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This study aimed to calculate Italy’s first national maternal mortality ratio (MMR) through an innovative record-linkage approach within the enhanced Italian Obstetric Surveillance System (ItOSS). A record-linkage retrospective cohort study was conducted nationwide, encompassing all women aged 11–59 years with one or more hospitalizations related to pregnancy or pregnancy outcomes from 2011 to 2019. Maternal deaths were identified by integrating data from the Death Registry and national and regional Hospital Discharge Databases supported by the integration of findings from confidential enquiries conducted through active surveillance. Maternal Mortality Ratio (MMR), direct MMR (DMMR), and causes of maternal death are the study main outcomes. The MMR was found to be 8.4 per 100,000 live births (95% CI 7.5–9.3), significantly higher than the 3.9 per 100,000 (95% CI 3.3–4.5) calculated solely from the Death Registry, with a notable declining trend over the study period. Causes of death have been classified according to the 10th International Classification of Diseases. Within 42 days from pregnancy outcome, leading causes were obstetric haemorrhage, sepsis, and cardiovascular diseases. Late maternal deaths were primarily attributed to suicide, malignancies, and cardiovascular diseases. This integrated methodology provides a comprehensive understanding of maternal mortality trends and causes in Italy, offering valuable insights for countries utilizing or planning enhanced surveillance systems.

Background. The global increase in caesarean section (CS) rates raises concerns about maternal and neonatal outcomes. Italy, with one of the highest CS rates in Europe, especially in the Calabria Region, faces challenges in reducing this trend. The Calabria Region has joined the “Easy-Net” Network Program (NET-2016-02364191) for the evaluation of audit & feedback (A&F) interventions to reduce CS rate. This study aims to analyze past trends, describe maternity unit (MU) characteristics, and provide a baseline assessment of CS rates using the Robson’s Ten Group Classification System (TGCS). Methods. This population-based cross-sectional study analyses CS rates using data from National and Regional Birth Registers, categorizing women with the Robson’s TGCS. Results. From 2017 to 2020, 54,041 births were registered in the Calabria Region. The results reveal a fluctuating CS rate (36.2%-38.1%) with variations from different Robson groups. Group 5 (previous CS) consistently increased, impacting overall rates, while Group 1 (nulliparous, cephalic, spontaneous labor) decreased. The groups 2b (6.8%-4.8%) and 4b (2.5%-1.8%), which represent respectively nulliparous and multiparous women with pre-labour CS, showed high rates despite their reduction over the years. In 2020, variations in CS rates across 11 MUs highlighted complexities, emphasizing the need for localized interventions. Conclusions. The study highlights the critical issue of high CS rates in the Calabria Region. It is advisable to monitor and reduce unnecessary CSs through evidence-based interventions, taking advantage of the Robson classification and an A&F strategy. These findings guide future efforts to enhance CS appropriateness and improve maternal and child health outcomes.

The variety of placental morphological findings with SARS-CoV-2 maternal infections has raised the issue of poor agreement in histopathological evaluation. The aims of this study were: to describe the histopathological placental features of a large sample of SARS-CoV-2-positive women who gave birth in Italy during the COVID-19 pandemic, to analyse the factors underlying these lesions, and to analyse the impact of placental impairment on perinatal outcomes. From 25 February 2020 to 30 June 2021, experienced perinatal pathologists examined 975 placentas of SARS-CoV-2-positive mothers enrolled in a national prospective study, adopting the Amsterdam Consensus Statement protocol. The main results included the absence of specific pathological findings for SARS-CoV-2 infections, even though a high proportion of placentas showed signs of inflammation, possibly related to a cytokine storm induced by the virus, without significant perinatal consequences. Further research is needed to better define the clinical implications of placental morphology in SARS-CoV-2 infections, but the results of this large cohort suggest that placentas do not seem to be a preferential target for the new Coronavirus infection.

Translating evidence-based guidelines into clinical practice is a complex challenge. This observational study aimed to assess the adherence to the Italian national guidelines on postpartum haemorrhage (PPH) and describe the clinical management of haemorrhagic events in a selection of maternity units (MUs) in six Italian regions, between January 2019 and October 2020. A twofold study design was adopted: (i) a before–after observational study was used to assess the adherence to national clinical and organisational key recommendations on PPH management, and (ii) a cross-sectional study enrolling prospectively 1100 women with PPH ≥ 1000 mL was used to verify the results of the before–after study. The post-test detected an improved adherence to 16/17 key recommendations of the guidelines, with clinical governance and communication with family members emerging as critical areas. Overall, PPH management emerged as appropriate except for three recommended procedures that emphasise different results between the practices adopted and the difference between what is considered acquired and what is actually practised in daily care. The methodology adopted by the MOVIE project and the adopted training materials and tools have proved effective in improving adherence to the recommended procedures for appropriate PPH management and could be adopted in similar care settings in order to move evidence into practice.

L’Italia è uno dei Paesi Europei con più alto tasso di tagli cesarei (TC) con grande variabilità inter e intraregionale. Nel 2021 la Calabria è risultata essere la terza regione italiana per alto tasso di TC (38,5%). La Regione Calabria ha aderito al programma di rete “Easy-Net” del Ministero della salute (NET-2016-02364191) sulla valutazione degli interventi di audit & feedback (A&F) (Easy-Net https://easy-net.info/). Il Progetto Easy-Net, coordinato dal Dipartimento di Epidemiologia del Servizio sanitario regionale del Lazio, e in Regione Calabria dall’Azienda Ospedaliera (AO) Pugliese Ciaccio di Catanzaro insieme al Ministero della salute e all’Istituto superiore di sanità, ha l’obiettivo di ridurre il tasso di TC in Regione Calabria, attraverso interventi volti alla promozione della qualità dell’assistenza ostetrica e perinatale basati sulla strategia di A&F. L’approccio multi-strategico adottato prevede l’utilizzo della classificazione di Robson, per identificare le aree critiche suscettibili di miglioramento nell’appropriatezza delle indicazioni al TC, e attività di A&F, per facilitare l’identificazione dei bisogni formativi e offrire percorsi di aggiornamento professionale. Questo articolo descrive il protocollo dello studio Easy-Net WP6 “Prospective audit and feedback approach: effectiveness in improving healthcare practice and in reducing the Caesarean Section rate” (NET-2016-02364191-6). Il progetto si sviluppa in cinque fasi che prevedono la rilevazione pre-intervento dei dati relativi agli indicatori di interesse e degli atteggiamenti del personale sul ricorso al TC e alla strategia di A&F. Dopo 12 mesi di intervento di A&F è prevista la rilevazione post-intervento e il calcolo degli indicatori e dei determinanti di appropriatezza. È inoltre previsto uno studio rivolto alle donne per rilevare le opinioni sul ricorso al TC su richiesta materna. Il protocollo dello studio è stato approvato dal Comitato Etico dell’AO Pugliese Ciaccio.

Background/Objectives: The increasing incidence of cancer during pregnancy is a growing public health concern, driven by delayed parenthood and rising maternal age. Pregnancy-associated cancer (PAC) presents complex clinical challenges, necessitating a balance between maternal cancer treatment and fetal safety. Historically considered incompatible with favorable pregnancy outcomes, evidence now suggests that pregnancy can often proceed without affecting cancer prognosis. A 2022 study in Italy provided the first population-based PAC estimates by linking cancer registries (CRs) and hospital discharge records (HDRs). This study aimed to update PAC estimates to 2019, covering 30% of the Italian population and addressing prior data limitations. Methods: A retrospective longitudinal analysis was conducted on women aged 15–49 diagnosed with malignant cancers between 2003 and 2019. Data from 21 Italian CRs were linked with HDRs to identify PAC cases, defined as obstetric hospitalizations occurring for women diagnosed with cancer in our study cohort in the period spanning from one year before to two years after a cancer diagnosis. All malignant cancers, excluding non-melanoma skin cancers, were analyzed. PAC rates were calculated per 1000 pregnancies, and trends were assessed using log-linear and JoinPoint regression models. Results: Among 131,774 women diagnosed with cancer, 6329 PAC cases were identified, with a PAC rate of 1.43 per 1000 pregnancies, consistent with global estimates. Thyroid (24.4%) and breast cancer (23.2%) were the most common. Analyzing the PAC rate by pregnancy outcome, in the period 2015–2019, this increased for both childbirths and miscarriages but decreased for voluntary terminations. Most hospitalizations (54%) occurred pre-diagnosis, peaking at diagnosis, especially for breast cancer (69%). Conclusions: PAC incidence is rising, particularly for live births and miscarriages, underscoring the need for multidisciplinary care and robust epidemiological insights to guide clinical management.

Maternal sepsis represents a leading cause of mortality and severe morbidity worldwide. In Italy, it is the second cause of direct maternal mortality. Delay in recognition and treatment initiation are the drivers of sepsis-associated adverse outcomes. Between November 2017 and October 2019, the Italian Obstetric Surveillance System coordinated a prospective population-based study on maternal sepsis occurring before or after childbirth from 22 weeks’ gestation onward and up to 42 days following the end of pregnancy. A nested 1:2 matched case-control study on postpartum sepsis was also performed. Maternal sepsis was diagnosed for the presence of suspected or confirmed infection alongside signs or symptoms of organ failure. The aim of this study was to assess maternal sepsis incidence and its associated risk factors, management, and perinatal outcomes. Six Italian regions, covering 48.2% of the national births, participated in the project. We identified an incidence rate of 5.5 per 10,000 maternities (95% CI 4.80–6.28). Seventy percent of patients had a low education level and one third were foreigners with a language barrier. Genital, respiratory, and urinary tract infections were the predominant sources of infection; the majority of cases was caused by E. coli and polymicrobial infections. The presence of vascular and indwelling bladder catheters was associated with a nine-fold increased risk of postpartum sepsis. There were no maternal deaths, but one fourth of women experienced a serious adverse event and 28.3% required intensive care; 1.8% of newborns died. Targeted interventions to increase awareness of maternal sepsis and its risk factors and management should be promoted.

Come si è arrivati a uno scollamento tale, per cui una nutrita comunità scientifica produce in modo quasi ossessivo evidenze sulla centralità dei così detti “primi mille giorni” di vita di un feto-neonato e, dall’altra parte, si ammette la brutalità, istituzionalizzata, di bambini cresciuti all’interno di un carcere? È tutto sbagliato. La vita è all’interno di una struttura che non sarà mai adeguata a un bambino. Questo bambino vorrebbe invitare gli amici a giocare ma sa di non poterlo fare, non tanto per i divieti del carcere ma perché è consapevole di “trovarsi in una situazione di cui non rendere partecipi i compagni”1. Ogni anno circa 100.000 bambini entrano in un carcere italiano (più di due milioni in Europa) per fare visita a uno o entrambi i genitori detenuti. Chi guida questi bambini, chi li orienta, chi li protegge fino a quando non saranno in grado di farlo da soli? E il corpo di polizia penitenziaria che si trova ad avere a che fare con un bambino, viene adeguatamente formato e, se necessario, ascoltato, sostenuto?

Introduction The study was implemented to provide guidance to decision-makers and clinicians by describing hospital care offered to women who gave birth with confirmed COVID-19 infection. Materials and methods National population‐based prospective cohort study involving all women with confirmed COVID-19 who gave birth between February 25 and April 22, 2020 in any Italian hospital. Results The incidence rate of confirmed SARS-CoV-2 infection in women who gave birth was 2.1 per 1000 maternities at a national level and 6.9/1000 in the Lombardy Region. Overall one third of the women developed a pneumonia and 49.7% assumed at least one drug. Caesarean rate was 32.9%, no mothers nor newborns died. Six percent of the infants tested positive for SARS – CoV-2 at birth. Conclusions Clinical features and outcomes of COVID-19 in women who gave birth are similar to those described for the general population, most women developing mild to moderate illness.

The new coronavirus emergency spread to Italy when little was known about the infection’s impact on mothers and newborns. This study aims to describe the extent to which clinical practice has protected childbirth physiology and preserved the mother–child bond during the first wave of the pandemic in Italy. A national population-based prospective cohort study was performed enrolling women with confirmed SARS-CoV-2 infection admitted for childbirth to any Italian hospital from 25 February to 31 July 2020. All cases were prospectively notified, and information on peripartum care (mother–newborn separation, skin-to-skin contact, breastfeeding, and rooming-in) and maternal and perinatal outcomes were collected in a structured form and entered in a web-based secure system. The paper describes a cohort of 525 SARS-CoV-2 positive women who gave birth. At hospital admission, 44.8% of the cohort was asymptomatic. At delivery, 51.9% of the mothers had a birth support person in the delivery room; the average caesarean section rate of 33.7% remained stable compared to the national figure. On average, 39.0% of mothers were separated from their newborns at birth, 26.6% practised skin-to-skin, 72.1% roomed in with their babies, and 79.6% of the infants received their mother’s milk. The infants separated and not separated from their SARS-CoV-2 positive mothers both had good outcomes. At the beginning of the pandemic, childbirth raised awareness and concern due to limited available evidence and led to “better safe than sorry” care choices. An improvement of the peripartum care indicators was observed over time.