10 research outputs found
Increased single-balloon Foley catheter volume for induction of labor and time to delivery: A systematic review and meta-analysis
No full textINTRODUCTION:
Induction of labor is a common intervention. The objective was to investigate whether larger Foley catheter volumes for labor induction decrease the total time from induction to delivery.
MATERIAL AND METHODS:
Randomized controlled trials comparing larger single-balloon volumes (60-80 mL) during Foley catheter cervical ripening with usual volume (30 mL) in women undergoing labor induction were identified by searching electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, PROSPERO, EMBASE, Scielo and the Cochrane Central Register of Controlled Trials) from inception through 2017. The primary outcome was mean time from induction to delivery in hours. Secondary outcomes included time from induction to vaginal delivery, delivery within 24 h, time to Foley expulsion, cesarean section, chorioamnionitis, epidural use, hemorrhage, meconium staining, and neonatal intensive care unit admission. Meta-analysis was performed using the random effects model of DerSimonian and Laird (PROSPERO CRD42017058885).
RESULTS:
Seven randomized controlled trials including 1432 singleton gestations were included in the systematic review. Women randomized to larger volumes of balloon had a significantly shorter time from induction to delivery (mean difference 1.97 h, 95% CI -3.88 to -0.06). There was no difference in cesarean section between groups (16 vs. 18%, relative risk 0.84, 95% CI 0.6-1.17). A larger balloon volume was associated with a nonsignificant decrease in time from induction to delivery in multiparous (mean difference 2.67 h, 95% CI -6.1 to 0.76) and nulliparous women (mean difference 1.82 h, 95% CI -4.16 to 0.53).
CONCLUSION:
Balloon volumes larger than 30 mL during Foley catheter induction reduce total time to delivery by approximately 2 h
Vaginal progesterone versus Intramuscular 17-hydroxyprogesterone caproate for Prevention of recurrent preterm birth (VIP): a randomized controlled trial
No full textBackground: Preterm birth is the leading cause of neonatal morbidity and mortality, and prior preterm birth is one of the strongest risk factors for preterm birth. National and international obstetric societies have different recommendations regarding progesterone formulation for prevention of recurrent preterm birth.
Objective: To determine whether vaginal progesterone is superior to 17OHPC in prevention of recurrent preterm birth (PTB) in singletons with prior spontaneous preterm birth (sPTB).
Design: This was an open-label multi-center pragmatic randomized controlled trial at five United States centers of singleton pregnancies \u3c24 weeks\u27 with a prior sPTB randomized 1:1 to either 200mg vaginal progesterone suppository nightly or 250mg intramuscular 17OHPC weekly from 16 weeks\u27 until 36 weeks\u27. Based on estimated recurrent PTB rate of 36% with 17OHPC, 95 participants needed in each arm to detect a 50% reduction in PTB rate with vaginal progesterone, with 80% power and 2-sided alpha 0.05. Primary outcome was PTB \u3c37 weeks. Pre-specified secondary outcomes included PTB\u3c34 and \u3c28 weeks, mean gestational age at delivery, neonatal morbidity/mortality, and measures of adherence. Analysis was by intention to treat. Chi square and student t-test were used as appropriate. P\u3c0.05 was considered significant.
Results: 205 participants were randomized; n=94 in vaginal progesterone and n=94 in 17OHPC were included. Although gestational age at enrollment was similar, those assigned to vaginal progesterone initiated therapy earlier (16.9 ±1.4 vs 17.8±2.5wks, p=0.001). Overall continuation of assigned formulation until delivery was similar (73% vs 69%, p=0.61). There was no significant difference in PTB\u3c37wks (31% vs 38%, p=0.28, RR 0.81 (0.54-1.20)), \u3c34 weeks (9.6% vs 14.9%, p=0.26, RR 0.64 (0.29-1.41)), or \u3c28 weeks (1.1% vs 4.3%, p=0.37, RR 0.25 (0.03-2.20)). Those in the vaginal progesterone group had a later mean gestational age at delivery than 17OHPC (37.36±2.72 vs 36.34±4.10 weeks, MD 1.02 (0.01-2.01), p=0.047).
Conclusions: Vaginal progesterone did not reduce the risk of recurrent preterm birth by 50% compared to 17OHPC, but may lead to increased latency to delivery. This trial is underpowered to detect a smaller, although still clinically significant, difference in preterm birth prevention efficacy. Patient factors that impact adherence and ability to obtain medication in a timely fashion should be included in counseling on progesterone selection.
Keywords: 17-hydroxyprogesterone caproate; preterm birth; preterm birth prevention; prior preterm birth; progesterone
J Womens Health (Larchmt) . 2020 May 29. doi: 10.1089/jwh.2019.8201. Online ahead of print. Prenatal Depression and Risk of Short Interpregnancy Interval in a Predominantly Puerto Rican Population
No full textBackground: Short interpregnancy interval (IPI) is associated with risk of adverse pregnancy outcomes; however, few studies have evaluated the role of depression as a risk factor for short IPI. Puerto Rican women in the United States experience disparities in adverse birth outcomes and have the highest birth rates. Methods: We analyzed the association between prenatal depressive symptoms and IPI in Proyecto Buena Salud, a prospective cohort of predominantly Puerto Rican women in Western Massachusetts (2006-2011). Depression was measured using the Edinburgh Postnatal Depression Scale (EPDS) in early, mid, and late pregnancy. We calculated follow-up time as the difference between the date of delivery of the index pregnancy and the last menstrual period of the subsequent pregnancy using medical records and billing data. We defined short IPI as ≤18 months. Results: Of 1262 eligible women, 35% (n = 440) had at least probable minor depression (EPDS scores ≥13) and 25% (n = 315) had probable major depression (EPDS scores ≥15). Participants were followed for a median of 3.7 years (interquartile range = 1.4-6.0 years) and 240 (20.6%) participants experienced a short IPI. After adjusting for risk factors, women with probable minor depression (adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] = 1.02-1.88) and probable major depression (aOR = 1.42, 95% CI = 1.02-1.97) during pregnancy had increased odds of short IPI. Conclusions: Prenatal depressive symptoms were common in this Puerto Rican population and were associated with a modest increase in odds of short IPI. Further examination of the pathways through which mental health may affect IPI in vulnerable populations is warranted
Prenatal diagnosis and risk stratification of congenital diaphragmatic hernia
No full textCongenital diaphragmatic hernia (CDH) is a rare heterogenous disorder with varying degrees of severity. Infant survival rates in high-income countries are approaching 80% in isolated CDH; however, over 50% will have long-term morbidities. Advanced antenatal imaging, including ultrasound and magnetic resonance imaging, has made it possible to prognosticate severity of CDH and to stratify risk when counseling expectant parents. Risk stratification can also better prepare healthcare teams to enable optimal neonatal management, and provide options for fetal intervention or, where legally permitted, pregnancy termination. Factors that may affect the immediate and long-term prognosis for CDH include prenatal diagnosis, gestational age at detection and delivery, side of the defect, presence of additional structural or genetic abnormalities, defect size, estimation of fetal lung volume, the extent of visceral herniation, and the delivery center’s experience in caring for neonates with CDH. Optimizing the outcome for families and infants begins with an early prenatal diagnosis followed by referral to a diverse and inclusive multidisciplinary center with CDH expertise. Prediction of disease severity is supported by accurate fetal imaging and comprehensive genetic testing, and allows the care team to provide realistic outcome expectations during the counseling of expectant parents of all racial and ethnic backgrounds
Induction of Labor Versus Expectant Management in Patients With Non-anomalous Idiopathic Polyhydramnios [16E]
No full textPrenatal Depression and Risk of Short Interpregnancy Interval In A Predominantly Puerto Rican Population
No full textBackground: Short interpregnancy interval (IPI) is associated with risk of adverse pregnancy outcomes; however, few studies have evaluated the role of depression as a risk factor for short IPI. Puerto Rican women in the United States experience disparities in adverse birth outcomes and have the highest birth rates.
Methods: We analyzed the association between prenatal depressive symptoms and IPI in Proyecto Buena Salud, a prospective cohort of predominantly Puerto Rican women in Western Massachusetts (2006–2011). Depression was measured using the Edinburgh Postnatal Depression Scale (EPDS) in early, mid, and late pregnancy. We calculated follow-up time as the difference between the date of delivery of the index pregnancy and the last menstrual period of the subsequent pregnancy using medical records and billing data. We defined short IPI as ≤18 months.
Results: Of 1262 eligible women, 35% (n = 440) had at least probable minor depression (EPDS scores ≥13) and 25% (n = 315) had probable major depression (EPDS scores ≥15). Participants were followed for a median of 3.7 years (interquartile range = 1.4–6.0 years) and 240 (20.6%) participants experienced a short IPI. After adjusting for risk factors, women with probable minor depression (adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] = 1.02–1.88) and probable major depression (aOR = 1.42, 95% CI = 1.02–1.97) during pregnancy had increased odds of short IPI.
Conclusions: Prenatal depressive symptoms were common in this Puerto Rican population and were associated with a modest increase in odds of short IPI. Further examination of the pathways through which mental health may affect IPI in vulnerable populations is warranted
371: Increased foley catheter balloon volume for induction of labor: A systematic review and meta-analysis
No full textVaginal progesterone vs intramuscular 17-hydroxyprogesterone caproate for prevention of recurrent preterm birth: a randomized controlled trial
No full textBACKGROUND: Preterm birth is the leading cause of neonatal morbidity and mortality, and previous preterm birth is one of the strongest risk factors for preterm birth. National and international obstetrical societies have different recommendations regarding progesterone formulation for the prevention of recurrent preterm birth. OBJECTIVE: This study aimed to determine whether vaginal progesterone is superior to 17-hydroxyprogesterone caproate in the prevention of recurrent preterm birth in patients with singleton pregnancies who had a previous spontaneous preterm birth. STUDY DESIGN: This was an open-label multicenter pragmatic randomized controlled trial at 5 US centers of patients with singleton pregnancies at \u3c24 weeks of gestation who had a previous spontaneous preterm birth randomized 1:1 to either 200 mg vaginal progesterone suppository nightly or 250 mg intramuscular 17-hydroxyprogesterone caproate weekly from 16 to 36 weeks of gestation. Based on the estimated recurrent preterm birth rate of 36% with 17-hydroxyprogesterone caproate, 95 participants were needed in each arm to detect a 50% reduction in preterm birth rate with vaginal progesterone, with 80% power and 2-sided alpha of 0.05. The primary outcome was preterm birth at \u3c37 weeks of gestation. Prespecified secondary outcomes included preterm birth at \u3c34 and \u3c28 weeks of gestation, mean gestational age at delivery, neonatal morbidity and mortality, and measures of adherence. Analysis was by intention to treat. The chi-square test and Student t test were used as appropriate. P\u3c.05 was considered significant. RESULTS: Overall, 205 participants were randomized; 94 participants in the vaginal progesterone group and 94 participants in 17-hydroxyprogesterone caproate group were included. Although gestational age at enrollment was similar, those assigned to vaginal progesterone initiated therapy earlier (16.9±1.4 vs 17.8±2.5 weeks; P=.001). Overall continuation of assigned formulation until delivery was similar (73% vs 69%; P=.61). There was no significant difference in preterm birth at \u3c37 (31% vs 38%; P=.28; relative risk, 0.81 [95% confidence interval, 0.54-1.20]), \u3c34 (9.6% vs 14.9%; P=.26; relative risk, 0.64 [95% confidence interval, 0.29-1.41]), or \u3c28 (1.1% vs 4.3%; P=.37; relative risk, 0.25 [95% confidence interval, 0.03-2.20]) weeks of gestation. Participants in the vaginal progesterone group had a later mean gestational age at delivery than participants in the 17-hydroxyprogesterone caproate group (37.36±2.72 vs 36.34±4.10 weeks; mean difference, 1.02 [95% confidence interval, 0.01-2.01]; P=.047). CONCLUSION: Vaginal progesterone did not reduce the risk of recurrent preterm birth by 50% compared with 17-OHPC; however, vaginal progesterone may lead to increased latency to delivery. This trial was underpowered to detect a smaller, but still clinically significant, difference in the efficacy of preterm birth prevention. Patient factors that impact adherence and ability to obtain medication in a timely fashion should be included in counseling on progesterone selection
Aspirin 162 mg vs 81 mg for preeclampsia prophylaxis in high-risk obese individuals: a comparative effectiveness open-label randomized trial (ASPREO).
No full textBACKGROUND: In the United States, leading medical societies recommend 81 mg of aspirin daily for the prevention of preeclampsia in women at risk, whereas the NICE guidelines in the United Kingdom recommend a dose as high as 150 mg of aspirin. Recent data also suggest that in the obese population, inadequate dosing or aspirin resistance may impact the efficacy of aspirin at the currently recommended doses.
OBJECTIVE: We evaluated whether daily administration of 162 mg aspirin would be more effective compared with 81 mg in decreasing the rate of preeclampsia with severe features in high-risk obese pregnant individuals.
STUDY DESIGN: We performed a randomized trial between May 2019 and November 2022. Individuals at 12-20 weeks of gestational age with a body mass index ≥30 kg/m
RESULTS: Approximately 220/343 (64.1%) individuals were randomized. The primary outcome was available for 209/220 (95%) individuals. Baseline characteristics were similar between groups, with the median gestational age at enrollment being 15.9 weeks in the 162 mg aspirin group and 15.6 weeks in the 81 mg aspirin group. Enrollment before 16 weeks occurred in 55 of 110 of those assigned to 162 mg and 58 of 110 of those assigned to 81 mg of aspirin. The primary outcome occurred in 37 of 107 individuals (35%) in the 162 mg aspirin group and 41 of 102 individuals (40%) in the 81 mg aspirin group (posterior relative risk, 0.88; 95% credible interval, 0.64-1.22). Bayesian analysis indicated a 78% probability of a reduction in the primary outcome with 162 mg aspirin compared with 81 mg aspirin dose. Rates of indicated preterm birth because of preeclampsia (21% vs 21%), small for gestational age (6.5% vs 2.9%), abruption (2.8% vs 3.0%), and postpartum hemorrhage (10.0% vs 8.8%) were similar between groups. Medication adverse effects were also similar.
CONCLUSION: Among high-risk obese individuals, there was a 78% probability of benefit that 162 mg aspirin compared with 81 mg will decrease the rate of preeclampsia with severe features. With the best estimate of a 12% reduction when using 162 mg of aspirin compared with 81 mg of aspirin in this population. This trial supports doing a larger multicenter trial
Teachers' Reactions to Foreign Language Learner Output
No full text[eng] "Teachers' Reactions to Foreign Language Learner Output" BY: Leticia Vicente-Rasoamalala TEXT: A series of theoretical and practical educational studies have suggested that learners need teacher assistance to progress in their learning. Therefore, a considerable amount of language classroom research has been concerned with the study of teacher activities, especially those focusing on their instructional methods. In an attempt to contribute to this research area, the general objective of the dissertation is to develop a better understanding of one recurrent practice in formal FL instruction: how teachers react to FL learner output in classroom oral interactions. To this end, the formal features and phenomena involved in Teacher Reaction Episodes (TREs) are addressed. 'Teacher reactions' refer to any instructional strategies that handle language learner oral productions. In traditional SLA research, this teacher practice has been conceptually examined under the rubric of 'corrective feedback'. This thesis covers multidisciplinary theoretical and methodological approaches related to TREs. Part I (Chapters 1-4) puts in perspective the general conceptual framework that underpins the empirical second part of the thesis. A literature review encompasses: i) general and specific components comprising TREs), ii) the features surrounding these instructional moves, iii) their potential benefits for FL learner acquisition and, iv) the methodological frameworks previously used to examine teacher reactions. We have identified the key questions that SLA research has addressed in relation to "Teacher Reactions to Foreign Language Learner Output" by covering different methods of enquiry such as: 1) SLA theories 2) Socioculturalism 3) FL classroom social interaction studies 4) Teacher reaction features in the light of SLA works Part II (Chapters 5-8) describes microanalysis case studies carried out for observing and identifying the turns of TREs. Video data collected from two Senegalese international bilingual schools illustrate the differential effects of teacher reactions on FL learner uptake. Through corpus-based evidence from three immersion settings, an attempt is made to discover conditions and means for felicitous TREs in acquisitional terms. The term "immersion" refers to the teaching approach in which students receive academic instruction of core content subjects in a language that is not usually their mother tongue (Wesche, 2001). Specifically, 3 language teachers were observed with their students in their FL immersion classrooms in three main differentiated learning settings, which involve different levels and languages: i. Advanced English immersion (Years 1, 2, 3, 4, 5 and 6) at the primary school (Setting 1); ii. Intermediate English immersion (Years 1, 2, 3, 4, 5 and 6) at the primary school (Setting 2); iii. Spanish as L3 immersion (Years 9 and 10) at the secondary school (Setting 3) In order to conduct further research in the area of teacher feedback (Lyster & Mori, 2006; Lyster & Ranta, 1997), this study has focused on teacher reactions to foreign language learner output in such peculiar formal instruction (FI) learning contexts. A total of 14 lessons were observed to this end in each classroom year level. This part of the dissertation has been theoretically and methodologically framed into one hybrid approach covering diverse complementary perspectives. For instance, the SLA social interactionist views, socioculturalism, Conversation Analysis and ethnomethodology. In methodological terms, this study aimed at: 1) describing the way(-s) in which learners and teachers verbally and non-verbally engage didactic negotiations during TREs; 2) identifying how TREs might be salient for language acquisition in engaging learner noticing of their deviant target language forms; 3) investigating if learners engage after teacher interventions, pay attention to their errors, and if they might fruitfully self-repair; 4) surveying teacher and learner beliefs on TREs. The results seem to reflect certain trends in relation to the error types, the kinds of teacher reactions and the immersion settings, classroom years and levels vis-à-vis learner uptake. Globally, learners receiving metalinguistic feedback appear to generate more uptake than those receiving recasts.[spa] Reacciones docentes ante el output de los aprendices de lenguas extranjeras TEXTO: Una serie de estudios teóricos y prácticos que versan sobre aspectos educativos han postulado que el soporte del profesor es necesario para la progresión del aprendizaje de los estudiantes. Por esta razón, un número considerable de trabajos ha indagado sobre las actividades docentes haciendo especial hincapié en los métodos didácticos aplicados con el fin de examinarlas. En un intento de contribuir en esta área de investigación, el objetivo general de esta tesis es profundizar en una práctica docente recurrente en la enseñanza de idiomas. Se trata de las reacciones de los profesores ante el output de los aprendices que tienen lugar durante las interacciones orales en las aulas de lenguas extranjeras. En particular, se pretende examinar los rasgos formales de los "episodios de reacciones docentes" (ERD) y los fenómenos circundantes que se manifiestan en ellos. Las "reacciones docentes" se refieren a la totalidad de estrategias didácticas verbales y no verbales que se despliegan ante las producciones orales de los aprendices de idiomas. Tradicionalmente, el campo de la adquisición de lenguas segundas examina de manera conceptual esta práctica docente como "feedback correctivo". Este trabajo contextualiza los estudios teóricos y metodológicos multidisciplinarios afines con los ERD abarcando: i) los componentes generales y específicos de los episodios de reacciones docentes, ii) las condiciones que rodean estas acciones, iii) los beneficios potenciales para el aprendiz en relación con el "feedback" o la retroalimentación docente en diferentes contextos de adquisición de lenguas y iv) los marcos metodológicos previamente aplicados para examinar las reacciones del profesor o del instructor de lenguas. Los datos recogidos mediante una videocámara en dos escuelas bilingües internacionales privadas de Senegal ilustran los efectos diferenciados de las reacciones docentes sobre las producciones subsiguientes ("uptake") de los aprendices. A través de un corpus basado en datos empíricos extraídos de tres contextos de inmersión, se ha intentado hallar las condiciones y los recursos que podrían posibilitar que las reacciones docentes ante el output de los aprendices de idiomas sean más facilitadoras en términos de adquisición. En el presente estudio, la provisión de feedback metalingüístico pareció generar más "uptake" por parte de los aprendices que en el caso de las reformulaciones
