To study the platelet function response to low-dose ASA with the Platelet Function Analyzer (PFA-100) in pregnant women and to identify maternal characteristics associated with non-responsiveness.
We ...conducted a prospective cohort study involving 87 pregnant women on ASA. The platelet function response to ASA was measured as the closure time obtained with epinephrine cartridges (CT-EPI) by the PFA-100. Non-response to ASA was defined as a CT-EPI < or =150 seconds after four weeks of therapy. Non-responders were given an escalating dose of ASA and their CT-EPI was tested again.
After four weeks of enteric-coated ASA 81 mg daily, 25/87 women (28.7%) were non-responders (95% CI 16.1 to 41.4). Among these women, a CT-EPI < or =150 seconds was found in 8/24 women (33.3%) after another four weeks of alternating ASA 81 mg and 162 mg daily. After a further four-week course of ASA 162 mg daily, a CT-EPI < or =150 seconds was found in 3/6 women (50.0%). Among the women who initially responded and who were reassessed at 24-32 weeks of pregnancy, the CT-EPI was < or =150 seconds in 9/36 (25.0%). There was no statistical difference in maternal characteristics between ASA responders and non-responders.
A significant number of pregnant women showed a lack of platelet function response to ASA 81 mg that was in most cases overcome with higher dosing. Furthermore, the prevalence of non-responsiveness increased with advancing pregnancy.
Objective 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. ...Study Design 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. Results 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. Conclusion Vitamin C and E supplementation did not reduce the rate of preeclampsia or GH, but increased the risk of fetal loss or perinatal death and preterm prelabor rupture of membranes.
Public health authorities have been alarmed by the progressive rise in rates of Caesarean section in Canada, approaching one birth in three in several provinces. We aimed therefore to consider what ...were preventable obstetrical interventions in women with a low-risk pregnancy and to propose an analytic framework for the reduction of the rate of CS. We obtained statistical variations of CS rates over time, across regions, and within professional practices from MED-ÉCHO, the Quebec hospitalization database, from 1969 to 2009. Data were extracted from a recent systematic review of the cascade of obstetrical interventions to calculate the population-attributable fractions for each intervention associated with an increased probability of CS. We thereby identified expectant management (as an alternative to labour induction) and planned vaginal birth after CS as the leading strategies for potentially reducing rates of CS in women at low risk. For vaginal birth after CS, an increase to its 1995 level could lower the current CS rate of 23.2% (2009 to 2010) to 21.0%. Other alternatives to obstetrical interventions with a potential for lowering CS rates included non-pharmacological pain control methods (such as continuous support during childbirth) in addition to usual care, intermittent auscultation of the fetal heart (instead of electronic fetal monitoring), and multidisciplinary internal quality assessment audits. We believe, therefore, that the concept of preventable CS is supported by empirical evidence, and we identified realistic strategies to maintain a CS rate in Quebec near 20%.
The aim of this study was to ascertain the contribution of perceived maternal stress and other components of a psychosocial profile to the occurrence of complications of pregnancy.
We conducted a ...prospective cohort study of pregnant women in a tertiary perinatal centre in Eastern Townships, Quebec. Psychosocial profile was assessed between 10 and 20 weeks' gestation and 25 and 30 weeks' gestation using six validated self-administered questionnaires. After delivery, data related to maternal, perinatal, and neonatal outcomes were collected. Descriptive, bivariate, and ANOVA repeated measures were performed.
Among 303 consenting women, 81 (26.7%) had at least one pregnancy complication. Biomedical risk factors were evenly distributed in both groups (with or without complications). Women with complications had higher mean perceived stress at 10 to 20 weeks than those with uneventful term pregnancies (32.6 ± 11.7 vs. 29.3 ± 10.3; P < 0.05). Among those with complications, women with preterm birth perceived even more stress at 10 to 20 weeks (34.4 ± 11.5 vs. 29.3 ± 10.3; P < 0.05) than those with term pregnancies. Peer social support at 25 to 30 weeks, in women with a complication, was reported to be less than in women with an uneventful term pregnancy (51.0 ± 16.6 vs. 55.5 ± 13.8; P < 0.05). Other psychosocial dimensions were similar in both groups.
Maternally perceived stress before 20 weeks' gestation is associated with complications of pregnancy and especially with preterm birth.
Abstract In Sherbrooke, the gestational diabetes mellitus (GDM) Regional Committee proposed GDM screening during the first trimester for all pregnant women based on a 50 g glucose challenge test (50 ...g GCT) followed directly by capillary self-monitoring blood glucose (SMBG) at home. We evaluated implementation of committee's recommendations on the clinical trajectory of women receiving prenatal care at our institution. We analyzed data collected systematically by the Blood Sampling in Pregnancy clinic from 2008 to 2011. We evaluated the clinical trajectory of 7710 pregnant women to assess GDM screening/diagnoses and referral rates to the diabetes care centre (DCC) for education and treatment during both the first and second trimesters. The Canadian Diabetes Association glycemic treatment targets in women with GDM were used as diagnosis thresholds and DCC referral decisions: Fasting glucose of 5.3 mmol/L and postprandial 2 h glucose of 6.7 mmol/L. We found that pregnant women were 28.0±4.8 years old, and their body mass indexes were 24.5±5.5 kg/m2 . During the first trimester, 47% of women were screened for GDM, mostly (84%) using the 50 g GCT. Following SMBG, 5.7% were referred to the DCC. Only 32% of women with early GDM had >1 GDM risk factor. Thereafter, 67% of normoglycemic women screened during the first trimester were screened again during the second trimester. Among women screened during the second trimester, most screening was done using 50 g GCT, and 8.8% were referred to the DCC following SMBG. Implementation of 50 g GCT testing followed by direct home SMBG was well implemented in our area. The importance of early GDM screening and rescreening during the second trimester still needs to be emphasized.
Is sleep disturbed in pregnancy? Naud, Kentia; Ouellet, Annie; Brown, Christine ...
Journal of obstetrics and gynaecology Canada
32, Številka:
1
Journal Article
Recenzirano
To assess features of sleep among pregnant women.
We conducted a prospective cohort study of low-risk pregnant women in a tertiary perinatal centre (CHUS) in Eastern Townships, Quebec. Sleep was ...assessed during the second trimester (mean gestational age 16.1 +/- 3.0 weeks) (T2) and third trimester (mean gestational age 27.5 +/- 1.8 weeks) (T3) using a validated self-administered questionnaire, the Pittsburgh Sleep Quality Index (PSQI). Scores in this index range from 0 to 21, representing the cumulative scoring of seven sleep components. Subjects with a score > 5 were identified as "poor sleepers." Descriptive, bivariate, and regression analyses were performed.
Among 260 consenting women, 192 (73.6%) had a term delivery without any adverse outcome. There were no differences in sleep parameters between pregnancies with adverse outcome and without adverse outcome. Mean overall PSQI scores showed evidence of deterioration in sleep quality from T2 (5.26 +/- 3.16) to T3 (6.73 +/- 4.02; P < 0.01). This deterioration was displayed in five of seven sleep components (P < 0.01). Scores in the "poor sleeper" range were recorded by 36% of women in T2 and 56%, of women in T3 (P < 0.01). "Poor sleep" in T2 and T3 was associated with low or high weight gain (P < 0.01), annual family income < $40,000 (P = 0.03), and single motherhood (P < 0.01). There was a trend for a seasonal influence on sleep scores (P = 0.08). The only predictor of poor sleep using multivariate analysis was single motherhood (P < 0.01).
Sleep is disturbed in early pregnancy and is worse in the third trimester. Interventions to improve sleep should be sought to optimize quality of life for pregnant women.
Summary Background Pre-eclampsia is a leading cause of maternal deaths. These deaths mainly result from eclampsia, uncontrolled hypertension, or systemic inflammation. We developed and validated the ...fullPIERS model with the aim of identifying the risk of fatal or life-threatening complications in women with pre-eclampsia within 48 h of hospital admission for the disorder. Methods We developed and internally validated the fullPIERS model in a prospective, multicentre study in women who were admitted to tertiary obstetric centres with pre-eclampsia or who developed pre-eclampsia after admission. The outcome of interest was maternal mortality or other serious complications of pre-eclampsia. Routinely reported and informative variables were included in a stepwise backward elimination regression model to predict the adverse maternal outcome. We assessed performance using the area under the curve (AUC) of the receiver operating characteristic (ROC). Standard bootstrapping techniques were used to assess potential overfitting. Findings 261 of 2023 women with pre-eclampsia had adverse outcomes at any time after hospital admission (106 5% within 48 h of admission). Predictors of adverse maternal outcome included gestational age, chest pain or dyspnoea, oxygen saturation, platelet count, and creatinine and aspartate transaminase concentrations. The fullPIERS model predicted adverse maternal outcomes within 48 h of study eligibility (AUC ROC 0·88, 95% CI 0·84–0·92). There was no significant overfitting. fullPIERS performed well (AUC ROC >0·7) up to 7 days after eligibility. Interpretation The fullPIERS model identifies women at increased risk of adverse outcomes up to 7 days before complications arise and can thereby modify direct patient care (eg, timing of delivery, place of care), improve the design of clinical trials, and inform biomedical investigations related to pre-eclampsia. Funding Canadian Institutes of Health Research; UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction; Preeclampsia Foundation; International Federation of Obstetricians and Gynecologists; Michael Smith Foundation for Health Research; and Child and Family Research Institute.
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 (http://www.pregnancyhypertension.org/article/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-eclampsia, 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).
To evaluate whether (1) the absolute magnitude of liver function test values, (2) the percentage change in liver function test values over time, or (3) the rate of change in liver function test ...values over time predicts adverse maternal outcomes in women with preeclampsia.
We used data from the PIERS (Pre-eclampsia Integrated Estimate of RiSk) study, a prospective multicentre cohort study assessing predictors of adverse maternal outcomes in women with preeclampsia. Women with at least one liver function test performed at the time of hospital admission were included. Liver functions were tested by serum concentrations of aspartate amino transferase (AST), alanine amino transferase (ALT), lactate dehydrogenase (LDH), albumin, total bilirubin, and the international normalized prothrombin time ratio. Parameters investigated were absolute levels, change within 48 hours of hospital admission, change from admission to delivery or outcome, and rate of change from admission to delivery or outcome of each liver function test. The ability of these parameters to predict adverse outcomes was assessed using logistic regression analyses and by calculating the receiver operating characteristic (ROC) area under the curve (AUC).
Of the 2008 women, 1056 (53%) had at least one abnormal liver function test result. The odds of having an adverse maternal outcome were higher in women with any abnormal liver function test than in women with normal results. When test results were stratified into quartiles, women with results in the highest quartile (lowest quartile for albumin) were at higher risk of adverse outcomes than women in the lowest quartile for all parameters (highest for albumin). The absolute magnitude of AST, ALT, and LDH predicted adverse maternal outcomes (AST: ROC AUC 0.73 95% CI 0.67 to 0.97; ALT: ROC AUC 0.73 95% CI 0.67 to 0.79; LDH: ROC AUC 0.74 95% CI 0.68 to 0.81). Neither change of liver function test results, within 48 hours of admission or from admission to delivery or outcome, nor rate of change were predictive.
We found abnormal liver function test results to be associated with an increased risk for adverse maternal outcomes. Levels of AST, ALT, and LDH were found to be modestly predictive of these outcomes.
Platelet count has been proposed as a screening test for generalized coagulopathy in women with preeclampsia. We performed this study to determine the relationship between platelet counts and the ...risk of abnormal coagulation and adverse maternal outcomes in women with preeclampsia.
We used data from women in the PIERS (Pre-eclampsia 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 preeclampsia. 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.
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