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PloS One 2019The number of studies associating the use of sildenafil in gestation is increasing. This drug inhibits phosphodiesterase type 5 (PDE5), an enzyme responsible for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The number of studies associating the use of sildenafil in gestation is increasing. This drug inhibits phosphodiesterase type 5 (PDE5), an enzyme responsible for degradation of nitric oxide, and its efficacy is greater in the placental territory, as the maternal side of the placenta have more PDE5 than other sites. For this reason, promising results have been observed related to the prevention of preeclampsia and intrauterine growth restriction and to improvement of maternal-fetal morbidity in cases of placental insufficiency.
OBJECTIVE
To evaluate the benefits of using sildenafil in pregnancy.
SEARCHED STRATEGY
MEDLINE, ClinicalTrials.gov, Embase, LILACS and Cochrane databases were searched through September 2018. There was no restriction in language or year of publication. This study was registered in PROSPERO (CRD42017060288).
SELECTION CRITERIA
Randomized clinical trials which used sildenafil for treatment or prevention of obstetric diseases compared with placebo were selected.
DATA COLLECTION AND ANALYSIS
The results were obtained using the inverse variance method for continuous variables and Man-Whitney for categorical variables.
MAIN RESULTS
Among a population of 598 pregnant women from the seven clinical trials included, 139 had pre-eclampsia, 275 had intrauterine growth restriction, and 184 had oligohydramnios. A significant increase of 222.58 grams [27.75 to 417.41] was observed in the fetal weight at birth of patients taking sildenafil. The other outcomes did not show any statistical significance. This may be due to the small number of patients used in each study and the great heterogeneity between the groups.
CONCLUSIONS
Sildenafil could be associated with increasing fetal weight at birth in placental insufficiency despite the limitations of this meta-analysis, even though more studies in this field are needed to introduce this drug into obstetric clinical practice.
Topics: Birth Weight; Delivery, Obstetric; Female; Fetus; Gestational Age; Headache; Humans; Infant; Infant Mortality; Labor, Obstetric; Pregnancy; Pregnancy Outcome; Publication Bias; Risk; Sildenafil Citrate; Umbilical Arteries
PubMed: 31339910
DOI: 10.1371/journal.pone.0219732 -
European Journal of Obstetrics,... Jul 2013The management of isolated oligohydramnios (IO) in post/term pregnancies is controversial. The aim of this paper was to review outcomes of term and post-term pregnancies... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The management of isolated oligohydramnios (IO) in post/term pregnancies is controversial. The aim of this paper was to review outcomes of term and post-term pregnancies with IO versus normal amniotic fluid (AF) at labor assessment.
STUDY DESIGN
A search in PubMed, Medline, EMBASE, and reference lists was performed. Inclusion criteria for articles selection: singleton pregnancy, definition of olgohydramnios as AFI <5cm, AF assessment at 37-42 gestational weeks.
EXCLUSION CRITERIA
fetal malformations, preterm delivery, premature rupture of membranes, intrauterine growth restriction. Perinatal outcomes were: obstetric intervention for non-reassuring fetal heart rate (cesarean section, operative delivery), meconium-stained AF, Apgar score <7 at 5min, umbilical artery pH <7.0, small for gestational age infants (SGA), admission to neonatal intensive care unit (NICU) and perinatal death. Meta-analysis compared outcomes of pregnancies with IO vs normal AF. Inter-studies heterogeneity was tested. Pooled odds ratio (OR) and 95% confidence interval (95% CI) were calculated. Differences between the two groups were considered significant if 95% CI did not encompass 1. MOOSE guidelines were followed.
RESULTS
Four articles provided 679 (17.2%) cases with IO and 3264 (82.8%) with normal AF. Obstetric interventions occurred more frequently in the IO than normal AF group (IO: 89/679, 13% vs normal; AF: 166/3354, 5%; OR: 2.30; 95% CI: 1.00-5.29). Meta-analysis did not show differences with regard to meconium, Apgar, pH, SGA, NICU and perinatal death.
CONCLUSION
In term or post-term pregnancies, IO is associated with increased risk of obstetric interventions but outcomes are similar to those of pregnancies with normal AF.
Topics: Delivery, Obstetric; Female; Humans; Infant, Newborn; Infant, Postmature; Oligohydramnios; Pregnancy; Pregnancy Outcome; Randomized Controlled Trials as Topic
PubMed: 23561019
DOI: 10.1016/j.ejogrb.2013.03.011 -
Journal of Clinical Medicine Apr 2023Neonatal hemochromatosis (NH) is an uncommon, severe disorder that results in fetal loss or neonatal death due to liver failure. NH is currently regarded as the... (Review)
Review
Neonatal hemochromatosis (NH) is an uncommon, severe disorder that results in fetal loss or neonatal death due to liver failure. NH is currently regarded as the phenotypic expression of gestational alloimmune liver disease (GALD). The diagnosis of NH-GALD is rarely prenatally established. In addition to providing a systematic review of the prenatal features that are identifiable using ultrasound (US) and MRI, we suggest a prenatal diagnosis algorithm for use in suspected NH during the first affected pregnancy. From a total of 586 database entries identified in PubMed, Google Scholar, and ResearchGate, we selected 18 studies published from 1993 to 2021 that reported maternal medical and obstetric history, prenatal ultrasound findings, and postpartum outcomes. We investigated the ultrasound and MRI features of these studies, along with the outcome due to this condition. A total of 74 cases were identified. The main reported prenatal US finding was fetal growth restriction (FGR) (33%), followed by oligohydramnios (13%) and hydrops fetalis (13%), with 13% cases described as uneventful. Other rare prenatal findings were fetal anemia, ascites, and abnormal fetal liver and spleen. Most pregnancies ended with fetal/perinatal death or therapeutic interruption of pregnancy. Favorable evolution with treatment (ensanguine transfusion and intravenous immunoglobulin (IVIG)) was reported for only 7% of fetuses. Using T2-weighted MRI, fetal extrahepatic siderosis confirmed prenatally in two cases and postnatally in 11 cases. IVIG treatment throughout subsequent pregnancies was found to significantly improve fetal prognosis. MRI should be indicated in selected cases of oligohydramnios, fetal hydrops, fetal hepatomegaly, ascites, or unexplained FGR or anemia after ruling out all other more frequently encountered conditions. MRI can be used to detect iron overload in the liver and extrahepatic siderosis.
PubMed: 37048762
DOI: 10.3390/jcm12072679 -
The Cochrane Database of Systematic... Jan 2014Amnioinfusion is thought to dilute meconium present in the amniotic fluid and so reduce the risk of meconium aspiration. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Amnioinfusion is thought to dilute meconium present in the amniotic fluid and so reduce the risk of meconium aspiration.
OBJECTIVES
To assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013).
SELECTION CRITERIA
Randomised trials comparing amnioinfusion with no amnioinfusion for women in labour with moderate or thick meconium staining of the amniotic fluid.
DATA COLLECTION AND ANALYSIS
Three review authors independently assessed eligibility and trial quality, and extracted data.
MAIN RESULTS
Fourteen studies of variable quality (4435 women) are included.Subgroup analysis was performed for studies from settings with limited facilities to monitor the baby's condition during labour and intervene effectively, and settings with standard peripartum surveillance.Settings with standard peripartum surveillance: there was considerable heterogeneity for several outcomes. There was no significant reduction in the primary outcomes meconium aspiration syndrome, perinatal death or severe morbidity, and maternal death or severe morbidity. There was a reduction in caesarean sections (CSs) for fetal distress but not overall. Meconium below the vocal cords diagnosed by laryngoscopy was reduced, as was neonatal ventilation or neonatal intensive care unit admission, but there was no significant reduction in perinatal deaths or other morbidity. Planned sensitivity analysis excluding trials with greater risk of bias resulted in an absence of benefits for any of the outcomes studied.Settings with limited peripartum surveillance: three studies were included. In the amnioinfusion group there was a reduction in CS for fetal distress and overall; meconium aspiration syndrome (three studies, 1144 women; risk ratio (RR) 0.17, 95% confidence interval (CI) 0.05 to 0.52); perinatal mortality (three studies, 1151 women; RR 0.24, 95% CI 0.11 to 0.53) and neonatal ventilation or neonatal intensive care unit admission. In one of the studies, meconium below the vocal cords was reduced and, in the other, neonatal encephalopathy was reduced.
AUTHORS' CONCLUSIONS
Amnioinfusion is associated with substantive improvements in perinatal outcome only in settings where facilities for perinatal surveillance are limited. It is not clear whether the benefits are due to dilution of meconium or relief of oligohydramnios.In settings with standard peripartum surveillance, some non-substantive outcomes were improved in the initial analysis, but sensitivity analysis excluding trials with greater risk of bias eliminated these differences. Amnioinfusion is either ineffective in this setting, or its effects are masked by other strategies to optimise neonatal outcome.The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion.
Topics: Amnion; Cesarean Section; Female; Humans; Infant, Newborn; Injections; Meconium; Meconium Aspiration Syndrome; Obstetric Labor Complications; Perinatal Mortality; Pregnancy; Randomized Controlled Trials as Topic; Sodium Chloride
PubMed: 24453049
DOI: 10.1002/14651858.CD000014.pub4 -
The Cochrane Database of Systematic... 2002Oligohydramnios (reduced amniotic fluid) may be responsible for malpresentation problems, umbilical cord compression, concentration of meconium in the liquor, and... (Review)
Review
BACKGROUND
Oligohydramnios (reduced amniotic fluid) may be responsible for malpresentation problems, umbilical cord compression, concentration of meconium in the liquor, and difficult or failed external cephalic version. Simple maternal hydration has been suggested as a way of increasing amniotic fluid volume in order to reduce some of these problems.
OBJECTIVES
The objective of this review was to assess the effects of maternal hydration on amniotic fluid volume and measures of pregnancy outcome.
SEARCH STRATEGY
The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: September 2001.
SELECTION CRITERIA
Randomised trials comparing maternal hydration with no hydration in pregnant women with reduced or normal amniotic fluid volume.
DATA COLLECTION AND ANALYSIS
Eligibility and trial quality were assessed by both reviewers.
MAIN RESULTS
Two studies of 77 women were included. The women were asked to drink two litres of water before having a repeat ultrasound examination. Maternal hydration in women with and without oligohydramnios was associated with an increase in amniotic volume (weighted mean difference for women with oligohydramnios 2.01, 95% confidence interval 1.43 to 2.56; and weighted mean difference for women with normal amniotic fluid volume 4.5, 95% confidence interval 2.92 to 6.08). Intravenous hypotonic hydration in women with oligohydramnios was associated with an increase in amniotic fluid volume (weighted mean difference 2.3, 95% confidence interval 1.36 to 3.24). Isotonic intravenous hydration had no measurable effect. No clinically important outcomes were assessed in any of the trials.
REVIEWER'S CONCLUSIONS
Simple maternal hydration appears to increase amniotic fluid volume and may be beneficial in the management of oligohydramnios and prevention of oligohydramnios during labour or prior to external cephalic version. Controlled trials are needed to assess the clinical benefits and possible risks of maternal hydration for specific clinical purposes.
Topics: Amniotic Fluid; Female; Fluid Therapy; Humans; Oligohydramnios; Pregnancy
PubMed: 11869566
DOI: 10.1002/14651858.CD000134 -
The Cochrane Database of Systematic... 2000Oligohydramnios (reduced amniotic fluid) may be responsible for malpresentation problems, umbilical cord compression, concentration of meconium in the liquor, and... (Review)
Review
BACKGROUND
Oligohydramnios (reduced amniotic fluid) may be responsible for malpresentation problems, umbilical cord compression, concentration of meconium in the liquor, and difficult or failed external cephalic version. Simple maternal hydration has been suggested as a way of increasing amniotic fluid volume in order to reduce some of these problems.
OBJECTIVES
The objective of this review was to assess the effects of maternal hydration on amniotic fluid volume and measures of pregnancy outcome.
SEARCH STRATEGY
The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: 1 February 1999.
SELECTION CRITERIA
Randomised trials comparing maternal hydration with no hydration in pregnant women with reduced or normal amniotic fluid volume.
DATA COLLECTION AND ANALYSIS
Eligibility and trial quality were assessed by both reviewers.
MAIN RESULTS
Two studies of 77 women were included. The women were asked to drink two litres of water before having a repeat ultrasound examination. Maternal hydration in women with and without oligohydramnios was associated with an increase in amniotic volume (weighted mean difference for women with oligohydramnios 2.01, 95% confidence interval 1.43 to 2.56; and weighted mean difference for women with normal amniotic fluid volume 4.5, 95% confidence interval 2.92 to 6.08). Intravenous hypotonic hydration in women with oligohydramnios was associated with an increase in amniotic fluid volume (weighted mean difference 2.3, 95% confidence interval 1.36 to 3.24). Isotonic intravenous hydration had no measurable effect. No clinically important outcomes were assessed in any of the trials.
REVIEWER'S CONCLUSIONS
Simple maternal hydration appears to increase amniotic fluid volume and may be beneficial in the management of oligohydramnios and prevention of oligohydramnios during labour or prior to external cephalic version. Controlled trials are needed to assess the clinical benefits and possible risks of maternal hydration for specific clinical purposes.
Topics: Amniotic Fluid; Female; Fluid Therapy; Humans; Oligohydramnios; Pregnancy
PubMed: 10796151
DOI: 10.1002/14651858.CD000134 -
BMC Cancer Apr 2021Over than one third (28-58%) of pregnancy-associated breast cancer (PABC) cases are characterized by positive epidermal growth factor receptor 2-positive (HER2)...
BACKGROUND
Over than one third (28-58%) of pregnancy-associated breast cancer (PABC) cases are characterized by positive epidermal growth factor receptor 2-positive (HER2) expression. Trastuzumab anti-HER2 monoclonal antibody is still the benchmark treatment of HER2-positive breast tumors. However, FDA has categorized Trastuzumab as a category D drug for pregnant patients with breast cancer. This systemic review aims to synthesize all currently available data of trastuzumab administration during pregnancy and provide an updated view of the effect of trastuzumab on fetal and maternal outcome.
METHODS
Eligible articles were identified by a search of MEDLINE bibliographic database and ClinicalTrials.gov for the period up to 01/09/2020; The algorithm consisted of a predefined combination of the words "breast", "cancer", "trastuzumab" and "pregnancy". This study was performed in accordance with the PRISMA guidelines.
RESULTS
A total of 28 eligible studies were identified (30 patients, 32 fetuses). In more than half of cases, trastuzumab was administered in the metastatic setting. The mean duration of trastuzumab administration during gestation was 15.7 weeks (SD: 10.8; median: 17.5; range: 1-32). Oligohydramnios or anhydramnios was the most common (58.1%) adverse event reported in all cases. There was a statistically significant decrease in oligohydramnios/anhydramnios incidence in patients receiving trastuzumab only during the first trimester (P = 0.026, Fisher's exact test). In 43.3% of cases a completely healthy neonate was born. 41.7% of fetuses exposed to trastuzumab during the second and/or third trimester were born completely healthy versus 75.0% of fetuses exposed exclusively in the first trimester. All mothers were alive at a median follow-up of 47.0 months (ranging between 9 and 100 months). Of note, there were three cases (10%) of cardiotoxicity and decreased ejection fraction during pregnancy.
CONCLUSIONS
Overall, treatment with trastuzumab should be postponed until after delivery, otherwise pregnancy should be closely monitored.
Topics: Adult; Amniotic Fluid; Antineoplastic Agents, Immunological; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Cardiotoxicity; Female; Fetus; Humans; Middle Aged; Oligohydramnios; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Trimesters; Receptor, ErbB-2; Time Factors; Trastuzumab; Young Adult
PubMed: 33902516
DOI: 10.1186/s12885-021-08162-3 -
Journal of Ultrasound in Medicine :... Aug 2014The objectives of this systematic review were to examine the reproducibility of sonographic estimates of amniotic fluid volume (AFV) in twin pregnancies, compare the... (Review)
Review
The objectives of this systematic review were to examine the reproducibility of sonographic estimates of amniotic fluid volume (AFV) in twin pregnancies, compare the association of sonographic estimates of AFV with dye-determined AFV, and correlate AFV with antepartum, intrapartum, and perinatal outcomes in twin pregnancies. Studies were included if they were adequately powered and investigated antepartum, intrapartum, and/or perinatal adverse outcome parameters in twin gestations. Studies with comparable populations and exclusion criteria were merged into forest plots. Data comparing the accuracy of AFV assessment, correlation of AFV with gestational age, and adverse outcomes were tabulated. Five of the 6 studies investigating AFV by the amniotic fluid index as a function of gestational age reported data fitting a quadratic equation, with fluid volumes peaking at mid gestation and then declining. This trend was less pronounced when AFV was assessed by the single deepest pocket (2 of 4 studies reporting a quadratic fit). Polyhydramnios was associated with prematurity in 2 of 4 studies (1 amniotic fluid index and 1 single deepest pocket), and oligohydramnios was associated with prematurity in 1 single deepest pocket study. Stillbirth was the only intrapartum outcome reported in more than 1 study. Perinatal outcomes associated with polyhydramnios included neonatal death (P < .05 in 1 of 2 studies), low Apgar scores (1 of 2 studies), neonatal intensive care unit admission (1 of 2 studies), and low birth weight (2 of 3 studies).
Topics: Amniotic Fluid; Female; Humans; Oligohydramnios; Polyhydramnios; Pregnancy; Pregnancy Outcome; Pregnancy, Twin; Reproducibility of Results; Twins; Ultrasonography, Prenatal
PubMed: 25063400
DOI: 10.7863/ultra.33.8.1353 -
The Journal of Maternal-fetal &... Nov 2021To compare the utility of maximum vertical pocket versus amniotic fluid index for predicting adverse perinatal outcomes. (Meta-Analysis)
Meta-Analysis
Diagnostic utility of maximum vertical pocket versus amniotic fluid index in assessing amniotic fluid volume for the prediction of adverse maternal and fetal outcomes: a systematic review and meta-analysis.
OBJECTIVE
To compare the utility of maximum vertical pocket versus amniotic fluid index for predicting adverse perinatal outcomes.
METHODS
Systematic review of randomized clinical studies comparing these two ultrasound techniques and random-effects meta-analysis to quantify a range of perinatal outcomes.
RESULT
Six studies with 4278 women were eligible. Use of the maximum vertical pocket reduced the rate of diagnosis of oligohydramnios (pooled relative risk 0.38; 95% confidence interval 0.27, 0.53). Use of the maximum vertical pocket was associated with significantly lower rates of non-reassuring fetal heart tracing, cesarean delivery for fetal distress, and induction of labor for oligohydramnios. There were no differences in the rates of cesarean delivery, presence of meconium, umbilical artery pH <7.1, 5-minute Apgar score <7, or admission to the neonatal intensive care unit.
CONCLUSION
The use of maximum vertical pocket is associated with a lower rate of pregnancy intervention without any worsening of adverse pregnancy outcomes.
Topics: Amniotic Fluid; Female; Fetal Distress; Humans; Infant, Newborn; Labor, Obstetric; Oligohydramnios; Pregnancy; Pregnancy Outcome
PubMed: 31709861
DOI: 10.1080/14767058.2019.1691988 -
American Journal of Obstetrics &... Jun 2024Counseling of pregnancies complicated by pre- and periviable premature rupture of membranes to reach shared decision-making is challenging, and the current limited... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Counseling of pregnancies complicated by pre- and periviable premature rupture of membranes to reach shared decision-making is challenging, and the current limited evidence hampers the robustness of the information provided. This study aimed to elucidate the rate of obstetrical and neonatal outcomes after expectant management for premature rupture of membranes occurring before or at the limit of viability.
DATA SOURCES
Medline, Embase, CINAHL, and Web of Science databases were searched electronically up to September 2023.
STUDY ELIGIBILITY CRITERIA
Our study included both prospective and retrospective studies of singleton pregnancies with premature rupture of membranes before and at the limit of viability (ie, occurring between 14 0/7 and 24 6/7 weeks of gestation).
METHODS
Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale for cohort studies. Moreover, our study used meta-analyses of proportions to combine data and reported pooled proportions. Given the clinical heterogeneity, a random-effects model was used to compute the pooled data analyses. This study was registered with the International Prospective Register of Systematic Reviews database (registration number: CRD42022368029).
RESULTS
The pooled proportion of termination of pregnancy was 32.3%. After the exclusion of cases of termination of pregnancy, the rate of spontaneous miscarriage or fetal demise was 20.1%, whereas the rate of live birth was 65.9%. The mean gestational age at delivery among the live-born cases was 27.3 weeks, and the mean latency between premature rupture of membranes and delivery was 39.4 days. The pooled proportion of cesarean deliveries was 47.9% of the live-born cases. Oligohydramnios occurred in 47.1% of cases. Chorioamnionitis occurred in 33.4% of cases, endometritis in 7.0%, placental abruption in 9.2%, and postpartum hemorrhage in 5.3%. Hysterectomy was necessary in 1.2% of cases. Maternal sepsis occurred in 1.5% of cases, whereas no maternal death was reported in the included studies. When focusing on neonatal outcomes, the mean birthweight was 1022.8 g in live-born cases. The neonatal intensive care unit admission rate was 86.3%, respiratory distress syndrome was diagnosed in 66.5% of cases, pulmonary hypoplasia or dysplasia was diagnosed in 24.0% of cases, and persistent pulmonary hypertension was diagnosed in 40.9% of cases. Of the surviving neonates, the other neonatal complications included necrotizing enterocolitis in 11.1%, retinopathy of prematurity in 27.1%, and intraventricular hemorrhage in 17.5%. Neonatal sepsis occurred in 30.2% of cases, and the overall neonatal mortality was 23.9%. The long-term follow-up at 2 to 4 years was normal in 74.1% of the available cases.
CONCLUSION
Premature rupture of membranes before or at the limit of viability was associated with a great burden of both obstetrical and neonatal complications, with an impaired long-term follow-up at 2 to 4 years in almost 30% of cases, representing a clinical challenge for both counseling and management. Our data are useful when initially approaching such patients to offer the most comprehensive possible scenario on short- and long-term outcomes of this condition and to help parents in shared decision-making. El resumen está disponible en Español al final del artículo.
Topics: Humans; Fetal Membranes, Premature Rupture; Pregnancy; Female; Fetal Viability; Infant, Newborn; Pregnancy Outcome; Gestational Age; Cesarean Section; Watchful Waiting; Abortion, Induced
PubMed: 38648897
DOI: 10.1016/j.ajogmf.2024.101370