The aim of this study was to investigate characteristics associated with ectopic pregnancy (EP) that could be utilized for predicting morbidity or mortality.
This was a retrospective analysis of ...pregnancy-related records from a tertiary center over a period of ten years. Data on age, gravidity, parity, EP risk, amenorrhea duration, abdominal pain presence and location, β-human chorionic gonadotropin (β-HCG) level, ultrasound findings, therapeutic intervention, exact EP implantation site and length of hospital stay (LOS) were obtained from the database. The LOS was used as a proxy for morbidity and was tested for an association with all variables. All statistical analyses were conducted with Stata® (ver. 16.1, Texas, USA).
The incidence of EP in a cohort of 30,247 pregnancies over a ten-year period was 1.05%. Patients presented with lower abdominal pain in 87.9% of cases, and the likelihood of experiencing pain was tenfold higher if fluid was detectable in the pouch of Douglas. Only 5.1% of patients had a detectable embryonic heartbeat, and 18.15% had one or more risk factors for EP. While most EPs were tubal, 2% were ovarian. The LOS was 1.9 days, and laparoscopic intervention was the main management procedure. The cohort included one genetically proven dizygotic heterotopic pregnancy (incidence, 3.3 × 10
) that was diagnosed in the 7th gestational week. The only association found was between the β-HCG level and LOS, with a linear regression β coefficient of 0.01 and a P-value of 0.04.
EP is a relatively common condition affecting approximately 1% of all pregnancies. β-HCG correlates with EP-related morbidity, but the overall morbidity rate of EP is low regardless of the implantation site. Laparoscopic surgery is an effective therapeutic procedure that is safe for managing EP, even in cases of heterotopic pregnancy.
Pregnancy and cardiovascular disease Ramlakhan, Karishma P; Johnson, Mark R; Roos-Hesselink, Jolien W
Nature reviews cardiology,
11/2020, Letnik:
17, Številka:
11
Journal Article
Recenzirano
Cardiovascular disease complicates 1-4% of pregnancies - with a higher prevalence when including hypertensive disorders - and is the leading cause of maternal death. In women with known ...cardiovascular pathology, such as congenital heart disease, timely counselling is possible and the outcome is fairly good. By contrast, maternal mortality is high in women with acquired heart disease that presents during pregnancy (such as acute coronary syndrome or aortic dissection). Worryingly, the prevalence of acquired cardiovascular disease during pregnancy is rising as older maternal age, obesity, diabetes mellitus and hypertension become more common in the pregnant population. Management of cardiovascular disease in pregnancy is challenging owing to the unique maternal physiology, characterized by profound changes to multiple organ systems. The presence of the fetus compounds the situation because both the cardiometabolic disease and its management might adversely affect the fetus. Equally, avoiding essential treatment because of potential fetal harm risks a poor outcome for both mother and child. In this Review, we examine how the physiological adaptations during pregnancy can provoke cardiometabolic complications or exacerbate existing cardiometabolic disease and, conversely, how cardiometabolic disease can compromise the adaptations to pregnancy and their intended purpose: the development and growth of the fetus.
The Novartis Safety Database collected cases from clinical trials and through a post-marketing phar- macovigilance non-interventional PRegnancy outcomes Intensive Monitoring (PRIM) study, where data ...from spontaneously reported pregnancies were collected using a set of targeted structured checklists. Pregnancy outcomes in women with MS exposed to ofatumumab during pregnancy or 6 months prior to last menstrual period (LMP) were analyzed and will be reported. Pregnancy and infant outcomes including congenital anomalies, infections, vaccinations, and developmental delays were collected from the reporting of pregnancy up to 1 year of infant age.At prior cutoff date of March-25-2022, there were 61 exposed pregnancies with 30 known outcomes and 17 live births after maternal exposure to ofatumumab during pregnancy or 6 months prior to LMP. No congenital anomalies, reports of B-cell depletion, immunoglobulin/hematological abnormalities, or serious infections were reported. Updated pregnancy outcomes with a cutoff date of Sep-25-2022 from the Database will be presented at the congress.Reporting the latest data on pregnancy outcomes after exposure to ofatumumab will provide informa- tion to healthcare professionals who treat people with MS of childbearing potential. In addition to the Novartis sponsored PRIM initiative, a prospective observational exposure registry on maternal and infant outcomes in patients exposed to ofatumumab is also underway.
COVID‐19 and acute coagulopathy in pregnancy Vlachodimitropoulou Koumoutsea, Evangelia; Vivanti, Alexandre J.; Shehata, Nadine ...
Journal of thrombosis and haemostasis,
July 2020, Letnik:
18, Številka:
7
Journal Article
Recenzirano
Odprti dostop
We present a putative link between maternal COVID‐19 infection in the peripartum period and rapid maternal deterioration with early organ dysfunction and coagulopathy. The current pandemic with ...SARS‐CoV‐2 has already resulted in high numbers of critically ill patients and deaths in the non‐pregnant population, mainly due to respiratory failure. During viral outbreaks, pregnancy poses a uniquely increased risk to women due to changes to immune function, alongside physiological adaptive alterations, such as increased oxygen consumption and edema of the respiratory tract. The laboratory derangements may be reminiscent of HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome, and thus knowledge of the COVID‐19 relationship is paramount for appropriate diagnosis and management. In addition to routine measurements of D‐dimers, prothrombin time, and platelet count in all patients presenting with COVID‐19 as per International Society on Thrombosis and Haemostasis (ISTH) guidance, monitoring of activated partial thromboplastin time (APTT) and fibrinogen levels should be considered in pregnancy, as highlighted in this report. These investigations in SARS‐CoV‐2‐positive pregnant women are vital, as their derangement may signal a more severe COVID‐19 infection, and may warrant pre‐emptive admission and consideration of delivery to achieve maternal stabilization.
BACKGROUND: Several risk factors for ectopic pregnancy (EP) have been identified, but the site of implantation of EP has been little studied. METHODS: A total of 1800 surgically treated EP was ...registered between January 1992 and December 2001 in the Auvergne EP register and the women concerned were followed up. In this large population-based sample, we studied the distribution of EP sites, immediate complications, determining factors, and subsequent fertility. RESULTS: EP sites were interstitial (2.4%), isthmic (12.0%), ampullary (70.0%), fimbrial (11.1%), ovarian (3.2%) or abdominal (1.3%). No cervical pregnancies were observed. Complications and treatment depended on the site of EP. In multivariate analysis, the only risk factor associated with EP site was current use of an intrauterine device (IUD), which was more frequent in distal EP. The 2 year cumulative rate of subsequent spontaneous intrauterine pregnancy (IUP) increased progressively from interstitial to ovarian EP. Fair concordance (weighted κ = 0.31) was observed between the sites of two successive EP if they were homolateral. CONCLUSION: In addition to providing an accurate description of the sites of implantation of EP, this study shows that current IUD use ‘protects’ against interstitial pregnancies, which are the most difficult to manage. It shows that subsequent fertility tends to be higher in women with distal EP.
BackgroundSexually transmitted infection (STI) recurrence contributes to the high global STI burden. We introduced STI screening and facilitated partner notification (PN) and treatment among women ...participating in a safer conception study in southwestern Uganda to understand impacts on STI incidence.MethodsA parent study enrolled women planning for pregnancy with a man with HIV or of unknown serostatus to assess pre-exposure prophylaxis use for safer conception. STI screening began after study-start, and all eligible women completed screening for chlamydia, gonorrhea, and trichomoniasis via GeneXpert nucleic acid amplification testing and syphilis via immunochromatographic testing and rapid plasma reagin. Multivariable Poisson regression was used to determine incident STI correlates.ResultsOf 134 women in the parent study, 94 underwent enrollment STI screening, of whom 23 were positive. Median age was 31 (IQR 28–35) years. All participants with STIs received counseling and treatment; 21/23 participants accepted PN cards and 18/23 accepted patient-delivered partner medications. By the six-month study-visit, 81 participants repeated STI testing (N=66 at that visit, N=15 at incident pregnancy visit; whichever came first); 13 participants were lost to follow-up. Of those with enrollment STIs, 19/23 returned for follow-up at six months; 18 reported delivering PN cards and discussing STIs with partner(s) and 14 reported medication delivery to partner(s). Incident STIs occurred in 17/81 participants with 42.57 person-years of follow-up (incidence rate 40/100 person-years). STI incidence was associated with enrollment STI (incidence rate ratio IRR 3.39, 95% confidence interval CI 1.22–9.43) and alcohol consumption (IRR 3.18, 95% CI 1.15–8.85).ConclusionsWe demonstrate a high STI prevalence and incidence among women planning for pregnancy in Uganda despite partner treatment promotion efforts. These infections are likely driven in part by re-infection from untreated partners. Novel STI PN interventions are needed to decrease the STI burden, especially among women planning for and with pregnancy.
Twin pregnancies carry a higher risk of congenital and structural malformations, and pregnancy complications including miscarriage, stillbirth, and intrauterine fetal death, compared with singleton ...pregnancies. Carrying a fetus with severe malformations or abnormal karyotype places the remaining healthy fetus at an even higher risk of adverse outcome and pregnancy complications. Maternal medical conditions or complicated obstetrical history could, in combination with twin pregnancy, cause increased risks for both the woman and the fetuses. To our knowledge, no previous studies have evaluated and compared the outcomes of all dichorionic twin pregnancies and compared the results of reduced twins with those of nonreduced and primary singletons in a national cohort. These data are important for clinicians when counseling couples about fetal reduction and its implications.
This study aimed to describe and compare the risks of adverse pregnancy outcomes, including the risk of pregnancy loss, in a national cohort of all dichorionic twins—reduced, nonreduced, and primary singletons. In addition, we examined the implications of gestational age at fetal reduction on gestational age at delivery.
This was a retrospective cohort study of all Danish dichorionic twin pregnancies, including pregnancies undergoing fetal reduction and a large proportion of randomly selected primary singleton pregnancies with due dates between January 2008 and December 2018. The primary outcome measures were adverse pregnancy outcomes (defined as miscarriage before 24 weeks, stillbirth from 24 weeks, or single intrauterine fetal death in nonreduced twin pregnancies), preterm delivery, and obstetrical pregnancy complications. Outcomes after fetal reduction were compared with those of nonreduced dichorionic twins and primary singletons.
In total, 9735 dichorionic twin pregnancies were included, of which 172 (1.8%) were reduced. In addition, 16,465 primary singletons were included. Fetal reductions were performed between 11 and 23 weeks by transabdominal needle-guided injection of potassium chloride, and outcome data were complete for all cases. Adverse pregnancy outcome was observed in 4.1% (95% confidence interval, 1.7%–8.2%) of reduced twin pregnancies, and 2.4% (95% confidence interval, 0.7%–6.1%) were delivered before 28 weeks, and 4.2% (95% confidence interval, 1.7%–8.5%) before 32 weeks. However, when fetal reduction was performed before 14 weeks, adverse pregnancy outcomes occurred in only 1.4% (95% confidence interval, 0.0%–7.4%), and delivery before 28 and 32 weeks diminished to 0% (95% confidence interval, 0.0%–5.0%) and 2.8% (95% confidence interval, 0.3%–9.7%), respectively. In contrast, 3.0% (95% confidence interval, 2.7%–3.4%) of nonreduced dichorionic twins had an adverse pregnancy outcome, and 1.9% (95% confidence interval, 1.7%–2.1%) were delivered before 28 weeks, and 7.3% (95% confidence interval, 6.9%–7.7%) before 32 weeks. Adverse pregnancy outcomes occurred in 0.9% (95% confidence interval, 0.7%–1.0%) of primary singletons, and 0.2% (95% confidence interval, 0.1%–0.3%) were delivered before 28 weeks, and 0.7% (95% confidence interval, 0.6%–0.9%) before 32 weeks. For reduced twins, after taking account of maternal factors and medical history, it was demonstrated that the later the fetal reduction was performed, the earlier the delivery occurred (P<.01). The overall risk of pregnancy complications was significantly lower among reduced twin pregnancies than among nonreduced dichorionic twin pregnancies (P=.02).
In a national 11-year cohort including all dichorionic twin pregnancies, transabdominal fetal reduction by needle guide for fetal or maternal indication was shown to be safe, with good outcomes for the remaining co-twin. Results were best when the procedure was performed before 14 weeks.
PDF
