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Shan D, Han J, Li T, Hu Y. Cesarean section "en caul" in preterm twin pregnancy: experience of a single center. Arch Gynecol Obstet 2024; 310:915-921. [PMID: 38575799 DOI: 10.1007/s00404-024-07472-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE The "en caul" cesarean section (CS) is a method to keep the amnion intact during CS. This amnion protection effect may have benefits in preterm twin pregnancy. This study aimed to explore the benefits and risks of this method in preterm twin pregnancy. METHODS This study is a retrospective analysis of preterm twin pregnancies underwent CS in West China Second University Hospital of Sichuan University from January 2011 to December 2022. Data on maternal and fetal outcomes were collected. Univariable analyses and multivariate logistic regression analyses were applied. The level of significance was set at p < 0.05. RESULTS A total of 182 patients were included (90 in the "en caul" group, 92 in the conventional group). "en caul" CS was associated with lower incidence for respiratory distress (aOR 0.47, 95% CI 0.25-0.88, for the first fetus; aOR 0.42, 95% CI 0.21-0.82, for the second fetus). This method was proved to have beneficial effects in improving the Apgar scores at 1st minute and reducing the mechanical ventilation rate in the second neonates (aOR 0.41, 95% CI 0.19-0.88). CONCLUSION "En caul" CS is an easy and safe technique to perform during CS for preterm twin pregnancy. The efficacy and safety of this method could be tested by future studies with larger sample size.
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Affiliation(s)
- Dan Shan
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, South Renmin Road, Section 3, Chengdu, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Jinbiao Han
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, South Renmin Road, Section 3, Chengdu, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China
| | - Tao Li
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, South Renmin Road, Section 3, Chengdu, 610041, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China.
| | - Yayi Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, South Renmin Road, Section 3, Chengdu, 610041, China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, 610041, China.
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Huang H, Ceavers O, Iregui MP, Howard MM. Being Pregnant during COVID-19: Exploring the COVID-19 Related Beliefs, Behaviors, and Birth Outcome among Users of a Pregnancy App. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:34. [PMID: 38248499 PMCID: PMC10815880 DOI: 10.3390/ijerph21010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
Being pregnant during COVID-19 increases the risk of experiencing severe COVID-19 symptoms, which in turn increases the risk of complications. This study aimed to examine COVID-19-related beliefs, behaviors, and birth outcomes among users of Count the Kicks (CTK), a fetal movement tracking app. This study used the End of Pregnancy Survey data from 1037 CTK users. We used descriptive analyses to analyze COVID-19-related beliefs and behaviors and used the chi-square statistic and Z statistic to examine factors associated with vaccination and birth outcome. Nearly half of the survey respondents reported not being concerned that in-person prenatal visits might lead to COVID-19 exposure. Most respondents (65.9%) had already received the COVID-19 vaccine at the time of the survey. The vaccination rate was statistically significantly lower among African Americans than the remaining race/ethnicity groups (mostly white). The healthy birth rate is lower among respondents with high-risk pregnancies, while the stillbirth rate is highest among Hispanics. Vaccination status was not associated with the likelihood of a healthy birth. Our findings confirmed that vaccination does not compromise birth outcomes, further contributing to the existing evidence of COVID vaccine safety during pregnancy. This study also demonstrates an example of using data from a pregnancy app to facilitate research on app users in real-time.
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Affiliation(s)
- Hui Huang
- School of Social Work, University of Texas at Arlington, Arlington, TX 76010, USA
| | - Olivia Ceavers
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA; (O.C.); (M.P.I.)
| | - Maria Pinzon Iregui
- Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA; (O.C.); (M.P.I.)
| | - Melissa M. Howard
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA 30602, USA;
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Okwaraji YB, Suárez-Idueta L, Ohuma EO, Bradley E, Yargawa J, Pingray V, Cormick G, Gordon A, Flenady V, Horváth-Puhó E, Sørensen HT, Sakkeus L, Abuladze L, Heidarzadeh M, Khalili N, Yunis KA, Al Bizri A, Karalasingam SD, Jeganathan R, Barranco A, van Dijk AE, Broeders L, Alyafei F, AlQubaisi M, Razaz N, Söderling J, Smith LK, Matthews RJ, Wood R, Monteath K, Pereyra I, Pravia G, Lisonkova S, Wen Q, Lawn JE, Blencowe H. Stillbirths: Contribution of preterm birth and size-for-gestational age for 125.4 million total births from nationwide records in 13 countries, 2000-2020. BJOG 2023. [PMID: 38018284 DOI: 10.1111/1471-0528.17653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/07/2023] [Accepted: 08/19/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE To examine the contribution of preterm birth and size-for-gestational age in stillbirths using six 'newborn types'. DESIGN Population-based multi-country analyses. SETTING Births collected through routine data systems in 13 countries. SAMPLE 125 419 255 total births from 22+0 to 44+6 weeks' gestation identified from 2000 to 2020. METHODS We included 635 107 stillbirths from 22+0 weeks' gestation from 13 countries. We classified all births, including stillbirths, into six 'newborn types' based on gestational age information (preterm, PT, <37+0 weeks versus term, T, ≥37+0 weeks) and size-for-gestational age defined as small (SGA, <10th centile), appropriate (AGA, 10th-90th centiles) or large (LGA, >90th centile) for gestational age, according to the international newborn size for gestational age and sex INTERGROWTH-21st standards. MAIN OUTCOME MEASURES Distribution of stillbirths, stillbirth rates and rate ratios according to six newborn types. RESULTS 635 107 (0.5%) of the 125 419 255 total births resulted in stillbirth after 22+0 weeks. Most stillbirths (74.3%) were preterm. Around 21.2% were SGA types (PT + SGA [16.2%], PT + AGA [48.3%], T + SGA [5.0%]) and 14.1% were LGA types (PT + LGA [9.9%], T + LGA [4.2%]). The median rate ratio (RR) for stillbirth was highest in PT + SGA babies (RR 81.1, interquartile range [IQR], 68.8-118.8) followed by PT + AGA (RR 25.0, IQR, 20.0-34.3), PT + LGA (RR 25.9, IQR, 13.8-28.7) and T + SGA (RR 5.6, IQR, 5.1-6.0) compared with T + AGA. Stillbirth rate ratios were similar for T + LGA versus T + AGA (RR 0.7, IQR, 0.7-1.1). At the population level, 25% of stillbirths were attributable to small-for-gestational-age. CONCLUSIONS In these high-quality data from high/middle income countries, almost three-quarters of stillbirths were born preterm and a fifth small-for-gestational age, with the highest stillbirth rates associated with the coexistence of preterm and SGA. Further analyses are needed to better understand patterns of gestation-specific risk in these populations, as well as patterns in lower-income contexts, especially those with higher rates of intrapartum stillbirth and SGA.
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Affiliation(s)
- Yemisrach B Okwaraji
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Eric O Ohuma
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ellen Bradley
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Judith Yargawa
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Veronica Pingray
- Institute for Clinical Effectiveness and Health Policy, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriela Cormick
- Institute for Clinical Effectiveness and Health Policy, Ciudad Autónoma de Buenos Aires, Argentina
- Centro de Investigaciones en Epidemiología y Salud Pública, National Scientific and Technical Research Council (CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Adrienne Gordon
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Vicki Flenady
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Luule Sakkeus
- School of Governance, Law and Society, Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
| | - Liili Abuladze
- School of Governance, Law and Society, Estonian Institute for Population Studies, Tallinn University, Tallinn, Estonia
- Population Research Unit, Väestöliitto, Finland
| | | | - Narjes Khalili
- Department of Community and Family Medicine, Preventive Medicine and Public Health Research Centre, Psychosocial Health Research Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Khalid A Yunis
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Ayah Al Bizri
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Shamala D Karalasingam
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Cyberjaya, Cyberjaya, Malaysia
| | - Ravichandran Jeganathan
- Department of Obstetrics & Gynaecology, Malaysia Monash Medical School, Johor Bahru, Malaysia
| | - Arturo Barranco
- Directorate of Health Information, Ministry of Health, Mexico City, Mexico
| | | | | | - Fawzya Alyafei
- Department of Paediatrics, Hamad General Hospital, Doha, Qatar
| | - Mai AlQubaisi
- NICU, Women Wellness and Research Centre, Doha, Qatar
| | - Neda Razaz
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Lucy K Smith
- Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Ruth J Matthews
- Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Rachael Wood
- Public Health Scotland, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kirsten Monteath
- Pregnancy, Birth and Child Health Team, Public Health Scotland, Edinburgh, UK
| | - Isabel Pereyra
- Faculty of Health Sciences, Catholic University of Maule, Curicó, Chile
| | - Gabriella Pravia
- Department of Wellness and Health, Catholic University of Uruguay, Montevideo, Uruguay
| | - Sarka Lisonkova
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Qi Wen
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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Lv Y, Zhou Y, Hu R, Liang Y, Lian Y, Wang J, Wei Y, Zhang Y, Qiao Y, He T. Association between hypoproteinaemia with massive proteinuria and small for gestational age in pre-eclampsia: a single-centre, retrospective cohort study using propensity score matching. BMJ Open 2023; 13:e071835. [PMID: 37463811 PMCID: PMC10357757 DOI: 10.1136/bmjopen-2023-071835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE To investigate the association between hypoproteinaemia with massive proteinuria and the incidence of small for gestational age in pre-eclampsia. DESIGN Retrospective cohort study using propensity score matching. SETTING Northwest Women's and Children's Hospital in Shaanxi Province, China, using data from January 2016 to December 2021. PARTICIPANTS Patients diagnosed with pre-eclampsia were grouped into the massive proteinuria group if the maximum proteinuria was >3.5 g/day and the minimum serum albumin was <30 g/L; otherwise, they were placed in the control group. OUTCOME MEASURES The primary outcome was the incidence of small for gestational age infants. Secondary outcomes included fetal death, admission to the neonatal intensive care unit, a 5 min APGAR score <7, severe small for gestational age, fetal growth restriction, birth weight, premature birth, and maternal outcomes such as eclampsia, encephalopathy, placental abruption, haemolysis, elevated liver enzymes and low platelet syndrome, heart failure and retinal detachment. RESULTS In total, 468 patients (234 from each group) were included, and the groups were well matched. The incidences of small for gestational age (33.76% vs 20.51%, OR 1.646, 95% CI 1.208 to 2.243, p=0.001), severe small for gestational age (14.70% vs 7.69%, OR 1.833, 95% CI 1.063 to 3.162, p=0.026), fetal growth restriction (23.93% vs 16.24%, OR 1.474, 95% CI 1.018 to 2.133, p=0.038), and the numbers of infants admitted to the neonatal intensive care unit (67.52% vs 58.55%, OR 1.153, 95% CI 1.003 to 1.326, p=0.044) were significantly higher in patients with hypoproteinaemia and massive proteinuria than in the control group. In addition, the median birth weight was significantly lower in the massive proteinuria group. There were no significant differences in maternal outcomes except for renal parameters, which were worse in the massive proteinuria group. CONCLUSION Hypoproteinaemia with massive proteinuria was associated with fetal growth and a higher incidence of small for gestational age infants in pre-eclampsia.
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Affiliation(s)
- Yanxiang Lv
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Ying Zhou
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Rui Hu
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Yan Liang
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Yanan Lian
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Jun Wang
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Yang Wei
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Yanmei Zhang
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Yuan Qiao
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
| | - Tongqiang He
- Obstetrics and Gynecology Intensive Care Unit, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China
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