VP46.21: Usefulness of transvaginal ultrasonography of the cervical canal in the screening of pregnant women at risk of premature labour

Abstract Objectives Nutrition during pregnancy is a critical dimension not only for women’s heath, but also for the offspring’s lifelong health. Very limited national data exist on the usual dietary intakes of pregnant women. The objective of this study was to estimate total usual nutrient intakes (from foods and dietary supplements) of pregnant women in the U.S. Methods Cross-sectional analysis of a nationally-representative sample of pregnant U.S. women, ages 20-40 years (n = 1,003) from NHANES 2001-2014. Total usual dietary intakes were estimated using the National Cancer Institute (NCI) method to adjust 2, 24-hour dietary recalls for within-person variation. Adherence with the Dietary Reference Intakes were used to assess the proportion at risk of inadequacy by the Estimated Average Requirement (%< EAR), assumed to be adequate by the Adequate Intake (% >AI), and at risk of excess by the Tolerable Upper Intake Level (% >UL). Results About 70% of pregnant women use a dietary supplement. Less than 5% of pregnant women have usual diets that are at risk for inadequate intakes of riboflavin (3%), niacin (1%), vitamin B12 (1%), iron (2%), phosphorus (< 0.5%), and selenium (< 0.5%). More pregnant women have usual intakes < EAR for vitamins A (15%), B6 (11%), folate (16%), C (11%), D (46%), E (43%), and minerals including copper (5%), calcium (13%), magnesium (47%) and zinc (11%). Few pregnant females have usual intakes >AI for potassium (2%) and choline (8%), whereas only 48% have vitamin K intakes >AI. The majority of pregnant women (95%) exceed the UL for sodium, while folic acid (34%), iron (28%), calcium (3%), and zinc (7%) were also of concern for intakes >UL. Conclusions Many U.S. pregnant women ( >10% < EAR or < 10% >AI) do not consume enough of key nutrients during pregnancy specifically vitamins A, C, D, E, K, B6, folate, and choline and minerals including potassium, calcium, magnesium, and zinc, while almost all are at risk of excessive consumption of sodium, and many at risk of excessive consumption of folic acid and iron. Improved dietary guidance to help pregnant women meet and not exceed dietary recommendations is warranted. Funding Sources Nestle Nutrition.

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Prevention of preterm delivery in women with multiple pregnancy

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2018-22(1)-24 ◽

2018 ◽

Vol 22 (1) ◽

pp. 126-132

Author(s):

A.V. Tkachenko

Keyword(s):

Pregnant Women ◽

Preterm Delivery ◽

Rating Scale ◽

Transvaginal Ultrasound ◽

Multiple Pregnancy ◽

Clinical Signs ◽

Cervical Canal ◽

Cervical Insufficiency ◽

Cervical Incompetence ◽

Vaginal Pessary

The objective — to asses the effectiveness of obstetric pessary for cervical incompetence correction in women with multiple pregnancy and infertility in the anamnesis, treated by ART. 30 ART treated pregnant women with infertility in the anamnesis, with dichorionic diamniotic twins (DCDA) were divided into 3 groups, depending on the gestational age when cervical incompetence was diagnosed and vaginal pessary placed: the I group consisted of 5 pregnant women (17%), whom pessary was inserted at 19–22 gestational weeks, the II group included 18 (60.0%) women with correction of cervical insufficiency from 23 to 27 weeks of gestation, the III — 7 (23%) of the patients with pessary implementation in terms of 28–32 gestational weeks. Diagnosis of cervical incompetence was based on the FMF criterias, the Score Rating Scale (Shtember Scale in the modification of G.M. Savelieva) and cervical indices (CI). The sonographic evaluation of cervical insufficiency considered the cervical length (less than 25 mm), opening of the internal os and / or cervical canal (9 mm or more), ICSC>0.22, IPC>0.18 and the Rating Scale score > 5–6 points. With the aim to treat cervical incompetence during pregnancy, silicone vaginal pessary (ASQ, perforated) was used. The cervical assessment by transvaginal ultrasound probe was performed every 2 weeks and evaluated 1 month after correction. The data obtained were processed statistically, using the Microsoft Excel software. The average age of pregnant women was 27.7±2.8 years (28–38 years). Extragenital pathology was determined in 83.3% of women. All pregnant women had infertility in anamnesis, treated by ART, 18 (60%) by standard IVF procedure and 12 (40%) using ICSI method. The number of primiparous and multiparous women was the same. Within pregnancy duration, there were artificial abortions in 8 (53,3%), miscarriages in 7 (46,7%), prematurity in 3 (20,0%) and term delivery in 2 (13,3%) patients in the anamnesis. The current pregnancy was complicated by threatened abortions in all groups, which clinical signs most often occurred within 8–10 and 14–17 weeks of gestation. The average duration of pessary placement in groups was 15.0±1.8; 12.2±1.6 and 4.7±2.1 weeks, respectively. According to ultrasonography evaluation, the visual lengthening of the cervix from 21.6±3.4 mm to 30.2±3.6 mm (p<0,05) were observed in all groups, during the first week of treatment. Preterm delivery occurred in 6 (20%) women, among them before 32 weeks — 3.3%, 32–34 weeks — 10% and in 35–36 weeks — 6.5% of observations. 16.7% of pregnant women had vaginal delivery, 25 (83.3%) underwent Cesarean Section, 76.7% of them had a planned CS. No cases of antenatal or intranatal fetal death happened, as well as newborns with extremely low body weight were not observed in women of all three groups. Results were obtained testify the role of cervical incompetence in the pathogenesis of perinatal losses in women with multiple pregnancy. Evaluation and diagnosis of cervical insufficiency to predict and prevent premature labor in such group of patients should be based on criteria of Fetal Medicine Foundation (FMF), using the method of transvaginal ultrasound cervicometry. An additional calculation of cervical indices may improve the reliability of the prognostic technique. The safety, accessibility and efficacy of obstetric vaginal pessary usage for non-surgical correction of cervical incompetence, as well as absence of severe complications in women with twin pregnancies, have been demonstrated.

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Microbial pathogens in urogenital infection in pregnant women

Journal of microbiology epidemiology immunobiology ◽

10.36233/0372-9311-2019-6-13-20 ◽

2019 ◽

pp. 13-20

Author(s):

A. V. Karaulov ◽

M. S. Afanasiev ◽

Yu. V. Nesvizhsky ◽

S. S. Afanasiev ◽

E. A. Voropaeva ◽

...

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Pregnancy Termination ◽

Clinical Manifestations ◽

Microbial Pathogens ◽

Enzyme Linked Immunosorbent Assay ◽

Cervical Canal ◽

Type I ◽

Urogenital Infection ◽

In Pregnancy

Introduction. Chronic and latent infections are often activated during pregnancy.Aim - to asses the pathogenetic role of microbial pathogens in urogenital tract infection (UTI) in pregnant women.Materials and methods. 89 pregnant women underwent general clinical examination, examination of smears from urethra, vagina, cervical canal; bacteriological analysis of vaginal contents; enzyme-linked immunosorbent assay, polymerase chain reaction and determination of specific antibodies for verification of herpes simplex virus (HSV) type I and II, cytomegalovirus (CMV), Epstein-Barr (EBV) and UTI pathogens in pregnant women in blood and mucosal scrapes.Results. Prevalence of Herpesviridae was revealed (90-100% -EBV, HSV type I and II, CMV); in 41% of cases - bacterial pathogens, in 57% of cases - Mycoplasma, Ureaplasma.Discussion. In preterm birth and pregnancy termination mycoplasma and ureaplasma were more often revealed, and in pregnancy termination - association of HSV type I and II in comparison with urgent birth; in the last equally often - HSV type I and association of HSV type I and II; in urgent birth (infection) more often - HSV type I, than association of HSV type I and II; in preterm birth more often - HSV type I, than the association of HSV types I and II, and less often than combination of HSV type I and association of HSV types I and II in pregnancy termination; in the last, the association of HSV types I and II is more common than HSV type I. Increase of TLRs genes expression levels depends on HSV type I less than from association of HSV types I and II, less than from combination of HSV type I and association of HSV types I and II (it determines the clinical manifestations of genital herpes).Conclusion. Microbial pathogens determine the character of pregnancy course, and HSV types I and II- are the triggers of the infectious process, prognosing its course.

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Maternal and Infant Death and the rVSV-ZEBOV Vaccine Through Three Recent Ebola Virus Epidemics-West Africa, DRC Équateur and DRC Kivu: 4 Years of Excluding Pregnant and Lactating Women and Their Infants from Immunization

Current Tropical Medicine Reports ◽

10.1007/s40475-019-00195-w ◽

2019 ◽

Vol 6 (4) ◽

pp. 213-222 ◽

Cited By ~ 9

Author(s):

David A. Schwartz

Keyword(s):

At Risk ◽

Clinical Trials ◽

West Africa ◽

Pregnant Women ◽

Ebola Virus ◽

Disease Outbreaks ◽

Case Fatality ◽

Viral Disease ◽

Lactating Women ◽

Health Communities

Abstract Purpose of Review Ebola virus infection has one of the highest overall case fatality rates of any viral disease. It has historically had an especially high case mortality rate among pregnant women and infants—greater than 90% for pregnant women in some outbreaks and close to 100 % in fetuses and newborns. The Merck recombinant vaccine against Ebola virus, termed rVSV-ZEBOV, underwent clinical trials during the 2013–2015 West Africa Ebola epidemic where it was found to be 100% efficacious. It was subsequently used during the 2018 DRC Équateur outbreak and in the 2018 DRC Kivu Ebola which is still ongoing, where its efficacy is 97.5 %. Pregnant and lactating women and their infants have previously been excluded from the design, clinical trials, and administration of many vaccines and drugs. This article critically examines the development of the rVSV-ZEBOV vaccine and its accessibility to pregnant and lactating women and infants as a life-saving form of prevention through three recent African Ebola epidemics—West Africa, DRC Équateur, and DRC Kivu. Recent Findings Pregnant and lactating women and their infants were excluded from participation in the clinical trials of rVSV-ZEBOV conducted during the West Africa epidemic. This policy of exclusion was continued with the occurrence of the DRC Équateur outbreak in 2018, in spite of calls from the public health and global maternal health communities to vaccinate this population. Following the onset of the DRC Kivu epidemic, the exclusion persisted. Eventually, the policy was reversed to include vaccination of pregnant and lactating women. However, it was not implemented until June 2019, 10 months after the start of the epidemic, placing hundreds of women and infants at risk for this highly fatal infection. Summary The historical policy of excluding pregnant and lactating women and infants from vaccine design, clinical trials, and implementation places them at risk, especially in situations of infectious disease outbreaks. In the future, all pregnant women, regardless of trimester, breastfeeding mothers, and infants, should have access to the Ebola vaccine.

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