scholarly journals Multicenter experience with digital single-operator cholangioscopy in pregnant patients

2021 ◽  
Vol 09 (02) ◽  
pp. E116-E121
Author(s):  
Olaya I. Brewer Gutierrez ◽  
Gala Godoy Brewer ◽  
Claudio Zulli ◽  
Sooraj Tejaswi ◽  
Rishi Pawa ◽  
...  
Keyword(s):  
Bile Duct ◽  
Clear Cut ◽  
Stent Removal ◽  
Single Operator ◽  
Gestational Age At Delivery ◽  
Maternal And Neonatal Outcomes ◽  
The Mean ◽  
Median Birth Weight ◽  
In Pregnancy

Abstract Background and study aims The use of fluoroscopy during pregnancy should be minimized given that a clear-cut safe radiation dose in pregnancy is unknown. The role of digital single-operator cholangioscopy (D-SOC) as an alternative to standard enodoscopic retrograde cholangiopancreatography (ERCP) in pregnant patients has not been comprehensively studied. This study assessed 1 Technical success defined as performance of ERCP with D-SOC without the use of fluoroscopy in pregnant patients; 2 safety of D-SOC in pregnancy; and 3 maternal and neonatal outcomes after D-SOC during/after pregnancy. Patients and methods This was an international, multicenter, retrospective study at 6 tertiary centers. Pregnant patients who underwent D-SOC for the treatment of bile duct stones and/or strictures were included. Results A total of 10 patients underwent D-SOC. Indications for ERCP were choledocholithiasis, strictures, previous stent removal, and choledocholithiasis/stent removal. Bile duct cannulation without fluoroscopy was achieved in 10 of 10 patients (100 %). Moreover, 50 % of patients (5/10) completed a fluoroless ERCP with D-SOC. Mean fluoroscopy dose and fluoroscopy time were 3.4 ± 7.2 mGy and 0.5 ± 0.8 min, respectively. One case of mild bleeding and one case of moderate post-ERCP pancreatitis occurred. The mean gestational age at delivery was 36.2 ± 2.6 weeks. Median birth weight was 2.5 kg [IQR: 2.2–2.8]. No birth defects were noted. Conclusion ERCP guided by D-SOC appears to be a feasible and effective alternative to standard ERCP in pregnant patients. It enables avoidance of radiation in half of cases.

scholarly journals Systematic Review and Meta-Analysis to Assess the Safety of Bupropion and Varenicline in Pregnancy

2018 ◽  
Vol 21 (8) ◽  
pp. 1001-1010 ◽  
Author(s):  
Emily Turner ◽  
Matthew Jones ◽  
Luis R Vaz ◽  
Tim Coleman
Keyword(s):  
Systematic Review ◽  
Gestational Age ◽  
Strong Evidence ◽  
Congenital Malformations ◽  
Meta Analysis ◽  
Public Health Issue ◽  
Design Quality ◽  
Gestational Age At Delivery ◽  
The Mean ◽  
In Pregnancy

AbstractIntroductionSmoking in pregnancy is a substantial public health issue, but, apart from nicotine replacement therapy (NRT), pharmacological therapies are not generally used to promote cessation. Bupropion and varenicline are effective cessation methods in nonpregnant smokers and this systematic review investigates their safety in pregnancy.MethodsWe searched MEDLINE, EMBASE, CINAHL, and PsychINFO databases for studies of any design reporting pregnancy outcomes after bupropion or varenicline exposure. We included studies of bupropion used for smoking cessation, depression, or where the indication was unspecified. Depending on study design, quality was assessed using the Newcastle-Ottawa Scale or Cochrane Risk of Bias Tool. Most findings are reported narratively but meta-analyses were used to produce pooled estimates for the proportion of live births with congenital malformations and of the mean birthweight and gestational age at delivery following bupropion exposure.ResultsIn total, 18 studies were included: 2 randomized controlled trials, 11 cohorts, 2 case– control studies, and 3 case reports. Study quality was variable. Gestational safety outcomes were reported in 14 bupropion and 4 varenicline studies. Meaningful meta-analysis was only possible for bupropion exposure, for which the pooled estimated proportion of congenital malformations amongst live-born infants was 1.0% (95% CI = 0.0%–3.0%, I2 = 80.9%, 4 studies) and the mean birthweight and mean gestational age at delivery was 3305.9 g (95% CI = 3173.2–3438.7 g, I2 = 77.6%, 5 studies) and 39.2 weeks (95% CI = 38.8–39.6 weeks, I2 = 69.9%, 5 studies), respectively.ConclusionsThere was no strong evidence that either major positive or negative outcomes were associated with gestational use of bupropion or varenicline. PROSPERO registration number CRD42017067064.ImplicationsWe believe this to be the first systematic review investigating the safety of bupropion and varenicline in pregnancy. Meta-analysis of outcomes following bupropion exposure in pregnancy suggests that there are no major positive or negative impacts on the rate of congenital abnormalities, birthweight, or premature birth. Overall, we found no evidence that either of these treatments might be harmful in pregnancy, and no strong evidence to suggest safety, but available evidence is of poor quality.

scholarly journals Prevalence of Anaemia at Booking amongst Antenatal Clinic Attendees in Some Health Facilities in Ogoni, South-South Nigeria

2021 ◽  
pp. 176-182
Author(s):  
S. Eli ◽  
G. P. Tee Popnen ◽  
D. G. B. Kalio ◽  
N. C. T. Briggs ◽  
K. E. Okagua
Keyword(s):  
Developing Countries ◽  
Cell Volume ◽  
Packed Cell Volume ◽  
Antenatal Clinic ◽  
Health Care Facilities ◽  
The World ◽  
The Mean ◽  
Anaemia In Pregnancy ◽  
In Pregnancy

Background: Anaemia in pregnancy is an indirect cause of maternal mortality. Myriad of factors predispose pregnant women to anaemia in pregnancy in the developing countries of the world of which poverty, illiteracy and ignorance are central. The prevalence of anaemia in the developing countries of the world is between 32% and 62.2%. Objective: To determine the prevalence of anaemia amongst antenatal clinic attendees in Ogoni, South-South Nigeria and offer preventive measures. Material and Methods: This was a retrospective four months cross-sectional study of antenatal clinic attendees at booking in three (3) primary health care facilities and general hospitals Bori and Tera, in Ogoni, South-South Nigeria. Three hundred and eighty (380) pregnant women’s biodata including their packed cell volume were collected. These pieces of information were computed using a structured proforma. The data were coded and analysed using statistical package for social sciences (SPSS) software version 25. Results: The mean age of the study antenatal clinic attendees was 28 years. The mean gestational age at booking was 25weeks. The range for the packed cell volume was 25% to 36% and the mean packed cell volume at booking was 30%. Three hundred and eighteen (318) (84.0%) had anaemia (with packed cell volume less than 33%). Majority of patients 249 (65.6%) had mild anaemia There was none with severe anaemia. Majority of patients had secondary level of education represented by 275 (72.3%). Conclusion: The prevalence of anaemia amongst antenatal clinic attendees at Ogoni was 84.0%. The role of pre-pregnancy care amongst women desirous of pregnancy, familly planning and the role of education cannot be over emphasized in the prevention of anaemia in pregnancy.

scholarly journals Intraductal papillary neoplasm of the bile duct: the role of single-operator cholangioscopy

VideoGIE ◽  
2018 ◽  
Vol 3 (2) ◽  
pp. 55-57 ◽  
Author(s):  
Janet W.C. Kung ◽  
Rowan W. Parks ◽  
Hamish M. Ireland ◽  
Timothy J. Kendall ◽  
Nicholas I. Church
Keyword(s):  
Bile Duct ◽  
Intraductal Papillary Neoplasm ◽  
Single Operator ◽  
Papillary Neoplasm

Maternal Nutrition in Pregnancy: the Special Role of Dietary Fats and Socio-Economic Interactions

1983 ◽  
Vol 1 (3-4) ◽  
pp. 209-212 ◽  
Author(s):  
Wendy Doyle ◽  
M. A. Crawford
Keyword(s):  
Maternal Nutrition ◽  
Dietary Fats ◽  
Special Role ◽  
Socioeconomic Group ◽  
Lower Socioeconomic Group ◽  
Lower Socioeconomic ◽  
Significant Difference ◽  
The Mean ◽  
In Pregnancy

Maternal food intakes were assessed for one week in each trimester of pregnancy in 100 mothers from two socio-economically contrasting areas of London. There were significant differences in energy, fat and protein intakes as well as in many of the micro nutrients. There was also a significant difference in the mean birthweights with 11.8 per cent of the birthweights below 2500g and 50 per cent at or below 3000g in the lower socioeconomic group.

scholarly journals Does Lung Ultrasound Have a Role in the Clinical Management of Pregnant Women with SARS COV2 Infection?

2021 ◽  
Vol 18 (5) ◽  
pp. 2762
Author(s):  
Maria Grazia Porpora ◽  
Lucia Merlino ◽  
Luisa Masciullo ◽  
Rossella D’Alisa ◽  
Gabriella Brandolino ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Gestational Age ◽  
Viral Infections ◽  
Lung Ultrasound ◽  
Safe Alternative ◽  
Major Health ◽  
Gestational Age At Delivery ◽  
Clinical Conditions ◽  
In Pregnancy

Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection is a major health threat. Pregnancy can lead to an increased susceptibility to viral infections. Although chest computed tomography (CT) represents the gold standard for the diagnosis of SARS-CoV-2 pneumonia, lung ultrasound (LUS) could be a valid alternative in pregnancy. The objectives of this prospective study were to assess the role of LUS in the diagnosis of lung involvement and in helping the physicians in the management of affected patients. Thirty pregnant women with SARS-CoV-2 infection were admitted at the obstetrical ward of our Hospital. Mean age was 31.2 years, mean gestational age 33.8 weeks. Several LUS were performed during hospitalization. The management of the patients was decided according to the LUS score and the clinical conditions. Mean gestational age at delivery was at 37.7 weeks, preterm birth was induced in 20% of cases for a worsening of the clinical conditions. No neonatal complications occurred. In 9 cases with a high LUS score, a chest CT was performed after delivery. CT confirmed the results of LUS, showing a significant positive correlation between the two techniques. LUS seems a safe alternative to CT in pregnancy and may help in the management of these patients.

scholarly journals Sleep Duration during Pregnancy using an Activity Tracking Device

2020 ◽  
Vol 10 (03) ◽  
pp. e309-e314
Author(s):  
Michelle A. Kominiarek ◽  
Chen Yeh ◽  
Lauren C. Balmert ◽  
Francesca Facco ◽  
William Grobman ◽  
...  
Keyword(s):  
Sleep Duration ◽  
Gestational Age ◽  
Mixed Models ◽  
Neonatal Outcomes ◽  
Activity Tracking ◽  
Gestational Age At Delivery ◽  
Maternal And Neonatal Outcomes ◽  
The Mean ◽  
Diabetes Gestational ◽  
Tracking Device

Abstract Objective The aim of this study was to describe sleep duration across gestation in women who wore an activity-tracking device (ATD) during pregnancy, and to study the association between sleep duration and adverse maternal and neonatal outcomes Study Design Women ≥ 18 years old who owned a smartphone were approached to participate in 2016 to 2017. Participants received instructions to wear and sync an ATD daily. Steps, sedentary hours, and sleep duration were wirelessly transmitted via cellular technology. We measured sleep duration for the main episode of sleep and excluded sleep times < 120 minutes. Mixed models were used to assess the trajectory of mean weekly hours of sleep by gestational age. Secondary analyses evaluated differences in pregnancy outcomes between insufficient (< 7/24 hours) and sufficient sleep (≥ 7/24 hours) groups, based on mean hours of sleep within the first 7 days of ATD use. Results The majority of 94 participants self-reported minority racial–ethnic status (33% non-Hispanic black and 51% Hispanic), had government insurance (83%), were nulliparous (61%), and had pre-pregnancy overweight or obesity (56%). The mean (standard deviation) duration of sleep was 7.2 ± 2.4 hours per 24 hours. In mixed models analyses, gestational age was statistically significantly associated with mean hours of sleep (β = −0.02; 95% confidence interval: −0.04 to −0.01; p < 0.001). Women who had < 7 hours of sleep had greater median daily steps compared with those who had ≥ 7 hours of sleep (median: 7,122; interquartile range [IQR]: 5,167–8,338 vs. median: 5,005; IQR: 4,115–7,059; p < 0.01), but there were no significant differences in other outcomes (sedentary time, gestational weight gain, pregnancy associated hypertension, gestational diabetes, gestational age at delivery, cesarean delivery, or mean birthweight), p  > 0.05 for all comparisons. Conclusion The mean sleep duration was 7.2 ± 2.4 hours among the 94 women in this cohort and decreased with advancing gestational age. Further research is required to evaluate sleep measurements with ATD in pregnant women and how sleep duration and quality is related to maternal and neonatal outcomes.

scholarly journals Measuring clients’ experiences with antenatal care before or after childbirth: it matters

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5851 ◽  
Author(s):  
Marisja Scheerhagen ◽  
Erwin Birnie ◽  
Arie Franx ◽  
Henk F. van Stel ◽  
Gouke J. Bonsel
Keyword(s):  
Maternity Care ◽  
Gold Standard ◽  
Postnatal Care ◽  
Median Score ◽  
Negative Experience ◽  
Before And After ◽  
Absolute Agreement ◽  
The Mean ◽  
In Pregnancy

Background When clients’ experiences with maternity care are measured for quality improvement, surveys are administered once, usually six weeks or more after childbirth. Most surveys conveniently cover pregnancy, childbirth and postnatal care all in one. However, the validity of measuring the experiences during pregnancy (antenatal experiences) after childbirth is unknown. We explored the relation between the measurement of antenatal experiences late in pregnancy but prior to childbirth (‘test’ or gold standard) and its retrospective measurement after childbirth (retrospective test). Additionally, we explored the role of modifying determinants that explained the gap between these two measurements. Methods and Findings Client’s experiences were measured by the ReproQuestionnaire that consists of an antenatal and postnatal version, and covers the eight WHO Responsiveness domains. 462 clients responded to the antenatal and postnatal questionnaire, and additionally filled out the repeated survey on antenatal experiences after childbirth. First, we determined the association between the test and retrospective test using three scoring models: mean score, equal or above the median score and having a negative experience. The association was moderate for having any negative experience (absolute agreement = 68%), for the median (absolute agreement = 69%) and for the mean score (ICC = 0.59). Multiple linear and logistic regression analysis for all three scoring models revealed systematic modifiers. The gap between antenatal and postnatal measurement was (partly) associated with clients’ experiences during childbirth and postnatal care and by professional discontinuity during childbirth but unrelated to the perceived health outcome. Conclusions The antenatal experiences should be measured before and not after childbirth, as the association between the antenatal experiences measured before and after childbirth is moderate.

scholarly journals The Role of Indomethacin in Isolated Polyhydramnios

2020 ◽  
Vol 8 (2) ◽  
pp. 52-56
Author(s):  
Greeshma Singham ◽  
Vivekanand Achanta ◽  
Satyaprabha Siripurapu ◽  
SubhaRanjan Samantaray
Keyword(s):  
Gestational Age ◽  
Test Results ◽  
Medical Sciences ◽  
End Of Treatment ◽  
Gestational Age At Delivery ◽  
The Mean ◽  
The Difference ◽  
A Prospective Study ◽  
Respiratory Embarrassment

Objective: To study the role of Indomethacin in patients with Idiopathic Polyhydramnios who were symptomatic. Methods: A prospective study was conducted in Prathima Institute of Medical Sciences, Karimnagar from September 2017 to May 2019. Eighteen patients with Idiopathic Polyhydramnios who presented with respiratory embarrassment, premature opening of os or presence of uterine activity were given Indomethacin orally at a dose of 25mg 6th hourly. The significance of changes in AFI was tested by paired t test. Results : There was significant improvement in the symptoms in all the eighteen patients. The mean age of the patients in our study was 26.4±5.5 years. The majority 14(77.7%) of women were multigravida. Mean gestational age at presentation was 30.78±1.56 weeks. Mean AFI at presentation was 31.56±3.68 cm. Indomethacin was given orally at a dose of 25mg, every 6th hourly for a mean duration of 22.5±6.38 days. Mean AFI at the end of treatment was 20.28±5.64 cm. Pregnancy was prolonged by an average of 5.5±1.89 weeks. The difference in AFI at the end of treatment was statistically significant (p<0.05). Oligohydramnios was seen in one patient. Mean gestational age at delivery was 36.28±1.41 weeks. 17(94.4%) of them had good neonatal outcome. There was one neonatal death at< 7 days of birth. Conclusion: Indomethacin significantly decreases amniotic fluid volume in patients with Idiopathic Polyhydramnios and relieves symptoms but close surveillance is necessary.

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