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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
Diagnosis and management of a heterotopic pregnancy and ruptured rudimentary uterine horn 30279994 2018 11 14 2054-7099 4 2018 Fertility research and practice Fertil Res Pract Diagnosis and management of a heterotopic pregnancy and ruptured rudimentary uterine horn. 6 10.1186/s40738-018-0051-7 Heterotopic pregnancies implanted in a rudimentary uterine horn account for 1 in 2-3 million gestations, and confer significant risk of morbidity due to uterine rupture and hemorrhage. A 34-year-old (...) nullipara presented with acute pelvic pain at 17 weeks of gestation with dichorionic-diamniotic twins, one in each horn of an anomalous uterus first diagnosed in pregnancy as bicornuate. Three-dimensional ultrasound and MRI revealed myometrial disruption in the left rudimentary uterine horn, and the patient underwent an uncomplicated abdominal hemi-hysterectomy. Fourteen days later, an uncomplicated dilation and curettage was performed for a fetal anomaly in the remaining twin in the right unicornuate
Outcomes of Pregnancy in Mothers With Cirrhosis: A National Populationâ€Based Cohort Study of 1.3 Million Pregnancies 30411076 2018 11 14 2471-254X 2 11 2018 Nov Hepatology communications Hepatol Commun Outcomes of Pregnancy in Mothers With Cirrhosis: A National Population-Based Cohort Study of 1.3 Million Pregnancies. 1299-1305 10.1002/hep4.1255 There are limited data on pregnancy outcomes in women with cirrhosis. To address this gap, we examined the records of singleton births from Sweden's (...) National Patient Register (NPR), Cause of Death Register (CDR), and Medical Birth Register (MBR) between 1997 and 2011 to assess exposure and pregnancy-related and liver-related outcomes of pregnant women with cirrhosis. Exposure status was defined as having an International Classification of Diseases (ICD) code for cirrhosis obtained prior to or during pregnancy. Poisson regression with cluster-robust standard errors was used to estimate relative risks (RRs) adjusted for maternal age, smoking
Understanding premarital pregnancies among adolescents and young women in Ouagadougou, Burkina Faso 30310826 2018 11 14 2331-1886 4 1 2018 Cogent social sciences Cogent Soc Sci Understanding premarital pregnancies among adolescents and young women in Ouagadougou, Burkina Faso. 1-18 10.1080/23311886.2018.1514688 In developing countries, young women between 15 and 24 years of age account for more than 40% of unsafe abortions due to the high number of unwanted and/or out-of-wedlock pregnancies (...) . However, much about the profile of adolescents and young women who usually experience premarital pregnancies remains unknown. This study sought to understand the risk of pregnancy before marriage among adolescents and young women in Ouagadougou, Burkina Faso. By using longitudinal data from a demographic surveillance system, we tested the explanatory power of two theoretical assumptions on premarital childbearing in sub-Saharan Africa, which assumptions are the cultural inheritance model
Development and evaluation of a novel Vital Signs Alert device for use in pregnancy in low-resource settings 30319784 2018 11 14 2055-642X 4 4 2018 Oct BMJ innovations BMJ Innov Development and evaluation of a novel Vital Signs Alert device for use in pregnancy in low-resource settings. 192-198 10.1136/bmjinnov-2017-000235 Haemorrhage, hypertension, sepsis and abortion complications (often from haemorrhage or sepsis) contribute to 60% of all maternal deaths. Each is associated with vital signs (...) (blood pressure (BP) and pulse) abnormalities, and the majority of deaths are preventable through simple and timely intervention. This paper presents the development and evaluation of the CRADLE Vital Signs Alert (VSA), an accurate, low-cost and easy-to-use device measuring BP and pulse with an integrated traffic light early warning system. The VSA was designed to be used by all cadres of healthcare providers for pregnant women in low-resource settings with the aim to prevent avoidable maternal
Overview of pregnancy complications Overview of pregnancy complications - Summary of relevant conditions | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Overview of pregnancy complications Last reviewed: August 2018 Last updated: September 2018 Introduction Complications in pregnancy can result from conditions that are specifically linked to the pregnant state as well as conditions that commonly arise or occur incidentally in women who are pregnant (...) . Serious sequelae might include miscarriage, pre-term labour or premature rupture of membranes, premature birth, stillbirth, low birth weight, macrosomia, birth defects, and infant and maternal morbidity or death. Complications affecting mother and fetus may arise at any stage of pregnancy, during labour, or postpartum. Related conditions Condition Description Regular antenatal care/screening is a key component of a healthy pregnancy. Nausea and vomiting in pregnancy (NVP), commonly referred
A Pre-Pregnancy Biomarker Risk Score Improves Prediction of Future Gestational Diabetes 30302420 2018 11 14 2472-1972 2 10 2018 Oct 01 Journal of the Endocrine Society J Endocr Soc A Pre-Pregnancy Biomarker Risk Score Improves Prediction of Future Gestational Diabetes. 1158-1169 10.1210/js.2018-00200 Previous studies have not examined the ability of multiple preconception biomarkers, considered together, to improve prediction of gestational diabetes mellitus (GDM). To develop a preconception (...) biomarker risk score and assess its association with subsequent GDM. A nested case-control study among a cohort of women with serum collected as part of a health examination (1984 to 1996) and subsequent pregnancy (1984 to 2009). Biomarkers associated with GDM were dichotomized into high/low risk. Integrated health care system. Two controls were matched to each GDM case (n = 256 cases) on year and age at examination, age at pregnancy, and number of pregnancies between examination and index pregnancy
Effect of high dose folic acid supplementation in pregnancy on pre-eclampsia (FACT): double blind, phase III, randomised controlled, international, multicentre trial. OBJECTIVE: To determine the efficacy of high dose folic acid supplementation for prevention of pre-eclampsia in women with at least one risk factor: pre-existing hypertension, prepregnancy diabetes (type 1 or 2), twin pregnancy, pre-eclampsia in a previous pregnancy, or body mass index ≥35. DESIGN: Randomised, phase III, double (...) blinded international, multicentre clinical trial. SETTING: 70 obstetrical centres in five countries (Argentina, Australia, Canada, Jamaica, and UK). PARTICIPANTS: 2464 pregnant women with at least one high risk factor for pre-eclampsia were randomised between 2011 and 2015 (1144 to the folic acid group and 1157 to the placebo group); 2301 were included in the intention to treat analyses. INTERVENTION: Eligible women were randomised to receive either daily high dose folic acid (four 1.0 mg oral
Effect of fish oil supplementation in pregnancy on bone, lean, and fat mass at six years: randomised clinical trial. OBJECTIVE: To examine the effect of supplementation with n-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) in pregnancy on anthropometry and body composition in offspring. DESIGN: Double blinded, randomised controlled trial. SETTING: Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort. PARTICIPANTS: 736 pregnant women and their offspring. INTERVENTION: n-3 (...) LCPUFA (fish oil) or control (olive oil) daily from pregnancy week 24 until one week after birth. MAIN OUTCOME MEASURES: Height/length, weight, head, and waist measurements and body composition from dual energy x ray absorptiometry (all pre-specified secondary endpoints of the n-3 LCPUFA trial; the primary outcome for the trial was persistent wheeze/asthma). RESULTS: The mean body mass index (BMI) z score was increased between age 0 and 6 years in the fish oil supplementation group compared
Does supportive legislation guarantee access to pregnancy termination and postabortion care services? Findings from a facility census in Central Province, Zambia 30233831 2018 11 14 2059-7908 3 4 2018 BMJ global health BMJ Glob Health Does supportive legislation guarantee access to pregnancy termination and postabortion care services? Findings from a facility census in Central Province, Zambia. e000897 10.1136/bmjgh-2018-000897 Zambia is one of the few countries in Africa to permit termination (...) of pregnancy (TOP) on a wide range of grounds. However, substantial barriers remain to TOP and postabortion care (PAC). We conducted a census of 153 facilities between March and May 2016. We defined facilities according to whether they met basic and/or comprehensive signal functions criteria for TOP and PAC. We linked our facility data to census data to estimate geographic accessibility under different policy scenarios. Overall, 16% of facilities reported they had performed a TOP and 39% performed a PAC
Comparison of pregnancy rates for poor responders using IVF with mild ovarian stimulation versus conventional IVF: a guideline Comparison of pregnancy rates for poor responders using IVF with mild ovarian stimulation versus conventional IVF: a guideline Practice Committee of the American Society for Reproductive Medicine American Society for Reproductive Medicine, Birmingham, Alabama Mild-stimulation protocols with in vitro fertilization (IVF) generally aim to use less medication than (...) conventional IVF. This guideline evaluates pregnancy and live-birth rates in patients expected to be poor responders using mild ovarian stimulation and natural-cycle protocols vs conventional IVF. (Fertil Steril 2018;109:993–9.2018 by American Society for Reproductive Medicine.) Earn online CME credit related to this document at www.asrm.org/elearn Discuss: You can discuss this article with its authors and with other readers at https://www.fertstertdialog.com/users/16110- fertility-and-sterility/posts
Clearing the Smoke on Cannabis: Maternal Cannabis Use during Pregnancy ? An Update Key Points • Cannabis is the illicit drug most commonly used during pregnancy. • Constituents of cannabis can pass into breast milk during lactation and are absorbed and metabolized by the infant. • Frequent cannabis use during pregnancy is associated with low birth weight and is part of a cluster of risk-factors correlated with other adverse birth outcomes. • Prenatal and early exposure to cannabis can alter (...) neurodevelopment leading to adverse effects on cognition and academic achievement. • There are also effects on behaviour in children and young adults, including attention deficits, increased hyperactivity and impulsivity, and increased likelihood of substance use. • Information on the effects of cannabis use during pregnancy is essential to help healthcare providers advise patients about the impact of cannabis use and improve the health and well-being of patients and their children. Background After alcohol
Risk of Spontaneous Abortion After Inadvertent Human Papillomavirus Vaccination in Pregnancy 29889760 2018 06 28 1873-233X 132 1 2018 Jul Obstetrics and gynecology Obstet Gynecol Risk of Spontaneous Abortion After Inadvertent Human Papillomavirus Vaccination in Pregnancy. 35-44 10.1097/AOG.0000000000002694 To evaluate the risk of spontaneous abortion after quadrivalent human papillomavirus (4vHPV) vaccination before and during pregnancy across seven integrated health systems within the Vaccine (...) Safety Datalink. Within a retrospective observational cohort, we compared risks for spontaneous abortion after 4vHPV in three exposure windows: distal (16-22 weeks before the last menstrual period [LMP]), peripregnancy (within 6 weeks before the LMP), and during pregnancy (LMP through 19 weeks of gestation). Women 12-27 years of age with a pregnancy between 2008 and 2014, with continuous insurance enrollment 8 months before and through pregnancy end, and with a live birth, stillbirth, or spontaneous
Management of Pregnancy VA/DOD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF PREGNANCY Department of Veterans Affairs Department of Defense QUALIFYING STATEMENTS The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. They are designed to provide information and assist decision making. They are not intended to define a standard of care and should not be construed as one. Neither should (...) these guidelines does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor. Version 3.0 – 2018VA/DoD Clinical Practice Guideline for the Management of Pregnancy March 2018 Page 2 of 147 Prepared by: The Management of Pregnancy Work Group With support from: The Office of Quality, Safety and Value, VA, Washington, DC & Office of Evidence Based Practice, U.S. Army
Segesterone acetate and ethinyl estradiol vaginal system (Annovera) - New vaginal ring used to prevent pregnancy for an entire year Drug Approval Package: Annovera (segesterone acetate and ethinyl estradiol) U.S. Department of Health and Human Services Search FDA Submit search Drug Approval Package: Annovera (segesterone acetate and ethinyl estradiol) Company: The Population Council, Inc. Application Number: 209627 Approval Date: 08/10/2018 Persons with disabilities having problems accessing
Safety Profile of Drug Use During Pregnancy at Peripheral Health Centres in Burkina Faso: A Prospective Observational Cohort Study 30155832 2018 11 14 2199-1154 5 3 2018 Sep Drugs - real world outcomes Drugs Real World Outcomes Safety Profile of Drug Use During Pregnancy at Peripheral Health Centres in Burkina Faso: A Prospective Observational Cohort Study. 193-206 10.1007/s40801-018-0141-1 Safety data of many drugs used during pregnancy remain scarce. This is especially true in developing (...) countries characterised by the absence of a robust pharmacovigilance system, high prevalence of different tropical diseases affecting patients and potential for drug-drug interactions. This study aimed to assess the safety profile of drugs used in women at high risk of malaria during pregnancy and delivery in Burkina Faso's health facilities. It also aimed to assess factors associated with the use of potentially risky drugs over the entire course of pregnancy. We enrolled pregnant women from their first
Maternal Allopurinol Prevents Cardiac Dysfunction in Adult Male Offspring Programmed by Chronic Hypoxia During Pregnancy 30354714 2018 11 14 1524-4563 72 4 2018 Oct Hypertension (Dallas, Tex. : 1979) Hypertension Maternal Allopurinol Prevents Cardiac Dysfunction in Adult Male Offspring Programmed by Chronic Hypoxia During Pregnancy. 971-978 10.1161/HYPERTENSIONAHA.118.11363 Integrating functional and molecular levels, we investigated the effects of maternal treatment with a xanthine oxidase (...) inhibitor on the programming of cardiac dysfunction in adult offspring using an established rat model of hypoxic pregnancy. Female Wistar rats were divided into normoxic or hypoxic (13% O 2 ) pregnancy±maternal allopurinol treatment (30 mg kg -1 d -1 ). At 4 months, hearts were isolated from 1 male per litter per outcome variable to determine cardiac function and responses to ischemia-reperfusion in a Langendorff preparation. Sympathetic dominance, perfusate CK (creatine kinase) and LDH (lactate