Vaginal progesterone in twin gestation with a short cervix:revisiting an individual patient data systematic review and meta-analysis

Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis

Twin pregnancies are at increased risk of stillbirth. Uncomplicated twin pregnancies are commonly delivered earlier to prevent stillbirth; however, there is a risk of neonatal complications associated with being born prior to 39 weeks’ gestation. The optimal gestational age for delivery in twin pregnancies is unknown and likely varies by chorionicity. The present study aimed to determine the prospective risk of stillbirth in women with uncomplicated monochorionic and dichorionic twin pregnancies, and neonatal mortality risks, when delivered beyond 34 weeks of gestation. Data on twin pregnancies that reported rates of stillbirth were obtained from MEDLINE, EMBASE, and Cochrane Library. Separ…

Increased doses of vaginal progesterone for the prevention of preterm birth in twin pregnancies: a randomised controlled double-blind multicentre trial

Objective  Previous trials have shown little benefit for preventing preterm birth in twin pregnancies using 90–200 mg of daily vaginal natural progesterone. Higher doses have not been tested. Our aim was to determine the efficacy and safety of two different daily doses of vaginal natural progesterone (200 and 400 mg), compared with placebo, for preventing preterm birth in unselected twin pregnancies. Design  Randomised controlled double-blind multicentre trial (1:1:1). Setting  The study was carried out in five university centres from Valencia, Murcia and Alicante (Spain). Population  Women with dichorionic diamniotic twin pregnancies. Methods  The women self-inserted two vaginal pessaries …

Disrupted PGR-B and ESR1 signaling underlies preconceptional defective decidualization linked to severe preeclampsia

AbstractDecidualization of the uterine mucosa drives the maternal adaptation to invasion by the placenta. Appropriate depth of placental invasion is needed to support a healthy pregnancy; shallow invasion is associated with the development of severe preeclampsia (sPE). Maternal contribution to sPE through failed decidualization is an important determinant of placental phenotype. However, the molecular mechanism underlaying the in vivo defect linking decidualization to sPE is unknown. Here, we discover the footprint encoding this decidualization defect comprising of 166 genes using global gene expression profiling in decidua from women who developed sPE in a previous pregnancy. This signatur…

Comparison of the anticonstrictor action of dihydropyridines (nimodipine and nicardipine) and Mg2+ in isolated human cerebral arteries.

The isometric tension recorded from ring segments of branches of human middle cerebral artery was the parameter used to study the inhibition of spasmogen-induced contractions as model for cerebral vasospasm. Concentration-response curves to 5-hydroxytryptamine (10(-9)-3 x 10(-5) M) and prostaglandin F2 alpha (10(-7)-3 x 10(-5) M) were inhibited in Ca(2+)-free medium and in Ca(2+)-free medium to which EGTA (1 mM) had been added, respectively. Nimodipine (10(-7), 10(-5) M), nicardipine (10(-7), 10(-5) M) and Mg2+ (magnesium sulfate 10(-4), 10(-2) M) inhibited the 5-HT-elicited contractions, and this inhibition was similar for the highest concentrations tested. In contrast, nimodipine and nica…

Effects of prandial glycemic changes on objective fetal heart rate parameters

Background. There is confusion in the literature about the potential effect of maternal glucose levels on the fetal heart rate (FHR) cardiotocographic interpretation.Methods. Study design: prospective clinical descriptive study. Subjects: 21 pregnant women with diabetes mellitus, 23 women with gestational diabetes and 18 healthy non-diabetic pregnant volunteers (control group). Treatment: maternal capillary glucose measurement and objective FHR analysis (Oxford System 8002) pre- and 1 h post-meal. Statistical analysis: descriptive statistics, Student t-tests and Pearson correlation studies.Results. Maternal capillary glucose levels ranged between 2.7–10.5 mmol/l pre-meal and 4.2–14.8 mmol/l…

Can antepartum computerized cardiotocography predict the evolution of intrapartum acid-base status in normal fetuses?

Background. To study the relationship between antepartum computerized cardiotocography (cCTG) and the evolution of intrapartum fetal acid-base balance in a low-risk population. Methods. Forty-nine healthy fetuses were prospectively followed up by antepartum cCTG (Oxford System 8002), fetal scalp blood sampling at the onset of the active phase of dilatation (3 cm) and at the beginning of the second stage of labor (10 cm) and study of acid-base status at birth in the umbilical cord. Correlation studies and linear regression analysis were performed. Results. Normal prelabor cCTG was followed by normal fetal acid-base balance in the different study periods. No relationship was found between cCT…

474: Cervical length and risk of preterm birth in European women with a twin pregnancy

Expression of aquaporins early in human pregnancy

Abstract Background Aquaporins (AQPs) constitute a family of channel proteins implicated in transmembrane water transport. Thirteen different AQPs (AQP0–12) have been described but their precise biologic function still remains unclear. AQPs 1, 3, 4, 8, and 9 expression has been described in human chorion, amnion and placenta; however, AQP4 is the only that has been identified in the first trimester of human pregnancy. Objective To assess multiplicity of AQPs expression from 10th to 14th week gestation. Population and methods Chorionic villi samples (CVS) collected in pregnant women for prenatal diagnosis were analysed by real time-PCR to assess cDNA expression of AQPs 1, 2, 3, 4, 5, 6, 7, 8…

Acute Promyelocytic Leukemia during Pregnancy: A Systematic Review of the Literature

The management of pregnant women with acute promyelocytic leukemia (APL) is a challenging situation where limited evidence-based information is available. We performed a systematic literature review to analyze the outcomes reported for both mother and fetus when APL is diagnosed during pregnancy. PubMed, Scopus and Web of Science databases were systematically searched to identify studies reporting cases of APL during pregnancy. Sixty-six articles met the eligibility criteria (53 single case reports). Ninety-two patients were eligible for induction therapy, with most them being treated with all-trans retinoic acid alone (32%) or combined with chemotherapy (43%), while the remaining patients …

Electrohysterogram Signals from Patients with Threatened Preterm Labor: Concentric Ring Electrode Vs Disk Electrode Recordings

The negative predictive value of cervical interleukin-6 for the risk assessment of preterm birth.

To determine the potential clinical use of cervical interleukin-6 (IL-6) as a negative predictor of preterm birth in symptomatic women.Observational prospective study carried out in a tertiary hospital.We studied 100 singleton pregnant women with threatened preterm delivery and intact membranes, between 24 and 34 weeks, recruited during the period 2006-2008. A cervical swab for IL-6 detection was taken and a transvaginal ultrasound scan was performed for measuring the cervical length.Five women delivered within 2 d and six women within 7 d. A high cervical IL-6 concentration was found in these women. The area under the ROC curve for cervical IL-6 was 0.97 for deliveries within 2 d after the…

Effectiveness of progestogens to improve perinatal outcome in twin pregnancies : an individual participant data meta-analysis

Background In twin pregnancies, the rates of adverse perinatal outcome and subsequent long-term morbidity are substantial, and mainly result from preterm birth (PTB). Objectives To assess the effectiveness of progestogen treatment in the prevention of neonatal morbidity or PTB in twin pregnancies using individual participant data meta-analysis (IPDMA). Search strategy We searched international scientific databases, trial registration websites, and references of identified articles. Selection criteria Randomised clinical trials (RCTs) of 17–hydroxyprogesterone caproate (17Pc) or vaginally administered natural progesterone, compared with placebo or no treatment. Data collection and analysis I…

Preeclampsia: a defect in decidualization is associated with deficiency of Annexin A2.

Background Decidualization defects in the endometrium have been demonstrated at the time of delivery in women with severe preeclampsia and to linger for years, which suggests a maternal contribution to the pathogenesis of this condition. Global transcriptional profiling reveals alterations in gene expression, which includes down-regulation of Annexin A2 in severe preeclampsia patients with decidualization resistance. Objective We investigated the functional role of Annexin A2 deficiency during endometrial decidualization and its potential contribution to shallow trophoblast invasion during implantation and subsequent placentation using in vitro and in vivo modeling. Study Design Annexin A2 …

Progestogens to prevent preterm birth in twin pregnancies:an individual participant data meta-analysis of randomized trials

Abstract Background Preterm birth is the principal factor contributing to adverse outcomes in multiple pregnancies. Randomized controlled trials of progestogens to prevent preterm birth in twin pregnancies have shown no clear benefits. However, individual studies have not had sufficient power to evaluate potential benefits in women at particular high risk of early delivery (for example, women with a previous preterm birth or short cervix) or to determine adverse effects for rare outcomes such as intrauterine death. Methods/design We propose an individual participant data meta-analysis of high quality randomized, double-blind, placebo-controlled trials of progestogen treatment in women with …

Pulsatile versus continuous oxytocin infusion for the oxytocin challenge test.

In a prospective study, 140 patients had an oxytocin challenge test with either a continuous or a pulsed infusion (one minute of infusion in every five minutes). Both infusion regimens had similar success rates in terms of uterine contractions (97.1 vs 98.6%). The potency ratio (pulsed versus continuous infusion) was significant at 2.7 (1.27 to 5.2), which means that more uterine activity was induced with each mU of oxytocin with pulsatile than with continuous administration. The total amount of oxytocin required to obtain three good contractions in 10 minutes was about 40% less with pulsed administration than with continuous infusion, but the test took 40 minutes longer with the pulsed tha…

The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies : an individual patient level meta-analysis

OBJECTIVE: To assess the effect of gestational age (GA) and cervical length (CL) measurements at transvaginal ultrasound (TVUS) in the prediction of preterm birth in twin pregnancy. DESIGN: Individual patient data (IPD) meta-analysis. SETTING: International multicentre study. POPULATION: Asymptomatic twin pregnancy. METHODS: MEDLINE and EMBASE searches were performed and IPD obtained from authors of relevant studies. Multinomial logistic regression analysis determined probabilities for birth at ≤28(+0) , 28(+1) to 32(+0) , 32(+1) to 36(+0) , and ≥36(+1) weeks as a function of GA at screening and CL measurements. MAIN OUTCOME MEASURES: Predicted probabilities for preterm birth at ≤28(+0) , 2…

Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta‐analysis of individual patient data

Objective To assess the efficacy of vaginal progesterone for the prevention of preterm birth and neonatal morbidity and mortality in asymptomatic women with a twin gestation and a sonographic short cervix (cervical length ≤ 25 mm) in the mid-trimester. Methods This was an updated systematic review and meta-analysis of individual patient data (IPD) from randomized controlled trials comparing vaginal progesterone with placebo/no treatment in women with a twin gestation and a mid-trimester sonographic cervical length ≤ 25 mm. MEDLINE, EMBASE, POPLINE, CINAHL and LILACS (all from inception to 31 December 2016), the Cochrane Central Register of Controlled Trials, Research Registers of ongoing tr…