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1.
Cancers (Basel) ; 16(6)2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38539534

RESUMO

The early and accurate diagnosis of endometrial cancer is of paramount importance for the survival of these patients. The aim of this study was to systematically appraise the available data regarding the accuracy of frozen section biopsy in diagnosing endometrial cancer. A thorough literature search was performed in PubMed/Medline, Scopus and the Cochrane Central Register of Controlled Trials databases from inception up to January 2023, with the use of specific, relevant key terms. A quality evaluation for each study was performed with the QUADAS-2 tool, whereas a bivariate random-effect model was performed to generate a summary receiver-operated curve. Heterogeneity was evaluated with Cochrane Q and Higgins' I2 statistics. Subgroup analyses were performed for studies focused on atypical hyperplasia and those focused on endometrial cancer. The search yielded 47 studies, involving 7790 patients with endometrial cancer. Among them, only 11 could be included in the quantitative analysis. QUADAS-2 evaluation resulted in rather high quality among the included studies. Quantitative synthesis resulted in a pooled sensitivity of 0.863 and pooled specificity of 0.916. The AUC was 0.948, the Q statistic was 10.488 (10 df, p = 0.399) and Higgins' I2 (4.655%) reported no significant heterogeneity. Subgroup analyses based on the diagnosis revealed a pooled sensitivity 0.886, specificity 0.862 and AUC 0.934 for endometrial cancer versus a sensitivity of 0.816, specificity of 0.962 and AUC 0.939 for atypical hyperplasia. Frozen section appears as a valid and reliable diagnostic tool for endometrial cancer. Its reliability seems to be even higher for the diagnosis of atypical hyperplasia. Therefore, this method may be considered in clinical practice and in settings with appropriate resources.

2.
Nutrients ; 16(3)2024 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-38337660

RESUMO

The early life theory states that the first 1000 days of a person's life are highly influential, as lasting health impacts can be attained during this period [...].


Assuntos
Desenvolvimento Fetal , Saúde Materna , Gravidez , Feminino , Humanos , Estado Nutricional
3.
Obstet Gynecol Surv ; 79(1): 54-63, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38306292

RESUMO

Importance: Several medications have been used to achieve medical abortion in the first trimester of pregnancy. The most commonly used is the combination of mifepristone and misoprostol; however, different doses and routes of administration have been proposed. Objective: The aim of this study was to summarize published data on the effectiveness, adverse effects, and acceptability of the various combinations of mifepristone and misoprostol in medical abortion protocols in the first trimester of pregnancy. Evidence Acquisition: This was a comprehensive review, synthesizing the findings of the literature on the current use of mifepristone and misoprostol for first-trimester abortion. Results: The combination of mifepristone and misoprostol seems to be more effective than misoprostol alone. Regarding the dosages and routes, mifepristone is administered orally, and the optimal dose is 200 mg. The route of administration of misoprostol varies; the sublingual and buccal routes are more effective; however, the vaginal route (800 µg) is associated with fewer adverse effects. Finally, the acceptability rates did not differ significantly. Conclusions: Different schemes for first-trimester medical abortion have been described so far. Future research needs to focus on identifying the method that offers the best trade-off between efficacy and safety in first-trimester medical abortion.


Assuntos
Abortivos não Esteroides , Aborto Induzido , Misoprostol , Gravidez , Feminino , Humanos , Mifepristona/efeitos adversos , Misoprostol/efeitos adversos , Primeiro Trimestre da Gravidez , Aborto Induzido/efeitos adversos , Abortivos não Esteroides/efeitos adversos
4.
Obstet Gynecol Surv ; 79(2): 105-121, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38377454

RESUMO

Importance: Postnatal care refers to the ongoing health care provision of both the mother and her offspring and contributes to the timely identification and effective management of complications in the postpartum period, to secure maternal and infant short- and long-term well-being. Objective: The aim of this study was to review and compare the most recently published influential guidelines on postnatal care practices. Evidence Acquisition: A comparative review of guidelines from the American College of Obstetricians and Gynecologists, the World Health Organization, the National Institute for Health and Care Excellence, and the Public Health Agency of Canada regarding postnatal care was conducted. Results: There is a consensus among the reviewed guidelines regarding the importance of health care provision in the postpartum period, including home visits and midwifery services, the use of telemedicine for the facilitation of communication with the patient, and the appropriate preparation for discharge, as well as the discharge criteria. All medical societies also agree on the clinical aspects that should be evaluated at each postnatal visit, although discrepancies exist with regard to the contact schedule. In addition, there is consistency regarding the management of postpartum infections, perineal pain, fecal and urinary incontinence, and physical activity guidance. Mental health issues should be addressed at each postnatal visit, according to all guidelines, but there is disagreement regarding routine screening for depression. As for the optimal interpregnancy interval, the American College of Obstetricians and Gynecologists recommends avoiding pregnancy for at least 6 months postpartum, whereas the National Institute for Health and Care Excellence recommends a 12-month interval. There is no common pathway regarding the recommended contraceptive methods, the nutrition guidance, and the postpartum management of pregnancy complications. Of note, the World Health Organization alone provides recommendations concerning the prevention of specific infections during the postnatal period. Conclusions: Postnatal care remains a relatively underserved aspect of maternity care, although the puerperium is a critical period for the establishment of motherhood and the transition to primary care. Thus, the development of consistent international protocols for the optimal care and support of women during the postnatal period seems of insurmountable importance to safely guide clinical practice and subsequently reduce maternal and neonatal morbidity.


Assuntos
Serviços de Saúde Materna , Obstetrícia , Recém-Nascido , Gravidez , Feminino , Humanos , Cuidado Pós-Natal/métodos , Período Pós-Parto , Anticoncepção/métodos
5.
J Clin Med ; 13(4)2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38398380

RESUMO

BACKGROUND AND OBJECTIVES: Accurate diagnosis of labor progress is crucial for making well-informed decisions regarding timely and appropriate interventions to optimize outcomes for both the mother and the fetus. The aim of this study was to assess the progress of the second stage of labor using intrapartum ultrasound. MATERIAL AND METHODS: This was a prospective study (December 2022-December 2023) conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece. Maternal-fetal and labor characteristics were recorded, and two ultrasound parameters were measured: the angle of progression (AoP) and the head-perineum distance (HPD). The correlation between the two ultrasonographic values and the maternal-fetal characteristics was investigated. Multinomial regression analysis was also conducted to investigate any potential predictors of the mode of delivery. RESULTS: A total of 82 women at the second stage of labor were clinically and sonographically assessed. The mean duration of the second stage of labor differed between vaginal and cesarean deliveries (65.3 vs. 160 min; p-value < 0.001) and between cesarean and operative vaginal deliveries (160 vs. 88.6 min; p-value = 0.015). The occiput anterior position was associated with an increased likelihood of vaginal delivery (OR: 24.167; 95% CI: 3.8-152.5; p-value < 0.001). No significant differences were identified in the AoP among the three different modes of delivery (vaginal: 145.7° vs. operative vaginal: 139.9° vs. cesarean: 132.1°; p-value = 0.289). The mean HPD differed significantly between vaginal and cesarean deliveries (28.6 vs. 41.4 mm; p-value < 0.001) and between cesarean and operative vaginal deliveries (41.4 vs. 26.9 mm; p-value = 0.002); it was correlated significantly with maternal BMI (r = 0.268; p-value = 0.024) and the duration of the second stage of labor (r = 0.256; p-value = 0.031). Low parity (OR: 12.024; 95% CI: 6.320-22.876; p-value < 0.001) and high HPD (OR: 1.23; 95% CI: 1.05-1.43; p-value = 0.007) were found to be significant predictors of cesarean delivery. CONCLUSIONS: The use of intrapartum ultrasound as an adjunctive technique to the standard clinical evaluation may enhance the diagnostic approach to an abnormal labor progress and predict the need for operative vaginal or cesarean delivery.

6.
Obstet Gynecol Surv ; 78(11): 690-708, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38134339

RESUMO

Importance: Fetal growth restriction (FGR) is a common pregnancy complication and a significant contributor of fetal and neonatal morbidity and mortality, mainly due to the lack of effective screening, prevention, and management policies. Objective: The aim of this study was to review and compare the most recently published influential guidelines on the management of pregnancies complicated by FGR. Evidence Acquisition: A descriptive review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine, the International Federation of Gynecology and Obstetrics, the International Society of Ultrasound in Obstetrics and Gynecology, the Royal College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada (SOGC), the Perinatal Society of Australia and New Zealand, the Royal College of Physicians of Ireland, the French College of Gynecologists and Obstetricians (FCGO), and the German Society of Gynecology and Obstetrics on FGR was carried out. Results: Several discrepancies were identified regarding the definition of FGR and small-for-gestational-age fetuses, the diagnostic criteria, and the need of testing for congenital infections. On the contrary, there is an overall agreement among the reviewed guidelines regarding the importance of early universal risk stratification for FGR to accordingly modify the surveillance protocols. Low-risk pregnancies should unanimously be evaluated by serial symphysis fundal height measurement, whereas the high-risk ones warrant increased sonographic surveillance. Following FGR diagnosis, all medical societies agree that umbilical artery Doppler assessment is required to further guide management, whereas amniotic fluid volume evaluation is also recommended by the ACOG, the SOGC, the Perinatal Society of Australia and New Zealand, the FCGO, and the German Society of Gynecology and Obstetrics. In case of early, severe FGR or FGR accompanied by structural abnormalities, the ACOG, the Society for Maternal-Fetal Medicine, the International Federation of Gynecology and Obstetrics, the Royal College of Obstetricians and Gynecologists, the SOGC, and the FCGO support the performance of prenatal diagnostic testing. Consistent protocols also exist on the optimal timing and mode of delivery, the importance of continuous fetal heart rate monitoring during labor, and the need for histopathological examination of the placenta after delivery. On the other hand, guidelines concerning the frequency of fetal growth and Doppler velocimetry evaluation lack uniformity, although most of the reviewed medical societies recommend an average interval of 2 weeks, reduced to weekly or less when umbilical artery abnormalities are detected. Moreover, there is a discrepancy on the appropriate timing for corticosteroids and magnesium sulfate administration, as well as the administration of aspirin as a preventive measure. Cessation of smoking, alcohol consumption, and illicit drug use are proposed as preventive measures to reduce the incidence of FGR. Conclusions: Fetal growth restriction is a clinical entity associated with numerous adverse antenatal and postnatal events, but currently, it has no definitive cure apart from delivery. Thus, the development of uniform international protocols for the early recognition, the adequate surveillance, and the optimal management of growth-restricted fetuses seem of paramount importance to safely guide clinical practice, thereby improving perinatal outcomes of such pregnancies.


Assuntos
Ginecologia , Obstetrícia , Recém-Nascido , Gravidez , Feminino , Humanos , Retardo do Crescimento Fetal/diagnóstico , Retardo do Crescimento Fetal/prevenção & controle , Aspirina/uso terapêutico , Cuidado Pré-Natal
7.
Obstet Gynecol Surv ; 78(12): 766-774, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38134342

RESUMO

Importance: Group B Streptococcus (GBS) colonization during pregnancy is associated with significant neonatal morbidity and mortality and represents a major public health concern, often associated with poor screening and management. Objective: The aim of this study was to review and compare the most recently published influential guidelines on the screening and management of this clinical entity during antenatal and intrapartum periods. Evidence Acquisition: A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, and the Society of Obstetricians and Gynecologists of Canada on the prevention of early-onset neonatal group B streptococcal disease was carried out. Results: There is a consensus among the reviewed guidelines regarding the optimal screening specimen type, indications for intrapartum antibiotic administration such as bacteriuria during pregnancy, clinical signs of chorioamnionitis or maternal pyrexia, and history of GBS-related neonatal disease. There is also agreement on several conditions where no intervention is recommended, that is, antepartum treatment of GBS and GBS-positive women with planned cesarean delivery and intact membranes. Controversy exists regarding the optimal screening time, with the Royal College of Obstetricians and Gynecologists stating against routine screening and on management strategies related to preterm labor and preterm prelabor rupture of membranes. Conclusions: The development of consistent international practice protocols for the timely screening of GBS and effective management of this clinical entity both during pregnancy and the intrapartum period seems of paramount importance to safely guide clinical practice and subsequently improve neonatal outcomes.


Assuntos
Complicações Infecciosas na Gravidez , Infecções Estreptocócicas , Recém-Nascido , Gravidez , Feminino , Humanos , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/prevenção & controle , Antibioticoprofilaxia/métodos , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/prevenção & controle , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Austrália , Streptococcus agalactiae
8.
Obstet Gynecol Surv ; 78(11): 657-681, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38134337

RESUMO

Importance: Osteoporosis causes increased morbidity and mortality, and thus poses a significant economic burden to the health systems worldwide. Objective: The aim of this study was to review and compare the most recently published major guidelines on diagnosis and management of this common medical entity. Evidence Acquisition: A thorough comparative review of the most influential guidelines from the RACGP (Royal Australian College of General Practitioners), the ESCEO-IOF (European Society for Clinical and Economic Aspects of Osteoporosis-International Osteoporosis Foundation), the NOGG (National Osteoporosis Guideline Group), the NAMS (North American Menopause Society), the ES (Endocrine Society), and the ACOG (American College of Obstetricians and Gynecologists) was conducted. Results: The reviewed guidelines generally agree on the definition, the criteria, and investigations used to diagnose osteoporosis. They also concur regarding the risk factors for osteoporosis and the suggested lifestyle modifications (calcium and vitamin D intake, normal body weight, reduction of alcohol consumption, and smoking cessation). However, there is lack of consensus on indications for fracture risk assessment in the general population and the exact indications for bone mineral density assessment. Referral to a bone specialist is reserved for complex cases of osteoporosis (NOGG, NAMS, and ACOG) or in case of inadequate access to care (RACGP). The use of hip protectors to reduce the risk of fractures is supported by RACGP, NOGG, and NAMS, solely for high-risk elderly patients in residential care settings. All guidelines reviewed recognize the efficacy of the pharmacologic agents (ie, bisphosphonates, denosumab, hormone therapy, and parathyroid hormone analogs). Nonetheless, recommendations regarding monitoring of pharmacotherapy differ, primarily in the case of bisphosphonates. The proposed intervals of repeat bone mineral density testing after initiation of drug therapy are set at 2 years (RACGP), 1-3 years (NAMS, ES, and ACOG), or 3-5 years (ESCEO-IOF and NOGG). All guidelines agree upon the restricted use of bone turnover markers only in bone specialist centers for treatment monitoring purposes. Finally, the definition of treatment failure varies among the reviewed guidelines. Conclusions: Osteoporosis is a distressing condition for women, mainly those of postmenopausal age. Thus, it seems of paramount importance to develop consistent international practice protocols for more cost-effective diagnostic and management techniques, in order to improve women's quality of life.


Assuntos
Osteoporose , Qualidade de Vida , Humanos , Feminino , Idoso , Austrália , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Densidade Óssea , Difosfonatos/uso terapêutico
9.
Eur J Obstet Gynecol Reprod Biol ; 291: 196-205, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37913556

RESUMO

This practice guideline follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation, bringing together groups and individuals throughout the world, with the goal of improving the management of preterm labor. In fact, this document provides further guidance for healthcare practitioners on the appropriate use of examinations with the aim to improve the accuracy in diagnosing preterm labor and allow timely and appropriate administration of tocolytics, antenatal corticosteroids and magnesium sulphate and avoid unnecessary or excessive interventions. Therefore, it is not intended to establish a legal standard of care. This document is based on consensus among perinatal experts throughout the world in the light of scientific literature and serves as a guideline for use in clinical practice.


Assuntos
Trabalho de Parto Prematuro , Nascimento Prematuro , Tocolíticos , Recém-Nascido , Feminino , Gravidez , Humanos , Trabalho de Parto Prematuro/diagnóstico , Trabalho de Parto Prematuro/prevenção & controle , Tocolíticos/uso terapêutico , Sulfato de Magnésio/uso terapêutico
10.
Nutrients ; 15(21)2023 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-37960200

RESUMO

OBJECTIVE: This study aimed to explore the potential impact of pre-pregnancy and early pregnancy maternal nutrition on the incidence of small-for-gestational-age neonates (SGA) in women with gestational diabetes mellitus (GDM). METHODS: A prospective cohort study was conducted between 2020 and 2022 at the 3rd Department of Obstetrics and Gynaecology (School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece). Pregnant women from routine care were surveyed about their dietary habits during two distinct periods: six months prior to pregnancy (period A) and from the onset of pregnancy until the oral glucose tolerance test at 24-28 gestational weeks (period B). The intake of various micronutrients and macronutrients was quantified from the questionnaire responses. Logistic regression models, adjusted for potential confounders including age, pre-pregnancy body mass index (BMI), smoking status, physical activity and parity, were used to evaluate the association between nutrient intake and small-for-gestational-age neonate incidence. RESULTS: In total, 850 women were screened and of these, 90 (11%) were diagnosed with gestational diabetes mellitus and were included in the study. There were significant associations between the intake of specific nutrients and the occurrence of small-for-gestational-age neonates; higher fat intake compared to non-small for gestationa age during period B (aOR: 1.1, p = 0.005) was associated with an increased risk for small-for-gestational-age neonates, while lower intake of carbohydrates (g) (aOR: 0.95, p = 0.005), fiber intake (aOR: 0.79, p = 0.045), magnesium (aOR: 0.96, p = 0.019), and copper (aOR:0.01, p = 0.018) intake during period B were significantly associated with a decreased risk for small-for-gestational-age neonates. CONCLUSIONS: The findings of this study highlight the potential role of maternal nutrition in modulating the risk of small for gestational age neonatesamong women with gestational diabetes mellitus. The results advocate for further research on the assessment and modification of both pre-pregnancy and early pregnancy nutrition for women, especially those at higher risk of gestational diabetes mellitus, to reduce the risk of gestational diabetes mellitus.


Assuntos
Diabetes Gestacional , Recém-Nascido , Feminino , Gravidez , Humanos , Lactente , Diabetes Gestacional/epidemiologia , Peso ao Nascer/fisiologia , Estudos Prospectivos , Dieta/efeitos adversos , Ingestão de Energia , Retardo do Crescimento Fetal
11.
Obstet Gynecol Surv ; 78(9): 544-553, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37976303

RESUMO

Importance: Cervical cerclage (CC) represents one of the few effective measures currently available for the prevention of preterm delivery caused by cervical insufficiency, thus contributing in the reduction of neonatal morbidity and mortality rates. Objective: The aim of this study was to review and compare the most recently published major guidelines on the indications, contraindications, techniques, and timing of placing and removal of CC. Evidence Acquisition: A descriptive review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the International Federation of Gynecology and Obstetrics (FIGO) on CC was carried out. Results: There is a consensus among the reviewed guidelines regarding the recommended techniques, the indications for rescue CC, the contraindications, as well as the optimal timing of CC placement and removal. All medical societies also agree that ultrasound-indicated CC is justified in women with history of prior spontaneous PTD or mid-trimester miscarriage and a short cervical length detected on ultrasound. In addition, after CC, serial sonographic measurement of the cervical length, bed rest, and routine use of antibiotics, tocolysis, and progesterone are unanimously discouraged. In case of established preterm labor, CC should be removed, according to ACOG, RCOG, and SOGC. Furthermore, RCOG and SOGC agree on the prerequisites that should be met before attempting CC. These 2 guidelines along with FIGO recommend history-indicated CC for women with 3 or more previous preterm deliveries and/or second trimester pregnancy miscarriages, whereas the ACOG suggests the use of CC in singleton pregnancies with 1 or more previous second trimester miscarriages related to painless cervical dilation or prior CC due to painless cervical dilation in the second trimester. The role of amniocentesis in ruling out intra-amniotic infection before rescue CC remains a matter of debate. Conclusions: Cervical cerclage is an obstetric intervention used to prevent miscarriage and preterm delivery in women considered as high-risk for these common pregnancy complications. The development of universal international practice protocols for the placement of CC seems of paramount importance and will hopefully improve the outcomes of such pregnancies.


Assuntos
Aborto Espontâneo , Cerclagem Cervical , Trabalho de Parto Prematuro , Nascimento Prematuro , Gravidez , Recém-Nascido , Feminino , Humanos , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Cerclagem Cervical/métodos , Aborto Espontâneo/prevenção & controle , Trabalho de Parto Prematuro/etiologia , Colo do Útero
12.
Clin Case Rep ; 11(8): e7806, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37614290

RESUMO

Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a rare but serious condition. The first-line antenatal management of FNAIT consists of weekly IVIG with or without corticosteroids, ideally starting before 16 weeks of gestation.

13.
Case Rep Womens Health ; 39: e00529, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37534193

RESUMO

Twin gestations are associated with an increased risk of intrahepatic cholestasis in pregnancy (ICP), probably attributed to the elevated pregnancy hormones. We report a case of a dichorionic diamniotic twin pregnancy, at the third trimester, complicated with ICP and severe, selective fetal growth restriction (sFGR). A 32-year-old primiparous woman with a dichorionic, diamniotic twin gestation conceived via in vitro fertilization (IVF) presented with pruritus at the maternity care unit at 26+4 weeks of pregnancy. Following a detailed assessment, she was diagnosed with severe sFGR and ICP. During her hospitalization, selective feticide of the FGR fetus was decided and a remarkable improvement in the symptoms and the laboratory findings of ICP was noticed. The incidence of ICP is reported to be higher in twin pregnancies, especially those conceived via IVF, compared with singletons. The optimal timing of delivery and management of twin pregnancies complicated with ICP remain unclear. In our case, selective reduction of the FGR fetus led to the resolution of ICP.

14.
J Perinat Med ; 51(9): 1132-1138, 2023 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-37548399

RESUMO

OBJECTIVES: To investigate the incidence and risk factors of bilobate placenta, as well as to assess its impact on preeclampsia (PE), preterm delivery (PTD) and small-for-gestational age (SGA) neonates. METHODS: A prospective study of singleton pregnancies, undergoing routine anomaly scan at 20+0-23+6 gestational weeks, was conducted, between 2018 and 2022. The impact of prenatally diagnosed bilobate placenta on PE, PTD and SGA was assessed. Multivariate logistic regression models were employed to assess the independent association between bilobate placenta and the main pregnancy outcomes, using specific confounders. Additionally, a risk factor analysis was performed. RESULTS: The study population included 6,454 pregnancies; the incidence of prenatally diagnosed bilobate placenta was 2.0 % (n=129). Bilobate placenta was associated with PE (aOR: 1.721; 95 % CI: 1.014-2.922), while no statistically significant association was found between this anatomical variation and SGA (aOR: 1.059; 95 % CI: 0.665-1.686) or PTD (aOR: 1.317; 95 % CI: 0.773-2.246). Furthermore, pregnancies with prenatally diagnosed bilobate placenta had an increased prevalence of abnormal cord insertion (marginal or velamentous) (9.8 vs. 27.1 %; p<0.001) and increased mean UtA PI z-score (0.03 vs. 0.23; p=0.039). Conception via ART (aOR: 3.669; 95 % CI: 2.248-5.989), previous history of 1st trimester miscarriage (aOR: 1.814; 95 % CI: 1.218-2.700) and advancing maternal age (aOR: 1.069; 95 % CI: 1.031-1.110) were identified as major risk factors for bilobate placenta. CONCLUSIONS: Bilobate placenta, excluding cases of co-existing vasa previa, is associated with higher incidence of PE, increased mean UtA PI z-score and higher probability of abnormal cord insertion, but not with increased risk for SGA or PTD. It is more common in pregnancies following ART and in women with a previous 1st trimester miscarriage.


Assuntos
Aborto Espontâneo , Doenças Placentárias , Pré-Eclâmpsia , Nascimento Prematuro , Gravidez , Recém-Nascido , Humanos , Feminino , Resultado da Gravidez/epidemiologia , Estudos Prospectivos , Incidência , Diagnóstico Pré-Natal , Retardo do Crescimento Fetal/diagnóstico , Doenças Placentárias/diagnóstico por imagem , Doenças Placentárias/epidemiologia , Fatores de Risco , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/epidemiologia , Nascimento Prematuro/epidemiologia , Placenta , Idade Gestacional , Ultrassonografia Pré-Natal
15.
Children (Basel) ; 10(7)2023 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-37508719

RESUMO

Hypoglycemia represents one of the most frequent metabolic disturbances of the neonate, associated with increased morbidity and mortality, especially if left untreated or diagnosed after the establishment of brain damage. The aim of this study was to review and compare the recommendations from the most recently published influential guidelines on the diagnosis, screening, prevention and management of this common neonatal complication. Therefore, a descriptive review of the guidelines from the American Academy of Pediatrics (AAP), the British Association of Perinatal Medicine (BAPM), the European Foundation for the Care of the Newborn Infants (EFCNI), the Queensland Clinical Guidelines-Australia (AUS), the Canadian Pediatric Society (CPS) and the Pediatric Endocrine Society (PES) on neonatal hypoglycemia was carried out. There is a consensus among the reviewed guidelines on the risk factors, the clinical signs and symptoms of NH, and the main preventive strategies. Additionally, the importance of early recognition of at-risk infants, timely identification of NH and prompt initiation of treatment in optimizing the outcomes of hypoglycemic neonates are universally highlighted. All medical societies, except PES, recommend screening for NH in asymptomatic high-risk and symptomatic newborn infants, but they do not provide consistent screening approaches. Moreover, the reviewed guidelines point out that the diagnosis of NH should be confirmed by laboratory methods of BGL measurement, although treatment should not be delayed until the results become available. The definition of NH lacks uniformity and it is generally agreed that a single BG value cannot accurately define this clinical entity. Therefore, all medical societies support the use of operational thresholds for the management of NH, although discrepancies exist regarding the recommended cut-off values, the optimal treatment and surveillance strategies of both symptomatic and asymptomatic hypoglycemic neonates as well as the treatment targets. Over the past several decades, ΝH has remained an issue of keen debate as it is a preventable cause of brain injury and neurodevelopmental impairment; however, there is no clear definition or consistent treatment policies. Thus, the establishment of specific diagnostic criteria and uniform protocols for the management of this common biochemical disorder is of paramount importance as it will hopefully allow for the early identification of infants at risk, the establishment of efficient preventive measures, the optimal treatment in the first hours of a neonate's life and, subsequently, the improvement of neonatal outcomes.

16.
Medicina (Kaunas) ; 59(6)2023 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-37374284

RESUMO

Objectives: To assess the incidence of prenatally diagnosed isolated single umbilical artery (iSUA) and its impact on major pregnancy outcomes, as well as to investigate potential risk factors. Materials and methods: A prospective study of singleton pregnancies, undergoing routine anomaly scans at 20+0-24+0 weeks of gestation, was carried out from 2018 to 2022. The effect of sonographically detected iSUA on small-for-gestational-age neonates (SGA) and preterm delivery (PTD) was evaluated using parameterized Student's t-test, nonparametric Mann-Whitney U test and the chi-square test. Multivariable logistic regression models were implemented to assess the independent association between iSUA and the main outcomes, as well as with potential risk factors, while adjusting for specific confounders. Results: The study population included 6528 singleton pregnancies and the incidence of prenatally diagnosed iSUA was 1.3%. Prenatally diagnosed iSUA had a statistically significant association with both SGA neonates (aOR: 1.909; 95% CI: 1.152-3.163) and PTD (aOR: 1.903; 95% CI: 1.035-3.498), while no association was identified between this sonographic finding and preeclampsia. With regard to risk factors, conception via assisted reproductive technology (ART) was associated with increased risk of iSUA (aOR: 2.234; 95% CI: 1.104-4.523), while no other independent predictor for the development of this anatomical variation was identified. Conclusions: Prenatally diagnosed iSUA seems to be associated with a higher incidence of SGA and PTD and is more common in pregnancies following ART, which constitutes a novel finding.


Assuntos
Nascimento Prematuro , Artéria Umbilical Única , Gravidez , Recém-Nascido , Feminino , Humanos , Resultado da Gravidez/epidemiologia , Artéria Umbilical Única/diagnóstico por imagem , Artéria Umbilical Única/epidemiologia , Incidência , Estudos Prospectivos , Fatores de Risco , Diagnóstico Pré-Natal , Nascimento Prematuro/epidemiologia , Ultrassonografia Pré-Natal
17.
Medicina (Kaunas) ; 59(6)2023 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-37374355

RESUMO

Background and Objectives: Postpartum hemorrhage (PPH) is an obstetrical emergency and although the mortality rate from PPH has decreased, it is still considered a challenge in obstetrics. This study aimed to estimate the rate of primary PPH, as well as to investigate the potential risk factors and management options. Material and methods: This was a retrospective case-control study of all cases with PPH (blood loss > 500 mL, irrespective of the mode of delivery) managed in the Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece, from 2015 to 2021. The ratio of cases to controls was estimated to be 1:1. The chi-squared test was used to examine if there was any relationship between several variables and PPH, while subgroup multivariate logistic regression analyses of certain causes of PPH were also conducted. Results: During the study period, from a total of 8545 births, 219 (2.5%) pregnancies were complicated with PPH. A maternal age > 35 years (OR: 2.172; 95% CI: 1.206-3.912; p = 0.010), preterm delivery (<37 weeks) (OR: 5.090; 95% CI: 2.869-9.030; p < 0.001) and parity (OR: 1.701; 95% CI: 1.164-2.487; p = 0.006) were identified as risk factors for PPH. Uterine atony was the main cause of PPH in 54.8% of the women, followed by placental retention in 30.5% of the sample. Regarding management, 57.9% (n = 127) of the women received uterotonic medication, while in 7.3% (n = 16), a cesarean hysterectomy was performed to control PPH. Preterm delivery (OR: 2.162; 95% CI: 1.138-4.106; p = 0.019) and delivery via a cesarean section (OR: 4.279; 95% CI: 1.921-9.531; p < 0.001) were associated with a higher need for multiple treatment modalities. Prematurity (OR: 8.695; 95% CI: 2.324-32.527; p = 0.001) was identified as an independent predictor for an obstetric hysterectomy. From the retrospective analysis of the births complicated by PPH, no maternal death was identified. Conclusions: Most of the cases complicated with PPH were managed with uterotonic medication. An advanced maternal age, prematurity and multiparity had a significant impact on the occurrence of PPH. More research is needed on the risk factors of PPH, while the establishment of validated predictive models would be of value.


Assuntos
Hemorragia Pós-Parto , Nascimento Prematuro , Recém-Nascido , Gravidez , Feminino , Humanos , Adulto , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Cesárea/efeitos adversos , Estudos de Casos e Controles , Estudos Retrospectivos , Incidência , Centros de Atenção Terciária , Grécia/epidemiologia , Nascimento Prematuro/epidemiologia , Placenta , Fatores de Risco
18.
Cureus ; 15(5): e38904, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37303332

RESUMO

Gynecological and general surgical conditions requiring surgical management during pregnancy constitute a medical challenge, which often entails the collaboration of numerous medical specialties. In recent years, laparoscopy in pregnancy has been accepted as a safe alternative to open surgery. This has led gynecological societies to conduct studies and issue guidelines related to laparoscopy in pregnancy, with a view to assisting and guiding clinicians and surgeons. The aim of this study was to review and compare the recommendations from various published national guidelines on laparoscopy in pregnant women. To that end, a descriptive review of guidelines from the British Society for Gynaecological Endoscopy (BSGE), the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), the Society of Obstetricians and Gynaecologists of Canada (SOCG), and the Collège National des Gynécologues et Obstétriciens Français (CNGOF) was conducted. Regarding diagnosis, the SAGES and SOCG societies recommend ultrasound as the preferred and safe imaging technique during pregnancy. In terms of the optimal timing for laparoscopic intervention, BSGE and SAGES do not restrict the laparoscopic approach based on safety, depending on the gestation week, whereas SOCG and CNGOF propose early second trimester and first and second quarter of pregnancy respectively. There is an overall consensus regarding patient positioning, initial port placement, insufflation pressure during the operation, venous thromboembolic (VTE) prophylaxis, fetal heart monitoring, and tocolysis among the reviewed guidelines. Moreover, only the BSGE mentions the need for corticosteroids, magnesium sulfate, and anti-D prophylactic administration.

19.
Obstet Gynecol Surv ; 78(5): 287-301, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37263963

RESUMO

Importance: Recurrent pregnancy loss (RPL) is one of the most frustrating clinical entities in reproductive medicine requiring not only diagnostic investigation and therapeutic intervention, but also evaluation of the risk for recurrence. Objective: The aim of this study was to review and compare the most recently published major guidelines on investigation and management of RPL. Evidence Acquisition: A descriptive review of guidelines from the Royal College of Obstetricians and Gynaecologists, the European Society of Human Reproduction and Embryology, the American Society for Reproductive Medicine, the French College of Gynecologists and Obstetricians, and the German, Austrian, and Swiss Society of Gynecology and Obstetrics on RPL was carried out. Results: There is consensus among the reviewed guidelines that the mainstays of RPL investigation are a detailed personal history and screening for antiphospholipid syndrome and anatomical abnormalities of the uterus. In contrast, inherited thrombophilias, vaginal infections, and immunological and male factors of infertility are not recommended as part of a routine RPL investigation. Several differences exist regarding the necessity of the cytogenetic analysis of the products of conception, parental peripheral blood karyotyping, ovarian reserve testing, screening for thyroid disorders, diabetes or hyperhomocysteinemia, measurement of prolactin levels, and performing endometrial biopsy. Regarding the management of RPL, low-dose aspirin plus heparin is indicated for the treatment of antiphospholipid syndrome and levothyroxine for overt hypothyroidism. Genetic counseling is required in case of abnormal parental karyotype. The Royal College of Obstetricians and Gynaecologists, the European Society of Human Reproduction and Embryology, and the French College of Gynecologists and Obstetricians guidelines provide recommendations that are similar on the management of cervical insufficiency based on the previous reproductive history. However, there is no common pathway regarding the management of subclinical hypothyroidism and the surgical repair of congenital and acquired uterine anomalies. Use of heparin for inherited thrombophilias and immunotherapy and anticoagulants for unexplained RPL are not recommended, although progesterone supplementation is suggested by the American Society for Reproductive Medicine and the German, Austrian, and Swiss Society of Gynecology and Obstetrics. Conclusions: Recurrent pregnancy loss is a devastating condition for couples. Thus, it seems of paramount importance to develop consistent international practice protocols for cost-effective investigation and management of this early pregnancy complication, with the aim to improve live birth rates.


Assuntos
Aborto Habitual , Síndrome Antifosfolipídica , Ginecologia , Hipotireoidismo , Trombofilia , Gravidez , Feminino , Masculino , Humanos , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/diagnóstico , Síndrome Antifosfolipídica/terapia , Aborto Habitual/diagnóstico , Aborto Habitual/etiologia , Aborto Habitual/prevenção & controle , Trombofilia/complicações
20.
Cureus ; 15(3): e36986, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37139280

RESUMO

Fetal and perinatal periods are critical phases for long-term development. Early diagnosis of maternal complications is challenging due to the great complexity of these conditions. In recent years, amniotic fluid has risen in a prominent position in the latest efforts to describe and characterize prenatal development. Amniotic fluid may provide real-time information on fetal development and metabolism throughout pregnancy as substances from the placenta, fetal skin, lungs, gastric fluid, and urine are transferred between the mother and the fetus. Applying metabolomics to monitor fetal well-being, in such a context, could help in the understanding, diagnosis, and treatment of these conditions and is a promising area of research. This review shines a spotlight on recent amniotic fluid metabolomics studies and their methods as an interesting tool for the assessment of many conditions and the identification of biomarkers. Platforms in use, such as proton nuclear magnetic resonance (1H NMR) and ultra-high-performance liquid chromatography (UHPLC), have different merits, and a combinatorial approach could be valuable. Metabolomics may also be used in the quest for habitual diet-induced metabolic signals in amniotic fluid. Finally, analysis of amniotic fluid can provide information on exposure to exogenous substances by detecting the exact levels of metabolites carried to the fetus and associated metabolic effects.

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