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Journal of Clinical Medicine Apr 2024: Numerous studies have aimed to predict prenatal and neonatal outcomes for pregnancies complicated by congenital cytomegalovirus (CMV). Presently, assessing CMV... (Review)
Review
: Numerous studies have aimed to predict prenatal and neonatal outcomes for pregnancies complicated by congenital cytomegalovirus (CMV). Presently, assessing CMV severity prenatally relies largely on fetal imaging. A controversy exists regarding CMV viral load (VL) and its association with fetal and neonatal sequelae. : To perform a systematic review and meta-analysis investigating the association between CMV DNA VL in amniotic fluid and fetal and neonatal outcomes in pregnancies with congenital CMV. : All cohort, case-control and observational studies that compared outcomes of fetuses with congenital CMV and provided information on individual patient CMV VL quantified in copies per milliliter (c/mL) from inception to January 2023 were included, with no geographical or language restrictions. A total of 1251 citations were reviewed with eight studies meeting inclusion criteria and included in meta-analysis. Affected pregnancies had a higher VL in the amniotic fluid compared to those unaffected with a mean difference of 2.2e+7 (range 1.5e+7 to 2.8e+7). In subgroup analysis, the VL was significantly higher in the fetuses, with imaging findings related to CMV compared to asymptomatic fetuses with a mean difference of 4.1e+7 (95% CI 2.8e+7-5.4e+7). However, among babies with congenital CMV, the VL was not significantly different between symptomatic and asymptomatic babies. : Amniotic fluid CMV VL is associated with fetal sequalae in congenital CMV, with a higher VL conferring a greater risk for prenatal injury.
PubMed: 38610901
DOI: 10.3390/jcm13072136 -
The Journal of Maternal-fetal &... Dec 2021To compare short-term outcomes of infants born with thick versus thin meconium stained amniotic fluid (MSAF) and to perform a systematic review of the topic.
OBJECTIVE
To compare short-term outcomes of infants born with thick versus thin meconium stained amniotic fluid (MSAF) and to perform a systematic review of the topic.
METHODS
A retrospective, single center, cohort study of infants' ≥34 weeks' gestation born with MSAF between 1 June 2013 and 30 September 2016. Birth resuscitation and respiratory outcomes were compared between the groups. A systematic review was conducted of similar studies published between 1 January 2000 and 30 June 2019.
RESULTS
1507 infants were eligible; 464 (30.8%) thick, 1,043 (69.2%) thin MSAF. The thick group required more respiratory support at birth and was 5.5-fold (95% CI: 2.51-11.95) more likely to and have meconium aspiration syndrome (MAS) and 2.1-fold more likely (95% CI: 0.89-4.83) to require either noninvasive respiratory support or intubation than the thin group. The thick group also had significantly higher oxygen supplementation >24 h ( < .001) and pneumothorax ( = .002). Across 12 studies included in the systematic review, infants with thick MSAF required more intensive birth resuscitation, ventilation support, with higher incidences of MAS. Study differences prohibited data comparisons and quantitative outcome evaluations.
CONCLUSION
Infants with thick MSAF required more intensive birth resuscitation and ventilation support. Our findings need confirmation in robust, prospective cohort studies.
Topics: Amniotic Fluid; Cohort Studies; Humans; Infant; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Prospective Studies; Retrospective Studies
PubMed: 31900012
DOI: 10.1080/14767058.2019.1706476 -
Travel Medicine and Infectious Disease 2021To describe the maternal clinical characteristics, maternal and perinatal outcomes in COVID-19-positive pregnant women. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To describe the maternal clinical characteristics, maternal and perinatal outcomes in COVID-19-positive pregnant women.
METHODS
Articles in all languages on the SARS-CoV-2 infection in pregnant women were sought from MEDLINE, EMBASE, Cochrane Library and LILACS; China National Knowledge Infrastructure Database (CNKI), Chinese Science and Technology Periodical Database (VIP) and Wan Fang Data between December 1, 2019 and April 27, 2020. Bulletins and national reports were also searched.
RESULTS
From 12,168 retrieved articles, 143 were selected for full-text assessment; 33 for descriptive analyses, and 4 case-controls for meta-analysis. In 322 infected pregnant women, aged 20-45 years, the most frequent maternal comorbidity was obesity (24.2%). Forty-two (28.4%) were asymptomatic at admission. Cough (n = 148,59.7%) and fever (n = 147,59.3%) were the most prevalent symptoms. In the meta-analysis, fever (OR: 0.13,95% CI 0.05 to 0.36) and cough (0.26,95% CI 0.11 to 0.59) were lower in pregnant women with COVID-19 than non-pregnant women with COVID-19.195 (60.6%) delivered, and 125 (38.8%) remained pregnant during the study. Cesarean was reported in 99 (50.8%) women and vaginal delivery in 64 (32.8%). The main adverse obstetric outcome was premature birth (n = 37,18.9%). Thirty patients (10.3%) with COVID-19-related complications required intensive care, one (0.3%) died. SARS-CoV-2 was absent in breast milk, amniotic fluid, placenta or umbilical cord blood.
CONCLUSIONS
The maternal clinical characteristics of COVID-19-positive pregnant include frequently fever and cough; however significantly less frequently than non-pregnant women with COVID-19. Iatrogenic preterm birth is the main adverse obstetric outcome. Current data does not support vertical transmission in the third trimester.
Topics: COVID-19; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Risk; SARS-CoV-2
PubMed: 33220455
DOI: 10.1016/j.tmaid.2020.101919 -
American Journal of Infection Control May 2023To evaluate the safety and efficacy of COVID-19 vaccines in pregnant women performing an updated meta-analysis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the safety and efficacy of COVID-19 vaccines in pregnant women performing an updated meta-analysis.
METHODS
We searched PubMed, Cochrane Central, and SCOPUS from inception to March 2022. Outcomes of interest were incidence of adverse maternal, fetal and neonatal consequences pertaining to safety of the vaccines. Secondarily, we analyzed the number of SARS-CoV-2 infections, hospitalization for COVID-19, and admission to the I.C.U. for COVID-19 assessing the effectiveness of vaccines. Results were pooled using a random effects model.
RESULTS
Ten observational studies (n=326,499) analyzing pregnant women were included. Our results suggest that COVID-19 vaccination prevents infection (OR: 0.56, 95% CI: 0.47, 0.67; P = <0.00001) and related hospitalizations (OR: 0.50, 95% CI: 0.31, 0.82; P = 0.006) effectively. It was also observed that vaccination does not change adverse outcomes in pregnancy, namely preeclampsia or eclampsia, stroke (four weeks of delivery), meconium-stained amniotic fluid, spontaneous vaginal delivery, operative vaginal delivery, cesarean delivery, postpartum hemorrhage, and blood transfusions. Furthermore, the vaccine was observed to be protective against neonatal COVID-19 I.C.U. admissions (OR: 0.85; 95% CI: 0.81, 0.90; P = <0.00001).
CONCLUSION
Our pooled analysis suggests that the COVID-19 vaccination in pregnant women prevents infection effectively and has no adverse outcomes. Future large-scale trials in a randomized fashion are needed to confirm our results.
Topics: Infant, Newborn; Pregnancy; Female; Humans; COVID-19 Vaccines; COVID-19; SARS-CoV-2; Delivery, Obstetric; Cesarean Section
PubMed: 36007670
DOI: 10.1016/j.ajic.2022.08.014 -
Archives of Disease in Childhood. Fetal... Jan 2021We aimed to systematically review and analyse the outcomes of non-endotracheal suctioning (non-ETS) versus ETS in non-vigorous meconium-stained neonates. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We aimed to systematically review and analyse the outcomes of non-endotracheal suctioning (non-ETS) versus ETS in non-vigorous meconium-stained neonates.
DESIGN
We conducted a systematic review of non-ETS and ETS in non-vigorous infants born through meconium-stained amniotic fluid (MSAF). We searched PubMed/Medline, Scopus, Clinical Trials.gov, Cumulative Index to Nursing and Allied Health, and Cochrane Library databases from inception to November 2019, using keywords and related terms. Only non-vigorous infants born through MSAF included in randomised controlled trials, were included. We calculated overall relative risks (RRs) and mean differences with 95% CIs using a random-effects model, to determine the impact of ETS in non-vigorous infants born through MSAF.
MAIN OUTCOME MEASURES
The primary outcome was the incidence of meconium aspiration syndrome (MAS). Secondary outcomes were respiratory outcome measures (pneumothorax, persistent pulmonary hypertension of the newborn, secondary pneumonia, need for respiratory support, duration of mechanical ventilation), initial resuscitation and others including shock, perinatal asphyxia, convulsions, neonatal mortality, blood culture-positive sepsis and duration of hospital stay.
RESULTS
A total of 2085 articles were identified in the initial database search. Four studies, including 581 non-vigorous meconium-stained infants, fulfilled the inclusion criteria, comprising 292 infants in the non-ETS group and 289 in the ETS group. No statistically significant difference was found for MAS (RR 0.98; 95% CI 0.71 to 1.35).
CONCLUSIONS
Initiating ETS soon after birth in non-vigorous meconium-stained infants may not alter their neonatal outcomes.
Topics: Amniotic Fluid; Female; Humans; Infant, Newborn; Intubation, Intratracheal; Meconium; Meconium Aspiration Syndrome; Obstetric Labor Complications; Pregnancy; Randomized Controlled Trials as Topic; Respiratory Tract Diseases; Severity of Illness Index
PubMed: 32561566
DOI: 10.1136/archdischild-2020-318941 -
PloS One 2021The evidence for vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is not well established. Therefore, the objective of this review... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The evidence for vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is not well established. Therefore, the objective of this review is to summarize emerging evidence on the vertical transmission of Severe Acute Respiratory Syndrome Coronavirus 2.
METHODS
We conducted a systematic search in PubMed, CINAHL, Web of Science, SCOPUS, and CENTRAL. Likewise, a search for preprint publications was conducted using MedRxiv and Research Square. Studies that addressed vertical transmission of SARS-CoV-2 (concept) among pregnant women infected by Covid-19 (population) in any setting (community, hospital, or home) in any country or context were considered for inclusion. Any types of studies or reports published between December 2019 and September 2020 addressing the effects of SARS-CoV-2 on pregnant women and their newborn babies were included. Studies were screened for eligibility against the inclusion criteria for the review by two reviewers.
RESULTS
We identified 51 studies reporting 336 newborns screened for COVID-19. From the 336 newborns screened for COVID-19, only 15 (4.4%) were positive for throat swab RT-PCR. All neonates with positive throat swab RT-PCR were delivered by cesarean section. Among neonates with throat swab SARS-CoV-2 positive only five (33.3%) had concomitant placenta, amniotic fluid, and cord blood samples tested, of which only one amniotic fluid sample is positive for RT PCR. Five neonates had elevated IgG and IgM but without intrauterine tissue tested. Four neonates had chest imaging suggestive of COVID-19 pneumonia.
CONCLUSION
Currently there is not enough evidence on vertical virologic transmission of COVID-19 infection during the third trimester of pregnancy. Additionally, there is no evidence to support cesarean delivery, abstaining from breast feeding nor mother and infant separation. Further research involving an adequate sample size of breast milk, placenta, amniotic fluid, and cord blood to ascertain the possibility of vertical transmission and breast milk transfer is needed.
Topics: COVID-19; COVID-19 Nucleic Acid Testing; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Complications, Infectious; SARS-CoV-2
PubMed: 33886645
DOI: 10.1371/journal.pone.0250196 -
The Journal of Maternal-fetal &... Dec 2022To perform a systematic review of the literature available on the association between the presence of microbial invasion of the amniotic cavity (MIAC) and/or...
OBJECTIVE
To perform a systematic review of the literature available on the association between the presence of microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation and long-term neurodevelopmental outcomes of infants from pregnancies complicated by preterm prelabor rupture of membranes (PPROM).
METHODS
A literature search, from their earliest entries to May 2020, was performed by employing three electronic databases (Web of Science, PubMed, and Scopus). The selection criteria were as follows: (1) singleton pregnancies with PPROM; (2) available information regarding MIAC and/or intra-amniotic inflammation; (3) long-term (at least one year of the corrected age) neurodevelopmental outcomes of respective infants.
RESULTS
The initial search identified 10,953 articles, of which 8 were selected for full-text reading; however, none were included in the review owing to the following reasons: (i) spontaneous preterm labor with intact membranes and/or indicated (iatrogenic) preterm delivery were included in the studies without providing separate data for PPROM ( = 5); (ii) long-term, at least one year of the corrected age, neurodevelopmental outcomes of infants were not assessed ( = 1); (iii) the presence of both the abovementioned reasons ( = 1); (iv) amniotic fluid was not assessed, and a long-term neurodevelopmental outcome was not evaluated ( = 1).
CONCLUSION
The literature search provides evidence of a knowledge gap in the association between the presence of MIAC and/or intra-amniotic inflammation and long-term neurodevelopmental outcomes in infants with PPROM.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Chorioamnionitis; Fetal Membranes, Premature Rupture; Amniotic Fluid; Inflammation; Gestational Age
PubMed: 33781152
DOI: 10.1080/14767058.2021.1903859 -
Resuscitation Apr 2020The International Liaison Committee on Resuscitation sought to review the initial management of non-vigorous newborns delivered through meconium stained amniotic fluid... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
The International Liaison Committee on Resuscitation sought to review the initial management of non-vigorous newborns delivered through meconium stained amniotic fluid (MSAF).
OBJECTIVE
To complete a systematic review and meta-analysis comparing endotracheal intubation and suctioning to immediate resuscitation without intubation for non-vigorous infants born at ≥34 weeks gestation delivered through MSAF.
DATA SOURCES
Medline, EMBASE, the Cochrane Database of Systematic Reviews, and other registries were searched from 1966 to November 7, 2019.
STUDY SELECTION
Studies were selected by pairs of independent reviewers in 2 stages.
DATA EXTRACTION
Reviewers extracted data, appraised risk of bias, and assessed Grading of Recommendations Assessment, Development and Evaluation certainty of evidence for each outcome.
RESULTS
Four randomized controlled trials (RCTs) included 581 patients and one observational study included 231 patients. No significant differences were observed between the group treated with tracheal suctioning compared with immediate resuscitation for survival at discharge (4 RCTs; risk ratio [RR] = 1.01; 95 % CI, 0.96-1.06; p = 0.69; observational study; no deaths), hypoxic ischemic encephalopathy and meconium aspiration syndrome.
LIMITATIONS
The certainty of evidence was low for survival at discharge and very low for all other outcomes.
CONCLUSIONS
For non-vigorous newborns delivered through MSAF, there is insufficient evidence to suggest routine immediate direct laryngoscopy with tracheal suctioning.
PROSPERO
CRD42019122778.
CLINICAL TRIALS REGISTRATION
PROSPERO; CRD42019122778.
Topics: Amniotic Fluid; Humans; Infant; Infant, Newborn; Intubation, Intratracheal; Meconium; Meconium Aspiration Syndrome; Observational Studies as Topic; Suction
PubMed: 32097677
DOI: 10.1016/j.resuscitation.2020.01.038 -
Therapeutic Drug Monitoring Apr 2020Antipsychotics are being increasingly prescribed during pregnancy and in the postpartum period. However, knowledge regarding the ability of antipsychotics to enter the...
BACKGROUND
Antipsychotics are being increasingly prescribed during pregnancy and in the postpartum period. However, knowledge regarding the ability of antipsychotics to enter the fetal, newborn, and infant circulation presents inconsistencies. Evidence for penetration ratios in an array of matrices will contribute to further studies examining the mechanistic pathway from antipsychotic use to adverse events.
METHODS
A systematic literature search of PubMed and EMBASE was performed to identify studies assessing the concentrations of antipsychotics in maternal blood (serum or plasma), amniotic fluid, umbilical cord blood, and/or breast milk. The penetration ratios were estimated by dividing the antipsychotic concentrations in the target matrix (ie, amniotic fluid, umbilical cord blood or breast milk) by the maternal concentration. Data are provided in means with ranges or SD depending on data availability.
RESULTS
Forty-nine eligible studies were identified. For amniotic fluid, the penetration ratios were estimated for quetiapine, clozapine, and flupentixol, with quetiapine displaying the highest ratio (mean 0.59, range 0.09-1.70 versus 0.56, range 0.31-0.82 for clozapine and 0.24, range 0.23-0.24 for flupentixol). For umbilical cord blood, olanzapine had the highest ratio (mean 0.71 ± 0.42) followed by haloperidol (mean 0.66 ± 0.40) and paliperidone (mean 0.53, range 0.50-0.58). In case of breast milk, the highest ratio was observed for amisulpride (mean 14.42, range 11.86-19.50) followed by clozapine (mean 3.19, range 2.79-4.32) and haloperidol (mean 3.11, range 0.59-6.67).
CONCLUSIONS
The ability of antipsychotics to enter the fetal, newborn, and infant circulation varies considerably among antipsychotics. Given sampling constraints of other matrices, measuring antipsychotic concentrations in maternal blood may represent the least expensive, most readily available, and reliable estimate of fetal/infant exposure.
Topics: Amniotic Fluid; Antipsychotic Agents; Female; Fetal Blood; Humans; Milk, Human; Pregnancy; Prenatal Exposure Delayed Effects
PubMed: 31425493
DOI: 10.1097/FTD.0000000000000692 -
PloS One 2022Obstructed labor is one of the five major causes of maternal mortality and morbidity in developing countries. In Ethiopia, it accounts for 19.1% of maternal death. The... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Obstructed labor is one of the five major causes of maternal mortality and morbidity in developing countries. In Ethiopia, it accounts for 19.1% of maternal death. The current review aimed to assess maternal and perinatal outcomes of obstructed labor in Ethiopia.
METHODS
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for this systematic review and meta-analysis. A literature search was made using PubMed/MEDLINE, CINAHL, Summon country-specific search, and Cochrane Libraries' online databases. Search terms were adverse outcome, obstructed labor, maternal outcome, fetal outcome, and Ethiopia. The Newcastle-Ottawa scale (NOS), based on a star scoring system, was used to assess the quality of the included studies. The meta-analysis was conducted using STATA 16 software. The pooled prevalence of an adverse maternal outcome, fetal outcome, and association between adverse outcome and obstructed labor was calculated using a random-effects model. Egger's test and funnel plot were used to evaluate publication bias.
RESULT
Eighty-seven studies were included in this review, with an overall sample size of 104259 women and 4952 newborns. The pooled incidence of maternal death was estimated to be 14.4% [14.14 (6.91-21.37). The pooled prevalence of uterine rupture and maternal near-miss was 41.18% (95% CI: 19.83, 62.54) and 30.5% [30.5 (11.40, 49.59) respectively. Other complications such as postpartum hemorrhage, sepsis, obstetric fistula, hysterectomy, bladder injury, cesarean section, and labor abnormalities were also reported. The pooled prevalence of perinatal death was 26.4% (26.4 (95% CI 15.18, 37.7). In addition, the association of obstructed labor with stillbirth, perinatal asphyxia, and meconium-stained amniotic fluid was also demonstrated.
CONCLUSIONS
In Ethiopia, the incidence of perinatal and maternal mortality among pregnant women with obstructed labor was high. The rate of maternal death and maternal near miss reported in this review was higher than incidences reported from high-income and most low and middle-income countries. Uterine rupture, postpartum hemorrhage, sepsis, fistula, hysterectomy, and bladder injury were also commonly reported. To improve the health outcomes of obstructed labor, it is recommended to address the three delay models: enhancing communities' health-seeking behavior, enhancing transportation for an obstetric emergency with different stakeholders, and strengthening the capacity of health facilities to handle obstetric emergencies.
Topics: Cesarean Section; Dystocia; Ethiopia; Female; Humans; Infant, Newborn; Maternal Death; Postpartum Hemorrhage; Pregnancy; Sepsis; Uterine Rupture
PubMed: 36178921
DOI: 10.1371/journal.pone.0275400