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Latest & greatest articles for pregnancy
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on pregnancy or other clinical topics then use Trip today.
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American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy Venous thromboembolism (VTE) complicates ∼1.2 of every 1000 deliveries. Despite these low absolute risks, pregnancy-associated VTE is a leading cause of maternal morbidity and mortality.These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians and others in decisions about the prevention (...) and management of pregnancy-associated VTE.ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used
Effects of dietary nitrate supplementation, from beetroot juice, on blood pressure in hypertensive pregnant women: A randomised, double-blind, placebo-controlled feasibility trial. Chronic hypertension in pregnancy is associated with significant adverse pregnancy outcomes, increasing the risk of pre-eclampsia, fetal growth restriction and preterm birth. Dietary nitrate, abundant in green leafy vegetables and beetroot, is reduced in vivo to nitrite and subsequently nitric oxide, and has been (...) demonstrated to lower blood pressure, improve vascular compliance and enhance blood flow in non-pregnant humans and animals. The primary aims of this study were to determine the acceptability and efficacy of dietary nitrate supplementation, in the form of beetroot juice, to lower blood pressure in hypertensive pregnant women. In this double-blind, placebo-controlled feasibility trial, 40 pregnant women received either daily nitrate supplementation (70 mL beetroot juice, n = 20) or placebo (70 mL nitrate
, and newborn macrosomia have risen dramatically, most likely as a consequence of rising rates of maternal obesity. 17,18 Physical activity has been proposed as a preventative or therapeutic measure to reduce pregnancy complications and optimize maternal- fetalhealth. 19,20 This evidence-based guideline apply to pregnant women and target users including obstetric care providers, policy- makers, and?tness professionals whoprovide guidanceon the impact of prenatal physical activity on maternal, fetal (...) as to identify pregnancy outcomes that were most important to them. During Con- sensus Meeting #1, the Guidelines Consensus Panel selected 37outcomesrelatedtomaternal,fetal,andneonatalhealth, 20 of which were rated as “critical” and 17 as “important” taking into consideration the feedback from pregnant women and the perspective of obstetric care providers based on their expert opinion (see Table 1 for outcomes). The Guidelines Consensus Panel also identi?ed 4 a priori sub- groups of women believed
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
What Is the Best Imaging Study to Rule Out Pulmonary Embolism in Pregnancy? (SRS diagnosis) What Is the Best Imaging Study to Rule Out Pulmonary Embolism in Pregnancy? TAKE-HOME MESSAGE Both computed tomography (CT) pulmonary angiography and lung scintigraphy (ie, ventilation-perfusion scan) are appropriate imaging options for exclusion of pulmonary embolism during pregnancy. EBEM Commentators Latha Ganti, MD, MBA David Lebowitz, MD Department of Clinical Sciences University of Central Florida (...) College of Medicine Orlando, FL Jestin N. Carlson, MD, MS, and Alan Jones, MD, serve as editors of the SRS series. Editor’s Note: This is a clinical synopsis, a regular feature of the Annals’ Systematic Review Snapshot (SRS) series. The source for this systematic review snapshot is: van Mens TE, Scheres LJJ, de Jong PG, et al. Imaging for theexclusion of pulmonary embolism in pregnancy. Cochrane Database Syst Rev. 2017;1:CD011053. Results Summary of results for the diagnosis of pulmonary embolism
Maternal-fetal transmission and adverse perinatal outcomes in pregnant women infected with Zika virus: prospective cohort study in French Guiana. To estimate the rates of maternal-fetal transmission of Zika virus, adverse fetal/neonatal outcomes, and subsequent rates of asymptomatic/symptomatic congenital Zika virus infections up to the first week of life.Cohort study with prospective data collection and subsequent review of fetal/neonatal outcomes.Referral centre for prenatal diagnosis (...) of the French Guiana Western Hospital.Pregnant women at any stage of pregnancy with a laboratory confirmed symptomatic or asymptomatic Zika virus infection during the epidemic period in western French Guiana. The cohort enrolled 300 participants and prospectively followed their 305 fetuses/newborns.Rate of maternal-fetal transmission of Zika virus (amniotic fluid, fetal and neonatal blood, urine, cerebrospinal fluid, and placentas); clinical, biological, and radiological outcomes (blindly reviewed
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: February 2019 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. 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.To prospectively validate a diagnostic strategy in pregnant women with suspected PE.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).11 centers in France and Switzerland between August 2008 and July 2016.Pregnant women with clinically suspected PE in emergency departments.Pulmonary embolism was excluded in patients with a low or intermediate pretest clinical probability and a negative D-dimer result. All others underwent lower limb CUS
Determinants of disclosure and non-disclosure of HIV-positive status, byÂ pregnant women in rural South Africa Disclosure of HIV status remains one of the major challenges to the effectiveness of the prevention of mother to child transmission of HIV in rural areas in South Africa. This study aimed at assessing the determinants of HIV status disclosure among HIV infected pregnant women who have disclosed their HIV status to someone, as well as among those who have disclosed to their partners (...) . Cross-sectional data was collected from 673 HIV sero-positive pregnant women receiving antenatal care services at 12 Community Health Centers in Mpumalanga province. Results indicated that over two-thirds (72.1%) disclosed their status to someone, while just over half (58.4%) disclosed to their partners. Multivariate analysis showed that both disclosure of ones HIV status to someone and to their male partners was significantly associated with increase in antiretroviral therapy (ART) adherence
β-Blocker Use in Pregnancy and the Risk for Congenital Malformations: An International Cohort Study. β-Blockers are a class of antihypertensive medications that are commonly used in pregnancy.To estimate the risks for major congenital malformations associated with first-trimester exposure to β-blockers.Cohort study.Health registries in the 5 Nordic countries and the U.S. Medicaid database.Pregnant women with a diagnosis of hypertension and their offspring.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.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. The pooled adjusted relative risk (RR) and risk difference per 1000 persons exposed
Mapping the landscape of global programmes to evaluate health interventions in pregnancy: the need for harmonised approaches, standards and tools 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 (...) . Stronger coordination mechanisms and a roadmap to support harmonised monitoring of maternal interventions across programmes and partners, working on improving pregnancy and early childhood health events, will greatly enhance ability to generate evidence-based policies.
Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial. 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.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 primary outcome was a composite
2018LancetControlled trial quality: predicted high
Cardiogenic Shock after Nifedipine Administration in a Pregnant Patient: A Case Report and Review of the Literature We present a case of a 21-year-old Caucasian woman at 27 weeks of pregnancy who was admitted to the obstetric department for pre-term labor. She received 10 mg of nifedipine 4 times in 1 h, according to the internal protocol. Shortly after, she brutally deteriorated with pulmonary edema and hypoxemia requiring transfer to the intensive care unit (ICU) for mechanical ventilation
Risk of Severe Acute Maternal Morbidity According to Planned Mode of Delivery in Twin Pregnancies 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 to limit confounding by indication. The primary outcome was a composite measure of intra- or postpartum severe acute maternal morbidity. Multivariate Poisson regression models and propensity score matching were used
Urinary stress incontinence and other maternal outcomes 2 years after caesarean or vaginal birth for twin pregnancy: a multicentre randomised trial Does planned caesarean compared with planned vaginal birth lower the risk of problematic urinary stress, faecal, or flatal incontinence?Women between 320/7 and 386/7 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 (...) outcomes.Among women with a twin pregnancy and no prior history of urinary stress incontinence, a management strategy of planned caesarean compared with planned vaginal birth reduces the risk of problematic urinary stress incontinence at 2 years postpartum. Our findings show that the prevalence but not the severity of urinary stress incontinence was associated with mode of birth.Canadian Institutes of Health Research (CIHR) (grant no. MCT-63164).For women with twins, planned caesarean compared with planned
Clinical and metabolic outcomes in pregnant women at risk for gestational diabetes mellitus supplemented with myo-inositol: a secondary analysis from 3 RCTs Gestational diabetes mellitus is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. Insulin sensitizing substances such as myo-inositol have been considered for the prevention of gestational diabetes mellitus and related complications.Because previous studies failed to show a clear reduction (...) pregnancy. Main measures were the rate of adverse clinical outcomes: macrosomia (birthweight, ≥4000 g), large-for-gestational-age babies (fetal growth, ≥90 percentile), fetal growth restriction (fetal growth, ≤3 percentile), preterm birth (delivery before week 37 since the last menstruation), gestational hypertension, and gestational diabetes mellitus.A significant reduction was observed for preterm birth (10/291 [3.4%] vs 23/304 [7.6%]; P=.03), macrosomia (6/291 [2.1%] vs 16/304 [5.3%]; P=.04), Large
Prenatal education of overweight or obese pregnant women to prevent childhood overweight (the ETOIG study): an open-label, randomized controlled trial We aimed to evaluate whether pre and perinatal education of pregnant women would reduce childhood overweight.Four French centers included women at ≤21 gestational weeks (GWs) with body mass index (BMI) >25 kg/m2 before pregnancy. Patients were randomized to a control group (routine care including at least one dietary visit) or an intervention
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 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 on admission for possible labour onset, using remote telephone randomisation. Both groups received IA during labour, with conversion to continuous CTG as clinically indicated.Caesarean section (primary outcome), obstetric interventions (e.g. continuous CTG during labour, fetal blood sampling, augmentation of labour) and neonatal morbidity
Cardiovascular risk model performance in women with and without hypertensive disorders of pregnancy 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