Pub Date : 2024-04-01DOI: 10.1016/j.xagr.2024.100350
Tulsi D. Patel MD , Ennet B. Chipungu MBBS , Jennifer M. Draganchuk MD , Chisomo Chalamanda DCM , Jeffrey P. Wilkinson MD
BACKGROUND
Obstructed labor leading to a vesicovaginal fistula remains a devastating outcome of childbirth in low-resource countries. Women with an irreparable vesicovaginal fistula may be candidates for a urinary diversion, such as the Mainz II modified ureterosigmoidostomy procedure. Previous reviews state that the procedure should be considered in low-resource countries. However, given the limited duration of postoperative follow-up, these studies do not adequately represent the long-term morbidity and mortality that is likely associated with this procedure. We present data that strongly support avoiding the procedure in low-resource countries.
OBJECTIVE
This study aimed to evaluate the postoperative status of the patient (dead, alive, lost to follow-up) and time to death following the Mainz II procedure.
STUDY DESIGN
This is a case series including 21 patients who underwent a Mainz II urinary diversion from April 2013 to June 2015 for management of irreparable vesicovaginal fistula at the Fistula Care Centre in Lilongwe, Malawi. Patients were seen postoperatively at 3, 6, 9, and 12 months, followed by every 6 to 12 months thereafter. Descriptive statistics were performed to summarize the data.
RESULTS
During the postoperative period, 8 (38.1%; 8/21) patients died, 5 (23.8%; 5/21) were lost to follow-up, and 8 (38.1%; 8/21) are currently alive and followed up at the Fistula Care Centre. We strongly suspect that 7 of the 8 deaths were related to the procedure given that the patients had illnesses that exacerbated the metabolic consequences of the procedure. The eighth patient died after being attacked by robbers. Unfortunately, the exact cause of death could not be determined for these patients. Given that most of the suspected illnesses would be treatable in an otherwise healthy patient, even in this low-resource setting, we surmised that the metabolic compromise from the Mainz II procedure likely contributed to their untimely death. The average time from procedure to death was 58 months, with the earliest death at 10 months and the most recent at 7 years after the procedure.
CONCLUSION
The Mainz II procedure is an option for patients with irreparable fistula. However, it should likely not be performed in low-resource countries given the long-term complications that often cannot be adequately addressed in these settings, leading to significant morbidity and mortality.
{"title":"Mainz II urinary diversion in low-resource settings: patient outcomes in women with irreparable fistula in Malawi","authors":"Tulsi D. Patel MD , Ennet B. Chipungu MBBS , Jennifer M. Draganchuk MD , Chisomo Chalamanda DCM , Jeffrey P. Wilkinson MD","doi":"10.1016/j.xagr.2024.100350","DOIUrl":"https://doi.org/10.1016/j.xagr.2024.100350","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Obstructed labor leading to a vesicovaginal fistula remains a devastating outcome of childbirth in low-resource countries. Women with an irreparable vesicovaginal fistula may be candidates for a urinary diversion, such as the Mainz II modified ureterosigmoidostomy procedure. Previous reviews state that the procedure should be considered in low-resource countries. However, given the limited duration of postoperative follow-up, these studies do not adequately represent the long-term morbidity and mortality that is likely associated with this procedure. We present data that strongly support avoiding the procedure in low-resource countries.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to evaluate the postoperative status of the patient (dead, alive, lost to follow-up) and time to death following the Mainz II procedure.</p></div><div><h3>STUDY DESIGN</h3><p>This is a case series including 21 patients who underwent a Mainz II urinary diversion from April 2013 to June 2015 for management of irreparable vesicovaginal fistula at the Fistula Care Centre in Lilongwe, Malawi. Patients were seen postoperatively at 3, 6, 9, and 12 months, followed by every 6 to 12 months thereafter. Descriptive statistics were performed to summarize the data.</p></div><div><h3>RESULTS</h3><p>During the postoperative period, 8 (38.1%; 8/21) patients died, 5 (23.8%; 5/21) were lost to follow-up, and 8 (38.1%; 8/21) are currently alive and followed up at the Fistula Care Centre. We strongly suspect that 7 of the 8 deaths were related to the procedure given that the patients had illnesses that exacerbated the metabolic consequences of the procedure. The eighth patient died after being attacked by robbers. Unfortunately, the exact cause of death could not be determined for these patients. Given that most of the suspected illnesses would be treatable in an otherwise healthy patient, even in this low-resource setting, we surmised that the metabolic compromise from the Mainz II procedure likely contributed to their untimely death. The average time from procedure to death was 58 months, with the earliest death at 10 months and the most recent at 7 years after the procedure.</p></div><div><h3>CONCLUSION</h3><p>The Mainz II procedure is an option for patients with irreparable fistula. However, it should likely not be performed in low-resource countries given the long-term complications that often cannot be adequately addressed in these settings, leading to significant morbidity and mortality.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000443/pdfft?md5=a73b794e4b7c2e7be3b463984bb4b156&pid=1-s2.0-S2666577824000443-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140551692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-30DOI: 10.1016/j.xagr.2024.100345
Fernando A. Ferrer-Marquez MD, Rocío P. Astudillo MD, Jorge A. Carvajal MD, PhD
BACKGROUND
Preterm birth accounts for 60% to 80% of neonatal mortality. Approximately one-third of preterm births are caused by the spontaneous onset of preterm labor. Nevertheless, 70% to 90% of women diagnosed with preterm labor will not deliver within 7 days. Thus, many women will be unnecessarily treated by preterm labor with risk medications. Better tools are needed to categorize women in preterm labor into high or low risk of preterm delivery.
OBJECTIVE
This study aimed to evaluate the amino-terminal pro-brain natriuretic peptide concentration in the amniotic fluid as a prognostic test to predict the risk of delivery within 48 hours or 7 days and before 34 0/7 or 37 0/7 weeks of gestation in women in preterm labor.
STUDY DESIGN
A total of 102 pregnant women presenting signs and symptoms of spontaneous preterm birth (22 0/7 to 34 0/7 weeks of gestation) were included. Amniotic fluid was obtained by amniocentesis, and amino-terminal pro-brain natriuretic peptide concentration was measured. Below normal concentration was defined as <0.5 multiples of the median of the standard curve according to gestational age. The risk of preterm delivery was estimated according to normal or lower-than-normal amino-terminal pro-brain natriuretic peptide concentrations. The predictive capacity of the test (below normal amino-terminal pro-brain natriuretic peptide concentration) was evaluated to identify spontaneous preterm birth at 48 hours or 7 days from amniocentesis and less than 34 0/7 or 37 0/7 weeks at delivery.
RESULTS
For the outcome delivery within 48 hours, lower-than-normal amino-terminal pro-brain natriuretic peptide concentration had 94.6% sensitivity, 73.8% specificity, 96.0% negative predictive value, 3.61 positive likelihood ratio, and 0.07 negative likelihood ratio. For the outcome delivery within 7 days, the test had 93.9% sensitivity, 88.7% specificity, 94.0% negative predictive value, 8.31 positive likelihood ratio, and 0.07 negative likelihood ratio. For the outcomes of spontaneous preterm birth before 34 0/7 and 37 0/7 weeks of gestation, below normal amino-terminal pro-brain natriuretic peptide concentrations had 80.0% sensitivity, 83.0% specificity, 78.0% negative predictive value, 4.70 positive likelihood ratio, and 0.24 negative likelihood ratio and 64.1% sensitivity, 91.7% specificity, 44.0% negative predictive value, 7.70 positive likelihood ratio, and 0.39 negative likelihood ratio, respectively.
CONCLUSION
Among patients in spontaneous preterm labor, the detection of lower-than-normal amino-terminal pro-brain natriuretic peptide concentrations (<0.5 multiples of the median) in amniotic fluid has an excellent predictive capacity to identify those patients at low risk of preterm delivery within 48 hours or 7 days.
{"title":"Clinical application of amino-terminal pro-brain natriuretic peptide concentration in amniotic fluid for the prediction of preterm birth in symptomatic women","authors":"Fernando A. Ferrer-Marquez MD, Rocío P. Astudillo MD, Jorge A. Carvajal MD, PhD","doi":"10.1016/j.xagr.2024.100345","DOIUrl":"10.1016/j.xagr.2024.100345","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Preterm birth accounts for 60% to 80% of neonatal mortality. Approximately one-third of preterm births are caused by the spontaneous onset of preterm labor. Nevertheless, 70% to 90% of women diagnosed with preterm labor will not deliver within 7 days. Thus, many women will be unnecessarily treated by preterm labor with risk medications. Better tools are needed to categorize women in preterm labor into high or low risk of preterm delivery.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to evaluate the amino-terminal pro-brain natriuretic peptide concentration in the amniotic fluid as a prognostic test to predict the risk of delivery within 48 hours or 7 days and before 34 0/7 or 37 0/7 weeks of gestation in women in preterm labor.</p></div><div><h3>STUDY DESIGN</h3><p>A total of 102 pregnant women presenting signs and symptoms of spontaneous preterm birth (22 0/7 to 34 0/7 weeks of gestation) were included. Amniotic fluid was obtained by amniocentesis, and amino-terminal pro-brain natriuretic peptide concentration was measured. Below normal concentration was defined as <0.5 multiples of the median of the standard curve according to gestational age. The risk of preterm delivery was estimated according to normal or lower-than-normal amino-terminal pro-brain natriuretic peptide concentrations. The predictive capacity of the test (below normal amino-terminal pro-brain natriuretic peptide concentration) was evaluated to identify spontaneous preterm birth at 48 hours or 7 days from amniocentesis and less than 34 0/7 or 37 0/7 weeks at delivery.</p></div><div><h3>RESULTS</h3><p>For the outcome delivery within 48 hours, lower-than-normal amino-terminal pro-brain natriuretic peptide concentration had 94.6% sensitivity, 73.8% specificity, 96.0% negative predictive value, 3.61 positive likelihood ratio, and 0.07 negative likelihood ratio. For the outcome delivery within 7 days, the test had 93.9% sensitivity, 88.7% specificity, 94.0% negative predictive value, 8.31 positive likelihood ratio, and 0.07 negative likelihood ratio. For the outcomes of spontaneous preterm birth before 34 0/7 and 37 0/7 weeks of gestation, below normal amino-terminal pro-brain natriuretic peptide concentrations had 80.0% sensitivity, 83.0% specificity, 78.0% negative predictive value, 4.70 positive likelihood ratio, and 0.24 negative likelihood ratio and 64.1% sensitivity, 91.7% specificity, 44.0% negative predictive value, 7.70 positive likelihood ratio, and 0.39 negative likelihood ratio, respectively.</p></div><div><h3>CONCLUSION</h3><p>Among patients in spontaneous preterm labor, the detection of lower-than-normal amino-terminal pro-brain natriuretic peptide concentrations (<0.5 multiples of the median) in amniotic fluid has an excellent predictive capacity to identify those patients at low risk of preterm delivery within 48 hours or 7 days.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266657782400039X/pdfft?md5=33a55557b8dfe548934c129b4137cb88&pid=1-s2.0-S266657782400039X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-30DOI: 10.1016/j.xagr.2024.100344
Samina Sultana MS , Touhidul A. Chowdhury FRCS , Tanzeem S. Chowdhury MRCOG , Nusrat Mahmud MSc , Rebeka Sultana FCPS , Naushaba T. Mahtab FCPS , Yushuf Sharker PhD , Firoz Ahmed PhD
BACKGROUND
Endometriosis is a disease among women of reproductive age, which causes several health problems, such as dysmenorrhea, dyspareunia, and subfertility. In addition, it increases psychological stress and often results in marital disharmony. Similarly, migraine is more frequent among this group of women. Several studies have shown an association between endometriosis and migraine among groups of populations completely different from Bangladesh.
OBJECTIVE
This study aimed to identify the association between endometriosis and migraine among the Bangladeshi population.
STUDY DESIGN
This nonrandomized case-control study was conducted with cases of endometriosis and controls without endometriosis who were confirmed by laparoscopy or laparotomy. Among the study participants, cases of migraine in 1 group of respondents who were already diagnosed as patients of migraine were identified, and the others with complaints of headaches were further confirmed by a medicine specialist. Patients were recruited from the Department of Obstetrics and Gynecology at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital and Ibrahim Medical College. The study was approved by the ethical review committee of the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital. Multivariate logistic regression was used to identify the association between endometriosis and migraine using odds ratios and 95% confidence intervals.
RESULTS
Of 1496 patients who underwent laparoscopy or laparotomy during the study period, the frequency of endometriosis was found to be 12.7%. A total of 190 patients with confirmed endometriosis cases and an equal number of controls without endometriosis were enrolled, maintaining the age distribution of the controls similar to that of the cases. Compared with controls, the distribution of age, body mass index, education, and marital status of the patients with endometriosis were similar. The average ages of respondents were 30.6 years in both the case and control groups. Regarding occupation, cases included more students than controls (12% vs 0%, respectively). The odds of suffering from dysmenorrhea and dyspareunia among the cases were 3.3 (95% confidence interval, 2.66–4.15; P<.001) and 9.5 (95% confidence interval, 5.3–17.9; P<.001) times higher than that of controls, respectively. In addition, the odds of menstrual irregularity was 60% lower among the cases than among controls (odds ratio, 0.4; 95% confidence interval, 0.24–0.64; P<.001). No significant difference was observed in having primary subfertility and secondary subfertility among the 2 groups of respondents. Univariate regression analysis showed that patients with endometriosis have 6.13 times higher odds (95% confidence interval, 2.50
{"title":"Migraine among women with endometriosis: a hospital-based case-control study in Bangladesh","authors":"Samina Sultana MS , Touhidul A. Chowdhury FRCS , Tanzeem S. Chowdhury MRCOG , Nusrat Mahmud MSc , Rebeka Sultana FCPS , Naushaba T. Mahtab FCPS , Yushuf Sharker PhD , Firoz Ahmed PhD","doi":"10.1016/j.xagr.2024.100344","DOIUrl":"10.1016/j.xagr.2024.100344","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Endometriosis is a disease among women of reproductive age, which causes several health problems, such as dysmenorrhea, dyspareunia, and subfertility. In addition, it increases psychological stress and often results in marital disharmony. Similarly, migraine is more frequent among this group of women. Several studies have shown an association between endometriosis and migraine among groups of populations completely different from Bangladesh.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to identify the association between endometriosis and migraine among the Bangladeshi population.</p></div><div><h3>STUDY DESIGN</h3><p>This nonrandomized case-control study was conducted with cases of endometriosis and controls without endometriosis who were confirmed by laparoscopy or laparotomy. Among the study participants, cases of migraine in 1 group of respondents who were already diagnosed as patients of migraine were identified, and the others with complaints of headaches were further confirmed by a medicine specialist. Patients were recruited from the Department of Obstetrics and Gynecology at the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital and Ibrahim Medical College. The study was approved by the ethical review committee of the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders General Hospital. Multivariate logistic regression was used to identify the association between endometriosis and migraine using odds ratios and 95% confidence intervals.</p></div><div><h3>RESULTS</h3><p>Of 1496 patients who underwent laparoscopy or laparotomy during the study period, the frequency of endometriosis was found to be 12.7%. A total of 190 patients with confirmed endometriosis cases and an equal number of controls without endometriosis were enrolled, maintaining the age distribution of the controls similar to that of the cases. Compared with controls, the distribution of age, body mass index, education, and marital status of the patients with endometriosis were similar. The average ages of respondents were 30.6 years in both the case and control groups. Regarding occupation, cases included more students than controls (12% vs 0%, respectively). The odds of suffering from dysmenorrhea and dyspareunia among the cases were 3.3 (95% confidence interval, 2.66–4.15; <em>P</em><.001) and 9.5 (95% confidence interval, 5.3–17.9; <em>P</em><.001) times higher than that of controls, respectively. In addition, the odds of menstrual irregularity was 60% lower among the cases than among controls (odds ratio, 0.4; 95% confidence interval, 0.24–0.64; <em>P</em><.001). No significant difference was observed in having primary subfertility and secondary subfertility among the 2 groups of respondents. Univariate regression analysis showed that patients with endometriosis have 6.13 times higher odds (95% confidence interval, 2.50","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000388/pdfft?md5=b53761037099a265963cdc215a171a88&pid=1-s2.0-S2666577824000388-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140405296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The incidence of preterm delivery is much higher in twin pregnancies than in singletons and even higher if a short cervical length is detected in the second trimester. Studies are contradictory regarding the efficacy of a cervical pessary to decrease preterm birth in twin pregnancies and short cervical length. To conduct a systematic review and meta-analysis investigating the efficacy of cervical pessary in prolonging gestation, preventing preterm birth, and reducing adverse neonatal outcomes in twin pregnancies with an asymptomatic short cervix.
Data sources
PubMed, Scopus, Web of Science, and ClinicalTrials.org were searched for randomized controlled trials from inception to June 2023.
Study eligibility criteria
In this study, randomized controlled trials comparing the cervical pessary to expectant management in the pregnant population with twin gestations and asymptomatic short cervix were included.
Methods
The Cochrane risk-of-bias-2 tool for randomized controlled trials was used for the evaluation of the risk of bias in included studies. A meta-analysis was performed by calculating risk ratio and mean difference with their 95% confidence interval using the random effects model or fixed effect model on the basis of heterogeneity and accounting for potential covariates among the included randomized controlled trials.
Results
A total of 6 randomized controlled trials were included in the analysis. Cervical pessary did not significantly increase the gestational age at delivery in twin pregnancies with asymptomatic patients (mean difference, 0.36 weeks [−0.27 to 0.99]; P=.270; I2=72.0%). Moreover, the cervical pessary use did not result in a reduction of spontaneous or all-preterm birth before 37 weeks of gestation (risk ratio, 0.88 [0.77–1.00]; P=.061; I2=0.0%). There was no statistically significant difference in the composite neonatal adverse outcomes (risk ratio, 1.001 [0.86–1.16]; P=.981; I2=20.9%), including early respiratory morbidity, intraventricular hemorrhage, necrotizing enterocolitis, and confirmed sepsis.
Conclusion
The use of cervical pessary in twin pregnancies with asymptomatic short cervix does not seem to be effective in increasing the gestational age at delivery, preventing preterm birth, or reducing adverse neonatal outcomes. This indicates that alternative interventions should be sought for the management of this patient population.
{"title":"The effect of cervical pessary on increasing gestational age at delivery in twin pregnancies with asymptomatic short cervix: a systematic review and meta-analysis of randomized controlled trials","authors":"Amir Hossein Norooznezhad MD , Nikan Zargarzadeh MD , Ali Javinani MD , Seyedeh Maedeh Nabavian MD , Shohra Qaderi MD , Shayan Mostafaei MD , Vincenzo Berghella MD , Yinka Oyelese MD , Alireza A. Shamshirsaz MD, FACOG","doi":"10.1016/j.xagr.2024.100347","DOIUrl":"10.1016/j.xagr.2024.100347","url":null,"abstract":"<div><h3>Objective</h3><p>The incidence of preterm delivery is much higher in twin pregnancies than in singletons and even higher if a short cervical length is detected in the second trimester. Studies are contradictory regarding the efficacy of a cervical pessary to decrease preterm birth in twin pregnancies and short cervical length. To conduct a systematic review and meta-analysis investigating the efficacy of cervical pessary in prolonging gestation, preventing preterm birth, and reducing adverse neonatal outcomes in twin pregnancies with an asymptomatic short cervix.</p></div><div><h3>Data sources</h3><p>PubMed, Scopus, Web of Science, and ClinicalTrials.org were searched for randomized controlled trials from inception to June 2023.</p></div><div><h3>Study eligibility criteria</h3><p>In this study, randomized controlled trials comparing the cervical pessary to expectant management in the pregnant population with twin gestations and asymptomatic short cervix were included.</p></div><div><h3>Methods</h3><p>The Cochrane risk-of-bias-2 tool for randomized controlled trials was used for the evaluation of the risk of bias in included studies. A meta-analysis was performed by calculating risk ratio and mean difference with their 95% confidence interval using the random effects model or fixed effect model on the basis of heterogeneity and accounting for potential covariates among the included randomized controlled trials.</p></div><div><h3>Results</h3><p>A total of 6 randomized controlled trials were included in the analysis. Cervical pessary did not significantly increase the gestational age at delivery in twin pregnancies with asymptomatic patients (mean difference, 0.36 weeks [−0.27 to 0.99]; <em>P</em>=.270; I<sup>2</sup>=72.0%). Moreover, the cervical pessary use did not result in a reduction of spontaneous or all-preterm birth before 37 weeks of gestation (risk ratio, 0.88 [0.77–1.00]; <em>P</em>=.061; I<sup>2</sup>=0.0%). There was no statistically significant difference in the composite neonatal adverse outcomes (risk ratio, 1.001 [0.86–1.16]; <em>P</em>=.981; I<sup>2</sup>=20.9%), including early respiratory morbidity, intraventricular hemorrhage, necrotizing enterocolitis, and confirmed sepsis.</p></div><div><h3>Conclusion</h3><p>The use of cervical pessary in twin pregnancies with asymptomatic short cervix does not seem to be effective in increasing the gestational age at delivery, preventing preterm birth, or reducing adverse neonatal outcomes. This indicates that alternative interventions should be sought for the management of this patient population.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000418/pdfft?md5=a600b492d02c7c4494c97bebd791dd05&pid=1-s2.0-S2666577824000418-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140404011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-29DOI: 10.1016/j.xagr.2024.100346
Karina Bilda de Castro Rezende MD, PhD , Rita G. Bornia MD, PhD , Daniel L. Rolnik MD, PhD, MPH , Joffre Amim Jr. MD, PhD , Luiza P. Ladeira MD , Valentina M.G. Teixeira MS , Antonio Jose L.A. da Cunha MD, PhD, MPH
BACKGROUND
The current version of the Fetal Medicine Foundation competing risks model for preeclampsia prediction has not been previously validated in Brazil.
OBJECTIVE
This study aimed (1) to validate the Fetal Medicine Foundation combined algorithm for the prediction of preterm preeclampsia in the Brazilian population and (2) to describe the accuracy and calibration of the Fetal Medicine Foundation algorithm when considering the prophylactic use of aspirin by clinical criteria.
STUDY DESIGN
This was a cohort study, including consecutive singleton pregnancies undergoing preeclampsia screening at 11 to 14 weeks of gestation, examining maternal characteristics, medical history, and biophysical markers between October 2010 and December 2018 in a university hospital in Brazil. Risks were calculated using the 2018 version of the algorithm available on the Fetal Medicine Foundation website, and cases were classified as low or high risk using a cutoff of 1/100 to evaluate predictive performance. Expected and observed cases with preeclampsia according to the Fetal Medicine Foundation–estimated risk range (≥1 in 10; 1 in 11 to 1 in 50; 1 in 51 to 1 in 100; 1 in 101 to 1 in 150; and <1 in 150) were compared. After identifying high-risk pregnant women who used aspirin, the treatment effect of 62% reduction in preterm preeclampsia identified in the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention trial was used to evaluate the predictive performance adjusted for the effect of aspirin. The number of potentially unpreventable cases in the group without aspirin use was estimated.
RESULTS
Among 2749 pregnancies, preterm preeclampsia occurred in 84 (3.1%). With a risk cutoff of 1/100, the screen-positive rate was 25.8%. The detection rate was 71.4%, with a false positive rate of 24.4%. The area under the curve was 0.818 (95% confidence interval, 0.773–0.863). In the risk range ≥1/10, there is an agreement between the number of expected cases and the number of observed cases, and in the other ranges, the predicted risk was lower than the observed rates. Accounting for the effect of aspirin resulted in an increase in detection rate and positive predictive values and a slight decrease in the false positive rate. With 27 cases of preterm preeclampsia in the high-risk group without aspirin use, we estimated that 16 of these cases of preterm preeclampsia would have been avoided if this group had received prophylaxis.
CONCLUSION
In a high-prevalence setting, the Fetal Medicine Foundation algorithm can identify women who are more likely to develop preterm preeclampsia. Not accounting for the effect of aspirin underestimates the screening performance.
{"title":"Performance of the first-trimester Fetal Medicine Foundation competing risks model for preeclampsia prediction: an external validation study in Brazil","authors":"Karina Bilda de Castro Rezende MD, PhD , Rita G. Bornia MD, PhD , Daniel L. Rolnik MD, PhD, MPH , Joffre Amim Jr. MD, PhD , Luiza P. Ladeira MD , Valentina M.G. Teixeira MS , Antonio Jose L.A. da Cunha MD, PhD, MPH","doi":"10.1016/j.xagr.2024.100346","DOIUrl":"10.1016/j.xagr.2024.100346","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>The current version of the Fetal Medicine Foundation competing risks model for preeclampsia prediction has not been previously validated in Brazil.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed (1) to validate the Fetal Medicine Foundation combined algorithm for the prediction of preterm preeclampsia in the Brazilian population and (2) to describe the accuracy and calibration of the Fetal Medicine Foundation algorithm when considering the prophylactic use of aspirin by clinical criteria.</p></div><div><h3>STUDY DESIGN</h3><p>This was a cohort study, including consecutive singleton pregnancies undergoing preeclampsia screening at 11 to 14 weeks of gestation, examining maternal characteristics, medical history, and biophysical markers between October 2010 and December 2018 in a university hospital in Brazil. Risks were calculated using the 2018 version of the algorithm available on the Fetal Medicine Foundation website, and cases were classified as low or high risk using a cutoff of 1/100 to evaluate predictive performance. Expected and observed cases with preeclampsia according to the Fetal Medicine Foundation–estimated risk range (≥1 in 10; 1 in 11 to 1 in 50; 1 in 51 to 1 in 100; 1 in 101 to 1 in 150; and <1 in 150) were compared. After identifying high-risk pregnant women who used aspirin, the treatment effect of 62% reduction in preterm preeclampsia identified in the Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence-Based Preeclampsia Prevention trial was used to evaluate the predictive performance adjusted for the effect of aspirin. The number of potentially unpreventable cases in the group without aspirin use was estimated.</p></div><div><h3>RESULTS</h3><p>Among 2749 pregnancies, preterm preeclampsia occurred in 84 (3.1%). With a risk cutoff of 1/100, the screen-positive rate was 25.8%. The detection rate was 71.4%, with a false positive rate of 24.4%. The area under the curve was 0.818 (95% confidence interval, 0.773–0.863). In the risk range ≥1/10, there is an agreement between the number of expected cases and the number of observed cases, and in the other ranges, the predicted risk was lower than the observed rates. Accounting for the effect of aspirin resulted in an increase in detection rate and positive predictive values and a slight decrease in the false positive rate. With 27 cases of preterm preeclampsia in the high-risk group without aspirin use, we estimated that 16 of these cases of preterm preeclampsia would have been avoided if this group had received prophylaxis.</p></div><div><h3>CONCLUSION</h3><p>In a high-prevalence setting, the Fetal Medicine Foundation algorithm can identify women who are more likely to develop preterm preeclampsia. Not accounting for the effect of aspirin underestimates the screening performance.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000406/pdfft?md5=689e0c8665c0e262200dee583da13c13&pid=1-s2.0-S2666577824000406-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-28DOI: 10.1016/j.xagr.2024.100342
Rachel A. Levy MD , Allison H. Kay MD , Nancy Hills PhD , Lee-may Chen MD , Jocelyn S. Chapman MD
BACKGROUND
Racial and ethnic disparities in pain management are well documented. Differences in pain assessment and management by language have not been studied in the postoperative setting in gynecologic surgery.
OBJECTIVE
This study aimed to investigate the association between language and immediate postoperative pain management by comparing pain assessments and perioperative opioid use in non-English speakers and English speakers.
STUDY DESIGN
This was a retrospective cohort study comparing perioperative outcomes between non–English-speaking patients and English-speaking patients who had undergone a gynecologic oncology open surgery between July 2012 and December 2020. The primary language was extracted from the electronic medical record. Opioid use is expressed in oral morphine equivalents. Proportions are compared using chi-square tests, and mean values are compared using 2-sample t tests. Although interpreter services are widely available in our institution, the use of interpreters for any given inpatient-provider interaction is not documented.
RESULTS
Between 2012 and 2020, 1203 gynecologic oncology patients underwent open surgery, of whom 181 (15.1%) were non-English speakers and 1018 (84.9%) were English speakers. There was no difference between the 2 cohorts concerning body mass index, surgical risk score, or preoperative opioid use. Compared with the English-speaking group, the non–English-speaking group was younger (57 vs 54 years old, respectively; P<.01) and had lower rates of depression (26% vs 14%, respectively; P<.01) and chronic pain (13% vs 6%, respectively; P<.01). Although non–English-speaking patients had higher rates of hysterectomy than English-speaking patients (80% vs 72%, respectively; P=.03), there was no difference in the rates of bowel resections, adnexal surgeries, lengths of surgery, intraoperative oral morphine equivalents administered, blood loss, use of opioid-sparing modalities, lengths of hospital stay, or intensive care unit admissions. In the postoperative period, compared with English-speaking patients, non–English-speaking patients received fewer oral morphine equivalents per day (31.7 vs 43.9 oral morphine equivalents, respectively; P<.01) and had their pain assessed less frequently (7.7 vs 8.8 checks per day, respectively; P<.01) postoperatively. English-speaking patients received a median of 19.5 more units of oral morphine equivalents daily in the hospital and 205.1 more units of oral morphine equivalents at the time of discharge (P=.02 and P=.04, respectively) than non–English-speaking patients. When controlling for differences between groups and several factors that may influence oral morphine equivalent use, English-speaking patients received a median of 15.9 more units of oral morphine equivalents daily in the hosp
{"title":"Exploring the relationship between language, postoperative pain, and opioid use","authors":"Rachel A. Levy MD , Allison H. Kay MD , Nancy Hills PhD , Lee-may Chen MD , Jocelyn S. Chapman MD","doi":"10.1016/j.xagr.2024.100342","DOIUrl":"10.1016/j.xagr.2024.100342","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Racial and ethnic disparities in pain management are well documented. Differences in pain assessment and management by language have not been studied in the postoperative setting in gynecologic surgery.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to investigate the association between language and immediate postoperative pain management by comparing pain assessments and perioperative opioid use in non-English speakers and English speakers.</p></div><div><h3>STUDY DESIGN</h3><p>This was a retrospective cohort study comparing perioperative outcomes between non–English-speaking patients and English-speaking patients who had undergone a gynecologic oncology open surgery between July 2012 and December 2020. The primary language was extracted from the electronic medical record. Opioid use is expressed in oral morphine equivalents. Proportions are compared using chi-square tests, and mean values are compared using 2-sample <em>t</em> tests. Although interpreter services are widely available in our institution, the use of interpreters for any given inpatient-provider interaction is not documented.</p></div><div><h3>RESULTS</h3><p>Between 2012 and 2020, 1203 gynecologic oncology patients underwent open surgery, of whom 181 (15.1%) were non-English speakers and 1018 (84.9%) were English speakers. There was no difference between the 2 cohorts concerning body mass index, surgical risk score, or preoperative opioid use. Compared with the English-speaking group, the non–English-speaking group was younger (57 vs 54 years old, respectively; <em>P</em><.01) and had lower rates of depression (26% vs 14%, respectively; <em>P</em><.01) and chronic pain (13% vs 6%, respectively; <em>P</em><.01). Although non–English-speaking patients had higher rates of hysterectomy than English-speaking patients (80% vs 72%, respectively; <em>P</em>=.03), there was no difference in the rates of bowel resections, adnexal surgeries, lengths of surgery, intraoperative oral morphine equivalents administered, blood loss, use of opioid-sparing modalities, lengths of hospital stay, or intensive care unit admissions. In the postoperative period, compared with English-speaking patients, non–English-speaking patients received fewer oral morphine equivalents per day (31.7 vs 43.9 oral morphine equivalents, respectively; <em>P</em><.01) and had their pain assessed less frequently (7.7 vs 8.8 checks per day, respectively; <em>P</em><.01) postoperatively. English-speaking patients received a median of 19.5 more units of oral morphine equivalents daily in the hospital and 205.1 more units of oral morphine equivalents at the time of discharge (<em>P</em>=.02 and <em>P</em>=.04, respectively) than non–English-speaking patients. When controlling for differences between groups and several factors that may influence oral morphine equivalent use, English-speaking patients received a median of 15.9 more units of oral morphine equivalents daily in the hosp","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000364/pdfft?md5=9d73e3d2d7b3f2a46f5c9a7881164edd&pid=1-s2.0-S2666577824000364-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-23DOI: 10.1016/j.xagr.2024.100335
Anne M. Ambia MD, David B. Nelson MD, Robert B. Martin MD, Robert D. Stewart MD, Susan Matulevicius MD, Donald D. McIntire PhD, F. Gary Cunningham MD
{"title":"The forgotten ventricle—right ventricular remodeling across pregnancy and postpartum: a report of original research","authors":"Anne M. Ambia MD, David B. Nelson MD, Robert B. Martin MD, Robert D. Stewart MD, Susan Matulevicius MD, Donald D. McIntire PhD, F. Gary Cunningham MD","doi":"10.1016/j.xagr.2024.100335","DOIUrl":"10.1016/j.xagr.2024.100335","url":null,"abstract":"","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000297/pdfft?md5=0260f807d700f1586659017d75cccf0a&pid=1-s2.0-S2666577824000297-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140268356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-14DOI: 10.1016/j.xagr.2024.100332
Haozhe Miao MD , Huiming Yang MD , Mengfei Yin MD , Yixuan Wang MD , Yuan Fang MD , Min Yang MD , Jialin Zou MD , Wenwen Zhang MD , Lingling Zhang MD , Chendan Liu MD , Yue Wang MD , Ze Wang MD , Yunhai Yu MD, PhD , Daimin Wei MD, PhD
BACKGROUND
The diagnostic criteria and phenotypes in polycystic ovary syndrome are heterogeneous. Currently, it is unclear how to assess a patient's prognosis based on the onset time of menstruation disturbance. Evidence on this topic is scarce and has mainly focused on menstrual patterns.
OBJECTIVE
This study aimed to assess the association between the onset time of menstrual disturbance and clinical features and in vitro fertilization pregnancy outcomes in patients with polycystic ovary syndrome.
STUDY DESIGN
Our study was a secondary analysis of data collected as part of a randomized controlled trial conducted to compare live birth rates between fresh embryo transfer and frozen embryo transfer in 1508 individuals with polycystic ovary syndrome. Here, 1500 participants were classified into 2 groups according to the onset time of menstrual disturbance: immediately after menarche (early group) and after at least 1 year of regular menstruation (late group). We compared the prepregnancy clinical features, variables of ovarian stimulation, pregnancy outcomes after the initial cycle of embryo transfer, and perinatal and neonatal complications in the 2 groups.
RESULTS
Compared with the late group, the early group had more antral follicles (32.00 [range, 27.25–39.50] vs 28.00 [range, 24.00–36.00]; P<.001), an elevated level of antimüllerian hormone (7.02 ng/mL [range, 3.60–11.47] vs 5.66 ng/mL [range, 3.65–8.92]; P=.024), a higher level of baseline luteinizing hormone (10.01±5.93 vs 8.51±5.53 IU/l; P<.001) and luteinizing hormone–to–follicle-stimulating hormone ratio (1.51 [range, 1.00–2.32] vs 1.45 [range, 0.92–2.13]; P<.001), lower levels of fasting glucose (5.47 mmol/L [range, 5.11–5.73] vs 5.50 mmol/L [range, 5.17–5.76]; P<.001), and insulin at 2 hours after 75-g oral glucose tolerance test (56.85 µU/mL [range, 34.63–94.54] vs 59.82 µU/mL [range, 33.56–94.67]; P=.027), a higher level of high-density lipoprotein (1.26 mmol/L [range, 1.04–1.37] vs 1.21 mmol/L [range, 1.07–1.45]; P=.006). During in vitro fertilization, the early group had a higher level of peak estradiol (4596.50 pg/mL [range, 2639.25–6321.00] vs 3954.00 pg/mL [range, 2378.75–6113.50]; P=.013), and luteinizing hormone (2.52 IU/L [range, 1.40–4.21] vs 1.93 IU/L [range, 0.91–3.32]; P=.010) on the day of human chorionic gonadotropin trigger. There was no statistically significant difference observed in the number of oocytes and embryos, the rates of pregnancy and live birth, and the risks of obstetrical and neonatal between the 2 groups.
CONCLUSION
An early onset of menstrual disturbance in patients with polycystic ovary syndrome may be associated with slightly more severe reproductive features and slightly milder metabolic features. Nonetheless, the outcomes of in vitro fertilizati
背景多囊卵巢综合征的诊断标准和表型各不相同。目前，还不清楚如何根据月经紊乱的发生时间来评估患者的预后。本研究旨在评估多囊卵巢综合征患者月经紊乱发生时间与临床特征和体外受精妊娠结局之间的关联。研究设计我们的研究是对随机对照试验收集的数据进行的二次分析，该试验旨在比较新鲜胚胎移植和冷冻胚胎移植对 1508 名多囊卵巢综合征患者的活产率。在此，我们根据月经紊乱的发生时间将 1500 名参与者分为两组：月经初潮后立即发病组（早期组）和月经规律至少 1 年后发病组（晚期组）。我们比较了两组患者的孕前临床特征、卵巢刺激变量、胚胎移植初始周期后的妊娠结局以及围产期和新生儿并发症。00 [range, 27.25-39.50] vs 28.00 [range, 24.00-36.00]; P<.001），抗苗勒氏管激素水平升高（7.02 ng/mL [range, 3.60-11.47] vs 5.66 ng/mL [range, 3.65-8.92]; P=.024），黄体生成素基线水平升高（10.01±5.93 vs 8.001）、较低的空腹血糖水平（5.47 mmol/L [range, 5.11-5.73] vs 5.50 mmol/L [range, 5.17-5.76]; P<.001）、75 克口服葡萄糖耐量试验后 2 小时的胰岛素（56.85 µU/mL [范围，34.63-94.54] vs 59.82 µU/mL [范围，33.56-94.67]；P=.027）、更高水平的高密度脂蛋白（1.26 mmol/L [范围，1.04-1.37] vs 1.21 mmol/L [范围，1.07-1.45]；P=.006）。在体外受精期间，早期组的雌二醇峰值水平更高（4596.50 pg/mL [range, 2639.25-6321.00] vs 3954.00 pg/mL [range, 2378.75-6113.50]；P=.013）和促黄体生成素（2.52 IU/L [范围，1.40-4.21] vs 1.93 IU/L [范围，0.91-3.32]；P=.010）。结论 多囊卵巢综合征患者月经紊乱的早期发生可能与稍严重的生殖特征和稍轻微的代谢特征有关。尽管如此，两组患者体外受精和胚胎移植初始周期的结果相当。
{"title":"Menstrual abnormalities effects on clinical features and in vitro fertilization pregnancy outcomes in women with polycystic ovarian syndrome","authors":"Haozhe Miao MD , Huiming Yang MD , Mengfei Yin MD , Yixuan Wang MD , Yuan Fang MD , Min Yang MD , Jialin Zou MD , Wenwen Zhang MD , Lingling Zhang MD , Chendan Liu MD , Yue Wang MD , Ze Wang MD , Yunhai Yu MD, PhD , Daimin Wei MD, PhD","doi":"10.1016/j.xagr.2024.100332","DOIUrl":"10.1016/j.xagr.2024.100332","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>The diagnostic criteria and phenotypes in polycystic ovary syndrome are heterogeneous. Currently, it is unclear how to assess a patient's prognosis based on the onset time of menstruation disturbance. Evidence on this topic is scarce and has mainly focused on menstrual patterns.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to assess the association between the onset time of menstrual disturbance and clinical features and in vitro fertilization pregnancy outcomes in patients with polycystic ovary syndrome.</p></div><div><h3>STUDY DESIGN</h3><p>Our study was a secondary analysis of data collected as part of a randomized controlled trial conducted to compare live birth rates between fresh embryo transfer and frozen embryo transfer in 1508 individuals with polycystic ovary syndrome. Here, 1500 participants were classified into 2 groups according to the onset time of menstrual disturbance: immediately after menarche (early group) and after at least 1 year of regular menstruation (late group). We compared the prepregnancy clinical features, variables of ovarian stimulation, pregnancy outcomes after the initial cycle of embryo transfer, and perinatal and neonatal complications in the 2 groups.</p></div><div><h3>RESULTS</h3><p>Compared with the late group, the early group had more antral follicles (32.00 [range, 27.25–39.50] vs 28.00 [range, 24.00–36.00]; <em>P</em><.001), an elevated level of antimüllerian hormone (7.02 ng/mL [range, 3.60–11.47] vs 5.66 ng/mL [range, 3.65–8.92]; <em>P</em>=.024), a higher level of baseline luteinizing hormone (10.01±5.93 vs 8.51±5.53 IU/l; <em>P</em><.001) and luteinizing hormone–to–follicle-stimulating hormone ratio (1.51 [range, 1.00–2.32] vs 1.45 [range, 0.92–2.13]; <em>P</em><.001), lower levels of fasting glucose (5.47 mmol/L [range, 5.11–5.73] vs 5.50 mmol/L [range, 5.17–5.76]; <em>P</em><.001), and insulin at 2 hours after 75-g oral glucose tolerance test (56.85 µU/mL [range, 34.63–94.54] vs 59.82 µU/mL [range, 33.56–94.67]; <em>P</em>=.027), a higher level of high-density lipoprotein (1.26 mmol/L [range, 1.04–1.37] vs 1.21 mmol/L [range, 1.07–1.45]; <em>P</em>=.006). During in vitro fertilization, the early group had a higher level of peak estradiol (4596.50 pg/mL [range, 2639.25–6321.00] vs 3954.00 pg/mL [range, 2378.75–6113.50]; <em>P</em>=.013), and luteinizing hormone (2.52 IU/L [range, 1.40–4.21] vs 1.93 IU/L [range, 0.91–3.32]; <em>P</em>=.010) on the day of human chorionic gonadotropin trigger. There was no statistically significant difference observed in the number of oocytes and embryos, the rates of pregnancy and live birth, and the risks of obstetrical and neonatal between the 2 groups.</p></div><div><h3>CONCLUSION</h3><p>An early onset of menstrual disturbance in patients with polycystic ovary syndrome may be associated with slightly more severe reproductive features and slightly milder metabolic features. Nonetheless, the outcomes of in vitro fertilizati","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000261/pdfft?md5=ca17a9118bb0b913dc4f86d2f1a2216e&pid=1-s2.0-S2666577824000261-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-14DOI: 10.1016/j.xagr.2024.100333
Irene J. Schaafsma MSc , Froukje J. Hoogenboom MSc , Gerard Dijkstra PhD , Jelmer R. Prins PhD , Marijn C. Visschedijk PhD
BACKGROUND
Pregnant women with active perianal Crohn's disease indicate a cesarean delivery according to the current European Crohn's and Colitis Organisation guidelines. This advice is based on the assumption that vaginal delivery leads to exacerbation of perianal disease and worsening of fecal continence. However, there is no strong evidence to support this.
OBJECTIVE
This study aims to examine the effects of the delivery method on perianal disease progression and fecal incontinence in women with perianal Crohn's disease.
STUDY DESIGN
In this retrospective cohort study, 102 women were selected from the 1000 inflammatory bowel disease cohort of a tertiary hospital in the Netherlands. All women are aged >18 years, have perianal Crohn's disease, and have given birth. In addition, all women completed a questionnaire. Fecal continence was scored using the Vaizey score. Using SPSS, descriptive analysis and linear regression analysis were performed, and P values <.05 were considered statistically significant.
RESULTS
The cesarean delivery rate within our cohort was 19.5%. Within the group of women who delivered at least one child vaginally (n=84), 25.5% reported alteration of fecal continence, compared with 13.1% in women who only had cesarean delivery (n=18). After a mean follow-up of 15 years, the median Vaizey score within the cesarean delivery group was 5, compared with 7 in the vaginal delivery group. Within the vaginal delivery group, 18.8% reported perianal disease progression, compared with 22.2% in the cesarean delivery group. No significant relation between mode of delivery and fecal continence or perianal disease progression was found (B, 0,97 [−1,19 to 3,14], P=.38).
CONCLUSION
Fecal incontinence and perianal disease progression after vaginal delivery in Crohn's disease women with active perianal fistula is not significantly increased in this retrospective cohort. This study opens the discussion for more tailored obstetric advice in women with perianal Crohn's disease.
{"title":"Vaginal delivery in women with perianal Crohn's disease: why not?","authors":"Irene J. Schaafsma MSc , Froukje J. Hoogenboom MSc , Gerard Dijkstra PhD , Jelmer R. Prins PhD , Marijn C. Visschedijk PhD","doi":"10.1016/j.xagr.2024.100333","DOIUrl":"10.1016/j.xagr.2024.100333","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Pregnant women with active perianal Crohn's disease indicate a cesarean delivery according to the current European Crohn's and Colitis Organisation guidelines. This advice is based on the assumption that vaginal delivery leads to exacerbation of perianal disease and worsening of fecal continence. However, there is no strong evidence to support this.</p></div><div><h3>OBJECTIVE</h3><p>This study aims to examine the effects of the delivery method on perianal disease progression and fecal incontinence in women with perianal Crohn's disease.</p></div><div><h3>STUDY DESIGN</h3><p>In this retrospective cohort study, 102 women were selected from the 1000 inflammatory bowel disease cohort of a tertiary hospital in the Netherlands. All women are aged >18 years, have perianal Crohn's disease, and have given birth. In addition, all women completed a questionnaire. Fecal continence was scored using the Vaizey score. Using SPSS, descriptive analysis and linear regression analysis were performed, and <em>P</em> values <.05 were considered statistically significant.</p></div><div><h3>RESULTS</h3><p>The cesarean delivery rate within our cohort was 19.5%. Within the group of women who delivered at least one child vaginally (n=84), 25.5% reported alteration of fecal continence, compared with 13.1% in women who only had cesarean delivery (n=18). After a mean follow-up of 15 years, the median Vaizey score within the cesarean delivery group was 5, compared with 7 in the vaginal delivery group. Within the vaginal delivery group, 18.8% reported perianal disease progression, compared with 22.2% in the cesarean delivery group. No significant relation between mode of delivery and fecal continence or perianal disease progression was found (B, 0,97 [−1,19 to 3,14], <em>P</em>=.38).</p></div><div><h3>CONCLUSION</h3><p>Fecal incontinence and perianal disease progression after vaginal delivery in Crohn's disease women with active perianal fistula is not significantly increased in this retrospective cohort. This study opens the discussion for more tailored obstetric advice in women with perianal Crohn's disease.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000273/pdfft?md5=821930dc1ae0d230f28eb0cf87d0d09b&pid=1-s2.0-S2666577824000273-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-13DOI: 10.1016/j.xagr.2024.100334
Huiming Yang MD , Haozhe Miao MD , Mengfei Yin MD , Yixuan Wang MD , Dingying Zhao MD , Min Yang MD , Jialin Zou MD , Wenwen Zhang MD , Lingling Zhang MD , Chendan Liu MD , Yue Wang MD , Ze Wang MD , Yunhai Yu MD, PhD , Daimin Wei MD, PhD
BACKGROUND
Frozen embryo transfer resulted in a higher birthweight and an increased risk of macrosomia than fresh embryo transfer. However, the mechanism was still unclear. When the impact of frozen embryo transfer on fetal growth began was unknown. Crown-rump length at 11–13 weeks had been regarded as a good indicator of fetal growth in the first trimester and had been used for gestational age calculation in women with uncertain last menstrual periods.
OBJECTIVE
To evaluate the association between frozen embryo transfer and early fetal growth, particularly the crown-rump length, then fresh embryo transfer. The secondary objective was to investigate the potential correlation between crown-rump length and birthweight.
STUDY DESIGN
This was a retrospective cohort study conducted at the Reproductive Medical Center of Shandong University. A total of 4949 patients who obtained singleton pregnancy after frozen embryo transfer and 1793 patients who got singleton pregnancy after fresh embryo transfer between January 1, 2017 and December 31, 2022 were included. The primary outcome was the crown-rump length measured via ultrasound at 11–13 weeks gestation. The secondary outcomes were perinatal outcomes, including birthweight and the risk of large for gestational age, small for gestational age, macrosomia, low birthweight, and premature delivery. Multivariable linear regression models were used to adjust for potential confounders of crown-rump length.
RESULTS
A total of 6742 live singleton births after frozen embryo transfer or fresh embryo transfer were included in this study. In the univariable analysis, the frozen embryo transfer group had a larger crown-rump length (5.75±0.53 cm vs 5.57±0.48 cm, P<.001) and an increased risk of larger-than-expected crown-rump length (13.5% vs11.2%, P=.013) than the fresh embryo transfer group. After adjusting for confounders in multivariable linear regression models, frozen embryo transfer was still associated with a larger crown-rump length (regression coefficient, 3.809 [95% confidence intervals, 3.621–3.997], P<.001). When subgrouped by fetal gender, the crown-rump length of the frozen embryo transfer group was larger than the fresh embryo transfer group in both male and female fetuses. In addition, the crown-rump length was consistently larger in the frozen embryo transfer group than the fresh embryo transfer group in subgroups of the peak estradiol levels. The comparisons among different crown-rump length groups showed that smaller-than-expected crown-rump length was associated with increased risks of small for gestational age (6.3% vs 3.0%, P<.001) and preterm delivery (9.6% vs 6.7%, P=.004) than normal crown-rump length.
CONCLUSION
Frozen embryo transfer was associated with a larger crown-rump length than fresh embryo transfer, suggesting that th
背景与新鲜胚胎移植相比，冷冻胚胎移植会导致出生体重增加，并增加巨型畸形的风险。然而，其机理尚不清楚。冷冻胚胎移植对胎儿生长的影响何时开始尚不清楚。11-13 周时的头臀长一直被认为是前三个月胎儿生长的良好指标，并被用于计算末次月经不确定的妇女的胎龄。研究设计这是在山东大学生殖医学中心进行的一项回顾性队列研究。共纳入了2017年1月1日至2022年12月31日期间冷冻胚胎移植后获得单胎妊娠的4949例患者和新鲜胚胎移植后获得单胎妊娠的1793例患者。主要结果是妊娠11-13周时通过超声波测量的胎冠臀长。次要结果是围产期结果，包括出生体重和胎龄大、胎龄小、巨大儿、低出生体重和早产的风险。本研究共纳入了 6742 例冷冻胚胎移植或新鲜胚胎移植后的单胎活产。在单变量分析中，与新鲜胚胎移植组相比，冷冻胚胎移植组的冠臀长度更大（5.75±0.53 cm vs 5.57±0.48 cm，P< .001），冠臀长度大于预期的风险更高（13.5% vs 11.2%，P=.013）。在多变量线性回归模型中对混杂因素进行调整后，冷冻胚胎移植仍与冠臀长度增大有关（回归系数，3.809 [95% 置信区间，3.621-3.997]，P< .001）。按胎儿性别分组时，无论是男胎还是女胎，冷冻胚胎移植组的冠臀长度均大于新鲜胚胎移植组。此外，在雌二醇峰值分组中，冷冻胚胎移植组的冠臀长度始终大于新鲜胚胎移植组。不同冠臀长度组之间的比较显示，与正常冠臀长度相比，冠臀长度小于预期与胎龄小（6.3% vs 3.0%，P<.001）和早产（9.6% vs 6.7%，P=.004）风险增加有关。妊娠头三个月胎儿发育不良可能与低出生体重和早产有关。
{"title":"The difference in early trimester fetal growth between singletons after frozen embryo transfer and fresh embryo transfer","authors":"Huiming Yang MD , Haozhe Miao MD , Mengfei Yin MD , Yixuan Wang MD , Dingying Zhao MD , Min Yang MD , Jialin Zou MD , Wenwen Zhang MD , Lingling Zhang MD , Chendan Liu MD , Yue Wang MD , Ze Wang MD , Yunhai Yu MD, PhD , Daimin Wei MD, PhD","doi":"10.1016/j.xagr.2024.100334","DOIUrl":"10.1016/j.xagr.2024.100334","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Frozen embryo transfer resulted in a higher birthweight and an increased risk of macrosomia than fresh embryo transfer. However, the mechanism was still unclear. When the impact of frozen embryo transfer on fetal growth began was unknown. Crown-rump length at 11–13 weeks had been regarded as a good indicator of fetal growth in the first trimester and had been used for gestational age calculation in women with uncertain last menstrual periods.</p></div><div><h3>OBJECTIVE</h3><p>To evaluate the association between frozen embryo transfer and early fetal growth, particularly the crown-rump length, then fresh embryo transfer. The secondary objective was to investigate the potential correlation between crown-rump length and birthweight.</p></div><div><h3>STUDY DESIGN</h3><p>This was a retrospective cohort study conducted at the Reproductive Medical Center of Shandong University. A total of 4949 patients who obtained singleton pregnancy after frozen embryo transfer and 1793 patients who got singleton pregnancy after fresh embryo transfer between January 1, 2017 and December 31, 2022 were included. The primary outcome was the crown-rump length measured via ultrasound at 11–13 weeks gestation. The secondary outcomes were perinatal outcomes, including birthweight and the risk of large for gestational age, small for gestational age, macrosomia, low birthweight, and premature delivery. Multivariable linear regression models were used to adjust for potential confounders of crown-rump length.</p></div><div><h3>RESULTS</h3><p>A total of 6742 live singleton births after frozen embryo transfer or fresh embryo transfer were included in this study. In the univariable analysis, the frozen embryo transfer group had a larger crown-rump length (5.75±0.53 cm vs 5.57±0.48 cm, <em>P</em><.001) and an increased risk of larger-than-expected crown-rump length (13.5% vs11.2%, <em>P</em>=.013) than the fresh embryo transfer group. After adjusting for confounders in multivariable linear regression models, frozen embryo transfer was still associated with a larger crown-rump length (regression coefficient, 3.809 [95% confidence intervals, 3.621–3.997], <em>P</em><.001). When subgrouped by fetal gender, the crown-rump length of the frozen embryo transfer group was larger than the fresh embryo transfer group in both male and female fetuses. In addition, the crown-rump length was consistently larger in the frozen embryo transfer group than the fresh embryo transfer group in subgroups of the peak estradiol levels. The comparisons among different crown-rump length groups showed that smaller-than-expected crown-rump length was associated with increased risks of small for gestational age (6.3% vs 3.0%, <em>P</em><.001) and preterm delivery (9.6% vs 6.7%, <em>P</em>=.004) than normal crown-rump length.</p></div><div><h3>CONCLUSION</h3><p>Frozen embryo transfer was associated with a larger crown-rump length than fresh embryo transfer, suggesting that th","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000285/pdfft?md5=24c86d00a94f2a705efe6756b10cefd6&pid=1-s2.0-S2666577824000285-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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