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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State-wide utilization and performance of traditional and cell-free DNA-based prenatal testing pathways: the Victorian Perinatal Record Linkage (PeRL) study.Ultrasound in Obstetrics and Gynecology
Women's choices of prenatal screening and diagnostic pathways have increased in complexity since the introduction of cell-free DNA (cfDNA) screening and chromosomal microarrays. We performed individual record-linkage of women undergoing screening with cfDNA, combined first trimester screening (CFTS), second trimester serum screening (STSS), and/or prenatal and postnatal cytogenetic testing to (i) obtain population-based estimates on women's utilization of screening and diagnosis, (ii) analyse the performance of different screening strategies, and (iii) report the residual risks of any major chromosome abnormality following a low risk aneuploidy screen.
Retrospective study of women resident in Victoria, Australia, undergoing screening or prenatal diagnosis in 2015. Patient-funded cfDNA referrals from multiple providers were merged with state-wide results for government-subsidized CFTS, STSS and invasive diagnostic procedures. Postnatal cytogenetic results from products of conception and infants up to 12 months of age were obtained to ascertain cases of false negative screening results and atypical chromosome abnormalities. Individual record-linkage was performed with LinkageWizTM and statistical analyses with STATA v14.0.
There were 79,140 births during the study period; 66,166 women (83.4%) underwent at least one form of aneuploidy screening. Linkage data were complete for 92.4% of women undergoing screening (n=61,911) and of these, 73.1% (n=45,275) used CFTS alone, 20.2% (n=12,520) used cfDNA alone; 5.3% (n=3268) used STSS alone, 1.3% (n=813) used both CFTS and cfDNA, and < 0.1% (n=35) used both STSS and cfDNA. CFTS had a combined sensitivity for trisomies 21, 13 and 18 of 89.57% (95%CI 82.64-93.93) for a screen positive rate (SPR) of 2.94%. There were 12 false negative results in the CFTS pathway (10 trisomy 21, 1 trisomy 18 and 1 trisomy 13). CfDNA had a combined sensitivity of 100% (95% CI 95.0-100.0) for trisomies 21, 13 and 18 for a 1.21% screen positive rate. When high risk cfDNA results for any chromosome, including the sex chromosomes, and failed cfDNA tests were treated as screen positives, the cfDNA SPR increased to 2.42%. The risk of any major chromosome abnormality (including atypical abnormalities) detected on prenatal or postnatal diagnostic testing after a low risk screening result was 1 in 1188 for CFTS (n=37) and 1 in 762 for cfDNA (n=16) (p= 0.13). The range of chromosome abnormalities detected after low risk cfDNA included pathogenic CNVs (n=6), triploidy (n=3), rare autosomal trisomies (n=3) and monosomy X (n=2).
Our state-wide linkage analysis delineated the utilization and clinical performance of the multitude of screening pathways available to pregnant women. The sensitivity of cfDNA for trisomies 21, 13 and 18 was clearly superior to CFTS. While there was no statistically significant difference in the residual risk of any major chromosome abnormality after low risk CFTS or cfDNA result, there were fewer live infants diagnosed with a major chromosome abnormality in the cfDNA cohort. These data provide valuable population-based evidence to inform practice recommendations and health policy. This article is protected by copyright. All rights reserved.
Investigating the care needs of those with endometriosis: Are we listening to the patients?Australian and New Zealand Journal
What do women with endometriosis need? What are the things that would make their lives easier? Where are the gaps in their care? Questions like the...
Infection-mediated preterm birth: Bacterial origins and avenues for intervention.Australian and New Zealand Journal
Preterm birth (PTB) is globally the leading cause of death and disability in children under five years of age. Intra-amniotic infection is well rec...
Fertility preservation in oncology patients: A literature review examining current fertility preservation techniques and access to oncofertility services in Australia.Australian and New Zealand Journal
In Australia, between the years 2010 and 2014, over 4500 adolescents and young adults (15-25 years old) were diagnosed with cancer. Treatment regimens are often gonadotoxic and are well known to induce ovarian and testicular failure. Oncofertility is an emerging discipline in obstetrics and gynaecology which seeks to preserve and restore the reproductive future of cancer patients.
To perform a systematic literature review to assess the current fertility preservation techniques available to patients and examine access and uptake of fertility preservation in Australia.
Electronic databases, including Medline, Cochrane Review, SCOPUS and CINHAL, were searched for peer-reviewed publications and national guidelines examining oncofertility practices from 2008 to July 2018. Three hundred and seventy-five articles were initially screened, with 158 articles for full text review and an additional five clinical guidelines were identified.
There is a paucity of Australian data on oncofertility with <50% of data included for analysis reflecting the Australian experience. The majority of primary research included retrospective papers with small cohort numbers. Key areas addressed included live birth outcomes, uptake of services and patient and physician perspectives on fertility preservation. Few articles sought to examine the positive and negative side effects of fertility preservation in oncology, social challenges of oncofertility and access to services worldwide.
Oncofertility is an emerging discipline which seeks to provide safe, efficient and effective fertility preservation options for young adults and adolescents diagnosed with cancer. A multi-disciplinary approach with collaborative communication with oncologists is key to providing this service within Australia.
Native tissue repair is cost-effective in primary anterior POP.BJOG
Vaginal meshes have been introduced without robust clinical evaluation and their use has subsequently been widespread. Concerns have been raised ab...
Ultrasound markers predicting complex gastroschisis and adverse outcome: a longitudinal prospective nationwide cohort study.Ultrasound in Obstetrics and Gynecology
To identify antenatal ultrasound markers and their predictive value in differentiating between simple and complex gastroschisis.
Prospective nationwide study in which serial longitudinal ultrasound examinations were performed at regular specified intervals between 20 and 37 weeks in isolated fetal gastroschisis cases. The primary outcome was simple or complex (bowel atresia, volvulus, perforation or necrosis) gastroschisis at birth. Fetal biometry, the occurrence of polyhydramnios, intra- and extra-abdominal bowel diameters and the pulsatility index (PI) of the superior mesenteric artery were assessed. Linear mixed modelling was used to compare the individual trajectories of both simple and complex cases. Logistic regression analysis was used to estimate the strength of association between the ultrasound parameters and outcome.
104 cases of isolated fetal gastroschisis were included. Four intra uterine deaths occurred. Eighty-one (81%) liveborn infants had simple and 19 (19%) had complex gastroschisis. We found no relationship between fetal biometric variables and complex gastroschisis. The PI of the superior mesenteric artery was significantly lower than in healthy controls, but did not differentiate between simple and complex cases. Both intra- and extra-abdominal bowel diameters were larger in complex cases (P<0.001 and P<0.05, respectively). If ≥ 3 measurements of the intra-abdominal bowel diameter were at or above the P97.7 in not necessarily successive measurements for a particular fetus, it was at increased risk of having complex gastroschisis (relative risk 1.56; 95% CI 1.02 - 2.10; positive predictive value 50.0 %, negative predictive value 81.4 %).
Based on this large prospective longitudinal study we found that intra-abdominal bowel dilation when repeatedly present during fetal development is the only variable to differentiate between simple and complex gastroschisis. However its positive predictive value and therefore the clinical usefulness is limited. This article is protected by copyright. All rights reserved.
Myelomeningocele sac associated with worse lower extremity neurologic sequela: evidence for prenatal neural stretch injury?Ultrasound in Obstetrics and Gynecology
To determine whether the presence of a myelomeningocele sac and myelomeningocele sac size correlate with compromised lower extremity function.
A single center, retrospective radiology database search was performed for cases of myelomeningocele (MMC) and myeloschisis (MS) prenatally diagnosed from 2013-2017. Ultrasound reports were reviewed for talipes and impaired lower extremity motion. In MMC cases, the sac volume was calculated from ultrasound measurements. MRI reports were reviewed for hindbrain herniation. Post hoc analysis of data from the multicenter Management of Myelomeningocele Study (MOMS) randomized controlled trial was then performed. The presence of a MMC sac was correlated with prenatal talipes and impaired fetal leg movements.
In total, 283 MMC and 121 MS cases were identified. MMC was associated with a lower incidence of hindbrain herniation compared to MS (80.9% vs 100%; p<0.001). When comparing MMC cases with hindbrain herniation to MS cases, a higher proportion of talipes was present in the MMC group (28.4% vs 16.5%, p=0.02). Mean sac volume was higher in cases of MMC associated with talipes compared to those cases without talipes (4.7±4.2mL vs 3.0±2.6mL; p=0.002). Review of the MOMS data demonstrated similar findings. Cases with a sac on baseline imaging had a higher incidence of talipes than those without a sac (28.2% vs 7.5%; p=0.007).
The presence of a MMC sac was associated with prenatal talipes, and this effect correlated with sac size. The presence of a larger sac in open spinal dysraphism may result in additional injury through mechanical stretching of the nerves, suggesting another acquired mechanism of injury to the exposed spinal tissue. This article is protected by copyright. All rights reserved.
Maternal arterial stiffness in hypertensive pregnancies with and without a small-for-gestational-age neonate.Ultrasound in Obstetrics and Gynecology
Pregnancies complicated by preeclampsia with a small for gestational age (SGA) neonate have poorer hemodynamic function compared to women with hypertensive disorders of pregnancy (HDP) and an appropriately grown neonate. Arterial stiffness is a recognised prognostic marker of cardiovascular disease in the general population. The aim of this study was to compare arterial stiffness in hypertensive pregnancies with and without SGA fetuses.
This was a prospective case control study of hypertensive and healthy normotensive pregnancies. Arterial stiffness, as assessed by pulse wave velocity (PWV) and aortic augmentation index (AIx), was recorded using a non-invasive device (Arteriograph®). Maternal and hemodynamic factors were adjusted for using linear regression analysis. Comparisons between groups were carried out using Mann-Whitney or Chi-Square (or Fisher's exact) test for categorical variables.
Sixty-nine patients with HDP with SGA, 129 patients with HDP with a normally grown fetus and 220 healthy controls were included in the analysis. Maternal age, weight, height and heart rate were significantly associated with brachial and aortic AIx, whilst maternal weight, height, mean arterial pressure, heart rate and gestational age were significant predictors of aortic PWV. Both the HDP with SGA and HDP-only groups had significantly higher adjusted aortic AIx compared to controls (12.5% and 10.0% vs. 7.6%; both p<0.05) and were significantly different to each other (P=0.002). Adjusted PWV was significantly higher in the HDP-only group compared to the control group and the HDP with SGA group (7.7m/s vs. 7.1m/s and 7.1m/s, both p<0.001). Conversely, the unadjusted value was not significantly different between the two hypertensive groups (p=0.414).
Pregnancies complicated by HDP with SGA or HDP-only have significantly higher aortic AIx compared to uncomplicated normotensive pregnancies. Aortic AIx was highest in those pregnancies complicated by preeclampsia with SGA, reflecting a progression in severity of arterial stiffness abnormality with a worsening clinical picture. These findings most likely reflect systemic reduced vascular compliance and increased systemic vascular resistance in HDP pregnancies. This article is protected by copyright. All rights reserved.
Outcome of twin pregnancies with two live fetuses at 11-13 weeks' gestation.Ultrasound in Obstetrics and Gynecology
To report and compare pregnancy outcome in dichorionic (DC), monochorionic-diamniotic (MCDA) and monochorionic-monoamniotic (MCMA) twins with two live fetuses at 11-13 weeks' gestation and examine the impact of endoscopic laser surgery for severe twin-to-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR) on the outcome of MCDA twins.
This was a retrospective analysis of prospectively collected data on twin pregnancies undergoing routine ultrasound examination at 11-13 weeks' gestation between 2002 and 2019. In pregnancies with no major abnormalities we compared overall survival, fetal loss at <24 weeks' gestation, perinatal death at ≥24 weeks, delivery at <37 and <32 weeks, and birth weight <5th percentile between DC, MCDA and MCMA twins.
The study population of 6,225 twin pregnancies with two live fetuses at 11-13 weeks' gestation with no major abnormalities, included 4,896 (78.7%) DC, 1,274 (20.4%) MCDA and 55 (0.9%) MCMA twins. In DC twins, the rate of loss of all fetuses at <24 weeks' gestation was 2.3%; this rate was higher in MCDA twins (7.7%, RR 3.258, 95% CI 2.706-3.923) and more so in MCMA twins (21.8%, RR 9.289, 95% CI 6.377-13.530). In DC twins, the rate of perinatal death at ≥24 weeks of all babies that were alive at 24 weeks was 1.0%; this rate was higher in MCDA twins (2.5%, RR 2.456, 95% CI 1.779 - 3.389) and more so in MCMA twins (9.3%, RR 9.130, 95% CI 4.584-18.184). In DC twins, the rate of preterm birth at <37 weeks' gestation in pregnancies with at least one livebirth was 48.6%; this rate was higher in MCDA twins (88.5%, RR 1.824, 95% CI 1.760-1.890) and more so in MCMA twins (100%, RR 2.060, 95% CI 2.000-2.121). In DC twins, the rate of preterm birth at <32 weeks was 7.4%; this rate was higher in MCDA twins (14.2%, RR 1.920, 95% CI 1.616-2.281) and more so in MCMA twins (26.8%, RR 3.637, 95% CI 2.172-6.089). In DC twin pregnancies with at least one livebirth, the rate of small for gestational age neonates among all livebirths was 31.2% and in MCDA twins this rate was higher (37.8%, RR 1.209, 95% CI 1.138-1.284); in MCMA twins the rate was not significantly different (33.3%, RR 1.067, 95% CI 0.783 to 1.455). Kaplan-Meier analysis showed a significant difference in survival between MCDA and MCMA twins, compared to DC twins, for both the interval of 12 to <24 weeks' gestation (log-rank test, P<0.0001 for both) and that of ≥24 to 38 weeks (log-rank test, P<0.0001 for both). Endoscopic laser ablation of inter-twin communicating placental vessels was carried out in 127 (10.0%) MCDA twin pregnancies for TTTS and / or sFGR and in 111 of these surgery was at <24 weeks; both babies survived in 62 (55.9%) cases, one baby survived in 25 (22.5%) cases and there were no survivors in 24 (21.6%) cases. In the extreme assumption that had laser surgery not been carried out in these cases all babies would have died, the total fetal loss rate at <24 weeks' gestation in MCDA twins would have been 13.5%.
The rates of fetal loss <24 weeks' gestation, perinatal death at ≥24 weeks and preterm birth are higher in MCDA and more so in MCMA twins than in DC twins. In MCDA twins the rate of fetal loss may have been reduced by endoscopic laser surgery in those that developed early TTTS and / or sFGR. These data would be useful in counselling parents as to the likely outcome of their pregnancy and in defining strategies for surveillance and interventions in the management of the different types of twin pregnancies. This article is protected by copyright. All rights reserved.
Prenatal diagnosis of fetal bowel strangulation.Ultrasound in Obstetrics and Gynecology
It has been well established that the appearance of pseudocysts and polyhydramnios are typical signs indicative of fetal bowel stenosis/obstruction...
Impact of maternal obesity on fetal cardiac screening: which follow-up strategy is cost-effective?Ultrasound in Obstetrics and Gynecology
To perform a cost-effectiveness analysis of incomplete fetal cardiac screening with different follow-up strategies for non-obese and obese women.
Three decision-analytic models-one each for non-obese, obese, and Class III obese women-were developed to compare follow-up (f/u) strategies for initial suboptimal fetal cardiac screening. Five strategies studied were: (a) no f/u ultrasound (US) but direct to fetal echocardiography (FE), (b) 1 f/u US and then FE if cardiac views were still suboptimal, (c) up to 2 f/u US and then FE if cardiac views were still suboptimal, (d) 1 f/u US and no FE, and (e) up to 2 f/u US and no FE. The models identified fetuses with major CHD in a theoretical cohort of 4,000,000 births. Outcomes related to neonatal mortality and neuro-developmental disability were calculated. A cost-effectiveness threshold was set at $100,000 per quality-adjusted life years (QALY). Base case, sensitivity analysis, and Monte Carlo simulation were performed.
In our base-case models for all BMI groups, no f/u US and direct referral to FE led to the best outcomes, detecting 7%, 25%, and 82% more CHD for non-obese, obese, and Class III obese respectively, compared to the baseline strategy, 1 f/u US and no FE. However, no f/u US and direct referral to FE was over the $100,000/QALY threshold and therefore not cost-effective. The cost-effective strategy for all BMI groups was up to 1 f/u US and no FE. Both 2 f/u US and no FE and 2 f/u and FE were dominated (more costly and less effective), while 1 f/u and FE was over the cost-effectiveness threshold. 1 f/u US and no FE was the optimal strategy in 97%, 93%, and 86% of trials in Monte Carlo for the non-obese, obese, and Class III obese models respectively.
For both non-obese and obese women, the optimal CHD screening strategy is no further US and immediate referral to FE; however, this strategy is not cost-effective. Considering costs, 1 f/u US and no FE is the preferred strategy. For both obese and non-obese women, Monte Carlo simulations were very clear that 1 f/u US and no FE was the optimal strategy. Both non-obese and obese women should be offered up to 1 f/u ultrasounds if fetal cardiac screening is not completed. This article is protected by copyright. All rights reserved.
Spontaneous regression of twin anemia-polycythemia sequence presenting in the first trimester.Ultrasound in Obstetrics and Gynecology
A 29-year old para 2 presented with a spontaneous monochorionic diamniotic twin pregnancy for the 12-week scan. Twin 1 had a fetal tachycardia of 1...