Papers by Serafina Garofalo
ABSTRACT Antiphospholipid syndrome is a disease that was discovered just 25 years ago. Although c... more ABSTRACT Antiphospholipid syndrome is a disease that was discovered just 25 years ago. Although clinical manifestations have been clearly described, pathogenetic mechanisms are still barely understood. A recent hypothesis involves inflammation in the setting of antiphospholipid syndrome morbidity and experimental data support the activation of a complement cascade as a pivotal event in its physiopathology. In this review, the authors will analyze the recent literature, focusing on contemporary and emerging aspects of complement-mediated disease pathogenesis, and pinpoint the clinical significance of this novel finding.
Clinical Reviews in Allergy Immunology, 2010
In pregnant women, antiphospholipid syndrome (APS) is associated with an increased risk of preecl... more In pregnant women, antiphospholipid syndrome (APS) is associated with an increased risk of preeclampsia, fetal intrauterine growth restriction, and other complications related to uteroplacental insufficiency. In the last two decades, several studies were performed to identify the predictive role of some parameters in relation to obstetric outcome in APS patients. Among these, the uterine velocimetry Doppler is the most studied. It provides a noninvasive method for the study of uteroplacental blood flow, being able to detect a condition of impaired placental perfusion, due to the presence of circulating antiphospholipid antibodies (aPL). To date, the uterine artery Doppler velocimetry resulted to be a useful tool to identify APS pregnancies at higher risk of adverse pregnancy outcome. False-positive IgM for toxoplasmosis, others, rubella, cytomegalovirus, herpes viruses (TORCH) complex is associated to a worse pregnancy outcome because it reflects a dysregulation of the immune system which may amplify placental autoimmune damage. Moreover low levels of complement components are related to an increased incidence of obstetrical complications, suggesting that placental deposition of immune complexes and activation of complement cascade may contribute to placental failure APS related. The abnormal uterine Doppler velocimetry, falsepositive TORCH IgM and low levels of complement components can be considered prognostic indexes of poor pregnancy outcome in APS.
Journal of Obstetrics and Gynaecology, Oct 30, 2014
An adverse influence on reproductive life and obstetric complications are known to occur in women... more An adverse influence on reproductive life and obstetric complications are known to occur in women with celiac disease (clinical and subclinical disease) or inflammatory bowel diseases. Treatment can improve the pregnancy outcome; therefore, it is advisable that a clinical evaluation is performed by a joint team of obstetricians, internists and surgeons. The preconception clinical evaluation of the affected women is useful to focus on the different clinical aspects of the disease and to indicate specific therapeutic strategies. In this study a review of the literature regard to celiac disease and inflammatory bowel disease in pregnancy is presented.
Anticancer research
Cancer complicates approximately 1 in 1000 pregnancies. In pregnancy management, whether the bene... more Cancer complicates approximately 1 in 1000 pregnancies. In pregnancy management, whether the benefits outweigh the risks derived from therapy must be carefully considered. Thirty-two pregnant patients with the diagnosis of malignancy were followed. The indications and timing for surgery, chemotherapy, radiotherapy or delayed treatment were decided according to the malignancy characteristics and gestational age. The patient's consent was obtained before every decision. The rate of live births, premature deliveries, foetal abnormalities and neonatal deaths was 97%, 82%, 9% and 3%, respectively. Three women (9%) died during puerperium because of disease progression. The cancer treatment took into full consideration the specific condition of each pregnant patient. A good rate of live births was observed, even if a high rate of preterm delivery occurred. The management of malignancy required a team of experts in order to optimise every available choice for maternal health and neonata...
International Journal of Clinical Rheumatology, 2013
ABSTRACT Antiphospholipid syndrome is a disease that was discovered just 25 years ago. Although c... more ABSTRACT Antiphospholipid syndrome is a disease that was discovered just 25 years ago. Although clinical manifestations have been clearly described, pathogenetic mechanisms are still barely understood. A recent hypothesis involves inflammation in the setting of antiphospholipid syndrome morbidity and experimental data support the activation of a complement cascade as a pivotal event in its physiopathology. In this review, the authors will analyze the recent literature, focusing on contemporary and emerging aspects of complement-mediated disease pathogenesis, and pinpoint the clinical significance of this novel finding.
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2014
Thrombosis Research, 2007
Thrombosis Research, 2007
Lupus, 2010
Our aims were to assess the frequency of false-positive IgM antibodies for cytomegalovirus in pre... more Our aims were to assess the frequency of false-positive IgM antibodies for cytomegalovirus in pregnant women with autoimmune diseases and in healthy women (controls) and to determine their relationship with pregnancy outcome. Data from 133 pregnancies in 118 patients with autoimmune diseases and from 222 pregnancies in 198 controls were assessed. When positive IgM for cytomegalovirus was detected, IgG avidity, cytomegalovirus isolation and polymerase chain reaction for CMV-DNA in maternal urine and amniotic fluid samples were performed in order to identify primary infection or false positivity. A statistically significantly higher rate of false-positive IgM was found in pregnancies with autoimmune diseases (16.5%) in comparison with controls (0.9%). A worse pregnancy outcome was observed among patients with autoimmune disease and false cytomegalovirus IgM in comparison with those without false positivity: earlier week of delivery (p = 0.017), lower neonatal birth weight (p = 0.0004) and neonatal birth weight percentile (p = 0.002), higher rate of intrauterine growth restriction (p = 0.02) and babies weighing less than 2000 g (p = 0.025) were encountered. The presence of false cytomegalovirus IgM in patients with autoimmune diseases could be used as a novel prognostic index of poor pregnancy outcome: it may reflect a non-specific activation of the immune system that could negatively affect pregnancy outcome. Lupus (2010) 19, 844-849.
Lupus, 2004
An adverse influence on reproductive life and obstetric complications are known to occur in women... more An adverse influence on reproductive life and obstetric complications are known to occur in women with celiac disease (clinical and subclinical disease) or inflammatory bowel diseases. Treatment can improve the pregnancy outcome; therefore, it is advisable that a clinical evaluation is performed by a joint team of obstetricians, internists and surgeons. The preconception clinical evaluation of the affected women is useful to focus on the different clinical aspects of the disease and to indicate specific therapeutic strategies. In this study a review of the literature regard to celiac disease and inflammatory bowel disease in pregnancy is presented.
Fetal Diagnosis and Therapy, 2006
Inherited thrombophilia is associated with thromboembolic events and/or poor obstetric outcome. W... more Inherited thrombophilia is associated with thromboembolic events and/or poor obstetric outcome. We evaluated the pregnancy outcome in women with inherited thrombophilia treated with low-molecular-weight heparin (LMWH). 38 thrombophilic women with a history of thromboembolic events and/or poor obstetric outcome were treated during their 39 consecutive pregnancies with LMWH from pregnancy verification until 4-6 weeks in puerperium. A fixed dose of enoxaparin 4,000 IU/day (except 1 case who required nadroparin 0.3 ml/day) was administered in most cases, adopting a higher dose (6,000 IU/day to 6,000 IU twice a day) in those with previous thromboembolic events. In the treated women, all had a good obstetric outcome, whereas in the previous untreated pregnancies (n = 78), the rate of fetal loss (early and late) was 76.9%, only 12 live infants survived (66.6%). Moreover, birth weight resulted significantly higher in live infants born to treated pregnancies in comparison to that of previous untreated pregnancies (p = 0.009). No maternal thrombosis or major bleeding complications were recorded. The treatment with LMWH improved pregnancy outcome resulting effective and safe in thrombophilic women with a history of thromboembolic events and/or poor obstetric outcome.
Clinical Reviews in Allergy & Immunology, 2010
In pregnant women, antiphospholipid syndrome (APS) is associated with an increased risk of preecl... more In pregnant women, antiphospholipid syndrome (APS) is associated with an increased risk of preeclampsia, fetal intrauterine growth restriction, and other complications related to uteroplacental insufficiency. In the last two decades, several studies were performed to identify the predictive role of some parameters in relation to obstetric outcome in APS patients. Among these, the uterine velocimetry Doppler is the most studied. It provides a noninvasive method for the study of uteroplacental blood flow, being able to detect a condition of impaired placental perfusion, due to the presence of circulating antiphospholipid antibodies (aPL). To date, the uterine artery Doppler velocimetry resulted to be a useful tool to identify APS pregnancies at higher risk of adverse pregnancy outcome. False-positive IgM for toxoplasmosis, others, rubella, cytomegalovirus, herpes viruses (TORCH) complex is associated to a worse pregnancy outcome because it reflects a dysregulation of the immune system which may amplify placental autoimmune damage. Moreover low levels of complement components are related to an increased incidence of obstetrical complications, suggesting that placental deposition of immune complexes and activation of complement cascade may contribute to placental failure APS related. The abnormal uterine Doppler velocimetry, falsepositive TORCH IgM and low levels of complement components can be considered prognostic indexes of poor pregnancy outcome in APS.
Autoimmunity Reviews, 2014
Objective: Firstly, to investigate the pregnancy outcome of women with primary Sjogren's Syndrome... more Objective: Firstly, to investigate the pregnancy outcome of women with primary Sjogren's Syndrome (pSS) in a case-control study; secondly, to perform a review of the literature in order to clarify if the pregnancy outcome is affected by pSS and influenced by the disease clinical onset. Method of study: Thirty-four pregnancies with pSS and 136 controls were retrospectively collected. Results: Six pregnancies occurred before the pSS diagnosis and 28 after the pSS diagnosis. Two cases were complicated by intrauterine atrio-ventricular block. A statistically significant increase of the rate of spontaneous abortions, preterm deliveries and cesarean section was found in pSS pregnancies. The mean neonatal birth weight and the mean neonatal birth weight percentile were significantly lower in the offspring of women with pSS in comparison to controls. Similar pregnancy outcome was observed in women with pSS diagnosis before and after the index pregnancy. Conclusions: Women with pSS experienced complicated pregnancies more frequently than controls, regardless of the onset of the symptoms, showing that the immunological disturbance is present throughout the reproductive life.
Annals of the New York Academy of Sciences, 2007
In pregnant women, antiphospholipid syndrome (APS) is associated with an increased risk for preec... more In pregnant women, antiphospholipid syndrome (APS) is associated with an increased risk for preeclampsia, fetal intrauterine growth restriction, and other complications related to uteroplacental insufficiency. In normal pregnancy, impedance to flow in the uterine arteries decreases with gestation, as the likely consequence of the physiologic change of spiral arteries into low-resistance vessels. The presence of antiphospholipid antibodies can impair this vascular adaptation, resulting in a reduced placental perfusion. Doppler investigation provides a noninvasive method for the study of uteroplacental blood flow. Several studies were performed to detect the predictive role of uterine artery Doppler velocimetry in relation to pregnancy outcome in APS patients. In some studies, a high resistance index in the uterine arteries strongly predicted the subsequent development of obstetric complications. In other studies, persistent bilateral uterine artery notches identified the risk of preeclampsia and fetal intrauterine growth restriction. To date, the uterine artery Doppler velocimetry resulted to be a useful tool for identifying APS pregnancies at risk for adverse pregnancy outcome. These findings might have important implications for the management of these patients.
Early Human Development, 2011
Background: Hypertensive disorders in pregnancy account for increased perinatal morbidity and mor... more Background: Hypertensive disorders in pregnancy account for increased perinatal morbidity and mortality when compared to uneventful gestations. Aims: To analyze perinatal outcome of pregnancies complicated by different kinds of hypertension to uncomplicated pregnancies in a series of Italian women and to compare our data with series from other countries. Study design: The sample was divided into four groups of hypertensive women: chronic hypertension (CH), gestational hypertension (GH), preeclampsia (PE), and chronic hypertension complicated by preeclampsia (CHPE). One thousand normal pregnancies served as controls. Subjects: Neonatal features of the offspring of 965 Italian women with hypertension in pregnancy were evaluated. Measures: Gestational age, birthweight and the rate of small for gestational age were the outcomes. Perinatal asphyxia and mortality were also assessed. Results: Gestational age, the mean of birth weight and birth percentile were significantly lower in all groups with hypertensive complications when compared with controls. The rate of very early preterm delivery (b 32 weeks) was 7.8% in CH, 5.9% in GH, 21.2% in PE and 37.2% in CHPE while it was to 1.2% in the control group. The rate of SGA was globally 16.2% in CH, 22.8% in GH, 50.7% in PE,.2% in CHPE and 5% in controls. The rate of SGA in PE was much higher than reported in series from other countries. Conclusion: Comparing our data with those reported from other countries, it is evident that the rate of fetal growth restriction in PE we found in our center, is significantly higher even in the presence of a global lower incidence of PE.
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Papers by Serafina Garofalo