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Journal de Gynecologie, Obstetrique Et... Dec 2014Study of epidemiology of pregnancy loss. (Review)
Review
OBJECTIVES
Study of epidemiology of pregnancy loss.
MATERIALS AND METHOD
A systematic review of the literature was performed using Pubmed and the Cochrane library databases and the guidelines from main international societies.
RESULTS
The occurrence of first trimester miscarriage is 12% of pregnancies and 25% of women. Miscarriage risk factors are ages of woman and man, body mass index greater than or equal to 25kg/m(2), excessive coffee drinking, smoking and alcohol consumption, exposure to magnetic fields and ionizing radiation, history of abortion, some fertility disorders and impaired ovarian reserve. Late miscarriage (LM) complicates less than 1% of pregnancies. Identified risk factors are maternal age, low level of education, living alone, history of previous miscarriage, of premature delivery and of previous termination of pregnancy, any uterine malformation, trachelectomy, existing bacterial vaginosis, amniocentesis, a shortened cervix and a dilated cervical os with prolapsed membranes. Fetal death in utero has a prevalence of 2% in the world and 5/1000 in France. Its main risk factors are detailed in the chapter.
Topics: Abortion, Spontaneous; Female; Fetal Death; Humans; Pregnancy; Pregnancy Outcome
PubMed: 25447360
DOI: 10.1016/j.jgyn.2014.09.011 -
Fetal Diagnosis and Therapy 2013To estimate the odds of severe cerebral injury and long-term neurodevelopmental impairment in monochorionic twins treated with amnioreduction versus laser surgery for... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
To estimate the odds of severe cerebral injury and long-term neurodevelopmental impairment in monochorionic twins treated with amnioreduction versus laser surgery for twin-twin transfusion syndrome.
METHODS
A systematic review and meta-analysis of studies on cerebral injury and long-term impairment after amnioreduction versus laser surgery were conducted. Odds ratios (OR) with their 95% confidence interval (CI) were computed.
RESULTS
Electronic and manual search identified 63 references. Five studies were included for analysis. We found an ample seven-fold higher risk of severe cerebral injury in live-born children treated with amnioreduction compared to laser (OR 7.69, 95% CI 2.78-20.0, p = 0.00). In children surviving the neonatal period, the odds were three-times higher following amnioreduction (OR 3.23, 95% CI 1.45-7.14, p = 0.00). Although not significant, monochorionic twins treated with amnioreduction had higher odds of periventricular leukomalacia and intraventricular hemorrhage (OR 2.08, 95% CI 0.86-5.00, p = 0.10 and OR 3.56, 95% CI 0.82-14.29, p = 0.09). Unfortunately, there were insufficient long-term outcome data available to estimate the odds of neurodevelopmental impairment.
CONCLUSION
Amnioreduction is associated with an increased risk of severe cerebral injury compared to laser surgery in twin-twin transfusion syndrome. Our study highlights a lack of studies focusing on long-term neurodevelopmental outcome. Follow-up into childhood is indispensable to determine outcome in terms of motor, cognitive and socioemotional development.
Topics: Amniocentesis; Brain Injuries; Cerebral Hemorrhage; Decompression, Surgical; Developmental Disabilities; Female; Fetofetal Transfusion; Humans; Infant, Newborn; Laser Coagulation; Leukomalacia, Periventricular; Odds Ratio; Pregnancy; Severity of Illness Index
PubMed: 22922370
DOI: 10.1159/000341814 -
The Cochrane Database of Systematic... Nov 2011Besides risks of miscarriage, pregnant women undergoing amniocentesis or chorionic villus sampling (CVS) are also concerned about pain associated with these procedures.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Besides risks of miscarriage, pregnant women undergoing amniocentesis or chorionic villus sampling (CVS) are also concerned about pain associated with these procedures. Currently, approaches to analgesia can be categorised in two broad categories - non-pharmacological and pharmacological agents.
OBJECTIVES
To evaluate whether different methods of analgesia have any impact on pain reduction during amniocentesis or chorionic villus sampling (CVS).
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2011).
SELECTION CRITERIA
All randomised trials comparing different method of analgesia for amniocentesis or CVS. We also include trials with quasi-randomised designs, but analyse and report their results separately.
DATA COLLECTION AND ANALYSIS
Both review authors assessed eligibility and trial quality and performed data extraction.
MAIN RESULTS
We included a total of five randomised studies (involving 805 women) evaluating different methods of analgesia for amniocentesis; there were no studies in women undergoing CVS.One RCT (N = 203) and one quasi-randomised study (N = 220) compared infiltrative local anaesthesia with no anaesthesia and found no statistical difference in experienced pain on the visual analogue scale (VAS) (mean differences (MD) -2.50 and 1.20; 95% confidence interval (CI) -6.98 to 1.98 and -2.67 to 5.07).One study (N = 200) compared light leg rubbing versus no intervention during amniocentesis and found no change in experienced anxiety (MD 0.2; 95% CI -0.63 to 1.03) or VAS pain score (MD 0.3; 95% CI -0.35 to 0.95) during amniocentesis.Another study with 62 patients did not find any benefit of using subfreezing temperature needle during amniocentesis in terms of decreased VAS pain score (MD -0.8; 95% CI -1.8 to 0.2). In addition, there was no difference between anticipated and actual pain (MD 0.4; 95% CI -0.82 to 1.62) (before/after comparison).There was also no difference in VAS pain scores in the study with 120 participants comparing lidocaine-prilocaine analgesic cream to placebo cream before amniocentesis (MD -0.6; 95% CI -1.44 to 0.24).
AUTHORS' CONCLUSIONS
In general, women who undergo amniocentesis could be informed that pain during procedure is minor and that there is currently insufficient evidence to support the use of local anaesthetics, leg rubbing or subfreezing the needle for pain reduction during procedure.
Topics: Amniocentesis; Analgesia; Anesthesia, Local; Chorionic Villi Sampling; Cryoanesthesia; Female; Humans; Lidocaine; Pain; Pregnancy; Prilocaine; Randomized Controlled Trials as Topic
PubMed: 22071854
DOI: 10.1002/14651858.CD008580.pub2 -
PloS One 2021Congenital CMV infection is the first worldwide cause of congenital viral infection but systematic screening of pregnant women and newborns for CMV is still debated in...
Current practices of management of maternal and congenital Cytomegalovirus infection during pregnancy after a maternal primary infection occurring in first trimester of pregnancy: Systematic review.
INTRODUCTION
Congenital CMV infection is the first worldwide cause of congenital viral infection but systematic screening of pregnant women and newborns for CMV is still debated in many countries.
OBJECTIVES
This systematic review aims to provide the state of the art on current practices concerning management of maternal and congenital CMV infection during pregnancy, after maternal primary infection (PI) in first trimester of pregnancy.
DATA SOURCES
Electronically searches on databases and hand searches in grey literature.
STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS
Primary outcome was listing biological, imaging, and therapeutic management interventions in two distinct populations: population 1 are pregnant women with PI, before or without amniocentesis; population 2 are pregnant women with congenitally infected fetuses (after positive amniocentesis). Secondary outcome was pregnancy outcome in population 2.
RESULTS
Out of 4,134 studies identified, a total of 31 studies were analyzed, with 3,325 pregnant women in population 1 and 1,021 pregnant women in population 2, from 7 countries (Belgium, France, Germany, Israel, Italy, Spain and USA). In population 1, ultrasound (US) examination frequency was 0.75/month, amniocentesis in 82% cases, maternal viremia in 14% and preventive treatment with hyperimmune globulins (HIG) or valaciclovir in respectively 14% and 4% women. In population 2, US examination frequency was 1.5/month, magnetic resonance imaging (MRI) in 44% cases at 32 weeks gestation (WG), fetal blood sampling (FBS) in 24% at 28 WG, and curative treatment with HIG or valaciclovir in respectively 9% and 8% patients.
CONCLUSIONS
This systematic review illustrates management of maternal and congenital CMV during pregnancy in published and non-published literature, in absence of international consensus.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42019124342.
Topics: Amniocentesis; Cytomegalovirus; Cytomegalovirus Infections; Disease Management; Female; Fetal Diseases; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Prenatal Diagnosis
PubMed: 34860861
DOI: 10.1371/journal.pone.0261011 -
The Cochrane Database of Systematic... 2000Amniocentesis test results are usually available only after 18 weeks gestation. Chorion villus sampling (CVS) may be performed transabdominally or transvaginally,... (Review)
Review
BACKGROUND
Amniocentesis test results are usually available only after 18 weeks gestation. Chorion villus sampling (CVS) may be performed transabdominally or transvaginally, usually between 10 and 12 weeks gestation.
OBJECTIVES
The objective of this review was to assess the safety and accuracy of chorion villus sampling compared to amniocentesis.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group trials register.
SELECTION CRITERIA
Randomised trials comparing first trimester chorion villus sampling and second trimester amniocentesis.
DATA COLLECTION AND ANALYSIS
Trial quality was assessed.
MAIN RESULTS
Three studies involving over 9000 women were included. The trials were generally of good quality. Compared to amniocentesis, chorion villus sampling was associated with more sampling and technical failures, and more false positive and false negative results. Pregnancy loss was more common after chorion villus sampling (odds ratio 1.33, 95% confidence interval 1.17 to 1.52). There is a suggestion (though not statistically significant) of an increase in stillbirths and neonatal deaths following chorion villus sampling. Maternal complications were uncommon.
REVIEWER'S CONCLUSIONS
The increase in miscarriages after chorion villus sampling compared to amniocentesis appear to be procedure related. Second trimester amniocentesis appears to be safer than chorion villus sampling. The benefits of earlier diagnosis with chorion villus sampling must be set against the greater risk of pregnancy loss.
Topics: Chorionic Villi Sampling; Female; Humans; Pregnancy; Randomized Controlled Trials as Topic; Risk
PubMed: 10796107
DOI: 10.1002/14651858.CD000055 -
The Cochrane Database of Systematic... Apr 1996Amniocentesis test results are usually available only after 18 weeks gestation. Chorion villus sampling (CVS) may be performed transabdominally or transvaginally,... (Review)
Review
BACKGROUND
Amniocentesis test results are usually available only after 18 weeks gestation. Chorion villus sampling (CVS) may be performed transabdominally or transvaginally, usually between 10 and 12 weeks gestation.
OBJECTIVES
The objective of this review was to assess the safety and accuracy of chorion villus sampling compared to amniocentesis.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group trials register.
SELECTION CRITERIA
Randomised trials comparing first trimester chorion villus sampling and second trimester amniocentesis.
DATA COLLECTION AND ANALYSIS
Trial quality was assessed.
MAIN RESULTS
Three studies involving over 9000 women were included. The trials were generally of good quality. Compared to amniocentesis, chorion villus sampling was associated with more sampling and technical failures, and more false positive and false negative results. Pregnancy loss was more common after chorion villus sampling (odds ratio 1.33, 95% confidence interval 1.17 to 1.52). There is a suggestion (though not statistically significant) of an increase in stillbirths and neonatal deaths following chorion villus sampling. Maternal complications were uncommon.
AUTHORS' CONCLUSIONS
The increase in miscarriages after chorion villus sampling compared to amniocentesis appear to be procedure related. Second trimester amniocentesis appears to be safer than chorion villus sampling. The benefits of earlier diagnosis with chorion villus sampling must be set against the greater risk of pregnancy loss.
Topics: Chorionic Villi Sampling; Female; Humans; Pregnancy; Randomized Controlled Trials as Topic; Risk
PubMed: 17636578
DOI: 10.1002/14651858.CD000055 -
American Journal of Obstetrics and... Mar 2015The aim of this study was to determine the diagnostic accuracy of comparative genomic hybridization (CGH) compared with karyotyping for the detection of numerical and... (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
The aim of this study was to determine the diagnostic accuracy of comparative genomic hybridization (CGH) compared with karyotyping for the detection of numerical and structural chromosomal alterations in prenatal diagnosis.
STUDY DESIGN
A metaanalysis was performed using searches of PubMed, EMBASE, CENTRAL, Cochrane Register of Diagnostic Test Accuracy Studies, Google Scholar, gray literature, and reference manuals. No language restriction was imposed. We included cross-sectional, cohort, and case-control studies published from January 1980 through March 2014 in the analysis. Studies of pregnant women who received chorionic villus biopsies, amniocentesis, or cordocentesis and then underwent CGH and karyotype analysis were included. Two independent reviewers assessed each study by title, abstract, and full text before its inclusion in the analysis. Methodological quality was assessed using QUADAS2, and a third reviewer resolved any disagreement. Conclusions were obtained through tests (sensitivity, specificity, and likelihood ratios) for the presence of numerical and structural chromosomal abnormalities. The reference used for these calculations was the presence of any abnormalities in either of the 2 tests (karyotype or CGH), although it should be noted that in most cases, the karyotyping test had a lower yield compared with CGH. Statistical analysis was performed in RevMan 5.2 and the OpenMeta[Analyst] program.
RESULTS
In all, 137 articles were found, and 6 were selected for inclusion in the systematic review. Five were included in the metaanalysis. According to the QUADAS2 analysis of methodology quality, there is an unclear risk for selection bias and reference and standard tests. In the other elements (flow, time, and applicability conditions), a low risk of bias was found. CGH findings were as follows: sensitivity 0.939 (95% confidence interval [CI], 0.838-0.979), I(2) = 82%; specificity 0.999 (95% CI, 0.998-1.000), I(2) = 0%; negative likelihood ratio 0.050 (95% CI, 0.015-0.173), I(2) = 0%; and positive likelihood ratio 1346.123 (95% CI, 389-4649), I(2) = 0%. Karyotype findings were as follows: sensitivity 0.626 (95% CI, 0.408-0.802), I(2) = 93%; specificity 0.999 (95% CI, 0.998-1.000), I(2) = 0%; negative likelihood ratio 0.351 (95% CI, 0.101-1.220), I(2) = 0%; and positive likelihood ratio 841 (95% CI, 226-3128), I(2) = 10%.
CONCLUSION
This systematic review provides evidence of the relative advantage of using CGH in the prenatal diagnosis of chromosomal and structural abnormalities over karyotyping, demonstrating significantly higher sensitivity with similar specificity.
Topics: Chromosome Aberrations; Chromosome Disorders; Comparative Genomic Hybridization; Female; Genetic Testing; Humans; Karyotyping; Pregnancy; Prenatal Diagnosis; Sensitivity and Specificity
PubMed: 25305409
DOI: 10.1016/j.ajog.2014.10.011 -
Fetal Diagnosis and Therapy 2009Pentasomy 49,XXXXY is a rare sex chromosome polysomy usually diagnosed postnatally by the combina- tion of mental retardation, facial dysmorphism, and genital, cardiac... (Review)
Review
OBJECTIVES
Pentasomy 49,XXXXY is a rare sex chromosome polysomy usually diagnosed postnatally by the combina- tion of mental retardation, facial dysmorphism, and genital, cardiac and skeletal malformations. Prenatal detection of 49,XXXXY is unusual and may be incidental due to non-specific ultrasound (US) findings. We report a case of 49,XXXXY diagnosed prenatally and present a literature review of the few prenatally diagnosed cases.
METHODS
We searched the PubMed electronic database without year and language restriction, using the keywords 'Prenatal', 'Diagnosis', and '49,XXXY', performing a systematic review.
RESULTS
We report a 35-year-old patient with normal first-trimester US but increased combined risk for trisomies 18 and 13. Amniocentesis at 16 weeks of gestation revealed a 49,XXXXY karyotype. Pregnancy was terminated at 19 weeks' gestation, and a male fetus with facial dysmorphism and hypospadia was delivered. A total of 12 articles were identified in the systematic review. All were case reports and dated from 1980 until 2008. The mean maternal age was 34.8 years (range 30-41). The most common prenatal US feature was cystic hygroma, present in 5 cases. Hypogenitalism was the most common macroscopic clinical feature identified after pathology examination in 7 cases. In 2 cases, there was an increase in first-trimester combined risk for trisomy 21.
CONCLUSIONS
Pentasomy 49,XXXXY is associated with a variety of non-specific US findings, of which cystic hygroma was the commonest. No specific sequence of findings could be identified in this review.
Topics: Adult; Amniocentesis; Aneuploidy; Female; Humans; Male; Pregnancy; Sex Chromosome Disorders
PubMed: 19816022
DOI: 10.1159/000236351 -
Journal of the Turkish German... 2016To perform a meta-analysis for an assessment of the risk of preeclampsia or gestational hypertension following chorionic villus sampling (CVS).
OBJECTIVE
To perform a meta-analysis for an assessment of the risk of preeclampsia or gestational hypertension following chorionic villus sampling (CVS).
DATA SOURCE
PubMed was systematically searched from its inception through January 2016.
MATERIAL AND METHODS
Nine reports were identified. A pre-specified scale was used to assess their quality.
TABULATION INTEGRATION AND RESULTS
We performed pooling into three subgroups with respect to the control group: A) Patients with no invasive prenatal diagnostic procedure served as a control group for comparison. The odds ratios for gestational hypertension (0.76, 95% CI 0.46-1.26), preeclampsia (0.83, 95% CI 0.42-1.67), and severe preeclampsia (0.49, 95% CI 0.04-5.78) or when hypertension categories were pooled (0.80, 95% CI 0.46-1.41) were not significantly different. B) Patients with midtrimester diagnostic amniocentesis and patients with no invasive prenatal diagnostic procedure were combined as a control group for comparison. The odds ratios for preeclampsia (1, 95% CI 0.46-2.18), severe preeclampsia (0.83, 95% CI 0.14-4.85), and pooled hypertension categories (1.07, 95% CI 0.63-1.84) were not significantly different. C) Patients with midtrimester diagnostic amniocentesis served as a control group. There was a significant difference in the odds ratio for preeclampsia between the CVS and amniocentesis groups (2.47, 95% CI 1.14-5.33). There was a marginal difference in the odds ratio for combined pregnancy-induced hypertension categories between the CVS and amniocentesis groups (1.61, 95% CI 1.02-2.53).
CONCLUSION
The available data do not indicate an increased risk of preeclampsia or gestational hypertension following first trimester CVS. The heterogeneity and retrospective design of existing studies are limiting factors for our analysis and findings.
PubMed: 27403071
DOI: 10.5152/jtgga.2016.16026 -
Journal of Obstetrics and Gynaecology... Jun 2006To assess the rate of fetal losses in twin pregnancies undergoing genetic mid-trimester amniocentesis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the rate of fetal losses in twin pregnancies undergoing genetic mid-trimester amniocentesis.
METHODS
In the first part of this investigation, a retrospective cohort study compared a group of women . 32 years old with twin pregnancies who underwent amniocentesis with a similar group unexposed to amniocentesis. Data were compiled from January 1990 to March 2004 for patients from a single institution. Pregnancies complicated by twin-to-twin transfusion syndrome, monoamniotic twins, or lethal fetal anomalies, and those treated by fetal reduction were excluded. The primary outcome was the loss of one or both fetuses prior to 24 weeks' gestation. In the second part of the investigation, a systematic review of the literature and a meta-analysis were performed.
RESULTS
In the first part of the study, data were collected for 132 women exposed to amniocentesis and 248 women not exposed to amniocentesis. There was no significant difference in the rate of fetal losses between the two groups (3.0% vs. 0.8%, P = 0.10). No losses occurred within four weeks of the procedure. In the second part of the investigation, four studies, including ours, were considered for a meta-analysis of 2026 women with twin pregnancies. Compared with women unexposed to the procedure, amniocentesis in women with twin pregnancies increased the risk of fetal losses prior to 20 to 24 weeks' gestation (odds ratio 2.42; 95% confidence intervals 1.24-4.74, P = 0.01) with an additional risk of one adverse outcome (1 or 2 fetal losses) for every 64 amniocenteses.
CONCLUSION
Genetic mid-trimester amniocentesis in twin pregnancies is associated.
Topics: Abortion, Spontaneous; Adult; Amniocentesis; Cohort Studies; Female; Gestational Age; Humans; Pregnancy; Pregnancy Trimester, Second; Pregnancy, Multiple; Retrospective Studies; Risk Factors; Twins
PubMed: 16857119
DOI: 10.1016/s1701-2163(16)32171-5