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Objective: To evaluate perinatal outcomes in case of non-primary maternal cytomegalovirus (CMV) infection. Methods: We performed a retrospective cohort study of pregnant women with active CMV infection referred to our unit over a 15-year period (January 2000 to December 2014). Non-primary infection was diagnosed on the basis of the results of confirmatory serological and virological tests (avidity test, immunoblotting, real-time PCR-DNA). The vertical transmission rate and the percentage of symptomatic congenital infection were determined in this group of patients. Results: A total of 205 pregnant women were enrolled. Congenital infection occurred in 7 (3.4%) fetuses/neonates. Symptomatic disease was present at birth in 3 of the 7 congenitally infected neonates (1.5%). Two out of 3 symptomatic newborns presented a pathologic second-trimester ultrasound scan. Conclusion: Maternal immunity offers substantial protection against intrauterine transmission of CMV infection, but not against disease once the fetus is infected.

Objective To evaluate the incidence of infants with birth weight less than the 10th centile for small for gestational age (SGA) in primary maternal cytomegalovirus (CMV) infection and to determine whether SGA predicts poor neurodevelopmental outcome. Methods A retrospective cohort study, which included singleton live-born infants from pregnancies complicated by primary maternal CMV infection. Infants were classified as uninfected or infected based on viral virus isolation and real-time PCR in urine at birth. SGA neonates rate and long-term sequelae were evaluated. Results Between 2000 and 2012, 848 women with primary CMV infection were referred to our center with 588 infants assessed at birth. Congenital CMV infection was diagnosed in 119 cases (20%), of which 8 were SGA (6.7%) compared with 27 out of the 469 uninfected infants (5.7%) (p-value = 0.69). Among the 119 infected babies, 14 infants were symptomatic at birth or at postnatal follow-up (12%), of whom two were SGA compared with six out of the 105 asymptomatic neonates (5.7% versus 15%, respectively, p-value = 0.22). Conclusion Congenital CMV infection does not seem to be associated with a higher incidence of SGA, and long-term outcomes do not seem to be affected by isolated impaired fetal growth. © 2014 John Wiley & Sons, Ltd.

There is clinical utility in having a simple and low-cost method of predicting birth weight. To identify abnormal fetal growth, in fact, can reduce the risk of adverse perinatal outcomes. A longitudinal observational cohort study, including 1034 low-risk singleton pregnancies at term, was performed at the Division of Prenatal Medicine, St. Orsola-Malpighi Hospital, University of Bologna, Bologna (Italy) to derive a reliable equation based on maternal characteristics. The following formula was obtained: estimated birth weight (g) = 1485.61 + (symphysis-fundal height (cm) × 23.37) + (11.62 cm × maternal abdominal circumference) + [body mass index (BMI) × (-6.81)] + (parity (0 = nulliparous, 1 = multiparous) × 72.25). Based on study results, 92% of the estimated weights were within the 10% of the actual weight at delivery. The role of obstetric and maternal factors in term birth weight prediction is, therefore, confirmed. Prospective estimations are needed to validate the model proposed. Key words: Symphysis-fundal height, multivariable birth weight prediction, term of pregnancy

Objective To evaluate the outcome of pregnancies complicated by placental insufficiency and abnormal umbilical artery Doppler prior to viability. Design A retrospective cohort study. Setting Italy. Population Singleton pregnancies with fetal growth restriction and absence of end-diastolic velocities (AEDVs) in the umbilical arteries prior to 24 weeks. Methods A retrospective cohort study of singleton pregnancies with fetal growth restriction and AEDVs in the umbilical arteries prior to 24 weeks. Main outcome measures Fetal growth restriction and AEDVs in the umbilical arteries prior to 24 weeks. Results Of 16 fetuses first seen at 20–23 weeks, only 12 survived and one of these developed cerebral palsy. Severe hypertensive disorders occurred in three mothers. In four women, the Doppler waveforms progressively improved and developed a normal pulsatility. These fetuses had a better outcome than those that had persistent alterations: they were delivered later (34 versus 28 weeks), had a larger birthweight (1598 versus 630 g) and developed fewer complications. Conclusions Placental insufficiency with AEDV in the umbilical arteries prior to fetal viability is associated with a high probability of perinatal death and neonatal complications. However, progressive amelioration of Doppler indices occurs in a subset of women, and these fetuses have a much better outcome.

Aim: To evaluate pregnancy outcome in women with fetal membranes at or beyond external os who underwent exam-indicated cerclage or conservative management. Material and Methods: Retrospective cohort study including 52 patients with fetal membranes at or beyond external os between 17 and 27 weeks of gestation, treated in two third-level hospitals, between January 2001 and April 2009. The outcomes of interest of the study, prolongation of pregnancy and neonatal survival rate, were stratified according to type of management, parity, clinical conditions and blood tests at admission and calculated using the Kaplan–Meier algorithm. Results: Of 52 women, 37 received exam-indicated cerclage and 15 were managed conservatively. The rate of patients still pregnant beyond 180 days within the cerclage group differed significantly from those of the conservative management group (80% vs 0%, respectively) (P-value

Objective The aim of this study was to evaluate the incidence of cervical lacerations with cerclage removal planned before labor compared to after the onset of labor by a systematic review of published studies. Study design Searches were performed in electronic databases from inception of each database to November 2014. We identified all studies reporting the rate of cervical lacerations and the timing of cerclage removal (either before or after the onset of labor). The primary outcome was the incidence of spontaneous and clinically significant intrapartum cervical lacerations (i.e. lacerations requiring suturing). Results Six studies, which met the inclusion criteria, were included in the analysis. The overall incidence of cervical lacerations was 8.9% (32/359). There were 23/280 (6.4%) cervical lacerations in the planned removal group, and 9/79 (11.4%) in the removal after labor group (odds ratio 0.70, 95% confidence interval 0.31–1.57). Conclusions In summary, planned removal of cerclage before labor was not shown to be associated with statistically significant reduction in the incidence of cervical lacerations. However, since that our data probably did not reach statistical significance because of a type II error, further studies are needed.

Objective: To evaluate radiologic findings and outcomes of cerebellar injuries in fetuses with severe anemia due to RhD alloimmunization undergoing intrauterine transfusions.Methods: Imaging of multiplanar neurosonography and magnetic resonance imaging (MRI) were reviewed. Pregnancy outcomes were recorded.Results: Cerebellar injuries were identified after the first intravascular transfusion in four fetuses. Two of these cases were previously reported. The median hemoglobin concentration was 2.1 g/dL. Prenatal neurosonography identified an echogenic collection involving the cerebellum suggestive for hemorrhage in three cases. A progressive hypoplasia of a hemisphere was demonstrated at follow-up examination in one of these cases. Hypoplasia of a cerebellar hemisphere was seen in the fourth fetus. Ultrasound diagnosis was confirmed by prenatal MRI in two cases. In the third case, the postnatal MRI showed as additional finding vermian involvement. One pregnancy was terminated and autopsy confirmed the presence of infratentorial hemorrhage. The remaining infants were delivered alive. At time of writing, a truncal ataxia was diagnosed in the child with vermian hypoplasia, while the other children have met all age-appropriate milestones.Conclusions: A severe anemia seems to put the fetus at risk of cerebellar damage, despite successful intravascular transfusion.

OBJECTIVE: To derive a birth weight predictive equation and to compare its diagnostic value with that of ultrasound. METHODS: A longitudinal observational cohort study, including singleton pregnancies at term, was performed at St. Orsola-Malpighi Hospital, University of Bologna (Italy). A birth weight prediction formula, including symphysis-fundal height (SFH), BMI, maternal abdominal circumference (mAC) and parity was derived from a general linear model (GLM) (retrospective study). Moreover, on a new series of patients, the fetal weight was estimated by using both GLM and ultrasound using Hadlock formula (prospective study). The residual analysis and the intraclass correlation coefficient (ICC) were used to test the accuracy of methods in predicting birth weight. RESULTS: Between January and November 2012, 1034 patients were included in the retrospective study and 44 in the prospective one. The following GLM was derived: estimated birth weight (g) = 1485.61 + (SFH (cm) × 23.37) + (11.62 (cm) × mAC) + [BMI × (-6.81)] + (parity (0 = nulliparous, 1 = multiparous) × 72.25). When prospectively applied, the GLM and ultrasound provided a percentage of prediction within ±10% of the actual weight of 73% and 84%, respectively. Ultrasound estimation, as opposite of GLM one, was significantly associated with neonatal weight (R(2 )= 0.388, F = 26.607, p value

Objectives: To evaluate whether transvaginal ultrasound cervical length (TVU CL) can predict antepartum bleeding (APB) in women with low-lying placenta. Study design: A retrospective study was performed including pregnancies with low-lying placenta for which third trimester TVU CL was available. Multiple pregnancies were excluded. Short cervix was defined as TVU CL ≤25mm. Outcomes of interest were compared with respect to the TVU CL. Results: Forty three cases of singleton pregnancies complicated by low-lying placenta in third trimester were identified. Short cervix was reported in 8 cases (19%). APB (75% vs. 31 %, p = 0.02), blood transfusions (25% vs. 3%, p = 0.02), lower birth weight (2246 vs. 2985g, p = 0.02), and neonatal intensive care unit (NICU) admissions (50% vs. 17%, p = 0.04) were more frequent in the women with short cervix. Rate of unplanned cesarean delivery for APB was similar between both the groups (25% vs. 28%, p = 0.83). Conclusions: In women with low-lying placenta persisting into third trimester, short cervical length can be used as a predictor for APB

Background: Second trimester emergency cerclage is an option for pregnant women presenting bulging fetal membranes. Despite a significant prolongation of pregnancy might be achieved, serious fetal and maternal events have been reported. Exclusion of infections through preprocedure amniocentesis has been proposed. Methods: A 37-year-old woman, gravida 4 para 1, was admitted at 21 weeks of gestation to our University Hospital due to bulging fetal membranes. An amniocentesis was performed in order to exclude an actual amniotic infection. Our Microbiology Department found a negative amniotic culture for bacteria and Mycoplasma and a normal glucose and interleukin-6 level, so a cervical cerclage was performed. The patient was discharged home on oral erythromycin. Results: After 48 h, the patient complained of hyperpyrexia, shivers and reduced fetal movements. Ultrasound at admission showed absent cardiac activity and after cerclage removal a non-viable fetus was delivered vaginally. Piperacillin and tazobactam were started, but the clinical course of the patient deteriorated and she developed a cold septic shock and was submitted to hysterectomy and transferred to the ICU of our hospital. Conclusion: This report heralds that even after negative amniocentesis, a life-threatening infection may not be excluded in women candidate for emergency cerclage due to bulging fetal membranes.

OBJECTIVE: To compare the fetal loss rate

an association with small for gestational age neonates? Giuliana Simonazzi, Alessandra Curti, Brunella Guerra, Margherita Contoli, Paola Murano, Chiara Puccetti, Antonio Farina, Nicola Rizzo Department of Obstetrics and Gynecology, St. Orsola Malpighi Hospital, Bologna, Italy, Department of Obstetrics and Gynecology, St. Orsola Malpighi Hospital, Bologna, Italy, bologna, Italy OBJECTIVE: to evaluate the rate of small for gestational age (SGA) neonates in primary cytomegalovirus (CMV) infection and the performance of prenatal ultrasound in prediction of SGA. STUDY DESIGN: Retrospective study including primary CMV infections referred to our Hospital between 2007 and 2011. Neonates were classified as uninfected, infected asymptomatic and symptomatic. Abdominal circumference (AC) and estimated fetal weight (EFW) were used to build up a ROC curve for evaluating the detection rate (DR) of ultrasound in prediction of infected SGA neonates. RESULTS: Follow-up was available in 209 cases. Sixty-two neonates (29%) resulted infected at birth; 14 were symptomatic (22%); congenital neurosensory hearing loss was diagnosed in all cases, one of them presented also a brain anomaly. The overall SGA rate was 10% and the distribution did not differ in the groups (8% vs 12% vs 21%, respectively). Prenatal ultrasound data were available in 130 cases. Uterine artery Doppler was altered in 2 cases (15%), both within uninfected group. According to prediction of SGA in maternal infection, a cut off of 10th centile of EFW achieved a DR of 25% (FPR of 6%). Within infected neonates, instead, a DR of 25% and 50% was achieved by AC and EFW, respectively (at FPR of 10%) and correspondent cut-off value were 22th and 10th centile. CONCLUSION: congenital CMV infection does not seem to be associated with increased rate of SGA neonates. Ultrasound not identify properly SGA neonates in case of both primary maternal infection or congenital infection. Neurosensory hearing loss is very frequent in infected SGA neonates.