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2.
BMC Neurol ; 21(1): 384, 2021 Oct 04.
Artículo en Inglés | MEDLINE | ID: mdl-34607558

RESUMEN

BACKGROUND: The underlying pathogenesis of cerebral palsy (CP) remains poorly understood. The possibility of an early inflammatory response after acute insult is of increasing interest. Patterns of inflammatory and related biomarkers are emerging as potential early diagnostic markers for understanding the etiologic diversity of CP. Their presence has been investigated in plasma and umbilical cord blood but not in cerebrospinal fluid (CSF). METHODS: A clinical CP sample was recruited using a single-time point cross-sectional design to collect CSF at point-of-care during a standard-of-care surgical procedure (intrathecal pump implant). Patient demographic and clinical characteristics were sourced from medical chart audit. RESULTS: Significant (p ≤ 0.001) associations were found among neuroinflammatory, neuroendocrine, and nociceptive analytes with association patterns varying by birth status (term, preterm, extremely preterm). When between birth-group correlations were compared directly, there was a significant difference between preterm and extremely preterm birth subgroups for the correlation between tumour necrosis factor alpha (TNFα) and substance P. CONCLUSION: This investigation shows that CSF can be used to study proteins in CP patients. Differences in inter-correlational patterns among analytes varying by birth status underscores the importance of considering birth status in relation to possible mechanistic differences as indicated by biomarker signatures. Future work should be oriented toward prognostic and predictive validity to continue to parse the heterogeneity of CP's presentation, pathophysiology, and response to treatment.


Asunto(s)
Parálisis Cerebral , Neuropéptidos , Nacimiento Prematuro , Estudios Transversales , Femenino , Sangre Fetal , Humanos , Recién Nacido , Embarazo
3.
BMC Pregnancy Childbirth ; 21(1): 676, 2021 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-34615505

RESUMEN

BACKGROUND: Since the emergence of COVID-19, preventative public health measures, including lockdown strategies, were declared in most countries to control viral transmission. Recent studies and anecdotes have reported changes in the prevalence of perinatal outcomes during national COVID-19lockdowns.The objective of this rapid review was to evaluate the impact of COVID-19 lockdowns on the incidence of low birth weight (LBW), preterm birth (PTB), and stillbirth. METHODS: Two reviewers searched EMBASE, CORD-19, LitCovid (PubMed), WHO Global research on corona virus disease (COVID-19), and MedRxiv for studies published in English from the first reports on COVID-19 until 17 July 2021. Perinatal outcomes of interest included LBW (< 2500 g), PTB (< 37 weeks), and stillbirth. RESULTS: Of the 1967 screened articles, 17 publications met the inclusion criteria (14 cohort studies, 1 case control and 2 cross-sectional studies). Studies included data from Denmark, UK, Ireland, Nepal, Italy, Israel, Botswana, Australia, China, Netherlands, Saudi Arabia, Austria, Zimbabwe, India, and Spain. The total sample size ranged from 3399 to 1,599,547 pregnant women. Thirteen studies examined PTB with conflicting results, reporting both an increase and a decrease in PTB incidence, with odds ratios [95% CI] ranging from 0.09 [0.01, 0.40] to 1.93 [0.76, 4.79]. Three studies found a decrease in LBW rates during lockdowns, one of which was statistically significant, with a rate ratio of 3.77 [1.21, 11.75]. Ten studies examined stillbirth rates, including four studies reporting a statistically significant increase in stillbirth rates, with adjusted relative risk ranging from 1.46 [1.13, 1.89] to 3.9 [1.83, 12.0]. Fourteen studies contained data that could be combined in a meta-analysis comparing perinatal outcomes before and during lockdown. We found that lockdown measures were associated with a significant risk of stillbirth with RR = 1.33 [95% CI 1.04, 1.69] when compared to before lockdown period. However, lockdown measures were not associated with a significant risk of PTB, LBW and VLBW compared to prepandemic periods. CONCLUSIONS: This review provides clues about the severity of the indirect influence of COVID-19 lockdown implementation; however, the criteria that lead to unexpected changes in LBW, PTB, and stillbirth remains unclear. Large studies showed conflicting results, reporting both increases and decreases in selected perinatal outcomes. Pooled results show a significant association between lockdown measures and stillbirth rates, but not low birth weight rates. Further studies examining the differences in other countries' lockdowns and sociodemographic groups from low to middle-income countries are needed. Exploration of perinatal outcomes during COVID-19 lockdown poses an opportunity to learn from and make changes to promote the reduction of the leading causes of childhood mortality worldwide.


Asunto(s)
COVID-19/prevención & control , Recién Nacido de Bajo Peso , Resultado del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Cuarentena , Mortinato/epidemiología , Femenino , Humanos , Incidencia , Oportunidad Relativa , Embarazo , SARS-CoV-2
4.
Zhonghua Er Ke Za Zhi ; 59(9): 743-751, 2021 Sep 02.
Artículo en Chino | MEDLINE | ID: mdl-34645214

RESUMEN

Objective: To analyze the influential factors of stunting among children under 7 years of age in nine cities of China in order to provide empirical data for early prevention and intervention for stunting. Methods: The survey was carried out with 1∶1 case-control study design in the communities and kindergartens of nine cities (Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou, and Kunming) from June to November in 2016. Children of heights lower than the 3rd percentile according to the 2009 children's height standard in China were included as the stunting case group (n=1 281), and those with normal height matched for geolocation, gender, and age were recruited as the control group (n=1 281). The height and weight were measured on site, and the information related to family, perinatal status, diet and feeding, lifestyle, and medical history was collected by questionnaire. Continuous variables were compared by paired samples t test and Wilcoxon matched-pair signed ranks test, and proportions were compared by paired Chi square test. Multivariate analysis were carried out using conditional Logistic regression model. Results: Among 1 281 pairs of stunting and control group, there were 677 pairs of boys and 604 pairs of girls, with 238 pairs of children under age 3 years and 1 043 pairs of children aged 3 to 7 years. The Z scores for height and weight of stunting group were lower than that of control group (-2.27 (-2.54, -2.08) vs. -0.59 (-1.04, -0.10), -1.85 (-2.35, -1.38) vs. -0.69 (-1.20, -0.21), Z=30.982, 25.580, both P<0.01). Among family related factors, parental education level, height, weight, and height of grandparents in stunting children were all lower than those in control group (all P<0.05). Among individual related factors, proportion of preterm birth, low birth weight, shorter birth length, mother's pregnancy complications, difficulties adding milk or complementary feeding, poor appetite, slow eating, picky and partial eating, passive eating, more snack intake, shorter sleep duration, difficulty falling asleep, disturbed sleep, and recurrent infectious diseases in infant in stunting children were all higher than those in control group (all P<0.05). Multivariate Logistic regression analysis results illustrate that the lower the parental education level and the parental height, the higher the risk of stunting. For example, the risk of stunting in children whose fathers had short stature was 6.46 times (95%CI: 2.73-15.30) of those children whose fathers' height were medium and the risk of stunting in children whose mothers were short stature was 10.56 times (95%CI: 4.92-22.69) of those children whose mothers' height were medium. The risks of stunting increase significantly among preterm children or those with low birth weight (OR=2.27, 95%CI: 1.33-3.88), birth length<45 cm (OR=3.56, 95%CI: 1.41-8.98), difficulties adding milk or complementary feeding (OR=2.04, 95%CI: 1.32-3.15), poor appetite (OR=3.20, 95%CI: 1.74-5.89), slow eating (OR=1.85, 95%CI: 1.31-2.63), and food allergy (OR=1.80, 95%CI: 1.02-3.16). Conclusion: Parental short stature, preterm birth or low birth weight, shorter birth length, feeding difficulty in infant, poor appetite, slow eating, and food allergy are the main risk factors for stunting in infants and children.


Asunto(s)
Nacimiento Prematuro , Estudios de Casos y Controles , Niño , Preescolar , China/epidemiología , Ciudades , Femenino , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/etiología , Humanos , Lactante , Recién Nacido , Masculino , Embarazo , Encuestas y Cuestionarios
5.
Zhonghua Er Ke Za Zhi ; 59(9): 772-776, 2021 Sep 02.
Artículo en Chino | MEDLINE | ID: mdl-34645218

RESUMEN

Objective: To investigate the epidemiology and clinical characteristics of adenovirus (ADV)-caused acute respiratory tract infection among hospitalized children in Kunming, China. Methods: Clinical and laboratory data were collected from 467 children with adenovirus infection who were hospitalized from January 1, 2019 to December 31, 2019 in 6 grade A class Ⅲ hospitals in Kunming area. The basic characteristics, epidemiology, mixed infection and adenovirus genotypes of the patients were retrospectively analyzed. The patients diagnosed with adenovirus pneumonia (AP) were divided into two groups, severe AP (SAP) group and general AP(GAP) group according to the severity of illness. Mann-Whitney U test or χ2 test was used for comparison between groups, while multivariate regression was applied to analyze the risk factors of SAP. Results: Among 15 635 hospitalized children with respiratory tract infection, 467 cases were adenovirus positive, with a detection rate of 2.99%. Of the 467 patients with adenovirus infection, 284 were male and 183 female, the age was 2.4 (1.1,3.9) years, including 44 cases (9.4%) < 0.5 years, 59 cases (12.6%) of 0.5 to<1.0 years, 176 cases (37.7%) of 1.0 to <3.0 years, 150 cases (32.1%) of 3.0 to <7.0 years, and 38 cases (8.1%) of 7.0 to 14.0 years. Adenovirus infection was common in autumn and winter, and the high incidence months were October to December, which accounted for 51.6% (241/467) of the whole year cases. Co-infection was detected in 226 cases (48.4%) out of 467 patients, in which one pathogen co-infection was the most frequent form (172 cases, 76.1%). Of the 262 pathogen detected 108 (41.2%) were Mycoplasma pneumoniae. In 144 of ADV-positve cases (30.8%) were taken geno-typing was done by PCR amplification, the results showed that 74 cases (51.4%) were ADV 3, 7 subtypes and 65 cases (45.1%) of ADV 1, 2,6 subtypes. Of the 467 cases of ADV infection, 320 (68.5%) were diagnosed with pneumonia, 82 (17.6%) with upper respiratory tract infection and pharyngeal tonsillitis, and 65 (13.9%) with bronchitis, laryngeal bronchitis, and asthmatic bronchitis. Among the 320 patients with AP, 56 cases were severe and 264 cases were general. Two cases (3.6%) in severe group died. Compared with the GAP group, the age was young [17 (11,42) months vs. 24 (14,44) months, Z=2.222, P=0.026], the fever duration was long [8 (5,14) days vs. 6 (3,9) days, Z=3.380, P<0.01], and the proportions of preterm birth and having underlying diseases were high [respectively 19.6% (11/56) vs. 6.1% (16/264), 26.8% (15/56) vs. 10.2% (27/264), χ2=8.965,11.109, P<0.05] in SAP group. Referring to laboratory markers, white blood cell count, C-reactive protein, creatine kinase-MB and lactate dehydrogenase were significantly increased in SAP group as compared to GAP group(all P<0.05). Multivariate Logistic regression analysis showed that preterm birth (OR=3.284, 95%CI 1.079-9.993, P=0.036), underlying disease (OR=3.284, 95%CI 1.079-9.993, P=0.036), fever duration ≥10 d (OR=2.523,95%CI 1.195-5.328, P=0.015) and C-reactive protein ≥50 mg/L (OR=3.156, 95%CI 1.324-7.524, P=0.010) were positively correlated with the risk of SAP. Conclusions: The incidence of adenovirus infection among hospitalized children in Kunming was lower than the national level, and no outbreak occurred in 2019. Subtype 3 and 7 of ADV are the predominant strains for infection, which usually occurs in autumn and winter and mainly causes pneumonia. Premature birth, underlining diseases, long fever duration and markedly increased C-reactive protein are the risk factors for developing into severe pneumonia. This paper presents the prevalence and clinical characteristics of adenovirus infection in children at high altitude area.


Asunto(s)
Infecciones por Adenoviridae , Neumonía Viral , Nacimiento Prematuro , Infecciones del Sistema Respiratorio , Infecciones por Adenoviridae/epidemiología , Niño , Niño Hospitalizado , Preescolar , China/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Neumonía Viral/epidemiología , Embarazo , Infecciones del Sistema Respiratorio/epidemiología , Estudios Retrospectivos
6.
Vaccine ; 39(44): 6535-6538, 2021 10 22.
Artículo en Inglés | MEDLINE | ID: mdl-34600749

RESUMEN

OBJECTIVE: During December 2020, a massive vaccination program was introduced in our country. The Pfizer-BioNTech, BNT162b2 vaccine was first offered exclusively to high-risk population, such as medical personnel (including pregnant women). In this study we compare short term outcomes in vaccinated vs. non-vaccinated pregnant women. METHODS: In this prospective observational cohort study, vaccinated and non-vaccinated pregnant women were recruited using an online Google forms questionnaire targeting medical groups on Facebook and WhatsApp. A second questionnaire was sent one month after the first one for interim analysis. Our primary outcome was composite complications in vaccinated and non-vaccinated groups, considered any of the following: vaginal bleeding, pregnancy loss, hypertension, gestational diabetes, and preterm birth. Secondary outcomes included: vaccine side effects, diagnosis of COVID-19 since the last questionnaire, prevalence of vaccinated participants, and reasons for refusal to be vaccinated. RESULTS: Overall, 432 women answered the first questionnaire, of which 326 responses were received to the second questionnaire. Vaccination rate increased from 25.5% to 62% within a month. Maternal age, gestational age at enrollment, nulliparity and number of children were similar in both groups. The rate of composite pregnancy complications was similar between vaccinated and non-vaccinated group (15.8% vs 20.1%, p = 0.37), respectively. The risk for COVID-19 infection was significantly lower in the vaccinated group (1.5% vs 6.5%, p = 0.024, Odds Ratio: 4.5, 95% confidence interval 1.19-17.6). CONCLUSIONS: mRNA vaccine during pregnancy does not seem to increase the rate of pregnancy complications and is effective in prevention of COVID-19 infection.


Asunto(s)
COVID-19 , Nacimiento Prematuro , Vacunas contra la COVID-19 , Niño , Femenino , Humanos , Recién Nacido , Embarazo , Nacimiento Prematuro/epidemiología , Estudios Prospectivos , SARS-CoV-2 , Vacunación
7.
Rev Med Suisse ; 17(755): 1774-1778, 2021 Oct 20.
Artículo en Francés | MEDLINE | ID: mdl-34669291

RESUMEN

Vitamin D deficiency affects more than half of the general population. During pregnancy vitamin D insufficiency is associated with a higher risk of complications such as an increased incidence of miscarriages. Preterm delivery, preeclampsia, gestational diabetes, growth retardation and low birth weight as well as postpartum hemorrhage are all pathologies whose incidence seems to be increased with hypovitaminosis D. This could be linked to the pregnancy changes of the immune system, on which vitamin D plays a well-known modulating role. Substitution, even if its benefit is not clearly established, should be considered as there are no side effects. Although lack of evidence regarding the timing of the introduction of treatment, substitution may be proposed before conception.


Asunto(s)
Complicaciones del Embarazo , Nacimiento Prematuro , Deficiencia de Vitamina D , Femenino , Humanos , Recién Nacido , Embarazo , Complicaciones del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Vitamina D , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/epidemiología , Vitaminas
8.
Psychiatr Danub ; 33(Suppl 10): 52-57, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34672272

RESUMEN

BACKGROUND: Antenatal Anxiety affects the mothers and their child. Spontaneous abortion, preeclampsia, preterm birth, and low birth weight are the most common consequences. In Bangladesh, we have very limited understanding about the burden of antenatal anxiety and its associated factors. We conducted a prospective longitudinal study to estimate the prevalence of anxiety symptoms and identify associated factors in pregnant women. SUBJECTS AND METHODS: A total of 1360 pregnant women were enrolled from 14 antenatal care (ANC) hospitals during September 2015 to August 2017. All selected women were assessed longitudinally at first, second and third trimesters of pregnancy. The State Anxiety Inventory (STAI-S) scale was used to measure the antenatal anxiety symptom. Generalize estimating equations (GEE) and alternating logistic regression (ALR) model were used to measure the risk factors and repetitive anxiety symptom measurements, respectively. RESULTS: Over the study period, more than half (53.18%) of the women reported anxiety in at least one antenatal assessment. The prevalence of anxiety symptom in the first, second, and third trimesters was 29.5%, 23.5%, and 37.5%, respectively. Maternal anxiousness was significantly associated with the trimester, poor education, low blood hemoglobin, and low family income. CONCLUSION: Women were at high risk of getting anxious during first and third trimesters of pregnancy. Findings of the study can be useful in developing and designing intervention to reduce anxiety in women during pregnancy.


Asunto(s)
Complicaciones del Embarazo , Nacimiento Prematuro , Ansiedad/epidemiología , Bangladesh/epidemiología , Niño , Análisis de Datos , Femenino , Humanos , Recién Nacido , Estudios Longitudinales , Embarazo , Complicaciones del Embarazo/epidemiología , Prevalencia , Estudios Prospectivos
9.
BMC Pregnancy Childbirth ; 21(1): 658, 2021 Sep 28.
Artículo en Inglés | MEDLINE | ID: mdl-34583679

RESUMEN

BACKGROUND: Whilst the impact of Covid-19 infection in pregnant women has been examined, there is a scarcity of data on pregnant women in the Middle East. Thus, the aim of this study was to examine the impact of Covid-19 infection on pregnant women in the United Arab Emirates population. METHODS: A case-control study was carried out to compare the clinical course and outcome of pregnancy in 79 pregnant women with Covid-19 and 85 non-pregnant women with Covid-19 admitted to Latifa Hospital in Dubai between March and June 2020. RESULTS: Although Pregnant women presented with fewer symptoms such as fever, cough, sore throat, and shortness of breath compared to non-pregnant women; yet they ran a much more severe course of illness. On admission, 12/79 (15.2%) Vs 2/85 (2.4%) had a chest radiograph score [on a scale 1-6] of ≥3 (p-value = 0.0039). On discharge, 6/79 (7.6%) Vs 1/85 (1.2%) had a score ≥3 (p-value = 0.0438). They also had much higher levels of laboratory indicators of severity with values above reference ranges for C-Reactive Protein [(28 (38.3%) Vs 13 (17.6%)] with p < 0.004; and for D-dimer [32 (50.8%) Vs 3(6%)]; with p < 0.001. They required more ICU admissions: 10/79 (12.6%) Vs 1/85 (1.2%) with p=0.0036; and suffered more complications: 9/79 (11.4%) Vs 1/85 (1.2%) with p=0.0066; of Covid-19 infection, particularly in late pregnancy. CONCLUSIONS: Pregnant women presented with fewer Covid-19 symptoms but ran a much more severe course of illness compared to non-pregnant women with the disease. They had worse chest radiograph scores and much higher levels of laboratory indicators of disease severity. They had more ICU admissions and suffered more complications of Covid-19 infection, such as risk for miscarriage and preterm deliveries. Pregnancy with Covid-19 infection, could, therefore, be categorised as high-risk pregnancy and requires management by an obstetric and medical multidisciplinary team.


Asunto(s)
COVID-19 , Unidades de Cuidados Intensivos/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo , Nacimiento Prematuro , Radiografía Torácica , Evaluación de Síntomas , Aborto Espontáneo/epidemiología , Aborto Espontáneo/etiología , Proteína C-Reactiva/análisis , COVID-19/sangre , COVID-19/epidemiología , COVID-19/terapia , COVID-19/transmisión , Estudios de Casos y Controles , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/fisiopatología , Complicaciones Infecciosas del Embarazo/terapia , Complicaciones Infecciosas del Embarazo/virología , Resultado del Embarazo/epidemiología , Embarazo de Alto Riesgo , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etiología , Radiografía Torácica/métodos , Radiografía Torácica/estadística & datos numéricos , SARS-CoV-2/aislamiento & purificación , Índice de Severidad de la Enfermedad , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos , Emiratos Árabes Unidos/epidemiología
10.
J Neurodev Disord ; 13(1): 41, 2021 09 21.
Artículo en Inglés | MEDLINE | ID: mdl-34548007

RESUMEN

INTRODUCTION: Preterm birth (<37 weeks) adversely affects development in behavioural, cognitive and mental health domains. Heightened rates of autism are identified in preterm populations, indicating that prematurity may confer an increased likelihood of adverse neurodevelopmental outcomes. The present meta-analysis aims to synthesise existing literature and calculate pooled prevalence estimates for rates of autism characteristics in preterm populations. METHODS: Search terms were generated from inspection of relevant high-impact papers and a recent meta-analysis. Five databases were searched from database creation until December 2020 with PRISMA guidelines followed throughout. RESULTS: 10,900 papers were retrieved, with 52 papers included in the final analyses, further classified by assessment method (screening tools N=30, diagnostic assessment N=29). Pooled prevalence estimates for autism in preterm samples was 20% when using screening tools and 6% when using diagnostic assessments. The odds of an autism diagnosis were 3.3 times higher in individuals born preterm than in the general population. CONCLUSIONS: The pooled prevalence estimate of autism characteristics in individuals born preterm is considerably higher than in the general population. Findings highlight the clinical need to provide further monitoring and support for individuals born preterm.


Asunto(s)
Trastorno Autístico , Nacimiento Prematuro , Trastorno Autístico/epidemiología , Femenino , Humanos , Recién Nacido , Embarazo , Nacimiento Prematuro/epidemiología , Prevalencia
11.
Bratisl Lek Listy ; 122(10): 721-726, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34570573

RESUMEN

OBJECTIVE: We present a simple 2D big ultrasound measurement of the fetal adrenal glands and their biometrical growth analysis highlighted as a potential preterm birth marker. METHODS: This was a prospective observational case-control study. Sixty-four patients were included in the study (32 with the diagnosis of imminent preterm birth before 37 and 32 controls) from January 2018 to May 2020. Anteroposterior dimensions and circumferences of the whole adrenal glands and their central zones were measured by simple B-mode ultrasound imaging. For the statistical analysis, StatsDirect 3.0 and ROC curves were used. As a studied descriptor, routine standard ultrasound cervical measurements were added (cervical length, funneling, sludge, cervical dilatation, and cervical glandular area). RESULTS: In biometrics of gestational age-related changes, a significant analysis of the overall growth of the adrenal gland was observed (circumference p < 0.001, anteroposterior diameter p = 0.02). The growth of the central zone was observed independently of gestational age. The growth of the central zone of the fetal adrenal glands revealed significant changes between the group of patients who delivered prematurely and control groups (p < 0.01). The ideal cut-off value of the proportion of enlargement of the fetal zone as a predictor of preterm delivery before week 37 was 45.1 %, with the sensitivity of 87.5 % and specificity of 85.4 %. CONCLUSIONS: A simple 2D B-mode measurement of the fetal adrenal glands´ central zone growth can be applied as an additional marker in the prediction of true preterm delivery. The natural biometrical overall growth of the adrenal glands seems to be dependent on gestational age, whereas that of the central adrenal gland zone seems to be independent on gestational age (Tab. 3, Fig. 5, Ref. 26).


Asunto(s)
Nacimiento Prematuro , Glándulas Suprarrenales/diagnóstico por imagen , Estudios de Casos y Controles , Femenino , Edad Gestacional , Humanos , Recién Nacido , Embarazo , Nacimiento Prematuro/diagnóstico por imagen , Estudios Prospectivos , Ultrasonografía , Ultrasonografía Prenatal
12.
Trials ; 22(1): 664, 2021 Sep 28.
Artículo en Inglés | MEDLINE | ID: mdl-34583760

RESUMEN

BACKGROUND: Preterm birth is associated with significant mortality and morbidity for mothers and babies. Women are identified as high risk for preterm birth based on either previous medical/pregnancy history or on ultrasound assessment of the cervix. Women identified as high risk can be offered a cervical cerclage (a purse string stitch) around the cervix (neck of the womb) to reduce the risk of preterm birth. In women who have a cervical cerclage, the procedure can be performed using either a monofilament (single-stranded) or braided (woven) suture material. Both suture materials are routinely used for cervical cerclage and there is uncertainty as to which is superior. METHODS: A multicentre, open, randomised controlled superiority trial of 2050 women presenting at obstetric units, deemed to be at risk of preterm birth and already scheduled to have a cervical cerclage as part of their standard care. Inclusion criteria include singleton pregnancies and an indication for cervical cerclage for either a history of three or more previous mid-trimester losses or premature births (≤ 28 weeks), insertion of cervical sutures in previous pregnancies, a history of mid trimester loss or premature birth with a (current) shortened (≤ 25 mm) cervix, or women whom clinicians deem to be at risk of preterm birth either by history or the results of an ultrasound scan. Exclusion criteria include women who have taken part in C-STICH previously, are aged less than 18 years old at the time of presentation, require a rescue cerclage, and are unwilling or unable to give informed consent and in whom a cerclage will be placed by any route other than vaginally (e.g. via an abdominal route). Following informed consent, women are randomised on a 1:1 basis to either monofilament or braided suture, by minimisation. The primary outcome is pregnancy loss (miscarriage and perinatal mortality, including any stillbirth or neonatal death in the first week of life), and secondary outcomes include the core outcome set for preterm birth trials. DISCUSSION: Optimising established interventions to prevent preterm birth is important in reducing perinatal mortality rates. TRIAL REGISTRATION: ISRCTN 15373349 . Registered before recruitment on 03 December 2014 prior to first recruit.


Asunto(s)
Cerclaje Cervical , Nacimiento Prematuro , Adolescente , Cuello del Útero/diagnóstico por imagen , Cuello del Útero/cirugía , Femenino , Humanos , Recién Nacido , Evaluación de Resultado en la Atención de Salud , Embarazo , Nacimiento Prematuro/etiología , Nacimiento Prematuro/prevención & control , Suturas
13.
Braz Oral Res ; 35(Supp 2): e102, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34586216

RESUMEN

In the last five decades, considerable progress has been made towards understanding the etiology and pathogenesis of periodontal diseases and their interactions with the host. The impact of an individual periodontal condition on systemic homeostasis became more evident because of this knowledge and prompted advances in studies that associate periodontitis with systemic diseases and conditions. The term Periodontal Medicine describes how periodontal infection/inflammation can affect extraoral health. This review presents the current scientific evidence on the most investigated associations between periodontitis and systemic diseases and conditions, such as cardiovascular diseases, diabetes, preterm birth and low birth weight, and pneumonia. Additionally, other associations between periodontitis and chronic inflammatory bowel disease, colorectal cancer, and Alzheimer's disease that were recently published and are still poorly studied were described. Thus, the aim of this review was to answer the following question: What is the future of Periodontal Medicine? Epidemiological evidence and the evidence of biological plausibility between periodontitis and general health reinforce the rationale that the study of Periodontal Medicine should continue to advance, along with improvements in the epidemiological method, highlighting the statistical power of the studies, the method for data analysis, the case definition of periodontitis, and the type of periodontal therapy to be applied in intervention studies.


Asunto(s)
Diabetes Mellitus , Enfermedades Periodontales , Periodontitis , Nacimiento Prematuro , Femenino , Humanos , Recién Nacido , Enfermedades Periodontales/epidemiología , Enfermedades Periodontales/terapia , Periodoncia , Periodontitis/epidemiología , Periodontitis/terapia , Embarazo
14.
Int J Gynaecol Obstet ; 155(1): 23-25, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34520053

RESUMEN

A pessary is a device made of synthetic material that is placed in the vagina and has been used for prevention of preterm birth. It has been suggested that a potential mechanism of the pessary is alteration of the cervico-uterine angle to a more posterior position, which reduces cervical compression in women with a singleton pregnancy and a short cervical length. Pessaries should not be used in routine clinical care to reduce the frequency of preterm birth or to improve outcomes (e.g. neonatal outcomes) related to preterm birth. In women with a twin pregnancy-regardless of cervical length-pessaries should not be used in routine clinical care to reduce the frequency of preterm birth or to improve outcomes (e.g. neonatal outcomes) related to preterm birth. Presently there is no sufficient evidence suggesting that pessaries should be used as a standard treatment to prevent preterm birth; their use should be reserved for study populations.


Asunto(s)
Pesarios , Nacimiento Prematuro , Cuello del Útero , Femenino , Humanos , Recién Nacido , Embarazo , Embarazo Gemelar , Nacimiento Prematuro/prevención & control
15.
Int J Gynaecol Obstet ; 155(1): 13-15, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34520054

RESUMEN

FIGO (the International Federation of Gynecology and Obstetrics) supports assisted reproductive technologies (ART) to achieve pregnancy and supports their availability in all nations. However, the increased frequency of preterm birth must be taken into account. Therefore, before in vitro fertilization (IVF) is started, other approaches, including expectant management, should be considered. Single embryo transfer is the best approach to ensure a live, healthy child. However, increased risks for preterm birth are also associated with a singleton IVF pregnancy and should be discussed and contrasted with spontaneous conception. Increased preterm birth and other adverse pregnancy outcomes in singleton IVF cycles warrant investigations to elucidate and mitigate. Minimizing embryo manipulation during cell culture is recommended. Increased risk of preterm birth and other pregnancy complications in ART could reflect the underlying reasons for infertility. This information should be discussed and further explored.


Asunto(s)
Nacimiento Prematuro , Femenino , Fertilización , Fertilización In Vitro , Humanos , Recién Nacido , Embarazo , Resultado del Embarazo , Nacimiento Prematuro/epidemiología , Técnicas Reproductivas Asistidas , Estudios Retrospectivos
16.
Int J Gynaecol Obstet ; 155(1): 19-22, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34520055

RESUMEN

Cervical cerclage is an intervention which when given to the right women can prevent preterm birth and second-trimester fetal losses. A history-indicated cerclage should be offered to women who have had three or more preterm deliveries and/or mid-trimester losses. An ultrasound-indicated cerclage should be offered to women with a cervical length <25 mm if they have had one or more spontaneous preterm birth and/or mid-trimester loss. In high-risk women who have not had a previous mid-trimester loss or preterm birth, an ultrasound-indicated cerclage does not have a clear benefit in women with a short cervix. However, for twins, the advantage seems more likely at shorter cervical lengths (<15 mm). In women who present with exposed membranes prolapsing through the cervical os, a rescue cerclage can be considered on an individual case basis, taking into account the high risk of infective morbidity to mother and baby. An abdominal cerclage can be offered in women who have had a failed cerclage (delivery before 28 weeks after a history or ultrasound-indicated [but not rescue] cerclage). If preterm birth has not occurred, removal is considered at 36-37 weeks in women anticipating a vaginal delivery.


Asunto(s)
Cerclaje Cervical , Nacimiento Prematuro , Cuello del Útero/diagnóstico por imagen , Cuello del Útero/cirugía , Femenino , Humanos , Recién Nacido , Embarazo , Segundo Trimestre del Embarazo , Nacimiento Prematuro/prevención & control
17.
Int J Gynaecol Obstet ; 155(1): 8-12, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34520056

RESUMEN

Iatrogenic preterm birth is a planned delivery that occurs before 37 weeks of gestation due to maternal and/or fetal causes. However, in some cases, such deliveries also occur with no apparent medical indication. The increasing numbers of iatrogenic preterm deliveries worldwide have led researchers to identify modifiable causes that allow the formulation of preventive strategies that could impact the overall preterm birth rate. The present document contains the FIGO (International Federation of Gynecology and Obstetrics) Working Group for Preterm Birth recommendations, aiming to reduce the rates of iatrogenic preterm birth based on four of the most common clinical scenarios and issues related to iatrogenic preterm delivery. The working group supports efforts to identify the contribution of iatrogenic preterm delivery to the overall preterm birth rate and encourages health authorities to establish preventive measures accordingly. We encourage care providers to maintain single embryo transfer policies to prevent multiple pregnancies as a substantial contributor of iatrogenic preterm birth. The working group also recommends that efforts to reduce unnecessary cesarean sections must be warranted, and mechanisms to ensure the appropriate time of delivery and strengthening of education and communication processes must be pursued.


Asunto(s)
Nacimiento Prematuro , Cesárea/efectos adversos , Femenino , Humanos , Enfermedad Iatrogénica/epidemiología , Enfermedad Iatrogénica/prevención & control , Recién Nacido , Embarazo , Embarazo Múltiple , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etiología , Atención Prenatal
18.
Int J Gynaecol Obstet ; 155(1): 26-30, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34520057

RESUMEN

For women with a singleton or a multiple pregnancy in situations where active neonatal care is appropriate, and for whom preterm birth is anticipated between 24 and 34 weeks of gestation, one course of prenatal corticosteroids should ideally be offered 18 to 72 h before preterm birth is expected to improve outcomes for the baby. However, if preterm birth is expected within 18 h, prenatal corticosteroids should still be administered. One course of corticosteroids includes two doses of betamethasone acetate/phosphate 12 mg IM 24 h apart, or two doses of dexamethasone phosphate 12 mg IM 24 h apart. In women in whom preterm birth is expected within 72 h and who have had one course of corticosteroids more than a week previously, one single additional course of prenatal corticosteroids could be given at risk of imminent delivery. Prenatal corticosteroids should not be offered routinely to women in whom late preterm birth between 34 and 36 weeks is anticipated. In addition, prenatal corticosteroids should not be given routinely before cesarean delivery at term. Neither should prenatal corticosteroids be given "just in case". Instead, prenatal steroid administration should be reserved for women for whom preterm birth is expected within no more than 7 days, based on the woman's symptoms or an accurate predictive test.


Asunto(s)
Nacimiento Prematuro , Síndrome de Dificultad Respiratoria del Recién Nacido , Corticoesteroides , Betametasona , Cesárea , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Nacimiento Prematuro/prevención & control , Atención Prenatal , Síndrome de Dificultad Respiratoria del Recién Nacido/prevención & control
19.
Int J Gynaecol Obstet ; 155(1): 16-18, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34520058

RESUMEN

Women at high risk of preterm birth (either a previous spontaneous preterm birth and/or sonographic short cervix) with a singleton gestation should be offered daily vaginal progesterone or weekly 17-OHPC treatment to prevent preterm birth. Benefit is most significant in those with prior history of preterm birth and a short cervix. For women with a previous spontaneous preterm birth and a cervix ≥30 mm the effectiveness of progesterone is uncertain. In asymptomatic women with no prior history of previous preterm birth, no mid-trimester loss, or no short cervical length, progesterone therapy is not recommended for the prevention of preterm birth. For those with unselected multiple pregnancies, progesterone therapy is not recommended for the prevention of preterm birth. Daily vaginal progesterone or weekly 17-OHPC treatment can be used for the prevention of preterm birth. The preparation used should be decided by the woman and her clinician. There is no evidence of neurological or developmental benefit or harm in babies whose mothers use progestogens for preterm birth prevention antenatally.


Asunto(s)
Nacimiento Prematuro , Progestinas , Administración Intravaginal , Cuello del Útero , Femenino , Humanos , Recién Nacido , Embarazo , Nacimiento Prematuro/prevención & control , Progesterona
20.
Int J Gynaecol Obstet ; 155(1): 5-7, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34520059

RESUMEN

FIGO calls for strengthening of health information systems for reproductive, maternal, newborn, and child health services, co-designed with users, to ensure the timely accessibility of actionable high-quality data for all stakeholders engaged in preventing and managing preterm birth consequences. FIGO calls for strengthening of investments and capacity for implementing digital registries and the continuity of reproductive, maternal, newborn, and child health services in line with WHO recommendations, and strengthening of the science of implementation and use of registries-from local quality improvement to big data exploration.


Asunto(s)
Nacimiento Prematuro , Niño , Femenino , Humanos , Recién Nacido , Embarazo , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/prevención & control , Sistema de Registros
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