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Seminars in Perinatology Mar 2019Early diagnosis of an extrauterine pregnancy is important for safe and effective management. However, a pregnancy's location often cannot be easily determined with... (Review)
Review
Early diagnosis of an extrauterine pregnancy is important for safe and effective management. However, a pregnancy's location often cannot be easily determined with abnormal implantations or prior to 5-6 weeks' gestation. Multiple testing strategies exist to diagnose an abnormal pregnancy when location is unknown, but caution needs to be used to avoid a false diagnosis. Medical treatment is optimal when an abnormal pregnancy is diagnosed early. Because most of these pregnancies are intrauterine, additional testing to localize the pregnancy will allow the correct choice of therapy and avoids unnecessary exposure to a toxic therapy. This testing strategy should be reserved for patients with significant concern for ectopic pregnancy, based on either risk factors or clinical findings. Overuse of this approach can lead to interruption of normal pregnancies.
Topics: Chorionic Gonadotropin, beta Subunit, Human; Early Diagnosis; Female; Gestational Age; Humans; Practice Guidelines as Topic; Pregnancy; Pregnancy, Ectopic; Ultrasonography
PubMed: 30606496
DOI: 10.1053/j.semperi.2018.12.006 -
The Journal of Adolescent Health :... Feb 2015To examine pregnancy rates and outcomes (births and abortions) among 15- to 19-year olds and 10- to 14-year olds in all countries for which recent information could be...
PURPOSE
To examine pregnancy rates and outcomes (births and abortions) among 15- to 19-year olds and 10- to 14-year olds in all countries for which recent information could be obtained and to examine trends since the mid-1990s.
METHODS
Information was obtained from countries' vital statistics reports and the United Nations Statistics Division for most countries in this study. Alternate sources of information were used if needed and available. We present estimates primarily for 2011 and compare them to estimates published for the mid-1990s.
RESULTS
Among the 21 countries with complete statistics, the pregnancy rate among 15- to 19-year olds was the highest in the United States (57 pregnancies per 1,000 females) and the lowest rate was in Switzerland (8). Rates were higher in some former Soviet countries with incomplete statistics; they were the highest in Mexico and Sub-Saharan African countries with available information. Among countries with reliable evidence, the highest rate among 10- to 14-year olds was in Hungary. The proportion of teen pregnancies that ended in abortion ranged from 17% in Slovakia to 69% in Sweden. The proportion of pregnancies that ended in live births tended to be higher in countries with high teen pregnancy rates (p = .02). The pregnancy rate has declined since the mid-1990s in the majority of the 16 countries where trends could be assessed.
CONCLUSIONS
Despite recent declines, teen pregnancy rates remain high in many countries. Research on the planning status of these pregnancies and on factors that determine how teens resolve their pregnancies could further inform programs and policies.
Topics: Abortion, Induced; Adolescent; Birth Rate; Child; Female; Humans; Pregnancy; Pregnancy Outcome; Pregnancy in Adolescence; Young Adult
PubMed: 25620306
DOI: 10.1016/j.jadohealth.2014.09.007 -
Obstetrical & Gynecological Survey May 2021As assisted reproductive technology has advanced, there has been an increase in gestational carriers/surrogate pregnancies. Information is needed to determine if these... (Review)
Review
IMPORTANCE
As assisted reproductive technology has advanced, there has been an increase in gestational carriers/surrogate pregnancies. Information is needed to determine if these pregnancies are high-risk pregnancies and should be managed by maternal fetal medicine or if they are not high risk and should be cared for by residency-trained obstetricians and gynecologists.
OBJECTIVE
In this review of the literature, we explore whether surrogate pregnancies should be classified as high-risk pregnancies and managed by subspecialists.
EVIDENCE ACQUISITION, RESULTS
Our literature search discovered 28 relevant studies that evaluated surrogate pregnancy and pregnancy complications/outcomes. We learned that the overall risk by using artificial reproductive technology and risks for hypertension, preterm delivery, cesarean delivery, low birth weight neonate, fetal anomalies, and stillbirth did not seem to increase maternal/perinatal risk to the level where a subspecialist was required for the inclusive management of a gestational surrogate. Given that the ideal gestational carrier is healthy, has previously had a term pregnancy, has a single embryo implanted, and has had no more than 3 prior cesarean deliveries, these pregnancies should be lower-risk pregnancies.
CONCLUSIONS
We recommend that close monitoring and high index of suspicion should be maintained for complications, but care for the surrogate pregnancy can be accomplished by a residency-trained obstetrician-gynecologist.
RELEVANCE
An uncomplicated surrogate pregnancy can be managed by a residency-trained obstetrician-gynecologist and does not need to be managed by high-risk obstetric subspecialists.
Topics: Cesarean Section; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk; Premature Birth; Stillbirth
PubMed: 34032862
DOI: 10.1097/OGX.0000000000000898 -
Theoretical Medicine and Bioethics Aug 2022In this paper, I reflect on an important article by Bob Veatch in the inaugural issue of the Hastings Center Report, entitled "Experimental Pregnancy." It is a report... (Randomized Controlled Trial)
Randomized Controlled Trial
In this paper, I reflect on an important article by Bob Veatch in the inaugural issue of the Hastings Center Report, entitled "Experimental Pregnancy." It is a report and elegant analysis of the Goldzieher Study, in which nearly 400 women were randomized to receive hormonal contraception or placebo absent consent or disclosure about placebo use, resulting in several pregnancies. Noting the study's limited notoriety, I first consider the narratives that have instead dominated bioethics' approach to pregnancy and research: thalidomide and diethylstibesterol (DES). These narratives have facilitated a narrow focus on avoiding fetal risk, to the exclusion of other ethically relevant considerations. I then revisit "Experimental Pregnancy" and offer two ways in which Bob's analysis serves as an important corrective, first, by foregrounding research subjects (persons who are or may become pregnant), and second, by normalizing pregnancy and thus foregrounding foundational ethical considerations that are sometimes lost amidst pregnancy's presumed exceptionalism.
Topics: Pregnancy; Female; Humans; Morals
PubMed: 35859087
DOI: 10.1007/s11017-022-09578-z -
Midwifery Sep 2023This study uses a meta-ethnography to synthesize qualitative research on the experiences of women during pregnancies after one or more perinatal losses. (Review)
Review
OBJECTIVE
This study uses a meta-ethnography to synthesize qualitative research on the experiences of women during pregnancies after one or more perinatal losses.
DESIGN
This interpretive meta-ethnography followed the Noblit and Hare approach and the eMERGe Meta-ethnography Reporting Guidance. Manual searches and a comprehensive systematic search were conducted in Pubmed, Scopus, Cinahl, Web of Science, and Psycinfo. Eleven studies met the research objective and inclusion criteria.
RESULTS
After reciprocal and refutational translations, the metaphor "The rainbow in the storm" and the following three themes emerged: (i) Between ambivalent feelings; (ii) being careful in the new pregnancy; and (iii) leaning on others. CERQual assessment showed that the results are (highly) reasonable representations of the phenomenon of interest.
CONCLUSIONS
Most women experienced their subsequent pregnancy with ambivalent feelings and needed to reduce expectations, continuously monitor the pregnancy's viability, and eliminate risky behavior to protect themselves. Understanding and recognition by others is needed and appreciated.
IMPLICATIONS FOR PRACTICE
Nurses and midwives play a crucial role in subsequent pregnancies and need to establish a care communion and ethical care during their encounters with affected women whose specific needs need to be incorporated into the guidelines and training curricula of care professionals to equip them with the necessary gender and cultural competences.
Topics: Pregnancy; Female; Humans; Parturition; Anthropology, Cultural; Qualitative Research; Midwifery
PubMed: 37399778
DOI: 10.1016/j.midw.2023.103762 -
Best Practice & Research. Clinical... Jan 2021The incidence of multiple births has risen in the last few decades. This rise is mainly due to the widespread use of assisted reproduction techniques mainly as a result... (Review)
Review
The incidence of multiple births has risen in the last few decades. This rise is mainly due to the widespread use of assisted reproduction techniques mainly as a result of increasing maternal age at conception. Twin and higher-order multiple pregnancies are associated with increased risk of perinatal, as well as maternal, mortality and morbidity compared to singleton pregnancies. There can also be psychosocial and socioeconomic implications for women and their families. In this chapter, we aim to discuss the risks associated with multiple pregnancies, the pros and cons of fetal reduction, the current techniques used in clinical practice, and how to approach counselling parents, enabling them to make informed decisions.
Topics: Counseling; Female; Humans; Maternal Age; Pregnancy; Pregnancy Outcome; Pregnancy Reduction, Multifetal; Pregnancy, Multiple; Pregnancy, Twin
PubMed: 32859535
DOI: 10.1016/j.bpobgyn.2020.06.013 -
The Journal of Allergy and Clinical... Sep 2023Primary immunodeficiencies (PID) are a heterogeneous group of rare inborn immunity defects. As management has greatly improved, morbidity and mortality are reduced in...
BACKGROUND
Primary immunodeficiencies (PID) are a heterogeneous group of rare inborn immunity defects. As management has greatly improved, morbidity and mortality are reduced in this population, while our knowledge on pregnancy's unfolding and outcome remains scarce.
OBJECTIVE
We conducted a retrospective monocentric study to study pregnancy outcomes in women with PID.
METHODS
The study cohort consisted of women over 18 included in the national registry for PID (CEREDIH), living in the greater Paris area, reporting ≥1 pregnancy. Data were collected through a standardized questionnaire and medical records. We analyzed PID features, pregnancy course and outcome, and neonatal features (NCT04581460).
RESULTS
We studied 93 women with PID (27 combined immunodeficiencies, 51 predominantly antibody deficiencies, and 15 innate immunodeficiencies) and their 222 pregnancies (67, 119, and 36 in each group, respectively). One hundred fifty-four (69%) of 222 pregnancies led to 157 live births, including 4 severe preterm births (3%), in the range of pregnancy outcome in the French general population. In a multivariate model, poor obstetrical outcome (fetal loss or pregnancy termination) was associated with history of severe infection (adjusted odds ratio 0.28, 95% confidence interval 0.11-0.67, P = .005). Only 59% pregnancies were led with optimal anti-infective prophylaxis; severe infections were reported in only 2 pregnancies (1%). One infant died during the neonatal period.
CONCLUSION
Pregnancy is achievable in women with a wide group of PID. Prematurity is increased and history of severe infection is associated with significant increase of fetal loss/pregnancy termination. Adjustment of care during pregnancy needs to be better delivered.
Topics: Infant; Infant, Newborn; Humans; Pregnancy; Female; Retrospective Studies; Infant, Premature; Immunologic Deficiency Syndromes; Primary Immunodeficiency Diseases; Infant, Newborn, Diseases
PubMed: 37210041
DOI: 10.1016/j.jaci.2023.05.006 -
Reproductive Biomedicine Online 2002Pregnancy and birth after IVF has attracted much critical attention. Overall, pregnancy rates are about 30-40% with three transferred embryos. Abortion rates are high... (Review)
Review
Pregnancy and birth after IVF has attracted much critical attention. Overall, pregnancy rates are about 30-40% with three transferred embryos. Abortion rates are high before 19 weeks of gestation, at 8% of established pregnancies, and ectopic pregnancies are regular occurrences. Pregnancy rates are highest (35%) in women aged 20-24 years, declining to 10% at and above age 40. The use of intracytoplasmic sperm injection (ICSI) and blastocyst transfer has transformed the establishment of pregnancies for couples with differing indications. High rates of implantation are achieved with blastocyst transfers, although many embryos die in vitro before this stage. Twins and triplets can result in up to 50% of pregnancies. Heterotopic pregnancies are rare. Abortion afflicts fetuses before 12 weeks (vanishing fetuses). Rates of spontaneous abortion can be as high as 50% with quadruplets and quintuplets, and may be even higher in cases of fetal aneuploidy. At birth, prematurity is high, especially with twins or higher multiple pregnancies. Fetal reduction is used to reduce multiple pregnancies for singletons. Ovarian hyperstimulation is a risk associated with multiple pregnancy.
Topics: Abortion, Spontaneous; Female; Fetal Death; Humans; Ovarian Hyperstimulation Syndrome; Parturition; Pregnancy; Pregnancy Complications; Pregnancy Reduction, Multifetal; Pregnancy Trimester, First; Pregnancy, Multiple; Reproductive Techniques; Risk Factors
PubMed: 12470551
DOI: 10.1016/s1472-6483(10)61602-1 -
African Journal of Reproductive Health Jun 2020Over forty percent of pregnancies worldwide are unintended, with a quarter of these from Africa. There is a growing body of evidence regarding the adverse health,... (Review)
Review
Over forty percent of pregnancies worldwide are unintended, with a quarter of these from Africa. There is a growing body of evidence regarding the adverse health, economic, societal, and developmental consequences of unintended pregnancies. The main aim of this systematic review is to report on the current prevalence and determinants of unintended pregnancies in sub-Saharan Africa. A literature search (in PubMed, Embase, PsycINFO and Scopus) was performed up to 29 May 2019. The Joanna Briggs Institute Reviewers' Manual guidelines to assess the quality of peer-reviewed quantitative articles were used to select articles that met our inclusion criteria. A total of 29 articles from 9 countries were included in the final review. The mean unintended pregnancy rate was 33.9%. The mean unwanted pregnancy rate was 11.2%, while the mean mistimed pregnancy rate was 22.1%. Mistimed pregnancies were more frequent across the 13 studies that classified unintended pregnancies into the unwanted and mistimed pregnancy sub-groups. Being an adolescent (19 years old or less), single, and having 5 children or more were consistent risk factors for unintended pregnancy. Awareness and use of modern contraception, level of education, socio-economic status, religion, and area of residence as independent variables were either protective or associated with an increased risk of reporting a pregnancy as being unintended. The unintended pregnancy rate in sub-Saharan Africa remains high, especially among singles, adolescents, and women with 5 or more children. There was no uniform tool used across studies to capture pregnancy intention. The studies did not capture pregnancy intention among women whose pregnancies ended up as stillbirths or abortions. More research is required to ascertain when it is best to capture pregnancy intention, and how exclusion or inclusion of pregnancies ending up as stillbirths or abortions impact reported unintended pregnancy rates.
Topics: Adolescent; Adult; Africa South of the Sahara; Contraception Behavior; Educational Status; Female; Humans; Pregnancy; Pregnancy, Unplanned; Pregnancy, Unwanted; Prevalence; Residence Characteristics; Social Class; Young Adult
PubMed: 34077104
DOI: 10.29063/ajrh2020/v24i2.18 -
Reproductive Biomedicine Online Sep 2017The current systematic review and meta-analysis evaluate the perinatal outcomes in twin pregnancies following multifetal pregnancy reduction (MPR) compared with... (Comparative Study)
Comparative Study Meta-Analysis Review
The current systematic review and meta-analysis evaluate the perinatal outcomes in twin pregnancies following multifetal pregnancy reduction (MPR) compared with non-reduced triplet pregnancies. All studies comparing perinatal outcome of twin pregnancies following MPR to non-reduced triplet pregnancies were considered. MEDLINE, non-indexed MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science were searched for relevant published articles up to August 2016. The search yielded 653 publications of which 92 were assessed for eligibility. A total of 24 studies met the inclusion criteria. Overall, the outcomes of pregnancies following MPR were better compared with expectantly managed triplets. The MPR group delivered at a later gestational age and was less likely to be delivered before 32 or 28 weeks' gestation. Newborns in the MPR group had significantly higher birthweight at delivery (mean difference 500 g [95% CI 439.95, 560.04]). Rates of pregnancy loss before 24 weeks' gestation and overall infant survival were comparable between the groups. This meta-analysis suggests that MPR of triplet pregnancies to twins is associated with improved perinatal outcome compared with non-reduced triplets. Should primary prevention of high order multiple pregnancy fail, MPR is an appropriate alternative to minimize the perinatal morbidity and mortality of triplet pregnancies.
Topics: Abortion, Spontaneous; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnancy Reduction, Multifetal; Pregnancy, Multiple; Pregnancy, Twin; Triplets; Twins
PubMed: 28625760
DOI: 10.1016/j.rbmo.2017.05.012