Induction of labour (IOL) is an increasingly common obstetric intervention globally. There is a choice of mechanical or pharmacological methods for induction of labour when the cervix is unfavorable. ...Which approach is both effective and safe however is not clear due to how trials are designed and reported. A tradeoff between the common primary outcomes of vaginal birth or time to delivery and rare safety outcomes mean trials are underpowered to determine both. There is also a lack of reporting of the indications for the operative births (prolonged labour or fetal compromise) and their relationship to each IOL method. We recommend that future trials should be large enough to adequately assess both effectiveness and safety outcomes, and that the indications for operative birth are also reported. This article is protected by copyright. All rights reserved.
Maternal creatine in pregnancy: a retrospective cohort study Dickinson, H; Davies‐Tuck, M; Ellery, SJ ...
BJOG : an international journal of obstetrics and gynaecology,
October 2016, 2016-Oct, 2016-10-00, 20161001, Letnik:
123, Številka:
11
Journal Article
Recenzirano
Odprti dostop
Objective
To estimate creatine concentrations in maternal plasma and urine, and establish relationships with maternal characteristics, diet and fetal growth.
Design
Retrospective cohort study.
...Setting
Lyell McEwin Hospital, Adelaide, Australia.
Population
A biobank of plasma and urine samples collected at 13, 18, 30 and 36 weeks’ gestation from 287 pregnant women from a prospective cohort of asthmatic and non‐asthmatic women.
Methods
Creatine was measured by enzymatic analysis. Change in creatine over pregnancy was assessed using the Friedman test. Linear mixed models regression was used to determine associations between maternal factors and diet with creatine across pregnancy and between creatine with indices of fetal growth at birth.
Main outcome measures
Maternal creatine concentrations, associations between maternal factors and creatine and between creatine and fetal growth parameters.
Results
Maternal smoking, body mass index, asthma and socio‐economic status were positively and parity negatively associated with maternal plasma and/or urine creatine. Maternal urine creatine concentration was positively associated with birthweight centile and birth length. After adjustment, each μmol/l increase in maternal urinary creatine was associated with a 1.23 (95% CI 0.44–2.02) unit increase in birthweight centile and a 0.11‐cm (95% CI 0.03–0.2) increase in birth length.
Conclusions
Maternal factors and fetal growth measures are associated with maternal plasma and urine creatine concentrations.
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Maternal creatine is altered by pregnancy; fetal growth measures are associated with maternal creatine concentrations.
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Maternal creatine is altered by pregnancy; fetal growth measures are associated with maternal creatine concentrations.
Although bone marrow lesions (BML) have been implicated in the pathogenesis of osteoarthritis, their natural history in a healthy population is unknown. This study in a healthy, pain-free population ...aimed to examine the natural history of BML; factors associated with incidence and progression of BML over 2 years and whether incident BML are associated with the development of pain.
271 subjects with no clinical knee osteoarthritis, being pain free at baseline, underwent magnetic resonance imaging of their dominant knee at baseline and 2 years later. The presence of BML was assessed.
In knees initially free of BML, incident BML developed in 14% of people over the study period. Increased body mass index (BMI; odds ratio (OR) 1.15, 95% CI 1.06 to 1.2, p = 0.001) was associated with incident BML. Those who developed a BML were more likely to develop knee pain compared with those in whom no BML developed (OR 4.2, 95% CI 1.2 to 15.1, p = 0.03). Among those in whom BML were present at baseline, 46% completely resolved. There was no association between age, gender and BMI and persistence of BML over 2 years.
In this healthy population, the rate of incident BML is lower than previously described in a population with osteoarthritis. Incident BML are associated with increased BMI and the development of pain. Approximately half the BML present at baseline resolved. These data suggest that in pain-free people with no clinical knee osteoarthritis, BML are reversible and may provide a target for interventions aimed at the prevention of knee osteoarthritis.
In 2015, the stillbirth rate after 28 weeks (late gestation) in Australia was 35% higher than countries with the lowest rates globally. Reductions in late gestation stillbirth rates have steadily ...improved in Australia. However, to amplify and sustain reductions, more needs to be done to reduce practice variation and address sub-optimal care. Implementing bundles for maternity care improvement in the UK have been associated with a 20% reduction in stillbirth rates. A similar approach is underway in Australia; the Safer Baby Bundle (SBB) with five elements: 1) supporting women to stop smoking in pregnancy, 2) improving detection and management of fetal growth restriction, 3) raising awareness and improving care for women with decreased fetal movements, 4) improving awareness of maternal safe going-to-sleep position in late pregnancy, 5) improving decision making about the timing of birth for women with risk factors for stillbirth.
This is a mixed-methods study of maternity services across three Australian states; Queensland, Victoria and New South Wales. The study includes evaluation of 'targeted' implementer sites (combined total approximately 113,000 births annually, 50% of births in these states) and monitoring of key outcomes state-wide across all maternity services. Progressive implementation over 2.5 years, managed by state Departments of Health, commenced from mid-2019. This study will determine the impact of implementing the SBB on maternity services and perinatal outcomes, specifically for reducing late gestation stillbirth. Comprehensive process, impact, and outcome evaluations will be conducted using routinely collected perinatal data, pre- and post- implementation surveys, clinical audits, focus group discussions and interviews. Evaluations explore the views and experiences of clinicians embedding the SBB into routine practice as well as women's experience with care and the acceptability of the initiative.
This protocol describes the evaluation of the SBB initiative and will provide evidence for the value of a systematic, but pragmatic, approach to strategies to reduce the evidence-practice gaps across maternity services. We hypothesise successful implementation and uptake across three Australian states (amplified nationally) will be effective in reducing late gestation stillbirths to that of the best performing countries globally, equating to at least 150 lives saved annually.
The Safer Baby Bundle Study was retrospectively registered on the ACTRN12619001777189 database, date assigned 16/12/2019.
To compare information obtained from preterm magnetic resonance imaging (MRI; 31-34 weeks) brain scan to that done at term equivalent age.
Prospective observational study of premature infants with ...evidence or suspicion of parenchymal brain injury on cranial ultrasound. Brain injury on two scans scored using a scoring system and analyzed.
Fourteen infants with a median (range) gestation at birth of 28 (25-29) weeks and birth weight of 1254 (680-1557) grams were studied. There was a strong correlation between the brain injury scores for the two scans (Spearman ρ=0.87, P=0.001) with excellent agreement between two radiologists (interclass correlation coefficient 0.9-0.94). There was also a high level of agreement between the preterm and term MRI two scores (Intraclass correlation coefficient, 0.79 (0.53-0.94)).
Preterm MRI is a feasible option for the assessment of preterm brain injury and analysis of data obtained from scan at preterm age is comparable to that obtained at term equivalent age.
Does natural variation exist in the endometrial stem/progenitor cell and protein composition of menstrual fluid across menstrual cycles in women?
Limited variation exists in the percentage of some ...endometrial stem/progenitor cell types and abundance of selected proteins in menstrual fluid within and between a cohort of women.
Menstrual fluid is a readily available biofluid that can represent the endometrial environment, containing endometrial stem/progenitor cells and protein factors. It is unknown whether there is natural variation in the cellular and protein content across menstrual cycles of individual women, which has significant implications for the use of menstrual fluid in research and clinical applications.
Menstrual fluid was collected from 11 non-pregnant females with regular menstrual cycles. Participants had not used hormonal medications in the previous 3 months. Participants collected menstrual fluid samples from up to five cycles using a silicone menstrual cup worn on Day 2 of menstrual bleeding.
Menstrual fluid samples were centrifuged to separate soluble proteins and cells. Cells were depleted of red blood cells and CD45+ leucocytes. Menstrual fluid-derived endometrial stem/progenitor cells were characterized using multicolour flow cytometry including markers for endometrial stem/progenitor cells N-cadherin (NCAD) and stage-specific embryonic antigen-1 (SSEA-1) (for endometrial epithelial progenitor cells; eEPC), and sushi domain containing-2 (SUSD2) (for endometrial mesenchymal stem cells; eMSC). The clonogenicity of menstrual fluid-derived endometrial cells was assessed using colony forming unit assays. Menstrual fluid supernatant was analyzed using a custom magnetic Luminex assay.
Endometrial stem/progenitor cells are shed in menstrual fluid and demonstrate clonogenic properties. The intraparticipant agreement for SUSD2+ menstrual fluid-derived eMSC (MF-eMSC), SSEA-1+ and NCAD+SSEA-1+ MF-eEPC, and stromal clonogenicity were moderate-good (intraclass correlation; ICC: 0.75, 0.56, 0.54 and 0.52, respectively), indicating limited variability across menstrual cycles. Endometrial inflammatory and repair proteins were detectable in menstrual fluid supernatant, with five of eight (63%) factors demonstrating moderate intraparticipant agreement (secretory leukocyte protein inhibitor (SLPI), lipocalin-2 (NGAL), lactoferrin, follistatin-like 1 (FSTL1), human epididymis protein-4 (HE4); ICC ranges: 0.57-0.69). Interparticipant variation was limited for healthy participants, with the exception of key outliers of which some had self-reported menstrual pathologies.
N/A. There are no OMICS or other data sets relevant to this study.
The main limitations to this research relate to the difficulty of obtaining menstrual fluid samples across multiple menstrual cycles in a consistent manner. Several participants could only donate across <3 cycles and the duration of wearing the menstrual cup varied between 4 and 6 h within and between women. Due to the limited sample size used in this study, wider studies involving multiple consecutive menstrual cycles and a larger cohort of women will be required to fully determine the normal range of endometrial stem/progenitor cell and supernatant protein content of menstrual fluid. Possibility for selection bias and true representation of the population of women should also be considered.
Menstrual fluid is a reliable source of endometrial stem/progenitor cells and related endometrial proteins with diagnostic potential. The present study indicates that a single menstrual sample may be sufficient in characterizing a variety of cellular and protein parameters across women's menstrual cycles. The results also demonstrate the potential of menstrual fluid for identifying endometrial and menstrual abnormalities in both research and clinical settings as a non-invasive method for assessing endometrial health.
This study was supported by grants from the Australian National Health and Medical Research Council to C.E.G. (Senior Research Fellowship 1024298 and Investigator Fellowship 1173882) and to J.E. (project grant 1047756), the Monash IVF Research Foundation to C.E.G. and the Victorian Government's Operational Infrastructure Support Program. K.A.W., M.L.D.-T., S.G.S. and J.E. declare no conflicts of interest. C.E.G. reports grants from NHMRC, during the conduct of the study; grants from EndoFound USA, grants from Ferring Research Innovation, grants from United States Department of Defence, grants from Clue-Utopia Research Foundation, outside the submitted work. CEF reports grants from EndoFound USA, grants from Clue-Utopia Research Foundation, outside the submitted work.
Summary Objectives Cartilage defects are highly prevalent in subjects with knee osteoarthritis (OA). Although they are associated with increased cartilage loss and joint replacement, there is little ...data on the natural history of cartilage defects. The aim of this study was to examine the progression of cartilage defects over 2 years in people with knee OA and to identify factors associated with progression. Methods One hundred and seventeen subjects with OA underwent magnetic resonance imaging of their dominant knee at baseline and follow-up. Cartilage defects were scored (0–4) at four sites. Bone size of the medial and lateral tibial plateau was determined. Height, weight, body mass index and physical activity were measured by standard protocols. Results The mean cartilage defect score increased significantly over the 2-year study period in all tibiofemoral compartments (all P < 0.001), except the lateral tibial compartment with age and tibial plateau bone area at baseline being predictors of progression. However, there was heterogeneity with 81% progressing at any site, 15% remaining stable and 4% decreasing. Conclusion Over 2 years, cartilage defects tend to progress in people with symptomatic OA, with only a small percentage decreasing in severity. Increasing age and increased bone area are risk factors for progression. Interventions aimed at preventing cartilage defects from occurring and reducing their severity may result in a reduction in the severity of OA, by reducing loss of articular cartilage and subsequent requirement for knee joint replacement.
To determine if apparently healthy post-term South Asian-born (SA) women were more likely to have abnormal post-term fetal surveillance than Australian- and New Zealand-born (AUS/NZ) women, whether ...those abnormalities were associated with increased rates of obstetric intervention and adverse perinatal outcomes, and whether SA women and their babies were at higher risk of adverse outcomes in the post-term period irrespective of their post-term surveillance outcomes.
Post-term surveillance and perinatal outcomes of 145 SA and 272 AUS/NZ nulliparous women with a singleton post-term pregnancy were compared in a retrospective multicentre cohort analysis.
Post-term SA women were not significantly more likely to have a low amniotic fluid index (AFI) than AUS/NZ women. However, they were nearly four times more likely (odds ratio 3.75; 95% CI 1.49-9.44) to have an abnormal CTG (P=0.005). Irrespective of maternal region of birth having an abnormal cardiotocography (CTG) or AFI was not associated with adverse intrapartum or perinatal outcomes. However, post-term SA women were significantly more likely than AUS/NZ women to have intrapartum fetal compromise (P=0.03) and an intrapartum cesarean section (P=0.002). Babies of SA women were more also significantly likely to be admitted to the Special Care Nursery or Neonatal Intensive Care Unit (P=0.02).
Post-term SA women experience higher rates of fetal compromise (antenatal and intrapartum) and obstetric intervention than AUS/NZ women. Irrespective of maternal region of birth an abnormal CTG or AFI was not predictive of adverse outcomes.
Obesity is a risk factor for osteoarthritis. Antiretroviral therapy (ART)-treated HIV-infected patients are frequently affected by overweight and obesity, and may be at increased risk of ...osteoarthritis. BMI however is a measure which does not discriminate adipose from non-adipose body mass, or fat distribution, which may have different effects. This study aimed to examine relationships between body composition and knee cartilage volume, as assessed by magnetic resonance imaging in HIV infection. 35 ART-treated HIV-infected men aged 51.7 years (mean) 7.9 (SD) and 18 healthy men aged 49.5 years (mean) 6.4 (SD) participated. Cartilage volume was measured on magnetic resonance imaging of the dominant knee using validated methods. Body composition was measured using dual x-ray absorptiometry. HIV-infected participants had less total body and gynoid fat (kg) (p = 0.04 and p = 0.007, respectively) and more percent android fat mass and percent trunk fat mass (p = 0.001 and p < 0.001, respectively) than controls. In HIV-infected participants there was an inverse association between total body fat mass and average tibial cartilage volume (R = -8.01, 95% CI -15.66, -0.36). Also, in HIV-infected participants there was an inverse association between android fat mass and average cartilage volume (R = -90.91, 95% CI -158.66, -23.16). This preliminary study found that both total body and android fat mass were inversely related to average knee cartilage volume in ambulant, ART-treated HIV-infected adults. These findings are features of early knee osteoarthritis and this may be of future significance in HIV.
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