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1.
Z Geburtshilfe Neonatol ; 223(6): 373-394, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31801169

RESUMO

AIMS: This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recently published scientific literature, the experience of the members of the guideline commission and the views of self-help groups. METHODS: The members of the participating medical societies and organizations developed Recommendations and Statements based on the international literature. The Recommendations and Statements were adopted following a formal consensus process (structured consensus conference with neutral moderation, voting done in writing using the Delphi method to achieve consensus). RECOMMENDATIONS: Part 2 of this short version of the guideline presents Statements and Recommendations on the tertiary prevention of preterm birth and the management of preterm premature rupture of membranes.


Assuntos
Ruptura Prematura de Membranas Fetais , Trabalho de Parto Prematuro/prevenção & controle , Guias de Prática Clínica como Assunto , Nascimento Prematuro , Sociedades Médicas , Prevenção Terciária , Incompetência do Colo do Útero , Áustria , Feminino , Ruptura Prematura de Membranas Fetais/prevenção & controle , Ruptura Prematura de Membranas Fetais/terapia , Humanos , Recém-Nascido , Obstetrícia , Gravidez , Nascimento Prematuro/prevenção & controle , Nascimento Prematuro/terapia , Sistema de Registros
2.
Z Geburtshilfe Neonatol ; 223(5): 304-316, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31623006

RESUMO

AIMS: This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent scientific literature, the experience of the members of the guideline commission and the views of self-help groups. METHODS: Based on the international literature, the members of the participating medical societies and organizations developed Recommendations and Statements. These were adopted following a formal process (structured consensus conference with neutral moderation, voting was done in writing using the Delphi method to achieve consensus). RECOMMENDATIONS: Part I of this short version of the guideline lists Statements and Recommendations on the epidemiology, etiology, prediction and primary and secondary prevention of preterm birth.


Assuntos
Guias de Prática Clínica como Assunto , Nascimento Prematuro , Áustria , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Prevenção Primária , Sistema de Registros , Prevenção Secundária , Sociedades Médicas
3.
Geburtshilfe Frauenheilkd ; 79(8): 800-812, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31423016

RESUMO

Aims This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent scientific literature, the experience of the members of the guideline commission and the views of self-help groups. Methods Based on the international literature, the members of the participating medical societies and organizations developed Recommendations and Statements. These were adopted following a formal process (structured consensus conference with neutral moderation, voting was done in writing using the Delphi method to achieve consensus). Recommendations Part I of this short version of the guideline lists Statements and Recommendations on the epidemiology, etiology, prediction and primary and secondary prevention of preterm birth.

4.
Geburtshilfe Frauenheilkd ; 79(8): 813-833, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31423017

RESUMO

Aims This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recently published scientific literature, the experience of the members of the guideline commission and the views of self-help groups. Methods The members of the participating medical societies and organizations developed Recommendations and Statements based on the international literature. The Recommendations and Statements were adopted following a formal consensus process (structured consensus conference with neutral moderation, voting done in writing using the Delphi method to achieve consensus). Recommendations Part 2 of this short version of the guideline presents Statements and Recommendations on the tertiary prevention of preterm birth and the management of preterm premature rupture of membranes.

5.
Placenta ; 78: 36-43, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30955709

RESUMO

INTRODUCTION: Starting from the second trimester of pregnancy, passive immunity is provided to the human fetus by transplacental transfer of maternal IgG. IgG transfer depends on the neonatal Fc receptor, FcRn. While FcRn localization in the placental syncytiotrophoblast (STB) has been demonstrated unequivocally, FcRn expression in placental-fetal endothelial cells (pFECs), which are part of the materno-fetal barrier, is still unclear. Therefore, this study aimed to elucidate the spatio-specific expression pattern of FcRn in placental tissue. METHODS: FcRn expression was investigated by western blotting in term placentas and in isolated human placental arterial and venous endothelial cells (HPAEC, HPVEC) using a validated affinity-purified polyclonal anti-peptide antibody against the cytoplasmic tail of FcRn α-chain. In situ localization of FcRn and IgG was studied by immunofluorescence microscopy on tissue sections of healthy term placentas. RESULTS: FcRn expression was demonstrated in placental vasculature particularly, in HPAEC, and HPVEC. FcRn was localized in cytokeratin 7+ STB and in CD31+ pFECs in terminal as well as stem villi in situ. Additionally, CD68+ placental macrophages exhibited FcRn expression in situ. Endogenous IgG partially co-localized with FcRn in STB, pFECs, and in placental macrophages. DISCUSSION: Placental FcRn expression in endothelial cells and macrophages is analogous to the expression pattern in other organs. FcRn expression in pFECs suggests an involvement of FcRn in IgG transcytosis and/or participation in recycling/salvaging of maternal IgG present in the fetal circulation. FcRn expression in placental macrophages may account for recycling of monomeric IgG and/or processing and presentation of immune complexes.

6.
Arch Gynecol Obstet ; 298(6): 1079-1084, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30225687

RESUMO

PURPOSE: To determine the incidence of gestational diabetes mellitus (GDM) in pregnant women who received vaginal progesterone due to short cervical length or to prevent recurrent preterm birth. METHODS: In this retrospective study, we included 190 women with singleton pregnancies at risk for preterm birth who received vaginal natural progesterone (200 mg daily between gestational weeks 16 + 0 and 36 + 0) for a minimum of 4 weeks and delivered > 28 weeks. The control group consisted of 242 age- and body mass index (BMI)-matched patients without progesterone administration. Data were acquired from a database containing prospectively collected information. Patients with pre-existing diabetes, and conception after in vitro fertilisation procedure were excluded. RESULTS: The incidence of GDM did not differ significantly between the progesterone-treated and the control group (14.7% vs. 16.9%, respectively; p = 0.597). In a binary regression model, patients with higher pre-pregnancy BMI (OR 1.1; p = 0.006), and those with a family history of diabetes had a higher risk for GDM development (OR 1.8; p = 0.040), whereas vaginal progesterone treatment had no significant influence (p = 0.580). CONCLUSION: The use of vaginal progesterone for the prevention of recurrent preterm delivery and in women with a short cervix does not seem to be associated with an increased risk of GDM.


Assuntos
Diabetes Gestacional/etiologia , Progesterona/uso terapêutico , Administração Intravaginal , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Gravidez , Progesterona/administração & dosagem , Progesterona/farmacologia , Estudos Retrospectivos
7.
Geburtshilfe Frauenheilkd ; 78(4): 382-399, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29720744

RESUMO

Purpose: This is an official interdisciplinary guideline, published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG), the Austrian Society of Gynaecology and Obstetrics (OEGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG). The guideline was developed for use in German-speaking countries and is backed by the German Society of Anaesthesiology and Intensive Medicine (DGAI), the Society of Thrombosis and Haemostasis Research (GTH) and the German Association of Midwives. The aim is to provide a consensus-based overview of the diagnosis and management of peripartum bleeding obtained from an evaluation of the relevant literature. Methods: This S2k guideline was developed from the structured consensus of representative members of the various professional associations and professions commissioned by the Guideline Commission of the DGGG. Recommendations: The guideline encompasses recommendations on definitions, risk stratification, prevention and management.

9.
J Perinat Med ; 45(1): 71-84, 2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-27514075

RESUMO

OBJECTIVE: Despite decades of research on risk indicators of spontaneous preterm birth (PTB), reliable biomarkers are still not available to screen or diagnose high-risk pregnancies. Several biomarkers in maternal and fetal compartments have been mechanistically linked to PTB, but none of them are reliable predictors of pregnancy outcome. This systematic review was conducted to synthesize the knowledge on PTB biomarkers identified using multiplex analysis. MATERIALS AND METHODS: Three electronic databases (PubMed, EMBASE and Web of Science) were searched for studies in any language reporting the use of multiplex assays for maternal biomarkers associated with PTB published from January 2005 to March 2014. RESULTS: Retrieved citations (3631) were screened, and relevant studies (33) were selected for full-text reading. Ten studies were included in the review. Forty-two PTB-related proteins were reported, and RANTES and IL-10 (three studies) followed by MIP-1ß, GM-CSF, Eotaxin, and TNF-RI (two studies) were reported more than once in maternal serum. However, results could not be combined due to heterogeneity in type of sample, study population, assay, and analysis methods. CONCLUSION: By this systematic review, we conclude that multiplex assays are a potential technological advancement for identifying biomarkers of PTB, although no single or combination of biomarkers could be identified to predict PTB risk.


Assuntos
Biomarcadores , Nascimento Prematuro , Feminino , Humanos , Gravidez
10.
Artigo em Alemão | MEDLINE | ID: mdl-27631446

RESUMO

Worldwide, post-partum haemorrhage (PHH) remains one of the leading causes for maternal mortality. The German Society of Gynaecology and Obstetrics, the German Midwifes' Society, the German Society of Thrombosis and Haemostasis and the German Society of Anaesthesiology and Intensive Care updated the former guideline. The resulting recommendations are the results of a structured literature search and a formal consensus process and contain all aspects of PPH including diagnosis, causes, risk factors and therapy. Key aspect of the anaesthesiological and haemostatic therapies is the development of an interdisciplinary standard operating procedure containing medical options related to the bleeding's cause and severity as well as the surgical option. For suspected PPH, this guideline emphasizes clinical and laboratory-based diagnostics, as only those will enable an early identification of the bleeding's causes and the resulting causative therapy. Recommendations cover evidence-based application of uterotonics for atony as well as tranexamic acid, calcium, factor concentrates and blood products. Additionally, recommendations are given on the topics of cell salvage, controlled hypotension and restrictive transfusion triggers.


Assuntos
Transfusão de Sangue/normas , Técnicas de Laboratório Clínico/normas , Técnicas Hemostáticas/normas , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/terapia , Guias de Prática Clínica como Assunto , Medicina Baseada em Evidências , Alemanha , Ginecologia/normas , Obstetrícia/normas , Resultado do Tratamento
11.
Am J Obstet Gynecol ; 215(6): 793.e1-793.e8, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27542720

RESUMO

BACKGROUND: The combination of the qualitative fetal fibronectin test and cervical length measurement has a high negative predictive value for preterm birth within 7 days; however, positive prediction is poor. A new bedside quantitative fetal fibronectin test showed potential additional value over the conventional qualitative test, but there is limited evidence on the combination with cervical length measurement. OBJECTIVE: The purpose of this study was to compare quantitative fetal fibronectin and qualitative fetal fibronectin testing in the prediction of spontaneous preterm birth within 7 days in symptomatic women who undergo cervical length measurement. STUDY DESIGN: We performed a European multicenter cohort study in 10 perinatal centers in 5 countries. Women between 24 and 34 weeks of gestation with signs of active labor and intact membranes underwent quantitative fibronectin testing and cervical length measurement. We assessed the risk of preterm birth within 7 days in predefined strata based on fibronectin concentration and cervical length. RESULTS: Of 455 women who were included in the study, 48 women (11%) delivered within 7 days. A combination of cervical length and qualitative fibronectin resulted in the identification of 246 women who were at low risk: 164 women with a cervix between 15 and 30 mm and a negative fibronectin test (<50 ng/mL; preterm birth rate, 2%) and 82 women with a cervix at >30 mm (preterm birth rate, 2%). Use of quantitative fibronectin alone resulted in a predicted risk of preterm birth within 7 days that ranged from 2% in the group with the lowest fibronectin level (<10 ng/mL) to 38% in the group with the highest fibronectin level (>500 ng/mL), with similar accuracy as that of the combination of cervical length and qualitative fibronectin. Combining cervical length and quantitative fibronectin resulted in the identification of an additional 19 women at low risk (preterm birth rate, 5%), using a threshold of 10 ng/mL in women with a cervix at <15 mm, and 6 women at high risk (preterm birth rate, 33%) using a threshold of >500 ng/mL in women with a cervix at >30 mm. CONCLUSION: In women with threatened preterm birth, quantitative fibronectin testing alone performs equal to the combination of cervical length and qualitative fibronectin. Possibly, the combination of quantitative fibronectin testing and cervical length increases this predictive capacity. Cost-effectiveness analysis and the availability of these tests in a local setting should determine the final choice.


Assuntos
Medida do Comprimento Cervical , Fibronectinas/metabolismo , Nascimento Prematuro/epidemiologia , Adulto , Análise Custo-Benefício , Europa (Continente)/epidemiologia , Feminino , Humanos , Modelos Logísticos , Trabalho de Parto Prematuro/diagnóstico por imagem , Trabalho de Parto Prematuro/metabolismo , Valor Preditivo dos Testes , Gravidez , Nascimento Prematuro/diagnóstico por imagem , Nascimento Prematuro/metabolismo , Estudos Prospectivos , Medição de Risco , Vagina/química , Adulto Jovem
12.
Pediatr Res ; 80(2): 311-8, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27057737

RESUMO

BACKGROUND: Preterm neonates display an impaired vaccine response. Neonatal antigen-presenting cells (APCs) are less effective to induce an adaptive immune response and to promote the development of immunological memory. Efficient adjuvantal toll-like receptor (TLR)-triggering may overcome the neonatal immunological impairment. Accordingly, the aim of this study was to investigate the immunostimulatory action of R-848 and CpG-B on neonatal APCs. METHODS: Surface marker and cytokine secretion of APCs were evaluated after incubation of cord blood and peripheral blood mononuclear cells with the indicated adjuvants and were analyzed using flow cytometry. RESULTS: TLR-specific stimulation resulted in a significant induction of costimulatory molecules on neonatal APCs. Stimulation with R-848 resulted in significant higher secretion of TNFα, IL-6, IL-10, IL-12/IL-23p40, IL-12p70, and IFN-γ. Interestingly, CpG-B resulted in significant higher secretion of TNFα and IL-6. CONCLUSION: In summary, the incubation of TLR-agonists induced activation and maturation of neonatal APCs. These data show that modern TLR-specific adjuvants achieve a direct effect and potent upregulation of activation and maturation markers and cytokines in preterm neonates. We thus conclude that agents triggering TLRs might possibly overcome neonatal lack of vaccine responses.


Assuntos
Células Apresentadoras de Antígenos/imunologia , Imidazóis/farmacologia , Oligodesoxirribonucleotídeos/farmacologia , Receptores Toll-Like/metabolismo , Adjuvantes Imunológicos/química , Células Apresentadoras de Antígenos/citologia , Citocinas/metabolismo , Feminino , Sangue Fetal/citologia , Sangue Fetal/efeitos dos fármacos , Citometria de Fluxo , Voluntários Saudáveis , Humanos , Sistema Imunitário , Recém-Nascido , Recém-Nascido Prematuro , Leucócitos Mononucleares/citologia , Leucócitos Mononucleares/efeitos dos fármacos , Masculino , Regulação para Cima
13.
PLoS One ; 9(9): e106717, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25181353

RESUMO

BACKGROUND: In the last decades, human full-term cord blood was extensively investigated as a potential source of hematopoietic stem and progenitor cells (HSPCs). Despite the growing interest of regenerative therapies in preterm neonates, only little is known about the biological function of HSPCs from early preterm neonates under different perinatal conditions. Therefore, we investigated the concentration, the clonogenic capacity and the influence of obstetric/perinatal complications and maternal history on HSPC subsets in preterm and term cord blood. METHODS: CD34+ HSPC subsets in UCB of 30 preterm and 30 term infants were evaluated by flow cytometry. Clonogenic assays suitable for detection of the proliferative potential of HSPCs were conducted. Furthermore, we analyzed the clonogenic potential of isolated HSPCs according to the stem cell marker CD133 and aldehyde dehydrogenase (ALDH) activity. RESULTS: Preterm cord blood contained a significantly higher concentration of circulating CD34+ HSPCs, especially primitive progenitors, than term cord blood. The clonogenic capacity of HSPCs was enhanced in preterm cord blood. Using univariate analysis, the number and clonogenic potential of circulating UCB HSPCs was influenced by gestational age, birth weight and maternal age. Multivariate analysis showed that main factors that significantly influenced the HSPC count were maternal age, gestational age and white blood cell count. Further, only gestational age significantly influenced the clonogenic potential of UCB HSPCs. Finally, isolated CD34+/CD133+, CD34+/CD133- and ALDH(high) HSPC obtained from preterm cord blood showed a significantly higher clonogenic potential compared to term cord blood. CONCLUSION: We demonstrate that preterm cord blood exhibits a higher HSPC concentration and increased clonogenic capacity compared to term neonates. These data may imply an emerging use of HSPCs in autologous stem cell therapy in preterm neonates.


Assuntos
Células-Tronco Hematopoéticas/citologia , Lactente Extremamente Prematuro/sangue , Nascimento a Termo/sangue , Antígeno AC133 , Adulto , Aldeído Desidrogenase/metabolismo , Antígenos CD/metabolismo , Antígenos CD34/metabolismo , Contagem de Células , Ensaio de Unidades Formadoras de Colônias , Feminino , Sangue Fetal/citologia , Citometria de Fluxo , Glicoproteínas/metabolismo , Células-Tronco Hematopoéticas/metabolismo , Humanos , Recém-Nascido , Mães , Peptídeos/metabolismo , Gravidez
14.
J Perinat Med ; 41(3): 233-40, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23314505

RESUMO

AIM: The aim of this study was to compare the performance of tests based on the detection of insulin-like growth factor binding protein 1 (IGFBP-1) and placental α-microglobulin-1 (PAMG-1) in diagnosing rupture of fetal membranes (ROM) across different patient populations. METHODS: A meta-analysis was conducted on prospective observational or cohort studies investigating ROM tests based on the detection of IGFBP-1 and PAMG-1 meeting the following criteria: (1) performance metrics calculated by comparing results to an adequate reference method; (2) sensitivity thresholds of the investigated tests matching those of the currently available tests; (3) study population, as a minimum, included patients between 25 and 37 weeks of gestation. Sensitivities, specificities, and diagnostic odds ratios were calculated. RESULTS: Across all patient populations, the analyzed performance measures of the PAMG-1 test were significantly superior compared with those of the IGFBP-1 test. Of particular clinical relevance, PAMG-1 outperformed IGFBP-1 in the equivocal group, which comprised patients with uncertain rupture of membranes (sensitivity, 96.0% vs. 73.9%; specificity, 98.9% vs. 77.8%; PAMG-1 vs. IGFBP-1 tests, respectively). CONCLUSIONS: Compared with its performance in women with known membrane status, the accuracy of the IGFBP-1 test decreases significantly when used on patients whose membrane status is unknown. In this latter clinically relevant population, the PAMG-1 test has higher accuracy than the IGFBP-1 test.


Assuntos
Ruptura Prematura de Membranas Fetais/diagnóstico , Proteína 1 de Ligação a Fator de Crescimento Semelhante à Insulina/análise , Líquido Amniótico/química , Biomarcadores/análise , Colo do Útero/metabolismo , Erros de Diagnóstico , Feminino , Ruptura Prematura de Membranas Fetais/fisiopatologia , Humanos , Proteína 1 de Ligação a Fator de Crescimento Semelhante à Insulina/metabolismo , Gravidez , Vagina/metabolismo
16.
Pediatr Radiol ; 41(11): 1416-20, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21909717

RESUMO

BACKGROUND: Lung MRI volumetrics may be valuable for fetal assessment following early preterm premature rupture of the foetal membranes (pPROM). OBJECTIVE: To evaluate the predictive value of MRI lung volumetrics after pPROM. MATERIALS AND METHODS: Retrospective cohort study of 40 fetuses after pPROM in a large, tertiary, perinatal referral center. Fetuses underwent MRI lung volumetrics. Estimated lung volume was expressed as percentage of expected lung volume (our own normal references). Primary outcome was neonatal mortality due to respiratory distress before discharge from hospital. RESULTS: Gestational age range was 16-27 weeks. Estimated-to-expected lung volume was 73% in non-survivors and 102% in survivors (P < 0.05). There were no survivors with a lung volume less than 60% of expected. By logistic regression, mortality could be predicted with a sensitivity of 80%, specificity of 86% and accuracy of 85%. CONCLUSION: Fetal MR lung volumetrics may be useful for predicting mortality due to respiratory distress in children with early gestational pPROM.


Assuntos
Ruptura Prematura de Membranas Fetais/mortalidade , Ruptura Prematura de Membranas Fetais/patologia , Mortalidade Infantil , Imagem por Ressonância Magnética , Complicações na Gravidez/patologia , Adulto , Feminino , Humanos , Recém-Nascido , Pulmão/patologia , Masculino , Tamanho do Órgão , Valor Preditivo dos Testes , Gravidez , Estudos Retrospectivos
17.
Neonatology ; 100(1): 52-6, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21212696

RESUMO

OBJECTIVE: In consideration of comprehensive and well-established vaccination programmes in industrialized countries, it is expected that immunity against tetanus among expectant mothers and their offspring is complete. Our study evaluated seroprotection against tetanus among newborns in Austria, who may gain passive immunity by transplacental transfer of maternal tetanus antibody. METHODS: Cord blood samples from 99 deliveries were analyzed for antibody concentration against tetanus toxoid by standardized ELISA. RESULTS: 85/99 (85.8%) individuals presented with levels of tetanus immunity having a protective antibody concentration ≥0.1 IU/ml. 9/99 (9.1%) samples showed low seropositivity, while in 5/99 (5.1%) samples no tetanus antibodies could be detected. The median antibody concentration was 0.95 IU/ml. CONCLUSIONS: Our data provide evidence for a lack of adequate tetanus immunity in 14.2% of newborns delivered in an Austrian University Hospital. This investigation is emphasizing the importance of stringent regimens concerning prenatal vaccination care, even in countries with generalized immunization programs. If indicated, maternal immunization during pregnancy should be initiated for protection of newborns.


Assuntos
Países Desenvolvidos/estatística & dados numéricos , Imunidade Materno-Adquirida/fisiologia , Recém-Nascido/imunologia , Tétano/epidemiologia , Tétano/imunologia , Adolescente , Adulto , Anticorpos Antibacterianos/sangue , Feminino , Sangue Fetal/imunologia , Sangue Fetal/metabolismo , Humanos , Recém-Nascido/sangue , Troca Materno-Fetal/imunologia , Gravidez , Estudos Retrospectivos , Tétano/sangue , Toxoide Tetânico/imunologia , Vacinação/métodos , Vacinação/estatística & dados numéricos , Adulto Jovem
18.
J Matern Fetal Neonatal Med ; 24(2): 330-6, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20670094

RESUMO

Preterm birth (PTB) is estimated to account for 6-10% of all births worldwide with 13 million PTBs occurring annually and 1 million resulting in death. The diagnosis of spontaneous preterm labor and accurate prediction of preterm delivery is notoriously difficult. Identification of effective risk assessment markers can potentially improve outcomes by enabling targeted therapy while allowing efficient use of resources and avoiding unnecessary interventions. Advances in perinatal medicine have not reduced PTB and effective measures that improve outcome are yet to be established. However, considerable progress has been made in the development of accurate methods (fetal fibronectin and cervical length assessment) to predict PTB in both symptomatic and asymptomatic high-risk women. The excellent negative predictive value of fFN has the ability to facilitate decision-making regarding admission, in utero transfer, administration of antenatal corticosteroids and/or tocolysis and has been shown to be cost-effective. This review describes the European perspective on the use of fFN and describes ongoing European clinical studies, which are appropriately designed with meaningful endpoints, which will undoubtedly facilitate a better understanding of test accuracy and cost-effectiveness within different populations.


Assuntos
Feto/metabolismo , Fibronectinas/análise , Nascimento Prematuro/diagnóstico , Medida do Comprimento Cervical/economia , Medida do Comprimento Cervical/métodos , Análise Custo-Benefício , Europa (Continente) , Feminino , Ruptura Prematura de Membranas Fetais/diagnóstico , Ruptura Prematura de Membranas Fetais/metabolismo , Fibronectinas/metabolismo , Humanos , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/metabolismo , Diagnóstico Pré-Natal/economia , Diagnóstico Pré-Natal/métodos , Prognóstico , Fatores de Risco , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/metabolismo
19.
J Matern Fetal Neonatal Med ; 23(9): 1004-8, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20059440

RESUMO

INTRODUCTION: It is internationally agreed that diabetes mellitus (DM) is associated with increased maternal and fetal morbidity and long-term complications. To avoid these complications, it is often necessary to induce birth before term. The impact of DM on spontaneous preterm birth (spontaneous labor, preterm premature rupture of membranes and/or cervical incompetence resulting in delivery before the completion of 37 gestation weeks) is still unexplained. Preterm birth accounts for the most neonatal deaths and infant morbidities, and therefore it still remains one of the biggest challenges in obstetrics. OBJECTIVE: Our study determined if there is an increasing tendency towards spontaneous preterm birth in mothers with gestational and preexisting DM. METHODS: In this retrospective cohort study, 187 pregnant women with gestational DM and preexisting DM were compared to a randomized control group consisting of 192 normoglycemic women concerning gestational age and perinatal outcome. Data were collected by the Medical University of Vienna. Multiple pregnancies and women with severe maternal diseases, such as preeclampsia, were excluded. RESULTS: Women with DM tended significantly more often to preterm births (P = 0.002). A significant difference in the incidence of spontaneous preterm birth was found (P = 0.047). CONCLUSION: DM affects the length of gestation and incidence of spontaneous preterm birth.


Assuntos
Diabetes Gestacional/epidemiologia , Gravidez em Diabéticas/epidemiologia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Ruptura Prematura de Membranas Fetais/etiologia , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Trabalho de Parto Prematuro/epidemiologia , Trabalho de Parto Prematuro/etiologia , Gravidez , Gravidez Múltipla , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
20.
Fertil Steril ; 90(4): 1155-60, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18177644

RESUMO

OBJECTIVE: To investigate the association of the common protein Z (PZ) intron F G79A gene polymorphism with recurrent early pregnancy loss (RPL) and its gene-gene interaction with known thrombophilic risk factors for RPL. DESIGN: Case control study. SETTING: University clinic. PATIENT(S): We enrolled 49 women with a history of two consecutive or three to six nonconsecutive pregnancy losses between the 8th and 12th weeks of gestation and 48 age-matched parous controls without a history of pregnancy complications. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Allele frequencies of the PZ intron F G79A polymorphism and its gene-gene interaction with known risk factors for RPL. RESULT(S): Fourteen case subjects (28.6%) and 24 control subjects (50.0%) carried at least one A allele. This was associated with a significant reduction of the relative risk for recurrent pregnancy loss (odds ratio [OR] 0.4, 95% confidence interval [CI] 0.2-0.9; adjusted OR 0.3, 95% CI 0.1-0.8). Coexistence of any thrombophilic risk factor studied with the 79A allele resulted in a clear reduction of the primal relative risk for recurrent pregnancy loss. CONCLUSION(S): The isolated presence of the PZ intron F 79A allele as well as the combination with known thrombophilic risk factors was protective against RPL between the 8th and 12th weeks of gestation.


Assuntos
Aborto Habitual/genética , Proteínas Sanguíneas/genética , Polimorfismo de Nucleotídeo Único/genética , Adulto , Feminino , Predisposição Genética para Doença/genética , Humanos , Íntrons/genética
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