Physical activity in low risk pregnant women: a cross-sectional study.

OBJECTIVES: The aim of this study is to analyze the quality and quantity of physical activity (PA) practiced by low-risk pregnant women before and during pregnancy. DESIGN: This cross-sectional study assesses the dietary habits, exercise habits and body mass index. We used an ad hoc health lifestyle multiple choice questionnaire. The data collection lasted 7 months, from the beginning of September 2018 to the end of March 2019. POPULATION: We recruited 175 Italian women with a singleton, low-risk pregnancy at 32-36 weeks of gestational age. RESULTS: In the periconceptional period, 52.6 % of women do not perform any PA. For the other 47.4% of women, the most practiced activities, both before and during gestation, are walking and swimming. Data on the sedentariness showed that about a quarter of the population remains inactive watching TV for more than two hours a day. Interestingly, the most statistically significant risk factor for sedentariness is the BMI > 25 kg/m². Therefore, overweight or obese women are more likely to maintain a sedentary lifestyle during pregnancy. CONCLUSIONS AND IMPLICATION FOR THE PRACTICE: Our study highlighted a high rate of sedentariness in pregnancy, especially among overweight and obese women. Thus, it is important to undertake interventions aimed at informing pregnant women of various benefits that PA can bring. In particular, because of the significant association between sedentariness and BMI greater than 25 kg/m2, it results crucial to direct these recommendations particularly to overweight/obese pregnant women, addressing them to a healthy lifestyle.

Study of childbirth education classes and evaluation of their effectiveness.

BACKGROUND: Childbirth education classes are antenatal support services offered to pregnant women or to the couple, aimed at increasing their knowledge regarding pregnancy, labour, delivery, breastfeeding, parenthood and newborn care. OBJECTIVE: The aim was to evaluate the effectiveness of Birthing Classes through the analysis of the occurrence of C-section, epidural analgesia, behavior during labor and delivery of the women who participated to the course as compared to those who did not attend it. Moreover, the level of satisfaction of pregnant women who attended the course was measured with a questionnaire of 20 items handed out after the delivery. METHODS: To measure the satisfaction level of pregnant women, in the period from February 2017 to October 2017, a questionnaire of 20 items was used. In order to analyze the results of the births the medical records were consulted. RESULTS: In the period of time going from February 2017 to October 2017 there were 147 women who have delivered and who have filled in the questionnaire. According to the multivariable analysis, there were no differences in the frequency of C-sections between the two groups (OR=0.8, 95%CI=0.3-1.7, p=0.503), whereas the frequency of epidural analgesia was lower in women who attended the Birthing Class (OR=0.3, 95%CI=0.1-0.9, p=0.036). We also observed that women who attended the Birthing Class: 1) had a higher likelihood of using breathing techniques during the labor (OR=5.5, 95%CI=1.5-20.0, p=0.009); 2) had a higher likelihood of taking advantage of the visualization exercises during the labor (OR=2.5, 95%CI=1.1-6.0, p=0.039). There was no other relevant difference between the two groups. DISCUSSION: The benefits of perinatal education are difficult to evaluate systematically, and further research would be required to determine real effects and agree upon reliable indicators of effectiveness. CONCLUSIONS: This study identified several positive factors that confirm the results of other studies indicating that antenatal classes are effective for women giving birth for the first time/nulliparous women, based on an analysis of childbirth outcomes, in order to improve maternal and neonatal health.

Survey of students of the degree course in obstetrics, on learning using case based learning (cbl) method in the area of professional teachings.

BACKGROUND: Case Based Learning (CBL) is a teaching methodology that, starting from a case associated with real life situations, is able to stimulate students to investigate, reflect and discuss to find the solution to the case. OBJECTIVE: The aim of this study is to investigate the satisfaction and the educational impact on the students of the Obstetrics Degree Course on Learning Case Based Learning CBL (on real clinical cases). METHODS: The observational study was carried out through the presentation of real clinical cases to a sample of 43 students of a degree course in Obstetrics and giving them questionnaires of evaluation regarding satisfaction and educational impact, using measurement scales which ranged from 1 (very bad) to 5 (excellent). RESULT: The higher satisfaction was towards the tutor's exhibition capacity and the integration between participants, for 2nd and 3rd year students, respectively. Likewise, the highest educational impact was associated with the effectiveness of the tutor facilitator. Differences in the degree of satisfaction were observed between the two students cohorts, in particular regarding relevance of the topics, as satisfaction was higher in 2nd year students (p=0.021), and regarding work times, as satisfaction was higher in 3rd year students (p=0.042). No significant differences in the educational impact were observed between 2nd and 3rd year students. DISCUSSIONS: Studies were examined to compare the effectiveness of Case Based Learning (CBL) to the use of other teaching methodologies. CONCLUSION: The results of the study highlight that the knowledge and skills acquired by Case Based Learning were useful and applicable in the workplace.

Signal transduction mechanisms and nitric oxide in hypoxic and ischemic human cardiac ventricular cell.

BACKGROUND: Nitric oxide (NO) plays a well-known role in regulating endocellular adaptive changes to acute hypoxia and ischemia. The reversible inhibition of complex IV of the mitochondrial respiratory chain fulfils a cytoprotective function, whereas the progressive inhibition of complex I and II reveals the onset of irreversible oxidative damage due to persistent NO production in response to prolonged hypoxia and/or ischemia. In hypoxic or ischemic human myocardial cells, death may be caused by apoptosis or necrosis following the activation of the biomolecular signal transduction mechanisms. The activation of MAPK (mitogen-activated protein kinase) followed by ERK (extracellular regulated kinase) and p21waf is necessary in this respect. The myocardial cell is well known for its postmitotic nature and through their activation these kinases aim to repair DNA damaged by oxidative stress in order to guarantee the survival of the cell itself. A direct correlation has been found between the activation of these kinases and NO production. It was decided to carry out this study in hypoxic and ischemic human heart ventricular tissue in order to confirm this connection. METHODS: In 10 patients undergoing cardiac valvular replacement, ventricular samples were collected before aortic clamping, after 15 min of ischemia and after 60 minutes during which the patients received doses of hematic cardioplegic solution at regular intervals. RESULTS: The results show a rapid increase in NO production in response to ischemia followed by a tendency for levels of this element to fall. MAPK, ERK and p21waf activation was parallel to No production, irrespective of the repeated administration of hematic cardioplegic solution. The heart tissue examined 60 minutes after aortic clamping came from a ventricular area subject to preconditioning mechanisms. In view of this, the data obtained must be seen in terms of the close correlation between the mitochondrial action played by NO and the contemporary and consequent activation of unique signal transduction mechanisms. CONCLUSIONS: This may prove important to our understanding of preconditioning mechanisms involving the myocardial and confirms the role played by the said kinases with regard to the survival of hypoxic and ischemic human heart tissue. Although not final, these deductions may be important in clinical and therapeutic terms for the management of critical patients.

Biomolecular and biochemical response of myocardial cell to ischemia and reperfusion in the course of heart surgery.

BACKGROUND: Previous studies have shown that biomolecular and biochemical adaptive changes antagonize oxidative damage due to hypoxia and ischemia in myocardial cells. The aim of our study was to verify in human ischemic and reperfused cardiac tissue the relationship between mitochondrial enzyme activities and the activation of HSP70 and c-fos syntheses in the context of a cytoprotective mechanism. Nitric oxide (NO) modulating effects on mitochondrial respiratory chain enzyme activities in ischemic and reperfused tissue were investigated (preliminary report). METHODS: During elective coronary artery bypass grafting, in 30 consecutive patients ventricle samples were taken one before aortic clamping the second after 55+/-8 min ischemic period and the third 34+/-5 after final reperfusion. Coronary sinus blood samples were taken in parallel to assess free radical release measured by malonaldehyde (MDA) levels. In a small number of patients (N=5) nitric oxide tissue levels were analyzed. RESULTS: When compared with normoxic tissue, a significant decrease in cytochrome Coxidase (COX) and succinate Cyt-c reductase (SCR) activities in ischemic and reperfused samples were observed. The activation of HSP70-72 and c-fos transcription factor was evident in courses of ischemia and reperfusion. Blood MDA levels underline the concept that oxyradical generation characterize the peroxidative damage in reoxygenated myocardial tissue while adaptive changes which occur in ischemic cells seem to antagonize the oxyradical injury. CONCLUSIONS: In the course of heart surgery the myocardial cell seems to prevent ischemic damage by activating some peculiar biomolecular and biochemical adaptive changes which permit the reversibility of the oxidative injury. In contrast it appears evident that massive and rapid reoxygenation of the cardiac tissue leads to peroxidative damage due to oxyradical generation. Nitric oxide seems to play a crucial role in cellular adaptation to ischemia even if further studies will be needed to elucidate these findings. From the data obtained in this work we cannot draw certain conclusions in terms of human cardiac cell adaptation to ischemia whereas it seems convincible that reoxygenation, as actually employed in clinical practice, compromises the integrity of the cells.

[Reconstruction of the aortic root: midterm results]. / Ricostruzione della radice aortica: risultati a medio termine.

BACKGROUND: The aim of this study was to assess mid-term results of aortic reconstruction. METHODS: According to Dr. David's technique, 20 patients (17 males, 3 females, median age 63 years) were examined, who underwent surgery between September 1996 and August 1999. Indications for operation were aortic insufficiency with ascending aorta aneurysm in 19 patients, and acute Stanford type A dissection in 1 patient. In every patient the native valve was preserved and suspended inside a tubular prosthesis on which the coronaries were reimplanted. RESULTS: No patient died in hospital. Follow-up (mean 13 months) was complete for all patients. One patient died of extracardiac causes. Seventeen of 19 survivors are in NYHA functional class I, the remaining 2 in class II. Nineteen patients underwent echocardiography which showed moderate aortic regurgitation in 1, mild in 6 and absent or trivial in 12. There were no instances of thromboembolism. CONCLUSIONS: These results are encouraging and have brought us to consider aortic reconstruction a valid alternative to traditional aortic root replacement. Dr. David's technique is reproducible and reliable in the long term.

Linear segmental annuloplasty for mitral valve repair.

A method of posterior mitral annulus remodeling is presented. The posterior annulus is divided into three segments, each segment encircled by a suture that is passed in a tourniquet. Coaptation of the leaflets can be achieved by tightening the tourniquets while the ventricle is being filled. This technique is simple and quick, avoids the use of foreign material, and requires less expertise and judgment than traditional annuloplasties.

A continuous suture technique for mechanical or bioprosthetic aortic valve replacement.

A continuous suture technique for aortic valve replacement was developed early in our experience. This technique has proved to be simple, quick, effective, and to have several advantages over alternative techniques.

Echocardiographic assessment of aortic valve replacement with stentless porcine xenografts.

Stentless porcine xenografts (SPXs) implanted in the aortic position have potential hemodynamic advantages over traditional valve prostheses because of the lack of a rigid stent. Twenty-four patients (mean age 59 years) who underwent aortic valve replacement with SPXs were studied by echocardiography early after and 26 +/- 10 months (range 8 to 40) after operation. Peak and mean gradients, as well as aortic valve area, did not change significantly from baseline (16.3 +/- 8 and 9.8 +/- 5.6 mm Hg, and 1.78 +/- 0.63 cm2, respectively) to follow-up study (12.5 +/- 5 and 7.7 +/- 3 mm Hg, and 1.8 +/- 0.65 cm2, respectively). At baseline, color flow Doppler imaging showed aortic valve regurgitation where the leaflets coapted centrally in 17 of 24 patients (trivial, n = 14; mild, n = 3). Besides the central leak, paravalvular regurgitation was seen in 4 patients (trivial, n = 3; mild, n = 1). At follow-up, 18 of 24 patients had aortic valve regurgitation (trivial, n = 11; mild, n = 6; and moderate, n = 1). New valvular regurgitation (graded as trivial, n = 2; mild, n = 2; and moderate, n = 1) was detected in 5 patients, and new paravalvular regurgitation (graded as mild) developed in 1 patient. Two patients underwent repeat operation for valve-related complications: (1) rupture of a valve cusp with acute pulmonary edema, and (2) fibrotic stenosis of the left coronary ostium with unstable angina. In conclusion, this study demonstrates good hemodynamic performance of the SPX in the aortic position.(ABSTRACT TRUNCATED AT 250 WORDS)

Regurgitant flow of mitral valve prostheses: an intraoperative transesophageal echocardiographic study.

To assess the regurgitant characteristics of mitral biologic and mechanical prostheses immediately after implantation, intraoperative transesophageal echocardiography was performed in 27 patients, aged 32 to 69 years, undergoing open-heart surgery for rheumatic heart disease (n = 19), mitral valve prolapse (n = 3), malfunctioning prostheses (n = 3), or periprosthetic leaks (n = 2). The prostheses included 13 biologic (Carpentier-Edwards) and 14 mechanical valves (five Starr-Edwards, five Medtronic-Hall, and four Bjork-Shiley). Physiologic transvalvular regurgitant flow was detected in both biologic and mechanical prostheses. The spatial extent of the regurgitant jets was usually greater in the mechanical than in the biologic valves, and systolic jets, characteristic of each type of valve, were visualized consistently. Trivial periprosthetic jets (PPJs) were observed in many implanted valves (14/27). The median maximal jet area was 0.46 cm2 (range 0.1 to 1.5 cm2). Cardiopulmonary bypass was reinstituted in two patients. In one patient a PPJ was judged extensive enough (area 3.6 cm2) to warrant surgical revision of the implant, but no dehiscence was found. In the other patient a turbulent PPJ (area 5.5 cm2) was associated with a 0.5 cm dehiscence at the surgical inspection. In conclusion, (1) all mitral prostheses exhibit physiologic transvalvular regurgitation, (2) trivial mitral PPJ is a common finding in newly implanted mitral valves and does not require the revision of the implant, and (3) further experience based on larger series of patients is required to determine the maximal acceptable size of a mitral PPJ detected by intraoperative transesophageal echocardiography.

Intraoperative echocardiography by a new miniaturized epicardial probe: preliminary findings.

Miniaturized probes constitute recent progress in the field of epicardial echocardiography. We recently used a new miniaturized probe, derived from a standard transesophageal probe, in a series of 12 adult patients who underwent cardiac surgery in order to test the possibility of obtaining new views for epicardial imaging. This study demonstrates the feasibility and safety of performing intraoperative echocardiography when using a miniaturized epicardial probe. This probe may be placed on a broader epicardial and vascular area, thus overcoming the size limitations of the commonly used epicardial probes. The major limitation found with the miniaturized probe, however, was the inability to obtain a true four-chamber view from the ventricular apex, due to the difficulty of holding the probe motionless between the apex and the diaphragm while the heart is beating. Although extensive experience with larger groups of patients and different pathologies will be required to define the full potential of this new probe, the advent of the miniaturized probe may further expand the applicability of epicardial echocardiography in pediatric patients during surgery for congenital heart disease.

Corrective repair of complete atrioventricular canal defects and major associated cardiac anomalies.

Twenty-nine patients with balanced forms of complete atrioventricular (AV) canal defects and tetralogy of Fallot in 12, double-outlet right ventricle (DORV) in 10, and additional anomalies associated with atrial isomerism in 7 underwent corrective repair. Age ranged from 39 days to 24 years (median, 3.7 years). Repair included reconstruction of the common AV valve in 25 patients and prosthetic valve replacement in 4. Construction of an intraventricular tunnel connecting the left ventricle with the aorta was accomplished in 23 of 25 patients with ventriculoarterial concordant or double-outlet connections. In 2 patients with situs inversus and associated DORV and in 4 patients in the isomerism group who had ventriculoarterial discordant connections, repair included intraatrial venous diversion by a modified Senning procedure in 2, a modified Mustard venous switch in 1, and a tailored atrial baffle in 3. A valved extracardiac conduit was required for repair in 4 patients. Partial anomalous systemic venous connection was repaired in 7 patients and total anomalous pulmonary venous connection, in 5. There was 1 hospital death (3%) and 3 late deaths (11%). There was 1 (3.6%) reoperation to replace an incompetent right (systemic) AV valve 17 months postoperatively, and each of the 25 surviving patients was in New York Heart Association Functional Class I (80%) or II (20%) at follow-up.