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CONTEXT: Acupressure and halogen light stimulation, are used to reduce false non-reactive nonstress test results related to fetal sleep. OBJECTIVE: This study was conducted to determine the effect of acupressure and halogen light stimulation on nonstress testing and anxiety during pregnancy. DESIGN: Randomized controlled experimental study. SETTING: The population of the study consisted of pregnant women who were requested to have a nonstress test. PARTICIPANTS: The sample of the study included 132 pregnant women (acupressure group:44; halogen light group:45, and control group:43). METHODS: The acupressure group was applied acupressure on the Zhiyin acupuncture point three times, the halogen light group was applied halogen light stimulation twice on the fetal head from the mother's abdomen. In the interpretation of the results, the level of statistical significance was taken as P < 0.05. MAIN OUTCOME PARTICIPANTS: In our study, there was no difference between the acupressure and halogen light groups in terms of the mean number of fetal movements, the number of accelerations, the time to the first acceleration, and the time to reach the reactive result in the nonstress test (P > 0.05), while the mean number of fetal movements and accelerations of these two groups were higher, and the mean time to the first acceleration and the mean time to reach the reactive result in the nonstress test were shorter than those of the control group (P < 0.05). In addition, no statistically significant difference was found between the groups in terms of mean state anxiety inventory scores (P > 0.05). RESULTS: Acupressure and halogen light stimulation increased the rates of reactive nonstress tests.
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BACKGROUND: A significant proportion of major fetal structural anomalies can be detected in the first trimester by ultrasound examination. However, the test performance of the first-trimester anomaly scan (FTAS) performed in a low-risk population as part of a nationwide prenatal screening program is unknown. Potential benefits of the FTAS include early detection of fetal anomalies, providing parents with more time for reproductive decision-making. OBJECTIVES: To investigate the uptake, test performance and time to a final prenatal diagnosis after referral. STUDY DESIGN: A nationwide implementation study was conducted in the Netherlands (November 2021-November 2022). The FTAS was performed between 12+3 and 14+3 weeks gestation by certified sonographers using a standard protocol. Women were referred to a tertiary care center if anomalies were suspected. Uptake, test performance and time to a final prenatal diagnosis (days between referral and date of final diagnosis/prognosis for reproductive decision-making) were determined. Test performance was calculated for first-trimester major congenital anomalies, such as anencephaly and holoprosencephaly and all diagnosed anomalies <24 weeks gestation. RESULTS: The FTAS uptake was 74.9% (129 704/173 129). In 1.0% (1 313/129 704), an anomaly was suspected, of which 54.9% (n=721) had abnormal findings on the detailed first-trimester diagnostic scan and 44.6% (n=586) showed normal results. In 0.5% (n=6), intra-uterine fetal death occurred. In the total group of 721 cases with abnormal findings, 332 structural anomalies, 117 genetic anomalies, 82 other findings (abnormal fetal biometry, sonomarkers, placental/umbilical cord anomaly, an-/oligohydramnios) and 189 cases with transient findings (defined as ultrasound findings which resolved <24 weeks gestation) were found, with one case having an unknown outcome. 0.9% (n=1164) of all cases with a normal FTAS were diagnosed with a fetal anomaly in the second trimester. Test performance included a sensitivity of 84.6% (126/149) for first-trimester major congenital anomalies and 31.6% (537/1701) for all types of anomalies. Specificity for all anomalies was 99.2% (98 055/98 830); positive predictive value 40.9% (537/1 312); negative predictive value 98.8% (98 055/99 219); positive likelihood ratio 40.3; negative likelihood ratio 0.7; false positive rate 0.8% (775/98 830) and false negative rate 68.4% (1 164/1 701). The median time to diagnosis for structural anomalies was 20 days (6-43 days; median GA 16+3), for genetic anomalies 17 days (8.5-27.5 days; median GA 15+6 weeks) and for first-trimester major congenital anomalies 9 days (5-22 days; median GA 14+6 weeks). CONCLUSIONS: The performance of a newly introduced nationwide FTAS in a low-risk population showed a high sensitivity for first-trimester major congenital anomalies and a lower sensitivity for all anomalies combined. The program was accompanied by a referral rate of 1.0%, of which 59.1% involved cases where anomalies were either not confirmed or resolved before 24 weeks gestation. Timing of diagnosis was around 16 weeks gestation for referred cases. To evaluate the balance between benefits and potential harm of the FTAS within a nationwide prenatal screening program, it is essential to assess the effectiveness of the program over time and to consider the perspectives of both women and their partners, as well as healthcare professionals.
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INTRODUCTION: Intrahepatic cholestasis of pregnancy (ICP) is a problem with an increasing incidence and negative maternal, fetal, and neonatal consequences. This problem is becoming increasingly important. This systematic review and meta-analysis aimed to determine the incidence of ICP and its adverse maternal, fetal, and neonatal adverse outcomes based on primary research studies. METHODS: This systematic review and meta-analysis used Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines and was conducted between June and September 2023 using the following keywords: obstetric cholestasis OR intrahepatic cholestasis AND pregnancy OR pregnant OR prenatal OR antenatal OR perinatal OR maternal OR fetal OR neonatal. Quality assessment of the studies was performed using the Critical Appraisal Checklists developed by the JBI Institute. Data were synthesized using meta-analysis methods. RESULTS: The analysis included 10 studies published between 2013 and 2023. The meta-analysis showed that the incidence of ICP was 1.7% (odds ratio [OR], 0.021; 95% CI, 0.012-0.027), whereas maternal, fetal, and neonatal adverse outcomes included cesarean birth (OR, 2.938; 95% CI, 1.467-5.881), preterm birth or preterm prelabor rupture of membranes (OR, 4.241; 95% CI, 1.996-9.009), hypertensive disorders of pregnancy (OR, 3.715; 95% CI, 1.545-8.929), maternal infection (OR, 3.301; 95% CI, 2.917-3.737), neonatal intensive care unit admission (OR, 2.715; 95% CI, 1.458-5.056), birth weight less than or equal to 2500 g (OR, 2.518; 95% CI, 1.296-4.892), and small for gestational age (OR, 1.915; 95% CI, 1.424-2.573). DISCUSSION: This systematic review and meta-analysis revealed that ICP has a high incidence and several maternal, fetal, and neonatal adverse outcomes. Therefore, midwives and other health professionals must be aware of these outcomes and provide appropriate care to pregnant individuals with ICP.
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Colestase Intra-Hepática , Complicações na Gravidez , Resultado da Gravidez , Humanos , Gravidez , Colestase Intra-Hepática/epidemiologia , Feminino , Complicações na Gravidez/epidemiologia , Recém-Nascido , Incidência , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Cesárea/estatística & dados numéricosRESUMO
Background: In cesarean delivery, factors such as general anesthesia affect bowel function, leading postpartum women to experience abdominal tenderness, gas, and constipation. Objective: This study aims to assess the impact of acupressure on bowel function after cesarean delivery. Design: A randomized-controlled experimental study was conducted. Participants: The study population comprised postpartum women who underwent cesarean delivery at Ondokuz Mayis University Health Practice and Research Hospital between July 2021 and January 2022. The sample consisted of 61 postpartum women (acupressure group: 31, control group: 30). Intervention: Participants were divided into two groups: the acupressure group and the control group. Women in the acupressure group received 14 minutes of acupressure application to the LI4 and TH6 points twice, once within the first postoperative hour and again three hours later. The control group received no acupressure intervention. Outcome Measures: Data were collected using a Postpartum Information Form and a Post-cesarean Follow-up Form. Statistical analyses included the Mann-Whitney U test, Student's t test, and chi-squared analysis. Results: The mean age of postpartum women in the acupressure group was 27.61±4.39, while in the control group, it was 28.50±3.85. The mean times for bowel sounds, flatulence, and bowel movements in the acupressure group (9.98±2.77, 19.43±10.25, and 27.13±10.77 hours, respectively) were significantly shorter than those in the control group (14.41±5.07, 23.33±4.20, and 46.16±17.95 hours, respectively) (P < .05). Conclusions: Acupressure was found to be effective in improving bowel function after cesarean delivery, significantly reducing the time taken for participants to experience bowel sounds, flatulence, and bowel movements.
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Acupressão , Cesárea , Humanos , Feminino , Acupressão/métodos , Adulto , Gravidez , Período Pós-Parto , Constipação Intestinal/terapia , Constipação Intestinal/fisiopatologiaRESUMO
Obtaining information about women's use of digital media, their behavior in acquiring health information in the digital environment and their level of health literacy will fill an important gap in the literature. This research was conducted to examine the digital media use and health literacy levels of women in Turkey. The population of the research was the female population between the ages of 20-60 in Turkey in 2020, and the sample consisted of 404 women in this age range. The data of this analytical-cross-sectional study were collected online with the Personal Information Form and the Turkish Health Literacy Scale-32. It was determined that 83.9% of the women participating in the study used digital media and 82.9% of them obtained health information in the digital environment. In the categorical score distribution of the scale, it was determined that the health literacy level of 48.8% of women was insufficient, 26.2% problematic/limited, 19.8% sufficient and 5.2% excellent. A significant relationship was determined between women's health literacy level and age, marital status, education level, employment status, perception of income level, place of residence, use of digital media and duration of use (p < .05). We concluded that majority of women in Turkey use digital media, obtain health information in the digital environment and have low health literacy levels.
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Letramento em Saúde , Humanos , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Turquia , Estudos Transversais , Internet , Saúde da MulherRESUMO
INTRODUCTION: The aim of this study was to use computerized analysis of the grayscale spectrum (histogram) to provide an objective assessment of the echogenicity of the fetal bowel. Moreover, we investigated the role of histogram analysis in the prenatal prediction of postnatal outcomes in fetuses with echogenic bowel (fetal echogenic bowel [FEB]). METHODS: This is a single-center retrospective study including all fetuses with a diagnosis of echogenic bowel (FEB) in the mid-second trimester between 2015 and 2021. Ultrasound images were analyzed using ImageJ software. The mean of the grayscale histograms of the bowel, liver, and iliac/femur bone was obtained for each patient, and the ratio between these structures was used to overcome gain variations. We compared these values with those of a matched control group of singleton uncomplicated pregnancies and with a group of patients referred for FEB, where the FEB was not confirmed by the expert operator (FEB false-positive). RESULTS: There was a statistically significant difference between bowel/liver and bowel/bone histogram ratios between the FEB group and the control groups (p < 0.05). Mean ratio cutoffs were provided for the diagnosis of FEB. Among the patients with confirmed FEB, both ratios were not able to discriminate the cases with adverse outcomes. In contrast, the presence of dilated bowel or other markers was associated with an adverse outcome. CONCLUSIONS: Histogram analysis may refine the diagnosis of FEB and reduce the number of false-positive diagnoses. For the prediction of the fetal outcome, the presence of additional features is clinically more significant than the degree of bowel echogenicity.
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Intestino Ecogênico , Gravidez , Feminino , Humanos , Estudos Retrospectivos , Ultrassonografia Pré-Natal/métodos , Feto/diagnóstico por imagem , UltrassonografiaRESUMO
INTRODUCTION: First-trimester anatomical screening (FTAS) by ultrasound has been introduced in many countries as screening for aneuploidies, but also as early screening for fetal structural abnormalities. While a lot of emphasis has been put on the detection rates of FTAS, little is known about the performance of quality control programs and the sonographers' learning curve for FTAS. The aims of the study were to evaluate the performance of a score-based quality control system for the FTAS and to assess the learning curves of sonographers by evaluating the images of the anatomical planes that were part of the FTAS protocol. METHODS: Between 2012-2015, pregnant women opting for the combined test in the North-Netherlands were also invited to participate in a prospective cohort study extending the ultrasound investigation to include a first-trimester ultrasound performed according to a protocol. All anatomical planes included in the protocol were documented by pictures stored for each examination in logbooks. The logbooks of six sonographers were independently assessed by two fetal medicine experts. For each sonographer, logbooks of examination 25-50-75 and 100 plus four additional randomly selected logbooks were scored for correct visualization of 12 organ-system planes. A plane specific score of at least 70% was considered sufficient. The intra-class correlation coefficient (ICC), was used to measure inter-assessor agreement for the cut-off scores. Organ-specific learning curves were defined by single-cumulative sum (CUSUM) analysis. RESULTS: Sixty-four logbooks were assessed. Mean duration of the scan was 22 ± 6 minutes and mean gestational age was 12+6 weeks. In total 57% of the logbooks graded as sufficient. Most sufficient scores were obtained for the fetal skull (88%) and brain (70%), while the lowest scores were for the face (29%) and spine (38%). Five sonographers showed a learning curve for the skull and the stomach, four for the brain and limbs, three for the bladder and kidneys, two for the diaphragm and abdominal wall and one for the heart and spine and none for the face and neck. CONCLUSION: Learning curves for FTAS differ per organ system and per sonographer. Although score-based evaluation can validly assess image quality, more dynamic approaches may better reflect clinical performance.
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Curva de Aprendizado , Ultrassonografia Pré-Natal , Gravidez , Humanos , Feminino , Lactente , Primeiro Trimestre da Gravidez , Ultrassonografia Pré-Natal/métodos , Estudos Prospectivos , UltrassonografiaRESUMO
AIM: The aim of this study was to determine the effect of acupressure on postpartum fatigue in women who gave birth by cesarean section. METHOD: This study is a randomized controlled experimental study. The study was conducted between August 2021 and January 2022 in the maternity wards of hospitals in Turkey. Multiparous women who gave birth by cesarean section were randomly assigned to acupressure (n = 60) and control (n = 62) groups. Acupressure was applied to the acupressure group for a total of four sessions on the points of LI4, ST36, and SP6, for an average of 15 min for each session. The application sessions continued for 48 h after the cesarean section. The data were collected with a Descriptive Information Form and the VAS-F. RESULTS: It was determined that the mean posttest score of the fatigue dimension of the VAS-F was found to be significantly lower in the acupressure group (p = 0.023). Additionally, in the acupressure group, while the differences between the pretest and posttest results of the both fatigue and energy dimensions of the VAS-F were statistically highly significant in the acupressure group (p = 0.000), only the difference in the energy dimension was found to be statistically significant in the control group (p = 0.016). CONCLUSIONS: As a result, acupressure was found to be effective in reducing postpartum fatigue in women who gave birth by cesarean section, and its usability for healthcare professionals was demonstrated.
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Acupressão , Cesárea , Gravidez , Feminino , Humanos , Acupressão/métodos , Período Pós-Parto , Parto , Fadiga/etiologia , Fadiga/terapiaRESUMO
The objective of this study is to examine the relationship between nausea and vomiting during pregnancy (NVP) and attachment styles in close relationships, marital adjustment, and ways of coping with stress. This study was performed in 2019 as an analytic case-control design. The study group consists of 60 pregnant women hospitalized with a nausea-vomiting/hyperemesis gravidarum diagnosis. The control group is composed of 64 pregnant women who applied for gynecology polyclinic for routine control. The participants were applied Pregnancy-Information Form, Experiences in Close Relationships Scale-Revised (ECR-R), Marital Adjustment Test (MAT), and Coping Styles Inventory (CSI). It was observed that the scores of the pregnant women in the study group from the helpless approach subscale of CSI were significantly higher than the control group and no significant difference was found between the two groups in terms of other scale scores. A negative correlation was found between the perceived severity of nausea and the seeking social support subscale of CSI in the study group. The study revealed findings that support the biopsychosocial approach to the etiology of NVP and showed that the women with NVP use a helpless approach in coping with stress and apply seeking social support as the severity of nausea decreases.
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Hiperêmese Gravídica , Casamento , Feminino , Gravidez , Humanos , Náusea , Hiperêmese Gravídica/diagnóstico , Hiperêmese Gravídica/psicologia , Adaptação PsicológicaRESUMO
Spirituality is an integral part of holistic care, but studies have revealed that the spiritual dimension of care is largely neglected in healthcare settings. This study evaluated midwives' perceptions of spirituality and spiritual care. The study is a cross-sectional design and was conducted from April 1 to June 30, 2018 in Aydin, Turkey. The research sample of the study contacted 101 midwives. The Spirituality and Spiritual Care Rating Scale were used to collect data. It was found that the midwives' perceptions of spirituality and spiritual care were affected by age, having children, family type, and working unit (p < 0.05).
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Tocologia , Terapias Espirituais , Estudantes de Enfermagem , Gravidez , Criança , Humanos , Feminino , Espiritualidade , Turquia , Estudos TransversaisRESUMO
The aim of this cross-sectional study was to determine pregnant women's knowledge and attitudes regarding coronavirus vaccines in Turkiye. The research population consisted of 400 pregnant women who applied to a public hospital in this city. The data of the study was collected with the 'Personal Information Form' and 'Attitudes Towards COVID-19 Vaccine Scale'. Only 2% of the pregnant women stated that they wanted to receive coronavirus vaccines in their current pregnancy and 9.5% wanted it during the postpartum period. It has been concluded that the vast majority of pregnant women have insufficient knowledge and negative thoughts about coronavirus vaccines and the place where they live and their thoughts on the safety of coronavirus vaccines affect their positive attitudes about coronavirus vaccines.IMPACT STATEMENTWhat is already known on this subject? Many epidemics in history have been controlled or eliminated with vaccines. However, there is still insufficient evidence about the effects of coronavirus infection and vaccines on pregnant women.What do the results of this study add? As a result, it was found that the vast majority of pregnant women had insufficient knowledge and negative thoughts about coronavirus vaccines and very few of them wanted to receive the coronavirus vaccine during pregnancy and the postpartum period.What are the implications of these findings for clinical practice and/or further research? In the light of these findings, it is recommended that increase the vaccination rates in pregnant women by turning existing negative attitudes towards coronavirus vaccines in pregnant women into positive ones, providing accurate and effective information by health professionals and the media to eliminate negative attitudes caused by lack of information in pregnant women, conducting more studies on obstacles to increasing vaccine acceptance during pregnancy, and conducting studies on the subject with wider audiences and regions.
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Vacinas contra COVID-19 , COVID-19 , Feminino , Humanos , Gravidez , COVID-19/prevenção & controle , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Gestantes/psicologia , VacinaçãoRESUMO
This study was conducted to determine the incidence of unplanned pregnancies and the factors affecting it during the COVID-19 pandemic. An analytical-cross-sectional study was carried out at a public hospital in Aydin, Turkey between January and October 2021. The sample of the study comprised 220 pregnant women. The data was collected with a Pregnant Information Form, and the Pearson Chi-square test and Binary Logistic Regression analysis were employed in the analysis. It was determined that the incidence of unplanned pregnancy during the COVID-19 pandemic was 33.6% and that number of living children [AOR:0.73, 95% CI:(0.23-0.99)], thought of having another child [AOR:1.21, 95% CI:(1.43-7.89)], the family planning method used [AOR:1.31, 95% CI:(1.05-5.22)], and having problems in reaching a family planning method [AOR:1.97, 95% CI:(0.04-0.50)] affected the occurrence of unplanned pregnancies (p < .05). IMPACT STATEMENTWhat is already known on this subject? Unplanned pregnancies adversely affect maternal and newborn health.What do the results of this study add? It was found that approximately one out of three pregnancies during the COVID-19 pandemic process was unplanned and that the number of living children, the thought of having another child, the family planning method used, and having problems in obtaining a family planning method affected the occurrence of unplanned pregnancies.What are the implications of these findings for clinical practice and/or further research? It can guide politicians in the arrangements regarding sexual and reproductive health services during the COVID-19 pandemic.
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COVID-19 , Anticoncepcionais , Gravidez não Planejada , Criança , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Transversais , Serviços de Planejamento Familiar , PandemiasRESUMO
OBJECTIVE: We aimed to evaluate the additional value of advanced fetal anatomical assessment by ultrasound in pregnancies with twice inconclusive noninvasive testing (NIPT) due to low fetal fraction (FF). METHODS: We performed a multicenter-retrospective study between 2017 and 2020 including 311 pregnancies with twice inconclusive NIPT due to low FF ≤ 1%. Women were offered invasive testing and advanced fetal anatomical assessment at ≤18 weeks' gestation. Ultrasound findings, genetic testing, and pregnancy/postnatal outcomes were evaluated. RESULTS: Ninety-two/311 (29.6%) women underwent invasive testing. Structural anomalies were diagnosed in 13/311 (4.2%) pregnancies (nine at the first scan and four at follow-up). In 6/13 (46.2%) cases, genetic aberrations were confirmed (one case of Trisomy 13 (detectable by NIPT), two of Triploidy, one of 16q12-deletion, HCN4-mutation and UPD(16) (nondetectable by NIPT). Genetic aberrations were found in 4/298 (1.3%) structurallynormal pregnancies (one 47XYY, two microscopic aberrations, one monogenic disorder found postpartum). Structural anomalies in genetically normal fetuses (2.0%) were not more prevalent compared to the general pregnant population (OR 1.0 [0.4-2.2]). CONCLUSION: In pregnancies with twice inconclusive NIPT due to low FF, fetal structural anomalies are not more prevalent than in the general obstetric population. The detailed anatomical assessment has the added value to detect phenotypical features suggestive of chromosomal/genetic aberrations and identify pregnancies where advanced genetic testing may be indicated.
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Ácidos Nucleicos Livres , Aberrações Cromossômicas , Feminino , Humanos , Canais Disparados por Nucleotídeos Cíclicos Ativados por Hiperpolarização/genética , Masculino , Gravidez , Primeiro Trimestre da Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Trissomia/diagnóstico , Trissomia/genética , Ultrassonografia , Ultrassonografia Pré-NatalRESUMO
INTRODUCTION: Since 2021, first-trimester anatomical screening (FTAS) is offered in the Netherlands alongside genome-wide cell-free DNA (cfDNA). Previously, only second-trimester anatomical screening (STAS) was offered. This study identifies structural abnormalities amenable to first-trimester diagnosis detected at/after STAS in the period following cfDNA implementation and preceding FTAS introduction. METHODS: This retrospective cohort includes 547 fetuses referred between 2017 and 2020 because of suspected structural abnormalities before/at/after STAS. Additional prenatal investigations and postnatal follow-up were searched. Abnormalities were classified into "always", "sometimes", and "never" detectable in the first-trimester based on a previously suggested classification. RESULTS: Of the 547 pregnancies, 13 (2.6%) received FTAS and 534 (97.6%) received a dating ultrasound and STAS. In 492/534 (92.1%) anomalies were confirmed; 66 (13.4%) belonged to the "always detectable" group in the first trimester, 303 (61.6%) to the "sometimes detectable", and 123 (25.0%) to the never detectable. Of the "always detectable" anomalies 29/66 (44%) were diagnosed during dating ultrasounds and 37 (56%) during STAS. The rate of termination of pregnancy for anomalies detected during FTAS and at/after STAS was 84.6% (n = 11/13) and 29.3% (n = 144/492) (p < 0.01). CONCLUSION: When FTAS is not part of screening paradigms, most fetal anomalies remain undetected until the second trimester or later in pregnancy, including 56% of anomalies "always detectable" in the first trimester.
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Ácidos Nucleicos Livres , Feminino , Feto/diagnóstico por imagem , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-NatalRESUMO
BACKGROUND: Prenatal diagnosis of several major congenital anomalies can be achieved in the first trimester of pregnancy. OBJECTIVE: This study investigates the timing of diagnosis and pregnancy outcome of foetuses and neonates with selected structural anomalies in the Northern Netherlands over a 10-year period when the prenatal screening programme changed significantly, but no first-trimester anatomical screening was implemented. METHODS: We performed a population-based retrospective cohort study with data from the EUROCAT Northern Netherlands database on pregnancies with delivery or termination of pregnancy for fetal anomaly (TOPFA) date between 2010 and 2019. The analysis was restricted to anomalies potentially detectable in the first trimester of pregnancy in at least 50% of cases, based on previously published data. These included: anencephaly, encephalocele, spina bifida, holoprosencephaly, tricuspid/pulmonary valve atresia, hypoplastic left heart, abdominal wall and limb reduction defects, lethal skeletal dysplasia, megacystis, multiple congenital anomalies. The primary outcome was the timing of diagnosis of each structural anomaly. Information on additional investigations, genetic testing and pregnancy outcome (live birth, TOPFA and foetal/neonatal death) was also collected. RESULTS: A total of 478 foetuses were included; 95.0% (n = 454) of anomalies were detected prenatally and 5.0% (n = 24) postpartum. Among the prenatally detected cases, 31% (n = 141) were diagnosed before 14 weeks of gestation, 65.6% (n = 298) between 14-22 weeks and 3.3% (n = 15) after 22 weeks. Prenatal genetic testing was performed in 80.4% (n = 365) of cases with prenatally diagnosed anomalies, and the results were abnormal in 26% (n = 95). Twenty-one% (n = 102) of pregnancies resulted in live births and 62.8% (n = 300) in TOPFA. Spontaneous death occurred in 15.9% (n = 76) of cases: in-utero (6.1%, n = 29), at delivery (7.7%, n = 37) or in neonatal life (2.1%, n = 10). CONCLUSION: Major structural anomalies amenable to early diagnosis in the first trimester of pregnancy are mostly diagnosed during the second trimester in the absence of a regulated first-trimester anatomical screening programme in the Netherlands and are associated with TOPFA and spontaneous death, especially in cases with underlying genetic anomalies.
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Anormalidades Múltiplas , Resultado da Gravidez , Recém-Nascido , Feminino , Gravidez , Humanos , Primeiro Trimestre da Gravidez , Resultado da Gravidez/epidemiologia , Países Baixos/epidemiologia , Estudos Retrospectivos , Estudos de Coortes , Diagnóstico Pré-Natal , Ultrassonografia Pré-Natal/métodosRESUMO
AIM: This study aimed to investigate the effects of the interventions in the delivery room on the delivery process and the newborn health. METHOD: The analytical-cross-sectional study was carried out with 354 puerperal women who gave birth in hospital between December 2016 and June 2017 in a public hospital. The data were collected by the data collection form developed by the researchers. Data analysis was done by using descriptive statistics and chi-square test in SPSS 21.00 program. RESULTS: The interventions were determined in continuous electro fetal monitoring (80.5%), oxytocin induction (79.9%), restriction of free movement (56.8%), amniotomy (49.7%), enema (44.1%), and movement restriction (56.8%). The intervention period of the second phase of delivery was longer and the rate of cesarean section was higher, and the need for NICU, suction difficulty, 5th APGAR score less than 7, trauma development, difficulty in suction, and higher trauma rates were found in infants. It was determined that the rate of oxygen need in puerperals admitted to the delivery room with cervical dilatation below five cm, vacuum and episiotomy applications in those who underwent amniotomy, and vacuum application rates in those undergoing oxytocin inductions were found to be high. In addition, the rate of fundal compression and episiotomy was significantly higher in patients who used continuous electro fetal monitoring, fundal compression and vacuum rate in patients who were administered analgesic drugs, and episiotomy rates in patients using analgesic drugs. CONCLUSION: It has been concluded that interventions in the first phase of labor negatively affect the delivery process and neonatal health and increase the need for intervention in the second phase.
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Objective: Sildenafil is under investigation as a potential agent to improve uteroplacental perfusion in fetal growth restriction (FGR). However, the STRIDER RCT was halted after interim analysis due to futility and higher rates of persistent pulmonary hypertension and mortality in sildenafil-exposed neonates. This hypothesis-generating study within the Dutch STRIDER trial sought to understand what happened to these neonates by studying their regional tissue oxygen saturation (rSO2) within the first 72 h after birth. Methods: Pregnant women with FGR received 25 mg placebo or sildenafil thrice daily within the Dutch STRIDER trial. We retrospectively analyzed the cerebral and renal rSO2 monitored with near-infrared spectroscopy (NIRS) in a subset of neonates admitted to two participating neonatal intensive care units, in which NIRS is part of standard care. Secondarily, blood pressure and heart rate were analyzed to aid interpretation. Differences in oxygenation levels and interaction with time (slope) between placebo- and sildenafil-exposed groups were tested using mixed effects analyses with multiple comparisons tests. Results: Cerebral rSO2 levels were not different between treatment groups (79 vs. 77%; both n = 14) with comparable slopes. Sildenafil-exposed infants (n = 5) showed lower renal rSO2 than placebo-exposed infants (n = 6) during several time intervals on day one and two. At 69-72 h, however, the sildenafil group showed higher renal rSO2 than the placebo group. Initially, diastolic blood pressure was higher and heart rate lower in the sildenafil than the placebo group, which changed during day two. Conclusions: Although limited by sample size, our data suggest that prenatal sildenafil alters renal but not cerebral oxygenation in FGR neonates during the first 72 post-natal hours. The observed changes in renal oxygenation could reflect a vasoconstrictive rebound from sildenafil. Similar changes observed in accompanying vital parameters support this hypothesis.
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Importance: Severe early onset fetal growth restriction caused by placental dysfunction leads to high rates of perinatal mortality and neonatal morbidity. The phosphodiesterase 5 inhibitor, sildenafil, inhibits cyclic guanosine monophosphate hydrolysis, thereby activating the effects of nitric oxide, and might improve uteroplacental function and subsequent perinatal outcomes. Objective: To determine whether sildenafil reduces perinatal mortality or major morbidity. Design, Setting, and Participants: This placebo-controlled randomized clinical trial was conducted at 10 tertiary referral centers and 1 general hospital in the Netherlands from January 20, 2015, to July 16, 2018. Participants included pregnant women between 20 and 30 weeks of gestation with severe fetal growth restriction, defined as fetal abdominal circumference below the third percentile or estimated fetal weight below the fifth percentile combined with Dopplers measurements outside reference ranges or a maternal hypertensive disorder. The trial was stopped early owing to safety concerns on July 19, 2018, whereas benefit on the primary outcome was unlikely. Data were analyzed from January 20, 2015, to January 18, 2019. The prespecified primary analysis was an intention-to-treat analysis including all randomized participants. Interventions: Participants were randomized to sildenafil, 25 mg, 3 times a day vs placebo. Main Outcomes and Measures: The primary outcome was a composite of perinatal mortality or major neonatal morbidity until hospital discharge. Results: Out of 360 planned participants, a total of 216 pregnant women were included, with 108 women randomized to sildenafil (median gestational age at randomization, 24 weeks 5 days [interquartile range, 23 weeks 3 days to 25 weeks 5 days]; mean [SD] estimated fetal weight, 458 [160] g) and 108 women randomized to placebo (median gestational age, 25 weeks 0 days [interquartile range, 22 weeks 5 days to 26 weeks 3 days]; mean [SD] estimated fetal weight, 464 [186] g). In July 2018, the trial was halted owing to concerns that sildenafil may cause neonatal pulmonary hypertension, whereas benefit on the primary outcome was unlikely. The primary outcome, perinatal mortality or major neonatal morbidity, occurred in the offspring of 65 participants (60.2%) allocated to sildenafil vs 58 participants (54.2%) allocated to placebo (relative risk, 1.11; 95% CI, 0.88-1.40; P = .38). Pulmonary hypertension, a predefined outcome important for monitoring safety, occurred in 16 neonates (18.8%) in the sildenafil group vs 4 neonates (5.1%) in the placebo group (relative risk, 3.67; 95% CI, 1.28-10.51; P = .008). Conclusions and Relevance: These findings suggest that antenatal maternal sildenafil administration for severe early onset fetal growth restriction did not reduce the risk of perinatal mortality or major neonatal morbidity. The results suggest that sildenafil may increase the risk of neonatal pulmonary hypertension. Trial Registration: ClinicalTrials.gov Identifier: NCT02277132.
Assuntos
Peso ao Nascer , Término Precoce de Ensaios Clínicos , Retardo do Crescimento Fetal/tratamento farmacológico , Inibidores da Fosfodiesterase 5/uso terapêutico , Doenças Placentárias/tratamento farmacológico , Citrato de Sildenafila/uso terapêutico , Adulto , Método Duplo-Cego , Feminino , Retardo do Crescimento Fetal/etiologia , Idade Gestacional , Humanos , Hipertensão Pulmonar/induzido quimicamente , Recém-Nascido , Doenças do Recém-Nascido/induzido quimicamente , Doenças do Recém-Nascido/prevenção & controle , Análise de Intenção de Tratamento , Masculino , Artéria Cerebral Média/fisiologia , Mortalidade Perinatal , Inibidores da Fosfodiesterase 5/efeitos adversos , Doenças Placentárias/fisiopatologia , Pré-Eclâmpsia/etiologia , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Fluxo Pulsátil , Citrato de Sildenafila/efeitos adversos , Artérias Umbilicais/fisiologiaRESUMO
PURPOSE: To investigate hemodynamic effects after antenatal corticosteroids (ACS) administration in appropriate for gestational age (AGA) and early growth restricted (GR) fetuses by measurement of Doppler cardiovascular function parameters. MATERIALS AND METHODS: Prospective cohort study. AGA and GR singleton pregnancies receiving ACS for fetal lung maturation between 24â+â0-33â+â6 weeks were enrolled. Feto-placental vascular hemodynamics were studied by: umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, renal artery (RenA) PI. Cardiac function was evaluated by ductus venosus (DV) PI and by echocardiographic parameters: E to A wave ratios (E/A) and mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE) for diastolic function, left and right myocardial performance index (MPI) for overall (diastolic and systolic) function. A single operator performed all the measurements at 3 different time points (E): E0 before or within 4 hours of ACS administration (baseline examination), E1 24-48 hours after the first dose and E2 7 days after the second dose of ACS.âThe values were expressed as z-scores. Pairwise comparisons with paired t-test were performed to compare measurements before and after exposure to ACS. RESULTS: 25 AGA and 20 GR fetuses (mean gestational age: 31â+â1 and 30â+â6, respectively) were included in the analysis. In the AGA group ACS administration was associated with a significant reduction in UA PI. In the GR fetuses ACS temporarily (E0-E1) restored UA-end diastolic flow (EDF) in 6 of 9 fetuses with A/R-EDF ("Return of EDF phenomenon") and produced a significant increase (worsening) in right MPI (both in E1-E2 and in E0-E2). CONCLUSION: ACS administration is associated with UA vasodilation in both AGA and GR fetuses and with an increase in right MPI in the latter group.âThis suggests a worsening in cardiac function in GR fetuses.
Assuntos
Retardo do Crescimento Fetal , Idade Gestacional , Hemodinâmica , Ultrassonografia Pré-Natal , Corticosteroides , Adulto , Velocidade do Fluxo Sanguíneo , Feminino , Feto , Humanos , Gravidez , Estudos Prospectivos , Artérias UmbilicaisRESUMO
PURPOSE: To determine the ocular biometric characteristics during the menstrual cycle using the optical low-coherence reflectometry (OLCR) biometry. METHODS: Twenty-two healthy women between the ages of 19 and 36 years with regular menstrual cycles were enrolled in this prospective study. Subjects with irregular menstrual cycles, those taking contraceptive pills, those with a history of ocular surgery or trauma, and women unable to cooperate with the ocular biometry device were excluded from this study. A complete ophthalmic examination was performed between 8.30 and 10.30 am for all participants. Also, central corneal thickness, axial length, anterior chamber depth, lens thickness, and keratometric measurements were made at the same time using the OLCR device. Measurements were taken at the beginning of the cycle (1-3 days), at ovulation (12-16 days), and at the end of the cycle (26-32 days). RESULTS: The mean age of the participants was 22.86±4.22 (range: 18-36) years. The difference in central corneal thickness, axial length, anterior chamber depth, lens thickness, and keratometry values were not statistically significant during the menstrual cycle. CONCLUSION: The ocular biometric parameters did not significantly vary during the menstrual cycle according to the OLCR biometry.