The effects of low-dose aspirin on preterm birth: a systematic review and meta-analysis of randomized controlled trials.

AIM: To conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated the efficacy of low-dose aspirin (LDA, ≤ 160 mg/day) on preventing preterm birth (PB). METHODS: Five databases were screened from inception until June 25, 2023. The RCTs were assessed for quality according to Cochrane's risk of bias tool. The endpoints were summarized as risk ratio (RR) with 95% confidence interval (CI). RESULTS: Overall, 40 RCTs were analyzed. LDA significantly decreased the risk of PB < 37 weeks (RR: 0.91, 95% CI 0.87, 0.96, p < 0.001, moderate certainty of evidence) with low between-study heterogeneity (I2 = 23.2%, p = 0.11), and PB < 34 weeks (RR: 0.78, 95% CI 0.61, 0.99, p = 0.04, low certainty of evidence) with high between-study heterogeneity (I2 = 58.3%, p = 0.01). There were no significant differences between both groups regarding the risk of spontaneous (RR: 0.94, 95% CI 0.83, 1.07, p = 0.37) and medically indicated (RR: 1.28, 95% CI 0.87, 1.88, p = 0.21) BP < 37 weeks. Sensitivity analysis revealed robustness for all outcomes, except for the risk of PB < 34 weeks. For PB < 37 weeks and PB < 34 weeks, publication bias was detected based on visual inspection of funnel plots for asymmetry and statistical significance for Egger's test (p = 0.009 and p = 0.0012, respectively). CONCLUSION: LDA can significantly reduce the risk of PB < 37 and < 34 weeks. Nevertheless, further high-quality RCTs conducted in diverse populations, while accounting for potential confounding factors, are imperative to elucidate the optimal aspirin dosage, timing of initiation, and treatment duration for preventing preterm birth and to arrive at definitive conclusions.

CO2 laser therapy for management of stress urinary incontinence in women: a systematic review and meta-analysis.

Background: Carbon dioxide (CO2) laser therapy is an emerging treatment for women with stress urinary incontinence (SUI). Objectives: To examine the efficacy of CO2 laser therapy for management of SUI-related symptoms in women. Design: A systematic review and meta-analysis of randomized controlled trials and cohort studies. Data sources and methods: Four databases were screened until January 2023. All efficacy continuous endpoints were assessed via subtraction of the posttreatment from pretreatment values. The data were summarized as mean difference (MD) with 95% confidence interval (CI) using the random-effects model. Results: A total of 15 studies with 700 patients were analyzed. CO2 laser therapy significantly decreased the 1-h pad weights at 3 months [n = 5 studies, MD = -3.656 g, 95% CI (-5.198, -2.113), p < 0.001], 6 months [n = 6 studies, MD = -6.583 g, 95% CI (-11.158, -2.008), p = 0.005], and 12 months [n = 6 studies, MD = -3.726 g, 95% CI (-6.347, -1.106), p = 0.005]. Moreover, CO2 laser therapy significantly decreased the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form Scores at 3 months [n = 10 studies, MD = -4.805, 95% CI (-5.985, -3.626), p < 0.001] and 12-months [n = 6 studies, MD = -3.726, 95% CI (-6.347, -1.106), p = 0.005]. Additionally, CO2 laser therapy significantly decreased the Pelvic Floor Impact Questionnaire scores at 6 months [n = 2 studies, MD = -11.268, 95% CI (-18.671, -3.865), p = 0.002] and 12 months [n = 2 studies, MD = -10.624, 95% CI (-18.145, -3.103), p = 0.006]. Besides, CO2 laser therapy significantly decreased the Urogenital Distress Inventory-6 scores at 3 months [n = 2 studies, MD = -21.997, 95% CI (-32.294, -11.699), p < 0.001], but not at 6 months [n = 3 studies, MD = -3.034, 95% CI (-7.357, 1.259), p = 0.169]. Lastly, CO2 laser therapy significantly increased the Vaginal Health Index Score at 6 months [n = 2 studies, MD = 2.826, 95% CI (0.013, 5.638), p = 0.047] and 12 months [MD = 1.553, 95% CI (0.173, 2.934), p = 0.027]. Conclusion: CO2 laser therapy improved the SUI-related symptoms in women. To obtain solid conclusions, future studies should be well-designed with standardized settings, consistent therapeutic protocols, and long-term follow-up periods.

Successful Pregnancy in a 29-Year-Old G3P2 Shortly After Unilateral Pneumonectomy and Systemic Chemotherapy for Lung Cancer: A Case Report.

BACKGROUND The incidence of tumors during pregnancy, generally, is very uncommon. The incidence of lung cancer during pregnancy, specifically, is exceedingly rare. Several investigations have documented favorable maternal-fetal outcomes for later pregnancies after pneumonectomy due to non-cancer-related causes (mostly progressive pulmonary tuberculosis). However, very little is known about maternal-fetal outcomes for future conceptions after pneumonectomy due to cancer-related causes and subsequent chemotherapy cycles. This is an important knowledge gap in the literature that needs to be filled. CASE REPORT A 29-year-old woman (non-smoker) had adenocarcinoma of the left lung, which was discovered during her pregnancy at 28 weeks of gestation. She underwent an urgent lower-segment transverse cesarean section at 30 weeks and subsequently underwent unilateral pneumonectomy and then completed her planned adjuvant chemotherapy. The patient was incidentally found to be pregnant at 11 weeks of gestation (roughly 5 months after the completion of her adjuvant chemotherapy cycles). Hence, the conception was estimated to have happened roughly 2 months after the completion of her chemotherapy cycles. A multidisciplinary team was formed and it was decided to keep her pregnancy as there was no clear medical reason to terminate it. The pregnancy was carried out to term gestation at 37+4 weeks with close monitoring, and she delivered a healthy baby via lower-segment transverse cesarean section. CONCLUSIONS Successful pregnancy after unilateral pneumonectomy and adjuvant systematic chemotherapy is rarely reported. The maternal-fetal outcomes after unilateral pneumonectomy and systematic chemotherapy need expertise and a multidisciplinary approach to prevent complications.

Prophylactic tranexamic acid during myomectomy: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To conduct a systematic review and meta-analysis of randomized controlled trials on the clinical efficacy and safety of prophylactic tranexamic acid (TXA) versus control (normal saline/no treatment) during myomectomy. METHODS: Six databases were screened from inception until 21-February-2022. The eligible studies were assessed for risk of bias. The outcomes were summarized as mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) in a random-effects model. RESULTS: Seven studies, comprising eight arms and 571 patients (TXA = 304 patients, control = 267 patients) were analyzed. The included studies had an overall low risk of bias. The mean intraoperative blood loss (MD = -224.34 ml, 95% CI [-303.06, -145.61], p < 0.001), mean postoperative blood loss, and mean total blood loss were significantly reduced in favor of the prophylactic TXA group. Additionally, the mean postoperative hemoglobin (MD = 0.4 mg/dl, 95% CI [0.11, 0.68], p = 0.006) and mean postoperative hematocrit levels were significantly higher in favor of the prophylactic TXA group. While the mean hospital stay was significantly reduced in favor of the prophylactic TXA group (MD = -0.39 d, 95% [-0.74, -0.04], p = 0.03), there was no significant difference between both groups regarding the mean operation time and rate of blood transfusion. None of the participants in both groups developed any incidence of thromboembolic events. The rate of nausea was significantly higher in disfavor of the prophylactic TXA group (RR = 2.68, 95% CI [1.11, 6.43], p = 0.03). CONCLUSION: Among patients undergoing myomectomy, prophylactic TXA was largely safe and linked to substantial reductions in perioperative blood loss and related morbidities.

Prenatal-onset INPPL1-related skeletal dysplasia in two unrelated families: Diagnosis and prediction of lethality.

This report describes two patients with INPPL1- related skeletal dysplasia diagnosed prenatally. A literature review is conducted to find out if high-lethality is associated with particular pathogenic variants in INPPL1 gene. Prediction of lethality in the prenatal setting has an impact on perinatal management. Some frameshift variants in INPLL1 gene are uniquely observed in lethal cases; however, more patients are needed to confirm the correlation.

Incidence and outcomes of women with Hodgkin's lymphoma in pregnancy: a population-based study on 7.9 million births.

OBJECTIVE: The purpose of our study was to estimate the incidence and maternal and fetal outcomes of Hodgkin's lymphoma (HL) in pregnancy. METHODS: We carried out a population-based cohort study on all births identified in the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 2003 to 2011. We calculated disease incidence and used logistic regression analysis to estimate the adjusted effect of HL on maternal and neonatal outcomes. RESULTS: There were 638 cases of HL in pregnancy among 7,916,388 births, for an overall incidence of 8.06 per 100,000 births, with no perceivable trend over the 8-year study period. Relative to controls, HL in pregnancy was more common among Caucasians and women aged 25-34 years. After adjusting for baseline characteristics, women with HL in pregnancy were more likely to have preterm births, odds ratio (OR) 1.93 (1.53, 2.42) require postpartum blood transfusion, OR 1.38 (1.05, 1.82), and have venous thromboembolism (VTE), OR 7.93 (2.97, 21.22). CONCLUSION: The incidence of HL in pregnancy appears to be higher than previously reported with no temporal trend over an 8-year period. Although there is a greater risk of preterm birth and maternal postpartum blood transfusion and VTE, overall maternal and neonatal major morbidity and mortality does not appear to be increased.

Incidence and determinants of sudden infant death syndrome: a population-based study on 37 million births.

BACKGROUND: The objective of our study is to measure the incidence of sudden infant death syndrome (SIDS), estimate the birth to death interval, and identify associated maternal and infant risk factors. METHODS: We carried out a population-based cohort study on 37 418 280 births using data from the Centers for Disease Control and Prevention's "Linked Birth-Infant Death" and "Fetal Death" data files from 1995 to 2004. Descriptive statistics and cox-proportional hazard models were used to estimate the adjusted effect of maternal and newborn characteristics on the risk of SIDS. RESULTS: There were 24 101 cases of SIDS identified for an overall 10-year incidence of 6.4 cases per 10 000 births. Over the study period, the incidence decreased from 8.1 to 5.6 per 10 000 and appeared to be most common among infants aged 2-4 months. Risk factors included maternal age <20 years, black, non-Hispanic race, smoking, increasing parity, inadequate prenatal care, prematurity and growth restriction. CONCLUSIONS: While the incidence of SIDS in the US has declined, it currently remains the leading cause of post-neonatal mortality, highlighting an important public health priority. Educational campaigns should be targeted towards mothers at increased risk in order to raise their awareness of modifiable risk factors for SIDS such as maternal smoking and inadequate prenatal care.

Pre and post-conceptional abdominal cerclage by laparoscopy or laparotomy.

The objective of this study was to evaluate the efficacy of abdominal cerclage via laparoscopy vs laparotomy and before vs after conception. We evaluated 16 studies of abdominal cerclage involving a total of 678 cases published between 1990 and 2013. We estimated the effect of laparotomy over laparoscopy and the effect of preconceptional over postconceptional cerclage using a generalized linear model by treating the success rates (third-trimester delivery and live birth) as dependent variables and laparotomy and preconceptional as independent factors. The results demonstrated that there was no difference in the rates of third-trimester delivery and live birth rates between preconceptional abdominal cerclage via laparoscopy (71.4%-83.3% and 90%-100%, respectively) or laparotomy (97.3%-100% and 100%, respectively). For postconceptional cerclage, the rates of third-trimester delivery and live birth via laparoscopy were 70% and 70% to 100%, respectively, and via laparotomy were 77.4% to 99.5% and 85.2% to 100%, respectively. There was no difference in the live birth rates when abdominal cerclage was performed before or during pregnancy. We concluded that the rates of third-trimester delivery and live birth after abdominal cerclage via laparoscopy are high and comparable to those via laparotomy. The efficacy of the procedure performed either before or during pregnancy is similar. Abdominal cerclage performed before conception is more practical than after conception. With the inherent advantages of laparoscopy over laparotomy, abdominal cerclage performed via laparoscopy is preferable, in particular when performed in non-pregnant women.