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Journal of Obstetrics and Gynaecology :... Dec 2023Heterotopic pregnancy (HP) is a rare but potentially life-threatening event with a high risk of maternal death, which also jeopardise the coexisting intrauterine...
Heterotopic pregnancy (HP) is a rare but potentially life-threatening event with a high risk of maternal death, which also jeopardise the coexisting intrauterine pregnancy (IUP), thus an early accurate diagnosis and prompt treatment can decrease adverse complications. We aimed to explore the early predictors for pregnancy outcomes of HP. We reviewed patients with HP following assisted reproductive technology in our institution between January 2013 and December 2020. The relationships between pregnancy outcomes and clinical features were analysed by logistic regression. We found that 29 patients (72.5%) of HP were accurately diagnosed by transvaginal ultrasonography (TVS). Eighteen patients in the surgery group had live births, three of whom delivered preterm. Additionally, the miscarriage rate was lower for patients with IUP cardiac activity than those without (16.7% vs. 90.0%, < .001). Further by logistic regression analysis, an IUP with cardiac activity at HP diagnosis was identified as favourable independent predictor of live birth ( < .001). Therefore, early diagnosis and prompt surgical intervention are recommended to prevent the development of HP.Impact of statement Heterotopic pregnancy (HP) has long been thought to be a rare but potentially life-threatening event with a high risk of complications. The early diagnosis of HP is challenging due to the co-existence of a viable intrauterine pregnancy (IUP) and the absence of typical clinical symptoms. This stduy showed that symptoms combined with routine transvaginal ultrasonography (TVS) scans reduce the rates of misdiagnosis of HP and prompt surgical intervention after diagnosis may minimise the incidence of miscarriage of the IUP. An IUP with cardiac activity at HP diagnosis is a predictor of a favourable prognosis of HP, and laparoscopy under general anaesthesia is effective and safe during the first trimester of pregnancy. Awareness, assessment and early interventions in view of symptoms combined with routine TVS is recommended to reduce the risk of miscarriage and ensure a favourable live birth rate.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Abortion, Spontaneous; Embryo Transfer; Fertilization in Vitro; Pregnancy, Heterotopic; Retrospective Studies
PubMed: 36534044
DOI: 10.1080/01443615.2022.2152660 -
Clinical Medicine (London, England) Nov 2023
Topics: Female; Pregnancy; Humans; Pregnancy Outcome; COVID-19
PubMed: 38182195
DOI: 10.7861/clinmed.23-6-s63 -
JAMA Oct 2023
Topics: Female; Humans; Pregnancy; Amnion; Infusions, Parenteral; Obstetric Surgical Procedures; Pregnancy Outcome; Prenatal Care
PubMed: 37847278
DOI: 10.1001/jama.2023.15927 -
American Journal of Obstetrics &... Apr 2024This study aimed to synthesize the available evidence on probiotic administration during pregnancy for the prevention of preeclampsia and its effects on related... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to synthesize the available evidence on probiotic administration during pregnancy for the prevention of preeclampsia and its effects on related maternal, fetal, and newborn outcomes.
DATA SOURCES
Six databases were systematically searched for eligible studies, namely Ovid MEDLINE, Embase, CINAHL, Cochrane, Global Index Medicus, and the Maternity and Infant Care Database, from inception to August 2, 2023.
STUDY ELIGIBILITY CRITERIA
Randomized controlled trials that evaluated the effects of probiotic administration on women during any stage of pregnancy were eligible for inclusion.
METHODS
The protocol was registered with the International Prospective Register of Systematic Reviews under identifier CRD42023421613. Evaluating study eligibility, extracting data, assessing risk of bias (ROB-2 tool), and rating certainty (Grading of Recommendations, Assessment, Development and Evaluations) were conducted independently by 2 authors. The primary outcomes were incidence of preeclampsia, eclampsia, and maternal mortality. A meta-analysis was performed, and the results were reported as risk ratios with 95% confidence intervals.
RESULTS
A total of 29 trials (7735 pregnant women) met the eligibility criteria. There was heterogeneity across the trials in the population of enrolled women and the type of probiotic tested (20 different strains), although most used oral administration. Probiotics may make no difference to the risk of preeclampsia (risk ratio, 1.14; 95% confidence interval, 0.84-1.53; 11 trials; 2401 women; low certainty evidence), preterm birth at <37 weeks' gestation (risk ratio, 0.93; 95% confidence interval, 0.66-1.30; 18 trials, 4016 women; low certainty evidence), or gestational age at delivery (mean difference, -0.03 weeks [≈0.2 days]; 95% confidence interval, -0.16 to 0.10 weeks [≈ -1.1 to 0.7 days]; 13 trials, 2194 women; low certainty evidence). It is difficult to assess the effects of probiotics on other secondary outcomes because the evidence was of very low certainty, however, no benefits or harms were observed.
CONCLUSION
Limited evidence suggests that probiotic supplementation does not affect the risk for preeclampsia. Further high-quality trials are needed to definitively assess the benefits and possible harms of probiotic supplementation during pregnancy. There is also a lack of data from trials that included women who were undernourished or who experienced microbial dysbiosis and for whom probiotic supplementation might be useful.
Topics: Humans; Probiotics; Pregnancy; Pre-Eclampsia; Female; Infant, Newborn; Pregnancy Outcome; Randomized Controlled Trials as Topic; Maternal Mortality; Premature Birth
PubMed: 38447676
DOI: 10.1016/j.ajogmf.2024.101322 -
Gynecological Endocrinology : the... Dec 2023The aim of this narrative review is to offer an overview about the role of progesterone levels on pregnancy outcome in patients undergoing assisted reproductive... (Review)
Review
PURPOSE
The aim of this narrative review is to offer an overview about the role of progesterone levels on pregnancy outcome in patients undergoing assisted reproductive technologies (ARTs).
METHODS
A detailed computerized search of the literature was performed in the main electronic databases (MEDLINE, EMBASE, Web of Science) to determine the importance of elevated progesterone levels at different stages of the cycle for pregnancy rates in the fertilization (IVF) cycle. Our review also provides information on the differences between elevated progesterone levels and their interpretation in normal and in poorly responding women.
RESULTS
After careful evaluation, our search strategy yielded a total of 15 included articles, showing the possible factors that may have had an impact on the increased progesterone level before human chorionic gonadotropin (HCG) injection and the different thresholds above which the pregnancy rate was lower. Furthermore, increased progesterone on cycle day 2 or 3 could serve as a marker for increased progesterone in the late follicular phase, which is associated with a lower pregnancy rate.
CONCLUSION
Despite the literature data that support the negative effect of elevated progesterone on fresh cycles, due to lack of randomized controlled trials, the value of measuring progesterone in daily practice is questionable. Available evidence supports the detrimental effect of elevated progesterone in different subgroups of women, although there is still the need for defining different thresholds and durations of high progesterone exposure. The need for various thresholds for different cohorts of women, the inter-assay variability is making this decision harder.
Topics: Pregnancy; Female; Humans; Progesterone; Reproductive Techniques, Assisted; Pregnancy Rate; Fertilization in Vitro; Pregnancy Outcome; Chorionic Gonadotropin
PubMed: 36963420
DOI: 10.1080/09513590.2023.2190806 -
BMC Pregnancy and Childbirth Nov 2023The acute respiratory disease caused by the coronavirus (COVID-19) has spread rapidly worldwide yet has not been eliminated. The infection is especially deadly in...
BACKGROUND
The acute respiratory disease caused by the coronavirus (COVID-19) has spread rapidly worldwide yet has not been eliminated. The infection is especially deadly in vulnerable populations. The current studies indicate that pregnant women are at greater risk of getting seriously ill. Even though fetuses protect against disease, the additional finding showed that the COVID-19 pandemic could increase fetal and maternal morbidities. In a situation where COVID-19 and new strains of the virus are still not controlled, scientists predicted that the world might experience another pandemic. Consequently, more research about the effects of COVID-19 infection on pregnancy outcomes is needed. This study aimed to compare the pregnancy outcomes of Iranian pregnant women in the first year of the pandemic with the previous year.
METHODS
This prospective cross-sectional study was performed to compare the pregnancy outcome during the COVID-19 pandemic among Iranian pregnant women who gave birth during the pandemic and one year before the pandemic (2019-2020 and 2020-2021). The sample size was 2,371,332 births registered at hospitals and birth centers platforms. The studied variables include stillbirth, congenital anomaly, birth weight, preeclampsia, gestational diabetes, cesarean section, ICU admission, mean of the gestational age at birth, preterm births, NICU admission, neonatal mortality and the percentage of deliveries with at least one complication such as blood transfusion and postpartum ICU admission. Analyzing data was done by using SPSS version 25 software.
RESULTS
We found statistical differences between pregnancy and birth outcomes during the COVID-19 pandemic compared to one year before. The risk of preeclampsia, gestational diabetes, cesarean section, preterm birth and NICU admission were clinically significant. Also, there was a significant decrease in mean gestational age.
CONCLUSION
The COVID-19 pandemic has affected the pregnancy outcome by increasing morbidities and complications during pregnancy, birth, and postpartum. In addition, extensive quarantine outbreaks disrupted the healthcare system and hindered access to prenatal services. It is necessary to develop preventive and therapeutic care protocols for similar pandemic conditions.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Pregnancy Outcome; Diabetes, Gestational; Pandemics; COVID-19; Pre-Eclampsia; Prospective Studies; Cesarean Section; Cross-Sectional Studies; Iran; Premature Birth
PubMed: 37993814
DOI: 10.1186/s12884-023-06098-z -
International Journal of Environmental... Nov 2023Paternal medication use around the time of conception is common, but information about its effects on pregnancy outcome and the health of the child is generally limited....
Paternal medication use around the time of conception is common, but information about its effects on pregnancy outcome and the health of the child is generally limited. The aim of this study is to examine the feasibility of studying paternal exposure in the Dutch Pregnancy Drug Register by using immunosuppressants as a proof of concept. In 113 of 15,959 pregnancies, long-term paternal immunosuppressant use was reported 3 months before conception. In total, 134 immunosuppressants were used. Pregnancy outcome was known for 54 cases and was in accordance with previous findings. Two spontaneous abortions, two premature births, six small for gestational age babies, and two major congenital malformations were reported. Time to pregnancy (TTP) was known for 9548 pregnancies, including 89 with paternal immunosuppressant use. TTP analysis did not show a difference in pregnancies with paternal immunosuppressant use compared to the control group. Moreover, the number of fertility treatments in the paternal immunosuppressant group was similar to the control group. In our opinion, it is feasible to use the Dutch Pregnancy Drug Register to study the effects of paternal exposure on pregnancy outcome. However, to study the potential effects on fertility, more information is needed, particularly since the beginning of pregnancy attempts.
Topics: Male; Female; Child; Pregnancy; Humans; Paternal Exposure; Pregnancy Outcome; Abortion, Spontaneous; Premature Birth; Immunosuppressive Agents
PubMed: 38063537
DOI: 10.3390/ijerph20237107 -
Medicina (Kaunas, Lithuania) Nov 2023: Gestational diabetes mellitus (GDM) is known to be associated with pregnancy complications but there is limited evidence about the strength of these associations in...
: Gestational diabetes mellitus (GDM) is known to be associated with pregnancy complications but there is limited evidence about the strength of these associations in recent clinical practice, especially after the introduction of strict guidelines for the management of pregnancies with GDM in a multidisciplinary team setting. The objectives of our study were to first compare the rates of complications in pregnancies with GDM with those that had pre-existing diabetes mellitus and those without diabetes; and second, to derive measures of effect size expressed as odds ratios after adjustment for confounding factors to assess the independent association of GDM in prediction of these pregnancy complications. : This was a prospective cohort study undertaken at a large maternity unit in the United Kingdom between January 2010 and June 2022. We included singleton pregnancies that were booked at our unit at 11-13 weeks' gestation. Multivariate regression analysis was carried out to determine the risks of complications in pregnancies with GDM after adjusting for pregnancy characteristics. Risks were expressed as odds ratio (OR) (95% confidence intervals [CI]) and expressed graphically in forest plots. : The study population included 53,649 singleton pregnancies including 509 (1%) with pre-existing DM, 2089 (4%) with GDM and 49,122 (95%) pregnancies without diabetes. Multivariate regression analysis demonstrated that there was a significant independent contribution from GDM in the prediction of adverse outcomes, including maternal complications such as preterm delivery, polyhydramnios, preeclampsia and delivery of large for gestational age neonates and elective caesarean section (CS); and neonatal complications including admission to neonatal intensive care unit, hypoglycaemia, jaundice and respiratory distress syndrome. : GDM is associated with an increased rate of pregnancy complications compared to those without diabetes, even after adjustment for maternal and pregnancy characteristics. GDM does not increase the risk of stillbirth, hypoxic ischaemic encephalopathy or neonatal death.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Diabetes, Gestational; Pregnancy Outcome; Prospective Studies; Cesarean Section; Pregnancy Complications
PubMed: 38138200
DOI: 10.3390/medicina59122096 -
Journal of Obstetrics and Gynaecology... Jun 2024The objective is to evaluate maternal and fetal outcomes at an extremely advanced maternal age (AMA) (over age 50 years) in Calgary. The secondary objective is to...
OBJECTIVES
The objective is to evaluate maternal and fetal outcomes at an extremely advanced maternal age (AMA) (over age 50 years) in Calgary. The secondary objective is to determine if there is a role in protocolizing complex care plans for patients at extreme AMAs.
METHODS
A retrospective chart review was conducted of all pregnancies ≥20 weeks gestation in patients over the age of 50 years that delivered in Calgary between January 2007 and December 2021. Pregnancy data were collected, including maternal age, pre-existing medical conditions, mode and timing of delivery, neonatal outcomes, neonatal intensive care unit (NICU) and adult intensive care unit (ICU) admissions, postpartum complications, and maternal or neonatal death. Data were extracted for maternity patients as well as neonatal ICU databases. Maternal and neonatal outcomes were assessed until discharge from hospital.
RESULTS
All 23 pregnancies identified were achieved through assisted reproductive technologies. Comorbidities varied, but the most common comorbidities included hypertension and gestational diabetes. Cesarean delivery was the most common form of delivery. Three cases involved postpartum maternal ICU admission. Neonatal outcomes included gestational ages of 22-39 weeks and birth weights of 486-3593 g, with 8 confirmed NICU admissions. The most common neonatal complications were jaundice and small for gestational age.
CONCLUSIONS
Extremely AMA patients are more likely to have pre-existing comorbidities and develop comorbidities during pregnancy. The potential for adverse maternal and fetal outcomes is greater for these pregnancies; however, the complications are diverse and developing a universal complex care plan is difficult.
Topics: Humans; Female; Pregnancy; Retrospective Studies; Pregnancy Outcome; Middle Aged; Pregnancy Complications; Infant, Newborn; Maternal Age; Alberta
PubMed: 38423466
DOI: 10.1016/j.jogc.2024.102418 -
Journal of Obstetrics and Gynaecology :... Dec 2023Proteinuria during pregnancy is closely related to the occurrence of adverse pregnancy outcomes. One hundred and forty-two women with proteinuria during pregnancy and...
Proteinuria during pregnancy is closely related to the occurrence of adverse pregnancy outcomes. One hundred and forty-two women with proteinuria during pregnancy and followed between January 2018 and December 2020 were evaluated. Based on the 24-h proteinuria value, they were divided as mild ( = 76, 300-1000 mg/day), moderate ( = 39, 1000-3500 mg/day) and severe ( = 27, >3500 mg/day) proteinuria. The rates of prematurity, low birth weight and neonatal asphyxia were significantly higher in the severe proteinuria group than in the mild and moderate groups, while the rates of foetal growth restriction and neonatal intensive care unit admission were significantly higher in the severe compared with the mild proteinuria group (all < .05). Logistic regression analysis showed that moderate proteinuria (OR = 97.2, 95%CI: 7.1-1334.2, = .001) and severe proteinuria (OR = 34.0, 95%CI: 1.6-711.0, = .023) were associated with adverse perinatal outcomes. Compared with mild proteinuria, moderate and severe proteinuria are associated with adverse pregnancy outcomes in perinatal infants.Impact Statement The production of proteinuria is closely related to the filtration function of the glomerulus, the reabsorption and secretion function of the renal tubules. For women with normal renal function before pregnancy, such physiological changes are less likely to cause adverse symptoms; however, for women with chronic kidney disease before pregnancy, especially those with significantly impaired renal function, the kidneys often cannot compensate for these physiological changes, which can lead to serious complications for both mother and infant. In our study, logistic regression analysis showed that the severity of proteinuria was independently associated with adverse perinatal outcomes. The ROC curve showed that 24-h proteinuria had a predictive value for adverse perinatal outcomes. Therefore, for patients with urine protein quantification ≥0.3 g/24 h, regular 24-h urine protein quantification during pregnancy could help predict adverse perinatal outcomes and improve prognosis. Proteinuria quantification can be used as one of the factors predicting adverse pregnancy outcomes. Thus, monitoring of urinary protein quantification in women during pregnancy should be strengthened for early detection of renal impairment, then interventions be used to improve maternal and infant outcomes.
Topics: Pregnancy; Infant, Newborn; Infant; Female; Humans; Pre-Eclampsia; Retrospective Studies; Pregnancy Outcome; Infant, Premature; Proteinuria
PubMed: 36178502
DOI: 10.1080/01443615.2022.2126299