Rossana Orabona

Endothelial dysfunction and vascular stiffness in women with previous pregnancy complicated by early or late pre‐eclampsia

Pre‐eclampsia (PE) is associated with an increased cardiovascular risk later in life. The persistence of endothelial dysfunction after delivery may represent the link between PE and cardiovascular disease. We aimed to evaluate endothelial function and arterial stiffness after delivery of pregnancy complicated by early‐onset (EO) or late‐onset (LO) PE and their correlation with gestational age and mean uterine artery pulsatility index at PE diagnosis and birth‐weight percentile.

Placental histological patterns and uterine artery Doppler velocimetry in pregnancies complicated by early or late pre‐eclampsia

To study placental patterns in pregnancies complicated by pre‐eclampsia (PE) and to verify whether the findings are related to gestational age (GA) at PE onset and second‐trimester uterine artery (UtA) Doppler.

Elastic properties of ascending aorta in patients with a previous pregnancy complicated by early or late preeclampsia

To evaluate the elastic properties of the ascending aorta in women with a previous pregnancy complicated by early‐onset (EO) or late‐onset (LO) pre‐eclampsia (PE) and the correlation with gestational age (GA), systolic/diastolic blood pressure (SBP/DBP) and mean uterine artery pulsatility index (UtA‐PI) at diagnosis of the disease as well as with birth weight of the neonate.

Neonatal morbidity after cesarean section before labor at 34(+0) to 38(+6) weeks: a cohort study

Abstract Objective: To describe morbidity in neonates born by cesarean section (CS) before labor between 34+0 and 38+6 weeks, stratified by gestational age. Methods: Cohort study from five Italian tertiary care hospitals. Consecutive singleton pregnancies delivered by CS before labor between 34+0 and 38+6 weeks of gestation from January 2010 to August 2011 were included. Women in labor, with premature rupture of membranes, or with previous administration of steroids were excluded. The incidence of neonatal complication by gestational week was calculated. Results: A total of 1135 cases were analyzed. Composite adverse neonatal outcomes, respiratory distress syndrome, transient tachypnea and use of continuous airway positive pressure decreased from 50%, 28%, 5% and 22% at 34 weeks of gestation, to 4.7%, 1.0%, 0.9% and 0.3% at 38 weeks of gestation. Multivariate analysis showed that the only variable independently associated with composite adverse neonatal outcome was gestational age at delivery (adjusted odds ratio 0.49; 95% confidence interval 0.39–0.61). Conclusions: The prevalence of neonatal complications in newborns delivered by CS before labor halves at each week of gestation from 34 to 38 weeks. Nonetheless complications, and mainly respiratory problems, are still present at early term gestation.

Elastic properties of ascending aorta in women with previous pregnancy complicated by early- or late-onset pre-eclampsia.

To evaluate the elastic properties of the ascending aorta in women with a previous pregnancy complicated by early‐onset (EO) or late‐onset (LO) pre‐eclampsia (PE) and the correlation with gestational age (GA), systolic/diastolic blood pressure (SBP/DBP) and mean uterine artery pulsatility index (UtA‐PI) at diagnosis of the disease as well as with birth weight of the neonate.

Maternal cardiac function after HELLP syndrome: an echocardiography study

To evaluate maternal hemodynamics in asymptomatic women with a previous pregnancy affected by hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and compare the findings to those of women with previous pre‐eclampsia (PE) and controls with a previous uncomplicated pregnancy.

Maternal endothelial function and vascular stiffness after HELLP syndrome: a case–control study

To assess endothelial function and arterial stiffness in women with a previous pregnancy complicated by pre‐eclampsia (PE) with hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome, and to compare these findings to those in women with previous PE but no HELLP and to those in controls with previous uncomplicated pregnancy, in order to investigate the influence of HELLP syndrome on subsequent cardiovascular impairment.

Ultrasound evaluation of left ventricular and aortic fibrosis after pre‐eclampsia

Myocardial fibrosis is associated with adverse clinical outcome in adults. Our aim was to investigate using echocardiographic calibrated integrated backscatter (cIBS) the presence of myocardial and/or aortic fibrosis in asymptomatic women with a history of early‐onset (EO) or late‐onset (LO) pre‐eclampsia (PE).

Fulminant ulcerative colitis in a healthy pregnant woman

This case report concerns a 25-year-old patient with 6-7 bloody stools/d, abdominal pain, tachycardia, and weight loss occurring during the third trimester of pregnancy. Severe ulcerative colitis complicated by toxic megacolon and gravidic sepsis was diagnosed by clinical evaluation, colonoscopy, and rectal biopsy that were performed safely without risk for the mother or baby. The patient underwent a cesarean section at 28+6 wk gestation. The baby was transferred to the neonatal intensive care unit of our hospital and survived without complications. Fulminant colitis was managed conservatively by combined colonoscopic decompression and medical treatment. Although current European guidelines describe toxic megacolon as an indication for emergency surgery for both pregnant and non-pregnant women, thanks to careful monitoring, endoscopic decompression, and intensive medical therapy with nutritional support, we prevented the woman from having to undergo emergency pancolectomy. Our report seems to suggest that conservative management may be a helpful tool in preventing pancolectomy if the patients condition improves quickly. Otherwise, surgery is mandatory.

The prognostic role of various indices and ratios of Doppler velocimetry in patients with pre-eclampsia

Abstract Doppler velocimetry is a non-invasive method to monitor pregnancies complicated by pre-eclampsia. We aimed to assess the predictive value of adverse perinatal or maternal outcome of three ratios, i.e. middle cerebral to umbilical arteries pulsatility indices (PI), middle cerebral to uterine arteries PI and uterine to umbilical arteries PI, compared with that of uterine and umbilical arteries PI in pre-eclamptic patients. This is a cohort study on 168 singleton pregnancies between January 2010 and June 2013. Doppler velocimetry was performed at the diagnosis of pre-eclampsia. Logistic regression analysis was performed and receiver-operating characteristics (ROC) curves were calculated to determine the predictive ability of each Doppler index. Multivariate analysis was run to adjust results for confounding parameters. Seventy-eight cases were complicated by adverse perinatal outcome, 79 by maternal one, 49 by both. Considering perinatal outcome, area under ROC curve was 0.730 for uterine arteries PI, 0.691 for umbilical artery PI and 0.834 for middle cerebral to uterine arteries PI ratio, while for maternal one 0.720 for uterine arteries PI, 0.686 for umbilical artery PI and 0.817 for middle cerebral to uterine arteries PI ratio. At multivariate analysis, only middle cerebral to uterine arteries PI ratio remain statistically significant for both outcomes (p = 0.001). The cited ratio appeared more accurate than all other considered indices in predicting perinatal and maternal outcomes in patients affected by pre-eclampsia.