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Liabsuetrakul T, Meher S. Intrapartum care algorithms for liquor abnormalities: oligohydramnios, meconium, blood and purulent discharge. BJOG 2024; 131 Suppl 2:90-101. [PMID: 35415944 DOI: 10.1111/1471-0528.16728] [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: 07/06/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022]
Abstract
AIM To construct evidence-based algorithms for the assessment and management of common amniotic fluid abnormalities detected during labour. POPULATION Low-risk singleton, term pregnant women in labour. SETTING Birth facilities in low- and middle-income countries. SEARCH STRATEGY We searched international guidelines published by the American College of Obstetricians and Gynecologists (ACOG), the National Institute for Health and Care Excellence (NICE), the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Royal College of Obstetricians and Gynaecologists (RCOG), the Society of Obstetrics and Gynaecology (SOGC) and the World Health Organization (WHO). We also searched The Cochrane Library and MEDLINE up to 20 January 2020 using keywords for relevant systematic reviews and randomised trials. CASE SCENARIOS We developed evidence-based intrapartum care algorithms for four case scenarios: oligohydramnios; meconium-stained amniotic fluid; bloody amniotic fluid or vaginal bleeding; and purulent amniotic fluid or discharge. These conditions may be associated with fetal and /or maternal morbidity. Differential diagnosis includes uteroplacental insufficiency, fetal growth restriction, fetal distress, abruption, placenta or vasa praevia, uterine rupture and intra-amniotic infection, respectively. Algorithms include how to assess for, diagnose and manage these conditions. CONCLUSIONS Four algorithms are presented, to provide a systematic approach and guidance on the clinical management for the following amniotic fluid abnormalities: oligohydramnios; meconium-stained liquor; bloody amniotic fluid or vaginal bleeding; and purulent amniotic fluid or discharge. These algorithms may be beneficial in supporting clinical decision making, particularly in low-resource settings. TWEETABLE ABSTRACT Evidence based algorithms for management of common amniotic fluid abnormalities seen during labour.
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Affiliation(s)
- T Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - S Meher
- The Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Edgbaston, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
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Xiao H, Yao C, Qi Z, Liu J, Liu X, Zhou Y, Tang E, Hu Y, Jiang Y, Li D, Du N, Li N, Li Y, Ji A, Cai T. Association between maternal short-term exposure to ambient air pollution and the risk of fetal distress: A matched case-control study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 860:160438. [PMID: 36435241 DOI: 10.1016/j.scitotenv.2022.160438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/15/2022] [Accepted: 11/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Ambient air pollution has been linked to gestational complications. However, the evidence on the relationship between air pollution and fetal distress is limited. OBJECTIVES To investigate the relationship between maternal short-term air pollution exposure and fetal distress, and to identify a potential susceptible population. METHODS This matched case-control study, involving 313 pregnancy women with fetal distress was conducted in Xi'an, the largest city in Northwest China from 2013 to 2016. Each woman with fetal distress was randomly matched with four women without fetal distress of the same age, same gestational week, and registration in the same period (n = 1252). Inverse distance-weighted (IDW) interpolation was applied to estimate maternal air pollution exposure based on the residential addresses. We employed conditional logistic regression model to evaluate the relationship between air pollutants and fetal distress. Distributed lag nonlinear model (DLNM) was performed to examine the exposure-response relationship between air pollutants and fetal distress. RESULTS Maternal short-term exposure to PM10, PM2.5-10 (PMc), SO2, NO2, and CO was associated with increased risk of fetal distress. Each 10 μg/m3 increment in PM10, PMc, SO2 at lag 014, and NO2 at lag 010, the odds ratio (ORs) of fetal distress were 1.027 (95 % confidence interval (CI): 1.004, 1.050), 1.058 (95 % CI: 1.014, 1.105), 1.140 (95 % CI: 1.029, 1.264), and 1.158 (95 % CI: 1.046, 1.283), respectively. Similarly, with a 0.1 mg/m3 increment in CO at lag 014, the OR of fetal distress was 1.029 (95 % CI: 1.002, 1.058). Stratified analyses showed that the estimate associations of PM10, PM2.5 and CO appeared to be stronger, although not statistically significantly, among women with gestational complications. CONCLUSION Maternal short-term exposure to ambient air pollution may increase the risk of fetal distress. Understanding the detrimental role of air pollution in fetal distress can help us better develop preventative methods in reducing its' impact on maternal and fetal health.
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Affiliation(s)
- Hua Xiao
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Chunyan Yao
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Zongli Qi
- Department of Pathology, Shaanxi Provincial People's Hospital, Xi'an 710068, China; Clinical Laboratory, Shaanxi Provincial People's Hospital, Xi'an 710068, China
| | - Jianghong Liu
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA
| | - Xiaoling Liu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yumeng Zhou
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Enjie Tang
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yuegu Hu
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yuexu Jiang
- The First People's Hospital of Guiyang, Guiyang 550000, China
| | - Dawei Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Ning Du
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Na Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China; Department of Nutrition and Food Hygiene, School of Public Health Guizhou Medical University, Guiyang 550025, China
| | - Yafei Li
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Ailing Ji
- Department of Preventive Medicine, Chongqing Medical and Pharmaceutical College, Chongqing 401331, China.
| | - Tongjian Cai
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, China.
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LotfAlizadeh M, MoeinDarbari S, MohebbanAzad N, Ghomian N. Efficacy of inhaled Desmopressin in pregnant women with idiopathic oligohydramnios - a randomized controlled trial. J Med Life 2022; 15:1352-1357. [PMID: 36567840 PMCID: PMC9762361 DOI: 10.25122/jml-2021-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/22/2022] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to investigate the therapeutic effect of inhaled Desmopressin (DDAVP) in pregnant women with idiopathic oligohydramnios. This randomized, double-blind clinical trial involved 44 pregnant women at 28-37 weeks of gestation with idiopathic oligohydramnios admitted in 2 academic hospitals in Mashhad, Iran, from 2018 to 2019. In the intervention group, 10µg DDAVP was nasally sprayed. The control group received intravenous maintenance fluid. The hematocrit, electrolytes, blood pressure and urine-specific gravity were evaluated at baseline and 3, 8, and 24 hours later. Amniotic fluid index (AFI) was measured using ultrasound at baseline, 24 and 48 hours later. There was no significant difference in the basic characteristics (age, body mass index, and gestational age) between the two groups. The pattern of changes of AFI (baseline, 24 and 48 hours later) increased in the intervention (4.16±0.86, 7.08±1.453 and 7.76±1.62, p<0.001) and control groups (4.23±0.70, 5.39±1.079 and 5.68±1.10, p<0.001). Serum sodium levels significantly declined in the intervention group (p<0.001) but not in the control group (p=0.07). There were no significant differences in potassium (p=0.89), hematocrit (p=0.23), systolic blood pressure (p=0.21) and diastolic blood pressure (p=0.97). However, urine-specific gravity had an increasing pattern in the intervention group (p<0.001) and a decreasing pattern in the control group (p<0.001). This study showed that Desmopressin inhalation could increase the AFI and urine specific gravity, enhancing oligohydramnios treatment in pregnant women, compared to serum administration.
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Affiliation(s)
- Marziye LotfAlizadeh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Somayeh MoeinDarbari
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neshat MohebbanAzad
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nayereh Ghomian
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,Corresponding Author: Nayereh Ghomian, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. E-mail:
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Chandra I, Sun L. Preterm and term preeclampsia: differences in biochemical parameter and pregnancy outcomes. Postgrad Med 2018; 130:703-707. [PMID: 30246594 DOI: 10.1080/00325481.2018.1527169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To analyze the similarities and differences in the clinical parameters, laboratory biomarkers, and pregnancy outcomes between preterm and term preeclampsia (PE). METHODS Data on 185 women diagnosed with PE were collected from a Jiangsu Province Hospital from January 2017 to December 2017 and analyzed. 74 (40%) patients were diagnosed with preterm PE, of which 70 (94.6%) patients with PE with severe features (PEs) and the rest with PE. 111 (60%) patients were diagnosed with term PE, of which 54 (48.6%) patients with PEs and the rest with PE. RESULTS Preterm PE group had significantly higher blood pressure than that of term PE, with mean delivery at gestational age of 34.3[Formula: see text]2.1 weeks for preterm PE and 39[Formula: see text]1.2 weeks for term PE. Preterm PE group was associated with previous cesarean section and PE history, fetal growth restriction (FGR), non-reassuring fetal status (NRFS), and fetal umbilical artery (UA) systolic velocity/diastolic velocity ratio (S/D R) abnormality, neonatal lower birth weight, lower APGAR score, and higher NICU transfer rate. 74.3% of pregnant women from preterm PE group had proteinuria of +2 to +4, whilst only 37.8% pregnant women from term PE group developed that condition. Liver and renal function, also serum Ca and K were significantly higher in preterm PE. CONCLUSION Our study found that preterm PE significantly correlated with higher incidence of PEs, neonatal morbidities, also higher liver and kidney function compared to term PE. These results may be helpful for obstetricians to make accurate quantification of risk regarding every result of antenatal check-up, and perform close follow up if any abnormalities were found on blood pressure, ultrasound, or blood tests.
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Affiliation(s)
- Ivana Chandra
- a Department of Obstetrics and Gynecology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , Jiangsu , China
| | - Lizhou Sun
- a Department of Obstetrics and Gynecology , The First Affiliated Hospital of Nanjing Medical University , Nanjing , Jiangsu , China
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Kongwattanakul K, Saksiriwuttho P, Chaiyarach S, Thepsuthammarat K. Incidence, characteristics, maternal complications, and perinatal outcomes associated with preeclampsia with severe features and HELLP syndrome. Int J Womens Health 2018; 10:371-377. [PMID: 30046254 PMCID: PMC6054275 DOI: 10.2147/ijwh.s168569] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To determine the incidence of preeclampsia with severe features among pregnant women and evaluate the characteristics, maternal complications, and perinatal outcomes between nonsevere preeclampsia versus preeclampsia with severe features and hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome. MATERIALS AND METHODS A retrospective descriptive study was conducted at Khon Kaen University's Srinagarind Hospital, a tertiary care facility in northeast Thailand. The pregnant women who had been diagnosed with preeclampsia according to American College of Obstetricians and Gynecologists guidelines from January 1, 2012 to December 31, 2016 were identified and their medical records were reviewed. Various characteristics were examined to compare maternal complications and perinatal outcomes. RESULTS There was a total of 11,199 deliveries during the study period, out of which 213 preeclamptic women were identified. One hundred and seven women (9.6 per 1,000 deliveries) were diagnosed with nonsevere preeclampsia, 90 (8 per 1,000 deliveries) had preeclampsia with severe features, and 16 (1.4 per 1,000 deliveries) had HELLP syndrome. Twenty-one women (9.9%) experienced postpartum hemorrhage; 11 (10.3%) in the nonsevere features preeclampsia group and 10 (9.4%) in the preeclampsia with severe features and HELLP syndrome group. Placental abruption (3 women; 1.4%) and heart failure (1 women; 0.4%) only occurred among women in the preeclampsia with severe features group. Neonatal complications were significantly higher in the preeclampsia with severe features and HELLP syndrome group (low birth weight =35.1% versus 74.3%, p<0.001; birth asphyxia =4.4% versus 18.2%, p=0.001; neonatal intensive care unit admission =7.0% versus 30.9%, p<0.001; neonatal resuscitation =15.8% versus 42.7%, p<0.001). Stillbirths only occurred in cases of preeclampsia with severe features and HELLP syndrome (3 cases, 1.4%). Intrapartum death was higher in cases of preeclampsia with severe features and HELLP syndrome, but without statistical significance (2.6% versus 6.4%, p=0.190). CONCLUSION The incidence of preeclampsia with severe features and HELLP syndrome was 9.5 per 1,000 deliveries. Severe maternal and perinatal outcomes were more commonly observed.
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Affiliation(s)
- Kiattisak Kongwattanakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,
| | - Piyamas Saksiriwuttho
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,
| | - Sukanya Chaiyarach
- Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,
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