scholarly journals Caesarean Section to Prevent Transmission of Hepatitis B: A Meta-Analysis

2014 ◽  
Vol 28 (8) ◽  
pp. 439-444 ◽  
Author(s):  
Matthew S Chang ◽  
Sravanya Gavini ◽  
Priscila C Andrade ◽  
Julia McNabb-Baltar
Keyword(s):  
Caesarean Section ◽  
Hepatitis B ◽  
Vaginal Delivery ◽  
Vertical Transmission ◽  
Meta Analysis ◽  
Delivery Mode ◽  
Significant Heterogeneity ◽  
Case Control Studies ◽  
Manual Search ◽  
Hbv Transmission

BACKGROUND: Vertical transmission of hepatitis B virus (HBV) occurs in up to 10% to 20% of births.OBJECTIVE: To assess whether Caesarean section, compared with vaginal delivery, prevents HBV transmission.METHODS: A systematic review and meta-analysis was conducted. Two investigators independently searched PubMed, EMBASE and other databases for relevant studies published between 1988 and 2013. A manual search of relevant topics and major conferences for abstracts was also conducted. Randomized trials, cohort and case-control studies assessing the effect of delivery mode on vertical transmission of HBV were included. Studies assessing antiviral therapy and patients with coinfection were excluded. The primary outcome was HBV transmission rates according to delivery method.RESULTS: Of the 430 studies identified, 10 were included. Caesarean section decreased the odds of HBV transmission by 38% compared with vaginal delivery (OR 0.62 [95% CI 0.40 to 0.98]; P=0.04) based on a random-effects model. Significant heterogeneity among studies was found (I2=63%; P=0.003), which was largely explained by variation in hepatitis B immune globulin (HBIG) administration. Meta-regression showed a significant linear association between the percentage of infants receiving HBIG per study and the log OR (P=0.005), with the least benefit observed in studies with 100% HBIG administration. Subgroup analysis of hepatitis B e-antigen-positive women who underwent Caesarean section did not show a significant reduction in vertical transmission.DISCUSSION: Caesarean section may protect against HBV transmission; however, convincing benefit could not be demonstrated due to significant study heterogeneity from variable HBIG administration, highlighting the importance of HBIG in HBV prevention.CONCLUSION: More high-quality studies are needed before any recommendations can be made.

Factor V Leiden mutation and pregnancy-related venous thromboembolism: What is the exact risk?

2006 ◽  
Vol 96 (07) ◽  
pp. 14-18 ◽  
Author(s):  
Jean-Francois Schved ◽  
Jean-Pierre Daures ◽  
Christine Biron-Andreani
Keyword(s):  
Venous Thromboembolism ◽  
Meta Analysis ◽  
Random Effect ◽  
Factor V Leiden ◽  
Significant Heterogeneity ◽  
Average Risk ◽  
Factor V ◽  
Case Control Studies ◽  
Factor V Leiden Mutation ◽  
Statistical Heterogeneity

SummaryThe magnitude of the association of factor V Leiden mutation with pregnancy-related venous thrombosis remains unclear. Our objective was to undertake a systematic review and a meta-analysis of the literature to estimate precisely the association of factor V Leiden mutation with the risk of first,or recurrent,pregnancy-related venous thromboembolism. Studies published before October 2005 were identified by Medline®. Using both fixed and random effect models, odds ratios (OR) with accompanying 95% confidential intervals (CI) were calculated for the factor V Leiden mutation and the clinical end-point (Yusuf-Peto adaptation of the Mantel-Haenszel, DerSimonian and Laird method).We identified 13 studies including 7 cohorts and 6 case control studies relating to factor V Leiden and pregnancy-related venous thrombosis.The results from the cohorts showe a pooled OR of 4.46 (95% CI,1.82–10.94;7,879 pooled women), with no evidence of statistical heterogeneity (p=0.36), for the risk of a first venous thromboembolism during pregnancy or the postpartum period associated with the factor V Leiden mutation.Case-control studies revealed a higher risk ( OR 8.6,95% CI, 5.85–12.63; 1,524 pooled women) with significant heterogeneity (p<0.005). Because of insufficient data, an analysis for the risk of recurrence could not be performed. Our findings emphasize the fact that limited data are available on this topic.This meta-analysis provides clinicians with an estimate of the average risk of a first thrombosis occurring during pregnancy in women carrying the factor V Leiden to assist the management of such women.

scholarly journals Indicators for mode of delivery in pregnant women with uteruses scarred by prior caesarean section: a retrospective study of 679 pregnant women

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Zhifen Hua ◽  
Fadwa El Oualja
Keyword(s):  
Retrospective Study ◽  
Caesarean Section ◽  
Pregnant Women ◽  
Vaginal Delivery ◽  
Gestational Age ◽  
Placenta Previa ◽  
Mode Of Delivery ◽  
Fetal Membrane ◽  
Delivery Mode ◽  
Maternal Preference

Abstract Background The delivery mode for pregnant women with uteruses scarred by prior caesarean section (CS) is a controversial issue, even though the CS rate has risen in the past 20 years. We performed this retrospective study to identify the factors associated with preference for CS or vaginal birth after CS (VBAC). Methods Pregnant women (n = 679) with scarred uteruses from Moulay Ali Cherif Provincial Hospital, Rashidiya, Morocco, were enrolled. Gestational age, comorbidity, fetal position, gravidity and parity, abnormal amniotic fluid, macrosomia, placenta previa or abruptio, abnormal fetal presentation, premature rupture of fetal membrane with labor failure, poor progression in delivery, and fetal outcomes were recorded. Results Out of 679 pregnant women ≥28 gestational weeks, 351 (51.69%) had a preference for CS. Pregnant women showed preference for CS if they were older (95% CI 1.010–1.097), had higher gestational age (95% CI 1.024–1.286), and a shorter period had passed since the last CS (95% CI 0.842–0.992). Prior gravidity (95% CI 0.638–1.166), parity (95% CI 0.453–1.235), vaginal delivery history (95% CI 0.717–1.818), and birth weight (95% CI 1.000–1.001) did not influence CS preference. In comparison with fetal preference, maternal preference was the prior indicator for CS. Correlation analysis showed that pregnant women with longer intervals since the last CS and history of gravidity, parity, and vaginal delivery showed good progress in the first and second stages of vaginal delivery. Conclusions We concluded that maternal and gestational age and interval since the last CS promoted CS preference among pregnant women with scarred uteruses.

scholarly journals Sa1020 Hepatitis B Virus Infection and Risk of Non-Hodgkin Lymphoma: A Meta-Analysis of Case-Control Studies

2013 ◽  
Vol 144 (5) ◽  
pp. S-974 ◽  
Author(s):  
Rajan Kanth ◽  
Anupama Inaganti ◽  
Naga Swetha Samji ◽  
Sarah D. Komanapalli ◽  
Brian B. Borg ◽  
...  
Keyword(s):  
Hepatitis B Virus ◽  
Virus Infection ◽  
Hepatitis B ◽  
Hodgkin Lymphoma ◽  
Meta Analysis ◽  
Case Control ◽  
Hepatitis B Virus Infection ◽  
Case Control Studies ◽  
Non Hodgkin Lymphoma ◽  
B Virus

scholarly journals Methylenetetrahydrofolate reductase (MTHFR) A1298C polymorphism and risk of lung cancer

2019 ◽  
Author(s):  
Vandana Rai
Keyword(s):  
Lung Cancer ◽  
Methylenetetrahydrofolate Reductase ◽  
Meta Analysis ◽  
Epidemiological Studies ◽  
Mthfr Gene ◽  
Significant Heterogeneity ◽  
Case Control Studies ◽  
Mthfr A1298c ◽  
A1298c Polymorphism ◽  
Allele Contrast

AbstractRecent epidemiological studies have reported association between methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms and lung cancer. The aim of the present study to perform a meta-analysis of published studies to validate the association between MTHFR A1298C polymorphism and risk of lung cancer.PubMed, Springer Link, Science Direct and Google Scholar databases were searched for eligible studies. Of the 78 initially identified studies, 11 case–control studies with 5,996 patients and 7,404 healthy controls were finally included in the present meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated to assess the association, and all statistical analyses were performed using MIX software (version 1.7).No statistically significant associations were found between the MTHFR A1298C polymorphism and lung cancer risk in the additive/ allele contrast, co-dominant/heterozygote, homozygote, dominant and recessive genetic models (C vs. A: OR= 0.95, 95% CI= 0.83-1.08; CC vs. AA: OR= 1.13, 95% CI= 0.83-1.5; AC vs. AA: OR= 0.86, 95% CI= 0.70-1.02; AC+CC vs. AA: OR= 0.89, 95% CI= 0.75-1.05; CC vs. AA+AC: OR= 1.20, 95% CI= 0.89-1.40). Significant heterogeneity between individual studies was evident in all five models. In conclusion, present meta-analysis results indicated that there is no significant association between MTHFR A1298C polymorphism and risk of lung cancer.

Hepatitis B reactivation in HBsAg-/cAb+ patients receiving rituximab: A meta-analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6592-6592
Author(s):  
Lee Mozessohn ◽  
Kelvin K. Chan ◽  
Jordan J. Feld ◽  
Lisa K Hicks
Keyword(s):  
At Risk ◽  
Hepatitis B ◽  
Meta Analysis ◽  
Antiviral Treatment ◽  
Case Series ◽  
Primary Data ◽  
Significant Heterogeneity ◽  
Hbv Reactivation ◽  
Mesh Terms ◽  
The Impact

6592 Background: Patients with hepatitis B virus (HBV) who are HBsAg+ are recognized to be at risk of HBV reactivation if rituximab is administered in the absence of antiviral treatment. Recently, it has been reported that patients with so-called “resolved HBV infection”(HBsAg-/cAb+) may also be at risk; however, the degree of risk is not known. Methods: We performed a systematic review of the English and Chinese language literature in Medline (1996 to July week 2 2012) and Embase (1996 to 2012 week 29) using the MeSH terms “lymphoma” and “hepatitis B”. Eligible studies were limited to those reporting primary data on HBV reactivation rates in HBsAg-/cAb+ patients receiving rituximab. We excluded case series with less than 5 patients. Pooled estimates were calculated for HBV reactivation and the impact of HBsAb status on HBV reactivation rate was explored. Results: Data from 445 patients in 12 studies were included. Using a standardized definition of HBV reactivation, (ALT >3 x upper limit of normal AND either an increase in HBV DNA from baseline OR HBsAg seroreversion), the pooled estimate for the risk of HBV reactivation in HBsAg-/cAb+ patients was 5.4% (I2 = 63%, P = 0.009). Significant heterogeneity was apparent. Exploratory analyses suggested that patients were less likely to reactivate if they were HBsAb+ (OR = 0.32; 95% CI 0.12-0.85, P = 0.0285). Conclusions: Our meta-analysis confirms that there is a measurable risk of HBV reactivation in HBsAg-/cAb+ patients exposed to rituximab HBsAb+ patients may be at lower risk than those who are HBsAb-. However, heterogeneity in the risk estimates limits their generalizability. Large prospective studies are needed to clarify the risk of HBV reactivation in HBsAg-/cAb+ patients and to inform decisions about best practice.

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