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Cusimano MC, Simpson A, Dossa F, Liani V, Kaur Y, Acuna S, Robertson D, Satkunaratnam A, Bernardini MQ, Ferguson SE, Baxter NN. Laparoscopic and Robotic Hysterectomy in Endometrial Cancer Patients with Obesity: A Systematic Review and Meta-Analysis of Conversions and Complications. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dong S, D'Souza R, Acuna S, Zaffar N, Bhagra C, Silversides C, Ross H. P6312Pregnancy outcomes in women with cardiothoracic transplants: a systematic review and meta-analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Increasing numbers of women with heart-lung transplants (HLT) are now planning and continuing with pregnancies. The risks of pregnancies in these women have not been systematically assessed.
Methods
A search strategy was designed for MEDLINE, EMBASE, and Cochrane Central from inception to January 2018 to identify studies reporting outcomes in three or more pregnancies following HLT. Pooled incidence of maternal outcomes and fetal and neonatal outcomes were calculated using random-effects meta-analysis and reported per 100 pregnancies with 95% confidence intervals (CI). Risk-of-bias was determined using the Joanna Briggs Checklist for Case Series. Subgroup analysis was conducted based on transplanted organ.
Results
A total of 3658 records were identified, 172 full texts reviewed, and 12 studies included. The included studies reported on 385 pregnancies in 272 transplant recipients. Maternal complications included mortality during pregnancy [0.5% (0, 1.1%)], mortality during the specified follow-up period [15.4% (10,4, 20.3%)], graft rejection during pregnancy [7.4% (4.2, 10.5%)], preeclampsia [12.3% (7.2%, 17.5%)], gestational diabetes [6.4% (2.6, 10.1%)], and caesarean deliveries [41.4% (33.4, 48.7%)]. As many as 78.4% (69.8, 86.9%) pregnancies resulted in live births. Of the remainder, 13.6% (6.3, 20.9%) resulted in miscarriages (fetal loss under 20 weeks of gestation), 2% (0.3, 3.7%) resulted in stillbirths (fetal loss after 20 weeks of gestation), and 6.8% (4.3, 9.3%) in pregnancy terminations for various reasons. Of those born live, 3.4% (1.3, 5.6%) succumbed in the neonatal period. Over half the pregnancies [51.2% (31, 71.3%)] resulted in preterm deliveries (<37 weeks of gestation). There were subgroup-specific variations in the prevalence of complications. For example, lung transplant recipients were less likely than heart transplant recipients to have pregnancies complicated by preeclampsia [8.3% (3.0, 13.6%) vs. 17.8% (10.8, 24.8%)] suffer maternal mortality during the follow up period [41.4% (23.4, 59.3%) vs. 10.8% (5.9, 15.8%)]. Studies had a moderate risk-of-bias.
Conclusions
Although large proportions of pregnancies in women with HLT result in live births and few maternal deaths occur during pregnancy, these women are at increased risk for preeclampsia, preterm birth, perinatal mortality and maternal mortality following childbirth. Subgroup-specific variations should be taken into account while counselling HLT recipients contemplating pregnancies.
Acknowledgement/Funding
None
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Affiliation(s)
- S Dong
- University of Toronto, Department of Medicine, Toronto, Canada
| | - R D'Souza
- Mount Sinai Hospital of the University Health Network, Obstetrics and Gynaecology, Toronto, Canada
| | - S Acuna
- University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, Canada
| | - N Zaffar
- Mount Sinai Hospital of the University Health Network, Obstetrics and Gynaecology, Toronto, Canada
| | - C Bhagra
- Mount Sinai Hospital of the University Health Network, Toronto, Canada
| | - C Silversides
- Mount Sinai Hospital of the University Health Network, Toronto, Canada
| | - H Ross
- Toronto General Hospital, Peter Munk Cardiac Centre, Toronto, Canada
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Mercado M, Hart R, Acuna S, Miller S, Sevick L, Baxter N, Burnstein M, Montbrun SD, Rotstein O, Tang G, Varatheswaran W, Brezden-Masley C. 2076 Evaluating carcinoembryonic antigen as a predictor and surveillance marker for colorectal cancer recurrence. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30999-6] [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]
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