivery, reported outcomes, were included. STUDY APPRAISAL AND SYNTHESIS METHODS: All the studies included have been evaluated according to the tool for evaluating the methodological quality of case reports and case series described by Murad et al. RESULTS: Six studies that involved 51 pregnant women were eligible for the systematic review. At the time of the report, 3 pregnancies were ongoing; of the remaining 48 pregnant women, 46 gave birth by cesarean delivery, and 2 gave birth vaginally; in this study, 1 stillbirth and 1 neonatal death were reported. CONCLUSION: Although vertical transmission of severe acute respiratory syndrome coronavirus 2 infection has been excluded thus far and the outcome for mothers and neonates has been generally good, the high rate of preterm delivery by cesarean delivery is a reason for concern. Cesarean delivery was typically an elective surgical intervention, and it is reasonable to question whether cesarean delivery for pregnant patients with coronavirus disease 2019 was warranted. Coronavirus disease 2019 associated with respiratory insufficiency in late pregnancies certainly creates a complex clinical scenario.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #291823
    Database COVID19

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  9. Article: Results of a Phase I-II Study on Laser Therapy for Vaginal Side Effects after Radiotherapy for Cancer of Uterine Cervix or Endometrium.

    Perrone, Anna Myriam / Tesei, Marco / Ferioli, Martina / De Terlizzi, Francesca / Della Gatta, Anna Nunzia / Boussedra, Safia / Dondi, Giulia / Galuppi, Andrea / Morganti, Alessio Giuseppe / De Iaco, Pierandrea

    Cancers

    2020  Volume 12, Issue 6

    Abstract: 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 ... ...

    Abstract 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 CO
    Language English
    Publishing date 2020-06-21
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers12061639
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Prenatal sonography of the foramen ovale predicts urgent balloon atrial septostomy in neonates with complete transposition of the great arteries.

    Della Gatta, Anna Nunzia / Contro, Elena / Lenzi, Jacopo / Balducci, Anna / Gargiulo, Gaetano / Bodnar, Tetyana / Palleri, Daniela / Bonetti, Simone / Hasan, Tammam / Donti, Andrea / Ragni, Luca / Angeli, Emanuela / Bartolacelli, Ylenia / Larcher, Laura / Pilu, Gianluigi / Perolo, Antonella

    American journal of obstetrics & gynecology MFM

    2021  Volume 3, Issue 5, Page(s) 100379

    Abstract: Background: Hypoxia caused by inadequate intracardiac mixing owing to a restrictive foramen ovale is a potentially life-threatening complication in neonates with dextro-transposition of the great arteries. An urgent balloon atrial septostomy is a ... ...

    Abstract Background: Hypoxia caused by inadequate intracardiac mixing owing to a restrictive foramen ovale is a potentially life-threatening complication in neonates with dextro-transposition of the great arteries. An urgent balloon atrial septostomy 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 balloon atrial septostomy at birth would help in optimizing the management of these neonates, minimizing the risk of hypoxic damage.
    Objective: This study aimed to predict with prenatal echocardiography the need of urgent balloon atrial septostomy in neonates with dextro-transposition of the great arteries.
    Study design: This was a retrospective cohort study of patients with a prenatal diagnosis of transposition of the great arteries that were delivered in our center between 2010 and 2019, for whom fetal ultrasound echocardiograms obtained at less than 3 weeks before delivery were available. The following parameters were systematically obtained at fetal echocardiography: size and appearance of the foramen ovale, septum primum excursion (foramen ovale flap angle at the maximal excursion), diameters of the atria, and size of the ductus arteriosus. Balloon atrial septostomy 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 transposition of the great arteries were referred to our echocardiography laboratory and 60 of these were included in the analysis; 27 underwent urgent balloon atrial septostomy, 11 elective balloon atrial septostomy, and 22 no balloon atrial septostomy. The size of the foramen ovale was the best predictor of an urgent balloon atrial septostomy. A measurement of >6.5 mm had a sensitivity of 100% and a false positive rate of 45%.
    Conclusion: Fetal echocardiography predicts the need of an urgent balloon atrial septostomy in fetuses with dextro-transposition of the great arteries although with a limited precision. In our experience, a measurement of the foramen ovale within 3 weeks of delivery had the greatest accuracy.
    MeSH term(s) Arteries ; Female ; Foramen Ovale/diagnostic imaging ; Humans ; Infant, Newborn ; Pregnancy ; Retrospective Studies ; Transposition of Great Vessels/diagnostic imaging ; Ultrasonography, Prenatal
    Language English
    Publishing date 2021-07-02
    Publishing country United States
    Document type Journal Article
    ISSN 2589-9333
    ISSN (online) 2589-9333
    DOI 10.1016/j.ajogmf.2021.100379
    Database MEDical Literature Analysis and Retrieval System OnLINE

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