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Latest & greatest articles for pregnancy
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Desmopressin acetate (DDAVP) for preventing and treating acute bleeds during pregnancy in women with congenital bleeding disorders. BACKGROUND: Congenital bleeding disorders can cause obstetric haemorrhage during pregnancy, labour and following delivery. Desmopressin acetate (DDAVP) is found to be an effective drug which can reduce the risk of haemorrhage and can also stop bleeding in certain congenital bleeding disorders. Its use in pregnancy has been controversial. Hence beneficial (...) and adverse effects of DDAVP in these groups of pregnant women should be evaluated.This is an update of a Cochrane Review first published in 2013 and updated in 2015. OBJECTIVES: To evaluate the efficacy and safety of DDAVP in preventing and treating acute bleeding in pregnant women with bleeding disorders. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Coaguopathies Trials Register comprising references identified from comprehensive electronic database searches
Diet and exercise can reduce the risk of developing diabetes during pregnancy Diet and exercise can reduce the risk of developing diabetes during pregnancy Dissemination Centre Discover Portal NIHR DC Discover Diet and exercise can reduce the risk of developing diabetes during pregnancy Published on 18 December 2018 doi: Diet and exercise are effective ways of preventing the development of diabetes during pregnancy, known as gestational diabetes. Gestational diabetes is becoming more common (...) and is associated with poorer outcomes for mother and baby. Diet, physical activity and weight are modifiable risk factors, but trials published to date have shown inconsistent results. This systematic review pooled 47 trials and found that any form of lifestyle intervention reduced the risk of gestational diabetes by 23%, with similar effects for diet, exercise or both. Interventions were most successful when targeted at high-risk populations, though body mass index alone was not associated with an effect
Imaging is the only way to diagnose blood clots in pregnancy Signal - Imaging is the only way to diagnose blood clots in pregnancy Dissemination Centre Discover Portal NIHR DC Discover Imaging is the only way to diagnose blood clots in pregnancy Published on 13 March 2018 No blood test can accurately tell if a pregnant or recently pregnant woman has a blood clot. All pregnant women with a suspected clot should continue to have imaging investigations as per current UK guidelines. This NIHR (...) -funded study recruited 328 pregnant or postpartum women with a suspected blood clot in the lung (pulmonary embolism) or leg (deep vein thrombosis). They had a blood test to measure the levels of 13 biomarkers, such as the D-dimer, to see if they could rule a blood clot in or out. It was hoped that this could reduce the number of women who would need confirmation from a scan, and so decrease their exposure to radiation. None of the tests were accurate enough. The range of levels for each biomarker
No clear “best” treatment of mild or severe sickness in pregnancy Signal - No clear “best” treatment of mild or severe sickness in pregnancy Dissemination Centre Discover Portal NIHR DC Discover No clear “best” treatment of mild or severe sickness in pregnancy Published on 3 January 2017 Pregnant women could benefit from simple, cheap, “self-help” remedies for mild nausea and vomiting. Ginger, vitamin B6 and possibly acupressure wrist-bands might relieve symptoms for some women, according (...) to a recent overview of research in this area. The review has identified some promising areas for future research. For sickness that doesn’t respond to “self-help” remedies, prescribed medication like antihistamines or anti-sickness tablets may help. Hospital treatment, including combinations of drugs and intravenous fluids, may be indicated if this doesn’t work. The review assessed 73 studies that measured how well 33 types of treatment worked for pregnant women experiencing nausea and vomiting. Severity
General surgery is mostly safe during pregnancy Signal - General surgery is mostly safe during pregnancy Dissemination Centre Discover Portal NIHR DC Discover General surgery is mostly safe during pregnancy Published on 10 January 2017 Routine data from English hospitals show that general surgery during pregnancy, such as removing the appendix or gallbladder, does not commonly harm mother or baby. This suggests that surgery in pregnant women is generally safe, but that mothers could be provided (...) with more specific estimates of the risks. This large observational study assessed the “real world” outcomes of nearly 6.5 million pregnancies at hospitals in England over a 10-year period. Women who had surgery during pregnancy for a condition unrelated to pregnancy were slightly more likely to experience miscarriage, preterm or caesarean delivery or a long stay in hospital. Babies were more also slightly more likely to be low birthweight or stillborn. However, the actual risks of negative outcomes
Donor eggs may be linked to higher risk of pregnancy complications following IVF Signal - Donor eggs may be linked to higher risk of pregnancy complications following IVF Dissemination Centre Discover Portal NIHR DC Discover Donor eggs may be linked to higher risk of pregnancy complications following IVF Published on 26 May 2016 Women who use donor eggs in their IVF may have significantly higher rates of pregnancy complications than those who use their own eggs, a systematic review and meta (...) -analysis has found. Use of donor eggs was linked to up to four times the risk of developing high blood pressure in pregnancy. Other risks associated with donor eggs were low birth weight in the baby, caesarean section and premature delivery. It is always possible that other factors, such as the age of women who use donor eggs, may have influenced the study results. Advanced maternal age is itself associated with pregnancy complications, including high blood pressure. Nevertheless it seems likely from
Links between antipsychotics in pregnancy and harmful outcomes for baby may be influenced by mother’s lifestyle Signal - Links between antipsychotics in pregnancy and harmful outcomes for baby may be influenced by mother’s lifestyle Dissemination Centre Discover Portal NIHR DC Discover Links between antipsychotics in pregnancy and harmful outcomes for baby may be influenced by mother’s lifestyle Published on 6 June 2016 This NIHR funded study found that antipsychotic use during pregnancy (...) was not associated with worse child outcomes after poorer health and riskier lifestyles were taken into account. For pregnant women these were things like other medications, obesity, smoking, alcohol and taking illicit drugs. The study also provides further evidence against the use of valproate during pregnancy for epilepsy, bipolar disorder or schizophrenia because of the increased risk of poor outcomes for the child. The risk was double that of taking the alternatives, lamotrigine or carbamazapine during
One type of drug for depression during pregnancy may be linked to a small increase in pre-term births Signal - One type of drug for depression during pregnancy may be linked to a small increase in pre-term births Dissemination Centre Discover Portal NIHR DC Discover One type of drug for depression during pregnancy may be linked to a small increase in pre-term births Published on 9 August 2016 Women who are depressed during pregnancy and who take selective serotonin inhibitors (SSRIs) may be (...) more likely to have a pre-term birth than those who do not take SSRIs. Pre-term birth occurred in 6.8% of women with depression during pregnancy treated with SSRIs compared to 5.8% of depressed women who were treated with talking therapies alone. However, because this is a review of observational (cohort) studies rather than randomised controlled trials it is not possible to say that SSRIs cause pre-term birth. For example, it is possible that women who had worse depression were more likely
Induction of labour within 24 hours, if waters break at 37 weeks of pregnancy, can reduce womb infection Signal - Induction of labour within 24 hours, if waters break at 37 weeks of pregnancy, can reduce womb infection Dissemination Centre Discover Portal NIHR DC Discover Induction of labour within 24 hours, if waters break at 37 weeks of pregnancy, can reduce womb infection Published on 23 May 2017 Inducing labour may halve the risk of infection in the womb when waters break from 37 weeks (...) was this study needed? Premature rupture of membranes (PROM) at full term (37 weeks or more) occurs in 8% of pregnancies. Spontaneous onset of labour within 24 hours occurs in approximately 95% of cases. Labour can be delayed for up to seven days if it does not start within 24 hours. The risk of maternal or neonatal infection and the need for caesarean section are increased by PROM. Untreated infections can lead to complications with reproductive organs, problems with fertility and general health. PROM
Treating subclinical thyroid dysfunction in pregnancy probably has no benefit Signal - Treating subclinical thyroid dysfunction in pregnancy probably has no benefit Dissemination Centre Discover Portal NIHR DC Discover Treating subclinical thyroid dysfunction in pregnancy probably has no benefit Published on 8 August 2017 Testing for and then treating pregnant women with mild or “subclinical” underactive thyroid did not improve pregnancy outcomes, newborn baby outcomes, or the child’s IQ (...) at three to five years. A clearly underactive thyroid (clinical hypothyroidism) in pregnancy has been linked with various adverse outcomes for the mother and baby, including pre-eclampsia, preterm birth, congenital defects and neurodevelopmental delay. This needs treatment. However, there has been debate around the harms and benefits from treating only mildly abnormal blood test results in women who do not show signs of thyroid problems, subclinical hypothyroidism. These two linked trials randomised
Aspirin reduces a woman’s chance of developing pre-eclampsia in pregnancy Signal - Aspirin reduces a woman’s chance of developing pre-eclampsia in pregnancy Dissemination Centre Discover Portal NIHR DC Discover Aspirin reduces a woman’s chance of developing pre-eclampsia in pregnancy Published on 31 October 2017 Giving low dose aspirin to high-risk women reduced their risk of pre-eclampsia before 37 weeks of pregnancy. Preterm pre-eclampsia developed in 1.6% of women given 150mg aspirin daily (...) compared with 4.3% who took a placebo. Pre-eclampsia is a condition which can harm mother and baby. In the mother, it causes high blood pressure and protein in the urine, which can show in pregnancy after 20 weeks. Women with risk factors, such as previous pre-eclampsia, diabetes or high blood pressure, are often prescribed 75mg aspirin from 12 weeks onwards. This study aimed to test double this dose (still classified as a `low dose’) after using a new risk assessment with additional clinical tests
No benefit from monitoring antiepileptic drug levels in pregnancy No benefit from monitoring antiepileptic drug levels in pregnancy Dissemination Centre Discover Portal NIHR DC Discover No benefit from monitoring antiepileptic drug levels in pregnancy Published on 9 October 2018 doi: Regular monitoring of antiepileptic drug levels in pregnant women with epilepsy does not improve seizure control compared with clinical features-based monitoring. This NIHR-funded study was conducted across 50 UK (...) hospitals and is the largest randomised trial in pregnant women with epilepsy. Just over 260 pregnant women with unstable antiepileptic drug levels were assigned to ongoing monthly blood checks or clinical features monitoring. There were no differences in seizures or other pregnancy outcomes between the two strategies. But umbilical cord blood showed that babies whose mothers received blood checks were exposed to higher levels of antiepileptic drugs. The study provides important information about
Vaginal progesterone, oral progesterone, 17-OHPC, cerclage, and pessary for preventing preterm birth in at-risk singleton pregnancies: an updated systematic review and network meta-analysis 30480871 2018 12 31 1471-0528 2018 Nov 27 BJOG : an international journal of obstetrics and gynaecology BJOG Vaginal progesterone, oral progesterone, 17-OHPC, cerclage, and pessary for preventing preterm birth in at-risk singleton pregnancies: an updated systematic review and network meta-analysis. 10.1111 (...) for preventing preterm birth in at-risk singleton pregnancies. We used a piloted data extraction form and performed Bayesian random-effects network meta-analyses with 95% credibility intervals (CrI), as well as pairwise meta-analyses, rating the quality of the evidence using GRADE. We included 40 trials (11 311 women). In at-risk women overall, vaginal progesterone reduced preterm birth <34 (OR 0.43, 95% CrI 0.20-0.81) and <37 weeks (OR 0.51, 95% CrI 0.34-0.74), and neonatal death (OR 0.41, 95% CrI 0.20-0.83
Termination of pregnancy Maternity and Neonatal C linical G uideline Queensland Health Termination of pregnancy Queensland Clinical Guideline: Termination of pregnancy Refer to online version, destroy printed copies after use Page 2 of 32 Document title: Termination of pregnancy Publication date: April 2013 Document number: MN13.21-V3-R19 Document supplement: The document supplement is integral to and should be read in conjunction with this guideline. Amendments: Full version history (...) : Intellectual Property Officer, Queensland Health, GPO Box 48, Brisbane Qld 4001, email email@example.com, phone (07) 3234 1479. Queensland Clinical Guideline: Termination of pregnancy Refer to online version, destroy printed copies after use Page 3 of 32 Flow Chart: Summary of termination of pregnancy Queensland Clinical Guidelines: Summary of termination of pregnancy Flowchart: F13.21-1-V3-R19 Legal requirements ToP Act 2018 Less than or equal to 22+0 weeks · A medical practitioner may perform
Syphilis in pregnancy Maternity and Neonatal C linical G uideline Queensland Health Syphilis in pregnancy Queensland Clinical Guideline: Syphilis in pregnancy Refer to online version, destroy printed copies after use Page 2 of 31 Document title: Syphilis in pregnancy Publication date: December 2018 Document number: MN18.44-V1-R23 Document supplement: The document supplement is integral to and should be read in conjunction with this guideline. Amendments: Full version history is supplied (...) Officer, Queensland Health, GPO Box 48, Brisbane Qld 4001, email firstname.lastname@example.org, phone (07) 3234 1479. Queensland Clinical Guideline: Syphilis in pregnancy Refer to online version, destroy printed copies after use Page 3 of 31 Flow Chart: Antenatal care IM: intramuscular injection, MSM: Men who have sex with men, PCR: Polymerase Chain Reaction QSSS: Queensland Syphilis Surveillance Service, STI: sexually transmitted infection, 4 weeks before birth · Indicated following risk assessment
Management of HIV in pregnancy and postpartum British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018 BHIVA guidelines on the management of HIV in pregnancy and postpartum 2 Guideline writing group Dr Yvonne Gilleece (Chair) Honorary Clinical Senior Lecturer and Consultant Physician in HIV and Genitourinary Medicine, Brighton and Sussex University Hospitals NHS Trust Dr Shema Tariq (Vice-chair) Postdoctoral Clinical Research Fellow, University College (...) NHS Trust Dr Luciana Rubinstein Consultant in Genitourinary Medicine, London North West Healthcare University NHS Trust, London Ms Sonali Sonecha Lead Directorate Pharmacist HIV/GUM, Chelsea and Westminster Healthcare NHS Foundation Trust, London Dr Lisa Thorley UK Community Advisory Board representative Dr Pat Tookey Honorary Senior Lecturer and Co-Investigator National Study of HIV in Pregnancy and Childhood, UCL Great Ormond Street Institute of Child Health, London Ms Jennifer Tosswill Clinical
Serial Third-Trimester Ultrasonography Compared With Routine Care in Uncomplicated Pregnancies: A Randomized Controlled Trial 30399092 2018 11 21 1873-233X 132 6 2018 Dec Obstetrics and gynecology Obstet Gynecol Serial Third-Trimester Ultrasonography Compared With Routine Care in Uncomplicated Pregnancies: A Randomized Controlled Trial. 1358-1367 10.1097/AOG.0000000000002970 Among uncomplicated pregnancies, serial third-trimester ultrasound examinations identified significantly more cases (...) a significant difference, the following secondary endpoints occurred with similar frequency in the ultrasound examination group than the routine care group: induction resulting from abnormal ultrasound examination findings (14% vs 6%), cesarean delivery in labor (5% vs 6%), and prespecified composite maternal morbidity (9% in both groups) and composite neonatal morbidity (1% vs 4%). Among uncomplicated pregnancies between 24 0/7 and 30 6/7 weeks of gestation, serial third-trimester ultrasound examinations
HIV infection in pregnancy HIV infection in pregnancy - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search HIV infection in pregnancy Last reviewed: November 2018 Last updated: December 2018 Important updates Dolutegravir should not be used during the first trimester of pregnancy The US Department of Health and Human Services has updated its guidance on the management of pregnant women living with HIV infection. The (...) guideline has been revised to include interim recommendations regarding the use of dolutegravir in pregnancy and at the time of conception due to concerns about a possible increased risk of neural tube defects in the fetus. Recommendations Do not use dolutegravir during the first trimester of pregnancy, in non-pregnant women who want to become pregnant or who are trying to conceive, or in women who cannot consistently use effective contraception. Perform a pregnancy test before starting treatment