Effectiveness of pregravid preparation in women of high infectious risk

2018 ◽  
pp. 31-35
Author(s):  
T.G. Romanenko ◽  
◽  
O.M. Sulimenko ◽  
Keyword(s):  
High Risk ◽  
Bacterial Vaginosis ◽  
Pregnant Women ◽  
Risk Group ◽  
Intrauterine Infection ◽  
Vaginal Candidiasis ◽  
Placental Dysfunction ◽  
Infectious Risk ◽  
Group I ◽  
Group Ii

The article presents the results of the effectiveness of the combined antimicrobial drug Guinex Forte, the effect of which is caused by metronidazole and miconazole, and the Orgil tablets at the stage of pregravid preparation in women of high-risk group, with regard to the development of placental insufficiency of infectious genesis and intrauterine infection. The objective: is to demonstrate the effectiveness of pregravid preparation for the normalization of vaginal biocenosis in pregnant women of high infectious risk. Materials and methods. 150 pregnant women were investigated, of which 100 with a high risk of infectious risk for placental dysfunction and intrauterine infection: Group I – 50 pregnant women who did not undergo pregravid preparation; Group II – 50 pregnant women who planned pregnancy and conducted pregravid preparation for prevention and treatment of bacterial vaginosis and vaginal candidiasis; Control group consisted of 50 pregnant women who gave birth again, without obstetrical and extragenital pathology in history. per vaginum. Results. In pregnant women in Group II, an intermediate type of dysbiosis was 1.2 times less likely than in pregnant women of group I, and vice versa, normocenosis was achieved 9.7 times more often in pregnant women who received pregravid preparation. After the therapy in the pregravid period, in pregnant women of group II in the first trimester of pregnancy quantitative and qualitative indices of biocenosis of the vagina were approaching, in most cases, to normal. In general, the spectrum of the microflora decreased from 21 to 14 species due to the reduction of pathogenic forms of staphylococci, streptococci, enterobacteria, E. coli, klebsiela, cornebacteria and clostridia. In patients of group II, the concentration of representatives of resident flora increased (lactobacillus Lg 5.06±0.7 CFU / ml and bifidobacterium-Lg 4.4±0.6 CFU / ml) and close to normal. Conclusion. Our proposed scheme of therapy and prevention of dysbiotic conditions in the pregravid period, in women of high infectious risk group led to a decrease in bacterial contamination of maternity paths of pregnant women in group II, which contributes to the restoration of vaginal microbiocenosis and positively affects the course of pregnancy, the condition of the fetus and the newborn. Key words: pregravid preparation, bacterial vaginosis, vulvovaginal candidiasis, placental dysfunction of infectious genesis, intrauterine infection.

Safety and Efficacy of Low-Molecular-Weight Heparin in Pregnant Women at Increased Risk of Venous Thromboembolism: A Prospective Stratified Multicentre Trial.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 715-715
Author(s):  
Rupert M. Bauersachs ◽  
Joachim Dudenhausen ◽  
Andree Faridi ◽  
Thorsten Fischer ◽  
Samson Fung ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Pregnant Women ◽  
Risk Group ◽  
High Risk Group ◽  
Group Iii ◽  
Group I ◽  
Increased Risk ◽  
At Deficiency ◽  
Group Ii ◽  
Heparin Prophylaxis

Abstract Women with a history of VTE, thrombophilia or both are at increased risk for VTE during pregnancy, but the optimal management strategy, and the need for thromboprophylaxis is not well defined in clinical guidelines because of limited trial data. The EThIG (Efficacy of Thromboprophylaxis as an Intervention during Gravidity) is a multicenter trial that prospectively enrolled 810 pregnant women at risk of VTE. Women were assigned to one of 3 management strategies: Low risk group I (including women with prior secondary VTE, or asymptomatic thrombophilia) with “watchful waiting” management, and dalteparin prophylaxis postpartum (50–100 IU/kg), or earlier if additional risk factors occurred; high risk group II (e.g. idiopathic VTE or symptomatic thrombophilia) receiving 50–100 IU/kg dalteparin; and very high-risk group III (e.g. acute VTE, prior long-term OAC, symptomatic AT-deficiency or antiphospholipid syndrome), receiving 100–200 IU/kg dalteparin. Primary efficacy outcome measure was symptomatic VTE, main safety outcome measures were haemorrhages, osteoporosis, thromboctopenia and pregnancy outcome. Results (mean ± SD / 95% CI): 810 women (age 30.8±5.4 years, weight 73.6±16.1kg) were enrolled, 28 % in group I, 58 % in II and 14% in III, including 66 women with acute VTE. 60.1% had prior VTE, 75.4% had thrombophilia (42.1 % FV-Leiden, 2.1 % homozygous, 9.5 % FII G20210A, 4.1% PC-, 1 % AT-deficiency; 17.4 % APS). 35.8 % had previous miscarriage, still birth or physical malformation. Comorbid conditions included lupus erythematosus, liver transplantation, ventricular septum defect, paraplegia, hepatitis C, nephrotic syndrome, asthma, chronic haemolytic anaemia, thalassaemia, osteoporosis and thrombocytopaenia. Median treatment initiation was at 17.0 weeks, at 24.0 weeks in group I, 14.5 weeks in group II and 16.0 weeks for group III. Mean daily dose was 66.2 ± 22.5 IU per kg (group I), 76.8 ± 24.1 IU per kg (group II) and 120.0 ± 49.1 IU per kg (group III). Objectively confirmed, symptomatic VTE occurred in 5 of 810 women (0.6%;0.2–1.5%). The rate of serious bleeding was 3.0% (1.9–4.4%), 0.9% (0.3–1.8%) occurred in the antepartum period, 2.1% (1.3–3.4%) peri-partum;1.1% (0.5–2.2%) was possibly heparin-related. There was no evidence of heparin-induced thrombocytopenia, and one case of osteoporosis (fracture of the saccygous bone during delivery). There were 94.4% successful pregnancies, 40 foetuses (4.9%; 3.6–6.7%) were lost due to miscarriage, 7 due to elective termination. Risk-stratified heparin prophylaxis was associated with a low incidence of symptomatic venous thromboembolism and few clinically important adverse events. Antepartum heparin prophylaxis is warranted in pregnant women with prior idiopathic thrombosis or symptomatic thrombophilia.

scholarly journals Use of Noninvasive Cerclage in Combination of Micronized Progesterone in Miscarriage Of Multifetal Pregnancy

2017 ◽  
Vol 24 (4) ◽  
Author(s):  
Iryna Nikitina ◽  
Alla Boychuk ◽  
Valentina Kondratiuk ◽  
Tatyana Babar
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
The State ◽  
Control Group ◽  
Group I ◽  
Prophylactic Measures ◽  
Neonatal Adaptation ◽  
Group Ii ◽  
Multifetal Pregnancy ◽  
Micronized Progesterone

We represent the results of the combined method of treatment and prevention of miscarriage in women with a multiple pregnancy and a high risk of the threat of termination the pregnancy because of using the obstetric unloading pessaries, combined with micronized progesterone. The efficiency of this method of treatment is evidenced by the rapid elimination of clinical symptoms of threatened abortion, accelerating the regression of ultrasound markers, reducing the number of complications in of pregnant women and reducing the time of their stay in hospital.Goal: To evaluate the effectiveness of the handling the obstetric pessary in combination with micronized progesterone at women with multifetal pregnancy and a high risk of miscarriage.Materials and methods. We analyzed 120 cases of multifetal pregnancies with signs of miscarriage within the terms from 16 to 28 weeks. The first group of the examined women was: 40 pregnant women with twins and signs of miscarriage, who in the scheme of treatment and prophylactic measures were offered to use the unloading obstetric pessaries in combination with continuous therapy by natural micronized progesterone until 36 weeks of pregnancy. The second group included 40 pregnant women with twins, who were laid seam on the cervix because of istmicocervical insufficiency and were applied short-term courses of therapy by gestagens. The control group comprised 40 pregnant women with twins at the age of 16-28 weeks of pregnancy who were conducted the therapy about the threat of miscarriage according to the current clinical protocols (Order of the Ministry of Health of Ukraine No. 624). It was carried out the analysis of the course of pregnancy, childbirth, the postpartum period and the state of neonatal adaptation in the surveyed groups.Results of the research and their discussion. In the first group, urgent childbirth occurred in 34 (85%) cases, in group II in 29 (72.5%) cases, in control group – in 25 (62.5%) cases. Cesarean delivery was performed in 7 (17.5%) patients of group I pregnant women, in 9 (22.5%) of group II patients and in 11 (27.5%) in the pregnant group. When studying the state of neonatal adaptation of newborns in the examined groups, the following results were obtained. The average weight of the newborns in group I was 3245 ±280 g, in group II 2865 ±365 g, in the control group - 2975 ±325 g (p>0.05). The evaluation of the state of newborns on the Apgar scale, respectively at the 1st and 5th minutes, was respectively: in newborns of the I group, 7.5 ± 1.4 and 8.4 ± 1.3 points, in group II - 7.3 ± 1.6 and 8.2 ± 1.1 points, in the control group – 7.2 ± 1.6 and 8.6 ± 1.2 (р 1-р 2> 0.05).Conclusions. Comprehensive prophylaxis of non-pregnancy in multiple pregnancies, combining the use of a traumatic cardiac cervix with the help of unloading obstetric pussies with progesterone preparations, allows prolonging pregnancy, preventing the development of prematurity, contributes to the improvement of perinatal indicators.

scholarly journals Screening of gestational diabetes mellitus using one-step versus two-step method: a comparative study

2020 ◽  
Vol 9 (8) ◽  
pp. 3372
Author(s):  
Deepti Khenwar ◽  
Juhi Agarwal ◽  
Sushruta Shriastava
Keyword(s):  
Diabetes Mellitus ◽  
High Risk ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Screening Test ◽  
Step Method ◽  
Group I ◽  
One Step ◽  
Group Ii

Background: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy. It affects 7% of all pregnancies worldwide and in India it ranges from 6 to 9% in rural and 12 to 21% in urban area. The aim of this study was to compare the DIPSI criteria with the two-step method (Carpenter and Couston criteria.) and to study merits and demerits of one step and two step tests for GDM.Methods: A total 400 pregnant women of gestational age between 24-28 weeks attending antenatal clinic at this study tertiary care center were enrolled in this study. 200 pregnant women were enrolled in each of the study group (Group I OGTT and Group II DIPSI).Results: In Group I (OGTT) screening 47 (23.5%) were tested positive. In Group II cases, screening test results were found positive among 44 (22%). Out of 95 high-risk pregnant women 38 (40%) were positive for GDM by OGTT and 34 (35.78%) were positive by DIPSI. Out of 305 non high-risk pregnant women, 9 (2.95%) were positive for GDM by OGTT and 10 (3.27%) were positive by DIPSI.Conclusions: Present study concludes that DIPSI is the test which can predict GDM in population comparable to another test like OGTT. Also, India’s major population reside in rural areas, ANC are mostly conducted by ANM, therefore screening test should be easy to perform and interpret.

scholarly journals Placental dysfunction as a basic pathology of perinatal complications

2021 ◽  
pp. 107-112
Author(s):  
О.V. Kravchenko
Keyword(s):  
Pregnant Women ◽  
Genital Tract ◽  
Pregnancy Termination ◽  
Perinatal Complications ◽  
Placental Dysfunction ◽  
Group I ◽  
Genital Tract Infections ◽  
Group Ii ◽  
Tract Infections ◽  
Micronized Progesterone

Research aim was to study the features of perinatal complications depending on the nature and timing of therapy in pregnant women with primary placental dysfunction.Materials and methods. 82 pregnant women with verified placental dysfunction (chorionic hypoplasia at 12–13 weeks) against the background of the threat of pregnancy termination and genital tract infections were included. All examined were divided into 2 groups: group I consisted of 42 pregnant women who started treatment before 16 weeks of gestation, group II consisted of 40 pregnant women whose treatment was started after 16 weeks of gestation. Women in group I received micronized progesterone, venotonic Normoven, Magnicum and Artihol. Antibacterial sanitation was carried out before 16 weeks of gestation. Group II also received micronized progesterone only. Antibacterial sanitation in this group was carried out after 16 weeks of gestation.Research results. After antibiotic therapy in group I monoinfections value decreased from 26.8 to 9.5%, mixed infections value decreased from 56.1 to 20.7%, while in group II the effectiveness of antibacterial therapy after 16 weeks was significantly lower. Statistically significant differences in weight, volume and area of the placenta in patients of studied groups were obtained. Assessing perinatal complications showed that the frequency of gestosis, premature birth, intrauterine growth retardation and intrauterine infection of the fetus were almost 2 times less frequent in group I than in group II.Conclusions. Placental dysfunction, which developed in the first trimester against the background of the threat of pregnancy termination and genital tract infections, is the basic pathology for complications of the perinatal period. A timely prescribed set of medical supplies, including micronized progesterone, venotonic Normoven, Artihol and Magnicum, was as an effective method of preventing perinatal complications in pregnant women with primary placental dysfunction. Antibiotic therapy up to 16 weeks of gestation does not fully prevent the development of perinatal complications, but it can significantly reduce the level of severe gestational pathology.

scholarly journals Features of delivery tactics in pregnant women with placental dysfunction and taking into account the concentration of vitamin D

2020 ◽  
Vol 17 (1) ◽  
pp. 70-77
Author(s):  
G. S. Manasova ◽  
N. V. Didenkul ◽  
N. V. Shapoval ◽  
N. V. Kuzmin ◽  
K. V. Korotkaya
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Caesarean Section Rate ◽  
Control Group ◽  
Compensatory Mechanisms ◽  
Placental Dysfunction ◽  
Group I ◽  
High Prevalence ◽  
Group Ii ◽  
Abdominal Delivery

The high prevalence of the vitamin D (VD) deficiency states (VDDS) among adults, as well as the data on the pleiotropic effects of calcitriol suggests its participation in the development of various complications and pregnancy outcomes. The objective of the present study is to analyze the pregnancy course and delivery tactics of pregnant women with placental dysfunction (PD) depending on the calcitriol availability. We examined 56 patients with PD (I – main group) and 40 conditionally healthy women with physiological pregnancy (II – control group). In addition to the standard clinical and laboratory examination, the level of vitamin D in the blood was determined by ELISA. The statistical analysis used the software Biostat, Statistica 6.0. In 76.8 % of group I women, the VD content corresponded to the deficit (38.4 %) and to the suboptimal status (38.4 %), (RR = 3.0; 95 % CI 2.39–3.76). In group II, VDDS was not detected and the suboptimal status was diagnosed in 31.45 %. The average VD level in group I was significantly lower than that in group II (31.4 ± 8.6 ng/ml vs 43.54 ± 11.2 ng/ml; Uemp = 42.5; p < 0.05). The caesarean section rate in group I was 3.4 times higher than that in group II (42.85 % vs 12.5 %; F = 0.00001; p < 0.01). The weight of newborns in group II significantly exceeded the weight of children in group I (3643.24 ± 136 g vs 3299.11 ± 128 g; t = 4.17; p < 0.01); a strong direct correlation was found between the weight of the newborn and the VD level in the blood of pregnant women (r = 0.71). VDDS increases 2 times the risk of abdominal delivery (RR = 1.27; 95 % CI 0.95–1.66). The VD status of a pregnant woman can have a certain influence on the formation of optimal adaptive-compensatory mechanisms in the utero-placental-fetal system and on the pregnancy outcome for mother and fetus.

scholarly journals Clinical evaluation of the efficacy and safety of the use of vagilac to treat bacterial vaginosis in pregnancy

2018 ◽  
pp. 90-94
Author(s):  
S. V. Novikova ◽  
L. S. Logutova ◽  
M. A. Ignatyeva
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Vaginosis ◽  
Pregnant Women ◽  
Inflammatory Diseases ◽  
Efficacy And Safety ◽  
Birth Canal ◽  
Systemic Antibiotic Therapy ◽  
Group I ◽  
Group Ii ◽  
In Pregnancy

Objective: evaluation of the efficacy and safety of the use of probiotic Vagilac® in the prevention and treatment of vaginal dysbiosis in pregnancy.Material and methods: 140 pregnant women admitted to the Obstetric Probationary Ward of Moscow Regional Research Institute of Obstetrics and Gynecology of the Ministry of Health of Moscow at 36–39 weeks of gestation were examined and treated. All patients underwent complex clinical and laboratory examination. The patients were divided into 2 groups: I – 60 pregnant women with the established diagnosis of «bacterial vaginosis» (BV) and II – 80 pregnant women, who received antibacterial therapy due to exacerbation of infectious extragenital diseases. Of 140 pregnant women, 100 (60 from Group I and 40 from Group II) received oral probiotic Vagilac® for 10–14 days before delivery: 60 women to treat bacterial vaginosis, and 40 to prevent vaginal dysbiosis against the background of systemic antibiotic therapy. The remaining 40 pregnant women from Group II did not receive the probiotic, for which reason the second group was divided into two subgroups (IIa and IIb).Results: the drug has proved itself as a probiotic that is capable to restore vaginal microflora after various disorders, maintain and keep a healthy balance of bacteria that normally live in the vagina, prevent any disorders associated with antibiotic therapy. During vaginal delivery, traumatic injuries of the birth canal tissues were more common in patients who did not receive Vagilac®. The newborns who were born by the mothers who received Vagilac®, had no manifestations of severe forms of infectious and inflammatory diseases.The conclusion. The conducted studies showed that the treatment of bacterial vaginosis in pregnant women with probiotic Vagilak® was effective, did not adversely affect the fetus/child; in the group with and without BV no candidiasis vulvaginitis was detected. 

Anamnestic factors that shape reproductive health of women with repeated unsuccessful popygamy in vitro fertilization

2016 ◽  
pp. 140-143
Author(s):  
N.V. Cotsabin ◽  
◽  
O.M. Makarchuk ◽  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Polycystic Ovary ◽  
High Risk Group ◽  
Stress Factors ◽  
Control Group ◽  
Fertilization In Vitro ◽  
Infertile Women ◽  
Group I

The proportion of patients with multiple unsuccessful attempts of assisted reproductive technology (ART) is about 30% of all patients treated with the use of ART. Women with history of unsuccessful ART attempts - a special category of patients who require emergency attention and a thorough examination at the stage of preparation for superovulation stimulation,the selection of embryos and endometrium preparation for embryo transfer. The objective: to distinguish high-risk group of unsuccessful attempts based on a detailed analysis of anamnestic and clinical data of infertile women with repeated unsuccessful ART attempts that requires more in-depth study of hormonal features, ovarian reserve and condition of the endometrium. Materials and methods. For better understanding of the problem of repeated unsuccessful ART attempts and сreation of efficient infertility treatment algorithms for these couples we conducted a thorough analysis of anamnestic data of three groups of infertile women (105 patients), which were distributed by age: group I – younger than 35, the II group – from 35 to 40, the III group - over 40 years. These groups of patients were compared with each other and with the control group of healthy women (30 persons). Results. Leading stress factors in the percentage three times prevailed in the group of infertile women and had a direct connection with the fact of procedure «fertilization in vitro» and chronic stressors caused by prolonged infertility. Primary infertility was observed significantly more frequent in patients younger than 35 years (p <0.05), secondary infertility - mostly in the second and third experimental groups (p <0.05). Noteworthy significant percentage of wellknown causes of infertility and idiopathic factor in all groups, and the prevalence of tubal-peritoneal factor in the second and third experimental groups, and endocrine dysfunction in the I experimental group. The most common disorder among this category of woman was polycystic ovary syndrome. Frequency of usual miscarriage among patients of I ana II groups was two times higher than in the third group (p <0.05). Among the experimental groups the leading place belongs urinary tract infection, respiratory tract diseases, pathologies of the cardiovascular system. Data of the stratified analysis show an increase likelihood of repeated unsuccessful ART attempts under the influence of constant chronic stress (odds ratio OR=2.06; 95% CI: 0.95–3.17; p<0.05). Conclusions. Among infertile patients with repeated unsuccessful ART attempts must be separated a high risk group of failures. The identity depends on the duration of infertility, female age and leading combination of factors. Key words: repeated unsuccessful ART attempts, anamnesis, infertility, high risk.

Frequency of Vitamin B12 Deficiency in Pregnant Women with Gestational Diabetes Mellitus

2021 ◽  
Vol 15 (10) ◽  
pp. 2753-2755
Author(s):  
Shazia Jamil ◽  
Naveed Mahmood ◽  
Israr-ul- Haque ◽  
Rabiah Haque ◽  
Muhammad Imran-ul-Hasan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Vitamin B12 ◽  
Pregnant Women ◽  
Vitamin B12 Deficiency ◽  
Group I ◽  
B12 Deficiency ◽  
Vitamin B 12 ◽  
Group Ii

Objective: To determine the prevalence of vitamin B-12 deficiency in pregnant women with gestational diabetes mellitus. Study Design: Retrospective study Place and Duration of Study: Department of Medicine, OMC Hospital, Jail Road Lahore from January, 2020 to December, 2020. Methods: Two hundred and thirty pregnant females were enrolled age between 18-45 years. Detailed demographics of enrolled cases age, gestational age, gravidity and body mass index were recorded after taking informed written consent. Among 230 cases, 100 women were non GDM (group I) and 130 had gestational diabetes mellitus (group II). Blood samples were taken from all the patients for measuring vitamin B12 status. Vitamin B12 was defined as <300 pg/ml. Results: Mean age of the patients in group I was 31.64±7.45 years with mean BMI 25.88±8.65 kg/m2 while mean age among GDM group was 34.55±5.71 years with mean BMI 27.36±9.44 kg/m2. Mean gestational age in group I was 33.72±4.21 weeks and in group II 35.08±9.27 weeks. In group I 20 (20%) had vitamin B12 deficiency and in group II rate ofvitamin B12 deficiency was high among 90 (69.2%) cases. We found a significantly relation between vitamin B12 and GDM with p value <0.0007. Conclusion: The prevalence of vitamin B-12 deficiency among pregnant women of gestational diabetes mellitus was significantly high as compared to normal pregnant women. Keywords: Pregnant Women, Gestational Diabetes Mellitus, Vitamin B12 deficiency

scholarly journals Screening for Coxiella burnetii infection during pregnancy: pros and cons according to the Wilson and Jungner criteria

2012 ◽  
Vol 17 (3) ◽  
Author(s):  
J M Munster ◽  
L M Steggerda ◽  
A C Leenders ◽  
J G Aarnoudse ◽  
E Hak
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Coxiella Burnetii ◽  
Q Fever ◽  
Risk Group ◽  
High Risk Group ◽  
Routine Screening ◽  
Maternal Complications ◽  
Clinical Consequences ◽  
Pros And Cons

In Europe the incidence of human Q fever has dramatically increased over the previous years. Untreated infections with Coxiella burnetii, the causal agent of Q fever, have been associated with both obstetric and maternal complications. The majority of pregnant women with a C. burnetii infection remain asymptomatic, hence screening could be of value to prevent unwanted outcomes in this high-risk group. We applied the updated Wilson and Jungner criteria to review the evidence for routine screening for C. burnetii infection during pregnancy. Since much uncertainty remains about the incidence, clinical consequences, diagnostics and treatment of C. burnetii infection during pregnancy, routine screening for C. burnetii infection during pregnancy should not be recommended. Rigorous studies to assess the effectiveness of C. burnetii screening are warranted.

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