scholarly journals Impact of SARS-CoV-2 on the clinical outcomes of pregnant women and their infants: Systematic Review and Meta-analysis Protocol

2020 ◽  
Author(s):  
Irina Oltean ◽  
Sarah Lawrence ◽  
Dina El Demellawy
Keyword(s):  
Systematic Review ◽  
Red Blood Cells ◽  
Pregnant Women ◽  
Clinical Outcomes ◽  
Blood Cells ◽  
Meta Analysis ◽  
Fetal Mortality ◽  
Placental Pathology ◽  
Statistical Heterogeneity ◽  
The Impact

An investigation into placental pathology in pregnant women with SARS-CoV-2 has not yet been examined extensively, yet this knowledge would be beneficial in understanding the potential for vertical transmission of SARS-CoV-2 during pregnancy. Currently, results are conflicting, with some evidence suggesting rare placental infection. However, compared to controls, one study determined that third trimester placentas were significantly more likely to show one feature of maternal vascular malperfusion (MVM). In light of the inconclusive evidence, the burden of illness of SARS-CoV-2 in pregnant women and their neonates or infants, remains a critical concern. The aim of this systematic review is to inform future obstetric guidelines, which should help provide SARS-CoV-2 clinical recommendations to the medical caregivers of pregnant women and their infants. This protocol outlines our objectives, which are to: examine the presence and frequency of any placental finding in the placentas of SARS-CoV-2 pregnant women, relative to controls recruited during the pandemic period; investigate the mean count and evolution of lymphocytes (including their T, B and NK differential counts), monocytes, eosinophils, basophils, neutrophils, and red blood cells in pregnant women with SARS-CoV-2 at various stages of pregnancy; and compare the fetal mortality outcome at early versus late trimester of pregnancy in pregnant women who test positive for SARS-CoV-2 versus controls. Our study will identify case series and case-control studies of asymptomatic and symptomatic pregnant women, and their neonates and/or infants, who test positive for SARS-CoV-2 during any stage of their pregnancy, as validated by laboratory confirmed positive antibody testing or using real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR). Only articles written in English, French or Chinese will be included. Literature reviews, systematic reviews, editorials, letters to the editor, conference abstracts, and commentaries will be excluded. Early scoping searches were run in April 2020 with MEDLINE and Embase using the OVID interface, and the Ovid interface and Global Health using the CAB Direct interface Disaster Lit: Database for Disaster Medicine and Public Health, MedRxiv and OSF Preprints. An update with adjusted terminology and refined database selection was run in July using MEDLINE, Embase and the WHO and CDC specialized COVID 19 database (July 2020). Search alerts for MEDLINE, Embase and Google Scholar will be in place throughout the review to identify newly emerging research, with a final search occurring in January 2021. Primary extracted outcomes include: mean counts of T-cells, B-cells, monocytes, eosinophils, neutrophils, basophils, and red blood cells, placental pathology findings, and mortality frequency such as number of abortions (<20 weeks) and stillbirths (20+ weeks). Observational studies will be assessed using the Ottawa-Newcastle scale. Forest plots will be utilized to visualize the data. Statistical heterogeneity of the included studies will be assessed using the I-squared test with 95% confidence intervals, and publication bias will be determined using a funnel plot and Egger’s test when possible (>10 included studies). If a meta-analysis will be undertaken, the strength of the body of evidence will be assessed using GRADE. Understanding the impact of SARS-CoV-2 on the health of neonates and infants can aid in identifying optimal management strategies to prevent adverse clinical outcomes.

Prenatal exercise is not associated with fetal mortality: a systematic review and meta-analysis

2018 ◽  
Vol 53 (2) ◽  
pp. 108-115 ◽  
Author(s):  
Margie H Davenport ◽  
Amariah J Kathol ◽  
Michelle F Mottola ◽  
Rachel J Skow ◽  
Victoria L Meah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Perinatal Mortality ◽  
Meta Analysis ◽  
Moderate Intensity ◽  
Fetal Mortality ◽  
Type Of Exercise ◽  
The Impact ◽  
Prenatal Exercise ◽  
Frequency Intensity

ObjectiveTo perform a systematic review of the relationship between prenatal exercise and fetal or newborn death.DesignSystematic review with random-effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies) if they were published in English, Spanish or French and contained information on the population (pregnant women without contraindication to exercise), intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [eg, dietary; “exercise + co-intervention”]), comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and outcome (miscarriage or perinatal mortality).ResultsForty-six studies (n=2 66 778) were included. There was ‘very low’ quality evidence suggesting no increased odds of miscarriage (23 studies, n=7125 women; OR 0.88, 95% CI 0.63 to 1.21, I2=0%) or perinatal mortality (13 studies, n=6837 women, OR 0.86, 95% CI 0.49 to 1.52, I2=0%) in pregnant women who exercised compared with those who did not. Stratification by subgroups did not affect odds of miscarriage or perinatal mortality. The meta-regressions identified no associations between volume, intensity or frequency of exercise and fetal or newborn death. As the majority of included studies examined the impact of moderate intensity exercise to a maximum duration of 60 min, we cannot comment on the effect of longer periods of exercise.Summary/conclusionsAlthough the evidence in this field is of ‘very low’ quality, it suggests that prenatal exercise is not associated with increased odds of miscarriage or perinatal mortality. In plain terms, this suggests that generally speaking exercise is ‘safe’ with respect to miscarriage and perinatal mortality.

scholarly journals Impact of SARS-CoV-2 on the clinical outcomes and placental pathology of pregnant women and their infants: A Systematic Review

Heliyon ◽  
2021 ◽  
pp. e06393
Author(s):  
Irina Oltean ◽  
Jason Tran ◽  
Sarah Lawrence ◽  
Brittany Ann Ruschkowski ◽  
Na Zeng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Clinical Outcomes ◽  
Placental Pathology

scholarly journals The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (4) ◽  
pp. 666
Author(s):  
Fahimeh Ramezani Tehrani ◽  
Marzieh Saei Ghare Naz ◽  
Razieh Bidhendi Yarandi ◽  
Samira Behboudi-Gandevani
Keyword(s):  
Systematic Review ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Diagnostic Criteria ◽  
Meta Analysis ◽  
Population Based ◽  
Maternal Outcomes ◽  
Care Providers ◽  
Iadpsg Criteria ◽  
The Impact

This systematic review and meta-analysis aimed to examine the impact of different gestational-diabetes (GDM) diagnostic-criteria on the risk of adverse-maternal-outcomes. The search process encompassed PubMed (Medline), Scopus, and Web of Science databases to retrieve original, population-based studies with the universal GDM screening approach, published in English language and with a focus on adverse-maternal-outcomes up to January 2020. According to GDM diagnostic criteria, the studies were classified into seven groups. A total of 49 population-based studies consisting of 1409018 pregnant women with GDM and 7,667,546 non-GDM counterparts were selected for data analysis and knowledge synthesis. Accordingly, the risk of adverse-maternal-outcomes including primary-cesarean, induction of labor, maternal-hemorrhage, and pregnancy-related-hypertension, overall, regardless of GDM diagnostic-criteria and in all diagnostic-criteria subgroups were significantly higher than non-GDM counterparts. However, in meta-regression, the increased risk was not influenced by the GDM diagnostic-classification and the magnitude of the risks among patients, using the IADPSG criteria-classification as the most strict-criteria, was similar to other criteria. In conclusion, a reduction in the diagnostic-threshold increased the prevalence of GDM, but the risk of adverse-maternal-outcome was not different among those women who were diagnosed through more or less intensive strategies. Our review findings can empower health-care-providers to select the most cost-effective approach for the screening of GDM among pregnant women.

scholarly journals What Is the Impact of Ambulatory Vital Sign Monitoring on Deterioration Detection and Related Clinical Outcomes in Hospitalised Patients: a Systematic Review and Meta-analysis.

2021 ◽  
Author(s):  
Carlos Morgado Areia ◽  
Christopher Biggs ◽  
Mauro Santos ◽  
Neal Thurley ◽  
Stephen Gerry ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Standard Care ◽  
Meta Analysis ◽  
Ambulatory Monitoring ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Monitoring Systems ◽  
Hospitalised Patients ◽  
The Impact

Abstract Background: Timely recognition of the deteriorating inpatient remains challenging. Ambulatory monitoring systems (AMS) may augment current monitoring practices. However, there are many challenges to implementation in the hospital environment, and evidence describing the clinical impact of AMS on deterioration detection and patient outcome remains unclear. Objective: To assess the impact of vital signs monitoring on detection of deterioration and related clinical outcomes in hospitalised patients using ambulatory monitoring systems, in comparison with standard care.Methods: A systematic search was conducted in August 2020 using MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, CENTRAL and Health Technology Assessment databases, as well as grey literature. Studies comparing the use of AMS against standard care for deterioration detection and related clinical outcomes in hospitalised patients were included. Deterioration related outcomes (primary) included unplanned intensive care admissions, rapid response team or cardiac arrest activation, total and major complications rate. Other clinical outcomes (secondary) included in-hospital mortality and hospital length of stay. Exploratory outcomes included alerting system parameters and clinical trial registry information. Results: Of 8706 citations, 10 studies with different designs met the inclusion criteria, of which 7 were included in the meta-analyses. Overall study quality was moderate. The meta-analysis indicated that the AMS, when compared with standard care, was associated with a reduction in intensive care transfers (risk ratio, RR, 0.87; 95% confidence interval, CI, 0.66 to 1.15), rapid response or cardiac arrest team activation (RR, 0.84; 95% CI 0.69 to 1.01), total (RR, 0.77; 95% CI 0.44 to 1.32) and major (RR, 0.55; 95% CI 0.24 to 1.30) complications prevalence. There was also association with reduced mortality (RR, 0.48; 95% CI 0.18 to 1.29) and hospital length of stay (mean difference, MD, -0.09; 95% CI -0.43 to 0.44). However, none were statistically significant.Conclusion: This systematic review indicates that implementation of AMS may have a positive impact on early deterioration detection and associated clinical outcomes, but differing design/quality of available studies and diversity of outcomes measures limits a definite conclusion. Our narrative findings suggested that alarms should be adjusted to minimise false alerts and promote rapid clinical action in response to deterioration.PROSPERO Registration number: CRD42020188633

scholarly journals Clinical manifestations and perinatal outcomes of pregnant women with COVID-19: a systematic review and meta-analysis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Jeong Yee ◽  
Woorim Kim ◽  
Ji Min Han ◽  
Ha Young Yoon ◽  
Nari Lee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Fetal Death ◽  
Web Of Science ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Perinatal Outcomes ◽  
Current Review ◽  
The Mean ◽  
The Impact

Abstract This systematic review and meta-analysis aimed to evaluate the impact of COVID-19 on pregnant women. We searched for qualified studies in PubMed, Embase, and Web of Science. The clinical characteristics of pregnant women with COVID-19 and their infants were reported as means and proportions with 95% confidence interval. Eleven studies involving with 9032 pregnant women with COVID-19 and 338 infants were included in the meta-analysis. Pregnant women with COVID-19 have relatively mild symptoms. However, abnormal proportions of laboratory parameters were similar or even increased, compared to general population. Around 30% of pregnant women with COVID-19 experienced preterm delivery, whereas the mean birth weight was 2855.9 g. Fetal death and detection of SARS-CoV-2 were observed in about 2%, whereas neonatal death was found to be 0.4%. In conclusion, the current review will serve as an ideal basis for future considerations in the treatment and management of COVID-19 in pregnant women.

Measles in pregnant women: A systematic review of clinical outcomes and a meta-analysis of antibodies seroprevalence

2020 ◽  
Vol 80 (2) ◽  
pp. 152-160
Author(s):  
Paola Congera ◽  
Alberto Enrico Maraolo ◽  
Serena Parente ◽  
Nicola Schiano Moriello ◽  
Vincenzo Bianco ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Clinical Outcomes ◽  
Meta Analysis

scholarly journals Impact of surgical margin status on the survival outcome after surgical resection of gastric cancer: a protocol for systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e040282
Author(s):  
Zhiyuan Jiang ◽  
Zhaolun Cai ◽  
Yuan Yin ◽  
Chaoyong Shen ◽  
Jinming Huang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Curative Intent ◽  
Term Survival ◽  
Effect Model ◽  
Statistical Heterogeneity ◽  
The Impact

IntroductionGenerally, complete resection with cancer cell negative (R0) margin has been accepted as the most effective treatment of gastric cancer and positive resection (R1/R2) margin has been associated with decreased survival to varied degrees. However, the independent impact of microscopical positive (R1) margin on long-term survival may be confounded. No meta-analysis has worked at the association between R1 margin and outcomes of gastric cancer and the available evidence are scant. Therefore, we plan to conduct a systematic review and meta-analysis to quantitatively explore the role of R1 margin on gastric (including oesophagogastric junction) cancer survival after curative intent resection.Methods and analysisThe protocol was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guideline. A systematic search of PubMed, Embase and the Cochrane Central Register of Controlled Trials databases will be performed from their inceptions to 30 April 2020 to identify randomised controlled trials (RCTs), cohort studies and case–control studies focusing on the impact of R1 margin on survival of gastric cancer after curative intent resection. The primary outcome will be the overall survival (OS) and disease-free survival (DFS) and the secondary outcomes will be 5-year OS rate and 5-year DFS rate. The Cochrane tool for bias assessment in randomised trials and Risk Of Bias In Non-randomised Studies-I for the assessment of bias in non-randomised studies (NRS) will be used. Statistical heterogeneity will be assessed by visual inspection of forest plots and measured using the I2 statistics. A fixed-effect model will be used when heterogeneity is low, otherwise, a random-effect model will be chosen. Publication bias will be assessed by funnel plots, subgroup analysis and sensitivity analysis will be performed in the right context. For each outcome, we will perform data synthesis separately for RCTs and NRS using Rev Man V.5.3 software and compile ‘summary of findings’ tables separately for RCTs and NRS using GRADEpro software. Grading of Recommendations, Assessment, Development and Evaluations considerations will also be used to make an overall assessment of the quality of evidence.Ethics and disseminationThere is no requirement for ethics approval because no patient data will be collected at an individual level in this systematic review and meta-analysis.The results of this systematic review will be published in a peer-reviewed journal and presented at relevant conferences, any deviations from the protocol will be clearly documented and explained in its final report.PROSPERO registration numberCRD42020165110.

scholarly journals Mechanical Thrombectomy for Middle Cerebral Artery Division Occlusions: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 6 (3-4) ◽  
pp. 242-253 ◽  
Author(s):  
Hisham Salahuddin ◽  
Aixa Espinosa ◽  
Mark Buehler ◽  
Sadik A. Khuder ◽  
Abdur R. Khan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcome ◽  
Middle Cerebral Artery ◽  
Clinical Outcomes ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Total N ◽  
Clinical Databases ◽  
The Impact

Background: Middle cerebral artery division (M2) occlusion was significantly underrepresented in recent mechanical thrombectomy (MT) randomized controlled trials, and the approach to this disease remains heterogeneous. Objective: To conduct a systematic review and meta-analysis of outcomes at 90 days among patients undergoing MT for M2 middle cerebral artery (MCA) occlusions. Methods: Five clinical databases were searched from inception through September 2016. Observational studies reporting 90-day modified Rankin Scale scores for patients undergoing MT for M2 MCA occlusions with an M1 MCA control group were selected. The primary outcome of interest was good clinical outcome 90 days after MT of an M1 or M2 MCA occlusion. Secondary outcomes of interest included mortality and excellent clinical outcome, recanalization rates, significant intracerebral hemorrhage, and procedural complications. Results: A total of 323 publications were identified, and 237 potentially relevant articles were screened. Six studies were included in the analysis (M1 = 1,203, M2 = 258; total n = 1,461). We found no significant differences in good clinical outcomes (1.10 [95% CI, 0.83-1.44]), excellent clinical outcomes (1.07 [0.65-1.79]), mortality at 3 months (0.85 [0.58-1.24]), recanalization rates (1.06 [0.32-3.48]), and significant intracranial hemorrhage (1.19 [0.61-2.30]). Conclusions: MT of M2 MCA occlusions is as safe as that of main trunk MCA occlusions, and comparable in terms of clinical outcomes and hemorrhagic complications. Randomized clinical trials are needed to assess the impact of MT in patients with M2 occlusions, given that M1 MCA occlusions have different natural histories than M2 occlusions.

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