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1.
Medicine (Baltimore) ; 99(2): e17908, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914010

RESUMO

This study is to determine accuracy of abdominal ultrasound and nuclear magnetic resonance imaging (MRI) for placenta accreta in the second and third trimester of pregnancy and to define the most relevant features of abdominal ultrasound and MRI for placenta accreta prediction.Between September 2012 and September 2018, 245 high risk of placenta accreta in the second trimester of pregnancy were prenatal diagnosed by abdominal ultrasound and MRI and they were followed up until the end of pregnancy.Forty-six patients at the second trimester of pregnancy and 40 patients at the third trimester of pregnancy were confirmed as placenta accreta. For the second and third trimester of pregnancy, the sensitivity (Se), specificity (Sp), positive and negative predictive value (PPV and NPV) of abdominal ultrasound were 95.65% versus 97.50%, 91.78% versus 90.70%, 88% versus 83%, and 97% versus 99%, respectively, while the Se, Sp, PPV, and NPV of MRI were 89.13% versus 92.50%, 87.67% versus 8721%, 82% versus 77%, and 93% versus 96%, respectively. Five features having significant statistical differences between normal placentation women and placenta accreta patients in second or third trimester of pregnancy, including loss of the normal retroplacental clear space, thinning or disappearance of the myometrium, increased vascularization at the uterine serosa-bladder wall interface, and vascularization perpendicular to the uterine wall on abdominal ultrasound, and uterine bulging and dark intraplacental bands on MRI.Abdominal ultrasound and MRI for placenta accreta in the second and third trimester of pregnancy could provide meaningful imaging evidences.


Assuntos
Imagem por Ressonância Magnética/métodos , Placenta Acreta/diagnóstico por imagem , Placenta/anormalidades , Ultrassonografia/métodos , Útero/diagnóstico por imagem , Adulto , Feminino , Humanos , Miométrio/patologia , Placenta Acreta/patologia , Valor Preditivo dos Testes , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal/normas , Ultrassonografia Pré-Natal/estatística & dados numéricos , Útero/irrigação sanguínea , Útero/patologia
2.
Mymensingh Med J ; 29(1): 104-107, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915344

RESUMO

Pregnancy is accompanied by changes in the maternal lipoprotein metabolism that may serve to satisfy the nutritional demands of the fetus in addition to the energy requirements of the mother. Early pregnancy is considered the anabolic phase, characterized by increased hepatic production of triglycerides and enhanced removal of triglycerides from the circulation, resulting in an increased deposition of fat in maternal adipose tissue. Late pregnancy is referred to as the catabolic phase, the release of free fatty acids from adipocytes is enhanced due to both relative insulin resistance and stimulation of hormones. Although it is known that cholesterol rises in pregnancy, at present it is not routinely measured or treated. However, a growing body of evidence from animal and human studies suggests adverse consequences of high cholesterol levels in pregnancy. High lipid profile, a major factor behind atherosclerosis may leads to unconsciousness. To avoid such problems during pregnancy this longitudinal study was carried out in the department of Biochemistry, Mymensingh Medical College in co-operation with the Department of Obstetrics and Gynecology, Mymensingh Medical College Hospital and Community Based Medical College Hospital, Bangladesh from July 2011 to December 2012 to compare the changes in high density lipoprotein cholesterol level during 2nd and 3rd trimester of pregnancy. A total of one hundred subjects were participated in this study comprising of second and third trimester of pregnancy. All subjects were made to fast overnight at least for a minimum of 8 hours. Blood samples were taken and analyzed by enzymatic colorimetric kit method. Pregnancy has been found to be associated with changes in lipid profile and this differs with each trimester. The average results were analyzed with respect to each pregnancy for the whole group. The study proves that serum High Density Lipoprotein (HDL) cholesterol increases in second trimester (48.71±7.61mg/dl) than third trimester (47.01±7.45mg/dl) of Pregnancy. So, Lipid profile estimation and monitoring should be made as a part of routine investigation during antenatal period.


Assuntos
HDL-Colesterol/sangue , Segundo Trimestre da Gravidez/sangue , Terceiro Trimestre da Gravidez/sangue , Animais , Bangladesh , Feminino , Humanos , Estudos Longitudinais , Gravidez
3.
Int J Gynaecol Obstet ; 148(1): 48-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31556455

RESUMO

OBJECTIVE: To clarify the association between postpartum depression (PPD) and anemia in each stage of pregnancy as well as in the postpartum period. METHODS: A prospective cohort study was conducted between May 2010 and November 2013 at a tertiary hospital in Japan. In total, 1128 women were assessed using the Edinburgh Postpartum Depression Scale (EPDS) at postpartum week 4 and a blood test was performed in the second trimester (24-28 weeks of gestation), third trimester (35-36 weeks of gestation), and postpartum week 1. The primary outcome was PPD, defined as an EPDS score of 9 or higher. Multivariate logistic regression analysis was used to elucidate the association between anemia and PPD for each period. Additionally, trend analysis was conducted to determine if there was a linear association between maternal hemoglobin concentration and PPD. RESULTS: Postpartum anemia was significantly associated with increased PPD risk (adjusted odds ratio 1.63, 95% confidence interval 1.17-2.26) whereas anemia in the second and third trimesters was not. Similarly, a significant inverse association was observed between the quintiles of maternal hemoglobin levels in the puerperium and the PPD risk (P value for trend 0.004). CONCLUSION: Postpartum anemia was associated with an increased risk of PPD.


Assuntos
Anemia/etiologia , Depressão Pós-Parto/complicações , Doenças do Recém-Nascido/etiologia , Adulto , Anemia/diagnóstico , Depressão Pós-Parto/diagnóstico , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Japão , Razão de Chances , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Adulto Jovem
4.
Int J Gynaecol Obstet ; 148(1): 53-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31571213

RESUMO

OBJECTIVE: To evaluate the disability and functioning of women with low-risk pregnancy in the second and third gestational trimesters. METHODS: A longitudinal observational study was conducted from June 5, 2015, to April 30, 2016, in Family Health Units in the city of Santa Cruz, Rio Grande do Norte, Brazil, involving women who were in the second trimester of pregnancy where the pregnancy had been classified as low-risk. A form was designed specifically for the study to collect sociodemographic, urogynecological, and obstetric data. Functioning and disability were assessed using WHODAS 2.0, and descriptive and inferential statistical analyses were performed. RESULTS: Higher levels of disability were observed in cognition in the second trimester (P=0.021), while mobility and life activities domains had higher scores (higher score meaning the woman was more adversely affected) in the third trimester (P=0.007 and P=0.029). Urinary incontinence in the second trimester affected functioning in participation (P=0.023). Pain affected life activities (P=0.023) in the second trimester and participation in the third trimester (P=0.044); and general functioning (P=0.050 and P=0.025), mobility (P=0.002 and P=0.001), and self-care (P=0.0446 and P=0.023) in the second and third trimesters, respectively. CONCLUSION: The findings showed that, even in a low-risk pregnancy, functioning can be affected in different domains. The identification of impairments to functioning could enable improvement in care. Longitudinal studies involving the first trimester and postpartum are necessary to gain insight into women's disability and functioning during the pregnancy-puerperal period.


Assuntos
Avaliação da Deficiência , Segundo Trimestre da Gravidez/fisiologia , Terceiro Trimestre da Gravidez/fisiologia , Gravidez/fisiologia , Atividades Cotidianas , Adulto , Brasil , Cognição/fisiologia , Feminino , Humanos , Estudos Longitudinais , Adulto Jovem
5.
BJOG ; 127(2): 264-274, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573753

RESUMO

OBJECTIVE: To characterise vaginal bacterial composition in early pregnancy and investigate its relationship with first and second trimester miscarriages. DESIGN: Nested case-control study. SETTING: Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London. POPULATION: 161 pregnancies: 64 resulting in first trimester miscarriage, 14 in second trimester miscarriage and 83 term pregnancies. METHODS: Prospective profiling and comparison of vaginal bacteria composition using 16S rRNA gene-based metataxonomics from 5 weeks' gestation in pregnancies ending in miscarriage or uncomplicated term deliveries matched for age, gestation and body mass index. MAIN OUTCOME MEASURES: Relative vaginal bacteria abundance, diversity and richness. Pregnancy outcomes defined as first or second trimester miscarriage, or uncomplicated term delivery. RESULTS: First trimester miscarriage associated with reduced prevalence of Lactobacillus spp.-dominated vaginal microbiota classified using hierarchical clustering analysis (65.6 versus 87.7%; P = 0.005), higher alpha diversity (mean Inverse Simpson Index 2.5 [95% confidence interval 1.8-3.0] versus 1.5 [1.3-1.7], P = 0.003) and higher richness 25.1 (18.5-31.7) versus 16.7 (13.4-20), P = 0.017), compared with viable pregnancies. This was independent of vaginal bleeding and observable before first trimester miscarriage diagnosis (P = 0.015). Incomplete/complete miscarriage associated with higher proportions of Lactobacillus spp.-depleted communities compared with missed miscarriage. Early pregnancy vaginal bacterial stability was similar between miscarriage and term pregnancies. CONCLUSIONS: These findings associate the bacterial component of vaginal microbiota with first trimester miscarriage and indicate suboptimal community composition is established in early pregnancy. While further studies are required to elucidate the mechanism, vaginal bacterial composition may represent a modifiable risk factor for first trimester miscarriage. TWEETABLE ABSTRACT: Vaginal bacterial composition in first trimester miscarriage is associated with reduced Lactobacillus spp. abundance and is independent of vaginal bleeding.


Assuntos
Aborto Espontâneo/microbiologia , Microbiota/fisiologia , Vagina/microbiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Londres , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , RNA Ribossômico 16S
7.
Medicine (Baltimore) ; 98(46): e17873, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725631

RESUMO

RATIONALE: We report a case of fetal lingual cyst that was diagnosed prenatally using 2-dimensional and 3-dimensional images during routine second trimester screening. To the best of our knowledge, this is the first description of a cystic lesion disappearing before birth. PATIENT CONCERNS: A 36-year-old woman at 22 weeks' gestation showed the presence of an oral cystic lesion in routine second trimester ultrasound screening. The lesion measured 18 × 15 × 15 mm. INTERVENTIONS: A follow-up ultrasound examination was performed every 4 to 6 weeks. OUTCOMES: The cyst disappeared in a follow-up ultrasound examination at 35 and 37 weeks of gestation. A male newborn who weighed 3480 g was delivered with no feeding difficulties. The boy was followed to 6 years after birth. The child had normal growth and development, and there was no recurrence of the cyst. LESSONS: Prenatally diagnosed lingual cysts are uncommon findings that can include many different pathologies with a wide spectrum of severity. Lingual cysts usually have a good prognosis.


Assuntos
Cistos/diagnóstico , Diagnóstico Pré-Natal/métodos , Doenças da Língua/diagnóstico , Adulto , Cistos/diagnóstico por imagem , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Segundo Trimestre da Gravidez , Doenças da Língua/diagnóstico por imagem , Ultrassonografia Pré-Natal
8.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(11): 1147-1151, 2019 Nov 06.
Artigo em Chinês | MEDLINE | ID: mdl-31683403

RESUMO

Objective: To examine the association of pre-pregnancy body mass and weight gain during pregnancy with macrosomia. Methods: From January 2015 to December 2015, a total of 20 477 pregnant women were recruited by probabilistic proportional scale sampling with simple randomization in Sichuan, Yunnan and Guizhou Provinces. Basic information of pregnant women, weight gain during pregnancy and weight of newborn were collected. A multiple logistic regression model was used to assess the association between the pre-pregnancy body mass and gestational weight gain indicators with macrosomia. Results: 20 321 mother-infant were included in the final analysis. 20 321 pregnant women were (30.09±4.10) years old and delivered at (39.20±1.29) weeks, among which 12 341 (60.73%) cases were cesarean delivery. The birth weight of 20 321 infants were (3 292.26±431.67) grams, and 970 (4.77%) were macrosomia. The multiple logistic regression model showed that after adjusting for the age of women, compared to the normal weight group in the pre-pregnancy, the overweight and obesity group elevated the risk of macrosomia, with OR (95%CI) about 1.99 (95%CI: 1.69-2.35) and 4.05 (95%CI: 3.05-5.39), respectively. After adjusting for the age, the pre-pregnancy BMI, delivery weeks, delivery mode and infant's gender, compared to the weight-gain appropriate group, higher weight gain rate in the mid-pregnancy and excessive total gestational weight gain elevated the risk of macrosomia, with OR (95%CI) about 1.99 (95%CI: 1.66-2.39) and 1.80 (95%CI: 1.55-2.08), respectively. Conclusion: The overweight before pregnancy, obesity before pregnancy, the rate of weight gain in the second trimester and the high total weight gain during pregnancy could increase the risk of macrosomia.


Assuntos
Índice de Massa Corporal , Macrossomia Fetal/epidemiologia , Sobrepeso/epidemiologia , Ganho de Peso , Adulto , Peso ao Nascer , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Obesidade/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez , Segundo Trimestre da Gravidez , Fatores de Risco
9.
Niger Postgrad Med J ; 26(4): 223-229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31621662

RESUMO

Context: Pre-eclampsia (PrE), a clinical syndrome characterised by elevated blood pressure arising after 20 weeks of gestation, is a leading cause of maternal death worldwide. We evaluated the role of uterine artery Doppler (UtAD) in screening for PrE among unselected, pregnant women. Methodology: This was a prospective cohort study of 170 healthy gravid women between 18 and 26 weeks of gestation recruited consecutively from the Antenatal Clinic of Braithwaite Memorial Specialist Hospital, Port-Harcourt, Nigeria, between July 2016 and June 2017. All had UtAD scans with an abnormal result defined as pulsatility index (PI), resistance index or systolic/diastolic (S/D) ratio >95th centile for gestational age or proto-diastolic notching. Outcome was obtained from antenatal records. Data were analysed using Statistical Package for Social Sciences, version 20 at statistical significance level of P < 0.05. Results: The prevalence of PrE was 7.6%. There was significant association between an abnormal PI (χ2 = 16.29, P = 0.00), S/D ratio (χ2 = 8.55, P = 0.00) and the combined result (χ2 = 11.5, P = 0.007) with subsequent PrE. The highest sensitivity (53.8%) was obtained for the combined result with specificity, negative predictive value (NPV) and positive predictive value of 86.6%, 95.8% and 25%, respectively, area under the curve (AUC) of 0.71 (95% confidence interval [CI]: 0.534-0.871). A normal result had a very high NPV for all indices. The accuracy for the prediction of severe PrE was greater for all indices being highest for the combined result AUC of 0.830 (95% CI: 0.624-1.000; P = 0.01). Conclusion: Abnormal UtAD indices were associated with PrE and may be used in PrE screening.


Assuntos
Pré-Eclâmpsia/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Artéria Uterina/diagnóstico por imagem , Útero/irrigação sanguínea , Adolescente , Adulto , Feminino , Idade Gestacional , Voluntários Saudáveis , Humanos , Nigéria , Valor Preditivo dos Testes , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Estudos Prospectivos , Fluxo Pulsátil/fisiologia , Curva ROC , Ultrassonografia Pré-Natal , Adulto Jovem
10.
Medicine (Baltimore) ; 98(40): e17396, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577749

RESUMO

Oral mifepristone combined with rivanol lactate (rivanol) is commonly used in second-trimester pregnancy termination. However, rivanol is not suitable to premature rupture of membranes and oligohydramnios because amniocentesis is difficult. Mifepristone combined with misoprostol is suitable for the patients with oligohydramnios. In accordance with the misoprostol dosing recommendations by the International Federation of Gynecology and Obstetrics (FIGO), the incidences of uterine rupture and cervical laceration are relatively high in Chinese pregnant women. The aim of our study was to optimize misoprostol dosing regimen in terms of efficacy and safety in Chinese pregnant women.We modified the Bishop Score, and then gave patients low-dose misoprostol according to the modified Bishop score. Based on the amniotic fluid volume (AFV) indicated by type-B ultrasonic instrument, the cases with AFV ≤2 cm receiving low-dose misoprostol combined with mifepristone and the cases with amniocentesis failure followed by receiving low-dose misoprostol combined with mifepristone were enrolled into study group, and the cases with AFV >2 cm receiving rivanol combined with mifepristone were enrolled into control group. The start time of uterine contractions, time of fetal expulsion, birth process, hospital day, successful induced labor rate, complete induced labor rate, and incomplete induced labor rate were observed and compared between the 2 groups.There were significant differences in the start time of uterine contractions, time of fetal expulsion, birth process, and hospital day between the control group and the study group (all P < .05). The successful induced labor rate, complete induced labor rate, and incomplete induced labor rate were also significantly different between the 2 groups (all P < .05).In the induced labor of 16 to 28 weeks pathological pregnancy, low-dose misoprostol can markedly improve the successful induced labor rate and complete induced labor rate, shorten the birth process and hospital day, and decrease uterine curettage rate and uterine rupture risk. Low-dose misoprostol combined with mifepristone is suitable to the induced labor of 16 to 28 weeks pathological pregnancy in Chinese women.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Induzido/métodos , Mifepristona/uso terapêutico , Misoprostol/uso terapêutico , Complicações na Gravidez/terapia , Segundo Trimestre da Gravidez , Abortivos não Esteroides/administração & dosagem , Abortivos não Esteroides/efeitos adversos , Aborto Induzido/efeitos adversos , Adulto , Grupo com Ancestrais do Continente Asiático , China , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Humanos , Mifepristona/administração & dosagem , Mifepristona/efeitos adversos , Misoprostol/administração & dosagem , Misoprostol/efeitos adversos , Oligo-Hidrâmnio/terapia , Gravidez , Fatores de Tempo , Ruptura Uterina/prevenção & controle
11.
Hypertension ; 74(5): 1124-1135, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31522621

RESUMO

Preeclampsia is a systemic syndrome that seems to originate from the placenta and is associated with an imbalance between angiogenic factors in the maternal circulation. One of the well-studied and widely used factors is PlGF (placental growth factor), the levels of which drop in women destined to develop preeclampsia. This drop is known to precede the development of actual signs and symptoms of preeclampsia, thus proving to be a useful screening tool in predicting the disease. The literature varies widely in terms of the clinical usefulness of the test. We conducted a meta-analysis to study the predictive accuracy of PlGF in asymptomatic women. Our analysis included 40 studies with 3189 cases of preeclampsia and 89 498 controls. The overall predictive odds ratio of the test was 9 (6-13). Subgroup analysis evaluating various PlGF thresholds demonstrated that the predictive values were highest for PlGF levels between 80 and 120 pg/mL with a high predictive odds ratio of 25 (7-88), a sensitivity of 0.78 (95% CI, 0.67-0.86), a specificity of 0.88 (95% CI, 0.75-0.95), a positive likelihood ratio of 6.3 (95% CI, 2.7-14.7), and a negative likelihood ratio of 0.26 (95% CI, 0.16-0.42). Additionally, the accuracy was higher when the test was performed after 14 weeks of gestation (OR, 10 [7-15]) and for prediction of early onset preeclampsia (OR, 18 [9-37]). We conclude that PlGF is a useful screening tool to predict preeclampsia. Nonetheless, its utility should be judged with caution and randomized controlled trials are warranted to explore if its implementation improves perinatal outcomes in asymptomatic women.


Assuntos
Programas de Rastreamento/métodos , Pré-Eclâmpsia/diagnóstico , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Biomarcadores/análise , Estudos de Casos e Controles , Intervalos de Confiança , Feminino , Humanos , Razão de Chances , Pré-Eclâmpsia/metabolismo , Valor Preditivo dos Testes , Gravidez , Proteínas da Gravidez/metabolismo , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Valores de Referência , Sensibilidade e Especificidade , Reino Unido
12.
Int J Gynaecol Obstet ; 147(3): 301-312, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31493314

RESUMO

BACKGROUND: Optimal dose, interval, and administration route of misoprostol with added benefit of mifepristone for management of second trimester intrauterine fetal death (IUFD) are not established. OBJECTIVES: To assess effectiveness, safety, and acceptability of medical management of second trimester IUFD. SEARCH STRATEGY: Research databases from January 2006 to October 2018. SELECTION CRITERIA: Randomized controlled trials with IUFD cases at 14-28 weeks of gestation. DATA COLLECTION AND ANALYSIS: We screened and extracted data, assessed risk of bias, conducted analyses, and assessed overall certainty of the evidence. MAIN RESULTS: Sixteen trials from 1695 citations. When misoprostol is used alone, 400 µg is more effective than 200 µg (RR 0.78; 95% CI, 0.66-0.92, moderate certainty evidence); the sublingual route is more effective than the oral route (RR 0.88; 95% CI, 0.70-1.11, low certainty evidence). There may be little to no difference between the sublingual and vaginal route (RR 0.93; 95% CI, 0.85-1.03, low certainty evidence). Certainty of evidence related to mifepristone-misoprostol regimens and safety and acceptability is very low. CONCLUSIONS: Misoprostol 400 µg every 4 hours, sublingually or vaginally, may be effective. We cannot draw conclusions about safety and acceptability, or about the added benefits of mifepristone.


Assuntos
Abortivos não Esteroides/administração & dosagem , Abortivos Esteroides/administração & dosagem , Aborto Induzido/métodos , Morte Fetal , Mifepristona/administração & dosagem , Misoprostol/administração & dosagem , Aborto Induzido/efeitos adversos , Relação Dose-Resposta a Droga , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Int J Gynaecol Obstet ; 147(2): 156-164, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31402445

RESUMO

BACKGROUND: Preterm birth causes an increased risk for perinatal morbidity and mortality. OBJECTIVE: To determine whether mid-trimester 17-alpha-hydroxyprogesterone caproate (17-OHPC) reduces the risk of recurrent preterm birth and adverse perinatal outcomes. SEARCH STRATEGY: Systematic search to identify relevant studies published in different languages, registered after 2000, using appropriate MeSH terms. SELECTION CRITERIA: Inclusion criteria were women between 16 and 26+6  weeks of pregnancy with history of preterm delivery in any pregnancy randomized to either 17-OHPC or placebo/no treatment. DATA COLLECTION AND ANALYSIS: The number of preterm births and adverse outcomes in the 17-OHPC and placebo arms over the total number of patients in each randomized group were used to calculate the risk ratio (RR) by random-effects models using the Mantel-Haenszel method. Between-study heterogeneity was assessed using tau2 , χ2 (Cochrane Q), and I2 statistics. MAIN RESULTS: Four studies were included. There was a 29% (RR 0.71; 95% CI, 0.53-0.96; P=0.001), 26% (RR 0.74; 95% CI, 0.58-0.96; P=0.021), and 40% (RR 0.60; 95% CI, 0.42-0.85; P=0.004) reduction in recurrent preterm birth at <37, <35, and <32 weeks, respectively, in the 17-OHPC group compared with placebo. The reduction in neonatal death was 68% (RR 0.32; 95% CI, 0.15-0.66; P=0.002). CONCLUSIONS: 17-OHPC could reduce the risk of recurrent preterm birth at <37, <35, and <28 weeks and neonatal death. PROSPERO: CDR42017082190.


Assuntos
Caproato de 17 alfa-Hidroxiprogesterona/uso terapêutico , Morte Perinatal/prevenção & controle , Nascimento Prematuro/prevenção & controle , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Segundo Trimestre da Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Medicine (Baltimore) ; 98(33): e16822, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415400

RESUMO

Fetal cardiovascular malformations is widely focused and screened, but the accuracy of screening is not satisfactory. In this study, we compared the types of congenital heart malformation, accompanying diseases and fetal outcomes in the first and second trimesters of pregnancy to clarify the advantage of early screening.From January 2013 to June 2018, 230 fetuses were diagnosed with congenital heart malformations using ultrasound method in Qilu Hospital of Shandong University, and divided into 2 groups:the first trimester fetuses (group A) and the second trimester fetuses (group B). In addition, we collected and organized medical data of 347 cases diagnosed with congenital heart disease during 1998 to 2005 (group C). We compared the spectrum of congenital heart disease, associated comorbidities and outcome of fetuses diagnosed with congenital heart disease.There were differences in the types and incidence of cardiac malformations between the first and second trimesters of pregnancy. The number of cases of non-cardiac malformation, congenital heart disease with single ventricular circulation, fetal intrauterine death and premature pregnancy termination was significantly lower in the late stage (group A and group B) than that in the early stage (group C). More patients were screened for trisomy 21, 18, 13 syndromes and Turner syndrome in group A than group B (P <.001). More fetuses with a 22q11 deletion were screened in group B than group C.Early pregnancy screening using ultrasound diagnosis is very important for fetuses with congenital heart disease.


Assuntos
Feto/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Ultrassonografia Pré-Natal/estatística & dados numéricos , Aberrações Cromossômicas/estatística & dados numéricos , Feminino , Cardiopatias Congênitas/embriologia , Cardiopatias Congênitas/genética , Humanos , Incidência , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos
15.
BMJ Case Rep ; 12(8)2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31383683

RESUMO

Uterine leiomyosarcoma (ULMS) is a highly malignant neoplasm which has been rarely described in pregnancy. A case of advanced metastatic ULMS presenting at 26 weeks gestation is reported. The principles in managing invasive cancer in pregnancy are discussed.


Assuntos
Leiomiossarcoma/patologia , Complicações Neoplásicas na Gravidez/patologia , Neoplasias Uterinas/patologia , Adulto , Evolução Fatal , Feminino , Humanos , Gravidez , Segundo Trimestre da Gravidez
16.
BJOG ; 126(12): 1448-1454, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31386246

RESUMO

OBJECTIVE: To examine the association between maternal alcohol consumption during pregnancy and the risk of preterm delivery. DESIGN: Prospective cohort study. SETTING: The Japan Environment and Children's Study (JECS). POPULATION: A total of 94 349 singleton pregnancies. METHODS: Participants completed questionnaires detailing alcohol consumption during the first trimester and during the second and third trimesters. Participants were divided into four categories according to alcohol consumption (non-drinkers, consumers of 1-149 g, 150-299 g and ≥300 g ethanol/week). We examined the effect of alcohol consumption during different stages of pregnancy on the risk of preterm delivery. Odds ratios (OR) and 95% CI were calculated relative to non-drinkers using logistic regression. MAIN OUTCOME MEASURES: Medical record-based preterm delivery. RESULTS: Alcohol consumption during the second and third trimesters, but not during the first trimester, was associated with increased risk of preterm delivery. Heavy alcohol consumption (≥300 g ethanol/week) during the second and third trimesters was associated with a four-fold higher risk compared with non-drinkers (multivariable OR 4.52; 95% CI 1.68-12.2). Light alcohol consumption (1-149 g ethanol/week) tended to be associated with lower risk of preterm delivery (multivariable OR 0.78; 95% CI 0.60-1.00). CONCLUSIONS: Heavy alcohol consumption during the second and third trimesters was associated with increased risk of preterm delivery among pregnant women. TWEETABLE ABSTRACT: Heavy drinking during pregnancy may increase the risk of preterm delivery.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Nascimento Prematuro/epidemiologia , Adulto , Estudos de Coortes , Feminino , Humanos , Japão/epidemiologia , Serviços de Saúde Materno-Infantil , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Nascimento Prematuro/etiologia , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários
17.
J Autism Dev Disord ; 49(11): 4572-4583, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31410696

RESUMO

Epidemiologic studies link increased autism spectrum disorder (ASD) risk to obstetrical conditions associated with inflammation and steroid dysregulation, referred to as prenatal metabolic syndrome (PNMS). This pilot study measured steroid-related biomarkers in early second trimester maternal serum collected during the first and second trimester evaluation of risk study. ASD case and PNMS exposure status of index offspring were determined through linkage with autism registries and birth certificate records. ASD case (N = 53) and control (N = 19) groups were enriched for PNMS exposure. Higher estradiol and lower sex hormone binding globulin (SHBG) were significantly associated with increased ASD risk. Study findings provide preliminary evidence to link greater placental estradiol activity with ASD and support future investigations of the prenatal steroid environment in ASD.


Assuntos
Transtorno do Espectro Autista/sangue , Estradiol/sangue , Segundo Trimestre da Gravidez/sangue , Globulina de Ligação a Hormônio Sexual/metabolismo , Adulto , Biomarcadores , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Projetos Piloto , Gravidez , Sistema de Registros , Adulto Jovem
18.
Arkh Patol ; 81(4): 43-47, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31407717

RESUMO

OBJECTIVE: To study a change in the architectonics of fetal surface veins of the placenta and the structure of the latter in cytomegalovirus infection in pregnant women. MATERIAL AND METHODS: Placentas were studied and divided in 3 groups: 1) 35 placentas from women with physiological pregnancy; 2) 37 placentas from women with an exacerbation of latent cytomegalovirus infection and with chronic compensated placental insufficiency; 3) 30 placentas from those with an exacerbation of latent cytomegalovirus infection and with chronic subcompensated placental insufficiency. After X-ray contrasting the fetal surface veins of the placenta and collecting its sections for morphological analysis, the changes in the blood vessels were compared with the structure of the villous chorion. RESULTS: As compared with Group 2, Group 3 showed reductions in placental weights and placental areas, as well as cotyledon asymmetry and a preponderance of anatomical forms with weak vascular contrasting along with the more frequent emergence of areas of varicosity, contraction, and inflammation of the umbilical vein, as well as the placental fetal surface veins. The investigators more often detected collagenization, fibrinoid degradation, and the increased stromal volume of the stem villi, fibrinoid deposition around the latter, and decreases in the proportion of the intervillous space and syncytiotrophoblast; dilatation of the veins and narrowing of the arteries of the stem villi; pronounced plethora of terminal villi and their avascular forms, intermediate immature villi, chorioamnionitis, deciduitis, pseudonecrosis, calcifications, as well as hemorrhages in the intervillous space. CONCLUSION: In the development of subcompensated placental insufficiency in women who have experienced an exacerbation of latent cytomegalovirus infection in the second trimester of pregnancy, an important role is assigned to anatomical and pathological changes in the umbilical, fetal surface, and villous chorionic veins, which indicate the development of fetoplacental hypertension, the deceleration of blood flow, and the longer contact of the pathogen with the endothelium and syncytiotrophoblast.


Assuntos
Infecções por Citomegalovirus , Placenta , Insuficiência Placentária , Complicações Infecciosas na Gravidez , Córion , Infecções por Citomegalovirus/complicações , Feminino , Humanos , Placenta/irrigação sanguínea , Placenta/patologia , Insuficiência Placentária/virologia , Gravidez , Complicações Infecciosas na Gravidez/patologia , Segundo Trimestre da Gravidez
19.
BMC Res Notes ; 12(1): 473, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370907

RESUMO

OBJECTIVE: Current literature suggests there may be a relationship between sex hormones, which dramatically increase during pregnancy, and nicotine use behaviors. We hypothesized that higher progesterone and progesterone:estradiol ratio (P/E2) would be associated with less smoking-related symptomatology (SRS), better mood and fewer cigarettes smoked per day (CPD) during ad libitum smoking and following overnight abstinence in pregnant women. Associations between SRS, mood, smoking behavior and sex hormones were estimated using multiple linear regression with adjustment for CPD and pregnancy trimester. RESULTS: There were 35 second trimester and 42 third trimester participants. Participants mean age was 26.2 (SD: 4.1), they smoked 11.3 CPD (SD: 4.4) and the mean nicotine dependence score was 4.94 (SD: 1.98). There were no statistically significant associations between progesterone levels, estradiol levels, or the P/E2 ratio and SRS or mood measures during ad libitum smoking or following overnight abstinence in this sample of pregnant women. Similarly, there were no associations between sex hormone levels and number of CPD smoked during the ad libitum period. Contrary to our hypothesis, we found no significant associations between sex hormones and SRS, mood or smoking behavior in this sample of pregnant women. Trial registration ClinicalTrials.gov (NCT01811225), December 6, 2012.


Assuntos
Fumantes/psicologia , Fumar/psicologia , Tabagismo/psicologia , Adulto , Afeto/fisiologia , Estudos Transversais , Estradiol/sangue , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Modelos Lineares , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Progesterona/sangue , Fumar/sangue , Tabagismo/sangue
20.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439565

RESUMO

Pregnant women who previously had bariatric surgery may develop acute abdominal pain during pregnancy. Two patients, 38-year-old twin primigravida (gestational age of 24+6 weeks) and a 26-year-old woman (gestational age of 24+0 weeks), both of whom had laparoscopic gastric bypass surgery previously, developed abdominal pain. The patients both had diffuse abdominal pain in combination with normal blood tests and imaging. Patient B had undergone laparoscopy at another centre after 5 weeks of gestation for internal herniation. After referral to our multidisciplinary bariatric-obstetric-neonatal (MD-BON) team, diagnostic laparoscopy was advised as internal herniation was deemed possible. In both patients, internal herniation was indeed found in Petersen's space and jejunal mesenteric defect, which was closed using laparoscopic surgery. Both women delivered healthy offspring afterwards. The presence of an MD-BON team allows for an increased awareness of potential long-term complications associated with earlier bariatric surgery in pregnancy.


Assuntos
Cirurgia Bariátrica , Hérnia Abdominal/diagnóstico , Complicações na Gravidez/diagnóstico , Dor Abdominal/etiologia , Adulto , Feminino , Hérnia Abdominal/complicações , Hérnia Abdominal/diagnóstico por imagem , Hérnia Abdominal/cirurgia , Humanos , Laparoscopia , Gravidez , Complicações na Gravidez/diagnóstico por imagem , Complicações na Gravidez/cirurgia , Segundo Trimestre da Gravidez , Gravidez de Gêmeos
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