We evaluated the utility of placental volume and three-dimensional (3D) vascular flow indices to predict early and late preeclampsia.
In 1,004 pregnancies attending routine care, we recorded ...first-trimester screening program for aneuploidy (FTSA) parameter and measured uterine artery pulsatility index (uterine-a PI). Placental volume and vascular flow indices were obtained using 3D power Doppler and VOCAL techniques.
Placental volume was lower and uterine-a PI was higher in both early and late preeclampsia groups versus nonaffected pregnancies. The prediction rate of placental volume in late preeclampsia was higher than that of uterine-a PI (AUROC 0.707 vs. 0.581, p < 0.011). The inclusion of placental volume improved significantly the prediction rate of total and late preeclampsia in the models constructed with maternal characteristics, FTSA, and uterine-a PI (AUROC 0.745 vs. 0.818, p < 0.004, and 0.740 vs. 0.812, p < 0.012, respectively). The inclusion of vascular indices did not improve the predictive value of these models.
Placental volume was an independent predictor of total, early, and late preeclampsia and its inclusion in combined predictive models significantly improved prediction rates. Reduced placental volume observed at first trimester in women with early and late preeclampsia suggests that these entities are the clinical expression of a similar pathophysiological process.
Customized weight curves for Spanish fetuses and newborns González González, Nieves Luisa; González Dávila, Enrique; Cabrera, Francisco ...
The journal of maternal-fetal & neonatal medicine,
09/2014, Letnik:
27, Številka:
14
Journal Article
Recenzirano
Abstract
Objectives: To construct a model of customized birthweight curves for use in a Spanish population.
Materials and methods: Data of 20 331 newborns were used to construct a customized ...birthweight model. Multiple regression analysis was performed with newborn weight as the dependent variable and gestational age (GA), sex and maternal (M) weight, height, parity and ethnic origin as the independent variables. Using the new model, 27 507 newborns were classified as adequate for GA (AGA), large for GA (LGA) or small for GA (SGA). The results were compared with those of other customized and non-customized models.
Results: The resulting formula for the calculation of optimal neonatal weight was:
Optimum weight (g) = 3289.681 + 135.413*GA40-14.063*GA402-0.838*GA403 + 113.889 (if multiparous) + 165.560 (if origin = Asia) + 161.550 (South America) + 67.927 (rest of Europe) +109.265 (North Africa) + 9.392*Maternal-Height + 4.856*Maternal-Weight-0.098*Maternal-Weight2 + 0.001*Maternal-Weight3 + 67.188*Sex + GA40*(6.890*Sex + 9.032 (If multiparous) +0.006*Maternal-Height3 + 0.260*Maternal-Weight) + GA402 (−0.378*Maternal-Height - 0.008*Maternal-Height2) + GA403 (−0.032*Maternal-Height).
Weight percentiles were obtained from standard data using optimum weight variation coefficient. Agreement between our customized model and other Spanish models was "good" (κ = 0.717 and κ = 0.736; p < 0.001).
Conclusions: Our model is comparable to other Spanish models, but offers the advantage of being customized, updated and freely available on the web. The 30.6% of infants classified as SGA using our model would be considered as AGA following a non-customized model.
Objective
To analyze the effects of substituting the National Diabetes Data Group (NDDG) criteria with the International Association of Diabetes and Pregnancy Study Groups (IADPSG) or American ...Diabetes Association (ADA) criteria for the diagnosis of early‐onset gestational diabetes mellitus (Early‐GDM) or first trimester abnormal glucose tolerance (1 t‐AGT).
Methods
A retrospective cohort study was conducted of 3200 women: 400 with Early‐GDM, 800 with GDM, and 2000 with Non‐GDM, according to the NDDG criteria. Rates of women with missed and new Early‐GDM according to the IADPSG or ADA criteria were calculated. Multivariate logistic regression analysis was used to compare perinatal outcomes between groups.
Results
Using the IADPSG criteria, 61.6% of women with Early‐GDM according to the NDDG were undiagnosed (Missed‐Early‐GDM group), and 25.9% of women with GDM and 15.7% of women with Non‐GDM were diagnosed with Early‐GDM (New‐Early‐GDM groups). Perinatal outcomes were worse in Missed‐Early‐GDM than in Non‐GDM and better in New‐Early‐GDM groups than in the Early‐GDM group. According to the ADA recommendations, only 11.8% of women with Early‐GDM according to the NDDG criteria were diagnosed.
Conclusion
Replacing the NDDG recommendations for the diagnosis of Early‐GDM with the IADPSG or ADA criteria would mean depriving a large number of women with AGT and higher risk of adverse perinatal outcomes from early treatment and treating others with lower risk.
Synopsis
Using the IADPSG or the ADA criteria, 61.6% and 88.2% of women with early‐onset gestational diabetes according to the two‐step approach, respectively, were undiagnosed.
Abstract Objective To evaluate the utility of first-trimester placental volume and vascular flow indices to predict intrauterine growth retardation (IUGR). Study Design In 1004 singleton pregnancies ...attending routine care we recorded maternal characteristics, biophysical and biochemical factors included in the first trimester screening for aneuploidy (FTSA) and uterine artery pulsatility index (PI). Placental volume, Vascularization Index, Flow Index and Vascularization Flow Index were obtained. Customized curves were used to define IUGR. We compared pregnancies with and without IUGR. The performance of different predictive models was described by the areas under the receiver operator characteristic (AUROC) curve. Predictive models of IUGR were compared using a two by two approach and subset analysis was performed. Results Placental volume and all vascular indices were significantly lower (p < 0.001, p ≤ 0.01), and uterine artery PI higher (p < 0.001), in pregnancies with IUGR, with and without associated pre-eclampsia. Results obtained in the analysis of homogeneous subsets showed that the effectiveness of combined predictive models for IUGR improved significantly after adding vascular indices or placental volume to maternal characteristics, FTSA variables and uterine artery PI (AUROC curve value 0.703 (95% CI 0.663–0.744) versus 0.720 (95% CI 0.681–0.759) and 0.735 (95% CI 0.696–0.733), respectively). The most effective model at first trimester was that which included only maternal characteristics, uterine a-PI and placental volume, similar to that of the most complex model built with all the factors analyzed in this study (AUROC curve value 0.735 (95% CI 0.696–0.773). Conclusions Placental volume and vascular indices were predictors factors of IUGR at first trimester. The effectiveness of combined predictive models for IUGR increased significantly after adding these factors, but the sensitivity of these models was too low for them to be considered useful in clinical practice.
To describe different models of multidisciplinary pregnancy care for patients with inflammatory and autoimmune rheumatic diseases, and the steps to follow concerning their implementation.
A ...qualitative study was conducted including: (1) a comprehensive literature search in PUBMED focused on multidisciplinary care models; (2) structured interviews with seven rheumatologists from multidisciplinary pregnancy clinics for patients with inflammatory and autoimmune rheumatic diseases. Data were collected related to the hospitals, medical departments, populations cared for, and multidisciplinary care models (type, material, and human resources, professional requirements, objectives, referral criteria, agendas, protocols, responsibilities, decision-making, research and educational activities, multidisciplinary clinical sessions, initiation/start, planning, advantages/disadvantages, and barriers/facilitators for implementation); (3) a nominal meeting group in which the results of searches and interviews were analyzed and the recommendations for the implementation of the multidisciplinary care models defined.
We analyzed seven models of multidisciplinary care in pregnancy, implemented 3-10 years ago, which can all be summarized by two different subtypes: parallel (patients are assessed the same day in the involved medical services) and preferential (patients are assessed on different days in the involved medical services) circuits. The implementation of a specific model results rather from an adaptation to the hospital's and professionals' circumstances. Correct planning and good harmony among professionals are key points to implementing a model.
Different multidisciplinary care models have been implemented for patients with inflammatory and autoimmune rheumatic diseases during pregnancy. They pretend to improve care, system efficiency, and collaboration among specialists and should be carefully implemented.
Objective: The aim of this study was to evaluate pregnancy complications and obstetric and perinatal outcomes in women with twin pregnancy and GDM. Study Design: An observational multicentre ...retrospective study was performed and 534 pregnant woman and 1068 twins infants allocated into two groups, 257 with GDM and 277 controls, were studied. Main Outcome Measures: Pregnant women characteristics, hypertensive complications, preterm delivery rate, mode of delivery and birthweight were analysed. Results: Pregnant women with GDM were older (p < 0.001) and had higher body mass index (p < 0.001) than controls. GDM was associated with higher risk of prematurity in twin pregnancy (odds ratio 1.64, 95% confidence interval 1.14-2.32, p = 0.005). This association was based on the association with other pregnancy complications. Birthweight Z-scores were significantly higher in the GDM group (p = 0.02). The rate of macrosomia was higher in the GDM group (p = 0.002) and small for gestational age (SGA) babies were significantly less frequent (p = 0.03). GDM was an independent predictor of macrosomia (p = 0.006). Conclusion: The presence of GDM in twin pregnancy was associated with a higher risk of hypertensive complications, prematurity and macrosomia, but significantly reduces the risk of SGA infants. Prematurity was related to the presence of other associated pregnancy complications.
Abstract
Objectives: To find the best early predictor model for fetal growth and large for gestational age (LGA) infants considering clinical, ultrasonographic and biochemical variables.
Method: In ...2097 singleton pregnancies at first trimester, we evaluated maternal characteristics, PAPP-A and ß-HCG proteins, fetal nuchal translucency thickness and uterine artery pulsatility index (UtA-PI). At second trimester fetal ultrasound biometry and UtA-PI were then measured. The relationships between birth weight and LGA and maternal characteristics, first and second trimester variables, and all variables combined, were studied. The performance of screening was determined by receiver operating characteristic curves analysis.
Results: Stepwise regression analysis showed that in the prediction of birthweight percentile there were significant contributions from all maternal factors, PAPP-A and Ut-A PI in the first trimester, and fetal biometric variables in the second trimester. Maternal charateristics combined with PAPP-A, β-hCG, fetal NT and uterine artery PI identified 30.2 % LGA (FPR 10%). The combined model reached a sensitivity of 41.2% (FPR 10%) and 56.2% (FPR 20%).
Conclusions: Sensitivity of the screening for LGA improves significantly after addition of second trimester ultrasound measurements to first trimester variables and maternal characteristics.
Objective: To determine the effect of using customized vs. standard population birthweight curves to define large for gestational age (LGA) infants. Methods: We analyzed data obtained from 2,097 ...singleton pregnancies using three different methods of classifying newborn birthweight: standard population curves, British or Spanish customized curves. We recorded maternal characteristics, proportion of LGA newborns when using each method, percentage of LGA according to one method but not for the others, and concordance between the different methods. Results: The proportion of LGA newborns according to Spanish customized curves was significantly lower than that calculated using either standard general population birthweight curves or British curves (p < 0.001). A third (33.9%) of the infants classified as LGA according to the general population method were adequate for gestational age (AGA) when the Spanish customized curves were used, and 18.5% of non-LGA were LGA according to customized curves (p < 0.001). Concordance between the different models high, but on excluding AGA the concordance coefficient was low (Cohen's κ <0.4). Conclusions: The use of customized curves allows differentiation between constitutional LGA and cases of fetal overgrowth, leading to a decrease in the rate of both false-positives and negatives as well as the overall proportion of LGA babies.
ICTUS ISQUÉMICO EN PUÉRPERA SECUNDARIO A EMBOLISMO PARADÓJICO Padilla Pérez, Ana Isabel; de la Torre Fernández de Vega, Javier; Carballo Lorenzo, Janet ...
Revista chilena de obstetricia y ginecología,
2010, Letnik:
75, Številka:
5
Journal Article
Odprti dostop
El infarto cerebral durante el embarazo o puerperio es una complicación grave que causa alta morbimortalidad materna. Presentamos el caso de una mujer previamente sana, de 32 años de edad, que sufrió ...embolismo cerebral posparto. La ecocardiografía confirma la presencia de foramen oval permeable, que puede ser causa de embolismo paradójico, causando un accidente vascular cerebral transitorio o infarto. Para prevenir episodios recurrentes de embolismo cerebral durante el embarazo, parto o puerperio, se realizó el cierre intervencional del foramen oval sin complicaciones.
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