Science Ostetricia e Ginecologia

Pavia, Italy

Science Ostetricia e Ginecologia

Pavia, Italy
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Arduini M.,Science Ostetricia e Ginecologia | Epicoco G.,Science Ostetricia e Ginecologia | Clerici G.,Science Ostetricia e Ginecologia | Bottaccioli E.,Science Ostetricia e Ginecologia | And 2 more authors.
International Journal of Gynecology and Obstetrics | Year: 2010

Objective: To report our experience with a new conservative management approach to treat postpartum hemorrhage (PPH) due to placenta previa accreta. Methods: A retrospective study of 9 patients with placenta previa accreta who underwent a conservative management protocol. The protocol consists of preventive radiological catheterization of the descending aorta, cesarean delivery, use of Affronti endouterine square hemostatic sutures, and placement of an intrauterine Bakri balloon in conjunction with B-Lynch suture. In the event of failure of the protocol, subsequent management employs ligation and/or reversible embolization of the uterine arteries followed by hysterectomy if unsuccessful. Results: Conservative management of PPH was successful in all 9 patients evaluated and avoided the need for ligation and/or reversible embolization of the uterine arteries. Conclusion: Management of PPH is dictated by several considerations including hemodynamic status and desire to preserve fertility. The initial results of this conservative protocol for treatment of PPH in high-risk patients with placenta previa accreta are encouraging. © 2009 International Federation of Gynecology and Obstetrics.


Revello M.G.,Science Ostetricia e Ginecologia | Genini E.,Science Virologia e Microbiologia | Gorini G.,Science Virologia e Microbiologia | Klersy C.,Servizio di Biometria e Epidemiologia Clinica | And 2 more authors.
Journal of Clinical Virology | Year: 2010

Background: The interpretation of a positive IgM antibody result to human cytomegalovirus (HCMV) in a pregnant woman is of major importance for the correct management of the pregnancy. Determination of HCMV-specific IgG avidity is considered an useful approach for distinguishing IgM antibody due to primary HCMV infection from IgM antibody elicited during non-primary infection. Objective: Comparative evaluation of eight commercial HCMV IgG avidity assays currently available in Europe. Study design: A panel of 198 sequential samples collected from 65 pregnant women at 0-90, 91-180, and >180 days after the onset of primary HCMV infection was retrospectively tested by Abbott, BioMérieux, Bio-Rad, DiaSorin, Diesse, Euroimmun, Radim, and Technogenetics HCMV IgG avidity assays according to the manufacturer's instructions. Results: None of the 198 samples tested yielded identical scores by the kits under evaluation. The Euroimmun and Radim assays showed the best correlation with expected results in terms of low (0-90 days), intermediate (90-180 days) and high (>180 days) avidity results, respectively. The best accuracy in diagnosing a recent (<90 days after the onset) or non-recent (>180 days after the onset) primary HCMV infection was shown by Radim followed by Euroimmun and Diesse. The best correlation with a well established in-house developed HCMV IgG avidity assay was shown by Radim. Conclusions: HCMV IgG avidity kits need to be improved and standardized. In the meantime, highly specific IgM assays are preferable for screening purposes in pregnant women. © 2010 Elsevier B.V.


Lilleri D.,Laboratori Sperimentali Of Ricerca | Gerna G.,Laboratori Sperimentali Of Ricerca | Furione M.,S.S. Virologia Molecolare | Zavattoni M.,S.S. Virologia Molecolare | Spinillo A.,Science Ostetricia e Ginecologia
Journal of Clinical Virology | Year: 2016

Background: Definition of onset for primary human cytomegalovirus (HCMV) infection during pregnancy is critical for several reasons, including diagnosis of pre-conceptional infections and definition of gestational age at the time of infection. Objective: To determine the onset of primary HCMV infection, differential kinetics of antibodies neutralizing infection of epithelial and fibroblast cells, as well as ELISA IgG antibodies to HCMV glycoprotein complexes (gC) gH/gL/pUL128L, gH/gL/gO, and gB were exploited and compared with conventional assays. Study design: In a series of 40 pregnant women with primary HCMV infection and ascertained HCMV-related mild clinical symptoms, the kinetics of different types of neutralizing and ELISA IgG antibodies were investigated with the aim of establishing criteria for dating the onset of primary infection in pregnant women without clinical symptoms. Results: IgG antibodies to gB and gH/gL/pUL128L, as well as antibodies neutralizing infection of epithelial cells appeared early after infection onset (within 2-3 weeks) and increased rapidly, whereas antibodies to gH/gL/gO and antibodies neutralizing infection of fibroblasts appeared later (>30 days) and increased slowly. Both the conventional diagnostic assays (IgG, and IgM antibody, and IgG avidity index) and the novel assays for determination of antibody responses directed against HCMV gC allowed the definition of an algorithm indicating the onset of primary HCMV infection in asymptomatic women within a period of 1-2 months. Conclusion: New neutralization and ELISA IgG assays to HCMV gC provide additional tools for dating the onset of primary infection in pregnancy. © 2016 Elsevier B.V.


Revello M.G.,Science Ostetricia e Ginecologia | Furione M.,Science Microbiologia e Virologia | Rognoni V.,Science Microbiologia e Virologia | Arossa A.,Science Ostetricia e Ginecologia | Gerna G.,Laboratori Sperimentali Of Ricerca
Journal of Clinical Virology | Year: 2014

Background: Cytomegalovirus (CMV) transmission from mother to fetus occurs at a much greater rate following primary rather than reactivated infections and CMV dissemination in the mother is considered a key step in the pathogenesis of fetal infection. However, knowledge of CMV DNAemia in CMV-seropositive pregnant women is very limited. Objective: Major objective of this study was to assess the prevalence and diagnostic value of CMV DNAemia in a large population of seropositive pregnant women. Study design: Serologic and DNAemia results obtained from 2211 blood samples of 1371 consecutive pregnant women referred to our Institution for suspected CMV infection in the period 2001-2010 were reviewed. Results: DNAemia was detected in 452/597 (75.7%) women with serologic evidence of primary CMV infection and in 4/774 (0.5%) women without evidence of primary infection. Conclusion: In pregnant women, CMV DNAemia is detected primarily during primary infection. CMV DNAemia determination may be helpful in the diagnosis of primary infection. © 2014 Elsevier B.V.


Revello M.G.,Science Ostetricia e Ginecologia | Fornara C.,Laboratori Sperimentali Of Ricerca Area Trapiantologica | Arossa A.,Science Ostetricia e Ginecologia | Zelini P.,Laboratori Sperimentali Of Ricerca Area Trapiantologica | Lilleri D.,Laboratori Sperimentali Of Ricerca Area Trapiantologica
Early Human Development | Year: 2014

Maternal preconception immunity confers substantial protection against HCMV infection and disease to the unborn child. However, the protective role played by single components of virus-specific humoral and cellular immunity is poorly defined. Recently, it was discovered that UL128-131 gene products are essential for the virus to exert endothelial/epithelial cell tropism during natural infection. This, together with the finding that the gH-gL-UL128-131 complex can elicit early, highly potent, and long-lasting neutralizing antibody response as well as other antibodies involved in cell-to-cell spreading and virus transfer from endothelial cells to leukocytes, indicate that antibodies may indeed potentially control virus dissemination in vivo and play a role in mother-to-fetus transmission as well. Additionally, passive immunization of pregnant women with primary HCMV infection has been reported to be highly beneficial for both prevention and therapy of congenital infection in nonrandomized studies. Recently, a phase IIB, randomized, double blind, hyperimmunoglobulin vs placebo trial (CHIP study) showed a lower, although not significant, rate of transmission in the hyperimmunoglobulin arm. Ongoing phase III controlled trials as well as laboratory investigations will hopefully help in better defining the protective role of maternal antibodies. © 2014 Elsevier Ireland Ltd.


Revello M.G.,Clinica Ostetrico Ginecologica | Fabbri E.,Ospedale Vittore Buzzi | Furione M.,Science Virologia e Microbiologia | Zavattoni M.,Science Virologia e Microbiologia | And 9 more authors.
Journal of Clinical Virology | Year: 2011

Background: The burden of congenital human cytomegalovirus (HCMV) infection is well recognized. However, screening for maternal infection remains controversial in view of diagnostic challenges, counseling difficulties, and absence of medical treatment. Objective: To assess the role of prenatal diagnosis and counseling in the management of pregnancy complicated by primary HCMV infection. Study design: Retrospective study aimed at investigating diagnostic features, options, and pregnancy outcome in 735 women with primary HCMV infection over a period of 20 years (1990-2009). Results: Overall, 25.6% women were found to be seronegative before the actual pregnancy. However, none were informed about HCMV infection and potential prevention strategies. Diagnosis of primary HCMV infection was achieved by seroconversion in 44.4% cases and by different combinations of virus-specific IgM, low IgG avidity, and DNAemia in 43.9% cases. Non-specific symptoms and/or haematological/biochemical alterations were recalled by 73.5% women. The onset of infection could be established, and counseling adjusted accordingly in >90% cases. The overall rate of vertical transmission was 37.1%, ranging from 5.6% for preconceptional infections to 64.1% for third trimester infections. Amniocentesis was chosen by 43.1% women, whereas pregnancy termination was requested by 15.6%. Conclusions: Reference virology centers and ad hoc trained and experienced physicians are required for accurate diagnosis of primary infection in pregnancy and ensuing counseling. Prenatal diagnosis has a central role in the management of pregnancies complicated by primary HCMV infection. HCMV-seronegative women should receive adequate information. © 2011 Elsevier B.V.


Furione M.,SS Virologia Molecolare | Rognoni V.,SS Virologia Molecolare | Sarasini A.,SS Virologia Molecolare | Zavattoni M.,SS Virologia Molecolare | And 3 more authors.
Journal of Medical Virology | Year: 2013

Following primary human cytomegalovirus (HCMV) infection, virus-specific IgG antibody shift from low to high avidity with individual variations in the rate of avidity maturation. The kinetics of the avidity maturation of IgG specific for HCMV nuclear antigen in pregnant women with primary infection was investigated. Absorbance values used for avidity index calculation of 286 sequential sera collected from 69 pregnant women with primary HCMV infection were retrieved. Percent difference in absorbance values of IgG antibody bound to the solid phase after urea treatment (IgG avidity) between early (T1, 0-90, median 31 days) and late (T2, 91-180, median 136 days) serum samples was calculated for each woman. Three groups of women were identified: 24/69 (34.8%) women showed high (>100%) avidity increase between T1 and T2 (pattern H), 29/69 (42%) low (<50%) increase (pattern L), and 16/69 (23.2%) intermediate increase (pattern I). Avidity values in T1 samples were significantly higher in women with pattern L compared to women with pattern H (P=0.01). Altogether, 28/69 (40.6%) women transmitted HCMV infection to their fetuses. Fetal infection preferentially occurred (P<0.01) in women with pattern H (15/24, 62.5%) compared with women with pattern L (7/29, 24.1%). In conclusion, different patterns of IgG avidity maturation can be detected following primary HCMV infection. Pregnant women with pattern H (rapid IgG avidity increase) appear to be at higher risk for fetal infection, whereas, pregnant women developing early antibody with high avidity appear to be at a lower risk of vertical transmission. © 2013 Wiley Periodicals, Inc.


Genini E.,Science Virologia e Microbiologia | Percivalle E.,Science Virologia e Microbiologia | Sarasini A.,Science Virologia e Microbiologia | Revello M.G.,Science Ostetricia e Ginecologia | And 2 more authors.
Journal of Clinical Virology | Year: 2011

Background: Recently, a new human cytomegalovirus (HCMV) glycoprotein complex has been identified and potentially proposed as a vaccine. Objective: The aim of this study was to determine whether the HCMV gH/gL/pUL128-pUL130-pUL131 (gH/gL/pUL128-131) 5-protein (pentameric) complex (which has been recently found to be indispensable for the infection of endothelial and epithelial cells) is able to elicit a consistent antibody response in both primary and reactivated HCMV infections. Study design: The antibody response was determined by both indirect immunofluorescence (IFA) and ELISA, using fixed (IFA) or lysed (ELISA) epithelial (ARPE-19) cells infected with one or more adenoviral vectors, each carrying one HCMV gene and, in parallel, with a control adenovirus vector. Results: The specificity of results was determined by the reactivity of human neutralizing mAbs recognizing two, three, or four proteins of the complex. In 14 cases of primary infection, an IgG antibody seroconversion to the UL128-131 gene products was consistently detected within 2-4 weeks after onset of infection, while antibodies persisted for at least 12 months. The IgG antibody response to UL128-131 gene products was generally superior to the response to gH and appeared to follow the neutralizing antibody response (as determined in epithelial cells). In reactivated infections, the antibody response showed a trend reminiscent of a booster response. IgG antibodies were detected in HCMV-seropositive healthy adult controls, but not in HCMV-seronegative individuals. Conclusions: The IgG antibody response to the pentameric complex could be a major target for the evaluation of the antibody response to a pentamer-based vaccine. © 2011 Elsevier B.V.


PubMed | S.S. Virologia Molecolare, Laboratori Sperimentali Of Ricerca and Science Ostetricia e Ginecologia
Type: | Journal: Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology | Year: 2016

Definition of onset for primary human cytomegalovirus (HCMV) infection during pregnancy is critical for several reasons, including diagnosis of pre-conceptional infections and definition of gestational age at the time of infection.To determine the onset of primary HCMV infection, differential kinetics of antibodies neutralizing infection of epithelial and fibroblast cells, as well as ELISA IgG antibodies to HCMV glycoprotein complexes (gC) gH/gL/pUL128L, gH/gL/gO, and gB were exploited and compared with conventional assays.In a series of 40 pregnant women with primary HCMV infection and ascertained HCMV-related mild clinical symptoms, the kinetics of different types of neutralizing and ELISA IgG antibodies were investigated with the aim of establishing criteria for dating the onset of primary infection in pregnant women without clinical symptoms.IgG antibodies to gB and gH/gL/pUL128L, as well as antibodies neutralizing infection of epithelial cells appeared early after infection onset (within 2-3 weeks) and increased rapidly, whereas antibodies to gH/gL/gO and antibodies neutralizing infection of fibroblasts appeared later (>30 days) and increased slowly. Both the conventional diagnostic assays (IgG, and IgM antibody, and IgG avidity index) and the novel assays for determination of antibody responses directed against HCMV gC allowed the definition of an algorithm indicating the onset of primary HCMV infection in asymptomatic women within a period of 1-2 months.New neutralization and ELISA IgG assays to HCMV gC provide additional tools for dating the onset of primary infection in pregnancy.


PubMed | Science Microbiologia e Virologia, Laboratori Sperimentali Of Ricerca and Science Ostetricia e Ginecologia
Type: Journal Article | Journal: Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology | Year: 2014

Cytomegalovirus (CMV) transmission from mother to fetus occurs at a much greater rate following primary rather than reactivated infections and CMV dissemination in the mother is considered a key step in the pathogenesis of fetal infection. However, knowledge of CMV DNAemia in CMV-seropositive pregnant women is very limited.Major objective of this study was to assess the prevalence and diagnostic value of CMV DNAemia in a large population of seropositive pregnant women.Serologic and DNAemia results obtained from 2211 blood samples of 1371 consecutive pregnant women referred to our Institution for suspected CMV infection in the period 2001-2010 were reviewed.DNAemia was detected in 452/597 (75.7%) women with serologic evidence of primary CMV infection and in 4/774 (0.5%) women without evidence of primary infection.In pregnant women, CMV DNAemia is detected primarily during primary infection. CMV DNAemia determination may be helpful in the diagnosis of primary infection.

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