Giuseppe Chiossi

Policlinico di Modena

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Maged M. Costantine

The Ohio State University

George R. Saade

The University of Texas Medical Branch at Galveston

Fabio Facchinetti

University of Modena and Reggio Emilia

Monica Longo

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Gary D.V. Hankins

The University of Texas Medical Branch at Galveston

Francesca Monari

University of Modena and Reggio Emilia

Antonio F. Saad

Inova Health System

Giovanni Battista La Sala

Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna "Bruno Ubertini"

Stefano Palomba

Sapienza University of Rome

Angela Falbo

Azienda Sanitaria Unità Locale di Reggio Emilia

Cooperative Institutions

The University of Texas Medical Branch at Galveston

University of Modena and Reggio Emilia

Hudson Institute

John Wiley & Sons (United Kingdom)

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Policlinico di Modena

Istituti di Ricovero e Cura a Carattere Scientifico

University of Alabama at Birmingham

University of North Carolina at Chapel Hill

University of Milan

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Retrospective Cohort Study on Acute Care in Obstetrics and Gynecology: Analogies and Differences When Compared to Emergency Medicine

Open Journal of Obstetrics and Gynecology (2017)

Giuseppe Chiossi Stefano Palomba Sara Balduzzi Maged M. Costantine Angela Falbo

Introduction: the demand for urgent obstetric and gynecology care has progressively increased: in the United States approximately 1.4 million gynecologic visits are made to the emergency department (ED) annually, while almost 75% of women make at least 1 unscheduled visit during pregnancy. Moreover, research has recently focused on setting standards in unscheduled care, and developing quality indicators to improve patients’ health. Therefore, we investigated the characteristics of women with acute gynecological or pregnancy complaints using quality indicators developed for emergency medicine, to better define the needs of this population and improve care. Methods: Retrospective cohort study on ED, and Obstetrics and Gynecology (ObGyn) triage visits, at a tertiary care hospital in Italy, during 2012. Data were analyzed with population-averaged logistic regression and Poisson regression. Results: When compared to the 33,557 ED visits, the 9245 ObGyntriage referrals were more frequently associated with pregnancy (≤12 weeks’ gestation, OR: 30.7, 95%CI; 24.5 - 38.4; >12 weeks’ gestation, OR 81.2, 95%CI; 64.8 - 101.4), vaginal bleeding (OR 156.6, 95%CI; 82.7 - 294.4), diurnal (night access OR 0.87, 95% CI; 0.78 - 0.96) and weekday access (holiday access OR 0.87, 95%CI; 0.78 - 0.95), frequent users (recurrent ED visits IRR 0.87, 95%CI; 0.83 - 0.9) and lower hospital admissions (ED admission OR 1.6, 95%CI; 1.4 - 1.8). Conclusion: ObGyn triage patients differed from ED users, and were at higher risk of “crowding”. Such diversities should be considered to improve female healthcare services and allocate resources more efficiently.

Triage

10.4236/ojog.2017.74049

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Perinatal outcomes in twin late preterm pregnancies: results from an Italian area-based, prospective cohort study

The Italian Journal of Pediatrics/Italian journal of pediatrics (2022)

Francesca Monari Giuseppe Chiossi Michela Ballarini Daniela Menichini Giancarlo Gargano

Abstract Background Multiple gestations represent a considerable proportion of pregnancies delivering in the late preterm (LP) period. Only 30% of LP twins are due to spontaneous preterm labor and 70% are medically indicated; among this literature described that 16–50% of indicated LP twin deliveries are non-evidence based. As non-evidence-based delivery indications account for iatrogenic morbidity that could be prevented, the objective of our observational study is to investigate first neonatal outcomes of LP twin pregnancies according to gestational age at delivery, chorionicity and delivery indication, then non evidence-based delivery indications. Methods Prospective cohort study among twins infants born between 34 + 0 and 36 + 6 weeks, in Emilia Romagna, Italy, during 2013–2015. The primary outcome was a composite of adverse perinatal outcomes. Results Among 346 LP twins, 84 (23.4%) were monochorionic and 262 (75.7%) were dichorionic; spontaneous preterm labor accounted for 85 (24.6%) deliveries, preterm prelabor rupture of membranes for 66 (19.1%), evidence based indicated deliveries were 117 (33.8%), while non-evidence-based indications were 78 (22.5%). When compared to spontaneous preterm labor or preterm prelabor rupture of membranes, pregnancies delivered due to maternal and/or fetal indications were associated with higher maternal age ( p < 0.01), higher gestational age at delivery ( p < 0.01), Caucasian race (p 0.04), ART use ( p < 0.01), gestational diabetes ( p < 0.01), vaginal bleeding ( p < 0.01), antenatal corticosteroids ( p < 0.01), diagnosis of fetal growth restriction (FGR) ( p < 0.01), and monochorionic ( p < 0.01). Two hundred twenty-six pregnancies (65.3%) had at least one fetus experiencing one composite of adverse perinatal outcome. Multivariate analysis confirmed that delivery indication did not affect the composite of adverse perinatal outcomes; the only characteristic that affect the outcome after controlling for confounding was gestational age at delivery ( p < 0.01). Moreover, there was at least one adverse neonatal outcome for 94% of babies born at 34 weeks, for 73% of those born at 35 weeks and for 46% of those born at 36 weeks ( p < 0.01). Conclusion Our study suggests that the decision to deliver or not twins in LP period should consider gestational age at delivery as the main determinant infants’ prognosis. Delivery indications should be accurately considered, to avoid iatrogenic early birth responsible of preventable complications.

Rupture of membranes

Twin Pregnancy

10.1186/s13052-022-01297-4

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Increasing BMI is associated with both endometrioid and serous histotypes among endometrial rather than ovarian cancers: a case-to-case study

Gynecologic Oncology (2019)

Giovanni Grandi Anna Myriam Perrone Giuseppe Chiossi Stefano Friso Angela Toss

Serous ovarian cancer

10.1016/j.ygyno.2019.04.684

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721 Randomized trial of fundal height versus point-of-care ultrasound during routine antenatal visits

American Journal of Obstetrics and Gynecology (2021)

Chasey Omere Daphne Arena Goncharov Claudia Pedroza Mauricio La Rosa Mary B. Munn

Prenatal Care

10.1016/j.ajog.2020.12.744

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Hyperemesis Gravidarum Complicated by Wernicke Encephalopathy: Background, Case Report, and Review of the Literature

Obstetrical & Gynecological Survey (2006)

Giuseppe Chiossi Isabella Neri Milena Cavazzuti Gianpaolo Basso Fabio Facchinetti

Wernicke encephalopathy (WE) is a rare but known complication of severe hyperemesis gravidarum caused by thiamine deficiency. This article presents an unusual case that occurred at our institution and reviews the 48 previously published cases of WE in pregnancy. Considering all the 49 cases, the mean (+/-standard deviation) patients' age was 26.7 +/- 4.9 years, the mean gestational age when WE manifested was 14.3 +/- 3.4 weeks, and the mean duration of vomiting and feeding difficulties was 7.7 +/- 2.8 weeks. Wernicke's classic triad (confusion, ocular abnormalities, and ataxia) manifested in only 46.9% (23 of 49) of the patients. Confusion affected 63.3% (31 of 49) of the patients, ocular signs 95.9% (47 of 49) and symptoms 57.1% (28 of 49), and ataxia 81.6% (40 of 49). Deterioration of consciousness affected 53.1% (26 of 49) of the subjects and memory impairment 61.2% (30 of 49). Complete remission of the disease occurred in only 14 of 49 cases. Symptom resolution required months and permanent impairments were common. The overall pregnancy loss rate, directly (spontaneous fetal loss) and indirectly (planned abortion) attributable to WE, was 47.9% (23 of 49). The diagnosis of WE is clinical and can be rapidly confirmed by magnetic resonance imaging. We emphasize the importance of thiamine supplementation to women with prolonged vomiting in pregnancy, especially before intravenous or parenteral nutrition. We also underline the necessity to promptly replace vitamin B1 when neurologic symptoms and/or signs develop in a patient with hyperemesis gravidarum.

Hyperemesis gravidarum

Wernicke's encephalopathy

Wernicke Encephalopathy

10.1097/01.ogx.0000206336.08794.65

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Nutritional Supplementation in Monochorionic Diamniotic Twin Pregnancies: Impact on Twin–Twin Transfusion Syndrome

American Journal of Perinatology (2008)

Giuseppe Chiossi Matthew R. Quigley Emmanuel Esaka Kristin Novic Jennifer U. Celebrezze

Twin-to-twin transfusion syndrome (TTTS) has been related to unbalanced unidirectional arteriovenous anastomoses in the placenta of monochorionic diamniotic (DiMo) twin gestations. As maternal malnutrition accounting for hypoproteinemia and anemia has been detected in severe cases of TTTS, the purpose of this study was to evaluate the impact of early diet supplementation on TTTS. Fifty-one DiMo twin pregnancies were given commercially available oral nutritional diet supplements and then compared in a retrospective cohort study to 52 twin gestations with the same chorionicity but not subjected to nutritional supplementation. Diet supplementation was associated with lower overall incidence of TTTS (20/52 versus 8/51, P = 0.02) and with lower prevalence of TTTS at delivery (18/52 versus 6/51, P = 0.012) when compared with no supplementation. Nutritional intervention also significantly prolonged the time between the diagnosis of TTTS and delivery (9.4 +/- 3.7 weeks versus 4.6 +/- 6.5 weeks; P = 0.014). The earlier nutritional regimen was introduced, the lesser chance of detecting TTTS ( P = 0.001). Although not statistically significant, dietary intervention was also associated with lower Quintero stage, fewer invasive treatments, and lower twin birth weight discordance. Diet supplementation appears to counter maternal metabolic abnormalities in DiMo twin pregnancies and improve perinatal outcomes in TTTS when combined with the standard therapeutic options.

Hypoproteinemia

10.1055/s-0028-1091400

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Low-Grade Chronic Inflammation in Pregnant Women With Polycystic Ovary Syndrome: A Prospective Controlled Clinical Study

The Journal of Clinical Endocrinology & Metabolism (2014)

Stefano Palomba Angela Falbo Giuseppe Chiossi Francesco Orio Achille Tolino

Polycystic ovary syndrome (PCOS) and pregnancy are conditions characterized by an increased low-grade chronic inflammation state. A higher incidence of pregnancy complications has been detected in pregnant PCOS women.The objective of the study was to test the hypothesis that the low-grade chronic inflammation state typical of PCOS patients persists during gestation and is exacerbated by pregnancy and contributes to the increased risk of obstetric/neonatal complications.This was a prospective controlled clinical study.The study was conducted at the Academic Department of Obstetrics and Gynecology of the "Pugliese-Ciaccio" Hospital of Catanzaro (Catanzaro, Italy).One hundred fifty pregnant PCOS women and 150 age- and body mass index-matched healthy pregnant controls participated in the study.INTERVENTIONS included serial clinical, biochemical, and ultrasonographic assessments before and throughout pregnancy.Serum levels of white blood cell count (WBC), C-reactive protein (CRP), and ferritin were measured.Pregnant women with PCOS had higher WBC, CRP, and ferritin levels at study entry and at all gestational ages than controls. Changes in serum WBC and ferritin levels were significantly higher in PCOS than in controls starting from the 12th week of gestation whereas those in CRP from the 20th week of gestation. By multivariable Cox proportional hazard analysis, in the PCOS group, a significant association with the risk of adverse obstetric/neonatal outcomes was found for WBC [hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.31-1.64; P = .010], CRP (HR 1.19, 95% CI 1.06-1.34; P = .019), and ferritin levels (HR 1.12, 95% CI 1.03-1.26; P = .011).In PCOS patients, the low-grade chronic inflammation persists during gestation and is exacerbated by pregnancy, and it is associated with adverse pregnancy outcomes.

10.1210/jc.2014-1214

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Citations (65)

226: Sildenafil citrate potentiates the effect of nifedipine on spontaneous uterine contractility in vitro

American Journal of Obstetrics and Gynecology (2009)

Giuseppe Chiossi Maged M. Costantine Ancizar Betancourt Gary D.V. Hankins Monica Longo

Contractility

Uterine contraction

Myometrium

Phosphodiesterase inhibitor

Tocolytic

10.1016/j.ajog.2009.10.241

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Prevalence of uterine rupture among women with one prior low transverse cesarean and women with unscarred uterus undergoing labor induction with PGE2: A systematic review and meta-analysis

PLoS ONE (2021)

Giuseppe Chiossi Roberto D’Amico Anna Tramontano Veronica Sampogna Viola Laghi

As uterine rupture may affect as many as 11/1000 women with 1 prior cesarean birth and 5/10.000 women with unscarred uterus undergoing labor induction, we intended to estimate the prevalence of such rare outcome when PGE2 is used for cervical ripening and labor induction.

Uterine rupture

Labor Induction

10.1371/journal.pone.0253957

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Does sildenafil citrate affect myometrial contractile response to nifedipine in vitro?

American Journal of Obstetrics and Gynecology (2010)

Giuseppe Chiossi Maged M. Costantine Ancizar Betancourt Gary D.V. Hankins Monica Longo

Contractility

Uterine contraction

Tocolytic

Myometrium

Tocolytic agent

10.1016/j.ajog.2010.05.007

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Citations (14)