Alessandro Svelato

Ospedale San Giovanni Calibita - Fatebenefratelli - Isola Tiberina - Roma

Summary Background To assess the equivalence of tranexamic acid (TRAN) versus synthetic oxytocin (OXY) in reducing post- partum blood loss, in full-term patients (37–42 weeks), at low risk of post-partum hemorrhage, with vaginal childbirth. Methods Phase III, randomized (1:1), open-label, longitudinal, multi-center, prospective clinical trial (Prot...

OBJECTIVE: The aim of this study is to assess whether the touch of osteo-pathic manipulative treatment (OMT) can affect the endogenous production of oxytocin in full-term pregnant women and the assessment of well-being following the treatment. PATIENTS AND METHODS: In this study have been enrolled 57 pregnant women at full-term pregnancy (37 th-41...

Objective: The use of episiotomy during operative vaginal birth (OVB) is rather debated among operators and in literature. It is also important to evaluate the indications for which episiotomy is performed. In fact, the consequences of an episiotomy can be invalidating for patients with long-lasting results. The aim of this study is the evaluation...

In this chapter we describe and classify various types of errors and mistake. After a brief introduction to the heuristic concept, we explain the clinical consequences of the errors and describe the behavioural theory of Daniel Kahneman and Amos Tversky. Using real clinical cases of sepsis and shoulder dystocia (SD) we explain how to evaluate diffe...

Simulation in a medical setting is an opportunity to learn new skills, in demanding circumstances, without exposing patients to risks. Training projects on the management of obstetric emergencies using simulations have shown to improve and increase confidence in the management of emergency situations. Furthermore, local training also seemed to faci...

Understanding how and why we have now entered the Anthropocene and opening our eyes to the deep reasons that lead us to ignore our future and that of the next generations will allow us to intervene in our incorrect behaviors in an adequate way, thus resolving the threats pollution hold in general and not only in pregnancy

This cross-sectional study aimed at evaluating the impact of different modalities of induction of labour (IOL) and delivery on levels of woman' satisfaction. All women aged 18 years or older, who underwent IOL for at-term pregnancy (≥41 weeks of gestation) in randomly selected days during the study period in 6 participating centres were eligible fo...

The placenta is a crucial interface between the fetus and the maternal environment. It allows for nutrient absorption, thermal regulation, waste elimination, and gas exchange through the mother's blood supply. Furthermore, the placenta determines important adjustments and epi-genetic modifications that can change the phenotypic expression of the in...

Microplastics (MPs) are defined as plastic particles smaller than 5 mm. They have been found almost everywhere they have been searched for and recent discoveries have also demonstrated their presence in human placenta, blood, meconium, and breastmilk, but their location and toxicity to humans have not been reported to date. The aim of this study wa...

The widespread use of plastics determines the inevitable human exposure to its by-products , including microplastics (MPs), which enter the human organism mainly by ingestion, inhalation , and dermal contact. Once internalised, MPs may pass across cell membranes and translocate to different body sites, triggering specific cellular mechanisms. Hence...

Background Since operative vaginal delivery may be risky for women and might cause neonatal complications, the aim of this study is to assess appropriateness of the procedure. This is a prospective, longitudinal, multicenter, observational study and it was conducted in three Italian Obstetric Units (Pisa, Massa Carrara and Prato). All term pregnant...

Introduction: The aim of the pilot randomized controlled field trial is to assess if a midwifery intervention is able to increase the maternal self-efficacy and reduce the stress level during the first six months after birth. Methods: The study was conducted in two different hospitals in Rome, Italy, involving women delivering at or beyond term,...

A productive debate is needed about the use of dinoprostone in labor induction.

Fetomaternal hemorrhage (FMH) was reported more than 60 years ago for the first time defined by the transfer or transfusion of fetal blood into the maternal circulation before or during delivery. The transfused volume is usually very small but when this value exceeds, it may be clinically significant. Antenatal diagnosis of severe FMH is difficult...

Synopsis Ultrasonography is very useful for the diagnosis of umbilical cord entanglements and for counseling with parents.

ABSTRACT Objective. Dystocia in labour is the most common indication for primary caesarean sections. We have investigated how Italian midwives are informed and aware of the diagnosis of dystocia in labour, which strategies they implement and how their culture can affect clinical decisions. Methods. Purpose-built questionnaire using convenience...

Letter

In this chapter we will explain what shoulder dystocia (SD) is and how it is defined. We will also talk about the risk factors and focus, in particular, on the three most important risk factors: fetal macrosomia, diabetes and previous shoulder dystocia. We will explain that whatever method is used to estimate the fetal weight at term of pregnancy,...

Perineal injury during childbirth and associated morbidity is a great challenge for modern midwifery.

Objectives To describe transfusion management during post‐partum haemorrhage (PPH) and the usefulness of standard or point‐of‐care (POC) laboratory tests for guiding haemostatic management. Background PPH is the leading cause of maternal mortality and severe maternal morbidity worldwide. Despite the efforts made in recent years, PPH is often burde...

Microplastics are particles smaller than five millimeters deriving from the degradation of plastic objects present in the environment. Microplastics can move from the environment to living organisms, including mammals. In this study, six human placentas, collected from consenting women with physiological pregnancies, were analyzed by Raman Microspe...

In healthcare, the patient safety system which has been developed following the study of the various phases necessary for its determination, supplies strategies to avoid the repetition of circumstances that originally has led an individual to make mistakes. In fact, the culture of risk management, starting from the consideration that the errors are...

Microplastics are particles smaller than five millimetres obtained from the degradation of plastic objects abandoned in the environment. Microplastics can move from the environment to living organisms and, in fact, they have been found in fishes and mammals. Six human placentas, prospectively collected from consenting women with uneventful pregnanc...

Background: The continue increase of interventions during labour in low risk population is a controversial issue of the current obstetric literature, given the lack of evidence demonstrating the benefits of unnecessary interventions for women or infants' health. This makes it important to have approaches to assess the burden of all medical interve...

Background: The experience of childbirth crucially impacts a mother's psychological well-being and the mother-infant relationship. It is recognised that negative births can be linked to different forms of discomfort, both for the mother as well as for the infant. This prospective longitudinal study aimed to study the effect of obstetric and psycho...

To evaluate three different intrapartum fetal heart rate (FHR) monitoring policies on CS performed for fetal distress in Robson groups I and III. Multicentre retrospective study in three different Obstetric Units in Italy (A, B and C). rcog (iPosterSessions - an aMuze! Interactive system) Page 2 of 7.

To evaluate if a constant monitoring of clinical performance and specific courses implementation and the spread of results, could reduce the number of prophylactic episiotomy. Design: longitudinal prospective cohort study performed in Massa Carrara Hospital between January 1, 2014 and December 31, 2017.

To assess the equivalence of tranexamic acid (TXA) versus oxytocin (OXY) in post partum haemorrhage (PPH) prophylaxis in term patients (37-42 w), at low risk of PPH. Longitudinal clinical, controlled, randomized, open-label, phase III study. Cod. EudraCT 2015-001950-13.

To investigate if obstetricians decision-making in case of OVD for suspected fetal distress, is heuristic or algorithmic. Multicentre observational study, carried out in Prato and Massa Carrara Obstetric units.

AbstractBackground:Spinal epidural hematoma is a rare but serious complication of epidural anaesthesia and neurologicalimpairment. Epidural hematoma usually becomes evident within a few hours of the procedure. Delayed clinicalpresentation of spinal epidural hematoma is even rarer and insidious.Case presentation:We reported a case of a 44-year-old w...

Our organism and the expression of our genetic inheritance are conditioned by the environment. This is demonstrated by experimental models on animals, but more and more evidence shows similarities also in humans. Evidence now supports that neonatal and maternal health also depends on the interactions between the environment and the DNA itself. Even...

Parole chiave: Epigenetica Periodo della nascita Imprinting Assistenza intrapartum Travaglio Ambiente Meccanismi biologici alla base dell'imprinting e della memoria cellulare le malattie che si manifestano nella vita adulta sono determinate non solo da fattori genetici, ma da numerosi fattori epigenetici che entrano in gioco già durante la vita fet...

In these 15 paragraphs, we have gathered the available knowledge in the medical literature about urgencies and emergencies that doctors, midwifves, and nurses may encounter in the daily management of obstetric and gynecological cases. The style is practical: the text is correlated with illustrations and algorithms, so that the reader can get the mo...

Epigenetics can be defined as the study of the changes in the genetic expression that do not involve changes in the inheritable DNA sequence. The epigenetic mechanisms can cause the characteristic phenotypic traits of the parents to be transmitted to their children, both directly and indirectly. During the first moment of life, numerous nucleotidic...

Postpartum hemorrhage (PPH) is one of the most frequent causes of mortality and morbidity in the obstetric population globally, causing about a quarter of maternal deaths yearly, and is the leading cause of maternal death worldwide. The management of PPH remains a topic of great debate, even in view of new diagnostic and therapeutic possibilities i...

Synthetic oxytocin (SynOT) (Pitocin®, Syntocinon®) is a drug that is used regularly to prevent and to care post partum haemorrhage in childbirth. On the other hand oxytocin (OT) is also an important mediator of life processes; it has been defined " the Great Facilitator of Life ". OT may affect behaviors and physiology to facilitate the propagation...

16 gyNeco aogoi Numero 3-2017 " It may be necessary to revisit the definition of labor dystocia because recent data show that contemporary labor progresses at a rate substantially slower than what was historically taught … ". Come, si evince da questa dichiarazione, emanata congiuntamente dalle due principali società scientifiche americane, le evid...

Objective: To understand the role of fetal spine position in determining a fetal head position at the time of birth and modality of delivery. Patients and methods: This was a multicenter prospective observational study. Fetal occiput and spine position were evaluated by intrapartum ultrasound. Eighty-six women were eligible for inclusion in the...

To the Editor: Tita et al. conducted a multicenter trial and concluded that among womenundergoing nonelective cesarean delivery, the addition of azithromycin to standard regimens for antibiotic prophylaxis was more effective than placebo in reducing the risk of maternal postoperative infection. However, neonatal adverse events were identified at th...

Purpose: Dystocia is the leading indication for primary caesarean sections. Our aim is to compare two approaches in the management of dystocia in labor in nulliparous women with a singleton fetus in cephalic presentation at term in spontaneous or induced labor. Methods: Prospective cohort study. Four hundred and nineteen consecutive patients wer...

We read with great interest “Avoiding the first caesarean section – results of structured organizational and cultural changes” by Blomberg (1). We understand Blomberg's attention toward the complex issue of dystocia, and we would like to ask the author some questions: How long did labor last in patients who were subject to augmentation of labor and...

Objective Purpose of the study was to evaluate whether the removal of cones deep <10 mm both therapeutic and safe in terms of fertility and pregnancy outcome. Methods Between January 2000 and January 2009 we collected data of 761 patients treated by LEEP for cervical intraepithelial neoplasia (CIN) in Gynecological Unit of Pisa University Hospital,...

Objectives: Case of shoulder dystocia unrelieved by standard maneuvers. Results:  A 28-years-old, caucasian primigravida was referred to our Department to be induced at 38 weeks of gestation because of gestational diabetes. After a prolonged first stage of labour, augmented with oxytocin, full dilation was achieved. Second stage lasted 90 minutes,...

Objectives:  Every attempt to modify the management of obstetric emergencies (OE) in a complex organization such as labor ward, involves a strong resistance to change. It is proved that courses on OE improve clinical outcomes. The aim of our study was to identify which kind of difficulties were encountered by the participants of OE courses to impl...

E pigenetica. Questa pa-rola è stata usata per la prima volta da Waddin-gton nel 1957. Il termine è usato per spiegare i processi molecolari attraverso cui i tratti genetici persistono durante la divisione cellulare, senza per questo cambiare la sequenza nucleotidica del DNA. Si tratta di processi che risultano dal silenziamento o dall'attivazione...

Objective: To evaluate the efficacy and feasibility of thermo-ablative fractional CO2 laser for the treatment of symptoms related to vulvo-vaginal atrophy (VVA) in post-menopausal women. Methods: From April 2013 to December 2013, post-menopausal patients who complained of one or more VVA-related symptoms and who underwent vaginal treatment with fra...

BACKGROUND: Symphysis pubis diastasis is defined as an abnormally wide gap of more than 10 mm between the two pubic bones. The present report describes a case of woman who experienced a symphysis pubic diastasis. CASE: Following delivery, a 38-year-old gravida 3 para 0 at 41,5 weeks gestation complained of severe pain in the symphysis pubic region....

Synthetic oxytocin (synOT) is a commonly used drug in labor and it can be applied in all stages of labor. SynOT has been increasingly used over the years, and is currently one of the most common drugs employed in obstetrics. The goal of synOT administration is to cause the augmentation of labor; unfortunately, guidelines for the administration of t...

Introduction Our aim was reduce cesarean sections (CS) in first four out of ten Robson’s classes, without increasing maternal and newborn morbidity. Methods This was a prospective health impact assessment study conducted at the Niguarda Hospital, Department of Obstetrics, in Milan, Italy. The study consists of three phases: (1) data capture and ana...

Introduction Previous studies contain conflicting results about the effects of nuchal cord (NC) in the perinatal outcome, intrapartum complications and way of delivery. Several studies were conflicting in the incidence of operative delivery (cesarean section and vacuum extraction), because of presence of NC. The purpose of our study is to test if c...

Introduction The purpose of this study was to examine the effects of a conservative and specific checklist, based on a protocol for oxytocin administration on maternal and newborn outcomes in the first Robson’s class patients. Methods This was a retrospective chart review and data extraction conducted at Sesto San Giovanni Hospital, Obstetrical Dep...

Objective: The primary aim of the study was to analyze the endometrioma recurrence rate in patients who underwent laparoscopic excision followed by postoperative long-term regimen of oral contraceptives (OCs). Materials and methods: 168 patients who underwent a conservative laparoscopic surgery for endometrioma, during the period between Septemb...

Chronic renal failure and endometrial osseous metaplasia: a hypothetical pathway Sir, We would like to bring to general attention the case of a 44-year-old woman who came to our clinic because of spotting and occasional periods of amenorrhea. She had had menarche at the age of 14 years, followed by regular menstrual cycles. Her medi-cal history rev...

Sir, We would like to bring to general attention the case of a 44-year-old woman who came to our clinic because of spotting and occasional periods of amenorrhea. She had had menarche at the age of 14 years, followed by regular menstrual cycles. Her medical history revealed that she had one living child, and had subsequently experienced two miscarri...

In this paper we describe a case of endometrial osseous mataplasia, whose diagnosis was histologically made after ultrasonographic and hysteroscopic observation. Osseous metaplasia of the endometrium is an uncommon disease, with controversial etiology and unclear pathogenesis. However, it believes that its actual incidence may be underestimated due...

Tuberculosis is a severe public health problem in developing countries, but it is taking on the characteristics of a global epidemic. By virtue of migration flows, in fact, we are observing a resurgence of this disease in western countries, in all its forms including the genital one. The problem became more serious with the emergence of multidrug-r...