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Antimicrobials during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Among 63 women who had COVID-19 infection in pregnancy, no evidence of vertical transmission was observed, and infants were born alive with normal birth weight. Preterm birth was 18 percent compared to 8 percent in controls (p = 0.11) (Edlow et al., 2020). The CDC, ACOG and Society for Maternal; Fetal Medicine support vaccination for pregnant women (Rasmussen et al., 2021). Of 3958, women who were women who were in a COVID-19 pregnancy registry 827 had a completed pregnancy of those vaccinated in the first trimester. 712 (86.1 percent) of 827 conceptions resulted in a live birth. 115 (13.9 percent) were a pregnancy loss. Neonatal outcomes were preterm birth (9.4 percent) and small size for gestational age (3.2 percent), with no neonatal deaths. Proportion of adverse pregnancy and neonatal outcomes among gravidas vaccinated against COVID-19 was similar to incidences before the COVID-19 pandemic (Shimabukuro et al., 2021). This included 46 spontaneous abortions (46/712, 5.6 percent).
Prelabor Rupture Of Membranes At Or Near Term
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
The risk factors associated with rupture of fetal membranes include low socioeconomic status, low body mass index (BMI) <19.8 kg/m2, nutritional deficiencies of ascorbic acid and copper, connective tissue disorders, smoking, cold knife cone biopsy, cervical cerclage, pulmonary disease, uterine overdistension, and amniocentesis [1]. In addition, pregnant women with a previous preterm birth, midtrimester short cervix, and preterm labor are at increased risk for PROM; however, the majority of cases have no identifiable cause [1].
Preconceptual Health
Published in Michelle Tollefson, Nancy Eriksen, Neha Pathak, Improving Women's Health Across the Lifespan, 2021
Nancy L. Eriksen, Kristi R. VanWinden, John McHugh
Regular exercise before pregnancy is associated with less back pain, fewer pregnancy symptoms, fewer sick leave days, and a possible reduction in pregnancy-related pelvic pain.138–140 It has also been associated with a 30% shorter average labor duration and fewer operative deliveries.125 One study found that prepregnancy exercise was associated with earlier term labor onset by an average of 5 days, but not with an increase in preterm birth.125 In fact, some data suggest that higher levels of physical activity and improved cardiorespiratory fitness preceding pregnancy are associated with a lower risk of preterm birth.141–143 Studies examining the association of prepregnancy exercise with Cesarean delivery, neonatal birth weight, or biometric measurements have not demonstrated a consistent association.125,140,141,143,144
Impact of prolonged use of adjuvant tocolytics after cervical cerclage on late abortion and premature delivery
Published in Journal of Obstetrics and Gynaecology, 2023
Li-Rong Zhao, Shu-Jing Lu, Qing Liu, Ying-Chun Yu, Li Xiao
Neonatal outcomes are related to gestational age at delivery. Preterm birth leads to severe complications in newborns (Raia et al. 2020). Gestational age is a critical factor affecting the development of premature infants. The risk of mortality and morbidity of newborns is related to the gestational age (Zhang et al. 2020), which means the lower the gestational age, the higher the risk of mortality and morbidity (Yu et al. 2020). Neonatal survival rate can be increased by 3% for each delayed day at 22–26 weeks of gestation (Lamont et al. 2016)and reaches 90% when the gestational age is delayed to 30 weeks (Chen et al. 2014). Jiang ZD (Jiang and Chen 2014) and Liu et al. (Liu et al. 2013) reported that more than half of the surviving infants had varying degrees of physical disabilities. Premature infants are also at risk of underdeveloped cognitive abilities (Spittle et al. 2012). The gestational age of more than 34 weeks is a common milestone of foetal development and maturity. Obstetricians should therefore plan to prolong the gestational age, and improve the survival rate and quality of life of premature infants.
Delivery prediction by quantitative analysis of four steroid metabolites with liquid chromatography tandem mass spectrometry in asymptomatic pregnant women
Published in Annals of Medicine, 2022
Lanlan Meng, Shaofei Su, Lin Li, Shengmin Liu, Youran Li, Ying Liu, Yifan Lu, Zhengwen Xu, Lin Liu, Qixin He, Yuanyuan Zheng, Xiaowei Liu, Yuting Cong, Yanhong Zhai, Zhen Zhao, Zheng Cao
Current clinical methods of determining gestational age and due date are based on the menstruation period and ultrasound imaging, which are imprecise and depend on accessibility in early pregnancy [7,8]. For the preterm birth prediction in clinical practice, ultrasonic measurement of cervical length (CL) alongside foetal fibronectin (fFN) testing has been shown to improve predictive accuracy and delivery outcome [9,10]. The presence of fFN in cervicovaginal secretions was associated with an increased risk of spontaneous preterm birth (sPTD) in numerous studies [11,12]. However, a meta-analysis demonstrates that the fFN test should not be used as a screening test in asymptomatic pregnant women with or without high risks of sPTD [13]. The development of a simple and accurate diagnostic assay, particularly one implemented in an asymptomatic population, remains an unmet need in clinical practice.
Postponed Withholding: Harmful for the Infant and Increasing the Complexity of Decision-Making
Published in The American Journal of Bioethics, 2022
Lien De Proost, Eline Bunnik, Angret de Boer, E. J (Joanne) Verweij
Syltern et al. (2022) propose a new approach to decision-making at the limit of viability: by default, intensive care will be initiated for every infant born in “the gray zone” of viability. This will be redirected toward palliative care in the second week unless the parents request otherwise. This novel approach is called postponed withholding (PPWH). PPWH is proposed by the authors to facilitate fair and balanced decision-making at the limit of viability. Furthermore, it is said to contribute to empowering parents in the highly vulnerable situation of extreme preterm birth, and to better support healthcare personnel (HCP) in making life-and-death decisions. Although facilitating balanced decision-making is a commendable goal, we are not convinced that the proposed change in choice architecture is the way to go. Firstly, PPWH might lead to over- as well as undertreatment, which is not in the best interests of extremely premature infants. Secondly, decision-making in the second week might be more complex than before birth, ethically, legally and psychologically. Finally, our own empirical research with adults who were born at the limit of viability illustrates that the harm of intensive care at birth must not be underestimated.