The impact of cervical surgery on intervention and preterm birth in high-risk pregnant women

2013 ◽  
Vol 170 (1) ◽  
pp. 296
Author(s):  
Nicola Vousden ◽  
Aia S. Mehdi ◽  
Andrew H. Shennan
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Pregnant Women ◽  
Cervical Surgery ◽  
The Impact

scholarly journals The Impact of Routine Transvaginal Ultrasound Measurement of the Cervical Length on the Prediction of Preterm Birth: A Retrospective Study in a Tertiary Hospital

2021 ◽  
Vol 43 (04) ◽  
pp. 264-274
Author(s):  
Joana Patricia Rodrigues Félix Peixoto de Almeida ◽  
Carla Maria Magno Bartosch ◽  
Alexandra Matias Pereira Cunha Coelho Macedo
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Maternal Age ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Ultrasound Measurement ◽  
Inverse Association ◽  
Second Trimester ◽  
Cervical Surgery ◽  
The Impact

AbstractPreterm birth (PTB) is a major obstetric problem associated with high rates of neonatal morbidity and mortality. The prevalence of PTB has not changed in the last decade; thus, the establishment of a screening test and effective treatment are warranted. Transvaginal ultrasound measurement of the cervical length (TUCL) has been proposed as an effective method to screen pregnant women at a higher risk of experiencing PTB. Objective To evaluate the applicability and usefulness of second-trimester TUCL to predict PTB in a cohort of Portuguese pregnant women. Methods Retrospective cross-sectional cohort study including all singleton pregnant women who performed their second-trimester ultrasound (between weeks 18 and 22 + 6 days) from January 2013 to October 2017 at Centro Hospitalar Universitário São João. Results Our cohort included 4,481 women. The prevalence of spontaneous PTB was of 4.0%, with 0.7% occurring before the 34th week of gestation. The mean TUCL was of 33.8 mm, and percentiles 3, 5 and 10 corresponded to TUCLs of 25.0 mm, 27.0 mm and 29.0 mm respectively. The multiple logistic regression analysis, including maternal age, previous PTB and cervical surgery showed a significant negative association between TUCL and PTB, with an odds ratio (OR) of 0.92 (95% confidence interval [95%CI]: 0.90–0.95; p < 0.001). The use of a TUCL of 20 mm is the best cut-off, when compared with the 25-mm cut-off, improving the prediction of risk. Conclusion The present study showed an inverse association between TUCL and PTB, and that the inclusion of other risk factors like maternal age, previous PTB and cervical surgery can improve the screening algorithm. Furthermore, it emphasizes that the TUCL cut-off that defines short cervix can differ according to the population.

The Compliance of Prescribed Activity Restriction in Women at High Risk for Preterm Birth

2020 ◽  
Author(s):  
Ghamar Bitar ◽  
Anthony Sciscione
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Medical Center ◽  
Compliance Rate ◽  
Tertiary Care ◽  
Prescribing Patterns ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Activity Restriction ◽  
The Impact

Objective Despite lack of evidence to support efficacy, activity restriction is one of the most commonly prescribed interventions used for the prevention of preterm birth. We have a departmental policy against the use of activity restriction but many practitioners still prescribe it in an effort to prevent preterm birth. We sought to evaluate the rate and compliance of women who are prescribed activity restriction during pregnancy to prevent preterm birth. Study Design This was a single-site retrospective questionnaire study at a tertiary care, academic affiliated medical center. Women with a history of preterm delivery or short cervix were included. Once patients were identified, each patient was contacted and administered a questionnaire. We assessed the rates of activity restriction prescription and compliance. Secondary outcomes included details regarding activity restriction and treatment in pregnancy. Continuous variables were compared with t-test and categorical variables with Chi-square test. The value p < 0.05 was considered significant. Results Among the 52 women who responded to the questionnaire, 18 reported being placed on activity restriction by a physician, with 1 self-prescribing activity restriction, giving a rate of our primary outcome of 19 of 52 (36.5%). All women reported compliance with prescribed activity restriction (100%). Gestational age at delivery was not different in women placed on activity restriction. Conclusion This questionnaire suggests that approximately one in three high-risk women were placed on activity restriction during their pregnancy despite a departmental policy against its use. The 100% compliance rate in patients placed on activity restriction is a strong reminder of the impact prescribing patterns of physicians can have on patients. Key Points

Amniotic fluid composition in pregnant women at high risk of preterm birth

2020 ◽  
Vol 8_2020 ◽  
pp. 82-87
Author(s):  
Khodzhaeva Z.S. Khodzhaeva ◽  
Gorina K.A. Gorina ◽  
Muminova K.T. Muminova ◽  
Ivanets T.Yu. Ivanets ◽  
Kessler Yu.V. Kessler ◽  
...  
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Amniotic Fluid ◽  
Pregnant Women ◽  
Fluid Composition

RELATIONSHIP OF MATERNAL VITAMIN B12 STATUS IN PREGNANCY WITH PRETERM BIRTH AND MATERNAL HEALTH RISKS

2020 ◽  
pp. 32-38
Author(s):  
VICTORIA LAZAROVA SPASOVA ◽  
LILIA IVANOVA KOLEVA ◽  
MARIETA ANTONOVA POPOVA ◽  
VALENTINA BOYANOVA PETKOVA ◽  
MILEN VENTZISLAVOV DIMITROV
Keyword(s):  
Preterm Birth ◽  
Vitamin B12 ◽  
Pregnant Women ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Inverse Association ◽  
Maternal Vitamin ◽  
B12 Deficiency ◽  
The Impact ◽  
In Pregnancy

Vitamin B12 is known to be vital for cell growth and population during pregnancy. This retrospective and prospective case−control study was aimed to disclose a health risk for pregnant women with vitamin B12 deficiency, as well as the one of the preterm birth. The main tasks set and performed in this research were as follows: to compare the obstetrics anamnesis between the women who gave birth on term and women who gave birth before term; to find the prevalence of vitamin B12 insufficiency in pregnancy; to determine its association with preterm birth and low birth weight; to examine its association with spontaneous abortions, and to investigate its relationship with obesity and hemoglobin levels in pregnant women. The conducted investigation involved 107 women who gave birth before the 37th week of gestation and 101 women who gave birth after the 37th week of gestation at the outpatient clinic of the University Hospital "Maichin Dom" in Bulgaria. Our study revealed a correlation between maternal vitamin B12 deficiency, overweight and low hemoglobin level. Our results showed no significant correlation between serum vitamin B12 level and the risk of preterm birth. However, we found an inverse association between vitamin B12 level and overweight before pregnancy and at the time of giving birth. As well there was confirmed the strong connection between meat consumption and vitamin B12 level. The paper emphasizes that the deficiency of the vitamin occurs most likely in the women with inadequate diets. Such a deficiency is actually confirmed to have serious health consequences for pregnant women and their offspring. Therefore further profound and numerous studies should be performed to properly assess the correlation between vitamin B12 and preterm birth, as well as to understand better the impact of vitamin B12 over pregnant women. Key words: vitamin B12, preterm birth, pregnancy, overweight, hemoglobin.

scholarly journals A Randomized Controlled Open Label Crossover Trial to Study Vaginal Colonization of Orally Administered Lactobacillus Reuteri RC-14 and Rhamnosus GR-1 in Pregnant Women at High Risk for Preterm Labor

Nutrients ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 1141 ◽  
Author(s):  
Enav Yefet ◽  
Raul Colodner ◽  
Merav Strauss ◽  
Yifat Gam Ze Letova ◽  
Zohar Nachum
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Bacterial Vaginosis ◽  
Pregnant Women ◽  
Lactobacillus Reuteri ◽  
Bacterial Strains ◽  
Open Label ◽  
Flight Mass Spectrometry ◽  
Vaginal Colonization ◽  
Probiotic Treatment

Lactobacilli administration has been suggested for the treatment and prevention of bacterial vaginosis, which increases the risk for preterm birth. We aimed to evaluate the vaginal colonization of lactobacilli orally administered to pregnant women at risk for preterm birth. We performed a randomized and controlled crossover study between January 2016 and May 2017. Forty pregnant women at high risk for preterm birth with normal vaginal flora (Nugent score ≤ 3) were randomized to either receive two oral capsules/day each containing 5 × 109 Lactobacilli (L.) rhamnosus GR-1 and L. reuteri RC-14 (n = 20) or no treatment (n = 20) for 2 months. Treatments were then crossed over for an additional two months. A vaginal examination and swabbing were performed for assessment of bacterial vaginosis at baseline and every month until study completion. At the same time points, vaginal samples were cultured and subjected to matrix-assisted-laser-desorption/ionization-time-of-flight-mass-spectrometry (MALDI TOF-MS) for the detection of the specific bacterial strains contained in the capsules. The primary endpoint was the presence of the administered lactobacilli strains in the vagina during the first two months of follow-up. Thirty-eight women completed the study. During the first two months of treatment, L. rhamnosus GR-1 was detected in one (5%) woman on the probiotic treatment and 2 (11%) women receiving no treatment (p = 0.6). L. rhamnosus GR-1 was detected in vaginal samples of 4 (11%) women during probiotic treatment (of both groups) and L. reuteri RC-14 was not detected in any samples. The rest of the endpoints were not different between the groups. Altogether, vaginal colonization of lactobacilli following oral administration is low during pregnancy.

scholarly journals Clinical Pharmacology Aspects of Some Tocolytic Drugs Used in Pregnant Women at Risk of Preterm Birth

2019 ◽  
Vol 9 (3) ◽  
pp. 162-166
Author(s):  
E. A. Sоkоvа ◽  
R. A. Chilova ◽  
O. A. Demidova ◽  
K. O. Akopov
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Preterm Labour ◽  
Plasma Concentrations ◽  
Cyclooxygenase Inhibitors ◽  
Pharmacokinetic Parameters ◽  
Clinical Effects ◽  
Spontaneous Preterm Birth ◽  
Rational Pharmacotherapy ◽  
The Impact

Spontaneous preterm birth is one of the most pressing issues in obstetrics, as it remains one of the leading causes of newborn morbidity and mortality. Pending issues of aetiology, pathogenesis, and absence of medicinal products indicated for the treatment of spontaneous preterm labour pose a challenge for rational pharmacotherapy. The paper presents the results of a scientific literature review on the problem of rational pharmacotherapy of spontaneous preterm labour using tocolytic drugs — calcium channel blockers, cyclooxygenase inhibitors. The paper summarises specific pharmacokinetic parameters of these drugs during pregnancy. It discusses pharmacogenetic aspects of using tocolytic drugs in pregnant women and their potential clinical effects. It was demonstrated that women with threatened miscarriage had high interindividual variability in nifedipine plasma concentrations depending on CYP3A5 genotype. It was shown that certain genetic polymorphisms of CYP2C9 may lead to an increased metabolic rate and an increase in indomethacin clearance resulting in the reduction of its efficacy. Yet, there is minimal research regarding this issue. Therefore, further research is needed to assess the impact of CYP3A5 and CYP2C9 genotypes on the efficacy and safety of nifedipine and indomethacin used as tocolytic drugs in obstetrics.

scholarly journals Hydroxychloroquine PK and exposure-response in pregnancies with lupus: the importance of adherence for neonatal outcomes

2022 ◽  
Vol 9 (1) ◽  
pp. e000602
Author(s):  
Stephen J Balevic ◽  
Daniel Weiner ◽  
Megan E B Clowse ◽  
Amanda M Eudy ◽  
Anil R Maharaj ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Physiological Changes ◽  
Third Trimester ◽  
Exposure Response ◽  
Multiple Gestations ◽  
Adjusted Logistic Regression ◽  
Using Data ◽  
Poor Outcomes ◽  
The Impact

ObjectiveEvaluate the impact of pregnancy physiology and medication non-adherence on serum hydroxychloroquine (HCQ) pharmacokinetics (PK) and exposure-response in SLE.MethodsWe conducted a PK analysis using data from two observational pregnancy registries. We enrolled pregnant women with SLE taking HCQ at least 3 months prior to, and throughout pregnancy, and excluded those with multiple gestations. Using the PK model, we conducted dosing simulations and imputed 0%/20%/40%/60% non-adherence to evaluate the impact of adherence versus physiological changes on HCQ concentrations. We compared the effect of pregnancy-average non-adherent concentrations (≤100 ng/mL vs >100 ng/mL) on preterm birth using adjusted logistic regression.ResultsWe enrolled 56 women who had 61 pregnancies. By the third trimester, mean apparent HCQ clearance increased by 59.6%. At a dosage of 400 mg/day, fully adherent patients are expected to have HCQ concentrations ≤100 ng/mL only 0.3% of the time, compared with 24.2% when 60% of doses are missed. Persistently low HCQ concentrations throughout pregnancy were associated with a significantly higher odds of preterm birth, controlling for lupus nephritis and race (OR 11.2; 95% CI 2.3 to 54.2; p=0.003).ConclusionsWe observed significant changes in HCQ PK during pregnancy, resulting in a shortening in the drug’s half-life by 10 days; however, medication non-adherence had a more pronounced effect on HCQ exposure compared with physiological changes alone. Moreover, pregnant women with non-adherent HCQ concentrations had significantly higher rates of preterm birth. Accordingly, optimising adherence in pregnancy may be more clinically meaningful than adjusting HCQ dosage to account for physiological changes. PK modelling indicates that serum HCQ concentrations ≤100 ng/mL are suggestive of non-adherence regardless of trimester and may help identify pregnancies at risk for poor outcomes.

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