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Medicine Apr 2023Ectopic pregnancy (EP), one of the most common gynecological emergencies, is the major cause of maternal death in the first trimester and increases the incidence of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ectopic pregnancy (EP), one of the most common gynecological emergencies, is the major cause of maternal death in the first trimester and increases the incidence of infertility and repeat ectopic pregnancy (REP). The aim of this study was to compare the effects of different treatment methods for tubal EP on natural pregnancy outcomes.
METHODS
We systematically searched PubMed, Embase, Cochrane Library, Web of Science, and Clinical Trials for observational studies on EP (published until October 30,2022 in English) comparing methotrexate (MTX) versus surgery, MTX versus salpingostomy, MTX versus salpingectomy, salpingostomy versus salpingectomy, and MTX versus expectant treatment. Our main endpoints included subsequent natural intrauterine pregnancy (IUP) and REP. We assessed the pooled data using Review Manager software (version 5.3) with a random effects model.
RESULTS
Of 1274 identified articles, 20 were eligible and 3530 participants were included in our analysis. There was a significant difference in the odds of subsequent IUP in tubal EP patients who underwent MTX compared with those who were treated with surgery [odds ratios (OR) = 1.52, 95% confidence interval (CI):1.20-1.92]. No significant difference was found in the odds of REP between the 2 groups (OR = 1.12, 95% confidence interval [CI]: 0.84-1.51). There was no significant difference in the odds of subsequent IUP and REP in patients after MTX compared to those after salpingostomy (OR = 1.04,95% CI: 0.79-1.38; OR = 1.10, 95% CI: 0.64-1.90). There was a significant difference in the odds of subsequent IUP in patients after MTX compared with those after salpingectomy (OR = 2.11, 95% CI: 1.52-2.93). No significant difference was found in the odds of REP between the 2 groups (OR = 0.98, 95% CI: 0.57-1.71). There was a significant difference in the odds of subsequent IUP between patients who underwent salpingostomy and those who underwent salpingectomy (OR = 1.61, 95% CI: 1.29-2.01). No significant difference was found in the odds of REP between the 2 groups (OR = 1.21, 95% CI: 0.62-2.37). There was no significant difference in the odds of subsequent IUP and REP in patients after MTX compared with those after expectant treatment (OR = 1.25, 95% CI: 0.64-2.45; OR = 0.69, 95% CI: 0.09-5.55).
CONCLUSION
For hemodynamically stable tubal EP patients, MTX has advantages over surgery, particularly salpingectomy, in improving natural pregnancy outcomes. However, MTX is not inferior to salpingostomy and expectant treatment.
Topics: Pregnancy; Female; Humans; Pregnancy, Ectopic; Pregnancy, Tubal; Methotrexate; Salpingostomy; Pregnancy Outcome
PubMed: 37115078
DOI: 10.1097/MD.0000000000033621 -
Cureus Oct 2022From conception to childbirth, there are many physical, hormonal, and psychological changes that a woman undergoes during pregnancy. During this time, balance is also... (Review)
Review
From conception to childbirth, there are many physical, hormonal, and psychological changes that a woman undergoes during pregnancy. During this time, balance is also affected, resulting in symptoms like vertigo and unsteadiness. These symptoms can lead to physical impairment and disability and can develop at any time. Vertigo in pregnancy has not been extensively written about. The subject of a narrative review is vertigo in pregnant patients. In pregnant women, hormonal alterations in the peripheral tissues and inner ear organs may contribute to vertigo. Meniere's disease, mild convulsive positional dizziness, and oculomotor migraines are all commonly exacerbated by pregnancy. Between the second and third trimesters of pregnancy, specific modifications to proprioception and hearing are also detected during physical examination. Patients who are pregnant typically experience these symptoms throughout this time. Some vertigo conditions can worsen during pregnancy, while others can appear at any time. Understanding audio-vestibular symptoms' pathological and clinical relationship during pregnancy requires more study.
PubMed: 36337796
DOI: 10.7759/cureus.29814 -
BMJ Open Mar 2023To identify the association between maternal SARS-CoV-2 infection in pregnancy and individual neonatal morbidities and outcomes, particularly longer-term outcomes such...
OBJECTIVES
To identify the association between maternal SARS-CoV-2 infection in pregnancy and individual neonatal morbidities and outcomes, particularly longer-term outcomes such as neurodevelopment.
DESIGN
Systematic review of outcomes of neonates born to pregnant women diagnosed with a SARS-CoV-2 infection at any stage during pregnancy, including asymptomatic women.
DATA SOURCES
MEDLINE, Embase, Global Health, WHOLIS and LILACS databases, last searched on 28 July 2021.
ELIGIBILITY CRITERIA
Case-control and cohort studies published after 1 January 2020, including preprint articles were included. Study outcomes included neonatal mortality and morbidity, preterm birth, caesarean delivery, small for gestational age, admission to neonatal intensive care unit, level of respiratory support required, diagnosis of culture-positive sepsis, evidence of brain injury, necrotising enterocolitis, visual or hearing impairment, neurodevelopmental outcomes and feeding method. These were selected according to a core outcome set.
DATA EXTRACTION AND SYNTHESIS
Data were extracted into Microsoft Excel by two researchers, with statistical analysis completed using IBM SPSS (Version 27). Risk of bias was assessed using a modified Newcastle-Ottawa Scale.
RESULTS
The search returned 3234 papers, from which 204 were included with a total of 45 646 infants born to mothers with SARS-CoV-2 infection during pregnancy across 36 countries. We found limited evidence of an increased risk of some neonatal morbidities, including respiratory disease. There was minimal evidence from low-income settings (1 study) and for neonatal outcomes following first trimester infection (17 studies). Neonatal mortality was very rare. Preterm birth, neonatal unit admission and small for gestational age status were more common in infants born following maternal SARS-CoV-2 infection in pregnancy in most larger studies.
CONCLUSIONS
There are limited data on neonatal morbidity and mortality following maternal SARS-CoV-2 infection, particularly from low-income countries and following early pregnancy infections. Large, representative studies addressing these outcomes are needed to understand the consequences for babies born to women with SARS-CoV-2.
PROSPERO REGISTRATION NUMBER
CRD42021249818.
Topics: Infant; Infant, Newborn; Pregnancy; Female; Humans; COVID-19; Premature Birth; SARS-CoV-2; Cesarean Section; Infant Mortality; Fetal Growth Retardation; Pregnancy Outcome; Pregnancy Complications, Infectious
PubMed: 36921946
DOI: 10.1136/bmjopen-2022-063052 -
Placenta Aug 2022Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has been implicated in the clinical pathology of... (Review)
Review
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has been implicated in the clinical pathology of multiple organs and organ systems. Due to the novelty of the disease, there is a need to review emerging literature to understand the profile of SARS-CoV-2 in the placenta. This review sought to evaluate the literature on the mediators, mechanism of entry, pathogenesis, detection, and pathology of SARS-CoV-2 in the placenta. Systematic literature searches found 96 eligible studies. Our review revealed that SARS-CoV-2 canonical mediators, angiotensin-converting enzyme-2 (ACE2), and transmembrane serine protease-2 (TMPRSS2) are variably expressed in various placenta compartments, including the villous cytotrophoblasts, syncytiotrophoblasts (STBs), and extravillous trophoblasts (EVTs) throughout pregnancy. Placental SARS-CoV-2 and coronavirus-associated receptors and factors (SCARFs), including basigin (BSG/CD147), dipeptidyl peptidase-4 (DPP4/CD26), cathepsin B/L (CTL B/L), furin, interferon-induced transmembrane protein (IFITM1-3), and lymphocyte antigen 6E (LY6E) may increase or reduce the permissiveness of the placenta to SARS-CoV-2. EVTs express genes that code for proteins that may drive viral pathogenesis in the placenta. Viral RNA, proteins, and particles were detected primarily in the STBs by in situ hybridization, immunohistochemistry, electron microscopy, and polymerase chain reaction. Placental pathology in SARS-CoV-2-infected placentas included maternal and fetal vascular malperfusion and a generally nonspecific inflammatory-immune response. The localization of SARS-CoV-2 receptors, proteases, and genes involved in coding proteins that drive viral pathogenesis in the placenta predisposes the placenta to SARS-CoV-2 infection variably in all pregnancy trimesters, with antecedent placental pathology. There is a need for further studies to explicate the mechanism of entry and pathogenesis of SARS-CoV-2 in the placenta.
Topics: COVID-19; Female; Humans; Placenta; Pregnancy; Pregnancy Complications, Infectious; SARS-CoV-2; Trophoblasts
PubMed: 35872511
DOI: 10.1016/j.placenta.2022.07.007 -
Environmental Research Jul 2021Exposure to ozone has been linked to reproductive outcomes, including preterm birth. In this systematic review, we summarize published epidemiologic cohort and... (Meta-Analysis)
Meta-Analysis Review
Exposure to ozone has been linked to reproductive outcomes, including preterm birth. In this systematic review, we summarize published epidemiologic cohort and case-control studies examining ozone exposures (estimated on a continuous scale) in early pregnancy (1st and 2nd trimesters (T1, T2)) and preterm birth using ratio measures, and perform a meta-analysis to evaluate the potential relationship between them. Studies were identified by searching PubMed and Web of Science, screened according to predefined inclusion/exclusion criteria, and evaluated for study quality. We extracted study data including effect estimates, confidence limits, study location, study years, ozone exposure assessment method, and mean or median ozone concentrations. Nineteen studies were identified and included, of which 18 examined T1 exposure (17 reported effect estimates), and 15 examined T2 exposure. Random effects meta-analysis was performed in the metafor package, R 3.5.3. The pooled OR (95% CI) for a 10 ppb increase in ozone exposure in T1 was 1.06 (1.03, 1.10) with a 95% prediction interval of 0.95, 1.19; for T2 it was 1.05 (1.02, 1.08) with a 95% prediction interval of 0.95, 1.16. Effect estimates for both exposure periods showed high heterogeneity. In meta-regression analyses of study characteristics, study location (continent) explained some (~20%) heterogeneity for T1 exposure studies, but no characteristic explained a substantial amount of heterogeneity for T2 exposure studies. Increased ozone exposure during early pregnancy is associated with preterm birth across studies.
Topics: Air Pollutants; Air Pollution; Female; Humans; Infant, Newborn; Ozone; Particulate Matter; Pregnancy; Pregnancy Outcome; Premature Birth
PubMed: 33989623
DOI: 10.1016/j.envres.2021.111317 -
Archives of Gynecology and Obstetrics Mar 2023To evaluate the impact of endocervical and decidual polypectomy on obstetrical outcomes of pregnant women. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To evaluate the impact of endocervical and decidual polypectomy on obstetrical outcomes of pregnant women.
METHODS
MEDLINE, Scopus, ClinicalTrials.gov, Scielo, EMBASE, Cochrane Library at the CENTRAL Register of Controlled Trials, and LILACS were searched from inception to April 2021. No language or geographical restrictions were applied. Inclusion criteria regarded observational studies concerning pregnant women with a cervical lesion who underwent cervical polypectomy. Co-primary outcomes were incidence of late pregnancy loss and preterm birth in women with endocervical or decidual polypectomy as well as polypectomy versus expectant management. Random effect meta-analyses to calculate risk ratio (RR) with 95% confidence interval (CI) were performed. Quality assessment of included papers was performed using Newcastle-Ottawa Scale criteria.
RESULTS
Three studies, with data provided for 3097 women, were included in quantitative analysis, with comparisons between endocervical and decidual polyps extracted from two studies and 156 patients. After a first trimester endocervical or decidual polypectomy, no significant differences were found for late pregnancy losses (RR 0.29 [95% CI 0.05, 1.80], I = 11%). Risk for preterm birth was significantly higher for decidual polyps' removal (RR 6.13 [95% CI 2.57, 14.59], I = 0%). One paper compared cervical polypectomy vs expectant management, with increased incidence of late pregnancy loss (4/142 vs 5/2799; p < 0.001) and preterm birth (19/142 vs 115/2799; p < 0.001) in women subjected to polypectomy.
CONCLUSIONS
Evidence regarding the removal of cervical polyps in pregnancy is extremely limited. However, the removal of either decidual or endocervical polyps seems associated with increased risk of pregnancy loss and preterm birth, with increased preterm birth risk following endocervical rather than decidual polypectomy.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Premature Birth; Abortion, Spontaneous; Cervix Uteri; Uterine Cervical Diseases
PubMed: 35396972
DOI: 10.1007/s00404-022-06550-z -
Medicina (Kaunas, Lithuania) Nov 2021: Since spontaneous uterine rupture in the mid-trimester is rare, maternal and fetal outcomes in subsequent pregnancies remain unclear. Therefore, this study aimed to... (Review)
Review
: Since spontaneous uterine rupture in the mid-trimester is rare, maternal and fetal outcomes in subsequent pregnancies remain unclear. Therefore, this study aimed to examine the maternal and fetal outcomes of subsequent pregnancies after prior mid-trimester uterine rupture. : A systematic review using PubMed, the Cochrane Central Register of Controlled Trials, and Scopus until 30 September 2021, was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The studies that clarified the maternal and fetal outcomes after prior mid-trimester uterine rupture and our case ( = 1) were included in the analysis. : Among the eligible cases, there were five women with eight subsequent pregnancies after prior mid-trimester uterine rupture. The timing of prior mid-trimester uterine rupture ranged from 15 to 26 weeks of gestation. The gestational age at delivery in subsequent pregnancies was 23-38 gestational weeks. Among the included cases ( = 8), those involving prior mid-trimester uterine rupture appeared to be associated with an increased prevalence of placenta accreta spectrum (PAS) ( = 3, 37.5%) compared with those involving term uterine rupture published in the literature; moreover, one case exhibited recurrent uterine rupture at 23 weeks of gestation (12.5%). No maternal deaths have been reported in subsequent pregnancies following prior mid-trimester uterine rupture. Fetal outcomes were feasible, except for one pregnancy with recurrent mid-trimester uterine rupture at 23 weeks of gestation, whose fetus was alive complicated by cerebral palsy. : Our findings suggest that clinicians should be aware of the possibility of PAS and possible uterine rupture in pregnancies after prior mid-trimester uterine rupture. Further case studies are warranted to assess maternal and fetal outcomes in pregnancies following prior mid-trimester prior uterine rupture.
Topics: Female; Fetus; Gestational Age; Humans; Placenta Accreta; Pregnancy; Uterine Rupture
PubMed: 34946239
DOI: 10.3390/medicina57121294 -
Nutrition Reviews Mar 2021Contrary to nutritional guidelines, accumulating evidence shows that pregnant women's energy intakes remain stable throughout trimesters. Although pregnant women may eat...
CONTEXT
Contrary to nutritional guidelines, accumulating evidence shows that pregnant women's energy intakes remain stable throughout trimesters. Although pregnant women may eat below their needs or underreport their energy intakes, it is also relevant to question how energy requirements - estimated through measurements of energy expenditure (EE) - change throughout pregnancy.
OBJECTIVE
This review examined prospective studies that measured EE during pregnancy, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
DATA SOURCES
PubMed/MEDLINE, Web of Science, Embase, and CINAHL databases were searched to identify relevant publications up to November 14, 2019.
STUDY SELECTION
All studies that measured EE prospectively and objectively during pregnancy were included in this systematic review. Two authors independently screened 4852 references. A total of 32 studies were included in the final analysis.
DATA EXTRACTION
One author extracted data and assessed the risk of bias and a second author did so for a random sample of studies (n = 7; 22%).
DATA ANALYSIS
Increases in resting EE ranged from 0.5% to 18.3% (8-239 kcal), from 3.0% to 24.1% (45-327 kcal), and from 6.4% to 29.6% (93-416 kcal) between early and mid-, mid- and late, and early and late pregnancy, respectively. Increases in total EE ranged from 4.0% to 17.7% (84-363 kcal), from 0.2% to 30.2% (5-694 kcal), and from 7.9% to 33.2% (179-682 kcal) between early and mid-, mid- and late, and early and late pregnancy, respectively. Participants were mainly of normal weight, although many studies did not report important covariates such as prepregnancy body mass index and gestational weight gain adequacy.
CONCLUSIONS
Additional high-quality longitudinal studies (ie, with multiple objective measurements of EE in all periods of pregnancy while considering important confounding variables, like gestational weight gain) are required.
Topics: Energy Metabolism; Female; Humans; Maternal Nutritional Physiological Phenomena; Pregnancy
PubMed: 32974660
DOI: 10.1093/nutrit/nuaa093 -
Epilepsia Open Dec 2023Several reports have described the autoimmune encephalitis' (AE) possible onset during pregnancy. In this systematic review, we summarize the available data on the... (Review)
Review
Several reports have described the autoimmune encephalitis' (AE) possible onset during pregnancy. In this systematic review, we summarize the available data on the diagnostic and therapeutic approach to AE during pregnancy, highlighting the associated maternal and fetal clinical outcomes. A systematic search of the literature was performed. The following databases were used: PubMed, Google Scholar, EMBASE, and CrossRef. The revision was registered on the PROSPERO platform (CRD42022336357). Forty-nine patients were included. AE onset was mainly observed during the first and the second trimester of pregnancy with psychiatric manifestations and seizures as main onset symptoms. CSF analysis showed AE-specific autoantibody positivity in 33 patients (anti-NMDA receptor as the most frequent). EEG generally showed normal findings. MRI revealed pathological findings in less than half of patients. Tumor screening was positive in 14 cases. First-line immunotherapy (single or combined) was generally employed while second line was administered in a minority of patients. Levetiracetam was the most used antiseizure medication. Cesarean section was performed in 18 women. Most of the women had an excellent early outcome after delivery but 22 showed persistent neurological deficits in long-term follow-up. Fetal outcome was positive in 33 cases, whereas 12 cases of fetal death were reported. A logistic regression showed that no variable significantly influenced the odds of good/bad maternal and fetal clinical outcome. Diagnosis and treatment of AE during pregnancy is challenging. The rate of miscarriage in women with AE seems to be higher than the general population. In addition, mothers may show long-term neurological deficits.
Topics: Humans; Pregnancy; Female; Cesarean Section; Encephalitis; Abortion, Spontaneous; Autoimmune Diseases of the Nervous System
PubMed: 37562964
DOI: 10.1002/epi4.12806 -
Viruses Mar 2022This systematic review summarizes current knowledges about maternal and neonatal outcomes following COVID-19 vaccination during pregnancy and breastfeeding. ( PubMed,... (Review)
Review
This systematic review summarizes current knowledges about maternal and neonatal outcomes following COVID-19 vaccination during pregnancy and breastfeeding. ( PubMed, Cochrane Library, and the Education Resources Information Center (ERIC) were searched up to 27 October 2021. The primary outcome was to estimate how many pregnant and lactating women were reported to be vaccinated and had available maternal and neonatal outcomes. Forty-five studies sourcing data of 74,908 pregnant women and 5098 lactating women who received COVID-19 vaccination were considered as eligible. No major side-effects were reported, especially during the second and third trimester of pregnancy and during breastfeeding. Conversely, available studies revealed that infants received specific SARS-CoV-2 antibodies after maternal vaccination. Vaccination against the SARS-CoV-2 virus should be recommended for pregnant women, after the pros and cons have been adequately explained. In particular, given the still limited evidence and considering that fever during the first months of gestation increases the possibility of congenital anomalies, they should be carefully counseled. The same considerations apply to breastfeeding women, also considering the immune responses that mRNA vaccines can generate in their human milk.
Topics: Breast Feeding; COVID-19; COVID-19 Vaccines; Female; Humans; Infant; Infant, Newborn; Lactation; Pregnancy; SARS-CoV-2
PubMed: 35336947
DOI: 10.3390/v14030539