scholarly journals Screening for Vaginal and Endocervical Infections in the First Trimester of Pregnancy? A Study That Ignites an Old Debate

Pathogens ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1610
Author(s):  
Leonie Toboso Silgo ◽  
Sara Cruz-Melguizo ◽  
María Luisa de la Cruz Conty ◽  
María Begoña Encinas Pardilla ◽  
María Muñoz Algarra ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Screening Program ◽  
Ureaplasma Urealyticum ◽  
Univariate Analysis ◽  
First Trimester ◽  
University Hospital ◽  
Obstetric Outcomes ◽  
Normal Flora ◽  
Increased Risk ◽  
First Trimester Of Pregnancy

Objectives: Vaginal and endocervical infections are considered a global health problem, especially after recent evidence of their association with preterm delivery and other adverse obstetric outcomes. Still, there is no consensus on the efficacy of a screening strategy for these infections in the first trimester of pregnancy. This study evaluated their prevalence and whether screening and treatment resulted as effective in reducing pregnancy and perinatal complications. Methods: A single-center prospective observational study was designed; a sample size of 400 first-trimester pregnant women was established and they were recruited between March 2016–October 2019 at the Puerta de Hierro University Hospital (Spain). They were screened for vaginal and endocervical infections and treated in case of abnormal flora. Pregnancy and delivery outcomes were compared between abnormal and normal flora groups by univariate analysis. Results: 109 patients had an abnormal flora result (27.2%). The most frequently detected infection was Ureaplasma urealyticum (12.3%), followed by Candida spp. (11.8%), bacterial vaginosis (5%), Mycoplasma hominis (1.2%) and Trichomonas vaginalis (0.8%). Patients with abnormal flora had a 5-fold increased risk of preterm premature rupture of membranes (5.3% vs. 1.1% of patients with normal flora, Odds Ratio 5.11, 95% Confidence Interval 1.20–21.71, p = 0.028). No significant differences were observed regarding preterm delivery or neonatal morbidity. Conclusions: Considering the morbimortality related to prematurity and that the results of our study suggest that the early treatment of abnormal flora could improve perinatal outcomes, the implementation of a screening program during the first trimester should be considered.

scholarly journals First Trimester Aneuploidy Screening Program for Preeclampsia Prediction in a Portuguese Obstetric Population

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Cláudia Teixeira ◽  
Eduardo Tejera ◽  
Helena Martins ◽  
António Tomé Pereira ◽  
Altamiro Costa-Pereira ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Late Onset ◽  
Screening Program ◽  
First Trimester ◽  
University Hospital ◽  
Aneuploidy Screening ◽  
Detection Rates ◽  
Crown Rump Length ◽  
Screening Programs ◽  
Obstetric Population

Objective. To evaluate the performance of a first trimester aneuploidy screening program for preeclampsia (PE) prediction in a Portuguese obstetric population, when performed under routine clinical conditions.Materials and Methods. Retrospective cohort study of 5672 pregnant women who underwent routine first trimester aneuploidy screening in a Portuguese university hospital from January 2009 to June 2013. Logistic regression-based predictive models were developed for prediction of PE based on maternal characteristics, crown-rump length (CRL), nuchal translucency thickness (NT), and maternal serum levels of pregnancy-associated plasma protein-A (PAPP-A) and free beta-subunit of human chorionic gonadotropin (freeβ-hCG).Results. At a false-positive rate of 5/10%, the detection rate for early-onset (EO-PE) and late-onset (LO-PE) PE was 31.4/45.7% and 29.5/35.2%, respectively. Although both forms of PE were associated with decreased PAPP-A, logistic regression analysis revealed significant contributions from maternal factors, freeβ-hCG, CRL, and NT, but not PAPP-A, for prediction of PE.Conclusion. Our findings support that both clinical forms of EO-PE and LO-PE can be predicted using a combination of maternal history and biomarkers assessed at first trimester aneuploidy screening. However, detection rates were modest, suggesting that models need to be improved with additional markers not included in the current aneuploidy screening programs.

scholarly journals Cervical Length and Androgens in Pregnant Women With Polycystic Ovary Syndrome: Has Metformin Any Effect?

2016 ◽  
Vol 101 (6) ◽  
pp. 2325-2331 ◽  
Author(s):  
Tone Shetelig Løvvik ◽  
Solhild Stridsklev ◽  
Sven M. Carlsen ◽  
Øyvind Salvesen ◽  
Eszter Vanky
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Preterm Delivery ◽  
Polycystic Ovary ◽  
First Trimester ◽  
Cervical Length ◽  
Cervical Ripening ◽  
Ovary Syndrome ◽  
Increased Risk ◽  
Gestational Week ◽  
Androgen Levels

Abstract Context: Women with polycystic ovary syndrome (PCOS) have increased risk of preterm delivery. Shortening of the cervix is a sign of preterm delivery. Objective: This study aimed to investigate potential effect of metformin on cervical length and whether androgen levels correlate with cervical length in PCOS pregnancies. Design and Setting: This was a sub-study of a randomized, placebo-controlled, multicenter study (The PregMet study) performed at 11 secondary or tertiary centers from 2005 to 2009. Participants: Two-hundred sixty-one pregnancies of 245 women with PCOS, age 18–42 years participated. Interventions: Participants were randomly assigned to metformin or placebo from first trimester to delivery. Outcome Measurements: We compared cervical length and androgen levels in metformin and placebo groups at gestational weeks 19 and 32. We also explored whether cervical length correlated with androgen levels. Results: We found no difference in cervical length between the metformin and the placebo groups at gestational week 19 and 32. Dehydroepiandrosterone (DHEAS) tended to be higher in the metformin group. There were no correlations between androgens and cervical length at week 19. At gestational week 32, androstenedione (P = .02) and DHEAS (P = .03) showed a trend toward negative correlation to cervical length. High androstenedione level correlated with shortening of cervical length from week 19 to 32 when adjusted for confounders (P = .003). T (P = .03), DHEAS (P = .02), and free testosterone index (P = .03) showed a similar trend. Conclusion: Metformin in pregnancy did not affect cervical length in women with PCOS. High maternal androgen levels correlated with cervical shortening from the second to the third trimester of pregnancy, as a sign of cervical ripening.

scholarly journals Could molecular assessment of calcium metabolism be a useful tool to early screen patients at risk for pre-eclampsia complicated pregnancy? Proposal and rationale

2015 ◽  
Vol 53 (7) ◽  
Author(s):  
Salvatore Gizzo ◽  
Marco Noventa ◽  
Stefania Di Gangi ◽  
Carlo Saccardi ◽  
Erich Cosmi ◽  
...  
Keyword(s):  
Calcium Intake ◽  
Calcium Metabolism ◽  
Large Scale ◽  
Calcium Supplementation ◽  
English Literature ◽  
First Trimester ◽  
Control Group ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
First Trimester Of Pregnancy

AbstractOne of the most frequent causes of maternal and perinatal morbidity is represented by hypertensive disorders during pregnancy. Women at high risk must be subjected to a more intensive antenatal surveillance and prophylactic treatments. Many genetic risk factors, clinical features and biomarkers have been proposed but none of these seems able to prevent pre-eclampsia onset. English literature review of manuscripts focused on calcium intake and hypertensive disorders during pregnancy was performed. We performed a critical analysis of evidences about maternal calcium metabolism pattern in pregnancy analyzing all possible bias affecting studies. Calcium supplementation seems to give beneficial effects on women with low calcium intake. Some evidence reported that calcium supplementation may drastically reduce the percentage of pre-eclampsia onset consequently improving the neonatal outcome. Starting from this evidence, it is intuitive that investigations on maternal calcium metabolism pattern in first trimester of pregnancy could represent a low cost, large scale tool to screen pregnant women and to identify those at increased risk of pre-eclampsia onset. We propose a biochemical screening of maternal calcium metabolism pattern in first trimester of pregnancy to discriminate patients who potentially may benefit from calcium supplementation. In a second step we propose to randomly allocate the sub-cohort of patients with calcium metabolism disorders in a treatment group (calcium supplementation) or in a control group (placebo) to define if calcium supplementation may represent a dietary mean to reduce pre-eclampsia onset and to improve pregnancy outcome.

scholarly journals Interleukin-1 Receptor Antagonist Gene Polymorphism, Vaginal Interleukin-1 Receptor Antagonist Concentrations, and Vaginal Ureaplasma urealyticum Colonization in Pregnant Women

2003 ◽  
Vol 71 (1) ◽  
pp. 271-274 ◽  
Author(s):  
Parrin T. Barton ◽  
Stefan Gerber ◽  
Daniel W. Skupski ◽  
Steven S. Witkin
Keyword(s):  
Pregnant Women ◽  
Receptor Antagonist ◽  
Ureaplasma Urealyticum ◽  
Interleukin 1 ◽  
First Trimester ◽  
Enzyme Linked Immunosorbent Assay ◽  
Interleukin 1 Receptor Antagonist ◽  
First Trimester Of Pregnancy ◽  
The Relationship ◽  
Uneventful Pregnancy

ABSTRACT Ureaplasma urealyticum is the microorganism most frequently isolated from amniotic fluids of women in preterm labor. The relationship between vaginal colonization with U. urealyticum, vaginal interleukin-1 receptor antagonist (IL-1ra) levels, and the IL-1ra genotype in pregnant women was examined. Vaginal specimens, obtained with a cotton swab from 207 women in their first trimester of pregnancy, were tested for IL-1ra concentrations by enzyme-linked immunosorbent assay and for U. urealyticum and IL-1ra genotypes by PCR. U. urealyticum was detected in 85 (41.1%) women. The median IL-1ra level was 450 ng/ml in women positive for U. urealyticum, as opposed to 225 ng/ml in women negative for this microorganism (P < 0.0001). Sixty-two percent of the 16 women who were homozygous for allele 2 of the IL-1ra gene (IL-1RN*2) were colonized with U. urealyticum, as opposed to 47% of the 49 women who were IL-1RN*1/IL-1RN*2 heterozygotes and 34% of the 133 women who were IL-1RN*1 homozygotes (P < 0.05). Median IL-1ra levels were 750 ng/ml in IL-1RN*2 homozygotes, 300 ng/ml in IL-1RN*1/IL-1RN*2 heterozygotes, and 250 ng/ml in IL-1RN*1 homozygotes (P = 0.02). The vast majority of subjects had an uneventful pregnancy and delivered a healthy infant at term. The IL-1ra genotype or U. urealyticum colonization was unrelated to birth weight. Pregnant women who are colonized with U. urealyticum during the first trimester have elevated vaginal IL-1ra concentrations and a higher prevalence of the IL-1RN*2 homozygote genotype than do noncolonized women.

scholarly journals A first trimester prediction model for large for gestational age infants: a preliminary study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Francesca Monari ◽  
Daniela Menichini ◽  
Ludovica Spano’ Bascio ◽  
Giovanni Grandi ◽  
Federico Banchelli ◽  
...  
Keyword(s):  
Prediction Model ◽  
Gestational Age ◽  
Predictive Accuracy ◽  
First Trimester ◽  
University Hospital ◽  
Large For Gestational Age ◽  
Aneuploidy Screening ◽  
Maternal Characteristics ◽  
Targeted Interventions ◽  
Increased Risk

Abstract Background Large for gestational age infants (LGA) have increased risk of adverse short-term perinatal outcomes. This study aims to develop a multivariable prediction model for the risk of giving birth to a LGA baby, by using biochemical, biophysical, anamnestic, and clinical maternal characteristics available at first trimester. Methods Prospective study that included all singleton pregnancies attending the first trimester aneuploidy screening at the Obstetric Unit of the University Hospital of Modena, in Northern Italy, between June 2018 and December 2019. Results A total of 503 consecutive women were included in the analysis. The final prediction model for LGA, included multiparity (OR = 2.8, 95% CI: 1.6–4.9, p = 0.001), pre-pregnancy BMI (OR = 1.08, 95% CI: 1.03–1.14, p = 0.002) and PAPP-A MoM (OR = 1.43, 95% CI: 1.08–1.90, p = 0.013). The area under the ROC curve was 70.5%, indicating a satisfactory predictive accuracy. The best predictive cut-off for this score was equal to − 1.378, which corresponds to a 20.1% probability of having a LGA infant. By using such a cut-off, the risk of LGA can be predicted in our sample with sensitivity of 55.2% and specificity of 79.0%. Conclusion At first trimester, a model including multiparity, pre-pregnancy BMI and PAPP-A satisfactorily predicted the risk of giving birth to a LGA infant. This promising tool, once applied early in pregnancy, would identify women deserving targeted interventions. Trial registration ClinicalTrials.gov NCT04838431, 09/04/2021.

scholarly journals The Role of Platelet Indices in Prediction of Pre-eclampsia

2021 ◽  
pp. 69-77
Author(s):  
Walaa Abdelghafar Elbasuony ◽  
Hossam Abd el-mohsein Hodeib ◽  
Adel Elshahat Eljejawy ◽  
Karam Abd el-fattah Shaheen
Keyword(s):  
Obstetric Care ◽  
First Trimester ◽  
Diagnostic Value ◽  
University Hospital ◽  
Distribution Width ◽  
Platelet Indices ◽  
Group I ◽  
Gestational Week ◽  
First Trimester Of Pregnancy ◽  
Group Ii

Objective: The aim of this work is to investigate the diagnostic value of platelet count (PC), mean platelet volume (MPV), the PC to MPV ratio and platelet distribution width (PDW) for prediction of pre-eclampsia (PE). Subjects and Methods: This prospective cohort study included 100 pregnant women, in the first trimester of pregnancy attending to University Hospital, Obstetric Outpatient Clinic, for routine obstetric care from January 2019 to December 2019. Routine obstetric follow-up consists of monthly visits until 32nd gestational week, bimonthly visits between 32nd and 36th gestational week, and weekly thereafter. Patients were classified into two groups: group I: 9 pre-eclamptic patients and group II: non pre-eclamptic 91 patients. CBC indices were measured at each planned visit Results: PC, PC/MPV were significantly decreased, MPV and PDW were significantly increased in group I than group II at the 2nd part of pregnancy. To predict pre-eclampsia, PC at cut-off ≤214, sensitivity was 77.78, specificity was 76.92. MPV at cut-off >9.7, sensitivity was 77.78, specificity was 100.00, PC-MPV at cut-off ≤26.89, sensitivity was 88.89, specificity was 78.02. PDW at cut-off >10.4, sensitivity was 88.89, specificity was 54.95. Conclusion: The increase in the MPV and PDW and the decrease in PC and PC/MPV were observed in preeclampsia. Thus, the platelet indices which are easily available, as well as economical, can also be used in the prediction and early diagnosis of preeclampsia.

scholarly journals Exposure to Propylthiouracil in the First Trimester of Pregnancy and Birth Defects: A Study at a Single Institution

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Ai Yoshihara ◽  
Jaeduk Yoshimura Noh ◽  
Natsuko Watanabe ◽  
Miho Fukushita ◽  
Masako Matsumoto ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Birth Defects ◽  
Antithyroid Drug ◽  
First Trimester ◽  
Control Group ◽  
Graves Disease ◽  
Increased Risk ◽  
Group A ◽  
First Trimester Of Pregnancy ◽  
Maternal Thyroid

Abstract Context Medical treatment of Graves disease during the first trimester has been the subject of controversy ever since treatment with an antithyroid drug during the first trimester was reported to possibly be associated with an increased risk of birth defects in newborns. Objective We investigated whether the incidence of birth defects among newborns born to mothers with Graves disease (GD) treated with propylthiouracil (PTU) during the first trimester of pregnancy was higher than in a control group that was not exposed to any medication. Methods We reviewed the cases of 1913 women with GD who gave birth between January 1, 2015, and May 31, 2019. Detailed information concerning the outcome of pregnancy and the presence of birth defects was collected at the first visit after the delivery and again 1 year after delivery. We classified the mothers and infants into 3 groups according to the treatment the mother had received for GD in the first trimester of pregnancy: a group in which the mothers had been treated with PTU alone (PTU group), a group in which the mothers had not been treated with any medication (control group), and a group in which the mothers had received some other medical treatment, such as thiamazole, potassium iodide, or 2 or more drugs (other treatment group). Results The incidence of malformed infant births was 5.5% (30/541 infants) in the PTU group and 5.7% (27/ 475 infants) in the control group. There were no specific birth defects in the PTU group, and there were no significant differences between PTU dosages or maternal thyroid function according to whether mothers had delivered a child with a birth defect. Conclusion The results of our retrospective study showed that treatment with PTU during the first trimester of pregnancy did not increase the incidence of birth defects among newborns.

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