The latest medical research on Obstetrics And Gynecology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about obstetrics and gynecology gathered by our medical AI research bot.
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How sFlt-1 can help after preeclampsia diagnosis.BJOG
Measurement of maternal serum soluble fms-like tyrosine kinase 1 (sFlt-1) and placental growth factor (PlGF), and the ratio between the two, has be...
Risk of preeclampsia in patients with maternal genetic predisposition to common medical conditions: a case-control study.BJOG
To assess whether women with a genetic predisposition to medical conditions known to increase preeclampsia risk have an increased risk of preeclampsia in pregnancy.
Genetic predisposition to medical conditions and their relationship with preeclampsia.
An increasing burden of risk alleles for elevated diastolic blood pressure (DBP) and increased body mass index (BMI) were associated with an increased risk of preeclampsia (DBP: overall OR 1.11 (95% CI: 1.01-1.21), p=0.025; BMI: OR 1.10 (1.00-1.20), p=0.042), while alleles associated with elevated alkaline phosphatase (ALP) were protective (OR 0.89 (0.82-0.97), p=0.008), driven primarily by pleiotropic effects of variants in the FADS gene region. The effect of DBP genetic loci was even greater in early-onset (<34 weeks) preeclampsia cases (OR 1.30 (1.08-1.56), p=0.005). For other traits, there was no evidence of an association.
These results suggest that the underlying genetic architecture of preeclampsia may be shared with other disorders, specifically hypertension and obesity.
Vasa praevia: perinatal outcome in pregnancies with a prenatal diagnosis: systematic review and meta-analysis.Ultrasound in Obstetrics and Gynecology
To derive accurate estimates of perinatal survival in pregnancies with and without a prenatal diagnosis of vasa praevia from a systematic review of literature and meta-analysis.
A search of MEDLINE, EMBASE and CINHAL was performed to review relevant citations reporting perinatal outcomes in pregnancies with vasa praevia. We selected prospective and retrospective cohort and population studies that provided data regarding both women with and without prenatal diagnosis of vasa praevia. Meta-analysis using random effects model was used to derive weighted pooled estimates of perinatal survival [(95% confidence intervals (CI)]. Incidence rate difference (IRD) meta-analysis was used to estimate the significance of difference in pooled proportions. Heterogeneity between studies was estimated using Cochrane's Q and I2 statistic.
There were 21 studies reporting pregnancy outcome in 683 pregnancies with a prenatal diagnosis of vasa praevia of which there were 3 stillbirths (1.01%; 95% CI: 0.40-1.87), 5 neonatal deaths (1.19%; 95% CI: 0.52-2.12), with 675 neonates who survived with a pooled estimate for perinatal survival of 98.6% (95%CI: 97.6-99.3). Data from seven studies including cases with and without prenatal diagnosis showed that the pooled perinatal survival in cases without prenatal diagnosis (61/118) was 72.1% (95%CI: 50.6-89.4), vs. 98.6% (95%CI: 96.7-99.7) in cases with a prenatal diagnosis (224/226). Therefore, the risk of perinatal death was 25-fold higher, if a prenatal diagnosis of vasa praevia was not made antenatally, compared to when it was (OR 25.39; 95% CI: 7.93-81.31). Similar to perinatal deaths, in pregnancies without a prenatal diagnosis, the risk of hypoxic morbidity is increased 50-fold compared to those with a prenatal diagnosis (36/61 without prenatal diagnosis vs. 5/224 with prenatal diagnosis; OR 50.09; 95% CI: 17.33-144.79); the intact perinatal survival in those without a prenatal diagnosis is significantly lower compared to when a prenatal diagnosis is made [28.1% (95%CI: 14.1-44.728.1%) vs. 96.7% (95%CI: 95%CI: 93.6-98.8) (IRD 73.4% (95%CI: 53.9-92.7), Z=-7.4066; p<0.001).
Prenatal diagnosis of vasa praevia is associated with a high rate of perinatal survival whereas lack of such an antenatal diagnosis significantly increases the risk of perinatal death and handicap. Further research studies should be undertaken to investigate strategies for incorporating prenatal screening for vasa praevia in routine clinical practice. This article is protected by copyright. All rights reserved.
Human Papillomavirus Vaccination: ACOG Committee Opinion Summary, Number 809.Obstetrics and Gynecology
Human papillomavirus (HPV) causes significant morbidity and mortality in women and men. The HPV vaccine significantly reduces the incidence of anog...
Human Papillomavirus Vaccination: ACOG Committee Opinion, Number 809.Obstetrics and Gynecology
Human papillomavirus (HPV) causes significant morbidity and mortality in women and men. The HPV vaccine significantly reduces the incidence of anog...
Precision and accuracy of robot-assisted technology with simplified express femoral workflow in measuring leg length and offset in total hip arthroplasty.Int J Med
Semi-active robot-assisted total hip arthroplasty (THA) has two options to measure the leg length discrepancy (LLD) and combined offset (CO), the "enhanced" femoral workflow and the so-called "express" simplified workflow. The purpose of this study was to determine the precision and accuracy of intraoperative LLD and CO measurement with express workflow robotic THA.
Between February 2018 and December 2019, 30 patients underwent an express workflow robot-assisted primary THA for intraoperative LLD and CO measurements. Postoperative radiographs were used for LLD and CO measurement. In order to examine the accuracy of the robotic system assessment, the absolute difference between the robotic assessments and radiographic evaluations was calculated.
Intraoperative robotic measurements reported a mean error of 0.2-0.6 mm for each registration, with no significant difference between them (p = 0.311). The average absolute discrepancies between the robotic and radiographic assessments in the LLD and CO measurements were 1.3 ± 1.5 mm (p = 0.17) and 1.1 ± 0.9 mm (p = 0.11), respectively, while the Pearson's correlation coefficients were 0.69 and 0.71.
An external marker without a femoral array inserted into a screw positioned in the greater trochanter would be an easier and faster method to measure LLD and CO. Our study showed that the measured values of LLD and CO obtained by intraoperative express workflow robot-assisted THA system were precise and accurate. This article is protected by copyright. All rights reserved.
Nasolacrimal duct stenosis - surgery with a novel robotic endoscope positioning system.Int J Med
Distal nasolacrimal duct stenosis is usually treated by head and neck surgeons with transnasal endoscopic dacryocystorhinostomy (DCR). The presented clinical study discusses advantages and drawbacks of a robot-assisted endoscope positioning system, which allows for hands-free visualization of the surgical field.
Two patients were treated by surgical DCR. The endoscopic positioning system (Medineering®, Munich, Germany) features a mechatronic holding arm with four segments and seven degrees of freedom. It is driven by using a foot pedal.
Visualization and instrumentation of the surgical field including the relevant anatomical landmarks were feasible. The endoscope position could be controlled with sufficient precision. The surgeon was able to maintain bimanual instrumentation.
The endoscope positioning system allows for two-handed surgery, which facilitates the essential steps of the surgical procedure. If the benefit of the system is sufficient for the use in clinical routine, has to be evaluated in repeated applications. This article is protected by copyright. All rights reserved.
Screening maternity populations during the COVID-19 pandemic.BJOG
With no end in sight to the outbreak of COVID-19, countries are struggling with strategies to halt the "second wave" and mitigate economic decline....
Two-dimensional transvaginal ultrasound versus sonohysterography for diagnosing endometrial polyps: systematic review and meta-analysis.Ultrasound in Obstetrics and Gynecology
To compare the diagnostic performance of two-dimensional transvaginal sonography (TVS) and sonohysterography (SHG) for the diagnosis of endometrial polyps in studies that used both of them in the same group of patients.
Systematic review and meta-analysis. We conducted an extensive search of papers comparing diagnostic performance of TVS and SHG for identifying endometrial polyps, using pathologic analysis as reference standard. This search was performed in Medline (PubMed), Cochrane Library and Web of Science from January 1990 to December 2019. Quality was assessed using QUADAS-2 tool.
1278 citations were identified, but after exclusions, we only included 25 papers in the meta-analysis. Regarding the studies included, the risk of bias evaluated in QUADS-2 was low for most of four domains, except for flow and timing, which was unclear in thirteen studies. Pooled sensitivity and specificity for TVS were 55.0% (95% confidence interval (CI):46.0%-64.0%) and 91.0% (95% CI=86.0%-94.0%), respectively. For SHG these figures were 92.0% (95% CI=87.0%-95.0%) and 93.0% (95% CI=91.0%-95.0%), respectively. Statistical differences were found when comparing both methods in terms of sensitivity (p<0.001), but not for specificity (p=0.0918). High heterogeneity was found for TVS and moderate for SHG.
Given that, SHG has better diagnostic positive and negative likelihood ratios than TVS; patients with a clinical suspicion of endometrial polyp should undergo SHG if TVS findings are inconclusive. This article is protected by copyright. All rights reserved.
Effects of maternal diabetes on fetal heart function at echocardiography: systematic review and meta-analysis.Ultrasound in Obstetrics and Gynecology
Diabetes in pregnancy is associated with both structural anomalies of the fetal heart, as well as hypertrophy and functional impairment. This systematic review and meta-analysis aims to estimate the effects of maternal diabetes on fetal cardiac function as measured by prenatal echocardiography.
We performed a search in the EMBASE, MEDLINE and CENTRAL databases from inception to 4 July 2019 for studies evaluating fetal cardiac function by echocardiography in pregnancies affected by diabetes compared to uncomplicated pregnancies. Outcome measures were cardiac hypertrophy, diastolic, systolic, and overall cardiac function by various ultrasound parameters. Quality of evidence was assessed using the Newcastle -Ottawa scale. Data of interventricular septum (IVS) thickness, myocardial performance index (MPI) and E/A ratio were pooled for meta-analysis using random-effects models.
Thirty-nine studies were included, representing data of 2,276 controls and 1,925 women with pregnancies affected by diabetes mellitus (DM). Of these, 1120 had gestational diabetes mellitus (GDM), 671 had pregestational diabetes mellitus (PDM) and in 134 diabetes type was not further specified. Fetal cardiac hypertrophy was more prevalent in diabetic pregnancies compared to nondiabetic controls in 21/26 studies and impaired diastolic function was observed in 22/28 studies. The association between DM and systolic function was inconsistent, with 10/25 of studies reporting no difference between cases and controls, although more recent studies measuring cardiac deformation, i.e. strain, did show decreased systolic function in diabetic pregnancy. Of the studies measuring overall cardiac function, the majority found significant impairment in fetuses in diabetic pregnancies. Results were similar when stratified for GDM and PDM. Effects were already present in the first trimester, but most profound in the third trimester. Meta-analysis of studies performed in the third trimester showed increased IVS thickness in both PDM (0.75 mm, 95% CI [0.56, 0.94]) and GDM (0.65mm, 95% CI [0.39, 0.93]), decreased E/A ratio in PDM (-0.09, 95% CI [-0.15, -0.03]), no difference in E/A ratio in GDM (-0.01, 95% CI [-0.02, 0.01], and no difference in MPI in both PDM and GDM compared to controls.
This study shows that maternal diabetes is associated with fetal cardiac hypertrophy, diastolic dysfunction, and overall impaired myocardial performance on prenatal ultrasound, irrespective of the diabetes being pregestational or gestational. Further studies are needed to demonstrate the relationship with long-term outcomes. This article is protected by copyright. All rights reserved.
Longitudinal evaluation of motor function in patients who underwent a prenatal or postnatal neural tube defect repair.Ultrasound in Obstetrics and Gynecology
In this study we aim to compare the evolution of motor function (MF) from mid-gestation to 12 months of life between prenatally and postnatally repaired neural tube defect (NTD) cases.
Retrospective cohort study of 127 patients who underwent prenatal (51 fetoscopic and 42 open) or postnatal (34 cases) NTD repair. Anatomical level of lesion (LL) was defined as the upper bony spinal defect at initial sonographic evaluation. Prenatal MF of the lower extremities was evaluated by ultrasound (US) following a metameric distribution based on Carreras et al.'s methodology. MF was scored at the time of diagnosis (MF1), at 6 weeks postoperatively in prenatally repaired cases or at 6 weeks after initial evaluation in postnatally repaired cases (MF2), and at last US before delivery (MF3). At birth and 12 months of life, MF was assessed by a detailed neurological examination. First sacral (S1) MF was considered as an intact MF. For statistical comparisons, we attributed numerical scores to each neurological level and MF were expressed as median MF[range MF]. Comparisons between prenatal and postnatal NTD repaired groups were performed by comparing MF as numerical scores and by comparing the proportion of cases with intact MF. Fetal MF was compared to anatomical LL and a better MF was defined when ≥2 levels better than the anatomical LL. To test the evolution of MF, differences over time were analyzed by comparing MF between MF1 and MF at follow-up assessment using paired t-tests.
At the time of referral, prenatally and postnatally repaired cases presented a similar anatomical LL (L3[T9-S1] vs L3[T7-S1], p=0.52), similar MF (S1[L1-S1] vs S1[L1-S1], p=0.52) and a similar proportion of case with intact MF (81% vs 79%, p=0.88) or with better MF based on the anatomical LL (62% vs 73%, p=0.24). When compared to prenatally repaired cases, postnatally repaired cases showed worse MF at birth (S1[L1-S1] vs L4[L1-S1], p<0.01), and at 12 months (S1[L1-S1] vs L4[L1-S1], p<0.01). In the prenatal repair group, MF remained stable from the time of referral to 12 months of life. The proportion of patients with S1 MF (81% [75/93]) was similar to MF2 (74% [64/87]), MF3 (74% [42/57]) at birth (68% [63/93]) and at 12 months of age (67% [39/58]) (p=0.30). In the postnatal repair group, worse MF starting from the third trimester to 12 months of life was observed. The proportion of patients with S1 MF at MF1 (79% [27/34]) was similar to MF2 (80% [12/15], p=0.92) but was lower at MF3 (25% [2/8], p<0.01), at birth (23% [8/34], p<0.01) and at 12 months (28% [7/25], p<0.01). Similar observations were detected when the proportion of cases with better MF than expected with the anatomical LL were compared between prenatally and postnatally repaired cases.
Postnatally repaired cases showed worse MF at birth, and at 12 months when compared to MF at midgestation. Fetal MF assessment is an adequate tool to identify those infants who should have a good clinical MF after delivery. Based on the results provided by this study, information obtained by fetal MF assessment can have an important role for patient counseling and for case selection for surgery. This article is protected by copyright. All rights reserved.
Normal human brainstem development in vivo: a quantitative fetal MRI study.Ultrasound in Obstetrics and Gynecology
This fetal MRI study aimed to characterize spatiotemporal growth differences of prenatal brainstem substructures and the cerebellum using linear biometry and planimetry. The resultant insights and reference data ultimately aim to increase diagnostic accuracy in detecting disorders of defective hindbrain segmentation.
Brain-normal fetuses with an exact midsagittal T2-weighted brain MRI were included. The area, height, and anteroposterior diameter of the midbrain, pons (basis pontis and pontine tegmentum), medulla oblongata, cerebellar vermis, as well as the transverse cerebellar diameter, were quantified. The diameters were assessed by a second observer to test interrater variability.
There were 161 brain-normal fetuses with a mean gestational age of 25.7±5.4 (ranging from weeks 14+0 to 39+2) who were included. All mentioned substructures of the fetal brainstem and cerebellum could be consistently measured (mean intraclass correlation coefficient between two observers, 0.933). Midbrain, pons, medulla oblongata, cerebellar vermis, and the transverse cerebellar diameter showed a linear growth pattern within the observed period. A significant change in the brainstem proportions occurred during the second and third trimester, with a relative increase in the pons (p<0.001) and a decrease in the midbrain (p<0.001).
The substructures of the fetal brainstem follow a distinct spatiotemporal growth pattern, characterized by a relative increase in the pons and decrease in the midbrain between 15 and 40 weeks of gestation. Caution is needed when interpreting fetal brainstem appearance during the early second trimester, as brainstem proportions differ significantly from the adult morphology. This article is protected by copyright. All rights reserved.