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The Cochrane Database of Systematic... 2000A major disadvantage of amniocentesis is that test results are usually available only after 18 weeks gestation. Early amniocentesis can now be done between 9 to 14 weeks... (Review)
Review
BACKGROUND
A major disadvantage of amniocentesis is that test results are usually available only after 18 weeks gestation. Early amniocentesis can now be done between 9 to 14 weeks gestation.
OBJECTIVES
The objective was to assess the safety and accuracy of early amniocentesis compared with chorion villus sampling.
SEARCH STRATEGY
The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: October 1998.
SELECTION CRITERIA
Randomised trials comparing early amniocentesis with transabdominal chorion villus sampling.
DATA COLLECTION AND ANALYSIS
One reviewer assessed eligibility and trial quality.
MAIN RESULTS
Three studies were included. Sampling failure was 0.4% in the early amniocentesis group compared to 2% in the chorion villus group (relative risk 0.23, 95% confidence interval 0.08 to 0.65). Consequently, more women in the chorion villus sampling group needed a second prenatal diagnostic test (relative risk 0.43, 95% confidence interval 0.21 to 0.88). There were no statistically significant differences in the laboratory failures (relative risk 0.43, 95% confidence interval 0. 17 to 1.10) or number of women with various chromosomal abnormalities (relative risk 0.51, 95% confidence interval 0.26 to 1. 04). Combined total pregnancy loss in the early amniocentesis group was 6.2% (57/915) compared with 5% (46/917) in the chorion villus sampling group (relative risk 1.24, 95% confidence interval 0.85 to 1.81). There were more spontaneous miscarriages after early amniocentesis (4.4% versus 2.3%, relative risk 1.92, 95% confidence interval 1.14 to 3.23). There was no difference in the incidence of neonatal respiratory distress and anomalies in the newborn infants. The incidence of talipes was greater in the early amniocentesis group, although haemangiomas were more common in the chorion villus sampling group.
REVIEWER'S CONCLUSIONS
Current data suggest that early amniocentesis is associated with a greater risk of spontaneous miscarriage and neonatal talipes compared to transabdominal chorion villus sampling. An increased risk of these complications needs to be weighed against fewer technical difficulties and the possibility of fewer neonatal haemangiomas.
Topics: Amniocentesis; Chorionic Villi Sampling; Female; Humans; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 10796116
DOI: 10.1002/14651858.CD000077 -
Archives of Gynecology and Obstetrics Aug 2016Cell free DNA (cfDNA) testing has evolved as an important tool in prenatal screening for trisomy 21. It can also be used in screening for monosomy X. We perform a... (Review)
Review
OBJECTIVE
Cell free DNA (cfDNA) testing has evolved as an important tool in prenatal screening for trisomy 21. It can also be used in screening for monosomy X. We perform a systemic review to determine the detection and false positive in screening for monosomy X and demonstrate a case that offers two possible explanations for the lower screening performance compared to trisomy 21.
CASE
A 31-year-old primigravida was referred to us due to an abnormal cfDNA test indicating monosomy X. However, the genitalia was male. An amniocentesis was done that indicated 46,X,idic(Y)(q11.21). SNP array analysis confirmed the Ypter-q11.21 duplication. A phenotypically normal male baby was born at 40 weeks. Postnatal karyotyping of several pregnancy tissues was carried out. While in most samples the karyotype was 46,X,idic(Y)(q11.21), in the four placenta samples and in the amniotic membranes there was mosaicism of 46,X,idic(Y)(q11.21) and 45,X.
DATA SOURCES
A search of the Medline and Embase database was done for articles about screening for monosomy X by cfDNA. We performed a systematic review to assess the detection and false-positive rate.
RESULTS
Seven studies fulfilled the inclusion criteria. In summary, there were 153 pregnancies with monosomy X and 4116 euploid ones. The detection and false-positive rate was 94.1 and 0.53 %.
CONCLUSION
Although the performance of cfDNA in prenatal screening for monosomy X is better than any other screening test, it is not comparable with invasive testing. One should be aware of the limitations especially if the ultrasound examination is contradictory with the cfDNA results.
Topics: Adult; Amniocentesis; DNA; Down Syndrome; Female; Humans; Karyotype; Karyotyping; Male; Mosaicism; Pregnancy; Prenatal Diagnosis; Turner Syndrome
PubMed: 27022934
DOI: 10.1007/s00404-016-4077-y -
International Journal of Clinical... Jun 2008The aim of this systematic review is to summarise and critically evaluate the evidence for the effectiveness of reiki. (Review)
Review
INTRODUCTION
The aim of this systematic review is to summarise and critically evaluate the evidence for the effectiveness of reiki.
METHODS
We searched the literature using 23 databases from their respective inceptions through to November 2007 (search again 23 January 2008) without language restrictions. Methodological quality was assessed using the Jadad score.
RESULTS
The searches identified 205 potentially relevant studies. Nine randomised clinical trials (RCTs) met our inclusion criteria. Two RCTs suggested beneficial effects of reiki compared with sham control on depression, while one RCT did not report intergroup differences. For pain and anxiety, one RCT showed intergroup differences compared with sham control. For stress and hopelessness a further RCT reported effects of reiki and distant reiki compared with distant sham control. For functional recovery after ischaemic stroke there were no intergroup differences compared with sham. There was also no difference for anxiety between groups of pregnant women undergoing amniocentesis. For diabetic neuropathy there were no effects of reiki on pain. A further RCT failed to show the effects of reiki for anxiety and depression in women undergoing breast biopsy compared with conventional care.
DISCUSSION
In total, the trial data for any one condition are scarce and independent replications are not available for each condition. Most trials suffered from methodological flaws such as small sample size, inadequate study design and poor reporting.
CONCLUSION
In conclusion, the evidence is insufficient to suggest that reiki is an effective treatment for any condition. Therefore the value of reiki remains unproven.
Topics: Anxiety Disorders; Depressive Disorder; Female; Humans; Male; Pain; Practice Patterns, Physicians'; Randomized Controlled Trials as Topic; Stress, Psychological; Therapeutic Touch; Treatment Outcome
PubMed: 18410352
DOI: 10.1111/j.1742-1241.2008.01729.x -
Acta Obstetricia Et Gynecologica... Nov 2020Emergency cerclage is the most common active intervention in pregnant women with cervical insufficiency. This meta-analysis aimed to compare the effectiveness of... (Comparative Study)
Comparative Study Meta-Analysis
INTRODUCTION
Emergency cerclage is the most common active intervention in pregnant women with cervical insufficiency. This meta-analysis aimed to compare the effectiveness of emergency cerclage vs expectant management on maternal and perinatal outcomes, and to assess the current status of evidence.
MATERIAL AND METHODS
A search was conducted from 1 June 2019 until 1 September 2019 and eligible studies were identified in the MEDLINE, Scopus, Cochrane and US clinical trials registry without limitations concerning the publication dates and languages. Randomized controlled trials (RCTs), non-RCTs and observational studies comparing emergency cerclage with no cerclage/expectant management, in women presenting with painless cervical dilatation were included.
RESULTS
The electronic search yielded 3607 potential studies, of which 38 were fully reviewed and 12 observational studies (1021 participants) were included. Cerclage was superior to expectant management for the primary outcomes of preterm birth before 28 and 32 gestational weeks, OR 0.25 (95% CI 0.16-0.39, five studies, N = 392, I = 41%, low quality) and 0.08 (95% CI 0.02-0.29, four studies, N = 176, I = 51%, low quality), respectively. Cerclage was also superior to expectant management for the secondary outcomes of fetal loss OR 0.26 (95% CI 0.12-0.56, 8 studies, N = 455, I = 46%, very low-quality), pregnancy prolongation in days mean difference 47.45 (95% CI 39.89-55.0, 12 studies, N = 1027 I = 86%, very low quality), gestational age at birth in weeks mean difference 5.68 (95% CI 4.69-6.67, 9 studies, N = 892, I = 73%, very low quality), admission to neonatal intensive care OR 0.21 (95% CI 0.07-0.70, two studies, N = 79, I = 36%, very low quality) and neonatal death OR 0.12 (95% CI 0.04-0.34, five studies, N = 130, I = 0%, very low quality). There were no differences between cerclage and expectant management concerning premature rupture of membranes during or after the procedure OR 0.68 (95% CI 0.31-1.48, two studies, N = 155, I = 85%, very low quality) and chorioamnionitis OR 1.14 (95% CI 0.31-4.25, three studies, N = 88, I = 33%, very low quality).
CONCLUSIONS
Emergency cerclage in pregnant women with painless cervical dilatation seems to decrease preterm births, prolong the pregnancy, and decrease the neonatal deaths and fetal losses, but does not increase the risk of chorioamnionitis and premature rupture of membranes. Despite the extremely favorable estimates for cerclage, the results should be viewed with caution because, as a result of the lack of randomized control trials, the quality of evidence is low to very low.
Topics: Cerclage, Cervical; Emergencies; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Intensive Care, Neonatal; Pregnancy; Premature Birth; Treatment Outcome; Uterine Cervical Incompetence; Watchful Waiting
PubMed: 32757297
DOI: 10.1111/aogs.13968 -
Journal of Obstetrics and Gynaecology... Nov 2003To provide information regarding the use of folic acid for the prevention of neural tube defects (NTDs) and other congenital anomalies, in order that physicians,... (Review)
Review
OBJECTIVE
To provide information regarding the use of folic acid for the prevention of neural tube defects (NTDs) and other congenital anomalies, in order that physicians, midwives, nurses, and other health-care workers can assist in the education of women in the preconception phase of their health care. OPTION: Folic acid supplementation is problematic, since 50% of pregnancies are unplanned and the health status of women may not be optimal.
OUTCOMES
Folic acid supplementation has been proven to decrease or minimize specific birth defects.
EVIDENCE
A systematic review of the literature, including review and peer-reviewed articles, government publications, the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) Policy Statement of March 1993, and statements from the American College of Obstetrics and Gynecology, was used to develop a new clinical practice guideline for the SOGC.
VALUES
Peer-review process within the committee structure.
BENEFITS, HARMS, AND COSTS
The benefit is reduced lethal and severe morbidity birth defects and the harm is minimal. The personal cost is of vitamin supplementation on a daily basis and eating a healthy diet.
RECOMMENDATIONS
1. Women in the reproductive age group should be advised about the benefits of folic acid supplementation during wellness visits (birth control renewal, Pap testing, yearly examination), especially if pregnancy is contemplated. (III-A) 2. Women should be advised to maintain a healthy nutritional diet, as recommended in Canada's Food Guide to Healthy Eating (good or excellent sources of folic acid: broccoli, spinach, peas, Brussels sprouts, corn, beans, lentils, oranges). (III-A) 3. Women who could become pregnant should be advised to take a multivitamin containing 0.4 mg to 1.0 mg of folic acid daily. (II-1A) 4. Women taking a multivitamin with folic acid supplement should be advised not to take more than 1 daily dose of vitamin supplement, as indicated on the product label. (II-2A) 5. Women in intermediate- to high-risk categories for NTDs (NTD-affected previous pregnancy, family history, insulin-dependent diabetes, epilepsy treatment with valproic acid or carbamazepine) should be advised that high-dose folic acid (4.0 mg-5.0 mg daily) supplementation is recommended. This should be taken as folic acid alone, not in a multivitamin format, due to risk of excessive intake of other vitamins such as vitamin A. (I-A) 6. The choice of a 5 mg folic acid daily dose for women considering a pregnancy should be made under medical supervision after minimizing the risk of undiagnosed vitamin B12 deficiency (hypersegmentation of polymorphonuclear cells, macrocystic indices, large ovalocytes, leukopenia, thrombocytopenia, markedly elevated lactate dehydrogenase level, confirmed red blood cell folate level). (II-2A) 7. Signs or symptoms of vitamin B12 deficiency should be considered before initiating folic acid supplementation of doses greater than 1.0 mg. (III-A) 8. A three-generation pedigree on the families of both the pregnant woman and the biological father should be obtained to identify increased risk for congenital birth defects (i.e., NTD, cardiac, chromosomal, genetic). (III-A) 9. Women who become pregnant should be advised of the availability of noninvasive screening tests and invasive diagnostic tests for congenital birth defects (including NTDs): maternal serum "triple marker screen" at 15 to 20 weeks, ultrasound at 16 to 20 weeks, and amniocentesis after 15 weeks of pregnancy if a positive screening test is present. (I-A) VALIDATION: This is a revision of a previous guideline and information from other consensus reviews from medical and government publications has been used.
Topics: Canada; Congenital Abnormalities; Female; Folic Acid; Humans; Neural Tube Defects; Pregnancy; Prenatal Care
PubMed: 14608448
DOI: 10.1016/s1701-2163(16)30248-1 -
Prenatal Diagnosis Dec 2017To review the literature for survival and phenotypes of liveborns with autosomal monosomy to inform decisions regarding transfer of in vitro fertilization-derived... (Review)
Review
Should embryos with autosomal monosomy by preimplantation genetic testing for aneuploidy be transferred?: Implications for embryo selection from a systematic literature review of autosomal monosomy survivors.
OBJECTIVE
To review the literature for survival and phenotypes of liveborns with autosomal monosomy to inform decisions regarding transfer of in vitro fertilization-derived embryos reported as monosomic on preimplantation genetic testing for aneuploidy (PGT-A).
METHOD
Ovid-Medline and EMBASE were systematically searched to identify published case reports of liveborn individuals with autosomal monosomy, full or mosaic, for a whole chromosome.
RESULTS
Fifty-three reports describing 56 individuals with autosomal monosomy met the selection criteria: 1 case each of monosomy 14 and 16, 3 each for monosomy 15 and 18, 1 for group "E", 5 for monosomy 20, 24 for monosomy 21, 7 for monosomy 22, and eleven for a "G" group chromosome. There were no reports with monosomy for the larger chromosomes 1 through 13, nor for chromosomes 17 or 19, autosomes with highest gene density. Most reported individuals had severe handicaps and died in infancy with some surviving longer.
CONCLUSION
Given potential for survival of handicapped individuals with autosomal monosomy for chromosomes 14, 15, 16, 18, 20, 21, and 22, low priority should be given to transfer of embryos apparently monosomic for these chromosomes. Couples electing transfer of monosomic embryos should consider amniocentesis for ongoing pregnancies but should be informed of its limitations.
Topics: Contraindications, Procedure; Embryo Transfer; Humans; Live Birth; Monosomy; Mosaicism; Preimplantation Diagnosis
PubMed: 29164644
DOI: 10.1002/pd.5185 -
The Cochrane Database of Systematic... Jan 2008Twin-twin transfusion syndrome, a condition affecting monochorionic twin pregnancies, is associated with a high risk of perinatal mortality and morbidity. A number of... (Review)
Review
BACKGROUND
Twin-twin transfusion syndrome, a condition affecting monochorionic twin pregnancies, is associated with a high risk of perinatal mortality and morbidity. A number of treatments have been introduced to treat the condition but it is unclear which intervention improves maternal and fetal outcome.
OBJECTIVES
The objective of this review was to evaluate the impact of treatment modalities in twin-twin transfusion syndrome.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2007) and the Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 4). We also searched conference proceedings and made personal contact with experts active in the area of the review.
SELECTION CRITERIA
Randomised and quasi-randomised studies of amnioreduction versus laser coagulation, septostomy versus laser coagulation or septostomy versus amnioreduction.
DATA COLLECTION AND ANALYSIS
One review author assessed eligibility and extracted data, which were checked by a second author. We contacted study authors for additional information.
MAIN RESULTS
Two studies (213 women) were included. This review shows that laser coagulation of anastomotic vessels results in less death of both infants per pregnancy (relative risk (RR) 0.33; 95% confidence interval (CI) 0.16 to 0.67, one trial), less perinatal death (RR 0.59; 95% CI 0.0.40 to 0.87 adjusted for cluster, one trial) and less neonatal death (RR 0.29; 95% CI 0.14 to 0.61 adjusted for cluster, one trial) than in pregnancies treated with amnioreduction. There is no difference in perinatal outcome between amnioreduction and septostomy. A third study is awaiting assessment. More babies were alive without neurological abnormality at the age of six months in the laser group than the amnioreduction groups (RR 1.66; 95% CI 1.17 to 2.35 adjusted for clustering, one trial). This difference did not persist beyond six months of age. There was no significant difference in the babies alive at six months with neurological abnormality treated by laser coagulation or amnioreduction (RR 0.58; 95% CI 0.18 to 1.86 adjusted for clustering, one trial).
AUTHORS' CONCLUSIONS
Endoscopic laser coagulation of anastomotic vessels should be considered in the treatment of all stages of twin-twin transfusion syndrome to improve perinatal outcome. Further research on the effect of treatment on milder forms of twin-twin transfusion syndrome (Quintero stage 1 and 2) are required. The long-term outcomes of survivors from the studies included in this review are required.
Topics: Amniocentesis; Amnion; Female; Fetofetal Transfusion; Humans; Laser Coagulation; Perinatal Mortality; Pregnancy; Pregnancy Reduction, Multifetal; Punctures; Randomized Controlled Trials as Topic
PubMed: 18254001
DOI: 10.1002/14651858.CD002073.pub2 -
The Cochrane Database of Systematic... 2001Twin-twin transfusion syndrome, a condition affecting monochorionic twin pregnancies, is associated with a high risk of perinatal mortality and morbidity. A number of... (Review)
Review
BACKGROUND
Twin-twin transfusion syndrome, a condition affecting monochorionic twin pregnancies, is associated with a high risk of perinatal mortality and morbidity. A number of treatments have been introduced to treat the condition but it is unclear which intervention improves maternal and fetal outcome.
OBJECTIVES
The objective of this review was to evaluate the impact of treatment modalities in twin-twin transfusion syndrome.
SEARCH STRATEGY
We searched The Cochrane Pregnancy and Childbirth Trials Register and Cochrane Controlled Trials Register. We also searched conference proceedings and made personal contact with experts active in the area of the review. Date of last search: August 2000.
SELECTION CRITERIA
Randomised and quasi-randomised studies of amnioreduction versus laser coagulation, septostomy versus laser coagulation or septostomy versus amnioreduction.
DATA COLLECTION AND ANALYSIS
Eligibility was assessed by one reviewer. Study authors were contacted for additional information.
MAIN RESULTS
No studies were included.
REVIEWER'S CONCLUSIONS
There is no current evidence from randomised trials to influence practice. Three ongoing randomised studies have been identified.
Topics: Amniocentesis; Amnion; Female; Fetofetal Transfusion; Humans; Laser Coagulation; Pregnancy; Pregnancy Reduction, Multifetal; Punctures; Randomized Controlled Trials as Topic
PubMed: 11279749
DOI: 10.1002/14651858.CD002073 -
Experimental and Therapeutic Medicine Sep 2020Fetal goitrous hypothyroidism is a rare condition associated with important obstetrical, neonatal complications, and neurodevelopmental impairments. Prenatal treatment...
Fetal goitrous hypothyroidism is a rare condition associated with important obstetrical, neonatal complications, and neurodevelopmental impairments. Prenatal treatment remains controversial, and the risk to benefit ratio must be accurately assessed and considered for individualized management. The objective of this review was to evaluate the feasibility, safety, and effectiveness of the conservative treatment of fetal goitrous hypothyroidism. In total, 25 reports that met our inclusion criteria were selected and the management of 38 cases was analyzed. Prenatal diagnosis consisted mainly of ultrasonographic findings. Fetal thyroid status was assessed by cordocentesis. Prenatal treatment varied widely in terms of levothyroxine (LT4) route of administration, dosage, number of injections, and frequency. Although different regimens and routes of administration were proposed, they seem to have similar results regarding fetal goiter reduction and thyroid status at birth. At birth, most babies had hypothyroidism, but the long-term follow-up indicated a normal psycho-neuromotor development. Our data confirm the feasibility of conservative treatment with LT4 for fetal goitrous hypothyroidism. Further studies are needed to determine the optimal management of this disorder.
PubMed: 32765729
DOI: 10.3892/etm.2020.8794