scholarly journals Cerclage for the Management of Cervical Insufficiency: A Review

2021 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Medical Records ◽  
Screening Tools ◽  
Cervical Insufficiency ◽  
Cervical Cerclage ◽  
Activity Restriction ◽  
Nonsurgical Management ◽  
Preconception Consultation ◽  
History Of ◽  
Early Preterm Birth ◽  
Prevention Of Recurrence

Cervical insufficiency (CI) is classically characterized as painless dilation of the uterine cervix in the second trimester that results in delivery of the pregnancy, typically prior to 24 weeks’ gestation. Treatment of the condition has centered on prevention of recurrence in women with a history of CI or early preterm birth. Universal screening tools for CI in women without a history of prior PTB are lacking. Cervical change that is painless may occur with minimal symptoms such as increasing of vaginal discharge/mucous, vaginal pressure or fullness; many women and their providers can dismiss pathologic symptoms that would otherwise be benign in women without CI. The management of CI is categorized as surgical vs. nonsurgical. The cornerstone of surgical management is composed of cervical cerclage, and may be placed by a transvaginal or transabdominal approach depending on the obstetric history. Nonsurgical management includes pessary or activity restriction. For women who have experienced a midtrimester loss due to suspected cervical insufficiency, postnatal or preconception consultation is essential to identify modifiable risk factors, collect medical records of the delivery, and review pathology results if available.

scholarly journals Double Cerclage In Cervical Insufficiency: A Single Tertiary Center Experience

2019 ◽  
pp. 1
Author(s):  
Ismet Hortu ◽  
Cagdas Sahin ◽  
Orkun Ilgen ◽  
Mert Kazandi ◽  
Ali Akdemir ◽  
...  
Keyword(s):  
Birth Weight ◽  
Cesarean Section ◽  
Perinatal Outcomes ◽  
Obstetric Outcomes ◽  
Cervical Insufficiency ◽  
Cervical Cerclage ◽  
History Of ◽  
Group 2 ◽  
Transvaginal Cerclage ◽  
Group 1

<p><strong>Objective:</strong> The aim of this study is to compare the perinatal outcomes of double cerclage via laparoscopic plus transvaginal technique in women with a history of transvaginal cerclage failure, between women with single transvaginal cerclage.</p><p><strong>Study Design:</strong> Five women who were diagnosed with cervical insufficiency with a history of at least one vaginal cerclage failure and 10 women who were diagnosed with cervical insufficiency were included in this study. Laparoscopic cerclage was performed to all women who have a medical history of vaginal cerclage failure, before pregnancy and additional transvaginal cervical cerclage was performed during their pregnancy (Group 1). Single transvaginal cervical cerclage was performed to the 10 women who had a short cervix and/or cervical insufficiency during their pregnancy (Group 2). The number of cerclage failure, perinatal outcomes, gestational week at the time of delivery, birth weight and Apgar scores were evaluated.</p><p><strong>Results:</strong> All five women in group 1 underwent a cesarean section. None of them had chorioamnionitis or poor obstetric outcomes and all gave birth after the 34th week of pregnancy. All ten women in group 2 were evaluated. Two women gave birth vaginally at the 33rd week of pregnancy. Remaining eight cases gave birth above 34th week of pregnancy. Six of the eight cases underwent cesarean section and two of the remaining were delivered vaginally. Mean birth weight of the fetuses were 2490±265 g and 2.710 ±361 g in group1 and group 2, respectively. Mean gestational age at the time of birth in group 1 and group 2 were found 36±1.83 weeks and 35.6±1.14 weeks, respectively.</p><p><strong>Conclusion:</strong> Laparoscopic cervical cerclage during pregnancy could be a safe and effective treatment. However, sometimes it might not be enough and transvaginal cervical cerclage may be needed to strengthen cervical tension.</p>

scholarly journals 37: Is a history of cervical cerclage or cervical insufficiency a risk factor for pelvic floor disorders?

2017 ◽  
Vol 216 (3) ◽  
pp. S596
Author(s):  
K. Addae-Donaedu ◽  
D. Sheyn ◽  
A. Bauer ◽  
D. Dawodu ◽  
D. Hackney ◽  
...  
Keyword(s):  
Risk Factor ◽  
Pelvic Floor ◽  
Pelvic Floor Disorders ◽  
Cervical Insufficiency ◽  
Cervical Cerclage ◽  
History Of

scholarly journals Assessment of the hormonal levels in different management strategies for women with cervical insufficiency and a history of anovulatory infertility

2021 ◽  
Vol 23 (1) ◽  
pp. 98-104
Author(s):  
L. V. Pakharenko ◽  
O. M. Perkhulyn
Keyword(s):  
In Vitro Fertilization ◽  
Management Strategies ◽  
Placental Lactogen ◽  
Cervical Insufficiency ◽  
Cervical Cerclage ◽  
Vitro Fertilization ◽  
Vaginal Progesterone ◽  
History Of ◽  
Anovulatory Infertility

Cervical insufficiency (CI) is one of the causes of preterm birth. The rate of CI is higher in women after in vitro fertilization treatment for infertility compared to the general population. The aim. To assess the hormonal level in women with CI and a history of anovulatory infertility in the second and third trimesters of pregnancy in different management strategies for CI. Materials and methods. 60 pregnant women with CI who conceived through in vitro fertilization treatment for anovulatory infertility were divided into two groups: in the I group (30 women), CI was corrected only with cervical cerclage / pessary in the II trimester of pregnancy, in the II group (30 persons), cervical cerclage / pessary was combined with vaginal progesterone 200 mg ones a day until 34 full weeks of gestation. 30 pregnant women without СІ or infertility with the physiological course of pregnancy were controls. The concentrations of estradiol, progesterone, placental lactogen, prolactin and cortisol were determined in the terms of 19–22 and 30–32 weeks of gestation in the maternal blood serum. Results. In the patients with CI at 19–22 gestational weeks, the estradiol and placental lactogen concentrations were slightly lower in the I and II groups than those in the control women, the level of progesterone was less in the I group by 13.44 %, in the II group – by 17.30 % (P < 0.05) compared to the controls; the levels of prolactin and cortisol in the I and II groups were increased significantly (P < 0.001). At 30–32 gestational weeks, the levels of estradiol (P < 0.05), progesterone (a decrease of 23.10 %, P < 0.001) and placental lactogen (a decrease of 10.74 %, P < 0.05) were significantly less as compared to the physiological ranges, while these parameters in the II group patients were on the lower limit of normal. In the I group, the concentrations of prolactin and cortisol were higher by 41.70 % (P < 0.001) and 27.36 % (P < 0.001), respectively, than the controls, in the II group – only by 24.10 % (P < 0.05) and 13.70 % (P < 0.05), respectively. Conclusions. In the women with cervical insufficiency after in vitro fertilization treatment for anovulatory infertility, the levels of estradiol, progesterone and placental lactogen are not significantly different from physiological indices, but the prolactin and cortisol concentrations are much higher. Adjunctive vaginal progesterone treatment to cervical cerclage/pessary in the third trimester of pregnancy promotes the normalization of progesterone, estradiol and placental lactogen levels, the decrease in prolactin and cortisol indices at 30–32 gestational weeks compared to the women with cervical cerclage/pessary alone.

scholarly journals Cerclage outcomes in singleton pregnancies at risk for preterm birth following assisted reproductive treatments

2021 ◽  
Vol 3 (3) ◽  
pp. 78-82
Author(s):  
Gülnaz Şahin ◽  
Ferruh Acet ◽  
Ege Nazan Tavmergen Goker ◽  
Erol Tavmergen
Keyword(s):  
At Risk ◽  
Preterm Birth ◽  
Gestational Age ◽  
Cervical Insufficiency ◽  
Special Group ◽  
Cervical Cerclage ◽  
Unicornuate Uterus ◽  
Gestational Age At Delivery ◽  
History Of ◽  
Singleton Pregnancies

Objective: We aimed to evaluate the obstetric and neonatal outcomes of singleton pregnancies at risk for preterm birth (PTB) following assisted reproductive treatments and underwent cervical cerclage placement. Material and methods: A total of 42 women with singleton pregnancies following ART who underwent cerclage between 2009-2021 were included in this retrospective study.  Indications of the cerclage procedure, gestational age at cerclage placement and delivery, neonatal birthweight, and requirement for admission to the neonatal unit of newborns were evaluated. Results: Of those cerclage placement performed in women with a history of second-trimester loss (19%), women with suspected cervical insufficiency according to pre-pregnancy evaluation (52.4%), women with the unicornuate uterus (4.8%), women with cervical shortening/or suspicious changes on ultrasonography (11.9%), and women with detection of cervical dilatation/shortening beyond 20 weeks of gestation (11.9%). Of the total group, 7.1% resulted in late miscarriages, while the remaining 92.9% ended with a live birth with mean gestational age at delivery of 37.0±2.5 weeks. Of those live births, 92.3% (36/39) delivered at >34 weeks and %74.4 (29/39) delivered at term. Except one neonatal death due to extremely PTB at 26th weeks, all infants were discharged from the hospital with well condition. Conclusion: ART pregnancies are evaluated as a special group as having a higher PTB risk at baseline. Cerclage may be considered in broader indications for suspected cervical insufficiency in these pregnancies. There is need for further studies on the effectiveness of cerclage in these ART pregnancies with suspected cervical insufficiency based on different criterions used.

Clinical Characteristics of Patients Diagnosed with Strongyloidiasis in a United States Urban Outpatient Dermatology Department: A Case Series

2017 ◽  
Vol 1 (3) ◽  
pp. 156-160
Author(s):  
Jacqueline Watchmaker ◽  
Sean Legler ◽  
Dianne De Leon ◽  
Vanessa Pascoe ◽  
Robert Stavert
Keyword(s):  
United States ◽  
Case Series ◽  
The United States ◽  
Screening Tools ◽  
Dermatology Department ◽  
Cutaneous Manifestations ◽  
Serologic Testing ◽  
Patient Reported ◽  
History Of ◽  
Endemic Areas

Background: Although considered a tropical disease, strongyloidiasis may be encountered in non-endemic regions, primarily amongst immigrants and travelers from endemic areas.  Chronic strongyloides infection may be under-detected owing to its non-specific cutaneous presentation and the low sensitivity of commonly used screening tools. Methods: 18 consecutive patients with serologic evidence of strongyloides infestation who presented to a single urban, academic dermatology clinic between September 2013 and October 2016 were retrospectively included.  Patient age, sex, country of origin, strongyloides serology titer, absolute eosinophil count, presenting cutaneous manifestations, and patient reported subjective outcome of pruritus after treatment were obtained via chart review.  Results: Of the 18 patients, all had non-specific pruritic dermatoses, 36% had documented eosinophila and none were originally from the United States. A majority reported subjective improvement in their symptoms after treatment. Conclusion:  Strongyloides infection and serologic testing should be considered in patients living in non-endemic regions presenting with pruritic dermatoses and with a history of exposure to an endemic area.Key Points:Chronic strongyloidiasis can be encountered in non-endemic areas and clinical manifestations are variableEosinophilia was not a reliable indicator of chronic infection in this case series Dermatologists should consider serologic testing for strongyloidiasis in patients with a history of exposure and unexplained pruritus

The use of a Domain Ontology for the Management of Essential Hypertension (Preprint)

2020 ◽  
Author(s):  
Emma Chavez ◽  
Vanessa Perez ◽  
Angélica Urrutia
Keyword(s):  
Decision Making ◽  
Essential Hypertension ◽  
Medical History ◽  
Medical Records ◽  
Medical Training ◽  
Relevant Information ◽  
Domain Ontology ◽  
Free Text ◽  
Snomed Ct ◽  
History Of

BACKGROUND : Currently, hypertension is one of the diseases with greater risk of mortality in the world. Particularly in Chile, 90% of the population with this disease has idiopathic or essential hypertension. Essential hypertension is characterized by high blood pressure rates and it´s cause is unknown, which means that every patient might requires a different treatment, depending on their history and symptoms. Different data, such as history, symptoms, exams, etc., are generated for each patient suffering from the disease. This data is presented in the patient’s medical record, in no order, making it difficult to search for relevant information. Therefore, there is a need for a common, unified vocabulary of the terms that adequately represent the diseased, making searching within the domain more effective. OBJECTIVE The objective of this study is to develop a domain ontology for essential hypertension , therefore arranging the more significant data within the domain as tool for medical training or to support physicians’ decision making will be provided. METHODS The terms used for the ontology were extracted from the medical history of de-identified medical records, of patients with essential hypertension. The Snomed-CT’ collection of medical terms, and clinical guidelines to control the disease were also used. Methontology was used for the design, classes definition and their hierarchy, as well as relationships between concepts and instances. Three criteria were used to validate the ontology, which also helped to measure its quality. Tests were run with a dataset to verify that the tool was created according to the requirements. RESULTS An ontology of 310 instances classified into 37 classes was developed. From these, 4 super classes and 30 relationships were obtained. In the dataset tests, 100% correct and coherent answers were obtained for quality tests (3). CONCLUSIONS The development of this ontology provides a tool for physicians, specialists, and students, among others, that can be incorporated into clinical systems to support decision making regarding essential hypertension. Nevertheless, more instances should be incorporated into the ontology by carrying out further searched in the medical history or free text sections of the medical records of patients with this disease.

scholarly journals The association of triglyceride levels with the incidence of initial and recurrent acute pancreatitis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Robert J. Sanchez ◽  
Wenzhen Ge ◽  
Wenhui Wei ◽  
Manish P. Ponda ◽  
Robert S. Rosenson
Keyword(s):  
Acute Pancreatitis ◽  
Medical Records ◽  
Adult Population ◽  
Baseline Period ◽  
Prior History ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Recurrent Acute Pancreatitis ◽  
History Of ◽  
Nationally Representative

Abstract Background This retrospective cohort study assessed the annualized incidence rate (IR) of acute pancreatitis (AP) in a nationally representative US adult population, as well as the variation in the risk of AP events across strata of triglyceride (TG) levels. Methods Data were obtained from IQVIA’s US Ambulatory Electronic Medical Records (EMR) database linked with its LRxDx Open Claims database. Inclusion criteria included ≥1 serum TG value during the overlapping study period of the EMR and claims databases, ≥1 claim in the 12-month baseline period, and ≥ 1 claim in the 12 months post index. All TG measurements were assigned to the highest category reached: < 2.26, ≥2.26 to ≤5.65, > 5.65 to ≤9.94, > 9.94, and > 11.29 mmol/L (< 200, ≥200 to ≤500, > 500 to ≤880, > 880, and > 1000 mg/dL, respectively). The outcome of interest was AP, defined as a hospitalization event with AP as the principal diagnosis. Results In total, 7,119,195 patients met the inclusion/exclusion criteria, of whom 4158 (0.058%) had ≥1 AP events in the prior 12 months. Most patients (83%) had TGs < 2.26 mmol/L (< 200 mg/dL), while < 1% had TGs > 9.94 mmol/L (> 880 mg/dL). Overall, the IR of AP was low (0.08%; 95% confidence internal [CI], 0.08–0.08%), but increased with increasing TGs (0.08% in TGs < 2.26 mmol/L [< 200 mg/dL] to 1.21% in TGs > 11.29 mmol/L [> 1000 mg/dL]). In patients with a prior history of AP, the IR of AP increased dramatically; patients with ≥2 AP events at baseline had an IR of 29.98% (95% CI, 25.1–34.9%). Conclusion The risk of AP increases with increasing TG strata; however, the risk increases dramatically among patients with a recent history of AP.

419 STOP-Bang Score and History of Radiation Predicts Risk of Obstructive Sleep Apnea in Cancer Patients: A Machine Learning Study

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A166-A166
Author(s):  
Ankita Paul ◽  
Karen Wong ◽  
Anup Das ◽  
Diane Lim ◽  
Miranda Tan
Keyword(s):  
Machine Learning ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cancer Patients ◽  
Prediction Accuracy ◽  
Screening Tools ◽  
Cancer Type ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
History Of

Abstract Introduction Cancer patients are at an increased risk of moderate-to-severe obstructive sleep apnea (OSA). The STOP-Bang score is a commonly used screening questionnaire to assess risk of OSA in the general population. We hypothesize that cancer-relevant features, like radiation therapy (RT), may be used to determine the risk of OSA in cancer patients. Machine learning (ML) with non-parametric regression is applied to increase the prediction accuracy of OSA risk. Methods Ten features namely STOP-Bang score, history of RT to the head/neck/thorax, cancer type, cancer stage, metastasis, hypertension, diabetes, asthma, COPD, and chronic kidney disease were extracted from a database of cancer patients with a sleep study. The ML technique, K-Nearest-Neighbor (KNN), with a range of k values (5 to 20), was chosen because, unlike Logistic Regression (LR), KNN is not presumptive of data distribution and mapping function, and supports non-linear relationships among features. A correlation heatmap was computed to identify features having high correlation with OSA. Principal Component Analysis (PCA) was performed on the correlated features and then KNN was applied on the components to predict the risk of OSA. Receiver Operating Characteristic (ROC) - Area Under Curve (AUC) and Precision-Recall curves were computed to compare and validate performance for different test sets and majority class scenarios. Results In our cohort of 174 cancer patients, the accuracy in determining OSA among cancer patients using STOP-Bang score was 82.3% (LR) and 90.69% (KNN) but reduced to 89.9% in KNN using all 10 features mentioned above. PCA + KNN application using STOP-Bang score and RT as features, increased prediction accuracy to 94.1%. We validated our ML approach using a separate cohort of 20 cancer patients; the accuracies in OSA prediction were 85.57% (LR), 91.1% (KNN), and 92.8% (PCA + KNN). Conclusion STOP-Bang score and history of RT can be useful to predict risk of OSA in cancer patients with the PCA + KNN approach. This ML technique can refine screening tools to improve prediction accuracy of OSA in cancer patients. Larger studies investigating additional features using ML may improve OSA screening accuracy in various populations Support (if any):

Status Epilepticus in Children With Epilepsy: The Role of Antiepileptic Drug Levels in Prevention

PEDIATRICS ◽  
1996 ◽  
Vol 98 (6) ◽  
pp. 1119-1121
Author(s):  
Joseph Maytal ◽  
Gerald Novak ◽  
Catherine Ascher ◽  
Robert Bienkowski
Keyword(s):  
Status Epilepticus ◽  
Antiepileptic Drug ◽  
Medical Records ◽  
Clinic Visit ◽  
Drug Levels ◽  
Progressive Encephalopathy ◽  
History Of ◽  
The Mean ◽  
Subtherapeutic Level

Objectives. To determine the association between subtherapeutic antiepileptic drug (AED) levels or AED withdrawal and status epilepticus (SE) in children with epilepsy. Methods. We studied the AED levels at the time of SE in 51 consecutive children with epilepsy. Information about prior AED levels, possible etiology of seizures, and acute precipitants was extracted from medical records. Results. The mean age at the time of SE was 5.7 years (range, 3 months through 18 years). Forty-three patients had history of remote insult, five had history of progressive encephalopathy, and three patients were classified as idiopathic. At the time of SE all AED levels were therapeutic in 34 (66%) patients and at least one level was therapeutic in 42 (82%) patients. All levels were subtherapeutic in 9 (18%) patients. Four patients had their AED reduced or discontinued less than 1 week before SE. Twelve patients with therapeutic AED levels on their most recent clinic visit had at least one subtherapeutic level at the time of SE. Eight (16%) patients were febrile and one was hyponatremic. Of the 51 patients, 31 (61%) had no obvious explanation for the development of SE, as all known AEDs were therapeutic and there were no known acute insults. Conclusions. Neurologically abnormal children with preexisting epilepsy are at high risk for development of SE despite having therapeutic AED levels at that time. Acute precipitants of SE, such as fever or AED withdrawal, may play a role in inducing SE only in a minority of patients.

Obtaining a Family Psychiatric History: Is it Worth the Effort?

1993 ◽  
Vol 38 (9) ◽  
pp. 590-594 ◽  
Author(s):  
Ronald A. Remick ◽  
Adele D. Sadovnick ◽  
Boris Gimbarzevsky ◽  
Raymond W. Lam ◽  
Athanasios P. Zis ◽  
...  
Keyword(s):  
Family History ◽  
Psychiatric Disorder ◽  
Mood Disorder ◽  
Mood Disorders ◽  
Medical Records ◽  
Psychiatric History ◽  
First Degree Relatives ◽  
History Of ◽  
Generated Family ◽  
Index Cases

The purpose of this study was to determine whether, for first-degree relatives of patients presenting to a mood disorders clinic, family history information on psychiatric conditions collected by a psychiatrist and incorporated into the patient's medical records is as informative as that gathered during an interview specifically designed to collect family history data. The study group consisted of 472 first-degree relatives of 78 randomly selected index cases from a large mood disorders genetic database. Family history of psychiatric disorders recorded in regular psychiatric medical records (“clinician history”), and data obtained by a genetic counsellor administering specific family psychiatric history questionnaires to patients and multiple family informants (“family history”) were compared using a kappa statistic. Good agreement between the two methods on the presence or absence of a psychiatric disorder was found among first-degree relatives of index cases, but poor agreement was found with respect to the presence or absence of a specific mood disorder diagnosis(es) in a relative. The results suggest that a clinician-generated family psychiatric history is sensitive to the presence or absence of a psychiatric disorder when compared to a more structured detailed genetic interview. However, for research purposes, a clinician-generated family psychiatric history of a specific mood disorder diagnosis, without supporting collateral information, may not be reliable for use in supporting a mood disorder diagnosis in a patient and/or his relatives.

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