@article {8506, title = {Amniocentesis and chorionic villus sampling in HIV-infected pregnant women: a multicentre case series.}, journal = {BJOG}, volume = {124}, year = {2017}, month = {2017 Jul}, pages = {1218-1223}, abstract = {

OBJECTIVES: To assess in pregnant women with HIV the rates of amniocentesis and chorionic villus sampling (CVS), and the outcomes associated with such procedures.

DESIGN: Observational study. Data from the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy were used.

SETTING: University and hospital clinics.

POPULATION: Pregnant women with HIV.

METHODS: Temporal trends were analysed by analysis of variance and by the Chi-square test for trend. Quantitative variables were compared by Student{\textquoteright}s t-test and categorical data by the Chi-square test, with odds ratios and 95\% confidence intervals calculated.

MAIN OUTCOME MEASURES: Rate of invasive testing, intrauterine death, HIV transmission.

RESULTS: Between 2001 and 2015, among 2065 pregnancies in women with HIV, 113 (5.5\%) had invasive tests performed. The procedures were conducted under antiretroviral treatment in 99 cases (87.6\%), with a significant increase over time in the proportion of tests performed under highly active antiretroviral therapy (HAART) (100\% in 2011-2015). Three intrauterine deaths were observed (2.6\%), and 14 pregnancies were terminated because of fetal anomalies. Among 96 live newborns, eight had no information available on HIV status. Among the remaining 88 cases with either amniocentesis (n = 75), CVS (n = 12), or both (n = 1), two HIV transmissions occurred (2.3\%). No HIV transmission occurred among the women who were on HAART at the time of invasive testing, and none after 2005.

CONCLUSIONS: The findings reinforce the assumption that invasive prenatal testing does not increase the risk of HIV vertical transmission among pregnant women under suppressive antiretroviral treatment.

TWEETABLE ABSTRACT: No HIV transmission occurred among women who underwent amniocentesis or CVS under effective anti-HIV regimens.

}, keywords = {Adult, Amniocentesis, Analysis of Variance, Anti-Retroviral Agents, Chi-Square Distribution, Chorionic Villi Sampling, Female, Fetal Death, HIV Infections, Humans, Infectious Disease Transmission, Vertical, Odds Ratio, Pregnancy, Pregnancy Complications, Infectious}, issn = {1471-0528}, doi = {10.1111/1471-0528.14183}, author = {Floridia, M and Masuelli, G and Meloni, A and Cetin, I and Tamburrini, E and Cavaliere, A F and Dalzero, S and Sansone, M and Alberico, S and Guerra, B and Spinillo, A and Chiad{\`o} Fiorio Tin, M and Ravizza, M} } @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 {10575, title = {Rate, correlates and outcomes of repeat pregnancy in HIV-infected women.}, journal = {HIV Med}, volume = {18}, year = {2017}, month = {2017 07}, pages = {440-443}, abstract = {

OBJECTIVES: The aim of the study was to assess the rate, determinants, and outcomes of repeat pregnancies in women with HIV infection.

METHODS: Data from a national study of pregnant women with HIV infection were used. Main outcomes were preterm delivery, low birth weight, CD4 cell count and HIV plasma viral load.

RESULTS: The rate of repeat pregnancy among 3007 women was 16.2\%. Women with a repeat pregnancy were on average younger than those with a single pregnancy (median age 30 vs. 33 years, respectively), more recently diagnosed with HIV infection (median time since diagnosis 25 vs. 51 months, respectively), and more frequently of foreign origin [odds ratio (OR) 1.36; 95\% confidence interval (CI) 1.10-1.68], diagnosed with HIV infection in the current pregnancy (OR: 1.69; 95\% CI: 1.35-2.11), and at their first pregnancy (OR: 1.33; 95\% CI: 1.06-1.66). In women with sequential pregnancies, compared with the first pregnancy, several outcomes showed a significant improvement in the second pregnancy, with a higher rate of antiretroviral treatment at conception (39.0 vs. 65.4\%, respectively), better median maternal weight at the start of pregnancy (60 vs. 61 kg, respectively), a higher rate of end-of-pregnancy undetectable HIV RNA (60.7 vs. 71.6\%, respectively), a higher median birth weight (2815 vs. 2885 g, respectively), lower rates of preterm delivery (23.0 vs. 17.7\%, respectively) and of low birth weight (23.4 vs. 15.4\%, respectively), and a higher median CD4 cell count (+47 cells/μL), with almost no clinical progression to Centers for Disease Control and Prevention stage C (CDC-C) HIV disease (0.3\%). The second pregnancy was significantly more likely to end in voluntary termination than the first pregnancy (11.4 vs. 6.1\%, respectively).

CONCLUSIONS: Younger and foreign women were more likely to have a repeat pregnancy; in women with sequential pregnancies, the second pregnancy was characterized by a significant improvement in several outcomes, suggesting that women with HIV infection who desire multiple children may proceed safely and confidently with subsequent pregnancies.

}, keywords = {Adult, Anti-HIV Agents, CD4 Lymphocyte Count, Emigrants and Immigrants, Female, HIV Infections, HIV-1, Humans, Infant, Low Birth Weight, Pregnancy, Premature Birth, Viral Load}, issn = {1468-1293}, doi = {10.1111/hiv.12473}, author = {Floridia, M and Tamburrini, E and Masuelli, G and Martinelli, P and Spinillo, A and Liuzzi, G and Vimercati, A and Alberico, S and Maccabruni, A and Pinnetti, C and Frisina, V and Dalzero, S and Ravizza, M} } @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 {1832, title = {Relation between maternal thrombophilia and stillbirth according to causes/associated conditions of death.}, journal = {Early Hum Dev}, volume = {88}, year = {2012}, month = {2012 Apr}, pages = {251-4}, abstract = {

OBJECTIVE: To investigate maternal thrombophilia in cases of Stillbirth (SB), also an uncertain topic because most case series were not characterised for cause/associated conditions of death.

STUDY DESIGN: In a consecutive, prospective, multicentre design, maternal DNA was obtained in 171 cases of antenatal SB and 326 controls (uneventful pregnancy at term, 1:2 ratio). Diagnostic work-up of SB included obstetric history, neonatologist inspection, placenta histology, autopsy, microbiology/chromosome evaluations. Results audited in each centre were classified by two of us by using CoDAC. Cases were subdivided into explained SB where a cause of death was identified and although no defined cause was detected in the remnants, 64 cases found conditions associated with placenta-vascular disorders (including preeclampsia, growth restriction and placenta abruption - PVD). In the remnant 79 cases, no cause of death or associated condition was found. Antithrombin activity, Factor V Leiden, G20210A Prothrombin mutation (FII mutation) and acquired thrombophilia were analysed.

RESULTS: Overall, the presence of a thrombophilic defect was significantly more prevalent in mothers with SBs compared to controls. In particular, SB mothers showed an increased risk of carrying Factor II mutation (OR=3.2, 95\% CI: 1.3-8.3, p=0.01), namely in unexplained cases. Such mutation was significantly associated also with previous SB (OR=8.9, 95\%CI 1.2-70.5). At multiple logistic regression, Factor II mutation was the only significantly associated variable with SB (adj OR=3.8, 95\% CI: 1.3-13.5).

CONCLUSION: These data suggest that Factor II mutation is the only condition specifically associated with unexplained SB and could represents a risk of recurrence. PVD-associated condition is unrelated to thrombophilia.

}, keywords = {Adult, Case-Control Studies, Cause of Death, Female, Fetal Diseases, Fetal Mortality, Humans, Infant, Newborn, Male, Placenta Diseases, Pre-Eclampsia, Pregnancy, Pregnancy Complications, Hematologic, Socioeconomic Factors, Stillbirth, Thrombophilia, Young Adult}, issn = {1872-6232}, doi = {10.1016/j.earlhumdev.2011.08.013}, author = {Monari, F and Alberico, S and Avagliano, L and Cetin, I and Cozzolino, S and Gargano, G and Marozio, L and Mecacci, F and Neri, I and Tranquilli, A L and Venturini, P and Facchinetti, F} } @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} }