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Clinical management guidelines for obstetrician-gynecologists
... En cuanto a la condición materna se deberá otorgar consulta prenatal cada semana desde la semana 34 hasta el término de la gestación, con especial vigilancia en las cifras de tensión arterial, debido a su elevada asociación de hipertiroidismo y preeclampsia. 37 La consulta prenatal deberá encaminarse a la búsqueda de síntomas o signos clínicos sugestivos de descompensación; está demostrado que el tercer trimestre es en el que se desencadena de forma más frecuente la serie de complicaciones asociadas entre hipertiroidismo y embarazo. 37 Se deberá realizar pruebas de bienestar fetal semanal durante la consulta de seguimiento a partir de la semana 32 en pacientes con hipertiroidismo. ...
... 37 La consulta prenatal deberá encaminarse a la búsqueda de síntomas o signos clínicos sugestivos de descompensación; está demostrado que el tercer trimestre es en el que se desencadena de forma más frecuente la serie de complicaciones asociadas entre hipertiroidismo y embarazo. 37 Se deberá realizar pruebas de bienestar fetal semanal durante la consulta de seguimiento a partir de la semana 32 en pacientes con hipertiroidismo. 37 Al nacimiento todos los hijos de madres con enfermedad de Graves (excepto las que tuvieron anticuerpos antirreceptor tiroideo negativos o no requirieron antitiroideos) deberán ser evaluados en búsqueda de disfunción tiroidea con perfi l tiroideo completo. ...
... 37 Se deberá realizar pruebas de bienestar fetal semanal durante la consulta de seguimiento a partir de la semana 32 en pacientes con hipertiroidismo. 37 Al nacimiento todos los hijos de madres con enfermedad de Graves (excepto las que tuvieron anticuerpos antirreceptor tiroideo negativos o no requirieron antitiroideos) deberán ser evaluados en búsqueda de disfunción tiroidea con perfi l tiroideo completo. ...
... [1][2][3] Placentas that fail to spontaneously separate can be a cause of significant surgical and hemorrhagic morbidity. 4,5 Untreated, retained placenta is considered the second leading cause of postpartum hemorrhage (PPH). 5,6 Although retained placenta is an obstetrical complication encountered relatively infrequently on the labor and delivery floor, recognizing patient risk factors and understanding management are important steps in mitigating this morbidity. ...
... After delivery of the infant and prior to diagnosis of retained placenta, active management is recommended to facilitate spontaneous placental separation, including oxytocin, controlled cord traction, and uterine massage. 4 These maneuvers have been shown to decrease the risk of postpartum hemorrhage, though it has not been shown that active management will prevent retained placenta. 22 Once diagnosed, the placenta is usually manually extracted from the uterus. ...
... Uterotonic medications, such as oxytocin, methylergonovine, carboprost, or other prostaglandins, should be given to facilitate contraction once the placenta is removed. 4 Nitroglycerine (NTG) has been used to facilitate manual extraction by relaxing uterine smooth muscle. 30 This may be particularly helpful when the placenta is trapped behind a partially closed cervix, though the use of NTG alone does not appear to facilitate spontaneous placental expulsion. ...
Retained placenta after vaginal delivery is diagnosed when a placenta does not spontaneously deliver within a designated amount of time, variably defined as a period of 18–60 mins. It may also be diagnosed if a patient experiences significant hemorrhage prior to delivery of the placenta. Normal placenta delivery requires adequate uterine contractions, with shearing of the placenta and decidua from the uterine wall and expulsion of the tissue. Thus, retained placenta can occur in the setting of significant uterine atony, abnormally adherent placenta, as with placenta accreta spectrum (PAS), or closure of the cervix prior to placental expulsion. Risk factors for retained placenta parallel those for uterine atony and PAS and include prolonged oxytocin use, high parity, preterm delivery, history of uterine surgery, and IVF conceptions. History of a prior retained placenta and congenital uterine anomalies also appear to be risk factors. Management entails manual removal of the placenta with adequate analgesia, as medical intervention alone has not been proven effective. Complications can include major hemorrhage, endometritis, or retained portions of placental tissue, the latter of which can lead to delayed hemorrhage or infection. Prophylactic antibiotics can be considered with manual placenta removal, though evidence regarding effectiveness is inconsistent. If hemorrhage is encountered, deployment of a massive transfusion protocol, uterine evacuation with suction, and use of intrauterine tamponade, as with an intrauterine balloon, should be initiated immediately. When a separation plane between the placenta and uterus is particularly difficult to create, PAS should be considered, and preparations should be made for hemorrhage and hysterectomy. Patients with risk factors for retained placenta should have a laboratory sample sent for blood type and antibody screening on admission to labor and delivery, and plans should be made for appropriate analgesia and preparations for hemorrhage if a retained placenta is encountered.
... Differential diagnosis for chronic pelvic pain. Adapted from ACOG [18]. ...
... Other options are transcutaneous electrical nerve stimulation techniques, specialized physiotherapy, and mind-body therapies. These treatments can be recommended to patients by specialists such as urologists, gastroenterologists, and gynecologists, emphasizing the importance of a multidisciplinary approach to management in this context [18]. ...
Background: Chronic pelvic pain is a debilitating condition affecting quality of life. Endometriosis is one of the leading causes of CPP, but recent studies highlighted the role of interstitial cystitis/bladder pain syndrome (IC/PBS) in causing CPP. Only some studies addressed the coexistence of these two conditions, which seems more frequent than what is supposed, leading to diagnostic delays and unnecessary surgeries. This systematic review aimed to evaluate the estimate of the prevalence of the comorbidity of endometriosis and IC/PBS. Methods: We performed a systematic review of the literature indexed on PubMed, Scopus, ISI Web of Science, and Cochrane using a combination of keywords and text words represented by “painful bladder syndrome”, “endometriosis”, “interstitial cystitis”, and “bladder pain syndrome”. We performed a meta-analysis of the results. Results: The meta-analysis shows that the coexistence of endometriosis and IC/PBS in women with CPP ranged from 15.5% to 78.3%, which is higher than the prevalence of IC/PBS in the general population. Conclusions: Prevalence data about the coexistence of endometriosis and IC/PBS are highly heterogeneous, probably due to the paucity of available data. However, in cases of endometriosis unresponsive to treatment, other reasons for CPP (such as IC/PBS) need to be ruled out.
... Relaxin regulates cardiovascular (CV) functions modulating blood pressure (BP), inflammation, cell injury/death, fibrosis, and angiogenesis. It also induces vasodilation ameliorating endothelial dysfunction in hypertension (HTN) [9]. ...
... It was furthermore shown that relaxin is a vasodilator of small systemic resistance arteries [18]. Relaxin is also involved in the regulation of cardiac [9] and renal collagen synthesis [20]. ...
Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia. It may be due to impaired insulin secretion, resistance to peripheral actions of insulin, or both. The aim of the work is to evaluate significance of serum relaxin in diabetic and non-diabetic patients with chronic kidney disease. 60 subjects aged from (18years to 60 years) in internal medicine department at Tanta University hospital (outpatient –inward). This study was carried out from between March 2020 to March 2021. There was insignificant difference between groups according to age There was an inverse significant correlation between serum relaxin level and HBA1C in group 2 .but not in group 3. There was an inverse significant correlation between serum relaxin level and creatinine in group 2 .and in group 3. the best cut of level of relaxin hormone in discriminating normal individuals fron CKD patients was 150 ng/dl with an area under the curve(AUC) of 0,988 yeilding sensitivity of 93%, specifity of 95% , positive predictive value (PPV) 97%, negative predictive value(NPV) 86% and accuracy of 93%. Serum RLX levels are significantly lower in patients with CKD than healthy subjects. Furthermore, when compared to non-diabetic patients, they are much lower in diabetic patients. This research suggests that RLX could be a useful therapeutic option for diabetic nephropathy patients with developed fibrosis. RLX has a high safety profile, with potentially fewer adverse effects than conventional treatments because it is a naturally occurring physiological hormone. However, further effort is required.
... Pregnancies complicated by preeclampsia (PE), a specific human multisystemic syndrome, are the major cause of maternal and fetal morbidity and mortality worldwide. 1,2 Preeclampsia diagnosis is made through the identification of hypertension and proteinuria from 20 weeks of gestation. More recently, in the absence of proteinuria, the presence of target organ damage, such as maternal neurological or hematological complications; renal insufficiency; and impaired liver function is also considered as preeclampsia. ...
... More recently, in the absence of proteinuria, the presence of target organ damage, such as maternal neurological or hematological complications; renal insufficiency; and impaired liver function is also considered as preeclampsia. 1,3,4 Some published data suggest that PE may be better understood if segregated into distinct phenotypes, with different etiologies and clinical manifestations. [5][6][7] This phenotypic classification may be based on the gestational age at time of disease diagnosis. ...
Objective:
Preeclampsia (PE) is a pregnancy-specific syndrome characterized by abnormal levels of cytokines and angiogenic factors, playing a role in the disease development. The present study evaluated whether immunological markers are associated with the gestational age and with the disease severity in preeclamptic women.
Methods:
Ninety-five women who developed PE were stratified for gestational age as preterm PE (< 37 weeks) and term PE (≥ 37 weeks of gestation) and compared for disease severity as well as plasma concentration of angiogenic factors and cytokines. The concentrations of placental growth factor (PlGF), vascular endothelial growth factor (VEGF), Fms-like soluble tyrosine kinase (sFlt-1) and soluble endoglin (sEng), as well as the cytokines, tumor necrosis factor-α (TNF-α) and interleukin 10 (IL-10), were determined by enzyme-linked immunosorbent assay (ELISA).
Results:
The comparison between preeclamptic groups showed a higher percentage of severe cases in preterm PE (82.1%) than in term PE (35.9%). Similarly, the concentrations of TNF-α, sFlt-1, and sEng, as well as TNF-α/IL-10 and sFlt-1/PlGF ratios were significantly higher in the preterm PE group. In contrast, concentrations of PlGF, VEGF, and IL-10 were significantly lower in women with preterm PE. Negative correlations between TNF-α and IL-10 (r = 0.5232) and between PlGF and sFlt1 (r = -0.4158) were detected in the preterm PE.
Conclusion:
In pregnant women with preterm PE, there is an imbalance between immunological markers, with the predominance of anti-angiogenic factors and TNF-α, associated with adverse maternal clinical outcomes.
... Roughly 350 million individuals all through the world are infected with HBV with Nigeria arranged amongst the endemic nations Eke et al. [5]. Vertical transmission is a way of acquiring new HBV cases every year with 35% to 50% of transmission from mother to neonate in endemic nations ACOG, [6]. Vertical transmission happens to a great extent by means of a neonate's introduction to maternal blood and vaginal discharge during birth. ...
... The danger of progression to chronic infection is as high as 95% among neonates subject to vertical transmission as against 5% among grown-ups who contract the infection. The danger of viral transmission is around 10-20% when maternal blood is sure for HBsAg [6,7]. ...
Hepatitis B virus is the causative agent of hepatitis B infection. The virus is a major public health crisis in sub-Saharan Africa with high burden of morbidity and mortality. Vertical transmission is a significant contributor of new cases. This study was designed to access the innate immune Original Research Article Onwuliri et al.; AJI, 3(4): 1-8, 2020; Article no.AJI.55896 2 competence of Hepatitis B viral infected pregnant women using neutrophil phagocytic function. In this cross sectional comparative observational study, simple random sampling technique was applied. A total of 100 Hepatitis B infected pregnant women and 100 controls were recruited. The data obtained were analysed using SPSS (version 23) software. A P probability value ≤ 0.05 was considered statistically significant. The results showed that proportion of phagocytic function was significantly lower (p < 0.05) for HBV infected subjects compared with control. The findings also revealed that trimester does not influence the percentage neutrophil phagocytic function. Conclusively Hepatitis B infection affects innate immunity. Pregnant women should be screened for Hepatitis B surface Antigen (HBsAg) during routine Antenatal clinic and drugs should be recommended for Hepatitis B infected pregnant women.
... Screening programmes for gestational diabetes are in place in many countries worldwide. Screening tests are performed in the second trimester (at gestational weeks 24-28) after the ingestion of 75 g (one bolus) or 50-100 g (two boluses) of glucose; venous plasma glucose levels are calculated 8,9 . It is appropriate to use the tolerance test using 75-g oral glucose (OGTT) to evaluate all pregnant women in Turkey (the type 2 diabetes prevalence is high in our country). ...
Background: Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. Early diagnosis and treatment are important; the condition can cause both maternal and foetal complications. Today, single-/double-bolus oral 50–100-g glucose tolerance tests (OGTTs) are preferred. We explored whether the peripheral blood platelet/lymphocyte ratio (PLR) and/or neutrophil/lymphocyte ratio (NLR) could guide diabetes screening of a target group (rather than all pregnant women). Materials and Methods: This retrospective study was conducted at the Obstetrics and Gynecology Clinic of Sanko University Hospital from January 2010 to January 2020. Pregnant women in gestational weeks 24 to 28 who underwent 75-g OGTTs were included. Patients were evaluated by dividing them into two groups. Group 1 included 300 women with GDM. Group 2 included 300 healthy pregnant women who were negative on the OGTT test. We retrieved patient ages, gestational weeks, all blood count data derived during pregnancy, fasting blood glucose levels, heights and weights, and body mass indices. Results: Leukocyte and neutrophil counts were significantly higher in the diabetic patient group than in the control group (both p < 0.01). The NLR and PLR differed significantly between the two groups (both p < 0.01), but the demographic data did not. Conclusion: Increase in white blood cell count, and elevations in the PLR and NLR, independently predicted GDM. Blood NLR and PLR can also be used as a GDM screening test. The NLR and PLR (markers of inflammation) were significantly increased in pre-diabetic and diabetic patients. The NLR and PLR may usefully predict pre-diabetes and GDM.
... (1) Hipertensi selama kehamilan dikelompokan menjadi empat kategori meliputi pre-eklampsiapre-eklampsia, hipertensi kronis (dari berbagai penyebab), dan hipertensi kronis dengan kombinasi pre-eklampsia hipertensi gestasional. (2) Preeklampsia merupakan gangguan tekanan darah saat hamil yang meningkatkan kematian dan komplikasi pada ibu hamil di seluruh dunia. (3) Preeklampsia merupakan keadaan meningkatnya tekanan darah wanita hamil diatas 160/110 mmHg disertai proteinuria pada usia kehamilan 20 minggu atau lebih. ...
Preeclampsia in Indonesia is the second leading cause of maternal death after bleeding with an incidence rate of 3-10%. Preeclampsia is the leading cause of death and complications among pregnant women globally. The risk of preeclampsia increases as the mother's weight increases during pregnancy. The purpose of this study was to determine the relationship between weight gain and the incidence of preeclampsia at the Banyumas Regency Health Center. This study used a casecontrol design. The results of this study showed that most respondents in the case group (preeclampsia) had an increase in weight during pregnancy in the abnormal category (weight ≥12.5 kg) as many as 66 respondents (66%) and in the control group (not preeclampsia) had an increase in weight in the normal category (weight <12.5 kg) as many as 97 respondents (97%). The results of the McNemara test stated that the proportion of weight gain ≥12.5 kg in the case group (preeclampsia) was 66% and the proportion of weight gain ≥12.5 kg in the control group (not preeclampsia) was 1% so that the difference in the proportion of weight gain ≥12.5 kg in the case group and control group was 65%. There is a relationship between weight gain and the incidence of preeclampsia in pregnant women at the Banyumas Regency Health Center with a p-value of <0.0001 (p-value ≤ α).
... There are different opinions on this matter. [14,15] Although it is clear that certain maternal and fetal thyroid dysfunctions are associated with low birth weight, the effects of thyroid function tests within normal ranges on fetal development is still unclear. [16] Therefore, we aimed in this study to investigate if there is any relationship between first trimester maternal TSH level and fetal birth weight in pregnant women who have no severe pregestational thyroid dysfunction, do not have any treatment for any thyroid dysfunction during pregnancy and have serum TSH results within normal ranges. ...
... It was stated that there is no sufficient evidence to carry out thyroid function tests even in asymptomatic pregnant women with mildly grown thyroid, but those with severe goiter or isolated nodules should be evaluated as any other patient. [99] In the committee opinion of ACOG published in October 2007, an approach against the routine screening of all pregnant women was asserted. [100] However, it was shown that these recommendations are quite old and testing pregnant women routinely for thyroid dysfunctions is a screening tool with cost-benefit balance. ...
... Various definitions of reactivity have been used. Most commonly, the non-stress test is considered reactive, or normal, if there are two or more fetal heart rate accelerations within a 20-minute period, with or without fetal movement percepted by the woman, according to (American College of Obstetricians and Gynecologists, 2011). The non-reactive non stress test lacks sufficient fetal heart rate accelerations over a 40-minute period. ...
... Gestational diabetes mellitus (GDM) is a condition wherein a woman without diabetes experiences hyperglycemia during pregnancy [1]. With the incidence of GDM increasing in correspondence with the global rise of metabolic diseases [2], 9-15% of the pregnant women develop GDM [3]. ...
The purpose of this study was to investigate lipid metabolism in the placenta of Gestational diabetes mellitus (GDM) individuals and to evaluate its effect on the fetus. We examined the expression of lipogenesis- and lipolysis-related proteins in the in vitro and in vivo GDM placenta models. The levels of sterol regulatory element binding protein-1c (SREBP-1c) were increased, and fat accumulated more during early hyperglycemia, indicating that lipogenesis was stimulated. When hyperglycemia was further extended, lipolysis was activated due to the phosphorylation of hormone-sensitive lipase (HSL) and expression of adipose triglyceride lipase (ATGL). In the animal model of GDM and in the placenta of GDM patients during the extended stage of GDM, the expression of SREBP-1c decreased and the deposition of fat increased. Similar to the results obtained in the in vitro study, lipolysis was enhanced in the animal and human placenta of extended GDM. These results suggest that fat synthesis may be stimulated by lipogenesis in the placenta when the blood glucose level is high. Subsequently, the accumulated fat can be degraded by lipolysis and more fat and its metabolites can be delivered to the fetus when the GDM condition is extended at the late stage of gestation. Imbalanced fat metabolism in the placenta and fetus of GDM patients can cause metabolic complications in the fetus, including fetal macrosomia, obesity, and type 2 diabetes mellitus.
... Betamethasone 12 mg, as a mixture of 6 mg each of betamethasone phosphate and betamethasone acetate is given intramuscularly (IM) as two doses 24 hours apart. The second option is dexamethasone 6 mg IM administered as four doses every 12 hours [22] . These drugs readily cross the placenta in a biologically active form [16] . ...
... Transvaginal and cervical measurements can be obtained via transvaginal ultrasounds as recommended by the American College of Obstetricians and Gynecologists (ACOG). [21] The ACOG suggests that this should be done routinely and before confirming the need for further treatment, testing for biomarkers can be performed if necessary. ...
Introduction : A staggering 30% of deaths in neonates are caused by preterm births. The most common cause of perinatal morbidity and mortality around the world is due to preterm births, also referred to as premature. Hence, the ability to predict preterm births would result in significantly reduced fatalities.
The likelihood of predicting a premature birth can be measured by the cervical length; however, there are other diagnostic procedures which utilize the contents of the cervico-vaginal fluid (CVF) for a more precise diagnosis. The latter also aids in detecting other pregnancy related anomalies. The phosphorylated insulin-like growth factor binding protein-1 (pIGFBP-1) is an example of a clinical biomarker which is frequently tested as it proves to be an indicator to predict preterm labour.
Aim : Thus, in this study, our aim was to evaluate the accuracy of pIGFBP-1 as a marker of preterm labour when coupled with cervical biometrics.
Materials and methods : A cross-sectional study of 32 pregnant women was conducted. The patients were split into 2 groups in which Group A consisted of those at risk of preterm labour and Group B – of women with normal and uncomplicated pregnancies. All participants were tested for pIGFBP-1 along with gathering data of transvaginal measurements of their cervical length.
Results : We found in all participants in the study a moderate association between the expression of pIGFBP-1 in the CVF and the onset of preterm birth. Eight patients showed positive results amongst the symptomatic patients and as predicted, within 14 days, 6 of those patients did go into preterm labour.
Conclusion : Appropriate scanning for pregnant women can be of excellent value as it has the potential to reduce the number of premature babies being born; this would also mean that the health complications associated with premature births can be prevented.
... Dunton ve arkadaşlarının 10 yaptığı çalışmada tanı anı EK hastaları arasında metastatik EEK hastaları %3 oranında görülmektedir. EK hastalarının beş yıllık sağkalım oranları lokal ileri hastalarda yaklaşık %68 ve metastatik hastalıkta %17'dir 11 . European Society for Medical Oncology (ESMO) EK kılavuzu performansı iyi olan metastatik hastalara palyatif cerrahi önermektedir 12 . ...
Endometrium kanseri (EK) gelişmiş ülkelerde en sık görülen jinekolojik kanserdir. Obezite en önemli risk faktörü olarak kabul edilmektedir. Endometrium kanserleri içerisinde en sık görülen alt tip endometrioid endometrial karsinomdur (EEK). Çalışmamızda metastatik EEK hastalarının demografik ve klinikopatolojik özelliklerini, kullanılan tedavi yöntemlerinin sağ kalıma etkisini incelemeyi amaçladık. Hastaların medyan yaşı 58 (39,4-81,9) idi. On altı hastanın hastaneye başvuru şikayeti vajinal kanamaydı. Medyan takip süresi 43 (0,2-104,3) aydı. Hastaların medyan progresyonsuz sağkalım (PS) süresi 39,9 ay (%95 güven aralığı (GA): 35,0-79,1), medyan genel sağkalım (GS) süresi 59,1 ay (%95 GA: 39,1-80,8) saptandı. Kemoradyoterapi alan hastaların PS ve GS süresi sadece kemoterapi ile tedavi edilen hastalara göre istatistiksel anlamlı olarak daha uzundu (log-rank testi, PS için p=0,012, GS için p=0,015). Çalışmamız metastatik evrede seçilmiş hasta grubunda kemoradyoterapinin tercih edilebileceğini desteklemektedir.
... 0.203). It is by far the most common cause of hyper androgenic anovulatory infertility and was described more than half a century ago, the underlying cause of this disorder is still uncertain [9]. The classic symptoms of the disease are due to increased ovarian androgen production and chronic anovulation. ...
Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women in the reproductive period. It is one of the leading causes of infertility. The manifestations of PCOS include irregular or no menstrual periods, excess body weight and facial hair, acne, heavy periods and pelvic pain. The aim of this study is to determine the efficacy of stair step protocol compared to traditional protocol in ovulation induction of polycystic ovarian syndrome (PCOS) patients in terms of increasing rate of ovulation and pregnancy. Methods: This study is non-blinded, multicenter, randomized controlled study and was carried out on infertile women attending the Fertility Clinic of Tanta University Hospital and Hurghada General Hospital. Two Hundred infertile patients with PCOS criteria and no other causes of infertility were enrolled according to inclusion and exclusion criteria. Results: Student t test was used for the continuous variables (FSH, LH, Prolactin, AMH, TSH, Free testosterone). Student t test was used for the continuous variables (Endometrial thickness, Time to ovulate (d)). Chi-square analysis was used for the categorical variables (Ovulation rate, Pregnancy rate). Chi-square analysis was used for the categorical variables (Ovulation rate per cycle). There was no significant difference between two groups as regards mild and severe side effects. Conclusions: This study concluded that stair step regimen improves the ovulation rate and pregnancy rate without any detrimental side effects compared to traditional regimen. It helps to know the sensitivity and resistance of an individual to clomiphene citrate much earlier and helps to plan ahead with alternative treatment for desired outcome. The advantage of shorter treatment period with similar side effects makes the stair step protocol suitable for use in routine clinical practice.
... Postpartum kanama nedenli anne ölümlerinin önlenmesinde en önemli yaklaşım, riskli gebelerin tespiti, önleyici girişimler, erken tanı ve zamanında yapılacak uygun tedavidir. Buna göre uzmanlık alanına bağlı olmadan, her hekimin AOB ile ilgili bilgi, farkındalık ve acil durumları yönetme yeterliliği kazanmış olması önemlidir (21,22). Öğrenci geribildirimleri, eğitimin niteliğinin arttırılmasında önemli bir yere sahiptir ve tıp eğitiminde, çıktıların değerlendirilmesinde giderek daha yaygın kullanılmaktadır (23,24). ...
Aim: In this study, it was aimed to increase the knowledge and awareness of intern physicians with a case-based course module, on postpartum haemorrhage and Emergency Obstetric Care, to teach basic life-saving approaches and thus to contribute on reducing maternal deaths.
Methods: A case-based course module structured in three parts was practised on six different internship groups of 82 students in total who took Family Medicine internship. Written feedback were received from all students at the end of the training module.
Results: 43% (n=35) of the participating students were female while 57% (n=47) were male. It was observed that all the students (n=82, 100%) participating in the case-based course module were highly satisfied. In addition to their positive opinions, twelve students (14.6%) also reported negative opinions. Ten of them (12.1%) stated that the theoretical course was long, two of them (0.02%) reported that they were discouraged by cases and medicolegal evaluation. Students recommended shortening the theoretical part of the course (n=10, 12.1%), increasing such courses related to emergencies (n=73, 89%), including case-based courses in all internships (n=66, 80%), also having simulation of the course (n=18, 22%). All of the students suggested continuing the course in the next years.
Conclusion: It was observed that case-based learning had a very positive effect on student participation, interest and satisfaction. In parallel with these results, the inclusion of case-based courses into the program, especially for important emergencies, and the planning of the simulation training for specific cases will contribute to the process.
... In the literature, spontaneous labor occurs within 24 to 48 h after PPROM in approximately 50% of women and 70-90% give birth within 7 days [13,[26][27][28]. In our study, 46.4% of women began labor within 48 h but only 62.2% gave birth within 7 days. ...
Background:
Preterm premature rupture of membranes (PPROM) is a complication responsible for a third of preterm births. Clinical management is initially hospital based, but homecare management is possible if patients are clinically stable 48 h after PPROM. This study set out to determine factors that are predictive of short latency (delivery ≤ 7 days) exceeding 48 h after PPROM, enabling estimation of the prevalence of maternal and neonatal complications and comparison of maternal and fetal outcomes between inpatient and outpatient management.
Method:
This was a monocentric retrospective study conducted between 1 January 2010 and 28 February 2017 on all patients experiencing PPROM at 24 to 34 weeks + 6 days and who gave birth after 48 h. Maternal, obstetric, fetal, and neonatal variables were included in the data collected. The primary endpoint was latency, defined as the number of days between rupture of membranes and delivery.
Results:
170 consecutive patients were analyzed. Short latency could be predicted by the need for tocolysis, a cervical length less than 25 mm at admission and the existence of anamnios. Outpatient follow-up was not found to lead to increased maternal morbidity or neonatal mortality.
Conclusion:
Our study highlights predictive factors of short latency exceeding 48 h after PPROM. Knowledge of these factors may provide justification for outpatient monitoring of patients presenting with a long cervix, absence of need for tocolysis and persistence of amniotic fluid and, thus, no risk factors after 48 h of admission.
... Normal blood loss was defined as less than 500 ml at vaginal delivery and less than 1000 ml at cesarean delivery (Obstetricians, American College of, and Gynecologists 2006). Postpartum blood loss was estimated by visual examination of the drapes. ...
This study aims to determine cutoff values for shock index (SI) to predict the need for transfusion and composite adverse outcomes in postpartum hemorrhage (PPH) cases. One hundred thirty PPH cases (study group) that necessitated blood transfusion were retrospectively compared to a frequency-matched control group (n = 130). Receiver operating characteristic (ROC) curves and decision tree [Classification & Regression Tree (C&RT) and Chi-square Automatic Interaction Detector (CHAID)] were used to identify cutoff values for SI. Cutoff values for postdelivery, peak and delta SI values for the prediction of PPH that required transfusion were 0.9125 (0.815 sensitivity, 0.923 specificity), 0.9145 (0.892 sensitivity, 0.823 specificity) and 0.195 (0.823 sensitivity, 0.885 specificity), while cutoff values for the same SI values in the prediction of composite adverse outcome were 1.315 (0.645 sensitivity, 0.616 specificity), 1.183 (0.613 sensitivity, 0.737 specificity) and 0.487 (0.710 sensitivity, 0.758 specificity). Delta SI was superior to postdelivery and peak SI in the prediction of PPH that required transfusion. Peak SI was superior to postdelivery and delta SI in the prediction of composite adverse outcome. In conclusion, increased postdelivery, peak, and delta SI values were related to adverse outcomes for PPH. SI seems to be a practical and effective method for the objective assessment of postpartum hemorrhage.
... This may be at least partially accounted for, given that all forceps delivery were performed at low cavity, as it is wellestablished that the rates of high degree perineal [22] tears are much higher following mid-cavity FE [19]. Moreover, the use of mediolateral episiotomy in most cases in the current cohort may also be a protective factor against OASIS occurrence [25]. ...
PurposeWhile the increased rates of high degree perineal tears were previously associated with the use of forceps, in the current era of low volume of forceps practice, factors associated with the occurrence of this potential complication remain understudied. We aim to evaluate factors associated with obstetric anal sphincter injury (OASIS) in obstetric units with a low volume forceps practice.MethodsA retrospective cohort study was conducted at two tertiary medical centers. All singleton pregnancies delivered by forceps extraction between 2011 and 2019 were analyzed. Women who experienced anal sphincter injury were compared to those who did not.ResultsThe study cohort included 764 forceps deliveries. There were 19 (2.5%) cases of OASIS. Women with anal sphincter injury had higher rates of gestational diabetes mellitus (21% vs. 5.6%, OR [95% CI] 4.46 (1.41–14.04), p = 0.02). Birth weights and the rate of macrosomia did not differ between groups. Induction of labor was more common among the OASIS group (68% vs. 41.7%, OR [95% CI] 3.0 (1.1–8.0), p = 0.02). Sequential use of forceps (after failed vacuum attempt) was associated with OASIS (8 (42%) vs. 76 (10.2%), OR [95% CI] 6.4 (2.5–16.4), p < 0.001). In a multivariate logistic regression, sequential forceps was the only factor independently associated with OASIS (OR [95% CI] 4.7 (1.3–18.2), p = 0.02).Conclusions
Rate of OASIS was relatively low in the current cohort. Sequential use of forceps was found to be the most important determinant in OASIS occurrence.
... All data were obtained from the hospital electronic database. Based on the American College of Obstetrics and Gynecology (ACOG) Practice Bulletin, [8] PPH was defined as blood loss of more than 500 mL within 24 h following vaginal delivery and more than 1,000 mL following cesarean delivery. Hypertensive disorders of pregnancy and placental accreta were also defined according to the ACOG criteria. ...
Objective: To develop a model to predict the risk of postpartum hemorrhage (PPH) following cesarean delivery in women with a scarred uterus.
Methods: A total of 4,637 pregnant women with scarred uterus who underwent a cesarean delivery at a large hospital between January 2014 and December 2017 were enrolled. The women were divided into PPH (n = 287) and non-PPH (n = 4,350) groups. A model to predict PPH (blood loss ≥1,000 mL within 24 h following cesarean delivery) was developed using multivariate logistic regression analysis. Receiver operating characteristic curve was drawn, and the area under curve (AUC) was calculated.
Results: The incidence of PPH was 6.19% (287 of 4,637 women). Seven independent risk factors were associated with PPH: maternal age (odds ratio [OR] = 1.42, 95% confidence interval [CI]: 1.02–1.97), previous gravidity (OR = 1.24, 95% CI: 1.01–1.50), placental location (posterior wall of uterus, OR = 0.69, 95% CI: 0.47–1.02; other locations, OR = 1.21, 95% CI: 0.81–1.80), placenta previa (incomplete placenta previa, OR = 10.51, 95% CI: 5.99–18.42; complete placenta previa, OR = 31.65, 95% CI: 21.07–47.54), placenta accreta (OR = 6.39, 95% CI: 4.02–10.16), hypertensive disorders of pregnancy (OR = 2.27, 95% CI: 1.40–3.68), and fetal position (breech position, OR = 2.07, 95% CI: 1.19–3.60; transverse position, OR = 1.07, 95% CI: 0.48–2.41). A predictive model with AUC of 0.89 was developed (95% CI: 0.86–0.91, P < 0.001).
Conclusions: A model was developed to predict PPH following cesarean delivery in women with a scarred uterus.
... For preeclampsia participants, additional measures including the severity of preeclampsia, lactate dehydrogenase (LDH), serum creatinine, AST, ALT, proteinuria by urine dipstick, proteinuria by 24-h urine collection, albumin: creatinine ratio, repeated measurements of UA, and repeated measurements of systolic and diastolic blood pressures were collected. The presence of proteinuria was defined by one positive measure for at least one of urine dipstick, 24-h urine collection, or albumin-creatinine, as per the ACOG guidelines [18]. The severity of preeclampsia was categorized based on the categories of blood pressure measurements as suggested by the Royal College of Obstetricians and Gynecologist guideline (2010); participants with diastolic blood pressure 90-99 mmHg and systolic blood pressure 140-149 mmHg were categorized as mild, participants with diastolic blood pressure 100-109 mmHg and systolic blood pressure 150-159 mmHg as moderate, and participants with diastolic blood pressure 110 mmHg or greater and systolic blood pressure 160 mmHg or greater as severe [19]. ...
Objectives:
To compare the distribution of uric acid (UA) concentration in women with normal and preeclamptic pregnancy, to investigate the significance of UA concentration in diagnosis of preeclampsia, and to estimate the UA rate of change over time before delivery.
Study design:
A case-control study of singleton pregnancies was completed at a tertiary care center in Kingston, Ontario. Patients with preeclampsia were recruited through two prospective cohort studies (n = 218); the Preeclampsia New Emerging Team (September 2003-October 2009) and the Maternal Health Clinic (May 2011-June 2016). Individuals who had an uncomplicated pregnancy and delivered (July 2016-August 2017), were included in the control arm (n = 73).
Main outcome measures:
Longitudinal analysis using a linear mixed-effects model examined the UA rate of change over time. The distribution of the UA level was compared using a t-test. The significance of the UA level in the diagnosis of preeclampsia was examined using multiple logistic regression.
Results:
The rate of change in UA before delivery had an increasing non-constant logarithmic trend with time. Mean UA level in preeclamptic pregnancies (369.53 ± 75.78 μmol/l) was significantly elevated compared with the normal pregnancies (292.55 ± 54.73 μmol/l). UA had an adjusted odds ratio of 1.39 (95%CI: 1.14-1.69; P = 0.001) associated with the incidence of preeclampsia and UA level >349 μmol/l close to delivery is an accurate measurement for diagnosing preeclampsia.
Conclusion:
The UA concentration in preeclamptic pregnancies is significantly increased compared to normal pregnancies and the level of UA may have diagnostic ability in the occurrence of preeclampsia.
... Balloon tamponade can help in unmanageable PPH or in areas/structures, where efficient methods for PPH are unavailable. Therefore, it has been recommended in several guidelines (The WHO, the American College of Obstetricians and Gynaecologists, the International Federation of Gynaecology and Obstetrics, the RCOG, and the International Confederation of Midwives) [103][104][105]. ...
Purpose
Patient blood management [PBM] has been acknowledged and successfully introduced in a wide range of medical specialities, where blood transfusions are an important issue, including anaesthesiology, orthopaedic surgery, cardiac surgery, or traumatology. Although pregnancy and obstetrics have been recognized as a major field of potential haemorrhage and necessity of blood transfusions, there is still little awareness among obstetricians regarding the importance of PBM in this area. This review, therefore, summarizes the importance of PBM in obstetrics and the current evidence on this topic.
Method
We review the current literature and summarize the current evidence of PBM in pregnant women and postpartum with a focus on postpartum haemorrhage (PPH) using PubMed as literature source. The literature was reviewed and analysed and conclusions were made by the Swiss PBM in obstetrics working group of experts in a consensus meeting.
Results
PBM comprises a series of measures to maintain an adequate haemoglobin level, improve haemostasis and reduce bleeding, aiming to improve patient outcomes. Despite the fact that the WHO has recommended PBM early 2010, the majority of hospitals are in need of guidelines to apply PBM in daily practice. PBM demonstrated a reduction in morbidity, mortality, and costs for patients undergoing surgery or medical interventions with a high bleeding potential. All pregnant women have a significant risk for PPH. Risk factors do exist; however, 60% of women who experience PPH do not have a pre-existing risk factor. Patient blood management in obstetrics must, therefore, not only be focused on women with identified risk factor for PPH, but on all pregnant women. Due to the risk of PPH, which is inherent to every pregnancy, PBM is of particular importance in obstetrics. Although so far, there is no clear guideline how to implement PBM in obstetrics, there are some simple, effective measures to reduce anaemia and the necessity of transfusions in women giving birth and thereby improving clinical outcome and avoiding complications.
Conclusion
PBM in obstetrics is based on three main pillars: diagnostic and/or therapeutic interventions during pregnancy, during delivery and in the postpartum phase. These three main pillars should be kept in mind by all professionals taking care of pregnant women, including obstetricians, general practitioners, midwifes, and anaesthesiologists, to improve pregnancy outcome and optimize resources.
... Anormal uterin kanama-bazen vajinal akıntı ve pyometra ile bağlantılı-en sık görülen semptomdur. Daha çok postmenapozal kanama olmak üzere, endometriyal kanserli hastaların %90'ında anormal vajinal kanama karşımıza çıkmaktadır ve bu kanama genellike hastalığın erken döneminde oluşmaktadır (1,2,26). Postmenapozal kadınlarda vajinal lekelenme, noktalanma dahil bütün vajinal kanamalar değerlendirilmelidir. Postmenapozal vajinal kanaması olan kadınların %3-20'sinde endometrial karsinoma, %5-15'inde endometrial hiperplazi saptanmaktadır. ...
... Most of the recommendations and guidelines focused on avoiding fetal hypoxia, but in 2008 a consensus of the National Institute of Child Health and Human Development (NICHHD), the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine clearly stated that the aim of EFM was to avoid the birth of acidotic fetuses and that the concept of fetal acidosis should replace the concept of fetal hypoxia. 2 The consensus reviewed and updated the definitions of fetal heart rate (FHR) tracings with the development of new guidelines that were subsequently revisited in 2009 by the ACOG with the definition of specific clinical management for each FHR category. 3,4 This interpretation of EFM tracings clearly highlighted that FHR deceleration represents a reversible sign of fetal hypoxia in utero in terms of a defense mechanism of the fetus towards the hypoxic stimulus, while the alteration of the FHR variability represents the highest risk factor for fetal acidosis. ...
Background. All guidelines regarding electronic fetal heart monitoring (EFM) before 2008 were designed to avoid more hypoxia than acidosis. In addition, the results of the Cochrane meta-analysis of 2013 do not show a significant improvement in neonatal outcomes using EFM or intermittent auscultation (IA).
... Most of the recommendations and guidelines focused on avoiding fetal hypoxia, but in 2008 a consensus of the National Institute of Child Health and Human Development (NICHHD), the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine clearly stated that the aim of EFM was to avoid the birth of acidotic fetuses and that the concept of fetal acidosis should replace the concept of fetal hypoxia. 2 The consensus reviewed and updated the definitions of fetal heart rate (FHR) tracings with the development of new guidelines that were subsequently revisited in 2009 by the ACOG with the definition of specific clinical management for each FHR category. 3,4 This interpretation of EFM tracings clearly highlighted that FHR deceleration represents a reversible sign of fetal hypoxia in utero in terms of a defense mechanism of the fetus towards the hypoxic stimulus, while the alteration of the FHR variability represents the highest risk factor for fetal acidosis. ...
Introduction
Placental‐derived extracellular vesicles (EVs) are nano‐organelles that facilitate intercellular communication between the feto‐placental unit and the mother. We evaluated a novel Multiple Microarray analyzer for identifying surface markers on plasma EVs that predict preterm delivery and preeclampsia compared to term delivery controls.
Material and Methods
In this prospective exploratory cohort study pregnant women between 24 and 40 gestational weeks with preterm delivery (n = 16), preeclampsia (n = 19), and matched term delivery controls (n = 15) were recruited from Bnai Zion Medical Center, Haifa, Israel. Plasma samples were tested using a multiple microarray analyzer. Glass slides with 17 antibodies against EV surface receptors ‐ were incubated with raw plasma samples, detected by biotinylated secondary antibodies specific to EVs or placental EVs (PEVs), and labeled with cyanine 5–streptavidin. PBS and whole human IgG served as controls. The fluorescent signal ratio to negative controls was log 2 transformed and analyzed for sensitivity and specificity using the area under the receiver operating characteristics curves (AUROC). Best pair ratios of general EVs/PEVs were used for univariate analysis, and top pairs were combined for multivariate analysis. Results were validated by comparison with EVs purified using standard procedures.
Results
Heatmaps differentiated surface profiles of preeclampsia, preterm delivery, and term delivery receptors on total EVs and PEVs. Similar results were obtained with enriched EVs and EVs from raw plasma. Univariate analyses identified markers predicting preterm delivery and preeclampsia over term delivery controls with AUC >0.6 and sensitivity >50% at 80% specificity. Combining the best markers in a multivariate model, preeclampsia prediction over term delivery had an AUC of 0.89 (95% CI: 0.72–1.0) with 90% sensitivity and 90% specificity, marked by inflammation (TNF RII), relaxation (placenta protein 13 (PP13)), and immune‐modulation (LFA1) receptors. Preterm delivery prediction over term delivery had an AUC of 0.97 (0.94–1.0), 84% sensitivity, and 90% specificity, marked by cell adhesion (ICAM), immune suppression, and general EV markers (CD81, CD82, and Alix). Preeclampsia prediction over preterm delivery had an AUC of 0.91 (0.79–0.99) with 80% sensitivity and 90% specificity with markers for complement activation (C1q) and autoimmunity markers.
Conclusions
The new, robust EV Multi‐Array analyzer and methodology offer a simple, fast diagnostic tool that reveals novel surface markers for major obstetric syndromes.
Resiko komplikasi dan perburukan luaran maternal dan fetal yang terjadi akibat hipertensi selama kehamilan dapat dicegah dengan pengendalian tekanan darah melalui terapi antihipertensi. Tujuan dari studi ini adalah untuk memberikan gambaran penggunaan obat antihipertensi berdasarkan efikasi dan keamanannya pada kasus hipertensi selama kehamilan. Desain studi adalah tinjauan pustaka menggunakan basis data elektronik MEDLINE (PubMed) dan Cochrane Library yang dilakukan hingga Agustus 2021. Strategi pencarian menggunakan kata kunci sesuai dengan topik studi. Artikel diseleksi berdasarkan judul dan abstrak diikuti dengan teks lengkap sesuai kriteria inklusi dan eksklusi. Obat antihipertensi yang dapat digunakan diantaranya IV urapidil, IV dihidralazin, IV urapidil, IV nikardipin, oral metildopa, oral isradipin, oral nifedipin, oral labetalol, oral furosemid, dan oral amlodipin. Urapidil lebih baik dalam mengontrol tekanan darah tinggi dibanding dihidralazin, meskipun efek penurunan tekanan darah yang dihasilkan tidak sekuat nikardipin. Meski demikian, urapidil memiliki tolerabilitas yang lebih baik dibandingkan dengan dihidralazin dan nikardipin. Adapun metildopa tidak memiliki perbedaan yang signifikan dalam efikasi untuk menurunkan tekanan darah dibandingkan dengan labetalol dan isradipin. Terdapat beberapa pilihan obat antihipertensi yang dapat digunakan dan telah dibandingkan dalam percobaan klinis sebagai terapi hipertensi pada kasus hipertensi selama kehamilan.
Background: In India, 25% of pregnancies develop preterm labor (PTL), resulting in 10 to 69% cases of preterm birth. Medical intervention to stop labor, reduce infection rate, and avoid infant respiratory distress has been the subject of studies for a long time. PTL patients usually get tocolytics, corticosteroids, antibiotics, and other clinically symptomatic and supportive therapy to accomplish this goal. Studies further showed that these tocolytic drugs lower intracellular calcium bioavailability via biochemical pathways, hindering the interaction of actin-myosin. Due to the poor success rate of labor arrest, researchers concluded from their studies that widespread adoption of medical management for PTL has been hampered. The high rate of major side effects of tocolytic drugs, particularly beta-mimetic ones, exacerbated this. We know of no clinical evidence on PTL management in India. Objective: The effectiveness and maternal side effects of MgSO4 and isoxsuprine in PTL arrest. Methods: In our study, we included a total of 82 pregnant women who had PTL discomfort and were admitted to the labor department. Both groups were randomly assigned patients. “Group 1 patients received isoxsuprine hydrochloride, whereas group 2 patients received MgSO4”. After that, a comprehensive clinical examination included vital signs, general, systemic, external genitalia, and PV (per vaginal) results. Investigations include CBC, BT, CT, urine full examination, ABO, RH group, serum electrolytes, RBS, vaginal swab, and Renal function test (RFT). Result: Significant difference (p <0.05) indicated that MgSO4 was more effective. Conclusion: MgSO4 can be used as a tocolytic agent in PTL as it shows better tolerance capacity when compared to isoxsuprine.
Socio-demographic Status of New Smear Positive Pulmonary Tuberculosis Cases Registered in DOTS Implemented TB Care Setting.
Proper notification is the first step towards the organization of national surveillance of congenital anomalies. By strengthening our existing system, we will be able to evaluate the real impact of anomalies on populations, in addition to producing useful information to promote prevention and care measures adjusted to the reality of each part of the world. For this, it is essential that professionals and institutions recognize the importance of congenital anomalies in the context of public health and register all those diagnosed at birth in official information systems.
La notificación adecuada en los sistemas de información oficiales es el primer paso hacia el establecimiento de una vigilancia nacional de anomalías congénitas. Fortaleciendo los sistemas existentes, será posible evaluar el impacto real de las anomalías en las poblaciones, además de producir información útil para promover medidas de prevención y atención ajustadas a la realidad de cada lugar. Por tanto, es fundamental que los profesionales e instituciones reconozcan la importancia de las anomalías congénitas en el contexto de la salud pública y registren a todas las anomalías congénitas diagnosticadas al nacer en los sistemas oficiales de información.
(1) Background: The bioavailability of nitric oxide (NO) and oxidative stress are important events related to the pathophysiology of preeclampsia (PE). In this present study, we aimed to evaluate the antioxidant effect of glibenclamide (GB) on the NO synthesis, oxidative stress, and antioxidant capacity in endothelial cells incubated with plasma from preeclamptic (PE) and normotensive pregnant women (NT). (2) Methods: Human umbilical vein endothelial cells (HUVECs) were incubated with a plasma pool from 10 NT and 10 PE pregnant women; NO/NOx quantification and ROS levels were assessed by a fluorescence compound; lipid peroxidation was evaluated employing thiobarbituric acid (TBA); and total antioxidant capacity was measured by ferric reduction ability power (FRAP) and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT). (3) Results: We found that endothelial cells incubated with plasma from PE showed lower NO and NOx levels compared with the NT group. However, GB treatment increased these levels, as well as the antioxidant capacity. Furthermore, a decrease was observed in ROS generation and lipid peroxidation (4) Conclusions: The GB treatment exerted a positive effect on the NO/NOx production by HUVEC incubated with plasma from NT and PE pregnant women, as well as in the reduction in oxidative stress and increase in the antioxidant capacity.
Background:
Hypertension in pregnancy causes significant maternal and fetal mortality and morbidity. A comprehensive assessment of the effectiveness of antihypertensive drugs for severe hypertension during pregnancy is needed to make informed decisions in clinical practice. This systematic review aimed to assess the efficacy and safety of antihypertensive drugs in severe hypertension during pregnancy.
Methods:
A systematic review using the electronic databases MEDLINE (PubMed) and Cochrane Library was performed until August 2021. The risk-of-bias 2 tool was used to assess the risk-of-bias in each study included. Meta-analysis was conducted to assess heterogeneity and to estimate the pooled effects size.
Results:
Seventeen studies fulfilled the inclusion criteria and 11 were included in the meta-analysis. Nifedipine was estimated to have a low risk in persistent hypertension compared to hydralazine (RR 0.40, 95% CI 0.23-0.71) and labetalol (RR 0.71, 95% CI 0.52-0.97). Dihydralazine was associated with a lower risk of persistent hypertension than ketanserin (RR 5.26, 95% CI 2.01-13.76). No difference was found in the risk of maternal hypotension, maternal and fetal outcomes, and adverse effects between antihypertensive drugs, except for dihydralazine, which was associated with more adverse effects than ketanserin.
Conclusions:
Several drugs can be used to treat severe hypertension in pregnancy, including oral/sublingual nifedipine, IV/oral labetalol, oral methyldopa, IV hydralazine, IV dihydralazine, IV ketanserin, IV nicardipine, IV urapidil, and IV diazoxide. In addition, nifedipine may be preferred as the first-line agent. There was no difference in the risk of maternal hypotension, maternal and fetal outcomes, and adverse effects between the drugs, except for adverse effects in IV dihydralazine and IV ketanserin.
Background: The purpose of this study was to investigate lipid metabolism in the placenta of Gestational diabetes mellitus (GDM) individuals and to evaluate its effect on the fetus.
Methods: We examined the expression of lipogenesis- and lipolysis-related proteins in the in vitro and in vivo GDM placenta models.
Results: The levels of sterol regulatory element binding protein-1c (SREBP-1c) were increased, and fat accumulated more during early hyperglycemia, indicating that lipogenesis was stimulated. When hyperglycemia was further extended, lipolysis was activated due to the phosphorylation of hormone-sensitive lipase (HSL) and expression of adipose triglyceride lipase (ATGL). In the animal model of GDM and in the placenta of GDM patients during the extended stage of GDM, the expression of SREBP-1c decreased and the deposition of fat increased. Similar to the results obtained in the in vitro study, lipolysis was enhanced in the animal and human placenta of extended GDM.
Conclusion: These results suggest that fat synthesis may be stimulated by lipogenesis in the placenta when the blood glucose level is high. Subsequently, the accumulated fat can be degraded by lipolysis and more fat and its metabolites can be delivered to the fetus when the GDM condition is extended at the late stage of gestation. Imbalanced fat metabolism in the placenta and fetus of GDM patients can cause metabolic complications in the fetus, including fetal macrosomia, obesity, and type 2 diabetes mellitus.
Aim: To evaluate whether serum platelets Mean Platelet Volum (MPV), and Red Cell Distribution width (RDW) are useful as predictors of preterm labour (PL) in patients with preterm labour (PL), and to compare the clinical efficacy of various serum inflammatory markers to predict the risk of preterm delivery (PD). Materials, and methods: The main group consisted of pregnant women who were earlier than the 37th gestational week. The control group has consisted of pregnant bigger than 37th weeks of gestation. The patients with PL who participated in the study group were divided into early preterm labour (EPL), and late preterm labour (LPL) groups. The two groups were investigated in terms of clinical aspects of RDW, and MPV and serum markers studied at admission. ROC curve analysis was used to determine the optimal MPV, RDW cut-off levels predicting PL. Results: Neutrophil (NEU), MPW, RDW, and neutrophil to lymphocyte ratio (NLR) were significantly higher in LPL than in women who gave birth at term (p=0.006, OR=1.411; p<0.001, OR=1.410; 0.002, OR=1.612, p=0.035, OR=1.294). In multivariate regression analysis, MPV positive was the strongest predictor variable. Besides, there was a significant correlation between MPV and RDW elevation, and neonatal intensive care needs (NICU) in women who delivered between 34 weeks, and 37 weeks. Conclusion: High RDW and MPV are independent predictors of preterm delivery in patients with LPL. In our study, we found that the increase of RDW and MPV was higher in women with high PL risk more than in healthy individuals. MPV has the highest area for prediction of preterm birth, and RDW>14,5, and MPV>9,6 have the highest sensitivity and specificity. RDW may be more significant than measuring any of the individual markers in the simultaneous use of preterm delivery. The simultaneous use of RDW and MPV with existing markers to increase our identifying abilities of preterm labour may be stronger than that of any of the individual markers.
Objectives
Preterm labour is the leading cause of hospitalization during pregnancy. In France, it results in more than 60,000 births before 37 weeks of gestation every year. Recent studies suggest that detection of placental α-microglobulin-1 (PAMG-1) in vaginal secretions among women presenting symptoms of preterm labour with intact membranes has good predictive value for the onset of spontaneous preterm delivery within 7 days. The test is especially interesting, in that the repetition of antenatal corticosteroids for foetal lung maturation is no longer recommended in France and the effect of the initial administration is most beneficial in the 24 h to 7 days afterwards.
Methods
We included all studies listed in PubMed and clinicaltrials.gov with the terms “PAMG-1” and either “preterm labor” or “preterm labour”, while excluding all studies on the subject of “rupture of the membranes” from 2000 through 2017. Ten studies were thus included.
Results
In women who had both the PAMG-1 and foetal fibronectin test, the PAMG-1 test was statistically superior to the measurement of cervical length for positive predictive value (p<0.0074), negative predictive value (p=0.0169) and specificity (p<0.001) for the prediction of spontaneous preterm delivery within 7 days.
Conclusion
The use of PAMG-1 may make it possible to target the women at risk with a shortened cervix on ultrasound (<25 mm) those with an imminent preterm delivery and therefore to adapt management, especially the administration of antenatal corticosteroid therapy.
Maternal stress during pregnancy is prevailing worldwide, which exposes fetuses to intrauterine hyper glucocorticoids (GC), programming offspring to obesity and metabolic diseases. Despite the importance of brown adipose tissue (BAT) in maintaining long-term metabolic health, impacts of prenatal hyper GC on postnatal BAT thermogenesis and underlying regulations remain poorly defined. Pregnant mice were administrated with synthetic GC dexamethasone (DEX) at levels comparable to fetal GC exposure of stressed mothers. Prenatal GC exposure dose-dependently reduced BAT thermogenic activity, contributing to lower body temperature and higher mortality of neonates; such difference was abolished under thermoneutrality, underscoring BAT deficiency was the major contributor to adverse changes in postnatal thermogenesis due to excessive GC. Prenatal GC exposure highly activated Redd1 expression and reduced Ppargc1a transcription from the alternative promoter (Ppargc1a-AP) in neonatal BAT. During brown adipocyte differentiation, ectopic Redd1 expression reduced Ppargc1a-AP expression and mitochondrial biogenesis; and the inhibitory effects of GC on mitochondrial biogenesis and Ppargc1a-AP expression were blocked by Redd1 ablation. Redd1 reduced protein kinase A phosphorylation and suppressed cyclic adenosine monophosphate (cAMP) -responsive element-binding protein (CREB) binding to the cAMP regulatory element (CRE) in Ppargc1a-AP promoter, leading to Ppargc1a-AP inactivation. In summary, excessive maternal GC exposure during pregnancy dysregulates Redd1-Ppargc1a-AP axis, which impairs fetal BAT development, hampering postnatal thermogenic adaptation and metabolic health of offspring.
Objective:
In 2010, national guidelines were published in Ireland recommending more sensitive criteria for the diagnosis of Gestational Diabetes Mellitus (GDM). The criteria were based on the 2008 Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study and were endorsed subsequently by the World Health Organization (WHO). Screening nationally is selective based on risk factors. We examined the impact of the new criteria on hospital trends nationally for GDM over the 10 years 2008-17.
Research design and methods:
Data from three national databases, the Hospital Inpatient Enquiry System (HIPE), National Perinatal Reporting System (NPRS) and the Irish Maternity Indicator System (IMIS), were analyzed using descriptive statistics, analysis of variance, and Poisson loglinear modelling.
Results:
The overall incidence of GDM nationally increased almost five-fold from 3.1% in 2008 to 14.8% in 2017 (p ≤ 0.001). The incidence varied widely across maternity units. In 2008, the incidence varied from 0.4 to 5.9% and in 2017 it varied from 1.9 to 29.4%. There were increased obstetric interventions among women with GDM over the decade, specifically women with GDM having increased cesarean sections (CS) and induction of labor (IOL) (p ≤ 0.001). These trends were significant in large and mid-sized maternity hospitals (p ≤ 0.001). The increase in GDM diagnosis could not be explained by an increase in maternal age nationally over the decade. The data did not include information on other risk factors such as obesity. The increased incidence in GDM diagnosis was accompanied by a decrease in high birthweight ≥ 4.5 kg nationally.
Conclusions:
We found adoption of the new criteria for diagnosis of GDM resulted in a major increase in the incidence of GDM rates. Inter-hospital variations increased over the decade, which may be explained by variations in the implementation of the new national guidelines in different maternity units. It is likely to escalate further as compliance with national guidelines improves at all maternity hospitals, with implications for provision and configuration of maternity services. We observed trends that may indicate improvements for women and their offspring, but more research is required to understand patterns of guideline implementation across hospitals and to demonstrate how increased GDM diagnosis will improve clinical outcomes.
Objective
(1) Determine the rate of completion of glucose screening for diabetes in the postpartum period for women who had gestational diabetes mellitus, and (2) compare the rates of follow up glucose screening between women who were low risk to those who were high risk.
Design
A retrospective comparative study.
Setting
An academic hospital in an urban community.
Participants
One hundred and seventy-five women with gestational diabetes who gave birth between January 2012 and September 2015.
Methods
The electronic medical record was reviewed to confirm diagnosis of gestational diabetes at 24–28 weeks and completion of 4–12 weeks postpartum glucose screening. All consecutive women meeting eligibility criteria were included.
Results
The rate of postpartum glucose screening was 38.9%. There were 22 (31.0%) low risk women and 46 (44.2%) women with high risk who had postpartum glucose screening (χ² = 3.12, p = 0.08).
Conclusions
The type of GDM, low or high risk, did not affect the rate of follow-up for postpartum glucose screening. Strategies need to be developed to improve postpartum screening rates in women with gestational diabetes.
Introduction
Some studies have investigated the effect of Lavender on pain and the healing of wounds. The aim of this systematic review was to investigate the effect of Lavender on pain and wound healing of episiotomy.
Methods
The Cochrane Library, MEDLINE (PubMed), Scopus, and Web of Science (all databases from inception until February 2020) were searched. Data were extracted from eligible studies by two review authors individually. Our inclusion criteria were full-text interventional studies published in English or any other languages. All data were analyzed using Review Manager 5.3. The protocol of this systematic review was registered in PROSPERO with the reference number CRD42020140623.
Results
Our search found six trials involving 415 participants. The use of Lavender could significantly reduce pain in women with episiotomy (95 % CI: -1.06 – -0.32). The use of Lavender has significantly improved the healing of episiotomy compared to the placebo (95 % CI: -2.13 – -1.34). In all studies, pain and healing of episiotomy were evaluated with Visual Analog Scale (VAS) and Redness, Edema, Ecchymosis, Discharge, Approximation (REEDA) scale respectively.
Conclusion
This review showed that the use of Lavender (in any form) in postpartum has a significant effect on pain relief and healing of episiotomy wound. All six studies that were included in this systematic review were from developing countries. A high level of heterogeneity was observed in the effect of Lavender on pain but not the healing of the episiotomy. Therefore, the results should be considered with caution. Using Lavender may be considered for wound healing of episiotomy.
Background
The need for development of population based nomograms for ultrasound fetal dating cannot be overemphasised. The objective of this study was to develop a nomogram of Fetal Neck Circumference (NC) for predicting gestational age for this population.Methods
This was a cross sectional prospective study of 203 singleton normal pregnant women of 15–40 weeks’ gestation. Fetal NC was measured the 5th, 50th and 95th centile values were estimated at each week of gestational age, 50th centile values were then compared to Caucasian and African population study to assess variability.ResultsA nomogram was derived and NC values showed no statistical significant difference compared to the Caucasians (p = 0.065, 0.257) and African (p = 0.947) population. There was a strong positive significant correlation (r2 = 0.799; p = 0.001) between NC and average gestational age. Method of least square yielded to the equation y = 2.22x + 5.390. NC relationship with BPD (r2 = 0.859; p = 0.001), FL (r2 = 0.842; p = 0.001) and HC (r2 = 0.662; p = 0.001) were also significant and positive. Estimated weekly increase in NC was 0.72 cm.Conclusion
This study derived nomogram for ultrasound measurement of fetal NC in a Northern Nigerian population. However, NC values from this study differ less with an African population than with Caucasian study population.
Objectives:
To evaluate the performance of a new ultrasound technique for the automatic assessment of the changes of the head-perineum distance (delta-HPD) and of the Angle of Progression (delta-AoP) during the active phase of the second stage of labour.
Methods:
Prospective observational cohort study including singleton term pregnancies with fetuses in cephalic presentation during the active phase of the second stage of labour. Using the transperineal approach, two short video clips of 10 sec each were recorded between the rest and the acme of two expulsive efforts to measure the AoP and the HDP. The clips were processed off-line and the changes of the two measurements (delta-HDP and delta-AoP) were calculated manually by experienced sonographers and using a new automatic system. The reliability of the algorithm was evaluated by comparing the automatic and the manual measurements, which were assumed as the reference gold standard.
Results:
Overall, 27 women were included. A significant correlation between the results obtained through the automated and the manual reference methods was found for both parameters (Intra-CC delta-HPD = 0.97; Intra-CC delta-AoP =0.99). The values of the coefficient of determination (r2deltaHPD = 0.98; r2deltaAoP =0.98) and the low residual errors (root mean square error delta-HPD =1.2 mm; root mean square error delta-AoP = 1.5°) confirm the good accuracy provided by the algorithm. The Bland-Altman analysis showed a mean difference of 0.52 mm (limits of agreement, 2.10 mm) for the delta-HPD (p=0.034) and of 0.35° (limits of agreement, 2.83°) for the delta-AoP (p=0.39).
Conclusions:
The automatic assessment of delta-AoP and delta-HPD during pushing efforts is feasible. The automatic measurement of delta-AoP appears reliable when compared to gold standard measurement. This article is protected by copyright. All rights reserved.
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