Obstetrical & Gynecological Survey最新文献

{"title":"Postnatal Care: A Comparative Review of Guidelines.","authors":"Sonia Giouleka, Ioannis Tsakiridis, Nikolaos Kostakis, Eirini Boureka, Apostolos Mamopoulos, Ioannis Kalogiannidis, Apostolos Athanasiadis, Themistoklis Dagklis","doi":"10.1097/OGX.0000000000001224","DOIUrl":"10.1097/OGX.0000000000001224","url":null,"abstract":"<p><strong>Importance: </strong>Postnatal care refers to the ongoing health care provision of both the mother and her offspring and contributes to the timely identification and effective management of complications in the postpartum period, to secure maternal and infant short- and long-term well-being.</p><p><strong>Objective: </strong>The aim of this study was to review and compare the most recently published influential guidelines on postnatal care practices.</p><p><strong>Evidence acquisition: </strong>A comparative review of guidelines from the American College of Obstetricians and Gynecologists, the World Health Organization, the National Institute for Health and Care Excellence, and the Public Health Agency of Canada regarding postnatal care was conducted.</p><p><strong>Results: </strong>There is a consensus among the reviewed guidelines regarding the importance of health care provision in the postpartum period, including home visits and midwifery services, the use of telemedicine for the facilitation of communication with the patient, and the appropriate preparation for discharge, as well as the discharge criteria. All medical societies also agree on the clinical aspects that should be evaluated at each postnatal visit, although discrepancies exist with regard to the contact schedule. In addition, there is consistency regarding the management of postpartum infections, perineal pain, fecal and urinary incontinence, and physical activity guidance. Mental health issues should be addressed at each postnatal visit, according to all guidelines, but there is disagreement regarding routine screening for depression. As for the optimal interpregnancy interval, the American College of Obstetricians and Gynecologists recommends avoiding pregnancy for at least 6 months postpartum, whereas the National Institute for Health and Care Excellence recommends a 12-month interval. There is no common pathway regarding the recommended contraceptive methods, the nutrition guidance, and the postpartum management of pregnancy complications. Of note, the World Health Organization alone provides recommendations concerning the prevention of specific infections during the postnatal period.</p><p><strong>Conclusions: </strong>Postnatal care remains a relatively underserved aspect of maternity care, although the puerperium is a critical period for the establishment of motherhood and the transition to primary care. Thus, the development of consistent international protocols for the optimal care and support of women during the postnatal period seems of insurmountable importance to safely guide clinical practice and subsequently reduce maternal and neonatal morbidity.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Rupture of the Unscarred Uterus: A Review of the Literature.","authors":"Inshirah Sgayer, Shirin Dabbah, Rola Khamisy Farah, Maya Wolf, Nadine Ashkar, Lior Lowenstein, Marwan Odeh","doi":"10.1097/OGX.0000000000001205","DOIUrl":"10.1097/OGX.0000000000001205","url":null,"abstract":"<p><strong>Importance: </strong>Uterine rupture is defined as a nonsurgical disruption of all layers of the uterus. Most ruptures occur in the presence of a scar, usually secondary to a previous cesarean delivery. Rupture of an unscarred uterus is rare and is associated with severe maternal and neonatal outcomes.</p><p><strong>Objective: </strong>To outline the literature on potential predisposing factors, clinical findings, and maternal and fetal outcomes of a rupture of an unscarred uterus.</p><p><strong>Evidence acquisition: </strong>PubMed was searched for the phrases \"uterine rupture,\" \"unscarred,\" and \"spontaneous.\" Individual case reports, retrospective case series, and review articles in English between 1983 and 2020 were included.</p><p><strong>Results: </strong>We found 84 case reports in 79 articles. The mean maternal age was 29.3 (SD, 5.7) years; 38 women (45.2%) were nulliparous. Uterine rupture occurred in 37% of the women at term; in 9.9%, the gestational age was ≤12 weeks. The most common clinical presentations were abdominal pain (77.4%), signs of hypovolemic shock (36.9%), fetal distress (31%), and vaginal bleeding (22.6%). The most common risk factors were the use of uterotonic drugs for induction or augmentation of labor and a prior curettage procedure. The most frequently ruptured site was the body of the uterus. Hysterectomy managed 36.9% of the ruptures. Four women died (4.8%). Perinatal mortality was 50.6%. Perinatal death was higher in developing than developed countries.</p><p><strong>Conclusions and relevance: </strong>Although rare, spontaneous rupture of the unscarred uterus has serious consequences to the mother and the fetus and should be included in the differential diagnosis of acute abdomen in pregnancy.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138885581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central Sensitization in Vulvodynia and Endometriosis: What Have We Been Overlooking So Far?","authors":"Giulia Emily Cetera, Camilla Erminia Maria Merli, Veronica Boero, Carlotta Caia, Federica Facchin, Giussy Barbara, Ermelinda Monti, Paolo Vercellini","doi":"10.1097/OGX.0000000000001183","DOIUrl":"10.1097/OGX.0000000000001183","url":null,"abstract":"<p><strong>Importance: </strong>Women experience more frequent and greater pain than men, although they receive less adequate treatment and are perceived as more anxious than males. Recent clinical research has lead to hypothesize a common etiology for overlapping chronic pain conditions and mood disorders, namely, central sensitization, which originates from an alteration of pain processing pathways in the central nervous system.</p><p><strong>Objective: </strong>The aim of this review was to collect all available evidence regarding the potential role of central sensitization in vulvodynia and endometriosis.</p><p><strong>Evidence acquisition: </strong>A systematic literature search was performed between July and August 2022 using the electronic database PubMed. The extracted data were summarized using a narrative approach.</p><p><strong>Results: </strong>Ten articles were chosen for the review. Participants' mean age was 39.2 years (SD = 5.1). Among serum markers of central sensitization, nitric oxide levels were greater in women with endometriosis than in controls, whereas brain-derived neurotrophic factor and S100B levels differed among pain conditions with structural anomalies and those without. Functional magnetic resonance imaging showed different resting state networks between patients with endometriosis and controls. In neurophysiology studies, cases had reduced pain thresholds, compared with healthy controls. Lastly, self-reported questionnaires suggested a central component of pain in women with endometriosis-related dyspareunia and associated bladder/pelvic floor tenderness.</p><p><strong>Conclusions and relevance: </strong>The management of vulvodynia and endometriosis may benefit from a new perspective, which considers their possible central etiology. It is compelling that treatment of pain starts to be considered a therapeutic goal in its own right.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138885579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention of Early-Onset Neonatal Group B Streptococcal Disease: A Comprehensive Review of Major Guidelines.","authors":"Eirini Boureka, Dimitrios Krasias, Ioannis Tsakiridis, Anna-Maria Karathanasi, Apostolos Mamopoulos, Apostolos Athanasiadis, Themistoklis Dagklis","doi":"10.1097/OGX.0000000000001223","DOIUrl":"10.1097/OGX.0000000000001223","url":null,"abstract":"<p><strong>Importance: </strong>Group B <i>Streptococcus</i> (GBS) colonization during pregnancy is associated with significant neonatal morbidity and mortality and represents a major public health concern, often associated with poor screening and management.</p><p><strong>Objective: </strong>The aim of this study was to review and compare the most recently published influential guidelines on the screening and management of this clinical entity during antenatal and intrapartum periods.</p><p><strong>Evidence acquisition: </strong>A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, and the Society of Obstetricians and Gynecologists of Canada on the prevention of early-onset neonatal group B streptococcal disease was carried out.</p><p><strong>Results: </strong>There is a consensus among the reviewed guidelines regarding the optimal screening specimen type, indications for intrapartum antibiotic administration such as bacteriuria during pregnancy, clinical signs of chorioamnionitis or maternal pyrexia, and history of GBS-related neonatal disease. There is also agreement on several conditions where no intervention is recommended, that is, antepartum treatment of GBS and GBS-positive women with planned cesarean delivery and intact membranes. Controversy exists regarding the optimal screening time, with the Royal College of Obstetricians and Gynecologists stating against routine screening and on management strategies related to preterm labor and preterm prelabor rupture of membranes.</p><p><strong>Conclusions: </strong>The development of consistent international practice protocols for the timely screening of GBS and effective management of this clinical entity both during pregnancy and the intrapartum period seems of paramount importance to safely guide clinical practice and subsequently improve neonatal outcomes.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138885580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and Management of Osteoporosis: A Comprehensive Review of Guidelines.","authors":"Elpiniki Rentzeperi, Stavroula Pegiou, Ioannis Tsakiridis, Ioannis Kalogiannidis, Anargyros Kourtis, Apostolos Mamopoulos, Apostolos Athanasiadis, Themistoklis Dagklis","doi":"10.1097/OGX.0000000000001181","DOIUrl":"10.1097/OGX.0000000000001181","url":null,"abstract":"<p><strong>Importance: </strong>Osteoporosis causes increased morbidity and mortality, and thus poses a significant economic burden to the health systems worldwide.</p><p><strong>Objective: </strong>The aim of this study was to review and compare the most recently published major guidelines on diagnosis and management of this common medical entity.</p><p><strong>Evidence acquisition: </strong>A thorough comparative review of the most influential guidelines from the RACGP (Royal Australian College of General Practitioners), the ESCEO-IOF (European Society for Clinical and Economic Aspects of Osteoporosis-International Osteoporosis Foundation), the NOGG (National Osteoporosis Guideline Group), the NAMS (North American Menopause Society), the ES (Endocrine Society), and the ACOG (American College of Obstetricians and Gynecologists) was conducted.</p><p><strong>Results: </strong>The reviewed guidelines generally agree on the definition, the criteria, and investigations used to diagnose osteoporosis. They also concur regarding the risk factors for osteoporosis and the suggested lifestyle modifications (calcium and vitamin D intake, normal body weight, reduction of alcohol consumption, and smoking cessation). However, there is lack of consensus on indications for fracture risk assessment in the general population and the exact indications for bone mineral density assessment. Referral to a bone specialist is reserved for complex cases of osteoporosis (NOGG, NAMS, and ACOG) or in case of inadequate access to care (RACGP). The use of hip protectors to reduce the risk of fractures is supported by RACGP, NOGG, and NAMS, solely for high-risk elderly patients in residential care settings. All guidelines reviewed recognize the efficacy of the pharmacologic agents (ie, bisphosphonates, denosumab, hormone therapy, and parathyroid hormone analogs). Nonetheless, recommendations regarding monitoring of pharmacotherapy differ, primarily in the case of bisphosphonates. The proposed intervals of repeat bone mineral density testing after initiation of drug therapy are set at 2 years (RACGP), 1-3 years (NAMS, ES, and ACOG), or 3-5 years (ESCEO-IOF and NOGG). All guidelines agree upon the restricted use of bone turnover markers only in bone specialist centers for treatment monitoring purposes. Finally, the definition of treatment failure varies among the reviewed guidelines.</p><p><strong>Conclusions: </strong>Osteoporosis is a distressing condition for women, mainly those of postmenopausal age. Thus, it seems of paramount importance to develop consistent international practice protocols for more cost-effective diagnostic and management techniques, in order to improve women's quality of life.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138885576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management and Interventions in Previable and Periviable Preterm Premature Rupture of Membranes: A Review.","authors":"Amy Phillips, Megan Pagan, Alex Smith, Megan Whitham, Everett F Magann","doi":"10.1097/OGX.0000000000001198","DOIUrl":"10.1097/OGX.0000000000001198","url":null,"abstract":"<p><strong>Importance: </strong>Periviable and previable premature rupture of membranes (pPPROM) occurs in <1% of pregnancies but can have devastating consequences for the mother and the fetus. Understanding risk factors, possible interventions, and both maternal and neonatal outcomes will improve the counseling and care provided for these patients.</p><p><strong>Objective: </strong>The aim of this review is to describe the etiology, risk factors, management strategies, neonatal and maternal outcomes, and recurrence risk for patients experiencing pPPROM.</p><p><strong>Evidence acquisition: </strong>A PubMed, Web of Science, and CINAHL search was undertaken with unlimited years searched. The search terms used included \"previable\" OR \"periviable\" AND \"fetal membranes\" OR \"premature rupture\" OR \"PROM\" OR \"PPROM.\" The search was limited to English language.</p><p><strong>Results: </strong>There were 181 articles identified, with 41 being the basis of review. Multiple risk factors for pPPROM have been identified, but their predictive value remains low. Interventions that are typically used once the fetus reaches 23 to 24 weeks of gestation have not been shown to improve outcomes when used in the previable and periviable stage. Neonatal outcomes have improved over time, but survival without severe morbidity remains low. Later gestational age at the time of pPPROM and longer latency period have been shown to be associated with improved outcomes.</p><p><strong>Conclusions and relevance: </strong>Periviable and previable premature rupture of membranes are uncommon pregnancy events, but neonatal outcomes remain poor, and routine interventions for PPROM >24 weeks of gestation have not proven beneficial. The 2 most reliable prognostic indicators are gestational age at time of pPPROM and length of the latency period.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138885578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fetal Growth Restriction: A Comprehensive Review of Major Guidelines.","authors":"Sonia Giouleka, Ioannis Tsakiridis, Apostolos Mamopoulos, Ioannis Kalogiannidis, Apostolos Athanasiadis, Themistoklis Dagklis","doi":"10.1097/OGX.0000000000001203","DOIUrl":"10.1097/OGX.0000000000001203","url":null,"abstract":"<p><strong>Importance: </strong>Fetal growth restriction (FGR) is a common pregnancy complication and a significant contributor of fetal and neonatal morbidity and mortality, mainly due to the lack of effective screening, prevention, and management policies.</p><p><strong>Objective: </strong>The aim of this study was to review and compare the most recently published influential guidelines on the management of pregnancies complicated by FGR.</p><p><strong>Evidence acquisition: </strong>A descriptive review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Society for Maternal-Fetal Medicine, the International Federation of Gynecology and Obstetrics, the International Society of Ultrasound in Obstetrics and Gynecology, the Royal College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada (SOGC), the Perinatal Society of Australia and New Zealand, the Royal College of Physicians of Ireland, the French College of Gynecologists and Obstetricians (FCGO), and the German Society of Gynecology and Obstetrics on FGR was carried out.</p><p><strong>Results: </strong>Several discrepancies were identified regarding the definition of FGR and small-for-gestational-age fetuses, the diagnostic criteria, and the need of testing for congenital infections. On the contrary, there is an overall agreement among the reviewed guidelines regarding the importance of early universal risk stratification for FGR to accordingly modify the surveillance protocols. Low-risk pregnancies should unanimously be evaluated by serial symphysis fundal height measurement, whereas the high-risk ones warrant increased sonographic surveillance. Following FGR diagnosis, all medical societies agree that umbilical artery Doppler assessment is required to further guide management, whereas amniotic fluid volume evaluation is also recommended by the ACOG, the SOGC, the Perinatal Society of Australia and New Zealand, the FCGO, and the German Society of Gynecology and Obstetrics. In case of early, severe FGR or FGR accompanied by structural abnormalities, the ACOG, the Society for Maternal-Fetal Medicine, the International Federation of Gynecology and Obstetrics, the Royal College of Obstetricians and Gynecologists, the SOGC, and the FCGO support the performance of prenatal diagnostic testing. Consistent protocols also exist on the optimal timing and mode of delivery, the importance of continuous fetal heart rate monitoring during labor, and the need for histopathological examination of the placenta after delivery. On the other hand, guidelines concerning the frequency of fetal growth and Doppler velocimetry evaluation lack uniformity, although most of the reviewed medical societies recommend an average interval of 2 weeks, reduced to weekly or less when umbilical artery abnormalities are detected. Moreover, there is a discrepancy on the appropriate timing for corticosteroids and magnesium sulfate administration, as well as","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":6.2,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138885577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Exciting Potential for ChatGPT in Obstetrics and Gynecology","authors":"Amos Grünebaum, Joseph Chervenak, Susan L. Pollet, Adi Katz, Frank A. Chervenak","doi":"10.1097/01.ogx.0000993696.39744.23","DOIUrl":"https://doi.org/10.1097/01.ogx.0000993696.39744.23","url":null,"abstract":"ABSTRACT In November 2022, AI Lab OpenAI launched the online chatbot ChatGPT (Chat Generative Pre-Trained Transformer), an accessible language model that uses the artificial intelligence (AI) branch of natural language processing (NLP) to answer prompts based on a library of 175 billion parameters from the “internet, books and other sources.” Because of its ability to answer clinical questions in plain English that can be understood by providers and patients alike, the potential for ChatGPT to be used as a clinical tool is obvious. Despite its impressive fund of source knowledge, these data are potentially biased and unreliable and may not reflect current stances. In addition, ChatGPT does not list sources for its information, and its current capability to answer clinical questions correctly is not well understood. This study aimed to assess answers given by ChatGPT in response to a spectrum of questions about obstetrics and gynecology including systems-level questions, ethical questions, and treatment-related decision making. A total of 14 questions were asked. The first question asked why US preterm birth rates are so high. The second question asked for a list of the most important interventions physicians can do to monitor, prevent, and treat premature births. The third question asked whether vaginal progesterone was effective and safe for preventing preterm birth in women with a short cervix in the midtrimester, and the fourth question asked the same question but in women with a history of preterm birth and no short cervix. The fifth question asked why maternal mortality rates in the United States are so high. The sixth question asked for a list of what obstetricians can do to prevent preeclampsia. The seventh question asked about the safety of hospital births when compared with planned home births in the United States. The eighth question asked whether it is ethically acceptable for an obstetrician to provide emergency cesarean delivery without a woman's informed consent to save the fetus or the mother. The ninth question asked how obstetricians should screen for domestic abuse and intimate partner violence in pregnancy. The 10th question asked if women should freeze their eggs and at what age. The 11th question asked about the risks and benefits of menopause hormone replacement therapy. The 12th question asked how abortion bans in the United States affect women's health and lives. The 13th question asked whether complex hyperplasia atypia surgery should be performed only by a gynecologist-oncologist. The final question asked whether we should continue using the term “pregnant woman” versus alternative including “pregnant person.” Overall, ChatGPT provided nuanced and informed answers to question on virtually any topic in obstetrics and gynecology, but occasionally revealed an apparent lack of insight into the questions being asked. ChatGPT can provide preliminary information about a wide range of topics and can be valuable to both providers","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136009881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heparin for Women With Recurrent Miscarriage and Inherited Thrombophilia (ALIFE2): An International Open-Label, Randomized Controlled Trial","authors":"Siobhan Quenby, Katie Booth, Louise Hiller, Arri Coomarasamy, Paulien G. de Jong, Eva N. Hamulyák, Luuk J. Scheres, Thijs F. van Haaps, Lauren Ewington, Shreeya Tewary, Mariëtte Goddijn, Saskia Middeldorp","doi":"10.1097/ogx.0000000000001209","DOIUrl":"https://doi.org/10.1097/ogx.0000000000001209","url":null,"abstract":"ABSTRACT Thrombophilia has been implicated in the cause of recurrent miscarriage, which affects approximately 3% of couples trying to conceive. International professional guidelines recommend heparin anticoagulation for antiphospholipid syndrome, an acquired thrombophilia responsible for approximately 15% of recurrent miscarriage, but not for other inherited thrombophilias due to an absence of evidence. Many clinicians prescribe heparin to women with recurrent miscarriage and inherited thrombophilia despite the professional recommendations. This international, open-label, randomized controlled trial aimed to compare the effect of low-molecular weight heparin (LMWH) and standard pregnancy surveillance on livebirth rates in women with recurrent miscarriage and inherited thrombophilia. Women aged 18–42 years with recurrent miscarriages who were attempting to conceive or less than 7 weeks pregnant and had an inherited thrombophilia were recruited across 40 hospitals in 5 countries. Women were randomly assigned to LMWH or no LMWH in a 1:1 ratio. Women randomized to LMWH self-administered it once a day subcutaneously, beginning as soon as possible after a positive pregnancy test and before 7 weeks of gestation and continuing throughout pregnancy. The primary study outcome was livebirth after 24 weeks of gestation. Livebirth was compared across randomized treatment groups using an χ 2 test with continuity correction, then a sensitivity analysis with logistic regression to adjust for stratification factors. A total of 326 women were randomized between August 2012 and January 2021. Of these, 164 were randomized to LMWH plus standard care and 162 to standard care alone. In the standard care group, 30 patients ultimately received LMWH for thromboprophylaxis per professional treatment guidelines. The mean age of participants was 33 years, and the median number of miscarriages before randomization was 3 (interquartile range, 2–4), with two thirds of patients having a history of 3 or more miscarriages. The most common thrombophilia diagnoses were heterozygosity for factor V Leiden, prothrombin G20210A mutation, and protein S deficiency. The livebirth rate was 72% (116/162) in the LMWH group, and 71% (112/158) in the standard care group, and no statistical significant was detected between the groups even after adjustment (odds ratio, 1.08; 95% confidence interval, 0.65–1.78; P = 0.77). No differences in adverse pregnancy outcomes or complications were observed between the groups. Easy bruising was reported by 45% (73) women in the LMWH group and 10% (16) in the standard care group. This randomized controlled trial demonstrates that although LMWH is safe in women with recurrent pregnancy loss and inherited thrombophilia, it does not result in an increased live birth rate compared with standard pregnancy surveillance.","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136010006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Dose Aspirin for the Prevention of Superimposed Preeclampsia in Women With Chronic Hypertension: A Systematic Review and Meta-analysis","authors":"Eleanor M. F. Richards, Veronica Giorgione, Oliver Stevens, Basky Thilaganathan","doi":"10.1097/01.ogx.0000993664.57399.b2","DOIUrl":"https://doi.org/10.1097/01.ogx.0000993664.57399.b2","url":null,"abstract":"ABSTRACT Women with chronic hypertension are at increased risk for the development of preeclampsia during pregnancy. Low-dose aspirin treatment has been studied in the context of preeclampsia prevention, but there have been conflicting results among different populations. Some reasons for this are heterogeneous treatment regimens including timing, dosage, and even target outcomes. Among populations where there are limited data on the effect of low-dose aspirin on preeclampsia are women with chronic hypertension. This study is a systematic review and meta-analysis designed to analyze the use of low-dose aspirin during pregnancy and to assess whether the treatment reduces the risk of superimposed preeclampsia in women with chronic hypertension. It also aimed to secondarily assess related outcomes such as small for gestational age (SGA), preterm birth, and perinatal mortality. Systematic searches and assessment isolated 9 articles for final analysis. Six of these were randomized controlled trials, and 3 were retrospective cohort studies. Four studies focused on populations of only women with chronic hypertension, and the others included women with several different risk factors for preeclampsia. The retrospective studies and one of the randomized controlled trials compared aspirin treatment with no treatment, and the others compared with a placebo group; all studies used a dose of aspirin between 60 and 150 mg daily. No studies were excluded from the analysis based on risk of bias, as none were determined to be “critical” or “high” risk, although risk of bias was determined to be a contributing factor to low-quality data. Final analysis included a pooled sample size of 1078 individuals with chronic hypertension on low-dose aspirin, compared with 1072 women with chronic hypertension in control groups. This analysis did not find a decreased odds of superimposed preeclampsia in either randomized controlled trials (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.55–1.25) or observational studies (OR, 1.21; 95% CI, 0.78–1.87). No significant differences were found with aspirin treatment, possibly due to risk of bias, heterogeneity, and imprecision. These findings held true when analyzed based on the timing of aspirin treatment induction (before or after 20 weeks' gestation), still finding no difference in the rate of superimposed preeclampsia. Low-dose aspirin treatment did reduce the odds of preterm birth according to a pooled analysis of 2 randomized controlled trials (OR, 0.62; 95% CI, 0.45–0.89). However, neither SGA nor perinatal mortality was shown to be significantly different in a pooled analysis of the studies that reported this outcome. Although these findings did not show statistical significance in reduction of preeclampsia in women with chronic hypertension due to aspirin treatment, the data are suggestive of benefit; many individuals in each study were lost to follow-up, and thus, the results of the analysis are different than they m","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136010150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}