1,721,034 research outputs found
Fetal growth in IVF/ICSI pregnancies from fresh/thawed embryo transfer and natural conception
No full textComment on “Accuracy of the FMF Bayes theorem-based model for predicting preeclampsia at 11–13 weeks of gestation in a Japanese population”
No full textIn Goto’s paper, the prediction model essentially revealed a 46
good degree of reproducibility in terms of detection rate (DR) 47
compared with the original results already shown by other 48
local and independent studies and obtained mainly in Eur- 49
opean populations (Caucasian in the vast majority of studies). 50
In particular, the DR for preterm PE at a fixed 10% false 51
positive rate (FPR) was 91% when all the available markers 52
(maternal factors, mean arterial pressure (MAP), uterine artery 53
pulsatility index (UtA-PI) and placental growth factor (PlGF)) 54
were included in the model. On the other hand, the prediction 55
for term PE was poorer with 60% DR at a fixed FPR of 10%. 56
The calibration curve for early PE (expected vs. observed 57
risk) was basically in line with the original estimation [2, 3]. 58
In fact, in a calibration plot, the very high expected and 59
observed risks (1:1–1:10) were quite similar, but a less correct 60
calibration (with underestimation of the validation model) was 61
obtained for the observed value. In fact, for an estimation of 62
1:600, the corresponding expected risk value was ~1:90. It is 63
unclear whether this abnormal calibration could affect DR 64
and/or FPR
Time to enhance COVID-19 vaccination in women of reproductive age
Full text linkPrevious evidence, including major works from the
Intercovid multinational consortium, showed that
COVID-19 in pregnancy is associated with adverse
maternal and neonatal outcomes such as hypertensive
disorders, preterm birth (particularly with iatrogenic
aetiology), gestational diabetes, foetal distress and
reduced foetal growth.1–4 In contrast, pregnant women
with complete or boosted vaccination status showed
reduced risks of severe morbidity and complications
compared to unvaccinated, underscoring the importance of vaccination coverage.5 Two studies from the
same consortium, published in The Lancet Regional
Health – Europe, reinforce the importance of COVID-19
vaccination in reducing risks of adverse outcomes,
including stillbirth and preterm birt
Cesarean Delivery Uptake Trends Associated with Patient Features and Threshold for Labor Anomalies
Full text linkDoes intrapartum epidural analgesia influence rate of emergency delivery for fetal compromise?
No full textLinked articles: This Editorial comments on Damhuis et al. and Tabernee Heijtmeijer et al
Spontaneous Preterm Birth Phenotyping Based on Cervical Length and Immune-Mediated Factors
Full text linkCervical length (CL) screening by ultrasonographic measurement is an established tool widely
implemented in the clinical protocols of preterm birth (PTB) prediction and prevention. Growing
evidence has shown immune-mediated factors in the etiology of spontaneous PTB (sPTB), with
robust biological plausibility supporting deep interrelationships with progressive cervical shortening.
We explore a retrospective cohort study that examined the sequential measurement of CL and
leucocyte markers in both singleton and twin pregnancies.1
The study’s objective was to identify the
clinical presentations associated with sPTB in relation to variations in these parameters.1
Progressive
CL shortening was associated with higher rates of sPTB in both singletons (4.1% vs 2.7%) and twins
(41.9% vs 18.2%) as compared with cases with stable CL. In addition, in singleton pregnancies,
individuals in the early preterm birth subgroup with a shortened or stable CL had elevated total white
blood cell count, neutrophil count, and neutrophil-to-lymphocyte ratio, along with a reduced
lymphocyte-to-monocyte ratio, in comparison with individuals in the full-term birth subgroup.
However, in twins, similar changes were exclusive to those with a shortened cervix. Finally, the study
quantified the association between immune-related indicators and risk of sPTB, incorporating CL. In
singleton pregnancies, an increase in the white blood cell count and neutrophil count was associated
with early sPTB for both stable and shortened CL. Conversely, in twins, there was a significantly
higher white blood cell count, neutrophil count, and monocyte count only in the subgroup with
shortened C
Fertility and mode of conception affect the risk of preterm birth related to both spontaneous and iatrogenic etiologies
No full textn
Hazard and cumulative incidence of umbilical cord metabolic acidemia at birth in fetuses experiencing the second stage of labor and pathologic intrapartum fetal heart rate requiring expedited delivery
Full text linkPurpose: The aim of the study was to determine the cause-specific hazard (CSH) and the cumulative incidence function (CIF) for umbilical cord metabolic acidemia at birth (MA; pH < 7.0 and/or BE ≤ − 12 mmol/L) at delivery in patients experiencing the 2nd stage of labor (2STG), stratified for both FIGO-2015 pathologic intrapartum cardiotocography requiring expedited delivery (CTG_RED) and duration of 2nd stage of labor. Methods: 3459 pregnancies experiencing the 2nd stage of labor and delivering at the Division of Obstetrics and Prenatal Medicine, IRCCS Sant’Orsola-Malpighi Hospital, Bologna (Italy), were identified between 2018 and 2019. Survival analysis was used to assess CSH and CIF for MA, stratified for FIGO-2015 pathologic CTG and relevant covariates. Results: FIGO-2015 pathological CTG with expedited operative delivery or urgent cesarean section within 10 or 20 min from diagnosis, respectively occurred in 282/3459 (8.20%). The rate of MA at delivery was 3.32% (115/3459). The spline of CSH for MA showed a direct correlation with the duration of 2STG always presenting higher values and greater slope in the presence of pathologic CTG, with plateau between 60 and 120 min and rapid increase after 120 min. The CIF at 180 min in the 2STG was 2.67% for nonpathological and 10.63% for pathological CTG_RED. Nulliparity, pathological CTG, and meconium-stained amniotic fluid resulted significant predictors of MA in our multivariable model. Conclusion: The risk for MA increases moderately across the 2STG with nonpathological CTG and quadruples with pathological CTG_RED. Adjustment for other predictors of MA including meconium-stained amniotic fluid and nulliparity reveals a significant hazard increase for MA associated with pathologic CTG_RED
Prenatal diagnosis of bladder exstrophy by 2D and 3D ultrasound
No full textWe are presenting a case in which prenatal diagnosis of bladder exstrophy was successfully performed at 23 weeks by the use of two-dimensional (2D) and three-dimensional (3D) ultrasound. The mother was 30 years old, primigravida. During a routine ultrasound scan the bladder was not visualized, the umbilical cord insertion was displaced downwards by an echogenic abdominal wall mass and 3D ultrasound confirmed an abdominal bulge below the umbilical cord insertion by the use of surface rendering mode. No other obvious fetal defect was observed. The anomaly was managed expectantly and genetic amniocentesis was not recommended. A viable female fetus was delivered at 39 weeks by elective Cesarean section with a birth-weight of 2555 g and Apgar score of 10/10. Postnatal clinical assessment confirmed the diagnosis and surgical intervention was performed 24 hours after birth for the reconstruction of the defect with a good neonatal outcome. The infant is one year old at present and in good condition. Prenatal diagnosis of bladder exstrophy is difficult and it has been extensively documented in 12 previously published cases. To our knowledge, this is the second report of prenatal diagnosis of bladder exstrophy supported by 3D ultrasound. Surface-rendering mode is a computerized algorithm which facilitates the imaging of surfaces within a region of interest in a three-dimensional fashion, rather than in cross-sectional planes. Surface rendering mode appears to be a helpful tool in the diagnosis of bladder exstrophy permitting the visualization of abdominal wall bulge, cord insertion and genitalia, playing a substantial role in the study of the anatomy. In this case 3D ultrasound was helpful in confirming the diagnosis of bladder exstrophy and simplified explanation and discussion with the parents
Convenient use of carbetocin during 70 elective cae- sarean deliveries [Praticità d'uso della carbetocina durante 70 tagli cesarei elettivi]
No full textObjective. To analyze the efficacy of a potent analogue of oxytocin during elective caesarean delivery. Study design. This clinical-pharmacologic case-control study was conducted prospectively in 70 pregnant women scheduled for c-section, 60 patients with a singleton pregnancy and ten with a twin pregnancy. We compared our standard uterotonic protocol (oxytocin plus ergometrine) versus a single intravenous bolus injection of 100 μg of carbetocin, administered immediately after foetal delivery in controlling perioperative blood loss. Results. The patients (30 with 1-2 previous CS, 10 with twin pregnancy and 30 with other indications for elective CS) were similar about their epidemiologic characteristics. Mean blood loss with carbetocin was 523 mL compared to 483 mL with oxytocin plus ergometrine (n.s.). The economic costs were higher in cases compared to controls (nearly 30 versus 8,5-11,5 euros). Conclusions. Carbetocin is a valid alternative to traditional uterotonic treatment with similar efficacy but easier to handle. In terms of handly and nursing the ratio cost/benefit is undoubtedly in favour of carbetoci
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