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BMC Medical Informatics and Decision... Jan 2022In case of extreme premature delivery at 24 weeks of gestation, both early intensive care and palliative comfort care for the neonate are considered treatment options....
BACKGROUND
In case of extreme premature delivery at 24 weeks of gestation, both early intensive care and palliative comfort care for the neonate are considered treatment options. Prenatal counseling, preferably using shared decision making, is needed to agree on the treatment option in case labor progresses. This article described the development of a digital decision aid (DA) to support pregnant women, partners and clinicians in prenatal counseling for imminent extreme premature labor.
METHODS
This DA is developed following the International Patient Decision Aid Standards. The Dutch treatment guideline and the Dutch recommendations for prenatal counseling in extreme prematurity were used as basis. Development of the first prototype was done by expert clinicians and patients, further improvements were done after alpha testing with involved clinicians, patients and other experts (n = 12), and beta testing with non-involved clinicians and patients (n = 15).
RESULTS
The final version includes information, probabilities and figures depending on users' preferences. Furthermore, it elicits patient values and provides guidance to aid parents and professionals in making a decision for either early intensive care or palliative comfort care in threatening extreme premature delivery.
CONCLUSION
A decision aid was developed to support prenatal counseling regarding the decision on early intensive care versus palliative comfort care in case of extreme premature delivery at 24 weeks gestation. It was well accepted by parents and healthcare professionals. Our multimedia, digital DA is openly available online to support prenatal counseling and personalized, shared decision-making in imminent extreme premature labor.
Topics: Counseling; Decision Making; Decision Support Techniques; Female; Gestational Age; Humans; Infant, Newborn; Obstetric Labor, Premature; Pregnancy
PubMed: 34991580
DOI: 10.1186/s12911-021-01735-z -
Obstetrical & Gynecological Survey May 2022Preterm labor (PTL) is one of the most common and serious pregnancy complications associated with significant perinatal morbidity and mortality, as well as long-term... (Review)
Review
IMPORTANCE
Preterm labor (PTL) is one of the most common and serious pregnancy complications associated with significant perinatal morbidity and mortality, as well as long-term neurologic impairment in the offspring.
OBJECTIVE
The aim of this study was to review and compare the most recently published major guidelines on diagnosis, management, prediction, and prevention of this severe complication of pregnancy.
EVIDENCE ACQUISITION
A descriptive review of guidelines from the National Institute for Health and Care Excellence (NICE), the World Health Organization, the American College of Obstetricians and Gynecologists, the New South Wales Government, and the European Association of Perinatal Medicine (EAPM) on PTL was carried out.
RESULTS
There is a consensus among the reviewed guidelines that the diagnosis of PTL is based on clinical criteria, physical examination, measurement of cervical length (CL) with transvaginal ultrasound (TVUS) and use of biomarkers, although there is disagreement on the first-line diagnostic test. The NICE and the EAPM are in favor of TVUS CL measurement, whereas the New South Wales Government mentions that fetal fibronectin testing is the mainstay for PTL diagnosis. Moreover, there is consistency among the guidelines regarding the importance of treating PTL up to 34 weeks of gestation, to delay delivery for 48 hours, for the administration of antenatal corticosteroids, magnesium sulfate, and in utero transfer to higher care facility, although several discrepancies exist regarding the tocolytic drugs of choice and the administration of corticosteroids and magnesium sulfate after 34 and 30 gestational weeks, respectively. Routine cesarean delivery in case of PTL is unanimously not recommended. Finally, the NICE, the American College of Obstetricians and Gynecologists, and the EAPM highlight the significance of screening for PTL by TVUS CL measurement between 16 and 24 weeks of gestation and suggest the use of either vaginal progesterone or cervical cerclage for the prevention of PTL, based on specific indications. Cervical pessary is not recommended as a preventive measure.
CONCLUSIONS
Preterm labor is a significant contributor of perinatal morbidity and mortality with a substantial impact on health care systems. Thus, it seems of paramount importance to develop consistent international practice protocols for timely diagnosis and effective management of this major obstetric complication and subsequently improve pregnancy outcomes.
Topics: Adrenal Cortex Hormones; Cervix Uteri; Female; Humans; Infant, Newborn; Magnesium Sulfate; Obstetric Labor, Premature; Pregnancy; Premature Birth; Tocolytic Agents
PubMed: 35522432
DOI: 10.1097/OGX.0000000000001023 -
The Journal of Maternal-fetal &... Dec 2023Spontaneous preterm birth (delivery before 37 completed weeks) is the single most important cause of perinatal morbidity and mortality. The rate is increasing world-wide...
Spontaneous preterm birth (delivery before 37 completed weeks) is the single most important cause of perinatal morbidity and mortality. The rate is increasing world-wide with a great disparity between low, middle and high income countries. It has been estimated that the cost of neonatal care for preterm babies is more than 4 times that of a term neonate admitted into the neonatal care. Furthermore, there are high costs associated with long-term morbidity in those who survive the neonatal period. Interventions to stop delivery once preterm labor starts are largely ineffective hence the best approach to reducing the rate and consequences is prevention. This is either primary (reducing or minimizing factors associated with preterm birth prior to and during pregnancy) or secondary - identification and amelioration (if possible) of factors in pregnancy that are associated with preterm labor. In the first category are optimizing maternal weight, promoting healthy nutrition, smoking cessation, birth spacing, avoidance of adolescent pregnancies and screening for and controlling various medical disorders as well as infections prior to pregnancy. Strategies in pregnancy, include early booking for prenatal care, screening and managing medical disorders and their complications, and identifying predisposing factors to preterm labor such as shortening of the cervix and timely instituting progesterone prophylaxis or cervical cerclage where appropriate. The use of biomarkers such as oncofetal fibronectin, placental alpha-macroglobulin-1 and IGFBP-1 where cervical screening is not available or to diagnosis PPROM would identify those that require close monitoring and allow the institution of antibiotics especially where infection is considered a predisposing factor. Irrespective of the approach to prevention, timing the administration of corticosteroids and where necessary tocolysis and magnesium sulfate are associated with an improved outcome. The role of genetics, infections and probiotics and how these emerging dimensions help in the diagnosis of preterm birth and consequently prevention are exciting and hopefully may identify sub-populations for targeted strategies.
Topics: Adolescent; Female; Humans; Infant, Newborn; Pregnancy; Early Detection of Cancer; Obstetric Labor, Premature; Placenta; Premature Birth; Uterine Cervical Neoplasms
PubMed: 36966809
DOI: 10.1080/14767058.2023.2183756 -
American Family Physician Jul 2019
Review
Topics: Abortion, Spontaneous; Female; Humans; Live Birth; Obstetric Labor, Premature; Pregnancy; Progestins
PubMed: 31259502
DOI: No ID Found -
Science Translational Medicine Nov 2014Preterm birth is a leading cause of infant morbidity and mortality worldwide, but current interventions to prevent prematurity are largely ineffective. Preterm birth is... (Review)
Review
Preterm birth is a leading cause of infant morbidity and mortality worldwide, but current interventions to prevent prematurity are largely ineffective. Preterm birth is increasingly recognized as an outcome that can result from a variety of pathological processes. Despite current research efforts, the mechanisms underlying these processes remain poorly understood and are influenced by a range of biological and environmental factors. Research with modern techniques is needed to understand the mechanisms responsible for preterm labor and birth and identify targets for diagnostic and therapeutic solutions. This review evaluates the state of reproductive science relevant to understanding the causes of preterm birth, identifies potential targets for prevention, and outlines challenges and opportunities for translating research findings into effective interventions.
Topics: Animals; Female; Humans; Infant, Newborn; Infant, Premature; Mice; Models, Biological; Obstetric Labor, Premature; Perinatology; Pregnancy; Premature Birth; Prenatal Care; Risk Factors; Term Birth; Translational Research, Biomedical; Uterus
PubMed: 25391484
DOI: 10.1126/scitranslmed.3009871 -
MCN. the American Journal of Maternal... 2015Globally, in 2012, there were 15 million babies born preterm. The majority of preterm births occur in resource-poor countries including India, Nigeria, Pakistan, and the... (Review)
Review
Globally, in 2012, there were 15 million babies born preterm. The majority of preterm births occur in resource-poor countries including India, Nigeria, Pakistan, and the Democratic Republic of Congo where many die due to lack of basic skilled nursing care. In September 2000, the United Nations signed the Millennium Development Declaration establishing eight Millennium Development Goals (MDGs). These MDGs provide specific, measurable targets that are designed to provide equitable health to all, particularly the most vulnerable including preterm babies. On May 2, 2014, the World Health Organization specifically targeted the nursing workforce as a key stakeholder in strategies to reduce global prematurity and end preventable preterm newborn deaths. Specific strategies include primary care, screening for risk factors, kangaroo mother care, and early initiation of breastfeeding with exclusive breastfeeding for the first 6 months of life. By sharing our knowledge and skills, nurses can contribute to global actions being taken to end preventable preterm newborn deaths.
Topics: Female; Global Health; Humans; Infant, Newborn; Infant, Premature; Maternal-Child Health Services; Obstetric Labor, Premature; Pregnancy
PubMed: 26295506
DOI: 10.1097/NMC.0000000000000174 -
Seminars in Perinatology Aug 2019Antenatal corticosteroids (ACS) are sporadically used in low and middle income countries (LMIC), although their use is considered by the World Health Organization (WHO)... (Review)
Review
Antenatal corticosteroids (ACS) are sporadically used in low and middle income countries (LMIC), although their use is considered by the World Health Organization (WHO) as essential for decreasing infant mortality. Presently the WHO recommends the use of ACS only when gestational age is known, delivery is imminent, and the delivery will be in a facility that can provide care for the mother and the infant. We review uncertainties about ACS in high income countries that are underappreciated for anticipating their effectiveness in LMIC. We discuss the implications of a large RCT that evaluated the use of ACS in LMIC and found no benefit for presumed preterm infants and increased mortality in larger infants. The treatment schedules for ACS have not been optimized and more is now known about how to improve treatment strategies to hopefully decrease risks such as neonatal hypoglycemia in LMIC. The benefits from ACS may depend on the patient populations and health care environment in which the therapy is used. Further trials are needed to evaluate the safety and efficacy of ACS in LMIC.
Topics: Adrenal Cortex Hormones; Adult; Developing Countries; Drug Administration Schedule; Female; Gestational Age; Guidelines as Topic; Humans; Infant; Infant Mortality; Infant, Premature; Infant, Premature, Diseases; Obstetric Labor, Premature; Pregnancy; Prenatal Care; Randomized Controlled Trials as Topic; World Health Organization
PubMed: 30979597
DOI: 10.1053/j.semperi.2019.03.012 -
American Family Physician Mar 2017In the United States, preterm delivery is the leading cause of neonatal morbidity and is the most common reason for hospitalization during pregnancy. The rate of preterm...
In the United States, preterm delivery is the leading cause of neonatal morbidity and is the most common reason for hospitalization during pregnancy. The rate of preterm delivery (before 37 weeks' gestation) has been declining since 2007. Clinical diagnosis of preterm labor is made if there are regular contractions and concomitant cervical change. Less than 10% of women with a clinical diagnosis of preterm labor will deliver within seven days of initial presentation. Women with a history of spontaneous preterm delivery are 1.5 to two times more likely to have a subsequent preterm delivery. Antenatal progesterone is associated with a significant decrease in subsequent preterm delivery in certain pregnant women. Current recommendations are to prescribe vaginal progesterone in women with a shortened cervix and no history of preterm delivery, and to use progesterone supplementation regardless of cervical length in women with a history of spontaneous preterm delivery. Cervical cerclage has been used to help correct structural defects or cervical weakening in high-risk women with a shortened cervix. A course of corticosteroids is the only antenatal intervention that has been shown to improve postdelivery neonatal outcomes, including a reduction in neonatal mortality, intracranial hemorrhage, necrotizing enterocolitis, and neonatal infection. Tocolytics, especially prostaglandin inhibitors and calcium channel blockers, may allow time for the administration of antenatal corticosteroids and transfer to a tertiary care facility if necessary. When used in specific at-risk populations, magnesium sulfate provides neuroprotection and decreases the incidence of cerebral palsy in preterm infants.
Topics: Education, Medical, Continuing; Female; Humans; Infant, Premature; Obstetric Labor, Premature; Practice Guidelines as Topic; Pregnancy; Prenatal Care; Progesterone; Risk Assessment; United States
PubMed: 28318214
DOI: No ID Found -
Advances in Experimental Medicine and... 2020Non-obstetric surgery is needed in 0.75-2% of pregnant women, and safety of anesthesia for mother and child are key points at this time. Some breast diseases need to be... (Review)
Review
Non-obstetric surgery is needed in 0.75-2% of pregnant women, and safety of anesthesia for mother and child are key points at this time. Some breast diseases need to be approached in a short time interval, and surgery must be performed during pregnancy . In these cases, the technique of anesthesia regarding local, regional or general anesthesia and type of anesthetic medicine are selected based on the extent of the procedure, gestational age, and condition of the mother and child. The ideal timing for any surgery during pregnancy is in the second trimester because the risk of fetal adverse effects as well as preterm labor are lower. However, surgery of breast cancer during pregnancy is performed in any trimester as guided by treatment guidelines and is not deferred based on anesthesia preferences. Various types of anesthesia for breast surgery during pregnancy , preoperative and postoperative considerations are discussed in this chapter.
Topics: Anesthesia; Anesthetics; Breast; Breast Neoplasms; Female; Fetus; Humans; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications
PubMed: 32816269
DOI: 10.1007/978-3-030-41596-9_14 -
Ceska Gynekologie 2020To summarize current knowledge regarding Lactobacillus crispatus-dominated vaginal microbiota in pregnancy, as well as an association between the presence of... (Review)
Review
OBJECTIVE
To summarize current knowledge regarding Lactobacillus crispatus-dominated vaginal microbiota in pregnancy, as well as an association between the presence of Lactobacillus crispatus-dominated vaginal microbiota and pregnancy complications.
DESIGN
Review.
SETTING
Department of Obstetrics and Gynecology, University Hospital Hradec Kralove.
MATERIAL AND METHODOLOGY
In this review, the results from literature available about the presence of L. crispatus-dominated microbiota in pregnancy are summarized.
RESULTS
Pregnant women with Lactobacillus crispatus-dominated vaginal microbiota is very common in pregnancy and it is associated with a lower risk of preterm delivery.
CONCLUSION
Lactobacillus crispatus-dominated vaginal microbiota represents an optimal vaginal microbiota in pregnancy.
Topics: Female; Humans; Infant, Newborn; Lactobacillus crispatus; Microbiota; Obstetric Labor, Premature; Pregnancy; Premature Birth; Vagina
PubMed: 32414287
DOI: No ID Found