Pregnancy

About: Pregnancy is a research topic. Over the lifetime, 163969 publications have been published within this topic receiving 4013502 citations. The topic is also known as: pregnancy & gestation.

Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

Abstract: Background The single most important risk factor for postpartum maternal infection is cesarean section. Although guidelines endorse the use of prophylactic antibiotics for women undergoing cesarean section, there is not uniform implementation of this recommendation. This is an update of a Cochrane review first published in 1995 and last updated in 2010. Objectives To assess the effects of prophylactic antibiotics compared with no prophylactic antibiotics on infectious complications in women undergoing cesarean section. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014) and reference lists of retrieved papers. Selection criteria Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic antibiotics versus no treatment in women undergoing cesarean section. Data collection and analysis Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. The clinically important primary outcomes were wound infection, endometritis, serious maternal infectious complications and adverse effects on the infant. We presented dichotomous data as risk ratios (RR), with 95% confidence intervals (CIs) and combined trials in meta-analyses. We assessed the quality of evidence using the GRADE approach. Main results We identified 95 studies enrolling over 15,000 women. Compared with placebo or no treatment, the use of prophylactic antibiotics in women undergoing cesarean section reduced the incidence of wound infection (RR 0.40, 95% CI 0.35 to 0.46, 82 studies, 14,407 women), endometritis (RR 0.38, 95% CI 0.34 to 0.42, 83 studies, 13,548 women) and maternal serious infectious complications (RR 0.31, 95% CI 0.20 to 0.49, 32 studies, 6159 women). When only studies that included women undergoing an elective cesarean section were analyzed, there was also a reduction in the incidence of wound infections (RR 0.62, 95% CI 0.47 to 0.82, 17 studies, 3537 women) and endometritis (RR 0.38, 95% CI 0.24 to 0.61, 15 studies, 2502 women) with prophylactic antibiotics. Similar estimates of effect were seen whether the antibiotics were administered before the cord was clamped or after. The effect of different antibiotic regimens was studied and similar reductions in the incidence of infections were seen for most of the antibiotics and combinations. There were no data on which to estimate the effect of maternal administration of antibiotics on infant outcomes. No studies systematically collected and reported on adverse infant outcomes nor the effect of antibiotics on the developing infant immune system. No studies reported on the incidence of oral candidiasis (thrush) in babies. Maternal adverse effects were also rarely described. We judged the evidence for antibiotic treatment compared with no treatment to be of moderate quality; most studies lacked an adequate description of methods and were assessed as being at unclear risk of bias. Authors' conclusions The conclusions of this review support the recommendation that prophylactic antibiotics should be routinely administered to all women undergoing cesarean section to prevent infection. Compared with placebo or no treatment, the use of prophylactic antibiotics in women undergoing cesarean section reduced the incidence of wound infection, endometritis and serious infectious complications by 60% to 70%. There were few data on adverse effects and no information on the effect of antibiotics on the baby, making the assessment of overall benefits and harms difficult. Prophylactic antibiotics given to all women undergoing elective or non-elective cesarean section is beneficial for women but there is uncertainty about the consequences for the baby.

Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: systematic review.

Abstract: OBJECTIVE: To evaluate the effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome by performing a systematic review of available published literature on pregnancies affected by COVID-19. METHODS: We performed a systematic review to evaluate the effect of COVID-19 on pregnancy, perinatal and neonatal outcome. We conducted a comprehensive literature search using PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure Database and Wan Fang Data up to and including 20 April 2020 (studies were identified through PubMed alert after that date). For the search strategy, combinations of the following keywords and medical subject heading (MeSH) terms were used: 'SARS-CoV-2', 'COVID-19', 'coronavirus disease 2019', 'pregnancy', 'gestation', 'maternal', 'mother', 'vertical transmission', 'maternal-fetal transmission', 'intrauterine transmission', 'neonate', 'infant' and 'delivery'. Eligibility criteria included laboratory-confirmed and/or clinically diagnosed COVID-19, patient being pregnant on admission and availability of clinical characteristics, including at least one maternal, perinatal or neonatal outcome. Exclusion criteria were non-peer-reviewed or unpublished reports, unspecified date and location of the study, suspicion of duplicate reporting and unreported maternal or perinatal outcomes. No language restrictions were applied. RESULTS: We identified a high number of relevant case reports and case series, but only 24 studies, including a total of 324 pregnant women with COVID-19, met the eligibility criteria and were included in the systematic review. These comprised nine case series (eight consecutive) and 15 case reports. A total of 20 pregnant patients with laboratory-confirmed COVID-19 were included in the case reports. In the combined data from the eight consecutive case series, including 211 (71.5%) cases of laboratory-confirmed and 84 (28.5%) of clinically diagnosed COVID-19, the maternal age ranged from 20 to 44 years and the gestational age on admission ranged from 5 to 41 weeks. The most common symptoms at presentation were fever, cough, dyspnea/shortness of breath, fatigue and myalgia. The rate of severe pneumonia reported amongst the case series ranged from 0% to 14%, with the majority of the cases requiring admission to the intensive care unit. Almost all cases from the case series had positive computed tomography chest findings. All six and 22 cases that had nucleic-acid testing in vaginal mucus and breast milk samples, respectively, were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Only four cases of spontaneous miscarriage or termination were reported. In the consecutive case series, 219/295 women had delivered at the time of reporting and 78% of them had Cesarean section. The gestational age at delivery ranged from 28 to 41 weeks. Apgar scores at both 1 and 5 min ranged from 7 to 10. Only eight neonates had birth weight < 2500 g and nearly one-third of neonates were transferred to the neonatal intensive care unit. There was one case of neonatal asphyxia and death. In 155 neonates that had nucleic-acid testing in throat swab, all, except three cases, were negative for SARS-CoV-2. There were no cases of maternal death in the eight consecutive case series. Seven maternal deaths, four intrauterine fetal deaths (one with twin pregnancy) and two neonatal deaths (twin pregnancy) were reported in a non-consecutive case series of nine cases with severe COVID-19. In the case reports, two maternal deaths, one neonatal death and two cases of neonatal SARS-CoV-2 infection were reported. CONCLUSIONS: Despite the increasing number of published studies on COVID-19 in pregnancy, there are insufficient good-quality data to draw unbiased conclusions with regard to the severity of the disease or specific complications of COVID-19 in pregnant women, as well as vertical transmission, perinatal and neonatal complications. In order to answer specific questions in relation to the impact of COVID-19 on pregnant women and their fetuses, through meaningful good-quality research, we urge researchers and investigators to present complete outcome data and reference previously published cases in their publications, and to record such reporting when the data of a case are entered into one or several registries. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Defining “Term” Pregnancy: Recommendations From the Defining “Term” Pregnancy Workgroup

Abstract: THE NATIONAL EMPHASIS ON REDUCING PRETERM BIRTH, and the increase in scheduled deliveries, has created confusion around the definition of term gestation. The concept of “term” gestation provides guidance to clinicians and influences the public’s perceptions about the optimal timing of delivery for a healthy pregnancy. Currently, a term birth is defined as a delivery that occurs neither preterm nor postterm. Because preterm is classically defined as delivery prior to 37 weeks following the onset of the last menstrual period and postterm as after 42 weeks, term has been conventionally defined as delivery between 37 and 42 weeks. The International Classification of Diseases defines term pregnancy as delivery between 37 weeks 0 days and 41 weeks 6 days. In 2005, a US National Institute of Child Health and Human Development workshop changed the designation of deliveries between 34 weeks 0 days and 36 weeks 6 days from near term to late preterm to emphasize that these infants experience morbidities and mortality similar to those of preterm infants and to highlight the adverse consequences of delivering before 37 weeks. This nomenclature acknowledged that fetal maturation is a continuum, yet the use of the label “term” for pregnancies spanning 37 weeks 0 days through 41 weeks 6 days’ gestation remained unchanged. Recent data demonstrate that maternal and neonatal adverse outcome rates are not the same across the 6-week gestational age range that constitutes term. Rather, the frequency of adverse outcomes is U-shaped, with the nadir around 39 weeks 0 days through 40 weeks 6 days’ gestation. Before the advent of more accurate methods, last menstrual period was used for pregnancy dating because women usually remembered that date but not the date of conception. With the advent of ultrasound, accurate early home pregnancy tests, assisted reproductive technologies, and home ovulation test kits, the actual timing of conception, and consequently of gestational age, is more accurately determined than in the past. Therefore, it may not be as appropriate to continue using the same broad gestational age definition of term as when dating was less accurate. To refine further the definition of term, the National Institute of Child Health and Human Development, the American Congress of Obstetricians and Gynecologists (formerly the American College of Obstetricians and Gynecologists), the American Academy of Pediatrics, the Society for Maternal-Fetal Medicine, the March of Dimes, and the World Health Organization (WHO) convened a meeting of experts and stakeholders on December 17, 2012, in Bethesda, Maryland, and this article reports recommendations from that workshop.

Dewhurst's Textbook of Obstetrics and Gynaecology for Postgraduates

Abstract: Normal and abnormal developement of the genital organs intersexuality primary amenorrhoea secondary amenorrhoea gynaecological disorders in childhood and adolescence hirsutism and virilism fertization, implantation and early development of the embryo the foetus, placenta and amniotic fluid normal pregnancy - anatomy, endocrinology and physiology antenatal care in normal pregnancy and prepregnancy care antenatal diagnosis of foetal abnormality and genetic disease abortion and ectopic pregnancy antepartum haemorrhage hypertensive disorders of pregnancy heart disease in pregnancy blood disorders of pregnancy urinary tract disorders in pregnancy diabetes and other endocine diseases complicating pregnancy immunological disorders in pregnancy miscellaneous disorders complicating pregnancy natural labour and its active management special circumstances affecting labour dystocia caused by the passages or passenger malpositions of the occiput and malpresentations complications of the third sof labour maternal injuries and complications obstetric operations and procedures foetal surveillance the puerperium and its complications multiple pregnancy neonatal care for obstetricians maternal and perinatal infections vital statistics and derived information for obstetricians the coagulation and fibrinolytic systems, and their disorders in obstetrics and gyaecology trophoblastic disease contraception and streilization infertility pelvic infection endometrosis dysfunctional uterine bleeding the menopause and climacteric prolapse urinary incontinence and other disorders of the lower urinary tract in women benign and malignant disorders of the vulva benign and malignant disorders of the vagina premalignant and malignant disease of the cervix benign tumours of the uterus malignant disease of the uterine body benign and malignant tumours of the ovary premenstrual syndrome sexual function and dysfunction.