@article {10565, title = {Immediate delivery or expectant management in gestational diabetes at term: the GINEXMAL randomised controlled trial.}, journal = {BJOG}, volume = {124}, year = {2017}, month = {2017 Mar}, pages = {669-677}, abstract = {

OBJECTIVE: To evaluate maternal and perinatal outcomes after induction of labour versus expectant management in pregnant women with gestational diabetes at term.

DESIGN: Multicentre open-label randomised controlled trial.

SETTING: Eight teaching hospitals in Italy, Slovenia, and Israel.

SAMPLE: Singleton pregnancy, diagnosed with gestational diabetes by the International Association of Diabetes and Pregnancy Study Groups criteria (IADPSGC), between 38 and 39 weeks of gestation, without other maternal or fetal conditions.

METHODS: Patients were randomly assigned to induction of labour or expectant management and intensive follow-up. Data were analysed by {\textquoteright}intention to treat{\textquoteright}.

MAIN OUTCOME MEASURES: The primary outcome was incidence of caesarean section. Secondary outcomes were maternal and perinatal mortality and morbidity.

RESULTS: A total of 425 women were randomised to the study groups. The incidence of caesarean section was 12.6\% in the induction group versus 11.7\% in the expectant group. No difference was found between the two groups (relative risk, RR 1.06; 95\% confidence interval, 95\% CI 0.64-1.77; P = 0.81). The incidence of non-spontaneous delivery, either by caesarean section or by operative vaginal delivery, was 21.0 and 22.3\%, respectively (RR 0.94; 95\% CI 0.66-1.36; P = 0.76). Neither maternal nor fetal deaths occurred. The few cases of shoulder dystocia were solved without any significant birth trauma.

CONCLUSIONS: In women with gestational diabetes, without other maternal or fetal conditions, no difference was detected in birth outcomes regardless of the approach used (i.e. active versus expectant management). Although the study was underpowered, the magnitude of the between-group difference was very small and without clinical relevance.

TWEETABLE ABSTRACT: Immediate delivery or expectant management in gestational diabetes at term?

}, keywords = {Adult, Delivery, Obstetric, Diabetes, Gestational, Female, Humans, Infant, Newborn, Israel, Italy, Maternal Mortality, Perinatal Mortality, Pregnancy, Pregnancy Outcome, Slovenia, Term Birth, Watchful Waiting}, issn = {1471-0528}, doi = {10.1111/1471-0528.14389}, author = {Alberico, S and Erenbourg, A and Hod, M and Yogev, Y and Hadar, E and Neri, F and Ronfani, L and Maso, G} } @article {10507, title = {Pregnant with HIV before age 25: data from a large national study in Italy, 2001-2016.}, journal = {Epidemiol Infect}, volume = {145}, year = {2017}, month = {2017 08}, pages = {2360-2365}, abstract = {

Young pregnant women with HIV may be at significant risk of unplanned pregnancy, lower treatment coverage, and other adverse pregnancy outcomes. In a large cohort of pregnant women with HIV in Italy, among 2979 pregnancies followed in 2001-2016, 9{\textperiodcentered}0\% were in women <25 years, with a significant increase over time (2001-2005: 7{\textperiodcentered}0\%; 2006-2010: 9{\textperiodcentered}1\%; 2011-2016: 12{\textperiodcentered}2\%, P < 0{\textperiodcentered}001). Younger women had a lower rate of planned pregnancy (23{\textperiodcentered}2\% vs. 37{\textperiodcentered}7\%, odds ratio (OR) 0{\textperiodcentered}50, 95\% confidence interval (CI) 0{\textperiodcentered}36-0{\textperiodcentered}69), were more frequently diagnosed with HIV in pregnancy (46{\textperiodcentered}5\% vs. 20{\textperiodcentered}9\%, OR 3{\textperiodcentered}29, 95\% CI 2{\textperiodcentered}54-4{\textperiodcentered}25), and, if already diagnosed with HIV before pregnancy, were less frequently on antiretroviral treatment at conception (<25 years: 56{\textperiodcentered}3\%; ⩾25 years: 69{\textperiodcentered}0\%, OR 0{\textperiodcentered}58, 95\% CI 0{\textperiodcentered}41-0{\textperiodcentered}81). During pregnancy, treatment coverage was almost universal in both age groups (98{\textperiodcentered}5\% vs. 99{\textperiodcentered}3\%), with no differences in rate of HIV viral suppression at third trimester and adverse pregnancy outcomes. The data show that young women represent a growing proportion of pregnant women with HIV, and are significantly more likely to have unplanned pregnancy, undiagnosed HIV infection, and lower treatment coverage at conception. During pregnancy, antiretroviral treatment, HIV suppression, and pregnancy outcomes are similar compared with older women. Earlier intervention strategies may provide additional benefits in the quality of care for women with HIV.

}, keywords = {Adolescent, Cohort Studies, Female, HIV Infections, Humans, Italy, Odds Ratio, Pregnancy, Young Adult}, issn = {1469-4409}, doi = {10.1017/S0950268817001340}, author = {Floridia, M and Masuelli, G and Tamburrini, E and Cetin, I and Liuzzi, G and Martinelli, P and Guaraldi, G and Spinillo, A and Vimercati, A and Maso, G and Pinnetti, C and Frisina, V and Dalzero, S and Ravizza, M} } @article {8288, title = {Time to optimise and enforce training in interpretation of intrapartum cardiotocograph.}, journal = {BJOG}, volume = {123}, year = {2016}, month = {2016 May}, pages = {866-9}, issn = {1471-0528}, doi = {10.1111/1471-0528.13846}, author = {Ugwumadu, A and Steer, P and Parer, B and Carbone, B and Vayssiere, C and Maso, G and Arulkumaran, S} } @article {3620, title = {Intrapartum fetal heart rate monitoring interpretation in labour: a critical appraisal.}, journal = {Minerva Ginecol}, volume = {67}, year = {2015}, month = {2015 Feb}, pages = {65-79}, abstract = {

Electronic fetal monitoring (EFM) has been introduced in the obstetrics practice as a test to identify the first signs of fetal deterioration, allowing a prompt intervention to reduce neonatal morbidity and mortality. However, results from clinical trials fail to demonstrate a clear benefit with the use of EFM. No decrease in the incidence of cerebral palsy due to intrapartum asphyxia has been achieved and a significant increase in the rate of operative deliveries and in medico-legal litigations has been observed instead. Despite the lack of evidence supporting its safety and effectiveness, this method is routinely used in the clinical practice and periodical updated guidelines to standardize the method of interpretation and proper actions are proposed. However, limitations still exist and the unavoidable consequences are the increasing rate of caesarean delivery, partly due to a defensive attitude in medical choices, and medico-legal litigations for presumed inappropriate evaluation in case of perinatal adverse event. While Obstetrics Societies are trying to "fight" the rise in caesarean section rates, intrapartum EFM tracings are taken in the court proceedings as one of the main evidences in case of adverse event. The aim of this review is to discuss the limitations of guidelines dealing with intrapartum EFM and the pathophysiological basis to assess the suspicious tracings which represent the most observed and critical issue of EFM interpretation.

}, issn = {1827-1650}, author = {Maso, G and Piccoli, M and De Seta, F and Parolin, S and Banco, R and Camacho Mattos, L and Bogatti, P and Alberico, S} } @article {1616, title = {Gestational diabetes and fetal growth acceleration: induction of labour versus expectant management.}, journal = {Minerva Ginecol}, volume = {62}, year = {2010}, month = {2010 Dec}, pages = {533-9}, abstract = {

AIM: The aim of the study was to compare elective induction of labour at 38 weeks versus expectant management in A1 and A2 gestational diabetes (GDM) pregnancies with fetal growth acceleration. Primary outcome of the study was C-section (CS) rate, while secondary outcomes were macrosomia incidence and adverse perinatal outcomes.

METHODS: A retrospective cohort study was carried out. Data were collected between 1996 and 2006 and evaluated through patients{\textquoteright} records analysis. Differences between the two study groups were investigated using non-parametric tests for continuous variables and χ2 test for categorical ones.

RESULTS: There was no significant difference between induction and expectant management in terms of caesarean section rate. A trend favoring women in the induction group in terms of incidence of macrosomia and neonatal outcomes was identified, but results were not statistically significant.

CONCLUSION: Labour induction at 38 weeks in GDM patients with fetal growth acceleration does not seem to determine an increased incidence of C-section in comparison to expectant management, particularly in case of maternal obesity.

}, keywords = {Adult, Body Mass Index, Cesarean Section, Diabetes, Gestational, Elective Surgical Procedures, Female, Fetal Development, Fetal Macrosomia, Gestational Age, Humans, Incidence, Infant, Newborn, Italy, Labor, Induced, Medical Records, Obesity, Pregnancy, Pregnancy Outcome, Retrospective Studies, Risk Factors, Statistics, Nonparametric, Watchful Waiting}, issn = {0026-4784}, author = {Alberico, S and Businelli, C and Wiesenfeld, U and Erenbourg, A and Maso, G and Piccoli, M and Ronfani, L} }