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1.
Cochrane Database Syst Rev ; 12: CD006105, 2020 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-33347618

RESUMO

BACKGROUND: The use of insulin-sensitising agents, such as metformin, in women with polycystic ovary syndrome (PCOS) who are undergoing ovulation induction or in vitro fertilisation (IVF) cycles has been widely studied. Metformin reduces hyperinsulinaemia and suppresses the excessive ovarian production of androgens. It is suggested that as a consequence metformin could improve assisted reproductive techniques (ART) outcomes, such as ovarian hyperstimulation syndrome (OHSS), pregnancy, and live birth rates. OBJECTIVES: To determine the effectiveness and safety of metformin as a co-treatment during IVF or intracytoplasmic sperm injection (ICSI) in achieving pregnancy or live birth in women with PCOS. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL via the Cochrane Register of Studies Online (CRSO), MEDLINE, Embase, PsycINFO, LILACS, the trial registries for ongoing trials, and reference lists of articles (from inception to 13 February 2020). SELECTION CRITERIA: Types of studies: randomised controlled trials (RCTs) comparing metformin treatment with placebo or no treatment in women with PCOS who underwent IVF or ICSI treatment. TYPES OF PARTICIPANTS: women of reproductive age with anovulation due to PCOS with or without co-existing infertility factors. Types of interventions: metformin administered before and during IVF or ICSI treatment. PRIMARY OUTCOME MEASURES: live birth rate, incidence of ovarian hyperstimulation syndrome. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the studies, extracted the data according to the protocol, and assessed study quality. We assessed the overall quality of the evidence using the GRADE approach. MAIN RESULTS: This updated review includes 13 RCTs involving a total of 1132 women with PCOS undergoing IVF/ICSI treatments. We stratified the analysis by type of ovarian stimulation protocol used (long gonadotrophin-releasing hormone agonist (GnRH-agonist) or short gonadotrophin-releasing hormone antagonist (GnRH-antagonist)) to determine whether the type of stimulation used influenced the outcomes. We did not perform meta-analysis on the overall (both ovarian stimulation protocols combined) data for the outcomes of live birth and clinical pregnancy rates per woman because of substantial heterogeneity. In the long protocol GnRH-agonist subgroup, the pooled evidence showed that we are uncertain of the effect of metformin on live birth rate per woman when compared with placebo/no treatment (risk ratio (RR) 1.30, 95% confidence interval (CI) 0.94 to 1.79; 6 RCTs; 651 women; I2 = 47%; low-quality evidence). This suggests that if the chance for live birth following placebo/no treatment is 28%, the chance following metformin would be between 27% and 51%. Only one study used short protocol GnRH-antagonist and reported live birth rate. Metformin may reduce live birth rate compared with placebo/no treatment (RR 0.48, 95% CI 0.29 to 0.79; 1 RCT; 153 women; low-quality evidence). This suggests that if the chance for live birth following placebo/no treatment is 43%, the chance following metformin would be between 13% and 34% (short GnRH-antagonist protocol). We found that metformin may reduce the incidence of OHSS (RR 0.46, 95% CI 0.29 to 0.72; 11 RCTs; 1091 women; I2 = 38%; low-quality evidence). This suggests that for a woman with a 20% risk of OHSS without metformin, the corresponding risk using metformin would be between 6% and 14%. Using long protocol GnRH-agonist stimulation, metformin may increase clinical pregnancy rate per woman compared with placebo/no treatment (RR 1.32, 95% CI 1.08 to 1.63; 10 RCTs; 915 women; I2 = 13%; low-quality evidence). Using short protocol GnRH-antagonist, we are uncertain of the effect of metformin on clinical pregnancy rate per woman compared with placebo/no treatment (RR 1.38, 95% CI 0.21 to 9.14; 2 RCTs; 177 women; I2 = 87%; very low-quality evidence). We are uncertain of the effect of metformin on miscarriage rate per woman when compared with placebo/no treatment (RR 0.86, 95% CI 0.56 to 1.32; 8 RCTs; 821 women; I2 = 0%; low-quality evidence). Metformin may result in an increase in side effects compared with placebo/no treatment (RR 3.35, 95% CI 2.34 to 4.79; 8 RCTs; 748 women; I2 = 0%; low-quality evidence). The overall quality of evidence ranged from very low to low. The main limitations were inconsistency, risk of bias, and imprecision. AUTHORS' CONCLUSIONS: This updated review on metformin versus placebo/no treatment before or during IVF/ICSI treatment in women with PCOS found no conclusive evidence that metformin improves live birth rates. In a long GnRH-agonist protocol, we are uncertain whether metformin improves live birth rates, but metformin may increase the clinical pregnancy rate. In a short GnRH-antagonist protocol, metformin may reduce live birth rates, although we are uncertain about the effect of metformin on clinical pregnancy rate. Metformin may reduce the incidence of OHSS but may result in a higher incidence of side effects. We are uncertain of the effect of metformin on miscarriage rate per woman.


Assuntos
Fertilização In Vitro , Hiperandrogenismo/tratamento farmacológico , Hiperinsulinismo/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Nascimento Vivo/epidemiologia , Metformina/uso terapêutico , Síndrome do Ovário Policístico/complicações , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/prevenção & controle , Viés , Intervalos de Confiança , Feminino , Humanos , Hipoglicemiantes/efeitos adversos , Metformina/efeitos adversos , Síndrome de Hiperestimulação Ovariana/epidemiologia , Síndrome de Hiperestimulação Ovariana/prevenção & controle , Indução da Ovulação/métodos , Placebos/uso terapêutico , Gravidez , Taxa de Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Injeções de Esperma Intracitoplásmicas
2.
Rev Med Suisse ; 16(712): 2026-2030, 2020 Oct 28.
Artigo em Francês | MEDLINE | ID: mdl-33112514

RESUMO

Vaginal cerclage can be used to treat cervical incompetence, thus reducing the risk of an unfavourable outcome. However, in some cases, it can be ineffective. One of the challenges for the gynaecologist-obstetrician is how to deal with a subsequent pregnancy after a failure of vaginal cerclage. The recently published MAVRIC study shows that performing abdominal cerclage prior or at the beginning of pregnancy reduces the rate of late miscarriage and premature delivery compared to vaginal cerclage. This implies a birth by caesarean section, and therefore a second surgery for the woman. However, it remains to determine the best surgical technique for abdominal cerclage. In the MAVIRC study, cerclage was done by laparotomy. It shall be elucidated whether this technique is superior to laparoscopy.


Assuntos
Abdome/cirurgia , Cerclagem Cervical , Incompetência do Colo do Útero/cirurgia , Vagina/cirurgia , Aborto Espontâneo/prevenção & controle , Cesárea , Feminino , Humanos , Laparoscopia , Laparotomia , Gravidez , Nascimento Prematuro/prevenção & controle
3.
Artigo em Inglês | MEDLINE | ID: mdl-32978069

RESUMO

Progesterone is essential for the maintenance of pregnancy, and progesterone deficiency is associated with miscarriage. The subject of whether progesterone supplementation in early pregnancy can prevent miscarriage has been a long-standing research question and has been investigated and debated in the medical literature for over 70 years. During this time, several different progestogens have been synthesised and tested for the prevention of miscarriage. In this chapter, we describe the prior evidence alongside the latest research using micronized natural progesterone as well as synthetic progestogens, which were used to treat both recurrent and threatened miscarriage. The totality of evidence indicates that women with a past history of miscarriage who present with bleeding in early pregnancy may benefit from the use of vaginal micronized progesterone. The clinical implications of the findings are discussed.


Assuntos
Aborto Habitual , Aborto Espontâneo , Ameaça de Aborto , Aborto Habitual/etiologia , Aborto Habitual/prevenção & controle , Aborto Espontâneo/prevenção & controle , Ameaça de Aborto/tratamento farmacológico , Ameaça de Aborto/prevenção & controle , Feminino , Humanos , Gravidez , Progesterona , Progestinas/uso terapêutico , Vagina
4.
Obstet Gynecol ; 136(4): 844-846, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925632

RESUMO

: With the current issue, the journal continues to bring new insights from Cochrane Systematic Reviews to the readers of Obstetrics & Gynecology. This month, we focus on potential interventions to improve pregnancy outcomes for women with recurrent pregnancy loss and antiphospholipid antibodies, the utility of pelvic floor muscle training in the perinatal period to prevent incontinence, and the use of adhesion barriers in gynecologic surgery. The summaries are published below, and the complete references with hyperlinks are listed in Box 1. BOX 1. ABSTRACTS DISCUSSED IN THIS SUMMARY.


Assuntos
Aborto Espontâneo , Incontinência Fecal , Procedimentos Cirúrgicos em Ginecologia , Assistência Perinatal , Aderências Teciduais , Incontinência Urinária , Aborto Espontâneo/etiologia , Aborto Espontâneo/prevenção & controle , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Incontinência Fecal/etiologia , Incontinência Fecal/prevenção & controle , Feminino , Fibrinolíticos/farmacologia , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/normas , Humanos , Debilidade Muscular/etiologia , Debilidade Muscular/reabilitação , Diafragma da Pelve/fisiopatologia , Assistência Perinatal/métodos , Assistência Perinatal/normas , Gravidez , Resultado da Gravidez , Melhoria de Qualidade , Revisões Sistemáticas como Assunto , Aderências Teciduais/etiologia , Aderências Teciduais/prevenção & controle , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle
5.
Arch Gynecol Obstet ; 302(1): 1-4, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32409923

RESUMO

BACKGROUND: Effective prevention of preterm birth as cause of serious risks for the infant as well as the mother pre- and postpartum is one of the still unsolved problems in modern medicine. METHOD: The government of the State of Thuringia in cooperation with the professional organization of obstetricians and gynecologists decided in 2016 to reestablish and promote a self-care screening program based on intravaginal (i.vag.) pH measurement to reduce the incidence of preterm birth by early diagnosis and therapy of genital infection. RESULTS: Starting at zero in 2016, > 80% of pregnant women in the state had their vaginal pH monitored at the end of 2018 (n = 17.180). This was associated with a reduced incidence of early preterm birth measured by gestational week ≤ 32 (1.46 vs. 1.26%). CONCLUSION: The fourth millennium goal missed worldwide in 2015 as well as the newly declared third objective of the UN could come closer using the simple and cheap i.vag. pH-self-screening regime in prevention of preterm birth, an approach partly turning the woman from being object of medical care to being the subject in self-control of her pregnancy. This is also a well perceived change in paradigm from the perspective of females as well as physicians.


Assuntos
Programas de Rastreamento/métodos , Nascimento Prematuro/epidemiologia , Vagina/química , Aborto Espontâneo/prevenção & controle , Administração Intravaginal , Feminino , Idade Gestacional , Humanos , Concentração de Íons de Hidrogênio , Incidência , Recém-Nascido , Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Vagina/metabolismo , Vagina/microbiologia
6.
Am J Trop Med Hyg ; 103(1): 160-163, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32458783

RESUMO

Yellow fever vaccine, a live attenuated vaccine, is primarily administered to pregnant women during outbreaks. A qualitative study was conducted in pregnant women on the perception of yellow fever mass vaccination. In total, interviews with 20 women-13 semi-structured interviews and one focus group discussion with seven participants-were analyzed. This study showed that conflicting information about vaccine safety led to concern about miscarriage. Furthermore, it was believed that vaccination during gestation would concurrently immunize the fetus by transplacental antibody transfer. Consultation of health workers at the vaccination site led to diverse recommendations. When vaccinating pregnant women, clear health communication is crucial. Vaccine recommendations should be obeyed, and health workers should be trained to address emerging vaccine concerns. Pregnant women should be informed that a booster dose is recommended to achieve lifelong immunity. After pregnancy, a booster should be offered to women in endemic areas.


Assuntos
Aborto Espontâneo/prevenção & controle , Surtos de Doenças , Conhecimentos, Atitudes e Prática em Saúde , Percepção Social , Vacina contra Febre Amarela/administração & dosagem , Febre Amarela/prevenção & controle , Vírus da Febre Amarela/imunologia , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/imunologia , Aborto Espontâneo/psicologia , Adulto , Feminino , Grupos Focais , Humanos , Imunização Secundária/psicologia , Vacinação em Massa/psicologia , Segurança do Paciente , Gravidez , Inquéritos e Questionários , Uganda/epidemiologia , Vacinas Atenuadas , Febre Amarela/epidemiologia , Febre Amarela/imunologia , Febre Amarela/psicologia
7.
BJOG ; 127(9): 1055-1063, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32324957

RESUMO

BACKGROUND: Threatened miscarriage is a common complication of pregnancy. Results of randomised controlled trials on the efficacy of progestogen in the treatment of threatened miscarriage remain inconsistent. OBJECTIVE: To investigate whether the use of progestogen is associated with improved event rate of live birth and other benefits in women with threatened miscarriage. SEARCH STRATEGY: Ovid MEDLINE, Ovid Embase and Cochrane CENTRAL Register of Controlled Trials from their inception until 8 July 2019. SELECTION CRITERIA: Randomised controlled trials comparing progestogen with a placebo or no treatment for pregnancy outcomes in women with threatened miscarriage. DATA COLLECTION AND ANALYSIS: Two authors independently conducted data extraction and assessed study quality. We calculated risk ratios (RR) and 95% confidence intervals using the Mantel-Haenszel approach for dichotomous outcomes. MAIN RESULTS: Ten trials with a total of 5056 participants were eligible for analysis. The use of progesterone increased the incidence of live birth (RR 1.07, 95% CI 1.00-1.15; P = 0.04; I2  = 18%), with benefit only seen with the use of oral progestogen (RR 1.17, 95% CI 1.04-1.31; P = 0.008; I2  = 0%) and not with vaginal progesterone (RR 1.04, 95% CI 1.00-1.08; P = 0.07; I2  = 0%). Similarly, progestogen reduced the risk of miscarriage (RR 0.73, 95% CI 0.59-0.92), with benefit only seen with oral progestogen and not with vaginal progesterone. CONCLUSION: Progestogens may have benefits on live birth rate and miscarriage rate for women with threatened miscarriage. These benefits appear to be confined to the use of oral progestogen, and no statistically significant improvements were seen with vaginal progesterone. TWEETABLE ABSTRACT: A meta-analysis of 10 trials found that progestogens increased live birth rates and reduced miscarriage rates for women with threatened miscarriage.


Assuntos
Ameaça de Aborto/tratamento farmacológico , Nascimento Vivo , Progesterona/uso terapêutico , Progestinas/uso terapêutico , Aborto Espontâneo/prevenção & controle , Administração Intravaginal , Administração Oral , Feminino , Humanos , Gravidez , Progesterona/administração & dosagem , Progestinas/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Int J Gynaecol Obstet ; 149(3): 370-376, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32246762

RESUMO

OBJECTIVE: To evaluate the effect of adjunctive use of vaginal progesterone after McDonald cerclage on the rate of second-trimester abortion in singleton pregnancy. METHODS: A randomized controlled trial at Woman's Health Hospital, Assiut University, Egypt, between April 2017 and March 2019 enrolled women eligible for McDonald cerclage. After cerclage, participants were randomly assigned to receive progesterone (400 mg pessary) once daily until 37 weeks or no progesterone. The primary outcome was rate of abortion before 28 weeks. Secondary outcomes included gestational age at delivery, preterm delivery, mean birthweight, Apgar score, and admission to the neonatal intensive care unit (NICU). RESULTS: The rate of spontaneous abortion was higher in the no-progesterone group (P=0.016). Mean gestational age and mean birthweight was higher in the progesterone group (P<0.001 and P=0.002, respectively). The frequency of preterm neonates, neonates with Apgar score less than 7, and admission to NICU was higher in the progesterone group than in the no-progesterone group (P=0.005, P=0.008, and P=0.044, respectively). CONCLUSION: Adjunctive use of vaginal progesterone after McDonald cerclage was found to decrease the frequency of second-trimester abortion and to improve perinatal outcomes in singleton pregnancy. Clinicaltrials.gov: NCT02846909.


Assuntos
Aborto Espontâneo/prevenção & controle , Cerclagem Cervical/métodos , Nascimento Prematuro/prevenção & controle , Progesterona/administração & dosagem , Progestinas/administração & dosagem , Aborto Espontâneo/epidemiologia , Administração Intravaginal , Adulto , Egito , Feminino , Humanos , Recém-Nascido , Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro/epidemiologia , Adulto Jovem
9.
PLoS One ; 15(4): e0231642, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32310980

RESUMO

PROBLEM: To investigate the relation of inflammation-related parameters and pregnancy outcome in women with the early threatened abortion. METHOD OF STUDY: 630 women with early threatened abortion were divided into two groups based on the pregnancy outcome. All of them had the blood routine examination before treating. The differences between two groups were analyzed by the Chi-squared test, Student T test, Mann-Whitney U test, Binary Logistic Regression, Marginal Structural Model and Threshold effect analysis. RESULTS: We found that there is no significant difference in the pregnancy outcome for NLR (OR:0.92, CI95%:0.72, 1.17) and PLR (OR:1.00, CI%:0.99, 1.01). However, a difference had a statistical significance in the pregnancy outcome when LMR less than 2.19 (OR:0.39, CI95%:0.19,0.82). CONCLUSIONS: This study suggested that higher LMR was related to the lower risk of miscarriage in the women with early threatened abortion in a way.


Assuntos
Aborto Espontâneo/sangue , Aborto Espontâneo/prevenção & controle , Adulto , Feminino , Humanos , Contagem de Linfócitos , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
10.
BJOG ; 127(6): 757-767, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32003141

RESUMO

OBJECTIVES: To assess the cost-effectiveness of progesterone compared with placebo in preventing pregnancy loss in women with early pregnancy vaginal bleeding. DESIGN: Economic evaluation alongside a large multi-centre randomised placebo-controlled trial. SETTING: Forty-eight UK NHS early pregnancy units. POPULATION: Four thousand one hundred and fifty-three women aged 16-39 years with bleeding in early pregnancy and ultrasound evidence of an intrauterine sac. METHODS: An incremental cost-effectiveness analysis was performed from National Health Service (NHS) and NHS and Personal Social Services perspectives. Subgroup analyses were carried out on women with one or more and three or more previous miscarriages. MAIN OUTCOME MEASURES: Cost per additional live birth at ≥34 weeks of gestation. RESULTS: Progesterone intervention led to an effect difference of 0.022 (95% CI -0.004 to 0.050) in the trial. The mean cost per woman in the progesterone group was £76 (95% CI -£559 to £711) more than the mean cost in the placebo group. The incremental cost-effectiveness ratio for progesterone compared with placebo was £3305 per additional live birth. For women with at least one previous miscarriage, progesterone was more effective than placebo with an effect difference of 0.055 (95% CI 0.014-0.096) and this was associated with a cost saving of £322 (95% CI -£1318 to £673). CONCLUSIONS: The results suggest that progesterone is associated with a small positive impact and a small additional cost. Both subgroup analyses were more favourable, especially for women who had one or more previous miscarriages. Given available evidence, progesterone is likely to be a cost-effective intervention, particularly for women with previous miscarriage(s). TWEETABLE ABSTRACT: Progesterone treatment is likely to be cost-effective in women with early pregnancy bleeding and a history of miscarriage.


Assuntos
Aborto Espontâneo/economia , Aborto Espontâneo/prevenção & controle , Progesterona/economia , Progestinas/economia , Hemorragia Uterina/tratamento farmacológico , Aborto Espontâneo/etiologia , Adolescente , Adulto , Análise Custo-Benefício , Método Duplo-Cego , Feminino , Humanos , Nascimento Vivo/economia , Gravidez , Progesterona/uso terapêutico , Progestinas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Medicina Estatal , Resultado do Tratamento , Reino Unido , Hemorragia Uterina/complicações , Hemorragia Uterina/economia , Adulto Jovem
11.
BJOG ; 127(6): 710-718, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31930663

RESUMO

OBJECTIVE: What are the cost per live birth and the incremental cost of preventing a miscarriage with preimplantation genetic testing for aneuploidy (PGT-A) by polar body biopsy and array-based comprehensive genome hybridisation (aCGH) versus regular IVF/ICSI without PGT-A for infertility treatment in women 36-40 years of age? DESIGN: Decision tree model. POPULATION: A randomised clinical trial on PGT-A (ESTEEM study). METHODS: Two treatment strategies were compared: one cycle of IVF/ICSI with or without PGT-A. Costs and effects were analysed with this model for four different cost scenarios: high-, higher medium, lower medium and low-cost. Base case, sensitivity, threshold, and probabilistic sensitivity analyses were used to examine the cost-effectiveness implications of PGT-A. RESULTS: PGT-A increased the cost per live birth by approximately 15% in the high-cost scenario to approximately 285% in the low-cost scenario. Threshold analysis revealed that PGT-A would need to be associated with an absolute increase in pregnancy rate by 6% to >39% or, alternatively, would need to be US$2,969 (high-cost scenario) to US$4,888 (low-cost scenario) cheaper. The incremental cost to prevent one miscarriage by PGT-A using the base case assumptions was calculated to be US$34,427 (high-cost scenario) to US$51,146 (low-cost scenario). A probabilistic sensitivity analysis showed cost-effectiveness for PGT-A from 1.9% (high-cost scenario) to 0.0% (low-cost scenario) of calculated samples. CONCLUSIONS: While avoiding unnecessary embryo transfers and miscarriages are important goals, patients and doctors need to be aware of the high-cost implications of applying PGT-A using aCGH on polar bodies. TWEETABLE ABSTRACT: PGT-A by polar body biopsy and comprehensive genome hybridisation increases cost per live birth and requires high financial spending per miscarriage averted.


Assuntos
Aborto Espontâneo/genética , Aneuploidia , Testes Genéticos/economia , Idade Materna , Diagnóstico Pré-Implantação/economia , Aborto Espontâneo/prevenção & controle , Adulto , Análise Custo-Benefício , Feminino , Humanos , Corpos Polares/transplante , Gravidez
12.
Am J Obstet Gynecol ; 222(3): 261.e1-261.e9, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31585096

RESUMO

BACKGROUND: Vaginal cerclage (a suture around the cervix) commonly is placed in women with recurrent pregnancy loss. These women may experience late miscarriage or extreme preterm delivery, despite being treated with cerclage. Transabdominal cerclage has been advocated after failed cerclage, although its efficacy is unproved by randomized controlled trial. OBJECTIVE: The objective of this study was to compare transabdominal cerclage or high vaginal cerclage with low vaginal cerclage in women with a history of failed cerclage. Our primary outcome was delivery at <32 completed weeks of pregnancy. STUDY DESIGN: This was a multicenter randomized controlled trial. Women were assigned randomly (1:1:1) to receive transabdominal cerclage, high vaginal cerclage, or low vaginal cerclage either before conception or at <14 weeks of gestation. RESULTS: The data for 111 of 139 women who were recruited and who conceived were analyzed: 39 had transabdominal cerclage; 39 had high vaginal cerclage, and 33 had low vaginal cerclage. Rates of preterm birth at <32 weeks of gestation were significantly lower in women who received transabdominal cerclage compared with low vaginal cerclage (8% [3/39] vs 33% [11/33]; relative risk, 0.23; 95% confidence interval, 0.07-0.76; P=.0157). The number needed to treat to prevent 1 preterm birth was 3.9 (95% confidence interval, 2.32-12.1). There was no difference in preterm birth rates between high and low vaginal cerclage (38% [15/39] vs 33% [11/33]; relative risk, 1.15; 95% confidence interval, 0.62-2.16; P=.81). No neonatal deaths occurred. In an exploratory analysis, women with transabdominal cerclage had fewer fetal losses compared with low vaginal cerclage (3% [1/39] vs 21% [7/33]; relative risk, 0.12; 95% confidence interval, 0.016-0.93; P=.02). The number needed to treat to prevent 1 fetal loss was 5.3 (95% confidence interval, 2.9-26). CONCLUSION: Transabdominal cerclage is the treatment of choice for women with failed vaginal cerclage. It is superior to low vaginal cerclage in the reduction of risk of early preterm birth and fetal loss in women with previous failed vaginal cerclage. High vaginal cerclage does not confer this benefit. The numbers needed to treat are sufficiently low to justify transabdominal surgery and cesarean delivery required in this select cohort.


Assuntos
Cerclagem Cervical/métodos , Nascimento Prematuro/prevenção & controle , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/prevenção & controle , Adulto , Feminino , Idade Gestacional , Humanos , Números Necessários para Tratar , Cuidado Pré-Concepcional , Gravidez , Nascimento Prematuro/epidemiologia
13.
J Womens Health (Larchmt) ; 29(3): 345-352, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31750752

RESUMO

Background: Very little is known about early pregnancy loss in women with disabilities. To address this gap, we analyzed nationally representative data on miscarriage and receipt of care focused on miscarriage prevention among women with and without disabilities. Materials and Methods: We used 2011-2015 National Survey of Family Growth data on women with at least one completed pregnancy within the past 5 years. Bivariate and multivariate analyses assessed the association of six disability categories (any, hearing, vision, cognitive, physical, independent living) with miscarriage occurrence and receipt of services intended to prevent miscarriage. Results: Our analytic sample included 3,843 women with 5,776 completed pregnancies within the past 5 years. Overall, 31.63% of women with disabilities and 21.83% of women without disabilities had had a miscarriage within the past 5 years. Compared to women without disabilities, women with any, cognitive, physical, and independent living disability had higher adjusted odds of experiencing miscarriage (any disability aOR = 1.65 [95% CI: 1.21-2.25]). These women also had higher odds of receiving services to prevent miscarriage compared with women without disabilities (any disability aOR = 1.71 [95% CI: 1.20-2.45]). Among women who received services, higher proportions of women with any, vision, physical, or independent living disability received recommendations for bed rest (e.g., 65.007% of women with independent living disability vs. 33.98% of women without disability, p = 0.018). Conclusions: In a representative sample of U.S. women, we found significant differences in the odds of miscarriage and in receipt of care to prevent miscarriage between women with and without disabilities. Further research is needed to understand why women with disabilities are more likely to experience a miscarriage. Such research is important for informing care recommendations.


Assuntos
Aborto Espontâneo/epidemiologia , Pessoas com Deficiência/estatística & dados numéricos , Aborto Espontâneo/prevenção & controle , Adolescente , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Gravidez , Estados Unidos/epidemiologia , Adulto Jovem
14.
J Ethnopharmacol ; 247: 112224, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-31509779

RESUMO

ETHNO-PHARMACOLOGICAL RELEVANCE: Corchorus olitorius is reportedly used in ethno-medicine to arrest threatened miscarriage and other conditions associated with excessive uterine contractions. The plant is also used as a purgative, demulscent and an anti-inflammatory agent. AIM OF THE STUDY: Against the background of ethno-medicinal use, this current work was designed to evaluate the gastrointestinal and uterine smooth muscles relaxant and anti-inflammatory effects of Corchorus olitorius leaf extract (COLE). MATERIALS AND METHODS: Pieces of uterine and gastrointestinal tissues were suspended separately in organ baths containing ideal physiological salt solutions bubbled with air and were tested for responses to standard drugs and COLE, then repeated in the presence of antagonists. Anti-inflammatory study was carried out via the egg albumin-induced paw edema model in rats. RESULTS: The application of COLE to pieces of uterine tissue significantly decreased the amplitudes of contractions in a dose dependent manner such that the highest dose applied (666.67 µg/ml) achieved a 100% inhibitory effect. Oxytocin induced contractions were also significantly inhibited by both salbutamol and COLE. On the isolated rabbit jejunum, the effect of COLE was also inhibitory and like atropine, significantly inhibited acetylcholine induced contractions. In the in vivo study, the extract inhibited charcoal meal movement in test rats when compared with control. Anti-inflammatory effect of COLE was significant and compared favourably with that of aspirin following in vivo trials. CONCLUSIONS: COLE therefore, may be a good tocolytic, anti-diarrheal and anti-inflammatory agent and offers hope of new drug discovery for such uses.


Assuntos
Anti-Inflamatórios/farmacologia , Antidiarreicos/farmacologia , Corchorus/química , Extratos Vegetais/farmacologia , Tocolíticos/farmacologia , Aborto Espontâneo/prevenção & controle , Animais , Anti-Inflamatórios/isolamento & purificação , Antidiarreicos/isolamento & purificação , Aspirina/farmacologia , Diarreia/tratamento farmacológico , Modelos Animais de Doenças , Edema/tratamento farmacológico , Edema/imunologia , Etnofarmacologia , Feminino , Motilidade Gastrointestinal/efeitos dos fármacos , Jejuno/efeitos dos fármacos , Jejuno/fisiologia , Contração Muscular/efeitos dos fármacos , Miométrio/efeitos dos fármacos , Nigéria , Extratos Vegetais/isolamento & purificação , Folhas de Planta/química , Gravidez , Coelhos , Ratos , Tocolíticos/isolamento & purificação
15.
PLoS One ; 14(12): e0215195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800574

RESUMO

Although maternal survival has improved in the last decades, evidence on illnesses and the use of health services during pregnancy remains scarce. Therefore, we aimed to assess the incidence and risk factors for illnesses among pregnant women and measure the use of health services. A prospective cohort study was conducted in three kebeles in rural southern Ethiopia among 794 pregnant women from May 2017 to July 2018. Each woman was followed every two weeks at home. Poisson and survival regression models were used for analysis. The incidence rate of episodes of illnesses was 93 per 100 pregnant-woman-weeks (95%CI: 90.6, 94.2), with an average of eight episodes of illnesses per woman. Anaemia accounted for 22% (177 of 794 women), and hypertension 3% (21 women of 794 women). However, utilization of health services for any illness episodes was only 8% (95%CI: 7.6%, 8.9%). The main reasons for not using health services were that the women thought the illness would heal by itself, women thought the illness was not serious, women could not afford to visit the health institutions, or women lacked confidence in the health institutions. The risk factors for illnesses are having many previous pregnancies in life time (ARR = 1.42; 95%CI = 1.02, 1.96), having history of stillbirth (ARR = 1.30; 95%CI = 1.03, 1.64), having history of abortion (AHR = 1.06; 95%CI = 1.02, 1.11), and walking more than 60 minutes to access the nearest hospital (AHR = 1.08; 95%CI = 1.03, 1.14). The risk factors for low use of health services are also having history of abortion (AHR = 2.50; 95%CI = 1.00, 6.01) and walking more than 60 minutes to access the nearest hospital (AHR = 1.91; 95%CI = 1.00, 3.63). Rural Ethiopian pregnant women experience a high burden of illness during pregnancy. Unfortunately, very few of these women utilize health services.


Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Complicações na Gravidez/prevenção & controle , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/prevenção & controle , Adolescente , Adulto , Anemia/epidemiologia , Anemia/prevenção & controle , Etiópia/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Prospectivos , População Rural , Adulto Jovem
16.
J Fam Pract ; 68(10): 668;569;572, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31860701

RESUMO

Yes. While medical management of early pregnancy loss with misoprostol frequently results in treatment failure, pretreating with mifepristone can increase efficacy.


Assuntos
Abortivos não Esteroides/uso terapêutico , Abortivos Esteroides/uso terapêutico , Aborto Espontâneo/prevenção & controle , Quimioterapia Combinada , Medicina de Família e Comunidade/normas , Mifepristona/uso terapêutico , Misoprostol/uso terapêutico , Administração Oral , Adulto , Feminino , Humanos , Guias de Prática Clínica como Assunto , Gravidez
17.
Sci Rep ; 9(1): 17612, 2019 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-31772225

RESUMO

Prostaglandins (PGs) have critical signaling functions in a variety of processes including the establishment and maintenance of pregnancy, and the initiation of labor. Most PGs are non-enzymatically degraded, however, the two PGs most prominently implicated in the termination of pregnancy, including the initiation of labor, prostaglandin E2 (PGE2) and prostaglandin F2α (PGF2α), are enzymatically degraded by 15-hydroxyprostaglandin dehydrogenase (15-HPGD). The role of PG metabolism by 15-HPGD in the maintenance of pregnancy remains largely unknown, as direct functional studies are lacking. To test the hypothesis that 15-PGDH-mediated PG metabolism is essential for pregnancy maintenance and normal labor timing, we generated and analyzed pregnancy in 15-HPGD knockout mice (Hpgd-/-). We report here that pregnancies resulting from matings between 15-HPGD KO mice (Hpgd-/- X Hpgd-/-KO mating) are terminated at mid gestation due to a requirement for embryo derived 15-HPGD. Aside from altered implantation site spacing, pregnancies from KO matings look grossly and histologically normal at days post coitum (dpc) 6.5 and 7.5 of pregnancy. However, virtually all of these pregnancies are resorbed by dpc 8.5. This resorption is preceded by elevation of PGF2∝ but is not preceded by a decrease in circulating progesterone, suggesting that pregnancy loss is a local inflammatory phenomenon rather than a centrally mediated phenomena. This pregnancy loss can be temporarily deferred by indomethacin treatment, but treated pregnancies are not maintained to term and indomethacin treatment increases maternal mortality. We conclude that PG metabolism to inactive products by embryo derived 15-HPGD is essential for pregnancy maintenance in mice, and may serve a similar function during human pregnancy.


Assuntos
Aborto Espontâneo/genética , Hidroxiprostaglandina Desidrogenases/fisiologia , Manutenção da Gravidez/fisiologia , Aborto Espontâneo/enzimologia , Aborto Espontâneo/prevenção & controle , Animais , Ciclo-Oxigenase 1/biossíntese , Ciclo-Oxigenase 1/genética , Ciclo-Oxigenase 2/biossíntese , Ciclo-Oxigenase 2/genética , Dinoprosta/metabolismo , Dinoprostona/metabolismo , Implantação do Embrião , Feminino , Feto/enzimologia , Regulação da Expressão Gênica no Desenvolvimento , Regulação Enzimológica da Expressão Gênica , Genótipo , Idade Gestacional , Hidroxiprostaglandina Desidrogenases/biossíntese , Hidroxiprostaglandina Desidrogenases/deficiência , Hidroxiprostaglandina Desidrogenases/genética , Indometacina/farmacologia , Indometacina/uso terapêutico , Indometacina/toxicidade , Morte Materna/etiologia , Proteínas de Membrana/biossíntese , Proteínas de Membrana/genética , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Gravidez , Manutenção da Gravidez/efeitos dos fármacos , Progesterona/metabolismo , RNA Mensageiro/biossíntese , RNA Mensageiro/genética
18.
Cochrane Database Syst Rev ; 2019(11)2019 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-31745982

RESUMO

BACKGROUND: Progesterone, a female sex hormone, is known to induce secretory changes in the lining of the uterus essential for successful implantation of a fertilized egg. It has been suggested that a causative factor in many cases of miscarriage may be inadequate secretion of progesterone. Therefore, clinicians use progestogens (drugs that interact with the progesterone receptors), beginning in the first trimester of pregnancy, in an attempt to prevent spontaneous miscarriage. This is an update of a review, last published in 2013. Since publication of the 2018 update of this review, we have been advised that the Ismail 2017 study is currently the subject of an investigation by the Journal of Maternal-Fetal & Neonatal Medicine. We have now moved this study from 'included studies' to 'Characteristics of studies awaiting classification' until the outcome of the investigation is known. OBJECTIVES: To assess the efficacy and safety of progestogens as a preventative therapy against recurrent miscarriage. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (6 July 2017) and reference lists from relevant articles, attempting to contact trial authors where necessary, and contacted experts in the field for unpublished works. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials comparing progestogens with placebo or no treatment given in an effort to prevent miscarriage. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two reviewers assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: Twelve trials (1,856 women) met the inclusion criteria. Eight of the included trials compared treatment with placebo and the remaining four trials compared progestogen administration with no treatment. The trials were a mix of multicenter and single-center trials, conducted in India, Jordan, UK and USA. In five trials women had had three or more consecutive miscarriages and in seven trials women had suffered two or more consecutive miscarriages. Routes, dosage and duration of progestogen treatment varied across the trials. The majority of trials were at low risk of bias for most domains. Ten trials (1684 women) contributed data to the analyses. The meta-analysis of all women, suggests that there may be a reduction in the number of miscarriages for women given progestogen supplementation compared to placebo/controls (average risk ratio (RR) 0.73, 95% confidence interval (CI) 0.54 to 1.00, 10 trials, 1684 women, moderate-quality evidence). A subgroup analysis comparing placebo-controlled versus non-placebo-controlled trials, trials of women with three or more prior miscarriages compared to women with two or more miscarriages and different routes of administration showed no clear differences between subgroups for miscarriage. None of the trials reported on any secondary maternal outcomes, including severity of morning sickness, thromboembolic events, depression, admission to a special care unit, or subsequent fertility. There was probably a slight benefit for women receiving progestogen seen in the outcome of live birth rate (RR 1.07, 95% CI 1.00 to 1.13, 6 trials, 1411 women, moderate-quality evidence). We are uncertain about the effect on the rate of preterm birth because the evidence is very low-quality (RR 1.13, 95% CI 0.53 to 2.41, 4 trials, 256 women, very low-quality evidence). No clear differences were seen for women receiving progestogen for the other secondary outcomes including neonatal death, fetal genital abnormalities or stillbirth. There may be little or no difference in the rate of low birthweight and trials did not report on the secondary child outcomes of teratogenic effects or admission to a special care unit. AUTHORS' CONCLUSIONS: For women with unexplained recurrent miscarriages, supplementation with progestogen therapy may reduce the rate of miscarriage in subsequent pregnancies.


Assuntos
Aborto Habitual/etiologia , Progesterona/metabolismo , Progestinas/uso terapêutico , Aborto Habitual/prevenção & controle , Aborto Espontâneo/prevenção & controle , Feminino , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Nascimento Prematuro/prevenção & controle , Progesterona/deficiência , Ensaios Clínicos Controlados Aleatórios como Assunto
19.
Nihon Koshu Eisei Zasshi ; 66(8): 397-406, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31548448

RESUMO

Objectives The final evaluation of the Japanese government's Healthy Parents and Children 21 project in 2014 noted an increase in low birth weight infants as an aspect that worsened. In order to reduce the number of low birth weight infants, miscarriages, and stillbirths in Kurume City, we conducted a survey aimed at researching new measures, including the search for new risk factors of birth complications.Methods The participants of this study were 2,986 pregnant women who submitted a pregnancy notification form in 2014. We excluded women who moved away from Kurume city or for whom birth weight records could not be obtained. Information from the pregnancy notification form was linked to birth weight records to examine the relationships between low birth weight infants, miscarriages, stillbirths, and pregnancy attributes. Variables that were shown to be related in an initial univariate analysis were analyzed further in a multiple logistic regression analysis with low birth weight, miscarriage, or stillbirth as the response variables.Results A multiple logistic regression analysis showed that being 35 years or older (odds ratio [OR]: 1.41), height less than 158 cm (OR: 1.45), non-pregnant body mass index (BMI) less than 18.5 (OR: 1.48), and detection of physical abnormalities by a physician during the pregnancy (OR: 2.20) were independent maternal factors that were significantly associated with low birth weight. Being aged 35 years or older (OR: 2.05) and smoking (OR: 3.42) were independent factors that were significantly associated with miscarriage and stillbirth. In addition, the cessation of alcohol use (OR: 0.51) significantly reduced this risk.Conclusion Because some biological factors such as "age" and "non-pregnant BMI" are invariable, we encourage pregnant women to get checkups to detect abnormalities early or to attend birthing classes that offer mental support, especially for pregnant women over 35 years. We want to tell young generations that pregnant women over 35 are at an increased risk of having low birth weight infants, miscarriages, and stillbirths, and those pregnant women with a lower BMI have an increased risk of low birth weight infants. "Maintenance of appropriate body weight," "smoking," "alcohol," socioeconomic issues such as "lack of systems for seeking advice and support staff," and "financial concerns" can be improved with health education from public health nurses and multidisciplinary support interventions. At the Children Care Support Center in Kurume city, professionals work together to provide continuous support to families during pregnancy, childbirth, and parenting. As a result, we may be able to contribute to reducing the number of low birth weight infants, miscarriages, and stillbirths.


Assuntos
Aborto Espontâneo/epidemiologia , Aborto Espontâneo/prevenção & controle , Recém-Nascido de Baixo Peso , Tocologia , Enfermeiras de Saúde Pública , Educação de Pacientes como Assunto/métodos , Natimorto/epidemiologia , Adolescente , Adulto , Fatores Etários , Índice de Massa Corporal , Feminino , Humanos , Japão/epidemiologia , Modelos Logísticos , Gravidez , Fatores de Risco , Apoio Social , Adulto Jovem
20.
Medicine (Baltimore) ; 98(34): e16883, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441864

RESUMO

Previous adverse pregnancy outcomes (APO) in women with hereditary thrombophilia have emerged as new indications for prophylactic use of low-molecular-weight heparin (LMWH) during pregnancy. Recent meta-analysis conducted to establish if LMWH may prevent recurrent placenta-mediated pregnancy complications point to important therapeutic effect but these findings are absolutely not universal. Furthermore, previous studies regarding LMWH prophylaxis for APO in women with inherited thrombophilia were performed in high risk patients with previous adverse health outcomes in medical, family and/or obstetric history. Therefore, the aim of this study was to investigate the effects of LMWH prophylaxis on pregnancy outcomes in women with inherited thrombophilias regardless of the presence of previous adverse health outcomes in medical, family, and obstetric history.Prospective analytical cohort study included all referred women with inherited thrombophilia between 11 and 15 weeks of gestation and followed-up to delivery. Patients were allocated in group with LWMH prophylaxis (study group) and control group without LWMH prophylaxis. The groups were compared for laboratory parameters and Doppler flows of umbilical artery at 28 to 30th, 32nd to 34th and 36th to 38th gestational weeks (gw), and for obstetric and perinatal outcomes.The study group included 221 women and control group included 137 women. Mean resistance index of the umbilical artery Ri in 28 to 30, 32 to 34, and 36 to 38 gw were significantly higher in the control group compared to study group (0.71 ±â€Š0.02 vs 0.69 ±â€Š0.02; 0.67 ±â€Š0.03 vs 0.64 ±â€Š0.02; and 0.67 ±â€Š0.05 vs 0.54 ±â€Š0.08, respectively). Intrauterine fetal death (IUFD) and miscarriages were statistically significantly more frequent in control group compared to the patients in study (P < .001). The frequencies of fetal growth restriction (FGR) and APO were significantly higher in the control group compared to the study group (P = .008 and P < .001, respectively). In a multivariate regression model with APO as a dependent variable, only Ri was detected as a significant protective factor for APO, after adjusting for age and LMWH prophylaxis (P < .001).We have demonstrated better perinatal outcomes in women with LMWH prophylaxis for APO compared to untreated women.


Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Complicações Hematológicas na Gravidez/tratamento farmacológico , Trombofilia/tratamento farmacológico , Aborto Espontâneo/prevenção & controle , Adulto , Estudos de Casos e Controles , Feminino , Morte Fetal/prevenção & controle , Retardo do Crescimento Fetal/prevenção & controle , Humanos , Recém-Nascido , Nascimento Vivo/epidemiologia , Gravidez , Estudos Prospectivos
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