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1.
Am J Perinatol ; 2020 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-32521559

RESUMO

OBJECTIVE: This study was aimed to estimate the value of transabdominal (TA) ultrasound measurement of cervical length (CL), as an alternative of transvaginal (TV) ultrasound, for universal screening of short cervix in the midtrimester. STUDY DESIGN: We conducted a prospective cohort study of nulliparous women with singleton pregnancy at 20 to 24 weeks of gestation. All participants underwent TA ultrasound followed by TV ultrasound with acquisitions of images and videos of the uterine cervix. A second sonographer, blinded to the participants' data and pregnancy outcomes, measured the CL using TA and TV images and videos. Pearson's correlation test and receiver operating characteristic (ROC) curve analyses were performed. RESULTS: A total of 805 participants were recruited, including 780 (97%) where TA CL measurement was feasible. We observed a strong correlation of CL between TA and TV (correlation coefficient: 0.57; p < 0.0001) with a mean TA measurement being 4 mm (95% confidence interval [CI]: -6 to 14 mm) below the mean TV measurement (mean of differences: 5 ± 4 mm). We observed that a TA CL <30 mm was highly predictive of a short cervix defined as a TV CL ≤25 mm (area under the ROC curve: 0.97; 95% CI: 0.95-0.99; p < 0.0001) with a sensitivity of 100% and a false-positive rate of 22%. CONCLUSION: Universal short cervix screening in nulliparous women could be performed using TA ultrasound, which could allow the avoidance of TV ultrasound in more than three quarter of women. In low-risk population, TV ultrasound could be reserved to women with TA CL <30 mm. KEY POINTS: · Cervical length (CL) measurement with transabdominal (TA) ultrasound is feasible in most cases and is strongly correlated with CL measured with transvaginal (TV) ultrasound.. · Using a cut-off of 30 mm for TA ultrasound as a first-step screening of short cervix in nulliparous women, three-quarter of TV ultrasound could have been avoided.. · Use of TA CL screening could alleviate some of the logistical challenges of universal TV CL screening..

2.
Eur J Obstet Gynecol Reprod Biol ; 233: 30-37, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30553135

RESUMO

OBJECTIVES: Preterm premature rupture of fetal membranes (PPROM) exposes the fetus to preterm birth, and optimal timing for delivery is controversial. The aim of this study was to compare intentional early delivery ("active management") with expectant management in very preterm birth (28-32 weeks). STUDY DESIGN: We conducted a prospective randomized controlled trial with intent-to-treat analysis, at 19 tertiary-care hospitals in France and 1 in Geneva, Switzerland. Inclusion criteria were women age ≥18 years, PPROM at 280/7 to 316/7 weeks' gestation, singleton pregnancy. Exclusion criteria were maternal/fetal indications for immediate delivery. All participants received prophylactic antibiotics (amoxicillin + gentamicin) and two doses of corticosteroids. Women in expectant management delivered at 34 weeks, sooner if medically indicated. Women in active management delivered 24 h after the second steroid dose. The primary outcome measure was a composite of neonatal death/severe adverse events: periventricular leukomalacia, intraventricular hemorrhage, sepsis, oxygen requirement at 36 weeks, and necrotizing enterocolitis. The secondary outcome was clinical chorioamnionitis. RESULTS: The trial was stopped prematurely, due to recruitment difficulties. Of 360 women assessed, 139 (40% of calculated sample size) were randomized: 70 to expectant management, 69 to active management. Mean gestational age at PPROM was similar in both groups (30 ± 1.3 vs. 30.2 ± 1.2 weeks, respectively). There were 35 cases of medical/suspected complications requiring delivery in expectant management vs. 4 in active management. Mean latency between PPROM and delivery was 11.7 ± 9.8 vs. 2.8 ± 0.6 days, respectively; P < 0.0001 (median 8.4 (1.8-44.2) vs. 2.7 (1.9-4.3)). There were more caesarean deliveries in active than expectant management (80% vs. 60%, respectively; P < 0.01). There were 2 chorioamnionitis cases, both in expectant management. One baby died in expectant management; 2 in active management (one with heart defect). There was no significant difference in sepsis rates. The combined neonatal death/severe adverse events measure was 12.9% for expectant management and 13.0% for active management (OR 0.98; 95% CI: 0.33-2.93, P = 0.97). CONCLUSION: For PPROM at 28-32 weeks, and with antenatal antibiotic and steroid therapy, there were no observed differences in neonatal health when comparing expectant management to early delivery. As expected, expectant management resulted in higher gestational age and birth weight. However, our study was underpowered to draw firm and reliable conclusions.


Assuntos
Ruptura Prematura de Membranas Fetais/terapia , Nascimento Prematuro/prevenção & controle , Conduta Expectante , Corticosteroides/administração & dosagem , Adulto , Antibacterianos/administração & dosagem , Cesárea/estatística & dados numéricos , Término Precoce de Ensaios Clínicos , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Prospectivos , Tocolíticos/administração & dosagem
3.
J Obstet Gynaecol Can ; 41(7): 960-970, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30559087

RESUMO

OBJECTIVE: This study aimed to evaluate the impact of educational tools concerning pre-eclampsia on knowledge, anxiety, and women's satisfaction. METHODS: The investigators conducted a randomized controlled trial from March to July 2014 at the Centre Hospitalier Universitaire de Sherbrooke (Sherbrooke, QC) by comparing ambulatory pregnant women (20-32 weeks of gestation) who were receiving educational tools on pre-eclampsia with control patients who received routine care. Tools consisted of an informative pamphlet, a video, and a pictographic magnet, all validated by a multidisciplinary team. The primary outcome was global knowledge (number of correct answers on 35 items) about the disease after 1 month, as assessed by questionnaire. Secondary outcomes included anxiety regarding pre-eclampsia and satisfaction concerning the different tools (a 1-6 Likert scale was used). RESULTS: Among 362 pregnant women approached for the research, 269 were randomized. After 1 month, 247 questionnaires (92%) were filled and analyzed: 122 from the control group and 125 from the intervention group. Baseline characteristics were similar between the groups. Patients who received the tools scored significantly higher on global knowledge (70.1% ± 19.2% compared with 51.1% ± 23.4%; mean difference of 19.0%; P < 0.001). Anxiety scores regarding pre-eclampsia were similar between the groups, with a mean of 2.40 out of 6 for the control group and 2.53 out of 6 for the intervention group (equivalence test, P < 0.001). High score levels of satisfaction for the pamphlet and video were found: 5.1 out of 6 and 5.2 out of 6, respectively. CONCLUSION: These well-received educational tools for pregnant women increased their knowledge about pre-eclampsia without increasing their anxiety about it. Women reported the highest satisfaction for the tools.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto , Satisfação do Paciente , Pré-Eclâmpsia/psicologia , Cuidado Pré-Natal , Adulto , Feminino , Humanos , Gravidez , Resultado do Tratamento
4.
Med Sci (Paris) ; 34(10): 799-805, 2018 Oct.
Artigo em Francês | MEDLINE | ID: mdl-30451673

RESUMO

Preterm birth is the leading cause of perinatal mortality and morbidity. Despite the efforts spent over the past 40 years to solve the physiopathological processes involved in the triggering of prematurity, efficient therapeutics are still lacking. Recently, growing body of evidence suggests that the maternal microbiome is a major player for a normal pregnancy and that dysbiosis is associated with preterm birth. The vaginal microbiome and its commensal Lactobacillus species may protect the uterus of ascending dissemination of pathogens. The uterus can also be contaminated with oral bacteria by the blood stream. Thus, the maternal microbiome can play both a protective role or a causal role in the triggering of preterm birth.


Assuntos
Microbiota/fisiologia , Mães , Nascimento Prematuro/microbiologia , Disbiose/complicações , Disbiose/fisiopatologia , Feminino , Humanos , Recém-Nascido , Placenta/microbiologia , Gravidez , Complicações na Gravidez/microbiologia , Vagina/microbiologia
5.
CMAJ Open ; 6(1): E44-E49, 2018 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-29348260

RESUMO

BACKGROUND: Preterm birth (birth before 37 wk of gestation) occurs in about 8% of pregnancies in Canada and is associated with high mortality and morbidity rates that substantially affect infants, their families and the health care system. Our overall goal is to create a transdisciplinary platform, the Canadian Preterm Birth Network (CPTBN), where investigators, stakeholders and families will work together to improve childhood outcomes of preterm neonates. METHODS: Our national cohort will include 24 maternal-fetal/obstetrical units, 31 neonatal intensive care units and 26 neonatal follow-up programs across Canada with planned linkages to provincial health information systems. Three broad clusters of projects will be undertaken. Cluster 1 will focus on quality-improvement efforts that use the Evidence-based Practice for Improving Quality method to evaluate information from the CPTBN database and review the current literature, then identify potentially better health care practices and implement identified strategies. Cluster 2 will assess the impact of current practices and practice changes in maternal, perinatal and neonatal care on maternal, neonatal and neurodevelopmental outcomes. Cluster 3 will evaluate the effect of preterm birth on babies, their families and the health care system by integrating CPTBN data, parent feedback, and national and provincial database information in order to identify areas where more parental support is needed, and also generate robust estimates of resource use, cost and cost-effectiveness around preterm neonatal care. INTERPRETATION: These collaborative efforts will create a flexible, transdisciplinary, evaluable and informative research and quality-improvement platform that supports programs, projects and partnerships focused on improving outcomes of preterm neonates.

6.
Int J Dev Neurosci ; 66: 37-44, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29360555

RESUMO

BACKGROUND: The goal was to evaluate whether there was neurodevelopmental deficits in newborns born to mothers with gestational diabetes mellitus (GDM) compared to control newborns born to healthy mothers. METHODS: Forty-six pregnant women (21 controls and 25 GDM) were recruited. Electroencephalogram (EEG) was recorded in the newborns within 48 h after birth. The EEG signal was quantitatively analyzed using power spectral density (PSD); coherence between hemispheres was calculated in paired channels of frontal, temporal, central and occipital regions. RESULTS: The left centro-occipital PSD in control newborns was 12% higher than in GDM newborns (p = 0.036) but was not significant after adjustment for gestational age. While coherence was higher in the frontal regions compared to the occipital regions (p < 0.001), there was no difference between the groups for the fronto-temporal, frontal-central, centro-occipital and tempo-occipital regions. CONCLUSION: Our results support that EEG differences between groups were mainly modified by gestational age and less by GDM status of the mothers. However, there is a need to confirm this result with a higher number of mother-newborns. Quantitative EEG in GDM newborns within 48 h after birth is feasible. This study emphasizes the importance of controlling blood glucose during GDM to protect infant brain development.


Assuntos
Ondas Encefálicas/fisiologia , Diabetes Gestacional/fisiopatologia , Eletroencefalografia , Adolescente , Adulto , Feminino , Humanos , Recém-Nascido , Projetos Piloto , Gravidez , Análise Espectral , Estatísticas não Paramétricas , Adulto Jovem
7.
J Matern Fetal Neonatal Med ; 31(2): 191-196, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28068846

RESUMO

OBJECTIVES: To evaluate the in vitro effect of tamsulosin and nifedipine on the contractility of pregnant rat ureters and to perform quantitative analysis of the pharmacological effects. Medical expulsive therapy (MET) is commonly used to treat urolithiasis. However, this treatment is seldom used in pregnant women since no studies support this practice. METHODS: This was an in vitro study on animal tissue derived from pregnant Sprague-Dawley rats. A total of 124 ureteral segments were mounted in an organ bath system and contractile response to methacholine (MCh) was assessed. Tamsulosin or nifedipine were added at cumulative concentrations (0.001-1 µM). The area under the curve (AUC) from isometric tension measurements was calculated. The effect of pharmacological agents and the respective controls were assessed by calculating the AUC for each 5-min interval. Statistical analyses were performed using the Mann-Whitney-Wilcoxon nonparametric test. RESULTS: Both drugs displayed statistically significant inhibitory activity at concentrations of 0.1 and 1 µM for tamsulosin and 1 µM for nifedipine when calculated as the AUC as compared to DMSO controls. CONCLUSION: Tamsulosin and nifedipine directly inhibit MCh-induced contractility of pregnant rat ureters. Further work is needed to determine the clinical efficacy of these medications for MET in pregnancy.


Assuntos
Nifedipino/farmacologia , Sulfonamidas/farmacologia , Ureter/efeitos dos fármacos , Animais , Feminino , Cálculos Renais , Cloreto de Metacolina/farmacologia , Gravidez , Ratos , Ratos Sprague-Dawley , Tansulosina , Ureter/fisiologia
8.
Am J Obstet Gynecol ; 217(3): 358.e1-358.e9, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28479286

RESUMO

BACKGROUND: Although physiologic transition from rhythmic contractions to uterine retraction postpartum remains a poorly understood process, it has been shown that the latter is essential in the prevention of hemorrhage and its negative consequences. OBJECTIVE: To investigate the transition from oscillatory contractions to tonic contracture in human myometrium after delivery, a mechanism purported to facilitate postpartum hemostasis. Protein kinase C (PKC) plays a key regulatory role in human uterine contractions because it can prevent dephosphorylation of regulatory proteins and sensitize the contractile machinery to low Ca2+. Thus, activation of PKC by phorbol 12,13-dibutyrate (PDBu) may act as a strong uterotonic agent. STUDY DESIGN: Uterine biopsies were obtained from consenting women undergoing elective caesarian delivery at term without labor (N = 19). Isometric tension measurements were performed on uterine strips (n = 114). The amplitudes and area under the curve of phasic contractions and tonic responses were measured and compared. A total of 1 µM PDBu was added to the isolated organ baths, and maximal tension of the uterine contracture was determined in the absence and presence of either 1 µM of staurosporine, 100 nM nifedipine, or 10 µM cyclopiazonic acid to assess the role of PKC and calcium sensitivity on uterine contractility. RESULTS: On the addition of PDBu on either basal or oxytocin-induced activity, consistent contractures were obtained concomitant with complete inhibition of phasic contractions. After a 30-minute incubation period, the mean amplitude of the PDBu-induced tone represented 65.3% of the amplitude of spontaneous contraction. Staurosporine, a protein kinase inhibitor, induced a 91.9% inhibition of PDBu contractures, a process not affected by nifedipine or cyclopiazonic acid, thus indicating that this mechanism is largely Ca2+ independent. CONCLUSION: Pharmacologic activation of PKC leads to a significant contracture of the myometrium. Together, these data suggest that the up-regulation of PKC plays a physiologic role in the modulation of uterine contracture after delivery. A switch from phasic to strong tonic contractions potentially may facilitate postpartum hemostasis.


Assuntos
Miométrio/efeitos dos fármacos , Dibutirato de 12,13-Forbol/farmacologia , Proteína Quinase C/efeitos dos fármacos , Contração Uterina/efeitos dos fármacos , Adulto , Inibidores Enzimáticos/farmacologia , Feminino , Humanos , Técnicas In Vitro , Indóis/farmacologia , Miométrio/metabolismo , Nifedipino/farmacologia , Proteína Quinase C/metabolismo , Estaurosporina/farmacologia , Tocolíticos/farmacologia , Adulto Jovem
9.
Am J Obstet Gynecol ; 217(1): 65.e1-65.e5, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28263751

RESUMO

BACKGROUND: Uterine rupture is a potential life-threatening complication during a trial of labor after cesarean delivery. Single-layer closure of the uterus at cesarean delivery has been associated with an increased risk of uterine rupture compared with double-layer closure. Lower uterine segment thickness measurement by ultrasound has been used to evaluate the quality of the uterine scar after cesarean delivery and is associated with the risk of uterine rupture. OBJECTIVE: To estimate the impact of previous uterine closure on lower uterine segment thickness. STUDY DESIGN: Women with a previous single low-transverse cesarean delivery were recruited at 34-38 weeks' gestation. Transabdominal and transvaginal ultrasound evaluation of the lower uterine segment thickness was performed by a sonographer blinded to clinical data. Previous operative reports were reviewed to obtain the type of previous uterine closure. Third-trimester lower uterine segment thickness at the next pregnancy was compared according to the number of layers sutured and according to the type of thread for uterine closure, using weighted mean differences and multivariate logistic regression analyses. RESULTS: Of 1613 women recruited, with operative reports available, 495 (31%) had a single-layer and 1118 (69%) had a double-layer closure. The mean third-trimester lower uterine segment thickness was 3.3 ± 1.3 mm and the proportion with lower uterine segment thickness <2.0 mm was 10.5%. Double-layer closure of the uterus was associated with a thicker lower uterine segment than single-layer closure (weighted mean difference: 0.11 mm; 95% confidence interval [CI], 0.02 to 0.21 mm). In multivariate logistic regression analyses, a double-layer closure also was associated with a reduced risk of lower uterine segment thickness <2.0 mm (odd ratio [OR], 0.68; 95% CI, 0.51 to 0.90). Compared with synthetic thread, the use of catgut for uterine closure had no significant impact on third-trimester lower uterine segment thickness (WMD: -0.10 mm; 95% CI, -0.22 to 0.02 mm) or on the risk of lower uterine segment thickness <2.0 mm (OR, 0.95; 95% CI, 0.67 to 1.33). Finally, double-layer closure was associated with a reduced risk of uterine scar defect (RR, 0.32; 95% CI, 0.17 to 0.61) at birth. CONCLUSION: Compared with single-layer closure, a double-layer closure of the uterus at previous cesarean delivery is associated with a thicker third-trimester lower uterine segment and a reduced risk of lower uterine segment thickness <2.0 mm in the next pregnancy. The type of thread for uterine closure has no significant impact on lower uterine segment thickness.


Assuntos
Cesárea/efeitos adversos , Cesárea/métodos , Útero/patologia , Técnicas de Fechamento de Ferimentos , Adulto , Recesariana/efeitos adversos , Recesariana/métodos , Cicatriz/prevenção & controle , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Gravidez , Estudos Prospectivos , Ultrassonografia , Ruptura Uterina/patologia , Útero/diagnóstico por imagem
10.
Am J Obstet Gynecol ; 216(5): 508.e1-508.e7, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28153654

RESUMO

BACKGROUND: Prolonged labor is a significant cause of maternal and fetal morbidity and very few interventions are known to shorten labor course. Skeletal muscle physiology suggests that glucose supplementation might improve muscle performance in case of prolonged exercise and this situation is analogous to the gravid uterus during delivery. Therefore, it seemed imperative to evaluate the impact of adding carbohydrate supplements on the course of labor. OBJECTIVE: We sought to provide evidence as to whether intravenous glucose supplementation during labor induction in nulliparous women can reduce total duration of active labor. STUDY DESIGN: We performed a single-center prospective double-blind randomized controlled trial comparing the use of parental intravenous dextrose 5% with normal saline to normal saline in induced nulliparous women. The study was conducted in a tertiary-level university hospital setting. Participants, caregivers, and those assessing the outcomes were blinded to group assignment. Inclusion criteria were singleton pregnancy at term with cephalic presentation and favorable cervix. Based on blocked randomization, patients were assigned to receive either 250 mL/h of intravenous dextrose 5% with normal saline or 250 mL/h of normal saline for the whole duration of induction, labor, and delivery. The primary outcome studied was the total length of active labor. Secondary outcomes included duration of the active phase of second stage of labor, the mode of delivery, Apgar scores, and arterial cord pH. RESULTS: In all, 100 patients were randomized into each group. A total of 193 patients (96 in the dextrose with normal saline group and 97 in the normal saline group) were analyzed in the study. The median total duration of labor was significantly less in the dextrose with normal saline group (499 vs 423 minutes, P = .024) than in the normal saline group. The probabilities of a woman being delivered at 200 minutes and 450 minutes were 18.8% and 77.1% in the dextrose with normal saline group vs 8.2% and 59.8% in the normal saline group (Kolmogorov-Smirnov test P value = .027). There was no difference in the rate of cesarean delivery, instrumented delivery, Apgar score, or arterial cord pH. CONCLUSION: Glucose supplementation significantly reduces the total length of labor without increasing the rate of complication in induced nulliparous women. Given the low cost and the safety of this intervention, glucose should be used as the default solute during labor.


Assuntos
Glucose/administração & dosagem , Trabalho de Parto Induzido , Trabalho de Parto , Edulcorantes/administração & dosagem , Índice de Apgar , Parto Obstétrico , Método Duplo-Cego , Feminino , Sangue Fetal/química , Humanos , Concentração de Íons de Hidrogênio , Infusões Intravenosas , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Paridade , Gravidez , Estudos Prospectivos , Fatores de Tempo
11.
J Matern Fetal Neonatal Med ; 30(14): 1715-1720, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27578415

RESUMO

OBJECTIVE: Antenatal magnesium sulfate (MgSO4) is recommended for fetal neuroprotection. The aim of this animal study was to assess the neuroprotective effect of in utero exposure to MgSO4, under inflammatory conditions. METHODS: Timed pregnant Sprague-Dawley (SD) rats (n = 29) received four intra-peritoneal (IP) injections of lipopolysaccharides (LPS; 200 µg/kg), combined with increasing concentrations of MgSO4 (25, 50 or 100 mg/kg, n = 19) or saline solution (SS; n = 10). In the second set of experiments, animals (n = 8) received a single IP injection of i) LPS (500 µg/kg), MgSO4 (50 mg/kg) and SS (n = 4) or ii) LPS (500 µg/kg), MgSO4 (50 mg/kg) and IL-6 (12 µg/kg) (n = 4). Neurodevelopmental outcomes of surviving pups (n = 212) were assessed by the open field and the rotarod tests. RESULTS: Pups' average weight at postnatal day (P) 25 was 75.77 g and 89.08 g in MgSO4 and control groups, respectively (p = 0.02). Pups in MgSO4 group have traveled a shorter distance and have shown reduced motor balance and coordination (p < 0.01). Average weight of pups receiving (LPS + MgSO4+ IL-6) was 92.26 g at P25, compared to 75.86 g in (LPS + MgSO4+SS) group (p < 0.05). CONCLUSIONS: In our model, MgSO4 induces pup's growth retardation and motor deficits, which may partly be related to a lower IL-6 circulating concentration.


Assuntos
Inflamação/complicações , Sulfato de Magnésio/uso terapêutico , Transtornos do Neurodesenvolvimento/prevenção & controle , Fármacos Neuroprotetores/uso terapêutico , Nascimento Prematuro/etiologia , Animais , Animais Recém-Nascidos/crescimento & desenvolvimento , Avaliação Pré-Clínica de Medicamentos , Feminino , Inflamação/mortalidade , Interleucina-6 , Lipopolissacarídeos , Gravidez , Ratos Sprague-Dawley , Teste de Desempenho do Rota-Rod
12.
Artigo em Inglês | MEDLINE | ID: mdl-27914513

RESUMO

OBJECTIVE: To evaluate the fatty acid profile of cord blood phospholipids (PL), cholesteryl esters (CE), triglycerides (TG) and non-esterified fatty acids (NEFA) in neonates born to mothers with gestational diabetes mellitus (GDM) compared to non-diabetic mothers. METHODS: The offspring of 30 pregnant women (15 non-diabetic controls, 15 with diet- or insulin-controlled GDM) were recruited before delivery. Cord blood was collected. After lipid extraction, PL, CE, TG and NEFA were separated by thin layer chromatography and analysed by gas chromatography. RESULTS: In GDM vs. control mothers, maternal glycated haemoglobin (A1C, mean±SD) was not different between groups: 5.3±0.5% vs. 5.3±0.3% (p=0.757), respectively. Cord plasma fatty acids were not different in TG, CE and NEFA between GDM and non-diabetic mothers. However, in PL, levels of palmitate, palmitoleate, oleate, vaccinate and di-homo-gamma-linolenate were significantly lower, with a trend for lower arachidonate (p=0.078), in neonates born to GDM mothers compared to controls. CONCLUSION: In contrast to other studies on cord blood docosahexaenoic acid (DHA) levels in GDM mothers, we did not found lower levels of DHA in cord PL, CE, TG or NEFA in neonates born to GDM compared to non-diabetic mothers.


Assuntos
Diabetes Gestacional/sangue , Ácidos Graxos/análise , Sangue Fetal/química , Adulto , Ésteres do Colesterol/sangue , Ácidos Graxos não Esterificados/sangue , Feminino , Humanos , Recém-Nascido , Fosfolipídeos/sangue , Gravidez , Triglicerídeos/sangue , Adulto Jovem
13.
BMC Pregnancy Childbirth ; 16(1): 294, 2016 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-27716107

RESUMO

BACKGROUND: While spirituality is well described in end-of-life care literature, research on its place in the delivery room remains largely limited to mother-oriented qualitative studies focusing on life-threatening situations (e.g., high-risk pregnancies). Our aim was to compare mothers' and fathers' spirituality during childbirth. METHODS: A mixed methods questionnaire was developed from our childbirth-related spirituality categorization and distributed to all parents of newborns, 12-24 h postpartum, over 45 consecutive days. Paired-sample t-tests and qualitative thematic analysis were used to compare mothers and fathers. Multiple linear regressions identified factors associated with their respective global scores (vaginal and cesarean deliveries separately). RESULTS: The global scores for mothers (38.6/50) and fathers (37.2/50) were similarly high (N = 197; p = 0.001). Highest-ranked ("respect", "moral responsibility", "beauty of life", "gratitude") and lowest-ranked spiritual themes ("prayer", "greater than self") were in agreement. Fathers scored higher on "fragility of life" (p = 0.006) and mothers on "self-accomplishment" (p<0.001), "letting go" (p<0.001), and "meaningfulness" (p = 0.003). "Admission of baby in neonatal unit" was associated with higher global score for both mothers and fathers. Other factors also increased fathers' (witnessing a severe tear) and mothers' scores (birthplace outside Canada; for vaginal deliveries, religious belonging and longer pushing stage). CONCLUSION: These first quantitative data on the prevalence of spirituality during childbirth highlight a high score for both parents, among a non-selected public hospital population. Spirituality emerges not only from unordinary situations but from any childbirth as an "intensification of the human experience". Significant differences for some spiritual themes indicate the need to consider the spirituality of both parents.


Assuntos
Parto Obstétrico/psicologia , Pai/psicologia , Mães/psicologia , Parto/psicologia , Espiritualidade , Adulto , Canadá , Salas de Parto , Parto Obstétrico/métodos , Feminino , Hospitais Públicos , Humanos , Masculino , Gravidez , Pesquisa Qualitativa , Inquéritos e Questionários
14.
Paediatr Perinat Epidemiol ; 30(6): 623-632, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27781295

RESUMO

BACKGROUND: The 3D Cohort Study (Design, Develop, Discover) was established to help bridge knowledge gaps about the links between various adverse exposures during pregnancy with birth outcomes and later health outcomes in children. METHODS: Pregnant women and their partners were recruited during the first trimester from nine sites in Quebec and followed along with their children through to 2 years of age. Questionnaires were administered during pregnancy and post-delivery to collect information on demographics, mental health and life style, medical history, psychosocial measures, diet, infant growth, and neurodevelopment. Information on the delivery and newborn outcomes were abstracted from medical charts. Biological specimens were collected from mothers during each trimester, fathers (once during the pregnancy), and infants (at delivery and 2 years of age) for storage in a biological specimen bank. RESULTS: Of the 9864 women screened, 6348 met the eligibility criteria and 2366 women participated in the study (37% of eligible women). Among women in the 3D cohort, 1721 of their partners (1704 biological fathers) agreed to participate (73%). Two thousand two hundred and nineteen participants had a live singleton birth (94%). Prenatal blood and urine samples as well as vaginal secretions were collected for ≥98% of participants, cord blood for 81% of livebirths, and placental tissue for 89% of livebirths. CONCLUSIONS: The 3D Cohort Study combines a rich bank of multiple biological specimens with extensive clinical, life style, and psychosocial data. This data set is a valuable resource for studying the developmental etiology of birth and early childhood neurodevelopmental outcomes.


Assuntos
Transtornos do Neurodesenvolvimento/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Adolescente , Adulto , Escolaridade , Feminino , Humanos , Estilo de Vida , Masculino , Idade Materna , Pessoa de Meia-Idade , Ontário/epidemiologia , Paridade , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Quebeque/epidemiologia , Fatores Socioeconômicos , Manejo de Espécimes/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
15.
Eur J Obstet Gynecol Reprod Biol ; 206: 92-98, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27649459

RESUMO

OBJECTIVE: The potency of acute montelukast treatment, a leukotriene receptor antagonist, has been demonstrated as tocolytic on in vitro myometrial contractility. This study assessed the ability of a 48h montelukast treatment to modify in vitro contractions under inflammatory conditions in a pregnant rat model. STUDY DESIGN: Pregnant Sprague-Dawley rats were injected intraperitoneally (gestational days 20-22) with lipopolysaccharides (LPS) 200µg/kg (4 treatments at 12h intervals) alone or combined with montelukast 10mg/kg/day or a saline solution for a 48h period. Uterine rings (n=72) were obtained by median laparotomy at day 22. Spontaneous contractile activities were compared using pharmacological compounds (oxytocin, nifedipine) along with assessment of contractile parameters. Myometrial subcellular fractions were also analyzed by Western blot to quantify oxytocin, cysteinyl leukotriene receptors and inflammation markers. RESULTS: In in vitro experiments, the area under the curve, the amplitude and the duration of phasic contractions were significantly reduced following 48h of LPS+montelukast treatment comparatively to the LPS group. Moreover, in this same group, oxytocin (10-9-10-7M) largely decreased uterine sensitivity (p=0.04). Following LPS and montelukast treatment, the tocolytic effectiveness of nifedipine (10-9-10-7M) was increased (p<0.01). Western blot analysis confirmed the presence of type 1 CysLT receptors in all treated groups. Hence, montelukast treatment restored TNF-α and COX-2 basal levels. CONCLUSION: Our results strongly suggest that montelukast treatment could facilitate a relative uterine quiescence by decreasing its sensitivity to uterotonic agent or by increasing tocolytic efficiency under proinflammatory conditions.


Assuntos
Acetatos/farmacologia , Antagonistas de Leucotrienos/farmacologia , Quinolinas/farmacologia , Tocolíticos/farmacologia , Contração Uterina/efeitos dos fármacos , Útero/efeitos dos fármacos , Animais , Feminino , Inflamação , Miométrio/efeitos dos fármacos , Gravidez , Ratos , Ratos Sprague-Dawley
16.
Am J Obstet Gynecol ; 215(5): 604.e1-604.e6, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27342045

RESUMO

BACKGROUND: Choice of delivery route after previous cesarean delivery can be difficult because both trial of labor after cesarean delivery and elective repeat cesarean delivery are associated with risks. The major risk that is associated with trial of labor after cesarean delivery is uterine rupture that requires emergency laparotomy. OBJECTIVE: This study aimed to estimate the occurrence of uterine rupture during trial of labor after cesarean delivery when lower uterine segment thickness measurement is included in the decision-making process about the route of delivery. STUDY DESIGN: In 4 tertiary-care centers, we prospectively recruited women between 34 and 38 weeks of gestation who were contemplating a vaginal birth after a previous single low-transverse cesarean delivery. Lower uterine segment thickness was measured by ultrasound imaging and integrated in the decision of delivery route. According to lower uterine segment thickness, women were classified in 3 risk categories for uterine rupture: high risk (<2.0 mm), intermediate risk (2.0-2.4 mm), and low risk (≥2.5 mm). Our primary outcome was symptomatic uterine rupture, which was defined as requiring urgent laparotomy. We calculated that 942 women who were undergoing a trial of labor after cesarean delivery should be included to be able to show a risk of uterine rupture <0.8%. RESULTS: We recruited 1856 women, of whom 1849 (99%) had a complete follow-up data. Lower uterine segment thickness was <2.0 mm in 194 women (11%), 2.0-2.4 mm in 217 women (12%), and ≥2.5 mm in 1438 women (78%). Rate of trial of labor was 9%, 42%, and 61% in the 3 categories, respectively (P<.0001). Of 984 trials of labor, there were no symptomatic uterine ruptures, which is a rate that was lower than the 0.8% expected rate (P=.0001). CONCLUSION: The inclusion of lower uterine segment thickness measurement in the decision of the route of delivery allows a low risk of uterine rupture during trial of labor after cesarean delivery.


Assuntos
Parto Obstétrico/métodos , Prova de Trabalho de Parto , Ruptura Uterina/epidemiologia , Útero/diagnóstico por imagem , Nascimento Vaginal Após Cesárea , Adulto , Tomada de Decisão Clínica , Feminino , Humanos , Tamanho do Órgão , Gravidez , Estudos Prospectivos , Medição de Risco , Ultrassonografia Pré-Natal , Útero/anatomia & histologia
17.
Environ Health ; 15: 49, 2016 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-27068391

RESUMO

BACKGROUND: Polybrominated diphenyl ethers are known endocrine disrupting environmental contaminants used as flame retardants. Their levels have increased in humans over the last ten years, raising concerns about their consequences on human health. Some animal studies suggest that PBDEs can affect fetal growth; however, the results of human studies are contradictory. This study evaluates the association between the most common PBDEs in maternal blood measured in early pregnancy and birth weight. METHODS: BDE-47, BDE-99, BDE-100 and BDE-153 levels were measured in 349 women during their first prenatal care visit at the University Hospital Center of Sherbrooke (Quebec, Canada). Birth weight and relevant medical information were collected from medical records. In contrast with previous studies, we examined the full range of clinical risk factors known to affect fetal growth as potential confounders, as well as other environmental pollutants that are likely to interact with fetal growth (polychlorinated biphenyls (PCBs), mercury, lead, cadmium and manganese). RESULTS: There was no statistically significant relationship between PBDE levels in early pregnancy and birth weight in both unadjusted and multivariate regression models. CONCLUSIONS: Our results suggest that PBDEs in early pregnancy have little or no direct impact on birth weight, at least at the levels of exposure in our population.


Assuntos
Peso ao Nascer , Disruptores Endócrinos/sangue , Poluentes Ambientais/sangue , Éteres Difenil Halogenados/sangue , Metais Pesados/sangue , Bifenilos Policlorados/sangue , Adolescente , Adulto , Estudos de Coortes , Feminino , Retardadores de Chama/análise , Humanos , Recém-Nascido , Masculino , Exposição Materna , Gravidez , Quebeque/epidemiologia , Adulto Jovem
18.
N Engl J Med ; 372(18): 1710-21, 2015 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-25923551

RESUMO

BACKGROUND: In Canada, cesarean delivery rates have increased substantially over the past decade. Effective, safe strategies are needed to reduce these rates. METHODS: We conducted a cluster-randomized, controlled trial of a multifaceted 1.5-year intervention at 32 hospitals in Quebec. The intervention involved audits of indications for cesarean delivery, provision of feedback to health professionals, and implementation of best practices. The primary outcome was the cesarean delivery rate in the 1-year postintervention period. RESULTS: Among the 184,952 participants, 53,086 women delivered in the year before the intervention and 52,265 women delivered in the year following the intervention. There was a significant but small reduction in the rate of cesarean delivery from the preintervention period to the postintervention period in the intervention group as compared with the control group (change, 22.5% to 21.8% in the intervention group and 23.2% to 23.5% in the control group; odds ratio for incremental change over time, adjusted for hospital and patient characteristics, 0.90; 95% confidence interval [CI], 0.80 to 0.99; P=0.04; adjusted risk difference, -1.8%; 95% CI, -3.8 to -0.2). The cesarean delivery rate was significantly reduced among women with low-risk pregnancies (adjusted risk difference, -1.7%; 95% CI, -3.0 to -0.3; P=0.03) but not among those with high-risk pregnancies (P=0.35; P = 0.03 for interaction). The intervention group also had a reduction in major neonatal morbidity as compared with the control group (adjusted risk difference, -0.7%; 95% CI, -1.3 to -0.1; P=0.03) and a smaller increase in minor neonatal morbidity (adjusted risk difference, -1.7%; 95% CI, -2.6 to -0.9; P<0.001). Changes in minor and major maternal morbidity did not differ significantly between the groups. CONCLUSIONS: Audits of indications for cesarean delivery, feedback for health professionals, and implementation of best practices, as compared with usual care, resulted in a significant but small reduction in the rate of cesarean delivery, without adverse effects on maternal or neonatal outcomes. The benefit was driven by the effect of the intervention in low-risk pregnancies. (Funded by the Canadian Institutes of Health Research; QUARISMA Current Controlled Trials number, ISRCTN95086407.).


Assuntos
Cesárea/estatística & dados numéricos , Capacitação em Serviço , Auditoria Médica , Adolescente , Adulto , Feminino , Fidelidade a Diretrizes , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Mortalidade Materna , Guias de Prática Clínica como Assunto , Gravidez , Resultado da Gravidez , Quebeque , Risco , Procedimentos Desnecessários/estatística & dados numéricos , Adulto Jovem
19.
J Clin Transl Endocrinol ; 2(4): 144-149, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29159119

RESUMO

Objective: Abnormal uterine contraction patterns were recently demonstrated in uterine strips from pregnant women treated with Levothyroxine (T4). These abnormalities were correlated with an increased risk of C-section delivery and associated surgical complications. To date, no study has investigated whether uterine contractility is modified by hypothyroidism or T4 treatment. Herein, we analyze the physiological role of T4 on uterine contractions. Study design: Female non-pregnant Sprague-Dawley rats (N = 22) were used and divided into four groups: 1) control, 2) hypothyroidism, 3) hypothyroidism treated with low T4 doses (20 µg/kg/day) and 4) with high T4 doses (100 µg/kg/day). Hypothyroidism was induced by an iodine-deficient diet. Isometric tension measurements were performed in vitro on myometrium tissues in isolated organ baths. Contractile activity parameters were quantified (amplitude, duration, frequency and area under the curve) using pharmacological tools to assess their effect. Results: Screening of thyroid function confirmed a hypothyroid state for all rats under iodine-free diet to which T4 was subsequently administered to counterbalance hypothyroidism. Results demonstrate that hypothyroidism significantly decreased contractile duration (-17%) and increased contractile frequency (+26%), while high doses of T4 increased duration (+200%) and decreased frequency (-51%). These results thus mimic the pattern of abnormal contractions previously observed in uterine tissue from T4-treated hypothyroid pregnant women. Conclusion: Our data suggest that changes in myometrial reactivity are induced by T4 treatment. Thus, in conjunction with our previous observations on human myometrial strips, management of hypothyroidism should be improved to reduce the rate of C-sections in this group of patients.

20.
Patient Prefer Adherence ; 8: 1337-46, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25328385

RESUMO

OBJECTIVE: To measure the willingness to pay (WTP) of women aged 18-45 years to receive drug treatment for ovulation induction (ie, the social value of normal cycles of ovulation for a woman of childbearing age) in order to feed the debate about the funding of fertility cares. SETTING: An anonymous questionnaire was used over the general population of Quebec. PARTICIPANTS: A total of 136 subjects were recruited in three medical clinics, and 191 subjects through an online questionnaire. METHOD: THE QUESTIONNAIRE CONSISTED OF THREE PARTS: introduction to the problematic, socioeconomic data collection to determine factors influencing the formation of WTP, and a WTP question using the simple bid price dichotomous choice elicitation technique. The econometric estimation method is based on the "random utility theory." Each subject responding to our questionnaire could express her uncertainty about the answer to our WTP question by choosing the answer "I do not know." OUTCOME MEASURE: The WTP in Canadian dollars of women aged 18-45 years to receive drug treatment for ovulation induction. RESULTS: Results are positive and indicate an average WTP exceeding 4,800 CAD, which is much more than the drug treatment cost. There is no evidence of sample frame bias or avidity bias across the two survey modes that cannot be controlled in econometric estimates. CONCLUSION: Medical treatment for ovulation induction is highly socially desirable in Quebec.

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