Amniocentesis and chorionic villus sampling Navaratnam, K; Alfirevic, Z
BJOG : an international journal of obstetrics and gynaecology,
01/2022, Letnik:
129, Številka:
1
Journal Article
Recenzirano
Key recommendationsWomen should be informed that the additional risk of miscarriage following amniocentesis or CVS performed by an appropriately trained operator is likely to be below 0.5%. Grade ...BAmniocentesis should not be performed prior to 15+0 weeks' gestation. Grade ACVS should not be performed prior to 10+0 weeks' gestation. Grade DWhere possible, to reduce the risk of technical challenges, CVS should be performed from 11+0 weeks' gestation onwards. Good Practice PointWomen with multiple pregnancies should be informed that the additional risk of miscarriage for twin pregnancy following CVS or amniocentesis performed by an appropriately trained operator is around 1%. Grade BScreening results for blood borne viruses, viral load and antigen test results should be reviewed when an invasive test is considered and individualised risk of viral transmission should be discussed. Grade C
Pautas de ISUOG para la práctica: evaluación ecográfica de la biometría y el crecimiento fetal
INTRODUCCIÓN
El objetivo de estas Pautas es describir la evaluación adecuada de la biometría fetal y el ...diagnóstico de los trastornos del crecimiento fetal. Estos trastornos consisten principalmente en la restricción del crecimiento fetal (RCF), también conocida como restricción del crecimiento intrauterino (RCIU), que a menudo está asociada con un tamaño pequeño para la edad gestacional (PEG) o grande para la edad gestacional (GEG), que pueden dar lugar a la macrosomía fetal; ambos se han asociado con una variedad de resultados maternos y perinatales adversos. La detección y el tratamiento adecuado de las anomalías del crecimiento fetal son componentes esenciales de la atención prenatal, y la ecografía fetal desempeña un papel fundamental en la evaluación de estas afecciones. Los parámetros biométricos fetales medidos con mayor frecuencia son (todas las siglas procedentes del inglés) el diámetro biparietal (BPD), el perímetro cefálico (HC), el perímetro abdominal (AC) y la longitud de la diáfisis del fémur (FL). Estas mediciones biométricas se pueden utilizar para estimar el peso del feto (PEF) mediante fórmulas diferentes1. Es importante diferenciar entre el concepto de tamaño fetal en un momento dado y el crecimiento fetal en sí, siendo este último un proceso dinámico cuya evaluación requiere al menos dos ecografías separadas en el tiempo. La historia y los síntomas de la madre, la evaluación del líquido amniótico y la velocimetría Doppler pueden proporcionar información adicional que se puede utilizar para identificar los fetos bajo riesgo de resultados adversos del embarazo. La estimación precisa de la edad gestacional es un prerrequisito para determinar si el tamaño del feto es apropiado para la edad gestacional (AEG). Excepto en el caso de los embarazos procedentes de tecnologías de reproducción asistida, la fecha de concepción no se puede determinar con precisión. Clínicamente, la fecha de la mayoría de los embarazos se establece en función del último período menstrual, aunque a veces esto puede ser incierto o poco fiable. Por lo tanto, el fechado de los embarazos mediante ecografía temprana a las 8‐14 semanas, mediante la medición de la longitud céfalo‐caudal (LCC) fetal, parece ser el método más fiable para establecer la edad gestacional. Una vez que la LCC excede los 84 mm, se debe usar el HC2–4 para establecer la fecha del embarazo. El HC, con o sin FL, se puede utilizar para estimar la edad gestacional a partir de la mitad del primer trimestre si no se dispone de una ecografía del primer trimestre y el historial menstrual no es fiable. Cuando se ha establecido la fecha prevista del parto mediante una exploración temprana precisa, no se deben utilizar exploraciones posteriores para recalcular la edad gestacional1. Las exploraciones en serie se pueden utilizar para determinar si el intervalo del crecimiento ha sido normal. En estas Pautas se asume que la edad gestacional es conocida y ha sido determinada según lo anterior, que el embarazo es de feto único y que la anatomía fetal es normal. En el Apéndice 1 se detallan los grados de recomendación utilizados en estas Pautas. El informe sobre los niveles de evidencia no es aplicable a estas Pautas.
摘要
ISUOG实践指南:胎儿生物测量与生长的超声评估
引言
本指南旨在描述胎儿生物测量的正确评估及胎儿生长障碍的诊断。这些疾病主要包括又称为宫内生长受限(IUGR)且往往与小于胎龄(SGA)有关的胎儿生长受限(FGR)，以及可能导致胎儿巨大的大于胎龄(LGA)。这两种疾病都与各种孕产期围产期不良结局有关。胎儿生长异常的筛查和适当处理是产前保健的重要组成部分，胎儿超声检测在这些疾病的评估中起着关键作用。最常测量的胎儿生物特征参数有双顶径(BPD)、头围(HC)、腹围(AC)和股骨骨干长度(FL)。可以根据这些生物特征测量值，运用各种不同的公式估算胎儿体重(EFW)。1务必要区分给定时间点胎儿大小与胎儿生长这两个不同的概念，后者是一个动态的过程。胎儿生长评估至少需要不同时间点的两次超声波扫描检测。产妇的病史和症状、羊水评估和多普勒测速可以提供更多信息，可以据此识别有不良妊娠结局风险的胎儿。准确估算胎龄是确定胎儿大小是否适合胎龄(AGA)的先决条件。无法精确确定受孕日期，辅助生殖技术引发的妊娠除外。临床上主要将末次月经日期定为受孕日期，虽然有时可能不太确定或不太可靠。因此，根据胎冠臀长(CRL)测量结果和第8‐14周早期超声波检测结果确定受孕日期，似乎是确定胎龄的最可靠方法。如果CRL超过84毫米，就要根据HC来确定受孕日期。2–4如果无法进行孕早期扫描且月经史不可靠，就可以通过HC——不管有没有FL——来估算孕中期孕龄。通过准确的孕早期扫描确定预产期后，就不要再做后续扫描来重新估算胎龄了。1可以通过连续扫描确定胎儿间隔生长是否正常。在本指南中，我们假设胎龄已知且已通过上述方式确定胎龄，孕产单生儿且胎儿解剖正常。本指南所用的推荐等级详情如附录1所示。本指南不适用报告证据等级。
This article's has been translated into Spanish and Chinese. Follow the links from the to view the translations.
Background
The inappropriate and inconsistent selection of primary outcomes (POs) in randomised controlled trials (RCTs) and systematic reviews (SRs) can make evidence difficult to interpret, ...limiting its usefulness to inform clinical practice.
Objectives
To systematically review the choice and consistency of POs in RCTs and SRs of preventative interventions for preterm birth.
Search strategy
Cochrane Pregnancy and Childbirth Group's Specialised Register of trials and a full list of published reviews and protocols.
Selection criteria
Full reports of RCTs for preterm birth prevention published after CONSORT (January 1997–January 2011), and Cochrane Reviews and protocols relevant to preterm birth prevention, for the same period.
Data collection and analysis
For RCTs, the PO was the outcome used for sample size calculation. For SRs, we included all outcomes listed as ‘primary’. Two review authors selected studies and double‐checked the data for accuracy.
Results
Seventy‐two different POs were reported by 103 RCTs. The three most common POs were based on length of gestation, with preterm birth before 37 weeks of gestation being the most common (18/103, 18%). Few RCTs chose perinatal morbidity (4/103) or mortality (1/103), or their composites (5/103), as POs. In 33 Cochrane Reviews, 29 different POs were reported. The three most common POs were based on death or morbidity in the baby, with death of the baby being the most common (22/33, 67%). POs were variably defined.
Conclusions
There is a lack of consistency in the choice and definitions of POs in clinical research related to preterm birth prevention. SRs are more likely to report morbidity and mortality as POs, whereas RCTs tend to use length of gestation. Researchers are urged to review the outcomes reported in RCTs and SRs in their respective areas of interest to highlight discrepancies and facilitate the development of core outcome sets.
Background
Clinical practice guidelines (CPG) endorse multiple strategies to prevent or manage preterm birth (PTB).
Objectives
To summarise CPG recommendations for PTB and identify areas of ...international consensus.
Search strategy
In May 2017 we searched for all CPG relevant to PTB without language restrictions.
Selection criteria
CPG were eligible if the following criteria were met: (1) the guideline was published or current from June 2013; (2) the guideline recommended practices for the prevention or management of PTB relevant to our prespecified clinical questions for screening, medications or surgery and other interventions; (3) publications on methods of guideline development for eligible CPG were included to enable quality assessment.
Data collection and analysis
Two authors classified CPG recommendations relevant to prespecified clinical questions. When more than 70% of CPGs reporting on a topic recommended or rejected an intervention, we regarded this as consensus. We summarised recommendations in tables.
Main results
We identified 49 guidelines from 16 guideline developers. We found consensus for several clinical practices: cervical length screening for high‐risk women; short‐term tocolysis; steroids for fetal lung maturation; and magnesium sulphate for fetal neuroprotection. We found discrepant recommendations for progesterone and fibronectin. No guideline identified an effective strategy for women with multiple pregnancy.
Conclusions
We identified interventions for which there is an international consensus on benefit for PTB. Systematic reviews of CPG using standardised methodology will help avoid duplication and target scarce resources for guideline developers globally.
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International clinical guidelines agree on the benefits and harmful effects of several important interventions to prevent preterm birth.
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International clinical guidelines agree on the benefits and harmful effects of several important interventions to prevent preterm birth.
Objective
To quantify the incidence of severe autoimmune thrombocytopenia (ITP) in pregnancy in the UK, determine current treatment strategies, and establish maternal and neonatal morbidity and ...mortality associated with severe ITP in pregnancy.
Design
A prospective national cohort study.
Setting
UK.
Population
Women with severe ITP, defined as platelets <50 × 109/L in pregnancy or antenatal treatment of isolated low platelets.
Methods
Data collected via the UK Obstetric Surveillance System (UKOSS) between 1 June 2013 and 31 January 2015 from all UK consultant‐led obstetric units.
Main outcome measure
Incidence of severe ITP in pregnancy.
Results
The estimated incidence of severe ITP in pregnancy is 0.83 per 10 000 maternities (95% CI 0.68–1.00). A total of 22 pregnant women (21%) did not receive any antenatal therapy, and 85 pregnant women (79%) received therapy. There was no difference between asymptomatic treated and untreated cohorts in severity of disease or outcome. Postpartum haemorrhage (51%) and severe postpartum haemorrhage (21%) was reported more frequently than the rate reported in the general pregnant population (5–10%). No neonates required treatment for thrombocytopenia and there were no cases of neonatal intracranial bleeding.
Conclusions
Current UK management of severe ITP in pregnancy results in an exceptionally low morbidity and mortality for the neonate. Mothers with ITP remain at increased risk of severe postpartum haemorrhage, and should be delivered at units that have the capacity to manage severe PPH effectively. Whilst balancing the risks for pregnancy from prophylactic antenatal treatment in asymptomatic women against observed low disease morbidity, we may be over treating asymptomatic patients.
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UKOSS study of severe ITP in pregnancy shows exceptionally low neonatal morbidity with current UK management.
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UKOSS study of severe ITP in pregnancy shows exceptionally low neonatal morbidity with current UK management.
Antiplatelet agents are pivotal for prevention of coronary artery disease and cerebrovascular disease worldwide. Individual patient data meta‐analysis indicates that low‐dose aspirin causes a 10% ...risk reduction in pre‐eclampsia for women at high individual risk. However, in the last 15 years it has emerged that a significant proportion of aspirin‐treated individuals exhibit suboptimal platelet response, determined biochemically and clinically, termed ‘aspirin non‐responsiveness’, ‘aspirin resistance’ and ‘aspirin treatment failure’. More recently, investigation of aspirin responsiveness has begun in pregnant women. This review explores the history and clinical relevance of ‘aspirin resistance’ applied to high‐risk obstetric populations.
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Is ‘aspirin resistance’ clinically relevant in high‐risk obstetrics?
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Is ‘aspirin resistance’ clinically relevant in high‐risk obstetrics?
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