Cinzia Orlandini

Women with endometriosis at first pregnancy have an increased risk of adverse obstetric outcome

Abstract Objective: To evaluate pregnancy, delivery and neonatal outcome in singleton primiparous versus multiparous women with/without endometriosis. Methods: Multicentric, observational and cohort study on a group of Caucasian pregnant women (n = 2239) interviewed during their hospitalization for delivery in five Italian Gynecologic and Obstetric Units (Siena, Rome, Padua, Varese and Florence). Results: Primiparous women with endometriosis (n = 219) showed significantly higher risk of small for gestational age fetuses (OR: 2.72, 95% CI 1.46–5.06), gestational diabetes (OR: 2.13, 95% CI 1.32–3.44), preterm premature rupture of membranes (OR: 2.93, 95% CI 1.24–6.87) and preterm birth (OR: 2.24, 95% CI 1.46–3.44), and were hospitalized for a longer period of time (p < 0.0001) comparing with control group (n = 1331). Multiparous women with endometriosis (n = 97) delivered significantly more often small for gestational age fetuses (OR: 2.93, 95% CI 1.28–6.67) than control group (n = 592). Newborns of primiparous women with endometriosis needed more frequently intensive care (p = 0.05) and were hospitalized for a longer period of time (p < 0.0001). Conclusions: Women with endometriosis at first pregnancy have an increased risk of impaired obstetric outcome, while a reduced number of complications occur in the successive gestation. Therefore, it is worthy for obstetricians to increase the surveillance in nulliparous women with endometriosis during pregnancy.

Transvaginal sonographic features of diffuse adenomyosis in 18–30‐year‐old nulligravid women without endometriosis: association with symptoms

To investigate whether there are sonographic features of diffuse adenomyosis in 18–30‐year‐old nulligravid women without endometriosis and to examine their association with symptoms of dysmenorrhea and abnormal uterine bleeding.

Histologic chorioamnionitis at term: implications for the progress of labor and neonatal wellbeing.

Objective: The aim of the present study was to evaluate: i) the rate of histologic chorioamnionitis in relation to the onset of labor and mode of delivery; ii) influence of clinical parameters on the risk of histologic chorioamnionitis in laboring women; iii) neonatal outcome in relation to histologic chorioamnionitis. Methods: A cohort study was conducted on 395 healthy women at term, with singleton uneventful pregnancy, of which 195 with spontaneous onset of labor and 200 with elective cesarean section. All placentas, collected after delivery, were examined for the diagnosis of histologic chorioamnionitis. Mode of delivery, presence of bacterial infection of placenta and membranes, maternal clinical parameters and neonatal outcome were recorded. Results: The rate of histologic chorioamnionitis in women with spontaneous onset of labor was significantly higher than in those experiencing elective cesarean section (28.7% vs. 11.5%). Nulliparity and the duration of labor were independent variables associated with acute histologic chorioamnionitis. The presence of histologic chorioamnionitis did not affect neonatal outcome. Conclusions: The present study showed a highest rate of histological chorionamniositis in women delivering after spontaneous onset of term labor, although the mode of delivery either vaginally or by emergency cesarean section was not influenced by the presence of this pathological condition.

Adenomyosis by transvaginal ultrasonographic features in nulligravid women without endometriosis aged 18–30 years: correlation with symptoms

To investigate whether there are sonographic features of diffuse adenomyosis in 18–30‐year‐old nulligravid women without endometriosis and to examine their association with symptoms of dysmenorrhea and abnormal uterine bleeding.

Endometriosis and Perceived Stress: Impact of Surgical and Medical Treatment

Background: The aim of the study was to investigate the levels of perceived stress in a group of women with a long-term history of endometriosis in conjunction with surgical and/or medical treatments. Methods: A clinical trial was conducted at the Department of Molecular and Developmental Medicine, University of Siena, in collaboration with a non-profit association of women with endometriosis, A.P.E. Onlus. Patients (n = 204) with a previous diagnosis of endometriosis (for at least 3 years) were included in this study. Each patient completed a semi-structured questionnaire and a validated scale to assess perceived stress, the Perceived Stress Scale (PSS) by e-mail. Results: The study showed that in women with a long-term history of endometriosis, the level of perceived stress was increased by repeated surgical treatments and reduced by some medical treatments. The median PSS value was 23 (range 9-36) and 30.6% of the study population were included in the highest stress category (>26). The highest levels were found in patients who had undergone the most surgery. The use of progestins was associated with a lower perceived stress (p = 0.004) than in the patients treated with gonadotropin-releasing hormones. Conclusions: Long-term endometriosis has a relevant impact on perceived stress, in particular in those undergoing repeated surgery.

Maternal anemia effects during pregnancy on male and female fetuses: are there any differences?

Abstract Objective: Sideropenic anemia is a common pregnancy disorder. The relationship between anemia and adverse pregnancy outcome are contradictory, and it is related to the severity of the hemoglobin deficit. The aim of the study was to evaluate the relationship between maternal mild anemia at third trimester of pregnancy, fetal birth weight and fetal gender. Study design: A retrospective study including 1131 single physiological term pregnancies was conducted. According to maternal Hb levels during the third trimester, pregnant women enrolled were divided in two groups: Group A (n = 156) with Hb ≤ 11 g/dl and Group B (n = 975) with Hb ≥ 11,1 g/dl. Results: Maternal characteristics, gestational age at delivery, Apgar score and post-partum hemorrhage were similar between groups. However, when neonatal sex was considerate, female newborns of anemic women had a higher birth weight (p = 0.01). Moreover, anemic women showed a significantly higher rate of emergency cesarean section (p = 0.006), in particular when the newborn was a male (p= 0.03). Conclusion: Maternal mild anemia in third trimester of pregnancy correlates with fetal birth weight, influencing fetal growth and delivery outcome on the basis of fetal gender. Even though the reason of this phenomenon is still unknown, these new data may represent a novel parameter to add significant prognostic information in relation to maternal mild anemia and neonatal outcome.

Sexual pain in women: Quality of sex life and marital relations

Common gynecological and dermatological conditions resulting in sexual pain are often observed in gynecological practice and are easily diagnosed with visual observation and laboratory tests. The lower genital tract diseases we are referring to are vaginitis, vaginoses, dermatoses, hypoestrogenism and endometriosis. All of them affect the vaginal mucosa with diverse mechanisms, their effects lasting for only few days or many months. Furthermore, they change the womens sense of wellbeing sometimes significantly and for a long period. The conditions we mentioned above are recognized promptly with basic gynecological interventions but when burning or sharp pain occurs with light pressure (as in case of penetration attempts) without physical signs we must suspect the genitopelvic pain penetration disorder. This condition was defined for the first time in the Diagnostic and Statistical Manual of Mental Disorders-5 and its dimensions include difficulty or pain at penetration associated with fear, anxiety, and pelvic floor hypertonus. Pain is most often localized at the vulvar vestibule and described as burning, pressure, and itching. These dimensions are iconic of sexual pain associated with vulvodyina and vaginismus but are common also in fibromyalgia, a syndrome of widespread chronic pain of unknown origin; sexual pain in fibromyalgia is mostly attributed both to the joint pathology and to the lower sensitive threshold that are the pathognomonic signs of this condition. In our study we analyzed the characteristics of pain as reported for each disease to evaluate its influence on sexuality and marital relations.

PCOS and Pregnancy: Impact of Endocrine and Metabolic Factors

Polycystic ovary syndrome (PCOS) is one of the most common endocrine–metabolic disorders, characterized by hyperandrogenism, hyperinsulinism, and polycystic ovaries. The origin of PCOS includes genetic factors and lifestyle influences. Elevated estrogen and androgens, low levels of progesterone, anovulation, and hyperinsulinemia contribute to endometrial, hormonal, and metabolic dysfunctions leading to adverse pregnancy outcome. In fact, women with PCOS have an increased risk of gestational diabetes, pregnancy-induced hypertension, preeclampsia, preterm birth, and need of cesarean section. Moreover, the comorbidity of obesity may increase the risk of obstetric complications since excess adipose tissue acts as an endocrine and inflammatory organ, with altered concentrations in leptin, TNF-α, and IL-6. Lifestyle modification may improve biochemical and endocrinological parameters, preventing progression of PCOS to type 2 diabetes and cardiovascular diseases later in life. Nutritional interventions, with or without metabolic drugs, are used as therapeutic tool.

Incidence of Menstrual Disorders is Not Influenced by Nulliparity

Background: Nulliparity is a condition that has been associated with some oncological gynecological diseases. Since religious community is a realistic example of nulliparous women, the present study aims to evidence if nulliparity is a risk factor for developing menstrual disorders and benign gynecological diseases. Materials and Methods: The present observational retrospective study enrolled 442 women divided in Group A (n=216; Catholic nuns) and Group B (n=226; parous women). All eligible women filled in standardized questionnaires, to obtain data on physiological and pathological aspects of menstrual cycle and related gynecological data. Statistical analysis was performed using univariate statistical analyses, Mann-Whitney U test or Fisher exact test. P<0.05 was considered statistically significant. Results: The results showed that nulliparity is not correlated with a different incidence of menstrual cycle disorders (in term of length or bleeding), or gynecological disorders (ovarian or uterine). Dysmenorrhea is more common in pluriparous women, with a higher use of painkillers in nulliparous women. Conclusion: Therefore, the present study suggests that nulliparity does not represent a risk factor for the development of menstrual irregularity and painful symptomatology, compared with pluriparous women.