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Hall M, Valencia CM, Soma-Pillay P, Luyt K, Jacobsson B, Shennan A. Effective and simple interventions to improve outcomes for preterm infants worldwide: The FIGO PremPrep-5 initiative. Int J Gynaecol Obstet 2024. [PMID: 38264849 DOI: 10.1002/ijgo.15269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 01/25/2024]
Abstract
Preterm birth remains the leading cause of mortality among under-5's and is a major contributor to the reduction in quality-of-life adjusted years and reduction in human capital. Globally, there are many interventions and care bundles that aim to reduce the impact of preterm birth once preterm labor has ensued and into the neonatal period; not all of these are applicable in all settings. Here, we introduce the FIGO PremPrep-5 initiative, which aims to disseminate key information on the most simple and effective interventions with the aim of increasing implementation globally. Before delivery, we recommend a course of antenatal corticosteroids, and intrapartum magnesium sulfate. At delivery, we recommend delayed cord clamping. Postnatally, we recommend early feeding with breast milk and immediate kangaroo care. While there are many other interventions that may improve outcomes at the time of labor and after preterm birth, these are clinically effective and relatively inexpensive options that can be practiced in most settings and supplemented with more advanced care. We include examples of a training video and infographics that will be used for dissemination.
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Affiliation(s)
- Megan Hall
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK
| | - Catalina M Valencia
- Department of Obstetrics and Gynecology, Universidad CES, Medellín, Colombia
- Maternal Fetal Medicine Unit, Clinica del Prado, Medellín, Colombia
| | - Priya Soma-Pillay
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Steve Biko Academic Hospital, Pretoria, South Africa
| | - Karen Luyt
- Bristol Medical School, University of Bristol, Bristol, UK
- Neonatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
| | - Andrew Shennan
- Department of Women and Children's Health, St Thomas' Hospital, King's College London, London, UK
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Valencia CM, Mol BW, Jacobsson B. Response: FIGO good practice recommendations on modifiable causes of iatrogenic preterm birth. Int J Gynaecol Obstet 2022; 159:335. [DOI: 10.1002/ijgo.14346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Catalina M. Valencia
- Department of Obstetrics and Gynaecology Universidad CES Medellín Colombia
- Fundared‐Materna Bogotá Colombia
| | - Ben W. Mol
- Department of Obstetrics and Gynaecology Monash University Clayton Australia
- Aberdeen Centre for Women's Health Research Institute of Applied Health Sciences, School of Medicine Aberdeen UK
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg Gothenburg Sweden
- Department of Obstetrics and Gynecology Sahlgrenska University Hospital Gothenburg Sweden
- Department of Genetics and Bioinformatics Domain of Health Data and Digitalization, Institute of Public Health Oslo Norway
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Valencia CM, Hersh AR, Burwick RM, Velásquez JA, Gutiérrez-Marín J, Edna F, Silva JL, Trujillo-Otálvaro J, Vargas-Rodríguez J, Bernal Y, Quintero A, Rincón M, Tolosa JE. Soluble concentrations of the terminal complement complex C5b-9 correlate with end-organ injury in preeclampsia. Pregnancy Hypertens 2022; 29:92-97. [PMID: 35820290 DOI: 10.1016/j.preghy.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/29/2022] [Accepted: 07/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to determine if soluble levels of C5b-9, the terminal complement complex, correlate with end-organ injury in preeclampsia. STUDY DESIGN Project COPA (Complement and Preeclampsia in the Americas), a multi-center observational study in Colombia from 2015 to 2016, enrolled hypertensive pregnant women into four groups: chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia with severe features. Trained coordinators collected clinical data, blood and urine. End-organ injury was defined by serum creatinine ≥ 1.0 mg/dl, aspartate transaminase ≥ 70U/L, platelet count < 150,000/µl, or lactate dehydrogenase ≥ 500 U/L. Data were analyzed by χ2 or Fisher's exact test with significance at P < 0.05. MAIN OUTCOME MEASURE C5b-9 concentrations in plasma and urine, using enzyme linked immunosorbent assays. RESULTS In total, 298 hypertensive participants were enrolled. Plasma and urine C5b-9 levels were measured in all participants and stratified by quartile (Q1-4), from lowest to highest C5b-9 concentration. Participants with low plasma C5b-9 levels (Q1) were more likely to have end-organ injury compared to those with higher levels (Q2-Q4) [platelet count < 150,000/μl (20.8% vs. 8.4%, P = 0.01); elevated serum creatinine ≥ 1.0 mg/dl (14.9% vs. 4.5%, P = 0.009)]. In contrast, participants with high urinary C5b-9 levels (Q4) were more likely to have end-organ injury compared to those with lower levels (Q1-Q3) [platelet count < 150,000/μl (19.7% vs. 7.4%, P = 0.003); elevated serum creatinine ≥ 1.0 mg/dl (12.3% vs. 4.4%, P = 0.025)]. CONCLUSION We identified a pattern of increased urine and low plasma C5b-9 levels in patients with preeclampsia and end-organ injury. Soluble C5b-9 levels may be used to identify complement-mediated end-organ injury in preeclampsia.
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Affiliation(s)
- Catalina M Valencia
- Clínica Reina Sofía Colsanitas SA, Bogotá, Distrito Capital de Bogotá, Colombia; Fundared-Materna, Bogotá, Distrito Capital de Bogotá, Colombia; Universidad CES, Medellín, Antioquia, Colombia.
| | - Alyssa R Hersh
- Fundared-Materna, Bogotá, Distrito Capital de Bogotá, Colombia; Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, OR, USA
| | - Richard M Burwick
- Fundared-Materna, Bogotá, Distrito Capital de Bogotá, Colombia; Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, OR, USA; Cedars-Sinai Medical Center, Department of Obstetrics and Gynecology, Los Angeles, CA, USA
| | - Jesús A Velásquez
- Fundared-Materna, Bogotá, Distrito Capital de Bogotá, Colombia; Universidad de Antioquia, Medellín, Antioquia, Colombia; Hospital Universitario San Vicente Fundación, Medellín, Antioquia, Colombia
| | - Jorge Gutiérrez-Marín
- Fundared-Materna, Bogotá, Distrito Capital de Bogotá, Colombia; Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia
| | - Francisco Edna
- Fundared-Materna, Bogotá, Distrito Capital de Bogotá, Colombia; ESE Clínica de Maternidad Rafael Calvo, Cartagena, Bolívar, Colombia
| | - Jaime L Silva
- Fundared-Materna, Bogotá, Distrito Capital de Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Distrito Capital de Bogotá, Colombia; Pontificia Universidad Javeriana, Bogotá, Distrito Capital de Bogotá, Colombia
| | - Juliana Trujillo-Otálvaro
- Fundared-Materna, Bogotá, Distrito Capital de Bogotá, Colombia; Hospital General de Medellín, Medellín, Antioquia, Colombia
| | - Johanna Vargas-Rodríguez
- Fundared-Materna, Bogotá, Distrito Capital de Bogotá, Colombia; Laboratorio Clínico Colsanitas, Bogotá, Distrito Capital de Bogotá, Colombia
| | - Yamile Bernal
- Fundared-Materna, Bogotá, Distrito Capital de Bogotá, Colombia; Laboratorio Clínico Colsanitas, Bogotá, Distrito Capital de Bogotá, Colombia
| | - Alvaro Quintero
- Fundared-Materna, Bogotá, Distrito Capital de Bogotá, Colombia; Hospital General de Medellín, Medellín, Antioquia, Colombia
| | - Mónica Rincón
- Fundared-Materna, Bogotá, Distrito Capital de Bogotá, Colombia; Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, OR, USA
| | - Jorge E Tolosa
- Fundared-Materna, Bogotá, Distrito Capital de Bogotá, Colombia; Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, OR, USA; St. Luke's University, Bethlehem, PA, USA
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Shennan A, Suff N, Jacobsson B, Simpson JL, Norman J, Grobman WA, Bianchi A, Mujanja S, Valencia CM, Mol BW. Abstracts of the XXIII FIGO World Congress of Gynecology & Obstetrics. Int J Gynaecol Obstet 2021; 155 Suppl 2:31-532. [PMID: 34669972 DOI: 10.1002/ijgo.13884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andrew Shennan
- Department of Women and Children's Health, King's College, London, UK
| | - Natalie Suff
- Department of Women and Children's Health, King's College, London, UK
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
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Shennan A, Suff N, Jacobsson B, Simpson JL, Norman J, Grobman WA, Bianchi A, Mujanja S, Valencia CM, Mol BW. FIGO good practice recommendations on magnesium sulfate administration for preterm fetal neuroprotection. Int J Gynaecol Obstet 2021. [PMID: 34669972 PMCID: PMC9292474 DOI: 10.1002/ijgo.13856] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In women at risk of early preterm imminent birth, from viability to 30 weeks of gestation, use of MgSO4 for neuroprotection of the fetus is recommended. In pregnancies below 32–34 weeks of gestation, the use of MgSO4 for neuroprotection of the fetus should be considered. MgSO4 should be administered regardless of the cause for preterm birth and the number of babies in utero. MgSO4 should be administered when early preterm birth is planned or expected within 24 h. When birth is planned, MgSO4 should commence as close as possible to 4 h before birth. If delivery is planned or expected to occur sooner than 4 h, MgSO4 should be administered, as there is still likely to be an advantage from administration within this time. The optimal regimen of MgSO4 for fetal neuroprotection is an intravenous loading dose of 4 g (administered slowly over 20–30 min), followed by a 1 g per hour maintenance dose. This regimen should continue until birth but should be stopped after 24 h if undelivered. When MgSO4 is administered, women should be monitored for clinical signs of magnesium toxicity at least every 4 h by recording pulse, blood pressure, respiratory rate, and deep tendon (for example, patellar) reflexes. MgSO4 for fetal neuroprotection is recommended to women at risk of imminent preterm birth below 30 weeks of gestation.
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Affiliation(s)
- Andrew Shennan
- Department of Women and Children's Health King's College London UK
| | - Natalie Suff
- Department of Women and Children's Health King's College London UK
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology Institute of Clinical Science Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Obstetrics and Gynecology Sahlgrenska University Hospital Gothenburg Sweden
- Department of Genetics and Bioinformatics Domain of Health Data and Digitalization Institute of Public Health Oslo Norway
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Abstract
Iatrogenic preterm birth is a planned delivery that occurs before 37 weeks of gestation due to maternal and/or fetal causes. However, in some cases, such deliveries also occur with no apparent medical indication. The increasing numbers of iatrogenic preterm deliveries worldwide have led researchers to identify modifiable causes that allow the formulation of preventive strategies that could impact the overall preterm birth rate. The present document contains the FIGO (International Federation of Gynecology and Obstetrics) Working Group for Preterm Birth recommendations, aiming to reduce the rates of iatrogenic preterm birth based on four of the most common clinical scenarios and issues related to iatrogenic preterm delivery. The working group supports efforts to identify the contribution of iatrogenic preterm delivery to the overall preterm birth rate and encourages health authorities to establish preventive measures accordingly. We encourage care providers to maintain single embryo transfer policies to prevent multiple pregnancies as a substantial contributor of iatrogenic preterm birth. The working group also recommends that efforts to reduce unnecessary cesarean sections must be warranted, and mechanisms to ensure the appropriate time of delivery and strengthening of education and communication processes must be pursued. Iatrogenic preterm birth contributes substantially to preterm birth rates globally and can be mitigated by identifying modifiable factors and formulating and supporting preventive strategies.
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Affiliation(s)
- Catalina M Valencia
- Department of Obstetrics and Gynaecology, Universidad CES, Medellín, Colombia.,Fundared-Materna, Bogotá, Colombia
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia.,Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Aberdeen, UK
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
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Levine LD, Valencia CM, Tolosa JE. Induction of labor in continuing pregnancies. Best Pract Res Clin Obstet Gynaecol 2020; 67:90-99. [PMID: 32527660 DOI: 10.1016/j.bpobgyn.2020.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
This chapter aims to provide an evidence-based approach to cervical-ripening methods and induction of labor in high-, middle-, and low-income countries. We will review the epidemiology of induction and will also review pharmacological and mechanical methods of cervical-ripening as well as oxytocin for induction. Lastly, we will review current guidelines of when to determine an induction to be failed.
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Affiliation(s)
- Lisa D Levine
- Maternal and Child Health Research Center, Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Catalina M Valencia
- Fetal Medicine Foundation, London, UK; Fundared-Materna, Bogotá, Colombia; Medicina Fetal S.A.S Medellin, Colombia
| | - Jorge E Tolosa
- Fundared-Materna, Bogotá, Colombia; Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Director of Research, St. Luke's University Health Network, 701 Ostrum Street, Suite 303, Bethlehem, PA, 18015, USA; Global Network for Perinatal & Reproductive Health (GNPRH), Division of Maternal Fetal Medicine Oregon Health & Science University, Portland, OR, USA
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Burwick RM, Velásquez JA, Valencia CM, Bernal YI, Silva JL, Gutiérrez-Marín JH, Edna-Estrada F, Trujillo-Otálvaro J, Rincón M, Tolosa JE. 306: Preeclampsia with severe features, defining a subset of women with complement-associated disease. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Valencia CM, Burwick R, Velásquez JA, Silva JL, Gutiérrez-Marín J, Edna-Estrada F, Trujillo-Otálvaro J, Bernal Y, Quintero A, Gómez AM, González N, Cabas C, Rincón M, Lenis-Ballesteros V, Tolosa JE. 67: Improved diagnosis of preeclampsia with severe features and end organ injury using complement activation measurement in urine and plasma. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Velasquez J, Burwick R, Valencia CM, Vargas J, Silva JL, Edna-Estrada F, Gutiérrez-Marín JH, Trujillo-Otálvaro J, Gómez AM, Rincón M, Cabas C, Quintero A, González N, Lenis-Ballesteros V, Tolosa JE. 329: Excess complement activation is associated with adverse outcomes in women with hypertensive disorders of pregnancy. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jani JC, Nicolaides KH, Gratacós E, Valencia CM, Doné E, Martinez JM, Gucciardo L, Cruz R, Deprest JA. Severe diaphragmatic hernia treated by fetal endoscopic tracheal occlusion. Ultrasound Obstet Gynecol 2009; 34:304-310. [PMID: 19658113 DOI: 10.1002/uog.6450] [Citation(s) in RCA: 264] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To examine operative and perinatal aspects of fetal endoscopic tracheal occlusion (FETO) in congenital diaphragmatic hernia (CDH). METHODS This was a multicenter study of singleton pregnancies with CDH treated by FETO. The entry criteria for FETO were severe CDH on the basis of sonographic evidence of intrathoracic herniation of the liver and low lung area to head circumference ratio (LHR) defined as the observed to the expected normal mean for gestation (o/e LHR) equivalent to an LHR of 1 or less. RESULTS FETO was carried out in 210 cases, including 175 cases with left-sided, 34 right-sided and one with bilateral CDH. In 188 cases the CDH was isolated and in 22 there was an associated defect. FETO was performed at a median gestational age of 27.1 (range, 23.0-33.3) weeks. The first eight cases were done under general anesthesia, but subsequently either regional or local anesthesia was used. The median duration of FETO was 10 (range, 3-93) min. Successful placement of the balloon at the first procedure was achieved in 203 (96.7%) cases. Spontaneous preterm prelabor rupture of membranes (PPROM) occurred in 99 (47.1%) cases at 3-83 (median, 30) days after FETO and within 3 weeks of the procedure in 35 (16.7%) cases. Removal of the balloon was prenatal either by fetoscopy or ultrasound-guided puncture, intrapartum by ex-utero intrapartum treatment, or postnatal either by tracheoscopy or percutaneous puncture. Delivery was at 25.7-41.0 (median, 35.3) weeks and before 34 weeks in 65 (30.9%) cases. In 204 (97.1%) cases the babies were live born and 98 (48.0%) were discharged from the hospital alive. There were 10 deaths directly related to difficulties with removal of the balloon. Significant prediction of survival was provided by the o/e LHR and gestational age at delivery. On the basis of the relationship between survival and o/e LHR in expectantly managed fetuses with CDH, as reported in the antenatal CDH registry, we estimated that in fetuses with left CDH treated with FETO the survival rate increased from 24.1% to 49.1%, and in right CDH survival increased from 0% to 35.3% (P < 0.001). CONCLUSIONS FETO in severe CDH is associated with a high incidence of PPROM and preterm delivery but a substantial improvement in survival.
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Affiliation(s)
- J C Jani
- Fetal Medicine and Treatment Unit of University Hospital Gasthuisberg, Leuven, Belgium
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