@article {10815, title = {Meconium-stained amniotic fluid: a risk factor for postpartum hemorrhage.}, journal = {Ther Clin Risk Manag}, volume = {14}, year = {2018}, month = {2018}, pages = {1671-1675}, abstract = {

Background/aim: Clinical data with respect to the impact of meconium on the risk of maternal hemorrhage are scarce. Therefore, in this study, we aimed to determine whether meconium-stained amniotic fluid (MSAF) represents a risk factor for postpartum hemorrhage (PPH) after vaginal delivery in a large unselected population.

Patients and methods: A retrospective cohort study evaluated 78,542 consecutive women who had a vaginal delivery between 24th and 44th weeks of gestation. The women who had undergone cesarean section were excluded to avoid possible bias. Postpartum blood loss was measured with graduated blood sack. Postpartum blood loss between 1,000 and 2,000 mL and >2,000 mL were classified as moderate and severe PPH, respectively.

Results: A total of 74,144 patients were available for analysis. According to the color of amniotic fluid (AF), two groups of patients were identified: MSAF (n=10,997) and clear AF (n=63,147). The rates of severe and massive PPH were found to be significantly higher in the MSAF group than that of clear AF group (OR=1.3, 95\% CI: 1.2-1.5, <0.001 and OR=2.5, 95\% CI: 1.5-4.2, <0.001). Operative vaginal delivery rate was found to be higher in the MSAF group than that of clear AF group, but the difference was only borderline significant (OR=1.5, 95\% CI: 1.0-2.2, =0.05). There were no significant differences between the MSAF and the clear AF groups with respect to episiotomies, second- or third-degree perineal tears, vaginal-perineal thrombus, cervical lacerations, vaginal births after cesarean section, twin deliveries, and placental retention rates.

Conclusion: To the best of our knowledge, this is the first clinical study that has investigated the role of MSAF as a risk factor for PPH after vaginal delivery in an unselected population. Our results suggest that MSAF is significantly associated with higher risk of moderate and severe PPH than clear AF.

}, issn = {1176-6336}, doi = {10.2147/TCRM.S150049}, author = {Bouch{\`e}, Carlo and Wiesenfeld, Uri and Ronfani, Luca and Simeone, Roberto and Bogatti, Paolo and Skerk, Kristina and Ricci, Giuseppe} } @article {8031, title = {Hysteroscopic chasing for endometrial cancer in a low-risk population: risks of overinvestigation.}, journal = {Arch Gynecol Obstet}, year = {2015}, month = {2015 Aug 28}, abstract = {

PURPOSE: To evaluate the appropriateness of the indications for hysteroscopy done, in fertile and postmenopausal women, for the detection of endometrial cancer.

METHODS: A retrospective analysis of 2673 consecutive women who underwent office hysteroscopy chasing for endometrial cancer between January 2012 and June 2014. According to their medical history only low-risk women entered the study.

RESULTS: A total of 1070 patients entered the study. The main outcome measure was the appropriateness of the indications for hysteroscopy. Appropriateness was assessed on the basis of guidelines of scientific societies and histologic report. According to the algorithm developed for appropriateness, 44~\% of procedures resulted in being inappropriate. In reproductive-aged women 57~\% of hysteroscopies were inappropriate. In postmenopausal women inappropriate hysteroscopies were 45~\%. In reproductive-aged women, the reasons for inappropriateness were: absence of abnormal uterine bleeding (AUB) or AUB without a trial of progestin therapy. In postmenopausal women, the reasons for inappropriateness were: ultrasound report of endometrial thickening or polyp without bleeding.

CONCLUSIONS: Hysteroscopy is often recommended for inappropriate indications. More evidence is needed to identify the risks of overinvestigation, overdiagnosis, and related overtreatment and to better identify the threshold beyond which benefits are likely to outweigh harms.

}, issn = {1432-0711}, doi = {10.1007/s00404-015-3868-x}, author = {Scrimin, Federica and Wiesenfeld, Uri and Galati, Emanuele F and Monasta, Lorenzo and Ricci, Giuseppe} } @article {7741, title = {Relevance of random biopsy at the transformation zone when colposcopy is negative.}, journal = {Obstet Gynecol}, volume = {125}, year = {2015}, month = {2015 Feb}, pages = {491}, keywords = {Cervical Intraepithelial Neoplasia, Colposcopy, Early Detection of Cancer, Female, Humans, Papillomavirus Infections, Precancerous Conditions, Uterine Cervical Neoplasms}, issn = {1873-233X}, doi = {10.1097/AOG.0000000000000652}, author = {Wiesenfeld, Uri and Mangino, Francesco Paolo and Toffoletti, Franco Giovanni and Ricci, Giuseppe} } @article {1765, title = {"GINEXMAL RCT: Induction of labour versus expectant management in gestational diabetes pregnancies".}, journal = {BMC Pregnancy Childbirth}, volume = {11}, year = {2011}, month = {2011}, pages = {31}, abstract = {

BACKGROUND: Gestational diabetes (GDM) is one of the most common complications of pregnancies affecting around 7\% of women. This clinical condition is associated with an increased risk of developing fetal macrosomia and is related to a higher incidence of caesarean section in comparison to the general population. Strong evidence indicating the best management between induction of labour at term and expectant monitoring are missing.

METHODS/DESIGN: Pregnant women with singleton pregnancy in vertex presentation previously diagnosed with gestational diabetes will be asked to participate in a multicenter open-label randomized controlled trial between 38+0 and 39+0 gestational weeks. Women will be recruited in the third trimester in the outpatient clinic or in the Day Assessment Unit according to local protocols. Women who opt to take part will be randomized according to induction of labour or expectant management for spontaneous delivery. Patients allocated to the induction group will be admitted to the obstetric ward and offered induction of labour via use of prostaglandins, Foley catheter or oxytocin (depending on clinical conditions). Women assigned to the expectant arm will be sent to their domicile where they will be followed up until delivery, through maternal and fetal wellbeing monitoring twice weekly. The primary study outcome is the Caesarean section (C-section) rate, whilst secondary measurements are maternal and neonatal outcomes. A total sample of 1760 women (880 each arm) will be recruited to identify a relative difference between the two arms equal to 20\% in favour of induction, with concerns to C-section rate. Data will be collected until mothers and newborns discharge from the hospital. Analysis of the outcome measures will be carried out by intention to treat.

DISCUSSION: The present trial will provide evidence as to whether or not, in women affected by gestational diabetes, induction of labour between 38+0 and 39+0 weeks is an effective management to ameliorate maternal and neonatal outcomes. The primary objective is to determine whether caesarean section rate could be reduced among women undergoing induction of labour, in comparison to patients allocated to expectant monitoring. The secondary objective consists of the assessment and comparison of maternal and neonatal outcomes in the two study arms. .

}, keywords = {Adolescent, Adult, Cesarean Section, Diabetes, Gestational, Female, Gestational Age, Humans, Intention to Treat Analysis, Labor, Induced, Patient Selection, Pregnancy, Pregnancy Outcome, Research Design, Watchful Waiting, Young Adult}, issn = {1471-2393}, doi = {10.1186/1471-2393-11-31}, author = {Maso, Gianpaolo and Alberico, Salvatore and Wiesenfeld, Uri and Ronfani, Luca and Erenbourg, Anna and Hadar, Eran and Yogev, Yariv and Hod, Moshe} } @article {1656, title = {Risk of preterm delivery in relation to maternal use of psychotropic medications during pregnancy: methodological issues.}, journal = {Am J Obstet Gynecol}, volume = {203}, year = {2010}, month = {2010 Oct}, pages = {e12-3; author reply e13}, keywords = {Benzodiazepines, Confounding Factors (Epidemiology), Data Interpretation, Statistical, Female, Humans, Multivariate Analysis, Pregnancy, Premature Birth, Psychotropic Drugs}, issn = {1097-6868}, doi = {10.1016/j.ajog.2010.04.044}, author = {Erenbourg, Anna and Wiesenfeld, Uri and Ronfani, Luca} }