-
European Journal of Obstetrics,... Sep 2023To evaluate maternal and perinatal outcomes of removal versus retention of cervical cerclage after premature preterm rupture of membranes (pPROM). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate maternal and perinatal outcomes of removal versus retention of cervical cerclage after premature preterm rupture of membranes (pPROM).
STUDY DESIGN
Medline, Embase and Cochrane databases were searched electronically on February 2023 utilizing combinations of the relevant medical subject heading (MeSH) terms, keywords, and word variants that were considered suitable for the topic. Either prospective or retrospective trials were considered suitable for the inclusion. The coprimary outcome of this study were pregnancy latency >7 days from pPROM and pregnancy latency >48 h from pPROM. Random effect head to-head meta-analyses were performed to directly compare each outcome, expressing the results as summary odds ratio (OR) for dichotomous outcomes and as mean difference (MD) for continuous outcomes, plus relative 95% confidence interval (CI). Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale.
RESULTS
Six studies involving a total of 377 women (169 in the "removal" and 208 in the "retention" group) were included. The rate of pregnancy prolongation >48 h was significantly lower in the removal compared to retention group (OR 0.15, 95% CI 0.07-0.31; p < 0.0001), as well as the rate of pregnancy prolongation >7 days (OR 0.30 95% CI 0.11-0.83; p = 0.02) and pregnancy latency expressed in days (MD -2.84 days, 95% CI -5.40 to -0.29; p = 0.03). The rate of chorioamnionitis was significantly lower in the removal compared to the retention group (OR 0.57 95% CI 0.34-0.96p = 0.03) as was the rate of Apgar score < 7 at 5 min (OR 0.22 95% CI 0.08-0.56; p = 0.002). There was no difference between removal and retention groups for all the other maternal and perinatal outcomes.
CONCLUSIONS
The decision whether to remove or retain cerclage in case of pPROM should balance the prematurity-related risks with that of infectious complications, thus highlighting the need for tailored management based on gestational age at occurrence of pPROM.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Cerclage, Cervical; Retrospective Studies; Prospective Studies; Fetal Membranes, Premature Rupture; Pregnancy Outcome; Premature Birth
PubMed: 37481990
DOI: 10.1016/j.ejogrb.2023.07.006 -
Tissue & Cell Aug 2023Background, recently, amnion-chorion membranes (ACMs), has provided new strategy to induce tissue regeneration in periodontal disorders. These biomaterials are rich... (Review)
Review
Background, recently, amnion-chorion membranes (ACMs), has provided new strategy to induce tissue regeneration in periodontal disorders. These biomaterials are rich sources of various biomarkers such as growth factors, proteins, and stem cells (SCs) which can accelerate regeneration. Numerous studies have been investigated beneficial effects of these materials on periodontal disorders⁹ tissue regeneration. Objective, the aim of this review was to evaluate therapeutic efficacy of these biomaterials, (combination of different effective biomarkers and SCs), more cost-effectiveness and with lower immune adverse effects on tissue regenerating in periodontal diseases. Methods, inclusion criterion was the English language and full text publications. Reviews, or strategies other than ACMs application for periodontal disorders treatment, and mechanism other than tissue regeneration were excluded. Data source, this search was done in PubMed, web of science (WOS) and Scopus using keywords. The search were repeated in May 2023 to identify any report that emerged during the time to develop the manuscript. After assessing bias, total of 151 articles were initially identified. After deleting duplication (30) using hand- screening, 121 papers met all inclusion criteria and were selected. Moreover, 31 papers were reviewed and excluded. Among remained articles (90), 57 articles excluded due to unrelated, 33 articles were assessed for the efficacy of ACMs on treating periodontal disorders. The most of studies used this material in the coronally flap technique. Miller recession defects was the most investigated periodontal disorder and clinical parameters were the most evaluated parameters in assessing the efficacy of ACMs. Discussion, different findings might be explained by different study designs, application techniques, or periodontal disorders in these studies. In the present review, we summarize the impacts of ACMs on tissues regeneration in treating periodontal disorders, but despite the promising and ameliorating results of this review, further studies are needed to assess these beneficial effects tissue to clarify the their helpfulness in clinical management of periodontal disorders. This review did not receive any funding.
Topics: Humans; Amnion; Guided Tissue Regeneration, Periodontal; Alveolar Bone Loss; Periodontal Diseases; Biocompatible Materials
PubMed: 37437330
DOI: 10.1016/j.tice.2023.102147 -
International Journal of Gynaecology... Nov 2023The utility of procalcitonin to identify obstetric sepsis is unknown. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The utility of procalcitonin to identify obstetric sepsis is unknown.
OBJECTIVE
To calculate the mean (range) procalcitonin in pregnancy among healthy women not in labor (group 1), healthy women in labor (group 2), and women with preterm prelabor rupture of membranes (PPROM) without clinical chorioamnionitis (group 3).
SEARCH STRATEGY
NLM PubMed, Elsevier Embase, and Wiley Cochrane Central Register of Controlled Trials from inception to February 21, 2022.
SELECTION CRITERIA
Ten or more pregnant women with procalcitonin reported at more than 20 weeks of pregnancy, with information on labor, PPROM, and infection. Exclusions were major medical comorbidities.
DATA COLLECTION AND ANALYSIS
Each abstract and full-text review was independently reviewed by the same two authors. Quality was reviewed using the Newcastle-Ottawa Scale. A meta-analysis was performed using a random effects model.
MAIN RESULTS
The systematic review included 25 studies: 10 (40%) of good quality and 15 (60%) of poor quality. The meta-analysis included 21 studies. Mean procalcitonin in group 1 was 0.092 ng/mL (range 0.036-0.049 ng/mL), in group 2 it was 0.130 ng/mL (range 0.049-0.259 ng/mL), and in group 3 it was 0.345 ng/mL (range 0.005-1.292 ng/mL).
CONCLUSIONS
Among healthy pregnant women not in labor, procalcitonin levels are comparable to those in non-pregnant adults and may be useful in identifying infection. Procalcitonin levels in other groups overlap abnormal values of procalcitonin in non-pregnant adults, and may not discriminate infection among women in labor or with obstetric comorbidities.
PROSPERO
CRD42020157376, registered 4/28/2020.
Topics: Adult; Female; Humans; Infant, Newborn; Pregnancy; Chorioamnionitis; Fetal Membranes, Premature Rupture; Labor, Obstetric; Procalcitonin; Observational Studies as Topic
PubMed: 37118923
DOI: 10.1002/ijgo.14813 -
American Journal of Perinatology Jul 2024Despite patient interest, there is little evidence regarding waterbirth. This review sought to compare maternal and perinatal outcomes in waterbirth, compared with... (Meta-Analysis)
Meta-Analysis
Despite patient interest, there is little evidence regarding waterbirth. This review sought to compare maternal and perinatal outcomes in waterbirth, compared with landbirth. This search was conducted using MEDLINE, Google Scholar, Web of Sciences, Scopus, ClinicalTrial.gov, OVID, and Cochrane Library from inception to November 15, 2021, with no language or geographic restrictions. Review was registered with PROSPERO under registration number: CRD42021288576. Selection criteria included randomized controlled trials of women with singleton cephalic gestations at ≥36 weeks comparing waterbirth to landbirth. The primary outcome was a perinatal composite outcome. Secondary outcomes included maternal and individual perinatal outcomes. Summary measures were reported as relative risk or mean difference with 95% confidence intervals using random effects model of DerSimonian and Laird. (Higgins ) > 0% was used to identify heterogeneity. Six trials including 706 patients were included. When reported, all patients were ≥ 37 weeks' gestation. Labor augmentation (41.7 vs. 84.7%, < 0.0001) and neuraxial anesthesia (10.5 vs. 72.4%, < 0.0001) were less common with waterbirth. Estimated blood loss, postpartum hemorrhage, perineal laceration, episiotomy, mode of delivery, and perinatal outcomes did not differ between groups. Chorioamnionitis and endometritis were not reported by any trial. Maternal satisfaction was higher ( = 0.01) and pain scores lower ( = 0.003) with waterbirth. Length of first stage ( < 0.00001), third stage ( = 0.02), and labor ( = 0.04) were shorter with waterbirth. The composite perinatal outcome could not be calculated due to lack of individual patient data. Compared with landbirth, waterbirth was associated with lower rates of neuraxial anesthesia and lower pain scores, with improved maternal satisfaction. KEY POINTS: · Data are limited regarding the safety and potential benefits of waterbirth.. · With waterbirth, maternal satisfaction was higher and pain scores lower. The first and third stages of labor and labor overall were shorter. No significant differences noted in other maternal outcomes, such as hemorrhage or laceration.. · Insufficient data are available regarding neonatal outcomes..
Topics: Humans; Pregnancy; Female; Natural Childbirth; Water; Delivery, Obstetric; Postpartum Hemorrhage
PubMed: 36791786
DOI: 10.1055/s-0043-1764145