ORCID Profile
0000-0003-4136-3070
Current Organisations
King's College London
,
King's Health Partners
,
University of British Columbia
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Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.PREGHY.2016.04.009
Abstract: The Hypertensive Disorders of Pregnancy (HDP) affect 7-10% of pregnancies worldwide and are one of the leading causes of mortality and morbidity in the perinatal period. An accurate assessment of mortality and morbidity is essential to provide effective care and treatment and benchmarking of these issues is required to enhance outcomes and define standards. To benchmark outcomes for women and babies following a diagnosis of hypertension between obstetric units in similar settings. Utilising a set of pre-defined clinical indicators, In idual Patient Data analysis techniques applied to the medical records of all women diagnosed with a HDP over a 12month period at six obstetric units within Australia and Canada. Statistical analysis included contingency table sand means testing oas appropriate utilising IBM SPSS V.18. Overall HDP rate of 7.6% of all deliveries, with a 3.0% preecl sia rate. Outcomes differed significantly between units and did not cluster within any in idual unit.
Publisher: Elsevier BV
Date: 09-2008
Publisher: Springer Science and Business Media LLC
Date: 12-2013
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.PREGHY.2016.04.008
Abstract: Pre-ecl sia is a serious complication of pregnancy and contributes to maternal and offspring mortality and morbidity. Randomised controlled trials evaluating therapeutic interventions for pre-ecl sia have reported many different outcomes and outcome measures. Such variation contributes to an inability to compare, contrast, and combine in idual studies, limiting the usefulness of research to inform clinical practice. The development and use of a core outcome set would help to address these issues ensuring outcomes important to all stakeholders, including patients, will be collected and reported in a standardised fashion. An international steering group including healthcare professionals, researchers, and patients, has been formed to guide the development of this core outcome set. Potential outcomes will be identified through a comprehensive literature review and semi-structured interviews with patients. Potential core outcomes will be entered into an international, multi-perspective online Delphi survey. All key stakeholders, including healthcare professionals, researchers, and patients will be invited to participate. The modified Delphi method encourages whole and stakeholder group convergence towards consensus 'core' outcomes. Once core outcomes have been agreed upon it is important to determine how they should be measured. The truth, discrimination, and feasibility assessment framework will assess the quality of potential outcome measures. High quality outcome measures will be associated with core outcomes. Mechanisms exist to disseminate and implement the resulting core outcome set within an international context. Embedding the core outcome set within future clinical trials, systematic reviews, and clinical practice guidelines could make a profound contribution to advancing the usefulness of research to inform clinical practice, enhance patient care, and improve maternal and offspring outcomes. The infrastructure created by developing a core outcome set for pre-ecl sia could be leveraged in other settings, for ex le selecting research priorities and clinical practice guideline development. PROSPECTIVE REGISTRATION: [1] Core Outcome Measures in Effectiveness Trials (COMET) registration number: 588. [2] International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42015015529.
Publisher: Informa UK Limited
Date: 2004
Publisher: Elsevier BV
Date: 03-2010
DOI: 10.1016/J.PLACENTA.2009.12.003
Abstract: Many genes exhibiting genomic imprinting, parent-of-origin differences in gene expression, are involved in regulating placental and fetal growth. The goal of the present study was to assess whether abnormal regulation of imprinted genes is associated with intrauterine growth restriction (IUGR) and/or preecl sia (PET). Genomic DNA was extracted from at least two whole villi s les from control (N=22), IUGR (N=13), PET (N=17), and PET+IUGR (N=21) placentas. Methylation was assessed using the Illumina GoldenGate Methylation Cancer Panel I array and Pyrosequencing and MS-SNuPE assays. The 11p15.5 ICR1 (associated with H19 and IGF2) methylation showed considerable intra-placental variability. Nonetheless, average methylation at this site was significantly decreased in normotensive IUGR placentas (p<0.001), but not in any other group. Methylation at ICR2 (KvDMR1 associated with CDKN1C and other maternally expressed 11p15.5 genes) was not significantly altered in any group and no significant changes in expression levels were observed in the genes controlled by this region. There were no significant methylation changes observed in any candidate imprinted gene evaluated by the Illumina array. LINE-1 methylation, a marker of whole genome methylation, was also similar in all groups. Reduced methylation of ICR1 is associated with normotensive IUGR but not IUGR associated with preecl sia, suggesting a different etiology of IUGR in this group. A reduction in placental IGF2 could be an adaptive response to restrict fetal growth in the presence of abnormal placentation or a response to poor fetal growth itself.
Publisher: Informa UK Limited
Date: 2009
Publisher: Springer Science and Business Media LLC
Date: 09-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2016
DOI: 10.1161/HYPERTENSIONAHA.116.07862
Abstract: To determine whether clinical outcomes differed by occurrence of severe hypertension in the international CHIPS trial (Control of Hypertension in Pregnancy Study), adjusting for the interventions of “less tight” (target diastolic blood pressure [dBP] 100 mm Hg) versus “tight” control (target dBP 85 mm Hg). In this post-hoc analysis of CHIPS data from 987 women with nonsevere nonproteinuric preexisting or gestational hypertension, mixed effects logistic regression was used to compare the following outcomes according to occurrence of severe hypertension, adjusting for allocated group and the influence of baseline factors: CHIPS primary (perinatal loss or high-level neonatal care for hours) and secondary outcomes (serious maternal complications), birth weight th percentile, preecl sia, delivery at or weeks, platelets ×10 9 /L, elevated liver enzymes with symptoms, maternal length of stay ≥10 days, and maternal readmission before 6 weeks postpartum. Three hundred and thirty-four (34.1%) women in CHIPS developed severe hypertension that was associated with all outcomes examined except for maternal readmission ( P =0.20): CHIPS primary outcome, birth weight th percentile, preecl sia, preterm delivery, elevated liver enzymes (all P .001), platelets ×10 9 /L ( P =0.006), and prolonged hospital stay ( P =0.03). The association between severe hypertension and serious maternal complications was seen only in less tight control ( P =0.02). Adjustment for preecl sia (464, 47.3%) did not negate the relationship between severe hypertension and the CHIPS primary outcome ( P .001), birth weight th percentile ( P =0.005), delivery at ( P .001) or weeks ( P .001), or elevated liver enzymes with symptoms ( P =0.02). Severe hypertension is a risk marker for adverse maternal and perinatal outcomes, independent of BP control or preecl sia co-occurrence. URL: pre-empt.cfri.ca/ . Unique identifier: ISRCTN 71416914. URL: www.clinicaltrials.gov/ . Unique identifier: NCT01192412.
Publisher: Springer Science and Business Media LLC
Date: 23-11-2015
Publisher: Springer Science and Business Media LLC
Date: 28-03-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2018
DOI: 10.1161/HYPERTENSIONAHA.117.10689
Abstract: For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data based on the Akaike information criterion. Randomization before (but not after) 24 weeks to less-tight (versus tight) control was associated with fewer babies with birth weight th centile ( P interaction =0.005), but more preterm birth ( P interaction =0.043), and no effect on perinatal death or high-level neonatal care hours ( P interaction =0.354). For the mother, less-tight (versus tight) control was associated with more severe hypertension at all gestational ages but particularly so before 28 weeks ( P interaction =0.076). In women with nonsevere, chronic, or gestational hypertension, there seems to be no gestational age at which less-tight (versus tight) control is the preferred management strategy to optimize maternal or perinatal outcomes. URL: www.isrctn.com . Unique identifier: ISRCTN71416914.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.JOGC.2018.11.033
Abstract: Fournir des directives sur l'administration prénatale de sulfate de magnésium visant à offrir une neuroprotection aux enfants prématurés. L'administration prénatale de sulfate de magnésium aux fins de neuroprotection fœtale devrait être envisagée chez les femmes enceintes de 33+6 semaines ou moins étant sur le point d'accoucher prématurément l'accouchement prématuré imminent est défini par une forte probabilité d'accouchement en raison d'un travail actif accompagné d'une dilatation du col d'au moins 4 cm, avec ou sans rupture prématurée des membranes avant le travail, ou comme un accouchement prématuré planifié pour des indications maternelles ou fœtales. Outre le sulfate de magnésium, aucun autre agent offrant une neuroprotection fœtale n'est connu. RéSULTATS: Les issues évaluées sont l'incidence de la paralysie cérébrale (PC) et du décès néonatal. DONNéES PROBANTES: La littérature publiée a été récupérée au moyen de recherches menées dans PubMed ou Medline, CINAHL et la Bibliothèque Cochrane en décembre 2017 à l'aide d'une terminologie et de mots-clés contrôlés (« magnesium sulphate », « cerebral palsy », « preterm birth »). Les résultats retenus provenaient de revues systématiques, d'essais cliniques randomisés et d'autres études observationnelles pertinentes. Aucune restriction de date ou de langue n'a été employée. Les recherches ont été refaites régulièrement, et les résultats ont été incorporés à la directive clinique jusqu'en décembre 2017. Nous avons également tenu compte de la littérature grise (non publiée) trouvée sur les sites Web d'organismes d'évaluation des technologies de la santé et d'autres organismes liés aux technologies de la santé, dans des collections de directives cliniques et dans des registres d'essais cliniques, et obtenue auprès d'associations nationales et internationales de médecins spécialistes. La qualité des données probantes a été évaluée au moyen des critères énoncés dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs (tableau 1). AVANTAGES, DéSAVANTAGES ET COûTS: L'administration prénatale de sulfate de magnésium aux fins de neuroprotection fœtale réduit le risque de « décès ou PC » (risque relatif [RR] : 0,85 intervalle de confiance [IC] à 95 % : 0,74-0,98 4 essais 4 446 enfants), de « décès ou PC modérée ou grave » (RR : 0,85 IC à 95 % : 0,73-0,99 3 essais 4 250 enfants), de « PC de quelque gravité que ce soit » (RR : 0,71 IC à 95 % : 0,55-0,91 4 essais 4 446 enfants), de « PC modérée ou grave » (RR : 0,60 IC à 95 % : 0,43-0,84 3 essais 4 250 enfants) et de « dysfonctionnement important de la motricité globale » (incapacité à marcher sans aide) à l'âge de deux ans [RR : 0,60 IC à 95 % : 0,43-0,83 3 essais 4 387 femmes). Les conclusions allaient dans le même sens d'une étude et d'une méta-analyse à l'autre. Aucune augmentation significative des coûts liés aux soins de santé n'est attendue, puisque les femmes admissibles à l'administration prénatale de sulfate de magnésium seront celles dont l'accouchement prématuré est imminent. Une directive clinique australienne sur l'administration prénatale de sulfate de magnésium aux fins de neuroprotection fœtale a été publiée en mars 2010 par l'Antenatal Magnesium Sulphate for Neuroprotection Guideline Development Panel. On y recommande la même posologie que dans la présente directive, mais seulement chez les femmes enceintes de moins de 30 semaines, pour deux raisons : premièrement, aucun sous-groupe d'âge gestationnel n'a semblé bénéficier d'un avantage clair et deuxièmement, en raison de cette incertitude, le comité a été d'avis qu'il valait mieux limiter les répercussions que pouvait avoir leur directive clinique sur la répartition des ressources. En mars 2010, l'American College of Obstetricians and Gynecologists a publié une opinion de comité sur l'administration de sulfate de magnésium aux fins de neuroprotection fœtale, dans laquelle on peut lire : « Les données probantes disponibles semblent indiquer que l'administration de sulfate de magnésium avant un accouchement prématuré anticipé réduit le risque de paralysie cérébrale chez les enfants survivants. » On n'y mentionne aucun seuil d'âge gestationnel, mais on recommande aux médecins de rédiger des lignes directrices sur les critères d'inclusions, la posologie, la tocolyse concomitante et la surveillance à exercer, selon les résultats d'un essai de grande envergure. De même, en 2015, l'Organisation mondiale de la Santé a également indiqué que l'administration de sulfate de magnésium aux fins de neuroprotection fœtale faisait partie des interventions recommandées pour améliorer les issues des grossesses prenant fin prématurément, mais a précisé que d'autres études portant sur la posologie et les traitements répétés étaient nécessaires. Les Instituts de recherche en santé du Canada (IRSC). DéCLARATION SOMMAIRE: RECOMMANDATIONS.
Publisher: Wiley
Date: 28-09-2016
Publisher: Elsevier BV
Date: 08-2015
Abstract: Vitamin D supplementation is recommended for breastfed infants. Maternal supplementation beginning in gestation is a potential alternative, but its efficacy in maintaining infant 25-hydroxyvitamin D [25(OH)D] concentration after birth is unknown. We determined the effect of 3 doses of maternal vitamin D supplementation beginning in gestation and continued in lactation on infant serum 25(OH)D and compared the prevalence of infant serum 25(OH)D cutoffs (>30, >40, >50, and >75 nmol/L) by dose at 8 wk of age. Pregnant women (n = 226) were randomly allocated to receive 10, 25, or 50 μg vitamin D₃/d from 13 to 24 wk of gestation until 8 wk postpartum, with no infant supplementation. Mother and infant blood was collected at 8 wk postpartum. At 8 wk postpartum, mean [nmol/L (95% CI)] infant 25(OH)D at 8 wk was higher in the 50-μg/d [75 (67, 83)] than in the 25-μg/d [52 (45, 58)] or 10-μg/d [45 (38, 52)] vitamin D groups (P < 0.05). Fewer infants born to mothers in the 50-μg/d group had a 25(OH)D concentration <30 nmol/L (indicative of deficiency) than infants in the 25- and 10-μg/d groups, respectively (2% compared with 16% and 43% P 75 nmol/L compared with 44% in the 50-μg/d group (P 30 nmol/L. At 8 wk postpartum, mean maternal 25(OH)D concentration was higher in the 50-μg/d [88 (84, 91)] than in the 25-μg/d [78 (74, 81)] or 10-μg/d [69 (66, 73)] groups (P < 0.05). Maternal supplementation beginning in gestation with 50 μg vitamin D₃/d protects 98% of unsupplemented breastfed infants against 25(OH)D deficiency (<30 nmol/L) to at least 8 wk, whereas 10 or 25 μg vitamin D/d protects only 57% and 84% of infants, respectively.
Publisher: Elsevier BV
Date: 07-2009
Publisher: Springer Science and Business Media LLC
Date: 04-2020
DOI: 10.1186/S12978-020-0875-6
Abstract: The PRECISE Network is a cohort study established to investigate hypertension, fetal growth restriction and stillbirth (described as “placental disorders”) in Kenya, Mozambique and The Gambia. Several pregnancy or birth cohorts have been set up in low- and middle-income countries, focussed on maternal and child health. Qualitative research methods are sometimes used alongside quantitative data collection from these cohorts. Researchers affiliated with PRECISE are also planning to use qualitative methods, from the perspective of multiple subject areas. This paper provides an overview of the different ways in which qualitative research methods can contribute to achieving PRECISE’s objectives, and discusses the combination of qualitative methods with quantitative cohort studies more generally. We present planned qualitative work in six subject areas (health systems, health geography, mental health, community engagement, the implementation of the TraCer tool, and respectful maternity care). Based on these plans, with reference to other cohort studies on maternal and child health, and in the context of the methodological literature on mixed methods approaches, we find that qualitative work may have several different functions in relation to cohort studies, including informing the quantitative data collection or interpretation. Researchers may also conduct qualitative work in pursuit of a complementary research agenda. The degree to which integration between qualitative and quantitative methods will be sought and achieved within PRECISE remains to be seen. Overall, we conclude that the synergies resulting from the combination of cohort studies with qualitative research are an asset to the field of maternal and child health.
Publisher: Springer Science and Business Media LLC
Date: 30-10-2018
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/IJGO.12469
Publisher: Informa UK Limited
Date: 2004
Publisher: Elsevier BV
Date: 10-2013
Publisher: Wiley
Date: 06-08-2018
DOI: 10.1002/UOG.19186
Publisher: Informa UK Limited
Date: 2004
Publisher: WHO Press
Date: 06-08-2013
Publisher: Springer Science and Business Media LLC
Date: 22-02-2023
DOI: 10.1038/S41467-023-36125-8
Abstract: Women of reproductive age are a group of particular concern with regards to vaccine uptake, related to their unique considerations of menstruation, fertility, and pregnancy. To obtain vaccine uptake data specific to this group, we obtained vaccine surveillance data from the Office for National Statistics, linked with COVID-19 vaccination status from the National Immunisation Management Service, England, from 8 Dec 2020 to 15 Feb 2021 data from 13,128,525 such women at population-level, were clustered by age (18–29, 30–39, and 40–49 years), self-defined ethnicity (19 UK government categories), and index of multiple deprivation (IMD, geographically-defined IMD quintiles). Here we show that among women of reproductive age, older age, White ethnicity and being in the least-deprived index of multiple deprivation are each independently associated with higher vaccine uptake, for first and second doses however, ethnicity exerts the strongest influence (and IMD the weakest). These findings should inform future vaccination public messaging and policy.
Publisher: Wiley
Date: 10-02-2012
Publisher: Cold Spring Harbor Laboratory
Date: 05-2023
DOI: 10.1101/2023.04.26.23289181
Abstract: Pre-ecl sia (PE) and gestational hypertension (GH) identify women at increased risk of chronic hypertension (CH) and cardiovascular disease, but as efforts to prevent PE and GH advance, fewer women at increased cardiovascular risk will be identified. Cohort of 26,511 women seen in two consecutive pregnancies. Included were women without CH, with information on maternal characteristics and blood pressure (BP) at 11-13 weeks’ gestation, and development of PE or GH in the index pregnancy. Logistic regression models were fitted for prediction of development of future CH by the 20 th week of the subsequent pregnancy. Performance of screening and risk calibration of the model were assessed. 1560 (5.9%) women developed PE or GH (index pregnancy), and 215 (0.8%) developed future CH, a median of 3.0 years later. Predictors from the index pregnancy of development of future CH were: early pregnancy maternal age, weight and BP Black or South Asian ethnicity family history of PE parity and development of PE or GH. PE or GH accounted for 52.1% (95% confidence interval 45.2-58.9%) of future CH. At a screen-positive-rate of 10%, a model including terms for maternal characteristics and early pregnancy BP accounted for 67.9% (61.2-74.5) of future CH addition of the development of PE or GH detected 73.5% (67.1-79.3) of future CH. Risks produced from the predictive model were well-calibrated and confirmed by five-fold cross-validation. Early maternal characteristics and BP are effective in predicting development of future CH. As new interventions are expected to reduce the occurrence of PE and GH, our study results offer an alternative strategy for identifying women at increased risk of future CH and are applicable worldwide.
Publisher: Wiley
Date: 03-07-2015
DOI: 10.1002/UOG.14860
Abstract: To assess the diagnostic accuracy of placental growth factor (PlGF) and ultrasound parameters to predict delivery of a small-for-gestational-age (SGA) infant in women presenting with reduced symphysis-fundus height (SFH). This was a multicenter prospective observational study recruiting 601 women with a singleton pregnancy and reduced SFH between 24 and 37 weeks' gestation across 11 sites in the UK and Canada. Plasma PlGF concentration < 5(th) centile, estimated fetal weight (EFW) 95(th) centile and oligohydramnios (amniotic fluid index < 5 cm) were compared as predictors for a SGA infant < 3(rd) customized birth-weight centile and adverse perinatal outcome. Test performance statistics were calculated for all parameters in isolation and in combination. Of the 601 women recruited, 592 were analyzed. For predicting delivery of SGA < 3(rd) centile (n = 78), EFW < 10(th) centile had 58% sensitivity (95% CI, 46-69%) and 93% negative predictive value (NPV) (95% CI, 90-95%), PlGF had 37% sensitivity (95% CI, 27-49%) and 90% NPV (95% CI, 87-93%) in combination, PlGF and EFW < 10(th) centile had 69% sensitivity (95% CI, 55-81%) and 93% NPV (95% CI, 89-96%). The equivalent receiver-operating characteristics (ROC) curve areas were 0.79 (95% CI, 0.74-0.84) for EFW < 10(th) centile, 0.70 (95% CI, 0.63-0.77) for low PlGF and 0.82 (95% CI, 0.77-0.86) in combination. For women presenting with reduced SFH, ultrasound parameters had modest test performance for predicting delivery of SGA < 3(rd) centile. PlGF performed no better than EFW < 10(th) centile in determining delivery of a SGA infant.
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/IJGO.12464
Publisher: Elsevier BV
Date: 2019
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/IJGO.12463
Publisher: MDPI AG
Date: 30-01-2021
DOI: 10.3390/NU13020472
Abstract: The placenta is a vital, multi-functional organ that acts as an interface between maternal and fetal circulation during pregnancy. Nutritional deficiencies during pregnancy alter placental development and function, leading to adverse pregnancy outcomes, such as pre-ecl sia, infants with small for gestational age and low birthweight, preterm birth, stillbirths and maternal mortality. Maternal nutritional supplementation may help to mitigate the risks, but the evidence base is difficult to navigate. The primary purpose of this umbrella review is to map the evidence on the effects of maternal nutritional supplements and dietary interventions on pregnancy outcomes related to placental disorders and maternal mortality. A systematic search was performed on seven electronic databases, the PROSPERO register and references lists of identified papers. The results were screened in a three-stage process based on title, abstract and full-text by two independent reviewers. Randomized controlled trial meta-analyses on the efficacy of maternal nutritional supplements or dietary interventions were included. There were 91 meta-analyses included, covering 23 types of supplements and three types of dietary interventions. We found evidence that supports supplementary vitamin D and/or calcium, omega-3, multiple micronutrients, lipid-based nutrients, and balanced protein energy in reducing the risks of adverse maternal and fetal health outcomes. However, these findings are limited by poor quality of evidence. Nutrient combinations show promise and support a paradigm shift to maternal dietary balance, rather than single micronutrient deficiencies, to improve maternal and fetal health. The review is registered at PROSPERO (CRD42020160887).
Publisher: Wiley
Date: 10-03-2022
DOI: 10.1002/UOG.24893
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/IJGO.12467
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/IJGO.12466
Publisher: Wiley
Date: 07-2020
DOI: 10.1002/UOG.22115
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/IJGO.12465
Publisher: Public Library of Science (PLoS)
Date: 21-01-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2008
Publisher: Springer Science and Business Media LLC
Date: 04-2020
DOI: 10.1186/S12978-020-0876-5
Abstract: It is widely acknowledged across the global health sector that research programmes need to be designed and implemented in a way that maximise opportunities for strengthening local capacity. This paper examines how the United Kingdom Research and Innovation (UKRI) Grand Challenges Research Fund (GCRF) funded PRECISE (PREgnancy Care Integrating translational Science, Everywhere) Network has been established as a platform to strengthen global capacity for research focused on the improvement of maternal, fetal and newborn health in sub-Saharan Africa. Best practice principles outlined in an ESSENCE on Health Research report have been considered in relation to the PRECISE Network capacity-building activities described in this paper. These activities are described at the in idual, programmatic and institutional levels, and successes, challenges and recommendations for future work are outlined. The paper concludes that the PRECISE leadership have an opportunity to review and refresh activity plans for capacity building at this stage in the project to build on achievements to date.
Publisher: Elsevier BV
Date: 07-2020
DOI: 10.1016/J.PREGHY.2020.06.005
Abstract: To develop consensus definitions for the core outcome set for pre-ecl sia. Potential definitions for in idual core outcomes were identified across four formal definition development initiatives, nine national and international guidelines, 12 Cochrane systematic reviews, and 79 randomised trials. Eighty-six definitions were entered into the consensus development meeting. Ten healthcare professionals and three researchers, including six participants who had experience of conducting research in low- and middle-income countries, participated in the consensus development process. The final core outcome set was approved by an international steering group. Consensus definitions were developed for all core outcomes. When considering stroke, pulmonary oedema, acute kidney injury, raised liver enzymes, low platelets, birth weight, and neonatal seizures, consensus definitions were developed specifically for low- and middle-income countries because of the limited availability of diagnostic interventions including computerised tomography, chest x-ray, laboratory tests, equipment, and electroencephalogram monitoring. Consensus on measurements for the pre-ecl sia core outcome set will help to ensure consistency across future randomised trials and systematic reviews. Such standardization should make research evidence more accessible and facilitate the translation of research into clinical practice. Video abstract can be available at: /ftrgvrfu0u9glqd/6.%20Standardising%20definitions%20in%20teh%20pre-ecl sia%20core%20outcome%20set%3A%20a%20consensus%20development%20study.mp4?dl=0.
Publisher: Wiley
Date: 07-2021
DOI: 10.1002/IJGO.13763
Publisher: Elsevier BV
Date: 03-2022
Publisher: Elsevier BV
Date: 2006
DOI: 10.1016/J.MEHY.2005.08.058
Abstract: Given the efficacy and safety of recombinant human activated protein C (rhAPC) in the systemic inflammatory response syndrome (SIRS), this study was designed to review the evidence for rhAPC as a possible therapeutic option in the treatment of severe ovarian hyperstimulation syndrome (OHSS). SIRS, like OHSS, is a proinflammatory and prothrombotic disorder whose cornerstone is endothelial dysfunction in which protein C deficiency is a frequent occurrence. Recently, the use of rhAPC has been shown to be of benefit with a reduction in mortality and an improvement in indicators of inflammation and coagulation. OHSS is typically an iatrogenic disorder resulting from ovarian stimulation as a component of infertility treatment. The pathogenesis of OHSS, like sepsis, is related to endothelial dysfunction and inflammation and can result in significant morbidity including end organ hypoperfusion, disseminated intravascular coagulation (DIC), thrombosis, and occasionally, death. We have performed a review of the literature to identify similarities between these disease processes to develop a theoretical basis for the use of rhAPC in patients with moderate to severe OHSS. Use of rhAPC in this group may attenuate the disease process and reduce the potential morbidity associated with this iatrogenic disorder.
Publisher: Springer Science and Business Media LLC
Date: 09-2016
Publisher: BMJ
Date: 12-2022
DOI: 10.1136/BMJOPEN-2021-060593
Abstract: To describe the process of community engagement (CE) in northern Karnataka, India and its impact on pre-ecl sia knowledge, birth preparedness and complication readiness, pregnancy-related care seeking and maternal morbidity. This study was a secondary analysis of a cluster randomised trial of Community Level Interventions for Pre-ecl sia (CLIP). A total of 12 clusters based on primary health centre catchment areas were randomised to intervention or control. CE was conducted in intervention clusters. CE attendance was summarised according to participant group using both quantitative and qualitative assessment. Pre-ecl sia knowledge, birth preparedness, health services engagement and perinatal outcomes was evaluated within trial surveillance. Outcomes were compared between trial arms using a mixed effects logistic regression model on RStudio (RStudio, Boston, USA). Community feedback notes were thematically analysed on NVivo V.12 (QSR International, Melbourne, Australia). Belagavi and Bagalkote districts in rural Karnataka, India. Pregnant women and women of reproductive age, mothers and mothers-in-law, community stakeholders and male household decision-makers and health workers. A total of 1379 CE meetings were conducted with 39 362 participants between November 2014 and October 2016. CE activities may have had an effect on modifying community attitudes towards hypertension in pregnancy and its complications. However, rates of pre-ecl sia knowledge, birth preparedness, health services engagement and maternal morbidities among in idual pregnant women were not significantly impacted by CE activities in their area. Evaluation of our CE programme in India demonstrates the feasibility of reaching pregnant women alongside household decision-makers, community stakeholders and health workers. More research is needed to explore the pathways of impact between broad community mobilisation to strengthen support for maternal care seeking and clinical outcomes of in idual pregnant women. NCT01911494 .
Publisher: Wiley
Date: 16-05-2014
Publisher: JMIR Publications Inc.
Date: 17-04-2015
DOI: 10.2196/MHEALTH.3942
Publisher: Wiley
Date: 29-09-2022
Publisher: Wiley
Date: 13-03-2014
Publisher: Wiley
Date: 09-2010
DOI: 10.3109/00016349.2010.499449
Abstract: Pre-ecl sia shares several similarities with atherosclerotic heart disease. We explored whether, like atherosclerosis, there is a potential link between cytomegalovirus (CMV) infection and pre-ecl sia. CMV IgG, IgM and IgA antibodies were determined by enzyme-linked immunosorbent assays in serums from pre-ecl sia (n = 78), normotensive intrauterine growth restriction (nIUGR) (n = 30) and normal pregnancy controls (n = 109). Data were analyzed by chi-squared, Kruskal-Wallis ANOVA and Mann-Whitney U-tests. Further, we conducted a comprehensive review of published studies on the relation between CMV infection and pre-ecl sia. Risk ratios (RRs) and 95% confidence interval (CI), according to CMV infection status, were calculated using Review Manager. Women with pre-ecl sia had increased CMV IgG seropositivity compared with nIUGR (p < 0.01) and normal pregnancy controls (p < 0.01). In addition, CMV IgG antibody level was higher in pre-ecl sia than normal pregnancy controls (p < 0.001). No difference was observed in CMV IgM or IgA among study groups. Data synthesis revealed that women with CMV infection were at higher risk in the development of pre-ecl sia, compared with women without CMV infection. Combined results for six studies yielded a RR of 1.5 (95% CI 1.2-1.9). CMV infection seems to affect the occurrence of pre-ecl sia. Evaluation of the relation between CMV infection and pre-ecl sia may provide mechanistic insights into pre-ecl sia-related inflammation.
Publisher: Wiley
Date: 21-04-2022
Publisher: Springer Science and Business Media LLC
Date: 09-2016
Publisher: Springer Science and Business Media LLC
Date: 12-06-2014
DOI: 10.1007/S11906-014-0454-8
Abstract: Pre-ecl sia remains the second leading direct cause of maternal death, >99 % of which occurs in less developed countries. Over 90 percent of the observed reduction in pre-ecl sia-related maternal deaths in the UK (1952-2008) occurred with antenatal surveillance and timed delivery. In this review, we discuss the pathogenesis, diagnostic criteria, disease prediction models, prevention and management of pre-ecl sia. The Pre-ecl sia Integrated Estimate of RiSk (PIERS) models and markers of angiogenic imbalance identify women at incremental risk for severe pre-ecl sia complications. For women at high risk of developing pre-ecl sia, low doses of aspirin (especially if started <17 weeks) and calcium are evidence-based preventative strategies heparin is less so. Severe hypertension must be treated and the Control of Hypertension In Pregnancy (CHIPS) Trial (reporting: 2014) will guide non-severe hypertension management. Magnesium sulfate prevents and treats ecl sia there is insufficient evidence to support alternative regimens. Pre-ecl sia predicts later cardiovascular disease however, at this time we do not know what to do about it.
Publisher: Elsevier BV
Date: 02-2011
Publisher: Elsevier BV
Date: 10-2016
Publisher: Wiley
Date: 05-2018
DOI: 10.1002/IJGO.12499
Publisher: Wiley
Date: 17-10-2022
Abstract: To examine the effect of self-declared race on serum placental growth factor (PlGF) and sFlt-1/PlGF ratio and the impact on pre-ecl sia (PE) prediction. Prospective observational study. Two UK maternity hospitals. 29 035 women with singleton pregnancies attending a routine 35 The predictive performance of PlGF and sFlt-1/PlGF for PE in minority racial groups (versus white) was examined. Delivery with PE. Compared with white women, mean PlGF was higher and sFlt-1/PlGF ratio lower in black, South Asian, East Asian and mixed race women. In white women at a PlGF concentration cut-off corresponding to a screen-positive rate (SPR) of 10%, detection rates (DRs) were 49.1% for PE at any time and 72.3% for PE within 2 weeks after screening. In black women, at the same PlGF concentration cut-off for white women, the SPR was 5.5%, and DRs 33.6% and 55.0%, respectively the number of PE cases was too small to evaluate screening performance in other racial groups. Using a fixed cut-off in sFlt-1/PlGF ratio to identify women at risk of developing PE, similarly diagnostically disadvantaged black women. Bias was overcome by adjusting metabolite concentrations for maternal characteristics and use of the competing risks model to estimate patient-specific risks. Screening for PE with fixed cut-offs in PlGF or sFlt-1/PlGF diagnostically disadvantages black women. It is essential that measured levels of PlGF be adjusted for race as well as other maternal characteristics.
Publisher: Apollo - University of Cambridge Repository
Date: 2021
DOI: 10.17863/CAM.56999
Publisher: The Society of Laparoscopic and Robotic Surgeons
Date: 2011
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.PREGHY.2018.01.004
Abstract: The fullPIERS model is a risk prediction model developed to predict adverse maternal outcomes within 48 h for women admitted with pre-ecl sia. External validation of the model is required before implementation for clinical use. We assessed the temporal and external validity of the fullPIERS model in high income settings using five cohorts collected between 2003 and 2016, from tertiary hospitals in Canada, the United States of America, Finland and the United Kingdom. The cohorts were grouped into three datasets for assessing the primary external, and temporal validity, and broader transportability of the model. The predicted risks of developing an adverse maternal outcome were calculated using the model equation and model performance was evaluated based on discrimination, calibration, and stratification. Our study included a total of 2429 women, with an adverse maternal outcome rate of 6.7%, 6.6%, and 7.0% in the primary external, temporal, and combined (broader) validation cohorts, respectively. The model had good discrimination in all datasets: 0.81 (95%CI 0.75-0.86), 0.82 (95%CI 0.76-0.87), and 0.75 (95%CI 0.71-0.80) for the primary external, temporal, and broader validation datasets, respectively. Calibration was best for the temporal cohort but poor in the broader validation dataset. The likelihood ratios estimated to rule in adverse maternal outcomes were high at a cut-off of ≥30% in all datasets. The fullPIERS model is temporally and externally valid and will be useful in the management of women with pre-ecl sia in high income settings although model recalibration is required to improve performance, specifically in the broader healthcare settings.
Publisher: Elsevier BV
Date: 08-1999
DOI: 10.1016/S0002-9378(99)70570-3
Abstract: In normal pregnancy there is both a neutrophilia and a mild neutrophil activation. In preecl sia both direct and indirect evidence supports further marked neutrophil activation. In the pathogenesis of preecl sia peripheral blood neutrophils may play a vital role in communicating between the preecl tic placenta and the maternal vascular endothelium and contribute to the endothelial cell dysfunction that characterizes the maternal syndrome of preecl sia. Preecl sia shares many elements with the systemic inflammatory response syndrome. Neutrophils, key effectors of the systemic inflammatory response syndrome, are associated with hepatic necrosis and adult respiratory distress syndrome, both of which most commonly kill women with preecl sia. We hypothesized that delayed neutrophil apoptosis could explain (1) the neutrophilia of normal pregnancy and (2) the differential maternal responses to the shared placental abnormality of preecl sia and normotensive intrauterine growth restriction. Neutrophils were isolated (dextran 500, Ficoll [Amersham Pharmacia Biotech AB, Uppsala, Sweden], and erythrocyte lysis) from (1) case patients with preecl sia at </=34 weeks' gestation, (2) healthy pregnant control subjects, (3) case patients with normotensive intrauterine growth restriction at </=34 weeks' gestation, and (4) nonpregnant female control subjects. Apoptosis was determined after 18 hours of incubation (with or without endotoxin or anti-Fas monoclonal antibody) by deoxyribonucleic acid profile (propidium iodide study), annexin V binding, and CD16 expression. Compared with propidium iodide profile values in nonpregnant women (median, 25% range, 14%-40%) neutrophil apoptosis was significantly delayed in normal pregnancy (median, 9.5% range, 7.6%-15%) and normotensive pregnancy with intrauterine growth restriction (median, 11% range. 9.3%-19%) and was further delayed in preecl sia (median, 6.9% range, 4.1%-8. 2% P </=.005 vs normal pregnancy and normotensive intrauterine growth restriction). All neutrophils remained sensitive to endotoxin inhibition but were resistant to anti-Fas induction of apoptosis. Spontaneous neutrophil apoptosis decreased as gestational age increased (r (2) = 0.48). Impaired neutrophil apoptosis may explain the neutrophilia associated with normal pregnancy. In women with preecl sia activated neutrophils remain in the circulation, perhaps contributing to the persistence of preecl sia after delivery. Neutrophils appear to modulate the variation in maternal response between preecl sia and normotensive intrauterine growth restriction.
Publisher: Springer Science and Business Media LLC
Date: 02-03-2016
Publisher: Springer Science and Business Media LLC
Date: 28-07-2017
Publisher: Elsevier BV
Date: 07-2020
Publisher: Springer Science and Business Media LLC
Date: 09-2016
Publisher: CMA Joule Inc.
Date: 10-08-2009
DOI: 10.1503/CMAJ.081727
Publisher: Elsevier BV
Date: 07-2020
Publisher: WHO Press
Date: 09-09-2020
Publisher: F1000 Research Ltd
Date: 14-11-2022
DOI: 10.12688/WELLCOMEOPENRES.18465.1
Abstract: Background: PRECISE-DYAD is an observational cohort study of mother-child dyads running in urban and rural communities in The Gambia and Kenya. The cohort is being followed for two years and includes uncomplicated pregnancies and those that suffered pregnancy hypertension, fetal growth restriction, preterm birth, and/or stillbirth. Methods: The PRECISE-DYAD study will follow up ~4200 women and their children recruited into the original PRECISE study. The study will add to the detailed pregnancy information and s les in PRECISE, collecting additional biological s les and clinical information on both the maternal and child health. Women will be asked about both their and their child’s health, their diets as well as undertaking a basic cardiology assessment. Using a case-control approach, some mothers will be asked about their mental health, their experiences of care during labour in the healthcare facility. In a sub-group, data on financial expenditure during antenatal, intrapartum, and postnatal periods will also be collected. Child development will be assessed using a range of tools, including neurodevelopment assessments, and evaluating their home environment and quality of life. In the event developmental milestones are not met, additional assessments to assess vision and their risk of autism spectrum disorders will be conducted. Finally, a personal environmental exposure model for the full cohort will be created based on air and water quality data, combined with geographical, demographic, and behavioural variables. Conclusions: The PRECISE-DYAD study will provide a greater epidemiological and mechanistic understanding of health and disease pathways in two sub-Saharan African countries, following healthy and complicated pregnancies. We are seeking additional funding to maintain this cohort and to gain an understanding of the effects of pregnancies outcome on longer-term health trajectories in mothers and their children.
Publisher: Elsevier BV
Date: 2012
DOI: 10.1016/J.PREGHY.2011.08.117
Abstract: To evaluate the clinical performance of a rapid point-of-care test, Triage PLGF (Alere, San Diego) in the diagnosis of preecl sia. For the reference range 2212 plasma s les were collected from 595 subjects with normotensive pregnancies, between week 17 of gestation and delivery. In the case-control part, two cohorts of women with preecl sia (80 women) were matched for maternal age, gestational age (GA) at s ling and parity with normotensive women who delivered at 37weeks or more. The areas under the receiver operating characteristic curves (GA<35weeks) were 1.0 and 0.994 (cohort 1 and 2, respectively). The clinical sensitivity of the Triage PLGF test for the pooled GA range of 21⩽GA<35, using a GA dependent cut-off, was 1.0 for both cohorts with specificities of 1.0 and 0.940. The Triage PLGF test distinguishes well between preterm pregnancies with and without preecl sia.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2017
DOI: 10.1161/HYPERTENSIONAHA.116.08706
Abstract: The hypertensive disorders of pregnancy are leading causes of maternal mortality and morbidity, especially in low- and middle-income countries. Early identification of women with preecl sia and other hypertensive disorders of pregnancy at high risk of complications will aid in reducing this health burden. The fullPIERS model (Preecl sia Integrated Estimate of Risk) was developed for predicting adverse maternal outcomes from preecl sia using data from tertiary centers in high-income countries and uses maternal demographics, signs, symptoms, and laboratory tests as predictors. We aimed to assess the validity of the fullPIERS model in women with the hypertensive disorders of pregnancy in low-resourced hospital settings. Using miniPIERS data collected on women admitted with hypertensive disorders of pregnancy between July 2008 and March 2012 in 7 hospitals in 5 low- and middle-income countries, the predicted probability of developing an adverse maternal outcome was calculated for each woman using the fullPIERS equation. Missing predictor values were imputed using multivariate imputation by chained equations. The performance of the model was evaluated for discrimination, calibration, and stratification capacity. Among 757 women with complete predictor data (complete-case analyses), the fullPIERS model had a good area under the receiver-operating characteristic curve of 0.77 (95% confidence interval, 0.72–0.82) with poor calibration ( P ·001 for the Hosmer–Lemeshow goodness-of-fit test). Performance as a rule-in tool was moderate (likelihood ratio: 5.9 95% confidence interval, 4.23–8.35) for women with ≥30% predicted probability of an adverse outcome. The fullPIERS model may be used in low-resourced setting hospitals to identify women with hypertensive disorders of pregnancy at high risk of adverse maternal outcomes in need of immediate interventions.
Publisher: Wiley
Date: 30-04-2013
Publisher: John Wiley & Sons, Ltd
Date: 24-01-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2018
DOI: 10.1161/HYPERTENSIONAHA.117.10318
Abstract: Early-onset preecl sia is associated with severe maternal and perinatal complications. The fullPIERS model (Preecl sia Integrated Estimate of Risk) showed both internal and external validities for predicting adverse maternal outcomes within 48 hours for women admitted with preecl sia at any gestational age. This ability to recognize women at the highest risk of complications earlier could aid in preventing these adverse outcomes through improved management. Because the majority (≈70%) of the women in the model development had late-onset preecl sia, we assessed the performance of the fullPIERS model in women with early-onset preecl sia to determine whether it will be useful in this subgroup of women with preecl sia. Three cohorts of women admitted with early-onset preecl sia between 2012 and 2016, from tertiary hospitals in Canada, the Netherlands, and United Kingdom, were used. Using the published model equation, the probability of experiencing an adverse maternal outcome was calculated for each woman, and model performance was evaluated based on discrimination, calibration, and stratification. The total data set included 1388 women, with an adverse maternal outcome rate of 7.3% within 48 hours of admission. The model had good discrimination, with an area under the receiver operating characteristic curve of 0.80 (95% confidence interval, 0.75–0.86), and a calibration slope of 0.68. The estimated likelihood ratio at the predicted probability of ≥30% was 23.4 (95% confidence interval, 14.83–36.79), suggesting a strong evidence to rule in adverse maternal outcomes. The fullPIERS model will aid in identifying women admitted with early-onset preecl sia in similar settings who are at the highest risk of adverse outcomes, thereby allowing timely and effective interventions.
Publisher: Georg Thieme Verlag KG
Date: 11-04-2012
Abstract: To determine whether early administration of aspirin prevents severe and mild preecl sia. A systematic review and meta-analysis of randomized controlled trials were performed. Studies in which women were randomized at or before 16 weeks' gestation to low-dose aspirin versus placebo or no treatment were included. The outcomes of interest were severe preecl sia and mild preecl sia. Pooled relative risks with their 95% confidence intervals (CIs) were calculated. Among 7941 citations retrieved, 352 were completely reviewed and four studies (392 women) fulfilled the inclusion criteria and were analyzed. When compared with controls, aspirin started at ≤16 weeks was associated with a significant reduction in severe (relative risk: 0.22, 95% CI: 0.08 to 0.57) but not mild (relative risk: 0.81, 95% CI: 0.33 to 1.96) preecl sia. Low-dose aspirin initiated at or before 16 weeks reduces the risk of severe preecl sia, but not mild preecl sia.
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.BPOBGYN.2011.02.003
Abstract: The hypertensive disorders of pregnancy (HDP) remain one of the major causes of maternal mortality and morbidity worldwide. Many international guidelines exist for the classification and assessment of women with hypertension in pregnancy, but definitions and recommendations within these documents are variable. Many recommended investigations do not actually correlate with increased risk of adverse outcomes, making it difficult to determine true prognosis. Although standardised assessment and surveillance has been shown to improve outcomes, the application of these monitoring strategies in many areas of the world is not possible owing to the cost associated with them. Not all of the tests recommended for surveillance of women with pre-ecl sia are independently predictive of adverse outcomes, and many unnecessary tests could be avoided if those tests that are most informative where identified. The Pre-ecl sia Integrated Estimate of RiSk study has identified a group of tests that can be used to predict risk of outcomes accurately up to 7 days after admission to a tertiary hospital with pre-ecl sia. This model needs to be validated in new populations and in different clinical settings before it can be implemented into clinical practice. Until this happens, clinicians should consider the whole clinical picture when assessing women with pre-ecl sia and making decisions around expectant management compared with stabilisation and delivery. Future research in the area of prognosis should focus on women with variable definitions of pre-ecl sia and the other HDP. All studies reviewed were limited to cases of severe pre-ecl sia, and results may not be generalisable across the spectrum of the disorder.
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.JOGC.2017.01.028
Abstract: To evaluate the performance of the Modified Early Obstetric Warning System (MEOWS) to predict maternal ICU admission in an obstetric population. Case-control study. Two maternity units in Vancouver, Canada, one with ICU facilities, between January 1, 2000, and December 31, 2011. Pregnant or recently delivered (≤6 weeks) women admitted to the hospital for >24 hours. Three control patients were randomly selected per case and matched for year of admission. Retrospective, observational, case-control validation study investigating the physiologic predictors of admission in the 24-hour period preceding either ICU admission >24 hours (cases) or following admission (control patients). Model performance was assessed based on sensitivity, specificity, and predictive values. Forty-six women were admitted to the ICU for >24 hours (0.51/1000 deliveries) the study included 138 randomly selected control patients. There were no maternal deaths in the cohort. MEOWS had high sensitivity (0.96) but low specificity (0.54) for ICU admission >24 hours, whereas ≥1 one red trigger maintained sensitivity (0.96) and improved specificity (0.73). Altering MEOWS trigger parameters may improve the accuracy of MEOWS in predicting ICU admission. Formal modelling of a MEOWS scoring system is required to support evidence-based care.
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.JOGC.2022.04.017
Abstract: To identify determinants of cesarean delivery (CD) and examine associations between mode of delivery (MOD) and maternal and perinatal outcomes. We conducted a retrospective analysis of a Canadian multicentre birth cohort derived from provincial data collected in 2008/2009. Maternal and perinatal characteristics and outcomes were compared between vaginal and cesarean birth and between the following MOD subgroups: spontaneous vaginal delivery (VD), assisted VD, planned cesarean delivery (CD), and intrapartum CD. Multivariate regression identified determinants of CD and the effects of MOD and previous CD on maternal and perinatal outcomes. The cohort included 264 755 births (72.1% VD and 27.9% CD) from 91 participating institutions. Determinants of CD included maternal age, parity, previous CD, chronic hypertension, diabetes, urinary tract infection or pyelonephritis, gestational hypertension, vaginal bleeding, labour induction, pre-term gestational age, low birth weight, large for gestational age, malpresentation, and male sex. CD was associated with greater risk of maternal and perinatal morbidity and mortality. Subgroup analysis demonstrated higher risk of adverse pregnancy outcomes with assisted VD and intrapartum CD than spontaneous VD. Planned CD reduced the risk of obstetric wound hematoma and perinatal mortality but increased maternal and neonatal morbidity. Previous CD increased the risk of maternal and neonatal morbidity among multiparous women. The CD rate in Canada is consistent with global trends reflecting demographic and obstetric intervention factors. The risk of adverse pregnancy outcomes with CD warrants evaluation of interventions to safely prevent nonessential cesarean birth.
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/S1701-2163(16)35015-0
Abstract: Platelet count has been proposed as a screening test for generalized coagulopathy in women with preecl sia. We performed this study to determine the relationship between platelet counts and the risk of abnormal coagulation and adverse maternal outcomes in women with preecl sia. We used data from women in the PIERS (Pre-ecl sia Integrated Estimate of RiSk) database. Abnormal coagulation was defined as either an international normalized ratio result greater than and/or a serum fibrinogen level less than the BC Women's Hospital laboratory's pregnancy-specific normal range. The relationship between platelet counts and adverse maternal outcomes was explored using a logistic regression analysis. The sensitivity, specificity, positive predictive value, and negative predictive value of platelet counts in identifying abnormal coagulation or adverse maternal outcomes were calculated. Abnormal coagulation occurred in 105 of 1405 eligible women (7.5%). The odds of having abnormal coagulation were increased for women with platelet counts < 50 × 10(9)/L (OR 7.78 95% CI 3.36 to 18.03) and between 50 and 99 × 10(9)/L (OR 2.69 95% CI 1.44 to 5.01) compared with women who had platelet counts above 150 × 10(9)/L. Platelet counts < 100 × 10(9)/L were associated with significantly increased odds of adverse maternal outcomes, most specifically blood transfusion. A platelet count of < 100 × 10(9)/L had good specificity in identifying abnormal coagulation and adverse maternal outcomes (92% [95% CI 91% to 94%] and 92% [95% CI 91% to 94%], respectively), but poor sensitivity (22% [95% CI 15% to 31%] and 16% [95% CI 11% to 23%], respectively). A platelet count < 100 × 10(9)/L is associated with an increased risk of abnormal coagulation and maternal adverse outcomes in women with preecl sia. However, the platelet count should not be used in isolation to guide care because of its poor sensitivity. Whether or not a platelet count is normal should not be used to determine whether further coagulation tests are needed.
Publisher: Elsevier BV
Date: 06-2014
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2020
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.PREGHY.2015.12.002
Abstract: A common challenge in medicine, exemplified in the analysis of biomarker data, is that large studies are needed for sufficient statistical power. Often, this may only be achievable by aggregating multiple cohorts. However, different studies may use disparate platforms for laboratory analysis, which can hinder merging. Using circulating placental growth factor (PlGF), a potential biomarker for hypertensive disorders of pregnancy (HDP) such as preecl sia, as an ex le, we investigated how such issues can be overcome by inter-platform standardization and merging algorithms. We studied 16,462 pregnancies from 22 study cohorts. PlGF measurements (gestational age ⩾20 weeks) analyzed on one of four platforms: R&D Systems, AlereTriage, RocheElecsys or AbbottArchitect, were available for 13,429 women. Two merging algorithms, using Z-Score and Multiple of Median transformations, were applied. Best reference curves (BRC), based on merged, transformed PlGF measurements in uncomplicated pregnancy across six gestational age groups, were estimated. Identification of HDP by these PlGF-BRCs was compared to that of platform-specific curves. We demonstrate the feasibility of merging PlGF concentrations from different analytical platforms. Overall BRC identification of HDP performed at least as well as platform-specific curves. Our method can be extended to any set of biomarkers obtained from different laboratory platforms in any field. Merged biomarker data from multiple studies will improve statistical power and enlarge our understanding of the pathophysiology and management of medical syndromes.
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.BPOBGYN.2011.04.002
Abstract: Pre-ecl sia and ecl sia are leading causes of maternal and perinatal morbidity and mortality worldwide. The exact prevalence, however, is unknown. The majority of pre-ecl sia related deaths in LMIC occur in the community and therefore, interventions must be focused at this level. There are a number of unique challenges facing LMIC but the principles of care for women with pre-ecl sia remain the same as in well resourced settings. Three primary delays lead to an increased incidence of maternal mortality from pre-ecl sia- delays in triage, transport and treatment. There are a number of other challenges facing LMIC and the health care worker shortage is particularly significant. Task shifting is a potential strategy to address this challenge. Community health care workers, specifically lady health care workers, are an integral part of the health care force in many LMIC and can be employed to provide timely care to women with pre-ecl sia. Prevention strategies should be applied to every pregnant woman since we cannot predict who will develop pre-ecl sia given the limitation in resources. Aspirin and calcium are the only two recommended therapies at this time. Measuring blood pressure and proteinuria is challenging in LMIC due to financial cost and lack of training. A detection tool that is affordable and can be easily applied is needed. Magnesium sulfate is the drug of choice for the prevention and treatment of ecl sia but it is underutilized due to barriers on multiple levels.
Publisher: Wiley
Date: 21-11-2013
DOI: 10.1002/PD.4016
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.AJOG.2011.06.058
Abstract: Placental growth factor and soluble Fms-like tyrosine kinase-1 may be potential diagnostic markers of preecl sia. We compared performances of 2 immunoassays, the Triage placental growth factor assay and the Elecsys soluble Fms-like tyrosine kinase-1 lacental growth factor ratio in diagnosing preecl sia. A single site, case-control study of 44 patients with preecl sia and 84 matched normal pregnant controls. S les were collected at the time of diagnosis. Assays were performed according to product inserts. Both assays had optimal performance in diagnosing early-onset preecl sia with area under the receiver operating characteristic curves of 0.99 (Triage: 100% sensitivity, 96% specificity Elecsys: 64% sensitivity, 100% specificity for early-onset preecl sia). Reassignment of the Elecsys cutoff for a positive test based on receiver operating characteristic curves increased sensitivity to 92%. Using product insert cutoffs, Triage appears to have greater sensitivity at only a small reduction in specificity compared with Elecsys in the diagnosis of early-onset preecl sia. A different cutoff may improve Elecsys sensitivity.
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.PREGHY.2019.12.002
Abstract: To examine the relationship between pregnancy outcomes and BP level and variability. Secondary analysis of CHIPS trial data (Control of Hypertension In Pregnancy Study, NCT01192412). International. Women with chronic or gestational hypertension. BP measurement was standardised in outpatient clinics. Adjusted (including for allocated group) mixed effects logistic regression was used to assess relationships between major CHIPS outcomes and both BP level (mean of clinic readings) and visit-to-visit within-participant BP variability (standard deviation and average real variability of absolute successive difference of BP values). BP values 7-28 days prior to outcomes (or birth for perinatal outcomes) were excluded in sensitivity analyses. Major CHIPS outcomes. Among 961 (97.4%) women, higher BP level was associated with more adverse maternal and perinatal outcomes (usually at p < 0.001) except for serious maternal complications. Among 913 (92.5%) women with at least two post-randomisation outpatient visits, higher BP variability was associated with increased odds of severe hypertension and pre-ecl sia (usually at p < 0.01). Sensitivity analyses suggested reverse causality for these maternal outcomes, but greater diastolic BP variability may have been associated with fewer adverse perinatal outcomes. Higher BP is an adverse prognostic marker, regardless of target BP. While the association between higher BP variability and severe hypertension and pre-ecl sia may be related to higher BP at diagnosis, our results suggest a possible advantage of BP variability for the fetus, through undefined mechanisms. Higher blood pressure (BP) is associated with more adverse pregnancy outcomes, but higher BP variability may be good for the baby.
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.BPOBGYN.2015.04.001
Abstract: Hypertensive disorders are the most common medical complication of pregnancy. As such, a large part of antenatal care is dedicated to the detection of pre-ecl sia, the most dangerous of the hypertensive disorders. The highlights of this chapter include progress in the use of out-of-office blood pressure measurement as an adjunct to office blood pressure measurement, pre-ecl sia defined as proteinuria or relevant end-organ dysfunction, antihypertensive therapy for severe and non-severe hypertension and post-partum follow-up to mitigate the increased cardiovascular risk associated with any of the hypertensive disorders of pregnancy.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2016
DOI: 10.1161/HYPERTENSIONAHA.116.07466
Abstract: The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned “less tight” (target diastolic 100 mm Hg) and “tight” (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per woman–infant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06 DM $5723, 95% confidence interval, −$296 to $12 272 P =0.0725) British Columbia ($30 593.69 versus $24 776.51 DM $5817 95% confidence interval, −$385 to $12 349 P =0.0725) or Alberta ($31 510.72 versus $25 510.49 DM $6000.23 95% confidence interval, −$154 to $12 781 P =0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system. URL: www.clinicaltrials.gov . Unique identifier: NCT01192412.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.PREGHY.2021.09.008
Abstract: All units managing hypertensive pregnant women should maintain and review uniform departmental management protocols and conduct regular audits of maternal & fetal outcomes. The cause(s) of pre-ecl sia and the optimal clinical management of the hypertensive disorders of pregnancy remain uncertain therefore, we recommend that every hypertensive pregnant woman be offered an opportunity to participate in research, clinical trials and follow-up studies.
Publisher: Elsevier BV
Date: 08-2020
Publisher: SPIE-Intl Soc Optical Eng
Date: 13-01-2020
Publisher: Elsevier BV
Date: 03-2019
Publisher: Wiley
Date: 07-09-2017
DOI: 10.1002/IJGO.12298
Abstract: An evaluation of outcome reporting is required to develop a core outcome set. To assess primary outcomes and outcome measure reporting in pre-ecl sia trials. Five online databases were searched from inception to January 2016 using terms including "preecl sia" and "randomized controlled trial". Randomized controlled trials evaluating treatments for pre-ecl sia published in any language were included. Primary outcomes and data on outcome measure reporting were systematically extracted and categorized. Overall, 79 randomized trials including data from 31 615 women were included. Of those, 38 (48%) reported 35 different primary outcomes 28 were maternal outcomes and seven were fetal/neonatal outcomes. Three randomized trials reported composite outcomes, incorporating between six and nine outcome components. The method of definition or measurement was infrequently or poorly reported. Even when outcomes were consistent across trials, different methods of definition or measurement were frequently described. In randomized trials evaluating interventions for pre-ecl sia, critical information related to the primary outcome, including definition and measurement, is regularly omitted. Developing a core outcome set for pre-ecl sia trials would help to inform primary outcome selection and outcome measure reporting.
Publisher: Springer Science and Business Media LLC
Date: 14-05-2020
Publisher: Oxford University Press (OUP)
Date: 19-02-2015
Publisher: Elsevier BV
Date: 12-2010
Publisher: Public Library of Science (PLoS)
Date: 12-2014
Publisher: Elsevier BV
Date: 11-2012
Publisher: Wiley
Date: 08-08-2011
Publisher: JMIR Publications Inc.
Date: 12-2021
Abstract: ltrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with Artificial Intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal trans-cerebellar diameter and head circumference. n this study we assess perceptions of pregnant women, their families and health care workers regarding feasibility and acceptability of this device in an appropriate setting. descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (n=52) and 18 in-depth interviews. verall, TraCer was found to be highly acceptable to women, their families and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers as well as save time and cost by reducing unnecessary referrals. It was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy towards the new technology indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of healthcare professional to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common with a tendency to over-estimate the diagnostic capability and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily a GA. his study shows a positive attitude towards TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse.
Publisher: Elsevier BV
Date: 2011
Publisher: Wiley
Date: 11-08-2015
Abstract: To compare pregnancy outcomes, accounting for allocated group, between methyldopa-treated and labetalol-treated women in the CHIPS Trial (ISRCTN 71416914) of 'less tight' versus 'tight' control of pregnancy hypertension. Secondary analysis of CHIPS Trial cohort. International randomised controlled trial (94 sites, 15 countries). Of 987 CHIPS recruits, 481/566 (85.0%) women treated with antihypertensive therapy at randomisation. Of 981 (99.4%) women followed to delivery, 656/745 (88.1%) treated postrandomisation. Logistic regression to compare outcomes among women who took methyldopa or labetalol, adjusted for the influence of baseline factors. CHIPS primary (perinatal loss or high level neonatal care for >48 hours) and secondary (serious maternal complications) outcomes, birthweight <10th centile, severe maternal hypertension, pre-ecl sia and delivery at <34 or <37 weeks. Methyldopa and labetalol were used commonly at randomisation (243/987, 24.6% and 238/987, 24.6%, respectively) and post-randomisation (224/981, 22.8% and 433/981, 44.1%, respectively). Following adjusted analyses, methyldopa (versus labetalol) at randomisation was associated with fewer babies with birthweight <10th centile [adjusted odds ratio (aOR) 0.48 95% CI 0.20-0.87]. Methyldopa (versus labetalol) postrandomisation was associated with fewer CHIPS primary outcomes (aOR 0.64 95% CI 0.40-1.00), birthweight <10th centile (aOR 0.54 95% CI 0.32-0.92), severe hypertension (aOR 0.51 95% CI 0.31-0.83), pre-ecl sia (aOR 0.55 95% CI 0.36-0.85), and delivery at <34 weeks (aOR 0.53 95% CI 0.29-0.96) or <37 weeks (aOR 0.55 95% CI 0.35-0.85). These nonrandomised comparisons are subject to residual confounding, but women treated with methyldopa (versus labetalol), particularly those with pre-existing hypertension, may have had better outcomes. There was no evidence that women treated with methyldopa versus labetalol had worse outcomes.
Publisher: Wiley
Date: 11-08-2015
Abstract: To determine whether the difference in outcomes between 'less tight' (target diastolic blood pressure [dBP] of 100 mmHg) versus 'tight' control (target dBP of 85 mmHg) in the CHIPS Trial (ISRCTN 71416914, pre-empt.cfri.ca/ CHIPS) depended on the choice of labetalol or methyldopa, the two most commonly used antihypertensive agents in CHIPS. Secondary analysis of CHIPS Trial data. International multicentre randomised controlled trial (94 sites, 15 countries). A total of 987 women with non-severe non-proteinuric pregnancy hypertension. Logistic regression was used for comparisons of 'less tight' versus 'tight' control among women treated with labetalol (but not methydopa) versus methyldopa (but not labetalol). Analyses were adjusted for the influence of baseline factors, including use of any antihypertensive therapy at randomisation. Main CHIPS Trial outcomes: primary (perinatal loss or high-level neonatal care for > 48 hours), secondary (serious maternal complications), birthweight < 10th centile, severe maternal hypertension, pre-ecl sia, and delivery at < 34 or < 37 weeks. Of 987 women in CHIPS, antihypertensive therapy was taken by 566 women at randomisation (labetalol 111 ['less tight'] versus 127 ['tight'] or methyldopa 126 ['less tight'] versus 117 ['tight']) and 815 women after randomisation (labetalol 186 ['less tight'] versus 247 ['tight'] and methyldopa by 98 ['less tight'] versus 126 ['tight']). Following adjustment, odds ratios for outcomes in 'less tight' versus 'tight' control were similar between antihypertensive groups according to 'at randomisation' and 'after randomisation' therapy. Outcomes for 'less tight' versus 'tight' control were not dependent on use of methyldopa or labetalol. In the CHIPS Trial, maternal and infant outcomes were not dependent on use of labetalol or methyldopa.
Publisher: Springer Science and Business Media LLC
Date: 06-2016
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.PREGHY.2013.04.007
Abstract: Circulating angiogenic factors are potential markers for preecl sia, but heterogeneous studies have failed to identify precise predictive/diagnostic properties. The Global CoLaboratory is investigating how to merge published data of angiogenic factors for meta-analysis on an in idual s le basis. To amalgamate pregnancy angiogenic factor studies, investigate diagnostic and predictive properties of these markers in preecl sia and placenta-related pregnancy complications, and to test if measures from disparate platforms can be standardised. This is the first report using PlGF measures to diagnose preecl sia. Data were derived from 15 cohorts, within and outside the CoLaboratory network. Women were classified as either case (confirmed diagnosis of preecl sia at s ling) or non-case (no preecl sia at s ling). In idual PlGF measurements from four different analytical platforms were used, along with transformations of the data (e.g. log-transformations, transformations to a baseline platform). Transformed measurements were standardised both for specific platforms and globally, stratifying on gestational age. Different statistical techniques were compared. The database currently contains 1442 cases and 11,512 non-cases, which were used to define an algorithm to merge PlGF measurements from different platforms. Non-case distributions were used to standardise case results. Diagnostic PlGF measurements in relation to preecl sia will be presented and confirm feasibility. Future studies can extend this approach to other angiogenic factors, prediction as well as diagnosis and to other placenta-related disorders.
Publisher: Springer Science and Business Media LLC
Date: 04-2020
Publisher: Springer Science and Business Media LLC
Date: 05-11-2020
DOI: 10.1186/S12884-020-03332-W
Abstract: The fullPIERS risk prediction model was developed to identify which women admitted with confirmed diagnosis of preecl sia are at highest risk of developing serious maternal complications. The model discriminates well between women who develop (vs. those who do not) adverse maternal outcomes. It has been externally validated in several populations. We assessed whether placental growth factor (PlGF), a biomarker associated with preecl sia risk, adds incremental value to the fullPIERS model. Using a cohort of women admitted into tertiary hospitals in well-resourced settings (the USA and Canada), between May 2010 to February 2012, we evaluated the incremental value of PlGF added to fullPIERS for prediction of adverse maternal outcomes within 48 h after admission with confirmed preecl sia. The discriminatory performance of PlGF and the fullPIERS model were assessed in this cohort using the area under the receiver’s operating characteristic curve (AUROC) while the extended model (fullPIERS +PlGF) was assessed based on net reclassification index (NRI) and integrated discrimination improvement (IDI) performances. In a cohort of 541 women delivered shortly ( 1 week) after presentation, 8.1% experienced an adverse maternal outcome within 48 h of admission. Prediction of adverse maternal outcomes was not improved by addition of PlGF to fullPIERS (NRI: -8.7, IDI − 0.06). Discriminatory performance (AUROC) was 0.67 [95%CI: 0.59–0.75] for fullPIERS only and 0.67 [95%CI: 0.58–0.76]) for fullPIERS extended with PlGF, a performance worse than previously documented in fullPIERS external validation studies (AUROC 0.75). While fullPIERS model performance may have been affected by differences in healthcare context between this study cohort and the model development and validation cohorts, future studies are required to confirm whether PlGF adds incremental benefit to the fullPIERS model for prediction of adverse maternal outcomes in preecl sia in settings where expectant management is practiced.
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/10641950701521742
Abstract: To determine the association between adverse maternal erinatal outcomes and Canadian and U.S. preecl sia severity criteria. Using PIERS data (Preecl sia Integrated Estimate of RiSk), an international continuous quality improvement project for women hospitalized with preecl sia, we examined the association between preecl sia severity criteria and adverse maternal and perinatal outcomes (univariable analysis, Fisher's exact test). Not evaluated were variables performed in 110 microM) or perinatal outcomes (dBP >110 mm Hg and suspected abruption) (at p < 0.01). In the PIERS cohort, most factors used in the Canadian or American classifications of severe preecl sia do not predict adverse maternal and/or perinatal outcomes. Future classification systems should take this into account.
Publisher: Public Library of Science (PLoS)
Date: 02-02-2018
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.PREGHY.2019.08.166
Abstract: The international CHIPS Trial (Control of Hypertension In Pregnancy Study) enrolled 987 women with chronic (75%) or gestational (25%) hypertension. Pre-ecl sia developed in 48% women remained on their allocated BP control and delivered an average of two weeks later. 'Less tight' control (target diastolic BP 100 mmHg) achieved BP that was 6/5mmHg higher (p < 0.001) than 'tight' control (target diastolic 85 mmHg, BP achieved 133/85 mmHg). 'Less tight' (vs. 'tight') control resulted in similar adverse perinatal outcomes (31.5% vs. 30.7% p = 0.84) that balanced birthweight < 10th percentile (16.1% vs. 19.8% p = 0.14) against preterm birth (35.6% vs. 31.5% p = 0.18). 12-month follow-up revealed no compelling evidence for developmental programming of child growth. However, 'less tight' (vs. 'tight') control resulted in more severe maternal hypertension (40.6% vs. 27.5% p < 0.001), and more women with platelets < 100 × 10
Publisher: Wiley
Date: 16-05-2007
DOI: 10.1111/J.1471-0528.2007.01315.X
Abstract: To determine whether 'less tight' (versus 'tight') control of nonsevere hypertension results in a difference in diastolic blood pressure (dBP) between groups. Randomised controlled trial (ISRCTN#57277508). Seventeen obstetric centres in Canada, Australia, New Zealand, and UK. Inclusion: pregnant women, dBP 90-109 mmHg, pre-existing/gestational hypertension live fetus(es) and 20-33(+6) weeks. Exclusion: systolic blood pressure > or = 170 mmHg and proteinuria, contraindication, or major fetal anomaly. Randomisation to less tight (target dBP, 100 mmHg) or tight (target dBP, 85 mmHg) blood pressure control. Primary: mean dBP at 28, 32 and 36 weeks. Secondary: clinician compliance and women's satisfaction. Other: serious perinatal and maternal complications. A total of 132 women were randomised to less tight (n = 66 seven had no study visit) or tight control (n= 66 one was lost to follow up seven had no study visit). Mean dBP was significantly lower with tight control: -3.5 mmHg, 95% credible interval (-6.4, -0.6). Clinician compliance was 79% in both groups. Women were satisfied with their care. With less tight (versus tight) control, the rates of other treatments and outcomes were the following: post-randomisation antenatal antihypertensive medication use: 46 (69.7%) versus 58 (89.2%), severe hypertension: 38 (57.6%) versus 26 (40.0%), proteinuria: 16 (24.2%) versus 20 (30.8%), serious maternal complications: 3 (4.6%) versus 2 (3.1%), preterm birth: 24 (36.4%) versus 26 (40.0%), birthweight: 2675 +/- 858 versus 2501 +/- 855 g, neonatal intensive care unit (NICU) admission: 15 (22.7%) versus 22 (34.4%), and serious perinatal complications: 9 (13.6%) versus 14 (21.5%). The CHIPS pilot trial confirms the feasibility and importance of a large definitive trial to determine the effects of less tight control on serious perinatal and maternal complications.
Publisher: Springer Science and Business Media LLC
Date: 2000
Publisher: BMJ
Date: 10-06-2020
DOI: 10.1136/BMJ.M2287
Publisher: Wiley
Date: 19-09-2013
DOI: 10.1111/JOG.12159
Abstract: Maternal floor infarction is a relatively rare condition characterized clinically by severe early onset fetal growth restriction with features of uteroplacental insufficiency. It has a very high recurrence rate and carries a significant risk or fetal demise. Pathological characteristics include massive and diffuse fibrin deposition along the decidua basalis and the perivillous space of the basal plate. We present a case of recurrent maternal floor infarction and propose diagnostic clues as well as potential therapeutic options.
Publisher: Wiley
Date: 02-2022
DOI: 10.1002/UOG.23757
Abstract: Stillbirth is a potentially preventable complication of pregnancy. Identifying women at high risk of stillbirth can guide decisions on the need for closer surveillance and timing of delivery in order to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none has yet been validated externally. In this study, we externally validated published prediction models for stillbirth using in idual participant data (IPD) meta‐analysis to assess their predictive performance. MEDLINE, EMBASE, DH‐DATA and AMED databases were searched from inception to December 2020 to identify studies reporting stillbirth prediction models. Studies that developed or updated prediction models for stillbirth for use at any time during pregnancy were included. IPD from cohorts within the International Prediction of Pregnancy Complications (IPPIC) Network were used to validate externally the identified prediction models whose in idual variables were available in the IPD. The risk of bias of the models and cohorts was assessed using the Prediction study Risk Of Bias ASsessment Tool (PROBAST). The discriminative performance of the models was evaluated using the C ‐statistic, and calibration was assessed using calibration plots, calibration slope and calibration‐in‐the‐large. Performance measures were estimated separately in each cohort, as well as summarized across cohorts using random‐effects meta‐analysis. Clinical utility was assessed using net benefit. Seventeen studies reporting the development of 40 prognostic models for stillbirth were identified. None of the models had been previously validated externally, and the full model equation was reported for only one‐fifth (20%, 8/40) of the models. External validation was possible for three of these models, using IPD from 19 cohorts (491 201 pregnant women) within the IPPIC Network database. Based on evaluation of the model development studies, all three models had an overall high risk of bias, according to PROBAST. In the IPD meta‐analysis, the models had summary C ‐statistics ranging from 0.53 to 0.65 and summary calibration slopes ranging from 0.40 to 0.88, with risk predictions that were generally too extreme compared with the observed risks. The models had little to no clinical utility, as assessed by net benefit. However, there remained uncertainty in the performance of some models due to small available s le sizes. The three validated stillbirth prediction models showed generally poor and uncertain predictive performance in new data, with limited evidence to support their clinical application. The findings suggest methodological shortcomings in their development, including overfitting. Further research is needed to further validate these and other models, identify stronger prognostic factors and develop more robust prediction models. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Publisher: Elsevier BV
Date: 05-2008
DOI: 10.1016/J.JPEDSURG.2007.12.030
Abstract: Management of gastroschisis varies. This study aims to determine which aspects of practice influence outcomes. All cases of simple gastroschisis (N = 99) in the Canadian Pediatric Surgery Network database were analyzed looking at methods of preoperative bowel protection, timing of closure, and closure techniques and outcome measures included time to onset of enteral feeds, duration of parenteral nutrition (PN), and length of stay (LOS). One third of infants had initial bowel protection using a spring-loaded silo, which was significantly associated with a delay (beyond 24 hours) in establishing primary closure. Neither preoperative bowel protection methods nor defect closure techniques conferred any significant effects on success at establishing primary closure or functional outcomes. After adjusting for all covariates, only failure to establish primary closure was associated with impaired outcomes with significantly delayed initiation of enteral feeds and prolonged LOS. Low birth weight (<2000 g) and younger gestational age (<36 weeks) were associated with a 3-fold increased risk of longer PN dependence and 5-fold risk of extended LOS, respectively. Babies undergoing the sutureless spontaneous closure technique had significant delays in initiating enteral feeds but no increased requirements for PN or LOS. Modes of preoperative bowel protection and techniques of abdominal wall closure ultimately have no association with functional outcomes in infants with gastroschisis. Failure to establish primary closure, however, is significantly associated with delays in establishing intestinal function and subsequent time to discharge.
Publisher: Springer Science and Business Media LLC
Date: 04-2020
DOI: 10.1186/S12978-020-0872-9
Abstract: The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) Network is a new and broadly-based group of research scientists and health advocates based in the UK, Africa and North America. This paper describes the protocol that underpins the clinical research activity of the Network, so that the investigators, and broader global health community, can have access to ‘deep phenotyping’ (social determinants of health, demographic and clinical parameters, placental biology and agnostic discovery biology) of women as they advance through pregnancy to the end of the puerperium, whether those pregnancies have normal outcomes or are complicated by one/more of the placental disorders of pregnancy (pregnancy hypertension, fetal growth restriction and stillbirth). Our clinical sites are in The Gambia (Farafenni), Kenya (Kilifi County), and Mozambique (Maputo Province). In each country, 50 non-pregnant women of reproductive age will be recruited each month for 1 year, to provide a final national s le size of 600 these women will provide culturally-, ethnically-, seasonally- and spatially-relevant control data with which to compare women with normal and complicated pregnancies. Between the three countries we will recruit ≈10,000 unselected pregnant women over 2 years. An estimated 1500 women will experience one/more placental complications over the same epoch. Importantly, as we will have accurate gestational age dating using the TraCer device, we will be able to discriminate between fetal growth restriction and preterm birth. Recruitment and follow-up will be primarily facility-based and will include women booking for antenatal care, subsequent visits in the third trimester, at time-of-disease, when relevant, during/immediately after birth and 6 weeks after birth. To accelerate progress towards the women’s and children’s health-relevant Sustainable Development Goals, we need to understand how a variety of social, chronic disease, biomarker and pregnancy-specific determinants health interact to result in either a resilient or a compromised pregnancy for either mother or fetus/newborn, or both. This protocol has been designed to create such a depth of understanding. We are seeking funding to maintain the cohort to better understand the implications of pregnancy complications for both maternal and child health.
Publisher: Wiley
Date: 05-2021
DOI: 10.1002/UOG.23631
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.PREGHY.2017.01.005
Abstract: To compare the Multistix 10SG/visual-read with two automated methods (Multistix 10SG/Clinitek 50 and Chemstrip 10A/Urisys 1100) to detect significant proteinuria among high-risk pregnant women. Prospective cohort study at British Columbia Women's Hospital & Health Centre, Vancouver, Canada. Diagnostic accuracy determined by sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-). 303 (89.6%) of 338 women had a urine s le tested by all three dipstick methods. 196 s les (64.7%) were collected in the morning (subsequent to their first void) and from outpatients. 107 s les (35.3%) were from inpatients at various times throughout the day. A PrCr ⩾30mg/mmol was present in 46 (15.2%) s les. The sensitivity for proteinuria was higher with Multistix 10SG/Clinitek 50 (65.2%) than with Multistix 10SG/visual-read (41.3%, p 90% for all methods studied, although it was highest for Multistix 10SG/visual-read (98.4%) compared with either Multistix 10SG/Clinitek 50 (92.6%, p 5), but LR- poor-fair (>0.20). 29 s les were discordant for proteinuria between methods. 28/29 women had negative proteinuria by Multistix 10SG/visual-read, but at least 1+ proteinuria by an automated method 17/28 were false positives and 11/28 true positives. Automated dipstick methods are more sensitive than visual urinalysis for proteinuria, but test performance is still only poor-fair as a 'rule-out' test for proteinuria. Whether the enhanced sensitivity would be worth the false positives, cost, and personnel training remains to be determined for detection of low-level proteinuria in pregnancy.
Publisher: Wiley
Date: 04-11-2010
DOI: 10.1111/J.1471-0528.2010.02754.X
Abstract: To determine the optimal timing of delivery in pregnancies with pre-existing (chronic) hypertension by quantifying the gestational age-specific risks of stillbirth associated with ongoing pregnancy and the gestational age-specific risks of neonatal mortality or serious neonatal morbidity following the induction of labour. Population-based cohort study. USA. A total of 171 669 singleton births to women with pre-existing hypertension between 1995 and 2005. Pregnancies additionally complicated by diabetes mellitus, cardiac, pulmonary or renal disease were excluded. The week-specific risks of stillbirth between 36 and 41 completed weeks of gestation were contrasted with the week-specific risks of neonatal mortality or serious neonatal morbidity among births following induction of labour in women with pre-existing hypertension. Stillbirth, neonatal mortality or serious neonatal morbidity (defined as a composite outcome which included any of the following: neonatal seizures, severe respiratory morbidity or 5-minute Apgar score ≤3). The risk of stillbirth in women with pre-existing hypertension remained stable at 1.0-1.1 per 1000 ongoing pregnancies until 38 weeks, before rising steadily to 3.5 per 1000 [95% confidence interval (CI): 2.4, 5.0] at 41 weeks. The risk of serious neonatal morbidity/neonatal mortality decreased sharply between 36 and 38 weeks from 137 [95% CI: 127, 146] to 26 [95% CI: 24, 29] per 1000 induced births, before stabilising beyond 39 weeks. Among women with otherwise uncomplicated pre-existing hypertension, delivery at 38 or 39 weeks appears to provide the optimal trade-off between the risk of adverse fetal and adverse neonatal outcomes.
Publisher: Cambridge University Press (CUP)
Date: 08-2003
Publisher: Elsevier BV
Date: 11-2021
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.AJOG.2008.06.009
Abstract: The objective of the study was to determine completeness of 24-hour urine collection in pregnancy. This was a retrospective laboratory/chart review of 24-hour urine collections at British Columbia Women's Hospital. Completeness was assessed by 24-hour urinary creatinine excretion (UcreatV): expected according to maternal weight for single collections and between-measurement difference for serial collections. For 198 randomly selected pregnant women with a hypertensive disorder (63% preecl sia), 24-hour urine collections were frequently inaccurate (13-54%) on the basis of UcreatV of 97-220 micromol/kg per day (11.0-25.0 mg/kg per day) or 133-177 micromol/kg per day (15.1-20.1 mg/kg per day) of prepregnancy weight (respectively). Lean body weight resulted in more inaccurate collections (24-68%). The current weight was frequently unavailable (28%) and thus not used. For 161 women (81% proteinuric) with serial 24-hour urine levels, a median [interquartile range] of 11 [5-31] days apart, between-measurement difference in UcreatV was 14.4% [6.0-24.9] 40 women (24.8%) had values 25% or greater, exceeding analytic and biologic variation. Twenty-four hour urine collection is frequently inaccurate and not a precise measure of proteinuria or creatinine clearance.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2023
DOI: 10.1161/HYPERTENSIONAHA.122.20565
Abstract: Most preecl sia occurs at term. There are no effective preventative strategies. We aimed to identify the optimal preecl sia screening and timing of birth strategy for prevention of term preecl sia. This secondary analysis was of data from a prospective nonintervention cohort study of singleton pregnancies delivering at ≥24 weeks, without major anomalies, at 2 United Kingdom maternity hospitals. At routine visits at 11 to 13 weeks’ (57 131 pregnancies screened, 1138 term preecl sia developed) or 35 to 36 weeks’ gestation (29 035 pregnancies screened, 619 term preecl sia), with patient-specific preecl sia risks determined by: United Kingdom National Institute for Health and Care Excellence guidance, and the Fetal Medicine Foundation competing-risks model. For each screening strategy, timing of birth for term preecl sia prevention was evaluated at gestational time points that were fixed (37, 38, 39, 40 weeks) or dependent on preecl sia risk by the competing-risks model at 35 to 36 weeks. Main outcomes were proportion of term preecl sia prevented, and number-needed-to-deliver to prevent one term preecl sia case. The proportion of term preecl sia prevented was the highest, and number-needed-to-deliver lowest, for preecl sia screening at 35 to 36 (rather than 11–13) weeks. For delivery at 37 weeks, fewer cases of preecl sia were prevented for National Institute for Health and Care Excellence (28.8%) than the competing-risks model (59.8%), and the number-needed-to-deliver was higher (16.4 versus 6.9, respectively). The risk-stratified approach (at 35–36 weeks) had similar preecl sia prevention (by 57.2%) and number-needed-to-deliver (8.4), but fewer women would be induced at 37 weeks (1.2% versus 8.8%). Risk-stratified timing of birth at term may more than halve the risk of term preecl sia.
Publisher: Springer Science and Business Media LLC
Date: 07-01-2021
DOI: 10.1186/S10020-020-00253-4
Abstract: Fetal growth restriction (FGR) is associated with increased risks for complications before, during, and after birth, in addition to risk of disease through to adulthood. Although placental insufficiency, failure to supply the fetus with adequate nutrients, underlies most cases of FGR, its causes are erse and not fully understood. One of the few diagnosable causes of placental insufficiency in ongoing pregnancies is the presence of large chromosomal imbalances such as trisomy confined to the placenta however, the impact of smaller copy number variants (CNVs) has not yet been adequately addressed. In this study, we confirm the importance of placental aneuploidy, and assess the potential contribution of CNVs to fetal growth. We used molecular-cytogenetic approaches to identify aneuploidy in placentas from 101 infants born small-for-gestational age (SGA), typically used as a surrogate for FGR, and from 173 non-SGA controls from uncomplicated pregnancies. We confirmed aneuploidies and assessed mosaicism by microsatellite genotyping. We then profiled CNVs using high-resolution microarrays in a subset of 53 SGA and 61 control euploid placentas, and compared the load, impact, gene enrichment and clinical relevance of CNVs between groups. Candidate CNVs were confirmed using quantitative PCR. Aneuploidy was over tenfold more frequent in SGA-associated placentas compared to controls (11.9% vs. 1.1% p = 0.0002, OR = 11.4, 95% CI 2.5–107.4), was confined to the placenta, and typically involved autosomes, whereas only sex chromosome abnormalities were observed in controls. We found no significant difference in CNV load or number of placental-expressed or imprinted genes in CNVs between SGA and controls, however, a rare and likely clinically-relevant germline CNV was identified in 5.7% of SGA cases. These CNVs involved candidate genes INHBB , HSD11B2 , CTCF , and CSMD3 . We conclude that placental genomic imbalances at the cytogenetic and submicroscopic level may underlie up to ~ 18% of SGA cases in our population. This work contributes to the understanding of the underlying causes of placental insufficiency and FGR, which is important for counselling and prediction of long term outcomes for affected cases.
Publisher: Informa UK Limited
Date: 11-08-2010
DOI: 10.3109/10641955.2010.484082
Abstract: We report the case of a woman who first received MgSO(4) for ecl sia prophylaxis and then was treated with MgSO(4) for ecl sia. She developed hyperkalemia without severe renal failure or another explanation. We recommend close monitoring, including serial measurements of electrolytes, when MgSO(4) is administered for ecl sia prophylaxis or treatment.
Publisher: BMJ
Date: 22-11-2018
DOI: 10.1136/BMJ.K4872
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.PLACENTA.2011.04.011
Abstract: Trophoblasts express Toll-like receptor 3 (TLR3). The artificial TLR3 ligand, PolyI:C, induces an inflammatory response in trophoblasts but an endogenous ligand has not been identified. Notably, inflammatory disorders of pregnancy are associated with increased circulating placenta-derived mRNA. Endogenous degraded, uncapped mRNA is recognized by TLR3 in other cell lines. We tested the hypothesis that plasma-derived mRNA induces an inflammatory response in a trophoblast cell line via TLR3. Experiments were performed in the human first trimester extravillous trophoblast cell line HTR-8/SV neo. Plasma-derived mRNA was lified using modified template switching and final in vitro transcription. We compared free mRNA (which favors cell surface interaction) to liposomally encapsulated mRNA (which favors intracellular mRNA delivery). We tested for the specific requirement of TLR3 signaling using siRNA. We tested for involvement of the canonical signaling pathway downstream of TLR3 by measuring NF-κB and IFN regulatory factor transcriptional activity using firefly-luciferase constructs. Free mRNA did not induce RANTES production. In contrast, liposomal mRNA resulted in marked induction of RANTES production (non-stimulated control 3.4 ± 0.6 pg/mL, liposomal mRNA 169.7 ± 26.2 pg/mL, p < 0.001), and this RANTES production was abolished by siRNA for TLR3. Downstream of TLR3, liposomal mRNA-induced dose-response NF-κB and IFN regulatory factor transcriptional activity, and IFN beta production. Plasma-derived 5' uncapped mRNA delivered intracellularly signals to induce NF-κB activation and increase RANTES production via TLR3.
Publisher: Elsevier BV
Date: 07-2018
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 11-2014
Publisher: Springer Science and Business Media LLC
Date: 28-02-2019
Publisher: Wiley
Date: 07-2019
DOI: 10.1002/UOG.20117
Abstract: Primary studies and systematic reviews provide estimates of varying accuracy for different factors in the prediction of pre-ecl sia. The aim of this study was to review published systematic reviews to collate evidence on the ability of available tests to predict pre-ecl sia, to identify high-value avenues for future research and to minimize future research waste in this field. MEDLINE, EMBASE and The Cochrane Library including DARE (Database of Abstracts of Reviews of Effects) databases, from database inception to March 2017, and bibliographies of relevant articles were searched, without language restrictions, for systematic reviews and meta-analyses on the prediction of pre-ecl sia. The quality of the included reviews was assessed using the AMSTAR tool and a modified version of the QUIPS tool. We evaluated the comprehensiveness of search, s le size, tests and outcomes evaluated, data synthesis methods, predictive ability estimates, risk of bias related to the population studied, measurement of predictors and outcomes, study attrition and adjustment for confounding. From 2444 citations identified, 126 reviews were included, reporting on over 90 predictors and 52 prediction models for pre-ecl sia. Around a third (n = 37 (29.4%)) of all reviews investigated solely biochemical markers for predicting pre-ecl sia, 31 (24.6%) investigated genetic associations with pre-ecl sia, 46 (36.5%) reported on clinical characteristics, four (3.2%) evaluated only ultrasound markers and six (4.8%) studied a combination of tests two (1.6%) additional reviews evaluated primary studies investigating any screening test for pre-ecl sia. Reviews included between two and 265 primary studies, including up to 25 356 688 women in the largest review. Only approximately half (n = 67 (53.2%)) of the reviews assessed the quality of the included studies. There was a high risk of bias in many of the included reviews, particularly in relation to population representativeness and study attrition. Over 80% (n = 106 (84.1%)) summarized the findings using meta-analysis. Thirty-two (25.4%) studies lacked a formal statement on funding. The predictors with the best test performance were body mass index (BMI) > 35 kg/m This review of reviews calls into question the need for further aggregate meta-analysis in this area given the large number of published reviews subject to the common limitations of primary predictive studies. Prospective, well-designed studies of predictive markers, preferably randomized intervention studies, and combined through in idual-patient data meta-analysis are needed to develop and validate new prediction models to facilitate the prediction of pre-ecl sia and minimize further research waste in this field. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2022
DOI: 10.1161/HYPERTENSIONAHA.121.18415
Abstract: We aimed to address which antihypertensives are superior to placebo/no therapy or another antihypertensive for controlling nonsevere pregnancy hypertension and provide future s le size estimates for definitive evidence. Randomized trials of antihypertensives for nonsevere pregnancy hypertension were identified from online electronic databases, to February 28, 2021 (registration URL: www.crd.york.ac.uk/PROSPERO/ unique identifier: CRD42020188725). Our outcomes were severe hypertension, proteinuria reecl sia, fetal/newborn death, small-for-gestational age infants, preterm birth, and admission to neonatal care. A Bayesian random-effects model generated estimates of direct and indirect treatment comparisons. Trial sequential analysis informed future trials needed. Of 1246 publications identified, 72 trials were included 61 (6923 women) were informative. All commonly prescribed antihypertensives (labetalol, other β-blockers, methyldopa, calcium channel blockers, and mixed/multi-drug therapy) versus placebo/no therapy reduced the risk of severe hypertension by 30% to 70%. Labetalol decreased proteinuria reecl sia (odds ratio, 0.73 [95% credible interval, 0.54–0.99]) and fetal/newborn death (odds ratio, 0.54 [0.30–0.98]) compared with placebo/no therapy, and proteinuria reecl sia compared with methyldopa (odds ratio, 0.66 [0.44–0.99]) and calcium channel blockers (odds ratio, 0.63 [0.41–0.96]). No other differences were identified, but credible intervals were wide. Trial sequential analysis indicated that 2500 to 10 000 women/arm (severe hypertension or safety outcomes) to 000/arm (fetal/newborn death) would be required to provide definitive evidence. In summary, all commonly prescribed antihypertensives in pregnancy reduce the risk of severe hypertension, but labetalol may also decrease proteinuria reecl sia and fetal/newborn death. Evidence is lacking for many other safety outcomes. Prohibitive s le sizes are required for definitive evidence. Real-world data are needed to in idualize care.
Publisher: Wiley
Date: 13-10-2010
DOI: 10.1111/J.1471-0528.2010.02742.X
Abstract: To determine in a group of pregnant women if vitamin D status, based on serum 25-hydroxyvitamin D (25OHD) concentration, was associated with a subsequent risk of pre-ecl sia or adverse pregnancy outcomes. Prospective cohort study. Vancouver, British Columbia, Canada (49°N). Women attending a specialist antenatal clinic because of clinical or biochemical risk factors for pre-ecl sia (n = 221). Serum 25OHD concentration measured between 10 and 20 weeks of gestation. Pre-ecl sia and composite adverse pregnancy outcomes. Of the women, 78% were vitamin D insufficient (25OHD <75 nmol/l) and 53% were vitamin D deficient (25OHD <50 nmol/l). There was no difference in the rates of pre-ecl sia, gestational hypertension, preterm birth or composite adverse pregnancy outcomes by 25OHD concentration. Vitamin D deficiency and insufficiency were common in a group of women at high risk of pre-ecl sia however, it was not associated with subsequent risk of an adverse pregnancy outcome.
Publisher: Elsevier BV
Date: 03-2010
DOI: 10.1016/J.AJOG.2010.01.050
Abstract: We sought to investigate whether prenatal vitamin C and E supplementation reduces the incidence of gestational hypertension (GH) and its adverse conditions among high- and low-risk women. In a multicenter randomized controlled trial, women were stratified by the risk status and assigned to daily treatment (1 g vitamin C and 400 IU vitamin E) or placebo. The primary outcome was GH and its adverse conditions. Of the 2647 women randomized, 2363 were included in the analysis. There was no difference in the risk of GH and its adverse conditions between groups (relative risk, 0.99 95% confidence interval, 0.78-1.26). However, vitamins C and E increased the risk of fetal loss or perinatal death (nonprespecified) as well as preterm prelabor rupture of membranes. Vitamin C and E supplementation did not reduce the rate of preecl sia or GH, but increased the risk of fetal loss or perinatal death and preterm prelabor rupture of membranes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2017
DOI: 10.1097/CCM.0000000000002018
Abstract: Mortality prediction scores have been used for a long time in ICUs however, numerous studies have shown that they over-predict mortality in the obstetric population. With sepsis remaining a major cause of obstetric mortality, we aimed to look at five mortality prediction scores (one obstetric-based and four general) in the septic obstetric population and compare them to a nonobstetric septic control group. Women in the age group of 16–50 years with an admission diagnosis or suspicion of sepsis were included. In a multicenter obstetric population (n = 797), these included all pregnant and postpartum patients up to 6 weeks postpartum. An age- and gender-matched control nonobstetric population was drawn from a single-center general critical care population ( n = 2,461). Sepsis in Obstetric Score, Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment, and Multiple Organ Dysfunction Scores were all applied to patients meeting inclusion criteria in both cohorts, and their area under the receiver-operator characteristic curves was calculated to find the most accurate predictor. A total of 146 septic patients were found for the obstetric cohort and 299 patients for the nonobstetric control cohort. The Sepsis in Obstetric Score, Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment, and Multiple Organ Dysfunction Scores gave area under the receiver-operator characteristic curves of 0.67, 0.68, 0.72, 0.79, and 0.84 in the obstetric cohort, respectively, and 0.64, 0.72, 0.61, 0.78, and 0.74 in the nonobstetric cohort, respectively. The Sepsis in Obstetric Score performed similarly to all the other scores with the exception of the Multiple Organ Dysfunction Score, which was significantly better ( p 0.05). The Sepsis in Obstetric Score, designed specifically for sepsis in obstetric populations, was not better than general severity of illness scoring systems. Furthermore, the Sepsis in Obstetric Score performance was no different in an obstetric sepsis population compared to a nonobstetric sepsis population. The Multiple Organ Dysfunction Score is a simple organ-based score, and this result supports the use of organ-based outcome predictors in ICU even in an obstetric sepsis population.
Publisher: Wiley
Date: 11-08-2012
DOI: 10.1016/J.IJGO.2012.03.012
Abstract: The hypertensive disorders of pregnancy (HDP pre-existing hypertension, gestational hypertension, and pre-ecl sia) remain important causes of maternal morbidity and mortality, especially in low- and middle-income countries. The paper summarizes the current state of evidence around possible technologies to support community-based improvements in maternal and perinatal outcomes for women with pre-ecl sia. Through the testing and, where proven, introduction of these technologies, we believe that HDP-related progress toward achieving Millennium Development Goal 5 can best be accelerated. The evidence and discussion are presented under the following headings: (1) prediction (2) prevention (3) diagnosis (4) risk stratification (5) decision aids (6) treatment (7) geographic information systems (8) communication and (9) community and patient education.
Publisher: Elsevier BV
Date: 07-2019
Publisher: BMJ
Date: 10-04-2008
Publisher: Springer Science and Business Media LLC
Date: 11-01-2018
Publisher: National Institute for Health and Care Research
Date: 04-2017
DOI: 10.3310/HTA21180
Abstract: The prognosis of early-onset pre-ecl sia (before 34 weeks’ gestation) is variable. Accurate prediction of complications is required to plan appropriate management in high-risk women. To develop and validate prediction models for outcomes in early-onset pre-ecl sia. Prospective cohort for model development, with validation in two external data sets. Model development: 53 obstetric units in the UK. Model transportability: PIERS (Pre-ecl sia Integrated Estimate of RiSk for mothers) and PETRA (Pre-Ecl sia TRial Amsterdam) studies. Pregnant women with early-onset pre-ecl sia. Nine hundred and forty-six women in the model development data set and 850 women (634 in PIERS, 216 in PETRA) in the transportability (external validation) data sets. The predictors were identified from systematic reviews of tests to predict complications in pre-ecl sia and were prioritised by Delphi survey. The primary outcome was the composite of adverse maternal outcomes established using Delphi surveys. The secondary outcome was the composite of fetal and neonatal complications. We developed two prediction models: a logistic regression model (PREP-L) to assess the overall risk of any maternal outcome until postnatal discharge and a survival analysis model (PREP-S) to obtain in idual risk estimates at daily intervals from diagnosis until 34 weeks. Shrinkage was used to adjust for overoptimism of predictor effects. For internal validation (of the full models in the development data) and external validation (of the reduced models in the transportability data), we computed the ability of the models to discriminate between those with and without poor outcomes ( c -statistic), and the agreement between predicted and observed risk (calibration slope). The PREP-L model included maternal age, gestational age at diagnosis, medical history, systolic blood pressure, urine protein-to-creatinine ratio, platelet count, serum urea concentration, oxygen saturation, baseline treatment with antihypertensive drugs and administration of magnesium sulphate. The PREP-S model additionally included exaggerated tendon reflexes and serum alanine aminotransaminase and creatinine concentration. Both models showed good discrimination for maternal complications, with anoptimism-adjusted c -statistic of 0.82 [95% confidence interval (CI) 0.80 to 0.84] for PREP-L and 0.75 (95% CI 0.73 to 0.78) for the PREP-S model in the internal validation. External validation of the reduced PREP-L model showed good performance with a c -statistic of 0.81 (95% CI 0.77 to 0.85) in PIERS and 0.75 (95% CI 0.64 to 0.86) in PETRA cohorts for maternal complications, and calibrated well with slopes of 0.93 (95% CI 0.72 to 1.10) and 0.90 (95% CI 0.48 to 1.32), respectively. In the PIERS data set, the reduced PREP-S model had a c -statistic of 0.71 (95% CI 0.67 to 0.75) and a calibration slope of 0.67 (95% CI 0.56 to 0.79). Low gestational age at diagnosis, high urine protein-to-creatinine ratio, increased serum urea concentration, treatment with antihypertensive drugs, magnesium sulphate, abnormal uterine artery Doppler scan findings and estimated fetal weight below the 10th centile were associated with fetal complications. The PREP-L model provided in idualised risk estimates in early-onset pre-ecl sia to plan management of high- or low-risk in iduals. The PREP-S model has the potential to be used as a triage tool for risk assessment. The impacts of the model use on outcomes need further evaluation. Current Controlled Trials ISRCTN40384046. The National Institute for Health Research Health Technology Assessment programme.
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.PREGHY.2018.05.009
Abstract: Preecl sia is characterized by maternal systemic inflammation and coagulation activation, akin to the sepsis syndrome. Recombinant human activated protein C (rhAPC drotrecogin alfa [activated]) may modify disease progression to safely prolong pregnancies and improve perinatal outcomes. Both maternal and perinatal risks are highest remote from term. Open-label, single arm safety and efficacy trial of rhAPC in consenting pregnant women with severe early-onset preecl sia. Disease severity-matched rhAPC-naïve controls were identified from an existing database. An additional six women were recruited as biomarker controls. Primary safety outcome: incidence of peripartum bleeding primary efficacy outcome: duration of pregnancy after enrolment. Twelve (31.6%) of 38 eligible women consented 3 did not receive the infusion due to staffing. Therefore, 9 women received rhAPC (24 μg/kg/hr for ≤96 h antenatally). No safety issues were identified. There was a marginal prolongation in eligibility-to-delivery intervals for women receiving rhAPC (Mantel-Cox p = 0.052 Gehan-Breslow-Wilcoxon p = 0.049). Compared with both the pre-infusion phase in the rhAPC-treated women themselves and with fullPIERS rhAPC-naïve women, rhAPC was associated with increased urine output during the infusion (6/9 vs 1/9 had urine output >100 mL/h during the infusion, Fisher's exact p = 0.003). These data support further investigation of APC in women with severe early-onset preecl sia recombinant and purified human APC is available. In addition, these data will inform the design and implementation of randomized controlled trials aiming to modify and/or moderate the proinflammatory and proacoagulant state of preecl sia.
Publisher: Wiley
Date: 19-12-2017
Abstract: Randomised trials and their syntheses in meta-analyses offer a unique opportunity to assess the frequency and severity of adverse reactions. To assess safety reporting in pre-ecl sia trials. Systematic search using bibliographic databases, including Cochrane Central Register of Controlled Trials, Embase, and MEDLINE, from inception to August 2017. Randomised trials evaluating anticonvulsant or antihypertensive medication for pre-ecl sia. Descriptive statistics appraising the adequacy of adverse reaction and toxicity reporting. We included 60 randomised trials. Six trials (10%) were registered with the International Clinical Trials Registry Platform, two registry records referred to adverse reactions, stating 'safety and toleration' and 'possible side effects' would be collected. Twenty-six trials (43%) stated the frequency of withdrawals within each study arm, and five trials (8%) adequately reported these withdrawals. Adverse reactions were inconsistently reported across eligible trials: 24 (40%) reported no serious adverse reactions and 36 (60%) reported no mild adverse reactions. The methods of definition or measurement of adverse reactions were infrequently reported within published trial reports. Pre-ecl sia trials regularly omit critical information related to safety. Despite the paucity of reporting, randomised trials collect an enormous amount of safety data. Developing and implementing a minimum data set could help to improve safety reporting, permitting a more balanced assessment of interventions by considering the trade-off between the benefits and harms. National Institute for Health Research (DRF-2014-07-051), UK Maternity Forum, Royal Society of Medicine, UK. Developing @coreoutcomes could help to improve safety reporting in #preecl sia trials. @NIHR_DC.
Publisher: Springer Science and Business Media LLC
Date: 12-2017
Publisher: Springer Science and Business Media LLC
Date: 04-2020
DOI: 10.1186/S12978-020-0873-8
Abstract: In less-resourced settings, adverse pregnancy outcome rates are unacceptably high. To effect improvement, we need accurate epidemiological data about rates of death and morbidity, as well as social determinants of health and processes of care, and from each country (or region) to contextualise strategies. The PRECISE database is a unique core infrastructure of a generic, unified data collection platform. It is built on previous work in data harmonisation, outcome and data field standardisation, open-access software (District Health Information System 2 and the Baobab Laboratory Information Management System), and clinical research networks. The database contains globally-recommended indicators included in Health Management Information System recording and reporting forms. It comprises key outcomes (maternal and perinatal death), life-saving interventions (Human Immunodeficiency Virus testing, blood pressure measurement, iron therapy, uterotonic use after delivery, postpartum maternal assessment within 48 h of birth, and newborn resuscitation, immediate skin-to-skin contact, and immediate drying), and an additional 17 core administrative variables for the mother and babies. In addition, the database has a suite of additional modules for ‘deep phenotyping’ based on established tools. These include social determinants of health (including socioeconomic status, nutrition and the environment), maternal co-morbidities, mental health, violence against women and health systems. The database has the potential to enable future high-quality epidemiological research integrated with clinical care and discovery bioscience.
Publisher: Public Library of Science (PLoS)
Date: 12-04-2019
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.EJOGRB.2014.05.021
Abstract: The internally validated fullPIERS model predicts adverse maternal outcomes in women with pre-ecl sia within 48h after eligibility. Our objective was to assess generalizability of this prediction model. External validation study using prospectively collected data from two tertiary care obstetric centers. The existing PETRA dataset, a cohort of women (n=216) with severe early-onset pre-ecl sia, ecl sia, HELLP syndrome or hypertension-associated fetal growth restriction was used. The fullPIERS model equation was applied to all women in the dataset using values collected within 48h after inclusion. The performance (ROC area and R-squared) of the model, risk stratification and calibration were assessed from 48h up to a week after inclusion. Of 216 women in the PETRA trial, 73 (34%) experienced an adverse maternal outcome(s) at any time after inclusion. Adverse maternal outcome was observed in 32 (15%) cases within 48h and 62 (29%) within 7 days after inclusion. The fullPIERS model predicted adverse maternal outcomes within 48h (AUC ROC 0.97, 95% CI: 0.87-0.99) and up to 7 days after inclusion (AUC ROC 0.80, 95% CI: 0.70-0.87). The fullPIERS model performed well when applied to the PETRA dataset. These results confirm the usability of the fullPIERS prediction model as a 'rule-in' test for women admitted with severe pre-ecl sia, ecl sia, HELLP syndrome or hypertension-associated fetal growth restriction. Future research should focus on intervention studies that assess the clinical impact of strategies using the fullPIERS model.
Publisher: Springer Science and Business Media LLC
Date: 09-2016
Publisher: Public Library of Science (PLoS)
Date: 06-12-2018
Publisher: Public Library of Science (PLoS)
Date: 11-2018
Publisher: Springer Science and Business Media LLC
Date: 27-04-2022
DOI: 10.1038/S41598-022-10869-7
Abstract: As metagenomic approaches for detecting infectious agents have improved, each tissue that was once thought to be sterile has been found to harbor a variety of microorganisms. Controversy still exists over the status of amniotic fluid, which is part of an immunologically privileged zone that is required to prevent maternal immune system rejection of the fetus. Due to this privilege, the exclusion of microbes has been proposed to be mandatory, leading to the sterile womb hypothesis. Since nucleic acid yields from amniotic fluid are very low, contaminating nucleic acid found in water, reagents and the laboratory environment frequently confound attempts to address this hypothesis. Here we present metagenomic criteria for microorganism detection and a metagenomic method able to be performed with small volumes of starting material, while controlling for exogenous contamination, to circumvent these and other pitfalls. We use this method to show that human mid-gestational amniotic fluid has no detectable virome or microbiome, supporting the sterile womb hypothesis.
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.PREGHY.2012.04.026
Abstract: Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal mortality in low and middle income countries (LMICs). HDP complicates pregnancy in many malarial endemic areas with the greatest burden in sub-saharan Africa. It has been suggested that there is a link between placental malaria infection (PMI) caused by Plasmodium falciparum and HDP. To our knowledge, a systematic review has never been conducted on the relationship between PMI and HDP and the modification of that relationship with parity. 1. To critically assess the association between PMI and HDP among a general obstetrical population in malarial endemic regions 2. To evaluate if the relationship between PMI and HDP is modified by parity. We conducted a systematic review for any study reporting on placental malaria and hypertension. A literature search based on a prospectively prepared protocol was conducted in PubMed Central and EMBASE until 06/09/2011. Additional data on parity of study participants in each study group was requested from corresponding authors of included studies by personal contact through email. Studies were assessed using the Newcastle-Ottawa Scale. The Cochrane Revman 5.1 software was used for statistical analysis according to standardised methodology. Risk Ratios with 95% confidence interval were calculated. Seven studies met our inclusion criteria [1-7]. These included cross-sectional, case control and observational studies. Six were in English and one was translated internally from French. One study [2] was further excluded because it did not represent a general obstetrical population. Our meta-analysis found no association between PMI and HDP in a general obstetric population in malaria endemic areas [RR of 1.00, 95% CI of 0.82,1.23]. Furthermore, we did not find that this relationship was modified by parity in two studies [RR (nulliparous) 0.92, 95% CI of 0.26,3.25)]. Events=women with HDP (). Although trends and associations have been reported in in idual studies, we did not find a significant association between PMI and the risk of HDP. There is an apparent need for a large prospective cohort study to be conducted on PMI and the possible association with HDP.
Publisher: BMJ
Date: 06-2019
DOI: 10.1136/BMJGH-2018-000894
Abstract: Existence of inequalities in quality and access to healthcare services at subnational levels has been identified despite a decline in maternal and perinatal mortality rates at national levels, leading to the need to investigate such conditions using geographical analysis. The need to assess the accuracy of global demographic distribution datasets at all subnational levels arises from the current emphasis on subnational monitoring of maternal and perinatal health progress, by the new targets stated in the Sustainable Development Goals. The analysis involved comparison of four models generated using Worldpop methods, incorporating region-specific input data, as measured through the Community Level Intervention for Pre-ecl sia (CLIP) project. Normalised root mean square error was used to determine and compare the models’ prediction errors at different administrative unit levels. The models’ prediction errors are lower at higher administrative unit levels. All datasets showed the same pattern for both the live birth and pregnancy estimates. The effect of improving spatial resolution and accuracy of input data was more prominent at higher administrative unit levels. The validation successfully highlighted the impact of spatial resolution and accuracy of maternal and perinatal health data in modelling estimates of pregnancies and live births. There is a need for more data collection techniques that conduct comprehensive censuses like the CLIP project. It is also imperative for such projects to take advantage of the power of mapping tools at their disposal to fill the gaps in the availability of datasets for populated areas.
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.PLACENTA.2016.03.010
Abstract: Discriminating between placentally-mediated fetal growth restriction and constitutionally-small fetuses is a challenge in obstetric practice. Placental growth factor (PlGF), measurable in the maternal circulation, may have this discriminatory capacity. Plasma PlGF was measured in women presenting with suspected fetal growth restriction (FGR ultrasound fetal abdominal circumference <10th percentile for gestational age) at sites in Canada, New Zealand and the United Kingdom. When available, placenta tissue underwent histopathological examination for lesions indicating placental dysfunction, blinded to PlGF and clinical outcome. Lesions were evaluated according to pre-specified severity criteria and an overall severity grade was assigned (0-3, absent to severe). Low PlGF (concentration <5th percentile for gestational age) to identify placental FGR (severity grade≥2) was assessed and compared with routine parameters for fetal assessment. For all cases, the relationship between PlGF and the s ling-to-delivery interval was determined. Low PlGF identified placental FGR with an area under the receiver-operator characteristic curve of 0.96 [95% CI 0.93-0.98], 98.2% [95% CI 90.5-99.9] sensitivity and 75.1% [95% CI 67.6-81.7] specificity. Negative and positive predictive values were 99.2% [95% CI 95.4-99.9] and 58.5% [95% CI 47.9-68.6], respectively. Low PlGF outperformed gestational age, abdominal circumference and umbilical artery resistance index in predicting placental FGR. Very low PlGF (<12 pg/mL) was associated with shorter s ling-to-delivery intervals than normal PlGF (13 vs. 29.5 days, P < 0.0001). Low PlGF identifies small fetuses with significant underlying placental pathology and is a promising tool for antenatal discrimination of FGR from fetuses who are constitutionally-small.
Publisher: Elsevier BV
Date: 09-2009
Publisher: Elsevier BV
Date: 10-2020
Publisher: Wiley
Date: 17-06-2013
DOI: 10.1111/PPE.12061
Abstract: The Maternal-Infant Research on Environmental Chemicals (MIREC) Study was established to obtain Canadian biomonitoring data for pregnant women and their infants, and to examine potential adverse health effects of prenatal exposure to priority environmental chemicals on pregnancy and infant health. Women were recruited during the first trimester from 10 sites across Canada and were followed through delivery. Questionnaires were administered during pregnancy and post-delivery to collect information on demographics, occupation, life style, medical history, environmental exposures and diet. Information on the pregnancy and the infant was abstracted from medical charts. Maternal blood, urine, hair and breast milk, as well as cord blood and infant meconium, were collected and analysed for an extensive list of environmental biomarkers and nutrients. Additional biospecimens were stored in the study's Biobank. The MIREC Research Platform encompasses the main cohort study, the Biobank and follow-up studies. Of the 8716 women approached at early prenatal clinics, 5108 were eligible and 2001 agreed to participate (39%). MIREC participants tended to smoke less (5.9% vs. 10.5%), be older (mean 32.2 vs. 29.4 years) and have a higher education (62.3% vs. 35.1% with a university degree) than women giving birth in Canada. The MIREC Study, while smaller in number of participants than several of the international cohort studies, has one of the most comprehensive datasets on prenatal exposure to multiple environmental chemicals. The biomonitoring data and biological specimen bank will make this research platform a significant resource for examining potential adverse health effects of prenatal exposure to environmental chemicals.
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.AJOG.2022.03.007
Abstract: A definition of preecl sia that incorporates the assessment of maternal, fetal, and uteroplacental status would optimize the identification of pregnancies at risk of complications at term gestational age. This definition would include "carrying forward" angiogenic test results from 35 to 36 weeks of gestation to term gestational age. Would this approach still be useful if testing is performed earlier or at a routine midgestation scan and the result is used to inform the diagnosis of preecl sia that developed thereafter? This study aimed to evaluate whether fetoplacental assessment at a 19- to 23-week scan could be "carried forward" to contribute to the classification of preecl sia and improve the detection of women and fetuses at risk of adverse outcomes associated with hypertension. In this prospective cohort study of singleton pregnancies at 2 maternity hospitals in England (October 2011 to March 2020), women attending a routine hospital visit at 19 to 23 weeks of gestation underwent an assessment that included history, ultrasonographic estimated fetal weight, Doppler measurements of the pulsatility index in uterine arteries, and serum placental growth factor. Preecl sia was defined according to various definitions: (1) traditional, based on new-onset proteinuria at ≥20 weeks of gestation (2) 2013 American College of Obstetricians and Gynecologists (3) 2018 International Society for the Study of Hypertension in Pregnancy maternal factor (4) 2018 International Society for the Study of Hypertension in Pregnancy maternal-fetal factor (death or growth restriction), based on ultrasound scans at the 19 0/7 to 23 6/7 week of gestation (an estimated fetal weight of 95th percentile) and (5) 2021 International Society for the Study of Hypertension in Pregnancy maternal-fetal factor plus placental growth factor (with abnormal placental growth factor defined as an estimated fetal weight of <5th percentile for gestational age). The detection rates for outcomes of interest (ie, severe maternal hypertension, major maternal morbidity, perinatal mortality or major neonatal morbidity, neonatal intensive care unit admission ≥48 hours, and birthweight of <3rd percentile) ascertained by health record review were compared using the chi-square test. A P value of <.05 was considered statistically significant. Among 40,241 singleton pregnancies, preecl sia incidence varied by definition, from lows of 2.6% (traditional) and 3.0% (American College of Obstetricians and Gynecologists) to a high of 3.8% (International Society for the Study of Hypertension in Pregnancy maternal-fetal factor plus placental growth factor). The International Society for the Study of Hypertension in Pregnancy maternal-fetal factor plus placental growth factor definition (vs the traditional) best identified women who developed adverse outcomes: severe hypertension (detection rate: 70.6% vs 52.8% P<.001), major maternal morbidity (detection rate: 100% vs 87.5% P=.027), perinatal mortality or major morbidity (detection rate: 84.6% vs 69.5% P=.004), neonatal intensive care unit admission ≥48 hours (detection rate: 76.6% vs 63.2% , P=.0002), and birthweight of <3rd percentile (detection rate: 81.3% vs 61.9% P<.0001]. The detection rates improved, going from the American College of Obstetricians and Gynecologists definition to the International Society for the Study of Hypertension in Pregnancy maternal-fetal factor plus placental growth factor definition, for severe hypertension (11.4% P=.003), perinatal mortality or major morbidity (10.6% P=.03), neonatal intensive care unit admission ≥48 hours (8.6% P=.01), and birthweight of <3rd percentile (16.2% P<.001). However, going from the International Society for the Study of Hypertension in Pregnancy maternal-fetal factor definition to the International Society for the Study of Hypertension in Pregnancy maternal-fetal factor plus placental growth factor definition, the detection of fetuses with a birthweight of <3rd percentile improved by 7.0% (P=.01), but no other improvement was seen for severe hypertension (1.7% P=.33), major maternal morbidity (0%), perinatal mortality or major morbidity (4.0% P=.20), and neonatal intensive care unit admission ≥48 hours (3.2% P=.17). The criteria for uteroplacental dysfunction (including placental growth factor) from the 19- to 23-week assessment can be used in the assessment of women who are later suspected of having PE, to best identify pregnancies at risk of adverse outcomes.
Publisher: Informa UK Limited
Date: 2009
DOI: 10.1080/10641950802601294
Abstract: SNOMED CT (Systematized NOmenclature of MEDicine Clinical Terms) is a standardized multilingual healthcare terminology. It was developed to meet the needs of our electronic world so that care can be documented and clinicians can retrieve and transmit data in electronic format. It is anticipated that SNOMED CT will provide the core general terminology for electronic health records and, as such, replace existing classification systems such as the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10). At present, there is no special interest group for the hypertensive disorders of pregnancy (HDP) within the SNOMED CT initiative. We believe that members of the ISSHP, and others interested in the HDP, should take a leadership role in this regard for a number of reasons.
Publisher: Elsevier BV
Date: 12-2014
Publisher: Wiley
Date: 14-06-2017
Abstract: Standardising outcome collection and reporting in pre-ecl sia trials requires an appraisal of current outcome reporting. To map maternal and offspring outcome reporting across randomised trials evaluating therapeutic interventions for pre-ecl sia. Randomised trials were identified by searching bibliographical databases from inception to January 2016. Randomised controlled trials. We systematically extracted and categorised outcome reporting. Seventy-nine randomised trials, reporting data from 31 615 maternal participants and 28 172 of their offspring, were included. Fifty-five different interventions were evaluated. Included trials reported 119 different outcomes, including 72 maternal outcomes and 47 offspring outcomes. Maternal outcomes were inconsistently reported across included trials for ex le, 11 trials (14%) reported maternal mortality, reporting data from 12 422 participants, and 16 trials (20%) reported cardiovascular morbidity, reporting data from 14 963 maternal participants. Forty-three trials (54%) reported fetal outcomes and 23 trials (29%) reported neonatal outcomes. Twenty-eight trials (35%) reported offspring mortality. There was poor reporting of childhood outcomes: six trials (8%) reported neurodevelopmental outcomes. Less than half of included trials reported any relevant information regarding harms for maternal participants and their offspring. Most randomised trials evaluating interventions for pre-ecl sia are missing information on clinically important outcomes, and in particular have neglected to evaluate efficacy and safety in the offspring of participants. Developing and implementing a minimum data set, known as a core outcome set, in future pre-ecl sia trials could help to address these issues. Future #preecl sia research requires a core outcome set to reduce #research waste. @coreoutcomes @jamesmnduffy International Prospective Register of Systematic Reviews: CRD42015015529 www.crd.york.ac.uk/PROSPERO/display_record.aspID=CRD42015015529.
Publisher: BMJ
Date: 05-2021
DOI: 10.1136/BMJGH-2020-004123
Abstract: The Community-Level Interventions for Pre-ecl sia (CLIP) trials ( NCT01911494 ) in India, Pakistan and Mozambique (February 2014–2017) involved community engagement and task sharing with community health workers for triage and initial treatment of pregnancy hypertension. Maternal and perinatal mortality was less frequent among women who received ≥8 CLIP contacts. The aim of this analysis was to assess the incremental costs and cost-effectiveness of the CLIP intervention overall in comparison to standard of care, and by PIERS (Pre-ecl sia Integrated Estimate of RiSk) On the Move (POM) mobile health application visit frequency. Included were all women enrolled in the three CLIP trials who had delivered with known outcomes by trial end. According to the number of POM-guided home contacts received (0, 1–3, 4–7, ≥8), costs were collected from annual budgets and spending receipts, with inclusion of family opportunity costs in Pakistan. A decision tree model was built to determine the cost-effectiveness of the intervention (vs usual care), based on the primary clinical endpoint of years of life lost (YLL) for mothers and infants. A probabilistic sensitivity analysis was used to assess uncertainty in the cost and clinical outcomes. The incremental per pregnancy cost of the intervention was US$12.66 (India), US$11.51 (Pakistan) and US$13.26 (Mozambique). As implemented, the intervention was not cost-effective due largely to minimal differences in YLL between arms. However, among women who received ≥8 CLIP contacts (four in Pakistan), the probability of health system and family (Pakistan) cost-effectiveness was ≥80% (all countries). The intervention was likely to be cost-effective for women receiving ≥8 contacts in Mozambique and India, and ≥4 in Pakistan, supporting WHO guidance on antenatal contact frequency. NCT01911494 .
Publisher: Public Library of Science (PLoS)
Date: 20-01-2017
Publisher: Springer Science and Business Media LLC
Date: 04-2020
DOI: 10.1186/S12978-020-0874-7
Abstract: PRECISE is a population-based, prospective pregnancy cohort study designed for deep phenotyping of pregnancies in women with placenta-related disorders, and in healthy controls. The PRECISE Network is recruiting ~ 10,000 pregnant women in three countries (The Gambia, Kenya, and Mozambique) representing sub-Saharan Africa. The principal aim is to improve our understanding of pre-ecl sia, fetal growth restriction and stillbirth. This involves the creation of a highly curated biorepository for state of the art discovery science and a rich database of antenatal variables and maternal and neonatal outcomes. Our overarching aim is to provide large s le numbers with adequate power to address key scientific questions. Here we describe our experience of establishing a biorepository in the PRECISE Network and review the issues and challenges surrounding set-up, management and scientific use. The feasibility of collecting and processing each s le type was assessed in each setting and plans made for establishing the necessary infrastructure. Quality control (QC) protocols were established to ensure that biological s les are ‘fit-for-purpose'. The management structures required for standardised s le collection and processing were developed. This included the need for transport of s les between participating countries and to external academic/commercial institutions. Numerous practical challenges were encountered in setting up the infrastructure including facilities, staffing, training, cultural barriers, procurement, shipping and s le storage. Whilst delaying the project, these were overcome by establishing good communication with the sites, training workshops and constant engagement with the necessary commercial suppliers. A Project Executive Committee and Biology Working Group together defined the biospecimens required to answer the research questions paying particular attention to harmonisation of protocols with other cohorts so as to enable cross-biorepository collaboration. Governance structures implemented include a Data and S le Committee to ensure biospecimens and data will be used according to consent, and prioritisation by scientific excellence. A coordinated s le and data transfer agreement will prevent delay in s le sharing. With adequate training and infrastructure, it is possible to establish high quality s le collections to facilitate research programmes such as the PRECISE Network in sub-Saharan Africa. These preparations are pre-requisites for effective execution of a biomarker-based approach to better understand the complexities of placental disease in these settings, and others.
Publisher: Elsevier BV
Date: 08-1982
DOI: 10.1016/0010-7824(82)90084-1
Abstract: In order to observe the effects of indomethacin upon the retention of silastic intrauterine contraceptive devices, rods containing indomethacin at various loadings were inserted unilaterally into adult rats. In other animals, an unmedicated rod was inserted into one uterine horn whilst an indomethacin-loaded rod was fitted to the other horn. Rods were not secured to the uterine wall and the retention of rods in both groups was determined at weekly intervals. The results show an increased retention for animals fitted with indomethacin-loaded rods over a 4-week period. All unmedicated rods, irrespective of whether a contralateral indomethacin rod was present or not, were expelled by 1 week after insertion.
Publisher: Elsevier BV
Date: 04-2011
Publisher: Public Library of Science (PLoS)
Date: 22-12-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2017
DOI: 10.1161/HYPERTENSIONAHA.116.08547
Abstract: In well-resourced settings, reduced circulating maternal-free placental growth factor (PlGF) aids in either predicting or confirming the diagnosis of preecl sia, fetal growth restriction, stillbirth, preterm birth, and delivery within 14 days of testing when preecl sia is suspected. This blinded, prospective cohort study of maternal plasma PlGF in women with suspected preecl sia was conducted in antenatal clinics in Maputo, Mozambique. The primary outcome was the clinic-to-delivery interval. Other outcomes included: confirmed diagnosis of preecl sia, transfer to higher care, mode of delivery, intrauterine fetal death, preterm birth, and low birth weight. Of 696 women, 95 (13.6%) and 601 (86.4%) women had either low ( pg/mL) or normal (≥100 pg/mL) plasma PlGF, respectively. The clinic-to-delivery interval was shorter in low PlGF, compared with normal PlGF, women (median 24 days [interquartile range, 10–49] versus 44 [24–81], P =0.0042). Also, low PlGF was associated with a confirmed diagnosis of preecl sia, higher blood pressure, transfer for higher care, earlier gestational age delivery, delivery within 7 and 14 days, preterm birth, cesarean delivery, lower birth weight, and perinatal loss. In urban Mozambican women with symptoms or signs suggestive of preecl sia, low maternal plasma PlGF concentrations are associated with increased risks of adverse pregnancy outcomes, whether the diagnosis of preecl sia is confirmed. Therefore, PlGF should improve the provision of precision medicine to in idual women and improve pregnancy outcomes for those with preecl sia or related placenta-mediated complications.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2016
Publisher: Springer Science and Business Media LLC
Date: 30-07-2010
Abstract: For ethical approval of a multicentre study in Canada, investigators must apply separately to in idual Research Ethics Boards (REBs). In principle, the protection of human research subjects is of utmost importance. However, in practice, the process of multicentre ethics review can be time consuming and costly, requiring duplication of effort for researchers and REBs. We used our experience with ethical review of The Canadian Perinatal Network (CPN), to gain insight into the Canadian system. The applications forms of 16 different REBs were abstracted for a list of standardized items. The application process across sites was compared. Correspondence between the REB and the investigators was documented in order to construct a timeline to approval, identify the specific issues raised by each board, and describe how they were resolved. Each REB had a different application form. Most (n = 9) had a two or three step application process. Overall, it took a median of 31 days (range 2-174 days) to receive an initial response from the REB. Approval took a median of 42 days (range 4-443 days). Privacy and consent were the two major issues raised. Several additional minor or administrative issues were raised which delayed approval. For CPN, the Canadian REB process of ethical review proved challenging. REBs acted independently and without unified application forms or submission procedures. We call for a critical examination of the ethical, privacy and institutional review processes in Canada, to determine the best way to undertake multicentre review.
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.JPEDSURG.2012.03.010
Abstract: Disease-specific outcome predictors are required for gastroschisis. We derived and validated a gastroschisis prognostic score (GPS) based on bowel appearance after birth. Visual scoring of bowel matting, necrosis, atresia, and perforation generated a novel gastroschisis bowel injury score recorded in a national database. Reweighting of score components by regression analysis led to assessments of model calibration and goodness of fit. The GPS was validated in subsequent cases. Records from 225 infants were used for model derivation. Only intestinal necrosis independently predicted mortality by regression analysis (odds ratio, 11.5 95% confidence interval, 4.2-31.4). Model recalibration identified that a GPS of 4 or more predicted mortality in 75% of nonsurvivors and 99% of survivors (P = .0001). A GPS of 2 or more demonstrated significantly worse survival outcomes compared with scores of 0 or 1 (length of stay: P = .011, days to first enteral feed: P = .013, days on total parenteral nutrition: P = .006). Model validation with 184 new patients yielded continued high-quality discrimination of outcomes. The GPS demonstrated "near-perfect" interobserver reliability between 2 surgeons (κ ≥ 0.86). The GPS allows the accurate and reliable identification of high-risk groups for mortality and morbidity based on bowel appearance at birth. This information can drive discussions regarding family counseling, resource allocation, and new therapies for these patients.
Publisher: Springer Science and Business Media LLC
Date: 29-11-2009
DOI: 10.1007/S11906-009-0073-Y
Abstract: The hypertensive disorders of pregnancy are a leading cause of maternal mortality and morbidity. Complications are not limited to preecl sia but also complicate both preexisting hypertension and isolated gestational hypertension. Blood pressure (BP) management is important but is only one aspect of management of the hypertensive disorders of pregnancy, which may be caused or exacerbated by underlying uteroplacental mismatch between maternal supply and fetal demand. BP treatment thresholds and goals vary in international guidelines, largely reflecting differences in opinion rather than differences in published data. Because of short-term maternal risks, there is consensus that BP should be treated when sustained at greater than or equal to 160 to 170 mm Hg systolic and/or 110 mm Hg diastolic. There is no consensus regarding management of nonsevere hypertension, and randomized controlled trials involving just over 3000 women have not clarified the relative maternal and perinatal risks and benefits. Although antihypertensive therapy may decrease transient severe maternal hypertension, therapy may also impair fetal growth and perinatal health and outcomes. The CHIPS Trial (Control of Hypertension In Pregnancy Study) is recruiting to answer this question.
Publisher: Wiley
Date: 05-06-2014
Abstract: Information about the recurrence of spontaneous preterm birth in subsequent twin/singleton pregnancies is scattered. To quantify the risk of recurrence of spontaneous preterm birth in different subtypes of subsequent pregnancies. An electronic literature search in OVID MEDLINE and EMBASE, complemented by PubMed, to find recent studies. Studies comparing the risk of spontaneous preterm birth after a previous preterm and previous term pregnancy. The absolute risk of recurrence with a 95% confidence interval and the absolute risk of preterm birth after a term delivery were calculated. Data from studies were pooled using the Mantel-Haenszel method. We detected 13 relevant studies. The risk of recurrence of preterm birth was significantly increased in all preterm pregnancy subtypes, compared with their term counterparts. Women pregnant with twins after a previous preterm singleton had the highest absolute risk of recurrence (57.0%, 95% CI 51.9-61.9%), and after a previous term singleton their absolute risk was 25% (95% CI 24.3-26.5%). Women pregnant with a singleton after a previous preterm twin pregnancy have an absolute recurrence risk of 10% (95% CI 8.2-12.3%), whereas a singleton pregnancy after delivering a previous twin up to term yields a low absolute risk of only 1.3% (95% CI 0.8-2.2). Women pregnant with a singleton after a previous preterm singleton have an absolute recurrence risk of 20% (95% CI 19.9-20.6). The risk of recurrence of preterm birth is influenced by the singleton/twin order in both pregnancies, and varies between 10% for a singleton after previous preterm twins to 57% for twins after a previous preterm singleton.
Publisher: Informa UK Limited
Date: 27-11-2009
DOI: 10.3109/10641950902968676
Abstract: In hypertensive pregnancy, to compare 24hr creatinine clearance (CrCl) with formulae-derived renal function (Cockcroft-Gault (CG) or Modified Diet in Renal Disease (MDRD)). Retrospective review (198 women, 63% preecl sia) using paired t-test (significant p 0.70) to compare 24hr and CG CrCl. The 24hr CrCl was compared with each of the CG and MDRD formulae by Bland-Altman plots. For 24hr CrCl, uncorrected values were similar to corrected using pre-pregnancy weight (p = 0.04) other weights gave consistently different CrCl (p < 0.0001). Limits of agreement were wide when CG and MDRD formulae were compared with 24hr CrCl. Compared with 24hr CrCl, MDRD estimates were consistently lower, and CG CrCl higher (current weight) or lower (pre-pregnancy or lean weight). MDRD and CG formulae should not be used in hypertensive pregnancy. Use of serum creatinine is advocated. If 24hr CrCl is performed, any correction should utilize pre-pregnancy weight. Neither the Cockcroft-Gault nor Modified Diet in Renal Disease formulae for glomerular filtration rate estimation are alternatives to 24hr creatinine clearance in hypertensive pregnancy.
Publisher: Elsevier BV
Date: 03-2015
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.PREGHY.2015.08.006
Abstract: To develop and internally validate a prognostic model for perinatal death that could guide community-based antenatal care of women with a hypertensive disorder of pregnancy (HDP) in low-resourced settings as part of a mobile health application. Using data from 1688 women (110 (6.5%) perinatal deaths) admitted to hospital after 32weeks gestation with a HDP from five low-resourced countries in the miniPIERS prospective cohort, a logistic regression model to predict perinatal death was developed and internally validated. Model discrimination, calibration, and classification accuracy were assessed and compared with use of gestational age alone to determine prognosis. Stillbirth or neonatal death before hospital discharge. The final model included maternal age a count of symptoms (0, 1 or ⩾2) and dipstick proteinuria. The area under the receiver operating characteristic curve was 0.75 [95% CI 0.71-0.80]. The model correctly identified 42/110 (38.2%) additional cases as high-risk (probability >15%) of perinatal death compared with use of only gestational age <34weeks at assessment with increased sensitivity (48.6% vs. 23.8%) and similar specificity (86.6% vs. 90.0%). Using simple, routinely collected measures during antenatal care, we can identify women with a HDP who are at increased risk of perinatal death and who would benefit from transfer to facility-based care. This model requires external validation and assessment in an implementation study to confirm performance.
Publisher: Springer Science and Business Media LLC
Date: 10-11-2017
Publisher: Springer Science and Business Media LLC
Date: 05-01-2018
Publisher: Springer Science and Business Media LLC
Date: 06-2016
Publisher: Georg Thieme Verlag KG
Date: 04-2017
Publisher: Elsevier
Date: 2006
Publisher: Elsevier BV
Date: 03-2009
Publisher: Massachusetts Medical Society
Date: 18-08-2022
DOI: 10.1056/NEJMC2207889
Publisher: Elsevier BV
Date: 11-2021
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.AJOG.2018.09.023
Abstract: Clinical research should ultimately improve patient care. To enable this, randomized controlled trials must select, collect, and report outcomes that are both relevant to clinical practice and genuinely reflect the perspectives of key stakeholders including health care professionals, researchers, and patients. Unfortunately, many randomized controlled trials fall short of this requirement. Complex issues, including a failure to take into account the perspectives of key stakeholders when selecting outcomes, variations in outcome definitions and measurement instruments, and outcome reporting bias make research evidence difficult to interpret, undermining the translation of research into clinical practice. Problems with poor outcome selection, measurement, and reporting can be addressed by developing, disseminating, and implementing core outcome sets. A core outcome set represents a minimum data set of outcomes developed using robust consensus science methods engaging erse stakeholders including health care professionals, researchers, and patients. Core outcomes should be routinely utilized by researchers, collected in a standardized manner, and reported consistently in the final publication. They are currently being developed across our specialty including infertility, endometriosis, and preecl sia. Recognizing poorly selected, collected, and reported outcomes as serious hindrances to progress in our specialty, more than 80 journals including the Journal, have come together to support the Core Outcomes in Women's and Newborn Health (CROWN) initiative. The consortium supports researchers to develop, disseminate, and implement core outcome sets. Implementing core outcome sets could make a profound contribution to addressing poorly selected, collected, and reported outcomes. Implementation should ensure future randomized controlled trials hold the necessary reach and relevance to inform clinical practice, enhance patient care, and improve patient outcomes.
Publisher: BMJ
Date: 07-04-2011
DOI: 10.1136/BMJ.D1863
Publisher: Wiley
Date: 19-10-2012
DOI: 10.1111/J.1471-0528.2012.03496.X
Abstract: The fullPIERS (Pre-ecl sia Integrated Estimate of RiSk) model is a promising tool for the prediction of adverse outcomes in pre-ecl sia, developed using the worst values for predictor variables measured within 48 hours of admission. We reassessed the performance of fullPIERS using predictor variables obtained within 6 and 24 hours of admission, and found that the stratification capacity, calibration ability, and classification accuracy of the model remained high. The fullPIERS model is accurate as a rule-in test for adverse maternal outcome, with a likelihood ratio of 14.8 (95% CI 9.1-24.1) or 17.5 (95% CI 11.7-26.3) based on 6- and 24-hour data, respectively, for the women identified to be at highest risk (predicted probability ≥ 30%).
Publisher: Wiley
Date: 05-11-2020
Publisher: Springer Science and Business Media LLC
Date: 09-2016
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.PREGHY.2013.02.002
Abstract: A diagnostic test to confirm pre-ecl sia would be beneficial for the clinical management of the syndrome. The Triage PlGF test is able to confirm pre-ecl sia with high accuracy, with the greatest efficacy at <35weeks gestation. We recently found that the anti-inflammatory protein sST2 is elevated in the plasma of pre-ecl tic women compared to normal controls. Here sST2 and PlGF are compared in early-onset and late-onset pre-ecl tic women. sST2 was found to be an equally good diagnostic tool for early-onset (sST2 AUC 0.944 versus PlGF AUC 0.995 not significant) but not late-onset disease.
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.PREGHY.2013.02.001
Abstract: We evaluated the frequency of measurable albuminuria (⩾6.00mg/L) for albumin:creatinine ratios (ACr) among 160 consecutive women attending high-risk clinics. Of last urine s les before delivery, 76 had measurable albuminuria and 41/76 (53.9%) had ACr ⩾2mg/mmol of which 7.3% had normal pregnancy outcome. 84 s les had albuminuria <6.00mg/L and 43/84 (51.2%) had ACr ⩾2mg/mmol of which 25.6% had normal pregnancy outcome (p=0.025). Excluding 48/160 (30.0%) dilute s les (urinary creatinine <3mM), no s les with unmeasurable albuminuria had ACr ⩾2mg/mmol. In pregnancy, urine is often dilute and without measurable albuminuria, leading to a clinically relevant proportion of false positive results by ACr.
Publisher: SAGE Publications
Date: 29-01-2017
Abstract: The leading direct causes of the estimated 196 maternal deaths per 100,000 live births globally are postpartum haemorrhage, the hypertensive disorders of pregnancy, obstructed labour, unsafe abortion and obstetric sepsis. Of the Sustainable Development Goals, one (Sustainable Development Goal 3.1) specifically addresses maternal mortality by 2030, the goal is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. Eleven other Sustainable Development Goals provide opportunities to intervene. Unapologetically, this review focusses the reader’s attention on health advocacy and its central role in altering the risks that many of the world’s women face from direct obstetric causes of mortality. Hard work to alter social determinants of health and health outcomes remains. That work needs to start today to improve the health and social equality of today’s girls who will be the women delivering their babies in 2030.
Publisher: Elsevier BV
Date: 09-2019
Publisher: Wiley
Date: 09-2022
DOI: 10.1002/UOG.26036
Abstract: The competing‐risks model for assessment of risk for pre‐ecl sia (PE) at 35–37 weeks' gestation identifies the majority of women who are at high risk of subsequent delivery with PE. We aimed to examine the incidence and relative risk of adverse pregnancy outcomes in patient groups stratified according to the estimated risk of delivery with PE. This was a prospective non‐interventional, observational study in women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The risk of delivery with PE for each patient in the study population was estimated using the competing‐risks model, combining the prior distribution of gestational age at delivery with PE and the likelihood from multiples of the median values of mean arterial pressure, placental growth factor and soluble fms‐like tyrosine kinase‐1. The patients were assigned to one of the following five risk categories: Group A, ≥ 1 in 2 Group B, 1 in 5 to 1 in 3 Group C, 1 in 20 to 1 in 6 Group D, 1 in 50 to 1 in 21 and Group E, 1 in 50. The outcome measures were delivery with PE, gestational hypertension (GH), small‐for‐gestational age (SGA) at birth, delivery by Cesarean section, stillbirth, neonatal death, perinatal death and admission to the neonatal unit (NNU) for at least 48 h. In each risk category, the proportion of women with each adverse outcome was determined and relative risks (RR) were calculated as compared with the lowest‐risk Group E. In the study population of 29 035 women, 1.6%, 2.7%, 8.2%, 9.8% and 77.8% were categorized into Groups A, B, C, D and E, respectively. Compared with women in Group E, women in the higher‐risk groups were more likely to have an adverse outcome. The RR of delivery with PE in Group A compared with Group E was 65.5 (95% CI, 54.1–79.1) and the respective values were 11.9 (95% CI, 9.1–15.5) for GH, 1.8 (95% CI, 1.5–2.1) for delivery by emergency Cesarean section, 1.5 (95% CI, 1.2–1.8) for delivery by elective Cesarean section, 8.9 (95% CI, 7.4–10.8) for SGA with birth weight 3 rd percentile, 4.8 (95% CI, 4.3–5.4) for SGA with birth weight 10 th percentile, 5.3 (95% CI, 1.4–20.5) for stillbirth and 3.4 (95% CI, 2.8–4.2) for NNU admission for ≥ 48 h. The RR for these pregnancy complications in higher‐risk groups ( vs Group E) was particularly high for cases with delivery within 2 weeks after assessment. In terms of SGA, both for birth weight 10 th and 3 rd percentiles, the trend in all cases was stronger than that observed when the analysis was confined to normotensive pregnancies. The rates of neonatal death were too small to allow meaningful comparisons between risk groups. Pregnant women identified by the competing‐risks model to be at high risk of PE are also at increased risk of GH, Cesarean section, stillbirth, SGA and NNU admission for ≥ 48 h. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2021
DOI: 10.1097/AOG.0000000000004619
Abstract: To externally validate the CIPHER (Collaborative Integrated Pregnancy High-Dependency Estimate of Risk) prognostic model for pregnant and postpartum women admitted to the intensive care unit. A retrospective and a prospective validation study were conducted at two reference centers in Brazil. A composite outcome was defined as maternal death or need for prolonged organ support (more than 7 days) or acute lifesaving intervention. To evaluate the performance of the CIPHER model, a receiver operating characteristic curve was used and score calibration was assessed by the Hosmer-Lemeshow test. We conducted a descriptive analysis comparing the results of the current study with the results of the model development study. A total of 590 women were included. The composite outcome was observed in 90 (15.2%) women. Of these, 13 (2.2%) were maternal deaths and 77 (13%) required one or more component of organ support or lifesaving intervention. The CIPHER model's area under the curve (AOC) did not show significant predictive ability (AOC 0.53, 95% CI 0.46–0.60), and consequently its calibration was poor (Hosmer-Lemeshow test P .05). The CIPHER model for prediction of mortality and need for interventions in critically ill obstetric patients did not perform well in our Brazilian population. Different predictors of morbidity and mortality may need to be used for patients receiving care in public hospitals in low- and middle-income countries.
Publisher: Public Library of Science (PLoS)
Date: 19-10-2009
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/S1701-2163(15)30588-0
Abstract: This executive summary presents in brief the current evidence assessed in the clinical practice guideline prepared by the Canadian Hypertensive Disorders of Pregnancy Working Group and published by Pregnancy Hypertension (rticle/S2210-7789(14)00004-X/fulltext) to provide a reasonable approach to the diagnosis, evaluation, and treatment of the hypertensive disorders of pregnancy. Published literature was retrieved through searches of Medline, CINAHL, and The Cochrane Library in March 2012 using appropriate controlled vocabulary (e.g., pregnancy, hypertension, pre-ecl sia, pregnancy toxemias) and key words (e.g., diagnosis, evaluation, classification, prediction, prevention, prognosis, treatment, postpartum follow-up). Results were restricted to systematic reviews, randomized control trials, controlled clinical trials, and observational studies published in French or English between January 2006 and February 2012. Searches were updated on a regular basis and incorporated in the guideline to September 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence in the guideline summarized here was rated using the criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table 1).
Publisher: Springer Science and Business Media LLC
Date: 13-01-2017
Publisher: Wiley
Date: 31-05-2018
DOI: 10.1111/AJO.12831
Abstract: At-risk small-for-gestational age (SGA) pregnancies in New Zealand are identified using Doppler ultrasound fetuses with Doppler abnormalities are considered growth restricted (FGR). Low maternal placental growth factor (PlGF) has also been associated with late-onset FGR. To investigate whether low PlGF at diagnosis of late-onset SGA identifies the same fetuses classified FGR by detailed Doppler studies, and the association between low PlGF and adverse pregnancy outcomes. Among an historical database of normotensive suspected SGA pregnancies (fetal abdominal circumference <10th percentile) ≥32 weeks gestation, the ability of low PlGF (<5th percentile) to identify FGR infants was investigated. 'Initial FGR' was an abnormal umbilical artery resistance index (RI) or estimated fetal weight <3rd customised centile. 'Secondary FGR' was abnormal internal carotid RI, cerebro-placental ratio and/or mean uterine artery RI. Development of hypertensive disease and adverse perinatal outcomes were compared by PlGF status. Of 136 SGA pregnancies, 56 (41.1%) had initial FGR. Of the remaining, 20 (25.0%) had secondary FGR, 17 (21.3%) low PlGF. The sensitivity of low PlGF identifying secondary FGR was 0.30 (95% CI 0.14-0.50), specificity 0.83 (0.70-0.92), positive predictive value 0.47 (0.23-0.72) and negative predictive value 0.70 (0.57-0.81). Overall, low PlGF occurred in 44/136 (32.4%) pregnancies and was associated with gestational hypertensive disease (63.6% vs 15.2%, P < 0.01), adverse perinatal outcome (34.1% vs 15.2%, P = 0.01) and very low birthweight (customised centile 2.2 vs 6.8, P < 0.01). At diagnosis of late-onset SGA, low PlGF was poor at identifying Doppler-defined FGR. Low PlGF identified pregnancies at risk of hypertensive disease, adverse perinatal outcome and very low birthweight.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2010
Publisher: Elsevier BV
Date: 07-2011
Publisher: Wiley
Date: 21-06-2020
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.PREGHY.2018.04.021
Abstract: As a follow-up to the CHIPS trial (Control of Hypertension In Pregnancy Study) of 'less tight' (versus 'tight') control of maternal blood pressure in pregnancy, CHIPS-Child investigated potential developmental programming of maternal blood pressure control in pregnancy, by examining measures of postnatal growth rate and hypothalamic-pituitary adrenal (HPA) axis activation. CHIPS follow-up was extended to 12 ± 2 months corrected post-gestational age for anthropometry (weight, length, head/waist circumference). For eligible children with consent for a study visit, we collected biological s les (hair/buccal s les) to evaluate HPA axis function (hair cortisol levels) and epigenetic change (DNA methylation analysis of buccal cells). The primary outcome was 'change in z-score for weight' between birth and 12 ± 2 mos. Secondary outcomes were hair cortisol and genome-wide DNA methylation status. Of 683 eligible babies, 183 (26.8%) were lost to follow-up, 83 (12.2%) declined, 3 (0.4%) agreed only to ongoing contact, and 414 (60.6%) consented. 372/414 (89.9%) had weight measured at 12mos. In 'less tight' (vs. 'tight') control, the primary outcome was similar [-0.26 (-0.53, +0.01) p = 0.14, p Results demonstrate no compelling evidence for developmental programming of growth or the HPA axis. Clinicians should look to the clinical findings of CHIPS to guide practice. Researchers should seek to replicate these findings and extend outcomes to paediatric blood pressure and neurodevelopment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2022
DOI: 10.1161/HYPERTENSIONAHA.121.18356
Abstract: There is no accepted definition or standardized monitoring for white coat hypertension in pregnancy. This Delphi procedure aimed to reach consensus on out-of-office blood pressure (BP) monitoring, and white coat hypertension diagnostic criteria and monitoring. Relevant international experts completed three rounds of a modified Delphi questionnaire. For each item, the predefined cutoff for group consensus was ≥70% agreement, with 60% to 70% considered to warrant reconsideration at the subsequent round, and % considered insufficient to warrant consideration. Of 230 experts, 137 completed the first round and 114 (114/137, 83.2%) completed all three. For out-of-office BP monitoring, there was consensus that home BP monitoring (HBPM) should be chosen instructions given, pairs of BP values taken, opportunity given for women to qualify values they do not regard as valid, and BP considered evaluated when ≥25% of values are above a cutoff. For HBPM, BP should be taken at least 2 to 3 d/wk, at minimum in the morning however, many factors may affect frequency and timing. Experts endorsed a clinic BP /90 mm Hg as normal. While not reaching consensus, most agreed that HBPM values should be lower than clinic BP. Among those, HBPM /85 mm Hg was considered normal. There was consensus that white coat hypertension warrants: HBPM at least 1 d/wk before 20 weeks, 2 to 3 d/wk after 20 weeks or if persistent hypertension develops, and symptom monitoring (ie, headache, visual symptoms, and right upper quadrant/epigastric pain). Consensus-based diagnostic criteria and monitoring strategies should inform clinical care and research, to facilitate evaluation of out-of-office BP monitoring on pregnancy outcomes.
Publisher: Wiley
Date: 02-2020
DOI: 10.1002/UOG.20851
Abstract: Fetal growth restriction (FGR) is associated with maternal cardiovascular changes. Sildenafil, a phosphodiesterase type-5 inhibitor, potentiates the actions of nitric oxide, and it has been suggested that it alters maternal hemodynamics, potentially improving placental perfusion. Recently, the Dutch STRIDER trial was stopped prematurely owing to excess neonatal mortality secondary to pulmonary hypertension. The main aim of this study was to investigate the effect of sildenafil on maternal hemodynamics in pregnancies with severe early-onset FGR. This was a cardiovascular substudy within a UK multicenter, placebo-controlled trial, in which 135 women with a singleton pregnancy and severe early-onset FGR (defined as a combination of estimated fetal weight or abdominal circumference below the 10 Included were 134 women assigned randomly to sildenafil (n = 69) or placebo (n = 65) who had maternal BP and HR recorded at baseline. At 1-2 h post-randomization, compared with baseline values, sildenafil increased maternal HR by 4 bpm more than did placebo (mean difference, 5.00 bpm (95% CI, 1.00-12.00 bpm) vs 1.25 bpm (95% CI, -5.38 to 7.88 bpm) P = 0.004) and reduced systolic BP by 1 mmHg more (mean difference, -4.13 mmHg (95% CI, -9.94 to 1.44 mmHg) vs -2.75 mmHg (95% CI, -7.50 to 5.25 mmHg) P = 0.048). Even after adjusting for maternal mean arterial pressure, sildenafil reduced aortic PWV by 0.60 m/s more than did placebo (mean difference, -0.90 m/s (95% CI, -1.31 to -0.51 m/s) vs -0.26 m/s (95% CI, -0.75 to 0.59 m/s) P = 0.001). Sildenafil was associated with a non-significantly greater decrease in SV index after 1-2 h post-randomization than was placebo (mean difference, -5.50 mL/m Sildenafil in a dose of 25 mg three times daily increases HR, reduces BP and reduces arterial stiffness in pregnancies complicated by severe early-onset FGR. These changes are short term, modest and consistent with the anticipated vasodilatory effect. They have no short- or long-term clinical impact on the mother. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Publisher: Elsevier BV
Date: 03-2005
DOI: 10.1016/S1701-2163(16)30519-9
Abstract: A meta-analysis of randomized controlled trials suggests that nifedipine appears to be a reasonable agent for treatment of acute severe hypertension in pregnancy. However, in a 1999 survey of Canadian practitioners, most stated that they rarely or never use nifedipine capsules for treatment of acute severe pregnancy hypertension. Also, there are case reports of adverse outcomes following use of nifedipine capsules in pregnancy, although the risks appear to have been overplayed. We suggest that a reasonable approach is ongoing use of nifedipine capsules, with perhaps an initial dosage of 5 mg rather than 10 mg. Having women swallow the capsule without first biting it may also be a prudent approach, because there is insufficient information from most of the published clinical trials to say exactly how the nifedipine capsules were administered. Further, use of the 10 mg nifedipine prolonged action tablet may also be a reasonable approach for treatment of severe hypertension in pregnancy, although more data are needed. Such research would be particularly relevant given that nifedipine appears to be a promising treatment for spontaneous preterm labour. We must resist the temptation to throw out of our limited therapeutic armamentarium an effective oral preparation before adequately considering the evidence.
Publisher: Wiley
Date: 18-06-2010
Publisher: Wiley
Date: 10-12-2010
DOI: 10.1111/J.1471-0528.2009.02428.X
Abstract: Pre-ecl sia involves a maternal inflammatory response that differs from both normal pregnancy and normotensive intrauterine growth restriction (IUGR). Our objective was to examine neutrophil Toll-like receptor (TLR), cryopyrin, nuclear factor-kappaB (NF-kappaB) subunit and interleukin-1beta (IL-1beta), and inflammatory cytokine profiles in women with pre-ecl sia or normotensive IUGR, as well as in normal pregnancy and non-pregnancy controls. A case-control study was performed. We examined the messenger RNA (mRNA) and protein expressions of TLR4 and TLR2, mRNA levels of cryopyrin, IL-1beta, NF-kappaB subunits p50 and p65, as well as maternal serum inflammatory cytokine profiles (IL-2, IL-6, tumour necrosis factor-alpha [TNF-alpha], interferon-gamma [IFN-gamma] and IL-10) in women with and without pre-ecl sia using real-time reverse transcription polymerase chain reactions, flow cytometry and multiplex immunoassays. A single tertiary maternity hospital in Vancouver, Canada. Women with early-onset pre-ecl sia ( or=34(+0) weeks of gestation, n = 25), women with normotensive IUGR (n = 25), women with normal pregnancy (n = 75) and non-pregnancy (n = 25) controls. Women with pre-ecl sia (as a single combined group of early- and late-onset, and particularly in women with early-onset pre-ecl sia) had increased TLR2 and TLR4 mRNA and protein expressions elevated cryopyrin, NF-kappaB subunit, and IL-1beta mRNA expression, and TNF-alpha:IL-10 and IL-6:IL-10 ratios compared with other groups. These data suggest that TLRs and cryopyrin may modulate the innate immune response of the maternal syndrome of pre-ecl sia, and might also trigger the differential inflammatory response existing between early onset pre-ecl sia and normotensive IUGR.
Publisher: Springer Science and Business Media LLC
Date: 06-2016
Publisher: MDPI AG
Date: 28-07-2020
Abstract: Background: Due to different social and physical environments across Africa, understanding how these environments differ in interacting with placental disorders will play an important role in developing effective interventions. Methods: A scoping review was conducted, to identify current knowledge on interactions between the physical and social environment and the incidence of placental disease in Africa. Results: Heavy metals were said to be harmful when environmental concentrations are beyond critical limits. Education level, maternal age, attendance of antenatal care and parity were the most investigated social determinants. Conclusions: More evidence is needed to determine the relationships between the environment and placental function in Africa. The results show that understanding the nature of the relationship between social determinants of health (SDH) and placental health outcomes plays a pivotal role in understanding the risk in the heterogenous communities in Africa.
Publisher: Wiley
Date: 04-2019
Publisher: Elsevier BV
Date: 03-2022
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2005
Publisher: Public Library of Science (PLoS)
Date: 21-12-2016
Publisher: Elsevier BV
Date: 07-2021
Publisher: Informa UK Limited
Date: 2008
Publisher: Informa UK Limited
Date: 2009
DOI: 10.1080/10641950802601252
Abstract: To compare outcomes associated with expectant vs. interventionist care of severe preecl sia in observational studies. Medline (01/1980-07/2007), bibliographies of retrieved papers, personal files, Cochrane Database of Systematic Reviews. Expectant or interventionist care of preecl sia at <34 wk. TABULATION, INTEGRATION, RESULTS: Data abstraction independently by two reviewers. Median [IQR] of clinical maternal erinatal outcomes presented. 72 publications, primarily from tertiary care centres in Dutch and developed world sites. Expectant care of severe preecl sia <34 wk (39 cohorts, 4,650 women), for which 40% of women are eligible, is associated with pregnancy prolongation of 7-14 d, and few serious maternal complications (median <5%), similar to interventionist care (2 studies, 42 women). Complication rates are higher with HELLP <34wk (12 cohorts, 438 women) and severe preecl sia <28wk (6 cohorts, 305 women), similar to interventionist care (6 cohorts, 467 women and 2 cohorts, 70 women, respectively). Expectant care of HELLP <34 wk (12 cohorts, 438 women) is associated with fewer days gained (median 5), but more serious maternal morbidity (e.g., ecl sia, median 15%). More than half of women have at least temporary improvement of HELLP. In the developed world, expectant (vs. interventionist) care of severe preecl sia or HELLP <34 wk is associated with reduced neonatal death and complications. Stillbirth is higher in Dutch and developing world sites where viability thresholds are higher. For preecl sia 80%. No predictors of adverse maternal erinatal outcomes were identified (13 studies). Future research should establish the best maternal/fetal monito regimen and indications for delivery with expectant care. A definitive RCT is needed.
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.MCE.2012.12.018
Abstract: In pre-ecl sia, placental leptin is up-regulated and leptin is elevated in maternal plasma. To investigate potential epigenetic regulation of the leptin (LEP) gene in normal and complicated pregnancy, DNA methylation was assessed at multiple reported regulatory regions in placentae from control pregnancies (n=111), and those complicated by early onset pre-ecl sia (EOPET arising <34 weeks n=19), late onset pre-ecl sia (LOPET arising ≥34 weeks n=18) and normotensive intrauterine growth restriction (nIUGR n=13). The LEP promoter was hypomethylated in EOPET, but not LOPET or nIUGR placentae, particularly at CpG sites downstream of the transcription start site (-10.1% P<0.0001). Maternal plasma leptin was elevated in EOPET and LOPET (P<0.05), but not nIUGR, compared with controls. EOPET cases showed a trend towards biallelic LEP expression rather than skewed allelic expression observed in control placentae, suggesting that loss of normal monoallelic expression at the LEP locus is associated with hypomethylation, leading to increased overall LEP expression.
Publisher: IMR Press
Date: 2007
DOI: 10.2741/2279
Abstract: This review reflects both the variable presentation and the systemic nature of preecl sia. Recommendations for the comprehensive evaluation and management of organ dysfunction associated with pre-ecl sia are included. The main points in the review are that: (1) Preecl sia is a systemic disorder that may affect many organ systems. (2) For preecl sia remote from term ( 160 mmHg or dBP more than 110 mmHg, or if sBP 140-159 mmHg and/or dBP 85-109 mmHg (prepregnancy renal disease or diabetes). (5) The treatment of nonsevere pregnancy hypertension should include a treatment goal of dBP 80-105 mmHg (depending on practitioner preference), with one of the following agents, Methyldopa, Labetalol, Nifedipine, or, with special indications (renal or cardiac diseases), diuretics. (6) Drugs to avoid: angiotensin-converting enzyme inhibitors angiotensin II receptor antagonists and atenolol. (7) For the acute management of severe hypertension, initially reduce dBP by 10 mmHg and maintain the blood pressure at or below that level with either Nifedipine or Labetalol. (8) For both prophylaxis against and treatment of ecl sia, MgSO4 (4 g IV stat, then 1 g/hr). (9) For recurrent seizures, MgSO4 (2g IV stat, then increase to 1.5 g/hr). (10) Total fluid intake should not exceed 80 ml/hr tolerate urine outputs as low as 10 ml/hr. (11) Early-onset and/or severe preecl sia predict later cardiovascular morbidity and mortality it would seem prudent to offer such women screening and lipid lowering interventions.
Publisher: Wiley
Date: 08-08-2016
DOI: 10.1111/CAG.12295
Publisher: Wiley
Date: 11-03-2011
DOI: 10.1111/J.1471-0528.2010.02879.X
Abstract: Sildenafil citrate therapy for severe early-onset intrauterine growth restriction. BJOG 2011 :624-628. Currently, there is no effective therapy for severe early-onset intrauterine growth restriction (IUGR). Sildenafil citrate vasodilates the myometrial arteries isolated from women with IUGR-complicated pregnancies. Women were offered Sildenafil (25 mg three times daily until delivery) if their pregnancy was complicated by early-onset IUGR [abdominal circumference (AC)< 5th percentile] and either the gestational age was <25(+0) weeks or an estimate of the fetal weight was <600 g (excluding known fetal anomaly/syndrome and/or planned termination). Sildenafil treatment was associated with increased fetal AC growth [odds ratio, 12.9 95% confidence interval (CI), 1.3, 126 compared with institutional Sildenafil-naive early-onset IUGR controls]. Randomised controlled trial data are required to determine whether Sildenafil improves perinatal outcomes for early-onset IUGR-complicated pregnancies.
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/S1701-2163(15)30358-3
Abstract: To assess the incremental value of blood oxygen saturation (SpO(2)) as a predictor in the miniPIERS model, a risk prediction model for adverse outcomes among women with a diagnosis of hypertensive disorder of pregnancy (HDP) in low-resourced settings. Using data from a prospective cohort including 852 women admitted to hospital for a HDP, the association between SpO(2) and adverse maternal outcome was assessed using logistic regression. The miniPIERS model was recalibrated and extended to include SpO(2). The incremental value of adding SpO(2) to the model was measured using a net reclassification index (NRI), sensitivity, specificity, positive and negative predictive values, and likelihood ratios. SpO(2) of 97%. After recalibration and extension, the miniPIERS model including SpO(2) (vs. not including SpO(2)) had improved sensitivity (32.8% vs. 49.6%) at the cost of minimally decreased specificity (91.5% vs. 96.2%) with a NRI of 0.122. SpO(2) is a significant independent predictor of risk in women with a HDP. Adding SpO(2) to the miniPIERS model improved the model's ability to correctly identify high-risk patients who would benefit most from interventions.
Publisher: Elsevier BV
Date: 05-2014
Publisher: Springer Science and Business Media LLC
Date: 03-02-2020
DOI: 10.1186/S12942-020-0197-5
Abstract: Travel time to care is known to influence uptake of health services. Generally, pregnant women who take longer to transit to health facilities are the least likely to deliver in facilities. It is not clear if modelled access predicts fairly the vulnerability in women seeking maternal care across different spatial settings. This cross-sectional analysis aimed to (i) compare travel times to care as modelled in a GIS environment with self-reported travel times by women seeking maternal care in Community Level Interventions for Pre-ecl sia: Mozambique, India and Pakistan and (ii) investigate the assumption that women would seek care at the closest health facility. Women were interviewed to obtain estimated travel times to health facilities (R). Travel time to the closest facility was also modelled (P) (closest facility tool (ArcGIS)) and time to facility where care was sought estimated (A) (route network layer finder (ArcGIS)). Bland–Altman analysis compared spatial variation in differences between modelled and self-reported travel times. Variations between travel times to the nearest facility (P) with modelled travel times to the actual facilities accessed (A) were analysed. Log-transformed data comparison graphs for medians, with box plots superimposed distributions were used. Modelled geographical access (P) is generally lower than self-reported access (R), but there is a geography to this relationship. In India and Pakistan, potential access (P) compared fairly with self-reported travel times (R) [P (H 0 : Mean difference = 0)] .001, limits of agreement: [− 273.81 56.40] and [− 264.10 94.25] respectively. In Mozambique, mean differences between the two measures of access were significantly different from 0 [P (H 0 : Mean difference = 0) = 0.31, limits of agreement: [− 187.26 199.96]]. Modelling access successfully predict potential vulnerability in populations. Differences between modelled (P) and self-reported travel times (R) are partially a result of women not seeking care at their closest facilities. Modelling access should not be viewed through a geographically static lens. Modelling assumptions are likely modified by spatio-temporal and/or socio-cultural settings. Geographical stratification of access reveals disproportionate variations in differences emphasizing the varied nature of assumptions across spatial settings. Trial registration ClinicalTrials.gov, NCT01911494. Registered 30 July 2013, t2/show/NCT01911494
Publisher: Springer Science and Business Media LLC
Date: 12-2021
DOI: 10.1186/S13643-021-01849-5
Abstract: Early onset fetal growth restriction secondary to placental insufficiency can lead to severe maternal and neonatal morbidity and mortality. Pre-clinical studies and a few small randomised clinical trials have suggested that phosphodiesterase type 5 (PDE-5) inhibitors may have protective effects against placental insufficiency in this context however, robust evidence is lacking. The STRIDER Consortium conducted four randomised trials to investigate the use of a PDE-5 inhibitor, sildenafil, for the treatment of early onset fetal growth restriction. We present a protocol for the pre-planned systematic review with in idual participant data meta-analysis, aggregate meta-analysis, and trial sequential analysis of these and other eligible trials. The main objective of this study will be to evaluate the effects of PDE-5 inhibitors on neonatal morbidity compared with placebo or no intervention among pregnancies with fetal growth restriction. We will search the following electronic databases with no language or date restrictions: OVID MEDLINE, OVID EMBASE, the Cochrane Controlled Register of Trials (CENTRAL), and the clinical trial registers Clinicaltrials.gov and World Health Organisation International Clinical Trials Registry Platform (ICTRP). We will identify randomised trials of PDE-5 inhibitors in singleton pregnancies with growth restriction. Two reviewers will independently screen all citations, full-text articles, and abstract data. Our primary outcome will be infant survival without evidence of serious adverse neonatal outcome. Secondary outcomes will include gestational age at birth and birth weight z -scores. We will assess bias using the Cochrane Risk of Bias 2 tool. We will conduct aggregate meta-analysis using fixed and random effects models, Trial Sequential Analysis, and in idual participant data meta-analysis using one- and two-stage approaches. The certainty of evidence will be assessed with GRADE. This pre-defined protocol will minimise bias during analysis and interpretation of results, toward the goal of providing robust evidence regarding the use of PDE-5 inhibitors for the treatment of early onset fetal growth restriction. PROSPERO (CRD42017069688).
Publisher: Cambridge University Press
Date: 04-07-2013
Publisher: Cold Spring Harbor Laboratory
Date: 12-06-2023
DOI: 10.1101/2023.06.09.23291201
Abstract: SARS-CoV-2 transmission in Sub-Saharan Africa has probably been underestimated. Population-based seroprevalence studies are needed to determine the extent of transmission in the continent. Blood s les from a cohort of Gambian pregnant women were tested for SARS-CoV-2 total IgM/IgG before ( Pre-pandemic1: October-December 2019 and Pre-pandemic2: February-June 2020) and during the pandemic ( Post-wave1 : October-December 2020, Post-wave2: May-June 2021 and Post-wave3 : October-December 2021). S les positive for total SARS-CoV-2 IgM/IgG were tested for protein-specific antibodies. SARS-CoV-2 total IgM/IgG seroprevalence was 0.9% 95%CI (0.2, 4.9) in Pre-pandemic1 4.1% (1.4, 11.4) in Pre-pandemic2 31.1% (25.2, 37.7) in Post-wave1 62.5% (55.8, 68.8) in Post-wave2 and 90.0% (85.1, 93.5) in Post-wave3. S-protein IgG and NCP-protein IgG seroprevalence also increased at each Post-wave period. Although S-protein IgG and NCP-protein IgG seroprevalence was similar at Post-wave1 , S-protein IgG seroprevalence was higher at Post-wave2 and Post-wave3 , [prevalence difference (PD) 13.5 (0.1, 26.8) and prevalence ratio (PR) 1.5 (1.0, 2.3) in Post-wave2 and 22.9 (9.2, 36.6) and 1.4 (1.1, 1.8) in Post-wave3 respectively, p .001]. SARS-CoV-2 transmission in The Gambia during the first three COVID-19 waves was high, differing significantly from official numbers of COVID-19 cases reported. Our findings are important for policy makers in managing the near-endemic COVID-19. High specificity of the IgM/IgG SARS-CoV-2 test using s les collected prepandemic Very high ( %) SARS-CoV-2 seroprevalence after third COVID-19 wave in The Gambia High SARS-CoV-2 transmission contrasts with low number of COVID-19 reported cases
Publisher: Informa Healthcare
Date: 18-02-2015
DOI: 10.1517/14740338.2015.998197
Abstract: Labetalol is one of the most commonly used antihypertensive medications for the treatment of hypertension during pregnancy, an increasingly common and leading cause of maternal mortality and morbidity worldwide. The literature reviewed included the 2014 Canadian national pregnancy hypertension guideline and its references. The additional published literature was retrieved through searches of Medline, CINAHL, and The Cochrane Library using appropriate controlled vocabulary (e.g., pregnancy, hypertension, pre-ecl sia, pregnancy toxemias) and key words (e.g., diagnosis, evaluation, classification, prediction, prevention, prognosis, treatment, and postpartum follow-up).Results were restricted to systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies published in French or English, Jan-Mar/14. The unpublished literature was identified by searching websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. We evaluated the impact of interventions on substantive clinical outcomes for mothers and babies. Labetalol is a reasonable choice for treatment of severe or non-severe hypertension in pregnancy. However, we should continue our search for other therapeutic options.
Publisher: Wiley
Date: 2023
DOI: 10.1002/UOG.26084
Abstract: To examine the relationship between the English index of multiple deprivation (IMD) and the incidence of pre‐ecl sia (PE), evaluate the distribution of IMD in a cohort of ethnically erse pregnant women in South East England and assess whether IMD improves the prediction of PE compared with that provided by the ‘history‐only’ competing‐risks model (based on maternal characteristics and medical history). This was a prospective, observational study of 159 125 women with a singleton pregnancy who attended their first routine hospital visit at 11 + 0 to 13 + 6 weeks' gestation in two maternity hospitals in the UK. The inclusion criteria were delivery at ≥ 24 weeks' gestation of babies without major abnormality. Participants completed a questionnaire on demographic characteristics and obstetric and medical history, which was then reviewed by a doctor together with the woman. Patients were asked to self‐identify as white, black, South Asian, East Asian or mixed race. IMD was used as a measure of socioeconomic status, which takes into account income, employment, education, skills and training, health and disability, crime, barriers to housing and services, and living environment. Each neighborhood is ranked according to their level of deprivation relative to that of other areas into one of five equal groups, with Quintile 1 containing the 20% most deprived areas and Quintile 5 containing the 20% least deprived areas. IMD was assigned based on a woman's postcode. Risk factors for PE and its incidence were assessed across IMD using chi‐square test or t ‐test, as appropriate. The relationship between IMD and gestational age at delivery with PE was evaluated by fitting parametric survival models for IMD alone, IMD combined with race and IMD combined with the Fetal Medicine Foundation history‐only competing‐risks model. The incidence of PE ( n = 4088, 2.6%) increased progressively across IMD quintiles, from 2.0% in Quintile 5 (least deprived) to 3.0% in Quintile 1 (most deprived). Compared with white women and those in other racial groups, black women had a higher incidence of PE (4.8%), were less often in IMD Quintiles 4 and 5, and were more often in IMD Quintiles 1 and 2. None of the IMD quintiles improved the prediction of PE compared with that provided by the history‐only competing‐risks model (which includes race). The history‐only competing‐risks model with vs without IMD had a similar detection rate for delivery with PE at 37 weeks' gestation (44.1% (95% CI, 41.1–47.2%) vs 43.9% (95% CI, 40.1–47.0%)) and at any gestational age (35.2% (95% CI, 33.8–36.7%) vs 35.1% (95% CI, 33.7–36.6%)), at a 10% screen‐positive rate. The incidence of PE is higher in women living in the most deprived areas in South East England and in black women ( vs those of other racial groups), who also live in areas of higher deprivation. However, in screening for PE, inclusion of IMD does not improve the prediction of PE provided by race and other maternal characteristics and elements of medical history. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2015
Publisher: Wiley
Date: 31-01-2013
Publisher: Wiley
Date: 13-10-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2015
Publisher: Elsevier BV
Date: 12-2021
Publisher: Wiley
Date: 21-08-2017
Abstract: Variation in outcome collection and reporting is a serious hindrance to progress in our specialty therefore, over 80 journals have come together to support the development, dissemination, and implementation of core outcome sets. This study systematically reviewed and characterised registered, progressing, or completed core outcome sets relevant to women's and newborn health. Systematic search using the Core Outcome Measures in Effectiveness Trial initiative and the Core Outcomes in Women's and Newborn Health initiative databases. Registry entries, protocols, systematic reviews, and core outcome sets. Descriptive statistics to describe characteristics and results. There were 49 core outcome sets registered in maternal and newborn health, with the majority registered in 2015 (n = 22 48%) or 2016 (n = 16 32%). Benign gynaecology (n = 8 16%) and newborn health (n = 3 6%) are currently under-represented. Twenty-four (52%) core outcome sets were funded by international (n = 1 <1%), national (n = 18 38%), and regional (n = 4 8%) bodies. Seven protocols were published. Twenty systematic reviews have characterised the inconsistency in outcome reporting across a broad range of relevant healthcare conditions. Four core outcome sets were completed: reconstructive breast surgery (11 outcomes), preterm birth (13 outcomes), epilepsy in pregnancy (29 outcomes), and maternity care (48 outcomes). The quantitative, qualitative, and consensus methods used to develop core outcome sets varied considerably. Core outcome sets are currently being developed across women's and newborn health, although coverage of topics is variable. Development of further infrastructure to develop, disseminate, and implement core outcome sets is urgently required. Forty-nine women's and newborn core outcome sets registered. 50% funded. 7 protocols, 20 systematic reviews, and 4 core outcome sets published. @coreoutcomes @jamesmnduffy.
Publisher: Elsevier BV
Date: 10-2014
Publisher: Elsevier BV
Date: 2003
DOI: 10.1016/S0959-289X(02)00161-9
Abstract: We present our experience in the anesthetic management of two parturients with pseudoxanthoma elasticum. The first had an epidural catheter inserted for labor analgesia and ultimately had a forceps delivery. The second had a cesarean section under epidural anesthesia and had a complicated postoperative course. There were no untoward effects of regional anesthesia in either of these two women. The anesthetic implications for parturients with pseudoxanthoma elasticum are discussed.
Publisher: Wiley
Date: 2007
DOI: 10.1002/PD.1736
Abstract: Assessing the number of fetal cells in the maternal circulation quantifies the volume of feto-maternal hemorrhage, enhancing the ability to provide effective prevention of Rhesus (Rh) allommunization and appropriate fetal surveillance in cases of significant feto-maternal hemorrhage. Having developed a standard curve with maternal s les spiked with known volumes of fetal red blood cells, we used a flow cytometric method using fluorescent labeled antihemoglobin F to quantitate fetal cells in the maternal circulatory system in two groups of women undergoing chorionic villus s ling (CVS), by either biopsy forceps or cannula aspiration (n = 170 women). We compared these results with the gold standard, the Betke-Kleihauer test. Our results show good correlation between the flow cytometric method and the traditional Betke-Kleihauer method for fetal red cell quantitation (r(2) = 0.99). Fetal red blood cells were identified in 10 women by the Betke-Kleihauer method, and in 26 women by flow cytometry. CVS was not associated with an increase in feto-maternal hemorrhage. Flow cytometry was both more sensitive and more timely for the quantitation of feto-maternal hemorrhage than was Betke-Kleihauer.
Publisher: Public Library of Science (PLoS)
Date: 16-06-2022
DOI: 10.1371/JOURNAL.PONE.0270150
Abstract: We urgently need answers to basic epidemiological questions regarding SARS-CoV-2 infection in pregnant and postpartum women and its effect on their newborns. While many national registries, health facilities, and research groups are collecting relevant data, we need a collaborative and methodologically rigorous approach to better combine these data and address knowledge gaps, especially those related to rare outcomes. We propose that using a sequential, prospective meta-analysis (PMA) is the best approach to generate data for policy- and practice-oriented guidelines. As the pandemic evolves, additional studies identified retrospectively by the steering committee or through living systematic reviews will be invited to participate in this PMA. Investigators can contribute to the PMA by either submitting in idual patient data or running standardized code to generate aggregate data estimates. For the primary analysis, we will pool data using two-stage meta-analysis methods. The meta-analyses will be updated as additional data accrue in each contributing study and as additional studies meet study-specific time or data accrual thresholds for sharing. At the time of publication, investigators of 25 studies, including more than 76,000 pregnancies, in 41 countries had agreed to share data for this analysis. Among the included studies, 12 have a contemporaneous comparison group of pregnancies without COVID-19, and four studies include a comparison group of non-pregnant women of reproductive age with COVID-19. Protocols and updates will be maintained publicly. Results will be shared with key stakeholders, including the World Health Organization (WHO) Maternal, Newborn, Child, and Adolescent Health (MNCAH) Research Working Group. Data contributors will share results with local stakeholders. Scientific publications will be published in open-access journals on an ongoing basis.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.PREGHY.2017.11.006
Abstract: The hypertensive disorders of pregnancy are a leading cause of maternal and perinatal mortality and morbidity. The ability to predict these complications using simple tests could aid in management and improve outcomes. We aimed to systematically review studies that reported on potential predictors of adverse maternal outcomes among women with a hypertensive disorder of pregnancy. We searched MEDLINE, Embase and CINAHL (inception - December 2016) for studies of predictors of severe maternal complications among women with a hypertensive disorder of pregnancy. Studies were selected in a two-stage process by two independent reviewers, excluding those reporting only on adverse fetal outcomes. We extracted data on study and test(s) characteristics and outcomes. Accuracy of prediction was assessed using sensitivity, specificity, likelihood ratios and area under the receiver operating curve (AUROC). Strong evidence of prediction was taken to be a positive likelihood ratio >10 or a negative likelihood ratio <0.1, and for multivariable models, an AUROC ≥0.70. Bivariate random effects models were used to summarise performance when possible. Of 32 studies included, 28 presented only model development and four examined external validation. Tests included symptoms and signs, laboratory tests and biomarkers. No single test was a strong independent predictor of outcome. The most promising prediction was with multivariable models, especially when oxygen saturation, or chest pain/dyspnea were included. Future studies should investigate combinations of tests in multivariable models (rather than single predictors) to improve identification of women at high risk of adverse outcomes in the setting of the hypertensive disorders of pregnancy.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2019
Publisher: Elsevier BV
Date: 07-2013
DOI: 10.1016/J.PREGHY.2013.03.001
Abstract: Pre-ecl sia is associated with increased risk to both the mother and fetus. Effective monitoring of the fetal condition is essential to the management of women with pre-ecl sia. The biophysical profile (BPP) is one monitoring tool available to clinicians. To compare the BPP test with cardiotocography/non-stress test (CTG/NST) alone for their ability to predict fetal acidemia at birth or a composite adverse perinatal outcome among women with preecl sia and to estimate the effect of BPP assessment on mode of delivery and birth outcome. Secondary analysis of a prospective cohort of women with preecl sia. The predictive ability of the tests was assessed based on sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-). Women assessed with the BPP were compared with matched controls not assessed with the BPP to determine the odds of Cesarean delivery or adverse perinatal outcomes after adjustment for potential confounders. Five out of 89 women (5.6%) had an abnormal BPP 18 out of 89 (20.2%) had an abnormal CTG/NST. Fetal acidemia was diagnosed in 13 fetuses (14.6%) composite adverse perinatal outcome in 68 fetuses/infants (76.4%). Both tests had relatively poor predictive performance for both outcomes (LR+ between 2.50 and 3.90 and LR- between 0.64 and 0.93). Assessment with the BPP was positively associated with fetal acidemia (adjusted OR 4.84 95% CI 1.33-17.66). The BPP and CTG/NST alone were poor predictors of perinatal outcome in this cohort multiple tests should be considered when assessing fetal risk in women with preecl sia.
Publisher: Springer Science and Business Media LLC
Date: 27-02-2023
DOI: 10.1038/S41562-023-01522-Y
Abstract: Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from −90% to +30%, were reported in many countries following early COVID-19 pandemic response measures (‘lockdowns’). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95–0.98, P value .0001), second (0.96, 0.92–0.99, 0.03) and third (0.97, 0.94–1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96–1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88–1.14, 0.98), third (0.99, 0.88–1.12, 0.89) and fourth (1.01, 0.87–1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02–1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03–1.15, 0.002), third (1.10, 1.03–1.17, 0.003) and fourth (1.12, 1.05–1.19, .001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.
Publisher: Elsevier BV
Date: 08-2021
Publisher: BMJ
Date: 2023
DOI: 10.1136/BMJGH-2022-009495
Abstract: Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies. We screened ongoing studies in our sequential, prospective meta-analysis. We pooled in idual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale. We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women. Pregnant women with SARS-CoV-2 infection—as compared with uninfected pregnant women—were at significantly increased risk of maternal mortality (10 studies n=1490 RR 7.68, 95% CI 1.70 to 34.61) admission to intensive care unit (8 studies n=6660 RR 3.81, 95% CI 2.03 to 7.17) receiving mechanical ventilation (7 studies n=4887 RR 15.23, 95% CI 4.32 to 53.71) receiving any critical care (7 studies n=4735 RR 5.48, 95% CI 2.57 to 11.72) and being diagnosed with pneumonia (6 studies n=4573 RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies n=5146 RR 5.50, 95% CI 1.12 to 27.12). Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies n=7637 RR 1.86, 95% CI 1.12 to 3.08) be born preterm (7 studies n=6233 RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies n=6071 RR 2.92, 95% CI 1.88 to 4.54) and to be born low birth weight (12 studies n=11 930 RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias. This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.
Publisher: Springer Science and Business Media LLC
Date: 06-2018
Publisher: BMJ
Date: 09-2000
DOI: 10.1136/EBM.5.5.141
Publisher: IGI Global
Date: 2009
DOI: 10.4018/978-1-60566-078-3.CH008
Abstract: Our ultimate goal as obstetric and neonatal care providers is to optimize care for mothers and their babies. As such, we need to identify practices that are associated with good outcomes. Although the randomized controlled trial is the gold standard for establishing the benefits of interventions, trials are very expensive and must be reserved for the most important of clinical questions. As an alternative, continuous quality improvement involves iterative cycles of practice change and audit of ongoing clinical care. An obvious prerequisite to this is ongoing data collection about interventions and outcomes, as well as demographics, pregnancy characteristics, and neonatal care that may affect the intervention- outcome relationship. In Canada (as in some other developed countries), much of the country is covered by regional reproductive care databases. These collect information on maternal demographics, pregnancy characteristics, labour and delivery, and basic information on maternal and perinatal outcomes. The primary objective of these databases is to monitor geographical trends and disparities in health outcomes. As such, there is little information about interventions, especially outside the period of labour and delivery. Also, there is no standardization of definitions, and efforts to produce a “minimal dataset” have not yet yielded agreement, even after many years of work. A more comprehensive system is required. Moving in this direction would serve many purposes: efficiency, economy in the setting of shrinking budgets, standardization of definitions, collaboration, and creation of stable background data collection onto which researchers could “clip” extra data required for specific studies. These activities would lay the foundation for the electronic health record, which cannot build its foundation on the “Tower of Babel” that is our current definitional structure in women’s health and obstetrics, in particular. Continuous quality improvement efforts and interaction with regional reproductive care programmes will facilitate translation and transfer of knowledge to care-givers and patients. These efforts raise concerns about privacy and security which remain major barriers to the EHR. However, security must be balanced with the need for health information.
Publisher: Informa UK Limited
Date: 2003
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2007
Publisher: Wiley
Date: 07-02-2021
Publisher: Springer Science and Business Media LLC
Date: 19-08-2019
Publisher: Wiley
Date: 07-2002
Publisher: Informa UK Limited
Date: 06-2020
Publisher: Elsevier BV
Date: 10-2004
DOI: 10.1016/S1701-2163(16)30137-2
Abstract: (1) To evaluate whether clinical variables reflecting the multiorgan dysfunctions of preecl sia can predict adverse maternal outcomes of preecl sia (2) to determine the usefulness of the mean platelet volume (MPV):platelet ratio as a novel measure of platelet consumption in predicting the severity of preecl sia. A retrospective chart review was conducted of cases of preecl sia seen in 3 tertiary level units from January 2001 to December 2001. Candidate predictors of adverse maternal outcome were gestational age (GA) on admission to hospital, blood pressure, proteinuria, urine output, uric acid, creatinine, aspartate transaminase (AST), lactate dehydrogenase, bilirubin, albumin, fraction of inspired oxygen:oxygen saturation (FIO2:SaO2) ratio, platelet count, MPV, MPV:platelet ratio, fibrinogen, and seizures. The combined adverse maternal outcomes included maternal death 1 or more of hepatic failure, hematoma, or rupture Glasgow coma scale or =50% FIO2 for >1 hour intubation or transfusion of > or =10 units of blood products. Descriptive, univariable, and multivariable analyses were performed, with significance set at P 10 units. In women who developed an adverse outcome, GA and fibrinogen were lower, and total leukocyte count, creatinine, and AST were greater. Multivariable logistic regression revealed that admission GA (odds ratio [OR], 0.91), dipstick protein (OR, 1.31), and MPV:platelet ratio (OR, 391.0) independently predicted the outcome. Several promising markers were identified: admission GA, dipstick proteinuria, and the MPV:platelet ratio. MPV:platelet ratio also showed promise as a marker of platelet consumption. A prospective study is required to develop a clinical prediction model for preecl sia.
Publisher: Wiley
Date: 13-08-2004
Publisher: Wiley
Date: 19-07-2023
Abstract: To compare the causes of death for women who died during pregnancy and within the first 42 days postpartum with those of women who died between days and within 1 year postpartum. Open population cohort (Health and Demographic Surveillance Systems). Ten Health and Demographic Surveillance Systems (HDSS) in The Gambia, Kenya, Malawi, Tanzania, Ethiopia and South Africa. 2114 deaths which occurred within 1 year of the end of pregnancy where a verbal autopsy interview was conducted from 2000 to 2019. InterVA5 and InSilicoVA verbal autopsy algorithms were used to attribute the most likely underlying cause of death, which were grouped according to adapted International Classification of Diseases‐Maternal Mortality categories. Multinomial regression was used to compare differences in causes of deaths within 42 days versus 43–365 days postpartum adjusting for HDSS and time period (2000–2009 and 2010–2019). Cause of death and the verbal autopsy Circumstances of Mortality Categories (COMCATs). Of 2114 deaths, 1212 deaths occurred within 42 days postpartum and 902 between 43 and 365 days postpartum. Compared with deaths within 42 days, deaths from HIV and TB, other infectious diseases, and non‐communicable diseases constituted a significantly larger proportion of late pregnancy‐related deaths beyond 42 days postpartum, and health system failures were important in the circumstances of those deaths. The contribution of HIV and TB to deaths beyond 42 days postpartum was greatest in Southern Africa. The causes of pregnancy‐related mortality within and beyond 42 days postpartum did not change significantly between 2000–2009 and 2010–2019. Cause of death data from the extended postpartum period are critical to inform prevention. The dominance of HIV and TB, other infectious and non‐communicable diseases to (late) pregnancy‐related mortality highlights the need for better integration of non‐obstetric care with ante‐, intra‐ and postpartum care in high‐burden settings.
Publisher: National Institute for Health and Care Research
Date: 12-2020
DOI: 10.3310/HTA24720
Abstract: Pre-ecl sia is a leading cause of maternal and perinatal mortality and morbidity. Early identification of women at risk is needed to plan management. To assess the performance of existing pre-ecl sia prediction models and to develop and validate models for pre-ecl sia using in idual participant data meta-analysis. We also estimated the prognostic value of in idual markers. This was an in idual participant data meta-analysis of cohort studies. Source data from secondary and tertiary care. We identified predictors from systematic reviews, and prioritised for importance in an international survey. Early-onset (delivery at 34 weeks’ gestation), late-onset (delivery at ≥ 34 weeks’ gestation) and any-onset pre-ecl sia. We externally validated existing prediction models in UK cohorts and reported their performance in terms of discrimination and calibration. We developed and validated 12 new models based on clinical characteristics, clinical characteristics and biochemical markers, and clinical characteristics and ultrasound markers in the first and second trimesters. We summarised the data set-specific performance of each model using a random-effects meta-analysis. Discrimination was considered promising for C -statistics of ≥ 0.7, and calibration was considered good if the slope was near 1 and calibration-in-the-large was near 0. Heterogeneity was quantified using I 2 and τ 2 . A decision curve analysis was undertaken to determine the clinical utility (net benefit) of the models. We reported the unadjusted prognostic value of in idual predictors for pre-ecl sia as odds ratios with 95% confidence and prediction intervals. The International Prediction of Pregnancy Complications network comprised 78 studies (3,570,993 singleton pregnancies) identified from systematic reviews of tests to predict pre-ecl sia. Twenty-four of the 131 published prediction models could be validated in 11 UK cohorts. Summary C -statistics were between 0.6 and 0.7 for most models, and calibration was generally poor owing to large between-study heterogeneity, suggesting model overfitting. The clinical utility of the models varied between showing net harm to showing minimal or no net benefit. The average discrimination for IPPIC models ranged between 0.68 and 0.83. This was highest for the second-trimester clinical characteristics and biochemical markers model to predict early-onset pre-ecl sia, and lowest for the first-trimester clinical characteristics models to predict any pre-ecl sia. Calibration performance was heterogeneous across studies. Net benefit was observed for International Prediction of Pregnancy Complications first and second-trimester clinical characteristics and clinical characteristics and biochemical markers models predicting any pre-ecl sia, when validated in singleton nulliparous women managed in the UK NHS. History of hypertension, parity, smoking, mode of conception, placental growth factor and uterine artery pulsatility index had the strongest unadjusted associations with pre-ecl sia. Variations in study population characteristics, type of predictors reported, too few events in some validation cohorts and the type of measurements contributed to heterogeneity in performance of the International Prediction of Pregnancy Complications models. Some published models were not validated because model predictors were unavailable in the in idual participant data. For models that could be validated, predictive performance was generally poor across data sets. Although the International Prediction of Pregnancy Complications models show good predictive performance on average, and in the singleton nulliparous population, heterogeneity in calibration performance is likely across settings. Recalibration of model parameters within populations may improve calibration performance. Additional strong predictors need to be identified to improve model performance and consistency. Validation, including examination of calibration heterogeneity, is required for the models we could not validate. This study is registered as PROSPERO CRD42015029349. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment Vol. 24, No. 72. See the NIHR Journals Library website for further project information.
Publisher: Wiley
Date: 24-02-2014
DOI: 10.1111/AJI.12199
Publisher: Springer Science and Business Media LLC
Date: 13-05-2022
DOI: 10.1186/S12884-022-04714-Y
Abstract: Iron-deficiency anemia is a known risk factor for several adverse perinatal outcomes, but data on its impact on specific maternal morbidities is less robust. Further, information on associations between anemia in early pregnancy and subsequent outcomes are understudied. The study population was derived from the Community Level Interventions for Pre-ecl sia (CLIP) trial in Karnataka State, India (NCT01911494). Included were women who were enrolled in either trial arm, delivered by trial end date, and had a baseline measure of hemoglobin (Hb). Anemia was classified by WHO standards into four groups: none (Hb ≥ 11 g/dL), mild (10.0 g/dL ≤ Hb 11.0 g/dL), moderate (7.0 g/dL ≤ Hb 10.0 g/dL) and severe (Hb 7.0 g/dL). Targeted maximum likelihood estimation was used to estimate confounder-adjusted associations between anemia and a composite (and its components) of adverse maternal outcomes, including pregnancy hypertension. E-values were calculated to assess robustness to unmeasured confounding. Of 11,370 women included, 10,066 (88.5%) had anemia, that was mild (3690, 32.5%), moderate (6023, 53.0%), or severe (68, 0.6%). Almost all women ( 99%) reported taking iron supplements during pregnancy. Blood transfusions was more often administered to those with anemia that was mild (risk ratio [RR] 2.16, 95% confidence interval [CI] 1.31–3.56), moderate (RR 2.37, 95% CI 1.56–3.59), and severe (RR 5.70, 95% CI 3.00–10.85). No significant association was evident between anemia severity and haemorrhage (antepartum or postpartum) or sepsis, but there was a U-shaped association between anemia severity and pregnancy hypertension and pre-ecl sia specifically, with the lowest risk seen among those with mild or moderate anemia. In Karnataka State, India, current management strategies for mild-moderate anemia in early pregnancy are associated with similar rates of adverse maternal or perinatal outcomes, and a lower risk of pregnancy hypertension and preecl sia, compared with no anemia in early pregnancy. Future research should focus on risk mitigation for women with severe anemia, and the potential effect of iron supplementation for women with normal Hb in early pregnancy.
Publisher: Massachusetts Medical Society
Date: 11-06-2015
DOI: 10.1056/NEJMC1503870
Publisher: Wiley
Date: 07-04-2016
DOI: 10.1111/AOGS.12877
Publisher: Elsevier BV
Date: 06-2008
Publisher: BMJ
Date: 11-2007
Publisher: Elsevier BV
Date: 11-2014
Publisher: Elsevier BV
Date: 10-2012
Publisher: JMIR Publications Inc.
Date: 27-12-2022
DOI: 10.2196/34823
Abstract: Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference. The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting. A descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (N=52) and 18 in-depth interviews. Overall, TraCer was found to be highly acceptable to women, their families, and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers, as well as save time and cost by reducing unnecessary referrals. TraCer was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy toward the new technology, indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of health care professionals to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common, with a tendency to overestimate the diagnostic capability, and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily the GA. This study shows a positive attitude toward TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse. Further research on clinical validation and related usability and safety evaluations are recommended.
Publisher: No publisher found
Date: 2015
Publisher: Wiley
Date: 25-02-2021
Abstract: To examine the association between pre‐ecl sia definition and pregnancy outcome. Secondary analysis of Control of Hypertension in Pregnancy Study (CHIPS) trial data. International multicentre randomised controlled trial (RCT). In all, 987 women with non‐severe non‐proteinuric pregnancy hypertension. We evaluated the association between pre‐ecl sia definitions and adverse pregnancy outcomes, stratified by hypertension type and blood pressure control. Main CHIPS trial outcomes: primary (perinatal loss or high‐level neonatal care for hours), secondary (serious maternal complications), birthweight th centile, severe maternal hypertension, delivery at or weeks, and maternal hospitalisation before birth. Of 979/987 women with informative data, 280 (28.6%) progressed to pre‐ecl sia defined restrictively by new proteinuria, and 471 (48.1%) to pre‐ecl sia defined broadly as proteinuria or one/more maternal symptoms, signs or abnormal laboratory tests. The broad (versus restrictive) definition had significantly higher sensitivities (range 62–79% versus 36–50%), lower specificities (range 53–65% versus 72–82%), and similar or higher diagnostic odds ratios and ‘true‐positive’ to ‘false‐positive’ ratios. Stratified analyses showed similar results. Addition of available fetoplacental manifestations (stillbirth or birthweight th centile) to the broad pre‐ecl sia definition improved sensitivity (74–87%). A broad (versus restrictive) pre‐ecl sia definition better identifies women who develop adverse pregnancy outcomes. These findings should be replicated in a prospective study within routine healthcare to ensure that the anticipated increase in surveillance and intervention in a larger number of women with pre‐ecl sia is associated with improved outcomes, reasonable costs and congruence with women's values. A broad (versus restrictive) pre‐ecl sia definition better identifies the risk of adverse pregnancy outcomes.
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.PLACENTA.2009.07.001
Abstract: Preecl sia is characterized by a systemic inflammatory response involving cytokines, chemokines, and anti-angiogenic factors such as sFLT-1. In many other inflammatory diseases related responses are triggered by toll-like receptor (TLR) stimulation. Therefore, we tested the hypothesis that TLR stimulation of a trophoblast cell line induces inflammatory mediator production and, in particular, production of the preecl sia-related anti-angiogenic factor sFLT-1. We stimulated human first trimester extravillous trophoblast cells (HTR-8/SV neo cell line) with a variety of TLR ligands and measured downstream NF-kappaB and IRF signaling, inflammatory mediator (RANTES), and sFLT-1 mRNA expression and protein production. Of all TLR ligands, we found that TLR3 ligation with polyI:C resulted in the biggest response with 5.6-fold increased signaling via NF-kappaB and 5.8-fold increased signaling via IRF. RANTES mRNA expression increased 2900 fold and protein production increased 1600 fold in response to TLR3 ligation. sFLT-1 mRNA expression increased 1.7-fold and protein production increased 3.1-fold in response to TLR3 ligation. Inhibitors of the NF-kappaB and IRF signaling pathway decreased TLR3 ligation-induced sFLT-1 protein production by 31.8% and 24.9%, respectively. We conclude that trophoblast cells respond to TLR3 ligation by signaling through both NF-kappaB and IRF pathways resulting in expression of inflammatory mediators and, in particular, the preecl sia-related anti-angiogenic factor sFLT-1.
Publisher: Springer Science and Business Media LLC
Date: 06-2018
Publisher: Wiley
Date: 05-2019
DOI: 10.1002/IJGO.12802
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/S1701-2163(16)32643-3
Abstract: To implement a set of clinical indicators to benchmark outcomes for women suffering from the hypertensive disorders of pregnancy. Seven clinical indicators were designed and applied retrospectively to data collected from two tertiary referral centres, Royal Prince Alfred Hospital, Sydney, Australia and British Columbia Women's Hospital and Health Centre, Vancouver BC, for all women coded as hypertensive during pregnancy under the International Classification of Disease (ICD-10) coding system in the years 2002-2004. Diagnostic categories were assigned using the Australasian Society for the Study of Hypertension in Pregnancy criteria, expressed in equivalent Canadian terms drawn from the Report of the Canadian Hypertension Society Consensus. Comparisons were made using the established clinical indicators. Data analysis using chi-square comparison was performed with significance set at P < 0.05. Seven outcome measures of maternal and neonatal mortality and morbidity were compared. Significant areas of difference between the two tertiary referral centres were seen in birth weights below the 10th centile (RPA 11% vs. BCW 20% P < 0.05) and below the 3rd centile (RPA 1.5% vs. BCW 7.5% P < 0.001). There were significantly more episodes of maternal pulmonary edema at BCW than at RPA (0.1% and 1.2%, respectively P < 0.001). Between similar centres, clinically significant differences in outcomes for HDP were identified. Further evaluation of differences may lead to analysis of possible contributors such as expectant versus urgent delivery management policies, rigidity of blood pressure control, and choice of antihypertensive drug.
Publisher: Cambridge University Press (CUP)
Date: 2017
DOI: 10.1017/S0266462317000320
Abstract: Background: Understanding cost-drivers and estimating societal costs are important challenges for economic evaluation of health technologies in low- and middle-income countries (LMICs). This study assessed community experiences of health resource usage and perceived cost-drivers from a societal perspective to inform the design of an economic model for the Community Level Interventions for Pre-ecl sia (CLIP) trials. Methods: Qualitative research was undertaken alongside the CLIP trial in two districts of Sindh province, Pakistan. Nine focus groups were conducted with a wide range of stakeholders, including pregnant women, mothers-in-law, husbands, fathers-in-law, healthcare providers at community and health facility-levels, and health decision olicy makers at district-level. The societal perspective included out-of-pocket (OOP), health system, and program implementation costs related to CLIP. Thematic analysis was performed using NVivo software. Results: Most pregnant women and male decision makers reported a large burden of OOP costs for in- and out-patient care, informal care from traditional healers, self-medication, childbirth, newborn care, transport to health facility, and missed wages by caretakers. Many healthcare providers identified health system costs associated with human resources for hypertension risk assessment, transport, and communication about patient referrals. Health decision olicy makers recognized program implementation costs (such as the mobile health infrastructure, staff training, and monitoring/supervision) as major investments for the health system. Conclusions: Our investigation of care-seeking practices revealed financial implications for families of pregnant women, and program implementation costs for the health system. The societal perspective provided comprehensive knowledge of cost drivers to guide an economic appraisal of the CLIP trial in Sindh, Pakistan.
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.EJOGRB.2014.06.003
Abstract: This paper investigates the quality of outcomes reported in systematic reviews and randomised controlled trials (RCTs) of bladder pain syndrome and its relationship with study quality and journal impact factor. We searched until August 2013 the Cochrane Library, EMBASE, Medline, CINAHL, LILACS and SIGLE, without language restrictions. Quality of outcome reporting in systematic reviews and constituent RCTs was assessed using a 6-point scale. Overall study quality was assessed using the AMSTAR and Jadad scoring systems, and impact factor in the year of publication was noted. Spearman's rank correlation was calculated. There were 8 systematic reviews, with a total of 28 RCTs (1732 patients), reporting 5 outcomes using 19 different measurement scales. The outcomes reported in in idual RCTs were urinary symptoms (100%), pain (64%), quality of life (39%), general wellbeing (36%) and bladder capacity (36%). The mean quality of outcomes reported was 1.63 (95% CI 0.29-2.96) for systematic reviews and 3.25 (95% CI 2.80-3.70) for RCTs. The quality of outcomes reported showed correlation with overall study quality (0.90, 95% CI 0.79-0.95, p<0.0001) but not with journal impact factor (0.07, 95% CI -0.31-0.43, p=0.35). Multivariable linear regression showed a relationship between quality of outcome reporting and study quality (β=0.05, p<0.0001), adjusting for effects of study type, impact factor and journal type. There is a need to generate consensus over a set of core outcomes in bladder pain syndrome using standardised reporting tools and to disseminate these through good publication practice.
Publisher: Springer Science and Business Media LLC
Date: 17-07-2013
Abstract: For clinicians, it is important to rely on accurate laboratory results for patient care and optimal use of health care resources. We sought to explore our observations that urine protein:creatinine ratios (PrCr) ≥30 mg/mmol are seen not infrequently associated with normal pregnancy outcome. Urine s les were collected prospectively from 160 pregnant women attending high-risk maternity clinics at a tertiary care facility. Urinary protein was measured using a pyrocatechol violet assay and urinary creatinine by an enzymatic method on Vitros analysers. Maternal erinatal outcomes were abstracted from hospital records. 91/233 (39.1%) s les had a PrCr ≥30 mg/mmol, especially when urinary creatinine concentration was mM (94.1%) vs. ≥3 mM (16.4%) (p 0.001). When using the last s le before delivery, 47/160 (29.4%) had a PrCr ≥30 mg/mmol in diluted urine vs. only 17/160 (15.4%) in more concentrated urine (p 0.001) PrCr positive results were also more frequent among the 32 (20.0%) women with known normal pregnancy outcome (90.9% vs. 0) (p 0.001). Using the same analyser, 0.12 g/L urinary protein was ‘detected’ in deionised water. Re-analysis of data from two cohorts revealed substantially less inflation of PrCr in dilute urine using a pyrogallol red assay. Random urinary PrCr was overestimated in dilute urine when tested using a common pyrocatechol violet dye-based method. This effect was reduced in cohorts when pyrogallol red assays were used. False positive results can impact on diagnosis and patient care. This highlights the need for both clinical and laboratory quality improvement projects and standardization of laboratory protein measurement.
Publisher: Springer Science and Business Media LLC
Date: 06-2016
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.EJOGRB.2016.07.509
Abstract: To compare women's views about blood pressure (BP) control in CHIPS (Control of Hypertension In Pregnancy Study) (NCT01192412). Quantitative and qualitative analysis of questionnaire responses. International randomised trial (94 sites, 15 countries). 911 (92.9%) women randomised to 'tight' (target diastolic blood pressure, 85mmHg) or 'less tight' (target diastolic blood pressure, 100mmHg) who completed questionnaires. A questionnaire was administered at ∼6-12 weeks postpartum regarding post-discharge morbidity and views about trial participation. Questionnaires were administered by the site co-ordinator, and contact was made by phone, home or clinic visit rarely, data was collected from medical records. Quantitative analyses were Chi-square or Fisher's exact test for categorical variables, mixed effects multinomial logistic regression to adjust for confounders, and p<0.001 for statistical significance. NVivo software was used for thematic analysis of women's views. Satisfaction, measured as willingness to have the same treatment in another pregnancy or recommend that treatment to a friend. Among the 533 women in 'tight' (N=265) vs. 'less tight' (N=268) control who provided comments for qualitative analysis, women in 'tight' (vs. 'less tight') control made fewer positive comments about the amount of medication taken (5 vs. 28 women, respectively) and intensity of BP monitoring (7 vs. 17, respectively). However, this did not translate into less willingness to either have the same treatment in another pregnancy (434, 95.8% vs. 423, 92.4%, respectively p=0.14) or recommend that treatment to a friend (435, 96.0% and 428, 93.4%, respectively p=0.17). Importantly, although satisfaction remained high among women with an adverse outcome, those in 'tight' control who suffered an adverse outcome (vs. those who did not) were not consistently less satisfied, whereas this was not the case among women in 'less tight' control among whom satisfaction was consistently lower for the CHIPS primary outcome (p<0.001), severe hypertension (p≤0.01), and pre-ecl sia (p<0.001). Women in 'tight' (vs. 'less tight') control were equally satisfied with their care, and more so in the face of adverse perinatal or maternal outcomes.
Publisher: Springer Science and Business Media LLC
Date: 30-03-2017
Publisher: Wiley
Date: 07-2022
DOI: 10.1002/UOG.24916
Abstract: There is little evidence related to the effects of the Omicron severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) variant on pregnancy outcomes, particularly in unvaccinated women. This study aimed to compare pregnancy outcomes of unvaccinated women infected with SARS‐CoV‐2 during the pre‐Delta, Delta and Omicron waves. This was a retrospective cohort study conducted at two tertiary care facilities: Sancaktepe Training and Research Hospital, Istanbul, Turkey, and St George's University Hospitals NHS Foundation Trust, London, UK. Included were women who tested positive for SARS‐CoV‐2 by real‐time reverse‐transcription polymerase chain reaction (RT‐PCR) during pregnancy, between 1 April 2020 and 14 February 2022. The cohort was ided into three periods according to the date of their positive RT‐PCR test: (i) pre‐Delta (1 April 2020 to 8 June 2021 in Turkey, and 1 April 2020 to 31 July 2021 in the UK), (ii) Delta (9 June 2021 to 27 December 2021 in Turkey, and 1 August 2021 to 27 December 2021 in the UK) and (iii) Omicron (after 27 December 2021 in both Turkey and the UK). Baseline data collected included maternal age, parity, body mass index, gestational age at diagnosis and comorbidities. The primary outcome was the need for oxygen supplementation, classified as oxygen support via nasal cannula or breather mask, non‐invasive mechanical ventilation with continuous positive airway pressure (CPAP) or high‐flow oxygen, mechanical ventilation with intubation, or extracorporeal membrane oxygenation (ECMO). Inferences were made after balancing of confounders, using an evolutionary search algorithm. Selected confounders were maternal age, body mass index and gestational age at diagnosis of infection. During the study period, 1286 unvaccinated pregnant women with RT‐PCR‐proven SARS‐CoV‐2 infection were identified, comprising 870 cases during the pre‐Delta period, 339 during the Delta wave and 77 during the Omicron wave. In the confounder‐balanced cohort, infection during the Delta wave vs during the pre‐Delta period was associated with increased need for nasal oxygen support (risk ratio (RR), 2.53 (95% CI, 1.75–3.65) P 0.001), CPAP or high‐flow oxygen (RR, 2.50 (95% CI, 1.37–4.56) P = 0.002), mechanical ventilation (RR, 4.20 (95% CI, 1.60–11.0) P = 0.003) and ECMO (RR, 11.0 (95% CI, 1.43–84.7) P = 0.021). The maternal mortality rate was 3.6‐fold higher during the Delta wave compared to the pre‐Delta period (5.3% vs 1.5%, P = 0.010). Infection during the Omicron wave was associated with a similar need for nasal oxygen support (RR, 0.62 (95% CI, 0.25–1.55) P = 0.251), CPAP or high‐flow oxygen (RR, 1.07 (95% CI, 0.36–3.12) P = 0.906) and mechanical ventilation (RR, 0.44 (95% CI, 0.06–3.45) P = 0.438) with that in the pre‐Delta period. The maternal mortality rate was similar during the Omicron wave and the pre‐Delta period (1.3% vs 1.3%, P = 0.999). The need for nasal oxygen support during the Omicron wave was significantly lower compared to the Delta wave (RR, 0.26 (95% CI, 0.11–0.64) P = 0.003). Perinatal outcomes were available for a subset of the confounder‐balanced cohort. Preterm birth before 34 weeks' gestation was significantly increased during the Delta wave compared with the pre‐Delta period (15.4% vs 4.9%, P 0.001). Among unvaccinated pregnant women, SARS‐CoV‐2 infection during the Delta wave, in comparison to the pre‐Delta period, was associated with increased requirement for oxygen support (including ECMO) and higher maternal mortality. Disease severity and pregnancy complications were similar between the Omicron wave and pre‐Delta period. SARS‐CoV‐2 infection of unvaccinated pregnant women carries considerable risks of morbidity and mortality regardless of variant, and vaccination remains key. Miscommunication of the risks of Omicron infection may impact adversely vaccination uptake among pregnant women, who are at increased risk of complications related to SARS‐CoV‐2. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Publisher: Wiley
Date: 27-06-2012
DOI: 10.1111/J.1600-0412.2012.01459.X
Abstract: Evidence profiled in the World Health Organization induction of labor guideline extended to 84 tables and 116 pages, which is hard to assimilate. Summarizing this evidence graphically can present information on key outcomes succinctly, illustrating where the gaps, strengths and weaknesses lie. For induction of labor, graphic representation clearly showed that evidence was lacking on maternal complications when comparing oxytocin with other agents, evidence was strong on birth within 24 h when comparing vaginal prostaglandins with placebo or no treatment, but again it was weak on uterine hyperstimulation when comparing oxytocin with vaginal prostaglandins. These graphs lots allow readers to capture the essence of the information gathered at a glance. The use of graphical displays when interpreting and publishing data on several comparisons and outcomes is encouraged.
Publisher: Wiley
Date: 04-2000
DOI: 10.1034/J.1399-0012.2000.140205.X
Abstract: To examine erythropoiesis in renal transplant pregnancies. Retrospective cohort study of 30 renal transplant cases and 30 age, smoking and parity-matched healthy controls with normal index pregnancy. Retrospective chart review and assay of frozen antenatal serum (for serum erythropoietin concentration [serum EPO]), transferrin receptor protein [TfR], ferritin, folate and B12) were performed. The linear regression equation for normal pregnancy controls was used to calculate predicted [serum EPO] and the observed redicted (O/P) log [serum EPO] was plotted. The relationship between [serum EPO] and haemoglobin (Hb) among transplant cases was considered to be different from that among controls if the slope of the O/P log [serum EPO] versus Hb regression was significantly different from zero. The transplant (14 cadaveric) to conception interval was (median [range]) 33.5 [4, 189] months. Immunosuppressants were azathioprine (n = 25), cyclosporine (n = 22) and/or prednisone (n = 25). Cases were more often primiparous (20 vs. 7 [controls] p = 0.01), had pre-existent hypertension (20 vs. 0 [controls] p < 0.001), developed new/increased hypertension or pre-ecl sia (28 vs. 0 [controls] p < 0.001) and an antenatal rise in creatinine (14 vs. 2 [controls] p < 0.001). In early pregnancy, cases had similar EPO (15.2 [2.6, 84.6] vs. 15.7 [6.4, 41.0] [controls] U/L) but lower Hb (101 [65, 129] vs. 116 [106, 150] g/L p < 0.001). Twenty-two (73%) cases had Hb < 100 g/L (vs. 4 [controls] p < 0.0001) Hb was comparable at 6 wk postpartum. With advancing gestational age (GA), Hb remained stable and serum EPO increased in both groups. The slope of the O/P log [serum EPO] versus Hb for transplant cases was significantly different from zero within both the 17-28 wk (slope +/- SEM: 0.010 +/- 0.002 p < 0.0001) and the 29-42 wk GA categories (0.006 +/- 0.003 p = 0.02). Cases showed smaller rises in serum TfR (change 481 [- 1471, 2780]) vs. 1119 [- 698, 4195] [controls] ng/mL p = 0.005). Anaemia frequently complicates renal transplant pregnancies, in which serum EPO is inappropriately low and the rate of erythropoiesis blunted.
Publisher: Elsevier BV
Date: 03-2021
Publisher: Elsevier BV
Date: 03-2008
Publisher: Springer Science and Business Media LLC
Date: 11-03-2014
Publisher: Wiley
Date: 25-02-2015
DOI: 10.1016/J.IJGO.2015.02.008
Abstract: While we believe that pre-ecl sia matters-because it remains a leading cause of maternal and perinatal morbidity and mortality worldwide-we are convinced that the time has come to look beyond single clinical entities (e.g. pre-ecl sia, postpartum hemorrhage, obstetric sepsis) and to look for an integrated approach that will provide evidence-based personalized care to women wherever they encounter the health system. Accurate outcome prediction models are a powerful way to identify in iduals at incrementally increased (and decreased) risks associated with a given condition. Integrating models with decision algorithms into mobile health (mHealth) applications could support community and first level facility healthcare providers to identify those women, fetuses, and newborns most at need of facility-based care, and to initiate lifesaving interventions in their communities prior to transportation. In our opinion, this offers the greatest opportunity to provide distributed in idualized care at scale, and soon.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.PREGHY.2017.12.005
Abstract: In well-resourced settings, reduced circulating maternal free placental growth factor (PlGF) aids in either predicting or confirming the diagnosis of preecl sia, fetal growth restriction, stillbirth, preterm birth, and delivery within 14 days of testing when pre-ecl sia is suspected. This operational pilot implementation of maternal plasma PlGF in women with suspected preecl sia was conducted in six antenatal clinics in Maputo, Mozambique (six control clinics for comparison). The primary outcome was transfer to higher levels of care, following the informative PlGF assay. Of antenatal visits, 133/31,993 (0.42%) and 20/33,841 (0.06%) resulted in pre-ecl sia-related transfers of care for women attending intervention and control clinics, respectively (p < .0001). The clinic-to-delivery for women with low PlGF (<100 pg/ml) interval was shorter, (vs normal PlGF (median 10 days [IQR 1-25] vs 36 [11-83], p < .0001)). Low PlGF was associated with younger maternal age, higher blood pressure, earlier delivery, more therapeutic interventions, preterm birth, lower birth weight, and perinatal loss. In addition, one-third of hypertensive women with PlGF < 50 pg/ml suffered a stillbirth. In urban Mozambican women with symptoms and/or signs suggestive of preecl sia, low maternal plasma PlGF concentrations are associated with increased risks of adverse pregnancy outcomes, especially early delivery and stillbirth. Therefore, introducing PlGF into the clinical care of women with suspected preecl sia was associated with increased transfers to higher levels of care low PlGF (<100 pg/ml) was associated with increased maternal and perinatal risks. PlGF < 50 pg/ml is particularly associated with stillbirth in women with suspected preecl sia.
Publisher: Elsevier BV
Date: 12-2016
Publisher: Elsevier BV
Date: 04-2023
DOI: 10.1016/J.AJOG.2022.09.047
Abstract: Preecl sia is associated with increased risks of life-threatening, -altering, and -ending complications. Assessment of risk for preecl sia at 35 to 36 weeks' gestation by the Fetal Medicine Foundation 36-week competing-risk model identifies approximately 75% of women who will develop term preecl sia, at a 10% screen-positive rate. This study aimed to assess whether the Fetal Medicine Foundation 36-week model can provide personalized guidance to women about the probable timing of their delivery, whether or not they develop pregnancy hypertension. In this prospective nonintervention screening study at 2 maternity hospitals in England, women who did not have preecl sia (American College of Obstetricians and Gynecologists definition) and were attending a routine hospital visit at 35 0/7 to 36 6/7 weeks' gestation underwent assessment of risk for preecl sia, including maternal demographic characteristics, medical history, mean arterial pressure, and serum placental growth factor and soluble fms-like tyrosine kinase-1. Fetal Medicine Foundation 36-week model risk categories for subsequent preecl sia were defined as: A, ≥0.500 B, 0.20 to 0.499 C, 0.05 to 0.199 D, 0.020 to 0.049 and E, <0.020. Obstetrical records were examined for all women to identify their gestational age at delivery, and whether they experienced a spontaneous onset of labor (irrespective of mode of delivery) or had a medically indicated birth (either induction of labor or unlabored cesarean delivery). The cumulative incidence of delivery and risk ratios, for all deliveries and for spontaneous deliveries, was assessed. Among 29,035 women with singleton pregnancies, 1.0%, 2.9%, 3.3%, 5.0%, 9.9%, and 77.9% were in A, B, C, D, and E risk strata, respectively. In the A (vs E) stratum, 71.95% (vs 33.52%) of births were medically indicated. Compared with women in stratum E, women in higher risk strata were more likely to deliver, and to deliver following spontaneous labor, before their due date. For ex le, of the women in stratum A (vs E), 14.2% (vs 1.1% risk ratio, 12.5 [95% confidence interval, 9.45-15.35]), 48.5% (vs 5.1% risk ratio, 8.47 [7.48-9.35]), 69.6% (vs 15.5% risk ratio, 3.86 [3.59-4.08]), and 90.1% (vs 44.8% risk ratio, 6.72 [4.53-9.95]) gave birth before 37 0/7, 38 0/7, 39 0/7, and 40 0/7 weeks, respectively. For women in stratum A (vs E), when censored for medically indicated births, spontaneous labor occurred more commonly before 37 0/7 (risk ratio, 4.31 [1.99-6.57]), 38 0/7 (risk ratio, 3.71 [2.48-4.88]), 39 0/7 (risk ratio, 2.87 [2.22-3.46]), and 40 0/7 (risk ratio, 1.42 [1.14-1.77]) weeks. Women in higher-risk strata gave birth earlier, and more frequently following medically indicated delivery, compared with those in lower-risk strata. Importantly, the proportion of women who gave birth following spontaneous onset of labor before their due date was also greater in higher-risk than in lower-risk women. The Fetal Medicine Foundation 36-week competing-risk model incorporates biomarkers of placental aging, including angiogenic imbalance these results imply that a fetoplacental response to placental aging may be an important trigger for the onset of labor at term.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
Publisher: Springer Science and Business Media LLC
Date: 18-04-2013
DOI: 10.1038/JHH.2013.31
Abstract: Birth weight (BW) has effects on blood pressure (BP). In order to explore the effects of macrosomia on BP in childhood and in adolescence, a longitudinal cohort study was conducted in Wuxi, China. Subjects with BW ≥4000 g, born in 1993-1995, were the exposed group the unexposed comparisons were matched by year of birth and sex of infant, with BW of 2500-4000 g. Follow-ups in 2005-6 and 2011-12 were conducted, and height, weight and BP were measured by trained doctors. Multi-mixed models in SAS were used to control for repeated measures to explore the effects of fetal macrosomia on BP. At the inception of the cohort, 1595 pairs of participants were recruited. At the end, 1112 in the exposed group and 1126 in the unexposed group finished both follow-ups. Among adolescents, mean (s.d.) of systolic BP (SBP) was 110.83 (9.43) mm Hg, which was statistically significantly higher than that in the unexposed group (mean ± s.d.: 109.33 ± 9.26) mm Hg (P=0.0002). After adjusting the repeated measures and birth year, sex, mother's occupation and delivery age, adding weight during pregnancy, hypertension during delivery, gestational age and parity, being a picky eater in childhood, the macrosomia group had higher SBP than the normal BW group the parameter estimate value was 1.03 (s.e.=0.30). When BMI in childhood and BMI in adolescence were added in the multi-model, the estimated β was 0.71 (s.e.=0.29). No statistically significant effect of macrosomia was found on diastolic BP among adolescents in the multianalysis.
Publisher: Cambridge University Press
Date: 13-12-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2011
Publisher: Georg Thieme Verlag KG
Date: 2017
Abstract: Objective The objective of this study was to compare clinical outcomes of preecl tic pregnancies according to the proteinuria level. Study Design Secondary analysis of a multicenter prospective cohort study of women with preecl sia (PE) symptomatology. Nonproteinuria, mild-proteinuria, and massive-proteinuria PEs were defined as: 165 mg in 12 hours or 300 mg in 24 hours, 165 mg to 2.69 g in 12 hours or 300 mg to 4.99 g in 24 hours, and ≥ 2.7 g in 12 hours or ≥ 5.0 g in 24 hours, respectively. In idual and composite maternal, fetal, and neonatal outcomes were compared among the PE groups. Results Of the 406 analyzed pregnancies, 36 (8.8%) had massive-proteinuria PE, 268 (66.0%) mild-proteinuria PE, and 102 (25.1%) nonproteinuria PE. Compared with the other groups, massive-proteinuria PE women had significantly higher blood pressures (p 0.001), epigastric pain (p = 0.007), and uric acid serum levels (p 0.001) prior to delivery. Composite maternal morbidity was similar across the groups. Delivery 340/7 weeks occurred in 80.6, 49.3, and 22.5% of massive-proteinuria, mild-proteinuria, and nonproteinuria PE groups, respectively (p 0.0001). Composite adverse neonatal outcomes were significantly higher in the massive-proteinuria PE compared with the other groups (p = 0.001). Conclusion While potentially not important diagnostically, massive proteinuria is associated with more severe clinical manifestations of PE prompting earlier delivery.
Publisher: Wiley
Date: 2006
DOI: 10.1002/PD.1534
Abstract: Prenatally diagnosed trisomy 16 mosaicism is associated with the increased risk of poor pregnancy outcome including intrauterine growth restriction, intrauterine death and fetal malformation. While maternal preecl sia has also been reported in some cases, this has not been systematically evaluated. To better define the risk of preecl sia and the clinical course of preecl sia in these pregnancies and to identify associated clinical variables, we reviewed 25 cases of prenatally diagnosed trisomy 16 mosaicism for which molecular studies were undertaken and sufficient obstetrical data were present to include/exclude the diagnosis of preecl sia. Six of 25 (24%) mosaic trisomy 16 cases exhibited preecl sia as compared to 3 of 44 (7%) matched controls. There were no differences between those mosaic trisomy 16 cases presenting with preecl sia and those that did not, in terms of the presence/absence of UPD, IUGR, malformation, or trisomy on amniocentesis. Four of the 6 (67%) preecl sia-associated fetuses were male, compared with only 4 of 19 (21%) (p = 0.06) nonpreecl sia case fetuses, and three of these also had hypospadias. The levels of trisomy tended to be high in placentas associated with preecl sia however very high levels of placental trisomy were also often seen in the absence of preecl sia. As it is impossible to predict which subset of cases is at highest risk, all women receiving a prenatal diagnosis of trisomy 16 mosaicism should be closely monitored for signs of preecl sia.
Publisher: S. Karger AG
Date: 2012
DOI: 10.1159/000331936
Abstract: i Objective: /i To determine whether the congenital cystic adenomatoid malformation (CCAM) volume ratio (CVR) is associated with fetal and postnatal outcome after prenatal diagnosis and antenatal expectant management in a provincial tertiary referral center that does not offer fetal surgery. i Methods: /i Retrospective cohort of 71 consecutive cases of prenatally diagnosed CCAM meeting study criteria (1996–2004). CVR was calculated on the initial ultrasound at the referral center, and associated with hydrops (Fisher’s exact test) and a composite adverse postnatal outcome consisting of death, intubation for respiratory distress, extracorporeal membrane oxygenation, non-elective surgery for symptomatology, or respiratory infection requiring hospital admission (Mann-Whitney test). i Results: /i A CVR .6 was significantly associated with hydrops (p = 0.003). In addition, the CVR was significantly associated with the composite adverse postnatal outcome (p = 0.004) at a mean age of follow-up of 41 months (range –117 months). For CVR and postnatal outcome, the area-under-the-curve receiver operating characteristic was 0.81 (95% CI 0.69–0.93, p = 0.006), and choosing a CVR cut-off of .56, the negative predictive value was 100% (95% CI 0.85–1.00). i Conclusion: /i In a provincial referral center with antenatal expectant management of CCAM, the CVR was associated with hydrops and postnatal outcome, with a CVR .56 predictive of good prognosis after birth.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Informa UK Limited
Date: 2007
DOI: 10.1080/10641950701547549
Abstract: Satisfaction with maternity care is strongly related to the patient-caregiver relationship and involvement in the decision-making process. We sought to compare women's views about their care in a randomized trial of 'less tight' vs. 'tight' control of non-proteinuric pre-existing or gestational hypertension in pregnancy. In the CHIPS Pilot Trial, women completed a postpartum questionnaire to assess their likes and dislikes about their blood pressure (BP) management and trial participation. Comparisons were descriptive. Baseline information was similar for the 'less tight' and 'tight' control groups. Of 132 women, 126 (95.5%) from 17 centers completed a postpartum questionnaire, usually within days of delivery. At least 90% of women in both groups were satisfied with their care, and would be willing to participate again or recommend participation to a friend. Women in both the 'less tight' and 'tight' groups were satisfied with BP management (98.4% vs. 95.1%), and the frequency of tests of maternal and fetal well being. Half of women in both groups perceived that their BP was too high and that caregivers thought that their BP was too high. More women in the 'less tight' (vs. the 'tight') control group took less medication than expected (71.7% vs. 38.2%). More women in the 'tight' (vs. the 'less tight') group took more medication than they expected (60.0% vs. 22.2%). At least 60% of all women used home BP monitoring. In the CHIPS Pilot Trial, while women stated that they were satisfied with their BP management and care, a surprising 50% in both groups thought that their BP was too high. The majority of women used home BP monitoring, the role of which must be further defined in hypertensive pregnancies.
Publisher: Springer Science and Business Media LLC
Date: 06-2016
Publisher: Georg Thieme Verlag KG
Date: 25-03-2013
Publisher: Mary Ann Liebert Inc
Date: 12-2016
Abstract: Exclusive breastfeeding is strongly recommended by the World Health Organization. Given the low rate of exclusive breastfeeding in Canada and the increasing reports of a history of adverse childhood experiences, this study sought to investigate the association between a history of adverse childhood experiences and breastfeeding initiation and breastfeeding. Data used for this study were based on the 2011-2012 Canadian Community Health Survey, collected using a cross-sectional survey. The outcome measures were breastfeeding initiation and exclusive breastfeeding for 6 months or more. History of adverse childhood experiences was the main explanatory variable. Multivariable logistic regression models were developed to investigate the effect on breastfeeding initiation and on exclusive breastfeeding in women who gave birth within 5 years before when the surveys were conducted. The study s le included 697 and 633 women for analyses on breastfeeding initiation and breastfeeding, respectively. The proportion of women with breastfeeding initiation and exclusive breastfeeding for up to 6 months in this study were 96.8% and 42.8%, respectively. After controlling for age and highest level of education, having a history of adverse childhood experiences was not significantly associated with breastfeeding initiation (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.10-1.87), but mothers with such history were less likely to exclusively breastfeed for up to 6 months compared with those without (OR 0.53, 95% CI 0.31-0.90). These findings suggest the need for more breastfeeding monitoring programs beyond the hospital environment to provide more support to Canadian mothers, especially those who have experienced adverse childhood experiences or trauma in the past.
Publisher: SAGE Publications
Date: 2016
Abstract: The distal villous hypoplasia (DVH) pattern is a placental correlate of fetal growth restriction. Because the pattern seems to involve less complexity than do appropriately developed placental villi, we postulated that it may be associated with lower fractal dimension—a mathematical measure of complexity. Our study objectives were to evaluate interobserver agreement related to the DVH pattern among expert pathologists and to determine whether pathologist classification of DVH correlates with fractal dimension. A study set of 30 images of placental parenchyma at ×4 magnification was created by a single pathologist from a digital slide archive. The images were graded for the DVH pattern according to pre-specified definitions and included 10 images graded as “no DVH” (grade = 0), 10 with mild to moderate DVH (grade = 1), and 10 with severe DVH (grade = 2). The images were randomly sorted and shown to a panel of 4 international experts who similarly graded the images for DVH. Weighted kappas were calculated. For each image, fractal dimension was calculated by the Box Counting method. The correlation coefficient between (1) the averaged DVH scores obtained by the 5 pathologists and (2) fractal dimension was calculated. The mean weighted kappa score among the observers was 0.59 (range: 0.42–0.70). The correlation coefficient between fractal dimension and the averaged DVH score was −0.915 ( P 0.001). Expert pathologists achieve fair to substantial agreement in grading DVH, indicating consensus on the definition of DVH. Distal villous hypoplasia correlates extremely well with fractal dimension and represents an objective measure for DVH.
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.AJOG.2011.09.019
Abstract: We investigated whether decreased concentrations of placental growth factor (PlGF) in maternal circulation differentiated placental intrauterine growth restriction (IUGR) from constitutionally small fetuses. Excluding congenital syndromes, infection, and aneuploidy, we assumed IUGR with an abnormal placental pathology to be of placental origin. The study design included a single site, case-control study of 16 cases (9 placental IUGR, 7 constitutionally small) and 79 normal controls with singleton pregnancies. Plasma PlGF was measured by Triage PlGF immunoassay according to the product insert. A positive PlGF test was defined as a concentration less than the fifth percentile for gestational age for normal pregnancy. A positive PlGF test was found in 9 of 9 placental IUGR cases, 1 of 7 constitutionally small fetuses, and 4 of 79 controls (P < .0001). PlGF identified placental IUGR from constitutionally small fetuses with 100% sensitivity and 86% specificity (P = .0009). These preliminary data suggest PlGF may identify placental IUGR antenatally.
Publisher: Wiley
Date: 23-01-2023
Abstract: To determine the relative burdens of maternal and perinatal complications for preterm and term pre‐ecl sia. Prospective observational cohort study. Two English maternity units. Unselected women with singleton pregnancies who developed pre‐ecl sia (International Society for the Study of Hypertension in Pregnancy definition). Outcomes were ascertained by health record review and compared between pregnancies with preterm (versus term) pre‐ecl sia. Severe maternal hypertension, maternal mortality or major maternal morbidity, perinatal mortality or major neonatal morbidity, neonatal unit (NNU) admission ≥48 hours, and birthweight rd percentile. Among 40 241 singleton pregnancies, 298 (0.7%, 95% confidence interval [CI] 0.66–0.83) and 1194 (3.0%, 95% CI 2.8–3.1) developed preterm and term pre‐ecl sia, respectively. Women with preterm (versus term) pre‐ecl sia more commonly experienced adverse maternal or perinatal events: severe hypertension 18.5% (95% CI 14.5–23.3) versus 13.6% (95% CI 11.7–15.6) maternal mortality/major morbidity 7.4% (95% CI 4.9–10.9) versus 2.2% (95% CI 1.5–3.2) perinatal mortality/major neonatal morbidity 29.5% (95% CI 24.6–34.9) versus 2.2% (95% CI 1.5–3.2) and birthweight rd percentile 54.4% (95% CI 48.7–59.9) versus 14.2% (95% CI 12.4–16.3). However, in absolute terms, most maternal complications occurred in women with term pre‐ecl sia, as did a large proportion of perinatal complications: severe hypertension 74.7% (95% CI 68.5–80.0) maternal mortality/major morbidity 54.2% (95% CI 40.3–67.4) perinatal mortality/major neonatal morbidity 22.8% (95% CI 16.1–31.3) NNU admission ≥48 hours 38.1% (95% CI 32.4–44.1) and birthweight rd percentile 51.2% (95% CI 45.8–56.5). Although adverse event risks are greater with preterm (versus term) pre‐ecl sia, term disease is associated with at least equivalent total numbers of maternal, and a significant proportion of perinatal, adverse events. Increased efforts should be made to decrease the incidence of term pre‐ecl sia.
Publisher: Elsevier BV
Date: 05-2011
Publisher: Springer Science and Business Media LLC
Date: 02-11-2020
DOI: 10.1186/S12916-020-01766-9
Abstract: Pre-ecl sia is a leading cause of maternal and perinatal mortality and morbidity. Early identification of women at risk during pregnancy is required to plan management. Although there are many published prediction models for pre-ecl sia, few have been validated in external data. Our objective was to externally validate published prediction models for pre-ecl sia using in idual participant data (IPD) from UK studies, to evaluate whether any of the models can accurately predict the condition when used within the UK healthcare setting. IPD from 11 UK cohort studies (217,415 pregnant women) within the International Prediction of Pregnancy Complications (IPPIC) pre-ecl sia network contributed to external validation of published prediction models, identified by systematic review. Cohorts that measured all predictor variables in at least one of the identified models and reported pre-ecl sia as an outcome were included for validation. We reported the model predictive performance as discrimination ( C -statistic), calibration (calibration plots, calibration slope, calibration-in-the-large), and net benefit. Performance measures were estimated separately in each available study and then, where possible, combined across studies in a random-effects meta-analysis. Of 131 published models, 67 provided the full model equation and 24 could be validated in 11 UK cohorts. Most of the models showed modest discrimination with summary C -statistics between 0.6 and 0.7. The calibration of the predicted compared to observed risk was generally poor for most models with observed calibration slopes less than 1, indicating that predictions were generally too extreme, although confidence intervals were wide. There was large between-study heterogeneity in each model’s calibration-in-the-large, suggesting poor calibration of the predicted overall risk across populations. In a subset of models, the net benefit of using the models to inform clinical decisions appeared small and limited to probability thresholds between 5 and 7%. The evaluated models had modest predictive performance, with key limitations such as poor calibration (likely due to overfitting in the original development datasets), substantial heterogeneity, and small net benefit across settings. The evidence to support the use of these prediction models for pre-ecl sia in clinical decision-making is limited. Any models that we could not validate should be examined in terms of their predictive performance, net benefit, and heterogeneity across multiple UK settings before consideration for use in practice. PROSPERO ID: CRD42015029349 .
Publisher: Bentham Science Publishers Ltd.
Date: 02-2010
Publisher: Johns Hopkins School Bloomberg School of Public Health, Center for Communication Programs
Date: 15-03-2021
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.PREGHY.2015.04.001
Abstract: Epidemiological findings suggest that the link between poverty and pre-ecl sia might be dietary calcium deficiency. Calcium supplementation has been associated with a modest reduction in pre-ecl sia, and also in blood pressure (BP). This exploratory sub-study of the WHO Calcium and Pre-ecl sia (CAP) trial aims to determine the effect of 500mg/day elemental calcium on the blood pressure of non-pregnant women with previous pre-ecl sia. Non-pregnant women with at least one subsequent follow-up trial visit at approximately 12 or 24weeks after randomization were included. Of 836 women randomized by 9 September 2014, 1st visit data were available in 367 women of whom 217 had previously had severe pre-ecl sia, 2nd visit data were available in 201 women. There was an overall trend to reduced BP in the calcium supplementation group (1-2.5mmHg) although differences were small and not statistically significant. In the subgroup with previous severe pre-ecl sia, the mean diastolic BP change in the calcium group (-2.6mmHg) was statistically larger than in the placebo group (+0.8mmHg), (mean difference -3.4, 95% CI -0.4 to -6.4 p=0.025). The effect of calcium on diastolic BP at 12weeks was greater than in those with non-severe pre-ecl sia (p=0.020, ANOVA analysis). There is an overall trend to reduced BP but only statistically significant in the diastolic BP of women with previous severe pre-ecl sia. This is consistent with our hypothesis that this group is more sensitive to calcium supplementation, however results need to be interpreted with caution.
Publisher: Georg Thieme Verlag KG
Date: 18-11-2010
Abstract: Accurate estimation of the glomerular filtration rate (GFR) in patients with preecl sia requires the collection of a 24-hour urine and can have important therapeutic and diagnostic implications. This procedure is often difficult or impossible to accomplish in this patient group. In this study, the Cockcroft-Gault, the Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas were evaluated for their accuracy in determining GFR in the setting of preecl sia. The estimated GFRs calculated from the above formulas were compared with the creatinine clearance values obtained from a 24-hour urine collections in 543 preecl tic patients recruited from several large hospitals. Additionally, a set of new equations, preecl sia GFR (PGFR), based on ethnicity, was created. The Cockcroft-Gault, MDRD, and CKD-EPI formulas were inaccurate in predicting GFR and both were significantly less accurate than PGFR. The latter formula provided an estimated GFR that was much closer to the creatinine clearance. Current GFR estimation equations based on serum creatinine values in nonpregnant patients are not reliable measures of renal function in patients with preecl sia. The use of a new formula (PGFR) is recommended.
Publisher: Wiley
Date: 20-03-2012
DOI: 10.1111/J.1471-0528.2012.03311.X
Abstract: Biomarkers have been proposed for identification of women at increased risk of developing pre-ecl sia. To investigate the capacity of circulating placental growth factor (PlGF), vascular endothelial growth factor (VEGF), soluble fms-like tyrosine kinase-1 (sFLT1) and soluble endoglin (sENG) to predict pre-ecl sia. Medline and Embase through October 2010 and reference lists of reviews, without constraints. We included original publications on testing of PlGF, VEGF, sFLT1 and sENG in serum or plasma of pregnant women at <30 weeks of gestation and before clinical onset of pre-ecl sia. Two reviewers independently identified eligible studies, extracted descriptive and test accuracy data and assessed methodological quality. Summary estimates of discriminatory performance were obtained. We included 34 studies. Concentrations of PlGF (27 studies) and VEGF (three studies) were lower in women who developed pre-ecl sia: standardised mean differences (SMD) -0.56 (95% CI -0.77 to -0.35) and -1.25 (95% CI -2.73 to 0.23). Concentrations of sFLT1 (19 studies) and sENG (ten studies) were higher: SMD 0.48 (95% CI 0.21-0.75) and SMD 0.54 (95% CI 0.24-0.84). The summary diagnostic odds ratios were: PlGF 9.0 (95% CI 5.6-14.5), sFLT1 6.6 (95% CI 3.1-13.7), sENG 4.2 (95% CI 2.4-7.2), which correspond to sensitivities of 32%, 26% and 18%, respectively, for a 5% false-positive rate. PlGF, sFLT1 and sENG showed modest but significantly different concentrations before 30 weeks of gestation in women who developed pre-ecl sia. Test accuracies of all four markers, however, are too poor for accurate prediction of pre-ecl sia in clinical practice.
Publisher: Informa UK Limited
Date: 03-2007
Abstract: Pregnancy is a metabolic and vascular 'stress test' for women and those who 'fail' are at increased risk of long-term cardiovascular complications. Specifically, women who develop preecl sia (and/or other manifestations of placental dysfunction) are at increased risk of coronary heart disease, stroke and cardiovascular disease in general. The risk is highest among women who develop both maternal (e.g., hypertension and proteinuria) and fetal (e.g., intrauterine growth restriction) manifestations of abnormal placentation, especially with preterm delivery. Most women who develop a maternal placental syndrome return to a normal clinical state in the weeks following pregnancy and their absolute risk of cardiovascular disease in the short term is very low. However, perhaps having a placentally complicated pregnancy affords women the opportunity to personalize risk and take action. Action is needed. The fact that we, as a population, are getting heavier and more sedentary is an urgent public health issue. The American Heart Association recommends that all women (even those at low cardiovascular risk) pursue dietary and lifestyle changes, in addition to smoking cessation. Engaging women of child-bearing age who may be motivated by a complicated pregnancy would be very valuable, from a public health perspective, given the prevalence and importance of cardiovascular disease in women, and the central role of the woman as caregiver to children, spouses and other family members.
Publisher: Elsevier BV
Date: 05-2021
DOI: 10.1016/J.PREGHY.2021.05.005
Abstract: To evaluate community-based health workers' ability to identify cases of hypertension in pregnancy, safely deliver methyldopa and magnesium sulphate and make referrals when appropriate. This was part of Nigeria Community-Level Interventions for Pre-ecl sia (CLIP) cluster randomized controlled trial (NCT01911494). Community-based Health Workers (CHW) recruited pregnant women from five Local Government Areas (clusters) and used mobile health aid for clinical assessment of pre-ecl sia. The primary outcome was the number of adverse events that occurred after the administration of magnesium sulphate and/or methyldopa to pregnant women by CHWs. Of 8790 women receiving mobile health-guided care, community-based health workers in Nigeria provided 309 women with hypertension (4.2% of delivered women), and safely administered 142 doses of intramuscular magnesium sulphate. Community Heath Extension Workers (CHEWs) and nurses gave fifty-two and sixty-seven doses of intramuscular magnesium sulphate respectively, twenty-three doses were given by other health care workers (midwives, community health officers, health assistants). The high rate of administration by nurses can be explained by turf protection as well as their seniority within the health system. Also, CHEWs and nurses gave 124 doses of oral methyldopa and 126 urgent referrals were completed. There were no complications related to administration of treatment or referral. These findings demonstrate the ability of community-based health workers to safely administer methyldopa and intramuscular magnesium sulphate. The use of task-sharing, therefore, could drastically reduce the three delays (triage, transport and treatment) associated with high maternal mortality and morbidity in rural communities in low- and middle-income countries.
Publisher: Elsevier BV
Date: 10-2011
Publisher: Wiley
Date: 28-06-2022
Abstract: Calcium supplementation reduces the risk of pre‐ecl sia, but questions remain about the dosage to prescribe and who would benefit most. To evaluate the effectiveness of high (≥1 g/day) and low ( g/day) calcium dosing for pre‐ecl sia prevention, according to baseline dietary calcium, pre‐ecl sia risk and co‐interventions, and intervention timing. CENTRAL, PubMed, Global Index Medicus and CINAHL, from inception to 2 February 2021, clinical trial registries, reference lists and expert input (CRD42018111239). Randomised controlled trials of calcium supplementation for pre‐ecl sia prevention, for women before or during pregnancy. Network meta‐analysis (NMA) also included trials of different calcium doses. Two independent reviewers extracted published data. The meta‐analysis employed random‐effects models and the NMA, a Bayesian random‐effects model, to obtain direct and indirect effect estimates. The meta‐analysis included 30 trials ( N = 20 445 women), and the NMA to evaluate calcium dosage included 25 trials ( N = 15 038). Calcium supplementation prevented pre‐ecl sia similarly with a high dose (RR 0.49, 95% CI 0.36–0.66) or a low dose (RR 0.49, 95% CI 0.36–0.65). By NMA, high‐dose (vs low‐dose) calcium did not differ in effect (RR 0.79, 95% CI 0.43–1.40). Calcium was similarly effective regardless of baseline pre‐ecl sia risk, vitamin D co‐administration or timing of calcium initiation, but calcium was ineffective among women with adequate average baseline calcium intake. Low‐ and high‐dose calcium supplementation are effective for pre‐ecl sia prevention in women with low calcium intake. This has implications for population‐level implementation where dietary calcium is low, and targeted implementation where average intake is adequate. A network meta‐analysis of 25 trials found that low‐dose calcium supplementation ( g/day) is as effective as high‐dose calcium supplementation (≥1 g/day) in halving the risk of pre‐ecl sia when baseline calcium intake is low.
Publisher: Wiley
Date: 24-04-2023
Abstract: To inform digital health design by evaluating diagnostic test properties of antenatal blood pressure (BP) outputs and levels to identify women at risk of adverse outcomes. Planned secondary analysis of cluster randomised trials. India, Pakistan, Mozambique. Women with in‐community BP measurements and known pregnancy outcomes. Blood pressure was defined by its outputs (systolic and/or diastolic, systolic only, diastolic only or mean arterial pressure [calculated]) and level: normotension‐1 ( /85 mmHg), normotension‐2 (135–139/85–89 mmHg), non‐severe hypertension (140–149/90–99 mmHg 150–154/100–104 mmHg 155–159/105–109 mmHg) and severe hypertension (≥160/110 mmHg). Dose–response (adjusted risk ratio [aRR]) and diagnostic test properties (negative [−LR] and positive [+LR] likelihood ratios) were estimated. Maternal erinatal composites of mortality/morbidity. Among 21 069 pregnancies, different BP outputs had similar aRR, −LR, and +LR for adverse outcomes. No BP level (even normotension‐1) was associated with low risk (all −LR ≥0.20). Across outcomes, risks rose progressively with higher BP levels above normotension‐1. For each of maternal central nervous system events and stillbirth, BP ≥155/105 mmHg showed at least good diagnostic test performance (+LR ≥5.0) and BP ≥135/85 mmHg at least fair performance, similar to BP ≥140/90 mmHg (+LR 2.0–4.99). In the community, normal BP values do not provide reassurance about subsequent adverse outcomes. Given the similar performance of BP cut‐offs of 135/85 and 140/90 mmHg for hypertension, and 155/105 and 160/110 mmHg for severe hypertension, digital decision support for women in the community should consider using these lower thresholds.
Publisher: Springer Science and Business Media LLC
Date: 29-11-2012
DOI: 10.1007/S00330-012-2721-X
Abstract: To assess the diagnostic accuracy of computed tomography (CT) angiography in the evaluation of patients with an episode of acute gastrointestinal haemorrhage. Systematic review and meta-analysis to estimate pooled accuracy indices. A bivariate random effects model was adjusted to obtain a summary receiver-operating characteristic (sROC) curve and the corresponding area under the curve (AUC). Twenty-two studies were included and provided data on 672 patients (range of age 5-74) with a mean age of 65 years. The overall sensitivity of CT angiography for detecting active acute GI haemorrhage was 85.2 % (95 % CI 75.5 % to 91.5 %). The overall specificity of CT angiography was 92.1 % (95 % CI 76.7 % to 97.7 %). The likelihood ratios for positive and negative test results were 10.8 (95 % CI 3.4 to 34.4) and 0.16 (95 % CI 0.1 to 0.27) respectively, with an AUC of 0.935 (95 % CI 0.693 to 0.989). The sources of heterogeneity explored had no significant impact on diagnostic performance. CT shows high diagnostic accuracy and is an excellent diagnostic tool for detection and localising of intestinal bleeding sites. It is highly available, provides fast detection and localisation of the bleeding site, and is minimally invasive. • CT angiography is increasingly used for investigating severe gastrointestinal bleeding. • This systematic review and meta-analysis updates previous ones. • In patients with massive gastrointestinal bleeding, CT angiography/MDCT detects bleeding accurately. • CT angiography is useful in locating the bleeding site and determining appropriate treatment.
Publisher: Wiley
Date: 16-11-2010
DOI: 10.1002/PD.2409
Abstract: Prenatally diagnosed confined placental trisomy is associated with increased risk for intrauterine growth restriction (IUGR) and preecl sia. However, it is unclear how often this might underlie pregnancy complications. Our objective was to evaluate the frequency and distribution of trisomic cells in placentae ascertained for IUGR and/or preecl sia. Comparative genomic hybridization was applied to two uncultured biopsies from each of 61 placentae referred with maternal preecl sia and/or IUGR, 11 cases with elevated maternal serum hCG and/or AFP but no IUGR or preecl sia, and 85 control placentae. Trisomy was observed in four placentae among the IUGR group (N = 43) but in no case of preecl sia in the absence of IUGR (N = 18). Trisomy was observed in 1 of the 11 cases ascertained for abnormal maternal serum screen. Each of these five cases was mosaic and not all s led sites showed the presence of trisomy. None of the 84 control placentas showed mosaic trisomy, although 1 case of nonmosaic 47,XXX was identified in this group. In cases in which diagnosis of the cause of IUGR may provide some benefit, testing should be performed using uncultured cells from multiple placental biopsies for the accurate diagnosis of trisomy mosaicism.
Publisher: Springer Science and Business Media LLC
Date: 06-2016
Publisher: Springer Science and Business Media LLC
Date: 29-06-2017
Publisher: BMJ
Date: 02-2019
DOI: 10.1136/BMJOPEN-2018-024042
Abstract: To identify and measure the place-specific determinants that are associated with adverse maternal and perinatal outcomes in the southern region of Mozambique. Retrospective cohort study. Choice of variables informed by literature and Delphi consensus. Study conducted during the baseline phase of a community level intervention for pre-ecl sia that was led by community health workers. A household census identified 50 493 households that were home to 80 483 women of reproductive age (age 12–49 years). Of these women, 14 617 had been pregnant in the 12 months prior to the census, of which 9172 (61.6%) had completed their pregnancies. A combined fetal, maternal and neonatal outcome was calculated for all women with completed pregnancies. A total of six variables were statistically significant (p≤0.05) in explaining the combined outcome. These included: geographic isolation, flood proneness, access to an improved latrine, average age of reproductive age woman, family support and fertility rates. The performance of the ordinary least squares model was an adjusted R 2 =0.69. Three of the variables (isolation, latrine score and family support) showed significant geographic variability in their effect on rates of adverse outcome. Accounting for this modest non-stationary effect through geographically weighted regression increased the adjusted R 2 to 0.71. The community exploration was successful in identifying context-specific determinants of maternal health. The results highlight the need for designing targeted interventions that address the place-specific social determinants of maternal health in the study area. The geographic process of identifying and measuring these determinants, therefore, has implications for multisectoral collaboration. NCT01911494 .
Publisher: Elsevier BV
Date: 04-2012
Publisher: Elsevier BV
Date: 05-2011
Publisher: Wiley
Date: 14-12-2010
DOI: 10.1111/J.1600-0897.2009.00745.X
Abstract: Systemic inflammation and abnormal oor placentation represent hallmarks of pre-ecl sia. Accumulating evidence suggests that infectious agents might increase the risk of pre-ecl sia the innate immune defense mechanisms may interact with pro-inflammatory pathways, and contribute to the development of pre-ecl sia. The evidence for this has been supported by indirect epidemiologic and clinical studies, as well as by some direct support from experimental studies. Recent data directly implicate signaling by Toll-like receptors in the pathogenesis of pre-ecl sia, and establish a crucial link between pre-ecl sia and defense against both foreign pathogens and endogenously generated inflammatory ligands. Here, we review the rapid progress in this field, which has improved our understanding of the interplay between pathogen invasion, innate immune defense mechanisms, and pre-ecl sia.
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1053/J.SEMPERI.2009.02.009
Abstract: The reason pre-ecl sia matters so much to maternity care providers is that adverse maternal and perinatal events cluster around the diagnosis of proteinuric gestational hypertension. While that is true, most pre-ecl sia is mild and evanescent, resolving rapidly postpartum. Therefore, every effort must be made to identify those women at greatest personal risk, and those bearing fetuses at greatest risk, so that they can be offered closer surveillance and lower thresholds for the use of effective interventions, such as delivery and the use of MgSO(4). Conversely, as delivery remote from term can increase perinatal risks and as liberal MgSO(4) use is associated with maternal morbidity, it may be as important to identify those women who have "mild" disease and bear little personal and/or fetal actuarial risk. For women with "mild" disease at presentation, expectant management remote from term or nonuse of MgSO(4) would be appropriate. Through the PIERS (Pre-ecl sia Integrated Estimate of RiSk) model research program, we have determined that most criteria for "severe" disease perform poorly when operationalized to predict adverse maternal and/or perinatal outcomes. However, with standardized assessment and surveillance of women with suspected and confirmed pre-ecl sia it is possible to lower maternal risks both within in idual institutions and across regions. In addition, the PIERS group developed, and is currently validating, 2 outcome prediction models (full-PIERS and mini-PIERS) that we hope will provide an evidence base for the definition of "severe" disease and guide clinical decision-making, especially remote from term when potential perinatal gains are so great.
Publisher: Springer Science and Business Media LLC
Date: 05-09-2022
DOI: 10.1186/S12978-022-01485-9
Abstract: Pre-ecl sia is a leading cause of maternal mortality and morbidity that involves pregnancy-related stressors on the maternal cardiovascular and metabolic systems. As nutrition is important to support optimal development of the placenta and for the developing fetus, maternal diets may play a role in preventing pre-ecl sia. The purpose of this scoping review is to map the maternal nutritional deficiencies and imbalances associated with pre-ecl sia incidence and discuss evidence consistency and linkages with current understandings of the etiology of pre-ecl sia. A narrative scoping review was conducted to provide a descriptive account of available research, summarize research findings and identify gaps in the evidence base. Relevant observational studies and reviews of observational studies were identified in an iterative two-stage process first involving electronic database searches then more sensitive searches as familiarity with the literature increased. Results were considered in terms of their consistency of evidence, effect sizes and biological plausibility. The review found evidence for associations between nutritional inadequacies and a greater risk of pre-ecl sia. These associations were most likely mediated through oxidative stress, inflammation, maternal endothelial dysfunction and blood pressure in the pathophysiology of pre-ecl sia. Maternal nutritional risk factors for pre-ecl sia incidence with the strongest consistency, effect and biological plausibility include vitamin C and its potential relationship with iron status, vitamin D (both on its own and combined with calcium and magnesium), and healthy dietary patterns featuring high consumption of fruits, vegetables, whole grains, fish, seafood and monounsaturated vegetable oils. Foods high in added sugar, such as sugary drinks, were associated with increased risk of pre-ecl sia incidence. A growing body of literature highlights the involvement of maternal dietary factors in the development of pre-ecl sia. Our review findings support the need for further investigation into potential interactions between dietary factors and consideration of nutritional homeostasis and healthy dietary patterns. Further research is recommended to explore gestational age, potential non-linear relationships, dietary ersity and social, cultural contexts of food and meals.
Publisher: Springer Science and Business Media LLC
Date: 09-2016
Publisher: Elsevier BV
Date: 03-2013
Publisher: Springer Science and Business Media LLC
Date: 06-2016
Publisher: Informa UK Limited
Date: 06-01-2014
DOI: 10.3109/10641955.2013.872253
Abstract: To validate a previously published prediction model for recurrent early-onset preecl sia (PE). We included 229 pregnant women with a history of early-onset PE and computed their risk using the prediction model, compared the predicted risk to their pregnancy outcomes and assessed performance of the model. Early-onset PE recurred in 6.6% of participants. The area under the receiver operating characteristic curve was 59% (95% CI: 45-73). The model created groups that were only moderately different in terms of their risk. The model's discriminate ability was poor and predictive performance insufficient to classify women into relevant risk groups.
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1053/J.SEMPERI.2009.02.001
Abstract: Although definitions of severe hypertension vary, thresholds of >or=160-170 mm Hg systolic and/or >or=110 mm Hg diastolic are in most common usage. A recent focus has been placed on systolic hypertension given the increased pulse pressure in these women. In pregnancy, there is a general consensus that severe hypertension should be treated. Among woman with pre-ecl sia, attention must be paid to other end organ dysfunction, as blood pressure (BP) management is but one aspect of care. The urgency of antihypertensive therapy will depend primarily on the absolute level of BP. However, most clinicians will also consider both the rate of BP rise and the presence of maternal symptoms. Most commonly, severe hypertension is treated with parenteral labetalol or hydralazine, or oral nifedipine (capsules or PA tablet). Other options will depend on local availability. MgSO(4) should not be relied on as an antihypertensive.
Publisher: Elsevier BV
Date: 08-2011
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.JOGC.2018.09.018
Abstract: The objective is to provide guidelines for the use of antenatal magnesium sulphate for fetal neuroprotection of the preterm infant. Antenatal magnesium sulphate administration should be considered for fetal neuroprotection when women present at ≤33 + 6 weeks with imminent preterm birth, defined as a high likelihood of birth because of active labour with cervical dilatation ≥4 cm, with or without preterm pre-labour rupture of membranes, and/or planned preterm birth for fetal or maternal indications. There are no other known fetal neuroprotective agents. The outcomes measured are the incidence of cerebral palsy (CP) and neonatal death. Published literature was retrieved through searches of PubMed or Medline, CINAHL, and the Cochrane Library in December 2017, using appropriate controlled vocabulary and key words (magnesium sulphate, cerebral palsy, preterm birth). Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 2017. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). Antenatal magnesium sulphate for fetal neuroprotection reduces the risk of "death or CP" (relative risk [RR] 0.85 95% confidence interval [CI] 0.74-0.98 4 trials, 4446 infants), "death or moderate-severe CP" (RR 0.85 95% CI 0.73-0.99 3 trials, 4250 infants), "any CP" (RR 0.71 95% CI 0.55-0.91 4, trials, 4446 infants), "moderate-to-severe CP" (RR 0.60 95% CI 0.43-0.84 3 trials, 4250 infants), and "substantial gross motor dysfunction" (inability to walk without assistance) (RR 0.60 95% CI 0.43-0.83 3 trials, 4287 women) at 2 years of age. Results were consistent between trials and across the meta-analyses. There is no anticipated significant increase in health care-related costs because women eligible to receive antenatal magnesium sulphate will be judged to have imminent preterm birth. Australian National Clinical Practice Guidelines were published in March 2010 by the Antenatal Magnesium Sulphate for Neuroprotection Guideline Development Panel. Antenatal magnesium sulphate was recommended for fetal neuroprotection in the same dosage as recommended in these guidelines. However, magnesium sulphate was recommended only at <30 weeks gestation, based on 2 considerations. First, no single gestational age subgroup was considered to show a clear benefit. Second, in the face of uncertainty, the committee felt it was prudent to limit the impact of their clinical practice guidelines on resource allocation. In March 2010, the American College of Obstetricians and Gynecologists issued a Committee Opinion on magnesium sulphate for fetal neuroprotection. It stated that "the available evidence suggests that magnesium sulfate given before anticipated early preterm birth reduces the risk of cerebral palsy in surviving infants." No official opinion was given on a gestational age cut-off, but it was recommended that physicians develop specific guidelines around the issues of inclusion criteria, dosage, concurrent tocolysis, and monitoring in accordance with 1 of the larger trials. Similarly, the World Health Organization also strongly recommends use of magnesium sulphate for fetal neuroprotection in its 2015 recommendations on interventions to improve preterm birth outcomes but cites further researching on dosing regimen and re-treatment. Canadian Institutes of Health Research (CIHR). RECOMMENDATIONS.
Publisher: BMJ
Date: 06-2008
DOI: 10.1136/EBM.13.3.81
Publisher: Wiley
Date: 24-10-2023
Publisher: Wiley
Date: 22-11-2022
Abstract: To compare pre-ecl sia risk factors identified by clinical practice guidelines (CPGs) with risk factors from hierarchical evidence review, to guide pre-ecl sia prevention. Our search strategy provided hierarchical evidence of relationships between risk factors and pre-ecl sia using Medline (Ovid), searched from January 2010 to January 2021. Published studies and CPGs. Pregnant women. We evaluated the strength of association and quality of evidence (GRADE). CPGs (n = 15) were taken from a previous systematic review. Pre-ecl sia. Of 78 pre-ecl sia risk factors, 13 (16.5%) arise only during pregnancy. Strength of association was usually 'probable' (n = 40, 51.3%) and the quality of evidence was low (n = 35, 44.9%). The 'major' and 'moderate' risk factors proposed by 8/15 CPGs were not well aligned with the evidence of the ten 'major' risk factors (alone warranting aspirin prophylaxis), associations with pre-ecl sia were definite (n = 4), probable (n = 5) or possible (n = 1), based on moderate (n = 4), low (n = 5) or very low (n = 1) quality evidence. Obesity ('moderate' risk factor) was definitely associated with pre-ecl sia (high-quality evidence). The other ten 'moderate' risk factors had probable (n = 8), possible (n = 1) or no (n = 1) association with pre-ecl sia, based on evidence of moderate (n = 1), low (n = 5) or very low (n = 4) quality. Three risk factors not identified by the CPGs had probable associations (high quality): being overweight 'prehypertension' at booking and blood pressure of 130-139/80-89 mmHg in early pregnancy. Pre-ecl sia risk factors in CPGs are poorly aligned with evidence, particularly for the strongest risk factor of obesity. There is a lack of distinction between risk factors identifiable in early pregnancy and those arising later. A refresh of the strategies advocated by CPGs is needed.
Publisher: Massachusetts Medical Society
Date: 29-01-2015
Publisher: Springer Science and Business Media LLC
Date: 26-05-2015
Publisher: Cambridge University Press (CUP)
Date: 11-2008
DOI: 10.1017/S0965539508002283
Abstract: Cardiovascular disease is the leading cause of death in women. The hypertensive disorders of pregnancy (HDP) are the most common medical complication of pregnancy, complicating up to 10% of pregnancies worldwide. They represent a leading cause of maternal mortality and morbidity in pregnancy. The most common of these disorders is gestational hypertension (5–6%). Using population-based data, approximately 1% of pregnancies are complicated by pre-existing hypertension, 5–6% by gestational hypertension without proteinuria, and 1–2% by pre-ecl sia.
Publisher: Elsevier BV
Date: 07-2014
Publisher: Springer Science and Business Media LLC
Date: 06-07-2021
DOI: 10.1186/S12978-021-01192-X
Abstract: Maternal mortality is an important public health problem in low-income countries. Delays in reaching health facilities and insufficient health care professionals call for innovative community-level solutions. There is limited evidence on the role of community health workers in the management of pregnancy complications. This study aimed to describe the feasibility of task-sharing the initial screening and initiation of obstetric emergency care for pre-ecl sia/ecl sia from the primary healthcare providers to community health workers in Mozambique and document healthcare facility preparedness to respond to referrals. The study took place in Maputo and Gaza Provinces in southern Mozambique and aimed to inform the Community-Level Interventions for Pre-ecl sia (CLIP) cluster randomized controlled trial. This was a mixed-methods study. The quantitative data was collected through self-administered questionnaires completed by community health workers and a health facility survey this data was analysed using Stata v13. The qualitative data was collected through focus group discussions and in-depth interviews with various community groups, health care providers, and policymakers. All discussions were audio-recorded and transcribed verbatim prior to thematic analysis using QSR NVivo 10. Data collection was complemented by reviewing existing documents regarding maternal health and community health worker policies, guidelines, reports and manuals. Community health workers in Mozambique were trained to identify the basic danger signs of pregnancy however, they have not been trained to manage obstetric emergencies. Furthermore, barriers at health facilities were identified, including lack of equipment, shortage of supervisors, and irregular drug availability. All primary and the majority of secondary-level facilities (57%) do not provide blood transfusions or have surgical capacity, and thus such cases must be referred to the tertiary-level. Although most healthcare facilities (96%) had access to an ambulance for referrals, no transport was available from the community to the healthcare facility. This study showed that task-sharing for screening and pre-referral management of pre-ecl sia and ecl sia were deemed feasible and acceptable at the community-level, but an effort should be in place to address challenges at the health system level.
Publisher: Massachusetts Medical Society
Date: 12-05-2022
Publisher: Wiley
Date: 17-08-2007
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.PREGHY.2014.01.003
Abstract: This guideline summarizes the quality of the evidence to date and provides a reasonable approach to the diagnosis, evaluation and treatment of the hypertensive disorders of pregnancy (HDP). The literature reviewed included the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) HDP guidelines from 2008 and their reference lists, and an update from 2006. Medline, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Registry of Controlled Trials (CCRCT) and Database of Abstracts and Reviews of Effects (DARE) were searched for literature published between January 2006 and March 2012. Articles were restricted to those published in French or English. Recommendations were evaluated using the criteria of the Canadian Task Force on Preventive Health Care and GRADE.
Publisher: Wiley
Date: 13-10-2020
Publisher: Wiley
Date: 18-06-2010
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Springer Science and Business Media LLC
Date: 15-09-2022
Publisher: Informa UK Limited
Date: 06-09-2010
DOI: 10.3109/10641950903242659
Abstract: Preecl sia is a syndrome of exaggerated innate inflammatory response. It is plausible that this innate inflammation may be mediated by Toll-like receptors (TLRs). A portion of the familial susceptibility to the development of preecl sia may be mediated by single nucleotide polymorphisms (SNPs) in the TLR gene sequences. Published reports vary in their finding an association between TLR SNPs and preecl sia risk. Common SNPs of the TLR2 (Arg753Gln) and co-segregating TLR4 (Asp299Gly and Thr399Ile) genes were screened in 94 women with pre-ecl sia and 176 healthy pregnancy controls. We performed a data synthesis of our findings with those in published reports to ascertain whether or not we could explain the apparent disparity in the literature. The presence of TLR2 (RR 2.57 [95% CI 1.31, 5.05]) and TLR4 (RR 2.06 [1.16, 3.67]) SNPs aggregated with early-onset ( or=34 + 0 weeks), preecl sia. Through synthesis of these and the published data, TLR polymorphisms appear to lower thresholds for early-onset and severe preecl sia, but not late-onset or mild disease. TLR2 and TLR4 SNPs appear to alter susceptibility to developing the maternal syndrome of preecl sia. Data synthesis of these data and other studies strengthens the association for early-onset and severe disease, in particular. A definitive and fully powered cohort study is required.
Publisher: Elsevier BV
Date: 2008
DOI: 10.1016/J.JPEDSURG.2007.09.011
Abstract: Outcomes studies for gastroschisis are constrained by small numbers, prolonged accrual, and nonstandardized data collection. The aim of this study is to create a national pediatric surgical network and database for gastroschisis (GS) that tracks cases from diagnosis to hospital discharge. The 16-center network serves a population of 32 million. Gastroschisis cases are ascertained at prenatal diagnosis. Perinatal data include maternal risk and fetal ultrasound variables, delivery plan and outcome, a postnatal bowel injury score, intended and actual surgical treatment, and neonatal outcomes. Institutional review board-approved data collection conforms to regional privacy legislation. Deidentified data are centralized and accessible for research through the network steering committee. To date, 114 cases of pre- and/or postnatal gastroschisis have been uploaded. Of 106 live-born infants (40 [38%] by cesarean delivery), 100 had complete records, and overall survival to discharge was 96%, with a mean survivor length of stay (LOS) of 46 days. Infants treated with attempted urgent closure (61%) had significantly shorter LOS (42 vs 57 days P = .048) but comparable LOS compared with those treated with silos and delayed closure. Fetal bowel dilation 18 mm or greater did not predict a difference in outcome. Population-based databases allow rapid case accrual and enable studies that should aid in the identification of optimal perinatal treatment.
Publisher: Ubiquity Press, Ltd.
Date: 2020
DOI: 10.5334/AOGH.3072
Publisher: Wiley
Date: 08-2003
Publisher: Wiley
Date: 21-11-2015
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJGH-2020-003716
Abstract: Technological advances and high throughput biological assays can facilitate discovery science in biobanks from population cohorts, including pregnant women. Biological pathways associated with health outcomes differ depending on geography, and high-income country data may not generalise to low-resource settings. We conducted a systematic review to identify prospective pregnancy cohorts in sub-Saharan Africa (SSA) that include biobanked s les with potential to enhance discovery science opportunity. Inclusion criteria were prospective data collection during pregnancy, with associated biobanking in SSA. Data sources included: scientific databases (with comprehensive search terms), grey literature, hand searching applicable reference lists and expert input. Results were screened in a three-stage process based on title, abstract and full text by two independent reviewers. The review is registered on PROSPERO (CRD42019147483). Fourteen SSA studies met the inclusion criteria from database searches (n=8), reference list searches (n=2) and expert input (n=4). Three studies have ongoing data collection. The most represented countries were South Africa and Mozambique (Southern Africa) (n=3), Benin (Western Africa) (n=4) and Tanzania (Eastern Africa) (n=4) including an estimated 31 763 women. S les commonly collected were blood, cord blood and placenta. Seven studies collected neonatal s les. Common clinical outcomes included maternal and perinatal mortality, malaria and preterm birth. Increasingly numerous pregnancy cohorts in SSA that include biobanking are generating a uniquely valuable resource for collaborative discovery science, and improved understanding of the high regional risks of maternal, fetal and neonatal morbidity and mortality. Future studies should align protocols and consider their added value and distinct contributions.
Publisher: Informa UK Limited
Date: 10-11-2011
DOI: 10.3109/10641950902972140
Abstract: To determine rates of and potential causative factors for acute pulmonary oedema (APO) in hypertensive women. Statistical analysis, including logistic regression, was applied to the in idual patient data (IPD) of all hypertensive women who delivered in 2005 at two comparable units. Of 880 cases analysed, there were no women with APO in unit one and 19 women in unit two. The women with APO received larger quantities of intravenous fluids, delivered at earlier gestations, via Caesarean section, following failed induction of labour and had a longer hospital stay. The development of APO in women with hypertension during pregnancy is associated with high levels of intravenous fluid administration.
Publisher: Springer Science and Business Media LLC
Date: 07-10-2019
DOI: 10.1186/S12884-019-2445-X
Abstract: Preecl sia (PE) is a major cause of short and long-term morbidity for affected infants, including consequences of fetal growth restriction and iatrogenic prematurity. In Brazil, this is a special problem as PE accounts for 18% of preterm births (PTB). In the PREPARE (Prematurity REduction by Pre-ecl sia cARE) study, we will test a novel system of integrated care based on risk stratification and knowledge transfer, to safely reduce PTB. This is a stepped wedge cluster randomised trial that will include women with suspected or confirmed PE between 20 + 0 and 36 + 6 gestational weeks. All pregnant women presenting with these findings at seven tertiary centres in geographically dispersed sites, throughout Brazil, will be considered eligible and evaluated in terms of risk stratification at admission. At randomly allocated time points, sites will transition to risk stratification performed according to sFlt-1/PlGF (Roche Diagnostics) measurement and fullPIERS score with both results will be revealed to care providers. The healthcare providers of women stratified as low risk for adverse outcomes (sFlt-1/PlGF ≤38 AND fullPIERS 10% risk) will receive the recommendation to defer delivery. sFlt-1/PlGF will be repeated once and fullPIERS score twice a week. Rates of prematurity due to preecl sia before and after the intervention will be compared. Additionally, providers will receive an active program of knowledge transfer about WHO recommendations for preecl sia, including recommendations regarding antenatal corticosteroids for foetal benefits, antihypertensive therapy and magnesium sulphate for seizure prophylaxis. This study will have 90% power to detect a reduction in PTB associated with PE from a population estimate of 1.5 to 1.0%, representing a 33% risk reduction, and 80% power to detect a reduction from 2.0 to 1.5% (25% risk reduction). The necessary number of patients recruited to achieve these results is 750. Adverse events, serious adverse events, both anticipated and unanticipated will be recorded. The PREPARE intervention expects to reduce PTB and improve care of women with PE without significant adverse side effects. If successful, this novel pathway of care is designed for rapid translation to healthcare throughout Brazil and may be transferrable to other low and middle income countries. ClinicalTrials.gov : NCT03073317.
Publisher: Springer Science and Business Media LLC
Date: 07-07-2022
DOI: 10.1186/S13104-022-06107-Y
Abstract: To determine the efficacy and safety of sildenafil citrate to improve outcomes in pregnancies complicated by early-onset, dismal prognosis, fetal growth restriction (FGR). Eligibility: women ≥ 18 years, singleton, 18 + 0–27 + 6 weeks’ gestation, estimated fetal weight 700 g, low PLFG, and ≥ 1 of (i) abdominal circumference 10th percentile for gestational age (GA) or (ii) reduced growth velocity and either abnormal uterine artery Doppler or prior early-onset FGR with adverse outcome. Ineligibility criteria included: planned termination or reversed umbilical artery end-diastolic flow. Eligibility confirmed by placental growth factor (P l GF) 5 th percentile for GA measured post randomization. Women randomly received (1:1) either sildenafil 25 mg three times daily or matched placebo until either delivery or 31 + 6 weeks. Primary outcome: delivery GA. The trial stopped early when Dutch STRIDER signalled potential harm despite distinct eligibility criteria and IRB and DSMB support to continue, because of futility. NCT02442492 [registered 13/05/2015]. Between May 2017 and June 2018, 21 (90 planned) women were randomised [10 sildenafil 11 placebo (1 withdrawal)]. Baseline characteristics, P l GF levels, maternal and perinatal outcomes, and adverse events did not differ. Delivery GA: 26 + 6 weeks (sildenafil) vs 29 + 2 weeks (placebo) p = 0.200. Data will contribute to an in idual participant data meta-analysis.
Publisher: Wiley
Date: 09-03-2023
Abstract: Linked article : This is a mini commentary on Hauspurg et al., pp. 715–726 in this issue. To view this article visit 0.1111/1471‐0528.17381 .
Publisher: Elsevier BV
Date: 2005
DOI: 10.1016/S1701-2163(16)30168-2
Abstract: To determine whether neonatal intensive care unit (NICU) outcomes vary by centre for inborn neonates of hypertensive pregnancies and, if so, whether that variation might be related to between-centre variations in obstetric practice. The study comprised a prospective cohort of 13 505 singleton neonates admitted to 17 Canadian NICUs. Adjusting for potential confounders, we used multivariate regression to analyze the relation between centre of delivery and 6 dependent variables: (1) Apgar score or = 10 (3) neonatal death (4) neonatal death or morbidity (owing to bronchopulmonary dysplasia [BPD], intraventricular hemorrhage [IVH], necrotizing enterocolitis [NEC], persistent ductus arteriosus [PDA], or periventricular leukomalacia [PVL]) (5) BPD alone and (6) major neonatal morbidity (that is, at least one of IVH, PVL, NEC, or PDA). NICU practices known to influence these outcomes were included in the modelling for neonatal death and neonatal morbidity. In a sensitivity analysis for practice variation, antenatal steroid exposure was both included and excluded in each regression. For 5 of the 6 dependent variables, we identified between-centre variation that was not explained solely by variation in antenatal corticosteroid use. Adjusted odds ratios varied from 0.11 to 5.6 (the reference centre was the median rate of the adverse outcome). In the pregnancy hypertension setting, between-centre variations in practice are associated with variations in neonatal physiology and survival. For infants admitted to NICU, the obstetric management of hypertensive pregnancies appears to have an effect on both short- and medium-term neonatal outcomes, even after correction for NICU management.
Publisher: Wiley
Date: 12-01-2005
DOI: 10.1111/J.1471-0528.2004.00483.X
Abstract: This trial compared two instruments for transcervical chorionic villus s ling (CVS). Randomised controlled trial. Regional university prenatal diagnosis and treatment centre. Two hundred women were randomised at 10(+0)-12(+6) weeks of gestation to transcervical CVS using cannula aspiration (CA) or biopsy forceps (BF). Women undergoing indicated CVS signed informed consent. Randomisation after decision to perform transcervical CVS. the rise in maternal serum alpha-fetoprotein (alpha-FP). (i) placental trauma (fetomaternal haemorrhage [FMH]) (ii) laboratory, procedure, and cytogenetic results and pregnancy outcomes (iii) patient and operator satisfaction and (iv) economic analyses. Analyses were performed by intention to treat. The -FP rise did not differ between groups there was no other evidence of placental trauma. BF were better tolerated by women, provided culturable tissue, after fewer instrument passes, with greater ease and in less time. BF were associated with cost savings. Unlike -FP, other markers of FMH were unaltered, questioning the reliability of alpha-FP as an indicator of FMH. Compared with CA, transcervical BF caused comparable placental trauma, appeared to be similarly effective and safe and were preferred by operators and patients.
Publisher: Elsevier BV
Date: 10-2016
DOI: 10.1016/J.JOGC.2016.06.013
Abstract: To assess the performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) mortality prediction model in pregnant and recently pregnant women receiving critical care in low-, middle-, and high-income countries during the study period (1985-2015), using a structured literature review. Ovid MEDLINE, Embase, Web of Science, and Evidence-Based Medicine Reviews, searched for articles published between 1985 and 2015. Twenty-five studies (24 publications), of which two were prospective, were included in the analyses. Ten studies were from high-income countries (HICs), and 15 were from low- and middle-income countries (LMICs). Median study duration and size were six years and 124 women, respectively. ICU admission complicates 0.48% of deliveries, and pregnant and recently pregnant women account for 1.49% of ICU admissions. One quarter were admitted while pregnant, three quarters of these for an obstetric indication and for a median of three days. The median APACHE II score was 10.9, with a median APACHE II-predicted mortality of 16.6%. Observed mortality was 4.6%, and the median standardized mortality ratio was 0.36 (interquartile range 0.23 to 0.73). The standardized mortality ratio was < 0.9 in 24 of 25 studies. Women in HICs were more frequently admitted with a medical comorbidity but were less likely to die than were women in LMICs. The APACHE II score consistently overestimates mortality risks for pregnant and recently pregnant women receiving critical care, whether they reside in HICs or LMICs. There is a need for a pregnancy-specific outcome prediction model for these women.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2021
DOI: 10.1161/HYPERTENSIONAHA.120.16851
Abstract: In pregnancy in well-resourced settings, limited data suggest that higher blood pressure (BP) visit-to-visit variability may be associated with adverse pregnancy outcomes. Included were pregnant women in 22 intervention clusters of the CLIP (Community-Level Interventions for Preecl sia) cluster randomized trials, who had received at least 2 prenatal contacts from a community health worker, including standardized BP measurement. Mixed-effects adjusted logistic regression assessed relationships between pregnancy outcomes and both BP level (median [interquartile range]) and visit-to-visit variability (SD and average real variability [ARV], adjusted for BP level), among all women and those who became hypertensive. The primary outcome was the CLIP composite of maternal and perinatal mortality and morbidity. Among 17 770 pregnancies, higher systolic and diastolic BP levels were associated with increased odds of the composite outcome per 5 mm Hg increase in BP (odds ratio [OR], 1.05 [95% CI, 1.03–1.07] and OR, 1.08 [1.06–1.11], respectively). Higher BP visit-to-visit variability was associated with increased odds, per a SD increase in BP variability measure, of (1) hypertension (systolic: OR, 2.09 [1.98–2.21] for SD and 1.52 [1.45–1.60] for ARV diastolic: OR, 2.70 [2.54–2.87] for SD and 1.86 [1.76–1.96] for ARV) and (2) the composite outcome (systolic: OR, 1.10 [1.06–1.14] for SD and 1.06 [1.02–1.10] for ARV diastolic: OR, 1.07 [1.03–1.11] for SD and 1.06 [1.02–1.09] for ARV). In 3 less-developed countries, higher BP level and visit-to-visit variability predicted adverse pregnancy outcomes, providing an opportunity for high-definition medicine.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2017
DOI: 10.1161/HYPERTENSIONAHA.117.10150
Abstract: The PlGF (placental growth factor) has been largely demonstrated to be associated with the diagnosis of the hypertensive disorders of pregnancy (HDPs) however, it is unclear how useful it is for the prognosis of the condition. Our objective was to provide a summary of important findings of its prognostic ability by systematically reviewing studies that examined the ability of the PlGF, either independently or combined with other factors, to predict maternal and fetal complications resulting from the HDPs. We included studies published before January 30, 2017, reporting on the use of the PlGF as a prognostic test for women with confirmed HDPs or suspected preecl sia. Of the 220 abstracts identified through MEDLINE, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature), 17 studies were eligible for our review. Prognostic performance was evaluated by sensitivity, specificity, likelihood ratios, and area under the receiver operating characteristic curve. PlGF showed moderate-to-high evidence (likelihood ratios of ≥5 or ≤0.2 or area under the receiver operating characteristic curves ≥0.70) for identifying women at the highest risk of preterm delivery or neonatal outcomes (10/12 studies) but showed no clinically useful performance for the prediction of adverse maternal outcomes. PlGF may aid in the management of women with HDPs to avert fetal complications. Future studies should determine an optimum threshold for the marker to guide delivery and should examine whether its use for predicting adverse maternal outcomes in women with HDPs can be improved.
Publisher: Informa UK Limited
Date: 06-09-2010
DOI: 10.3109/10641950903242642
Abstract: The maternal syndrome of preecl sia results from systemic endothelial activation by a number of factors that primarily derive from the intervillous space, so-called intervillous soup. Co-precipitants, such as innate immune activators, may lower the threshold to develop the maternal syndrome in preecl sia. We examined whether, like atherosclerosis, preecl sia is associated with infection with Chlamydia pneumoniae (C. pneumoniae). A case-control study was performed on 50 women with preecl sia, 57 women with normal pregnancies at term, and 25 non-pregnant controls. Anti-C. pneumoniae antibodies were examined by enzyme-linked immunosorbent assay and C. pneumoniae genomic DNA (gDNA) loads were measured by real-time PCR. We also performed a data synthesis of the relationship between anti-C. pneumoniae seroprevalence and preecl sia risk. Neither the number of women with measurable copy numbers of C. pneumoniae gDNA, the anti-C. pneumoniae seroprevalence, nor antibody indices of IgG, IgM, or IgA to C. pneumonia varied between groups. However, when measurable, gDNA copy numbers of C. pneumoniae were increased in women with preecl sia compared with the normal pregnant (p < 0.05) and non-pregnant controls (p < 0.05). For women with measurable C. pneumoniae gDNA, their copy numbers were correlated with anti-C. pneumoniae IgG concentrations (r2 = 0.49 p < 0.0001). Data synthesis reveals that anti-C. pneumoniae IgG seroprevalence is associated with preecl sia risk. Our data suggest an association between C. pneumoniae infection and preecl sia. While not a uniform and singular precipitant of the maternal syndrome of preecl sia, C. pneumoniae infection may be a co-precipitant with other components of the intervillous soup. Further investigations appear warranted.
Publisher: American Medical Association (AMA)
Date: 18-08-2020
Publisher: Elsevier BV
Date: 02-2014
Publisher: Elsevier BV
Date: 04-2007
Publisher: Elsevier BV
Date: 06-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 25-03-2021
Publisher: BMJ
Date: 27-07-2020
DOI: 10.1136/BMJ.M2915
Publisher: Springer Science and Business Media LLC
Date: 06-2016
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/S1701-2163(16)30047-0
Abstract: Magnesium sulphate (MgSO4) has been recommended for fetal neuroprotection to prevent cerebral palsy, with national societies adopting new guidelines for its use. A knowledge translation project to implement Canadian guidelines is ongoing. Discussion about MgSO4 for fetal neuroprotection could not occur distinct from MgSO4 for ecl sia prophylaxis and treatment. Thus, in order to explore standardization of MgSO4 use in Canada, we sought to compare local protocols for ecl sia and fetal neuroprotection across tertiary perinatal centres. Twenty-five Canadian tertiary perinatal centres were asked to submit their protocols for use of MgSO4 for ecl sia prophylaxis/treatment and fetal neuroprotection. Information abstracted included date of protocol, definitions of indications for treatment, details of MgSO4 administration, maternal and fetal monitoring, antidote for toxicity, and abnormal signs requiring physician attention. Descriptive analyses were used to compare site protocols with known definitions of preecl sia. Data from the Canadian Perinatal Network (CPN) were used to verify what was done in clinical practice. Twenty-two of the 25 centres submitted protocols for ecl sia prevention/treatment. Eleven of these provided a definition of preecl sia that warranted treatment five of the 22 advised treatment of severe preecl sia only. Criteria for treatment and monitoring procedures varied across centres. Sixteen of the 22 sites with protocols had data from the CPN. Of 635 women with pre-ecl sia, 422 (66.5%) received MgSO4. Twenty of 25 centres provided protocols for fetal neuroprotection. Definitions of indications were consistent across sites, except for gestational age cut-off. This study suggests that local protocols are often inconsistent with published evidence. While this may be related to local institutional practices, relevant processes must be put in place to maximize uniformity of practice and improve patient care.
Publisher: Elsevier BV
Date: 06-2011
Publisher: Elsevier BV
Date: 2006
DOI: 10.1016/J.PLACENTA.2004.11.007
Abstract: Syncytiotrophoblast microparticles (STBM) are shed into the maternal circulation in higher amounts in pre-ecl sia compared to normal pregnancy and are believed to be the stimulus for the systemic inflammatory response and endothelial cell damage which characterises the maternal syndrome. The excess shedding of STBM may be caused by hypoxia as a result of poor placentation, which is often a feature of pre-ecl sia. Similar placental pathology occurs in some cases of normotensive intrauterine growth restriction (nIUGR), but in the absence of maternal disease. To examine whether the shedding of STBM in nIUGR occurs to the same extent as in pre-ecl sia. A prospective case-control study in a tertiary referral centre of: 1) women with early-onset pre-ecl sia (EOPET or = 34 week), 3) women with nIUGR), 4) matched normal pregnant women (NPC), and 5) non-pregnant women. An ELISA using the antitrophoblast antibody NDOG2 was used to measure STBM levels in peripheral venous plasma. Non-parametric analyses were conducted with statistical significance set at p < 0.05. STBM levels rise during normal pregnancy. EOPET was associated with increased STBM levels (EOPET (median): 41 ng/ml, n = 15) compared with matched normal pregnancy (16 ng/ml, n = 15 Wilcoxon p = 0.005). LOPET (50 ng/ml, n = 10) and nIUGR (18 ng/ml, n = 8) STBM levels did not differ from matched normal pregnancy (36 ng/ml, n = 15, and 36 ng/ml, n = 8, respectively). Background levels in non-pregnant plasma were 0.49 ng/ml, n = 10. Increased STBM levels were found in EOPET but not in nIUGR providing further evidence for their role in the pathogenesis of the maternal syndrome.
Publisher: Elsevier BV
Date: 11-2015
Publisher: Elsevier BV
Date: 09-2021
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.MAYOCP.2018.04.033
Abstract: Hypertension complicates up to 10% of pregnancies worldwide. Pregnancy hypertension is defined as systolic blood pressure (BP) equal to or greater than 140 mm Hg or diastolic BP equal to or greater than 90 mm Hg, usually on the basis of measurements in office/clinic settings and using various BP devices. Hypertensive disorders of pregnancy are classified into (1) chronic hypertension diagnosed before pregnancy or before 20 weeks' gestation, (2) gestational hypertension diagnosed at equal to or greater than 20 weeks, or (3) preecl sia, defined restrictively as gestational hypertension with proteinuria or broadly as gestational hypertension with proteinuria or an end-organ manifestation consistent with preecl sia. Absolute BP values equal to or greater than 140/90 mm Hg are associated with increased maternal and perinatal risks, particularly with preecl sia. This review focuses on antihypertensive therapy of hypertensive disorders of pregnancy as a specific management strategy. Underpinning this therapy is the need for accurate measurement of BP, agreed-upon classification of pregnancy hypertension, agreed-upon BP thresholds for enhanced surveillance and antihypertensive treatment, and collaborative teamwork in management. Challenges relate to the methodology of studies on which care is based, as well as aspects of the care itself, particularly the unregulated use of home BP monitoring. Pitfalls include the unsubstantiated belief that nifedipine and magnesium sulfate cannot be used together and the perception that severe hypertension and nonsevere hypertension are separate entities rather than lying along a spectrum of BP values. The following must be addressed by future research: guidance for nuanced care as women transition between severe and nonsevere hypertension, personalized antihypertensive therapy, and incorporation of women's values into research priorities and clinical practice when antihypertensive care is chosen.
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.EJOGRB.2019.08.007
Abstract: Severe early-onset fetal growth restriction (FGR) predisposes to fetal death, neonatal death, neonatal morbidity and neurodisability. The use of placental biomarkers has been proposed for risk stratification in pre-ecl sia, but they could be equally useful in fetal growth restriction in aiding management. To determine the efficacy of angiogenic biomarkers at predicting adverse pregnancy outcome in severe early-onset fetal growth restriction. This is a secondary analysis of the multicentre, placebo-controlled STRIDER UK randomised controlled trial of singleton pregnancies with severe early-onset fetal growth restriction. Women with FGR pregnancies between 22 A complete data set was available for 105 of 135 randomised women. Multivariate regression analysis identified estimated fetal weight (EFW) and sFlt-1:PlGF as independent predictors of livebirth (EFW OR: 1.01 (1.008, 1.021) p < 0.001 and lower sFlt-1:PlGF ratio OR: 0.53 (0.284, 0.994) p = 0.048) and overall survival (EFW OR: 1.01 (1.006, 1.015) p < 0.001 and lower sFlt-1/PlGF ratio OR: 0.51 (0.286, 0.904) p = 0.021). EFW was a consistent predictor for all outcomes other than gestation at delivery. sFlt-1:PlGF ratio was a consistent predictor for all outcomes other than neonatal morbidity. In severe early-onset FGR pregnancies livebirth and overall survival can be predicted using a model involving EFW and sFlt-1:PlGF ratio. This model require validation in a larger cohort but may allow informed decision making about pregnancy management, especially in previable cases.
Publisher: Springer Science and Business Media LLC
Date: 10-05-2022
DOI: 10.1038/S41467-022-30052-W
Abstract: Safety and effectiveness of COVID-19 vaccines during pregnancy is a particular concern affecting vaccination uptake by this vulnerable group. Here we evaluated evidence from 23 studies including 117,552 COVID-19 vaccinated pregnant people, almost exclusively with mRNA vaccines. We show that the effectiveness of mRNA vaccination against RT-PCR confirmed SARS-CoV-2 infection 7 days after second dose was 89·5% (95% CI 69·0-96·4%, 18,828 vaccinated pregnant people, I 2 = 73·9%). The risk of stillbirth was significantly lower in the vaccinated cohort by 15% (pooled OR 0·85 95% CI 0·73–0·99, 66,067 vaccinated vs. 424,624 unvaccinated, I 2 = 93·9%). There was no evidence of a higher risk of adverse outcomes including miscarriage, earlier gestation at birth, placental abruption, pulmonary embolism, postpartum haemorrhage, maternal death, intensive care unit admission, lower birthweight Z-score, or neonatal intensive care unit admission ( p 0.05 for all). COVID-19 mRNA vaccination in pregnancy appears to be safe and is associated with a reduction in stillbirth.
Publisher: Wiley
Date: 04-2016
Publisher: Elsevier BV
Date: 02-2018
Location: Australia
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2009
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Funder: Canadian Institutes of Health Research
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Funder: Canadian Institutes of Health Research
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Funder: Canadian Institutes of Health Research
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Funder: Canadian Institutes of Health Research
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Funder: Canadian Institutes of Health Research
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Funder: Canadian Institutes of Health Research
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Funder: Medical Research Council
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Funder: Michael Smith Foundation for Health Research
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Funder: Bill and Melinda Gates Foundation
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Funder: Wellcome Trust
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Funder: Canadian Institutes of Health Research
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Funder: Canadian Institutes of Health Research
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Funder: Canadian Institutes of Health Research
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Funder: Canadian Institutes of Health Research
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Funder: Canadian Institutes of Health Research
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Funder: Wellcome Trust
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Funder: Medical Research Council
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