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Reshama Navathe, Vincenzo Berghella
PURPOSE OF REVIEW: Tocolytic agents have been used for over 60 years in the fight against preterm labor, which ultimately can lead to preterm birth. Currently, clinicians can choose from a variety of drug classes to achieve the primary goal of delaying delivery by 48 h, thereby allowing time for administration of corticosteroids for fetal lung maturity, and if appropriate, starting magnesium sulfate for fetal neuroprotection. However, there are currently no known therapies to maintain the tocolytic effect beyond those initial 48 h...
October 18, 2016: Current Opinion in Obstetrics & Gynecology
Serena Xodo, Gabriele Saccone, Ewoud Schuit, Isis Amer-Wåhlin, Vincenzo Berghella
Recently, a meta-analysis, including 26,526 laboring vertex singletons at term, summarized all available level-1 data from six high-quality randomized clinical trials on the use of ST analysis (STAN) during labor as an adjunct to conventional intrapartum fetal heart rate monitoring. The meta-analysis showed that STAN did not improve perinatal outcomes or decrease cesarean deliveries. Nonetheless there are still reasons to believe STAN may have a role in the future research on intrapartum fetal monitoring. Out of six trials included in the meta-analysis, two included all cephalic singletons in labor, and four enrolled only high-risk pregnant women...
October 13, 2016: Journal of Maternal-fetal & Neonatal Medicine
Gabriele Saccone, Vincenzo Berghella
OBJECTIVE:  To evaluate the effectiveness of antenatal corticosteroids given at ≥34 weeks' gestation. DESIGN:  Systematic review with meta-analysis. DATA SOURCES:  Electronic databases were searched from their inception to February 2016. ELIGIBILITY CRITERIA FOR STUDY SELECTION:  Randomized clinical trials comparing antenatal corticosteroids with placebo or no treatment in women with a singleton pregnancy at ≥34 weeks' gestation...
October 12, 2016: BMJ: British Medical Journal
Johanna Quist-Nelson, Kathryn Landers, Rebekah McCurdy, Vincenzo Berghella
BACKGROUND: External cephalic version (ECV) increases the likelihood of a vaginal delivery in patients with breech presentation. Our objective was to determine the rate of cephalic vaginal delivery in women undergoing ECV after PROM. METHODS: We performed a systematic review of all case reports, case series, and clinical trials of patients undergoing an ECV after PROM ≥ 24 weeks. Maternal demographics and outcome data were obtained. The primary outcome was rate of cephalic vaginal delivery...
October 9, 2016: Journal of Maternal-fetal & Neonatal Medicine
Rebecca J Baer, Juan Yang, Christina D Chambers, Kelli K Ryckman, Audrey F Saftlas, Vincenzo Berghella, Chris Dunkel Schetter, Gary M Shaw, David K Stevenson, Laura L Jelliffe-Pawlowski
There is well-established literature indicating change in partner as a risk for preeclampsia, yet the research on the risk of preterm birth after a change in partners has been sparse and inconsistent. Using a population of California live born singletons, we aimed to determine the risk of preterm birth after a change in partner between the first and second pregnancies. The risk of preterm and early term delivery in the second pregnancy was calculated for mothers who did or did not change partners between births with the referent group as women who delivered both pregnancies at term and did not change partners...
October 8, 2016: Journal of Perinatal Medicine
Adeeb Khalifeh, Johanna Quist-Nelson, Vincenzo Berghella
OBJECTIVE: To evaluate the incidence of implementation of universal cervical length (CL) screening for preterm birth (PTB) prevention among institutions with Maternal-Fetal Medicine (MFM) fellowship training in the United states. METHODS: In January 2015, we conducted a national survey of institutions with MFM Fellowship Programs regarding implementation of universal CL screening, defined as CL screening of women with singleton gestations without a prior spontaneous PTB...
September 7, 2016: Journal of Maternal-fetal & Neonatal Medicine
Jessica N Buck, Kelly M Orzechowski, Vincenzo Berghella
PURPOSE: Racial minorities experience higher rates of spontaneous preterm birth (sPTB). Our objective was to evaluate whether there are racial discrepancies in the incidence of second trimester short cervical length (≤25mm). MATERIALS AND METHODS: Retrospective cohort of women with singleton gestations without prior sPTB undergoing universal second trimester transvaginal ultrasound cervical length (CL) screening between January 2012 and December 2013. Black women were compared to non-Hispanic white women...
August 23, 2016: Journal of Maternal-fetal & Neonatal Medicine
Gabriele Saccone, Adeeb Khalifeh, Andrew Elimian, Elham Bahrami, Kefayat Chaman-Ara, Mohammad Amin Bahrami, Vincenzo Berghella
OBJECTIVE: Randomized controlled trials (RCTs) have recently compared intramuscular 17-alpha-hydroxy-progesterone caproate (17-OHPC) to vaginal progesterone for reducing the risk of spontaneous preterm birth (SPTB) in singletons with prior SPTB. The aim of this systematic review with meta-analysis was to evaluate the efficacy of vaginal progesterone compared with 17-OHPC in prevention of SPTB in singleton gestations with prior SPTB. METHODS: Searches were performed in electronic databases...
August 22, 2016: Ultrasound in Obstetrics & Gynecology
Giuseppe M Maruotti, Gabriele Saccone, Francesco D'Antonio, Vincenzo Berghella, Laura Sarno, Maddalena Morlando, Antonia Giudicepietro, Pasquale Martinelli
OBJECTIVE: To evaluate the diagnostic accuracy of intracranial translucency (IT) in the detection of spina bifida (SB) in the first trimester of pregnancy. METHODS: We included study assessing the accuracy of sonographic measurements of IT in a mid-sagittal view of the fetal face in prediction of SB in the first trimester of pregnancy. The primary outcome was the accuracy of IT in prediction of spina bifida. Summary estimates of sensitivity, specificity, positive and negative likelihood ratios (LR), and diagnostic odds ratio for the overall predictive accuracy of IT were computed...
August 8, 2016: Prenatal Diagnosis
Juan Yang, Rebecca J Baer, Vincenzo Berghella, Christina Chambers, Paul Chung, Tumaini Coker, Robert J Currier, Maurice L Druzin, Miriam Kuppermann, Louis J Muglia, Mary E Norton, Larry Rand, Kelli Ryckman, Gary M Shaw, David Stevenson, Laura L Jelliffe-Pawlowski
OBJECTIVE: To examine recurrent preterm birth and early term birth in women's initial and immediately subsequent pregnancies. METHODS: This retrospective cohort study included 163,889 women who delivered their first and second liveborn singleton neonates between 20 and 44 weeks of gestation in California from 2005 through 2011. Data from hospital discharge records and birth certificates were used for analyses. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression models adjusted for risk factors...
August 2016: Obstetrics and Gynecology
Anna Maria Berghella, Ida Contasta, Roberto Lattanzio, Giancarlo Di Gregorio, Irma Campitelli, Silvino Marino, Luigi Liborio Liberatore, Luca Navarra, Giampaolo Caterino, Antonio Mongelli, Vincenzo Vittorini, Matteo Basta, Mauro Domenicucci, Nunzia Antonucci, Tiziana Del Beato, Enzo Secinaro, Fabiana Ciccone, Patrizia Pellegrini
The definition of personalized treatments in tumor disease could lead to an improvement of the therapeutic success rate. Therefore, biomarkers are urgently required in order to select the patients that could benefit from adjuvant therapies in the initial phase of the disease and to better define and treat the clinical/therapeutic subgroups in the advanced pathological phases. Disregulation of cytokine physiological network is directly involved in the genesis and progression of tumors. Cytokines are of central importance in the regulation of immune system, but they are rarely released singly: each cytokine is able to induce the production of many others factors leading to a network in which they cooperate with other cell regulators such as hormones and neuropeptides...
June 30, 2016: Current Drug Targets
Daniele Di Mascio, Elena Rita Magro-Malosso, Gabriele Saccone, Gregary D Marhefka, Vincenzo Berghella
BACKGROUND: Preterm birth is the major cause of perinatal mortality in the United States. In the past, pregnant women have been recommended to not exercise because of presumed risks of preterm birth. Physical activity has been theoretically related to preterm birth because it increases the release of catecholamines, especially norepinephrine, which might stimulate myometrial activity. Conversely, exercise may reduce the risk of preterm birth by other mechanisms such as decreased oxidative stress or improved placenta vascularization...
June 16, 2016: American Journal of Obstetrics and Gynecology
A C Eke, G Saccone, V Berghella
BACKGROUND: Depression is a prevalent condition in pregnancy affecting about 10% of women. Maternal depression has been associated with an increase in preterm births (PTB), low birthweight and fetal growth restriction, and postnatal complications. Available treatments for depressive disorders are psychotherapeutic interventions and antidepressant medications including selective serotonin inhibitors (SSRIs). SSRI use during pregnancy has been associated with several fetal and neonatal complications; so far, however, the risk of PTB in women using SSRIs during pregnancy is still a subject of debate...
May 30, 2016: BJOG: An International Journal of Obstetrics and Gynaecology
Serena Xodo, Gabriele Saccone, Antonella Cromi, Pinar Ozcan, Emanuela Spagnolo, Vincenzo Berghella
It is imperative to have evidence-based guidelines for cesarean delivery. The aim of this meta-analysis was to evaluate the effectiveness of a cephalad-caudad compared to transverse blunt expansion of the uterine incision to reduce blood loss in women who underwent low-segment transverse cesarean delivery. We therefore performed a systematic search in electronic databases from their inception until March 2016. We included all randomized trials comparing cephalad-caudad versus transverse (control group) blunt expansion of the uterine incision in women who underwent a low transverse cesarean delivery...
July 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Adeeb Khalifeh, Johanna Quist-Nelson, Vincenzo Berghella
INTRODUCTION: To evaluate the incidence of implementation of universal cervical length (CL) screening for preterm birth (PTB) prevention among institutions with Maternal-Fetal Medicine (MFM) fellowship training in the United States. METHODS: In January 2015, we conducted a national survey of institutions with MFM Fellowship Programs regarding implementation of universal CL screening, defined as CL screening of women with singleton gestations without a prior spontaneous PTB...
May 2016: Obstetrics and Gynecology
Rupsa C Boelig, Samantha J Barton, Gabriele Saccone, Anthony J Kelly, Steve J Edwards, Vincenzo Berghella
BACKGROUND: Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy affecting 0.3% to 1.0% of pregnancies, and is one of the most common indications for hospitalization during pregnancy. While a previous Cochrane review examined interventions for nausea and vomiting in pregnancy, there has not yet been a review examining the interventions for the more severe condition of hyperemesis gravidarum. OBJECTIVES: To assess the effectiveness and safety, of all interventions for hyperemesis gravidarum in pregnancy up to 20 weeks' gestation...
2016: Cochrane Database of Systematic Reviews
Matilde Sansone, Laura Sarno, Gabriele Saccone, Vincenzo Berghella, Giuseppe Maria Maruotti, Annalisa Migliucci, Angela Capone, Pasquale Martinelli
OBJECTIVE: To evaluate the risk of preeclampsia in pregnant women with human immunodeficiency virus (HIV). METHODS: This is a 26-year population-based retrospective cohort study. Human immunodeficiency virus-infected pregnant women were compared with a HIV-negative comparison group. The primary outcome was the incidence of preeclampsia. We planned subgroup analysis according to antiretroviral therapy. RESULTS: A total of 84,725 women were included in the analysis, of whom 453 were HIV-infected and 84,272 HIV-negative...
June 2016: Obstetrics and Gynecology
Zita Gambacorti-Passerini, Alexis C Gimovsky, Anna Locatelli, Vincenzo Berghella
INTRODUCTION: There is concern about the risk of uterine rupture in the subsequent pregnancy after myomectomy. This risk is reported in literature to be around 0.7-1%. The aim of this study was to evaluate the incidence of uterine rupture and associated risk factors in women who had a trial of labor after prior myomectomy. MATERIAL AND METHODS: A systematic review of the literature was performed including all cohort studies with at least five cases reporting outcomes of pregnancies after prior myomectomy...
July 2016: Acta Obstetricia et Gynecologica Scandinavica
Vincenzo Berghella, Gabriele Saccone
OBJECTIVE DATA: Fetal fibronectin is an extracellular matrix glycoprotein that is produced by amniocytes and cytotrophoblasts and has been shown to predict spontaneous preterm birth. STUDY: The aim of this systematic review and metaanalysis of randomized clinical trials was to evaluate the effect of the use of fetal fibronectin in the prevention of preterm birth in singleton pregnancies with threatened preterm labor. STUDY APPRAISAL AND SYNTHESIS METHODS: The research was conducted with the use of MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial...
October 2016: American Journal of Obstetrics and Gynecology
Jennifer McIntosh, Helen Feltovich, Vincenzo Berghella, Tracy Manuck
Preterm birth remains a major cause of neonatal death and short and long-term disability in the US and across the world. The majority of preterm births are spontaneous and cervical length screening is one tool that can be utilized to identify women at increased risk who may be candidates for preventive interventions. The purpose of this document is to review the indications and rationale for CL screening to prevent preterm birth in various clinical scenarios. The Society for Maternal-Fetal Medicine recommends (1) routine transvaginal cervical length screening for women with singleton pregnancy and history of prior spontaneous preterm birth (grade 1A); (2) routine transvaginal cervical length screening not be performed for women with cervical cerclage, multiple gestation, preterm premature rupture of membranes, or placenta previa (grade 2B); (3) practitioners who decide to implement universal cervical length screening follow strict guidelines (grade 2B); (4) sonographers and/or practitioners receive specific training in the acquisition and interpretation of cervical imaging during pregnancy (grade 2B)...
September 2016: American Journal of Obstetrics and Gynecology
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