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The Journal of Maternal-fetal &... Dec 2023Intraplacental choriocarcinoma is a gestational trophoblastic neoplasia located within the placenta. Due to the usual silent presentation, more than half of the cases... (Review)
Review
INTRODUCTION
Intraplacental choriocarcinoma is a gestational trophoblastic neoplasia located within the placenta. Due to the usual silent presentation, more than half of the cases are diagnosed incidentally. It has been demonstrated that this pathology is linked to feto-maternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction. The aim of our review was to establish if there are recurrent signs that might lead to an early diagnosis and better management in cases complicated by FMH.
MATERIALS AND METHODS
We performed a systematic review of the literature from 2000 up to March 2023. The adopted research strategy included the following terms: (gestational choriocarcinoma obstetrics outcome) AND (intraplacental choriocarcinoma) AND (gestational choriocarcinoma). The MEDLINE (PubMed), Google Scholar, and Scopus databases were searched.
RESULTS
The research strategy identified 19 cases of FMH coexisting with intraplacental choriocarcinoma (IC), as described in 17 studies. The perinatal mortality rate was 36.8%. In eight cases, histological diagnosis of IC was made post-delivery. Metastatic lesions were found in 75% (6/8) of described cases. One case of maternal death has been described. Chemotherapy was necessary in seven cases. Sporadical prenatal ultrasound signs were described.
DISCUSSION
The diagnosis of IC is usually delayed, mostly due to aspecific symptoms and signs. Histological analysis of the placenta, when not routinely performed, should be performed when warning symptoms are encountered. The maternal prognosis was good, with a mortality rate of 5.5%. A fertility-sparing approach is always possible even in the presence of metastasis. Chemotherapy seems to be useful in cases of maternal and neonatal metastasis.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Fetomaternal Transfusion; Placenta; Choriocarcinoma; Placenta Diseases; Prenatal Care
PubMed: 38010764
DOI: 10.1080/14767058.2023.2285238 -
BMC Public Health Apr 2015Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that... (Review)
Review
BACKGROUND
Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014.
METHODS
PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period.
RESULTS
We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies.
CONCLUSIONS
The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence.
Topics: Child; Child Mortality; Child Welfare; Child, Preschool; Female; Health Policy; Humans; Infant; Infant Welfare; Infant, Newborn; Maternal Health Services; Maternal Mortality; Maternal Welfare; Nigeria; Outcome Assessment, Health Care; Pregnancy
PubMed: 25881020
DOI: 10.1186/s12889-015-1688-3 -
BJOG : An International Journal of... Feb 2024A systematic review with met-analysis was performed to summarise the evidence on the effect of intrapartum azithromycin on maternal and neonatal infections and deaths. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
A systematic review with met-analysis was performed to summarise the evidence on the effect of intrapartum azithromycin on maternal and neonatal infections and deaths.
SEARCH STRATEGY
PubMed, Scopus and Web of Science databases were searched in March 2023.
SELECTION CRITERIA
Randomised controlled trials comparing intrapartum single-dose of azithromycin with placebo.
DATA COLLECTION AND ANALYSIS
Maternal infections, maternal mortality, neonatal sepsis, neonatal mortality. We used the random-effects Mantel-Haenszel method to calculate risk ratios (RR) with 95% confidence intervals (95% CI). We assessed risk of bias of the included studies and estimated the evidence certainty using the GRADE approach.
MAIN RESULTS
After screening 410 abstracts, five studies with 44 190 women and 44 565 neonates were included. The risk of bias was low in four and had some concerns in one of the studies. The risk of endometritis was 1.5% in the azithromycin group and 2.3% in the placebo group (RR 0.64, 95% CI 0.55-0.75), and the evidence certainty was high. The respective risk for chorioamnionitis was 0.05% and 0.1% (RR 0.50, 95% CI 0.22-1.18; evidence certainty moderate). The wound infection rate was lower in the azithromycin group (1.6%) than in the placebo group (2.5%), RR 0.52 (95% CI 0.30-0.89; moderate certainty evidence). The maternal sepsis rate was 1.1% in the azithromycin group and 1.7% in the placebo group (RR 0.66, 95% CI 0.56-0.77; evidence certainty high). Mortality rates did not show evidence of a difference (0.09% versus 0.08%; RR 1.26, 95% CI 0.65-2.42; moderate certainty evidence). The neonatal mortality rate was 0.7% in the azithromycin group and 0.8% in the placebo group (RR 0.94, 95% CI 0.76-1.16; moderate certainty evidence). The neonatal sepsis rate was 7.6% in the azithromycin group and 7.4% in the placebo group (RR 1.02, 95% CI 0.96-1.09; moderate certainty evidence).
CONCLUSIONS
Intrapartum administration of azithromycin to the mother reduces maternal postpartum infections, including sepsis. Impact on maternal mortality remains undecided. Azithromycin does not reduce neonatal sepsis or mortality rates.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Azithromycin; Chorioamnionitis; Neonatal Sepsis; Pregnancy Complications, Infectious; Sepsis; Randomized Controlled Trials as Topic; Peripartum Period
PubMed: 37691261
DOI: 10.1111/1471-0528.17655 -
PloS One 2018Pregnancy-related critical illness leads to death for 3-14% of affected women. Although identifying patients at risk could facilitate preventive strategies, guide... (Meta-Analysis)
Meta-Analysis
PURPOSE
Pregnancy-related critical illness leads to death for 3-14% of affected women. Although identifying patients at risk could facilitate preventive strategies, guide therapy, and help in clinical research, no prior systematic review of this literature exploring the validity of risk prediction models for maternal mortality exists. Therefore, we have systematically reviewed and meta-analyzed risk prediction models for maternal mortality.
METHODS
Search strategy: MEDLINE, EMBASE and Scopus, from inception to May 2017. Selection criteria: Trials or observational studies evaluating risk prediction models for maternal mortality. Data collection and analysis: Two reviewers independently assessed studies for eligibility and methodological quality, and extracted data on prediction performance.
RESULTS
Thirty-eight studies that evaluated 12 different mortality prediction models were included. Mortality varied across the studies, with an average rate 10.4%, ranging from 0 to 41.7%. The Collaborative Integrated Pregnancy High-dependency Estimate of Risk (CIPHER) model and the Maternal Severity Index had the best performance, were developed and validated from studies of obstetric population with a low risk of bias. The CIPHER applies to critically ill obstetric patients (discrimination: area under the receiver operating characteristic curve (AUC) 0.823 (0.811-0.835), calibration: graphic plot [intercept-0.09, slope 0.92]). The Maternal Severity Index applies to hospitalized obstetric patients (discrimination: AUC 0.826 [0.802-0.851], calibration: standardized mortality ratio 1.02 [0.86-1.20]).
CONCLUSIONS
Despite the high heterogeneity of the study populations and the limited number of studies validating the finally eligible prediction models, the CIPHER and the Maternal Severity Index are recommended for use among critically ill and hospitalized pregnant and postpartum women for risk adjustment in clinical research and quality improvement studies. Neither index has sufficient discrimination to be applicable for clinical decision making at the individual patient level.
Topics: Area Under Curve; Critical Illness; Databases, Factual; Delivery, Obstetric; Female; Humans; Maternal Mortality; Pregnancy; ROC Curve; Risk
PubMed: 30513118
DOI: 10.1371/journal.pone.0208563 -
Midwifery Apr 2018it is critically important to explore a possible relationship between cesarean section and maternal mortality in Latin America, where the highest cesarean section rates... (Review)
Review
BACKGROUND
it is critically important to explore a possible relationship between cesarean section and maternal mortality in Latin America, where the highest cesarean section rates in the world are found. Our aim was to conduct a systematic literature review on the relationship between maternal death and caesarean section in Latin America.
METHODS
we undertook a systematic review through six electronic databases. Studies that reported any association analysis between maternal mortality and the mode of delivery in Latin America were included. Papers that fulfilled the inclusion criteria were then read fully, and a quality assessment was conducted with the PROMPT tool.
RESULTS
seven articles were identified for final analysis, all of which were observational studies. Most of the studies were retrospective (6) and one was prospective. Of the retrospective studies, 3 were case control and 3 were cross-sectional. Most of the publications on this topic suggest that there may be an increased risk of maternal mortality with cesarean section compared with vaginal birth (odds ratio ranging from 1.6 to 7.08). However, it is evident that there is a lack of studies with this subject, especially those that take into account the differences in risk between women delivered by cesarean section or by vaginal birth.
CONCLUSIONS
most of the articles showed that there may be an increased risk of maternal mortality with cesarean section compared with vaginal birth. However, it is clear that there is a limited number of studies published on this issue. Additional studies with a better methodological design should be conducted.
Topics: Adult; Cesarean Section; Female; Humans; Latin America; Maternal Death; Maternal Mortality; Pregnancy; Pregnancy Complications
PubMed: 29421643
DOI: 10.1016/j.midw.2018.01.009 -
Clinical Infectious Diseases : An... May 2020Yersinia pestis continues to cause sporadic cases and outbreaks of plague worldwide and is considered a tier 1 bioterrorism select agent due to its potential for...
BACKGROUND
Yersinia pestis continues to cause sporadic cases and outbreaks of plague worldwide and is considered a tier 1 bioterrorism select agent due to its potential for intentional use. Knowledge about the clinical manifestations of plague during pregnancy, specifically the maternal, fetal, and neonatal risks, is very limited.
METHODS
We searched 12 literature databases, performed hand searches, and consulted plague experts to identify publications on plague during pregnancy. Articles were included if they reported a case of plague during pregnancy and at least 1 maternal or fetal outcome.
RESULTS
Our search identified 6425 articles, of which 59 were eligible for inclusion and described 160 cases of plague among pregnant women. Most published cases occurred during the preantibiotic era. Among those treated with antimicrobials, the most commonly used were sulfonamides (75%) and streptomycin (54%). Among cases treated with antimicrobials, maternal mortality and fetal fatality were 29% and 62%, respectively; for untreated cases, maternal mortality and fetal fatality were 67% and 74%, respectively. Five cases demonstrated evidence of Y. pestis in fetal or neonatal tissues.
CONCLUSIONS
Untreated Y. pestis infection during pregnancy is associated with a high risk of maternal mortality and pregnancy loss. Appropriate antimicrobial treatment can improve maternal survival, although even with antimicrobial treatment, there remains a high risk of pregnancy loss. Limited evidence suggests that maternal-fetal transmission of Y. pestis is possible, particularly in the absence of antimicrobial treatment. These results emphasize the need to treat or prophylax pregnant women with suspected plague with highly effective antimicrobials as quickly as possible.
Topics: Anti-Bacterial Agents; Bioterrorism; Disease Outbreaks; Female; Humans; Plague; Pregnancy; Yersinia pestis
PubMed: 32435806
DOI: 10.1093/cid/ciz1228 -
Bulletin of the World Health... Apr 2017To investigate, within so-called general populations, the relationship between maternal survival and mortality of children younger than five years. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To investigate, within so-called general populations, the relationship between maternal survival and mortality of children younger than five years.
METHODS
We conducted a systematic review of literature published between January 1990 and November 2016 that reported maternal vital status and the corresponding mortality of children younger than five years. Seven studies were included in a qualitative analysis and four in a random-effects meta-analysis. Summary estimates of the odds of dying by maternal survival were obtained and statistical heterogeneity estimated. Quality of the included studies and evidence was assessed using a Cochrane tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation criteria, respectively.
FINDINGS
Among children younger than five years, those whose mother had died were found to be 4.09 times (95% confidence interval, CI: 2.40-6.98) more likely to die than those with surviving mothers. Due to heterogeneity (I: 83%), further pooled estimates were not possible. For children that were motherless as a result of maternal mortality, the increased odds of dying ranged from 1.40 (95% CI: 0.47-4.21) to 2.92 (95% CI: 1.21-7.04) among those aged between two and four years, 6.1 (95% CI: 2.27-16.77) to 33.78 (95% CI: 24.21-47.14) for those younger than one year and 4.39 (95% CI: 3.34-5.78) to 51.68 (95% CI: 20.26-131.80) for those younger than six months.
CONCLUSION
The loss of a mother was associated with increased mortality among children, especially when maternal death occurred in the first year of the child's life.
Topics: Child Mortality; Child, Preschool; Humans; Infant; Infant Mortality; Infant, Newborn; Maternal Death; Mothers; Survivors
PubMed: 28479623
DOI: 10.2471/BLT.15.157149 -
International Journal of Gynaecology... Apr 2022Serum biomarkers are commonly used to support the diagnosis of infection in non-pregnant patients whose clinical presentation suggests infection. The utility of serum... (Review)
Review
BACKGROUND
Serum biomarkers are commonly used to support the diagnosis of infection in non-pregnant patients whose clinical presentation suggests infection. The utility of serum biomarkers for infection in pregnant and postpartum women is uncertain.
SEARCH STRATEGY
PubMed, CINAHL, EMBASE, ClinicalTrials.gov, Cochrane Library, CINAHL, and SCOPUS were searched from inception to February 2020.
SELECTION CRITERIA
Full-text manuscripts in English were included if they reported the measurement of maternal serum biomarkers-and included a control group-to identify infection in pregnant and postpartum women.
DATA COLLECTION AND ANALYSIS
two authors independently screened manuscripts, extracted data, and assessed methodologic quality.
MAIN RESULTS
Interleukin-6 (IL-6), C-reactive protein, procalcitonin, insulin-like growth factor binding protein 1, tumor necrosis factor-α, calgranulin B, neopterin, and interferon-γ inducible protein 10 reliably indicated infection. Intercellular adhesion molecule 1, monocyte chemotactic and activating factor, soluble IL-6 receptor, and IL-8 were not useful markers in pregnant and postpartum women.
CONCLUSIONS
Findings suggest that certain biomarkers have diagnostic value when maternal infection is suspected, but also confirms limitations in this population.
Topics: Biomarkers; Female; Humans; Postpartum Period; Pregnancy
PubMed: 33999419
DOI: 10.1002/ijgo.13747 -
Frontiers in Global Women's Health 2022Obstetric emergencies are life-threatening medical problems that develop during pregnancy, labor, or delivery. There are a number of pregnancy-related illnesses and...
BACKGROUND
Obstetric emergencies are life-threatening medical problems that develop during pregnancy, labor, or delivery. There are a number of pregnancy-related illnesses and disorders that can endanger both the mother's and the child's health. During active labor and after delivery, obstetrical crises can arise (postpartum). While the vast majority of pregnancies and births proceed without a hitch, all pregnancies are not without risk. Pregnancy can bring joy and excitement, but it can also bring anxiety and concern. Preterm birth, stillbirth, and low birth weight are all adverse pregnancy outcomes, leading causes of infant illness, mortality, and long-term physical and psychological disorders.
PURPOSE
The purpose of this study is to assess the magnitude and association of obstetric emergencies and adverse maternal-perinatal outcomes in Ethiopia.
METHOD
We used four databases to locate the article: PUBMED, HINARI, SCIENCE DIRECT, and Google Scholar. Afterward, a search of the reference lists of the identified studies was done to retrieve additional articles. For this review, the PEO (population, exposure, and outcomes) search strategy was used. Population: women who had obstetric emergencies in Ethiopia. Exposure: predictors of obstetric emergencies. Outcome: Women who had an adverse perinatal outcome. Ethiopian women were the object of interest. The primary outcome was the prevalence of adverse maternal and perinatal outcomes among Ethiopian women. Obstetrical emergencies are life-threatening obstetrical conditions that occur during pregnancy or during or after labor and delivery. The Joanna Briggs Institute quality assessment tool was used to critically appraise the methodological quality of studies. Two authors abstracted the data by study year, study design, sample size, data collection method, and study outcome. Individual studies were synthesized using comprehensive meta-analysis software and STATA version 16. Statistical heterogeneity was checked using the Cochran Q test, and its level was quantified using the statistics. Summary statistics (pooled effect sizes) in an odd ratio with 95% confidence intervals were calculated.
RESULT
A total of 35 studies were used for determining the pooled prevalence of adverse maternal and perinatal outcomes; twenty-seven were included in determining the odd with 95% CI in the meta-analysis, from which 14 were cross-sectional, nine were unmatched case-control studies, and 14 were conducted in the south nation and nationality Peoples' Region, and eight were from Amhara regional states, including 40,139 women who had an obstetric emergency. The magnitude of adverse maternal and perinatal outcomes following obstetric emergencies in Ethiopia was 15.9 and 37.1%, respectively. The adverse maternal outcome increased by 95% in women having obstetric emergencies (OR 2.29,95% CI 2.43-3.52), and perinatal deaths also increased by 95% in women having obstetric emergencies (OR 3.84,95% CI 3.03-4.65) as compared with normotensive women.
CONCLUSION
This review demonstrated the high prevalence of perinatal mortality among pregnant women with one of the obstetric emergencies in Ethiopia. Adverse maternal and perinatal outcomes following obstetric emergencies such as ICU admission, development of PPH, giving birth CS, maternal death, NICU admission, LBW, and perinatal death were commonly reported in this study.
PubMed: 36386434
DOI: 10.3389/fgwh.2022.942668 -
SAGE Open Medicine 2023Pregnancy in women over the age of 35 years is considered advanced maternal age. The relationship between advanced maternal age and the risk of perinatal mortality is... (Review)
Review
BACKGROUND
Pregnancy in women over the age of 35 years is considered advanced maternal age. The relationship between advanced maternal age and the risk of perinatal mortality is still controversial. As a result, this systematic review and meta-analysis were carried out to clarify the relationship between advanced maternal age and perinatal mortality in Ethiopia.
METHODS
The following electronic databases were used for this systematic review and meta-analysis: PubMed, Web of Science, Scopus, Science Direct, Google Scholar, HINARI, and African Journals Online up to March 2022. Addis Ababa, Gondor, and Jimma University research repositories were also searched. A random-effects model was used to pool study-specific odds ratios.
RESULTS
A total of 18 articles, including a total of 45,541 participants, were included in the meta-analysis. A total of 11 cross-sectional, 2 case-control, and 5 cohort studies were included. The overall pooled estimate indicates that women with advanced maternal age had a 1.58 higher risk of perinatal mortality compared to women in the younger age group (odds ratio = 1.58; 95% Confidence Interval: 1.13-2.03). The subgroup analysis also revealed that there were differences in the effect size as the geographical region differed. The result showed that the odd of perinatal mortality was highest in the Oromia region and lowest in the Southern Nations Nationalities and Peoples' Region.
CONCLUSION
The overall pooled estimate indicates that women with advanced maternal age had a 1.58-fold higher risk of perinatal mortality. Even though this risk could also be increased with other comorbid diseases, it is important for healthcare providers and other concerned stakeholders to be aware of the increased risks associated with advanced maternal age and provide different intervention programs designed to create awareness and provide counseling services to couples who seek to have a child in their later ages about the risks of advanced maternal age pregnancy on perinatal mortality and other adverse pregnancy outcomes.
PubMed: 37786897
DOI: 10.1177/20503121231201282