European Journal of Obstetrics and Gynecology and Reproductive Biology: X最新文献

{"title":"Determining the cost-effectiveness of follitropin alfa biosimilar compared to follitropin alfa originator in women undergoing fertility treatment in France","authors":"Matthieu Lehmann ,&nbsp;Elisangela Arbo ,&nbsp;Jean-Luc Pouly ,&nbsp;Paul Barrière ,&nbsp;Lauren Amy Boland ,&nbsp;Samuel George Bean ,&nbsp;Julian Jenkins","doi":"10.1016/j.eurox.2024.100311","DOIUrl":"https://doi.org/10.1016/j.eurox.2024.100311","url":null,"abstract":"<div><h3>Objective</h3><p>The study assessed cost-effectiveness of follitropin alfa biosimilar versus the originator in terms of cost per cumulative live-birth (CLB) for the French healthcare system based on real-world evidence. Follitropin alfa biosimilars have been shown to have comparable clinical outcomes to the originator, in both clinical studies and real-world settings, in terms of oocyte retrieval and cumulative live-birth rate (CLBR). Previous health economic studies comparing the cost-effectiveness of follitropin alfa biosimilars against the originator utilised clinical trial data, leaving ambiguity over cost-effectiveness in real-world settings. Additionally, previous cost-effectiveness analysis has been performed for live-births following only fresh embryo transfers, whereas, fresh and frozen transfers are common in clinical practice. This study investigates the cost per CLB, which more closely models clinical practice.</p></div><div><h3>Study design</h3><p>A decision-tree cost-effectiveness model was developed based on the total costs and CLBR per ovarian stimulation (OS) for a follitropin alfa biosimilar (Bemfola®, Gedeon Richter Plc, Budapest, Hungary) and the originator (Gonal-f®, Merck KGaA, Darmstadt, Germany). A time horizon of one year from oocyte retrieval to embryo transfer was used but costs from resulting transfers were also included. Clinical inputs were taken from the REOLA real-world study or clinician insights, while acquisition costs were taken from French public databases. The output was cost per CLB following one OS. One-way sensitivity analysis was performed to determine the largest model drivers.</p></div><div><h3>Results</h3><p>Cost per CLB was €18,147 with follitropin alfa biosimilar and €18,834 with the originator, saving €687 per CLB following OS with the biosimilar. When wastage estimates were considered the biosimilar cost saving is estimated to be between €796 and €1155 per CLB further increasing cost savings. Irrespective of wastage, if used ubiquitously throughout France for ART, the biosimilar could save the French health system €13,994,190 or lead to 771 more births when compared to its higher-cost originator. Sensitivity analysis showed that the originator’s relative CLBR had the greatest impact on the model.</p></div><div><h3>Conclusion</h3><p>This analysis demonstrates that the follitropin alfa biosimilar, Bemfola®, is a more cost-effective option for OS compared with the originator from a French healthcare payer perspective, in terms of cost per CLB.</p></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"22 ","pages":"Article 100311"},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590161324000310/pdfft?md5=711cbb1f39bdcf1ceadafda15a6e8e55&pid=1-s2.0-S2590161324000310-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140821959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A historical narrative review through the field of tocolysis in threatened preterm birth","authors":"Tijn van Winden ,&nbsp;Carolien Roos ,&nbsp;Ben W. Mol ,&nbsp;E. Pajkrt ,&nbsp;Martijn A. Oudijk","doi":"10.1016/j.eurox.2024.100313","DOIUrl":"https://doi.org/10.1016/j.eurox.2024.100313","url":null,"abstract":"<div><p>Preterm birth presents a significant challenge in clinical obstetrics, requiring effective strategies to reduce associated mortality and morbidity risks. Tocolytic drugs, aimed at inhibiting uterine contractions, are a key aspect of addressing this challenge. Despite extensive research over many years, determining the most effective tocolytic agents remains a complex task, prompting better understanding of the underlying mechanisms of spontaneous preterm birth and recording meaningful outcome measures. This paper provides a comprehensive review of various obsolete and current tocolytic drug regimens that were instituted over the past century, examining both historical contexts and contemporary challenges in their development and adoption. The examination of historical debates and advancements highlights the complexity of introducing new therapies. While the search for effective tocolytics continues, questions arise regarding their actual benefits in obstetric care and the necessity for ongoing exploration. The presence of methodological limitations in current research emphasizes the importance of well-designed randomized controlled trials with robust endpoints and extended follow-up periods.In response to these complexities, the consideration of shifting towards prevention strategies aimed at addressing the root causes of preterm labor becomes more and more evident. This potential shift may offer a more effective approach than relying solely on tocolytics to delay labor initiation.Ultimately, effectively managing threatened preterm birth necessitates ongoing investigation, innovation, and a willingness to reassess strategies in pursuit of optimal outcomes for mothers, neonates, and long-term child health.</p></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"22 ","pages":"Article 100313"},"PeriodicalIF":0.0,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590161324000334/pdfft?md5=a89fed44464c6af42ed47bc4fc0d3b51&pid=1-s2.0-S2590161324000334-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140821961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic occlusion balloons of both internal iliac arteries in caesarean hysterectomy for placenta accreta spectrum disorder reduces blood loss: A retrospective comparative study","authors":"Saber Hassine Abouda ,&nbsp;Haithem Aloui ,&nbsp;Hadhami JAOUAD ,&nbsp;Sofiene B. MARZOUK ,&nbsp;Hatem Frikha ,&nbsp;Rami Hammami ,&nbsp;Mohamed Badis Channoufi ,&nbsp;Hayen Maghrebi","doi":"10.1016/j.eurox.2024.100310","DOIUrl":"https://doi.org/10.1016/j.eurox.2024.100310","url":null,"abstract":"<div><h3>Background</h3><p>The placenta accreta spectrum is a complex disorder characterized by abnormal invasion of the placenta into the uterine wall, posing a significant risk of life-threatening haemorrhage for patients. Its incidence is on the rise, largely attributed to the increasing rates of caesarean sections. Management of this spectrum involves a multidisciplinary approach, although standardized protocols are not yet established. While caesarean hysterectomy remains the standard Gold, several adjunctive treatments have emerged in recent years to mitigate bleeding risk and associated morbidity. Among these, prophylactic occlusion balloons placed in the internal iliac arteries have shown promise. The aim of our study is to demonstrate the effect of prophylactic occlusion balloons in both uterine iliac arteries in the management of placental accreta spectrum disorders.</p></div><div><h3>Methods</h3><p>A retrospective monocentric cohort study was conducted in the Department \"C\" of Gynaecology and Obstetrics at the Maternity Center of Tunis. The study spanned three years, from January 2nd, 2020, to December 31st, 2022. The study population consisted of two groups: Control Group (CG) comprised patients who underwent caesarean hysterectomy without internal-iliac prophylactic occlusion balloons, and Occlusion balloons of both internal iliac arteries Group (OBIIAG) included patients who underwent caesarean hysterectomy with internal-iliac prophylactic occlusion balloons.</p></div><div><h3>Results</h3><p>A total of 38 patients were included in the study, all of whom exhibited similar epidemiological characteristics and comparable personal and obstetric histories. The most prevalent risk factor among the patients was a history of caesarean section (92%). On average, patients were diagnosed at 30 weeks of gestation, with third-trimester bleeding being the most common presentation (71% of cases). The median gestational age at delivery was between 36 and 37 weeks. We observed a significant difference in blood loss between the two groups (2888 ml in the control group and 1828 ml in the group with internal-iliac prophylactic occlusion balloons, p &lt; 0.05). Implementation of this technique resulted in a reduced need for massive transfusions (p &lt; 0.01) and shorter operating times (126 min for the control group and 92 min for the group with internal-iliac prophylactic occlusion balloons; p = 0.04). There were no significant differences in morbidity between the two groups.</p></div><div><h3>Conclusion</h3><p>The intra-iliac prophylactic occlusion balloons can help reduce the risk of hemorrhage and the morbidities that come with the placenta accreta spectrum disorder.</p></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"22 ","pages":"Article 100310"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590161324000309/pdfft?md5=2500dacacac6d0834eead00f3aa23ebe&pid=1-s2.0-S2590161324000309-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140821960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the use of oral contraceptives and the occurrence of systemic hypertension: A systematic review with statistical comparison between randomized clinical trial interventions","authors":"Ingrid Soares de Souza ,&nbsp;Gabriel Zorello Laporta ,&nbsp;Juliana Zangirolami-Raimundo ,&nbsp;Isabel Cristina Esposito Sorpreso ,&nbsp;Heloisa Carla Lopes Silva dos Santos ,&nbsp;José Maria Soares Júnior ,&nbsp;Rodrigo Daminello Raimundo","doi":"10.1016/j.eurox.2024.100307","DOIUrl":"https://doi.org/10.1016/j.eurox.2024.100307","url":null,"abstract":"<div><h3>Introduction</h3><p>In the WHO eligibility criteria, there is agreement that hypertensive women taking Oral Contraceptive Hormonal Combined (OCHC) may be at increased risk of cardiovascular disease. The risk-to-benefit ratio hinges on the severity of the condition. While a mild increase in blood pressure is a common occurrence in consumers of OCHC, the potential for developing high blood pressure exists during oral contraceptive use. Consequently, there is a possibility of increased cardiovascular risk, with limited available data on this issue.</p></div><div><h3>Objective</h3><p>To evaluate the potential effects of OCHC on blood pressure through a systematic review with statistical analysis of existing randomized controlled trials.</p></div><div><h3>Method</h3><p>This systematic review with statistical comparison adheres to the recommendations outlined in the PRISMA (Principal Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The analysis strategy involves comparing the mean difference in blood pressure change according to the type of treatment, in addition to the calculation of clinically relevant outcomes (CRO).</p></div><div><h3>Results</h3><p>Our findings suggest a clinically relevant outcome related to the increase in blood pressure in users of ethinyl estradiol combined with gestodene in a cyclic regimen over 6 months. Conversely, a decrease in blood pressure was observed among users of ethinyl estradiol combined with chlormadinone over 24 months of usage.</p></div><div><h3>Conclusion</h3><p>While our study found minor variations in blood pressure across varying forms of oral contraceptives, these differences are not significant enough to warrant specific clinical recommendations. However, the results suggest that individuals with hypertension should exercise caution with ethinyl estradiol, particularly when administered cyclically alongside gestodene, due to the potential risk of increased blood pressure. Additionally, the use of oral contraceptives containing ethinyl estradiol paired with chlormadinone acetate or ethinyl estradiol combined with drospirenone may be more suitable for individuals at a high risk of developing hypertension.</p></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"22 ","pages":"Article 100307"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590161324000279/pdfft?md5=c1cd82fd1555743c1b7b2a5b0019130c&pid=1-s2.0-S2590161324000279-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140821962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of pregnancy outcomes after bariatric surgery by sleeve gastrectomy versus gastric bypass","authors":"Marie-Anne Joly ,&nbsp;Violaine Peyronnet ,&nbsp;Muriel Coupaye ,&nbsp;Séverine Ledoux ,&nbsp;Nicolas Pourtier ,&nbsp;Lucile Pencole ,&nbsp;Laurent Mandelbrot","doi":"10.1016/j.eurox.2024.100309","DOIUrl":"10.1016/j.eurox.2024.100309","url":null,"abstract":"<div><h3>Objective</h3><p>Bariatric surgery has an impact on subsequent pregnancies, in particular an association between gastric bypass and small for gestational age. Knowledge is lacking on whether sleeve gastrectomy is associated with more favorable pregnancy outcomes. This study aimed to compare the impact of sleeve gastrectomy and Roux-en-Y gastric bypass on the incidence of small for gestational age (SGA), and of adverse pregnancy outcomes.</p></div><div><h3>Study design</h3><p>We conducted a retrospective study in a single reference center, including all patients with a history of sleeve or bypass who delivered between 2004 and 2021 after their first pregnancy following bariatric surgery. We compared the incidence of SGA, intrauterine growth retardation, preterm delivery and adverse maternal outcomes between patients who had sleeve versus bypass.</p></div><div><h3>Results</h3><p>Of 244 patients, 145 had a sleeve and 99 had a bypass. The proportion of SGA &lt; 10th percentile did not differ between the two groups (38/145 (26.2 %) vs 22/99 (22.22 %), respectively, p = 0.48). Preterm birth &lt; 37 WG was lower in the sleeve group (5/145 (3.45%) vs 12/99 (12.12 %) in the bypass group (p = 0.01), as well as NICU hospitalizations (3 (2.07%) vs 12/99 (12.12%), p &lt; 0.01). There was no difference regarding adverse maternal outcomes such as gestational diabetes and hypertensive complications. The proportion of SGA was not lower in patients with bypass when adjusting for other risk factors (BMI, smoking, geographic origin, diabetes and hypertension) (aOR 0.70; 95%CI 0.01 – 2.85).</p></div><div><h3>Conclusion</h3><p>sleeve was associated with an incidence of SGA which was as high as after bypass, however the incidence of preterm birth was lower.</p></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"22 ","pages":"Article 100309"},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590161324000292/pdfft?md5=940dd5fdbd5b6c16c1699ac80b68884e&pid=1-s2.0-S2590161324000292-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140770793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal substance use disorder: Examining the impact on adverse pregnancy outcomes","authors":"Alexandra S. Ragsdale ,&nbsp;Noor Al-Hammadi ,&nbsp;Travis M. Loux ,&nbsp;Sabel Bass ,&nbsp;Justine M. Keller ,&nbsp;Niraj R. Chavan","doi":"10.1016/j.eurox.2024.100308","DOIUrl":"10.1016/j.eurox.2024.100308","url":null,"abstract":"<div><h3>Objective</h3><p>Substance use disorder is a growing concern in the USA, especially among pregnant women. This study was undertaken to assess the impact of substance use disorder on adverse pregnancy outcomes using a nationwide sample of inpatient pregnancy hospitalizations in the USA, and to elucidate the influence on each type of adverse pregnancy outcome.</p></div><div><h3>Study design</h3><p>A cross-sectional analysis of inpatient pregnancy hospitalizations in the USA from the Healthcare Cost and Utilization Project National Inpatient Sample from 2016 to 2020 was conducted. International Classification of Diseases – 10th revision and diagnosis-related group codes were used to identify inpatient pregnancy-related delivery hospitalizations with a substance use disorder and/or adverse pregnancy outcomes. Propensity score matching and multiple logistic regression analyses were undertaken to predict the likelihood of adverse pregnancy outcomes among pregnancy hospitalizations with and without substance use disorder. Subgroup analyses were performed to estimate the impact of substance use disorder on each adverse pregnancy outcome.</p></div><div><h3>Results</h3><p>From 3,238,558 hospitalizations, the prevalence of adverse pregnancy outcomes was substantially higher among pregnancy hospitalizations with substance use disorder (35.6 %) compared with pregnancy hospitalizations without substance use disorder (25.1 %, <em>p</em> &lt; 0.001). After matching and model adjustment for sociodemographic covariates, substance use disorder was identified as an independent predictor of adverse pregnancy outcomes [adjusted odds ratio (aOR) 1.47, 95 % confidence interval (CI) 1.45–1.49]. In subgroup analyses based on type of adverse pregnancy outcome, the greatest exposure risks were fetal growth restriction (aOR 1.96, 95 % CI 1.91–2.01), antepartum hemorrhage (aOR 1.79, 95 % CI 1.73–1.85) and preterm birth (aOR 1.65, 95 % CI 1.62–1.68).</p></div><div><h3>Conclusion</h3><p>Patients with substance use disorder are at higher risk of adverse pregnancy outcomes, particularly fetal growth restriction, antepartum hemorrhage and preterm birth.</p></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"22 ","pages":"Article 100308"},"PeriodicalIF":0.0,"publicationDate":"2024-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590161324000280/pdfft?md5=0066dd11c289dd83ba2d08cee16d839e&pid=1-s2.0-S2590161324000280-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140760265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors of early spontaneous preterm birth despite carrying a cervical pessary in singleton pregnancies with a short cervix: Development of a risk prediction model","authors":"Carme Merced ,&nbsp;Laia Pratcorona ,&nbsp;Teresa Higueras ,&nbsp;Mireia Vargas ,&nbsp;Esther Del Barco ,&nbsp;Judit Solà ,&nbsp;Elena Carreras ,&nbsp;Maria Goya","doi":"10.1016/j.eurox.2024.100305","DOIUrl":"https://doi.org/10.1016/j.eurox.2024.100305","url":null,"abstract":"<div><h3>Introduction</h3><p>We aimed to identify the incidence and risk factors of spontaneous preterm birth in pessary carriers with singleton pregnancies and a short cervix in the mid-trimester of pregnancy.</p></div><div><h3>Material and Methods</h3><p>Patient data were obtained from the PECEP Trial. We analyzed singleton pregnancies in pessary carriers with a short cervix (≤25 mm) between 18 and 22 gestational weeks. Demographics and obstetric history were compared to identify risk factors for spontaneous preterm birth &lt; 34 gestational weeks. Each demographic and obstetric variable was compared between spontaneous preterm birth &lt; 34 and ≥ 34 weeks of gestation.</p><p>Regression analysis was used to identify risk factors. A risk score model was generated using the odds ratio for significant factors. The risk score model and spontaneous preterm birth risk were assessed using the receiver operating characteristic curve. Perinatal outcomes were compared by risk score.</p></div><div><h3>Results</h3><p>Among 190 pregnant individuals, 12 (6.3%) had spontaneous preterm birth &lt; 34 gestational weeks. In the bivariate analysis, statistically significant differences between those with and without spontaneous preterm birth were only observed for mean cervical length at diagnosis and mean cervical length after pessary placement. By multiple logistic regression analysis, maternal age (OR 0.818; 95% CI 0.69–0.97; <em>P</em> 0.020), cervical length at diagnosis (OR 0.560; 95% CI 0.43–0.73; <em>P</em> &lt; 0.001) and smoking status (OR 7.276; 95% CI 1.02–51.80; <em>P</em> 0.048) remained significantly associated with spontaneous preterm birth.</p><p>The ROC curve from the multiple logistic regression analysis, including cervical length, maternal age and smoking status, had an area under the curve (AUC) of 0.952 <em>(P &lt;</em> 0.001). The ROC curve for the risk score model incorporating all three variables had an AUC of 0.864 (95% CI 0.77–0.96; <em>P</em> &lt; 0.001). A high-risk score was predictive of spontaneous preterm birth with a sensitivity of 75%, specificity of 84%, positive predictive value of 24%, and negative predictive value of 98%.</p><p>Women with a high-risk score had a significantly reduced latency to delivery and poorer neonatal outcomes than those with a low-risk score.</p></div><div><h3>Conclusions</h3><p>Patients at a high risk for spontaneous preterm birth despite pessary therapy may be identified using cervical length at diagnosis added to maternal age and smoking status.</p></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"22 ","pages":"Article 100305"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590161324000255/pdfft?md5=7b586bb0185f29ad5bf9e5c2ae8d1e7d&pid=1-s2.0-S2590161324000255-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140339747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DNA damage and ALAD polymorphism in high blood lead (Pb) levels of pregnant women attending a tertiary care teaching hospital","authors":"Mahesh Chandra Sahu ,&nbsp;Kuldip Upadhyay ,&nbsp;Shweta Gupta ,&nbsp;Kabita Chanania ,&nbsp;Sanghamitra Pati","doi":"10.1016/j.eurox.2024.100300","DOIUrl":"10.1016/j.eurox.2024.100300","url":null,"abstract":"<div><h3>Background</h3><p>Pregnant women are particularly vulnerable to lead toxicity due to increased absorption and decreased elimination of lead from their bodies. The δ-aminolevulinic acid dehydratase (ALAD) gene plays a crucial role in lead metabolism, and its polymorphisms have been implicated in modifying the susceptibility to lead toxicity.</p></div><div><h3>Methods</h3><p>A cross-sectional study was conducted involving 90 pregnant women and blood samples were collected to measure blood lead levels (BLL) and assessed DNA damage using the comet assay. ALAD polymorphisms were genotyped using PCR-RFLP analysis with MspI restriction enzyme. Statistical analysis, including chi-square tests, logistic regression, and correlation analysis, was performed to determine associations between ALAD polymorphisms, BLL, and DNA damage.</p></div><div><h3>Results</h3><p>From 90 pregnant women the participants, 16 had high BLL (≥5 μg/dL), while the remaining 74 had normal levels (&lt;5 μg/dL). The ALAD 1–2 genotype was found to be significantly associated with high BLL (p &lt; 0.001). Pregnant women with the ALAD 1–2 genotype exhibited higher levels of DNA damage compared to those with other genotypes (p &lt; 0.001). Furthermore, a positive correlation was observed between the transfer of lead concentration from mother to infant and DNA damage severity (r = 0.511, p &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>The combination of comet assay and polymorphism analysis offers a comprehensive approach to understanding the impact of lead exposure during pregnancy. These findings underscore the urgent need for effective regulatory measures to reduce lead exposure in the environment and mitigate its adverse effects of lead on maternal and child health.</p></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"22 ","pages":"Article 100300"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590161324000206/pdfft?md5=ceafb223f2e4989f935245cdae7eee6a&pid=1-s2.0-S2590161324000206-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140407832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberculosis in pregnancy and adverse neonatal outcomes in two peruvian hospitals","authors":"Noelia V. Garay-Aguilar ,&nbsp;Lizbeth R. Reynoso-Rosales ,&nbsp;Anita P. Llamo-Vilcherrez ,&nbsp;Carlos J. Toro-Huamanchumo","doi":"10.1016/j.eurox.2024.100304","DOIUrl":"https://doi.org/10.1016/j.eurox.2024.100304","url":null,"abstract":"<div><h3>Background</h3><p>According to the World Health Organization, tuberculosis (TB) ranks among the top 10 causes of death worldwide. The significance of TB during pregnancy lies in its symptoms, which can be mistaken for physiological changes associated with pregnancy. This confusion can lead to maternal-perinatal complications.</p></div><div><h3>Objective</h3><p>To evaluate the association between pulmonary TB in pregnancy and adverse neonatal outcomes in two Peruvian hospitals.</p></div><div><h3>Methods</h3><p>This is a retrospective cohort study. The target population consisted of pregnant women with and without pulmonary TB whose deliveries were attended at two public hospitals, located in Lima, Peru. The adverse neonatal outcomes were prematurity, low birth weight (LBW), and being small for gestational age (SGA). Crude and adjusted relative risks (RRa) were calculated with their respective 95% confidence intervals (95%CI).</p></div><div><h3>Results</h3><p>Information from 212 patients was analyzed; 48.1% had TB during pregnancy, and 23.1% had adverse neonatal outcomes (8%, 11.3%, and 12.3% for LBW, prematurity, and SGA, respectively). In the adjusted model, pregnant women with pulmonary TB had a 3.52 times higher risk of having a newborn with at least one of the adverse outcomes than those who were not exposed (aRR, 3.52; 95%CI: 1.93–6.68).</p></div><div><h3>Conclusion</h3><p>Pulmonary TB in pregnancy was jointly and independently associated with adverse neonatal outcomes, including LBW, prematurity, and being SGA.</p></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"22 ","pages":"Article 100304"},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590161324000243/pdfft?md5=c55bee8b0723a6cd84f392078b22dd56&pid=1-s2.0-S2590161324000243-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140320933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The anesthetic approach to repeated cesarean sections: A prospective cohort study","authors":"Jacob Weinstein ,&nbsp;Rasha Muhalwes ,&nbsp;Alexander Ronenson ,&nbsp;Stephen H. Halpern ,&nbsp;Sorina Grisaru-Granovsky ,&nbsp;Tamer Akawi ,&nbsp;Yaacov Gozal ,&nbsp;Daniel Shatalin ,&nbsp;Alexander Ioscovich","doi":"10.1016/j.eurox.2024.100301","DOIUrl":"10.1016/j.eurox.2024.100301","url":null,"abstract":"<div><h3>Objective</h3><p>Each repeat cesarean section (CS) potentially adds surgical complexity. The determination of appropriate anesthesia strategy to meet the surgical challenge is of crucial importance for the maternal and neonatal outcome.</p></div><div><h3>Study design</h3><p>This prospective cohort study was conducted from 1-Jan-2021 to 31-Dec-2021 at a single large obstetric centre of all repeat CS. We compared the characteristics and the appropriateness of the anesthesia techniques for low-order repeat CS (LOR-CS) (1 or 2 previous CS) and high order repat CS (HOR-CS) group (3 or more repeat CS).</p></div><div><h3>Results</h3><p>During the study period, 1057 parturients met the study entry criteria, with 821 parturients in the LOR-CS group and 236 parturients in the HOR-CS group. The use of spinal anesthesia was more common for HOR-CS 84.3%. Overall surgical time varied between LOR-CS (38 min, 29–49) and HOR-CS (42 min, 31–57) (p = 0.004).</p><p>The rate of moderate and severe adhesions was relatively high in HOR-CS and the duration of overall surgical time for cases with mild adhesions was 38 min (29–48), for moderate adhesions was 44 min (34.8–56.5), and for severe adhesions was 56 min (44.8–74.3). There was no significant difference in the Estimated Blood Loss (EBL) between LOR-CS and HOR-CS, with values of 653 ± 292 ml vs. 660 ± 285 ml, respectively.</p></div><div><h3>Conclusion</h3><p>Our data indicate that spinal anesthesia, standard monitoring and regular anesthetic setup are safe and suitable for the majority of HOR-CS, except in cases with high suspicion of placental accreta spectrum.</p></div>","PeriodicalId":37085,"journal":{"name":"European Journal of Obstetrics and Gynecology and Reproductive Biology: X","volume":"22 ","pages":"Article 100301"},"PeriodicalIF":0.0,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590161324000218/pdfft?md5=8fe66eb243cc478704f13df254fa6270&pid=1-s2.0-S2590161324000218-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140268666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}