RESUMO
Purpose of the Study: To evaluate the usefulness of glycosylated fibronectin (GlyFn) as point-of-care (POC) test for triaging and managing hypertension cases in pregnancy. Materials and Methods: It is a retrospective case control study done in 51 cases of hypertension (HTN) and pre-eclampsia (PE) where patients with GlyFn levels more than 350 µg/ml were included in the study group and GlyFn less than 350 µg/ml were included in the control group. Maternal and fetal outcomes were evaluated and compared. Results: Maternal and fetal morbidity leading to delivery within 10 days of testing (p value-0.0035, 95% CI 4.05 to 19.13) and worsening of Dopplers (p value-0.0031) is significantly high in study group. Gestational age (Mean 35 weeks vs. 32 weeks, p value of 0.0008, 95% CI 1.31-4.65) and birth weight (Mean 2.2 kg vs. 1.48 kg, p value 0.0009 95% CI 0.32 to 1.16) are significantly less in the study group despite there is no difference in the gestational age at testing (Mean 32.25 weeks vs. 30.9 weeks, p value 0.203, 95% CI - 0.75 to 3.42). Abnormal PE laboratory parameters (PE profile) are seen only in the study group and none in the control group (p value 0.015). Conclusion: Our results demonstrate that in pregnant women with hypertension, glycosylated fibronectin is useful for predicting maternal and fetal morbidity occurring within 10 days of testing. In low-resource settings, it will be a useful cost-effective tool for appropriate triage and improved outcomes.
RESUMO
OBJECTIVE: To evaluate the relative contributions of urethral mobility and urethral function to stress incontinence. METHODS: This was a case-control study with group matching. Eighty primiparous women with self-reported new stress incontinence 9-12 months postpartum were compared with 80 primiparous continent controls to identify impairments specific to stress incontinence. Eighty nulliparous continent controls were evaluated as a comparison group to allow us to determine birth-related changes not associated with stress incontinence. Urethral function was measured with urethral profilometry, and vesical neck mobility was assessed with ultrasound and cotton swab test. Urethral sphincter anatomy and mobility were evaluated using magnetic resonance imaging. The associations among urethral closure pressure, vesical neck movement, and incontinence were explored using logistic regression. RESULTS: Urethral closure pressure (+/-standard deviation) in primiparous incontinent women (62.9+/-25.2 cm H(2)0) was lower than in primiparous continent women (83.9+/-21.0, P<.001; effect size d=0.91) who were similar to nulliparous women (90.3+/-25.0, P=.091). Vesical neck movement measured during cough with ultrasonography was the mobility measure most associated with stress incontinence; 15.6+/-6.2 mm in incontinent women compared with 10.9+/-6.2 in primiparous continent women (P<.001, d=0.76) or nulliparas (9.9+/-5.0, P=.322). Logistic regression disclosed the two-variable model (max-rescaled R(2)=0.37, P<.001) was more strongly associated with stress incontinence than either single-variable model, urethral closure pressure (R(2)=0.25, P<.001) or vesical neck movement (R(2)=0.16 P<.001). CONCLUSION: Lower maximal urethral closure pressure is the measure most associated with de novo stress incontinence after first vaginal birth followed by vesical neck mobility. LEVEL OF EVIDENCE: II.