Monochorionic-diamniotic twin pregnancy complicated by spontaneous septostomy and cord entanglement. a systematic review, evaluation of complication rates and presentation of an additional case

Background: Our purpose is to describe the ultrasound findings, both with bi-dimensional and three-dimensional imaging, suggestive of spontaneous septostomy in monochorionic-diamniotic twin pregnancies. Methods: PubMed, Medline and reference lists were searched using “Spontaneous septostomy and twin pregnancy” as keywords. Seventeen articles reporting a total of 25 cases, adding our own, were included in the systematic review. Only English full text articles, the main purpose of which was to describe spontaneous septostomy in twin pregnancies, were included. Results: In our sample the major ultrasound sign arousing suspicion of spontaneous septostomy was found to be an absent or disrupted inter-twin membrane (79% of cases). Twins close to each-other were described in 33% of cases, while cord entanglement was suspected only in 27% of cases. We reported a lower antenatal detection of entanglement when compared with intrapartum evaluation (27% vs 59%). Adverse fetal outcomes occurred in 12% of cases, while 88% of cases were born alive. Conclusions: Spontaneous septostomy represents a diagnostic and clinical challenge for obstetrics providers. Clinicians must focus on ultrasound findings to close surveil fetal wellness and reduce both fetal and neonatal impairment

Metformin reduces maternal weight gain in obese pregnant women: a systematic review and meta‐analysis of two randomized controlled trials

Obese pregnant women are likely to face several gestational and neonatal complications. Metformin is an effective oral antihyperglycaemic agent that is considered to be effective during pregnancy. The aim of our study was to evaluate the effect of metformin on obstetric and perinatal outcomes in obese pregnant women. Electronic databases were searched (MEDLINE, EMBASE, Web of Science, Scopus, ClinicalTrials.gov, OVID, and Cochrane Library). The selection criteria included only randomized clinical trials (RCTs) of obese pregnant women randomized to a daily metformin regimen or to a placebo condition. The type of participants included women with a body mass index (BMI) ≥ 30 kg/m2 who did not have diabetes mellitus, any other disease, or a contraindication to metformin use. The summary measures were reported as relative risk (RR) with 95% confidence intervals (CIs). The primary outcome was the effect on maternal weight gain (MWG). Two double-blind RCTs, including 849 obese pregnant women, were included in the meta-analysis: 428 (50.4%) were randomized to the metformin group, and 421 (49.6%) were randomized to the placebo group. The use of metformin was significantly associated with lower MWG. Metformin was also associated with a significantly lower incidence of preeclampsia (PE) and admission to the neonatal intensive care unit (NICU). Metformin could be considered a useful drug for the treatment of obese, nondiabetic pregnant women because it can significantly decrease weight gain in pregnant women and improve perinatal outcomes by reducing the incidence of PE and NICU admission. However, women should be aware of the uncertainties concerning the long-term effects of metformin transplacental passage on metabolic outcomes

Risk of neural tube defects according to maternal body mass index: a systematic review and meta-analysis

Introduction: The aim of our systematic review and meta-analysis was to evaluate the risk of neural tube defects (NTDs) according to the pre-pregnancy body mass index. Materials and methods: Electronic databases were searched (MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID, and Cochrane Library). Selection criteria included prospective and retrospective cohort studies reporting the prevalence of fetal NTDs in obese, overweight, and underweight pregnant women. Odds ratios (ORs) comparing risk among these subsets of pregnancies with normal weight mothers were determined with 95% confidence intervals (CI). The evaluated outcome was the association between maternal underweight, overweight, and obesity and the risk of NTDs. Results: We included ten studies published between 2000 and 2017, including underweight, overweight, and obese pregnant women with fetal NTD (cases) and pregnant women with recommended BMI with fetal NTD (controls). Compared with normal BMI women, obese mothers were at significantly higher risk of fetal NTDs (0.53 vs. 0.33%; OR 1.62 95% CI 1.32-1.99, p < .0001), while no difference for the risk of NTDs was found when comparing overweight (0.34 vs. 0.32%; OR 1.09 95% CI 0.92-1.3, p = .3) and underweight (0.65 vs. 0.24%; OR 1.34 95% CI 0.73-2.47, p = .34) with normal weight pregnant women. Discussion: Obese pregnant women are at significantly higher risk NTDs, while no significant difference has been found in overweight and underweight pregnant women. Key message Obese pregnant women are at significantly higher risk of NTDs, such as spina bifida compared with normal weight women. No difference was found when comparing overweight and underweight with normal weight women

Obstetrical outcomes in women with history of breast cancer: a systematic review and meta-analysis

Purpose: Potential risk of adverse obstetrical outcomes has been shown among breast cancer survivors. Therefore, the aim of this systematic review and meta-analysis was to evaluate the relationship between history of breast cancer (BC) and obstetrical outcomes. Methods: PubMed, EMBASE, and Medline were searched from the inception of each database to April 2019. Selection criteria included prospective and retrospective cohort studies of BC pregnant survivors. The meta-analysis was performed by computing odds ratios (ORs) using both fixed and random-effects models. Quality assessment of the included studies was performed using the Newcastle–Ottawa Scale and the review was registered with PROSPERO number CRD42019127716. Results: Four studies, including 1466 cases of BC survivors and 6,912,485 controls, were included. Compared with controls, a higher incidence of obstetrical complication was found in women with history of BC. The incidence of preterm birth (PTB) in the study group was 11.05% compared with 7.79% in the control group (1.68, 95% confidence interval 1.43–1.99). Breast cancer history was also associated with low birth weight (LBW) (study group: 9.26% vs. control group: 5.54%, 1.88, CI 95% 1.55–2.27), cesarean section (CS) (study group: 19.76% vs. control group 10.81%, 1.78, CI 95% 1.39–2.27), intrauterine fetal death (IUFD) (study group: 0.004% vs. control group 0.36%, of 1.25 CI 95% 0.36–4.35), and fetal anomalies (study group: 5.8% vs. control group: 4.26%, 1.45 CI 95% 1.01–2.09). Conclusions: History of BC was associated with adverse obstetrical outcomes

Pregnant women's knowledge and behaviour to prevent cytomegalovirus infection: an observational study

Objectives Congenital cytomegalovirus (cCMV) infection can negatively affect pregnancy outcomes, but may be prevented by simple precautions. Literature suggests that gynaecologists do not always adequately inform about preventive behaviour and most pregnant women have a low-level knowledge regarding cCMV infection. The aim of this study is to evaluate knowledge and risk behaviours related to cCMV infection in an unselected group of pregnant women. Methods An institutional based cross-sectional study was conducted in three Maternal and Fetal Divisions in Rome between November and February 2019 on 296 pregnant women, their knowledge on cCMV was measured using six cytomegalovirus (CMV) related questions. Results Out of the 296 respondents, 59.1% had heard, read or seen information about cCMV infection. Regarding the way of transmission, 96/296 (32.4%) correctly recognize children as a potential source of the infection but only 25/296 (8.44%) knew all prevention practices, 28/296 (9.5%) of women reported that they have never performed cCMV test during pregnancy. Conclusions The results of this survey show that knowledge on cCMV infection among pregnant women is poor. This highlights the need to improve counselling on all preventive practices for cCMV infection during perinatal care consultation