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2.
AJOG Glob Rep ; 3(3): 100246, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37645655

RESUMEN

BACKGROUND: Previous studies that evaluated low gestational weight gain or weight loss among prepregnancy obesity classes have not determined the amount of gestational weight gain associated with the lowest risk of adverse perinatal outcomes and neonatal morbidity among singleton term births. OBJECTIVE: This study aimed to evaluate the relationship of specific gestational weight gain categories of weight loss, stable weight, and low gain considered below the 2009 Institute of Medicine guidelines to perinatal outcomes and neonatal morbidity for singleton, term live births among prepregnancy obesity classes. STUDY DESIGN: This was a retrospective cohort study of 18,476 women among 3 classes of prepregnancy obesity, based on measured prepregnancy weight, and delivering a live singleton pregnancy at ≥37 weeks of gestation at a Kaiser Permanente Northern California hospital (2009-2012). Variables from electronic medical records included perinatal outcomes, sociodemographics, and measured prepregnancy and delivery weights to calculate total gestational weight gain, used to define 5 gestational weight gain categories: weight loss (<-2.0 kg), stable weight (-2.0 to +1.9 kg), low gain (+2.0 to 4.9 kg), gain within guidelines (+5.0 to 9.1 kg; referent), and gain above guidelines (>9.1 kg). Logistic regression models estimated adjusted odds ratios and 95% confidence intervals of maternal and newborn perinatal outcomes (hypertensive disorders, cesarean delivery, size for gestational age, length of stay, neonatal intensive care unit admission) associated with gestational weight gain categories stratified by prepregnancy obesity classes 1, 2, and 3. RESULTS: Low gain occurred in 8%, 12%, and 13% of women in obesity class 1 (body mass index, 30.0-34.9), class 2 (body mass index, 35.0-39.9), and class 3 (body mass index, ≥40), respectively. Compared with gestational weight gain within Institute of Medicine guidelines, low gain was associated with similar or improved maternal and newborn perinatal outcomes for all obesity classes without increased odds of neonatal intensive care unit admission, neonatal length of stay ≥3 days, or small for gestational age. The percentages of small for gestational age for the low gain category were 4.4%, 3.0%, and 4.3% among prepregnancy obesity classes 1, 2, and 3, respectively, and comparable with the gestational weight gain within the guideline category (P>.05). The adjusted odds ratios of small-for-gestational age were not statistically significant for all obesity classes; class 1 (1.16; 95% confidence interval, 0.79-1.71) , class 2 (1.05; 95% confidence interval 0.58-1.93), and class 3 (2.03; 95% confidence interval 0.97-4.27). CONCLUSION: Lower gestational weight gain of +2.0 to 4.9 kg showed the most favorable perinatal outcomes, without higher small for gestational age or neonatal morbidity for all obesity classes.

3.
JAMA ; 329(7): 593, 2023 02 21.
Artículo en Inglés | MEDLINE | ID: mdl-36809327
4.
Pregnancy Hypertens ; 28: 134-138, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35381471

RESUMEN

OBJECTIVE: To evaluate the association of blood pressure category < 20 weeks according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) criteria with adverse perinatal outcomes. STUDY DESIGN: A retrospective cohort study of singleton deliveries between 1/2014 and 10/2017 was undertaken. Blood pressure category assigned by 2017 ACC/AHA criteria applied to blood pressures prior to 20 weeks gestation: normal (systolic < 120 and diastolic < 80), elevated blood pressure (systolic 120-129 and diastolic < 80 mmHg), stage 1 hypertension (systolic 130-139 and/or diastolic 80-89), stage 2 hypertension (prior diagnosis of chronic hypertension or systolic ≥ 140 or diastolic ≥ 90 mmHg). MAIN OUTCOME MEASURES: The primary outcome was preeclampsia. Secondary outcomes included preterm birth and postpartum readmission. Chi-square, ANOVA and Kruskal-Wallis tests and multivariable Poisson regression were used for analysis. RESULTS: Of the 6,067 eligible pregnancies, 3,855 (63.5%) had normotensive blood pressure, 1,224 (20.2%) elevated blood pressure, 624 (10.3%) stage 1 hypertension, and 364 (6.0%) stage 2 hypertension. Compared to 4.6% prevalence of preeclampsia among normotensive pregnancies, higher categories were associated with higher preeclampsia prevalence: elevated blood pressure (10.7%, adjusted relative risk (aRR) 2.2, 95% confidence interval (CI) 1.8-2.6), stage 1 hypertension (15.1%, aRR 2.7, 95% CI 2.2-3.4) and stage 2 hypertension (38.7%, aRR 6.2, 95% CI 5.1-7.4). Non-normal categories were also associated with a higher risk of preterm birth and postpartum readmission. CONCLUSION: Patients with elevated blood pressure and stage 1 and 2 hypertension at < 20 weeks are at increased risk of adverse obstetric perinatal outcomes.


Asunto(s)
Hipertensión , Preeclampsia , Nacimiento Prematuro , Presión Sanguínea/fisiología , Femenino , Humanos , Recién Nacido , Preeclampsia/epidemiología , Embarazo , Nacimiento Prematuro/epidemiología , Estudios Retrospectivos , Estados Unidos/epidemiología
7.
Am J Perinatol ; 38(2): 105-110, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32736408

RESUMEN

OBJECTIVE: This study aimed to assess the association of preimplantation genetic testing (PGT) with abnormal placentation among a cohort of pregnancies conceived after frozen embryo transfer (FET). STUDY DESIGN: This is a retrospective cohort study of women who conceived via FET at the University of California, San Francisco from 2012 to 2016 with resultant delivery at the same institution. The primary outcome was abnormal placentation, including placenta accreta, retained placenta, abruption, placenta previa, vasa previa, marginal or velamentous cord insertion, circumvallate placenta, circummarginate placenta, placenta membranacea, bipartite placenta, and placenta succenturiata. Diagnosis was confirmed by reviewing imaging, delivery, and pathology reports. Our secondary outcome was hypertensive disease of pregnancy. RESULTS: A total of 311 pregnancies were included in analysis; 158 (50.8%) underwent PGT. Baseline demographic characteristics were similar between groups except for age at conception and infertility diagnosis. Women with PGT were more likely to undergo single embryo transfer (82.3 vs. 64.1%, p < 0.001). There were no statistically significant differences in the rate of the primary outcome (26.6 vs. 27.4%, p = 0.86) or hypertensive disorders of pregnancy (33.5 vs. 33.3%, p = 0.97), which remained true after multivariate analysis was performed. CONCLUSION: Among pregnancies conceived after FET, PGT is not associated with a statistically significant increased risk of abnormal placentation or hypertensive disorders of pregnancy. KEY POINTS: · In pregnancies conceived by FET, PGT is not associated with increased risk of abnormal placentation.. · In pregnancies conceived by FET, PGT is not associated with increased risk of hypertensive disorders.. · Differences in outcomes of PGT pregnancies may be related to FET rather than trophectoderm biopsy..


Asunto(s)
Transferencia de Embrión/efectos adversos , Pruebas Genéticas/estadística & datos numéricos , Hipertensión Inducida en el Embarazo/epidemiología , Enfermedades Placentarias/epidemiología , Adulto , Criopreservación/métodos , Femenino , Humanos , Hipertensión Inducida en el Embarazo/etiología , Modelos Logísticos , Análisis Multivariante , Enfermedades Placentarias/etiología , Embarazo , Estudios Retrospectivos , San Francisco/epidemiología
8.
Obstet Gynecol ; 136(5): 972-980, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33030865

RESUMEN

In this Commentary, we explain the case for a standardized cesarean delivery surgical technique. There are three strong arguments for a standardized approach to cesarean delivery, the most common major abdominal surgery performed in the world. First, standardization within institutions improves safety, efficiency, and effectiveness in health care delivery. Second, surgical training among obstetrics and gynecology residents would become more consistent across hospitals and regions, and proficiency in performing cesarean delivery measurable. Finally, standardization would strengthen future trials of cesarean delivery technique by minimizing the potential for aspects of the surgery which are not being studied to bias results. Before 2013, more than 155 randomized controlled trials, meta-analyses or systematic reviews were published comparing various aspects of cesarean delivery surgical technique. Since 2013, an additional 216 similar studies have strengthened those recommendations and offered evidence to recommend additional cesarean delivery techniques. However, this amount of cesarean delivery technique data creates a forest for the trees problem, making it difficult for a clinician to synthesize this volume of data. In response to this difficulty, we propose a comprehensive, evidence-based and standardized approach to cesarean delivery technique.


Asunto(s)
Cesárea/normas , Atención a la Salud/normas , Obstetricia/normas , Femenino , Humanos , Embarazo , Estándares de Referencia
10.
Am J Perinatol ; 36(5): 443-448, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30414602

RESUMEN

OBJECTIVE: This article evaluates gender differences in academic rank and National Institutes of Health (NIH) funding among academic maternal-fetal medicine (MFM) physicians. STUDY DESIGN: This was a cross-sectional study of board-certified academic MFM physicians. Physicians were identified in July 2017 from the MFM fellowship Web sites. Academic rank and receipt of any NIH funding were compared by gender. Data on potential confounders were collected, including years since board certification, region of practice, additional degrees, number of publications, and h-index. RESULTS: We identified 659 MFM physicians at 72 institutions, 312 (47.3%) male and 347 (52.7%) female. There were 246 (37.3%) full, 163 (24.7%) associate, and 250 (37.9%) assistant professors. Among the 154 (23.4%) MFM physicians with NIH funding, 89 (57.8%) were male and 65 (42.2%) were female (p = 0.003). Adjusting for potential confounders, male MFM physicians were twice as likely to hold a higher academic rank than female MFM physicians (adjusted odds ratio [aOR], 2.04 [95% confidence interval, 1.39-2.94], p < 0.001). There was no difference in NIH funding between male and female MFM physicians (aOR, 1.23 [0.79-1.92], p = 0.36). CONCLUSION: Compared with female academic MFM physicians, male academic MFM physicians were twice as likely to hold a higher academic rank but were no more likely to receive NIH funding.


Asunto(s)
Docentes Médicos/estadística & datos numéricos , National Institutes of Health (U.S.)/economía , Obstetricia , Perinatología , Médicos/estadística & datos numéricos , Apoyo a la Investigación como Asunto/estadística & datos numéricos , Estudios Transversales , Docentes Médicos/economía , Becas , Femenino , Humanos , Masculino , Médicos/economía , Embarazo , Factores Sexuales , Estados Unidos
11.
Eur J Obstet Gynecol Reprod Biol ; 231: 180-187, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30396107

RESUMEN

Intrahepatic cholestasis of pregnancy (ICP) is a poorly understood disease of the late second or third trimester of pregnancy, typically associated with rapid resolution following delivery. It is characterized by pruritis, elevated serum bile acids, and abnormal liver function tests and has been linked to stillbirth, meconium passage, respiratory distress syndrome and fetal asphyxial events. The incidence is highly variable, dependent both on the ethnic makeup of the population as well as the diagnostic criteria being used. Management is challenging for clinicians, as laboratory abnormalities often lag behind clinical symptoms making diagnosis difficult. The American Congress of Gastroenterology, Government of Western Australia Department of Health, the Royal College of Obstetricians and Gynaecologists, Society for Maternal Fetal Medicine, European Association for the Study of the Liver, and South Australia Maternal and Neonatal Community of Practice have all released guidelines to address the risks, diagnosis and management of ICP. We performed a descriptive review of these guidelines along with a literature search to address conflicting recommendations and highlight new evidence. The variations in the guidelines reflect the heterogeneity of the literature and the challenges of diagnosing and managing ICP.


Asunto(s)
Colestasis Intrahepática/diagnóstico , Colestasis Intrahepática/tratamiento farmacológico , Parto Obstétrico , Guías de Práctica Clínica como Asunto , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/tratamiento farmacológico , Colagogos y Coleréticos/uso terapéutico , Dexametasona/uso terapéutico , Femenino , Humanos , Embarazo , Ácido Ursodesoxicólico/uso terapéutico
12.
JAMA ; 320(14): 1439-1440, 2018 10 09.
Artículo en Inglés | MEDLINE | ID: mdl-30304414
13.
Am J Perinatol ; 35(12): 1173-1177, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-29689578

RESUMEN

OBJECTIVE: Given that recent consensus guidelines established to decrease cesarean delivery (CD) rates use 6 cm to define the onset of the active phase of labor, our objective was to evaluate maternal and neonatal outcomes after CD for the indication of arrest of dilation at 4 to 5 cm compared with ≥ 6 cm. STUDY DESIGN: We performed a secondary analysis using data from the Maternal Fetal-Medicine Units Network Cesarean Registry. We included nulliparous women with term, singleton, vertex gestations who underwent primary CD for arrest of dilation. We compared those who reached a maximum cervical dilation of 4 to 5 cm with those of ≥6 cm. Our primary outcome was composite maternal morbidity that included chorioamnionitis, endometritis, transfusion, wound complication, operative injury, intensive care unit admission, or death. RESULTS: Of the 73,257 women in the dataset, 5,681 met the inclusion criteria. After adjusting for confounders, there was no difference in composite maternal (adjusted odds ratio [aOR]: 1.19; 95% confidence interval [CI]: 0.94-1.52) or neonatal morbidity (aOR: 0.94; 95% CI: 0.79-1.10) between the groups. CONCLUSION: In this historical cohort, maternal and neonatal outcomes after CD for arrest of dilation ≥ 6 cm were comparable to those performed at 4 to 5 cm and support recent labor management guidelines.


Asunto(s)
Cesárea/estadística & datos numéricos , Corioamnionitis/epidemiología , Primer Periodo del Trabajo de Parto/fisiología , Complicaciones del Trabajo de Parto/epidemiología , Adulto , Femenino , Humanos , Trabajo de Parto Inducido , Modelos Logísticos , Morbilidad , Periodo Periparto , Guías de Práctica Clínica como Asunto , Embarazo , Estudios Prospectivos , Curva ROC , Adulto Joven
14.
Am J Perinatol ; 35(10): 919-924, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29304545

RESUMEN

OBJECTIVE: The objective of this study was to examine laterality as a predictor of outcomes among fetuses with prenatally diagnosed congenital diaphragmatic hernia (CDH). METHODS: This is a retrospective cohort study of pregnancies with CDH evaluated at our center from 2008 to 2016 compared cases with right-sided CDH (RCDH) versus left-sided CDH (LCDH). The primary outcome was survival to discharge. Secondary outcomes included ultrasound predictors of poor prognosis (liver herniation, stomach herniation, lung area-to-head circumference ratio [LHR]), concurrent anomalies, hydrops, stillbirth, preterm birth, mode of delivery, small for gestational age, use of extracorporeal membrane oxygenation, and length of stay. Terminations and stillbirths were excluded from analyses of neonatal outcomes. RESULTS: In this study, 157 (83%) LCDH and 32 (17%) RCDH cases were identified. Survival to discharge was similar (64 vs. 66.4%, p = 0.49) with regard to laterality. RCDH had higher rates of liver herniation (90.6 vs. 72%, p = 0.03), hydrops fetalis (15.6 vs. 1.3%, p < 0.01), and lower LHR (0.87 vs. 0.99, p = 0.04). LCDH had higher rates of stomach herniation (69.4 vs. 12.5%, p < 0.01). Rates of other outcomes were similar in univariate analyses. Adjusting for microarray abnormalities, the odds for survival to discharge for RCDH compared with LCDH was 0.93 (0.38-2.30, p = 0.88). CONCLUSION: Compared with LCDH, fetuses with RCDH had higher rates of adverse ultrasound predictors, but equivalent survival.


Asunto(s)
Enfermedades Fetales/mortalidad , Hernias Diafragmáticas Congénitas/mortalidad , Diagnóstico Prenatal , Ultrasonografía Prenatal , Anomalías Múltiples , Adolescente , Adulto , Oxigenación por Membrana Extracorpórea , Femenino , Enfermedades Fetales/diagnóstico por imagen , Edad Gestacional , Hernias Diafragmáticas Congénitas/diagnóstico por imagen , Humanos , Recién Nacido , Modelos Logísticos , Pulmón/anatomía & histología , Análisis Multivariante , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , San Francisco , Adulto Joven
15.
Am J Perinatol ; 35(2): 110-119, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28910850

RESUMEN

OBJECTIVE: The objective of this study was to compare national guidelines on the prevention of RhD alloimmunization. STUDY DESIGN: We performed a review of four national guidelines on prevention of alloimmunization from the American Congress of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynaecologists, Society of Obstetricians and Gynaecologists of Canada, and The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. We compared the indications/contraindications, timing, dosing, formulation and route of anti-D immune globulin, and management of unique circumstances. The references were compared with regard to the number of randomized control trials, Cochrane Reviews, and systematic reviews/meta-analyses cited. RESULTS: Variation exists in recommendations on the timing and need for consent prior to routine antenatal anti-D immune globulin administration, prophylaxis for unique circumstances (e.g., threatened abortion < 12 weeks, complete molar pregnancy), and the use of cell-free fetal DNA testing for fetal RhD genotype. CONCLUSION: These variations in recommendations reflect the heterogeneity of the literature on the prevention of alloimmunization and highlight the need for synthesis of evidence to create an international guideline on prevention of alloimmunization. This may improve safety, quality, optimize outcomes, and stimulate future trials.


Asunto(s)
Guías de Práctica Clínica como Asunto , Complicaciones Hematológicas del Embarazo/prevención & control , Atención Prenatal/normas , Isoinmunización Rh/prevención & control , Globulina Inmune rho(D)/uso terapéutico , Australia , Canadá , Femenino , Humanos , Nueva Zelanda , Embarazo , Estados Unidos
16.
Am J Perinatol ; 35(2): 103-109, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28505681

RESUMEN

OBJECTIVE: To determine if there was an association between prenatal care adherence and neonatal intensive care unit (NICU) admission or stillbirth, and adverse perinatal outcomes in women with preexisting diabetes mellitus (DM) and gestational DM (GDM). MATERIALS AND METHODS: This is a retrospective cohort study among women with DM and GDM at a Diabetes in Pregnancy Program at an academic institution between 2006 and 2014. Adherence with prenatal care was the percentage of prenatal appointments attended divided by those scheduled. Adherence was divided into quartiles, with the first quartile defined as lower adherence and compared with the other quartiles. RESULTS: There were 443 women with DM and 499 with GDM. Neonates of women with DM and lower adherence had higher rates of NICU admission or stillbirth (55 vs. 39%; p = 0.003). A multivariable logistic regression showed that the lower adherence group had higher likelihood of NICU admission (adjusted odds ratio: 1.61 [1.03-2.5]; p = 0.035). Those with lower adherence had worse glycemic monitoring and more hospitalizations. Among those with GDM, most outcomes were similar between groups including NICU admission or stillbirth. CONCLUSION: Women with DM with lower adherence had higher rates of NICU admission and worse glycemic control. Most outcomes among women with GDM with lower adherence were similar.


Asunto(s)
Diabetes Gestacional/epidemiología , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Embarazo en Diabéticas/epidemiología , Atención Prenatal/normas , Mortinato/epidemiología , Adulto , Glucemia , Femenino , Edad Gestacional , Humanos , Recién Nacido , Modelos Logísticos , Análisis Multivariante , Embarazo , Estudios Retrospectivos , Rhode Island/epidemiología
17.
Am J Perinatol ; 35(3): 209-214, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28709165

RESUMEN

OBJECTIVE: To determine if there was a difference in glycemic control admissions or perinatal outcomes in women with type 1 diabetes mellitus (DM) treated with multiple daily injections (MDIs) versus continuous subcutaneous insulin infusion (CSII). MATERIALS AND METHODS: This was a retrospective cohort study of women with type 1 DM with a singleton gestation who delivered between 2006 and 2014 at a tertiary hospital and received care at a dedicated DM clinic. Women who used MDI were compared with those who used CSII. The primary outcome was glycemic control admission during pregnancy. Secondary outcomes included adverse perinatal outcomes. RESULTS: There were a total of 156 women; 107 treated with MDI and 49 with CSII. Women treated with MDI had higher rates of glycemic control admissions versus those treated with CSII (68.2 vs. 30.6%, p < 0.001). Adjusting for age, ethnicity, public insurer, duration of DM, first recorded hemoglobin A1c (HbA1c), and DM comorbidities, the likelihood of admission remained higher in women on MDI versus CSII (AOR 5.9 [1.7-20.6]). Women treated with MDI had higher rates of postprandial hypoglycemia. Other perinatal outcomes were similar between the groups. CONCLUSION: Women with type 1 DM treated with MDI were more likely to have glycemic control admissions and postprandial hypoglycemia than those treated with CSII.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hemoglobina Glucada/análisis , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación , Embarazo en Diabéticas/tratamiento farmacológico , Adulto , Glucemia/efectos de los fármacos , Comorbilidad , Femenino , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes/efectos adversos , Recién Nacido , Inyecciones , Insulina/efectos adversos , Sistemas de Infusión de Insulina , Modelos Logísticos , Masculino , Embarazo , Resultado del Embarazo , Estudios Retrospectivos , Rhode Island , Centros de Atención Terciaria , Adulto Joven
18.
JAMA Netw Open ; 1(8): e186529, 2018 12 07.
Artículo en Inglés | MEDLINE | ID: mdl-30646333

RESUMEN

Importance: Congenital Zika virus infection causes a spectrum of adverse birth outcomes, including severe birth defects of the central nervous system. The association of prenatal ultrasonographic findings with adverse neonatal outcomes, beyond structural anomalies such as microcephaly, has not been described to date. Objective: To determine whether prenatal ultrasonographic examination results are associated with abnormal neonatal outcomes in Zika virus-affected pregnancies. Design, Setting, and Participants: A prospective cohort study conducted at a single regional referral center in Rio de Janeiro, Brazil, from September 1, 2015, to May 31, 2016, among 92 pregnant women diagnosed during pregnancy with Zika virus infection by reverse-transcription polymerase chain reaction, who underwent subsequent prenatal ultrasonographic and neonatal evaluation. Exposures: Prenatal ultrasonography. Main Outcomes and Measures: The primary outcome measure was composite adverse neonatal outcome (perinatal death, abnormal finding on neonatal examination, or abnormal finding on postnatal neuroimaging). Secondary outcomes include association of specific findings with neonatal outcomes. Results: Of 92 mother-neonate dyads (mean [SD] maternal age, 29.4 [6.3] years), 55 (60%) had normal results and 37 (40%) had abnormal results on prenatal ultrasonographic examinations. The median gestational age at delivery was 38.6 weeks (interquartile range, 37.9-39.3). Of the 45 neonates with composite adverse outcome, 23 (51%) had normal results on prenatal ultrasonography. Eleven pregnant women (12%) had a Zika virus-associated finding that was associated with an abnormal result on neonatal examination (adjusted odds ratio [aOR], 11.6; 95% CI, 1.8-72.8), abnormal result on postnatal neuroimaging (aOR, 6.7; 95% CI, 1.1-38.9), and composite adverse neonatal outcome (aOR, 27.2; 95% CI, 2.5-296.6). Abnormal results on middle cerebral artery Doppler ultrasonography were associated with neonatal examination abnormalities (aOR, 12.8; 95% CI, 2.6-63.2), postnatal neuroimaging abnormalities (aOR, 8.8; 95% CI, 1.7-45.9), and composite adverse neonatal outcome (aOR, 20.5; 95% CI, 3.2-132.6). There were 2 perinatal deaths. Abnormal findings on prenatal ultrasonography had a sensitivity of 48.9% (95% CI, 33.7%-64.2%) and a specificity of 68.1% (95% CI, 52.9%-80.1%) for association with composite adverse neonatal outcomes. For a Zika virus-associated abnormal result on prenatal ultrasonography, the sensitivity was lower (22.2%; 95% CI, 11.2%-37.1%) but the specificity was higher (97.9%; 95% CI, 88.7%-99.9%). Conclusions and Relevance: Abnormal results on prenatal ultrasonography were associated with adverse outcomes in congenital Zika infection. The absence of abnormal findings on prenatal ultrasonography was not associated with a normal neonatal outcome. Comprehensive evaluation is recommended for all neonates with prenatal Zika virus exposure.


Asunto(s)
Anomalías Congénitas , Complicaciones Infecciosas del Embarazo , Resultado del Embarazo/epidemiología , Ultrasonografía Prenatal/estadística & datos numéricos , Infección por el Virus Zika , Adulto , Brasil/epidemiología , Anomalías Congénitas/diagnóstico por imagen , Anomalías Congénitas/epidemiología , Anomalías Congénitas/virología , Femenino , Humanos , Recién Nacido , Masculino , Neuroimagen , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico por imagen , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/virología , Estudios Prospectivos , Adulto Joven , Infección por el Virus Zika/complicaciones , Infección por el Virus Zika/diagnóstico por imagen , Infección por el Virus Zika/epidemiología , Infección por el Virus Zika/virología
20.
Obstet Gynecol Surv ; 72(4): 235-241, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28426125

RESUMEN

IMPORTANCE: Preterm birth is a major contributor to perinatal morbidity and mortality. The most common intervention performed to improve perinatal outcomes for a woman experiencing cervical dilation in the second trimester without signs or symptoms of preterm labor is the cerclage. OBJECTIVE: We sought to review and compare available national guidelines on cerclage use. EVIDENCE ACQUISITION: We performed a descriptive review of 3 national guidelines on cerclage: The American Congress of Obstetricians and Gynecologists Practice Bulletin on "Cerclage for the Management of Cervical Insufficiency," Green-top Guideline from the Royal College of Obstetricians and Gynaecologists entitled "Cervical Cerclage," and the Society of Obstetricians and Gynaecologists of Canada Clinical Practice Bulletin entitled "Cervical Insufficiency and Cervical Cerclage." Guidelines were compared, and the following aspects of cerclage use for prevention of preterm delivery were summarized: indications and contraindications, risk factors for cervical insufficiency, perioperative considerations, and timing of removal. Recommendations and strength of evidence were reviewed based on each guideline's method of reporting. The references were compared with regard to the total number of randomized control trials, Cochrane Reviews, and systematic reviews/meta-analyses cited. RESULTS: The variations highlighted in the guidelines reflect the heterogeneity of the literature contributing to guidelines and the challenges of diagnosing and managing cervical insufficiency. CONCLUSIONS: A cohesive international guideline may improve safety and quality and optimize patient outcomes. TARGET AUDIENCE: Obstetricians and gynecologists, family physicians. LEARNING OBJECTIVES: After completing this activity, the learner should be better able to outline variations in indications and contraindications for cervical cerclage use by international guideline, identify variation in perioperative considerations for cervical cerclage use by international guideline, and recognize variation in timing of removal by international guideline.


Asunto(s)
Cerclaje Cervical/normas , Trabajo de Parto Prematuro/prevención & control , Obstetricia/normas , Guías de Práctica Clínica como Asunto/normas , Incompetencia del Cuello del Útero/cirugía , Femenino , Humanos , Metaanálisis como Asunto , Embarazo , Segundo Trimestre del Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Literatura de Revisión como Asunto , Estados Unidos
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