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32 results on '"Caissutti C."'

1. Reduced prevalence of fetal exposure to alcohol in Italy: a nationwide survey

Author

Camandona, F, Vaccari, L, Travan, L, Maso, G, Stampalija, T, Zanazzo, L, Pisana, P, Driul, L, Barbui, E, Caissutti, C, Valente, E, Ricchi, A, Bettiga, E, Piccolo, E, Pati, M, Pedori, S, Antonazzo, P, Sottile, G, Lo Faro, F, Tini, A, Massacesi, M, Rapisarda, C, Vivirito, G, Pinna, G, D'Anna, M, Klein, L, Bucolo, A, D'Anna, R, Monaco, C, La Ferrera, G, Capobianco, G, Olzai, M, Angioni, S, D'Alterio, M, Serravalle, P, Vicquery, C, Scalchi, S, Morando, C, Meneghin, M, Scapolan, C, Maggino, T, Guarinoni, B, Cristina Napolitano, G, De Vita, M, Di Carlo, C, Interlandi, F, Bisceglia, M, Michelangelo, B, Arnulfo, A, Finale, E, Marozio, L, Natali, I, Grazia, S, Staffler, A, Tarani, L, Coriale, G, Messina, M, D'Angelo, A, Bonito, M, Haass, C, Capasso, L, Raimondi, F, De Bernardo, G, Iacobelli, P, Spadarella, S, Enrica, M, Rabuano, R, Calzatini, F, Bossi, A, Aversa, S, Prefumo, F, Bellan, C, Leone, G, Ciammella, M, Von-Wunster, S, Liguori, A, Ornaghi, S, Fumagalli, S, Sanguineti, F, Gianola, G, Cagnacci, A, Amidani, A, Sisto, A, Di Marcello, F, Santillo, V, Di Bartolomeo, C, Gerli, S, Cagnoli, G, Petrisano, M, Pesce, S, Di Lascio, N, Falvino, S, Appio, P, Targiani, V, Cavaliere, A, Turrini, I, Belli, G, Beatrice, G, Florio, P, Innocenti, E, Magi, L, Civitelli, F, Nappi, L, Sorrentino, F, Silvestris, T, Indrio, F, Laforgia, N, Rizzo, V, La Rocca, M, Pradal, U, Memo, L, Diaz, C, Riscica, P, Bazzo, S, La Maida, N, Di Giorgi, A, Pellegrini, M, Ceccanti, M, Caruso, S, Ricci, G, Neri, I, Lana, S, Minutillo, A, Berretta, P, Busardo, F, Pichini, S, Camandona F., Vaccari L., Travan L., Maso G., Stampalija T., Zanazzo L., Pisana P., Driul L., Barbui E., Caissutti C., Valente E., Ricchi A., Bettiga E., Piccolo E., Pati M., Pedori S., Antonazzo P., Sottile G., Lo Faro F., Tini A., Massacesi M., Rapisarda C., Vivirito G., Pinna G., D'anna M., Klein L., Bucolo A., D'Anna R., Monaco C., La Ferrera G., Capobianco G., Olzai M. G., Angioni S., D'Alterio M. N., Serravalle P., Vicquery C., Scalchi S., Morando C., Meneghin M., Scapolan C., Maggino T., Guarinoni B., Cristina Napolitano G. M., De Vita M. G., Di Carlo C., Interlandi F., Bisceglia M., Michelangelo B., Arnulfo A., Finale E., Marozio L., Natali I., Grazia S. M., Staffler A., Tarani L., Coriale G., Messina M. P., D'Angelo A., Bonito M., Haass C., Capasso L., Raimondi F., De Bernardo G., Iacobelli P., Spadarella S., Enrica M., Rabuano R., Calzatini F., Bossi A., Aversa S., Prefumo F., Bellan C., Leone G., Ciammella M., Von-Wunster S., Liguori A., Ornaghi S., Fumagalli S., Sanguineti F., Gianola G., Cagnacci A., Amidani A., Sisto A., Di Marcello F., Santillo V., Di Bartolomeo C., Gerli S., Cagnoli G., Petrisano M., Pesce S., Di Lascio N., Falvino S., Appio P., Targiani V., Cavaliere A. F., Turrini I., Belli G., Beatrice G., Florio P., Innocenti E. D., Magi L., Civitelli F., Nappi L., Sorrentino F., Silvestris T., Indrio F., Laforgia N., Rizzo V., La Rocca M., Pradal U., Memo L., Diaz C., Riscica P., Bazzo S., La Maida N., Di Giorgi A., Pellegrini M., Ceccanti M., Caruso S., Ricci G., Neri I., Lana S., Minutillo A., Berretta P., Busardo F. P., Pichini S., Camandona, F, Vaccari, L, Travan, L, Maso, G, Stampalija, T, Zanazzo, L, Pisana, P, Driul, L, Barbui, E, Caissutti, C, Valente, E, Ricchi, A, Bettiga, E, Piccolo, E, Pati, M, Pedori, S, Antonazzo, P, Sottile, G, Lo Faro, F, Tini, A, Massacesi, M, Rapisarda, C, Vivirito, G, Pinna, G, D'Anna, M, Klein, L, Bucolo, A, D'Anna, R, Monaco, C, La Ferrera, G, Capobianco, G, Olzai, M, Angioni, S, D'Alterio, M, Serravalle, P, Vicquery, C, Scalchi, S, Morando, C, Meneghin, M, Scapolan, C, Maggino, T, Guarinoni, B, Cristina Napolitano, G, De Vita, M, Di Carlo, C, Interlandi, F, Bisceglia, M, Michelangelo, B, Arnulfo, A, Finale, E, Marozio, L, Natali, I, Grazia, S, Staffler, A, Tarani, L, Coriale, G, Messina, M, D'Angelo, A, Bonito, M, Haass, C, Capasso, L, Raimondi, F, De Bernardo, G, Iacobelli, P, Spadarella, S, Enrica, M, Rabuano, R, Calzatini, F, Bossi, A, Aversa, S, Prefumo, F, Bellan, C, Leone, G, Ciammella, M, Von-Wunster, S, Liguori, A, Ornaghi, S, Fumagalli, S, Sanguineti, F, Gianola, G, Cagnacci, A, Amidani, A, Sisto, A, Di Marcello, F, Santillo, V, Di Bartolomeo, C, Gerli, S, Cagnoli, G, Petrisano, M, Pesce, S, Di Lascio, N, Falvino, S, Appio, P, Targiani, V, Cavaliere, A, Turrini, I, Belli, G, Beatrice, G, Florio, P, Innocenti, E, Magi, L, Civitelli, F, Nappi, L, Sorrentino, F, Silvestris, T, Indrio, F, Laforgia, N, Rizzo, V, La Rocca, M, Pradal, U, Memo, L, Diaz, C, Riscica, P, Bazzo, S, La Maida, N, Di Giorgi, A, Pellegrini, M, Ceccanti, M, Caruso, S, Ricci, G, Neri, I, Lana, S, Minutillo, A, Berretta, P, Busardo, F, Pichini, S, Camandona F., Vaccari L., Travan L., Maso G., Stampalija T., Zanazzo L., Pisana P., Driul L., Barbui E., Caissutti C., Valente E., Ricchi A., Bettiga E., Piccolo E., Pati M., Pedori S., Antonazzo P., Sottile G., Lo Faro F., Tini A., Massacesi M., Rapisarda C., Vivirito G., Pinna G., D'anna M., Klein L., Bucolo A., D'Anna R., Monaco C., La Ferrera G., Capobianco G., Olzai M. G., Angioni S., D'Alterio M. N., Serravalle P., Vicquery C., Scalchi S., Morando C., Meneghin M., Scapolan C., Maggino T., Guarinoni B., Cristina Napolitano G. M., De Vita M. G., Di Carlo C., Interlandi F., Bisceglia M., Michelangelo B., Arnulfo A., Finale E., Marozio L., Natali I., Grazia S. M., Staffler A., Tarani L., Coriale G., Messina M. P., D'Angelo A., Bonito M., Haass C., Capasso L., Raimondi F., De Bernardo G., Iacobelli P., Spadarella S., Enrica M., Rabuano R., Calzatini F., Bossi A., Aversa S., Prefumo F., Bellan C., Leone G., Ciammella M., Von-Wunster S., Liguori A., Ornaghi S., Fumagalli S., Sanguineti F., Gianola G., Cagnacci A., Amidani A., Sisto A., Di Marcello F., Santillo V., Di Bartolomeo C., Gerli S., Cagnoli G., Petrisano M., Pesce S., Di Lascio N., Falvino S., Appio P., Targiani V., Cavaliere A. F., Turrini I., Belli G., Beatrice G., Florio P., Innocenti E. D., Magi L., Civitelli F., Nappi L., Sorrentino F., Silvestris T., Indrio F., Laforgia N., Rizzo V., La Rocca M., Pradal U., Memo L., Diaz C., Riscica P., Bazzo S., La Maida N., Di Giorgi A., Pellegrini M., Ceccanti M., Caruso S., Ricci G., Neri I., Lana S., Minutillo A., Berretta P., Busardo F. P., and Pichini S.

Published
2023

3. Fetal brain hemodynamics in pregnancies at term: correlation with gestational age, birthweight and clinical outcome

Author

Ciardulli, A., D'Antonio, Francesco, Caissutti, C., Manzoli, Lamberto, Flacco, M. E., Buongiorno, S., Saccone, G., Rosati, Paolo, Lanzone, Antonio, Scambia, Giovanni, Berghella, Vincenzo, D'Antonio F., Manzoli L., Rosati P. (ORCID:0000-0003-0270-7328), Lanzone A. (ORCID:0000-0003-4119-414X), Scambia G. (ORCID:0000-0003-2758-1063), Berghella V., Ciardulli, A., D'Antonio, Francesco, Caissutti, C., Manzoli, Lamberto, Flacco, M. E., Buongiorno, S., Saccone, G., Rosati, Paolo, Lanzone, Antonio, Scambia, Giovanni, Berghella, Vincenzo, D'Antonio F., Manzoli L., Rosati P. (ORCID:0000-0003-0270-7328), Lanzone A. (ORCID:0000-0003-4119-414X), Scambia G. (ORCID:0000-0003-2758-1063), and Berghella V.

Abstract

Introduction: The primary aim of this study was to ascertain the strength of association between cerebral blood flow assessed in anterior (ACA), middle (MCA), and posterior (PCA) cerebral arteries and the following clinical outcomes: small for gestational age (SGA), induction of labor (IOL) for oligohydramnios and caesarean section (CS) for nonreassuring fetal status (NRFS) during labor. Material and methods: Retrospective analysis of prospectively collected data on consecutive singleton pregnancies from 40 0/7 to 41 6/7 week of gestation. UA, ACA, MCA, PCA pulsatility index (PI) were measured from 40 weeks of gestations. Furthermore, the ratios between cerebral blood flow and UA (CPR, ACA/UA and PCA/UA) were calculated and correlated with the observed outcomes. Results: Two hundred twenty-four singleton pregnancies were included in the study. Mean PI of either ACA (p =.04), MCA (p =.008), and PCA (p =.003) were lower in the SGA compared to non-SGA group; furthermore, mean PCA PI was significantly lower than MCA PI (p =.04). Furthermore, CPR (p =.016), ACA/UA (p =.02), and PCA/UA (p =.003) were significantly lower in the SGA group compared to controls. UA, ACA, MCA, and PCA PI were higher in women undergoing IOL for oligohydramnios compared to controls. Logistic regression analysis showed that CPR and PCA/UA ratio were independently associated with SGA. SGA, ACA PI, and ACA/UA were independently associated with CS for NRFS. Finally, birthweight centile, were independently associated with IOL oligohydramnios. Despite this, the predictive accuracy of Doppler in detecting any of the explored outcome was only poor to moderate. Conclusion: Redistribution of cerebral blood flow at term is significantly associated with SGA, IOL for oligohydramnios and CS for NRFS in labor. However, the predictive accuracy of Doppler at term is only poor to moderate, thus advising against its use in clinical practice as a standalone screening test for adverse perinatal outcome in pregnancie

Published
2021

4. Prenatal management and timing of delivery of uncomplicated monochorionic monoamniotic twin pregnancy: the MONOMONO study

Author

Saccone G, Berghella V, Locci M, Ghi T, Frusca T, Lanna M, Faiola S, Fichera A, Prefumo F, Rizzo G, Bosi C, Arduino B, D'Alessandro P, Borgo M, Arduino S, Cantanna E, Simonazzi G, Rizzo N, Francesca G, Seravalli V, Miller JL, Magro-Malosso ER, Di Tommaso M, Dall'Asta A, Galli L, Volpe N, Visentin S, Cosmi E, Sarno L, Caissutti C, Driul L, Anastasio H, Di Mascio D, Panici PB, Vena F, Brunelli R, Ciardulli A, D'Antonio F, Schoen C, Suhag A, Gambacorti-Passerini ZM, Baz MAA, Magoga G, Busato E, Filippi E, Suárez MJR, Alderete FG, Ortuno PA, Vitagliano A, Mollo A, Raffone A, Vendola M, Navaneethan P, Wimalasundera R, Napolitano R, Aquino CI, D'Agostino S, Gallo C, Maruotti GM, Flacco ME, Baschat AA, Venturella R, Guida M, Martinelli P, Zullo F., Saccone, G, Berghella, V, Locci, M, Ghi, T, Frusca, T, Lanna, M, Faiola, S, Fichera, A, Prefumo, F, Rizzo, G, Bosi, C, Arduino, B, D'Alessandro, P, Borgo, M, Arduino, S, Cantanna, E, Simonazzi, G, Rizzo, N, Francesca, G, Seravalli, V, Miller, Jl, Magro-Malosso, Er, Di Tommaso, M, Dall'Asta, A, Galli, L, Volpe, N, Visentin, S, Cosmi, E, Sarno, L, Caissutti, C, Driul, L, Anastasio, H, Di Mascio, D, Panici, Pb, Vena, F, Brunelli, R, Ciardulli, A, D'Antonio, F, Schoen, C, Suhag, A, Gambacorti-Passerini, Zm, Baz, Maa, Magoga, G, Busato, E, Filippi, E, Suárez, Mjr, Alderete, Fg, Ortuno, Pa, Vitagliano, A, Mollo, A, Raffone, A, Vendola, M, Navaneethan, P, Wimalasundera, R, Napolitano, R, Aquino, Ci, D'Agostino, S, Gallo, C, Maruotti, Gm, Flacco, Me, Baschat, Aa, Venturella, R, Guida, M, Martinelli, P, and Zullo, F.

Published
2018

5. Vaginal Cleansing before Cesarean Delivery

Author

Caissutti, C., Saccone, G., Zullo, F., Quist-Nelson, J., Felder, L., Ciardulli, A., Berghella, V., Caissutti, Claudia, Saccone, Gabriele, Zullo, Fabrizio, Quist-Nelson, Johanna, Felder, Laura, Ciardulli, Andrea, and Berghella, Vincenzo

Subjects
Intravaginal, Administration, Intravaginal, Anti-Infective Agents, Local, Female, Humans, Povidone-Iodine, Pregnancy, Preoperative Care, Randomized Controlled Trials as Topic, Surgical Wound Infection, Cesarean Section, Vagina, Obstetrics and Gynecology, Anti-Infective Agents, Local, Administration, Human
Abstract

OBJECTIVE: To assess the efficacy of vaginal cleansing before cesarean delivery in reducing postoperative endometritis. DATA SOURCES: MEDLINE, Ovid, EMBASE, Scopus, Clinicaltrials.gov, and Cochrane Library were searched from their inception to January 2017. METHODS OF STUDY SELECTION: Selection criteria included all randomized controlled trials comparing vaginal cleansing (ie, intervention group) with a control group (ie, either placebo or no intervention) in women undergoing cesarean delivery. Any method of vaginal cleansing with any type of antiseptic solution was included. The primary outcome was the incidence of endometritis. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of relative risk (RR) with 95% CI. TABULATION, INTEGRATION, AND RESULTS: Sixteen trials (4,837 women) on vaginal cleansing immediately before cesarean delivery were identified as relevant and included in the review. In most of the included studies, 10% povidone-iodine was used as an intervention. The most common way to perform the vaginal cleansing was the use of a sponge stick for approximately 30 seconds. Women who received vaginal cleansing before cesarean delivery had a significantly lower incidence of endometritis (4.5% compared with 8.8%; RR 0.52, 95% CI 0.37-0.72; 15 studies, 4,726 participants) and of postoperative fever (9.4% compared with 14.9%; RR 0.65, 95% CI 0.50-0.86; 11 studies, 4,098 participants) compared with the control group. In the planned subgroup analyses, the reduction in the incidence of endometritis with vaginal cleansing was limited to women in labor before cesarean delivery (8.1% compared with 13.8%; RR 0.52, 95% CI 0.28-0.97; four studies, 440 participants) or those with ruptured membranes (4.3% compared with 20.1%; RR 0.23, 95% CI 0.10-0.52; three studies, 272 participants). CONCLUSION: Vaginal cleansing immediately before cesarean delivery in women in labor and in women with ruptured membranes reduces the risk of postoperative endometritis. Because it is generally inexpensive and a simple intervention, we recommend preoperative vaginal preparation before cesarean delivery in these women with sponge stick preparation of povidone-iodine 10% for at least 30 seconds. More data are needed to assess whether this intervention may be also useful for cesarean deliveries performed in women not in labor and for those without ruptured membranes.

Published
2017

8. Effectiveness of seminal plasma in in vitro fertilisation treatment: a systematic review and meta-analysis.

Author

Saccone, G, Di Spiezio Sardo, A, Ciardulli, A, Caissutti, C, Spinelli, M, Surbek, D, Wolff, M, and von Wolff, M

Subjects
FERTILIZATION in vitro, PREGNANCY, EMBRYOS, SEMINAL proteins, SEMEN, OVUM, META-analysis, BIRTH rate, HUMAN reproductive technology, TIME, SYSTEMATIC reviews, FETAL development
Abstract

Background: With in vitro fertilization (IVF) techniques, only 20-25% of the transferred embryos lead to a pregnancy.Objective: To evaluate the beneficial effects of seminal plasma (SP) or semen applied at the time of oocyte aspiration or embryo transfer.Search Strategy: Electronic databases were searched from their inception up to August 2017.Selection Criteria: We included all randomized controlled trials (RCTs) evaluating the effects of SP or semen in IVF treatment. Trials were considered if women were exposed to any kind of SP or semen (either SP/semen injection or sexual intercourse) around the time of oocyte pickup and embryo transfer.Data Collection and Analysis: The primary outcome was clinical pregnancy rate (CPR).Main Results: Eight RCTs on women undergoing IVF (2128 in total) were included in the meta-analysis. Women randomized in the intervention group had a significantly higher CPR compared with controls (30.0 versus 25.1%; RR 1.20; 95% CI, 1.04-1.39). No significant differences were found in the secondary outcomes, including livebirth rate, biochemical pregnancy, miscarriage, multiple pregnancies, and birth weight. The subgroup analyses (four RCTs, 780 participants), including only those RCTs in which prepared undiluted SP was injected just after oocyte pickup, conformed with the overall analysis for the primary outcome (46.3 versus 37.2%; RR 1.23; 95% CI, 1.05-1.45).Conclusion: Because intravaginal or intracervical SP application around the time of oocyte pickup is associated with higher CPR, local application SP may be considered as a potential treatment to improve implantation.Tweetable Abstract: SP at the time of oocyte pickup is associated with higher CPR. [ABSTRACT FROM AUTHOR]

Published
2019
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9. Uterine massage as part of active management of the third stage of labour for preventing postpartum haemorrhage during vaginal delivery: a systematic review and meta-analysis of randomised trials.

Author

Saccone, G., Caissutti, C., Ciardulli, A., Abdel‐Aleem, H., Hofmeyr, G. J., Berghella, V., and Abdel-Aleem, H

Subjects
*HEMORRHAGE prevention, *UTERINE contraction, *PUERPERAL disorders, *LABOR complications (Obstetrics), *OXYTOCIN, *RANDOMIZED controlled trials, *PREVENTION, *THERAPEUTICS, *COMPARATIVE studies, *DELIVERY (Obstetrics), *LABOR (Obstetrics), *MASSAGE therapy, *RESEARCH methodology, *MEDICAL cooperation, *META-analysis, *RESEARCH, *UTERUS, *VAGINA, *SYSTEMATIC reviews, *EVALUATION research, *TREATMENT effectiveness, PREVENTION of pregnancy complications
Abstract

The article evaluates the efficacy of uterine massage as part of active management of third stage of labour in addition to oxytocin and controlled cord traction after vaginal delivery in preventing postpartum hemorrhage through a meta-analysis of randomized controlled trials. Topics include a list of terms searched from electronic databases used in the study, the seven domains related to risk of bias assessed in each trial and the limited evidence of uterine massage efficacy found by the study.

Published
2018
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10. Inpatientvsoutpatient management and timing of delivery of uncomplicated monochorionic monoamniotic twin pregnancy: the MONOMONO study

Author

Saccone, Gabriele, Berghella, Vincenzo, Locci, Mariavittoria, Ghi, Tullio, Frusca, Tiziana, Lanna, Mariano, Faiola, Stefano, Fichera, Anna, Prefumo, Federico, Rizzo, Giuseppe, Bosi, Costanza, Arduino, Bruno, D'Alessandro, Pietro, Borgo, Maria, Arduino, Silvana, Cantanna, Elisabetta, Simonazzi, Giuliana, Rizzo, Nicola, Francesca, Giorgetta, Seravalli, Viola, Miller, Jena L., Magro-Malosso, Elena Rita, Di Tommaso, Mariarosaria, Dall'Asta, Andrea, Galli, Letizia, Volpe, Nicola, Visentin, Silvia, Cosmi, Erich, Sarno, Laura, Caissutti, Claudia, Driul, Lorenza, Anastasio, Hannah, Di Mascio, Daniele, Panici, Pierluigi Benedetti, Vena, Flaminia, Brunelli, Roberto, Ciardulli, Andrea, D'Antonio, Francesco, Schoen, Corina, Suhag, Anju, Gambacorti-Passerini, Zita Maria, Baz, Maria Angeles Anaya, Magoga, Giulia, Busato, Enrico, Filippi, Elisa, Suárez, María José Rodriguez, Alderete, Francisco Gamez, Ortuno, Paula Alonso, Vitagliano, Amerigo, Mollo, Antonio, Raffone, Antonio, Vendola, Marianne, Navaneethan, Preethi, Wimalasundera, Ruwan, Napolitano, Raffaele, Aquino, Carmen Imma, D'Agostino, Serena, Gallo, Cinzia, Maruotti, Giuseppe Maria, Flacco, Maria Elena, Baschat, Ahmet A., Venturella, Roberta, Guida, Maurizio, Martinelli, Pasquale, Zullo, Fulvio, Saccone G, Berghella V, Locci M, Ghi T, Frusca T, Lanna M, Faiola S, Fichera A, Prefumo F, Rizzo G, Bosi C, Arduino B, D'Alessandro P, Borgo M, Arduino S, Cantanna E, Simonazzi G, Rizzo N, Francesca G, Seravalli V, Miller JL, Magro-Malosso ER, Di Tommaso M, Dall'Asta A, Galli L, Volpe N, Visentin S, Cosmi E, Sarno L, Caissutti C, Driul L, Anastasio H, Di Mascio D, Panici PB, Vena F, Brunelli R, Ciardulli A, D'Antonio F, Schoen C, Suhag A, Gambacorti-Passerini ZM, Baz MAA, Magoga G, Busato E, Filippi E, Suárez MJR, Alderete FG, Ortuno PA, Vitagliano A, Mollo A, Raffone A, Vendola M, Navaneethan P, Wimalasundera R, Napolitano R, Aquino CI, D'Agostino S, Gallo C, Maruotti GM, Flacco ME, Baschat AA, Venturella R, Guida M, Martinelli P, Zullo F., Saccone, G., Berghella, V., Locci, M., Ghi, T., Frusca, T., Lanna, M., Faiola, S., Fichera, A., Prefumo, F., Rizzo, G., Bosi, C., Arduino, B., D'Alessandro, P., Borgo, M., Arduino, S., Cantanna, E., Simonazzi, G., Rizzo, N., Francesca, G., Seravalli, V., Miller, J. L., Magro-Malosso, E. R., Di Tommaso, M., Dall'Asta, A., Galli, L., Volpe, N., Visentin, S., Cosmi, E., Sarno, L., Caissutti, C., Driul, L., Anastasio, H., Di Mascio, D., Panici, P. B., Vena, F., Brunelli, R., Ciardulli, A., D'Antonio, F., Schoen, C., Suhag, A., Gambacorti-Passerini, Z. M., Baz, M. A. A., Magoga, G., Busato, E., Filippi, E., Suarez, M. J. R., Alderete, F. G., Ortuno, P. A., Vitagliano, A., Mollo, A., Raffone, A., Vendola, M., Navaneethan, P., Wimalasundera, R., Napolitano, R., Aquino, C. I., D'Agostino, S., Gallo, C., Maruotti, G. M., Flacco, M. E., Baschat, A. A., Venturella, R., Guida, M., Martinelli, P., and Zullo, F.

Subjects
Cardiotocography, chorionicity, Twins, Cesarean delivery, cord accident, cord entanglement, healthcare, monochorionic, multiple gestation, perinatal death, respiratory distress syndrome, twin pregnancy, Radiological and Ultrasound Technology, Reproductive Medicine, Radiology, Nuclear Medicine and Imaging, Obstetrics and Gynecology, 0302 clinical medicine, Pregnancy, Nuclear Medicine and Imaging, Outpatients, Health care, Prenatal, Medicine, 030212 general & internal medicine, Twin Pregnancy, Monochorionic monoamniotic twin pregnancy, Ultrasonography, Cord entanglement, 030219 obstetrics & reproductive medicine, Obstetrics, Adult, Female, Fetal Death, Humans, Infant, Newborn, Inpatients, Length of Stay, Live Birth, Perinatal Death, Pregnancy, Twin, Prenatal Care, Retrospective Studies, Statistics, Nonparametric, Twins, Monozygotic, Ultrasonography, Prenatal, Perinatal Mortality, Statistics, General Medicine, cesarean delivery, health care, Radiology, medicine.medical_specialty, Socio-culturale, Monozygotic, Multiple Gestation, 03 medical and health sciences, Nonparametric, Radiology, Nuclear Medicine and imaging, business.industry, Infant, Twin, Newborn, Settore MED/40 - Ginecologia e Ostetricia, business, Outpatient management
Abstract

OBJECTIVES: Monoamniotic twin pregnancies are at increased risk of perinatal complications, primarily owing to the risk of cord entanglement. There is no recommendation on whether such pregnancies should be managed in hospital or can be safely managed in an outpatient setting, and the timing of planned delivery is also a subject of debate. The aim of this study was to compare the perinatal outcomes of inpatient vs outpatient fetal surveillance approaches employed among 22 participating study centers, and to calculate the fetal and neonatal death rates according to gestational age, in non-anomalous monoamniotic twins from 26 weeks' gestation. METHODS: The MONOMONO study was a multinational cohort study of consecutive women with monochorionic monoamniotic twin pregnancies, who were referred to 22 university hospitals in Italy, the USA, the UK and Spain, from January 2010 to January 2017. Only non-anomalous uncomplicated monoamniotic twin pregnancies with two live fetuses at 26 + 0 weeks' gestation were included in the study. In 10 of the centers, monoamniotic twins were managed routinely as inpatients, whereas in the other 12 centers they were managed routinely as outpatients. The primary outcome was intrauterine fetal death. We also planned to assess fetal and neonatal death rates according to gestational age per 1-week interval. Outcomes are presented as odds ratio (OR) with 95% CIs. The main outcome was analyzed using both standard logistic regression analysis, in which each fetus was treated as an independent unit, and a generalized mixed-model approach, with each twin pair treated as a cluster unit, considering that the outcome for a twin is not independent of that of its cotwin. RESULTS: 195 consecutive pregnant women with a non-anomalous uncomplicated monoamniotic twin gestation (390 fetuses) were included. Of these, 75 (38.5%) were managed as inpatients and 120 (61.5%) as outpatients. The overall perinatal loss rate was 10.8% (42/390) with a peak fetal death rate of 4.3% (15/348) occurring at 29 weeks' gestation. There was no significant difference in mean gestational age at delivery (31 weeks), birth weight (∼1.6 kg), or emergency delivery rate between the inpatient and outpatient surveillance groups. Based on generalized mixed-model analysis, there was no statistically significant difference in fetal death rates between inpatient management commencing from around 26 weeks compared with outpatient surveillance protocols from 30 weeks (3.3% vs 10.8%; adjusted OR 0.21 (95% CI, 0.04-1.17)). Maternal length of stay in the hospital was 42.1 days in the inpatient group, and 7.4 days in the outpatient group (mean difference 34.70 days (95% CI, 31.36-38.04 days). From 32 + 0 to 36 + 6 weeks, no fetal or neonatal death in either group was recorded. 46 fetuses were delivered after 34 + 0 weeks, and none of them died in utero or within the first 28 days postpartum. CONCLUSION: In uncomplicated monoamniotic twins, inpatient surveillance is associated with similar fetal mortality as outpatient management. After 31 + 6 weeks, and up to 36 + 6 weeks, there were no intrauterine fetal deaths or neonatal deaths. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Published
2018
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11. Weight discordance and perinatal mortality in monoamniotic twin pregnancy: analysis of MONOMONO, NorSTAMP and STORK multiple-pregnancy cohorts

Author

Gabriele, Saccone, Asma, Khalil, Basky, Thilanagathan, Svetlana, Glinianaia, Vincenzo, Berghella, Francesco, D'Antonio, Mariavittoria, Locci, Tullio, Ghi, Tiziana, Frusca, Mariano, Lanna, Stefano, Faiola, Anna, Fichera, Federico, Prefumo, Giuseppe, Rizzo, Costanza, Bosi, Bruno, Arduino, Pietro, D'Alessandro, Maria, Borgo, Silvana, Arduino, Elisabetta, Cantanna, Giuliana, Simonazzi, Nicola, Rizzo, Giorgetta, Francesca, Viola, Seravalli, Miller, Jena L., Elena Rita Magro‐Malosso, Mariarosaria Di Tommaso, Andrea, Dall'Asta, Letizia, Galli, Nicola, Volpe, Silvia, Visentin, Erich, Cosmi, Laura, Sarno, Claudia, Caissutti, Lorenza, Driul, Hannah, Anastasio, DI MASCIO, Daniele, BENEDETTI PANICI, Pierluigi, Vena, Flaminia, Brunelli, Roberto, Andrea, Ciardulli, Corina, Schoen, Anju, Suhag, Zita Maria Gambacorti‐Passerini, Maria Angeles Anaya Baz, Giulia, Magoga, Enrico, Busato, Elisa, Filippi, María José Rodriguez Suárez, Francisco Gamez Alderete, Paula Alonso Ortuno, Amerigo, Vitagliano, Antonio, Mollo, Antonio, Raffone, Marianne, Vendola, Preethi, Navaneethan, Ruwan, Wimalasundera, Raffaele, Napolitano, Carmen Imma Aquino, Serena, D'Agostino, Cinzia, Gallo, Giuseppe Maria Maruotti, Maria Elena Flacco, Baschat, Ahmet A., Roberta, Venturella, Maurizio, Guida, Pasquale, Martinelli, Fulvio Zullo Therese Hannon, Sturgiss, Stephen N., Judith, Rankin, Nicola, Miller, Danielle, Martin, Arash, Bahamie, Amar, Bhide, Aris, Papageorghiou, Anne, Deans, Kim, Morgan, Michael, Egbor, Adetunji, Matiluko, Cheryl, Ellis, Hina, Gandhi, Rosol, Hamid, Renata, Hutt, Lesley, Roberts, Faz, Pakarian, Elisabeth, Peregrine, Saccone, G, Khalil, A, Thilaganathan, B, Glinianaia, Sv, Berghella, V, D'Antonio, F, Guida, M, et al., : MONOMONO, Norstamp, STORK research, Collaboratives, Papageorghiou, A, Saccone G1, Khalil A2,3, Thilaganathan B2,3, Glinianaia SV4, Berghella V5, D'Antonio F6, and MONOMONO, NorSTAMP and STORK research collaboratives. Zullo F, Locci M, Guida M, Anastasio H, Ghi T, Frusca T, Dall'Asta A, Galli L, Volpe N, Lanna M, Faiola S, Fichera A, Prefumo F, Rizzo G, Arduino S, Cantanna E, Simonazzi G, Seravalli V, Rita Magro-Malosso E, Di Tommaso M, L Miller J, A Baschat A, Vitagliano A, Visentin S, Cosmi E, Caissutti C, Driul L, Di Mascio D, Benedetti Panici P, Vena F, Brunelli R, Ciardulli A, Schoen C, Suhag A, Maria Gambacorti-Passerini Z, Angeles Anaya Baz M, Magoga G, Busato E, Filippi E, José Rodriguez Suárez M, Gamez Alderete F, Alonso Ortuno P, Vendola M, Navaneethan P, Wimalasundera R, Napolitano R, Mollo A, Imma Aquino C, D'Agostino S, Gallo C, Venturella R, Flacco M, Hannon T, N Sturgiss S, Rankin J, Miller N, Martin D, Bahamie A, Bhide A, Papageorghiou A, Deans A, Morgan K, Egbor M, Matiluko A, Ellis C, Gandhi H, Hamid R, Hutt R, Roberts L, Pakarian F, Peregrine E.

Subjects
chorionicity, Predictive Value of Test, Logistic regression, Cohort Studies, 0302 clinical medicine, Pregnancy, Risk of mortality, Birth Weight, 030212 general & internal medicine, Fetal Monitoring, Twin Pregnancy, 030219 obstetrics & reproductive medicine, Fetal Growth Retardation, Radiological and Ultrasound Technology, Obstetrics, Perinatal mortality, cord entanglement, Obstetrics and Gynecology, Cesarean delivery, healthcare, Prenatal Care, General Medicine, twin pregnancy, cesarean delivery, cord accident, health care, monochorionic, multiple gestation, perinatal death, respiratory distress syndrome, Fetal Weight, Female, Human, Adult, medicine.medical_specialty, Logistic Model, Risk Assessment, Multiple Gestation, 03 medical and health sciences, Predictive Value of Tests, medicine, Humans, Radiology, Nuclear Medicine and imaging, Perinatal Mortality, Fetus, business.industry, Infant, Newborn, Odds ratio, Twins, Monozygotic, medicine.disease, Logistic Models, Reproductive Medicine, ROC Curve, Pregnancy, Twin, Settore MED/40 - Ginecologia e Ostetricia, Cohort Studie, business
Abstract

Objectives:The primary objective was to quantify the risk of perinatal mortality in non‐anomalous monochorionic monoamniotic (MCMA) twin pregnancies complicated by birth‐weight (BW) discordance. The secondary objectives were to investigate the effect of inpatientvsoutpatient fetal monitoring on the risk of mortality in weight‐discordant MCMA twin pregnancies, and to explore the predictive accuracy of BW discordance for perinatal mortality. Methods:This analysis included data on 242 MCMA twin pregnancies (484 fetuses) from three major research collaboratives on twin pregnancy (MONOMONO, STORK and NorSTAMP). The primary outcomes were the risks of intrauterine (IUD), neonatal (NND) and perinatal (PND) death, according to weight discordance at birth from ≥ 10% to ≥ 30%. The secondary outcomes were the association of inpatientvsoutpatient fetal monitoring with the risk of mortality in weight‐discordant pregnancies, and the accuracy of BW discordance in predicting mortality. Logistic regression and receiver‐operating‐characteristics‐curve analyses were used to analyze the data. Results:The risk of IUD was significantly increased in MCMA twin pregnancies with BW discordance ≥ 10% (odds ratio (OR), 2.2; 95% CI, 1.1–4.4;P= 0.022) and increased up to an OR of 4.4 (95% CI, 1.3–14.4;P= 0.001) in those with BW discordance ≥ 30%. This association remained significant on multivariate logistic regression analysis for BW‐discordance cut‐offs ≥ 20%. However, weight discordance had low predictive accuracy for mortality, with areas under the receiver‐operating‐characteristics curve of 0.60 (95% CI, 0.46–0.73), 0.52 (95% CI, 0.33–0.72) and 0.57 (95% CI, 0.45–0.68) for IUD, NND and PND, respectively. There was no difference in the risk of overall IUD, single IUD, double IUD, NND or PND between pregnancies managed as an inpatient compared with those managed as an outpatient, for any BW‐discordance cut‐off. Conclusions:MCMA twin pregnancies with BW discordance are at increased risk of fetal death, signaling a need for increased levels of monitoring. Despite this, the predictive accuracy for mortality is low; thus, detection of BW discordance alone should not trigger intervention, such as iatrogenic delivery. The current data do not demonstrate an advantage of inpatient over outpatient management in these cases. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Published
2020

12. Which criteria should be used for starting pharmacologic therapy for management of gestational diabetes in pregnancy? Evidence from randomized controlled trials

Author

A. Dhanya Mackeen, Vincenzo Berghella, Melisa Lott, Adeeb Khalifeh, Claudia Caissutti, Gabriele Saccone, Caissutti, C., Saccone, G., Khalifeh, A., Mackeen, A. D., Lott, M., and Berghella, V.

Subjects
Blood Glucose, Pediatrics, medicine.medical_specialty, endocrine system diseases, Diabete, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Diabetes mellitus, medicine, Humans, Pharmacologic therapy, 030212 general & internal medicine, Randomized Controlled Trials as Topic, Pregnancy, therapy, 030219 obstetrics & reproductive medicine, exercise, business.industry, nutritional and metabolic diseases, Obstetrics and Gynecology, Glucose Tolerance Test, medicine.disease, Gestational diabetes, Diabetes, Gestational, Pediatrics, Perinatology and Child Health, Female, pregnancy, business, diet
Abstract

Introduction: There is inconclusive evidence to support any specific criteria for starting pharmacologic therapy after diet in women with gestational diabetes mellitus (GDM). We aimed to analyze the most used criteria for starting pharmacologic treatment for patients with GDM. Material and methods: Electronic databases were searched from their inception to September 2017. We included all the randomized controlled trials (RCTs) of GDM managed initially by diet and exercise reporting criteria for starting pharmacologic therapy. RCTs in women with pregestational diabetes were excluded. Data regarding glucose values used for starting pharmacologic therapy were extracted and carefully reviewed. Results: We included 15 RCTs (4307 women) in the meta-analysis. For fasting glucose target, 8/14 (57%) used a value lower or equal to 90 mg/dL and the remainder used values 50% of the values higher than the target values and another one (7%) used >30%. Conclusion: The majority of RCTs (87%) used very tight criteria of either 1 or 2 values over the target values in the 1 or 2-week period for starting pharmacologic treatment for patients with GDM; more than 50% used 2 values. Key Message Pharmacologic therapy should be considered in women with gestational diabetes when, despite an adequate diet and exercise, 1 or 2 blood glucose values are over the target values of 90mg/dL fasting or 120mg/dL 2-hour postprandial over 1 or 2 weeks.

Published
2019

13. Fetal brain hemodynamics in pregnancies at term: correlation with gestational age, birthweight and clinical outcome

Author

Giovanni Scambia, Vincenzo Berghella, S. Buongiorno, Gabriele Saccone, Andrea Ciardulli, Antonio Lanzone, Paolo Rosati, Francesco D'Antonio, Maria Elena Flacco, Lamberto Manzoli, Claudia Caissutti, Ciardulli, Andrea, D'Antonio, Francesco, Caissutti, Claudia, Manzoli, Lamberto, Flacco, Maria Elena, Buongiorno, Silvia, Saccone, Gabriele, Rosati, Paolo, Lanzone, Antonio, Scambia, Giovanni, Berghella, Vincenzo, Ciardulli, A., D'Antonio, F., Caissutti, C., Manzoli, L., Flacco, M. E., Buongiorno, S., Saccone, G., Rosati, P., Lanzone, A., Scambia, G., and Berghella, V.

Subjects
Middle Cerebral Artery, Cerebral arteries, Hemodynamics, Birthweight, Oligohydramnios, Doppler ultrasound, Umbilical Arteries, Correlation, small for gestational age, 0302 clinical medicine, Pregnancy, Birth Weight, 030212 general & internal medicine, reproductive and urinary physiology, prenatal diagnosi, 030219 obstetrics & reproductive medicine, Fetal Growth Retardation, oligohydramnio, Obstetrics and Gynecology, Gestational age, Brain, Cerebral blood flow, Pulsatile Flow, Cardiology, Female, medicine.medical_specialty, Socio-culturale, Prenatal diagnosis, Gestational Age, Ultrasonography, Prenatal, 03 medical and health sciences, Internal medicine, medicine, Humans, cerebroplacental ratio, oligohydramnios, pregnancy outcome, prenatal diagnosis, Retrospective Studies, business.industry, Cesarean Section, Ultrasonography, Doppler, medicine.disease, eye diseases, Settore MED/40 - GINECOLOGIA E OSTETRICIA, Pediatrics, Perinatology and Child Health, Small for gestational age, business
Abstract

Introduction: The primary aim of this study was to ascertain the strength of association between cerebral blood flow assessed in anterior (ACA), middle (MCA), and posterior (PCA) cerebral arteries and the following clinical outcomes: small for gestational age (SGA), induction of labor (IOL) for oligohydramnios and caesarean section (CS) for nonreassuring fetal status (NRFS) during labor. Material and methods: Retrospective analysis of prospectively collected data on consecutive singleton pregnancies from 40 0/7 to 41 6/7 week of gestation. UA, ACA, MCA, PCA pulsatility index (PI) were measured from 40 weeks of gestations. Furthermore, the ratios between cerebral blood flow and UA (CPR, ACA/UA and PCA/UA) were calculated and correlated with the observed outcomes. Results: Two hundred twenty-four singleton pregnancies were included in the study. Mean PI of either ACA (p = .04), MCA (p = .008), and PCA (p = .003) were lower in the SGA compared to non-SGA group; furthermore, mean PCA PI was significantly lower than MCA PI (p = .04). Furthermore, CPR (p = .016), ACA/UA (p = .02), and PCA/UA (p = .003) were significantly lower in the SGA group compared to controls. UA, ACA, MCA, and PCA PI were higher in women undergoing IOL for oligohydramnios compared to controls. Logistic regression analysis showed that CPR and PCA/UA ratio were independently associated with SGA. SGA, ACA PI, and ACA/UA were independently associated with CS for NRFS. Finally, birthweight centile, were independently associated with IOL oligohydramnios. Despite this, the predictive accuracy of Doppler in detecting any of the explored outcome was only poor to moderate. Conclusion: Redistribution of cerebral blood flow at term is significantly associated with SGA, IOL for oligohydramnios and CS for NRFS in labor. However, the predictive accuracy of Doppler at term is only poor to moderate, thus advising against its use in clinical practice as a standalone screening test for adverse perinatal outcome in pregnancies at term. Key Message Redistribution of cerebral blood flow at term is significantly associated with SGA, IOL for oligohydramnios and CS for NRFS in labor.

Published
2019
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14. Effectiveness of seminal plasma in in vitro fertilization treatment: A systematic review and meta-analysis

Author

A. Di Spiezio Sardo, Gabriele Saccone, A Ciardulli, Claudia Caissutti, M von Wolff, Marialuigia Spinelli, D Surbek, Saccone, G., Di Spiezio Sardo, A., Ciardulli, A., Caissutti, C., Spinelli, M., Surbek, D., and von Wolff, M.

Subjects
Male, medicine.medical_specialty, Oocyte, Time Factors, Pregnancy Rate, medicine.medical_treatment, Birth weight, Oocyte Retrieval, Semen, Fertilization in Vitro, ICSI, law.invention, Miscarriage, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Pregnancy, In vitro fertilization, medicine, Humans, Embryo Implantation, 610 Medicine & health, Seminal plasma, Randomized Controlled Trials as Topic, 030219 obstetrics & reproductive medicine, In vitro fertilisation, business.industry, Obstetrics, Obstetrics and Gynecology, medicine.disease, Embryo transfer, Implantation, Fertility, Meta-analysis, Female, business
Abstract

BACKGROUND With in vitro fertilization (IVF) techniques, only 20-25% of the transferred embryos lead to a pregnancy. OBJECTIVE To evaluate the beneficial effects of seminal plasma (SP) or semen applied at the time of oocyte aspiration or embryo transfer. SEARCH STRATEGY Electronic databases were searched from their inception up to August 2017. SELECTION CRITERIA We included all randomized controlled trials (RCTs) evaluating the effects of SP or semen in IVF treatment. Trials were considered if women were exposed to any kind of SP or semen (either SP/semen injection or sexual intercourse) around the time of oocyte pickup and embryo transfer. DATA COLLECTION AND ANALYSIS The primary outcome was clinical pregnancy rate (CPR). MAIN RESULTS Eight RCTs on women undergoing IVF (2128 in total) were included in the meta-analysis. Women randomized in the intervention group had a significantly higher CPR compared with controls (30.0 versus 25.1%; RR 1.20; 95% CI, 1.04-1.39). No significant differences were found in the secondary outcomes, including livebirth rate, biochemical pregnancy, miscarriage, multiple pregnancies, and birth weight. The subgroup analyses (four RCTs, 780 participants), including only those RCTs in which prepared undiluted SP was injected just after oocyte pickup, conformed with the overall analysis for the primary outcome (46.3 versus 37.2%; RR 1.23; 95% CI, 1.05-1.45). AUTHORS' CONCLUSION Because intravaginal or intracervical SP application around the time of oocyte pickup is associated with higher CPR, local application SP may be considered as a potential treatment to improve implantation. TWEETABLE ABSTRACT SP at the time of oocyte pickup is associated with higher CPR.

Published
2019

15. Uterine massage for preventing postpartum hemorrhage at cesarean delivery: Which evidence?

Author

Vincenzo Berghella, Claudia Caissutti, Gabriele Saccone, Andrea Ciardulli, Saccone, G., Caissutti, C., Ciardulli, A., and Berghella, V.

Subjects
Spontaneous vaginal delivery, medicine.medical_specialty, Psychological intervention, 03 medical and health sciences, 0302 clinical medicine, Blood loss, Pregnancy, medicine, Humans, 030212 general & internal medicine, Cesarean delivery, reproductive and urinary physiology, Randomized Controlled Trials as Topic, Massage, 030219 obstetrics & reproductive medicine, Cesarean Section, Obstetrics, business.industry, Postpartum Hemorrhage, Obstetrics and Gynecology, medicine.disease, Confidence interval, Reproductive Medicine, Relative risk, Female, Maternal death, Uterine massage, business
Abstract

Background Cesarean delivery could be complicated by postpartum hemorrhage (PPH), the first cause of maternal death. Objectives To evaluate the efficacy of uterine massage in preventing postpartum hemorrhage at cesarean delivery. Data sources Electronic databases from their inception until October 2017. Study eligibility criteria, participants, and interventions We included all RCTs comparing uterine massage alone or as part of the active management of labor before or after delivery of the placenta, or both, with non-massage in the setting of cesarean delivery. Data collection and analysis The primary outcome was PPH, defined as blood loss >1000 mL. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of mean difference (MD) or relative risk (RR) with 95% confidence interval (CI). Results Only 3 RCTs comparing uterine massage vs no uterine massage were found. The quality of these 3 trials in general was very low with high or unclear risk of bias. All of them included only women in the setting of spontaneous vaginal delivery and none of them included cesarean delivery, and therefore the meta-analysis was not feasible. Conclusions There is not enough evidence to determine if uterine massage prevents postpartum hemorrhage at cesarean delivery.

Published
2018

16. Phytoremediation of perfluoroalkyl and polyfluoroalkyl substances (PFAS): Insights on plant uptake, omics analysis, contaminant detection and biomass disposal.

Author

Marzi D, Valente F, Luche S, Caissutti C, Sabia A, Capitani I, Capobianco G, Serranti S, Masi A, Panozzo A, Ricci A, Bolla PK, Vamerali T, Brunetti P, and Visioli G

Subjects
Biomass, Environmental Monitoring methods, Soil Pollutants metabolism, Soil Pollutants analysis, Environmental Pollutants metabolism, Environmental Pollutants analysis, Biodegradation, Environmental, Fluorocarbons metabolism, Fluorocarbons analysis, Plants metabolism
Abstract

The unique properties of per- and polyfluoroalkyl substances (PFAS) have driven their pervasive use in different industrial applications, leading to substantial environmental pollution and raising critical concerns about the long-term impacts on ecosystem and human health. To tackle the global challenge of PFAS contamination, there is an urgent need for sustainable and efficient remediation strategies. Phytoremediation has emerged as a promising eco-friendly approach with the potential to mitigate the spread of these persistent contaminants. However, addressing this complex issue requires interdisciplinary cutting-edge research to develop comprehensive and scalable solutions for effective PFAS management. This review highlights recent advancements in the detection, quantification, and monitoring of PFAS uptake by plants, providing a detailed description of PFAS accumulation in several plant species. Besides, the physiological and molecular responses elicited by these pollutants are described. Leveraging omic technologies, including genomics, transcriptomics, and proteomics, provides unprecedented insights into the plant-PFAS interaction. Novel approaches based on artificial intelligence to predict this interaction and up to date disposal and valorization methods for PFAS-contaminated plant biomass, are discussed here. This review offers an interdisciplinary approach to explore what has been discovered so far about PFAS phytoremediation, covering the entire process from contaminant uptake to sustainable disposal, providing a roadmap for future research., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Published
2025
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17. Urban Air Pollution and Plant Tolerance: Omics Responses to Ozone, Nitrogen Oxides, and Particulate Matter.

Author

Antenozio ML, Caissutti C, Caporusso FM, Marzi D, and Brunetti P

Abstract

Urban air pollution is a crucial global challenge, mainly originating from urbanization and industrial activities, which are continuously increasing. Vegetation serves as a natural air filter for air pollution, but adverse effects on plant health, photosynthesis, and metabolism can occur. Recent omics technologies have revolutionized the study of molecular plant responses to air pollution, overcoming previous limitations. This review synthesizes the latest advancements in molecular plant responses to major air pollutants, emphasizing ozone (O 3 ), nitrogen oxides (NO X ), and particulate matter (PM) research. These pollutants induce stress responses common to other abiotic and biotic stresses, including the activation of reactive oxygen species (ROSs)-scavenging enzymes and hormone signaling pathways. New evidence has shown the central role of antioxidant phenolic compound biosynthesis, via the phenylpropanoid pathway, in air pollution stress responses. Transcription factors like WRKY, AP2/ERF, and MYB, which connect hormone signaling to antioxidant biosynthesis, were also affected. To date, research has predominantly focused on laboratory studies analyzing individual pollutants. This review highlights the need for comprehensive field studies and the identification of molecular tolerance traits, which are crucial for the identification of tolerant plant species, aimed at the development of sustainable nature-based solutions (NBSs) to mitigate urban air pollution.

Published
2024
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18. Fetal brain hemodynamics in pregnancies at term: correlation with gestational age, birthweight and clinical outcome.

Author

Ciardulli A, D'Antonio F, Caissutti C, Manzoli L, Flacco ME, Buongiorno S, Saccone G, Rosati P, Lanzone A, Scambia G, and Berghella V

Subjects
Birth Weight, Brain diagnostic imaging, Female, Fetal Growth Retardation, Gestational Age, Hemodynamics, Humans, Middle Cerebral Artery diagnostic imaging, Pregnancy, Pulsatile Flow, Retrospective Studies, Ultrasonography, Doppler, Umbilical Arteries diagnostic imaging, Cesarean Section, Ultrasonography, Prenatal
Abstract

Introduction: The primary aim of this study was to ascertain the strength of association between cerebral blood flow assessed in anterior (ACA), middle (MCA), and posterior (PCA) cerebral arteries and the following clinical outcomes: small for gestational age (SGA), induction of labor (IOL) for oligohydramnios and caesarean section (CS) for nonreassuring fetal status (NRFS) during labor., Material and Methods: Retrospective analysis of prospectively collected data on consecutive singleton pregnancies from 40 0/7 to 41 6/7 week of gestation. UA, ACA, MCA, PCA pulsatility index (PI) were measured from 40 weeks of gestations. Furthermore, the ratios between cerebral blood flow and UA (CPR, ACA/UA and PCA/UA) were calculated and correlated with the observed outcomes., Results: Two hundred twenty-four singleton pregnancies were included in the study. Mean PI of either ACA ( p  = .04), MCA ( p  = .008), and PCA ( p  = .003) were lower in the SGA compared to non-SGA group; furthermore, mean PCA PI was significantly lower than MCA PI ( p  = .04). Furthermore, CPR ( p  = .016), ACA/UA ( p  = .02), and PCA/UA ( p  = .003) were significantly lower in the SGA group compared to controls. UA, ACA, MCA, and PCA PI were higher in women undergoing IOL for oligohydramnios compared to controls. Logistic regression analysis showed that CPR and PCA/UA ratio were independently associated with SGA. SGA, ACA PI, and ACA/UA were independently associated with CS for NRFS. Finally, birthweight centile, were independently associated with IOL oligohydramnios. Despite this, the predictive accuracy of Doppler in detecting any of the explored outcome was only poor to moderate., Conclusion: Redistribution of cerebral blood flow at term is significantly associated with SGA, IOL for oligohydramnios and CS for NRFS in labor. However, the predictive accuracy of Doppler at term is only poor to moderate, thus advising against its use in clinical practice as a standalone screening test for adverse perinatal outcome in pregnancies at term. Key Message Redistribution of cerebral blood flow at term is significantly associated with SGA, IOL for oligohydramnios and CS for NRFS in labor.

Published
2021
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20. One-step versus two-step diagnostic testing for gestational diabetes: a randomized controlled trial.

Author

Khalifeh A, Eckler R, Felder L, Saccone G, Caissutti C, and Berghella V

Subjects
Adult, Female, Glucose Tolerance Test methods, Humans, Pregnancy, Young Adult, Diabetes, Gestational diagnosis
Abstract

Objective: To evaluate the incidence of gestational diabetes mellitus (GDM) using the one-step as compared with the two-step approach. Study design: This was a parallel group nonblinded randomized trial conducted at Thomas Jefferson University Hospital (TJUH) in Philadelphia, Pennsylvania from June 2016 to December 2016. The primary outcome was GDM incidence in the one-step compared to the two-approach. Pregnant women without a history of pregestational diabetes were offered screening for GDM at gestational age 24-28 weeks. Obese women, defined as having a BMI ≥30 kg/m 2 , as well as those with a history of a pregnancy complicated by GDM, a history of a macrosomic baby (>4000 g), or with polycystic ovarian syndrome (PCOS), were offered early screening at their initial prenatal visit, and screening was repeated at 24-28 weeks if initially normal. Women were excluded if they had pre-existing diabetes or had a history of bariatric surgery. Women who were eligible were randomized in a 1:1 ratio to either the one-step or two-step approaches. A sample size of 142 women was planned per group. Women randomized to the one-step approach, after an overnight fast, were given a 2-h glucose tolerance test, which consisted of a 75-g glucose load. Blood glucose levels were measured fasting, at 1 h and 2 h after the glucose load. Diagnostic cutoffs for GDM diagnosis were one value of either fasting ≥92 mg/dL, 1 h ≥180 mg/dL, or 2 h ≥153 mg/dL, respectively. Women randomized to the two-step approach were given a nonfasting 50-g glucose load, and the blood glucose level was measured an hour after the glucose load. If that value was ≥135 mg/dL, the patient had a 3-h glucose tolerance test consisting of a 100-g glucose load. Diagnostic cutoffs for GDM diagnosis for this 3-h test were ≥2 abnormal values of fasting ≥95 mg/dL, 1 h ≥180 mg/dL, 2 h ≥155 mg/dL and 3 h ≥140 mg/dL, respectively. All analyses were done using an intention-to-treat approach, evaluating women according to the treatment group to which they were randomly allocated. Results: Two hundred eighty-four women agreed to take part in the study and underwent randomization from June 2015 to December 2015. Of them, 249 completed the screening and were followed up for the primary endpoint. Out of the 249 women who completed the screening, 123 were assigned to the one-step group and 126 to the two-step group. GDM occurred in 10 women (8.1%) in the one-step group, and 7 women (5.6%) in the two-step group ( p  = .42). Preeclampsia, preterm birth (PTB), induction of labor, mode of delivery and incidence of gestational age (OASIS) were not significantly different. Perinatal outcomes were similar as well. Conclusions: Screening for GDM with one-step, compared with the two-step approach, resulted in a similar incidence of GDM.

Published
2020
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21. Which criteria should be used for starting pharmacologic therapy for management of gestational diabetes in pregnancy? Evidence from randomized controlled trials.

Author

Caissutti C, Saccone G, Khalifeh A, Mackeen AD, Lott M, and Berghella V

Subjects
Blood Glucose analysis, Diabetes, Gestational diagnosis, Diabetes, Gestational diet therapy, Female, Glucose Tolerance Test, Humans, Pregnancy, Randomized Controlled Trials as Topic, Diabetes, Gestational drug therapy
Abstract

Introduction: There is inconclusive evidence to support any specific criteria for starting pharmacologic therapy after diet in women with gestational diabetes mellitus (GDM). We aimed to analyze the most used criteria for starting pharmacologic treatment for patients with GDM. Material and methods: Electronic databases were searched from their inception to September 2017. We included all the randomized controlled trials (RCTs) of GDM managed initially by diet and exercise reporting criteria for starting pharmacologic therapy. RCTs in women with pregestational diabetes were excluded. Data regarding glucose values used for starting pharmacologic therapy were extracted and carefully reviewed. Results: We included 15 RCTs (4307 women) in the meta-analysis. For fasting glucose target, 8/14 (57%) used a value lower or equal to 90 mg/dL and the remainder used values <99 mg/dL. Of the 10 RCTs targeting 2-h postprandial values, the majority (9/10, 90%) used 120 mg/dL. The majority of RCTs (13/15, 87%) recommended pharmacologic therapy if either 1 or 2 values per 1- or 2-week period were higher than the target values: 7/13 (54%) used 1 value and 6/13 (46%) used 2 values higher than target values. One RCT (7%) used >50% of the values higher than the target values and another one (7%) used >30%. Conclusion: The majority of RCTs (87%) used very tight criteria of either 1 or 2 values over the target values in the 1 or 2-week period for starting pharmacologic treatment for patients with GDM; more than 50% used 2 values. Key Message Pharmacologic therapy should be considered in women with gestational diabetes when, despite an adequate diet and exercise, 1 or 2 blood glucose values are over the target values of 90mg/dL fasting or 120mg/dL 2-hour postprandial over 1 or 2 weeks.

Published
2019
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22. The One Step approach for diagnosing gestational diabetes is associated with better perinatal outcomes than the Two Step approach: evidence of randomized clinical trials.

Author

Berghella V, Caissutti C, Saccone G, and Khalifeh A

Subjects
Cesarean Section statistics & numerical data, Female, Fetal Macrosomia epidemiology, Humans, Hypertension, Pregnancy-Induced epidemiology, Hypoglycemia epidemiology, Infant, Newborn, Intensive Care Units, Neonatal, Outcome Assessment, Health Care, Pre-Eclampsia epidemiology, Pregnancy, Premature Birth epidemiology, Randomized Controlled Trials as Topic, Diabetes, Gestational diagnosis, Glucose Tolerance Test methods
Published
2019
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23. One step versus two step approach for gestational diabetes screening: systematic review and meta-analysis of the randomized trials.

Author

Saccone G, Caissutti C, Khalifeh A, Meltzer S, Scifres C, Simhan HN, Kelekci S, Sevket O, and Berghella V

Subjects
Diabetes, Gestational epidemiology, Female, Fetal Macrosomia prevention & control, Humans, Incidence, Pregnancy, Pregnancy Outcome epidemiology, Randomized Controlled Trials as Topic, Diabetes, Gestational diagnosis, Mass Screening methods
Abstract

Introduction: To compare both the prevalence of gestational diabetes mellitus (GDM) as well as maternal and neonatal outcomes by either the one-step or the two-step approaches., Material and Methods: Electronic databases were searched from their inception until June 2017. We included all randomized controlled trials (RCTs) comparing the one-step with the two-step approaches for the screening and diagnosis of GDM. The primary outcome was the incidence of GDM., Results: Three RCTs (n = 2333 participants) were included in the meta-analysis. 910 were randomized to the one step approach (75 g, 2 hrs), and 1423 to the two step approach. No significant difference in the incidence of GDM was found comparing the one step versus the two step approaches (8.4 versus 4.3%; relative risk (RR) 1.64, 95%CI 0.77-3.48). Women screened with the one step approach had a significantly lower risk of preterm birth (PTB) (3.7 versus 7.6%; RR 0.49, 95%CI 0.27-0.88), cesarean delivery (16.3 versus 22.0%; RR 0.74, 95%CI 0.56-0.99), macrosomia (2.9 versus 6.9%; RR 0.43, 95%CI 0.22-0.82), neonatal hypoglycemia (1.7 versus 4.5%; RR 0.38, 95%CI 0.16-0.90), and admission to neonatal intensive care unit (NICU) (4.4 versus 9.0%; RR 0.49, 95%CI 0.29-0.84), compared to those randomized to screening with the two step approach., Conclusions: The one and the two step approaches were not associated with a significant difference in the incidence of GDM. However, the one step approach was associated with better maternal and perinatal outcomes.

Published
2019
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25. Perspectives on diagnostic strategies for HIP-dealing with the barriers and challenges: USA.

Author

Caissutti C and Berghella V

Subjects
Early Diagnosis, Female, Humans, Hyperglycemia epidemiology, Hyperglycemia prevention & control, Mass Screening methods, Mass Screening trends, Pregnancy, Pregnancy Outcome, Prevalence, United States epidemiology, Hyperglycemia diagnosis, Mass Screening standards, Practice Guidelines as Topic standards
Abstract

Background: Gestational diabetes (GDM) affects up to 7-18% of pregnant women and is associated with several maternal and perinatal morbidities. International organizations suggest several different recommendations regarding how to screen and to manage hyperglycemia in pregnancy (HIP)., Objective: We aimed to analyze the most important and employed guidelines about screening and management of HIP and we investigated existing related literature., Results: We found several different criteria for screening for HIP, with the main difference being between non-USA-based IADPSG (One-step) approach, and the USA-based (Two-step) approach. The use of IADPSG approach (One-step) is associated with an increase in the incidence of GDM, improvement of several maternal and perinatal outcomes, and cost-effectiveness, compared to the USA-based Two-step criteria., Conclusions: As the One-Step approach endorsed by IADPSG, WHO, and FIGO is associated with maternal and perinatal benefits, it should be preferred to the Two-Step approach currently endorsed by the USA-based societies such as ACOG and SMFM. The hope is to approve universal screening guidelines based on the One-step approach to improve health care and reduce costs and adverse outcomes for women with GDM., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Published
2018
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26. Chewing gum improves postoperative recovery of gastrointestinal function after cesarean delivery: a systematic review and meta-analysis of randomized trials.

Author

Ciardulli A, Saccone G, Di Mascio D, Caissutti C, and Berghella V

Subjects
Female, Humans, Pregnancy, Randomized Controlled Trials as Topic, Cesarean Section rehabilitation, Chewing Gum, Gastrointestinal Motility, Postoperative Care
Abstract

Objective: To examine whether chewing gum hastens the return of gastrointestinal function after a cesarean delivery., Methods: All randomized controlled trials comparing the use of chewing gum in the immediate postoperative recovery period (i.e. intervention group) with a control group were included in the meta-analysis. The primary outcome was the time to first flatus in hours. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of mean difference (MD) or relative risk (RR) with 95% confidence interval (CI)., Results: Seventeen trials, including 3041 women, were analyzed. Trials were of moderate to low quality with different inclusion criteria. In most of the included trials chewing gum was given right after delivery, three times a day for 30 min each and until the first flatus. Women who were randomized to the chewing gum group had a significantly lower mean time to first flatus (MD - 6.49 h, 95%CI -8.65 to -4.33), to first bowel sounds (MD - 8.48 h, 95%CI -9.04 to -7.92), less duration of stay (MD - 0.39 days, 95%CI -0.78 to -0.18), lower time to first feces (MD - 9.57 h, 95% CI -10.28 to 8.87) and to the first feeling of hunger (MD - 2.89 h, 95%CI -4.93 to -0.85), less number of episodes of nausea or vomiting (RR 0.33, 95%CI 0.12 to 0.87), less incidence of ileus (RR 0.39, 95%CI 0.19 to 0.80) and significantly higher satisfaction., Conclusions: Gum chewing starting right after cesarean delivery three times a day for about 30 min until the first flatus is associated with early recovery of bowel motility. As this is a simple, generally inexpensive intervention, providers should consider implementing cesarean postoperative care with gum chewing.

Published
2018
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27. Uterine massage for preventing postpartum hemorrhage at cesarean delivery: Which evidence?

Author

Saccone G, Caissutti C, Ciardulli A, and Berghella V

Subjects
Female, Humans, Pregnancy, Randomized Controlled Trials as Topic, Cesarean Section adverse effects, Massage, Postpartum Hemorrhage prevention & control
Abstract

Background: Cesarean delivery could be complicated by postpartum hemorrhage (PPH), the first cause of maternal death., Objectives: To evaluate the efficacy of uterine massage in preventing postpartum hemorrhage at cesarean delivery., Data Sources: Electronic databases from their inception until October 2017., Study Eligibility Criteria, Participants, and Interventions: We included all RCTs comparing uterine massage alone or as part of the active management of labor before or after delivery of the placenta, or both, with non-massage in the setting of cesarean delivery., Data Collection and Analysis: The primary outcome was PPH, defined as blood loss >1000 mL. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of mean difference (MD) or relative risk (RR) with 95% confidence interval (CI)., Results: Only 3 RCTs comparing uterine massage vs no uterine massage were found. The quality of these 3 trials in general was very low with high or unclear risk of bias. All of them included only women in the setting of spontaneous vaginal delivery and none of them included cesarean delivery, and therefore the meta-analysis was not feasible., Conclusions: There is not enough evidence to determine if uterine massage prevents postpartum hemorrhage at cesarean delivery., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Published
2018
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28. Very tight vs. tight control: what should be the criteria for pharmacologic therapy dose adjustment in diabetes in pregnancy? Evidence from randomized controlled trials.

Author

Caissutti C, Saccone G, Ciardulli A, and Berghella V

Subjects
Biomarkers blood, Blood Glucose metabolism, Diabetes, Gestational blood, Diabetes, Gestational diagnosis, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Humans, Hypoglycemic Agents therapeutic use, Pregnancy, Pregnancy in Diabetics blood, Pregnancy in Diabetics diagnosis, Randomized Controlled Trials as Topic, Diabetes, Gestational drug therapy, Hypoglycemic Agents administration & dosage, Pregnancy in Diabetics drug therapy
Abstract

Introduction: There is inconclusive evidence from randomized controlled trials (RCTs) to support any specific criteria for pharmacologic therapy dose adjustment in diabetes in pregnancy. Our objective was to analyze the criteria for dose adjustment of pharmacologic treatment for diabetes mellitus (DM) in pregnancy., Material and Methods: Data sources: MEDLINE, OVID and Cochrane Library were searched from their inception to September 2017. Selection criteria included all trials of DM in pregnancy managed by oral hypoglycemic agents or insulin reporting criteria for pharmacologic therapy dose adjustment. RCTs in women with pregestational DM and gestational DM (GDM) were included. For each trial, data regarding glucose values used for pharmacologic therapy dose adjustment were extracted and carefully reviewed., Results: Of 51 RCTs on therapy for GDM or pregestational DM, 17 (4230 women) were included as they reported criteria for pharmacologic therapy dose adjustment. Most of them (88%, 15/17) included women with GDM only. For RCTs including women with GDM, 12/16 (75%) used the two-step approach, three (19%) the one-step approach and one (6%) either the one- or two-step approach. Regarding the type of initial therapy, 13 (77%) RCTs used different types and doses of insulin; nine (53%) used metformin; five (30%) used glyburide; and one (6%) used placebo. In most RCTs, glucose monitoring was assessed four times daily, i.e. fasting (all RCTs) and two hours (15 RCTs, 88%) after each of the three main meals - breakfast, lunch, and dinner. For fasting glucose target, all used a value <105 mg/dL; nine (53%) used 95 mg/dL as target. Of the 15 RCTs using a two-hour postprandial value as target, 11 (73%) had 120 mg/dL as cutoff. Regarding the criteria for pharmacologic therapy dose adjustment, we found six different criteria. The majority of RCTs (9/17, 53%) used either one or two values per week higher than the target values, of which two-thirds used only one value (35% of total), and one-third (18% of total) two values. Five RCTs (29%) used >50%, one (6%) >30%, and one (6%) >20% of the values higher than the target value; one (6%) used the appearance of glycosuria., Conclusions: When evaluating RCTs which included criteria for pharmacologic GDM therapy dose adjustment, the most common criterion for diagnosis was the two-step test, and the most common used therapies were insulin and metformin. Regarding glucose monitoring, the most common frequency was four times per day, fasting and two hours after each main meal, using as target glucose values 95 and 120 mg/dL, respectively. Importantly, we found six different criteria for pharmacologic GDM therapy dose adjustment, with the majority using very tight criteria of either one or two values per week higher than the target values, of which two-thirds used only one value, and one-third used two values., (© 2017 Nordic Federation of Societies of Obstetrics and Gynecology.)

Published
2018
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29. Small fetal thymus and adverse obstetrical outcome: a systematic review and a meta-analysis.

Author

Caissutti C, Familiari A, Khalil A, Flacco ME, Manzoli L, Scambia G, Cagnacci A, and D'antonio F

Subjects
Humans, Infant, Newborn, Infant, Small for Gestational Age, Premature Birth diagnostic imaging, Thymus Gland diagnostic imaging, Thymus Gland embryology, Ultrasonography, Prenatal methods
Abstract

Introduction: The aim of this study was to explore the association between small fetal thymus on ultrasound and adverse obstetrical outcome., Material and Methods: Medline, Embase, Cochrane and Web of Science databases were searched. Primary outcome was the risk of preterm birth before 37 and 34 weeks of gestation in fetuses with, compared to those without, a small thymus on ultrasound., Secondary Outcomes: occurrence of chorioamnionitis, intrauterine growth restriction, neonatal sepsis, gestational age at birth, birthweight, neonatal morbidity and preeclampsia., Results: Twelve studies including 1744 fetuses who had ultrasound assessment of thymus during pregnancy were included. Women with preterm premature rupture of the membranes or with preterm labor were at higher risk of preterm birth before 37 weeks (p = 0.01), or before 34 weeks (p < 0.001) for fetuses with a small fetal thymus compared to those without a small thymus, and the risk of chorioamnionitis was higher when the thymus was small (p < 0.001). Fetuses with small thymus were not at higher risk of intrauterine growth restriction (p = 0.3). A small thymus increased the risk of neonatal sepsis (p = 0.007) and morbidity (p = 0.003), but not the risk of preeclampsia (p = 0.9)., Conclusions: A small fetal thymus is associated with a higher risk of preterm birth, chorioamnionitis, neonatal sepsis and morbidity, but not with intrauterine growth restriction and preeclampsia., (© 2017 Nordic Federation of Societies of Obstetrics and Gynecology.)

Published
2018
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30. Are women positive for the One Step but negative for the Two Step screening tests for gestational diabetes at higher risk for adverse outcomes?

Author

Caissutti C, Khalifeh A, Saccone G, and Berghella V

Subjects
Female, Fetal Macrosomia diagnosis, Humans, Pregnancy, Diabetes, Gestational diagnosis, Glucose Tolerance Test standards, Mass Screening methods, Pregnancy Outcome epidemiology
Abstract

Introduction: The aim of this study was to evaluate if women meeting criteria for gestational diabetes mellitus (GDM) by the One Step test as per International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria but not by other less strict criteria have adverse pregnancy outcomes compared with GDM-negative controls. The primary outcome was the incidence of macrosomia, defined as birthweight > 4000 g., Material and Methods: Electronic databases were searched from their inception until May 2017. All studies identifying pregnant women negative at the Two Step test, but positive at the One Step test for IADPSG criteria were included. We excluded studies that randomized women to the One Step vs. the Two Step tests; studies that compared different criteria within the same screening method; randomized studies comparing treatments for GDM; and studies comparing incidence of GDM in women doing the One Step test vs. the Two Step test., Results: Eight retrospective cohort studies, including 29 983 women, were included. Five study groups and four control groups were identified. The heterogeneity between the studies was high. Gestational hypertension, preeclampsia and large for gestational age, as well as in some analyses cesarean delivery, macrosomia and preterm birth, were significantly more frequent, and small for gestational age in some analyses significantly less frequent, in women GDM-positive by the One Step, but not the Two Step., Conclusion: Women meeting criteria for GDM by IADPSG criteria but not by other less strict criteria have an increased risk of adverse pregnancy outcomes such as gestational hypertension, preeclampsia and large for gestational age, compared with GDM-negative controls. Based on these findings, and evidence from other studies that treatment decreases these adverse outcomes, we suggest screening for GDM using the One Step IADPSG criteria., (© 2017 Nordic Federation of Societies of Obstetrics and Gynecology.)

Published
2018
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31. Vaginal Cleansing Before Cesarean Delivery: A Systematic Review and Meta-analysis.

Author

Caissutti C, Saccone G, Zullo F, Quist-Nelson J, Felder L, Ciardulli A, and Berghella V

Subjects
Administration, Intravaginal, Female, Humans, Pregnancy, Preoperative Care, Randomized Controlled Trials as Topic, Anti-Infective Agents, Local administration & dosage, Cesarean Section, Povidone-Iodine administration & dosage, Surgical Wound Infection prevention & control, Vagina
Abstract

Objective: To assess the efficacy of vaginal cleansing before cesarean delivery in reducing postoperative endometritis., Data Sources: MEDLINE, Ovid, EMBASE, Scopus, Clinicaltrials.gov, and Cochrane Library were searched from their inception to January 2017., Methods of Study Selection: Selection criteria included all randomized controlled trials comparing vaginal cleansing (ie, intervention group) with a control group (ie, either placebo or no intervention) in women undergoing cesarean delivery. Any method of vaginal cleansing with any type of antiseptic solution was included. The primary outcome was the incidence of endometritis. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of relative risk (RR) with 95% CI., Tabulation, Integration, and Results: Sixteen trials (4,837 women) on vaginal cleansing immediately before cesarean delivery were identified as relevant and included in the review. In most of the included studies, 10% povidone-iodine was used as an intervention. The most common way to perform the vaginal cleansing was the use of a sponge stick for approximately 30 seconds. Women who received vaginal cleansing before cesarean delivery had a significantly lower incidence of endometritis (4.5% compared with 8.8%; RR 0.52, 95% CI 0.37-0.72; 15 studies, 4,726 participants) and of postoperative fever (9.4% compared with 14.9%; RR 0.65, 95% CI 0.50-0.86; 11 studies, 4,098 participants) compared with the control group. In the planned subgroup analyses, the reduction in the incidence of endometritis with vaginal cleansing was limited to women in labor before cesarean delivery (8.1% compared with 13.8%; RR 0.52, 95% CI 0.28-0.97; four studies, 440 participants) or those with ruptured membranes (4.3% compared with 20.1%; RR 0.23, 95% CI 0.10-0.52; three studies, 272 participants)., Conclusion: Vaginal cleansing immediately before cesarean delivery in women in labor and in women with ruptured membranes reduces the risk of postoperative endometritis. Because it is generally inexpensive and a simple intervention, we recommend preoperative vaginal preparation before cesarean delivery in these women with sponge stick preparation of povidone-iodine 10% for at least 30 seconds. More data are needed to assess whether this intervention may be also useful for cesarean deliveries performed in women not in labor and for those without ruptured membranes., Systematic Review Registration: PROSPERO International prospective register of systematic reviews, https://www.crd.york.ac.uk/PROSPERO/, CRD42017054843.

Published
2017
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32. Scientific Evidence for Different Options for GDM Screening and Management: Controversies and Review of the Literature.

Author

Caissutti C and Berghella V

Subjects
Diabetes, Gestational epidemiology, Diabetes, Gestational therapy, Female, Humans, Male, Practice Guidelines as Topic, Pregnancy, Diabetes, Gestational diagnosis, Mass Screening methods
Abstract

Background. Gestational diabetes (GDM) affects up to 7% of pregnant women and is associated with several maternal and perinatal morbidities. International organizations suggest several different recommendations regarding how to screen and to manage GDM. Objective. We aimed to analyze the most important and employed guidelines about screening and management of GDM and we investigated existing related literature. Results. We found several different criteria for screening for GDM, for monitoring GDM, and for starting pharmacological therapy. When using IADPSG criteria, GDM rate increased, perinatal outcomes improved, and screening became cost-effective. Compared to no treatment, treatment of women meeting criteria for GDM by IADPSG criteria but not by other less strict criteria has limited evidence for an effect on adverse pregnancy outcomes.

Published
2017
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