1
|
Mullins E, Perry A, Banerjee J, Townson J, Grozeva D, Milton R, Kirby N, Playle R, Bourne T, Lees C. Pregnancy and neonatal outcomes of COVID-19: The PAN-COVID study. Eur J Obstet Gynecol Reprod Biol 2022; 276:161-167. [PMID: 35914420 PMCID: PMC9295331 DOI: 10.1016/j.ejogrb.2022.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/15/2022] [Accepted: 07/14/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess perinatal outcomes for pregnancies affected by suspected or confirmed SARS-CoV-2 infection. METHODS Prospective, web-based registry. Pregnant women were invited to participate if they had suspected or confirmed SARS-CoV-2 infection between 1st January 2020 and 31st March 2021 to assess the impact of infection on maternal and perinatal outcomes including miscarriage, stillbirth, fetal growth restriction, pre-term birth and transmission to the infant. RESULTS Between April 2020 and March 2021, the study recruited 8239 participants who had suspected or confirmed SARs-CoV-2 infection episodes in pregnancy between January 2020 and March 2021. Maternal death affected 14/8197 (0.2%) participants, 176/8187 (2.2%) of participants required ventilatory support. Pre-eclampsia affected 389/8189 (4.8%) participants, eclampsia was reported in 40/ 8024 (0.5%) of all participants. Stillbirth affected 35/8187 (0.4 %) participants. In participants delivering within 2 weeks of delivery 21/2686 (0.8 %) were affected by stillbirth compared with 8/4596 (0.2 %) delivering ≥ 2 weeks after infection (95 % CI 0.3-1.0). SGA affected 744/7696 (9.3 %) of livebirths, FGR affected 360/8175 (4.4 %) of all pregnancies. Pre-term birth occurred in 922/8066 (11.5%), the majority of these were indicated pre-term births, 220/7987 (2.8%) participants experienced spontaneous pre-term births. Early neonatal deaths affected 11/8050 livebirths. Of all neonates, 80/7993 (1.0%) tested positive for SARS-CoV-2. CONCLUSIONS Infection was associated with indicated pre-term birth, most commonly for fetal compromise. The overall proportions of women affected by SGA and FGR were not higher than expected, however there was the proportion affected by stillbirth in participants delivering within 2 weeks of infection was significantly higher than those delivering ≥ 2 weeks after infection. We suggest that clinicians' threshold for delivery should be low if there are concerns with fetal movements or fetal heart rate monitoring in the time around infection. The proportion affected by pre-eclampsia amongst participants was not higher than would be expected, although we report a higher than expected proportion affected by eclampsia. There appears to be no effect on birthweight or congenital malformations in women affected by SARS-CoV-2 infection in pregnancy and neonatal infection is uncommon. This study reflects a population with a range of infection severity for SARS-COV-2 in pregnancy, generalisable to whole obstetric populations.
Collapse
Affiliation(s)
- E Mullins
- Imperial College London and The George Institute for Global Health, Imperial College Healthcare NHS Trust, London W12 0HS, UK.
| | - A Perry
- Lead Research Midwife and Manager, Women's Health Research Centre, Imperial College London, W12 0HS, UK
| | - J Banerjee
- Imperial College Healthcare NHS Trust, Institute of Reproductive and Developmental Biology, Imperial College London, W12 0HS, UK
| | - J Townson
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - D Grozeva
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - R Milton
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - N Kirby
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - R Playle
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - T Bourne
- Imperial College London, Consultant Gyanecologist, Queen Charlotte's and Chelsea Hospital, London W12 0HS, UK
| | - C Lees
- Centre for Fetal Care, Imperial College Healthcare NHS Trust, Institute of Reproductive and Developmental Biology, Imperial College London, London W12 0HS, UK
| |
Collapse
|
2
|
Mullins E, Hudak ML, Banerjee J, Getzlaff T, Townson J, Barnette K, Playle R, Perry A, Bourne T, Lees CC. Pregnancy and neonatal outcomes of COVID-19: coreporting of common outcomes from PAN-COVID and AAP-SONPM registries. Ultrasound Obstet Gynecol 2021; 57:573-581. [PMID: 33620113 PMCID: PMC8014713 DOI: 10.1002/uog.23619] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Few large cohort studies have reported data on maternal, fetal, perinatal and neonatal outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy. We report the outcome of infected pregnancies from a collaboration formed early during the pandemic between the investigators of two registries, the UK and Global Pregnancy and Neonatal outcomes in COVID-19 (PAN-COVID) study and the American Academy of Pediatrics (AAP) Section on Neonatal-Perinatal Medicine (SONPM) National Perinatal COVID-19 Registry. METHODS This was an analysis of data from the PAN-COVID registry (1 January to 25 July 2020), which includes pregnancies with suspected or confirmed maternal SARS-CoV-2 infection at any stage in pregnancy, and the AAP-SONPM National Perinatal COVID-19 registry (4 April to 8 August 2020), which includes pregnancies with positive maternal testing for SARS-CoV-2 from 14 days before delivery to 3 days after delivery. The registries collected data on maternal, fetal, perinatal and neonatal outcomes. The PAN-COVID results are presented overall for pregnancies with suspected or confirmed SARS-CoV-2 infection and separately in those with confirmed infection. RESULTS We report on 4005 pregnant women with suspected or confirmed SARS-CoV-2 infection (1606 from PAN-COVID and 2399 from AAP-SONPM). For obstetric outcomes, in PAN-COVID overall and in those with confirmed infection in PAN-COVID and AAP-SONPM, respectively, maternal death occurred in 0.5%, 0.5% and 0.2% of cases, early neonatal death in 0.2%, 0.3% and 0.3% of cases and stillbirth in 0.5%, 0.6% and 0.4% of cases. Delivery was preterm (< 37 weeks' gestation) in 12.0% of all women in PAN-COVID, in 16.1% of those women with confirmed infection in PAN-COVID and in 15.7% of women in AAP-SONPM. Extreme preterm delivery (< 27 weeks' gestation) occurred in 0.5% of cases in PAN-COVID and 0.3% in AAP-SONPM. Neonatal SARS-CoV-2 infection was reported in 0.9% of all deliveries in PAN-COVID overall, in 2.0% in those with confirmed infection in PAN-COVID and in 1.8% in AAP-SONPM; the proportions of neonates tested were 9.5%, 20.7% and 87.2%, respectively. The rates of a small-for-gestational-age (SGA) neonate were 8.2% in PAN-COVID overall, 9.7% in those with confirmed infection and 9.6% in AAP-SONPM. Mean gestational-age-adjusted birth-weight Z-scores were -0.03 in PAN-COVID and -0.18 in AAP-SONPM. CONCLUSIONS The findings from the UK and USA registries of pregnancies with SARS-CoV-2 infection were remarkably concordant. Preterm delivery affected a higher proportion of women than expected based on historical and contemporaneous national data. The proportions of pregnancies affected by stillbirth, a SGA infant or early neonatal death were comparable to those in historical and contemporaneous UK and USA data. Although maternal death was uncommon, the rate was higher than expected based on UK and USA population data, which is likely explained by underascertainment of women affected by milder or asymptomatic infection in pregnancy in the PAN-COVID study, although not in the AAP-SONPM study. The data presented support strong guidance for enhanced precautions to prevent SARS-CoV-2 infection in pregnancy, particularly in the context of increased risks of preterm delivery and maternal mortality, and for priority vaccination of pregnant women and women planning pregnancy. Copyright © 2021 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- E. Mullins
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - M. L. Hudak
- Department of Pediatrics, Division of NeonatologyUniversity of Florida College of MedicineJacksonvilleFLUSA
| | - J. Banerjee
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - T. Getzlaff
- Department of Pediatrics, Division of NeonatologyUniversity of Florida College of MedicineJacksonvilleFLUSA
| | - J. Townson
- Centre for Trials ResearchCollege of Biomedical and Life Sciences, Cardiff UniversityCardiffUK
| | - K. Barnette
- Department of Pediatrics, Division of NeonatologyUniversity of Florida College of MedicineJacksonvilleFLUSA
| | - R. Playle
- Centre for Trials ResearchCollege of Biomedical and Life Sciences, Cardiff UniversityCardiffUK
| | - A. Perry
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - T. Bourne
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| | - C. C. Lees
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
- Queen Charlotte's and Chelsea HospitalImperial College Healthcare NHS TrustLondonUK
| |
Collapse
|
3
|
Affiliation(s)
- H C Laycock
- Department of Paediatric Anaesthesia and Pain, Great Ormond Street Hospital, London, UK.,Faculty of Medicine, Department of Surgery and Cancer, Imperial College London, London, UK
| | - E Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| |
Collapse
|
4
|
Mylrea-Foley B, Bhide A, Mullins E, Thornton J, Marlow N, Stampalija T, Napolitano R, Lees CC. Building consensus: thresholds for delivery in TRUFFLE-2 randomized intervention study. Ultrasound Obstet Gynecol 2020; 56:285-287. [PMID: 32533800 DOI: 10.1002/uog.22124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 06/11/2023]
Affiliation(s)
- B Mylrea-Foley
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's University of London, London, UK
| | - E Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - C C Lees
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, London, UK
| |
Collapse
|
5
|
Mullins E, Evans D, Viner RM, O'Brien P, Morris E. Reply. Ultrasound Obstet Gynecol 2020; 56:122-123. [PMID: 32608568 DOI: 10.1002/uog.22112] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- E Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Queen Charlotte's and Chelsea Hospital, London, UK
| | - D Evans
- North Bristol NHS Trust, Bristol, UK
- The Royal College of Paediatrics and Child Health, London, UK
| | - R M Viner
- The Royal College of Paediatrics and Child Health, London, UK
- University College London, London, UK
| | - P O'Brien
- University College London Hospitals NHS Foundation Trust, London, UK
- The Royal College of Obstetricians and Gynaecologists, London, UK
| | - E Morris
- The Royal College of Obstetricians and Gynaecologists, London, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| |
Collapse
|
6
|
Mullins E, Evans D, Viner RM, O'Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol 2020; 55:586-592. [PMID: 32180292 DOI: 10.1002/uog.22014] [Citation(s) in RCA: 281] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 05/06/2023]
Abstract
OBJECTIVES There are limited case series reporting the impact on women affected by coronavirus during pregnancy. In women affected by severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), the case fatality rate appears higher in those affected in pregnancy compared with non-pregnant women. We conducted a rapid review to guide health policy and management of women affected by COVID-19 during pregnancy, which was used to develop the Royal College of Obstetricians and Gynaecologists' (RCOG) guidelines on COVID-19 infection in pregnancy. METHODS Searches were conducted in PubMed and MedRxiv to identify primary case reports, case series, observational studies and randomized controlled trials describing women affected by coronavirus in pregnancy. Data were extracted from relevant papers. This review has been used to develop guidelines with representatives of the Royal College of Paediatrics and Child Health (RCPCH) and RCOG who provided expert consensus on areas in which data were lacking. RESULTS From 9965 search results in PubMed and 600 in MedRxiv, 21 relevant studies, all of which were case reports or case series, were identified. From reports of 32 women to date affected by COVID-19 in pregnancy, delivering 30 babies (one set of twins, three ongoing pregnancies), seven (22%) were asymptomatic and two (6%) were admitted to the intensive care unit (ICU), one of whom remained on extracorporeal membrane oxygenation. No maternal deaths have been reported to date. Delivery was by Cesarean section in 27 cases and by vaginal delivery in two, and 15 (47%) delivered preterm. There was one stillbirth and one neonatal death. In 25 babies, no cases of vertical transmission were reported; 15 were reported as being tested with reverse transcription polymerase chain reaction after delivery. Case fatality rates for SARS and MERS were 15% and 27%, respectively. SARS was associated with miscarriage or intrauterine death in five cases, and fetal growth restriction was noted in two ongoing pregnancies affected by SARS in the third trimester. CONCLUSIONS Serious morbidity occurred in 2/32 women with COVID-19, both of whom required ICU care. Compared with SARS and MERS, COVID-19 appears less lethal, acknowledging the limited number of cases reported to date and that one woman remains in a critical condition. Preterm delivery affected 47% of women hospitalized with COVID-19, which may put considerable pressure on neonatal services if the UK's reasonable worst-case scenario of 80% of the population being affected is realized. Based on this review, RCOG, in consultation with RCPCH, developed guidance for delivery and neonatal care in pregnancies affected by COVID-19, which recommends that delivery mode be determined primarily by obstetric indication and recommends against routine separation of affected mothers and their babies. We hope that this review will be helpful for maternity and neonatal services planning their response to COVID-19. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- E Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Queen Charlotte's and Chelsea Hospital, London, UK
| | - D Evans
- North Bristol NHS Trust, Bristol, UK
- The Royal College of Paediatrics and Child Health, London, UK
| | - R M Viner
- The Royal College of Paediatrics and Child Health, London, UK
- University College London, London, UK
| | - P O'Brien
- University College London Hospitals NHS Foundation Trust, London, UK
- The Royal College of Obstetricians and Gynaecologists, London, UK
| | - E Morris
- The Royal College of Obstetricians and Gynaecologists, London, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| |
Collapse
|
7
|
Mullins E, Evans D, Viner RM, O'Brien P, Morris E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet Gynecol 2020; 55:586-592. [PMID: 32180292 DOI: 10.1101/2020.03.06.20032144] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 05/18/2023]
Abstract
OBJECTIVES There are limited case series reporting the impact on women affected by coronavirus during pregnancy. In women affected by severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), the case fatality rate appears higher in those affected in pregnancy compared with non-pregnant women. We conducted a rapid review to guide health policy and management of women affected by COVID-19 during pregnancy, which was used to develop the Royal College of Obstetricians and Gynaecologists' (RCOG) guidelines on COVID-19 infection in pregnancy. METHODS Searches were conducted in PubMed and MedRxiv to identify primary case reports, case series, observational studies and randomized controlled trials describing women affected by coronavirus in pregnancy. Data were extracted from relevant papers. This review has been used to develop guidelines with representatives of the Royal College of Paediatrics and Child Health (RCPCH) and RCOG who provided expert consensus on areas in which data were lacking. RESULTS From 9965 search results in PubMed and 600 in MedRxiv, 21 relevant studies, all of which were case reports or case series, were identified. From reports of 32 women to date affected by COVID-19 in pregnancy, delivering 30 babies (one set of twins, three ongoing pregnancies), seven (22%) were asymptomatic and two (6%) were admitted to the intensive care unit (ICU), one of whom remained on extracorporeal membrane oxygenation. No maternal deaths have been reported to date. Delivery was by Cesarean section in 27 cases and by vaginal delivery in two, and 15 (47%) delivered preterm. There was one stillbirth and one neonatal death. In 25 babies, no cases of vertical transmission were reported; 15 were reported as being tested with reverse transcription polymerase chain reaction after delivery. Case fatality rates for SARS and MERS were 15% and 27%, respectively. SARS was associated with miscarriage or intrauterine death in five cases, and fetal growth restriction was noted in two ongoing pregnancies affected by SARS in the third trimester. CONCLUSIONS Serious morbidity occurred in 2/32 women with COVID-19, both of whom required ICU care. Compared with SARS and MERS, COVID-19 appears less lethal, acknowledging the limited number of cases reported to date and that one woman remains in a critical condition. Preterm delivery affected 47% of women hospitalized with COVID-19, which may put considerable pressure on neonatal services if the UK's reasonable worst-case scenario of 80% of the population being affected is realized. Based on this review, RCOG, in consultation with RCPCH, developed guidance for delivery and neonatal care in pregnancies affected by COVID-19, which recommends that delivery mode be determined primarily by obstetric indication and recommends against routine separation of affected mothers and their babies. We hope that this review will be helpful for maternity and neonatal services planning their response to COVID-19. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- E Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, Queen Charlotte's and Chelsea Hospital, London, UK
| | - D Evans
- North Bristol NHS Trust, Bristol, UK
- The Royal College of Paediatrics and Child Health, London, UK
| | - R M Viner
- The Royal College of Paediatrics and Child Health, London, UK
- University College London, London, UK
| | - P O'Brien
- University College London Hospitals NHS Foundation Trust, London, UK
- The Royal College of Obstetricians and Gynaecologists, London, UK
| | - E Morris
- The Royal College of Obstetricians and Gynaecologists, London, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
| |
Collapse
|
8
|
Affiliation(s)
- E Mullins
- Department of Health; London UK
- The Hillingdon Hospitals NHS Foundation Trust; Uxbridge UK
| | - O Murphy
- Department of Health; London UK
- Imperial College London; London UK
| | - SC Davies
- Department of Health; London UK
- National Institute for Health and Research; London UK
| |
Collapse
|
9
|
Hughes R, Matamala J, Barraza G, Campero M, Castillo J, Guiloff R, Acevedo L, Verdugo R, Cavada G, Orellana P, Orellana P, Wang Y, Honeyman J, Ramirez C, Rojas H, Sazunic I, Mullins E. Nerve Conduction Studies (NCS) in Patients with Central (CNS) and Peripheral (PNS) Nervous System Diseases with and without Neuropathic Pain (NP). J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.1282] [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: 11/26/2022]
|
10
|
Ramirez Rondon C, Rojas H, Sazunic I, Mullins E, Honeyman J, Guiloff R. Intraepidermal nerve fibre density (ienfd) in the assessment of central nervous system disease. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.863] [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: 10/22/2022]
|
11
|
Prior T, Mullins E, Bennett P, Kumar S. Influence of parity on fetal hemodynamics and amniotic fluid volume at term. Ultrasound Obstet Gynecol 2014; 44:688-692. [PMID: 24585483 DOI: 10.1002/uog.13332] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/22/2014] [Accepted: 01/31/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Pregnancy complications, particularly those associated with placental dysfunction, occur more frequently in nulliparous than in parous women. This difference may be a consequence of improved trophoblastic invasion and, as a result, improved placental function following previous pregnancy. Placental dysfunction in cases of fetal growth restriction may be identified by ultrasound assessment of fetoplacental hemodynamics and amniotic fluid volume. In this prospective observational study, we investigated whether differences in these measures of placental function exist between nulliparous and parous women, prior to active labor. METHODS Over a 2-year period, 456 nulliparous and 152 parous women with uncomplicated singleton pregnancies were recruited to this prospective observational study. Each participant underwent an ultrasound assessment prior to active labor, during which fetal biometry, umbilical artery, middle cerebral artery and umbilical venous Dopplers, as well as amniotic fluid volume, were assessed. All cases were followed up within 48 h of delivery. Ultrasound parameters and intrapartum outcomes were then compared between the nulliparous and parous groups. RESULTS Compared with nulliparous women, parous women had significantly higher fetal middle cerebral artery pulsatility index, cerebroplacental ratio and amniotic fluid volume. In nulliparous women, middle cerebral artery flow rate was also significantly higher and represented a greater percentage of umbilical venous flow than was observed in parous women. CONCLUSION Prior to the active phase of labor, ultrasound parameters indicative of placental function differ significantly between nulliparous and parous pregnancy, even amongst an uncomplicated, low-risk cohort.
Collapse
Affiliation(s)
- T Prior
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, London, UK; Institute for Reproductive and Developmental Biology, Imperial College London, London, UK
| | | | | | | |
Collapse
|
12
|
Abstract
In a review of 103 sets of data from 23 different studies of choice, Baum (1979) concluded that whereas undermatching was most commonly observed for responses, the time measure generally conformed to the matching relation. A reexamination of the evidence presented by Baum concludes that undermatching is the most commonly observed finding for both measures. Use of the coefficient of determination by both Baum (1979) and de Villiers (1977) for assessing when matching occurs is criticized on statistical grounds. An alternative to the loss-in-predictability criterion used by Baum (1979) is proposed. This alternative statistic has a simple operational meaning and is related to the usual F-ratio test. It can therefore be used as a formal test of the hypothesis that matching occurs. Baum (1979) also suggests that slope values of between .90 and 1.11 can be considered good approximations to matching. It is argued that the establishment of a fixed interval as a criterion for determining when matching occurs, is inappropriate. A confidence interval based on the data from any given experiment is suggested as a more useful method of assessment.
Collapse
|
13
|
Flick M, Welch S, La Jeunesse C, Talmage K, Mullins E, Palumbo J, Thornton S, Degen J. ID: 097 Mice expressing a thrombin variant engineered to favor anticoagulant function are resistant to S. aureus-induced sepsis. J Thromb Haemost 2006. [DOI: 10.1111/j.1538-7836.2006.00097.x] [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: 11/29/2022]
|
14
|
Frangoul H, Fowler K, Hamilton R, Billheimer D, Wu H, Mullins E, Mulder J, Poedling K. Survey of hospice referral practices among 541 pediatric oncologists. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.8074] [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: 11/20/2022] Open
Affiliation(s)
- H. Frangoul
- Vanderbilt Children's Hospital, Nashville, TN; Alive Hospice, Nashville, TN
| | - K. Fowler
- Vanderbilt Children's Hospital, Nashville, TN; Alive Hospice, Nashville, TN
| | - R. Hamilton
- Vanderbilt Children's Hospital, Nashville, TN; Alive Hospice, Nashville, TN
| | - D. Billheimer
- Vanderbilt Children's Hospital, Nashville, TN; Alive Hospice, Nashville, TN
| | - H. Wu
- Vanderbilt Children's Hospital, Nashville, TN; Alive Hospice, Nashville, TN
| | - E. Mullins
- Vanderbilt Children's Hospital, Nashville, TN; Alive Hospice, Nashville, TN
| | - J. Mulder
- Vanderbilt Children's Hospital, Nashville, TN; Alive Hospice, Nashville, TN
| | - K. Poedling
- Vanderbilt Children's Hospital, Nashville, TN; Alive Hospice, Nashville, TN
| |
Collapse
|
15
|
Hautenne-Dekay D, Mullins E, Sewell D, Hagan DW. Wet-nesting of foodservice dishware: investigation and analysis of potential bacterial contamination. J Am Diet Assoc 2001; 101:933-4. [PMID: 11501873 DOI: 10.1016/s0002-8223(01)00231-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
16
|
Abstract
Hydrogen breath testing (HBT) is frequently used as an alternative to small bowel aspiration in the diagnosis of small intestinal bacterial overgrowth (SIBO). The role of the glucose HBT was assessed in 30 elderly patients. A positive HBT was recorded in 15 of 20 SIBO cases and 7 of 10 culture negatives (sensitivity 75% and specificity 30%). The correlation coefficients between hydrogen gas (H2) rise and total bacterial count (r = 0.21) and H2 rise and anaerobic count (r = 0) were not significant. Fasting H2 levels were raised in only 4 of the 20 SIBO cases. This study indicates that the HBT is not reliable in the diagnosis of SIBO in the elderly. There was no evidence from the data that different H2 levels or bacterial counts would significantly alter the reliability of the HBT. This work suggests that factors other than small bowel bacteria are involved in the production and expiration of H2 in the elderly, and that these factors need to be considered in the interpretation of this breath test.
Collapse
Affiliation(s)
- M Mac Mahon
- Mercer's Institute for Research on Ageing, Dublin, Ireland
| | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
OBJECTIVES To assess the prevalence of typical clinical features and need for treatment of small intestinal bacterial overgrowth (SIBO) in the elderly. DESIGN Random selection of patients, regardless of their nutritional status. SETTING Acute admissions ward in the Dept. of Medicine for the Elderly. PATIENTS Thirty elderly patients between 68 and 90 years of age. MEASUREMENTS Active clinical problems, including the presence of recent weight loss and diarrhea, were recorded. Routine blood tests, including serum vitamin B12, red cell folate, albumin and calcium, and qualitative small bowel bacteriology results, were analyzed. The effect of age on all variables was studied. RESULTS Twenty of the 30 small bowel aspirates had proven SIBO, and strict anaerobes were isolated in 15. The mean blood test values did not differ significantly between culture-positive and culture-negative patients. There was no significant correlation between those variables and the total bacterial counts. Of the 20 proven SIBO cases, eight had anemia, five had hypoalbuminemia, five had diarrhea, four complained of recent weight loss, and none had B12 deficiency. Alternative causes other than SIBO were identified for many of these abnormalities. Advancing age correlated significantly with rising counts of small bowel strict anaerobes. CONCLUSIONS These data suggest that age may be a predisposing factor in the development of anaerobic overgrowth but that SIBO is a benign entity in the elderly. Contrary to previous recommendations, treatment of this condition is not routinely indicated.
Collapse
Affiliation(s)
- M MacMahon
- Mercer's Institute for Research on Ageing, St. James's Hospital, Ireland
| | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
Greyhounds are usually transported by air between Ireland and England in wooden kennels similar in size to greyhound racing starting traps. These kennels have been criticised in the belief that their small size leads to unnecessary stress. The present study compared plasma ACTH, cortisol, lactate and non-esterified fatty acid concentrations in 12 greyhounds transported either in the existing wooden kennels or in wider perspex kennels, which were stowed either in the belly hold or in the main cargo hold of jet freighter aircraft. Increased kennel size did not appear to result in decreased stress responses but there was a significantly greater stress response in the dogs kept in the belly hold of the aircraft. Individual variation between dogs was the most significant feature of the study.
Collapse
Affiliation(s)
- D P Leadon
- Clinical Pathology Unit, Irish Equine Centre, Johnstown, Naas, County Kildare
| | | |
Collapse
|
19
|
Allwright SP, Colgan PA, McAulay IR, Mullins E. Natural background radiation and cancer mortality in the Republic of Ireland. Int J Epidemiol 1983; 12:414-8. [PMID: 6654560 DOI: 10.1093/ije/12.4.414] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
An extensive area of rural Ireland was monitored in detail for natural background radiation (NBR); average background radiation values were derived for all District Electoral Divisions (DEDs) in this area. Cancer mortality rates were calculated for the DEDs aggregated according to average NBR. No association was apparent between cancer mortality rates and levels of natural background radiation.
Collapse
|