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Archives of Gynecology and Obstetrics Feb 2021Cesarean scar pregnancy (CSP) is one of the serious complications associated with cesarean delivery (CD). This meta-analysis aims to identify risk factors associated... (Meta-Analysis)
Meta-Analysis
PURPOSE
Cesarean scar pregnancy (CSP) is one of the serious complications associated with cesarean delivery (CD). This meta-analysis aims to identify risk factors associated with massive hemorrhage during the CSP treatment.
METHODS
Eight electronic databases were searched for case-control studies published before December 31th, 2018, which compared the possible factors causing massive bleeding during the CSP treatment. Quantitative synthesis was performed by RevMan 5.3. Sensitivity analysis and publication bias were performed by Stata 12.0.
RESULTS
Total 20 case - control studies including 3101 CSP patients with previous CD met the inclusion criteria. Bleeding group had 573 patients and the control group had 2528 patients. The risk factors for massive bleeding during CSP treatment included multiple gravidities (MD = 0.15, 95% CI 0.03-0.28, P = 0.73), big maximum diameter of gestation sac (MD = 18.49 mm, 95%CI 15.34-21.65, P < 0.01), high gestational days (MD = 8.98 days, 95% CI 4.12-13.84, P < 0.01), high β-HCG level (MD = 21.39 IU/ml, 95% CI 7.36-35.41, P = 0.03; MD = 3.02 U/ml, 95% CI 0.21-5.84, P < 0.01) and rich blood flow around the lesion (OR = 6.73, 95% CI 3.93-11.51, P = 0.59). While, thick myometrium (MD = - 4.94 mm, 95% CI - 6.12 to - 3.75, P < 0.01) may be protective factor.
CONCLUSIONS
Multiple gravidities, big gestation sac, large gestational days, high serum β-HCG level, abundant blood supply to pregnancy sac and thin myometrium maybe the risk factors for massive bleeding during the CSP treatment.
Topics: Adult; Case-Control Studies; Cesarean Section; Chorionic Gonadotropin, beta Subunit, Human; Cicatrix; Female; Gestational Sac; Humans; Myometrium; Postoperative Complications; Pregnancy; Pregnancy, Ectopic; Risk Factors; Treatment Outcome; Uterine Hemorrhage; Uterus
PubMed: 33219842
DOI: 10.1007/s00404-020-05877-9 -
The Science of the Total Environment Oct 2020Prenatal exposure to widespread environmental toxicants is detrimental to maternal health and fetal development. The effects of environmental toxicants on maternal and...
Prenatal exposure to widespread environmental toxicants is detrimental to maternal health and fetal development. The effects of environmental toxicants on maternal and fetal metabolic profile changes have not yet been summarized. This systematic review aims to summarize the current studies exploring the association between prenatal exposure to environmental toxicants and metabolic profile alterations in mother and fetus. We searched the MEDLINE (PubMed) electronic database for relevant literature conducted up to September 18, 2019 with some key terms. From the initial 155 articles, 15 articles met the inclusion and exclusion criteria, and consist of highly heterogeneous research methods. Seven studies assessed the effects of multiple environmental pollutants (metals, organic pollutants, nicotine, air pollutants) on the maternal urine and blood metabolomic profile; five studies evaluated the effects of arsenic, polychlorinated biphenyls (PCBs), nicotine, and ambient fine particulate matter (PM) on the cord blood metabolomic profile; and one study assessed the effects of smoking exposure on the amniotic fluid metabolomic profile. The alteration of metabolic pathways in these studies mainly involve energy metabolism, hormone metabolism, oxidative stress and inflammation. No population study investigated the association between environmental toxicants and placental metabolomics. This systematic review provides evidence that prenatal exposure to a variety of environmental pollutants can affect maternal and fetal metabolomic characteristics. Integration of environmental toxicant exposure and metabolomics data in maternal-fetal samples is helpful to understand the interaction between toxicants and metabolites, so as to reveal the pathogenesis of fetal disease or diseases of fetal origin.
Topics: Biomarkers; Environmental Exposure; Female; Fetus; Hazardous Substances; Humans; Maternal Exposure; Maternal Health; Metabolomics; Pregnancy
PubMed: 32535459
DOI: 10.1016/j.scitotenv.2020.139626 -
Journal of Assisted Reproduction and... Jul 2020The objective of this systematic review and metaanalysis was to examine if the probability of pregnancy after ovarian stimulation for in vitro fertilization (IVF), using... (Meta-Analysis)
Meta-Analysis
Is the probability of pregnancy after ovarian stimulation for IVF associated with serum estradiol levels on the day of triggering final oocyte maturation with hCG? A systematic review and meta-analysis.
PURPOSE
The objective of this systematic review and metaanalysis was to examine if the probability of pregnancy after ovarian stimulation for in vitro fertilization (IVF), using GnRH analogues and gonadotrophins is associated with serum estradiol level (Ε) on the day of triggering final oocyte maturation with human chorionic gonadotrophin (hCG).
METHODS
Twenty-one studies were eligible for this systematic review, including 19,598 IVF cycles, whereas three studies were eligible for metaanalysis, including 641 IVF cycles. The main outcome measure was achievement of ongoing pregnancy/live birth and, if not available, clinical pregnancy or biochemical pregnancy.
RESULTS
Pooling of data showed no differences in the probability of clinical pregnancy between patients with high and low Ε levels on the day of triggering final oocyte maturation. The pooled effect sizes for the Ε thresholds groups constructed, regarding clinical pregnancy were 2000-3000 pg/mL-OR 0.91, 95% CI 0.55 to 1.50, (fair quality/moderate risk of bias, n = 1 study), 3000-4000 pg/mL-OR 0.89, 95% CI 0.46 to 1.70, (fair quality/moderate risk of bias, n = 1 study, good quality/no information on which to base a judgement about risk of bias n = 2 studies), 4000-5000 pg/mL-OR 0.74, 95% CI 0.37 to 1.49 fair quality/moderate risk of bias, n = 1 study), 5000-6000 pg/mL-OR 0.62, 95% CI 0.19 to 1.98, (fair quality/moderate risk of bias, n = 1 study). In addition, no difference was observed in the probability of ongoing pregnancy for the Ε threshold group of 3000-4000 pg/mL OR 0.85, 95% CI 0.40 to 1.81(good quality/no information on which to base a judgement about risk of bias, n = 1 study).
CONCLUSION
Currently, there is insufficient evidence to support or deny the presence of an association between the probability of pregnancy and serum Ε levels on the day of triggering final oocyte maturation with hCG in women undergoing ovarian stimulation for IVF.
Topics: Chorionic Gonadotropin; Embryo Transfer; Estradiol; Female; Fertilization in Vitro; Humans; In Vitro Oocyte Maturation Techniques; Live Birth; Ovulation Induction; Pregnancy; Pregnancy Rate
PubMed: 32472447
DOI: 10.1007/s10815-020-01829-z -
American Journal of Reproductive... Jun 2020Studies have investigated the gestational outcomes of new immunological therapies in the treatment of patients with recurrent implantation failure (RIF) in assisted... (Meta-Analysis)
Meta-Analysis
Studies have investigated the gestational outcomes of new immunological therapies in the treatment of patients with recurrent implantation failure (RIF) in assisted reproductive technology (ART). The objective of this article is to assess the current state of evidence available in the literature on intrauterine perfusion immunotherapies in women undergoing ART treatments. By considering the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), the authors performed systematic review by searching the databases of PubMed/MEDLINE and Scopus using the following key words: "recurrent implantation failure," "intrauterine infusion," "Platelet-Rich Plasma (PRP)," "Peripheral Blood Mononuclear Cells (PBMC)," "Granulocyte Colony-Stimulating Factor (G-CSF)," and "Human Chorionic Gonadotropin (hCG)." The authors analyzed the indications and the impact of new immunological therapies with intrauterine infusions on the pregnancy outcomes of patients undergoing ART. PRP, PBMC, G-CSF, and hCG were the four most used immunological therapies with intrauterine infusion. These new therapies appear to improve the results of ART treatments in cases of RIF. However, the small number of studies does not allow definitive conclusions about the effectiveness of these therapies.
Topics: Blood Transfusion, Intrauterine; Chorionic Gonadotropin; Embryo Implantation; Female; Granulocyte Colony-Stimulating Factor; Humans; Immunotherapy; Leukocytes, Mononuclear; Platelet-Rich Plasma; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 32248580
DOI: 10.1111/aji.13242 -
Obstetrics and Gynecology Jan 2020To estimate the incidence of gestational trophoblastic neoplasia following complete and partial molar pregnancy after reaching normal human chorionic gonadotropin (hCG)... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To estimate the incidence of gestational trophoblastic neoplasia following complete and partial molar pregnancy after reaching normal human chorionic gonadotropin (hCG) levels to guide evidence-based follow-up recommendations.
DATA SOURCES
MEDLINE, EMBASE, Web of Science, POPLINE, Cochrane, and ClinicalTrials.gov were searched from inception to November 2018, using the intersection of "gestational trophoblastic disease," "molar pregnancy," and "human chorionic gonadotropin" themes.
METHODS OF STUDY SELECTION
Search results were screened to identify cohort studies of molar pregnancy reporting gestational trophoblastic neoplasia development, with at least 6 months of intended normal hCG follow-up.
TABULATION, INTEGRATION, AND RESULTS
Two reviewers independently identified articles for inclusion. Data were extracted using a standardized form. For meta-analysis, cumulative incidence of gestational trophoblastic neoplasia, with CIs by the Agresti-Coull method, and pooled risk ratios (RRs) comparing complete and partial mole were calculated. Among the 19 eligible studies that reported adequate data for inclusion in the primary meta-analysis, we found low incidence of gestational trophoblastic neoplasia after normal hCG level following both complete mole (64/18,357, 0.35%, 95% CI 0.27-0.45%), and partial mole (5/14,864, 0.03%, 95% CI 0.01-0.08%). There was a significantly higher risk of gestational trophoblastic neoplasia after complete compared with partial molar pregnancy (RR 4.72, 95% CI 1.81-12.3, P=.002). Among gestational trophoblastic neoplasia cases after normal hCG level following complete mole, 89.6% occurred when the time from evacuation to normalization was 56 days or longer, and 60.7% were diagnosed beyond the commonly recommended 6-month surveillance interval. Sensitivity analyses, including those limiting to studies at low risk of bias, did not significantly affect results. We found an overall incidence of gestational trophoblastic neoplasia of 15.7% for complete mole (1,354/8,611, 95% CI 15.0-16.5%) and 3.95% for partial mole (221/5,593, 95% CI 3.47-4.50%).
CONCLUSION
Gestational trophoblastic neoplasia development after normal hCG level following molar pregnancy is rare. Recommendations for frequency and duration of hCG follow-up can be minimized to lessen burden on patients and informed by the type of molar pregnancy and time interval from uterine evacuation to hCG normalization.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42019116414.
Topics: Chorionic Gonadotropin; Female; Gestational Trophoblastic Disease; Humans; Hydatidiform Mole; Incidence; Pregnancy; Risk Factors; Uterine Neoplasms; Vacuum Curettage
PubMed: 31809433
DOI: 10.1097/AOG.0000000000003566 -
European Journal of Obstetrics,... Dec 2019To investigate whether intrauterine perfusion of hCG before embryo transfer (ET) is effective in women experienced two or more implantation failures. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate whether intrauterine perfusion of hCG before embryo transfer (ET) is effective in women experienced two or more implantation failures.
STUDY DESIGN
Systematic review and meta-analysis. In the current meta-analysis, Pubmed, EMBASE and The Cochrane Library were searched for trials which compared the efficacy of intrauterine perfusion of hCG with no perfusion of hCG in women undergoing in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), or frozen embryo transfer (FET) before ET. The primary outcomes are the clinical pregnancy rate (CPR) and live birth rate (LBR).
RESULTS
Six trials consisted of 1432 women were eligible for quantitative analysis. CPR (including 6 trials consisted of 1432 women) and LBR (including 3 trials consisted of 870 women) were significantly improved in the hCG group compared to the control group, with a CPR of 41.8 % vs. 31.2 % (RR 1.30, 95 % CI 1.14∼1.50, P < .001), an LBR of 27.8 % vs. 18.0 % (RR 1.52, 95 % CI 1.18∼1.96, P = .001).
CONCLUSION
Intrauterine perfusion of hCG is effective in improving clinical pregnancy rate and live birth rate in women who experienced two or more implantation failures, which might provide a potential therapeutical intervention for recurrent implantation failure (RIF). Although promising, further evidence from multicenter, randomized controlled trials are needed to confirm the conclusion from the current meta-analysis.
Topics: Chorionic Gonadotropin; Embryo Implantation; Embryo Transfer; Female; Fertilization in Vitro; Humans; Live Birth; Pregnancy; Pregnancy Rate; Reproductive Control Agents; Treatment Failure; Treatment Outcome
PubMed: 31704529
DOI: 10.1016/j.ejogrb.2019.10.039 -
In Vivo (Athens, Greece) 2019Studies on the impact of intrauterine human Chorionic Gonadotropin (hCG) administration in order to improve the In Vitro Fertilization (IVF) outcome have yielded... (Meta-Analysis)
Meta-Analysis
BACKGROUND/AIM
Studies on the impact of intrauterine human Chorionic Gonadotropin (hCG) administration in order to improve the In Vitro Fertilization (IVF) outcome have yielded conflicting results. The aim of the present systematic review and meta-analysis is to investigate whether timing of intrauterine hCG administration prior to embryo transfer affects its efficiency.
MATERIALS AND METHODS
A systematic search of the literature on Pubmed/Medline, Embase and Cochrane databases was performed. Only Randomized Control Trials were included in this meta-analysis.
RESULTS
Live birth rates were not improved following hCG administration (RR=1.13, 95%CI=0.88-1.46, p=0.34) in the pooled results. Combined live birth and ongoing pregnancy rates were borderline statistically significant following hCG administration (RR=1.27, 95%CI=1.00-1.62, p=0.05). Following subgroup analysis regarding live birth and ongoing pregnancy rates, only the 5-12 minutes prior to the embryo transfer group reported a statistically significant improvement.
CONCLUSION
Intrauterine infusion of hCG within an IVF-Intracytoplasmic Sperm Injection (ICSI) cycle improves outcome only when administered 5-12 min prior to embryo transfer.
Topics: Animals; Chorionic Gonadotropin; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Female; Live Birth; Pregnancy; Pregnancy Rate
PubMed: 31662498
DOI: 10.21873/invivo.11664 -
Pregnancy Hypertension Jul 2019The apelinergic-axis (Apelin, Elabela and their receptor APJ) is involved in many physiological and pathological processes. Both Elabela/APJ and Apelin/APJ are...
The apelinergic-axis (Apelin, Elabela and their receptor APJ) is involved in many physiological and pathological processes. Both Elabela/APJ and Apelin/APJ are implicated in the pathophysiology of preeclampsia in rodents. However, the findings regarding the apelinergic axis in human preeclamptic placental development have been rather conflicting. In this systematic review we present an overview of the current evidence regarding the pathophysiological role of Apelin, Elabela and their receptor in human preeclamptic pregnancies. The databases used for this systematic review were Pubmed, Scopus, Google Scholar and ClinicalTrials.gov. The reference lists of the selected studies were also screened for any additional studies. The last search was performed on the 25th of March 2019. Thirteen studies were included and subjected to quality assessment so that only high quality datasets were finally selected and included in this systematic evaluation. In total, 410 women that developed preeclampsia or IUGR and 409 healthy control pregnancies were included. The findings of this review suggest that circulating Apelin levels are increased in early onset/severe preeclamptic patients while Apelin levels in severe preeclamptic placenta tissues appear to show the opposite. Circulating Elabela levels in early-onset preeclamptic women do not differ from controls, while its levels in late-onset preeclampsia remain inconclusive. The studies on Elabela and APJ expression in placental tissues require larger sample sizes with defined preeclampsia subtypes to draw any definite conclusions. Large cohort studies with affected and control groups matched for Body Mass Index and gestational age at sampling are essential in order to substantiate other current findings.
Topics: Apelin; Apelin Receptors; Female; Humans; Peptide Hormones; Placenta; Pre-Eclampsia; Pregnancy
PubMed: 31487633
DOI: 10.1016/j.preghy.2019.06.002 -
BMC Pregnancy and Childbirth Aug 2019Oxytocin is a key hormone in childbirth, and synthetic oxytocin is widely administered to induce or speed labour. Due to lack of synthetized knowledge, we conducted a...
BACKGROUND
Oxytocin is a key hormone in childbirth, and synthetic oxytocin is widely administered to induce or speed labour. Due to lack of synthetized knowledge, we conducted a systematic review of maternal plasma levels of oxytocin during physiological childbirth, and in response to infusions of synthetic oxytocin, if reported in the included studies.
METHODS
An a priori protocol was designed and a systematic search was conducted in PubMed, CINAHL, and PsycINFO in October 2015. Search hits were screened on title and abstract after duplicates were removed (n = 4039), 69 articles were examined in full-text and 20 papers met inclusion criteria. As the articles differed in design and methodology used for analysis of oxytocin levels, a narrative synthesis was created and the material was categorised according to effects.
RESULTS
Basal levels of oxytocin increased 3-4-fold during pregnancy. Pulses of oxytocin occurred with increasing frequency, duration, and amplitude, from late pregnancy through labour, reaching a maximum of 3 pulses/10 min towards the end of labour. There was a maximal 3- to 4-fold rise in oxytocin at birth. Oxytocin pulses also occurred in the third stage of labour associated with placental expulsion. Oxytocin peaks during labour did not correlate in time with individual uterine contractions, suggesting additional mechanisms in the control of contractions. Oxytocin levels were also raised in the cerebrospinal fluid during labour, indicating that oxytocin is released into the brain, as well as into the circulation. Oxytocin released into the brain induces beneficial adaptive effects during birth and postpartum. Oxytocin levels following infusion of synthetic oxytocin up to 10 mU/min were similar to oxytocin levels in physiological labour. Oxytocin levels doubled in response to doubling of the rate of infusion of synthetic oxytocin.
CONCLUSIONS
Plasma oxytocin levels increase gradually during pregnancy, and during the first and second stages of labour, with increasing size and frequency of pulses of oxytocin. A large pulse of oxytocin occurs with birth. Oxytocin in the circulation stimulates uterine contractions and oxytocin released within the brain influences maternal physiology and behaviour during birth. Oxytocin given as an infusion does not cross into the mother's brain because of the blood brain barrier and does not influence brain function in the same way as oxytocin during normal labour does.
Topics: Female; Humans; Labor, Obstetric; Oxytocics; Oxytocin; Parturition; Pregnancy
PubMed: 31399062
DOI: 10.1186/s12884-019-2365-9 -
Archives of Gynecology and Obstetrics Sep 2019Chronic ectopic pregnancy (CEP) is a variant of ectopic pregnancy (EP) characterized by low or absent serum human chorionic gonadotropin (hCG) levels, resistance to...
BACKGROUND
Chronic ectopic pregnancy (CEP) is a variant of ectopic pregnancy (EP) characterized by low or absent serum human chorionic gonadotropin (hCG) levels, resistance to methotrexate (MTX), and an adnexal mass with fibrosis, necrosis, and blood clots due to repeated and gradual fallopian tube wall disintegration. CEP may complicate the course of patients with EP and is difficult to diagnose.
CASE PRESENTATION
The case of a 36-year-old woman with EP, low serum hCG levels, a small echogenic adnexal mass, and resistance to MTX is presented. Salpingectomy was performed and histology demonstrated CEP with fibrosis, necrosis, and a hematocele within degenerated chorionic villi.
SYSTEMATIC LITERATURE REVIEW
In a database search, 19 case reports, 3 case-control studies, and 3 case series describing 399 patients with CEP were identified. Serum hCG was negative in 40/124 cases (32%) with reported levels of serum hCG. The most common presenting symptom was abdominal pain (284/399 [71%]), followed by irregular vaginal bleeding (219/399 [55%]), and fever (20/399 [5%]). 73/399 (18%) women were asymptomatic. An adnexal mass was seen in 144/298 (48%) cases with perioperative ultrasound examination and with a mean largest diameter of 6.8 cm. Data on treatment modalities and outcomes were available for 297 women. Of these, 89% underwent surgery as first-line therapy. Laparoscopy was performed in most cases. MTX was the first-line therapy in a minority of cases. Complete resolution was achieved by first-line therapy in 287/297 (97%) cases. Adverse events were reported in 218 patients with CEP. Among those, adverse events ≥ grade 3 were seen in 186/218 (85%) cases. There was no case of treatment-related mortality.
CONCLUSION
CEP is a variant of EP with low or absent trophoblast activity. A prolonged clinical course is typical and surgery is the mainstay of treatment.
Topics: Abdominal Pain; Adnexal Diseases; Adult; Case-Control Studies; Chorionic Gonadotropin; Female; Fever; Humans; Pregnancy; Pregnancy Complications; Pregnancy, Ectopic; Salpingectomy; Uterine Hemorrhage; Uterus
PubMed: 31338659
DOI: 10.1007/s00404-019-05240-7