Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 617
Filtrar
1.
Wiad Lek ; 73(2): 239-244, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32248152

RESUMO

OBJECTIVE: The aim: The purpose of the study is a comparative evaluating the effectiveness of using the different methods of treatment of miscarriage in multiple pregnancies taking into account the condition of the cervix. PATIENTS AND METHODS: Materials and methods: 86 pregnant women with diarrheal twins were monitored. On the basis of studying the premorbid background, somatic and reproductive history, features of the gestational period, leading antenatal risk factors for the development of complications in multiple pregnancies were identified. With the help of transvaginal cervicometry the prognostic ultrasound criteria of the condition of the cervix and its obstructive capacity in case of premature birth are investigated. RESULTS: Results: In the event of uncomplicated pregnancy multiple birth is characterized by a gradual shortening of the cervix in dynamics from 43.2 ± 3.9 mm to 38.2 ± 4.0 mm by 20 weeks, from 37.7 ± 4.1 mm to 30.2 ± 3.9 mm to 30 weeks, to 21.1 ± 3.1 mm to 37 weeks. In the period of 25-27 weeks, the appearance of a V-shaped opening of the uterine cervix in half of the women was observed, which remained until the end of gestation. Shortening of the cervix was the most significant in patients with the risk of abortion who received only tocolytic therapy. In the 2nd trimester revealed a V- or U-shaped opening of the cervical canal. In pregnant women at risk who had an obstetric pessary, a decrease in the length of the cervix was found, which was similar to the rate of its shortening in uncomplicated multiple pregnancies. The condition of the cervix in the presence of a pessary before delivery probably did not differ from the condition of the cervix with the normal course of multiple pregnancies. CONCLUSION: Conclusions: Pregnant women with uncomplicated multiple pregnancies revealed a decrease in the length of the cervix with an increase in gestation. At the end of pregnancy, the internal jaws acquired a predominantly Y-shape. In pregnant women with the risk of pregnancy termination who received tocolytic therapy, the cervix was the shortest. In late gestation, V- and U-shaped internal jaws were observed. Changes in the cervix after the placement of obstetric pessaries are similar to changes in uncomplicated pregnancy.


Assuntos
Gravidez Múltipla , Administração Intravaginal , Medida do Comprimento Cervical , Feminino , Humanos , Pessários , Gravidez , Nascimento Prematuro
2.
PLoS One ; 15(1): e0224874, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31995557

RESUMO

Antenatal vaginal progesterone (VP) reduces the risk of preterm birth (PTB) in women with shortened cervical length, and we hypothesize that it may also prevent PTB in women with HIV as their primary risk factor. We conducted a pilot feasibility study in Lusaka, Zambia to investigate uptake, adherence, and retention in preparation for a future efficacy trial. This was a double-masked, placebo-controlled, randomized trial of 200mg daily self-administered VP suppository or placebo. Pregnant women with HIV who were initiating or continuing antiretroviral therapy were eligible for participation. Potential participants underwent ultrasound to assess eligibility; we excluded those ≥24 gestational weeks, with non-viable, multiple gestation, or extrauterine pregnancies, with short cervix (<2.0cm), or with prior spontaneous PTB. Participants initiated study product between 20-24 weeks of gestation and continued to 37 weeks (or delivery, if sooner). The primary outcome was adherence (proportion achieving ≥80% study product use), assessed by dye stain assay of returned single-use vaginal applicators. Secondary outcomes with pre-defined feasibility targets were: uptake (≥50% eligible participants enrolled) and retention (≥90% ascertainment of delivery outcomes). We also evaluated preliminary efficacy by comparing the risk of spontaneous PTB <37 weeks between groups. From July 2017 to June 2018, 208 HIV-infected pregnant women were eligible for screening and 140 (uptake = 67%) were randomly allocated to VP (n = 70) or placebo (n = 70). Mean adherence was 94% (SD±9.4); 91% (n = 125/137) achieved overall adherence ≥80%. Delivery outcomes were ascertained from 134 (96%) participants. Spontaneous PTB occurred in 10 participants (15%) receiving placebo and 8 (12%) receiving progesterone (RR 0.82; 95%CI:0.34-1.97). Spontaneous PTB < 34 weeks occurred in 6 (9%) receiving placebo and 4 (6%) receiving progesterone (RR 0.67; 95%CI:0.20-2.67). In contrast to findings from vaginal microbicide studies in HIV-uninfected, non-pregnant women, our trial participants were highly adherent to daily self-administered vaginal progesterone. The study's a priori criteria for uptake, adherence, and retention were met, indicating that a phase III efficacy trial would be feasible.


Assuntos
Infecções por HIV/tratamento farmacológico , Nascimento Prematuro/tratamento farmacológico , Progesterona/administração & dosagem , Vagina/efeitos dos fármacos , Administração Intravaginal , Adulto , Medida do Comprimento Cervical , Colo do Útero/efeitos dos fármacos , Colo do Útero/fisiopatologia , Colo do Útero/virologia , Estudos de Viabilidade , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/virologia , Humanos , Recém-Nascido , Gravidez , Gravidez Múltipla , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/fisiopatologia , Vagina/fisiopatologia , Vagina/virologia , Zâmbia/epidemiologia
4.
J Matern Fetal Neonatal Med ; 33(1): 136-141, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30198351

RESUMO

Objectives: To determine intraobserver and interobserver variability in the measurement of different cervical length (CL) components at the first trimester (endocervical canal and isthmus), describe the optimum measurement method (single line or two lines) and establish a normality curve of first trimester CL in our population.Methods: Women who attended the first-trimester US scan, between 11.0 and 13.6 weeks of gestation at Vall d'Hebron Universitary Hospital, Barcelona, Spain were included. Inclusion criteria were singleton pregnancies in women over 18 years of age, no gestational complications, uterine malformations or uterine surgery. Lengths of the endocervical canal and uterine isthmus were measured using two methods.Results: Both methods for endocervical canal measurement, single line and two lines, showed low intraobserver variability between examiners, with no statistical differences in the majority of measurements. A correct correlation existed between examiners using the single-line two-line measurements, with a concordance correlation coefficient of 0.76.Conclusions: Cervical length in the first trimester was reproducible for the same physician and between different physicians; however, it is essential to ensure examiners receive adequate training in the technique.


Assuntos
Medida do Comprimento Cervical , Colo do Útero/diagnóstico por imagem , Primeiro Trimestre da Gravidez , Ultrassonografia Pré-Natal , Adolescente , Adulto , Medida do Comprimento Cervical/métodos , Medida do Comprimento Cervical/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Variações Dependentes do Observador , Gravidez , Espanha/epidemiologia , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/estatística & dados numéricos , Adulto Jovem
5.
Lakartidningen ; 1162019 Oct 08.
Artigo em Sueco | MEDLINE | ID: mdl-31593290

RESUMO

Due to a low level of understanding of mechanisms involved in spontaneous preterm delivery there is a lack of reliable biomarkers. Existing biomarkers have a low positive predictive value but a high negative predictive value. Use of tests with high negative predictive value will reduce unnecessary interventions and hospitalization of women with threatening preterm delivery. When given to the right pregnant women, antenatal corticosteroid treatment are still the most important obstetrical intervention and reduces both neonatal mortality and short- and long-term morbidity.Several ongoing national Swedish multicenter studies may increase the understanding of the roles of cervical length, preeclampsia screening and magnesium sulfate dosage in the context of preterm delivery in a Nordic setting. Major development has been achieved in prediction and prevention of preterm preeclampsia at the cost of a 10% screen positive rate.


Assuntos
Nascimento Prematuro , Corticosteroides/administração & dosagem , Biomarcadores/análise , Cerclagem Cervical , Medida do Comprimento Cervical , Colo do Útero/anatomia & histologia , Feminino , Fibronectinas/análise , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Sulfato de Magnésio/administração & dosagem , Pessários , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/prevenção & controle , Gravidez , Nascimento Prematuro/diagnóstico , Nascimento Prematuro/prevenção & controle , Nascimento Prematuro/terapia , Cuidado Pré-Natal/métodos , Progesterona/administração & dosagem , Suécia , Tocolíticos/administração & dosagem
8.
Cochrane Database Syst Rev ; 9: CD007235, 2019 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-31553800

RESUMO

BACKGROUND: Measurement of cervical length by ultrasound is predictive of preterm birth (PTB). There are three methods of ultrasound cervical assessment: transvaginal (TVU), transabdominal (TAU), and transperineal (TPU, also called translabial). Cervical length measured by TVU is a relatively new screening test, and has been associated with better prediction of PTB than previously available tests. It is unclear if cervical length measured by ultrasound is effective for preventing PTB. This is an update of a review last published in 2013. OBJECTIVES: To assess the effectiveness of antenatal management based on transvaginal, transabdominal, and transperineal (also called translabial) ultrasound screening of cervical length for preventing preterm birth. SEARCH METHODS: For this update, we searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) to 30 August 2018; reviewed the reference lists of all articles, and contacted experts in the field for additional and ongoing trials. SELECTION CRITERIA: We included published and unpublished randomised controlled trials (RCT) including pregnant women between the gestational ages of 14 to 32 weeks, for whom the cervical length was screened for risk of PTB with TVU, TAU, or TPU. This review focused on studies based on knowledge versus no knowledge of cervical length results, or ultrasound versus no ultrasound for cervical length. We excluded studies based on interventions (e.g. progesterone, cerclage) for short cervical length. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. MAIN RESULTS: We included seven RCTs (N = 923): one examined asymptomatic women with twin pregnancies; four included women with singleton pregnancies and symptoms of preterm labour (PTL); one included women with singleton pregnancies and symptoms of preterm premature rupture of membranes (PPROM); and one included asymptomatic singletons. All trials used TVU for screening.We assessed the risk of bias of the included studies as mixed, and the quality of the evidence for primary outcomes as very low for all populations.For asymptomatic women with twin pregnancies, it is uncertain whether knowledge of TVU-measured cervical length compared to no knowledge reduces PTB at less than 34 weeks (risk ratio (RR) 0.62, 95% confidence intervals (CI) 0.30 to 1.25; 1 study, 125 participants) because the quality of the evidence is very low. The results were also inconclusive for preterm birth at 36, 32, or 30 weeks; gestational age at birth, and other maternal and perinatal outcomes.Four trials examined knowledge of TVU-measured cervical length of singletons with symptoms of PTL versus no knowledge. We are uncertain of the effects because of inconclusive results and very low-quality evidence for: preterm births at less than 37 weeks (average RR 0.59, 95% CI 0.26 to 1.32; 2 studies, 242 participants; I² = 66%; Tau² = 0.23). Birth occurred about four days later in the knowledge groups (mean difference (MD) 0.64 weeks, 95% CI 0.03 to 1.25; 3 trials, 290 women). The results were inconclusive for the other outcomes for which there were available data: PTB at less than 34 or 28 weeks; birthweight less than 2500 g; perinatal death; maternal hospitalisation; tocolysis; and steroids for fetal lung maturity.The trial of singletons with PPROM (N = 92) evaluated safety of using TVU to measure cervical length in this population as its primary outcome, not its effect on management. The results were inconclusive for incidence of maternal and neonatal infections between the TVU and no ultrasound groups.In the trial of asymptomatic singletons (N = 296), in which women either received TVU or not, the results were inconclusive for preterm birth at less than 37 weeks (RR 1.27, 95% CI 0.61 to 2.61; I² = 0%), gestational age at birth, and other perinatal and maternal outcomes.We downgraded evidence for limitations in study design, inconsistency between the trials, and imprecision, due to small sample size and wide confidence intervals crossing the line of no effect.No trial compared the effect of knowledge of the CL with no knowledge of CL in other populations, such as asymptomatic women with singleton pregnancies, or symptomatic women with twin pregnancies. AUTHORS' CONCLUSIONS: There are limited data on the effects of knowing the cervical length, measured by ultrasound, for preventing preterm births, which preclude us from drawing any conclusions for women with asymptomatic twin or singleton pregnancies, singleton pregnancies with PPROM, or other populations and clinical scenarios.Limited evidence suggests that knowledge of transvaginal ultrasound-measured cervical length, used to inform the management of women with singleton pregnancies and symptoms of preterm labour, appears to prolong pregnancy by about four days over women in the no knowledge groups.Future studies could look at specific populations separately (e.g. singleton versus twins; symptoms versus no symptoms of PTL), report on all pertinent maternal and perinatal outcomes, and include cost-effectiveness analyses. Most importantly, future studies should include a clear protocol for management of women based on TVU-measured cervical length.


Assuntos
Medida do Comprimento Cervical/métodos , Colo do Útero/diagnóstico por imagem , Trabalho de Parto Prematuro/prevenção & controle , Nascimento Prematuro/prevenção & controle , Feminino , Humanos , Gravidez , Gravidez Múltipla , Gravidez de Gêmeos , Nascimento Prematuro/diagnóstico por imagem , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Wien Klin Wochenschr ; 131(19-20): 468-474, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31312917

RESUMO

OBJECTIVE: To examine the association between third trimester cervical length (CL) measurement and duration of the first stage of labor. METHODS: This prospective cohort study included women with a singleton pregnancy who had routine CL measurements taken by transvaginal ultrasonography between 37 and 39 weeks gestation. Subjective duration of the first stage of labor was defined as the duration of contractions that the women subjectively had from the onset of regular contractions to full effacement of the cervix. Objective duration of first stage of labor was defined as 3 cm cervical dilation independent of cervical effacement until full effacement of the cervix. Associations between variables were analyzed using nonparametric correlations coefficients. A model relating the duration of labor to predictors was built using linear regression. RESULTS: In this analysis a total of 129 women were included. There was no significant correlation between CL and subjective duration of labor (ρ = -0.037, p = 0.695); however, a reduction in CL increased the objective duration of the first stage of labor (ρ = -0.269, p = 0.013). In univariate analysis parity (p = 0.018), hypertensive disorders (p = 0.013) and induction of labor (p = 0.022) were significantly associated with subjective duration of the first stage of labor. CONCLUSION: A long cervix in the third trimester is not associated with a prolonged first stage of labor. Induction of labor and multiparity were associated with a shorter first stage of labor while hypertension was associated with a longer duration of labor.


Assuntos
Medida do Comprimento Cervical , Colo do Útero , Primeira Fase do Trabalho de Parto , Terceiro Trimestre da Gravidez , Colo do Útero/anatomia & histologia , Feminino , Humanos , Paridade , Gravidez , Estudos Prospectivos , Ultrassonografia Pré-Natal
10.
BJOG ; 126(13): 1569-1575, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31339631

RESUMO

OBJECTIVE: The QUiPP algorithm combines cervical length, quantitative fetal fibronectin (qfFN) and medical history to quantify risk of preterm birth. We assessed the utility of QUiPP to inform preterm birth prevention treatment decisions. DESIGN: A prospective cohort study with a subsequent impact assessment using the QUiPP risk of birth before 34 weeks' gestation. SETTING: A UK tertiary referral hospital. SAMPLE: In all, 119 women with previous spontaneous preterm birth (sPTB) or preterm premature rupture of membranes (PPROM) before 34 weeks' gestation. METHODS: Cervical length and qfFN were measured at 19+0 to 23+0  weeks' gestation. Clinical management was based on history and cervical length. After birth, clinicians were unblinded to qfFN results and QUiPP analysis was undertaken. MAIN OUTCOME MEASURES: Predictive statistics of QUiPP algorithm using 10% risk of sPTB before 34+0  weeks as treatment threshold. RESULTS: Fifteen of 119 women (13%) had PPROM or sPTB before 34 weeks. Of these, 53% (8/15) had QUiPP risk of sPTB before 34+0  weeks above 10%. Applying this treatment threshold in practice would have doubled our treatment rate (20 versus 42%). QUIPP threshold of 10% had positive likelihood ratio (LR) of 1.3 (95% CI 0.76-2.18), and negative LR of 0.8 (95% CI 0.45-1.40) for predicting sPTB before 34+0  weeks. CONCLUSIONS: Use of the QUiPP algorithm in this population may lead to substantial increase in interventions without evidence that currently available treatment options are beneficial for this particular group. TWEETABLE ABSTRACT: Independent study finds that the QUiPP algorithm could lead to substantial increases in treatment without evidence of benefit.


Assuntos
Ruptura Prematura de Membranas Fetais/epidemiologia , Segundo Trimestre da Gravidez/fisiologia , Nascimento Prematuro/epidemiologia , Adulto , Algoritmos , Biomarcadores/análise , Medida do Comprimento Cervical , Tomada de Decisão Clínica , Feminino , Ruptura Prematura de Membranas Fetais/prevenção & controle , Fibronectinas/análise , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Nascimento Prematuro/prevenção & controle , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Reino Unido/epidemiologia
11.
Zhonghua Fu Chan Ke Za Zhi ; 54(5): 318-323, 2019 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-31154713

RESUMO

Objective: To investigate the predictive value of cervical length (CL) measured by transvaginal ultrasound for preterm birth <32 weeks, <34 weeks in twin pregnancies in the second and the third trimester of pregnancy. Methods: A total of 490 twin pregnant women with CL measured by transvaginal ultrasound during the second trimester of pregnancy (20-24 weeks) and the third trimester of pregnancy (28-32 weeks) delivered in Peking University Third Hospital, and Tongzhou Maternal and Child Health Hospital from January 2014 to December 2017 were collected, and 161 cases out of which were measured by CL during both the second trimester and the third trimester of pregnancy. Based on the measured gestational weeks, 427 cases were in the second trimester group and 224 cases in the third trimester group. The predictive value of CL for preterm birth was evaluated by calculating the optimal cut-off point with sensitivity and specificity. Logistic regression analysis was used to assess the relationship between CL and preterm birth after adjusting for confounding factors (age of pregnant women, chorionic status, mulipara, assisted reproductive pregnancy and pre-pregnancy body mass index). Results: (1) The median CL of pregnant women in the second trimester group and the third trimester group were 36 mm (33-40 mm) and 28 mm (18-33 mm) respectively. In the second trimester group, 151 cases (35.4%, 151/427) were preterm birth and 276 cases (64.6%, 276/427) were full-term birth; the median CL of preterm and full-term pregnant women were 34 mm (30-37 mm) and 37 mm (34-40 mm), respectively, with significant difference (P<0.01). In the third trimester group, 100 cases (44.6%, 100/224) were preterm birth and 124 cases (55.4%, 124/224) were full-term birth; the median CL of preterm and full-term pregnant women were 22 mm (15-30 mm) and 31 mm (23-34 mm), respectively, with significant difference (P<0.01). (2) Prediction of preterm birth <32 weeks and <34 weeks was performed with CL in the second trimester group. The area under the receiver-operating characteristics curve were 0.78 (95%CI: 0.70-0.86) and 0.71 (95%CI: 0.64-0.79), respectively. The optimal cut-off points were 36.5 mm and 33.5 mm, respectively. After adjusting for confounding factors, CL was inversely associated with preterm birth <32 weeks and <34 weeks of gestation. (3) Prediction of preterm birth <32 weeks and <34 weeks were performed with CL in the third trimester group. The area under the receiver-operating characteristics curve were 0.86 (0.75-0.96) and 0.75 (0.67-0.84), respectively. The optimal cut-off points were 17.5 mm and 18.5 mm, respectively. After adjusting for confounding factors, CL was inversely associated with preterm birth at <32 weeks and <34 weeks of gestation. Conclusions: CL measured by transvaginal ultrasound in the second and the third trimester is a good predictor for preterm birth of twin pregnancy. CL≤36.5 mm and ≤33.5 mm at 20-24 weeks of gestation could predict preterm birth <32 weeks and <34 weeks respectively. CL≤17.5 mm and ≤18.5 mm at 28-32 weeks of gestation could predict preterm birth <32 weeks and <34 weeks respectively.


Assuntos
Medida do Comprimento Cervical/métodos , Colo do Útero/diagnóstico por imagem , Gravidez de Gêmeos , Nascimento Prematuro , Ultrassonografia Pré-Natal/métodos , Criança , Feminino , Humanos , Recém-Nascido , Valor Preditivo dos Testes , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Sensibilidade e Especificidade , Ultrassonografia
12.
Ceska Gynekol ; 84(1): 55-60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31213059

RESUMO

OBJECTIVE: Contemporary role of cerclage as a preterm birth treatment. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology of the First Faculty of Medicine and General Teaching Hospital in Prague. METHODS: Research of existing literature, predominantly foreign journal articles, but also Czech literature and personal experience with the method. RESULTS: Cerclage is one of the well-known surgical procedures carried out during pregnancy. Its aim is to provide a mechanical support to the cervical canal and to keep the cervix closed. The cervical mucous plug serves as a mechanical barrier between the vagina and the uterine cavity, but it also contains many immune components which protect the fetal compartment from ascendent infections. Application of a cervical stitch can help to retain the mucous plug and thus increases the immunity of the cervical canal. Results of 15 randomised studies (Cochraine Database of Systematic R) suggest that in women with increased risk of preterm birth, cerclage decreases the occurrence of preterm birth relative to the expectant management. CONCLUSIONS: Despite the decreasing numbers of cerclage surgeries, it is still a useful method of preterm birth prevention for a specific group of women. More recently, a progesterone treatment has gained popularity. Its application, however, must begin before the 16th week of pregnancy.


Assuntos
Cerclagem Cervical/métodos , Colo do Útero/cirurgia , Nascimento Prematuro/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Incompetência do Colo do Útero/cirurgia , Medida do Comprimento Cervical , Feminino , Humanos , Gravidez , Cuidado Pré-Natal , Incompetência do Colo do Útero/diagnóstico , Vagina
13.
J Clin Ultrasound ; 47(7): 389-393, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31245845

RESUMO

PURPOSE: To investigate the correlation between cervical length measurements using transvaginal and transperineal approaches at 16-24 weeks of gestation. METHODS: The prospective study recruited 110 singleton pregnant women. All the measurements were performed by one operator who was blinded to the results of both approaches. Cervical length was first measured by transvaginal sonography (TVUS) then transperineal sonography (TPUS). The transvaginal approach was used as the reference measurement. Patient preference regarding the sonographic approaches was evaluated using questionnaire. RESULTS: Cervical length was successfully measured by TVUS in all cases. TPUS was successful in 108/110 participants. There was high correlation between the results of TVUS and TPUS (Pearson's correlation coefficient was .94; 95% CI .9 to .95. Lin's concordance correlation coefficient was .94; 95% CI .92-.96). The estimated difference in cervical length measured using TVUS and TPUS was .2 mm. The 95% tolerance interval for paired observation was -1.8 to 2.3 mm. The interobserver coefficient of TPUS measurement was .98 (95% CI .92-.99). TPUS was rated as resulting in mild or no discomfort and was preferred by most women. CONCLUSION: TVUS and TPUS techniques showed high correlation in cervical length measurement with high interobserver reliability. More patients preferred TPUS. TPUS should be considered as an alternative method of cervical length measurement.


Assuntos
Medida do Comprimento Cervical/métodos , Colo do Útero/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
15.
Int J Gynaecol Obstet ; 146(2): 206-211, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30973655

RESUMO

OBJECTIVE: To evaluate whether maternal HIV serostatus and plasma viral load (VL) are associated with midtrimester cervical length (CL). METHODS: The Zambian Preterm Birth Prevention Study (ZAPPS) is an ongoing prospective cohort that began enrolling in Lusaka in August 2015. Pregnant women undergo ultrasound to determine gestational age and return for CL measurement at 16-28 weeks. We evaluated crude and adjusted associations between dichotomous indicators and short cervix (≤2.5 cm) via logistic regression, and between VL and CL as a continuous variable via linear regression. RESULTS: This analysis includes 1171 women enrolled between August 2015 and September 2017. Of 294 (25.1%) HIV-positive women, 275 (93.5%) had viral load performed close to CL measurement; of these, 148 (53.8%) had undetectable virus. Median CL was 3.6 cm (IQR 3.5-4.0) and was similar in HIV-infected (3.7 cm, IQR 3.5-4.0) versus uninfected (3.6 cm, IQR 3.5-4.0) participants (P=0.273). The odds of short CL were similar by HIV serostatus (OR 0.64; P=0.298) and detectable VL among those infected (OR 2.37, P=0.323). We observed no association between log VL and CL via linear regression (-0.12 cm; P=0.732). CONCLUSION: We found no evidence of association between HIV infection and short CL.


Assuntos
Medida do Comprimento Cervical/estatística & dados numéricos , Infecções por HIV/sangue , Carga Viral , Adulto , Feminino , Idade Gestacional , Infecções por HIV/diagnóstico , Humanos , Modelos Lineares , Programas de Rastreamento , Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , Adulto Jovem , Zâmbia/epidemiologia
16.
Ital J Pediatr ; 45(1): 45, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971310

RESUMO

BACKGROUND: Preterm birth is a health and social problem, considered the leading cause of neonatal mortality worldwide. It is associated with higher rates of neurodevelopmental morbidity, sensorineural impairments and other complications. The aim of the study was to describe the incidence and the major risk factors associated with preterm birth. METHODS: We performed a single center, observational and retrospective Cohort study in the Division of Obstetrics and Gynaecology, University Hospital "G. Martino", Messina. Clinical records of all pregnant women who delivered from 1st January 2010 to 31 of December 2016 were collected. RESULTS: In the 7 years considered, a total of 7954 pregnant women were included in our study. The majority of all preterm births were due to infants born late preterm (71.83%), 26.45% were due to preterm and 1.72% to extremely preterm. The preterm cohort had a higher proportion of history of preterm delivery (p < 0.0001), and unmarried (p = 0.003) and underweight or obese patients (p < 0.0001). In addition, prematurity was associated with presence of uterine anomalies (p < 0.0001), vaginal/urinary infections (p = 0.02), poli/oligohydramnios (p < 0.0001), maternal diabetes (p = 0.004), hypertension (p < 0.0001), short cervical length (p < 0.0001). CONCLUSIONS: We suggest prompt identification of all risk factors associated with preterm birth to apply immediate and appropriate specific interventions.


Assuntos
Nascimento Prematuro/epidemiologia , Adulto , Medida do Comprimento Cervical , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Itália/epidemiologia , Estado Civil , Obesidade/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Magreza/epidemiologia
17.
Int J Gynaecol Obstet ; 145(3): 331-336, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30941761

RESUMO

OBJECTIVE: To validate the utility of fetal fibronectin (fFN) and cervical length (CL) in predicting preterm delivery among symptomatic nulliparous women. METHODS: A retrospective cohort study of nulliparous women who presented with uterine contractions, abdominal pain, or cervical change at 21-34 gestational weeks at Fukushima Medical University Hospital, Japan, between 2008 and 2017. fFN (categorized as <50 ng/dL, 50-199 ng/dL, >200 ng/dL) and CL (≥15 mm or <15 mm) were evaluated simultaneously. Adjusted odds ratios (aORs) and confidence intervals (CIs) for preterm delivery before 37 or 34 weeks, and delivery within 28 or 14 days were calculated (references: fFN, <50 ng/dL; CL, ≥15 mm). RESULT: Among 285 women who met the study criteria, CL less than 15 mm was a risk factor for preterm delivery before 37 (aOR, 4.1; 95% CI, 1.1-6.7) and 34 (aOR, 6.8; 95% CI, 2.3-20.2) weeks. fFN of 200 ng/dL or higher was a risk factor for delivery within 28 (aOR, 19.8; 95% CI, 4.3-90.2) and 14 (aOR, 10.8; 95% CI, 1.7-67.6) days. CONCLUSION: Among symptomatic nulliparous women, short CL was found to be a risk factor for preterm delivery and higher fFN levels were related to short gestational latency.


Assuntos
Medida do Comprimento Cervical , Fibronectinas/sangue , Nascimento Prematuro/diagnóstico , Adulto , Feminino , Humanos , Recém-Nascido , Japão , Valor Preditivo dos Testes , Gravidez , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
18.
J Obstet Gynaecol Res ; 45(6): 1134-1142, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30884065

RESUMO

AIM: This study aimed to evaluate the association of bidet toilet use with abnormal vaginal microbial colonization and preterm birth (PTB) in high-risk pregnancies. METHODS: This is a prospective cohort study of 208 women, who were admitted to a high-risk pregnancy unit, due to preterm labor, preterm premature rupture of the membrane, or short cervical length, in two tertiary hospitals from April 2015 to July 2017. Responses to a questionnaire about using bidet toilet and vaginal culture were obtained upon admission. Maternal baseline characteristics, vaginal culture results, and pregnancy and neonatal outcomes were compared between bidet toilet users and nonusers. RESULTS: Among the 204 subjects, 67 (32.8%) women were identified as bidet toilet users. Overall, bidet toilet use was associated with a higher rate of abnormal vaginal microbial colonization, compared to the nonusers (60.7% vs 44.2%, P = 0.036). Notably, Escherichia coli colonization rate was significantly higher in bidet toilet users than nonusers (13.1% vs 3.3%, P = 0.023). Bidet toilet users had a significantly higher rate of PTB before 37 weeks of gestation, compared to the nonusers (87.3% vs 73.0%, P = 0.040). CONCLUSION: Our study suggests that chronic use of a bidet toilet is associated with a higher rate of abnormal vaginal colonization by Gram-negative bacteria and PTB in high-risk pregnancies.


Assuntos
Aparelho Sanitário/efeitos adversos , Complicações na Gravidez/etiologia , Nascimento Prematuro/etiologia , Doenças Vaginais/etiologia , Doenças Vaginais/microbiologia , Adulto , Aparelho Sanitário/estatística & dados numéricos , Medida do Comprimento Cervical , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Trabalho de Parto Prematuro/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Estudos Prospectivos , Doenças do Colo do Útero/epidemiologia , Doenças Vaginais/epidemiologia , Adulto Jovem
19.
Am J Obstet Gynecol ; 221(1): 55.e1-55.e14, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30826339

RESUMO

BACKGROUND: No intervention has proved effective to date in reducing the spontaneous preterm birth rate in twin pregnancies following an episode of threatened preterm labor and with a short cervix remaining. This study was designed to ascertain whether cervical pessaries are useful in preventing spontaneous preterm birth in women with twin pregnancies and a short cervix remaining after a threatened preterm labor episode. STUDY DESIGN: This open, randomized, controlled trial was conducted in 132 pregnant women who had not delivered 48 hours after a threatened preterm labor episode and had a short cervix remaining (≤20 mm between 240 and 296 weeks and ≤10 mm between 300 and 336 weeks). Patients were randomly assigned to cervical pessary (n = 67) or routine management (n = 65). The primary outcome was the spontaneous preterm birth rate before 34 weeks. Spontaneous preterm birth before 28 and 37 weeks and neonatal morbidity and mortality were also evaluated in an intention-to-treat analysis. RESULTS: Significant differences were observed in the spontaneous preterm birth rate before 34 weeks between the pessary and routine management groups (11 of 67 [16.4%] in the pessary group vs 21 of 65 [32.3%] in the control group; relative risk, 0.51 [confidence interval, 0.27-0.97]; P = .03). No significant differences were observed in the preterm birth rate < 28 weeks or < 37 weeks between groups. The pessary group less frequently required readmission for new threatened preterm labor episodes (4 of 67 [5.6%] vs 14 of 65 [21.5%]; relative risk, 0.28 [confidence interval, 0.10-0.80]; P = .009). Significant reduction was observed in the number of neonates weighing less than 2500 g (17.9% [24 of 134] vs 70.8% [92 of 130]; relative risk, 0.25 [confidence interval, 0.15-0.43]; P < .0001). CONCLUSION: Pessary use did significantly lower the spontaneous preterm birth rate before 34 weeks in twin pregnancies with maternal short cervix remaining after a threatened preterm labor episode. Pessary use also reduced the threatened preterm labor recurrence and neonates' weight less than 2500 g.


Assuntos
Colo do Útero/diagnóstico por imagem , Trabalho de Parto Prematuro/prevenção & controle , Pessários , Gravidez de Gêmeos , Nascimento Prematuro/prevenção & controle , Adulto , Medida do Comprimento Cervical , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Trabalho de Parto Prematuro/tratamento farmacológico , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/terapia , Recidiva , Tocolíticos/uso terapêutico
20.
BMC Pregnancy Childbirth ; 19(1): 68, 2019 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-30760248

RESUMO

BACKGROUND: Accurate diagnosis of preterm labour is needed to ensure correct management of those most at risk of preterm birth and to prevent the maternal and fetal risks incurred by unnecessary interventions given to the large majority of women, who do not deliver within a week of presentation. Intervention "just-in-case" results in many avoidable admissions, women being transferred out of their local hospital unnecessarily and most women receiving unwarranted drugs, such as steroids and tocolytics. It also precludes appropriate transfers for others as neonatal cots are blocked pre-emptively, resulting in more dangerous ex-utero transfers. We have developed the QUiPP App which is a clinical decision-making aid based on previous outcomes of women, quantitative fetal fibronectin (qfFN) values and cervical length. It is hypothesised that using the QUiPP app will reduce inappropriate admissions and transfers. METHODS: A multi-site cluster randomised trial will evaluate whether the QUiPP app reduces inappropriate management for threatened preterm labour. The 13 participating centres will be randomly allocated to receive either intervention or control. If the QUiPP app calculates risk of delivery within 7 days to be is less than 5%, clinicians are advised that interventions may be withheld. Women's experience of threatened preterm labour assessment will be explored using self-completed questionnaires, with a subset of participants being invited to semi-structured interview. A health economics analysis is also planned. DISCUSSION: We hypothesise that the QUiPP app will improve identification of the most appropriate women for admission and transfer and ensure that therapies known to reduce risk of preterm neonatal morbidities are offered to those who need them. We will determine which women do not require these therapies, thereby reducing over-medicalisation and the associated maternal and fetal risks for these women. The findings will inform future national guidelines on threatened preterm labour. Beyond obstetrics, evaluating the impact of an app in an emergency setting, and our emphasis on balancing harms of over-treatment as well as under-treatment, make EQUIPTT a valuable contribution to translational medicine. TRIAL REGISTRATION: The EQUIPTT trial was prospectively registered on 16th January 2018 with the ISRCTN registry (no. 17846337 ).


Assuntos
Tomada de Decisão Clínica/métodos , Fibronectinas/sangue , Trabalho de Parto Prematuro/prevenção & controle , Diagnóstico Pré-Natal/métodos , Medida do Comprimento Cervical , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Multicêntricos como Assunto , Trabalho de Parto Prematuro/sangue , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Medição de Risco , Triagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA