Background Varying work schedules are suspected of increasing risks to pregnant women and to fetal wellbeing. In particular, maternal hormonal disturbance arising from sleep deprivation or circadian rhythm disruption might impair fetal growth or lead to complications of pregnancy. Two independent meta-analyses (from 2000 to 2007) reported a small adverse effect of shift work on the risk of preterm delivery (PTD). However, these reviews were based on few high-quality studies.Objectives To provide an updated review of the associations of shift work with PTD, low birthweight (LBW), smallfor-gestational-age (SGA) infants and pre-eclampsia.Search strategy and selection criteria We conducted a systematic search of MEDLINE using combinations of keywords and MeSH terms.Data collection and analysis For each relevant paper we abstracted standard details, used to summarise design features and rate methodological quality. We calculated pooled estimates of relative risk (RR) in random-effect meta-analyses.Main results We retrieved 23 relevant studies. The pooled estimate of RR for PTD was 1.16 (95% CI 1.00-1.33, 16 studies), but when five reports of poorer methodological quality were excluded, the estimated RR decreased to 1.03 (95% CI 0.93-1.14). We also observed increased RRs for LBW (RR 1.27, 95% CI 0.93-1.74) and for SGA (RR 1.12, 95% CI 1.03-1.22), which varied little by study quality. Little evidence was found on pre-eclampsia.Conclusions These findings suggest that overall, any risk of PTD, LBW, or SGA arising from shift work in pregnancy is small.Keywords Meta-analysis, occupational exposures, preterm delivery, shift work, small for gestational age.Please cite this paper as: Bonzini M, Palmer K, Coggon D, Carugno M, Cromi A, Ferrario M. Shift work and pregnancy outcomes: a systematic review with meta-analysis of currently available epidemiological studies.
Background. Intestinal-type primary vaginal adenocarcinoma is an extremely rare neoplasm, and very few cases are reported adenocarcinoma at vaginal level (an organ almost free from glandular tissue) is particularly challenging given the anatomical this district. The main diagnostic issue consists in determining whether the vaginal neoplasm is primary, or it is a metastatic disease that extends to the vagina. A fundamental role in guiding diagnostic and therapeutic pathways is played by the pathologist. Objective. This study is a systematic review of the literature therapeutic approaches chosen for every single case of intestinal-type primary vaginal adenocarcinoma described. Moreover, we report the case diagnosed and managed at our center. Methods. PubMed, ClinicalTrials.gov, Scopus, and Web of Science databases were systematically searched for records from January 1 st , 1989, to December 1 st , 2019. Results. Overall, 23 cases of intestinal-type primary vaginal adenocarcinoma are reported in the literature. This tumor often presents with atypical vaginal discharge (64.7% of cases) third (83.3%) of the vagina. The average age at its presentation is 53.6 years. Diagnostic workup looks at ruling out possible primary distant sources of the disease and colonoscopy is often a major role, and the key markers investigated are CEA, CK20, CK7, and CDX2. Most patients are diagnosed with early-stage disease (85% of patients FIGO I) and the lesion average size is 3 cm. Of 18 patients with available data, a surgical approach was adopted in 8 cases. Ten patients underwent radiotherapy.
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