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Ferro J, Diago V, Diago DM, Pellicer N, Olmo I, Vázquez S, Lara C, Perales A, Serra V. The effectiveness of cervical cerclage in twin pregnancies with a mid-trimester short cervix: A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2024; 294:33-38. [PMID: 38184898 DOI: 10.1016/j.ejogrb.2023.12.029] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To analyze the effectiveness of cerclage in twin pregnancies with a short cervix. STUDY DESIGN Retrospective cohort study performed in two University Institutions in Valencia (Spain) with two different protocols for the management of asymptomatic dichorionic diamniotic twin pregnancies with mid-trimester cervical length ≤ 25 mm: treatment with indomethacin, antibiotics and cerclage (cerclage group) (N = 43) versus expectant management (control group) (N = 37). RESULTS The initial cervical length was similar in both groups but detection of a short cervix was performed earlier in the cerclage group (21.6 vs 24.1 weeks, p < 0.001). Women with cerclage had a greater pregnancy latency (12.5 vs. 7.7 weeks, p < 0.001); higher gestational age at delivery (34.1 vs. 31.8 weeks, p < 0.04); less spontaneous preterm birth (SPB) < 28 weeks (11.6 % vs 37.8 %, p < 0.009); higher birthweight (2145 vs 1733 g, p < 0.001); lower birthweight < 1500 g (12.5 % vs 40.0 %, p < 0.001); less admissions to the neonatal intensive care unit (NICU) (24.1 % vs 43.3 %, p < 0.03); shorter stay at NICU (25.6 vs 49.4 days, p < 0.02); lower respiratory distress requiring mechanical ventilation (14.9 % vs 36.5 %, p < 0.02); fewer patent ductus arteriosus (8.9 % vs 26.9 %, p < 0.008); and lower composite adverse neonatal outcome (26.6 % vs. 44.8 %, p < 0.03). Cerclage and gestational age at diagnosis were the only independent predictors of SPB < 32 and < 28 weeks by multivariate analysis. The cumulative data in the literature show promising beneficial effects of cerclage. CONCLUSION Our data suggest that cerclage in asymptomatic twin pregnancies with a short cervix may reduce the earliest SPB and may improve neonatal outcome.
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Affiliation(s)
- Jaime Ferro
- Unidad de Medicina Materno-Fetal, Instituto Universitario IVI Valencia, IVIRMA Global, Valencia, Spain
| | - Vicente Diago
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | - Diana M Diago
- Servicio de Obstetricia, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Nuria Pellicer
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Inés Olmo
- Unidad de Medicina Materno-Fetal, Instituto Universitario IVI Valencia, IVIRMA Global, Valencia, Spain; Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | - Sheila Vázquez
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Coral Lara
- Unidad de Medicina Materno-Fetal, Instituto Universitario IVI Valencia, IVIRMA Global, Valencia, Spain
| | - Alfredo Perales
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | - Vicente Serra
- Unidad de Medicina Materno-Fetal, Instituto Universitario IVI Valencia, IVIRMA Global, Valencia, Spain; Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universidad de Valencia, Valencia, Spain.
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Nieto-Tous M, Diaz-Martinez A, De-Arriba-García M, Roca-Prats A, Monfort-Beltrán S, Ivañez-Muñoz M, Alberola-Rubio J, Perales A, Monfort-Ortiz R. GESTACOVID Project: Psychological and Perinatal Effects in Spanish Pregnant Women Subjected to Strict Confinement Due to the COVID-19 Pandemic and Their Evolution during De-Escalation. J Clin Med 2023; 13:248. [PMID: 38202254 PMCID: PMC10779534 DOI: 10.3390/jcm13010248] [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: 11/27/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
The lockdown and de-escalation process following the COVID-19 pandemic led to a period of new normality. This study aimed to assess the confinement impact on the mental health of peripartum women, as their psychological well-being may be particularly vulnerable and thus affect their offspring's development. A cross-sectional epidemiological study was conducted among women who gave birth during strict confinement (G0) and the new normality period (G1), in which a self-administered paper-based questionnaire assessed 15 contextual factors and the General Health Questionnaire-12 (GHQ-12). For each item, it was verified whether the positive screening rate differed in each confinement phase, and a risk factor study was conducted. For G0, significantly higher positive screening and preterm birth rates were observed in the positive screening group. In the case of G1, maternal age (>35 years), decreased physical activity, and normal weight were found to be protective factors against distress. This study underscores the heightened mental health risk for postpartum women during major psychosocial upheavals (war, economic crisis, natural disasters, or pandemics), along with their resilience as the positive screening rate decreases with the new normality. Findings encourage adopting strategies to identify high-risk women and promote effective measures, such as promoting physical activity.
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Affiliation(s)
- Mar Nieto-Tous
- Departmento de Obstetricia y Ginecología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (R.M.-O.)
| | - Alba Diaz-Martinez
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain
| | | | - Alba Roca-Prats
- Departmento de Obstetricia y Ginecología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (R.M.-O.)
| | - Sara Monfort-Beltrán
- Departmento de Obstetricia y Ginecología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (R.M.-O.)
| | - María Ivañez-Muñoz
- Departmento de Obstetricia y Ginecología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (R.M.-O.)
| | - José Alberola-Rubio
- Instituto de Investigación Sanitaria La Fe de Valencia, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Alfredo Perales
- Departmento de Obstetricia y Ginecología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (R.M.-O.)
- Departamento de Pediatría, Obstetricia y Ginecología, Facultad de Medicina, Universitat de València, 46010 Valencia, Spain
| | - Rogelio Monfort-Ortiz
- Departmento de Obstetricia y Ginecología, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain (R.M.-O.)
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Conde-Agudelo A, Romero R, Rehal A, Brizot ML, Serra V, Da Fonseca E, Cetingoz E, Syngelaki A, Perales A, Hassan SS, Nicolaides KH. Vaginal progesterone for preventing preterm birth and adverse perinatal outcomes in twin gestations: a systematic review and meta-analysis. Am J Obstet Gynecol 2023; 229:599-616.e3. [PMID: 37196896 PMCID: PMC10646154 DOI: 10.1016/j.ajog.2023.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To evaluate the efficacy of vaginal progesterone for the prevention of preterm birth and adverse perinatal outcomes in twin gestations. DATA SOURCES MEDLINE, Embase, LILACS, and CINAHL (from their inception to January 31, 2023), Cochrane databases, Google Scholar, bibliographies, and conference proceedings. STUDY ELIGIBILITY CRITERIA Randomized controlled trials that compared vaginal progesterone to placebo or no treatment in asymptomatic women with a twin gestation. METHODS The systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions. The primary outcome was preterm birth <34 weeks of gestation. Secondary outcomes included adverse perinatal outcomes. Pooled relative risks with 95% confidence intervals were calculated. We assessed the risk of bias in each included study, heterogeneity, publication bias, and quality of evidence, and performed subgroup and sensitivity analyses. RESULTS Eleven studies (3401 women and 6802 fetuses/infants) fulfilled the inclusion criteria. Among all twin gestations, there were no significant differences between the vaginal progesterone and placebo or no treatment groups in the risk of preterm birth <34 weeks (relative risk, 0.99; 95% confidence interval, 0.84-1.17; high-quality evidence), <37 weeks (relative risk, 0.99; 95% confidence interval, 0.92-1.06; high-quality evidence), and <28 weeks (relative risk, 1.00; 95% confidence interval, 0.64-1.55; moderate-quality evidence), and spontaneous preterm birth <34 weeks of gestation (relative risk, 0.97; 95% confidence interval, 0.80-1.18; high-quality evidence). Vaginal progesterone had no significant effect on any of the perinatal outcomes evaluated. Subgroup analyses showed that there was no evidence of a different effect of vaginal progesterone on preterm birth <34 weeks of gestation related to chorionicity, type of conception, history of spontaneous preterm birth, daily dose of vaginal progesterone, and gestational age at initiation of treatment. The frequencies of preterm birth <37, <34, <32, <30, and <28 weeks of gestation and adverse perinatal outcomes did not significantly differ between the vaginal progesterone and placebo or no treatment groups in unselected twin gestations (8 studies; 3274 women and 6548 fetuses/infants). Among twin gestations with a transvaginal sonographic cervical length <30 mm (6 studies; 306 women and 612 fetuses/infants), vaginal progesterone was associated with a significant decrease in the risk of preterm birth occurring at <28 to <32 gestational weeks (relative risks, 0.48-0.65; moderate- to high-quality evidence), neonatal death (relative risk, 0.32; 95% confidence interval, 0.11-0.92; moderate-quality evidence), and birthweight <1500 g (relative risk, 0.60; 95% confidence interval, 0.39-0.88; high-quality evidence). Vaginal progesterone significantly reduced the risk of preterm birth occurring at <28 to <34 gestational weeks (relative risks, 0.41-0.68), composite neonatal morbidity and mortality (relative risk, 0.59; 95% confidence interval, 0.33-0.98), and birthweight <1500 g (relative risk, 0.55; 95% confidence interval, 0.33-0.94) in twin gestations with a transvaginal sonographic cervical length ≤25 mm (6 studies; 95 women and 190 fetuses/infants). The quality of evidence was moderate for all these outcomes. CONCLUSION Vaginal progesterone does not prevent preterm birth, nor does it improve perinatal outcomes in unselected twin gestations, but it appears to reduce the risk of preterm birth occurring at early gestational ages and of neonatal morbidity and mortality in twin gestations with a sonographic short cervix. However, more evidence is needed before recommending this intervention to this subset of patients.
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Affiliation(s)
- Agustin Conde-Agudelo
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI.
| | - Roberto Romero
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
| | - Anoop Rehal
- Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Maria L Brizot
- Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vicente Serra
- Maternal-Fetal Medicine Unit, Instituto Valenciano de Infertilidad, University of Valencia, Valencia, Spain; Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - Eduardo Da Fonseca
- Departamento de Obstetrícia e Ginecologia, Hospital do Servidor Público Estadual Francisco Morato de Oliveira and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Elcin Cetingoz
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Istanbul, Turkey
| | - Argyro Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
| | - Alfredo Perales
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain; Department of Obstetrics, University Hospital La Fe, Valencia, Spain
| | - Sonia S Hassan
- Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Physiology, Wayne State University School of Medicine, Detroit, MI
| | - Kypros H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, United Kingdom
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Perales A, Lipsker D, Cribier B, Lenormand C. Non-scarring alopecia of lupus erythematosus: A comprehensive review. Ann Dermatol Venereol 2023; 150:260-269. [PMID: 37598015 DOI: 10.1016/j.annder.2023.04.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/05/2023] [Accepted: 04/04/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Although non-scarring alopecia (NSA) is a frequent clinical finding in patients with systemic lupus erythematosus (SLE), it has been poorly described in the literature. It is considered a nonspecific sign in the current classification of skin lesions of LE. The aim of this study was to give an updated overview of the spectrum of NSA in LE patients, with emphasis on the clinical significance thereof. METHOD We conducted a review of the English literature using the PubMed-Medline database using the keywords "Alopecia" + "Lupus erythematosus". Publications describing LE patients with NSA were included. RESULTS Data for 237 patients from 27 publications were analyzed. Ninety-one patients had diffuse NSA, 43 had patchy NSA, 83 had lupus hair, 3 had alopecia of dermal cutaneous LE, and 17 had alopecia of linear and annular lupus panniculitis of the scalp. Patients with diffuse/patchy NSA and lupus hair shared the following features: strong association with systemic activity of LE, subtle clinical/trichoscopic signs of inflammation, histological aspect consistent with lesions specific to cutaneous LE, high likelihood of response to SLE therapy, and absence of progression to scarring alopecia. Association with SLE was rare in patients with dermal cutaneous LE or linear and annular lupus panniculitis of the scalp, and skin-directed therapies were most often effective. One patient of each subtype progressed to scarring alopecia. DISCUSSION Diffuse/patchy NSA and lupus hair may represent a topographic variation of a single entity specific for LE. Prospective studies are warranted to further document the clinical significance of this manifestation.
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Affiliation(s)
- A Perales
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - D Lipsker
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - B Cribier
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France
| | - C Lenormand
- Clinique dermatologique, Université de Strasbourg et Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France.
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Romero R, Conde-Agudelo A, Rehal A, Da Fonseca E, Brizot ML, Rode L, Serra V, Cetingoz E, Syngelaki A, Tabor A, Perales A, Hassan SS, Nicolaides KH. Vaginal progesterone for the prevention of preterm birth and adverse perinatal outcomes in twin gestations with a short cervix: an updated individual patient data meta-analysis. Ultrasound Obstet Gynecol 2022; 59:263-266. [PMID: 34941003 PMCID: PMC9333094 DOI: 10.1002/uog.24839] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/06/2021] [Accepted: 12/14/2021] [Indexed: 05/27/2023]
Affiliation(s)
- R Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
- Detroit Medical Center, Detroit, MI, USA
| | - A Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
| | - A Rehal
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - E Da Fonseca
- Departamento de Obstetrícia e Ginecologia, Hospital do Servidor Publico Estadual 'Francisco Morato de Oliveira' and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - M L Brizot
- Department of Obstetrics and Gynecology, Pontifical Catholic University of São Paulo School of Medical and Health Sciences, São Paulo, Brazil
| | - L Rode
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Juliane Marie Centre, Department of Obstetrics, Copenhagen, Denmark
| | - V Serra
- Maternal-Fetal Medicine Unit, Instituto Valenciano de Infertilidad, University of Valencia, Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - E Cetingoz
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Uskudar, Istanbul, Turkey
| | - A Syngelaki
- Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - A Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - A Perales
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
- Department of Obstetrics, University Hospital La Fe, Valencia, Spain
| | - S S Hassan
- Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - K H Nicolaides
- Fetal Medicine Research Institute, King's College Hospital, London, UK
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Aguilar-Redondo P, Viñals A, Cabello P, Delgado J, Azcona D, Polo R, Perales A, Zucca D. SPR stoichiometric calibration of a single energy CT and validation using fresh tissue samples. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00029-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Romero R, Conde-Agudelo A, Rode L, Brizot ML, Cetingoz E, Serra V, Da Fonseca E, Tabor A, Perales A, Hassan SS, Nicolaides KH. Vaginal progesterone in twin gestation with a short cervix: revisiting an individual patient data systematic review and meta-analysis. Ultrasound Obstet Gynecol 2021; 58:943-945. [PMID: 34516022 PMCID: PMC9335349 DOI: 10.1002/uog.24765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/07/2021] [Indexed: 06/01/2023]
Affiliation(s)
- R Romero
- Perinatology Research Branch, Eunice Kennedy Shriver National, Institute for Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
- Detroit Medical Center, Detroit, MI, USA
| | - A Conde-Agudelo
- Perinatology Research Branch, Eunice Kennedy Shriver National, Institute for Child Health and Human Development, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA
| | - L Rode
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Juliane Marie Centre, Department of Obstetrics, Copenhagen, Denmark
| | - M L Brizot
- Department of Obstetrics and Gynecology, Pontifical Catholic University of São Paulo School of Medical and Health Sciences, São Paulo, Brazil
| | - E Cetingoz
- Department of Obstetrics and Gynecology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Uskudar, Istanbul, Turkey
| | - V Serra
- Maternal-Fetal Medicine Unit, Instituto Valenciano de Infertilidad, University of Valencia, Valencia, Spain
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
| | - E Da Fonseca
- Departamento de Obstetrícia e Ginecologia, Hospital do Servidor Publico Estadual 'Francisco Morato de Oliveira' and School of Medicine, University of São Paulo, São Paulo, Brazil
| | - A Tabor
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - A Perales
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Valencia, Spain
- Department of Obstetrics, University Hospital La Fe, Valencia, Spain
| | - S S Hassan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA
- Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
- Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Peguero A, Herraiz I, Perales A, Melchor JC, Melchor I, Marcos B, Villalain C, Martinez-Portilla R, Mazarico E, Meler E, Hernandez S, Matas I, Del Rio M, Galindo A, Figueras F. Placental growth factor testing in the management of late preterm preeclampsia without severe features: a multicenter, randomized, controlled trial. Am J Obstet Gynecol 2021; 225:308.e1-308.e14. [PMID: 33823150 DOI: 10.1016/j.ajog.2021.03.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/14/2021] [Accepted: 03/25/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In women with late preterm preeclampsia, the optimal time for delivery remains a controversial topic, because of the fine balance between the maternal benefits from early delivery and the risks for prematurity. It remains challenging to define prognostic markers to identify women at highest risk for complications, in which case a selective, planned delivery may reduce the adverse maternal and perinatal outcomes. OBJECTIVE This trial aimed to determine whether using an algorithm based on the maternal levels of placental growth factor in women with late preterm preeclampsia to evaluate the best time for delivery reduced the progression to preeclampsia with severe features without increasing the adverse perinatal outcomes. STUDY DESIGN This parallel-group, open-label, multicenter, randomized controlled trial was conducted at 7 maternity units across Spain. We compared selective planned deliveries based on maternal levels of placental growth factor at admission (revealed group) and expectant management under usual care (concealed group) with individual randomization in singleton pregnancies with late preterm preeclampsia from 34 to 36+6 weeks' gestation. The coprimary maternal outcome was the progression to preeclampsia with severe features. The coprimary neonatal outcome was morbidity at infant hospital discharge with a noninferiority hypothesis (noninferiority margin of 10% difference in incidence). Analyses were conducted according to intention-to-treat. RESULTS Between January 1, 2016, and December 31, 2019, 178 women were recruited. Of those women, 88 were assigned to the revealed group and 90 were assigned to the concealed group. The data analysis was performed before the completion of the required sample size. The proportion of women with progression to preeclampsia with severe features was significantly lower in the revealed group than in the concealed group (adjusted relative risk, 0.5; 95% confidence interval, 0.33-0.76; P=.001). The proportion of infants with neonatal morbidity was not significantly different between groups (adjusted relative risk, 0.77; 95% confidence interval, 0.39-1.53; P=.45). CONCLUSION There is evidence to suggest that the use of an algorithm based on placental growth factor levels in women with late preterm preeclampsia leads to a lower rate of progression to preeclampsia with severe features and reduces maternal complications without worsening the neonatal outcomes. This trade-off should be discussed with women with late preterm preeclampsia to allow shared decision making about the timing of delivery.
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Affiliation(s)
- Anna Peguero
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia Fetal i+D Fetal Medicine Research Center, Barcelona, Spain
| | - Ignacio Herraiz
- Fetal Medicine Unit-Red de Salud Materno Infantil y del Desarrollo (SAMID), Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre. Instituto de Investigación Hospital 12 de Octubre (imas12). Universidad Complutense de Madrid, Madrid, Spain
| | - Alfredo Perales
- Department of Obstetrics and Gynecology, Hospital Universitario La Fe, Valencia, Spain
| | - Juan Carlos Melchor
- Obstetrics and Gynecology Service, BioCruces Health Research Institute, Hospital Universitario Cruces (Basque Country University), Biscay, Spain
| | - Iñigo Melchor
- Obstetrics and Gynecology Service, BioCruces Health Research Institute, Hospital Universitario Cruces (Basque Country University), Biscay, Spain
| | - Beatriz Marcos
- Department of Obstetrics and Gynecology, Hospital Universitario La Fe, Valencia, Spain
| | - Cecilia Villalain
- Fetal Medicine Unit-Red de Salud Materno Infantil y del Desarrollo (SAMID), Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre. Instituto de Investigación Hospital 12 de Octubre (imas12). Universidad Complutense de Madrid, Madrid, Spain
| | - Raigam Martinez-Portilla
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia Fetal i+D Fetal Medicine Research Center, Barcelona, Spain
| | - Edurne Mazarico
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia Fetal i+D Fetal Medicine Research Center, Barcelona, Spain
| | - Eva Meler
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia Fetal i+D Fetal Medicine Research Center, Barcelona, Spain; Department of Obstetrics, Gynecology, and Reproductive Medicine, Dexeus University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sandra Hernandez
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia Fetal i+D Fetal Medicine Research Center, Barcelona, Spain
| | - Isabel Matas
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia Fetal i+D Fetal Medicine Research Center, Barcelona, Spain
| | - Maria Del Rio
- Obstetrics and Gynecology, Hospital de la Creu Roja, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Galindo
- Fetal Medicine Unit-Red de Salud Materno Infantil y del Desarrollo (SAMID), Department of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre. Instituto de Investigación Hospital 12 de Octubre (imas12). Universidad Complutense de Madrid, Madrid, Spain
| | - Francesc Figueras
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), Institut Clínic de Ginecologia, Obstetrícia i Neonatologia Fetal i+D Fetal Medicine Research Center, Barcelona, Spain.
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Garrido-Gómez T, Castillo-Marco N, Muñoz-Blat I, Cordero T, Clemente-Ciscar M, Monfort R, Perales A, Simón C. DEFECTIVE DECIDUALIZATION AFTER SEVERE PREECLAMPSIA IS CONNECTED TO DYSREGULATION OF PROGESTERONE RECEPTOR B AND ESTROGEN RECEPTOR 1. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.116] [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: 10/20/2022]
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10
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Azcona J, Aguilar B, Irazola L, Viñals A, Cabello P, Zucca D, Perales A, Polo R, Delgado J, Burguete J. PO-1696 Clinical commissioning a synchrotron-based proton therapy system. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08147-0] [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]
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11
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Arce P, Bolst D, Bordage MC, Brown JMC, Cirrone P, Cortés-Giraldo MA, Cutajar D, Cuttone G, Desorgher L, Dondero P, Dotti A, Faddegon B, Fedon C, Guatelli S, Incerti S, Ivanchenko V, Konstantinov D, Kyriakou I, Latyshev G, Le A, Mancini-Terracciano C, Maire M, Mantero A, Novak M, Omachi C, Pandola L, Perales A, Perrot Y, Petringa G, Quesada JM, Ramos-Méndez J, Romano F, Rosenfeld AB, Sarmiento LG, Sakata D, Sasaki T, Sechopoulos I, Simpson EC, Toshito T, Wright DH. Report on G4-Med, a Geant4 benchmarking system for medical physics applications developed by the Geant4 Medical Simulation Benchmarking Group. Med Phys 2021; 48:19-56. [PMID: 32392626 PMCID: PMC8054528 DOI: 10.1002/mp.14226] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 04/26/2020] [Accepted: 04/30/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Geant4 is a Monte Carlo code extensively used in medical physics for a wide range of applications, such as dosimetry, micro- and nanodosimetry, imaging, radiation protection, and nuclear medicine. Geant4 is continuously evolving, so it is crucial to have a system that benchmarks this Monte Carlo code for medical physics against reference data and to perform regression testing. AIMS To respond to these needs, we developed G4-Med, a benchmarking and regression testing system of Geant4 for medical physics. MATERIALS AND METHODS G4-Med currently includes 18 tests. They range from the benchmarking of fundamental physics quantities to the testing of Monte Carlo simulation setups typical of medical physics applications. Both electromagnetic and hadronic physics processes and models within the prebuilt Geant4 physics lists are tested. The tests included in G4-Med are executed on the CERN computing infrastructure via the use of the geant-val web application, developed at CERN for Geant4 testing. The physical observables can be compared to reference data for benchmarking and to results of previous Geant4 versions for regression testing purposes. RESULTS This paper describes the tests included in G4-Med and shows the results derived from the benchmarking of Geant4 10.5 against reference data. DISCUSSION Our results indicate that the Geant4 electromagnetic physics constructor G4EmStandardPhysics_option4 gives a good agreement with the reference data for all the tests. The QGSP_BIC_HP physics list provided an overall adequate description of the physics involved in hadron therapy, including proton and carbon ion therapy. New tests should be included in the next stage of the project to extend the benchmarking to other physical quantities and application scenarios of interest for medical physics. CONCLUSION The results presented and discussed in this paper will aid users in tailoring physics lists to their particular application.
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Affiliation(s)
| | - D Bolst
- Centre For Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - M-C Bordage
- CRCT (INSERM and Paul Sabatier University), Toulouse, France
| | - J M C Brown
- Department of Radiation Science and Technology, Delft University of Technology, Delft, The Netherlands
| | | | | | - D Cutajar
- Centre For Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | | | - L Desorgher
- Institute of Radiation Physics (IRA), Lausanne University Hospital, Lausanne, Switzerland
| | | | - A Dotti
- SLAC National Accelerator Laboratory, Stanford, CA, USA
| | - B Faddegon
- University of California, San Francisco, CA, USA
| | - C Fedon
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Guatelli
- Centre For Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - S Incerti
- Université de Bordeaux, CNRS/IN2P3, UMR5797, Centre d'Études Nucléaires de Bordeaux Gradignan, Gradignan, France
| | - V Ivanchenko
- Tomsk State University, Tomsk, Russian Federation
- CERN, Geneva, Switzerland
| | - D Konstantinov
- NRC "Kurchatov Institute" - IHEP, Protvino, Russian Federation
| | - I Kyriakou
- Medical Physics Laboratory, University of Ioannina, Ioannina, Greece
| | - G Latyshev
- NRC "Kurchatov Institute" - IHEP, Protvino, Russian Federation
| | - A Le
- Centre For Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | | | | | | | | | - C Omachi
- Nagoya Proton Therapy Center, Nagoya, Japan
| | | | - A Perales
- Medical Physics Department of Clínica Universidad de Navarra, Pamplona, Spain
| | - Y Perrot
- IRSN, Fontenay-aux-Roses, France
| | | | | | | | - F Romano
- INFN Catania Section, Catania, Italy
- Medical Physics Department, National Physical Laboratory, Teddington, UK
| | - A B Rosenfeld
- Centre For Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | | | - D Sakata
- Centre For Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | | | - I Sechopoulos
- Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Expert Center for Screening (LRCB), Nijmegen, The Netherlands
| | - E C Simpson
- Department of Nuclear Physics, Research School of Physics, Australian National University, Canberra, Australia
| | - T Toshito
- Nagoya Proton Therapy Center, Nagoya, Japan
| | - D H Wright
- SLAC National Accelerator Laboratory, Stanford, CA, USA
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12
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Diaz-Martinez A, Mas-Cabo J, Prats-Boluda G, Garcia-Casado J, Cardona-Urrego K, Monfort-Ortiz R, Lopez-Corral A, De Arriba-Garcia M, Perales A, Ye-Lin Y. A Comparative Study of Vaginal Labor and Caesarean Section Postpartum Uterine Myoelectrical Activity. Sensors (Basel) 2020; 20:s20113023. [PMID: 32466584 PMCID: PMC7308960 DOI: 10.3390/s20113023] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/04/2020] [Accepted: 05/23/2020] [Indexed: 11/16/2022]
Abstract
Postpartum hemorrhage (PPH) is one of the major causes of maternal mortality and morbidity worldwide, with uterine atony being the most common origin. Currently there are no obstetrical techniques available for monitoring postpartum uterine dynamics, as tocodynamometry is not able to detect weak uterine contractions. In this study, we explored the feasibility of monitoring postpartum uterine activity by non-invasive electrohysterography (EHG), which has been proven to outperform tocodynamometry in detecting uterine contractions during pregnancy. A comparison was made of the temporal, spectral, and non-linear parameters of postpartum EHG characteristics of vaginal deliveries and elective cesareans. In the vaginal delivery group, EHG obtained a significantly higher amplitude and lower kurtosis of the Hilbert envelope, and spectral content was shifted toward higher frequencies than in the cesarean group. In the non-linear parameters, higher values were found for the fractal dimension and lower values for Lempel-Ziv, sample entropy and spectral entropy in vaginal deliveries suggesting that the postpartum EHG signal is extremely non-linear but more regular and predictable than in a cesarean. The results obtained indicate that postpartum EHG recording could be a helpful tool for earlier detection of uterine atony and contribute to better management of prophylactic uterotonic treatment for PPH prevention.
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Affiliation(s)
- Alba Diaz-Martinez
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (A.D.-M.); (J.M.-C.); (G.P.-B.); (J.G.-C.); (K.C.-U.)
| | - Javier Mas-Cabo
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (A.D.-M.); (J.M.-C.); (G.P.-B.); (J.G.-C.); (K.C.-U.)
| | - Gema Prats-Boluda
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (A.D.-M.); (J.M.-C.); (G.P.-B.); (J.G.-C.); (K.C.-U.)
| | - Javier Garcia-Casado
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (A.D.-M.); (J.M.-C.); (G.P.-B.); (J.G.-C.); (K.C.-U.)
| | - Karen Cardona-Urrego
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (A.D.-M.); (J.M.-C.); (G.P.-B.); (J.G.-C.); (K.C.-U.)
| | - Rogelio Monfort-Ortiz
- Servicio de Obstetricia, Hospital Universitario y Politécnico de La Fe, 46026 Valencia, Spain; (R.M.-O.); (A.L.-C.); (M.D.A.-G.); (A.P.)
| | - Angel Lopez-Corral
- Servicio de Obstetricia, Hospital Universitario y Politécnico de La Fe, 46026 Valencia, Spain; (R.M.-O.); (A.L.-C.); (M.D.A.-G.); (A.P.)
| | - Maria De Arriba-Garcia
- Servicio de Obstetricia, Hospital Universitario y Politécnico de La Fe, 46026 Valencia, Spain; (R.M.-O.); (A.L.-C.); (M.D.A.-G.); (A.P.)
| | - Alfredo Perales
- Servicio de Obstetricia, Hospital Universitario y Politécnico de La Fe, 46026 Valencia, Spain; (R.M.-O.); (A.L.-C.); (M.D.A.-G.); (A.P.)
| | - Yiyao Ye-Lin
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (A.D.-M.); (J.M.-C.); (G.P.-B.); (J.G.-C.); (K.C.-U.)
- Correspondence: ; Tel.: +34-96-387-70-00 (ext. 76026)
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Mas-Cabo J, Prats-Boluda G, Garcia-Casado J, Alberola-Rubio J, Monfort-Ortiz R, Martinez-Saez C, Perales A, Ye-Lin Y. Electrohysterogram for ANN-Based Prediction of Imminent Labor in Women with Threatened Preterm Labor Undergoing Tocolytic Therapy. Sensors (Basel) 2020; 20:s20092681. [PMID: 32397177 PMCID: PMC7248811 DOI: 10.3390/s20092681] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 12/22/2022]
Abstract
Threatened preterm labor (TPL) is the most common cause of hospitalization in the second half of pregnancy and entails high costs for health systems. Currently, no reliable labor proximity prediction techniques are available for clinical use. Regular checks by uterine electrohysterogram (EHG) for predicting preterm labor have been widely studied. The aim of the present study was to assess the feasibility of predicting labor with a 7- and 14-day time horizon in TPL women, who may be under tocolytic treatment, using EHG and/or obstetric data. Based on 140 EHG recordings, artificial neural networks were used to develop prediction models. Non-linear EHG parameters were found to be more reliable than linear for differentiating labor in under and over 7/14 days. Using EHG and obstetric data, the <7- and <14-day labor prediction models achieved an AUC in the test group of 87.1 ± 4.3% and 76.2 ± 5.8%, respectively. These results suggest that EHG can be reliable for predicting imminent labor in TPL women, regardless of the tocolytic therapy stage. This paves the way for the development of diagnostic tools to help obstetricians make better decisions on treatments, hospital stays and admitting TPL women, and can therefore reduce costs and improve maternal and fetal wellbeing.
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Affiliation(s)
- J Mas-Cabo
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain
| | - G Prats-Boluda
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain
| | - J Garcia-Casado
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain
| | | | - R Monfort-Ortiz
- Servicio de Obstetricia, H.U. P. La Fe, 46026 Valencia, Spain
| | - C Martinez-Saez
- Servicio de Obstetricia, H.U. P. La Fe, 46026 Valencia, Spain
| | - A Perales
- Servicio de Obstetricia, H.U. P. La Fe, 46026 Valencia, Spain
| | - Y Ye-Lin
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain
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Santolaria A, Perales A, Montesinos P, Sanz MA. Acute Promyelocytic Leukemia during Pregnancy: A Systematic Review of the Literature. Cancers (Basel) 2020; 12:cancers12040968. [PMID: 32295152 PMCID: PMC7225915 DOI: 10.3390/cancers12040968] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 11/16/2022] Open
Abstract
The management of pregnant women with acute promyelocytic leukemia (APL) is a challenging situation where limited evidence-based information is available. We performed a systematic literature review to analyze the outcomes reported for both mother and fetus when APL is diagnosed during pregnancy. PubMed, Scopus and Web of Science databases were systematically searched to identify studies reporting cases of APL during pregnancy. Sixty-six articles met the eligibility criteria (53 single case reports). Ninety-two patients were eligible for induction therapy, with most them being treated with all-trans retinoic acid alone (32%) or combined with chemotherapy (43%), while the remaining patients received chemotherapy alone. Three patients were treated with arsenic-based regimens after delivery. Overall complete remission rate was 89%, with no statistically significant differences according to the type of induction and gestational age. During the first trimester, women were more likely to experience spontaneous and induced abortion compared to those during the second trimester (88% vs. 30%) (p < 0.0001), while only one patient diagnosed during the third trimester terminated in stillbirth. Twelve of 16 infants with neonatal complications had respiratory distress syndrome. Except two early deaths (Potter’s syndrome and pulmonary hemorrhage), all neonates evolved favorably. This study confirms that gestational age does not affect the results in the mother, but is closely related to fetal viability. Our results may be useful for the process of decision making that requires the involvement of the patient, hematologist, obstetrician and neonatologist.
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Affiliation(s)
- Andrea Santolaria
- Department of Obstetrics and Gynecology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.); (A.P.)
| | - Alfredo Perales
- Department of Obstetrics and Gynecology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain; (A.S.); (A.P.)
- Department of Obstetrics and Gynecology, University of Valencia, 46010 Valencia, Spain
| | - Pau Montesinos
- Department of Hematology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain;
- Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, 28029 Madrid, Spain
| | - Miguel A. Sanz
- Department of Hematology, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain;
- Centro de Investigación Biomédica en Red de Cáncer, Instituto Carlos III, 28029 Madrid, Spain
- Department of Medicine, University of Valencia, 46010 Valencia, Spain
- Correspondence:
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Garrido-Gomez T, Quiñonero A, Dominguez F, Rubert L, Perales A, Hajjar KA, Simon C. Preeclampsia: a defect in decidualization is associated with deficiency of Annexin A2. Am J Obstet Gynecol 2020; 222:376.e1-376.e17. [PMID: 31738896 DOI: 10.1016/j.ajog.2019.11.1250] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/31/2019] [Accepted: 11/07/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Decidualization defects in the endometrium have been demonstrated at the time of delivery in women with severe preeclampsia and to linger for years, which suggests a maternal contribution to the pathogenesis of this condition. Global transcriptional profiling reveals alterations in gene expression, which includes down-regulation of Annexin A2 in severe preeclampsia patients with decidualization resistance. OBJECTIVE We investigated the functional role of Annexin A2 deficiency during endometrial decidualization and its potential contribution to shallow trophoblast invasion during implantation and subsequent placentation using in vitro and in vivo modeling. STUDY DESIGN Annexin A2 gene and protein levels were assessed during in vitro decidualization of human endometrial stromal cells isolated from biopsy specimens that were collected from women with previous severe preeclampsia (n=5) or normal obstetric outcomes (n=5). Next, Annexin A2 was inhibited with small interference RNA in control human endometrial stromal cells that were isolated from endometrial biopsy specimens (n=15) as an in vitro model to analyze decidualization defects at the morphologic level and the secretion of prolactin and insulin-like growth binding protein-1. Annexin A2-inhibited cells were used to evaluate motility and promotion of embryo invasion. Decidualization and placentation defects of Annexin A2 deficiency were confirmed with the use of an Annexin A2-null mouse model. RESULTS Annexin A2 gene and protein levels were down-regulated during in vitro decidualization of human endometrial stromal cells from women with previous severe preeclampsia compared with control individuals. To assess its role in the endometrial stroma, we inhibited Annexin A2 expression and detected decidualization failure as evidenced by impaired morphologic transformation, which was associated with altered actin polymerization and low prolactin and insulin-like growth binding protein-1 secretions. Functionally, in vitro models demonstrated that Annexin A2 inhibition failed to support embryo invasion. This finding was corroborated by reduced trophoblast spreading through human endometrial stromal cells, lack of motility of these cells, and reduced trophoblast invasion in the presence of conditioned media from Annexin A2-inhibited cells. Extending our discovery to an animal model, we detected that Annexin A2-null mice have a functional deficiency in decidualization and placentation that impairs fetal growth as a feature that is associated with severe preeclampsia. CONCLUSION Together, in vitro and in vivo results suggest that endometrial defects in Annexin A2 expression impair decidualization of endometrial stromal cells as well as the uterine microenvironment that promotes embryo implantation and placentation. Our findings highlight the maternal contribution to the pathogenesis of severe preeclampsia and suggest that evaluation of Annexin A2 may provide a novel strategy to assess a woman's risk of experiencing this disease and perhaps discover therapeutic interventions to improve decidualization.
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16
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Sarasqueta C, Perales A, Escobar A, Baré M, Redondo M, Fernández de Larrea N, Briones E, Piera JM, Zunzunegui MV, Quintana JM. Impact of age on the use of adjuvant treatments in patients undergoing surgery for colorectal cancer: patients with stage III colon or stage II/III rectal cancer. BMC Cancer 2019; 19:735. [PMID: 31345187 PMCID: PMC6659283 DOI: 10.1186/s12885-019-5910-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Many older patients don’t receive appropriate oncological treatment. Our aim was to analyse whether there are age differences in the use of adjuvant chemotherapy and preoperative radiotherapy in patients with colorectal cancer. Methods A prospective cohort study was conducted in 22 hospitals including 1157 patients with stage III colon or stage II/III rectal cancer who underwent surgery. Primary outcomes were the use of adjuvant chemotherapy for stage III colon cancer and preoperative radiotherapy for stage II/III rectal cancer. Generalised estimating equations were used to adjust for education, living arrangements, area deprivation, comorbidity and clinical tumour characteristics. Results In colon cancer 92% of patients aged under 65 years, 77% of those aged 65 to 80 years and 27% of those aged over 80 years received adjuvant chemotherapy (χ2trends < 0.001). In rectal cancer preoperative radiotherapy was used in 68% of patients aged under 65 years, 60% of those aged 65 to 80 years, and 42% of those aged over 80 years (χ2trends < 0.001). Adjusting by comorbidity level, tumour characteristics and socioeconomic level, the odds ratio of use of chemotherapy compared with those under age 65, was 0.3 (0.1–0.6) and 0.04 (0.02–0.09) for those aged 65 to 80 and those aged over 80, respectively; similarly, the odds ratio of use of preoperative radiotherapy was 0.9 (0.6–1.4) and 0.5 (0.3–0.8) compared with those under 65 years of age. Conclusions The probability of older patients with colorectal cancer receiving adjuvant chemotherapy and preoperative radiotherapy is lower than that of younger patients; many of them are not receiving the treatments recommended by clinical practice guidelines. Differences in comorbidity, tumour characteristics, curative resection, and socioeconomic factors do not explain this lower probability of treatment. Research is needed to identify the role of physical and cognitive functional status, doctors’ attitudes, and preferences of patients and their relatives, in the use of adjuvant therapies. Electronic supplementary material The online version of this article (10.1186/s12885-019-5910-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Sarasqueta
- Biodonostia Health Research Institute - Donostia University Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Paseo Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Gipuzkoa, Spain.
| | - A Perales
- Biodonostia Health Research Institute - Donostia University Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Paseo Dr. Beguiristain s/n, 20014, Donostia-San Sebastián, Gipuzkoa, Spain
| | - A Escobar
- Research Unit, Hospital Basurto / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Avda Montevideo, 18, 48013, Bilbao, Bizkaia, Spain
| | - M Baré
- Clinical Epidemiology and Cancer Screening, Corporació Sanitaria Parc Taulí / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Parc Taulí 1, 08208, Sabadell, Barcelona, Spain
| | - M Redondo
- Research Unit, Costa del Sol Hospital / Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Autovía A-7, Km 187, 29603, Marbella, Málaga, Spain
| | - N Fernández de Larrea
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III / Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avda de Monforte de Lemos, 5, 28029, Madrid, Spain
| | - E Briones
- Epidemiology Unit, Seville Health District, Andalusian Health Service / Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Avda de la Constitución, 18, 41071, Seville, Spain
| | - J M Piera
- Medical Oncology Unit, Donostia University Hospital, Paseo Dr. Beguiristain 109, 20014, Donostia-San Sebastián, Gipuzkoa, Spain
| | - M V Zunzunegui
- Departement de médecine sociale et préventive Institut de recherche en santé publique (IRSPUM), University of Montréal, Pavillon 7101, salle 3111 7101, Avenue du Parc Montréal, Montréal, Québec, H3N 1X9, Canada
| | - J M Quintana
- Research Unit, Galdakao-Usansolo Hospital / REDISSEC, Labeaga Auzoa, 48960, Galdakao, Bizkaia, Spain
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Mas-Cabo J, Ye-Lin Y, Garcia-Casado J, Alberola-Rubio J, Perales A, Prats-Boluda G. Uterine contractile efficiency indexes for labor prediction: A bivariate approach from multichannel electrohysterographic records. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2018.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Garrido-Gomez T, Amadoz A, Jimenez Almazan J, Mateos P, Blesa D, Rubert L, Perales A, Simon C. Global transcriptional profiling corroborates an endometrial defective decidualization pattern in severe preeclampsia. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.323] [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: 10/28/2022]
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Mas-Cabo J, Prats-Boluda G, Perales A, Garcia-Casado J, Alberola-Rubio J, Ye-Lin Y. Uterine electromyography for discrimination of labor imminence in women with threatened preterm labor under tocolytic treatment. Med Biol Eng Comput 2018; 57:401-411. [PMID: 30159659 DOI: 10.1007/s11517-018-1888-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/12/2018] [Accepted: 08/22/2018] [Indexed: 11/29/2022]
Abstract
As one of the main aims of obstetrics is to be able to detect imminent delivery in patients with threatened preterm labor, the techniques currently used in clinical practice have serious limitations in this respect. The electrohysterogram (EHG) has now emerged as an alternative technique, providing relevant information about labor onset when recorded in controlled checkups without administration of tocolytic drugs. The studies published to date mainly focus on EHG-burst analysis and, to a lesser extent, on whole EHG window analysis. The study described here assessed the ability of EHG signals to discriminate imminent labor (< 7 days) in women with threatened preterm labor undergoing tocolytic therapy, using both EHG-burst and whole EHG window analyses, by calculating temporal, spectral, and non-linear parameters. Only two non-linear EHG-burst parameters and four whole EHG window analysis parameters were able to distinguish the women who delivered < 7 days from the others, showing that EHG can provide relevant information on the approach of labor, even in women with threatened preterm labor under the effects of tocolytic therapy. The whole EHG window outperformed the EHG-burst analysis and is seen as a step forward in the development of real-time EHG systems able to predict imminent labor in clinical praxis. Graphical abstract The ability of EHG recordings to predict imminent labor (< 7 days) was analyzed in preterm threatened patients undergoing tocolytic therapies by means of EHG-burst and whole EHG window analysis. The non-linear features were found to have better performance than the temporal and spectral parameters in separating women who delivered in less than 7 days from those who did not.
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Affiliation(s)
- Javier Mas-Cabo
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n Ed.7F, 46022, Valencia, Spain
| | - Gema Prats-Boluda
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n Ed.7F, 46022, Valencia, Spain.
| | | | - Javier Garcia-Casado
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n Ed.7F, 46022, Valencia, Spain
| | | | - Yiyao Ye-Lin
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n Ed.7F, 46022, Valencia, Spain
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Garcia-Casado J, Ye-Lin Y, Prats-Boluda G, Mas-Cabo J, Alberola-Rubio J, Perales A. Electrohysterography in the diagnosis of preterm birth: a review. Physiol Meas 2018; 39:02TR01. [PMID: 29406317 DOI: 10.1088/1361-6579/aaad56] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Preterm birth (PTB) is one of the most common and serious complications in pregnancy. About 15 million preterm neonates are born every year, with ratios of 10-15% of total births. In industrialized countries, preterm delivery is responsible for 70% of mortality and 75% of morbidity in the neonatal period. Diagnostic means for its timely risk assessment are lacking and the underlying physiological mechanisms are unclear. Surface recording of the uterine myoelectrical activity (electrohysterogram, EHG) has emerged as a better uterine dynamics monitoring technique than traditional surface pressure recordings and provides information on the condition of uterine muscle in different obstetrical scenarios with emphasis on predicting preterm deliveries. OBJECTIVE A comprehensive review of the literature was performed on studies related to the use of the electrohysterogram in the PTB context. APPROACH This review presents and discusses the results according to the different types of parameter (temporal and spectral, non-linear and bivariate) used for EHG characterization. MAIN RESULTS Electrohysterogram analysis reveals that the uterine electrophysiological changes that precede spontaneous preterm labor are associated with contractions of more intensity, higher frequency content, faster and more organized propagated activity and stronger coupling of different uterine areas. Temporal, spectral, non-linear and bivariate EHG analyses therefore provide useful and complementary information. Classificatory techniques of different types and varying complexity have been developed to diagnose PTB. The information derived from these different types of EHG parameters, either individually or in combination, is able to provide more accurate predictions of PTB than current clinical methods. However, in order to extend EHG to clinical applications, the recording set-up should be simplified, be less intrusive and more robust-and signal analysis should be automated without requiring much supervision and yield physiologically interpretable results. SIGNIFICANCE This review provides a general background to PTB and describes how EHG can be used to better understand its underlying physiological mechanisms and improve its prediction. The findings will help future research workers to decide the most appropriate EHG features to be used in their analyses and facilitate future clinical EHG applications in order to improve PTB prediction.
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Affiliation(s)
- J Garcia-Casado
- Centro de Investigación e Innovación en Bioingeniería (CI2B), Universitat Politècnica de València (UPV), Camino de Vera SN, 46022, Valencia, Spain
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Benalcazar-Parra C, Monfort-Orti R, Ye-Lin Y, Prats-Boluda G, Alberola-Rubio J, Perales A, Garcia-Casado J. Comparison of labour induction with misoprostol and dinoprostone and characterization of uterine response based on electrohysterogram. J Matern Fetal Neonatal Med 2017; 32:1586-1594. [PMID: 29251182 DOI: 10.1080/14767058.2017.1410791] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study is to compare the uterine activity response between women administered dinoprostone (prostaglandin E2) and misoprostol (prostaglandin E1) for induction of labour (IOL) by analysing not only the traditional obstetric data but also the parameters extracted from uterine electrohysterogram (EHG). METHODS Two cohorts were defined: misoprostol (25-µg vaginal tablets; 251 women) and dinoprostone cohort (10 mg vaginal inserts; 249 women). All the mothers were induced by a medical indication of a Bishop Score < = 6. RESULTS The misoprostol cohort was associated with a shorter time to achieve active labour (p = .017) and vaginal delivery (p = .009) and with a higher percentage of vaginal delivery in less than 24 h in mothers with a very unfavourable cervix score (risk ratio (RR): 1.41, IC95% 1.17-1.69, p = .002). Successful inductions with misoprostol showed EHG parameter values significantly higher than basal state for amplitude and pseudo Montevideo units (PMU) 60' after drug administration, while spectral parameters significantly increased after 150'. This response was not observed in failed inductions. In the successful dinoprostone group, the duration and number of contractions increased significantly after 120', PMU did so after 180', and no significant differences were found for spectral parameters, possibly due to the slower pharmacokinetics of this drug. CONCLUSION Successful inductions of labour by misoprostol are associated with earlier effective contractions than in labours induced by dinoprostone.
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Affiliation(s)
- Carlos Benalcazar-Parra
- a Centro de Investigación e Innovación en Bioingeniería , Universitat Politècnica de Valéncia , Valencia , España
| | - Rogelio Monfort-Orti
- b Servicio de Obstetricia y Ginecología , Hospital Universitario y Politécnico La Fe de Valencia , Valencia , España
| | - Yiyao Ye-Lin
- a Centro de Investigación e Innovación en Bioingeniería , Universitat Politècnica de Valéncia , Valencia , España
| | - Gema Prats-Boluda
- a Centro de Investigación e Innovación en Bioingeniería , Universitat Politècnica de Valéncia , Valencia , España
| | - Jose Alberola-Rubio
- b Servicio de Obstetricia y Ginecología , Hospital Universitario y Politécnico La Fe de Valencia , Valencia , España
| | - Alfredo Perales
- b Servicio de Obstetricia y Ginecología , Hospital Universitario y Politécnico La Fe de Valencia , Valencia , España
| | - Javier Garcia-Casado
- a Centro de Investigación e Innovación en Bioingeniería , Universitat Politècnica de Valéncia , Valencia , España
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Perales A, Delgado JL, de la Calle M, García‐Hernández JA, Escudero AI, Campillos JM, Sarabia MD, Laíz B, Duque M, Navarro M, Calmarza P, Hund M, Álvarez FV. sFlt-1/PlGF for prediction of early-onset pre-eclampsia: STEPS (Study of Early Pre-eclampsia in Spain). Ultrasound Obstet Gynecol 2017; 50:373-382. [PMID: 27883242 PMCID: PMC5836987 DOI: 10.1002/uog.17373] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 05/25/2016] [Revised: 11/08/2016] [Accepted: 11/11/2016] [Indexed: 05/31/2023]
Abstract
OBJECTIVE A high ratio of soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) has been linked to pre-eclampsia (PE). We evaluated the sFlt-1/PlGF ratio as a predictive marker for early-onset PE in women at risk of PE. METHODS This prospective, Spanish, multicenter study included pregnant women with a risk factor for PE, including intrauterine growth restriction, PE, eclampsia or hemolysis, elevated liver enzymes and low platelet count syndrome in previous pregnancy, pregestational diabetes or abnormal uterine artery Doppler. The primary objective was to show that the sFlt-1/PlGF ratio at 20, 24 and 28 weeks' gestation was predictive of early-onset PE (< 34 + 0 weeks). Serum sFlt-1 and PlGF were measured at 20, 24 and 28 weeks. Multivariate logistic regression was used to develop a predictive model. RESULTS A total of 819 women were enrolled, of which 729 were suitable for analysis. Of these, 78 (10.7%) women developed PE (24 early onset and 54 late onset). Median sFlt-1/PlGF ratio at 20, 24 and 28 weeks was 6.3 (interquartile range (IQR), 4.1-9.3), 4.0 (IQR, 2.6-6.3) and 3.3 (IQR, 2.0-5.9), respectively, for women who did not develop PE (controls); 14.5 (IQR, 5.5-43.7), 18.4 (IQR, 8.2-57.9) and 51.9 (IQR, 11.5-145.6) for women with early-onset PE; and 6.7 (IQR, 4.6-9.9), 4.7 (IQR, 2.8-7.2) and 6.0 (IQR, 3.8-10.5) for women with late-onset PE. Compared with early-onset PE, the sFlt-1/PlGF ratio was significantly lower in controls (P < 0.001 at each timepoint) and in women with chronic hypertension (P < 0.001 at each timepoint), gestational hypertension (P < 0.001 at each timepoint) and late-onset PE (P < 0.001 at each timepoint). A prediction model for early-onset PE was developed, which included the sFlt-1/PlGF ratio plus mean arterial pressure, being parous and previous PE, with areas under the receiver-operating characteristics curves of 0.86 (95% CI, 0.77-0.95), 0.91 (95% CI, 0.85-0.97) and 0.93 (95% CI, 0.86-0.99) at 20, 24 and 28 weeks, respectively, and was superior to models using the sFlt-1/PlGF ratio alone or uterine artery mean pulsatility index. CONCLUSIONS The sFlt-1/PlGF ratio can improve prediction of early-onset PE for women at risk of this condition. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A. Perales
- Hospital Universitario y Politécnico La FeValenciaSpain
| | | | | | | | | | | | | | - B. Laíz
- Hospital Universitario y Politécnico La FeValenciaSpain
| | - M. Duque
- Hospital Universitario La PazMadridSpain
| | - M. Navarro
- Hospital Universitario Materno Infantil de CanariasGran CanariaSpain
| | - P. Calmarza
- Hospital Universitario Miguel ServetZaragozaSpain
| | - M. Hund
- Roche Diagnostics International LtdRotkreuzSwitzerland
| | - F. V. Álvarez
- Hospital Universitario Central de AsturiasOviedoSpain
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Rodriguez E, Zamora J, Monfort I, Rubert L, Fuster S, Diago V, Perales A. Unusual twin pregnancy: complete hydatidiform mole with coexistent normal fetus. CLIN EXP OBSTET GYN 2017. [DOI: 10.12891/ceog3571.2017] [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: 11/01/2022]
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Alberola-Rubio J, Garcia-Casado J, Prats-Boluda G, Ye-Lin Y, Desantes D, Valero J, Perales A. Prediction of labor onset type: Spontaneous vs induced; role of electrohysterography? Comput Methods Programs Biomed 2017; 144:127-133. [PMID: 28494996 DOI: 10.1016/j.cmpb.2017.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 08/01/2016] [Revised: 01/31/2017] [Accepted: 03/21/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Induction of labor (IOL) is a medical procedure used to initiate uterine contractions to achieve delivery. IOL entails medical risks and has a significant impact on both the mother's and newborn's well-being. The assistance provided by an automatic system to help distinguish patients that will achieve labor spontaneously from those that will need late-term IOL would help clinicians and mothers to take an informed decision about prolonging pregnancy. With this aim, we developed and evaluated predictive models using not only traditional obstetrical data but also electrophysiological parameters derived from the electrohysterogram (EHG). METHODS EHG recordings were made on singleton term pregnancies. A set of 10 temporal and spectral parameters was calculated to characterize EHG bursts and a further set of 6 common obstetrical parameters was also considered in the predictive models design. Different models were implemented based on single layer Support Vector Machines (SVM) and with aggregation of majority voting of SVM (double layer), to distinguish between the two groups: term spontaneous labor (≤41 weeks of gestation) and IOL late-term labor. The areas under the curve (AUC) of the models were compared. RESULTS The obstetrical and EHG parameters of the two groups did not show statistically significant differences. The best results of non-contextualized single input parameter SVM models were achieved by the Bishop Score (AUC= 0.65) and GA at recording time (AUC= 0.68) obstetrical parameters. The EHG parameter median frequency, when contextualized with the two obstetrical parameters improved these results, reaching AUC= 0.76. Multiple input SVM obtained AUC= 0.70 for all EHG parameters. Aggregation of majority voting of SVM models using contextualized EHG parameters achieved the best result AUC= 0.93. CONCLUSIONS Measuring the electrophysiological uterine condition by means of electrohysterographic recordings yielded a promising clinical decision support system for distinguishing patients that will spontaneously achieve active labor before the end of full term from those who will require late term IOL. The importance of considering these EHG measurements in the patient's individual context was also shown by combining EHG parameters with obstetrical parameters. Clinicians considering elective labor induction would benefit from this technique.
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Affiliation(s)
- Jose Alberola-Rubio
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n Ed.8B, 46022 Valencia, Spain; Servicio de Obstetricia y Ginecología, Área de la Salud de la Mujer, Hospital Universitario y Politécnico La Fe de Valencia, Bulevar Sur SN, 46033, Valencia, Spain.
| | - Javier Garcia-Casado
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n Ed.8B, 46022 Valencia, Spain.
| | - Gema Prats-Boluda
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n Ed.8B, 46022 Valencia, Spain
| | - Yiyao Ye-Lin
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n Ed.8B, 46022 Valencia, Spain
| | - Domingo Desantes
- Servicio de Obstetricia y Ginecología, Área de la Salud de la Mujer, Hospital Universitario y Politécnico La Fe de Valencia, Bulevar Sur SN, 46033, Valencia, Spain
| | - Javier Valero
- Servicio de Obstetricia y Ginecología, Área de la Salud de la Mujer, Hospital Universitario y Politécnico La Fe de Valencia, Bulevar Sur SN, 46033, Valencia, Spain
| | - Alfredo Perales
- Servicio de Obstetricia y Ginecología, Área de la Salud de la Mujer, Hospital Universitario y Politécnico La Fe de Valencia, Bulevar Sur SN, 46033, Valencia, Spain
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Perales A, Cortés-Giraldo M, Schardt D, Pavón J, Quesada J, Gallardo M. PO-0791: Determination of water mean ionization potential for Geant4 simulations of therapeutical ion beams. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31228-8] [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: 11/24/2022]
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Romero R, Conde‐Agudelo A, El‐Refaie W, Rode L, Brizot ML, Cetingoz E, Serra V, Da Fonseca E, Abdelhafez MS, Tabor A, Perales A, Hassan SS, Nicolaides KH. Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta-analysis of individual patient data. Ultrasound Obstet Gynecol 2017; 49:303-314. [PMID: 28067007 PMCID: PMC5396280 DOI: 10.1002/uog.17397] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [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: 12/03/2016] [Revised: 12/23/2016] [Accepted: 12/29/2016] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess the efficacy of vaginal progesterone for the prevention of preterm birth and neonatal morbidity and mortality in asymptomatic women with a twin gestation and a sonographic short cervix (cervical length ≤ 25 mm) in the mid-trimester. METHODS This was an updated systematic review and meta-analysis of individual patient data (IPD) from randomized controlled trials comparing vaginal progesterone with placebo/no treatment in women with a twin gestation and a mid-trimester sonographic cervical length ≤ 25 mm. MEDLINE, EMBASE, POPLINE, CINAHL and LILACS (all from inception to 31 December 2016), the Cochrane Central Register of Controlled Trials, Research Registers of ongoing trials, Google Scholar, conference proceedings and reference lists of identified studies were searched. The primary outcome measure was preterm birth < 33 weeks' gestation. Two reviewers independently selected studies, assessed the risk of bias and extracted the data. Pooled relative risks (RRs) with 95% confidence intervals (CI) were calculated. RESULTS IPD were available for 303 women (159 assigned to vaginal progesterone and 144 assigned to placebo/no treatment) and their 606 fetuses/infants from six randomized controlled trials. One study, which included women with a cervical length between 20 and 25 mm, provided 74% of the total sample size of the IPD meta-analysis. Vaginal progesterone, compared with placebo/no treatment, was associated with a statistically significant reduction in the risk of preterm birth < 33 weeks' gestation (31.4% vs 43.1%; RR, 0.69 (95% CI, 0.51-0.93); moderate-quality evidence). Moreover, vaginal progesterone administration was associated with a significant decrease in the risk of preterm birth < 35, < 34, < 32 and < 30 weeks' gestation (RRs ranging from 0.47 to 0.83), neonatal death (RR, 0.53 (95% CI, 0.35-0.81)), respiratory distress syndrome (RR, 0.70 (95% CI, 0.56-0.89)), composite neonatal morbidity and mortality (RR, 0.61 (95% CI, 0.34-0.98)), use of mechanical ventilation (RR, 0.54 (95% CI, 0.36-0.81)) and birth weight < 1500 g (RR, 0.53 (95% CI, 0.35-0.80)) (all moderate-quality evidence). There were no significant differences in neurodevelopmental outcomes at 4-5 years of age between the vaginal progesterone and placebo groups. CONCLUSION Administration of vaginal progesterone to asymptomatic women with a twin gestation and a sonographic short cervix in the mid-trimester reduces the risk of preterm birth occurring at < 30 to < 35 gestational weeks, neonatal mortality and some measures of neonatal morbidity, without any demonstrable deleterious effects on childhood neurodevelopment. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.
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Affiliation(s)
- R. Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institutes of Health, Department of Health and Human ServicesBethesda, MD and DetroitMIUSA
- Department of Obstetrics and GynecologyUniversity of MichiganAnn ArborMIUSA
- Department of Epidemiology and BiostatisticsMichigan State UniversityEast LansingMIUSA
- Center for Molecular Medicine and GeneticsWayne State UniversityDetroitMIUSA
| | - A. Conde‐Agudelo
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institutes of Health, Department of Health and Human ServicesBethesda, MD and DetroitMIUSA
- Department of Obstetrics and GynecologyWayne State University School of MedicineDetroitMIUSA
| | - W. El‐Refaie
- Department of Obstetrics and Gynecology, Mansoura University HospitalsMansoura UniversityMansouraEgypt
| | - L. Rode
- Center of Fetal Medicine and Pregnancy, Department of ObstetricsCopenhagen University HospitalRigshospitaletCopenhagenDenmark
- Department of Clinical BiochemistryHerlev and Gentofte HospitalHerlevDenmark
| | - M. L. Brizot
- Department of Obstetrics and GynecologySão Paulo University Medical SchoolSão PauloBrazil
| | - E. Cetingoz
- Department of Obstetrics and GynecologyZeynep Kamil Women and Children Diseases Education and Research HospitalUskudarIstanbulTurkey
| | - V. Serra
- Maternal‐Fetal Medicine Unit, Instituto Valenciano de InfertilidadUniversity of ValenciaValenciaSpain
- Department of Pediatrics, Obstetrics and GynecologyUniversity of ValenciaValenciaSpain
| | - E. Da Fonseca
- Departamento de Obstetrícia e Ginecologia, Hospital do Servidor Publico Estadual ‘Francisco Morato de Oliveira’ and School of MedicineUniversity of São PauloSão PauloBrazil
| | - M. S. Abdelhafez
- Department of Obstetrics and Gynecology, Mansoura University HospitalsMansoura UniversityMansouraEgypt
| | - A. Tabor
- Center of Fetal Medicine and Pregnancy, Department of ObstetricsCopenhagen University HospitalRigshospitaletCopenhagenDenmark
- University of CopenhagenFaculty of Health SciencesCopenhagenDenmark
| | - A. Perales
- Department of Pediatrics, Obstetrics and GynecologyUniversity of ValenciaValenciaSpain
- Department of ObstetricsUniversity Hospital La FeValenciaSpain
| | - S. S. Hassan
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institutes of Health, Department of Health and Human ServicesBethesda, MD and DetroitMIUSA
- Department of Obstetrics and GynecologyWayne State University School of MedicineDetroitMIUSA
| | - K. H. Nicolaides
- Harris Birthright Research Centre for Fetal MedicineKing's College HospitalLondonUK
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Rodriguez E, Zamora JO, Monfort IR, Rubert L, Fuster S, Diago V, Perales A. Unusual twin pregnancy: complete hydatidiform mole with coexistent normal fetus. CLIN EXP OBSTET GYN 2017; 44:492-493. [PMID: 29949305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The authors present a case of complete hydatidiform mole and coexisting fetus (CHMCF) in which mole gestation caused a placenta previa; with a posterior preterm premature rupture of membranes (PPROM) and ending in the 28h week of gestation due to acute chorioamnionitis, obtaining a live preterm newborn.
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Cheong-See F, Schuit E, Arroyo-Manzano D, Khalil A, Barrett J, Joseph KS, Asztalos E, Hack K, Lewi L, Lim A, Liem S, Norman JE, Morrison J, Combs CA, Garite TJ, Maurel K, Serra V, Perales A, Rode L, Worda K, Nassar A, Aboulghar M, Rouse D, Thom E, Breathnach F, Nakayama S, Russo FM, Robinson JN, Dodd JM, Newman RB, Bhattacharya S, Tang S, Mol BWJ, Zamora J, Thilaganathan B, Thangaratinam S. Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. BMJ 2016; 354:i4353. [PMID: 27599496 PMCID: PMC5013231 DOI: 10.1136/bmj.i4353] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the risks of stillbirth and neonatal complications by gestational age in uncomplicated monochorionic and dichorionic twin pregnancies. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, and Cochrane databases (until December 2015). REVIEW METHODS Databases were searched without language restrictions for studies of women with uncomplicated twin pregnancies that reported rates of stillbirth and neonatal outcomes at various gestational ages. Pregnancies with unclear chorionicity, monoamnionicity, and twin to twin transfusion syndrome were excluded. Meta-analyses of observational studies and cohorts nested within randomised studies were undertaken. Prospective risk of stillbirth was computed for each study at a given week of gestation and compared with the risk of neonatal death among deliveries in the same week. Gestational age specific differences in risk were estimated for stillbirths and neonatal deaths in monochorionic and dichorionic twin pregnancies after 34 weeks' gestation. RESULTS 32 studies (29 685 dichorionic, 5486 monochorionic pregnancies) were included. In dichorionic twin pregnancies beyond 34 weeks (15 studies, 17 830 pregnancies), the prospective weekly risk of stillbirths from expectant management and the risk of neonatal death from delivery were balanced at 37 weeks' gestation (risk difference 1.2/1000, 95% confidence interval -1.3 to 3.6; I(2)=0%). Delay in delivery by a week (to 38 weeks) led to an additional 8.8 perinatal deaths per 1000 pregnancies (95% confidence interval 3.6 to 14.0/1000; I(2)=0%) compared with the previous week. In monochorionic pregnancies beyond 34 weeks (13 studies, 2149 pregnancies), there was a trend towards an increase in stillbirths compared with neonatal deaths after 36 weeks, with an additional 2.5 per 1000 perinatal deaths, which was not significant (-12.4 to 17.4/1000; I(2)=0%). The rates of neonatal morbidity showed a consistent reduction with increasing gestational age in monochorionic and dichorionic pregnancies, and admission to the neonatal intensive care unit was the commonest neonatal complication. The actual risk of stillbirth near term might be higher than reported estimates because of the policy of planned delivery in twin pregnancies. CONCLUSIONS To minimise perinatal deaths, in uncomplicated dichorionic twin pregnancies delivery should be considered at 37 weeks' gestation; in monochorionic pregnancies delivery should be considered at 36 weeks. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014007538.
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Affiliation(s)
- Fiona Cheong-See
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London E1 2AB, UK
| | - Ewoud Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, Netherlands Stanford Prevention Research Center, Stanford University, Palo Alto, Stanford, CA 94305, USA
| | - David Arroyo-Manzano
- Clinical Biostatistics Unit, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Asma Khalil
- Fetal Medicine Unit, St George's Healthcare NHS Trust, London SW17 0QT, UK
| | - Jon Barrett
- Evaluative Clinical Sciences, Women and Babies Research Program, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - K S Joseph
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC V6Z 2K5, Canada
| | - Elizabeth Asztalos
- Department of Newborn and Developmental Paediatrics, Women and Babies Research Program, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Karien Hack
- Department of Gynaecology and Obstetrics, Diakonessenhuis, 3582 KE Utrecht, Netherlands
| | - Liesbeth Lewi
- Department of Obstetrics-Gynaecology, University Hospitals, 3000 Leuven, Belgium Department of Development and Regeneration: Pregnancy, Fetus and Neonate, KU Leuven, Belgium
| | - Arianne Lim
- Department of Obstetrics and Gynaecology, Academic Medical Centre, 1105 AZ Amsterdam, Netherlands
| | - Sophie Liem
- Department of Obstetrics and Gynaecology, Academic Medical Centre, 1105 AZ Amsterdam, Netherlands
| | - Jane E Norman
- University of Edinburgh MRC Centre for Reproductive Health, Queen's Medical Research Institute, Edinburgh EH16 4TY, UK
| | - John Morrison
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS, USA
| | - C Andrew Combs
- Obstetrix Collaborative Research Network, Center for Research, Education and Quality, Mednax National Medical Group, FL 33323, USA
| | - Thomas J Garite
- Obstetrix Collaborative Research Network, Center for Research, Education and Quality, Mednax National Medical Group, FL 33323, USA University of California Irvine, Irvine, CA 92697, USA
| | - Kimberly Maurel
- Obstetrix Collaborative Research Network, Center for Research, Education and Quality, Mednax National Medical Group, FL 33323, USA
| | - Vicente Serra
- Maternal-Fetal Medicine Unit, Instituto Valenciano de Infertilidad, University of Valencia, Spain Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Valencia, Jefe Servicio Obstetricia Hospital U P La FE, Torre F, Valencia, Espana
| | - Alfredo Perales
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Valencia, Jefe Servicio Obstetricia Hospital U P La FE, Torre F, Valencia, Espana Department of Obstetrics, University Hospital La Fe, Valencia, 46026 València, Spain
| | - Line Rode
- Centre of Fetal Medicine, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Katharina Worda
- Department of Obstetrics and Gynaecology, Medical University of Vienna, 1090 Wien, Austria
| | - Anwar Nassar
- Department of Obstetrics and Gynaecology, American University of Beirut Medical Centre, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Mona Aboulghar
- The Egyptian IVF Centre, Maadi and Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Oula, Giza, Egypt
| | - Dwight Rouse
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Brown University Women and Infants Hospital, Providence, RI 02905, USA
| | - Elizabeth Thom
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Republic of Ireland
| | - Fionnuala Breathnach
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Republic of Ireland
| | - Soichiro Nakayama
- Department of Maternal Fetal Medicine, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka 594-1101, Japan
| | - Francesca Maria Russo
- Department of Obstetrics and Gynecology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Julian N Robinson
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jodie M Dodd
- Robinson Research Institute, and Discipline of Obstetrics and Gynaecology, University of Adelaide, North Adelaide SA 5006, Australia
| | - Roger B Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29403, USA
| | - Sohinee Bhattacharya
- University of Aberdeen, Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, Aberdeen AB25 2ZL, UK
| | - Selphee Tang
- Department of Obstetrics and Gynecology, Alberta Health Services, Calgary, AB T2N 2T9, Canada
| | - Ben Willem J Mol
- Australian Research Centre for Health of Women and Babies, Robinson Institute, University of Adelaide, North Adelaide, SA 5006, Australia
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London E1 2AB, UK
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Diago Almela VJ, Martinez-Varea A, Perales-Puchalt A, Alonso-Diaz R, Perales A. Good prognosis of cerclage in cases of cervical insufficiency when intra-amniotic inflammation/infection is ruled out. J Matern Fetal Neonatal Med 2016; 28:1563-8. [PMID: 25212978 DOI: 10.3109/14767058.2014.960836] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine if absence of sub-clinical intra-amniotic inflammation improves the prognosis of rescue cerclage in cases of bulging membranes. METHODS Cohort study with all women with bulging membranes admitted into our hospital between 2009 and 2013. Patients underwent amniocentesis to quantify amniotic glucose, leukocytes, IL-6 and leukocyte esterase levels and for microbiological culture. All patients without intra-amniotic inflammation or sub-clinical chorioamnionitis were proposed a physical examination-indicated cervical cerclage. Those who did not accept were treated with bed rest. RESULTS We enrolled 31 women. Median gestational age at diagnosis was 23 + 1 (21–25 + 4) weeks. Median interval until delivery was 12 (3–52.5) d. IL-6 had the highest diagnostic accuracy for good prognosis. Patients with IL6 <2.90 ng/ml were diagnosed later in pregnancy and presented a longer interval until delivery (89 versus 4 d), higher gestational age at delivery (35 + 1 versus 23 + 3 weeks) and a lower rate of prematurity (54.5% versus 100%) and perinatal mortality (0% versus 80%) than those with IL-6 ≥2.90 ng/ml. Rescue cerclage and low Il-6 were the best predictors of good outcome. CONCLUSION IL-6 levels in amniotic fluid may be of clinical value for individualizing the management of patients with bulging membranes for placement of rescue cerclage.
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Pamplona Bueno L, Ferri Folch B, Juárez Pallarés I, Akhoundova F, Desantes Real D, Pérez Martínez G, Diago Almela VJ, Perales A. Haemoperitoneum after spontaneous vaginal delivery due to uterine artery pseudoaneurysm rupture. J OBSTET GYNAECOL 2016; 36:670-1. [PMID: 26790042 DOI: 10.3109/01443615.2015.1134457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- L Pamplona Bueno
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
| | - B Ferri Folch
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
| | - I Juárez Pallarés
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
| | - F Akhoundova
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
| | - D Desantes Real
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
| | - G Pérez Martínez
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
| | - V J Diago Almela
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
| | - A Perales
- a Department of Obstetrics and Gynecology, Maternal-Fetal Medicine , University Hospital La Fe , Valencia , Spain
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Rubert L, Lozoya T, Monfort R, Domingo S, Diago V, Perales A. Obstetric outcomes after a radical trachelectomy complicated with haematometra: A case report. J OBSTET GYNAECOL 2015; 36:424-5. [PMID: 26466847 DOI: 10.3109/01443615.2015.1086987] [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: 11/13/2022]
Affiliation(s)
- L Rubert
- a Department of Obstetrics and Gynecology , La Fe University Hospital , Valencia , Spain
| | - T Lozoya
- a Department of Obstetrics and Gynecology , La Fe University Hospital , Valencia , Spain
| | - R Monfort
- a Department of Obstetrics and Gynecology , La Fe University Hospital , Valencia , Spain
| | - S Domingo
- a Department of Obstetrics and Gynecology , La Fe University Hospital , Valencia , Spain
| | - V Diago
- a Department of Obstetrics and Gynecology , La Fe University Hospital , Valencia , Spain
| | - A Perales
- a Department of Obstetrics and Gynecology , La Fe University Hospital , Valencia , Spain
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Garcia-Tejedor A, Maiques-Montesinos V, Diago-Almela VJ, Pereda-Perez A, Alberola-Cuñat V, López-Hontangas JL, Perales-Puchalt A, Perales A. Risk factors for vertical transmission of hepatitis C virus: a single center experience with 710 HCV-infected mothers. Eur J Obstet Gynecol Reprod Biol 2015; 194:173-7. [PMID: 26409061 DOI: 10.1016/j.ejogrb.2015.09.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/31/2015] [Accepted: 09/03/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the risk factors on the perinatal transmission of hepatitis C virus (HCV). STUDY DESIGN A retrospective cohort study with 711 infants born to 710 HCV-infected mothers was conducted at the Hospital La Fe, in Valencia, Spain, from 1986 to 2011. As potential risk factors for transmission we analyzed: maternal age, mode of acquisition of HCV infection, HIV co-infection, antiretroviral treatment against HIV, CD4 cell count, HIV and HCV viral load, liver enzyme levels during pregnancy, smoking habit, gestational age, intrapartum invasive procedures, length of rupture of membranes, length of labor, mode of delivery, episiotomy, birth weight, newborn gender and type of feeding. RESULTS Overall perinatal HCV transmission rate was 2.4%. The significant risk factors related with HCV transmission were maternal virus load >615copies/mL (OR 9.3 [95% CI 1.11-78.72]), intrapartum invasive procedures (OR 10.1 [95% CI 2.6-39.02]) and episiotomy (OR 4.2 [95% CI 1.2-14.16]). HIV co-infection and newborn female were near significance (p=0.081 and 0.075, respectively). CONCLUSIONS Invasive procedures as fetal scalp blood sampling or internal electrode and episiotomy increase vertical transmission of HCV, especially in patients with positive HCV RNA virus load at delivery.
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Affiliation(s)
- Amparo Garcia-Tejedor
- Department of Obstetrics and Gynecology, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Department of Gynecology, Hospital Universitario Bellvitge-Idibell, Barcelona, Spain.
| | | | | | - Antonio Pereda-Perez
- Department of Pediatrics, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Vicente Alberola-Cuñat
- Department of Obstetrics and Gynecology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Alfredo Perales-Puchalt
- Department of Obstetrics and Gynecology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Alfredo Perales
- Department of Obstetrics and Gynecology, Hospital Universitari i Politècnic La Fe, Valencia, Spain; Facultad Medicina, Departamento Pediatría Obstetricia y Ginecología, Universidad Valencia, Spain
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Kindinger LM, Poon LC, Cacciatore S, MacIntyre DA, Fox NS, Schuit E, Mol BW, Liem S, Lim AC, Serra V, Perales A, Hermans F, Darzi A, Bennett P, Nicolaides KH, Teoh TG. The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta-analysis. BJOG 2015; 123:877-84. [PMID: 26333191 DOI: 10.1111/1471-0528.13575] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the effect of gestational age (GA) and cervical length (CL) measurements at transvaginal ultrasound (TVUS) in the prediction of preterm birth in twin pregnancy. DESIGN Individual patient data (IPD) meta-analysis. SETTING International multicentre study. POPULATION Asymptomatic twin pregnancy. METHODS MEDLINE and EMBASE searches were performed and IPD obtained from authors of relevant studies. Multinomial logistic regression analysis determined probabilities for birth at ≤28(+0) , 28(+1) to 32(+0) , 32(+1) to 36(+0) , and ≥36(+1) weeks as a function of GA at screening and CL measurements. MAIN OUTCOME MEASURES Predicted probabilities for preterm birth at ≤28(+0) , 28(+1) to 32(+0) , and 32(+1) to 36(+0) . RESULTS A total of 6188 CL measurements were performed on 4409 twin pregnancies in 12 studies. Both GA at screening and CL had a significant and non-linear effect on GA at birth. The best prediction of birth at ≤28(+0) weeks was provided by screening at ≤18(+0) weeks (P < 0.001), whereas the best prediction of birth between 28(+1) and 36(+0) weeks was provided by screening at ≥24(+0) weeks (P < 0.001). Negative prediction value of 100% for birth at ≤28(+0) weeks is achieved at CL 65 mm and 43 mm at ultrasound GA at ≤18(+0) weeks and at 22(+1) to 24(+0) weeks, respectively. CONCLUSION In twin pregnancies, prediction of preterm birth depends on both CL and the GA at screening. When CL is <30 mm, screening at ≤18(+0) weeks is most predictive for birth at ≤28(+0) weeks. Later screening at >22(+0) weeks is most predictive of delivery at 28(+1) to 36(+0) weeks. In twins, we recommend CL screening in twins to commence from ≤18(+0) weeks. TWEETABLE ABSTRACT An individual patient meta-analysis assessing gestation and CL in the prediction of preterm birth in twins.
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Affiliation(s)
- L M Kindinger
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK.,Fetal Medicine Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - L C Poon
- Fetal Medicine Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.,Harris Birthright Research Centre for Fetal Medicine, Kings College Hospital, London, UK
| | - S Cacciatore
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - D A MacIntyre
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - N S Fox
- Maternal Fetal Medicine Associates, PLLC, New York, NY, USA
| | - E Schuit
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | - B W Mol
- The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia
| | - S Liem
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - A C Lim
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - V Serra
- Maternal-Fetal Medicine Unit, Instituto Valenciano de Infertilidad, University of Valencia, Valencia, Spain
| | - A Perales
- Department of Paediatrics, Obstetrics and Gynaecology, La FE, University and Polytechnic Hospital, University of Valencia, Valencia, Spain
| | - F Hermans
- Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - A Darzi
- Department of Academic Surgery, St Marys Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - P Bennett
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, Kings College Hospital, London, UK
| | - T G Teoh
- Fetal Medicine Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Perales A, Delgado JL, de la Calle M, García-Hernández JA, Escudero AI, Campillos JM, Sarabia MD, Laíz B, Duque M, Navarro M, Calmarza P, Hund M, Álvarez FV. O23. STEPS (Study of Early Preeclampsia in Spain): sFlt-1/PlGF for the prediction of early-onset preeclampsia in singleton pregnancies. Pregnancy Hypertens 2015. [DOI: 10.1016/j.preghy.2015.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ye-Lin Y, Alberola-Rubio J, Prats-Boluda G, Bueno Barrachina JM, Perales A, Valero J, Desantes D, Garcia-Casado J. Non-invasive electrohysterogram recording using flexible concentric ring electrode. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:4050-3. [PMID: 25570881 DOI: 10.1109/embc.2014.6944513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Non-invasive electrohysterogram (EHG) recording could provide valuable information about uterine dynamics. Bipolar EHG has usually been performed using monopolar disposable electrodes. Recently concentric ring electrodes have been used for EHG recordings so as to acquire more localized electrical activity which may be helpful for deducing uterine contraction efficiency. Nevertheless concentric ring electrodes have commonly been implemented in rigid substrates. Therefore they do not adapt to the body surface curvature which may cause discomfort for patients and a poor contact between electrode and skin. The aim of this paper is to examine the feasibility of picking up EHG signals (BC-EHG) using a new flexible tripolar concentric ring (TCR) electrode placed on the abdominal surface, and to compare it with the conventional bipolar recordings. For this purpose, a total of 7 recording sessions were carried out in 7 pregnant women. Each recording implied simultaneous acquisition of one bipolar EHG signal and of two bipolar concentric EHG (BC-EHG) signals using the flexible TCR electrode. Then a set of temporal and spectral parameters was computed from both bipolar EHG and BC-EHG bursts. Experimental results show no noticeable difference in duration and in dominant frequency in Fast Wave High frequency range. Nonetheless, the low frequency content (0.1-0.2 Hz) of BC-EHG records is smaller than that of bipolar record. These results suggest that the new flexible TCR electrode permits to pick up uterine electrical activity and may provide additional information for deducing uterine efficiency.
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Hermans F, Gyamfi-Bannerman C, Lim A, Liem S, Serra V, Perales A, Rode L, Worda K, Tabor A, Schuit E, Mol BW. 474: Cervical length and risk of preterm birth in European women with a twin pregnancy. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ye-Lin Y, Alberola-Rubio J, Prats-Boluda G, Perales A, Desantes D, Garcia-Casado J. Feasibility and analysis of bipolar concentric recording of electrohysterogram with flexible active electrode. Ann Biomed Eng 2014; 43:968-76. [PMID: 25274161 DOI: 10.1007/s10439-014-1130-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 09/19/2014] [Indexed: 11/25/2022]
Abstract
The conduction velocity and propagation patterns of the electrohysterogram (EHG) provide fundamental information on the electrophysiological condition of the uterus. However, the accuracy of these measurements can be impaired by both the poor spatial selectivity and sensitivity to the relative direction of the contraction propagation associated with conventional disc electrodes. Concentric ring electrodes could overcome these limitations. The aim of this study was to examine the feasibility of picking up surface EHG signals using a new flexible tripolar concentric ring electrode (TCRE), and to compare these signals with conventional bipolar recordings. Simultaneous recording of conventional bipolar signals and bipolar concentric EHG (BC-EHG) were carried out on 22 pregnant women. Signal bursts were characterized and compared. No significant differences were found between the channels in either duration or dominant frequency in the Fast Wave High frequency range. Nonetheless, the high pass filtering effect of the BC-EHG recordings gave lower frequency content between 0.1 and 0.2 Hz. Although the BC-EHG signal amplitude was about 5-7 times smaller than that of bipolar recordings, a similar signal-to-noise ratio was obtained. These results suggest that the flexible TCRE is able to pick up uterine electrical activity and could provide additional information for deducing the uterine electrophysiological condition.
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Affiliation(s)
- Y Ye-Lin
- Institute of Research and Innovation in Bioengineering, Universidad Politécnica de Valencia, Camino de Vera s/n Ed.7F, 46022, Valencia, Spain,
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Schuit E, Stock S, Rode L, Rouse DJ, Lim AC, Norman JE, Nassar AH, Serra V, Combs CA, Vayssiere C, Aboulghar MM, Wood S, Çetingöz E, Briery CM, Fonseca EB, Worda K, Tabor A, Thom EA, Caritis SN, Awwad J, Usta IM, Perales A, Meseguer J, Maurel K, Garite T, Aboulghar MA, Amin YM, Ross S, Cam C, Karateke A, Morrison JC, Magann EF, Nicolaides KH, Zuithoff NPA, Groenwold RHH, Moons KGM, Kwee A, Mol BWJ. Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an individual participant data meta-analysis. BJOG 2014; 122:27-37. [PMID: 25145491 DOI: 10.1111/1471-0528.13032] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND In twin pregnancies, the rates of adverse perinatal outcome and subsequent long-term morbidity are substantial, and mainly result from preterm birth (PTB). OBJECTIVES To assess the effectiveness of progestogen treatment in the prevention of neonatal morbidity or PTB in twin pregnancies using individual participant data meta-analysis (IPDMA). SEARCH STRATEGY We searched international scientific databases, trial registration websites, and references of identified articles. SELECTION CRITERIA Randomised clinical trials (RCTs) of 17-hydroxyprogesterone caproate (17Pc) or vaginally administered natural progesterone, compared with placebo or no treatment. DATA COLLECTION AND ANALYSIS Investigators of identified RCTs were asked to share their IPD. The primary outcome was a composite of perinatal mortality and severe neonatal morbidity. Prespecified subgroup analyses were performed for chorionicity, cervical length, and prior spontaneous PTB. MAIN RESULTS Thirteen trials included 3768 women and their 7536 babies. Neither 17Pc nor vaginal progesterone reduced the incidence of adverse perinatal outcome (17Pc relative risk, RR 1.1; 95% confidence interval, 95% CI 0.97-1.4, vaginal progesterone RR 0.97; 95% CI 0.77-1.2). In a subgroup of women with a cervical length of ≤25 mm, vaginal progesterone reduced adverse perinatal outcome when cervical length was measured at randomisation (15/56 versus 22/60; RR 0.57; 95% CI 0.47-0.70) or before 24 weeks of gestation (14/52 versus 21/56; RR 0.56; 95% CI 0.42-0.75). AUTHOR'S CONCLUSIONS In unselected women with an uncomplicated twin gestation, treatment with progestogens (intramuscular 17Pc or vaginal natural progesterone) does not improve perinatal outcome. Vaginal progesterone may be effective in the reduction of adverse perinatal outcome in women with a cervical length of ≤25 mm; however, further research is warranted to confirm this finding.
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Affiliation(s)
- E Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands
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Borras D, Perales-Puchalt A, Ruiz Sacedón N, Perales A. Angiogenic growth factors in maternal and fetal serum in pregnancies complicated with intrauterine growth restriction. J OBSTET GYNAECOL 2014; 34:218-20. [DOI: 10.3109/01443615.2013.834304] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brik M, Aguar M, Valiente A, Perales A. Cervical IL-6 and pIGFBP-1 and the prediction of neonatal outcome in symptomatic preterm labour. J Matern Fetal Neonatal Med 2013; 27:1241-7. [DOI: 10.3109/14767058.2013.854326] [Citation(s) in RCA: 2] [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: 11/13/2022]
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41
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Gonzalez-Coloma A, Hernandez MG, Perales A, Fraga BM. Chemical ecology of canarian laurel forest: Toxic diterpenes fromPersea indica (Lauraceae). J Chem Ecol 2013; 16:2723-33. [PMID: 24264325 DOI: 10.1007/bf00988081] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/1989] [Accepted: 03/29/1990] [Indexed: 11/25/2022]
Abstract
The tree speciesP. indica (Lauraceae) is an important endemism in the Canary Islands laurel forest and can readily be distinguished by its defoliated appearance due to the seasonal action of wild rats (Rattus rattus), which eat the plant and become intoxicated. These observations and the phytochemical interest of this plant species led us to study the potentially toxic chemicals responsible for such action. We found that an ethanolic extract ofP. indica and its water fraction were toxic when injected into laboratory mice. The mice also died after ingestion of the stems and showed a significant preference for those extracted and rehydrated with an 8% aqueous extract solution when compared with the water control. Two compounds that have been isolated from the toxic fraction and identified by spectroscopic methods are the polyhydroxy pentacyclic diterpenes ryanodol and cinnceylanol. Possible ecological implications are discussed.
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Affiliation(s)
- A Gonzalez-Coloma
- Instituto de Productos Naturales Orgánicos, C. S. I. C., Ave. Astrofísico F. Sanchez, 2. La Laguna, 38206, Tenerife, Canary Islands, Spain
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Ruiz-Sacedón N, Perales-Puchalt A, Borras D, Gómez R, Perales A. Angiogenic growth factors in maternal and fetal serum in concordant and discordant twin pregnancies. J Matern Fetal Neonatal Med 2013; 27:870-3. [PMID: 24041202 DOI: 10.3109/14767058.2013.845156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess soluble fms-like tyrosin kinase 1 (sFlt-1), free vascular endothelial growth factor (f-VEGF) and the f-VEGF/sFlt-1 quotient in twin pregnancies, and to determine if they are impaired in discordant twins. METHODS Case-control study between 18 discordant and 46 concordant twin pregnancies. Angiogenic growth factors were measured in maternal serum during pregnancy and in umbilical artery and vein at birth. RESULTS Discordant twins were more often conceived by assisted reproductive techniques than concordant twins. Maternal plasma f-VEGF was significantly lower in discordant twins (p = 0.04). F-VEGF and f-VEGF/sFlt-1 in the whole sample show a significant higher level in concordant twins. When we analyzed umbilical cord angiogenic factors, the smaller twin had a lower f-VEGF/sFlt-1 quotient (p = 0.01). We found no correlations between maternal or umbilical growth factors and placental or fetal weight. No difference was found in veno-arterial levels of angiogenic factors in each twin; however, there was a significant rise in arterial f-VEGF (p = 0.06) in discordant twins. CONCLUSION Mothers of discordant twins have a more anti-angiogenic environment compared to those of concordant twins. We also found an anti-angiogenic environment in the small twin when we compared umbilical vein angiogenic factors against its big co-twin.
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Pérez-Sancho M, García-Seco T, Arrogante L, García N, Martínez I, Diez-Guerrier A, Perales A, Goyache J, Domínguez L, Álvarez J. Development and evaluation of an IS711-based loop mediated isothermal amplification method (LAMP) for detection of Brucella spp. on clinical samples. Res Vet Sci 2013; 95:489-94. [DOI: 10.1016/j.rvsc.2013.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 03/14/2013] [Accepted: 05/04/2013] [Indexed: 11/16/2022]
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Perales-Puchalt A, Brik M, Diago VJ, Perales A. The negative predictive value of cervical interleukin-6 for the risk assessment of preterm birth. J Matern Fetal Neonatal Med 2013; 26:1278-81. [PMID: 23480455 DOI: 10.3109/14767058.2013.783798] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the potential clinical use of cervical interleukin-6 (IL-6) as a negative predictor of preterm birth in symptomatic women. STUDY DESIGN Observational prospective study carried out in a tertiary hospital. PATIENTS AND METHODS We studied 100 singleton pregnant women with threatened preterm delivery and intact membranes, between 24 and 34 weeks, recruited during the period 2006-2008. A cervical swab for IL-6 detection was taken and a transvaginal ultrasound scan was performed for measuring the cervical length. RESULTS Five women delivered within 2 d and six women within 7 d. A high cervical IL-6 concentration was found in these women. The area under the ROC curve for cervical IL-6 was 0.97 for deliveries within 2 d after the test, and 0.85 for deliveries within 7 d. The optimal cut-off point was a cervical IL-6 concentration of 210 pg/ml. The negative predictive value (NPV) was 100% for deliveries within 2 d, and 98.5% for deliveries within 7 d (when considering a prevalence of preterm birth of 8%). Cervical IL-6 and sonographic measurement of cervical length showed similar NPV. CONCLUSION A low-cervical IL-6 concentration can accurately identify symptomatic women with a very low chance to progress to preterm birth within 2-7 d.
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Vila-Vives JM, Hidalgo-Mora JJ, Perales-Puchalt A, Diago V, Plana A, Perales A. Spontaneous arrest of flow in a TRAP sequence. J OBSTET GYNAECOL 2013; 33:313-4. [PMID: 23550871 DOI: 10.3109/01443615.2012.761182] [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: 11/13/2022]
Affiliation(s)
- J M Vila-Vives
- Department of Obstetrics, La Fe University Hospital, Valencia, USA.
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Ye-Lin Y, Prats-Boluda G, Alberola-Rubio J, Bueno Barrachina JM, Perales A, Garcia-Casado J. Prediction of labor using non-invasive Laplacian EHG recordings. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:7428-7431. [PMID: 24111462 DOI: 10.1109/embc.2013.6611275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Non-invasive electrohysterogram (EHG) recordings could be used as an alternative technique for monitoring uterine dynamics. Bipolar recordings of EHG have proven to provide valuable information to predict labor. Recently it has been stated that uterine EHG bursts could also be identified in Laplacian recordings on abdominal surface. Taking into account that Laplacian potential technique permits to acquire more localized electrical activity than conventional recordings; these recordings could also be helpful for deducing uterine contraction efficiency. The aim of this paper is to examine the feasibility of Laplacian potential EHG recording for labor prediction and to compare it with monopolar recordings. To this purpose, a total of 42 EHG recordings were acquired from women of similar gestational age: 29 antepartum patients, and 13 patients in labor. Then linear and non-linear classifiers have been implemented using EHG burst parameters as input features. Experimental results show significant differences in temporal and spectral parameters in both monopolar and Laplacian potential recordings between the two groups. In addition, support vector machine based classifier achieved an accuracy of 93% for labor prediction for monopolar recordings, 92% for bipolar recordings and 91% for Laplacian potential.
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Melchor J, Fabre E, Casellas M, Espinosa J, García-Hernández J, Martínez-Astorquiza T, Orós D, Perales A, Ramirez-Pineda M, Serra B. W292 LABOUR INDUCTION IN CONTROVERSIAL CLINICAL CIRCUMSTANCES. RESULTS FROM A NATIONAL SURVEY. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)62015-3] [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]
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Serra V, Perales A, Meseguer J, Parrilla JJ, Lara C, Bellver J, Grifol R, Alcover I, Sala M, Martínez-Escoriza JC, Pellicer A. Increased doses of vaginal progesterone for the prevention of preterm birth in twin pregnancies: a randomised controlled double-blind multicentre trial. BJOG 2012; 120:50-7. [DOI: 10.1111/j.1471-0528.2012.03448.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [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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Escobar J, Gormaz M, Arduini A, Gosens K, Martinez A, Perales A, Escrig R, Tormos E, Roselló M, Orellana C, Vento M. Expression of aquaporins early in human pregnancy. Early Hum Dev 2012; 88:589-94. [PMID: 22336497 DOI: 10.1016/j.earlhumdev.2012.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [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] [Received: 06/30/2011] [Revised: 01/06/2012] [Accepted: 01/07/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Aquaporins (AQPs) constitute a family of channel proteins implicated in transmembrane water transport. Thirteen different AQPs (AQP0-12) have been described but their precise biologic function still remains unclear. AQPs 1, 3, 4, 8, and 9 expression has been described in human chorion, amnion and placenta; however, AQP4 is the only that has been identified in the first trimester of human pregnancy. OBJECTIVE To assess multiplicity of AQPs expression from 10th to 14th week gestation. POPULATION AND METHODS Chorionic villi samples (CVS) collected in pregnant women for prenatal diagnosis were analysed by real time-PCR to assess cDNA expression of AQPs 1, 2, 3, 4, 5, 6, 7, 8, 9, and 11, and compared with AQPs expression in placentas from normal term pregnancies. RESULTS 26 CVS corresponding to 26 pregnant women (age: 32.7±4.5 years; gestational age: 12.4±0.9 weeks) and 10 placental samples corresponding to normal term pregnancies were analysed. In CVS karyotype was normal in 16 cases, trisomy in 6 cases, mosaicism in 1 and unknown in 1. We found high mRNA expression for AQPs 1, 3, 9 and 11, low for AQPs 4, 5, and 8, and non-detectable for AQPs 2, 6, and 7 in chorionic villi. CONCLUSIONS This is the first study systematically assessing the expression of a multiplicity of AQPs in chorionic villi samples between 10th and 14th weeks of gestation. High expression of AQP11 has been identified for the first time in early stages of human pregnancy. Chromosomal abnormalities did not alter AQPs' expression.
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Affiliation(s)
- Javier Escobar
- Neonatal Research Unit, Research Institute Hospital La Fe, Bulevar Sur s/n, Valencia, Spain
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