1,721,011 research outputs found
Administration of antenatal corticosteroid is associated with reduced fetal growth velocity: a longitudinal study
No full textObjective: To elucidate whether antenatal administration of corticosteroids in pregnancies with threatened preterm labor affects growth velocity. Methods: A cohort of 262 pregnancies exposed to antenatal corticosteroids longitudinally studied and delivered from 36 weeks (cases) were compared to an unexposed group of 270 women (controls). Methods: Fetal growth was assessed analyzing the growth velocity of head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW). Growth velocity (GV) was calculated as the difference in the Z-score between the biometric measurements recorded at the time of steroids administration and at 36 week of gestation, divided by the time interval (expressed in days) between the two scans and multiplied by 100. Similarly, changes in the Pulsatility Index (PI) of uterine, umbilical (UA), middle cerebral (MCA) arteries and cerebroplacental ratio (CPR) during the same time interval were also computed. Results: Median gestational age at steroid administration (30.2 weeks vs 30.4) and follow-up ultrasound (36.4 weeks vs 36.4) were similar between cases and controls. In pregnancies exposed to antenatal corticosteroids, growth velocity in the HC (−0.61 vs. 0.12; p ≤ 0.001), AC (−0.55 vs. −0.04; p ≤ 0.001) and EFW (−0.89 vs. 0.06; p ≤ 0.001) were lower when compared to pregnancies not exposed to steroid therapy, while there was no difference in the growth velocity of FL (−0.05 vs 0.19; p =.06) or in any of the Doppler parameters explored. Conclusion: In pregnancies exposed to antenatal steroid therapy, there is a significant reduction in fetal growth velocity not otherwise associated with changes in cerebroplacental Dopplers
Prediction of delivery after 40 weeks by antepartum ultrasound in singleton nulliparous women: a prospective cohort study
Full text linkBackground: Induction of labor at 39 weeks of gestation is associated with better maternal and perinatal outcomes than expectant management. However, a policy of induction of labor implies the identification of women who will deliver after 40 weeks, who are at higher risk of adverse outcome. Objective: This study primarily aimed to elucidate the role of antepartum ultrasound in predicting the onset of spontaneous labor in a cohort of low-risk singleton pregnancies, and secondarily to compare its diagnostic performance with that of other ultrasonographic and clinical parameters. Study design: This was a prospective study including singleton nulliparous women undergoing a dedicated ultrasound assessment at 36 to 38 weeks of gestation. The primary outcome was delivery ≥40 weeks of gestation. The ultrasound parameters explored were cervical length, posterior cervical angle, angle of progression, and head-perineum distance. Multivariate logistic regression, Kaplan-Meier, and area under the curve analyses were used to test the strength of association and diagnostic performance of variables considered in predicting delivery ≥40 weeks. Results: A total of 457 women were included, and 49.2% delivered ≥40 weeks. Cervical length was longer (30 vs 19 mm; P≤.0001) and posterior cervical angle wider (105° vs 98°, P≤.0001) in women delivering ≥40 weeks than those delivering 24 mm at 36 to 37 weeks of gestation shows the optimal combination of sensitivity and specificity in predicting delivery ≥40 weeks. The findings from this study can help in identifying those women for whom elective induction of labor at 39 weeks of gestation would be beneficial in reducing the risk of adverse pregnancy outcome
Fetal Cardiac Remodeling Is Affected by the Type of Embryo Transfer in Pregnancies Conceived by in vitro Fertilization: A Prospective Cohort Study
No full textThe added value of umbilical vein flow in predicting fetal macrosomia at 36 weeks of gestation: A prospective cohort study
No full textIntroduction: Current models based on fetal biometry and maternal characteristics have a poor performance in predicting macrosomia. The primary aim of this study was to elucidate the diagnostic performance of fetal venous and arterial Dopplers in predicting macrosomia in the third trimester of pregnancy; the secondary aim was to build a multiparametric prediction model including pregnancy, ultrasound and Doppler characteristics able to predict macrosomia accurately. Material and methods: Prospective cohort study including 2156 singleton pregnancies scheduled for routine ultrasound assessment at 36 weeks of gestation. Fetal biometry, estimated fetal weight (EFW), pulsatility index of the uterine, umbilical, and middle cerebral arteries, cerebroplacental ratio and umbilical vein blood flow (UVBF) normalized for fetal abdominal circumference (UVBF/AC) were recorded. Primary outcome was the prediction of fetal macrosomia, defined as a birthweight >90th percentile; secondary outcome was the prediction of newborns >4000 g. Logistic regression and area under the curve (AUC) analyses were used to analyze the data. Results: Fetal macrosomia complicated 9.8% of pregnancies, and 7.7% of newborns had a birthweight >4000 g. At multivariate logistic regression analysis, maternal body mass index (adjusted odds ratio [aOR] 1.23), pregestational diabetes (aOR 1.83), a prior newborn with a birthweight >95th centile (aOR 1.49), EFW (aOR 2.23) and UVBF (aOR1.84) were independently associated with macrosomia, whereas gestational diabetes mellitus (P =.07) or any of the other Doppler parameters were not. EFW had an AUC of 0.750 and of 0.801 alone and in association with maternal characteristics for the prediction of macrosomia, respectively. The addition of UVBF to this model significantly improved the prediction of fetal macrosomia provided by maternal and ultrasound parameters with an AUC of 0.892 (De Long P =.044 and P =.0078, respectively). The predictive performance for birthweight >4000 g was similar and significantly improved when UVBF was included in the diagnostic algorithm. Conclusions: Umbilical vein blood flow evaluation in the third trimester improves the diagnosis of fetal macrosomia. The optimal diagnostic performance for macrosomia is achieved by a multiparametric model including umbilical vein flow, maternal characteristics and EFW
Autoimmune diseases and pregnancy
No full textPregnancy in autoimmune diseases remains an argument of debate. In last years great improvements were done and with the correct medical support women with disease such as Systemic Lupus Erythematosus or Antiphospholipid Syndrome can afford a pregnancy and have healthy babies. The starting point is a good counselling. Women should be informed about risks that can occur taking some medications while pregnant and, on the other hand, that there are medications that can be safety assumed during pregnancy. Furthermore, there are known maternal risks factor such as the presence of antiphospholipid antibodies or anti-Ro/SSA antibodies that must be carefully manage by both rheumatologists and obstetrics. In addition, also disease activity during pregnancy can represent an issue. For all these reason, a multidisciplinary approach is mandatory in order to give our patients an optimal medical support, before, during and after pregnancy
Sonoelastographic assessment of the uterine cervix in the prediction of imminent delivery in singleton nulliparous women near term: a prospective cohort study.
No full textUltrasound assessment of the cervix in predicting successful membrane sweeping: a prospective observational study
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Prediction of delivery after 40 weeks by antepartum ultrasound in singleton multiparous women: a prospective cohort study
No full textObjective: Universal elective induction of labor (IOL) in singleton parous pregnancies has been advocated to reduce the rate of cesarean section (CD), without impacting on maternal outcome. However, about 50% of women deliver after 40 weeks; therefore, an accurate estimation of the time of delivery might avoid unnecessary early IOL. The aim of this study was to test the diagnostic accuracy of ultrasound in predicting delivery ≥40 weeks of gestation in singleton parous women. Methods: Prospective cohort study of singleton parous women undergoing a dedicated ultrasound assessment at 36–38 weeks of gestation. The primary outcome was spontaneous vaginal delivery ≥40 weeks of gestation. Cervical length (CL), posterior cervical angle (PCA), sonoelastographic hardness ratio (HR), angle of progression (AoP) and head perineal distance (HPD) were measured. Multivariate logistic regression and area under the curve (AUC) analyses were used to test the diagnostic accuracy of different maternal and ultrasound characteristics in predicting delivery ≥40 weeks. Results: 518 singleton pregnancies were included in the analysis and 235 (45.4%) delivered ≥40 weeks. CL (29 vs 19 mm; p ≤.0001) and HPD (50 vs 47 mm; p =.001) were longer, HR higher (38.9 vs 35.5; p =.04), while PCA (98° vs 104°; p ≤.0001) and AOP narrower (93° vs 98°; p =.029) in pregnancies delivered compared to those not delivered after 40 weeks of gestation. At multivariable logistic regression analysis, CL (aOR 1.206; 95% CI 1.164–1.250), HPD (aOR 1.127; 95% CI 1.066–1.191) and HR (aOR 1.022; 95% CI 1.003–1.041 were the only variables independently associated with delivery ≥40 weeks. CL showed had an AUC of 0.863 in predicting delivery ≥40 weeks of gestation, with an optimal cutoff of 23.5 mm. Integration of HPD and HR did not significantly improve the diagnostic performance of CL alone to predict delivery ≥40 weeks (AUC 0.870; p =.472). Conclusion: Cervical length at 36–38 weeks has a good diagnostic accuracy to predict spontaneous vaginal delivery at ≥40 weeks. Universal assessment of CL in the third trimester of pregnancy may help in identifying those women who may benefit of elective IOL at 39 weeks
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