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1.
J Korean Med Sci ; 35(11): e66, 2020 Mar 23.
Artículo en Inglés | MEDLINE | ID: mdl-32193899

RESUMEN

BACKGROUND: This study aimed to evaluate the effect of cervical cerclage on the recurrence risk for preterm birth in singleton pregnant women after a twin spontaneous preterm birth (sPTB). METHODS: This multicenter retrospective cohort study included women who had a singleton pregnancy from January 2009 to December 2018 at 10 referral hospitals and a twin sPTB before the current pregnancy. We compared the cervical lengths during pregnancy and pregnancy outcomes, according to the placement of prophylactic or emergency cerclage. We evaluated the independent risk factors for sPTB (< 37 weeks of gestation) in a subsequent singleton pregnancy. RESULTS: For the index singleton pregnancy, preterm birth occurred in seven (11.1%) of 63 women. There was no significant difference in the cervical lengths during pregnancy in women with and without cerclage. In a multivariate logistic regression analysis, the placement of emergency cerclage was an independent risk factor for subsequent singleton preterm birth (odds ratio [OR], 93.188; 95% confidence interval [CI], 1.633-5,316.628; P = 0.027); however, the placement of prophylactic cerclage (OR, 19.264; 95% CI, 0.915-405.786; P = 0.057) was not a factor. None of the women who received prophylactic cerclage delivered before 35 weeks' gestation in the index singleton pregnancy. CONCLUSION: Cerclage did not lower the risk of preterm birth in a subsequent singleton pregnancy after a twin sPTB. However, emergency cerclage was an independent risk factor for preterm birth and there was no preterm birth before 35 weeks' gestation in the prophylactic cerclage group. Therefore, close monitoring of the cervical length and prophylactic cerclage might be considered in women who have experienced a twin sPTB at extreme gestation.


Asunto(s)
Cerclaje Cervical , Embarazo Gemelar , Nacimiento Prematuro/prevención & control , Adulto , Cuello del Útero , Femenino , Humanos , Modelos Logísticos , Análisis Multivariante , Embarazo , Resultado del Embarazo , República de Corea , Estudios Retrospectivos , Factores de Riesgo
2.
Laeknabladid ; 106(3): 139-143, 2020.
Artículo en Islandés | MEDLINE | ID: mdl-32124737

RESUMEN

INTRODUCTION: Newborn jaundice is caused by increased levels of bilirubin in the blood of the newborn during the first days after birth. Generally, neonatal jaundice does not need to be treated, however, if the blood bilirubin concentration becomes too high, it can cause neurological damage. Due to the prevalence of neonatal jaundice, it is important to assess its risk factors and their importance. This study at the National University Hospital of Iceland from 1997-2018, determines the risk factors for severe neonatal jaundice and their significance. MATERIAL AND METHODS: This was a retrospective case control study conducted at the National University Hospital of Iceland. It included all newborns diagnosed with severe jaundice (≥350 micromol/L) following a pregnancy of at least 37 weeks that were treated at the National University Hospital of Iceland from 1997 until 2018. General information on the pregnancy, health of the child at birth, as well as the diagnosis and treatment of jaundice was collected. 339 children met the inclusion criteria for this study. For each child diagnosed with severe jaundice one control was found. RESULTS: The incidence of severe jaundice from 1997 to 2018 was 0.52%. Of the 339 children, 16% were found to have a known significant risk factor for severe neonatal jaundice. The most common were ABO incompatibility and cephalohematoma. Only one child had severe neonatal jaundice because of Rhesus incompatibility. Regression analysis revealed the significant risk factors as followins: shorter pregnancy, bruising at birth, male gender, discharge before 36 hours after birth and relative weight loss the first five days of life. 33% were diagnosed during a -routine doctor's examination five days after birth. CONCLUSION: Early discharge from the hospital and -relative weight loss the first few days after birth are significant independent risk factors for severe neonatal jaundice. Most cases were diagnosed during a routine doctors five-day check- up. This indicates that there is room for improvement in the evaluation of jaundice in post-natal home care. Monitoring of neonates with Rhesus incompatibility in Iceland exemplary. Boys are at an increased risk for severe neonatal jaundice. It is espe-cially noteworthy given that the negative effect of jaundice on learning ability appears to be greater in boys than in girls.


Asunto(s)
Ictericia Neonatal , Femenino , Humanos , Islandia/epidemiología , Incidencia , Recién Nacido , Ictericia Neonatal/diagnóstico , Ictericia Neonatal/epidemiología , Masculino , Nacimiento Prematuro , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Pérdida de Peso
3.
Wiad Lek ; 73(1): 25-30, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32124801

RESUMEN

OBJECTIVE: The aim is to identify mRNA expression of innate (TLR2 and TLR4) and adaptive (IL1 ß, IL17A, FoxP3, Tbet, Roryt) immunity in maternal-fetal interface and evaluate the contribution of SNP genes of IL1ß (rs1143627), TNFα (rs1800629), IL4 (rs2243250), IL10 (rs1800896, rs1800872) and RLN2 (rs4742076, rs3758239) to PTB, associated with PPROM in 26-34 weeks of gestation. PATIENTS AND METHODS: Materials and methods: We had done open cohort randomized research during period 2016-2018 years. The case group consisted of 50 women with PPROM in preterm pregnancy, 26-34 weeks of gestation. For the control group we collected samples from 50 women without previous history of PTB. To determine the level of mRNA target genes we used thermocycler CFX96™Real-Time PCR Detection Systems ("Bio-Rad Laboratories, Inc.", USA) and set of reagents Maxima SYBR Green / ROX qPCR MasterMix (2x) (Thermo Scientific, USA). RESULTS: Results: In the population of the Zaporizhzhia region, there is no reliable clinical association between the IL1ß and TNFα genes and a high risk of PTB. We obtained high reliable data on SNP genes RLN2 rs4742076 and rs3758239 in Zaporizhzhia women. The distribution of the rs2243250 gene polymorphism alleles of the IL4 gene of the main study group - TT homozygotes were determined in 2 (4%) cases, CT heterozygotes were found in 11 (22%), CC homozygotes in 37 (74%) cases. In the study of polymorphism rs1800872 of the IL10 gene, the main group of homozygous TT studies was identified in 7 (14%) cases, TG heterozygotes were found in 18 (36%), GG homozygotes in 25 (50%) cases. The range of all obtained values of the relative normalized expression of TLR2 gene in the placenta of 0.79-163.44 (median - 31.06), in the fetal membranes - 1.1-126.06 (median - 10.22). The placement of all obtained values compared to mRNA expression of the TLR4 gene was lower than the TLR2 in the placenta, which was 0.39-43.85 (median - 7.74) and higher in the fetal membranes - 0.18-216.01 (median - 40.04). We observed an 8.33-fold decreased expression in FoxP3 in decidua, especially in 31-32 weeks of PPROM manifestation (27.03-fold). In amniotic membranes a similar trend of reduction of FoxP3 expression was found, overall level decreased in 2.33 times, especially in 31-32 weeks of PPROM manifestation (10.64-fold). CONCLUSION: Conclusions: Among Zaporizhzhia population, combination of IL4 (rs2243250), IL10 (rs1800896 and rs1800872), RLN2 (rs4742076 and rs3758239) supports the role for functional polymorphisms in immunoregulatory genes in the susceptibility to PTL, associated with PPROM. Marked increased transcriptional activity of components of innate (TLR2, TLR4), adaptive (Th1, Th17) immune system and conversely decreased expression of Treg (FoxP3) in the maternal-fetal interface are involved in immune pathways of PTB and contribute in the fetal inflammatory response syndrome.


Asunto(s)
Rotura Prematura de Membranas Fetales , Trabajo de Parto Prematuro , Polimorfismo de Nucleótido Simple , Nacimiento Prematuro , Inmunidad Adaptativa , Alelos , Femenino , Humanos , Recién Nacido , Embarazo
4.
Medicine (Baltimore) ; 99(8): e19213, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080112

RESUMEN

This study described the prevalence of adverse pregnancy outcomes (APOs) in Chinese HIV-infected pregnant women, and examined the relationship between maternal HIV infection /HIV-related factors and APOs.This prospective cohort study was carried out among 483 HIV-infected pregnant women and 966 HIV-uninfected pregnant women. The HIV-infected and HIV-uninfected women were enrolled from midwifery hospitals in Hunan province between October 2014 and September 2017. All data were extracted in a standard structured form, including maternal characteristics, HIV infection status, HIV-related factors and their pregnancy outcomes. APOs were assessed by maternal HIV infection status and HIV-related factors using logistic regression analysis.The incidences of stillbirth (3.9% vs 1.1%), preterm birth (PTB) (8.9% vs 3.7%), low birth weight (LBW) (12.2% vs 3.1%) and small for gestational age (SGA) (21.3% vs 7.0%) were higher in HIV-infected women than HIV-uninfected women, with adjusted ORs of 2.77 (95%CI: 1.24-6.17), 2.37 (95%CI: 1.44-3.89), 4.20 (95%CI: 2.59-6.82) and 3.26 (95%CI: 3.26-4.64), respectively. No differences were found in neonatal asphyxia or birth defects between HIV-infected and HIV-uninfected groups, with adjusted ORs of 1.12 (95%CI: 0.37-3.43) and 1.10 (95%CI: 0.51-2.39), respectively. Among HIV-infected pregnant women, different antiretroviral (ARV) regimens were significantly associated with stillbirths, but not PTB, LBW or SGA. Compared with untreated HIV infection (10.1%), both mono/dual therapy and HAART were associated with a reduced risk of stillbirths (2.0% and 3.2%, respectively), with an AOR of 0.19 (95%CI: 0.04-0.92) and 0.31 (95%CI: 0.11-0.85), respectively. Initial time of ARV drugs use and HIV infection status of the sexual partner were not associated with maternal APOs.The findings of this study indicated that maternal HIV infection was associated with significantly increased risks of stillbirth, PTB, LBW and SGA, but not neonatal asphyxia or birth defects. On the condition that most HIV-infected pregnant women started ARV therapy in or after the second trimester, both mono/dual therapy and HAART had a protective effect on stillbirth compared with untreated HIV infection. As some important confounders were not effectively controlled and the specific regimens of HAART were not analyzed, the above findings may have certain bias.


Asunto(s)
Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Resultado del Embarazo/epidemiología , Adulto , Factores de Edad , Antirretrovirales/administración & dosificación , Antirretrovirales/efectos adversos , China/epidemiología , Femenino , Humanos , Recién Nacido de Bajo Peso , Embarazo , Nacimiento Prematuro , Estudios Prospectivos , Características de la Residencia , Factores Socioeconómicos , Mortinato/epidemiología , Adulto Joven
5.
Oral Health Prev Dent ; 18(1): 77-83, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32051974

RESUMEN

PURPOSE: The aim of this study was to evaluate the association between periodontitis and preterm birth in a Spanish Caucasian population, based on clinical and biochemical outcomes. Epidemiological studies have suggested that periodontitis is a potential risk factor for preterm birth. However, other studies have shown high heterogeneity in their results. Some factors such as number of evaluations during pregnancy, sample size, study population and maternal age may have an impact on the variability of the result. METHODS AND MATERIALS: This cohort study enrolled 158 pregnant women, 39 with periodontitis and 119 without periodontitis. All pregnant women were evaluated in the first, second and third trimester. RESULTS: Statistically significant differences were found in periodontal parameters between both groups, but no statistically significant differences were found in biochemical parameters during pregnancy. The duration of pregnancy in healthy patients was 38.78 ± 4.49 weeks, and in patients with periodontitis 37.81 ± 4.89 weeks, with no statistical difference (p > 0.05). This showed that periodontitis was not associated with preterm birth in a Spanish Caucasian cohort. CONCLUSION: In this study, periodontitis stage II, grade B, was not statistically associated with preterm birth. Pregnancy is a short period of time in order to evaluate long-term oral systemic infections. Adverse pregnancy outcomes are more difficult to occur. Thus, since pregnancy timing average cannot be changed, the stages of periodontal disease (initial, moderate, advanced) could be another factor to study.


Asunto(s)
Periodontitis , Nacimiento Prematuro , Estudios de Cohortes , Femenino , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Embarazo , Resultado del Embarazo , Factores de Riesgo
6.
J Korean Med Sci ; 35(7): e26, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32080985

RESUMEN

BACKGROUND: We aimed to investigate whether various immune-related plasma proteins, alone or in combination with conventional clinical risk factors, can predict spontaneous preterm delivery (SPTD) and intra-amniotic infection in women with premature cervical dilation or a short cervix (≤ 25 mm). METHODS: This retrospective study included 80 asymptomatic women with premature cervical dilation (n = 50) or a short cervix (n = 30), who underwent amniocentesis at 17-29 weeks. Amniotic fluid (AF) was cultured, and maternal plasma was assayed for interleukin (IL)-6, matrix metalloproteinase (MMP)-9, tissue inhibitor of metalloproteinases (TIMP)-1, and complements C3a and C5a, using enzyme-linked immunosorbent assay (ELISA) kits. The primary outcome measures were SPTD at < 32 weeks and positive AF cultures. RESULTS: The plasma levels of IL-6, C3a, and C5a, but not of MMP-9 and TIMP-1, were significantly higher in women with SPTD at < 32 weeks than in those who delivered at ≥ 32 weeks. The women who delivered at < 32 weeks had more advanced cervical dilatation, and higher rates of antibiotic and tocolytic administration and were less likely to be given vaginal progesterone than those who delivered at ≥ 32 weeks. Using a stepwise regression analysis, a combined prediction model was developed, which included the plasma IL-6 and C3a levels, and cervical dilatation (area under the curve [AUC], 0.901). The AUC for this model was significantly greater than that for any single variable included in the predictive model. In the univariate analysis, plasma IL-6 level was the only significant predictor of intra-amniotic infection. CONCLUSION: In women with premature cervical dilation or a short cervix, maternal plasma IL-6, C3a, and C5a levels could be useful non-invasive predictors of SPTD at < 32 weeks. A combination of these biomarkers and conventional clinical factors may clearly improve the predictability for SPTD, as compared with the biomarkers alone. An increased plasma level of IL-6 predicted intra-amniotic infection.


Asunto(s)
Biomarcadores , Complemento C3a , Interleucina-6 , Primer Periodo del Trabajo de Parto , Complicaciones Infecciosas del Embarazo , Nacimiento Prematuro , Inhibidor Tisular de Metaloproteinasa-1 , Adulto , Amniocentesis , Biomarcadores/sangre , Cuello del Útero , Complemento C3a/análisis , Complemento C5a/análisis , Femenino , Humanos , Interleucina-6/sangre , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/inmunología , Nacimiento Prematuro/diagnóstico , Nacimiento Prematuro/inmunología , Estudios Retrospectivos , Inhibidor Tisular de Metaloproteinasa-1/sangre
8.
Rev Med Liege ; 75(2): 105-110, 2020 Feb.
Artículo en Francés | MEDLINE | ID: mdl-32030935

RESUMEN

Late preterm infants are born between 34 weeks of amenorrhea and 36 weeks 6 days. Late preterms represent the largest proportion of premature infants (about 75 %). Late prematurity is increasing in recent decades. While studies initially focused on mortality and morbidity related to very preterm birth, the late preterms have been the subject of increased attention over the past 15 years. Late preterm infants have an increased risk of respiratory complications, infections, feeding problems, hypothermia and hypoglycemia. Neonatal, infant and during adulthood mortalities are significantly higher in late preterm than in term infants. In addition, late preterm infants carry an increased risk of long-term morbidities, such as neurodevelopmental delay, cerebral palsy, chronic respiratory or metabolic diseases. This review highlights the evidence that late preterm infants are high risk newborns and require adapted follow-up.


Asunto(s)
Enfermedades del Prematuro , Recien Nacido Prematuro , Nacimiento Prematuro , Adulto , Femenino , Edad Gestacional , Humanos , Lactante , Recién Nacido , Morbilidad , Embarazo
9.
Rev Med Suisse ; 16(682): 350-353, 2020 Feb 19.
Artículo en Francés | MEDLINE | ID: mdl-32073768

RESUMEN

Management of patients at high risk of extreme premature birth between 23 and 26 weeks should be performed by an experienced multidisciplinary team. In order to optimize guidance for couples with regard to this complex decision, we developed joint guidelines between obstetricians and neonatologists, in order to standardize practices and insure individualized care plans. Fetal outcome is not solely associated with gestational age but is multifactorial, and this should be considered when counseling parents. Thus, enhancement of fetal lung maturation, a major prognostic factor, should be promptly acted upon when delivery is anticipated. Antenatal corticosteroids should not be withheld while awaiting the parents' ultimate decision on neonatal care.


Asunto(s)
Trabajo de Parto Prematuro , Atención Perinatal , Femenino , Edad Gestacional , Humanos , Recien Nacido Extremadamente Prematuro , Recién Nacido , Embarazo , Nacimiento Prematuro
10.
BMJ ; 368: m237, 2020 02 19.
Artículo en Inglés | MEDLINE | ID: mdl-32075794

RESUMEN

OBJECTIVE: To evaluate the risk of adverse maternal and infant outcomes following in utero exposure to duloxetine. DESIGN: Cohort study nested in the Medicaid Analytic eXtract for 2004-13. SETTING: Publicly insured pregnancies in the United States. PARTICIPANTS: Pregnant women 18 to 55 years of age and their liveborn infants. INTERVENTIONS: Duloxetine exposure during the etiologically relevant time window, compared with no exposure to duloxetine, exposure to selective serotonin reuptake inhibitors, exposure to venlafaxine, and exposure to duloxetine before but not during pregnancy. MAIN OUTCOME MEASURES: Congenital malformations overall, cardiac malformations, preterm birth, small for gestational age infant, pre-eclampsia, and postpartum hemorrhage. RESULTS: Cohort sizes ranged from 1.3 to 4.1 million, depending on the outcome. The number of women exposed to duloxetine varied by cohort and exposure contrast and was around 2500-3000 for early pregnancy exposure and 900-950 for late pregnancy exposure. The base risk per 1000 unexposed women was 36.6 (95% confidence interval 36.3 to 36.9) for congenital malformations overall, 13.7 (13.5 to 13.9) for cardiovascular malformations, 107.8 (107.3 to 108.3) for preterm birth, 20.4 (20.1 to 20.6) for small for gestational age infant, 33.6 (33.3 to 33.9) for pre-eclampsia, and 23.3 (23.1 to 23.4) for postpartum hemorrhage. After adjustment for measured potential confounding variables, all baseline characteristics were well balanced for all exposure contrasts. In propensity score adjusted analyses versus unexposed pregnancies, the relative risk was 1.11 (95% confidence interval 0.93 to 1.33) for congenital malformations overall and 1.29 (0.99 to 1.68) for cardiovascular malformations. For preterm birth, the relative risk was 1.01 (0.92 to 1.10) for early exposure and 1.19 (1.04 to 1.37) for late exposure. For small for gestational age infants the relative risks were 1.14 (0.92 to 1.41) and 1.20 (0.83 to 1.72) for early and late pregnancy exposure, respectively, and for pre-eclampsia they were 1.12 (0.96 to 1.31) and 1.04 (0.80 to 1.35). The relative risk for postpartum hemorrhage was 1.53 (1.08 to 2.18). Results from sensitivity analyses were generally consistent with the findings from the main analyses. CONCLUSIONS: On the basis of the evidence available to date, duloxetine is unlikely to be a major teratogen but may be associated with an increased risk of postpartum hemorrhage and a small increased risk of cardiac malformations. While continuing to monitor the safety of duloxetine as data accumulate over time, these potential small increases in risk of relatively uncommon outcomes must be weighed against the benefits of treating depression and pain during pregnancy in a given patient. TRIAL REGISTRATION: EUPAS 15946.


Asunto(s)
Clorhidrato de Duloxetina/efectos adversos , Complicaciones del Embarazo/tratamiento farmacológico , Resultado del Embarazo/epidemiología , Inhibidores de Captación de Serotonina y Norepinefrina/efectos adversos , Anomalías Inducidas por Medicamentos/epidemiología , Anomalías Inducidas por Medicamentos/etiología , Adolescente , Adulto , Estudios de Cohortes , Clorhidrato de Duloxetina/uso terapéutico , Femenino , Cardiopatías Congénitas/inducido químicamente , Cardiopatías Congénitas/epidemiología , Humanos , Recién Nacido Pequeño para la Edad Gestacional , Persona de Mediana Edad , Hemorragia Posparto/inducido químicamente , Hemorragia Posparto/epidemiología , Preeclampsia/inducido químicamente , Embarazo , Complicaciones del Embarazo/epidemiología , Nacimiento Prematuro/inducido químicamente , Nacimiento Prematuro/epidemiología , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Efectos Tardíos de la Exposición Prenatal/epidemiología , Inhibidores de Captación de Serotonina y Norepinefrina/uso terapéutico , Estados Unidos/epidemiología , Adulto Joven
11.
BJOG ; 127(5): 537-547, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-31912613

RESUMEN

BACKGROUND: Physical, psychological and sexual intimate partner violence (IPV) has been described in the literature as different types of IPV experienced by women during pregnancy all over the world. OBJECTIVES: To review and summarise systematically the empirical evidence on the links between IPV during pregnancy and the perinatal health of mothers and fetuses/neonates. SEARCH STRATEGY: MEDLINE (Ovid), CINAHL, Embase, Nursing@ovid (Ovid) and LILACS were searched (2008-2018). SELECTION CRITERIA: Observational studies that examined perinatal health outcomes (i.e. pre-term birth, low birthweight, miscarriage, perinatal death and premature rupture of membranes) in pregnant women exposed to IPV. DATA COLLECTION AND ANALYSIS: Information on study characteristics, type of IPV measured, study design, methodological quality and outcome variable extracted. RESULTS: Fifty studies were included. Twenty-nine analysed undifferentiated IPV (n = 25 489), 34 included physical IPV (n = 7333), 22 analysed psychological IPV (n = 7833) and 18 examined sexual IPV (n = 2388). Fifteen studies were from Asia, 12 from North America and Oceania, and 12 from Central and South America. The studies examined the association between IPV and 39 different perinatal health outcomes. The most frequent outcomes reported were pre-term birth (50%), low birthweight (46%), miscarriage (30%), perinatal death (20%) and premature rupture of membranes (20%). A significant association with perinatal health outcomes was reported by 12 of the studies analysing undifferentiated IPV, 18 physical IPV, six psychological IPV and two sexual IPV. CONCLUSIONS: The relation between IPV and perinatal health outcomes can be seen in different epidemiological designs and countries. In all, 39 different outcomes were identified and 29 were associated with IPV. TWEETABLE ABSTRACT: A variety of poor perinatal health outcomes are associated with psychological, physical and sexual IPV.


Asunto(s)
Violencia de Pareja , Mujeres Embarazadas , Aborto Espontáneo/epidemiología , Femenino , Rotura Prematura de Membranas Fetales/epidemiología , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Violencia de Pareja/psicología , Muerte Perinatal , Embarazo , Mujeres Embarazadas/psicología , Nacimiento Prematuro/epidemiología
12.
Lancet ; 395(10220): 250-252, 2020 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-31982051
13.
Mymensingh Med J ; 29(1): 60-65, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31915337

RESUMEN

In spite of the recommendation for rescue antenatal corticosteroids (ACS), the optimal time interval between primary and rescue courses has not been clearly demonstrated. The aim of this retrospective study was to determine the effects of the interval between a single ACS (Dexamethasone) course and delivery on the incidence of respiratory distress syndrome (RDS) in neonates at Mymensingh Medical College Hospital Center from 1st January 2017 to 30th June 2017. Injection Dexamethasone 2 doses (12.5mg IM 12 hourly for 2 doses) or 4 doses (6mg IM every 12 hours for 4 doses) use to arrest preterm labor as well as to prevent RDS delivered beyond 48 hours after ACS administration between 24 and 34 weeks gestation. The risk of RDS was compared between patients who delivered within seven days (Group I) and 7-14 days (Group II) after ACS administration. We included 140 and 60 patients in Group I and Group II respectively. After adjusting for confounders, the ACS delivery interval was significantly associated with RDS in Group II (adjusted odds ratio 12.8, 95% confidence interval 1.31-164.7). A longer ACS delivery interval is associated with a higher risk of RDS. Thus, the use of a rescue course could be expected to reduce the incidence of RDS in patients beyond seven days after ACS administration who remain at risk for preterm delivery within seven days, especially in cases of placenta previa and/or women bearing a male fetus.


Asunto(s)
Corticoesteroides/administración & dosificación , Dexametasona/administración & dosificación , Nacimiento Prematuro/prevención & control , Atención Prenatal/métodos , Síndrome de Dificultad Respiratoria del Recién Nacido/epidemiología , Corticoesteroides/efectos adversos , Bangladesh/epidemiología , Dexametasona/efectos adversos , Femenino , Humanos , Incidencia , Recién Nacido , Recien Nacido Prematuro , Masculino , Embarazo , Síndrome de Dificultad Respiratoria del Recién Nacido/prevención & control , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
14.
N C Med J ; 81(1): 24-27, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31908328

RESUMEN

In working to improve the health of North Carolinians, a critical focus starts with our mothers and infants and their surrounding communities. North Carolina's perinatal outcomes, as evidenced by maternal morbidity and mortality, infant mortality, preterm births, and the larger context of lifelong physical and mental health of our citizens, offer areas for improvement and policy implications. In addition, the unacceptable disparities that remain despite some overall improvement in outcomes warrant full attention. This issue of the NCMJ highlights the state of perinatal health in North Carolina; the importance of a risk-appropriate perinatal system of care; the opportunities for supporting our parents, children, and families; and how we as a state and as a community can come together to improve the safety and experience of giving birth in North Carolina and beyond.


Asunto(s)
Salud del Lactante/estadística & datos numéricos , Salud Materna/estadística & datos numéricos , Femenino , Humanos , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Mortalidad Materna/tendencias , North Carolina/epidemiología , Embarazo , Nacimiento Prematuro/epidemiología
15.
BMJ ; 368: l6779, 2020 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-31941696

RESUMEN

The studyChappell LC, Brocklehurst P, Green ME, et al. Planned early delivery or expectant management for late preterm pre-eclampsia (PHOENIX): a randomised controlled trial. Lancet 2019;394:1181-90.This project was funded by the NIHR Health Technology Assessment Programme (project number 12/25/03).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000838/mothers-benefit-from-a-planned-earlier-delivery-for-late-pre-eclampsia.


Asunto(s)
Preeclampsia , Nacimiento Prematuro , Femenino , Humanos , Recién Nacido , Madres , Embarazo , Evaluación de la Tecnología Biomédica , Espera Vigilante
18.
Sci Total Environ ; 713: 136472, 2020 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-31955080

RESUMEN

This paper is one of the first to examine the associations between prenatal sunshine exposure and birth outcomes, specifically the incidence of low birth weight (LBW) and small for gestational age (SGA), based on a nationally representative birth record dataset in China. During the sample period in the 1990s, migration was limited in rural China, allowing us to address the identification challenges, like residential sorting and avoidance behaviors. We found a nonlinear relationship between the length of sunlight and birth outcomes. In particular, prenatal exposure to increasing sunshine was associated with a reduction in the incidence of LBW and SGA, especially in the second trimester during pregnancy. This finding was consistent with the clinical evidence suggesting positive effects of sunshine on birth outcomes via obtaining vitamin D or relieving maternal stress.


Asunto(s)
Recién Nacido de Bajo Peso , Nacimiento Prematuro , Luz Solar , Peso al Nacer , China , Femenino , Humanos , Recién Nacido , Recién Nacido Pequeño para la Edad Gestacional , Masculino , Embarazo
19.
Lancet ; 395(10220): 285-293, 2020 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-31982074

RESUMEN

BACKGROUND: Preterm birth remains a common cause of neonatal mortality, with a disproportionately high burden in low-income and middle-income countries. Meta-analyses of low-dose aspirin to prevent pre-eclampsia suggest that the incidence of preterm birth might also be decreased, particularly if initiated before 16 weeks of gestation. METHODS: ASPIRIN was a randomised, multicountry, double-masked, placebo-controlled trial of low-dose aspirin (81 mg daily) initiated between 6 weeks and 0 days of pregnancy, and 13 weeks and 6 days of pregnancy, in nulliparous women with an ultrasound confirming gestational age and a singleton viable pregnancy. Participants were enrolled at seven community sites in six countries (two sites in India and one site each in the Democratic Republic of the Congo, Guatemala, Kenya, Pakistan, and Zambia). Participants were randomly assigned (1:1, stratified by site) to receive aspirin or placebo tablets of identical appearance, via a sequence generated centrally by the data coordinating centre at Research Triangle Institute International (Research Triangle Park, NC, USA). Treatment was masked to research staff, health providers, and patients, and continued until 36 weeks and 7 days of gestation or delivery. The primary outcome of incidence of preterm birth, defined as the number of deliveries before 37 weeks' gestational age, was analysed in randomly assigned women with pregnancy outcomes at or after 20 weeks, according to a modified intention-to-treat (mITT) protocol. Analyses of our binary primary outcome involved a Cochran-Mantel-Haenszel test stratified by site, and generalised linear models to obtain relative risk (RR) estimates and associated confidence intervals. Serious adverse events were assessed in all women who received at least one dose of drug or placebo. This study is registered with ClinicalTrials.gov, NCT02409680, and the Clinical Trial Registry-India, CTRI/2016/05/006970. FINDINGS: From March 23, 2016 to June 30, 2018, 14 361 women were screened for inclusion and 11 976 women aged 14-40 years were randomly assigned to receive low-dose aspirin (5990 women) or placebo (5986 women). 5780 women in the aspirin group and 5764 in the placebo group were evaluable for the primary outcome. Preterm birth before 37 weeks occurred in 668 (11·6%) of the women who took aspirin and 754 (13·1%) of those who took placebo (RR 0·89 [95% CI 0·81 to 0·98], p=0·012). In women taking aspirin, we also observed significant reductions in perinatal mortality (0·86 [0·73-1·00], p=0·048), fetal loss (infant death after 16 weeks' gestation and before 7 days post partum; 0·86 [0·74-1·00], p=0·039), early preterm delivery (<34 weeks; 0·75 [0·61-0·93], p=0·039), and the incidence of women who delivered before 34 weeks with hypertensive disorders of pregnancy (0·38 [0·17-0·85], p=0·015). Other adverse maternal and neonatal events were similar between the two groups. INTERPRETATION: In populations of nulliparous women with singleton pregnancies from low-income and middle-income countries, low-dose aspirin initiated between 6 weeks and 0 days of gestation and 13 weeks and 6 days of gestation resulted in a reduced incidence of preterm delivery before 37 weeks, and reduced perinatal mortality. FUNDING: Eunice Kennedy Shriver National Institute of Child Health and Human Development.


Asunto(s)
Aspirina/administración & dosificación , Preeclampsia/epidemiología , Nacimiento Prematuro/epidemiología , Adolescente , Adulto , Aspirina/efectos adversos , Presión Sanguínea , Parto Obstétrico/estadística & datos numéricos , Países en Desarrollo , Método Doble Ciego , Femenino , Humanos , Preeclampsia/prevención & control , Embarazo , Resultado del Embarazo/epidemiología , Nacimiento Prematuro/prevención & control , Adulto Joven
20.
BJOG ; 127(4): 467-476, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31803995

RESUMEN

OBJECTIVE: To describe spontaneous preterm birth prevention practices self-reported before and after the dissemination of relevant guidelines, and to identify personal and organisational factors associated with adherence. DESIGN: A repeated cross-sectional vignette-based survey study. SETTING: French obstetricians. POPULATION: French obstetricians practicing in public or private maternity units. METHODS: Before and after the dissemination of the 2017 French guidelines on the prevention of spontaneous preterm birth, participants were asked to complete a web-based self-administered questionnaire based on two clinical vignettes. Vignette 1 focused on respondents' attitudes towards strict bed rest, cerclage, and progesterone treatment for women with a short cervix in mid-trimester; vignette 2 focused on attitudes towards strict bed rest and maintenance tocolysis after successful tocolysis for preterm labour. A mixed quantitative and qualitative analysis was conducted. MAIN OUTCOME MEASURES: Non-adherence to guidelines for the prevention of spontaneous preterm birth in responses to each vignette. RESULTS: We obtained complete responses from 286 obstetricians before and 282 obstetricians after guideline dissemination, including 145 obstetricians participating in both. After dissemination, 51.4% of obstetricians self-reported non-adherent practices for vignette 1 and 22.3% of obstetricians self-reported non-adherent practices for vignette 2. No improvement was observed after dissemination. The quantitative analysis identified factors associated with non-adherence, including older age and practice in non-university or small hospitals, whereas the qualitative analysis highlighted barriers to implementation, including fear of change, habits, work overload, and lack of time. CONCLUSIONS: Adherence to guidelines was generally low, with practices unmodified by their dissemination. Improvement is required, especially regarding applicability. TWEETABLE ABSTRACT: Adherence to guidelines to prevent spontaneous preterm birth was generally low and remained unmodified after guideline dissemination.


Asunto(s)
Trabajo de Parto Prematuro , Médicos , Nacimiento Prematuro , Anciano , Estudios Transversales , Femenino , Humanos , Recién Nacido , Embarazo , Encuestas y Cuestionarios
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