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Latest & greatest articles for pregnancy
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Early Pregnancy Loss INTERIM UPDATE ACOG PRACTICE BULLETIN Clinical Management Guidelines for Obstetrician–Gynecologists NUMBER 200 (Replaces Practice Bulletin Number 150, May 2015) CommitteeonPracticeBulletins—Gynecology.ThisPracticeBulletinwasdevelopedbytheACOGCommitteeonPractice Bulletins—GynecologyincollaborationwithSarahPrager,MD;VanessaK.Dalton,MD,MPH;andRebeccaH.Allen,MD,MPH. INTERIM UPDATE: This Practice Bulletin is updated as highlighted to reflect recent evidence regarding the use (...) of mife- pristone combined with misoprostol for medical management of early pregnancy loss. This Practice Bulletin also includes limited, focused updates to align with Practice Bulletin No. 181, Prevention of Rh D Alloimmunization. Early Pregnancy Loss Early pregnancy loss, or loss of an intrauterine pregnancy within the first trimester, is encountered commonly in clinical practice. Obstetricians and gynecologists should understand the use of various diagnostic tools to differentiate between viable
Clinic-Based Programs to Prevent Repeat Teen Pregnancy: A Systematic Review 30342636 2018 10 21 1873-2607 55 5 2018 Nov American journal of preventive medicine Am J Prev Med Clinic-Based Programs to Prevent Repeat Teen Pregnancy: A Systematic Review. 736-746 S0749-3797(18)32121-4 10.1016/j.amepre.2018.08.001 The purpose of this paper is to synthesize and evaluate the evidence on the effectiveness of repeat teen pregnancy prevention programs offered in clinical settings. Multiple databases were (...) one short-term (e.g., increased knowledge); medium-term (e.g., increased contraceptive use); or long-term (e.g., decreased repeat teen pregnancy) outcome, or identified contextual barriers or facilitators for providing adolescent-focused family planning services. Standardized abstraction methods and tools were used to synthesize the evidence and assess its quality. Only studies of clinic-based programs focused on repeat teen pregnancy prevention were included in this review. The search strategy
Ectopic pregnancy Ectopic pregnancy - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Ectopic pregnancy Last reviewed: October 2018 Last updated: October 2018 Summary Typically presents 6-8 weeks after last normal menstrual period, but can present earlier or later. Risk increases with prior ectopic pregnancy, tubal surgery, history of sexually transmitted infections, smoking, in vitro fertilisation, or if pregnant (...) of referred pain from intraperitoneal blood. Definition A fertilised ovum implanting and maturing outside of the uterine endometrial cavity, with the most common site being the fallopian tube (97%), followed by the ovary (3.2%) and the abdomen (1.3%). Bouyer J, Coste J, Fernandez H, et al. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002 Dec;17(12):3224-30. http://humrep.oxfordjournals.org/content/17/12/3224.full http://www.ncbi.nlm.nih.gov/pubmed/12456628?tool
Diagnosis of Pulmonary Embolism During Pregnancy: A Multicenter Prospective Management Outcome Study. Background: Data on the optimal diagnostic management of pregnant women with suspected pulmonary embolism (PE) are limited, and guidelines provide inconsistent recommendations on use of diagnostic tests. Objective: To prospectively validate a diagnostic strategy in pregnant women with suspected PE. Design: Multicenter, multinational, prospective diagnostic management outcome study involving (...) pretest clinical probability assessment, high-sensitivity D-dimer testing, bilateral lower limb compression ultrasonography (CUS), and computed tomography pulmonary angiography (CTPA). (ClinicalTrials.gov: NCT00740454 ). Setting: 11 centers in France and Switzerland between August 2008 and July 2016. Patients: Pregnant women with clinically suspected PE in emergency departments. Intervention: Pulmonary embolism was excluded in patients with a low or intermediate pretest clinical probability
β-Blocker Use in Pregnancy and the Risk for Congenital Malformations: An International Cohort Study. Background: β-Blockers are a class of antihypertensive medications that are commonly used in pregnancy. Objective: To estimate the risks for major congenital malformations associated with first-trimester exposure to β-blockers. Design: Cohort study. Setting: Health registries in the 5 Nordic countries and the U.S. Medicaid database. Patients: Pregnant women with a diagnosis of hypertension and (...) their offspring. Measurements: First-trimester exposure to β-blockers was assessed. Outcomes were any major congenital malformation, cardiac malformations, cleft lip or palate, and central nervous system (CNS) malformations. Propensity score stratification was used to control for potential confounders. Results: Of 3577 women with hypertensive pregnancies in the Nordic cohort and 14 900 in the U.S. cohort, 682 (19.1%) and 1668 (11.2%), respectively, were exposed to β-blockers in the first trimester
Mapping the landscape of global programmes to evaluate health interventions in pregnancy: the need for harmonised approaches, standards and tools 30364289 2018 11 14 2059-7908 3 5 2018 BMJ global health BMJ Glob Health Mapping the landscape of global programmes to evaluate health interventions in pregnancy: the need for harmonised approaches, standards and tools. e001053 10.1136/bmjgh-2018-001053 Pregnant women and their babies are among the populations most vulnerable to untoward health (...) outcomes. Yet current standards for evaluating health interventions cannot be met during pregnancy because of lack of adequate evidence. The situation is even more concerning in low-income and middle-income countries, where the need for effective interventions is the greatest. Meeting the Sustainable Development Goals for health will require strengthened attention to maternal and child health. In this paper we examine ongoing initiatives aimed at improving the assessment of maternal interventions. We
Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial. BACKGROUND: Preterm delivery during pregnancy (<37 weeks' gestation) is a leading cause of perinatal mortality and morbidity. Treating bacterial vaginosis during pregnancy can reduce poor outcomes, such as preterm birth. We aimed to investigate whether treatment of bacterial vaginosis decreases late miscarriages or spontaneous very preterm birth. METHODS: PREMEVA (...) was a double-blind randomised controlled trial done in 40 French centres. Women aged 18 years or older with bacterial vaginosis and low-risk pregnancy were eligible for inclusion and were randomly assigned (2:1) to three parallel groups: single-course or triple-course 300 mg clindamycin twice-daily for 4 days, or placebo. Women with high-risk pregnancy outcomes were eligible for inclusion in a high-risk subtrial and were randomly assigned (1:1) to either single-course or triple-course clindamycin
The Relationship Between Fish Oil Supplementation During Pregnancy and Incidence of Asthma in Children "The Relationship Between Fish Oil Supplementation During Pregnancy and" by JesAnne Tageson-Ramirez < > > > > > Title Author Date of Graduation Summer 8-11-2018 Degree Type Capstone Project Degree Name Master of Science in Physician Assistant Studies Rights . Abstract Background: The incidence of asthma is increasing in the United States. Some researchers believe this rise is due to higher (...) , wheezing, asthma, respiratory sounds, pregnancy, and perinatal. Studies were assessed for quality based on GRADE criteria. Results: There were 264 articles that were screened, 5 of which applied to the clinical question with only 2 articles meeting the eligibility criteria. One study found a significant decrease in the incidence of asthma in children when mothers were supplemented with high dose fish oil during pregnancy. The other study found no significant difference in the incidence of asthma
Moderate Exercise throughout Pregnancy and a Decreased Risk of Unplanned Cesarean Sections "Moderate Exercise throughout Pregnancy and a Decreased Risk of Unplann" by Larissa Hosler < > > > > > Title Author Date of Graduation Summer 8-11-2018 Degree Type Capstone Project Degree Name Master of Science in Physician Assistant Studies Rights . Abstract Background: Overall cesarean section rates have increased in the United States from 20.7% in 1996 to 32.9% in 2009. Research shows that maternal (...) morbidity is higher among women who have cesarean deliveries versus patients who have vaginal deliveries. With the rate of cesarean sections increasing in recent years, there have been efforts put in place to reduce these numbers. One method of combating this trend could be increasing exercise throughout the course of pregnancy. This review assesses the current evidence of the benefits of moderate exercise in decreasing the risk of unplanned cesarean section. Methods: An exhaustive search of available
Admission cardiotocography versus intermittent auscultation of the fetal heart in low-risk pregnancy during evaluation for possible labour admission - a multicentre randomised trial: the ADCAR trial 30126064 2018 09 19 1471-0528 2018 Aug 20 BJOG : an international journal of obstetrics and gynaecology BJOG Admission cardiotocography versus intermittent auscultation of the fetal heart in low-risk pregnancy during evaluation for possible labour admission - a multicentre randomised trial (...) : the ADCAR trial. 10.1111/1471-0528.15448 To assess the effect of admission cardiotocography (ACTG) versus intermittent auscultation (IA) of the fetal heart (FH) in low-risk pregnancy during assessment for possible labour on caesarean section rates. A parallel multicentre randomised trial. Three maternity units in the Republic of Ireland. Healthy, low-risk pregnant women, at term and ≥ 18 years old, who provided written informed consent. Women were randomised to receive IA of the FH or 20 minutes ACTG
Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention: A Systematic Review 30095777 2018 08 22 1873-233X 132 3 2018 Sep Obstetrics and gynecology Obstet Gynecol Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention: A Systematic Review. 591-604 10.1097/AOG.0000000000002784 To summarize best available prospective data on typical and perfect use effectiveness of fertility awareness-based methods for avoiding pregnancy. We conducted a systematic review (...) of studies published in English, Spanish, French, or German by June 2017 in MEDLINE, EMBASE, CINAHL, Web of Science, and ClinicalTrials.gov. We reviewed 8,755 unique citations and included 53 studies that contained 50 or greater women using a specific fertility awareness-based method to avoid pregnancy, calculated life table pregnancy probabilities or Pearl rates, and prospectively measured pregnancy intentions and outcomes. We systematically evaluated study quality. Of 53 included studies, we ranked 0
Risk of Severe Acute Maternal Morbidity According to Planned Mode of Delivery in Twin Pregnancies 30095775 2018 08 22 1873-233X 132 3 2018 Sep Obstetrics and gynecology Obstet Gynecol Risk of Severe Acute Maternal Morbidity According to Planned Mode of Delivery in Twin Pregnancies. 647-655 10.1097/AOG.0000000000002788 To evaluate the association between the planned mode of delivery and severe acute maternal morbidity in women with twin pregnancies. In this planned secondary analysis (...) of the JUmeaux MODe d'Accouchement cohort, a national prospective population-based study of twin deliveries conducted from February 2014 to March 2015 in 176 hospitals performing more than 1,500 annual deliveries in France, we included women with twin pregnancies at 24 weeks of gestation or greater with two live fetuses. Women delivering before 24 weeks of gestation, those with recognized indications for cesarean delivery, and those with severe acute maternal morbidity symptomatic before labor were excluded
Cardiovascular risk model performance in women with and without hypertensive disorders of pregnancy 30209122 2018 09 13 1468-201X 2018 Sep 12 Heart (British Cardiac Society) Heart Cardiovascular risk model performance in women with and without hypertensive disorders of pregnancy. heartjnl-2018-313439 10.1136/heartjnl-2018-313439 Compare the predictive performance of Framingham Risk Score (FRS), Pooled Cohort Equations (PCEs) and Systematic COronary Risk Evaluation (SCORE) model between women (...) with and without a history of hypertensive disorders of pregnancy (hHDP) and determine the effects of recalibration and refitting on predictive performance. We included 29 751 women, 6302 with hHDP and 17 369 without. We assessed whether models accurately predicted observed 10-year cardiovascular disease (CVD) risk (calibration) and whether they accurately distinguished between women developing CVD during follow-up and not (discrimination), separately for women with and without hHDP. We also recalibrated
Urinary stress incontinence and other maternal outcomes 2 years after caesarean or vaginal birth for twin pregnancy: a multicentre randomised trial 30007113 2018 09 03 1471-0528 2018 Jul 14 BJOG : an international journal of obstetrics and gynaecology BJOG Urinary stress incontinence and other maternal outcomes 2 years after caesarean or vaginal birth for twin pregnancy: a multicentre randomised trial. 10.1111/1471-0528.15407 Does planned caesarean compared with planned vaginal birth lower (...) the risk of problematic urinary stress, faecal, or flatal incontinence? Women between 32 0/7 and 38 6/7 weeks of gestation with a twin pregnancy were randomised to planned caesarean or planned vaginal birth. The trial took place at 106 centres in 25 countries. A total of 2305 of the 2804 women enrolled in the study completed questionnaires at 2 years (82.2% follow-up): 1155 in the planned caesarean group and 1150 in the planned vaginal birth group. A structured self-administered questionnaire completed
Asymptomatic Bacteriuria in Pregnancy Canadian Task Force on Preventive Health Care | Asymptomatic Bacteriuria in Pregnancy (2018) English Menu Asymptomatic Bacteriuria in Pregnancy (2018) Asymptomatic Bacteriuria in Pregnancy (2018) Click to view article Tools Additional Documents Click to see additional documents Endorsements This Clinical Practice Guideline has been endorsed by the Nurse Practitioners’ Association of Canada (NPAC). This Clinical Practice Guideline has been endorsed (...) were based on the overall balance between possible benefits and harms of screening, weighing the potential benefits against any harms. Overall, very low-quality evidence from four cohort studies (n=7,611) was found for the benefits and harms of screening for asymptomatic bacteriuria (ASB) in pregnancy. There were few events, effect estimates were highly imprecise and we are uncertain about the benefits and harms of screening. Linked evidence for screening that considers the effectiveness
Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. BACKGROUND: Antihypertensive drugs are often used in the belief that lowering blood pressure will prevent progression to more severe disease, and thereby improve pregnancy outcome. This Cochrane Review is an updated review, first published in 2001 and subsequently updated in 2007 and 2014. OBJECTIVES: To assess the effects of antihypertensive drug treatments for women with mild to moderate hypertension during (...) pregnancy. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (13 September 2017), and reference lists of retrieved studies. SELECTION CRITERIA: All randomised trials evaluating any antihypertensive drug treatment for mild to moderate hypertension during pregnancy, defined as systolic blood pressure 140 to 169 mmHg and/or diastolic blood pressure 90 to 109 mmHg. Comparisons were of one