1,721,030 research outputs found
Diagnosis of deep venous thrombosis and pulmonary embolism in pregnancy
No full textAccurate diagnosis of deep venous thrombosis and pulmonary embolism is required because treatment can be lifesaving, although inappropriate anticoagulation exposes the mother and fetus to hemorrhage and other hazards. Clinicians must be aware of which patients are at risk, as deep venous thrombosis is frequently asymptomatic. Clinical diagnosis is unreliable for deep venous thrombosis and pulmonary thromboembolism; therefore, objective tests are required. Venography is the gold standard test for deep venous thrombosis but is invasive. It has been superseded by less invasive tests such as compression ultrasound. This test, although not yet rigorously scrutinized in pregnancy, is now the first-line investigation. Where doubt remains, venography, CT, and magnetic resonance imaging have a role. Ventilation-perfusion scanning is the pivotal test for pulmonary thromboembolism for pregnancy, and it need not expose the fetus to excess radiation. If the results of this test are unclear, deep venous ultrasound can guide management of suspected pulmonary thromboembolism, thus avoiding pulmonary angiography
Should women trying to conceive avoid dairy products?
No full textNo abstract is available for this article
The deep venous system in the puerperium: an ultrasound study
No full textObjective: To study the vessel wall diameter and blood flow velocity within the proximal deep venous system of the leg in the puerperium and to compare these measures with respect to the left versus right leg, 4th versus 42nd postnatal day, and vaginal versus caesarean delivery.Design: A combined longitudinal and cross-sectional observational study.Setting: The ultrasound department of a teaching maternity hospital.Results: A reduction in vessel diameter and an increase in flow velocity was observed between the 4th and 42nd postnatal day. Vessel diameter was greater and flow velocity was reduced in the left compared to the right leg. In those delivered by caesarean section, a trend towards reduced flow velocity in the proximal deep leg veins was observed when compared with those delivered vaginally.Conclusions: These data suggest possible physiological mechanisms behind previous clinical observations relating to the period of greatest risk of deep vein thrombosis in the puerperium, the relative preponderance of left sided deep vein thrombosis and the risk of deep vein thrombosis associated with caesarean section.<br/
Gonadotropin therapy for the treatment of anovulation and for ovarian hyperstimulation for IVF
No full textKnowledge of the mechanisms of single dominant follicle selection has led to the development of a novel and effective ovulation induction regimen for anovulatory women; the step down protocol. This commences with a fixed high gonadotropin dose followed by several decremental steps. For some patients the initial dose is too high, risking ovarian hyperstimulation syndrome. A major improvement to this approach would, therefore, be the ability to use initial screening characteristics to assess the individual FSH threshold beforehand. For IVF treatment, interfering in the process of single dominant follicle selection in ovulatory women by late follicular phase administration of low doses of FSH may result in a significantly reduced duration of stimulation and amounts of exogenous FSH preparations used. Less monitoring would be required and chances for short-term complications or long term risks may be reduced
Does glucocorticoid therapy in the peri-implantation period have an impact on IVF outcomes?
No full textPurpose of review: Failure of the embryo to implant remains the major limiting step in assisted reproductive techniques success rates. The existing evidence supports a possible role of glucocorticoids in improving the intrauterine environment and therefore embryo implantation. The present study aims to summarize the available evidence and make recommendations about the use of glucocorticoids.Recent findings: A recent meta-analysis on glucocorticoids to improve embryo implantation showed no beneficial effect in the routine IVF/intracytoplasmic sperm injection population, although a subgroup analysis of women undergoing IVF did show a borderline improvement in pregnancy rates. Studies on women with autoantibodies or treatment cycles in which assisted hatching is performed have also indicated a benefit from glucocorticoid cotreatment. No significant improvement in pregnancy rates, however, has been demonstrated in women with recurrent implantation failure in whom assisted hatching is performed in combination with glucocorticoids. Conflicting results have been reported on the use of glucocorticoids to improve the ovarian response.Summary: Although evidence to support the empirical use of glucocorticoids to improve implantation is insufficient, these may be beneficial in specific patient groups. More studies are required to confirm the efficacy and safety of adjuvant glucocorticoid therapy, and they should only be empirically used in the context of randomized controlled trials.<br/
The duration of the interpregnancy interval in multiparous women and maternal weight gain between pregnancies: findings from a UK population-based cohort
Full text linkMaternal obesity in pregnancy increases the risk of adverse long-term health outcomes in both mother and offspring. A population-based cohort of prospectively collected routine antenatal healthcare data collected between January 2003 and September 2017 at University Hospital Southampton, UK was utilised to investigate the association between duration of interpregnancy interval between successive pregnancies and gain in maternal body mass index by the start of the next pregnancy. Records of 19362 women with two or more consecutive singleton live births were analysed. Two-thirds had gained weight when presenting to antenatal care for their subsequent pregnancy with 20% becoming overweight/obese. Compared to an interval of 24–35 months, an interval of 12–23 months was associated with lowest risk of weight gain (adjusted RR 0.91, 99% CI 0.87 to 0.95, p < 0.001) and ≥36 months with greatest risk (adjusted RR 1.11, 99% CI 1.07 to 1.15, p < 0.001) for the first to second pregnancy. This study shows that most multiparous women start their pregnancy with a higher weight than their previous one. An interval of 12–23 months is associated with the lowest risk of starting the second pregnancy with a higher body weight accounting for age. In countries with high prevalence of maternal obesity, birth spacing may merit exploration as a factor impacting on perinatal morbidity
Immune modulation treatments-where is the evidence?
No full textWhile advances in assisted reproductive techniques have been substantial, failure of the apparently viable embryo to implant remains a source of distress and frustration to patients and specialists alike. The unique maternal immunological response to the embryo and the notion that defects in early placentation underlie the great complications of pregnancy have focused attention on the therapeutic potential of peri-implantation immunomodulation. On the face of it, the rationale for this approach is very attractive. However, as will be argued in this review, the clinical evidence base supporting the use of immunosuppressive treatments is weak and difficult to apply in practice and fails the needs of both doctors and their patients. This evidence gap is filled by justifications that are based largely on meeting patient expectations and commercial imperatives. However, this does not mean that immunomodulation treatments should be written off as ineffective. The literature in this field, while suffering the same challenges of heterogeneity, small studies, and publication bias as other areas of medicine, does hint at the way forward. Recurrent implantation failure and pregnancy loss are not diagnoses but clinical presentations that require appropriate phenotyping and etiological investigation. We are increasingly gaining the tools to make an “endometrial diagnosis,” and these will allow us to design clinical studies of interventions that treat the underlying cause rather than the symptoms of implantation failure. The current evidence base does not support the clinical use of immunomodulation therapies in patients undergoing IVF. However, more discerning phenotyping may identify groups who could benefit
Is the duration of the preceding inter-pregnancy interval associated with offspring’s size at birth? – analysis of a UK population-based cohort
No full textBackground: short and long intervals between pregnancies have been associated with increased risk of adverse birth outcomes including low birth weight and stillbirth. Birthweight is an indicator of the in-utero environment and a key early life risk factor for long-term health outcomes such as obesity and cardiovascular disease. The World Health Organization recommended in 2005 waiting at least 24 months after a live birth before getting pregnant again. There are no UK guidelines on birth spacing. We aimed to investigate the association between duration of the inter-pregnancy interval between successive live birth pregnancies and risk of having a small-for-gestational age (SGA) or large-for-gestational age (LGA) baby.
Methods: a population-based cohort of prospectively collected routine healthcare data for antenatal care between January 2003 and September 2017 (total n=82 098 pregnancies) at University Hospital Southampton, Hampshire, UK was used. Records of women with their first two singleton live-birth pregnancies were analysed (n=15 922 women). Inter-pregnancy interval was defined as timing between a live birth and the next conception. SGA was defined as <10th percentile weight and LGA as >90th percentile weight for gestational age. Logistic regression was used to examine the association between risk of SGA or LGA and inter-pregnancy interval. The models were adjusted for maternal age, ethnicity, highest educational qualification, employment status, baseline maternal BMI, between pregnancy change in maternal BMI, smoking status at second pregnancy booking appointment and conception following infertility treatment. Sensitivity analyses was conducted adjusting for SGA or LGA in previous pregnancies.
Results: twelve percent of first pregnancy and 7% of second pregnancy births were SGA. Seven percent of first pregnancy and 13% of second pregnancy births were LGA. Three percent of women each had SGA and LGA babies in both pregnancies. Compared to an interval of 24–35 months, there was a lower risk of SGA birth in second pregnancy with an interval of 12–23 months (adjusted OR 0.82, 95% CI 0.69 to 0.98, p=0.03). The association remained after adjusting for previous outcome of SGA in sensitivity analysis. No association was observed between risk of SGA with intervals of <12 or ≥36 months or LGA and inter-pregnancy interval.
Conclusion: an inter-pregnancy interval of 12–23 months was associated with lower risk of SGA, however the duration of the interval was not associated with LGA risk. In high-income countries with relatively healthy pregnant population, further research considering the potential advantages of shorter optimal interval between pregnancies than that recommended by WHO is needed
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