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Trends in nuchal translucency measurement at late first trimester ultrasound, and prenatal diagnostic testing after the introduction of cell-free fetal DNA screening: data from a large health system in New York from 2010–2023 无细胞胎儿 DNA 筛查引入后,孕晚期超声检查和产前诊断检测中颈部透明层测量的趋势:2010-2023 年纽约大型医疗系统的数据:产前诊断的趋势。
IF 3.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-19 DOI: 10.1016/j.ajogmf.2024.101499
Frank I. Jackson DO, Insaf Kouba MD, Nathan A. Keller MD, Luis A. Bracero MD, Nidhi Vohra MD, Matthew J. Blitz MD, MBA
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引用次数: 0
Cesarean delivery, labor duration, and mothers’ mortality risk over 50 years of follow-up 剖腹产、产程和 50 年随访期间母亲的死亡风险:剖腹产和产妇死亡率。
IF 3.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-19 DOI: 10.1016/j.ajogmf.2024.101498
Susanna D. Mitro PhD , Rajeshwari Sundaram PhD , Sonia M. Grandi PhD , Stefanie N. Hinkle PhD , James L. Mills MD , Pauline Mendola PhD , Sunni L. Mumford PhD , Yan Qiao MPH , Anokhi Cifuentes MPH , Cuilin Zhang MD, PhD , Enrique F. Schisterman PhD , Katherine L. Grantz MD, MS

Background

Pregnancy complications have been recognized as a window to future health. Though cesarean delivery is common, it is unknown whether labor duration and mode of delivery are associated with maternal long-term mortality.

Objective

To examine whether labor duration and mode of delivery were associated with all-cause and cause-specific mortality.

Study Design

Participants were mothers from the multisite Collaborative Perinatal Project (CPP) cohort (1959–1966; n=43,646, limited to last CPP delivery). We ascertained all-cause and specific causes of death as of 2016 via linkage to the National Death Index and Social Security Death Master File. Hazard ratios (HR) testing mode of delivery and labor duration were estimated using Cox proportional hazards models adjusted for demographic and clinical characteristics. We further stratified analyses by parity.

Results

Among participants with a recorded delivery mode, 5.9% (2486/42,335) had a cesarean delivery. Participants who had a cesarean were older (26.9 vs 24.3 years), with higher body mass index (24.0 vs 22.7 kg/m2), were less likely to be nulliparous (21% vs 30%), and more likely to have a household income of at least $6000 (22% vs 17%), to smoke ≥1 pack/d (18% vs 15%), to have diabetes mellitus (12% vs 1%) and to have a prior medical condition (47% vs 34%), compared to participants with a vaginal delivery. Delivery mode was similar by race/ethnicity, marital status, and education. Median labor duration was 395 minutes among participants who had an intrapartum cesarean delivery and 350 minutes among participants delivered vaginally. By 2016, 52.2% of participants with a cesarean delivery and 38.5% of participants with a vaginal delivery had died. Cesarean vs vaginal delivery was significantly associated with increased risk for all-cause mortality (HR=1.16 (95% confidence interval [CI]: 1.09, 1.23); in nulliparas, HR=1.27 (95% CI: 1.09, 1.47); in multiparas, HR=1.13 (95% CI: 1.06, 1.21) as well as increased risk of death from cardiovascular disease, diabetes, respiratory disease, infection, and kidney disease. Associations with death from cardiovascular disease, infection, and kidney disease were stronger for multiparas than nulliparas, though the association with death from diabetes was stronger among nulliparas. Labor duration was not significantly related to overall mortality.

Conclusion

In a historic United States cohort with a low cesarean delivery rate, cesarean delivery was an indicator for subsequent increased mortality risk, particularly related to cardiovascular disease and diabetes. Future studies with long-term follow-up are warranted given the current high prevalence of cesarean delivery.
背景:妊娠并发症被认为是未来健康的窗口。虽然剖宫产很常见,但分娩持续时间和分娩方式是否与孕产妇长期死亡率有关尚不清楚:研究设计:研究设计:参与者为多地点围产期合作项目队列中的母亲(1959-1966 年;n=43646,仅限于围产期合作项目的最后一次分娩)。我们通过与国家死亡指数和社会保障死亡主档案的链接,确定了截至 2016 年的全因死亡和特定死因。检验分娩方式和分娩持续时间的危险比使用考克斯比例危险模型进行估计,并根据人口统计学和临床特征进行调整。我们还进一步按胎次进行了分层分析:在有分娩方式记录的参与者中,5.9%(2486/42335)为剖宫产。与阴道分娩的参试者相比,剖宫产的参试者年龄更大(26.9 岁对 24.3 岁),体重指数更高(24.0 公斤对 22.7 公斤/平方米),更不可能是无阴道分娩(21% 对 30%),更有可能家庭收入至少为 6000 美元(22% 对 17%),吸烟≥1 包/天(18% 对 15%),患有糖尿病(12% 对 1%)和曾有过疾病(47% 对 34%)。分娩方式在种族/民族、婚姻状况和教育程度方面相似。剖宫产参与者的中位分娩持续时间为 395 分钟,阴道分娩参与者的中位分娩持续时间为 350 分钟。到 2016 年,52.2% 的剖宫产参与者和 38.5% 的阴道分娩参与者已经死亡。剖宫产与阴道分娩相比,与全因死亡风险增加显著相关(危险比 = 1.16(95% 置信区间:1.09,1.23);无胎儿的危险比 = 1.27(95% 置信区间:1.09,1.47);多胎儿的危险比 = 1.13(95% 置信区间:1.06,1.21)),与心血管疾病、糖尿病、呼吸系统疾病、感染和肾脏疾病死亡风险增加也显著相关。多胎妊娠者死于心血管疾病、感染和肾脏疾病的几率要高于单胎妊娠者,而单胎妊娠者死于糖尿病的几率要高于多胎妊娠者。分娩持续时间与总死亡率无明显关系:结论:在一个剖宫产率较低的美国历史性队列中,剖宫产是随后死亡风险增加的一个指标,尤其是与心血管疾病和糖尿病有关。鉴于目前剖宫产的高流行率,今后有必要进行长期随访研究。
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引用次数: 0
Lived experience of hypertensive disorders of pregnancy: a systematic review and meta-synthesis 妊娠高血压疾病的生活经历:系统综述和元综合:妊娠高血压疾病的生活经历。
IF 3.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-17 DOI: 10.1016/j.ajogmf.2024.101494
Sara R. Wetzler MPhil , Tabitha Wishlade MSc , Frances Cates , Isla Kuhn MSc , Catherine E. Aiken PhD

Background

Hypertensive disorders are major causes of maternal and neonatal morbidity and mortality, affecting ∼10% pregnancies worldwide.

Objective

Understanding the lived experience of women with hypertensive disorders during pregnancy is important to inform best practice and provide holistic care.

Study Design

This is a systematic review and meta-synthesis of studies containing qualitative components relating to direct lived experience of hypertensive disorders of pregnancy. Medline via Ovid, Embase via Ovid, CINAHL via Ebsco, PsycINFO via Ebsco, Scopus, Web of Science Core Collection, and ASSIA via ProQuest were searched between database inception and June 2024. Quality assessment was performed using the Critical Appraisal Skills Programme checklist for qualitative research. Themes were labeled and organized into a framework using NVivo software.

Results

Eighteen studies were included in the meta-synthesis. Anxiety, stress, fear and panic emerged as the most common emotional experiences during hypertensive disorders of pregnancy. Loss of control was also mentioned frequently and consistently across studies (frequency effect size 38.9% and intensity effect size 15.3%). Emotional responses to physical symptoms or lack thereof, and feelings about the impact of the complicated pregnancy on family and community also emerged as central themes associated with hypertensive disorders of pregnancy.

Conclusion

A range of emotional experiences was captured across the studies included in our meta-synthesis, some of which were observed across global settings whereas others were context-dependent. Interventions and care pathways for pregnancies affected by hypertensive disorders should aim to support women through complex emotional experiences as well as reducing morbidity and mortality.
目标:高血压疾病是导致孕产妇和新生儿发病和死亡的主要原因,影响着全球 10%的孕妇。了解妊娠期高血压妇女的生活经历对于提供最佳实践和整体护理非常重要:数据来源:在数据库建立至 2024 年 6 月期间,通过 Ovid 对 Medline、Ovid 对 Embase、Ebsco 对 CINAHL、Ebsco 对 PsycINFO、Scopus、Web of Science Core Collection 和 ProQuest 对 ASSIA 进行了检索:研究评估和综合方法:采用定性研究的 "批判性评估技能计划 "清单进行质量评估。使用 NVivo 软件对主题进行标记并组织成一个框架:结果:18 项研究被纳入元综合。焦虑、压力、恐惧和惊慌是妊娠高血压疾病期间最常见的情绪体验。失去控制也是各研究中经常提到的问题(频率效应大小为 38.9%,强度效应大小为 15.3%)。对身体症状或缺乏身体症状的情绪反应,以及对复杂妊娠对家庭和社区的影响的感受,也是与妊娠高血压紊乱相关的核心主题:我们的元综述研究涵盖了一系列情感体验,其中一些情感体验是在全球范围内观察到的,而其他情感体验则取决于具体情况。针对受妊娠高血压疾病影响的妊娠妇女的干预措施和护理路径应旨在支持妇女度过复杂的情感经历,并降低发病率和死亡率。
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引用次数: 0
The association between perinatal depressive symptoms and child neurodevelopment 围产期抑郁症状与儿童神经发育之间的关系。
IF 3.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-16 DOI: 10.1016/j.ajogmf.2024.101488
Emily S. Miller MD, MPH , Maged M. Costantine MD, MBA , Lisa Mele ScM , Michael W. Varner MD , Uma M. Reddy MD, MPH , Ronald J. Wapner MD , John M. Thorp Jr MD , George R. Saade MD , Alan T.N. Tita MD, PhD , Dwight J. Rouse MD , Baha Sibai MD , Brian M. Mercer MD , Steve N. Caritis MD , Brian M. Casey MD , Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD, United States

Background

Perinatal depression has been suggested to adversely impact child neurodevelopment. However, the complexity of the early childhood environment challenges conclusive findings.

Objective

To evaluate whether there is an association between perinatal depressive symptoms and child intelligence quotient (IQ) at 5 years of age.

Study Design

Secondary analysis of an ancillary study to a multicenter randomized trial of thyroxine therapy for pregnant individuals with subclinical hypothyroidism. Dyads of infants and birthing parent, with completed Center for Epidemiological Studies-Depression (CES-D) screens during pregnancy and postpartum and child neurodevelopment testing completed at five years of age (n=209) were included. CES-D screening was performed at 11–20 weeks, 34–38 weeks, and one-year postpartum. Depressive symptoms were categorized as antenatal (i.e., a positive screen at any point during pregnancy) or postpartum. The primary outcome was child IQ score < 85 at 5 years of age using the Wechsler Preschool and Primary Scale of Intelligence III (WPPSI-III) Full Scale test. Secondary outcomes included other assessments of childhood neurodevelopment. Bivariable analyses and multivariable logistic regressions were utilized.

Results

Of the 209 birthing people included, 72 (34%) screened positive for depression during pregnancy and 32 (15%) screened positive one year postpartum. Children born to individuals with a positive antenatal depression screen had a higher odds of IQ < 85 at 5 years of age compared with children born to individuals with a CES-D < 16 (35% vs. 18%, OR 2.4, 95% CI 1.2–4.7). Similar findings were seen for children born to individuals with a positive postpartum depression screen (47% vs. 21%, OR 3.3, 95% CI 1.5–7.3). These associations did not persist in multivariable analyses that controlled for social determinants of health and clinical characteristics (adjusted odd ratio [aOR] 1.4, 95% CI 0.7–3.1; aOR 2.1, 95% CI 0.9–5.1, for antenatal and postpartum depressive symptoms, respectively). Similar findings were observed for other adverse neurodevelopmental outcomes.

Conclusions

Having a positive perinatal depression screen was not associated with child cognitive outcomes after controlling for covariates including social determinants of health.
背景:围产期抑郁症被认为会对儿童的神经发育产生不利影响。然而,幼儿期环境的复杂性给研究结果带来了挑战:研究设计:研究设计:一项针对亚临床甲状腺功能减退症孕妇的甲状腺素治疗多中心随机试验的辅助研究的二次分析。研究对象包括在孕期和产后完成流行病学研究中心抑郁(CES-D)筛查并在5岁时完成儿童神经发育测试的婴儿和分娩父母(人数=209)。CES-D 筛查分别在怀孕 11-20 周、34-38 周和产后一年进行。抑郁症状分为产前(即孕期任何时候筛查呈阳性)和产后两种。主要结果是儿童在5岁时通过韦氏学前和小学智力量表III(WPPSI-III)全量表测试获得的智商分数小于85分。次要结果包括对儿童神经发育的其他评估。研究采用了双变量分析和多变量逻辑回归:在纳入的 209 名产妇中,有 72 人(34%)在怀孕期间筛查出抑郁阳性,32 人(15%)在产后一年筛查出抑郁阳性。产前抑郁筛查呈阳性者所生子女的智商结论几率更高:在控制了包括社会健康决定因素在内的协变量后,围产期抑郁筛查呈阳性与儿童认知结果无关。
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引用次数: 0
Association between interpreter use and small for gestational age infants 使用口译员与胎龄小婴儿之间的关系:非英语患者使用口译员与胎龄过小的关系。
IF 3.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-14 DOI: 10.1016/j.ajogmf.2024.101486
Carrie A. Sibbald MD, Amy Godecker PhD, MS, Erin J. Bailey MD, Janine S. Rhoades MD, Jacquelyn H. Adams MD, MSCI

Background

Limited English proficiency is associated with worse health outcomes regardless of health literacy. Prior research suggests that using interpreter services for low English proficiency helps mitigate the language barrier, is associated with improved health outcomes, and patient satisfaction; however, obstetric and neonatal outcomes and pregnancy risks in this population are not well studied.

Objectives

The primary purpose of this study was to determine if low English proficiency is an independent risk factor for small for gestational age infants by utilizing interpreter use as a proxy for low English proficiency. Due to the known challenges in communication with a language barrier and discrimination against people whose first language is not English, we hypothesized that this could result in an increase in high risk conditions in pregnancy such as SGA. Our hypothesis was that the need for an interpreter would be associated with having small for gestational age infants.

Study Design

We performed a retrospective cohort study at a single center using data between 1/1/2016 and 12/31/2021; we included singleton, live births ≥ 21 weeks gestation. We excluded multiple gestations, intrauterine fetal demise, and delivery < 21 weeks. The primary outcome was rate of small for gestational age. Small for gestational age was defined as birthweight < 10th percentile for gestational age using the 2018 Fenton newborn growth curve. Multivariable logistic regression was performed to control for confounding variables.

Results

Of the 26,260 patients included in the study, 71.3% were non-Hispanic White, 9.5% were Hispanic/Latino, and 7.9% were non-Hispanic Black. Overall, 1,662 (6.3%) patients utilized an interpreter. Over half (58.0%) of patients requesting interpreter services were Hispanic. In unadjusted analyses, the rate of small for gestational age was not different between patients who used interpreter services (n=106, 6.4%) and those who did not (n=1612, 6.6 %), P=.779. After adjusting for race/ethnicity, gravidity, gestational age, private insurance, diabetes, hypertension, and prepregnancy body mass index, the use of interpreter services was associated with decreased odds of small for gestational age (aOR 0.67, 95% CI 0.53–0.84).

Conclusions

Our findings suggest that use of an interpreter is associated with a lower incidence of small for gestational age when controlling for patient characteristics and social determinants of health. Additional research is required to explore this association, but our results indicate that recognizing demographic risk factors and providing patients with social resources such as access to interpreter services may positively impact obstetric and neonatal outcomes.
背景:无论健康素养如何,英语水平有限都与较差的健康结果有关。先前的研究表明,英语水平低时使用口译服务有助于缓解语言障碍,与改善健康结果和患者满意度相关;然而,对这一人群的产科和新生儿结果以及妊娠风险的研究并不充分:本研究的主要目的是通过使用翻译人员作为低英语水平的代表,确定低英语水平是否是导致小胎龄婴儿的一个独立风险因素。由于众所周知的语言障碍和对母语非英语者的歧视会给沟通带来挑战,我们假设这可能会导致妊娠高风险情况(如 SGA)的增加。我们的假设是,对翻译的需求与胎龄小的婴儿有关:我们在一个中心进行了一项回顾性队列研究,使用了 2016 年 1 月 1 日至 2021 年 12 月 31 日期间的数据;我们纳入了妊娠期≥21 周的单胎活产婴儿。我们排除了多胎妊娠、胎儿宫内夭折以及使用2018年芬顿新生儿生长曲线的胎龄百分位数分娩。为控制混杂变量,我们进行了多变量逻辑回归:在纳入研究的26260名患者中,71.3%为非西班牙裔白人,9.5%为西班牙裔/拉丁美洲人,7.9%为非西班牙裔黑人。总体而言,有 1662 名(6.3%)患者使用了口译员。超过一半(58.0%)要求口译服务的患者为西班牙裔。在未经调整的分析中,使用口译服务的患者(n = 106,6.4%)与未使用口译服务的患者(n = 1612,6.6%)的胎龄偏小率没有差异,p = 0.779。在对种族/民族、孕酮、孕龄、私人保险、糖尿病、高血压和孕前体重指数进行调整后,使用口译服务与胎龄偏小的几率降低有关(aOR 0.67,95% CI 0.53 - 0.84):我们的研究结果表明,在控制了患者特征和健康的社会决定因素后,使用口译服务与胎儿过小的发生率降低有关。还需要进行更多的研究来探讨这种关联,但我们的研究结果表明,认识到人口风险因素并为患者提供社会资源(如获得口译服务)可能会对产科和新生儿预后产生积极影响。
{"title":"Association between interpreter use and small for gestational age infants","authors":"Carrie A. Sibbald MD,&nbsp;Amy Godecker PhD, MS,&nbsp;Erin J. Bailey MD,&nbsp;Janine S. Rhoades MD,&nbsp;Jacquelyn H. Adams MD, MSCI","doi":"10.1016/j.ajogmf.2024.101486","DOIUrl":"10.1016/j.ajogmf.2024.101486","url":null,"abstract":"<div><h3>Background</h3><div>Limited English proficiency is associated with worse health outcomes regardless of health literacy. Prior research suggests that using interpreter services for low English proficiency helps mitigate the language barrier, is associated with improved health outcomes, and patient satisfaction; however, obstetric and neonatal outcomes and pregnancy risks in this population are not well studied.</div></div><div><h3>Objectives</h3><div>The primary purpose of this study was to determine if low English proficiency is an independent risk factor for small for gestational age infants by utilizing interpreter use as a proxy for low English proficiency. Due to the known challenges in communication with a language barrier and discrimination against people whose first language is not English, we hypothesized that this could result in an increase in high risk conditions in pregnancy such as SGA. Our hypothesis was that the need for an interpreter would be associated with having small for gestational age infants.</div></div><div><h3>Study Design</h3><div>We performed a retrospective cohort study at a single center using data between 1/1/2016 and 12/31/2021; we included singleton, live births ≥ 21 weeks gestation. We excluded multiple gestations, intrauterine fetal demise, and delivery &lt; 21 weeks. The primary outcome was rate of small for gestational age. Small for gestational age was defined as birthweight &lt; 10th percentile for gestational age using the 2018 Fenton newborn growth curve. Multivariable logistic regression was performed to control for confounding variables.</div></div><div><h3>Results</h3><div>Of the 26,260 patients included in the study, 71.3% were non-Hispanic White, 9.5% were Hispanic/Latino, and 7.9% were non-Hispanic Black. Overall, 1,662 (6.3%) patients utilized an interpreter. Over half (58.0%) of patients requesting interpreter services were Hispanic. In unadjusted analyses, the rate of small for gestational age was not different between patients who used interpreter services (<em>n</em>=106, 6.4%) and those who did not (<em>n</em>=1612, 6.6 %), <em>P</em>=.779. After adjusting for race/ethnicity, gravidity, gestational age, private insurance, diabetes, hypertension, and prepregnancy body mass index, the use of interpreter services was associated with decreased odds of small for gestational age (aOR 0.67, 95% CI 0.53–0.84).</div></div><div><h3>Conclusions</h3><div>Our findings suggest that use of an interpreter is associated with a lower incidence of small for gestational age when controlling for patient characteristics and social determinants of health. Additional research is required to explore this association, but our results indicate that recognizing demographic risk factors and providing patients with social resources such as access to interpreter services may positively impact obstetric and neonatal outcomes.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"6 11","pages":"Article 101486"},"PeriodicalIF":3.8,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reflective and emotional writing in maternal-fetal medicine: American Journal of Obstetrics & Gynecology Maternal-Fetal Medicine welcomes submissions for its new “Ob E-motions” article format 母胎医学中的反思与情感写作:AJOG MFM 欢迎为其新的 "Ob E-motions "文章格式投稿:母胎医学中的情感写作。
IF 3.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-13 DOI: 10.1016/j.ajogmf.2024.101491
Fabrizio Zullo MD
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引用次数: 0
Corrigendum to Intramuscular progesterone in women with twins and a prior singleton spontaneous preterm birth American Journal of Obstetrics & Gynecology MFM/ Volume 2 (2020)/100124 美国妇产科学杂志》MFM/ 第 2 卷(2020 年)/100124 对双胞胎和单胎自发性早产妇女使用肌内黄体酮的更正
IF 3.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-13 DOI: 10.1016/j.ajogmf.2024.101479
Andrew Ward MD , Victoria Greenberg MD , Breanna Valcarcel BA , Rupsa C. Boelig MD , Huda B. Al-Kouatly MD , Vincenzo Berghella MD
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引用次数: 0
Fetal hepatobiliary cysts: clinical spectrum and differential diagnosis 胎儿肝胆囊肿:临床表现和鉴别诊断
IF 3.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-12 DOI: 10.1016/j.ajogmf.2024.101463
Wei Sun PhD, Yun Xiu MD, Fujiao He MD, Yixin Zhang MD, Yao Zhang MD, Lizhu Chen PhD
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引用次数: 0
Selective fetal reduction of uncomplicated dichorionic twins on parental request vs ongoing twins and pregnancy outcomes: a systematic review and meta-analysis 根据父母要求选择性减少无并发症双绒毛膜促性腺激素胎儿与持续双胎及妊娠结局:系统回顾和元分析》。
IF 3.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-12 DOI: 10.1016/j.ajogmf.2024.101492
Ioannis Mitrogiannis MSc , Christos Chatzakis PhD , Alexandros Sotiriadis MD, PhD , Stylianos Makrydimas MD , Alexandros Katrachouras MSc , Athina Efthymiou MSc , George Makrydimas MD, PhD
<div><h3>OBJECTIVE</h3><div>This study aimed to assess the effect of elective fetal reduction on maternal–fetal outcomes in uncomplicated twin pregnancies compared with ongoing twin pregnancies.</div></div><div><h3>DATA SOURCES</h3><div>The data sources included PubMed, Scopus (until December 2023), and references of retrieved articles.</div></div><div><h3>STUDY ELIGIBILITY CRITERIA</h3><div>We included clinical studies examining the association between selective fetal reduction of uncomplicated dichorionic twins on pregnancy outcomes.</div></div><div><h3>METHODS</h3><div>Quality assessment of observational studies was conducted using the ROBINS-I tool. The overall quality of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. A quantitative analysis was performed for electively reduced dichorionic twins. The primary outcome was preterm birth. The secondary outcomes were gestational age at delivery, stillbirth, neonatal intensive care unit admission, gestational diabetes mellitus, preeclampsia, and pregnancy loss at <24 weeks of gestation. Summary odds ratios with 95% confidence intervals were calculated, and random-effects models were used for data synthesis.</div></div><div><h3>RESULTS</h3><div>The initial electronic search yielded 745 studies; 175 studies were further identified from reference citations. Five articles included appropriate data and were finally included in the meta-analysis. All studies were evaluated as having “moderate risk of bias.” These 5 studies reported on dichorionic twins. Elective reduction in dichorionic twins reduces the risk for preterm birth at <37 weeks (4 studies; n=1577; odds ratio, 0.14; 95% confidence interval, 0.09–0.22; moderate-quality evidence), <34 weeks (3 studies; n=1335; odds ratio, 0.22; 95% confidence interval, 0.07–0.69; low-quality evidence), and <32 weeks (3 studies; n=1335; odds ratio, 0.31; 95% confidence interval, 0.11–0.88; low-quality evidence), gestational diabetes (3 studies; n=1410; odds ratio, 0.57; 95% confidence interval, 0.33–0.97; low-quality evidence), pregnancy-associated hypertensive disorders (2 studies; n=581; odds ratio, 0.29; 95% confidence interval, 0.10–0.83; low-quality evidence), and birthweight <10th centile (2 studies; n=1163; odds ratio, 0.27; 95% confidence interval, 0.17–0.43; moderate-quality evidence) and <5th centile (2 studies; n=1163; odds ratio, 0.31; 95% confidence interval, 0.19–0.50; low-quality evidence), and increases gestational age at delivery (4 studies; n=1362; mean difference, 2.93 weeks; 95% confidence interval, 2.08–3.77; moderate-quality evidence). The risks for stillbirth (2 studies; n=1311; odds ratio, 1.63; 95% confidence interval, 0.43–6.21; very low-quality evidence) and pregnancy loss at <24 weeks (3 studies; n=1436; odds ratio, 1.20; 95% confidence interval, 0.55–2.58; very low-quality evidence) were not statistically significantly different.</div></div><di
研究目的本研究旨在评估无并发症双胎妊娠中选择性减胎术对母胎结局的影响,并与持续性双胎妊娠进行比较:数据来源:PubMed、Scopus(截至 2023 年 12 月)和检索到的文章参考文献:采用 ROBINS-I 工具对观察性研究进行质量评估。证据的总体质量按照 GRADE 进行评估。对选择性减胎的二绒毛膜双胎进行了定量分析。主要结果是早产。次要结局是分娩时的胎龄、死产和新生儿重症监护室、妊娠糖尿病、先兆子痫和妊娠期<24周的妊娠损失。研究人员计算了汇总的几率比(ORs)及 95% 的置信区间(CIs),并使用随机效应模型进行数据综合:最初的电子检索产生了 745 项研究;从参考引文中进一步确定了 175 项研究。有 5 篇文章包含了适当的数据,最终被纳入荟萃分析。所有研究均被评估为 "中度偏倚风险"。这五篇研究报告的对象是二雌双胞胎。对二绒毛膜双胎进行选择性减胎术可降低早产th百分位数(2项研究;n=1163;OR 0.27,95% CI 0.17-0.43;中等质量证据)、出生体重<5百分位数(2项研究;n=1163;OR 0.31,95% CI 0.19-0.50;低质量证据)的风险,并增加分娩时的胎龄{4项研究;n=1362;MD 2.93周,95% CI 2.08-3.77;中等质量证据}。死胎(2 项研究;n= 1311;OR 1.63,95% CI 0.43-6.21;极低质量证据)或妊娠损失< 24 周(3 项研究;n= 1436;OR 1.20,95% CI 0.55-2.58;极低质量证据)的风险在统计学上没有显著差异:结论:与二绒毛膜双胎妊娠相比,接受选择性胎儿减胎术的二绒毛膜双胎妊娠的早产<37周、妊娠期糖尿病、妊娠期高血压疾病的发生率较低,胎龄推迟近3周。这些关联往往基于质量很低的证据;因此,在解释这些结果时应谨慎,并应开展进一步的研究。
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引用次数: 0
Lest we're lost 免得迷失方向
IF 3.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-09-12 DOI: 10.1016/j.ajogmf.2024.101487
Suneet P. Chauhan MD, Hon DSc
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引用次数: 0
期刊
American Journal of Obstetrics & Gynecology Mfm
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