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Article ; Online: A vaginal birth is a cost-reduction strategy for women with a low-lying placenta.

Colciago, Elisabetta / Ferrara, Pietro / Vaglio Tessitore, Isadora / Mantovani, Lorenzo G / Vergani, Patrizia / Ornaghi, Sara

Minerva obstetrics and gynecology

2024

Abstract: Background: Alongside health consequences, cesarean delivery (CD) has been associated with increased healthcare resource utilization (HCRU). A CD should be performed in case of placenta previa; in turn, the most appropriate mode of birth in women with a ...

Abstract	Background: Alongside health consequences, cesarean delivery (CD) has been associated with increased healthcare resource utilization (HCRU). A CD should be performed in case of placenta previa; in turn, the most appropriate mode of birth in women with a low-lying placenta (LLP) is still controversial. Since no previous data are available on the topic, the aim of this study was to evaluate the HCRU and economic impact on the Italian HC system of vaginal birth (VB) and CD in women with a LLP. Methods: This retrospective study used patient-level real-world data of a cohort of women with a LLP confirmed at 28-30 weeks. A cost-minimization analysis (CMA) was conducted to compare VB and CD. Since Diagnosis-Related-Group payment may not reflect the actual use of hospital resources, a micro-costing analysis (MCA) was performed to more comprehensively evaluate the economic impact of VB and CD. Results: The study included 86 women with a LLP at the third trimester scan, of which 49 (57%) had a VB and 37 (43%) underwent a CD. The CMA showed an economically marginal difference between VB and CD, especially when considering opportunity costs associated with the resources needed to look after women. However, the MCA identified charges for each VB being about half of those for each CD. Conclusions: The use of patient-level real-world data allowed to generate basic information to assess the value of available interventions in case of LLP. A VB should be promoted in women with LLP, avoiding further burden on the HC system's limited resources.
Language	English
Publishing date	2024-03-27
Publishing country	Italy
Document type	Journal Article
ZDB-ID	3062815-5
ISSN	2724-6450
ISSN (online)	2724-6450
DOI	10.23736/S2724-606X.24.05443-5
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Article ; Online: Women's attitude towards COVID-19 vaccination in pregnancy: A survey study in northern Italy.

Colciago, Elisabetta / Capitoli, Giulia / Vergani, Patrizia / Ornaghi, Sara

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

2022 Volume 162, Issue 1, Page(s) 139–146

Abstract: Objective: To investigate attitudes and risk perceptions towards the coronavirus disease 2019 (COVID-19) vaccine and reasons for hesitancy among pregnant women.: Methods: A prospective survey study was conducted at a University Maternity Department. ... ...

Abstract	Objective: To investigate attitudes and risk perceptions towards the coronavirus disease 2019 (COVID-19) vaccine and reasons for hesitancy among pregnant women. Methods: A prospective survey study was conducted at a University Maternity Department. Participants included any pregnant woman aged 18 years or older, able to understand the Italian language, who accessed the antenatal clinic for a prenatal appointment. The survey comprised questions about sociodemographic characteristics, pregnancy vaccination history, and perception of risk related to the immunization for the woman herself and her infant. Results: A total of 538 women completed the questionnaire, 445 (82.7%) accepted COVID-19 vaccination. Women vaccinated against pertussis were three times more likely to take up the COVID-19 vaccine (odds ratio [OR] 3.19; 95% confidence interval [CI] 1.78-5.72). Having had COVID-19 during pregnancy (OR 0.24; 95% CI 0.11-0.54), and having a high-risk perception towards the immunization for the fetus (OR 0.18; 95% CI 0.09-0.34) were factors associated with vaccine hesitancy. Lack of safety data in pregnancy and the possibility of harm to the fetus were the main concerns. Conclusion: A trusting and supportive relationship with the healthcare professional to address fears, and the transmission of evidence-based information, are pivotal to guide women through an informed choice. Understanding the determinants implicated in women's decision making might guide towards effective public health strategies to boost vaccine acceptance.
MeSH term(s)	Pregnancy ; Female ; Humans ; COVID-19/prevention & control ; COVID-19 Vaccines ; Prospective Studies ; Vaccination ; Italy ; Attitude
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-10-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	80149-5
ISSN	1879-3479 ; 0020-7292
ISSN (online)	1879-3479
ISSN	0020-7292
DOI	10.1002/ijgo.14506
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Article ; Online: Midwives' experiences of providing maternity care to women and families during the COVID-19 pandemic in Northern Italy.

Fumagalli, Simona / Borrelli, Sara / Ornaghi, Sara / Vergani, Patrizia / Nespoli, Antonella

Women and birth : journal of the Australian College of Midwives

2022 Volume 36, Issue 1, Page(s) e57–e64

Abstract: Problem: The COVID-19 pandemic has significantly challenged maternity provision internationally. Rapid and radical changes were implemented, with midwives facing anxiety and moral distress if not able to provide optimal and woman-centred care in line ... ...

Abstract	Problem: The COVID-19 pandemic has significantly challenged maternity provision internationally. Rapid and radical changes were implemented, with midwives facing anxiety and moral distress if not able to provide optimal and woman-centred care in line with professional values. Background: Healthcare professionals' stress and burnout are commonly reported during other global emergencies, which may eventually contribute to reduced quality of care. There is lack of evidence of the challenges faced by midwives in Italy during the COVID-19 pandemic. Aim: To explore midwives' experiences of providing care to women and families during the COVID-19 pandemic. Methods: Qualitative interpretive phenomenological approach, using semi-structured interviews and thematic analysis. The sample included 15 midwives. Ethical approval was obtained. Findings: Four themes were identified: 1) adjusting to the ever-evolving organisation of care; 2) physical, psychological and relational challenges; 3) support network; 4) deferred sense of awareness. Discussion: Midwives faced professional and personal challenges during the pandemic, displaying feelings of fear, anxiety, uncertainty, discomfort, lack of support and knowledge with potential long-term effects. Adjusting to the continuous, rapid and drastic re-organisation of maternity services was particularly challenging. Factors facilitating a safe, supportive and empowering workplace included support from colleagues and managers, access to appropriate PPE, reliable guidelines, good communication and emotional support. Positive aspects of personal and professional development included communication skills, establishment of trusting relationships, sense of empowerment and teamwork. Conclusion: In the context of a pandemic, optimisation of midwives' physical, emotional and psychological wellbeing should be considered. Timely and comprehensive guidelines and appropriate resources should be provided to assist midwives in facilitating family-centred respectful maternity care and preserving childbirth as a bio-psychosocial event.
MeSH term(s)	Female ; Humans ; Pregnancy ; Midwifery ; Pandemics ; Maternal Health Services ; COVID-19/epidemiology ; Parturition ; Italy/epidemiology ; Qualitative Research
Language	English
Publishing date	2022-04-19
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2235085-8
ISSN	1878-1799 ; 1871-5192
ISSN (online)	1878-1799
ISSN	1871-5192
DOI	10.1016/j.wombi.2022.04.011
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Article ; Online: Characteristics and outcomes of pregnant women with placenta accreta spectrum in Italy: A prospective population-based cohort study.

Ornaghi, Sara / Maraschini, Alice / Donati, Serena

PloS one

2021 Volume 16, Issue 6, Page(s) e0252654

Abstract: Introduction: Placenta accreta spectrum (PAS) is a rare but potentially life-threatening event due to massive hemorrhage. Placenta previa and previous cesarean section are major risk factors for PAS. Italy holds one of the highest rates of primary and ... ...

Abstract	Introduction: Placenta accreta spectrum (PAS) is a rare but potentially life-threatening event due to massive hemorrhage. Placenta previa and previous cesarean section are major risk factors for PAS. Italy holds one of the highest rates of primary and repeated cesarean section in Europe; nonetheless, there is a paucity of high-quality Italian data on PAS. The aim of this paper was to estimate the prevalence of PAS in Italy and to evaluate its associated factors, ante- and intra-partum management, and perinatal outcomes. Also, since severe morbidity and mortality in Italy show a North-South gradient, we assessed and compared perinatal outcomes of women with PAS according to the geographical area of delivery. Material and methods: This was a prospective population-based study using the Italian Obstetric Surveillance System (ItOSS) and including all women aged 15-50 years with a diagnosis of PAS between September 2014 and August 2016. Six Italian regions were involved in the study project, covering 49% of the national births. Cases were prospectively reported by a trained clinician for each participating maternity unit by electronic data collection forms. The background population comprised all women who delivered in the participating regions during the study period. Results: A cohort of 384 women with PAS was identified from a source population of 458 995 maternities for a prevalence of 0.84/1000 (95% CI, 0.75-0.92). Antenatal suspicion was present in 50% of patients, who showed reduced rates of blood transfusion compared to unsuspected patients (65.6% versus 79.7%, P = 0.003). Analyses by geographical area showed higher rates of both concomitant placenta previa and prior CS (62.1% vs 28.7%, P<0.0001) and antenatal suspicion (61.7% vs 28.7%, P<0.0001) in women in Southern compared to Northern Italy. Also, these women had lower rates of hemorrhage ≥2000 mL (29.6% vs 51.2%, P<0.0001), blood transfusion (64.5% vs 87.5%, P = 0.001), and severe maternal morbidity (5.0% vs 11.1%, P = 0.036). Delivery in a referral center for PAS occurred in 71.9% of these patients. Conclusions: Antenatal suspicion of PAS is associated with improved maternal outcomes, also among high-risk women with both placenta previa and prior CS, likely because of their referral to specialized centers for PAS management.
MeSH term(s)	Adolescent ; Adult ; Blood Transfusion ; Cesarean Section ; Cohort Studies ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Italy/epidemiology ; Middle Aged ; Placenta Accreta/epidemiology ; Placenta Accreta/pathology ; Placenta Previa/epidemiology ; Placenta Previa/pathology ; Pregnancy ; Prevalence ; Prospective Studies ; Risk Factors ; Young Adult
Language	English
Publishing date	2021-06-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0252654
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Article ; Online: Midwives' stress and burnout during the Omicron wave in Italy: An observational survey.

Fumagalli, Simona / Panzeri, Maria / Borrelli, Sara / Ornaghi, Sara / Antolini, Laura / Sacco, Gaia Giulia Angela / Formenti, Martina / Sala, Serena / Nespoli, Antonella

Journal of advanced nursing

2024

Abstract: Aim: To evaluate midwives' level of stress and burnout during the COVID-19 Omicron phase in Italy. Secondary aims were to explore the impact of the pandemic on midwives' personal dimensions and professional activities and potential supporting strategies. ...

Abstract	Aim: To evaluate midwives' level of stress and burnout during the COVID-19 Omicron phase in Italy. Secondary aims were to explore the impact of the pandemic on midwives' personal dimensions and professional activities and potential supporting strategies. Design: A mixed-methods study was undertaken from July to December 2022. Methods: Data were collected using a national online observational survey. Descriptive and inferential analyses were performed to evaluate stress, burnout and the impact of the pandemic on personal and professional dimensions. A deductive qualitative approach was used to analyse open-ended responses, that were merged with quantitative data following a convergent mixed-methods approach. Results: A total of 1944 midwives participated in the survey. The stress summary score mean was 10.34, and 562 midwives (28.91%) experienced burnout. The intention to reduce working hours was reported by 202 midwives (10.39%), with 60.40% (n = 122) of them experiencing burnout. The intention to leave clinical practice within the following 2 years was reported by 239 (12.29%), with 68.20% (n = 163) of them experiencing burnout. All the personal dimensions and professional activities considered were defined by more than half of midwives as being impacted 'Moderately' or 'To a great extent' by pandemic. Stress and burnout frequencies increased when the midwives' perception of the pandemic effects was higher. Potential supporting strategies described by midwives as the most important in increasing their ability to cope with the pandemic were 'Women's awareness of the midwives' role' (n = 1072; 55.14%) and 'Family and friends' emotional support' (n = 746; 38.38%). Conclusion: Our findings suggested strategies to support a positive and safe working environment for midwives during a pandemic emergency, with potential transferability to similar contexts when human resources are lacking. It is recommended that maternity services provide the necessary resources for a safe and supportive working environment to prevent high stress levels and chronic burnout. Impact: Studies conducted during the first COVID-19 pandemic wave showed an increased level of stress, anxiety, burnout, post-traumatic stress disorder and depression experienced by healthcare professionals; moreover, midwives experienced drastic changes in care pathways and policies with struggles identified when providing high-quality woman-centred care following pandemic restrictions. Although it is recommended, there is lack of knowledge about long-term psychological effects of COVID-19 for midwives. Our study highlights that during the Omicron wave midwives experienced a high level of stress and burnout with an impact on individual dimensions and professional activities. Their stress and burnout were influenced by several factors, including restrictions in place, lack of organizational acknowledgement, work overload and need for extra childcare cover. Maternity services should provide the necessary resources for a safe and supportive working environment to prevent high stress levels and chronic burnout. Recommendations on how to facilitate this are suggested. Reporting method: During the writing process, we referred to 'The Strengthening the Reporting of Observational Studies Epidemiology Statement', the guidelines for reporting observational studies from the Equator network. Patient or public contribution: No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Work overload conditions negatively impacted on the quality of maternity services. Improving organizational aspects, reducing working hours, promoting family and friends' emotional support and improving women's awareness of midwife's role were the main strategies reported by midwives. These suggestions for ensuring a positive and safe working environment for midwives during a pandemic emergency could potentially be applied to similar situations where human resources are lacking.
Language	English
Publishing date	2024-01-19
Publishing country	England
Document type	Journal Article
ZDB-ID	197634-5
ISSN	1365-2648 ; 0309-2402
ISSN (online)	1365-2648
ISSN	0309-2402
DOI	10.1111/jan.16065
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Article ; Online: Pregnancy and Delivery Outcomes in Women With Persistent Versus Resolved Low-Lying Placenta in the Late Third Trimester.

Ornaghi, Sara / Vaglio Tessitore, Isadora / Vergani, Patrizia

Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine

2021 Volume 41, Issue 1, Page(s) 123–133

Abstract: Objectives: The safest mode of delivery in low-lying placenta is debatable. Little is known about outcomes in low-lying placenta resolved during the late third trimester. We compare outcomes of women with persistent versus resolved low-lying placenta.!## ...

Abstract	Objectives: The safest mode of delivery in low-lying placenta is debatable. Little is known about outcomes in low-lying placenta resolved during the late third trimester. We compare outcomes of women with persistent versus resolved low-lying placenta. Methods: A retrospective analysis on a prospective cohort of women with low-lying placenta confirmed at 28-30 weeks sonography (01/2009 to 03/2018). Women were followed up serially every 2 to 3 weeks until delivery to assess the placental edge-to-internal os distance (IOD), and included if scan was performed within 28 days before delivery. Results: There were 86 women: in 21 the low-lying placenta resolved, whereas in 65 persisted (n = 15 IOD 1-10 mm, n = 50 IOD 11-20 mm). Antepartum bleeding associated with higher rates of urgent cesarean delivery in 1-10 mm (P = .041) but not in 11-20 mm (P = 1.000) and >20 mm (P = .333). Among women with IOD >10 mm allowed to labor, vaginal delivery occurred in 76.7% (11-20 mm) and 94.1% (>20 mm) (P = .155), with no difference according to parity (70% and 80% in multiparas, P = .696; 60% and 72.7% in nulliparas, P = .698). Severe PPH (P = .922) and hemoglobin drop (P = .109) were similar among groups. Women with IOD 11-20 mm and >20 mm and vaginal delivery bled less than women with similarly located placenta and cesarean delivery (P = .009 and P = .048). Conclusions: Women with IOD >10 mm have high chances of deliver vaginally with no further increase of their hemorrhagic risk. Success of vaginal delivery is independent of parity and antepartum bleeding. Labor should be managed in an adequate hospital setting.
MeSH term(s)	Female ; Humans ; Parity ; Placenta/diagnostic imaging ; Pregnancy ; Pregnancy Trimester, Third ; Prospective Studies ; Retrospective Studies
Language	English
Publishing date	2021-03-05
Publishing country	England
Document type	Journal Article
ZDB-ID	604829-8
ISSN	1550-9613 ; 0278-4297
ISSN (online)	1550-9613
ISSN	0278-4297
DOI	10.1002/jum.15687
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Article ; Online: Effects of social and sensory deprivation in newborns: A lesson from the Covid-19 experience.

Purpura, Giulia / Fumagalli, Simona / Nacinovich, Renata / Riva, Anna / Ornaghi, Sara / Serafini, Marzia / Nespoli, Antonella

Early human development

2023 Volume 185, Page(s) 105853

Abstract: Background: Infancy is a complex period of human life, in which environmental experiences have a fundamental role for neurodevelopment. Although conditions of social and sensory deprivation are uncommon in high income countries, the Covid-19 pandemic ... ...

Abstract	Background: Infancy is a complex period of human life, in which environmental experiences have a fundamental role for neurodevelopment. Although conditions of social and sensory deprivation are uncommon in high income countries, the Covid-19 pandemic abruptly modified this condition, by depriving people of their social stimuli of daily life. Aim: To understand the impact of this deprivation on infants' behaviour, we investigated the short-term effects of isolation and use of individual protective systems by mothers during the first two weeks of life. Methods: The study included 11 mother-infant dyads with mothers tested positive to SARS-CoV-2 at the time of delivery (Covid group) and 11 dyads with a SARS-CoV-2 negative mother as controls. Neurobehavioral, visual, and sensory processing assessments were performed from birth to 3 months of age. Results: Findings showed the effect of deprivation on some neurobehavioral abilities of infants in the Covid group; in addition, differences in sensory maturation trends were observed, although they tended to gradually decrease until disappearance at 3 months of age. Conclusion: These findings suggest the significant effects of early sensory and social deprivation during the first two weeks of life, but also provide several insights on the ability of the brain to restore its aptitudes by deleting or reducing the effects of early deprivation before the critical periods' closure.
Language	English
Publishing date	2023-08-30
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	752532-1
ISSN	1872-6232 ; 0378-3782
ISSN (online)	1872-6232
ISSN	0378-3782
DOI	10.1016/j.earlhumdev.2023.105853
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Article ; Online: Delivery table shield to assist suspected and confirmed severe acute respiratory syndrome coronavirus 2-positive women in labor.

Ornaghi, Sara / Fumagalli, Simona / Nespoli, Antonella / Vergani, Patrizia

American journal of obstetrics and gynecology

2020 Volume 223, Issue 5, Page(s) 777–778

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus ; Coronavirus Infections ; Delivery, Obstetric ; Female ; Humans ; Pandemics ; Pneumonia, Viral ; Pregnancy ; Pregnancy Complications, Infectious/diagnosis ; Pregnancy Complications, Infectious/epidemiology ; Protective Devices ; SARS-CoV-2 ; Severe Acute Respiratory Syndrome/diagnosis
Keywords	covid19
Language	English
Publishing date	2020-07-17
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80016-8
ISSN	1097-6868 ; 0002-9378
ISSN (online)	1097-6868
ISSN	0002-9378
DOI	10.1016/j.ajog.2020.07.022
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Article ; Online: Lived experiences of the partners of COVID-19 positive childbearing women: A qualitative study.

Nespoli, Antonella / Ornaghi, Sara / Borrelli, Sara / Vergani, Patrizia / Fumagalli, Simona

Women and birth : journal of the Australian College of Midwives

2021 Volume 35, Issue 3, Page(s) 289–297

Abstract: Problem: Several maternity units worldwide have rapidly put in place changes to maternity care pathways and restrictive preventive measures in the attempt to limit the spread of COVID-19, resulting in birth companions often not being allowed to be ... ...

Abstract	Problem: Several maternity units worldwide have rapidly put in place changes to maternity care pathways and restrictive preventive measures in the attempt to limit the spread of COVID-19, resulting in birth companions often not being allowed to be present at birth and throughout hospital admission. Background: The WHO strongly recommends that the emotional, practical, advocacy and health benefits of having a chosen birth companion are respected and accommodated, including women with suspected, likely or confirmed COVID-19. Aim: To explore the lived experiences of the partners of COVID-19 positive childbearing women who gave birth during the first pandemic wave (March and April 2020) in a Northern Italy maternity hospital. Methods: A qualitative study using an interpretive phenomenological approach was undertaken. Audio-recorded semi-structured interviews were conducted with 14 partners. Thematic data analysis was conducted using NVivo software. Ethical approval was obtained from the relevant Ethics Committee prior to commencing the study. Findings: The findings include five main themes: (1) emotional impact of the pandemic; (2) partner and parent: a dual role; (3) not being present at birth: a 'denied' experience; (4) returning to 'normality'; (5) feedback to 'pandemic' maternity services and policies. Discussion and conclusion: Key elements of good practice to promote positive childbirth experiences in the context of a pandemic were identified: presence of a birth companion; COVID-19 screening tests for support persons; timely, proactive and comprehensive communication of information to support persons; staggered hospital visiting times; follow-up of socio-psychological wellbeing; antenatal and postnatal home visiting; family-centred policies and services.
MeSH term(s)	COVID-19/epidemiology ; Delivery, Obstetric ; Female ; Humans ; Infant, Newborn ; Maternal Health Services ; Parturition ; Pregnancy ; Qualitative Research
Language	English
Publishing date	2021-08-02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2235085-8
ISSN	1878-1799 ; 1871-5192
ISSN (online)	1878-1799
ISSN	1871-5192
DOI	10.1016/j.wombi.2021.07.006
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Article ; Online: The experiences of childbearing women who tested positive to COVID-19 during the pandemic in northern Italy.

Fumagalli, Simona / Ornaghi, Sara / Borrelli, Sara / Vergani, Patrizia / Nespoli, Antonella

Women and birth : journal of the Australian College of Midwives

2021 Volume 35, Issue 3, Page(s) 242–253

Abstract: Problem: The COVID-19 pandemic has significantly challenged maternity provision internationally. COVID-19 positive women are one of the childbearing groups most impacted by the pandemic due to drastic changes to maternity care pathways put in place.: ... ...

Abstract	Problem: The COVID-19 pandemic has significantly challenged maternity provision internationally. COVID-19 positive women are one of the childbearing groups most impacted by the pandemic due to drastic changes to maternity care pathways put in place. Background: Some quantitative research was conducted on clinical characteristics of pregnant women with COVID-19 and pregnant women's concerns and birth expectations during the COVID-19 pandemic, but no qualitative findings on childbearing women's experiences during the pandemic were published prior to our study. Aim: To explore childbearing experiences of COVID-19 positive mothers who gave birth in the months of March and April 2020 in a Northern Italy maternity hospital. Methods: A qualitative interpretive phenomenological approach was undertaken. Audio-recorded semi-structured interviews were conducted with 22 women. Thematic analysis was completed using NVivo software. Ethical approval was obtained from the research site's Ethics Committee prior to commencing the study. Findings: The findings include four main themes: 1) coping with unmet expectations; 2) reacting and adapting to the 'new ordinary'; 3) 'pandemic relationships'; 4) sharing a traumatic experience with long-lasting emotional impact. Discussion: The most traumatic elements of women's experiences were the sudden family separation, self-isolation, transfer to a referral centre, the partner not allowed to be present at birth and limited physical contact with the newborn. Conclusion: Key elements of good practice including provision of compassionate care, presence of birth companions and transfer to referral centers only for the most severe COVID-19 cases should be considered when drafting maternity care pathways guidelines in view of future pandemic waves.
MeSH term(s)	COVID-19/epidemiology ; Female ; Humans ; Infant, Newborn ; Male ; Maternal Health Services ; Pandemics ; Parturition/psychology ; Pregnancy ; Pregnant Women/psychology ; Qualitative Research
Language	English
Publishing date	2021-01-09
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2235085-8
ISSN	1878-1799 ; 1871-5192
ISSN (online)	1878-1799
ISSN	1871-5192
DOI	10.1016/j.wombi.2021.01.001
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