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Kosińska Kaczyńska K, Rebizant B, Bednarek K, Dabrowski FA, Kajdy A, Muzyka-Placzyńska K, Filipecka-Tyczka D, Uzar P, Kwiatkowski S, Torbe A, Grzesiak M, Kaczmarek P, Żyła M, Brawura-Biskupski-Samaha R. Emergency cerclage using double-level versus single-level suture in the management of cervical insufficiency (Cervical Occlusion double-level Stitch Application, COSA): study protocol for a multicentre, non-blinded, randomised controlled trial. BMJ Open 2023; 13:e071564. [PMID: 37286317 DOI: 10.1136/bmjopen-2023-071564] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Cervical insufficiency accounts for 15% of recurrent pregnancy losses between 16 and 28 weeks of gestation. The aim of the study is to verify the effectiveness of emergency double-level cerclage with vaginal progesterone in cervical insufficiency treatment in terms of the prevention of preterm delivery before 34 weeks of gestation. METHODS AND ANALYSIS This trial is a multicentre, non-blinded, randomised study with 1:1 allocation ratio. The study is conducted at tertiary perinatal care departments in Poland. It will include patients with cervical insufficiency with the fetal membranes visible in the open cervical canal or protruding into the vagina between 16+0 and 23+6 weeks of pregnancy. They will be randomised into two arms: emergency single-level cerclage with vaginal progesterone or double-level cerclage with vaginal progesterone. All will be administered antibiotics and indomethacin. The primary outcome is the rate of deliveries below 34+0 weeks of gestation, while secondary outcomes include gestational age at delivery, neonatal outcomes, maternal outcomes according to the Core Outcome Set for Evaluation of Interventions to Prevent Preterm Birth and cerclage procedure complications. The planned number of participants according to the power analysis is 78. ETHICS AND DISSEMINATION The study protocol was written in accordance with the Standard Protocol Items: Recommendations for Interventional Trials statement. It was created according to the requirements of the Declaration of Helsinki for Medical Research involving Human Subject. Ethical approval was obtained from the Ethics Committee of the Centre of Postgraduate Medical Education (no. 1/2022). The study protocol was approved and published by ClinicalTrials.gov (posted on 24 February 2022). All participants gave a written informed consent. After completion of the study its results will be published in a peer-reviewed English language journal. TRIAL REGISTRATION NCT05268640.
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Affiliation(s)
- Katarzyna Kosińska Kaczyńska
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, Warszawa, Poland
| | - Beata Rebizant
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, Warszawa, Poland
| | - Katarzyna Bednarek
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, Warszawa, Poland
| | - Filip Andrzej Dabrowski
- Department of Obstetrics, Perinatology and Neonatology, Center of Postgraduate Medical Education, Warszawa, Poland
| | - Anna Kajdy
- 1st Department of Obstetrics and Gynecology, Center of Postgraduate Medical Educatiion, Warsaw, Poland
| | | | - Dagmara Filipecka-Tyczka
- 1st Department of Obstetrics and Gynecology, Center of Postgraduate Medical Educatiion, Warsaw, Poland
| | - Piotr Uzar
- Department of Obstetrics and Gynecology, Pomeranian Medical University Szczecin, Szczecin, Poland
| | - Sebastian Kwiatkowski
- Department Obstetrics and Gynecology, Pomorski Uniwersytet Medyczny w Szczecinie, Szczecin, Zachodniopomorskie, Poland
| | - Andrzej Torbe
- Department of Obstetrics and Gynecology, Pomeranian Medical University Szczecin, Szczecin, Poland
| | - Mariusz Grzesiak
- Department of Perinatology Obstetrics and Gynecology, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland
| | - Piotr Kaczmarek
- Department of Perinatology Obstetrics and Gynecology, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland
| | - Monika Żyła
- Department of Perinatology Obstetrics and Gynecology, Polish Mother's Memorial Hospital-Research Institute, Lodz, Poland
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Cyganek A, Dabrowski FA, Pietrzak B, Jabiry-Zieniewicz Z, Grzechocinska B, Madej A, Wielgos M. Intrauterine growth restriction in pregnant women after kidney transplantation as a marker of preeclampsia. Ginekol Pol 2018; 87:769-722. [PMID: 27958636 DOI: 10.5603/gp.2016.0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/24/2016] [Accepted: 10/25/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Delayed motherhood is associated with an increasing number of comorbidities such as glomerulonephritis, systemic lupus erythematosus, and diabetic nephropathy. Women after renal transplant belong to the group of patients who require a highly individualized approach to treatment and diagnosis. The aim of the study was to validate the commonly used diagnostic criteria for preeclampsia which seem to be irrelevant in patients with chronic renal insufficiency. MATERIAL AND METHODS The course of pregnancy and delivery were retrospectively analyzed in 48 renal transplant patients. Two patients were excluded. Group I included 23 patients with eutrophic neonates, while Group II consisted of 23 patients with fetal hypotrophy (birth weight of < 10th percentile). RESULTS The duration of pregnancy was 34.5 and 35 weeks in Groups I and II, respectively. Mean birth weight in Groups I and II was 2608.64 g and 2046.30 g, respectively (p = 0.002). Mean weight percentile in Groups I and II was 36.57 and 2.91, respectively (p < 0.000). Proteinuria in the first half of pregnancy occurred in 16 and 14 patients from Groups I and II, respectively, and increased in the second half of pregnancy in 6 and 6 patients from Groups I and II, respectively. Patients from Group II were more prone to urinary tract infections (0.43 vs. 0.79; p = 0.02). CONCLUSIONS Current diagnostic criteria for preeclampsia are insufficient in case of pregnant women after kidney transplant. General criteria should be applied with special care in women with chronic kidney disease or in patients with systemic lupus erythematosus. As a predictive factor of neonatal morbidity, intrauterine growth restriction seems to be more valuable than typical markers of kidney function.
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Jabiry-Zieniewicz Z, Dabrowski FA, Pietrzak B, Wyzgal J, Bomba-Opoń D, Zieniewicz K, Wielgos M. Pregnancy in the liver transplant recipient. Liver Transpl 2016; 22:1408-17. [PMID: 27197796 DOI: 10.1002/lt.24483] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/28/2016] [Accepted: 05/12/2016] [Indexed: 12/27/2022]
Abstract
During gestation, the woman's body undergoes various changes, and the line between physiology and pathology is very thin even in healthy women. Today, many of the liver transplant recipients are young women, who at one point in their lives may consider the possibility of pregnancy. Clinicians have to counsel them about the time of conception, the risk of miscarriage, the deterioration of the mother's health status, and the risk of birth defects. This review, based on our 20 years of clinical experience and up-to-date literature, provides comprehensive guidelines on pregnancy management in liver transplant recipients. Pregnancy in liver transplant recipients is possible but never physiological. Proper management and pharmacotherapy lowers the incidence of complications and birth defects. Critical factors for perinatal success include stable graft function before pregnancy, proper preparation for pregnancy, and cautious observation during its course. Liver Transplantation 22 1408-1417 2016 AASLD.
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Affiliation(s)
| | | | - Bronislawa Pietrzak
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Wyzgal
- Department of Nephrological Nursing, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Bomba-Opoń
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
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