Pregnancy in immigrant women

Objective: We wanted to study how foreign women face pregnancy and childbirth in a society quite different from their own. Methods: In 2004 we studied 328 pregnant women at the Department of Gynaecology at the "General Hospital Umberto 1" in Rome. Information on patients' personal lives and experiences was collected. Results: Women were classified into six (6) groups based on nationality, race, religion and culture. Conclusions: Arabian women had the most natural childbirths. African women had a longer duration of gestation. Women from Eastern Europe underwent frequent tests and examinations, but had the highest chance of having preterm births. Chinese women did not usually undergo many examinations and were able to tolerate pain during childbirth quite well

Sensitivity and specificity of in vivo COVID-19 screening by detection dogs: Results of the C19-Screendog multicenter study

Trained dogs can recognize the volatile organic compounds contained in biological samples of patients with COVID-19 infection. We assessed the sensitivity and specificity of in vivo SARS-CoV- 2 screening by trained dogs. We recruited five dog-handler dyads. In the operant conditioning phase, the dogs were taught to distinguish between positive and negative sweat samples collected from volunteers’ underarms in polymeric tubes. The conditioning was validated by tests involving 16 positive and 48 negative samples held or worn in such a way that the samples were invisible to the dog and handler. In the screening phase the dogs were led by their handlers to a drive-through facility for in vivo screening of volunteers who had just received a nasopharyngeal swab from nursing staff. Each volunteer who had already swabbed was subsequently tested by two dogs, whose responses were recorded as positive, negative, or inconclusive. The dogs’ behavior was constantly monitored for attentiveness and wellbeing. All the dogs passed the conditioning phase, their responses showing a sensitivity of 83-100% and a specificity of 94-100%. The in vivo screening phase involved 1251 subjects, of whom 205 had a COVID-19 positive swab and two dogs per each subject to be screened. Screeningsensitivity and specificity were respectively 91.6-97.6% and 96.3-100% when only one dog was involved, whereas combined screening by two dogs provided a higher sensitivity. Dog wellbeing was also analysed: monitoring of stress and fatigue suggested that the screening activity did not adversely impact the dogs’ wellbeing. This work, by screening a large number of subjects, strengthen recent findings that trained dogs can discriminate between COVID-19 infected and healthy human subjects and introduce two novel research aspects: i) assessement of signs of fatigue and stress in dogs during training and testing, and ii) combining screening by two dogs to improve detection sensitivity and specificity. Using some precautions to reduce the risk of infection and spillover, in vivo COVID-19 screening by a dog-handler dyad can be suitable to quickly screen large numbers of people: it is rapid, non- invasiveand economical, since it does not involve actual sampling, lab resources or waste management, and is suitable to screen large numbers of people

Ruolo dell’immunoprofilassi anti-D pre-partum: evidenze scientifiche

L’immunoprofilassi anti-D è attualmente raccomandata alla prima gravidanza alla madre Rh negativa entro 72 ore dal parto di un neonato Rh positivo: la profilassi prevede la somministrazione per via intramuscolare di una dose di IgG anti-D compresa tra 1.000 UI e 1.650 UI. Divenuta una pratica di routine a partire dagli anni ’70, l’immunoprofilassi anti-D ha consentito di ottenere una drastica riduzione della mortalità neonatale per MEN, ma, nonostante ciò, l’alloimmunizzazione rimane ancor oggi la causa più frequente di anemia fetale. Diversi studi clinici randomizzati hanno dimostrato che una profilassi anti-D prenatale di routine, eseguita in aggiunta alla profilassi post-partum, può ridurre ulteriormente il rischio di isoimmunizzazione dall’1.6%-1.8% allo 0.2%. Le attuali Linee Guida NICE Agosto 2008 raccomandano, infatti, in aggiunta alla profilassi post-partum, una profilassi prenatale che prevede la somministrazione di due dosi di Ig anti-D da 500 UI ognuna, alla 28ª e alla 34ª settimana di gestazione rispettivamente, oppure due dosi di Ig anti-D da 1.000 UI-1.650 UI ognuna alla 28ª e alla 34ª settimana, oppure una singola dose da 1.500 UI alla 28ª settimana o tra la 28ª e la 30ª settimana di gestazione

Outcome materno-fetale in gravide affette da epilessia

Obiettivo: in Italia l’epilessia è la patologia neurologica più frequente. La frequenza dell’epilessia in gravidanza è del 3-6‰ . L’effetto della gravidanza sulla malattia è imprecisabile. Nelle gravide epilettiche verrebbe registrato un aumento di preeclampsia, sanguinamento vaginale, distacco di placenta, parto pretermine. Sono descritti, inoltre, aumenti di IUGR, mortalità perinatale ed emorragie feto-neonatali. Scopo dello studio è quello di determinare l’entità dell’influenza della sindrome epilettica sulla gravidanza. Metodi: sono state esaminate 9.000 pazienti di cui 65 presentavano diagnosi di epilessia. Lo studio include informazioni relative all’andamento della gravidanza, alla modalità del parto e allo stato clinico del bambino. Per la valutazione dell’andamento della gravidanza, abbiamo rilevato la comparsa di complicanze della stessa. Per la valutazione clinica del neonato abbiamo segnalato il punteggio Apgar attribuitogli, il peso alla nascita, presenza e tipo di malformazioni congenite. Risultati: per le complicazioni ostetriche, su 65 gravide epilettiche, il 7,7% ha avuto un parto prematuro; altra complicanza è l’ipertensione materna, riscontrata nell’11% dei casi. Per le complicanze fetoneonatali, il 6% dei neonati alla nascita era moderatamente depresso, il 10,8% di peso inferiore ai 2.500g, il ritardo di crescita intrauterina si è evidenziato nel 5% dei casi e le malformazioni congenite nel 7%. Il 58% delle gravide epilettiche è stato sottoposto a taglio cesareo. Conclusioni: si è riscontrato un tasso di complicazioni maternofetali del 15%. Per gli exitus materno-neonatali abbiamo dimostrato come, in un campione attentamente monitorato ed assistito, tale rischio sia praticamente azzerato. Possiamo concludere che le problematiche dell’epilessia in gravidanza non si discostano da quelle di altre patologie ostetriche

La minaccia di parto pretermine

Il parto pretermine costituisce ancora oggi una patologia della gravidanza di estremo rilievo essendo gravato da una elevata mortalità neonatale; infatti attualmente è responsabile di circa il 75% delle morti neonatali, e da una elevata morbilità neonatale, provocata da molteplici complicanze. Per ridurre tale rischio è importante eseguire un corretto approccio terapeutico basato sull’impiego di un trattamento non farmacologico ed un trattamento farmacologico, basato quest’ultimo sull’impiego di diversi agenti tocolitici, considerati il pilastro del management farmacologico primario del travaglio pretermine, con lo scopo di posticipare il parto di almeno 48 ore, accelerando la maturazione polmonare del feto e quindi di ridurre l’incidenza della sindrome da distress respiratorio. I tocolitici in uso sono: il solfato di magnesio, gli inibitori della sintesi di prostaglandine, i calcio-antagonisti, il progesterone, i beta-mimetici, gli antagonisti recettoriali dell’ossitocina. Nel corso degli anni sono stati eseguiti diversi studi che valutano l’importanza di questi farmaci nel prevenire il parto pretermine non soltanto quando sono somministrati singolarmente ma anche la loro efficacia quando sono somministrati mediante schemi terapeutici combinati. Un ulteriore progresso della terapia verrà probabilmente dall’utilizzazione clinica del BRL 37344, sostanza che agisce sui recettori b3-adrenergici. A tal proposito sono stati effettuati diversi studi per valutare se la modulazione dei recettori b3-adrenergici possa costituire un nuovo approccio scientifico per la tocolisi con l’insorgenza di minori effetti avversi cardiovascolari rispetto alla modulazione dei recettori b2-adrenergici. In definitiva, nel proporre uno schema terapeutico si dovranno valutare i costi e i benefici di ogni singolo farmaco

Sperimentazione di una nuova formulazione di fitoestrogeni, progestinici naturali, rhodiola, minerali e vitamine antiossidanti per promuovere il benessere della donna in menopausa

Gli Autori riportano i risultati di un loro studio clinico effettuato su 50 donne in menopausa trattate con un integratore alimentare contenente Fitoestrogeni e Dioscorea Villosa.Tutte le pazienti, durante il trattamento, sono state sottoposte a follow-up clinico ed in particolare a controlli dell’eco pattern endometriale. Il tasso di abbandono conseguente alla comparsa di effetti collaterali è stato molto basso (8%). Sono stati registrati, nell’80% delle donne, risultati positivi su: vampate di calore, osteoporosi, sistema nervoso e secchezza vaginale, senza l’insorgenza di patologie grav

[Inherited thrombophilia in pregnancy: a systematic review].

The purpose of this study was to conduct a systematic review of the literature of studies that examined the association between inherited thrombophilias and adverse pregnancy outcomes. We have evaluated developments in this area published since 1998. The published studies differ widely in design, mostly in patients and controls selection and in data analytic approach. Despite the growing evidence in the literature, there are still gaps in our knowledge of thrombophilia in pregnancy, specially regarding less prevalent thrombophilic defects, such as deficiencies in antithrombin, protein C, and S. Several studies on the association on factor V Leiden showed that it may play a role not only in second trimester losses, but also in pre-eclampsia, intrauterine growth-retardation, and placental abruption. Studies on the prothrombin gene mutation yielded conflicting results. Further large prospective studies are needed to asses the relative clinical and cost effectiveness of anticoagulant therapies in the prevention of pregnancy adverse outcomes

trombofilia congenita in gravidanza

The purpose of this study was to conduct a systematic review of the literature of studies that examined the association between inherited thrombophilias and adverse pregnancy outcomes. We have evaluated developments in this area published since 1998. The published studies differ widely in design, mostly in patients and controls selection and in data analytic approach. Despite the growing evidence in the literature, there are still gaps in our knowledge of thrombophilia in pregnancy, expecially regarding less prevalent thrombophilic defects, such as deficiencies in antithrombin, protein C, and S. Several studies on the association on factor V Leiden showed that it may play a role not only in second trimester losses, but also in pre-eclampsia, intrauterine growth-retardation, and placental abruption. Studies on the prothrombin gene mutation yielded conflicting results. Further large prospective studies are needed to asses the relative clinical and cost effectiveness of anticoagulant therapies in the prevention of pregnancy adverse outcomes

The clinical use of a preparation based on phyto-oestrogens in the treatment of menopausal disorders

In order to evaluate the efficacy of soya isoflavones (genistein and daidzein) in the treatment of the principal menopausal disorders, a double blind randomized study was performed on a sample of 50 women (with an average age of 53.3 +/- 3.1 years) with Climacteric syndrome referred to the I Clinica Ostetrica e Ginecologica, Policlinico Umberto I, Roma. The research protocol involved the random subdivision of the enrolled sample into two groups of 25 women, group 1 (with an average age of 53.3 +/- 3.5 years, and an average menopausal age of 51.6 +/- 1.8 years) and group 2 (with an average age of 53.1 +/- 2.9 years, and an average menopausal age of 51.3 +/- 1.2 years), who were to receive treatment for three months with the product being studied and with a placebo. After the three-month period, as an additional check, the group initially treated with the placebo would move to the phyto-oestrogens and viceversa. All of the patients were subjected to a series of clinical and instrumental examinations and were asked to fill in a questionnaire concerning their complaints, at the start, at halfway (third month) and at the end (sixth month) of the trial. The results of the evaluation of the questionnaires performed on the 47 patients who had completed the trial showed, in the first three months, an improvement in the symptoms (hot flushes) in 11 patients treated with phyto-oestrogens against 6 patients from the group that received only the placebo. In the second three-month period the hot flushes reappeared in 4 of the 11 patients who had previously seen improvements and had then passed to the placebo. In contrast, the group that passed to the phyto-oestrogens, after treatment with the placebo, experienced the disappearance of hot flushes in 11 women, including the 6 who had already improved in the first three months. There was no significant reduction in anxiety, insomnia or vaginal dryness. None of the enrolled patients indicated complaints linked to the treatment. It can be concluded that the use of a product based on phyto-oestrogens, such as the one experimented, can lead to a significant reduction in some of the disorders linked with the menopause, especially hot flushes