Elena Rita Magro-Malosso

Exercise during pregnancy and risk of preterm birth in overweight and obese women: a systematic review and meta-analysis of randomized controlled trials

The incidence of overweight and obesity in pregnancy has risen significantly in the last decades. Overweight and obesity have been shown to increase the risk for some adverse obstetric outcomes. Lifestyle interventions, such as diet, physical activity and behavior changes, may reduce these risks by promoting weight loss and/or preventing excessive weight gain. The possible impact of exercise on the risk of preterm birth (PTB) in overweight or obese women is controversial. Therefore, the aim of our study was to evaluate the effect of exercise on the risk of PTB in overweight or obese pregnant women.

Exercise during pregnancy and risk of gestational hypertensive disorders: a systematic review and meta-analysis

Gestational hypertensive disorders, including gestational hypertension and preeclampsia, are one of the leading causes of maternal morbidity and mortality. The aim of our study was to evaluate the effect of exercise during pregnancy on the risk of gestational hypertensive disorders.

Induction of labour for suspected macrosomia at term in non‐diabetic women: a systematic review and meta‐analysis of randomized controlled trials

Several randomized controlled trials (RCTs) compared induction of labour with expectant management in non‐diabetic women with suspected fetal macrosomia.

Prediction of preterm delivery by fetal fibronectin in symptomatic and asymptomatic women with cervical length ≤20 mm.

Abstract Objective: To evaluate the diagnostic accuracy of cervicovaginal fetal fibronectin (fFN) in predicting preterm delivery (PTD) in symptomatic and asymptomatic women with cervical length (CL) ≤ 20 mm. Methods: A retrospective cohort study on pregnant singleton women admitted for CL ≤ 20 mm, with or without uterine contractions, between 22 and 34 weeks. For each group, symptomatic and asymptomatic, the following outcomes were evaluated: PTD before 37 and 34 weeks, delivery within 48 h, 7, 14 and 21 days after fibronectin sampling. Results: 128 women admitted for CL ≤ 20 mm were identified. Of these, 43 had uterine contractions, while 85 were asymptomatic. A positive fFN test was detected in 33% of symptomatic patients and it was significantly associated with PTD < 37 and 34 weeks and within 48 hours, 7, 14 and 21 days from admission (p < 0.05). After logistic regression analysis, fFN remained an independent predictor for all outcomes. In the asymptomatic group fFN test was positive only in 6% of patients, and a positive result was not significantly associated with any of the outcomes. Conclusions: In women with contractions and CL ≤ 20 mm, fFN is an effective marker of PTD. Sensitivity and specificity rates for PTD within 7–14 days are higher than those reported in studies including women with CL > 20 mm. In asymptomatic women, fFN appeared not as effective in predicting PTD.

Maternal steroid therapy for fetuses with immune-mediated complete atrioventricular block: a systematic review and meta-analysis

Abstract Introduction: To explore the effect of maternal fluorinated steroid therapy on fetuses affected by immune-mediated complete atrio-ventricular block (CAVB) in utero. Material and methods: Pubmed, Embase, Cinahl, and ClinicalTrials.gov databases were searched. Only studies reporting the outcome of fetuses with immune CAVB diagnosed on prenatal ultrasound without any cardiac malformations and treated with fluorinated steroids compared to those not treated were included. The primary outcome observed was the regression of CAVB; secondary outcomes were need for pacemaker insertion, overall mortality, defined as the occurrence of either intrauterine (IUD) or neonatal (NND) death, IUD, NND, termination of pregnancy (TOP). Furthermore, we assessed the occurrence of all these outcomes in hydropic fetuses compared to those without hydrops at diagnosis. Meta-analyses of proportions using random effect model and meta-analyses using individual data random-effect logistic regression were used to combine data. Results: Eight studies (162 fetuses) were included. The rate of regression was 3.0% (95%CI 0.2–9.1) in fetuses treated and 4.3% (95%CI 0.4–11.8) in those not treated, with no difference between the two groups (odds ratio (OR): 0.9, 95%CI 0.1–15.1). Pacemaker at birth was required in 71.5% (95%CI 56.0–84.7) of fetuses-treated and 57.8% (95%CI 40.3–74.3) of those not treated (OR: 9, 95%CI 0.4–3.4). There was no difference in the overall mortality rate (OR: 0.5, 95%CI 0.9–2.7) between the two groups; in hydropic fetuses, mortality occurred in 76.2% (95%CI 48.0–95.5) of the treated and in 23.8% (95%CI 1.2–62.3) of the untreated group, while in those without hydrops the corresponding figures were 8.9% (95%CI 2.0–20.3) and 12% (95%CI 8.7–42.2), respectively. Improvement or resolution of hydrops during pregnancy occurred in 76.2% (95%CI 48.0–95.5) of cases treated and in 23.3% (95%CI 1.2–62.3) of those nontreated with fluorinated steroids. Conclusions: The findings from this systematic review do not suggest a potential positive contribution of antenatal steroid therapy in improving the outcome of fetuses with immune CAVB.

Maternal steroid therapy for fetuses with second‐degree immune‐mediated congenital atrioventricular block: a systematic review and meta‐analysis

The aim of this study was to explore the effect of maternal fluorinated steroid therapy on fetuses affected by second‐degree immune‐mediated congenital atrioventricular block.

Latent Syphilis Infection in Pregnancy: An Ultrasound Diagnosed Case of Penicillin Treatment Failure

We report a case of early latent syphilis (reactive serologic tests without clinical evidence of disease within 24 months from the onset of the infection) in pregnancy. Despite an appropriate maternal treatment with benzathine penicillin G, sonographic signs of fetal syphilis were detected. Follow-up scans, in addiction to serial serological tests, have allowed the identification of fetal infection and therefore the failure of antibiotic therapy. We highlight the importance of ultrasound in suspecting fetal infection and in evaluation of the fetal response after penicillin treatment.