scholarly journals Pregnancy-related complications and perinatal outcomes following progesterone supplementation before 20 weeks of pregnancy in spontaneously achieved singleton pregnancies: a systematic review and meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Hanglin Wu ◽  
Songying Zhang ◽  
Xiaona Lin ◽  
Jing He ◽  
Shasha Wang ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Recurrent Miscarriage ◽  
Perinatal Outcomes ◽  
Quality Of Evidence ◽  
Moderate Quality ◽  
Threatened Miscarriage ◽  
History Of ◽  
Progesterone Supplementation ◽  
Singleton Pregnancies

Abstract Background Progesterone supplementation is widely performed in women with threatened miscarriage or a history of recurrent miscarriage; however, the effects of early progesterone supplementation on pregnancy-related complications and perinatal outcomes in later gestational weeks remain unknown. Methods Ovid MEDLINE, the Cochrane Library, Embase and ClinicalTrials.gov were searched until April 3rd, 2021. Randomized controlled trials regarding spontaneously achieved singleton pregnancies who were treated with progestogen before 20 weeks of pregnancy and were compared with those women in unexposed control groups were selected for inclusion. We performed pairwise meta-analyses with the random-effects model. The risk of bias was assessed according to the Cochrane Collaboration tool. The primary outcomes included preeclampsia (PE), and gestational diabetes mellitus (GDM), with the results presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results We identified nine eligible studies involving 6439 participants. The pooled OR of subsequent PE following early progestogen supplementation was 0.64 (95% CI 0.42–0.98, moderate quality of evidence). A lower OR for PE was observed in the progestogen group when the subgroup analysis was performed in the vaginal subgroup (OR 0.62, 95%CI 0.40–0.96). There was insufficient evidence of a difference in the rate of GDM between pregnant women with early progestogen supplementation and unexposed pregnant women (OR 1.02, 95% CI 0.79–1.32, low quality of evidence). The pooled OR of low birth weight (LBW) following oral dydrogesterone was 0.57 (95% CI 0.34–0.95, moderate quality of evidence). The results were affected by a single study and the total sample size of enrolled women did not reach the required information size. Conclusion Use of vaginal micronized progesterone (Utrogestan) in spontaneously achieved singleton pregnancies with threatened miscarriage before 20 weeks of pregnancy may reduce the risk of PE in later gestational weeks. Among spontaneously achieved singleton pregnancies with threatened miscarriage or a history of recurrent miscarriage, use of oral dydrogesterone before 20 weeks of pregnancy may result in a lower risk of LBW in later gestational weeks. However, the available data were not sufficient to reach definitive conclusions, which highlighted the need for future studies.

scholarly journals REGULATION OF PERIPHERAL B-LYMPHOCYTE DIFFERENTIATION IN RECURRENT MISCARRIAGE

2021 ◽  
Vol 23 (4) ◽  
pp. 711-716
Author(s):  
A. I. Malyshkina ◽  
N. Yu. Sotnikova ◽  
A. V. Kust ◽  
D. N. Voronin
Keyword(s):  
Pregnant Women ◽  
B Lymphocytes ◽  
B Lymphocyte ◽  
Comparison Group ◽  
Recurrent Miscarriage ◽  
Main Group ◽  
Lymphocyte Differentiation ◽  
Spontaneous Miscarriage ◽  
Threatened Miscarriage ◽  
History Of

The important role of immune disorders in recurrent miscarriage has been proven. Clarification of the character of B-lymphocyte differentiation and its regulation factors in women with threatened miscarriage and recurrent miscarriage in history is an urgent problem, since it will reveal the immune mechanisms of the pathogenesis of this pathology. Purpose: to establish the features of B-lymphocyte differentiation and factors of its regulation in women with a history of recurrent miscarriage and threatening spontaneous miscarriage at the time of examination.Were examined pregnant women aged 18-40 years at a gestation period of 5-12 weeks. The main group consisted of 60 pregnant women with a threatening spontaneous miscarriage at the time of examination and a history of recurrent miscarriage. As a control, 35 pregnant women with uncomplicated pregnancy were examined. The comparison group consisted of 25 primary pregnant women with threatened spontaneous miscarriage at the time of examination. The material for the study was peripheral venous blood. Subpopulations of B-lymphocytes CD19+, CD19+ IgD+, CD20+IgM+, CD20+IgG+ were determined by flow cytometry; CD19+CD20- CD38+, CD19+CD27- , CD19+CD27+. Serum levels of BAFF and APRIL were assessed by enzyme-linked immunosorbent assay.In the main group, an increase in the proportion of B-cells, CD20+IgM+-lymphocytes and memory cells was recorded in the peripheral blood, along with a decrease in the level of naive cells and plasma cells. In the comparison group, an increase in the proportion of immature IgM+B-cells, circulating memory cells, along with a decrease in naive B-lymphocytes, was registered. in the main group there was a pronounced decrease in the serum BAFF level compared with the control and comparison groups. Analysis of the APRIL content showed a pronounced downward trend in groups with threatened miscarriage relative to healthy pregnant women. Thus, threatening habitual and sporadic miscarriages were associated with a shift in the differentiation of B-lymphocytes towards immature forms and a lack of regulatory influence of BAFF and APRIL, which is reflected in the disruption of B-cell homeostasis and weakening of humoral effector mechanisms at the systemic level. The revealed changes may indicate a single mechanism for the development of a threatening spontaneous miscarriage, the severity of which increases with repeated loss of pregnancy. These changes can lead to an increase in effector cytotoxic mechanisms and an increase in proinflammatory cytokines, which can lead to the development of damaging reactions in the fetoplacental complex, which can be reflected in the clinical picture of the threat of termination of pregnancy. 

IUI for unexplained infertility—a network meta-analysis

2019 ◽  
Vol 26 (1) ◽  
pp. 1-15 ◽  
Author(s):  
N A Danhof ◽  
R Wang ◽  
M van Wely ◽  
F van der Veen ◽  
B W J Mol ◽  
...  
Keyword(s):  
Live Birth ◽  
Ovarian Stimulation ◽  
Meta Analysis ◽  
Multiple Pregnancy ◽  
Pregnancy Rates ◽  
Natural Cycle ◽  
Ongoing Pregnancy ◽  
Quality Of Evidence ◽  
Moderate Quality

ABSTRACT BACKGROUND IUI for unexplained infertility can be performed in a natural cycle or in combination with ovarian stimulation. A disadvantage of ovarian stimulation is an increased risk of multiple pregnancies with its inherent maternal and neonatal complication risks. Stimulation agents for ovarian stimulation are clomiphene citrate (CC), Letrozole or gonadotrophins. Although studies have compared two or three of these drugs to each other in IUI, they have never been compared to one another in one analysis. OBJECTIVE AND RATIONALE The objective of this network meta-analysis was to compare the effectiveness and safety of IUI with CC, Letrozole or gonadotrophins with each other and with natural cycle IUI. SEARCH METHODS We searched PubMed, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL and the Clinical Trial Registration Database indexed up to 16 August 2018. We included randomized controlled trials that compared a stimulation regimen with CC, Letrozole or gonadotrophins to each other or to natural cycle IUI among couples with unexplained infertility. We performed the network meta-analysis within a multivariate random effects model. OUTCOMES We identified 26 studies reporting on 5316 women. The relative risk (RR) for live birth/ongoing pregnancy rates comparing IUI with CC to natural cycle IUI was 1.05 (95% CI 0.63–1.77, low quality of evidence), while comparing IUI with Letrozole to natural cycle IUI was 1.15 (95% CI 0.63–2.08, low quality of evidence) and comparing IUI with gonadotrophins to natural cycle IUI was 1.46 (95% CI 0.92–2.30, low quality of evidence). The RR for live birth/ongoing pregnancy rates comparing gonadotrophins to CC was 1.39 (95% CI 1.09–1.76, moderate quality of evidence), comparing Letrozole to CC was 1.09 (95% CI 0.76–1.57, moderate quality of evidence) and comparing Letrozole to gonadotrophins was 0.79 (95% CI 0.54–1.15, moderate quality of evidence). We did not perform network meta-analysis on multiple pregnancy due to high inconsistency. Pairwise meta-analyses showed an RR for multiple pregnancy rates of 9.11(95% CI 1.18–70.32) comparing IUI with gonadotrophins to natural cycle IUI. There was no data available on multiple pregnancy rates following IUI with CC or Letrozole compared to natural cycle IUI. The RR for multiple pregnancy rates comparing gonadotrophins to CC was 1.42 (95% CI 0.68–2.97), comparing Letrozole to CC was 0.97 (95% CI 0.47–2.01) and comparing Letrozole to gonadotrophins was 0.29 (95% CI 0.14–0.58). In a meta-analysis among studies with adherence to strict cancellation criteria, the RR for live births/ongoing pregnancy rates comparing gonadotrophins to CC was 1.20 (95% CI 0.95–1.51) and the RR for multiple pregnancy rates comparing gonadotropins to CC was 0.80 (95% CI 0.38–1.68). WIDER IMPLICATIONS Based on low to moderate quality of evidence in this network meta-analysis, IUI with gonadotrophins ranked highest on live birth/ongoing pregnancy rates, but women undergoing this treatment protocol were also at risk for multiple pregnancies with high complication rates. IUI regimens with adherence to strict cancellation criteria led to an acceptable multiple pregnancy rate without compromising the effectiveness. Within a protocol with adherence to strict cancellation criteria, gonadotrophins seem to improve live birth/ongoing pregnancy rates compared to CC. We, therefore, suggest performing IUI with ovarian stimulation using gonadotrophins within a protocol that includes strict cancellation criteria. Obviously, this ignores the impact of costs and patients preference.

The status of biocenosis in pregnant women with a history of recurrent miscarriage

2018 ◽  
Vol 10_2018 ◽  
pp. 106-111 ◽  
Author(s):  
Solovyeva A.V. Solovyeva ◽  
Gerasimova O.P. Gerasimova ◽  
Ermolenko K.S. Ermolenko ◽  
Gevorgyan D.A. Gevorgyan ◽  
◽  
...  
Keyword(s):  
Pregnant Women ◽  
Recurrent Miscarriage ◽  
The Status ◽  
History Of

Abnormal cytokine levels in non-pregnant women with a history of recurrent miscarriage

2004 ◽  
Vol 115 (1) ◽  
pp. 51-54 ◽  
Author(s):  
Rhoda Wilson ◽  
Carol Jenkins ◽  
Helen Miller ◽  
Iain B McInnes ◽  
Judith Moore ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Recurrent Miscarriage ◽  
Cytokine Levels ◽  
History Of

scholarly journals Overview of evidence-based clinical practice guidelines for preoperative care: a systematic review.

2020 ◽  
Author(s):  
Agustín Ciapponi ◽  
Tapia-López Elena ◽  
Virgilio Sacha ◽  
Ariel Bardach
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cochrane Library ◽  
Evidence Based ◽  
Agree Ii ◽  
Quality Of Evidence ◽  
Moderate Quality

Abstract Background Our aim was to summarize and compare relevant recommendations from evidence-based CPGs (EB-CPGs). Methods Systematic review of clinical practice guidelines. Data sources: PubMed, EMBase, Cochrane Library, LILACS, Tripdatabase and additional sources. In July 2017, we searched CPGs that were published in the last 10 years, without language restrictions, in electronic databases, and also searched specific CPG sources, reference lists and consulted experts. Pairs of independent reviewers selected EB-CPGs and rated their methodological quality using the AGREE-II instrument. We summarized recommendations, its supporting evidence and strength of recommendations according to the GRADE methodology. Results We included 16 EB-CPGs out of 2262 references identified. Only nine of them had searches within the last five years and seven used GRADE. The median (percentile 25-75) AGREE-II scores for rigor of development was 49% (35-76%) and the domain ‘applicability’ obtained the worst score: 16% (9-31%). We summarized 31 risk stratification recommendations, 21.6% of which were supported by high/moderate quality of evidence (41% of them were strong recommendations), and 16 therapeutic/preventive recommendations, 59% of which were supported by high/moderate quality of evidence (75.7% strong). We found inconsistency in ratings of evidence level. ‘Guidelines’ applicability’ and ‘monitoring’ were the most deficient domains. Only half of the EB-CPGs were updated in the past five years. Conclusions We present many strong recommendations that are ready to be considered for implementation as well as others to be interrupted, and we reveal opportunities to improve guidelines’ quality.

scholarly journals Efficacy of Longdan Xiegan Decoction on the Treatment of Eczema: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Ziteng Hu ◽  
Lidong Gao ◽  
Chengxian Li ◽  
Alberto Cucco ◽  
Shang Wang ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Total Effective Rate ◽  
Meta Analysis ◽  
Effective Rate ◽  
Biomedical Literature ◽  
Cure Rate ◽  
Quality Of Evidence ◽  
Moderate Quality ◽  
Quality Evidence

Background. Longdan Xiegan decoction (LDXGD) has been widely used in the treatment of eczema. In recent years, randomized controlled trials (RCTs) of LDXGD for the treatment of eczema have gradually increased. Most of the results show that LDXGD is effective in treating eczema. However, whether these conclusions are reliable or not requires meta-analysis. Objective. This study aimed to systematically evaluate the clinical efficacy of LDXGD in the treatment of eczema. Materials and Methods. Seven electronic databases, including PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, Chinese Biomedical Literature on Disc (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and Chinese Science and Technology Periodical Database (VIP) were systematically searched from their inception until January 2021. Risk of bias was assessed using criteria from the Cochrane Collaboration and meta-analysis was conducted on the screened literature data using Review Manage (RevMan 5.3). Then, to assess the quality of evidence, the GRADE criteria was adopted. Results. 14 RCTs with 1080 participants were identified. Meta-analysis indicated that compared with western medicine (WM), the cure rate and the total effective rate of LDXGD in treating eczema were higher. Meanwhile, the recurrence rate and the levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor (TNF-α) after treatment were lower. The adverse reaction was reported in 5 out of 14 studies without significant statistical difference. According to GRADE criteria, the quality of evidence was low for all outcomes except for the cure rate (moderate-quality evidence) and the total effective rate (moderate-quality evidence). Conclusion. The clinical efficacy of LDXGD in the treatment of eczema was more effective compared with the one of conventional WM alone. However, due to the limitation of the quality of the included studies, additional studies are required to further confirm these results.

scholarly journals ECLAMPTIC PATIENTS

2015 ◽  
Vol 22 (11) ◽  
pp. 1464-1470
Author(s):  
Sadia Zahoor ◽  
Tahira Malik ◽  
Sonia Zulfiqar
Keyword(s):  
Pregnant Women ◽  
Tertiary Care ◽  
Perinatal Outcomes ◽  
Basic Care ◽  
Induced Hypertension ◽  
Qualitative Variables ◽  
Unfavorable Cervix ◽  
Hospital Study ◽  
Very High

Background: Hypertensive disorders are the second most common cause ofmaternal death worldwide. Eclampsia is the extension of pregnancy induced hypertension tothe point of conclusions, coma or both. Objectives: To find out the incidence of eclampsiaamong pregnant women and to identify the maternal and perinatal outcomes of eclampticpatients treated in a tertiary care referral hospital. Study Design: Discretional cross sectionalstudy. Setting: Department of Obstetrics & Gynecology, Sheikh Zayed Hospital, Rahim YarKhan. Period: January 2014 to December 2014. Methods: A total number of 96 patients out of10513 who were diagnosed as being eclamptic during the study period were included in thisstudy. While normal pregnant women and Patient’s with uncertain diagnosis was excluded. Allpatient variables were entered and analyzed using SPSS v20. Frequency and percentages wereused to express qualitative variables. Results: There were total ninety six patients (0.913%) outof 10,513 who presented with eclampsia. Most of eclamptic patients were of having age >21years. Among patients who developed eclampsia 52 (54.16%) were in Ante partum period and40 (41.66%) were in postpartum period. Out of 96, five patients died before delivery and thirteenafter delivery, seventy eight patients developed one or more complications during delivery.Out of total 91 deliveries, 54 (59.30%) were delivered by cesarean section (C/S). Main reasonfor C/S was unfavorable cervix. Out of total ninety one deliveries two were twins and eightynine singletons. Fifty eight (62.36%) babies were born at a gestational age <37 weeks. Birthasphyxia occurred in sixty one (65.60%) newborns. There were twenty two (23.65%) perinataldeaths, fourteen (63.64%) were stillbirths and eight (36.36%) were early neonatal deaths.Conclusion: Eclampsia is found to be associated with very high rates of maternal mortality andmorbidity as well as perinatal mortality. Early diagnosis of eclampsia and its timely managementcan reduce the risk of this mortality. This can be made possible by provision of basic facilitiesand improvements in the quality of basic care provided by our antenatal clinics.

scholarly journals European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia

2021 ◽  
pp. 239698732110397
Author(s):  
Rainer Dziewas ◽  
Emilia Michou ◽  
Michaela Trapl-Grundschober ◽  
Avtar Lal ◽  
Ethem Murat Arsava ◽  
...  
Keyword(s):  
Treatment Options ◽  
Standard Operating Procedure ◽  
Dietary Interventions ◽  
Stroke Patients ◽  
Pharmacological Agents ◽  
Quality Of Evidence ◽  
Post Stroke ◽  
Moderate Quality ◽  
Grade Approach

Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD.

Role of CD20 + IL-10 + B-lymphocytes in immunoregulatory processes in women with reccurent miscarriage

2021 ◽  
Vol 66 (8) ◽  
pp. 485-488
Author(s):  
A. V. Kust ◽  
N. Y. Sotnikova ◽  
A. I. Malyshkina ◽  
D. N. Voronin
Keyword(s):  
Pregnant Women ◽  
B Lymphocytes ◽  
Recurrent Miscarriage ◽  
Sharp Decrease ◽  
Main Group ◽  
Relative Content ◽  
Control Group ◽  
Becton Dickinson ◽  
Spontaneous Miscarriage ◽  
History Of

To determine the level of CD20 + IL-10 + B-lymphocytes in pregnant women with the threat of termination of pregnancy at 5-12 weeks and recurrent miscarriage in history and compare the data obtained with the end of gestation. A survey of 65 women at a gestational age of 5-12 weeks was carried out. The main group consisted of 33 women with a threatening recurrent miscarriage at the time of the examination, the comparison group consisted of 10 pre-pregnant women with a threatening sporadic miscarriage at the time of the examination, the control group consisted of 22 pregnant women without signs of a threatening miscarriage. The main group, depending on the outcomes of pregnancy, is divided into 2 subgroups: subgroup A - pregnancy ended in undeveloped pregnancy or miscarriage (9 women), subgroup B - pregnancy ended in childbirth (24 women). The relative content of CD20 + IL-10 + B-lymphocytes was determined by flow cytometry on FACSCanto II (Becton Dickinson, USA). Women in the main group had a significantly lower level of CD20 + IL-10 + B-lymphocytes in comparison with the rest of the surveyed. A retrospective analysis revealed that among women of subgroup A there was a sharp decrease in CD20 + IL-10 + cells compared with subgroup B. Prediction of a non-developing pregnancy and spontaneous miscarriage up to 22 weeks of gestation in pregnant women with threatened spontaneous miscarriage and a history of recurrent miscarriage is possible with the relative content of CD20 + IL-10 + equal to or less than 4.5% (sensitivity 100%, specificity 82.6%, accuracy 87.9%).

Regulation of the functional activity of peripheral B lymphocytes in pregnant women with a history of recurrent miscarriage

2021 ◽  
Vol 70 (4) ◽  
pp. 73-79
Author(s):  
Anna I. Malyshkina ◽  
Natalia Y. Sotnikova ◽  
Dmitriy N. Voronin ◽  
Alena V. Kust
Keyword(s):  
Pregnant Women ◽  
Mrna Expression ◽  
B Lymphocytes ◽  
Functional Activity ◽  
Recurrent Miscarriage ◽  
Quantitative Polymerase Chain Reaction ◽  
Main Group ◽  
Control Group ◽  
Spontaneous Miscarriage ◽  
History Of

BACKGROUND:The frequency of recurrent miscarriage is up to 5 % of all desired pregnancies and is mainly due to immunological disorders. Dysfunction in the regulation of the functional activity of B lymphocytes is the pathogenetic link in multiple obstetric complications, including habitual miscarriage. AIM:The aim of this study was to characterize the regulation of the functional activity of peripheral B lymphocytes in pregnant women with threatened spontaneous miscarriage and a history of habitual miscarriage. MATERIALS AND METHODS:We examined 88 women aged 18-40 years at a gestation period of 5-12 weeks. The main group consisted of 36 patients with threatened spontaneous miscarriage at the time of examination and a history of habitual miscarriage. The control group included 28 women with uncomplicated pregnancy. The comparison group consisted of 24 primary pregnant patients with threatened spontaneous abortion at the time of examination. BAFF and APRIL levels in the blood serum were determined by enzyme immunoassay. The content of CD19+BAFFR+B lymphocytes in the lymphocyte gate was evaluated in the peripheral blood by flow cytometry using monoclonal antibodies. Akt mRNA expression was assessed using real-time reverse-transcription quantitative polymerase chain reaction. CD19+В lymphocytes were isolated by direct magnetic separation. RESULTS:In the main group, there was an increase in expression of BAFF receptors on peripheral CD19+B lymphocytes and a decrease in the serum BAFF concentration compared to the parameters in the other study groups. We also found a pronounced trend towards a decrease in the serum APRIL level in the main and comparison groups of patients compared to healthy pregnant women. Besides, Akt mRNA expression in peripheral CD19+B lymphocytes was increased in the main group. CONCLUSIONS:Threatened habitual abortion is associated with the deficit of the regulatory influence of BAFF and APRIL, which is expressed in the disruption of B cell homeostasis and the weakening of humoral effector mechanisms.

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